bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence and Factors Associated with Uptake of Modern Contraceptive Method Post-Abortion at Mbagala Hospital, Temeke, Dar es Salaam, Tanzania
Authors: Temu Sadick Zephania , Kilewo Charles , Msuya Sia , Mvunta David H. 
Published: October 2023

Abstract

Background: The uptake of modern contraceptives post-abortion care bridges the gap of unmet need for modern contraceptives which can reduce the rate of unintended pregnancies and recurrent abortion, thus improving women's health. Studies have demonstrated variations in the uptake of modern contraceptives, even within the same country.
Objective: To assess the factors associated with the uptake of modern contraceptive methods among women who received care at a comprehensive post-abortion care (cPAC) unit at Mbagala Hospital in Temeke, Dar es Salaam, after having an abortion.
Methodology: A cross-sectional analytical study involving 234 post-abortion women was conducted at Mbagala Hospital in Temeke, Dar es Salaam, from October 2020 to March 202. The convenient sampling technique was employed to collect data using a pretested structured questionnaire. Subsequently, the data was cleaned and analyzed using SPSS Version 23. A Chi-square test with a significance level set at P-value < 0.2 was used to test associations, and multivariable analysis was employed to identify independent factors associated with the uptake of modern contraceptives, with a P-value of less than 0.05 being significant.
Results: The uptake of modern contraceptives post-abortion was 67% among 234 post-abortion women, with the most commonly used method being injectable (35.9%). Higher uptake of modern contraceptives was observed in those aged 15 to 19 years with an Adjusted Odds Ratio (AOR) of 5.97 (95% CI 1.24-28.58), and in those aged 20 to 24 years, with an AOR of 3.55 (95%CI 1.54-8.18). Self-employed individuals also showed higher uptake with an AOR of 2.59 (95%CI 1.13-5.91). On the other hand, nulliparous and primiparous women were less likely to use modern contraceptives, with AORs of 0.12 (95%CI 0.02-0.60) and 0.22 (95% CI 0.16-1.70), respectively.
Conclusion and Recommendation: Two-thirds of the women (67%) received modern contraceptives as part of post-abortion care. However, there was a missed opportunity to prevent unwanted pregnancies in 33% of the women who received care. Greater efforts should be made to reach out to older women (aged 25 years or older), those who are employed, and those with four or more children in order to increase the uptake rate.
MedGAN: Optimized Generative Adversarial Network with Graph Convolutional Networks for Novel Molecule Design
Authors: Macedo Bruno , Ribeiro-Vaz Inês , Taveira-Gomes Tiago 
Published: October 2023

Abstract
Generative Artificial Intelligence can be an important asset in the process of drug discovery to answer the demand for novel medicines. This work outlines the optimization and fine-tuning steps of MedGAN, a deep learning model based in Wasserstein Generative Adversarial Networks and Graph Convolutional Networks, developed to generate new quinoline-scaffold molecules from complex molecular graphs, including hyperparameter adjustments and evaluations of drug-likeness attributes like pharmacokinetics, toxicity, and synthetic accessibility. The best model performance metrics achieved 0.25 validity, 0.62 connectivity, 0.92 quinoline scaffold, 0.93 novelty and 0.95 uniqueness, preserving chirality, atom charge and favourable drug-like properties while generating 4,831 novel quinolines. These results emphasizes valuable insights into how activation functions, optimizers, learning rates, neuron units, molecule size and constitution, and scaffold structure affect the performance of generative models, and their potential to create new molecular structures, enhancing deep learning applications in computational drug design.
Multiple Mediation of the Association between Childhood Emotional Abuse and Adult Obesity by Anxiety and Bulimia
Authors: Zhang Hongwei , Liu Ziqi , Zheng Hui , Xu Ting , Liu Lin , Xu Tao , Yuan Ti-Fei , Han Xiaodong 
Published: October 2023

Abstract
Bulimia is the most primitive reason for overweight and obesity. The extended literature has indicated that childhood emotional abuse has a close relationship with adverse mood states, bulimia, and obesity. To comprehensively understand the potential links among these factors, we evaluated a multiple mediation model in which anxiety/depression and bulimia were mediators between childhood emotional abuse and body mass index (BMI). A set of self-report questionnaires, including the Childhood Trauma Questionnaire (CTQ), Beck Anxiety Inventory [1], Beck Depression Inventory (BDI), and Eating Disorder Inventory (EDI), was sent out. Clinical data from 37 obese patients (age: 29.65 ± 5.35, body mass index (BMI): 37.59 ± 6.34) and 37 demographically well-matched healthy people with normal body weight (age: 31.35 ± 10.84, BMI: 22.16 ± 3.69) were included in the investigation. We first performed an independent t test to compare all scales or subscale scores between the two groups. Then, we conducted Pearson correlation analysis to test every two variables’ pairwise correlation. Finally, multiple mediation analysis was performed with BMI as the outcome variable, childhood emotional abuse as the predictive variable, and “anxiety → bulimia”/“depression → bulimia” as the mediating variables. The results show that the obese group reported higher childhood emotional abuse (t = 2.157, p = 0.034), worse mood state (anxiety: t = 5.466, p < 0.001; depression: t = 2.220, p = 0.030), and higher bulimia (t = 3.400, p = 0.001) than the healthy control group. Positive correlations were found in every pairwise combination of BMI, childhood emotional abuse, anxiety, and bulimia. Multiple mediation analyses indicate that childhood emotional abuse is positively linked to BMI (β = 1.312, 95% CI = 0.482–2.141). The “anxiety → bulimia” model is attested to play multiple mediating roles in the relationship between childhood emotional abuse and obesity (indirect effect = 0.739, 95% CI = 0.261–1.608, 56.33% of the total effect). These findings confirm that childhood emotional abuse contributes to adulthood obesity through the multiple mediating effects of anxiety and bulimia. The present study adds another potential model to facilitate our understanding of the eating psychopathology of obesity.
Clinical Safety and Feasibility of a Novel Implantable Neuroimmune Modulation Device for the Treatment of Rheumatoid Arthritis: Initial Results From the Randomized, Double-Blind, Sham-controlled Reset RA Study
Authors: Peterson Daniel , Poppel Mark Van , Boling Warren , Santos Perry , Schwalb Jason , Eisenberg Howard , Mehta Ashesh , Spader Heather , Botros James , Vrionis Frank D. , Ko Andrew , Adelson P. David , Lega Bradley , Konrad Peter , Calle Guillermo , Vale Fernando L. , Bucholz Richard , Richardson Mark 
Published: October 2023

Abstract

Background
Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease that causes persistent synovitis, bone damage, and progressive joint destruction. Neuroimmune modulation through electrical stimulation of the vagus nerve activates the inflammatory reflex and has been shown to inhibit the production and release of inflammatory cytokines and decrease clinical signs and symptoms in RA. The RESET-RA study was designed to determine the safety and efficacy of an active implantable device for treating RA.
Methods
The RESET-RA study is a randomized, double-blind, sham-controlled, multi-center, two-stage pivotal trial that enrolled patients with moderate-to-severe RA who were incomplete responders or intolerant to at least one biologic or targeted synthetic disease-modifying anti-rheumatic drug. A predefined blinded interim analysis was performed in patients enrolled in the study's initial stage (Stage 1) that included demographics, enrollment rates, device implantation rates, and safety of the surgical procedure, device, and stimulation over 12 weeks of treatment.
Results
Sixty patients were implanted during Stage 1 of the study. All device implant procedures were completed without intraoperative complications, infections, or surgical revisions. No unanticipated adverse events were reported during the perioperative period and at the end of 12 weeks of follow-up. No study discontinuations were due to adverse events, and no serious adverse events were related to the device or stimulation. Two serious adverse events were related to the implantation procedure: vocal cord paresis and prolonged hoarseness. These were reported in two patients and are known complications of surgical implantation procedures with vagus nerve stimulation devices. The adverse event of vocal cord paresis resolved after vocal cord augmentation injections with filler and speech therapy. The prolonged hoarseness had improved with speech therapy but mild hoarseness persists.
Conclusions
The surgical procedures for implantation of the novel neuroimmune modulation device for the treatment of RA were safe, and the device and its use were well tolerated.
Trial registration:
NCT04539964; registered August 31, 2020, https://www.clinicaltrials.gov/study/NCT04539964
Food-web complexity, consumer behavior and diet specialism: impacts on ecosystem stability
Authors: Perälä Tommi , Kuisma Mikael , Uusi-Heikkilä Silva , Kuparinen Anna 
Published: October 2023

Abstract

Ecological stability is a fundamental aspect of food web dynamics. In this study, we explore the factors influencing stability in complex ecological networks, characterizing it through biomass oscillations and species persistence. Using an Extended Niche model, we generate diverse food web structures and investigate the effects of intraspecific consumer interference, network size, connectance, and diet specialism on stability. Our findings reveal that intraspecific consumer interference plays a pivotal role in shaping stability. Higher interference results in stable dynamics, reducing oscillations and extinctions. Additionally, differences emerge between food webs comprised of invertebrate consumers and those of ectotherm vertebrates, with the latter showing higher oscillations. Network size and connectance also influence stability, where larger and more connected webs tend to exhibit reduced oscillations. Overall, our study sheds light on the complex interplay of factors affecting ecological stability in food webs. Understanding these dynamics is crucial for biodiversity conservation and ecosystem management.
Administration of a Combination of COX-2/TGF-β1 siRNAs Induces Hypertrophic Scar Fibroblast Apoptosis through a TP53 mediated Caspase Pathway
Authors: Fu Rao , Zhou Sizheng , Liu Chuanqi , Zhou Jia , Li Qingfeng 
Published: October 2023

Abstract

Hypertrophic scar (HTS) formation is a pathological fibrotic skin disease, with no satisfactory treatments available currently. Inducing apoptosis of HTS-derived fibroblasts (HSFs) are becoming promising approaches. In this research, we aim to improve the technology with co-delivery COX-2 and TGF-β1 siRNAs and further investigate the underlying mechanism. Firstly, the HSFs were transfected with 1 µg/ml COX-2 and/or TGF-β1 siRNAs, and proved that the apoptosis of HSFs was greater induced by COX-2/TGF-β1 siRNAs than either COX-2 or TGF-β1 siRNA alone by flow cytometry. To investigate the impact of co-silencing TGF-β1 and COX-2 mRNA expression in vivo, we established HTSs model in rat tails. Our results confirmed that co-silencing of TGF-β1 and COX-2 mRNA expression could significantly alleviate the HTS formation in vivo. Furthermore, we explored the potential molecular mechanism and revealed that the protein levels of TP53, Bcl-2 and Caspase-3 were downregulated while Bax and Cleaved Caspase-3 were upregulated in the COX-2/TGF-β1 siRNA groups compared with HKP group. Taken together, our results demonstrated that simultaneous silencing of COX-2 and TGF-β1 expression by siRNAs induced HSF apoptosis through a TP53 mediated caspase pathway. Therefore, COX-2/TGF-β1 siRNAs might serve as a novel and effective therapeutic alternative for HTSs treatments.
Attitudes and Perceptions toward Neurology and Neurosurgery among Zambian Medical Students: An e-survey
Authors: mukambo emmanuel , Mbiydzenyuy Ngala Elvis 
Published: October 2023

Abstract
Background: Prevalence and incidence of organic and non-organic brain diseases have skyrocketed over the past decades, while on the other hand, the number of trained neurologists and neurosurgeons has not kept pace. Building a larger, robust neurological/neurosurgical workforce, therefore, becomes an apparent solution. However, the fear of neurosciences and clinical neurology represents an important perceptual impediment that limits consideration of a career in these fields.
Objective: To assess the attitudes and perceptions of Zambian medical students towards a career specialty in neurosurgery and neurology.
Methodology: This was a cross-sectional survey of medical students from six (6) Zambian medical universities. A 20-item online survey containing multiple choice, Likert-scale, and free-response questions was adapted from prior literature and administered through social media. Preliminary information that explains the objectives of the study and asks for the participants’ consent was sent with the questionnaire.
Results: A total of 1236 complete responses were obtained from medical students across Zambia. Most students (70.9%) considered neurology and neurosurgery as difficult subjects because of the very long training time and were majorly dissuaded from pursuing a career in these fields because of their perceived inability to maintain a work-life balance. Neurosurgery (36.6%) and neurology (28.1%) were ranked 7th and 8th respectively on a list of 10 medical and surgical specialties. Eighty-one percent and 89% of participants who considered neurosurgery and neurology as future careers respectively agreed that insufficient knowledge of the students about neurology/neurosurgery and the difficulty of neurological disorders contribute to consideration of neurology and neurosurgery as difficult specialties (p<0.01).
Conclusion: Numerous factors are associated with medical students’ attitudes. Most of these significantly stem from inadequate or absent early career exposure to these career specialties. Therefore, the incorporation of earlier, rigorous, and focused neurology/neurosurgery education programs in medical pedagogy would be a cornerstone effort toward an improved understanding and positive perception of neurology and neurosurgery among medical students.
Apps for ADHD Management: A Scoping Review
Authors: Capistrán Jonathan Hernández- , Alor-Hernández Giner , Sánchez-Morales Laura Nely , Machorro-Cano Isaac 
Published: October 2023

Abstract
Background
Attention Deficit Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental disorder diagnosed using DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) criteria. Medications are the primary treatment, leading to the emergence of mobile apps as alternative solutions to support people with ADHD.
Purpose
This review uses the Arksey and O'Malley scoping framework to assess mobile apps for ADHD. It examines their characteristics, target users, treatment modalities, treatment techniques, gamification elements, and medical support.
Methods
We searched for relevant records published within the 2013–2023 period in eight digital libraries and explored two virtual app stores (Google Play Store and Apple’s App Store). We found 1,562 potentially relevant apps, 63 of which were analyzed in the review. The apps were categorized as either commercial or non-commercial and further divided into video game and non-video game apps. The study revolved around six research questions.
Results
The majority (27%) of ADHD apps promote cognitive treatment, while 16% clinical diagnosis aid. The prioritized treatment techniques are cognitive (15.5%) and executive functions (10.85%) techniques. Only two of the 35 commercial apps are medically endorsed. Levels and statistics are the most popular gamification elements.
Conclusions
The study demonstrates the wide availability of mental health apps catering to individuals diagnosed with ADHD as well as parents and caregivers. Furthermore, it highlights various areas for future research and development, aiming to facilitate the integration of digital health interventions, particularly mobile apps, to aid in the diagnosis and treatment of ADHD.
A rare and unique manifestation of a huge penile tumor , think traumatic origin : a case report and review of literature
Authors: huang Xi , yang Tineng , peng Xiaoyang , cao Peng , chen Hua lei 
Published: October 2023

Abstract
Giant fibroepithelial polyps of mesodermal and ectodermal origin are rare benign tumors of the penis; mostly exhibiting aggressive growth patterns and known classically to be one of the transformable forms of advanced penile cancer with high capabilities of forming a spectrum of heterogeneous lesions. There are currently only a few reported cases in the medical literature. We present a single case of a 57-year-old man born and raised in a tropical island of Southern China with symptomatic urinary retention due to an enlarging penile mass on the glans of the penis of approximately 19 years duration, which was associated with post-trauma-induced paraplegia of the lower limbs and subsequent urogenital infections. The patient had notable general history, followed by consultation for more than four years of aggressive penile mass not improving under the patient’s decision to resort only to usual home treatments. He was reconciled when his symptoms worsened and the biopsy examination revealed a possible penile fibromatosis, there was no known metastasis on systemic examination as the mass was localized on the glans of the penis from the top to the base, with no obvious palpable mass or bumps on both sides of the scrotum. The penile mass was large, measuring 18 × 9 centimeters by length and width, as its thickest part is covered with cauliflower-like lumps which are hard in texture and are pink to reddish-brown. On excision of the tumor perioperatively, the corpus cavernosum and urethral cavernous body were exposed, and there was a fistula of about 0.3cm*0.2cm on the surface of the cavernous urethra, consistent with penile fibromatosis of the penis, with highly important clinical characteristics of value to medical literature during the supportive therapy, surgical total radical resection and urethroplasty of the penis. This case report is the longest and largest mass of its kind to be reported on the penis. It provides guidance for the clinical treatment and research of penile cancer.
Long-term outcomes of the application of fibrin sealant in the prevention of cervical anastomotic leakage after McKeown esophagectomy
Authors: Huang Yan , Li Zhichao , Fu Jianhua , Huang Sheng , Wu Jiadi , Fang Caiyan , Chen Jiyang , Su Huilin , Yang Hong , Lin Yaobin 
Published: October 2023

Abstract
Background
Anastomotic leakage remains an issue after esophagectomy. Previous studies have indicated that the intraoperative application of fibrin sealant could reduce the incidence of anastomotic leakage. This study reported survival outcomes among EC or EJC patients who received the intraoperative application of fibrin sealant during McKeown esophagectomy.
Methods
We designed a retrospective study including 227 patients with esophageal or esophagogastric junction cancer undergoing McKeown esophagectomy performed by our team between January 2018 and December 2019, of whom 86 patients were included in the FS group and 141 patients were included in the control group. Intraoperatively, 2.5 ml of porcine fibrin sealant was applied circumferentially to the cervical anastomosis in the FS group. The primary outcome was the impact of applying fibrin sealant to cervical anastomosis on the survival of patients after surgery.
Results
The median follow-up was 41 months (range, 0–52). The three-year overall survival (FS group vs. control group: 75.6% vs. 74,4%, p = 0.96) and the three-year disease-free survival (82% vs. 74,4%, p = 0.116) were not significantly different between the two groups. In the long-term follow-up, the total rates of AL between the two groups were 4.7% vs. 19.9% (p = 0.003), while the total rates of anastomotic stricture were 2.3% vs. 7.1% (p = 0.139). Cervical local recurrence was 4.7% versus 2.1% (p = 0.431). Cox regression analyses showed that the application of FS was not a predictor for overall survival.
Conclusions
The intraoperative application of fibrin sealant could prevent cervical anastomotic leakage after McKeown esophagectomy but did not improve survival outcomes. Further prospective clinical trials are warranted.
Exploring Antibiotic Appropriateness and Clinical Outcomes among Adult Intensive Care Unit Patients in Two Tertiary Hospitals in Ethiopia: A Prospective Observational Study
Authors: Tilahun Zerihun , Kumsa Legese , Gebre Mohammed , Fisseha Henok , Chelkeba Legese 
Published: October 2023

Abstract
Background: Antimicrobial resistance, driven by antimicrobial misuse, poses a global threat. Research on antibiotic utilization in Ethiopian intensive care units (ICUs) is lacking. This study seeks to assess the judiciousness of antibiotic utilization and its ramifications on clinical outcomes for adult ICU patients in two tertiary hospitals.
Methods: This study, conducted between April 1, 2021, and September 30, 2021, examined antibiotic appropriateness in adult ICU patients, following Infectious Disease Society of America (IDSA) guidelines. Data, including socio-demographics, clinical profiles, antibiotic use, and clinical outcomes, were analyzed using EpiData version 4.6 and SPSS version 25. Logistic regression and Cox proportional hazard ratios identified factors associated with inappropriate antibiotic use and ICU mortality.
Results: The study enrolled a total of 206 participants, with 113 (54.9%) being male and 124 (60.2%) residing in urban areas. Approximately 24.8% of patients received antibiotics in a manner inconsistent with IDSA guidelines. Independent factors associated with inappropriate antibiotic use included male gender (Adjusted Odds Ratio [AOR] = 3.6, 95% Confidence Interval [CI] 1.65, 7.70) and the administration of two or more antibiotics (AOR = 4.5, 95% CI 1.29, 15.84). The ICU mortality rate was 21.8%, with comorbid conditions (Adjusted Hazard Ratio [AHR] = 3.7, 95% CI 1.55, 8.87) and inappropriate antibiotic administration (AHR = 10.7, 95% CI 4.56, 25.1) identified as independent risk factors exacerbating ICU mortality.
Conclusion: Inappropriate antibiotic use is a pressing public health concern in the study's setting, underscoring the need for robust policies to reduce it in ICUs. The study found that male gender and the concurrent use of multiple antibiotics are significant factors linked to inappropriate antibiotic utilization in ICUs. Targeted interventions are essential to enhance patient care and combat antimicrobial resistance.