bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors associated with lifetime HIV testing among women in four Southeast Asian countries: Evidence from the demographic and health surveys
Authors: Khin Soe Ohnmar , Hone San , Lin Chunqing , Comulada W Scott , Detels Roger , Lee Sung-Jae 
Published: March 2023

Background Southeast Asian countries have been trying to increase HIV testing coverage of women since awareness of HIV status is essential to eliminate mother-to-child transmission of HIV. This study determined factors related to lifetime HIV testing uptake among women aged 15–49 years in four Southeast Asian countries: Myanmar, Cambodia, the Philippines and Timor-Leste. Methods This study used cross-sectional data from the 2015–16 Myanmar Demographic and Health Survey (DHS), the 2014 Cambodia DHS, the 2017 Philippines National DHS and the 2016 Timor-Leste DHS. We conducted multivariable logistic regression analyses to identify factors associated with lifetime HIV testing among women aged 15–49 years who completed the surveys in each country and ran a fixed effects logistic regression model using pooled data. Results The proportions of lifetime HIV testing uptake among women aged 15–49 years were 42.1% in Cambodia, 19.5% in Myanmar, 4.6% in the Philippines, and 3.7% in Timor-Leste. Marital status, age, education, and wealth were significantly associated with lifetime HIV testing uptake among women in all four countries. Other factors (e.g., comprehensive knowledge of HIV, rural/urban residence, positive attitudes towards negotiation for safer sex) were also significant determinants of HIV testing uptake among women in some of these countries. Conclusions A multi-sectoral collaboration of related sectors and organizations is necessary to increase access to HIV testing and HIV knowledge of women to overcome the barriers to HIV testing. It is critical to make HIV testing services available and accessible to women, especially in rural areas.
Evaluation of Virtual Reality High-Fidelity Adult Mannequin-based Simulation of Real-Life Clinical Scenarios in Teaching Clinical Pharmacology to Medical Students
Authors: Gudadappanavar Anupama M. , Hombal Prashant , Benni Jyoti M. , Patel Sachin , Tubaki Basavaraj R. 
Published: March 2023

Background Presently, competency-based medical (CBME) curriculum challenges the medical educators to provide continuing education with new approaches to make learning more stimulating, motivating, and entertaining, fostering excellence in clinical practice. To address these issues, educators have advocated the use of virtual reality and mannequins to teach clinical pharmacology. Objectives To study the effect, perception, and feedback of virtual reality high-fidelity adult mannequin-based (VHFM) simulation of real-life clinical scenarios over conventional tutorials in teaching clinical pharmacology to medical students. Material and Methods An interventional study was designed for 2nd year MBBS students for a period of 6 months. The enrolled students were randomly assigned to the test group (VHFM) or control group (tutorials). The CAE Healthcare Ltd. maestro, high-fidelity prehospital mannequin (APOLLO) was used in the test group. Three sessions consisting of six different cases were discussed, and multiple-choice questions (MCQs)-based pre-test, post–test, and retest after a month were conducted in both groups and compared. The perception and feedback of faculty and students were obtained by using a modified and revalidated questionnaire. Results The test group outperformed the control group ( p <.001) in all sessions based on pre-test, post-test, and retest scores, and within-group comparisons revealed significant improvements in both groups. Students’ perceptions and feedback regarding VHFM were more enthusiastic and promising than in the tutorial group. Conclusions VHFM is student-centered, provides an active learning environment, and aids in skill development. We strongly suggest VHFM-based learning as a complement to traditional teaching strategies in pharmacology, especially for teaching clinical reasoning to medical students.
Classification of the Os Calcis Subtalar Morphology in Symptomatic Flexible Pediatric Pes Planus Deformity Using Weightbearing CT and Distance Mapping
Authors: Efrima Ben , Barbero Agustin , Ovadia Joshua E. , Indino Cristian , Maccario Camilla , Usuelli Federico Giuseppe 
Published: March 2023

Background: The etiology of symptomatic pediatric pes planus (PP) deformity is unclear. Reduced os calcis subtalar joint (OCST) anterior facet morphology has been suggested to result in less support to the talar head and a higher propensity to develop PP deformity. Weightbearing computed tomography (WBCT) and distance mapping (DM) offer new opportunities to investigate PP deformity in general and the OCST specifically. The purpose of this study is to investigate the OCST morphology using DM and to classify PP subtalar subtypes with DM using Bruckner’s A-D classification system. Methods Forty feet in 25 patients in a national referral center were evaluated for symptomatic PP deformity that failed nonoperative treatment. A WBCT scan was performed as part of the preoperative evaluation. Visualization of the distance distribution between the articulating surfaces of the subtalar joint was based on a DM technique. Intra- and interobserver agreement of the subtalar morphology was assessed using Bruckner’s classification system. Results: The mean age was 10.7 ± 1.4 years. The following mean ± SD and median ± ranges were semiautomatically measured for this group: Meary angle −21 ± 8, calcaneal inclination 15 ± 4 degrees, talar coverage angle 39 (range 32.6-49) degrees, and hindfoot moment-arm 16 ± 5 mm. Classifying subtalar morphology using DM yielded an excellent intra- and interobserver agreement. The individual percentages of each individual subtype were calculated: type A 5%, type B 48%, type C 4%, and type D in 44%. Conclusion: This study demonstrated excellent intraobserver and interobserver agreement in classifying the OCST using DM. A higher prevalence of types B and D was observed compared to types A and C in this PP cohort. Level of Evidence: Level III, retrospective study.
Information Architects: Using Community-Engaged and Qualitative Methods to Design a Technology-Based Nutrition and Cancer Risk Intervention for Rural Adults
Authors: Vilaro Melissa J. , McAlindon Kathryn , Mertens Gillian , Ashley Taylor , Zalake Mohan , Cooks Eric J. , Krieger Janice L. 
Published: March 2023

Background Nearly half of all cancer deaths are preventable through modification or avoidance of key risk factors. As such, there is a growing urgency to identify effective, low-resource, and scalable technologies that support clinical care and patient self-management of health behaviors. Purpose Informed by theories of cognitive load and user-centered design approaches, we develop a culturally tailored, multicomponent digital intervention to engage rural adults between 50-73 years old with their personalized nutrition risk factors for colorectal cancer (CRC) prevention. Method A total of 48 adults tested a Virtual Health Assistant (VHA) prototype during focus groups in individual think-aloud interviews to facilitate iterative adaptations to a web-based CRC prevention intervention. Qualitative data was analyzed to identify user needs and preferences related to information and with a focus on avoiding cognitive overload. Results The VHA serves as a conceptual pre-training for users helping them understand CRC prevention key concepts and engendering motivation to act on the promoted behavior. A website was identified as a strategy to fill information gaps and present actionable information, after the VHA interaction. Cognitive load reducing strategies were used including segmenting where information is presented in learner-controlled segments rather than continuously. Conclusions Findings indicate potential benefits of designing CRC prevention information technologies with the rural older adults. Integrating patient-centered needs before launching health information web content will be important as the rapid growth of telemedicine aims to reach traditionally marginalized and underserved populations. Theoretically informed considerations for potential adverse outcomes (eg, information overload) are discussed.
CT measurements of tracheal diameter and length in normocephalic cats
Authors: Zimmermann Jeannette , Brunner Anna , Underberg Julius , Vincenti Simona 
Published: March 2023

Objectives The aim of this study was to measure the tracheal dimensions of normocephalic cats using CT. Methods CT images of 15 client-owned normocephalic cats were retrospectively evaluated to measure the length of the feline trachea. Transverse and vertical inner diameters were measured in five different tracheal regions, and the cross-sectional area of the tracheal lumen was calculated for each point of measurement. Descriptive statistics were applied using a two-tailed t-test. Results The mean ± SD length of the trachea was 125.13 ± 14.41 mm. Male cats had significantly larger tracheas than female cats. The transverse diameter first increased by 0.94 mm between the most cranial point of measurement and the middle of the trachea. It then decreased by 1.38 mm between the middle of the trachea and the most caudal point of measurement. The vertical diameter decreased by 1.16 mm between the first point of measurement and the penultimate point, and then increased by 0.06 mm between the penultimate point of measurement and the end of the trachea. The two different diameters resulted in an elliptical trachea shape. Conclusions and relevance The feline trachea was circular only at its cranial and caudal ends, and elliptical with a dorsoventral flattening along the rest of its length. Vertical and transverse diameters varied along the entire length. Tracheal shape differences should be considered when performing permanent tracheostomy, tracheal anastomosis or stenting in cats.
A rare case of aortic arch variation complicated with multiple ruptured intracranial aneurysms
Authors: Liu Wei , Li Jialu , Zhou Baoyuan 
Published: March 2023

Objectives Previous reports on aortic arch variations have emphasized on its cardiovascular significance. We present a case of a rare variation of aortic arch complicated with multiple ruptured intracranial aneurysms. Methods This case report reviews the effects of the diameter of internal carotid artery of isolated origins on cerebral vessels. Results The brachiocephalic trunk, left external carotid artery, left internal carotid artery, left vertebral artery, and the left subclavian artery originating from the aortic arch complicated with multiple ruptured intracranial aneurysms have not been reported. Conclusions Variation of the aortic arch may affect carotid and cerebral vessel structures as well as blood flow and is a potential risk factor for stroke. Third aortic arch degeneration, or dorsal aorta non-degeneration, is a potential embryologic mechanism for the absence of the left common carotid artery.
KEYNOTE—522 and male spindle cell carcinoma of the breast: A case report
Authors: Niver Harper E , Foxhall Edward , Lahiry Anup 
Published: March 2023

Metaplastic Breast Cancer (MBC) is a rare group of tumors often presenting as triple-negative. MBC accounts for less than 1% of all breast cancers with the spindle cell variant comprising less than 0.5%. While rare, spindle cell carcinoma is the commonest subtype in the western world. It has a more aggressive biological behavior with increased risk of recurrence and death due to disease compared to triple negative breast cancers. There is no treatment guideline for management of MBC due to the rarity of the disease. Instead, treatment is theorized based off success with other types of aggressive breast and metaplastic cancers of different tissue. We present the first known case report of male spindle cell carcinoma of the breast treated with KEYNOTE-522 regimen. Therapy included a first phase with pembrolizumab (dose of 200 mg) every 3 weeks plus paclitaxel and carboplatin and second phase, with four cycles of pembrolizumab with doxorubicin-cyclophosphamide.
C1-inhibitor treatment in patients with severe complement-mediated autoimmune hemolytic anemia
Authors: de Boer Esther C. W. , Jalink Marit , Delvasto-Nuñez Laura , Meulenbroek Elisabeth M. , Baas Inge , Janssen Susanne R. , Folman Claudia C. , Gelderman Kyra A. , Wouters Diana , Engel Marije D. , de Haas Masja , Kersten Marie José , Jongerius Ilse , Zeerleder Sacha , Vos Josephine M. I. 
Published: March 2023

Abstract
Complement-mediated (CM) autoimmune hemolytic anemia (AIHA) is characterized by the destruction of red blood cells (RBCs) by autoantibodies that activate the classical complement pathway. These antibodies also reduce transfusion efficacy via the lysis of donor RBCs. Because C1-inhibitor (C1-INH) is an endogenous regulator of the classical complement pathway, we hypothesized that peritransfusional C1-INH in patients with severe CM-AIHA reduces complement activation and hemolysis, and thus enhances RBC transfusion efficacy. We conducted a prospective, single-center, phase 2, open-label trial (EudraCT2012-003710-13). Patients with confirmed CM-AIHA and indication for the transfusion of 2 RBC units were eligible for inclusion. Four IV C1-INH doses (6000, 3000, 2000, and 1000 U) were administered with 12-hour intervals around RBC transfusion. Serial blood samples were analyzed for hemolytic activity, RBC opsonization, complement activation, and inflammation markers. Ten patients were included in the study. C1-INH administration increased plasma C1-INH antigen and activity, peaking at 48 hours after the first dose and accompanied by a significant reduction of RBC C3d deposition. Hemoglobin levels increased briefly after transfusion but returned to baseline within 48 hours. Overall, markers of hemolysis, inflammation, and complement activation remained unchanged. Five grade 3 and 1 grade 4 adverse event occurred but were considered unrelated to the study medication. In conclusion, peritransfusional C1-INH temporarily reduced complement activation. However, C1-INH failed to halt hemolytic activity in severe transfusion-dependent–CM-AIHA. We cannot exclude that posttransfusional hemolytic activity would have been even higher without C1-INH. The potential of complement inhibition on transfusion efficacy in severe CM-AIHA remains to be determined.
Changes in the gender pay gap over time: the case of West Germany
Authors: Bonaccolto-Töpfer Marina , Castagnetti Carolina , Rosti Luisa 
Published: March 2023

AbstractUsing data from the German Socio-Economic Panel, this paper analyzes changes in the gender pay gap in West Germany between 1984 and 2020. The literature generally observes a catching-up of women over time with a slowdown since the mid-1990s and often concentrates on the USA. We present both an aggregate and detailed decomposition of changes in wages allowing us to directly test for changes in the components of the decomposition across gender and time. Apart from standard OLS, we use linear unconditional quantile regressions in order to be able to take changes in the gap and its components at the mean and across the distribution into account. We find that the gender pay gap statistically significantly declined at the bottom and the middle, while it increased at the top of the wage distribution. These results suggest that glass ceiling is a major challenge to the West German labour market.
Evaluation of real-time monitored ozone concentration from Abuja, Nigeria
Authors: Ihedike Christabel , Mooney John D. , Fulton John , Ling Jonathan 
Published: March 2023

AbstractReal-time ozone (O3) concentration is vital for accurate analysis of O3 to inform the public about O3 concentrations that may have an adverse effect on health. Few studies have analysed air pollution in Abuja, Nigeria and non on real-time ozone concentrations. As a result, there is a scarcity of data and information on real-time ozone pollution, pointing to a gap that needs to be urgently closed to enable a better understanding of ozone pollution and the causes and consequences in terms of the associated health risks.In this study, -time concentrations of ground-level ozone were measured in a busy urban pollution monitoring station. Using a real-time ozone monitor to enable real-time monitoring of O3 concentration of ozone for the first time in Abuja. The ozone concentrations followed a clear pattern with high concentrations being recorded during the dry (harmattan) season. Concentrations higher than the WHO standard of (eight-hour averaged) 100 µg/m3, occurred on 53 days over the 5-month dry season. Of those 53 days, 18 had ozone concentrations greater than 200 µg/m3. Daily patterns showed a rise throughout the day, reaching a peak in the evening. Weekday/weekend differences were less pronounced than those found in other studies. High temperatures and local climatic conditions in Abuja encourage the formation of ozone. In this study, we confirm the concentration of ozone, and the pattern can be episodic and potentially damaging to health. There is a need for better regulation and measures to reduce ozone, particularly when local climatic conditions, such as harmattan, favour the development of photochemical smog in such settings.
Spatiotemporal distribution and bivariate binary analysis of antenatal and delivery care utilizations in Ethiopia: EDHS 2000–2016
Authors: Awoke Shegaw Mamaru , Tesfaw Lijalem Melie , Derebe Muluwerk Ayele , Fenta Haile Mekonnen 
Published: March 2023

Abstract
Background
Antenatal care (ANC) is a maternal health care service given by skilled health professionals to pregnant women. Women may give birth at home or in health institutions. Home delivery care (DC) increases the likelihood of mortality of the mother and the newborn. Globally, each year nearly 303,000 maternal deaths occurred from complications of pregnancy and childbirth. Ethiopia alone accounted for 13,000 deaths, which disproportionately affects women living in different places of the country. Thus, this study aimed to assess the spatiotemporal patterns and associated factors of antenatal and delivery care utilization in Ethiopia.

Method
This study used the 2000 to 2016 EDHS (Ethiopian and Demographic Health Survey) data as a source. A total weighted sample of 30,762 women (7966 in 2000, 7297 in 2005, 7908 in 2011, and 7591 in 2016) was used. The separate and bivariate logistic regression analyses with and without the spatial effect were modeled using SAS version 9.4 and ArcGIS version 10.8.

Results
The spatial distribution of ANC and DC was non-random in Ethiopia. The overall odds ratio of ANC and DC was 2.09. In 2016, 31.8% and 33.2% of women had ANC and DC respectively. The estimated odds of following ANC among mothers from middle and rich households were 1.346 and 1.679 times the estimated odds of following ANC among mothers from poor households respectively. Women who had attained higher education were 1.56 and 2.03 times more likely to have ANC and DC respectively compared to women who had no formal education.

Conclusions
Despite the government's report that women now have better access to maternal health care, a sizable proportion of women continue to give birth at home without going to the advised antenatal care appointment. Women and husbands with low education, having non-working partners, religion, regions of dwelling, residing in rural, lower birth order, low birth interval, unable to access mass media, low wealth status, and earlier EDHS survey years were significant predictors that hinder antenatal and delivery care utilization simultaneously in Ethiopia. Whereas the spatial variable significantly affects antenatal care and being unable to access mobile phones lead to low utilization of delivery care. We recommend that policymakers, planners, and researchers consider these variables and the spatiotemporal distribution of ANC and DC to reduce maternal mortality in Ethiopia. Besides, it is recommended that further studies use the latest EDHS survey data.
Behavioral and social determinants of early childhood caries among Palestinian preschoolers in Jerusalem area: a cross-sectional study
Authors: Kateeb Elham , Lim Sungwoo , Amer Saif , Ismail Amid 
Published: March 2023

Abstract
Background
This study came to determine the prevalence of Early Childhood Carries (ECC) among preschoolers in a marginalized population and describe the influence of behavioral and social determinants on the development of ECC.

Methods
This is a cross-sectional study that was carried out in four random preschools in the Jerusalem Governorate of the Occupied Palestinian Territories. All children aged 3–5 years old in the selected schools were screened for ECC using the decayed, missing, and filled teeth index (dmft). Data on children’s socio-economic, feeding habits, hygiene habits, access to care, parental level of stress, social support, and locus of control were collected by a validated questionnaire sent to the children’s main caregivers. Descriptive statistics were generated and bivariable and multivariable analyses were used to explain the influence of different behavioral and social determinants on ECC levels.

Results
Four hundred and fifty-seven preschoolers completed the questionnaire and the clinical screening. Ninety-seven percent (n = 447) had experienced dental decay, with an average dmft score of 6.6 ± 4.3. After accounting for potential confounding, parents’ internal locus of control was associated with lower dental caries among children (IRR = 0.97, 95% CI = 0.97, 0.98). Having routine, preventive visits versus never seeing a dentist were associated with lower dmft scores (IRR = 0.42, 95% CI = 0.33, 0.52). Night feeding habits (putting things other than water in the baby bottle at night, having children sleep while being breastfed at night) were positively associated with children’s dental caries (IRR = 1.06, 95% CI = 1.04, 1.09: IRR = 1.15, 95% CI = 1.03, 1.29, respectively). Not adding sugar to the bottle was negatively associated with children’s dental caries (IRR = 0.86, 95% CI = 0.74, 1.00).

Conclusions
Preschoolers in this study suffered from high dental caries experience. Although infant feeding habits were key factors in explaining the elevated level of the disease, system and socio-psychological factors were also detrimental to ECC prevalence. Policies and interventions to alleviate the burden of ECC need to address socioeconomic determinants of health in addition to feeding and hygiene practices.
Deep vein thrombosis in a patient with Cronkhite-Canada syndrome: a complex case report
Authors: Feng Xiao-Kai , Chen Xiao-Fen , Wang Bei-Bei , Zeng Zhi-Gang , Liu Chao , Sha Wei-Hong , Ma Juan 
Published: March 2023

Abstract
Background
Cronkhite-Canada syndrome (CCS) is a rare disease characterized by generalized gastrointestinal polyps, ectodermal abnormalities and variable gastrointestinal symptoms. Few cases to date have described complications with deep vein thrombosis (DVT). Here we reported a rare case of CCS concomitant with DVT. The patient’s clinical details, endoscopic findings, safety, and efficacy are reported.

Case presentation
A 58-year-old patient was admitted to our hospital with recurrent diarrhea, overall abnormal appearance, including hyperpigmentation, hair loss and onychodystrophy, and multiple polyps distributed along the gastrointestinal tract except the esophagus. After considerable assessment, the patient was diagnosed with CCS. She was also diagnosed with concurrent DVT, nephrotic syndrome, and infectious enteritis during the course of disease. After treatment with a combination of methylprednisolone, mesalazine, antibiotics, rivaroxaban, and nutritional support during the 24 months of following the patient in this case, the clinical manifestations and endoscopic findings reached complete remission two years after the diagnosis.

Conclusion
To our knowledge, this study is the first case of CCS complicated with DVT reported in China. Although rare, it is important to consider that DVT may occur after CCS and that it is vital to conduct careful follow-up.