bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Quality of Primary Care Performance in Private Sector Facilities in Nairobi, Kenya: A Cross-Sectional Descriptive Survey
Authors: Mohamoud Gulnaz , Mash Robert 
Published: September 2021

Abstract
BackgroundIntegrated health services with an emphasis on primary care are needed for effective primary health care and achievement of universal health coverage. The key elements of high quality primary care are first-contact access, continuity, comprehensiveness, coordination, and person-centredness. In Kenya, there is little information on these key elements and such information is needed to improve service delivery. This study aimed to evaluate the quality of primary care performance in a group of private sector clinics in Nairobi, Kenya.Methods A cross-sectional descriptive study adapted the Primary Care Assessment Tool for the Kenyan context and surveyed 412 systematically sampled primary care users, from 13 PC clinics. Data was analysed to measure 11 domains of primary care performance and two aggregated primary care scores using the Statistical Package for Social Sciences.Results Mean primary care score was 2.64 (SD=0.23) and the mean expanded primary care score was 2.68 (SD=0.19), implying poor overall performance. The domains of first contact-utilisation, coordination (information system), family-centredness and cultural competence had mean scores of >3.0 (acceptable to good performance). The domains of first contact (access), coordination, comprehensiveness (provided and available), ongoing care and community-orientation had mean scores of < 3.0 (poor performance). Older respondents (p=0.05) and those with higher affiliation to the clinics (p=0.01) were more likely to rate primary care as acceptable to good.Conclusion These primary care clinics in Nairobi had a poor overall performance. There was a report of acceptable-to-good performance in first-contact utilisation, the information systems, family centredness and cultural competence. However, patients rated first-contact access, ongoing care, coordination of care, comprehensiveness of services, community orientation and availability of a complete primary health care team, as poor. Performance could be improved by deploying family physicians, increasing the scope of practice to become more comprehensive, improving access after-hours and marketing the use of the clinics to the practice population.
The role of m6A RNA methylation-related lncRNAs in the prognosis and tumor immune microenvironment of papillary thyroid carcinoma
Authors: Wang WenLong , Shen Cong , Zhao Yunzhe , Sun Botao , Qiu Xiangyuan , Yin Shujuan , Li Xinying 
Published: September 2021

Abstract
Background: Emerging evidence has indicated that N6-methylandenosine (m6A) RNA methylation plays a critical role in cancer development. However, the function of m6A RNA methylation-related long noncoding RNAs (m6A-lncRNAs) in papillary thyroid carcinoma (PTC) has never been reported. This study aimed to investigate the role of m6A-lncRNAs in the prognosis and tumor immune microenvironment of PTC.Methods: The gene expression data of lncRNAs and 20 m6A methylation regulators with corresponding clinicopathological information download from the Cancer Genome Atlas database. Based on consensus clustering analysis, LASSO Cox regression, nivariate and multivariate Cox regression analysis were used to determine the role of m6A-lncRNA in the prognosis and tumor immune microenvironment of PTC.Results: Three subgroups (clusters 1, 2, and 3) were identified by consensus clustering of 19 prognosis-related m6A-lncRNA regulators，of which cluster 1 preferentially related with unfavorable prognosis, lower immune scores, and distinct immune infiltrate level. A risk-score model was established based on 8 prognosis-related m6A-lncRNAs. Patients with a high-risk score had a worse prognosis and the ROC indicated a reliable prediction performance for patients with PTC (AUC=0.802). As expected, the immune scores, infiltration levels of immune cells and ESTIMATE scores in the low-risk subgroups were notably higher (p < 0.001) compared with those of high-risk subgroups. Furthermore, GSEA analysis showed that tumor associated pathways, hallmarks, and biological processes were remarkably enriched in the high-risk subgroup. Further analysis indicated that the risk score and age were independent prognostic factors for PTC. An integrated nomogram was constructed that accurately predicted the survival status (AUC = 0.963). Moreover, a lncRNA–miRNA–mRNA regulated network was established based on seven prognosis-related m6A-lncRNAs. Additional, 30 clinical samples and different PTC cells were validated. Conclusions: This is the first study to reveal that m6A-lncRNAs play a vital role in the prognosis and TME of PTC. To a certain degree, m6A-lncRNAs can be considered as new, promising prognostic biomarkers and treatment targets.
Risk Stratification Model for Predicting Coronary Care Unit Readmission
Authors: Chen Tien-Yu , Tseng Chien-Hao , Wu Po-Jui , Chung Wen-Jung , Lee Chien-Ho , Wu Chia-Chen , Cheng Cheng-I 
Published: September 2021

Abstract
Background: Use of statistical models for assessing the clinical risk of readmission to medical and surgical intensive care units is well established. However, models for predicting risk of coronary care unit (CCU) readmission are rarely reported. Therefore, this study investigated the characteristics and outcomes of patients readmitted to CCU to identify risk factors for CCU readmission and to establish a scoring system for identifying patients at high risk for CCU readmission. Methods: Medical data were collected for 40,187 patients with a history of readmission to the CCU of a single multi‐center healthcare provider in Taiwan during 2010-2019. Characteristics and outcomes were compared between a readmission group and a non-readmission group. Data were segmented at a 9:1 ratio for model building and validation.Results: The number of patients with a CCU readmission history after transfer to a standard care ward was 2397 (5.9%). The twelve factors that had the strongest associations with CCU readmission were used to develop and validate a CCU readmission risk scoring and prediction model. When the model was used to predict CCU readmission, the receiver-operating curve characteristic was 0.7217 for risk score model group and 0.7316 for the validation group. A CCU readmission risk score was assigned to each patient. The patients were then stratified by risk score into low risk (-20-5), moderate risk (6-26) and high risk (27-33) cohorts check scores, which showed that CCU readmission risk significantly differed among the three groups.Conclusions: This study developed a model for estimating CCU readmission risk. By using the proposed model, clinicians can improve CCU patient outcomes and medical care quality.
The Integrity of Synthetic Magnesium Silicate in Charged Compounds
Authors: House Krystal , Hao Zhigang , Pan Long , O’Carroll Deirdre , xu shiyou , Liu Yuxin 
Published: September 2021

Abstract
Magnesium silicate is an inorganic compound which can be used as an ingredient in product formulations for many different purposes. Since its compatibility with other ingredients is critical for product quality and stability, it is essential to characterize the integrity of magnesium silicate in different solutions used for various product formulations. In this paper, we have determined the magnitude of dissociation of synthetic magnesium silicate in positive, neutral, and negative charged compounds using Scanning Electron Microscopy (SEM), Energy Dispersive X-ray Spectroscopy (EDS), and verified the results using Liquid Chromatography-High Resolution Mass Spectrometry (LC-HRMS). Negatively charged compounds were found to significantly impact magnesium silicate dissociation, resulting in physio-chemical separation between magnesium and silicate ions while the positively charged compound had a minor effect on dissociation due to ion competition, and the neutral compound did not have such an impact on magnesium silicate dissociation. Further, when the magnesium ions are dissociated from the synthetic magnesium silicate, the morphology is changed accordingly, and the structural integrity of the synthetic magnesium silicate is damaged. The results provide a scientific confidence and guidance for product development using the synthetic magnesium silicate.
Intraosseous Fluid Resuscitation Causes Systemic Fat Emboli in a Porcine Hemorrhagic Shock Model
Authors: Kristiansen Steinar , Storm Benjamin , Dahle Dalia , Josefsen Terje Domaas , Dypwik Knut , Nilsen Bent Aksel , Waage-Nielsen Erik 
Published: September 2021

Abstract
BackgroundIntraosseous cannulation can be life-saving when intravenous access cannot be readily achieved. However, it has been shown that the procedure may cause fat emboli to the lungs and brain. Fat embolization may cause serious respiratory failure and fat embolism syndrome. We investigated whether intraosseous fluid resuscitation in pigs in hemorrhagic shock caused pulmonary or systemic embolization to the heart, brain, or kidneys and if this was enhanced by open chest conditions.MethodsWe induced hemorrhagic shock in anesthetized pigs followed by fluid-resuscitation through bilaterally placed tibial intraosseous cannulas. A subgroup underwent median sternotomy with pericardiectomy and pleurotomy before hemorrhagic shock was induced. We used invasive hemodynamic and respiratory monitoring including Swan Ganz pulmonary artery catheter and transesophageal echocardiography and obtained biopsies from the lungs, heart, brain, and left kidney postmortem.ResultsAll pigs exposed to intraosseous infusion had pulmonary fat emboli in postmortem biopsies. Additionally, seven of twenty-one pigs had coronary fat emboli. None of the pigs with open chest had fat emboli in postmortem lung, heart, or kidney biopsies. During fluid-resuscitation, three pigs developed significant ST-elevations on ECG; all of these animals had coronary fat emboli on postmortem biopsies. ConclusionsSystemic fat embolism occurred in the form of coronary fat emboli in a third of the animals who underwent intraosseous fluid resuscitation. Open chest conditions did not increase the incidence of systemic fat embolization.
The Interaction Between Long Non-Coding RNA LINC01564 and POU2F1 Promotes the Proliferation and Metastasis of Gastric Cancer
Authors: Wang Jixu , Hou Futao , Tang Lusheng , Xiao Ke , Yang Tengfei , Wang Zhiqiang , Liu Gu 
Published: September 2021

Abstract
Background: An increasing number of studies have demonstrated that long non-coding RNAs (lncRNAs) serve as key regulators in tumor development and progression. However, only a few lncRNAs have been functionally characterized in gastric cancer (GC). Methods: Bioinformatics analysis was conducted to find lncRNAs that are associated with GC metastasis. RNA FISH, RIP, and RNA pull down assays were used to study the complementary binding of LINC01564 complementary to the 3’UTR of transcription factor POU2F1. The transcription activation of LINC01564 by POU2F1 as a transcription factor was examined by ChIP assay. In vitro assays such as MTT, cell invasion assay, and clonogenic assay were conducted to examined the impacts of LINC01564 and POU2F1 on GC cell proliferation and invasion. Experiments in vivo were performed to access the impacts of LINC01564 and POU2F1 on GC metastasis. Results: The results showed that LINC01564 complementary bound to the 3’UTR of POU2F1 to form an RNA duplex, whereby stabilizing POU2F1 mRNA and increasing the enrichment in cells. The level of LINC01564 was also increased by POU2F1 through transcription activation. In vitro assays showed that LINC01564 promoted the proliferation, invasion and migration of GC cells through increasing POU2F1. In vivo experiments indicate the promotion of GC proliferation and metastasis by the interaction between LINC01564 and POU2F1. Conclusion: Taken together, our results indicate that the interaction between LINC01564 and POU2F1 promotes the proliferation, migration and invasion of GC cells.
Correlation of MRI and Arthroscopic Findings With Clinical Outcome in Temporomandibular Joint Disorders: A Retrospective Cohort Study
Authors: Vervaeke Kobbe , Verhelst Pieter-Jan , Orhan Kaan , Lund Bodil , Benchimol Daniel , Cruyssen Fréderic Van der , De Laat Antoon , Jacobs Reinhilde , Politis Constantinus 
Published: September 2021

Abstract
Background: Arthroscopy is a minimally invasive diagnostic tool and treatment strategy in patients suffering from temporomandibular disorders (TMD) when conservative treatment fails. This study aimed to find specific variables on pre-operative MRI or during arthroscopy that could predict success of arthroscopic lysis and lavage.Methods: This retrospective analysis compared pre-operative maximum interincisal opening (MIO), pain and main complaint (pain, limited MIO or joint sounds) with results at short-term and medium-term follow-up (ST and MT respectively). Different variables scored on MRI or arthroscopy were used to make a stepwise regression model, subsequently a combined analysis was conducted using variables from both MRI and arthroscopy.Results: A total of 47 patients (50 joints) met the inclusion criteria. The main complaint improved by 62% and 53% at ST and MT respectively. The absolute or probable absence of a crumpled disc scored on MRI predicted success at ST and MT (p=0.0112 and p=0.0054), and remained significant at MT in the combined analysis (p=0.0078). Arthroscopic findings of degenerative joint disease predicted success at ST (p=0.0178), absolute or probable absence of discal reduction scored during arthroscopy significantly predicted success in the combined analysis at ST (p=0.0474).Conclusion: To improve selection criteria for patients undergoing an arthroscopic lysis and lavage of the TMJ, future research might focus on variables visualized on MRI. Although more research is needed, disc shape and in particular the absolute or probable absence of a crumpled disc might be used as predictive variable for success.
Workload Assessment of Medical Doctors at Primary Health Care Centers in the Duhok Governorate
Authors: Al-Dabbagh Samim Ahmed , Sulaiman Hushyar Musa , Abdulkarim Nazik Abdulrahman 
Published: September 2021

Abstract
Background: A shortage in human resources, particularly physicians, has become a challenge confronting health authorities in the Duhok governorate, as these resources are the key input for delivering health care. It has become necessary to identify the most appropriate scientifically sound method for having adequate staffing levels. This study aimed to forecast the required number of physicians to cope with the current workload at the main primary health care centers in the Duhok governorate.Methods: A cross-sectional study was adopted to collect data for one full year. Data collection included both primary and secondary data sources. A semi-structured questionnaire was developed to obtain information every month from health centers on activities related to training and leaves. Data analysis was performed using Workload Indicators of Staffing Need software.Results: Sixty-one primary health care centers met the final criteria for analysis. The study revealed physician shortages and inequity in the distribution of staffing. In these centers, 145 physicians lacked an adequate delivery of health services based on the workload imposed on them. The 'workload indicators of staffing need' ratio was 0.33, indicating high work pressure on medical doctors. Some centers offered more health care than others but had fewer doctors based on the current staffing practices. Conclusions: This study pointed out the importance for the public health sector and academic medical institutions to use Workload Indicators of Staffing Needs software in health policy administration to restructure their efforts to address the physician shortages and distribution imbalances at primary health care facilities.
Driving Pressure is Not Predictive of ARDS Outcome in Chest Trauma Patients Under Mechanical Ventilation
Authors: ramin severin , Arcelli Matteo , Bouchdoug Karim , Laumon Thomas , Duflos Camille , De Jong Audrey , Jaber Samir , Capdevila Xavier , Charbit Jonathan 
Published: September 2021

Abstract
Background: The relationship between the driving pressure of the respiratory system (ΔPrs) under mechanical ventilation and worse outcome has never been studied specifically in chest trauma patients. The objective of the present study was to assess in cases of chest trauma the relationship between ΔPrs and severity of acute respiratory distress syndrome (ARDS) or death and length of stay. Methods: A retrospective analysis of severe trauma patients (ISS >15) with chest injuries admitted to the Trauma Center from January 2010 to December 2018 was performed. Patients who received mechanical ventilation were included in our analysis. Mechanical ventilation parameters and ΔPrs were recorded during the stay in the intensive care unit. Association of ΔPrs and ARDS with mortality and outcomes was specifically studied at the onset of ARDS (ΔPrs-ARDS) by receiver operator characteristic curve analysis, Kaplan-Meier curves and multivariate analysis.Results: Among the 266 chest trauma patients studied, 194 (73%) developed ARDS. ΔPrs was significantly higher in the ARDS group versus in the no ARDS group (11.6±2.4 cm H2O vs 10.9±1.9 cm H2O, p=0.04). Among the patients with ARDS, no difference according to the duration of mechanical ventilation was found between the high ΔPrs group (ΔPrs-ARDS >14 cm H2O) and the low ΔPrs group (ΔPrs-ARDS ≤14 cm H2O), (p=0.75). ΔPrs-ARDS was not independently associated with the duration of mechanical ventilation (hazard ratio [HR], 1.006; 95% CI, 0.95–1.07; p=0.8) or mortality (HR, 1.07; 95% CI, 0.9–1.28; p=0.45).Conclusion: A high ΔPrs-ARDS was not significantly associated with an increase in mechanical ventilation duration or mortality risk in ARDS patients with chest trauma in contrast with medical patients.
Rapid Diagnosis of Biliary Atresia in Infants, a Multicenter Retrospective Analysis
Authors: Long Junshan , Dong Qi , Jiang Mingliang , Fu Cejun , Wang Yixi , Dong Kun , Zhang Jing , Dong Chunqiang 
Published: September 2021

Abstract
Background: Although the laboratory and imaging examinations of Biliary atresia (BA) has improved, some patients have not received timely diagnosis and treatment.Methods: 200 infants with BA and intrahepatic cholestasis(IC) from three centers were included in this study. Before an operation, the stool color and liver function were compared in infants with BA and IC within 90 days. Results: There were 115 patients with BA and 85 patients with IC seeing doctors within 90 days of age. The incidence rate of clay-colored stool, light-colored stool, and normal stool in the two groups was 58.3% vs. 17.7%, 39.1% vs. 65.9%, and 2.6% vs. 16.5%, and the difference was statistically significant (P<0.001). Compared with IC, the direct bilirubin (Dbil) and gamma glutamine transpeptidase (GGT) of BA was higher (PDbil =0.022, PGGT <0.001 ). According to ROC curve analysis, combined clay-colored stool, Dbil>75.3 umol/L and GGT>252 U/L, BA was diagnosed (AUC=0.911; 95% CI, 0.870 to 0.952), with the sensitivity of 88.7% and specificity of 80.0% was better than the single diagnosis (P<0.001).Conclusion: For infants within 90 days of age, stool color, Dbil, and GGT are simple and effective diagnostic indicators in BA.
The SNPs rs429358 and rs7412 of APOE gene are Association With Dyslipidemia but Not Cerebral Infarction in Northern Chinese Han population
Authors: GOU Dongyun , HE Sha , Yuan Mengwei , LIU Ziqian , WANG Yanyong , YANG Jie , xiaowei MA 
Published: September 2021

Abstract
BackgroundTo analyze the relationship between apolipoprotein E(APOE) (including the SNPs rs429358 and rs7412) gene and cerebral infarction(CI) in Northern Chinese Han population.Methods457 CI patients and 416 controls (without CI) in Chinese Han population were recruited for our study to test the SNPs by polymerase chain reaction (PCR)-fluorescence probe technique.ResultsThe distribution of APOE genotypes were in Hardy-Weinberg equilibrium, and the frequencies of ɛ4 allele orɛ4 containing were significantdifference between CI and control groups. Compared to ε2 or ε3 carriers, ε4 carriers had a high level of total cholesterol (TC) and low-density lipoprotein cholesterol(LDL-C) and high presenceof dyslipidemia in recruited peoples. And we found APOE ε4 allele was associated with an increased risk of dyslipidemia in the control and CI groups (OR = 2.232, 95% CI= 1.143-4.361, P<0.000; OR = 3.442, 95% CI= 1.885-6.284, P=0.019). However, further logistic regression showed that ɛ4 allele or carriers were not the independent risk factors of CI (OR = 2.232, 95% CI= 1.143-4.361, P=0.144; OR = 3.442, 95% CI= 1.885-6.284, P=0.162).ConclusionAPOE ε4 allele was associated with an increased risk of dyslipidemia (OR = 2.232, 95% CI= 1.143-4.361; OR = 3.442, 95% CI= 1.885-6.284), but ɛ4 allele or carriers were not the independent risk factors of CI in Northern Chinese Han population (OR = 2.232, 95% CI= 1.143-4.361, P=0.144; OR = 3.442, 95% CI= 1.885-6.284, P=0.162).
Correlation Between Salivary Microbiology and H2S Concentration of Oral Cavity
Authors: Jiang Jiarui , Huang Yufeng , Luo Na , Mi Qili , Li Xuemei , Zhang Wei , Zhu Baokun , Gao Qian 
Published: September 2021

Abstract
Background: Halitosis is caused by metabolites produced by oral microorganisms. Hydrogen sulfide is the most important compound that leads to the oral malodor, and is thought to be closely correlated with the activity of oral microorganism. Therefore, it is important to clarify the correlation between oral microbes and metabolites. Methods: Based on the 16S rRNA gene amplicon and shotgun metagenomic sequencing of oral microorganism, and oral malodor test, this study attempted to explain the contribution of oral microorganisms to the hydrogen sulfide of oral malodor. Results: The data shows that microbial taxa consisted in the H2S low and high groups are different, and most of the enriched taxa in the H2S high group are genus that correlated with H2S concentration. The two species Fusobaeterium periodonticum and Prevotella nanceiensis are significant different in both coverage breadth and depth and LPS biosynthesis contributions in two groups. According to KEGG metabolism pathways detected by HUMAnN2, subjects of the H2S high group may have a high risk to bacterial infection, since the LPS biosynthesis is enrichment. The contribution of F. periodonticum to sulfur metabolism between two groups is significantly different, and the relative abundance of F. periodonticum is higher in the H2S high group as well. Conclusions: The H2S content, is significantly associated with the composition and abundance of microorganisms in the oral cavity. The increase of microbial abundance and metabolism of some sulfide products are the main causes of halitosis. The most of the enriched microorganisms enriched in people with high H2S are associated with oral diseases such as caries and periodontal diseases, indicating that the diseases associated with oral microbes are not independent of each other and have some associations between some oral diseases.