bluuebunny/crossref_metadata_2025_split huggingface dataset:
A cross-sectional analysis of refractive error prevalence and associated factors among elementary school children in Hawassa, Ethiopia
Authors: Alem Kindie Desta , Gebru Elias Abera 
Published: March 2021

Objective This study assessed the prevalence of refractive error (RE) and its associated factors among elementary school children in Hawassa, Ethiopia. Methods In this school-based cross-sectional study, a random selection technique with proportional allocation was used to ensure a representative sample of students. Survey questionnaires were used to collect sociodemographic, environmental, and family history data. Clinical examinations were performed to assess RE and ocular health. Associations between dependent and independent variables were computed using adjusted odds ratios (AORs) and 95% confidence intervals (CIs). Results Overall, 529 children participated in this study, with a response rate of 95.5% (529/554). Most participants were aged ≥12 years (337 [63.7%]), in grade levels 5 to 8 (307 [58%]), and attended public schools (366 [69.2%]). RE prevalence was 12.9% (95% CI: 10.0–16.1). Higher grade level (AOR=3.18, 95% CI: 1.68–5.97), positive family history of RE (AOR=3.69, 95% CI: 1.57–8.67), lack of paternal formal education (AOR=3.25, 95% CI: 1.20–8.77), and public school attendance (AOR=3.33, 95% CI: 1.52–7.27) were factors significantly associated with RE. Conclusions RE prevalence among elementary school children in Hawassa was higher than in previous reports. Grade level, family history, paternal education level, and school type significantly influenced RE status.
Progesterone activates the cyclic AMP-protein kinase A signalling pathway by upregulating ABHD2 in fertile men
Authors: Jiang Feng , Zhu Yong , Chen Ying , Tang Xiaofeng , Liu Liu , Chen Guowu , Liu Yulin , Sun Xiaoxi 
Published: March 2021

Objective This was a prospective study to investigate whether progesterone affects sperm activity by regulating the cyclic AMP-protein kinase A (cAMP-PKA) signalling pathway via α/β hydrolase domain-containing protein 2 (ABHD2). Methods Spermatozoa were collected from healthy and infertile men (with oligoasthenospermia or abnormal acrosome; n = 30/group). The expression of and mutations in ABHD2 were detected by quantitative PCR, western blot, and gene sequencing. The expression of ABHD2 in the presence of progesterone was detected in all groups, and cAMP and PKA levels were detected by ELISA in fertile men after treatment with ABHD2 antibody and PKA inhibitor H-89, respectively. Results Expression of ABHD2 mRNA and protein were reduced in spermatozoa from infertile compared with fertile men. Four gene mutation sites were detected in spermatozoa from the infertile groups. Progesterone increased mRNA and protein levels of ABHD2 in healthy spermatozoa but not in spermatozoa from infertile men. The levels of cAMP and PKA were increased by progesterone in healthy spermatozoa, and the progesterone-increased cAMP and PKA were decreased by ABHD2 antibody and H-89, respectively. Conclusion Progesterone regulates the ABHD2-mediated cAMP-PKA signalling pathway in healthy spermatozoa, which provides a new target for clinical diagnosis and treatment of infertility.
Analysis of Mortality in Patients Treated With Phenylephrine in Septic Shock
Authors: Patel Vishal V. , Sullivan Jesse B. , Cavanaugh Joseph 
Published: March 2021

Background: Phenylephrine is a selective α1-receptor agonist used to manage shock. Current guidelines for septic shock recommend limited utilization of phenylephrine due to the lack of evidence available. This deviates from previous guidelines, which had recommendations of when utilization may be appropriate. Objective: The primary objective of this study was to evaluate mortality in patients receiving phenylephrine for the management of septic shock. Methods: This was a retrospective chart review from September 2015 to September 2017 evaluating all adult patients admitted to an intensive care unit (ICU) on vasopressors for management of septic shock. Patients were divided into 2 groups, those treated with phenylephrine and those treated without phenylephrine. The primary outcome was mortality. Secondary objectives included days on vasopressors and ICU length of stay. Two subgroup analyses were performed: 1 for phenylephrine as first-line therapy and 1 for patients with tachycardia at initiation of vasopressors. Patients started on phenylephrine for salvage therapy were excluded from this study. Results: 499 patients enrolled in the study. 148 (32%) were enrolled in the phenylephrine group. Phenylephrine was associated with an increase in mortality (56% vs 41%; p = 0.003). There was no difference in the days on vasopressors or ICU length of stay. Patients who had ongoing tachycardia were associated with increased mortality with phenylephrine (54% vs 36%, p = 0.02). There was no difference in mortality when phenylephrine was started as the initial vasopressor. Conclusion: Utilization of phenylephrine in septic shock patients, especially those with ongoing tachycardia, was associated with an increased rate of mortality.
Hexagonal boron nitride nanoparticles trigger oxidative stress by modulating thiol/disulfide homeostasis
Authors: Kar F , Söğüt İ , Hacıoğlu C , Göncü Y , Şenturk H , Şenat A , Erel Ö , Ay N , Kanbak G 
Published: March 2021

Background: Hexagonal boron nitride nanoparticles (hBN NPs) are encouraging nanomaterials with unique chemical properties in medicine and biomedical fields. Until now, the optimal hBN NP’s dosage and biochemical mechanism that can be used for in vivo systems has not been fully revealed. The main aim of this article is to reveal characteristics, serum and tissue interactions and any acute cytotoxic effect of different dose of hBN NPs for the first time. Methods: hBN NPs at concentrations varying between 50–3200 µg/kg was administered by intravenous injection to Wistar albino rats (n = 80) divided into seven dosage and control groups. Blood and tissue samples were taken after 24 hours. Results: Our findings suggested that higher doses hBN NPs caused oxidative stress on the serum of rats dose-dependently. However, hBN NPs did not affect thiol/disulfide homeostasis on kidney, liver, spleen, pancreas and heart tissue of rats. Furthermore, hBN NPs increased serum disulfide formation by disrupting the thiol/disulfide balance in rats. Also, LOOH and MPO levels increased at high doses, while CAT levels decreased statistically. Conclusion: The results revealed that hBN NPs induce oxidative stress in a dose-dependent manner by modulating thiol/disulfide homeostasis in rats at higher concentrations
Improving Advance Care Planning Documentation Using Reminders to Patients and Physicians: A Longitudinal Study in Primary Care
Authors: Halpert Karen D. , Ward Kimberly , Sloane Philip D. 
Published: March 2021

Objective: Documenting advance care planning (ACP) in primary care requires multiple triggers. New Medicare codes make it easier for providers to bill for these encounters. This study examines the use of patient and provider reminders to trigger advance care planning discussions in a primary care practice. Secondary outcome was billing of new ACP billing codes. Methods: Patients 75 years and older scheduled for a primary care appointment were screened for recent ACP documentation in their chart. If none was found, an electronic or mail message was sent to the patient, and an electronic message to their provider, about the need to have discussion at the upcoming visit. Chart review was performed 3 months after the visit to determine if new ACP discussion was documented in the chart. Results: In the 3 months after the reminder had been sent to patients and providers, new ACP documentation or billing was found in 28.8% of the patients. Most new documentation was health care decision maker (75.6% of new documentation) with new DNR orders placed for 32.3% of these patients. The new Medicare billing code was filled 10 times (7.8%). Conclusion: Reminders sent to both patients and providers can increase documentation of ACP during primary care visits, but rarely triggers a full ACP conversation.
Children’s subversive interactions in the school mealtime
Authors: Stone Samantha , Murakami Kyoko 
Published: March 2021

School mealtimes in England are highly orchestrated practices that have a specific temporal order of when and how the meal should be eaten. At the same time, the social conditions of the mealtime offer children opportunities for emergent interactions. In this study, we examine children’s non-legitimate voices and the dynamic conflictual nature of children’s interactions that are no longer fully governed by the established school mealtime order. To illustrate these ideas, data are drawn from the 5 years of ethnographic fieldwork conducted by the first author in a primary school in South West England. The analyses address how children use the school mealtime chronotope as a resource to experiment and challenge predefined rules. Our findings illustrate how children transcend the edges of acceptability and probe social order to form their own social critique and uncovering what is not easily explainable or changeable. As an implication we underline the potential for researching children’s socialisation as part of expanding discussions on the significance of school mealtimes.
Relationship Between Serum Inflammatory Factor Levels and Differentiated Thyroid Carcinoma
Authors: Zhang Xue , Li Su , Wang Jinhui , Liu Fubao , Zhao Yong 
Published: March 2021

Background: Some evidence supports that the significance of inflammation is linked to a variety of tumors, including thyroid carcinoma. This work measured the preoperative serum inflammatory factors in thyroid tumors to explore their diagnostic values. Material and Methods: Altogether 487 thyroid tumor patients were recruited, their neutrophil (NE), white blood cell (WBC), monocyte (MO), lymphocyte (LY), platelet (PLT) counts, together with monocyte/lymphocyte ratio (MLR), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), C-reactive protein (CRP), interleukin (IL)-1β, IL-2, IL-27, and tumor necrosis factor-α (TNF-α) levels were compared with controls. Afterward, the receiver operating characteristics (ROC) curve was plotted to further evaluate the values of these inflammatory markers in diagnosis. In addition, multivariable regression analysis was conducted to analyze all these inflammatory factors. Results: Serum PLR, NLR, CRP, and IL-27 levels in thyroid adenoma (TA) and differentiated thyroid carcinoma (DTC) patients were higher than those in controls. Only the areas under the curve (AUC) for CRP and IL-27 were significant in the context of DTC. Besides, the AUC for IL-27 was significant between papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC) groups, while that for NLR+PLR was also significant between PTC and healthy control groups. According to multivariable logistic regression analysis, IL-27 and CRP were associated with DTC. Conclusions: Inflammation plays an important role in TA and DTC progression. Preoperative IL-27 and CRP levels help to differentially diagnose DTC. Moreover, IL-27 assists in distinguishing FTC from PTC, and NLR+PLR is important for the differential diagnosis of PTC.
Study on Relationships of Tumor Status and Gene Polymorphism With Blood Concentration of MTX and Toxicities in 63 Pediatric Mature B Cell Lymphoma in Chinese Population
Authors: Huang Shuang , Jin Lin , Yang Jing , Duan Long Yan , Zhang Meng , Zhou Ju Chun , Zhang Hong Yong 
Published: March 2021

Objective: This study investigated the relationships of tumor status (stage, renal involvement, bone marrow status, bulky disease, liver function), tumor gene polymorphism, and methotrexate (MTX) dosage (stratified by treatment group) with blood MTX levels and adverse reactions (ADR). Methods: We retrospectively reviewed 63 mature B cell lymphoma patients who were treated in our center. Genotyping of the MTHFR 677 and SLCO1B1 genes was carried out, and the relationships between tumor status, polymorphism of the genes, MTX level, and ADR were analyzed. Results: Altogether, 63 children were included. The mean blood MTX concentration was 0.25 ± 0.2 umol/L at 45 h. Liver dysfunction and bulky disease were both correlated with MTX level (both P < 0.05). ADRs were higher among patients with blood MTX > 0.5 mmol/l at 45 h than for the groups with lower blood MTX. The MTHFR 677 CT genotype was correlated with liver function damage (P = 0.04); the rs11045879 locus CC genotype of SLCO1B1, stage IV, and bulky disease at the time of diagnosis were correlated with 4° neutropenia (P < 0.05). Stage IV, bulky disease, leukemia stage at the time of diagnosis, and C2 treatment group were correlated with severe anemia (P < 0.05). Stage IV, bulky disease, leukemia stage, renal invasion at the time of diagnosis, and C2 treatment group were associated with severe thrombocytopenia (P < 0.05). Bulky disease and renal invasion at the time of diagnosis were associated with severe mucositis and severe infection (P < 0.05). Conclusion: Taken together, our data demonstrate that gene polymorphism, MTX levels, tumor status, and treatment group might be useful to optimize MTX therapy and estimate toxicity.
Coronary artery bypass graft surgery versus stenting for patients with chronic kidney disease and complex coronary artery disease: a systematic review and meta-analysis
Authors: Cui Kongyong , Liu Hong , Yuan Fei , Xu Feng , Zhang Min , Zhang Mingduo , Wang Wei , Zhang Dongfeng , Tian Jinfan , Lyu Shuzheng , Dou Kefei 
Published: March 2021

Background: The relative role of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) with stent implantation in patients with chronic kidney disease (CKD) and complex coronary artery disease (CAD) remains debatable due to the lack of randomized controlled trials (RCTs). We therefore performed this meta-analysis to compare the outcomes of the two strategies in CKD patients with multivessel and/or left main disease. Methods: Electronic databases including PubMed, EMBASE and Cochrane Library were comprehensively searched to identify the eligible subgroup analysis of RCTs and propensity-matched registries. The primary endpoint was all-cause mortality during the longest follow-up. Results: Five subgroup analyses of RCTs and six propensity-matched registries involving 26,441 patients were analyzed. Overall, the strategy of CABG was associated with lower risks of long-term mortality [odds ratio (OR) 0.83, 95% confidence interval (CI) 0.74–0.93], myocardial infarction (OR, 0.41; 95% CI, 0.27–0.62), and repeat revascularization (OR, 0.25; 95% CI, 0.16–0.39) compared with PCI in CKD patients with complex CAD. However, CABG was slightly associated with higher risk of stroke than PCI (OR, 1.33; 95% CI, 1.00–1.77). Nonetheless, the higher stroke risk in the CABG group no longer existed during long-term follow-up (OR, 0.92; 95% CI, 0.37–2.25) (>3 years). Conclusion: This meta-analysis supports the current guideline advising CABG for patients with CKD and complex CAD. At the expense of slightly increased risk of stroke, CABG reduces the incidences of long-term all-cause death, myocardial infarction and repeat revascularization compared with PCI.
Effects and Safety of Lumbar Fusion Techniques in Lumbar Spondylolisthesis: A Network Meta-Analysis of Randomized Controlled Trials
Authors: Kang Yi-No , Ho Yu-Wan , Chu William , Chou Wen-Shiang , Cheng Shih-Hao 
Published: March 2021

Study Design: Network meta-analysis of randomized controlled trials. Objectives: Lumbar spondylolisthesis is a common indication for spinal fusion. Lumbar interbody fusion (LIF) is popular method to achieve arthrodesis, but previous syntheses usually used head-to-head comparison of 2 surgical methods, and no of them pooled analysis with high-quality. This network meta-analysis of randomized controlled trials was carried out to simultaneously compare fusion techniques in the treatment of lumbar spondylolisthesis. Methods: Three databases were searched for randomized controlled trials (RCTs) on this topic. After critical appraisal, fusion rate, overall adverse events, operative time, Oswestry Disability Index, and pain were extracted for analysis. We conduced network meta-analysis using contrast-based method. Primary outcomes were reported as risk ratio (RR) with 95% confidence interval (CI). Results: Fifteen RCTs (n = 992) met our eligibility criteria. The RCTs treated patients posterolateral fusion (PLF), posterior LIF (PLIF), transforaminal LIF (TLIF), minimally invasive (MIS) TLIF, extreme lateral LIF (XLIF), and circumferential fusion. The pooled estimate showed that circumferential fusion led to significantly higher fusion rate than PLF (RR = 2.15, 95%CI:1.41–3.28), PLIF (RR = 2.11, 95%CI:1.38–3.22), TLIF (RR = 2.13, 95%CI:1.39–3.27), MIS-TLIF (RR = 2.13, 95%CI:1.35–3.35), and XLIF (RR = 2.01, 95%CI: 1.25–3.22). Moreover, circumferential fusion exhibited the best balance in probability between fusion rate and adverse event rate. No evidence showed inconsistency or small-study effect in the results. Conclusions: Collectively, circumferential fusion might be worth to be recommended because it exhibits the best balance between fusion rate and overall adverse event. PLF is still an inferior procedure and requires shorter operative time.
A conceptual model to guide research on the activities and effects of innovation champions
Authors: Shea Christopher M 
Published: March 2021

Background: The importance of having a champion to promote implementation efforts has been discussed in the literature for more than five decades. However, the empirical literature on champions remains underdeveloped. As a result, health organizations commonly use champions in their implementation efforts without the benefit of evidence to guide decisions about how to identify, prepare, and evaluate their champions. The goal of this article is to present a model of champion impact that draws upon previous literature and is intended to inform future research on champions and serve as a guide for practitioners serving in a champion role. Methods: The proposed model is informed by existing literature, both conceptual and empirical. Prior studies and reviews of the literature have faced challenges in terms of operationalizing and reporting on champion characteristics, activities, and impacts. The proposed model addresses this challenge by delineating these constructs, which allows for consolidation of factors previously discussed about champions as well as new hypothesized relationships between constructs. Results: The model proposes that a combination of champion commitment and champion experience and self-efficacy influence champion performance, which influences peer engagement with the champion, which ultimately influences the champion’s impact. Two additional constructs have indirect effects on champion impact. Champion beliefs about the innovation and organizational support for the champion affect champion commitment. Conclusion: The proposed model is intended to support prospective studies of champions by hypothesizing relationships between constructs identified in the champion literature, specifically relationships between modifiable factors that influence a champion’s potential impact. Over time, the model should be modified, as appropriate, based on new findings from champion-related research. Plain language summary An innovation champion is an individual who works within an organization and who dedicates themselves to promoting a change within the organization, such as implementing a new intervention or a new quality improvement effort. Health organizations commonly rely on innovation champions, and existing literature on champions suggests they are important for successful organizational change. However, many questions remain about what effective champions do and what types of support they need to perform their champion role well. The goal of this article is to present a model of champion impact that draws upon previous literature and is intended to serve as a guide for future research on champions. In doing so, the model could support coordinated research efforts that answer questions about the characteristics, activities, and impacts of champions. Ultimately, this research could lead to development of useful guidance and tools for health system leaders to support champions within their organizations.
Governance challenges of mobility platforms: the case of Merwede, Utrecht
Authors: van den Hurk Martijn , Pelzer Peter , Riemens Rianne 
Published: March 2021

Abstract
Background
Merwede is an envisioned neighbourhood in Utrecht (the Netherlands) that provides an instructive case to learn about the governance challenges of digital mobility platforms. Unique about Merwede is how the development of a mobility platform is envisioned to be integrated into the development of a new neighbourhood.

Methodology
This article discusses the case of Merwede and provides insights into its proposed mobility platform and how it is made. It illuminates governance challenges relevant to the design and operation of an unconventional mobility concept by disentangling outstanding practical issues concerning three key governance dimensions—organizational structures, decision-making processes, and instruments.

Results
The research provides an empirical illustration of governance questions that come up when mobility becomes a service and is integrated into the urban fabric from the very beginning of a development process. Already in the plan development stage, Merwede illustrates that difficult decisions are to be made and competing interests come to the fore.
Relationship between neighborhood census-tract level socioeconomic status and respiratory syncytial virus-associated hospitalizations in U.S. adults, 2015–2017
Authors: Holmen Jenna E. , Kim Lindsay , Cikesh Bryanna , Kirley Pam Daily , Chai Shua J. , Bennett Nancy M. , Felsen Christina B. , Ryan Patricia , Monroe Maya , Anderson Evan J. , Openo Kyle P. , Como-Sabetti Kathryn , Bye Erica , Talbot H. Keipp , Schaffner William , Muse Alison , Barney Grant R. , Whitaker Michael , Ahern Jennifer , Rowe Christopher , Langley Gayle , Reingold Art 
Published: March 2021

Abstract
Background
Respiratory syncytial virus (RSV) infection causes substantial morbidity and mortality in children and adults. Socioeconomic status (SES) is known to influence many health outcomes, but there have been few studies of the relationship between RSV-associated illness and SES, particularly in adults. Understanding this association is important in order to identify and address disparities and to prioritize resources for prevention.

Methods
Adults hospitalized with a laboratory-confirmed RSV infection were identified through population-based surveillance at multiple sites in the U.S. The incidence of RSV-associated hospitalizations was calculated by census-tract (CT) poverty and crowding, adjusted for age. Log binomial regression was used to evaluate the association between Intensive Care Unit (ICU) admission or death and CT poverty and crowding.

Results
Among the 1713 cases, RSV-associated hospitalization correlated with increased CT level poverty and crowding. The incidence rate of RSV-associated hospitalization was 2.58 (CI 2.23, 2.98) times higher in CTs with the highest as compared to the lowest percentages of individuals living below the poverty level (≥ 20 and < 5%, respectively). The incidence rate of RSV-associated hospitalization was 1.52 (CI 1.33, 1.73) times higher in CTs with the highest as compared to the lowest levels of crowding (≥5 and < 1% of households with > 1 occupant/room, respectively). Neither CT level poverty nor crowding had a correlation with ICU admission or death.

Conclusions
Poverty and crowding at CT level were associated with increased incidence of RSV-associated hospitalization, but not with more severe RSV disease. Efforts to reduce the incidence of RSV disease should consider SES.