bluuebunny/crossref_metadata_2025_split huggingface dataset:
Socioeconomic, geographic and health system factors associated with rising C-section rate in Indonesia: a cross-sectional study using the Indonesian demographic and health surveys from 1998 to 2017
Authors: Wyatt Sage , Silitonga Permata Imani Ima , Febriani Esty , Long Qian 
Published: May 2021

IntroductionCaesarean section (C-section) has been a public health concern globally. This study investigated the change in C-section rate in 1998–2017 in Indonesia and explored the socioeconomic, geographic and health system factors associated with the use of C-section.MethodsWe analysed data from demographic health surveys in 2002–2003, 2007, 2012 and 2017 in Indonesia. We included women who reported giving birth within 5 years of each round of the survey (n=56 462) into the analysis. Cross-tabulation was used to examine change of C-section rate by year. We conducted bivariate and multivariate logistic regressions to study the determinants of C-section use.ResultsIn Indonesia, the C-section rate increased from 4.0% in 1998 to 18.5% in 2017. In 2017, the C-section rate in urban areas (22.9%) was almost two times that in rural areas (11.8%). It was almost three times among the richest wealth quintile (36.5%), compared with the poorest wealth quintile (12.9%). Between 2008 and 2017, the difference in the C-section rate by public services enlarged between the poorest and the richest groups. The absolute increase of the C-sections by private services was more than public services over time. In 2013–2017, the C-section rates by public and private services were 22.5% and 23.1%, respectively. After adjusting for all variables, higher education, higher household wealth, primiparity and use of public childbirth services were positively associated with C-section.ConclusionsThe C-section rate increased steadily in the past two decades in Indonesia. Women’s socioeconomic status and health system factors were associated with the increased use of C-section.
Proposal of MUAC as a fast tool to monitor pregnancy nutritional status: results from a cohort study in Brazil
Authors: Miele Maria J , Souza Renato T , Calderon IMP , Feitosa Francisco , Leite Debora F , Rocha Filho Edilberto , Vettorazzi Janete , Mayrink Jussara , Fernandes Karayna G , Vieira Matias C , Pacagnella Rodolfo C , Cecatti Jose Guilherme 
Published: May 2021

ObjectiveIn Brazil, although the assessment of maternal nutritional status is recommended using body mass index (BMI), this is only possible in settings adequately prepared. Midupper arm circumference (MUAC) is another biological variable identified as a tool for rapid assessment of nutritional status that is correlated with BMI. Therefore, we aim to surrogate BMI by MUAC cut-offs for rapid screening of maternal nutritional status starting at midpregnancy.DesignAnalysis of the multicentre cohort study entitled ‘Preterm SAMBA’ using an approach of validation of diagnostic test.SettingOutpatient prenatal care clinics from five tertiary maternity hospitals from three different Brazilian regions.Participants1165 pregnant women attending prenatal care services from 2015 to 2018 and with diverse ethnic characteristics who were enrolled at midpregnancy and followed in three visits at different gestational weeks.Primary and secondary outcome measuresSensitivity, specificity, positive and negative predictive values, likelihood ratio and accuracy of MUAC being used instead of BMI for the assessment of nutritional status of women during pregnancy.ResultsWe found a strong correlation between MUAC and BMI, in the three set points analysed (r=0.872, 0.870 and 0.831, respectively). Based on BMI categories of nutritional status, we estimated the best MUAC cut-off points, finding measures according to each category: underweight <25.75 cm (19–39 weeks); overweight 28.11–30.15 cm (19–21 weeks), 28.71–30.60 cm (27–29 weeks) and 29.46–30.25 cm (37–39 weeks); and obese >30.15 cm (19–21 weeks), >30.60 cm (27–29 weeks) and >30.25 cm (37–39 weeks) per gestational week. Therefore, we defined as adequate between 25.75–28.10 cm (19–21 weeks), 25.75–28.70 cm (27–29 weeks) and 25.75–29.45 cm (37–39 weeks) of MUAC.ConclusionWe conclude that MUAC can be useful as a surrogate for BMI as a faster screening of nutritional status in pregnant women.
Renal replacement treatment initiation with twice-weekly versus
thrice-weekly haemodialysis in patients with incident dialysis-dependent
kidney disease: rationale and design of the TWOPLUS pilot clinical
trial
Authors: Murea Mariana , Moossavi Shahriar , Fletcher Alison J , Jones Deanna N , Sheikh Hiba I , Russell Gregory , Kalantar-Zadeh Kamyar 
Published: May 2021

Introduction
The optimal haemodialysis (HD) prescription—frequency and dose—for
patients with incident dialysis-dependent kidney disease (DDKD) and
substantial residual kidney function (RKF)—that is, renal urea clearance
≥2 mL/min/1.73 m2 and urine volume ≥500 mL/day—is
not known. The aim of the present study is to test the feasibility and
safety of a simple, reliable prescription of incremental HD in patients
with incident DDKD and RKF.

Methods and analysis
This parallel-group, open-label randomised pilot trial will enrol 50
patients from 14 outpatient dialysis units. Participants will be
randomised (1:1) to receive twice-weekly HD with adjuvant
pharmacological therapy for 6 weeks followed by thrice-weekly HD
(incremental HD group) or outright thrice-weekly HD (standard HD group).
Age ≥18 years, chronic kidney disease progressing to DDKD and urine
output ≥500 mL/day are key inclusion criteria; patients with left
ventricular ejection fraction <30% and acute kidney injury requiring
dialysis will be excluded. Adjuvant pharmacological therapy (ie,
effective diuretic regimen, patiromer and sodium bicarbonate) will
complement twice-weekly HD. The primary feasibility end points are
recruitment rate, adherence to the assigned HD regimen, adherence to
serial timed urine collections and treatment contamination. Incidence
rate of clinically significant volume overload and metabolic imbalances
in the first 3 months after randomisation will be used to assess
intervention safety.

Ethics and dissemination
The study has been reviewed and approved by the Institutional Review
Board of Wake Forest School of Medicine in North Carolina, USA. Patient
recruitment began on 14 June 2019, was paused between 13 March 2020 and
31 May 2020 due to COVID-19 pandemic, resumed on 01 June 2020 and will
last until the required sample size has been attained. Participants will
be followed in usual care fashion for a minimum of 6 months from last
individual enrolled. All regulations and measures of ethics and
confidentiality are handled in accordance with the Declaration of
Helsinki.

Trial registration number
NCT03740048; Pre-results.
RNA helicase DDX5 enables STAT1 mRNA translation and interferon signalling in hepatitis B virus replicating hepatocytes
Authors: Sun Jiazeng , Wu Guanhui , Pastor Florentin , Rahman Naimur , Wang Wen-Hung , Zhang Zhengtao , MERLE Philippe , Hui Lijian , Salvetti Anna , Durantel David , Yang Danzhou , Andrisani Ourania 
Published: May 2021

ObjectiveRNA helicase DDX5 is downregulated during HBV replication and poor prognosis HBV-related hepatocellular carcinoma (HCC). The objective of this study is to investigate the role of DDX5 in interferon (IFN) signalling. We provide evidence of a novel mechanism involving DDX5 that enables translation of transcription factor STAT1 mediating the IFN response.Design and resultsMolecular, pharmacological and biophysical assays were used together with cellular models of HBV replication, HCC cell lines and liver tumours. We demonstrate that DDX5 regulates STAT1 mRNA translation by resolving a G-quadruplex (rG4) RNA structure, proximal to the 5′ end of STAT1 5′UTR. We employed luciferase reporter assays comparing wild type (WT) versus mutant rG4 sequence, rG4-stabilising compounds, CRISPR/Cas9 editing of the STAT1-rG4 sequence and circular dichroism determination of the rG4 structure. STAT1-rG4 edited cell lines were resistant to the effect of rG4-stabilising compounds in response to IFN-α, while HCC cell lines expressing low DDX5 exhibited reduced IFN response. Ribonucleoprotein and electrophoretic mobility assays demonstrated direct and selective binding of RNA helicase-active DDX5 to the WT STAT1-rG4 sequence. Immunohistochemistry of normal liver and liver tumours demonstrated that absence of DDX5 corresponded to absence of STAT1. Significantly, knockdown of DDX5 in HBV infected HepaRG cells reduced the anti-viral effect of IFN-α.ConclusionRNA helicase DDX5 resolves a G-quadruplex structure in 5′UTR of STAT1 mRNA, enabling STAT1 translation. We propose that DDX5 is a key regulator of the dynamic range of IFN response during innate immunity and adjuvant IFN-α therapy.
A new look on CSI imperfection in downlink NOMA systems
Authors: Le Anh-Tu , Do Dinh-Thuan 
Published: May 2021

Observing that cooperative scheme benefits to non-orthogonal multiple access (NOMA) systems, we focus on system performance analysis of downlink. However, spectrum efficiency is still high priority to be addressed in existing systems and hence this paper presents full-duplex enabling in NOMA systems. Other challenge needs be considered related to channel state information (CSI). In particular, we derive closedform expressions of outage probability for such NOMA systems under the presence of CSI imperfection. Furthermore, to fully exploit practical environment, we provide system model associated with Nakagami-m fading. The Monte-Carlo simulations are conducted to verify the exactness of considered systems.
Deintensification or No Statin Treatment Is Associated With Higher Mortality in Patients With Ischemic Stroke or Transient Ischemic Attack
Authors: Dearborn-Tomazos Jennifer L. , Hu Xin , Bravata Dawn M. , Phadke Manali A. , Baye Fitsum M. , Myers Laura J. , Concato John , Zillich Alan J. , Reeves Mathew J. , Sico Jason J. 
Published: May 2021

Background and Purpose:
Practice guidelines recommend that most patients receive moderate- or high-potency statins after ischemic stroke or transient ischemic attack (TIA) of atherosclerotic origin. We tested the association of different patterns of potency for prescribed statin therapy—assessed before admission and at hospital discharge for ischemic stroke or TIA—on mortality in a large, nationwide sample of US Veterans.

Methods:
The study population included patients with an ischemic stroke or TIA occurring during 2011 at any of the 134 Veterans Health Administration facilities. We used electronic outpatient pharmacy files to identify statin dose at hospital admission and within 7 days after hospital discharge. We categorized statin dosing as low, moderate, or high potency; moderate or high potency was considered at goal. We created 6 mutually exclusive groups to reflect patterns of statin potency from hospital admission to discharge: goal to goal, low to goal, goal to low or goal to none (deintensification), none to none, none to low, and low to low. We used logistic regression to compare 30-day and 1-year mortality across statin potency groups.

Results:
The population included 9380 predominately White (71.1%) men (96.3%) who were hospitalized for stroke or TIA. In this sample, 34.1% of patients (n=3194) were discharged off a statin medication. Deintensification occurred in 14.0% of patients (n=1312) and none to none in 20.5% (n=1924). Deintensification and none to none were associated with a higher odds of mortality as compared with goal to goal (adjusted odds ratio 1-year mortality: deintensification versus goal to goal, 1.26 [95% CI, 1.02–1.57]; none to none versus goal to goal, 1.59 [95% CI, 1.30–1.93]). Adjustments for differences in baseline characteristics using propensity weighted scores demonstrated similar results.

Conclusions:
Underutilization of statins, including no treatment or underdosing after stroke (deintensification), was observed in approximately one-third of veterans with ischemic stroke or TIA and was associated with higher mortality when compared with patients who were at goal for statin prescription dosing.
Hierarchical Learning of Statistical Regularities over Multiple Timescales of Sound Sequence Processing: A Dynamic Causal Modeling Study
Authors: Fitzgerald Kaitlin , Auksztulewicz Ryszard , Provost Alexander , Paton Bryan , Howard Zachary , Todd Juanita 
Published: May 2021

Abstract
Our understanding of the sensory environment is contextualized on the basis of prior experience. Measurement of auditory ERPs provides insight into automatic processes that contextualize the relevance of sound as a function of how sequences change over time. However, task-independent exposure to sound has revealed that strong first impressions exert a lasting impact on how the relevance of sound is contextualized. Dynamic causal modeling was applied to auditory ERPs collected during presentation of alternating pattern sequences. A local regularity (a rare p = .125 vs. common p = .875 sound) alternated to create a longer timescale regularity (sound probabilities alternated regularly creating a predictable block length), and the longer timescale regularity changed halfway through the sequence (the regular block length became shorter or longer). Predictions should be revised for local patterns when blocks alternated and for longer patterning when the block length changed. Dynamic causal modeling revealed an overall higher precision for the error signal to the rare sound in the first block type, consistent with the first impression. The connectivity changes in response to errors within the underlying neural network were also different for the two blocks with significantly more revision of predictions in the arrangement that violated the first impression. Furthermore, the effects of block length change suggested errors within the first block type exerted more influence on the updating of longer timescale predictions. These observations support the hypothesis that automatic sequential learning creates a high-precision context (first impression) that impacts learning rates and updates to those learning rates when predictions arising from that context are violated. The results further evidence automatic pattern learning over multiple timescales simultaneously, even during task-independent passive exposure to sound.
Dissipating and reflecting internal waves
Authors: Shakespeare Callum J. , Arbic Brian K. , Hogg Andrew McC. 
Published: May 2021

AbstractInternal waves generated at the seafloor propagate through the interior of the ocean, driving mixing where they break and dissipate. However, existing theories only describe these waves in two limiting cases. In one limit, the presence of an upper boundary permits bottom-generated waves to reflect from the ocean surface back to the seafloor, and all the energy flux is at discrete wavenumbers corresponding to resonant modes. In the other limit, waves are strongly dissipated such that they do not interact with the upper boundary and the energy flux is continuous over wavenumber. Here, a novel linear theory is developed for internal tides and lee waves that spans the parameter space in between these two limits. The linear theory is compared with a set of numerical simulations of internal tide and lee wave generation at realistic abyssal hill topography. The linear theory is able to replicate the spatially-averaged kinetic energy and dissipation of even highly non-linear wave fields in the numerical simulations via an appropriate choice of the linear dissipation operator, which represents turbulent wave breaking processes.
‘Wasn’t offered one, too poorly to ask for one’ – Reasons why some patients do not receive a psychosocial assessment following self-harm: Qualitative patient and carer survey
Authors: Quinlivan Leah , Gorman Louise , Littlewood Donna L , Monaghan Elizabeth , Barlow Stephen J , Campbell Stephen , Webb Roger T , Kapur Nav 
Published: May 2021

Objective: Psychosocial assessment following self-harm presentations to hospital is an important aspect of care. However, many people attending hospital following self-harm do not receive an assessment. We sought to explore reasons why some patients do not receive a psychosocial assessment following self-harm from the perspective of patients and carers. Methods: Between March and November 2019, we recruited 88 patients and 14 carers aged ⩾18 years from 16 mental health trusts and community organisations in the United Kingdom, via social media, to a co-designed qualitative survey. Thematic analyses were used to interpret the data. Results: Patients’ reasons for refusing an assessment included long waiting times, previous problematic interactions with staff and feeling unsafe when in the emergency department. Two people refused an assessment because they wanted to harm themselves again. Participants reported organisational reasons for non-assessment, including clinicians not offering assessments and exclusion due to alcohol intoxication. Other patients felt they did not reach clinically determined thresholds because of misconceptions over perceived heightened fatality risk with certain self-harm methods (e.g. self-poisoning vs self-cutting). Conclusion: Our results provide important insights into some of the reasons why some people may not receive a psychosocial assessment following self-harm. Parallel assessments, compassionate care and specialist alcohol services in acute hospitals may help reduce the number of people who leave before an assessment. Education may help address erroneous beliefs that self-injury and self-harm repetition are not associated with greatly raised suicide risk.
Comparing the social networks of service users with long term mental health needs living in community with those in a general adult in-patient unit
Authors: Rusca Roberto , Onwuchekwa Ike-Foster , Kinane Catherine , MacInnes Douglas 
Published: May 2021

Background: Relationships are vital to recovery however, there is uncertainty whether users have different types of social networks in different mental health settings and how these networks may impact on users’ wellbeing. Aims: To compare the social networks of people with long-term mental illness in the community with those of people in a general adult in-patient unit. Method: A sample of general adult in-patients with enduring mental health problems, aged between 18 and 65, was compared with a similar sample attending a general adult psychiatric clinic. A cross-sectional survey collected demographic data and information about participants’ social networks. Participants also completed the Short Warwick Edinburgh Mental Well-Being Scale to examine well-being and the Significant Others Scale to explore their social network support. Results: The study recruited 53 participants (25 living in the community and 28 current in-patients) with 339 named as important members of their social networks. Both groups recorded low numbers in their social networks though the community sample had a significantly greater number of social contacts (7.4 vs. 5.4), more monthly contacts with members of their network and significantly higher levels of social media use. The in-patient group reported greater levels of emotional and practical support from their network. Conclusions: People with serious and enduring mental health problems living in the community had a significantly greater number of people in their social network than those who were in-patients while the in-patient group reported greater levels of emotional and practical support from their network. Recommendations for future work have been made.
Exploring the prevalence of personality disorder and the feasibility of using the SAPAS as a screening tool for personality disorder in an emergency department in India
Authors: Sen Piyal , Barnicot Kirsten , Podder Priyanka , Dasgupta Indraneel , Gormley Mariko 
Published: May 2021

Background Personality disorders (PD) lead to frequent emergency department (ED) visits. Existing studies have evaluated high-risk ED populations in Western settings. PD screening tools, such as the Standardized Assessment of Personality – Abbreviated Scale (SAPAS), have thus far only been validated in Western populations. Aims This study aimed to establish the screened prevalence of PD, and to evaluate the performance of the SAPAS as a screening tool within an ED setting in India. Methods The study took place in the ED of a private multi-speciality hospital in Kolkata, India. All attendees were approached during two days per week over three months, except those who were medically unfit to participate. The SAPAS and the International Personality Disorder Examination (IPDE) were translated into Bengali and then used as screening tools for PD and as the reference standard for PD diagnosis. Results Out of 120 ED attendees approached, 97 participated (48 men and 49 women), of whom 24% met the criteria for a diagnosis of PD. A cut-off score of 4 on the SAPAS provided the best trade-off between sensitivity and specificity for detecting PD. Conclusion The prevalence of PD was similar to Western samples, and the SAPAS showed promise for use in a non-Western setting.
Sadness, despair and anger when a patient dies alone from COVID-19: A thematic content analysis of Twitter data from bereaved family members and friends
Authors: Selman Lucy E , Chamberlain Charlotte , Sowden Ryann , Chao Davina , Selman Daniel , Taubert Mark , Braude Philip 
Published: May 2021

Background: To inform clinical practice and policy, it is essential to understand the lived experience of health and social care policies, including restricted visitation policies towards the end of life. Aim: To explore the views and experiences of Twitter social media users who reported that a relative, friend or acquaintance died of COVID-19 without a family member/friend present. Design: Qualitative content analysis of English-language tweets. Data sources: Twitter data collected 7–20th April 2020. A bespoke software system harvested selected publicly-available tweets from the Twitter application programming interface. After filtering we hand-screened tweets to include only those referring to a relative, friend or acquaintance who died alone of COVID-19. Data were analysed using thematic content analysis. Results: 9328 tweets were hand-screened; 196 were included. Twitter users expressed sadness, despair, hopelessness and anger about their experience and loss. Saying goodbye via video-conferencing technology was viewed ambivalently. Clinicians’ presence during a death was little consolation. Anger, frustration and blame were directed at governments’ inaction/policies or the public. The sadness of not being able to say goodbye as wished was compounded by lack of social support and disrupted after-death rituals. Users expressed a sense of political neglect/mistreatment alongside calls for action. They also used the platform to reinforce public health messages, express condolences and pay tribute. Conclusion: Twitter was used for collective mourning and support and to promote public health messaging. End-of-life care providers should facilitate and optimise contact with loved ones, even when strict visitation policies are necessary, and provide proactive bereavement support.