bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing Inequities in Cervical Cancer Quality of Care and Survival Related to Ethnicity and Socioeconomic Factors
Authors: Cantwell Christopher J. , Moroney Marisa R. , Sheeder Jeanelle , Guntupalli Saketh R. 
Published: May 2021

Objective
This study aimed to assess the effect that race and socioeconomic factors have on the provision of care to cervical cancer patients based on National Comprehensive Cancer Network (NCCN) recommended treatment guidelines.

Materials and Methods
To do this, we completed a retrospective cohort study using the American College of Surgeon's Nation Cancer Database from 2004 to 2016. We identified all reported cases of cervical cancer in that period. Two cohorts were created using self-reported racial demographic data, Hispanic- and White, non-Hispanic–identified patients. Our primary outcome variables were adherence to NCCN-recommended treatment and 5-year overall survival. Adherence to NCCN-recommended treatment was determined by the provision of surgical and/or radiation and/or chemotherapy treatment based on the clinical stage at time of diagnosis and the presence or absence of lymphovascular space invasion. We used bivariate analyses to compare baseline characteristics between the 2 cohorts, multivariable logistic regression to identify independent predictors of 5-year survival, and Cox proportional hazards models to compute survival by group.

Results
The difference in NCCN-adherent care between the 2 cohorts was found to be not statistically significant (p = .880). A log rank (Mantel-Cox) χ2 test showed that there was a statistically significant difference between the 2 groups in overall survival with the Hispanic-identified patients living longer (p < .001). Our study is limited by the effect large databases confer on finding statistical significance.

Conclusions
Hispanic-identified women with cervical cancer receive NCCN-compliant care and live longer than their White, non-Hispanic counterparts.
Paired Testing of Sexually Transmitted Infections With Urine Pregnancy Tests in Incarcerated Women
Authors: Dang Christine M. , Pao Julie , Taherzadeh Dena , Nijhawan Ank E. 
Published: May 2021

Background
In correctional facilities, sexually transmitted infections (STIs) are common, are often asymptomatic, and may lead to adverse outcomes such as infertility and increased HIV acquisition. In January 2020, testing for Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) was paired with routine urine pregnancy tests among women entering a large county jail to increase testing and detection of STIs.

Methods
The results of all GC/CT urine tests in the Dallas County Jail were collected from October 2019 to February 2020. Medical records were reviewed to collect demographic factors and to determine the positivity of GC/CT infections, time to results, and time to treatment.

Results
With paired testing, monthly testing rates increased 4.7-fold among incarcerated females from 125 to 589 tests without substantial change for males (174 to 163). The number of infections detected in females increased from 25 (7%) of 359 to 62 (5.3%) of 1171 for GC and 42 (11.2%) of 374 to 129 (11%) of 1177 for CT without a significant difference in GC (P = 0.23) or CT positivity (P = 0.66). Younger women (≤25 years) had the highest rates of CT (18.8% [66/350]), whereas GC was highest among women aged 31 to 35 years (9.9% [32/321]). Average time to results and treatment were 5.8 and 1.8 days, respectively.

Conclusions
Pairing GC/CT testing with routine urine pregnancy tests resulted in a large (4.7-fold) increase in the number of STI tests and a comparable increase (3.7- to 4.6-fold) in the number of infections detected. Future efforts should focus on incorporating STI testing into routine jail practices and expediting treatment to further improve outcomes in this vulnerable population.
A Narrative Review of Where We Are With Point-of-Care Sexually Transmitted Infection Testing in the United States
Authors: Gaydos Charlotte A. , Manabe Yukari C. , Melendez Johan H. 
Published: May 2021

Background
Point-of-care (POC) tests enable immediate diagnosis and targeted treatment of sexually transmitted infections (STIs), which could accelerate control of ongoing epidemics. Although older nucleic acid amplification tests have improved the accuracy of laboratory-based tests for STIs, newer POC tests can facilitate control efforts. We sought to review the performance and time to result of POC assays for STIs in the last 10 years.

Methods
The authors performed a PubMed, US National Library of Medicine, National Center for Biotechnology Information search for POC tests for STIs or sexually transmitted diseases.

Results
Diagnostic technology for POC assays for STIs has achieved high sensitivity and specificity (>90%) using recent molecular advances in the last 10 years. Three POC tests for chlamydia and gonorrhea and 2 for trichomonas have been cleared by the Food and Drug Administration and can provide rapid results during the clinical encounter. Two POC assays for syphilis are now cleared by the Food and Drug Administration. Other similar POC assays are in development. These “fast followers” have faster time to result and will extend the diagnostic armamentarium at POC.

Conclusions
New technology has improved the performance accuracy of STI POC diagnostics. Innovation in device format has resulted in accurate POC assays, which can decrease the time to result and accelerate the detection and treatment of STIs during the clinical encounter. The full implementation potential of these newer tests will depend on the ability of these tests to achieve Clinical Laboratory Improvement Amendments–waived status so they can be performed by nonlaboratorians with no previous training.
Low Awareness of Mycoplasma genitalium in Men Who Have Sex With Men in Sydney, Australia
Authors: Varma Rick , Bradley Isabella , Patel Prital , McNulty Anna 
Published: May 2021

Objectives

Mycoplasma genitalium (M. genitalium) is a sexually transmitted infection of importance because of the high prevalence rates and antimicrobial resistance (AMR) among men who have sex with men (MSM).

Methods
A prospective cross-sectional analysis was carried out on MSM who presented rectally asymptomatic at a central Sydney sexual health clinic or a community site for routine testing. Between March and May 2017, participants were asked to complete a questionnaire before testing. We used multivariable logistic regression to identify factors associated with awareness and concern toward M. genitalium and AMR.

Results
Overall, 692 (92.5%) of 746 (95% confidence interval [CI], 90.7–94.5) MSM had no prior awareness of M. genitalium; 512 (68.6%) of 746 (95% CI, 65.2–72.0) were not concerned or were neutral about the infection; and 234 (31.4%) of 746 (95% CI, 28.0–34.8) were a little, somewhat, or very concerned. High partner numbers (adjusted odds ratio [AOR], 4.2; 95% CI, 2.1–8.2) and inconsistent condom users (AOR, 3.1; 95% CI, 1.2–8.2) and no condoms used (AOR, 3.9; 95% CI, 1.2–12.6) were associated with awareness of the infection. Time since arrival in Australia of more than 10 years (AOR, 1.73; 95% CI, 1.09–2.75), more than 12 months (AOR, 1.91; 95% CI, 1.31–2.79), and recreational drug use (AOR, 1.95; 95% CI, 1.17–3.24) were associated with concern around having M. genitalium. Overall, 61.6% (458/744; 95% CI, 58.2–65.3) MSM reported that they would increase condom use (38.6% agreed and 23.1% strongly agreed) after reading about AMR. Among the remaining 38.4% (286/744), 28.4% indicated a neutral response to increasing their condom use. Relative to MSM born in Australia, Latin American (AOR, 7.3; 95% CI, 2.9–18.4) or Asian MSM (AOR, 2.3; 95% CI, 1.4–3.3), were significantly more likely to increase condom use after reading a statement on AMR.

Conclusions
Knowledge of M. genitalium remains low among MSM. Targeted messages using AMR and treatment difficulties with M. genitalium is unlikely to change behavior for a large proportion of MSM.
Effects of Patient Sexual Orientation and Gender Identity on Medical Students' Decision Making Regarding Preexposure Prophylaxis for Human Immunodeficiency Virus Prevention: A Vignette-Based Study
Authors: Bunting Samuel R. , Feinstein Brian A. , Hazra Aniruddha , Garber Sarah S. 
Published: May 2021

Introduction
Preexposure prophylaxis (PrEP) is a pillar of our national strategy to end the human immunodeficiency virus (HIV) epidemic. However, one of the largest obstacles to realizing the effectiveness of PrEP is expansion of prescription to all patients at risk for HIV. In this vignette-based study, we sought to investigate medical students' decision making regarding PrEP by presenting fictional patients, all of whom had HIV risk factors based on sexual behavior.

Methods
We systematically varied patients' sexual orientation or gender identity (heterosexual female, gay male, bisexual male, transgender male, transgender female, gender nonbinary person). We assessed the medical students' willingness to prescribe PrEP to the patients, as well as their perceptions of the patients' HIV risk and behavior.

Results
A total of 670 US medical students completed the study. The heterosexual female patient was least frequently identified as a PrEP candidate, was viewed as least likely to adhere to PrEP, and the most likely to engage in condomless sex if prescribed PrEP; however, was considered at lower overall HIV risk. Lower perceived HIV risk and anticipated PrEP adherence were both associated with lower willingness to prescribe PrEP. Willingness to prescribe PrEP was highest for the gay male patient and lowest for the heterosexual female.

Conclusions
These analyses suggest that assumptions about epidemiological risk based on patients' gender identity or sexual orientation may reduce willingness to prescribe PrEP to heterosexual women, ultimately hindering uptake in this critical population.
Early Clinical Prediction of Independent Outdoor Functional Walking Capacity in a Prospective Cohort of Traumatic Spinal Cord Injury Patients
Authors: Jean Stephanie , Mac-Thiong Jean-Marc , Jean Marie-Christine , Dionne Antoine , Bégin Jean , Richard-Denis Andréane 
Published: May 2021

Objective
The first objective was to identify a method for early prediction of independent outdoor functional walking 1 yr after a traumatic spinal cord injury using the motor and sensory function derived from the International Standards for Neurological Classification of Spinal Cord Injury assessment during acute care. Then, the second objective was to develop a clinically relevant prediction rule that would be accurate, easy to use, and quickly calculated in clinical setting.

Design
A prospective cohort of 159 traumatic spinal cord injury patients was analyzed. Bivariate correlations were used to determine the assessment method of motor strength and sensory function as well as the specific dermatomes and myotomes best associated with independent outdoor functional walking 1 yr after injury. An easy-to-use clinical prediction rule was produced using a multivariable linear regression model.

Results
The highest motor strength for a given myotome (L3 and L5) and preserved light touch sensation (dermatome S1) were the best predictors of the outcome. The proposed prediction rule displayed a sensitivity of 84.21%, a specificity of 85.54%, and a global accuracy of 84.91% for classification.

Conclusions
After an acute traumatic spinal cord injury, accurately predicting the ability to walk is challenging. The proposed clinical prediction rule aims to enhance previous work by identifying traumatic spinal cord injury patients who will reach a mobility level that fosters social participation and quality of life in the chronic period after the injury.

To Claim CME Credits
Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME

CME Objectives
Upon completion of this article, the reader should be able to: (1) Revise the different motor and sensory function assessment methods used for prognostication of walking after an acute traumatic spinal cord injury; (2) Identify clinical factors that are significantly associated with functional walking 1 yr after a traumatic spinal cord injury; and (3) Accurately estimate the likelihood of reaching independent outdoor functional walking in the chronic phase after an acute traumatic spinal cord injury.

Level
Advanced

Accreditation
The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Population-Based HIV Impact Assessments Survey Methods, Response, and Quality in Zimbabwe, Malawi, and Zambia
Authors: Sachathep Karampreet , Radin Elizabeth , Hladik Wolfgang , Hakim Avi , Saito Suzue , Burnett Janet , Brown Kristin , Phillip Neena , Jonnalagadda Sasi , Low Andrea , Williams Dan , Patel Hetal , Herman-Roloff Amy , Musuka Godfrey , Barr Beth , Wadondo-Kabonda Nellie , Chipungu Gertrude , Duong Yen , Delgado Stephen , Kamocha Stanley , Kinchen Steve , Kalton Graham , Schwartz Leah , Bello George , Mugurungi Owen , Mulenga Lloyd , Parekh Bharat , Porter Laura , Hoos David , Voetsch Andrew Charles , Justman Jessica 
Published: May 2021

Background:
The population-based HIV impact assessment (population-based HIV impact assessments) surveys are among the first to estimate national adult HIV incidence, subnational prevalence of viral load suppression, and pediatric HIV prevalence. We summarize the survey methods implemented in Zimbabwe, Malawi, and Zambia, as well as response rates and quality metrics.

Methods:
Each cross-sectional, household-based survey used a 2-stage cluster design. Survey preparations included sample design, questionnaire development, tablet programming for informed consent and data collection, community mobilization, establishing a network of satellite laboratories, and fieldworker training. Interviewers collected demographic, behavioral, and clinical information using tablets. Blood was collected for home-based HIV testing and counseling (HBTC) and point-of-care CD4+ T-cell enumeration with results immediately returned. HIV-positive blood samples underwent laboratory-based confirmatory testing, HIV incidence testing, RNA polymerase chain reaction (viral load), DNA polymerase chain reaction (early infant diagnosis), and serum antiretroviral drug detection. Data were weighted for survey design, and chi square automatic interaction detection-based methods were used to adjust for nonresponse.

Results:
Each survey recruited a nationally representative, household-based sample of children and adults over a 6–10-month period in 2015 and 2016. Most (84%–90%) of the 12,000–14,000 eligible households in each country participated in the survey, with 77%–81% of eligible adults completing an interview and providing blood for HIV testing. Among eligible children, 59%–73% completed HIV testing. Across the 3 surveys, 97.8% of interview data were complete and had no errors.

Conclusion:
Conducting a national population-based HIV impact assessment with immediate return of HIV and other point-of-care test results was feasible, and data quality was high.
Construct and Criterion-Related Validity of the Clinical Frailty Scale in Persons With HIV
Authors: McMillan Jacqueline M. , Gill Michael J. , Power Christopher , Fujiwara Esther , Hogan David B. , Rubin Leah H. 
Published: May 2021

Background:
The co-occurrence of frailty and cognitive impairment in older (50+ years) persons with HIV (PWH) is common and increases the risk of poor outcomes. In HIV clinics, the most commonly used frailty measures are the frailty phenotype (FP), which requires measuring grip strength and gait speed to implement, and the frailty index (FI) based on comprehensive health data collected on patients. We examined construct and criterion-related validity (as it predicts cognition) of the Clinical Frailty Scale (CFS), a less resource-intensive approach for assessing frailty, in relation to these more commonly used frailty assessments (FP and FI).

Setting/Methods:
A total of 143 older (age 50+) PWH (mean age 57 years; 88% male) seen at the Southern Alberta Clinic underwent both frailty screening with the FP, CFS, and FI and neuropsychological testing. Mixed-effects regressions examined the associations between frailty status and cognition.

Results:
Concordance with the FP was slightly superior for the CFS than the FI. The FP and CFS had similar associations with domain-specific cognitive performance with frail PWH performing worse than nonfrail individuals on tests requiring manual dexterity (Trail Making Part A and B; Symbol Digit; and Grooved Pegboard; P values <0.05). Neither were associated with executive function, learning, or memory performance. The FI was associated with worse fluency, fine motor skills (Grooved Pegboard), and Trail Making Part A.

Conclusion:
The CFS is a simple screening tool with good construct and criterion-related validity. It was associated with a similar pattern of cognitive deficits as the FP. If confirmed and the associations are extended to other clinically significant characteristics and outcomes, the CFS can be considered as an alternative to the FP and FI in assessing frailty in older PWH.
Brief Report: Young Age and Sex Work Are Associated With HIV Seroconversion Among Transgender Women in São Paulo, Brazil
Authors: Amelia de Sousa Mascena Veras Maria , Roza Saggese Gustavo S. , Gomez Junior José L. , Silveira Paula , Paiatto Beatriz , Ferreira Denis , Alves de Souza Paola , Calado Rodrigo , Castejon Márcia Jorge , Yamashiro Rosemeire , Fernando de Macedo Brígido Luis , Turner Caitlin , Lin Jess , Wilson Erin C , McFarland Willi 
Published: May 2021

Background:
Transgender women worldwide have the highest prevalence of HIV and the lowest access to prevention among groups at risk of HIV. However, few longitudinal studies have directly measured HIV incidence and identified predictors of HIV acquisition among transgender women.

Setting:
São Paulo, Latin America's largest city.

Methods:
We conducted a longitudinal study among transgender women in São Paulo. Participants were recruited by a long-chain peer referral process from May 2017 to July 2019. Those aged 18 years and older and who were HIV-negative at baseline were retested every 6 months up to 18 months. HIV incidence was calculated by dividing the number of seroconversions by the person-years (PYs) of follow-up; 95% confidence intervals (CIs) were constructed assuming a Poisson distribution. Conditional maximum likelihood ratios assessed differences in HIV incidence by risk factors.

Results:
A racially/ethnically diverse sample of 545 HIV-negative transgender women was enrolled. In 485.5 PYs of follow-up, 13 seroconversions were observed, yielding an incidence of 2.68 per 100 PYs (95% CI: 1.43 to 4.58). HIV incidence was significantly higher among transgender women aged 18–24 years (rate ratio 3.85, 95% CI: 1.24 to 12.93) and among those who engaged in sex work in the preceding month (rate ratio 5.90, 95% CI: 1.71 to 26.62).

Conclusions:
HIV transmission continues at a high rate among transgender women in Brazil. Factors such as young age, lower level of education, and limited employment opportunities may lead to dependence on sex work that in turn increases HIV risk. Transgender-friendly prevention services, particularly programs delivering pre-exposure prophylaxis, are urgently needed.
Brief Report: Viral Load Monitoring in Pregnancy to Predict Peripartum Viremia in South Africa
Authors: Odayar Jasantha , Kabanda Siti , Malaba Thokozile R. , Lesosky Maia , Myer Landon 
Published: May 2021

Introduction:
Enhanced postnatal prophylaxis is recommended in infants of women with viremia during labor, as identified by viral load (VL) testing late in pregnancy. However, data on the use of antenatal VL to predict peripartum viremia are few, particularly in women starting antiretroviral therapy (ART) in pregnancy who experience initial VL declines.

Methods:
Between January 2016 and August 2017, we identified HIV-infected women who initiated ART (tenofovir, emtricitabine, and efavirenz) antenatally and had a VL <400 copies/mL before delivery in Cape Town, South Africa. VLs were repeated postdelivery, and sensitivity, specificity, and positive and negative likelihood ratios (LR+ and LR−) for antenatal VL <100 copies/mL in predicting peripartum VLs <100 and <400 copies/mL were calculated.

Results:
Among 322 women (median age 29 years, 44% with a history of ART use, median gestation of antenatal VL 33 weeks), antenatal VL was <100 copies/mL in 89% and 100–400 copies/mL in 11%. At a median 9 days postpartum, 91%, 7%, and 2% of women had a VL <100, 100–400, and >400 copies/mL, respectively. Sensitivity of antenatal VL <100 copies/mL in predicting peripartum VL <100 copies/mL was 0.95 (95% confidence interval: 0.92 to 0.97), and specificity was 0.71 (95% confidence interval: 0.51 to 0.87; LR+ 3.28, LR− 0.07). Performance was slightly weaker to detect peripartum VL <400 copies/mL but was similar across strata of gestation at antenatal VL and history of ART use.

Discussion:
Antenatal VL is a useful predictor of peripartum viremia in women who started ART in pregnancy and attained a VL <400 copies/mL antenatally and may be used to target enhanced postnatal prophylaxis interventions.
Time scale performance of rapid antigen testing for SARS-COV-2: evaluation of ten rapid antigen assays
Authors: Abusrewil Zakarya , Alhudiri Inas M , Kaal Hamza Hussein , El Meshri Salah Edin , Ebrahim Fawzi O. , Dalyoum Tarek , Efrefer Abdussamee A , Ibrahim Khaled , Elfghi Mohammed Ben , Abusrewil Suleiman , Elzagheid Adam 
Published: May 2021

AbstractThere is a great demand for more rapid tests for SARS-COV-2 detection to reduce waiting time, boost public health strategies for combating disease, decrease costs, and prevent overwhelming laboratory capacities. This study was conducted to assess the performance of 10 lateral flow device viral antigen immunoassays for the detection of SARS-CoV-2 in nasopharyngeal swab specimens. We analyzed 231 nasopharyngeal samples collected from October 2020-December 2020, from suspected COVID-19 cases and contacts of positive cases at Biotechnology Research Center laboratories, Tripoli, Libya. The performance of 10 COVID-19 Antigen (Ag) rapid test devices for the detection of SARS-CoV-2 antigen was compared to RT-qPCR. In this study 161 cases had symptoms consistent with COVID-19. The mean duration from symptom onset was 6.6 ±4.3 days. The median cycle threshold (Ct) of positive samples was 25. Among the 108 positive samples detected by RT-qPCR, the COVID-19 antigen (Ag) tests detected 83 cases correctly. All rapid Ag test devices used in this study showed 100% specificity. While tests from 6 manufacturers had an overall sensitivity range from 75-100%, the remaining 4 tests had sensitivity of 50-71.43%. Sensitivity during the first 6 days of symptoms and in samples with high viral loads (Ct<25), was 100% in all but 2 of the test platforms. False negative samples had a median Ct of 34 and an average duration of onset of symptoms of 11.3 days (range=5-20 days). Antigen test diagnosis has high sensitivity and specificity in early disease when patients present less than 7 days of symptom onset. Patients are encouraged to test as soon as they get COVID-19 related symptoms within 1 week and to seek medical advice within 24 hrs. if they develop disturbed smell/taste. The use of rapid antigen tests is important for controlling COVID-19 pandemic and reducing burden on molecular diagnostic laboratories.