bluuebunny/crossref_metadata_2025_split huggingface dataset:
An evaluation of the effectiveness, facilitators and barriers of HIV Teen Clubs in achieving successful transition from teen to adult care in Blantyre, Malawi using the RE‐AIM Framework.
Authors: Galagade Jerome , Mwapasa Victor 
Published: October 2020

Abstract
Background: High attrition is a major problem for Adolescent Living with HIV (ALHIV) transitioning from pediatric to adult care. Although the HIV Teen Club model has been shown to promote antiretroviral (ARV) adherence and viral suppression among ALHIV, its effect on promoting transitioning ALHIV from pediatric to adult care has not been formally evaluated. We sought to estimate the proportion of ALHIV enrolled in HIV Teen Clubs who successfully transitioned to adult care within six months of the expected transition time and assess health facilities’ fidelity in implementing HIV Teen Clubs’ adult care transition protocols and factors associated with successful transition to adult Care.Methods: From September 2018 to June 2019, we conducted a retrospective descriptive cohort study involving ALHIV attending HIV Teen Clubs in 14 primary health facilities in Blantyre, Malawi who had reached the recommended transition age of 18/19 years between July - December 2017. After obtaining consent, we reviewed their records to assess the proportion who successfully transitioned and also factors associated with transitioning. Checklist was used to ascertain fidelity of implementation of HIV Teen Club transition protocols. In-depth interviews were conducted with service providers (SP) in health facilities providing HIV Teen Club to get their perspectives on reasons for successful or unsuccessful transition.Results: Of the 131 eligible ALHIV enrolled in the study, only 6.9% (n=9) successfully transitioned to adult care within six months of the expected transition time. The overall fidelity in implementing adult care transition protocols in health facilities was medium. There was an association between implementation fidelity and ALHIV successful transition with 2 out of 3 health facilities with high implementation fidelity also successfully transitioning ALHIV into adult care. Successful ALHIV transitioning was associated with urban location of health facilities and ownership of the facilities by NGOs. SPs reported that lack of training in transitioning ALHIV, lack of clear guidelines, inadequate human resource and refusal of ALHIV to transition were some of the health system factors negatively influencing successful transition.Conclusions: Training and mentorship of SP in implementing transitioning protocols and adequately resourcing HIV teen clubs may improve their operations and facilitate successful transitioning.
U-shaped association between serum bilirubin levels and peripheral arterial disease in Chinese males with hypertension
Authors: Shi Yumeng , Hu Lihua , Li Minghui , Huang Xiao , Ding Congcong , Zhou Wei , Wang Tao , Zhu Lin juan , Bao Huihui , Cheng Xiaoshu 
Published: October 2020

Abstract
Background: Previous studies have indicated that serum total bilirubin might play an important role in peripheral artery disease (PAD). However, the effects of different levels of serum total bilirubin (TBiL) on PAD development remain uncertain, and there are limited data in male participants. We aimed to examine the prevalence of PAD and TBiL among Chinese male adults with hypertension.Methods: A total of 5129 hypertensive male subjects aged 27-93 years were included in the current study. The outcome was peripheral arterial disease (PAD), defined as present when the ABI of either side was ≤ 0.90.Results: Of 5129 hypertensive male participants, 194 (3.78%) had PAD, and the mean serum total bilirubin was 15.67 (7.76) μmol/L. Compared to participants in Q2-Q3 of LgTBiL, there was a significantly increased prevalence of PAD for participants in both Q1 (OR, 1.49; 95% CI: 1.04-2.14) and Q4 (OR, 1.70; 95% CI: 1.16-2.48). After adjusting for potential confounders, a nonlinear U-shaped relationship was detected between TBiL and the prevalence of PAD, and the inflection point was calculated to be 1.08 (LgTBiL = 1.08, TBiL = 12.02 μmol/L). The ORs (95% CIs) were 0.11 (0.02, 0.83) on the left side of the inflection point and 5.26 (1.59, 17.38) on the right side of the inflection point. Similar results were found in various subgroups.Conclusions: This cross-sectional study showed that there was a U-shaped curve for the prevalence of PAD with TBiL concentration in Chinese males with hypertension, with a turning point at 12.02 μmol/L.
Correlation of Next-Generation Sequencing Based Genotypic Profiles with MICM Characteristics in NPM1 Mutated Acute Myeloid Leukemia
Authors: Wang Biao , Yang Bin , Wu Wei , Liu Xuan , Li Haiqian 
Published: October 2020

Abstract
The purpose of this study was to analyze association between next-generation sequencing (NGS) genomic profile and conventional MICM characteristics in patients with acute myeloid leukemia (AML) with NPM1 mutation (NPM1mut). We selected 238 NPM1mut patients with available NGS information on 112 genes related to blood diseases, using χ2 and Mann-Whitney U test to analyze the distribution correlation between genomic alterations and MICM parameters. Compared with NPM1mut/FLT3-ITD(−), the NPM1mut/FLT3-ITD(+) group presented a slightly common M5 [78/143 (54.5%) vs. 64/95 (67.4%); P=0.048], more higher CD34 and CD7 expression rates (CD34: 20.6% vs. 47.9%, P<0.001; CD7: 29.9% vs. 61.5%, P<0.001), and lack of favorable- and adverse-risk karyotypes (6.4% vs. 0%; P=0.031). In entire NPM1mut cohort, totaling 240 NPM1 mutation events were identified, of whom 10 (10/240, 4.2%) were missense types. When confining analysis to the 205 cases with NPM1mut insertions/deletions type and normal karyotype, multivariable logistic analysis showed that FLT3-ITD was positively correlated with CD34 and CD7 expression (HR=5.29 [95% CI 2.64-10.60], P<0.001; HR=3.47 [95% CI 1.79-6.73], P<0.001; respectively). Ras-pathway mutation was positively correlated with HLA-DR expression (HR=4.05 [95% CI 1.70-9.63], P=0.002), and KRAS mutation negatively with MPO expression (HR=0.18 [95% CI 0.05-0.62], P=0.007). DNMT3A-R882 was positively correlated with CD7 and HLA-DR expression (HR=3.59 [95% CI 1.80-7.16], P<0.001; HR=13.41 [95% CI 4.56-39.45], P<0.001; respectively). DNMT3A mutation was negatively correlated with MPO expression (HR=0.35 [95% CI 1.48-8.38], P=0.004). TET2/IDH1 mutations were negatively correlated with CD34 and CD7 expression (HR=0.26 [95% CI 0.11-0.62], P=0.002; HR=0.30 [95% CI 0.14-0.62], P=0.001; respectively), and positively with MPO expression (HR=3.52 [95% CI 1.48-8.38], P=0.004). NPM1mut co-existing mutations in signaling pathways (FLT3-ITD and Ras-pathway) and methylation modifiers (DNMT3A and TET2/IDH1) are linked with the expression of CD34, CD7, HLA-DR and MPO, thereby providing a mechanism explanation for the immunophenotypic heterogeneity of this AML entity.
rTMS modulates precuneus-hippocampal subregion circuit in subjective cognitive decline&nbsp;
Authors: Chen Jiu , Hu Guanjie , Xue Chen , Qi Wenzhang , Xu Wenwen , Chen Shanshan , Rao Jiang , Liu Wan , Zhang Fuquan , Zhang Xiangrong 
Published: October 2020

Abstract
Background: To identify whether repetitive transcranial magnetic stimulation (rTMS) could ameliorate the HIPsub network connectivity by modulating one node of hippocampal subregions (HIPsub) network in subjective cognitive decline (SCD) subjects.Methods: In the first cohort, we analyzed three HIPsub (HIPe, HIPc, and HIPp) functional connectivity to identify HIPsub network connectivity alterations that relate to SCD. And we further applied a SVM approach using the alterations to identify how well this could distinguish SCD from CN. In the second cohort, rTMS with 5-day of once-daily for 2 weeks was used to modulate the altered HIPsub network connectivity in a sham-controlled design.Results: SCD subjects showed differently altered patterns of HIPsub network connectivity compared to controls. The SVM classifier showed that the abnormalities had a high power to discriminate SCD from CN, with an ACC of 86.0%, an AUC of 92.9%, 83.8% sensitivity, and 89.1% specificity. Restoration of HIPc connectivity with left parahippocampa gyrus and HIPp connectivity with left middle temporal gyrus corresponded to amelioration of episodic memory in SCD patients after 2 weeks of rTMS. Conclusion: rTMS can restore the posterior hippocampus connectivity by modulating the precuneus in SCD subjects. Correction of breakdown in HIPc and HIPp related to cognitive and perceptual processing can simultaneously ameliorate episodic memory in SCD subjects.
Accurate and Objective Determination of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Disease Severity with a Wearable Sensor
Authors: Palombo Turner , Campos Andrea , Vernon Suzanne D. , Roundy Shad 
Published: October 2020

Abstract
Background Approximately 2.5 million people in the U.S. suffer from myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). This disease negatively impacts patients’ ability to function, often resulting in difficulty maintaining employment, sustaining financial independence, engaging socially with others, and in particularly severe cases, consistently and adequately performing activities of daily living. The focus of this research was to develop a sensor-based method to measure upright activity defined as time with feet on the floor and referred to as UpTime, as an indicator of ME/CFS disease severity. Methods A commercially available inertial measurement unit (IMU), the Shimmer, was selected for this research. A Kalman filter was used to convert IMU data collected by the Shimmer to angle estimates. Angle estimate accuracy was confirmed by comparison to a motion capture system. Leg angle estimates were then converted to personalized daily UpTime scores using a critical angle of 39º from vertical to differentiate between upright (feet on the floor) and not upright. A six-day, case-control study with 15 subjects (five healthy controls, five moderate-level ME/CFS, and five severe-level ME/CFS) was conducted to determine the utility of UpTime for assessing disease severity. Results UpTime was found to be a significant measure of ME/CFS disease severity. Severely ill ME/CFS patients spend less than 20% of each day with feet on the floor. Moderately ill ME/CFS patients spend between 20-30% of each day with feet on the floor. Healthy controls have greater than 30% UpTime. IMU-measured UpTime was more precise than self-reported hours of upright activity which were over-estimated by patients. Conclusions UpTime is an accurate and objective measure of upright activity, a measure that can be used to assess disease severity in ME/CFS patients. Due to its ability to accurately monitor upright activity, UpTime can also be used as a reliable endpoint for evaluating ME/CFS treatment efficacy. Future studies with larger samples and extended data collection periods are required to fully confirm the use of UpTime as a measure of disease severity in ME/CFS. With the added perspective of large-scale studies, this sensor-based platform could provide a recovery path for individuals struggling with ME/CFS.
Scale Validation for the identification of falsified hand sanitizer: Public and Regulatory Authorities Perspectives from United Arab Emirates
Authors: Jairoun Ammar Abdulrahman , Al-Hemyari Sabaa Saleh , Shahwan Moyad , El-Dahiyat Faris , Jamshed SHAZIA 
Published: October 2020

Abstract
Background: Since the time of declaration of global pandemic of COVID-19 by World Health Organization (WHO), falsified hand sanitizers surfaced regularly in markets, posing possible harm to public due to unlisted inclusion of methanol. The current research is an attempt to develop and validate a tool to document falsified hand sanitizer in the UAE community.Method: A descriptive cross-sectional community-based study was conducted among 1280 randomly selected participants. Respondents were sent a web-based electronic link to the survey via email. Content validity, factor analyses and known group validity were used to develop and validate a new scale to identify falsified hand sanitizer. Test-retest reliability, internal consistency, item internal consistency (IIC), and intraclass correlation coefficients (ICCs) were used to assess the reliability of the scale. SPSS version 24 was used to conduct data analysis.Results: A total of 1280 participants were enrolled in the study. The content validity index (CVI) was 0.83 with the final scale of 12 items. The Kaiser-Meyer-Olkin (KMO) value was 0.788, with the Bartlett test of sphericity achieving statistical significance (p <0.001). Our factor analysis revealed a 3-component model. The 3-factor solution was confirmed by PCFA analysis and had associations with good fit values. The PCFA for NFI was 0.970, CFI 0.978, and TLI 0.967. All values were in excess of 0.95, with RMSEA values below 0.06 at 0.03; all of these values indicated a good model fit. The Cronbach's alpha was good overall (0.867). All factors had a Cronbach's alpha value in excess of 0.70. The instrument demonstrated that every item met the IIC correlation standard ≥ 0.40. The scale displayed good overall ICC statistics of 0.867 (95% CI 0.856 - 0.877) with statistical significance (p < 0.001). The scale's test-retest reliability was assessed through correlation of the falsified hand sanitizer identification score of respondents at the two time points. The test-retest correlation coefficient was 0.770 (p value <0.01). Participants with post-graduate education were more likely to identify the falsified hand sanitizer compared to those with high school education. (p < 0.001).Conclusions: This study developed and validated a new scale for the measurement of falsified hand sanitizer. This is expected to improve and promote collaboration between the health regulators and the public and hereby encourage customer satisfaction and participation.
Costs and healthcare utilisation of patients with heart failure in Spain
Authors: Escobar Carlos , Varela Luis , Palacios Beatriz , Capel Margarita , Sicras Antoni , Sicras Aram , Hormigo Antonio , Alcazar Roberto , Manito Nicolas , Botana Manuel 
Published: October 2020

Abstract
Background: Increasing the knowledge about heart failure (HF) costs and their determinants is important to ascertain how HF management can be optimized, leading to a significant decrease of HF costs. This study evaluated the cumulative costs and healthcare utilisation in HF patients in Spain. Methods: Observational, retrospective, population-based study using BIG-PAC database, which included data from specialized and primary care of people ≥18 years, from seven autonomous communities in Spain, who received care for HF between 2015 and 2019. The healthcare and medication costs were summarized on a yearly basis starting from the index date (1st January 2015), and then cumulatively until 2019.Results: We identified 17,163 patients with HF (year 2015: mean age 77.3±11.8 years, 53.5% men, 51.7% systolic HF, 43.6% on NYHA functional class II). During the 2015-2019 period, total HF associated costs reached 15,373 Euros per person, being cardiovascular disease hospitalizations the most important determinant (75.8%), particularly HF hospitalizations (51.0%). Total medication cost accounted for 7.0% of the total cost. During this period, there was a progressive decrease of cardiovascular disease hospital costs per year (from 2,834 Euros in 2015 to 2,146 Euros in 2019, P<0.001), as well as cardiovascular and diabetic medication costs. Conclusions: During the 2015-2019 period, costs of HF patients in Spain were substantial, being HF hospitalizations the most important determinant. Medication costs represented only a small proportion of total costs. Improving HF management, particularly through the use of drugs that reduce HF hospitalization may be helpful to reduce HF burden.
Agnostic Evaluation of Ipilimumab and Nivolumab Association: a Metanalysis.
Authors: Marchetti Paolo , Botticelli Andrea , Ascierto Antonio Paolo , Curigliano Giuseppe , Giannarelli Diana 
Published: October 2020

Abstract
Background. Ipilimumab and Nivolumab, targeting the molecules CTLA-4, PD-1, respectively,have shown efficacy against several types of cancer. Despite these results, only a small percentage of patients maintains a long-lasting effect. Even Ipilimumab, in combination with nivolumab, has demonstrated a significant clinical benefit in multiple tumor types. However, no trial has been designed with the primary endpoint to compare the efficacy of nivolumab plus ipilimumab combined, compared to nivolumab alone. Hence, the added value of ipilimumab in the combination has not clearly been established yet. The aim of this study was to demonstrate the superiority of the combination strategy compared to the single agent therapy.Materials and methods. We performed a meta-analysis of Phase I-II-III Clinical Trials, published from 2010 up to 2020, in which the combination of ipilimumab plus nivolumab was compared to nivolumab alone. We extracted ORR, OS and PFS HR on the basis of treatment from the subgroup analysis of each trial. Results. A total of 7 trials were included in the present meta-analysis. Overall, 1313 patients were treated with the nivolumab plus ipilimumab combination compared to 1110 patients treated with nivolumabalone. All trials reported the Objective response rate(ORR), no heterogeneity was found among studies and the pooled Odds Ratio was highly in favor of the nivolumab plus ipilimumab combination with respect to nivolumab alone (1.683; 95% CI: 1.407-2.012; P<0.0001). Three studies were considered for Progression free survival (PFS) analysis, and the pooled Hazard Ratio favored the combination of nivolumab plus ipilimumab with respect to nivolumab alone (0.807; 95% CI: 0.719-0.907; P<0.0001). The Overall survival(OS) endpoint was considered only in 2 trials, and the pooled HR favored, also in this case, the combination of nivolumab plus ipilimumab with respect to nivolumab alone (0.87; 95% CI: 0.763-0.997; P=0.045).Conclusions. The combination of ipilimumab plus nivolumab seems to be superior to nivolumab alone in cancer patients, regardless of histology.
Association between electronic cigarette use and tobacco cigarette smoking initiation in adolescents: A systematic review and meta-analysis
Authors: O'Brien Doireann , Long Jean , Quigley Joan , Lee Caitriona , McCarthy Anne , Kavanagh Paul 
Published: October 2020

Abstract
Aim: This systematic review of longitudinal cohort studies aimed to explore whether electronic cigarette (e-cigarette) use by adolescents who had never smoked conventional tobacco cigarettes (tobacco cigarettes) at baseline was associated with subsequent initiation of tobacco cigarette smoking. The analysis included studies based in Europe and North America. Methods: This study followed all the principles of a systematic review and meta-analysis. A key word search identified peer-reviewed literature published between 1 January 2005 and 2 October 2019 from seven bibliographic databases and one search engine. Using a predefined inclusion/exclusion criteria two authors independently screened abstracts, and subsequently, full text papers. Eligible papers were quality assessed and scored by two authors. Included papers had data on population characteristics, exposure and outcome measures extracted into an adapted Cochrane Data Extraction Form. Statistical analysis was preceded by a feasibility assessment, and included a pairwise random effects meta-analysis, and sensitivity and subgroup analyses. Findings: From an initial 6,619 studies, 14 unique studies in 21 papers were identified. Overall, the studies populations were between 13 and 19 years at baseline. Nine of the 14 unique longitudinal studies with follow-up periods between 4 and 24 months were eligible for inclusion in a meta-analysis of the association between ever use of e-cigarettes and subsequent initiation of tobacco cigarette use. Based on primary study adjusted odds ratios, our meta-analysis calculated a 4.06 (95% confidence interval (CI): 3.00-5.48) times higher odds of initiating tobacco cigarette smoking for those who had ever used e-cigarettes at baseline, although the odds ratio was reduced slightly (to 3.71 times odds, 95%CI: 2.83-4. 86) when only the four high-quality studies were included. The initial meta-analysis model had a moderate to high statistical heterogeneity, sensitivity analysis restricted to high-quality studies had a low to moderate statistical heterogeneity.Conclusion: The systematic review found that e-cigarette use was associated with initiation of tobacco cigarette smoking among adolescents in Europe and North America, identifying a potentially serious public health harm. Given the widespread availability and use of e-cigarettes, this study further supports urgent action by policymakers to prevent their use by adolescents to reduce direct harms in this vulnerable population group, as well as to protect gains in reducing tobacco cigarette initiation.
Higher expression of monocyte chemotactic protein 1 in mild COVID-19 patients may be correlated with the inhibition of IFN signaling
Authors: Xi Xueyan , Guo Yang , Zhu Min , Wei Yuhui , Li Gang , Du Boyu , Wang Yunfu 
Published: October 2020

Abstract
Background: The level of chemokines was markedly elevated in severe COVID-19 patients. But the role of chemokines in mild COVID-19 has not yet been established. However, most of the COVID-19 patients in Shiyan City, China, had mild cases. The purpose of this study is to evaluate the level of chemokines in mild COVID-19 patients and explore the correlation between chemokines and host immune response.Methods: In this study, the level of chemokines in the serum for COVID-19 patients in Shiyan City was detected by ELISA. The expression of chemokine receptors and other signal molecules was measured by real-time PCR.Results: We first demonstrated that COVID-19 patients are characterized by higher level of chemokines. Meanwhile, monocyte chemotactic protein 1 (MCP-1) has also shown higher expression in patients with mild cases of COVID-19. The receptor of MCP-1, CCR2, was also found to be expressed at higher level in the same mild COVID-19 patients. Finally, we found the downregulation of interferon regulatory factor 3 (IRF3) was significantly negative correlated with the concentration of MCP-1 in mild COVID-19 patients.Conclusion: Higher expression of MCP-1 in mild COVID-19 patients may be correlated with the inhibition of IFN signaling. The finding adds our understanding to the immune-pathologic mechanisms of SARS-CoV-2 infection, and provides potential therapeutic targets and strategies.