bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hematoma cavity separation and neomembrane thickness are potential triggers of recurrence of chronic subdural hematoma
Authors: Liu Hongbin , Yan Rudan , Xie Fei , Richard Seidu A. 
Published: June 2022

Abstract
Background
Chronic subdural hematoma (CSDH) is the anomalous and encapsulated accumulation of fluid of complex origin consisting of old blood, mostly or totally liquified and cerebrospinal fluid (CSF) in the subdural space usually after a head injury in the elderly. Almost all the research on surgical techniques and endoscopic assisted evacuation of CSDH focused on the just the evacuation and not abnormal anatomical structures that causes recurrences.

Objectives
We investigated abnormal anatomical structures that triggers recurrence of CSDH during craniotomy as well as burr-hole craniostomy with endoscopic assistance.

Materials and methods
We retrospectively analyzed all patients with CSDH who underwent craniostomy and burr-hole craniotomy with endoscopic assisted evacuation of hematoma between April 2017 and November 2020 at our institution. Clinical data obtained was categorized into patient-related, radiology as well as surgery and endoscopic evaluations.

Results
A total of 143 patients (109 men and 34 women) aged 43–94 years (mean age, 68.35 years) with CSDH were included in this study. We observed a recurrence rate of 4.9% (7/143). Recurrences occurred between 2 and 6 months after the operation in patients with recurrences. Our data revealed that, age, hypertension, history of injury, diabetes, antiplatelet or anticoagulant use were not associated with hematoma recurrence. Nevertheless, all the patients with recurrence of hematoma were males. Interestingly, our univariate and multivariate analyses found neomembrane thickness and hematoma cavity separation as independent risk factors (OR,45.822; 95% CI,2.666-787.711; p = 0.008) for the recurrence of CSDH (p < 0.05). Also, we observed thickened membranes connecting/separating the dura and the thickened arachnoid/pia matters in all the 7 patients with hematoma recurrence.

Conclusions
The treatment of patients with CSDH ought to include the identification and resection of abnormal thickened membranes connecting/separating the dura and the thickened arachnoid/pia matters to avoid recurrence. Comparatively, endoscopy showed hematoma cavity separation or neomembrane thickness just as seen during craniotomy.
Spatial distribution and predictors of intimate partner violence among women in Nigeria
Authors: Bolarinwa Obasanjo Afolabi , Ahinkorah Bright Opoku , Frimpong James Boadu , Seidu Abdul-Aziz , Tessema Zemenu Tadesse 
Published: June 2022

Abstract
Background
Globally, intimate partner violence is one of the major health problems women face every day. Its consequences are enormous. However, our search of the available literature revealed that no study had examined the spatial distribution of intimate partner violence and the predictors of intimate partner violence among women in Nigeria using current nationally representative data. This study, therefore, sought to examine the spatial distribution of intimate partner violence and its predictors among women in Nigeria.

Method
We sourced data from the 2018 Nigeria Demographic and Health Survey for this study. A sample size of 8,968 women was considered for this study. We employed ﻿both multilevel and spatial analyses to ascertain the factors associated with intimate partner violence and its spatial clustering.

Results
The hot spot areas for intimate partner violence in Nigeria were Gombe, Bauchi, Adamawa, Plateau, Kogi, Edo, Ebonyi, and Rivers. The likelihood of experiencing intimate partner violence among women in Nigeria was high among women with primary education, those that were previously married, women currently working, women who were Yoruba, women with parity of four and above and women who were exposed to mass media while low odds of intimate partner violence was reported among women who were Muslims. Women who resided in the North East region and those who lived in communities with medium socioeconomic status were more likely to experience intimate partner violence, while women who were within the richest wealth index and those residing in the South West region were less likely to experience intimate partner violence.

Conclusion
The study found regional variations in the prevalence of intimate partner violence among women in Nigeria. Therefore, policymakers should focus their attention on the hotspots for intimate partner violence in the country. There is also the need to consider the factors identified in this study to reduce intimate partner violence among women in Nigeria. Empowering women would yield a significant improvement in the fight against gender-based violence.
Is there any association between adherence to the Mediterranean Diet and Dietary Total Antioxidant Capacity with Bacterial Vaginosis? Results from a Case–Control study
Authors: Noormohammadi Morvarid , Eslamian Ghazaleh , Kazemi Seyyedeh Neda , Rashidkhani Bahram 
Published: June 2022

Abstract
Background
Bacterial vaginosis, BV, is a common inflammatory vaginal dysbiosis. The Mediterranean diet, MD, containing foods rich in antioxidant compounds, is shown to be beneficial for inflammatory conditions. This study aimed to investigate the association between MD adherence and dietary total antioxidant capacity (DTAC) with BV.

Methods
This case–control study was conducted on 143 BV-affected and 151 healthy individuals aged between 15 and 45 years. The Amsel criteria were used to detect newly diagnosed patients with BV by a gynecologist. The 168-item food frequency questionnaire (FFQ) was used to record participants' dietary intakes in the last year. The reported data in the FFQ was used to measure adherence to the MD by calculating the Medi-Lite score and to measure the DTAC by calculating ferric-reducing antioxidant power, FRAP, based on the related databases. Logistic regression models were used to determine the association between Medi-Lite and DTAC and BV odds.

Results
The highest tertile of Medi-Lite score was associated with a reduced odds of BV in the crude model (Odds Ratio, OR: 0.49, 95% Confidence Interval, 95% CI 0.25, 0.96, P for trend: 0.023). This significant inverse association was not observed in the last model adjusted for age, body mass index (kg/m2), waist circumferences (cm), cigarette smoking, frequency of pregnancy, and physical activity (MET/h/d). In crude and adjusted odels, BV odds decreased in the highest tertile of vegetable (adjusted OR, aOR: 0.32, 95% CI 0.16, 0.63, P for trend: 0.001), fish (aOR: 0.46, 95% CI 0.25, 0.84, P for trend: 0.009), legumes (aOR: 0.26, 95% CI 0.14, 0.50, P for trend < 0.001), and meat (aOR: 0.29, 95% CI 0.15, 0.56, P for trend < 0.001) groups. There was no significant association between DTAC and BV odds.

Conclusions
The significant inverse association between the MD adherence and BV odds did not remain after modifying for confounders; besides, DTAC was not associated with BV odds. However, some of the MD components might be associated with a reduced odds of BV.
Factors influencing use of conventional and traditional Korean medicine-based health services: a nationwide cross-sectional study
Authors: Sasaki Yui , Park Jeong-Su , Park Sunju , Cheon Chunhoo , Shin Yong-Cheol , Ko Seong-Gyu , Jang Bo-Hyoung 
Published: June 2022

Abstract
Background
In Korea, conventional medicine (CM) and traditional Korean medicine (KM) are run as a dual healthcare system; however, the backgrounds and characteristics of the users of both medical services have not yet been compared. This study aimed to identify the differences in factors determining the use of CM and KM health services.

Methods
A secondary data analysis of a nationwide cross-sectional survey was conducted in this study. The Survey on the Experience with Healthcare Services 2017 asked participants about their most recent outpatient visit to a health service. Initially, a descriptive analysis was performed on respondents who visited the CM or KM health service in the last 12 months. Then, logistic regression analysis using Andersen’s behavioral model was performed, to identify the factors affecting health service selection, by classifying demographic variables into predisposing, enabling, and need factors. Respondents who replied they did not frequently use CM/KM and those with missing data were excluded.

Results
Of the total 11,098 respondents, 7,116 (64.1%) reported to have used CM/KM: 2,034 (18.3%), 4,475 (40.3%), and 607 (5.5%) for hospital CM, clinic CM, and KM, respectively. In logistic regression analysis, of the 2,723 (24.5%) respondents analyzed, 822 (7.4%) went to a hospital, 1,689 (15.2%) to a clinic, and 212 (1.9%) opted for KM service. Respondents with a higher number of chronic diseases were less likely to use KM (one disease, odds ratio: 0.52, 95% confidence interval: 0.36–0.76; two diseases: 0.51, 0.31–0.85; three to five diseases: 0.26, 0.10–0.69). Respondents with a high income were likely to go to the hospital (4Q vs. 1Q: 1.92, 1.35–2.72) and less likely to go to the clinic (4Q vs. 1Q: 0.49, 0.35–0.68).

Conclusions
Significant differences were observed on the enabling factor (income) for CM and need factors (number of chronic diseases) for KM. Our analysis suggests that through the healthcare policy, we should consider stratifying user backgrounds and needs for each medical service.
Core competencies for a biomedical laboratory scientist – a Delphi study
Authors: Stollenwerk Maria M. , Gustafsson Anna , Edgren Gudrun , Gudmundsson Petri , Lindqvist Magnus , Eriksson Tommy 
Published: June 2022

Abstract
Background
After completing university education, biomedical laboratory scientists work in clinical laboratories, in biomedical research laboratories, in biotech, and in pharmaceutical companies. Laboratory diagnostics have undergone rapid development over the recent years, with the pace showing no signs of abatement. This rapid development challenges the competence of the staff and will most certainly influence the education of future staff. This study aimed to examine what was considered the necessary competencies needed to pursue a career as a biomedical laboratory scientist.

Methods
A modified Delphi technique was used, with the panel of experts expressing their views in a series of three questionnaire. Consensus was defined as the point which 75 % or more of the panel participants agreed that a particular competency was necessary.

Results
The study highlights the perceived importance of mostly generic competencies that relate to quality, quality assurance, and accuracy, as well as different aspects of safety, respect, trustworthiness (towards patients/clients and colleagues), and communication skills. The results also stress the significance of self-awareness and professionality.

Conclusions
We identified important competencies for biomedical laboratory scientists. Together with complementary information from other sources, i.e., guidelines, laws, and scientific publications, the competencies identified can be used as learning outcomes in a competency-based education to provide students with all the competencies needed to work as professional biomedical laboratory scientists.
On the role of deep learning model complexity in adversarial robustness for medical images
Authors: Rodriguez David , Nayak Tapsya , Chen Yidong , Krishnan Ram , Huang Yufei 
Published: June 2022

Abstract
Background
Deep learning (DL) models are highly vulnerable to adversarial attacks for medical image classification. An adversary could modify the input data in imperceptible ways such that a model could be tricked to predict, say, an image that actually exhibits malignant tumor to a prediction that it is benign. However, adversarial robustness of DL models for medical images is not adequately studied. DL in medicine is inundated with models of various complexity—particularly, very large models. In this work, we investigate the role of model complexity in adversarial settings.

Results
Consider a set of DL models that exhibit similar performances for a given task. These models are trained in the usual manner but are not trained to defend against adversarial attacks. We demonstrate that, among those models, simpler models of reduced complexity show a greater level of robustness against adversarial attacks than larger models that often tend to be used in medical applications. On the other hand, we also show that once those models undergo adversarial training, the adversarial trained medical image DL models exhibit a greater degree of robustness than the standard trained models for all model complexities.

Conclusion
The above result has a significant practical relevance. When medical practitioners lack the expertise or resources to defend against adversarial attacks, we recommend that they select the smallest of the models that exhibit adequate performance. Such a model would be naturally more robust to adversarial attacks than the larger models.
Patient safety culture as perceived by operating room professionals: a mixed-methods study
Authors: Aouicha Wiem , Tlili Mohamed Ayoub , Sahli Jihene , Mtiraoui Ali , Ajmi Thouraya , Said Latiri Houyem , Chelbi Souad , Ben Rejeb Mohamed , Mallouli Manel 
Published: June 2022

Abstract
Background
Routine assessments of patient safety culture within hospitals have been widely recommended to improve patient safety. Experts suggested that mixed-methods studies can help gain a deeper understanding of the concept. However, studies combining quantitative and qualitative approaches exploring patient safety culture are still lacking. This study aimed to explore patient safety culture as perceived by operating room professionals of two university hospitals in Sousse, Tunisia.

Methods
Based on a mixed-methods approach, a cross-sectional survey followed by semi-structured interviews were conducted over a period of two months (December 2019 to January 2020). This study took place in all the operating rooms of two public university hospitals in the district of Sousse, Tunisia. To collect data for this survey, the French version of the Hospital Survey On Patient Safety Culture was used. For interviews, 13 participants were selected purposively using a critical case sampling approach and a topic guide was prepared. Anonymity and confidentiality were respected.

Results
Overall, twelve operating rooms, with different surgical specialties, were included in the study. Survey feedback was provided by 297 professionals representing a response rate of 85.6%. Concerning patient safety culture, the 10 dimensions had low scores (below 50%) and were considered “to be improved”. The highest score was found in ‘teamwork within units’ (45%). Whereas, the lowest scores were allocated to ‘non-punitive response to error’ (22.9%), followed by “frequency of adverse event reported” (25.6%) and “communication openness” (26.3%). Per qualitative data, participants provided a more detailed picture of patient safety issues such as underreporting, absence of an effective reporting system, lack of freedom of expression, and an existing blame culture in operating rooms.

Conclusions
The findings of this study showed a concerning perception held by participants about the lack of a patient safety culture in their operating rooms. It seems essential to design, implement and evaluate strategies that promote a positive patient safety culture and obliterate punitive climate in operating rooms.
Is living in a household with children associated with SARS-CoV-2 seropositivity in adults? Results from the Swiss national seroprevalence study Corona Immunitas
Authors: Blankenberger Jacob , Kaufmann Marco , Albanese Emiliano , Amati Rebecca , Anker Daniela , Camerini Anne-Linda , Chocano-Bedoya Patricia , Cullati Stéphane , Cusini Alexia , Fehr Jan , Harju Erika , Kohler Philipp , Kriemler Susi , Michel Gisela , Rodondi Nicolas , Rodondi Pierre-Yves , Speierer Alexandre , Tancredi Stefano , Puhan Milo A. , Kahlert Christian R. ,   on behalf of the Corona Immunitas Research Group
Published: June 2022

Abstract
Background
We aimed to determine whether living in a household with children is associated with SARS-CoV-2 seropositivity in adults and investigated interacting factors that may influence this association.

Methods
SARS-CoV-2 serology testing was performed in randomly selected individuals from the general population between end of October 2020 and February 2021 in 11 cantons in Switzerland. Data on sociodemographic and household characteristics, employment status, and health-related history was collected using questionnaires. Multivariable logistic regression was used to examine the association of living with children <18 years of age (number, age group) and SARS-CoV-2 seropositivity. Further, we assessed the influence of reported non-household contacts, employment status, and gender.

Results
Of 2393 working age participants (18–64 years), 413 (17.2%) were seropositive. Our results suggest that living with children and SARS-CoV-2 seropositivity are likely to be associated (unadjusted odds ratio (OR) 1.22, 95% confidence interval [0.98–1.52], adjusted OR 1.25 [0.99–1.58]). A pattern of a positive association was also found for subgroups of children aged 0–11 years (OR 1.21 [0.90–1.60]) and 12–17 years (OR 1.14 [0.78–1.64]). Odds of seropositivity were higher with more children (OR 1.14 per additional child [1.02–1.27]). Men had higher risk of SARS-CoV-2 infection when living with children than women (interaction: OR 1.74 [1.10–2.76]).

Conclusions
In adults from the general population living with children seems associated with SARS-CoV-2 seropositivity. However, child-related infection risk is not the same for every subgroup and depends on factors like gender. Further factors determining child-related infection risk need to be identified and causal links investigated.

Trial registration
https://www.isrctn.com/ISRCTN18181860
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Myeloid DNA methyltransferase3b deficiency aggravates pulmonary fibrosis by enhancing profibrotic macrophage activation
Authors: Qin Wanhai , Spek C. Arnold , Scicluna Brendon P. , van der Poll Tom , Duitman JanWillem 
Published: June 2022

Abstract
Background
Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive and severe disease characterized by excessive matrix deposition in the lungs. Macrophages play crucial roles in maintaining lung homeostasis but are also central in the pathogenesis of lung diseases like pulmonary fibrosis. Especially, macrophage polarization/activation seems to play a crucial role in pathology and epigenetic reprograming is well-known to regulate macrophage polarization. DNA methylation alterations in IPF lungs have been well documented, but the role of DNA methylation in specific cell types, especially macrophages, is poorly defined.

Methods
In order to determine the role of DNA methylation in macrophages during pulmonary fibrosis, we subjected macrophage specific DNA methyltransferase (DNMT)3B, which mediates the de novo DNA methylation, deficient mice to the bleomycin-induced pulmonary fibrosis model. Macrophage polarization and fibrotic parameters were evaluated at 21 days after bleomycin administration. Dnmt3b knockout and wild type bone marrow-derived macrophages were stimulated with either interleukin (IL)4 or transforming growth factor beta 1 (TGFB1) in vitro, after which profibrotic gene expression and DNA methylation at the Arg1 promotor were determined.

Results
We show that DNMT3B deficiency promotes alternative macrophage polarization induced by IL4 and TGFB1 in vitro and also enhances profibrotic macrophage polarization in the alveolar space during pulmonary fibrosis in vivo. Moreover, myeloid specific deletion of DNMT3B promoted the development of experimental pulmonary fibrosis.

Conclusions
In summary, these data suggest that myeloid DNMT3B represses fibrotic macrophage polarization and protects against bleomycin induced pulmonary fibrosis.
How frequently should “living” guidelines be updated? Insights from the Australian Living Stroke Guidelines
Authors: Turner Tari , McDonald Steve , Wiles Louise , English Coralie , Hill Kelvin 
Published: June 2022

Abstract
Background
“Living guidelines” are guidelines which are continually kept up to date as new evidence emerges. Living guideline methods are evolving. The aim of this study was to determine how frequently searches for new evidence should be undertaken for the Australian Living Stroke Guidelines.

Methods
Members of the Living Stroke Guidelines Development Group were invited to complete an online survey. Participants nominated one or more recommendation topics from the Living Stroke Guidelines with which they had been involved and answered questions about that topic, assessing whether it met criteria for living evidence synthesis, and how frequently searches for new evidence should be undertaken and why. For each topic we also determined how many studies had been assessed and included, and whether recommendations had been changed.

Results
Fifty-seven assessments were received from 33 respondents, covering half of the 88 guideline topic areas. Nearly all assessments (49, 86%) were that the continual updating process should be maintained. Only three assessments (5%) deemed that searches should be conducted monthly; 3-monthly (14, 25%), 6-monthly (13, 23%) and yearly (17, 30%) searches were far more frequently recommended. Rarely (9, 16%) were topics deemed to meet all three criteria for living review. The vast majority of assessments (45, 79%) deemed the topic a priority for decision-making. Nearly half indicated that there was uncertainty in the available evidence or that new evidence was likely to be available soon.
Since 2017, all but four of the assessed topic areas have had additional studies included in the evidence summary. For eight topics, there have been changes in recommendations, and revisions are underway for an additional six topics.
Clinical importance was the most common reason given for why continual evidence surveillance should be undertaken. Workload for reviewers was a concern, particularly for topics where there is a steady flow of publication of small trials.

Conclusions
Our study found that participants felt that the vast majority of topics assessed in the Living Stroke Guidelines should be continually updated. However, only a fifth of topic areas were assessed as conclusively meeting all three criteria for living review, and the definition of “continual” differed widely. This work has informed decisions about search frequency for the Living Stroke Guidelines and form the basis of further research on methods for frequent updating of guidelines.