bluuebunny/crossref_metadata_2025_split huggingface dataset:
Single nucleotide polymorphisms associated with postoperative inadequate analgesia after single-port VATS in Chinese population
Authors: Xing Xiufang , Bai Yongyu , Sun Kai , Yan Min 
Published: February 2020

Abstract
Background
Postoperative inadequate analgesia following video-assisted thoracoscopic surgery (VATS) is a common and significant clinical problem. While genetic polymorphisms may play role in the variability of postoperative analgesia effect, few studies have evaluated the associations between genetic mutations and inadequate analgesia after single-port VATS.

Methods
Twenty-eight single nucleotide polymorphisms (SNPs) among 18 selected genes involved in pain perception and modulation were genotyped in 198 Chinese patients undergoing single-port VATS. The primary outcome was the occurrence of inadequate analgesia in the first night and morning after surgery which was defined by a comprehensive postoperative evaluation. Multivariable logistic regression analyses were used to identify the association between genetic variations and postoperative inadequate analgesia.

Results
The prevalence of postoperative inadequate analgesia was 45.5% in the present study. After controlling for age and education level, association with inadequate analgesia was observed in four SNPs among three genes encoding voltage-gated sodium channels. Patients with the minor allele of rs33985936 (SCN11A), rs6795970 (SCN10A), and 3312G > T (SCN9A) have an increased risk of suffering from inadequate analgesia. While the patients carrying the minor allele of rs11709492 (SCN11A) have lower risk experiencing inadequate analgesia.

Conclusions
We identified that SNPs in SCN9A, SCN10A, and SCN11A play a role in the postoperative inadequate analgesia after single-port VATS. Although future larger and long-term follow up studies are warranted to confirm our findings, the results of the current study may be utilized as predictors for forecasting postoperative analgesic effect for patients receiving this type of surgery.

Trial registration
This study was retrospectively registered in the ClinicalTrials.gov Registry (NCT03916120) on April 16, 2019.
Why do you need a biostatistician?
Authors: Zapf Antonia , Rauch Geraldine , Kieser Meinhard 
Published: February 2020

AbstractThe quality of medical research importantly depends, among other aspects, on a valid statistical planning of the study, analysis of the data, and reporting of the results, which is usually guaranteed by a biostatistician. However, there are several related professions next to the biostatistician, for example epidemiologists, medical informaticians and bioinformaticians. For medical experts, it is often not clear what the differences between these professions are and how the specific role of a biostatistician can be described. For physicians involved in medical research, this is problematic because false expectations often lead to frustration on both sides. Therefore, the aim of this article is to outline the tasks and responsibilities of biostatisticians in clinical trials as well as in other fields of application in medical research.
Evidence-based intrapartum practice and its associated factors at a tertiary teaching hospital in the Philippines, a descriptive mixed-methods study
Authors: Masuda Chisato , Ferolin Shirley Kristine , Masuda Ken , Smith Chris , Matsui Mitsuaki 
Published: February 2020

Abstract
Background
Evidenced-based practice is a key component of quality care. However, studies in the Philippines have identified gaps between evidence and actual maternity practices. This study aims to describe the practice of evidence-based intrapartum care and its associated factors, as well as exploring the perceptions of healthcare providers in a tertiary hospital in the Philippines.

Methods
A mixed-methods study was conducted, which consisted of direct observation of intrapartum practices during the second and third stages, as well as semi-structured interviews and focus group discussions with care providers to determine their perceptions and reasoning behind decisions to perform episiotomy or fundal pressure. Univariate and multivariate logistic regression were used to analyse the relationship between observed practices and maternal, neonatal, and environmental factors. Qualitative data were parsed and categorised to identify themes related to the decision-making process.

Results
A total of 170 deliveries were included. Recommended care, such as prophylactic use of oxytocin and controlled cord traction in the third stage, were applied in almost all the cases. However, harmful practices were also observed, such as intramuscular or intravenous oxytocin use in the second stage (14%) and lack of foetal heart rate monitoring (57%). Of primiparae, 92% received episiotomy and 31% of all deliveries received fundal pressure. Factors associated with the implementation of episiotomy included primipara (adjusted Odds Ratio [aOR] 62.3), duration of the second stage of more than 30 min (aOR 4.6), and assisted vaginal delivery (aOR 15.0). Factors associated with fundal pressure were primipara (aOR 3.0), augmentation with oxytocin (aOR 3.3), and assisted delivery (aOR 4.8). Healthcare providers believe that these practices can prevent laceration. The rate of obstetric anal sphincter injuries (OASIS) was 17%. Associated with OASIS were assisted delivery (aOR 6.0), baby weights of more than 3.5 kg (aOR 7.8), episiotomy (aOR 26.4), and fundal pressure (aOR 6.2).

Conclusions
Our study found that potentially harmful practices are still conducted that contribute to the occurrence of OASIS. The perception of these practices is divergent with current evidence, and empirical knowledge has more influence. To improve practices the scientific evidence and its underlying basis should be understood among providers.
Influence of extending expansive open-door laminoplasty to C1 and C2 on cervical sagittal parameters
Authors: Wang Wen-xuan , Zhao Yi-bo , Lu Xiang-dong , Zhao Xiao-feng , Jin Yuan-zhang , Chen Xian-wei , Fan Yan-xin , Wang Xiao-nan , Zhou Run-tian , Zhao Bin 
Published: February 2020

Abstract
Background
For patients with spinal canal stenosis in the upper cervical spine who undergo C3–7 laminoplasty alone, it remains impossible to achieve full decompression due to its limited range. This study explores the extension of expansive open-door laminoplasty (EODL) to C1 and C2 for the treatment of cervical spinal stenosis of the upper cervical spine and its effects on cervical sagittal parameters.

Methods
A retrospective analysis of 33 patients presenting with symptoms of cervical spondylosis myelopathy (CSM) and ossification in the posterior longitudinal ligament (OPLL) of the upper cervical spine from February 2013 to December 2015 was performed. Furthermore, the changes in the C0–2 Cobb angle, C1–2 Cobb angle, C2–7 Cobb angle, C2–7 SVA, and T1-Slope in lateral X-rays of the cervical spine were measured before, immediately after, and 1 year after the operation. JOA and NDI scores were used to evaluate spinal cord function.

Results
The C0–2 and C1–2 Cobb angles did not significantly increase (P = 0.190 and P = 0.081), but the C2–7 Cobb angle (P = 0.001), C2–7 SVA (P < 0.001), and T1-Slope (P < 0.001) significantly increased from preoperative to 1 year postoperative. In addition, C2–7 SVA was significantly correlated with the T1-Slope (Pearson = 0.376, P < 0.001) and C0–2 Cobb angle (Pearson = 0.287, P = 0.004), and the C2–7 SVA was negatively correlated with the C2–7 Cobb angle (Pearson = − 0.295, P < 0.001). The average preoperative and postoperative JOA scores were 8.3 ± 1.6 and 14.6 ± 1.4 points, respectively, indicating in a postoperative neurological improvement rate of approximately 91.6%. The average preoperative and final follow-up NDI scores were 12.62 ± 2.34 and 7.61 ± 1.23.

Conclusions
The sagittal parameters of patients who underwent EODL extended to C1 and C2 included loss of cervical curvature, increased cervical anteversion and compensatory posterior extension of the upper cervical spine to maintain visual balance in the field of vision. However, the changes in cervical spine parameters were far less substantial than the alarm thresholds reported in previous studies. We believe that EODL extended to C1 and C2 for the treatment of patients with spinal canal stenosis in the upper cervical spine is a feasible and safe procedure with excellent outcomes.
Contribution of a synchronic teleneurology program to decrease the patient number waiting for a first consultation and their waiting time in Chile
Authors: Constanzo Freddy , Aracena-Sherck Paula , Hidalgo Juan Pablo , Peña Lorena , Marrugo Mery , Gonzalez Jonathan , Vergara Gerardo , Alvarado Cristóbal 
Published: February 2020

Abstract
Backround
There is a shortage of medical specialists in Chile, including neurologists; currently, there are 56,614 patients waiting for a first adult Neurology appointment in the country. The Teleneurology Program at the Hospital Las Higueras de Talcahuano (HHT) was implemented in 2015 to help reduce both the number of patients waiting for a first consultation and their waiting times.

Methods
This retrospective study analyzed a cohort of 8269 patients referred to the HHT Neurology clinic between 2013 and 2018, from primary, secondary, and tertiary health centers. Cox regression analyses were performed to determine the factors influencing each outcome (number of patients waiting for a consultation and waiting time), such as age, gender, referral health establishment and the type of consultation (whether in situ at the HHT or by synchronic telepresence through the Teleneurology Program).

Results
Out of the 8269 patients included in the study, 1743 consulted the neurologist through the Teleneurology Program, while 6526 received a consultation in situ at the HHT. Since its implementation (2015) until the end of 2018, the Teleneurology program contributed to decrease the number of patients waiting for their first appointment from 3084 to 298. Waiting time for the first consultation was 60% shorter for patients enrolled in the Teleneurology program than those with consultation in situ at HHT (6.23 ± 6.82 and 10.47 ± 8.70 months, respectively). Similar differences were observed when sorting patient data according to the referral health center. Cox regression analysis showed that patients waiting for a traditional in situ first adult Neurology consultation at the HHT had a higher risk (OR = 6.74) of waiting 90% longer than patients enrolled in the Teleneurology Program, without significant differences due to gender or age.

Conclusions
Data from this study show a significant contribution of the Teleneurology Program at the HHT to decrease the number of patients waiting for a first consultation with a neurologist, as well as shorter waiting times, when derived from primary and secondary health centers.
Maternal, neonatal, and child health systems under rapid urbanization: a qualitative study in a suburban district in Vietnam
Authors: Heo Jongho , Kim Seung Yun , Yi Jinseon , Yu Soo-Young , Jung Da Eun , Lee Sangmi , Jung Ju Youn , Kim Hyunsuk , Do Ngan , Lee Hwa-Young , Nam You-Seon , Hoang Van Minh , Luu Ngoc Hoat , Lee Jong-Koo , Tran Thi Giang Huong , Oh Juhwan 
Published: February 2020

Abstract

Background
Vietnam has been successful in increasing access to maternal, neonatal, and child health (MNCH) services during last decades; however, little is known about whether the primary MNCH service utilization has been properly utilized under the recent rapid urbanization. We aimed to examine current MNCH service utilization patterns at a district level.

Methods
The study was conducted qualitatively in a rural district named Quốc Oai. Women who gave a birth within a year and medical staff at various levels participated through 43 individual in-depth interviews and 3 focus group interviews.

Results
Primary MNCH services were underutilized due to a failure to meet increased quality needs. Most of the mothers preferred private clinics for antenatal care and the district hospital for delivery due to the better service quality of these facilities compared to that of the commune health stations (CHSs). Mothers had few sociocultural barriers to acquiring service information or utilizing services based on their improved standard of living. A financial burden for some services, including caesarian section, still existed for uninsured mothers, while their insured counterparts had relatively few difficulties.

Conclusions
For the improved macro-efficiency of MNCH systems, the government needs to rearrange human resources and/or merge some CHSs to achieve economies of scale and align with service volume distribution across the different levels.
Relationship between the number of hospital pharmacists and hospital pharmaceutical expenditure: a macro-level panel data model of fixed effects with individual and time
Authors: Wei Ming , Wang Xuemei , Zhang Dandan , Zhang Xinping 
Published: February 2020

Abstract
Background
The rapid increase in pharmaceutical expenditure (PE) has been a main problem of global healthcare reform for decades. Previous studies demonstrated that pharmacists play an indispensable role in controlling PE, but macro-research evidence is scarce. Exploring the role of pharmacists from a macro-perspective is essential for pharmacy source allocation with an advantage of extensive applicability over regions. This study aimed to explore the relationship between the number of hospital pharmacists and hospital PE and to provide a macro-perspective evidence to curb the increasing PE and decline unnecessary medications.

Methods
Data were extracted from China Health Statistics Yearbook from 2011 to 2018. A panel dataset with 31 provinces from 2010 to 2017 was constructed. Amongst them, ‘Number of hospital pharmacists per 1 million of population’ (HLPT) was selected as an independent variable, ‘Per visit of hospital outpatient pharmaceutical expenditure’ (OTPE) and ‘Per capita of hospital inpatient pharmaceutical expenditure’ (ITPE) were selected as dependent variables, and ‘Number of hospital physicians per 1 million of population’ (HLPN) and ‘Drug price index’ (DPI) were applied as control variables. Fixed-effect panel data analysis was performed to evaluate the relationship between the number of hospital pharmacists and hospital PE.

Results
HLPT had a significant and negative relationships with OTPE (β1 = − 0.0893, p = 0.0132) and ITPE (β1 = − 4.924, p < 0.001). Considering the control variables, the significant and negative relationships with HLPT and OTPE remained unchanged (β1 = − 0.141, p < 0.001; β1 = − 4.771, p < 0.001, respectively), indicating that an increase in hospital pharmacist per 1 million of population led to a decrease of ¥474 million ($67.4 million) OTPE and ¥902 million ($128 million) ITPE in 2017. Overall, in 2017, an increase of 1 hospital pharmacist led to a decrease of approximately ¥1 million ($142 thousands) hospital PE nationwide.

Conclusion
This study confirmed the negative relationship between hospital pharmacists and hospital PE, indicating that hospital pharmacists might play a significant role in controlling PE. Pharmacists were encouraged to participate in more drug-therapy-related activities, such as medication reconciliation.
Anti-apoptotic proteins in the autophagic world: an update on functions of XIAP, Survivin, and BRUCE
Authors: Cheung Chun Hei Antonio , Chang Yung-Chieh , Lin Tzu-Yu , Cheng Siao Muk , Leung Euphemia 
Published: February 2020

AbstractX-linked inhibitor of apoptosis protein (XIAP), survivin, and BRUCE are members of the inhibitor-of-apoptosis protein (IAP) family known for their inhibitory effects on caspase activity and dysregulation of these molecules has widely been shown to cause embryonic defects and to promote tumorigenesis in human. Besides the anti-apoptotic functions, recent discoveries have revealed that XIAP, survivin, and BRUCE also exhibit regulatory functions for autophagy in cells. As the role of autophagy in human diseases has already been discussed extensively in different reviews; in this review, we will discuss the emerging autophagic role of XIAP, survivin, and BRUCE in cancer cells. We also provide an update on the anti-apoptotic functions and the roles in maintaining DNA integrity of these molecules. Second mitochondria-derived activator of caspases (Smac) is a pro-apoptotic protein and IAPs are the molecular targets of various Smac mimetics currently under clinical trials. Better understanding on the functions of XIAP, survivin, and BRUCE can enable us to predict possible side effects of these drugs and to design a more “patient-specific” clinical trial for Smac mimetics in the future.
Social science research contributions to antimicrobial resistance: protocol for a scoping review
Authors: Vedadhir Abou Ali , Rodrigues Carla , Lambert Helen 
Published: February 2020

AbstractBackgroundAntimicrobial resistance (AMR) is an escalating global health issue with complex and dynamic interdependencies, high uncertainty and decision stakes, multiple drivers and stakeholders with diverse values and interests, and various aspects and outcomes. Addressing and combating this critical global challenge requires the formation and establishment of an interdisciplinary research approach that goes beyond the biosciences principally concerned with antimicrobial resistance to include other relevant natural and social sciences. The objective of this study will be to review and map existing social science knowledge and literature relating to antimicrobial resistance.MethodsThe review team will undertake the scoping review using the Arksey and O'Malley methodological framework and also the Joanna Briggs Institute methods manual. Publications in English (from 1998 onwards) will be searched using several databases including PubMed/MEDLINE, Web of Science, Scopus, Anthropological Plus, Sociological Abstracts, International Bibliography of the Social Sciences (IBSS), PsycINFO and EconLit. Grey literature will also be searched (e.g. Google Scholar). Two reviewers will independently screen all citations, full-text articles, and abstract data. Publication types will include original articles, editorials, commentaries, protocols, and books in the social science research literature on AMR. All study designs (quantitative, qualitative, and mixed-methods) will be included. A PRISMA Flow Diagram of search and study selection will be used to report final figures on included and excluded studies. To provide a descriptive summary of the literature, data will be collated, stored, and charted using Microsoft Excel software. The analysis will also involve identifying themes and gaps in the existing literature and summarizing, describing and displaying all pertinent information using thematic construction approaches including qualitative content analysis methods.DiscussionThis protocol describes a systematic method to identify, map, and synthesize social science research evidence on antimicrobial resistance. By mapping evidence and identifying potential knowledge gaps where further research is warranted, the resulting scoping review will provide useful insights for the design, implementation, and reorientation of future research agendas on AMR at multiple levels.Systematic review registration: This protocol has been registered with the Open Science Framework (OSF):https://osf.io/hyaem.
CIES: Cloud-based Intelligent Evaluation Service for video homework using CNN-LSTM network
Authors: Song Rui , Xiao Zhiyi , Lin Jinjiao , Liu Ming 
Published: February 2020

AbstractVideo (used as a form of examination or homework) as an efficient approach for examining students’ abilities is drawing increasing attention in the education field. How to assess video assignments effectively and accurately has become a significant topic in academia. This work proposes a method based on a multi-channel CNN-LSTM hybrid architecture to extract and classify image features such as students’ actions and expressions, as well as audio features such as speech rates and pauses in the video assignments, and then conducts a two-category assessment of “qualified” or “unqualified”. Additionally, build this system in a cloud computing environment as a Cloud-based Intelligent Evaluation Service application could provide universal service to meet the needs of multiple teaching units. The proposed method is shown to be feasible and effective through experiments.
The relationship between financial development and income inequality in Turkey
Authors: Destek Mehmet Akif , Sinha Avik , Sarkodie Samuel Asumadu 
Published: February 2020

AbstractReducing income inequality and enhancing access to financial institutions play a vital role in achieving the Sustainable Development Goal 10, especially in developing countries. While there are studies on the nexus between financial development and economic growth, literature on financial development–income inequality nexus is limited and lack consensus. This paper examined the different dimensions of financial development on income inequality for the period 1990 to 2015 in Turkey. For this purpose, four financial development indices (i.e., overall financial development index, banking sector development index, stock market development index, and bond market development index) were constructed with principal component analysis (PCA). In addition to financial development indicators, the impact of real income, government expenditures, and inflation on income inequality were investigated using the ARDL bound testing procedure. The results showed that increasing real income and government expenditures reduce income inequality. We found a positive impact of inflation on income inequality in the short run, while the reverse holds in the long run. In the case of financial development, an inverted U-shaped relationship with income inequality for overall financial development and banking sector development was confirmed. A monotonically decreasing relationship between stock market development and income inequality was found in Turkey. The study highlights that the implementation of policies that eradicate discriminatory laws and facilitate equal access to financial privileges will promote equity and decline the outcomes of income inequality.
Personal narratives of nurses who care for patients at the end of life
Authors: Pérez-Vega María Elena , Cibanal-Juan Luis 
Published: February 2020

Background: Little attention has been paid to the ways in which nurses personally experience, understand and assign meaning to providing palliative care. Aim: A qualitative study of four nurses working with patients in the terminal phase in a hospital in Mexico was conducted to understand their lived professional experiences and relationships with death. Methods: Four interviews were analysed using the Greimasian actantial-semiotic model. Actants were categorised by narrative role and their actions were analysed. The grammatical features of the narration were also examined. Findings: Nurses sought a good death for the patient, which they typically achieved, and spiritual peace for themselves, which they often did not. Nurses placed a high value on personal, social and professional recognition for their work. The philosophical themes affecting nursing as a vocation that emerged included life and death, truth and honesty and the role of God and the family. These professional values were often contradictory, and these dilemmas should be addressed in professional training and support.