bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sub-national analysis and determinants of numbers of antenatal care contacts in Nigeria: assessing the compliance with the WHO recommended standard guidelines
Authors: Fagbamigbe Adeniyi Francis , Olaseinde Olugbenga , Setlhare Vincent 
Published: May 2021

AbstractBackgroundNigeria has unimpressive maternal and child health indicators. Compliance with the WHO guidelines on the minimum number of antenatal care (ANC) contacts could improve these indicators. We assessed the compliance with WHO recommended standards on ANC contacts in Nigeria and identify the associated factors.MethodsNationally representative cross-sectional data during pregnancy of 21,785 most recent births within five years preceding the 2018 Nigeria Demographic Health Survey was used. The number of ANC contacts was categorised into “None”, “1–3”, “4–7” and “8 or more” contacts based on subsequent WHO guidelines. Descriptive statistics, bivariable and multivariable multinomial logistic regression was used atp = 0.05.ResultsAbout 25 % of the women had no ANC contact, 58 % had at least 4 contacts while only 20 % had 8 or more ANC contacts. The highest rate of 8 or more ANC contacts was in Osun (80.2 %), Lagos (76.8 %), and Imo (72.0 %) while the lowest rates were in Kebbi (0.2 %), Zamfara (1.1 %) and Yobe (1.3 %). Respondents with higher education were twelve times (adjusted relative risk (aRR): 12.46, 95 % CI: 7.33–21.2), having secondary education was thrice (aRR: 2.91, 95 % CI: 2.35–3.60), and having primary education was twice (aRR: 2.17, 95 % CI: 1.77–2.66) more likely to make at least 8 contacts than those with no education. Respondents from households in the richest and middle wealth categories were 129 and 67 % more likely to make 8 or more ANC contacts compared to those from households in the lowest wealth category respectively. The likelihood of making 8 ANC contacts was 89 and 47 % higher among respondents from communities in the least and middle disadvantaged groups, respectively, compared to the most disadvantaged group. Other significant variables were spouse education, health care decision making, media access, ethnicity, religion, and other community factors.ConclusionsCompliance with WHO guidelines on the minimum number of ANC contacts in Nigeria is poor. Thus, Nigeria has a long walk to attaining sustainable development goal’s targets on child and maternal health. We recommend that the maternal and child health programmers should review existing policies and develop new policies to adopt, implement and tackle the challenges of adherence to the WHO recommended minimum of 8 ANC contacts. Women's education, socioeconomic status and adequate mobilization of families should be prioritized. There is a need for urgent intervention to narrow the identified inequalities and substantial disparities in the characteristics of pregnant women across the regions and states.
High mortality rate of obstetric critically ill women in Rwanda and its predictability
Authors: Rudakemwa Alcade , Cassidy Amyl Lucille , Twagirumugabe Théogène 
Published: May 2021

Abstract
Background
Reasons for admission to intensive care units (ICUs) for obstetric patients vary from one setting to another. Outcomes from ICU and prediction models are not well explored in Rwanda owing to lack of appropriate scores. This study aimed to assess reasons for admission and accuracy of prediction models for mortality of obstetric patients admitted to ICUs of two public tertiary hospitals in Rwanda.

Methods
We prospectively collected data from all obstetric patients admitted to the ICUs of the two public tertiary hospitals in Rwanda from March 2017 to February 2018 to identify reasons for admission, demographic and clinical characteristics, outcome including death and its predictability by both the Modified Early Obstetric Warning Score (MEOWS) and quick Sequential Organ Failure Assessment (qSOFA). We analysed the accuracy of mortality prediction models by MEOWS or qSOFA by using logistic regression adjusting for factors associated with mortality. Area under the Receiver Operating characteristic (AUROC) curves is used to show the predicting capacity for each individual tool.

Results
Obstetric patients (n = 94) represented 12.8 % of all 747 ICU admissions which is 1.8 % of all 4.999 admitted women for pregnancy or labor. Sepsis (n = 30; 31.9 %) and obstetric haemorrhage (n = 24; 25.5 %) were the two commonest reasons for ICU admission. Overall ICU mortality for obstetric patients was 54.3 % (n = 51) with average length of stay of 6.6 ± 7.525 days. MEOWS score was an independent predictor of mortality (adjusted (a)OR 1.25; 95 % CI 1.07–1.46) and so was qSOFA score (aOR 2.81; 95 % CI 1.25–6.30) with an adjusted AUROC of 0.773 (95 % CI 0.67–0.88) and 0.764 (95 % CI 0.65–0.87), indicating fair accuracy for ICU mortality prediction in these settings of both MEOWS and qSOFA scores.

Conclusions
Sepsis and obstetric haemorrhage were the commonest reasons for obstetric admissions to ICU in Rwanda. MEOWS and qSOFA scores could accurately predict ICU mortality of obstetric patients in resource-limited settings, but larger studies are needed before a recommendation for their use in routine practice in similar settings.
Integrated analysis of methylation-driven genes and pretreatment prognostic factors in patients with hepatocellular carcinoma
Authors: He Dongsheng , Liao Shengyin , Cai Lifang , Huang Weiming , Xie Xuehua , You Mengxing 
Published: May 2021

Abstract
Background
The potential reversibility of aberrant DNA methylation indicates an opportunity for oncotherapy. This study aimed to integrate methylation-driven genes and pretreatment prognostic factors and then construct a new individual prognostic model in hepatocellular carcinoma (HCC) patients.

Methods
The gene methylation, gene expression dataset and clinical information of HCC patients were downloaded from The Cancer Genome Atlas (TCGA) database. Methylation-driven genes were screened with a Pearson’s correlation coefficient less than − 0.3 and a P value less than 0.05. Univariable and multivariable Cox regression analyses were performed to construct a risk score model and identify independent prognostic factors from the clinical parameters of HCC patients. The least absolute shrinkage and selection operator (LASSO) technique was used to construct a nomogram that might act to predict an individual’s OS, and then C-index, ROC curve and calibration plot were used to test the practicability. The correlation between clinical parameters and core methylation-driven genes of HCC patients was explored with Student’s t-test.

Results
In this study, 44 methylation-driven genes were discovered, and three prognostic signatures (LCAT, RPS6KA6, and C5orf58) were screened to construct a prognostic risk model of HCC patients. Five clinical factors, including T stage, risk score, cancer status, surgical method and new tumor events, were identified from 13 clinical parameters as pretreatment-independent prognostic factors. To avoid overfitting, LASSO analysis was used to construct a nomogram that could be used to calculate the OS in HCC patients. The C-index was superior to that from previous studies (0.75 vs 0.717, 0.676). Furthermore, LCAT was found to be correlated with T stage and new tumor events, and RPS6KA6 was found to be correlated with T stage.

Conclusion
We identified novel therapeutic targets and constructed an individual prognostic model that can be used to guide personalized treatment in HCC patients.
Comprehensive analysis of DNA damage repair genes reveals pathogenic variants beyond BRCA and suggests the need for extensive genetic testing in pancreatic cancer
Authors: Rapposelli Ilario Giovanni , Zampiga Valentina , Cangini Ilaria , Arcangeli Valentina , Ravegnani Mila , Valgiusti Martina , Pini Sara , Tamberi Stefano , Bartolini Giulia , Passardi Alessandro , Martinelli Giovanni , Calistri Daniele , Frassineti Giovanni Luca , Falcini Fabio , Danesi Rita 
Published: May 2021

Abstract
Background
Pancreatic cancer (PC) is a major cause of cancer death. In an effort to improve treatment strategies and outcomes, DNA damage repair (DDR) pathways have been introduced as a new target in PC and in other cancers, through the exploitation of synthetic lethality. Furthermore, genes involved in DDR are among the major determinants of cancer susceptibility. In addition to the well-known BRCA1 and BRCA2 genes, a plethora of other targets in the same pathways are now emerging.

Methods
We analyzed samples from 60 patients, affected by PC and already tested for BRCA, using a panel with 24 other cancer susceptibility genes.

Results
We detected 8 pathogenic or likely pathogenic mutations (13.3% of samples analyzed), 4 of which were found in non-BRCA genes (2 in ATM, 1 each in PALB2 and RAD50). Furthermore, 4 pathogenic or likely pathogenic mutations were found in patients without a personal or familial history of cancer.

Conclusions
Our results suggest that genetic testing with a comprehensive gene panel should be perfomed in all patients with PC, in order to allow screening for PC and other gene-related cancers in all at risk family members and to assess patients’ eligibility for emerging therapeutic options.
Risk perceptions and attitudinal responses to COVID-19 pandemic: an online survey in Ethiopia
Authors: Birhanu Zewdie , Ambelu Argaw , Fufa Diriba , Mecha Mohammed , Zeynudin Ahmed , Abafita Jemal , Belay Ashenafi , Doyore Feleke , Oljira Lemessa , Bacha Endale , Feyisa Jilcha , Hadis Zinabu , Ayele Ketema , Addisu Yohannes , Gutu Birhanu , Tesfaye Demu , Tilahun Temesgen , Imana Gudeta , Tolosa Tadele , Mekonen Seblework , Yitayih Yimenu , Jibat Nega , Moges Mathewos , Adamu Ayinengida , Teym Abraham , Kenea Adamu , Addis Taffere , Mengesha Akalework , Kebede Yohannes 
Published: May 2021

AbstractBackgroundEffective risk communication is one of the critical strategies in the response to COVID-19. This study examined risk perceptions and attitudinal responses to COVID-19 among the educated section of the society in Ethiopia.MethodsAn internet-based survey was conducted from April 22 to May 04, 2020, in Ethiopia. A questionnaire addressing the perception of health threat-combination of perceived vulnerability (PV) and perceived seriousness (PS), and perceived efficacy-combinations of perceived response efficacy (PRE), perceived self-efficacy (PSE), and perceived collective efficacy (PCE). The data were analyzed using SPSS 21.0. Descriptive statistics were computed after the standardization of the scores. The scores for overall efficacy and threat were split by median value and response classifications were generated through threat by efficacy interactions. For statistical significance, 95% CI andp-value < 0.05 were used.ResultsA total of 929 respondents submitted their responses. Eight hundred and twenty-eight (89.1%) of the respondents were male and 753 (81.1%) were Christian. The perceived threat to COVID-19 was generally low (median = 58.3). The median score for overall efficacy, PRE, and PSE were 79.8, 87.5, and 80.0, respectively. However, the median value (66.7) for PCE was relatively low. Perceived threat significantly varied by age, education, occupation, and place of residence (p < 0.05). Perceived efficacy significantly differed by gender, residence, and use of some sources of information (p < 0.05). In terms of response to COVID-19, 290 (31.2%), 239 (25.7%), 175 (18.8%) and 225 (24.2%) of the respondents were in the responsive, pro-active, avoidant, and indifferent attitudinal categories, respectively. The avoidant and indifferent groups constituted a fear control response (mal-adaptive motivation towards COVID-19 protective behavior) whereas responsive and pro-active categories formed a danger control response (self-protective motivation). These responses varied significantly by residence, region, religion, and sources of information (p < 0.05).ConclusionsUnderstanding people’s perceived health threat and efficacy is a critical step toward creating risk communication campaigns. Hence, this study provided an insight that has the potential to inform the COVID-19 risk communication campaigns targeting the educated section of the society, by ensuring a balanced combination of threat appeals and efficacy messages for improved self-protective responses.
Osteitis fibrosa cystica mimicking bone tumor, a case report
Authors: Nasser Maya L. , Medawar Serge , Younan Tonine , Abboud Halim , Trak-Smayra Viviane 
Published: May 2021

Abstract
Background
We report a case of osteitis fibrosa cystica, a rare benign resorptive bone lesion caused by hyperparathyroidism, that presented on imaging as an aggressive bone tumor.

Case presentation
The patient is a 51-year-old male complaining of severe sustained pain of the right hip region. Imaging studies were suspicious for a malignant tumor of the right iliac bone. Biopsy under CT guidance was performed and showed remodeled bone trabeculae with numerous osteoclasts, excluding bone tumor and raising the possibility of osteitis fibrosa cystica. Complementary tests disclosed elevated blood level of parathyroid hormone and a partially cystic enlarged left inferior parathyroid gland consistent with adenoma. After parathyroidectomy, the clinical symptoms were relieved and the radiological findings were significantly improved, which confirmed the diagnosis.

Conclusions
Metabolic diseases-associated bone lesions should always be considered in the differential diagnosis of bone tumors, to avoid unnecessary surgeries and treatments.
A multi-site study on the impact of an advance care planning workshop on attitudes, beliefs and behavioural intentions over a 6-month period
Authors: Yu C. C. , Koh E. J. , Low J. A. , Ong M. L. , Sim A. G. H. , Hong D. Y. Q. , Chong R. , Low J. , Ng R. 
Published: May 2021

Abstract
Background
This study evaluated the impact of the adapted version of the Respecting Choices® The Living Matters Advance Care Planning (ACP) facilitator training programme on trainees’ attitudes on facilitation 6 months post-training.

Setting and participants
Two hundred and twenty-one healthcare professionals consisting of doctors, nurses, medical social workers from different training venues in Singapore participated in the first phase of the study (pre- and post) of which 107 participated in the second phase 6 months later (follow-up).

Methods
Participants self-rated their attitudes, beliefs and behavioural intentions through surveys at three time points in an evaluation design that utilised repeated measures one-way ANOVA (pre-, post-, follow-up). Between-group differences were also examined using independent t-test.

Results
At follow-up, mean scores increased significantly in understanding, confidence, and competence. Changes in effect sizes were large. Although trainees continued to think that ACP is emotionally draining for facilitators, more than before, facilitation experience was considered pleasant for themselves with the positive change significant and moderate in effect size. Those who had experience completing/initiating ACP significantly held more positive views than those who did not.

Conclusions
The ACP facilitator training programme had lasting effects on enhancing the understanding, competence, and confidence of trainees. Importantly, findings showed that experience in actual facilitation within 6 months after training was important and giving trainees opportunities to facilitate is recommended.
Classification of COVID-19 electrocardiograms by using hexaxial feature mapping and deep learning
Authors: Ozdemir Mehmet Akif , Ozdemir Gizem Dilara , Guren Onan 
Published: May 2021

Abstract
Background
Coronavirus disease 2019 (COVID-19) has become a pandemic since its first appearance in late 2019. Deaths caused by COVID-19 are still increasing day by day and early diagnosis has become crucial. Since current diagnostic methods have many disadvantages, new investigations are needed to improve the performance of diagnosis.

Methods
A novel method is proposed to automatically diagnose COVID-19 by using Electrocardiogram (ECG) data with deep learning for the first time. Moreover, a new and effective method called hexaxial feature mapping is proposed to represent 12-lead ECG to 2D colorful images. Gray-Level Co-Occurrence Matrix (GLCM) method is used to extract features and generate hexaxial mapping images. These generated images are then fed into a new Convolutional Neural Network (CNN) architecture to diagnose COVID-19.

Results
Two different classification scenarios are conducted on a publicly available paper-based ECG image dataset to reveal the diagnostic capability and performance of the proposed approach. In the first scenario, ECG data labeled as COVID-19 and No-Findings (normal) are classified to evaluate COVID-19 classification ability. According to results, the proposed approach provides encouraging COVID-19 detection performance with an accuracy of 96.20% and F1-Score of 96.30%. In the second scenario, ECG data labeled as Negative (normal, abnormal, and myocardial infarction) and Positive (COVID-19) are classified to evaluate COVID-19 diagnostic ability. The experimental results demonstrated that the proposed approach provides satisfactory COVID-19 prediction performance with an accuracy of 93.00% and F1-Score of 93.20%. Furthermore, different experimental studies are conducted to evaluate the robustness of the proposed approach.

Conclusion
Automatic detection of cardiovascular changes caused by COVID-19 can be possible with a deep learning framework through ECG data. This not only proves the presence of cardiovascular changes caused by COVID-19 but also reveals that ECG can potentially be used in the diagnosis of COVID-19. We believe the proposed study may provide a crucial decision-making system for healthcare professionals.

Source code
All source codes are made publicly available at: https://github.com/mkfzdmr/COVID-19-ECG-Classification
The situation and influencing factors of outpatient satisfaction in large hospitals: Evidence from Henan province, China
Authors: Ren Weicun , Sun Lei , Tarimo Clifford Silver , Li Quanman , Wu Jian 
Published: May 2021

AbstractBackgroundThe level of outpatient satisfaction plays a significant role in improving the quality and utilization of healthcare services. Patient satisfaction gives providers insights into various aspects of services including the effectiveness of care and level of empathy. This study aimed to evaluate the level of patient satisfaction in the outpatient department and to explore its influencing factors in large hospitals (accommodating over 1000 beds) of Henan province, China.MethodsWe analyzed data from Henan Large Hospitals Patient Satisfaction Survey conducted in the year 2018 and included 630 outpatients. Structural Equation Model (SEM) was used to explore the relationship among evaluation indicators of outpatient satisfaction levels. We used Dynamic Matter-Element Analysis (DMA) to evaluate the status of outpatient satisfaction. Binary Logistic Regression (BLR) was adopted to estimate the impact of personal characteristics towards outpatient satisfaction.ResultsThe overall score for outpatient satisfaction in large hospitals was 66.28±14.73. The mean outpatient satisfaction scores for normal-large, medium-large, and extra-large hospitals were 63.33±12.12, 70.11±16.10, 65.41±14.67, respectively, and were significantly different (F= 11.953,P< 0.001). Waiting time, doctor-patient communication, professional services, and accessibility for treatment information were shown to have directly positive correlations with outpatient satisfaction (r= 0.42, 0.47, 0.55, 0.46, allP< 0.05). Results from BLR analysis revealed that patients’ age and frequency of hospital visits were the main characteristics influencing outpatient satisfaction (P< 0.05).ConclusionsThe outpatient satisfaction of large hospitals is moderately low. Hospital managers could shorten the waiting time for outpatients and improve the access to treatment information to improve the satisfaction of outpatients. It is also necessary to enhance service provision for outpatients under the age of 18 as well as the first-time patients.
New therapeutic approaches of mesenchymal stem cells-derived exosomes
Authors: Janockova Jana , Slovinska Lucia , Harvanova Denisa , Spakova Timea , Rosocha Jan 
Published: May 2021

AbstractMesenchymal stem cells (MSCs) have been demonstrated to have a great potential in the treatment of several diseases due to their differentiation and immunomodulatory capabilities and their ability to be easily cultured and manipulated. Recent investigations revealed that their therapeutic effect is largely mediated by the secretion of paracrine factors including exosomes. Exosomes reflect biophysical features of MSCs and are considered more effective than MSCs themselves. Alternative approaches based on MSC-derived exosomes can offer appreciable promise in overcoming the limitations and practical challenges observed in cell-based therapy. Furthermore, MSC-derived exosomes may provide a potent therapeutic strategy for various diseases and are promising candidates for cell-based and cell-free regenerative medicine. This review briefly summarizes the development of MSCs as a treatment for human diseases as well as describes our current knowledge about exosomes: their biogenesis and molecular composition, and how they exert their effects on target cells. Particularly, the therapeutic potential of MSC-derived exosomes in experimental models and recent clinical trials to evaluate their safety and efficacy are summarized in this study. Overall, this paper provides a current overview of exosomes as a new cell-free therapeutic agent.
Using dynamic cell communication improves treatment strategies of breast cancer
Authors: Liu Zhibo , Hu Song , Yun Zehui , Hu Wanshan , Zhang Shuhua , Luo Daya 
Published: May 2021

AbstractSeveral insights from the clinical treatment of breast cancer patients have revealed that only a portion of patients achieve the expected curative effect after traditional targeted therapy, that surgical treatment may promote the development of cancer metastasis, and that the optimal combination of neoadjuvant chemotherapy and traditional treatment is not clear. Therefore, a more precise classification of breast cancer and selection of treatment methods should be undertaken to improve the efficacy of clinical treatment. In the clinical treatment of breast cancer, cell communication molecules are often selected as therapeutic targets. However, various cell communications are not static. Their dynamic changes are related to communicating cells, communicating molecules, and various intertwined internal and external environmental factors. Understanding the dynamic microenvironment can help us improve therapeutic efficacy and provide new ways to more accurately determine the cancer status. Therefore, this review describes multiple types of cellular communication in the breast cancer microenvironment and incorporates internal and external environmental factors as variable signaling factors in cell communication. Using dynamic and developmental concepts, we summarize the functional changes in signaling molecules and cells to aid in the diagnosis and treatment of breast cancer.