bluuebunny/crossref_metadata_2025_split huggingface dataset:
Obstructive Sleep Apnea and Its Cardiac Implications in the United States: An Age‐Stratified Analysis Between Young and Older Adults
Authors: Strenth Chance , Wani Anna , Alla Rupini , Khan Safia , Schneider Frank David , Thakur Bhaskar 
Published: June 2024

Background
Obstructive sleep apnea (OSA) is a common sleep disorder associated with cardiovascular risks. This study aimed to assess the prevalence of probable OSA and its relationship with cardiovascular risks and diseases focusing on age‐stratified young adults (20–40 years) and older (>40 years).

Methods and Results

The study used a cross‐sectional design, analyzing data from the National Health and Nutrition Examination Survey conducted between 2013 and 2018, comprising 9887 community‐dwelling adults aged ≥20 years. Probable OSA was determined on the basis of self‐report of OSA‐related symptoms (eg, snoring, gasping/breath cessation while sleeping). Cardiovascular risk factors, including hypertension, diabetes, hyperlipidemia, and metabolic syndrome, were evaluated according to established guidelines. Cardiovascular diseases (CVDs) included self‐reported heart conditions, including congestive heart failure, coronary heart disease, angina, heart attacks, and strokes. Individuals with probable OSA showed a significantly higher prevalence of health conditions, including hypertension (adjusted prevalence ratio [aPR], 1.19;
P
<0.001), diabetes (aPR, 1.17;
P
: 0.01), metabolic syndrome (aPR, 1.14;
P
<0.001), heart attack (aPR, 1.63;
P
<0.01), stroke (aPR, 1.41;
P
: 0.03), and any CVD event (aPR, 1.36;
P
: 0.01) after adjusting for relevant factors. Young adults with probable OSA showed higher prevalence rates of any CVD events (aPR, 3.44;
P
<0.001), hypertension (aPR, 1.45;
P
<0.001), metabolic syndrome (aPR, 1.25;
P
<0.001), and angina (aPR, 10.39;
P
<0.001).

Conclusions
The study suggests early identification and management of OSA in individuals at risk for CVD. While cross‐sectional, it emphasizes that health care providers should recognize OSA as significantly associated with CVDs and its precursor risks in young adults, stressing proactive care and screening to reduce CVD risk in this population.
Frictions and Logics of ‘Good State’ Support to International Criminal Justice: The Case of Norway
Authors: Lohne Kjersti 
Published: June 2024

Abstract
Despite the significance of state support to international criminal justice institutions, we lack systematic knowledge about what animates states’ foreign policy on international criminal justice, as well as how international criminal justice impacts domestic societies. This article analyses a subset of findings regarding Norway from the EU cost Action (ca18228) survey on States’ encounters with international criminal justice. While Norway’s positioning in the ‘global atrocity justice constellation’ is driven by strategic foreign policy aims to protect and strengthen the liberal international order, the paper reveals how the ‘State’ in international criminal justice is far from a homogenous, unitary entity, but rather is composed of conflicting and incongruent logics of governance impacting its support to international criminal justice.
Staring Down the Barrel: The Deployment of the Harquebus by the Hōjō of Odawara, 1530–1590
Authors: Turnbull Stephen 
Published: June 2024

Abstract
According to a popular theory, the Hōjō family of Odawara were hopelessly old-fashioned in their approach to firearms technology compared to their contemporaries in sixteenth century Japan. The third daimyo Hōjō Ujiyasu (1515–1571) has been singled out for particular criticism because he allegedly preferred to train his samurai by making them chase dogs, and as a result the Hōjō found themselves “staring down the barrel” when Toyotomi Hideyoshi advanced upon them in 1590. This article argues that this negative impression derives from a well-established Hōjō principle of frugality that was exaggerated by later accounts in gunkimono (“war tales”), whose authors did not see firearms as suitable material for their heroic narratives. By contrast, more reliable primary sources—letters, written orders, troop muster lists and garrison inventories—demonstrate that the Hōjō were no laggards in the development and deployment of firearms. Instead an investigation of the Hōjō’s embrace of the harquebus provides an excellent historical and technological case study. The finer details of their experience—as revealed by archaeological investigation and a unique eyewitness account of the effects of gunfire from a Hōjō fortress—also provide unique insights into the complex processes that were involved. Their defeat in 1590 was not due to being old-fashioned but to the application of military force on an overwhelming scale that none could have resisted.
Thyroid Cancer Incidence and Tumor Size in New Mexico American Indians, Hispanics, and Non-Hispanic Whites, 1992 to 2019
Authors: West Jordan , Wiemann Brianne Z. , Esce Antoinette R. , Olson Garth T. , Boyd Nathan H. 
Published: June 2024

Background: The incidence of thyroid cancer in the United States has risen dramatically since the 1970s, driven by an increase in the diagnosis of small tumors. There is a paucity of published New Mexico (NM) specific data regarding thyroid cancer. We hypothesized that due to New Mexico’s unique geographic and cultural makeup, the incidence of thyroid cancer and tumor size at diagnosis in this state would differ from that demonstrated on a national level. Methods: The New Mexico Tumor Registry (NMTR) was queried to include all NM residents diagnosed with thyroid cancer between 1992 and 2019. For 2010 to 2019, age-adjusted incidence rates were calculated via direct method using the 2000 United States population as the adjustment standard. Differences in incidence rate and tumor size by race/ethnicity and residence (metropolitan vs non-metropolitan) were assessed with rate ratios between groups. For 1992 to 2019, temporal trends in age-adjusted incidence rates for major race/ethnic groups in NM [Non-Hispanic White (NHW), Hispanic, and American Indian (AI)] were assessed by joinpoint regression using National Cancer Institute software. Results: Our study included 3,161 patients for the time period 2010 to 2019, including NHW (1518), Hispanic (1425), and AI (218) cases. The overall incidence rates for NM AIs were lower than those for Hispanics and NHWs because of a decreased incidence of very small tumors (<1.1 cm). The incidence rates for large tumors (>5.1 cm) was equivalent among groups. In the early 2000s, Hispanics also had lower rates of small tumors when compared to NHWs but this trend disappeared over time. Conclusion: AIs in New Mexico have been left out of the nationwide increase in incidental diagnosis of small thyroid tumors. This same pattern was noted for Hispanics in the early 2000s but changed over time to mirror incidence rates for NHWs. These data are illustrative of the health care disparities that exist among New Mexico’s population and how these disparities have changed over time.
Facilitators and Barriers to Developing a Research Program: A Focused Ethnography of New Tenure-Track PhD-Prepared Nursing Faculty
Authors: Savard Winnifred , Raymond Christy , Richter Solina , Olson Joanne K. , Paul Pauline 
Published: June 2024

Background Creating a research program is a critical requirement for new PhD-prepared tenure-track nursing faculty in Canada. Purpose The purpose of this article is to present key findings of new faculty members focusing on facilitators and barriers to development of their research program. Method We conducted focused ethnography research examining the experience of 17 new faculty members from across Canada. Results The following themes were identified: teaching release, preparation from PhD program, intense feelings, supports and processes, mentoring, obtaining grants, and effects of the COVID-19 pandemic. Conclusions Implications for practice include identifying ways to facilitate faculty retention as they develop their research program. This research will be of interest to deans of nursing and new faculty members.
Investigating adherence to tyrosine kinase inhibitors in renal cancer
Authors: Angus Fiona , Wang Yubo , Rigg Alexander , Chen Li-Chia 
Published: June 2024

Introduction Tyrosine kinase inhibitors (TKIs) have been used as the first-line treatment for many patients with renal cell carcinoma (RCC), the seventh most common cancer in the United Kingdom. However, suboptimal adherence to TKIs can result in poor clinical prognosis. This study quantified RCC patients’ adherence to TKIs and explored factors associated with suboptimal adherence. Method This retrospective cohort study was conducted at a specialist oncology tertiary hospital in Northwest England, using pharmacy dispensing records between November 2021 and March 2022. TKI prescriptions dispensed to patients with RCC were extracted to calculate the persistency gaps (≥7 or ≥14 days) and medication possession ratio (MPR). Multilevel regression analysis was conducted to associate MPR and persistency gaps with specific patient-related and TKI-related factors. This study did not require ethics approval. Results Of the 2225 prescriptions dispensed to 109 patients, 469 (23.4%) and 274 (13.7%) persistency gaps of ≥7 and ≥14 days were identified. About 75% and 92% of patients had a persistency gap of ≥7 days within the first 90 days and 180 days. The length of time since the first TKI prescription ( p < 0.001) and the use of sunitinib( p = 0.003) were significantly associated with the number of prescription gaps of ≥7 days. Moreover, the median MPR was 95.6% (interquartile range: 90.7%, 100.1%). Similarly, the length of time since the first TKI prescription was dispensed ( p < 0.001) and the use of sunitinib ( p = 0.034) were significantly associated with MPR. Discussion and conclusion This single-centre study found that patients with RCC generally adhere to TKIs (MPR > 90%), but many patients experienced a persistency gap. The crucial window to mitigate TKI utilisation is within 180 days after the initial dispensing of TKIs. Further large-scale studies are required to comprehensively investigate other factors associated with adherence to TKIs and develop interventions to improve adherence and medication use problems.
Quantitative microbial risk assessment for Escherichia Coli O157: H7 via drinking water in the Gaza Strip, Palestine
Authors: Abuzerr Samer , Hadi Mahdi , Zinszer Kate , Nasseri Simin , Yunesian Masud , Mahvi Amir Hossein , Nabizadeh Ramin , Mohammed Shimels Hussien 
Published: June 2024

Introduction: Microbial contamination of drinking water, particularly by pathogens such as Escherichia coli O157: H7, is a significant public health concern worldwide, especially in regions with limited access to clean water like the Gaza Strip. However, few studies have quantified the disease burden associated with E. coli O157: H7 contamination in such challenging water management contexts. Objective: This study aimed to conduct a comprehensive Quantitative Microbial Risk Assessment to estimate the annual infection risk and disease burden attributed to E. coli O157: H7 in Gaza’s drinking water. Methods: Applying the typical four steps of the Quantitative Microbial Risk Assessment technique—hazard identification, exposure assessment, dose-response analysis, and risk characterization—the study assessed the microbial risk associated with E. coli O157: H7 contamination in Gaza’s drinking water supply. A total of 1317 water samples from various sources across Gaza were collected and analyzed for the presence of E. coli O157: H7. Using Microsoft ExcelTM and @RISKTM software, a Quantitative Microbial Risk Assessment model was constructed to quantify the risk of infection associated with E. coli O157: H7 contamination. Monte Carlo simulation techniques were employed to assess uncertainty surrounding input variables and generate probabilistic estimates of infection risk and disease burden. Results: Analysis of the water samples revealed the presence of E. coli O157: H7 in 6.9% of samples, with mean, standard deviation, and maximum values of 1.97, 9.74, and 112 MPN/100 ml, respectively. The risk model estimated a median infection risk of 3.21 × 10-01 per person per year and a median disease burden of 3.21 × 10-01 Disability-Adjusted Life Years per person per year, significantly exceeding acceptable thresholds set by the WHO. Conclusion: These findings emphasize the urgent need for proactive strategies to mitigate public health risks associated with waterborne pathogens in Gaza.
Prevalence of Chronic Kidney Disease in Individuals With Type 2 Diabetes Within Primary Care: A Cross-Sectional Study
Authors: Silva-Tinoco Ruben , Cuatecontzi-Xochitiotzi Teresa , Morales-Buenrostro Luis E. , Gracia-Ramos Abraham Edgar , Aguilar-Salinas Carlos A. , Castillo-Martínez Lilia 
Published: June 2024

Aims: To assess the prevalence and risk factors for chronic kidney disease (CKD) among adults with type 2 diabetes within primary care. Methods: This cross-sectional study evaluated 1319 individuals receiving standard care across 26 primary units from July 2017 to January 2023. The estimated glomerular filtration rate (eGFR) and albuminuria were used for the diagnosis of CKD. CKD was defined by eGFR values of <60 mL/min/1.73 m2 and/or albumin-to-creatine ratio ≥30 mg/g. Logistic regression was applied to identify factors associated with CKD and study variables. Results: The median age of participants (60.6% females) was 55 years and the median diabetes duration was 10 years. The overall CKD prevalence in the study population was 39.2%. Within the CKD group, the prevalence rates of albuminuria, albuminuria coupled with low eGFR and isolated low eGFR were 72.1%, 19%, and 8.9%, respectively. The prevalence of CKD was 30.6% among participants under 40 years old and a higher value was observed in middle-aged adults with early-onset diabetes (at age <40 years) compared with the later-onset group. Multivariable analyses identified associations between CKD and factors such as age, the male sex, diabetes duration, hypertension, retinopathy, and metformin use. Conclusion: A relatively high prevalence of CKD, especially in non-elderly adults, was revealed in this primary care study. Early recognition strategies for CKD are crucial for timely prevention within primary care.
Time to Rethink Intended Learning Outcomes for Sustainable Development? A Qualitative Exploration and Reflection of Course Syllabuses in Swedish Undergraduate Physiotherapy Education
Authors: Swärdh Emma , Brodin Nina , Pettersson Anna , Palstam Annie 
Published: June 2024

OBJECTIVE Several calls to action for the implementation of education for sustainable development in health profession education have been put forth during the last few years. The aim was therefore to explore and describe sustainability-focused intended learning outcomes (SD-ILOs) in curricula of undergraduate physiotherapy education in Sweden. METHODS Using a deductive, descriptive, and qualitative approach, SD-ILOs in programs ( n = 8) and course syllabuses ( n = 143) from eight higher education institutions providing physiotherapy undergraduate education in Sweden were analyzed. SD-ILOs were described based on the subject content or condition, level of cognitive processes, sustainability learning dimensions, and key sustainability competencies. RESULTS Six of the eight physiotherapy programs provided course syllabuses with SD-ILOs. However, only 3% ( n = 36) of all ILOs were sustainability-focused. A larger part of the SD-ILOs, 78% ( n = 28) was described within the cognitive dimension of learning, and 80% ( n = 27) were linked to either the cognitive process ‘understanding’ or ‘analyzing’. The most frequently identified key competency in the SD-ILOs was ‘systems-thinking’ n = 10 (28%), and 30% ( n = 11) lacked key competency. CONCLUSION There is an urgent need for rapid initiatives to enhance sustainable development education in Swedish undergraduate physiotherapy education. Pedagogical approaches that cover not only cognitive dimensions of learning for sustainable development but also socio-emotional and behavioral dimensions, as well as more complex cognitive learning processes must also be developed. The current lack of key sustainability competencies further emphasizes the necessity to enrich physiotherapy curricula with action-oriented learning to develop powerful future sustainability agency within healthcare and the public health arena.
Short-Term Radiographic Outcomes of Bone Versus Metallic Augmented, Central Screw Type Baseplate in Reverse Total Shoulder Arthroplasty: Matched Case-Control Study
Authors: Lo Eddie Y , Nazemi Monia , Ouseph Alvin , Edwards Audrene S , Weingast Nancy , Krishnan Sumant G 
Published: June 2024

Background Although glenoid bone grafting and metallic augmented baseplates have demonstrated success in restoring the glenohumeral joint line in the recent literature, there remain no consensus guidelines defining the use of one versus the other. Methods Between 2017 and 2020, 15 primary RTSA with screw-in metallically augmented glenoid baseplates were identified and 2:1 matched by age, sex, and body mass index with primary bony-augmented glenoid baseplate patients. Patients with previous glenoid implantation or fracture were excluded. Charts, routine radiographic series (Grashey, Scapula Y, Axillary lateral), and 3-dimensional computed tomography (3D CT) scans were retrospectively reviewed. Structural patient-specific metal or bony augmentation was indicated based on preoperative glenoid morphology as identified by 3D CT. Aseptic failure was identified as hardware breakage and/or shift in glenoid baseplate component position. Results There were 45 eligible cases with mean age of 65.7 years (range 44-85 years) and 65.5 years (range 42-82 years) for the metallic-augmented and bone graft group, respectively. Correspondingly, mean follow up was 22.6 months (range 12-53 months), and 27.3 months (range 11-53 months). At latest follow up, there were no baseplate failures in the metallic augment group and 2 baseplate failures (7%) in the bone graft group at a mean of 42.5 months (range 32-53 months) postoperatively. Mean age of the bone failure group was 64.5 years (range 64-65 years). Conclusion Contemporary reversed shoulder arthroplasty glenoid baseplate designs appear to have low incidence of failure. Further analysis is necessary to determine if a critical degree of glenoid retroversion or inclination is preferable with a specific form of augmentation. Level of Evidence III; Retrospective Cohort Comparison.
Optimizing liver health before and after gene therapy for hemophilia A
Authors: Ragni Margaret V. , Mead Henry , de Jong Ype P. , Kaczmarek Radoslaw , Leavitt Andrew D. , Long Brian , Nugent Diane J. , Sabatino Denise E. , Fong Sylvia , von Drygalski Annette , Walsh Christopher E. , Luxon Bruce A. 
Published: June 2024

Abstract
Gene therapy for severe hemophilia A uses an adeno-associated virus (AAV) vector and liver-specific promoters that depend on healthy hepatocyte function to achieve safe and long-lasting increases in factor VIII (FVIII) activity. Thus, hepatocyte health is an essential aspect of safe and successful gene therapy. Many people living with hemophilia A have current or past chronic hepatitis C virus infection, metabolic dysfunction–associated steatosis or steatohepatitis, or other conditions that may compromise the efficacy and safety of AAV-mediated gene therapy. In addition, gene therapy may induce an immune response to transduced hepatocytes, leading to liver inflammation and reduced FVIII activity. The immune response can be treated with immunosuppression, but close monitoring of liver function tests and factor levels is necessary. The long-term risk of hepatocellular carcinoma associated with gene therapy is unknown. Routine screening by imaging for hepatocellular carcinoma, preferable every 6 months, is essential in patients at high risk and recommended in all recipients of hemophilia A gene therapy. This paper describes our current understanding of the biologic underpinnings of how liver health affects hemophilia A gene therapy, and provides practical clinical guidance for assessing, monitoring, and managing liver health both before and after gene therapy.
Titration of anti-IL-5 biologics in severe asthma: an open-label randomised controlled trial (the OPTIMAL study)
Authors: Soendergaard Marianne Baastrup , Bjerrum Anne-Sofie , Rasmussen Linda Makowska , Lock-Johansson Sofie , Hilberg Ole , Hansen Susanne , von Bulow Anna , Porsbjerg Celeste 
Published: June 2024

BackgroundAnti-interleukin (IL)-5 biologics effectively reduce exacerbations and the need for maintenance oral corticosteroids (mOCS) in severe eosinophilic asthma. However, it is unknown how long anti-IL-5 treatment should be continued. Data from clinical trials indicate a gradual but variable loss of control after treatment cessation. In this pilot study of titration, we evaluated a dose-titration algorithm in patients who had achieved clinical control on an anti-IL-5 biologic.MethodsIn this open-label randomised controlled trial conducted over 52 weeks, patients with clinical control (no exacerbations or mOCS) on anti-IL-5 treatment were randomised to continue with unchanged intervals or have dosing intervals adjusted according to a titration algorithm that gradually extended dosing intervals and reduced them again at signs of loss of disease control. The OPTIMAL algorithm was designed to down-titrate dosing until signs of loss of control, to enable assessment of the longest dosing interval possible.ResultsAmong 73 patients enrolled, 37 patients were randomised to the OPTIMAL titration arm; 78% of patients tolerated down-titration of treatment. Compared to the control arm, the OPTIMAL arm tended to have more exacerbations during the study (32%versus17%; p=0.13). There were no severe adverse events related to titration, and lung function and symptoms scores remained stable and comparable in both study arms throughout.ConclusionThis study serves as a proof of concept for titration of anti-IL-5 biologics in patients with severe asthma with clinical control on treatment, and the OPTIMAL algorithm provides a potential framework for individualising dosing intervals in the future.
Longitudinal validation of King's Sarcoidosis Questionnaire in a prospective cohort with mild sarcoidosis
Authors: Møller Janne , Prior Thomas Skovhus , Hilberg Ole , Birring Surinder , Bendstrup Elisabeth 
Published: June 2024

BackgroundQuality of life is impaired in patients with sarcoidosis. The King's Sarcoidosis Questionnaire (KSQ) is a brief questionnaire assessing health-related quality of life in patients with sarcoidosis, comprising subdomains of General Health Status (GHS), Lung, Medication, Skin and Eyes. The aim of this study was to enhance the validation of the KSQ, incorporating longitudinal validation and known-groups validity in a cohort with mild sarcoidosis.MethodsThe KSQ was linguistically validated according to guidelines. Patients with sarcoidosis completed KSQ and other questionnaires at baseline, after 2 weeks and at 12 months. Forced vital capacity (FVC) was measured. Concurrent validity, reliability and responsiveness were assessed.ResultsIn patients (n=150), the KSQ had moderate to strong correlations with the Short Form-12 (Mental Component Summary), the King's Brief Interstitial Lung Disease questionnaire and the Fatigue Assessment Scale (r=0.30–0.70) and weak correlations with the Short Form-12 (Physical Component Summary) and FVC (r=0.01–0.29). The KSQ GHS and Lung domains were able to discriminate between groups of patients stratified according to fatigue, treatment and FVC. The KSQ had high internal consistency (Cronbach's α=0.73–0.90) and repeatability (interclass correlation coefficients 0.72–0.81). Correlations to comparable questionnaires at baseline were moderate or strong for the GHS, Lung and GHS–Lung subdomains and weak or moderate for FVC. The KSQ was responsive to changes over time.ConclusionThis study strengthened the validation of the KSQ by introducing known-groups validity and assessments of responsiveness over 12 months in patients with mild sarcoidosis.