bluuebunny/crossref_metadata_2025_split huggingface dataset:
Do Primary Care Clinicians Incorporate Comorbidities and Concurrent Medications When Prescribing Opioids for Low Back Pain? A Retrospective Cross-Sectional Analysis
Authors: Keller Michelle Sophie , Truong Lyna , Mays Allison Moser , Needleman Jack , Heilemann MarySue V. , Nuckols Teryl K 
Published: September 2020

Abstract
Background Given the risks of opioid therapy, clinicians are under growing pressure to treat pain with non-opioid medications. Yet non-opioid analgesics such as non-steroidal anti-inflammatory drugs have their own risks; patients with kidney disease or gastrointestinal diseases can experience serious adverse events. We examined how primary care clinicians balance patient comorbidities and concurrent medications when prescribing opioids. Methods We used a retrospective cross-sectional study design and data from one health system. We identified office visits for low back pain from 2012-2017 and sampled the first visit per patient per year (N= 24,543 visits). We created indicators reflecting contraindications for NSAIDs (kidney, liver, cardiovascular/cerebrovascular, and gastrointestinal diseases; concurrent use of anticoagulants/antiplatelets) and opioids (depression, anxiety, substance use and bipolar disorders, chronic corticosteroid use, and concurrent benzodiazepines) and estimated four logistic regression models, with the first model including all patient visits and then stratifying for previous opioid use. Results Patients received an opioid prescription at 4% of visits. Among all patients, kidney disease (marginal effect [ME]: 3%; 95%CI: 1%-4%) or chronic/concurrent anticoagulant/antiplatelet prescriptions (ME: 2%, 95%CI: 1%-3%) were associated with a higher probability of receiving an opioid prescription. Concurrent benzodiazepines (ME: 7%, 95%CI: 5%-9%) and substance use diagnoses (ME: 1%, 95%CI: 0%-3%) were also associated with a higher probability of opioid prescription receipt. Among patients with long-term opioid use, contraindications for NSAIDs were not associated with a higher probability of opioid prescription receipt, while the probability of opioid receipt among those with concurrent benzodiazepines was substantially higher (ME: 10%, 95%CI: 14%-53%).Conclusions Among our entire sample, patients with kidney disease were 75% more likely to receive an opioid prescription for low back pain. Among patients with long-term opioid use, we did not find the same association. Patients with long-term use were likely started on opioids when opioid prescribing was more liberal; discussions regarding non-opioid options would be worthwhile for this population. Patients with concurrent benzodiazepines were 175% more likely to receive an opioid prescription; among patients with long-term opioid use, they were 250% more likely to receive opioids. These findings are troubling, as this combination is dangerous and can lead to overdose.
Use of Health Information Exchange in The Continuity of Care as Viewed by Patients and Nurses: A Cross Sectional Study
Authors: Itzhaki Michal , Koren Ella , Hussien Khaled Abu , Levy Liron , Gantz Irit , Barnoy Sivia 
Published: September 2020

Abstract
Background: Patients' attitudes towards sharing their personal health information are critical for implementation of Health Information Exchange (HIE). Nurses contribute significantly to information sharing within the care continuum in hospitals and community. The purpose of this study was to examine the awareness and readiness of chronic ill patients and nurses to use HIE.Methods: A cross sectional study among 312 inpatients with a chronic illness, 110 nurses working in internal wards, and 55 contact nurses working in a large Health Maintenance Organization. Multiple linear regressions were performed to assess the associations between knowledge, attitudes, socio-demographics, and both the readiness and intention to use HIE. Results: Mean levels of awareness were low across all three groups. The readiness to share information with medical healthcare providers was higher than the readiness to share information with agents not involved in direct care. Contact nurses expressed more positive attitudes than internal ward nurses or patients (F=11.25; p=.0001) and were more willing than patients to share information with health care workers (F=16.786; p=0001). All nurses (Internal ward and contact) were more willing to share information with medical agents not involved in direct care as compared to patients (F=8.072; p=.0001). Contact nurses expressed a significantly greater intention to use HIE than did internal ward nurses or patients (F=9.825; p=.0001), Knowledge, attitudes and being a nurse predicted the intention to share information on HIE with medical health care providers (F=29.91), and with agents not involved in direct care (F=19.65).Conclusions: Before implementation of an HIE system, it is important to raise awareness, readiness, and intention to use HIE among the general public, nurses, and other medical staff. Policy makers should organize national campaigns under the auspices of the Ministry of Health, in order to present the advantages of HIE and provide detailed information about the systems.
Study on Income for the Workforce of Public Health Institutions in Beijing Between 2011 and 2016
Authors: Qiu Wuqi , Yang Yujie , Meng Yueli , Mao Ayan 
Published: September 2020

Abstract
Background: This article analyses the average annual incomes of the workforce of municipal and district level public health institutions in Beijing between 2011 and 2016, and provides a useful reference for strengthening of public health services in China. Methods: This investigation combined quantitative analysis with qualitative investigation through a questionnaire survey and interviews with key informant. Results: Remuneration was relatively high for staff of the Municipal Maternal and Child Health Care Hospital and the staff of the Mental Health Institution, who had the highest annual average income among municipal specialized public health institutions between 2011 and 2016. The average annual incomes of the Municipal CDC, HSI, TCI, Municipal Emergency Medical Centre and Red Cross Blood Centre were all lower than the average annual income of the workers in the city's health industry (157,200 yuan). The average annual income of staff in the public health institutions at district level in Beijing is generally lower than that for staff in municipal institutions, especially those with high professional positions. Conclusions: The average income of public health workers in Beijing is generally lower than that of other health workers in the whole city. The result is a lack of professional attractiveness, which affects the stability and development of Beijing public health personnel.
Elevated ILC3s-related Inflammatory Factors may Promote Tendinopathy
Authors: Xu Peng , Yue Jiawei , Xu Xu , Wu Yumin 
Published: September 2020

Abstract
Background: The prevalence of tendinopathy has risen dramatically over the last few decades and has become a common and serious orthopedic problem in sports injury and elderly populations. Immune cells have been shown to be associated with tendinopathy, with the percentage of Group 3 Innate Lymphoid Cells (ILC3s) having been shown to be upregulated in tendon tissue compared with peripheral blood. Methods: We used flow cytometry to investigate the percentage of circulating ILC3s in patients with tendinopathy and controls patients; Realtime-PCR was performed to detect the mRNA levels of ILC3s surface markers, CD45, IL-23R, ICOS and ILC3s-related inflammatory factors and transcription factors IL-17A, IL-22 and RORC in tendon samples. Results: Our results showed that the proportion of ILC3s in the peripheral blood circulation of patients with tendinopathy has no significant difference from that of controls by flow cytometry for Lin‑IL-2R+IL-23R + cells; however, the surface marker of ILC3s was upregulated in tendon tissue. In addition, IL-23, a characteristic activating factor of ILC3s, was also upregulated. Relative mRNA expression levels of IL-17A and IL-22 were also upregulated in tendinopathy tendon tissue compared to control patients. Conclusions: These results suggest that ILC3s may be a potential immune factor for tendinopathy.
Blood Eosinophils and Mortality in Patients With Acute Respiratory Distress Syndrome: A Propensity Score Matching Analysis
Authors: Chen Haotian , Mao Yue , Xu Jianfeng , Huang Xiaoxia , Zhou Niya , Wang Yongkui 
Published: September 2020

Abstract
Background: The effect of blood eosinophils on mortality in acute respiratory distress syndrome (ARDS) patients and whether this effect is impacted by corticosteroids are unclear. This study explored the relationship between blood eosinophils and 28-day mortality in ARDS patients and investigated whether the relationship varied according to corticosteroid use.Methods: The Medical Information Mart for Intensive Care III database was employed to extract data. Patients with ARDS who were 16 years or older, used mechanical ventilation during the ICU stay and stayed in the ICU for at least 48 consecutive hours were screened for inclusion. Cox regression models using the stepwise backward method and propensity score matching (PSM) were employed to assess the relationship between blood eosinophil counts and 28-day mortality.Result: A total of 3372 patients were included, and the 28-day mortality rate was 24.23% (817/3372). The crude 28-day mortality was significantly lower in patients with eosinophil count ≥2% (105/574 vs. 712/2798, p< 0.001) than in those with eosinophil count <2%. In the Cox regression model, the eosinophil count ≥2% showed a significant association with decreased 28-day mortality (hazard ratio (HR) 0.761; 95% confidence interval (CI) =0.620-0.935, p=0.009). In a subgroup analysis, we detected an interactive effect of eosinophils and corticosteroids use (p value for interaction, p=0.006). In the corticosteroid non-use subgroup, eosinophil counts ≥2% were significantly related to decreased 28-day mortality (HR=0.730, 95% CI =0.577-0.923), but the result was non-significant in the corticosteroid non-use subgroup model (p=0.231). A total of 574 well-matched pairs were obtained by a 1:1 matching algorithm after PSM. The 28-day mortality remained significantly lower in the eosinophil count ≥2% group than in the eosinophil count <2% group (105/574 vs 136/574, p=0.025).Conclusions: Higher eosinophil counts are related to lower 28-day mortality in ARDS patients, and this relationship can be counteracted by using corticosteroids.
Altered Spontaneous Brain Activity in Somatic Symptom Disorder: A Resting-state fMRI Study
Authors: Cui Yangyang , Liang Huai-Bin , Zhu Qian , Qin Zhaoxia , Hu Yue , Liu Yi-Sheng , Zhao Rong , Qiao Yuan , Tang Wei , Gao Tingting , Liu Jian-Ren , Du Xiaoxia 
Published: September 2020

Abstract
Background: Somatic symptom disorders (SSDs) are common medical disorders characterized by various biological, social, and psychological pathogenic factors. Little is known about the neural correlations of SSD. Methods: In this study, we evaluated the dysfunction in 45 patients with SSD and in 43 controls by combining the regional homogeneity (ReHo) amplitudes of low-frequency fluctuation (ALFF) methods based on resting-state functional magnetic resonance imaging. Results: Compared to the controls, the patients with SSD exhibited significantly greater ReHo in the right cingulate gyrus and smaller ReHo in the right precuneus, left inferior and temporal gyrus extending to the left middle temporal gyrus and left parahippocampal gyrus, and right pons. The SSD patients showed higher ALFF values in the cingulate gyrus extending to the left medial frontal gyrus, right insula extending to the right inferior frontal gyrus, and left medial frontal gyrus extending to the left anterior cingulate cortex. Conclusions: These dysfunction areas seem to have a particular importance for the occurrence of SSD, which may result in dysfunction in self-relevant processes, emotional processing, multimodal integration, arousal, interoception, and body perception.
Reconfiguration of Multistable 3D Ferromagnetic Mesostructures
Guided by Energy Landscape Surveys
Authors: Li Yi , Avis Sam , Chen Junbo , Wu Guangfu , Zhang Teng , Kusumaatmaja Halim , WANG XUEJU 
Published: September 2020

Abstract
Reconfigurable three-dimensional (3D) structures that can reversibly change their geometries and thereby their functionalities are promising for a wide range of applications. Despite intensive studies, the lack of fundamental understanding of the highly nonlinear multistable states existing in these structures has significantly hindered the development of reconfigurable systems that can realize rapid, well-controlled shape change. Herein we present a systematic, integrated experimental and computational study to control and tailor the multistable states of 3D structures and their reconfiguration paths. Our energy landscape analysis using a discrete shell model and minimum energy pathway methods leads to design maps for a controlled number of stable states by varying geometry and material parameters, and energy-efficient reconfiguration paths among the multistable states. Concurrently, our experiments show that 3D structures assembled from ferromagnetic composite thin films of diverse geometries can be rapidly reconfigured among their multistable states, with the number of stable states and reconfigurable paths in excellent agreement with computational predictions. In addition, we demonstrate a wide breadth of applications including reconfigurable 3D light emitting systems, remotely- controlled release of particles/drugs from a reconfigurable structure, and 3D structure arrays that can form desired patterns following the written path of a magnetic “pen”. Our results represent a critical step towards the rational design and development of well-controlled, rapidly and remotely reconfigurable structures for many applications.
Epidemiology of Clinically Suspected and Laboratory-Confirmed Bloodstream Infections at A South African Neonatal Unit
Authors: Dramowski Angela , Bekker A , Cotton M F , Whitelaw A C , Coffin S 
Published: September 2020

Abstract
Background: Data from Africa reporting the epidemiology of infection in hospitalised neonates are limited. Methods: We conducted a cross-sectional study with convenience sampling to characterise neonates investigated with blood culture/s for suspected infection at a 124-bed neonatal unit in Cape Town, South Africa (1 February-31 October 2018). Enrolled neonates were classified as having proven bloodstream infection (BSI) (blood culture-positive with a pathogen) or presumed infection (clinically suspected but blood culture-negative) or potentially at risk of infection (maternal risk factors at birth). Results: Of 1299 hospitalised neonates with >1 blood culture sampling episode, 712 (55%) were enrolled: 126 (17.7%) had proven BSI; 299 (42%) had presumed infection and 287 (40.3%) were potentially at risk of infection. Neonates with proven BSI had lower birth weight and higher rates of co-existing surgical conditions versus the presumed/potential infection groups (p<0.001). Median onset of proven BSI versus presumed infection was at 8 (IQR 5-13) and 1 (IQR 0-5) days respectively (p<0.001). Most proven BSI were healthcare-associated (114/126; 90.5%), with Klebsiella pneumoniae (80.6% extended-spectrum β-lactamase producers) and Staphylococcus aureus (66.7% methicillin-resistant) predominating. Mortality from proven BSI (34/126; 27%) was substantially higher than that observed in presumed (8/299; 2.7%) and potential infections (3/287; 1.0%) (p<0.001). The odds of death from proven BSI was 3-fold higher for Gram-negatives than for Gram-positive/fungal pathogens (OR 3.23; 95%CI 1.17-8.92). Conclusion: Proven BSI episodes were predominantly healthcare-associated and associated with a high case fatality rate. Most neonates with presumed infection or at potential risk of infection had favourable 30-day outcomes.
Comparison of Cognitive and Other Developmental Functions in Children With Stunting and Malnutrition
Authors: Handryastuti Setyo , Pusponegoro Hardiono D. , Nurdadi Surastuti , Chandra Anita , Pramita Feka A. , Soebadi Amanda , Widjaja Ivan R. , Rafli Achmad 
Published: September 2020

Abstract
Background. Stunting is the impairment of growth and development due to malnutrition and/or chronic disease/infection. According to the Indonesia Basic National Health Survey 2013, prevalence of stunting in Indonesia reached 37.2%. Various studies have shown that impaired cognitive development may be found in children with stunting and malnutrition. This research has purpose to determine cognitive development in stunted children and malnourished children, using Bayley Scale of Infant Development III (Bayley-III). Methods. A cross-sectional study in 51 children aged 6 month to 3 year old who fullfiled the inclusion criteria at the Outpatient Clinic of Dr.Cipto Mangunkusumo National General Hospital from June 2017 until January 2018. Cognitive development was assessed using the Bayley Scale of Infant Development Third Edition (Bayley-III). Results. Twenty six children with stunting and 25 children with malnutrition without stunting with age of subjects were 11.0 month (2.0-34.0) and 16.0 month (7.0-25.6) respectively. Bayley-III percentile in cognitive scale were 12.5 (0.1-75) and 16.0 (0.1-99.9) with P (p-value)=0.55. Conclusions: Stunted children showed lower cognitive scores compared to the children with malnutrition. Although it was not significant, but it showed that Bayley-III scores group of stunting and malnutrition groups of children with normal stature far below the 50 percentile (P50). This showed that both children with stunting and malnutrition possible to have decreased cognitive function. Further research is needed with a larger sample to get comprehensive conclusions. Early detection and intervention also should be aimed at children who are experienced growth faltering to prevent developmental problems, especially cognitive function.
Safety of Allogenic Human Cord Blood Derived Mononuclear Cells for Extreme Preterms Infants at High Risk of Death: A Descriptive Study
Authors: Chen Jia , Mei Yabo , Du Xue , Li Qiuping , Wang Zizhen , Zhang Xing , Chen Yuhan , Zhang Yanping , Feng Zhichun 
Published: September 2020

Abstract
Backgroud Extreme preterm infants are at a high risk for developing preterm complications and death. Despite advances in medical care, many survivors face a lifetime of disability. Objective To assess the short term safety of and four-year follow-up outcomes of allogenic, human umbilical cord blood (hUCB) derived mononuclear cells(MNCs) infusion to extreme preterm infants with high risk potential of death. Method This study was a phase I, open-label, single-arm, single-center trial to evaluate the safety of allogenic, hUCB-MNCs infusion for extreme preterm infants with high risk potential of death. HUCB MNCs characteristics, pre- and postinfusion vital signs and laboratory investigations were recorded. Temporal proﬁles of cytokines and growth factors from blood were test. Clinical data including mortality rates, preterm complications and follow-up outcomes were recorded. Results After processing, relatively MNCs mean (1.9±0.8) ×106/kg; volume mean (11.25±2.12)ml/kg were infused to 10 extremely preterm infants with high risk of death. No adverse effects were noticed during treatment. 40% received extubation and weaned to nasal CPAP successfully; 30% received lower FiO2; no infants suffered from late onset sepsis; 30% received poor response to MNCs infusion. 40% infants suffered from ROP and only one infant needed laser surgery. No patients suffered from NEC after MNCs infusion. All ten infants who received hUCB MNCs infusion survived inhospital and prevent deterioration of clinical features, but 4 infants discharged against the advice of the doctor by their parents and lost connection. Regarding the rest 6 infants, no home oxygen therapy and rehospitalization, no suffered from other long-term respiratory complications at visit 1～visit 3. One infant showed cerebral palsy at visit 1, no clinical evidence associated this with MNCs infusion. Blood level of HGF signiﬁcantly increased, but MMP-9, IL-6, IL-8, TNF-α and TGF-β levels were significantly lower at 24h post infusion compared with baseline (P < 0.05).Conclusions Collection, preparation, and infusion of allogenic hUCB MNCs to extreme preterm infants is feasible and safe. Trial registration The study was registered on Chinese Clinical Trials.gov (NO. ChiCTR–OPN - 15006932). Registered 17 August 2015, http://www.chictr.org.cn/edit.aspx?pid=11662&htm=4.
Identification Of The Molecular Targets And Immunophenotype Of Gastric Cancer By Bioinformatics Analysis
Authors: Yang Tao , Zhang KeGang , Xu Rui , You Junhao , Li Fang 
Published: September 2020

Abstract
Background: Gastric cancer (GC) is the most lethal tumor of gastrointestinal tract worldwide. Despite advances in various therapies, the prognosis of GC remains poor. Moreover, only a small fraction of GC patients benefit from immunotherapy. Therefore, it is urgent to deeply understand the molecular characteristics and immunophenotype of GC. Methods: We analyzed the gene expression profile of GSE118916 from GEO database, including the mRNA expression profiles of 15 pairs of GC tumor and adjacent non-tumor tissues. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were performed using the online website DAVID. And then the survival prediction values of the top 10 up-regulated genes were analyzed using Kaplan–Meier plotter database. Finally, the immune cells infiltration was analyzed using CIBERSORT online tool.Results: A total of 1156 DEGs were identified, including 633 up-regulated genes and 523 down-regulated genes. The up-regulated genes were mainly enriched in cell adhesion, proliferation, migration and inflammation response. In addition, the up-regulated genes were significantly enriched in acid metabolism, complement and coagulation cascades, cell adhesion and p53 signaling pathway, which were all significant in tumor progression, relapse and metastasis. In addition, the up-regulated genes CTSL and PIEZO1 were associated with poor prognosis in GC patients. Moreover, a unique immune-suppressive microenvironment was identified in GC tissues. Conclusions: CTSL and PIEZO1 might be potential biomarkers and therapeutic targets in GC patients.