bluuebunny/crossref_metadata_2025_split huggingface dataset:
Engagement in perinatal depression treatment: a qualitative study of barriers across and within racial/ethnic groups
Authors: Iturralde Esti , Hsiao Crystal A. , Nkemere Linda , Kubo Ai , Sterling Stacy A. , Flanagan Tracy , Avalos Lyndsay A. 
Published: July 2021

Abstract
Background
To better understand previously observed racial/ethnic disparities in perinatal depression treatment rates we examined care engagement factors across and within race/ethnicity.

Methods
Obstetric patients and women’s health clinician experts from a large healthcare system participated in this qualitative study. We conducted focus groups with 30 pregnant or postpartum women of Asian, Black, Latina, and White race/ethnicity with positive depression screens. Nine clinician experts in perinatal depression (obstetric, mental health, and primary care providers) were interviewed. A semi-structured format elicited treatment barriers, cultural factors, and helpful strategies. Discussion transcripts were coded using a general inductive approach with themes mapped to the Capability-Opportunity-Motivation-Behavior (COM-B) theoretical framework.

Results
Treatment barriers included social stigma, difficulties recognizing one’s own depression, low understanding of treatment options, and lack of time for treatment. Distinct factors emerged for non-White women including culturally specific messages discouraging treatment, low social support, trauma history, and difficulty taking time off from work for treatment. Clinician factors included knowledge and skill handling perinatal depression, cultural competencies, and language barriers. Participants recommended better integration of mental health treatment with obstetric care, greater treatment convenience (e.g., telemedicine), and programmatic attention to cultural factors and social determinants of health.

Conclusions
Women from diverse backgrounds with perinatal depression encounter individual-level, social, and clinician-related barriers to treatment engagement, necessitating care strategies that reduce stigma, offer convenience, and attend to cultural and economic factors. Our findings suggest the importance of intervention and policy approaches effecting change at multiple levels to increase perinatal depression treatment engagement.
Women with multiple gestations have an increased risk of development of hypertension in the future
Authors: Cho Geum Joon , Jung Un Suk , Kim Ho Yeon , Lee Soo Bin , Kim Minjeong , Ahn Ki-Hoon , Han Sung Won , Hong Soon-Cheol , Kim Hai-Joong , Kim Younghan , Oh Min-Jeong 
Published: July 2021

Abstract
Background
Multiple gestations are associated with an increased incidence of preeclampsia. However, there exists no evidence for an association between multiple gestations and development of hypertension(HTN) later in life. This study aimed to determine whether multiple gestations are associated with HTN beyond the peripartum period.

Methods
In this retrospective nationwide population-based study, women who delivered a baby between January 1, 2007, and December 31, 2008, and underwent a national health screening examination within one year prior to their pregnancy were included. Subsequently, we tracked the occurrence of HTN during follow-up until December 31, 2015, using International Classification of Diseases-10th Revision codes.

Results
Among 362,821 women who gave birth during the study period, 4,944 (1.36%) women had multiple gestations. The cumulative incidence of HTN was higher in multiple gestations group compared with singleton group (5.95% vs. 3.78%, p < 0.01, respectively). On the Cox proportional hazards models, the risk of HTN was increased in women with multiple gestations (HR 1.35, 95% CI 1.19, 1.54) compared with those with singleton after adjustment for age, primiparity, preeclampsia, atrial fibrillation, body mass index, blood pressure, diabetes mellitus, high total cholesterol, abnormal liver function test, regular exercise, and smoking status.

Conclusions
Multiple gestations are associated with an increased risk of HTN later in life. Therefore, guidelines for the management of high-risk patients after delivery should be established.
Comparative analysis of the effects of collection methods on salivary steroids
Authors: Zhu Ce , Yuan Chao , Ren Qidi , Wei Fangqiao , Yu Shunlan , Sun Xiangyu , Zheng Shuguo 
Published: July 2021

Abstract
Background
Steroid hormone test for saliva was a promising area of research, however the impact of different collection methods on salivary steroids was underexplored so far. This study was designed to compare the effects of different collection methods (unstimulated or stimulated by chewing paraffin, forepart or midstream) on salivary flow rate, concentrations and secretion rates of steroids in saliva.

Methods
Whole-saliva samples were collected from 10 systemically and orally healthy participants, whose forepart and midstream segments of saliva were collected under unstimulated and stimulated conditions, with the salivary flow rate of each sample recorded. The concentrations and secretion rates of salivary steroids including testosterone, dehydroepiandrosterone (DHEA) and progesterone were measured by ELISA, with the multiple of change calculated.

Results
The results indicated mechanical stimulation used in collection of saliva samples could affect concentrations and secretion rates of steroids, whereas forepart and midstream segments had little differences in levels of salivary steroids, which effects could be partly influenced by individual specificity. The asynchronism in change of secretion rate of steroids with that of salivary flow rate might play an important role during this course.

Conclusion
Based on these findings, we suggested to use the same collection method throughout one analytical study on salivary steroids or in longitudinal observations to ensure the comparability of the saliva samples collected.
Development of clinical competence – a longitudinal survey of nurse practitioner students
Authors: Taylor I. , Bing-Jonsson P. C. , Finnbakk E. , Wangensteen S. , Sandvik L. , Fagerström L. 
Published: July 2021

Abstract
Background
In order to achieve a sustainable standard of advanced clinical competence for nurse practitioners leading to a credible role, it is important to investigate the development of clinical competence among nurse practitioner students.

Aim
The aim of the present study is to analyse the development of nurse practitioner students’ self-assessed clinical competence from the beginning of their education to after completion of their clinical studies.

Design
The study involved the application of a longitudinal survey design adhering to STROBE guidelines.

Methods
The participants consisted of 36 registered nurses from a nurse practitioner programme at a Norwegian university. The Professional Nurse Self-Assessment Scale II was used for data collection during the period August 2015 to May 2020.

Results
The students developed their clinical competence the most for direct clinical practice. Our findings are inconclusive in terms of whether the students developed clinical competence regarding consultation, coaching and guidance, and collaboration. However, they do indicate a lack of development in some aspects of clinical leadership. The students with the lowest level of clinical competence developed their clinical competence regarding direct clinical practice significantly more than the students with the highest level of clinical competence. The differences between students with high and low levels of clinical competence were levelled out during their education. Thus, the students as a whole became a more homogenous group after completion of their clinical studies. Previous work experience in primary healthcare was a statistically significant, yet minor, predictor of the development of clinical competence.

Conclusion
Our findings indicate that the students developed their clinical competence for direct clinical practice in accordance with the intended learning outcomes of the university’s Master’s programme and international standards for nurse practitioners. It is imperative that the clinical field supports nurse practitioners by facilitating extended work-task fits that are appropriate to their newly developed clinical competence. We refrain from concluding with a recommendation that prior clinical work experience should be an entry requirement for nurse practitioner programmes. However, we recommend an evaluation of the nurse practitioner education programme with the aim of investigating whether the curriculum meets the academic standards of clinical leadership expected in advanced level of nursing.
Organisational and advance care planning program characteristics associated with advance care directive completion: a prospective multicentre cross-sectional audit among health and residential aged care services caring for older Australians
Authors: Detering Karen M. , Sinclair Craig , Buck Kimberly , Sellars Marcus , White Ben P. , Kelly Helana , Nolte Linda 
Published: July 2021

AbstractBackgroundAdvance care planning (ACP) and advance care directive (ACD) completion improve outcomes for patients, family, clinicians and the healthcare system. However, uptake remains low. Despite increasing literature regarding organisational-level ACP characteristics leading to success, there is a lack of data measuring the impact of these factors on ACD prevalence.MethodsA prospective multi-centre, cross-sectional audit of health records among older Australians accessing general practices (GP), hospitals and residential aged care facilities (RACF) was undertaken to describe organisational and ACP-program characteristics across services, document ACD prevalence, and assess organisation-level predictors of ACD prevalence. Organisational-level data included general and ACP-program characteristics. Patient/resident data included demographics and presence of ACDs.ResultsOne hundred organisations (GP = 15, hospitals = 27, RACFs = 58) participated, contributing data from 4187 patient/resident health records. Median prevalence of ACDs across organisations was 19.4%, (range = 0–100%). In adjusted models, organisational sector type was the strongest predictor of ACD prevalence, with higher rates in RACFs (unadjusted 28.7%, adjusted 20.6%) than hospitals (unadjusted 6.4%, adjusted 5.8%) or GPs (unadjusted 2.5%, adjusted 6.6%). RACFs in regional and rural/remote areas had higher prevalence than metropolitan organisations. Organisations supported by government funding and those that were Not For Profit had higher prevalence than those that were privately funded, and organisations with an ACP program that had been implemented at least 3 years before data collection had higher prevalence than those with either no program or a more recent program.ConclusionsThe median ACD prevalence was low, with substantial variation across organisations. Sector type was the strongest predictor, being highest in RACFs. Low prevalence rates, overall and in particular sectors, have implications for improvements. Further research into organisational factors associated with ACP/ACD completion is required.
Adapting to the COVID-19 pandemic on Building Research in Diet and Cognition (BRIDGE) trial
Authors: Fitzgibbon Marian , Blumstein Lara , Schiffer Linda , Antonic Mirjana A. , McLeod Andrew , Dakers Roxanne , Restrepo Leo , Boots Elizabeth A. , Sanchez-Flack Jennifer C. , Tussing-Humphreys Lisa , Lamar Melissa 
Published: July 2021

Abstract
Background
The COVID-19 pandemic has altered the research landscape for clinical trials, requiring thoughtful consideration regarding how to handle the risks and benefits of continuing them.

Design
This brief report describes the experience of adapting the Building Research in Diet and Cognition (BRIDGE) study, a randomized clinical trial examining the effects of the Mediterranean diet, with and without weight loss, on cognitive functioning in 185 older obese African American adults during the COVID-19 pandemic.

Measurement
The University of Illinois at Chicago (UIC) developed an expedited amendment process for research shifting to remote data collection. We conducted the study in three consecutive groups. For group 3, 14-month data collection period, we adapted our protocol to allow data collection via telephone and e-mail. We were unable to collect certain measures that required face-to-face contact.

Results
For measures that could be collected remotely, 14-month retention was similar for group 3 compared to groups 1 and 2: data were collected for 86.9% of group 3 (remote) and 87.9% of groups 1 and 2 (face to face), p = .84.

Conclusions
In order to preserve the integrity of our clinical trial and ensure the safety of our participants and staff during the COVID-19 pandemic, we had to carefully and efficiently adapt our data collection procedures. The procedures put in place allowed us to collect our primary outcomes and the majority of our secondary outcomes and will enable us to examine the role of dietary intake, with and without weight loss, on cognitive functioning in a vulnerable and high-risk population.

Trial registration
ClinicalTrials.gov NCT3129048. Registration Date: 4/17/2017.
Electrospun wound dressings containing bioactive natural products: physico-chemical characterization and biological assessment
Authors: Arampatzis Athanasios S. , Kontogiannopoulos Konstantinos N. , Theodoridis Konstantinos , Aggelidou Eleni , Rat Angélique , Willems Anne , Tsivintzelis Ioannis , Papageorgiou Vassilios P. , Kritis Aristeidis , Assimopoulou Andreana N. 
Published: July 2021

Abstract

Background
Current research on skin tissue engineering has been focusing on novel therapies for the effective management of chronic wounds. A critical aspect is to develop matrices that promote growth and uniform distribution of cells across the wound area, and at the same time offer protection, as well as deliver drugs that help wound healing and tissue regeneration. In this context, we aimed at developing electrospun scaffolds that could serve as carriers for the bioactive natural products alkannin and shikonin (A/S).

Methods
A series of polymeric nanofibers composed of cellulose acetate (CA) or poly(ε-caprolactone) (PCL) and varying ratios of a mixture of A/S derivatives, has been successfully fabricated and their physico-chemical and biological properties have been explored.

Results

Scanning electron microscopy revealed a uniform and bead-free morphology for CA scaffolds, while for PCL beads along the fibers were observed. The average diameters for all nanofibers ranged between 361 ± 47 and 487 ± 88 nm. During the assessment of physicochemical characteristics, CA fiber mats exhibited a more favored profile, while the assessment of the biological properties of the scaffolds showed that CA samples containing A/S mixture up to 1 wt.% achieved to facilitate attachment, survival and migration of Hs27 fibroblasts. With respect to the antimicrobial properties of the scaffolds, higher drug-loaded (1 and 5 wt.%) samples succeeded in inhibiting the growth of
Staphylococcus epidermidis and S. aureus
around the edges of the fiber mats. Finally, carrying out a structure-activity relationship study regarding the biological activities (fibroblast toxicity/proliferation and antibacterial activity) of pure A/S compounds – present in the A/S mixture – we concluded that A/S ester derivatives and the dimeric A/S augmented cell proliferation after 3 days, whereas shikonin proved to be toxic at 500 nM and 1 μM and alkannin only at 1 μM. Additionally, alkannin, shikonin and acetyl-shikonin showed more pronounced antibacterial properties than the other esters, the dimeric derivative and the A/S mixture itself.

Conclusions
Taken together, these findings indicate that embedding A/S derivatives into CA nanofibers might be an advantageous drug delivery system that could also serve as a potential candidate for biomedical applications in the field of skin tissue engineering.
Randomized Phase II Trial of MIBG Versus MIBG, Vincristine, and Irinotecan Versus MIBG and Vorinostat for Patients With Relapsed or Refractory Neuroblastoma: A Report From NANT Consortium
Authors: DuBois Steven G. , Granger M. Meaghan , Groshen Susan , Tsao-Wei Denice , Ji Lingyun , Shamirian Anasheh , Czarnecki Scarlett , Goodarzian Fariba , Berkovich Rachel , Shimada Hiroyuki , Villablanca Judith G. , Vo Kieuhoa T. , Pinto Navin , Mosse Yael P. , Maris John M. , Shusterman Suzanne , Cohn Susan L. , Goldsmith Kelly C. , Weiss Brian , Yanik Gregory A. , Twist Clare J. , Irwin Meredith S. , Haas-Kogan Daphne A. , Park Julie R. , Marachelian Araz , Matthay Katherine K. 
Published: July 2021

PURPOSE 131I-metaiodobenzylguanidine (MIBG) is an active radiotherapeutic for neuroblastoma. The primary aim of this trial was to identify which of three MIBG regimens was likely associated with the highest true response rate. PATIENTS AND METHODS Patients 1-30 years were eligible if they had relapsed or refractory neuroblastoma, at least one MIBG-avid site, and adequate autologous stem cells. Patients received MIBG 18 mCi/kg on day 1 and autologous stem cell on day 15. Patients randomly assigned to arm A received only MIBG; patients randomly assigned to arm B received intravenous vincristine on day 0 and irinotecan daily on days 0-4; patients randomly assigned to arm C received vorinostat (180 mg/m2/dose) orally once daily on days 1 to 12. The primary end point was response after one course by New Approaches to Neuroblastoma Therapy criteria. The trial was designed with 105 patients to ensure an 80% chance that the arm with highest response rate was selected. RESULTS One hundred fourteen patients were enrolled, with three ineligible and six unevaluable, leaving 105 eligible and evaluable patients (36 in arm A, 35 in arm B, and 34 in arm C; 55 boys; and median age 6.5 years). After one course, the response rates (partial response or better) on arms A, B, and C were 14% (95% CI, 5 to 30), 14% (5 to 31), and 32% (18 to 51). An additional five, five, and four patients met New Approaches to Neuroblastoma Therapy Minor Response criteria on arms A, B, and C, respectively. On arms A, B, and C, rates of any grade 3+ nonhematologic toxicity after first course were 19%, 49%, and 35%. CONCLUSION Vorinostat and MIBG is likely the arm with the highest true response rate, with manageable toxicity. Vincristine and irinotecan do not appear to improve the response rate to MIBG and are associated with increased toxicity.
A Randomized, Multicenter, Open-Label, Blinded End Point, Phase 2, Feasibility, Efficacy, and Safety Trial of Preoperative Microvascular Protection in Patients Undergoing Major Abdominal Surgery
Authors: Yanase Fumitaka , Tosif Shervin H. , Churilov Leonid , Yee Ken , Bellomo Rinaldo , Gunn Kerry , Kim Chang , Krizhanovskii Camilla , Hahn Robert G. , Riedel Bernhard , Weinberg Laurence 
Published: July 2021

BACKGROUND:
The endothelial glycocalyx, a carbohydrate-rich layer coating all endothelial surfaces, plays a fundamental role in the function of microcirculation. The primary aim of this study was to evaluate the feasibility of using dexamethasone and albumin to protect the endothelial glycocalyx in patients undergoing abdominal surgery. Secondary and exploratory outcomes included efficacy and safety.

METHODS:
We conducted a multicenter, open-label, blinded end point, phase 2, randomized trial. Patients undergoing colorectal, pancreas, or liver surgery were recruited and randomized to receive either intravenous dexamethasone (16 mg) and 20% albumin (100 mL) at induction of anesthesia, then 200 mL of 20% albumin with each subsequent 1000 mL of crystalloid administered (dexamethasone and albumin [Dex-Alb] group), or crystalloid fluid only with no dexamethasone (control group). Feasibility end points included patient recruitment and retention, consent rate, and successful study drug administration. The primary efficacy end point was the measurement of plasma syndecan-1 level on postoperative day (POD) 1, and secondary end points were heparan sulfate levels and inflammatory markers measured at 4 perioperative timepoints. Safety end points included errors in administration of the intervention, hyperglycemia, occurrence of postoperative complications, and patient retention.

RESULTS:
Seventy-two patients were randomized. All feasibility end points were achievable. There were no statistically significant differences observed in median (interquartile range) syndecan-1 levels on POD 1 (39 ng·mL−1 [20–97] in the Dex-Alb group versus 41 ng·mL−1 [19–84] in the control group; difference in medians −2.1, 95% confidence interval [CI], −13 to 8.6; P = .69). The Dex-Alb group had lower POD 1 heparan sulfate levels (319 ng·mL−1 [161–717] in the Dex-Alb group versus 1422 [670–2430] ng·mL−1 in the control group; difference in medians −1085, 95% CI, −1779 to −391) and C-reactive protein (CRP) levels on POD 1 (48 [29–77] mg·L−1 in the Dex-Alb group versus 85 mg·L−1 [49–133] in the control group; difference in medians −48, 95% CI, −75 to −21). Fewer patients had one or more postoperative complication in the Dex-Alb group than in the control group (6 [17%] vs 18 patients [50%]; odds ratio = 0.2, 95% CI, 0.06–0.6).

CONCLUSIONS:
Intravenous dexamethasone and albumin administration was feasible but did not reduce syndecan-1 on POD 1 in patients undergoing abdominal surgery. Given the clinically important CIs observed between the groups for heparan sulfate, CRP, and postoperative complications, a larger trial assessing the associations between dexamethasone and albumin administration and these outcomes is warranted.
Integrating perspectives of patients, healthcare professionals, system developers and academics in the co-design of a digital information tool
Authors: Grynne Annika , Browall Maria , Fristedt Sofi , Ahlberg Karin , Smith Frida 
Published: July 2021

Background
Patients diagnosed with cancer who are due to commence radiotherapy, often, despite the provision of a considerable amount of information, report a range of unmet information needs about the treatment process. Factors such as inadequate provision of information, or the stressful situation of having to deal with information about unfamiliar things, may influence the patient’s ability to comprehend the information. There is a need to further advance the format in which such information is presented. The composition of information should be tailored according to the patient’s individual needs and style of learning.

Method and findings
The PD methodology is frequently used when a technology designed artefact is the desired result of the process. This research is descriptive of its kind and provides a transparent description of the co-design process used to develop an innovative digital information tool employing PD methodology where several stakeholders participated as co-designers. Involving different stakeholders in the process in line with recommended PD activities enabled us to develop a digital information tool that has the potential to be relevant and user-friendly for the ultimate consumer.

Conclusions
Facilitating collaboration, structured PD activities can help researchers, healthcare professionals and patients to co-design patient information that meets the end users’ needs. Furthermore, it can enhance the rigor of the process, ensure the relevance of the information, and finally have a potential to employ a positive effect on the reach of the related digital information tool.