bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using participatory action research to improve immunization utilization in areas with pockets of unimmunized children in Nigeria
Authors: Akwataghibe Ngozi N. , Ogunsola Elijah A. , Popoola Oluwafemi A. , Agbo Adanna I. , Dieleman Marjolein A. 
Published: August 2021

AbstractBackgroundIn 2005, Nigeria adopted the Reaching Every Ward strategy to improve vaccination coverage for children 0–23 months of age. By 2015, Ogun state had full coverage (100%) in 12 of its 20 local government areas, but eight had pockets of unimmunized children, with the highest burden (37%) in Remo North. A participatory action research (PAR) approach was used to facilitate implementation of local solutions to contextual barriers to immunization in Remo North. This article assesses and seeks to explain the outcomes of the PAR implemented in Remo North to understand whether and possibly how it improved immunization utilization.MethodsThe PAR intervention took place from 2016 to 2017. It involved two (4-month) cycles of dialogue and action between community members, frontline health workers and local government officials in two wards of Remo North, facilitated by the research team. The PAR was assessed using a pre/post-intervention-only design with mixed methods. These included household surveys of caregivers of 215 and 213 children, respectively, 25 semi-structured interviews with stakeholders involved in immunization service delivery and 16 focus group discussions with community members. Data were analysed using the Strategic Advisory Group of Experts (SAGE) vaccine hesitancy framework.ResultsCollaboration among the three stakeholder groups enabled the development and implementation of solutions to identified problems related to access to and use of immunization services. At endline, assessment by card for children older than 9 months revealed a significant increase in those fully immunized, from 60.7% at baseline to 90.9% (p < .05). A significantly greater number of caregivers visited fixed government health facilities for routine immunization at endline (83.2%) than at baseline (54.2%) (p < .05). The reasons reported by caregivers for improved utilization of routine immunization services were increased community mobilization activities and improved responsiveness of the health workers. Spillover effects into maternal health services enhanced the use of immunization services by caregivers. Spontaneous scale-up of actions occurred across Remo North due to the involvement of local government officials.ConclusionThe PAR approach achieved contextual solutions to problems identified by communities. Collection and integration of evidence into discussions/dialogues with stakeholders can lead to change. Leveraging existing structures and resources enhanced effectiveness.
Prospective relations between maternal emotional eating, feeding to soothe, and infant appetitive behaviors
Authors: Temmen Chelsie D. , Lipsky Leah M. , Faith Myles S. , Nansel Tonja R. 
Published: August 2021

Abstract
Background
Infant obesogenic appetitive behaviors are associated with greater infant weight and child obesity, yet little is known about maternal influences on infant appetitive behaviors. This study examines the relations between maternal eating behaviors, feeding to soothe, and infant appetitive behaviors in a longitudinal sample of United States mothers.

Methods
Pregnant women were recruited in the first trimester (< 12 weeks) and followed through 1 year postpartum. Mothers reported their own eating behaviors (eating competence, restrained, emotional, and external eating) in pregnancy; feeding to soothe their infant at 2, 6, and 12 months postpartum; and their infants’ appetitive behaviors (enjoyment of food, food responsiveness, slowness in eating, and satiety responsiveness) at 6 months. Three path models were estimated to examine the direct relations of maternal eating behaviors with infant appetitive behaviors, the indirect relations of maternal eating behaviors with infant appetitive behaviors through feeding to soothe, and the longitudinal relations between feeding to soothe and infant appetitive behaviors.

Results
Maternal eating behaviors and infant appetitive behaviors were directly and indirectly related in all three models. Greater maternal eating competence was related to greater enjoyment of food but was not related to feeding to soothe. Greater maternal restrained and external eating were not directly related to infant appetitive behaviors but were indirectly related to greater infant responsiveness to food through more frequent feeding to soothe. Additionally, several longitudinal relations between feeding to soothe behaviors and infant appetitive behaviors were present. More frequent feeding to soothe at 2 months was related to greater responsiveness to food at 6 months, which was then related to more frequent feeding to soothe at 6 months. Furthermore, greater satiety responsiveness, faster eating speed, and greater responsiveness to food at 6 months were related to more frequent feeding to soothe at 12 months.

Conclusions
Maternal eating behaviors were related to infant appetitive behaviors directly and indirectly through feeding to soothe. Additionally, results suggest feeding to soothe and infant appetitive behaviors may be bidirectionally linked. These results underscore the need to examine how parental feeding behaviors are influenced both by parental eating behaviors and child appetitive behaviors throughout infancy.

Trial registration
Clinicaltrials.gov. Registration ID – NCT02217462. Date of registration – August 13, 2014.
A three-dimensional printed model in preoperative consent for ventricular septal defect repair
Authors: Deng Xicheng , He Siping , Huang Peng , Luo Jinwen , Yang Guangxian , Zhou Bing , Xiao Yunbin 
Published: August 2021

AbstractBackgroundThe 3D printing technology in congenital cardiac surgery has been widely utilized to improve patients’ understanding of their disease. However, there has been no randomized controlled study on its usefulness in surgical consent for congenital heart disease repair.MethodsA randomized controlled study was performed during consent process in which guardians of candidates for ventricular septal defect repair were given detailed explanation of the anatomy, indication for surgery and potential complication and risks using 3D print ventricular septal defect model (n = 20) versus a conventional 2D diagram (n = 20). A questionnaire was finished by each guardian of the patients. Data collected from questionnaires as well as medical records were statistically analyzed.ResultsStatistically significant improvements in ratings of understanding of ventricular septal defect anatomy (p = 0.02), and of the surgical procedure and potential complications (p = 0.02) were noted in the group that used the 3D model, though there was no difference in overall ratings of the consent process (p = 0.09). There was no difference in questionnaire score between subjects with different education levels. The clinical outcomes, as represented by the duration of intensive care unit stay, intubation duration was comparable between the two groups.ConclusionsThe results indicated that it was an effective tool which may be used to consent for congenital heart surgery. Different education levels do not affect guardians’ understanding in consent. The impact of 3D printing used in this scenario on long term outcomes remains to be defined.
Survival and long-term outcomes following in-hospital cardiac arrest in a Swiss university hospital: a prospective observational study
Authors: Fuchs Alexander , Käser Dominic , Theiler Lorenz , Greif Robert , Knapp Jürgen , Berger-Estilita Joana 
Published: August 2021

AbstractBackgroundIncidence of in-hospital cardiac arrest is reported to be 0.8 to 4.6 per 1,000 patient admissions. Patient survival to hospital discharge with favourable functional and neurological status is around 21–30%. The Bern University Hospital is a tertiary medical centre in Switzerland with a cardiac arrest team that is available 24 h per day, 7 days per week. Due to lack of central documentation of cardiac arrest team interventions, the incidence, outcomes and survival rates of cardiac arrests in the hospital are unknown. Our aim was to record all cardiac arrest team interventions over 1 year, and to analyse the outcome and survival rates of adult patients after in-hospital cardiac arrests.MethodsWe conducted a prospective single-centre observational study that recorded all adult in-hospital cardiac arrest team interventions over 1 year, using an Utstein-style case report form. The primary outcome was 30-day survival after in-hospital cardiac arrest. Secondary outcomes were return of spontaneous circulation, neurological status (after return of spontaneous circulation, after 24 h, after 30 days, after 1 and 5 years), according to the Glasgow Outcomes Scale, and functional status at 30 days and 1 year, according to the Short-form-12 Health Survey.ResultsThe cardiac arrest team had 146 interventions over the study year, which included 60 non-life-threatening alarms (41.1%). The remaining 86 (58.9%) acute life-threatening situations included 68 (79.1%) as patients with cardiac arrest. The mean age of these cardiac arrest patients was 68 ± 13 years, with a male predominance (51/68; 75.0%). Return of spontaneous circulation was recorded in 49 patients (72.1%). Over one-third of the cardiac arrest patients (27/68) were alive after 30 days with favourable neurological outcome. The patients who survived the first year lived also to 5 years after the event with favourable neurological and functional status.ConclusionsThe in-hospital cardiac arrest incidence on a large tertiary Swiss university hospital was 1.56 per 1000 patient admissions. After a cardiac arrest, about a third of the patients survived to 5 years with favourable neurological and functional status. Alarms unrelated to life-threatening situations are common and need to be taken into count within a low-threshold alarming system.Trial Registration: The trial was registered in clinicaltrials.gov (NCT02746640).
The NUDGE trial pragmatic trial to enhance cardiovascular medication adherence: study protocol for a randomized controlled trial
Authors: Glasgow Russell E. , Knoepke Christopher E. , Magid David , Grunwald Gary K. , Glorioso Thomas J. , Waughtal Joy , Marrs Joel C. , Bull Sheana , Ho P. Michael 
Published: August 2021

AbstractBackgroundNearly half of patients do not take their cardiovascular medications as prescribed, resulting in increased morbidity, mortality, and healthcare costs. Mobile and digital technologies for health promotion and disease self-management offer an opportunity to adapt behavioral “nudges” using ubiquitous mobile phone technology to facilitate medication adherence. The Nudge pragmatic clinical trial uses population-level pharmacy data to deliver nudges via mobile phone text messaging and an artificial intelligent interactive chat bot with the goal of improving medication adherence and patient outcomes in three integrated healthcare delivery systems.MethodsThe Theory of mHealth, the Expanded RE-AIM/PRISM, and the PRECIS-2 frameworks were used for program planning, implementation, and evaluation, along with a focus on dissemination and cost considerations. During the planning phase, the Nudge study team developed and piloted a technology-based nudge message and chat bot of optimized interactive content libraries for a range of diverse patients. Inclusion criteria are very broad and include patients in one of three diverse health systems who take medications to treat hypertension, atrial fibrillation, coronary artery disease, diabetes, or hyperlipidemia. A target of approximately 10,000 participants will be randomized to one of 4 study arms: usual care (no intervention), generic nudge (text reminder), optimized nudge, and optimized nudge plus interactive AI chat bot. The PRECIS-2 tool indicated that the study protocol is very pragmatic, although there is variability across PRECIS-2 dimensions.DiscussionThe primary effectiveness outcome is medication adherence defined by the proportion of days covered (PDC) using pharmacy refill data. Implementation outcomes are assessed using the RE-AIM framework, with a particular focus on reach, consistency of implementation, adaptations, cost, and maintenance/sustainability. The project has limitations including limited power to detect some subgroup effects, medication complications (bleeding), and longer-term outcomes (myocardial infarction). Strengths of the study include the diverse healthcare systems, a feasible and generalizable intervention, transparent reporting using established pragmatic research and implementation science frameworks, strong stakeholder engagement, and planning for dissemination and sustainment.Trial registrationClinicalTrials.govNCT03973931. Registered on 4 June 2019. The study was funded by the NIH; grant number is 4UH3HL144163-02 issued 4/5/19.
C-STICH2: emergency cervical cerclage to prevent miscarriage and preterm birth—study protocol for a randomised controlled trial
Authors: Hodgetts-Morton Victoria , Hewitt Catherine A. , Jones Laura , Leighton Lisa , Pilarski Nicole , Molloy Eleanor , Hinshaw Kim , Norman Jane , Waugh Jason , Stock Sarah , Thornton Jim , Toozs-Hobson Philip , Johnston Tracey , Coomarasamy Arri , Thangaratinam Shakila , Mol Ben , Pajkrt Eva , Marlow Neil , Roberts Tracy , Middleton Lee , Brocklehurst Peter , Morris Katie 
Published: August 2021

Abstract
Background
Cervical cerclage is a recognised treatment to prevent late miscarriage and pre-term birth (PTB). Emergency cervical cerclage (ECC) for cervical dilatation with exposed unruptured membranes is less common and the potential benefits of cerclage are less certain. A randomised control trial is needed to accurately assess the effectiveness of ECC in preventing pregnancy loss compared to an expectant approach.

Methods
C-STICH2 is a multicentre randomised controlled trial in which women presenting with cervical dilatation and unruptured exposed membranes at 16 + 0 to 27 + 6 weeks gestation are randomised to ECC or expectant management. Trial design includes 18 month internal pilot with embedded qualitative process evaluation, minimal data set and a within-trial health economic analysis.
Inclusion criteria are ≥16 years, singleton pregnancy, exposed membranes at the external os, gestation 16 + 0–27 + 6 weeks, and informed consent. Exclusion criteria are contraindication to cerclage, cerclage in situ or previous cerclage in this pregnancy.
Randomisation occurs via an online service in a 1:1 ratio, using a minimisation algorithm to reduce chance imbalances in key prognostic variables (site, gestation and dilatation). Primary outcome is pregnancy loss; a composite including miscarriage, termination of pregnancy and perinatal mortality defined as stillbirth and neonatal death in the first week of life. Secondary outcomes include all core outcomes for PTB. Two-year development outcomes will be assessed using general health and Parent Report of Children’s Abilities-Revised (PARCA-R) questionnaires. Intended sample size is 260 participants (130 each arm) based on 60% rate of pregnancy loss in the expectant management arm and 40% in the ECC arm, with 90% power and alpha 0.05. Analysis will be by intention-to-treat.

Discussion
To date there has been one small trial of ECC in 23 participants which included twin and singleton pregnancies. This small trial along with the largest observational study (n = 161) found ECC to prolong pregnancy duration and reduce deliveries before 34 weeks gestation. It is important to generate high quality evidence on the effectiveness of ECC in preventing pregnancy loss, and improve understanding of the prevalence of the condition and frequency of complications associated with ECC. An adequately powered RCT will provide the highest quality evidence regarding optimum care for these women and their babies.

Trial registration
ISRCTN Registry ISRCTN12981869. Registered on 13th June 2018.
RETRACTED ARTICLE: Mesenchymal stem cell-derived exosomal miR-146a reverses diabetic β-cell dedifferentiation
Authors: He Qin , Song Jia , Cui Chen , Wang Jinbang , Hu Huiqing , Guo Xinghong , Yang Mengmeng , Wang Lingshu , Yan Fei , Liang Kai , Liu Zhaojian , Liu Fuqiang , Sun Zheng , Dong Ming , Hou Xinguo , Chen Li 
Published: August 2021

Abstract
Background
Mesenchymal stem cells (MSCs) show promising therapeutic potential in treating type 2 diabetes mellitus (T2DM) in clinical studies. Accumulating evidence has suggested that the therapeutic effects of MSCs are not due to their direct differentiation into functional β-cells but are instead mediated by their paracrine functions. Among them, exosomes, nano-sized extracellular vesicles, are important substances that exert paracrine functions. However, the underlying mechanisms of exosomes in ameliorating T2DM remain largely unknown.

Methods
Bone marrow mesenchymal stem cell (bmMSC)-derived exosomes (bmMDEs) were administrated to T2DM rats and high-glucose-treated primary islets in order to detect their effects on β-cell dedifferentiation. Differential miRNAs were then screened via miRNA sequencing, and miR-146a was isolated after functional verification. TargetScan, reporter gene detection, insulin secretion assays, and qPCR validation were used to predict downstream target genes and involved signaling pathways of miR-146a.

Results
Our results showed that bmMDEs reversed diabetic β-cell dedifferentiation and improved β-cell insulin secretion both in vitro and in vivo. Results of miRNA sequencing in bmMDEs and subsequent functional screening demonstrated that miR-146a, a highly conserved miRNA, improved β-cell function. We further found that miR-146a directly targeted Numb, a membrane-bound protein involved in cell fate determination, leading to activation of β-catenin signaling in β-cells. Exosomes derived from miR-146a-knockdown bmMSCs lost the ability to improve β-cell function.

Conclusions
These findings demonstrate that bmMSC-derived exosomal miR-146a protects against diabetic β-cell dysfunction by acting on the NUMB/β-catenin signaling pathway, which may represent a novel therapeutic strategy for T2DM.
MSCs from polytrauma patients: preliminary comparative study with MSCs from elective-surgery patients
Authors: López Raúl , Martí-Chillón Gerardo J. , Blanco Juan F. , da Casa Carmen , González-Robledo Javier , Pescador David , Preciado Silvia , Muntión Sandra , Sánchez-Guijo Fermín 
Published: August 2021

Abstract
Background
Polytrauma is a major clinical problem due to its impact on morbidity and mortality, especially among the younger population. Its pathophysiology is not completely elucidated, and the study of the involvement of certain cell populations with therapeutic potential, such as mesenchymal stromal cells (MSCs), is an area of growing interest, as mesenchymal cells have anti-inflammatory, immunoregulatory, and osteogenic potential.

Methods
In the present preliminary work, we have evaluated the characteristics of MSCs in terms of proliferation, immunophenotype, cell cycle, clonogenic capacity, and multilineage differentiation ability in a series of 18 patients with polytrauma and compared them to those from otherwise healthy patients undergoing elective spinal surgery.

Results
MSCs from polytrauma patients displayed higher proliferative potential with significantly higher cumulative population doublings, increased expression of some important cell adhesion molecules (CD105, CD166), and an early pre-osteogenic differentiation ability compared to those of the control group.

Conclusions
MSCs could potentially be of help in the repair process of polytrauma patients contribute to both cell-tissue repair and anti-inflammatory response. This potential should be further explored in larger studies.
New insights into mitophagy and stem cells
Authors: Lin Qingyin , Chen Jiaqi , Gu Lifang , Dan Xingang , Zhang Cheng , Yang Yanzhou 
Published: August 2021

AbstractMitophagy is a specific autophagic phenomenon in which damaged or redundant mitochondria are selectively cleared by autophagic lysosomes. A decrease in mitophagy can accelerate the aging process. Mitophagy is related to health and longevity and is the key to protecting stem cells from metabolic stress damage. Mitophagy decreases the metabolic level of stem cells by clearing active mitochondria, so mitophagy is becoming increasingly necessary to maintain the regenerative capacity of old stem cells. Stem cell senescence is the core problem of tissue aging, and tissue aging occurs not only in stem cells but also in transport amplifying cell chambers and the stem cell environment. The loss of the autophagic ability of stem cells can cause the accumulation of mitochondria and the activation of the metabolic state as well as damage the self-renewal ability and regeneration potential of stem cells. However, the claim remains controversial. Mitophagy is an important survival strategy against nutrient deficiency and starvation, and mitochondrial function and integrity may affect the viability, proliferation and differentiation potential, and longevity of normal stem cells. Mitophagy can affect the health and longevity of the human body, so the number of studies in this field has increased, but the mechanism by which mitophagy participates in stem cell development is still not fully understood. This review describes the potential significance of mitophagy in stem cell developmental processes, such as self-renewal, differentiation and aging. Through this work, we discovered the role and mechanism of mitophagy in different types of stem cells, identified novel targets for killing cancer stem cells and curing cancer, and provided new insights for future research in this field.
A systematic summary of survival and death signalling during the life of hair follicle stem cells
Authors: Hu Xi-Min , Li Zhi-Xin , Zhang Dan-Yi , Yang Yi-Chao , Fu Shen-ao , Zhang Zai-Qiu , Yang Rong-Hua , Xiong Kun 
Published: August 2021

AbstractHair follicle stem cells (HFSCs) are among the most widely available resources and most frequently approved model systems used for studying adult stem cells. HFSCs are particularly useful because of their self-renewal and differentiation properties. Additionally, the cyclic growth of hair follicles is driven by HFSCs. There are high expectations for the use of HFSCs as favourable systems for studying the molecular mechanisms that contribute to HFSC identification and can be applied to hair loss therapy, such as the activation or regeneration of hair follicles, and to the generation of hair using a tissue-engineering strategy. A variety of molecules are involved in the networks that critically regulate the fate of HFSCs, such as factors in hair follicle growth and development (in the Wnt pathway, Sonic hedgehog pathway, Notch pathway, and BMP pathway), and that suppress apoptotic cues (the apoptosis pathway). Here, we review the life cycle, biomarkers and functions of HFSCs, concluding with a summary of the signalling pathways involved in HFSC fate for promoting better understanding of the pathophysiological changes in the HFSC niche. Importantly, we highlight the potential mechanisms underlying the therapeutic targets involved in pathways associated with the treatment of hair loss and other disorders of skin and hair, including alopecia, skin cancer, skin inflammation, and skin wound healing.