bluuebunny/crossref_metadata_2025_split huggingface dataset:
Architecture for Children With Autism Spectrum Disorder and Their Therapists
Authors: Norouzi Neda , Garza Cristina Michelle 
Published: May 2021

Objectives: The objective of this study is to identify an architectural design framework that can be applied to create adaptable, transformative therapy rooms that benefit children with autism and their therapists. Background: Previous research suggests that environment shapes and influences human behavior. However, there remains a lack of evidence of effective design for pediatric rehabilitation therapy rooms. This study specifically focuses on how the design of the therapy room influences the patient’s level of comfort and participation as well as the therapists’ quality and efficiency of treatment to improve the overall therapeutic experience. Method: Two different surveys were conducted to improve the design of a therapeutic room based on professional therapist experiences. A grounded theory approach was employed to identify specific codes and categories. Results: The result of this study is an architectural framework based on specific design tenets and their properties that not only can be utilized by architects and interior designers for building a new therapy center but could also be used for remodeling existing therapy rooms.
Comprehensive assessment of exposure to clozapine in association with side effects among patients with treatment-resistant schizophrenia: a population pharmacokinetic study
Authors: Nomura Nobuyuki , Kitagawa Kohei , So Ryuhei , Misawa Fuminari , Kodama Masafumi , Takeuchi Hiroyoshi , Bies Robert , Straubinger Thomas , Banker Christopher , Mizuno Yuya , Mimura Masaru , Uchida Hiroyuki 
Published: May 2021

Background: There have been scarce data on the distribution of clozapine concentrations in comparison with the recommended range (350–600 ng/ml) or their relationship with side effects among patients with treatment-resistant schizophrenia. Furthermore, no studies have assessed the association between side effects and overall exposure to the drug by calculating the 24-h area-under-curve (AUC). Methods: In- and outpatients with schizophrenia or schizoaffective disorder (ICD-10) who were receiving a stable dose of clozapine for ⩾2 weeks were included. Side effects were assessed using the Glasgow antipsychotic side-effects scale for clozapine (GASS-C). Using two collected plasma samples, plasma clozapine and norclozapine concentrations at peak and trough and their 24-h AUC were estimated using population pharmacokinetic models. Results: A total of 108 patients completed the study (mean ± SD age, 43.0 ± 10.1 years; clozapine dose, 357.5 ± 136.9 mg/day); 33 patients (30.6%) showed estimated trough concentrations of clozapine within the recommended range (350–600 ng/ml) whereas the concentrations were higher and lower than this range among 37 (43.5%) and 28 (25.9%) patients (%), respectively. There were no significant correlations between estimated peak or trough concentrations or 24-h AUC of both clozapine or norclozapine, and GASS-C total or individual scores. No significant differences were found between GASS-C total or individual item scores between the patients with estimated trough concentrations of clozapine of >600 ng/ml and the other subjects. Conclusion: The results suggest that clozapine or norclozapine concentrations are not linked directly to the extent of side effects experienced in clozapine-treated patients with treatment-resistant schizophrenia while the cross-sectional study design limits the interpretation of any causal relationships. These findings indicate that side effects associated with clozapine may occur at any dose or concentration.
Asymmetric expression of homoeologous genes contributes to dietary adaption of an allodiploid hybrid fish derived from Megalobrama amblycephala (♀) × Culter alburnus (♂)
Authors: Li Wuhui , Wang Shi , Hu Jie , Tang Chenchen , Wu Chang , Liu Junmei , Ren Li , Sun Chengfei , Dong Junjian , Liu Shaojun , Ye Xing 
Published: May 2021

Abstract
Background
Hybridization, which can quickly merge two or more divergent genomes and form new allopolyploids, is an important technique in fish genetic breeding. However, the merged subgenomes must adjust and coexist with one another in a single nucleus, which may cause subgenome interaction and dominance at the gene expression level and has been observed in some allopolyploid plants. In our previous studies, newly formed allodiploid hybrid fish derived from herbivorous Megalobrama amblycephala (♀) × carnivorous Culter alburnus (♂) had herbivorous characteristic. It is thus interesting to further characterize whether the subgenome interaction and dominance derive dietary adaptation of this hybrid fish.

Results
Differential expression, homoeolog expression silencing and bias were investigated in the hybrid fish after 70 days of adaptation to carnivorous and herbivorous diets. A total of 2.65 × 108 clean reads (74.06 Gb) from the liver and intestinal transcriptomes were mapped to the two parent genomes based on specific SNPs. A total of 2538 and 4385 differentially expressed homoeologous genes (DEHs) were identified in the liver and intestinal tissues between the two groups of fish, respectively, and these DEHs were highly enriched in fat digestion and carbon metabolism, amino acid metabolism and steroid biosynthesis. Furthermore, subgenome dominance were observed in tissues, with paternal subgenome was more dominant than maternal subgenome. Moreover, subgenome expression dominance controlled functional pathways in metabolism, disease, cellular processes, environment and genetic information processing during the two dietary adaptation processes. In addition, few but sturdy villi in the intestine, significant fat accumulation and a higher concentration of malondialdehyde in the liver were observed in fish fed carnivorous diet compared with fish fed herbivorous diet.

Conclusions
Our results indicated that diet drives phenotypic and genetic variation, and the asymmetric expression of homoeologous genes (including differential expression, expression silencing and bias) may play key roles in dietary adaptation of hybrid fish. Subgenome expression dominance may contribute to uncovering the mechanistic basis of heterosis and also provide perspectives for fish genetic breeding and application.
Insights into the genome architecture and evolution of Shiga toxin encoding bacteriophages of Escherichia coli
Authors: Pinto Graça , Sampaio Marta , Dias Oscar , Almeida Carina , Azeredo Joana , Oliveira Hugo 
Published: May 2021

Abstract
Background
A total of 179 Shiga toxin-producing Escherichia coli (STEC) complete genomes were analyzed in terms of serotypes, prophage coding regions, and stx gene variants and their distribution. We further examined the genetic diversity of Stx-converting phage genomes (Stx phages), focusing on the lysis-lysogeny decision and lytic cassettes.

Results
We show that most STEC isolates belong to non-O157 serotypes (73 %), regardless the sources and geographical regions. While the majority of STEC genomes contain a single stx gene (61 %), strains containing two (35 %), three (3 %) and four (1 %) stx genes were also found, being stx2 the most prevalent gene variant. Their location is exclusively found in intact prophage regions, indicating that they are phage-borne. We further demonstrate that Stx phages can be grouped into four clusters (A, B, C and D), three subclusters (A1, A2 and A3) and one singleton, based on their shared gene content. This cluster distribution is in good agreement with their predicted virion morphologies. Stx phage genomes are highly diverse with a vast number of 1,838 gene phamilies (phams) of related sequences (of which 677 are orphams i.e. unique genes) and, although having high mosaicism, they are generally organized into three major transcripts. While the mechanisms that guide lysis–lysogeny decision are complex, there is a strong selective pressure to maintain the stx genes location close to the lytic cassette composed of predicted SAR-endolysin and pin-holin lytic proteins. The evolution of STEC Stx phages seems to be strongly related to acquiring genetic material, probably from horizontal gene transfer events.

Conclusions
This work provides novel insights on the genetic structure of Stx phages, showing a high genetic diversity throughout the genomes, where the various lysis-lysogeny regulatory systems are in contrast with an uncommon, but conserved, lytic system always adjacent to stx genes.
Granulomatous colitis in a patient with metastatic melanoma under immunotherapy: a case report and literature review
Authors: Sakellariou Stratigoula , Zouki Dionysia N. , Ziogas Dimitrios C. , Pouloudi Despoina , Gogas Helen , Delladetsima Ioanna 
Published: May 2021

Abstract
Background
Immune checkpoint inhibitors (ICPIs) have changed the way advanced malignancies are currently confronted, improving cancer patients’ outcomes but also generating distinct immune-related (ir) adverse events. ICPIs-induced colitis is a common complication showing different clinical and histological manifestations. In the literature review, 14 cases with ICPIs related colon granulomas have been reported in 5 studies with either limited or unavailable information regarding histology. Granulomatous reactions can be mistakenly perceived as disease recurrence or progression. Better understanding and identification of this infrequent histological display can help to avoid misdiagnosis and mismanagement.

Case presentation
A 63-year-old female patient with metastatic melanoma was admitted to the hospital with symptoms of nausea, persistent diarrhea and shivering fever under consecutive treatments with ICPIs, initially pembrolizumab and subsequently ipilimumab. Sigmoidoscopy was performed revealing mucosal edema, hyperemia and erosions of the rectum and sigmoid colon. Histological evaluation of sigmoid colon mucosa biopsies revealed an unusual colitis pattern characterized by multiple intracryptal granulomas attributed to ICPIs therapy. Steroids were administered and the patient recovered. ICPIs treatment was discontinued. The patient was subsequently treated with chemotherapy but follow up radiology showed disease progression. A re-challenge with another ICPI regimen was decided and the patient is currently under immunotherapy with stable disease regarding melanoma status and without any sign of colitis recurrence.

Conclusions
The present report provides detailed histological description of a distinctive ICPIs-induced granulomatous colitis and highlights the need for awareness of the distinct adverse events and reaction patterns in the context of immunotherapy.
A randomized clinical study on the impact of Comprehensive Geriatric Assessment (CGA) based interventions on the quality of life of elderly, frail, onco-hematologic patients candidate to anticancer therapy: protocol of the ONCO-Aging study
Authors: Mahmoud Abdurraouf Mokhtar , Biello Federica , Maggiora Paola Maria , Bruna Riccardo , Burrafato Giovanni , Cappelli Miriam , Varughese Feba , Martini Veronica , Platini Francesca , Deambrogi Clara , Patriarca Andrea , Nicolosi Maura , Vachanaram Ajay ram , Pisani Carla , Ferrara Eleonora , Catania Elvira , Azzolina Danila , Barone-Adesi Francesco , Krengli Marco , Gaidano Gianluca , Gennari Alessandra 
Published: May 2021

AbstractBackgroundAge is considered as one of the most important risk-factor for many types of solid and hematological cancers, as their incidence increases with age in parallel to the ever-growing elderly population. Moreover, cancer incidence is constantly increasing as a consequence of the increase in life expectancy that favors the process of cellular senescence. Geriatric assessment has been increasingly recognized as predictive and prognostic instrument to detect frailty in older adults with cancer. In particular, the G8 score is a simple and reproducible instrument to identify elderly patients who should undergo full geriatric evaluation. Due to their frailty, elderly patients may be often under-treated and a therapeutic choice based also on a comprehensive geriatric assessment (CGA) is recommended. With these premises, we aim to test the impact of the CGA based interventions on the quality of life (QoL) of frail elderly onco-hematological patients, identified by the G8 screening, candidate for innovative target directed drugs or treatments including the combination of radiotherapy and chemotherapy (RT + CT).MethodsPatients aged > 65 years, candidate to target directed agents or to RT + CT treatments are screened for frailty by the G8 test; those patients classified as frail (G8 ≤ 14) are randomized to receive a CGA at baseline or to conventional care. The primary endpoint is QoL, assessed by EORTC QLQ-C30C. As collateral biological study, the potential prognostic/predictive role of T-cell senescence and myeloid derived suppressor cells (MDSC) are evaluated on plasma samples.DiscussionThis trial will contribute to define the impact of CGA on the management of frail elderly onco-hematologic patients candidate to innovative biological drugs or to integrated schedules with the association of RT + CT. Furthermore, the use of plasma samples to assess the potential prognostic value of imbalance of immune-competent cells is expected to contribute to the individualized care of elderly patients, resulting into a fine tuning of the therapeutic strategies.Trial registrationClinicalTrials.gov ID:NCT04478916. registered July 21, 2020 – retrospectively registered.
Identification of transmission chains and clusters associated with COVID-19 in Tunisia
Authors: Safer Mouna , Letaief Hejer , Hechaichi Aicha , Harizi Chahida , Dhaouadi Sonia , Bouabid Leila , Darouiche Sondes , Gharbi Donia , Elmili Nawel , Ben Salah Hamida , Hammami Mongi , Talmoudi Khouloud , Moussa Rim , Charaa Nejib , Termiz Hasna , Ltaief Fethi , Tounekti Habib , Makhlouf Mohamed , Belguith Sriha Asma , Ben Fredj Manel , Khalfallah Sonia , Jabrane Houcine , Mchirgui Selma , Amich Chedli , Dabghi Radhia , Anez Zid , Abdelkader Latifa , Mhamdi Moncef , Ouerfeli Nabil , Zoghlami Salah , Bougatef Souha , Chahed Mohamed Kouni , Bouafif Ben Alaya Nissaf 
Published: May 2021

Abstract
Background
The aim of this study was to characterize the transmission chains and clusters of COVID-19 infection in Tunisia.

Methods
All cases were confirmed by Reverse Transcriptase Polymerase Chain Reaction of a nasopharyngeal specimen. Contact tracing is undertaken for all confirmed cases in order to identify close contacts that will be systematically screened and quarantined. Transmission chains were identified based on field investigation, contact tracing, results of screening tests and by assessing all probable mode of transmission and interactions.

Results
As of May 18, 2020, 656 cases out of a total of 1043 confirmed cases of Coronavirus disease 2019 belong to 127 transmission chains identified during the epidemic (mean age 42.36 years, Standard deviation 19.56 and sex ratio 0.86). The virus transmission is the most concentrated in the governorate of Tunis (31.5%), Ariana (10.2%) and Ben Arous (10.2%). Virus transmission occurred 50 times (9.72% of secondary transmission events) between two different governorates. A maximum of seven generations of secondary infection was identified, whereas 62% of these secondary infections belong the first generation. A total of 11 “super spreader” cases were identified in this investigation. Four large clusters have been identified. The evolution of secondary cases highlighted two peaks: one in 2nd April and a second in 16 th April whereas imported cases caused local transmission of virus during the early phase of the epidemic.

Conclusion
Correct contact tracing and early active case finding is useful to identify transmission chains and source of infection in order to contain the widespread transmission in the community.
A deep learning approach for dental implant planning in cone-beam computed tomography images
Authors: Kurt Bayrakdar Sevda , Orhan Kaan , Bayrakdar Ibrahim Sevki , Bilgir Elif , Ezhov Matvey , Gusarev Maxim , Shumilov Eugene 
Published: May 2021

Abstract
Background
The aim of this study was to evaluate the success of the artificial intelligence (AI) system in implant planning using three-dimensional cone-beam computed tomography (CBCT) images.

Methods
Seventy-five CBCT images were included in this study. In these images, bone height and thickness in 508 regions where implants were required were measured by a human observer with manual assessment method using InvivoDental 6.0 (Anatomage Inc. San Jose, CA, USA). Also, canals/sinuses/fossae associated with alveolar bones and missing tooth regions were detected. Following, all evaluations were repeated using the deep convolutional neural network (Diagnocat, Inc., San Francisco, USA) The jaws were separated as mandible/maxilla and each jaw was grouped as anterior/premolar/molar teeth region. The data obtained from manual assessment and AI methods were compared using Bland–Altman analysis and Wilcoxon signed rank test.

Results
In the bone height measurements, there were no statistically significant differences between AI and manual measurements in the premolar region of mandible and the premolar and molar regions of the maxilla (p > 0.05). In the bone thickness measurements, there were statistically significant differences between AI and manual measurements in all regions of maxilla and mandible (p < 0.001). Also, the percentage of right detection was 72.2% for canals, 66.4% for sinuses/fossae and 95.3% for missing tooth regions.

Conclusions
Development of AI systems and their using in future for implant planning will both facilitate the work of physicians and will be a support mechanism in implantology practice to physicians.
Effects of a ‘Baby-Friendly Hospital Initiative’ on exclusive breastfeeding rates at a private hospital in Lebanon: an interrupted time series analysis
Authors: Clermont Adrienne , Gemayel Josianne El , Hammoud Rola , Wang Jiangxia , Beciu Hortenzia , Sinno Mona , Berends Wilma , Rosenblum Nadine , Bienstock Jessica L. , Byrnes Kristen , Samuels Roger 
Published: May 2021

Abstract
Background
Exclusive breastfeeding (EBF) through six months of age has been scientifically validated as having a wide range of benefits, but remains infrequent in many countries. The WHO/UNICEF Baby-Friendly Hospital Initiative (BFHI) is one approach to improve EBF rates.

Methods
This study documents the implementation of BFHI at Clemenceau Medical Center (CMC), a private hospital in Lebanon, and analyzes data on EBF practices among CMC’s patients before, during, and after the implementation period. The process of launching the BFHI at CMC is discussed from the perspective of key stakeholders using the SQUIRE guidelines for reporting on quality improvement initiatives. As an objective measure of the program’s impact, 2,002 live births from July 2015 to February 2018 were included in an interrupted time series analysis measuring the rates of EBF at discharge prior to, during, and following the bundle of BFHI interventions.

Results
The steps necessary to bring CMC in line with the BFHI standards were implemented during the period between November 2015 and February 2016. These steps can be grouped into three phases: updates to hospital policies and infrastructure (Phase 1); changes to healthcare staff practices (Phase 2); and improvements in patient education (Phase 3). The baseline percentage of EBF was 2.4 % of all live births. Following the BFHI intervention, the observed monthly change in EBF in the “Follow-Up” period (i.e., the 24 months following Phases 1–3) was significantly increased relative to the baseline period (+ 2.0 % points per month, p = 0.006). Overall, the observed rate of EBF at hospital discharge increased from 2.4 to 49.0 % of all live births from the first to the final month of recorded data.

Conclusions
Meeting the BFHI standards is a complex process for a health facility, requiring changes to policies, practices, and infrastructure. Despite many challenges, the results of the interrupted time series analysis indicate that the BFHI reforms were successful in increasing the EBF rate among CMC’s patients and sustaining that rate over time. These results further support the importance of the hospital environment and health provider practices in breastfeeding promotion, ultimately improving the health, growth, and development of newborns.
Predicting factors of failed induction of labor in three hospitals of Southwest Ethiopia: a cross-sectional study
Authors: Ejigu Amare Genetu , Lambyo Shewangizaw H/mariam 
Published: May 2021

Abstract
Introduction
Failed induction of labor affects maternal and neonatal outcomes as well as the cost of healthcare, especially in low-resource setting regions in which the prevalence of failed induction is higher despite the incidence of labor induction is low. This study aimed to assess the prevalence of failed induction of labor in southwest Ethiopia.

Method
A hospital-based cross-sectional study was conducted among 441 induced women from March 1 to August 30, 2018. A systematic random sampling technique was used to select study participants. Data were collected using a pretested and structured questionnaire. Bivariable and multivariable logistic regression models were done and fitted to identify predictors of failed induction. An adjusted odds ratio with 95% confidence interval (CI) was calculated to determine the level of significance.

Result
Premature rupture of membrane was the most common cause of labor induction and the commonly used method of labor induction were oxytocin infusion. Cesarean section was done for 28.1% of induced women. Failed induction of labor was found to be 21%. Primiparous [AOR = 2.35 (1.35–4.09)], analgesia/anesthesia [AOR = 4.37 (1.31–14.59)], poor Bishop Score [AOR = 2.37 (1.16–4.84)], Birth weight ≥ 4 k grams [AOR = 2.12 (1.05–4.28)] and body mass index [AOR = 5.71 (3.26–10.01)] were found to be significantly associated with failed induction of labor.

Conclusion
The prevalence of failed induction of labour was found to be high. Preparation of the cervix before induction in primi-parity women is suggested to improve the success of induction. To achieve the normal weight of women and newborns, proper nutritional interventions should be given for women of reproductive age. It is better to use analgesia/anesthesia for labor induction when it becomes mandatory and there are no other optional methods of no- pharmacologic pain management.