bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluating and Strengthening the Health System of Curaҫao to Improve its Performance for Future Outbreaks of Infectious Diseases.
Authors: Mulderij-Jansen Vaitiare , Gerstenbluth Izzy , Duits Ashley , Tami Adriana , Bailey Ajay 
Published: March 2021

Abstract
BackgroundVector-borne diseases (VBDs) such as dengue, chikungunya, and Zika pose a significant challenge to health systems in countries they affect, especially countries with less developed healthcare systems. Therefore countries are encouraged to strengthen their healthcare systems to achieve more resilient systems. This qualitative study aims to examine the performance of the health system of the Dutch Caribbean island of Curaҫao with regards to the prevention and control of VBDs in the last decennium by using the WHO health system building blocks.MethodsFrom January 2019 to February 2020, a multi-method qualitative study was performed in Curaçao., applying content analysis of documents (n = 50), five focus group discussions (n = 30), interviews with experts (n = 11), and fifteen observation sessions. The study was designed based on the WHO framework: health system building blocks. Two cycles of inductive and deductive coding were employed, and Nvivo software was used to analyse the data.ResultsThis study’s data highlighted the challenges (e.g., insufficient oversight, coordination, leadership skills, structure, and communication) that the departments of the health system of Curaҫao faced during the last three epidemics of VBDs (2010–2020). Furthermore, low levels of collaboration between governmental and non-governmental organisations (e.g., semi-governmental and private laboratories) and insufficient capacity building to improve skills (e.g., entomological, surveillance skills) were also observed. Lastly, we observed how bottlenecks in one building block negatively influenced other building blocks (e.g., inadequate leadership/governance obstructed the workforce's performance).ConclusionsThis study uncovers potential organisational bottlenecks that have affected the performance of the health system of Curaҫao negatively. We recommend starting with the reinforcement of oversight of the integrated vector management program to ensure the development, implementation, and evaluation of related legislation, policies, and interventions. Also, we recommend evaluating and reform the existing administrative and organisational structure of the health system by taking the cultural style, challenges, and barriers of the current health system into account. More efforts are needed to improve the documentation of agreements, the recruitment, and evaluation of the workforce's performance. Based on our findings, we conceptualised actions to strengthen the health system's building blocks to improve its performance for future outbreaks of infectious diseases.
Association of Triglyceride-Glucose&nbsp;Index&nbsp;with the Incidence of Ketoacidosis in Chinese Children with Type 1 Diabetes
Authors: Gao Long , Wang Xinhui , Shu Jianbo , Zhang Mingying , Zhi Xiufang , Guan Jun , Gu Chunyu , Pu Linjie , Cai Chunquan , Yang Wei , Lv Ling 
Published: March 2021

Abstract
Objective: The relationship between triglyceride-glucose index (TyG index) and the prevalence of type 2 diabetes mellitus (T2DM) has been confirmed by former studies. However, it remains uncertain whether TyG index has a predictive value in T1DM patients with diabetic ketoacidosis (DKA).Methods: The study retrospectively enrolled 143 patients ((boys/girls = 60/83) with T1DM in the Endocrine inpatient wards of Tianjin Children’s Hospital from June 2017 to May 2019.TyG index was calculated as follows: ln[fasting triglycerides (mg/dL)×fasting plasma glucose (mg/dL)/2]. These patients stratifed by the optimal cut-off point of TyG index were divided into the lower TyG index group (n=73) and higher TyG index group (n=70).Results: TyG index and related lipid parameters were significantly higher in patients with DKA compared with those without. Compared with patients in lower TyG index group, those with higher TyG index seemed to be younger. Multiple linear regression analysis showed that increase of TC (95%CI: 0.018~0.568, p=0.037) level and decrease of T3(95%CI:-2.314~-0.668,p=0.001) level were associated with the risk of higher TyG index. A linear equation was obtained between TC, T3 and TyG index (TyG index=10.226+0.299*TC-1.384*T3, R2=0.481). Conclusions: Increased TyG index is a significant predictor of DKA in children with T1DM. Higher TC and lower T3 levels were associated with higher TyG index. Further studies need to be conducted to determine whether interventions for TyG index have a positive impact on improving clinical prognosis.
Design Matters in Patient-Level Prediction: Evaluation of a Cohort vs. Case-Control Design When Developing Predictive Models in Observational Healthcare Datasets
Authors: Reps Jenna , Ryan Patrick B. , Rijnbeek Peter R. , Schuemie Martijn J. 
Published: March 2021

Abstract
Background: The study design used to develop prediction models in observational healthcare databases (e.g., case-control and cohort) may impact the clinical usefulness. We aim to quantify how the choice of design impacts prediction model performance. Aim: To empirically investigate differences between models developed using a case-control design and a cohort design.Methods: Using a US claims database, we replicated two published prediction models (dementia and type 2 diabetes) which were developed using a case-control design, and also train models for the same prediction questions using cohort designs. We validated each model on data mimicking the point in time the models would be applied in clinical practice. We calculate the models’ discrimination and calibration-in-the-large performances.Results: The dementia models obtained area under the receiver operating characteristics of 0.560 and 0.897 for the case-control and cohort designs respectively. The type 2 diabetes models obtained area under the receiver operating characteristics of 0.733 and 0.727 for the case-control and cohort designs respectively. The dementia and diabetes case-control models were both poorly calibrated, whereas the dementia cohort model achieved good calibration. We show that careful construction of a case-control design can lead to comparable discriminative performance as a cohort design, but case-control designs generally oversample the outcome leading to miscalibration. Conclusion: Any case-control design can be converted to a cohort design. We recommend that researchers with observational data use the less subjective and generally better calibrated cohort design. However, if a carefully constructed case-control design is used, then the model must be prospectively validated using a cohort design for fair evaluation and be recalibrated.
The Presurgical Controlling Nutritional Status (CONUT) Score is Independently Associated with Severe Peristomal Skin Disorders: A Single-center Retrospective Cohort Study
Authors: Shiraishi Takuya , Ogawa Hiroomi , Katayama Chika , Osone Katsuya , Okada Takuhisa , Katoh Ryuji , Sano Akihiko , Sakai Makoto , Sohda Makoto , Shirabe Ken , Saeki Hiroshi 
Published: March 2021

Abstract
Purpose: While nutritional interventions may potentially lower the risk of peristomal skin disorders (PSDs) and their exacerbation, no prior studies have evaluated the relationship between PSDs and nutritional status using the Controlling Nutritional Status (CONUT) score. Therefore, the purpose of this study was to assess the impact of preoperative nutritional status on stoma development, and determine risk factors for postoperative PSDs and their increased severity. Methods: A retrospective analysis was performed in 116 consecutive patients with rectal cancer who underwent radical surgery with stoma creation, including ileostomy and colostomy. Results: PSDs were diagnosed in 32 patients (27.6%); 10 (8.7%) cases were defined as severe based on the ABCD-stoma score. A multivariate analysis indicated that the laparoscopic approach (odds ratio [OR], 3.221; 95% confidence interval [CI], 1.001–10.362; P = 0.050) and ileostomy (OR, 3.394; 95% CI, 1.349–8.535; P = 0.009) were both independent risk factors for PSD. In a separate multivariate analysis for severe PSD, the only independent risk factor was the CONUT score (OR, 11.298; 95% CI, 1.382–92.373; P = 0.024). Conclusion: Severe PSDs are associated with preoperative nutritional disorders, as determined via the CONUT score. Furthermore, PSDs may potentially increase in severity, regardless of stoma type.
Left-behind Experience, Parent-child Communication and Psychological Resilience: a Structural Equation Modeling Analysis
Authors: Zhou Chi , Lv Qiaohong , Yang Nancy , Wang Feng 
Published: March 2021

Abstract
Background: Rapid urbanization has caused left-behind children to become a social problem in China. Psychological resilience is an important mediating/intermediate variable. This study aims to examine the role of parental migration status and parent communication on the psychological and related behavioral status of left-behind children through psychological resilience. Methods: A cross-sectional survey was conducted in Anhui Province of China, and a questionnaire survey was conducted with 1992 teens using the Chinese version of the Parent-Adolescent Communication Scale, Connor-Davidson Resilience Scale, and Strength and Difficulties Questionnaires. Results: Compared with the never left-behind group, left behind children had relatively lower PACS, CD-RISC and SDQ scores. Absence of parents is related with poorer psychological resilience, while good parent communication is related with better psychological resilience. Better psychological resilience is related with fewer psychological problems among different parental migration status. The currently left-behind status demonstrated a negative influence on psychological resilience, while never left-behind status had a positive effect.Conclusions: Interventions are needed to enhance psychological resilience of left-behind children to prevent psychological and related behavioral problems.
A Deterministic Approach for Protecting Privacy in Sensitive Personal Data
Authors: Avraam Demetris , Jones Elinor , Burton Paul 
Published: March 2021

Abstract
Background: Data privacy is one of the biggest challenges for any organisation which processes personal data, especially in the area of medical research where data include sensitive information about patients and study participants. Sharing of data is therefore problematic, which is at odds with the principle of open data that is so important to the advancement of society and science. Several statistical methods and computational tools have been developed to help data custodians and analysts overcome this challenge. However, no single solution can fully protect a dataset and often combinations of methods and multifaceted systems are essential.Results: We propose a new deterministic approach for anonymising personal data. The method stratifies the underlying data by the categorical variables and re-distributes the continuous variables preserving their spatial properties.Conclusions: The procedure makes data re-identification difficult while minimising the loss of utility; the latter means that informative statistical analysis can still be conducted. We demonstrate its use on real data, including data from the 1958 Birth Cohort.
A Study on Predicting the Length of Hospital Stay for Chinese Patients With Ischemic Stroke Based on the XGBoost&nbsp;Algorithm
Authors: Rui Chen , Zhang Shengfa , Li Jie , Guo Dongwei , Zhang Weijun , Tian Donghua , Gu Linni , Qu Zhiyong , Wang Xiaohua 
Published: March 2021

Abstract
Background China faced the most significant challenge from stroke because it imposes a heavy burden on families, national health services, social services, and the economy. The length of hospital stay (LOS) was an essential indicator of utilization of medical services and was usually used to assess the efficiency of hospital management and patient quality of care. This study established a prediction model based on the machine learning algorithm to predict the ischemic stroke patients' LOS.MethodsA total of 18,195 ischemic stroke patients' electronic medical records and 28 attributes were extracted from electronic medical records in a large comprehensive hospital in China. After preprocessing the data and feature selection, the XGBoost algorithm was used for building a machine learning model. The 10-fold cross-validation was used for model validation. The accuracy (ACC), recall rate (RE) and F1 measure were used to evaluate the performance of the prediction model of LOS of ischemic stroke patients. Finally, the XGBoost algorithm was used to identify and remove irrelevant features by ranking all attributes based on feature importance.ResultsThe average ACC, RE and F1 measure were 0.96, 0.82 and 0.79, respectively, under the 10-fold cross-validation. According to the analysis of the importance of features, the LOS of ischemic stroke patients was affected by demographic characteristics, past medical history, admission examination features, and operation characteristics. Finally, the features, including NIHSS, MRS, Hemiplegia aphasia, age, BMI and TIA etc. were found to be the top ten features in importance in predicting the LOS of ischemic stroke patients.ConclusionsThe XGBoost algorithm was an appropriate machine learning method for predicting the LOS of patients with ischemic stroke. Based on the prediction model, an intelligent medical management prediction system could be developed to predict the LOS based on ischemic stroke patients' electronic medical records.
Sexual Wellbeing in Early Adolescence: A Cross-sectional Assessment Among Girls and Boys in Urban Indonesia
Authors: Kågesten Anna E , Pinandari Anggriyani Wahyu , Page Anna , Wilopo Siswanto Agus , Reeuwijk Miranda van 
Published: March 2021

Abstract
Background: Early adolescence (ages 10-14) is a critical period of physical, cognitive, social and emotional development, which affect sexual and reproductive health and rights. Yet, little is known about positive or healthy aspects of sexuality development during this period of life, especially in South East Asia where sexual norms remain restrictive. The objective of this study is to assess the prevalence and correlates of sexual wellbeing among early adolescent girls and boys ages in Indonesia.Methods: Data for this cross-sectional study were collected as part of the Global Early Adolescent Study via a school-based survey in three Indonesian urban sites in 2018 (N=4309). We assessed the prevalence of multiple indicators of sexual wellbeing (e.g. sexual and reproductive health knowledge and communication, gender attitudes, body satisfaction, self-efficacy, freedom from violence) and tested for differences by gender using Chi-square, Student t-test, and Wilcoxon rank-sum test. Multivariable logistic regression models were used to assess the adjusted odds ratio of selected indicators in relation to sociodemographic factors, romantic and sexual experiences. Results: The mean age of students was 12 years (53% girls); 90% had started puberty. Sexual and reproductive health knowledge and communication was low overall, but higher among boys than girls. Boys were more likely than girls to report high body satisfaction, less feelings of sexual guilt, but also to experience physical peer violence. In contrast, girls were more likely to hold gender equal attitudes, greater self-efficacy to say no, and to report being bullied by boys. In multivariable models, romantic experiences, perceived voice (boys and girls) and decision-making (girls) were associated with three or more indicators of sexual wellbeing. Conclusions: While young adolescents in Indonesia score high on some aspects of sexual wellbeing, misconceptions, feelings of guilt and uncertainties related to sexuality are common, with clear gender differences. These findings confirm the need for comprehensive sexuality education that begins early in adolescence.
Rapid metformin effects on multiple intestinal functions in high-fat high-sucrose fed mice
Authors: Bravard Amélie , Gérard Céline , Defois Clémence , Benoit Bérengère , Makki Kassem , Meugnier Emmanuelle , Rainteau Dominique , Rieusset Jennifer , Godet Murielle , Vidal Hubert 
Published: March 2021

Abstract
Although the mechanism of action of the antidiabetic drug metformin is still a matter of discussions, it is well accepted that the gut plays an important role. To gain more insights into the mechanisms that occur in the different regions of the intestinal tract in response to metformin treatment, adult male mice were fed a high-fat-high sucrose (HFS) diet for 8 days. Metformin treatment by gavage (300 mg/day/kg body weight) during the HFS diet improved glucose tolerance. Metformin counteracted HFS diet-induced overexpression of a network of genes involved in the transport of glucose and fatty acids in the small intestine, and induced beneficial modification of secondary bile acid profile in the caecum, with reduction in DCA and LCA levels and increased abundance of UDCA and TUDCA, potentially leading to FRX inhibition. In parallel, metformin treatment was associated with specific changes in the microbiota composition in the lumen of the different regions of the gut, counteracting the effects of HFS diet on the abundances of some bacterial groups generally associated with metabolic disturbances (f-Lachnospiraceae, f-Petostreptococcaceae, g-Clostidium). In addition, metformin promotes a strong increase in the abundance of Akkermansia muciniphila in the intestinal lumen all along the gut. Therefore, the present work clearly emphasises the role of all the regions of the intestinal tract in the beneficial action of the antidiabetic drug metformin in a prediabetic mouse model.
Technology and performance analysis of preventing surface subsidence by sealing and backfilling the goaf with Urban waste
Authors: Xiong Yu , Kong Dezhong , Wang Yuliang , Liu Qinzhi , Gong Yuanheng 
Published: March 2021

Abstract
In order to solve the current two major environmental problems of urban waste pollution and surface subsidence above the coal mine goaf, the technology of sealing and backfilling the goaf with urban waste is proposed. This technology takes "waste disposal" and "goaf backfilling" as the design theme, and uses waste screening, processing, transportation, and backfilling as the design links. Aiming at the processing of loose waste, the waste drying and briquetting integrated machine is designed, which comprehensively utilizes the methods of waste physical disposal and heat disposal to dehydrate and press the waste into a block with a particle size of 150mm, and finally pass the six-sided winding package. The entire processing technology ensures the strength of the waste materials and no filtrate. For the processing of solid aggregate waste, it is crushed into recycled concrete raw materials for goaf backfilling. Aiming at the goaf backfilling, the goaf backfilling coal mining method is designed, the backfilling hydraulic support is modified, and the backfilling mechanism is added to realize the integration of “mining-backfilling” in the working face. The backfilling technology embodies the key issues of the sealing of the backfilling space and the strength of the backfilling body with third times of sealing strengthening. Using urban waste as the backfilling materials for the goal area, the waste pollution and the surface subsidence are turned into “two benefits”, and the construction of waste-free cities and green mines is promoted.
High-Resolution Radioluminescence Microscopy of FDG Uptake in an Engineered 3D Tumor-Stoma Model
Authors: Khan Syamantak , Kim Sungwoo , Yang Yunzhi Peter , Pratx Guillem 
Published: March 2021

Abstract
PURPOSEThe increased glucose metabolism of cancer cells is the basis for 18F-fluorodeoxyglucose positron emission tomography (FDG-PET). However, due to its coarse image resolution, PET is unable to resolve the metabolic role of cancer-associated stroma, which often influences the metabolic reprogramming of a tumor. This study investigates the use of radioluminescence microscopy for imaging FDG uptake in engineered 3D tumor models with high resolution.METHODMulticellular tumor spheroids (A549 lung adenocarcinoma) were co-cultured with GFP-expressing human umbilical vein endothelial cells (HUVECs) within an artificial extracellular matrix to mimic a tumor and its surrounding stroma. The tumor model was constructed as a 200 µm-thin 3D layer over a transparent CdWO4 scintillator plate to allow high-resolution imaging of the cultured cells. After incubation with FDG, the radioluminescence signal was collected by a highly sensitive widefield microscope. Fluorescence microscopy was performed using the same instrument to localize endothelial and tumor cells.RESULTSSimultaneous and co-localized brightfield, fluorescence and radioluminescence imaging provided high-resolution information on the distribution of FDG in the engineered tissue. The microvascular stromal compartment as a whole took up a large fraction of the FDG, comparable to the uptake of the tumor spheroids. In vitro gamma counting confirmed that A549 and HUVEC cells were both highly glycolytic with rapid FDG-uptake kinetics. Despite the relative thickness of the tissue constructs, an average spatial resolution of 64 ± 4 µm was achieved for imaging FDG.CONCLUSIONOur study demonstrates the feasibility of imaging the distribution of FDG uptake in engineered in vitro tumor models. With its high spatial resolution, the method can separately resolve tumor and stromal components. The approach could be extended to more advanced engineered cancer models but also to surgical tissue slices and tumor biopsies.
A Computational Model of the Epidermis With the Deformable Dermis and Its Application to Skin Diseases
Authors: Ohno Kota , Kobayashi Yasuaki , Uesaka Masaaki , Gotoda Takeshi , Denda Mitsuhiro , Kosumi Hideyuki , Watanabe Mika , Natsuga Ken , Nagayama Masaharu 
Published: March 2021

Abstract
The skin barrier is provided by the organized multi-layer structure of epidermal cells, which is dynamically maintained by a continuous supply of cells from the basal layer. The epidermal homeostasis can be disrupted by various skin diseases, which often cause morphological changes not only in the epidermis but in the dermis. We present a three-dimensional agent-based computational model of the epidermis that takes into account the deformability of the dermis. Our model can produce a stable epidermal structure with well-organized layers. We show that its stability depends on the cell supply rate from the basal layer. Modeling the morphological change of the dermis also enables us to investigate how the stiffness of the dermis affects the structure and barrier functions of the epidermis. Besides, we show that our model can simulate the formation of a corn (clavus) by assuming hyperproliferation and rapid differentiation. We also provide experimental data for human corn, which supports the model assumptions and the simulation result.