bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical menopause: A toolkit for healthcare professionals
Authors: Garg Akanksha , Robinson Lynne 
Published: November 2021

Surgical menopause (bilateral oophorectomy) is commonly undertaken during a hysterectomy to treat various medical conditions. Menopausal symptoms can be particularly severe due to the sudden loss of ovarian function. This clinical toolkit is intended to guide healthcare professionals caring for women undergoing surgical menopause. Women commonly experience vasomotor symptoms, sexual dysfunction and an increased risk of cardiovascular and osteoporotic disease. Compared with a natural menopause, loss of libido can be more pronounced following a surgical menopause. Hormone Replacement Therapy (HRT) plays a significant role in managing surgical menopause, especially in women aged under 45 years old. All women undergoing surgical menopause should have adequate counselling regarding the hormonal consequences of surgery and the role of HRT with a view to provide individualised, patient-centred care.
Epidemiology of Tibial Fractures in Professional American Football Athletes From 2013 to 2019
Authors: Knapik Derrick M. , Mack Christina D. , Lee Rebecca , Heersink William , Tanenbaum Joseph E. , Wetzel Robert J. , Voos James E. 
Published: November 2021

Background: Lower extremity injuries occur with high frequency in National Football League (NFL) athletes and cause high burden to players and teams. Tibial fractures are among the most severe lower extremity injuries sustained in athletes and are associated with prolonged time loss from sport. Purpose: To determine the number of tibial fractures in NFL athletes from the 2013 to 2019 NFL seasons and describe athlete demographics, fracture characteristics, and details of injury onset. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review of the NFL injury database was performed to identify all NFL athletes sustaining tibial fractures over the 2013 to 2019 NFL seasons. Athlete characteristics, injury characteristics, days missed, and treatment (operative vs nonoperative) were examined. Descriptive statistics were used to calculate means, standard deviations, ranges, and percentages. Results: A total of 64 tibial fractures were identified in 60 athletes, resulting in a median loss of 74 days. Defensive secondary athletes had the highest number of injuries (n = 10; 16%), followed by running backs (n = 9; 14%), while 61% of these injuries occurred during NFL regular-season games, primarily between weeks 13 and 17. The most commonly reported activity during injury was athletes being tackled, with a direct impact to the tibia being the most common mechanism of injury. Lateral tibial plateau fractures were the most frequently reported, while distal tibial fractures resulted in the greatest number of days lost. The median time lost for injuries requiring surgery was 232 days compared with 56 days for injuries treated using conservative management. Conclusion: The highest proportion of tibial fractures were injuries to defensive secondary athletes and athletes being tackled while sustaining a direct impact to the leg, primarily to the lateral tibial plateau. Tibial fracture injuries were commonly sustained during NFL regular-season games, primarily during the final 4 weeks of the NFL regular season. Further investigations examining performance and career longevity in athletes sustaining tibial fractures are warranted to help improve the health and safety of NFL athletes.
Minimal change disease following the Moderna COVID-19 vaccine: first case report
Authors: Thappy Shaefiq , Thalappil Sherin R. , Abbarh Shahem , Al-Mashdali Abdulrahman , Akhtar Mohammed , Alkadi Mohamad M. 
Published: November 2021

Abstract
Background
There have been cases of minimal change disease (MCD) reported following previous vaccines. During the COVID-19 era, only 3 cases of new-onset MCD and a case of MCD relapse were reported following the Pfizer-BioNTech COVID-19 vaccine. We herein report the first case of MCD after receiving the Moderna COVID-19 vaccine.

Case presentation
A 43-year-old man presented to hospital 3 weeks after receiving the first dose of the Moderna vaccine, with both bilateral lower extremities and scrotal edema. He initially developed a sudden-onset bilateral lower extremities swelling on day 7 post-vaccine. He, then, developed dyspnea and scrotal swelling over a time span of 2 weeks. On physical examination, his blood pressure was 150/92 mmHg. There was a decreased air entry at lung bases, bilateral lower extremities and scrotal edema. Labs revealed hypoalbuminemia, hyperlipidemia and 15 g of proteinuria. His immunologic and serologic work up was negative. Renal biopsy showed concomitant MCD and IgA nephropathy. Patient was treated with oral steroids and had a good response; his edema resolved, serum albumin improved, and proteinuria decreased to 1 g within 2 weeks of treatment.

Conclusions
To the best of our knowledge, MCD has not been previously reported after receiving the Moderna COVID-19 vaccine. It remains unclear whether the COVID-19 mRNA vaccines are associated with the development of MCD, or it coincided with the mass vaccination. Further studies are needed to determine the incidence of MCD post COVID-19 vaccines and the underlying pathophysiology of glomerular injury post vaccination.
The effectiveness of intervention based on the transactional model on improving coping efforts and stress moderators in hemodialysis patients in Tehran: a randomized controlled trial
Authors: Ghaffari Mohtasham , Morowatisharifabad Mohammad Ali , Jadgal Mohammad Saeed , Mehrabi Yadollah , Alizadeh Somayeh 
Published: November 2021

Abstract
Background
Present study was conducted to determine the effect of training on coping efforts and stress moderators, based on transactional model of Lazarus and Folkman, in hemodialysis patients.

Methods
This is a randomized controlled clinical trial on 116 hemodialysis patients referred to dialysis centers in Tehran from May to August 2018. The patients were assigned to two experimental and control groups using a simple randomization method. The intervention included 6 training sessions in the form of coping efforts and moderators of transactional model. Data were collected before and 3 months after the intervention. Data were analyzed using SPSS 16.

Results
After 3 months training intervention, there was significant increase in the intervention group in the mean scores of coping efforts (P < 0.001), moderators and subscales of emotional regulation from 51.18 ± 20.42 to 64.87 ± 13.18 (P < 0.001), dispositional coping style from 45.56 ± 19.45 to 55.84 ± 18.03 and social support from 49.61 ± 20.14 to 55.55 ± 17.35 (P < 0.005).

Conclusion
The training based on transactional model was successful in the increase of social support, dispositional coping style and emotional regulation in hemodialysis patients. Therefore, Nurses and healthcare providers can use this program to help hemodialysis patients to increase their adaptation to the illness and reduce stress.

Trial registration
IRCT registration number: IRCT20180524039814N1; Registration date: 13-08-2018; Registration timing: retrospectively registered: Last update: 13-08-2018.
Impact of the line of treatment on progression-free survival in patients treated with T-DM1 for metastatic breast cancer
Authors: Migeotte A. , Dufour V. , van Maanen A. , Berliere M. , Canon J. L. , Taylor D. , Duhoux F. P. 
Published: November 2021

Abstract
Background
Trastuzumab emtansine (T-DM1) is indicated as second-line treatment for human epidermal growth factor receptor 2 (HER2)-positive metastatic or unresectable locally advanced breast cancer, after progression on trastuzumab and a taxane-based chemotherapy.
We wished to determine if the line of treatment in which T-DM1 is administered has an impact on progression-free survival (PFS) and in particular, if prior treatment with capecitabine/lapatinib or pertuzumab modifies PFS of further treatment with T-DM1.

Patients and methods
We performed a multicenter retrospective study in 3 Belgian institutions. We evaluated PFS with T-DM1 in patients treated for HER2 positive metastatic or locally advanced unresectable breast cancer between January 1, 2009 and December 31, 2016.

Results
We included 51 patients. The median PFS was 9.01 months. The line of treatment in which T-DM1 (1st line, 2nd line, 3rd line or 4+ lines) was administered had no influence on PFS (hazard ratio 0.979, CI95: 0.835–1.143).
There was no significant difference in PFS whether or not patients had received prior treatment with capecitabine/lapatinib (9.17 vs 5.56 months, p-value 0.875).
But, patients who received pertuzumab before T-DM1 tended to exhibit a shorter PFS (3.55 months for T-DM1 after pertuzumab vs 9.50 months for T-DM1 without pretreatment with pertuzumab), even if this difference was not statistically significant (p-value 0.144).

Conclusion
Unlike with conventional chemotherapy, the line of treatment in which T-DM1 is administered does not influence PFS in our cohort of patients with advanced HER2-positive breast cancer.
TGF-β protects osteosarcoma cells from chemotherapeutic cytotoxicity in a SDH/HIF1α dependent manner
Authors: Xu Yangbo , Li Yafei , Chen Xiaofan , Xiang Feifan , Deng Yong , Li Zhong , Wei Daiqing 
Published: November 2021

Abstract
Background
In the widespread adoption of chemotherapy, drug resistance has been the major obstacle to tumor elimination in cancer patients. Our aim was to explore the role of TGF-β in osteosarcoma-associated chemoresistance.

Methods
We performed a cytotoxicity analysis of methotrexate (MTX) and cisplatin (CIS) in TGF-β-treated osteosarcoma cells. Then, the metabolite profile of the core metabolic energy pathways in Saos-2 and MG-63 cell extracts was analyzed by 1H-NMR. We detected the expression of succinate dehydrogenase (SDH), STAT1, and hypoxia-inducible factor 1α (HIF1α) in TGF-β-treated osteosarcoma cells and further tested the effects of these molecules on the cytotoxicity induced by chemotherapeutic agents. Using in vivo experiments, we examined the tumor growth and survival time of Saos-2-bearing mice treated with a combination of chemotherapeutic agents and a HIF1α inhibitor.

Results
The metabolic analysis revealed enhanced succinate production in osteosarcoma cells after TGF-β treatment. We further found a decrease in SDH expression and an increase in HIF1α expression in TGF-β-treated osteosarcoma cells. Consistently, blockade of SDH efficiently enhanced the resistance of Saos-2 and MG-63 cells to MTX and CIS. Additionally, a HIF1α inhibitor significantly strengthened the anticancer efficacy of the chemotherapeutic drugs in mice with osteosarcoma cancer.

Conclusion
Our study demonstrated that TGF-β attenuated the expression of SDH by reducing the transcription factor STAT1. The reduction in SDH then caused the upregulation of HIF1α, thereby rerouting glucose metabolism and aggravating chemoresistance in osteosarcoma cells. Linking tumor cell metabolism to the formation of chemotherapy resistance, our study may guide the development of additional treatments for osteosarcoma.
Game-based training of selective voluntary motor control in children and youth with upper motor neuron lesions: protocol for a multiple baseline design study
Authors: Fahr Annina , Kläy Andrina , Coka Larissa S. , van Hedel Hubertus J. A. 
Published: November 2021

Abstract
Background
Impairments of selective control of joint movements can have consequences for many activities of daily life, but there are only a few interventions to improve selective voluntary motor control (SVMC). We have developed a treatment option to specifically enhance SVMC exploiting the advantages of interactive computer play technology. It targets SVMC by training selective activation of a muscle or a selective joint movement while it provides immediate feedback about involuntary muscle activations/movements at an (unwanted) joint. This study aims to investigate the effectiveness of this game-based intervention to enhance SVMC in children and youth with upper motor neuron lesions.

Methods
We will conduct a randomized, non-concurrent, multiple baseline design study. Patients aged between 6 and 20 years with reduced SVMC due to an upper motor neuron lesion will be included. During the baseline phase of random length, participants will attend their regular intensive rehabilitation program, and in the intervention phase, they will additionally complete 10 therapy sessions (à 40 min) of the game-based SVMC training. The primary outcome will be a short SVMC assessment conducted repeatedly throughout both phases, which quantifies movement accuracy and involuntary movements. Changes in clinical SVMC measures, muscle strength, cortical excitability, motor control of the inhibited/unwanted movement, and functional independence will be assessed as secondary outcomes. We will use a mixed-effect model to determine the change in the course of the primary outcome when the intervention is introduced, and we will compare changes between phases for secondary outcomes with paired tests.

Discussion
This study will provide first evidence whether SVMC can be improved with our game-based training. The single-case design takes into account the individualization required for this intervention, and it can help to address the challenges of intervention trials in our setting.

Trial registration
German Clinical Trials Register: DRKS00025184, registered on 28.04.2021.
The association between obesity and problematic smartphone use among school-age children and adolescents: a cross-sectional study in Shanghai
Authors: Ma Zhicong , Wang Jiangqi , Li Jiang , Jia Yingnan 
Published: November 2021

Abstract
Background
The study aimed to investigate the association between content-based problematic smartphone use and obesity in school-age children and adolescents, including variations in the association by educational stage and sex.

Methods
Two-stage non-probability sampling was used to recruit 8419 participants from nineteen primary schools, five middle schools, and thirteen high schools in Shanghai in December 2017. Obesity was identified by body mass index (BMI), which was obtained from the school physical examination record, while problematic smartphone use was measured by the Revised Problematic Smartphone Use Classification Scale as the independent variable.

Results
The rates of obesity varied with educational stages, while problematic smartphone use increased with educational stages. Male students reported higher obesity rates (37.1%vs19.4%, P < 0.001) and greater problematic smartphone use scores (25.65 ± 10.37 vs 22.88 ± 8.94, P < 0.001) than female students. Problematic smartphone use for entertainment (smartphone users addicted to entertainment games, music, videos, novels and other applications) was positively associated to obesity status for primary school [odds ratio (OR), 1.030; 95% confidence interval (95% CI), 1.005–1.057] and high school students (OR, 1.031; 95% CI, 1.004–1.059). For female students, problematic smartphone use for entertainment was positively associated with obesity status (OR, 1.046; 95% CI, 1.018–1.075).

Conclusions
Problematic smartphone use may be associated with obesity in children and adolescents. The association differed based on the educational stage and sex, and the difference possessed dimensional specificity.
SARS-CoV-2 PCR and antibody positivity among school staff at the beginning and end of the first school term
Authors: Alishaq Moza , Jeremijenko Andrew , Nafady-Hego Hanaa , Al Ajmi Jameela Ali , Elgendy Mohamed , Thomas Anil George , Coyle Peter V. , Elgendy Hamed , Abou-Samra Abdul-Badi , Butt Adeel A. 
Published: November 2021

Abstract
Background
There is controversy regarding the role of in-person attendance in schools and transmission of the SARS-CoV-2 pandemic. Several studies have demonstrated no increase in transmission, while some have reported large outbreaks with in-person attendance. We determined the incidence and risk factors for SARS-CoV-2 infection among school staff after one school term.

Methods
Nasopharyngeal swabs (NPS) for SARS-CoV-2 RT-PCR and blood for SARS-CoV-2 antibody testing were obtained from staff at a large international school in Qatar at the beginning of the 2020–2021 school year and repeated at the end of the first term.

Results
A total of 376 staff provided samples for testing. At the beginning of the 2020–2021 school year, the PCR positivity for SARS-CoV-2 was 13%, while seropositivity was 30.1%. A majority of those who tested positive either by PCR or serologically, were non-teaching staff. At the end of the first school term four months later, only 3.5% of the initially antibody-negative staff had seroconverted. In multivariable logistic regression analysis, male gender (OR 11.48, 95%CI 4.77–27.64), non-teaching job category (OR 3.09, 95%CI 1.10–8.64), contact with a confirmed case (OR 20.81, 95%CI 2.90–149.18), and presence of symptoms in the preceding 2 weeks [1–2 symptoms OR 4.82, 95%CI 1.79–12.94); ≥3 symptoms OR 42.30, 95%CI 3.76–476.43) independently predicted SARS-CoV-2 infection in school staff before school starting.

Conclusion
Male gender, non-teaching job, presence of symptoms, and exposure to a confirmed case were associated with higher risk of infection. These data can help policymakers in determining the optimal strategy for school reopening.
Fear, distress, and perceived risk shape stigma toward Ebola survivors: a prospective longitudinal study
Authors: Antonaccio Cara M. , Pham Phuong , Vinck Patrick , Collet Katharine , Brennan Robert T. , Betancourt Theresa S. 
Published: November 2021

Abstract
Background
During the 2014–15 Ebola Virus Disease (EVD) epidemic, thousands of people in Sierra Leone were infected with the devastating virus and survived. Years after the epidemic was declared over, stigma toward EVD survivors and others affected by the virus is still a major concern, but little is known about the factors that influence stigma toward survivors. This study examines how key personal and ecological factors predicted EVD-related stigma at the height of the 2014–2015 epidemic in Sierra Leone, and the personal and ecological factors that shaped changes in stigma over time.

Methods
Using three waves of survey data from a representative sample in the Western Urban and Western Rural districts of Sierra Leone, this study examines factors associated with self-reported personal stigma toward Ebola survivors (11 items, α = 0.77) among 1008 adults (74.6% retention rate) from 63 census enumeration areas of the Western Rural and Western Urban districts of Sierra Leone. Participants were randomly sampled at the height of the EVD epidemic and followed up as the epidemic was waning and once the epidemic had been declared over by the WHO. Three-level mixed effects models were fit using Stata 16 SE to examine cross-sectional associations as well as predictors of longitudinal changes in stigma toward EVD survivors.

Results
At the height of the EVD epidemic, female sex, household wealth, post-traumatic stress, EVD-related fear and perceived infection risk are a few of the factors which predicted higher levels of stigma toward survivors. On average, stigma toward EVD survivors decreased significantly as the epidemic declined in Sierra Leone, but female sex, EVD fear, and risk perceptions predicted a slower rate of change.

Conclusion
This study identified key individual and psychosocial characteristics which may predict higher levels of stigma toward infectious disease survivors. Future studies should pursue a better understanding of how personal characteristics and perceptions, including psychosocial distress, fear, and perceived infection risk serve as pathways for stigma in communities affected by infectious disease.
Exploring implementation of a nationwide requirement to increase physical activity in the curriculum in Danish public schools: a mixed methods study
Authors: Koch Sofie , Pawlowski Charlotte Skau , Skovgaard Thomas , Pedersen Natascha Holbæk , Troelsen Jens 
Published: November 2021

Abstract
Background
In 2014, the Danish Government introduced a wide-ranging school reform that applied to all public schools in Denmark. A distinctive feature of the reform was that it became mandatory to implement an average of 45 min of daily physical activity within the curriculum. Using the RE-AIM framework as an evaluation tool, the objective of the current study was to evaluate the reach, effectiveness, adoption, implementation, and maintenance of mandatory physical activity within the curriculum at ten Danish schools.

Methods
A complementary mixed-methods approach using accelerometers, questionnaires, and semi-structured interviews was conducted. A total of 10 schools were invited to participate, including 846 students, 76 teachers, and 10 school managers on various levels. Students were invited to wear an accelerometer for seven consecutive days. Teachers were invited to participate in a questionnaire, and school managers were encouraged to take part in a semi-structured interview.

Results
Results showed that, on average, 45.2% of the students were active at least 45 min daily within the curriculum. Teacher and school management interest in physical activity, competencies development, and shared decision-making were identified as central factors for adoption of the requirement. Scheduling physical activity within scheduels and collaborations with external parties were found to influence implementation. Finally, internal coordination, motivated school staff, and school management priority were identified as central factors for maintenance.

Conclusions
This study provides an evaluation on a nationwide physical activity requirement in Danish public schools. When introducing a wide-ranging nation-wide requirement on physical activity within the curriculum, school managers need to prioritize and support the implementation process. Teachers need to be involved in the decision processes in order to ensure motivation and local ownership. The study also highlights the benefits of an internal coordinator as well as development of a shared strategy among schools, municipalities, and other stakeholders in order to succeed with the implementation.