bluuebunny/crossref_metadata_2025_split huggingface dataset:
Emergency nurses’ strategies in addressing uncertainty and change in the management of emerging infectious diseases: A grounded theory approach
Authors: Lam Stanley Kam Ki , Kwong Enid Wai Yung , Hung Maria Shuk Yu , Pang Samantha Mei Che , Chien Wai Tong 
Published: September 2019

Abstract
Background Uncertainty and change are the inevitable challenges facing emergency nurses, as they are bound by the nature of emergency care. During an epidemic event, emergency care settings are intertwined with urgency, uncertainty, and change, which continuously pose challenges to emergency nurses on their capacity to act on their duties in a well-planned and systematic manner. However, there has been a paucity of understanding concerning emergency nurses’ actions and strategies to address the instabilities and vulnerabilities of the circumstance. The present study aimed to explore emergency nurses’ behaviours and strategies in addressing the challenges of uncertainty and change during an epidemic event. Methods A qualitative design based upon a Straussian grounded theory approach was selected as the method of inquiry. A total of 26 emergency nurses from Hong Kong were recruited in the study by purposive and theoretical sampling strategies. Semi-structured, face-to-face, individual interviews were conducted for data collection. The data were transcribed verbatim and analysed through the grounded theory coding procedures. The COREQ guidelines were applied in the reporting of the present study. Results Rehearsing for improvisation was revealed as the core category. Four interplaying sub-categories were identified: (a) sensing the unclear situation, (b) equipping for the impending battle, (c) calibrating to the evolving guidelines, and (d) navigating the new role and duties. The nurses demonstrated their prudence to orientate themselves to an ambiguous work situation and displayed the flexibility to embrace changes in their practice, roles, and duties. Conclusions The findings delineate that emergency nurses were required to prepare and equip themselves with skills and strategies to improvise and adapt to the management of an epidemic event. The findings also offer insights into the development of education and training schemes that allow emergency nurses to acquire and augment their abilities of decision-making and problem-solving in public health responses.
Fertility Desire and Associated Factors among HIV Positive Women in University of Gondar Comprehensive Specialized hospital, Northwest Ethiopia. Institution based cross-sectional study.
Authors: wondim Amare , Admasie Addisu , Abebaw Yonatan 
Published: September 2019

Abstract
Background: HIV positive individuals may or may not have fertility desire to have children. But the extent of these desires and how it varies by individual, social, health and demographic characteristics is not well understood. Objective: To assess fertility desire and its associated factors among HIV positive women in Gondar referral hospital, Northwest Ethiopia; 2019. Method: Institutional -based cross-sectional study design was conducted from May-June 2019 on 351 HIV positive women at Gondar comprehensive specialized referral hospital. Interview based, pre-tested and structured questionnaires was used to collect the data. Data consistency was checked and entered into Epi-info seven then exported to SPSS versions 20 for further analysis. Bivariable and multivariable logistic regression was used to determine the association between dependent and independent variables. P-values less than 0.05 with 95% CI was taken to declare a statistically significant. Result: Among study participants, 183(52.1%) HIV positive women had fertility desire. Women in the age 15-19 years (AOR: 6.88, CI=1.84-25.79), being married (AOR: 4.42, CI=1.47-13.28), unable to read and write (AOR: 0.39, CI=0.18-0.82), having no partners fertility desire and discussion with health care provider (AOR: 0.04, CI=0.02-0.12) and (AOR=0.31, CI=0.17-0.57), respectively were significantly associated factors. Conclusion: Being young age and married, educational status of women, partner desire and discussion with health care provider were obtained as significant factors of fertility desire. Hence health care providers have to give health information and education about fertility desire and other reproductive issue to clients. Keywords : ART users, women, Fertility desire, Gondar, Ethiopia.
Psychometric Validation of a Novel PRO Measure for Assessing Patient-reported Experience of Cognitive Impairment in Schizophrenia (PRECIS)
Authors: Rosen Raymond C. , Trudeau Jeremiah J. , Silverstein Steven , Henderson David C. , Smith Adam , Walling David P. , Garcia Miguel , Davis Bethany , Derogatis Leonard , Sand Michael 
Published: September 2019

Abstract
Background Cognitive impairment associated with schizophrenia (CIAS) can be a distressing feature that contributes to the burden of the disorder, as well as being a strong predictor of functional impairment. To fully assess the burden to patients living with this illness, there is a need to develop a specific measure of patient-reported outcomes (PROs). Methods Following initial development of the Patient-Reported Experience of Cognitive Impairment in Schizophrenia (PRECIS) instrument, the domain structure, reliability (inter-item consistency and test-retest reliability), and validity (discriminant validity, divergent, and convergent validity) of the tool were assessed in patients (aged 18–55 years) with CIAS participating in a 12-week, Phase II, randomized, double-blind, placebo-controlled study to evaluate the efficacy, safety, and tolerability of BI 409306. Healthy control subjects were recruited separately. The PRECIS instrument was completed at baseline, Week 6, Week 9, and Week 12. Results The questionnaire responses of 410 patients with schizophrenia and 88 control subjects were compared. Of the original 35 items included in the draft PRECIS instrument, 11 were eliminated due to poor performance against pre-defined criteria, resulting in a 24-item questionnaire. In confirmatory factor analysis, the 24 items loaded well onto 5 domains (Attention, Memory, Executive Function, Communication, and Bother). The revised 24-item PRECIS instrument demonstrated adequate discriminant validity between patient and control groups in each of the 5 domains (p<0.0001), convergent validity as shown by a significant correlation between PRECIS scores and the Schizophrenia Cognition Rating Scale (SCoRS; p<0.0001), good internal consistency (Cronbach’s alpha score: 0.942), and adequate test-retest reliability (intra-class correlation coefficient [ICC]: 0.78). A simplified, user-friendly scoring method was identified, which assigned scores to each of the 5 domains using a 5-category Likert scale. Conclusions PRECIS is a novel self-completed sensitive instrument designed to measure the subjective experience of cognitive impairment in patients with schizophrenia. The test development process included patient input, perceptions, and feedback, and strong evidence for the validity and reliability of the instrument was demonstrated. The scale provides a patient-based perspective to complement existing objective measures of cognition and serves to define key patient-based endpoints for use in future clinical studies.
Self-stigma and associated factors among Outpatients with Schizophrenia in low income East African countries: Ethiopia
Authors: Weldemariam Hailemarim Hailesilasiie , Tsegabrihan Hagos 
Published: September 2019

Abstract
Background Even though there are efforts to expand of psychiatric treatment and recovery, there is limited data on the extent that self stigma complicates the psychiatric treatment adherence and lives of outpatients with schizophrenia in low income East African countries. This study was conducted with aim determine distribution of self stigma and associated socio-demographic and clinical factors among outpatients with schizophrenia in Ethiopia. Methods the study was an institution based cross-sectional conducted at Ayder Referral Hospital, Northern Ethiopia. Single population proportion formula was used to calculate sample size. Consecutive consenting outpatients with schizophrenia selected and assessed using Tigrigna version of the perceived devaluation and discrimination scale. Result data was collected from 2016 outpatients with schizophrenia; with response rate of 92.7%, who were males (70.8%), single (59.7%), within age range of 23 to34 years (42.1%), (Orthodox in religion (81.6%), could not read and write (52.8%), unemployed (86.6%), living in rural areas (55.1%) and with their family (82.9%). The mean ages of the participants were 32.9 years. 67.1% of the study participants reported self stigma. Factors such as being single (AOR=6.2, 95% CI= 1.83-21.21), rural resident (AOR=3.7, 95% CI= 1.47-9.14), living alone (AOR=9.5, 95% CI= 1.59-56.40), low educational status (AOR= 13.4, 95% CI=2.1-13.16), being with the illness with delayed treatment for more than eleven years (AOR=11.6, 95% CI=2.19-61.7), non-adherence to clinical follow up (AOR=10.6, 95% CI=2.96-12.7) and medications non-adherence (AOR=3.7, 95% CI=1.10-12.37) were positively significantly associated with self stigma of outpatients with schizophrenia. Conclusion and Recommendation self stigma is major problem of outpatients with schizophrenia of low income country Ethiopia. Especially, self stigma complicates the lives of single and low educational level persons with schizophrenia and is likely disrupt the psychiatric treatment and recovery process. Our findings recommend that non-governmental and international charity organizations shall help persons with schizophrenia reduce their self stigma.
Developing an evidence-based ethics education program for surgical residents in Guatemala
Authors: Arévalo Maria Lorena Aguilera , Seikavizza Sergio Nicholas Martínez , Rodriguez Ery Mario , Siguantay Miguel Angel , Ovalle Jorge-Fernando Solares , Rosales Luis Fernando Talé , Barchi Francis 
Published: September 2019

Abstract
Background: Training in responsible conduct of research and human subjects protections (RCR/HSP) is seldom included in postgraduate medical education in low-and middle-income (LMIC) countries despite requirements that residents undertake research projects. Investigators introduced a Spanish-language training program in RCR/HSP for surgical residents in Guatemala using “off-the-shelf” on-line materials, developed a new in-person curriculum specific to the local context, and compared the two teaching modalities with the aim of generating recommendations to improve resident training. Methods: In 2018, surgical residents in three large urban hospitals in Guatemala City completed two on-line programs in RCR/HSP as well as pre- and post-training assessments. Residents in the intervention arm also completed seven weeks of in-person training. Assessments tested awareness of key concepts in the on-line courses with particular attention to international and Guatemalan research regulations. Group differences in matched (pre- and post-) mean scores were analyzed using t-tests to determine gains by study arm assignment. Results: Of the 160 surgical residents, 140 completed pre- and post-training assessments and were included in the analytic sample. Overall mean scores improved from 52.7 to 58.7 points out of 100.The differences in gains between the two arms were very small and there was insufficient statistical power to detect significance. Trainees completing in-person training reported greater confidence in recognizing ethical issues, understanding the legal and ethical requirements for research, and identifying, reporting and avoiding scientific misconduct than trainees who completed on-line training only. Conclusion: Differences in gains in RCR/HSP knowledge and self-efficacy between trainees completing on-line training only and those completing in-person as well as on-line training are too modest to preference one mode of instruction over another in this setting. Given the limited availability of RCR/HSP faculty, financial resources, and time in the surgical training schedule, however, the investigators recommend that academic authorities in Guatemala consider on-line training programs in RCR/HSP in all surgical residency programs as an affordable and scalable strategy to build ethical research skills in its surgical workforce.
A retrospective observational study of intraductal breast papilloma and its coexisting lesions: a real-world experience
Authors: Mao Xiaoyun , Wang Huan , Sun Zhe , Fan Chuifeng , Jin Feng 
Published: September 2019

Abstract
Background: Breast intraductal papilloma are a heterogeneous group. The aim of this study is to investigate the intraductal breast papilloma and its coexisting lesions retrospectively in real-world practice. Methods: We retrospectively identified 4450 intraductal breast papilloma and its coexisting lesions. Results: 18.36% coexisted with malignant lesions of the breast, 37.33% coexisted with atypia hyperplasia, 25.24% coexisted with benign lesions and only 19.10% coexisted without concomitant lesions. In addition, 36.80% of intraductal breast papilloma had nipple discharge, 51.46% had a palpable breast mass and 16.45% had both nipple discharge and a palpable breast mass. 28.18% experienced discomfort or were asymptomatic. Furthermore, 98.99% had ultrasound abnormalities, 53.06% had intraductal hypoechoic upon ultrasound. 31.89% had mammographic distortion, 14.45% had microcalcification upon mammography. Intraductal breast papilloma with malignancy had significant correlations with clinical manifestations. Conclusion: Coexisting malignancy was also related to ultrasound abnormality (BIRADS 4C and 5), mammographic distortion and microcalcification upon mammography but was not related to the intraductal hypoechoic upon ultrasound. Coexisting atypical hyperplasia correlated with nipple discharge but not palpable mass, mammographic distortion or intraductal hypoechoic upon ultrasound. The coexisting atypia hyperplasia was also related to abnormality upon ultrasound or microcalcification compared with the benign lesions. The intraductal papilloma coexists with malignancy or atypia hyperplasia accounted for more than 50%, the clinical information on papilloma and its coexisting lesions is nonspecific. We recommended surgical treatment for benign intraductal papillary lesions. Impact: The current study provides insight into the real-world pattern of intraductal papillomas and their coexisting lesions in a population of Chinese women.
Molecular subtyping improves prognostication of Stage 2 colorectal cancer
Authors: Purcell Rachel Violet , Schmeier Sebastian , Lau Yee Chen , Pearson John F , Frizelle Francis A 
Published: September 2019

Abstract
Background: Post-surgical staging is the mainstay of prognostic stratification for colorectal cancer (CRC). Here, we compare TNM staging to consensus molecular subtyping (CMS) and assess the value of subtyping in addition to stratification by TNM. Methods: Three hundred and eight treatment-naïve colorectal tumours were accessed from our institutional tissue bank. CMS typing was carried out using tumour gene-expression data. Post-surgical TNM-staging and CMS were analysed with respect to clinicopathologic variables and patient outcome. Results: CMS alone was not associated with survival, while TNM stage significantly explained mortality. Addition of CMS to TNM-stratified tumours showed a prognostic effect in stage 2 tumours; CMS3 tumours had a significantly lower overall survival (P = 0.006). Stage 2 patients with a good prognosis showed immune activation and up-regulation of tumour suppressor genes. Conclusions: Although stratification using CMS does not outperform TNM staging as a prognostic indicator, gene-expression based subtyping shows promise for improved prognostication in stage 2 CRC.
Glioma SOX2 expression decreased after adjuvant therapy
Authors: Yu Wei , Ren Xiaoqiu , Hu Chunxiu , Tan Yinuo , Shui Yongjie , Chen Zexin , Zhang Lili , Peng Jiaping , Wei Qichun 
Published: September 2019

Abstract
Objectives: SOX2 is regarded as an important marker in stem cell. The change of SOX2 expression after adjuvant therapy in high grade glioma (HGG) remains unknown so far. Few patients with recurrent glioma have opportunity to undergo operation once again, so the recurrent glioma samples are scarce. This study tries to analyze SOX2 expression in paired primary and recurrent HGG, aims to better understand the transformation law of SOX2 after adjuvant therapy in HGG. Methods: Twenty-four recurrent HGG patients who undergone a second resection were included. 16 patients received adjuvant therapy, the remaining 8 patients didn’t receive any adjuvant therapy at all. The protein expression of SOX2 in paired primary and recurrent HGG was tested by immunohistochemistry. The statistical analysis was conducted by IBM SPSS Statistics 19.0. Results: In primary HGG, SOX2 expression of 3+,2+,1+ and 0+ were seen in 20 (83.3%), 1 (4.2%), 1 (4.2%) and 2 cases (8.3%), respectively. The expression of SOX2 was decreased in recurrent HGG compared to the paired primary sample (p=0.001). The decrease of SOX2 was often seen in patients received chemotherapy, radiotherapy or both (p=0.003). Patients with SOX2 high expression in primary glioma had a longer median PFS than those with SOX2 low expression with marginal statistic significance (12.7 vs. 5.4 months, p=0.083). For cases with SOX2 high expression in the primary glioma, those had SOX2 low expression after recurrence seemed to have worse prognosis as compared to patients with stable SOX2 high expression (PFS: 10.4 vs. 14.9 months, p=0.036; OS: 27.0 vs 49.5 months, p=0.005). Conclusions: This is the first study comparing the protein expression of SOX2 in recurrent HGG and its paired primary tumor. SOX2 high expression is common in brain HGG, a tendency of decreased SOX2 expression in recurrent gliomas was evidenced. Lower SOX2 expression was seen in those patients received adjuvant chemotherapy and/or radiotherapy. Patients with low SOX2 expression in primary HGG usually have poorer prognosis, those with SOX2 expression decreased in recurrent HGG had worse outcome.
A multicenter randomized trial of personalized acupuncture, fixed acupuncture, letrozole and placebo on live birth for infertility in women with polycystic ovary syndrome
Authors: Huang Shiya , Hu Min , Ng Ernest Hung Yu , Stener-Victorin Elisabet , Zheng Yanhua , Wen Qidan , Li Juan , Yu Chuyi , Liu Jia , Wang Cong , Lai Maohua , Wang Xinhua , Wen Xiaohui , Li Shuna , Quan Kewei , Shang Hongcai , Ma Hongxia , Qiao Jie 
Published: September 2019

Abstract
BACKGROUND Traditional Chinese Medicine (TCM) usually involves syndrome and disease differentiation, and for acupuncture selection of appropriate points and skillful needling techniques. Many clinical trials on acupuncture used fixed acupuncture protocols without accounting for individual differences. We here design a multicenter randomized controlled trial (RCT) to evaluate whether personalized or fixed acupuncture increases the likelihood of live births for infertility in women with polycystic ovary syndrome (PCOS) compared with placebo letrozole. We hypothesis that letrozole is more effective than personalized acupuncture, and personalized acupuncture is more effective than fixed acupuncture, which is more effective than placebo letrozole. Moreover, personalized acupuncture is more likely to reduce miscarriage rate and the risk of pregnancy complications than letrozole.METHODS / DESIGN The study is a randomized assessor-blind controlled trial. A total of 1,100 infertile women with PCOS will be recruited from 28 hospitals and randomly allocated into four groups: A) letrozole, B) personalized acupuncture, C) fixed acupuncture, or D) placebo letrozole. They will receive treatment for 16 weeks and the primary outcome is live birth. Secondary outcomes include ovulation rate, ongoing pregnancy rate, miscarriage rate, hormonal and metabolic profile, and quality-of-life scores. The side effect profile will be recorded throughout the trial. All statistical analyses will be performed using the SPSS program V.21.0 (SPSS, Chicago, Illinois, USA) and a p value <0.05 will be considered statistically significant.DISCUSSION This study is the first multicentre RCT to compare personalized or fixed acupuncture, letrozole or placebo letrozole on live birth for infertility in women with PCOS. This findings will inform whether personalized acupuncture therapy could be as an alternative treatment method on live birth for infertile women with PCOS.
Children’s Empathy and Family Income: The Mediating Role of Family Communication Pattern
Authors: Amanda Gianti , Agoes Salim Rose Mini 
Published: September 2019

The research examined whether the communication patterns in the family by conversation and conformity orientations served as mediators of the relation between children’s empathy and family income. The research was conducted to parents of children age six to eight years old as the participants (N = 233) in Jakarta, Indonesia. The parents’ completed parent’s questionnaire for children’s empathy, family income, and family communication pattern. The relation analyzed using PROCESS Hayes. The results that the family communication pattern partially mediated the children’s empathy and family income. This research result shows a couple of findings. First, the children who come from a low-income family with family conformity orientation have lower empathy. The second finding is that the children with the family who have family conversation orientation have higher empathy. This second finding works for both low and high incomes family. Besides, only conformity orientation is found to mediate the effect of family income on child’s empathy. This research finds there are connections between family environment and children’s behavior. Developing the children’s empathy going to be positive for their social-emotional outcomes in the future is paramount because the children learn to express and regulate their emotion in a positive way when they have higher empathy.