bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Retrospective Analysis of Creatinine-Based Kidney Function With and Without Sex Assigned at Birth Among Transgender Adults
Authors: Fadich Sarah K. , Kalayjian Alin , Greene Dina N. , Cirrincione Lauren R. 
Published: October 2021

Background Clinicians use sex-based kidney function estimating equations, but the appropriate sex modifier for transgender adults undergoing hormone therapy (HT) is undetermined. Objectives Compare median estimated creatinine clearance (eCrCL; Cockcroft-Gault) and estimated glomerular filtration rates (eGFRs; Modification of Diet in Renal Disease [MDRD] and Chronic Kidney Disease Epidemiology Study [CKD-EPI]) before and during HT when estimated with and without sex assigned at birth. Methods Single-system retrospective cohort study of transgender adults (2007-2017) prescribed ≥90 days HT (index date = first order) and measured serum creatinine ≤6 months pre-index date (baseline) and ≤12 months post-index date. We grouped patients based on testosterone or estrogen treatment and compared eCrCL and eGFRs at baseline up to 6-12 months post-index date using equations based on sex assigned at birth (female or male modifier in testosterone or estrogen groups, respectively) or gender identity (male or female modifier in testosterone or estrogen groups, respectively). We used Wilcoxon signed-rank tests (Bonferroni correction) for all comparisons. Results In total, 29 (median age 26 years, follow-up 259 days) and 41 patients (29 years, 250 days) were prescribed testosterone or estrogen, respectively. In the testosterone group, the maximum eCrCL and eGFR changes based on sex assigned at birth were −14%, P = 0.0181; −18%; P = 0.0009, respectively, and based on gender identity were +5%, P > 0.025 and +11%, P = 0.0094, respectively. In the estrogen group, eCrCL or eGFRs based on sex assigned at birth did not change from baseline but based on gender identity were −17%, P < 0.0001 and −26%, P < 0.0001, respectively. Conclusion and Relevance Female-based equations may underestimate kidney function in transgender adults undergoing testosterone or estrogen treatment. Prospective cohort studies are needed to confirm the clinical significance of these findings.
Epidemiological Profile and Clinicopathological, Therapeutic, and Prognostic Characteristics of Nasopharyngeal Carcinoma in Northern Morocco
Authors: Reffai Ayman , Mesmoudi Mohamed , Derkaoui Touria , Ghailani Nourouti Naima , Barakat Amina , Sellal Nabila , Mallick Parag , Bennani Mechita Mohcine 
Published: October 2021

Background Nasopharyngeal carcinoma is a multifactorial disease mainly affecting the Asian and North African populations including Morocco. This study aimed to determine the epidemiological profile of nasopharyngeal carcinoma in Northern Morocco as well as its clinicopathological, therapeutic, and prognostic characteristics. Methods 129 patients with nasopharyngeal carcinoma followed at the regional center of oncology of Tangier in the period between April 2017 and July 2019, and diagnosed elsewhere from March 2000 to February 2019, were included in this study. Statistical analysis of the data was realized using Statistical Package for the Social Sciences (SPSS) software. Results Nasopharyngeal carcinoma (NPC) represented 5% of all cases with a median age of 50. The most affected age group was 40–54 years (41.1%). Of all patients, 65.9% were men and 34.1% were women with a sex ratio of 1.93 (Male/Female). Undifferentiated nasopharyngeal carcinomas were the most common histological type affecting 96.12% of patients. At diagnosis, the majority of patients (82.2%) had an advanced stage of NPC (III, VIa, b, c) including 5.4% of metastatic cases (IVc). Most cases (86%) had lymph node involvement with cervical mass being the most common clinical presentation. 81.4% of patients received radiotherapy combined with chemotherapy. Among these patients, 54.3% had concurrent radiochemotherapy preceded by induction chemotherapy. The 5-year overall survival (OS) was 86.8% for all patients. It represented 91.3% for early stages, 87.9% for locally advanced stages, and 57.1% for the metastatic stage significantly. The disease-free survival (DFS) at 5 years was 87.6% knowing that relapse occurred in 16 cases. Conclusions Nasopharyngeal carcinoma is a particular disease with a late declaration. It is common in Morocco as is the case in other endemic areas with a high prevalence. Patients’ survival is significantly influenced by disease staging.
Attention-Deficit/Hyperactivity Disorder as a Risk Factor for COVID-19 Infection
Authors: Cohen Herman Avner , Gerstein Maya , Yaniv Noga , Richenberg Yael , Jacobson Eyal , Marton Shoval , Hoshen Moshe , Shkalim Zemer Vered 
Published: October 2021

Objective: To postulate that ADHD is a potential risk factor for COVID-19 infection; to evaluate the COVID-19 risk factor on drug-treated ADHD subjects. Methods: A retrospective chart review was performed on ADHD subjects aged 6 to 18 years in Israel, who had undergone at least one COVID-19 test during the study period. Results: Of the 64,409 subjects included in the study, 6,207 (9.64%) had at least one positive COVID-19 test result, 13,300 (20.65%) were diagnosed with ADHD, and of whom 1,751 (13%) had purchased at least two ADHD medications 3 months prior to COVID-19 testing and were defined as being medically treated. Medically-treated ADHD subjects had a significantly lower likelihood to be infected with COVID-19 than untreated subjects. Conclusion: Untreated ADHD patients seem to constitute a risk group for COVID-19 infection. Drug treatment ameliorates risk of spreading COVID-19 infection within the pediatric population and secondary spread in the general population.
Multi-Level Analysis and Spatial Interpolation of Distributions and Predictors of Childhood Diarrhea in Nigeria
Authors: Bolarinwa Obasanjo Afolabi , Tadesse Tessema Zemenu , Frimpong James Boadu , Seidu Abdul-Aziz , Opoku Ahinkorah Bright 
Published: October 2021

Background: Diarrhea is one of the health problems contributing to Nigeria’s under-5 mortality rate, ranked as the eighth highest globally. As our search is concerned, there is limited evidence on the spatial distribution of childhood diarrhea in Nigeria. Therefore, this study aimed to examine the spatial distribution and predictors of diarrhea among under-5 children in Nigeria. Materials and Methods: Using data from the child’s recode file of the 2018 Nigeria Demographic and Health Survey, a sample of 28 583 children of women of reproductive age was considered as the sample size for this study. The outcome variable used in this study was childhood diarrhea. We employed both multilevel and spatial analyses to ascertain the factors associated with childhood diarrhea as well as its spatial clustering. Results: The regional distribution of the prevalence of diarrhea among children in Nigeria ranged from 0% to 62%. The hotspots for childhood diarrhea were in Yobe, Bauchi, Gombe, Kano, Sokoto, Imo, and Taraba. The likelihood of a child having diarrhea in Nigeria was higher among women whose partners have secondary education and above [aOR = 1.18; 95%CI = 1.05-1.33], women currently working [aOR = 1.24; 95%CI = 1.13-1.35], women practicing Islam [aOR = 1.24; 95%CI = 1.04-1.46], and women who were exposed to mass media [aOR = 1.29; 95%CI = 1.18-1.42], compared to women whose partners had no formal education, women not currently working, women practicing Christianity, and those who were not exposed to mass media. Children born to mothers who reside in North East [aOR = 2.55; 95%CI = 2.10-3.10], and communities with medium socioeconomic status [aOR = 1.44; 95%CI = 1.09-1.91] were more likely to experience diarrhea compared to those born to mothers residing in the North Central and in communities with low socioeconomic status. Conclusion: High proportions of childhood diarrhea among under-5 children in Nigeria were located in Yobe, Bauchi, Gombe, Kano, Sokoto, Imo, and Taraba. Policies and interventions that seek to reduce or eliminate diarrhea diseases among under-5 children in Nigeria should take a keen interest in the factors identified as predictors of childhood diarrhea in this study as this will help in achieving the aims of WASH, ORT corners, and SDG 3 by the year 2030.
Does tourism activity reduce the size of the informal economy? Capturing long-term heterogeneous linkages around the world
Authors: Salinas Aldo , Ortiz Cristian , Ponce Pablo , Changoluisa Javier 
Published: October 2021

This paper investigates the long-term and causal relationship between tourism activity and the informal economy in 76 countries from 1995 to 2015. We explore this relationship at the global level and by country group, using panel, co-integration techniques that indicate the existence of a long-run co-integration relationship between tourism and informal economy for the whole sample and at the level of country groups. Additionally, the paper analyzes the long-run coefficients of the model by using fully modified ordinary least square regressions (FMOLS). The results from FMOLS evidence a negative and significant impact of tourism on the informal economy at the global level and in high, upper-middle, and lower-middle income countries, but a positive link in low-income countries. However, the results reveal a heterogeneous long-run relationship within country groups. Also, the result of the Dumitrescu-Hurlin Granger causality test indicates bidirectional causality in the global sample, but the direction of causality varies by country group. The main policy implication derived from our findings suggests that in order to reduce the size of informal economy, policy-makers should foster tourism activities. JEL Classification : J01, L83, C23, O57, C00, C01
Diabetes mellitus is associated with an increased incidence of aortic valve stenosis
Authors: Roderburg Christoph , Loosen Sven H , Luedde Tom , Kostev Karel , Luedde Mark 
Published: October 2021

Background: The prognosis of patients with diabetes mellitus (DM) is particularly determined by vascular comorbidities. A recent theory implies that DM could also promote aortic valve stenosis (AS). The present study investigates this association in a large collective of outpatients. Methods: This retrospective cohort study compared the incidence of AS in patients with an initial diagnosis of type 2 DM and a matched non-DM cohort in 809 general and diabetologist practices in Germany between January 2005 and December 2018. Cox regression models were performed to study the association between type 2 DM and AS incidence. Results: A total of 78,805 patients with type 2 DM and 78,805 patients without diabetes were analysed. Diabetes patients were more frequently diagnosed with obesity (52% vs 21%). Four percent of patients with and three percent of without diabetes were diagnosed with AS ( p < 0.001). Diabetes was significantly associated with an increased incidence of AS (HR: 1.36, p < 0.001). This association was higher in men (HR: 1.41) versus women (HR: 1.30). The strongest association was observed in young patients (18–50 years, HR: 2.35, p < 0.001). Conclusion: In our study, diabetes patients had a higher incidence of aortic stenosis during their disease course.
Exploring the use of knobology for image optimisation in final year sonography students
Authors: Mallard Samantha , Kennedy Narelle , Najafzadeh Abriz Afrooz , Quinton Ann 
Published: October 2021

Introduction Image optimisation is essential for acquisition of quality images in ultrasound and critical to the diagnostic ability of the examination. These skills are taught to sonography students early in their education, but research has found that retention of non-rehearsed knowledge decreases significantly after a year. The aim of this study was to determine which optimisation tools (knobology) final year sonography students use, how often and why they chose to adjust parameters and assess barriers to optimisation of knobology tools. Methods A prospective study using data from an anonymous online survey of 34 final year sonography students. Results Survey results showed that 19/34 (55%) of students “frequently” optimise all Doppler settings and 23/34 (67%) of students “frequently” optimise basic parameter settings (depth, focus, time gain compensation). Time constraints (24/34 (70%)) and loss of gained knowledge of sonography principles and instrumentation (17/34 (50%)) were the major barriers to the use of knobology. The majority 28/34 (82%) believed they would benefit from further training. Conclusion This study demonstrates that although most students are optimising settings to improve image quality, sonography principles and instrumentation knowledge loss and time constraints prevent students from maximising machine capabilities. This study supports the need for further training prior to final year clinical placement.
Capecitabine in combination with bendamustine in pretreated women with HER2-negative metastatic breast cancer: results of a phase II trial (AGMT MBC-6)
Authors: Rinnerthaler Gabriel , Gampenrieder Simon Peter , Petzer Andreas , Hubalek Michael , Petru Edgar , Sandholzer Margit , Andel Johannes , Balic Marija , Melchardt Thomas , Hauser-Kronberger Cornelia , Schmitt Clemens A. , Ulmer Hanno , Greil Richard 
Published: October 2021

Background: Bendamustine, a medication approved for the treatment of indolent non-Hodgkin lymphoma, has already shown anticancer activity in metastatic breast cancer (MBC). Here, we present the results of a phase II trial of bendamustine in combination with capecitabine in pre-treated patients with MBC. Patients and methods: AGMT MBC-6 is a multicentre, open-label, single-arm phase II study in HER2-negative MBC. All patients were pre-treated with anthracyclines and/or taxans and had measurable disease. Patients received per os 1000 mg/m2 capecitabine twice daily on days 1 to 14 in combination with 80 mg/m2 bendamustine intravenously on days 1 and 8 of a 3-week cycle for a maximum of eight cycles, followed by a capecitabine maintenance therapy. The primary endpoint was overall response rate (ORR). Results: From September 2013 to May 2015, 40 patients were recruited in eight Austrian centres. The median age was 60 years (range 29–77). Twenty-five per cent of patients had triple-negative breast cancer (TNBC) and 93% showed visceral involvement. With 17 partial and one complete remission, ORR was 46%. Median progression-free survival (PFS) was 7.5 months [95% confidence interval (CI) 6.1–10.7]. The most common non-haematological adverse events (AEs) of grade 3 were hand-foot syndrome (13%), fatigue (10%), nausea (8%), and dyspnoea (8%). One grade 4 non-haematological AE (hepatic failure) and three grade 4 haematological AEs (neutropenia) were observed. One patient died of restrictive cardiomyopathy, in which a relationship to capecitabine cannot be excluded, but seems unlikely. Conclusion: The combination of capecitabine and bendamustine shows promising efficacy and moderate toxicity. Further evaluation of this drug combination is warranted. The clinical trial AGMT MBC-6 was registered at ClinicalTrials.gov , ( https://clinicaltrials.gov/ ; identifier: NCT01891227).
Isotoxic high-dose stereotactic body radiotherapy integrated in a total multimodal neoadjuvant strategy for the treatment of localized pancreatic ductal adenocarcinoma
Authors: Bouchart Christelle , Engelholm Jean-Luc , Closset Jean , Navez Julie , Loi Patrizia , Gökburun Yeter , De Grez Thierry , Mans Laura , Hendlisz Alain , Bali Maria Antonietta , Eisendrath Pierre , Van Gestel Dirk , Hein Matthieu , Moretti Luigi , Van Laethem Jean-Luc 
Published: October 2021

Background: Our aim was to evaluate the feasibility and safety of isotoxic high-dose (iHD) stereotactic body radiation therapy (SBRT) in a total neoadjuvant sequence for the treatment of localized pancreatic adenocarcinoma. Materials and methods: Biopsy-proven borderline resectable/locally advanced pancreatic cancer (BR/LAPC) patients were included in this observational prospective analysis from August 2017 to April 2020 without excluding tumours showing a radiological direct gastrointestinal (GI) invasion. An induction chemotherapy by modified fluorouracil, irinotecan and oxaliplatin was performed for a median of six cycles. In case of non-progression, an isotoxic high-dose stereotactic body radiotherapy (iHD-SBRT) was delivered in 5 fractions followed by a surgical exploration. The primary endpoint was acute/late gastrointestinal grade ⩾3 toxicity. Secondary endpoints were overall survival (OS), progression-free survival (PFS) and local control (LC). Results: A total of 39 consecutive patients (21 BR and 18 LAPC) were included: 34 patients (87.2%, 18 BR and 16 LAPC) completed the planned neoadjuvant sequence. After iHD-SBRT, 19 patients [55.9% overall, 13/18 BR (72.2%) and 6/16 LAPC (37.5%)] underwent an oncological resection among the 25 patients surgically explored (73.5%). The median follow up was 18.2 months. The rates of acute and late GI grade 3 toxicity were, respectively, 2.9% and 4.2%. The median OS and PFS from diagnosis were, respectively, 24.5 and 15.6 months. The resected patients had improved median OS and PFS in comparison with the non-resected patients (OS: 32.3 versus 18.2 months, p = 0.02; PFS: 24.1 versus 7.1 months, p < 0.001). There was no survival difference between the BR and LAPC patients. The 1-year LC from SBRT was 74.1% and the median locoregional PFS was not reached for both BR and LAPC patients. Conclusions: iHD-SBRT displays an excellent toxicity profile, also for potentially high-risk patients with radiological direct GI invasion at diagnosis and can be easily integrated in a total neoadjuvant strategy. The oncological outcomes are promising and emphasise the need for further exploration of iHD-SBRT in phase II/III trials.
Current Sport Organization Guidelines From the AMSSM 2019 Youth Early Sport Specialization Research Summit
Authors:   AMSSM Collaborative Research Network Youth Early Sport Specialization Summit, Tenforde Adam S. , Montalvo Alicia M. , Nelson Vicki R. , Myer Greg D. , Brenner Joel S. , DiFiori John P. , Jayanthi Neeru A. , Marshall Stephen W. , Kliethermes Stephanie A. , Beutler Anthony I. , Herman Daniel C. 
Published: October 2021

Context: Youth athletes may be at elevated risk for adverse health due to sport specialization. Sport organizations have developed guidelines for participation during growth and development. Objective: To assess youth sport development guidelines using a 15-item framework across sport organizations and governing bodies in soccer, basketball, ice hockey, and swimming. Data Sources: English-language results from January 1, 2000, to December 31, 2018, from published sport organization guidelines and athlete development plans. Study Selection: Two investigators independently reviewed publications identified from sport organizations. A total of 23 guidelines were incorporated, including 5 general sport organizations and 18 sport-specific guidelines. Study Design: Systematic review. Level of Evidence: Level 4. Data Extraction: Two investigators independently identified all recommendations that fit within a predetermined rubric of recommendations encompassing 4 domains: Psychological Development/Approach, Physical Development/Load, Facilities and Resources, and Timing and Monitoring of Specialization. Sport-specific guidelines on volume were summarized. Results: Sport organizations and sport-specific guidelines had consensus on 2 items out of the 15-item: emphasis on early skill development and access to well-trained coaches. While recommended by all sports organization, multisport participation was emphasized by 3 of 4 sports, excluding soccer. Volume recommendations were inconsistent between and within sports. No group proposed methods to monitor athlete well-being. Conclusion: This review highlights areas of agreement within sport organizations and governing bodies. Creating a framework to guide youth sport specialization may lead to specific and consistent guidelines.
Healthcare workers’ preparedness and response during COVID-19 pandemic
Authors: Trivedi Ashish , Fontelera Maria , Ishak Norzawani , Lai Alice , Win Kyaw N , Ismail Khalifah , Koh David 
Published: October 2021

Background Healthcare workers (HCWs) are most at risk of contracting SARS-CoV-2 and COVID-19 infection. Their preparedness, as a result of provision and access to personal protective equipment (PPE), training programmes and awareness and practices on infection prevention and control measures, is integral for the prevention of infectious disease transmission. Objectives This study was conducted to assess the preparedness and practices of HCWs during COVID-19 first wave outbreak in Brunei Darussalam. Methods A cross-sectional study using a pre-designed and self-administered web-based questionnaire was conducted among HCWs from government and private health sectors ranging from primary to tertiary health facilities in Brunei Darussalam. Data were analysed using descriptive statistics, and chi-square test was used for statistical significance. Results A total of 511 HCWs participated in the study. Nurses (64%) and HCWs based at hospitals (66%) made up the majority of the study participants, with 74% having occupational exposure to COVID-19 cases. More than 99% of HCWs used respiratory PPE, and 94% used gloves. 74% had undergone respirator fit testing and 65% had received PPE awareness session within the last one year. Coverage in training programmes was found to be low among HCWs from private health facilities. Conclusions Majority of HCWs who had received updated training programmes and therefore were better prepared came from government health facilities. HCWs from private health facilities lacked preparedness training programmes and as such, there needs to be improvement to enhance preparedness measures in light of the ongoing COVID-19 pandemic and for future infectious disease outbreaks.
Knowledge of childhood autism among nurses working in governmental hospitals of Addis Ababa, Ethiopia
Authors: Tasew Salem , Mekonnen Hussen , Goshu Abel Tibebu 
Published: October 2021

Introduction: Autism is a neurodevelopmental disorder that occurs in the early childhood period and is characterized by altered social interaction, communication problems, repetitive, and stereotyped behavior. Genetic, environmental, or physical risk factors are associated with prenatal, natal, or postnatal complications, leading to the development of autism spectrum disorders. Prompt diagnosis and management should be an integral component of the care provision in countries like Ethiopia. Objective: This study aimed to assess knowledge of childhood autism among nurses working in governmental hospitals in Addis Ababa, Ethiopia. Methods: Institutional based cross-sectional study design was used. The sample size was calculated using the single population proportion formula, and the final sample size was 360. Final study subjects were selected by using the simple random sampling method. Data were collected using structured self-administered questionnaires and were then coded and entered into Epi-data version 3.1 and exported to SPSS version 21 for analysis. Descriptive statistics were utilized to show frequencies and percentages, and analysis of variance was carried out to compute the association between the dependent and independent variables. Independent t-test was also done to see the association between dependent variables and independent variables with two means. A p-value of less than 0.05 was considered statistically significant. Results: The mean score for knowledge-related items was 8.79 ± 0.4. In this study, out of 331 nurses, 180 (54.35%) had good knowledge. Significant mean score difference was observed among age distribution (F-Ratio = 2.8, p-value = 0.04), level of education (F-ratio = 13.97, p < 0.001) and work experience (F-Ratio = 3.07 p-value = 0.017). Conclusion: A significant gap was observed in the overall knowledge of childhood autism among nurses employed in the governmental hospitals of Addis Ababa. The respondents’ knowledge level was significantly different among age group distributions, education levels, and work experience.