bluuebunny/crossref_metadata_2025_split huggingface dataset:
Knowledge, attitude and experience of episiotomy practice among obstetricians and midwives: a cross-sectional study from China
Authors: Yang Jingxuan , Bai Hua 
Published: April 2021

ObjectiveEpisiotomy is still performed widely by obstetricians and midwives in some Chinese maternity units, but the reasons are unknown. This study aims to determine the knowledge, attitude and experience towards the practice of episiotomy among obstetricians and midwives in China’s public hospitals and consider strategies to reduce its practice.MethodsA cross-sectional web survey using a self-administered questionnaire was conducted among obstetricians and midwives in 90 public hospitals in Henan Province, China.Results900 (82.21%) participants completed the questionnaire. Average knowledge level (4.15, SD=1.10) on complications and overuse was identified among participants. Episiotomy was performed more frequently in secondary hospitals than in tertiary hospitals (p<0.05). Senior clinicians were more likely to perform episiotomy than younger ones (p<0.05). Almost half of the clinicians (42.11%) considered the current rate of episiotomy (45%) to be right or too low. The most common reason for performing episiotomy identified by obstetricians (83.94%) and midwives (79.69%) was to reduce third-degree or fourth-degree perineal laceration. Both obstetricians (80.29%) and midwives (82.57%) agreed that the most significant obstacle to reducing the rate of episiotomy was lack of training on reducing perineal tears.ConclusionIn sum, episiotomy was driven by previous training, practitioners’ experience and local norms rather than the latest medical evidence. Clinicians in secondary hospitals and senior clinicians are key training targets. It is urgent to improve current clinical policies and surgical procedure guidelines for obstetricians and midwives regarding episiotomy.
Palliative medicine integration in the USA: cancer centre executives’ attitudes
Authors: Chen Joseph , de la Rosa Allison , Lai Dejian , Dev Rony , Revere Frances Lee , Lairson David , Wermuth Paige , Bruera Eduardo , Hui David 
Published: April 2021

ObjectivesTo compare cancer centre (CC) executives’ attitudes towards palliative care between National Cancer Institute-designated CCs (NCI-CCs) and non-NCI-designated CCs (non-NCI-CCs) in 2018 and to examine the changes in attitudes and beliefs between 2009 and 2018.MethodsCC chief executives at all NCI-CCs and a random sample of non-NCI-CCs were surveyed from April to August 2018. Twelve questions examined the executives’ attitudes towards palliative care integration, perceived barriers and self-assessments. The primary outcome was agreement on the statement ‘a stronger integration of palliative care services into oncology practice will benefit patients at my institution.’ Survey findings from 2018 were compared with data from 2009 to examine changes in attitudes.Results52 of 77 (68%) NCI-CCs and 88 of 126 (70%) non-NCI-CCs responded to the survey. A vast majority of executives at NCI-CCs and non-NCI-CCs endorsed palliative care integration (89.7% vs 90.0%; p>0.999). NCI-CCs were more likely to endorse increasing funding for palliative care (52.5% vs 23.1%; p=0.01) and hiring physician specialists (70.0% vs 37.5%; p=0.004) than non-NCI-CCs. The top three perceived barriers among NCI-CCs and non-NCI-CCs were limited institutional budgets (57.9% vs 59.0%; p=0.92), poor reimbursements (55.3% vs 43.6%; p=0.31), and lack of adequately trained palliative care physicians and nurses (52.6% vs 43.6%; p=0.43). Both NCI-CCs and non-NCI-CCs favourably rated their palliative care services (89.7% vs 71.8%; p=0.04) with no major changes since 2009.ConclusionCC executives endorse integration of palliative care, with greater willingness to invest in palliative care among NCI-CCs. Resource limitation continues to be a major barrier.
Surgical treatment for infective endocarditis in the ageing society: a nationwide retrospective study in Japan
Authors: Kiriyama Hiroyuki , Kaneko Hidehiro , Itoh Hidetaka , Kamon Tatsuya , Morita Kojiro , Jo Taisuke , Fujiu Katsuhito , Daimon Masao , Takeda Norifumi , Morita Hiroyuki , Yasunaga Hideo , Komuro Issei 
Published: April 2021

ObjectiveThe current status of surgical treatment for infective endocarditis (IE) among very elderly people is unclear.MethodsWe extracted data on patients in Japan with community-acquired IE who were admitted and discharged between April 2010 and February 2018 using a nationwide inpatient, the Diagnosis Procedure Combination database. We divided patients into three groups: non-elderly (<65 years), elderly (65–79 years) and very elderly (≥80 years). A 1:1 propensity score matching was performed to compare proportions of surgical treatment and in-hospital mortality among the groups.ResultsWe identified 20 667 eligible patients (median age 70 years, 61.0% men). The proportion of very elderly patients significantly increased (19.1% in 2010 to 29.7% in 2018). The proportion of surgical treatment was significantly lower, and in-hospital mortality was significantly higher in very elderly patients. This tendency was more pronounced among patients with in-hospital complications such as heart failure, stroke or embolism. Surgical treatment was significantly associated with lower in-hospital mortality even in very elderly patients, both in an unmatched (OR 0.61; 95% CI 0.47 to 0.78) and a propensity score matched cohort (OR 0.61; 95% CI 0.43 to 0.85).ConclusionsThe proportion of very elderly patients with IE was increasing, and very elderly patients had higher in-hospital mortality. The proportion of surgical treatment for IE among very elderly patients was low, but it was associated with lower in-hospital mortality. Further studies are needed to establish the optimal strategy for IE among very elderly patients.
Chapter 7.4 Active volcanoes in Marie Byrd Land
Authors: Dunbar N. W. , Iverson N. A. , Smellie J. L. , McIntosh W. C. , Zimmerer M. J. , Kyle P. R. 
Published: April 2021

Abstract

Two volcanoes in Marie Byrd Land, Mount Berlin and Mount Takahe, can be considered active, and a third, Mount Waesche, may be as well; although the chronology of activity is less well constrained. The records of explosive activity of these three volcanoes is well represented through deposits on the volcano flanks and tephra layers found in blue ice areas, as well as by the presence of cryptotephra layers found in West and East Antarctic ice cores. Records of effusive volcanism are found on the volcano flanks but some deposits may be obscured by pervasive glacerization of the edifices. Based on a compilation of tephra depths–ages in ice cores, the activity patterns of Mount Takahe and Mount Berlin are dramatically different. Mount Takahe has erupted infrequently over the past 100 kyr. Mount Berlin, by contrast, has erupted episodically during this time interval, with the number of eruptions being dramatically higher in the time interval between
c.
32 and 18 ka. Integration of the Mount Berlin tephra record from ice cores and blue ice areas over a 500 kyr time span reveals a pattern of geochemical evolution related to small batches of partial melt being progressively removed from a single source underlying Mount Berlin.
Absence does not mean absence: modern-day land use and the visibility of the archaeological record (the Kibbanahalli Palaeolithic Complex, southern India)
Authors: Srinivas Akash 
Published: April 2021

Abstract
Kibbanahalli is an important Lower Palaeolithic site-complex in southern Karnataka, a state in the southern region of Peninsular India. This region is crucial as it is somewhat centrally located between areas to the north, east and south, where decades of systematic Palaeolithic research has led to the establishment of firm cultural stratigraphy(ies) and even, in some cases, of chronology(ies). However, in stark contrast to these regions, southern Karnataka is often ignored in prehistoric research. Over 90 years of (intermittent) investigations at this site-complex have laid the foundations of our understanding of the Palaeolithic occupation of this region. It is of utmost importance to continue Palaeolithic research in this area as it is one of the fastest-growing industrializing and urbanizing zones of the world, with large population centres such as Bangalore (Bengaluru), Mysore (Mysuru) and others located here. Documenting the rich Palaeolithic heritage in this region before its eventual surrender to the forces of ‘development’ is thus a priority. Further, it is also necessary, if possible, to qualify and quantify the impact of these developmental processes on the visibility and preservation of the archaeological record, in general, and the Palaeolithic record, in particular, which might serve as a model for future research in similar regions. These recent investigations have led to the identification of many new Palaeolithic localities, and a secure identification of the technological attribution of their lithic assemblages. The presence of a uniform stratigraphic association of the archaeological horizon and similarities in their lithic collections has led to the reclassification of the many localities at Kibbanahalli and its vicinity into a site-complex. This paper reports on a series of field observations and remotely sensed data collected to understand the distribution pattern of the various Palaeolithic localities of this site-complex. Results of this study highlight the critical role played by modern-day land-use patterns on the observed distribution of the archaeological record, as well as its visibility. This observation challenges previous interpretations regarding the settlement patterns and strategies suggested for the Palaeolithic occupation of this region. Further, this study draws attention to the need and necessity to understand the role of various site formation processes, especially modern-day land-use activities, on the observed and observable patterns in the archaeological record, as well as the visibility, or lack thereof, of the archaeological record.
Potential Predictors of Poor Prognosis among Severe COVID-19 Patients: A Single-Center Study
Authors: Ghaith Mazen M. , Albanghali Mohammad A. , Aldairi Abdullah F. , Iqbal Mohammad S. , Almaimani Riyad A. , AlQuthami Khalid , Alqasmi Mansour H. , Almaimani Wail , El-Readi Mahmoud Zaki , Alghamdi Ahmad , Almasmoum Hussain A 
Published: April 2021

Background. Timely detection of the progression of the highly contagious coronavirus disease (COVID-19) is of utmost importance for management and intervention for patients in intensive care (ICU). Aim. This study aims to better understand this new infection and report the changes in the various laboratory tests identified in critically ill patients and associated with poor prognosis among COVID-19 patients admitted to the ICU. Methods. This was a retrospective study that included 160 confirmed SARS-CoV-2-positive patients. Results. Elevated serum ferritin, D-dimer, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and nonconjugated bilirubin levels were present in 139 (96%), 131 (96%), 107 (68%), 52 (34%), and 89 (70%) patients, respectively. Renal parameters were abnormal in a significant number of cases with elevated creatinine and blood urea nitrogen in 93 (62%) and 102 (68%) cases, respectively. Hematological profiles revealed lower red blood cell count, hemoglobin, eosinophils, basophils, monocytes, and lymphocytes in 90 (57%), 103 (65%), 89 (62%), 105 (73%), 35 (24%), and 119 (83%) cases, respectively. The neutrophil count was found to increase in 71.3% of the cases. There was significantly higher mortality (83%) among patients older than 60 years

p
=
0.001

and in female patients (75%)

p
=
0.012

. Patients with lung diseases had a poor outcome compared to patients with other comorbidities

p
=
0.002

. There was a significant association between elevated D-dimer levels and increased mortality

p
=
0.003

. Elevated levels of AST, creatinine, blood urea nitrogen, and bilirubin were significantly associated with unfavorable outcomes. Conclusion. Different parameters can be used to predict disease prognosis, especially the risk of poor prognosis. Accurate diagnosis and monitoring of disease progression from the early stages will help in reducing mortality and unfavorable outcomes.
FDA Approval Summary: Pembrolizumab for the First-line Treatment of Patients with MSI-H/dMMR Advanced Unresectable or Metastatic Colorectal Carcinoma
Authors: Casak Sandra J. , Marcus Leigh , Fashoyin-Aje Lola , Mushti Sirisha L. , Cheng Joyce , Shen Yuan-Li , Pierce William F. , Her Leah , Goldberg Kirsten B. , Theoret Marc R. , Kluetz Paul G. , Pazdur Richard , Lemery Steven J. 
Published: April 2021

Abstract
The FDA approved pembrolizumab on June 29, 2020, for the treatment of patients with unresectable or metastatic microsatellite instability-high (MSI-H) colorectal cancer with no prior systemic treatment for advanced disease. The approval was based on data from Study Keynote-177, which randomly allocated patients to receive either pembrolizumab or standard of care (SOC) with chemotherapy. Overall survival (OS) and independently assessed progression-free survival (PFS) were the primary endpoints. At the time of the final PFS analysis and second prespecified interim OS analysis, the estimated median PFS was 16.5 months (95% CI: 5.4–32.4) versus 8.2 months (95% CI: 6.1–10.2) in the pembrolizumab and SOC arms, respectively [HR: 0.60 (95% CI: 0.45–0.80); two-sided P = 0.0004]. FDA assessed unblinded OS data during the review of the application and identified no safety concerns that would preclude approval of this supplement. Adverse reactions occurring in &gt;30% of patients receiving pembrolizumab were diarrhea, fatigue/asthenia, and nausea. Adverse reactions occurring in &gt;30% of patients receiving SOC were diarrhea, nausea, fatigue/asthenia, neutropenia, decreased appetite, peripheral neuropathy (high-level term), vomiting, abdominal pain, constipation, and stomatitis. Duration of treatment in the pembrolizumab arm was almost double (median 11.1 months, range 0–30.6 months) than the duration of treatment in patients receiving SOC (median, 5.7 months). Approval of pembrolizumab is likely to change the treatment paradigm for first-line treatment with MSI-H advanced colorectal cancer given the study results and different safety profile.
Dianhydrogalactitol Overcomes Multiple Temozolomide Resistance Mechanisms in Glioblastoma
Authors: Jiménez-Alcázar Miguel , Curiel-García Álvaro , Nogales Paula , Perales-Patón Javier , Schuhmacher Alberto J. , Galán-Ganga Marcos , Zhu Lucía , Lowe Scott W. , Al-Shahrour Fátima , Squatrito Massimo 
Published: April 2021

Abstract
Glioblastoma (GBM) is the most frequent and aggressive primary tumor type in the central nervous system in adults. Resistance to chemotherapy remains one of the major obstacles in GBM treatment. Identifying and overcoming the mechanisms of therapy resistance is instrumental to develop novel therapeutic approaches for patients with GBM. To determine the major drivers of temozolomide (TMZ) sensitivity, we performed shRNA screenings in GBM lines with different O6-methylguanine-DNA methyl-transferase (MGMT) status. We then evaluated dianhydrogalactitol (Val-083), a small alkylating molecule that induces interstrand DNA crosslinking, as a potential treatment to bypass TMZ-resistance mechanisms. We found that loss of mismatch repair (MMR) components and MGMT expression are mutually exclusive mechanisms driving TMZ resistance in vitro. Treatment of established GBM cells and tumorsphere lines with Val-083 induces DNA damage and cell-cycle arrest in G2–M phase, independently of MGMT or MMR status, thus circumventing conventional resistance mechanisms to TMZ. Combination of TMZ and Val-083 shows a synergic cytotoxic effect in tumor cells in vitro, ex vivo, and in vivo. We propose this combinatorial treatment as a potential approach for patients with GBM.
New efficient GAF routing protocol using an optimized weighted sum model in WSN
Authors: Aznaoui Hanane , Ullah Arif , Raghay Said , Aziz Layla , Hayat Khan Mubashir 
Published: April 2021

<span>A wireless sensor network (WSN) composed by a large number of sensor nodes that are insufficient in terms of processing power, storage and energy. The principal tasks of nodes is gathering and transmitting data collected to the base station (BS). Consequently the major essential criteria for designing a WSN are the network lifetime. In this paper an efficient GAF routing protocol for gathered data is introduced. It proposes an energy-efficient routing in WSN based on the basic version. In this system sensor nodes are distributed using Gaussian law and an active leader is elected for each virtual grid to reduce the energy dissipated using an optimized weighted sum model where maximum remaining energy and minimum distance criteria are considered. Moreover routing data is based on transmission range for enhancing the energy efficiency during data routing. The experimental results shows that the proposed EE-GAF produces better performance than the existing GAF basic and optimized-GAF routing protocol in terms of number of dead node and energy consumption. It is obviously proves that the proposed EE-GAF can improve the network lifetime</span>
Design and analysis of RNS-based sign detector for moduli set {2^n, 2^n - 1, 2^n + 1}
Authors: Kumar Raj , Mishra Ram Awadh 
Published: April 2021

Magnitude comparison, sign detection and overflow detection are essential operations of residue number system (RNS) that are used in digital signal processing (DSP) applications. Moreover, sign detection attracts significant attention in RNS as it can also be used in division and magnitude comparison operations. However, these operations are not easy to perform in RNS. So, there is a need arise to propose a computationally advanced RNS based sign detector. This paper presents an area and power-efficient sign detection circuit for modulo {2<sup>n </sup>- 1, 2<sup>n</sup>, 2<sup>n</sup> + 1} using mixed radix conversion technique. The proposed sign detector is constructed using a carry save adder (CSA), a modified parallel prefix adder and a carry-generation circuit. Based on the synthesized results using synopsys design compiler, the introduced design offers better results in terms of the area required and power consumption. Although, the speed will remain the same when compared to the recent sign detectors for the same moduli set.
Mature Adult Mice With Exercise-Preconditioning Show Better Recovery After Intracerebral Hemorrhage
Authors: Kinoshita Keita , Hamanaka Gen , Ohtomo Ryo , Takase Hajime , Chung Kelly K. , Lok Josephine , Lo Eng H. , Katsuki Hiroshi , Arai Ken 
Published: April 2021

Background and Purpose:
Physical exercise offers therapeutic potentials for several central nervous system disorders, including stroke and cardiovascular diseases. However, it is still mostly unknown whether and how exercise preconditioning affects the prognosis of intracerebral hemorrhage (ICH). In this study, we examined the effects of preconditioning on ICH pathology in mature adult mice using treadmill exercise.

Methods:
Male C57BL/6J (25-week old) mice were subjected to 6 weeks of treadmill exercise followed by ICH induction. Outcome measurements included various neurological function tests at multiple time points and the assessment of lesion volume at 8 days after ICH induction. In addition, plasma soluble factors and phagocytotic microglial numbers in the peri-lesion area were also measured to determine the mechanisms underlying the effects of exercise preconditioning.

Results:
The 6-week treadmill exercise preconditioning promoted recovery from ICH-induced neurological deficits in mice. In addition, mice with exercise preconditioning showed smaller lesion volumes and increased numbers of phagocytotic microglia. Furthermore, the levels of several soluble factors, including endostatin, IGFBP (insulin-like growth factor-binding protein)-2 and -3, MMP (matrix metallopeptidase)-9, osteopontin, and pentraxin-3, were increased in the plasma samples from ICH mice with exercise preconditioning compared with ICH mice without exercise.

Conclusions:
These results suggest that mice with exercise preconditioning may suffer less severe injury from hemorrhagic stroke, and therefore, a habit of physical exercise may improve brain health even in middle adulthood.
Cerebral Hemodynamics and Executive Function in Sickle Cell Anemia
Authors: Prussien Kemar V. , Compas Bruce E. , Siciliano Rachel E. , Ciriegio Abagail E. , Lee Chelsea A. , Kassim Adetola A. , DeBaun Michael R. , Donahue Manus J. , Jordan Lori C. 
Published: April 2021

Background and Purpose:
Individuals with sickle cell anemia experience cognitive deficits, even in the absence of cerebral infarcts or strokes. This study tested the hypothesis that elevated cerebral blood flow and oxygen extraction fraction are associated with lower executive function in individuals with sickle cell anemia.

Methods:

Three-Tesla brain magnetic resonance imaging was performed, including anatomic, gray matter cerebral blood flow, and global oxygen extraction fraction imaging. Executive function was measured using the working memory index from an age-appropriate Wechsler battery and tasks from the National Institutes of Health Toolbox Cognition Battery. Bivariate and multivariate models were examined (significance:
P
<0.05).

Results:
Fifty-four participants (age range=6–31 years) with sickle cell anemia were enrolled. Hematocrit was positively related to fluid cognition, cerebral blood flow was inversely related to working memory and inhibitory control, and oxygen extraction fraction was inversely related to processing speed. Associations remained significant in multivariate analyses controlling for age, income, and infarcts.

Conclusions:
Elevated cerebral blood flow and oxygen extraction fraction, markers of hemodynamic impairment, are associated with deficits in executive function in individuals with sickle cell anemia.
Denominational Mobility among Palestinian Christians
Authors: Parkkinen Mari 
Published: April 2021

Abstract
This article examines denominational mobility – switching or crossing denominational lines – among Palestinian Christians in Palestine. The study uses qualitative methods and content-driven analysis of interviews with thirty-five Palestinian Christians, conducted in February, March, April and November 2017. The results suggest that denominational mobility is happening among Palestinian Christians between Orthodox, Catholic, mainline Protestant, and Evangelical communities. The analysis revealed three main motives for this denominational mobility: personal belief, marital and family reasons and socio/economic related reasons. Interviewees most often mentioned personal belief as the primary reason for denominational mobility, followed by marital or family matters. Additionally, within the population interviewed, young adults and women were the most mobile in their denominational affiliation. Furthermore, this research suggests that an individualistic impulse in denominational mobility is present within the Palestinian Christian community where denominational mobility traditionally is not encouraged.