bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing the use of anti-PD1 monotherapy as adjuvant therapy and determinants of treatment choice in stage III cutaneous melanoma in the US
Authors: Whitman Eric D. , Totev Todor I. , Jiang Shan , da Costa Wilson L. , Grebennik Dmitri , Wang Hongjue , Boca Andra-Ecaterina , Ayyagari Rajeev 
Published: March 2024

Abstract
Background
The objective of this study was to describe real-world adjuvant therapy (AT) use by disease substage and assess determinants of treatment choice among patients with stage III melanoma.

Methods
This non-interventional retrospective study included survey responses and data from patient records provided by US medical oncologists. Survey responses, patient demographic/clinical characteristics, treatment utilization, and reasons for treatment were reported descriptively. The association between patient and disease characteristics and AT selection was assessed using logistic and multinomial regression models, overall and stratified by AJCC8 substage (IIIA vs. IIIB/C/D) and type of AT received (anti-PD1 monotherapy, BRAF/MEK, no AT), respectively.

Results
In total 152 medical oncologists completed the survey and reviewed the charts of 507 patients (168 stage IIIA; 339 stages IIIB/IIIC/IIID); 405 (79.9%) patients received AT (360/405 (88.9%) received anti-PD1 therapy; 45/405 (11.1%) received BRAF/MEK therapy). Physicians reported clinical guidelines (61.2%), treatment efficacy (37.5%), and ECOG performance status (31.6%) as drivers of AT prescription. Patient-level data confirmed that improving patient outcomes (79%) was the main reason for anti-PD1 prescription; expected limited treatment benefit (37%), patient refusal (36%), and toxicity concerns (30%) were reasons for not prescribing AT. In multivariable analyses stage IIIB/IIIC/IIID disease significantly increased the probability of receiving AT (odds ratio [OR] 1.74) and anti-PD1 therapy (OR 1.82); ECOG 2/3 and Medicaid/no insurance decreased the probability of AT receipt (OR 0.37 and 0.42, respectively) and anti-PD1 therapy (OR 0.41 and 0.42, respectively) among all patients and patients with stage IIIA disease.

Conclusion
Most patients were given AT with a vast majority treated with an anti-PD1 therapy. Physician- and patient-level evidence confirmed the impact of disease substage on AT use, with stage IIIA patients, patients without adequate insurance coverage, and worse ECOG status having a lower probability of receiving AT.
Optimizing care for children with difficult-to-treat and severe asthma through specialist paediatric asthma centres: expert practical experience and advice
Authors: Pijnenburg M. W. , Rubak S. , Skjerven H. O. , Verhulst S. , Elenius V. , Hugen C. , Jauhola O. , Kempeneers C. , Melén E. , Reier Nilsen T. , Rutjes N. W. , Ruotsalainen M. , Schaballie H. , Zwitserloot A. M. , Proesmans M. , Mäkelä M. J. 
Published: March 2024

AbstractSevere asthma in children carries an unacceptable treatment burden, yet its rarity means clinical experience in treating it is limited, even among specialists. Practical guidance is needed to support clinical decision-making to optimize treatment for children with this condition.This modified Delphi convened 16 paediatric pulmonologists and allergologists from northern Europe, all experienced in treating children with severe asthma. Informed by interviews with stakeholders involved in the care of children with severe asthma (including paediatricians, nurses and carers), and an analysis of European guidelines, the experts built a consensus focused on the gaps in existing guidance. Explored were considerations for optimizing care for patients needing biologic treatment, and for selecting home or hospital delivery of biologics. This consensus is aimed at clinicians in specialist centres, as well as general paediatricians, paediatric allergologists and paediatric pulmonologists who refer children with the most severe asthma to specialist care. Consensus is based on expert opinion and is intended for use alongside published guidelines.Our discussions revealed three key facets to optimizing care. Firstly, early asthma detection in children presenting with wheezing and/or dyspnoea is vital, with a low threshold for referral from primary to specialist care. Secondly, children who may need biologics should be referred to and managed by specialist paediatric asthma centres; we define principles for the specialist team members, tests, and expertise necessary at such centres, as well as guidance on when homecare biologics delivery is and is not appropriate. Thirdly, shared decision-making is essential at all stages of the patient’s journey: clear, concise treatment plans are vital for patient/carer self-management, and structured processes for transition from paediatric to adult services are valuable. The experts identified the potential for specialist paediatric asthma nurses to play a significant role in facilitating multidisciplinary working.Through this project is agreed a framework of practical advice to optimize the care of children with severe asthma. We encourage clinicians and policymakers to implement this practical advice to enhance patient care.
The effect of the Yara smartphone application on anxiety, sleep quality, and suicidal thoughts in patients with major depressive disorder in Iran: a randomized controlled trial
Authors: Soltani Zeinab , Parizad Naser , Radfar Moloud , Alinejad Vahid , Arzanlo Mohammad , Haghighi Mahmonir 
Published: March 2024

Abstract
Background
Depression is one of the most common mental disorders that leads to anxiety, sleep disturbances, and suicidal thoughts. Due to the high cost of treatment and the reluctance of many patients to seek medical help, major depressive disorder (MDD) is becoming more prevalent. Therefore, alternative methods like smartphone applications can help prevent and improve depression symptoms. The present study aimed to determine the effect of the newly developed Yara smartphone application on anxiety, sleep quality, and suicidal thoughts in patients with MDD.

Methods
This randomized controlled trial with a pretest-posttest design was conducted on Iranian patients with MDD in 2022. Sixty-four patients were recruited using convenience sampling and randomly assigned to two control and intervention groups. The intervention was conducted using the Yara smartphone application for three months. Data were collected using the Spielberger State-Trait Anxiety Inventory (STAI), Pittsburgh Sleep Quality Index (PSQI), and Beck Scale for Suicidal Ideation (BSSI). Data were first entered into IBM SPSS Statistics for Windows, version 22 (IBM Corp., Armonk, N.Y., USA) and then analyzed using descriptive and analytical statistics.

Results
There was no statistically significant difference in the mean score of anxiety and sleep quality between the intervention and control groups before the intervention (p ≥ .05). However, this difference in the mean score of anxiety and sleep quality was statistically significant in the two groups after the intervention (p < .05). The results showed no statistically significant difference in the mean score of suicidal thoughts between the two groups before and after the intervention (p ≥ .05). The use of the Yara smartphone application had a significant positive effect on anxiety and sleep quality in depressed patients (p < .001). At the same time, it had no significant effect on suicidal thoughts (p ≥ .05).

Conclusion
Considering the positive effect of using the Yara smartphone application on reducing anxiety and improving sleep quality in depressed patients, this application can help alleviate the problems of depressed patients alongside existing treatment methods. Thus, this application is recommended for this group of patients in psychiatric clinics and departments. The Yara application's effectiveness was not approved on suicidal thoughts in this study so that further investigation would be necessary.

Trial Registration
Iranian Registry of Clinical Trial approval code (IRCT# IRCT20131112015390N7).
Psychometric analysis and linguistic adaptation of the Persian version of Contraceptive Self-Efficacy Scale (CSES-P)
Authors: Azari Nadereh , Mahmoodi Hassan , Mousavi Saeed , Mirghafourvand Mojgan , Keikhaee Razieh , Shaghaghi Abdolreza 
Published: March 2024

Abstract
Background
This study was aimed to test adaptability of the Contraceptive Self-Efficacy Scale (CSES) for use on Persian-speaking women of reproductive age.

Method
A preliminary draft of the Contraceptive Self Efficacy Scale (CSES) was prepared according to the standard translation/back translation procedures and an expert panel appraised its content and face validities. The approved draft was tested on 400 randomly selected women of reproductive age (15–49 years) at the 29th Bahman Hospital of in Tabriz, the capital city of East Azerbaijan province, North West of Iran from May to August 2018. The exploratory and confirmatory factor analysis (EFA, CFA) was carried out to verify the implicit factor structure of the CSES for use on Persian-speaking women of fertile age. The Cronbach’s α and Interclass Correlation coefficients were estimated for internal consistency and accuracy assessment of the instrument.

Results
This translated scale indicated good internal consistency (0.9) and reliability (0.9). A four-factor solution best fitted the study data and the estimated fit indices were in the acceptable range (chi square/ degree of freedom = 2.956, the Root Mean Square Error of Approximation = 0.070, Confirmatory Fit Index = 0.667, The Tucker-Lewis Index = 0.599).

Conclusion
The CSES-P can be considered as a potentially valid and reliable tool to assess contraceptive self-efficacy among Persian-speaking women. The CSES-P is a general instrument to measure overall contraceptive self-efficacy of the Iranian reproductive age women and it would also be fascinating to work on method specific self-efficacy tools in future.
Efficient hip joint distraction using the AO large femoral distractor in treating acetabular fractures associated with marginal impaction and intraarticular incarcerated fragments
Authors: Badran Mahmoud , Khalifa Ahmed A. , Fergany Ali , Ibrahim Bahaaeldin , Moustafa Mohamed , Adem Ephrem , Gilyen Botond , Farouk Osama 
Published: March 2024

Abstract
Purpose
The results after acetabular fracture are primarily related to the quality of articular reduction. Using the AO large femoral distractor, incarcerated fragments can be easily removed, and marginally impacted fragments can be elevated under direct visualization without further re-dislocating the joint. The current study aimed to evaluate our early results of using the AO large femoral distractor as an assisting tool during ORIF of acetabular fractures associated with marginal impaction or intraarticular incarcerated fragments.

Methods
Eighteen patients were included in this retrospective case series study diagnosed with an acetabular fracture associated with either marginal impaction injury or an intraarticular incarcerated fragment. On a usual operative table, all patients were operated upon in a prone position through the Kocher Langenbeck approach. The AO large femoral distractor was used to facilitate hip joint distraction. Postoperative fracture reduction and joint clearance were assessed in the immediate postoperative CT scans.

Results
The average age of the patients was 30 ± 8.2 years; 13 (72.2%) were males. All cases had a posterior wall fracture, and it was associated with transverse fractures, posterior column fractures, and T-type fractures in five (27.8%), two (11.1%), and one (5.6%) patients, respectively. Intraarticular incarcerated fragments were present in 13 (72.2%) cases and marginal impaction in five (27.8%). Fracture reduction measured on the postoperative CT scans showed an anatomical reduction in 14 (77.8%) patients, imperfect in four (22.2%), and complete clearance of the hip joint of any incarcerated fragments.

Conclusion
The use of the AO large femoral distractor is a reliable and reproducible technique that can be applied to assist in the removal of incarcerated intraarticular fragments and to ease the reduction of marginally impacted injuries associated with acetabular fractures.
Radiation safety compliance awareness among healthcare workers exposed to ionizing radiation
Authors: Allam Shaimaa Mohamed Elghareeb , Algany Mohamed Mustafa Abd , Khider Yasmin Ibrahim Abdelkader 
Published: March 2024

Abstract
Background
In recent years, there has been a marked growth in the use of ionizing radiation in medical imaging for both diagnosis and therapy, which in turn has led to increased radiation exposure among healthcare workers.

Aim
The purpose of this study was to assess the level of safety compliance awareness among healthcare workers exposed to ionizing radiation.

Research design
A descriptive cross-sectional design was used for this investigation.

Setting
This study was conducted online, using social media sites such as WhatsApp, Instagram, and Facebook.

Subjects
A purposive sample of 384 Egyptian healthcare workers was enrolled in the current study.

Tool
A safety compliance awareness questionnaire was used in this study to collect pertinent data.

Results
The result of this study showed that 65.4% and 64.1% of the studied sample chose the correct answers that mammography and CT scans involve the use of x-rays. However, 64.3% and 67.2% of the studied sample chose the wrong answers, saying that MRI and Ultrasound involve the use of X-rays. Moreover, 47.14%, 43.5%, and 57% of the studied sample never used a dosimeter, did not follow dosimeter controls, and did not wear a lead collar.

Conclusion
Most of the healthcare workers studied had poor knowledge about radiation exposure safety. Moreover, most of the healthcare workers in the current study demonstrated inadequate practice compliance concerning radiation protection procedures.

Recommendation
Should encourage hospital training programs to include radiation safety topics in their training plans for healthcare workers.
Global job satisfaction and fluctuation among community general practitioners: a systematic review and meta-analysis
Authors: Deng Qilin , Liu Yifang , Cheng Ziyi , Wang Qi , Liu Junan 
Published: March 2024

Abstract
Introduction
Community General Practitioners (CGPs) are crucial to primary healthcare worldwide. Their job satisfaction significantly impacts the quality and accessibility of healthcare. However, a comprehensive global perspective on this issue remains absent, necessitating this systematic review and meta-analysis.

Methods
This systematic review and meta-analysis sourced literature from PubMed, Web of Science, CNKI, and Wanfang, up to June 14, 2023. Of the 2,742 identified studies, 100 articles were selected for meta-analysis to assess satisfaction levels, and 97 studies were chosen for comparative analysis of influential factors. We employed both meta-analytic and comparative analytic methodologies, focusing on varying geographical, economic, and temporal contexts.

Results
The pooled rate and corresponding 95% confidence interval (CI) for job satisfaction among CGPs was 70.82% (95%CI: 66.62–75.02%) globally. Studies utilizing 5-point score scale obtained a random effect size of 3.52 (95%CI: 3.43–3.61). Diverse factors influenced satisfaction, with remuneration and working conditions being predominant. A noticeable decline in job satisfaction has been observed since the coronavirus disease 2019 outbreak, with satisfaction rates dropping from an average of 72.39% before 2009 to 63.09% in those published after 2020.

Conclusions
The downward trend in CGPs’ job satisfaction is concerning and warrants urgent attention from policymakers, especially in regions with an acute shortage of CGPs. The findings from this comprehensive review and meta-analysis provide essential insights for informed healthcare policy-making. It highlights the urgency of implementing strategies to enhance CGP satisfaction, thereby improving the effectiveness of primary healthcare systems globally.
Exploring healthcare provider retention in a rural and frontier community in Northern Idaho
Authors: Moore Jonathan D. , Lords Allie M. , Casanova Madeline P. , Reeves Ashley J. , Lima Ann , Wilkinson Cody , Deming Sarah M. , Baker Russell T. 
Published: March 2024

Abstract
Background
A shortage of healthcare providers, particularly in primary care and mental health, exists in the predominately rural state of Idaho. There are also barriers to retaining healthcare providers to work in rural and remote communities. Limited research using U.S. samples has explored factors that may affect the retention of healthcare providers in rural areas. Additionally, due to differences between communities, it is important to conduct community-level investigations to better understand how these factors may affect retention in rural areas. Therefore, the purpose of this study was to explore factors affecting healthcare provider retention in a rural community in Northern Idaho.

Methods
A modified version of the Nursing Community Apgar Questionnaire (NCAQ) was completed by 30 healthcare providers in a rural and frontier community in Northern Idaho to assess factors influencing healthcare provider retention. Factors were classified into classes including geographic, economic, scope of practice, medical support, and facility and community support classes. Retention factors were assessed on their perceived importance to retention as well as whether they were perceived as an advantage or challenge to retention based on Likert scales. A “Community Apgar” score was also created by combining the importance and advantage/challenge factors.

Results
Overall, items in the medical support group had the highest importance of any other class and included factors such as nursing workforce. Additionally, the facility and community support class, which included factors such as televideo support, was rated the highest advantage class and had the highest Apgar score, indicating it contained the factor that healthcare providers identified as the most important advantage (i.e., medical reference resources).

Conclusion
Our study identified multiple factors that healthcare providers deemed as important advantages or disadvantages to retaining healthcare providers in rural areas. Overall, facility and community support factors were found to have the highest advantage in the retention of rural providers. Rural healthcare organizations looking to increase healthcare provider retention should target retention efforts towards these factors. Additional research should also be conducted on other rural samples across the U.S. to make comparisons of findings.
Association of TRAIL receptor with phosphatase SHP-1 enables repressing T cell receptor signaling and T cell activation through inactivating Lck
Authors: Chyuan I-Tsu , Liao Hsiu-Jung , Tan Tse-Hua , Chuang Huai-Chia , Chu Yu-Chuan , Pan Meng-Hsun , Wu Chien-Sheng , Chu Ching-Liang , Sheu Bor-Ching , Hsu Ping-Ning 
Published: March 2024

Abstract
Background
T cell receptor (TCR) signaling and T cell activation are tightly regulated by gatekeepers to maintain immune tolerance and avoid autoimmunity. The TRAIL receptor (TRAIL-R) is a TNF-family death receptor that transduces apoptotic signals to induce cell death. Recent studies have indicated that TRAIL-R regulates T cell-mediated immune responses by directly inhibiting T cell activation without inducing apoptosis; however, the distinct signaling pathway that regulates T cell activation remains unclear. In this study, we screened for intracellular TRAIL-R-binding proteins within T cells to explore the novel signaling pathway transduced by TRAIL-R that directly inhibits T cell activation.

Methods
Whole-transcriptome RNA sequencing was used to identify gene expression signatures associated with TRAIL-R signaling during T cell activation. High-throughput screening with mass spectrometry was used to identify the novel TRAIL-R binding proteins within T cells. Co-immunoprecipitation, lipid raft isolation, and confocal microscopic analyses were conducted to verify the association between TRAIL-R and the identified binding proteins within T cells.

Results
TRAIL engagement downregulated gene signatures in TCR signaling pathways and profoundly suppressed phosphorylation of TCR proximal tyrosine kinases without inducing cell death. The tyrosine phosphatase SHP-1 was identified as the major TRAIL-R binding protein within T cells, using high throughput mass spectrometry-based proteomics analysis. Furthermore, Lck was co-immunoprecipitated with the TRAIL-R/SHP-1 complex in the activated T cells. TRAIL engagement profoundly inhibited phosphorylation of Lck (Y394) and suppressed the recruitment of Lck into lipid rafts in the activated T cells, leading to the interruption of proximal TCR signaling and subsequent T cell activation.

Conclusions
TRAIL-R associates with phosphatase SHP-1 and transduces a unique and distinct immune gatekeeper signal to repress TCR signaling and T cell activation via inactivating Lck. Thus, our results define TRAIL-R as a new class of immune checkpoint receptors for restraining T cell activation, and TRAIL-R/SHP-1 axis can serve as a potential therapeutic target for immune-mediated diseases.
Regulation mechanism and bioactivity characteristic of surfactin homologues with C14 and C15 fatty acid chains
Authors: Su Yumeng , Gao Ling , Li Chenyu , Wang Liang , Zhou Huimin , Zhang Chenhao , Xia Xiaole 
Published: March 2024

Abstract
Background
Surfactin, a green lipopeptide bio-surfactant, exhibits excellent surface, hemolytic, antibacterial, and emulsifying activities. However, a lack of clear understanding of the synthesis regulation mechanism of surfactin homologue components has hindered the customized production of surfactin products with different biological activities.

Results
In this study, exogenous valine and 2-methylbutyric acid supplementation significantly facilitated the production of C14–C15 surfactin proportions (up to 75% or more), with a positive correlation between the homologue proportion and fortified concentration. Subsequently, the branched-chain amino acid degradation pathway and the glutamate synthesis pathway are identified as critical pathways in regulating C14–C15 surfactin synthesis by transcriptome analysis. Overexpression of genes bkdAB and glnA resulted in a 1.4-fold and 1.3-fold increase in C14 surfactin, respectively. Finally, the C14-rich surfactin was observed to significantly enhance emulsification activity, achieving an EI24 exceeding 60% against hexadecane, while simultaneously reducing hemolytic activity. Conversely, the C15-rich surfactin demonstrated an increase in both hemolytic and antibacterial activities.

Conclusion
This study presents the first evidence of a potential connection between surfactin homologue synthesis and the conversion of glutamate and glutamine, providing a theoretical basis for targeting the synthesis regulation and structure–activity relationships of surfactin and other lipopeptide compounds.

Graphical Abstract