bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quality of antenatal care and its sociodemographic determinants: results of the 2015 Pelotas birth cohort, Brazil
Authors: Morón-Duarte Lina Sofia , Varela Andrea Ramirez , Bertoldi Andrea Dâmaso , Domingues Marlos R. , Wehrmeister Fernando C. , Silveira Mariangela Freitas 
Published: October 2021

Abstract
Background
Inadequate antenatal care (ANC) has been associated with adverse pregnancy outcomes. ANC quality is considered a key component of the right to health and a route to equity and dignity for women and their children. Although ANC coverage is relatively high in Brazil, there are revealed some health disparities when coverage is examined by socio-demographic determinants. In this study we evaluated ANC quality and its socio-demographic determinants using data from the 2015 Pelotas birth cohort, Rio Grande do Sul, Brazil.

Methods
This study is part of the 2015 Pelotas population-based birth cohort (n = 3923 pregnant women) conducted in southern Brazil. ANC quality was assessed through 19 content and service utilization indicators recommended by the Brazilian Ministry of Health. Descriptive analyses and associations of each of the ANC indicators and independent variables were performed using the chi-square and linear trend test. ANC indicators were analyzed individually and aggregated as a score. Associations between ANC score quality and socio-demographic variables were assessed with ordinal regressions. Mediation analysis with G-computation was performed to estimate direct and indirect effect of mother’s level of education on ANC quality mediated by the number of consultations and timing of ANC initiation. Base and post confounders were included.

Results
The results showed that except for breast examination, height measurement, tetanus toxoid vaccination and ANC starting at the first trimester, all ANC indicators showed more than 80% coverage during ANC visits.
In the adjusted analysis, inadequate quality ANC was associated with lower maternal education level, not having a partner, being multiparous, being attended by a private provider and by the same professional in all consultations. In the mediation analyses, 6.8% of the association between ANC quality and mother’s education was mediated by the trimester in which ANC started, while 12.8% was mediated by the number of ANC visits.

Conclusions
ANC quality is associated with pregnant women’s socio-demographic characteristics. Significant efforts are needed to improve the quality of facility-based maternity care.
Translating evidence into policy: opinions and insights of Health Researchers and Policymakers in Nepal
Authors: Tiwari Biplav Babu , Ban Anusha , Gurung Sony , Karki Khem Bahadur 
Published: October 2021

Abstract
Background
The Evidence-Based Policymaking (EBP) process in Nepal is rife with poor practices where often policymakers are portrayed as perpetrators for such practices. However, we need to think of the EBP as a two-sided coin where both research pull and research push play equally significant roles. This study aimed to assess the perception of Nepalese health policymakers and researchers on EBP and identify appropriate mechanisms to integrate evidence into policies.

Methods
Following the constructivist philosophical paradigm, qualitative research design was used in the study with the grounded theory approach. Purposive sampling was performed, and the 12 in-depth interviews were conducted, where number of interviews was finalized using saturation theory. All interviews were audio-recorded, transcribed, translated to English, coded line by line, and then developed into themes. Thematic analysis technique was used to manually analyze the data.

Results
Study participants highlighted that evidence is being utilized during policy formulation but not in the amount it should be, with a preference for anecdotal evidence further reducing the chance. Apart from these barriers, poor credibility of information obtained, poorly targeted dissemination, inadequate policy-based researches, and policymakers and researchers operating within the spheres of their own with a feeble link to channel the flow of information between them were identified by participants. On the other hand, the publication of one-pager research brief, conduction of nationally representative surveys especially quantitative studies, the practice of cost-effectiveness study, and policymaker’s involvement during the research were some facilitators identified.

Conclusions
Moreover, the study accentuates that better communication strategies such as the establishment of formal forums with policymakers and researchers, better-targeted dissemination, and identification of priority areas have wide potential to promote a unified front of health policymakers and researchers for EBP.
Taxonomy-aware, sequence similarity ranking reliably predicts phage–host relationships
Authors: Zielezinski Andrzej , Barylski Jakub , Karlowski Wojciech M. 
Published: October 2021

Abstract
Background
Characterizing phage–host interactions is critical to understanding the ecological role of both partners and effective isolation of phage therapeuticals. Unfortunately, experimental methods for studying these interactions are markedly slow, low-throughput, and unsuitable for phages or hosts difficult to maintain in laboratory conditions. Therefore, a number of in silico methods emerged to predict prokaryotic hosts based on viral sequences. One of the leading approaches is the application of the BLAST tool that searches for local similarities between viral and microbial genomes. However, this prediction method has three major limitations: (i) top-scoring sequences do not always point to the actual host; (ii) mosaic virus genomes may match to many, typically related, bacteria; and (iii) viral and host sequences may diverge beyond the point where their relationship can be detected by a BLAST alignment.

Results
We created an extension to BLAST, named Phirbo, that improves host prediction quality beyond what is obtainable from standard BLAST searches. The tool harnesses information concerning sequence similarity and bacteria relatedness to predict phage–host interactions. Phirbo was evaluated on three benchmark sets of known virus–host pairs, and it improved precision and recall by 11–40 percentage points over currently available, state-of-the-art, alignment-based, alignment-free, and machine-learning host prediction tools. Moreover, the discriminatory power of Phirbo for the recognition of virus–host relationships surpassed the results of other tools by at least 10 percentage points (area under the curve = 0.95), yielding a mean host prediction accuracy of 57% and 68% at the genus and family levels, respectively, and drops by 12 percentage points when using only a fraction of viral genome sequences (3 kb). Finally, we provide insights into a repertoire of protein and ncRNA genes that are shared between phages and hosts and may be prone to horizontal transfer during infection.

Conclusions
Our results suggest that Phirbo is a simple and effective tool for predicting phage–host relationships.
Krüppel-homolog 1 exerts anti-metamorphic and vitellogenic functions in insects via phosphorylation-mediated recruitment of specific cofactors
Authors: Wu Zhongxia , Yang Libin , Li Huihui , Zhou Shutang 
Published: October 2021

Abstract
Background
The zinc-finger transcription factor Krüppel-homolog 1 (Kr-h1) exerts a dual regulatory role during insect development by preventing precocious larval/nymphal metamorphosis and in stimulating aspects of adult reproduction such as vitellogenesis. However, how Kr-h1 functions both as a transcriptional repressor in juvenile metamorphosis and an activator in adult reproduction remains elusive. Here, we use the insect Locusta migratoria to dissect the molecular mechanism by which Kr-h1 functions as activator and repressor at these distinct developmental stages.

Results
We report that the kinase PKCα triggers Kr-h1 phosphorylation at the amino acid residue Ser154, a step essential for its dual functions. During juvenile stage, phosphorylated Kr-h1 recruits a corepressor, C-terminal binding protein (CtBP). The complex of phosphorylated Kr-h1 and CtBP represses the transcription of Ecdysone induced protein 93F (E93) and consequently prevents the juvenile-to-adult transition. In adult insects, phosphorylated Kr-h1 recruits a coactivator, CREB-binding protein (CBP), and promotes vitellogenesis by inducing the expression of Ribosomal protein L36. Furthermore, Kr-h1 phosphorylation with the concomitant inhibition of E93 transcription is evolutionarily conserved across insect orders.

Conclusion
Our results suggest that Kr-h1 phosphorylation is indispensable for the recruitment of transcriptional cofactors, and for its anti-metamorphic and vitellogenic actions in insects. Our data shed new light on the understanding of Kr-h1 regulation and function in JH-regulated insect metamorphosis and reproduction.
Cost-effectiveness evaluation of add-on dapagliflozin for heart failure with reduced ejection fraction from perspective of healthcare systems in Asia–Pacific region
Authors: Liao Chia-Te , Yang Chun-Ting , Toh Han Siong , Chang Wei-Ting , Chang Hung-Yu , Kuo Fang-Hsiu , Lee Mei-Chuan , Hua Yi-Ming , Tang Hsin-Ju , Strong Carol , Ou Huang-Tz 
Published: October 2021

Abstract
Background
With emerging evidence on the efficacy of adding dapagliflozin to standard care for patients with heart failure with reduced ejection fraction (HFrEF), this study assessed the cost-effectiveness of add-on dapagliflozin to standard care versus standard care alone for HFrEF from the perspective of healthcare systems in the Asia–Pacific region.

Methods
A Markov model was applied to project the outcomes of treatment in terms of lifetime medical cost and quality-adjusted life-years. The transition probabilities between health states in the model were obtained from the Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction trial. Country-specific costs and utilities were extracted for modeling. The incremental cost-effectiveness ratio against a country-specific willingness-to-pay threshold was applied to determine the cost-effectiveness of treatment. A series of sensitivity analyses were performed to ensure the robustness of the study results. Costs are presented in 2020 United States dollars.

Results
The incremental cost-effectiveness ratios for add-on dapagliflozin versus standard care alone were $5277, $9980, $12,305, $16,705, and $23,227 per quality-adjusted life-year gained in Korea, Australia, Taiwan, Japan, and Singapore, respectively. When using add-on dapagliflozin to standard care versus standard care alone, ~ 100% of simulations were cost-effective at a willingness-to-pay threshold of one gross domestic product per capita of the given Asia–Pacific country; however, the probability of being cost-effective for using add-on dapagliflozin decreased when the time horizon for simulation was restricted to 18 months and when the cardiovascular mortality for the two treatments (43.8% and 33.0%, respectively) was assumed to be the same. The cost-effectiveness results were most sensitive to cardiovascular mortality of treatment.

Conclusions
Adding dapagliflozin to standard care is cost-effective for HFrEF in healthcare systems in the Asia–Pacific region, which supports the rational use of dapagliflozin for HFrEF in this region.
Pathogenic fungi infection attributes of malarial vectors Anopheles maculipennis and Anopheles superpictus in central Iran
Authors: Moosa-Kazemi Seyed Hassan , Asgarian Tahereh Sadat , Sedaghat Mohammad Mehdi , Javar Saeedeh 
Published: October 2021

Abstract
Background
Due to the effect of synthetic and commercial insecticides on non-target organisms and the resistance of mosquitoes, non-chemical and environmentally friendly methods have become prevalent in recent years. The present study was to isolate entomopathogenic fungi with toxic effects on mosquitoes in natural larval habitats.

Methods
Larvae of mosquitoes were collected from Central, Qamsar, Niasar, and Barzok Districts in Kashan County, Central Iran by standard dipping method, from April to late December 2019. Dead larvae, live larvae showing signs of infection, and larvae and pupae with a white coating of fungal mycelium on the outer surface of their bodies were isolated from the rest of the larvae and sterilized with 10% sodium hypochlorite for 2 min, then washed twice with distilled water and transferred to potato-dextrose-agar (PDA) and water-agar (WA) media and incubated at 25 ± 2 °C for 3–4 days. Larvae and fungi were identified morphologically based on identification keys.

Results
A total of 9789 larvae were collected from urban and rural areas in Kashan County. Thirteen species were identified which were recognized to belong to three genera, including Anopheles (7.89%), Culiseta (17.42%) and Culex (74.69%). A total of 105 larvae, including Anopheles superpictus sensu lato (s.l), Anopheles maculipennis s.l., Culex deserticola, Culex perexiguus, and Culiseta longiareolata were found to be infected by Nattrassia mangiferae, Aspergillus niger, Aspergillus fumigatus, Trichoderma spp., and Penicillium spp. Of these, Penicillium spp. was the most abundant fungus isolated and identified from the larval habitats, while An. superpictus s.l. was the most infected mosquito species.

Conclusions
Based on the observations and results obtained of the study, isolated fungi had the potential efficacy for pathogenicity on mosquito larvae. It is suggested that their effects on mosquito larvae should be investigated in the laboratory. The most important point, however, is the proper way of exploiting these biocontrol agents to maximize their effect on reducing the population of vector mosquito larvae without any negative effect on non-target organisms.
Sharp loss: a new loss function for radiotherapy dose prediction based on fully convolutional networks
Authors: Bai Xue , Zhang Jie , Wang Binbing , Wang Shengye , Xiang Yida , Hou Qing 
Published: October 2021

Abstract
Background
Neural-network methods have been widely used for the prediction of dose distributions in radiotherapy. However, the prediction accuracy of existing methods may be degraded by the problem of dose imbalance. In this work, a new loss function is proposed to alleviate the dose imbalance and achieve more accurate prediction results. The U-Net architecture was employed to build a prediction model. Our study involved a total of 110 patients with left-breast cancer, who were previously treated by volumetric-modulated arc radiotherapy. The patient dataset was divided into training and test subsets of 100 and 10 cases, respectively. We proposed a novel ‘sharp loss’ function, and a parameter γ was used to adjust the loss properties. The mean square error (MSE) loss and the sharp loss with different γ values were tested and compared using the Wilcoxon signed-rank test.

Results
The sharp loss achieved superior dose prediction results compared to those of the MSE loss. The best performance with the MSE loss and the sharp loss was obtained when the parameter γ was set to 100. Specifically, the mean absolute difference values for the planning target volume were 318.87 ± 30.23 for the MSE loss versus 144.15 ± 16.27 for the sharp loss with γ = 100 (p < 0.05). The corresponding values for the ipsilateral lung, the heart, the contralateral lung, and the spinal cord were 278.99 ± 51.68 versus 198.75 ± 61.38 (p < 0.05), 216.99 ± 44.13 versus 144.86 ± 43.98 (p < 0.05), 125.96 ± 66.76 versus 111.86 ± 47.19 (p > 0.05), and 194.30 ± 14.51 versus 168.58 ± 25.97 (p < 0.05), respectively.

Conclusions
The sharp loss function could significantly improve the accuracy of radiotherapy dose prediction.
Lipid biomarkers and Cancer risk - a population-based prospective cohort study in Taiwan
Authors: Chang Yu-Chen , Lin Chien-Ju , Yeh Tzu-Lin , Tsai Ming-Chieh , Hsu Le-Yin , Chien Kuo-Liong , Hsu Hsin-Yin 
Published: October 2021

Abstract
Background
Blood lipids are essential components for cellular growth. An inverse association between serum lipid levels and risk of cancer has led to a controversy among previous studies. The aim of this prospective cohort study was to investigate the association between blood lipids change and risk of cancer incidence.

Methods
A cohort of 4130 Taiwanese adults from the Taiwanese Survey on the Prevalence of Hypertension, Hyperglycemia, and Hyperlipidemia database underwent repeated examinations in 2002 and 2007. Six groups were established based on the combined baseline (lower/higher) and interval change (decreasing/stable/increasing) in plasma lipid levels. Multivariable Cox proportional hazard model was used to investigate the relationship between lipids change and all-cause cancer incidence.

Results
Two hundred and forty cancer events developed over a median follow-up of 13.4 years. Comparing these with individuals with decreasing lower-baseline lipid levels, cancer risk reduction was demonstrated in those with increasing lower-baseline total cholesterol (adjusted hazard ratio [aHR], 0.48; 95% confidence interval [CI], 0.27 to 0.85), low-density lipoprotein cholesterol (LDL-C; aHR, 0.56; 95% CI, 0.35 to 0.92), and non–high-density lipoprotein cholesterol (non-HDL-C) (aHR, 0.54; 95% CI, 0.31 to 0.92) levels. A decreased risk for cancer incidence also presented in participants with stable lower-baseline, decreasing and increasing higher-baseline LDL-C levels, and with decreasing and stable higher-baseline non-HDL-C levels.

Conclusions
The interval decline in lower-baseline total cholesterol, LDL-C, and non-HDL-C levels was linked to a higher risk for all-cause cancer incidence. More attention to a potential cancer risk may be warranted for an unexplained fall in serum lipids.
Simvastatin induced ferroptosis for triple-negative breast cancer therapy
Authors: Yao Xianxian , Xie Ruihong , Cao Yongbin , Tang Jing , Men Yongzhi , Peng Haibao , Yang Wuli 
Published: October 2021

AbstractTriple-negative breast cancer (TNBC), a management of aggressive breast cancer, remains an unmet medical challenge. Although a wave of efforts had spurred to design novel therapeutic method of TNBC, unpredictable prognosis with lacking effective therapeutic targets along with the resistance to apoptosis seriously limited survival benefits. Ferroptosis is a non-apoptotic form of cell death that is induced by excessive lipid peroxidation, which provide an innovative way to combat cancer. Emerging evidence suggests that ferroptosis plays an important role in the treatment of TNBC cells. Herein, a novel ferroptosis nanomedicine was prepared by loading simvastatin (SIM), a ferroptosis drug, into zwitterionic polymer coated magnetic nanoparticles (Fe3O4@PCBMA) to improve the therapeutic effect of TNBC. The as-obtained Fe3O4@PCBMA-SIM nanoparticles demonstrated more cytotoxicity against MDA-MB-231 than MCF-7 due to the higher expression of 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase (HMGCR), which demonstrated that statins could effectively kill TNBC. Further experiments showed that SIM could inhibit the expression of HMGCR to downregulate the mevalonate (MVA) pathway and glutathione peroxidase 4 (GPX4), thereby inducing cancer cell ferroptosis. What’s more, PCBMA endows Fe3O4@PCBMA longer blood circulation performance to enhance their accumulation at tumor sites. Given that Fe3O4 have proven for clinical applications by the U.S. Food and Drug Administration (FDA) and SIM could induce cancer cell ferroptosis, the developed Fe3O4@PCBMA-SIM nanosystem would have great potential in clinics for overcoming the drug resistance brought about by apoptotic drugs to cancer cells.
Comparison of content and psychometric properties for assessment tools used for brain tumor patients: a scoping review
Authors: Ģiga Lelde , Pētersone Anete , Čakstiņa Silva , Bērziņa Guna 
Published: October 2021

AbstractAimsTo determine the most frequently utilized functional status assessment instruments for patients with brain tumors, compare their contents, using the International Classification of Functioning, Disability and Health (ICF), and their psychometric properties.MethodsA scoping review was conducted to explore possible assessment instruments and summarize the evidence. A systematic literature search was performed for identification of the frequently used functional assessment tool in clinical trials in PubMed, ScienceDirect, and ProQuest databases. The content of most used instruments was linked to the ICF categories. The psychometric qualities of these assessment tools were systematically searched and analyzed.ResultsNine most used assessment tools in clinical trials were identified. The most frequently used assessment instrument is the Karnofsky Performance Scale, which is developed for a general assessment of oncological patients. Out of four self-assessment tools, two were disease-specific (EORTC QLQ-BN20 and FACT-Br), EORTC QLQ-C30 has been shown good psychometric properties in patients with brain tumors as well as in patients with various oncological diseases, similar to the SF-36, it is used in patients with brain tumors as well as in patients with various diseases. The Functional Independence Measure and the Barthel Index were two objective assessment tools that described functioning, but two were neuropsychological tests (MMSE and Trial Making Test). Two hundred eighty-three meaningful concepts were identified and linked to 102 most relevant second-level categories covering all components of the ICF. Forty-nine studies reporting psychometric properties of those nine assessment tools were identified, indicating good reliability and validity for all the instruments.ConclusionNine most frequently utilized functional status assessment instruments for patients with brain tumors represent all components of the ICF and have good psychometric properties. However, the choice of the tool depends on the clinical question posed and the aim of its use.
Preimplantation genetic testing for BRCA gene mutation carriers: a cost effectiveness analysis
Authors: Michaan Nadav , Leshno Moshe , Cohen Yoni , Safra Tamar , Peleg-Hasson Shira , Laskov Ido , Grisaru Dan 
Published: October 2021

Abstract
Background
Gynecologic oncologists should be aware of the option of conception through IVF/PGT-M for families with high BRCA related morbidity or mortality. Our objective was to investigate the cost-effectiveness of preimplantation genetic testing for selection and transfer of BRCA negative embryo in BRCA mutation carriers compared to natural conception.

Methods
Cost-effectiveness of two strategies, conception through IVF/PGT-M and BRCA negative embryo transfer versus natural conception with a 50% chance of BRCA positive newborn for BRCA mutation carriers was compared using a Markovian process decision analysis model. Costs of the two strategies were compared using quality adjusted life years (QALYs’). All costs were discounted at 3%. Incremental cost effectiveness ratio (ICER) compared to willingness to pay threshold was used for cost-effectiveness analysis.

Results
IVF/ PGT-M is cost-effective with an ICER of 150,219 new Israeli Shekels, per QALY gained (equivalent to 44,480 USD), at a 3% discount rate.

Conclusions
IVF/ PGT-M and BRCA negative embryo transfer compared to natural conception among BRCA positive parents is cost effective and may be offered for selected couples with high BRCA mutation related morbidity or mortality. Our results could impact decisions regarding conception among BRCA positive couples and health care providers.