bluuebunny/crossref_metadata_2025_split huggingface dataset:
Refining breast cancer classification: Customized attention integration approaches with dense and residual networks for enhanced detection
Authors: Alam Mohammad Sakif , Efat Anwar Hossain , Hasan SM Mahedy , Uddin Md Palash 
Published: January 2025

Objective Breast cancer detection is critical for timely and effective treatment, and automatic detection systems can significantly reduce human error and improve diagnosis speed. This study aims to develop an accurate and robust framework for classifying breast cancer into benign and malignant categories using a novel machine learning architecture. Methods We propose a dense-ResNet attention integration (DRAI) architecture that combines DenseNet and ResNet models with three attention mechanisms to enhance feature extraction from the BreakHis dataset. The attention mechanisms focus on regionally important features, improving classification accuracy. A triple-level ensemble (TLE) method combines the performance of multiple models, further enhancing prediction accuracy. Results The proposed DRAI architecture with TLE achieves an accuracy of 99.58% in classifying breast cancer into benign and malignant categories, surpassing existing methodologies. This high accuracy demonstrates the effectiveness of the fusion architecture and its ability to reduce manual errors in breast cancer diagnosis. Conclusion The DRAI architecture with TLE provides a robust, automated framework for breast cancer classification. Its exceptional accuracy lays a solid foundation for future advancements in automated diagnostics and offers a reliable method for aiding early breast cancer detection.
Applying a Dignity Lens in Migration and Displacement
Authors: Perrin Paul Clayton 
Published: January 2025

Executive Summary Recognizing that migration and displacement are longstanding elements of human history, the paper emphasizes the critical role of respecting the inherent dignity of migrating persons as an important part of the right-to-stay dialogue. Although international frameworks, such as the Sphere Handbook, the Paris Declaration, and UNHCR’s Durable Solutions, have provided a critical foundation for addressing many of the basic needs of migrating populations, they largely focus on material aspects of well-being, overshadowing the equally essential need for other aspects of one’s dignity — a recognition of the inherent equal value that each human being possesses — to be respected and upheld. This approach positions dignity as a luxury to be addressed only after other basic needs are met. However, evidence shows that ensuring physical safety, food, and shelter alone does not fulfill the complex needs of migrating individuals, who often experience emotional distress and social marginalization when their dignity is ignored. By framing dignity as an intrinsic human right that is not contingent on external conditions or something that can be distributed out of the back of a truck, the paper argues that organizations can foster deeper engagement with migrant communities. Two case studies — Georgia and Afghanistan — highlight the consequences of placing primacy on biophysical needs over respect for dignity. In Georgia, despite robust efforts to provide for material well-being, displaced persons reported significant emotional distress due to a sense of being marginalized and ignored. In Afghanistan, a disconnect between international aid organizations and local communities fostered resentment, exacerbating insecurity and undermining trust in humanitarian efforts. Both these cases underscore that fulfilling physical needs alone does not equate to a life with dignity. To improve our ability to uphold human dignity in the right-to-stay debate and in supporting migrating communities, three recommendations are proposed: (1) adopt a dignity-centered approach that values the immaterial aspects of human existence, (2) integrate dignity into accountability measures, and (3) tailor dignity-affirming practices to local needs. Only by elevating dignity to a core operational principle can humanitarian efforts more holistically address the complex challenges faced by displaced populations. In conclusion, this paper underscores the need for a transformative approach to humanitarian response that centers human dignity as a fundamental principle. As humanitarian organizations increasingly recognize the importance of dignity in displacement contexts, there is an opportunity to deepen engagement with affected communities, ensuring that their voices and values inform interventions. By embedding dignity within humanitarian frameworks, we can create responses that truly support displaced populations’ well-being, facilitating resilience and restoring agency in the face of displacement.
Prediabetes and diabetes mellitus type II after ischemic stroke
Authors: Moelgg Kurt , Karisik Anel , Scherer Lukas , Buergi Lucie , Dejakum Benjamin , Komarek Silvia , Granna Julian , Boehme Christian , Pechlaner Raimund , Toell Thomas , Knoflach Michael , Kiechl Stefan , Kaser Susanne , Egger Alexander , Griesmacher Andrea , Mayer-Suess Lukas 
Published: January 2025

Introduction: The progression of diabetes status in post-stroke patients remains under-investigated, particularly regarding new treatments for type II diabetes mellitus (DM II), like glucagon-like peptide 1 receptor agonists (GLP-1-RA) and sodium-glucose co-transporter-2 (SGLT-2) inhibitors, which have not been studied in the post-stroke setting. Patients and methods: Eight hundred eighty-four consecutive ischemic stroke patients recruited to our prospective STROKE-CARD Registry were assessed concerning their glycemic status at baseline (normoglycemia, prediabetes, DM II) and change over time within 1 year follow-up. Multivariate logistic regression was performed to identify factors associated with transitioning from normoglycemia to prediabetes or DM II. Additionally, we reviewed ongoing clinical trials for GLP-1-RA and SGLT-2 inhibitors in the context of acute ischemic stroke. Results: At baseline, 44.6% ( n = 394) of individuals had normoglycemia, 33.9% ( n = 300) were prediabetic, and 21.5% had DM II ( n = 190). After 1 year, normoglycemia decreased by 12.1 percentage points ( n = 107), whereas prediabetes and DM II increased by 10.2 percentage ( n = 90) points and 1.9 percentage points ( n = 17), respectively. Statin therapy was the only significant risk factor for progression. 23.4% ( n = 207) of our cohort would have met eligibility criteria for a recent trial on semaglutide in obese non-diabetics with prior cardiovascular disease. However, only one ongoing trial aims at evaluating short-term cardiovascular risk reduction in stroke patients. Discussion: GPrediabetes and DM II are frequent in ischemic stroke patients. Even within an intensified post-stroke disease management setting, a considerable amount of stroke survivors convert to prediabetes or DM II within the first year. Our results demonstrate a notable proportion of patients qualifying inclusion in studies examining the efficacy of GLP-1-RA agonists and SGLT-2 inhibitors in secondary prevention. Conclusion: Given the high prevalence and progression of prediabetes and DM II in stroke survivors, there is a need for clinical trials evaluating the use of GLP-1-RA and SGLT-2 inhibitors in this population.
Management of acute ischemic stroke in the emergency department: optimizing the brain
Authors: Ganti Latha 
Published: January 2025

AbstractAcute ischemic stroke is a devastating condition that afflicts more than 12 million people every year. Globally, stroke is the 2nd leading cause of death and 3rd leading cause of disability worldwide. While not all patients can avail themselves of existing acute therapies, all patients can benefit from brain optimization measures. This paper details the 12 steps in the management of acute ischemic stroke in the emergency department.
Clinical profile, treatment, and outcomes of testicular cancer in a resource-limited setting: a study from Sudan
Authors: Eltahir Eltahir Ahmed , Awad Sami Mahjoub Taha , Osman Yassin Mohammed , Ahmed Mohammed El Imam Mohammed , Elhassan Moawia Mohammed Ali 
Published: January 2025

Abstract
Background
Testicular cancer is a rare malignancy, with limited data on its clinical characteristics and outcomes in Africa. This study aims to provide baseline information on the clinical presentation, treatment, and outcomes of testicular cancer in Sudan, a low-income African nation.

Methods
A retrospective review was conducted at two tertiary care centers in central Sudan. Data were extracted for patients > 15 years of age diagnosed with testicular cancer from 2007 to 2015, with a follow-up of up to 5 years. Patients were identified from hospital records at the National Cancer Institute and Gezira Hospital for Renal disease and Surgery.

Results
The study included 50 patients with a mean age of 41.9 years (SD = 18.9). Testicular swelling was the most common presenting symptom, reported in 70% of patients (n = 35). The median time from the initial complaint to diagnosis was 6 months (range: 1–36). Seminoma was the predominant histopathological subtype accounting for 68% of cases, and 64% of patients presented with advanced-stage disease (stage III). Radical orchidectomy was performed in 86% of patients. Chemotherapy was administered to 88% of patients, while 10% received radiotherapy. At the last follow-up, 44% of patients were in remission, 18% were alive with disease progression, and 36% had died.

Conclusions
This study highlights the high mortality rate associated with testicular cancer in this resource-limited setting, which is likely due to delayed diagnosis and the advanced stage at presentation. Enhancing health education is crucial to promote early detection and ensure timely access to care, ultimately improving patient outcomes.
Analytical performance of OncoPrism-HNSCC, an RNA-based assay to inform immune checkpoint inhibitor treatment decisions for recurrent/metastatic head and neck squamous cell carcinoma
Authors: Hiken Jeffrey , Earls Jon , Flanagan Kevin C. , Wellinghoff Rachel L. , Ponder Michelle , Messina David N. , Glasscock Jarret I. , Duncavage Eric J. 
Published: January 2025

Abstract
Background
While immune checkpoint inhibitor (ICI) therapies can significantly improve outcomes for patients with recurrent/metastatic head and neck squamous cell carcinoma (RM-HNSCC), only about 15–20% benefit from such treatments. Clinical tests that guide the use of ICIs are therefore critically needed. OncoPrism-HNSCC was developed to address this need. The assay combines next generation RNA sequencing-based immunomodulatory gene expression signatures with machine learning algorithms to generate an OncoPrism score that classifies patients as having low, medium, or high likelihood of disease control in response to ICI treatment. Also, OncoPrism-HNSCC leverages the same FFPE patient tumor RNA used for ICI response prediction to identify rare cases where oncogenic rearrangements in NTRK1/2/3 or ALK genes may occur, and which may indicate the use of potentially highly effective targeted therapies. The clinical performance of OncoPrism-HNSCC has been validated. Here, we report its analytical performance in the presence of potentially confounding sources of variation.

Methods
The assay’s analytical sensitivity was assessed by varying RNA input quantity and quality, observing the effect on ICI response prediction scores. Analytical specificity was tested by spiking increasing percentages of genomic DNA into input RNA. Intra-assay and inter-assay precision were evaluated, and the analytical sensitivity, specificity, and precision of gene fusion detection were assessed. Concordance with orthogonal methods of gene fusion detection was tested on 67 FFPE clinical samples.

Results
Varying RNA inputs as low as four-fold below the nominal input amount had little effect on ICI response prediction scores. RNA quality levels below the test threshold had no significant effect. Genomic DNA spike-ins up to 30% had only a small effect on scores. The pooled standard deviation for multiple operators, reagent lots, batches, and sequencers yielded an overall variance represented by just 0.87% of the score range of the test (0–100). NTRK and ALK gene fusion detection was 100% concordant with orthogonal methods.

Conclusions
Robust and reliable analytical performance of the OncoPrism-HNSCC assay supports its clinical use, even in the presence of variation typically encountered in the laboratory setting.
Changes and continuities in gambling careers during the COVID-19 pandemic: a longitudinal qualitative study of regular sports bettors in Britain
Authors: Brown Ashley , Donnachie Craig , Critchlow Nathan , Bunn Christopher , Dobbie Fiona , Gray Cindy M , Purves Richard , Reith Gerda , Wardle Heather , Hunt Kate 
Published: January 2025

Abstract
Background
To explore continuities and changes in gambling behaviour during the COVID-19 pandemic and the factors that influenced these among a sample of regular sports bettors.

Methods
A longitudinal qualitative study using in-depth interviews. Sixteen sports bettors living in Britain took part in the first interviews in July-November 2020, and 13 in the follow-up interviews in March-September 2021.

Results
Individual patterns of gambling were episodic: it was common for gambling to increase during some periods of the pandemic and to decrease during others, reflecting the dynamic and (often) challenging circumstances which people were living through at the time. Changes and continuities in gambling during the pandemic were influenced by a range of factors which we have grouped into two main themes relating to ‘gambling and the sports landscape’ and ‘disruption to day-to-day life’. It was common for a constellation of factors to influence gambling behaviour rather than a single factor. These constellations of factors varied from person to person and at different times during the pandemic.

Conclusions
Findings of the present study are consistent with earlier literature examining gambling careers before the advent of COVID-19 showing that gambling trajectories are non-linear. Our research suggests that ‘typical’ patterns of gambling behaviour (e.g. being episodic), and the broader known risk and protective factors within individuals, families, communities and societies have been amplified during the pandemic. Findings highlight the adaptability of the gambling industry to continue to reach consumers through product offerings and marketing even in a period of unprecedented restrictions on supply, and show the potential resulting harms of these actions among gamblers at risk of experiencing gambling problems. Taken together, findings from this study provide important new insights relevant to discussions about gambling regulation, and support calls for multifaceted and comprehensive policy, regulatory, and treatment approaches, to minimise gambling-related harms.
The effectiveness of a 10-week family-focused e-Health healthy lifestyle program for school-aged children with overweight or obesity: a randomised control trial
Authors: Zhu Diana , Dordevic Aimee L. , Gibson Simone , Davidson Zoe E. 
Published: January 2025

Abstract
Background
Electronic health (e-Health) interventions may increase effectiveness and address limitations of conventional in-person childhood obesity treatment programs. This study evaluates the effectiveness of a 10-week e-Health (web-based) healthy lifestyle program for school-aged children with overweight/obesity.

Methods
In this randomised control trial (RCT), families with children aged 7–13 years with overweight/obesity (body mass index, BMI ≥ 85th percentile), living in Victoria, Australia, were recruited. Families were randomised to intervention or waitlist control and received the 10-week web-based program. The primary outcome was the change in children’s BMI z-score over 10 weeks. Other outcomes included change in children’s waist circumference, dietary intake, physical activity, and quality of life over 10 weeks.

Results
Of 148 children (125 families) recruited, 102 children (85 families) completed the RCT. A significant decrease in children’s BMI z-scores was observed in the intervention compared to the control group over 10 weeks (mean difference 0.11; 95% CI, 0.02–0.20). The web-based program was also effective in improving children’s quality of life and lifestyle behaviour changes over 10 weeks. In the intervention group, there was a significant increase in children’s quality of life scores (intervention versus control: median change (IQR) = 11 (3, 17) versus 1 (-3, 7); p = 0.034), overall diet quality scores (6 (2, 10) versus 2 (-3, 5); p < 0.001), and daily physical activity levels (5.2 (-2.6, 12.8) versus − 0.2 (-8.2, 4.5); p = 0.022) compared to the control group.

Conclusions
A web-based healthy lifestyle program effectively improved short-term health-related outcomes in children with overweight/obesity. Further research is needed to identify determinants of program effectiveness, evaluate sustained effects, and equitably tailor childhood obesity e-Health interventions to diverse populations.

Trial registration
This study was registered with the Australian New Zealand Clinical Trial Registry (ACTRN12621001762842) on November 11, 2021, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=383053.
Consumer perspectives on the national electronic health record and barriers to its adoption in Germany: does health policy require a change in communication?
Authors: Kröner Saskia , Schreiweis Björn , Strotbaum Veronika , Brandl Lea Christine , Pobiruchin Monika , Wiesner Martin 
Published: January 2025

Abstract
Background
The national health record (ePA) was introduced January 1st, 2021 in Germany and is available to every person insured under statutory health insurance. This study investigated the acceptance and expectations of the national health record in Germany, focusing on consumer perspectives, expectations, barriers, information needs, and communication aspects.

Methods
An exploratory, observational, cross-sectional online survey was conducted one year after ePA introduction, followed by descriptive statistical analysis.

Results
The top three ePA use cases were medical document collection, simplified data exchange between medical institutions, and emergency medical information. Adoption barriers included lack of information and access, privacy concerns, and perceived lack of necessity. Participants that felt informed about the ePA, reported they received information primarily from health insurances, the media, and educational or professional sources, mainly through printed brochures, social media, or via emails. Most participants (86.5%) preferred being informed through conversations, particularly with health insurance providers (81.5%) and doctors (61.0%). Written information was highly desired (94.5%), preferably via email or information letters/flyers. However, more than half of the participants (55.6%) reported being uninformed about the ePA introduction.

Conclusion
The study revealed a communication gap between providers and consumers, leading to a low acceptance rate of digital health technologies. Comparisons with other countries showed low adoption rates for opt-in systems. The authors suggest changing communication strategies, given users prefer direct information from doctors or health insurance companies. Adopting an opt-out system with professional social media and marketing campaigns could increase nationwide ePA adoption.
The costs and logistics of distributing ‘forest packs’ containing novel vector control tools to forest-exposed populations in Cambodia
Authors: Yukich Joshua , Doum Dyna , McIver David J. , Richardson Jason H. , Sovannaroth Siv , Lobo Neil F. , Tatarsky Allison 
Published: January 2025

Abstract
Background
Malaria incidence in the Greater Mekong Subregion has been on the decline, and most remaining malaria risk in the region is concentrated among hard-to-reach populations, especially those with exposure to forested areas. New vector control tools focused on outdoor protection in forest settings are needed for these populations.

Methods
The delivery of a ‘forest pack’ containing a volatile pyrethroid spatial repellent (VPSR), a topical repellent, and pyrethroid treatment of clothing was evaluated in an operational study in Cambodia. Costs were collected using micro-costing approaches and the cost of distribution for the ‘forest pack’ was estimated using standard economic evaluation approaches and examined in sensitivity analyses.

Results
The cost per eligible person (the target population) per malaria season for the whole pack was estimated to be 138 USD, which was nearly entirely driven by the cost of the products.

Conclusions
Modifications to the ‘forest pack’ including adding a longer-lasting spatial repellent product or a reduced-cost topical repellent could significantly reduce the cost of pack distribution over the course of a malaria season.
Combining an internal tension relieving technique with anterior cruciate ligament reconstruction (ACLR) reduces graft failure rate and improves functional outcomes: a systematic review and meta-analysis
Authors: Wen Yixin , Huang Wei , Li Minghui , Jiang Yong , Tong Yibo , Mei Hongjun , Tan Junfeng 
Published: January 2025

Abstract
Purpose
Graft rupture is a significant cause of graft failure in anterior cruciate ligament reconstruction (ACLR). To address this issue, clinicians have combined the internal tension relieving technique (ITRT) with ACLR to improve graft stiffness, aiming to reduce the risk of graft failure. The purpose of this study is to compare the graft failure rates and clinical functional outcomes between ITRT-assisted ACLR and conventional ACLR.

Methods
Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a search was conducted in databases including Ovid, PubMed, Web of Science, Embase, Cochrane Library, Wanfang Data, CNKI, and VIP Medical Database for clinical controlled trials comparing the ITRT combined with ACLR to conventional ACLR. The search period spanned from the establishment of the databases to September 2024. Studies meeting the inclusion and exclusion criteria were selected, with two independent reviewers conducting literature screening, quality assessment, and data extraction. Data analysis was performed using RevMan 5.4 software. The evaluated outcomes included graft failure rate, Lysholm Knee Scoring Scale, Tegner activity score, Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) score, Visual Analog Scale (VAS) score, Single Assessment Numeric Evaluation (SANE), return to sport (RTS) rate, and knee joint laxity.

Results
A total of 11 studies were included in the final analysis, with 1,339 patients (592 patients with ITRT-assisted ACLR and 747 patients with conventional ACLR). The combined analysis results indicated that, compared to conventional ACLR, ITRT-assisted ACLR showed significant advantages in reducing graft failure rates (RR = 0.44; 95% CI: 0.23, 0.83; P = 0.01), increasing return-to-sport rates (MD = 1.75; 95% CI: 1.05, 2.91; P = 0.03), and improving knee scores (including KOOS score and Tegner activity score) (all P values < 0.05). However, no significant differences were observed between the two approaches in terms of Lysholm knee score, VAS score, IKDC score, and knee joint laxity.

Conclusions
This meta-analysis highlighted the significance and superiority of combining ITRT with ACLR compared to conventional ACLR, particularly in reducing graft failure rate and improving knee function outcomes. The ITRT-assisted ACLR procedure may represent the optimal approach for minimizing graft failure. However, given the limitations of short-term follow-up and reliance on retrospective studies, more randomized controlled trials and longer follow-up periods are needed to further evaluate the long-term graft failure rates and functional outcomes.