bluuebunny/crossref_metadata_2025_split huggingface dataset:
Why not both? Rethinking categorical and continuous approaches to bilingualism
Authors: Kremin Lena V. , Byers-Heinlein Krista 
Published: July 2021

Aims and Objectives: Bilingualism is a complex construct, and it can be difficult to define and model. This paper proposes that the field of bilingualism can draw from other fields of psychology, by integrating advanced psychometric models that incorporate both categorical and continuous properties. These models can unify the widespread use of bilingual and monolingual groups that exist in the literature with recent proposals that bilingualism should be viewed as a continuous variable. Approach: In the paper, we highlight two models of potential interest: the factor mixture model and the grade-of-membership model. These models simultaneously allow for the formation of different categories of speakers and for continuous variation to exist within these categories. We discuss how these models could be implemented in bilingualism research, including how to develop these models. When using either of the two models, researchers can conduct their analyses on either the categorical or continuous information, or a combination of the two, depending on which is most appropriate to address their research question. Conclusions: The field of bilingualism research could benefit from incorporating more complex models into definitions of bilingualism. To help various subfields of bilingualism research converge on appropriate models, we encourage researchers to pre-register their model selection and planned analyses, as well as to share their data and analysis scripts. Originality: The paper uniquely proposes the incorporation of advanced statistical psychometric methods for defining and modeling bilingualism. Significance: Conceptualizing bilingualism within the context of these more flexible models will allow a wide variety of research questions to be addressed. Ultimately, this will help to advance theory and lead to a fuller and deeper understanding of bilingualism.
Consumer Journeys of Adolescent Girls and Young Women in South Africa: Implications for Marketing HIV Prevention Products
Authors: Dugas Michelle , Crowley Kenyon , Gao Guodong (Gordon) , McHarry Lorcan , Kenmuir Louise , Piper Jeanna , Veronese Fulvia , Agarwal Ritu 
Published: July 2021

Background: Female-initiated prevention products could reduce HIV infection rates in contexts with pronounced gender inequality like South Africa, but uptake and adherence remain low when available. Insights into the behavior of target consumers are needed to effectively promote these products; however, perceptions of stigma may discourage honest reporting. Focus of the Article: To address this need, we examined differences among the consumer journeys of six segments of South African adolescent girls and young women (AGYW), who vary on sexual health beliefs, sexual experience, and self-enhancement, when buying hygiene products. Research Question: We hypothesized that segments would differ in what motivated their purchases and in engagement with different touchpoints, reflecting a need for targeted outreach strategies. Methods: 1,500 low-income, Black South African AGYW (14–25 years of age) were surveyed face-to-face in their homes about their consumer journeys when purchasing deodorant and sanitary products, with the aim of extending the insights obtained to HIV prevention. Results: We found notable similarities across segments but also several important differences underscoring the potential for tailored marketing of HIV prevention products. Among some of the segments, differences were found in prepurchase mindsets and touchpoints, retail and brand drivers, and postpurchase feelings. Recommendations for Research or Practice: These findings highlight the need for tailored outreach among AGYW and may inform the design of effective, personalized marketing strategies that enhance the appeal of HIV prevention products. Limitations: To circumvent potential stigma associated with HIV, survey questions were anchored on personal hygiene products. While this may encourage greater honesty, findings may not fully generalize to HIV prevention products.
Covariate adjustment in subgroup analyses of randomized clinical trials: A propensity score approach
Authors: Yang Siyun , Li Fan , Thomas Laine E , Li Fan 
Published: July 2021

Background: Subgroup analyses are frequently conducted in randomized clinical trials to assess evidence of heterogeneous treatment effect across patient subpopulations. Although randomization balances covariates within subgroups in expectation, chance imbalance may be amplified in small subgroups and adversely impact the precision of subgroup analyses. Covariate adjustment in overall analysis of randomized clinical trial is often conducted, via either analysis of covariance or propensity score weighting, but covariate adjustment for subgroup analysis has been rarely discussed. In this article, we develop propensity score weighting methodology for covariate adjustment to improve the precision and power of subgroup analyses in randomized clinical trials. Methods: We extend the propensity score weighting methodology to subgroup analyses by fitting a logistic regression propensity model with pre-specified covariate–subgroup interactions. We show that, by construction, overlap weighting exactly balances the covariates with interaction terms in each subgroup. Extensive simulations were performed to compare the operating characteristics of unadjusted estimator, different propensity score weighting estimators and the analysis of covariance estimator. We apply these methods to the Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training trial to evaluate the effect of exercise training on 6-min walk test in several pre-specified subgroups. Results: Standard errors of the adjusted estimators are smaller than those of the unadjusted estimator. The propensity score weighting estimator is as efficient as analysis of covariance, and is often more efficient when subgroup sample size is small (e.g. <125), and/or when outcome model is misspecified. The weighting estimators with full-interaction propensity model consistently outperform the standard main-effect propensity model. Conclusion: Propensity score weighting is a transparent and objective method to adjust chance imbalance of important covariates in subgroup analyses of randomized clinical trials. It is crucial to include the full covariate–subgroup interactions in the propensity score model.
Drug labeling changes and pediatric hematology/oncology prescribing: Measuring the impact of U.S. legislation
Authors: Benning Tyler J , Shah Nilay D , Inselman Jonathan W , Van Houten Holly K , Ross Joseph S , Wyatt Kirk D 
Published: July 2021

Background/Aims: The Pediatric Research Equity Act and Best Pharmaceuticals for Children Act are intended to promote the conduct of clinical trials that generate pediatric-specific evidence about drug safety and efficacy. This study assesses the quality of evidence generated through Pediatric Research Equity Act–mandated and Best Pharmaceuticals for Children Act–incentivized clinical trials of hematology/oncology drugs and characterizes subsequent changes in pediatric drug utilization rates. Methods: Trial characteristics (blinding, randomization, and comparator group) were determined for clinical trials that supported pediatric label changes. Using data from OptumLabs® Data Warehouse, a de-identified administrative claims database, we calculated pediatric utilization rates for each drug. We calculated monthly utilization rates from January 2003 (or from the first month in which data were available) to December 2018. Results: We identified 11 hematology/oncology drugs that underwent pediatric label changes under the Pediatric Research Equity Act Pediatric Research Equity Act and/or Best Pharmaceuticals for Children Act, and we identified 15 trials supporting these changes. Of these trials, 36% (5/14) were randomized, 31% (4/13) were blinded, and 36% (5/14) used a comparator group. A median of 49 children (interquartile range 29.5) received the drug under investigation across these trials. Pediatric label changes were not associated with subsequent changes in pediatric drug utilization. Although some drugs saw increased pediatric use after gaining new pediatric indications, this pattern was not consistently observed. In addition, there was no evidence to suggest that drugs were utilized less frequently after they failed to receive pediatric indications. Conclusions: Clinical trials of hematology/oncology drugs conducted under the Pediatric Research Equity Act Pediatric Research Equity Act and Best Pharmaceuticals for Children Act generally have low methodological rigor, and the resulting label changes are not consistently associated with changes in pediatric utilization. Alternative regulatory strategies and study designs may be necessary to maximize the impact of newly generated knowledge on drug utilization.
Overdiagnosis and overtreatment of nipple and breast candidiasis: A review of the relationship between diagnoses of mammary candidiasis and Candida albicans in breastfeeding women
Authors: Douglas Pamela 
Published: July 2021

Background: Breastfeeding mothers commonly experience nipple pain accompanied by radiating, stabbing or constant breast pain between feeds, sometimes associated with pink shiny nipple epithelium and white flakes of skin. Current guidelines diagnose these signs and symptoms as mammary candidiasis and stipulate antifungal medications. Aim: This study reviews existing research into the relationship between Candida albicans and nipple and breast pain in breastfeeding women who have been diagnosed with mammary candidiasis; whether fluconazole is an effective treatment; and the presence of C. albicans in the human milk microbiome. Method: The author conducted three searches to investigate (a) breastfeeding-related pain and C. albicans; (b) the efficacy of fluconazole in breastfeeding-related pain; and (c) composition of the human milk mycobiome. These findings are critiqued and integrated in a narrative review. Results: There is little evidence to support the hypothesis that Candida spp, including C. albicans, in maternal milk or on the nipple-areolar complex causes the signs and symptoms popularly diagnosed as mammary candidiasis. There is no evidence that antifungal treatments are any more effective than the passage of time in women with these symptoms. Candida spp including C. albicans are commonly identified in healthy human milk and nipple-areolar complex mycobiomes. Discussion: Clinical breastfeeding support remains a research frontier. The human milk microbiome, which includes a mycobiome, interacts with the microbiomes of the infant mouth and nipple-areolar complex, including their mycobiomes, to form protective ecosystems. Topical or oral antifungals may disrupt immunoprotective microbial homeostasis. Unnecessary use contributes to the serious global problem of antifungal resistance. Conclusion: Antifungal treatment is rarely indicated and prolonged courses cannot be justified in breastfeeding women experiencing breast and nipple pain. Multiple strategies for stabilizing microbiome feedback loops when nipple and breast pain emerge are required, in order to avoid overtreatment of breastfeeding mothers and their infants with antifungal medications.
LncRNA CASC2 is involved in the development of chronic obstructive pulmonary disease via targeting miR-18a-5p/IGF1 axis
Authors: Liu Panpan , Zhang Huali , Zeng Haizhu , Meng Yingxia , Gao Hongchang , Zhang Meilan , Zhao Lei 
Published: July 2021

Aims: Chronic obstructive pulmonary disease (COPD) is a systemic disease. Several long non-coding RNAs (lncRNAs) have been identified to be aberrantly expressed in COPD patients. This study investigated the role of lncRNA cancer susceptibility candidate 2 (CASC2) in COPD, as well as its potential mechanism. Methods: Fifty smokers with COPD and another 50 smokers without COPD were recruited. Receiver operating characteristic curve was constructed to assess the diagnostic value of CASC2 in COPD patients. 16HBE cells were treated with cigarette smoke extract (CSE) to establish a cell model. qRT-PCR was used for the measurement of mRNA levels. The cell viability and apoptosis were detected by using Cell Counting Kit-8 and flow cytometry assay. Enzyme-linked immunosorbent assay was performed to detect the levels of proinflammatory cytokines. Luciferase reporter assay was performed for the target gene analysis. Results: Serum CASC2 was dramatically decreased in COPD patients compared with smokers without COPD, and was positively associated with FEV1 (forced expiratory volume in one second). Serum CASC2 was overexpressed in severe COPD patients, and had the diagnostic accuracy to distinguish COPD patients from smokers. CASC2 overexpression alleviated CSE-induced apoptosis and inflammation in 16HBE cells. CASC2 functions as a ceRNA of miR-18a-5p. Upregulation of miR-18a-5p reversed the influence of CASC2 on cell apoptosis and inflammation in 16HBE cells. IGF1 was the target gene of miR-18a-5p. Conclusion: CASC2 was downregulated in COPD patients and it might be a promising biomarker for the disease diagnosis. Overexpression of CASC2 might inhibit the bronchial epithelial cell apoptosis and inflammation via targeting miR-18a-5p/IGF1 axis. The reviews of this paper are available via the supplemental material section.
Predicting conversion to multiple sclerosis in patients with radiologically isolated syndrome: a retrospective study
Authors: Chaloulos-Iakovidis Panagiotis , Wagner Franca , Weber Lea , Diem Lara , Chan Andrew , Salmen Anke , Friedli Christoph , Hoepner Robert 
Published: July 2021

Aims: To retrospectively analyse the Bernese radiologically isolated syndrome (RIS) cohort with the goal of developing a prediction score for conversion to multiple sclerosis (MS). Methods: A total of 31 patients with RIS were identified by screening medical records of neurological patients seen at the University Hospital of Bern between 2004 and 2017 for the diagnoses ‘radiologically isolated syndrome’ and ‘RIS’ adhering to 2009 Okuda recommendations. We analysed clinical, paraclinical and magnetic resonance imaging data during a maximum follow-up period of 3 years and identified significant predictors of conversion to MS. Results: Data were available for 31 patients meeting 2009 Okuda RIS criteria. During the 3 years of follow up, 5/31 RIS patients converted to relapsing-remitting (RR) MS. In our univariate analysis, gadolinium (Gd) enhancement, brainstem and cerebellar hemisphere lesions, immune cell count and albumin concentration in cerebrospinal fluid (CSF), and anti-nuclear antibody (ANA) positivity in serum were identified as significant predictors of conversion to MS. Integrating these factors into our ‘RIS–MS prediction score’ enabled us to calculate a cut-off for prediction of conversion to MS within 3 years with high specificity [1.0, 95% confidence interval (CI) 0.84–1.00) and acceptable sensitivity (0.6, 95% CI 0.17–0.93)]. Conclusion: Our RIS–MS prediction score, if validated in an independent cohort, integrating radiological (Gd enhancement, brainstem and cerebellar hemisphere lesions) and paraclinical factors (ANA in serum, cell count and albumin in CSF) could be a useful prognostic tool for early recognition of RIS patients with a high risk of clinical progression to MS.
Degenerative Cervical Spondylosis: A Cause of Vertigo?
Authors: Shende Chetan , Rathod Tushar , Marathe Nandan , Mohanty Shubhranshu , Kamble Prashant , Mallepally Abhinandan Reddy , Sathe Ashwin 
Published: July 2021

Study Design: Prospective observational study. Objectives: Studying the effect of degenerative cervical spondylosis(CS) on blood flow velocity of vertebral artery (VA) during cervical spine rotation in different head positions and its association with vertigo. Introduction: Vertigo is one of the most common complaints seen in an out-patient clinic. Its association with CS remains an enigma for a treating physician. This study planned to systematically analyze the association between vertigo and CS by evaluating VA blood flow dynamics in different head positions. Methods: 100 patients with ages ranging from 20-80 years were recruited. First group of 50 patients with CS with vertigo were compared with second study group of 50 patients having CS without vertigo. Cervical radiographs were used to evaluate CS using cervical degenerative index (CDI). Color doppler was used to measure VA blood flow with head in neutral position and 60° lateral rotation with 30° extension. Same procedure was repeated on opposite side. Measurements performed included peak systolic blood flow velocity(PSV) and end diastolic blood flow velocity (EDV). Results: Among patients with CS, patients having vertigo showed significantly more evident degenerative changes (CDI ≥25) ( P=<0.001). High grade CS patients (CDI ≥25) with vertigo had statistically significant lower blood flow parameters with head rotation in the left and right VAs as compared to CS patients without vertigo. Conclusion: This study highlights important pathophysiological mechanism of vertigo observed in patients of CS. The magnitude of reduction in VA blood flow was significantly higher in patients with advanced CS presenting as vertigo.
Virulence factors and molecular characteristics of Shigella flexneri isolated from calves with diarrhea
Authors: Zhu Zhen , Wang Weiwei , Cao Mingze , Zhu Qiqi , Ma Tenghe , Zhang Yongying , Liu Guanhui , Zhou Xuzheng , Li Bing , Shi Yuxiang , Zhang Jiyu 
Published: July 2021

AbstractBackgroundThe natural hosts ofShigellaare typically humans and other primates, but it has been shown that the host range ofShigellahas expanded to many animals. AlthoughShigellais becoming a major threat to animals, there is limited information on the genetic background of local strains. The purpose of this study was to assess the presence of virulence factors and the molecular characteristics ofS. flexneriisolated from calves with diarrhea.ResultsFifty-fourS. flexneriisolates from Gansun, Shanxi, Qinghai, Xinjiang and Tibet obtained during 2014 to 2016 possessed four typical biochemical characteristics ofShigella. The prevalences ofipaH,virA,ipaBCD,ial,sen,set1A,set1Bandstxwere 100 %, 100 %, 77.78 %, 79.63 %, 48.15 %, 48.15 and 0 %, respectively. Multilocus variable number tandem repeat analysis (MLVA) based on 8 variable number of tandem repeat (VNTR) loci discriminated the isolates into 39 different MLVA types (MTs), pulsed field gel electrophoresis (PFGE) based onNotI digestion divided the 54 isolates into 31 PFGE types (PTs), and multilocus sequence typing (MLST) based on 15 housekeeping genes differentiated the isolates into 7 MLST sequence types (STs).ConclusionsThe findings from this study enrich our knowledge of the molecular characteristics ofS. flexnericollected from calves with diarrhea, which will be important for addressing clinical and epidemiological issues regarding shigellosis.
Using hand grip strength to detect slow walking speed in older adults: the Yilan study
Authors: Lin Yen-Huai , Chen Hsi-Chung , Hsu Nai-Wei , Chou Pesus 
Published: July 2021

Abstract
Background
Walking speed is an important health indicator in older adults, although its measurement can be challenging because of the functional decline due to aging and limited environment. The aim of this study was to examine whether hand grip strength can be a useful proxy for detecting slow walking speed in this population.

Methods
A cross-sectional study was conducted using the cohort from the Yilan Study in Taiwan. Community-dwelling older adults aged 65 years and older were included. Slow walking speed was defined as a 6-meter walking speed < 1.0 m/s, according to the 2019 Asian Working Group for Sarcopenia diagnostic criteria. Stepwise multiple linear regression was used to determine the most significant variables associated with walking speed. Receiver operating characteristic analysis was used to determine the optimal cutoff values for hand grip strength in detecting slow walking speed.

Results
A total of 301 participants with an average age of 73.9 ± 6.8 years were included; 55.1 % participants were women. In stepwise multiple linear regression analysis that included various variables, hand grip strength was found to be the most explainable factor associated with walking speed among all participants and among participants of each sex. The optimal cutoff values for hand grip strength in the detection of slow walking speed were 19.73 kg for all participants (sensitivity: 55 %, specificity: 83 %, area under the curve: 0.74, accuracy: 66.9 %), 35.10 kg for men (sensitivity: 92 %, specificity: 42 %, area under the curve: 0.70, accuracy: 66.4 %), and 17.93 kg for women (sensitivity: 62 %, specificity: 80 %, area under the curve: 0.76, accuracy: 67.9 %).

Conclusions
Hand grip strength was found to be a useful proxy for the identification of slow walking speed in older adults.
COVID-19 viral load not associated with disease severity: findings from a retrospective cohort study
Authors: Abdulrahman Abdulkarim , Mallah Saad I. , Alqahtani Manaf 
Published: July 2021

Abstract
Background
Being able to use COVID-19 RT-PCR Ct values as simple clinical markers of disease outcome or prognosis would allow for the easy and proactive identification and triaging of high-risk cases. This study’s objective was thus to explore whether a correlation exists between COVID-19 viral loads, as indicated by RT-PCR Ct values, and disease severity, as indicated by respiratory indices.

Results
A multi-centre cross-sectional retrospective study was conducted, using data obtained from Bahrain’s National COVID-19 Task force’s centralised database. The study period ranged from May 2, 2020 to July 31, 2020. A multivariable logistic regression was used to assess for a correlation using data from a total of 1057 admitted COVID-19 cases. The covariates adjusted for included sex, age, presentation, and comorbidities. In our cohort, Ct value showed no statistical significance for an association with requirement for oxygenation on admission (Odds ratio 1.046; 95%CI 0.999 to 1.096, p = 0.054).

Conclusion
Viral load, as indicated by Ct values, did not seem to be associated with requirement for oxygenation on admission in our cohort. We postulate however that time since onset of symptom may have acted as an unaccounted-for confounder. As such, RT-PCR Ct values may not be a useful prognostic clinical tool in isolation.