bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors influencing the uptake of evidence in child health policy-making: results of a survey among 23 European countries
Authors: Zdunek Kinga , Alexander Denise , Schröder-Bäck Peter , Rigby Michael , Blair Mitch 
Published: November 2021

Abstract
Background
The ability to successfully transfer knowledge across international boundaries to improve health across the European Region is dependent on an in-depth understanding of the many factors involved in policy creation. Across countries we can observe various approaches to evidence usage in the policy-making process. This study, which was a part of the Models of Child Health Appraised (MOCHA) project assessing patterns of children’s primary care in Europe, focused on how and what kind of evidence is used in child health policy-making processes in European countries and how it is applied to inform policy and practice.

Method
In this study, a qualitative approach was used. The data were analysed in accordance with the thematic analysis protocol. The MOCHA project methodology relies on experienced country agents (CA) recruited for the project and paid to deliver child health data in each of 30 European countries. CAs are national experts in the child health field who defined the country-specific structured information and data. A questionnaire designed as a semi-structured survey instrument asked CAs to indicate the sources of evidence used in the policy-making process and what needed to be in place to support evidence uptake in policy and practice.

Results
In our data we observed two approaches to evidence usage in child health policy formulation. The scientific approach in our understanding refers to the so-called bottom-up initiatives of academia which identify and respond to the population’s needs. Institutional approaches can be informed by scientific resources as well; however, the driving forces here are governmental institutions, whose decisions and choices are based not only on the population needs but also on political, economic and organizational factors. The evidence used in Europe can also be of an external or internal nature. Various factors can affect the use of evidence in child health policy-making. Facilitators are correlated with strong scientific culture development, whereas barriers are defined by a poor tradition of implementing changes based on reliable evidence.

Conclusions
Focusing on the facilitators and actively working to reduce the barriers can perceivably lead to faster and more robust policy-making, including the development of a culture of scientific grounding in policy creation.
The impact of participant mental health on attendance and engagement in a trial of behavioural weight management programmes: secondary analysis of the WRAP randomised controlled trial
Authors: Jones Rebecca A. , Mueller Julia , Sharp Stephen J. , Vincent Ann , Duschinsky Robbie , Griffin Simon J. , Ahern Amy L. 
Published: November 2021

Abstract
Background
Low attendance and engagement in behavioural weight management trials are common. Mental health may play an important role, however previous research exploring this association is limited with inconsistent findings. We aimed to investigate whether mental health was associated with attendance and engagement in a trial of behavioural weight management programmes.

Methods
This is a secondary data analysis of the Weight loss referrals for adults in primary care (WRAP) trial, which randomised 1267 adults with overweight or obesity to brief intervention, WW (formerly Weight Watchers) for 12-weeks, or WW for 52-weeks. We used regression analyses to assess the association of baseline mental health (depression and anxiety (by Hospital Anxiety and Depression Scale), quality of life (by EQ5D), satisfaction with life (by Satisfaction with Life Questionnaire)) with programme attendance and engagement in WW groups, and trial attendance in all randomised groups.

Results
Every one unit of baseline depression score was associated with a 1% relative reduction in rate of WW session attendance in the first 12 weeks (Incidence rate ratio [IRR] 0.99; 95% CI 0.98, 0.999). Higher baseline anxiety was associated with 4% lower odds to report high engagement with WW digital tools (Odds ratio [OR] 0.96; 95% CI 0.94, 0.99). Every one unit of global quality of life was associated with 69% lower odds of reporting high engagement with the WW mobile app (OR 0.31; 95% CI 0.15, 0.64). Greater symptoms of depression and anxiety and lower satisfaction with life at baseline were consistently associated with lower odds of attending study visits at 3-, 12-, 24-, and 60-months.

Conclusions
Participants were less likely to attend programme sessions, engage with resources, and attend study assessments when reporting poorer baseline mental health. Differences in attendance and engagement were small, however changes may still have a meaningful effect on programme effectiveness and trial completion. Future research should investigate strategies to maximise attendance and engagement in those reporting poorer mental health.

Trial registration
The original trial (ISRCTN82857232) and five year follow up (ISRCTN64986150) were prospectively registered with Current Controlled Trials on 15/10/2012 and 01/02/2018.
It’s a small bit of advice, but actually on the day, made such a difference…: perceptions of quality in abortion care in England and Wales
Authors: Whitehouse Katherine C. , Blaylock Rebecca , Makleff Shelly , Lohr Patricia A. 
Published: November 2021

Abstract
Background
Quality of care (QOC) is increasingly identified as an important contributor to healthcare outcomes, however little agreement exists on what constitutes quality in abortion care or the recommended indicators from the service-user perspective. Our study aimed to explore perceptions and experiences of abortion QOC in England and Wales.

Methods
We performed in-depth interviews (via phone or in-person) with participants who had an abortion at a nationwide independent sector provider in the previous 6 months. We explored their experiences of the abortion service at each point in the care pathway, their perspectives on what contributed to and detracted from the experience meeting their definitions of quality, and their reflections on different aspects of QOC. We used content analysis to generate themes.

Results
From December 2018 to July 2019, we conducted 24 interviews. Ten participants had a surgical and 14 had a medical abortion. Seventeen (71%) were treated in the first 12 weeks of pregnancy and 7 (29%) beyond that, with an average gestational age of 10 weeks + 5 days (range 5–23 + 6). We identified 4 major themes that contributed to participant’s perception of high quality care: (1) interpersonal interactions with staff or other patients, (2) being informed and prepared, (3) participation and choices in care and (4) accessibility. Nearly all participants identified interpersonal interactions with staff as an important contributor to quality with positive interactions often cited as the best part of their abortion experience and negative interactions as the worst. For information and preparation, participant described not only the importance of being well prepared, but how incongruencies between information and the actual experience detracted from quality. Participants said that making choices about their care, for example, method of abortion, was a positive contributor. Finally, participants identified access to care, specifically in relation to waiting times and travel, as an important aspect of QOC.

Conclusions
Participants situated quality in abortion care in 4 domains: interpersonal aspects of care, information and preparation, choices, and accessibility. Indicators identified can be used to develop standard metrics to ensure care meets service-user needs.
Impact of the COVID-19 pandemic on intimate partner violence in Sudan, Malawi and Kenya
Authors: Ahmed Salma A. E. , Changole Josephine , Wangamati Cynthia Khamala 
Published: November 2021

AbstractThe COVID-19 infection control and prevention measures have contributed to the increase in incidence of intimate partner violence (IPV) and negatively impacted access to health and legal systems. The purpose of this commentary is to highlight the legal context in relation to IPV, and impact of COVID-19 on IPV survivors and IPV prevention and response services in Kenya, Malawi, and Sudan. Whereas Kenya and Malawi have ratified the Convention on Elimination of all forms of Discrimination against Women (CEDAW) and have laws against IPV, Sudan has yet to ratify the convention and lacks laws against IPV. Survivors of IPV in Kenya, Malawi and Sudan have limited access to quality health care, legal and psychosocial support services due to COVID-19 infection control and prevention measures. The existence of laws in Kenya and Malawi, which have culminated into establishment of IPV services, allows a sizable portion of the population to access IPV services in the pandemic period albeit sub-optimal. The lack of laws in Sudan means that IPV services are hardly available and as such, a minimal proportion of the population can access services. Civil society’s push in Kenya has led to prioritisation of IPV services. Thus, a vibrant civil society, committed governments and favourable IPV laws, can lead to better IPV services during the COVID-19 pandemic period.
Measuring mental workload in assistive wearable devices: a review
Authors: Marchand Charlotte , De Graaf Jozina B. , Jarrassé Nathanaël 
Published: November 2021

AbstractAs wearable assistive devices, such as prostheses and exoskeletons, become increasingly sophisticated and effective, the mental workload associated with their use remains high and becomes a major challenge to their ecological use and long-term adoption. Numerous methods of measuring mental workload co-exist, making analysis of this research topic difficult. The aim of this review is to examine how mental workload resulting from the use of wearable assistive devices has been measured, in order to gain insight into the specific possibilities and limitations of this field. Literature searches were conducted in the main scientific databases and 60 articles measuring the mental workload induced by the use of a wearable assistive device were included in this study. Three main families of methods were identified, the most common being ’dual task’ and ’subjective assessment’ methods, followed by those based on ’physiological measures’, which included a wide variety of methods. The variability of the measurements was particularly high, making comparison difficult. There is as yet no evidence that any particular method of measuring mental workload is more appropriate to the field of wearable assistive devices. Each method has intrinsic limitations such as subjectivity, imprecision, robustness or complexity of implementation or interpretation. A promising metric seems to be the measurement of brain activity, as it is the only method that is directly related to mental workload. Finally, regardless of the measurement method chosen, special attention should be paid to the measurement of mental workload in the context of wearable assistive devices. In particular, certain practical considerations, such as ecological situations and environments or the level of expertise of the participants tested, may be essential to ensure the validity of the mental workload assessed.
Optimized hip-knee-ankle exoskeleton assistance reduces the metabolic cost of walking with worn loads
Authors: Bryan Gwendolyn M. , Franks Patrick W. , Song Seungmoon , Reyes Ricardo , O’Donovan Meghan P. , Gregorczyk Karen N. , Collins Steven H. 
Published: November 2021

Abstract
Background
Load carriage is common in a wide range of professions, but prolonged load carriage is associated with increased fatigue and overuse injuries. Exoskeletons could improve the quality of life of these professionals by reducing metabolic cost to combat fatigue and reducing muscle activity to prevent injuries. Current exoskeletons have reduced the metabolic cost of loaded walking by up to 22% relative to walking in the device with no assistance when assisting one or two joints. Greater metabolic reductions may be possible with optimized assistance of the entire leg.

Methods
We used human-in the-loop optimization to optimize hip-knee-ankle exoskeleton assistance with no additional load, a light load (15% of body weight), and a heavy load (30% of body weight) for three participants. All loads were applied through a weight vest with an attached waist belt. We measured metabolic cost, exoskeleton assistance, kinematics, and muscle activity. We performed Friedman’s tests to analyze trends across worn loads and paired t-tests to determine whether changes from the unassisted conditions to the assisted conditions were significant.

Results
Exoskeleton assistance reduced the metabolic cost of walking relative to walking in the device without assistance for all tested conditions. Exoskeleton assistance reduced the metabolic cost of walking by 48% with no load (p = 0.05), 41% with the light load (p = 0.01), and 43% with the heavy load (p = 0.04). The smaller metabolic reduction with the light load may be due to insufficient participant training or lack of optimizer convergence. The total applied positive power was similar for all tested conditions, and the positive knee power decreased slightly as load increased. Optimized torque timing parameters were consistent across participants and load conditions while optimized magnitude parameters varied.

Conclusions
Whole-leg exoskeleton assistance can reduce the metabolic cost of walking while carrying a range of loads. The consistent optimized timing parameters across participants and conditions suggest that metabolic cost reductions are sensitive to torque timing. The variable torque magnitude parameters could imply that torque magnitude should be customized to the individual, or that there is a range of useful torque magnitudes. Future work should test whether applying the load to the exoskeleton rather than the person’s torso results in larger benefits.
How to prevent alcohol and illicit drug use among students in affluent areas: a qualitative study on motivation and attitudes towards prevention
Authors: Kvillemo Pia , Hiltunen Linda , Demetry Youstina , Carlander Anna-Karin , Hansson Tim , Gripenberg Johanna , Elgán Tobias H. , Einhorn Kim , Skoglund Charlotte 
Published: November 2021

Abstract
Background
The use of alcohol and illicit drugs during adolescence can lead to serious short- and long-term health related consequences. Despite a global trend of decreased substance use, in particular alcohol, among adolescents, evidence suggests excessive use of substances by young people in socioeconomically affluent areas. To prevent substance use-related harm, we need in-depth knowledge about the reasons for substance use in this group and how they perceive various prevention interventions. The aim of the current study was to explore motives for using or abstaining from using substances among students in affluent areas as well as their attitudes to, and suggestions for, substance use prevention.

Methods
Twenty high school students (age 15–19 years) in a Swedish affluent municipality were recruited through purposive sampling to take part in semi-structured interviews. Qualitative content analysis of transcribed interviews was performed.

Results
The most prominent motive for substance use appears to be a desire to feel a part of the social milieu and to have high social status within the peer group. Motives for abstaining included academic ambitions, activities requiring sobriety and parental influence. Students reported universal information-based prevention to be irrelevant and hesitation to use selective prevention interventions due to fear of being reported to authorities. Suggested universal prevention concerned reliable information from credible sources, stricter substance control measures for those providing substances, parental involvement, and social leisure activities without substance use. Suggested selective prevention included guaranteed confidentiality and non-judging encounters when seeking help.

Conclusions
Future research on substance use prevention targeting students in affluent areas should take into account the social milieu and with advantage pay attention to students’ suggestions on credible prevention information, stricter control measures for substance providers, parental involvement, substance-free leisure, and confidential ways to seek help with a non-judging approach from adults.
The basis and advances in clinical application of boron neutron capture therapy
Authors: He Huifang , Li Jiyuan , Jiang Ping , Tian Suqing , Wang Hao , Fan Ruitai , Liu Junqi , Yang Yuyan , Liu Zhibo , Wang Junjie 
Published: November 2021

AbstractBoron neutron capture therapy (BNCT) was first proposed as early as 1936, and research on BNCT has progressed relatively slowly but steadily. BNCT is a potentially useful tool for cancer treatment that selectively damages cancer cells while sparing normal tissue. BNCT is based on the nuclear reaction that occurs when 10B capture low-energy thermal neutrons to yield high-linear energy transfer (LET) α particles and recoiling 7Li nuclei. A large number of 10B atoms have to be localized within the tumor cells for BNCT to be effective, and an adequate number of thermal neutrons need to be absorbed by the 10B atoms to generate lethal 10B (n, α)7Li reactions. Effective boron neutron capture therapy cannot be achieved without appropriate boron carriers. Improvement in boron delivery and the development of the best dosing paradigms for both boronophenylalanine (BPA) and sodium borocaptate (BSH) are of major importance, yet these still have not been optimized. Here, we present a review of this treatment modality from the perspectives of radiation oncology, biology, and physics. This manuscript provides a brief introduction of the mechanism of cancer-cell-selective killing by BNCT, radiobiological factors, and progress in the development of boron carriers and neutron sources as well as the results of clinical study.
Dual-layer spectral detector CT to study the correlation between pericoronary adipose tissue and coronary artery stenosis
Authors: Zhu Xiaolong , Chen Xujiao , Ma Shaowei , Zhou Ke , Hou Yang 
Published: November 2021

Abstract
Background
To investigate the relationship of pericoronary adipose tissue (PCAT) with coronary artery stenosis using dual-layer spectral detector CT (SDCT).

Methods
99 patients were retrospectively divided into normal group, non-significant stenosis group and significant stenosis group (n = 33 in each group). Fat attenuation index (FAI) 40kev, spectral curve slope (λHU), effective atomic number (Eff-Z) and epicardial fat volume (EFV) were quantitatively evaluated of the narrowest part of the lesion tissue by SDCT.

Results
There were significant differences in PCAT parameters on SDCT (FAI40keV, λHU, Eff-Z and EFV) among the three groups (P < 0.05). FAI40keV, λHU, and Eff-Z in significant stenosis group were statistically different from those in normal group and non-significant stenosis group (P < 0.05). FAI40keV, λHU, and Eff-Z in non-significant stenosis group were statistically different from significant stenosis group (P < 0.05). EFV in normal group were significantly lower in non-significant stenosis group and significant stenosis group (P < 0.001). Univariate and multivariate logistic regression analyses identified FAI40keV (OR = 1.50, 95%CI 1.01 to 1.09) and λHU (OR = 6.81, 95%CI 1.87 to 24.86) as independent predictors of significant stenosis. FAI40keV and λHU had quite good discrimination, with an AUC of 0.84 and 0.80 respectively.

Conclusion
FAI40keV, λHU, and Eff-Z on SDCT in significant stenosis group were significantly different from normal and non-significant stenosis group while EFV in normal group were significantly different from non-significant stenosis group and significant stenosis group. FAI40kev and λHU were risk factors for significant stenosis.
Double arterial cannulation versus right axillary artery cannulation for acute type A aortic dissection: a retrospective study
Authors: Zhang He , Xie Wei , Lu Yuzhou , Pan Tuo , Zhou Qing , Xue Yunxing , Wang Dongjin 
Published: November 2021

Abstract
Background
Cannulation strategy in surgery for acute type A aortic dissection (ATAAD) remains controversial. We aimed to retrospectively analyze the safety and efficacy of double arterial cannulation (DAC) compared with right axillary cannulation (RAC) for ATAAD.

Methods
From January 2016 to December 2018, 431 ATAAD patients were enrolled in the study. Patients were divided into DAC group (n = 341) and RAC group (n = 90). Propensity score matching analysis was performed to compare the early and mid-term outcomes between these two groups. To confirm the organ protection effect by DAC, intraoperative blood gas results and cardiopulmonary bypass parameters were compared between the two groups.

Results
Demographics and preoperative comorbidities were comparable between two groups, while patients in DAC group were younger than RAC group (51.55 ± 13.21 vs. 56.07 ± 12.16 years, P < 0.001). DAC had a higher incidence of limb malperfusion (18.2% vs. 10.0%, P = 0.063) and lower incidence of coronary malperfusion (5.3% vs. 12.2%, P = 0.019). No significant difference in cardiopulmonary bypass and cross-clamp time was found between the two groups. The in-hospital mortality was 13.5% (58/431), while there was no difference between the two groups (13.5% vs. 13.3%; P = 0.969). Patients who underwent DAC had higher incidence of postoperative stroke (5.9% vs. 0%, P = 0.019) and lower incidence of postoperative acute kidney injury (AKI) (24.7% vs. 40.3%; P = 0.015). During a mean follow-up period of 31.8 (interquartile range, 25–45) months, the overall survival was 81.5% for DAC group and 78.0% for RAC group (P = 0.560). Intraoperative blood gas results and cardiopulmonary bypass parameters showed that DAC group had more intraoperative urine output volume than RAC group (P = 0.05), and the time of cooling (P = 0.04) and rewarming (P = 0.04) were shorter in DAC group.

Conclusions
DAC will not increase the surgical risks compared to RAC, but could reduce the incidence of postoperative AKI which may be benefit for renal protection.
Therapeutic potential of triptolide in autoimmune diseases and strategies to reduce its toxicity
Authors: Cheng Yaxin , Zhao Yonghua , Zheng Ying 
Published: November 2021

AbstractWith the increasing epidemiology of autoimmune disease worldwide, there is an urgent need for effective drugs with low cost in clinical treatment. Triptolide, the most potent bioactive compound from traditional Chinese herb Tripterygium Wilfordii Hook F, possesses immunosuppression and anti-inflammatory activity. It is a potential drug for the treatment of various autoimmune diseases, but its clinical application is still restricted due to severe toxicity. In this review, the pharmacodynamic effects and pharmacological mechanisms of triptolide in autoimmune diseases are summarized. Triptolide exerts therapeutic effect by regulating the function of immune cells and the expression of cytokines through inflammatory signaling pathways, as well as maintaining redox balance and gut microbiota homeostasis. Meanwhile, the research progress on toxicity of triptolide to liver, kidney, reproductive system, heart, spleen, lung and gastrointestinal tract has been systematically reviewed. In vivo experiments on different animals and clinical trials demonstrate the dose- and time- dependent toxicity of triptolide through different administration routes. Furthermore, we focus on the strategies to reduce toxicity of triptolide, including chemical structural modification, novel drug delivery systems, and combination pharmacotherapy. This review aims to reveal the potential therapeutic prospect and limitations of triptolide in treating autoimmune diseases, thus providing guiding suggestions for further study and promoting its clinical translation.