bluuebunny/crossref_metadata_2025_split huggingface dataset:
An exploratory study of the barriers and facilitators to the implementation of community health worker programmes in conflict-affected South Sudan.
Authors: Lutwama George William , Kok Maryse , Jacobs Eelco 
Published: March 2021

Abstract
Background: Community health workers (CHWs) are crucial for increasing access to health services to communities. Due to decades of conflict and under-funding, access to health care in South Sudan remains severely limited. To improve equitable access to healthcare, the government has introduced “the Boma Health Initiative (BHI)”, a strategy to harmonise community health programmes across the country. In order to scale up the BHI, it is necessary to assess the recent CHW programmes and draw lessons for future implementation. This study aimed to explore the characteristics, barriers, and facilitators to the implementation of CHW interventions in South Sudan between 2011 and 2019.Methods: The study used a qualitative approach drawing from 26 key informant interviews and a scoping review of 21 Health Pooled Fund (HPF) programme reports from October 2016 to June 2018 and policy documents from 2011 to 2019. The results were thematically analysed based on a conceptual framework on factors influencing the performance of CHWs.Results: Funding of CHW programmes has come from international donors, channelled through non-governmental organisations (NGOs) that have implemented a variety of CHW programmes. Communities have been participating in the selection of voluntary CHWs, intervention areas, and occasionally in the supervision of activities performed by CHWs. The coordination mechanisms among stakeholders have been weak, leading to wastage and duplication of resources. Although training of CHWs is done, training duration was short, and refresher-trainings were rare. There were and still are disparities in the type of incentives provided to CHWs. Monitoring and supportive supervision activities have been insufficient; drug misuse and stock-outs were common. Conclusion: Despite their challenges, CHW programmes can be implemented in conflict-affected South Sudan if the local human capital is leveraged and engaged by NGOs as implementing partners. Robust coordination efforts are required to build synergies among stakeholders for the effective implementation of the BHI strategy.
A Single Intravenous Infusion of Human Choriodecidual Mesenchymal Stem Cell Decreases Early Burn Mortality in a Rodent Model
Authors: Yeong Eng-Kean , Ling Thai-Yen 
Published: March 2021

Abstract
Background:Systemic inflammatory responses (SIR) are the main cause of pulmonary dysfunction leading to mortality within hours of extensive burns. Based on previous studies showing that cell entrapment occurs in the lungs following the infusion of human choriodecidual mesenchymal stem cells (hcMSCs), we hypothesize that the intravenous infusion of hcMSCs, with an immunomodulatory potential, will decrease the risk of SIR induced pulmonary failure leading to mortality in burn patients. Methods:Forty adult male Sprague-Dawley rats were randomized into two groups. Group A (sham control, n = 10) received no injury or intervention; the remaining rats (n = 30) were subjected to burns covering 40 % of the total body surface area by immersion of the dorsum in 100 °C water for 15 s under general anesthesia. Injured rats were further randomized into different treatment groups: Group B (saline only control, n = 10), Group C (saline plus culture medium control, n = 10), and Group D (saline plus 2 × 106 hcMSCs, n = 10). Culture medium or hcMSCs were given in a single infusion via the tail vein immediately after burns. Mortality was evaluated on post-burn days 7 and 14. Results:The overall mortality among injured rats was 30 % (9/30). In the first week post-injury, four rats in Group C and three in Group B versus none in Group D died. In the second week, one rat in both Groups C and D died. Altogether, mortality among Group D rats was 10 %, significantly lower than that in groups B and C combined (40 %; p<0.001).Conclusions:We show that a single intravenous infusion of 2 × 106 hcMSCs decreased burn mortality in a severely burned animal model. However, clinical translation requires additional studies to exclude potential adverse effects and to determine the optimal dosage and timing of administration.
Associations between self-rated oral health, subjective oral conditions, oral health behaviours and oral health-related quality of life among college students: A study using structural equation modelling
Authors: Yin Nan , Zheng Suge , Ju Nianting , Hua Tiantian , Ding Wei , Zhang Wei , Zhou Haoyun , Zhang Yanyong , Li Wenhao , Ge Hui , Zhang Shunhua , Liao Shengkai 
Published: March 2021

Abstract
Background: This study aimed to evaluate the relationship between self-rated oral health, subjective oral conditions, oral health behaviours, and oral health-related quality of life (OHRQoL) in Chinese college students.Methods: We conducted an online cross-sectional survey inviting college students from eastern China. A total of 1,708 participants were included. We constructed a structural equation model to explain and assess the associations among self-rated oral health, subjective oral conditions, oral health behaviours, and OHRQoL.Results: Self-rated oral health had a direct positive effect on subjective oral conditions and OHRQoL. Oral health behaviours had a direct negative effect on subjective oral conditions and OHRQoL, while oral health behaviours had a direct negative effect on tooth condition perception and oral health interventions. Subjective oral conditions had a direct positive effect on OHRQoL. There was a positive correlation between oral health behaviours and self-rated oral health. In addition, subjective oral conditions partially mediated both the effect of oral health behaviours on OHRQoL and the effect of self-rated oral health on OHRQoL.Conclusion: There were influential associations between self-rated oral health, subjective oral conditions, oral health behaviours, and OHRQoL among college students in eastern China.
Intubation Timing as Determinant&nbsp;of Outcome in Patients with Acute Respiratory Distress Syndrome by SARS-CoV-2 Infection
Authors: Vera Magdalena , Kattan Eduardo , Born Pablo , Rivas Elizabeth , Amthauer Macarena , Nesvadba Annael , Lara Barbara , Rao Isabel , Espíndola Eduardo , Rojas Luis , Hernández Glenn , Bugedo Guillermo , Castro Ricardo 
Published: March 2021

Abstract
Background: SARS-CoV-2 infection presents in many cases with pneumonia and respiratory failure. It is not clear whether the time of intubation and connection to mechanical ventilation (MV) in this condition is associated with an increase in mortality or represents the natural course of the disease.We conducted an observational, prospective, single-center study to describe the characteristics and outcomes of acute respiratory distress syndrome (ARDS) patients with confirmed COVID-19 and treated with invasive MV to determine whether the time-to-intubation following hospital admission is associated with worse outcomes.Methods: We prospectively included consecutive patients with SARS-CoV-2 infection and moderate to severe ARDS, admitted to an intensive care unit (ICU) and connected to MV between March 17 and July 31, 2020. We examined their general characteristics, ventilatory management, and clinical outcomes. Time of intubation was defined as the time from hospital admission to endotracheal intubation and was categorized as early (<72 hours) or late (≥72 hours). Mann-Whitney U, Kruskal Wallis, chi-square, and Fisher’s exact, were used when appropriate. Uni and multivariate analyses between main outcome and explanatory variables were performed.Results: A total of 183 consecutive patients were included, 28% (51/183) were female, and their median age was 62 years [54-70]. One hundred (55%) patients were subjected to early and 83 (45%) to late intubation. Patients intubated after 72 hours were older and presented more comorbidities. Mortality was higher in the group of patients with late intubation (41% versus 21%; p= 0.002), a PaO2/FiO2 ratio <100 mmHg at admission (p= 0.029), and that were older than 60 years (p= 0.008).ConclusionsIn acute COVID-19 patients with moderate to severe ARDS, intubation after 72 hours following hospital admission, age >60 years-old and a PaO2/FiO2 ratio <100 at admission may appear to be associated with increased ICU mortality. Further studies are required to confirm our findings and establish the best timing for intubation in COVID-19 patients admitted to the ICU with respiratory failure.
Macrophage conditioned media promotes adipocyte cancer-association, which in turn stimulates breast cancer proliferation and migration
Authors: Bosco Dale B. , Ren Yi , Vallega Karin A. , Sang Qing-Xiang Amy 
Published: March 2021

Abstract
Background Breast cancer is the most common cancer in women and the leading cause of female cancer deaths worldwide. Obesity causes chronic inflammation and is a risk factor for post-menopausal breast cancer and poor prognosis. Obesity triggers increased infiltration of macrophages into adipose tissue, yet little research has focused on the effects of macrophages in early stages of breast tumor development in obese patients. In this study, the effects of pro-inflammatory macrophages on breast cancer-adipocyte crosstalk were investigated.Methods An innovative human cell co-culture system was used to model the paracrine interactions among adipocytes, macrophages, and breast cancer cells, and how they facilitate tumor progression. The effects on cancer cells were examined using cell counts and migration assays. Quantitative reverse-transcription polymerase chain reaction was used to measure the expression levels of several cytokines and proteases to analyze adipocyte cancer-association.Results Macrophage conditioned media intensified the effects of breast cancer-adipocyte crosstalk. Adipocytes became delipidated and increased production of pro-inflammatory cytokines, even in the absence of cancer cells, although the expression levels were highest with all three cell components. As a result, co-cultured breast cancer cells became more aggressive, with increased proliferation and migration compared to adipocyte-breast cancer co-cultures treated with unconditioned media.Conclusions Macrophage conditioned media promotes adipocyte cancer-association. These macrophage-adipocyte paracrine interactions promote breast cancer cell proliferation and migration. Thus, macrophages may contribute to adipocyte inflammation and cancer-association and promote breast cancer progression.
Pre- and Post-home Visit Behaviors using an after-hours House Call (AHHC) Medical Services: A Questionnaire-based Survey in Tokyo, Japan
Authors: INOKUCHI Ryota , MORITA Kojiro , JIN Xueying , ISHIKAWA Masatoshi , TAMIYA Nanako 
Published: March 2021

Abstract
Background: To reduce the burden caused by emergency department (ED) visits and ambulance use, after-hours house call (AHHC) medical services have been implemented. Examining the pre-and post-home visit behaviors of those who use AHHC medical services, stratified by age and illness severity, may help determine the populations these services should target effectively to reduce ED visits and ambulance use.Methods: This questionnaire-based study used data from anonymized medical records and internet-based questionnaires completed by patients who used AHHC medical services in Tokyo, Japan, between January 1 and December 31, 2019. The questionnaire consisted of two questions: what action would the patient have taken in the absence of AHHC services, and what action was taken within three days following the use of the AHHC services.Results: Of the 15,787 patients who used AHHC medical services during the study period, 2,128 completed the questionnaire (13.5% response rate). Individuals aged <15 years and 16–64 years were the most common users of AHHC services (≤15 years, 71.4%; 16–64 years, 26.8%). Before using the AHHC service, the majority of patients in each patient age group would have visited the ED if the AHHC service had not been available (≤15 years, 47.8%; 16–64 years, 42.8%; ≥65 years, 43.6%), and the proportion of patients originally planning to call an ambulance was higher among those in higher age groups (≤15 years, 1.1%; 16–64 years, 6.0%; ≥65 years, 20.5%). After using AHHC services, the majority of patients (68.1%) did not visit a hospital within three days, but the proportion of patients who visited an ED and called an ambulance within that time increased as their illness severity increased.Conclusions: Increasing AHHC medical services awareness among older adults and encouraging repeated use of AHHC services for patients with severe illnesses may help reduce ED visits and ambulance use.
Analysis of Viral Load Change in Case of HIV/AIDS Patients Under ART Follow-up in Arba Minch General Hospital
Authors: Erango Markos Abiso , Gergiso Kabtamu Tolosie , Hebo Sultan Hussen 
Published: March 2021

Abstract
Background: Monitoring human immunodeficiency virus plasma viral load over time is critical to identify virologic treatment failure in patients taking antiretroviral therapy. The aim of this study was to determine whether the overtime viral load changes depends on patient characteristic measured at baseline of human immunodeficiency virus patients at Arba Minch General Hospital.Methods: This prospective follow up study was conducted using data obtained from medical records, patient interviews, and laboratory workup for six months. The study was employed among 152 adult patients that were selected by systematic random sampling. Longitudinal data analysis that accounts for the correlated nature of the data handled through linear mixed effect models were used to fit the data set in this study.Result: The mean viral load declines over time for each of the adherence level groups. The estimates of linear (p = 0.0006) and quadratic visit time (p=0.0256) effects and the baseline characteristics sex, age, adherence level, and Isoniazid preventive therapy had significant effects on change of viral load of patients over time. Conclusion: In order to improve the status of the patient’s viral load over time, considering the patients’ differences in adherence to antiretroviral therapy, sex, age, and Isoniazid preventive therapy are important.
Irreversibility Analysis in Darcy-Forchheimer Flow of Nanofluid by a Stretched Surface
Authors: Hayat T , Kainat Zobia , Alsaedi A , Khan Sohail A. 
Published: March 2021

Abstract
The aim of this articles is to investigate the entropy optimization in unsteady MHD flow Darcy-Forchheimer nanofluids towards a stretchable sheet. The surface we tend to think about is porous and stretchy under acceleration. Flow occurs due to the stretching of the surface. Four distinct types of aqueous nanostructures are taken in this examination where copper oxide (CuO), copper (Cu), titanium dioxide (TiO2) and aluminum oxide (Al2O3) are the nanoparticles. Irreversibility analysis are discussed through second law of thermodynamics. The expression of energy is mathematically designed and discussed according to heat generation / absorption, dissipation, thermal radiation, and joule heating. The nonlinear PDE (partial differential conditions) is first changed to ODE (normal differential conditions) through the use of appropriate similarity variables. Here we used the numerically embedded solution technique to develop a numerical result for the obtained nonlinear flow expression. Influence of various flow parameter velocity temperature distribution and entropy generation are discussed. Reduction occurs in velocity profile for larger porosity and magnetic parameters. An enhancement in entropy generation and temperature distribution is seen for Brinkman number. An opposite effect is noticed in velocity and temperature through solid volume friction.
Determinants of Utilization of Institutional Delivery Services in Zambia: An Analytical Cross-sectional Study
Authors: Rashid Mamunur , Hiswåls Anne-Sofie , Chowdhury Mohammad Rocky Khan , Macassa Gloria 
Published: March 2021

Abstract
IntroductionInstitutional delivery at birth is an important indicator of improvements in maternal health, which remains one of the targets of sustainable development goals intended to reduce the maternal mortality ratio. Despite the importance of delivering at institutions with skilled attendants, approximately 15% of women prefer to give birth at home, according to the 2018 Zambia Demographic and Health Survey (ZDHS). Therefore, the aim of the present study was to identify determinants of utilization of institutional delivery in Zambia. MethodsA population based cross-sectional study design was used to examine 9841 women between 15 and 49 years of age from the 2018 ZDHS. Both descriptive and inferential statistics were used. Logistic regression was applied to calculate crude odds ratio (OR), adjusted OR, 95% confidence interval (CI). The level of significance was set at p ≤ 0.05 for all analyses. ResultsThe proportions of institutional and home delivery were 93.6% and 6.2%, respectively, in urban areas. The corresponding figures were 80.2% and 19.8% in rural areas. Sociodemographic factors – woman’s (OR 1.76; 95% CI: 1.04–2.99) and husband’s secondary/higher education (OR 1.83; 95% CI: 1.09–3.05), higher wealth index (OR 2.31; 95% CI: 1.27–4.22) and rural place of residence (OR 0.55; 95% CI: 0.30–0.98) – were significantly associated with institutional delivery. Healthcare-related factors – 5-12 visits to antenatal care (ANC) (OR 2.33; 95% CI: 1.66–3.26), measuring blood pressure (OR 1.65; 95% CI: 1.02–2.66) and testing blood samples (OR 2.01; 95% CI: 1.04s–3.88) during pregnancy – were found to be significantly associated with institutional delivery. ConclusionsThe present study shows that sociodemographic factors such as women’s and husband’s secondary or higher education, higher wealth index, place of residence as well as healthcare-related factors such as 5-12 ANC visits, measuring blood pressure and testing blood samples during pregnancy were found to be significantly associated with institutional delivery. To improve institutional delivery and reduce maternal and newborn mortality, policymakers and public health planners should design an effective intervention program targeting these factors.
A Distributed Content-Based Video Retrieval System for Large Data-sets
Authors: SAOUDI ElMehdi , Andaloussi Said Jai 
Published: March 2021

Abstract
With the rapid growth of the volume of video data and the development of multimedia technologies, it has become necessary to have the ability to accurately and quickly browse and search through information stored in large multimedia databases. For this purpose, content-based video retrieval ( CBVR ) has become an active area of research over the last decade. In this paper, We propose a content-based video retrieval system providing similar videos from a large multimedia data-set based on a query video. The approach uses vector motion-based signatures to describe the visual content and uses machine learning techniques to extract key-frames for rapid browsing and efficient video indexing. We have implemented the proposed approach on both, single machine and real-time distributed cluster to evaluate the real-time performance aspect, especially when the number and size of videos are large. Experiments are performed using various benchmark action and activity recognition data-sets and the results reveal the effectiveness of the proposed method in both accuracy and processing time compared to state-of-the-art methods.
NAG-1/GDF15 Exerts Anti-diabetic Effects through the Insulin Signaling Pathway
Authors: Lertpatipanpong Pattawika , Lee Jaehak , Eling Thomas , Oh Seung Yon , Seong Je Kyung , Baek Seung Joon 
Published: March 2021

Abstract
Nonsteroidal anti-inflammatory drug-activated gene-1 (NAG-1) has a role in various diseases. Here, the anti-diabetic effects of NAG-1 were evaluated using a high-fat diet (HFD)/streptozotocin (STZ)-induced diabetic mouse model. NAG-1-overexpressing transgenic (NAG-1 Tg) mice exhibited lower bodyweight and fasting blood glucose and insulin levels than wildtype (WT) mice. The homeostatic model assessment of insulin resistance scores of NAG-1 Tg mice were three times lower than those of WT mice. Hematoxylin and eosin staining demonstrated that NAG-1 Tg mice exhibited a smaller lipid droplet size in the adipose tissues, lower lipid accumulation in the hepatocytes, and larger beta cell area in the pancreas, compared to WT mice. Immunohistochemical analysis revealed downregulated expression of cleaved caspase-3, an apoptosis marker, in the beta cells of NAG-1 Tg mice. The adiponectin and leptin mRNA levels were upregulated and downregulated in NAG-1 Tg mice, respectively. Additionally, the IRS1/PI3K/AKT signaling pathway, especially Foxo1, which regulates gluconeogenesis in the muscle and WAT, was downregulated in NAG-1 Tg mice. Furthermore, NAG-1 overexpression promoted As160 (AKT substrate of 160 kDa) expression in both muscles and adipocytes and the mRNA levels of the Nlrp3 pathway members were downregulated in NAG-1 Tg mice. Our findings suggest that NAG-1 expression alleviates diabetes in mice.
Clinical efficacy and immunity of a novel immune-modulatory peptide vaccine against IDO/PD-L1 (IO102/IO103) in combination with nivolumab in patients with metastatic melanoma
Authors: Kjeldsen Julie , Lorentzen Cathrine , Martinenaite Evelina , Ellebaek Eva , Donia Marco , Holmstroem Rikke , Klausen Tobias , Hendel Helle , Ehrnrooth Eva , Zocca Mai-Britt , Pedersen Ayako , Andersen Mads , Svane Inge Marie 
Published: March 2021

Abstract
Anti-PD-1 (aPD1) therapy is an effective treatment for metastatic melanoma (MM); however, >50% of the patients progress due to resistance. Improved combination therapies enhancing aPD1 efficacy without leading to increased toxicity are needed. In this non-randomized phase I/II study (ClinicalTrials.gov: NCT03047928), we treated 30 aPD1 naive MM patients with a novel immune-modulatory vaccine (IO102/IO103) activating indoleamine 2,3-dioxygenase (IDO) and programmed death ligand-1 (PD-L1) specific T-cells combined with nivolumab. The vaccine has a dual mechanism of action, targeting both immunosuppressive cells and tumour cells expressing IDO/PD-L1. The vaccine was administered every two weeks for the first 6 injections and every fourth week thereafter, for up to 15 vaccines. Nivolumab was administered every two weeks (3mg/kg) for a maximum of 2 years. The primary endpoint was safety and feasibility; the systemic toxicity profile was comparable to nivolumab monotherapy, except for local and transient reactions at the vaccination site. Secondary endpoints were clinical efficacy and immunogenicity. An ORR of 80% (CI: 62.7-90.5%) was reached, with the majority of 43% (CI: 27.4-60.8%) achieving a complete response. After a median follow-up of 22.9 months, the median PFS was 26 months (CI: 15.4-69). Vaccine-specific responses were detected in vitro in blood from >93% of the patients on vaccination, suggesting the induction of memory response up to 6 months after the last vaccine. Vaccine reactive T-cells comprised both CD4+ and CD8+ T-cells. Paired biopsies from five patients with matched longitudinal PBMCs showed T-cell influx at the tumour site of peripherally expanded T-cells in responding patients and general enrichment of IDO and PD-L1 clones after treatment. These unprecedented clinical efficacy data support further validation in a larger randomized trial, to confirm the clinical potential of this first-in-class immunomodulating vaccine.