bluuebunny/crossref_metadata_2025_split huggingface dataset:
Chronic Hypoxia Decreases Endothelial Connexin 40, Attenuates Endothelium‐Dependent Hyperpolarization–Mediated Relaxation in Small Distal Pulmonary Arteries, and Leads to Pulmonary Hypertension
Authors: Si Rui , Zhang Qian , Cabrera Jody Tori O. , Zheng Qiuyu , Tsuji‐Hosokawa Atsumi , Watanabe Makiko , Hosokawa Susumu , Xiong Mingmei , Jain Pritesh P. , Ashton Anthony W. , Yuan Jason X.‐J. , Wang Jian , Makino Ayako 
Published: December 2020

Background
Abnormal endothelial function in the lungs is implicated in the development of pulmonary hypertension; however, there is little information about the difference of endothelial function between small distal pulmonary artery (PA) and large proximal PA and their contribution to the development of pulmonary hypertension. Herein, we investigate endothelium‐dependent relaxation in different orders of PAs and examine the molecular mechanisms by which chronic hypoxia attenuates endothelium‐dependent pulmonary vasodilation, leading to pulmonary hypertension.

Methods and Results

Endothelium‐dependent relaxation in large proximal PAs (second order) was primarily caused by releasing NO from the endothelium, whereas endothelium‐dependent hyperpolarization (EDH)–mediated vasodilation was prominent in small distal PAs (fourth–fifth order). Chronic hypoxia abolished EDH‐mediated relaxation in small distal PAs without affecting smooth muscle–dependent relaxation. RNA‐sequencing data revealed that, among genes related to EDH, the levels of
Cx37
,
Cx40
,
Cx43
, and
IK
were altered in mouse pulmonary endothelial cells isolated from chronically hypoxic mice in comparison to mouse pulmonary endothelial cells from normoxic control mice. The protein levels were significantly lower for connexin 40 (Cx40) and higher for connexin 37 in mouse pulmonary endothelial cells from hypoxic mice than normoxic mice. Cx40 knockout mice exhibited significant attenuation of EDH‐mediated relaxation and marked increase in right ventricular systolic pressure. Interestingly, chronic hypoxia led to a further increase in right ventricular systolic pressure in Cx40 knockout mice without altering EDH‐mediated relaxation. Furthermore, overexpression of Cx40 significantly decreased right ventricular systolic pressure in chronically hypoxic mice.

Conclusions
These data suggest that chronic hypoxia‐induced downregulation of endothelial Cx40 results in impaired EDH‐mediated relaxation in small distal PAs and contributes to the development of pulmonary hypertension.
Mapping the Margins in Health Services Research: How Does Race Intersect With Gender and Socioeconomic Status to Shape Difficulty Accessing HealthCare Among Unequal Brazilian States?
Authors: Constante Helena Mendes , Bastos João Luiz 
Published: December 2020

Research on healthcare inequities has centralized whether marginalized racial, gender, or socioeconomic (SES) groups are afforded equitable access to care, yet scant investigations have focused on how race intersects with other social statuses to shape difficulty accessing health services. Contextual specificity has also been under-researched in this field of knowledge. Data from 59,249 respondents 18 years of age and over from the 2013 Brazilian National Health Survey were analyzed using multilevel regressions models. We test 3 hypotheses: racial, gender, and socioeconomically oppressed groups are each more likely to report difficulty accessing health services (H1); compared to high-SES white men, low-SES Black women report expressively higher frequencies of the outcome (H2); and intersectional healthcare inequities are larger among low-SES Brazilian states (H3). Partially supporting H1 and H2, results suggest that race and SES, but not gender, are each strong predictors of difficulty accessing healthcare, with low-SES Black respondents facing the highest odds of reporting this outcome. Although H3 was not supported, intersectional groups residing in low-SES Brazilian states were more likely to report difficulty accessing healthcare. This study demonstrated that, together with contextual specificity, the intersections of race with other axes of marginalization should be at the forefront of research and policy addressing healthcare inequities.
“SET” for Success: Targeted Instruction in Learning Strategies and Behavior Change in Introductory Psychology
Authors: McCabe Jennifer A. , Friedman-Wheeler Dara G. , Davis Samuel R. , Pearce Julia 
Published: December 2020

Background: Undergraduates may not use the most effective learning strategies, particularly those considered “desirable difficulties” such as spacing, elaboration, and testing (“SET”). Objective: This study examined knowledge-based, metacognitive, and behavioral outcomes from interventions designed to teach undergraduates about the “SET” strategies and about behavior change techniques to support adoption of these study behaviors. Method: Introductory psychology students ( n = 244) received a learning-strategies-only intervention (LS), a learning-strategies-plus-behavior-change (LS+BC) intervention, or no intervention. They completed three assessment surveys to measure outcomes across the semester. Results: Intervention participants showed enhanced knowledge of the “SET” strategies. LS participants rated testing as more helpful, reported higher use of elaboration and testing, and had marginally higher final course grades than the control group. Adding behavior-change training did not enhance the outcomes. Growth mindset was associated with greater intervention-related gains on several measures. Conclusion: Curriculum-embedded LS training was associated with positive shifts in “SET” strategy knowledge and with behavioral changes for two strategies. Teaching Implication: This study provides evidence of the benefits of LS training as integrated into the introductory psychology curriculum, and can help guide educators to support students in acquiring more effective study strategies.
Low health numeracy is associated with higher disease activity in systemic lupus erythematosus
Authors: Maheswaranathan Mithu , Eudy Amanda M , Bailey Stacy C , Rogers Jennifer L , Clowse Megan EB 
Published: December 2020

Objective Evidence suggests low health literacy is prevalent in the United States and associated with worse clinical outcomes, yet few studies have investigated health literacy in systemic lupus erythematosus (SLE). The objective of this study was to determine the prevalence of low health literacy and numeracy in lupus patients and to examine its association with disease characteristics. Methods Patients with SLE were recruited from an academic center clinic. Participants completed in-person assessments of health literacy (Rapid Estimate of Adult Literacy in Medicine, REALM) and numeracy (Numeracy Understanding in Medicine Instrument Shortened Version, S-NUMi). Clinical disease activity measures were obtained, including urine protein to creatinine ratio (UPC), Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and physician global assessment (PhGA) scores. Results Ninety-five SLE patients participated in the study; 13% had low health literacy and 73% had limited health numeracy. Patients with lower health literacy and numeracy were more likely to be Black, have Medicaid insurance, and earn income <$50 K annually. In linear regression models, patients with limited health numeracy had, on average, PhGA scores 0.31 points higher (95% CI: 0.02, 0.60) than patients with adequate numeracy, after adjusting for race and age. No clinical outcomes were associated with health literacy. Conclusion In this exploratory study, we found SLE patients with low numeracy had higher disease activity. Our findings indicate that lower health literacy and numeracy are more common among Black and socioeconomically disadvantaged patients. Additional research will be needed to investigate the impact of health literacy on other outcomes and racial disparities in SLE.
Induced abortions in women with systemic lupus erythematosus
Authors: Venne Karel , Scott Susan , Bernatsky Sasha , Vinet Evelyne 
Published: December 2020

Objectives To determine the rates of induced abortions in women with systemic lupus erythematosus (SLE) compared to women from the general population and assess disease-related predictors of induced abortion in women with SLE. Methods We identified women with SLE (15-45 years) and determined the number of induced abortions, using Quebec’s administrative databases. We calculated the standardized incidence ratio (SIR) using general population rates. We also performed a nested-case control analysis to investigate predictors of induced abortions in SLE women (such as teratogenic immunosuppressive and corticosteroid exposures). Results Among 2508 women with SLE, we observed 293 induced abortions [incidence rate of 17.1 induced abortions per 1000 person-years (95% CI 15.2, 19.2)]. There was no clear difference in the number of induced abortions among women with SLE versus women from the general population (SIR 1.10; 95% CI 0.98, 1.24). In the multivariable analysis, we did not observe higher rates of induced abortions among women exposed to teratogenic immunosuppressives [rate ratio (RR) 0.37; 95% CI 0.13, 1.07] or using corticosteroids (RR 0.67; 95% CI 0.39, 1.16). Conclusion Our findings suggest that women with SLE have a similar rate of induced abortions as compared to the general population. This raises some concerns as unplanned pregnancies in SLE women can lead to adverse maternal and fetal outcomes. Our results should prompt further research on family planning counselling in women with SLE.
Relational welfare: a socially just response to co-creating health and wellbeing for all
Authors: Von Heimburg Dina , Ness Ottar 
Published: December 2020

Aims: Contemporary approaches to pursuing public value and the vision of health and wellbeing for all have evolved notably in the past few decades, with distinct approaches termed ‘co-creation’ and ‘health promotion’ gaining traction. This article explores a critique of ongoing paradigmatic shifts in public health and the public sector, focusing on cross-fertilisation between co-creation and the promotion of health and wellbeing. Drawing on Nancy Fraser’s claims for social justice through redistribution, recognition and representation to achieve participatory parity, we discuss a need for transformative change to achieve societal goals of creating health and wellbeing for all, leaving no one behind. Conclusions: Health promotion and co-creation converge in a quest for active citizenship through participation, as well as embracing a whole-of-government and whole-of-society approach. However, inequity in such processes, as well as health and wellbeing outcomes, are still persistent and contradictory to health promotion aims. This article argues that radically attending to human relationships and our dependency on other humans as a ‘collective’ need to be placed at the core of future-forming social construction of public and democratic institutions to allow the ongoing cross-fertilisation between health promotion and co-creation to work. Responding to this calls for transformation, the article presents a framework for developing a relational approach to welfare. The framework advocates for ‘relational welfare’, which captures the intersection of the welfare state, democracy and human relationships attending to social justice, capabilities and health and wellbeing for all as key public values in societal development.
Evaluation of the Efficacy and Safety of an eGlycemic Management System in a Community Hospital Setting
Authors: Bouldin Mary Grace , Hong Beatrice , Setji Tracy , Greenlee James , Cooper April , Thompson Julie , Capes Kellie 
Published: December 2020

Background: Glucommander is an eGlycemic management system (eGMS) for intravenous (IV) and subcutaneous (SQ) insulin therapy in hospitalized patients. The purpose of this study was to evaluate the efficacy and safety of Glucommander compared to previously utilized nomograms in the community hospital setting. Methods: This study was a retrospective, single-center cohort study comparing measures of efficacy and safety of IV and SQ insulin therapy via eGMS versus nomogram-driven IV insulin therapy followed by provider-ordered basal-bolus SQ insulin. The primary efficacy endpoint was percent of blood glucose (BG) readings per patient in target glycemic range. Safety objectives were percent of hyperglycemic events, hypoglycemic events, and severe hypoglycemic events after achieving target blood glucose range, and mean number of each event per patient. Results: The percentage of BG readings in range was significantly higher for eGMS patients ( n = 110) than comparison cohort patients ( n = 108, 84.6% vs 76.8%, P < .001). Hyperglycemic events occurred for significantly fewer patients in the eGMS cohort relative to the comparison cohort (81.8% vs 92.6%, P = .03). Overall, there was no significant difference between cohorts in rate of hypoglycemic events, but hypoglycemic events while on IV insulin occurred in a significantly higher percentage of eGMS cohort patients than comparison cohort patients (30.9% vs 15.7%, P < .01). There were no significant differences in incidence of severe hypoglycemic events. Conclusions: Our study found that Glucommander maintained a higher percentage of BG readings in target BG range per patient compared to previously utilized nomograms. This result was driven by an improvement in hyperglycemia, but not hypoglycemia.
Brainstem hyperintensity in patients with vestibular schwannoma is associated with labyrinth signal on magnetic resonance imaging but not vestibulocochlear tests
Authors: Teixeira Bernardo Corrêa de Almeida , Constanzo Felipe , Sens Patricia , Ramina Ricardo , Escuissato Dante Luiz 
Published: December 2020

Objectives Focal hyperintensity in the dorsal brainstem (HDB) has been described in large cerebellopontine angle tumours and is thought to represent vestibular nuclei degeneration, but its functional significance has not been thoroughly investigated. Our aim was to analyse its relationship to imaging characteristics of the tumour and inner-ear structures and to vestibulocochlear functional tests. Methods We retrospectively reviewed 54 patients with a histological diagnosis of vestibular schwannoma (VS). Magnetic resonance imaging tumour characteristics (size, cystic composition and distance from the cochlear aperture), signal intensity ratio of the cochlea and vestibule in fluid-attenuated inversion recovery (FLAIR) and fast imaging employing steady-state acquisition (FIESTA)/fast spin-echo imaging with variable flip angles (CUBE) and vestibulocochlear function tests (audiometry, auditory brainstem response (ABR) and video head impulse testing (vHIT)) were obtained. Statistical analyses were performed to evaluate their relation to focal HDB. Results Focal HDB was found in 22% of VS. It was significantly associated with large ( p < 0.001) and cystic ( p = 0.004) tumours and also with tumours located further from the cochlear aperture ( p = 0.039). The signal intensity ratio of the cochlea on FLAIR was higher in patients with HDB ( p < 0.014), but this difference was not observed in FIESTA/CUBE ( p = 0.981). Audiometry, ABR and vHIT results did not significantly differ in patients with HDB, but ABR results were worse in patients with higher cochlear signal intensity on FLAIR sequences ( p = 0.026). Conclusions Focal HDB in patients with VS was associated with increased signal intensity ratio of the cochlea on FLAIR in patients with VS but not directly to the results of vestibulocochlear function tests.
Which Factors Influence Clinical Outcomes After Superior Capsular Reconstruction Surgery?
Authors: Lee Seung-Jun , Kang Suk-Woong , Chung Ilkwon , Jang Hyungseo 
Published: December 2020

Background: Arthroscopic superior capsular reconstruction (ASCR) has recently been introduced as an alternative treatment for patients with massive irreparable rotator cuff tears. However, the results of ASCR are still limited, and little information about retear after ASCR or subsequent treatment has been reported. Purpose: To investigate the retear rate of patients who underwent ASCR and to analyze the clinical outcomes of treatments performed for a retear. Study Design: Case-control study; Level of evidence, 3. Methods: This was a retrospective analysis of prospectively collected data from 42 patients (46 shoulders) who underwent ASCR between March 2015 and April 2018. All patients were divided into 2 groups: those with no retear (30 shoulders) and those with retear (16 shoulders). Pre- and postoperative clinical and radiological results were compared between the 2 groups. The retear pattern and treatment outcomes of the retear group were analyzed. Results: The overall incidence of retear was 35% (16/46). No difference was found in preoperative demographic or clinical data between the 2 groups. Preoperative magnetic resonance imaging data showed a significant between-group difference in the preoperative Goutallier grade of the subscapularis (1.5 ± 1.1 in the no-retear group vs 2.5 ± 1.3 in the retear group; P = .016). In the retear group, there were 10 cases of lateral side tears, 3 cases of midsubstance tears, 2 cases of medial side tears, and 1 case of medial and lateral tears. Reoperation was performed in 8 patients who had lateral insertion tear. Conclusion: Overall, clinical scores improved after ASCR in patients with massive irreparable rotator cuff tears. However, 35% (16/46) of the patients showed retear, and lateral side retear occurred in 68% (11/16). The clinical outcome of the patients with preoperative subscapularis atrophy or postoperative lateral side retears was worse, and reoperation was often required. Therefore, it is important that the lateral side be firmly fixed during the ASCR procedure.
Rotator Cuff Repair Improves Clinical Function and Stability in Patients Older Than 50 Years With Anterior Shoulder Dislocations and Massive Rotator Cuff Tears
Authors: Ji Xiaoxi , Ye Lingchao , Hua Yinghui , Zhou Xiaobo 
Published: December 2020

Background: Older patients with shoulder instability have a higher prevalence of rotator cuff tears and anterior capsular lesions. Simultaneous rotator cuff repair and labral repair are commonly performed to improve shoulder stability and function. Purpose: To investigate the clinical outcomes of arthroscopic rotator cuff repair for older patients with shoulder dislocations combined with massive rotator cuff tears and intact labral tissue. Study Design: Case series; Level of evidence, 3. Methods: A cohort consisting of 11 patients older than 50 years with shoulder dislocations and massive rotator cuff tears undergoing arthroscopic rotator cuff repair was identified between December 2015 and January 2018. Rotator cuff repair was performed after Bankart, superior labral anterior-posterior, and humeral avulsion of the glenohumeral ligament lesions were excluded during arthroscopic surgery. Preoperative and 12-month postoperative outcomes including modified University of California Los Angeles (UCLA), American Shoulder and Elbow Surgeons (ASES), Western Ontario Shoulder Instability Index (WOSI), and visual analog scale for pain scores as well as range of motion (ROM) were recorded. Results: The supraspinatus tendon was torn in all patients. Also, 36.4% of the patients had 3 rotator cuff tendons torn. For shoulder function, the preoperative UCLA score (12.1 ± 2.5 [range, 9-16]) and ASES score (35.4 ± 12.7 [range, 24-44]) significantly improved to 29.4 ± 4.3 (range, 24-35; P < .001) and 79.4 ± 16.0 (range, 45-95; P < .001), respectively, at 12 months postoperatively. None of the patients experienced shoulder redislocations at 12 months after surgery. For shoulder stability, the postoperative WOSI score (156.8 ± 121.0 [range, 45-365]) was significantly better than was the preoperative score (713.0 ± 238.6 [range, 395-1090]) ( P < .001). For comparisons between preoperative and postoperative ROM, forward flexion, abduction, and external and internal rotation at the side significantly improved. Conclusion: For patients older than 50 years with shoulder dislocations combined with massive rotator cuff tears and an intact labrum, arthroscopic rotator cuff repair alone achieved satisfactory functional outcomes and ROM without the recurrence of dislocations.
IL-6 levels are dramatically high in the sputum from children with sickle cell disease during acute chest syndrome
Authors: Allali Slimane , de Montalembert Mariane , Rignault-Bricard Rachel , Taylor Melissa , Brice Joséphine , Brousse Valentine , Talbot Jean-Marc , Moulin Florence , Heilbronner Claire , Hermine Olivier , Maciel Thiago Trovati 
Published: December 2020

Key Points
Sputum interleukin-6 (IL-6) level is high during acute chest syndrome (ACS) in pediatric sickle cell disease, supporting anti–IL-6 trials. Sputum IL-8, CCL2, and CCL3 levels are also high during ACS, possibly contributing to recruitment of inflammatory cells in the lungs.
Indoor monitoring of heavy metals and NO2 using active monitoring by moss and Palmes diffusion tubes
Authors: Zechmeister Harald G. , Rivera Marcela , Köllensperger Gunda , Marrugat Jaume , Künzli Nino 
Published: December 2020

Abstract
Background
Indoor pollution is a real threat to human health all over the world. Indoor pollution derives from indoor sources (e.g. smoking, gas stoves, coated furniture) as well as from outdoor sources (e.g. industries, vehicles). Long-term monitoring measurements in indoor environments are missing to a large extent due to a lack of simple to operate measuring devices. Mosses proved well as biomonitors in hundreds of studies. Nevertheless, indoor use has been extremely scarce. Therefore, this study aimed to determine indoor and outdoor pollution by active biomonitoring using moss as well as NO2 samplers to analyse outdoor and indoor levels of pollution. We exposed moss (Pleurozium schreberi) for 8 weeks indoors and outdoors in 20 households in the city of Girona, Spain. Al, Cr, Cu, Zn, Sn, Cd, Pb, Mo, and Sb were analysed by moss-samplers. Additionally, NO2 was measured with Palmes diffusion tubes.

Results
Compared to the pre-exposure analysis, concentrations of almost all elements both on indoor and outdoor mosses increased. Except for Cd, all metals and NO2 had, on average, higher concentrations in outdoor mosses than at corresponding indoor sites. However, some 20% of the samples showed inverse patterns, thus, indicating both indoor and outdoor sources. Indoor/outdoor correlations of elements were not significant, but highest for markers of traffic-related pollution, such as Sn, Sb, and NO2. The wide range of indoor–outdoor ratios of NO2 exemplified the relevance of indoor sources such as smoking or gas cooking. Though mostly excluded in this study, a few sites had these sources present.

Conclusions
The study at hand showed that moss exposed at indoor sites could be a promising tool for long-time biomonitoring. However, it had also identified some drawbacks that should be considered in future indoor studies. Increments of pollutants were sometimes really low compared to the initial concentration and therefore not detectable. This fact hampers the investigation of elements with low basic element levels as, e.g. Pt. Therefore, moss with real low basic levels is needed for active monitoring, especially for future studies in indoor monitoring. Cloned material could be a proper material for indoor monitoring yet never was tested for this purpose.