bluuebunny/crossref_metadata_2025_split huggingface dataset:
Digital cognitive–behavioural therapy for insomnia compared with digital patient education about insomnia in individuals referred to secondary mental health services in Norway: protocol for a multicentre randomised controlled trial
Authors: Kallestad Håvard , Saksvik Simen , Vedaa Øystein , Langsrud Knut , Morken Gunnar , Lydersen Stian , Simpson Melanie R , Dørheim Signe Karen , Holmøy Bjørn , Selvik Sara G , Hagen Kristen , Stiles Tore Charles , Harvey Allison , Ritterband Lee , Sivertsen Børge , Scott Jan 
Published: June 2021

IntroductionInsomnia is highly prevalent in outpatients receiving treatment for mental disorders. Cognitive–behavioural therapy for insomnia (CBT-I) is a recommended first-line intervention. However, access is limited and most patients with insomnia who are receiving mental healthcare services are treated using medication. This multicentre randomised controlled trial (RCT) examines additional benefits of a digital adaptation of CBT-I (dCBT-I), compared with an online control intervention of patient education about insomnia (PE), in individuals referred to secondary mental health clinics.Methods and analysisA parallel group, superiority RCT with a target sample of 800 participants recruited from treatment waiting lists at Norwegian psychiatric services. Individuals awaiting treatment will receive an invitation to the RCT, with potential participants undertaking online screening and consent procedures. Eligible outpatients will be randomised to dCBT-I or PE in a 1:1 ratio. Assessments will be performed at baseline, 9 weeks after completion of baseline assessments (post-intervention assessment), 33 weeks after baseline (6 months after the post-intervention assessment) and 61 weeks after baseline (12 months after the post-intervention assessment). The primary outcome is between-group difference in insomnia severity 9 weeks after baseline. Secondary outcomes include between-group differences in levels of psychopathology, and measures of health and functioning 9 weeks after baseline. Additionally, we will test between-group differences at 6-month and 12-month follow-up, and examine any negative effects of the intervention, any changes in mental health resource use, and/or in functioning and prescription of medications across the duration of the study. Other exploratory analyses are planned.Ethics and disseminationThe study protocol has been approved by the Regional Committee for Medical and Health Research Ethics in Norway (Ref: 125068). Findings from the RCT will be disseminated via peer-reviewed publications, conference presentations, and advocacy and stakeholder groups. Exploratory analyses, including potential mediators and moderators, will be reported separately from main outcomes.Trial registration numberClinicalTrials.gov Registry (NCT04621643); Pre-results.
Rationale and design of the Prevent Anal Cancer Self-Swab Study: a protocol for a randomised clinical trial of home-based self-collection of cells for anal cancer screening
Authors: Nyitray Alan G , Schick Vanessa , Swartz Michael D , Giuliano Anna R , Fernandez Maria E , Deshmukh Ashish A , Ridolfi Timothy J , Ajala Christopher , Brzezinski Bridgett , Sandoval Micaela , Nedjai Belinda , Smith Jennifer S , Chiao Elizabeth Y 
Published: June 2021

IntroductionSquamous cell carcinoma of the anus is a common cancer among sexual minority men, especially HIV-positive sexual minority men; however, there is no evidenced-based national screening protocol for detection of anal precancers. Our objective is to determine compliance with annual anal canal self-sampling or clinician-sampling for human papillomavirus (HPV) DNA.Methods and analysisThis is a prospective, randomised, two-arm clinical study to evaluate compliance with annual home-based versus clinic-based HPV DNA screening of anal canal exfoliated cells. The setting is primary care community-based clinics. Recruitment is ongoing for 400 HIV-positive and HIV-negative sexual minority men and transgender persons, aged>25 years, English or Spanish speaking, no current use of anticoagulants other than nonsteroidal anti-inflammatory drugs and no prior diagnosis of anal cancer. Participants are randomised to either receive a swab in the mail for home-based collection of an anal canal specimen at 0 and 12 months (arm 1) or attend a clinic for clinician collection of an anal canal specimen at 0 and 12 months (arm 2). Persons will receive clinic-based Digital Anal Rectal Examinations and high-resolution anoscopy-directed biopsy to assess precancerous lesions, stratified by study arm. Anal exfoliated cells collected in the study are assessed for high-risk HPV persistence and host/viral methylation. The primary analysis will use the intention-to-treat principle to compare the proportion of those who comply with 0-month and 12-month sampling in the home-based and clinic-based arms. The a priori hypothesis is that a majority of persons will comply with annual screening with increased compliance among persons in the home-based arm versus clinic-based arm.Ethics and disseminationThe study has been approved by the Medical College of Wisconsin Human Protections Committee. Results will be disseminated to communities where recruitment occurred and through peer-reviewed literature and conferences.Trial registration numberNCT03489707.
Complex interplay between moral distress and other risk factors of burnout in ICU professionals: findings from a cross-sectional survey study
Authors: Kok Niek , Van Gurp Jelle , van der Hoeven Johannes G , Fuchs Malaika , Hoedemaekers Cornelia , Zegers Marieke 
Published: June 2021

BackgroundBurnout threatens intensive care unit (ICU) professionals’ capacity to provide high-quality care. Moral distress is previously considered a root cause of burnout, but there are other risk factors of burnout such as personality, work–life balance and culture. This study aimed to disentangle the associations of ICU professionals’ moral distress and other risk factors with the components of burnout—emotional exhaustion, depersonalisation and personal accomplishment—suggesting informed burnout prevention strategies.MethodsCross-sectional survey completed in 2019 of ICU professionals in two Dutch hospitals. The survey included validated measure for burnout (the Dutch Maslach Burnout Inventory), moral distress (Moral Distress Scale), personality (short Big Five Inventory), work–home balance (Survey Work–Home Interaction Nijmegen) and organisational culture (Culture of Care Barometer). Each of the three components of burnout was analysed as a separate outcome, and for each of the components, a separate regression analysis was carried out.Results251 ICU professionals responded to the survey (response rate: 53.3%). Burnout prevalence was 22.7%. Findings showed that moral distress was associated with emotional exhaustion (β=0.18, 95% CI 0.9 to 0.26) and depersonalisation (β=0.19, 95% CI 0.10 to 0.28) and with increased emotional exhaustion mediated by negative work-to-home spillover (β=0.09, 95% CI 0.04 to 0.13). Support from direct supervisors mitigates the association between moral distress and emotional exhaustion (β=0.16, 95% CI 0.04 to 0.27).ConclusionsUnderstanding moral distress as a root cause of burnout is too simplified. There is an important interplay between moral distress and work–home imbalance. Interventions that support individual coping with moral distress and a work–home imbalance, and the support of direct supervisors, are paramount to prevent burnout in physicians and nurses.
Age suit simulation replicates in healthy young adults the functional challenges to balance experienced by older adults: an observational study
Authors: Watkins Carole Anne , Higham Ellie , Gilfoyle Michael , Townley Charley , Hunter Sue 
Published: June 2021

BackgroundAge simulation can have a positive effect on empathic understanding and perception of ageing. However, there is limited evidence for its ability to replicate objectively the physical and functional challenges of ageing.ObjectiveTo observe whether age suit simulation can replicate in healthy young adults the physical and physiological balance disturbance and falls risk experienced by older adults.MethodologyHealthy young adults aged 20–40 years (16 male) were recruited to the study using convenience sampling from a student population. Participants performed three validated balance tests—Functional Reach Test (FRT), Timed Up and Go (TUG) and Berg Balance Scale (BBS)—first without the age suit and then with the age suit, using a standardised protocol, following the same sequence.Results30 participants completed all tests. Statistically significant differences between without-age-suit and with-age-suit performance were recorded for FRT distance (p<0.000005), time taken to complete the TUG (p<0.0005) and BBS score (p<0.001). A comparison of participant scores with normative FRT and TUG scores identified that the suit had ‘aged’ the majority of participants to the normative values for older adults (60+), with some reaching the values for individuals aged 70–89. However, no scores achieved the values indicative of increased falls risk.ConclusionsThe age suit is a valid educational tool that extends the value of age simulation beyond a more general empathising role, enabling those working with an older population to experience and understand the functional challenges to balance experienced by older adults as part of their training.
Is concurrent intravenous alteplase in patients undergoing endovascular treatment for large vessel occlusion stroke cost-effective even if the cost of alteplase is only US$1?
Authors: Ospel Johanna Maria , McDonough Rosalie , Kunz Wolfgang G , Goyal Mayank 
Published: June 2021

BackgroundThe added value of intravenous (IV) alteplase in large vessel occlusion (LVO) stroke over and beyond endovascular treatment (EVT) is controversial. We compared the long-term costs and cost-effectiveness of a direct-to-EVT paradigm in LVO stroke patients presenting directly to the mothership hospital to concurrent EVT and IV alteplase.MethodsWe used a decision model consisting of a short-run model to analyze costs and functional outcomes within 90 days after the index stroke and a long-run Markov state transition model (cycle length of 12 months) to estimate expected lifetime costs and outcomes. Outcome data were from the DIRECT-MT trial (NCT03469206). Incremental cost-effectiveness ratios and net monetary benefits were calculated and probabilistic sensitivity analysis was performed. Analysis was performed from a healthcare perspective and a societal perspective using both a minimal assumed alteplase cost of US$1 and true alteplase cost.ResultsWhen assuming a minimal cost of alteplase of $1, EVT with concurrent IV alteplase resulted in incremental lifetime cost of $5664 (healthcare perspective)/$4804 (societal perspective) and a decrement of 0.25 quality-adjusted life years (QALYs) compared with EVT only, indicating dominance of the EVT only approach. Net monetary benefits were consistently higher for EVT only compared with EVT with concurrent alteplase. Probabilistic sensitivity analysis showed increased costs without an increase in QALYs for EVT and concurrent IV alteplase compared with EVT only. Results were even more in favor of EVT when the true cost of alteplase was used for analysis.ConclusionEVT without concurrent alteplase is the preferred strategy from a health economic standpoint.
Dynamic mode decomposition of elliptical liquid jets in crossflow
Authors: Mokhtarpour Keivan , Jadidi Mehdi , Dolatabadi Ali 
Published: June 2021

The dynamics of round and elliptical liquid jets in subsonic crossflow was studied using high-speed imaging technique. The experiments were performed at constant gaseous Weber number and liquid–gas momentum flux ratios of 6.45 and 17.87, respectively, with orifices of different aspect ratios (AR) having an equivalent diameter of 0.43 mm. All of the cases were carried out inside an open-loop subsonic wind tunnel with a test section of 100 mm × 100 mm × 750 mm. For each case, dynamic modes were generated directly from the snapshots using a variant of the Arnoldi method known as the dynamic mode decomposition (DMD). The DMD results indicate that elliptical liquid jets have more small-scaled patterns with higher frequencies compared with the round liquid jets. As the first attempt to investigate the dynamics of elliptical liquid jets in crossflow, this study captures the dominant spatiotemporal structures. We also found that the orifice AR can significantly alter the jet wavelengths. The data from this study contribute to understanding the behavior of elliptical liquid jets exposed to gas crossflow in an enhanced capillary breakup regime.
On the initial singularity in Kantowski–Sachs spacetime
Authors: Ghorani Elham , Heydarzade Yaghoub 
Published: June 2021

AbstractThe emergent universe scenario is a proposal for resolving the Big Bang singularity problem in the standard Friedmann–Lemaitre–Robertson–Walker cosmology. In the context of this scenario, the Universe originates from a nonsingular static state. In the present work, considering the realization of the emergent universe scenario, we address the possibility of having a nonsingular Kantowski–Sachs type static state. Considering four and five dimensional models (with and without brane), it is shown that both the existence and stability of a nonsingular state depend on the dimensions of the spacetime and the nature of the fluid supporting the geometry.
The response of calcareous nannoplankton to the latest Pliensbachian–early Toarcian environmental changes in the Camino Section (Basque Cantabrian Basin, northern Spain)
Authors: Fraguas Ángela , Gómez Juan José , Goy Antonio , Comas-Rengifo María José 
Published: June 2021

Abstract

Quantitative analysis performed on latest Pliensbachian–early Toarcian calcareous nannofossil assemblages from the Camino section (Basque Cantabrian Basin) allowed their response to the environmental changes recorded during this time interval to be deciphered, characterized by an extinction event. The results were introduced within a principal component analysis and compared with the stable isotope and total organic carbon curves. During the latest Pliensbachian, the Mirabile and the lowermost part of the Semicelatum Ammonite Subzones,
Schizosphaerella
,
Bussonius prinsii
,
Biscutum finchii
,
Calcivascularis jansae
and
Similiscutum avitum
, taxa that probably thrived in rather cold waters, dominated the calcareous nannofossil assemblages. Coinciding with warmer and wetter conditions, which probably led to an increase in surface water fertility, recorded slightly below the extinction boundary, the mesotrophic taxa
B. novum
,
L. hauffii
and
Calyculus
spp. were dominant. Nevertheless,
T. patulus
and
C. jansae
, which became extinct just below the extinction boundary, show preferences for oligotrophic conditions. Salinities similar to those of modern oceans have been inferred around the extinction boundary, considering the coupling between the abundances of
Calyculus
spp. and the species richness together with the absence of black shales. After the extinction boundary, nannofossil assemblages were dominated by the deep-dwelling
C. crassus
and the shallow-dwelling
Lotharingius
species, interpreted as opportunistic taxa. This work confirms that calcareous nannofossils are a really useful tool for palaeoceanographic and palaeoenvironmental reconstructions, especially in terms of climatic changes.
Livestock Production Challenges and Improved Forage Production Efforts in the Damot Gale District of Wolaita Zone, Ethiopia
Authors: Mengistu Shimelis , Nurfeta Ajebu , Tolera Adugna , Bezabih Melkamu , Adie Abera , Wolde-meskel Endalkachew , Zenebe Mesfin 
Published: June 2021

This study was conducted to identify major livestock production constraints and improved forage production efforts in the Damot Gale district. Four representative kebeles, two associated with our NGO project and two from nonproject outreach activities, were selected. Forty farmers from each kebele were randomly chosen for the purpose of individual interviews using a semistructured questionnaire. Data collected were analyzed using SPSS (version 20) and Excel. The topmost livestock production constraint was feed shortage where a larger proportion of farmers (75.6%) suffered from the problem with higher (

p

≤ 0.01) severity in nonproject intervention areas. Of these, 38.6% were challenged for a period of three months while another 61.4% suffered for about four months. Purchasing grass (31.4%) and concentrate (33.5%) and feeding enset (Ensete ventricosum) leaf (21.49%) were the most commonly adopted coping mechanisms to alleviate feed shortages during the dry season, while using purchased grass and enset leaf was the main coping strategy in nonproject intervention (

p

≤ 0.01) areas. The majority of households (90.75%) participate in improved forage production regardless of farm size. Desho grass (Pennisetum pedicellatum) (71.38%) and elephant grass (Pennisetum purpureum) (42.63%) are the most common improved forages in both study areas. These forages are produced for the purpose of two or more functions (feed, cash, and preventing erosion) that vary (

p

≤ 0.01) among intervention status. Major niche locations adopted for improved forage production include farm land, soil and water conservation structures, and perimeter fencing. Greatest constraints on improved forage production were seed/material shortage followed by land shortage and lack of awareness. Project intervention (

p

≤ 0.01), tropical livestock unit (TLU) holding (

p

≤ 0.01), and forage seed/planting material access (

p

< 0.05) were identified as factors (among others) having significant relationship with improved forage development. Strong extension services and efficient input delivery for farmers are vital to support profitable livestock production and resource utilization.
Association between Human Polyomaviruses and Keratinocyte Carcinomas: A Prospective Cohort Study
Authors: Amorrortu Rossybelle P. , Zhao Yayi , Messina Jane L. , Schell Michael J. , Fenske Neil A. , Cherpelis Basil S. , Sondak Vernon K. , Giuliano Anna R. , Pawlita Michael , McKay-Chopin Sandrine , Gheit Tarik , Waterboer Tim , Tommasino Massimo , Rollison Dana E. 
Published: June 2021

Abstract

Background:
A positive association between Merkel cell polyomavirus (MCPyV) infection and cutaneous squamous cell carcinoma (cuSCC) has been observed in at least one previous case–control study. To evaluate this association in a prospective context, we investigated infections with human polyomaviruses (HPyV), including MCPyV, as predictors of keratinocyte carcinomas, including cuSCC and basal cell carcinoma (BCC), among a cohort of immunocompetent individuals enrolled in the Viruses in Skin Cancer (VIRUSCAN) Study.

Methods:
Associations between markers of baseline HPyV infection (serum antibodies and viral DNA in eyebrow hairs and skin swabs) and incident keratinocyte carcinomas were modeled using Cox proportional hazards regression. Proportions of baseline HPyV infections that were concordant with a subsequent tumor positive for the same HPyV type were assessed.

Results:
No significant associations were observed between baseline markers of MCPyV or other HPyV infections and cuSCC or BCC. Less than 4.5% of baseline MCPyV infections were also detected in subsequently developed keratinocyte carcinoma tumors.

Conclusions:
HPyV infection was not a predictor of keratinocyte carcinoma risk in this prospective cohort.

Impact:
Cancer-associated infections represent attractive targets for cancer prevention; however, HPyV infections have limited potential as novel targets for cuSCC prevention.
Low-Fat Dietary Modification and Risk of Ductal Carcinoma In Situ of the Breast in the Women's Health Initiative Dietary Modification Trial
Authors: Peila Rita , Chlebowski Rowan , Manson JoAnn E. , Crane Tracy E. , Lane Dorothy S. , Saquib Nazmus , Shadyab Aladdin H. , Tabung Fred K. , Barac Ana , Zhang Zhenzhen , Pan Kathy , Wassertheil-Smoller Sylvia , Rohan Thomas E. 
Published: June 2021

Abstract

Background:
Results of observational studies of the association between dietary fat and risk of invasive breast cancer have been inconsistent. In the Women's Health Initiative dietary modification (DM) randomized trial designed to lower fat intake, the intervention was not associated with a statistically significant reduction of overall breast cancer risk. However, the DM association with risk of ductal carcinoma in situ (DCIS) of the breast, a putative breast cancer precursor, has not been reported.

Methods:
A total of 48,835 postmenopausal women, ages 50–79 years at enrollment, with no breast cancer history and ≥32% of total energy intake from fat, were randomly assigned either to a dietary intervention (n = 19,541) designed to reduce total fat intake to 20% of energy and to increase vegetable, fruit, and grain consumption, or to a comparison group (n = 29,294). Cox proportional hazards models were used to estimate HRs and 95% confidence intervals for the association between the intervention and DCIS risk.

Results:
During 18.7 years (median) cumulative follow-up, including intervention (∼8.7 years) and post-intervention phases (∼13.0 years), 817 DCIS cases were ascertained. No evidence of an association between the DM intervention and DCIS risk was observed overall, or by trial phase (intervention and post-intervention). Similarly, no associations were found in subgroups defined by potential risk factors for DCIS.

Conclusions:
DM aiming to reduce fat intake was not associated with altered risk of DCIS.

Impact:
These results do not provide evidence of an association between dietary fat reduction and the risk of DCIS among postmenopausal women.
Memory-like Differentiation Enhances NK Cell Responses to Melanoma
Authors: Marin Nancy D. , Krasnick Bradley A. , Becker-Hapak Michelle , Conant Leah , Goedegebuure Simon P. , Berrien-Elliott Melissa M. , Robbins Keenan J. , Foltz Jennifer A. , Foster Mark , Wong Pamela , Cubitt Celia C. , Tran Jennifer , Wetzel Christopher B. , Jacobs Miriam , Zhou Alice Y. , Russler-Germain David , Marsala Lynne , Schappe Timothy , Fields Ryan C. , Fehniger Todd A. 
Published: June 2021

Abstract

Purpose:
Treatment of advanced melanoma is a clinical challenge. Natural killer (NK) cells are a promising cellular therapy for T cell–refractory cancers, but are frequently deficient or dysfunctional in patients with melanoma. Thus, new strategies are needed to enhance NK-cell antitumor responses. Cytokine-induced memory-like (ML) differentiation overcomes many barriers in the NK-cell therapeutics field, resulting in potent cytotoxicity and enhanced cytokine production against blood cancer targets. However, the preclinical activity of ML NK against solid tumors remains largely undefined.

Experimental Design:
Phenotypic and functional alterations of blood and advanced melanoma infiltrating NK cells were evaluated using mass cytometry. ML NK cells from healthy donors (HD) and patients with advanced melanoma were evaluated for their ability to produce IFNγ and kill melanoma targets in vitro and in vivo using a xenograft model.

Results:
NK cells in advanced melanoma exhibited a decreased cytotoxic potential compared with blood NK cells. ML NK cells differentiated from HD and patients with advanced melanoma displayed enhanced IFNγ production and cytotoxicity against melanoma targets. This included ML differentiation enhancing melanoma patients' NK-cell responses against autologous targets. The ML NK-cell response against melanoma was partially dependent on the NKG2D- and NKp46-activating receptors. Furthermore, in xenograft NSG mouse models, human ML NK cells demonstrated superior control of melanoma, compared with conventional NK cells.

Conclusions:
Blood NK cells from allogeneic HD or patients with advanced melanoma can be differentiated into ML NK cells for use as a novel immunotherapeutic treatment for advanced melanoma, which warrants testing in early-phase clinical trials.