bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors associated with the timely uptake of initial HIV virologic test among HIV-exposed infants attending clinics within a faith-based HIV program in Kenya; a cross-sectional study
Authors: Gaitho Douglas , Kinoti Freda , Mwaniki Lawrence , Kemunto Diana , Ogoti Victor , Njigua Catherine , Kubo Elizabeth , Langat Agnes , Mecha Jared 
Published: March 2021

AbstractBackgroundEarly infant diagnosis (EID) of HIV, followed by effective care including antiretroviral therapy (ART), reduces infant mortality by 76% and HIV progression by 75%. In 2015, 50% of 1.2 million HIV-exposed infants (HEI) in 21 priority countries received a virologic test within the recommended 2 months of birth. We sought to identify factors associated with timely uptake of virologic EID among HEI and gain insight into missed opportunities.MethodsThis was a cross-sectional study that used de-identified data from electronic medical records of 54 health facilities within the Christian Health Association of Kenya (CHAK) HIV Project database. All HEI who had their first HIV virologic test done between January 2015 and December 2017 were included in the study and categorized as either having the test within or after 8 weeks of birth. Multivariate linear mixed effects regression model was used to determine factors associated with uptake of the first HIV EID polymerase chain reaction (PCR). Predictor variables studied include sex, birth weight, the entry point into care, provision of ART prophylaxis for the infant, maternal ART at time of EID, mode of delivery, and place of delivery.ResultsWe included 2020 HEI of whom 1018 (50.4%) were female. A majority, 1596 (79.0%) had their first HIV PCR within 2 months of birth at a median age of 6.4 weeks (interquartile range 6–7.4). Overall, HIV positivity rate at initial test among this cohort was 1.2%. Delayed HIV PCR testing for EID was more likely to yield a positive result [adjusted odds ratio (aOR) = 1.29 (95% confidence interval (CI) 1.09–1.52)p = 0.003]. Infants of mothers not on ART at the time of HIV PCR test and infants who had not received prophylaxis to prevent vertical HIV transmission had significant increased odds of a delayed initial test [aOR = 1.27 (95% CI = 1.18–1.37)p = < 0.0001] and [aOR = 1.43 (95% CI 1.27–1.61)p = < 0.001] respectively.ConclusionAn initial HIV PCR test done after 8 weeks of birth is likely to yield a positive result. Barriers to accessing ART for treatment among HIV-infected pregnant and breastfeeding women, and prophylaxis for the HEI were associated with delayed EID. In order to ensure timely EID, programs need to incorporate both facility and community strategy interventions to ensure all pregnant women seek antenatal care and deliver within health facilities.
The role of accommodation environments in student mental health and wellbeing
Authors: Worsley Joanne D. , Harrison Paula , Corcoran Rhiannon 
Published: March 2021

Abstract
Background
Due to the increasing concern over student mental health and wellbeing, attention has turned to the matter of creating environments, communities, and institutions which enable students to flourish.

Methods
To explore the role of accommodation environments in first year student mental health and wellbeing, eight focus groups were conducted in two universities in North West England and analysed using thematic analysis.

Results
Three overarching themes were identified: ‘The betwixt space’; ‘Accommodations as vessels to cultivate friendships and communities’; and ‘The importance of accommodation-based pastoral staff’. As attachment to place and relationships with significant others are disrupted by the transition, this leaves young people vulnerable whilst they go through a process to re-attach to new people and a new environment, and loneliness and social isolation were keenly felt during this period. Physical attributes of place that prevent social cohesion further exacerbated feelings of loneliness.

Conclusions
As it is common for students to withdraw physically and psychologically when they do not form friendships within their flat, accommodation-based pastoral staff have an important role to fulfil. Although these findings demonstrate the importance of the human element within accommodation, designing places that facilitate community, a sense of we-ness, and belonging is crucial.
Older working adults in the HEAF study are more likely to report loneliness after two years of follow-up if they have negative perceptions of their work quality
Authors: Bevilacqua Gregorio , D’Angelo Stefania , Ntani Georgia , Syddall Holly Emma , Harris Elizabeth Clare , Linaker Cathy , Stevens Martin , Cooper Cyrus , Walker-Bone Karen 
Published: March 2021

Abstract
Background
Loneliness is an important public health issue associated with mortality and morbidity. Often researched amongst older people, less is known about risk factors for loneliness among adults aged 50–64 years who are in work. We investigated (a) if exit from the workforce increases the odds of loneliness; (b) whether adverse psychosocial work factors are associated with increased odds of loneliness over 2 years of follow-up; and (c) whether the association is stronger among subjects still working compared with those who have exited the workforce.

Methods
Data came from the Health and Employment After Fifty (HEAF) study, a large population cohort who provided questionnaire information about work and health at baseline and 2 annual follow-ups. Logistic regression was used to explore the association between psychosocial risk factors and loneliness at follow-up 2, with adjustment for loneliness at baseline, sex, age, self-rated health, living alone, and mental health diagnosis.

Results
Of the initial 8134 participants, 4521 were working at baseline and provided data for this analysis. Of those, 507 (11.2%) were defined as lonely at 2 years’ follow-up. Exiting the workforce was not significantly associated with loneliness (OR = 1.1, 95%CI: 0.7–1.7). However, negative psychosocial work factors predicted loneliness at follow-up. After mutual adjustment, lack of choice at work (OR: 1.5, 95%CI: 1.1–1.9), often lying awake worrying about work (OR: 1.4, 95%CI: 1.0–1.9) and perceived not coping with physical demands of the job (OR: 1.3, 95%CI: 1.0–1.7) were independent predictors, with associations robust to adjustment for demographic factors and health. Associations were only slightly altered when we restricted the sample to those who remained in work until the end of follow-up.

Conclusions
Loneliness amongst middle-aged working adults is not predicted by permanent work exit but is predicted by individuals’ perceptions about their work. Provision of good-quality work, matched to the capacity of the older worker, could prevent loneliness.
Mind the gap: what explains the rural-nonrural inequality in diarrhoea among under-five children in low and medium-income countries? A decomposition analysis
Authors: Fagbamigbe A. F. , Oyinlola F. F. , Morakinyo O. M. , Adebowale A. S. , Fagbamigbe O. S. , Uthman A. O. 
Published: March 2021

Abstract
Background
Diarrhoea poses serious health problems among under-five children (U5C) in Low-and Medium-Income Countries (LMIC) with a higher prevalence in rural areas. A gap exists in knowledge on factors driving rural-non-rural inequalities in diarrhoea development among U5C in LMIC. This study investigates the magnitude of rural-non-rural inequalities in diarrhoea and the roles of individual-level and neighbourhood-level factors in explaining these inequalities.

Methods
Data of 796,150 U5C, from 63,378 neighbourhoods across 57 LMIC from the most recent Demographic and Health Survey (2010–2018) was analysed. The outcome variable was the recent experience of diarrhoea while independent variables consist of the individual- and neighbourhood-level factors. Data were analysed using multivariable Fairlie decomposition at p < 0.05 in Stata Version 16 while visualization was implemented in R Statistical Package.

Results
Two-thirds (68.0%) of the children are from rural areas. The overall prevalence of diarrhoea was 14.2, 14.6% vs 13.4% among rural and non-rural children respectively (p < 0.001). From the analysis, the following 20 countries showed a statistically significant pro-rural inequalities with higher odds of diarrhoea in rural areas than in nonrural areas at 5% alpha level: Albania (OR = 1.769; p = 0.001), Benin (OR = 1.209; p = 0.002), Burundi (OR = 1.399; p < 0.001), Cambodia (OR = 1.201; p < 0.031), Cameroon (OR = 1.377; p < 0.001), Comoros (OR = 1.266; p = 0.029), Egypt (OR = 1.331; p < 0.001), Honduras (OR = 1.127; p = 0.027), India (OR = 1.059; p < 0.001), Indonesia (OR = 1.219; p < 0.001), Liberia (OR = 1.158; p = 0.017), Mali (OR = 1.240; p = 0.001), Myanmar (OR = 1.422; p = 0.004), Namibia (OR = 1.451; p < 0.001), Nigeria (OR = 1.492; p < 0.001), Rwanda (OR = 1.261; p = 0.010), South Africa (OR = 1.420; p = 0.002), Togo (OR = 1.729; p < 0.001), Uganda (OR = 1.214; p < 0.001), and Yemen (OR = 1.249; p < 0.001); and pro-non-rural inequalities in 9 countries. Variations exist in factors associated with pro-rural inequalities across the 20 countries. Overall main contributors to pro-rural inequality were neighbourhood socioeconomic status, household wealth status, media access, toilet types, maternal age and education.

Conclusions
The gaps in the odds of diarrhoea among rural children than nonrural children were explained by individual-level and neighbourhood-level factors. Sustainable intervention measures that are tailored to country-specific needs could offer a better approach to closing rural-non-rural gaps in having diarrhoea among U5C in LMIC.
Association of the presence and its types of lamina fractures with posterior dural tear and neurological deficits in traumatic thoracic and lumbar burst fractures
Authors: Shi Xuchao , Xiang Shate , Dai Bo , He Zhennian 
Published: March 2021

Abstract
Introduction
The appropriate and optimal treatment for thoracic and lumbar (TL) burst fractures remains a topic of debate. Characterization of vertical laminar fractures (coronal cross-sectional imaging) is presented in this study to determine the severity and treatment options in TL burst fractures.

Methods
A retrospective evaluation of 341 consecutive patients with TL burst fractures was divided into Group I (whole), Group II (partial), and Group III (intact) based on the vertical laminar fracture morphology from coronal images on computed tomography (CT) scans. The presence of preoperative neurological status was reviewed, and several radiological parameters were measured. In addition, the incidence of dural tears was calculated in patients that underwent a decompression with posterior approach.

Results
In total, 270 lumbar and 71 thoracic burst fractures were analyzed. Compared with the intact group, the two other groups had significantly shorter central canal distance, wider interpedicular distance, and smaller spinal canal area, in particular, Group III. The incidences of preoperative neurological deficits in Groups I to III were 63.0, 22.2, and 6.3%, respectively. The incidences of dural tears in Groups I to III were 25.6, 6.3, and 0%, respectively.

Conclusion
The morphology of vertical laminar fractures observed across the coronal plane was important. Patients with “whole”, “partial” and “intact” laminar fractures indicated different severity of TL burst fractures. Due to the high probability of dural tears, decompression is recommended as a primary intervention for patients with “whole” laminar fractures. However, for patients without vertical laminar fractures, minimally invasive technique might be a better choice to avoid approach-related complications.
Oro-facial malignancy in north of Iraq: a retrospective study of biopsied cases
Authors: Fuoad Sura Ali Ahmed , Mohammad Dena Nadhim , Hamied Marwa Abdul-Salam , Garib Balkees Taha 
Published: March 2021

AbstractBackgroundIdentifying the prevalence of orofacial malignancies is essential to provide health-care programs and services for a specific population. This study aimed to specify the prevalence, clinical and histopathological features of oral malignancies in Sulaimani for over 12 years.MethodsAll archived reports for orofacial specimens from 2008 to 2019 were collected from three major centers in Sulaimani governorate. The demographic data, date, type of surgery, lesion's site, and diagnosis were recorded. The ICD-10 coding was specified for each case. A Chi-square test was used to assess differences between genders. A one-way ANOVA test was applied to analyze the differences in mean age distributions among different sites of oral malignancies and oral squamous cell carcinoma histopathological grades.P < 0.05 was considered significant.ResultsOrofacial malignant lesions account for 14.53% of the total sample. Patients' mean age was (55.46 ± 18.48) years, and they were predominantly males (M: F ratio = 1.15:1). The tongue was the frequently affected site (14.8%). A Chi-square test showed no significant difference between genders concerning age (P = 0.118), years of registration (P = 0.28), and site (P = 0.29). The C06 (represents; cheek mucosa C06.0, the vestibule of mouth C06.1, retromolar area C06.2, and other unspecified parts of mouth C06.8) was the most frequent topographical ICD-code (18.1%). Carcinoma was a frequent malignancy (63.2%). OSCC was the most common lesion (56.4%). It commonly affects males, and the tongue was the frequent site (24.1%) followed by lip (17.8%).ConclusionsThere is a slight increase in the registered oral malignancies in Sulaimani city over 12 years; they were predominated in males, in 61–70 years old patients, and being oral squamous cell carcinoma types.
Accurate diagnosis of colorectal cancer based on histopathology images using artificial intelligence
Authors: Wang K. S. , Yu G. , Xu C. , Meng X. H. , Zhou J. , Zheng C. , Deng Z. , Shang L. , Liu R. , Su S. , Zhou X. , Li Q. , Li J. , Wang J. , Ma K. , Qi J. , Hu Z. , Tang P. , Deng J. , Qiu X. , Li B. Y. , Shen W. D. , Quan R. P. , Yang J. T. , Huang L. Y. , Xiao Y. , Yang Z. C. , Li Z. , Wang S. C. , Ren H. , Liang C. , Guo W. , Li Y. , Xiao H. , Gu Y. , Yun J. P. , Huang D. , Song Z. , Fan X. , Chen L. , Yan X. , Li Z. , Huang Z. C. , Huang J. , Luttrell J. , Zhang C. Y. , Zhou W. , Zhang K. , Yi C. , Wu C. , Shen H. , Wang Y. P. , Xiao H. M. , Deng H. W. 
Published: March 2021

Abstract
Background
Accurate and robust pathological image analysis for colorectal cancer (CRC) diagnosis is time-consuming and knowledge-intensive, but is essential for CRC patients’ treatment. The current heavy workload of pathologists in clinics/hospitals may easily lead to unconscious misdiagnosis of CRC based on daily image analyses.

Methods
Based on a state-of-the-art transfer-learned deep convolutional neural network in artificial intelligence (AI), we proposed a novel patch aggregation strategy for clinic CRC diagnosis using weakly labeled pathological whole-slide image (WSI) patches. This approach was trained and validated using an unprecedented and enormously large number of 170,099 patches, > 14,680 WSIs, from > 9631 subjects that covered diverse and representative clinical cases from multi-independent-sources across China, the USA, and Germany.

Results
Our innovative AI tool consistently and nearly perfectly agreed with (average Kappa statistic 0.896) and even often better than most of the experienced expert pathologists when tested in diagnosing CRC WSIs from multicenters. The average area under the receiver operating characteristics curve (AUC) of AI was greater than that of the pathologists (0.988 vs 0.970) and achieved the best performance among the application of other AI methods to CRC diagnosis. Our AI-generated heatmap highlights the image regions of cancer tissue/cells.

Conclusions
This first-ever generalizable AI system can handle large amounts of WSIs consistently and robustly without potential bias due to fatigue commonly experienced by clinical pathologists. It will drastically alleviate the heavy clinical burden of daily pathology diagnosis and improve the treatment for CRC patients. This tool is generalizable to other cancer diagnosis based on image recognition.
Oral probiotic activities and biosafety of Lactobacillus gasseri HHuMIN D
Authors: Mann Soyon , Park Myeong Soo , Johnston Tony V. , Ji Geun Eog , Hwang Keum Taek , Ku Seockmo 
Published: March 2021

Abstract
Background
Lactobacillus spp. have been researched worldwide and are used in probiotics, but due to difficulties with laboratory cultivation of and experimentation on oral microorganisms, there are few reports of Lactobacillus spp. being isolated from the oral cavity and tested against oral pathogens. This research sought to isolate and determine the safety and inhibitory capabilities of a Lactobacillus culture taken from the human body.

Results
One organism was isolated, named “L. gasseri HHuMIN D”, and evaluated for safety. A 5% dilution of L. gasseri HHuMIN D culture supernatant exhibited 88.8% inhibition against halitosis-producing anaerobic microorganisms and the organism itself exhibited powerful inhibitory effects on the growth of 11 oral bacteria. Hydrogen peroxide production reached 802 μmol/L after 12 h and gradually diminished until 24 h, it efficiently aggregated with P. catoniae and S. sanguinis, and it completely suppressed S. mutans-manufactured artificial dental plaque. L. gasseri HHuMIN D’s KB cell adhesion capacity was 4.41 cells per cell, and the cell adhesion of F. nucleatum and S. mutans diminished strongly in protection and displacement assays.

Conclusion
These results suggest that L. gasseri HHuMIN D is a safe, bioactive, lactobacterial food ingredient, starter culture, and/or probiotic microorganism for human oral health.
The role of opioids in cancer response to immunotherapy
Authors: Botticelli Andrea , Cirillo Alessio , Pomati Giulia , Cerbelli Bruna , Scagnoli Simone , Roberto Michela , Gelibter Alain , Mammone Giulia , Calandrella Maria Letizia , Cerbelli Edoardo , Di Pietro Francesca Romana , De Galitiis Federica , Lanzetta Gaetano , Cortesi Enrico , Mezi Silvia , Marchetti Paolo 
Published: March 2021

Abstract
Background
The response to immunotherapy can be impaired by several factors including external intervention such as drug interactions with immune system. We aimed to examine the immunomodulatory action of opioids, since immune cells express opioid receptors able to negatively influence their activities.

Methods
This observational, multicenter, retrospective study, recruited patients with different metastatic solid tumors, who have received immunotherapy between September 2014 and September 2019. Immunotherapy was administered according to the standard schedule approved for each primary tumor and line of treatment. The concomitant intake of antibiotics, antifungals, corticosteroids and opioids were evaluated in all included patients. The relationship between tumor response to immunotherapy and the oncological outcomes were evaluated. A multivariate Cox-proportional hazard model was used to identify independent prognostic factors for survival.

Results
One hundred ninety-three patients were recruited. Overall, progression-free survival (PFS) and overall survival (OS) were significantly shorter in those patients taking opioids than in those who didn’t (median PFS, 3 months vs. 19 months, HR 1.70, 95% CI 1.37–2.09, p < 0.0001; median OS, 4 months vs. 35 months, HR 1.60, 95% CI 1.26–2.02, p < 0.0001). In addition, PFS and OS were significantly impaired in those patients taking corticosteroids, antibiotics or antifungals, in those patients with an ECOG PS ≥ 1 and in patients with a high tumor burden. Using the multivariate analyses, opioids and ECOG PS were independent prognostic factors for PFS, whereas only ECOG PS resulted to be an independent prognostic factor for OS, with trend toward significance for opioids as well as tumor burden.

Discussion
Our study suggests that the concomitant administration of drugs as well as some clinical features could negatively predict the outcomes of cancer patients receiving immunotherapy. In particular, opioids use during immunotherapy is associated with early progression, potentially representing a predictive factor for PFS and negatively influencing OS as well.

Conclusions
A possible negative drug interaction able to impair the immune response to anti-PD-1/PD-L1 agents has been highlighted. Our findings suggest the need to further explore the impact of opioids on immune system modulation and their role in restoring the response to immunotherapy treatment, thereby improving patients' outcomes.
Prediction of hepatocellular carcinoma risk in patients with chronic liver disease from dynamic modular networks
Authors: Chen Yinying , Yang Wei , Chen Qilong , Liu Qiong , Liu Jun , Zhang Yingying , Li Bing , Li Dongfeng , Nan Jingyi , Li Xiaodong , Wu Huikun , Xiang Xinghua , Peng Yehui , Wang Jie , Su Shibing , Wang Zhong 
Published: March 2021

Abstract
Background
Discovering potential predictive risks in the super precarcinomatous phase of hepatocellular carcinoma (HCC) without any clinical manifestations is impossible under normal paradigm but critical to control this complex disease.

Methods
In this study, we utilized a proposed sequential allosteric modules (AMs)-based approach and quantitatively calculated the topological structural variations of these AMs.

Results
We found the total of 13 oncogenic allosteric modules (OAMs) among chronic hepatitis B (CHB), cirrhosis and HCC network used SimiNEF. We obtained the 11 highly correlated gene pairs involving 15 genes (r > 0.8, P < 0.001) from the 12 OAMs (the out-of-bag (OOB) classification error rate < 0.5) partial consistent with those in independent clinical microarray data, then a three-gene set (cyp1a2-cyp2c19-il6) was optimized to distinguish HCC from non-tumor liver tissues using random forests with an average area under the curve (AUC) of 0.973. Furthermore, we found significant inhibitory effect on the tumor growth of Bel-7402, Hep 3B and Huh7 cell lines in zebrafish treated with the compounds affected those three genes.

Conclusions
These findings indicated that the sequential AMs-based approach could detect HCC risk in the patients with chronic liver disease and might be applied to any time-dependent risk of cancer.