bluuebunny/crossref_metadata_2025_split huggingface dataset:
A perspective on Chiropractic Councils on Education accreditation standards and processes from the inside: a narrative description of expert opinion, part 1: Themes
Authors: Innes Stanley I. , Cope Vicki , Leboeuf-Yde Charlotte , Walker Bruce F. 
Published: September 2019

Abstract

Background
The aim of this study was to report on key informant opinions of Councils on Chiropractic Education (CCE) regarding recent research findings reporting on improving accreditation standards and processes for chiropractic programs (CPs).

Methods
This qualitative study employed in-depth semi-structured interviews with key experienced personnel from the five CCEs in June and July of 2018. The interviews consisted of open-ended questions on a range of issues surrounding accreditation, graduate competency standards and processes. All interviews were audio-recorded, and transcribed verbatim. The transcripts were analysed to develop codes and themes using thematic analysis techniques assisted by NVivo coding software. The study followed the COREQ guidelines for qualitative studies.

Results
Six themes were isolated from the interview transcripts; they were: professional differences; keep it in the family; to focus on outcomes or be prescriptive?; more resources please; inter-profession integration; and CPs making ends meet. Most respondents saw a need for CCEs standards and processes to improve interdisciplinarity while at the same time preserving the ‘uniqueness’ of chiropractic. Additionally, informants viewed CCEs as carrying out their functions with limited resources while simultaneously dealing with vocal disparate interest groups. Diverse views were observed on how CCEs should go about their business of assessing chiropractic programs for accreditation and re-accreditation.

Conclusions
An overarching confounder for positive changes in CCE accreditation standards and processes is the inability to clearly define basic and fundamental terms such as ‘chiropractic’ and its resultant scope of practice. This is said to be because of vocal, diverse and disparate interest groups within the chiropractic profession. Silence or nebulous definitions negotiated in order to allow a diversity of chiropractic practice to co-exist, appears to have complicated and hindered the activities of CCEs. Recommendations are made including an adoption of an evidence-based approach to accreditation standards and processes and the use of expertise from other health professions. Further, the focus of attention should be moved away from professional interests and toward that of protection of the public and the patient.
Trends and determinants of early initiation of breastfeeding and exclusive breastfeeding in Ethiopia from 2000 to 2016
Authors: Ahmed Kedir Y. , Page Andrew , Arora Amit , Ogbo Felix Akpojene 
Published: September 2019

Abstract

Background
At the national level in Ethiopia, there is limited knowledge of trends and factors associated with early initiation of breastfeeding and exclusive breastfeeding (EBF), particularly during the Millenium Development Goal (MDG) era (2000–2015). The study aimed to examine the trends and determinants of early initiation of breastfeeding and EBF in Ethiopia between 2000 and 2016.

Methods
Using the Ethiopia Demographic and Health Survey (EDHS) data for the years: 2000 (n = 3680), 2005 (n = 3528), 2011 (n = 4037) and 2016 (n = 3861), trends in early initiation of breastfeeding and EBF were estimated. Multivariate logistic regression models that adjusted for confounders, sampling weight, clustering and stratification were used to examine the association between socioeconomic, demographic, health service and community level factors with early initiation of breastfeeding and EBF from 2000 to 2016.

Results
The prevalence of early initiation of breastfeeding increased from 48.8% in 2000 to 75.7% in 2016 in Ethiopia. Improvement in EBF prevalence was not statistically significant (from 54.5% in 2000 to 59.9% in 2016). Over the study period, informal maternal employment (Adjusted Odds Ratio [aOR] 0.75; 95% Confidence Interval [CI] 0.68, 0.83), frequent antenatal care visits (aOR 0.74; 95% CI 0.65, 0.85), and cesarean birthing (aOR 0.22; 95% CI 0.17, 0.30) were associated with delayed initiation of breastfeeding. Birthing in the health facility (aOR 1.35; 95% CI 1.05, 1.75) and residing in the metropolis region (aOR 1.95; 95% CI 1.65, 2.32) were associated with timely initiation of breastfeeding. In a similar period, informally employed mothers (aOR 1.37; 95% CI 1.15, 1.63) and those with six or more family size (aOR 1.46; 95% CI 1.10, 1.93) were more likely to exclusively breastfeed their babies.

Conclusion
Early initiation of breastfeeding improved in Ethiopia during the MDG era but it is still below the national target; progress in EBF remained slow. To improve breastfeeding outcomes and meet the global breastfeeding targets in Ethiopia, infant feeding efforts should focus on improving key modifiable factors, including place and mode of birthing and socioeconomic status of mothers.
Skeletal muscle mass correlates with increased toxicity during neoadjuvant radiochemotherapy in locally advanced esophageal cancer: A SAKK 75/08 substudy
Authors:   for the Swiss Group for Clinical Cancer Research (SAKK), Panje Cédric M. , Höng Laura , Hayoz Stefanie , Baracos Vickie E. , Herrmann Evelyn , Garcia Schüler Helena , Meier Urs R. , Henke Guido , Schacher Sabina , Hawle Hanne , Gérard Marie-Aline , Ruhstaller Thomas , Plasswilm Ludwig 
Published: September 2019

Abstract

Background
Sarcopenia, the critical depletion of skeletal muscle mass, is an independent prognostic factor in several tumor entities for treatment-related toxicity and survival. In esophageal cancer, there have been conflicting results regarding the value of sarcopenia as prognostic factor, which may be attributed to the heterogeneous patient populations and the retrospective nature of previous studies. The aim of our study was therefore to determine the impact of sarcopenia on prospectively collected specific outcomes in a subgroup of patients treated within the phase III study SAKK 75/08 with trimodality therapy (induction chemotherapy, radiochemotherapy and surgery) for locally advanced esophageal cancer.

Methods
Sarcopenia was assessed by skeletal muscle index at the 3rd lumbar vertebra (L3) in cross-sectional computed tomography scans before induction chemotherapy, before radiochemotherapy and after neoadjuvant therapy in a subgroup of 61 patients from four centers in Switzerland. Sarcopenia was determined by previously established cut-off values (Martin et al., PMID: 23530101) and correlated with prospectively collected outcomes including treatment-related toxicity, postoperative morbidity, treatment feasibility and survival.

Results
Using the published cut-off values, the prevalence of sarcopenia increased from 29.5% before treatment to 63.9% during neoadjuvant therapy (p < 0.001). Feasibility of neoadjuvant therapy and surgery was not different in initially sarcopenic and non-sarcopenic patients. We observed in sarcopenic patients significantly increased grade ≥ 3 toxicities during chemoradiation (83.3% vs 52.4%, p = 0.04) and a non-significant trend towards increased postoperative complications (66.7% vs 42.9%, p = 0.16). No difference in survival according to sarcopenia could be observed in this small study population.

Conclusions
Trimodality therapy in locally advanced esophageal cancer is feasible in selected patients with sarcopenia. Neoadjuvant chemoradiation increased the percentage of sarcopenia. Sarcopenic patients are at higher risk for increased toxicity during neoadjuvant radiochemotherapy and showed a non-significant trend to more postoperative morbidity.
Modular hemipelvic endoprosthesis with a sacral hook: a finite element study
Authors: Wang Bo , Sun Peidong , Yao Hao , Tu Jian , Xie Xianbiao , Ouyang Jun , Shen Jingnan 
Published: September 2019

AbstractBackgroundA novel hemipelvic endoprosthesis with a sacral hook was introduced previously, and its clinical outcome with midterm follow-up showed decreased prosthesis-related complications, especially decreased rate of aseptic loosening. The aim of present study was to evaluate the role of a sacral hook in prosthesis stability and the biomechanical properties of this hemipelvic endoprosthesis.MethodsA three-dimensional model of the postoperative pelvis was developed using computed tomography (CT) images. A force of 500 N was applied, and the distribution of stress and displacement was evaluated. Comparisons were performed to explore the role of the sacral hook in prosthesis stability. Prosthesis improvement was simulated to reduce unexpected breakage of the pubic connection plate.ResultsIn the reconstructed hemipelvis, stress distributions were concentrated on the superior area of the acetabulum, sacral connection component, and sacral hook. A maximum stress of 250 MPa was observed at the root of the sacral connection component. The sacral hook reduced the maximum stress and displacement by 14.1% and 32.5%, respectively, when the prosthesis was well fixed and by 10.0% and 42.1%, respectively, when aseptic loosening occurred. Increasing the thickness of the pubic connection plate from 2 to 3.5 mm reduced the maximum stress by 32.0% and 15.8%, respectively.ConclusionA hemipelvic endoprosthesis with a sacral hook fulfills the biomechanical demands of the hemipelvis and is safe under static conditions. The sacral hook is important for prosthesis stability. Increasing the thickness of the pubic connection plate can reduce the maximum stress and risk of fatigue breakage.
Comparative assessment of net CO2 exchange across an urbanization gradient in Korea based on eddy covariance measurements
Authors: Hong Je-Woo , Hong Jinkyu , Chun Junghwa , Lee Yong Hee , Chang Lim-Seok , Lee Jae-Bum , Yi Keewook , Park Young-San , Byun Young-Hwa , Joo Sangwon 
Published: September 2019

AbstractBackgroundIt is important to quantify changes in CO2sources and sinks with land use and land cover change. In the last several decades, carbon sources and sinks in East Asia have been altered by intensive land cover changes due to rapid economic growth and related urbanization. To understand impact of urbanization on carbon cycle in the monsoon Asia, we analyze net CO2exchanges for various land cover types across an urbanization gradient in Korea covering high-rise high-density residential, suburban, cropland, and subtropical forest areas.ResultsOur analysis demonstrates that the urban residential and suburban areas are constant CO2sources throughout the year (2.75 and 1.02 kg C m−2 year−1at the urban and suburban sites), and the net CO2emission indicate impacts of urban vegetation that responds to the seasonal progression of the monsoon. However, the total random uncertainties of measurement are much larger in the urban and suburban areas than at the nonurban sites, which can make it challenging to obtain accurate urban flux measurements. The cropland and forest sites are strong carbon sinks because of a double-cropping system and favorable climate conditions during the study period, respectively (− 0.73 and − 0.60 kg C m−2 year−1at the cropland and forest sites, respectively). The urban area of high population density (15,000 persons km−2) shows a relatively weak CO2emission rate per capita (0.7 t CO2 year−1 person−1), especially in winter because of a district heating system and smaller traffic volume. The suburban area shows larger net CO2emissions per capita (4.9 t CO2 year−1 person−1) because of a high traffic volume, despite a smaller building fraction and population density (770 persons km−2).ConclusionsWe show that in situ flux observation is challenging because of its larger random uncertainty and this larger uncertainty should be carefully considered in urban studies. Our findings indicate the important role of urban vegetation in the carbon balance and its interaction with the monsoon activity in East Asia. Urban planning in the monsoon Asia must consider interaction on change in the monsoon activity and urban structure and function for sustainable city in a changing climate.
Detection of NRAS mutation in cell-free DNA biological fluids from patients with kaposiform lymphangiomatosis
Authors: Ozeki Michio , Aoki Yoko , Nozawa Akifumi , Yasue Shiho , Endo Saori , Hori Yumiko , Matsuoka Kentaro , Niihori Tetsuya , Funayama Ryo , Shirota Matsuyuki , Nakayama Keiko , Fukao Toshiyuki 
Published: September 2019

Abstract

Background
Kaposiform lymphangiomatosis (KLA) has recently been distinguished as a novel subtype of generalized lymphatic anomaly (GLA) with foci of spindle endothelial cells. All cases of KLA involve multiple organs and have an unfavorable prognosis. However, the molecular pathogenesis is unknown, and there are no useful biomarkers. In the present study, we performed genetic analysis to elucidate the cause of this disease and detect biomarkers for it.

Methods
We performed whole-exome sequencing of DNA samples from leukocytes and a biopsy specimen and analyzed cell-free DNA (cfDNA) from plasma and pleural effusion of patients to identify the NRAS c.182A > G (p.Q61R) mutation using the droplet digital polymerase chain reaction (ddPCR).

Results
All KLA patients (patients 1–5) had invasive and aggressive features (hemorrhagic pleural effusions, coagulation disorder, and thrombocytopenia) and characteristic findings of KLA in their pathological examinations. In whole exome sequencing for patient 1, c.182A > G missense variant (p.Q61R) in NRAS was identified in fresh frozen samples of a mass on the left chest wall at a frequency of 5% of total alleles but not in his blood leukocytes. Furthermore, the same mutation was detected in cfDNA isolated from plasma and pleural effusion by using ddPCR. ddPCR analysis of plasma/pleural effusion samples from an additional four KLA patients showed that the same mutation was detected in isolated cfDNA in three of the four, as well as in a tissue sample from one of the three plasma/effusion-positive patients that had been obtained to confirm the mutation.

Conclusion
These results provide the first evidence that NRAS oncogenic variant was identified in DNA samples from KLA patients from not only two affected lesions but also plasma and pleural effusion.
Validation of a childhood eating disorder outcome scale
Authors: Nagamitsu Shinichiro , Fukai Yoshimitsu , Uchida So , Matsuoka Michiko , Iguchi Toshiyuki , Okada Ayumi , Sakuta Ryoichi , Inoue Takeshi , Otani Ryoko , Kitayama Shinji , Koyanagi Kenshi , Suzuki Yuichi , Suzuki Yuki , Sumi Yoshino , Takamiya Shizuo , Fujii Chikako , Tsurumaru Yasuko , Ishii Ryuta , Kakuma Tatsuyuki , Yamashita Yushiro 
Published: September 2019

Abstract
We developed and validated a childhood eating disorder outcome scale based on outcomes associated with body mass index standard deviation score (BMI-SDS). This prospective observational study included 131 children with eating disorders (aged 5–15 years). Participants’ outcomes scales were completed at the first visit and at 1, 3, 6, and 12 months. The scale evaluated 12 outcomes: body weight change (BW), eating attitude (EA), fear of being fat (FF), body image distortion (BD), menstruation (ME), perceived physical condition (PC), attending school (AS), disease recognition by school (RS), family function (FA), disease recognition by parent (RP), social adaptation (SA), and relationships with friends (RF). Responses to all items were on a four-point Likert scale. Exploratory factor analysis was used to determine the number of factors based on the 12 outcomes. The relation between outcome scale scores and BMI-SDS over the 12-month follow-up period was analyzed. Two types of factors were extracted: disease-specific factors (EA, FF, BD) and biopsychosocial factors (BW, PC, AS, FA, SA, RF). Three items (ME, RS, RP) were excluded because they showed no significant loading effect. There was a significant negative correlation between the outcome scale and BMI-SDS, and changes in outcome scale scores from baseline to 12 months were significantly associated with improvement in BMI-SDS. We developed a childhood eating disorder outcome scale characterized by disease-specific and biopsychosocial factors. Biopsychosocial management combined with a therapeutic approach for disease-specific symptoms may support body weight recovery for children with eating disorders.
Spectrum and prevalence of BRCA1/2 germline mutations in Pakistani breast cancer patients: results from a large comprehensive study
Authors: Rashid Muhammad Usman , Muhammad Noor , Naeemi Humaira , Khan Faiz Ali , Hassan Mariam , Faisal Saima , Gull Sidra , Amin Asim , Loya Asif , Hamann Ute 
Published: September 2019

Abstract

Background
Pathogenic germline mutations in BRCA1 and BRCA2 (BRCA1/2) account for the majority of hereditary breast and/or ovarian cancers worldwide. To refine the spectrum of BRCA1/2 mutations and to accurately estimate the prevalence of mutation in the Pakistani population, we studied 539 breast cancer patients selected for family history and age of diagnosis.

Methods
Comprehensive screening for BRCA1/2 germline mutations was performed using state-of-the-art technologies.

Results
A total of 133 deleterious mutations were identified in 539 families (24.7%), comprising 110 in BRCA1 and 23 in BRCA2. The prevalence of BRCA1/2 small-range mutations and large genomic rearrangements was 55.4% (36/65) for families with breast and ovarian cancer, 27.4% (67/244) for families with two or more cases of breast cancer, 18.5% (5/27) for families with male breast cancer, and 12.3% (25/203) for families with a single case of early-onset breast cancer. Nine mutations were specific to the Pakistani population. Eighteen mutations in BRCA1 and three in BRCA2 were recurrent and accounted for 68.2% (75/110) and 34.8% (8/23) of all identified mutations in BRCA1 and BRCA2, respectively. Most of these mutations were exclusive to a specific ethnic group and may result from founder effects.

Conclusions
Our findings show that BRCA1/2 mutations account for one in four cases of hereditary breast/ovarian cancer, one in five cases of male breast cancer, and one in eight cases of early-onset breast cancer in Pakistan. Our study suggests genetic testing of an extended panel of 21 recurrent BRCA1/2 mutations for appropriately selected patients and their families in Pakistan.
A functional role for the cancer disparity-linked genes, CRYβB2 and CRYβB2P1, in the promotion of breast cancer
Authors: Barrow Maya A. , Martin Megan E. , Coffey Alisha , Andrews Portia L. , Jones Gieira S. , Reaves Denise K. , Parker Joel S. , Troester Melissa A. , Fleming Jodie M. 
Published: September 2019

Abstract

Background
In the USA, the breast cancer mortality rate is 41% higher for African-American women than non-Hispanic White women. While numerous gene expression studies have classified biological features that vary by race and may contribute to poorer outcomes, few studies have experimentally tested these associations. CRYβB2 gene expression has drawn particular interest because of its association with overall survival and African-American ethnicity in multiple cancers. Several reports indicate that overexpression of the CRYβB2 pseudogene, CRYβB2P1, and not CRYβB2 is linked with race and poor outcome. It remains unclear whether either or both genes are linked to breast cancer outcomes. This study investigates CRYβB2 and CRYβB2P1 expression in human breast cancers and breast cancer cell line models, with the goal of elucidating the mechanistic contribution of CRYβB2 and CRYβB2P1 to racial disparities.

Methods
Custom scripts for CRYβB2 or CRYβB2P1 were generated and used to identify reads that uniquely aligned to either gene. Gene expression according to race and tumor subtype were assessed using all available TCGA breast cancer RNA sequencing alignment samples (n = 1221). In addition, triple-negative breast cancer models engineered to have each gene overexpressed or knocked out were developed and evaluated by in vitro, biochemical, and in vivo assays to identify biological functions.

Results
We provide evidence that CRYβB2P1 is expressed at higher levels in breast tumors compared to CRYβB2, but only CRYβB2P1 is significantly increased in African-American tumors relative to White American tumors. We show that independent of CRYβB2, CRYβB2P1 enhances tumorigenesis in vivo via promoting cell proliferation. Our data also reveal that CRYβB2P1 may function as a non-coding RNA to regulate CRYβB2 expression. A key observation is that the combined overexpression of both genes was found to suppress cell growth. CRYβB2 overexpression in triple-negative breast cancers increases invasive cellular behaviors, tumor growth, IL6 production, immune cell chemoattraction, and the expression of metastasis-associated genes. These data underscore that both CRYβB2 and CRYβB2P1 promote tumor growth, but their mechanisms for tumor promotion are likely distinct.

Conclusions
Our findings provide novel data emphasizing the need to distinguish and study the biological effects of both CRYβB2 and CRYβB2P1 as both genes independently promote tumor progression. Our data demonstrate novel molecular mechanisms of two understudied, disparity-linked molecules.
The clinical effect of arrhythmia monitoring after myocardial infarction (BIO-GUARD|MI):study protocol for a randomized controlled trial
Authors: Jons Christian , Sogaard Peter , Behrens Steffen , Schrader Jürgen , Mrosk Sascha , Bloch Thomsen Poul Erik 
Published: September 2019

Abstract

Background
The increasing use of implantable cardiac monitors (ICMs) allows early documentation of asymptomatic cardiac arrhythmias that would previously have gone unnoticed. The addition of remote monitoring to cardiac devices means that physicians receive an early warning in cases of new-onset arrhythmias. While remote monitoring has been suggested to increase survival in heart failure patients with implantable defibrillators, trials using ICMs for continuous electrocardiographic monitoring of cardiac arrhythmias in the postmyocardial infarction setting have shown that patients who experienced cardiac arrhythmias such as atrial fibrillation, bradycardia, and ventricular tachyarrhythmia have an increased risk of major adverse cardiac events.

Methods
The Biomonitoring in patients with preserved left ventricular function after diagnosed myocardial infarction (BIO-GUARD-MI) study is designed to investigate and clarify whether the incidence of major adverse cardiac events can be decreased by early detection and treatment of cardiac arrhythmias using an ICM in patients after myocardial infarction. In addition, the study will allow us to describe the interplay between baseline characteristics, arrhythmias, and clinical events to improve the treatment of this high-risk patient population. The study will enroll and randomize a cohort of high-risk postmyocardial infarction patients with CHA2DS2-VASc score ≥ 4 and left ventricular ejection fraction > 35% to an ICM or conventional treatment. Physicians are provided with suggestions on how to respond to ICM-documented arrhythmias. An estimated 1400 patients will be enrolled and followed until 372 primary endpoints have occurred. In this paper, we describe the literature and rationale behind the design and interventions towards new-onset arrhythmias, as well as future perspectives and limitations for the use of ICMs.

Discussion
Remote monitoring may improve clinical outcome if it uncovers conditions with low symptom burden which cause or indicate an increased risk. A simple and easily implementable response to the information is important. Cardiac arrhythmias frequently start as asymptomatic, shorter lasting, and nightly events. The BIO-GUARD-MI trial represents the first attempt to simplify the response to the rather complex nature of heart arrhythmias.

Trial registration
Clinical Trials, NCT02341534. Registered on 19 January 2015.