bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cytomorphological changes of oral mucosal cells among smokeless tobacco users in low and middle-income country settings: new findings from Pakistan
Authors: Hassan Sabreen , Sifat Ayesha , Munib Mohammad , Saeed Saleha , Nisa Waqar U. , Durrani Sofia Haider , Rahim Abid , Ullah Naeem , Afaq Saima , Ali Khattak Farhad , Haq Zia Ul 
Published: December 2024

Abstract
Background
Chronic tobacco use, in any form, induces significant cellular alterations in the oral mucosa. This study investigates four distinct cytomorphological changes in oral mucosal cells among smokeless tobacco users, examining their association across different genders and age groups.

Materials and methods
This cross-sectional study involved collecting mucosal samples from smokeless tobacco (naswar/snuff) users through consecutive sampling. The prepared smears were examined for dysplastic changes. Data analysis was performed using SPSS, with Chi-square tests and logistic regression employed to evaluate proportions and associations.

Results
Among 100 Naswar/snuff users, the labial sulcus mucosa was the most common site affected (47%). The most frequent cytomorphological change was micronuclei (46%), followed by nuclear budding (25%), perinuclear halo (18%), and binucleated cells (14%). In the 51–60 age group, micronuclei (78.9%), nuclear budding (55.3%), binucleation (31.6%), and perinuclear halo (36.8%) were more prevalent (P < 0.005). Gender analysis revealed that micronuclei were more common in females (54.2%) compared to males (43.4%), while nuclear budding was more prevalent in males (27.6%) than females (P < 0.28). Logistic regression indicated that individuals aged 51–60 were more likely to exhibit micronuclei (OR = 1.15, 95% CI: 0.22 to 5.83, P = 0.863) and nuclear budding (OR = 15.34, 95% CI: 9.23 to 30.75, P < 0.05).

Conclusion
The dysplastic changes observed included micronuclei, nuclear budding, binucleated cells, and perinuclear halo, with micronuclei being the most prevalent. These findings could facilitate the early diagnosis of oral lesions and their timely management in habitual smokeless tobacco users.
The pandemic within a pandemic: mental health and wellbeing of racially Minoritised women experiencing domestic abuse during the COVID-19 pandemic in the UK
Authors: Mishra Ankita , Gibson-Miller Jilly , Wood Chantelle 
Published: December 2024

Abstract
Background
The prevalence of domestic abuse is greater in times of humanitarian crisis, and the COVID-19 pandemic has been no different. Considerable evidence indicates that domestic abuse disproportionately impacts the mental health and wellbeing of racially Minoritised women. The present study aimed to explore racially Minoritised women’s experiences of domestic abuse and mental health in the COVID-19 pandemic in the UK.

Method
An online cross-sectional survey was used with racially Minoritised women (n = 1202) in the UK during the third national lockdown.

Results
Results demonstrate complex interplay of psychosocial factors, such as the roles of autonomy, resilience, self-silencing, family functioning, and social support as predictors of mental health and wellbeing during the ‘shadow pandemic’.

Conclusion
Implications such as incorporating culturally competent mental health support, exploring the complex and multiple underpinnings of mental health in racially Minoritised victim-survivors of domestic abuse for future pandemic preparedness and support provision are discussed.
Liver transplantation in a boy with TFAM mutation associated mtDNA depletion syndrome
Authors: Zhao Jing , Chen Lian , Wang Ni , Xie Xin-bao 
Published: December 2024

AbstractMitochondrial transcription factor A (TFAM) deficiency may cause mtDNA depletion syndrome, which manifests as neonatal liver failure or primary ovarian insufficiency, hearing loss, seizures, and intellectual disability. Treatment focusing on symptomatic management, and the clinical prognosis remains poor. Here, we describe a novel case of TFAM mutation presenting with progressive neonatal cholestasis, hypoglycemia and abnormal amino acid profiling. The patient progressed to liver failure at 6 months of age but did not exhibit neurological involvement. No morphologic abnormalities were observed in muscle biopsy, while mtDNA copy number was reduced in comparison to age- and tissue-matched controls. After liver transplantation, liver biochemistries and blood amino acid profiling normalized three weeks later. Moreover, the boy was doing well post-transplant without any clinical concerns, and his development and neurological examination remain normal 33 months after liver transplantation. Our report suggests that liver transplantation appears to have a favorable profile in such patients.
Vaccination strategies to identify and reach zero-dose and under-immunized children in crisis-affected states in Sudan: a qualitative study
Authors: Sabahelzain Majdi M. , Almaleeh Alaa , Abdelmagid Nada , Abdalla Omayma , Nor Barni , Mounier-Jack Sandra , Singh Neha S. 
Published: December 2024

Abstract
Background
Globally, 21 million children were un- or under-vaccinated with Diphtheria-Tetanus-Pertussis (DTP)-containing vaccines in 2023. Around 20% of zero-dose children, those who had not received any DTP doses, live in conflict-affected settings in low and middle-income countries. There is insufficient evidence on vaccination interventions to identify and reach zero-dose children in these settings. This study aimed to map and assess current vaccination strategies to identify and reach zero-dose and under-vaccinated children in the crisis-affected states of South Kordofan, South Darfur and Blue Nile in Sudan.

Methods
We conducted a cross-sectional qualitative study guided by the (Identify-Reach-Monitor-Measure-Advocate (IRMMA) framework, developed by Gavi, the Vaccine Alliance. We conducted 20 individual semi-structured interviews during November and December 2022. We interviewed governmental and non-governmental vaccination stakeholders at federal, state and locality levels. We used the IRMMA framework to analyze the interview transcripts.

Results
Zero-dose and under-immunized children in the study sites were concentrated in opposition-controlled areas, nomadic communities, and remote rural areas. Zero-dose and under-immunized children in accessible areas were identified through routine vaccination strategies and surveillance reports. Various strategies were used in inaccessible areas. This includes tasking local institutions and individuals trusted by communities to identify and reach children, and infrequent integration and co-delivery of routine vaccines with other health interventions such as COVID-19 vaccination and insecticidal net distribution. There are inaccurate population estimates and a lack of guidance from ministries of health for measuring and monitoring zero-dose and under-immunized children. Respondents conflated advocacy with mobilization, and advocacy was broadly characterized as an ad hoc activity mostly connected to immunization campaigns.

Conclusions
Our study underscored the complexity of vaccinating zero-dose and under-immunized children in crisis-affected states of Sudan. Further research is needed to evaluate these practices and the role of non-governmental organizations (NGOs) and community engagement in improving vaccination coverage. Furthermore, exploring alternative funding methods and using geographic information systems (GIS) could enhance vaccination data and address funding limitations.
Multi-locus investigation of Anopheles-mediated selective pressure on Plasmodium falciparum in Africa
Authors: Gunarathna Isuru , Spear Joseph D. , Carter Tamar E. 
Published: December 2024

Abstract
Background
The high burden of malaria in Africa is largely due to the presence of competent and adapted Anopheles vector species. With invasive Anopheles stephensi implicated in malaria outbreaks in Africa, understanding the genomic basis of vector-parasite compatibility is essential for assessing the risk of future outbreaks due to this mosquito. Vector compatibility with P. falciparum arises from ancient coevolution and involves genes such as Pfs47 in P. falciparum and P47Rec in Anopheles. Questions remain about whether sub-continental vector variation is a selective pressure on current Plasmodium populations.

Methods
We analyzed the genetic diversity in parasite–vector interaction genes in P. falciparum and An. gambiae from 9 and 15 countries in Africa, respectively. Specifically, we looked for evidence of malaria vector-mediated selection within three P. falciparum genes (Pfs47, Pfs16, Pfs37) and conducted association analyses with occurrence probabilities of prominent malaria vectors.

Results
Higher protein haplotype diversities of Pfs47 and Pfs16 were associated with the probability of occurrence of An. arabiensis and An. funestus together. Only Pfs16 carried a signature of positive selection consistently (average Tajima’s D = −2.96), which was associated with the probability of occurrence of An. funestus. These findings support vector-mediated selection on the basis of vector species diversity that may be occurring within Africa. We also employed phylogenetic analyses of An. gambiae interaction genes (P47Rec, APN1, HPX15) to identify significant subspecies diversity as a prerequisite to vector-population-mediated selection. Anopheles gambiaeHPX15 revealed significant within-species differentiation (multiple branches bootstrap > 70) compared with absence of variation in P47Rec, suggesting that further investigation into subspecies-mediated selection on the basis of HPX15 is needed. Finally, we observed five amino acid changes at P47Rec in invasive An. stephensi compared with dominant African Anopheles species, calling for further investigation of the impact these distinct P47Rec variants might have on local African P. falciparumPfs47 diversity.

Conclusions
Overall, these findings suggest that vector variation within Africa could influence P. falciparum diversity and lay a genomic framework for future investigation of invasive An. stephensi’s impact on African malaria.

Graphical Abstract
Developing and disseminating an electronic penicillin allergy de-labelling tool using the model for improvement framework
Authors: Saravanabavan Sujen , McKernan Patrick , Cameron Scott , Kwan Natasha , Kang Kristopher T. , Roberts Ashley , Carr Roxane , Mak Raymond , Elwood Chelsea , Paquette Vanessa , Stimpson Rochelle , Abrahams Bethina , Chan Edmond S. , Slayter Kathryn , Rahier Alicia , Sainchuk Irina , Olsen Sharla , Kucey Melissa , Shamseddine Jinan , Babiker Zahir Osman Eltahir , Wong Tiffany 
Published: December 2024

Abstract
Background
Many clinicians feel uncomfortable with de-labelling penicillin allergies despite ample safety data. Point of care tools effectively support providers with de-labelling. This study’s objective was to increase the number of providers intending to pursue a penicillin oral challenge by 15% by February 2023.

Methods
A validated de-labelling algorithm was translated into an electronic point of care tool and disseminated to eight healthcare institutions. Applying the Model for Improvement Framework, three PDSA cycles were conducted, where collected data and completed surveys were analysed to implement changes. Number of providers intending to pursue an oral challenge, tool usage as well as number of clinicians who felt satisfied with the tool and felt confident in its ability to risk-stratify patients was collected.

Results
50.4% of providers intended to give an oral challenge of penicillin with version 1, which improved to 65.5% with version 2, representing a 15.1% increase. With version 1 of the tool, there was an average of 61.3 counts of tool usage per month. 73.1% of providers felt satisfied with the tool and 76.9% felt confident in its ability to risk-stratify patients. With version 2 of the tool, after implementing changes through three PDSA cycles, monthly usage counts increased to an average of 98.6. Furthermore, 100.0% of providers felt satisfied with the tool and 98.1% felt confident with the tool’s ability to risk-stratify patients.

Conclusion
Our quality improvement approach demonstrated improvement in the percentage of providers that intended to pursue an oral challenge and felt satisfied and confident in the risk-stratification capabilities of penicillin allergy de-labelling tool. Electronic tools should be further incorporated into institutional penicillin de-labelling protocols.
Attenuated sex-related DNA methylation differences in cancer highlight the magnitude bias mediating existing disparities
Authors: Zhou Jiaqi , Li Miao , Chen Yu , Wang Shangzi , Wang Danke , Suo Chen , Chen Xingdong 
Published: December 2024

Abstract
Background
DNA methylation (DNAm) influences both sex differences and cancer development, yet the mechanisms connecting these factors remain unclear.

Methods
Utilizing data from The Cancer Genome Atlas, we conducted a comprehensive analysis of sex-related DNAm effects in nine non-reproductive cancers, compared to paired normal adjacent tissues (NATs), and validated the results using independent datasets. First, we assessed the extent of sex differential DNAm between cancers and NATs to explore how sex-related DNAm differences change in cancerous tissues. Next, we employed a multivariate adaptive shrinkage approach to model the covariance of cancer-related DNAm effects between sexes, aiming to elucidate how sex impacts aberrant DNAm patterns in cancers. Finally, we investigated correlations between the methylome and transcriptome to identify key signals driving sex-biased DNAm regulation in cancers.

Results
Our analysis revealed a significant attenuation of sex differences in DNAm within cancerous tissues compared to baseline differences in normal tissues. We identified 3,452 CpGs (Pbonf < 0.05) associated with this reduction, with 72% of the linked genes involved in X chromosome inactivation. Through covariance analysis, we demonstrated that sex differences in cancer are predominantly driven by variations in the magnitude of shared DNAm signals, referred to as “amplification.” Based on these patterns, we classified cancers into female- and male-biased groups and identified key CpGs exhibiting sex-specific amplification. These CpGs were enriched in binding sites of critical transcription factors, including P53, SOX2, and CTCF. Integrative multi-omics analyses uncovered 48 CpG-gene-cancer trios for females and 380 for males, showing similar magnitude differences in DNAm and gene expression, pointing to a sex-specific regulatory role of DNAm in cancer risk. Notably, several genes regulated by these trios were previously identified as drug targets for cancers, highlighting their potential as sex-specific therapeutic targets.

Conclusions
These findings advance our understanding of how sex, DNAm, and gene expression interact in cancer, offering insights into the development of sex-specific biomarkers and precision medicine.
Predictors of intention to stay in the profession among novice nurses: a cross-sectional study
Authors: Savitsky Bella , Shvartsur Rachel , Kagan Ilya 
Published: December 2024

Abstract
Background
Preserving new graduate nurses in the profession is an essential step for addressing the nursing shortage and sustaining the future of the profession. This study aimed to examine the relationship between employment characteristics and job satisfaction of novice nurses and their willingness to stay in the nursing profession in the next 5 years.

Methods
Novice nurses’ intention to stay in the profession was assessed, considering demographics, employment characteristics, and components of job satisfaction. Among the sample of 216 novice nurses (93% response rate), four components of job satisfaction were extracted and included in the multivariable logistic regression model with the intention to stay in the profession as a dependent variable.

Results
Professional self-accomplishment was significantly and positively associated with the intention to stay in the profession, with an elevation of one standard deviation in this component associated with more than a two-fold increase in the odds of staying (OR = 2.3, 95% CI 1.3–3.9). This component contributed 10% to the variance in intention to stay. Independently, managerial support also contributed 10% to the variance and was significantly associated with willingness to stay (OR = 1.9, 95% CI 1.2–3.0). Overall, self-accomplishment, managerial support, and healthier organizational culture were significantly associated with novice nurses’ intention to stay, whereas work conditions and rewards were not. The multivariable analysis model explained 38.0% of the variance in the intention to stay in the profession.

Conclusions
This study found that novice nurses’ intention to stay in the profession is highly associated with their self-accomplishment and better managerial support. Thus, to enhance the retention of novice nurses, managers must establish an environment that fosters professional development and support. This involves providing engaging work assignments, facilitating the seamless integration of novice nurses into the team, and offering managerial support and guidance.
Automated surveillance for surgical site infections (SSI) in hospitals and surveillance networks–expert perspectives for implementation
Authors: Denkel Luisa A. , Arnaud Isabelle , Brekelmans Manon , Puig-Asensio Mireia , Amin Hoger , Gubbels Sophie , Iversen Pernille , Abbas Mohamed , Presterl Elisabeth , Astagneau Pascal , van Rooden Stephanie ,   PRAISE SSI working group, Aghdassi Seven , Düsseldorf Heike , Mertens Karl , van Mourik Maaike S. M. , van der Werff Suzanne D. 
Published: December 2024

Abstract
Background
This work aims at providing practical recommendations for implementing automated surveillance (AS) of surgical site infections (SSI) in hospitals and surveillance networks. It also provides an overview of the steps, choices, and obstacles that need to be taken into consideration when implementing such surveillance. Hands-on experience with existing automated surveillance systems of SSI (AS SSI systems) in Denmark, France, the Netherlands and Spain is described regarding trend monitoring, benchmarking, quality control, and research for surveillance purposes.

Methods
Between April and October 2023, specific aspects/options of various surveillance purposes for AS SSI were identified during regular meetings of the SSI working group in the PRAISE (Providing a Roadmap for Automated Infection Surveillance in Europe) network. Expert discussions provided the basis for this perspective article.

Results
Decisions for implementation of AS SSI systems highly depend on the purpose of the surveillance. AS SSI systems presented here differ according to study population, setting, central or local implementation; the level of automation, design, and the data sources used. However, similarities were found for the rationales of automation, design principles and obstacles that were identified. There was consensus among all the experts that shortcomings in interoperability of databases, limited time, a want of commitment on the part of stakeholders, and a shortage of resources for information technology (IT) specialists represent the main obstacles for implementing AS SSI. To overcome obstacles, various solutions were reported, including training in the development of AS systems and the interpretation of AS SSI results, early consultation of end-users, and regular exchanges between management levels, IT departments, infection prevention and control (IPC) teams, and clinicians.

Conclusion
Clarity on the intended application (e.g. purpose of surveillance) and information on the availability of electronic and structured data are crucial first steps necessary for guiding decisions on the design of AS systems. Adequate resources for IT specialists and regular communication between management, IT departments, IPC teams, and clinicians were identified as essential for successful implementation. This perspective article may be helpful for a wider implementation of more homogeneous AS SSI systems in Europe.
Differential seasonal performance of C3-epi-D3 level and proportion on multiple metabolic disorders in patients with type 2 diabetes mellitus
Authors: Chen Xiaohong , Peng Bi , Ye Wenchun , Wu Bitao , Yang Qiang , Tang Jie , Yang Yuwei 
Published: December 2024

Abstract
Background and aim
Recent Mendelian randomization and meta analysis suggest a controversial causality between C3-epimer of 25 hydroxyvitamin D3 (C3-epi-D3) and type 2 diabetes mellitus (T2DM). The clinical evidence regarding the impact of C3-epi-D3 on the progression of T2DM is currently insufficient. This study aims to investigate whether C3-epi-D3 has any effect on metabolic disorders of T2DM patients.

Methods
A total of 1222 patients with T2DM were prospectively enrolled in this study and followed up every 1 to 2 months for 3 to 6 months. Kidney biomarkers, lipids, electrolytes, and 25 hydroxyvitamin D (25-OHD) metabolites were measured as required during follow-up, to investigate the association of C3-epi-D3 levels and %C3-epi-D3 with metabolic disorders, including dyslipidemia, chronic kidney disease (CKD), and calcium-phosphorus metabolic disorder.

Results
Among these T2DM patients, there were age and seasonal differences in C3-epi-D3 levels (χ2 = 10.419 and 19.609, P = 0.034 and < 0.001), but only seasonal difference in %C3-epi-D3 (χ2 = 79.299, P < 0.001). C3-epi-D3 levels showed an evident correlation with calcium-phosphorus product during autumn and winter (ρ = − 0.336 and − 0.304, both P < 0.001), and was confirmed as an independent factor on calcium-phosphorus metabolic disorder during autumn and winter by subsequent partial correlation analysis (rpartial = − 0.300 and − 0.319, both P < 0.001). Both C3-epi-D3 levels and %C3-epi-D3 showed evident correlation with the severity of chronic kidney disease (CKD) in summer (ρ = 0.344 and 0.445, both P < 0.001). But subsequent multinomial logistic regression confirmed that only %C3-epi-D3 independently associated with moderate CKD severity in summer (OR = 1.348, P < 0.001), as well as serious CKD severity in spring, summer, and autumn (OR = 1.324, 1.342, and 1.698, all P < 0.001). Additionally, no evident correlation was observed between C3-epi-D3 and dyslipidemia.

Conclusion
Our study releases a seasonally differential impact of C3-epi-D3 levels and proportions on metabolic disorders of T2DM patients, considering to be potentially related to their pathogenesis of different metabolic disorders. The independent association between %C3-epi-D3 and CKD suggests a potential pathological relevance involving C3-epi-D3 itself.
Exchange rate pass-through at high and low frequencies in Turkey: a continuous wavelet transform model approach
Authors: Bilgili Faik , Kuşkaya Sevda , Gençoğlu Pelin , Ünlü Fatma , Magazzino Cosimo 
Published: December 2024

AbstractThis paper investigates the effect of the exchange rate on prices through wavelet analysis for the period 2010:01-2019:12 in Turkey. The Wavelet Transform outcomes reveal that at a higher frequency, an upsurge in the Consumer Price Index (CPI) is associated with an increase in the exchange rate, for the period 2011:03-2013:12, and an increase in the exchange rate is accompanied by a higher CPI during the 2015:02-2018:10 period. Moreover, at a lower frequency, an increase in CPI is accompanied by a rise in the exchange rate during the 2014:01-2017:12 period. These results highlight that the pass-through effect is empirically confirmed in Turkey. It is also shown that the power of the pass-through effect might vary from one sub-sample period to another with different frequencies.