bluuebunny/crossref_metadata_2025_split huggingface dataset:
Resilience of Health Systems in Conflict Affected Governorates of Iraq, 2014-2018
Authors: Ibrahim Shaimaa , Al-Dahir Sara , Al-Mulla Taha , Lami Faris , Hossain SM Moazzem , Baqui Abdullah , Burnham Gilbert 
Published: January 2021

Abstract
ObjectivesThe objective of this study was to assess the resilience of health services in four governorates affected by conflict from 2014-2018, and to convey recommendations.MethodsHealth managers from Al Anbar, Ninawa, Salah-al-din, and Kirkuk governorates assessed resilience factors of Primary Health Care services affected by the 2014-2017 ISIS insurgency. Additional information was gathered from key informants and a health facility Unicef survey. Three specific aspects were examined: 1) meeting health needs in the immediate crisis response, 2) adaptation of services, 3) restructuring and recovery measures. Data from and MoH/UNICEF national health facility survey were 2017-2019 analyzed for functionality.FindingsThere were many common themes across the four governorates, with local variations.1. Absorption. The shock to the public sector health services by the invasion by ISIS caught the in the four governorates unprepared, with limited abilities to continue to provide services. Pharmacies and private clinics sometimes withstood the initial shock better. 2. Adaptation. After the initial shock, many health facilities adapted by focused on urgent needs for injury and communicable disease care. In most locations, maternal, neonatal, and child health (MNCH) preventive and promotive services stopped. Ill persons would sometimes consult health workers in their houses at night for security reasons. 3. Restructuring or transformative activities. In most areas, health services restructuring was continuing in 2020. Some heavily damaged facilities are still functioning below pre-crisis level, with reduced service availability. Rebuilding lost community trust in the public sector is proving difficult, though in some communities, trust remained strong.ConclusionHealth services generally had little preparation and limited resilience to the ISIS influx. Governorates are, in places, still restructuring services after the liberation from ISIS in 2017. Disaster planning was identified by all participants as a missing component, as managers anticipated future emergencies.
The Potential Molecular Mechanism of Autologous Adipose Tissue Grafting in Treating Keloid Patients: a Case-control Study
Authors: Zhou Jiong , Shen Ji-Yang , Tao Li-En , Chen Huan 
Published: January 2021

Abstract
Background: Keloids represent the dysregulation of cutaneous wound healing caused by aberrant fibroblast activities. Adipose-derived stem cells have been recognized as a promising treatment for keloids. However, their molecular mechanisms have not been fully elucidated. Methods: Skin biopsies were obtained from 10 keloid patients and 9 healthy volunteers. Fibroblasts isolated from all samples were divided into 2 groups, one co-cultured with adipose-derived stem cells, the other growing independently. Between each group, we compared the wound healing rate, fibroblasts’ survival rate, apoptosis rates, mRNA expressions and protein level of Col-1, Col-3, CTGF, P-4-HB. Results: In our research, no significant differences between normal fibroblasts and keloid fibroblasts in terms of wound-healing rate, survival rate, or apoptosis rate were found at the baseline. Adipose-derived stem cells strongly suppressed keloid fibroblasts’ proliferative and invasive behavior, but negatively regulated keloid fibroblast apoptosis. The further measurement of key components in keloid formation showed that adipose-derived stem cells upregulated Col-3 and CTGF levels in normal fibroblasts but downregulated protein expression of CTGF and P-4-HB in keloid fibroblasts. Conclusions: Adipose-derived stem cells had the potential to serve as a promising alternative for keloid treatment.
Exosomal miR-100-5p Inhibits Osteogenesis of BMSCs and Angiogenesis of VECs By Suppressing BMPR2/Smad1/5/9 Signaling Pathway
Authors: Yang Wu , Zhu Weiwen , Yang Yunfei , Guo Minkang , Qian Husun , Jiang Weiqian , Chen Yu , Lian Chengjie , Xu Zijie , Bai Haobo , Chen Tingmei , Zhang Jian 
Published: January 2021

Abstract
Background: Non-traumatic osteonecrosis of the femoral head (NONFH) is a common, progressive, and refractory orthopedic disease. We aimed to figure out whether exosomal miRNA from necrotic bone tissues of the non-traumatic osteonecrosis of the femoral head (NONFH) patients are involved in the pathogenesis of NONFH and reveal the underlying mechanisms.Methods: RT-PCR and western blotting were used to detect the expression of osteogenic, adipogenic and angiogenic markers. ALP staining and Alizarin red s (ARS) staining were used to evaluate osteogenic differentiation of BMSCs. Oil red staining was conducted to test the adipocyte deposition. Tube formation assay was used to study angiogenesis of vascular endothelial cells (VECs). HE staining and IHC staining were used to detect the effect of NONFH-exosomes in vivo. MicroRNA sequencing was conducted to find potential regulators in NONFH-exosomes.Results: The NONFH-exosomes can lead to NONFH-like impairment on BMSCs, HUVECs and rats. MiR-100-5p was upregulated in NONFH-exosomes and could inhibit osteogenesis of BMSCs and angiogenesis of HUVECs by targeting BMPR2.Conclusion: The NONFH-exosomal miR-100-5p can lead to NONFH-like damage by targeting BMPR2 and suppressing BMPR2/SMAD1/5/9 signaling pathway, which may be involved in the pathomechanism of non-traumatic osteonecrosis of the femoral head (NONFH).
Genetic Effects on Longitudinal Cognitive Decline During the Early Stages of Alzheimer's Disease
Authors: Kumar Atul , Shoai Maryam , Palmqvist Sebastian , Stomrud Erik , Hardy John , Mattsson-Carlgren Niklas , Hansson Oskar 
Published: January 2021

Abstract
Background

Cognitive decline in early-stage Alzheimer’s disease (AD) may depend on genetic variability.
Methods

In the Swedish BioFINDER study, we used polygenic scores (PGS) (for AD, intelligence and educational attainment), and genetic variants (in a genome-wide association study [GWAS]) to predict longitudinal cognitive change (measured by MMSE) over a mean of 4.2 years. We included 555 β-amyloid (Aβ) negative cognitively unimpaired (CU) individuals, 206 Aβ-positive CU (preclinical AD), 110 Aβ-negative mild cognitive impairment (MCI) patients, and 146 Aβ-positive MCI patients (prodromal AD).
Results

Polygenic scores for AD (in Aβ-positive individuals) and intelligence (independent of Aβ-status) were associated with cognitive decline. Eight genes were associated with cognitive decline in GWAS (3 independent of Aβ-status).
Conclusions

AD risk genes may influence cognitive decline in early AD, while genes related to intelligence may modulate cognitive decline irrespective of disease. Therapies targeting the implicated biological pathways may modulate the clinical course of AD.
Prevalence of high HDL-Cholesterol and its Associated Factors Among Childbearing Age Tunisian women: A Cross-Sectional Study
Authors: Cherifa Fatma Ben , Ati Jalila El , Doggui Radhouene , Hellal Fayçal , Ati-Hellal Myriam El 
Published: January 2021

Abstract

Background: The protective role of high HDL-C against cardiovascular risk has been questioned recently. Due to the increasing trend of CVD in Tunisia, this study aimed to determine the prevalence of high HDL-C and its associated factors in childbearing age Tunisian women. Methods: A cross-sectional survey was conducted among a subsample of 1689 women, aged 20 to 49 y in the Great Tunis region. Data on socio-demographic and lifestyle factors were collected by a questionnaire. Overall adiposity was assessed by BMI. All biological variables were assayed in blood samples coated with EDTA by enzymatic methods. Stata software (2015) was used for data management and statistical analysis. Results: High HDL-C values were recorded in 26.6% of selected women. After adjustment for all socio-demographic and lifestyle factors, age, hypertension and smoking were negatively associated with high HDL-C levels while family history of cancer was positively associated with high HDL-C in women. Conclusions: Additional investigation on the relationship between high HDL-C and cancer risk should be performed due to controversial results.
The Effectiveness of a Men-only Supportive Expressive Therapy Group Intervention for Psychosocial Health Outcomes in Gastrointestinal Cancer Patients: A 6-month longitudinal study
Authors: Oberoi Devesh , Martopullo Celestina , Bultz Barry D. , Carlson Linda Ellen 
Published: January 2021

Abstract
Background: An increasing number of gastrointestinal cancer (GI) patients suffer from the side effects of cancer treatment that can affect their psychosocial health outcomes such as mood states and quality of life. Despite its demonstrated usefulness in female cancer patients, the Supportive Expressive Group Therapy (SEGT) has not been tested in male cancer patients. The current study sought to examine the longitudinal effects of a professionally-led, men-only supportive-expressive group therapy (SEGT) on mood states, coping, and quality of life (QoL) in male GI cancer patients. Methods: Male GI cancer patients (n=31), at different stages of cancer treatment, were recruited from an ongoing men-only biweekly GI cancer SEGT. Data were collected at baseline (before or near the beginning of group attendance) and at three months and six months follow-up. All outcomes were patient-reported and included demographic data as well as the validated questionnaires: Profile of Mood States (POMS) for mood states, Functional Assessment of Cancer Therapy-General (FACT-G) for QoL, and Ways of Coping-cancer version (WOC) for coping. Linear mixed models were used to examine the change in the outcomes over time. Effect sizes were estimated using Cohen’s d. Results: The Anxiety (p=.04; d=0.70), Depression (p=.03; d=0.93) and Anger (p=.04; d=1.28) subscales of the POMS decreased between baseline and six months. Participants also reported improvements in coping through Distancing (distancing oneself from negative thoughts, being more accepting of the situation, and looking for positives) of the WOC (p=.04; d=0.4) between baseline and six months. There was no change in any of the FACT subscales (QoL) over time. Conclusions: This is the first study to investigate the effects of a SEGT intervention in male cancer patients. Participation in the intervention was associated with improved mood states and coping in male GI cancer patients; however, there was no change in measures of QoL.
Why secondary school geography students perform poorly in external examinations
Authors: Eze Emmanuel 
Published: January 2021

Abstract
The perpetual decline of students’ performance in external geography examinations necessitated this enquiry to identify causes of failure reported by examiners. This study, therefore, adopted a qualitative approach to analyze West African Examination Council (WAEC) chief examiners’ reports from 2008 to 2018 to extract vital information on why Nigerian students perform poorly in geography, using the grounded theory methodology and RQDA for data analyses. Poor map work, inadequate preparation and scanty explanation of points were identified. Ideal geography teachers ought to be multiplied in schools, with the utilization of relevant instructional resources and student-centered teaching strategies for improvements.
Initial CT blend sign is not associated with poor outcome in patients following stereotactic minimally invasive surgery
Authors: Yang Xu , Zhu Yan , Zhang Linshan , Wang Likun , Mao Yuanhong , Li Yinghui , Luo Jingbiao , Wu Guofeng 
Published: January 2021

Abstract
Background: The initial computed tomography (CT) blend sign has been used as an imaging marker to predict haematoma expansion and poor outcomes in patients with a small volume intracerebral haemorrhage (ICH). However, the relationship between the blend sign and outcomes remains elusive. The present study aimed to retrospectively measure the impact of initial CT blend signs on short-term outcomes in patients with hypertensive ICH who underwent stereotactic minimally invasive surgery (sMIS). Methods: We enrolled 242 patients with spontaneous ICH. Based on the initial CT features, the patients were assigned to a blend sign group (91 patients) or a nonblend sign (control) group (151 patients). The NIHSS, GCS and mRS were used to measure the effects of sMIS. The rates of severe pulmonary infection and cardiac complications were also compared between the two groups. Results: No significant differences in NIHSS and GCS scores were observed between the two groups. The proportion of patients with good outcomes during follow-up was not different between the two groups. The rate of rehaemorrhaging increased in the blend sign group. No significant differences in severe pulmonary infections and cardiac complications were noted between the two groups. Conclusions: The initial CT blend sign was not associated with poor outcomes in patients with hypertensive ICH who underwent sMIS. ICH patients with CT blend signs should undergo sMIS if they are suitable candidates for surgery.
Self-esteem, Social Support and Coping Strategies of left-behind Children in Rural China, and the Intermediary Role of Subjective Support：a cross-sectional survey
Authors: Cui Shu , Cheng Fangshuo , Zhang Ling , Zhang Chao , Yuan Qiuyu , Huang Cui , Zhang Kai , Zhou Xiaoqin 
Published: January 2021

Abstract
Background: Negative coping strategies and behavioral problems are common among Chinese left-behind children, which are related to a variety of negative consequences. At this stage of development, the relevant factors of coping strategies need to be further studied, in which social support and self-esteem are worthy of our attention. The aim of this study is to detected the current situation of self-esteem, social support, and coping styles of left-behind children (LBC) in rural China and the relationship between the three.Methods: 322 children from 3 schools in China participated in this study, including 236 LBC and 86 non-left-behind children (NLBC) to assess self-esteem, social support and coping strategies.Results: The LBC group had lower self-esteem score and lower total social support (subjective support, objective support and support-seeking behavior) than the NLBC group. In terms of coping strategies, the LBC group was lower than the NLBC group in problem-solving and rationalization. The self-esteem score in LBC was significant positive associated with the subjective support score, objective support score, problem-solving and help-seeking score. In addition, self-esteem has significant mediating effect between subjective support and problem-solving, subjective support and help-seeking, respectively.Conclusions: The finding indicate that Chinese LBC’s self-esteem and social support need to be improved. Given the significant correlativity between self-esteem, subjective support and coping strategy, it is necessary to promote Chinese LBC’s self-esteem and social support, especially subjective support.
The climate change mitigation effects of daily active travel in cities
Authors: Brand Christian , Dons Evi , Anaya-Boig Esther , Avila-Palencia Ione , Clark Anna , Nazelle Audrey de , Gascon Mireia , Gaupp-Berghausen Mailin , Gerike Regine , Gotschi Thomas , Iacorossi Francesco , Kahlmeier Sonja , Laeremans Michelle , Nieuwenhuijsen Mark , Mendoza Juan Orjuela , Racioppi Francesca , Raser Elisabeth , Rueda David Rojas , Standaert Arnout , Stigell Erik , Sulikova Simona , Wegener Sandra , Panis Luc Int 
Published: January 2021

Abstract
Active travel (walking or cycling for transport) is considered the most sustainable form of personal transport. Yet its net effects on mobility-related CO2 emissions are complex and under-researched. Here we collected travel activity data in seven European cities and derived life cycle CO2 emissions across modes and purposes. Daily mobility-related life cycle CO2 emissions were 3.2 kgCO2 per person, with car travel contributing 70% and cycling 1%. Cyclists had 84% lower life cycle CO2 emissions than non-cyclists. Life cycle CO2 emissions decreased by -14% per additional cycling trip and decreased by -62% for each avoided car trip. An average person who ‘shifted travel modes’ from car to bike decreased life cycle CO2 emissions by 3.2 kgCO2/day. Promoting active travel should be a cornerstone of strategies to meet net zero carbon targets, particularly in urban areas, while also improving public health and quality of urban life.
Favored location of a stabilizing screw for syndesmotic diastasis: Recommendation based on clinical and theoretical considerations
Authors: Wu Chi-Chuan , Yeh Wen-Ling , Lee Po-Cheng , Chou Ying-Chao , Hsu Yung-Heng , Yu Yi-Hsun 
Published: January 2021

Abstract
BackgroundAnkle injuries are common; however, simultaneous malleolar fractures and syndesmotic diastasis (SD) are relatively fewer. There is no consensus about the optimal technique for syndesmotic stabilization. We hypothesized that the optimal location of stabilization should be at the syndesmosis based on theoretical consideration. The aim of this study was to compare the various locations of a stabilizing screw and determinate the preferable location from clinical and theoretical viewpoints. Patients and MethodsOver a 10-year period, we retrospectively studied 63 consecutive adult patients with combined injuries. The malleolar fractures were internally stabilized with screws and plates, and stress tests were performed to re-confirm syndesmotic instability. The diastatic syndesmosis was stabilized with cortical screws under image intensifier guidance. In the present study, we enrolled patients with only one syndesmotic screw (55 patients) and divided them into the trans-syndesmotic (TR) or the supra-syndesmotic (SU) group. Clinical and functional outcomes between the two groups were compared. The favored location was determined based on the data analysis.ResultsWe followed 48 patients for at least one year (average, 1.8 years; range, 1.0-7.0 years). The TR group included 31 patients and the SU group included 17 patients. None of the clinical and functional comparisons were statistically significant (p > 0.05).ConclusionAlthough statistical comparison showed no significant differences, TR screw insertion has biomechanical and biological merits. The study’s failure to show clear advantages of TR screw insertion for clinical and functional outcomes can be attributed to the small sample size and early screw removal. Clinically, TR insertion of a screw with late removal (> 3 months) might be a better choice.Level of evidence: Therapy/Prevention, III, retrospective cohort study.
Hidden Bedside Rationing in the Netherlands: a Cross-Sectional Survey among Physicians in Internal Medicine
Authors: de Ruijter Ursula , Lingsma Hester , Bax Willem , Legemaate Johan 
Published: January 2021

Abstract
Background Healthcare rationing can be defined as withholding beneficial care for cost reasons. One form in particular, hidden bedside rationing, is problematic because it may result in conflicting loyalties for physicians, unfair inequality among patients and illegitimate distribution of resources. Our aim is to establish whether bedside rationing occurs in the Netherlands, whether it qualifies as hidden and what physician characteristics are associated with its practice.Methods Cross-sectional online questionnaire on knowledge of -, experience with -, and opinion on rationing among physicians in internal medicine within the Dutch healthcare system. Multivariable ordinal logistic regression was used to explore relations between hidden bedside rationing and physician characteristics.Results The survey was distributed among 1139 physicians across 11 hospitals with a response rate of 18% (n=203). Most participants (n=129; 64%) had experience prescribing a cheaper course of treatment while a more effective but more expensive alternative was available, suggesting bedside rationing. Subsequently, 32 (24%) participants never disclosed this decision to their patient, qualifying it as hidden. The majority of participants (n=153; 75%) rarely discussed treatment cost. Employment at an academic hospital was independently associated with more bedside rationing (OR=17 95%CI 6.1-48). Furthermore, residents were more likely to disclose rationing to their patients than internists (OR=3.2, 95%CI 2.1-4.7), while salaried physicians were less likely to do so than physicians in private practice (OR=0.5, 95%CI 0.4-0.8).Conclusion Hidden bedside rationing occurs in the Netherlands: patient choice is on occasion limited with costs as rationale and this is not always disclosed. To what extent distribution of healthcare should include bedside rationing in the Netherlands, or any other country, remains up for debate.
Visualization of clinical teaching citations using social network analysis
Authors: Hazrati Hakimeh , Bigdeli Shoaleh , Arabshahi Seyed Kamran Soltani , Gavgani Vahideh Zarea , Vahed Nafiseh 
Published: January 2021

Abstract
BackgroundAnalyzing the previous research literature in the filed of clinical teaching has potential to show the trend and future direction of this field. This study aimed to visualize the co-authorship networks and scientific map of research outputs of clinical teaching and medical education by Social Network Analysis (SNA).Methods We Identified 1229 publications on clinical teaching through a systematic search strategy in the Scopus (Elsevier), Web of Science (Clarivate Analytics) and Medline (NCBI/NLM) through PubMed from the year 1980 to 2018.The Ravar PreMap, Netdraw, UCINet and VOSviewer software were used for data visualization and analysis. ResultsBased on the findings of study the network of clinical teaching was weak in term of cohesion and the density in the co-authorship networks of authors (clustering coefficient (CC): 0.749, density: 0.0238) and collaboration of countries (CC: 0.655, density: 0.176). In regard to centrality measures; the most influential authors in the co-authorship network was Rosenbaum ME, from the USA (0.048). More, the USA, the UK, Canada, Australia and the Netherlands have central role in collaboration countries network and has the vertex co-authorship with other that participated in publishing articles in clinical teaching. Analysis of background and affiliation of authors showed that co-authorship between clinical researchers in medicine filed is weak. Nineteen subject clusters were identified in the clinical teaching research network, seven of which were related to the expected competencies of clinical teaching and three related to clinical teaching skills.Conclusions In order to improve the cohesion of the authorship network of clinical teaching, it is essential to improve research collaboration and co-authorship between new researchers and those who have better closeness or geodisk path with others, especially those with the clinical background. To reach to a dense and powerful topology in the knowledge network of this field encouraging policies to be made for international and national collaboration between clinicians and clinical teaching specialists. In addition, humanitarian and clinical reasoning need to be considered in clinical teaching as of new direction in the field from thematic aspects.