bluuebunny/crossref_metadata_2025_split huggingface dataset:
Unveiling Recurrence Patterns: Analyzing Predictive Risk Factors for Breast Cancer Recurrence after Surgery
Authors: Shahmoradi Monireh , Fazilat Ahmad , Ghaderi-Zefrehei Mostafa , Ardalan Arash , Bigdeli Ali , Nafissi Nahid , Babaei Ebrahim , Rahmani Mahsa 
Published: November 2024

Objectives: Breast cancer (BC) stands as the second-leading cause of female-specific cancer-related fatalities globally, necessitating comprehensive research to address its critical aspects. This study aimed to explore the time intervals between surgery and disease recurrence in BC patients and their survival utilizing various parametric and semi-parametric models. Methods: After the examination of data collected from 2010 to 2021 at a BC Center in Tehran, Iran, 171 cases met the criteria for analysis out of 2246 datasets. Model fitting, was assessed through the Akaike Information Criterion (AIC), and indicated the logistic distribution as the most fit one among concurrent and independent variable models. Results: The Cox proportional hazard regression model consistently demonstrated superior fitting, characterized by the lowest AIC values. The average age at diagnosis was 50.39 years, with a standard deviation of 11.13. Typical survival time was estimated 53.44 months, falling within a confidence interval of 51.41–55.48 months at a 95% confidence level. The 1-year survival rate was determined at 0.92 (95% CI: 0.89–0.94). Notably, patient age while cancer diagnosis, progesterone receptor (PR), tumor grade, and tumor stage were found to be statistically significant ( P < .05) risk factors for prediction of BC recurrence after surgery in Iran by Cox model. Conclusions: Our findings underscore the importance of further exploration and consideration of the identified risk factors in BC research and treatment strategies.
Nigerian Hospital and Community Pharmacists’ Knowledge, Awareness, and Perceptions of Autism Spectrum Disorders
Authors: Aiyeolemi Ayobami Adesoji , Amaeze Ogochukwu Ukamaka , Okugbeni Veronica , Kehinde Oyinlade , Adeleke Adekunle Faid , Barner Jamie C 
Published: November 2024

Background: Pharmacists can play a role in enhancing treatment outcomes of autistic people, but they must possess sufficient knowledge and awareness of autism spectrum disorders (ASD). Current evidence is scant among Nigerian pharmacists. The objectives of this study were to: (1) Describe and compare Nigerian hospital and community pharmacists’ ASD knowledge, awareness, and perceptions; (2) Determine if there is a significant correlation between ASD knowledge, awareness, and perceptions; (3) Determine if demographic and practice-related factors are significantly related to pharmacists’ ASD awareness. Method: Hospital and community pharmacists were administered a self-report survey to assess ASD knowledge and awareness, as well as confidence in caring for autistic people, and perceived benefits of ASD training and care. Data were collected from August to December 2021 and analyzed using inferential and descriptive statistics. Cronbach’s alphas were used to assess reliability. Results: Of respondents, (Total N = 383; N = 201 hospital pharmacists from various states) and N = 182 community pharmacists in Lagos state) community pharmacists had significantly higher mean knowledge than hospital pharmacists (58.10% ± 19.00% vs 53.20% ± 20.10%; P = .016). Overall mean awareness score was 2.90 ± 0.80, with no significant difference between community and hospital pharmacists ( P = .096). Perception regarding ASD continuing education (CE) was strongly correlated with the perceived benefits of pharmacy services to autistic people in Nigeria ( r = .69; P < .0001). Additionally, awareness was positively correlated with knowledge ( r = .47, P < .0001) and perceived confidence in ASD medication counseling ( r = .54, P < .0001). Multivariate analysis revealed that being a hospital pharmacist, having courses on ASD during pharmacy degree programs, undergoing ASD CE, and having <5 years of practice experience were significantly ( P < 0.05) associated with higher ASD awareness. Conclusion: Respondents had suboptimal knowledge and awareness of ASD. Including ASD in the pharmacy curriculum and providing CE programs may help improve pharmacists’ ability to provide more optimal patient care services for autistic people.
Innovative Surgical Left Atrial Appendage Closure Technique: Early Experience of Inverted Spiral Closure Technique
Authors: Nagaoka Eiki , Arai Hirokuni , Mizuno Tomohiro , Oi Keiji , Fujiwara Tatsuki , Oishi Kiyotoshi , Fujita Tomoyuki 
Published: November 2024

Objective: Simultaneous closure of the left atrial appendage (LAA) during cardiac procedures has become a common preventive measure against cardiogenic embolic events associated with atrial fibrillation. However, this strategy encounters limitations during minimally invasive mitral valve surgery through a right minithoracotomy because access to the LAA is limited. The use of endocardial sutures for surgical exclusion of the LAA is also well established but has a notable rate of closure failure. We introduced a new surgical LAA closure technique called the inverted spiral closure technique (ISCT). Methods: Between July 2020 and August 2021, 26 patients underwent LAA closure with ISCT concomitant to mitral valve surgery in our hospital. Early postoperative outcomes and any stroke or thromboembolic event during the follow-up were evaluated. Transthoracic or transesophageal echocardiography (TEE) was used to assess LAA patency. Results: The ISCT procedure was performed successfully in all cases. No significant persistent flow between the left atrium and LAA was observed on intraoperative TEE. During a median follow-up of 1.1 years, no patients experienced stroke, myocardial infarction, or death. Postoperative echocardiography showed no significant residual flow within the LAA. One patient was incidentally found to have recanalization between the left atrium and LAA several months after surgery on an enhanced computed tomography scan during coronary evaluation. Conclusions: The ISCT can be performed reliably through the same left atriotomy for mitral valve surgery and is a useful and effective technique for surgical LAA exclusion. There are still not enough patients and modalities for postoperative evaluation.
Outcomes of Mucous Cystectomy and Osteophytectomy Using a Random Nonadvancement Flap Technique
Authors: Behzadpour Vafa , Gartner Austin M. , Morris Harry A. , Hearon Bernard F. 
Published: November 2024

Background: The purpose of this study was to determine the clinical outcomes of mucous cystectomy and osteophytectomy using a random nonadvancement flap technique. Methods: This was a therapeutic outcomes study of patients who underwent mucous cystectomy under local anesthesia by 1 of 2 hand fellowship-trained surgeons between 2012 and 2022. The key features of the surgical technique include designing a random nonadvancement flap with the cyst at its base; transecting the cyst pedicle as the flap is elevated; resecting the cyst wall from the undersurface of the reflected flap; decompressing the distal joint by removing marginal osteophytes; and insetting the flap without advancement. Patient demographic and disease-specific data were extracted from medical records and compiled in an electronic database. At minimum 1-year follow-up, patients were queried by telephone regarding wound complications, cyst recurrence, and satisfaction with outcome. Results: The study cohort included 64 cysts in 61 patients, mean age 63 ± 10 years. The index or middle finger was affected in 63% of cases. At early postoperative follow-up, digital pain improved or resolved in 97% of cases. There were no complications of wound dehiscence or infection. At median 5-year follow-up in 34 cases, all patients except 1 were satisfied with the surgical outcome. There were 2 cyst recurrences in the study cohort (3%) and only 1 secondary procedure. Conclusions: Our study demonstrated that mucous cystectomy and distal joint osteophytectomy using a random nonadvancement flap is an effective surgical technique with low procedure complication and cyst recurrence rates and high patient satisfaction.
Prognostic factors and treatment choice for stage IV, low-volume metastasis hormone-sensitive prostate cancer: cross-sectional study of real-world data
Authors: Elewaily Mohamed Ibrahim , Campione Marina , Hassan Mona Ali , Anpalakhan Shobana , Atsumi Naoko , Smalley Benjamin , Ashraf Anza , Gale Joanna , Maniam Akash , Banna Giuseppe Luigi 
Published: November 2024

Background: Many metastatic prostate cancer prognostics have been suggested, but few are validated. Nodal metastasis burden and baseline biochemical characteristics are overlooked in the currently accepted stratifications for metastatic hormone-sensitive prostate cancer (mHSPC). Prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) is likely to increase the incidence of pelvic nodal and mHSPC undetected by conventional scans. However, there is no consensus on managing regional nodal metastasis (N1M0) and no separate guidelines for non-regional nodal (M1a) and low-volume bone (M1b) spread but collectively as a part of low-volume CHAARTED disease. Objectives: To assess the different prognostic factors for stage IV disease classified as CHAARTED low-volume on a real-world series of patients and to examine treatment preference for each of the disease subcategories. Methods and design: This retrospective cross-sectional study included patients diagnosed with HSPC at stage IV, with low-volume disease according to the CHAARTED criteria. Data were collected from the database of Portsmouth and St. Mary NHS Hospitals between February 2017 and August 2023. Patient characteristics were analysed, and prognostic factors were evaluated using Cox regression analysis. 5-year progression-free survival (PFS) was the primary outcome measure. Results: Data on 126 patients were analysed. Seven patients (6%) had N1M0, 28 (22%) M1a, and 91 (72%) M1b. 5-year PFS was 80.9% for M1a and 54.9% for M1b metastases, p = 0.3. High prostate-specific antigen (PSA) value (⩾25) was identified as an independent prognostic factor for PFS with HR = 2.80 (95% CI: 1.19–6.56), p = 0.0179. Variable treatment preference for each subclass reflects the uncertainty regarding the best regimen and the importance of consolidation prostate radiotherapy (cRT) in clinical practice. Conclusion: Early results of our data analysis underscore the significance of baseline PSA as an independent prognostic factor alongside anatomical tumour extent of spread in stage IV low-volume metastasis prostate cancer. There is no agreement on treatment for each subcategory, necessitating further real-world studies and clinical trials. Further follow-up would assess the prognostic benefit of cRT.
Shen Gu An Capsule Inhibition of Postmenopausal Osteoporosis in Ovariectomized Mice Using Network Pharmacology-Based Mechanism Prediction and Pharmacological Validation
Authors: Du Meilin , Yuan Shiguo , Wang Jiayang , Zhao Qiangqiang , Ye Baofei , Wu Haiyan , Xu Liangliang , Hou Yu 
Published: November 2024

Background Postmenopausal osteoporosis (PMOP) is characterized by low bone mass and increased bone fragility in postmenopausal women. Shen Gu An capsule (SGA) has been clinically used to treat bone diseases, especially PMOP with kidney Yang deficiency. Objectives We aimed to study the effect of SGA on the treatment of PMOP. Methodology The key candidate targets and pathways of SGA for treating PMOP were predicted by Network pharmacology analysis. Then, in vivo validation using bilaterally ovariectomized C57BL/6 mice was performed, and the bone quality was analyzed by Micro-CT and histological analysis. Results In this study, we obtained 113 active compounds and 82 targets via the database of Traditional Chinese Medicine Systems Pharmacology. Subsequently, compound-target and protein−protein interaction networks were constructed. Then GO and KEGG analysis revealed that NF-κB signaling pathway might be the underlying mechanism as its well-known function in osteoclastogenesis. Furthermore, the in vivo experiments using ovariectomized mice demonstrated that SGA could decrease the number of osteoclasts and preserve bone mass through inhibiting the NF-κB signaling pathway. Conclusions SGA could prevent postmenopausal osteoporosis in ovariectomized mice through inhibiting NF-κB signaling pathway. The finding of this study provides more evidence for the clinical application of SGA to treat osteoporosis.
Emerging trends in fungal endocarditis: clinical complexity, diagnostic challenges, and therapeutic implications – a case series and literature review
Authors: Naguthevar Santhanam , Ravindra Akshatha , Kumar Deepak , Meena Durga Shankar , Bohra Gopal Krishana , Jain Vidhi , Garg M. K. , Deora Surender , Choudhary Rahul 
Published: November 2024

Background: Fungal infective endocarditis (IE) is a rare, yet increasingly recognised condition associated with substantial mortality rates. Candida and Histoplasma are among the notable causative agents, presenting diverse clinical manifestations and complexities in diagnosis and management. Objectives: This study was undertaken to examine the clinical profiles, diagnostic challenges, treatment modalities, and outcomes of four compelling cases involving Candida and Histoplasma endocarditis. Methods & Design: This was a descriptive case series study conducted from July 2021 to July 2023. All patients with definite/possible endocarditis diagnosed based on modified Duke’s criteria were reviewed in this study. Data on demographics, risk factors, clinical signs and symptoms, echocardiography findings, microbiological aetiology, complications, treatment, and outcomes were collected. Results: Among 212 suspected IE cases reviewed, 54 met the modified Duke’s criteria for possible or definite IE, with four instances identified as fungal endocarditis. Candida species accounted for three cases, while an uncommon instance of Histoplasma Endocarditis (HE) was also observed. Clinical presentations varied, with fever and dyspnoea being prominent symptoms. Risk factors included chronic kidney disease, prior surgeries, prosthetic valves, and immunocompromised states. Diagnosis posed challenges due to the resemblance to bacterial IE, low blood culture yields, and delayed suspicion. Various diagnostic approaches, including blood cultures, serological markers, and imaging, were employed. Therapeutic strategies involved antifungal agents and surgical intervention, where feasible. However, despite prompt treatment initiation, many patients faced rapid clinical deterioration, emphasising the severity and aggressive nature of fungal endocarditis. Mortality rates remained notably high across the cohort. Conclusion: This study highlights the criticality of early suspicion, prompt diagnosis, and a multidisciplinary approach to managing fungal endocarditis. While recognising the limitations in current diagnostic tools and therapeutic options, the study underscores the urgent need for enhanced diagnostic modalities and novel treatment strategies to improve outcomes in these challenging cases.
A Financing Constraints Paradox? Internal Finance and Capital Structure Link for Tourism Firms: Asian Emerging Market evidence
Authors: Tuğsal Doruk Ömer , Martial Gohore Bi Irie Claude 
Published: November 2024

The aim of the study is to investigate the relationship between the internal financial and capital structure of an organization in the travel and tourism sector. The study shows how financial constraints on tourism companies affect their ability to finance themselves. The study also shows a relationship between tax shielding and financial leverage. This study analyzes panel data collected over a 21 year period, from 1998 to 2019, from over 100 publicly traded tourism companies in three Asian countries. A panel data methodology and the generalized method of moments estimation (GMM) were used in this empirical study. To support our hypothesis, using a generic method to evaluate parameter estimation will be our most effective method to improve the literature. Overall, the results show that financially stressed tourism firms use their option of debt-free tax avoidance to increase leverage. There is also a positive correlation between tax haven and leverage for firms with limited resources. The correlations between financial leverage and corporate debt supported by the results theoretically support the pecking order. By providing useful insights into the tax shielding of non-debt, which is significantly correlated with leverage for firms operating in tourism, this study closes the gap in firms’ capital structure decisions regarding access to finance. JEL Classification: G0, G01, L25
Examining the Reliability and Validity of Coding Perceived Force Severity and Bracing in the NHL Concussion Spotter Program
Authors: Riegler Kaitlin E. , Echemendia Ruben , Meeuwisse Willem , Comper Paul , Hutchison Michael G. , Delaney J. Scott , Bruce Jared M. 
Published: November 2024

Background: Data obtained from the National Hockey League (NHL) have shown that a risk prediction model, including both visible signs and mechanisms of injury, improves the identification of possible concussion. However, only about half of concussions diagnosed by club medical staff in the NHL exhibit visible signs. At present, the NHL concussion spotter protocol does not include central league spotters’ subjective judgments of the severity of forces associated with a direct hit to the head (perceived force severity [PFS]) or whether players brace before a hit (bracing). Purpose: To examine the interrater reliability, preliminary validity, and association with concussion diagnosis of central league spotter determinations of PFS and bracing. Study Design: Cross-sectional study. Methods: Video footage of 1071 events after a direct or indirect blow to the head were observed from the 2020-2021 and 2021-2022 NHL seasons. These events were classified into 4 groups: concussion with visible signs; concussion without visible signs; no concussion with visible signs; and no concussion without visible signs. A total of 50 events were randomly selected from the total events in each group. Then, 2 raters (NHL central league spotters) coded PFS for each of the 200 video events as low, medium, or high. Bracing was coded as no bracing, insufficient bracing, or full bracing. Results: Interrater reliability was fair to moderate for the categorical and continuous ratings of both PFS (κ = 0.36 and 0.45, respectively) and bracing (κ = 0.40 and 0.49, respectively). There was no significant association between concussion diagnosis and either PFS ( Z = 0.00, P = .99) or bracing ( Z = 0.77, P = .44). Exploratory, post hoc analyses suggested a possible relationship between bracing and reduced concussion risk among a select subsample of events with no visible signs ( r = −0.29, P < .01). Conclusion: The interrater reliability for PFS and for bracing was fair to moderate. Neither PFS nor bracing were significantly related to concussion diagnosis, but they were significantly associated with other visible signs and mechanisms of injury.
Toward a coping-in-combination approach: The benefits of combining coping strategies for purpose in life of the self-employed
Authors: Lerman Michael , Ju Huiqing , Nikolaev Boris 
Published: November 2024

The self-employment coping literature typically treats coping strategies separately. In contrast to this approach, we introduce a control perspective to examine the effects of combining coping strategies on a highly salient well-being outcome for the self-employed: purpose in life. Drawing on the Midlife in the United States (MIDUS) dataset ( N = 693), moderation analysis reveals that persistence and positive reappraisal mitigate the negative effect of lowering aspirations on purpose in life. In robustness tests, we find consistent results across similar well-being indicators. Our evidence highlights the need to study specific coping strategies in tandem and provides a more nuanced perspective on the differential effects of both primary (i.e., persistence) and secondary (i.e., positive reappraisal and lowering aspirations) coping strategies. JEL CLASSIFICATION: I - Health, Education, and Welfare
Medical influence: what does success look like?
Authors: Wintz Diane , Wright Kelly , Schaffer Kathryn B. 
Published: November 2024

Background: Social media influencers have revolutionized information, gaining viewers, retention, and interest with short videos. Medical teams could potentially benefit from this medium for educating patients. Defining success in this endeavor remains unclear. Objective: We are a surgeon-nurse team that sought to promote our messages on social media to gain viewers and interest in our website. Design: An educational podcast focusing on end-of-life discussions was linked to social media platforms, including Instagram and TikTok, to gain views on our website. Methods: Eleven podcast episodes were produced and published over a 3-month period, between November 2023 and January 2024. The podcast episodes were promoted to “similar clients” based on internal algorithms by a podcast streaming service, Spotify. The promotion provided by Spotify and website views were compared to responses evident by other social media posts. Results: After 3 months of publishing podcast episodes on Spotify, with free publicity, our podcast gained 10,400 promotions, 486 listeners, 49 followers, and approximately 1200 random website views. In comparison, the podcast content garnered more than 50,000 video clip views on TikTok and Instagram, after funding these brief video promotions. TikTok and Instagram both charged $20 or more per promotion. Paid promotion opportunities resulted in no website visits or podcast followers. Conclusion: Our own experience with social media promotion was inadequate in generating interest in our content. The authors would encourage other teams to be strategic with paid promotions and to consider engaging a marketing expert to improve the potential for mass interest in content and promotional efficiency. Additionally, based on these findings, the authors would appreciate more transparency in the algorithms behind successful promotions to better understand “what success looks like” for medical messaging.