bluuebunny/crossref_metadata_2025_split huggingface dataset:
Non-communicable diseases, sociodemographic vulnerability and the risk of mortality in hospitalised children and adolescents with COVID-19 in Brazil: a cross-sectional observational study
Authors: Sousa Braian Lucas Aguiar , Brentani Alexandra , Costa Ribeiro Cecilia Claudia , Dolhnikoff Marisa , Grisi Sandra Josefina Ferraz Ellero , Ferrer Ana Paula Scoleze , Ferraro Alexandre Archanjo 
Published: September 2021

ObjectivesTo analyse how previous comorbidities, ethnicity, regionality and socioeconomic development are associated with COVID-19 mortality in hospitalised children and adolescents.DesignCross-sectional observational study using publicly available data from the Brazilian Ministry of Health.SettingNationwide.Participants5857 patients younger than 20 years old, all of them hospitalised with laboratory-confirmed COVID-19, from 1 January 2020 to 7 December 2020.Main outcome measureWe used multilevel mixed-effects generalised linear models to study in-hospital mortality, stratifying the analysis by age, region of the country, presence of non-communicable diseases, ethnicity and socioeconomic development.ResultsIndividually, most of the included comorbidities were risk factors for mortality. Notably, asthma was a protective factor (OR 0.4, 95% CI 0.24 to 0.67). Having more than one comorbidity increased almost tenfold the odds of death (OR 9.67, 95% CI 6.89 to 13.57). Compared with white children, Indigenous, Pardo (mixed) and East Asian had significantly higher odds of mortality (OR 5.83, 95% CI 2.43 to 14.02; OR 1.93, 95% CI 1.48 to 2.51; OR 2.98, 95% CI 1.02 to 8.71, respectively). We also found a regional influence (higher mortality in the North—OR 3.4, 95% CI 2.48 to 4.65) and a socioeconomic association (lower mortality among children from more socioeconomically developed municipalities—OR 0.26, 95% CI 0.17 to 0.38)ConclusionsBesides the association with comorbidities, we found ethnic, regional and socioeconomic factors shaping the mortality of children hospitalised with COVID-19 in Brazil. Our findings identify risk groups among children that should be prioritised for public health measures, such as vaccination.
Role of Dutch internal policy advisors in a hospital quality improvement programme and their influence on nurses’ role development: a qualitative study
Authors: van Schothorst - van Roekel Jannine , Weggelaar - Jansen Anne Marie J W M , Hilders Carina C G J M , Wallenburg Iris , de Bont Antoinette 
Published: September 2021

ObjectiveNurses are vital in providing and improving quality of care. To enhance the quality improvement (QI) competencies of nurses, hospitals in the Netherlands run developmental programmes generally led by internal policy advisors (IPAs). In this study, we identify the roles IPAs play during these programmes to enhance the development of nurses’ QI competencies and studied how these roles influenced nurses and management.DesignAn exploratory ethnographical study comprising observations, informal conversations, semistructured interviews, focus groups and a strategy evaluation meeting.SettingA teaching hospital in an urban region in the Netherlands.ParticipantsIPAs (n=7) in collaboration with four teams of nurses (n=131), team managers (n=4), senior managers (n=4) and the hospital director (n=1).ResultsWe identified five distinct advisory roles that IPAs perform in the hospital programme: gatekeeper, connector, converter, reflector and implementer. In describing these roles, we provide insights into how IPAs help nurses to develop QI competencies. The IPA’s professional background was a driving force for nurses’ QI role development. However, QI development was threatened if IPAs lost sight of different stakeholders’ interests and consequently lost their credibility. QI role development among nurses was also threatened if the IPA took on all responsibility instead of delegating it timely to managers and nurses.ConclusionsWe have shown how IPAs’ professional background and advisory knowledge connect organisational, managerial and professional aims and interests to enhance professionalisation of nurses.
Prevalence, awareness, treatment and control of hypertension among Ngawa Tibetans in China: a cross-sectional study
Authors: Li Tingxin , Shuai Ping , Wang Jinghong , Wang Lin 
Published: September 2021

ObjectivesTo explore the prevalence, awareness, treatment and control rate of hypertension and analyse the potential social environment factors among Ngawa Tibetans in China.DesignThis was a cross-sectional observational study.SettingThe investigation based on a multistage stratified cluster sampling was conducted in the Ngawa area, Sichuan Province, Southwest China. Tibetan residents were selected by random sampling method from one city and six counties in Ngawa.MethodsBasic demographical information, physical activity and blood pressure were collected. In addition, the participants completed the questionnaire. A multivariate logistic regression analysis was used to examine the association between the prevalence, awareness, treatment and control rate of hypertension and the potential risk factors.ParticipantsThe sample comprised 2228 Ngawa Tibetan residents (age 18–80 years) from September 2018 to June 2019.ResultsThe prevalence rate of hypertension was 24.6%. The control rate was 6.2%, while the awareness rate (32.3%) and treatment rate (21.7%) of hypertension had been significantly improved.ConclusionThe prevalence of hypertension among Ngawa Tibetans was high. The awareness and treatment were improved in recent years. But the control rate was low. The government needs to strengthen the basic medical care and health education for Ngawa Tibetans.
Young people’s perceptions of accessing a community pharmacy for a chlamydia testing kit: a qualitative study based in North East England
Authors: Ahmaro Lara , Lindsey Laura , Forrest Simon , Whittlesea Cate 
Published: September 2021

ObjectivesChlamydia testing among young people in community pharmacies in North East England has been low compared with other remote settings offering testing for the past few years. To understand why this may be, to maximise service provision, the perceptions of young men and women about pharmacy testing and possible chlamydia treatment were gathered and interpreted.DesignIndepth, semistructured interviews.SettingFour youth centres in North East England.ParticipantsThe study included 26 young people aged 16–23. The sample of participants comprised those with a history of chlamydia testing as well as those never tested.InterviewsFace-to-face interviews were conducted between October 2018 and May 2019. The interview schedule covered young people’s perceptions of sexually transmitted infections, provision of pharmacy sexual and reproductive health and chlamydia testing, and potential chlamydia treatment. Data from the interviews were subjected to thematic analysis.ResultsThe geographical accessibility and long opening times of community pharmacies in North East England were perceived benefits of the service. However, young people had concerns about being judged by pharmacy staff or overheard by customers when requesting the test. Men did not want to be seen by their peers accessing the pharmacy. These barriers were associated with a perceived stigma of chlamydia. Despite this, young people thought that pharmacist advice on the test kit would be important to ensure they complete it correctly. Those never tested favoured how the kit could be taken home to complete the urine sample. The option of including chlamydia treatment was reported to be convenient and comforting.ConclusionSupporting pharmacies in North East England to offer a confidential chlamydia testing service is necessary to overcome young people’s perceived barriers to testing. Delivering testing as an integrated sexual health package with other pharmacy services, together with treatment where suitable, will increase acceptance for testing and timely access to treatment.
Deprescribing intervention activities mapped to guiding principles for use in general practice: a scoping review
Authors: Coe Amy , Kaylor-Hughes Catherine , Fletcher Susan , Murray Elizabeth , Gunn Jane 
Published: September 2021

ObjectiveTo identify and characterise activities for deprescribing used in general practice and to map the identified activities to pioneering principles of deprescribing.SettingPrimary care.Data sourcesMedline, EMBASE (Ovid), CINAHL, Australian New Zealand Clinical Trials Registry (ANZCTR), Clinicaltrials.gov, ISRCTN registry, OpenGrey,Annals of Family Medicine, BMC Family Practice, Family PracticeandBritish Journal of General Practice(BJGP) from inception to the end of June 2021.Study selectionIncluded studies were original research (randomised controlled trial, quasi-experimental, cohort study, qualitative and case studies), protocol papers and protocol registrations.Data extractionScreening and data extraction was completed by one reviewer; 10% of the studies were independently reviewed by a second reviewer. Coding of full-text articles in NVivo was conducted and mapped to five deprescribing principles.ResultsFifty studies were included. The most frequently used activities were identification of appropriate patients for deprescribing (76%), patient education (50%), general practitioners (GP) education (48%), and development and use of a tapering schedule (38%). Six activities did not align with the five deprescribing principles. As such, two principles (engage practice staff in education and appropriate identification of patients, and provide feedback to staff about deprescribing occurrences within the practice) were added.ConclusionActivities and guiding principles for deprescribing should be paired together to provide an accessible and comprehensive guide to deprescribing by GPs. The addition of two principles suggests that practice staff and practice management teams may play an instrumental role in sustaining deprescribing processes within clinical practice. Future research is required to determine the most of effective activities to use within each principle and by whom.
Qualitative study of UK health professionals’ experiences of working at the point of care during the COVID-19 pandemic
Authors: Baldwin Sharin , George Joicy 
Published: September 2021

ObjectivesTo develop an understanding of health professionals’ experiences of working at the point of care during the COVID-19 pandemic, the impact on their health and well-being and their support needs.DesignA qualitative study using semistructured interviews. Data were analysed using framework analysis.SettingOne large National Health Service integrated care trust.ParticipantsA purposive sample of 19 qualified health professionals (doctors, nurses or allied health professionals), working with patients with COVID-19 admitted to the hospitals between March and May 2020 were eligible to take part.ResultsEight major categories were identified: (1) Working in a ‘war zone’, (2) ‘Going into a war zone without a weapon’, (3) ‘Patients come first’, (4) Impact of COVID-19, (5) Leadership and management, (6) Support systems, (7) Health professionals’ support needs, and (8) Camaraderie and pride. Health professionals reported increased levels of stress, anxiety and a lack of sleep. They prioritised their patients’ needs over their own and felt a professional obligation to be at work. A key finding was the reported camaraderie among the health professionals where they felt that they were ‘fighting this war together’.ConclusionsThis study provides a valuable insight into the experiences of some of the frontline health professionals working in a large London-based hospital trust during the first COVID-19 peak. Findings from this study could be used to inform how managers, leaders and organisations can better support their health professional staff during the current pandemic and beyond.
GDF15 induces immunosuppression via CD48 on regulatory T cells in hepatocellular carcinoma
Authors: Wang Zhaowei , He Lei , Li Weina , Xu Chuanyang , Zhang Jieyu , Wang Desheng , Dou Kefeng , Zhuang Ran , Jin Boquan , Zhang Wei , Hao Qiang , Zhang Kuo , Zhang Wangqian , Wang Shuning , Gao Yuan , Gu Jintao , Shang Lei , Tan Zhijun , Su Haichuan , Zhang Yingqi , Zhang Cun , Li Meng 
Published: September 2021

BackgroundA better understanding of the molecular mechanisms that manifest in the immunosuppressive tumor microenvironment (TME) is crucial for developing more efficacious immunotherapies for hepatocellular carcinoma (HCC), which has a poor response to current immunotherapies. Regulatory T (Treg) cells are key mediators of HCC-associated immunosuppression. We investigated the selective mechanism exploited by HCC that lead to Treg cells expansion and to find more efficacious immunotherapies.MethodsWe used matched tumor tissues and blood samples from 150 patients with HCC to identify key factors of Treg cells expansion. We used mass cytometry (CyTOF) and orthotopic cancer mouse models to analyze overall immunological changes after growth differentiation factor 15 (GDF15) gene ablation in HCC. We used flow cytometry, coimmunoprecipitation, RNA sequencing, mass spectrum, chromatin immunoprecipitation and Gdf15–/–, OT-I and GFP transgenic mice to demonstrate the effects of GDF15 on Treg cells and related molecular mechanism. We used hybridoma technology to generate monoclonal antibody to block GDF15 and evaluate its effects on HCC-associated immunosuppression.ResultsGDF15 is positively associated with the elevation of Treg cell frequencies in patients wih HCC. Gene ablation of GDF15 in HCC can convert an immunosuppressive TME to an inflammatory state. GDF15 promotes the generation of peripherally derived inducible Treg (iTreg) cells and enhances the suppressive function of natural Treg (nTreg) cells by interacting with a previously unrecognized receptor CD48 on T cells and thus downregulates STUB1, an E3 ligase that mediates forkhead box P3 (FOXP3) protein degradation. GDF15 neutralizing antibody effectively eradicates HCC and augments the antitumor immunity in mouse.ConclusionsOur results reveal the generation and function enhancement of Treg cells induced by GDF15 is a new mechanism for HCC-related immunosuppression. CD48 is the first discovered receptor of GDF15 in the immune system which provide the possibility to solve the molecular mechanism of the immunomodulatory function of GDF15. The therapeutic GDF15 blockade achieves HCC clearance without obvious adverse events.
A DSAS-based study of central shoreline change in Jiangsu over 45 years
Authors: Song Yuan , Shen Yongming , Xie Ruofan , Li Jialin 
Published: September 2021

Abstract
A large-scale sand ridge group is distributed in the central Jiangsu coastal area, and a deposition muddy sea bank was developed in the nearshore area. Quantitative monitoring of coastline changes is of great significance for tidal beach development and protection. The shorelines of the central coast of Jiangsu within six periods (1973–2018) were extracted in this study, and their length changes over the years were analyzed. The Digital Shoreline Analysis System (DSAS) was employed to generate a cross section perpendicular to the baseline and calculate the linear regression rate (LRR) of the shoreline, changes in end point rate (EPR), and net shoreline movement (NSM), based on which the shoreline change features were analyzed. The DSAS results indicated that the shorelines in the study area maintained fluctuating growth and presented a continuous advancing trend towards the sea. From the changes in shoreline evolution distance during 1973–2018, the advancing shorelines in the study area accounted for over 50% of the total shorelines and presented first rising and then declining trends with the period of 2003–2013 taken as the time boundary. The average shoreline change rate was 207 m/year, and the periods with the highest change degrees were 1983–1993 and 1993–2013. The shoreline change tended to be stable during 2013–2018, and only a few estuaries and ports underwent obvious erosion and sedimentation.
Theoretical challenges for flavor physics
Authors: Grossman Yuval , Ligeti Zoltan 
Published: September 2021

AbstractWe discuss some highlights of the FCC-$$ee$$

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flavor physics program. It will help to explore various aspects of flavor physics: to test precision calculations, to probe nonperturbative QCD methods, and to increase the sensitivity to physics beyond the standard model. In some areas, FCC-$$ee$$

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will do much better than current and near-future experiments. We briefly discuss several probes that can be relevant for maximizing the gain from the FCC-$$ee$$

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flavor program.
A subsidiariedade como princípio densificador da efetivação dos direitos sociais prestacionais no Estado federal brasileiro: o caso do Município de Pelotas/RS
Authors: Massaú Guilherme Camargo 
Published: September 2021

Este artigo teve como objetivo analisar a relação federativa entre a União e o município em face da prestação do direito social à saúde. As dimensões do pacto federativo analisadas foram a competência administrativa e a competência de arrecadar diretamente recursos financeiros. A partir dessas duas competências, pôde-se identificar a existência (ou não) do equilíbrio entre o ente central e o ente periférico. O estudo pautou-se pelo princípio da subsidiariedade, pois tal princípio refere-se à distribuição de competências. A pesquisa empregou o método hipotético-dedutivo, com pesquisa bibliográfica, considerando as hipóteses de distribuição de competências e de receitas financeiras conjuntamente com os gastos públicos com a saúde, para analisar se o ente municipal possuía autonomia suficiente para realizar suas obrigações constitucionais relativas à saúde.
Diabetic Aldehyde Dehydrogenase 2 Mutant (ALDH2*2) Mice Are More Susceptible to Cardiac Ischemic‐Reperfusion Injury Due to 4‐Hydroxy‐2‐Nonenal Induced Coronary Endothelial Cell Damage
Authors: Pan Guodong , Roy Bipradas , Palaniyandi Suresh Selvaraj 
Published: September 2021

Background
Aldehyde dehydrogenase‐2 (ALDH2), a mitochondrial enzyme, detoxifies reactive aldehydes such as 4‐hydroxy‐2‐nonenal (4HNE). A highly prevalent E487K mutation in ALDH2 (ALDH2*2) in East Asian people with intrinsic low ALDH2 activity is implicated in diabetic complications. 4HNE‐induced cardiomyocyte dysfunction was studied in diabetic cardiac damage; however, coronary endothelial cell (CEC) injury in myocardial ischemia‐reperfusion injury (IRI) in diabetic mice has not been studied. Therefore, we hypothesize that the lack of ALDH2 activity exacerbates 4HNE‐induced CEC dysfunction which leads to cardiac damage in ALDH2*2 mutant diabetic mice subjected to myocardial IRI.

Methods and Results
Three weeks after diabetes mellitus (DM) induction, hearts were subjected to IRI either in vivo via left anterior descending artery occlusion and release or ex vivo IRI by using the Langendorff system. The cardiac performance was assessed by conscious echocardiography in mice or by inserting a balloon catheter in the left ventricle in the ex vivo model. Just 3 weeks of DM led to an increase in cardiac 4HNE protein adducts and, cardiac dysfunction, and a decrease in the number of CECs along with reduced myocardial ALDH2 activity in ALDH2*2 mutant diabetic mice compared with their wild‐type counterparts. Systemic pretreatment with Alda‐1 (10 mg/kg per day), an activator of both ALDH2 and ALDH2*2, led to a reduction in myocardial infarct size and dysfunction, and coronary perfusion pressure upon cardiac IRI by increasing CEC population and coronary arteriole opening.

Conclusions
Low ALDH2 activity exacerbates 4HNE‐mediated CEC injury and thereby cardiac dysfunction in diabetic mouse hearts subjected to IRI, which can be reversed by ALDH2 activation.
Pericardial Adipose Tissue–Derived Leptin Promotes Myocardial Apoptosis in High‐Fat Diet–Induced Obese Rats Through Janus Kinase 2/Reactive Oxygen Species/Na+/K+‐ATPase Signaling Pathway
Authors: Wang Ping , Luo Chaodi , Zhu Danjun , Song Yan , Cao Lifei , Luan Hui , Gao Lan , Zheng Shuping , Li Hao , Tian Gang 
Published: September 2021

Background
Pathophysiologic mechanisms underlying cardiac structural and functional changes in obesity are complex and linked to adipocytokines released from pericardial adipose tissue (PAT) and cardiomyocyte apoptosis. Although leptin is involved in various pathological conditions, its role in paracrine action of pericardial adipose tissue on myocardial apoptosis remains unknown. This study was designed to investigate the role of PAT‐derived leptin on myocardial apoptosis in high‐fat diet–induced obese rats.

Methods and Results

Hearts were isolated from lean or high‐fat diet–induced obese Wistar rats for myocardial remodeling studies. Obese rats had abnormal myocardial structure, diastolic dysfunction, greatly elevated cardiac apoptosis, enhanced cardiac fibrosis, and increased oxidative stress level. ELISA detected significantly higher than circulating leptin level in PAT of obese, but not lean, rats. Western blot and immunohistochemical analyses demonstrated increased leptin receptor density in obese hearts. H9c2 cardiomyoblasts, after being exposed to PAT‐conditioned medium of obese rats, exhibited pronounced reactive oxygen species–mediated apoptosis, which was partially reversed by leptin antagonist. Moreover, leptin derived from PAT of obese rats inhibited Na
+
/K
+
‐ATPase activity of H9c2 cells through stimulating reactive oxygen species, thereby activating calcium‐dependent apoptosis. Pretreatment with specific inhibitors revealed that Janus kinase 2/signal transducer and activator of transcription 3 and phosphoinositide 3‐kinase/protein kinase B signaling pathways were involved in leptin‐induced myocardial apoptosis.

Conclusions

PAT‐derived leptin induces myocardial apoptosis in high‐fat diet–induced obese rats via activating Janus kinase 2/signal transducer and activator of transcription 3/reactive oxygen species signaling pathway and inhibiting its downstream Na
+
/K
+
‐ATPase activity.