bluuebunny/crossref_metadata_2025_split huggingface dataset:
Decellularized Human Umbilical Cord Wharton Jelly Scaffold Improves Tendon Regeneration in a Rabbit Rotator Cuff Tendon Defect Model
Authors: Yuan Zhiguo , Cao Fuyang , Gao Cangjian , Yang Zhen , Guo Quanyi , Wang You 
Published: November 2021

Background: Owing to limited self-healing capacity, failure of rotator cuff tendon healing is a common complication after surgery. Biological scaffolds have garnered attention owing to their potential to enhance healing outcomes. Purpose: To verify the effect of the decellularized umbilical cord Wharton jelly (DUCWJ) scaffold as a bridging scaffold in a rabbit model of acute rotator cuff tendon defect. Study Design: Controlled laboratory study. Methods: We fabricated a DUCWJ scaffold using a physicochemical decellularized method, evaluating changes in the umbilical cord Wharton jelly before and after decellularization. Scanning electron microscopy and biomechanical testing were performed to determine the microstructure and mechanical properties. We assessed cytocompatibility and cell regulatory behavior of the scaffold toward tendon stem/progenitor cells (TSPCs). A supraspinatus tendon defect was created in 54 New Zealand White rabbits, allocated to the DUCWJ scaffold repair group and the negative control group (without scaffold). Histology, reverse transcription polymerase chain reaction, and biomechanical tensile strength were assessed at 4, 8, and 12 weeks postoperatively. Results: Decellularization completely removed cells from the umbilical cord Wharton jelly, retained a considerable amount of glycosaminoglycan and collagen, and preserved the microstructure and tensile strength. The DUCWJ scaffold facilitated migration and proliferation of TSPCs in vitro. Tendon-related gene expression revealed that the DUCWJ scaffold could maintain the tenocyte phenotype of TSPCs. In the in vivo study, the DUCWJ scaffold improved tendon healing and enhanced the biomechanical strength of repaired tendons. Histological evaluation scores of the DUCWJ group were significantly higher than those of the negative control at 4, 8, and 12 weeks after surgery ( P < .05). In repaired tendon tissues, reverse transcription polymerase chain reaction findings revealed that the DUCWJ scaffold stimulated tendon development and maturation. Furthermore, an overall increase in ultimate load and tensile modulus was noted over time; the DUCWJ group presented better results than the negative control group ( P < .05). Conclusion: The DUCWJ scaffold has an excellent 3-dimensional porous structure, good biocompatibility, and fundamental biomechanical characteristics, and it promotes migration, attachment, and proliferation of TSPCs. The in vivo animal study demonstrated that the DUCWJ scaffold has potential for tendon regeneration in an acute rotator cuff tendon defect model Clinical Relevance: DUCWJ scaffolds have potential as a regenerative material to augment rotator cuff healing in the clinical setting.
The influence of work-family conflict on social worker job satisfaction
Authors: Jia Cindy Xinshan , Fu Chengzhe 
Published: November 2021

Summary The current study employed the Stress-Strain-Outcome model to understand the structural process of work support, work-family conflict (WFC), burnout, and job satisfaction among Chinese social workers. Using structural equation modeling, we employed a survey dataset of 1,414 social workers to estimate how burnout mediated the influences of work support and WFC on job satisfaction. Findings The results revealed that WFC directly promotes all three dimensions of burnout (i.e., depersonalization, emotional exhaustion, and reduced personal accomplishment), and indirectly impairs job satisfaction through the partial mediation of emotional exhaustion and reduced personal accomplishment, net of role stresses or other demographic characteristics. Work support eased burnout and promoted job satisfaction. Applications We highlight that WFC is a noteworthy job stressor impairing social workers’ vocational health. Possible initiatives to promote social support and prevent such stressors are recommended.
Novel Use of an Internal Distractor for Metacarpal Lengthening
Authors: Bashour Laura E. , Hill Charles , Frommer Sarah A. , Henry Steven L. 
Published: November 2021

Background In patients who have had proximal digit amputation, metacarpal distraction osteogenesis is an option to improve digital length and function. One drawback is that traditional external distraction devices are large and cumbersome; the option of a low-profile internal device is therefore appealing. Internal distractors are commonly used in craniofacial reconstruction, but use in the hand has not been reported. We describe a case series of the novel use of an internal distractor in metacarpal lengthening. Methods In this single-center case series, patients who underwent metacarpal distraction by the senior author using a uniplanar internal distractor were reviewed, and indications, outcomes, and complications were analyzed. Results There were 5 cases in 4 patients (age range: 7-33 years). Indications were traumatic amputation in 4 cases and congenital hypoplasia in 1. All were successfully distracted, with a mean final length gain of 1.3 cm (range: 1.0-1.7 mm). Mean time from device placement to consolidation was 3.5 months. Complications included activation arm site infection in 2 cases, both occurring after the distraction period, necessitating device removal before full consolidation. In these cases, the device was removed after the distraction period and replaced with a Kirschner wire for stabilization through the consolidation period. Conclusions Metacarpal distraction was successfully achieved with an internal distraction device. Although infection was common, it occurred after the distraction period and did not preclude length gain. We feel that this low-profile device offers advantages over cumbersome external devices typically used for metacarpal lengthening.
How Can We Make Hand Surgery Carbon Neutral?
Authors: Borg Tiffanie-Marie 
Published: November 2021

Background Climate change is a major public health threat worldwide. Operating theaters are responsible for extensive waste production due to the resource-intensive nature of surgery, including hand surgery. Methods An online literature search was performed to ascertain the approaches that surgeons may undertake to positively impact the environment. Results Surgeons can make hand surgery more carbon neutral through various measures that have been categorized as pre-, intra-, and postoperative interventions. With all changes, the aims are to minimize waste and costs while optimizing patient outcomes. Conclusions Administrative obstacles to implementing pro-climate hospital changes may be overcome by also considering likely cost benefits with many environmentally friendly measures. New measures in hand surgery should consider patient safety, clinical efficacy, cost effectiveness, and the environmental impact.
Nutrition for Hospital Workers During a Crisis: Effect of a Plant-Based Dietary Intervention on Cardiometabolic Outcomes and Quality of Life in Healthcare Employees During the COVID-19 Pandemic
Authors: Kahleova Hana , Berrien-Lopez Rickisha , Holtz Danielle , Green Amber , Sheinberg Rosanne , Gujral Harpreet , Holubkov Richard , Barnard Neal D. 
Published: November 2021

The study tested the effects of a vegan diet on cardiometabolic outcomes and quality of life among healthcare employees during the COVID-19 pandemic. Overweight hospital employees were enrolled and randomly assigned (in a 1:1 ratio) to an intervention group, which was asked to follow a low-fat vegan diet, or a control group, asked to make no diet changes. However, due to COVID-19 disruptions, all participants remained on their usual diets from March to June (12 weeks), creating a de facto control period, and all (n = 12) started the vegan diet with online classes in June, which continued for 12 weeks. Nine participants completed all final assessments. A crossover ANOVA was used for statistical analysis of differences in cardiovascular health during the control period and during the intervention. Despite the ongoing crisis, body weight decreased (treatment effect −5.7 kg [95% CI −9.7 to −1.7]; P = .01); fasting plasma glucose decreased (−11.4 mg/dL [95% CI −18.8 to −4.1]; P = .007); total and LDL-cholesterol decreased (−30.7 mg/dL [95% CI −53.8 to −7.5]; P = .02; and −24.6 mg/dL [−44.8 to −4.3]; P = .02, respectively); diastolic blood pressure decreased (−8.5 mm Hg [95% CI −16.3 to −.7]; P = .03); and quality of life increased ( P = .005) during the intervention period, compared with the control period. A vegan diet improved cardiometabolic outcomes and quality of life in healthcare workers at the height of the COVID-19 pandemic.
Comprehensive analysis of prognostic value of lymph node classifications in esophageal squamous cell carcinoma: a large real-world multicenter study
Authors: Wen Junmiao , Chen Jiayan , Chen Donglai , Jabbour Salma K. , Xue Tao , Guo Xufeng , Ma Haitao , Ye Fei , Mao Yiming , Shu Jian , Liu Yangyang , Lu Xueguan , Zhang Zhen , Chen Yongbing , Fan Min 
Published: November 2021

Background: We aim to assess the prognostic ability of three common lymph node–based staging algorithms, namely, the number of positive lymph nodes (pN), the lymph node ratio (LNR), and log odds of positive lymph nodes (LODDS) in patients with esophageal squamous cell carcinoma (ESCC). Methods: A total of 3902 ESCC patients treated at 10 Chinese institutions between 2003 and 2013 were included, along with 2465 patients from the Surveillance, Epidemiology, and End Results (SEER) database. The prognostic ability of the aforementioned algorithms was evaluated using time-dependent receiver operating characteristic (tdROC) curves, R2, Harrell’s concordance index (C-index), and the likelihood ratio chi-square score. The primary outcomes included cancer-specific survival (CSS), overall survival (OS), and CSS with a competing risk of death by non-ESCC causes. Results: LODDS had better prognostic performance than pN or LNR in both continuous and stratified patterns. In the multicenter cohort, the multivariate analysis showed that the model based on LODDS classification was superior to the others in predictive accuracy and discriminatory capacity. Two nomograms integrating LODDS classification and other clinicopathological risk factors associated with OS as well as cancer-specific mortality were constructed and validated in the SEER database. Finally, a novel TNLODDS classification which incorporates the LODDS classification was built and categorized patients in to three new stages. Conclusion: Among the three lymph node–based staging algorithms, LODDS demonstrated the highest discriminative capacity and prognostic accuracy for ESCC patients. The nomograms and novel TNLODDS classification based on LODDS classification could serve as precise evaluation tools to assist clinicians in estimating the survival time of individual patients and improving clinical outcomes postoperatively in the future.
Seeking healthcare services post-stroke: a qualitative descriptive study exploring family caregiver and stroke survivor perspectives in an asian setting
Authors: Tyagi Shilpa , Luo Nan , Tan Chuen Seng , Tan Kelvin Bryan , Tan Boon Yeow , Menon Edward , Venketasubramanian N. , Loh Wei Chin , Fan Shu Hui , Yang Kenneth Lam Thuan , Chan Audrey Swee Ling , Farwin Aysha , Lukman Zunairah Binti , Koh Gerald Choon-Huat 
Published: November 2021

AbstractAimExploration of the healthcare journey post-stroke is incomplete without acknowledging the crucial role of family caregivers. With limited literature documenting the role of caregivers in the healthcare journey post-stroke, we aimed to describe the healthcare experiences of family caregivers and stroke survivors across different caregiver identities in Singapore.MethodsWe conducted a qualitative descriptive study involving semi-structured interviews with transcripts analysed using thematic analysis. 26 stroke survivors and 35 family caregivers purposively sampled from multiple settings.ResultsFindings were summarized into seeking care and experience of healthcare encounters. Seeking care comprised of the following themes: factors influencing seeking care, decision to seek care and role of caregiver in seeking care. Experience of healthcare encounters comprised of the following themes: service around the patient, service with care and role of caregiver in healthcare encounters.ConclusionMulti-dimensional role of caregivers in healthcare experience emerged as a major finding. Unique to our Asian context, as per the participants’ accounts, family caregivers seemed to be central in healthcare decision-making for stroke survivors, with adult-child caregivers commonly reported being engaged in collaborative decision-making. While spousal caregivers preferred a relational healthcare experience, adult-child caregivers preferred a transactional one. Practical implications include equipping caregivers with skillset to make healthcare decisions, provision of supportive decision-making environment for caregivers and reinforcing communication aspects in the medical, nursing and allied healthcare curriculum to improve healthcare experience.
Pattern of internet use for pregnancy-related information and its predictors among women visiting primary healthcare in Qatar: a cross-sectional study
Authors: Al-Dahshan Ayman , Chehab Mohamad , Mohamed Ayatullah , Al-Kubaisi Noora , Selim Nagah 
Published: November 2021

Abstract
Background
Internet usage has been steadily increasing and the available online information for pregnant women today is immense.

Objective
This study aimed to investigate the prevalence of women who search for information relating to pregnancy on the internet and to identify predictors of this behavior among expecting women visiting primary health care (PHC) centers in Qatar.

Methods
A cross-sectional study was conducted at the antenatal clinics of six PHC centers in Qatar from June 1 to December 31, 2019. Pregnant women were recruited through a systematic random sampling technique. Participants were interviewed using a structured questionnaire. Descriptive and analytic statistics were used when appropriate. A multivariable logistic regression analysis was constructed to identify the predictors of internet use for pregnancy-related information.

Results
The study included 403 pregnant women (response rate: 87.9%). Most of them were in the 26–35 years age category (71.5%), in the second trimester (55.5%), and had 1–2 children at home (51.5%). The internet was the most common source (81.1%) of pregnancy-related information. The access to online information was mainly through websites (67.3%), mobile applications (48.3%), and social media platforms (39.7%). The most frequently searched topics online were fetal development (74.3%), diet during pregnancy (53.6%), and management of health problems (39.6%). The multivariable regression model identified the age group 26–35 years (AOR: 4.93; 95% CI: 2.14, 11.38), Arabs (AOR: 4.12; 95% CI: 2.03, 8.36), tertiary education (AOR: 5.22; 95% CI: 1.78, 15.33), being a housewife (AOR: 6.37; 95% CI: 1.44, 28.19), or employed (AOR: 5.56 95% CI: 1.31, 23.63), and having up to 2 children as independent predictors of internet use for pregnancy-related information.

Conclusion
The internet was a commonly used source of health information among pregnant women in Qatar. Internet use was significantly associated with the age group of 26–35 years, Arabs, higher level of education, being employed or a housewife, and having up to two children.
Optimum design of reference points distribution in three-dimensional reconstruction of dental model in intercuspal position
Authors: Wu Yujia , Hu Zhewen , Zhang Xinyue , Bai Hefei , Sun Yuchun , Fan Baolin 
Published: November 2021

Abstract
Purpose
The scanning of plaster models for three-dimensional (3D) construction requires their rigid fixation in the intercuspal position. Factors such as installation, motion, and scanning procedures influenced the accuracy of this method, which ultimately influence the results. Therefore, the present study attempted to provide an optimal and accurate method with less complex procedures and a more accessible equipment for determining the intercuspal relation in the 3D occlusal construction of dental models.

Methods
A pair of plastic mounting plates that could be directly attached to a mechanical articulator was designed and 3D printed. Nine axial hemispherical concaves were introduced on the axial surface of each plate. The rigidly fixed maxillary and mandibular dental models were scanned directly. The distances DR between nine pairs of concaves on both mounting plates adhered to the maxillary and mandibular sections of the articulator were measured using the three-coordinate measuring machine Faro Edge as the reference. The present study comprised seven test groups varying in number and location. Assessing the reference points from each of the seven groups performed the 3D construction. The Geomagic Studio software was used to construct the concaves of digital casts, and the distances DM between the pairs of concaves were measured as test values. Variable differences between DR and DM were analyzed.

Results
An optimum distribution scheme was obtained for reference point registration by quantitatively evaluating accuracy levels of the 3D constructions of different reference point distribution patterns. This scheme can serve as a reference for related studies and dental clinic operations.

Conclusions
Three-dimensional construction of the intercuspal relation during scanning of the maxillary and mandibular models with an accuracy of 0.046 mm ± 0.009 mm can be achieved using the improved design of mounting plates.
A survey of cancer care institutions in Nepal to inform design of a pain management mobile application
Authors: LeBaron Virginia , Adhikari Abish , Bennett Rachel , Chapagain Acharya Sandhya , Dhakal Manita , Elmore Catherine E. , Fitzgibbon Kara , Gongal Rajesh , Kattel Regina , Koirala Ganesh , Maurer Martha , Munday Daniel , Neupane Bijay , Sagar Sharma Krishna , Shilpakar Ramila , Shrestha Sudip , Thapa Usha , Zhang Hexuan , Dillingham Rebecca , Dutta Paudel Bishnu 
Published: November 2021

AbstractBackgroundOne way to improve the delivery of oncology palliative care in low and middle-income countries (LMICs) is to leverage mobile technology to support healthcare providers in implementing pain management guidelines (PMG). However, PMG are often developed in higher-resourced settings and may not be appropriate for the resource and cultural context of LMICs.ObjectivesThis research represents a collaboration between the University of Virginia and the Nepalese Association of Palliative Care (NAPCare) to design a mobile health application (‘app’) to scale-up implementation of existing locally developed PMG.MethodsWe conducted a cross-sectional survey of clinicians within Nepal to inform design of the app. Questions focused on knowledge, beliefs, and confidence in managing cancer pain; barriers to cancer pain management; awareness and use of the NAPCare PMG; barriers to smart phone use and desired features of a mobile app.FindingsSurveys were completed by 97 palliative care and/or oncology healthcare providers from four diverse cancer care institutions in Nepal. 49.5% (n = 48) had training in palliative care/cancer pain management and the majority (63.9%,n = 62) reported high confidence levels (scores of 8 or higher/10) in managing cancer pain. Highest ranked barriers to cancer pain management included those at the country/cultural level, such as nursing and medical school curricula lacking adequate content about palliative care and pain management, and patients who live in rural areas experiencing difficulty accessing healthcare services (overall mean = 6.36/10). Most nurses and physicians use an Android Smart Phone (82%,n = 74), had heard of the NAPCare PMG (96%,n = 88), and reported frequent use of apps to provide clinical care (mean = 6.38/10,n = 92). Key barriers to smart phone use differed by discipline, with nurses reporting greater concerns related to cost of data access (70%,n = 45) and being prohibited from using a mobile phone at work (61%;n = 39).ConclusionsSmart phone apps can help implement PMG and support healthcare providers in managing cancer pain in Nepal and similar settings. However, such tools must be designed to be culturally and contextually congruent and address perceived barriers to pain management and app use.
Cumulative risk exposure and emotional symptoms among early adolescent girls
Authors: Demkowicz Ola , Panayiotou Margarita , Humphrey Neil 
Published: November 2021

Abstract
Background
From early adolescence, girls and women report the highest rates of emotional symptoms, and there is evidence of increased prevalence in recent years. We investigate risk factors and cumulative risk exposure (CRE) in relation to emotional symptoms among early adolescent girls.

Methods
We used secondary data analysis, drawing on data capturing demographic information and self-reported emotional symptoms from 8327 girls aged 11–12 years from the 2017 baseline data collection phase of the HeadStart evaluation. We used structural equation modelling to identify risk factors in relation to self-reported emotional symptoms, and collated this into a CRE index to investigate associations between CRE and emotional symptoms.

Results
Four risk factors were found to have a statistically significant relationship with emotional symptoms among early adolescent girls: low academic attainment, special educational needs, low family income, and caregiving responsibilities. CRE was positively associated with emotional symptoms, with a small effect size.

Conclusions
Results identify risk factors (outlined above) that are associated with emotional symptoms among early adolescent girls, and highlight that early adolescent girls experiencing a greater number of risk factors in their lives are likely to also experience greater emotional distress. Findings highlight the need for identification and targeted mental health intervention (e.g., individual or group counselling, approaches targeting specific symptoms), for those facing greater risk and/or with emergent symptoms.