bluuebunny/crossref_metadata_2025_split huggingface dataset:
A critical analysis of health care purchasing arrangements in Kenya: A case study of the county departments of health
Authors: Mbau Rahab , Barasa Edwine , Munge Kenneth , Mulupi Stephen , Nguhiu Peter K. , Chuma Jane 
Published: August 2018

SummaryBackgroundPurchasing in health care financing refers to the transfer of pooled funds to health care providers for the provision of health care services. There is limited empirical work on purchasing arrangements and what is required for strategic purchasing in low‐ and middle‐income countries. We conducted this study to critically assess the purchasing arrangements of the county departments of health (CDOH) who are the largest purchasers of health care in Kenya.MethodsWe used a qualitative case study approach to assess the extent to which the purchasing actions of the CDOH in Kenya were strategic. We purposively sampled 10 counties and collected data using in‐depth interviews (n = 81), focus group discussions (n = 4), and documents review. We analyzed data using a framework approach.ResultsCounty departments of health did not practice strategic purchasing. The government's (national and county) role as a steward for the purchasing function was characterized by poor accountability and inadequate budgetary allocations for service delivery. The absence of a purchaser‐provider split between the CDOH and public health care providers undermined provider selection based on performance and quality. Poor public participation and ineffective complaints and feedback mechanisms limited public accountability and responsiveness to the needs of the people.ConclusionOur findings show that while there are frameworks that could promote strategic purchasing of the CDOH, strategic purchasing is impaired by poor implementation of these frameworks and the inherent weaknesses of a public integrated purchasing system that lacks purchaser‐provider split.
Challenges toward achieving universal health coverage in Ghana, Kenya, Nigeria, and Tanzania
Authors: Umeh Chukwuemeka A. 
Published: August 2018

SummaryAlthough many sub‐Saharan African countries have made efforts to provide universal health coverage (UHC) for their citizens, several of these initiatives have achieved little success. This study aims to review the challenges facing UHC in Ghana, Kenya, Nigeria, and Tanzania, and to suggest program or policy changes that might bolster UHC.Routine data reported by the World Bank and World Health Organization, as well as annual reports of the national health insurance schemes of Ghana, Kenya, Nigeria, and Tanzania, were analyzed. The data were supplemented by a review of published and gray literature on health insurance coverage in these four countries.The analysis showed that some of the challenges facing UHC in these countries include (1) large proportion of the population living in extreme poverty and unable to pay premiums, (2) large informal sector whose members are mostly uninsured, (3) high dropout rate from insurance schemes, (4) poorly funded primary health care system, and (5) segmented health insurance fund pool.In order to achieve UHC by 2030, it will be important for these countries to (1) raise sufficient revenue to finance their health systems, (2) improve the efficiency of revenue utilization, (3) identify and provide coverage for the very poor, (4) reduce the proportion of the population that is underinsured, and (5) improve access to quality health care in rural areas.
Controls on stream hydrochemistry dynamics in a high Arctic snow‐covered watershed
Authors: Docherty Catherine L. , Riis Tenna , Milner Alexander M. , Christoffersen Kirsten Seestern , Hannah David M. 
Published: August 2018

AbstractArctic streams are highly sensitive to climate change due to warmer air temperature and increased precipitation associated with an encroaching low Arctic climatic zone into currently high‐Arctic coastal areas. Increases in nivation processes and permafrost degradation will lead to potential changes in stream physicochemical habitat, although these impacts are poorly understood. To address this gap, physicochemical habitat characteristics in streams around Zackenberg in Northeast Greenland National Park were investigated during the summers of 2013 to 2016. Streams with different sized snowpacks represented both low and high snowfall conditions leading to different nivation processes. Streams with larger snowpacks displayed lower channel stability, with higher channel mobility, suspended sediment and solute concentrations. Suspended sediment concentration was identified as a key driver of stream solute concentrations, and varying snowpack levels caused high interannual variability in solute concentrations. Winter snowpack size was confirmed to be an important driver of stream physicochemical habitat in an Arctic region with low glacial cover. We predict climate change will strongly impact stream hydrochemistry in this region through increased nivation processes alongside active layer thickening and solifluction, thereby increasing stream suspended sediment and solute concentrations. These findings indicate that hydrochemistry was principally a function of erosion, with variation being determined by spatial and temporal patterns in erosional processes, and as such, alternative methods to fingerprint water sources should be considered in this region.
Comparison of the INTERGROWTH‐21st, National Institute of Child Health and Human Development, and WHO fetal growth standards
Authors: Hua Xiaolin , Shen Minxue , Reddy Uma M. , Buck Louis Germaine , Souza Joao Paulo , Gülmezoglu A. Metin , Zhang Jun 
Published: August 2018

AbstractObjectiveTo compare the ability of the INTERGROWTH‐21st, National Institute of Child Health and Human Development, and WHO fetal growth standards to identify fetuses at risk of adverse perinatal outcomes.MethodsA retrospective analysis was performed among women enrolled in a multicenter randomized controlled trial (Routine Antenatal Diagnostic Imaging with Ultrasound) that was conducted in six states in the USA between November 1987 and May 1991. The predictive capability of various biometric indicators (biparietal diameter, femur length, abdominal circumference, head circumference, estimated fetal weight, and birthweight) was evaluated. Adverse outcomes included severe morbidity and perinatal death.ResultsThere were 9409 women included. Biometric indicators measured at a gestational age of 18–24 weeks had insufficient predictive sensitivity (range, 4%–47%). By contrast, measurements taken at 28–34 weeks predicted statistically significant relative risk (range 1.5–10.2; P<0.05 for 27/30 relative risk values) and area under the receiver operating characteristic curve (range, 0.50–0.59; P<0.05 for 8/15 curves). Nonetheless, differences in accuracy between standards for predicting adverse perinatal outcomes were subtle (P>0.05 for differences in area under the curve values).ConclusionAlthough useful to monitor fetal growth trajectory and the level of risk, all three fetal growth standards provided limited accuracy for identifying fetuses at risk of adverse perinatal outcomes.
Effects of prophylactic uterine artery embolization on second‐trimester induced abortions in patients with placenta previa
Authors: Wang Ning , Li Xing‐Miao , Fei Yi‐Lin , Liu Yan‐Min , Lin Jun , Jiang Xiu‐Xiu 
Published: August 2018

AbstractObjectiveTo evaluate the effects of prophylactic uterine artery embolization (UAE) on second‐trimester induced abortions in patients with placenta previa.MethodsThe present study was a retrospective review of second‐trimester induced abortions in the presence of placenta previa that conducted between January 1, 2008, and October 31, 2017, at a university hospital in Hangzhou, China. Pregnancy outcomes including intraoperative blood loss, transfusion, dilatation and evacuation, hysterotomy delivery, and hysterectomy were compared between patients with and without prophylactic UAE.ResultsThere were 54 patients included in the study. In patients with partial placenta previa (n=15), the volume of intraoperative blood loss and the frequency of dilatation and evacuation were not significantly different between the UAE and non‐UAE groups (P>0.05). No patient had a transfusion, hysterotomy delivery, or hysterectomy. Among patients with complete placenta previa (n=39), the volumes of intraoperative blood loss (P=0.014) and transfusion (P=0.046) were significantly lower in the UAE group compared with the non‐UAE group. The rates of dilatation and evacuation, and hysterotomy delivery did not differ between the groups (P>0.05), but were numerically higher in the non‐UAE group. No patient was treated with hysterectomy.ConclusionProphylactic UAE before a second‐trimester induced abortion had significant advantages in women with complete placenta previa, but it did not improve the pregnancy outcome in patients with partial placenta previa.Chinese Clinical Trial RegistryChiCTR‐OPC‐14005334.
COGNITIVE AND SOCIOEMOTIONAL FUNCTIONING AT 4½ YEARS IN CHILDREN BORN TO MOTHERS WHO HAVE RECEIVED TREATMENT FOR SUBSTANCE‐ABUSE PROBLEMS WHILE PREGNANT
Authors: Haabrekke Kristin , Siqveland Torill , Nygaaard Egil , Bjornebekk Astrid , Slinning Kari , Wentzel‐Larsen Tore , Walhovd Kristine B. , Smith Lars , Moe Vibeke 
Published: August 2018

ABSTRACTCognitive and socioemotional functioning at 4½ years of age were examined in children born to mothers with substance‐abuse problems (n = 22) recruited from residential treatment institutions while pregnant, and then compared to children born to mothers with mental health problems (n = 18) and children from a low‐risk group (n = 26). No significant group differences in cognitive functioning were found, but the children born to mothers with substance‐abuse problems showed more caregiver‐reported socioemotional problems than did the low‐risk children, like the children born to mothers with mental health problems. Birth weight had an effect on internalizing problems at 4½ years and mediated the relation between group and socioemotional problems, although not when controlling for caregiver education, single parenthood, and anxiety and depression. At 4½ years, 7 children born to mothers with substance‐abuse problems were placed in foster care. These children had lower birth weight and higher caregiver‐rated internalizing problems. In addition to emphasizing the importance of the quality of the prenatal environment, this study suggests that families with previous substance abuse are in need of long‐term follow‐up to address socioemotional problems and enhance further positive child cognitive development. The foster‐placed children may be in particular need of long‐term follow‐up.
#NeverthelessMemesPersisted: Building Critical Memetic Literacy in the Classroom
Authors: Harvey Lauren , Palese Emily 
Published: August 2018

AbstractAs our students’ consumption of internet memes through social media increases, a critical perspective toward these memes becomes increasingly important. Memes present teachers with a powerful and relevant way to approach critical analysis and discussion in the 21st‐century classroom. In this article, the authors present a framework for incorporating critical discussion and creation of memes into classrooms. Harnessing the power and prevalence of memes, the authors explore how internet memes can be used as a vehicle for critically engaging students. When they understand the characteristics that make memes an effective vector of cultural transmission, students can more critically recognize, consume, and produce these tools for humor and social and political critique.
Graphene oxide severely inhibits DNase activity
Authors: Huo Da , Zhang Bing , Peng Qi , Li Hongyue , Wang Hui , Yu Qilin , Li Mingchun 
Published: August 2018

AbstractGraphene oxide (GO) is an important type of 2D nanomaterial and widely used in biomedicine, sensors, photocatalysis and electronic materials. With the extensive exposure of GO, its biological effect is debatable. In this study, we found a novel biological effect of GO, ie, suppression of deoxyribonuclease (DNase). GO inhibited DNA degradation when DNA or the DNA/RNA mixture was exposed to DNase. Moreover, GO suppressed nuclear fragmentation when the nuclei were treated with DNase. Interestingly, GO neither interacted with DNA nor influenced the interaction between DNase and DNA. Further investigation revealed that GO had a strong activity of adsorbing l‐phenylalanine and l‐histidine, key amino acid residues in the active site of DNase. These results suggest that GO could suppress the activity of DNase by interaction with the active site of DNase, and have an impact on DNase‐related cellular processes (eg, apoptosis), implying its potential application in treating diseases associated with disorderly DNase function.
Chronic Kidney Disease Is Associated With Greater Bone Marrow Adiposity
Authors: Woods Gina N , Ewing Susan K , Sigurdsson Sigurdur , Kado Deborah M , Ix Joachim H , Hue Trisha F , Eiriksdottir Gudny , Xu Kaipin , Gudnason Vilmundur , Lang Thomas F , Vittinghoff Eric , Harris Tamara B , Rosen Clifford J , Li Xiaojuan , Schwartz Ann V 
Published: August 2018

ABSTRACT

Bone marrow adiposity is associated with aging, osteoporosis, and reduced hematopoiesis, as well as anorexia nervosa, but little is known about the underlying mechanisms that affect marrow adiposity. Chronic kidney disease (CKD) may influence bone marrow adipose tissue (BMAT), possibly through loss of lean mass or higher circulating levels of sclerostin. To test these hypotheses, we investigated the cross-sectional association between estimated glomerular filtration rate (eGFR) as a measure of kidney function and 1H-MRS-based measurement of vertebral BMAT (L1 to L4) in 475 older adults from the Age Gene/Environment Susceptibility (AGES)-Reykjavik study. Mean BMAT was compared in those with eGFR &gt;60 (n = 297) versus those with eGFR 45 to 60 (n = 120) or eGFR &lt;45 (n = 58) using linear regression models. Participants had a mean age of 81.5 (SD 4.1) years, mean eGFR of 64.3 (SD 16.1) mL/min/1.734 cm2, mean BMAT of 54.5% (SD 8.5); 48.2% were women. In unadjusted and adjusted models (age, visit window, gender, diabetes and visceral adipose tissue), BMAT was higher in those with eGFR &lt;45 (adjusted mean 58.5%; 95% CI, 56.2 to 60.7) compared with those with eGFR &gt;60 (adjusted mean 53.8%; 95% CI, 52.8 to 54.8) (p = 0.0002). BMAT did not differ in those with eGFR 45 to 60 (adjusted mean 54.3%; 95% CI, 52.8 to 55.9) compared with those with eGFR &gt;60 (p = 0.58). In a subgroup of participants with serum sclerostin available (n = 253), additional adjustment for sclerostin attenuated the difference in adjusted mean vertebral BMAT between those with eGFR &lt;45 versus &gt;60 from 3.7% (p = 0.04) to 2.4% (p = 0.20). CKD stage 3b or worse was associated with greater bone marrow adiposity; this association may be partially mediated by sclerostin. © 2018 American Society for Bone and Mineral Research.
The Spectrum of Fundamental Basic Science Discoveries Contributing to Organismal Aging
Authors: Farr Joshua N , Almeida Maria 
Published: August 2018

ABSTRACT

Aging research has undergone unprecedented advances at an accelerating rate in recent years, leading to excitement in the field as well as opportunities for imagination and innovation. Novel insights indicate that, rather than resulting from a preprogrammed series of events, the aging process is predominantly driven by fundamental non-adaptive mechanisms that are interconnected, linked, and overlap. To varying degrees, these mechanisms also manifest with aging in bone where they cause skeletal fragility. Because these mechanisms of aging can be manipulated, it might be possible to slow, delay, or alleviate multiple age-related diseases and their complications by targeting conserved genetic signaling pathways, controlled functional networks, and basic biochemical processes. Indeed, findings in various mammalian species suggest that targeting fundamental aging mechanisms (eg, via either loss-of-function or gain-of-function mutations or administration of pharmacological therapies) can extend healthspan; ie, the healthy period of life free of chronic diseases. In this review, we summarize the evidence supporting the role of the spectrum of fundamental basic science discoveries contributing to organismal aging, with emphasis on mammalian studies and in particular aging mechanisms in bone that drive skeletal fragility. These mechanisms or aging hallmarks include: genomic instability, telomere attrition, epigenetic alterations, loss of proteostasis, deregulated nutrient sensing, mitochondrial dysfunction, cellular senescence, stem cell exhaustion, and altered intercellular communication. Because these mechanisms are linked, interventions that ameliorate one hallmark can in theory ameliorate others. In the field of bone and mineral research, current challenges include defining the relative contributions of each aging hallmark to the natural skeletal aging process, better understanding the complex interconnections among the hallmarks, and identifying the most effective therapeutic strategies to safely target multiple hallmarks. Based on their interconnections, it may be feasible to simultaneously interfere with several fundamental aging mechanisms to alleviate a wide spectrum of age-related chronic diseases, including osteoporosis. © 2018 American Society for Bone and Mineral Research.
Reversibly immortalized human umbilical cord–derived mesenchymal stem cells (UC‐MSCs) are responsive to BMP9‐induced osteogenic and adipogenic differentiation
Authors: Shu Yi , Yang Chao , Ji Xiaojuan , Zhang Linghuan , Bi Yang , Yang Ke , Gong Mengjia , Liu Xing , Guo Qi , Su Yuxi , Qu Xiangyang , Nan Guoxin , Zhao Chen , Zeng Zongyue , Yu Xinyi , Zhang Ruyi , Yan Shujuan , Lei Jiayan , Wu Ke , Wu Ying , An Liping , Huang Shifeng , Gong Cheng , Yuan Chengfu , Liu Wei , Huang Bo , Feng Yixiao , Zhang Bo , Dai Zhengyu , Shen Yi , Luo Wenping , Wang Xi , Haydon Rex C. , Luu Hue H. , Reid Russell R. , Wolf Jennifer Moriatis , Lee Michael J. , He Tong‐Chuan , Li Yasha 
Published: August 2018

AbstractHuman mesenchymal stem cells (MSCs) are a heterogeneous subset of nonhematopoietic multipotent stromal stem cells and can differentiate into mesodermal lineage, such as adipocytes, osteocytes, and chondrocytes, as well as ectodermal and endodermal lineages. Human umbilical cord (UC) is one of the most promising sources of MSCs. However, the molecular and cellular characteristics of UC‐derived MSCs (UC‐MSCs) require extensive investigations, which are hampered by the limited lifespan and the diminished potency over passages. Here, we used the piggyBac transposon–based simian virus 40 T antigen (SV40T) immortalization system and effectively immortalized UC‐MSCs, yielding the iUC‐MSCs. A vast majority of the immortalized lines are positive for MSC markers but not for hematopoietic markers. The immortalization phenotype of the iUC‐MSCs can be effectively reversed by flippase recombinase–induced the removal of SV40T antigen. While possessing long‐term proliferation capability, the iUC‐MSCs are not tumorigenic in vivo. Upon bone morphogenetic protein 9 (BMP9) stimulation, the iUC‐MSC cells effectively differentiate into osteogenic, chondrogenic, and adipogenic lineages both in vitro and in vivo, which is indistinguishable from that of primary UC‐MSCs, indicating that the immortalized UC‐MSCs possess the characteristics similar to that of their primary counterparts and retain trilineage differentiation potential upon BMP9 stimulation. Therefore, the engineered iUC‐MSCs should be a valuable alternative cell source for studying UC‐MSC biology and their potential utilities in immunotherapies and regenerative medicine.
MFG‐E8/integrin β3 signaling contributes to airway inflammation response and airway remodeling in an ovalbumin‐induced murine model of asthma
Authors: Zhi Yueli , Huang Han , Liang Lihong 
Published: August 2018

AbstractAsthma is the most common chronic childhood disease worldwide, characterized by airway remodeling and chronic inflammation, orchestrated primarily by Th2 cytokines. The aim of the current study was to explore the influences of milk fat globule epidermal growth factor 8 (MFG‐E8)/integrin β3 signaling involved in airway inflammation and remodeling in asthma. BALB/c mice were sensitized by intraperitoneal injection of ovalbumin (OVA), followed by OVA nebulization. The levels of MFG‐E8 expression were declined markedly in the OVA‐induced allergy murine model. In addition, administration of MFG‐E8 strongly reduced the accumulation of T‐helper type 2 (Th2)‐associated cytokines (such as interleukin‐4, ‐5, and ‐13) as well as chemokine CCL11 (eotaxin) in bronchoalveolar lavage fluid and tissues in the OVA‐sensitized mice. Moreover, MFG‐E8 remarkably repressed the total immunoglobulin E and OVA‐specific immunoglobulin E in serum in OVA‐challenged mice. Meanwhile, treatment with recombinant murine MFG‐E8 noticeably prevented inflammatory cell infiltration into the airways, as showed by a marked decrease in the numbers of total immune cells, eosinophils, neutrophils, macrophages, and lymphocytes in the bronchoalveolar lavage fluid in response to OVA challenge. Importantly, MFG‐E8 apparently alleviated OVA‐driven airway remodeling, which were evidenced by declined secretion of important mediators of airway remodeling, including transforming growth factor‐β1, matrix metalloproteinase 9, ADAM8, and vascular endothelial growth factor, and reduced airway collagen deposition and inhibited goblet cell hyperplasia in OVA‐induced asthma in mice. Mechanistically, integrin 3 contributes to the protective effect of MFG‐E8 in inhibiting airway inflammation and remodeling in OVA‐driven features of allergic asthma. Overall, MFG‐E8, as a candidate molecule to evaluate airway inflammation and remodeling, could be a potential target for the management and prevention of asthma exacerbations, suggesting that MFG‐E8/integrin β3 signaling may serve as a promising therapeutic agent for childhood asthma.
RETRACTED: (2R,3R)Dihydromyricetin inhibits osteoclastogenesis and bone loss through scavenging LPS‐induced oxidative stress and NF‐κB and MAPKs pathways activating
Authors: Zhang Xuejun , Li Xin , Fang Jianguo , Hou Xiaolong , Fang Huang , Guo Fengjing , Li Feng , Chen Anmin , Huang Shilong 
Published: August 2018

AbstractOsteolysis is a serious complication of several chronic inflammatory diseases and is closely associated with a local chronic inflammatory reaction with a variety of causes. However, similarities exist in the mechanisms of their pathological processes. Inflammatory factors and oxidative stress–induced nuclear factor κB (NF‐κB) and mitogen‐activated protein kinases (MAPKs) signaling pathways play a center role in bone erosion. Dihydromyricetin (DMY) is a natural compound with anti‐inflammatory and antioxidative effect, which are commonly used in chronic pharyngitis and alcohol use disorders. In the current study, we identified that DMY attenuated lipopolysaccharide (LPS)–induced oxidative stress through inhibiting the production of reactive oxygen species (ROS) and nitric oxide (NO), downregulated COX‐2 and iNOS, and promoted the activity of the antioxidative system by activating superoxide dismutase (SOD) and Nrf2/HO‐1 pathway. To further investigate the underlying mechanism, we found that DMY inhibits osteoclast (OC) differentiation and bone resorption activity through blocking the RANKL‐induced activation of the NF‐κB and MAPKs signaling pathways and then downregulated c‐Fos and NFATc1, which is essential for OC differentiation. Furthermore, DMY inhibited LPS‐induced osteolysis in vivo. Collectively, these results indicate that DMY might be a promising prophylactic antiosteoclastic/resorptive agent in preventing or treating bone lysis diseases.