bluuebunny/crossref_metadata_2025_split huggingface dataset:
Feasibility of computer-generated telephonic message-based follow-up system among healthcare workers with diabetes: a randomized controlled trial
Authors: Sadanshiv Mahima , Jeyaseelan Lakshmanan , Kirupakaran Henry , Sonwani Vikas , Sudarsanam Thambu David 
Published: July 2020

IntroductionTo assess the feasibility of computer-generated educational messaging system in healthcare workers of a tertiary care hospital. The secondary objectives were glycemic control, patient satisfaction and adherence to lifestyle modifications.Research design and methodsSingle-center parallel-group open-labeled randomized controlled trial with computer generated block randomization.SettingHealthcare workers with diabetes working in Christian Medical College Vellore, Tamil Nadu.Participants431 assessed, 341 met the selection criteria, 320 participants were randomized and 161 were taken into intervention arm and 159 in the control arm.InterventionComputer-generated short message service (SMS) based on transtheoretical model of behavioral change, 2 messages per week for 3 months, along with standard of care diabetic care. Messages had educational material regarding healthy eating habits and exercise and these messages were sent twice weekly. The messages were scheduled via an automatic calendar in a way that each subject in the intervention arm received 15 educational messages per month.Control group received only standard of care diabetic care which included dietary advice, exercise regimen and diabetic medications under supervision of their physician every 3 months.Follow-up6 months.Results95.65% of people in the intervention arm (n=154) received regular messages, out of which 93.17% read the messages regularly. 80.12% acted on the messages. 93.17% felt more satisfied with their healthcare.While both groups showed improvement in body mass index (BMI) and hemoglobin A1c (HbA1c), the difference was greater in the intervention with regard to both decrease in BMI (−0.6, p<0.001) and HBA1c (−0.48, p<0.001).ConclusionsSMS-based education system is feasible in improving healthcare among healthcare workers with diabetes. It improves patient satisfaction, adherence and improves healthcare among individuals with diabetes by decreasing their BMI and decreasing HbA1c.
Development of a physiotherapy-led atraumatic back pain pathway: a novel initiative to improve the management of complex back pain in the emergency village
Authors: Angus Michelle Louise , Martin Bruce , Dickens Victoria , Mohammad Saeed , Siddique Irfan 
Published: July 2020

ObjectivesTo see if consultant physiotherapists could effectively manage spinal patients within the emergency village of a tertiary spinal referral centre.DesignA change was made to the traditional medical model for managing patients presenting to the emergency department with low back pain that could not be managed within the national 4-hour standard.ParticipantsA convenience sample of patients presenting to the emergency department of a tertiary spinal surgical centre who are unable to be managed in a timely manner by the clinicians in the emergency department.InterventionConsultant physiotherapists took on autonomous ownership of this group of patients, including clinical assessment, management and appropriate follow-up often without the need for medical input.OutcomesThe new model showed a reduction in the number of admissions, a significant reduction in length of stay and an improvement in overall staff and patient satisfaction along with a reduction in patients returning to the emergency department.ConclusionsConsultant physiotherapists are in an ideal position to manage this cohort of patients autonomously in the emergency village allowing medics to be released to manage other patient groups.
Barriers and facilitators to neonatal health and care-seeking behaviours in rural Cambodia: a qualitative study
Authors: Watson Gabriella , Patel Kaajal , Leng Daly , Vanna Dary , Khut Sophanou , Prak Manila , Turner Claudia 
Published: July 2020

ObjectivesNeonatal mortality remains persistently high in low-income and middle-income countries. In Cambodia, there is a paucity of data on the perception of neonatal health and care-seeking behaviours at the community level. This study aimed to identify influencers of neonatal health and healthcare-seeking behaviour in a rural Cambodian province.DesignA qualitative study using focus group discussions and thematic content analysis.SettingFour health centres in a rural province of Northern Cambodia.ParticipantsTwenty-four focus group discussions were conducted with 85 community health workers in 2019.ResultsCommunity health workers recognised an improvement in neonatal health over time. Key influencers to neonatal health were identified as knowledge, sociocultural behaviours, finances and transport, provision of care and healthcare engagement. Most influencers acted as both barriers and facilitators, with the exception of finances and transport that only acted as a barrier, and healthcare engagement that acted as a facilitator.ConclusionUnderstanding health influencers and care-seeking behaviours is recognised to facilitate appropriate community health programmes. Key influencers and care-seeking behaviours have been identified from rural Cambodia adding to the current literature. Where facilitators have already been established, they should be used as building blocks for continued change.
Role of unsafe medical practices and sexual behaviours in the hepatitis B and C syndemic and HIV co-infection in Rwanda: a cross-sectional study
Authors: Makuza Jean Damascene , Nisingizwe Marie Paul , Rwema Jean Olivier Twahirwa , Dushimiyimana Donatha , Habimana Dominique Savio , Umuraza Sabine , Serumondo Janvier , Ngwije Alida , Semakula Muhamed , Gupta Neil , Nsanzimana Sabin , Janjua Naveed Zafar 
Published: July 2020

ObjectivesThis study describes the burden of the hepatitis B, C and HIV co-infections and assesses associated risk factors.SettingThis analysis used data from a viral hepatitis screening campaign conducted in six districts in Rwanda from April to May 2019. Ten health centres per district were selected according to population size and distance.ParticipantsThe campaign collected information from 156 499 participants (51 496 males and 104 953 females) on sociodemographic, clinical and behavioural characteristics. People who were not Rwandan by nationality or under 15 years old were excluded.Primary and secondary outcomesThe outcomes of interest included chronic hepatitis C virus (HCV) infection, chronic hepatitis B virus (HBV) infection, HIV infection, co-infection HIV/HBV, co-infection HIV/HCV, co-infection HBV/HCV and co-infection HCV/HBV/HIV. Multivariable logistic regressions were used to assess factors associated with HBV, HCV and HIV, mono and co-infections.ResultsOf 156 499 individuals screened, 3465 (2.2%) were hepatitis B surface antigen positive and 83% (2872/3465) of them had detectable HBV desoxy-nucleic acid (HBV DNA). A total of 4382 (2.8%) individuals were positive for antibody-HCV (anti-HCV) and 3163 (72.2%) had detectable HCV ribo-nucleic acid (RNA). Overall, 36 (0.02%) had HBV/HCV co-infection, 153 (0.1%) HBV/HIV co-infection, 238 (0.15%) HCV/HIV co-infection and 3 (0.002%) had triple infection. Scarification or receiving an operation from traditional healer was associated with all infections. Healthcare risk factors—history of surgery or transfusion—were associated with higher likelihood of HIV infection with OR 1.42 (95% CI 1.21 to 1.66) and OR 1.48 (1.29 to 1.70), respectively, while history of physical traumatic assault was associated with a higher likelihood of HIV and HBV/HIV co-infections with OR 1.69 (95% CI 1.51 to 1.88) and OR 1.82 (1.08 to 3.05), respectively.ConclusionsOverall, mono-infections were common and there were differences in significant risk factors associated with various infections. These findings highlight the magnitude of co-infections and differences in underlying risk factors that are important for designing prevention and care programmes.
Novel education-based intervention to reduce inappropriate antibiotic prescribing for treatment of gonorrhoea in China: protocol for a cluster randomised controlled trial
Authors: Jiang Ting-Ting , Yang Yun-Qing , Cao Ning-Xiao , Yin Yue-Ping , Chen Xiang-Sheng 
Published: July 2020

IntroductionInappropriate use of antibiotics to treat gonorrhoea can lead to antibiotic resistance. Education programmes may be helpful for improving physician prescribing behaviours in accordance with treatment guidelines. As traditional education based on printed materials may have limited effect on guideline-based treatment, innovative education strategies are needed. The current trial aims to assess the effectiveness of a novel education intervention to increase guideline-based treatment of gonorrhoea in China.Methods and analysisWe will conduct a two-arm cluster randomised control trial at 144 hospitals (clusters) in eight Chinese provinces. The intervention will include an online training video developed on the WenJuanXing platform that covers workflows and requirements for managing a patient with uncomplicated gonorrhoea. Outpatient physicians in dermatology (dermatovenerology), urology, andrology and gynaecology will be given access to the video via a quick response code. In hospitals allocated to the control arm, physicians will continue to participate in their standard of care training programme. The primary outcome is the proportion of gonorrhoea antibiotic prescriptions adherent to Chinese national guidelines at the cluster level. In addition, to understand the reasons of physician’s non-adherence to the intervention by conducting a questionnaire survey will be considered as the secondary outcome of the study.Ethics and disseminationEthical approval was obtained from the Medical Ethics Committee of the Chinese Academy of Medical Sciences Institute of Dermatology (2020-LS-004). All physicians will provide an informed consent prior to participating in the study. Findings of the trial will be disseminated through conferences and peer-reviewed journals, and will be used to develop training programmes for physicians.Trial registration numberChiCTR2000029591.
Comparison of mortality risk in patients with cirrhosis and COVID-19 compared with
patients with cirrhosis alone and COVID-19 alone: multicentre matched cohort
Authors: Bajaj Jasmohan S , Garcia-Tsao Guadalupe , Biggins Scott W , Kamath Patrick S , Wong Florence , McGeorge Sara , Shaw Jawaid , Pearson Meredith , Chew Micheal , Fagan Andrew , de la Rosa Rodriguez Randolph , Worthington Janelle , Olofson Amy , Weir Vanessa , Trisolini Calvin , Dwyer Sarah , Reddy K Rajender 
Published: July 2020

Objective
Comorbid conditions are associated with poor prognosis in COVID-19. Registry
data show that patients with cirrhosis may be at high risk. However, outcome
comparisons among patients with cirrhosis+COVID-19 versus patients with COVID-19 alone
and cirrhosis alone are lacking. The aim of this study was to perform these
comparisons.

Design
A multicentre study of inpatients with cirrhosis+COVID-19 compared with
age/gender-matched patients with COVID-19 alone and cirrhosis alone was performed.
COVID-19 and cirrhosis characteristics, development of organ failures and
acute-on-chronic liver failure (ACLF) and mortality (inpatient death+hospice) were
compared.

Results
37 patients with cirrhosis+COVID-19 were matched with 108 patients with COVID-19
and 127 patients with cirrhosis from seven sites. Race/ethnicity were similar.
Patients with cirrhosis+COVID-19 had higher mortality compared with patients with
COVID-19 (30% vs 13%, p=0.03) but not between patients with cirrhosis+COVID-19 and
patients with cirrhosis (30% vs 20%, p=0.16). Patients with cirrhosis+COVID-19 versus
patients with COVID-19 alone had equivalent respiratory symptoms, chest findings and
rates of intensive care unit transfer and ventilation. However, patients with
cirrhosis+COVID-19 had worse Charlson Comorbidity Index (CCI 6.5±3.1 vs 3.3±2.5,
p<0.001), lower presenting GI symptoms and higher lactate. Patients with cirrhosis
alone had higher cirrhosis-related complications, maximum model for end-stage liver
disease (MELD) score and lower BiPAP/ventilation requirement compared with patients
with cirrhosis+COVID-19, but CCI and ACLF rates were similar. In the entire group, CCI
(OR 1.23, 95% CI 1.11 to 1.37, p<0.0001) was the only variable predictive of
mortality on multivariable regression.

Conclusions
In this multicentre North American contemporaneously enrolled study,
age/gender-matched patients with cirrhosis+COVID-19 had similar mortality compared
with patients with cirrhosis alone but higher than patients with COVID-19 alone. CCI
was the only independent mortality predictor in the entire matched cohort.
Chronobiological patterns of acute aortic dissection in central China
Authors: Xia Liangtao , Huang Lu , Feng Xin , Xiao Jiewen , Wei Xiang , Yu Xinyu 
Published: July 2020

BackgroundAcute aortic dissection (AAD) is a life-threatening emergency with poor clinical outcomes. Understanding the chronological patterns of AAD onset would be helpful for identifying the triggers of AAD and preventing this catastrophic event.MethodsWe collected data from 2048 patients diagnosed with AAD at Tongji Hospital (Wuhan, China) from 2011 to 2018. The χ2test was used to determine whether a specific period had significantly different seasonal/weekly distributions from other periods. Fourier models were used to analyse the rhythmicity in monthly/circadian distribution.ResultsThe mean age was 53.4±10.9 years, and 1161 patients (56.7%) were under 55 years. One thousand six hundred fifty-seven patients (80.9%) were male, and 935 cases (45.7%) were type A dissections. The proportions of patients with comorbid hypertension/diabetes were 60.3% (1234 cases) and 1.8% (36 cases), respectively. A peak was identified in colder periods (winter/December) and a trough in warmer periods (summer/June). No significant variation was observed in weekly distribution. Fourier analysis showed a statistically significant circadian variation (p<0.001) with a nocturnal trough in 2:00–3:00, a morning peak in 9:00–10:00, and an afternoon peak in 16:00–17:00. Subgroup analyses identified circadian rhythmicity in all subgroups except for the female group and younger group (younger than 55 years).ConclusionOur results confirmed that the onset of AAD exhibits significant seasonal, monthly and circadian patterns. Patients with AAD with different Stanford-type dissections, sexes, ages and hypertension statuses could present different circadian variations. These findings may provide novel perspectives for identifying the triggers of AAD and better preventing this catastrophic event.
Correlates of clinical benefit from immunotherapy and targeted therapy in metastatic renal cell carcinoma: comprehensive genomic and transcriptomic analysis
Authors: Dizman Nazli , Lyou Yung , Salgia Nicholas , Bergerot Paulo Gustavo , Hsu JoAnn , Enriquez Daniel , Izatt Tyler , Trent Jeffrey M , Byron Sara , Pal Sumanta 
Published: July 2020

BackgroundThe clinical significance of tumor-specific genomic alterations in metastatic renal cell carcinoma (mRCC) is emerging, with several studies suggesting an association between PBRM1 mutations and response with immunotherapy (IO). We sought to determine genomic predictors of differential response to vascular endothelial growth factor–tyrosine kinase inhibitors (VEGF-TKIs) and IO.MethodsConsecutive patients who underwent genomic profiling were identified; patients receiving either VEGF-TKIs or IO were included. Clinical tumor-normal whole exome sequencing and tumor whole transcriptome sequencing test were performed using a Clinical Laboratory Improvement Amendments (CLIA)-certified assay (Ashion Analytics; Phoenix, Arizona, USA). Genomic findings were compared between patients with clinical benefit (CB; complete/partial response or stable disease for >6 months) and no clinical benefit (NCB) in VEGF-TKI-treated patient cohort and IO-treated patient cohort.Results91 patients received genomic profiling and 58 patients received VEGF-TKI and/or IO therapy. 17 received sequenced treatment involving both VEGF-TKI and IO, resulting in 32 patients in the IO cohort and 43 patients in the VEGF-TKI cohort. The most commonly used IO and VEGF-TKIs were nivolumab (66%) and sunitinib (40%). The most frequently detected alterations in the overall cohort were in VHL (64%), PBRM1 (38%), SETD2 (24%), KDM5C (17%) and TERT (12%). TERT promoter mutations were associated with NCB in the IO cohort (p=0.038); transcriptomic analysis revealed multiple differentially regulated pathways downstream of TERT. TERT promoter mutations and PBRM1 mutations were found to be mutually exclusive. While PBRM1 mutations were more prevalent in patients with CB with IO and VEGF-TKIs, no statistically significant association was found.ConclusionsOur analysis found that TERT promoter mutations may be a negative predictor of outcome with IO and are mutually exclusive with PBRM1 loss-of-function mutations.
Extended galactic rotational velocity profiles in f(R) gravity background
Authors: Sharma Vipin Kumar , Yadav Bal Krishna , Verma Murli Manohar 
Published: July 2020

AbstractAn attempt has been made to explore the geometric effects of f(R) action on the galactic dynamics under the weak field approximation. The rotational velocity is calculated beyond the Einstein’s geometric theory of gravity. It is inspired by the cosmological geometric relation obtained in the power-law f(R) gravity model in vacuum. We analyse the action with a small positive deviation from the Einstein–Hilbert gravity action (taking R as $$f(R)\propto R^{1+\delta }$$f(R)∝R1+δ) at the galactic scales for the explanation of the flatness paradox associated with the clustered galactic dark matter. We obtain the contribution of a dynamical f(R) cosmological background geometry on accelerating the test mass. Furthermore, the integrated effective acceleration of the test mass due to a massive spherically symmetric source in f(R) background is calculated via the study of geodesics for the suitable spacetime metric and an equation for the effective rotational velocity has been developed. We test the viability of the proposed model by tracing the motion of a test mass far from the disk of galactic matter for smaller $$\delta $$δ. The possible galactic rotational velocity curves in f(R) background are discussed for the formula obtained with $$\delta<< 1$$δ<<1. We also obtain constraints on $$\delta $$δ$$O(10^{-6})$$O(10-6) confirmed by observations.
Fecal Immunologic Test Results and Diagnostic Colonoscopy in a Mexican Population at Average Risk for Colorectal Cancer
Authors: Manzano-Robleda Maria Del Carmen , Espinosa-Tamez Priscilla , Potter Michael B. , Lajous Martin , Van Loon Katherine , Zhang Li , Jimenez-Peña Alejandro , Sánchez Del Monte Julio , Mohar Alejandro , Hernández-Guerrero Angélica 
Published: July 2020

Abstract
Colorectal cancer is preventable and treatable by screening and early detection. Fecal immunochemical tests (FIT) for average risk individuals is an effective strategy for screening. Incidence and mortality in Mexico is increasing and large-scale screening programs do not yet exist. The aim of this study was to evaluate the feasibility of FIT-based colorectal cancer screening program in Mexico City. For more than 15 months, average risk individuals in Mexico City were invited to participate at Mexico's Instituto Nacional de Cancerologia (INCan, Mexico City, Mexico). Participants received an FIT kit for stool collection, results ≥20 ng/mL were referred for high quality colonoscopy. Participants' results were classified according to the most advanced clinical finding as: adenocarcinoma, high-risk adenomas, low-risk adenomas, serrated lesions, hyperplastic polyps, and no polyps. Sequential analyses were performed to assess the positive predictive value (PPV) of FIT. A total of 810 participants were eligible, 737 (91.0%) returned the FIT and 112 (15.2%) had an abnormal result. Of these participants, 87 (77.7%) completed colonoscopy. Clinical findings of participants included: seven (8.1%) adenocarcinomas, 18 (20.7%) high-risk adenomas, 23 (26.4%) low-risk adenomas, one (1.2%) serrated lesions, 14 (16.1%) hyperplasic polyps, and 24 (27.6%) no polyps. The PPV of FIT using the ≥20 ng/mL was 8.1% for cancer and 20.7% for high-risk adenomas. In conclusion, colorectal cancer screening with FIT is feasible at INCan in Mexico City, where resources are available. Further studies are needed to determine feasibility of colorectal cancer screening in other settings, as well as optimal hemoglobin detection cut-off points to maximize the population benefits of colorectal cancer screening with FIT in Mexico.
Upper Gastrointestinal Cancer in China: Spatial Epidemiologic Evidence from Screening Areas
Authors: Li Peng , Jing Jing , Li Rui , Ge Miao , Jia Peng , Hu Wenbiao , Qi Xin , Wei Wen-Qiang , Zhuang Guihua 
Published: July 2020

Abstract
Upper gastrointestinal cancer (UGIC) including esophageal cancer and gastric cancer, which has been a significant burden in China. Few studies have explored the spatial pattern and association of incidence and mortality using nationwide data. This study aims to explore the spatial pattern and association of incidence and mortality between esophageal cancer and gastric cancer, and identify high-risk areas of the cancers to provide scientific evidence for tailoring endoscopic screening programs. We collected UGIC data in 2014 from a National Cancer Report, and then adopted methods of correlation analysis and spatial statistics to identify high-risk areas on the cancers and to explore the pattern. The results show a spatial autocorrelation on the spatial distribution of incidence and mortality of esophageal and gastric cancers, and the relative risks were from 2.52 (95% CI (confidence interval), 2.37–2.67; P &lt; 0.001) to 3.80 (95% CI, 3.46–4.18; P &lt; 0.001) in primary risk areas, respectively. Moreover, esophageal cancer shows an upward and then downward trend from west to east, and from south to north, yet gastric cancer exhibits an upward and then downward trend only from south to north. This study indicates habitants in overlapping risk areas have heavier cancer burdens, and suggests esophageal cancer and gastric cancer have a significant correlation. Therefore, more endoscopic screening attention should focus on overlapping risk areas.
Chemotherapeutic Tumor Microparticles Elicit a Neutrophil Response Targeting Malignant Pleural Effusions
Authors: Xu Pingwei , Tang Ke , Ma Jingwei , Zhang Huafeng , Wang Dianheng , Zhu Liyan , Chen Jie , Wei Keke , Liu Jincheng , Fang Haiqing , Tang Liang , Zhang Yi , Xie Jing , Liu Yuying , Meng Rui , Liu Li , Dong Xiaorong , Yang Kunyu , Wu Gang , Ma Fei , Huang Bo 
Published: July 2020

Abstract
Malignant pleural effusion (MPE) is a frequent complication of various cancers and often leads to a poor quality of life, prognosis, and life expectancy, and its management remains palliative. New approaches that can effectively treat MPE are highly desirable. Here, we show that methotrexate (MTX)-packaging tumor cell–derived microparticles (MTX-MP) act as an effective immunotherapeutic agent to treat patients with MPE by mobilizing and activating neutrophils. We find that MTX-MP perfusion via a pleural catheter elicits the recruitment of neutrophils in patients through macrophage-released CXCL1 and CXCL2. By performing ex vivo experiments, we find that the recruited neutrophils are activated and release reactive oxygen species (ROS) and neutrophil extracellular trap (NET) to kill tumor cells. Neutrophil-released NETs were also able to seal off the damaged endothelium, facilitating MPE resolution in vitro and in tumor-bearing mice. These findings reveal the potential for use of cell-derived materials to package drugs as an immunotherapeutic agent against MPE.