bluuebunny/crossref_metadata_2025_split huggingface dataset:
Men’s and women’s knowledge of danger signs relevant to postnatal and neonatal care-seeking: A cross sectional study from Bungoma County, Kenya
Authors: Roney Emma , Morgan Christopher , Gatungu Daniel , Mwaura Peter , Mwambeo Humphrey , Natecho Alice , Comrie-Thomson Liz , Gitaka Jesse N. 
Published: May 2021

Background
Neonatal and maternal mortality rates remain high in Kenya. Knowledge of neonatal danger signs may reduce delay in deciding to seek care. Evidence is emerging on the influential role of male partners in improving maternal and newborn health. This study analysed the factors that determine men’s and women’s knowledge and practices in postnatal and neonatal care-seeking, in order to inform design of future interventions.

Methods
A quantitative, cross-sectional study was undertaken in Bungoma County, Kenya. Women who had recently given birth (n = 348) and men whose wives had recently given birth (n = 82) completed questionnaires on knowledge and care-seeking practices relating to the postnatal period. Univariate and multivariate logistic regression analyses were performed to investigate associations with key maternal and newborn health outcomes.

Results
51.2% of women and 50.0% of men knew at least one neonatal danger sign, however women knew more individual danger signs than men. In the univariate model, women’s knowledge of a least one neonatal danger sign was associated with attending antenatal care ≥4 times (OR 4.46, 95%CI 2.73–7.29, p<0.001), facility birth (OR 3.26, 95%CI 1.89–5.72, p<0.001), and having a male partner accompany them to antenatal care (OR 3.34, 95%CI 1.35–8.27, p = 0.009). Higher monthly household income (≥10,000KSh, approximately US$100) was associated with facility delivery (AOR 11.99, 95%CI 1.59–90.40, p = 0.009).

Conclusion
Knowledge of neonatal danger signs was low, however there was an association between knowledge of danger signs and increased healthcare service use, including male partner involvement in antenatal care. Future interventions should consider the extra costs of facility delivery and the barriers to men participating in antenatal and postnatal care.
Nurse-sensitive outcomes in district nursing care: A Delphi study
Authors: Veldhuizen Jessica D. , van den Bulck Anne O. E. , Elissen Arianne M. J. , Mikkers Misja C. , Schuurmans Marieke J. , Bleijenberg Nienke 
Published: May 2021

Objectives
To determine nurse-sensitive outcomes in district nursing care for community-living older people. Nurse-sensitive outcomes are defined as patient outcomes that are relevant based on nurses’ scope and domain of practice and that are influenced by nursing inputs and interventions.

Design
A Delphi study following the RAND/UCLA Appropriateness Method with two rounds of data collection.

Setting
District nursing care in the community care setting in the Netherlands.

Participants
Experts with current or recent clinical experience as district nurses as well as expertise in research, teaching, practice, or policy in the area of district nursing.

Main outcome measures
Experts assessed potential nurse-sensitive outcomes for their sensitivity to nursing care by scoring the relevance of each outcome and the ability of the outcome to be influenced by nursing care (influenceability). The relevance and influenceability of each outcome were scored on a nine-point Likert scale. A group median of 7 to 9 indicated that the outcome was assessed as relevant and/or influenceable. To measure agreement among experts, the disagreement index was used, with a score of <1 indicating agreement.

Results
In Delphi round two, 11 experts assessed 46 outcomes. In total, 26 outcomes (56.5%) were assessed as nurse-sensitive. The nurse-sensitive outcomes with the highest median scores for both relevance and influenceability were the patient’s autonomy, the patient’s ability to make decisions regarding the provision of care, the patient’s satisfaction with delivered district nursing care, the quality of dying and death, and the compliance of the patient with needed care.

Conclusions
This study determined 26 nurse-sensitive outcomes for district nursing care for community-living older people based on the collective opinion of experts in district nursing care. This insight could guide the development of quality indicators for district nursing care. Further research is needed to operationalise the outcomes and to determine which outcomes are relevant for specific subgroups.
Deep reinforcement learning approaches for global public health strategies for COVID-19 pandemic
Authors: Kwak Gloria Hyunjung , Ling Lowell , Hui Pan 
Published: May 2021

BackgroundUnprecedented public health measures have been used during this coronavirus 2019 (COVID-19) pandemic to control the spread of SARS-CoV-2 virus. It is a challenge to implement timely and appropriate public health interventions.Methods and findingsPopulation and COVID-19 epidemiological data between 21st January 2020 to 15th November 2020 from 216 countries and territories were included with the implemented public health interventions. We used deep reinforcement learning, and the algorithm was trained to enable agents to try to find optimal public health strategies that maximized total reward on controlling the spread of COVID-19. The results suggested by the algorithm were analyzed against the actual timing and intensity of lockdown and travel restrictions. Early implementations of the actual lockdown and travel restriction policies, usually at the time of local index case were associated with less burden of COVID-19. In contrast, our agent suggested to initiate at least minimal intensity of lockdown or travel restriction even before or on the day of the index case in each country and territory. In addition, the agent mostly recommended a combination of lockdown and travel restrictions and higher intensity policies than the policies implemented by governments, but did not always encourage rapid full lockdown and full border closures. The limitation of this study was that it was done with incomplete data due to the emerging COVID-19 epidemic, inconsistent testing and reporting. In addition, our research focuses only on population health benefits by controlling the spread of COVID-19 without balancing the negative impacts of economic and social consequences.InterpretationCompared to actual government implementation, our algorithm mostly recommended earlier intensity of lockdown and travel restrictions. Reinforcement learning may be used as a decision support tool for implementation of public health interventions during COVID-19 and future pandemics.
Antiviral kinetics of tenofovir alafenamide and tenofovir disoproxil fumarate over 24 weeks in women of childbearing potential with chronic HBV
Authors: Pan Calvin Q. , Chang Ting-Tsung , Bae Si Hyun , Brunetto Maurizia , Seto Wai-Kay , Coffin Carla S. , Tan Susanna K. , Mo Shuyuan , Flaherty John F. , Gaggar Anuj , Nguyen Mindie H. , Çelen Mustafa Kemal , Thompson Alexander , Gane Edward J. 
Published: May 2021

Background/Purpose
Use of tenofovir disoproxil fumarate (TDF) improves patient outcomes in preventing mother-to-child transmission (pMTCT) of the hepatitis B virus (HBV) in mothers with chronic HBV and high viral loads. Given the lack of data for tenofovir alafenamide (TAF) in pMTCT, rates of early viral suppression with TAF and TDF were evaluated in women of childbearing potential (WOCBP) participating in 2 randomized, double-blind, Phase 3 studies in chronic HBV.

Methods
In a patient subset meeting WOCBP criteria and with baseline HBV DNA >200,000 IU/mL, rates of viral suppression with TAF or TDF in achieving the target of HBV DNA <200,000 IU/mL at weeks 12 and 24 were assessed. Multivariate logistic regression was used to identify factors predictive of failure to suppress HBV DNA to the target level.

Results
In 275 of 1298 (21%) patients meeting WOCBP criteria with high viral load, 93% and 96% had HBV DNA <200,000 IU/mL at weeks 12 and 24, respectively. Results for TAF (n = 194) vs TDF (n = 81) treatment were similar at weeks 12 and 24 (94% vs. 90% and 97% vs. 93%), respectively. High baseline HBV DNA level, genotype D infection, and prior interferon (week 24 only) were predictive of failure to achieve the target level. Both treatments were well tolerated with TAF showing less impact on renal and bone parameters.

Conclusions
In WOCBP with high VL, no differences were found between TAF and TDF in reducing HBV DNA to levels associated with lower transmission risk. These data support ongoing studies of TAF for pMTCT.
Phenome-wide association of 1809 phenotypes and COVID-19 disease progression in the Veterans Health Administration Million Veteran Program
Authors: Song Rebecca J. , Ho Yuk-Lam , Schubert Petra , Park Yojin , Posner Daniel , Lord Emily M. , Costa Lauren , Gerlovin Hanna , Kurgansky Katherine E. , Anglin-Foote Tori , DuVall Scott , Huffman Jennifer E. , Pyarajan Saiju , Beckham Jean C. , Chang Kyong-Mi , Liao Katherine P. , Djousse Luc , Gagnon David R. , Whitbourne Stacey B. , Ramoni Rachel , Muralidhar Sumitra , Tsao Philip S. , O’Donnell Christopher J. , Gaziano John Michael , Casas Juan P. , Cho Kelly ,   on behalf of the VA Million Veteran Program COVID-19 Science Initiative
Published: May 2021

BackgroundThe risk factors associated with the stages of Coronavirus Disease-2019 (COVID-19) disease progression are not well known. We aim to identify risk factors specific to each state of COVID-19 progression from SARS-CoV-2 infection through death.Methods and resultsWe included 648,202 participants from the Veteran Affairs Million Veteran Program (2011-). We identified characteristics and 1,809 ICD code-based phenotypes from the electronic health record. We used logistic regression to examine the association of age, sex, body mass index (BMI), race, and prevalent phenotypes to the stages of COVID-19 disease progression: infection, hospitalization, intensive care unit (ICU) admission, and 30-day mortality (separate models for each). Models were adjusted for age, sex, race, ethnicity, number of visit months and ICD codes, state infection rate and controlled for multiple testing using false discovery rate (≤0.1). As of August 10, 2020, 5,929 individuals were SARS-CoV-2 positive and among those, 1,463 (25%) were hospitalized, 579 (10%) were in ICU, and 398 (7%) died. We observed a lower risk in women vs. men for ICU and mortality (Odds Ratio (95% CI): 0.48 (0.30–0.76) and 0.59 (0.31–1.15), respectively) and a higher risk in Black vs. Other race patients for hospitalization and ICU (OR (95%CI): 1.53 (1.32–1.77) and 1.63 (1.32–2.02), respectively). We observed an increased risk of all COVID-19 disease states with older age and BMI ≥35 vs. 20–24 kg/m2. Renal failure, respiratory failure, morbid obesity, acid-base balance disorder, white blood cell diseases, hydronephrosis and bacterial infections were associated with an increased risk of ICU admissions; sepsis, chronic skin ulcers, acid-base balance disorder and acidosis were associated with mortality.ConclusionsOlder age, higher BMI, males and patients with a history of respiratory, kidney, bacterial or metabolic comorbidities experienced greater COVID-19 severity. Future studies to investigate the underlying mechanisms associated with these phenotype clusters and COVID-19 are warranted.
Failure Analysis of a Diesel Engine Crankshaft
Authors: Zhang H. Y. , Qu S. , Dong C. , Fu C. M. , Zang Q. S. , Zhang Z. F. 
Published: May 2021

Abstract
A six-cylinder crankshaft in a 12L diesel engine was locked after testing for about 840 hours in the bench test. The fractography investigation indicates that fatigue is the dominant failure mechanism of the crankshaft. It is found that the fatigue crack mainly initiated at the fillet of the crankweb between the 6th main journal and 6th crankpin. The fatigue crack initiation area lies outside the induction surface hardened zone. From detailed metallographic inspection, abnormal microstructure containing Widmannstatten was found in the fatigue crack initiation area and the 5th main journal, while that was not found at the severely deformed crankweb. Since the region containing Widmannstatten has lower hardness, the root cause of the failure may be that the abnormal microstructure lowered the fatigue strength at the stress concentrated fillet. The crankshaft prematurely fractured under the complex stress condition in the bench test.
Analytical treatment of the critical properties of a generalized van der Waals equation
Authors: Amin Magdy E 
Published: May 2021

Abstract
The two-parameter van der Waals (vdW) equation of state is generalized, by adding another two parameters to the attractive term. General relations between thermodynamic functions of the generalized vdW equation and the hard sphere gas are derived. The cubic equation of the generalized vdW is solved and the critical points (P

c
, V

c
, T

c
) are obtained for general k. The critical properties of the vdW real gas such as the isothermal compressibility K

T
, the isobaric expansion coefficient α and the isobaric heat capacity C

P
are calculated exactly. The temperature dependence of K

T
, α and C

P
is investigated close to the critical point on the critical isobar path P

r
= 1(P = P

c
). Numerical calculations for K

T
and C

P
are presented above and below P

r
.
Late diagnosis of classic congenital adrenal hyperplasia: long-term consequences during adulthood
Authors: Aveiro-Lavrador Mariana , De Sousa Lages Adriana , Barros Luísa , Paiva Isabel 
Published: May 2021

Summary
Congenital adrenal hyperplasia (CAH) is a group of autosomal recessive disorders related to enzyme deficiencies in the adrenal steroidogenesis pathway leading to impaired corticosteroid biosynthesis. Depending on the extension of enzyme defect, there may be variable severities of CAH – classic and non-classic. We report the case of a 37-year-old male patient with a previously unknown diagnosis of classic CAH referred to Endocrinology evaluation due to class III obesity and insulin resistance. A high diagnostic suspicion was raised at the first Endocrinology consultation after careful past medical history analysis especially related to the presence of bilateral adrenal myelolipomas and primary infertility. A genetic test confirmed the presence of a variant of the CYP21A2 in homozygous with an enzymatic activity of 0–1%, corresponding to a classic and severe CAH form. Our case represents an unusually late definitive diagnose of classic CAH since the definition was established only during adulthood in the fourth decade of life. The missing diagnosis of classic 21 hydroxylase deficiency during infancy led to important morbidity, with a high impact on patients’ quality of life.

Learning points

Congenital adrenal hyperplasia (CAH) refers to a group of autosomal recessive enzyme disorders responsible for an impaired cortical adrenal hormonal synthesis.

CAH may be divided into two major forms: classic and non-classic CAH.

If untreated, CAH may be fatal or may be responsible for important multi-organ long-term consequences that can be undervalued during adulthood.

Adrenal myelolipomas are associated with chronic exposure to high ACTH levels and continuous androgen hyperstimulation typically found in undertreated CAH patients.

Testicular adrenal rest tumours (TART) and primary infertility can be the first manifestation of the disease during adulthood.
Mass spectrometry imaging identifies metabolic patterns associated with malignant potential in pheochromocytoma and paraganglioma
Authors: Murakami Masanori , Sun Na , Greunke Christian , Feuchtinger Annette , Kircher Stefan , Deutschbein Timo , Papathomas Thomas , Bechmann Nicole , William Wallace Paal , Peitzsch Mirko , Korpershoek Esther , Friemel Juliane , Gimenez-Roqueplo Anne-Paule , Robledo Mercedes , J L M Timmers Henri , Canu Letizia , Weber Achim , R de Krijger Ronald , Fassnacht Martin , Knösel Thomas , Kirchner Thomas , Reincke Martin , Karl Walch Axel , Kroiss Matthias , Beuschlein Felix 
Published: May 2021

Objective
Within the past decade, important genetic drivers of pheochromocytoma and paraganglioma (PPGLs) development have been identified. The pathophysiological mechanism that translates these alterations into functional autonomy and potentially malignant behavior has not been elucidated in detail. Here we used MALDI-mass spectrometry imaging (MALDI-MSI) of formalin-fixed paraffin-embedded tissue specimens to comprehensively characterize the metabolic profiles of PPGLs.

Design and methods
MALDI-MSI was conducted in 344 PPGLs and results correlated with genetic and phenotypic information. We experimentally silenced genetic drivers by siRNA in PC12 cells to confirm their metabolic impact in vitro.

Results
Tissue abundance of kynurenine pathway metabolites such as xanthurenic acid was significantly lower (P = 2.35E−09) in the pseudohypoxia pathway cluster 1 compared to PPGLs of the kinase-driven PPGLs cluster 2. Lower abundance of xanthurenic acid was associated with shorter metastasis-free survival (log-rank tests P = 7.96E−06) and identified as a risk factor for metastasis independent of the genetic status (hazard ratio, 32.6, P = 0.002). Knockdown of Sdhb and Vhl in an in vitro model demonstrated that inositol metabolism and sialic acids were similarly modulated as in tumors of the respective cluster.

Conclusions
The present study has identified distinct tissue metabolomic profiles of PPGLs in relation to tumor genotypes. In addition, we revealed significantly altered metabolites in the kynurenine pathway in metastatic PPGLs, which can aid in the prediction of its malignant potential. However, further validation studies will be required to confirm our findings.
Selection Criteria for Sustainable Suppliers in the Supply Chain of Copper Mining in Chile
Authors: Gahona Flores Orlando Francisco 
Published: May 2021

The objective of this research was to identify the criteria for the selection of sustainable suppliers in the supply chain of copper mining located in the Antofagasta region in Chile, through the information obtained in the application of a survey managers mining companies in 2018. The research results show that mining companies use economic, environmental and social criteria in the selection of sustainable suppliers, which are consistent with the research carried out by Dickson (1966) and Zimmer, Frohling and Schultmann ( 2016). However, the differentiation that mining companies make in the evaluation of criteria when it comes to suppliers of goods or service providers stands out as an important finding. In the case of suppliers of goods, economic criteria are valued more preferably, such as: quality, delivery on time, price, historical performance and previous sales. On the other hand, when it comes to service providers, environmental and social criteria, such as: occupational health and safety management and environmental management, are valued with greater importance.
Entrenamiento corporal: factores asociados a la pedagogía teatral para el desarrollo de la creatividad motricia
Authors: Muñoz -Salazar Luz Elena 
Published: May 2021

Este documento da cuenta del proceso de investigación que buscó identificar los factores del entrenamiento corporal asociados a la pedagogía teatral, que incidieron en el desarrollo de la creatividad motricia para la dramaturgia de la puesta en escena del Monólogo Marranadas, del dramaturgo caleño Víctor Hugo Enríquez Lenis. La investigación se desarrolló desde el enfoque metodológico cualitativo con diseño Método Comparativo Constante (MCC); la población fue la Licenciatura en Arte Teatral de Bellas Artes, Cali, Colombia, entre los años 2006 y 2012 ; la muestra estuvo constituida por diez (10) programas analíticos de clases prácticas, los cuales se revisaron documentalmente con el instrumento rejilla de análisis de elaboración propia, y cinco (5) docentes de entrenamiento corporal a quienes se aplicó el instrumento entrevista estructurada con preguntas abiertas. El análisis de la información permitió identificar que los factores del entrenamiento corporal asociados a la pedagogía teatral que incidieron en el desarrollo de la creatividad motricia de la estudiante Luz Elena Muñoz Salazar fueron: la contextualización, la diversidad en la programación y la creatividad controlada.
Modifications of the fit and combination of surgical masks and KN95 respirators to increase respiratory protection against SARS-CoV-2
Authors: Ruiz Manuel Chavez , Camargo Betsabe Ruffner , Torres Lenin Rueda , Bellido Cristofer 
Published: May 2021

Objetivo. En el presente trabajo se ha desarrollado una metodología para la evaluación de la protección respiratoria en mascarillas quirúrgicas y respiradores de uso común en la población peruana, considerando las partículas de mayor probabilidad de contener virus activo del SARS-COV-2, la cual incluye la capacidad de filtración del material empleado y el ajuste proporcionado por el dispositivo de protección respiratoria.
Metodología. Se ha determinado una relación lineal directa entre el logaritmo de la concentración de partículas suspendidas en aire y el tiempo transcurrido; por lo cual es posible comparar la cantidad de partículas internas y externas a la mascarilla o respirador en un mismo período de tiempo y conocer el porcentaje de protección respiratoria de cada muestra evaluada.
Conclusiones: Se obtiene concordancia entre los valores obtenidos de protección respiratoria y los esperados considerando el nivel de filtración del material empleado que compone cada mascarilla quirúrgica o respirador, y el nivel de ajuste presentado por los mismos, observándose un incremento significativo en los niveles de protección respiratoria mejorando el ajuste en los mismos.
The precuneal cortex: anatomy and seizure semiology
Authors: Al‐Ramadhani Ruba R. , Shivamurthy Veeresh Kumar N. , Elkins Kathryn , Gedela Satyanarayana , Pedersen Nigel P. , Kheder Ammar 
Published: May 2021

AbstractThe purpose of this review is to describe the functional anatomy of the precuneal cortex and outline some semiological features of precuneal seizures. The precuneal cortex is a structure that occupies the posterior medial portion of the parietal lobe, and it has broad cortical and subcortical connections. Neuroanatomical tracing, functional imaging, as well as electrical stimulation studies of humans and other primates have elucidated many complex integrative functions of the precuneus including visuo‐spatial imagery, sensorimotor functions, and consciousness. Based on the understanding of its functions and connectivity, descriptions of potential seizure semiologies are hypothesized and compared to what is available in the literature. The latter is mostly in the form of case reports or case series. Seizures may involve simple or complex motor or sensory manifestations including abnormal eye movements, visual hallucinations, sensation of motion, or medial temporal‐like seizures.
A Study On Effectiveness Of Competency Mapping Through Training AndDevelopment
Authors: Et. al. Dr. Saikumari V, 
Published: May 2021

In today’s corporate world, many companies and organization are increasingly focusing on human capital as a competitive advantage in rapidly changing environment. Many successful companies realize that their employees are their greatest asset. Therefore, companies are increasingly investing in educating their own employees so that they can grow and change within the company and make it more profitable.
The range of training opportunities varies considerable from company to company so, when researching potential employers, it is important for job seekers who care about this to investigate the level and type of training provided to employees. After employees have been selected for various positions in an organization, training them for specific tasks to which they have been assigned assumes greater importance.
This study suggests the organization to implement more modern training methodologies, then to provide practical training to the employees and to provide specific learning assignments or projects for participants to improve on their competency gap.