bluuebunny/crossref_metadata_2025_split huggingface dataset:
Associations between pre-pregnancy body mass index and gestational weight gain with pregnancy outcomes in women with polycystic ovary syndrome
Authors: Zhang Lirui , Zheng Wei , Liu Cheng , Liang Xin , Zhang Li , Tian Zhihong , Li Guanghui 
Published: September 2020

Abstract
Background: The influence of pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) on perinatal outcomes of women with polycystic ovary syndrome (PCOS) remains unclear. Therefore, we explored how the above indicators influence pregnancy outcomes in women with PCOS. Methods: A retrospective study was conducted involving the baseline characteristics, laboratory data, and pregnancy outcomes of 722 pregnant women with PCOS. Subjects were grouped in a way to find out risks in their pregnancy outcomes. Multivariable logistic regression analysis was performed to investigate how BMI and GWG were associated with perinatal outcomes.Results：Among women with PCOS, underweight increased the risk of small for gestational age (SGA) (OR 12.35, 95% CI 3.56-42.82), but reduced the risk of large for gestational age (LGA). Overweight but not obese women were more susceptible to developing preeclampsia (PE) than women with normal weight. In PCOS women with BMI＜25 kg/m2 before pregnancy, inadequate GWG was a protective factor for gestational hypertension (GH) and postpartum hemorrhage (PPH), excessive GWG exhibited a positive correlation with LGA. But in PCOS women with BMI ≥25 kg/m2, excessive GWG increased the probability of undergoing a cesarean section. Inadequate GWG did not reduce the likelihood of LGA in women with BMI ≥ 25 kg/m2, and excessive GWG did not reduce the probability of SGA in women with BMI＜25 kg/m2.Conclusion: The impacts of pre-pregnancy BMI, GWG on maternal and infant outcomes among PCOS women are similar to reported results in general pregnant women. However, some unique trends were also observed in PCOS women. While the underweight factor significantly increased the risk of SGA birth, overweight but not obesity was correlated with the risk of PE. Inadequate GWG was a protective factor for GH and PPH only in women with pregestational BMI＜25 kg/m2. Inadequate GWG did not reduce the probability of LGA in women with BMI ≥ 25 kg/m2, and similarly, excessive GWG did not reduce the probability of SGA in women with BMI＜25 kg/m2. Overall, these findings indicate that women with PCOS should begin weight management before pregnancy.
Developmental trends in early childhood and their predictors from an Indian birth cohort
Authors: Koshy Beena , Sriniva Manikandan , Bose Anuradha , John Sushil Mathew , Mohan Venkata Raghava , Roshan Reeba , Ramanujam Karthikeyen , Kang Gagandeep 
Published: September 2020

Abstract
Background: Early childhood developmental pattern analyses not only project future cognition potential, but also identify potential risks for possible intervention. There is a paucity of literature evaluating developmental trends in the low and middle income country settings. Methods: Trends of early childhood development at 6, 15, 24 and 36 months of age and their predictors were explored in a longitudinal community-based birth cohort study in an urban slum in Vellore, South India. Development was assessed using the Bayley Scales of Infant and Toddler Development-III (BSID-III). Results: The birth cohort enrolled 251 children with 94%, 91% and 87% follow-up at 6, 24 and 36 months respectively. Child development domains of cognition, language, motor and social skills showed a significant decline in scores between 6 and 36 months of age. Cognition change was maximum augmented by higher socio-economic position (SEP) and nurturing home environment while stunting had the maximum negative impact. Higher maternal cognition, higher SEP, and caregiver responsivity positively contributed to language change over time, while higher maternal depression contributed negatively. An enriching home environment, growth parameters and blood iron status had high association with change in motor skills. Conclusions: A triple intervention plan to enhance home environment and nurturance, early childhood nutrient supplementation, and maternal education and well-being might prevent child developmental decline in high risk settings.
8q24 Clear Cell Renal Cell Carcinoma Germline Variant is Associated with VHL Mutation Status and Clinical Aggressiveness
Authors: Eckel-Passow Jeanette E , Yan Huihuang , Kosel Matthew , Serie Daniel , Jenkins Robert , Costello Brian , Leibovich Bradley , Ho Thai , Parker Alexander 
Published: September 2020

Abstract
Background

The four most commonly-mutated genes in clear cell renal cell carcinoma (ccRCC) tumors are BAP1 , PBRM1 , SETD2 and VHL . And, there are currently 14 known RCC germline variants that have been reproducibly shown to be associated with RCC risk. However, the association of germline genetics with tumor genetics and clinical aggressiveness are unknown.

Methods

We analyzed 420 ccRCC patients from The Cancer Genome Atlas (TCGA). Molecular subtype was determined based on acquired mutations in BAP1 , PBRM1 , SETD2 and VHL . Aggressive subtype was defined clinically using Mayo SSIGN score and molecularly using the ccA/ccB gene expression subtype. Publically-available Hi-C data were used to link germline risk variants with candidate target genes.

Results

The 8q24 variant rs35252396 was significantly associated with VHL mutation status (OR=1.6, p=0.0037) and SSIGN score (OR=1.9, p=0.00094), after adjusting for multiple comparisons. We observed that, while some germline variants have interactions with nearby genes, some variants demonstrate long-range interactions with target genes.

Conclusions

These data further demonstrate the link between rs35252396, HIF pathway and ccRCC clinical aggressiveness, providing a more comprehensive picture of how germline genetics and tumor genetics interact with respect to tumor development and progression.
Adult-onset IgE-mediated food allergy at a Winnipeg allergy clinic – a case series
Authors: Walter Graham , Kalicinsky Chrystyna 
Published: September 2020

Abstract
Background It is a putatively understood phenomenon that the overall prevalence of allergic disease has been increasing in recent decades – particularly in industrialized nations. Despite this, there is a relative scarcity of data concerning the development of food-related allergic disease in the adult population. In addition, the paucity of data as it pertains to the Canadian population is particularly marked when compared to other nations. We sought to determine common culprit foods and the reactions they elicited in a series of 14 patients seen in the Winnipeg allergy and immunology clinic.Methods We conducted a retrospective review of patients identified by academic allergists in Winnipeg, Manitoba as fitting criteria for adult-onset IgE-mediated food allergy from May 2018 – July 2020. We included patients with IgE-mediated symptoms, including the pollen-food syndrome which developed at the age of 16 or later. We collected data regarding the food which induced the reaction, what the reaction was, and any concomitant atopic disease.ResultsThe most common culprit food identified was shellfish, followed by finfish, pollen-food syndrome, and wheat/flour. The most common reaction experienced was anaphylaxis, followed by food-dependent exercise-induced anaphylaxis and isolated (muco)cutaneous symptoms. With regard to concomitant atopic disease, allergic rhinitis/rhinoconjunctivitis stood out as the most prevalent.Conclusions Adult-onset food allergy – particularly with resultant anaphylaxis – is an important phenomenon to recognize, even when patients have previously tolerated the food in question.
The Immediate Effect of COVID-19 Pandemic on Children and Adolescents with Obsessive Compulsive Disorder
Authors: Nissen Judith Becker , Højgaard David , Thomsen Per Hove 
Published: September 2020

Abstract
Background: Obsessive compulsive disorder (OCD) is a distressing psychiatric disorder. Traumas may trigger or aggravate OCD symptoms. COVID-19 pandemic has coursed a global crisis and has been associated with onset of psychiatric disorders in adults. Little is known about children/adolescents with OCD. The present study aimed to examine how children/adolescents with OCD react towards COVID-19 crisis. Methods: A questionnaire was distributed to two separate groups of children/adolescents. One group was a clinical group newly diagnosed at a specialized OCD clinic. All the children/adolescents had a current close contact to a therapist or doctor. The other group was a survey group identified through the Danish OCD Association. Most of these children/adolescents were diagnosed years ago, and their primary treatment was completed. For the clinical group, data from patient files was available. Results: In both groups, but most pronounced in the survey group, participants experienced a worsening of their OCD, anxiety, and depressive symptoms. The aggravation of OCD correlated with the worsening of anxiety, depressive symptoms, and the extent of avoidance behavior. For both groups, OCD aggressive symptoms predicted a significant worsening. Poor baseline insight showed a trend to predict a symptom worsening. The worsening was most pronounced in children with early age of onset and a family history of attention deficit hyperactivity disorder.Conclusions: To our knowledge, this is one of the first studies examining the effect of COVID-19 in children/adolescents with OCD. The effect was examined in two separate populations strengthening the findings. The study points towards an influence of the OCD phenotype, baseline insight suggesting a continued vulnerability, and a family history of psychiatric disorders. Trial registration: The study is approved by the Danish Data Protection Agency (1-16-02-147-20) registered 1st of April 2020. Oral and written information was given to parents and patients and written consent from patients over 15 years and parents were received.
Association of higher arterial ketone body ratio (acetoacetate/β-hydroxybutyrate) with relevant nutritional marker in hemodialysis patients
Authors: Inaba Masaaki , Kumeda Yasuro , Yamada Shinsuke , Toi Norikazu , Hamai Chie , Noguchi Koichi , Yasuda Eikichi , Furumitsu Yutaka , Emoto Masanori , Ohno Yoshiteru 
Published: September 2020

Abstract
Background: An association of higher levels of β-hydroxybutyrate (β-HB) in serum with greater mortality in hemodialysis (HD) patients has been reported. This study examined the significance of arterial ketone body ratio (AcAc/β-HB), a relevant marker of energy state, in HD patients. Methods: The levels of arterial AcAc and β-HB, and AcAc/β-HB ratio were determined in 49 HD patients just before undergoing an HD session. Additionally, changes in those levels during the session were examined to investigate their associations with clinical nutritional markers. Results: Arterial β-HB, but not AcAc, was significantly higher at the baseline in 25 patients with type 2 diabetes mellitus (T2DM) as compared to 24 non-DM patients, with a significant reduction in arterial AcAc/β-HB ratio seen in those with DM. Although the arterial AcAc/β-HB ratio before the HD session was significantly higher in the non-DM group, it did not differ significantly after the session between the groups, indicating a faster rate of β-HB disappearance from circulation in non-DM HD patients during the interdialytic period. Multiple regression analysis, which included age, gender, presence/absence of DM, log HD duration, log β-HB, and log AcAc/β-HB ratio as independent variables, revealed an independent and significant association of log AcAc/β-HB ratio, but not log β-HB, with serum albumin and uric acid. Conclusion: We found that a decreased AcAc/β-HB ratio resulting from increased β-HB, but not increased b-HB itself, was a significant factor independently associated with decreased levels of serum albumin and uric acid, known to be related to higher mortality in HD patients. Furthermore, it is possible that higher mortality in DM HD patients can be explained by reduced arterial AcAc/β-HB ratio.
A contact-independent T6SS killing pathway mediated by a microcin-like nuclease effector possesses intrinsic cell-entry mechanisms
Authors: Song Li , Pan Junfeng , Yang Yantao , Zhang Zhenxing , Cui Rui , Jia Shuangkai , Wang Zhuo , Yang Changxing , Xu Lei , Dong Tao , Wang Yao , Shen Xihui 
Published: September 2020

Abstract
The type VI secretion system (T6SS) is generally considered as a contact-dependent, receptor-independent bacterial weapon that injects toxic effectors into eukaryotic and prokaryotic cells to cause cellular damage. Herein, we report a non-canonical contact-independent T6SS killing pathway in Yersinia pseudotuberculosis (Yptb) that secretes an unusual microcin-like nuclease effector Tce1. The 67 amino acid Tce1 functions as a Ca2+, Mg2+-dependent DNase toxin and its toxicity is inhibited by the cognate immunity protein Tci1. Yptb T6SS-3 can mediate either contact-dependent competition by directly injecting Tce1 into neighboring cells as canonical T6SSs, or contact-independent competition by secreting Tce1 into the extracellular milieu. The entry of secreted Tce1 into target cells requires OmpF and BtuB in the outer membrane and TolB in the periplasm of target cells. This dual mode property of T6SS-3 enabling effector delivery confers Yptb competitive advantages not only on solid surfaces, but also in liquid culture. The Tce1-mediated T6SS antibacterial pathway is also required for optimal colonization of the mouse gut by Yptb, whereby it eliminates competing commensals and enteric pathogens. The discovery of a contact-independent, receptor-dependent long-range T6SS delivery mechanism provides a new perspective for understanding the physiological roles of T6SS in competition.
Malpractice Claimed Calls within the Swedish Healthcare Direct: A Descriptive – Comparative Case Study
Authors: Bjorkman Annica , Engström Maria , Winblad Ulrika , Holmström Inger K 
Published: September 2020

Abstract
Background: Medical errors are reported as a malpractice claim, and it is of uttermost importance to learn from the errors to enhance patient safety. The Swedish national telephone helpline SHD is staffed by registered nurses; its aim is to provide qualified healthcare advice for all residents of Sweden; it handles about 5 million calls annually. The aim of the present study was twofold: to describe all malpractice claims and healthcare providers’ reported measures regarding calls to Swedish Healthcare Direct (SHD) during the period January 2011-December 2018 and to compare these findings with results from a previous study covering the period 2003-2010.Methods: The study used a descriptive and comparative design. A total sample of all reported malpractice claims regarding calls to SHD (n=35) made during the period 2011-2018 was retrieved. Data were analysed and compared with all reported medical errors during the period 2003-2010 (n=33). Results: Telephone nurses’ failure to follow the computerized decision support system (CDSS) (n=18) was identified as the main reason for error during the period 2011-2018, while failure to listen to the caller (n=12) was the main reason during the period 2003-2010. Staff education (n=21) and listening to one’s own calls (n=16) were the most common measures taken within the organization during the period 2011-2018, compared to discussion in work groups (n=13) during the period 2003-2010.Conclusion: The proportion of malpractice claims in relation to all patient contacts to SHD is still very low; it seems that only the most severe patient injuries are reported. The fact that telephone nurses’ failure to follow the CDSS is the most common reason for error is notable, as SHD and healthcare organizations stress the importance of using the CDSS to enhance patient safety. The healthcare organizations seem to have adopted a more systematic approach to handling malpractice claims regarding calls, e.g., allowing telephone nurses to listen to their own calls instead of having discussions in work groups in response to events. This enables nurses to understand the latent factors contributing to error and provides a learning opportunity.
Is the Whole Greater Than the Sum of Its Parts? The Implementation and Outcomes of a Whole Blood Program in Ecuador
Authors: Himmler Amber Nicole , Armijos Monica Eulalia Galarza , Naranjo Jeovanni Reinoso , Patiño Sandra Gioconda Peña , Altamirano Doris Sarmiento , Lazo Nube Flores , Andrade Raúl Pino , Aguilar Hernán Sacoto , de Córdova Lenin Fernández , Agurto Cecibel Cevallos , Raykar Nakul , Puyana Juan Carlos , Molina Juan Carlos Salamea 
Published: September 2020

Abstract
Background: Hemorrhagic shock is a major cause of mortality in low-and-middle-income countries (LMICs). Many institutions in LMICs lack the resources to adequately prescribe balanced resuscitation. This study aims to describe the implementation of a whole blood program in Latin America and discuss the outcomes of the patients that received whole blood (WB). Methods: We conducted a retrospective review of patients resuscitated with WB from 2013-2019. Five units of O+ WB were made available on a consistent basis for patients presenting in hemorrhagic shock. Variables collected included: sex, age, service treating the patient, units of WB administered, units of components administered, admission vital signs, admission hemoglobin, Shock Index, intraoperative crystalloid and colloid administration, symptoms of transfusion reaction, length-of-stay and in-hospital mortality.Results: The sample includes a total of 101 patients, 57 of whom were trauma and acute care surgery (TACS) patients and 44 of whom were obstetrics and gynecology patients. No patients developed symptoms consistent with a transfusion reaction. Average shock index was 1.16 (±0.55). On average, patients received 1.66 (±0.80) units of whole blood. Overall mortality was 14/101 (13.86%) in the first 24 hours and 6/101 (5.94%) after 24 hours.Conclusion: Implementing a WB protocol is achievable in LMICs. Whole blood allows for more efficient delivery of hemostatic resuscitation and is ideal for resource-restrained settings. To our knowledge, this is the first description of a whole blood program implemented in a civilian hospital in Latin America.
Knowledge, attitudes and practices towards COVID-19 in Saudi Arabia: Planning implications for public health pandemics
Authors: Almalki Mohammed J. 
Published: September 2020

Abstract
BackgroundSaudi Arabian authorities have implemented a number of preventive measures to confront COVID-19, including complete public lockdown, limitations on many services and a public awareness campaign. The success of these preventive measures is highly dependent on individuals’ compliance, which is influenced by their knowledge, attitudes and practices towards this disease. This study aims to assess the knowledge, attitudes and practices towards COVID-19 among the population of Saudi Arabia.MethodsThis is a cross-sectional design study conducted between May 4 and May 21, 2020, using an online survey of 1135 participants. The survey instrument consisted of demographic characteristics, 19 items on knowledge, 4 items on attitudes and 6 items on practices. Descriptive statistics, independent sample t-test, analysis of variance, Mann–Whitney U test, Kruskal–Wallis test, standard multiple regression analysis and ordinal logistic regression analysis were conducted. ResultsThe majority of the study participants were knowledgeable about COVID-19, with an overall correct rate of 77%. Most participants were worried of contracting COVID-19 (96.3%), and they held positive attitudes towards the intent to use a vaccine for COVID-19 if it was available (81%), informing health authorities if they developed symptoms of COVID-19 (98.1%) and confidence in the government efforts during the COVID-19 pandemic (90%). Most participants were also taking precautions such as keeping social distancing (99.2%), avoiding leaving the house (98.6%) and wearing face masks in public (92.2%). Nearly all of the respondents stated that they were avoiding shaking hands (96.8%), avoiding touching their face with unwashed hands (96.7%) and washing/rubbing hands as recommended (96.6%). Male participants with higher education level and high income who had attended a health education activity were more likely to have more COVID-19 knowledge.ConclusionsThe findings of this research suggest that the Saudi population are generally knowledgeable and have good attitudes and practices regarding COVID-19. Health authorities in Saudi Arabia may benefit from the findings of this research, as the results could be used to improve planning for COVID-19-related efforts and to plan for future health crises. Such planning will help local authorities react promptly to prevent any health threats to the Saudi population and to those who visit Islamic holy places in Saudi Arabia.
Paediatric Intensive Care Staff Experiences of Debriefing Post Critical Incident; a Qualitative Study of the Leeds ‘time Out’ Method
Authors: Winton Mark , Cooper Sian , Latchford Gary 
Published: September 2020

Abstract
BackgroundHow intensive care teams respond to critical incidents is important for maintaining effective patient care, staff education and morale(1). We investigated Paediatric Intensive Care (PIC) staff experiences of participating in novel 20 minute group ‘time outs’ held after critical incidents.MethodA qualitative study using semi-structured interviews with staff attendees of ‘time outs’. Interviews transcribed and analysed using thematic analysis. Results shared with interviewees for participant validation. Ethical approval granted by the University of Leeds School of Medicine Research Ethics Committee (approval number SOMREC17-020).Results8 semi-structured interviews lasted on average 45 minutes each. Participant roles; 1 Consultant, 1 PIC grid trainee, ST3 Paediatrician, 1 Advanced Nurse Practitioner, 2 Band 6 Nurses and 2 Band 7 Nurses. Thematic analysis generated 1,060 initial codes, subsequently revised until a thematic map emerged, containing five main themes: 1. Context and culture in which critical incidents and ‘time outs’ are embedded, including hierarchy and local politics.2. Pragmatics of organising and evaluating ‘time outs’.3. Position of valued clinical psychologists, who were removed from the ‘time outs’.4. Reflections on coping and resilience, notably blame and fear.5. Process of attending a time out and its impact – both positive (clinical knowledge and the ability to cope) and negative (damaging if inappropriately run).ConclusionThe data contextualised the time outs within the complex PIC environment, with politics, communication challenges and hierarchies affecting how staff respond and how they are supported following critical incidents. Though practical challenges of time outs were noted, this intervention has potential to improve the understanding and well-being of PIC staff after critical incidents.