bluuebunny/crossref_metadata_2025_split huggingface dataset:
Child marriage among Somali refugees in Ethiopia: a cross sectional survey of adolescent girls and adult women
Authors: Elnakib Shatha , Hunersen Kara , Metzler Janna , Bekele Hailu , Robinson W. Courtland 
Published: June 2021

Abstract
Background
Despite child marriage receiving increased attention over the past two decades, research on child marriage in humanitarian settings remains scarce. This study sought to quantify child marriage among Somali adolescent girls residing in Kobe refugee camp in Ethiopia and to identify its correlates and consequences.

Methods
A cross-sectional survey was conducted using multi-stage cluster-based sampling with probability proportional to size. We randomly sampled households that have at least one female aged 15–49 and at least one adolescent female aged 10–19. In addition to calculating the proportion of girls married under age 18, we used survival methods – namely Kaplan Meier graphs and Cox proportional hazard models – to identify risk factors associated with child marriage in this context. We also used descriptive statistics to describe marital age preferences among female adults and presented measures of important sexual and reproductive health indicators among married adolescent girls.

Results
A total of 603 adult women were surveyed and a household roster was created with information on 3319 household members, of whom 522 were adolescent girls aged 15–19. Of those, 14% were currently married (95% Confidence Interval [CI] 0.11–0.18), and 11% were ever married under age 18 (95% CI 8–15%). Several variables were found to be significantly associated with hazard of child marriage including schooling, sex and employment status of head of household, as well as number of girls under age 18 in the childhood home.. Adult women tended to incorrectly identify minimum legal age at marriage and preferred low marital age for boys and girls – particularly in households of child brides. Among married adolescent girls, contraceptive use was very low (11%; 95% CI 4.94–22.40), and early childbearing was common (60%; 95% CI 45.56–72.89).

Conclusions
This research contributes to the evidence base on child marriage in humanitarian settings. Insights generated from this study have the potential to inform programs and interventions aiming to prevent and mitigate the impacts of this harmful practice.
The correlation between the change of Hounsfield units value and Modic changes in the lumbar vertebral endplate
Authors: Zhu Jiandong , Wu Hao , Chen Yilei , Liu Junhui , Shan Zhi , Fan Shunwu , Zhao Fengdong 
Published: June 2021

Abstract
Objectives
To evaluate the changes of Hounsfield units (HU) value in different types of Modic changes (MCs) and to analyze the correlation between the change of HU value and area ratio of MCs region, bone mineral density (BMD), and degree of intervertebral disc degeneration.

Methods
One hundred fifty-eight endplates with MCs were included and analyzed. HU values of MCs regions and adjacent vertebral corresponding regions without MCs were measured. The area ratio of MCs region was defined as the area of MCs divided by the area of endplate or the vertebral sagittal plane. BMD was measured by Dual-energy x-ray absorptiometry (DXA). Degree of intervertebral disc degeneration was evaluated based on Pfirrmann classification. According to the types of variables, descriptive statistics, Kolmogorove-Smirnov test, paired t-test, Wilcoxon signed-rank test, Independent-Samples T Test, and Pearson correlation analysis were used.

Results
The HU values in any types of MCs are significantly higher than that of adjacent vertebral corresponding regions without MCs (P < 0.001). The HU value of the type III MCs is higher than that of the type I and type II MCs. HU value was positively correlated with BMD. In the levels with Grade V disc degeneration, the area ratio of MCs region was significant increased.

Conclusions
HU values of the vertebral endplate and bone marrow were increased in most MCs regions with all types of MCs. HU value of endplates had a significantly positive correlation with BMD. Higher area ratio of MCs region is associated with more severe intervertebral disc degeneration.
Research activities and critical appraisal skills among Saudi orthopedic residents
Authors: Al-Mohrej Omar A. , Alsadoun Nouf F. , Alshaalan Fawaz N. , Alturki Rayan I. , Al-Rabiah Anwar M. , Hamdi Nezar B. , Ilyas Imran , AlHussainan Thamer S. 
Published: June 2021

Abstract
Background
Medical research is a central part of any residency training. In view of the new Saudi orthopedic committee promotion regulation that mandates each resident to participate in a research project, the challenges that stand in the way of completion of substantial research within surgical residency must be investigated. The aim of this study was to assess the practice, attitudes, perception, and limitations associated with research among residents in the Saudi orthopedic program in the central region.

Methods
A cross-sectional study was conducted between June and July 2020 using an online-based survey. The total number of study participants was 128 orthopedic residents out of the 191 residents enrolled in the central region program. Data were analyzed, and descriptive statistics in the form of frequency and percentage were determined, analytical tests were performed with P < 0.05 being statistically significant.

Results
Most residents (95 %) participated in a research project during residency. Most projects (53.10 %) were case reports followed by retrospective studies (48.40 %). The majority (79.70 %) did not attend a research methods course during residency. Experience in research differed significantly (P < 0.05) by age, residency year, and center. The mean involvement score was significantly higher among males at 3 (± 1) than among females at 2 (± 0) (P < 0.001). Only 40.60 % have access to orthopedic journals, and the same percentage (40.60 %) knew how to Critique original articles. There was a statistically significant difference in the accessibility score according to the training center. Lack of faculty support and mentorship were the main barriers to medical research at 62.50 and 39.10 %, respectively. A total of 68.80 % reported that funding was not available through their institutes.

Conclusions
In Saudi Arabia, the level of meaningful clinical research and publications by orthopedic residents is still low. The results of this study should be taken into consideration before the implementation of the new promotion criteria in the centers under the umbrella of Saudi orthopedic committee.
Translation and psychometric evaluation of the German version of the IcanSDM measure – a cross-sectional study among healthcare professionals
Authors: Lindig Anja , Hahlweg Pola , Christalle Eva , Giguere Anik , Härter Martin , von dem Knesebeck Olaf , Scholl Isabelle 
Published: June 2021

Abstract
Background
Shared decision-making (SDM) between patients and healthcare professionals (HCPs) is a key component of patient-centred care. To implement SDM in clinical practice and to evaluate its effects, it is helpful to know about HCPs’ perception of SDM barriers. The measure IcanSDM was developed in Canada and assesses the perception of SDM barriers. To our knowledge, no equivalent measure exists in German. Therefore, the aim of this study was to translate and adapt the IcanSDM measure to be used by a German speaking population and evaluate its psychometric properties.

Methods
This is a cross-sectional psychometric study based on a secondary analysis of baseline data from a SDM implementation study. The original 8-item IcanSDM was translated into German using a team translation protocol. We assessed comprehensibility via cognitive interviews with n = 11 HCPs. Based on results of cognitive interviews, the translated IcanSDM version was revised. Two hundred forty-two HCPs filled out the measure. Psychometric analysis included acceptance (completion rate), item characteristics (response distribution, skewness, item difficulties, corrected item-total correlations, inter-item correlations), factorial structure (confirmatory factor analysis (CFA), model fit), and internal consistency (Cronbach’s α).

Results
We translated and adapted the German IcanSDM successfully except for item 8, which had to be revised after the cognitive interviews. Completion rate was 98%. Skewness of the items ranged between −.797 and 1.25, item difficulties ranged between 21.63 and 70.85, corrected item-total-correlations ranged between .200 and .475, inter-item correlations ranged between .005 and .412. Different models based on CFA results did not provide a valid factorial structure. Cronbach’s α ranged between .563 and .651 for different factor models.

Conclusion
We provide the first German measure for assessing perception of SDM barriers by HCPs. The German IcanSDM is a brief measure with good acceptance. However, we found unsatisfying psychometric properties, which were comparable to results of the original scale. In a next step, the IcanSDM should be further developed and modified and predictive validity should be evaluated.
Protocol for a two-arm pragmatic stepped-wedge hybrid effectiveness-implementation trial evaluating Engagement and Collaborative Management to Proactively Advance Sepsis Survivorship (ENCOMPASS)
Authors: Kowalkowski Marc , Eaton Tara , McWilliams Andrew , Tapp Hazel , Rios Aleta , Murphy Stephanie , Burns Ryan , Gutnik Bella , O’Hare Katherine , McCurdy Lewis , Dulin Michael , Blanchette Christopher , Chou Shih-Hsiung , Halpern Scott , Angus Derek C. , Taylor Stephanie P. 
Published: June 2021

AbstractBackgroundSepsis survivors experience high morbidity and mortality, and healthcare systems lack effective strategies to address patient needs after hospital discharge. The Sepsis Transition and Recovery (STAR) program is a navigator-led, telehealth-based multicomponent strategy to provide proactive care coordination and monitoring of high-risk patients using evidence-driven, post-sepsis care tasks. The purpose of this study is to evaluate the effectiveness of STAR to improve outcomes for sepsis patients and to examine contextual factors that influence STAR implementation.MethodsThis study uses a hybrid type I effectiveness-implementation design to concurrently test clinical effectiveness and gather implementation data. The effectiveness evaluation is a two-arm, pragmatic, stepped-wedge cluster randomized controlled trial at eight hospitals in North Carolina comparing clinical outcomes between sepsis survivors who receive Usual Care versus care delivered through STAR. Each hospital begins in a Usual Care control phase and transitions to STAR in a randomly assigned sequence (one every 4 months). During months that a hospital is allocated to Usual Care, all eligible patients will receive usual care. Once a hospital transitions to STAR, all eligible patients will receive STAR during their hospitalization and extending through 90 days from discharge. STAR includes centrally located nurse navigators using telephonic counseling and electronic health record-based support to facilitate best-practice post-sepsis care strategies including post-discharge review of medications, evaluation for new impairments or symptoms, monitoring existing comorbidities, and palliative care referral when appropriate. Adults admitted with suspected sepsis, defined by clinical criteria for infection and organ failure, are included. Planned enrollment is 4032 patients during a 36-month period. The primary effectiveness outcome is the composite of all-cause hospital readmission or mortality within 90 days of discharge. A mixed-methods implementation evaluation will be conducted before, during, and after STAR implementation.DiscussionThis pragmatic evaluation will test the effectiveness of STAR to reduce combined hospital readmissions and mortality, while identifying key implementation factors. Results will provide practical information to advance understanding of how to integrate post-sepsis management across care settings and facilitate implementation, dissemination, and sustained utilization of best-practice post-sepsis management strategies in other heterogeneous healthcare delivery systems.Trial registrationNCT04495946. Submitted July 7, 2020; Posted August 3, 2020.
How muscle stiffness affects human body model behavior
Authors: Trube Niclas , Riedel Werner , Boljen Matthias 
Published: June 2021

Abstract
Background
Active human body models (AHBM) consider musculoskeletal movement and joint stiffness via active muscle truss elements in the finite element (FE) codes in dynamic application. In the latest models, such as THUMS™ Version 5, nearly all human muscle groups are modeled in form of one-dimensional truss elements connecting each joint. While a lot of work has been done to improve the active and passive behavior of this 1D muscle system in the past, the volumetric muscle system of THUMS was modeled in a much more simplified way based on Post Mortem Human Subject (PMHS) test data. The stiffness changing effect of isometric contraction was hardly considered for the volumetric muscle system of whole human body models so far. While previous works considered this aspect for single muscles, the effect of a change in stiffness due to isometric contraction of volumetric muscles on the AHBM behavior and computation time is yet unknown.

Methods
In this study, a simplified frontal impact using the THUMS Version 5 AM50 occupant model was simulated. Key parameters to regulate muscle tissue stiffness of solid elements in THUMS were identified for the material model MAT_SIMPLIFIED_FOAM and different stiffness states were predefined for the buttock and thigh.

Results
During frontal crash, changes in muscle stiffness had an effect on the overall AHBM behavior including expected injury outcome. Changes in muscle stiffness for the thigh and pelvis, as well as for the entire human body model and for strain-rate-dependent stiffness definitions based on literature data had no significant effect on the computation time.

Discussion
Kinematics, peak impact force and stiffness changes were in general compliance with the literature data. However, different experimental setups had to be considered for comparison, as this topic has not been fully investigated experimentally in automotive applications in the past. Therefore, this study has limitations regarding validation of the frontal impact results.

Conclusion
Variations of default THUMS material model parameters allow an efficient change in stiffness of volumetric muscles for whole AHBM applications. The computation time is unaffected by altering muscle stiffness using the method suggested in this work. Due to a lack of validation data, the results of this work can only be validated with certain limitations. In future works, the default material models of THUMS could be replaced with recently published models to achieve a possibly more biofidelic muscle behavior, which would even allow a functional dependency of the 1D and 3D muscle systems. However, the effect on calculation time and model stability of these models is yet unknown and should be considered in future studies for efficient AHBM applications.
Trajectories of antidepressant use before and after a suicide attempt among refugees and Swedish-born individuals: a cohort study
Authors: Amin Ridwanul , Rahman Syed , Helgesson Magnus , Björkenstam Emma , Runeson Bo , Tinghög Petter , Mehlum Lars , Qin Ping , Mittendorfer-Rutz Ellenor 
Published: June 2021

Abstract
Background
To identify key information regarding potential treatment differences in refugees and the host population, we aimed to investigate patterns (trajectories) of antidepressant use during 3 years before and after a suicide attempt in refugees, compared with Swedish-born. Association of the identified trajectory groups with individual characteristics were also investigated.

Methods
All 20–64-years-old refugees and Swedish-born individuals having specialised healthcare for suicide attempt during 2009–2015 (n = 62,442, 5.6% refugees) were followed 3 years before and after the index attempt. Trajectories of annual defined daily doses (DDDs) of antidepressants were analysed using group-based trajectory models. Associations between the identified trajectory groups and different covariates were estimated by chi2-tests and multinomial logistic regression.

Results
Among the four identified trajectory groups, antidepressant use was constantly low (≤15 DDDs) for 64.9% of refugees. A ‘low increasing’ group comprised 5.9% of refugees (60–260 annual DDDs before and 510–685 DDDs after index attempt). Two other trajectory groups had constant use at medium (110–190 DDDs) and high (630–765 DDDs) levels (22.5 and 6.6% of refugees, respectively). Method of suicide attempt and any use of psychotropic drugs during the year before index attempt discriminated between refugees’ trajectory groups. The patterns and composition of the trajectory groups and their association, discriminated with different covariates, were fairly similar among refugees and Swedish-born, with the exception of previous hypnotic and sedative drug use being more important in refugees.

Conclusions
Despite previous reports on refugees being undertreated regarding psychiatric healthcare, no major differences in antidepressant treatment between refugees and Swedish-born suicide attempters were found.
Platelet adhesion in type 2 diabetes: impact of plasma albumin and mean platelet volume
Authors: Johansson Mona , Eriksson Andreas C. , Östgren Carl Johan , Whiss Per A. 
Published: June 2021

Abstract
Background
Altered mean platelet volume (MPV) and plasma albumin has been reported in type 2 diabetes (T2D). MPV is suggested to predict cardiovascular risk but there is a lack of evidence for associations between MPV and platelet adhesion. Plasma albumin and magnesium are other factors reported to influence thrombotic risk. The objectives of this study were to assess the association between platelet adhesion and plasma factors with a potential role to affect platelet activation.

Methods
Blood was collected from 60 T2D patients and 60 healthy controls. Platelet adhesion to different protein surfaces induced by various soluble activators were measured in microplates. MPV, albumin and magnesium were analysed together with additional routine tests.

Results
Despite normal levels, plasma albumin significantly correlated with adhesion of T2D platelets but not with controls. There was a significant association between MPV and platelet adhesion in both groups, but association was smaller in T2D. Levels of glucose, HbA1c or magnesium did not correlate with platelet adhesion.

Conclusions
Plasma albumin was associated with platelet adhesion in T2D suggesting that albumin may be a factor to consider upon cardiovascular risk assessment. MPV was more associated with the level of platelet adhesion in healthy individuals than in well-controlled T2D patients.
Interleukin-24 regulates mucosal remodeling in inflammatory bowel diseases
Authors: Ónody Anna , Veres-Székely Apor , Pap Domonkos , Rokonay Réka , Szebeni Beáta , Sziksz Erna , Oswald Franz , Veres Gábor , Cseh Áron , Szabó Attila J. , Vannay Ádám 
Published: June 2021

Abstract
Background
Recently, increased interleukin (IL)-24 expression has been demonstrated in the colon biopsies of adult patients with inflammatory bowel disease (IBD). However, the role of IL-24 in the pathomechanism of IBD is still largely unknown.

Methods
Presence of IL-24 was determined in the samples of children with IBD and in the colon of dextran sodium sulfate (DSS) treated mice. Effect of inflammatory factors on IL24 expression was determined in peripheral blood (PBMCs) and lamina propria mononuclear cells (LPMCs). Also, the impact of IL-24 was investigated on HT-29 epithelial cells and CCD-18Co colon fibroblasts. Expression of tissue remodeling related genes was investigated in the colon of wild type (WT) mice locally treated with IL-24 and in the colon of DSS treated WT and Il20rb knock out (KO) mice.

Results
Increased amount of IL-24 was demonstrated in the serum and colon samples of children with IBD and DSS treated mice compared to that of controls. IL-1β, LPS or H2O2 treatment increased the expression of IL24 in PBMCs and LPMCs. IL-24 treatment resulted in increased amount of TGF-β and PDGF-B in HT-29 cells and enhanced the expression of extracellular matrix (ECM)-related genes and the motility of CCD-18Co cells. Similarly, local IL-24 treatment increased the colonic Tgfb1 and Pdgfb expression of WT mice. Moreover, expression of pro-fibrotic Tgfb1 and Pdgfb were lower in the colon of DSS treated Il20rb KO compared to that of WT mice. The disease activity index of colitis was less severe in DSS treated Il20rb KO compared to WT mice.

Conclusion
Our study suggest that IL-24 may play a significant role in the mucosal remodeling of patients with IBD by promoting pro-fibrotic processes.
Perspectives in immunotherapy: meeting report from the immunotherapy bridge (December 2nd–3rd, 2020, Italy)
Authors: Ascierto Paolo A. , Bifulco Carlo , Ciardiello Fortunato , Demaria Sandra , Emens Leisha A. , Ferris Robert , Formenti Silvia C. , Galon Jerome , Khleif Samir N. , Kirchhoff Tomas , McQuade Jennifer , Odunsi Kunle , Patnaik Akash , Paulos Chrystal M. , Taube Janis M. , Timmerman John , Fox Bernard A. , Hwu Patrick , Puzanov Igor 
Published: June 2021

AbstractImproved understanding of tumor immunology has enabled the development of therapies that harness the immune system and prevent immune escape. Numerous clinical trials and real-world experience has provided evidence of the potential for long-term survival with immunotherapy in various types of malignancy. Recurring observations with immuno-oncology agents include their potential for clinical application across a broad patient population with different tumor types, conventional and unconventional response patterns, durable responses, and immune-related adverse events. Despite the substantial achievements to date, a significant proportion of patients still fail to benefit from current immunotherapy options, and ongoing research is focused on transforming non-responders to responders through the development of novel treatments, new strategies to combination therapy, adjuvant and neoadjuvant approaches, and the identification of biomarkers of response. These topics were the focus of the virtual Immunotherapy Bridge (December 2nd–3rd, 2020), organized by the Fondazione Melanoma Onlus, Naples, Italy, in collaboration with the Society for Immunotherapy of Cancer and are summarised in this report.