bluuebunny/crossref_metadata_2025_split huggingface dataset:
Regional lymph node metastases in cutaneous melanoma: a single-center analysis from southeast europe
Authors: Rajović Milica , Jaukovic Ljiljana , Kandolf Sekulovic Lidija , Radulovic Marija , Petrov Nenad , Mijuskovic Zeljko , Stepic Nenad , Nikolic Zivan 
Published: February 2021

Objective: Sentinel lymph node biopsy is the standard of care for nodal staging in clinically node-negative melanoma patients. Our goal was to present 10-year results of sentinel lymph node biopsy at our institution and to evaluate the clinicopathologic factors as potential predictors of sentinel lymph node and non-sentinel lymph node metastatic involvement in patients with cutaneous melanoma. Methods: We have analyzed clinicopathologic and lymphoscintigraphic characteristics in 420 patients with cutaneous melanoma who underwent sentinel lymph node biopsy between 2010 and 2019. In addition, we have examined the results of group of patients with positive sentinel lymph node biopsy undergoing complete lymph node dissection. Results: The overall detection rate of sentinel lymph node biopsies was 97.1%, of which 18.8% was metastatic. Drainage to one regional basin was seen in 345 patients (83.1%) and to multiple drainage regions in 71 patients (17%). In-transit lymph nodes were detected in 20 patients. On univariate logistic regression analysis, male gender, primary tumor thickness with nodular histology, acral location, presence of ulceration, and the number of nodes harvested were significantly associated with sentinel lymph node biopsy status ( p < 0.05). On multivariate analysis, the Breslow thickness was the only independent predictor of sentinel lymph node biopsy status. The metastases in non-sentinel lymph node found in 26 patients with positive sentinel lymph node (35.6%) correlated on univariate, as well as on multivariate logistic regression, with tumor subtype and number of sentinel lymph node harvested. Conclusions: In addition to the well-established primary tumor thickness as a predictor of sentinel lymph node biopsy positivity, we observed acral location and nodular melanoma subtype to significantly enhance the risk of metastases in sentinel lymph node(s). Primary tumor histology and number of nodes harvested were the only statistically significant variables predicting the non-sentinel lymph node status on multivariate analysis. Lymphoscintigraphy imaging characteristics were not significantly associated with sentinel lymph node status.
Exploring Mistakes and Failures in Social Marketing: The Inside Story
Authors: Cook Julie , Lynes Jennifer , Fries Sarah 
Published: February 2021

Background: Social marketing successes are relatively well-documented, but mistakes and failures in the field are not. When mistakes and failures are reported, they are usually on an ad hoc basis, as opposed to a systematic gathering of evidence. This paper is the second half of a two-part research study that aims to understand the perceptions of social marketing professionals with regard to mistakes and failures in the field. Focus: This article is related to research and evaluation of the social marketing field. Research Question: What are the perceptions of the social marketing community regarding mistakes and failures in the field? Importance to the field: A greater understanding of mistakes and failures in the social marketing field will assist practitioners to assess their own shortcomings, address causes of mistakes and failures, and improve program outcomes. Method: This research is qualitative and exploratory, with a constructivist, grounded theory methodology. Surveys were completed by 100 social marketing community members. Survey data was analyzed and coded using SPSS software and Microsoft Excel. Results: According to the analyzed survey data, the social marketing community believes that inadequate research, poor strategy development, and mismanagement of stakeholders are the most common mistakes made by social marketers. Further, weak evaluation and monitoring is considered to be the “least well-managed” program element. Poor strategy development, external influences, and poorly designed program and behavioral objectives are considered to be the primary reasons for social marketing program failure. Recommendations for research or practice: Future research may explore the extent to which external influences lead to social marketing program success or failure, particularly in comparison to mistakes made by social marketers. Additionally, practitioners should be aware of and develop strategies to mitigate common mistakes and failures in order to improve program outcomes. Limitations: The 100 social marketing professionals who responded to the survey are not representative of the global social marketing community. Further, responses were based on self-report rather than direct observation, which may make them more susceptible to bias.
A qualitative evidence synthesis of users’ experience of mobile health applications in the self-management of type 2 diabetes
Authors: O’Neill Margaret , Houghton Catherine , Crilly Geraldine , Dowling Maura 
Published: February 2021

Aim The aim of this qualitative evidence synthesis was to identify and synthesise qualitative research relating to experiences of using mobile health (mHealth) applications to aid self-management of Type 2 Diabetes. Methods Using a systematic search strategy, 11 databases were searched (Medline, CINAHL, PsychInfo, PubMed, Web of Science, Embase, Cochrane Library, Scopus, ProQuest A&1, ProQuest UK & Ireland, Mednar). “Best fit” framework synthesis was used guided by the Health Information Technology Acceptance Model (HITAM). Assessment of methodological limitations was conducted using Critical Appraisal Skills Programme (CASP) and confidence in the review findings were guided by GRADE-CERQual. Results Fourteen eligible studies were included in the synthesis (7 qualitative and 5 mixed methods). Key themes identified under the health, information and technology zones of the HITAM revealed the benefits of mHealth apps, barriers to their use, their perceived usefulness and ease of use. Discussion Most people used the apps for feedback on their self-management and found them helpful in their communication with health care providers. Some embraced the technology and found it easy to use while others found mHealth apps to be counterintuitive.
Spinal GABAergic neurons are under feed-forward inhibitory control driven by Aδ and C fibers in Gad2 td-Tomato mice
Authors: Liu Peng , Zhang Xiao , He Xiaolan , Jiang Zhenhua , Wang Qun , Lu Yan 
Published: February 2021

Background Spinal GABAergic neurons act as a critical modulator in sensory transmission like pain or itch. The monosynaptic or polysynaptic primary afferent inputs onto GABAergic neurons, along with other interneurons or projection neurons make up the direct and feed-forward inhibitory neural circuits. Previous research indicates that spinal GABAergic neurons mainly receive excitatory inputs from Aδ and C fibers. However, whether they are controlled by other inhibitory sending signals is not well understood. Methods We applied a transgenic mouse line in which neurons co-expressed the GABA-synthesizing enzyme Gad65 and the enhanced red fluorescence (td-Tomato) to characterize the features of morphology and electrophysiology of GABAergic neurons. Patch-clamp whole cell recordings were used to record the evoked postsynaptic potentials of fluorescent neurons in spinal slices in response to dorsal root stimulation. Results We demonstrated that GABAergic neurons not only received excitatory drive from peripheral Aβ, Aδ and C fibers, but also received inhibitory inputs driven by Aδ and C fibers. The evoked inhibitory postsynaptic potentials (eIPSPs) mediated by C fibers were mainly Glycinergic (66.7%) as well as GABAergic mixed with Glycinergic (33.3%), whereas the inhibition mediated by Aδ fibers was predominately both GABA and Glycine-dominant (57.1%), and the rest of which was purely Glycine-dominant (42.9%). Conclusion These results indicated that spinal GABAergic inhibitory neurons are under feedforward inhibitory control driven by primary C and Aδ fibers, suggesting that this feed-forward inhibitory pathway may play an important role in balancing the excitability of GABAergic neurons in spinal dorsal horn.
Cardiovascular risk factors are negatively associated with rheumatoid arthritis disease outcomes
Authors: Cui Kangping , Movahedi Mohammad , Bombardier Claire , Kuriya Bindee 
Published: February 2021

Aims: Rheumatoid arthritis (RA) is associated with cardiovascular disease (CVD), but the influence of CVD risk factors on RA outcomes is limited. We examined if CVD risk factors alone are associated with RA disease activity and disability. Methods: We performed a cross-sectional analysis of participants in the Ontario Best Practices Research Initiative, RA registry. Patients were categorized into mutually exclusive CVD categories: (1) No established CVD and no CVD risk factors; (2) CVD risk factors only including ⩾1 of hypertension, dyslipidemia, diabetes, or smoking; or (3) history of established CVD event. Multivariable regression analyses examined the effect of CVD status on Disease Activity Score 28 (DAS28-ESR), Clinical Disease Activity Index (CDAI), and Health Assessment Questionnaire Disability Index (HAQ-DI) scores at baseline. Results: Of 2033 patients, 50% had at least 1 CVD risk factor, even in the absence of established CVD. The presence of ⩾1 CVD risk factor was independently associated with higher CDAI [β coefficient 1.59, 95% confidence interval (CI) 0.29–2.90, p = 0.02], DAS28-ESR (β coefficient 0.20, 95% CI 0.06–0.34, p = 0.01) and HAQ-DI scores (β coefficient 0.15, 95% CI 0.08–0.22, p < 0.0001). The total number of CVD risk factors displayed a dose response, as >1 CVD risk factor was associated with higher disease activity and disability, compared with having one or no CVD risk factors. Conclusion: CVD risk factors alone, or in combination, are associated with higher disease activity and disability in RA. This emphasizes the importance of risk factor recognition and management, not only to prevent CVD, but also to improve potential RA outcomes.
Using Case-Based Reasoning in a Learning System: A Prototype of a Pedagogical Nurse Tool for Evidence-Based Diabetic Foot Ulcer Care
Authors: Bender Clara , Cichosz Simon Lebech , Malovini Alberto , Bellazzi Riccardo , Pape-Haugaard Louise , Hejlesen Ole 
Published: February 2021

Background: Currently, evidence-based learning systems to increase knowledge and evidence level of wound care are unavailable to wound care nurses in Denmark, which means that they need to learn about diabetic foot ulcers from experience and peer-to-peer training, or by asking experienced colleagues. Interactive evidence-based learning systems built on case-based reasoning (CBR) have the potential to increase wound care nurses’ diabetic foot ulcer knowledge and evidence levels. Method: A prototype of a CBR-interactive, evidence-based algorithm-operated learning system calculates a dissimilarity score (DS) that gives a quantitative measure of similarity between a new case and cases stored in a case base in relation to six variables: necrosis, wound size, granulation, fibrin, dry skin, and age. Based on the DS, cases are selected by matching the six variables with the best predictive power and by weighing the impact of each variable according to its contribution to the prediction. The cases are ranked, and the six cases with the lowest DS are visualized in the system. Results: Conventional education, that is, evidence-based learning material such as books and lectures, may be less motivating and pedagogical than peer-to-peer training, which is, however, often less evidence-based. The CBR interactive learning systems presented in this study may bridge the two approaches. Showing wound care nurses how individual variables affect outcomes may help them achieve greater insights into pathophysiological processes. Conclusion: A prototype of a CBR-interactive, evidence-based learning system that is centered on diabetic foot ulcers and related treatments bridges the gap between traditional evidence-based learning and more motivating and interactive learning approaches.
Autologous Protein Solution Effect on Chondrogenic Differentiation of Mesenchymal Stem Cells from Adipose Tissue and Bone Marrow in an Osteoarthritic Environment
Authors: Pagani Stefania , Veronesi Francesca , Giavaresi Gianluca , Filardo Giuseppe , Papio Tiziana , Romandini Iacopo , Fini Milena 
Published: February 2021

Objective Osteoarthritis (OA) is an inflammatory and degenerative disease, and the numerous treatments currently used are not fully effective. Mesenchymal stem cells (MSCs) and platelet-rich plasma (PRP) are proposed for OA treatment as biologic therapies. The aim of the study was to observe the role of autologous protein solution (APS), a type of PRP, on chondrogenic differentiation of 2 types of MSCs, from bone marrow (BMSCs) and adipose tissue (ADSCs), in an in vitro osteoarthritic microenvironment. Design Inflammatory culture conditions, mimicking OA, were obtained by adding interleukin-1β (IL-1β) and tumor necrosis factor α (TNFα), or synovial fluid from patient osteoarthritic knees (OSF), to the culture medium. MSCs were then treated with APS. Results After 1 month of culture, both cell types formed mature micromasses, partially altered in the presence of IL-1β and TNFα but quite preserved with OSF. Inflammatory conditions hindered differentiation in terms of gene expression, not counterbalanced by APS. APS triggered type I collagen deposition and above all contributed to decrease the expression of metalloproteinases in the most aggressive conditions (IL-1β and TNFα in the culture medium). ADSCs originated micromasses more mature and less prone toward osteogenic lineage than BMSCs, thus showing to better adapt in an aggressive environment than BMSC. Conclusions APS seems to act better on inflammation front and, between cell types, ADSCs respond better to the inflammatory microenvironment of OA and to the treatment with APS than BMSCs.
Impact of a change in rostering practices on absenteeism: An observational descriptive study
Authors: Fan Esther Monica Peijin , Aloweni Fazila , Lim Mei Ling , Woh Kelly Chai Yuen , Ang Shin Yuh 
Published: February 2021

Background: There was a change in rostering practice from a regular three-shift system to an irregular three-shift system. Objective: This study observed the trend of absenteeism before and after a change in rostering practice. Methods: An observational design was used to collect sick-leave data from six months before the change in rostering practice to 12 months after. The average number of sick-leave days per month before and after the change were compared. Data for nursing hours per patient day (NHPPD) were also collected. Results: An increase in the number of sick-leave days was seen in three out of five wards following the change in rostering practice. Average sick leave across the five wards increased from 173.7 days per month before the change to 213.4 days per month after the change. Data for NHPPD showed no drastic change in manpower (e.g. resignation/training leave) during this period. Conclusions: There was an observed increase in absenteeism following the change in the rostering practice of nurses.
Remote administration of the symbol digit modalities test to individuals with multiple sclerosis is reliable: A short report
Authors: Eilam-Stock Tehila , Shaw Michael T , Sherman Kathleen , Krupp Lauren B , Charvet Leigh E 
Published: February 2021

Background The Symbol Digit Modalities Test (SDMT) is the gold standard for cognitive screening in multiple sclerosis (MS). Objective Due to the recent COVID-19 pandemic and the increased need for virtual clinical visits, we examined the reliability of remote administration of the SDMT vs. standard in-person administration to individuals with MS. Methods Pearson’s correlation analysis was performed between SDMT scores on the in-person and remote administrations. Results For n = 132 participants, remote and in-person SDMT scores were strongly correlated (r = .80, p = .000). Conclusion Remote administration of the SDMT is a reliable cognitive screening approach in MS.
Low-Energy Pelvic Ring Fractures: A Care Conundrum
Authors: Abernathy Bailey R. , Schroder Lisa K. , Bohn Deborah C. , Switzer Julie A. 
Published: February 2021

Introduction: A need exists for improved care pathways for patients experiencing low-energy pelvic ring fractures. A review of the current literature was performed to understand the typical patient care and post-acute rehabilitation pathway within the US healthcare system. We also sought to summarize reported clinical outcomes worldwide. Significance: Low-energy pelvic ring fracture patients usually do not qualify for inpatient admission, yet they often require post-acute rehabilitative care. The Center for Medicare and Medicaid Services’ (CMS) 3-day rule is a barrier to obtaining financial coverage of this rehabilitative care. Results: Direct admission of some patients to post-acute care facilities has shown promise with decreased cost, improved patient outcomes, and increased patient satisfaction. Secondary fracture prevention programs may also improve outcomes for this patient population. Conclusions: Post-acute care innovation and secondary fracture prevention should be prioritized in the low-energy pelvic fragility fracture patient population. To demonstrate the effect and feasibility of these improved care pathways, further studies are necessary.
Evaluation of Spinal Fusion in Thoracic and Thoracolumbar Spine on Standard X-Rays: A New Grading System for Spinal Interbody Fusion
Authors: Patil Nirmal D. , El Ghait Hussein Abou , Boehm Christian , Boehm Heinrich 
Published: February 2021

Study Design: Retrospective evaluation of prospectively collected data. Objective: Analyzing time course and stages of interbody fusion of a uniformly operated cohort, defining a grading system and establishing diagnosis-dependent periods of bone healing. Methods: Sequential lateral radiographs of 238 patients (313 levels) with interbody fusion operated thoracoscopically were analyzed. Results: Evaluation of 1696 radiographs with a mean follow-up of 65.19 months and average numbers of 5.42 (2-18) images per level was performed. Diagnoses were Pyogenic Spondylitis (74), Fracture (96), Ankylosing Spondylitis (38) and Degenerative Disease (105). No case with Grade 2 deteriorated to Grade 5. On average, Grade 4 persisted for 113 days, Grade 3 for 197 days, Grade 2 for 286 days and Grade 1 for 316 days. The first 95% of levels (“Green Zone”, ≤ Grade 2) fused at 1 year, the remaining 4% levels fused between 12 and 17 months (“Yellow Zone”) and the last 1% (“Red Zone”) fused after 510 days. Conclusion: Sequential lateral radiographs permit evaluation of interbody fusion. Grade 2 is the threshold point for fusion; once accomplished, failure is unlikely. If fusion (Grade 2,1 or 0) is not reached within 510 days, it should be regarded as failed. The 510-day-threshold could reduce the necessity of CT scanning for assessing fusion.
Posterior Focal Curettage and Spine Stability Reconstruction by Temporary Pedicle Screw Fixation in Children With Collapsed Vertebrae due to Eosinophilic Granuloma
Authors: Zheng Yiming , Ning Bo , Wu Chunxing , Qian Chuang , Meng Junrong , Wang Dahui 
Published: February 2021

Study Design: Retrospective case series. Objectives: To evaluate the efficacy of growth-preserving posterior spinal column reconstruction surgery in children with collapsed vertebral eosinophilic granuloma (EG). Methods: We retrospectively reviewed 15 confirmed cases of vertebral EG who met the inclusion and exclusion criteria from March 2015 to March 2018 in our hospital. The recovery of diseased vertebrae was assessed. Results: The cases were composed of 11 males and 4 females with a mean age of 74.3 ± 38.8 months. Nine cases presented with thoracic vertebral destruction, 6 cases with lumbar vertebral destruction. Under Garg’s classification, 10, 3 and 2 cases were classified as Grade IIA, IB and IIB lesions, respectively. All patients had mild to moderate night-aggravated back pain and recovered at 1-week after surgery. Three patients had Frankel D neurologic symptoms and recovered at 1-week, 1-week and 4-weeks after surgery, respectively. Follow-up time after surgery ranged from 1.9 years to 4.5 years, with a mean of 2.9 years. The median vertebral height at 12 months after surgery was significantly higher than the preoperative height. Furthermore, the vertebral heights of all diseased vertebrae displayed significant recovery trends at 3, 6 and 12 months after surgical treatment. The percentages of vertebral height recovery to references at 12 months after surgery ranged from 34.7% to 92.5%, with an average of 71.2%. Conclusions: In children with collapsed vertebral EGs, active surgical treatment is necessary to retain the ability to restore height and to reconstruct the spine stability.
Prevalence of dysmenorrhea, its association with overall academic engagement, and management among nursing undergraduates at Peradeniya University, Sri Lanka: A cross-sectional study
Authors: Alahakoon A. M. Shashi Shardha , Wickramarathne D. B. Mahinda 
Published: February 2021

Background: Dysmenorrhea or painful menstrual periods is one of the common health issues the female university students experience which intervenes with academic activities and quality of life. Objectives: We aimed to find the prevalence, intensity, extent of impairment in academic engagement, and efficacy of the management of dysmenorrhea among nursing students at Peradeniya University, Sri Lanka. Methodology: This cross sectional study comprised 86 female nursing students who represented all four academic years. A self-administered questionnaire was used. The intensity and level of dysmenorrhea were assessed. Association of the extent of working impairment with the level of pain determined by Pearson correlation. Duration of dysmenorrhea persisted before and after management was compared using paired sample t-test. The effectiveness of management was analyzed using Wilcoxon signed-rank test. Results: The prevalence of dysmenorrhea was 97.7%. The majority (54.7%) suffered moderate pain. Mean age of the participants was 24.02 (±1.503). During the period of dysmenorrhea, 32.6%, 33.7%, and 17.4% students experienced slight, moderate, and heavy impairment of overall academic engagement. A positive correlation was observed between level of pain and extent of academic impairment ( p < 0.05). The majority practiced pharmacological and non-pharmacological pain relieving methods together. Wilcoxon signed-rank test value revealed more negative ranks and statistically significant reduction in intensity in post-management period ( z = −7.793, p = 0). Post-management dysmenorrhea duration was significantly reduced than pre-management ( t76 = 8.984, p = 0). Conclusion: A substantial percent of undergraduates suffer from dysmenorrhea. It is associated impairment of overall academic engagement. The nursing students were able to manage dysmenorrhea successfully.