bluuebunny/crossref_metadata_2025_split huggingface dataset:
Coping with loneliness and stigma associated with HIV in a resource-limited setting, making a case for mental health interventions; a sequential mixed methods study
Authors: Ninnoni Jerry Paul , Agyemang Sampson Opoku , Bennin Lydia , Agyare Elizabeth , Gyimah Leveana , Senya Kafui , Baddoo Nyonuku Akosua , Annor Francis , Obiri-Yeboah Dorcas 
Published: March 2023

Abstract
Background
Challenges such as stigma and loneliness may increase vulnerability to Human Immunodeficiency Virus (HIV) infection and negatively affect the quality of life of people living with HIV (PLHIV) despite the massive investment in access to antiretroviral therapy. This study aims to determine the level of loneliness and stigma and explore the coping resources employed by PLHIV in a resource-constrained setting.

Methods
This was a sequential mixed methods study conducted at the Cape Coast Teaching Hospital (CCTH) in Ghana between May and December 2021. A total of 395 adults were selected using a simple random sampling technique. HIV Stigma Scale and UCLA Loneliness Scale were used to collect quantitative data. A purposive sampling technique was applied to recruit 18 participants to saturation using a semi-structured interview guide. SPSS version 21 was used for the statistical analysis of the quantitative data. HIV-related loneliness and stigma levels were estimated, and bivariate and multivariable logistic regression were used to evaluate associated factors using a statistical significance of p-value (p < .05). In general, the thematic analysis approach by Braun and Clark was employed to analyse the qualitative data. Findings were then triangulated.

Results
The mean age was 46.79 years (± 12.53), 75.4% of the participants were female, with a prevalence of stigma of 99.0% (95%CI = 97.4–99.7) and loneliness of 30.1% (95%CI = 25.6–34.9). Tertiary-level education and instrumental support were associated with lower levels of loneliness. In contrast, comorbidity, personalised stigma, negative self-image, and self-blame were positively related to loneliness. Thematic analyses of the qualitative data produced a range of themes that showed that people living with HIV rely on personal resources, social support networks, and behaviour modification strategies to manage their condition. In particular, some of these strategies include; religiosity and spirituality, family and friends, medication and professional support systems.

Conclusion
The results suggest that PLHIV in the developing world face enormous challenges, socially, psychologically and financially. Although there have been global efforts to make HIV services accessible, the findings suggest a need for integrating mental health services contextually to reduce loneliness and HIV-related stigma to improve quality of life.
Increased D-dimer level was a poor predictor of neuroblastoma, especially in the high-risk group
Authors: Ma Yue , Li Changchun , Zhao Zhenzhen , Yang Chao , Zhou Jianwu , Peng Liang , Deng Xiaobin , Wang Shan 
Published: March 2023

Abstract
Purpose
D-dimer levels are associated with tumor progression and prognosis in various cancers. However, there are few research about the relationship between D-dimer and neuroblastoma (NB). This study assessed the relationships of D-dimer levels with clinical features and overall survival (OS) in patients with NB.

Methods
Information about the clinical features of 365 patients and the prognosis of 301 patients was collected. The relationship between D-dimer levels and clinical features or OS was analyzed. We constructed the risk score based on Cox regression analysis and verified the predictive efficacy of the model through ROC curve and calibration curve.

Results
The results showed that D-dimer levels were significantly increased in patients with nonmediastinal tumor, tumor larger than 10 cm, stage 3–4 disease, bone marrow metastasis, unfavorable histology, bone metastasis, NMYC amplification, and the high-risk group (all P < 0.05). The Kaplan–Meier survival analysis showed that there were significant differences in 3- and 5-year OS (87.4% vs. 32.3%, 79.3% vs. 32.3%, P < 0.0001) between the low D-dimer and high D-dimer groups. In the high-risk group, the OS of high D-dimer was significantly lower than that of low D-dimer (P < 0.0001). All cases were divided into the training cohort (N = 211) and the validation cohort (N = 90). Multivariate analysis further suggested that D-dimer level, bone metastasis, and NMYC status were independent prognostic factors for OS (all P < 0.05). Based on the above three factors, we constructed the risk score in the training cohort. Survival analysis showed that compared with the other groups, the group with 11 scores had the worst prognosis (3-year OS 0%, P < 0.0001). The time-dependent ROC analysis and calibration curve indicated that the risk score had good accuracy.

Conclusions
Patients with high D-dimer levels tended to have unfavorable clinical characteristics and poor prognosis.
The dimensional and morphological assessment of the frontal sinus in sex estimation among different populations
Authors: Zheng Bowen , Zhong Yuan , Al-Worafi Nassem Ali , Liu Yi 
Published: March 2023

AbstractBackgroundThe purpose of the present study was to determine the dimorphic potential of the frontal sinus (FS) index, area, and the combination of both variables to ascertain its accuracy in sex discrimination among Bosnian, Chinese, and Nepalese.MethodsA retrospective study analyzed the digital standardized lateral cephalometric of 654 Bosnian, Chinese, and Nepalese adult patients (116 females, 102 males; age range 17–40 years). The following FS parameters were analyzed: The maximum height, width, and area of the FS, and the ratio of height and width was calculated as the FS index. The measurements were analyzed using logistic regression analysis for the FS index, area, and combined FS index and area.ResultsStatistically significant differences were observed between the mean values of the FS index and the area between females and males in each population. The highest frequency of bilateral absence of FS was detected among females, specifically in Chinese (6.6%). Logistic regression equation derived from the present study differentiated between sexes with higher classification percentages for the FS index and area with 62.4%, 75.2%, and 78.4% among Bosnian, Chinese, and Nepalese subjects, respectively.ConclusionsThe results of the present study highlight the implications of the combined FS index and area as a reliable approach in sex estimation in forensic science whenever both the FS structure and lateral cephalometric are available.
Research progress on non-protein-targeted drugs for cancer therapy
Authors: Zhang Yiwen , Lu Lu , Song Feifeng , Zou Xiaozhou , Liu Yujia , Zheng Xiaowei , Qian Jinjun , Gu Chunyan , Huang Ping , Yang Ye 
Published: March 2023

AbstractNon-protein target drugs, especially RNA-based gene therapies for treating hereditary diseases, have been recognized worldwide. As cancer is an insurmountable challenge, no miracle drug is currently available. With the advancements in the field of biopharmaceuticals, research on cancer therapy has gradually focused on non-protein target-targeted drugs, especially RNA therapeutics, including oligonucleotide drugs and mRNA vaccines. This review mainly summarizes the clinical research progress in RNA therapeutics and highlights that appropriate target selection and optimized delivery vehicles are key factors in increasing the effectiveness of cancer treatment in vivo.
Effects of a remote-handling-concept–based task-oriented arm training (ReHab-TOAT) on arm-hand skill performance in chronic stroke: a study protocol for a two-armed randomized controlled trial
Authors: Elmanowski Jule , Seelen Henk , Geers Richard , Kleynen Melanie , Verbunt Jeanine 
Published: March 2023

Abstract
Background
Improving arm-hand skill performance is a major therapeutic target in stroke rehabilitation and needs intensive and varied training. However, guided treatment time is limited. Technology can assist in the training of patients, offering a higher intensity and more variety in content. A new task-oriented arm training approach was developed, using a ‘Remote Handling concept based’ device to provide haptic feedback during the performance of daily living activities (ReHab-TOAT). This study aims to investigate the effects of ReHab-TOAT on patients’ arm-hand function and arm-hand skill performance, quality of life of both patients in the chronic phase after stroke and their caregivers and the patients’ perception regarding the usability of the intervention.

Methods
A randomized clinical trial was designed. Adult chronic stroke patients suffering from hemiparesis and arm-hand problems, with an Utrechtse Arm-hand Test score of 1–3, will be invited to participate. Participants in the experimental group receive ReHab-TOAT additional to care as usual. ReHab-TOAT contains task-oriented arm training for stroke patients in combination with haptic feedback, generated by a remote handling device. They will train for 4 weeks, 3× per week, 1.5h per day. Participants in the control group will receive no additional therapy apart from care as usual. The Fugl-Meyer Assessment (FMA), measuring participants’ motor performance of the affected arm, is used as the primary outcome measure. Secondary outcome measures are arm-hand capacity of the patient (ARAT), perceived arm-hand skill performance (MAL), actual arm-hand skill performance (accelerometry), patients’ quality of life (EuoQol-5D) and caregivers’ quality of life (CarerQoL). Participants’ perception regarding the usability of the intervention, including both the developed approach and technology used, will be evaluated by the System Usability Scale and a questionnaire on the user experience of technology. Measurements will be performed at 1, 2, 3 and 4 weeks pre-intervention (baseline); immediately post-intervention; and 3, 6 and 9 months post-intervention. Statistical analysis includes linear mixed model analysis.

Discussion
This study is designed to investigate the evidence regarding the effects of ReHab-TOAT on patients’ performance at different levels of the International Classification of Functioning, disability and health (ICF) model, i.e. a framework measuring functioning and disability in relation to a health condition, and to provide insights on a successful development and research process regarding technology-assisted training in co-creation.

Trial registration
Netherlands Trial Register NL9541. Registered on June 22, 2021
The COSI trial: a study protocol for a multi-centre, randomised controlled trial to explore the clinical and cost-effectiveness of the Circle of Security-Parenting Intervention in community perinatal mental health services in England
Authors: Rosan Camilla , Dijk Kim Alyousefi-van , Darwin Zoe , Babalis Daphne , Cornelius Victoria , Phillips Rachel , Richards Lani , Wright Hannah , Pilling Steve , Fearon Pasco , Pizzo Elena , Fonagy Peter 
Published: March 2023

Abstract
Background
Perinatal mental health difficulties affect up to 27% of birthing parents during pregnancy and the first postnatal year, and if untreated are associated with difficulties in bonding and long-term adverse outcomes to children. There are large evidence gaps related to psychological treatment, particularly in group therapy approaches and parent-infant interventions. One intervention showing preliminary efficacious findings and user acceptability is Circle of Security-Parenting (COS-P), which is a brief, weekly, group programme. However, these studies were underpowered and predominantly non-randomised, and there has never been a research trial in England or with birthing parents experiencing severe and complex perinatal mental health difficulties. The aim of the research is to conduct a randomised control trial to test whether COS-P will reduce perinatal mental health symptoms in birthing parents accessing NHS perinatal mental health services, compared to treatment as usual (TAU). Secondary objectives include exploring whether the intervention improves parenting sensitivity, emotion regulation skills, attachment security and infant development. Additionally, the project aims to examine whether the intervention is acceptable to parents and NHS staff, and whether it is cost-effective.

Methods
COSI is an individually randomised, single-blind parallel arm controlled trial with an embedded internal pilot aiming to recruit 369 participants in a 2:1 ratio (intervention: TAU). Participants will be recruited from ten NHS community perinatal mental health services in England and screened based on clinical levels of both mental health symptoms (average CORE-OM score ≥ 1.1) and postnatal bonding difficulties (total PBQ score ≥ 12). This trial has 90% power to detect a MCID of 5 points on the CORE-OM. Primary and secondary outcomes will be measured at baseline, 3, 7 and 12 months after baseline. Service use and quality of life measures will also be collected alongside a process evaluation of parents’ and interveners’ views and experiences.

Discussion
This will be the first large pragmatic trial to test whether COS-P is effective for birthing parents with severe and complex perinatal mental health difficulties in improving their mental health symptoms. If shown to be effective, the intervention could be delivered widely across the NHS and other similar services globally.

Trial registration
ISRCTN, ISRCTN18308962. Registered 18 February 2022.
The need for a new keyword — “Trial registry-metaresearch” — to track certain uses of clinical trial registry records
Authors: Saberwal Gayatri 
Published: March 2023

AbstractPublic clinical trial registries contain a large amount of information about a large number of trials. Academic researchers have conducted various analyses using such data. However, some of these studies do not concern the medical condition or intervention that is the focus of each trial. We list examples of publications that have performed such analyses. Currently, there is no keyword to track relevant publications. Here, we propose a novel keyword, “Trial registry-metaresearch”, that could be used in such publications. This would be a great help to researchers who wish to more systematically search the literature for such metaresearch.
Umbilical catheter placement aided by coronary guidewires
Authors: Gendera Katarzyna , Georgiev Stanimir , Ewert Peter , Eckstein Stefan , Fusch Christoph , Rochow Niels 
Published: March 2023

AbstractCatheterization of the umbilical vessels has proven to be an effective and relatively rapid method for gaining central vascular access in neonates. However, it can be technically difficult, the procedure may last 30 min or longer, and it can be associated with complications in some patients. We suggest using a coronary guidewire during catheterization of umbilical vessels to support the placement of umbilical catheters and significantly reduce a risk for complications. We tested the proposed technique in 6 successful ex vivo bench tests of catheterization of the umbilical vessels in stillborn piglets immediately after birth. We are confident that using coronary guidewire as a guiding tool during catheterization of the umbilical vessels is a rapid and safe method. We expect that it allows to obtain a vascular access with lower risk for dangerous procedural complications, which could be a lifesaving in critically ill patients. However, the approach needs to be validated in a comparative study in neonates.
COVID19 detection in appendix of acute appendicitis in a child: a case report and review of literature
Authors: Kono Jun , Yoshimaru Koichiro , Matsuura Toshiharu , Tamaki Akihiko , Takemoto Junkichi , Matsumoto Shinya , Hotta Taeko , Kohashi Kenichi , Oda Yoshinao , Tajiri Tatsuro 
Published: March 2023

Abstract
Background
Gastrointestinal symptoms are one of the most common presentations of Coronavirus disease-19 (COVID-19), even in children. Higher rates of complicated appendicitis have been demonstrated in the era of the COVID-19 outbreak, and it has been recently suggested that acute appendicitis may occur as a complication of COVID-19. However, the relationship between appendicitis and COVID-19 remains unclear.

Case presentation
A 7-year-old male presented to the pediatric emergency department with 2 days’ history of lower abdominal discomfort and tenderness. On examination, his abdomen was distended with diffuse mild tenderness at the lower abdomen, which was aggravated by movement. He was also tested and was found to be positive for SARS-CoV-2. Computed tomography showed perforated appendicitis with a fecalith. The patient was admitted and laparoscopic appendectomy was successfully performed. Postoperatively, a minor intra-abdominal abscess was present, which successfully treated with antibiotics. Histopathology showed a markedly inflamed appendix with mucosal ulceration and transmural neutrophilic inflammation, which was consistent with phlegmonous appendicitis. Reverse transcription quantitative polymerase chain reaction using a surgically extracted appendix specimen revealed the presence of SARS-CoV-2 virus, which indicated a pathophysiological relationship between appendicitis and COVID-19.

Conclusion
The present case will provide further understanding of pediatric patients with concomitant COVID-19 and acute appendicitis.
Vitamin D status, including serum levels and sun exposure are associated or correlated with bone mass measurements diagnosis, and bone density of the spine
Authors: khodabakhshi Adeleh , Davoodi Sayed Hossein , Vahid Farhad 
Published: March 2023

Abstract
Background
Osteoporosis is a health complication worldwide, especially in developing countries. The prevalence was reported to be 18.3% globally. While the effect of biochemical factors on fracture risk/odds has been documented, the association/correlation between serum 25(OH)D levels, vitamin D dietary intake, and sun exposure with bone mineral density (BMD) remains controversial. This study aimed to evaluate the association and correlation between vitamin D status, including serum levels, dietary intakes, and sun exposure with BMD. We hypothesized that vitamin D-related factors would have different correlations/associations with BMD, which would help better evaluate future studies’ results.

Methods
A total of 186 individuals were included in this study (winter 2020). BMD was measured by Dual-energy X-ray absorptiometry. Blood serum levels of 25(OH)D, phosphorus, calcium, parathyroid hormone (PTH), and calcitonin were tested using standard lab tests. Valid and reliable questionnaires were used for sun exposure assessment and dietary intakes.

Results
There was a significant protective association between spine BMD (classifications, two groups) (OR = 0.69, 95%CI: 0.50–0.94; p-value = 0.023), BMD diagnosis (classifications, two groups) (OR = 0. 69, 95%CI: 0.49–0.87; p-value = 0.036) and sun exposure. There was a significant and moderate correlation between Spine measurements (Spine BMD: Pearson correlation coefficient = 0.302, p-value = 0.046; Spine T-score: Pearson correlation coefficient = 0.322, p-value = 0.033, Spine Z-score: Pearson correlation coefficient = 0.328, p-value = 0.030) and serum 25(OH)D. In addition, participants with osteopenia and osteoporosis significantly consume a higher amount of soluble fiber than the normal BMD group. There was no significant correlation between vitamin D intake and BMD.

Conclusion
In conclusion, serum 25(OH)D levels and sun exposure are correlated and associated with BMD. However, prospective studies are needed to investigate the association between dietary vitamin D intake and BMD.
Effects of ambiguity on innovation strategies
Authors: Kim Hwa-Sung 
Published: March 2023

AbstractTechnological innovations significantly influence individual firms and other innovations, such as financial innovations. The future of a firm depends on its innovation investment strategy. According to the literature, innovation investments are affected by ambiguity. This study examines how ambiguity affects the innovation strategies of managers. We show that the innovation strategies of ambiguity-averse managers differ from those of ambiguity-neutral managers. Unlike ambiguity-neutral managers, ambiguity-averse managers consider a broader variety of innovation strategies for a wider range of future innovation arrival times. Regarding the profitability of a future innovation, ambiguity-averse managers delay the investment decision until the profitability of the innovation is less ambiguous. Moreover, we examine innovation strategies under various conditions, including the risk of innovation outdatedness, management disputes, and the varying volatility of innovations.
Adrenocortical carcinoma: Report of data from 66 patients with a rare disease at a cancer center.
Authors: Abduch Rafael Haikal dos Santos , Tariki Milena Shizue , Formiga Maria Nirvana , Bezerra Stephania Martins , Torrezan Giovana Tardin , Rinck José Augusto 
Published: March 2023

1 Background: Adrenocortical carcinoma (ACC) is a rare (1,02 per million population) disease with unfavorable prognosis. In Brazil, the incidence is about 15 times higher than in the rest of the world, mainly due to significant prevalence of the TP53-R337H germline mutation in this population. Methods: We performed a retrospective analysis of 66 patients diagnosed with ACC at AC Camargo Cancer Center. Clinical, pathological, epidemiological, treatment and survival data were collected from the patient’s chart and described. Results: Between 2004 and 2021, 66 patients were diagnosed with ACC. The median age was 45 years and 56% were female. 23 (35%) patients had at least one first-degree relative with a history of cancer and 8 (12%) had a second primary tumor. Ten patients were tested for Li-Fraumeni Syndrome and 30% went positive (TP53- R337H germline mutation). Two of them had first-degree relative with cancer. In our cohort, 22 (33%) patients were stage IV, 14 (21%) stage III, 19 (29%) stage II, 6 (9%) stage I and 5 (7%) unknown stage. 36% of tumors were considered functional (cortisol and/or androgens). At 50 months the estimated OS was 25,9% in the metastatic group and 83% in the localized group (p<0.0001). Among localized patients, 13 (29%) received adjuvant mitotane and 31 (70%) were followed without mitotane. The 12-month DFS rate was 50,8% in the mitotane group versus 67,8% in the group without mitotane (p = 0.83). The Ki67 index was performed in 20 localized patients. The 12-month DFS rate was 58,2% in the high Ki67 index (>10%) group versus 75% in the low ki67 index (≤10%) group (p = 0.47). In metastatic scenario 31 (47%) underwent systemic treatment and the most common (71%) first line chemotherapy was EDP (etoposide-doxorubicin-cisplatin) plus mitotane with an objective response rate of 27% and 56% of them had progression of disease as the best response to treatment. 14 patients received second line and 7 received third line treatment. Gemcitabine-capecitabine,cisplatin-based and Pembrolizumab were the most common regimens used in advanced lines. Conclusions: ACC has a poor prognosis and a significant prevalence of personal and family history of cancer. EDP-mitotane was the preferred regimen used as the first line treatment. As a rare disease, worldwide data can add evidence for future improvements in adrenal cancer.