bluuebunny/crossref_metadata_2025_split huggingface dataset:
Precision Medicine Enables More TNM-Like Staging in Patients With Chronic Limb Threatening Ischemia
Authors: McGinigle Katharine L. , Freeman Nikki L. B. , Marston William A. , Farber Alik , Conte Michael S. , Kosorok Michael R. , Kalbaugh Corey A. 
Published: July 2021

Introduction: In cancer, there are survival-based staging systems and tailored, stage-based treatments. There is little personalized treatment in vascular disease. The 2019 Global Vascular Guidelines on the Management of CLTI proposed successful treatment hinges upon Patient risk, Limb severity, and ANatomic complexity (PLAN). We sought to confirm a three axis approach and define how increasing severity affects mortality, not just limb loss.Methods: Patients revascularized for incident CLTI at our institution from 2013 to 2017 were included. Outcomes were mortality, limb loss, the composite endpoint of amputation-free survival. Using Bayesian machine learning, specifically supervised topic modeling, clusters of patient features associated with mortality were formed after controlling for revascularization type. Patients were assigned to the cluster they belonged to with highest probability; clusters were characterized by analyzing the characteristics of patients within them. Patient outcomes were used to order the clusters into stages with increasing mortality.Results: We defined three distinct clusters as the basis for patient- and limb-centered stages. Across stages, rates of 1-year mortality were 7.6, 13.8, 18.9% and rates of amputation-free survival were 84.8, 79.3, and 63.2%. Stage one had patients with rest pain and previous revascularization who were less likely to have wounds, diabetes, and renal disease. Stage two had doubled mortality, likely related to diabetes prevalence. Stage three is characterized by high rates of complicated comorbidities, particularly end stage renal disease, and significantly higher rate of limb loss (22.6 vs. 8% in stages one and two).Conclusion: Using precision medicine, we have demonstrated clustering of CLTI patients that can be used toward a robust staging system. We provide empiric evidence for PLAN and detail about how changes in each variable affect survival and amputation-free survival.
Added Value of Vaisala AQT530 Sensors as a Part of a Sensor Network for Comprehensive Air Quality Monitoring
Authors: Petäjä Tuukka , Ovaska Aino , Fung Pak Lun , Poutanen Pyry , Yli-Ojanperä Jaakko , Suikkola Jari , Laakso Mikko , Mäkelä Taneli , Niemi Jarkko V. , Keskinen Jorma , Järvinen Anssi , Kuula Joel , Kurppa Mona , Hussein Tareq , Tarkoma Sasu , Kulmala Markku , Karppinen Ari , Manninen Hanna E. , Timonen Hilkka 
Published: July 2021

Poor air quality influences the quality of life in the urban environment. The regulatory observation stations provide the backbone for the city administration to monitor urban air quality. Recently a suite of cost-effective air quality sensors has emerged to provide novel insights into the spatio-temporal variability of aerosol particles and trace gases. Particularly in low concentrations these sensors might suffer from issues related e.g., to high detection limits, concentration drifts and interdependency between the observed trace gases and environmental parameters. In this study we characterize the optical particle detector used in AQT530 (Vaisala Ltd.) air quality sensor in the laboratory. We perform a measurement campaign with a network of AQT530 sensors in Helsinki, Finland in 2020–2021 and present a long-term performance evaluation of five sensors for particulate (PM10, PM2.5) and gaseous (NO2, NO, CO, O3) components during a half-year co-location study with reference instruments at an urban traffic site. Furthermore, short-term (3–5 weeks) co-location tests were performed for 25 sensors to provide sensor-specific correction equations for the fine-tuning of selected pollutants in the sensor network. We showcase the added value of the verified network of 25 sensor units to address the spatial variability of trace gases and aerosol mass concentrations in an urban environment. The analysis assesses road and harbor traffic monitoring, local construction dust monitoring, aerosol concentrations from fireworks, impact of sub-urban small scale wood combustion and detection of long-range transport episodes on a city scale. Our analysis illustrates that the calibrated network of Vaisala AQT530 air quality sensors provide new insights into the spatio-temporal variability of air pollution within the city. This information is beneficial to, for example, optimization of road dust and construction dust emission control as well as provides data to tackle air quality problems arising from traffic exhaust and localized wood combustion emissions in the residential areas.
Predicting In-hospital Mortality Using D-Dimer in COVID-19 Patients With Acute Ischemic Stroke
Authors: Kim Youngran , Khose Swapnil , Abdelkhaleq Rania , Salazar-Marioni Sergio , Zhang Guo-Qiang , Sheth Sunil A. 
Published: July 2021

Background: Coronavirus disease 2019 (COVID-19) has been associated with coagulopathy, and D-dimer levels have been used to predict disease severity. However, the role of D-dimer in predicting mortality in COVID-19 patients with acute ischemic stroke (AIS) remains incompletely characterized.Methods: We conducted a retrospective cohort study using the Optum® de-identified COVID-19 Electronic Health Record dataset. Patients were included if they were 18 or older, had been hospitalized within 7 days of confirmed COVID-19 positivity from March 1, 2020 to November 30, 2020. We determined the optimal threshold of D-dimer to predict in-hospital mortality and compared risks of in-hospital mortality between patients with D-dimer levels below and above the cutoff. Risk ratios (RRs) were estimated adjusting for baseline characteristics and clinical variables.Results: Among 15,250 patients hospitalized with COVID-19 positivity, 285 presented with AIS at admission (2%). Patients with AIS were older [70 (60–79) vs. 64 (52–75), p &lt; 0.001] and had greater D-dimer levels at admission [1.42 (0.76–3.96) vs. 0.94 (0.55–1.81) μg/ml FEU, p &lt; 0.001]. Peak D-dimer level was a good predictor of in-hospital mortality among all patients [c-statistic 0.774 (95% CI 0.764–0.784)] and among patients with AIS [c-statistic 0.751 (95% CI 0.691–0.810)]. Among AIS patients, the optimum cutoff was identified at 5.15 μg/ml FEU with 73% sensitivity and 69% specificity. Elevated peak D-dimer level above this cut-off was associated with almost 3 times increased mortality [adjusted RR 2.89 (95% CI 1.87–4.47), p &lt; 0.001].Conclusions: COVID-19 patients with AIS present with greater D-dimer levels. Thresholds for outcomes prognostication should be higher in this population.
An Exploratory Study on the Stable Radiomics Features of Metastatic Small Pulmonary Nodules in Colorectal Cancer Patients
Authors: Liu Caiyin , Meng Qiuhua , Zeng Qingsi , Chen Huai , Shen Yilian , Li Biaoda , Cen Renli , Huang Jiongqiang , Li Guangqiu , Liao Yuting , Wu Tingfan 
Published: July 2021

ObjectivesTo identify the relatively invariable radiomics features as essential characteristics during the growth process of metastatic pulmonary nodules with a diameter of 1 cm or smaller from colorectal cancer (CRC).MethodsThree hundred and twenty lung nodules were enrolled in this study (200 CRC metastatic nodules in the training cohort, 60 benign nodules in the verification cohort 1, 60 CRC metastatic nodules in the verification cohort 2). All the nodules were divided into four groups according to the maximum diameter: 0 to 0.25 cm, 0.26 to 0.50 cm, 0.51 to 0.75 cm, 0.76 to 1.0 cm. These pulmonary nodules were manually outlined in computed tomography (CT) images with ITK-SNAP software, and 1724 radiomics features were extracted. Kruskal-Wallis test was performed to compare the four different levels of nodules. Cross-validation was used to verify the results. The Spearman rank correlation coefficient is calculated to evaluate the correlation between features.ResultsIn training cohort, 90 features remained stable during the growth process of metastasis nodules. In verification cohort 1, 293 features remained stable during the growth process of benign nodules. In verification cohort 2, 118 features remained stable during the growth process of metastasis nodules. It is concluded that 20 features remained stable in metastatic nodules (training cohort and verification cohort 2) but not stable in benign nodules (verification cohort 1). Through the cross-validation (n=100), 11 features remained stable more than 90 times.ConclusionsThis study suggests that a small number of radiomics features from CRC metastatic pulmonary nodules remain relatively stable from small to large, and they do not remain stable in benign nodules. These stable features may reflect the essential characteristics of metastatic nodules and become a valuable point for identifying metastatic pulmonary nodules from benign nodules.
Development, Optimization and Evaluation of 2-Methoxy-Estradiol Loaded Nanocarrier for Prostate Cancer
Authors: Alhakamy Nabil A. , Ahmed Osama A. , Fahmy Usama A. , Asfour Hani Z. , Alghaith Adel F. , Mahdi Wael A. , Alshehri Sultan , Md Shadab 
Published: July 2021

The therapeutic efficacy of antineoplastic agents possessing a selective target to the nucleus of the cancer cells could be enhanced through novel formulation approaches. Thus, toward the improvement of the anticancer potential of 2-methoxy estradiol (2 ME) on prostate cancer, the drug was entrapped into the hydrophobic micelles core formulated with Phospholipon 90G and d-α-tocopheryl polyethylene glycol succinate (TPGS). Optimization of the formulation was done by Box-Behnken statistical design using Statgraphics software to standardize percentages of TPGS and phospholipid to obtain the smallest particle size. The optimized formulation was found to be spherical with nanometer size of 152 ± 5.2 nm, and low PDI (0.234). The entrapment efficiency of the micelles was 88.67 ± 3.21% with &gt;93% release of 2 ME within 24 h. There was a 16-fold increase in apoptosis and an 8-fold increase in necrosis of the PC-3 cells when incubated with 2 ME micellar delivery compared to control cells (2.8 ± 0.2%). This increased apoptosis was further correlated with increased BAX expression (11.6 ± 0.7) and decreased BCL-2 expression (0.29 ± 0.05) in 2 ME micelles treated cells when compared to the control group. Further, loss of mitochondrial membrane potential (∼50-fold) by the drug-loaded micelles and free drug compared to control cells was found to be due to the generation of ROS. Findings on cell cycle analysis revealed the significant arrest of the G2-M phase of the PC-3 cells when incubated with the optimized formulation. Simultaneously, a significantly increased number of cells in pre-G1 revealed the maximum apoptotic potential of the drug when delivered via micellar formulation. Finally, upregulation of caspase-9, p53, and NO, with downregulation of TNF-α, NF-κβ, and inflammatory mediators of the PC-3 cells established the superiority of the micellar approach against prostate cancer. In summary, the acquired results highlighted the potentiality of the 2 ME-micellar delivery tool for controlling the growth of prostate cancer cells for improved efficacy.
Physiological Responses and Bout Analysis in Elite Kickboxers During International K1 Competitions
Authors: Rydzik Łukasz , Maciejczyk Marcin , Czarny Wojciech , Kędra Andzej , Ambroży Tadeusz 
Published: July 2021

Background:Kickboxing is a combat sport with various forms of competition. Kickboxing according to the K1 rules is one of the most interesting and quickly developing forms of kickboxing. According to the K1 rules, it is possible to use a variety of techniques with great force. The aim of this study was to investigate the physiological responses during a real sports fight and to perform a technical and tactical analysis of the kickboxing bout according to the K1 rules.Methods:This study was conducted during two cycles of the international kickboxing league according to the K1 rules in a group of 15 elite athletes. The indicators of technical and tactical training were evaluated in real sports bout. Blood lactate (LA) levels and heart rate (HR) were measured during and after the bout.Results:The efficiency of the attack was on average 59.3 ± 2.7, its effectiveness was 50.3 ± 10.01, and its activeness was 112.3 ± 29. The peak LA concentration was 14.6 ± 1.9 mmol/L. LA concentration did not decrease to baseline after 20 min of recovery.Conclusion:A kickboxing bout was found to induce strong physiological stress for the participants. Reported HR and LA concentration show that the intensity of the fight was close to maximal, and anaerobic metabolism played an important role during a fight.
Factors Associated With Fear of Cancer Recurrence in Family Caregivers of Cancer Survivors: A Systematic Review
Authors: O'Rourke Louise , Fisher Peter L. , Campbell Sophie , Wright Amelia , Cherry Mary Gemma 
Published: July 2021

Objective: Fear of cancer recurrence (FCR) is a significant concern for family caregivers of cancer survivors and is associated with many adverse outcomes, including increased emotional distress and poorer quality of life. Although several theoretical models have been proposed to account for FCR in cancer survivors, their applicability to caregivers is unknown. The aim of this review was to identify clinical, demographic and psychological factors that are associated with, and predict, FCR in caregivers of cancer survivors.Method: AMED, CINAHL, Medline, PsycINFO, and Scopus were systematically searched for relevant studies reporting quantitative data on factors associated with FCR or similar constructs (e.g., worry or anxiety about cancer recurrence) in family caregivers of adult cancer survivors. Included studies were assessed for methodological quality using a standardized checklist adapted from the Agency for Healthcare Research and Quality.Results: Sixteen studies, half of which were cross-sectional, were included and summarized narratively. Non-modifiable factors, including age (n = 6) and treatment modality (n = 4), were found to be associated with increased FCR. Significant positive associations were also reported between illness perceptions and FCR (n = 3). However, there was heterogeneity across included studies with regards to factors examined and most were conducted in the USA. There were also several methodological limitations to the included studies.Conclusions: Research examining FCR in caregivers of cancer survivors has predominantly focused on demographic and clinical factors. Given the paucity of research exploring the psychological mechanisms underpinning FCR, future research should investigate theoretical underpinnings of FCR in caregivers of cancer survivors to support the development of psychological interventions for this population.Systematic Review Registration: PROSPERO, identifier [CRD42019119729].
Respect Is Central: A Critical Review of Implementation Frameworks for Continuous Quality Improvement in Aboriginal and Torres Strait Islander Primary Health Care Services
Authors: Redman-MacLaren Michelle , Turner (Anmatyerre/Jaru) Nalita Nungarrayi , Taylor Judy , Laycock Alison , Vine Kristina , Thompson (Gurindji) Quitaysha , Larkins Sarah , Carlisle Karen , Thompson Sandra , Bailie Ross , Matthews (Quandamooka) Veronica 
Published: July 2021

Background: Primary health care (PHC) services are complex systems, shaped by an interplay of factors at individual, organisational and broader system levels. For Aboriginal and Torres Strait Islander PHC services, closer relationships with the people they serve, local knowledge of community, and cultural awareness are critical. Continuous quality improvement (CQI) has proven to be an effective process for identification of priority issues in health care delivery and for instigating the design, implementation and evaluation of improvement interventions in these settings. However, wide-scale variation in care quality persists partly due to the mismatch between CQI interventions and context.Methods: This critical review of implementation frameworks for CQI in Aboriginal and Torres Strait Islander primary health care was conducted in two phases: (1) a review of primary published implementation frameworks used in PHC contexts, and (2) a comparison of key features of these frameworks with quality concepts identified by high-improving Aboriginal and Torres Strait Islander PHC services in remote Australia.Results: We found nine primary implementation frameworks previously used in PHC contexts guiding interventions within and between macro (broader contextual) level; meso (health service) level; and micro (community and inter-personal) level systems. There was commonality between these frameworks and key quality concepts in Aboriginal and Torres Strait Islander PHC. However, none of the frameworks covered all concepts with rare consideration of communities driving health improvement, two-way learning (integrating cultural knowledge into healthcare provision), and caring staff—engendering trusting relationships with community enacted through respect.Conclusion: Respect, as a secret essence, privileges the importance of culture, and is an essential element of CQI implementation frameworks for positive change in Aboriginal and Torres Strait Islander PHC services. It is essential to work with communities to design workforce models that grow a caring stable workforce to ensure improvements in quality of care that are effective for their context.
Prevalence and Correlation Analysis of Soil-Transmitted Helminths Infections and Treatment Coverage for Preschool and School Aged Children in Kenya: Secondary Analysis of the National School Based Deworming Program Data
Authors: Okoyo Collins , Campbell Suzy J. , Minnery Mark , Owaga Chrispin , Onyango Nelson , Medley Graham , Mwandawiro Charles 
Published: July 2021

Background:Soil-transmitted helminths (STH) are among the most common parasitic infections globally, disproportionately affecting children. Treatment of STH in Kenya is often targeted at preschool (PSAC) and school aged (SAC) children delivered through annual mass drug administration (MDA) in primary schools. Understanding group-specific prevalence and dynamics between treatment and coverage is critical for continued treatment success. This study aims to provide detailed information on group-specific infection prevalence and relative reductions (RR), and their relationships with treatment coverage over time. Additionally, it aims to quantify the correlation between the observed school level infection prevalence and treatment coverage.Methods:Secondary analysis of existing data collected between 2012 and 2018 by the monitoring and evaluation (M&amp;E) program of the National School-Based Deworming (NSBD) program was used. The M&amp;E program conducted surveys utilizing cross-sectional study design, at four survey time points, in a nationally-representative sample of schoolchildren across counties in Kenya. In each participating school, the program randomly sampled 108 children per school, of both groups. Infection prevalence was estimated using binomial regression, RR in prevalence using multivariable mixed effects model, statistical correlations using structural equation modeling, and change-point-analysis using the binary segmentation algorithm.Results:Overall, STH prevalence for PSAC was 33.7, 20.2, 19.0, and 17.9% during Year 1 (Y1), Year 3 (Y3), Year 5 (Y5), and Year 6 (Y6) surveys, respectively with an overall RR of 46.9% (p= 0.001) from Y1 to Y6. Similarly, overall STH prevalence for SAC was 33.6, 18.4, 14.7, and 12.5% during Y1, Y3, Y5, and Y6 surveys, respectively with an overall RR of 62.6% (p&lt; 0.001). An overall (all time points) significant but very weak negative correlation was found between treatment coverage and undifferentiated STH prevalence (r= −0.144,p= 0.002) among PSAC but not in SAC. Further, we observed inter-county heterogeneity variation in infection prevalence, RR, as well as correlations.Conclusion:The analysis showed that after six rounds of MDA, prevalence of STH has significantly declined among both groups of children, however not to a point where it is not a public health problem (below 1%). The analysis, additionally established an overall significant but weak negative correlation between treatment coverage and prevalence, indicating that the current treatment coverage might not be sufficient to drive the overall STH prevalence to below 1%. These findings will allow STH control programs in Kenya to make decisions that will accelerate the attainment of STH elimination as a public health problem.
Supporting Child Development Through Parenting Interventions in Low- to Middle-Income Countries: An Updated Systematic Review
Authors: Zhang Linlin , Ssewanyana Derrick , Martin Marie-Claude , Lye Stephen , Moran Greg , Abubakar Amina , Marfo Kofi , Marangu Joyce , Proulx Kerrie , Malti Tina 
Published: July 2021

Background: Over 250 million children in low- and middle-income countries are at risk of not achieving their fullest developmental potential due to co-occurring risks such as poor nutrition and inadequate learning opportunities. Early intervention programs integrating the aspects of nurturing care, that is, good health, adequate nutrition, safety and security, responsive caregiving, and learning opportunities, may ameliorate against the negative impact of these adverse conditions.Methods: This meta-analytic review updates the evidence base of parenting interventions comprising stimulation and responsive caregiving components on developmental outcomes for children under age 2 years in low- and middle-income countries. It also describes and assesses the moderation effects of population characteristics and implementation features on the intervention effectiveness. Studies were identified based on previous systematic reviews and an updated literature search in eight databases and the gray literature up to December 2020. A random-effect model was used to explore the pooled effect sizes accounted for by the intervention for developmental outcome of cognition, language, motor, and social-emotional capacities. Exploratory moderation analyses were also conducted.Results: Twenty-one randomized controlled trials representing over 10,400 children from 12 low- and middle-income countries and regions across three continents (Africa, Latin America, and Asia) were identified. The interventions showed overall small-to-moderate effects on children's cognitive development (ES = 0.44; 95% CI = [0.30, 0.57]); language development (ES = 0.33; 95% CI = [0.18, 0.49]); and motor skills (ES = 0.21; 95% CI = [0.10, 0.32]). The overall effect on social-emotional development was non-significant (ES = 0.17; 95% CI = [−0.01, 0.34]). Effect sizes (ES) varied significantly across the studies. Parenting programs that targeted vulnerable groups, including rural communities and caregivers with lower education levels, had more significant effects on children's development. Group sessions (vs. individual visits) and high program dose (≥12 sessions) were also associated with stronger effects on child development. Further research is needed to determine the effectiveness of the workforce and training on programmatic outcomes.Conclusion: The findings indicate that parenting interventions that encourage nurturing care are effective in improving the early development of children, especially among vulnerable populations. We discuss opportunities to strengthen the implementation of research-based parenting interventions in such contexts.