bluuebunny/crossref_metadata_2025_split huggingface dataset:
Heterogeneity and other problems in a pooled analysis of snus use and mortality
Authors: Rodu Brad , Plurphanswat Nantaporn 
Published: May 2021

A recent analysis of Swedish snus use and mortality combined eight Swedish datasets and found that exclusive Swedish male snus users have statistically significant increased mortality from all causes, cardiovascular diseases and other causes. These findings, from the Swedish Collaboration on Health Effects of Snus Use, are in sharp contrast with previous pooled results from the same group. The discrepant results may be indicative of unresolved statistical problems that haven’t been addressed by the collaboration authors in any of their studies. The most important problem is unresolved heterogeneity among the eight cohorts, which we describe in detail, and we show how the use of the random effects method by the authors was not sufficient. We explain why the tables in the article are uninformative, and we demonstrate why the exclusion of smokers in the analysis was not validated and eliminated important information. Finally, we strongly recommend some straightforward and easily implemented corrective measures.
Risk messages relating to fertility and pregnancy: a media content analysis
Authors: Marshall Olivia , Blaylock Rebecca , Murphy Clare , Sanders Julia 
Published: May 2021

Background:The UK print and online media is an important channel by which scientific research is communicated to the public. Media risk messages relating to pregnancy or fertility contribute to the context of reproductive decision making, but their fidelity to the underlying science has been questioned.Method:We measured the volume, distribution and content of science-based risk headlines relating to pregnancy or fertility in the UK media over four months. We grouped headlines into unique stories and categorised them by exposure and outcome of interest. We selected four unique stories for closer content analysis and assessed their fidelity to the underlying science, with attention to the role of press releases.Results:We identified 171 headlines over four months (average 43 per month), comprising 56 unique stories. The unique stories most commonly concerned maternal risk factors (n=46) and child health outcomes (n=46). Maternal health outcomes were less frequently the focus (n=20). The most common risk factors in the media coverage were maternal food and drink (n=15), maternal medication and medical interventions (n=9), and maternal health factors (n=6). Media reports were largely faithful to press releases. Where substantive deviations from the underlying scientific study were identified, these could mostly be traced back to press releases or quotes from the study’s authors. Press releases often omitted caveats which were reinstated at the media reporting stage, alongside additional expert criticism.Conclusions:Frequent science-based risk messages in the UK media frame mothers as vectors of potential harm to children, who are the focus of health outcomes. Largely, the media does not introduce misinformation, but reports press releases faithfully with additional caveats and expert commentary. Press releases fulfil an interpretative role, often omitting caveats and introducing new elements and advice to women. Their role as a bridge between scientific and lay audiences is discussed.
False-positive drug test results in patients taking psychotropic drugs. A literature review
Authors: Masternak Sebastian , Padała Olga , Karakuła-Juchnowicz Hanna 
Published: May 2021

WstępW literaturze można znaleźć opisy przypadków wskazujące na fałszywie dodatnie wyniki powszechnie wykonywanych testów na obecność substancji psychoaktywnych u osób przyjmujących zalecone przez lekarza leki psychotropowe. Wiarygodność przeprowadzanych testów ma ogromne znaczenie dla badanej osoby, biorąc pod uwagę zarówno aspekty kliniczne, jak i możliwe skutki prawne. Celem pracy był przegląd literatury dotyczącej fałszywie dodatnich wyników testów narkotykowych u pacjentów przyjmujących leki psychotropowe.Materiał i metodyDokonano przeglądu narracyjnego dostępnej literatury w języku angielskim i polskim korzystając z baz MEDLINE/PubMed oraz Google Scholar, używając słów kluczy: fałszywie dodatni wynik testu narkotykowego oraz nazw zarejestrowanych leków z grup: przeciwdepresyjnych, przeciwpsychotycznych, stabilizujących nastrój, a także używanych w leczeniu zespołu hiperkinetycznego. Wzięto pod uwagę artykułu typu przeglądowego, opisy przypadków oraz prace oryginalne z lat 1990-2019.WynikiFałszywie dodatnie wyniki testów narkotykowych odnotowano w przypadku wielu leków używanych w psychiatrii: klomipraminy, amitryptyliny, bupropionu, trazodonu, sertraliny, wenlafaksyny, hydroksyzyny, haloperidolu, sulpirydu, pernazyny, lewomepromazyny, arypiprazolu, rysperydonu, amisulprydu, kwetiapiny, lamotryginy, karbamazepiny, metylofenidatu i atomoksetyny. Dla pozostałych leków branych pod uwagę w pracy nie znaleziono takich doniesień.WnioskiPrzy interpretacji testów narkotykowych z moczu należy zachować ostrożność, szczególnie gdy badana osoba wyraźnie zaprzecza zażywaniu substancji psychoaktywnych. W takich sytuacjach należy dokładnie przeanalizować stosowane leki i upewnić się, czy uzyskany wynik nie jest wynikiem fałszywie dodatnim. Skuteczną metodą pozwalającą potwierdzić lub wykluczyć obecność narkotyków w moczu w przypadku niejasnych wyników testów jest chromatografia gazowa. Niestety większość dostępnych w literaturze danych stanowią opisy przypadków, zasadne wydaje się być zatem przeprowadzenie badań na dużej grupie osób przyjmujących leki psychotropowe.
Ultra-sensitive silicon temperature sensor based on cascaded Mach–Zehnder interferometers
Authors: Ding Zuoqin , Dai Daoxin , Shi Yaocheng 
Published: May 2021

An ultra-sensitive temperature sensor without sacrificing detection range is demonstrated on the silicon-on-insulator (SOI) platform using cascaded Mach–Zehnder interferometers (MZIs). The sensitivity enhancement is achieved by tailoring the geometric parameters of the two MZIs to have similar free spectral ranges (FSRs) but quite different sensitivities. The proposed sensor only needs single lithography for the sensing unit, without introducing negative thermo-optic coefficient (TOC) materials. The measured sensitivity is 1753.7 pm/°C from 27°C to 67°C, which is higher than any reported results on a silicon platform and about 21.9 times larger than conventional all-silicon temperature sensors.
Evaluation of two communication tools, slideshow and theater, to improve participants’ understanding of a clinical trial in the informed consent procedure on Pemba Island, Tanzania
Authors: Palmeirim Marta S. , Mohammed Ulfat A. , Ross Amanda , Ame Shaali M. , Ali Said M , Keiser Jennifer 
Published: May 2021

Background
Clinical trial participants are required to sign an informed consent form (ICF). However, information is lacking on the most effective methods to convey trial relevant information prior to inviting participants to sign the ICF, being particularly pertinent in low-income countries. A previous study on Pemba Island, Tanzania, found that a verbal information session (IS) was significantly better than providing an ICF alone. However, knowledge gaps remained. Building on these findings, we investigated the effect of adding a slideshow or a theater to the IS in the informed consent procedure of an anthelminthic clinical trial.

Methodology/principal findings
A total of 604 caregivers were randomized into the control group that only received an ICF (n = 150) or an ICF plus one of three intervention strategies: (i) verbal IS (n = 135), (ii) verbal IS with a slideshow (n = 174) or (iii) verbal IS followed by a theater (n = 145). All modes of information covered the same key messages. Participants’ understanding was assessed using a semi-structured questionnaire. The mean score of caregivers in the control group (ICF only) was 4.41 (standard deviation = 1.47). Caregivers attending the IS alone were more knowledgeable than those in the control group (estimated difference in mean scores: 2.40, 95% confidence interval (CI) 1.95 to 2.86, p < 0.01). However, there was no evidence of an improvement compared to the IS only when participants attended a slideshow (0.09, 95% CI -0.53 to 0.35, p = 0.68) or a theater (0.28, 95% CI -0.27 to 0.82, p = 0.32). Three out of 10 key messages remained largely misunderstood, regardless of the mode of information group.

Conclusions/significance
Our study confirmed that, in this setting, an ICF alone was not sufficient to convey clinical trial-related information. An IS was beneficial, however, additional theater and slideshows did not further improve understanding. Future research should explore methods to improve communication between study teams and participants for different key messages, study types and settings.
Prognostic value of pre-treatment systemic immune-inflammation index in patients with endometrial cancer
Authors: Matsubara Sho , Mabuchi Seiji , Takeda Yoshinori , Kawahara Naoki , Kobayashi Hiroshi 
Published: May 2021

Background
The systemic immune-inflammation index (SII), which is calculated using absolute platelet, neutrophil, and lymphocyte counts, has recently attracted attentions as a prognostic indicator in patients with solid malignancies. In the current study, we retrospectively investigated the prognostic significance of pre-treatment SII among patients with endometrial cancer.

Method
Endometrial cancer patients treated at Nara medical university hospital between 2008 and 2018 were included in the current study. Receiver operating characteristic (ROC) curve was used to find the optimal SII cut-off values for 3-years progression free survival (PFS) and overall survival (OS). Then, the predictive abilities of SII and its superiority over neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were investigated. Kaplan-Meier method was used to calculate the OS and PFS rates, and log-rank test was used to compare the survival rate between two groups. Univariate and multivariate Cox regression analysis were performed to identify risk factors for PFS and OS.

Result
A total of 442 patients were included in the current study. The cut-off value of SII for predicting PFS and OS were defined by ROC analysis as 931 and 910, respectively. Univariate analyses showed that elevated SII was associated with significantly shorter survival (p <0.001 for both PFS and OS). Cox regression analyses revealed that an advanced FIGO stage (p <0.001 for both PFS and OS) and an elevated SII (p = 0.014 for PFS, p = 0.011 for OS) are the independent prognostic factors for survival. When SII was compared with NLR and PLR, SII showed greater area under curve for predicting survival.

Conclusion
The SII is an independent prognostic factor in endometrial cancer patients, allowing more precise survival estimation than PLR or NLR.
Evaluating changes in workplace culture: Effectiveness of a caregiver-friendly workplace program in a public post-secondary educational institution
Authors: Dardas Anastassios , Williams Allison , Wang Li 
Published: May 2021

Background
Workplace experience, defined as the evaluation of the work environment and performance, and a characteristic of workplace culture, can influence an employee’s work-life balance. Most carer-employees, who combine paid full-time work and informal caregiving responsibilities, struggle to maintain a healthy work-life balance. Caregiver-Friendly Workplace Programs are designed to improve the work experience, and ultimately, the work-life balance of carer-employees. The purpose of this study is to identify changes in workplace culture through the examination of the efficacy of a caregiver-friendly workplace program on workplace experience. First, we identify whether awareness of a caregiver-friendly workplace program directly increases the amount of work support received and, in turn, improves workplace experience. Second, we will examine if significant differences in the amount of work support received translates into an improved workplace experience for carer-employees over time.

Methods
Two university-wide online surveys were conducted separately; time 1 (T1) during the summer of 2015, and time 2 (T2), in the summer of 2017. In each survey, nearly 7000 employees received the invitation to participate with a response rate ranging 10% (T1) to 12% (T2). Respondents were asked about their sociodemographic characteristics, caregiving responsibilities (if applicable), awareness of caregiver-friendly workplace program, types of work support received, and work experience. Reliability analyses was conducted for three scales: awareness of caregiver-friendly workplace program; work support, and; workplace experience. Proportional T-tests were used to examine the difference amongst the intervention scales over time. Structural equation modeling (SEM), via path analysis, was used to investigate the causal indirect (awareness of caregiver-friendly workplace program to work support to workplace experience) relationship that define the workplace culture.

Results
No significant changes in workplace culture were found over time. However, awareness of caregiver-friendly workplace programs is shown to positively impact the amount of support received, which sequentially improves workplace experience, and ultimately workplace culture. This therefore suggests that the implementation of caregiver-friendly workplace programs is potentially effective.

Conclusions
Results suggest that amount of support received, and workplace experience would be better reassessed via a longer time period (i.e., 5 yr. window), and improved support for managers and supervisors is needed to supplement relationships with their employees.
Challenges and needed reforms in midwifery and nursing regulatory systems in India: Implications for education and practice
Authors: Mayra Kaveri , Padmadas Sabu S. , Matthews Zoë 
Published: May 2021

Background
In India, nursing regulation is generally weak, midwifery coexists with nursing, and 88% of nursing and midwifery education is provided by the private health sector. The Indian health system faces major challenges for health care provision due to poor quality, indeterminate regulatory functions and lack of reforms.

Methods
We undertook a qualitative investigation to understand midwifery and nursing education, and regulatory systems in India, through a review of the regulatory Acts, and an investigation of the perceptions and experiences of senior midwifery and nursing leaders representing administration, advocacy, education, regulation, research and service provision in India with an international perspective.

Results
There is a lack of importance accorded to midwifery roles within the nursing system. The councils and Acts do not adequately reflect midwifery practice, and remain a barrier to good quality care provision. The lack of required amendment of Acts, lack of representation of midwives and nurses in key governance positions in councils and committees have restrained and undermined leadership positions, which have also impaired the growth of the professions. A lack of opportunities for professional practice and unfair assessment practices are critical concerns affecting the quality of nursing and midwifery education in private institutions across India. Midwifery and nursing students are generally more vulnerable to discrimination and have less opportunities compared to medical students exacerbated by the gender-based challenges.

Conclusions
India is on the verge of a major regulatory reform with the National Nursing and Midwifery Commission Bill, 2020 being drafted, which makes this study a crucial and timely contribution. Our findings present the challenges that need to be addressed with regulatory reforms to enable opportunities for direct-entry into the midwifery profession, improving nursing education and practice by empowering midwives and nurses with decision-making powers for nursing and midwifery workforce governance.
Strengthening health systems to improve the value of tuberculosis diagnostics in South Africa: A cost and cost-effectiveness analysis
Authors: Foster Nicola , Cunnama Lucy , McCarthy Kerrigan , Ramma Lebogang , Siapka Mariana , Sinanovic Edina , Churchyard Gavin , Fielding Katherine , Grant Alison D. , Cleary Susan 
Published: May 2021

Background
In South Africa, replacing smear microscopy with Xpert-MTB/RIF (Xpert) for tuberculosis diagnosis did not reduce mortality and was cost-neutral. The unchanged mortality has been attributed to suboptimal Xpert implementation. We developed a mathematical model to explore how complementary investments may improve cost-effectiveness of the tuberculosis diagnostic algorithm.

Methods
Complementary investments in the tuberculosis diagnostic pathway were compared to the status quo. Investment scenarios following an initial Xpert test included actions to reduce pre-treatment loss-to-follow-up; supporting same-day clinical diagnosis of tuberculosis after a negative result; and improving access to further tuberculosis diagnostic tests following a negative result. We estimated costs, deaths and disability-adjusted-life-years (DALYs) averted from provider and societal perspectives. Sensitivity analyses explored the mediating influence of behavioural, disease- and organisational characteristics on investment effectiveness.

Findings
Among a cohort of symptomatic patients tested for tuberculosis, with an estimated active tuberculosis prevalence of 13%, reducing pre-treatment loss-to-follow-up from ~20% to ~0% led to a 4% (uncertainty interval [UI] 3; 4%) reduction in mortality compared to the Xpert scenario. Improving access to further tuberculosis diagnostic tests from ~4% to 90% among those with an initial negative Xpert result reduced overall mortality by 28% (UI 27; 28) at $39.70/ DALY averted. Effectiveness of investment scenarios to improve access to further diagnostic tests was dependent on a high return rate for follow-up visits.

Interpretation
Investing in direct and indirect costs to support the TB diagnostic pathway is potentially highly cost-effective.
Artificial intelligence for classifying uncertain images by humans in determining choroidal vascular running pattern and comparisons with automated classification between artificial intelligence
Authors: Sonoda Shozo , Shiihara Hideki , Terasaki Hiroto , Kakiuchi Naoko , Funatsu Ryoh , Tomita Masatoshi , Shinohara Yuki , Uchino Eisuke , Udagawa Takuma , An Guangzhou , Akiba Masahiro , Yokota Hideo , Sakamoto Taiji 
Published: May 2021

PurposeAbnormalities of the running pattern of choroidal vessel have been reported in eyes with pachychoroid diseases. However, it is difficult for clinicians to judge the running pattern with high reproducibility. Thus, the purpose of this study was to compare the degree of concordance of the running pattern of the choroidal vessels between that determined by artificial intelligence (AI) to that determined by experienced clinicians.MethodsThe running pattern of the choroidal vessels in en face images of Haller’s layer of 413 normal and pachychoroid diseased eyes was classified as symmetrical or asymmetrical by human raters and by three supervised machine learning models; the support vector machine (SVM), Xception, and random forest models. The data from the human raters were used as the supervised data. The accuracy rates of the human raters and the certainty of AI’s answers were compared using confidence scores (CSs).ResultsThe choroidal vascular running pattern could be determined by each AI model with an area under the curve better than 0.94. The random forest method was able to discriminate with the highest accuracy among the three AIs. In the CS analyses, the percentage of certainty was highest (66.4%) and that of uncertainty was lowest (6.1%) in the agreement group. On the other hand, the rate of uncertainty was highest (27.3%) in the disagreement group.ConclusionAI algorithm can automatically classify with ambiguous criteria the presence or absence of a symmetrical blood vessel running pattern of the choroid. The classification was as good as that of supervised humans in accuracy and reproducibility.
The magnitude of neonatal near miss and associated factors among live births in public hospitals of Jimma Zone, Southwest Ethiopia, 2020: A facility-based cross-sectional study
Authors: Wondimu Merertu , Balcha Fikadu , Bacha Girma , Habte Aklilu 
Published: May 2021

Background
Neonates with severe complications at birth or during the neonatal period who nearly died but survived constitute neonatal near miss (NNM) cases. Identifying NNM cases and correcting contributing factors are of the utmost importance to get relevant controls for neonatal deaths. However, limited studies are assessing the prevalence of NNM and associated factors with NNM cases in Ethiopia. So, this study is aimed at assessing the magnitude of neonatal near miss and associated factors among live births in public hospitals of Jimma zone, southwest Ethiopia, 2020.

Methods
A facility-based cross-sectional study was conducted among 260 neonates from April 1–30 / 2020. Face to face interviewer-administered structured questionnaire was used to collect data from the mothers and a standard checklist was used for their neonates. The data was encoded and entered into Epi-Data version 4.2 and exported to SPSS version 23 for analysis. Independent variables with marginal associations (p-value <0.25) in the bivariable analysis were eligible for multivariable logistic regression analysis to detect an association with outcome variables. Finally, adjusted odds ratios (AOR) with 95% CI were used to estimate the strength of associations, and statistical significance was declared at a p-value < 0.05.

Result
The magnitude of NNM was 26.7% with [95%CI: 21.6–32.5]. Hypertension during pregnancy [AOR: 3.4; 95%CI: 1.32–8.88], mode of delivery [AOR: 3.32; 95%CI: 1.48–7.45], Obstructed labor [AOR: 2.95; 95%CI: 1.32–6.45] and non-vertex fetal presentation during delivery [AOR: 4.61; 95%CI: 2.16–9.84] were identified as significantly predictors of NNM.

Conclusion and recommendation
Over a quarter of the neonates were with NNM cases, which is relatively higher than the report of studies done in other countries. Hypertension during pregnancy, cesarean delivery, prolonged labor, and non-vertex fetal presentation were all found to increase the likelihood of NNM. Therefore, concerted efforts are needed from local health planners and health care providers to improve maternal health care services especially in early identification of the complications and taking appropriate management.