bluuebunny/crossref_metadata_2025_split huggingface dataset:
Knowledge and utilisation of preconception care and associated factors among women in Ethiopia: systematic review and meta-analysis
Authors: Ayele Alemu Degu , Belay Habtamu Gebrehana , Kassa Bekalu Getnet , Worke Mulugeta Dile 
Published: April 2021

Abstract
Background
Preconception care is the provision of biomedical, behavioural, and social health interventions provided to women and couples before conception. However, in Ethiopia, little is known and practised to support preconception care. Therefore, this study aimed to assess women’s knowledge and utilisation of preconception care and its associated factors in Ethiopia using systematic review and meta-analysis.

Method
In the current meta-analysis, variables were searched from different electronic database systems, which included PubMed, Google Scholar, EMBASE, HINAR, Scopus, Web of Sciences, and Grey literature. Data were extracted using a standardised data collection measurement tool. The data were analysed by using STATA 14 statistical software. I2 tests assessed heterogeneity between the studies. A random-effect model was used to forecast the pooled knowledge and utilisation of preconception care.

Results
Thirteen full-text studies were included. The pooled prevalence of knowledge and utilisation of preconception care among women in Ethiopia was 30.95% and 16.27% respectivelly. Secondary education (OR = 2.78, 95% CI,2.01–3.85), college and above (OR = 5.05, 95% CI,2.70–9.44), and antenatal care (OR = 3.89, 95% CI, 1.69–8.98) were significantly associated with knowledge level whereas; age (OR = 2.43, 95% CI, 1.30–4.53) and knowledge on preconception care (OR = 3.95, 95% CI,2.35–6.62) were positively associated with utilisation of preconception.

Conclusions
Women’s level of knowledge and utilisation of preconception care was significantly low. Educational status and antenatal care follow-up were factors shown to affect knowledge of preconception care. Age and having a sound knowledge of preconception care indicated a significant association towards utilisation of preconception care. Thus, integrating preconception care strategies and policies that can address all the components of preconception care services with other maternal and child health services will be essential when designing effective implementation strategies to improve preconception care uptake. Besides this, advocating for better education for women, awareness creation, and increasing antenatal care services are essential.
Prospero registration: CRD42020218062
I felt so much conflict instead of joy: an analysis of open-ended comments from people in British Columbia who declined care recommendations during pregnancy and childbirth
Authors: Stoll Kathrin , Wang Jessie J. , Niles Paulomi , Wells Lindsay , Vedam Saraswathi 
Published: April 2021

Abstract
Background
No Canadian studies to date have examined the experiences of people who decline aspects of care during pregnancy and birth. The current analysis bridges this gap by describing comments from 1123 people in British Columbia (BC) who declined a test or procedure that their care provider recommended.

Methods
In the Changing Childbirth in BC study, childbearing people designed a mixed-methods study, including a cross-sectional survey on experiences of provider-patient interactions over the course of maternity care. We conducted a descriptive quantitative content analysis of 1540 open ended comments about declining care recommendations.

Results
More than half of all study participants (n = 2100) declined care at some point during pregnancy, birth, or the postpartum period (53.5%), making this a common phenomenon. Participants most commonly declined genetic or gestational diabetes testing, ultrasounds, induction of labour, pharmaceutical pain management during labour, and eye prophylaxis for the newborn. Some people reported that care providers accepted or supported their decision, and others described pressure and coercion from providers. These negative interactions resulted in childbearing people feeling invisible, disempowered and in some cases traumatized. Loss of trust in healthcare providers were also described by childbearing people whose preferences were not respected whereas those who felt informed about their options and supported to make decisions about their care reported positive birth experiences.

Conclusions
Declining care is common during pregnancy and birth and care provider reactions and behaviours greatly influence how childbearing people experience these events. Our findings confirm that clinicians need further training in person-centred decision-making, including respectful communication even when choices fall outside of standard care.
STING and cGAS gene expressions were downregulated among HIV-1-infected persons after antiretroviral therapy
Authors: de Lima Lorena Leticia Peixoto , de Oliveira Allysson Quintino Tenório , Moura Tuane Carolina Ferreira , da Silva Graça Amoras Ednelza , Lima Sandra Souza , da Silva Andrea Nazaré Monteiro Rangel , Queiroz Maria Alice Freitas , Cayres-Vallinoto Izaura Maria Vieira , Ishak Ricardo , Vallinoto Antonio Carlos Rosário 
Published: April 2021

Abstract
Background
The HIV-1 epidemic is still considered a global public health problem, but great advances have been made in fighting it by antiretroviral therapy (ART). ART has a considerable impact on viral replication and host immunity. The production of type I interferon (IFN) is key to the innate immune response to viral infections. The STING and cGAS proteins have proven roles in the antiviral cascade. The present study aimed to evaluate the impact of ART on innate immunity, which was represented by STING and cGAS gene expression and plasma IFN-α level.

Methods
This cohort study evaluated a group of 33 individuals who were initially naïve to therapy and who were treated at a reference center and reassessed 12 months after starting ART. Gene expression levels and viral load were evaluated by real-time PCR, CD4+ and CD8+ T lymphocyte counts by flow cytometry, and IFN-α level by enzyme-linked immunosorbent assay.

Results
From before to after ART, the CD4+ T cell count and the CD4+/CD8+ ratio significantly increased (p < 0.0001), the CD8+ T cell count slightly decreased, and viral load decreased to undetectable levels in most of the group (84.85%). The expression of STING and cGAS significantly decreased (p = 0.0034 and p = 0.0001, respectively) after the use of ART, but IFN-α did not (p = 0.1558). Among the markers evaluated, the only markers that showed a correlation with each other were STING and CD4+ T at the time of the first collection.

Conclusions
ART provided immune recovery and viral suppression to the studied group and indirectly downregulated the STING and cGAS genes. In contrast, ART did not influence IFN-α. The expression of STING and cGAS was not correlated with the plasma level of IFN-α, which suggests that there is another pathway regulating this cytokine in addition to the STING–cGAS pathway.
Comparison of the drug retention and reasons for discontinuation of tumor necrosis factor inhibitors and interleukin-6 inhibitors in Japanese patients with elderly-onset rheumatoid arthritis—the ANSWER cohort study
Authors: Jinno Sadao , Onishi Akira , Dubreuil Maureen , Hashimoto Motomu , Yamamoto Wataru , Murata Koichi , Takeuchi Tohru , Kotani Takuya , Maeda Yuichi , Ebina Kosuke , Son Yonsu , Amuro Hideki , Hara Ryota , Katayama Masaki , Saegusa Jun 
Published: April 2021

Abstract
Background
This multi-center, retrospective study aimed to clarify retention rates and reasons for discontinuation of either tumor necrosis factor inhibitors (TNFi) or interleukin-6 inhibitors (IL-6i) in patients with elderly-onset rheumatoid arthritis (EORA).

Methods
Patients with rheumatoid arthritis (RA) enrolled in a Japanese multicenter observational registry between 2011 and 2020 were included. EORA was defined as RA with onset at 60 or over. To adjust confounding by indication for treatment with TNFi or IL-6i, a propensity score based on multiple baseline characteristics variables was used to compare the drug retention and causes for discontinuation between TNFi and IL-6i. Adjusted cumulative incidence of drug discontinuation for each reason was compared between the two groups using the Fine-Gray model.

Results
Among a total of 9,550 patients in the registry, 674 TNFi and 297 IL-6i initiators with EORA were identified. Age, the proportion of females, disease duration, and baseline disease activity at the time of TNFi or IL-6i initiation were similar between the two groups. After adjusting for differences in baseline characteristics between the two groups, overall drug discontinuation was significantly lower in the IL-6i as compared to the TNFi (HR = 0.71, 95%CI = 0.59–0.86, p < 0.001). The adjusted cumulative incidence of discontinuation due to lack of effectiveness was lower with the IL-6i (HR = 0.46, 95%CI = 0.33–0.63, p < 0.001) while those due to adverse events (HR = 0.82, 95%CI = 0.56–1.18, p = 0.28) or achievement of clinical remission (HR = 1.09, 95%CI = 0.62–1.91, p = 0.76) were similar between the two groups.

Conclusions
In EORA patients initiating a TNFi or IL-6i, significantly higher drug retention was observed with IL-6i. Discontinuation due to lack of effectiveness was significantly less frequent in IL-6i while discontinuations due to adverse event or achievement of clinical remission were similar between the two groups.
Intra- and inter-rater reliability of rectus femoris muscle thickness measured using ultrasonography in healthy individuals
Authors: Takahashi Yosuke , Fujino Yuji , Miura Kohei , Toida Ayumi , Matsuda Tadamitsu , Makita Shigeru 
Published: April 2021

Abstract
Background
Ultrasonography (US) is a feasible and accessible method for the measurement of skeletal muscle mass. This technique presents acceptable intra-rater reliability; however, there are a few reports on its inter-rater reliability. Additionally, relative reliability should equally be inspected to determine the presence of systematic errors. Therefore, this study aimed to investigate the intra- and inter-rater reliabilities and absolute reliability of rectus femoris muscle thickness as measured using US.

Methods
The participants included in our study comprised 12 healthy young men (26.5 ± 3.9 years. Rectus femoris muscle thickness was measured from the right side of the thigh using US by two trained physical therapists. Inter- and intra-rater reliabilities were determined using the intraclass correlation coefficient (ICC) (1, 1) and ICC (2, 1) methods, respectively. Absolute reliability was evaluated using Bland − Altman analysis. Additionally, we calculated the minimal detectable change at the 95% level of confidence (MDC95).

Result
According to the results of the Bland − Altman analysis, no fixed or proportional errors were present. The ICC (1, 1) was 0.95, and the ICC (2, 1) was 0.70. The MDC95 values of rectus femoris thickness for the intra- and inter-rater reliabilities were 2.0 mm and 4.3 mm, respectively.

Conclusions
In our study, intra- and inter-rater reliabilities were measured at “excellent” and “moderate” levels in the healthy individuals based on a previously defined scale. Moreover, we determined the measurement error for quantifying rectus femoris thickness. Therefore, the measurement of rectus femoris thickness using US could be considered applicable in clinical research.
Project Rosetta: a childhood social, emotional, and behavioral developmental feature mapping
Authors: Maslowski Alyson , Abbas Halim , Abrams Kelley , Taraman Sharief , Garberson Ford , Segar Susan 
Published: April 2021

Abstract
Background
A wide array of existing instruments are commonly used to assess childhood behavior and development for the evaluation of social, emotional and behavioral disorders such as Autism Spectrum Disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and anxiety. Many of these instruments either focus on one diagnostic category or encompass a broad set of childhood behaviors. We analyze a wide range of standardized behavioral instruments and identify a comprehensive, structured semantic hierarchical grouping of child behavioral observational features. We use the hierarchy to create Rosetta: a new set of behavioral assessment questions, designed to be minimal yet comprehensive in its coverage of clinically relevant behaviors. We maintain a full mapping from every functional feature in every covered instrument to a corresponding question in Rosetta.

Results
In all, 209 Rosetta questions are shown to cover all the behavioral concepts targeted in the eight existing standardized instruments.

Conclusion
The resulting hierarchy can be used to create more concise instruments across various ages and conditions, as well as create more robust overlapping datasets for both clinical and research use.
Interobserver variability of injury severity assessment in polytrauma patients: does the anatomical region play a role?
Authors: Bolierakis Eftychios , Schick Sylvia , Sprengel Kai , Jensen Kai Oliver , Hildebrand Frank , Pape Hans-Christoph , Pfeifer Roman 
Published: April 2021

Abstract
Background
The Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS) are widely used to assess trauma patients. In this study, the interobserver variability of the injury severity assessment for severely injured patients was analyzed based on different injured anatomical regions, and the various demographic backgrounds of the observers.

Methods
A standardized questionnaire was presented to surgical experts and participants of clinical polytrauma courses. It contained medical information and initial X-rays/CT-scans of 10 cases of severely injured patients. Participants estimated the severity of each injury based on the AIS. Interobserver variability for the AIS, ISS, and New Injury Severity Score (NISS) was calculated by employing the statistical method of Krippendorff's α coefficient.

Results
Overall, 54 participants were included. The major contributing medical specialties were orthopedic trauma surgery (N = 36, 67%) and general surgery (N = 13, 24%). The measured interobserver variability in the assessment of the overall injury severity was high (α ISS: 0.33 / α NISS: 0.23). Moreover, there were differences in the interobserver variability of the maximum AIS (MAIS) depending on the anatomical region: αhead and neck: 0.06, αthorax: 0.45, αabdomen: 0.27 and αextremities: 0.55.

Conclusions
Interobserver agreement concerning injury severity assessment appears to be low among clinicians. We also noted marked differences in variability according to injury anatomy. The study shows that the assessment of injury severity is also highly variable between experts in the field. This implies the need for appropriate education to improve the accuracy of trauma evaluation in the respective trauma registries.
Differences in glycemic control between the treatment arms in cardiovascular outcome trials of type 2 diabetes medications do not explain cardiovascular benefits
Authors: McGuire Darren K. , Inzucchi Silvio E. , Johansen Odd Erik , Rosenstock Julio , George Jyothis T. , Marx Nikolaus 
Published: April 2021

AbstractHyperglycemia is an undisputed epidemiological risk factor for microvascular complications in both type 1 and type 2 diabetes, integral in their causal pathways. Importantly, interventions that reduce the hyperglycemic burden in patients with either type of diabetes reduce the risk of microvascular complications (e.g., retinopathy, nephropathy, neuropathy). Hence, for microvascular risk, hyperglycemia is a proven risk factor and a proven treatment target, as reflected by treatment recommendations and guidelines across most scientific societies world-wide. However, although reducing the hyperglycemic burden to reduce microvascular risk remains a cornerstone of care for patients with type 2 diabetes, this therapeutic imperative does not apply to cardiovascular risk mitigation. This latter aspect is important in the context of interpreting therapeutic impact of treating hyperglycemia on risk for macrovascular complications in patients with type 2 diabetes. This letter, in response to a previous paper, discuss how modest differential glucose control contribute little if anything to the results observed of contemporary cardiovascular outcome trials in type 2 diabetes.
Posterior cruciate ligament repair with suture tape augmentation: a case series with minimum 2-year follow-up
Authors: Hopper Graeme P. , Irfan Ahmer , Jenkins Joanne M. , Wilson William T. , Mackay Gordon M. 
Published: April 2021

Abstract
Purpose
The posterior cruciate ligament (PCL) is an important stabilizer of the knee and can be damaged in up to 20% of ligamentous injuries. Numerous techniques for surgical treatment have been described in the literature with none shown to be clearly superior. The aim of this study was to assess the 2-year outcomes of PCL repair with suture tape augmentation.

Methods
Seventeen patients undergoing PCL repair with suture tape augmentation were prospectively followed up for a minimum of two years. One patient was lost to follow-up leaving sixteen patients in the final analysis (94.1%). Indications for this procedure were acute Grade III PCL ruptures, symptomatic chronic tears and PCL tears as part of a multi-ligament injury. Exclusion criteria were patients with retracted PCL remnants or poor tissue quality. Patient-reported outcomes were measured using the Knee Injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analogue Pain Scale (VAS-pain), Veterans RAND 12 Item Health Survey (VR-12) and Marx Activity Scale. Patients with any postoperative complications were identified. Mean differences between the outcomes pre-operatively and at two years postoperatively were evaluated using paired t-tests with significance set at p < 0.05.

Results
The mean KOOS at 2 years was 87.0, 75.5, 93.0, 69.6 and 54.2 for pain, symptoms, ADL, sport/recreation and QOL respectively. These improved significantly from 60.2, 49.8, 65.0, 33.0 and 34.2 preoperatively (p < 0.05). The mean WOMAC scores at 2 years were 91.0, 78.3 and 93.0 for pain, stiffness and function respectively. These improved significantly from 63.0, 51.7 and 65.0 preoperatively (p < 0.01). The VAS score improved from 3.0 to 0.8 (p < 0.01) and the VR-12 score improved from 34.9 to 50.9 at 2 years (p < 0.001). However, the Marx activity scale decreased from 8.7 pre-injury to 6.3 at 2 years (N.S.). One patient (6.3%) suffered a re-rupture.

Conclusion
PCL repair with suture tape augmentation demonstrates satisfactory patient reported outcome measures at minimum 2-year follow-up. These figures compare favorably with success rates described in the literature for PCL reconstruction techniques. Therefore, PCL repair with suture tape augmentation is an effective treatment option in selected patients.

Level of evidence
IV
Variations in structural MRI quality significantly impact commonly used measures of brain anatomy
Authors: Gilmore Alysha D. , Buser Nicholas J. , Hanson Jamie L. 
Published: April 2021

AbstractSubject motion can introduce noise into neuroimaging data and result in biased estimations of brain structure. In-scanner motion can compromise data quality in a number of ways and varies widely across developmental and clinical populations. However, quantification of structural image quality is often limited to proxy or indirect measures gathered from functional scans; this may be missing true differences related to these potential artifacts. In this study, we take advantage of novel informatic tools, the CAT12 toolbox, to more directly measure image quality from T1-weighted images to understand if these measures of image quality: (1) relate to rigorous quality-control checks visually completed by human raters; (2) are associated with sociodemographic variables of interest; (3) influence regional estimates of cortical surface area, cortical thickness, and subcortical volumes from the commonly used Freesurfer tool suite. We leverage public-access data that includes a community-based sample of children and adolescents, spanning a large age-range (N = 388; ages 5–21). Interestingly, even after visually inspecting our data, we find image quality significantly impacts derived cortical surface area, cortical thickness, and subcortical volumes from multiple regions across the brain (~ 23.4% of all areas investigated). We believe these results are important for research groups completing structural MRI studies using Freesurfer or other morphometric tools. As such, future studies should consider using measures of image quality to minimize the influence of this potential confound in group comparisons or studies focused on individual differences.
Improved chromosome-level genome assembly and annotation of the seagrass, Zostera marina (eelgrass)
Authors: Ma Xiao , Olsen Jeanine L. , Reusch Thorsten B.H. , Procaccini Gabriele , Kudrna Dave , Williams Melissa , Grimwood Jane , Rajasekar Shanmugam , Jenkins Jerry , Schmutz Jeremy , Van de Peer Yves 
Published: April 2021

Background: Seagrasses (Alismatales) are the only fully marine angiosperms. Zostera marina (eelgrass) plays a crucial role in the functioning of coastal marine ecosystems and global carbon sequestration. It is the most widely studied seagrass and has become a marine model system for exploring adaptation under rapid climate change. The original draft genome (v.1.0) of the seagrass Z. marina (L.) was based on a combination of Illumina mate-pair libraries and fosmid-ends. A total of 25.55 Gb of Illumina and 0.14 Gb of Sanger sequence was obtained representing 47.7× genomic coverage. The assembly resulted in ~2000 unordered scaffolds (L50 of 486 Kb), a final genome assembly size of 203MB, 20,450 protein coding genes and 63% TE content. Here, we present an upgraded chromosome-scale genome assembly and compare v.1.0 and the new v.3.1, reconfirming previous results from Olsen et al. (2016), as well as pointing out new findings. Methods: The same high molecular weight DNA used in the original sequencing of the Finnish clone was used. A high-quality reference genome was assembled with the MECAT assembly pipeline combining PacBio long-read sequencing and Hi-C scaffolding. Results: In total, 75.97 Gb PacBio data was produced. The final assembly comprises six pseudo-chromosomes and 304 unanchored scaffolds with a total length of 260.5Mb and an N50 of 34.6 MB, showing high contiguity and few gaps (~0.5%). 21,483 protein-encoding genes are annotated in this assembly, of which 20,665 (96.2%) obtained at least one functional assignment based on similarity to known proteins. Conclusions: As an important marine angiosperm, the improved Z. marina genome assembly will further assist evolutionary, ecological, and comparative genomics at the chromosome level. The new genome assembly will further our understanding into the structural and physiological adaptations from land to marine life.