bluuebunny/crossref_metadata_2025_split huggingface dataset:
Critical assessment of uncertainty in economic evaluations on influenza vaccines for the elderly population in Spain
Authors: Ortiz-de-Lejarazu Leonardo Raúl , Díez Domingo Javier , de Miguel Ángel Gil , Martinón Torres Federico , Margüello Esther Redondo , López-Belmonte Claver Juan Luis , Palomo-Jiménez Paloma I. , Farré Avellà J. Manel , Abellán Perpiñán José María 
Published: February 2025

Abstract

Background
Influenza is a seasonal infection with a huge impact on morbidity and mortality in older adults, for whom vaccination is recommended. New influenza vaccines for this population have been introduced in Spain in the past 5 years, and a number of cost-effectiveness analyses (CEA) have been published to aid healthcare decision-making. The objective of this study was to assess possible sources of uncertainty in the CEAs of influenza vaccines for the older adults in Spain.

Methods
A systematic review was performed to identify Spanish CEAs published since 2016. Potential sources of structural, methodologic and parametric uncertainty in CEA results were systematically analysed using the TRansparent Uncertainty ASsessmenT (TRUST) Tool, quality assessment checklists, and the WHO guidance on economic evaluations of influenza vaccine strategies. The primary sources of efficacy/effectiveness were analysed in depth to ascertain whether they could support the conclusions of the respective CEAs.

Results
Seven CEAs were included. Overall, they were designed and performed in accordance with the applicable guidelines; however, some critical sources of uncertainty were detected, mainly: (1) the choice and use of efficacy/effectiveness data (real-world single season studies, meta-analyses including studies with high risk of bias and/or high heterogeneity with biased interpretation); (2) use of fewer than 5 seasons to estimate influenza burden; (3) generalized use of influenza-like illness data to estimate effectiveness and burden, among others.

Conclusions
Seemingly well-designed studies may conceal important sources of uncertainty that affect the results. This must be taken into account when interpreting results to support decision-making.
BreathCarer: Informal carers of patients with chronic breathlessness: a mixed-methods systematic review of burden, needs, coping, and support interventions
Authors: Blütgen Saskia , Pralong Anne , Wilharm Carolin , Eisenmann Yvonne , Voltz Raymond , Simon Steffen T. 
Published: February 2025

Abstract

Background
Breathlessness is a common symptom in chronic and advanced diseases, and it poses a significant burden to patients and to their informal carers. They play a crucial role in sustainable care for patients living with breathlessness, but their challenges and needs are often neglected.

Objective
To provide a systematic overview of the literature on the burden, needs, coping and use of healthcare and social services by carers of patients suffering from chronic breathlessness due to any life-limiting disease.

Design
A mixed-methods systematic review (PROSPERO CRD42022312989).

Data sources
Medline, CENTRAL, PsycINFO, and CINAHL were searched and complemented with forward and backward searches and expert consultation.

Review methods
The mixed-methods review included any study on burden, needs and coping among carers of patients with breathlessness published from the inception of the databases until July 2023. A narrative analysis of the quantitative results and a pragmatic meta-aggregation of the qualitative findings were performed, followed by a mixed-methods convergent segregated approach.

Findings
A total of 53 studies with 4,849 carers were included. Breathlessness is highly burdensome for carers who live with and care for patients or for those who do not live with the patients and care for them. Breathlessness is a significant risk factor for high carers’ burden, contributing to deteriorating physical and mental health among carers and creating an urgent need for external support. A major challenge is the sense of being trapped in a state of constant alertness and anxiety, centred around managing the patient's breathlessness. Carers bear substantial emotional burden due to uncertainty, sleep disturbances, and social isolation, which leads to severe psychological distress. Their unmet needs for professional guidance, self-management strategies, and social interaction are high. While supportive interventions, such as specialized services and multidisciplinary approaches, can alleviate some of the burden, there remains a lack of targeted interventions specifically designed for carers.

Conclusions
This review highlights the substantial burden associated with caring for patients with chronic breathlessness, the unmet needs of carers and the lack of supportive care structures, leaving them with little option but to accept the situation.
Hospitalizations, emergency medical care utilization, and contacts with the regional on-call medical services among nursing home residents in Germany: a cross-sectional study in 44 nursing homes
Authors: Lienesch Paula , Rothgang Heinz , Gerhardus Ansgar , Wolf-Ostermann Karin , Hoffmann Falk , Czwikla Jonas 
Published: February 2025

Abstract

Background
Nursing home residents frequently utilize medical care, but there lacks a complete picture of their acute medical care utilization. We quantified hospitalizations, emergency medical care utilization, and contacts with the regional on-call medical services among nursing home residents, and investigated individual characteristics that may be associated with the utilization of these medical care types.

Methods
Cross-sectional data from the “Needs-based provision of medical care to nursing home residents” (MVP-STAT) study were analyzed, which were collected in 44 German nursing homes from 442 residents in 2018/2019. Proportions of residents with at least one hospitalization, emergency medical care utilization (via the nationwide phone number 112), and contact with an on-call medical service (nationwide via 116117) over the previous 12 months were determined. Associations between individual characteristics and the utilization of the three medical care types were examined using multivariable logistic regressions.

Results
Of the analyzed residents, 45.8% were hospitalized, 23.2% utilized emergency medical care, and 12.1% had contact with an on-call medical service at least once in the previous 12 months. Hospitalizations were positively associated with male vs. female sex (adjusted odds ratio 1.99 [95% confidence interval 1.22–3.26]), age group 85 + vs. 60–74 years (2.15 [1.12–4.13]), long-term care grades 4/5 vs. 1/2 (2.78 [1.48–5.21]), 6 + vs. 0–1 Elixhauser diseases (2.58 [1.01–6.62]), and the risk or presence of vs. no malnutrition (3.10 [1.52–6.35] and 2.01 [1.26–3.21]); and not associated with years of residence in the respective nursing home. Emergency medical care utilization was positively associated with age group 85 + vs. 60–74 years (2.58 [1.14–5.84]) and long-term care grades 3 and 4/5 vs. 1/2 (2.65 [1.07–6.55], 6.31 [2.60–15.35]); negatively associated with 5 + vs. 1- < 3 years of residence (0.46 [0.24–0.86]); and not associated with sex, the number of Elixhauser diseases, and nutritional status. No associations were found with on-call medical services.

Conclusions
Hospitalizations and emergency medical care utilization were more frequent among nursing home residents than contacts with on-call medical services. Future studies should investigate whether the frequent hospitalizations and emergency medical care utilization among nursing home residents are justified, or whether they can be reduced by strengthening medical care provision by on-call doctors and other professionals.

Trial registration
DRKS00012383 [2017/12/06].
Barriers to uptake of harm reduction techniques for GBMSM who use drugs in night-clubs and sex-on-premises venues in London and the Southeast: a mixed-methods, qualitative study
Authors: Naulls Stephen , Oniti K. , Eccles J. , Stone J. M. 
Published: February 2025

Abstract

Background
Drug-related harm is a significant public health concern in the UK, particularly among underserved groups such as gay, bisexual, and other men who have sex with men (GBMSM). This study explores the role of night-time venues (for example night clubs or sex-on-premises venues) in promoting harm reduction strategies for GBMSM who use drugs, highlighting unique challenges within these spaces.

Methods
The study used a mixed-methods approach, including an online survey (n = 53) and semi-structured interviews (n = 8). Participants included GBMSM with lived experience of substance use in night-time venues, as well as those providing support to this population. Data was collected through a Likert-scale survey and thematic analysis of qualitative responses.

Results
Findings reveal dissatisfaction among survey respondents about the level of support for harm reduction provided by night-time venues, which are perceived as inconsistent in their approach towards substance use. The study also identifies economic and legal barriers faced by venues that prevent the endorsement of harm reduction techniques.

Conclusions
Addressing these barriers could transform night-time venues into effective sites for harm reduction, particularly by targeting “afters” culture (the phenomenon where club-goers will return to a residential setting and continue substance use for prolonged periods ‘after’ the night-time venue closes or the event ends) and promoting safer practices. This research suggests that coordinated efforts with local government and policy reform are crucial to fostering safer environments for GBMSM.
Indocyanine green nebulization visualizes the pulmonary bronchus during video-assisted thoracoscopic surgery
Authors: Xu Hao , Wu Xun , Zhao Songjing , Wang Zhenfan , Jiang Guanchao , Li Yun , Zhou Jian 
Published: February 2025

Abstract

Background
Intraoperative tracheobronchial injury is a rare but serious complication of lung surgery. With the increasing number of segmentectomies, surgeons need to locate finer and less easily identified segmental bronchi or even subsegmental bronchi. However, there is no simple or feasible method for visualizing the bronchus during surgery.

Case presentation
Herein, we report a case in which indocyanine green (ICG) inhalation was used to visualize the pulmonary bronchus during video-assisted thoracoscopic surgery. The patient was a woman with a GGO located in the anterior segment of the right upper lobe, and thoracoscopic segmentectomy was scheduled. ICG (3.75 mg/ml) was inhaled into the lung on the operative side after single-lung ventilation for 5 min. During surgery, the anterior segmental bronchus was difficult to locate accurately. Under the overlay imaging window of the NIF imaging system, the bronchus was shown in green, indicating the bronchi in contrast to the surrounding lung tissue. We dissected the bronchi with the assistance of fluorescence imaging and were surprised to find that the bifurcation of the anterior and apical bronchi could be clearly identified by navigation via the inhaled ICG and NIF system. Segmentectomy was successfully performed, and no adverse events were recorded.

Conclusion
This case showed that ICG nebulization is feasible and safe for visualizing the pulmonary bronchus during thoracoscopic surgery. This method has great application potential for reducing intraoperative tracheobronchial injury.
An analysis of ambulance re-contacts after non-conveyance: a retrospective cohort study in the Netherlands
Authors: de Loor Susanne E. , Verheij Tessa , Karol Thomas , Cuppen Franciscus G. M. H. M. , van Dijk Frits , Goldstein Femke , Janssen Joyce , Ebben Remco H. A. 
Published: February 2025

Abstract

Background
Non-conveyance is an increasing part of ambulance care and has to be safe. One of the indicators to measure safety is an ambulance re-contact within 72 h. However, solely measuring the percentage of re-contacts has limited validity as it lacks insight in actual reasons of an ambulance re-contact. Therefore, the aim of our study was to analyze the incidence, reasons and outcomes of ambulance re-contacts within 72 h after non-conveyance.

Methods
We conducted a one year (2022) retrospective study in one EMS region in the Netherlands. Medical records of all non-conveyance runs with a re-contact were analyzed using a framework to categorize re-contact reasons in illness-related, patient-related, professional-related, and unrelated. Re-contact outcomes were measured in terms of (non-)conveyance and mortality.

Results
585/13.879 (4.2%) non-conveyance runs had a re-contact within 72 h. 547/585 (93.5%) re-contacts could be categorized with the framework. Re-contacts were related to the illness (n = 267, 48.8%), the patient (n = 130, 23.8%), the professional (n = 106, 19.4%) and unrelated (n = 44, 8.0%). Four subreasons accounted for 68.5% of reasons for re-contacts: progression of disease (19.4%), recurrent disease process/exacerbation (18.6%), reassessment and ambulance request by another medical professional (15.9%), and psychiatric disorder and/or substance abuse (14.6%). 403/547 (73.7%) patients with a re-contact were conveyed to the hospital. Mortality rate for patients with a re-contact was 0.5%.

Conclusions
Re-contact incidence after non-conveyance is relatively low, with a very small part of re-contacts related to ambulance care professionals making errors in diagnosis or treatment. Combined with low re-contact mortality, this indicates safe non-conveyance decisions. Re-contacts as quality indicator cover a variety of reasons, with almost half of the re-contacts being related to illness. Four subcategories accounted for the majority of all reasons for re-contacts: progression of disease, recurrent disease process/exacerbation, reassessment and ambulance request by another medical professional, and psychiatric disorder and/or substance abuse. Three-quarters of the patients were conveyed, although more re-contacts due to patient related reasons ended in non-conveyance again.
Classifications of triple-negative breast cancer: insights and current therapeutic approaches
Authors: Chen Ziqi , Liu Yumeng , Lyu Minchuan , Chan Chi Ho , Sun Meiheng , Yang Xin , Qiao Shuangying , Chen Zheng , Yu Sifan , Ren Meishen , Lu Aiping , Zhang Ge , Li Fangfei , Yu Yuanyuan 
Published: February 2025

Abstract
Triple-negative breast cancer (TNBC) is an aggressive and challenging type of cancer, characterized by the absence of specific receptors targeted by current therapies, which limits effective targeted treatment options. TNBC has a high risk of recurrence and distant metastasis, resulting in lower survival rates. Additionally, TNBC exhibits significant heterogeneity at histopathological, proteomic, transcriptomic, and genomic levels, further complicating the development of effective treatments. While some TNBC subtypes may initially respond to chemotherapy, resistance frequently develops, increasing the risk of aggressive recurrence. Therefore, precisely classifying and characterizing the distinct features of TNBC subtypes is crucial for identifying the most suitable molecular-based therapies for individual patients. In this review, we provide a comprehensive overview of these subtypes, highlighting their unique profiles as defined by various classification systems. We also address the limitations of conventional therapeutic approaches and explore innovative biological strategies, all aimed at advancing the development of targeted and effective therapeutic strategies for TNBC.
Targeting secretory autophagy in solid cancers: mechanisms, immune regulation and clinical insights
Authors: Li Xinyu , Zhao Haiying 
Published: February 2025

Abstract
Secretory autophagy is a classical form of unconventional secretion that integrates autophagy with the secretory process, relying on highly conserved autophagy-related molecules and playing a critical role in tumor progression and treatment resistance. Traditional autophagy is responsible for degrading intracellular substances by fusing autophagosomes with lysosomes. However, secretory autophagy uses autophagy signaling to mediate the secretion of specific substances and regulate the tumor microenvironment (TME). Cytoplasmic substances are preferentially secreted rather than directed toward lysosomal degradation, involving various selective mechanisms. Moreover, substances released by secretory autophagy convey biological signals to the TME, inducing immune dysregulation and contributing to drug resistance. Therefore, elucidating the mechanisms underlying secretory autophagy is essential for improving clinical treatments. This review systematically summarizes current knowledge of secretory autophagy, from initiation to secretion, considering inter-tumor heterogeneity, explores its role across different tumor types. Furthermore, it proposes future research directions and highlights unresolved clinical challenges.
Using tree-based models to identify factors contributing to trait negative affect in adults
Authors: Cañizares Catalina , Gómez-Maquet Yvonne , Ferro Eugenio , Torres Carlos Arturo , Agudelo Diana María , Odom Gabriel 
Published: February 2025

Abstract

Background
Individuals with high levels of negative affect (NA) are at an increased risk of experiencing distress and negative self-views. Theoretical models suggest that NA plays a critical role in psychopathology, particularly in Major Depressive Disorder (MDD), and is linked to cognitive-perceptual and affective regulation issues.

Objective
Determine whether maladaptive cognitive schemas, attributional style, childhood adversity, and lifestyle factors (including alcohol and drug use and physical activity) could effectively predict negative affect (NA) in adults.

Methods
A secondary data analysis was performed on a sample of 342 depressed and non-depressed adults. Beta regression and regression tree analyses were conducted to identify the principal risk factors and their interactions. The regression tree model was trained with 5-fold cross-validation on 75% of the sample, with 25% of observations held for testing.

Results
The findings revealed that the cognitive schemas of disconnection and rejection and impaired autonomy had a significant impact on the likelihood of higher scores on the State Depression Inventory (IDER) test (p < 0.001), as indicated by both beta regression and regression tree analyses. Additionally, childhood adversity emerged as a crucial factor in determining high levels of NA. The regression tree model achieved strong performance metrics, including an R-squared value of 0.77.

Conclusions
This study represents a significant step forward in the understanding of NA, as it considers a broad range of individual factors, such as cognitive schemas, lifestyle, and demographics, to predict its impact on NA, with potential implications for prevention programs aimed at reducing NA.
Development and validation of an instrument for assessing secondary students’ transdisciplinary STEM practices
Authors: Yang Kai-Lin , Fang Su-Chi , Fan Szu-Chun 
Published: February 2025

Abstract

Background
Given that limited well-developed instruments are available to assess students’ transdisciplinary STEM practices (T-STEMP), this study aims to develop and validate an instrument for examining secondary students’ T-STEMP competence. According to the T-STEMP assessment framework proposed in our previous study, we developed items and validated the items using Bayesian structural equation modeling (BSEM) and item response theory (IRT).

Results
First, the structure of T-STEMP has been justified, that the four design phases are related to a common third-order factor: knowledge-based reasoning and each design phase is composed of three key design challenges. The goodness of fit indices indicated that a two-parameter logistic (2PL) graded response model could fit the data well. The discrimination parameters indicated that most of the items for different grades performed well in distinguishing between students with various ability levels. The Cronbach’s alpha also indicated that the instrument had good reliability in terms of internal consistency.

Conclusions
The model of one third-order factor with four second-order factors and 12 first-order factors was justified as the fitted model representing the structure of the T-STEMP instrument. It means that the four design phases are related to knowledge-based reasoning and each design phase is composed of three key design challenges. The IRT findings show that Taiwanese students may have basic T-STEMP competence, but the breadth and depth of their responses to the key design challenges need to be advanced. Implications for further studies and suggestions for STEM teaching are also provided.
Topographic correlation of microperimetry with foveal microstructure characteristics in idiopathic epiretinal membrane patients with an ectopic inner foveal layer
Authors: Wang Qianqian , Wang Congyao , Su Yihua , Yu Fenfen , Chen Tingting , Dong Xia , Wan Pengxia 
Published: February 2025

Abstract

Purpose
To identify foveal structure-function topographic association and relationship in patients with idiopathic epiretinal membrane (ERM) related to ectopic inner foveal layer (EIFL).

Methods
This was a cross-sectional, observational study that involved 40 individuals with idiopathic ERM: 22 without EIFL (Group 1) and 18 with EIFL (Group 2). Quantitative foveal light sensitivity was measured using microperimetry, and foveal microstructure was assessed using spectral-domain optical coherence tomography (SD-OCT) and optical coherence tomography angiography (OCTA). Multiple indices of microvascular parameters of OCTA images were further processed using the AngioTool software. LASSO regression and quantile regression analyses were performed to identify the spatial distribution correlation between foveal light sensitivity and foveal microstructure parameters.

Results
Group 2 exhibited reduced light sensitivity across all parameters of microperimetry compared to Group 1 (P < 0.001). Additionally, the central foveal thickness, the percentage of ellipsoid zone disruption, and the foveal avascular zone area were significantly lower in Group 1 than in Group 2 (all P < 0.005). Compared to Group 1, the vessel density (VD) and perfusion density of the foveal region was significantly increased in Group 2 (P < 0.001). In contrast, Group 2 showed significantly decreased VD in the parafoveal region compared with Group 1 (P < 0.05). Significant differences in OCTA parameters including ‘total number of junctions’, ‘junction density’, ‘total vessel length’, ‘average vessel length’, ‘total number of end points’ were observed between Group 1 and Group 2 (all P < 0.01). The foveal light sensitivity was significantly positively correlated with VD in the parafoveal region and negatively correlated with EIFL alteration, best-corrected visual acuity and ellipsoid zone disruption [Log(λ) = − 0.18303, λ = 0.6561].

Conclusions
The presence of EIFL and decreased VD in the parafoveal region, factors that collectively elevate the risk of disease progression, are significantly and independently correlated with reduced microperimetric retinal sensitivity in patients with idiopathic ERM.