bluuebunny/crossref_metadata_2025_split huggingface dataset:
Process of adhesion of the Adequate Childbirth Program to improve obstetric care in private hospitals in Brazil
Authors: de Oliveira Débora Cecília Chaves , Rodrigues Andreza , de Azevedo Nicida Lucia Regina , Gomes Maysa Luduvice , Torres Jacqueline Alves , Engstrom Elyne Montenegro 
Published: January 2023

Abstract
Background
In 2015, a quality improvement project called “Projeto Parto Adequado-PPA” was implemented in Brazilian private hospitals to reduce unnecessary high rates of cesarean sections. This study aimed to analyze the decision-making process of managers and care leaders to adhere to the PPA.

Methods
The Healthy Birth study is evaluative research that used mixed methods to evaluate the implementation and effects of the Adequate Childbirth Program in 12 hospitals that participated in the program. Eight out of 12 hospitals were selected for a qualitative approach. We interviewed ten managers and 24 care leaders from July to October 2017. The interviews were transcripted, and data was systematized using the MaxQda software, with Thematic Content Analysis, to identify the facilitators and barriers for adherence to the Adequate Childbirth Program. We used the conceptions of the Diffusion of Innovation as an analytical reference.

Results
The main reasons to adhere to the Adequate Childbirth Program were the absence of other quality improvements programs in Brazilian private services using multifaceted interventions, social and market status for participating; commitment to quality of care; and the possibility of structural reforms related to the Adequate Childbirth Program implementation. In addition, inviting hospital influencers to learn about the objectives and intentions of the project before joining was considered an important strategy to motivate hospitals.

Conclusion
Social, cultural, and economic constructs motivated adherence. The invitation strategy used by the Adequate Childbirth Program coordination, through socially respected members in Brazil, such as doctors, was highly valued by the leaders of the hospital team and encouraged adherence to the Program.
Scale-up of a novel vital signs alert device to improve maternity care in Sierra Leone: a mixed methods evaluation of adoption
Authors: Bright Sophie , Moses Francis , Ridout Alex , Sam Betty , Momoh Mariama , Goodhart Venetia , Smart Francis , Mannah Margaret , Issa Sattu , Herm-Singh Simren , Reid Fiona , Seed Paul T. , Bunn James , Shennan Andrew , Augustin Katrin , Sandall Jane 
Published: January 2023

Abstract
Background
The CRADLE (Community blood pressure monitoring in Rural Africa: Detection of underLying pre-Eclampsia) Vital Signs Alert device—designed specifically to improve maternity care in low resource settings—had varying impact when trialled in different countries. To better understand the contextual factors that may contribute to this variation, this study retrospectively evaluated the adoption of CRADLE, during scale-up in Sierra Leone.

Methods
This was a mixed methods study. A quantitative indicator of adoption (the proportion of facilities trained per district) was calculated from existing training records, then focus groups were held with ‘CRADLE Champions’ in each district (n = 32), to explore adoption qualitatively. Template Analysis was used to deductively interpret qualitative data, guided by the NASSS (non-adoption, abandonment, scale-up, spread, sustainability) Framework.

Findings
Substantial but non-significant variation was found in the proportion of facilities trained in each district (range 59–90%) [X2 (7, N = 8) = 10.419, p = 0.166]. Qualitative data identified complexity in two NASSS domains that may have contributed to this variation: ‘the technology’ (for example, charging issues, difficulty interpreting device output and concerns about ongoing procurement) and ‘the organisation’ (for example, logistical barriers to implementing training, infighting and high staff turnover). Key strategies mentioned to mitigate against these issues included: transparent communication at all levels; encouraging localised adaptations during implementation (including the involvement of community leaders); and selecting Champions with strong soft skills (particularly conflict resolution and problem solving).

Conclusions
Complexity related to the technology and the organisational context were found to influence the adoption of CRADLE in Sierra Leone, with substantial inter-district variation. These findings emphasise the importance of gaining an in-depth understanding of the specific system and context in which a new healthcare technology is being implemented. This study has implications for the ongoing scale-up of CRADLE, and for those implementing or evaluating other health technologies in similar contexts.
Parent-young communication on sexual and reproductive health issues and its associated factors: experience of students in Agaro Town, Ethiopia
Authors: Abdissa Daba , Sileshi Workitu 
Published: January 2023

AbstractBackgroundSexual and reproductive health (SRH) is at the base of young people's living and wellbeing. A significant number of young peoples are affected by avoidable SRH problems due to a lack of appropriate knowledge regarding SRH. Parent-young communication on SRH is critical in informing them about risk and protective behaviors which in turn decrease the likelihood of involvement in risky sexual behaviors. Therefore, the purpose of this study was to evaluate the parent-young communication on SRH issues and associated factors among secondary and preparatory school students at Agaro town, Southwestern Ethiopia.MethodsSchool based cross-sectional study was conducted from April 13 to April 20, 2019 using stratified random sampling technique. A total of 315 students were included to the study. Data were collected using pretested interviewer-administered structured questionnaire entered into Epi data version 3.1; and analyzed using SPSS version 20. A variable having a p-value of < 0.25 in the bivariable logistic regression model was subjected to multivariable logistic regression analysis to avoid the confounding variable’s effect. Adjusted odds ratios were calculated at the 95% confidence interval and considered significant with a p-value of < 0.05.ResultsThe mean age of the respondents was 20.2 ± 2.6 years. The study finding showed that 61.3% of the participants were discussed on SRH issues with their parents. According to multivariate analysis; educational status of mother [primary education (AOR = 3.67; 95%CI = 1.93, 6.97),secondary education(AOR:2.86; 95%CI = 1.20, 6.80)],educational status of father[primary education (AOR = 5.8;95%CI = 2.8, 12.3,secondary education (AOR = 3.21; 95%CI = 1.55, 6.59)],having family size of < 5 (AOR = 6.4; 95%CI = 3.36, 12.37) and having boy/girlfriend(AOR = 1.99; 95%CI = 1.0, 3.8) were significantly associated with parent-young people communication.ConclusionAbout two third of the participants communicate with their parents about SRH issues and parents’ educational status, family size of < 5 and having boy/girlfriend were significantly associated with it. The main reasons for not communicated was cultural taboos, shame and parents lack of knowledge. Therefore, it is necessary to educate and equip students and parents to address the identified problems.
Chromosome-level genome assembly of a high-altitude-adapted frog (Rana kukunoris) from the Tibetan plateau provides insight into amphibian genome evolution and adaptation
Authors: Chen Wei , Chen Hongzhou , Liao Jiahong , Tang Min , Qin Haifen , Zhao Zhenkun , Liu Xueyan , Wu Yanfang , Jiang Lichun , Zhang Lixia , Fang Bohao , Feng Xueyun , Zhang Baowei , Reid Kerry , Merilä Juha 
Published: January 2023

AbstractBackgroundThe high-altitude-adapted frogRana kukunoris, occurring on the Tibetan plateau, is an excellent model to study life history evolution and adaptation to harsh high-altitude environments. However, genomic resources for this species are still underdeveloped constraining attempts to investigate the underpinnings of adaptation.ResultsTheR. kukunorisgenome was assembled to a size of 4.83 Gb and the contig N50 was 1.80 Mb. The 6555 contigs were clustered and ordered into 12 pseudo-chromosomes covering ~ 93.07% of the assembled genome. In total, 32,304 genes were functionally annotated. Synteny analysis between the genomes ofR. kukunorisand a low latitude speciesRana temporariashowed a high degree of chromosome level synteny with one fusion event between chr11 and chr13 forming pseudo-chromosome 11 inR. kukunoris. Characterization of features of theR. kukunorisgenome identified that 61.5% consisted of transposable elements and expansions of gene families related to cell nucleus structure and taste sense were identified. Ninety-five single-copy orthologous genes were identified as being under positive selection and had functions associated with the positive regulation of proteins in the catabolic process and negative regulation of developmental growth. These gene family expansions and positively selected genes indicate regions for further interrogation to understand adaptation to high altitude.ConclusionsHere, we reported a high-quality chromosome-level genome assembly of a high-altitude amphibian species using a combination of Illumina, PacBio and Hi-C sequencing technologies. This genome assembly provides a valuable resource for subsequent research onR. kukunorisgenomics and amphibian genome evolution in general.
Mesorectal motion evaluation in rectal cancer MR-guided radiotherapy: an exploratory study to quantify treatment margins
Authors: Boldrini Luca , Chiloiro Giuditta , Cusumano Davide , Romano Angela , Placidi Lorenzo , Turco Gabriele , Antonelli Marco Valerio , Nardini Matteo , Galetto Matteo , Indovina Luca , Gambacorta Maria Antonietta 
Published: January 2023

Abstract
Background
Mesorectal motion (MM) is a source of uncertainty during neoadjuvant chemoradiotherapy (nCRT) delivery for locally advanced rectal cancer (LARC). Previously published experiences using cone-beam computed tomography imaging have already described significant movement. Aim of this analysis is to assess inter-fraction MM using the higher tissue contrast provided by hybrid magnetic resonance imaging (MRI) in LARC patients (pts) treated with MRI guided radiation therapy (MRgRT).

Methods
The total mesorectum, its superior (Msup), middle (Mmid) and lower (Mlow) regions were contoured on the positioning MRIs acquired on simulation day and on each treatment day. Six PTVs were obtained adding 0.5, 0.7, 1, 1.3, 1.5 and 2 cm margin to the whole mesorectum, starting from the simulation MRI. Margins including 95% of the mesorectal structures during whole treatment in 95% of patients (pts) were considered adequate.

Results
A total number of 312 fractions of 12 consecutive pts was retrospectively analyzed. The different mesorectum regions show specific motion variability. In particular, Msup shows larger variability in left, right and anterior directions, while the Mlow in caudal and posterior ones. The anterior margin is significantly larger in the Msup than in the other regions.

Conclusion
Different mesorectal regions move differently throughout the radiotherapy treatment, with the largest MM in the Msup anterior direction. Asymmetrical margins are recommended.
Codelivery of TGF-β1 and anti-miR-141 by PLGA microspheres inhibits progression of intervertebral disc degeneration
Authors: Xiao Liang , Gao Daokuan , Zhang Yu , Liu Chen , Yin Zongsheng 
Published: January 2023

Abstract
Background
Cervical and lumbar pain is usually caused by degeneration of the nucleus pulposus (NP). As a powerful therapeutic strategy, tissue engineering can effectively restore the normal biological properties of the spinal unit. Previous studies suggested that poly(lactic-co-glycolic acid) (PLGA) microspheres are effective carriers of cells and biomolecules in NP tissue engineering. This study aims to explore the therapeutic effect of PLGA microspheres coloaded with transforming growth factor-β1 (TGF-β1) and anti-miR-141 on intervertebral disc degeneration (IDD).

Methods
PLGA microspheres were characterized by scanning electron microscopy, a laser particle size analyzer, and laser confocal microscopy. The in vitro release rate of biomolecules from the microspheres was analyzed by reversed-phase high-performance liquid chromatography and agarose gel electrophoresis. The rat NP cells (NPCs) treated with the solutions released from microspheres for different lengths of time were assigned to a control group (Ctrl), an empty PLGA microsphere group (Mock microsphere, MS), a TGF-β1-loaded PLGA microsphere group (TMS), an anti-miR-141-loaded PLGA microsphere group (AMS), and an anti-miR-141 + TGF-β1-loaded PLGA microsphere group (ATMS). The proliferation and apoptosis of NPCs were observed by alamar blue and flow cytometry. The gene and protein expression of cartilage markers COL2A1 and ACAN were observed by RT-qPCR and Western blot. The rat model of IDD was established by tail puncture. Rats were divided into a control group (Ctrl), a mock operation group (Mock), a TGF-β1 microsphere group (TMS), an anti-miR-141 microsphere group (AMS), and an anti-miR-141 + TGF-β1 microsphere group (ATMS). The degree of rat tail IDD was assessed in each group through magnetic resonance imaging (MRI), safranin O-fast green staining, immunohistochemistry, and Western blotting.

Results
PLGA microspheres were stably coloaded and could sustainably release TGF-β1 and anti-miR-141. The results of in vitro cell experiments showed that the release solution of PLGA microspheres significantly enhanced the proliferation of NPCs without inducing their apoptosis and significantly upregulated cartilage markers in NPCs. The effect of microspheres was greater in the ATMS group than that in the TMS group and AMS group. In vivo experiments showed that IDD could be effectively inhibited and reversed by adding microspheres coloaded with TGF-β1 and/or anti-miR-141, and the effect was greatest in the ATMS group.

Conclusion
PLGA microspheres coloaded with TGF-β1 and anti-miR-141 can reverse IDD by inhibiting the degeneration of NPCs.
Ultrasound-guided serratus anterior plane block for transapical transcatheter aortic valve implantation
Authors: Peng Ling , Ding Meng , Wei Wei 
Published: January 2023

Abstract
Background
Reducing postoperative pain due to the thoracotomy incisions in patients undergoing transapical transcatheter aortic valve implantation remains a challenge.

Methods
We introduced ultrasound-guided serratus anterior plane block (SAPB) in a patient with severe aortic insufficiency and chronic obstructive pulmonary disease before surgical intervention.

Results
The patient’s postoperative 1 h, 4 h, and 12 h resting visual analogue scale scores were 3, 1, and 1 without single injection of morphine or dezocine for rescue analgesia.

Conclusions
Ultrasound-guided SAPB could improve analgesia after transapical transcatheter aortic valve implantation.
Helicobacter pylori-induced NAT10 stabilizes MDM2 mRNA via RNA acetylation to facilitate gastric cancer progression
Authors: Deng Min , Zhang Long , Zheng Wenying , Chen Jiale , Du Nan , Li Meiqi , Chen Weiqing , Huang Yonghong , Zeng Ning , Song Yuanbin , Chen Yongming 
Published: January 2023

Abstract
Background
N4-acetylcytidine (ac4C), a widespread modification in human mRNAs that is catalyzed by the N-acetyltransferase 10 (NAT10) enzyme, plays an important role in promoting mRNA stability and translation. However, the biological functions and regulatory mechanisms of NAT10-mediated ac4C were poorly defined.

Methods
ac4C mRNA modification status and NAT10 expression levels were analyzed in gastric cancer (GC) samples and compared with the corresponding normal tissues. The biological role of NAT10-mediated ac4C and its upstream and downstream regulatory mechanisms were determined in vitro and in vivo. The therapeutic potential of targeting NAT10 in GC was further explored.

Results
Here, we demonstrated that both ac4C mRNA modification and its acetyltransferase NAT10 were increased in GC, and increased NAT10 expression was associated with disease progression and poor patient prognosis. Functionally, we found that NAT10 promoted cellular G2/M phase progression, proliferation and tumorigenicity of GC in an ac4C-depedent manner. Mechanistic analyses demonstrated that NAT10 mediated ac4C acetylation of MDM2 transcript and subsequently stabilized MDM2 mRNA, leading to its upregulation and p53 downregulation and thereby facilitating gastric carcinogenesis. In addition, Helicobacter pylori (Hp) infection contributed to NAT10 induction, causing MDM2 overexpression and subsequent p53 degradation. Further investigations revealed that targeting NAT10 with Remodelin showed anti-cancer activity in GC and augmented the anti-tumor activity of MDM2 inhibitors in p53 wild-type GC.

Conclusions
These results suggest the critical role of NAT10-mediated ac4C modification in GC oncogenesis and reveal a previously unrecognized signaling cascade involving the Hp-NAT10-MDM2-p53 axis during GC development.
Esketamine-based opioid-free anaesthesia alleviates postoperative nausea and vomiting in patients who underwent laparoscopic surgery: study protocol for a randomized, double-blinded, multicentre trial
Authors: Chen Hai-yan , Meng Xiao-yan , Gao Hao , Liu Hui , Qiu Hai-Bo , Lu Jun , Song Jin-Chao 
Published: January 2023

Abstract
Background
Although opioids are commonly prescribed in clinical anaesthesia, the significant side effects attributed to their overuse are raising increasing concerns. One way to reduce perioperative opioid consumption is to apply opioid-reduced anaesthesia (ORA) and even opioid-free anaesthesia (OFA), which involves regional techniques, neuraxial anaesthesia, nonopioid analgesics or combined use. The aim of this study was to investigate whether the application of OFA by using esketamine in intraoperative analgesia could minimize the side effects of postoperative nausea and vomiting (PONV), as well as other short-term side effects related to anaesthesia.

Methods/design
The study was designed as a prospective, randomized, controlled, multicentre trial. A total of 278 patients were enrolled; participants were nonsmoking female patients aged 18–50 years and scheduled for laparoscopic appendectomy or cholecystectomy, ASA at I–III, with no serious physical or mental diseases. Both groups received usual perioperative care except for the analgesic medication of either esketamine or sufentanil. The primary outcome was the incidence of PONV 3 days after surgery. Secondary outcomes included recovery status, pain, sedation level and overall recovery, delirium and cognition, anxiety and depression and total consumption of analgesic agents.

Discussion
This trial may show that the synergy of esketamine and propofol anaesthesia reduces PONV as well as other short-term adverse events, thereby providing a better safety and satisfaction profile of ERAS for laparoscopic appendectomy and cholecystectomy.

Trial registration
Chinese Clinical Trial Registry ChiCTR2100047169. Registered on June 9, 2021
The CALM trial protocol: a randomised controlled trial of a guided self-help cognitive behavioural therapy intervention to reduce dental anxiety in children
Authors: Marshman Zoe , Rodd Helen , Fairhurst Caroline , Porritt Jenny , Dawett Bhupinder , Day Peter , Innes Nicola , Vernazza Christopher , Newton Tim , Ronaldson Sarah , Cross Liz , Ross Jennie , Baker Sarah R. , Hewitt Catherine , Torgerson David , Ainsworth Hannah 
Published: January 2023

Abstract
Background
Globally, around 13% of children experience dental anxiety (DA). This group of patients frequently miss dental appointments, have greater reliance on treatment under general anaesthesia (GA) and have poorer oral health-related quality of life (OHRQoL) than their non-dentally anxious peers. Recently, a low-intensity cognitive behavioural therapy (CBT)-based, self-help approach has been recommended for management of childhood anxiety disorders. A feasibility study conducted in secondary care found this guided self-help CBT resource reduced DA and a randomised controlled trial was recommended. The present study aims to establish the clinical and cost-effectiveness of a guided self-help CBT intervention to reduce DA in children attending primary dental care sites compared to usual care.

Methods
This 4-year randomised controlled trial will involve 600 children (aged 9–16 years) and their parent/carers in 30 UK primary dental care sites. At least two dental professionals will participate in each site. They will be assigned, using random allocation, to receive the CBT training and deliver the intervention or to deliver usual care. Children with DA attending these sites, in need of treatment, will be randomly allocated to be treated either by the intervention (CBT) or control (usual care) dental professional. Children will complete questionnaires relating to DA, OHRQoL and HRQoL before treatment, immediately after treatment completion and 12 months post-randomisation. Attendance, need for sedation/GA and costs of the two different approaches will be compared. The primary outcome, DA, will be measured using the Modified Child Dental Anxiety Scale. Scores will be compared between groups using a linear mixed model.

Discussion
Treating dentally anxious patients can be challenging and costly. Consequently, these children are frequently referred to specialist services for pharmacological interventions. Longer waiting times and greater travel distances may then compound existing healthcare inequalities. This research will investigate whether the intervention has the potential to reduce DA and improve oral health outcomes in children over their life-course, as well as upskilling primary dental healthcare professionals to better manage this patient group.

Trial registration
This clinical trial has been registered with an international registry and has been allocated an International Standard Randomised Controlled Trial Number (ISRCTN27579420).
Risk factors of occupational skin diseases among traditional batik manufacturing workers in Yogyakarta, Indonesia
Authors: Febriana Sri Awalia , Erdina  , Dewi Kusuma , Ridora Yohanes , Anggraeni Agustina , Indrastuti Niken , Waskito Fajar , Oginawati Katharina , Tanziha Ikeu , Prakoeswa Cita Rosita Sigit 
Published: January 2023

Abstract
Objective
Batik is one of the Indonesian traditional arts made by decorating fabric using the resist dyeing technique. Currently, batik manufacturing serves as an important source of livelihood in Indonesia. However, the production process of traditional batik involves a range of chemicals and some repetitive physical movements, making batik production inseparable from physical and chemical hazards which increase the risk of developing occupational skin diseases (OSD). This study aimed to identify the risk factors related to OSD, including occupational contact dermatitis (OCD), among traditional batik manufacturing workers in Yogyakarta, Indonesia.

Results
The study demonstrated that working duration (≥ 8 h daily) and type of work (wet process only) were statistically significant as risk factors for developing OSD. While for OCD, our results found that gender (male), history of atopy, and type of work (all and wet phase only) were risk factors for OCD development among traditional batik manufacturing workers.