bluuebunny/crossref_metadata_2025_split huggingface dataset:
Identification of profiles associated with conversions between the Alzheimer’s disease stages, using a machine learning approach
Authors: Dauphinot Virginie , Laurent Marie , Prodel Martin , Civet Alexandre , Vainchtock Alexandre , Moutet Claire , Krolak-Salmon Pierre , Garnier-Crussard Antoine 
Published: July 2024

Abstract
Background
The identification of factors involved in the conversion across the different Alzheimer’s disease (AD) stages is crucial to prevent or slow the disease progression. We aimed to assess the factors and their combination associated with the conversion across the AD stages, from mild cognitive impairment to dementia, at a mild, moderate or severe stage and to identify profiles associated with earliest/latest conversion across the AD stages.

Methods
In this study conducted on the real-life MEMORA cohort data collected from January 1, 2013, and December 31, 2019, three cohorts were selected depending on the baseline neurocognitive stage from a consecutive sample of patients attending a memory center, aged between 50 and 90 years old, with a diagnosis of AD during the follow-up, and with at least 2 visits at 6 months to 1 year of interval. A machine learning approach was used to assess the relationship between factors including socio-demographic characteristics, comorbidities and history of diseases, prescription of drugs, and geriatric hospitalizations, and the censored time to conversion from mild cognitive impairment to AD dementia, from the mild stage of dementia to the moderate or severe stages of AD dementia, and from the moderate stage of AD dementia to the severe stage. Profiles of earliest/latest conversion compared to median time to conversion across stages were identified. The median time to conversion was estimated with a Kaplan-Meier estimator.

Results
Overall, 2891 patients were included (mean age 77±9 years old, 65% women). The median time of follow-up was 28 months for mild cognitive impairment (MCI) patients, 33 months for mild AD dementia and 30 months for moderate AD dementia. Among the 1264 patients at MCI stage, 61% converted to AD dementia (median time to conversion: 25 months). Among the 1142 patients with mild AD dementia, 59% converted to moderate/severe stage (median time: 23 months) and among the 1332 patients with moderate AD dementia, 23% converted to severe stage (Q3 time to conversion: 22 months). Among the studied factors, cardiovascular comorbidities, anxiety, social isolation, osteoporosis, and hearing disorders were identified as being associated with earlier conversion across stages. Symptomatic treatment i.e. cholinesterase inhibitors for AD was associated with later conversion from mild stage of dementia to moderate/severe stages.

Conclusion
This study based on a machine learning approach allowed to identify potentially modifiable factors associated with conversion across AD stages for which timely interventions may be implemented to delay disease progression.
The ABCs of Stargardt disease: the latest advances in precision medicine
Authors: Zaydon Yasmine A. , Tsang Stephen H. 
Published: July 2024

AbstractStargardt disease (STGD) is the most common form of inherited juvenile macular dystrophy and is caused by sequence variants in the ABCA4 gene. Due to its genetic complexity and phenotypic variability, STGD poses significant therapeutic challenges. In the past decade, a lot of progress has been made regarding our understanding of the molecular and clinical aspects of STGD, along with its mechanisms. This has led to the development of new therapies, and there are human clinical trials currently ongoing. This paper evaluates the emergence of pharmacological approaches targeting the visual cycle to mitigate retinal damage, the role of gene therapy in correcting specific genetic defects, and the use of stem cell therapies aimed at retinal regeneration by showcasing the latest clinical trials and precision medicine approaches.
Shootings across the rural–urban continuum
Authors: Ceccato Vania , Mentel Patryk , Levine Ned , Gerell Manne 
Published: July 2024

AbstractIn this article, we investigate situations involving firearm violence in Sweden. The spatiotemporal distribution of records is assessed in different contexts across the country and linked to land use, demographic, and socio-economic characteristics by area and by street segment. The findings emphasize the prevalence of evening shootings, particularly in economically disadvantaged areas where young people congregate in public places often in residential areas, in parks, in playgrounds, and in transit areas. Although two-thirds of shootings took place in larger urban municipalities, our study sheds light on the non-uniform distribution of gun violence along the rural–urban continuum. We conclude by offering suggestions for future research and practical interventions to address this pressing issue that negatively affects people and communities.
Protocol and preregistration for the CODEC project: measuring, modelling and mechanistically understanding the nature of cognitive variability in early childhood
Authors: Coolen Ilse E. J. I. , van Langen Jordy , Hofman Sophie , van Aagten Fréderique E. , Schaaf Jessica V. , Michel Lea , Aristodemou Michael , Judd Nicholas , van Hout Aran T. B. , Meeussen Emma , Kievit Rogier A. 
Published: July 2024

Abstract
Background
Children’s cognitive performance fluctuates across multiple timescales. However, fluctuations have often been neglected in favour of research into average cognitive performance, limiting the unique insights into cognitive abilities and development that cognitive variability may afford. Preliminary evidence suggests that greater variability is associated with increased symptoms of neurodevelopmental disorders, and differences in behavioural and neural functioning. The relative dearth of empirical work on variability, historically limited due to a lack of suitable data and quantitative methodology, has left crucial questions unanswered, which the CODEC (COgnitive Dynamics in Early Childhood) study aims to address.

Method
The CODEC cohort is an accelerated 3-year longitudinal study which encompasses 600 7-to-10-year-old children. Each year includes a ‘burst’ week (3 times per day, 5 days per week) of cognitive measurements on five cognitive domains (reasoning, working memory, processing speed, vocabulary, exploration), conducted both in classrooms and at home through experience sampling assessments. We also measure academic outcomes and external factors hypothesised to predict cognitive variability, including sleep, mood, motivation and background noise. A subset of 200 children (CODEC-MRI) are invited for two deep phenotyping sessions (in year 1 and year 3 of the study), including structural and functional magnetic resonance imaging, eye-tracking, parental measurements and questionnaire-based demographic and psychosocial measures. We will quantify developmental differences and changes in variability using Dynamic Structural Equation Modelling, allowing us to simultaneously capture variability and the multilevel structure of trials nested in sessions, days, children and classrooms.

Discussion
CODEC’s unique design allows us to measure variability across a range of different cognitive domains, ages, and temporal resolutions. The deep-phenotyping arm allows us to test hypotheses concerning variability, including the role of mind wandering, strategy exploration, mood, sleep, and brain structure. Due to CODEC’s longitudinal nature, we are able to quantify which measures of variability at baseline predict long-term outcomes. In summary, the CODEC study is a unique longitudinal study combining experience sampling, an accelerated longitudinal ‘burst’ design, deep phenotyping, and cutting-edge statistical methodologies to better understand the nature, causes, and consequences of cognitive variability in children.

Trial registration
ClinicalTrials.gov - NCT06330090
Cognitive testing and the hazards of cut-offs
Authors: Series Hugh , Burns Alistair 
Published: July 2024

SUMMARYThe article reviews some basic statistical concepts used in medicine, including the mean, standard deviation, sensitivity and specificity. Using this background the authors describe how these can be applied to cognitive tests, taking the Montreal Cognitive Assessment (MoCA) as an example. Two different approaches to using the MoCA in diagnosing dementia are considered: one using a fixed cut-off score, the other taking account of normative data about the effects of age and educational level on MoCA scores. It is recommended that clinicians assessing cognitive function should not rely on a fixed cut-off score, but where possible compare the patient's result with those of people of comparable age and educational background, although normative data of this kind are not always available.
Imparting Knowledge to Others: A Qualitative Study Exploring How Ethiopian Women Prefer to Receive Cervical Cancer Education
Authors: Tubassum Rushna , Tisha Tasnim , Boey Emma , Rahman Nimra , Halkiyo Atota B. , Hussein Asiya Jaylan , Dedefo Abdulkerim , Bekele Etsegenet , Pierz Amanda J. , Tefera Biniyam , Madhivanan Purnima , Lott Breanne E. 
Published: July 2024

PURPOSE Cervical cancer is the second deadliest cancer among women in Ethiopia. While preventable through timely screening, there is a low uptake of cancer screening among women due to low awareness and education. Cervical cancer screening practices are essential in decreasing morbidity from disease. We aim to explore Ethiopian women's preferences for cancer education and how that influences their decision to be screened or not. METHODS In 2022, four focus group discussions (n=50) were conducted in Adama, Ethiopia after completing the informed consent process. Audio recordings were translated and transcribed verbatim, analyzed by a student research team (RT, NR, TT) using iterative content analysis. Using Dedoose software, a codebook was developed, and excerpts were inductively and deductively coded for major, minor, and emergent themes, and direct participant quotes were used to illustrate participants cancer education and screening decision-making preferences. RESULTS Most participants had never been screened for cervical cancer (70%) and almost half had no formal education (44%). They expressed the importance of group and family-based education. Involvement of their spouses, children, and other relatives was highly relevant to the need of ‘family suppor’ at the psychological and financial level during one's decision to get screened. Group education at the hospital-level and ‘home to home’ engagement was also expressed in the need for ‘imparting knowledge to others’ in the community. To enhance patient-provider communication, peer education was described as a facilitator to education to ‘ease the process and encourage exchange of information' between patients and their providers. Finally, common suggestions included educating a patient about screening methods for complete understanding of testing procedures and increasing cancer awareness through ‘community sensitization' CONCLUSION These qualitative findings can inform the development of culturally sensitive and health-literate educational interventions that increase cervical cancer knowledge and promote equitable healthcare access and outcomes in Ethiopia. Recommendations include focusing on improved patient-provider communication and family-oriented education. It is important to address cancer stigma and misconceptions to increase uptake of life-saving screening. It is also important to examine how these factors impact patient-provider relationships and necessitate improved education strategies to reduce barriers in health communication for cancer prevention.
Multidisciplinary Cancer Treatment Capacity in Ukraine During the War
Authors: Horiachok Maksym , Kizub Darya , Dzhemiliev Ali , Huivaniuk Inesa , Kopetskyi Vyacheslay , Reutova Mila , Uzlova Anna , Matiushenko Inesa , Kasianchyk Mariia , Beznosenko Andriy , Melnitchouk Nelya 
Published: July 2024

PURPOSE Assessment of cancer diagnostic and treatment capacity is crucial to optimizing cancer care, especially in the setting of limited resources, including as a result of war. We assessed personnel, equipment, and treatment availability during Russia's full-scale invasion of Ukraine to define gaps that could then be addressed with tailored strategies. METHODS An online survey designed in collaboration with oncology specialists from the National Cancer Institute in Ukraine was distributed to oncologists in Ukraine through oncology-related social media. Data were analysed using descriptive statistics. RESULTS 192 physicians from all regions of Ukraine, including 53 (23.6%) medical oncologists, 89 (46.4%) surgical oncologists, and 32 (16.7%) radiation oncologists completed the survey. The average number of medical oncologists per regional cancer centre was 4.7 compared to 2.5 seen as the optimal number. The average number of nurses trained in chemotherapy administration was 6.4 compared to the desired number of 8.6. The average number of chemotherapy infusion machines was 8.2 compared to 17.7 desired. On average, 5.7 ports were put in per month compared to 22.1 desired. Average number of infusion chairs was 6.4 compared to 16.3 desired, while the number of inpatient chemotherapy beds was 26.8 compared to 34.0 perceived as the optimal number. The reported average number of surgical oncologists was 12.1 with an optimal average of 6.0. The average number of surgical beds was 52.8 v 60.7 desired. The average and optimal numbers of the following were fairly close: surgical oncology trainees (2.1 v 2.6), operating room nurses (4.1 v 4.3), anesthesiologists (4.4 v 4.2), operating rooms (3.6 v 3.4), anaesthesia machines (4.4 v 4.0), average surgeries per week (21.5 v 21.8). The average number of radiation oncologists was 7.9 compared to 8.5 optimal numbers. For other metrics, average and optimal numbers were somewhat close: number of radiation therapy laboratory technicians (7.9 v 8.5), medical physicists (3.8 v 4.8), dosimetrists (1.5 v 2.1), Cobalt 60 machines (0.9 v 1.1), brachytherapy machines (1.1 v 1.7). CONCLUSION We identified important equipment and personnel gaps in oncology care in Ukraine. Results are limited by the decreased number of respondents from areas directly affected by active hostilities.
Novel, Plastic-Free Vaginal Applicator for Reduction of Environmental and Systemic Plastic Chemical Exposures That Associate With Cancers
Authors: Clifton Dennis , Fichorova Raina , Feldman Sarah , Romaguera Josefina , Godoy-Vitorino Filipa , Fremlin Jenny , Ellington-Lawrence Rayne , Carey Vincent , Pena Nancy , Diaz Janice , Stokes Erisa , Ellington Joanna 
Published: July 2024

PURPOSE A cost-effective, prebiotic gel (PreBioGyn) is being developed to prevent genital cancers by reducing biological risk factors for women including vaginal infections, mucosal inflammation, and plastic contaminant exposure. PreBioGyn is packaged in a reduced-plastic system, using a Kraft-paper vaginal applicator. Vaginal mucosa has high absorption and permeability putting women at risk to contaminants in feminine-care products. Specifically, cell toxic levels of phthalates and bisphenols are found in 90% of these products with increased serum levels (e.g. 5X) occurring in some users. Short-term exposure to plastics used in these products results in over 5,000 leachable chemicals migrating into water samples. Plastic chemical burdens are amplified for women in low-resource settings, women who also have increased genital cancer risks. These studies evaluated the dosing accuracy, user acceptance, and cytotoxicity of the paper PreBioGyn applicator. METHODS (1) Dosing accuracy of the paper applicator was compared to that of plastic applicators used with existing vaginal gels (Trimosan and RepHresh; modified ISO11608-1:2014). (2) Table-top acceptability of the paper applicator was scored by 42 HPV-positive women in two locations (BWH and UPRMSC). Women were not educated about any benefits of plastic-free vaginal applicators. (3) Cytotoxicity of the paper applicator was tested (ISO 10993-1:2018, 10993-5:2009, 10993-12:2012) with 48 hr extract exposure to L929 cells. Latex glove extracts served as positive controls. RESULTS For the PreBioGyn paper applicator: (1) 90% of gel doses fell within target levels (+10%) which was significantly more accurate as compared to the two plastic applicators. (2) The proportion of women who scored the applicator in Likert responses as neutral or better (vs a negative acceptance score) was >50% for appearance, feel, and dose-preparation; and >64% for use with vaginal medications as part of a cancer prevention program. (3) No cytotoxicity or biological reactivity was seen in applicator extracts. Latex extracts resulted in severe destruction of cells. CONCLUSION The novel paper applicator was safe, effective and acceptable in these studies. Acceptability was equal to published ratings for many plastic applicators used in existing vaginal products. The reduced-plastic PreBioGyn delivery system is designed to minimize plastic contaminant exposure in the vagina and the environment, further supporting its adoption as a cancer prevention gel.
Patient Financial Well-Being and Access to Cancer Treatment During Wartime
Authors: Ivanykovych Taras , Kizub Darya , Antoniv Marta , Dzhemiliev Ali , Naumova Marta , Uzlova Anna , Matiushenko Inesa , Reutova Mila , Kopetskyi Viacheslay , Huivaniuk Inesa , Beznosenko Andriy , Melnitchouk Nelya 
Published: July 2024

PURPOSE The high cost of cancer care is a barrier to treatment.,We explored the impact of patient-reported financial well-being on access to cancer care during Russia’s full-scale invasion of Ukraine. Ukraine has universal health insurance (UHC) that covers most cancer care costs. METHODS Cancer patients receiving treatment at public cancer centers in Cherkasy, Dnipro, Kyiv, and Kharkiv (the city closest to the front lines) filled out surveys in October 2023. Results were analyzed using descriptive statistics, Chi-Squared test, and Fisher’s exact test. RESULTS 522 patients filled out surveys, including 329 (63%) women. 214 (41%) were from Kyiv, 141 (27%) from regional centers, 167 (32%) from small towns/villages. 177 (34%) reported having money only for food, 183 (35%) for basic necessities, 131 (25%) for everything needed but not savings, and 26 (5%) were able to make savings. Among 522, 240 (46%) received all diagnostic procedures through UHC, 224 (43%) paid for some and 57 (11%) paid for all aspects of diagnosis. Official payments were most common for CT (73%), MRI (72%), PET-CT (44%), and biopsy (31%). Around half of patients had all treatment covered through UHC in case of chemotherapy (318 (61%)), radiotherapy (256 (49%)) and surgery (245 (47%)). Official payments were made most often for surgery (188 (36%)), radiotherapy (130 (25%)), and chemotherapy (120 (23%)). The most frequent official or unofficial payments for surgery were made in Kharkiv (55% vs. 41-50%, p < 0.05). Among 201 (39%) who paid for treatment, 64 (32%) bought surgical instruments, 58 (29%) bought cancer medicines, and 20 (10%) paid to avoid waiting for treatment. There were no significant differences in wait times for diagnosis and treatment were observed based on financial status (p > 0.05). CONCLUSION Reported financial well-being did not impact wait times for cancer care in Ukraine in the setting of UHC, even in times of war. In Kharkiv, the proximity of wartime hostilities resulted in increased out-of-pocket payments for treatment. Future research should describe strategies for overcoming barriers to access in the setting of limited resources and also evaluate the quality of cancer care against existing guidelines.
Sources of Diagnostic Delay for HIV-Associated Lymphoma in a Fine Needle Aspiration Clinic in Soweto, South Africa
Authors: Arora Arshia , Tshabalala Nomathemba , Xian Rena , Ambinder Richard , Omar Tanvier , Martinson Neil , Vogt Samantha 
Published: July 2024

PURPOSE Fine needle aspiration (FNA) is an important diagnostic modality used in the evaluation of lymphadenopathy in people living with HIV (PWH) to differentiate between tuberculosis (TB) and lymphoma. However, an FNA suggestive of lymphoma is generally not sufficient for diagnosis and needs to be confirmed by biopsy. We evaluated time to diagnosis for PWH with FNA findings suggestive of lymphoma in Soweto, South Africa. METHODS PWH with lymphadenopathy presenting to an FNA clinic in Soweto, South Africa were enrolled in a prospective observational study between September 2021 to December 2022. Participants were interviewed at initial presentation to the FNA clinic and prospectively followed for 8 months or until death. Patient intervals (PI) and healthcare practitioner intervals (HPI) were obtained and descriptive statistics performed. RESULTS Among 146 PWH, 20 participants had FNA cytology suggestive of lymphoma and one participant was ultimately diagnosed with lymphoma although the initial FNA showed reactive adenopathy. The median age for these 21 participants was 46 years (IQR: 38 - 51) with a male predominance (67%). The median CD4 count was 213 (IQR 137 - 304) and 7/20 (35%) had an undetectable viral load. Biopsy confirmation of lymphoma occurred in 11/21 participants, while 8/21 died prior to biopsy confirmation and 2/21 completed 8 months of follow-up alive without biopsy confirmation. Additionally, 2/11 diagnosed with lymphoma died within 2 weeks of diagnosis. The PI was evaluable for 15 participants and was a median of 30 days (IQR 11-71). The HPI was a median of 88 days (IQR 55-134). First presentation with symptoms was to a clinic (10/21; 48%), pharmacy (8/21; 38%), or traditional healer (3/21; 14%). The median clinic visits prior to FNA was 2 (IQR: 2-3). For those that died, there was a trend towards a longer PI, first presentation to either the pharmacy or a traditional healer, and a median total visits prior to FNA. CONCLUSION Sources of diagnostic delay for the diagnosis of HIV-associated lymphoma include initial presentation to a non-healthcare practitioner, prolonged median HPI, and non-standardized process of referral for evaluation of lymphadenopathy. Interventions to improve the diagnostic triage are warranted.