bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors associated with mortality of pediatric sepsis patients at the pediatric intensive care unit in a low-resource setting
Authors: Rusmawatiningtyas Desy , Rahmawati Arini , Makrufardi Firdian , Mardhiah Nurul , Murni Indah Kartika , Uiterwaal Cuno S. P. M. , Savitri Ary I. , Kumara Intan Fatah , Nurnaningsih  
Published: October 2021

Abstract
Background
Sepsis is the leading cause of death worldwide in pediatric populations. Studies in low-resource settings showed that the majority of pediatric patients with sepsis still have a high mortality rate.

Methods
We retrospectively collected records from 2014 to 2019 of patients who had been diagnosed with sepsis and admitted to PICU in our tertiary hospital. Cox proportional hazard regression modeling was used to evaluate associations between patient characteristics and mortality.

Results
Overall, 665 patients were enrolled in this study, with 364 (54.7%) boys and 301 (46.3%) girls. As many as 385 patients (57.9%) died during the study period. The median age of patients admitted to PICU were 1.8 years old with interquartile range (IQR) ±8.36 years and the median length of stay was 144 h (1–1896 h). More than half 391 patients (58.8%) had a good nutritional status. Higher risk of mortality in PICU was associated fluid overload percentage of > 10% (HR 9.6, 95% CI: 7.4–12.6), the need of mechanical ventilation support (HR 2.7, 95% CI: 1.6–4.6), vasoactive drugs (HR 1.5, 95% CI: 1.2–2.0) and the presence of congenital anomaly (HR 1.4, 95% CI: 1.0–1.9). On the contrary, cerebral palsy (HR 0.3, 95% CI: 0.1–0.5) and post-operative patients (HR 0.4, 95% CI: 0.3–0.6) had lower mortality.

Conclusion
PICU mortality in pediatric patients with sepsis is associated with fluid overload percentage of > 10%, the need for mechanical ventilation support, the need of vasoactive drugs, and the presence of congenital anomaly. In septic patients in PICU, those with cerebral palsy and admitted for post-operative care had better survival.
The impact of the emergency medical services (EMS) automation system on patient care process and user workflow
Authors: Afzali Faezeh , Jahani Yunes , Bagheri Fatemeh , khajouei Reza 
Published: October 2021

Abstract
Background
One of the important components of the health system is the emergency medical services (EMS) system. The EMS system was implemented at Kerman University of Medical Sciences teaching hospitals to communicate the situation of patients being transferred to the hospital by EMS and to provide facilities tailored to the patient's condition. The objective of this study was to investigate the impact of the EMS system on the patient care process and the workflow of users.

Methods
The hospital information system (HIS) report was used to investigate the impact of the EMS system on the patient care process and a questionnaire was distributed among 244 participants to determine its impact on the workflow of the users. Mann–Whitney U was used to analyze HIS reports, and Chi-square was used to analyze the data collected by questionnaires.

Results
The EMS system reduced the patient's stay in hospital by an average of 3 h and 45 min. It also increased the number of patients' discharge from the emergency room to 2.2% and reduced the death rate by 1.3% (p < 0.001). Besides, 78% of physicians, 75% of nurses and 83% of technicians stated that this system has positively influenced their workflow.

Conclusions
The EMS system reduced the patient's stay in hospital and mortality, and increased the speed of patient service, readiness of users to provide patient care and the number of discharged patients. However, problems such as inappropriate technical infrastructure of the EMS system should be solved to improve patients' recovery, reduce mortality and improve user satisfaction.
Health services related factors affecting the pap smear services in Fiji: a qualitative study
Authors: Kunatoga Aliti , Mohammadnezhad Masoud 
Published: October 2021

Abstract
Background
Cervical cancer is the thirdly vast usual cause of cancer in women, and the second vast majority cause of death among women aged 14 to 44 years, both in developed and developing countries. This paper aims to explore the perception of women and Health Care Workers (HCWs) about health care related factors affecting the Pap smear services among women who are screened in the Women Wellness Centre (WWC) in Suva, Fiji.

Methods
This study used a qualitative method in July–September 2019 in which women screened for cervical cancer used in–depth interviews whereas HCWs used Focus Group Discussion (FGD) in WWC in Suva, Fiji. This study used purposive maximum variation sampling where participants are selected according to the inclusion and exclusion criteria. Semi–structured open ended questionnaires were used to collect the data among participants. Data coding was done until theoretical saturation was reached. Thematic analysis was used and all the text has been coded, themes were abstracted from the coded text segments.

Results
A total of 20 women screened for cervical cancer and 5 HCWs were present during the duration of the study. Health care system was a factor recognized by both groups to have been a cause for the hindrance of cervical screening. There were 8 themes identified from the study, 3 themes from the women screened for cervical cancer and 5 from HCWs. Nearly all the participants reported about the compromised of cervical cancer screening services delivery because of factors such as lack of equipment and supplies, shortage of staff, long distances to health facilities, turnaround time and delay of results which affect the uptake of cervical cancer screening services.

Conclusion
While improvement has been made in the distribution of cervical cancer screening in WWC, a number of barriers and factors affect service uptake and delivery. Investments to be made in order to address the identified barriers such as turnaround time, long distances to health facilities, shortage of supplies and staff in order to improve uptake of cervical cancer screening services.
Impact of myocardial scars on left ventricular deformation in type 2 diabetes mellitus after myocardial infarction by contrast-enhanced cardiac magnetic resonance
Authors: Gao Yue , Xu Hua-yan , Guo Ying-kun , Wen Xiao-ling , Shi Rui , Li Yuan , Yang Zhi-gang 
Published: October 2021

Abstract
Background
Type 2 diabetes mellitus (T2DM) is a major risk factor for coronary artery disease and myocardial infarction (MI). The interaction of diabetic cardiomyopathy and MI scars on myocardial deformation in T2DM patients is unclear. Therefore, we aimed to evaluate myocardial deformation using cardiac magnetic resonance (CMR) in T2DM patients with previous MI and investigated the influence of myocardial scar on left ventricular (LV) deformation.

Methods
Overall, 202 T2DM patients, including 46 with MI (T2DM(MI+)) and 156 without MI (T2DM(MI−)), and 59 normal controls who underwent CMR scans were included. Myocardial scars were assessed by late gadolinium enhancement. LV function and deformation, including LV global function index, LV global peak strain (PS), peak systolic strain rate (PSSR), and peak diastolic strain rate (PDSR), were compared among these groups. Correlation and multivariate linear regression analyses were used to investigate the relationship between myocardial scars and LV deformation.

Results
Decreases were observed in LV function and LV global PS, PSSR, and PDSR in the T2DM(MI+) group compared with those of the other groups. Reduced LV deformation (p < 0.017) was observed in the T2DM(MI+) group with anterior wall infarction. The increased total LV infarct extent and infarct mass of LV were related to decreased LV global PS (radial, circumferential, and longitudinal directions; p < 0.01) and LV global PSSR (radial and circumferential directions, p < 0.02). Multivariate analysis demonstrated that NYHA functional class and total LV infarct extent were independently associated with LV global radial PS (β =  − 0.400 and β =  − 0.446, respectively, all p < 0.01; model R2 = 0.37) and circumferential PS (β = 0.339 and β = 0.530, respectively, all p < 0.01; model R2 = 0.41), LV anterior wall infarction was independently associated with LV global longitudinal PS (β = 0.398, p = 0.006).

Conclusions
The myocardial scarring size in T2DM patients after MI is negatively correlated with LV global PS and PSSR, particularly in the circumferential direction. Additionally, different MI regions have different effects on the reduction of LV deformation, and relevant clinical evaluations should be strengthened.
Cost impact of procalcitonin-guided decision making on duration of antibiotic therapy for suspected early-onset sepsis in neonates
Authors: Geraerds A. J. L. M. , van Herk Wendy , Stocker Martin , el Helou Salhab , Dutta Sourabh , Fontana Matteo S. , Schuerman Frank A. B. A. , van den Tooren-de Groot Rita K. , Wieringa Jantien , Janota Jan , van der Meer-Kappelle Laura H. , Moonen Rob , Sie Sintha D. , de Vries Esther , Donker Albertine E. , Zimmerman Urs , Schlapbach Luregn J. , de Mol Amerik C. , Hoffman-Haringsma Angelique , Roy Madan , Tomaske Maren , Kornelisse René F. , van Gijsel Juliette , Visser Eline G. , van Rossum Annemarie M. C. , Polinder Suzanne 
Published: October 2021

Abstract
Backgrounds
The large, international, randomized controlled NeoPInS trial showed that procalcitonin (PCT)-guided decision making was superior to standard care in reducing the duration of antibiotic therapy and hospitalization in neonates suspected of early-onset sepsis (EOS), without increased adverse events. This study aimed to perform a cost-minimization study of the NeoPInS trial, comparing health care costs of standard care and PCT-guided decision making based on the NeoPInS algorithm, and to analyze subgroups based on country, risk category and gestational age.

Methods
Data from the NeoPInS trial in neonates born after 34 weeks of gestational age with suspected EOS in the first 72 h of life requiring antibiotic therapy were used. We performed a cost-minimization study of health care costs, comparing standard care to PCT-guided decision making.

Results
In total, 1489 neonates were included in the study, of which 754 were treated according to PCT-guided decision making and 735 received standard care. Mean health care costs of PCT-guided decision making were not significantly different from costs of standard care (€3649 vs. €3616). Considering subgroups, we found a significant reduction in health care costs of PCT-guided decision making for risk category ‘infection unlikely’ and for gestational age ≥ 37 weeks in the Netherlands, Switzerland and the Czech Republic, and for gestational age < 37 weeks in the Czech Republic.

Conclusions
Health care costs of PCT-guided decision making of term and late-preterm neonates with suspected EOS are not significantly different from costs of standard care. Significant cost reduction was found for risk category ‘infection unlikely,’ and is affected by both the price of PCT-testing and (prolonged) hospitalization due to SAEs.
A connectome is not enough – what is still needed to understand the brain ofDrosophila?
Authors: Scheffer Louis K. , Meinertzhagen Ian A. 
Published: October 2021

ABSTRACTUnderstanding the structure and operation of any nervous system has been a subject of research for well over a century. A near-term opportunity in this quest is to understand the brain of a model species, the fruit fly Drosophila melanogaster. This is an enticing target given its relatively small size (roughly 200,000 neurons), coupled with the behavioral richness that this brain supports, and the wide variety of techniques now available to study both brain and behavior. It is clear that within a few years we will possess a connectome for D. melanogaster: an electron-microscopy-level description of all neurons and their chemical synaptic connections. Given what we will soon have, what we already know and the research that is currently underway, what more do we need to know to enable us to understand the fly's brain? Here, we itemize the data we will need to obtain, collate and organize in order to build an integrated model of the brain of D. melanogaster.
Does dietary β-carotene influence ontogenetic colour change in the southern corroboree frog?
Authors: Walton Sara J. , Silla Aimee J. , Endler John A. , Byrne Phillip G. 
Published: October 2021

ABSTRACT
Ontogenetic colour change occurs in a diversity of vertebrate taxa and may be closely linked to dietary changes throughout development. In various species, red, orange and yellow colouration can be enhanced by the consumption of carotenoids. However, a paucity of long-term dietary manipulation studies means that little is known of the role of individual carotenoid compounds in ontogenetic colour change. We know even less about the influence of individual compounds at different doses (dose effects). The present study aimed to use a large dietary manipulation experiment to investigate the effect of dietary β-carotene supplementation on colouration in southern corroboree frogs (Pseudophryne corroboree) during early post-metamorphic development. Frogs were reared on four dietary treatments with four β-carotene concentrations (0, 1, 2 and 3 mg g−1), with frog colour measured every 8 weeks for 32 weeks. β-Carotene was not found to influence colouration at any dose. However, colouration was found to become more conspicuous over time, including in the control treatment. Moreover, all frogs expressed colour maximally at a similar point in development. These results imply that, for our study species, (1) β-carotene may contribute little or nothing to colouration, (2) frogs can manufacture their own colour, (3) colour development is a continual process and (4) there may have been selection for synchronised development of colour expression. We discuss the potential adaptive benefit of ontogenetic colour change in P. corroboree. More broadly, we draw attention to the potential for adaptive developmental synchrony in the expression of colouration in aposematic species.
Ad Blocking
Authors: Gritckevich Aleksandr , Katona Zsolt , Sarvary Miklos 
Published: October 2021

In recent years, ad blocking has become a significant threat to advertising-supported content. Adblockers typically negotiate with publishers, allowing some ads to go through in return for a payment, a practice called (partial) whitelisting in the industry. Ad blocking has a direct positive effect on consumers by reducing advertising intensity. On the other hand, the practice clearly hurts publishers and reduces their incentives to invest in content quality. Lower content quality, in turn has an indirect negative effect on consumers. This paper builds an analytic model to explore the net impact of ad blocking on consumers, how it depends on various market characteristics, and how uniformly it affects consumers. The results show that under a broad set of market conditions, total consumer surplus and even total welfare decline under ad blocking. Whereas some consumers are always better off with an ad blocker, for the average consumer, the impact of quality decline is larger than that of ad reduction. The analysis highlights the detrimental role of ad blockers’ current revenue model—in which value is created for the consumers but it is captured from publishers—in decreasing quality, consumer surplus, and total welfare. Analyzing the impact of varying levels of negotiation power between the ad blocker and publisher reveals that full negotiation power is not preferred by the ad blocker. A lower negotiation power allows the ad blocker to commit to less value extraction from the publisher, thereby leading to higher content quality. Additional model extensions show that the main results are robust. In the case of multiple publishers with different levels of competition between them, the strong negative effect of ad blocking on quality holds. This paper was accepted by Juanjuan Zhang, marketing.
The prevalence of suicidal behavior and its associated factors among wives with polygamy marriage living in Gedeo zone, southern Ethiopia, 2020
Authors: Kassaw Chalachew , Shumye Seid 
Published: October 2021

IntroductionPolygamy is a trend of marriage characterized by having two and more wives or husbands at the same time. In low and middle-income countries including Ethiopia, polygamy has a significant negative effect on the social, economic, physical, and mental well-being of women. Therefore, this study aimed to assess the prevalence and associated factors of suicidal behavior among wives with polygamy marriage living in the Gedeo zone, Southern Ethiopia, 2020.MethodsA community-based study employing cross-sectional design and systematic sampling technique was used to select wives with polygamy marriage who are residents of Gedeo Zone from November to December 2020. The World Health Organization Suicidal Behavior Questions (SBQ-5) was adapted to explore the outcome variable. The Logistic regression at 95% CI, p<0.05 was used to identify factors associated with suicidal behavior.ResultsThis study enrolled 423 respondents. The study revealed that, the overall prevalence of suicidal behavior was 157(37%). Illiteracy, being a wife of a husband with three and more other wives, current history of depression, intimate partner violence, and poor social support were significantly associated with suicidal behavior at 95% confidence interval, p < 0.05.ConclusionThis study found that one-third of the respondents had suicidal behavior. Different significant socio-demographic and psychosocial variables were identified. Thus, due attention should be given to minimize the practice and its effect on the mental wellbeing of a mother and their children.
“Diagnostic-Therapeutic Management in Patients with Extrahepatic Bile Duct Cancer”
Authors: Hassan Razeeb , Alam J. M. H. Qausar , Uddin Md. Abbas , Akhter Mousumi 
Published: October 2021

Introduction: Biliary tract tumors, or cholangiocarcinomas (CCAs), comprise a heterogeneous group of malignant tumors that can affect any part of the biliary tree, from the interlobular canals of Hering to the primary biliary duct. In the last 20-30 years, the incidence of these tumours has increased especially after the introduction of the new imaging techniques endoscopic retrograde cholangiopancreatography (ERCP, percutaneous transhepatic cholangiography) and the increased interest for this pathology.
Objective: To evaluate the diagnostic methods and therapeutical results in patients with extrahepatic bile duct cancer.
Material and Method: This cross-sectional study was conducted in the Department of Surgery, Department of Surgery, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from Jun-2018 to July-2021. We included 124 consecutive patients with suspected bile duct cancer who underwent endoscopic retrograde cholangiopancreatography (ERCP). Every patient underwent an ultrasound (US) examination before ERCP. ERCP was considered as the “gold standard” for diagnosis. The therapy applied consisted of endoscopic stenting, US guided biliary drainage or surgery. The sensitivity, specificity and accuracy were calculated for every tumour localisation and also globally for all tumours.
Results. The sensitivity, specificity and accuracy of US were 85.9%, 76.9% and 84.4% for hilar localization, 59.1%, 50% and 57.1% for the mid common bile duct (CBD) and 33.3%, 42.8% and 36.8% for the distal CBD tumours. The global performances for US in diagnosing extrahepatic chlonagiocarcinoma were 73.5%, 61.5% and 70.9%. In 73 cases (74.5%) an endoscopic stent was placed. In 11 cases (11.2%) we performed an US guided biliary drainage and in 14 cases (14.2%) surgery was recommended.
Conclusion: Ultrasonography proved to be a reliable method for the diagnosis of bile duct cancer in spite of its low accuracy for distal localization. The combination of the two investigations (US and ERCP) was very efficient in the management of these patients. Endoscopic stenting for hilar localization is a good therapeutical option.
Acute and Chronic Toxicity, Antioxidant (in Vitro and in Vivo), and Cytotoxic Effect of Peganum Harmala L. Hydromethanolic Seeds Extract Safety Profile and Biological Activities of Peganum harmala L
Authors: Mounira Dehiri , Abdelouahab Diafat , Widad Fatmi , Amirouche Deghima , Mansour Riadh Ben , Rebai Khalil , Bouaziz Mohamed , Faycel Benbacha 
Published: October 2021

Abstract
Peganum harmala L. (Harmel) is a widely used plant in the traditional Algerian medicine. The objective of the present study was to assess the safety profile of the P. harmala hydromethanolic seed extract (PhHm). The acute toxicity of PhHm extract was carried out based on OECD guidelines 425, where the extract was administered to mice by gavage in single doses. While in the chronic study, the extract was administered orally for 90 days in rats. The antioxidant (in vitro and in vivo) and antiproliferative activities of PhHm extract were also investigated. In the acute and chronic toxicity, the extract did not cause any behavioral changes and any mortality. In both study a significant increase in liver enzymes was observed while urea and creatinine levels decreased in the treated animals. In the repeated oral administration of PhHm extract, an increase of the platelet numbers was noted and the histological examination of the liver showed a leukocyte infiltration and a vascular congestion. For kidneys, the presence of glomerular and modular congestion was also observed and sinusoidal dilation in chronic toxicity. The PhHm extract was more cytotoxic to HeLa cell line and exhibited potent antioxidant in vitro and in vivo. It can be suggested, based on the results of this study that the PhHm seed extract was moderately toxic in acute administration (LD50 of 501.47 mg/kg) and the use of this extract is safe at doses ≤ 100 mg/kg. P. harmala could be a potential source of bioactive compounds with antioxidant and antiproliferative potential.
Radiomics Analysis of Contrast-enhanced CT for Staging Liver Fibrosis: An Update for Image Biomarker
Authors: Wang Jin-Cheng , Tang Shengnan , Mao Yingfan , Wu Jin , Xu Shanshan , Yue Qi , Chen Jun , He Jian , Yin Yin 
Published: October 2021

Abstract
BackgroundTo establish and validate a radiomics-based model for staging liver fibrosis at contrast-enhanced CT images.Materials and MethodsThis retrospective study developed two radiomics-based models (R-score: radiomics signature; R-fibrosis: integrate radiomic and serum variables) in a training cohort of 332 patients (median age, 59 years; interquartile range, 51-67 years; 256 men) with biopsy-proven liver fibrosis who underwent contrast-enhanced CT between January 2017 and December 2020. Radiomic features were extracted from non-contrast, arterial and portal phase CT images and selected by using the least absolute shrinkage and selection operator (LASSO) logistic regression to differentiate stage F3-F4 from stage F0-F2. Optimal cutoffs to diagnose significant fibrosis (stage F2-F4), advanced fibrosis (stage F3-F4) and cirrhosis (stage F4) were determined by receiver operating characteristic curve analysis. Diagnostic performance was evaluated by area under the curve, Obuchowski index, calibrations and decision curve analysis. An internal validation was conducted in 111 randomly assigned patients (median age, 58 years; interquartile range, 49-66 years; 89 men).ResultsIn the validation cohort, R-score and R-fibrosis (Obuchowski index, 0.843 and 0.846, respectively) significantly outperformed aspartate transaminase-to-platelet ratio (APRI) (Obuchowski index, 0.651; P < .001) and fibrosis-4 index (FIB-4) (Obuchowski index, 0.676; P < .001) for staging liver fibrosis. By using the cutoffs, R-fibrosis and R-score had a sensitivity range of 70%-87%, specificity range of 71%-97%, and accuracy range of 82%-86% in diagnosing significant fibrosis, advanced fibrosis and cirrhosis.Conclusion﻿Radiomic analysis of contrast-enhanced CT images can reach great diagnostic performance of liver fibrosis.