bluuebunny/crossref_metadata_2025_split huggingface dataset:
Change in timing of induction protocol in nulliparous women to optimise timing of birth: results from a single centre study
Authors: Slade Laura , Digance Georgina , Bradley Angela , Woodman Richard , Grivell Rosalie 
Published: April 2022

Abstract
Background
Induction of labour (IOL) is a common obstetric intervention. When planning IOL, especially in women at risk for complications at delivery, the aim should be for delivery to occur when senior staff are available to optimise safe care.

Methods
A change in timing of IOL protocol at our institution was introduced in November 2018 aiming to increase births occurring “in-hours” defined as 08:00 to 20:00 h. This retrospective cohort study compares the odds of “in-hours” birth before and after the intervention and the association on birth outcomes. The study compared outcomes during the new IOL pathway period to a historical birth cohort from January to December 2017. Inclusion criteria were nulliparous women undergoing planned IOL at term with a cephalic singleton pregnancy. Logistic regression was used to compare odds of in-hours birth for the 2 periods with adjustment for maternal age at delivery, gestation, more than 2 cervical ripening agents required, undergoing IOL for post-dates pregnancy, mode of birth, whether or not IOL proceeded according to planned protocol and missing values using multiple imputation.

Results
The rate of deliveries occurring in-hours were higher following the intervention; n = 118/285 (45.6%) pre-intervention versus n = 251/470 (53.4%) post-intervention; adjusted OR = 1.47, 95% CI = 1.07–2.01, p = 0.02). The percentage of caesarean sections (CS) occurring in-hours was significantly lower in the pre-intervention group n = 71/153 (28.3%) compared with the post intervention group = 35/132(46.4%) (p < 0.001)). The rate of CS was higher in the pre intervention n = 132/285(46.3%) compared with the post intervention group n = 153/470 (32.4%)).

Conclusions
The change in induction procedures was associated with a significantly higher rate of births occurring in-hours and a lower rate of overall of CS. This policy change led to a better pattern of timing of birth for nulliparous women undergoing IOL.
Novel pathological predictive factors for extranodal extension in oral squamous cell carcinoma: a retrospective cohort study based on tumor budding, desmoplastic reaction, tumor-infiltrating lymphocytes, and depth of invasion
Authors: Noda Yuri , Ishida Mitsuaki , Ueno Yasuhiro , Fujisawa Takuo , Iwai Hiroshi , Tsuta Koji 
Published: April 2022

AbstractBackgroundExtranodal extension (ENE) is a poor prognostic factor for oral squamous cell carcinoma (OSCC). Identifying ENE by clinical and/or radiological examination is difficult, thereby leading to unnecessary neck dissections. Currently, no definitive predictors are available for ENE. Thus, we aimed to determine the histological predictors of ENE by routine histopathological examination using biopsy and surgically resected specimens.MethodsThis retrospective study included 186 surgically resected OSCC and 83 matched biopsy specimens. Clinical features associated with the tumor microenvironment, including desmoplastic reaction (DR), tumor budding (TB), and tumor-infiltrating lymphocytes (TILs), were evaluated using hematoxylin and eosin-stained primary OSCC and neck dissection specimens. These histological features were divided into two groups: DR-immature (DR-I) and DR-mature (DR-M); TB-high (TB-H) and TB-low (TB-L); and TILs-low (TILs-L) and TILs-high (TILs-H). Clinical depth of invasion (cDOI) and pathological DOI (pDOI) were adapted for biopsies and resections, respectively; DOI was evaluated as DOI > 10 mm and DOI ≤ 10 mm. The clinicopathological relationships between these histopathological features and ENE and the independent risk factors for ENE were analyzed. The histological predictors of ENE were evaluated.ResultsThe histological status of DR, TILs, and TB present in biopsy and resection specimens showed high accuracy with that of ENE. DR-I, TILs-L, and TB-H were significantly associated with lymph node metastasis, cDOI, and pDOI. Bivariate and multivariate analyses revealed that TB-H and pDOI > 10 mm in resections were independent factors for the presence of ENE (ENE +). The combination of TB-H/pDOI > 10 mm in resection specimens showed high specificity (91%) and accuracy (83%) regarding ENE + . Although there proved to be no independent factors in biopsies, DR-I and TILs-L were significantly associated with ENE + (p < 0.001). The combination of DR-I/TILs-L/cDOI > 10 mm in biopsies exhibited high sensitivity and specificity with ENE + (70% and 77%, respectively,p < 0.001). These histological predictors could detect even minor ENE (< 2 mm).ConclusionsThe tumor microenvironment status in primary OSCC was significantly associated with that of ENE, and TB-H was an independent risk factor for ENE. The histological status of DR-I/TILs-L/cDOI > 10 mm in biopsy specimens and TB-H/pDOI > 10 mm in resection specimens is a useful predictor of ENE.
HOX and PBX gene dysregulation as a therapeutic target in glioblastoma multiforme
Authors: Arunachalam Einthavy , Rogers William , Simpson Guy R. , Möller-Levet Carla , Bolton Gemma , Ismael Mohammed , Smith Christopher , Keegen Karl , Bagwan Izhar , Brend Tim , Short Susan C. , Hong Bangxing , Otani Yoshihiro , Kaur Balveen , Annels Nicola , Morgan Richard , Pandha Hardev 
Published: April 2022

AbstractBackgroundGlioblastoma multiforme (GBM) is the most common high-grade malignant brain tumour in adults and arises from the glial cells in the brain. The prognosis of treated GBM remains very poor with 5-year survival rates of 5%, a figure which has not improved over the last few decades. Currently, there is a modest 14-month overall median survival in patients undergoing maximum safe resection plus adjuvant chemoradiotherapy.HOXgene dysregulation is now a widely recognised feature of many malignancies.MethodsIn this study we have focused onHOXgene dysregulation in GBM as a potential therapeutic target in a disease with high unmet need.ResultsWe show significant dysregulation of these developmentally crucial genes and specifically thatHOXgenes A9, A10, C4 and D9 are strong candidates for biomarkers and treatment targets for GBM and GBM cancer stem cells. We evaluated a next generation therapeutic peptide, HTL-001, capable of targetingHOXgene over-expression in GBM by disrupting the interaction between HOX proteins and their co-factor, PBX. HTL-001 induced both caspase-dependent and –independent apoptosis in GBM cell lines.ConclusionIn vivo biodistribution studies confirmed that the peptide was able to cross the blood brain barrier. Systemic delivery of HTL-001 resulted in improved control of subcutaneous murine and human xenograft tumours and improved survival in a murine orthotopic model.
Promoting exercise behavior and cardiorespiratory fitness among college students based on the motivation theory
Authors: Li Bo , Han Shanshan , Meng Shuqiao , Lee Jaewoo , Cheng Jie , Liu Yang 
Published: April 2022

AbstractBackgroundIn recent years, there has been an increase in the incidence of health problems among college students in China, the lack of adequate physical exercise is the major reason. This study aimed to investigate methods to promote exercise behavior and cardiovascular fitness among college students based on the motivation theory.MethodsCardiovascular fitness levels of 641 college students (20.72 ± 1.41 years old) were measured. Exercise motivation was assessed using the physical exercise motivation scale and physical exercise rating scale. Correlation analysis, regression analysis, and structural equation models were used to assess exercise motivation, exercise behavior, and cardiovascular fitness. Energy relationships were determined to develop a path model that promotes exercise behavior and aerobic fitness among college students.ResultsThe exercise motivation of college students was directly related to cardiovascular fitness (effect value: 0.577) or indirectly related through the mediating effect of exercise behavior (effect value: 0.215). The influence of health motivation on exercise behavior (β = 0.132,p = 0.001) and cardiovascular fitness (β = 0.251,p < 0.001) was greater than that of other factors of motivation.ConclusionsThe physical exercise behavior of college students partially mediates the relationship between exercise motivation and cardiovascular fitness. Therefore, the educational concept of “Health First” should be promoted in college sports. Internal motivation of exercise can be transformed into external motivation to improve students’ exercise behavior and cardiovascular fitness through enhancing their cardiopulmonary capacity.
Medical students’ self-evaluation of character, and method of character education
Authors: Hur Yera , Yeo Sanghee , Lee Keumho 
Published: April 2022

Abstract
Background
As medical doctors must have a strong sense of ethics, character education is particularly important for them compared with other professions. This follow-up study aimed to establish the foundation for developing a character education program in medical schools by (1) conducting a survey among medical students on the self-assessment of one’s character based on eight qualities (service and sacrifice, empathy and communication, care and respect, honesty and humility, responsibility and calling, collaboration and magnanimity, creativity and positivity, patience and leadership), the perceived importance of character, and satisfaction with character education at medical school, and (2) analyzing the usefulness of learning methods for acquiring character elements. It also aimed at verifying the (3) gender differences in self-evaluation of character elements, and (4) academic-year differences in the survey items.

Methods
Medical students’ perceptions were identified through a questionnaire survey among 856 medical students from five South Korean medical schools. The questionnaire comprised items on the achievement level of the character element, importance of character in the medical curriculum, satisfaction with character education in medical schools, and the learning method’s degree of helpfulness. Descriptive statistics, t-test, and one-way ANOVA were used to compare responses.

Results
The importance of eight-character qualities had high average scores, whereas the average scores for satisfaction with character education and achievement level were comparatively low. For the question on each learning method’s helpfulness in gaining the eight-character qualities, the score of team-based learning activities was the highest, followed by club activities, relationships with peers, role modeling of professors, and course study. Regarding satisfaction with character education, male students gave higher scores than female students, manifesting a statistically significant difference. Regarding the importance of the character element in medical education, statistically significant differences existed based on academic year.

Conclusion
Medical students’ perceptions of character education varied according to gender and academic year. They regarded character education highly but were unsatisfied with the current character education at medical schools. Thus, diverse character education curricula must be developed and implemented along with extra-curricular character programs. An effective approach to implementing character education can be discovered by verifying the differences in students’ perceptions based on the character education courses in medical schools.
Efficacy of a blended learning programme in enhancing the communication skill competence and self-efficacy of nursing students in conducting clinical handovers: a randomised controlled trial
Authors: Chung Jessie Yuk Seng , Li William Ho Cheung , Cheung Ankie Tan , Ho Laurie Long Kwan , Chung Joyce Oi Kwan 
Published: April 2022

Abstract
Background
A clinical handover is an essential nursing practice that ensures patient safety. However, most newly graduated nurses struggle to conduct clinical handovers as they lack sufficient communication skill competence and self-efficacy in this practice. This study aimed to examine the efficacy of a blended learning programme on the communication skill competence and self-efficacy of final-year nursing students in conducting clinical handovers.

Methods
A randomised controlled design was used. A convenience sample of 96 final-year baccalaureate nursing students at a local university. Data were collected in 2020. Participants were randomly assigned to either an experimental group (n = 50) that received a blended learning programme with face-to-face training and an online module on handover practice, or a waitlist control group (n = 46) that received only face-to-face handover training during the study period and an online module immediately after the completion of data collection. The primary outcome was the communication skill competence and the secondary outcome was the self-efficacy of the participants in conducting clinical handovers. An analysis of covariance was used to examine the between-subjects effects on self-efficacy and communication skill competence in conducting clinical handovers after controlling for the significantly correlated variables. A paired sample t-test was used to determine the within-subjects effects on self-efficacy.

Results
The participants in the experimental group had significantly higher communication skill competence (p < 0.001) than those in the waitlist control group. Although both groups showed a significant improvement in self-efficacy, the mean scores of the experimental group were higher than those of the waitlist control group (p < 0.001).

Conclusions
This study demonstrated the efficacy of a blended learning approach in improving the communication skill competence and self-efficacy of final-year nursing students in conducting clinical handovers. Nurse educators should incorporate a blended learning approach into the nursing curriculum to optimise the content of training programmes for teaching nursing students in conducting clinical handovers.

Trial registration
The study protocol was registered in the Registration ClinicalTrials.gov (NCT05150067; retrospective registration; date of registration 08/12/2021).
The impact of medical insurance reimbursement on postoperative inflammation reaction in distinct cardiac surgery from a single center
Authors: Jiang Qin , Yu Tao , Huang Keli , Huang Xiaobo , Zhang Qingfeng , Hu Shengshou 
Published: April 2022

Abstract
Background
Evidences shows that socioeconomic status is reversely associated with the risk of morbidity and mortality for people with cardiovascular disease via pro-inflammation mechanism, but the population profile is not deeply defined on. We aimed to investigate the impact of medical insurance coverage on postoperative systemic inflammatory reaction in two kinds of disease populations undergoing distinct cardiac procedures.

Methods
A total of 515 patients receiving open mitral valve procedure with high-total expense from May 2013 through May 2021 in Sichuan Provincial People’s Hospital were retrospectively collected and stratified according to medical insurance reimbursement: low coverage with high out-pocket (< 30%), medium coverage (≤ 60%, but ≥ 30%), and high coverage (> 60%). Another 118 cases undergoing atrium septum defect (ASD) or patent foramen ovale (PFO) occlusion and taking on consistent low-total expense and low-coverage (< 30%) were also classified according to their insured conditions. The postoperative systemic inflammatory response indexes were high sensitivity C-reactive protein (hs-CRP) and the neutrophil–lymphocyte ratio (NLR).

Results
Low insurance reimbursement population undergoing open mitral valve procedure had a higher level of hs-CRP and NLR but not troponin I protein or lactate within 48 h postoperatively, and higher thoracic drainage, longer ventilation use and stay in intensive care unit. No significant difference in inflammatory indexes existed among diverse medical insurance coverage in population undergoing ASD/PFO occlusion.

Conclusions
Higher inflammatory reaction and weaker clinical recovery was associated with lower insurance coverage population undergoing open mitral valve procedure but not ASD/PFO interventional occlusion procedure.
Clinically relevant CHK1 inhibitors abrogate wild-type and Y537S mutant ERα expression and proliferation in luminal primary and metastatic breast cancer cells
Authors: Pescatori Sara , Leone Stefano , Cipolletti Manuela , Bartoloni Stefania , di Masi Alessandra , Acconcia Filippo 
Published: April 2022

Abstract
Background
Challenges exist in the clinical treatment of luminal estrogen receptor α (ERα)-positive breast cancers (BCs) both to prevent resistance to endocrine therapy (ET) and to treat ET-resistant metastatic BCs (MBC). Therefore, we evaluated if kinases could be new targets for the treatment of luminal primary and MBCs.

Methods
~ 170 kinase inhibitors were applied to MCF-7 cells either with adaptative or genetic resistance to ET drugs and both ERα levels and cell proliferation were measured. Robust-Z-score calculation identified AZD7762 (CHK1/CHK2 inhibitor) as a positive hit. Subsequently, Kaplan–Meier analyses of CHK1 and CHK2 impact on ERα-positive BC patients relapse-free-survival (RFS), bioinformatic evaluations of CHK1 and CHK2 expression and activation status as a function of ERα activation status as well as drug sensitivity studies in ERα-positive BC cell lines, validation of the impact of the ATR:CHK1 and ATM:CHK2 pathways on the control of ERα stability and BC cell proliferation via inhibitor- and siRNA-based approaches, identification of the molecular mechanism required for inhibitor-dependent ERα degradation in BC and the impact of CHK1 and CHK2 inhibition on the 17β-estradiol (E2):ERα signaling, synergy proliferation studies between ET-drugs and clinically relevant CHK1 inhibitors in different luminal BC cell lines, were performed.

Results
A reduced CHK1 expression correlates with a longer RFS in women with ERα-positive BCs. Interestingly, women carrying luminal A BC display an extended RFS when expressing low CHK1 levels. Accordingly, CHK1 and ERα activations are correlated in ERα-positive BC cell lines, and the ATR:CHK1 pathway controls ERα stability and cell proliferation in luminal A BC cells. Mechanistically, the generation of DNA replication stress rather than DNA damage induced by ATR:CHK1 pathway inhibition is a prerequisite for ERα degradation. Furthermore, CHK1 inhibition interferes with E2:ERα signaling to cell proliferation, and drugs approved for clinical treatment of primary and MBC (4OH-tamoxifen and the CDK4/CDK6 inhibitors abemaciclib and palbociclib) exert synergic effects with the CHK1 inhibitors in clinical trials for the treatment of solid tumors (AZD7762, MK8776, prexasertib) in preventing the proliferation of cells modeling primary and MBC.

Conclusions
CHK1 could be considered as an appealing novel pharmacological target for the treatment of luminal primary and MBCs.
Impact of COVID-19 lockdown restrictions on cardiac rehabilitation participation and behaviours in the United Kingdom
Authors: Kirwan Richard , Perez de Heredia Fatima , McCullough Deaglan , Butler Tom , Davies Ian G. 
Published: April 2022

Abstract
Background
COVID-19 lockdown measures led to the suspension of centre-based cardiac rehabilitation (CR). We aimed to describe the impact of lockdown on CR behaviours and perceptions of efficacy in a sample of CR participants.

Methods
An online survey was conducted amongst CR participants from May to October 2020, COVID-19-related lockdown restrictions. Anthropometric data, participant-determined levels of motivation and self-perceived efficacy, CR practices etc., pre- and post-lockdown, were collected.

Results
The probability of practicing CR in public gyms and hospitals decreased 15-fold (47.2% pre-, 5.6% post-lockdown; OR[95% CI] 0.065[0.013; 0.318], p < 0.001), and 34-fold (47.2% pre, 2.8% post; OR[95% CI] 0.029[0.004; 0.223], p < 0.001), respectively. Amongst participants, 79.5% indicated that their CR goals had changed and were 78% less likely to engage in CR for socialization after lockdown (47.2% pre, 16.7% post; OR[95% CI] 0.220[0.087; 0.555]; p = 0.002). The probability of receiving in-person supervision decreased by 90% (94.4% pre, 16.7% post; OR[95% CI] 0.011[0.002; 0.056]), while participants were almost 7 times more likely to use online supervision (11.1% pre, 44.4% post; OR[95% CI] 6.824[2.450; 19.002]) (both p < 0.001). Fifty percent indicated that their enjoyment of CR was lower than before lockdown and 27.8% reported they would be less likely to continue with CR in the newer format.

Conclusions
Lockdown was associated with considerable changes in how CR was practiced, motivation levels and willingness to continue with CR. Further research is warranted to develop and improve strategies to implement in times when individuals cannot attend CR in person and not only during pandemics.
The effect of animal versus plant protein on muscle mass, muscle strength, physical performance and sarcopenia in adults: protocol for a systematic review
Authors: Reid-McCann Rachel J. , Brennan Sarah F. , McKinley Michelle C. , McEvoy Claire T. 
Published: April 2022

Abstract
Background
The evidence base for the role of dietary protein in maintaining good muscle health in older age is strong; however, the importance of protein source remains unclear. Plant proteins are generally of lower quality, with a less favourable amino acid profile and reduced bioavailability; therefore, it is possible that their therapeutic effects may be less than that of higher quality animal proteins. This review aims to evaluate the effectiveness of plant and animal protein interventions on muscle health outcomes.

Methods
A robust search strategy was developed to include terms relating to dietary protein with a focus on protein source, for example dairy, meat and soy. These were linked to terms related to muscle health outcomes, for example mass, strength, performance and sarcopenia. Five databases will be searched: MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, Embase and Web of Science. Studies included will be randomised controlled trials with an adult population (≥ 18) living in the community or residential homes for older adults, and only English language articles will be included. Two independent reviewers will assess eligibility of individual studies. The internal validity of included studies will be assessed using Cochrane Risk of Bias 2.0 tool. Results will be synthesised in narrative format. Where applicable, standardised mean differences (SMD) (95% confidence interval [CI]) will be combined using a random-effects meta-analysis, and tests of homogeneity of variance will be calculated.

Discussion
Dietary guidelines recommend a change towards a plant-based diet that is more sustainable for health and for the environment; however, reduction of animal-based foods may impact protein quality in the diet. High-quality protein is important for maintenance of muscle health in older age; therefore, there is a need to understand whether replacement of animal protein with plant protein will make a significant difference in terms of muscle health outcomes. Findings from this review will be informative for sustainable nutritional guidelines, particularly for older adults and for those following vegan or vegetarian diets.

Systematic review registration
PROSPERO CRD420201886582