bluuebunny/crossref_metadata_2025_split huggingface dataset:
Norepinephrine versus ephedrine for hypotension prophylaxis during cesarean section under spinal anesthesia
Authors: Elagamy Ashraf E. , Kamaly Aiman M. , Shahin Mohamed I. , Saleh Mohamed 
Published: January 2021

Abstract
Background
Spinal anesthesia is the preferred anesthetic method for elective cesarean sections (C.S.) due to considerable risks regarding airway management associated with physiological changes of pregnancy. Hypotension is reported to occur in up to 80% of spinal anesthesia cases. Many approaches have been tried to prevent spinal hypotension, e.g., fluid loading, vasopressors, or both. The aim of this prospective, randomized, double blind study is to compare the administration of intermittent i.v. boluses of norepinephrine and ephedrine to guard against the hypotensive effect of spinal anesthesia during cesarean delivery.

Methods
In the present study, 120 pregnant female undergoing elective CS were randomly divided into “group E” for ephedrine and “group N” for norepinephrine, 60 female in each group. Standard spinal anesthetic technique using 25 spinal needle under complete aseptic technique with injection of 1.8–2.2 ml of heavy bupivacaine 0.5% plus 25 μg of fentanyl according to female height. Group E will receive 10 mg of i.v. diluted ephedrine as hypotension prophylaxis, and group N will receive 16 μg as hypotension prophylaxis at the time of intrathecal block. Measurements of intraoperative episodes of hypotension and their treatment with the same dose of the studied drug in each group, incidence of intraoperative nausea and vomiting, and APGAR score of baby at 1 and 5 min will be recorded.

Results
Compared with ephedrine, norepinephrine maintained maternal blood pressure. Further, it was associated with lower numbers of hypotension episodes, but more frequency of bradycardia during cesarean delivery.

Conclusion
Norepinephrine can be used as an alternative vasopressor to maintain maternal blood pressure during spinal anesthesia for cesarean delivery, with no adverse effect on neonatal outcome.
Impacts of increasing fine fuel loads on acorn germination and early growth of oak seedlings
Authors: Nation Rachel E. , Alexander Heather D. , Denny Geoff , McDaniel Jennifer K. , Paulson Alison K. 
Published: January 2021

AbstractBackgroundPrescribed fire is increasingly used to restore and maintain upland oak (QuercusL. spp.) ecosystems in the central and eastern US. However, little is known about how prescribed fire affects recently fallen acorns under different fine fuel loads, which can vary with stand composition and basal area, burn season, and fire frequency. We conducted plot-level (1 m2) burns in an upland oak stand in northern Mississippi, USA, during December 2018, using single (i.e.,ambient), double, and triple fine fuel loads, representative of those in nearby unburned and recently fire-treated, closed-canopy stands. Pre burn, we placed 30 acorns each of white oak (Quercus albaL.) and Shumard oak (Quercus shumardiiBuckley) ~1 cm below the litter surface in five plots of each fuel treatment. Immediately post burn, we planted unburned and burned acorns in a greenhouse. After ~50% of each species’ unburned acorns germinated, we measured percent germination and height, basal diameter, and leaf number of germinating seedlings weekly for 11 weeks. Then, we harvested seedlings to determine above- and belowground biomass.ResultsThe single fuel treatment reduced acorn germination rates of both species to ~40% compared to ~88% in unburned acorns. When burned in double and triple fuel loads, acorns of both species had a <5% germination rate. There was no difference in basal diameter, leaf number, or biomass of seedlings from burned versus unburned acorns for either species. However, seedlings originating from burned acorns of both species were ~11% shorter than those from unburned acorns. Thus, both species responded similarly to fuel load treatments.ConclusionsAcorns of both species exhibited greater survival with lower fine fuel loads, and consequently lower percent fuel consumption. Acorns germinating post fire generally produced seedlings with growth patterns similar to seedlings originating from unburned acorns. These findings indicate that regular, repeated prescribed fires or canopy reductions that limit fine fuel accumulation and create heterogeneous fuel beds are likely to increase acorn germination rates relative to unburned sites or those with recently introduced fire.
Interleukin-6 and C-reactive protein/albumin ratio as predictors of COVID-19 severity and mortality
Authors: El-Shabrawy Mohamed , Alsadik Maha E. , El-Shafei Maher , Abdelmoaty Ahmed A. , Alazzouni Ahmed S. , Esawy Marwa M. , Shabana Marwa A. 
Published: January 2021

Abstract
Background
Coronavirus disease 2019 (COVID-19) was announced in early December 2019. The pandemic situation is declared. This study aimed to evaluate the role of biomarkers in estimating the severity and predicting the prognosis of COVID-19.

Results
A total of 116 confirmed patients were included in this study. The patients were evaluated clinically. The disease severity was assessed. The measured and calculated laboratory tests were done. The primary outcome is the 30-day mortality. Patients were assigned to the severe (14.7%) and non-severe (85.3%) groups. At IL-6 level of 32.3 pg/mL (the highest Youden’s index = 0.77), IL-6 can differentiate severe from non-severe patients with 82.4% sensitivity and 94.4% specificity. IL-6 can predict the severity [odds ratio of 87.7 (95% CI = 18.9-408.2) (P < 0.0001)]. After adjustment to the significant clinical and laboratory parameters, IL-6 had an adjusted odds ratio of 30.8 (95% CI = 1.1-728.3) (P = 0.046). A high CRP/albumin ratio of > 11.4 was associated with COVID-19 mortality [hazard ratio = 59.9 (95% CI = 7.4–488.3) (P < 0.0001)]. High CRP/albumin ratio had an adjusted hazard ratio of 26.5 (95% CI = 2.6-270.7) after adjustment of age and presence of co-morbidities (P = 0.006).

Conclusion
IL-6 level could effectively discriminate COVID-19 severity. CRP/albumin ratio was an independent risk factor for 30-day mortality rate in patients with COVID-19. IL-6 and CRP/albumin ratio seem to be valuable biomarkers in evaluating the severity and prognosis of COVID-19, respectively.
Patient Perceptions of Treatment Benefit and Toxicity in Advanced Cancer: A Prospective Cross-Sectional Study
Authors: Patell Rushad , Einstein David , Miller Eric , Dodge Laura , Halleck Jennifer , Buss Mary 
Published: January 2021

PURPOSE: Prior studies show that many patients receiving palliative cancer therapies misperceive likelihood of cure. Patients’ understanding of treatment benefits and risks beyond cure is unknown. We explore patient perceptions of palliative treatment in the novel therapeutic era. METHODS: We surveyed patients with advanced solid cancers and their oncologists regarding benefits and risks of palliative therapies. We assessed perceived likelihood of tumor response, survival benefit, symptom palliation, and side effects. We used generalized estimating equations to calculate least squares means of misperception (patient-assessed minus physician-assessed likelihood of benefit), accounting for clustering by physician, and compared the degree of misperception by participant characteristics. RESULTS: Of the 119 patients enrolled, median age was 65 years (range, 59-73 years), 55% were male, and 56% had prior treatment. Treatments included chemotherapy (60%), immunotherapy (24%), and targeted therapy (15%). Compared with their oncologists, patients overestimate curability (median misperception, 20%; interquartile range [IQR], 0 to 60), chances of tumor response (median, 20%; IQR, 0 to 40), symptom palliation (median, 10%; IQR, −10 to 30), and survival benefit (median, 20%; IQR, 0 to 40). Toxicity was relatively accurately estimated (median, 0.5%; IQR, −20 to 20). Immunotherapy was associated with higher risk of misperception of tumor response and toxicity. Misperceptions of tumor response and curability did not correlate (r = 0.13, P = .15). CONCLUSION: Compared with their oncologists, patients overestimated chances of tumor response, symptom palliation, and survival benefit, but accurately perceived likelihood of toxicity. There was no strong correlation between perception of curability and other goals of therapy. Communication focused on treatment goals alongside risks may reduce misperceptions and facilitate informed choices by patients.
Anesthesiology Residents’ Experiences and Perspectives of Residency Training
Authors: Sun Huaping , Chen Dandan , Warner David O. , Zhou Yan , Nemergut Edward C. , Macario Alex , Keegan Mark T. 
Published: January 2021

BACKGROUND:
Anesthesiology residents’ experiences and perspectives about their programs may be helpful in improving training. The goals of this repeated cross-sectional survey study are to determine: (1) the most important factors residents consider in choosing an anesthesiology residency, (2) the aspects of the clinical base year that best prepare residents for anesthesia clinical training, and what could be improved, (3) whether residents are satisfied with their anesthesiology residency and what their primary struggles are, and (4) whether residents believe their residency prepares them for proficiency in the 6 Accreditation Council for Graduate Medical Education (ACGME) Core Competencies and for independent practice.

METHODS:
Anesthesiologists beginning their US residency training from 2013 to 2016 were invited to participate in anonymous, confidential, and voluntary self-administered online surveys. Resident cohort was defined by clinical anesthesia year 1, such that 9 survey administrations were included in this study—3 surveys for the 2013 and 2014 cohorts (clinical anesthesia years 1–3), 2 surveys for the 2015 cohort (clinical anesthesia years 1–2), and 1 survey for the 2016 cohort (clinical anesthesia year 1).

RESULTS:
The overall response rate was 36% (4707 responses to 12,929 invitations). On a 5-point Likert scale with 1 as “very unimportant” and 5 as “very important,” quality of clinical experience (4.7–4.8 among the cohorts) and departmental commitment to education (4.3–4.5) were rated as the most important factors in anesthesiologists’ choice of residency. Approximately 70% of first- and second-year residents agreed that their clinical base year prepared them well for anesthesiology residency, particularly clinical training experiences in critical care rotations, anesthesiology rotations, and surgery rotations/perioperative procedure management. Overall, residents were satisfied with their choice of anesthesiology specialty (4.4–4.5 on a 5-point scale among cohort-training levels) and their residency programs (4.0–4.1). The residency training experiences mostly met their expectations (3.8–4.0). Senior residents who reported any struggles highlighted academic more than interpersonal or technical difficulties. Senior residents generally agreed that the residency adequately prepared them for independent practice (4.1–4.4). Of the 6 ACGME Core Competencies, residents had the highest confidence in professionalism (4.7–4.9) and interpersonal and communication skills (4.6–4.8). Areas in residency that could be improved include the provision of an appropriate balance between education and service and allowance for sufficient time off to search and interview for a postresidency position.

CONCLUSIONS:
Anesthesiology residents in the United States indicated they most value quality of clinical training experiences and are generally satisfied with their choice of specialty and residency program.
Gender, Sovereignty, and the Discourse of Rights in Native Women’s Activism
Authors: Barker Joanne 
Published: January 2021

AbstractDrawing from Native feminist theories and sovereignty studies, this essay examines the 1983 and 1985 amendments and the activism that led to their development and passage as an instance of the co-constitutive relationship of gender and sovereignty. By looking at how the discourse of rights was mobilized from very different contexts to very different ends by various constituencies of Indian men, women, and their allies, this essay modestly opens the conflicts surrounding gender politics and women’s rights in Native sovereignty movements. I hope to provide a forum for thinking about the kinds of social reformations that are needed to bring about social equity between and for men and women in Indian communities—an equity that is an essential aspect of decolonization and social justice for Native peoples in North America.
What Is Reproductive Justice?
Authors: Price Kimala 
Published: January 2021

AbstractFrustrated by the individualist approach of the “choice” paradigm used by the mainstream reproductive rights movement in the United States, a growing coalition of women of color organizations and their allies have sought to redefine and broaden the scope of reproductive rights by using a human rights framework. Dubbing itself “the movement for reproductive justice,” this coalition connects reproductive rights to other social justice issues such as economic justice, education, immigrant rights, environmental justice, sexual rights, and globalization, and believes that this new framework will encourage more women of color and other marginalized groups to become more involved in the political movement for reproductive freedom. Using narrative analysis, this essay explores what reproductive justice means to this movement, while placing it within the political, social, and cultural context from which it emerged.
The SPECTRUM Consortium: a new UK Prevention Research Partnership consortium focussed on the commercial determinants of health, the prevention of non-communicable diseases, and the reduction of health inequalities
Authors: Horton Marie , Perman-Howe Parvati R. , Angus Colin , Bishop Julie , Bogdanovica Ilze , Brennan Alan , Britton John , Brose Leonie S. , Brown Jamie , Collin Jeff , Dockrell Martin , Fitzgerald Niamh , Friel Sharon , Gillespie Duncan , Gilmore Anna B. , Hill Sarah E. , Knai Cecile , Langley Tessa , Martin Sancha , McNeill Ann , Moore Graham , Munafò Marcus R. , Murray Rachael L. , Opazo Breton Magdelena , Pearce Jamie , Petticrew Mark , Reid Garth , Robson Deborah , Rutter Harry , Shahab Lion , Shortt Niamh , Smith Katherine , Syrett Keith , Bauld Linda 
Published: January 2021

The main causes of non-communicable diseases (NCDs), health inequalities and health inequity include consumption of unhealthy commodities such as tobacco, alcohol and/or foods high in fat, salt and/or sugar. These exposures are preventable, but the commodities involved are highly profitable. The economic interests of ‘Unhealthy Commodity Producers’ (UCPs) often conflict with health goals but their role in determining health has received insufficient attention. In order to address this gap, a new research consortium has been established. This open letter introduces the SPECTRUM (Shaping Public hEalth poliCies To Reduce ineqUalities and harM) Consortium: a multi-disciplinary group comprising researchers from 10 United Kingdom (UK) universities and overseas, and partner organisations including three national public health agencies in Great Britain (GB), five multi-agency alliances and two companies providing data and analytic support. Through eight integrated work packages, the Consortium seeks to provide an understanding of the nature of the complex systems underlying the consumption of unhealthy commodities, the role of UCPs in shaping these systems and influencing health and policy, the role of systems-level interventions, and the effectiveness of existing and emerging policies. Co-production is central to the Consortium’s approach to advance research and achieve meaningful impact and we will involve the public in the design and delivery of our research. We will also establish and sustain mutually beneficial relationships with policy makers, alongside our partners, to increase the visibility, credibility and impact of our evidence. The Consortium’s ultimate aim is to achieve meaningful health benefits for the UK population by reducing harm and inequalities from the consumption of unhealthy commodities over the next five years and beyond.
Polygenic risk scores in cardiovascular risk prediction: A cohort study and modelling analyses
Authors: Sun Luanluan , Pennells Lisa , Kaptoge Stephen , Nelson Christopher P. , Ritchie Scott C. , Abraham Gad , Arnold Matthew , Bell Steven , Bolton Thomas , Burgess Stephen , Dudbridge Frank , Guo Qi , Sofianopoulou Eleni , Stevens David , Thompson John R. , Butterworth Adam S. , Wood Angela , Danesh John , Samani Nilesh J. , Inouye Michael , Di Angelantonio Emanuele 
Published: January 2021

Background
Polygenic risk scores (PRSs) can stratify populations into cardiovascular disease (CVD) risk groups. We aimed to quantify the potential advantage of adding information on PRSs to conventional risk factors in the primary prevention of CVD.

Methods and findings
Using data from UK Biobank on 306,654 individuals without a history of CVD and not on lipid-lowering treatments (mean age [SD]: 56.0 [8.0] years; females: 57%; median follow-up: 8.1 years), we calculated measures of risk discrimination and reclassification upon addition of PRSs to risk factors in a conventional risk prediction model (i.e., age, sex, systolic blood pressure, smoking status, history of diabetes, and total and high-density lipoprotein cholesterol). We then modelled the implications of initiating guideline-recommended statin therapy in a primary care setting using incidence rates from 2.1 million individuals from the Clinical Practice Research Datalink. The C-index, a measure of risk discrimination, was 0.710 (95% CI 0.703–0.717) for a CVD prediction model containing conventional risk predictors alone. Addition of information on PRSs increased the C-index by 0.012 (95% CI 0.009–0.015), and resulted in continuous net reclassification improvements of about 10% and 12% in cases and non-cases, respectively. If a PRS were assessed in the entire UK primary care population aged 40–75 years, assuming that statin therapy would be initiated in accordance with the UK National Institute for Health and Care Excellence guidelines (i.e., for persons with a predicted risk of ≥10% and for those with certain other risk factors, such as diabetes, irrespective of their 10-year predicted risk), then it could help prevent 1 additional CVD event for approximately every 5,750 individuals screened. By contrast, targeted assessment only among people at intermediate (i.e., 5% to <10%) 10-year CVD risk could help prevent 1 additional CVD event for approximately every 340 individuals screened. Such a targeted strategy could help prevent 7% more CVD events than conventional risk prediction alone. Potential gains afforded by assessment of PRSs on top of conventional risk factors would be about 1.5-fold greater than those provided by assessment of C-reactive protein, a plasma biomarker included in some risk prediction guidelines. Potential limitations of this study include its restriction to European ancestry participants and a lack of health economic evaluation.

Conclusions
Our results suggest that addition of PRSs to conventional risk factors can modestly enhance prediction of first-onset CVD and could translate into population health benefits if used at scale.
Breast self-examination practice and its determinants among women in Ethiopia: A systematic review and meta-analysis
Authors: Yeshitila Yordanos Gizachew , Kassa Getachew Mullu , Gebeyehu Selamawit , Memiah Peter , Desta Melaku 
Published: January 2021

Background
The survival rate from breast cancer is lowest in African countries and the distribution of breast self-examination practice of and its determinants are not well investigated in Ethiopia. Therefore, this systematic review and meta-analysis was designed to determine the pooled prevalence of breast self-examination and its associated factors among women in Ethiopia.

Methods
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed for this systematic review and meta-analysis. The databases used were; PUBMED, Cochrane Library, Google Scholar, CINAHL, African Journals Online, Dimensions and Summon per country online databases. Search terms used were; breast self-examination, breast cancer screening, early detection of breast cancer and Ethiopia. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used for critical appraisal of studies. The meta-analysis was conducted using STATA 15 software. The pooled meta-analysis was computed to present the pooled prevalence and relative risks (RRs) of the determinate factors with 95% confidence intervals (CIs).

Results
We identified 2,637 studies, of which, 40 articles (with 17,820 participants) were eligible for inclusion in the final meta-analysis. The pooled estimate of breast self-examination in Ethiopia was 36.72% (95% CI: 29.90, 43.53). The regional distribution breast self-examination ranged from 21.2% (95% CI: 4.49, 37.91) in Tigray to 61.5% (95% CI: 53.98, 69.02) in Gambela region. The lowest prevalence of breast self-examination was observed among the general population (20.43% (95% CI: 14.13, 26.72)). Women who had non-formal educational status (OR = 0.4 (95% CI: 0.21, 0.77)), family history of breast cancer (OR = 2.04 (95% CI: 1.23, 3.39)), good knowledge of breast self-examination (OR = 4.8 (95% CI: 3.03, 7.6)) and favorable attitude toward breast self-examination (OR = 2.75, (95% CI: 1.66, 4.55)) were significantly associated with practice of breast self-examination.

Conclusions
Only a third of women in Ethiopia practiced breast examination despite WHO guidelines advocating for this practice among all women of reproductive age. Intervention programs should address the factors that are associated with breast self-examination. Population specific programs are needed to promote breast self-examination.
Psychological therapies for adolescents with borderline personality disorder (BPD) or BPD features—A systematic review of randomized clinical trials with meta-analysis and Trial Sequential Analysis
Authors: Jørgensen Mie Sedoc , Storebø Ole Jakob , Stoffers-Winterling Jutta M. , Faltinsen Erlend , Todorovac Adnan , Simonsen Erik 
Published: January 2021

Objectives
To review the effectiveness of psychological therapies for adolescents with borderline personality disorder (BPD) or BPD features.

Methods
We included randomized clinical trials on psychological therapies for adolescents with BPD and BPD features. Data were extracted and assessed for quality according to Cochrane guidelines, and summarized as mean difference (MD) with 95% confidence intervals (CI) for continuous data and as Odds ratios (OR) with 95% CI for dichotomous data. Risk of bias was assessed using Cochrane’s risk of bias tool for each domain. When possible, we pooled trials into meta-analyses, and used Trial Sequential Analysis (TSA) to control for random errors. Quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE).

Results
10 trials on adolescents with BPD or BPD features were included. All trials were considered at high risk of bias, and the quality of the evidence was rated as “very low”. We did TSA on the primary outcome and found that the required information size was reached. The risk of random error was thus discarded.

Conclusion
Only 10 trials have been conducted on adolescents with BPD or BPD features. Of these only few showed superior outcomes of the experimental intervention compared to the control intervention. No adverse effects of the interventions were mentioned. Attrition rates varied from 15–75% in experimental interventions. The overall quality was very low due to high risk of bias, imprecision and inconsistency, which limits the confidence in effect estimates. Due to the high risk of bias, high attrition rates and underpowered studies in this area, it is difficult to derive any conclusions on the efficacy of psychological therapies for BPD in adolescence. There is a need for more high quality trials with larger samples to identify effective psychological therapies for this specific age group with BPD or BPD features.