bluuebunny/crossref_metadata_2025_split huggingface dataset:
Accuracy of clinical predictions of prognosis at the end-of-life: evidence from routinely collected data in urgent care records
Authors: Orlovic M. , Droney J. , Vickerstaff V. , Rosling J. , Bearne A. , Powell M. , Riley J. , McFarlane P. , Koffman J. , Stone P. 
Published: April 2023

Abstract
Background
The accuracy of prognostication has important implications for patients, families, and health services since it may be linked to clinical decision-making, patient experience and outcomes and resource allocation. Study aim is to evaluate the accuracy of temporal predictions of survival in patients with cancer, dementia, heart, or respiratory disease.

Methods
Accuracy of clinical prediction was evaluated using retrospective, observational cohort study of 98,187 individuals with a Coordinate My Care record, the Electronic Palliative Care Coordination System serving London, 2010–2020. The survival times of patients were summarised using median and interquartile ranges. Kaplan Meier survival curves were created to describe and compare survival across prognostic categories and disease trajectories. The extent of agreement between estimated and actual prognosis was quantified using linear weighted Kappa statistic.

Results
Overall, 3% were predicted to live “days”; 13% “weeks”; 28% “months”; and 56% “year/years”. The agreement between estimated and actual prognosis using linear weighted Kappa statistic was highest for patients with dementia/frailty (0.75) and cancer (0.73). Clinicians’ estimates were able to discriminate (log-rank p < 0.001) between groups of patients with differing survival prospects. Across all disease groups, the accuracy of survival estimates was high for patients who were likely to live for fewer than 14 days (74% accuracy) or for more than one year (83% accuracy), but less accurate at predicting survival of “weeks” or “months” (32% accuracy).

Conclusion
Clinicians are good at identifying individuals who will die imminently and those who will live for much longer. The accuracy of prognostication for these time frames differs across major disease categories, but remains acceptable even in non-cancer patients, including patients with dementia. Advance Care Planning and timely access to palliative care based on individual patient needs may be beneficial for those where there is significant prognostic uncertainty; those who are neither imminently dying nor expected to live for “years”.
Psychological wellbeing of Australian community health service staff during the COVID-19 pandemic: a longitudinal cohort study
Authors: Holton Sara , Wynter Karen , Peeters Anna , Georgalas Alexandra , Yeomanson Ann , Rasmussen Bodil 
Published: April 2023

Abstract
Background
Hospital clinical staff have reported poor psychosocial wellbeing during the COVID-19 pandemic. Little is known about community health service staff who undertake various roles including education, advocacy and clinical services, and work with a range of clients. Few studies have collected longitudinal data. The aim of this study was to assess the psychological wellbeing of community health service staff in Australia during the COVID-19 pandemic at two time points in 2021.

Methods
A prospective cohort design with an anonymous cross-sectional online survey administered at two time points (March/April 2021; n = 681 and September/October 2021; n = 479). Staff (clinical and non-clinical roles) were recruited from eight community health services in Victoria, Australia. Psychological wellbeing was assessed using the Depression, Anxiety and Stress Scale (DASS-21) and resilience using the Brief Resilience Scale (BRS). General linear models were used to measure the effects of survey time point, professional role and geographic location on DASS-21 subscale scores, adjusting for selected sociodemographic and health characteristics.

Results
There were no significant differences in respondent sociodemographic characteristics between the two surveys. Staff’s mental health declined as the pandemic continued. Adjusting for dependent children, professional role, general health status, geographic location, COVID-19 contact status and country of birth; depression, anxiety and stress scores were significantly higher for respondents in the second survey than the first (all p < 0.001). Professional role and geographic location were not statistically significantly associated with scores on any of the DASS-21 subscales. Higher levels of depression, anxiety and stress were reported among respondents who were younger, and had less resilience or poorer general health.

Conclusions
The psychological wellbeing of community health staff was significantly worse at the time of the second survey than the first. The findings indicate that the COVID-19 pandemic has had an ongoing and cumulative negative impact on staff wellbeing. Staff would benefit from continued wellbeing support.
Evaluation of Ethiopia’s field epidemiology training program – frontline: perspectives of implementing partners
Authors: Kebebew Tolcha , Woldetsadik Mahlet A. , Barker Jordan , Cui Angelina , Abedi Aisha A. , Sugerman David E. , Williams Desmond E. , Turcios-Ruiz Reina M. , Takele Tariku , Zeynu Neima 
Published: April 2023

Abstract
Background
Field Epidemiology Training Program (FETP) has been adopted as an epidemiology and response capacity building strategy worldwide. FETP-Frontline was introduced in Ethiopia in 2017 as a three-month in-service training. In this study, we evaluated implementing partners’ perspectives with the aim of understanding program effectiveness and identifying challenges and recommendations for improvement.

Methods
A qualitative cross-sectional design was utilized to evaluate Ethiopia’s FETP-Frontline. Using a descriptive phenomenological approach, qualitative data were collected from FETP-Frontline implementing partners, including regional, zonal, and district health offices across Ethiopia. We collected data through in-person key informant interviews, using semi-structured questionnaires. Thematic analysis was conducted, assisted with MAXQDA, while ensuring interrater reliability by using the consistent application of theme categorization. The major themes that emerged were program effectiveness, knowledge and skills differences between trained and untrained officers, program challenges, and recommended actions for improvement. Ethical approval was obtained from the Ethiopian Public Health Institute. Informed written consent was obtained from all participants, and confidentiality of the data was maintained throughout.

Results
A total of 41 interviews were conducted with key informants from FETP-Frontline implementing partners. The regional and zonal level experts and mentors had a Master of Public Health (MPH), whereas district health managers were Bachelor of Science (BSc) holders. Majority of the respondents reflected a positive perception towards FETP-Frontline. Regional and zonal officers as well as mentors mentioned that there were observable performance differences between trained and untrained district surveillance officers. They also identified various challenges including lack of resources for transportation, budget constraints for field projects, inadequate mentorship, high staff turnover, limited number of staff at the district level, lack of continued support from stakeholders, and the need for refresher training for FETP-Frontline graduates.

Conclusions
Implementing partners reflected a positive perception towards FETP-Frontline in Ethiopia. In addition to scaling-up the program to reach all districts to achieve the International Health Regulation 2005 goals, the program also needs to consider addressing immediate challenges, primarily lack of resources and poor mentorship. Continued monitoring of the program, refresher training, and career path development could improve retention of the trained workforce.
Egg-laying by female Aedes aegypti shapes the bacterial communities of breeding sites
Authors: Mosquera Katherine D. , Martínez Villegas Luis Eduardo , Rocha Fernandes Gabriel , Rocha David Mariana , Maciel-de-Freitas Rafael , A. Moreira Luciano , Lorenzo Marcelo G. 
Published: April 2023

Abstract
Background
Aedes aegypti, the main arboviral mosquito vector, is attracted to human dwellings and makes use of human-generated breeding sites. Past research has shown that bacterial communities associated with such sites undergo compositional shifts as larvae develop and that exposure to different bacteria during larval stages can have an impact on mosquito development and life-history traits. Based on these facts, we hypothesized that female Ae. aegypti shape the bacteria communities of breeding sites during oviposition as a form of niche construction to favor offspring fitness.

Results
To test this hypothesis, we first verified that gravid females can act as mechanical vectors of bacteria. We then elaborated an experimental scheme to test the impact of oviposition on breeding site microbiota. Five different groups of experimental breeding sites were set up with a sterile aqueous solution of larval food, and subsequently exposed to (1) the environment alone, (2) surface-sterilized eggs, (3) unsterilized eggs, (4) a non-egg laying female, or (5) oviposition by a gravid female. The microbiota of these differently treated sites was assessed by amplicon-oriented DNA sequencing once the larvae from the sites with eggs had completed development and formed pupae. Microbial ecology analyses revealed significant differences between the five treatments in terms of diversity. In particular, between-treatment shifts in abundance profiles were detected, showing that females induce a significant decrease in microbial alpha diversity through oviposition. In addition, indicator species analysis pinpointed bacterial taxa with significant predicting values and fidelity coefficients for the samples in which single females laid eggs. Furthermore, we provide evidence regarding how one of these indicator taxa, Elizabethkingia, exerts a positive effect on the development and fitness of mosquito larvae.

Conclusions
Ovipositing females impact the composition of the microbial community associated with a breeding site, promoting certain bacterial taxa over those prevailing in the environment. Among these bacteria, we found known mosquito symbionts and showed that they can improve offspring fitness if present in the water where eggs are laid. We deem this oviposition-mediated bacterial community shaping as a form of niche construction initiated by the gravid female.
Third dose mRNA vaccination against SARS-CoV-2 reduces medical complaints seen in primary care: a matched cohort study
Authors: Methi Fredrik , Gran Jon Michael , Valberg Morten , Kinge Jonas Minet , Telle Kjetil , Magnusson Karin 
Published: April 2023

Abstract
Background
SARS-CoV-2 mRNA vaccination has been associated with both side effects and a reduction in COVID-related complaints due to the decrease in COVID-19 incidence. We aimed to investigate if individuals who received three doses of SARS-CoV-2 mRNA vaccines had a lower incidence of (a) medical complaints and (b) COVID-19-related medical complaints, both as seen in primary care, when compared to individuals who received two doses.

Methods
We conducted a daily longitudinal exact one-to-one matching study based on a set of covariates. We obtained a matched sample of 315,650 individuals aged 18–70 years who received the 3rd dose at 20–30 weeks after the 2nd dose and an equally large control group who did not. Outcome variables were diagnostic codes as reported by general practitioners or emergency wards, both alone and in combination with diagnostic codes of confirmed COVID-19. For each outcome, we estimated cumulative incidence functions with hospitalization and death as competing events.

Results
We found that the number of medical complaints was lower in individuals aged 18–44 years who received three doses compared to those who received two doses. The differences in estimates per 100,000 vaccinated were as follows: fatigue 458 less (95% confidence interval: 355–539), musculoskeletal pain 171 less (48–292), cough 118 less (65–173), heart palpitations 57 less (22–98), shortness of breath 118 less (81–149), and brain fog 31 less (8–55). We also found a lower number of COVID-19-related medical complaints: per 100,000 individuals aged 18–44 years vaccinated with three doses, there were 102 (76–125) fewer individuals with fatigue, 32 (18–45) fewer with musculoskeletal pain, 30 (14–45) fewer with cough, and 36 (22–48) fewer with shortness of breath. There were no or fewer differences in heart palpitations (8 (1–16)) or brain fog (0 (− 1–8)). We observed similar results, though more uncertain, for individuals aged 45–70 years, both for medical complaints and for medical complaints that were COVID-19 related.

Conclusions
Our findings suggest that a 3rd dose of SARS-CoV-2 mRNA vaccine administered 20–30 weeks after the 2nd dose may reduce the incidence of medical complaints. It may also reduce the COVID-19-related burden on primary healthcare services.
An archetypes approach to malaria intervention impact mapping: a new framework and example application
Authors: Bertozzi-Villa Amelia , Bever Caitlin A. , Gerardin Jaline , Proctor Joshua L. , Wu Meikang , Harding Dennis , Hollingsworth T. Deirdre , Bhatt Samir , Gething Peter W. 
Published: April 2023

Abstract
Background
As both mechanistic and geospatial malaria modeling methods become more integrated into malaria policy decisions, there is increasing demand for strategies that combine these two methods. This paper introduces a novel archetypes-based methodology for generating high-resolution intervention impact maps based on mechanistic model simulations. An example configuration of the framework is described and explored.

Methods
First, dimensionality reduction and clustering techniques were applied to rasterized geospatial environmental and mosquito covariates to find archetypal malaria transmission patterns. Next, mechanistic models were run on a representative site from each archetype to assess intervention impact. Finally, these mechanistic results were reprojected onto each pixel to generate full maps of intervention impact. The example configuration used ERA5 and Malaria Atlas Project covariates, singular value decomposition, k-means clustering, and the Institute for Disease Modeling’s EMOD model to explore a range of three-year malaria interventions primarily focused on vector control and case management.

Results
Rainfall, temperature, and mosquito abundance layers were clustered into ten transmission archetypes with distinct properties. Example intervention impact curves and maps highlighted archetype-specific variation in efficacy of vector control interventions. A sensitivity analysis showed that the procedure for selecting representative sites to simulate worked well in all but one archetype.

Conclusion
This paper introduces a novel methodology which combines the richness of spatiotemporal mapping with the rigor of mechanistic modeling to create a multi-purpose infrastructure for answering a broad range of important questions in the malaria policy space. It is flexible and adaptable to a range of input covariates, mechanistic models, and mapping strategies and can be adapted to the modelers’ setting of choice.
Application of mathematical modelling to inform national malaria intervention planning in Nigeria
Authors: Ozodiegwu Ifeoma D. , Ambrose Monique , Galatas Beatriz , Runge Manuela , Nandi Aadrita , Okuneye Kamaldeen , Dhanoa Neena Parveen , Maikore Ibrahim , Uhomoibhi Perpetua , Bever Caitlin , Noor Abdisalan , Gerardin Jaline 
Published: April 2023

AbstractBackgroundFor their 2021–2025 National Malaria Strategic Plan (NMSP), Nigeria’s National Malaria Elimination Programme (NMEP), in partnership with the World Health Organization (WHO), developed a targeted approach to intervention deployment at the local government area (LGA) level as part of the High Burden to High Impact response. Mathematical models of malaria transmission were used to predict the impact of proposed intervention strategies on malaria burden.MethodsAn agent-based model ofPlasmodium falciparumtransmission was used to simulate malaria morbidity and mortality in Nigeria’s 774 LGAs under four possible intervention strategies from 2020 to 2030. The scenarios represented the previously implemented plan (business-as-usual), the NMSP at an 80% or higher coverage level and two prioritized plans according to the resources available to Nigeria. LGAs were clustered into 22 epidemiological archetypes using monthly rainfall, temperature suitability index, vector abundance, pre-2010 parasite prevalence, and pre-2010 vector control coverage. Routine incidence data were used to parameterize seasonality in each archetype. Each LGA’s baseline malaria transmission intensity was calibrated to parasite prevalence in children under the age of five years measured in the 2010 Malaria Indicator Survey (MIS). Intervention coverage in the 2010–2019 period was obtained from the Demographic and Health Survey, MIS, the NMEP, and post-campaign surveys.ResultsPursuing a business-as-usual strategy was projected to result in a 5% and 9% increase in malaria incidence in 2025 and 2030 compared with 2020, while deaths were projected to remain unchanged by 2030. The greatest intervention impact was associated with the NMSP scenario with 80% or greater coverage of standard interventions coupled with intermittent preventive treatment in infants and extension of seasonal malaria chemoprevention (SMC) to 404 LGAs, compared to 80 LGAs in 2019. The budget-prioritized scenario with SMC expansion to 310 LGAs, high bed net coverage with new formulations, and increase in effective case management rate at the same pace as historical levels was adopted as an adequate alternative for the resources available.ConclusionsDynamical models can be applied for relative assessment of the impact of intervention scenarios but improved subnational data collection systems are required to allow increased confidence in predictions at sub-national level.
The association of intimate partner violence and contraceptive use: a multi-country analysis of demographic and health surveys
Authors: Muluneh Muluken Dessalegn , Francis Lyn , Agho Kingsley , Stulz Virginia 
Published: April 2023

Abstract
Background
Intimate partner violence (IPV) affects millions of women each year and has been recognized as a leading cause of poor health, disability, and death among women of reproductive age. However, the existing studies about the association between IPV and contraceptive use have been found to be conflicting and relatively less studied, particularly in low and middle income countries, including Eastern Sub Saharan Africa (SSA). This study examines the relationship between IPV and contraceptive use in Eastern SSA countries.

Methods
The Demographic and Health Surveys (DHS) from 2014 to 2017 were a multi-stage cluster sample survey of 30,715 ever married (or cohabitating) women of reproductive age from six countries. The six Eastern SSA datasets were pooled and multivariable logistic regression using a hierarchical approach was performed to examine the association between IPV and contraceptive use after adjusting for women, partners, and household and health facility factors.

Result
Two thirds of women 67% [66.55, 67.88] were not using any modern contraceptive methods and almost half (48%) of the women had experienced at least one form of IPV from their partners. Our analysis showed a strong association with decreased odds of physical violence [adjusted odds ratios (aOR) = 0.72, 95%CI: 0.67, 0 0.78] among women not using any contraceptive methods. Other factors associated with women not using any contraceptive methods were older women (35–49 years), illiterate couples and women from poorest households. Women who had no access to any form of communication [aOR = 1.12, 95%CI: 1.08, 1.36], unemployed partner [aOR = 1.55, 95%CI: 1.23, 1.95] and women who travelled long distances to access health services [aOR = 1.16, 95%CI: 1.06, 1.26] significantly reported increased odds of not using any contraceptive methods.

Conclusion
Our study indicated that physical violence was negatively associated with not using any contraceptive method among married women in Eastern SSA countries. Tailored intervention messages to reduce IPV including physical violence among women not using contraceptive methods in East Africa should target those from low-socioeconomic groups especially, older women with no access to any form of communication, unemployed partners, and illiterate couples.
MicroRNA-19b-3p dysfunction of mesenchymal stem cell-derived exosomes from patients with abdominal aortic aneurysm impairs therapeutic efficacy
Authors: Zhang Yuxiao , Huang Xiaoran , Sun Tucheng , Shi Linli , Liu Baojuan , Hong Yimei , Fu Qing-Ling , Zhang Yuelin , Li Xin 
Published: April 2023

AbstractSenescence of vascular smooth muscle cells (VSMCs) contributes to the formation of abdominal aortic aneurysm (AAA). Although mesenchymal stem cell exosomes (MSC-EXO) have been confirmed to restrict the development of AAA, their biological activity depends largely on the physiological state of the MSCs. This study aimed to compare the effects of adipose-derived MSC-EXO from healthy donors (HMEXO) and AAA patients (AMEXO) on senescence of VSMCs in AAA and explore the underlying mechanisms. An ApoE-/- mouse model of AAA was used to investigate the therapeutic effects of HMEXO, AMEXO or miR-19b-3p-AMEXO on AAA development. This in vitro model of AAA was established by treating VSMCs with Ang II (Angiotensin II). The senescence of VSMCs was determined by senescence-associated β-galactosidase (SA-β-gal) staining. The morphology of mitochondria in VSMCs was examined by MitoTracker staining. HMEXO exhibited superior capacity compared with AMEXO to inhibit VSMC senescence and attenuate AAA formation in Ang II–treated ApoE-/- mice. In vitro, both AMEXO and HMEXO inhibited Ang II-induced VSMC senescence via downregulation of mitochondrial fission. Notably, compared with HMEXO, the ability of AMEXO to inhibit VSMC senescence was significantly decreased. miRNA sequencing and the expression of miR-19b-3p was significantly decreased in AMEXO compared with HMEXO. Luciferase assay suggested that MST4 (Mammalian sterile-20-like kinase 4) is a potential target of miR-19b-3p. Mechanistically, miR-19b-3p in HMEXO ameliorated VSMC senescence by inhibiting mitochondrial fission via regulation of the MST4/ERK/Drp1 signaling pathway. Overexpression of miR-19b-3p in AMEXO improved their beneficial effect on AAA formation. Our study reveals that MSC-exosomal miR-19b-3p exerts protective effects against Ang II-induced AAA and VSMC senescence via regulation of the MST4/ERK/Drp1 pathway. The pathological state of AAA patients alters the miRNA components of AMEXO and impairs their therapeutic benefits.