bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of a group mindfulness-based cognitive programme on smartphone addictive symptoms and resilience among adolescents: study protocol of a cluster-randomized controlled trial
Authors: Tang Anson Chui Yan , Lee Regina Lai Tong 
Published: June 2021

AbstractBackgroundSmartphone addiction in adolescent is a significant global health issue since the last decade. Evidence has shown that the uncontrolled use of smartphone would lead to undesirable impact on their growth and development. However, evidence-based interventions to manage adolescents’ smartphone addictive behaviors is lacking. The proposed study aims to examine the effect of a group mindfulness-based cognitive programme(MBCP) on resilience, smartphone behavior and addictive symptoms in young adolescents.MethodsIt is an open-label, parallel-group, cluster-randomized controlled trial with repeated measurement analysis. Four primary schools in Hong Kong will be recruited and randomly allocated in a ratio of 1:1 to the intervention/control group. A convenience sample of 240 class level 5 primary school students, 60 from each school, will be recruited. Participants in the intervention group will receive a 12-week MBCP which comprises 90-minute supervised practice at school and daily home practice. Resilience will be measured by Connor-Davidson Resilience Scale – 25 (Chinese version); smartphone behavior will be represented by time spent/day using the smartphone and types of functions used; addictive symptoms will be measured by Smartphone Addiction Scale-Short Version (Chinese Version). Baseline assessment(T0) will be conducted before the intervention starts. Post-tests will be conducted in weeks 4, 8, 12 of the intervention, and 3 months follow-up. Intention-to-Treat analysis will be applied to the variables. Generalized Estimating Equation model will be used to compare differences in resilience scores, smartphone behavior and addiction scores between and within groups, adjusted for socio-demographic factors.P < 0.05 with two-tailed test will be regarded as significance.DiscussionIt is expected that adolescents will demonstrate better resilience and lesser smartphone addictive symptoms after joining the MBCP. The study will be the first provided empirical evidence to support the promising application of MBCP to manage smartphone use among adolescents. It introduces community stakeholders including community nurses a non-invasive and simple-to-administer intervention to tackle problematic smartphone use among adolescent clients.Trial registrationChinese Clinical Trial Registry, ChiCTR2000033273, Registered on 26 May 2020.
Barriers and facilitators to implementing evidence based bleeding management in Australian Cardiac Surgery Units: a qualitative interview study analysed with the theoretical domains framework and COM-B model
Authors: Pearse Bronwyn L. , Keogh Samantha , Rickard Claire M. , Fung Yoke L. 
Published: June 2021

Abstract
Background
Bleeding during cardiac surgery is a common complication that often requires the transfusion of blood products. The combination of bleeding and blood product transfusion incrementally increases adverse outcomes including infection and mortality. Following bleeding management guideline recommendations could assist with minimising risk but adherence is not high, and the cause for lack of adherence is not well understood. This study aimed to identify barriers and facilitators to practicing and implementing evidenced-based intra-operative, bleeding management in Australian cardiac surgery units.

Methods
We used a qualitative descriptive design to conduct semi-structured interviews with Australian cardiac surgeons, anaesthetists and perfusionists. The Theoretical Domains Framework (TDF) was utilised to guide interviews and thematically analyse the data. Categorised data were then linked with the three key domains of the COM-B model (capability, opportunity, motivation - behaviour) to explore and understand behaviour.

Results
Seventeen interviews were completed. Nine of the 14 TDF domains emerged as significant. Analysis revealed key themes to improving capability included, standardisation, monitoring, auditing and feedback of data and cross discipline training. Opportunity for change was improved with interpersonal and interdepartmental collaboration through shared goals, and more efficient and supportive processes allowing clinicians to navigate unfamiliar business and financial models of health care. Results suggest as individuals, clinicians had the motivation to make change and healthcare organisations have an obligation and a responsibility to partner with clinicians to support change and improve goal directed best practice.

Conclusion
Using a theory-based approach it was possible to identify factors which may be positively or negatively influence clinicians ability to implement best practice bleeding management in Australian cardiac surgical units.
Variation among hospitals in the continuity of care for older hospitalized patients: a cross-sectional cohort study
Authors: Goodwin James S. , Li Shuang , Zhou Jie , Kuo Yong-Fang , Nattinger Ann 
Published: June 2021

Abstract
Background
Little is known about how continuity of care for hospitalized patients varies among hospitals. We describe the number of different general internal medicine physicians seeing hospitalized patients during a medical admission and how that varies by hospital.

Methods
We conducted a retrospective study of a national 20% sample of Medicare inpatients from 01/01/16 to 12/31/18. In patients with routine medical admissions (length of stay of 3–6 days, no Intensive Care Unit stay, and seen by only one generalist per day), we assessed odds of receiving all generalist care from one generalist. We calculated rates for each hospital, adjusting for patient and hospital characteristics in a multi-level logistic regression model.

Results
Among routine medical admissions with 3- to 6-day stays, only 43.1% received all their generalist care from the same physician. In those with a 3-day stay, 50.1% had one generalist providing care vs. 30.8% in those with a 6-day stay. In a two-level (admission and hospital) logistic regression model controlling for patient characteristics and length of stay, the odds of seeing just one generalist did not vary greatly by patient characteristics such as age, race/ethnicity, comorbidity or reason for admission. There were large variations in continuity of care among different hospitals and geographic areas. In the highest decile of hospitals, the adjusted mean percentage of patients receiving all generalist care from one physician was > 84.1%, vs. < 24.1% in the lowest decile. This large degree of variation persisted when hospitals were stratified by size, ownership, location or teaching status.

Conclusions
Continuity of care provided by generalist physicians to medical inpatients varies widely among hospitals. The impact of this variation on quality of care is unknown.
Long non-coding RNA LINC01116 is activated by EGR1 and facilitates lung adenocarcinoma oncogenicity via targeting miR-744-5p/CDCA4 axis
Authors: Ren Ping , Chang Liang , Hong Xiaodong , Xing Lei , Zhang Hong 
Published: June 2021

Abstract
Background
Lung adenocarcinoma (LAD) is one of the most frequently diagnosed pathological categories of human lung cancer. Nevertheless, the link between long non-coding RNA (lncRNA) LINC01116 and LAD remains poorly investigated.

Methods
QRT-PCR and western blot were applied for quantifying the expression of RNAs and proteins. Both functional experiments assays in vitro and xenografts model in vivo were implemented for analyzing LINC01116 function in LAD while molecular relationship among RNAs was investigated via mechanism experiments.

Results
LINC01116 was expressed at an abnormally high level in LAD, which was induced by transcription activator EGR1. LINC01116 depletion restrained proliferation, migration and invasion, yet facilitated apoptosis of LAD cells. MiR-744-5p could bind to LINC01116. MiR-744-5p inhibitor reversed the inhibitory effects of silencing LINC01116 on LAD malignant behaviors. In addition, cell division cycle-associated protein 4 (CDCA4) shared binding sites with miR-744-5p. Silencing LINC01116 elicited decline in CDCA4 mRNA and protein levels. Moreover, CDCA4 up-regulation could counteract the biological effects of LINC01116 knockdown on LAD cells.

Conclusion
Our data revealed that LINC01116 promoted malignant behaviors of LAD cells by targeting miR-744-5p/CDCA4 axis, implying the theoretical potential of LINC01116 as a novel target for LAD treatment.
Three-dimensional analysis of the characteristics of joint motion and gait pattern in a rodent model following spinal nerve ligation
Authors: Seto Takayuki , Suzuki Hidenori , Okazaki Tomoya , Imajo Yasuaki , Nishida Norihiro , Funaba Masahiro , Kanchiku Tsukasa , Taguchi Toshihiko , Sakai Takashi 
Published: June 2021

Abstract
Background
The spinal nerve ligation (SNL) rat is well known as the most common rodent model of neuropathic pain without motor deficit. Researchers have performed analyses using only the von Frey and thermal withdrawal tests to evaluate pain intensity in the rat experimental model. However, these test are completely different from the neurological examinations performed clinically. We think that several behavioral reactions must be observed following SNL because the patients with neuropathic pain usually have impaired coordination of the motions of the right–left limbs and right–left joint motion differences. In this study, we attempted to clarify the pain behavioral reactions in SNL rat model as in patients. We used the Kinema-Tracer system for 3D kinematics gait analysis to identify new characteristic parameters of each joint movement and gait pattern.

Results
The effect of SNL on mechanical allodynia was a 47 ± 6.1% decrease in the withdrawal threshold during 1–8 weeks post-operation. Sagittal trajectories of the hip, knee and ankle markers in SNL rats showed a large sagittal fluctuation of each joint while walking. Top minus bottom height of the left hip and knee that represents instability during walking was significantly larger in the SNL than sham rats. Both-foot contact time, which is one of the gait characteristics, was significantly longer in the SNL versus sham rats: 1.9 ± 0.15 s vs. 1.03 ± 0.15 s at 4 weeks post-operation (p = 0.003). We also examined the circular phase time to evaluate coordination of the right and left hind-limbs. The ratio of the right/left circular time was 1.0 ± 0.08 in the sham rats and 0.62 ± 0.15 in the SNL rats at 4 weeks post-operation.

Conclusions
We revealed new quantitative parameters in an SNL rat model that are directly relevant to the neurological symptoms in patients with neuropathic pain, in whom the von Frey and thermal withdrawal tests are not used at all clinically. This new 3D analysis system can contribute to the analysis of pain intensity of SNL rats in detail similar to human patients’ reactions following neuropathic pain.
Prenatal prediction and typing of placental invasion using MRI deep and radiomic features
Authors: Xuan Rongrong , Li Tao , Wang Yutao , Xu Jian , Jin Wei 
Published: June 2021

Abstract
Background
To predict placental invasion (PI) and determine the subtype according to the degree of implantation, and to help physicians develop appropriate therapeutic measures, a prenatal prediction and typing of placental invasion method using MRI deep and radiomic features were proposed.

Methods
The placental tissue of abdominal magnetic resonance (MR) image was segmented to form the regions of interest (ROI) using U-net. The radiomic features were subsequently extracted from ROI. Simultaneously, a deep dynamic convolution neural network (DDCNN) with codec structure was established, which was trained by an autoencoder model to extract the deep features from ROI. Finally, combining the radiomic features and deep features, a classifier based on the multi-layer perceptron model was designed. The classifier was trained to predict prenatal placental invasion as well as determine the invasion subtype.

Results
The experimental results show that the average accuracy, sensitivity, and specificity of the proposed method are 0.877, 0.857, and 0.954 respectively, and the area under the ROC curve (AUC) is 0.904, which outperforms the traditional radiomic based auxiliary diagnostic methods.

Conclusions
This work not only labeled the placental tissue of MR image in pregnant women automatically but also realized the objective evaluation of placental invasion, thus providing a new approach for the prenatal diagnosis of placental invasion.
Equity in newborn care, evidence from national surveys in low- and middle-income countries
Authors: Peven Kimberly , Mallick Lindsay , Taylor Cath , Bick Debra , Day Louise T. , Kadzem Lionel , Purssell Edward 
Published: June 2021

Abstract
Background
High coverage of care is essential to improving newborn survival; however, gaps exist in access to timely and appropriate newborn care between and within countries. In high mortality burden settings, health inequities due to social and economic factors may also impact on newborn outcomes. This study aimed to examine equity in co-coverage of newborn care interventions in low- and low middle-income countries in sub-Saharan Africa and South Asia.

Methods
We analysed secondary data from recent Demographic and Health Surveys in 16 countries. We created a co-coverage index of five newborn care interventions. We examined differences in coverage and co-coverage of newborn care interventions by country, place of birth, and wealth quintile. Using multilevel logistic regression, we examined the association between high co-coverage of newborn care (4 or 5 interventions) and social determinants of health.

Results
Coverage and co-coverage of newborn care showed large between- and within-country gaps for home and facility births, with important inequities based on individual, family, contextual, and structural factors. Wealth-based inequities were smaller amongst facility births compared to non-facility births.

Conclusion
This analysis underlines the importance of facility birth for improved and more equitable newborn care. Shifting births to facilities, improving facility-based care, and community-based or pro-poor interventions are important to mitigate wealth-based inequities in newborn care, particularly in countries with large differences between the poorest and richest families and in countries with very low coverage of care.
Prenatal exposure to ambient air pollutants and early infant growth and adiposity in the Southern California Mother’s Milk Study
Authors: Patterson William B. , Glasson Jessica , Naik Noopur , Jones Roshonda B. , Berger Paige K. , Plows Jasmine F. , Minor Hilary A. , Lurmann Frederick , Goran Michael I. , Alderete Tanya L. 
Published: June 2021

Abstract
Background
Prior epidemiological and animal work has linked in utero exposure to ambient air pollutants (AAP) with accelerated postnatal weight gain, which is predictive of increased cardiometabolic risk factors in childhood and adolescence. However, few studies have assessed changes in infant body composition or multiple pollutant exposures. Therefore, the objective of this study was to examine relationships between prenatal residential AAP exposure with infant growth and adiposity.

Methods
Residential exposure to AAP (particulate matter < 2.5 and 10 microns in aerodynamic diameter [PM2.5, PM10]; nitrogen dioxide [NO2]; ozone [O3]; oxidative capacity [Oxwt: redox-weighted oxidative potential of O3 and NO2]) was modeled by spatial interpolation of monitoring stations via an inverse distance-squared weighting (IDW2) algorithm for 123 participants from the longitudinal Mother’s Milk Study, an ongoing cohort of Hispanic mother-infant dyads from Southern California. Outcomes included changes in infant growth (weight, length), total subcutaneous fat (TSF; calculated via infant skinfold thickness measures) and fat distribution (umbilical circumference, central to total subcutaneous fat [CTSF]) and were calculated by subtracting 1-month measures from 6-month measures. Multivariable linear regression was performed to examine relationships between prenatal AAP exposure and infant outcomes. Models adjusted for maternal age, pre-pregnancy body mass index, socioeconomic status, infant age, sex, and breastfeeding frequency. Sex interactions were tested, and effects are reported for each standard deviation increase in exposure.

Results
NO2 was associated with greater infant weight gain (β = 0.14, p = 0.02) and TSF (β = 1.69, p = 0.02). PM10 and PM2.5 were associated with change in umbilical circumference (β = 0.73, p = 0.003) and TSF (β = 1.53, p = 0.04), respectively. Associations of Oxwt (pinteractions < 0.10) with infant length change, umbilical circumference, and CTSF were modified by infant sex. Oxwt was associated with attenuated infant length change among males (β = -0.60, p = 0.01), but not females (β = 0.16, p = 0.49); umbilical circumference among females (β = 0.92, p = 0.009), but not males (β = -0.00, p = 0.99); and CTSF among males (β = 0.01, p = 0.03), but not females (β = 0.00, p = 0.51).

Conclusion
Prenatal AAP exposure was associated with increased weight gain and anthropometric measures from 1-to-6 months of life among Hispanic infants. Sex-specific associations suggest differential consequences of in utero oxidative stress. These results indicate that prenatal AAP exposure may alter infant growth, which has potential to increase childhood obesity risk.
Characteristics and prognosis of patients with cryptogenic stroke and suggestive of patent foramen ovale
Authors: Choi Jaehuk , Kang Min-Kyung , Jun Jin-Sun , Shin Dong Geum , Han Donghoon , Choi Seonghoon , Cho Jung Rae , Lee Namho 
Published: June 2021

Abstract
Aims
The purpose of this study were to identify the usefulness of screening for PFO using agitated saline echocardiography (ASE) and characteristics and prognosis of patients with suggestive of patent foramen ovale (PFO).

Methods
Three hundred three patients (mean age, 53 ± 9 years; 199 [66%] men) admitted with acute stroke or suspicion of stroke were included. Patients were classified into those with and without right-to-left shunt (RLS) according to the ASE results (positive ASE [n = 92] vs. negative ASE [n = 211]). Fifty-one out of ninety-two patients with positive ASE and twenty-one out of two hundred eleven patients with negative ASE underwent TEE with ASE to confirm PFO.

Results
Ninety-two were positive for ASE and thirty-six of the fifty-one patients who underwent TEE were confirmed as having PFO. Of the patients with RLS grade 1, 50% were diagnosed with PFO and all patients with RLS grade ≥ 2 were diagnosed with PFO. All patients with negative ASE had no PFO (sensitivity of 100% and specificity of 58%). Patients with positive ASE were younger, had a lower body mass, and a lower prevalence of hypertension. The positive ASE patients had a higher mean Sʹ velocity and better diastolic function. Four of ninety-one patients with positive ASE and thirteen of one hundred seventy-seven showed recurrence of stroke and suspicion of stroke.

Conclusion
Transthoracic ASE is a good method to screen for PFO. Patients with suggestive of PFO had lower risk factors, less atherosclerosis, and better cardiac performance.
MicroRNA engineered umbilical cord stem cell-derived exosomes direct tendon regeneration by mTOR signaling
Authors: Yao Zhixiao , Li Juehong , Xiong Hao , Cui Haomin , Ning Jiexin , Wang Shikun , Ouyang Xingyu , Qian Yun , Fan Cunyi 
Published: June 2021

Abstract
Background
Exosomes are extracellular vesicles of nano-structures and represent an emerging nano-scale acellular therapy in recent years. Tendon regeneration is a sophisticated process in the field of microsurgery due to its poor natural healing ability. To date, no successful long-term solution has been provided for the healing of tendon injuries. Functional recovery requires advanced treatment strategies. Human umbilical cord mesenchymal stem cell-derived exosomes (HUMSC-Exos) are considered as promising cell-free therapeutic agents. However, few studies reported their potential in the tendon repair previously. In this study, we explored the roles and underlying mechanisms of HUMSC-Exos in the tendon regeneration.

Results
Expression of tendon‐specific markers in, and collagen deposition by, tendon-derived stem cells (TDSCs) treated with HUMSC-Exos increased in vitro. In a rat Achilles tendon injury model, treatment with HUMSC-Exos improved the histological structure, enhanced tendon-specific matrix components, and optimized biomechanical properties of the Achilles tendon. Findings in miRNA sequencing indicated a significant increase in miR-29a-3p in HUMSC-Exo-treated Achilles tendons. Next, luciferase assay in combination with western blot identified phosphatase and tensin homolog (PTEN) as the specific target of miR-29a-3p. Furthermore, we applied a miR-29a-3p-specific agonist to engineer HUMSC-Exos. These HUMSC-Exos overexpressing miR-29a-3p amplified the gain effects of HUMSC-Exos on tendon healing in vivo. To explore the underlying mechanisms, a transforming growth factor-β1 (TGF-β1) inhibitor (SB-431542), mTOR inhibitor (rapamycin), and engineered HUMSC-Exos were employed. The results showed that TGF-β1 and mTOR signaling were involved in the beneficial effects of HUMSC-Exos on tendon regeneration.

Conclusion
The findings in our study suggest that PTEN/mTOR/TGF-β1 signaling cascades may be a potential pathway for HUMSC-Exos to deliver miR-29a-3p for tendon healing and implicate a novel therapeutic strategy for tendon regeneration via engineered stem cell-derived exosomes.

Graphic abstract
Organizational support for frontline harm reduction and systems navigation work among workers with living and lived experience: qualitative findings from British Columbia, Canada
Authors: Greer A. , Buxton J. A. , Pauly B. , Bungay V. 
Published: June 2021

Abstract
Background
The inclusion of people with lived and living experience of substance use is essential to effective and client-centered harm reduction services and strategies. The aim of this study is to critically examine and characterize peer worker roles and the definition, recognition, and support for these roles within harm reduction organizations.

Methods
Fifteen interviews were conducted with peer workers—people with lived and living experience of substance use engaged in harm reduction service delivery—in British Columbia, Canada. An interpretive descriptive approach to data analysis was used to generate themes that best illustrated the roles of peer workers.

Findings
Two interrelated and overarching themes are presented: (1) peer work in practice; (2) organizational support. Our findings illustrate that peer work is incredibly complex and demanding, requiring peers to be at the forefront of support within their communities while simultaneously navigating the oppressive structures within which they work. While peer workers found a high degree of purpose and meaning in their day-to-day work, their roles lacked definition within organizations, which produced feelings of ineffectiveness and being undervalued. A lack of organizational understanding and recognition of their roles was evident from unclear "peer" role titles, a lack of role communication and expectations, the representation of experiential knowledge, and a lack of role support and training.

Conclusions
These findings may help harm reduction organizations understand peer work and worker roles which may inform and promote equity in future harm reduction initiatives that include people with living and lived experience of substance use.