bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development and psychometric properties of surveys to assess provider perspectives on the barriers and facilitators of effective care transitions
Authors: Johnson Maurice C. , Liu Helen , Sorra Joann , Brock Jane , Gass Brianna , Li Jing , Clouser Jessica Miller , Hirschman Karen , Carpenter Deborah , Nguyen Huong Q. , Williams Mark V. 
Published: May 2021

Abstract
Background
The quality of the discharge process and effective care transitions between settings of care are critical to minimize gaps in patient care and reduce hospital readmissions. Few studies have explored which care transition components and strategies are most valuable to patients and providers. This study describes the development, pilot testing, and psychometric analysis of surveys designed to gain providers’ perspectives on current practices in delivering transitional care services.

Methods
We underwent a comprehensive process to develop items measuring unique aspects of care transitions from the perspectives of the three types of providers (downstream, ambulatory, and hospital providers). The process involved 1) an environmental scan, 2) provider interviews, 3) survey cognitive testing, 4) pilot testing, 5) a Stakeholder Advisory Group, 6) a Scientific Advisory Council, and 7) a collaborative Project ACHIEVE (Achieving Patient-Centered Care and Optimized Health in Care Transitions by Evaluating the Value of Evidence) research team. Three surveys were developed and fielded to providers affiliated with 43 hospitals participating in Project ACHIEVE. Web-based survey administration resulted in 948 provider respondents. We assessed response variability and response missingness. To evaluate the composites’ psychometric properties, we examined intercorrelations of survey items, item factor loadings, model fit indices, internal consistency reliability, and intercorrelations between the composite measures and overall rating items.

Results
Results from psychometric analyses of the three surveys provided support for five composite measures: 1) Effort in Coordinating Patient Care, 2) Quality of Patient Information Received, 3) Organizational Support for Transitional Care, 4) Access to Community Resources, and 5) Strength of Relationships Among Community Providers. All factor loadings and reliability estimates were acceptable (loadings ≥ 0.40, α ≥ 0.70), and the fit indices showed a good model fit. All composite measures positively and significantly correlated with the overall ratings (0.13 ≤ r ≤ 0.71).

Conclusions
We determined that the items and composite measures assessing the barriers and facilitators to care transitions within this survey are reliable and demonstrate satisfactory psychometric properties. The instruments may be useful to healthcare organizations and researchers to assess the quality of care transitions and target areas of improvement across different provider settings.
Synergies and fragmentation in country level policy and program agenda setting, formulation and implementation for Global Health agendas: a case study of health security, universal health coverage, and health promotion in Ghana and Sierra Leone
Authors: Agyepong Irene Akua , M’Cormack-Hale Fredline A. O. , Brown Amoakoh Hannah , Derkyi-Kwarteng Abigail N. C. , Darkwa Theresa Ethel , Odiko-Ollennu Wallace 
Published: May 2021

AbstractBackgroundGlobal health agendas have in common the goal of contributing to population health outcome improvement. In theory therefore, whenever possible, country level policy and program agenda setting, formulation and implementation towards their attainment should be synergistic such that efforts towards one agenda promote efforts towards the other agendas. Observation suggests that this is not what happens in practice. Potential synergies are often unrealized and fragmentation is not uncommon. In this paper we present findings from an exploration of how and why synergies and fragmentation occur in country level policy and program agenda setting, formulation and implementation for the global health agendas of Universal Health Coverage (UHC), Health Security (HS) and Health Promotion (HP) in Ghana and Sierra Leone. Our study design was a two country case study. Data collection involved document reviews and Key Informant interviews with national and sub-national level decision makers in both countries between July and December 2019. Additionally, in Ghana a stakeholder workshop in December 2019 was used to validate the draft analysis and conclusions.ResultsNational and global context, country health systems leadership and structure including resources were drivers of synergies and fragmentation. How global as well as country level actors mobilized power and exercised agency in policy and program agenda setting and implementation processes within country were also important drivers.ConclusionsThere is potential in both countries to pull towards synergies and push against fragmentation in agenda setting, formulation and implementation of global health agendas despite the resource and other structural constraints. It however requires political and bureaucratic prioritization of synergies, as well as skilled leadership. It also requires considerable mobilization of country level actor exercise of agency to counter sometimes daunting contextual, systems and structural constraints.
Barriers and facilitators to implementing the CURE stop smoking project: a qualitative study
Authors: Wearn Angela , Haste Anna , Haighton Catherine , Mallion Verity , Rodrigues Angela M. 
Published: May 2021

AbstractBackgroundThe Conversation, Understand, Replace, Experts and evidence-based treatment (CURE) project aims to provide a comprehensive offer of both pharmacotherapy and specialist support for tobacco dependence to all smokers admitted to hospital and after discharge. CURE was recently piloted within a single trust in Greater Manchester, with preliminary evidence suggesting this intervention may be successful in improving patient outcomes. Plans are currently underway to pilot a model based upon CURE in other sites across England. To inform implementation, we conducted a qualitative study, which aimed to identify factors influencing healthcare professionals’ implementation behaviour within the pilot site.MethodsIndividual, semi-structured telephone interviews were conducted with 10 purposively sampled health professionals involved in the delivery and implementation of the CURE project pilot. Topic guides were informed by the Theoretical Domains Framework (TDF). Transcripts were analysed in line with the framework method, with data coded to TDF domains to highlight important areas of influence and then mapped to the COM-B to support future intervention development.ResultsEight TDF domains were identified as important areas influencing CURE implementation; ‘environmental context and resources’ (physical opportunity), ‘social influence’ (social opportunity), ‘goals’, ‘professional role and identity’ and ‘beliefs about consequences’ (reflective motivation), ‘reinforcement’ (automatic motivation), ‘skills’ and ‘knowledge’ (psychological capability). Most domains had the potential to both hinder and/or facilitate implementation, with the exception of ‘beliefs about consequences’ and ‘knowledge’, which were highlighted as facilitators of CURE. Participants suggested that ‘environmental context and resources’ was the most important factor influencing implementation; with barriers most often related to challenges integrating into the wider healthcare context.ConclusionsThis qualitative study identified multi-level barriers and facilitators to CURE implementation. The use of theoretical frameworks allowed for the identification of domains known to influence behaviour change, and thus can be taken forward to develop targeted interventions to support future service implementation. Future work should focus on discussing these findings with a broad range of stakeholders, to ensure resultant intervention strategies are feasible and practicable within a healthcare context. These findings complement wider evaluative work to support nationwide roll out of NHS funded tobacco dependence treatment services in acute care trusts.
The modification effect of temperature on the relationship between air pollutants and daily incidence of influenza in Ningbo, China
Authors: Zhang Rui , Meng Yujie , Song Hejia , Niu Ran , Wang Yu , Li Yonghong , Wang Songwang 
Published: May 2021

Abstract
Background
Although exposure to air pollution has been linked to many health issues, few studies have quantified the modification effect of temperature on the relationship between air pollutants and daily incidence of influenza in Ningbo, China.

Methods
The data of daily incidence of influenza and the relevant meteorological data and air pollution data in Ningbo from 2014 to 2017 were retrieved. Low, medium and high temperature layers were stratified by the daily mean temperature with 25th and 75th percentiles. The potential modification effect of temperature on the relationship between air pollutants and daily incidence of influenza in Ningbo was investigated through analyzing the effects of air pollutants stratified by temperature stratum using distributed lag non-linear model (DLNM). Stratified analysis by sex and age were also conducted.

Results
Overall, a 10 μg/m3 increment of O3, PM2.5, PM10 and NO2 could increase the incidence risk of influenza with the cumulative relative risk of 1.028 (95% CI 1.007, 1.050), 1.061 (95% CI 1.004, 1.122), 1.043 (95% CI 1.003, 1.085), and 1.118 (95% CI 1.028, 1.216), respectively. Male and aged 7–17 years were more sensitive to air pollutants. Through the temperature stratification analysis, we found that temperature could modify the impacts of air pollution on daily incidence of influenza with high temperature exacerbating the impact of air pollutants. At high temperature layer, male and the groups aged 0–6 years and 18–64 years were more sensitive to air pollution.

Conclusion
Temperature modified the relationship between air pollution and daily incidence of influenza and high temperature would exacerbate the effects of air pollutants in Ningbo.
Bioinformatics analysis and identification of genes and molecular pathways in steroid-induced osteonecrosis of the femoral head
Authors: Lin Tianye , Chen Weijian , Yang Peng , Li Ziqi , Wei Qiushi , Liang Du , Wang Haibin , He Wei , Zhang Qingwen 
Published: May 2021

Abstract
Background
Steroid-induced osteonecrosis of the femoral head (ONFH) is a common hip joint disease and is difficult to be diagnosed early. At present, the pathogenesis of steroid-induced ONFH remains unclear, and recognized and effective diagnostic biomarkers are deficient. The present study aimed to identify potentially important genes and signaling pathways involved in steroid-induced ONFH and investigate their molecular mechanisms.

Methods
Microarray data sets GSE123568 (peripheral blood) and GSE74089 (cartilage) were obtained from the Gene Expression Omnibus database, including 34 ONFH samples and 14 control samples. Morpheus software and Venn diagram were used to identify DEGs and co-expressed DEGs, respectively. Besides, we conducted Kyoto Encyclopedia of Genome (KEGG) and gene ontology (GO) pathway enrichment analysis. We construct a protein-protein interaction (PPI) network through GEO2R and used cytoHubba to divide the PPI network into multiple sub-networks. Additionally, quantitative real-time polymerase chain reaction (qRT-PCR) was performed to verify the bioinformatics analysis results.

Results
A total of 118 intersecting DEGs were obtained between the peripheral blood and cartilage samples, including 40 upregulated genes and 78 downregulated genes. Then, GO and KEGG pathway enrichment analysis revealed that upregulated DEGs focused on the signaling pathways related to staphylococcus aureus infection, leishmaniasis, antigen processing, and presentation, as well as asthma and graft-versus-host disease. Downregulated genes were concentrated in the FoxO signaling pathway, AMPK signaling pathway, signaling pathway regulating stem cell pluripotency, and mTOR signaling pathway. Some hub genes with high interactions such as CXCR1, FPR1, MAPK1, FOXO3, FPR2, CXCR2, and TYROBP were identified in the PPI network. The results of qRT-PCR demonstrated that CXCR1, FPR1, and TYROBP were upregulated while MAPK1 was downregulated in peripheral blood of steroid-induced ONFH patients. This was consistent with the bioinformatics analysis.

Conclusions
The present study would provide novel insight into the genes and associated pathways involved in steroid-induced ONFH. CXCR1, FPR1, TYROBP, and MAPK1 may be used as potential drug targets and biomarkers for the diagnosis and prognosis of steroid-induced ONFH.
Mental health and sleep habits/problems in children aged 3–4 years: a population study
Authors: Horiuchi Fumie , Kawabe Kentaro , Oka Yasunori , Nakachi Kiwamu , Hosokawa Rie , Ueno Shu-ichi 
Published: May 2021

AbstractBackgroundSleep is essential for mental health at all ages, but few studies have investigated the importance of sleep for mental health in early childhood. Therefore, this study examined the association between mental health and sleep habits/problems in children aged 3–4 years.MethodsChildren aged 3 to 4 years who were living in the community (n = 415; 211/204 boys/girls) were recruited for this study. Their mental health was assessed using the Strengths and Difficulties Questionnaire (SDQ), and their sleep habits/problems were evaluated using the Child and Adolescent Sleep Checklist.ResultsBased on the total difficulties score of the SDQ, the children were divided into two groups: a poor mental health group (n = 76) and a control group (n = 339). In terms of sleep habits, which included total sleep time, bedtime, wake time, and nap conditions, there were no differences between the two groups. Regarding sleep-related problems, however, anxiety before going to sleep (p = 0.026), circadian rhythm abnormalities (p = 0.014), and sleepiness during classes outside of naptimes (p = 0.031) were significantly higher in the poor mental health group than in the control group. Multiple regression analysis showed that poor mental health status was significantly associated with sleepiness and snoring (p = 0.017 andp = 0.018, respectively).ConclusionsThe mental health status of 3–4-year-old children was associated with sleep-related problems, namely sleepiness and snoring. Healthcare providers should pay attention to children’s irregular sleep-wake patterns; moreover, interventions for appropriate sleep hygiene will reduce the psychological burden on both children and their families.
Technical and tactical diagnosis model of table tennis matches based on BP neural network
Authors: Huang Wenwen , Lu Miaomiao , Zeng Yuxuan , Hu Mengyue , Xiao Yi 
Published: May 2021

Abstract
Background
The technical and tactical diagnosis of table tennis is extremely important in the preparation for competition which is complicated by an apparent nonlinear relationship between athletes’ performance and their sports quality. The neural network model provides a high nonlinear dynamic processing ability and fitting accuracy that may assist in the diagnosis of table tennis players’ technical and tactical skill. The main purpose of this study was to establish a technical and tactical diagnosis model of table tennis matches based on a neural network to analyze the influence of athletes’ techniques and tactics on the competition results.

Methods
A three-layer Back Propagation (BP) neural network model for table tennis match diagnosis were established. A Double Three-Phase evaluation method produced 30 indices that were closely related to winning table tennis matches. A data sample of 100 table tennis matches was used to establish the diagnostic model (n = 70) and evaluate the predictive ability of the model (n = 30).

Results
The technical and tactical diagnosis model of table tennis matches based on BP neural network had a high-level of prediction accuracy (up to 99.997%) and highly efficient in fitting (R2 = 0.99). Specifically, the technical and tactical diagnosis results indicated that the scoring rate of the fourth stroke of Harimoto had the greatest influence on the winning probability.

Conclusion
The technical and tactical diagnosis model of table tennis matches based on BP neural network was highly accurate and efficiently fit. It appears that the use of the model can calculate athletes’ technical and tactical indices and their influence on the probability of winning table tennis matches. This, in turn, can provide a valuable tool for formulating player’s targeted training plans.
Role of CD44 in increasing the potency of mesenchymal stem cell extracellular vesicles by hyaluronic acid in severe pneumonia
Authors: Zhou Li , Hao Qi , Sugita Shinji , Naito Yoshifumi , He Hongli , Yeh Che-chung , Lee Jae-Woo 
Published: May 2021

AbstractBackgroundAlthough promising, clinical translation of human mesenchymal stem or stromal cell-derived extracellular vesicles (MSC EV) for acute lung injury is potentially limited by significant production costs. The current study was performed to determine whether pretreatment of MSC EV with high molecular weight hyaluronic acid (HMW HA) would increase the therapeutic potency of MSC EV in severe bacterial pneumonia.MethodsIn vitro experiments were performed to determine the binding affinity of HMW HA to MSC EV and its uptake by human monocytes, and whether HMW HA primed MSC EV would increase bacterial phagocytosis by the monocytes. In addition, the role of CD44 receptor on MSC EV in the therapeutic effects of HMW HA primed MSC EV were investigated. InPseudomonas aeruginosa(PA) pneumonia in mice, MSC EV primed with or without HMW HA were instilled intravenously 4 h after injury. After 24 h, the bronchoalveolar lavage fluid, blood, and lungs were analyzed for levels of bacteria, inflammation, MSC EV trafficking, and lung pathology.ResultsMSC EV bound preferentially to HMW HA at a molecular weight of 1.0 MDa compared with HA with a molecular weight of 40 KDa or 1.5 MDa. HMW HA primed MSC EV further increased MSC EV uptake and bacterial phagocytosis by monocytes compared to treatment with MSC EV alone. In PA pneumonia in mice, instillation of HMW HA primed MSC EV further reduced inflammation and decreased the bacterial load by enhancing the trafficking of MSC EV to the injured alveolus. CD44 siRNA pretreatment of MSC EV prior to incubation with HMW HA eliminated its trafficking to the alveolus and therapeutic effects.ConclusionsHMW HA primed MSC EV significantly increased the potency of MSC EV in PA pneumonia in part by enhancing the trafficking of MSC EV to the sites of inflammation via the CD44 receptor on MSC EV which was associated with increased antimicrobial activity.
Conditioned medium from induced pluripotent stem cell-derived mesenchymal stem cells accelerates cutaneous wound healing through enhanced angiogenesis
Authors: Liang Xiaoting , Lin Fang , Ding Yue , Zhang Yuelin , Li Mimi , Zhou Xiaohui , Meng Qingshu , Ma Xiaoxue , Wei Lu , Fan Huimin , Liu Zhongmin 
Published: May 2021

Abstract
Background
Mesenchymal stem cells (MSCs) can improve cutaneous wound healing via the secretion of growth factors. However, the therapeutic efficacy of MSCs varies depending upon their source. Induced pluripotent stem cells are emerging as a promising source of MSCs with the potential to overcome several limitations of adult MSCs. This study compared the effectiveness of conditioned medium of MSCs derived from induced pluripotent stem cells (iMSC-CdM) with that derived from umbilical cord MSCs (uMSC-CdM) in a mouse cutaneous wound healing model. We also investigated the mechanisms of protection.

Methods
The iMSC-CdM or uMSC-CdM were topically applied to mice cutaneous wound model. The recovery rate, scar formation, inflammation and angiogenesis were measured. We compared angiogenesis cytokine expression between iMSC-CdM and uMSC-CdM and their protective effects on human umbilical vein endothelial cells (HUVECs) under H2O2-induced injury. The effects of iMSC-CdM on energy metabolism, mitochondria fragmentation and apoptosis were measured.

Results
Topical application of iMSC-CdM was superior to the uMSC-CdM in accelerating wound closure and enhancing angiogenesis. Expression levels of angiogenetic cytokines were higher in iMSC-CdM than they were in uMSC-CdM. The iMSC-CdM protected HUVECs from H2O2 induced injury more effectively than uMSC-CdM did. Administration of iMSC-CdM stimulated HUVEC proliferation, tube formation and energy metabolism via the ERK pathway. Mechanistically, iMSC-CdM inhibited H2O2-induced mitochondrial fragmentation and apoptosis of HUVECs.

Conclusion
Collectively, these findings indicate that iMSC-CdM is more effective than uMSC-CdM in treating cutaneous wounds, and in this way, iMSC-CdM may serve as a more constant and sustainable source for cell-free therapeutic approach.

Graphical abstract
Gut microbiome variation modulates the effects of dietary fiber on host metabolism
Authors: Murga-Garrido Sofia M. , Hong Qilin , Cross Tzu-Wen L. , Hutchison Evan R. , Han Jessica , Thomas Sydney P. , Vivas Eugenio I. , Denu John , Ceschin Danilo G. , Tang Zheng-Zheng , Rey Federico E. 
Published: May 2021

AbstractBackgroundThere is general consensus that consumption of dietary fermentable fiber improves cardiometabolic health, in part by promoting mutualistic microbes and by increasing production of beneficial metabolites in the distal gut. However, human studies have reported variations in the observed benefits among individuals consuming the same fiber. Several factors likely contribute to this variation, including host genetic and gut microbial differences. We hypothesized that gut microbial metabolism of dietary fiber represents an important and differential factor that modulates how dietary fiber impacts the host.ResultsWe examined genetically identical gnotobiotic mice harboring two distinct complex gut microbial communities and exposed to four isocaloric diets, each containing different fibers: (i) cellulose, (ii) inulin, (iii) pectin, (iv) a mix of 5 fermentable fibers (assorted fiber). Gut microbiome analysis showed that each transplanted community preserved a core of common taxa across diets that differentiated it from the other community, but there were variations in richness and bacterial taxa abundance within each community among the different diet treatments. Host epigenetic, transcriptional, and metabolomic analyses revealed diet-directed differences between animals colonized with the two communities, including variation in amino acids and lipid pathways that were associated with divergent health outcomes.ConclusionThis study demonstrates that interindividual variation in the gut microbiome is causally linked to differential effects of dietary fiber on host metabolic phenotypes and suggests that a one-fits-all fiber supplementation approach to promote health is unlikely to elicit consistent effects across individuals. Overall, the presented results underscore the importance of microbe-diet interactions on host metabolism and suggest that gut microbes modulate dietary fiber efficacy.