bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical treatment of stoma-related hernias: retrospective cohort study of damage claims to the Swedish National Patient Insurance Company 2010–2016
Authors: Nyman Johan , Lindmark Mikael , Gunnarsson Ulf , Strigård Karin 
Published: November 2021

Abstract
Background
Parastomal hernia and stoma-site hernia are common stoma complications. Parastomal hernia repair is associated with high complication and recurrence rates. Insurance data can provide novel information on the consequences of perioperative complications from the patient’s point of view. The aim was to investigate what types of complications associated with stoma-related hernia surgery that cause patients to apply for economic compensation through the patient insurance system and to investigate demographic and clinical differences among cases based on gender and type of center at which the surgery was performed.

Methods
A national patient damage claim database was searched for ICD-10 codes related to parastomal and stoma-site hernia surgery over a seven-year period. Medical records were screened for claims associated with parastomal hernia repair, relocation or reversal due to parastomal hernia, or stoma-site hernia repair. Claims were classified according to one of four primary complaints: surgical, anesthetic, medical or other. Clinical and demographic differences between genders and hospital types were investigated. Reasons for non-compensation were analyzed.

Results
Thirty claims met the inclusion criteria. Eighteen were related to parastomal hernia repair, seven to stoma-site hernia repair, three to stoma reversal and two to relocation due to parastomal hernia. Twenty-five claims were primarily surgical, two related to anesthesia and three classified as other. Seven claims were granted compensation. No demographic or clinical differences were found apart from female gender being associated with previous parastomal hernia repair [6 women and 0 men (p = 0.02)].

Conclusion
Surgical complaints predominated. Few claims were compensated, reflecting the complexity and unsatisfactory outcomes of these procedures. Many claims were identified in relation to the incidence of stoma-related hernia surgery.

Trial registration

Due to its retrospective and descriptive nature, the study was not registered in any registry.
Exploring the factors that affect the transition from student to health professional: an Integrative review
Authors: Opoku Eric Nkansah , Khuabi Lee-Ann Jacobs-Nzuzi , Van Niekerk Lana 
Published: November 2021

Abstract

Background
The nature of a new health professional’s transition from student to health professional is a significant determinant of the ease or difficulty of the journey to professional competence. The integrative review will explore the extent of literature on the factors that impact the transition of new health professionals into practice, identify possible gaps and synthesise findings which will inform further research. The aim was to identify research conducted in the last two decades on the barriers, facilitators and coping strategies employed by new health professionals during their transition into practice.

Methods
Whittemore and Knafl’s methodological framework for conducting integrative reviews was used to guide this review. Sources between 1999 and 2019 were gathered using EBSCOhost (including CINAHL, Medline, Academic Search Premier, Health Science: Nursing and Academic Edition), PubMed, Scopus, Cochrane and Web of Science, as well as hand searching and follow-up of bibliographies followed. The Covidence platform was used to manage the project. All studies were screened against a predetermined selection criteria. Relevant data was extracted from included sources and analysed using thematic analysis approach.

Results
Of the 562 studies identified, relevant data was extracted from 24 studies that met the inclusion criteria, and analysed to form this review. Thematic analysis approach was used to categorise the findings into theme areas. Four overarching themes emerged namely: systems and structures, personal capacities, professional competence and mediating processes. Each theme revealed the barriers, facilitators and coping strategies of transition into practice among new health graduates.

Conclusion
The transition into practice for new health practitioners has been described as complex and a period of great stress. Increasing clinical and practical experiences during education are required to support new health professionals in the process of closing the gap between learning and practice. Continued professional development activities should be readily available and attendance of these encouraged.
An exploratory study on needs for clinical research training: data from Chinese hospitals
Authors: Liu Wei , Huang Wei , Liu Chang , Li Pei , Chen Jing 
Published: November 2021

Abstract
Objective
Through preliminary investigation of needs for clinical research training, to provide some initial evidence for design and operation of clinical research training programs in China.

Methods
An online questionnaire containing 23 questions about demographics, current practice of clinical research and needs for clinical research training was formulated to collect data from physicians and researchers in hospital. Convenience sampling was adopted.

Results
A total of 600 valid questionnaires were collected, including 507 from physicians, 58 from full-time clinical researchers and 35 from full-time basic medical researchers. Results showed that 14 % of the participants never participated in any clinical research, difficulties in data statistics were reported by more than 70 % of participants, and over 50 % reported training needs for cohort and biobank construction, data management and clinical study design. As to the training form, a combined on-line lecture with off-line communication is preferred. As for the content of the training program, strategies for literature reading and grant writing are highly demanded.

Conclusions
In China, even physicians in top hospitals tend to encounter various difficulties when conducting clinical research. This study highlights the importance of systematic training for future physician scientists in China, with a particular focus on data statistics, cohort and biobank construction and data management.
Interpretable time-aware and co-occurrence-aware network for medical prediction
Authors: Sun Chenxi , Dui Hongna , Li Hongyan 
Published: November 2021

Abstract
Background
Disease prediction based on electronic health records (EHRs) is essential for personalized healthcare. But it’s hard due to the special data structure and the interpretability requirement of methods. The structure of EHR is hierarchical: each patient has a sequence of admissions, and each admission has some co-occurrence diagnoses. However, the existing methods only partially model these characteristics and lack the interpretation for non-specialists.

Methods
This work proposes a time-aware and co-occurrence-aware deep learning network (TCoN), which is not only suitable for EHR data structure but also interpretable: the co-occurrence-aware self-attention (CS-attention) mechanism and time-aware gated recurrent unit (T-GRU) can model multilevel relations; the interpretation path and the diagnosis graph can make the result interpretable.

Results
The method is tested on a real-world dataset for mortality prediction, readmission prediction, disease prediction, and next diagnoses prediction. Experimental results show that TCoN is better than baselines with 2.01% higher accuracy. Meanwhile, the method can give the interpretation of causal relationships and the diagnosis graph of each patient.

Conclusions
This work proposes a novel model—TCoN. It is an interpretable and effective deep learning method, that can model the hierarchical medical structure and predict medical events. The experiments show that it outperforms all state-of-the-art methods. Future work can apply the graph embedding technology based on more knowledge data such as doctor notes.
Implementation challenges and perception of care providers on Electronic Medical Records at St. Paul’s and Ayder Hospitals, Ethiopia
Authors: Bisrat Alemayehu , Minda Dagne , Assamnew Bekalu , Abebe Biruk , Abegaz Teshome 
Published: November 2021

Abstract
Background
In resources constrained settings, effectively implemented Electronic Medical Record systems have numerous benefits over paper-based record keeping. This system was implemented in the 2009 Gregorian Calendar in the two Ethiopian territory hospitals, Ayder and St. Paul’s. The pilot implementation and similar re-deployment efforts done in 2014 and 2017 Gregorian Calendar failed at St. Paul's. This study aimed to assess the current status, identify challenges, success factors and perception of health care providers to the system to inform on future roll-outs and scale-up plans.

Methods
A cross sectional study design with quantitative and qualitative methods was employed. A survey was administered October to December 2019 using a structured questionnaire. A total of 240 health care providers participated in the study based on a stratified random sampling technique. An interview was conducted with a total of 10 persons that include IT experts and higher managements of the hospital. Descriptive statistics were employed to summarize the survey data using SPSS V.21. Qualitative data were thematically presented.

Results
St. Paul’s hospital predominantly practiced the manual medical recording system. The majority of respondents (30.6%) declared that a lack of training and follow up, lack of management commitment, poor network infrastructure and hardware/software-related issues were challenges and contributed to EMR system failure at St. Paul’s. Results from the qualitative data attested to the above results. The system is found well-functioning at Ayder, and the majority of respondents (38%) noted that lack of training and follow-up was the most piercing challenge. As per the qualitative findings, ICT infrastructure, availability of equipment, incentive mechanisms, and management commitment are mentioned as supportive for successful implementation. At both hospitals, 70 to 95% of participants hold favorable perceptions and are willing to use the system.

Conclusion
Assessing the readiness of the hospital, selecting and acquiring standard and certified EMR systems, provision of adequate logistic requirements including equipment and supplies, and upgrading the hospital ICT infrastructure will allow sustainable deployment of an EMR system.
Transforming growth factor-β1 decreases erythropoietin production through repressing hypoxia-inducible factor 2α in erythropoietin-producing cells
Authors: Shih Hong-Mou , Pan Szu-Yu , Wu Chih-Jen , Chou Yu-Hsiang , Chen Chun-Yuan , Chang Fan-Chi , Chen Yi-Ting , Chiang Wen-Chih , Tsai Hsing-Chen , Chen Yung-Ming , Lin Shuei-Liong 
Published: November 2021

Abstract
Background
Renal erythropoietin (EPO)-producing (REP) cells produce EPO through hypoxia-inducible factor (HIF) 2α-activated gene transcription. Insufficient EPO production leads to anemia in patients with chronic kidney disease. Although recombinant EPO is effective to improve anemia, no reliable REP cell lines limit further progress of research and development of novel treatment.

Methods
We screened Epo mRNA expression in mouse fibroblast cell lines. Small interfering RNA specific for HIF1α or HIF2α was transfected to study Epo expression in C3H10T1/2 cells. The effect of transforming growth factor-β1 (TGF-β1) on HIF-EPO axis was studied in C3H10T1/2 cells and mice.

Results
Similar to mouse REP pericytes, C3H10T1/2 cells differentiated to α-smooth muscle actin+ myofibroblasts after exposure to TGF-β1. Specific HIF knockdown demonstrated the role of HIF2α in hypoxia-induced Epo expression. Sustained TGF-β1 exposure increased neither DNA methyltransferase nor methylation of Epas1 and Epo genes. However, TGF-β1 repressed HIF2α-encoding Epas1 promptly through activating activin receptor-like kinase-5 (ALK5), thereby decreasing Epo induction by hypoxia and prolyl hydroxylase domain inhibitor roxadustat. In mice with pro-fibrotic injury induced by ureteral obstruction, upregulation of Tgfb1 was accompanied with downregulation of Epas1 and Epo in injured kidneys and myofibroblasts, which were reversed by ALK5 inhibitor SB431542.

Conclusion
C3H10T1/2 cells possessed the property of HIF2α-dependent Epo expression in REP pericytes. TGF-β1 induced not only the transition to myofibroblasts but also a repressive effect on Epas1-Epo axis in C3H10T1/2 cells. The repressive effect of TGF-β1 on Epas1-Epo axis was confirmed in REP pericytes in vivo. Inhibition of TGF-β1-ALK5 signaling might provide a novel treatment to rescue EPO expression in REP pericytes of injured kidney.
Effect of PLC-β1/CaM signaling pathway mediated by AT1R on the occurrence and development of hepatocellular carcinoma
Authors: Xu Zhou-wei , Liu Na-na , Wang Xing-yu , Ding Bai-cheng , Zhang Hai-feng , Li Ying , Sun Wu-yi , Wei Wei 
Published: November 2021

Abstract
Objective
To study the roles of AT1R, PLC-β1, CaM and other related signal molecules in the formation and development of hepatocellular carcinoma (HCC) and their correlation.

Methods
ELISA and immunohistochemistry were used to analyze the expressions of target proteins in serum and liver tissue of HCC patients, and the correlation between AT1R, PLC-β1 and CaM and postoperative survival status of patients was followed up and determined. CCK-8 method was used to screen the doses of Ang II and candesartan sensitive to HepG2 and HCCLM3 cells. Transwell experiment was used to observe the effects of different drugs on the migration and invasion activity of HCC cells. Meanwhile, flow cytometry and Western blot were used to detect the expression levels of AT1R, PLC-β1 and CaM in the cells. Then PLC-β1 siRNA was selected to transfect HCC cells, so as to further clarify the mechanism of the above signal proteins. HepG2 cells were inoculated under the hepatic capsule of mice to induce the formation of HCC in situ. Ang II and candesartan were used to stimulate HCC mice to observe the difference in liver appearance and measure the liver index. Finally, ELISA and immunofluorescence experiments were selected to analyze the levels of target proteins in mouse serum and liver tissue.

Results
The expression levels of target proteins in serum and liver tissue of HCC patients were significantly increased, and the postoperative survival time of patients with high expression of AT1R, PLC-β1 or CaM was obviously shortened. Ang II and candesartan could significantly promote and inhibit the motility of HCC cells, and had different effects on the levels of AT1R, PLC-β1 and CaM in cells. However, in hepatocellular carcinoma cells transfected with PLC-β1 siRNA, the intervention ability of drugs was obviously weakened. Ang II could significantly promote the formation and progression of mouse HCC, while candesartan had the opposite effect. Meanwhile, medications could affect the expressions of target proteins in mouse serum and liver tissue.

Conclusion
AT1R, PLC-β1 and CaM may be risk factors affecting the formation and prognosis of HCC, and the PLC-β1/CaM signaling pathway mediated by AT1R is an important way to regulate the migration and invasion activity of HCC cells.
The tumor suppressor activity of DLC1 requires the interaction of its START domain with Phosphatidylserine, PLCD1, and Caveolin-1
Authors: Sanchez-Solana Beatriz , Wang Dunrui , Qian Xiaolan , Velayoudame Parthibane , Simanshu Dhirendra K. , Acharya Jairaj K. , Lowy Douglas R. 
Published: November 2021

Abstract
Background
DLC1, a tumor suppressor gene that is downregulated in many cancer types by genetic and nongenetic mechanisms, encodes a protein whose RhoGAP and scaffolding activities contribute to its tumor suppressor functions. The role of the DLC1 START (StAR-related lipid transfer; DLC1-START) domain, other than its binding to Caveolin-1, is poorly understood. In other START domains, a key function is that they bind lipids, but the putative lipid ligand for DLC1-START is unknown.

Methods
Lipid overlay assays and Phosphatidylserine (PS)-pull down assays confirmed the binding of DLC1-START to PS. Co-immunoprecipitation studies demonstrated the interaction between DLC1-START and Phospholipase C delta 1 (PLCD1) or Caveolin-1, and the contribution of PS to those interactions. Rho-GTP, cell proliferation, cell migration, and/or anchorage-independent growth assays were used to investigate the contribution of PS and PLCD1, or the implications of TCGA cancer-associated DLC1-START mutants, to DLC1 functions. Co-immunoprecipitations and PS-pull down assays were used to investigate the molecular mechanisms underlying the impaired functions of DLC1-START mutants. A structural model of DLC1-START was also built to better understand the structural implications of the cancer-associated mutations in DLC1-START.

Results
We identified PS as the lipid ligand for DLC1-START and determined that DLC1-START also binds PLCD1 protein in addition to Caveolin-1. PS binding contributes to the interaction of DLC1 with Caveolin-1 and with PLCD1. The importance of these activities for tumorigenesis is supported by our analysis of 7 cancer-associated DLC1-START mutants, each of which has reduced tumor suppressor function but retains wildtype RhoGAP activity. Our structural model of DLC1-START indicates the mutants perturb different elements within the structure, which is correlated with our experimental findings that the mutants are heterogenous with regard to the deficiency of their binding properties. Some have reduced PS binding, others reduced PLCD1 and Caveolin-1 binding, and others are deficient for all of these properties.

Conclusion
These observations highlight the importance of DLC1-START for the tumor suppressor function of DLC1 that is RhoGAP-independent. They also expand the versatility of START domains, as DLC1-START is the first found to bind PS, which promotes the binding to other proteins.
How children with juvenile idiopathic arthritis view participation and communication in healthcare encounters: a qualitative study
Authors: Lundberg Veronica , Eriksson Catharina , Lind Torbjörn , Coyne Imelda , Fjellman-Wiklund Anncristine 
Published: November 2021

Abstract
Background
Children report that they do not participate in their healthcare as much as they want, despite having the lawful right to form their own views and the right to express those views freely in all matters affecting them. Children and parents appeared to be more satisfied when healthcare professionals (HCP) use a participatory style in healthcare encounters.

Aim
To explore how children, adolescents and young adults with Juvenile Idiopathic Arthritis (JIA) and parents of children with JIA view their participation and communication in healthcare encounters with healthcare professionals.

Methods
Using a qualitative study design, participatory workshops were held separately for children and young adults with JIA and parents of children with JIA. The workshop data were analysed with Graneheim and Lundman’s Qualitative Content Analysis resulting in one main theme and two subthemes.

Results
The theme “Feeling alienated or familiar with healthcare encounters” illuminates how children felt alienated at healthcare encounters if they found the encounters emotionally distressing. Children could withhold information regarding their health and function from both HCPs and their family and friends. The subtheme “Distancing oneself from healthcare” describe why children felt reluctant to engage in the healthcare encounters and experienced difficulty expressing how they really felt. The subtheme “Being a normal event in life” describe how children felt more comfortable over time engaging with HCPs when they knew what would happen, and felt that HCPs gave them the necessary support they needed to participate.

Conclusions
Children’s participation in healthcare encounters varied depending if children felt alienated or familiar to the healthcare situations. Children distance themselves and are reluctant to engage in healthcare encounters if they find them emotionally distressing and feel disregarded. Over time, children can become more familiar and at ease with healthcare situations when they feel safe and experience personal and positive encounters. When the children are prepared for the encounter, provided with the space and support they want and receive tailored help they are more enabled to participate.
Factors associated with antiretroviral therapy adherence among people living with HIV in Haiti: a cross-sectional study
Authors: Dorcélus Ludentz , Bernard Joseph , Georgery Constant , Vanessa Clerveau 
Published: November 2021

Abstract
Background
Socioeconomic, demographic and clinical factors can affect adherence to treatment among people living with HIV (PLH) and potentially have an impact on their prognosis and survival. The main objective of this study was to assess these factors as potential barriers to adherence among patients receiving care in central Haiti.

Methods
A cross-sectional study was conducted among PLH receiving antiretroviral therapy (ART) at the TB/HIV clinic at St. Therese Hospital in Hinche, Haiti. A total of 426 potential participants were approached during their follow-up visits from June to August 2019, of whom 411 participated in the study. After giving informed consent, study participants completed a structured interview that included the Self-Report Item Scale (SRIS), a standard measure, to assess adherence. Socio-demographic, economic and clinical factors were assessed for their association with adherence.

Results
The 411 participating patients represented 39% of the patient population at the TB/HIV clinic during the timeframe of the study. The mean age was 43.7 years (range: 19–80), 65.5% were female and 78.1% had only achieved a primary level of schooling. Nearly 78% had received ART for less than 10 years, 3.41% reported having poor adherence and 28% less than excellent adherence. Factors related to poor adherence in bivariate analysis were age less than 40 years (OR: 6.32, 95% CI 2.04–10.58, p < 0.01) and inability to meet basic needs (OR: 2.70, 95% CI 1.04–7.0, p = 0.03).

Conclusions
To improve medication adherence, the hospital should strengthen patient counselling of younger recipients of ART and provide financial assistance and other social service interventions. Studies should be implemented in other HIV management centers in Haiti and similar contexts to examine barriers to ART adherence with the goal of improving prognosis and survival in the long-term among PLH in resource-limited setting.
Worldwide initiatives aimed to train professionals in the use of the ICD-11
Authors: Giordano Giulia M. 
Published: November 2021

Abstract
Background
The chapter on mental disorders of the 11th revision of the International Classification of Diseases (ICD-11) has been now finalized. Training of mental health professionals in the use of the chapter is taking place worldwide.

Main body of the abstract
Information is provided on the ICD-11 training courses taking place recently, including that co-organized by the Naples World Health Organization (WHO) Collaborating Centre on Research and Training in Mental Health and the European Psychiatric Association; those which will be held in the next few months, such as the one co-organized by the World Psychiatric Association and the Global Mental Health Academy, to be held online from 8 to 29 November 2021; and the training course set up by the WHO Collaborating Centre on Mental Health at the Columbia University, in collaboration with the WHO Department of Mental Health and Substance Use, which can be accessed only by the members of the WHO Global Clinical Practice Network.

Conclusion
Psychiatrists of all countries of the world are encouraged to become familiar with the ICD-11 chapter on mental disorders, which will be adopted shortly by most countries worldwide.