bluuebunny/crossref_metadata_2025_split huggingface dataset:
Physicians’ attitudes on the implementation of an antimicrobial stewardship program in Lebanese hospitals
Authors: Sayegh Nathalie , Hallit Souheil , Hallit Rabih , Saleh Nadine , Zeidan Rouba K. 
Published: February 2021

Background: Misuse of antibiotics and antimicrobial resistance are global concerns. Antibiotic stewardship programs (ASP) are advocated to reduce pathogens resistance by ensuring appropriate antimicrobial use. Several factors affect the implementation of ASPs in hospitals. The size and types of care provided, as well as the complexity of antibiotic prescription, are all issues that are considered in designing an effective hospital-based program.
Objectives: To examine physicians’ attitude on implementation of an antimicrobial stewardship program in Lebanese hospitals.
Methods: A descriptive cross-sectional survey was carried out using an online questionnaire. Survey items assessed ASP implementations, physicians’ attitudes, usefulness of the tools, and barriers of implementation. The questionnaire was based on the Center for Disease Control core-elements.
Results: 158 physicians completed the survey with a response rate of 4%. Our results showed that the majority (66%) of physicians were familiar with the ASP concept. Most respondents reported a lack of regular educational programs (41%), as well as a lack of support from the medical staff (76%). This study demonstrated positive attitudes and support for ASP implementation. However, ASPs were reported as affecting physicians’ autonomy by 34 % of the participants. Antibiotic rounds and prospective audit and feedback were rated as most useful interaction methods with the ASPs. A minimal support of the Ministry Of Public Health, as well as the absence of regulation and of national guidelines, were reported as barriers to ASPs. The shortage of Infectious Disease physicians was seen as a barrier by half of the respondents.
Conclusions: Physicians are supportive of ASP, with preference for interventions that provide information and education rather than restrictive ones. Additional research is needed on a larger sample of physicians.
Tibial pilon fractures: Single center experience
Authors: ALTUN Erkan , CİVAN Osman , ÜRGÜDEN Mustafa 
Published: February 2021

Aim: This study aims to investigate the mid-term clinical outcomes of surgically treated Pilon Fractures (PF).
Material and Methods: Twenty patients, surgically treated for PF between 2002 and 2012 were included in the study. Patients were evaluated functionally based on the Weber and American Orthopaedic Foot & Ankle Society (AOFAS) protocols.
Results: Mean follow-up period was 31.55 (20–48) months. Nine (45%) of the 20 patients had open fractures. According to the Rüedi–Allgöwer Classification: type 1 in nine, type 2 in nine (45%) and type 3 fractures were observed in two patients. A comparison of the duration of union between closed and open fractures revealed that the union of open fractures took a significantly longer time (p= 0.004). Moreover, soft tissue complications developed to a proportionally lesser extent in patients who were applied staged fixation compared with those were applied direct fixation, although the difference was not statistically significant (p= 0.999).
Conclusion: The surgical treatment phase of PF should comply with maximum care provided and attention paid to soft tissue. It should be remembered that the fate/outcome of certain fractures is determined at the time of the incident and that certain negative outcomes are inevitable in some patients despite the best efforts.
AKTIVITAS ANTIOKSIDAN DAN TOTAL FENOL COKLAT YANG DIPERKAYA DENGAN KAYU MANIS (Cinnamomum verum) DAN JAHE (Zingiber officinale)
Authors: Nurhayati Rifa , Agustin Ika , Herawati Ervika Rahayu Novita 
Published: February 2021

<p class="Abstrak"><span lang="EN-GB">Coklat adalah produk yang diformulasi dari massa kakao, dicampur dengan atau tanpa penambahan gula, susu, atau bahan makanan lain yang diizinkan. Kakao kaya akan polifenol, terutama katekin dan <em>procyanidin</em>. Kakao juga mengandung berbagai mineral seperti magnesium dan zat besi. Berbagai manfaat kakao membuat coklat tidak hanya menjadi makanan pilihan tetapi juga memiliki nilai fungsional bagi mereka yang mengkonsumsinya. Salah satu diversifikasi coklat olahan adalah fortifikasi dengan jahe atau bubuk kayu manis. Penelitian ini bertujuan untuk mengetahui karakteristik fisik, kimia, dan mikrobiologis coklat yang difortifikasi dengan jahe dan kayu manis. Analisis fisik yang dilakukan adalah uji tekstur dan warna, analisis kimia dengan uji proksimat (kadar air, kadar abu, kadar lemak, kadar protein dan kadar karbohidrat <em>by different</em>), uji kadar fenol total dan uji antioksidan (DPPH) sedangkan analisis mikrobiologis dilakukan dengan <em>total plate count</em>. Hasilnya menyebutkan bahwa penambahan jahe dan kayu manis meningkatkan nilai kekerasan, <em>cohesiveness</em> dan <em>gumminess</em> dalam coklat. Kadar fenol meningkat dari 4,83 mg GAE/mg di coklat original menjadi 6,77 mg GAE/mg di coklat kayu manis dan 6,83 mg GAE/mg di coklat jahe.</span></p><p class="Abstrak"> </p><p class="Abstrak"><strong><span class="Heading2Char"><span lang="EN-GB">Antioxidant Activity And Total Phenolic Content of Chocolate Enriched With <em>Cinnamomum verum</em> And<em> Zingiber officinale</em></span></span></strong></p><p class="Abstrak"><span lang="EN-GB">Chocolate is a product that is produced from the cocoa mass, mixed with or without the addition of sugar, milk or other food ingredients that are permitted. Cocoa is rich in polyphenols, especially catechins and procyanidins. Cocoa also contains various minerals such as magnesium and iron. The various benefits of cocoa make chocolate not only a preferred food but also has functional value for those who consume it. One diversification of processed chocolate bars is fortification with ginger or cinnamon powder. This study aims to determine the physical, chemical and microbiological characteristics of chocolate bars added with ginger and cinnamon. Physical analysis performed was texture and color test, chemical analysis with proximate test (water content, ash content, fat content, protein content and carbohydrate content by difference), total phenol content test and antioxidant test (DPPH) while microbiological analysis was carried out with total plate count. The results mentioned that the addition of ginger and cinnamon increased the value of hardness, cohesiveness and gumminess parameter in chocolate. However, phenol levels increased from 4.83 mg GAE/mg in original chocolate to 6.77 mg GAE/mg in cinnamon chocolate and 6.83 mg GAE/mg in ginger chocolate.</span></p>
Assessment of mosquito collection methods for dengue surveillance
Authors: Garjito Triwibowo Ambar , Susanti Lulus , Mujiyono Mujiyono , Prihatin Mega Tyas , Susilo Dwi , Nugroho Sidiq Setyo , Mujiyanto Mujiyanto , Wigati Raden Ajeng , Satoto Tri Baskoro Tunggul , Manguin Sylvie , Gavotte Laurent , Frutos Roger 
Published: February 2021

Abstract
Background
Several methods exist to collect and assess the abundance of dengue vector mosquitoes, i.e. morning adult collection using an aspirator, pupal collection, various ovitraps, whole night collection using human landing methods, and larval collection. Several of these methods are officially implemented to monitor mosquito density and make decisions on treatments for dengue control. This monitoring is also constrained by the need to conduct this assessment on a “one point/one day” process. This diversity of methods might be a source of variability and lack of statistical significance. There is also a lack of published data regarding the effectiveness of these methods
Methods
A mosquito survey was conducted in 39 locations corresponding to 15 dengue endemic provinces in Indonesia. The larval surveys were performed by collecting at least one single Aedes larva from each container, and then reared up until hatching. Three adult mosquito sampling methods were also used, including morning resting collection, human landing collection, animal baited trap. All field samples were tested for dengue. Factor Analysis of Mixed Data (FAMD) was conducted to analyze the effectiveness of the collection methods against mosquito species and dengue incidence.
Results
A total of 44,675 mosquitoes were collected. The single larva method was the most efficient method. Out of a total of 89 dengue-positive pools, the most frequently encountered virus was DENV2, which made up half of the positive samples, followed by DENV3 and DENV1, respectively. FAMD showed that no correlation could be found between any methods and the presence of dengue virus in mosquitoes. Moreover, no correlation could be found between any methods and with the incidence.
Conclusions
There was no consistency in the efficacy of a given method and the incidence of dengue in the human population. There was no correlation between any of the parameters considered, i.e. method, incidence of dengue, location and presence of dengue virus in mosquitoes.
Clinical verification of body mass index and tumor immune response in patients with breast cancer receiving preoperative chemotherapy
Authors: Takada Koji , Kashiwagi Shinichiro , Asano Yuka , Goto Wataru , Kouhashi Rika , Yabumoto Akimichi , Ishihara Sae , Morisaki Tamami , Shibutani Masatsune , Tanaka Hiroaki , Hirakawa Kosei , Ohira Masaichi 
Published: February 2021

Abstract
Purpose: The body mass index (BMI) is commonly used as a simple indicator of obesity; patients with early-stage breast cancer who are obese (OB) per BMI measurements have been shown to have high postoperative recurrence and low survival rates. On the other hand, it has been shown that lymphocytes present in the vicinity of malignant growths that are involved in the tumors’ immune responses influence the efficacy chemotherapy. Therefore, we hypothesized that OB patients with breast cancer have a lower density of tumor-infiltrating lymphocytes (TILs), which may influence the therapeutic effect of preoperative chemotherapy (POC). In this study, we measured pretreatment BMI and TILs in patients with breast cancer who underwent POC, examined the correlations between these two factors, and retrospectively analyzed their therapeutic outcomes and prognoses.Methods: The participants in this study were 421 patients with breast cancer who underwent surgical treatment after POC between February 2007 and January 2019. The patient’s height and weight were measured before POC to calculate the BMI (weight [kg] divided by the square of the height [m2]). According to the World Health Organization categorization, patients who weighed under 18.5 kg/m2 were classified as underweight (UW), those ≥18.5 kg/m2 and >25 kg/m2 were considered normal weight (NW), those ≥25 kg/m2 and <30 kg/m2 were overweight (OW), and those ≥30 kg/m2 were OB. The TILs were those lymphocytes that infiltrated the tumor stroma according to the definition of the International TILs Working Group 2014.Results: The median BMI was 21.9 kg/m2 (range, 14.3–38.5 kg/m2); most patients (244; 64.5%) were NW. Among all 378 patients with breast cancer, the TIL density was significantly lower in OB than in NW and OW patients (vs. NW: p=0.001; vs. OW: p=0.003). Furthermore, when examining patients with each breast cancer type individually, the OS of those with TNBC who had low BMIs was significantly poorer than that of their high-BMI counterparts (log rank p=0.031).Conclusions: Our data did not support the hypothesis that obesity affects the tumor immune microenvironment; however, we showed that being UW does affect the tumor immune microenvironment.
A prognostic model for hepatocellular carcinoma based on apoptosis-related genes
Authors: Liu Renjie , Wang Guifu , Zhang Chi , Bai Dousheng 
Published: February 2021

Abstract
Background: Dysregulation of the balance between proliferation and apoptosis is the basis for human hepatocarcinogenesis. In many malignant tumors, such as hepatocellular carcinoma (HCC), there is a correlation between apoptotic dysregulation and poor prognosis. However, the prognostic values of apoptosis-related genes (ARGs) in HCC have not been elucidated. Methods: To screen for differentially expressed ARGs, the expression levels of 161 ARGs from The Cancer Genome Atlas (TCGA) database(https://cancergenome.nih.gov/) were analyzed. Gene Ontology (GO) enrichment and the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses were performed to evaluate the underlying molecular mechanisms of differentially expressed ARGs in HCC. The prognostic values of ARGs were established using Cox regression, and subsequently, a prognostic risk model for scoring patients was developed. Kaplan-Meier (K-M) and receiver operating characteristic (ROC) curves were plotted to determine the prognostic value of the model. Results: Compared to normal tissues, 43 highly up-regulated and 8 down-regulated ARGs in HCC tissues were screened. GO analysis results revealed that these 51 genes are indeed related to the apoptosis function. KEGG analysis revealed that these 51 genes were correlated with MAPK, P53, TNF, and PI3K-AKT signaling pathways, while Cox regression revealed that 5 ARGs (PPP2R5B, SQSTM1, TOP2A, BMF, and LGALS3) were associated with prognosis and were, therefore, obtained to develop the prognostic model. Based on the median risk scores, patients were categorized into high-risk and low-risk groups. Patients in the low-risk groups exhibited significantly elevated two-year or five-year survival probabilities (p < 0.0001). The risk model had a better clinical potency than the other clinical characteristics, with the area under the ROC curve (AUC = 0.741). The prognosis of HCC patients was established from a plotted nomogram. Conclusion: Based on the differential expression of ARGs, we established a novel risk model for predicting HCC prognosis. This model can also be used to inform the individualized treatment of HCC patients.
Discovery and Characterization of a Hidden Retroviral Enhancer
by Viral DNA-capture-seq Approach
Authors: Matsuo Misaki , Ueno Takaharu , Monde Kazuaki , Tan Benjy Jek Yang , Miyazato Paola , Uchiyama Kyosuke , Islam Saiful , Katsuya Hiroo , Nakajima Shinsuke , Tokunaga Masahito , Nosaka Kisato , Hata Hiroyuki , Utsunomiya Atae , Fujisawa Jun-ichi , Satou Yorifumi 
Published: February 2021

Abstract
Human T-cell leukemia virus type 1 (HTLV-1) is a retrovirus that causes a cancer of infected cells called adult T-cell leukemia (ATL). There is both sense and antisense transcription from the integrated provirus. Sense transcription tends to be suppressed, but antisense transcription is constitutively active in vivo even in proviruses lacking the 5’ long terminal repeat (LTR), a known viral enhancer and promoter. Various efforts have been made to elucidate the regulatory mechanism of HTLV-1 provirus for several decades; however, it remains unknown how HTLV-1 antisense transcription is maintained. Here, using proviral DNA-capture followed by high-throughput sequencing, we found a previously unidentified viral enhancer not in the LTR but in the middle of the HTLV-1 provirus. The host transcription factors, SRF and ELK-1, bind to this enhancer region both in cell lines and in freshly isolated ATL cells. HTLV-1 containing mutations in the SRF- and ELK-1-binding sites markedly decreased chromatin openness at the viral enhancer, viral gene transcription, and enhancing effects on host gene transcription near the viral integration site. Aberrant host genome transcription was observed at nearby integration sites in defective proviruses containing the enhancer in ATL cells. This finding reveals how the exogenous retrovirus achieves persistent infection in the host via the internal viral enhancer and resolves certain long-standing questions concerning HTLV-1 infection. We anticipate that the DNA-capture-seq approach can be applied to analyze regulatory mechanisms of other oncogenic viruses integrated into the host cellular genome.
W246G Mutant ELOVL4 Impairs Synaptic Plasticity in Parallel and Climbing Fibers and Causes Motor Defects in a Rat Model of SCA34
Authors: Nagaraja Raghavendra , Sherry David , Fessler Jennifer , Stiles Megan , Li Feng , Multani Karanpreet , Orock Albert , Ahmad Mohiuddin , Brush Richard , Anderson Robert E , Agbaga Martin-Paul Gameli , Deak Ferenc 
Published: February 2021

Abstract
Spinocerebellar ataxias (SCA) are a group of neurodegenerative disorders caused by a number of different mutations the leads to loss of motor coordination with characteristic ages of onset, symptomatology, and rates of progression. SCA type 34 (SCA34) is an age-related cerebellar neurodegenerative disorder caused by mutations in the Fatty Acid Elongase-4 (ELOVL4). The ELOVL4 is an essential enzyme that mediates biosynthesis of Very Long Chain Saturated and Polyunsaturated Fatty Acids (VLC-SFA and VLC-PUFA, resp., ≥28 carbons) that are critical for the normal function of brain, skin, retina, Meibomian glands, and testes in which ELOVL4 is expressed. Global deletion or homozygous expression of truncated mutant ELOVL4 that lack VLC-SFA and VLC-PUFA biosynthesis cause severe skin disorders, seizures and neonatal mortality in rodents and humans. To understand the consequences of ELOVL4 mutations in pathogenesis of SCA34, we generated a rat model of SCA34 by knock-in of the SCA34-causing 736T>G (p.W246G) ELOVL4 mutation. We show that heterozygous and homozygous rats carrying the W246G mutation developed impaired motor deficits by two months of age. Our electrophysiological studies using cerebellar slices found marked reduction of long-term potentiation at parallel fiber synapses and long-term depression at climbing fiber synapses onto Purkinje cells in the homozygous W246G mutant rats. Our results further point to ELOVL4 products as being essential for motor function and cerebellar synaptic plasticity. These results suggest that in SCA34 patients, ataxia likely arises from primary impairment of synaptic plasticity and cerebellar network desynchronization that precedes cerebellar degeneration and loss of motor coordination with aging.
Socioeconomic Inequalities in Treatment and Relative Survival Among Patients with Diffuse Large B-Cell Lymphoma: A Hong Kong Population-Based Study
Authors: Lee Shing Fung , Evens Andrew , Ng Andrea , Luque-Fernandez Miguel-Angel 
Published: February 2021

Abstract
The influence of socioeconomic status (SES) on access to standard chemotherapy and/or monoclonal antibody therapy, and associated secular trends, relative survival, and excess mortality, among diffuse large B-cell lymphoma (DLBCL) patients is not clear. We conducted a Hong Kong population-based cohort study and identified adult patients with histologically diagnosed DLBCL between 2000 and 2018. We examined the association of SES levels with the odds and the secular trends of receipt of chemotherapy and/or rituximab. Additionally, we estimated the long-term relative survival by SES utilizing Hong Kong life tables. Among 4,017 patients with DLBCL, 2,363 (58.8%) patients received both chemotherapy and rituximab and 740 (18.4%) patients received chemotherapy alone, while 1,612 (40.1%) and 914 (22.8%) patients received no rituximab or chemotherapy, respectively. On multivariable analysis, low SES was associated with lesser use of chemotherapy (odd ratio [OR], 0.44; 95% CI 0.34–0.57) and rituximab (OR, 0.41; 95% CI, 0.32–0.52). The socioeconomic disparity for either treatment showed no secular trend of change. Additionally, patients with low SES showed increased excess mortality, with a hazard ratio of 2.34 (95% CI, 1.67–3.28). Improving survival outcomes for patients with DLBCL requires provision of best available medical care and securing access to treatment regardless of patients’ SES.
Promoting healthy foods among urban school children in Bangladesh: A qualitative inquiry of the challenges and opportunities
Authors: Hasan A M Rumayan , Smith George , Rashid Md Harunor , Selim Mohammad Abdus , Rasheed Sabrina 
Published: February 2021

Abstract
Background Food habits are directly associated with overweight and obesity in adolescence and adulthood. Urban Bangladeshi school children tend to consume foods dense in calories and few fruits and vegetables. The current study explored the barriers and opportunities for promoting healthy diets in households and schools from the perspective of teachers and parents in urban Bangladesh.Methods We conducted 14 key informant interviews with school teachers and 6 focus group interviews with mothers of school children. We used inductive thematic analysis manually.Results Schools were important for development of food preferences, however, most school cafeterias provided foods based on profit rather than health considerations. Mothers were generally concerned about chemicals added to raw foods in markets which led to limited fruit and vegetable consumption. Mothers, especially those who were employed, struggled to have time to prepare healthy foods for their children. Foods prepared outside home have acquired many meanings beyond convenience.Conclusions There were social, cultural, and environmental challenges to promoting healthy foods to children. It is important to formulate policies and guidance to create a supportive environment for healthy foods in schools. As processed foods and foods prepared outside the home have become an important part of the urban food culture, it is also important to develop and implement strict regulations and guidelines for production, processing, and distribution. It is also important to educate consumers about identifying and choosing healthy foods. Implementing existing laws related to food safety should also boost the population’s confidence in the food system.
Health Care Seeking Behavior of Elderly People in Rural Part of Jimma Zone, South West Ethiopia
Authors: Teyib Abdi , Alemayehu Dereje , Tufa Tilahun , Birhanu Negalign 
Published: February 2021

Abstract
Background: Aging is the process of becoming older. Old age comprises age group of 60 year and above. Health care seeking behavior is any activity undertaken by individuals who perceive themselves to have a health problem or to be ill for the purpose of finding an appropriate therapy. Though health care seeking behavior of peoples have significant role for their health, limited number of studies were done so far in Ethiopia particularly among elderly peoples. To the best of our knowledge health seeking behavior of elderly people in Ethiopia haven’t been addressed well by previous researchers. Hence, the objective of this study was to measure health care seeking behavior and associated factors among elderly people in rural parts of Jimma zone, south west Ethiopia, 2020. Methods: Community based cross-sectional study was conducted among elderly peoples living in rural parts of Jimma Zone from March 10 to30, 2020. Multi stage sampling technique was used to select study participants. A total of 590 elderly peoples were included in the study. Data were collected using interviewer administered questionnaire. The data were entered into Epi data version 3.1 and exported to SPSS version 23 for analysis. Descriptive statistics were used to summarize the data. Bivariate and multivariate logistic regression analyses were used to identify factors associated with health seeking behavior. P – Value ≤ 0.05 was used to declare statistical significance.Result: The level of health care seeking behavior of elderly peoples in rural part of Jimma zone was 89.2%. Being female [AOR= 0.422(95%CI: 0.204–0.874)], good perception towards health facility[AOR= 20.676(95%CI: 5.077–84.205)], service option availability [AOR=8.597(95%CI: 1.998 – 36.989)], affordable price of modern health service [AOR=3.589(95%CI:1.631–7.900)], awareness about the cause of their sickness[AOR=6.060(95%CI:1.539–23.866)], and having good housing condition[AOR=5.017(95%CI=1.924–13.082) were predictors of health care seeking behavior. Conclusion: Health care seeking behavior of elderly people in rural part of Jimma zone was higher than what was reported in many other studies. Special attention is need from government and concerned stakeholders to take action on the identified factors of health care seeking behavior of elderly people.