bluuebunny/crossref_metadata_2025_split huggingface dataset:
Suicidal behaviors and associated factors among patients attending an emergency department: a facility-based cross-sectional study
Authors: Wordefo Dureti Kassim , Kassim Faiz Mohammed , Birhanu Elizabeth , Mamo Girma 
Published: June 2023

AbstractBackgroundEmergency departments (ED) are an important site for screening patients with suicidal behaviors. However, there is insufficient data in low-and middle-income countries regarding the magnitude of suicidal attempts among patients attending EDs. Therefore, the present study aimed to screen suicidal behavior and factors associated with suicide in patients attending an ED of Addis Ababa Burn, Emergency and Trauma Hospital, Ethiopia.MethodA facility-based quantitative cross-sectional study was conducted between April and June 2018. A total of 398 participants were recruited using a consecutive sampling technique. The collected data collected includes structured questionnaires containing sociodemographic determinants, chronic medical illness conditions, substance use characteristics, social support level, common mental disorders (CMD) screening, suicidal behaviors assessment and suicidal attempts reason and method.ResultsThe prevalence of suicidal behavior and suicidal attempts were 8% and 6.3%, respectively. Suicide was attempted most frequently in the 18–24 age group. There was no overall difference in sex distribution for suicidal attempts. However, there were sex-based differences when the age group was taken into consideration. The commonest underlying reason for the attempt was social reasons (44%), while the most frequently reported attempt method was hanging (36%). No single factor was found to be significantly associated with the suicidal attempt.ConclusionAlthough suicidal behaviors are more common in patients attending the ED than in the general population, these facts have previously got little attention in patient attending EDs in low and middle income countries. The present findings support the need for a more detailed assessment of suicidal behaviours in patients attending ED and in patients with CMD.
Impact of anesthetist licensing examination on quality of education in Ethiopia: a qualitative study of faculty and student perceptions
Authors: Asemu Yohannes Molla , Yigzaw Tegbar , Desta Firew Ayalew , Melese Tewodros Abebaw , Gemeda Leulayehu Akalu , Scheele Fedde , van den Akker Thomas 
Published: June 2023

Abstract
Background
Ethiopia drastically increased the anesthesia workforce density by training ‘associate clinician anesthetists’ as a task-shifting and sharing strategy. However, there were growing concerns about educational quality and patient safety. Accordingly, the Ministry of Health introduced the anesthetist national licensing examination (NLE) to assure the quality of education. However, empirical evidence is scarce to support or refute the overall impact of NLEs, which are relatively costly for low- and middle-income settings. Therefore, this study aimed to explore the impact of introducing NLE on anesthetists’ education in Ethiopia.

Methods
We conducted a qualitative study using a constructivist grounded theory approach. Data were prospectively collected from ten anesthetist teaching institutions. Fifteen in-depth interviews were conducted with instructors and academic leaders, and six focus groups were held with students and recently tested anesthetists. Additional data were gathered by analyzing relevant documents, including versions of curricula, academic committee minutes, program quality review reports, and faculty appraisal reports. Interviews and group discussions were audiotaped, transcribed verbatim and analyzed using Atlas.ti 9 software.

Results
Both faculty and students demonstrated positive attitudes toward the NLE. Student motivation, faculty performance, and curriculum strengthening were the three primary changes that emerged, resulting in three subsequent spin-offs on assessment, learning, and quality management practices. Academic leaders’ dedication to evaluating examination data and turning these into action led to changes that improved education quality. Increased accountability, engagement, and collaboration were the predominant factors facilitating change.

Conclusion
Our study indicates that the Ethiopian NLE has prompted anesthesia teaching institutions to improve their teaching, learning, and assessment practices. However, more work is required to improve exam acceptability among stakeholders and drive broader changes.
METTL3-mediated m6A modification of SIRT1 mRNA inhibits progression of endometriosis by cellular senescence enhancing
Authors: Wang Xiaotong , Wang Jing , Zhao Xibo , Wu Han , Li Jixin , Cheng Yan , Guo Qiuyan , Cao Xuejiao , Liang Tian , Sun Liyuan , Zhang Guangmei 
Published: June 2023

Abstract
Background
Endometriosis (EMs), the ectopic planting of functional endometrium outside of the uterus, is a leading cause of infertility and pelvic pain. As a fundamental mRNA modification, N6-methyladenosine (m6A) participates in various pathological processes. However, the role of m6A RNA modification in endometriosis remains unclear. The present study explores METTL3-mediated m6A modification and the mechanisms involved in endometriosis.

Methods
The dominant m6A regulators in EMs were analysed using RT‒PCR. Candidate targets and possible mechanisms of METTL3 were assessed by m6A-mRNA epitranscriptomic microarray and RNA sequencing. A primary ESCs model was employed to verify the effect of METTL3 on m6A modification of SIRT1 mRNA, and the mechanism was elucidated by RT‒PCR, Western blotting, MeRIP, and RIP assays. CCK-8 viability assays, Transwell invasion assays, EdU proliferation assays, wound healing migration assays, and senescence-associated β-galactosidase staining were performed to illuminate the potential biological mechanism of METTL3 and SIRT1 in ESCs in vitro. An in vivo PgrCre/ + METTL3 −/− female homozygous mouse model and a nude mouse xenograft model were employed to further investigate the physiologic consequences of METTL3-mediated m6A alteration on EMs.

Results
Our data show that decreased METTL3 expression significantly downregulates m6A RNA methylation levels in ESCs. Silencing m6A modifications mediated by METTL3 accelerates ESCs viability, proliferation, migration, and invasion in vitro. The m6A reader protein YTHDF2 binds to m6A modifications to induce the degradation of SIRT1 mRNA. SIRT1/FOXO3a signalling pathway activation is subsequently inhibited, promoting the cellular senescence of ESCs and inhibiting the ectopic implantation of ESCs in vitro and in vivo.

Conclusions
Our findings demonstrate that METTL3-mediated m6A methylation epigenetically regulates the ectopic implantation of ESCs, resulting in the progression of endometriosis. Our study establishes METTL3-YTHDF2-SIRT1/FOXO3a as a critical axis and potential mechanism in endometriosis.
Youth cannabis use in Canada post-legalization: service providers’ perceptions, practices, and recommendations
Authors: Kourgiantakis Toula , Lee Eunjung , Kosar A. Kumsal Tekirdag , Tait Christine , Lau Carrie K.Y. , McNeil Sandra , Craig Shelley , Ashcroft Rachelle , Williams Charmaine C. , Goldstein Abby L. , Chandrasekera Uppala , Sur Deepy , Henderson J. L. 
Published: June 2023

AbstractBackgroundIn 2018, Canada legalized recreational cannabis use with the purpose of protecting youth and restricting access. However, concerns have been raised that this objective has not been met as rates of cannabis use among youth aged 16–24 have not declined. Youth cannabis use is associated with various adverse effects including psychosis, anxiety, depression, suicidality, respiratory distress, cannabinoid hyperemesis syndrome, and intoxications. Service providers play a crucial role in addressing youth cannabis use. This study aimed to understand Ontario service providers’ perceptions, practices, and recommendations on youth cannabis use.MethodsThis mixed method study included a survey and two focus groups. The survey was distributed to mental health service providers serving youth aged 16–24 across Ontario who were given the option to participate in a focus group. The survey included closed and open-ended questions regarding perceptions, practices, and recommendations, while the focus groups explored these categories in greater depth. Descriptive statistics were used to analyze close-ended questions and interpretative content analysis was applied for open-ended questions. Focus group data were analyzed using thematic analysis.ResultsThe survey was completed by 160 service providers and 12 participated in two focus groups. Regarding perceptions, 60% of survey participants agreed with legalization, 26% had a strong understanding of medical versus recreational cannabis, 84% believed that cannabis has physical and mental health risks, and 49% perceived stigmatization. Less than half of the survey participants reported screening or assessing cannabis use, 16% stated they are highly familiar with treating cannabis use, and 67% reported that they rarely work with families. Subthemes identified in the focus groups under perceptions included normalization and stigmatization, harms for youth, and stigma, racism, and discrimination. Subthemes under practice included cannabis not being the primary focus, challenges with screening, assessment, and intervention, and referral to specialized services. Both the survey and focus group participants recommended increasing public education, enhancing service provider training, improving regulation and policies, reducing stigma and minimization, improving service access, and providing more culturally responsive services.ConclusionYouth cannabis use in Canada remains a significant public health concern, necessitating a more comprehensive plan to protect Ontario youth and reduce associated harms.
Developing Angelman syndrome-specific clinician-reported and caregiver-reported measures to support holistic, patient-centered drug development
Authors: Connor-Ahmad Siobhan , Tjeertes Jorrit , Chladek Michael , Newton Louise , Symonds Tara , Clinch Susanne , Vincenzi Brenda , McDougall Fiona 
Published: June 2023

Abstract
Background
Angelman syndrome (AS) is a rare, heterogenous neurogenetic condition, which significantly impacts the lives of people with AS and their families. Valid and reliable measures reporting key symptoms and functional impairments of AS are required to support development of patient-centered therapies. We describe the development of clinician- and caregiver-reported, AS-specific Global Impression scales for incorporation into clinical trials. Best practice US Food and Drug Administration guidance for measure development was followed with input from expert clinicians, patient advocates, and caregivers during content generation and refinement.

Results
Initial measurement domains for the Symptoms of AS—Clinician Global Impression (SAS-CGI) and the Caregiver-reported AS Scale (CASS) were identified from a conceptual disease model of AS symptoms and impacts, derived from interviews with caregivers and clinicians. Two rounds of cognitive debriefing (CD) interviews were performed; clinicians debriefed the SAS-CGI, with patient advocates and caregivers debriefing the CASS to ensure relevance and comprehension. Feedback was used to refine items and ensure wording was age-appropriate and captured AS-specific symptoms, as well as associated impacts and functional impairments. The SAS-CGI and CASS capture global assessments of seizures, sleep, maladaptive behaviors, expressive communication, fine and gross motor skills, cognition, and self-care, which were determined by clinicians, patient advocates, and caregivers to be the most challenging aspects of AS. Additionally, the measures include items for assessing overall AS symptoms and the meaningfulness of any change. In addition to ratings for severity, impact, and change, a notes field was included in the SAS-CGI to provide the rationale for the chosen rating. CD interviews confirmed the measures covered key concepts of AS from the perspective of clinicians and caregivers, and demonstrated that the measures’ instructions, items, and response options were clear and appropriate. Interview feedback informed adjustments to the wording of the instructions and the items.

Conclusions
The SAS-CGI and CASS were designed to capture multiple AS symptoms, reflecting the heterogeneity and complexity of AS in children 1 to 12 years old. These clinical outcome assessments have been incorporated into AS clinical studies, which will allow for the evaluation of their psychometric properties and inform further refinements if needed.
Single-cell analysis reveals HBV-specific PD-1+CD8+ TRM cells in tumor borders are associated with HBV-related hepatic damage and fibrosis in HCC patients
Authors: Liu Lulu , Liu Junwei , Li Pan , Luo Jijun , Qin Rui , Peng Qiao , Li Bin , Wei Xuyong , Wang Tian , Shi Hongyu , Wang Ming-Da , Li Chao , Fang Weijia , Chen Wei , Xu Xiao , Yang Tian , Yin Weiwei , Zeng Xun 
Published: June 2023

AbstractImmune checkpoint blockade (ICB) treatment of hepatocellular carcinoma (HCC) patients with hepatitis B virus (HBV) infection may activate viral-specific T cells to attack HBV infected hepatocytes and thus induce immune-related liver injury. Therefore, it is important to deeply understand the impacts of HBV infection on HCC immune microenvironment in order to better design effective immunotherapies for HBV+ (HBV infected) HCC patients. Here, We performed cytometry by time-of-flight (CyTOF) analyses to characterize the distinct immune compositions of HCC tumors, tumor borders, and their associations with HCC/HBV related clinical characteristics. We identified 31 distinct immune clusters and found significant associations between immune signatures with clinicopathological features of HCC. We further revealed the HBV infection had more effects on shaping immune compositions in tumor borders than in tumors, with the significant enrichment of HBV-specific PD-1+CD8+ tissue-resident memory T (TRM) cells in tumor borders of HBV+ patients. We confirmed this subset with a more exhausted phenotype and respond more actively under anti-PD-L1 treatment, suggesting its involvement in immune-related liver injury induced by ICB treatment to HBV+ HCC patients. Our study shows it may be necessary to consider antiviral prophylaxis for HBV+ HCC patients receiving ICB treatment.
The effectiveness and health-economic evaluation of “Partner in Balance,” a blended self-management program for early-stage dementia caregivers: study protocol for a cluster-randomized controlled trial
Authors: Osstyn Sander L. , Handels Ron , Boots Lizzy M. M. , Balvert Sanne C. E. , Evers Silvia M. A. A. , de Vugt Marjolein E. 
Published: June 2023

Abstract

Background

Informal caregivers of people with dementia are crucial in dementia care. However, they are insufficiently supported and report caregiver burdens, which urges the need for cost-effective interventions aimed at supporting caregivers. This paper presents the design of a study evaluating the effectiveness, cost-effectiveness, and cost-utility of a blended self-management program for early-stage dementia caregivers.

Methods/design
A pragmatic, cluster randomized controlled trial with a shared control group will be conducted. Participants will be informal caregivers of people with early-stage dementia and will be recruited by local care professionals. Randomization will be carried out at the level of the care professional level in a ratio of 35% to 65% (control arm vs. intervention arm). Participants in the control arm will receive care as usual and the intervention arm will receive the blended care self-management program “Partner in Balance” within a usual care setting in the Netherlands. Data will be collected at baseline and at 3-, 6-, 12-, and 24-month follow-ups. The primary outcome for effectiveness (part 1) is care management self-efficacy. For the health-economic evaluation (part 2) total care costs and the quality of life for individuals with dementia (cost-effectiveness) and quality-adjusted life years (cost-utility) will be the base case analysis. Secondary outcomes (parts 1 and 2) will include depression, anxiety, perceived informal caregiving stress, service-use self-efficacy, quality of life, caregivers’ gain, and perseverance time. A process evaluation (part 3) will investigate the internal and external validity of the intervention.

Discussion
In this trial, we plan to evaluate the effectiveness, cost-effectiveness, and cost-utility of “Partner in Balance” among informal caregivers of people with dementia. We expect to find a significant increase in care management self-efficacy, and the program to be cost-effective, and provide valuable insights to stakeholders of “Partner in Balance.”

Trial registration
ClinicalTrials.gov, NCT05450146. Registered on 4 November 2022.
Live-cell imaging of chromatin contacts opens a new window into chromatin dynamics
Authors: van Staalduinen Jente , van Staveren Thomas , Grosveld Frank , Wendt Kerstin S. 
Published: June 2023

AbstractOur understanding of the organization of the chromatin fiber within the cell nucleus has made great progress in the last few years. High-resolution techniques based on next-generation sequencing as well as optical imaging that can investigate chromatin conformations down to the single cell level have revealed that chromatin structure is highly heterogeneous at the level of the individual allele. While TAD boundaries and enhancer–promoter pairs emerge as hotspots of 3D proximity, the spatiotemporal dynamics of these different types of chromatin contacts remain largely unexplored. Investigation of chromatin contacts in live single cells is necessary to close this knowledge gap and further enhance the current models of 3D genome organization and enhancer–promoter communication. In this review, we first discuss the potential of single locus labeling to study architectural and enhancer–promoter contacts and provide an overview of the available single locus labeling techniques such as FROS, TALE, CRISPR–dCas9 and ANCHOR, and discuss the latest developments and applications of these systems.
Loculated pericardial hematoma compressing the right atrium post mechanical aortic valve replacement and the role of point-of-care echocardiography: a case report
Authors: Hamdan Mira , Khoury Fady , Kossaify Antoine 
Published: June 2023

Abstract
Background
Bleeding in the postoperative period after cardiac surgery is relatively frequent, especially in patients with early anticoagulant therapy, as in the case of mechanical valve replacement. Diffuse hemopericardium is relatively easy to diagnose; however, loculated pericardial hematomas leading to hemodynamic collapse are relatively rare and their diagnosis is more challenging.

Case presentation
This report is of a 75-year-old Asian woman who presented dyspnea, confusion and hemodynamic collapse related to loculated pericardial hematoma compressing the right atrium 3 days after mechanical aortic valve replacement. Urgent transthoracic echocardiogram performed as point-of-care approach showed right atrial compression, the aortic valve prosthesis had normal function. Surgical removal of the hematoma resulted in complete recovery.

Conclusion
Loculated pericardial hematoma might lead to hemodynamic collapse. Close monitoring of hemodynamic parameters is essential, also point-of-care echocardiography is essential for early recognition and prompt management in patients with critical hemodynamic condition.
Digital image watermarking using discrete cosine transformation based linear modulation
Authors: Alomoush Waleed , Khashan Osama A. , Alrosan Ayat , Attar Hani H. , Almomani Ammar , Alhosban Fuad , Makhadmeh Sharif Naser 
Published: June 2023

AbstractThe proportion of multimedia traffic in data networks has grown substantially as a result of advancements in IT. As a result, it's become necessary to address the following challenges in protecting multimedia data: prevention of unauthorized disclosure of sensitive data, in addition to tracking down the leak's origin, making sure no alterations may be made without permission, and safeguarding intellectual property for digital assets. watermarking is a technique developed to combat this issue, which transfer secure data over the network. The main goal of invisible watermarking is a hidden exchange of data and a message from being discovered by a third party. The objective of this work is to develop a digital image watermarking using discrete cosine transformation based linear modulation. This paper proposed an invisible watermarking method for embedding information into the transformation domain for the grey scale images. This method used the embedding of a stego-text into the least significant bit (LSB) of the Discrete Cosine Transformation (DCT) coefficient by using a linear modulation algorithm. Also, a stego-text is embedded with different sizes ten times within images after embedding the stego-image immune to different kinds of attack, such as salt and pepper, rotation, cropping, and JPEG compression with different criteria. The proposed method is tested using four benchmark images. Also, to evaluate the embedding effect, PSNR, NC and BER are calculated. The outcomes show that the proposed approach is practical and robust, where the obtained results are promising and do not raise any suspicion. In addition, it has a large capacity, and its results are imperceptible, especially when 1bit/block is embedded.
Co-occurrence of iron, folate, and vitamin A deficiency among pregnant women in eastern Ethiopia: a community-based study
Authors: Fite Meseret Belete , Tura Abera Kenay , Yadeta Tesfaye Assebe , Oljira Lemessa , Wilfong Tara , Mamme Newas Yusuf , Asefa Gemechu , Gurmu Demiraw Bikila , Habtu Wossene , Waka Feyissa Challa , Demiss Nahom Tefera , Woldeyohannes Meseret , Tessema Masresha , Alemayehu Dawit , Hassen Tahir Ahmed , Motuma Aboma , Roba Kedir Teji 
Published: June 2023

Abstract
Background
It is well known that the magnitude of undernutrition in Ethiopia is unacceptably high. The burden of co-occurrence of iron, folate, and vitamin A deficiency, on the other hand, has received less attention. Thus, in this study, we looked at the prevalence of iron, folate, and vitamin A deficiency in pregnant women in eastern Ethiopia.

Methods
A community-based cross-sectional study was conducted among 397 pregnant women in Haramaya district, eastern Ethiopia. An interview-assisted questionnaire and blood serum were collected from pregnant women using standard techniques and shipped to an EPHI for micronutrient analysis. Factors associated with the co-occurrence of iron, folate, and vitamin A deficiency were identified using binary and multiple logistic regressions.

Results
According to this study, 81.6% of the participants were deficient in at least one micronutrient, and 53.53.2% were deficient in two or more. Women who did not receive iron-folic acid supplementation (AOR = 2.44; 95% CI = 1.52–3.92), did not attend Antenatal care (ANC) follow up (AOR = 2.88; 95% CI = 1.81–4.61), and reported low consumption of diversified diet (AOR = 2.18 (95% CI = 1.35–3.51) had a higher risk of co-occurrence of iron, folate, and vitamin A deficiency.

Conclusion
This study found that more than half of pregnant women were in multiple micronutrients, indicating a major public health issue. In addition to the IFA supplementation programs that are already in place, there is a need for multiple micronutrient supplementation.