bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnosis and management of keratoconus by eye care practitioners in Kenya
Authors: Rashid Zahra Aly , Moodley Vanessa R , Mashige Khathutshelo Percy 
Published: January 2023

Abstract
Background
To explore current eye care practice in keratoconus diagnosis and management in Kenya.

Methods
An online questionnaire was distributed to ophthalmic clinical officers (OCO) and optometrists.

Results
A total of 203 responses were received from 52 OCOs and 151 optometrists with a response rate of 24.4% and 53.5% respectively. The majority reported having access to retinoscopes (88.5%; p = 0.48) and slit lamps (76.7; p = 0.14). Few practitioners had access to a corneal topographer (13.5%; p = 0.08) and rigid contact lens (CL) fitting sets (OCOs 5.8%, optometrists 33.8%; p < 0.01). One-third did not feel that retinoscopy (38.7%; p = 0.21), slit lamp findings (30.3%; p = 0.10) and corneal topography (36.6%; p = 0.39) are important investigations in keratoconus diagnosis. Corneal topography was not recommended in two-thirds of patients (59.0%; p = 0.33) with vernal keratoconjunctivitis (VKC). The majority counselled against eye rubbing in mild (73.6%; p = 0.90) VKC, 52.9% in moderate (p = 0.40) and 43.6% in severe (p = 0.24) cases. The majority prescribed spectacles in mild (90.2%; p = 0.95), 29% (p = 0.97) in moderate and 1.9% (p = 0.05) in severe cases. When the binocular best corrected visual acuity (BCVA) with spectacles was ≤ 6/18, 76.9% of OCOs and 58.9% of optometrists referred for CLs (p = 0.02). When binocular BCVA with CLs dropped to ≤ 6/18, 83.7% (p = 0.18) referred to the ophthalmologist for surgical intervention. Few OCOs fitted rigid CLs (15.4% OCOs, 51.0% optometrists; p = 0.01), majority referred to optometrists (82.7% OCOs, 43.7% optometrists; p < 0.01). Progression was monitored in 70.1% (p = 0.11) of mild, 50.9% (p = 0.54) moderate and 25.3% (p = 0.31) advanced cases. Few OCOs (15.4%) performed corneal cross-linking (CXL). A few respondents (5.4%; p = 0.13) did not know when to refer keratoconus patients for CXL. Co-management with ophthalmologists was reported by 58.0% (p = 0.06) of respondents.

Conclusion
The results of this study highlight the need to map services for keratoconus patients, review current curricula and continuous education priorities for mid-level ophthalmic workers, develop guidelines for the diagnosis and management of keratoconus and improve interdisciplinary collaboration.
Cognitive rehabilitation for improving cognitive functions and reducing the severity of depressive symptoms in adult patients with Major Depressive Disorder: a systematic review and meta-analysis of randomized controlled clinical trials
Authors: Mokhtari Saba , Mokhtari Asieh , Bakizadeh Farah , Moradi Alireza , Shalbafan Mohammadreza 
Published: January 2023

Abstract
Introduction
Nearly 40% of patients with Major Depressive Disorder (MDD) have been found to experience cognitive impairment in at least one domain. Cognitive impairment associated with MDD is disproportionately represented in patients that have not fully returned to psychosocial functioning. As awareness regarding cognitive dysfunction in MDD patients grows, so does the interest in developing newer treatments that specifically address these deficits.

Method
In the present study, we conduct a systematic review of controlled randomized clinical trials that used cognitive training and remediation interventions for improving cognitive functions and reducing symptom severity in adult patients with MDD. We selected studies published before March 2022 using search databases including PubMed, ScienceDirect, Scopus, and Google scholar. For conducting the meta-analysis, standard differences in means with the random effect model and with a 95% confidence interval of change in outcome measures from baseline to post-intervention between the cognitive rehabilitation and the control groups were calculated.

Results
The database search resulted in identifying 756 studies of interest, which ultimately 15 studies with 410 participants in the cognitive rehabilitation group and 339 participants in the control group were included. The meta-analysis of the data extracted from these studies, shows a moderate and significant effect on the executive function (d = 0.59 (95% CI, 0.25 to 0.93) p-value = 0.001, I2 = 15.2%), verbal learning (d = 0.45 (95% CI, 0.12 to 0.78) p-value = 0.007, I2 = 0.00%), and working memory (d = 0.41 (95% CI, 0.18 to 0.64) p-value < 0.001, I2 = 33%) of MDD patients. Although, there were no significant difference between intervention and control group in attention (d = 0.32 (95% CI, -0.01 to 0.66) p-value = 0.058, I2 = 0.00%) or depressive symptoms.

Conclusion
This systematic review and meta-analysis indicate that cognitive rehabilitation is an effective intervention for the executive function, verbal learning, and working memory of MDD patients. Due to the importance of these neuropsychological deficits in day-to-day life and the core symptoms of MDD, cognitive rehabilitation should be considered an important part of treating MDD. Further research in this area and concentrated on these particular deficits is warranted.
Obstacles and facilitators to communicating with children about their parents’ mental illness: a qualitative study in a sub-district of Mpumalanga, South Africa
Authors: Dean Lucy , Buechner Hadassah , Moffett Bianca , Maritze Meriam , Dalton Louise J. , Hanna Jeffrey R. , Rapa Elizabeth , Stein Alan , Tollman Stephen , Kahn Kathleen 
Published: January 2023

Abstract
Background
Given that common mental disorders are one of the leading causes of disease burden worldwide, it is likely that many children are growing up with a parent or other adult within their family who has anxiety or depression. Parents with a mental illness may not consider it appropriate to discuss their illness with their child, and consequently an absence of communication may lead to stigmatization, shame, misunderstanding their parents’ symptoms, and even blaming themselves. There is a scarcity of research exploring the experiences and perceptions of healthcare professionals about communication with children of parents with mental illness in low-resource and African contexts.

Methods
A qualitative study using semi-structured interviews with healthcare professionals (n = 15) was conducted within the Bushbuckridge sub-district of Mpumalanga Province, South Africa. Data were analysed using Thematic Analysis.

Results
Four themes were identified relating to the obstacles around communication with children. These included: (1) finding an appropriate language to describe mental illness, as well as the prevailing cultural explanations of mental illness (2) the stigma associated with mental illness (3) the perceived role of children in society and (4) mental health services and staff skills. Two themes that addressed facilitators of communication about parental mental illness were identified: (1) the potential to increase mental health awareness amongst the broader community through social media, the internet, and general psychoeducation (2) healthcare professionals’ concerns for the wellbeing and future mental health of patients’ children, as well as their hopes for increased mental health awareness amongst future generations.

Conclusions
This study provides insight into healthcare professionals’ attitudes and perceptions about talking to patients and families within their community about mental illness. The results provide recommendations about possible ways to promote sharing information about a parent’s mental illness with children at an individual and community level. Future research should focus on the collaborative creation of culturally sensitive psychoeducational resources and evidence-based guidelines. This must be supported by systemic and organisational change in order for professionals to successfully facilitate conversations with patients who are parents, and their children.
Pattern of weight gain in pregnant women in slum areas of Hamadan using multilevel ordinal regression
Authors: Manoochehri Zohreh , Moghimbeigi Abbas , Ezzati-Rastegar Khadije , Faradmal Javad 
Published: January 2023

Abstract
Background
Adequate gestational weight gain (GWG) is an important factor for maternal and fetal health. This is especially important in low-income and slum areas due to limited access to health services and malnutrition. Thus, the purpose of this study is to evaluate the pattern of GWG changes in the slum areas of Hamadan in Iran.

Methods
In this longitudinal study, the study sample consisted of 509 pregnant women who referred to nine health care clinics in the slum areas of Hamadan. Women's weight gain based on the recommended GWG by U.S. Institute of Medicine (IOM) was divided into three categories: Inadequate weight gain, Adequate weight gain, and Excessive weight gain. In order to evaluate the trend of GWG, a multi-level ordinal model was used.

Results
According to pre-pregnancy BMI, a little more than half people (56.6%) were overweight or obese. 85.4% women in the first trimester and 49.1% in the second trimester did not have adequate GWG, but in the third trimester (38.9%) had adequate GWG. Based on multivariate analysis, pre- pregnancy BMI has a significant effect on the odds of inadequate GWG (P-value = 0.021); with one unit increase in pre-pregnancy BMI, the odds of inadequate GWG grows by 1.07 times compared to adequate and excessive GWG.

Conclusions
In general, women did not have adequate weight gain in the first and second trimesters.Thus, designing appropriate interventions to achieve optimal GWG seems to be necessary in slums.
Surgical mortality in patients in extremis: futility in emergency abdominal surgery
Authors: Ramírez-Giraldo Camilo , Isaza-Restrepo Andrés , García-Peralta Juan Camilo , González-Tamayo Juliana , Ibáñez-Pinilla Milcíades 
Published: January 2023

Abstract
Background
The number of older patients with multiple comorbidities in the emergency service is increasingly frequent, which implies the risk of incurring in futile surgical interventions. Some interventions generate false expectations of survival or quality of life in patients and families and represent a negligible therapeutic benefit in patients whose chances of survival are minimal. In order to address this dilemma, we describe mortality in a cohort of patients undergoing emergency laparotomy with a risk ≥ 75% per the ACS NSQIP Surgical Risk Calculator.

Methods
A retrospective observational study was designed to analyze postoperative mortality and factors associated with postoperative mortality in a cohort of patients undergoing emergency laparotomy between January 2018 and December 2021 in a high-complexity hospital who had a mortality risk ≥ 75% per the ACS NSQIP Surgical Risk Calculator.

Results
A total of 890 emergency laparotomies were performed during the study period, and 50 patients were included for the analysis. Patient median age was 82.5 (IQR: 18.25) years old and 33 (66.00%) were male. The most frequent diagnoses were mesenteric ischemia 21 (42%) and secondary peritonitis 18 (36%). Mortality in the series was 92%. Twenty-four (54.34%) died within the first 24 h of the postoperative period; 11 (23.91%) within 72 h and 10 (21.73%) within 30 days. APACHE II and SOFA scores were statistically significantly higher in patients who died.

Conclusions
All available tools should be used to make decisions, with the most reliable and objective information possible, and be particularly vigilant in patients at extreme risk (mortality risk greater than 75% according to ACS NSQIP Surgical Risk Calculator) to avoid futility and its consequences. The available information should be shared with the patient, the family, or their guardians through an assertive and empathetic communication strategy. It is necessary to insist on a culture of surgical ethics based on reflection and continuous improvement in patient care and to know how to accompany them in order to have a proper death.
The morphology of permanent maxillary first molars evaluated by cone-beam computed tomography among a Yemeni population
Authors: Mufadhal Abdulbaset A. , Madfa Ahmed A. 
Published: January 2023

AbstractBackgroundThe study's objective was to use CBCT to ascertain the root and root canal anatomy of the permanent maxillary first molars in a Yemeni population. It was considered how gender affected the prevalence of root canal morphology.MethodsA sample of 373 CBCT records of maxillary permanent first molars belonging to 373 Yemeni individuals (162 males and 211 females) aged between 12 and 65 years were included in this study. Using CBCT on the teeth, the root form and canal morphology for each root based on Vertucci's classification were evaluated. The distribution of MB2 occurrence was documented. The prevalence and resemblance of the men and females were investigated. The Chi-square test was performed to evaluate the findings.ResultsOf the 373 maxillary first molars studied, the three separated root form was found in 94.9% of the studied MFMs while the two fused and one separate root form was found in 4.5%. The majority of the three-rooted MFMs (82.6%) had more than three root canals (four canals in 77.2% and five canals in 5.4%). The prevalence of MB2 was as high as 82.3% of the three-rooted MFMs. Vertucci type II configuration was the most frequent canal type (25%) followed by Vertucci type III (23.1%) and Vertucci type I (17.7%) in the mesiobuccal root. Vertucci type I was the most prevalent canal configuration in the distobuccal root and palatal root of the three-rooted MFMs (96% and 99.5%, respectively).ConclusionsThe maxillary first molars' root canal morphology indicated notable variations among a Yemeni population. The maxillary first molars of most of the Yemeni participants in this study had three roots and four canals. In light of the high occurrence of MB2 (82.3%) in permanent maxillary first molars, our findings emphasize the need of searching for and using cutting-edge techniques to locate the MB2 canals. Males outnumbered females in proportion.
Using cognitive interviews to improve a measure of organizational readiness for implementation
Authors: McClam Maria , Workman Lauren , Dias Emanuelle M. , Walker Timothy J. , Brandt Heather M. , Craig Derek W. , Gibson Robert , Lamont Andrea , Weiner Bryan J. , Wandersman Abraham , Fernandez Maria E. 
Published: January 2023

Abstract
Background
Organizational readiness is a key factor for successful implementation of evidence-based interventions (EBIs), but a valid and reliable measure to assess readiness across contexts and settings is needed. The R = MC2 heuristic posits that organizational readiness stems from an organization’s motivation, capacity to implement a specific innovation, and its general capacity. This paper describes a process used to examine the face and content validity of items in a readiness survey developed to assess organizational readiness (based on R = MC2) among federally qualified health centers (FQHC) implementing colorectal cancer screening (CRCS) EBIs.

Methods
We conducted 20 cognitive interviews with FQHC staff (clinical and non-clinical) in South Carolina and Texas. Participants were provided a subset of items from the readiness survey to review. A semi-structured interview guide was developed to elicit feedback from participants using “think aloud” and probing techniques. Participants were recruited using a purposive sampling approach and interviews were conducted virtually using Zoom and WebEx. Participants were asked 1) about the relevancy of items, 2) how they interpreted the meaning of items or specific terms, 3) to identify items that were difficult to understand, and 4) how items could be improved. Interviews were transcribed verbatim and coded in ATLAS.ti. Findings were used to revise the readiness survey.

Results
Key recommendations included reducing the survey length and removing redundant or difficult to understand items. Additionally, participants recommended using consistent terms throughout (e.g., other units/teams vs. departments) the survey and changing pronouns (e.g., people, we) to be more specific (e.g., leadership, staff). Moreover, participants recommended specifying ambiguous terms (e.g., define what “better” means).

Conclusion
Use of cognitive interviews allowed for an engaged process to refine an existing measure of readiness. The improved and finalized readiness survey can be used to support and improve implementation of CRCS EBIs in the clinic setting and thus reduce the cancer burden and cancer-related health disparities.
Tetrahydrocurcumin regulates the tumor immune microenvironment to inhibit breast cancer proliferation and metastasis via the CYP1A1/NF-κB signaling pathway
Authors: Zeng Anqi , Yu Xinyue , Chen Bao , Hao Lu , Chen Ping , Chen Xue , Tian Yuan , Zeng Jing , Hua Hua , Dai Ying , Zhao Junning 
Published: January 2023

AbstractThe NF-κB signaling pathway is overactivated in tumor cells, and the activation of the NF-κB signaling pathway releases a large number of inflammatory factors, which enhance tumor immunosuppression and promote tumor metastasis. The cytochrome P450 (CYP450) system consists of important metabolic enzymes present in different tissues and progressive tumors, which may lead to changes in the pharmacological action of drugs in inflammatory diseases such as tumors. In this study, the anticancer effect of tetrahydrocurcumin (THC), an active metabolite of curcumin, on breast cancer cells and the underlying mechanism were investigated. Result showed that THC selectively inhibited proliferation and triggered apoptosis in breast cancer cells in a concentration- and time-dependent manner. Moreover, THC-induced cell apoptosis via a mitochondria-mediated pathway, as indicated by the upregulated ratio of Bax/Bcl-2 and reactive oxygen species (ROS) induction. In addition, THC could affect the CYP450 enzyme metabolic pathway and inhibit the expression of CYP1A1 and activation of the NF-κB pathway, thereby inhibiting the migration and invasion of breast cancer cells. Furthermore, after overexpression of CYP1A1, the inhibitory effects of THC on the proliferation, metastasis, and induction of apoptosis in breast cancer cells were weakened. The knockdown of CYP1A1 significantly enhanced the inhibitory effect of THC on the proliferation, metastasis, and apoptosis induction of breast cancer cells. Notably, THC exhibited a significant tumor growth inhibition and anti-pulmonary metastasis effect in a tumor mouse model of MCF-7 and 4T1 cells by regulating the tumor immunosuppressive microenvironment. Collectively, these results showed that TH could effectively trigger apoptosis and inhibit the migration of breast cancer cells via the CYP1A1/NF-κB signaling pathway, indicating that THC serves as a potential candidate drug for the treatment of breast cancer.
Clinical usefulness of the lymphocyte-to-monocyte ratio and aggregate index of systemic inflammation in patients with esophageal cancer: a retrospective cohort study
Authors: Wang Hui-Ke , Wei Qian , Yang Ya-Lan , Lu Tai-Ying , Yan Yan , Wang Feng 
Published: January 2023

Abstract
Background
Multiple perioperative inflammatory markers are considered important factors affecting the long-term survival of esophageal cancer (EC) patients. Hematological parameters, whether single or combined, have high predictive value.

Aim
To investigate the inflammatory status of patients with preoperative EC using blood inflammatory markers, and to establish and validate competing risk nomogram prediction models for overall survival (OS) and progression-free survival (PFS) in EC patients.

Methods
A total of 508 EC patients who received radical surgery (RS) treatment in The First Affiliated Hospital of Zhengzhou University from August 5, 2013, to May 1, 2019, were enrolled and randomly divided into a training cohort (356 cases) and a validation cohort (152 cases). We performed least absolute shrinkage and selection operator (LASSO)-univariate Cox- multivariate Cox regression analyses to establish nomogram models. The index of concordance (C-index), time-dependent receiver operating characteristic (ROC) curves, time-dependent area under curve (AUC) and calibration curves were used to evaluate the discrimination and calibration of the nomograms, and decision curve analysis (DCA) was used to evaluate the net benefit of the nomograms. The relative integrated discrimination improvement (IDI) and net reclassification improvement (NRI) were calculated to evaluate the improvement in predictive accuracy of our new model compared with the AJCC staging system and another traditional model. Finally, the relationship between systemic inflammatory response markers and prognostic survival was explored according to risk plot, time-dependent AUC, Kaplan–Meier and restricted cubic spline (RCS).

Results
Based on the multivariate analysis for overall survival (OS) in the training cohort, nomograms with 10 variables, including the aggregate index of systemic inflammation (AISI) and lymphocyte-to-monocyte ratio (LMR), were established. Time-dependent ROC, time-dependent AUC, calibration curves, and DCA showed that the 1-, 3-, and 5 year OS and PFS probabilities predicted by the nomograms were consistent with the actual observations. The C-index, NRI, and IDI of the nomograms showed better performance than the AJCC staging system and another prediction model. Moreover, risk plot, time-dependent AUC, and Kaplan–Meier showed that higher AISI scores and lower LMR were associated with poorer prognosis, and there was a nonlinear relationship between them and survival risk.

Conclusion
AISI and LMR are easy to obtain, reproducible and minimally invasive prognostic tools that can be used as markers to guide the clinical treatment and prognosis of patients with EC.