bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multimorbidity and health literacy: A population-based survey among 28,627 Danish adults
Authors: Pedersen Sofie Emilie , Aaby Anna , Friis Karina , Maindal Helle Terkildsen 
Published: October 2021

Aim: Individuals with multimorbidity often have complex healthcare needs challenging their health literacy skills. This study aimed to investigate the association between the number of physical conditions and health literacy and to examine the difference in health literacy levels between individuals with multimorbidity based on physical conditions and individuals with additional mental disorders. Methods: Respondents aged 25 years or older from a Danish population-based survey were included ( N = 28,627). Multimorbidity was assessed based on 18 self-reported chronic conditions; health literacy was measured using two scales from the Health Literacy Questionnaire focusing on understanding health information and engaging with healthcare providers. Associations were examined using multiple logistic regression analysis. Results: We found a positive association between number of physical conditions and the odds of having difficulties in understanding health information and engaging with healthcare providers. For example, the adjusted odds ratio (OR) of having difficulties in understanding health information was 1.45 (95% confidence interval (CI): 1.09–1.94) for individuals with two physical conditions compared with individuals without multimorbidity. The associations formed a positive exposure–response pattern. Furthermore, respondents with both mental and physical conditions had more than twice the odds of having health literacy difficulties compared to respondents with only physical conditions (adjusted OR 2.53 (95% CI 2.02–3.18) and 2.28 (95% CI 1.92–2.72) for the scales, respectively). Conclusions: Our results suggest that responding to patients’ health literacy needs is crucial for individuals with multimorbidity – especially those with combined mental and physical conditions.
Parent–Child Interaction Therapy for a 3-Year-Old Girl With Post-Traumatic Stress Disorder: Restoration to Her Father’s Care Following a Period in Out-of-Home Care
Authors: Warren Jessica M. , Hanstock Tanya , Hunt Sally , Halpin Sean 
Published: October 2021

Child abuse and neglect in very young children can lead to trauma-related stress symptoms that can be challenging to treat. Children exposed to multiple traumas occurring in the context of a caregiving relationship are sometimes more severely affected, evidenced by diverse negative behavioral, physical, social, and emotional consequences. Some of these children go on to develop post-traumatic stress disorder (PTSD). Parent–child interaction therapy (PCIT) is a dyadic play-based treatment for children with behavior problems and their parents or caregivers. There is limited research relating to the application of PCIT with very young children with PTSD with some studies actively excluding families where PTSD was present (Herschell et al., 2017). Additionally, there are no articles relating to treatment of a child restored to the care of a parent following out-of-home care (OOHC) and fewer still relating to a child restored to the care of her father. This case study illustrates the use of PCIT with a 3-year-old girl with PTSD, recently restored to her father’s care. It highlights how the use of PCIT in this case not only improved behavioral indicators of traumatic stress, but also afforded this child permanency and stability. The case study provides a summary of the progression of this intervention and the results obtained throughout treatment and 4 years post-intervention. The results indicated that PCIT, with trauma-informed tailoring, was an effective treatment in this case and contributed to safe and permanent care for this child.
Capturing the Impact of Public Narrative: Methodological Challenges Encountered and Opportunities Opened
Authors: Aiello Emilia , Sorde-Marti Teresa 
Published: October 2021

Public narrative is a leadership practice of translating values into action. It links the three elements of self, us, and now: why I am called, why we are called, and why we are called to act now. Taught and learned for more than 15 years now through various learning environments (in-person or online courses, in-person or online workshops, etc.), the Narratives4Change research project (H2020, Nr. 841355) aimed at studying how public narrative is being used by individuals as a leadership practice within different domains of practice and across diverse cultural and geographical contexts, as well as what are the impacts achieved. An endeavor never carried before, capturing evidence of impact of public narrative going beyond the usage and transference posed several methodological challenges. To overcome them, we engaged in an on-going process of dialogue with researchers experienced in social impact analysis, and practitioners and leaders well experienced in using public narrative. Drawing on the work done in the framework of the Narratives4Change project, this article explains its methodological design, presenting and discussing two of the strategies adopted to capture the impact dimension, and how they were implemented. On the one hand, the communicative orientation of the mixed-methods research design of the project allowed researchers to empirically grasp the manifold agentic orientations that can be triggered by public narrative. On the other hand, how the Social Impact Open Repository criteria for social impact analysis was incorporated at the time of exploring and deepening into the social reality that was being observed sets us off on an “impact-oriented analytical mindset” that facilitated identifying evidence of impacts. Specific examples of how each of these strategies played out during the methodological design and implementation of the research are discussed, drawing lessons that can also inform the design of future research projects.
Oncology workload in a tertiary hospital during the COVID-19 pandemic
Authors: Chiang Jianbang , Yang Valerie , Han Shuting , Zhuang Qingyuan , Zhou Siqin , Mathur Sachin , Kang Mei Ling , Ngeow Joanne , Yap Swee Peng , Tham Chee Kian 
Published: October 2021

Introduction Workload in oncology during a pandemic is expected to increase as manpower is shunted to other areas of need in combating the pandemic. This increased workload, coupled with the high care needs of cancer patients, can have negative effects on both healthcare providers and their patients. Methods This study aims to quantify the workload of medical oncologists compared to internal medicine physicians and general surgeons during the current COVID-19 pandemic, as well as the previous H1N1 pandemic in 2009. Results Our data showed decrease in inpatient and outpatient workload across all three specialties, but the decrease was least in medical oncology (medical oncology −18.5% inpatient and −3.8% outpatient, internal medicine −5.7% inpatient and −24.4% outpatient, general surgery −17.6% inpatient, and −39.1% outpatient). The decrease in general surgery workload was statistically significant. The proportion of emergency department admissions to medical oncology increased during the COVID-19 pandemic. Furthermore, the study compared the workload during COVID-19 with the prior H1N1 pandemic in 2009 and showed a more drastic decrease in patient numbers across all three specialties during COVID-19. Discussion We conclude that inpatient and outpatient workload in medical oncology remains high despite an ongoing COVID-19 pandemic. The inpatient medical oncology workload is largely contributed by the stable number of emergency department admissions, as patients who require urgent care will present to a healthcare facility, pandemic or not. Healthcare systems should maintain manpower in medical oncology to manage this vulnerable group of patients in light of the prolonged COVID-19 pandemic.
Podocyte Infolding Glomerulopathy, First Case Report From North America
Authors: Ting Julie Anne , Hung Wayne , McRae Susanna A. , Barbour Sean J. , Copland Michael , Riazy Maziar 
Published: October 2021

Rationale: Podocyte infolding glomerulopathy (PIG) is a newly described condition with only 37 cases reported worldwide. Due to its rarity, the pathogenesis and evolution of this disease is unclear. This case report contributes to our collective knowledge about the clinical and histological progression of this disease. Presenting concerns of the patient: Over the course of a year, a 52-year-old Malaysian woman with no known prior medical history developed progressively worsening edema and other findings consistent with nephrotic syndrome. Diagnosis: Unlike most patients with PIG, this patient did not have any autoimmune disease. She was Hepatitis B core antibody positive with a Hepatitis B surface antibody >1000, suggesting prior Hepatitis B infection with immunity. A renal biopsy was performed which was consistent with PIG. A second renal biopsy was done 2 years later which again showed characteristic findings of PIG with worsened podocyte effacement but no interval change in chronicity. Interventions: The patient was treated with blood pressure control and renin-angiotensin-aldosterone system (RAAS) blockade with irbesartan and spironolactone. She was also treated with prednisone at 1 mg/kg for 2 months followed by a taper for a total of 7 months of prednisone treatment. Outcomes: The patient had a partial response to a course of prednisone. However, since stopping steroids, her proteinuria and renal function has been gradually worsening. Teaching points: PIG is mostly found in patients of East Asian descent. It presents as proteinuria and is often associated with autoimmune disease but can be idiopathic. It is characterized on renal biopsy by infolding or protrusion of podocyte cytoplasm into glomerular basement membrane, as well as intramembranous cytoplasmic microspherules or microtubules. Atypical membranous nephropathy should be ruled out prior to diagnosis. Unlike membranous nephropathy, PIG usually responds at least partially to steroid monotherapy. To our knowledge, this is the first reported case of PIG from North America. Furthermore, it is the first case of PIG with repeat biopsy showing interval worsening of PIG rather than either resolution of PIG or transformation of PIG to a different diagnosis.
Community Health Workers Improve Smoking Cessation When They Recruit Patients in Their Home Villages
Authors: Umnuaypornlert Adinat , Dede Adam J. O. , Pangtri Sudarat 
Published: October 2021

Introduction/Objective: Community health workers (CHWs) can play a vital role in many aspects of healthcare, particularly for underserved communities, but it is unclear what factors are most important in determining the success of CHW-based programs. We wanted to assess what factors contribute to the effectiveness of CHWs in a smoking cessation program. Methods: We trained CHWs in 3 areas regarding smoking cessation: knowledge, attitude, and practice (KAP). The training program utilized the 5A’s as approach. CHWs actively sought out people addicted to cigarettes to participate. Patients received support from CHWs and a team of medical professionals for a year. At the conclusion of the program, focus group discussions with a group of CHWs, a group of patients, and a group of medical professionals were conducted. Results: On average, patients reduced their cigarettes/day by 7.2% and 29% of patients were completely cigarette free at a 1-year follow-up. Patients marginally decreased exhalation CO levels and increased lung capacity. CHWs gained a good understanding of health risks associated with smoking and common methods to help quit. Their attitude became more sympathetic and caring. CHWs exhibited patient-specific solutions to help with smoking cessation and actively sought out people to participate in the smoking cessation program. Conclusions: A smoking cessation program combining CHWs and pharmacists was effective. Key factors were having CHWs that are respected and established in their communities, using CHWs who know their patients and can provide individually tailored solutions, and empowering CHWs with intensive training.
Degradation of paraquat herbicide using hybrid AOP process: statistical optimization, kinetic study, and estimation of electrical energy consumption
Authors: Ghavi Azam , Bagherian Ghadamali , Rezaei-Vahidian Hadi 
Published: October 2021

Abstract
Background
This work studied the performance of UV/PS/TiO2NPs and UV/PI/TiO2NPs as hybrid advanced oxidation processes for degradation of paraquat in aqueous solution, because this very toxic herbicide is used third most widely.

Results
The effects of several factors such as UV irradiation, initial oxidant concentration, TiO2 nanoparticles dosage, and pH on the degradation efficiency were investigated. The process optimization was performed by the central composite design as a tool of response surface methodology for 30 mgL−1 of the herbicide initial concentration at 25 ℃ and 40 min of degradation process. Based on the results, a degradation efficiency of 77% and 90% were obtained for the UV/PS/TiO2NPs and UV/PI/TiO2NPs processes, respectively, in the optimum conditions. The mineralization efficiency of the paraquat solution using UV/PS/TiO2NPs and UV/PI/TiO2NPs processes are about 32% and 55%, respectively, after 40 min. The kinetic studies show that both processes follow a pseudo-first-order kinetic model, and the kinetic constants are 0.0299 min−1 for the PS process and 0.0604 min−1 for the PI process. The electrical energy consumption was estimated to be about 481.60 kWhm−3 for the PS process and 238.41 kWhm−3 for the PI process.

Conclusions
The degradation and mineralization efficiency of the paraquat solution using the UV/PI/TiO2NPs process was more than that of the UV/PS/TiO2NPs process at the optimum conditions after 40 min.
A computational model of mutual antagonism in the mechano-signaling network of RhoA and nitric oxide
Authors: Surendran Akila , Forbes Dewey C. , Low Boon Chuan , Tucker-Kellogg Lisa 
Published: October 2021

Abstract
Background
RhoA is a master regulator of cytoskeletal contractility, while nitric oxide (NO) is a master regulator of relaxation, e.g., vasodilation. There are multiple forms of cross-talk between the RhoA/ROCK pathway and the eNOS/NO/cGMP pathway, but previous work has not studied their interplay at a systems level. Literature review suggests that the majority of their cross-talk interactions are antagonistic, which motivates us to ask whether the RhoA and NO pathways exhibit mutual antagonism in vitro, and if so, to seek the theoretical implications of their mutual antagonism.

Results
Experiments found mutual antagonism between RhoA and NO in epithelial cells. Since mutual antagonism is a common motif for bistability, we sought to explore through theoretical simulations whether the RhoA-NO network is capable of bistability. Qualitative modeling showed that there are parameters that can cause bistable switching in the RhoA-NO network, and that the robustness of the bistability would be increased by positive feedback between RhoA and mechanical tension.

Conclusions
We conclude that the RhoA-NO bistability is robust enough in silico to warrant the investment of further experimental testing. Tension-dependent bistability has the potential to create sharp concentration gradients, which could contribute to the localization and self-organization of signaling domains during cytoskeletal remodeling and cell migration.
RNA-Seq reveals different responses to drought in Neotropical trees from savannas and seasonally dry forests
Authors: Sobreiro Mariane B. , Collevatti Rosane G. , dos Santos Yuri L. A. , Bandeira Ludmila F. , Lopes Francis J. F. , Novaes Evandro 
Published: October 2021

Abstract
Background
Water is one of the main limiting factors for plant growth and crop productivity. Plants constantly monitor water availability and can rapidly adjust their metabolism by altering gene expression. This leads to phenotypic plasticity, which aids rapid adaptation to climate changes. Here, we address phenotypic plasticity under drought stress by analyzing differentially expressed genes (DEG) in four phylogenetically related neotropical Bignoniaceae tree species: two from savanna, Handroanthus ochraceus and Tabebuia aurea, and two from seasonally dry tropical forests (SDTF), Handroanthus impetiginosus and Handroanthus serratifolius. To the best of our knowledge, this is the first report of an RNA-Seq study comparing tree species from seasonally dry tropical forest and savanna ecosystems.

Results
Using a completely randomized block design with 4 species × 2 treatments (drought and wet) × 3 blocks (24 plants) and an RNA-seq approach, we detected a higher number of DEGs between treatments for the SDTF species H. serratifolius (3153 up-regulated and 2821 down-regulated under drought) and H. impetiginosus (332 and 207), than for the savanna species. H. ochraceus showed the lowest number of DEGs, with only five up and nine down-regulated genes, while T. aurea exhibited 242 up- and 96 down-regulated genes. The number of shared DEGs among species was not related to habitat of origin or phylogenetic relationship, since both T. aurea and H impetiginosus shared a similar number of DEGs with H. serratifolius. All four species shared a low number of enriched gene ontology (GO) terms and, in general, exhibited different mechanisms of response to water deficit. We also found 175 down-regulated and 255 up-regulated transcription factors from several families, indicating the importance of these master regulators in drought response.

Conclusion
Our findings show that phylogenetically related species may respond differently at gene expression level to drought stress. Savanna species seem to be less responsive to drought at the transcriptional level, likely due to morphological and anatomical adaptations to seasonal drought. The species with the largest geographic range and widest edaphic-climatic niche, H. serratifolius, was the most responsive, exhibiting the highest number of DEG and up- and down-regulated transcription factors (TF).
Fatal and nonfatal firearm injuries in the eastern Democratic Republic of Congo: a hospital-based retrospective descriptive cohort study assessing correlates of adult mortality
Authors: Budema Paul Munguakonkwa , Murhega Roméo Bujiriri , Tshimbombu Tshibambe Nathanael , Toha Georges Kuyigwa , Cikomola Fabrice Gulimwentuga , Mudekereza Paterne Safari , Mubenga Léon-Emmanuel , Maheshe-Balemba Ghislain , Badesire Darck Cubaka , Kanmounye Ulrick Sidney 
Published: October 2021

Abstract
Introduction
The Eastern Democratic Republic of Congo (DRC) has been the battleground for multiple armed conflicts, resulting in many fatal and nonfatal firearm injuries (F&NFFIs). Chronic insecurity has stressed the health system’s resources and created barriers to seeking, reaching, and receiving timely care further increasing the F&NFFI burden. Our institution is the largest trauma center in the region and receives the bulk of F&NFFI cases. We aimed to identify correlates of mortality in Congolese F&NFFI patients.

Methods
We included all F&NFFI patients admitted to our institution between 2017 and 2020. We extracted data from patient charts and admission logs. We identified mortality correlates using the two-sample t-test, Chi-square test, and multivariable regression analysis. A P-value of less than 0.05 was considered statistically significant.

Results
This study included 814 adult patients, mostly male (86%) with an average age of 34.5 years and living 154.4 km away from the hospital on average. The most affected anatomical sites were the lower limbs (48.2%) and upper limbs (23.2%). The median length of stay was 34.0 days, and the in-hospital mortality rate was 3.6%. In addition, mortality was negatively correlated with diastolic blood pressure (P = 0.01), SaO2 (P < 0.001), and hemoglobin concentration (P = 0.002).

Conclusion
F&NFFIs cause an enormous burden in the region, and mortality is correlated with some clinical and biological variables. Thus, the study findings will inform F&NFFI referral, triage, and management in low-resource and mass casualty settings.
Examining the association between paramedic transport to the emergency department and hospital admission: a population-based cohort study
Authors: Strum Ryan P. , Mowbray Fabrice I. , Worster Andrew , Tavares Walter , Leyenaar Matthew S. , Correia Rebecca H. , Costa Andrew P. 
Published: October 2021

Abstract
Background
Increasing hospitalization rates present unique challenges to manage limited inpatient bed capacity and services. Transport by paramedics to the emergency department (ED) may influence hospital admission decisions independent of patient need/acuity, though this relationship has not been established. We examined whether mode of transportation to the ED was independently associated with hospital admission.

Methods
We conducted a retrospective cohort study using the National Ambulatory Care Reporting System (NACRS) from April 1, 2015 to March 31, 2020 in Ontario, Canada. We included all adult patients (≥18 years) who received a triage score in the ED and presented via paramedic transport or self-referral (walk-in). Multivariable binary logistic regression was used to determine the association of mode of transportation between hospital admission, after adjusting for important patient and visit characteristics.

Results
During the study period, 21,764,640 ED visits were eligible for study inclusion. Approximately one-fifth (18.5%) of all ED visits were transported by paramedics. All-cause hospital admission incidence was greater when transported by paramedics (35.0% vs. 7.5%) and with each decreasing Canadian Triage and Acuity Scale level. Paramedic transport was independently associated with hospital admission (OR = 3.76; 95%CI = 3.74–3.77), in addition to higher medical acuity, older age, male sex, greater than two comorbidities, treatment in an urban setting and discharge diagnoses specific to the circulatory or digestive systems.

Conclusions
Transport by paramedics to an ED was independently associated with hospital admission as the disposition outcome, when compared against self-referred visits. Our findings highlight patient and visit characteristics associated with hospital admission, and can be used to inform proactive healthcare strategizing for in-patient bed management.