bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cesarean delivery on maternal request and its influencing factors in Chongqing, China
Authors: Deng Ruibin , Tang Xian , Liu Jiaxiu , Gao Yuwen , Zhong Xiaoni 
Published: May 2021

AbstractBackgroundA high rate of cesarean delivery has become a cause of global concern. Although the rate of cesarean delivery has declined over recent years, it remains at a high level largely because of cesarean delivery on maternal request (CDMR). Unnecessary cesarean delivery has limited significance in benefiting maternal and infant physical health; in some ways, it might pose potential risks instead. With the implementation of the “Two-child Policy” in China, an increasing number of women plan to have a second child. Accordingly, how to handle the CDMR rate in China remains an important issue.MethodsData were collected from a longitudinal follow-up study conducted in Chongqing, China, from 2018 to 2019. A structured questionnaire was administered to subjects for data collection. Basic information, including demographic characteristics, living habits, medical history, and follow-up data of pregnant women, as well as their families and society, was collected. Additionally, delivery outcomes were recorded. Logistic regression was performed to analyze the factors influencing CDMR.ResultsThe rate of cesarean delivery in Chongqing, China was 36.01 %, and the CDMR rate was 8.42 %. Maternal request (23.38 %), fetal distress (22.73 %), and pregnancy complications (9.96 %) were the top three indications for cesarean delivery. Logistic regression analysis showed that older age (OR = 4.292, 95 % CI: 1.984–9.283) and being a primiparous woman (OR = 6.792, 95 % CI: 3.230-14.281) were risk factors for CDMR. In addition, CDMR was also associated with factors such as the tendency to choose cesarean delivery during late pregnancy (OR = 5.525, 95 % CI: 2.116–14.431), frequent contact with mothers who had undergone vaginal deliveries (OR = 0.547, 95 % CI: 0.311–0.961), and the recommendation of cesarean delivery by doctors (OR = 4.071, 95 % CI: 1.007–16.455).Conclusions“Maternal request” has become the primary indication for cesarean delivery. The occurrence of CDMR is related to both the personal factors of women during pregnancy and others. Medical institutions and obstetricians should continue popularizing delivery knowledge among pregnant women, enhancing their own professional knowledge about delivery, adhering to the standard indications for cesarean delivery, and providing pregnant women with adequate opportunities for attempting vaginal delivery.
Spinal arteriovenous malformation in a pediatric patient with a history of congenital syphilis: a case report
Authors: Bertoli Mia J. , Parikh Kruti , Klyde David , Mazzola Catherine A. , Pandya Shah Shridevi 
Published: May 2021

Abstract
Background
Spinal arteriovenous malformations in children are extremely rare and pose great risk for intraoperative hemorrhage. Congenital syphilis sometimes presents with vascular symptoms, however, there is little published on patients with a history of congenital syphilis presenting with spinal arteriovenous malformations.

Case presentation
A 15-month-old female with a history of congenital syphilis presented with urinary retention, fever, and subacute onset of paraplegia. MRI showed a lesion at T8-L1, angiogram was performed which confirmed the presence of a complex type IVc arteriovenous malformation and fistula from Artery of Adamkiewicz at L1-L2. It also showed peri medullary dilated veins and a pseudoaneurysm that compressed the spinal cord at T8-T10. Somatosensory evoked potentials and motor-evoked potentials were not recordable on the bilateral lower extremities prior to surgery. Once the patient was optimized for surgery, osteoplastic laminotomies from T6-T12 were performed. The dura was opened and the intradural, intramesenchymal hematoma was evacuated. There were two episodes of brisk arterial bleeding with hypotension during resection of the hematoma. The patient was taken to the angiography suite from the OR to successfully coil the large aneurysm. Intraoperative spinal cord monitoring remained undetectable in the bilateral lower extremities. The patient’s paraplegia remained unchanged from preoperative presentation.

Conclusion
Congenital syphilis may present with vascular changes that might impact surgical approaches and treatment outcomes in patients with spinal arteriovenous malformations. Preparation for massive transfusion and intraoperative monitoring are imperative in ensuring a safe perioperative experience.
High incidence of postoperative silent venous thromboembolism in ulcerative colitis: a retrospective observational study
Authors: Shimada Norimitsu , Ohge Hiroki , Kitagawa Hiroki , Yoshimura Kosuke , Shigemoto Norifumi , Uegami Shinnosuke , Watadani Yusuke , Uemura Kenichiro , Takahashi Shinya 
Published: May 2021

Abstract
Background
The incidence of postoperative venous thromboembolism (VTE) is high in patients with inflammatory bowel disease. We aimed to analyze the incidence and predictive factors of postoperative VTE in patients with ulcerative colitis.

Methods
Patients with ulcerative colitis who underwent colon and rectum surgery during 2010–2018 were included. We retrospectively investigated the incidence of postoperative VTE.

Results

A total of 140 colorectal surgery cases were included. Postoperative VTE was detected in 24 (17.1 %). Portal–mesenteric venous thrombosis was the most frequent VTE (18 cases; 75 %); of these, 15 patients underwent total proctocolectomy (TPC) with ileal pouch–anal anastomosis (IPAA). In univariate analysis, VTE occurred more frequently in patients with neoplasia than in those refractory to medications (27.2 % vs. 12.5 %; p < 0.031). TPC with IPAA was more often associated with VTE development (28 %) than total colectomy (10.5 %) or proctectomy (5.9 %). On logistic regression analysis, TPC with IPAA, total colectomy, long operation time (> 4 h), and high serum D-dimer level (> 5.3 µg/mL) on the day following surgery were identified as predictive risk factors.

Conclusions
Postoperative VTE occurred frequently and asymptomatically, especially after TPC with IPAA. Serum D-dimer level on the day after surgery may be a useful predictor of VTE.
A study of Chinese medical students’ communication pattern in delivering bad news: an ethnographic discourse analysis approach
Authors: Pun Jack 
Published: May 2021

Abstract
Background
Breaking bad news is inevitable for prospective doctors, it is important for medical students to learn how to humanely communicate devastating news to patients. This study explores the discourse strategies used by Chinese medical students when conducting critical conversations via role-play scenarios.

Methods
Fifty Year-6 medical students attending the ‘Serious Illness Communication Module’ were recruited from a local medical school in Hong Kong. They were asked to participate voluntarily in two role-play scenarios requiring them to break bad news to a simulated patient in Cantonese. The verbal interactions were video-recorded and analysed using an ethnographic discourse approach to unpack the quality of the observed interaction sequences and identify the discourse strategies strategically used by the medical students to overcome any communication breakdowns (e.g. linguistic expressions conveying diagnoses) and show empathy to patients.

Results
Six discourse strategies for delivering bad news were identified in the Chinese context: (1) placing great emphasis on patients’ emotional needs; (2) informing patients with a balanced focus on medical and emotional needs; (3) directing patients’ attention to treatment options; (4) acknowledging concerns about dying patients’ physical discomfort and wishes; (5) directing bad news disclosure to patients; and (6) addressing the family expectations of patients. The majority of the Chinese medical students in this study used a patient-oriented approach to cater to the patients’ emotional and physical needs. They also often informed and acknowledged the patients’ family members.

Conclusions
When delivering bad news, medical students should be equipped with discourse strategies that effectively balance interpersonal communication with the communication of medical expertise, which is integral to ensuring patients’ participation, their understanding and satisfaction with their clinicians. This is in accordance with the existing communication frameworks for critical conversation and demonstrates awareness of the needs in the Chinese context. However, some students demonstrated poor sensitivity to non-verbal cues, such as tone, manners and attitude. Thus, more training using a culturally appropriate model of communication for critical conversation should be promoted.
Development and validation of REAGERA-P, a new questionnaire to evaluate health care provider preparedness to identify and manage elder abuse
Authors: Simmons Johanna , Wenemark Marika , Ludvigsson Mikael 
Published: May 2021

Abstract
Background
Elder abuse is prevalent and associated with morbidity but often goes unnoticed in health care. Research on the health care response to victims calls for valid measurements. This article describes the development and validation of a questionnaire to evaluate health care provider preparedness to care for older adults subjected to abuse, the REAGERA-P (Responding to Elder Abuse in GERiAtric Care – Provider questionnaire).

Method
REAGERA-P was developed in phase I. The questionnaire includes a case vignette, self-efficacy scales for identifying and managing elder abuse cases and cause for concern as well as organizational barriers when talking with older patients about abuse. Content validity was ensured by a review committee, and cognitive interviews were conducted to ensure face validity and to examine cognitive processes to ensure comprehension. REAGERA-P was then administered to health care providers (n = 154, response rate 99 %) to test for construct validity. Factor analysis was performed, and internal consistency was tested for the self-efficacy scales. Convergent validity was tested by investigating associations between relevant variables. Some items were revised in phase II, and new cognitive interviews were performed. Parts of the questionnaire were tested for responsiveness by administering it to medical interns (n = 31, response rate 80 %) before and after an educational intervention.

Results
REAGERA-P showed good content and face validity. The factor analysis revealed two factors: one for asking questions about abuse (Cronbach’s α = 0.75) and one for managing the response to the questions (Cronbach’s α = 0.87). Results suggest good convergent validity for the self-efficacy scales and for questions about cause for concern and organizational barriers. The responsiveness of the self-efficacy scales was good: the mean on the scale for asking questions (range 0–30) was 15.0 before the intervention and 21.5 afterwards, the mean on the scale for managing the response (range 0–50) was 22.4 before the intervention and 32.5 afterwards.

Conclusion
REAGERA-P is a new questionnaire that can be used to evaluate health care provider preparedness to identify and manage cases of elder abuse, including educational interventions conducted among staff to improve health care responses to victims of elder abuse. This initial testing of the questionnaire indicates that the REAGERA-P has good validity.
Examining the role of environmental corporate social responsibility in building green corporate image and green competitive advantage
Authors: Alam S. M. Shafiul , Islam K. M. Zahidul 
Published: May 2021

AbstractGreen concern is making a profound impact on building green competitive advantage (GCA) across the globe. Apparel sector of Bangladesh is at crossroads regarding sustainability of firms. Green initiatives are thus required for ensuring the survival of apparel sector. The current study attempts to examine the interplay among environmental corporate social responsibility (ECSR) dimensions, green corporate image (GCI), and green competitive advantage of firms. To address the research topic, structural equation modeling approach has been adopted. Based on prior research findings, five hypotheses have been devised and finally evaluated by collecting data from 53 apparel firms enlisted with Dhaka Stock Exchange, Bangladesh. The study findings reveal that the ECSR dimensions have critical role to play over building GCI and GCA at the firm level. The study attempted to integrate ECSR, GCI, and GCA and contributes to the holistic understanding of the green anxieties of the business world. Understanding the critical role of ECSR, this study calls for proactive managerial actions regarding organizational sustainability.
Seasonal shifts in surface water-groundwater connections in a ferricrete-impacted stream estimated from electrical resistivity
Authors: Rickel Ariel , Hoagland Beth , Navarre-Sitchler Alexis , Singha Kamini 
Published: May 2021

The efficacy of the hyporheic zone (HZ) — where surface water and groundwater mix — for processing nutrients or the uptake of metals is dependent on the streambed hydraulic conductivity and stream discharge, among other characteristics. Here, we have explored electrical resistivity tomography (ERT) of hyporheic exchange in Cement Creek near Silverton, Colorado, which is affected by ferricrete precipitation. To quantify flows through the HZ, we have conducted 4 h salt injection tracer tests and collected time-lapse ERT of the streambed and banks of Cement Creek at high and low flow. We have installed piezometers to conduct slug tests, which suggest a low-permeability zone at 44 cm depth likely composed of ferricrete that cemented the cobbles together. Based on the ERT, the tracer released into the stream is constrained within the shallow streambed with little subsurface flow through the banks. The tracer is detected in the HZ for a longer time at high flow compared to low flow, suggesting that more flow paths were available to connect the stream to the HZ. The tracer is confined above the ferricrete layer during the high- and low-flow tests. Mass transfer and storage area parameters are calculated from combined analysis of apparent bulk conductivity derived from ERT and numerical modeling of the tracer breakthrough curves. The hyporheic storage area estimated at low discharge ([Formula: see text]) is smaller than that at high discharge ([Formula: see text]) and residence times are 2.7 h at low discharge and 4.1 h at high discharge. During high discharge, in-stream breakthrough curves display slower breakthrough and longer tails, which is consistent with the time-lapse electrical inversions and 1D transport with inflow and storage modeling. Our findings indicate that ferricrete reduces the hydraulic conductivity of the streambed and limits the areal extent of the HZ, which may lower the potential for pollutant attenuation from the metal-rich waters of Cement Creek.
An open-source framework for the implementation of large-scale integral operators with flexible, modern high-performance computing solutions: Enabling 3D Marchenko imaging by least-squares inversion
Authors: Ravasi Matteo , Vasconcelos Ivan 
Published: May 2021

Numerical integral operators of the convolution type form the basis of most wave-equation-based methods for the processing and imaging of seismic data. Because several of these methods require the solution of an inverse problem, multiple forward and adjoint passes of the modeling operator are generally required to converge to a satisfactory solution. We have highlighted the memory requirements and computational challenges that arise when implementing such operators on 3D seismic data sets and their use for solving large systems of integral equations. A Python framework is presented that leverages libraries for distributed storage and computing, and it provides a high-level symbolic representation of linear operators. A driving goal for our work is not only to offer a widely deployable, ready-to-use high-performance computing framework, but also to demonstrate that it enables addressing research questions that are otherwise difficult to tackle. To this end, the first example of 3D full-wavefield target-oriented imaging, which comprises two subsequent steps of seismic redatuming, is presented. The redatumed fields are estimated by means of gradient-based inversion using the full data set as well as spatially decimated versions of the data set as a way to investigate the robustness of both inverse problems to spatial aliasing in the input data set. Our numerical example shows that when one spatial direction is finely sampled, satisfactory redatuming and imaging can also be accomplished when the sampling in the other direction is coarser than a quarter of the dominant wavelength. Although aliasing introduces noise in the redatumed fields, they are less sensitive to well-known spurious artifacts compared to cheaper, adjoint-based redatuming techniques. These observations are shown to hold for a relatively simple geologic structure, and although further testing is needed for more complex scenarios, we expect them to be generally valid while possibly breaking down for extreme cases (e.g., highly heterogeneous/scattering media).
Performance of the Aldosterone to Renin Ratio as a Screening Test for Primary Aldosteronism
Authors: Hung Annie , Ahmed Sumaiya , Gupta Ankur , Davis Alexandra , Kline Gregory A , Leung Alexander A , Ruzicka Marcel , Hiremath Swapnil , Hundemer Gregory L 
Published: May 2021

Abstract

Context
The aldosterone to renin ratio (ARR) is the guideline-recommended screening test for primary aldosteronism. However, there are limited data in regard to the diagnostic performance of the ARR.

Objective
To evaluate the sensitivity and specificity of the ARR as a screening test for primary aldosteronism.

Methods
We searched the MEDLINE, Embase, and Cochrane databases until February 2020. Observational studies assessing ARR diagnostic performance as a screening test for primary aldosteronism were selected. To limit verification bias, only studies where dynamic confirmatory testing was implemented as a reference standard regardless of the ARR result were included. Study-level data were extracted and risk of bias and applicability were assessed using the QUADAS-2 tool.

Results
Ten studies, involving a total of 4110 participants, were included. Potential risk of bias related to patient selection was common and present in half of the included studies. The population base, ARR positivity threshold, laboratory assay, and reference standard for confirmatory testing varied substantially between studies. The reported ARR sensitivity and specificity varied widely with sensitivity ranging from 10% to 100% and specificity ranging from 70% to 100%. Notably, 3 of the 10 studies reported an ARR sensitivity of &lt;50%, suggesting a limited ability of the ARR to adequately identify patients with primary aldosteronism.

Conclusions
ARR performance varied widely based on patient population and diagnostic criteria, especially with respect to sensitivity. Therefore, no single ARR threshold for interpretation could be recommended. Limitations in accuracy and reliability of the ARR must be recognized in order to appropriately inform clinical decision-making.
FSH-stimulated Inhibin B (FSH-iB): A Novel Marker for the Accurate Prediction of Pubertal Outcome in Delayed Puberty
Authors: Chaudhary Shakun , Walia Rama , Bhansali Anil , Dayal Devi , Sachdeva Naresh , Singh Tulika , Bhadada Sanjay Kumar 
Published: May 2021

Abstract

Background
Clinicians have long been struggling to find an effective tool to predict onset of puberty.

Objective
To explore stimulability of inhibin B after exogenous FSH and its potential role for prediction of onset of puberty.

Design and participants
Study subjects were enrolled into “exploratory cohort” (n = 42) and “validation cohort” (n = 19). The exploratory cohort was further divided into group 1 (healthy children with spontaneous puberty [SP], n = 26) and group 2 (patients with hypogonadotropic hypogonadism [HH], n = 16). The validation cohort included children who presented with complaints of delayed puberty.

Intervention and outcome
Participants were subjected to FSH stimulation test and GnRH analogue stimulation test. Cutoffs derived from the exploratory cohort for basal and FSH stimulated inhibin B (FSH-iB) were applied on the validation cohort. Basal LH, GnRH analogue-stimulated LH, basal inhibin B, and FSH-iB were compared with clinical outcomes on a prospective follow-up for prediction of onset of puberty.

Results
There was statistically significant increment in inhibin B after exogenous FSH in group 1 (SP) in both male (188.8 pg/mL; P = 0.002) and female (1065 pg/mL; P = 0.023) subjects. The increment was not statistically significant in group 2 (HH) in both sexes. FSH-iB at a cutoff of 116.14 pg/mL in males and 116.50 pg/mL in females had 100% sensitivity and specificity for labelling entry into puberty. On application of these cutoffs on the validation cohort, FSH-iB had 100% positive predictive value, negative predictive value, and diagnostic accuracy for prediction of pubertal onset.

Conclusion
Inhibin B was stimulable in both male and female subjects. FSH-iB can be considered a novel and promising investigation for prediction of onset of puberty. Future studies are required for further validation.
A Unique Genotype of Pseudohypoaldosteronism Type 1b in a Highly Consanguineous Population
Authors: Alzahrani Ali S , Alswailem Meshael , Abbas Bassam Bin , Qasem Ebtesam , Alsagheir Afaf , Al Shidhani Azza , Al Sinani Aisha , Al Badi Maryam , Al-Maqbali Ali , Al Shawi Manal , Albunyan Abdulhameed , Bin Nafisah Abdulghani , Shi Yufei 
Published: May 2021

Abstract

Context
Pseudohypoaldosteronism (PHA) is a condition in which serum aldosterone level is normal or elevated but its action is deficient.

Objective
This study describes the molecular genetics of PHA 1b in the highly consanguineous population of 2 Arabian Gulf countries, Saudi Arabia and Oman.

Methods
This study enrolled 22 patients from 13 unrelated families (2 families with 5 patients from Oman and 11 families with 17 patients from Saudi Arabia). All of these patients had presented within the first 10 days of life with nausea and vomiting, hyponatremia, hyperkalemia, and hypotension. We isolated DNA from peripheral blood and PCR-sequenced all exons and exon-intron boundaries of SCNN1A and, if negative, SCNN1B and SCNN1G using the Dideoxy Chain termination method.

Results
We found a total of 8 mutations in 13 families as follows: 6 mutations in SCNN1A, 1 in SCNN1B, and 1 in SCNN1G. All of these mutations were novel except one. SCNN1A mutations were: c.1496A&gt;G, p.Q499R (novel) in 1 patient; c.1453C&gt;T, p.Q485X (novel) in 1 patient; c.1322_1322delA, p.N441Tfs*41 (novel) in 2 patients of 1 family; c.876 + 2 delGAGT (novel) in 3 patients of 1 family; c.203_204 delTC, p.I68Tfs*76 (a known mutation) in 8 patients of 5 families; and whole SCNN1A gene deletion (novel) in 2 patients of 2 families. In addition, a nonsense SCNN1B mutation c.1694C&gt;A, p.S565X (novel) was found in 3 siblings from 1 Omani family, and an SCNN1G deletion mutation c.527_528 delCA, p.T176Rfs*9 (novel) in 2 siblings from another Omani family.

Conclusion
We characterized a unique genotype of PHA 1b with several novel gene structure–disrupting mutations in SCNN1A, SCNN1B, and SCNN1G in a highly consanguineous population.