bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perceptions of Facilitators and Barriers to Mental Health Treatment Engagement Among Decision-making Competent Adolescents in Greece
Authors: Tsamadou Eftychia , Voultsos Polychronis , Emmanouilidis Anastasios , Ampatzoglou Grigorios 
Published: February 2021

Abstract
Background: A subset of adolescents with mental disorders are likely to be (share) decision making competent and hence can make their treatment engagement more effective. Treatment engagement is decisive in achieving successful outcomes. However, there are high rates of drop-out in mental health settings.Aim: This study aims at identifying barriers to or facilitators of mental health care engagement among adolescents with decision-making competence in Greece. Methods: Participants were adolescents in therapy for mental disorders recruited from an outpatient tertiary hospital setting. First, potential participants with decision making competence were identified. Second, 50 participants were interviewed about their perceptions of treatment. The interviews were auto-recorded. A transcription verbatim and data analysis were conducted. All the requirements of a qualitative research and ethical considerations were observed.Results: All the participants highlighted their experience with facilitators rather than barriers to their treatment engagement. Facilitators included: a) positive treatment outcomes and adolescent's perceived usefulness of treatment, b) a meaningful adolescent-therapist relationship, c) family’s supportive role, d) symptoms and negative self-image, and e) developing social relationships and acceptance by peers. The participants equally highlighted the importance of getting rid of their symptoms and improve their socialization skills. Other facilitators included: achieving professional and personal goals in life, enhancing their independence and self-esteem / self-image, or even just confessing to another trustworthy person. Friends were reported as having a neutral or mild supportive role. The barriers included ineffective and unhelpful treatment, negative experiences with their therapist, relief from symptoms and mental health therapy-related stigma. Conclusion: For the most part, the findings enhance prior studies. Participants highlighted facilitators rather than barriers to treatment engagement. For the most part, the findings enhance prior studies. However, we identified some nuances which might be used by therapists to enhance the adolescents’ treatment engagement. For instance, bearing in their mind that by the subsiding of symptoms adolescents are most likely to terminate the treatment prematurely and highlighting the achievement of adolescents’ future goals as well as the potential family’s enhanced well-being because of the improvement of adolescents’ mental health may contribute to reducing the attrition rate.
Contemporary Treatment Patterns and Survival of Cervical Cancer Patients in Ethiopia
Authors: Deressa Biniyam Tefera , Assefa Mathewos , Tafesse Ephrem , Kantelhardt Eva Johanna , Soldatovic Ivan , Cihoric Nikola , Rauch Daniel , Jemal Ahmedin 
Published: February 2021

Abstract
Background: Cervical cancer is the second commonly diagnosed cancer and the second leading cause of cancer death in women in Ethiopia, with rates among the highest worldwide. However, there are limited data on cervical cancer treatment patterns and survival in the country. Herein, we examine treatment patterns and survival of cervical cancer patients treated in Tikur Anbessa Hospital Radiotherapy Center (TAHRC), the only hospital with radiotherapy facility in the country. Methods: Women with histologically verified cervical cancer who were seen in 2014 at TAHRC were included. Information about clinical characteristics and treatments were extracted from the patients’ medical record files. The information on vital status was obtained from medical chart and through telephone calls. Result: Of the 349 cervical cancer patients treated at the radiotherapy center of TAHRC in 2014, medical records were retrieved for 242 patients. The median age at diagnosis was 48 years. The median waiting time for radiotherapy was 5.58 months. Stage migration occurred in 13% of patients while waiting for radiotherapy. Consequently, the proportion of patients with stage III or IV disease increased from 66% at first consultation to 74% at the initiation of radiotherapy. Among 151 patients treated with curative intent, only 34 (22.5%) of the patients received concurrent chemotherapy while the reaming patients received radiotherapy alone. Fifty-two months overall survival rate was 21.5% (14.6% in the worst-case scenario). As expected, survival was lower in patients with advanced stage at initiation of radiotherapy and in those treated as palliative care. Conclusion: The survival of cervical cancer patients remains low in Ethiopia because of late presentation and delay in receipt of radiotherapy, leading to stage migration in substantial proportion of the cases. Concerted and coordinated multisectoral efforts are needed to promote early presentation of cervical cancer and to shorten the unacceptable, long waiting time for radiotherapy.
Antibodies against dextransucrase from Streptococcus mutans display anti-biofilm and growth suppressing activities
Authors: Rather Shabeer Ahmad , Mahmood Akhtar , Singh Lakhvinder , Bhatia Alka , Sharma Sukesh Chander , Rather Abid Majid 
Published: February 2021

Abstract
Dextransucrase produced by Streptococcus mutans play an essential role in the formation of dental caries by synthesizing exopolysaccharides from sucrose, an important metabolite of the organism. In this study we report the location of dextransucrase in Streptococcus mutans cells and describe that antibodies raised against dextransucrase inhibited biofilm formation and reduced the adherence and hydrophobic properties of Streptococcus mutans. Western blot analysis and immunoelectron microscopy revealed that dextransucrase is located abundantly in the membrane fraction in S. mutans cells. Scanning electron microscopy and fluorescence microscopy revealed reduced cell density, impaired bioflim (plaque) formation in presence of dextransucrase antibodies. Genes associated with bioflim formation in S. mutans such as GtfB, GtfC, BrpA, relA, Smu630, vicK were down regulated (50–97%) in presence of the enzyme antibody. Presence of enzyme antibodies reduced adherence of S. mutans cells to glass surfaces by 58% and hydrophobicity by 55.2%. However dextransucrase antibodies did not affect acid production by S. mutans, under the experimental conditions. Immunohistochemistry studies with certain human samples displayed no cross reactivity with dextransucrase antibody. These findings suggest that antibodies against dextransucrase exhibit a profound inhibitory effect on the vital cariogenic factors of S. mutans and have no cross reactivity with human tissues tested, thus implying that dextransucrase could be a promising antigen to study its anticariogenic potential.
The Association between Urine Elements and Fasting Glucose Levels in a Community-Based Elderly People in Beijing
Authors: Liu Liu , Li Ang , Xu Qun , Wang Qin , Han Feng , Xu Chunyu , Liu Zhe , Xu Dongqun , Xu Donggang 
Published: February 2021

Abstract
Epidemiological studies have demonstrated that various kinds of urinary element concentrations were different between healthy, prediabetes, and diabetes patients. Meanwhile, many studies have explored the relationship between element concentration and fasting blood glucose (FBG), but the association between joint exposure to co-existing elements and FBG level has not been well understood. The study explored the associations of joint exposure to co-existing urinary elements with FBG level in a cross-sectional design. 275 retired elderly people were recruited from Beijing, China. The questionnaire survey was conducted, and biological samples were collected. The generalized linear model (GLM) and two-phase Bayesian kernel machine regression (BKMR) model were used to perform in-depth association analysis between urinary elements and FBG. The GLM analysis showed that Zn, Sr, and Cd were significantly correlated with the FBG level, under control potential confounding factors. The BKMR analysis demonstrated 8 elements (Zn, Se, Fe, Cr, Ni, Cd, Mn, and Al) had a higher influence on FBG (Posterior inclusion probabilities >0.1). Further intensive analyses result of the BKMR model indicated that the overall estimated exposure of 8 elements was positively correlated with the FBG level and was statistically significant when all element concentrations were at their 65th percentile. Meanwhile, the BKMR analysis showed that Cd and Zn had a statistically significant association with FBG levels when other co-existing elements were controlled at different levels (25th, 50th or 75th percentile), respectively. The results of the GLM and BKMR model were inconsistent. The BKMR model could flexibly calculate the joint exposure to co-existing elements, evaluate the possible interaction effects and nonlinear correlations. The meaningful conclusions were found that it was difficult to get by traditional methods. This study will provide methodological reference and experimental evidence for the association between joint exposure to co-existing elements and FBG in elderly people.
Beyond conceptual understanding of barriers to national adaptation policy: A comparative analysis of South Korea and the UK
Authors: Lee Seunghan , Paavola Jouni , Dessai Suraje 
Published: February 2021

Abstract
Despite progress with national adaptation policies, the adaptation deficit is growing. Barriers to adaptation are a key reason for the adaptation deficit. Past research on barriers only offers a conceptual understanding of the barriers, with limited insight into real adaptation processes. Common causality, interrelationships and dynamics of the barriers remain under-researched. Examining the cases of South Korea and the UK, this research aims to improve our understanding of the common barriers to national adaptation policy. Drawing from semi-structured interviews and documentary material, we identify 54 common factors in the two countries (17 barriers, 17 origins, 20 influences), and eight key barriers: conflicts between government departments, frequent rotating of civil servants, lack of political will, unclear range of participants in national adaptation policy, low priority of adaptation, uncertainty about the effectiveness of adaptation policy, differences between adaptation and election timelines, and lack of understanding of adaptation. We explain the origins and links between factors and the common causal mechanisms of barriers to national adaptation policy, as well as their influences by mapping them. Based on the mapping, we argue that there are barriers that are easier to address than others, and that there is a need to focus on them to reduce the adaptation deficit effectively. We conclude by discussing the policy implications of our findings.
The impact of participant engagement activities in supporting dapivirine ring use among participants enrolled in the Phase III MTN-020/ASPIRE study
Authors: Garcia Morgan , Luecke Ellen , Mayo Ashley , Scheckter Rachel , Ndase Patrick , Kiweewa Flavia Matovu , Kemigisha Doreen , Mansoor Leila E. , Singh Nishanta , Woeber Kubashni , Morar Neetha S. , Jeenarain Nitesha , Gaffoor Zakir , Gondwe Daniel K. , Makala Yvonne , Reddy Krishnaveni , Palanee-Philips Thesla , Baeten Jared M. , Straten Ariane van der , Soto-Torres Lydia , Torjesen Kristine , Musara Petina 
Published: February 2021

Abstract
Background: Low adherence to investigational products can negatively impact study outcomes, limiting the ability to demonstrate efficacy. To continue advancing potential new HIV prevention technologies for at-risk individuals, efforts are needed to improve adherence among study participants. In MTN-020/ASPIRE, a phase III randomized, double-blind, placebo-controlled study of the dapivirine vaginal ring carried out across 15 sites in sub-Saharan Africa, a multifaceted approach to adherence support was implemented, including a strong focus on participant engagement activities (PEAs). In this manuscript, we describe PEAs and participant attendance, and analyze the potential impact of PEAs on ring use. Methods: All sites implemented PEAs and submitted activity and attendance reports to the study management team throughout the study. Participant demographics were collected via case report forms. Ring use was estimated based on residual dapivirine remaining in the last returned ring by each participant and connected to PEA attendance using participant identification numbers. We used multivariate logistic regression to explore differences in ring use between PEA attendance groups and reviewed qualitative reports for illustrative quotes highlighting participant experiences with PEAs. Results: 2,312 of 2,629 study participants attended at least one of 389 PEAs conducted across sites. Participant country and partner knowledge of study participation were most strongly associated with PEA attendance (p < 0.005) with age, education, and income status also associated with event attendance (p < 0.05). When controlling for these variables, participants who attended at least one event were more likely to return a last ring showing at least some use (AOR=3.52) than those who never attended an event. There was an even stronger correlation between a last returned ring showing use and participant attendance at multiple events (AOR=4.03). Conclusions: Our analysis supports the growing body of work illustrating the importance of meaningfully engaging research participants to achieve study success and aligns with other analyses of adherence support efforts during ASPIRE. While causation between PEA attendance and product use cannot be established, residual drug levels in returned rings strongly correlated with participant attendance at PEAs, and the benefits of incorporating PEAs should be considered when designing future studies of investigational products.
Targeting adaptation to safeguard sustainable development against climate-change impacts
Authors: Fuldauer Lena , Thacker Scott , Haggis Robyn , Nerini Francesco Fuso , Nicholls Robert , Hall Jim 
Published: February 2021

Abstract
The international community has committed to achieve 17 Sustainable Development Goals (SDGs) by 2030 and to enhance climate action under the Paris Agreement. Yet achievement of the SDGs is already threatened by climate-change impacts. Here we show that further adaptation this decade is urgently required to safeguard 68% of SDG targets against acute and chronic threats from climate change. We analyse how the relationship between SDG targets and climate-change impacts is mediated by ecosystems and socio-economic sectors, which provides a framework for targeting adaptation. Adaptation of wetlands, rivers, cropland, construction, water, electricity and housing in the most vulnerable countries should be a global priority to safeguard sustainable development by 2030. We have applied our systems framework at the national scale in Saint Lucia and Ghana, which is helping to align National Adaptation Plans with the SDGs, thus ensuring that adaptation is contributing to, rather than detracting from, sustainable development.
Cerebrospinal Fluid Rhinorrhea Post COVID-19&nbsp;Nasopharyngeal Swab: a Case Report
Authors: Berdouk Sabrina , AlHefeiti Suhailah 
Published: February 2021

Abstract
Background: Cerebrospinal fluid rhinorrhea is a potentially life threatening condition and it is a rare emergency presentation. Most cases has been related to head trauma. However, CSF leak post COVID swab has been rarely reported.Case presentation: We report a 10 year old Emirati male, who presented to emergency department complaining of unilateral clear watery nasal discharge for 14 days, the discharge started after COVID-19 nasopharyngeal swab. The patient is a known case of 3MC syndrome and he underwent surgical repair for cleft lip and cleft palate. From the history and physical examination CSF rhinorrhea was highly suspected and nasal endoscopy confirmed the diagnosis of cribriform defect on the left side. The patient underwent surgical repair and his symptoms resolved after the surgery.Conclusion: We can conclude that COVID-19 nasopharyngeal swab has potential life threatening complications and one should consider the contraindications and the alternative methods available to detect COVID-19 to minimize the potential risks.
Development and Validation of a Risk Score for Predicting 1-Year Mortality Risk of STEMI Based on a Nationwide Cohort in China
Authors: Chen Si , Che Qianzi , Zhang Yan , Jia Jia , Wu Yiqun , Huo Yong , Chen Dafang 
Published: February 2021

Abstract
BackgroundA risk assessment for identifying long-term risk of post-discharge mortality in Chinese STEMI patients remains a concern. The aim of this study is to establish a bedside available risk scoring system for predicting 1-year mortality risk among Chinese STEMI patients. Methods STEMI patients(n=12611) were enrolled from the China STEMI Care Project Phase 2(CSCAP-2) collected between 2015 and 2016. Confounding bias was controlled using propensity score matching. Epidemiological, clinical, laboratory, and imaging variables, treatment strategy and medicine records were screened using extreme gradient boosting and nomogram according to the hazard ratio of Cox regression analysis to construct a predictive score. A validation cohort included 7342 patients collected in 2017 from CSCAP-2 was analyzed using receiver ROC and expectation (E)/observation (O) ratio to validate the risk scoring system. Results From 39 potential predictors, 8 variables were independent predictive factor and were included in the risk score: Killip class, early reperfusion strategy, Non-PCI intraoperative anticoagulants, heart rate, gender, age, anterior-wall myocardial infarction (AWMI) and inferior-wall myocardial infarction (IWMI). The new model demonstrated an excellent discrimination and calibration. The c-statistic and E/O ratio were 0.87(95%CI, 0.80-0.93) and 1.14(95%CI, 0.93-1.39) in the train set, 0.88 (95%CI, 0.78-0.96) and 1.15(95%CI, 0.85-1.56) in the test set, meanwhile, 0.89(95%CI, 0.82-0.95) and 1.00(95%CI, 0.81-1.23) in the validation cohort. The score has better sensitivity than the GRACE score and can recognize risk stratification among STEMI patients (P<0.001).Conclusions We developed a risk scoring system for predicting 1-year mortality risk of STEMI in a large Chinese population. The new score is easy-to-use and demonstrating a good discriminatory accuracy in predicting both short-term and long-term mortality risk in Chinese patients with STEMI.
Entropy analysis of n-grams and estimation of the number of meaningful language texts. Cyber security applications
Authors: Malashina Anastasia 
Published: February 2021

Abstract
We estimate the n-gram entropies of English- language texts, using dictionaries and taking into account punctuation, and find a heuristic method for estimating the marginal entropy. We propose a method for evaluating the coverage of empirically generated dictionaries and an ap- proach to address the disadvantage of low coverage. In ad- dition, we compare the probability of obtaining a meaning- ful text by directly iterating through all possible n-grams of the alphabet and conclude that this is only possible for very short text segments.
Anoplasty For Fused Anus Following Fournier’s Gangrene Debridement: A Case Report
Authors: Muniandy Jothinathan , Henry Fitjerald , Teh Yong Sim 
Published: February 2021

Abstract
Anal stenosis is a rare debilitating surgical condition. The severity and level of the impacted region determines the management options. Numerous tension free anoplasty techniques and its varying success rates have been reported. A patient-tailored anoplasty approach depending on the severity, location, and extent of anal stenosis is rudimentary. We present a case of fused anus following extensive surgical debridement for Fournier’s Gangrene. Colonoscopy illumination guided neo-anal creation was performed, which resulted in low severe anal stenosis six weeks later. Subsequently, Y-V anoplasty, lateral internal sphincterotomy, and colostomy closure were done which showed good initial recovery. However, six months later, the anal stenosis recurred, for which diamond-shaped anoplasty was offered but patient had refused any further surgical intervention. The clinical management challenge and learning experience is shared within the report.
Intestine epithelial cell-derived extracellular vesicles alleviate inflammation induced by Clostridioides difficile TcdB through the activity of TGF-β1
Authors: Wan Shuangshuang , Song Guangzhong , Hu Hui , Xu Yaqing , Zeng Peng , Lin Shan , Song Xiaojun , Jin Dazhi 
Published: February 2021

Abstract
Objective: Clostridioides difficile infection (CDI) has been primarily associated with the toxin B (TcdB), which can activate the intestinal immune system and lead to pathological damage. Even though the biological functions of intestine epithelial cell-derived extracellular vesicles (I-Evs) have been well documented, the role of I-Evs in the process of CDI is still unknown. Methods: I-Evs were isolated from mouse intestine tissues by ultracentrifugation protocol, identified by electron microscopy, nanoparticle tracking, sucrose density gradient centrifugation, and western blotting. Intestinal pathological damage was measured after intraperitoneal injection of TcdB into mice. Results: We isolated I-Evs ranging from 100–200 nm in mean diameter, with a density of 1.09-1.17 g/mL. These I-Evs expressed the extracellular vesicle-associated specific surface markers, CD63 and TSG101. In vitro, 50 µg I-Evs decreased the expression of IL-6, TNF-a, IL-1β, and IL-22 induced by 0.8 ng/mL C. difficile TcdB, and increased expression of TGF-b1. In vivo, I-Evs also promoted regulatory T cell induction, which improved the survival rate of mice up to 80% relative to C. difficile TcdB mice, dependent on the TGF-b1 signalling pathway. Conclusion: As an emerging immunotherapy, I-Evs can reduce the intraperitoneal infection induced by C. difficile TcdB and improve survival in mice.