bluuebunny/crossref_metadata_2025_split huggingface dataset:
Accessibility of basic paediatric emergency care in Malawi: analysis of a national facility census
Authors: Johansson Emily White , Lindsjo Cecilia , Weiss Daniel , Nsona Humphreys , Selling Katarina Ekholm , Lufesi Norman , Hildenwall Helena 
Published: July 2019

Abstract
Background

Emergency care is among the weakest parts of health systems in low-income countries. Previous studies estimated accessibility to emergency care based on population travel times to nearest hospital with no assessment of hospital readiness to provide such care. We analysed a Malawi national facility census with comprehensive inventory audits and geocoded facility locations to identify hospitals equipped to provide basic paediatric emergency care with estimated travel times to these hospitals from non-equipped facilities and relative to Malawi’s population distribution.

Methods

We analysed a Malawi national facility census in 2013-2014 to identify hospitals equipped to manage critically ill children according to an extended version of WHO Emergency Triage, Assessment and Treatment (ETAT) guidelines. These guidelines include 25 components including staff, transport, equipment, diagnostics, medications, fluids, feeds and consumables that defined an emergency-equipped hospital in our study. We estimated travel times to emergency-equipped hospitals from non-equipped facilities and relative to population distributions using geocoded facility locations and an established accessibility mapping approach using global road network datasets from OpenStreetMap and Google.

Results

Four (3.5%, 95% CI: 1.3-8.9) of 116 Malawi hospitals were emergency-equipped. Least available items were nasogastric tubes in 34.5% of hospitals (95% CI: 26.4-43.6), blood typing services (40.4%, 95% CI: 31.9-49.6), micro nebulizers (50.9%, 95% CI: 41.9-60.0), and radiology (54.2%, 95% CI: 45.1-63.0). Nationally, the median travel time from non-equipped facilities to the nearest emergency-equipped hospital was 73 minutes (95% CI: 67-77) ranging 1-507 minutes. Approximately one-quarter (27%) of Malawians lived over 120 minutes from an emergency-equipped hospital with significantly better accessibility in Central than North and South regions (16% vs. 38% and 35%, p<0.001).

Conclusions

There are unacceptable deficiencies in accessibility of basic paediatric emergency care in Malawi. Reliable supply chains for essential drugs and commodities are needed, particularly nasogastric tubes, asthma drugs and blood, along with improved capacity for time-sensitive referral. Further child mortality reductions will require substantial investments to expand basic paediatric emergency care into all Malawi hospitals for better managing critically ill children at highest mortality risk.
Husband’s Willingness-to-Pay for HIV and Syphilis Screening at Antenatal Care Clinic under the Thai Universal Coverage Scheme
Authors: Anunsittichai Orawan , Pongpirul Krit , Puthanakit Thanyawee , Roowicha Koranit , Kaewprasert Jirarat , Songtaweesin Wipaporn Natalie , Chaithongwongwattana Surasith 
Published: July 2019

Abstract
Background Screening for sexually transmitted infection (STI) especially HIV as early detection and treatment have been financially supported under the Thai Universal Coverage (UC) scheme since 2009 (THB140 for HIV). However, there has been no evidence-based strategic risk-based implementation nor economic evaluation whereas husbands who accompanied the pregnant women are likely to have lower risk than those who did not come along. This study is aimed to explore husband’s willingness-to-pay (WTP) for his HIV and syphilis screenings at ANC.
Methods A survey of 200 randomly selected husbands of pregnant women was conducted at King Chulalongkorn Memorial Hospital from April to June 2018. A pilot study using an open-ended question was conducted to estimate the mean and standard deviation of WTP for HIV and syphilis screenings. Then, two contingent valuation methods (bidding and payment scale) were performed for the final WTP assessments, using the mean WTP identified from the pilot study as a starting WTP with 1⁄4 SD step up/down. Multivariate linear regression was performed to explore potential determinants of the price that the husbands are willing to pay.
Results During the study period, 597 pregnant women received their first ANC. Of 368 accompanying husbands, 200 were enrolled in the study. Their median age was 31 (IQR 27-36) years old and 67% had a first child. Eighty-eight percent of the participants were willing to test for STIs. Based on the bidding method, WTP for HIV and syphilis tests were US$14.5 (IQR 12.4-14.5) and US$9.7 (IQR 10-12), respectively. The payment scale method suggested approximately three-quarter of the price. Expecting the first child and higher education were associated with a higher price (P <0.01).
Conclusions The husbands presented at antenatal care clinic are willing to pay at least two times the cost of the STI test. The financial support to promote STI screenings should be reconsidered to cover other groups with higher sexual behavior risks and less willingness-to- pay.
Management Outcome and Associated Factors among Intestinal Obstruction Patients Treated Surgically, Eastern Ethiopia
Authors: Derseh Tesfaye , Minuye Biniam , Yusouf Mohammed , Dingeta Tariku 
Published: July 2019

Abstract
Background

Intestinal obstruction is a global problem consuming much in terms of surgical services. It is a common surgical emergency and a significant health problem in Ethiopia. Several factors contribute to poor management outcomes in the case of intestinal obstruction. Post-operative mortality rate ranges from 3% to 30%. Despite this high rate of mortality, there is no recently published literature that has explored Intestinal Obstruction and its associated factors at Chiro General Hospital.

Methods

Institution based cross-sectional study was conducted among 254 of patients admitted with Intestinal obstruction who treated surgically at Chiro General Hospital. Data were collected using checklists from individual patient cards by trained three BSc nurses from 13 to 18 July 2018 and completeness of data collection was checked every day by the principal Investigator. Data were entered to Epi-Data version 3.1 computer software and exported to SPSS statistical software version 22 for analysis. Bivariable binary logistic regression was used to saw the association between each independent variable and dependent variable. All variables with P-value < 0.2 during bi-variable analyses were considered for multivariable logistic regression analyses. Odds ratio along with 95%CI were estimated to measure the strength of the association. Level of statistical significance was declared at p value less or equal to 0.05.

Results

In this study the magnitude of unfavorable outcome of Intestinal Obstruction was 21.3% (95% CI: (16.5, 26.4). Age group of 55 years or above [AOR=2.9, 95%CI: (1.03, 8.4)], duration of illness of 24hrs or above [AOR=3.1, 95%CI: (1.03, 9.4)], pre-operative diagnosis of gangrenous SBO & gangrenous LBO [(AOR=3.6, 95%CI: (1.3, 9.8)), (AOR=4.2, 95%CI: (1.3, 13.7))], respectively were significantly associated with unfavorable outcome.

Conclusions

The magnitude of unfavourable management outcome of patients with Intestinal obstruction who treated surgically in this study was high. Old age, late presentation of illness and gangrenous bowel obstruction were significantly associated with unfavourable management outcome. So that early detection prompt management of patients with Intestinal obstruction reduce the occurrence of unfavourable outcome of patients.
IS RADIOGRAPHIC LUMBAR SPONDYLOLISTHESIS ASSOCIATED WITH OCCUPATIONAL EXPOSURES? FINDINGS FROM A NESTED CASE CONTROL STUDY WITHIN THE WAKAYAMA SPINE STUDY
Authors: Ishimoto Yuyu , Cooper Cyrus , Ntani Georgia , Yamada Hiroshi , Hashizume Hiroshi , Nagata Keiji , Muraki Shigeyuki , Tanaka Sakae , Yoshida Munehito , Yoshimura Noriko , Walker-Bone Karen 
Published: July 2019

Abstract
Objective

To explore the relationship between radiographic spondylolisthesis and occupational factors in a case-control study nested within the Wakayama Spine Study (WSS).

Design

The WSS is a cross-sectional observational study amongst Japanese adults. All participants completed a lifetime occupational history and underwent X-rays of the lumbar spine (L1-S1) according to a pre-defined protocol. One trained surgeon graded the presence of a spondylolisthesis based upon ≥5% anterior or posterior slip at one or more levels. Cases, with lumbar spondylolisthesis, were compared with controls without, for their principal occupation and occupational exposures.

Results

In total, data were available for 722 adults (245 men and 477 women), mean age 70.1 (range 53-93) years. According to the pre-defined radiographic criteria, 117 were defined with spondylolisthesis (cases), leaving 605 controls. Cases were not significantly different from controls for age, gender, BMI, smoking or alcohol intake. However, occupational driving ≥ 2hours/day was associated with a doubling of the risk of being a case (OR 2.39, 95% CI 1.08-5.27) after adjustment for age, gender and BMI. Additionally, after stratification by age using 75 years as a cut-point, working in the agricultural/ fishing industries was associated with a greater than 3-fold increased risk of spondylolisthesis (OR 3.47, 95% CI 1.29-9.29) among those aged <75 years. Climbing slopes/steps and walking were associated with reduced odds ratios.

Conclusions

A history of occupational driving and working in the agricultural/fishing industry were associated with radiographic spondylolisthesis in this cross-sectional population study. This finding requires further evaluation in longitudinal studies.
Simulation Study on the Effect of Grading Diagnosis and Treatment Based on System Dynamics Model in the Context of Medical Alliance——Taking Jiangsu Province as An Example
Authors: tang shaoliang , Qiu Jiahuan , Tang Kean 
Published: July 2019

Abstract
Abstract: Objective

To study the core influencing factor of the implementation of Grading diagnosis and treatment system in the context of Jiangsu medical alliance. Methods By constructing the grading diagnosis and treatment system dynamics model under the background of medical alliance, the number of first-time treatments at the primary level was taken as the core evaluation index. By intervening on different targets, we would study the influence on the core evaluation index. Results The selected six intervention targets had positive effects on graded diagnosis and treatment. Among them, the intervention of medical resource subsidence, the construction of information platform between medical alliances and the technical level of primary level had the greatest impact. Conclusion In order to better promote the development of the grading diagnosis and treatment system, we can focus on the construction of medical alliances: For example, implementing the sinking of high quality medical resources in the medical alliance to strengthen the discipline construction of primary level; breaking the information island in the medical alliance, and strengthening the construction of information platform; building and expanding the green channel for two-way referral, implementing the differentiation of medical insurance policies, and improving the mechanism of benefit sharing in the medical alliances to gradually realize the orderly rationalization of medical treatment.
The emotional labour of quality improvement work in end of life care: a qualitative study of Patient and Family Centred Care in England
Authors: Boulton Richard , Boaz Annette 
Published: July 2019

Abstract
BACKGROUND
There is a growing emphasis on understanding patient experience in order to inform efforts to support improvement. This paper reports findings from an implementation study of an evidence based intervention called Patient and Family Centred Care (PFCC) designed to tap into patient experience as a basis for improvement. In this study the PFCC intervention was spread to a new service area (end of life care) and delivered at scale in England. The findings presented here focus specifically on one key aspect of the intervention: staff shadowing of patients, designed to help staff connect emotionally with patients’ experiences of their service in order to bring about improvements.
METHODS
The study methods were ethnographic observations of key events, semi-structured interviews with members of participating teams and the programme implementation support team and managers, and a review of the documents used in the set up and running of the programme.
RESULTS
One of the key strengths of the PFCC approach is to encourage staff through shadowing to engage with patient experience of services. Many staff described the process of shadowing as a transformative experience that alerted them to immediate areas where their services could be improved. However, engaging with patient experience of end of life care services also had unintended consequences for some staff in the form of emotional labour. Furthermore, we observed difficulties encountered by staff that are not accounted for in the existing PFCC literature relating to how care service structures may unevenly distribute the amount of ‘emotional labour’ that staff members need to invest in implementing the programme.
CONCLUSIONS
Connecting with patient experience is a crucial aspect of a number of quality improvement interventions that aim to help staff to engage with the lived experience of their services and reconnect their motivations for working in the health care system. However, there may be unintended consequences for health care staff, particularly in sensitive areas of service delivery such as end of life care. The ‘emotional labour’ for staff of engaging in quality improvement work informed by patient experience should be considered in planning and supporting patient experience led quality improvement.
The diversity between curatively resected pancreatic head and body-tail cancers based on the 8th edition of AJCC staging system: a multicenter cohort study
Authors: Sheng Weiwei , Dong Ming , Wang Guosen , Shi Xiaoyang , Gao Wei , Wang Kewei , Song He , Shi Gang , Tan Xiaodong 
Published: July 2019

Abstract
Background
To our knowledge, there are no studies to systematically compare the detailed clinical significance between curatively resected pancreatic head (ph) and body-tail (pbt) ductal cancers based on the new 8th edition of AJCC staging system (8th AJCC stage) that was just applied in clinical practice in 2018.

Methods

351 cases of curatively resected pancreatic adenocarcinoma (PC) patients from three center hospitals were entered into this multicenter cohort study.

Results

Increasing tumor size (P<0.001), T stage (T1+T2 vs T3+T4, P=0.003), frequent postoperative liver metastasis (PLM) (P=0.002) and 8th AJCC stage (IA to VI, P<0.001; I+II vs III+IV, P=0.002) were closely associated with the progression of pbt cancers compared with that in ph cancer patients. Moreover, tumor size≥3cm (P=0.012), 8th AJCC stage (III+IV) (P=0.025) and PLM (P=0.010) were identified as independent risk factors in pbt cancers in logistic analysis. Patients with pbt cancers had a significantly worse overall survival compared with ph cancer patients (P=0.007). Moreover, pbt was an independent unfavorable factor in multivariate analysis (P=0.009). In addition to 8th AJCC stage, vascular invasion and PLM, increasing tumor size tumor size and advanced T stage were also closely associated with the poor prognosis in 131 cases of pbt cancer patients compared with Ph cancers.

Conclusion

Pbt, as an independent unfavorable factor for the prognosis of PC patients, are much more aggressive than that in ph cancers according to 8th AJCC staging system. 8th AJCC staging system are more comprehensive and sensitive to reflect the malignant biology of pbt cancers.
The Relationship between Ferroptosis and Tumors: A Novel Landscape for Therapeutic Approach
Authors: Xia Xiaojun , Fan Xiaoping , Zhao Mingyi , Zhu Ping 
Published: July 2019

Background:Ferroptosis is a newly discovered form of iron-dependent oxidative cell death characterized by lethal accumulation of lipid-based reactive oxygen species (ROS). It is distinct from other forms of cell death including apoptosis, necrosis, and autophagy in terms of morphology, biochemistry and genetics.Discussion:Ferroptosis can be induced by system xc- inhibitors or glutathione peroxidase 4 (GPx4) inhibitors, as well as drugs such as sorafenib, sulfasalazine (SAS), and artesunate (ART). Ferroptosis has been recently shown to be critical in regulating growth of tumors, such as hepatocellular carcinoma (HCC), renal cell carcinoma (RCC), non-small cell lung cancer (NSCLC), ovarian cancer, pancreatic carcinoma, and diffuse large B cell lymphoma (DLBCL). Ferroptosis is also associated with resistance to chemotherapeutic drugs and the anti-tumor efficacy of immunotherapy.Conclusion:This review summarizes the mechanism of ferroptosis and its relationship with different types of tumors, to advance our understanding of cell death and to find a novel approach for clinical cancer management.
Cell Penetrating Peptide: Sequence-Based Computational Prediction for Intercellular Delivery of Arginine Deiminase
Authors: Zarei Mahboubeh , Rahbar Mohammad Reza , Negahdaripour Manica , Morowvat Mohammad Hossein , Nezafat Navid , Ghasemi Younes 
Published: July 2019

Background:Cell-Penetrating Peptides (CPPs), a family of short peptides, are broadly used as the carrier in the delivery of drugs and different therapeutic agents. Thanks to the existence of valuable databases, computational screening of the experimentally validated CPPs can help the researchers to select more effective CPPs for the intercellular delivery of therapeutic proteins. Arginine deiminase of Mycoplasma hominis, an arginine-degrading enzyme, is currently in the clinical trial for treating several arginine auxotrophic cancers. However, some tumor cells have developed resistance to ADI treatment. The ADI resistance arises from the over-expression of argininosuccinate synthetase 1 enzyme, which is involved in arginine synthesis. Intracellular delivery of ADI into tumor cells is suggested as an efficient approach to overcome the aforesaid drawback.Objective:In this study, in-silico tools were used for evaluating the experimentally validated CPPs to select the best CPP candidates for the intracellular delivery of ADI.Results:In this regard, 150 CPPs of protein cargo available at CPPsite were retrieved and evaluated by the CellPPD server. The best CPP candidates for the intracellular delivery of ADI were selected based on stability and antigenicity of the ADI-CPP fusion form. The conjugated forms of ADI with each of the three CPPs including EGFP-hcT (9-32), EGFP-ppTG20, and F(SG)4TP10 were stable and nonantigenic; thus, these sequences were introduced as the best CPP candidates for the intracellular delivery of ADI. In addition, the proposed CPPs had appropriate positive charge and lengths for an efficient cellular uptake.Conclusion:These three introduced CPPs not only are appropriate for the intracellular delivery of ADI, but also can overcome the limitation of its therapeutic application, including short half-life and antigenicity.
Azacyanines as Novel Topoisomerase II Alpha Inhibitors
Authors: Guloglu Sercan , Kirmaci Fahriye Nur , Çetinkol Özgül Persil , Forough Mehrdad , Gulkaya Aybuke 
Published: July 2019

Introduction:Topoisomerase II alpha (Topo IIα) has become one of the extensively exploited targets in chemotherapy due to its role in regulating the topological constraints of DNA during replication and transcription. Small molecules targeting Topo IIα’s activity such as etoposide (VP-16) and doxorubicin are extensively used in the treatment of many different types of cancer.Objective:Here, the effects of three small molecules, named as azacyanines, on Topo IIα have been assessed.Methods:In-vitro Topoisomerase IIα drug screening kit and agarose gel imaging were used for the assessment of Topo IIα’s activity.Results:Our results revealed that all the azacyanines investigated decreased the catalytic activity of Topo IIα dramatically. More importantly, the decrease in the catalytic activity of Topo IIα in the presence of azacyanines was higher than the presence of VP-16, which is a commercially available chemotherapy drug. Upon further investigation, it has been observed that Azamethyl’s catalytic inhibition of Topo IIα was concentration dependent and the catalytic activity of Topo IIα was almost completely abolished in the presence of 100.0 μM of Azamethyl.Conclusion:These findings reveal the potential of azacyanines as effective Topo IIα inhibitors and chemotherapeutic agents.
Positive Association Between Plasma Levels of Advanced Glycation and Precursor of Lipoxidation end Products with Gastrointestinal Problems in Children with Autism
Authors: Ghodsi Ramin , Kheirouri Sorayya 
Published: July 2019

Background:
Increased oxidative stress has been reported in autistic patients besides,
evidence linking oxidative stress to enhancement of advanced glycation and lipoxidation end products
(AGEs and ALEs) and their precursors.

Objective:
This study aimed to compare the plasma levels of the AGEs and precursors of ALEs in
autistic and healthy children and to evaluate their relationship with autism comorbidities.

Methods:
In this descriptive study, 54 children, 36 autistic and 18 healthy participated. Plasma levels
of AGEs and precursors of ALEs were measured by ELISA method. Severity of autism and
Gastrointestinal (GI) disorders were measured by GARSII questionnaire and QPGS-ROME III
questionnaire, respectively.

Results:
Plasma levels of AGEs and precursors of ALEs in autistic children were comparable with
healthy children. Plasma levels of AGEs and precursor of ALEs were correlated with physical activity
and GI disorders in autistic children. A strong association was also found between AGEs and
precursors of ALEs.

Conclusions:
The results indicate that AGEs and ALEs have a strong correlation together but the
AGEs and precursor of ALEs in autistic children are not different from healthy children.
Cognitive Behavioral Therapy Online for Adult Depression: A 10 Year Systematic Literature Review
Authors: Stavropoulos Vasileios , Cokorilo Sandra , Kambouropoulos Alexa , Collard James , Gomez Rapson 
Published: July 2019

Background:Acceptance, adherence and efficacy aspects of Cognitive Behavioural Therapy (CBT) online have invited significant interest, especially in the context of “stepped care” models, which advocate progressive stages of intervention in addressing depression. Objectives: The current work aspires to comprehensively identify critical factors linked to the applicability of online CBT, in order to inform clinical practices and future research targeting depressive behaviors in early and middle adulthood.Methods:To serve these goals: a) the PRISMA systematic literature perspective is followed; b) a systematic search of online databases between 2008-2018 was undertaken and; c) a compositehybrid model, resulting from the integration of broadly adopted conceptualizations from the areas of psychological treatment and internet use behaviors, was combined with an interpretative phenomenological analysis perspective to organize the findings.Results:In total, 28 studies were included in the present review. Factors defining the efficacy, adherence and acceptability of online CBT targeting depression (during early and middle adulthood) were classified into parameters related to the individual receiver, the context and the CBT activities involved.Conclusion:Despite the cautiousness warranted by the limitations, as well as the diverge methodology of the reviewed studies, findings appear to favour the provision of brief, therapist supported, online CBT interventions, especially in addressing moderate depression during early and middle adulthood.