bluuebunny/crossref_metadata_2025_split huggingface dataset:
“She Knows Me Best”: A Qualitative Study of Patient and Caregiver Views on the Role of the Primary Care Physician Follow-Up Post-Discharge
Authors: Griffiths Sarah , Stephen Gaibrie , Kiran Tara , Okrainec Karen 
Published: March 2021

Abstract
BackgroundPatients with chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) are at high-risk of readmission after hospital discharge. There is conflicting evidence however on whether timely follow-up with a primary care provider reduces that risk. The objective of this study is to understand the perspectives of patients with COPD and CHF, and their caregivers, on the role of primary care provider follow-up after hospital discharge.MethodsA qualitative study design with semi-structured interviews was conducted among patients or their family caregivers admitted with COPD or CHF who were enrolled in a multicenter mixed-methods study at three acute care hospitals in Ontario, Canada. Participants were interviewed between December 2017 to January 2019, the majority discharged from hospital at least 30 days prior to their interview. Interviews were analyzed independently by three authors using a deductive directed content analysis, with the fourth author cross-comparing themes.ResultsInterviews with 16 participants (eight patients and eight caregivers) revealed four main themes. First, participants valued visiting their primary care provider after discharge to build upon their longitudinal relationship. Second, primary care providers played a key role in coordinating care. Third, there were mixed views on the ideal time for follow-up, with many participants expressing a desire to delay follow-up to stabilize following their acute hospitalization. Fourth, the link between the post-discharge visit and preventing hospital readmissions was unclear to participants, who often self-triaged based on their symptoms when deciding on the need for emergency care.ConclusionsPatients and caregivers valued in-person follow-up with their primary care provider following discharge from hospital because of the trust established through pre-existing longitudinal relationships. Our results suggest policy makers should focus on improving rates of primary care provider attachment and systems supporting informational continuity.
Cervical Cancer Screening Uptake and Determinant Factors Among Women in Ambo Town, Western Oromia, Ethiopia: Community based Cross Sectional Study
Authors: Natae Shewaye Fituma , Nigatu Digafe Tsegaye , Negawo Mulu Kitaba , Mengesha Wakeshe Willi 
Published: March 2021

Abstract
Background: Cervical cancer is one of the principal causes of cancer death among women worldwide. It is the second most common cancer and the leading cause of cancer-related death in Ethiopian women; about 77.6% of women died of 6,294 new cases reported in 2019. Early screening for cervical cancer has substantial advantage to reduce the incidence, morbidity, and mortality attributed to cervical cancer. So far, there are limited evidence on the level of cervical cancer screening uptake and its determinant in low- and middle-income countries including Ethiopia. Consequently, the current study aimed to assess the level of cervical cancer screening uptake and its determinant among women of Ambo town, western Oromia, Ethiopia.Methods: A community-based cross-sectional study was conducted among 422 women aged 20-65years. Systematic random sampling was employed to recruit the eligible women from randomly selected sub-districts found in Ambo town. Interviewer-administered questionnaire was used to collect the data. Epi info was used for data entry and management from which it was exported to SPSS version 25 for detailed analysis. Variables in binary logistic regression with a p-value <0.25 were candidate for multivariable logistic regression. Estimates were presented using odds ratios (ORs) with 95% CI. Statistical Significance was declared at p value<0.05.Results: In the present study 392 women were participated giving a response rate of 93%. Overall, 63% of the respondents were known the availability of cervical cancer screening service. Only 8.7% (34) of the study participants were received cervical cancer screening in their lifetime. Being in the age group of 30-39 years (AOR=3.2; 95% CI [1.22, 8.36]) and 40-49years (AOR=4.8; 95% CI [1.42, 16.41]), having cervical cancer related discussion with health care provider (AOR=3.5; 95% CI [1.17, 10.7]), and knowing availability cervical cancer screening service (AOR=2.8; 95% CI [1.03, 7.87]) were significantly associated with uptake of cervical cancer screening. Conclusion: In this study, cervical cancer screening uptake is very low. The study also highlighted important factors that affect uptake of cervical cancer screening service. Therefore, this study result call urgent interventions by all stockholders to increase cervical cancer service uptake through continues promotions and by securing its availability and accessibility for all eligible women at all levels.
Pediatric Soft Tissue Injuries During the COVID-19 Lockdown
Authors: Olshinka Asaf , Shoufani Rami , Shachar Tal , Lvovsky Alex , Kalish Eyal , Ad-El Dean D. , Yaacobi Dafna (Shilo) 
Published: March 2021

Abstract
The authors have requested that this preprint be removed from Research Square.
A New Approach to Produce IgG4-like Bispecific Antibodies
Authors: Zhao Caizhi , Zhang Wei , Gong Guihua , Xie Liping , Wang Ming-Wei , Hu Youjia 
Published: March 2021

Abstract
While achieving rapid developments in recent years, bispecific antibodies are still difficult to design and manufacture, due to mismatch of both heavy and light chains. Here we report a novel technology to make correct bispecific molecules. The knob-into-hole method was used to pair two distinct heavy chains as a heterodimer. IgG4 S228P CH1-CL interface was then partially replaced by T-cell receptor α/β constant domain to increase the efficiency of cognate heavy and light chain pairing. Following expression and purification, the bispecific antibody interface exchange was confirmed by DNA sequencing and LC-MS/MS. To ensure its validity, we combined a monovalent bispecific antibody against PD-1 (sequence from Pembrolizumab) and LAG3 (sequence from Relatlimab). The results showed that the molecule could be assembled correctly at a ratio of 95% in cells. In vitro functional assay demonstrated that the purified bispecific antibody exhibits an enhanced agonist activity compared to that of the parental antibodies. Low immunogenicity was predicted by an open-access software and ADA test.
COVID-19 in Conflict Border Regions: A Case of South Kordofan, Sudan
Authors: Sserwanja Quraish , Adam Mohammed Bashir , Kawuki Joseph , Olal Emmanuel 
Published: March 2021

Abstract
The novel coronavirus disease (COVID-19) was first reported in Sudan on 13 March 2020. Since then, Sudan has experienced one of the highest COVID-19 spread and fatalities in Africa. As per 12 December 2020, Sudan had a total of 21,591 cases, 1,355 cumulative deaths at a case fatality rate (CFR) of 6.28%. South Kordofan State has 17.4% COVID-19 case fatality rate, the fifth highest rate among the 18 States. The State is home to over 200,000 poor and displaced people from years of destructive civil unrests. To date, several localities such as the Nubba mountains region remain under rebel control and are not accessible. South Kordofan State Ministry of Health in collaboration with the federal government and non-governmental organizations set up four isolation centres with 40 total bed capacity, but with only two mechanical ventilators and no testing centre. There is still need for further multi-sectoral coalition and equitable allocation of resources to strengthen the health systems of rural and conflict affected regions. This article aims at providing insight into the current State of COVID-19 in South Kordofan amidst the second wave to address the dearth of COVID-19 information in rural and conflict affected regions.
Effect of Exogenous pH on Cell Growth of Breast Cancer Cells
Authors: Lee Sungmun 
Published: March 2021

Abstract

Breast cancer is the most common cancer in women and the most life-threatening cancer in women worldwide. One key feature of cancer cells including breast cancer cells is a reversed pH gradient, and extracellular pH (pHe) of cancer cells is more acidic than normal cells. Cancer cells have lower pHe of ~ 6.7–7.1 and higher intracellular pH (pHi) of 7.4, while normal cells have pHe of 7.4 and lower pHi of 7.2. Here, we investigated how exogenous pH affected breast cancer cells. MDA-MB-231 cell lines were cultured in five different pHs, pH 6.0, pH 6.7, pH 7.4, pH 8.4, and pH 9.2 of medium. The cells were growing in pH 6.0 and pH 9.2 however, not as fast as in other pHs. Especially they were floating in more acidic conditions than pH 6.3. In alkaline pH (pH 8.4 and pH 9.2), more cells were early apoptotic and they were in S phase. In acidic pH (pH 6.0), more cells were late apoptotic or necrotic and more cells were at G2/M phase in acidic pH (pH 6.0 and pH 6.7). The results suggested that MDA-MB-231 cells experienced different cell growth and cell metabolism in different pHs.
An Intelligent Control Approach for Defect-Free Friction Stir Welding
Authors: Cobos Richard , Salas Santiago D. , Angulo Wilfredo , Liao T. Warren 
Published: March 2021

Abstract
An intelligent control approach is proposed as an alternative for the friction stir welding of an aluminum alloy. A validated empirical model is re-written from transfer functions to a set of ordinary differential equations, allowing to observe the force dynamics as a function of inputs of interest. A defect-free set-point is proposed for exploiting available labeled experimental data which defines operational boundaries and a region in which the probability of achieving defect-free welds with good mechanical properties is the highest. An intelligent controller in the fashion of a Recurrent Neural Network is constructed. Computational experiments were carried out to verify the adequacy in disturbance rejection as well as to visualize the capabilities in achieving the proposed defect-free set-point by the controller. The intelligent approach is compared with a set of decoupled proportional-integral controllers and a linear model predictive control strategy. From this study it is concluded that the intelligent controller shows superiority and good applicability for the studied problem.
New technique for false lumen coiling of spontaneous isolated superior mesenteric artery dissection
Authors: YAMAGUCHI HIDENORI , Murata Satoru , Ueda Tatsuo , Mine Takahiko , Onozawa Shiro , Hayashi Hiromitsu , Kumita Shin-ichiro 
Published: March 2021

Abstract
Background: Spontaneous isolated visceral artery dissection is rarely encountered. Endovascular intervention with good outcomes has become popular for patients with persistent symptoms or developing ischemia. We could perform life-saving treatment for a spontaneous isolated superior mesenteric artery dissection with a unique endovascular intervention.Case presentation: We describe the case of an 80-year-old man who presented with acute abdominal pain and a spontaneous isolated superior mesenteric artery dissection measuring 35 mm in major diameter and 6.6 mm in minor diameter on abdominal contrast-enhanced computed tomography. After admission, abdominal pain was progressive, and a repeated scan revealed progression of the dissection. As an endovascular intervention, via the bilateral femoral approach, detachable coils were placed in the false lumen of the superior mesenteric artery dissection through the false lumen under the micro-balloon occlusion at the point of re-entry and entry through the true lumen to prevent coil migration. Technical and clinical success was achieved without serious adverse events.Conclusion: Coil embolization using micro-balloon assistance combined with the double-catheter technique for a large entry and re-entry false lumen of a spontaneous isolated superior mesenteric artery dissection was useful and feasible.
Celastrol Attenuates the Remodeling of Pulmonary Vascular and Right Ventricular in Monocrotaline-Induced Pulmonary Arterial Hypertension in Rats
Authors: li huayang , Liu Quan , Yue Yuan , Wang Shunjun , Huang Suiqing , Huang Lin , Li Luo , Zhang Yitao , Wu Zhongkai 
Published: March 2021

Abstract
PurposePulmonary arterial hypertension (PAH) is a progressive angio-proliferative disease with high morbidity and mortality. Although the histopathology is well described, its therapeutic effect is still unsatisfactory. This study investigated the treatment of celastrol on PAH rats right ventricular (RV) dysfunction, RV remodeling and pulmonary vascular remodeling and its possible mechanisms.MethodsPAH in rats was induced by monocrotaline (MCT) single subcutaneously injection. After daily delivery of Celastrol (1mg/kg) or vehicle via intraperitoneal injection for 4 weeks, the effects of celastrol on RV function, fibrosis, and pulmonary vascular remodeling were assessed. Macrophage infiltration, expression of inflammatory cytokines, including MCP-1, IL-1β, IL-6, IL-10 and the expression of NF-kB signaling pathway-associated protein, IkBα, p-IKKα/β and p65 were further detected. Finally, the effect of celastrol on human pulmonary artery smooth cells (HPASMCs) proliferation under hypoxia was studied in vitro.ResultsRats with PAH had degressive RV function, increased RV fibrosis and pulmonary arteries with interstitial thickening and prominent media hypertrophy. Treatment with celastrol improved RV function, attenuated RV fibrosis and pulmonary vascular remodeling. Significantly deceased macrophage infiltration, lower level of pro-inflammatory cytokines, higher level of anti-inflammatory cytokine and inhibited NF-κB signaling pathway were observed in lung tissues of rats with celastrol treatment. Moreover, celastrol significantly suppressed the proliferation of HPASMCs under hypoxia. Conclusions﻿We showed that, in rats with PAH, celastrol could improve RV function, attenuate RV and pulmonary vascular remodeling and the proliferation of HPASMCs under hypoxia. The suppression of NF-κB signaling pathway may be a part of the protective mechanism.
Daple deficiency causes hearing loss in adult mice by inducing defects in cochlear stereocilia and apical microtubules
Authors: Ozono Yoshiyuki , Tamura Atsushi , Nakayama Shogo , Herawati Elisa , Hanada Yukiko , Ohata Kazuya , Takagishi Maki , Takahashi Masahide , Imai Takao , Ohta Yumi , Oshima Kazuo , Sato Takashi , Inohara Hidenori , Tsukita Sachiko 
Published: March 2021

Abstract
The V-shaped arrangement of hair bundles on cochlear hair cells is critical for the auditory sensing. However, regulation of hair bundle arrangements is not fully understood. Recently, defects in hair bundle arrangement were reported in postnatal Dishevelled-associating protein (Daple)-deficient mice. Here, we found that adult Daple-/- mice exhibited hearing disturbances over a broad frequency range through auditory brainstem response testing. Consistently, distorted patterns of hair bundles were detected in almost all regions, more typically in the basal region of the cochlear duct. In adult Daple-/- mice, apical microtubules were irregularly aggregated, and the number of microtubules attached to plasma membranes was decreased. Similar phenotypes were manifested upon nocodazole treatment in a wild type cochlea culture without affecting the microtubule structure of the kinocilium. These results indicate critical roles of Daple in hair bundle arrangement, through the orchestration of apical microtubule distribution, and thereby in hearing, especially at high frequencies.
Treatment of Persistent Post-traumatic Headache With the anti-CGRP Receptor Antibody Erenumab: a Case Report
Authors: Papenhoff Mike Christian , Dudda Marcel 
Published: March 2021

Abstract
Background: Calcitonin gene-related peptide (CGRP) has only recently emerged as a potential target in posttraumatic headache. To our knowledge this is the first description of a patient with persistent posttraumatic headache following severe traumatic head injury who has been treated with the CGRP-receptor-monoclonal antibody erenumab.Case presentation: A 56-year-old man presented with a 30-year history of frequent migraine-like posttraumatic headaches following a high-voltage head injury that he treated with an excessive intake of peripheral analgesics. Although amitriptyline was reasonably effective, it had to be discontinued when the patient developed restless legs syndrome in the second year of treatment. Under therapy with erenumab he achieved a rapid and stable reduction in his symptoms down to only 2–3 headache days per month without adverse events.Conclusions: This case demonstrates that the inhibition of the CGRP-receptor with erenumab could be an effective treatment option in migraine-like post-traumatic headache even decades after the traumatic event.
Virtual Voice Assistant Applications Improved Expressive Verbal Abilities and Social Interactions in Children with Autism Spectrum Disorder: A Single-Subject Experimental Study
Authors: Safi Mohammed F , Sadrani Badriya Al , Mustafa Ashraf 
Published: March 2021

Abstract
Background: Children with autism spectrum disorder (ASD) tend to have communication and social interaction deficits. Their impaired communication is derived from difficulties in acquiring language. The use of interactive technologies has been demonstrated to enhance verbal and non-verbal communication, as well as the social interaction tendencies of children with ASD. Artificial intelligence has played a growing role in the habilitation of children with ASD. However, little research exists on the possible roles and effectiveness of virtual voice assistants in developing language and social skills in children with ASD. This study examined the effects of using a voice assistant in children with ASD on two outcomes: speech skills (expressive verbal vocabulary and production of short phrases) and social interaction skills (playing/sharing). Methods: An interventional single-case design study was used to explore this concept using three children with ASD between the ages of 4 and 11 years. The participants used an accessible virtual voice assistant, Apple’s Siri, for three months. Pre- and post-intervention questionnaires and semi-structured interviews with mothers were administered to measure the communication and social interaction skills of the participating children. Results: Participant One, Two and Three showed a notable improvement in the total number of correct words produced with fewer attempts during the VVA intervention compared with the baseline phase. Further, all participants showed increases in the social interactions in the intervention phase, compared with the baseline phase. Finally, all the mothers noted improvement in their children’s speech intelligibility and social interactions. Conclusions: Results showed that the virtual voice assistant had positive effects on the speech and social interaction skills of children with ASD. The findings of this study implied that children with ASD can use readily available voice assistant software to improve their speech and social interaction skills. Furthermore, this study’s findings could be used to develop strategies to increase the availability of artificial intelligence infrastructure in schools and homes to help children with ASD.
Ganesh pilot study: The evolution of metabolism during different levels of NIV in healthy volunteers
Authors: Jonckheer Joop , Mekeirele Michael , Vanhonacker Domien , Costa Olivier R , Londersele Peter van , Diltoer Marc , Waele Elisabeth De 
Published: March 2021

Abstract
BackgroundMetabolism of critically ill adult patients is variable and influenced by intrinsic and extrinsic factors. Energy expenditure and thereby metabolism can be captured with indirect calorimetry (IC). An increased respiratory muscle use due to acute hypercapnic failure during Chronic Obstructive Pulmonary Disease exacerbation or other pulmonary problems may increase energy expenditure. Therefore, noninvasive ventilation (NIV) can be used in these conditions. It decreases the work of breathing by supporting muscle activity which will in turn cause a lower muscle metabolism. When this therapy fails, a higher mortality is observed due to delayed intubation. No good single early clinical parameter for NIV failure has been identified. Metabolism seems a promising parameter that has not been researched yet. We explored if IC connected to the NIV device will capture metabolic alterations due to different levels of support with NIV in healthy subjects. Patient and methodsIn this pilot study, metabolism objectified by Resting Energy Expenditure was measured with IC in 5 healthy subjects receiving NIV with increasing levels of support. Noninvasive hemodynamic monitoring was applied. Rate of perceived exertion was also assessed. ResultsDuring increasing levels of inspiratory support, linear regression showed increasing energy expenditure with a function of Y 1 =18,42*X+743,3 and decreasing levels of dyspnea with a function of Y 5 = -0,565*X + 4,42. Friedman test was not significantly different (p=0,364) for energy expenditure but was significantly different (p= 0,014) for the rate of perceived exertion. Further analysis of the rate of perceived exertion with Wilcoxon matched-pairs rank test showed no difference for the different levels of support compared to only positive end-expiratory pressure (PEEP).ConclusionIndirect calorimetry captures metabolic alterations induced by NIV treatment. Metabolism is influenced by increasing levels of support in healthy volunteers. Rate of perceived exertion is not correlated with metabolic alterations induced by NIV.
Combining renal cell arrest and damage biomarkers to predict progressive AKI in patient with sepsis
Authors: Tao Xiaolei , Chen Chunbo , Luo Weihong , Zhou Jing , Tian Jianwei , Yang Xiaobing , Hou Fanfan 
Published: March 2021

Abstract
Background
Sepsis is the most common trigger for AKI and up to 40% of mild or moderate septic AKI would progress to more severe AKI, which is associated with significantly increased risk for death and later CKD/ESRD. Early identifying high risk patients for AKI progression is a major challenge in patients with septic AKI.
Objectives
This study aims to evaluated the utility of combining renal cell arrest and damage biomarkers for predicting the progression of AKI in patient with sepsis.
Methods
This is a prospective, multicenter cohort study which enrolled adult patients with sepsis and initially developed stage 1 or 2 AKI from January 2014 to March 2018. AKI was diagnosed and staged according to 2012 KDIGO-AKI guidelines. Renal cell arrest biomarkers (urinary TIMP2*IGFBP7, u[TIMP-2]*[IGFBP7]) and renal damage biomarkers (urinary KIM-1[uKIM-1] and urinary IL-18 [uIL-18]) were measured at time of AKI clinical diagnosis, and the utility of biomarkers for predicting septic AKI progression alone or in combination were evaluated. The primary outcome was AKI progression defined as worsening of AKI stage. The second outcome was AKI progression with subsequent death during hospitalization.
Results
Among 433 screened patients, 149 patients with sepsis and stage 1 or 2 AKI were included, in which 63 patients developed progressive AKI and 49 patients subsequently died during hospitalization. u[TIMP-2]*[IGFBP7], uKIM-1 and uIL-18 independently predicted the progression of septic AKI in which u[TIMP-2]*[IGFBP7] showed the greatest AUC (0.745; 95%CI, 0.667–0.823) as compared to uKIM-1 (AUC 0.719; 95%CI 0.638-0.800) and uIL-18 (AUC 0.619; 95%CI 0.525–0.731). Combination of u[TIMP-2]*[IGFBP7] with uKIM-1 improved the performance of predicting septic AKI progression with AUC of 0.752. u[TIMP-2]*[IGFBP7], alone or combined with uKIM-1/uIL-18, improved the risk reclassification over the clinical risk factor model alone both for the primary and secondary outcomes, as evidenced by significant category-free net reclassification index.
Conclusions
Combination of renal cell arrest and damage biomarkers enhanced the prediction of AKI progression in patients with sepsis and improved risk reclassification over the clinical risk factors.