bluuebunny/crossref_metadata_2025_split huggingface dataset:
Geographical variability and factors associated with caesarean section delivery in India: a comparative assessment of Bihar and Tamil Nadu
Authors: Roy Avijit , Paul Pintu , Chouhan Pradip , Rahaman Margubur , Kapasia Nanigopal 
Published: September 2021

Abstract
Background
Caesarean section delivery is a major life-saving obstetric surgical intervention for mothers and babies from pregnancy and childbirth related complications. This paper attempts to investigate the geographical variations and correlating factors of caesarean section delivery in India, particularly focusing on the states of Bihar and Tamil Nadu, accounting for one of the lowest and highest prevalence states of caesarean section delivery respectively.

Methods
This study is based on secondary data, collected from the fourth round of the National Family Health Survey (NFHS-4), 2015–16. We utilized 190,898 women aged 15–49 years who had a living child during the past 5 years preceding the survey. In this study, caesarean section delivery was the outcome variable. A variety of demographic, socio-economic, and pregnancy- and delivery-related variables were considered as explanatory variables. Descriptive statistics, bivariate percentage distribution, Pearson’s Chi-square test, and multivariate binary logistic regression models were employed to draw the inferences from data.

Results
Of participants, about 19% of women had undergone caesarean section delivery in the country. The state-wise distribution shows that Telangana (60%) followed by Andhra Pradesh (42%) and Tamil Nadu (36%) represented the topmost states in caesarean delivery, while Bihar (7%), Madhya Pradesh (10%), and Jharkhand (11%) placed at the bottom end. Multivariate logistic models show that the likelihood of caesarean delivery was higher among older women (35–49 years), women with higher levels of education, Muslims, women belonging to the upper quintiles of the household wealth, and those who received antenatal care (ANC), experienced pregnancy loss and delivery complications. Moreover, the odds of caesarean section delivery were remarkably greater for the private health sector than the public health sector in both focused states: Bihar (odds ratio [OR] = 12.84; 95% confidence interval [CI]: 10.90, 15.13) and Tamil Nadu (OR = 2.90; 95% CI: 2.54, 3.31).

Conclusion
Findings of this study suggest that improvement in female education, providing economic incentives, and spreading awareness through mass media could raise the caesarean section delivery among women whose vaginal delivery could be unsafe for them as well as for their babies. Moreover, providing adequate ANC and well-equipped public healthcare services would facilitate caesarean delivery among needy women.
Ang-(1–7) protects skeletal muscle function in aged mice
Authors: Li Ying , Song Jiao , Jiang Yangyang , Yang Xue , Cao Li , Xiao Chun , Li Suli , Dong Birong , Huang Xiaoli 
Published: September 2021

AbstractBackgroundThe angiotensin-converting enzyme 2 (ACE2)/angiotensin 1–7 (Ang-(1–7)) axis has been shown to protect against the age-associated decline in skeletal muscle function. Here, we investigated the protective effects of ACE2 in mitigating the age-associated decline of skeletal muscle function and to identify the potential underlying molecular mechanisms.MethodsWe measured the expression levels of Ang-(1–7) in C57BL/6J mice of different ages and correlated these levels with measures of skeletal muscle function. We also investigated the expression of myocyte enhancer factor 2 A (MEF2A) in ACE2 knockout (ACE2KO) mice and its relationship with muscle function. We then treated aged ACE2KO mice for four weeks with Ang-(1–7) and characterized the levels of MEF2A and skeletal muscle function before and after treatment. We assessed the impact of Ang-(1–7) on the growth and differentiation of C2C12 cells in vitro and assessed changes in expression of the glucose transporter type 4 (Glut4).ResultsAged mice showed reduced skeletal muscle function and levels of Ang-(1–7) expression in comparison to young and middle-aged mice. In ACE2KO mice, skeletal muscle function and MEF2A protein expression were significantly lower than in age-matched wild-type (WT) mice. After one month of Ang-(1–7) treatment, skeletal muscle function in the aged ACE2KO mice improved, while MEF2A protein expression was similar to that in the untreated group. In C2C12 cells, Ang-(1–7) was shown to promote along with the upregulated expression of Glut4.ConclusionsThe ACE2/ Ang-(1–7) axis has a protective function in skeletal muscle and administration of exogenous Ang-(1–7) can delay the age-related decline in the function of skeletal muscle.
Comparing the locking screw direction of three locking plates for lateral clavicle fractures: a simulation study
Authors: Abe Shingo , Koizumi Kota , Murase Tsuyoshi , Kuriyama Kohji 
Published: September 2021

Abstract
Background
The locking plate is a useful treatment for lateral clavicle fractures, however, there are limits to the fragment size that can be fixed. The current study aimed to measure the screw angles of three locking plates for lateral clavicle fractures. In addition, to assess the number of screws that can be inserted in different fragment sizes, to elucidate the size limits for locking plate fixation.

Methods
The following three locking plates were analyzed: the distal clavicle plate [Acumed, LLC, Oregon, the USA], the LCP clavicle plate lateral extension [Depuy Synthes, LLC, PA, the USA], and the HAI clavicle plate [HOMS Engineering, Inc., Nagano, Japan]. We measured the angles between the most medial and lateral locking screws in the coronal plane and between the most anterior and posterior locking screws in the sagittal plane. A computer simulation was used to position the plates as laterally as possible in ten normal three-dimensional clavicle models. Lateral fragment sizes of 10, 15, 20, 25, and 30 mm were simulated in the acromioclavicular joint, and the number of screws that could be inserted in the lateral fragment was assessed. Subsequently, the area covered by the locking screws on the inferior surface of the clavicle was measured.

Results
The distal clavicle plate had relatively large screw angles (20° in the coronal plane and 32° in the sagittal plane). The LCP clavicle lateral extension had a large angle (38°) in the sagittal plane. However, the maximum angle of the HAI clavicle plate was 13° in either plane. The distal clavicle plate allowed most screws to be inserted in each size of bone fragment. For all locking plates, all screws could be inserted in 25 mm fragments. The screws of distal clavicle plate covered the largest area on the inferior surface of the clavicle.

Conclusions
Screw angles and the numbers of screws that could be inserted in the lateral fragment differed among products. Other augmented fixation procedures should be considered for fractures with fragment sizes < 25 mm that cannot be fixed with a sufficient number of screws.
Reframing cancer: challenging the discourse on cancer and cancer drugs—a Norwegian perspective
Authors: Stenmarck Mille Sofie , Engen Caroline , Strand Roger 
Published: September 2021

Abstract
Background
As the range of therapeutic options in the field of oncology increases, so too does the strain on health care budgets. The imbalance between what is medically possible and financially feasible is frequently rendered as an issue of tragic choices, giving rise to public controversies around health care rationing.

Main body
We analyse the Norwegian media discourse on expensive cancer drugs and identify four underlying premises: (1) Cancer drugs are de facto expensive, and one does not and should not question why. (2) Cancer drugs have an indubitable efficacy. (3) Any lifetime gained for a cancer patient is an absolute good, and (4) cancer patients and doctors own the truth about cancer. Applying a principle-based approach, we argue that these premises should be challenged on moral grounds. Within the Norwegian public discourse, however, the premises largely remain unchallenged due to what we find to be unjustified claims of moral superiority. We therefore explore alternative framings of the issue of expensive cancer drugs and discuss their potential to escape the predicament of tragic choices.

Conclusions
In a media discourse that has seemingly stagnated, awareness of the framings within it is necessary in order to challenge the current tragic choices predicament the discourse finds itself in. In order to allow for a discourse not solely concerned with the issue of tragic choices, the premises that underlie it must be subjected to critical examination. As the field of oncology advances rapidly, we depend on a discussion of its opportunities and challenges that is meaningful, and that soberly addresses the future of cancer care—both its potential and its limits.
Criteria for assessing the quality of clinical practice guidelines in paediatrics and neonatology: a mixed-method study
Authors: Dagard Joanna , Mazille-Orfanos Nadia , Georgi Nawras , Dechicha Intissar , Carrault Guy , Pladys Patrick , Beuchée Alain 
Published: September 2021

AbstractBackgroundEvidenced-based practice is a key component of quality care. This study aims to explore users’ expectations concerning paediatric local clinical practice guidelines.MethodsA mixed method approach was applied, including material from quantitative questionnaire and semi-structured interviews. Data were analysed using descriptive statistics and qualitative content analysis. Data were analysed with constant comparative method. Qualitative data were parsed and categorized to identify themes related to decision-making.ResultsA total of 83 physicians answered the survey (response rate 83%). 98% of the participants wanted protocols based on international guidelines, 80% expected a therapeutic content. 24 semi-structured interviews were conducted to understand implementation processes, barriers and facilitators. Qualitative analysis revealed 5 emerging themes: improvement of local clinical practice guidelines, patterns of usage, reasons for non-implementation, alternative sources and perspectives.ConclusionSome criteria should be considered for the redaction of local clinical practice guidelines: focus on therapeutic, ease of access, establish local clinical practice guidelines based on international guidelines adapted to the local setting, document references and include trainees such as residents in the redaction.
Single-cell DNA and RNA sequencing reveals the dynamics of intra-tumor heterogeneity in a colorectal cancer model
Authors: Ono Hanako , Arai Yasuhito , Furukawa Eisaku , Narushima Daichi , Matsuura Tetsuya , Nakamura Hiromi , Shiokawa Daisuke , Nagai Momoko , Imai Toshio , Mimori Koshi , Okamoto Koji , Hippo Yoshitaka , Shibata Tatsuhiro , Kato Mamoru 
Published: September 2021

Abstract
Background
Intra-tumor heterogeneity (ITH) encompasses cellular differences in tumors and is related to clinical outcomes such as drug resistance. However, little is known about the dynamics of ITH, owing to the lack of time-series analysis at the single-cell level. Mouse models that recapitulate cancer development are useful for controlled serial time sampling.

Results
We performed single-cell exome and transcriptome sequencing of 200 cells to investigate how ITH is generated in a mouse colorectal cancer model. In the model, a single normal intestinal cell is grown into organoids that mimic the intestinal crypt structure. Upon RNAi-mediated downregulation of a tumor suppressor gene APC, the transduced organoids were serially transplanted into mice to allow exposure to in vivo microenvironments, which play relevant roles in cancer development. The ITH of the transcriptome increased after the transplantation, while that of the exome decreased. Mutations generated during organoid culture did not greatly change at the bulk-cell level upon the transplantation. The RNA ITH increase was due to the emergence of new transcriptional subpopulations. In contrast to the initial cells expressing mesenchymal-marker genes, new subpopulations repressed these genes after the transplantation. Analyses of colorectal cancer data from The Cancer Genome Atlas revealed a high proportion of metastatic cases in human subjects with expression patterns similar to the new cell subpopulations in mouse. These results suggest that the birth of transcriptional subpopulations may be a key for adaptation to drastic micro-environmental changes when cancer cells have sufficient genetic alterations at later tumor stages.

Conclusions
This study revealed an evolutionary dynamics of single-cell RNA and DNA heterogeneity in tumor progression, giving insights into the mesenchymal-epithelial transformation of tumor cells at metastasis in colorectal cancer.
The effect of Helicobacter pylori eradication on prognosis of postoperative early gastric cancer: a multicenter study
Authors: Wang Liang , Wang Jinfeng , Li Sha , Bai Fei , Xie Hailong , Shan Hanguo , Liu Zhuo , Ma Tiexiang , Tang Xiayu , Tang Haibing , Qin Ang , Lei Sanlin , Zuo Chaohui 
Published: September 2021

Abstract
Objective
To investigate the effect of Helicobacter pylori (H. pylori) eradication on the prognosis of postoperative early gastric cancer (EGC).

Methods
This is a retrospective study based on data from 6 hospitals. We identified 429 patients with EGC who underwent curative gastrectomy from January 2010 to December 2016. All of the patients were tested for H. pylori. Patients were divided into two groups, the successful H. pylori eradication group (group A, 268 patients) and the non-H. pylori eradication group (group B, 161 patients), for calculating the disease-free survival (DFS) and overall survival (OS) of each group.

Result
Positive node metastasis (hazard ratio (HR), 3.13; 95% confidence interval (CI), 1.84–5.32; P < 0.001), undifferentiated type (HR, 2.54; 95% CI, 1.51–4.28; P < 0.001), and non-H. pylori eradication (HR, 1.73; 95% CI, 1.08–2.77; P = 0.023) were statistically significantly independent risk factors of recurrence. Patient’s age ≥60 years old (HR, 3.32; 95% CI, 2.00–5.53; P < 0.001), positive node metastasis (HR, 3.71; 95% CI, 2.25–6.12; P < 0.001), undifferentiated type (HR, 3.06; 95% CI, 1.79–5.23; P < 0.001), and non-H. pylori eradication (HR, 1.83; 95% CI, 1.11–3.02; P = 0.018) were statistically significantly independent risk factors of overall survival.

Conclusion
H. pylori eradication treatment could prevent the recurrence of postoperative EGC to prolong the overall survival of patients with EGC.
Healthcare resource use and costs for people with type 2 diabetes mellitus with and without severe mental illness in England: longitudinal matched-cohort study using the Clinical Practice Research Datalink
Authors: Wang Han-I. , Han Lu , Jacobs Rowena , Doran Tim , Holt Richard I. G. , Prady Stephanie L. , Gilbody Simon , Shiers David , Alderson Sarah , Hewitt Catherine , Taylor Jo , Kitchen Charlotte E. W. , Bellass Sue , Siddiqi Najma 
Published: September 2021

BackgroundApproximately 60 000 people in England have coexisting type 2 diabetes mellitus (T2DM) and severe mental illness (SMI). They are more likely to have poorer health outcomes and require more complex care pathways compared with those with T2DM alone. Despite increasing prevalence, little is known about the healthcare resource use and costs for people with both conditions.AimsTo assess the impact of SMI on healthcare resource use and service costs for adults with T2DM, and explore the predictors of healthcare costs and lifetime costs for people with both conditions.MethodThis was a matched-cohort study using data from the Clinical Practice Research Datalink linked to Hospital Episode Statistics for 1620 people with comorbid SMI and T2DM and 4763 people with T2DM alone. Generalised linear models and the Bang and Tsiatis method were used to explore cost predictors and mean lifetime costs respectively.ResultsThere were higher average annual costs for people with T2DM and SMI (£1930 higher) than people with T2DM alone, driven primarily by mental health and non-mental health-related hospital admissions. Key predictors of higher total costs were older age, comorbid hypertension, use of antidepressants, use of first-generation antipsychotics, and increased duration of living with both conditions. Expected lifetime costs were approximately £35 000 per person with both SMI and T2DM. Extrapolating nationally, this would generate total annual costs to the National Health Service of around £250 m per year.ConclusionsOur estimates of resource use and costs for people with both T2DM and SMI will aid policymakers and commissioners in service planning and resource allocation.
A randomized controlled trial of the effect of a community-based intervention on patient activation, health-related quality of life, and acute care use.
Authors: Patel Manali I. , Khateeb Sana Indravadan , Krajcinovic Ivana , Salava Deb , Coker Tumaini 
Published: September 2021

1 Background: Low-income and minority populations have disproportionately less activation in their cancer care, worse health-related quality of life (HrQOL), and greater acute care use than affluent and white populations. Community-based interventions are needed to improve patient experiences and quality of cancer care among these populations. We used community-based participatory methods to refine a previously tested intervention for use in Atlantic City NJ. The intervention, LEAPS, uses community health workers trained to activate patients to discuss advance care planning and their symptom burden with cancer clinicians and to connect patients with culturally-relevant community resources to overcome complications from social determinants of health. We conducted a randomized controlled trial of LEAPS in collaboration with a employer-union health fund. Members of the employer-union health fund with newly diagnosed with hematologic and solid tumor cancers were randomized to the 6-month intervention or to usual care. The objective was to determine if the intervention improved HrQOL at 4 months post-enrollment as compared to baseline more than usual care and secondarily the effect on change in patient activation at 4 months post-enrollment as compared to baseline and acute care use within 12 months post-enrollment. Methods: We conducted patient interviews to assess HrQOL and patient activation and obtained claims data for health care use. We used regression models to evaluate differences in health-related quality of life (validated Functional Assessment of Cancer Therapy-General) scores and patient activation (validated Patient Activation Measure) scores between groups over time and exact poisson regression adjusted for length of follow-up to compare emergency department and hospitalization utilization. Results: A total of 160 patients were consented and randomized into the study (80 intervention; 80 control). There were no differences in demographic or clinical factors across groups. The majority were non-white (74%), female (53%), mean age 57 years. The most common diagnoses were breast (31%) and lung (21%) cancer and the majority were diagnosed with stage 3 or 4 (63%). At 4 months, the intervention group had greater improvements in quality of life as compared to the control group (difference in difference: 9.56 p < 0.001), greater change in patient activation (difference in difference: 12.43 (p < 0.001)), and lower acute care use (hospital visits (1.10 (1.53) +/- 1.83 (1.31), p = 0.02) and emergency department use (1.2 (2.82) versus 3.47 (3.62) p = 0.03). Conclusions: Integration of community-based interventions into cancer care for low-income and minority populations may be a more effective and sustainable way to ensure equitable cancer care. Clinical trial information: NCT03699748.
Changes in systemic cancer therapy prior-authorization requests during the COVID-19 pandemic.
Authors: Parsons Helen , Zhao Jingxuan , Gupta Arjun , Henk Henry J. , Yabroff K. Robin 
Published: September 2021

100 Background: The coronavirus (COVID-19) pandemic transformed norms and approaches to delivering cancer care in the US throughout 2020. While initial reports in regional and single institution studies suggest postponement or modification of cancer treatments, limited evidence exists on the long-term national impact of COVID-19 on cancer treatment throughout the year. Methods: Using de-identified OptumLabs Data Warehouse data, which includes data from the Optum Cancer Guidance Program’s electronic prior authorization (ePA) platform, we compared monthly rates (per 100,000 person-months) of requests for authorization for insurance coverage of systemic cancer therapy in January-December 2020 (COVID) versus January-December 2019 (non-COVID). Results: We identified a total of 94,726 prior-authorization requests for chemotherapy in 2020 compared to 106,272 requests in 2019, indicating a 10.8% overall decline during the pandemic. Prior-authorization request rates were 6.3% higher in March 2020 as many stay-at-home orders were implemented across states (Table). Prior authorization requests then significantly declined in April and May 2020 (3.3% and 14.4% lower rates in 2020 vs. 2019) during the stay-at-home orders before briefly increasing again in June. As COVID-19 infections and deaths increased throughout the fall, requests for prior-authorization significantly declined in each month from August through December 2020. Conclusions: The COVID-19 pandemic led to significant overall declines in requests for prior authorizations for chemotherapy in 2020 versus 2019. While requests rebounded somewhat in early spring and summer of 2020, rates were markedly lower, relative to those in 2019, during COVID-19’s second wave. Overall, these results suggest continued modifications or delays in cancer treatment that may result in worse outcomes for individuals with cancer in 2020 and should be evaluated in future studies. [Table: see text]