bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sexual and reproductive health of adolescent Syrian refugee girls in Lebanon: a qualitative study of healthcare provider and educator perspectives
Authors: Fahme Sasha Abdallah , Sieverding Maia , Abdulrahim Sawsan 
Published: June 2021

AbstractBackgroundAdolescent Syrian refugee girls in Lebanon are thought to experience a disproportionate risk of poor sexual and reproductive health, related in part to conflict and displacement. The purpose of this qualitative study was to explore healthcare provider and educator perceptions of the sexual and reproductive health determinants and care-seeking behaviors of this vulnerable population. The findings of the study will inform a health intervention that aims to reduce early marriage and improve access to sexual and reproductive health information and services.MethodsIn-depth interviews and focus group discussions were conducted with stakeholders who work with adolescent Syrian refugee girls in an under-resourced area of eastern Lebanon bordering Syria. Data analysis followed principles of Clarke and Braun’s thematic analysis.ResultsStudy participants perceived adolescent pregnancy, reproductive tract infections, and sexual- and gender-based violence as major population health needs. The study also identified a number of influencing structural and sociocultural determinants of health, including early marriage, adolescent disempowerment, and men’s disengagement from care. A conceptual framework based upon the Gelberg–Andersen Behavioral Model for Vulnerable Populations was developed to relate these determinants and guide pathways for potential interventions.ConclusionsAdolescent sexual and reproductive health interventions among Syrian refugees in Lebanon should adopt a multi-pronged, community-based approach to address underlying health determinants and engage with men and parents of adolescents. Special attention should be given to provider biases in healthcare settings accessible to adolescents, as these may reflect underlying tensions between host and refugee populations and discourage adolescents from seeking care.
Temporal phylogeny and molecular characterization of echovirus 30 associated with aseptic meningitis outbreaks in China
Authors: Tian Xiaoling , Han Zhenzhi , He Yulong , Sun Qiang , Wang Wenrui , Xu Wenbo , Li Hongying , Zhang Yong 
Published: June 2021

Abstract
Background
An outbreak of aseptic meningitis occurred from June to August 2016, in Inner Mongolia Autonomous Region, China.

Methods
To determine its epidemiological characteristics, etiologic agent, and possible origin, specimens were collected for virus isolation and identification, followed by molecular epidemiological analysis.

Results
A total of 363 patients were clinically diagnosed from June 1st to August 31st 2016, and most cases (63.1%, n = 229) were identified between June 22nd and July 17th, with children aged 6 to 12 years constituting the highest percentage (68.9%, n = 250). All viral isolates from this study belonged to genotype C of echovirus 30 (E30), which dominated transmission in China. To date, two E30 transmission lineages have been identified in China, of which Lineage 2 was predominant. We observed fluctuant progress of E30 genetic diversity, with Lineage 2 contributing to increased genetic diversity after 2002, whereas Lineage 1 was significant for the genetic diversity of E30 before 2002.

Conclusions
We identified the epidemiological and etiological causes of an aseptic meningitis outbreak in Inner Mongolia in 2016, and found that Lineage 2 played an important role in recent outbreaks. Moreover, we found that Gansu province could play an important role in E30 spread and might be a possible origin site. Furthermore, Fujian, Shandong, Taiwan, and Zhejiang provinces also demonstrated significant involvement in E30 evolution and persistence over time in China.
Metabolic and hormonal effects of melatonin and/or magnesium supplementation in women with polycystic ovary syndrome: a randomized, double-blind, placebo-controlled trial
Authors: Alizadeh Mohammad , Karandish Majid , Asghari Jafarabadi Mohammad , Heidari Lida , Nikbakht Roshan , Babaahmadi Rezaei Hossein , Mousavi Reihaneh 
Published: June 2021

Abstract
Background
Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders among women of reproductive age. This study was designed to investigate the effects of melatonin and/or magnesium supplementation on metabolic profile and levels of sex hormones in PCOS women.

Methods
In an 8-week randomized double-blind placebo-controlled trial, 84 subjects with PCOS aged 18–40 years were randomly assigned based on the random block procedure to take magnesium, melatonin, magnesium plus melatonin, and placebo. Fasting blood samples were obtained at the beginning and end of the study.

Results
After intervention, the mean Pittsburg Sleep Quality Index score decreased significantly in both co-supplementation and melatonin groups (P < 0.001). Magnesium supplementation in combination with melatonin resulted in a significant greater decrease in testosterone concentrations compared with the placebo (P < 0.05). Co-supplementation of magnesium-melatonin had significantly reduced serum insulin levels (geometric means difference: − 1.11 (mIU/mL) (percent change: − 15.99)), homeostasis model of assessment-insulin resistance (HOMA-IR) (− 0.28 (− 18.66)), serum cholesterol (mean difference: − 16.08 (mg/dl) [95% CI − 24.24, − 7.92]), low-density lipoprotein cholesterol (LDL-C) − 18.96 (mg/dl) [− 28.73, − 9.20]) and testosterone levels (− 0.09 (ng/ml) (− 25.00)), as compared to the baseline values (P < 0.05). An increase in serum high-density lipoprotein cholesterol (HDL-C) levels was also observed following the administration of the melatonin alone (2.76 (mg/dl) [0.57, 4.95]) or in combination with magnesium (2.19 (mg/dl) [0.61, 3.77]) (P < 0.05).

Conclusions
Co-supplementation with magnesium and melatonin had beneficial effects on sleep quality and total testosterone. Additionally, melatonin supplementation alone was found to be associated with a significant reduction in PSQI score. Moreover, combined melatonin and magnesium supplementation was more effective in improving serum levels of cholesterol, LDL-C, HDL-C and insulin, and HOMA-IR.
Trial registration: Iranian Registry of Clinical Trial. http://www.irct.ir: IRCT20191130045556N1, January 2020.
Geometric and dosimetric impact of 3D generative adversarial network-based metal artifact reduction algorithm on VMAT and IMPT for the head and neck region
Authors: Nakamura Mitsuhiro , Nakao Megumi , Imanishi Keiho , Hirashima Hideaki , Tsuruta Yusuke 
Published: June 2021

Abstract
Background
We investigated the geometric and dosimetric impact of three-dimensional (3D) generative adversarial network (GAN)-based metal artifact reduction (MAR) algorithms on volumetric-modulated arc therapy (VMAT) and intensity-modulated proton therapy (IMPT) for the head and neck region, based on artifact-free computed tomography (CT) volumes with dental fillings.

Methods
Thirteen metal-free CT volumes of the head and neck regions were obtained from The Cancer Imaging Archive. To simulate metal artifacts on CT volumes, we defined 3D regions of the teeth for pseudo-dental fillings from the metal-free CT volumes. HU values of 4000 HU were assigned to the selected teeth region of interest. Two different CT volumes, one with four (m4) and the other with eight (m8) pseudo-dental fillings, were generated for each case. These CT volumes were used as the Reference. CT volumes with metal artifacts were then generated from the Reference CT volumes (Artifacts). On the Artifacts CT volumes, metal artifacts were manually corrected for using the water density override method with a value of 1.0 g/cm3 (Water). By contrast, the CT volumes with reduced metal artifacts using 3D GAN model extension of CycleGAN were also generated (GAN-MAR). The structural similarity (SSIM) index within the planning target volume was calculated as quantitative error metric between the Reference CT volumes and the other volumes. After creating VMAT and IMPT plans on the Reference CT volumes, the reference plans were recalculated for the remaining CT volumes.

Results
The time required to generate a single GAN-MAR CT volume was approximately 30 s. The median SSIMs were lower in the m8 group than those in the m4 group, and ANOVA showed a significant difference in the SSIM for the m8 group (p < 0.05). Although the median differences in D98%, D50% and D2% were larger in the m8 group than the m4 group, those from the reference plans were within 3% for VMAT and 1% for IMPT.

Conclusions
The GAN-MAR CT volumes generated in a short time were closer to the Reference CT volumes than the Water and Artifacts CT volumes. The observed dosimetric differences compared to the reference plan were clinically acceptable.
Psychological and social interventions for mental health issues and disorders in Southeast Asia: a systematic review
Authors: Maddock Alan , Blair Carolyn , Ean Nil , Best Paul 
Published: June 2021

Abstract
Background
Mental health issues and disorders are major public health challenges, particularly in low- and middle-income countries in Southeast Asia, where chronic shortages in mental health services and human resources exist. The development of effective and accessible mental health systems in Southeast Asia will require evidence based psychological and social interventions. This systematic review provides a narrative synthesis of the evidence on the effectiveness of such interventions for mental health issues and disorders in Southeast Asia.

Methods
A comprehensive literature search of 7 electronic databases (PsycINFO, Medline (Ovid), Cochrane library, EMBASE, SCOPUS, APA PsycArticles, and Social Care Online) was undertaken.

Results
Thirty two studies employing RCT designs to evaluate the effectiveness of a range of psychological and social mental health interventions on a number of different mental health outcomes were included in this review. The disparate intervention programmes reviewed were categorised as: lay delivered, yoga, aerobic and/or meditation based, cognitive behavioural therapy oriented, eye movement desensitization and reprocessing based (EMDR), health worker delivered, and hybrid programmes. The majority of the studies included in this review were of low to moderate quality due to the variability in the quality of the study design. The highest quality, and most promising evidence came from the evaluations of lay delivered interventions. This evidence demonstrates the feasibility and potential sustainability of implementing such interventions in resource constrained contexts.

Conclusions
The review findings indicate that a disparate array of mental health interventions can be implemented effectively in a range of Southeast Asian mental health and health settings. There is a clear need for significantly more research however, through higher quality and larger scale RCTs before it will be known more definitively, if these interventions are effective, and for whom they are most effective in different Southeast Asian contexts.
Prevalence and correlates of suicidal behaviour among adults in Malawi: a nationally representative cross-sectional survey in 2017
Authors: Pengpid Supa , Peltzer Karl 
Published: June 2021

Abstract
Background
The study aimed to assess the prevalence and associated factors of suicidal behaviour (SB) among adults in Malawi.

Methods
Data were analysed from 4187 persons aged 18–69 years (median age: 32 years) that took part in the nationally representative cross-sectional “2017 Malawi STEPS survey.”

Results
The prevalence of ever suicide attempt was 0.8%, and the prevalence of SB (ideation, plan and/or attempt) in the past year was 7.9% (6.0% among men and 9.6% among women). In adjusted logistic regression analysis, among men, being 30 years and older and having an alcohol family problem were positively and obesity was negatively associated with SB in the past year. Moreover, in univariate analysis, early smoking initiation was positively and not using active transportation was negatively associated with SB in the past year. Among women, having an alcohol family problem, death from suicide of a close family member, having a cardiovascular incident (heart attack, stroke, or angina) and not using active transportation increased the odds of SB in the past year. In addition, in univariate analysis, low systolic blood pressure (< 100 mmHg), not taking antihypertensive medication, and current alcohol use were associated with past year SB.

Conclusion
Almost one in ten participants engaged in SB in the past year and several associated factors were identified that can inform intervention programmes.
A framework for handling missing accelerometer outcome data in trials
Authors: Tackney Mia S. , Cook Derek G. , Stahl Daniel , Ismail Khalida , Williamson Elizabeth , Carpenter James 
Published: June 2021

AbstractAccelerometers and other wearable devices are increasingly being used in clinical trials to provide an objective measure of the impact of an intervention on physical activity. Missing data are ubiquitous in this setting, typically for one of two reasons: patients may not wear the device as per protocol, and/or the device may fail to collect data (e.g. flat battery, water damage). However, it is not always possible to distinguish whether the participant stopped wearing the device, or if the participant is wearing the device but staying still. Further, a lack of consensus in the literature on how to aggregate the data before analysis (hourly, daily, weekly) leads to a lack of consensus in how to define a “missing” outcome. Different trials have adopted different definitions (ranging from having insufficient step counts in a day, through to missing a certain number of days in a week). We propose an analysis framework that uses wear time to define missingness on the epoch and day level, and propose a multiple imputation approach, at the day level, which treats partially observed daily step counts as right censored. This flexible approach allows the inclusion of auxiliary variables, and is consistent with almost all the primary analysis models described in the literature, and readily allows sensitivity analysis (to the missing at random assumption) to be performed. Having presented our framework, we illustrate its application to the analysis of the 2019 MOVE-IT trial of motivational interviewing to increase exercise.
Letter on “Sharing trial results directly with trial participants and other stakeholders after the SARS-CoV-2 pandemic hit the UK – experience from the ActWELL trial”
Authors: Bruhn Hanne , Anderson Annie S. , Hickman Amy , Macaskill E. Jane , Treweek Shaun 
Published: June 2021

AbstractAfter the SARS-CoV-2 pandemic took hold in the UK, the ActWELL trial team’s plans to present the trial results to participants and other stakeholders had to change. Instead of face-face events, three online events were planned and hosted successfully. In this article, we describe the choices made in planning and organisation of the online events including things we would do differently if we were to do it again. We think that online events are a useful platform when informing participants and other stakeholders of the results of your trial, even beyond the SARS-CoV-2 pandemic, and we hope this article can help other trial teams to plan their own online events.
Anti-peptidylarginine deiminase-4 antibodies at mucosal sites can activate peptidylarginine deiminase-4 enzyme activity in rheumatoid arthritis
Authors: Demoruelle M. Kristen , Wang Hong , Davis Ryan L. , Visser Ashley , Hoang Johnny , Norris Jill M. , Holers V. Michael , Deane Kevin D. , Darrah Erika 
Published: June 2021

Abstract
Background
Mucosal sites are hypothesized to play a role in the development of rheumatoid arthritis (RA). Since serum anti-peptidylarginine deiminase (PAD)4 antibodies, including a subset that cross-react with PAD3 (PAD3/4), are specific for RA and associate with severe disease, we sought to examine whether anti-PAD4 and anti-PAD3/4 antibodies were present in the lung and oral mucosa of subjects with RA and “at-risk” for RA.

Methods
We included 37 RA, 25 healthy control, and 46 subjects “at-risk” for RA based on familial RA and/or serum anti-citrullinated protein antibody (ACPA) positivity. Paired serum, sputum, and saliva were evaluated for anti-PAD4 and anti-PAD3/4 using immunoprecipitation and ACPA using ELISA. Immunoglobulins (Ig) were purified from representative samples, and their effect on citrullination of histone H3 by recombinant human PAD4 was measured by anti-citH3 immunoblot.

Results
Anti-PAD4 antibodies were detected in the serum of 6/37 (16.2%), sputum of 3/37 (8.1%), and saliva of 3/33 (9.1%) RA subjects and in the serum and sputum of 1/46 (2.2%) at-risk subjects. None of the healthy controls had anti-PAD4 antibodies at any site. Serum, sputum, and salivary anti-PAD4 antibodies were more prevalent in RA subjects with RA duration >2 years. Purified antibodies from representative anti-PAD4-positive and anti-PAD3/4-positive sputum were primarily of the IgA isotype and able to increase PAD4 enzymatic activity.

Conclusions
Anti-PAD4 antibodies are present in the sputum and saliva of a portion of RA patients and are infrequent in at-risk subjects. Importantly, the ability of anti-PAD4, and particularly anti-PAD3/4, antibodies in the sputum to enhance PAD4 enzymatic activity suggests that anti-PAD4 may play an active role in the RA lung.
The association of laminin levels with insulin resistance and non-alcoholic hepatosteatosis
Authors: Altun Özgür , Arman Yücel , Yoldemir Şengül Aydın , Pala Ayşe Selcen , Gümüşkaya Perihan Özkan , Özcan Mustafa , Karataş Mustafa , Dikker Okan , Tükek Tufan 
Published: June 2021

Abstract
Background
Laminin, one of the largest glycoproteins of the basement membrane, is an important component of the extracellular matrix. Functions of the basement membrane include regulation of cell signaling behaviors and structural support. Laminin plays a critical role in the regulation of insulin action in muscle, liver, and adipose tissue. The study mainly investigates an association between the change in serum laminin levels and insulin resistance and non-alcoholic hepatosteatosis.

Methods
This prospective study included a total of 90 participants; 60 patients diagnosed with Grade 2–3 non-alcoholic hepatosteatosis and 30 age- and sex-matched healthy controls between December 2019 and December 2020. Routine laboratory tests including glucose, insulin, homeostatic model of assessment-insulin resistance (HOMA-IR), alanine aminotransferase (ALT), aspartate aminotransferase (AST), triglyceride, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and C-reactive protein and laminin levels were measured in the serum of the patient and control groups. Enzyme-linked immunosorbent assay was used for the measurement of laminin levels.

Results
The median serum laminin levels were lower in patients with hepatic steatosis, compared to the control group (72 ng/L vs. 82 ng/L, respectively; p = 0.003). In the patients with insulin resistance, median laminin levels were lower, regardless of the presence of non-alcoholic hepatosteatosis (67 ng/L vs. 85 ng/L, respectively; p = 0.007). There was a weak, negative correlation between the laminin levels and HOMA-IR.

Conclusions
Our study results suggest that, although there is no exact link between laminin and non-alcoholic hepatosteatosis, serum laminin levels are lower in patients with insulin resistance by regulating the insulin effect through integrins.
Generalized Jensen’s functional on time scales via extended Montgomery identity
Authors: Ramzan Sofia , Nosheen Ammara , Bibi Rabia , Pečarić Josip 
Published: June 2021

AbstractIn the paper, we use Jensen’s inequality for diamond integrals and generalize it forn-convex functions with the help of an extended Montgomery identity. Moreover, the bounds have been suggested for identities associated with the generalized Jensen-type functional.
Analytical solitons for the space-time conformable differential equations using two efficient techniques
Authors: Neirameh Ahmad , Parvaneh Foroud 
Published: June 2021

AbstractExact solutions to nonlinear differential equations play an undeniable role in various branches of science. These solutions are often used as reliable tools in describing the various quantitative and qualitative features of nonlinear phenomena observed in many fields of mathematical physics and nonlinear sciences. In this paper, the generalized exponential rational function method and the extended sinh-Gordon equation expansion method are applied to obtain approximate analytical solutions to the space-time conformable coupled Cahn–Allen equation, the space-time conformable coupled Burgers equation, and the space-time conformable Fokas equation. Novel approximate exact solutions are obtained. The conformable derivative is considered to obtain the approximate analytical solutions under constraint conditions. Numerical simulations obtained by the proposed methods indicate that the approaches are very effective. Both techniques employed in this paper have the potential to be used in solving other models in mathematics and physics.
A study of a nonlinear coupled system of three fractional differential equations with nonlocal coupled boundary conditions
Authors: Ahmad Bashir , Hamdan Soha , Alsaedi Ahmed , Ntouyas Sotiris K. 
Published: June 2021

AbstractIn this research we introduce and study a new coupled system of three fractional differential equations supplemented with nonlocal multi-point coupled boundary conditions. Existence and uniqueness results are established by using the Leray–Schauder alternative and Banach’s contraction mapping principle. Illustrative examples are also presented.