bluuebunny/crossref_metadata_2025_split huggingface dataset:
Environmental injustice - Neighborhood characteristics as confounders and effect modifiers for the association between air pollution exposure and cognitive function
Authors: Li Zhenjiang , Christensen Grace M. , Lah James J. , Marcus Michele , Russell Armistead G. , Ebelt Stefanie , Waller Lance A. , Huels Anke 
Published: October 2021

ABSTRACTBackgroundAir pollution has been associated with cognitive decline among the elderly. Previous studies have not evaluated the simultaneous effect of neighborhood-level socioeconomic status (N-SES), which can be an essential source of bias.ObjectivesWe explored N-SES as a confounder and effect modifier in a cross-sectional study of air pollution and cognitive function among the elderly.MethodsWe included 12,058 participants age 50+ years from the Emory Healthy Aging Study in Metro Atlanta using the Cognitive Function Instrument (CFI) score as our outcome, with higher scores representing worse cognition. We estimated 9-year average ambient carbon monoxide (CO), nitrogen oxides (NOx), and fine particulate matter (PM2.5) concentrations at residential addresses using a fusion of dispersion and chemical transport models. We collected census-tract level N-SES indicators and created two composite measures using principal component analysis and k-means clustering. Associations between pollutants and CFI and effect modification by N-SES were estimated via linear regression models adjusted for age, education, race and N-SES.ResultsN-SES confounded the association between air pollution and CFI, independent of individual characteristics. We found significant interactions between all air pollutants and N-SES for CFI (p-values<0.001) suggesting that effects of air pollution differ depending on N-SES. Participants living in areas with low N-SES were most vulnerable to air pollution. In the lowest N-SES urban areas, interquartile range (IQR) increases in CO, NOx, and PM2.5 were associated with 5.4% (95%-confidence interval, -0.2,11.4), 4.9% (-0.4,10.4), and 9.8% (2.2,18.0) increases in CFI, respectively. In lowest N-SES suburban areas, IQR increases in CO, NOx, and PM2.5 were associated with higher increases in CFI, namely 13.4% (1.3,26.9), 13.4% (0.3,28.2), and 17.6% (2.8,34.5), respectively.DiscussionN-SES is an important confounder and effect modifier in our study. This finding could have implications for studying health effects of air pollution in the context of environmental injustice.
Knowledge towards breast cancer, and breast self-examination practices and its barriers among university female students in Bangladesh: Findings from a cross-sectional study
Authors: Sarker Rumpa , Islam Md. Saiful , Moonajilin Mst. Sabrina , Rahman Mahmudur , Gesesew Hailay Abrha , Ward Paul R 
Published: October 2021

AbstractEarly diagnosis of breast cancer is the best approach towards its control that may result in alleviating related mortality and morbidity. This study aimed to evaluate knowledge about breast cancer and both practices and perceived barriers to breast self-examination among female university students in Bangladesh. A cross-sectional study was carried out with 400 female students of Jahangirnagar University, Bangladesh. Participants were sampled from female dormitories at the university from January to April 2020. Proportionate stratified random sampling was conducted to calculate the study sample from each dormitory. A pre-tested, semi-structured self-reported questionnaire was employed to collect data from participants during the survey periods. The questionnaire consists of demographic variables, items about knowledge about breast cancer, breast self-examination practices and its barriers. We applied descriptive and inferential statistics, and data were analyzed using SPSS. Participants aged between 18-26 years and comprised university students of 1st year (20%), 2nd year (24%), 3rd year (22%), 4th year (21%) and Master’s (14.%). 18% of them had reported positive family history (mother, aunt, sister/cousin, grandmother) of breast cancer. The overall mean score of total knowledge items was 15 (SD = 3) out of 43, with an overall correct rate of 34%. The mean score of total knowledge items was significantly higher (p<0.001) among Master’s students and students with family members who have breast cancer. Only one in five students (21%) ever practiced breast self-examination. The mean score of practice towards breast self-examination was significantly higher (p<0.001) among participants who reported having family member of breast cancer. It is noted that the total knowledge score about breast cancer and practice towards breast self-examination are significantly correlated with each other (r = 0.54; p<0.001). About 33% participants had reported that ‘lack of knowledge as the main barrier to practicing breast self-examination followed by ‘I do not have the symptoms’ (22%), and shyness/ uncomfortable feelings (17%). The study revealed low levels of knowledge about breast cancer and low breast self-examination practices. This implies the need of promotion and implementation of educational interventions programs that are social and culturally appropriate and suitable for specific age groups.
A capacity assessment of healthcare workers to provide second-line antiretroviral therapy in Malawi: 2016
Authors: Ng’ambi Wingston , Babaye Yusuf , Nyasulu Paul , Jahn Andreas , Kalua Thoko , Longwe-Ngwira Abiba , Odo Michael , Namakhoma Ireen , Nyirenda Rose , O’Malley Gabrielle 
Published: October 2021

ABSTRACTINTRODUCTIONAccording to the estimates by the World Health Organisation, Malawi is lagging behind for the number of patients that should have been on second-line ART. In settings like Malawi the low switching may be attributable to low knowledge of clinical assessment for first-line antiretroviral treatment (ART) failure. We analyzed the knowledge level of different cadres of health workers on the management of second-line ART.METHODSThis cross-sectional study assessed whether the first-line ART providers were capable to provide second-line ART in Malawi. Descriptive statistics were conducted using STATA v15.0. The passing score was 80%. Associations were assessed using Chi-Square tests with a statistical significance set at P<0.05.RESULTSOf the 754 ART providers assessed, 290 (38%) were eligible to prescribe second-line ARVs. We observed significant differences for eligibility by cadre and district (P<0.001). Furthermore, 69% of the ART providers correctly identified second-line ARVs while 9% of the providers correctly chose second-line ARVs for management of different side-effects. Both competencies varied by cadre and district (P<0.001). Of the ART providers, 9% correctly interpreted the VL results which we found to significantly vary by cadre (P<0.001) and not districts. However, 78% of ART providers were able to prescribe correct dose of second-line ART which did not significantly vary by cadre (P=0.27). Spatial analysis showed Thyolo and Chiradzulu as high performing districts.CONCLUSIONSThis assessment found that registered nurses had comparable knowledge to medical doctors with at least Bachelor of Medicine and Bachelor of Surgery and clinical officers with a Diploma in Clinical Medicine in most areas but not in correctly selecting second line ARVs. To strengthen task shifting approaches, capacity building should focus on how to correctly select second line regimen and interpret viral load results. Training activities should also consider regional and district-level variability in capacity.
Efficacy of Spirulina for Allergic Rhinitis
Authors: Batista Iury Gomes , Person Osmar Clayton , Bogar Priscila , Angélico Júnior Fernando Veiga 
Published: October 2021

ABSTRACTIntroductionAllergic rhinitis is a condition of high prevalence in the population and widely studied, with several treatments being consecrated for its control. Spirulina is a dietary supplement that modulates immune function, and has been shown to modulate the inflammatory response of allergic rhinitis.PurposeTo evaluate spirulina in the treatment and control of allergic rhinitis.Material and MethodsThis is a systematic review of randomized clinical trials. Searches were performed for randomized clinical trials relating spirulina to allergic rhinitis in five electronic databases: Cochrane - Central Register of Controlled Trials - CENTRAL (2021), PUBMED (1966-2021), EMBASE (1974-2021), LILACS (1982-2021) AND SCOPUS (2021). Two investigators independently extracted data and assessed trial quality.ResultsTwo clinical trials involving a total of 215 patients were included. Both studies assessed the efficacy of spirulina in improving allergic rhinitis as the primary outcome. The first study described a significant reduction in runny nose, nasal congestion and itching over time of medication use (p<0.001) and in the second study the prevalence of rhinorrhea (P = 0.021), nasal congestion or obstruction (P = 0.039) and decreased smell (P = 0.030) were significantly less in the experimental group than in the control group.ConclusionsThe included studies were in favor of the use of spirrulina. However, the level of evidence is very low and limited. We should have caution due to the small number of clinical trials and participants in these studies. It is recommended to carry out new RCTs following the CONSORT standardization.
Combining faecal immunochemical testing with blood test results to identify patients with symptoms at risk of colorectal cancer: a consecutive cohort of 16,604 patients tested in primary care
Authors: Withrow Diana R , Shine Brian , Oke Jason , Tamm Andres , James Tim , Morris Eva , Davies Jim , Harris Steve , East James E , Nicholson Brian D 
Published: October 2021

Structured abstractObjectiveFaecal immunochemical tests (FITs) are used to triage primary care patients with low risk colorectal cancer symptoms for referral to colonoscopy. The aim of this study was to determine whether combining FIT with routine blood test results could improve the performance of FIT in the primary care setting.DesignResults of all consecutive FITs requested by primary care providers between March 2017 and December 2020 were retrieved from the Oxford University Hospitals NHS Foundation Trust. Demographic factors (age, sex), reason for referral, and results of blood tests within 90 days were also retrieved. Patients were followed up for incident colorectal cancer in linked hospital records. The sensitivity, specificity, positive and negative predictive values of FIT alone, FIT paired with blood test results, and several multivariable FIT models, were compared.ResultsAmong 16,604 eligible patients, 139 colorectal cancers were diagnosed (0.8%). Sensitivity and specificity of FIT alone at a threshold of 10 µg Hb/g were 92.1% and 91.5% respectively. Compared to FIT alone, blood test results did not improve the performance of FIT. Pairing blood test abnormalities with FIT reduced the number of abnormal results needed to detect one cancer but increased the number of cancers missed. Multivariable models retaining FIT, sex, and mean cell volume performed similarly to FIT alone.ConclusionFIT is a highly sensitive tool for identifying higher risk individuals presenting to primary care with lower risk symptoms. Combining blood test results with FIT does not appear to lead to better discrimination for colorectal cancer than using FIT alone.
Response to the coronavirus disease 2019 (COVID-19) pandemic at private retail pharmacies in Kenya: a mixed methods study
Authors: Mugo Peter , Mumbi Audrey , Munene Daniella , Nzinga Jacinta , Molyneux Sassy , Barasa Edwine 
Published: October 2021

AbstractBackgroundPrivate retail pharmacies in developing countries present a unique channel for COVID-19 prevention. We assessed the response to the COVID-19 pandemic by pharmacies in Kenya, aiming to identify strategies for maximising their contribution to the national response.MethodsWe conducted a prospective mixed-methods study, consisting of a questionnaire survey (n=195), a simulated client survey (n=103), and in-depth interviews (n=18). Data collection started approximately seven months after the pandemic reached Kenya. Quantitative data were summarized using measures of central tendency and multivariable modelling done using logistic regression. Qualitative analysis followed a thematic approach.ResultsThe initial weeks of the pandemic were characterized by fear and panic among service providers and a surge in client flow. Subsequently, 61% of pharmacies experienced a dip in demand to below pre-pandemic levels and 31% reported challenges with unavailability, high price, and poor-quality of products. Almost all pharmacies were actively providing preventive materials and therapies; educating clients on prevention measures; counselling anxious clients; and handling and referring suspect cases. Fifty-nine pharmacies (55% [95% CI 45-65%]) reported ever receiving a client asking for COVID-19 testing and a similar proportion supported pharmacy-based testing. For treatment, most pharmacies (71%) recommended alternative therapies and nutritional supplements such as vitamin C; only 27% recommended conventional therapies such as antibiotics. While 48% had at least one staff member trained on COVID-19, a general feeling of disconnection from the national program prevailed.ConclusionsPrivate pharmacies in Kenya were actively contributing to the COVID-19 response, but more deliberate engagement, support and linkages are required. Notably, there is an urgent need to develop guidelines for pharmacy-based COVID-19 testing, a service that is clearly needed and which could greatly increase test coverage. Roll-out of this and other pharmacy-based COVID-19 programs should be accompanied with implementation research in order to inform current and future pandemic responses.
A novel computational methodology for GWAS multi-locus analysis based on graph theory and machine learning
Authors: Saha Subrata , Singh Himanshu Narayan , Soliman Ahmed , Rajasekaran Sanguthevar 
Published: October 2021

AbstractBackgroundCurrent form of genome-wide association studies (GWAS) is inadequate to accurately explain the genetics of complex traits due to the lack of sufficient statistical power. It explores each variant individually, but current studies show that multiple variants with varying effect sizes actually act in a concerted way to develop a complex disease. To address this issue, we have developed an algorithmic framework that can effectively solve the multi-locus problem in GWAS with a very high level of confidence. Our methodology consists of three novel algorithms based on graph theory and machine learning. It identifies a set of highly discriminating variants that are stable and robust with little (if any) spuriousness. Consequently, likely these variants should be able to interpret missing heritability of a convoluted disease as an entity.ResultsTo demonstrate the efficacy of our proposed algorithms, we have considered astigmatism case-control GWAS dataset. Astigmatism is a common eye condition that causes blurred vision because of an error in the shape of the cornea. The cause of astigmatism is not entirely known but a sizable inheritability is assumed. Clinical studies show that developmental disorders (such as, autism) and astigmatism co-occur in a statistically significant number of individuals. By performing classical GWAS analysis, we didn’t find any genome-wide statistically significant variants. Conversely, we have identified a set of stable, robust, and highly predictive variants that can together explain the genetics of astigmatism. We have performed a set of biological enrichment analyses based on gene ontology (GO) terms, disease ontology (DO) terms, biological pathways, network of pathways, and so forth to manifest the accuracy and novelty of our findings.ConclusionsRigorous experimental evaluations show that our proposed methodology can solve GWAS multi-locus problem effectively and efficiently. It can identify signals from the GWAS dataset having small number of samples with a high level of accuracy. We believe that the proposed methodology based on graph theory and machine learning is the most comprehensive one compared to any other machine learning based tools in this domain.
Higher mortality associated with the SARS-CoV-2 Delta variant in the Western Cape, South Africa, using RdRp target delay as a proxy
Authors: Hussey Hannah , Davies Mary-Ann , Heekes Alexa , Williamson Carolyn , Valley-Omar Ziyaad , Hardie Diana , Korsman Stephen , Doolabh Deelan , Preiser Wolfgang , Maponga Tongai , Iranzadeh Arash , Engelbrecht Susan , Wasserman Sean , Schrueder Neshaad , Boloko Linda , Symons Greg , Raubenheimer Peter , Viljoen Abraham , Parker Arifa , Cohen Cheryl , Jassat Waasila , Lessells Richard , Wilkinson Robert J , Boulle Andrew , Hsiao Nei-yuan 
Published: October 2021

AbstractA novel proxy for the Delta variant, RNA-dependent RNA polymerase target delay in the Seegene Allplex™ 2019-nCoV PCR assay, was associated with higher mortality (adjusted Odds Ratio 1.45 [95%CI 1.13-1.86]), compared to presumptive Beta infection, in the Western Cape, South Africa (April-July 2021). Prior diagnosed infection and vaccination were protective.
Mapping routine measles vaccination and factors related to uncompleted vaccination in Japan: An ecological study
Authors: Matsumoto Yuki 
Published: October 2021

AbstractObjectiveFew studies in Japan have considered regional differences in immunisation coverage and have geographically examined its distribution. We aimed to identify the municipal-level distribution of immunisation coverage and explore regional characteristics associated with its regional differences through ecological studies.DesignAn ecological study.SettingJapan municipalities.ParticipantsAll 1737 municipalities.Outcome measureThe mean measles-rubella (MR) vaccination rate distribution from 2013 to 2018 was drawn using GIS. We tested the null hypothesis of non-random distribution using spatial autocorrelation analysis (Global Moran’s I). We presented clusters of municipalities with significantly higher and lower vaccination rates by hot spot analysis (Getis-Ord Gi*). Furthermore, we estimated among municipality characteristics, regional ones associated with vaccination rates.ResultsAccording to Global Moran’s I, the MR vaccine coverage distribution was clustered significantly (z = 11.44, p <0.00). Based on the hot spot analysis, the western Japan region tended to have more cold spots with low inoculation rates, small numbers of births and areas with considerable annual variations in vaccination rates. In multiple regression analysis using regional characteristics as independent variables, the 1-year and 6-month check-up rates (Model 2: 95% confidence interval [CI], 0.21-0.36), number of births (0.96-1.54), and standard deviation of the vaccination rate in a target year per municipality (0.17-0.24), were positively associated with the vaccination rate. Contrariwise, average mothers’ age (−1.15 to -0.34), percentage of single-parent households (−0.48 to -0.17), percentage of households with multiple children (−0.12 to -0.04), and moving-in rates (−0.26 to -0.05) were negatively associated with vaccination rate.ConclusionTo eliminate regional differences in immunisation coverage, it is practical to identify areas with low immunisation coverage for a proactive corrective approach. The regional characteristics identified in this study, such as population structure, administrative characteristics, and trends in socioeconomic status in municipalities will make it possible to identify target areas.Strengths and limitations of this studyThe mean measles-rubella (MR) vaccination rate distribution from 2013 to 2018 was drawn using GIS.We tested the null hypothesis of non-random distribution using spatial autocorrelation analysis (Global Moran’s I).We presented clusters of municipalities with significantly higher and lower vaccination rates by hot spot analysis (Getis-Ord Gi*).Furthermore, we estimated among municipality characteristics, regional ones associated with vaccination rates
The challenges of independence: ontogeny of at-sea behaviour in a long-lived seabird
Authors: Delord Karine , Weimerskirch Henri , Barbraud Christophe 
Published: October 2021

AbstractThe transition to independent foraging represents an important developmental stage in the life cycle of most vertebrate animals. Juveniles differ from adults in various life history traits and tend to survive less well than adults in most long-lived animals. Several hypotheses have been proposed to explain higher mortality including that of inadequate/inferior foraging skills compared to adults, young naïve individuals combining lack of experience and physical immaturity. Thus a change in behaviour, resulting in an improvement of skills acquired from growing experience, is expected to occur during a period of learning through the immaturity phase. Very few studies have investigated the ontogeny of foraging behaviour over long periods of time, particularly in long-lived pelagic seabirds, due to the difficulty of obtaining individual tracking data over several years. We investigated the foraging behaviour, through activity patterns, during the three life stages of the endangered Amsterdam albatross by using miniaturized activity loggers on naïve juveniles, immatures and adults. Naïve juveniles during their first month at sea after leaving their colony exhibited lower foraging effort (greater proportion of time spent sitting on water, longer and more numerous bouts on water, shorter and fewer flying bouts). Patterns of activity parameters in juveniles after independence suggested a progressive change of foraging performances during the first two months after fledging. We found sex differences in activity parameters according to time since departure from the colony and month of the year, consistent with the important sexual dimorphism in the Amsterdam albatross. Regardless of life stage considered, activity parameters exhibited temporal variability reflecting the modulation of foraging behaviour. This variability is discussed in light of both extrinsic (i.e. environmental conditions such as variability in food resources or in wind) and intrinsic (i.e. energetic demands linked to plumage renew during moult) factors.