bluuebunny/crossref_metadata_2025_split huggingface dataset:
COVID-19 outbreak and dental health care provision in Nigeria: a national survey
Authors: Aladelusi Timothy Olukunle , Atiba Foluso Ayobami , Gbadebo Shakeerah Olaide , Adeyemo Yewande Isabella , Olusanya Adeola Adenike , Akadiri Oladimeji Adeniyi 
Published: October 2021

AbstractBackgroundThe impact of the COVID-19 pandemic on the world is unprecedented, posing greater threats to vulnerable healthcare systems, especially in developing countries. This study aimed to assess the knowledge of dental healthcare providers in Nigeria about the disease and evaluate their responses to the preventive measures necessitated by COVID-19.MethodsThis was an online self-administered questionnaire-based study conducted among dentists practicing in Nigeria. A message containing the link to the survey was sent widely via social medial platforms and electronic mails to dentists practicing in Nigeria. The data collection was done between the 2ndof June and 3rd of July 2020.ResultsA total of 314 responses was recorded. Fever was the most specified generalized symptom (97.5%), while the use of masks (100%), hand hygiene (99.7%), social distancing (97.7%) and surface cleaning (99.4%) were the most commonly employed general preventive methods. The main identified risk of transmission in the clinic was aerosol generating procedures (98.7%).ConclusionThe general knowledge of dental personnel in our study population appears to be adequate on the common clinical features of COVID-19 but less adequate regarding the less common features. The COVID-19 pandemic has also modified some aspects of dental service delivery but more needs to be done in this regard. Preventive measures against the transmission of COVID-19 in dental practice settings include proper utilization of teledentistry, clinical triage, preprocedural 1% hydrogen peroxide oral rinses, and the use of appropriate Personal Protective Equipment (PPE) which should always be encouraged.
Long term impact of the WHI studies on information-seeking and decision-making in menopause symptoms management: a longitudinal analysis of questions to a medicines call centre
Authors: Natari Rifani B. , Hollingworth Samantha A. , Clavarino Alexandra M. , Dingle Kaeleen D. , McGuire Treasure M. 
Published: October 2021

Abstract
Background
While women are taking a greater role in decisions about menopause symptom management, the legacy of the Women’s Health Initiative (WHI) studies persist. Despite hormone therapy (HT) being effective in reducing all-cause mortality, many women seeking relief of menopausal symptoms exaggerate HT harms and overstate the perceived benefits or ignore the risks of alternative therapies. We aimed to explore the longitudinal impact of the widely-publicised WHI 2002 study on women’s information-seeking and describe determinants of decision-making about managing menopausal symptoms.

Methods
In a longitudinal analysis of both quantitative and qualitative data, we explored consumer questions about menopause-related medicines received by two Australian medicines call centres (1996–2010) before, during, and after WHI 2002. We analysed calls by age and gender of caller and patient, their relationship, postcode, enquiry type, and motivation to help-seek. We compared calls regarding HT and herbal medicines (HM) with the rest of calls, and thematically analysed question narratives across the three time-periods.

Results
There were 1,829 menopause-related calls received of over this time-period, with a call surge, primarily from women in their mid-fifties, in the two months after the WHI 2002 publication. Two in three calls were motivated by negative media reports as women sought support for decision-making, primarily reassurance to cease HT. While HT safety concerns persisted for eight years post-publication, the nature of information-seeking changed over time. Callers subsequently sought reassurance to use menopause treatments together with their other medicines; and pursued HT substitutes, including HM, in response to HT product discontinuation.

Conclusions
Women sought information or reassurance to support a decision, based on dynamic changes in internal (symptom or risk intolerance, attitude towards menopause and treatment preferences) and external factors (perceived source trust and changes in treatment availability). In assessing HT benefit versus risk, women tend to overestimate risk with HT safety concerns persisting over time. Decision-making in managing menopause symptoms is complex and dynamic. Reassurance to reach or justify decisions from a perceived trusted source can support informed decision-making.
A comparative analysis of the influence of contraceptive use and fertility desire on the duration of second birth interval in four sub-Saharan African countries
Authors: Afolabi Rotimi Felix , Fagbamigbe Adeniyi Francis , Palamuleni Martin Enock 
Published: October 2021

AbstractBackgroundFertility decline characterised by inter-birth intervals remains rather slow or stall in many countries of sub-Saharan African (SSA). Non-adherence to optimal inter-birth intervals often occasioned by low prevalence of contraceptive use and high fertility desires often lead to poor maternal and child health outcomes. Additionally, information on the influence of contraception and fertility desire on interval between first and second births (SBI) is rarely available. This study therefore aimed to examine the influence of fertility desire and contraception on SBI among women in four SSA countries.MethodsWe analysed cross-sectional data on women aged 15–49 years who participated in the recent Demographic and Health Surveys in DR Congo, Ethiopia, Nigeria and South Africa. Semi-parametric Cox proportional hazards regression was employed for the analysis at 5% significance level.ResultsThe median time to second birth was 34 months in DR Congo; 35 months, Nigeria; 42 months, Ethiopia; and 71 months, South Africa. About 70% of the women desired additional child(ren) and two-thirds have never used contraceptive in both Nigeria and DR Congo. The hazard of second birth was significantly lower among women who desired additional child(ren) compared to desired for no more child in DR Congo (aHR = 0.93; CI: 0.89–0.97), Ethiopia (aHR = 0.64; CI: 0.61–0.67) and South Africa (aHR = 0.51; CI: 0.47–0.55). Women who had never used contraceptive were 12%, 20% and 24% more likely to lengthen SBI than those who were current users in DR Congo, Nigeria and South Africa respectively. DR Congo and Nigerian women were about two times more likely to shorten SBI compared with their South African counterparts. Other significant determinants of SBI include ethnicity, rural residential, age and marital status at first birth, wealth and employment status.ConclusionFindings showed differentials in the linkage between second birth interval and the desired fertility and contraception by country, demonstrating the importance of context. The contribution of these factors to second birth interval requires country context-specific attention if further decline in fertility and poor health outcomes associated with sub-optimal inter-birth interval is to be attained in SSA.
The implementation of routine procedural transvaginal sonography to decrease retained products of conception: a quality improvement initiative
Authors: Larish M. Alyssa , Jensen E. Claire , Mara C. Kristin , Green C. Isabel , Hopkins R. Matthew , Laughlin-Tommaso K. Shannon , Burnett L. Tatnai , Breitkopf M. Daniel 
Published: October 2021

Abstract
Background
Retained products of conception (POC) following uterine evacuation can lead to adverse sequelae, including hemorrhage, endometritis, intrauterine adhesions, and reoperation. Use of procedural transvaginal sonography (TVUS) in the operating room has been proposed to help decrease retained POC.

Methods
A retrospective review of all first trimester uterine evacuation procedures from 1/2015 to 2/2017 was performed, noting use of transabdominal ultrasonography, retained products of conception, and complications. A practice change was implemented in May 2018, in which routine intra-procedural TVUS use was initiated. A second retrospective chart review was conducted to assess for post-implementation incidence of retained POC, re-operation, and associated complications.

Results
Prior to intra-procedural TVUS implementation, 130 eligible procedures were performed during the specified timeframe, with 9/130 (6.9%) incidence of retained products of conception. TAUS was performed in 59/130 (45.4%) of procedures, and 4/9 (44.4%) of those with retained products. There were eight re-operative procedures in seven patients, and two patients were treated with misoprostol. Complications included hemorrhage, Asherman’s syndrome and endometritis. Following implementation, 95 first trimester procedures were performed with transvaginal sonography, with 0 (0%) cases of retained POC (p = 0.01), no incidences of re-operation (p = 0.02), and one case of Asherman’s syndrome. TVUS findings led to additional focused suction curettage in 20/95 (21.0%) of procedures. The endometrium was measured on procedure completion in 64 procedures, with a mean thickness of 5.5 mm (1–12 mm).

Conclusion
Implementation of routine TVUS during uterine evacuation may reduce the incidence of retained POC and associated reoperation rates. Further multi-center trials are needed to confirm this finding.
Improving handover competency in preclinical medical and health professions students: establishing the reliability and construct validity of an assessment instrument
Authors: Michael Meghan , Griggs Andrew C. , Shields Ian H. , Sadighi Mozhdeh , Hernandez Jessica , Chan Chrissy , McHugh Mary , Nichols Blake E. , Joshi Kavita , Testa Daniel , Raj Sonika , Preble Richard , Lazzara Elizabeth H. , Greilich Philip E. 
Published: October 2021

Abstract
Background
As part of the worldwide call to enhance the safety of patient handovers of care, the Association of American Medical Colleges (AAMC) requires that all graduating students “give or receive a patient handover to transition care responsibly” as one of its Core Entrustable Professional Activities (EPAs) for Entering Residency. Students therefore require educational activities that build the necessary teamwork skills to perform structured handovers. To date, a reliable instrument designed to assess teamwork competencies, like structured communication, throughout their preclinical and clinical years does not exist.

Method
Our team developed an assessment instrument that evaluates both the use of structured communication and two additional teamwork competencies necessary to perform safe patient handovers. This instrument was utilized to assess 192 handovers that were recorded from a sample of 229 preclinical medical students and 25 health professions students who participated in a virtual course on safe patient handovers. Five raters were trained on utilization of the assessment instrument, and consensus was established. Each handover was reviewed independently by two separate raters.

Results
The raters achieved 72.22 % agreement across items in the reviewed handovers. Krippendorff’s alpha coefficient to assess inter-rater reliability was 0.6245, indicating substantial agreement among the raters. A confirmatory factor analysis (CFA) demonstrated the orthogonal characteristics of items in this instrument with rotated item loadings onto three distinct factors providing preliminary evidence of construct validity.

Conclusions
We present an assessment instrument with substantial reliability and preliminary evidence of construct validity designed to evaluate both use of structured handover format as well as two team competencies necessary for safe patient handovers. Our assessment instrument can be used by educators to evaluate learners’ handoff performance as early as their preclinical years and is broadly applicable in the clinical context in which it is utilized. In the journey to optimize safe patient care through improved teamwork during handovers, our instrument achieves a critical step in the process of developing a validated assessment instrument to evaluate learners as they seek to accomplish this goal.
A framework for validating AI in precision medicine: considerations from the European ITFoC consortium
Authors: Tsopra Rosy , Fernandez Xose , Luchinat Claudio , Alberghina Lilia , Lehrach Hans , Vanoni Marco , Dreher Felix , Sezerman O.Ugur , Cuggia Marc , de Tayrac Marie , Miklasevics Edvins , Itu Lucian Mihai , Geanta Marius , Ogilvie Lesley , Godey Florence , Boldisor Cristian Nicolae , Campillo-Gimenez Boris , Cioroboiu Cosmina , Ciusdel Costin Florian , Coman Simona , Hijano Cubelos Oliver , Itu Alina , Lange Bodo , Le Gallo Matthieu , Lespagnol Alexandra , Mauri Giancarlo , Soykam H.Okan , Rance Bastien , Turano Paola , Tenori Leonardo , Vignoli Alessia , Wierling Christoph , Benhabiles Nora , Burgun Anita 
Published: October 2021

Abstract
Background
Artificial intelligence (AI) has the potential to transform our healthcare systems significantly. New AI technologies based on machine learning approaches should play a key role in clinical decision-making in the future. However, their implementation in health care settings remains limited, mostly due to a lack of robust validation procedures. There is a need to develop reliable assessment frameworks for the clinical validation of AI. We present here an approach for assessing AI for predicting treatment response in triple-negative breast cancer (TNBC), using real-world data and molecular -omics data from clinical data warehouses and biobanks.

Methods
The European “ITFoC (Information Technology for the Future Of Cancer)” consortium designed a framework for the clinical validation of AI technologies for predicting treatment response in oncology.

Results
This framework is based on seven key steps specifying: (1) the intended use of AI, (2) the target population, (3) the timing of AI evaluation, (4) the datasets used for evaluation, (5) the procedures used for ensuring data safety (including data quality, privacy and security), (6) the metrics used for measuring performance, and (7) the procedures used to ensure that the AI is explainable. This framework forms the basis of a validation platform that we are building for the “ITFoC Challenge”. This community-wide competition will make it possible to assess and compare AI algorithms for predicting the response to TNBC treatments with external real-world datasets.

Conclusions
The predictive performance and safety of AI technologies must be assessed in a robust, unbiased and transparent manner before their implementation in healthcare settings. We believe that the consideration of the ITFoC consortium will contribute to the safe transfer and implementation of AI in clinical settings, in the context of precision oncology and personalized care.
Prevalence, student nurses’ knowledge and practices of needle stick injuries during clinical training: a cross-sectional survey
Authors: Al Qadire Mohammad , Ballad Cherry Ann C. , Al Omari Omar , Aldiabat Khaldoun M. , Shindi Yousef Abu , Khalaf Atika 
Published: October 2021

Abstract
Background
The incidence of needle stick injuries is higher among nurses with a low level of knowledge on the prevention of needle stick injury, and who have not received the relevant training during their undergraduate study. The aim of this study was to determine the level of knowledge of the prevention guidelines and the prevalence of needle stick injury among students in Oman.

Methods
An online cross-sectional survey using a questionnaire and involving 167 students from a governmental university was conducted. The questionnaire consists of 30 questions; eight general questions, knowledge related questions, and questions about risk factors, prevention measures, and actions in a case of needle stick injury. Ethical approval was obtained and the link to the survey was shared with students using their university email portal.

Results
Of the participants, 81.2% were females; mean age was 23.3 (SD = 4.5) years. The mean total knowledge score was 6.6 out of 10 (SD = 2.1). In addition, 18.2% (n = 32) of the students experienced needle stick injury. Most of the injuries 71.9% (n = 24) occurred during medication preparation and administration. The main cause of NSI as reported by students was recapping the needles (59%, n = 19).

Conclusions
This study demonstrates that student nurses have a moderate level of knowledge about needle stick injury prevention measures and lack many facets of safe infection control practice. These findings require the collaborative effort of nursing administrators from both academic and clinical areas, to develop effective strategies to reduce or eliminate the occurrence of needle stick injury.
Resilient and responsive healthcare services and systems: challenges and opportunities in a changing world
Authors: Wiig Siri , O’Hara Jane K. 
Published: October 2021

Abstract
Background
Resilient and responsive healthcare systems is on the agenda as ever before. COVID-19, specialization of services, resource demands, and technology development are all examples of aspects leading to adaptations among stakeholders at different system levels whilst also attempting to maintain high service quality and safety. This commentary sets the scene for a journal collection on Resilient and responsive health systems in a changing world. The commentary aims to outline main challenges and opportunities in resilient healthcare theory and practice globally, as a backdrop for contributions to the collection.

Main text
Some of the main challenges in this field relate to a myriad of definitions and approaches to resilience in healthcare, and a lack of studies having multilevel perspectives. Also, the role of patients, families, and the public in resilient and responsive healthcare systems is under researched. By flipping the coin, this illustrates opportunities for research and practice and raise key issues that future resilience research should pay attention to. The potential of combining theoretical lenses from different resilience traditions, involvement of multiple stakeholders in co-creating research and practice improvement, and modelling and visualizing resilient performance are all opportunities to learn more about how healthcare succeeds under stress and normal operations.

Conclusion
A wide understanding of resilience and responsiveness is needed to support planning and preparation for future disasters and for handling the routine small-scale adaptation. This collection welcomes systematic reviews, quantitative, qualitative, and mixed-methods research on the topic of resilience and responsiveness in all areas of the health system.
Integrated bioinformatics analysis of core regulatory elements involved in keloid formation
Authors: Li Chuying , Jin Meitong , Luo Yinli , Jin Zhehu , Pi Longquan 
Published: October 2021

Abstract
Background
Keloid is a benign fibro-proliferative dermal tumor formed by an abnormal scarring response to injury and characterized by excessive collagen accumulation and invasive growth. The mechanism of keloid formation has not been fully elucidated, especially during abnormal scarring. Here, we investigated the regulatory genes, micro-RNAs (miRNAs) and transcription factors (TFs) that influence keloid development by comparing keloid and normal scar as well as keloid and normal skin.

Methods
Gene expression profiles (GSE7890, GSE92566, GSE44270 and GSE3189) of 5 normal scar samples, 10 normal skin samples and 18 keloid samples from the Gene Expression Omnibus (GEO) database were interrogated. Differentially expressed genes (DEGs) were identified between keloid and normal skin samples as well as keloid and normal scar samples with R Project for Statistical Computing. Gene Ontology (GO) functional enrichment analysis was also performed with R software. DEG-associated protein–protein interaction (PPI) network was constructed by STRING, followed by module selection from the PPI network based on the MCODE analysis. Regulatory relationships between TF/miRNA and target genes were predicted with miRnet and cytoscape. Core regulatory genes were verified by RT-qPCR.

Results
We identified 628 DEGs, of which 626 were up-regulated and 2 were down-regulated. Seven core genes [neuropeptide Y(NPY), 5-hydroxytryptamine receptor 1A(HTR1A), somatostatin (SST), adenylate cyclase 8 (ADCY8), neuromedin U receptor 1 (NMUR1), G protein subunit gamma 3 (GNG3), and G protein subunit gamma 13 (GNG13)] all belong to MCODE1 and were enriched in the “G protein coupled receptor signaling pathway” of the GO biological process category. Furthermore, nine core miRNAs (hsa-mir-124, hsa-let-7, hsa-mir-155, hsa-mir-26a, hsa-mir-941, hsa-mir-10b, hsa-mir-20, hsa-mir-31 and hsa-mir-372), and two core TFs (SP1 and TERT) were identified to play important roles in keloid formation. In the TF/miRNA-target gene network, both hsa-mir-372 and hsa-mir-20 had a regulatory effect on GNG13, ADCY8 was predicted to be target by hsa-mir-10b, and HTR1A and NPY were potentially by SP1. Furthermore, the expression of core regulatory genes (GNG13, ADCY8, HTR1A and NPY) was validated in clinical samples.

Conclusions
GNG13, ADCY8, NPY and HTR1A may act as core genes in keloid formation and these core genes establish relationship with SP1 and miRNA (hsa-mir-372, hsa-mir-20, hsa-mir-10b), which may influence multiple signaling pathways in the pathogenesis of keloid.
Empagliflozin protects the heart against ischemia/reperfusion-induced sudden cardiac death
Authors: Hu Zhaoyang , Ju Feng , Du Lei , Abbott Geoffrey W. 
Published: October 2021

Abstract
Background
Empagliflozin is a selective sodium–glucose cotransporter 2 (SGLT2) inhibitor used to lower blood sugar in adults with type 2 diabetes. Empagliflozin also exerts cardioprotective effects independent from glucose control, but its benefits on arrhythmogenesis and sudden cardiac death are not known. The purpose of this study was to examine the effect of empagliflozin on myocardial ischemia/reperfusion-provoked cardiac arrhythmia and sudden cardiac death in vivo.

Methods
Male Sprague Dawley rats were randomly assigned to sham-operated, control or empagliflozin groups. All except for the sham-operated rats were subjected to 5-min left main coronary artery ligation followed by 20-min reperfusion. A standard limb lead II electrocardiogram was continuously measured throughout the experiment. Coronary artery reperfusion-induced ventricular arrhythmogenesis and empagliflozin therapy were evaluated. The hearts were used for protein phosphorylation analysis and immunohistological assessment.

Results
Empagliflozin did not alter baseline cardiac normal conduction activity. However, empagliflozin eliminated myocardial vulnerability to sudden cardiac death (from 69.2% mortality rate in the control group to 0% in the empagliflozin group) and reduced the susceptibility to reperfusion-induced arrhythmias post I/R injury. Empagliflozin increased phosphorylation of cardiac ERK1/2 after reperfusion injury. Furthermore, inhibition of ERK1/2 using U0126 abolished the anti-arrhythmic action of empagliflozin and ERK1/2 phosphorylation.

Conclusions
Pretreatment with empagliflozin protects the heart from subsequent severe lethal ventricular arrhythmia induced by myocardial ischemia and reperfusion injury. These protective benefits may occur as a consequence of activation of the ERK1/2-dependent cell-survival signaling pathway in a glucose-independent manner.