bluuebunny/crossref_metadata_2025_split huggingface dataset:
Putting the auto in ethnography: The embodied process of reflexivity on positionality
Authors: Morrow Felicity , Kettle Martin 
Published: August 2023

This article describes an unexpected methodological shift made in response to the COVID-19 pandemic during doctoral research, and exemplifies reflexivity in action whilst negotiating my complex positionality as both a researcher and a social worker. The first UK national lockdown was announced after I had conducted 3 months of ethnographic data collection in a local authority adult social work team, thus halting my research. As society shut down, face-to-face research was paused overnight, however, the local authority continued to provide essential services and support. Forging a path forward, I successfully gained a job practising as a social worker within the team and completed a supplementary ethics application to include auto-ethnographic data which would complement the existing ethnography. Although practicing reflexivity and analysing positionality are established and encouraged parts of ethnographic research, how a researcher actively conducts them varies and usually remains unseen. Methodologies are often presented in a sanitised and polished manner, depriving the reader of the messy yet informative reality of research. This article draws upon fieldnotes to practically illustrate and bring this reflexivity on positionality to the fore. As I move from participant-observer to complete-participant, the findings zoom in on my experience of navigating positionality, revealing a micro picture of the details and subtleties of this process. This unexpected research journey enhanced my level of intimacy with the phenomenon, the research site, and the participants. Overall, this example of enacting reflexivity helps to bridge the gap between how positionality is theorised and how it actively practiced. Finally, this article is a call for more open, deeper, and continual reflexivity on our positionality as researchers.
A novel pre-bending tool for elastic stable intramedullary nailing: An efficient and accurate study
Authors: Shu Wen , Yu LongJun , Slongo Theddy , Rai Saroj , Zhong Haobo , Tang Xin 
Published: August 2023

Purpose: The elastic stable intramedullary nail has been recognized as an accepted technique for treating pediatric long bone fractures. The principle of the technique is “3-point support and fixation,” and it should be followed to achieve the optimum outcome without implant failure and complications. However, tools have yet to be reported for pre-bending of the elastic stable intramedullary nail. This study aims to present a novel tool for pre-bending the elastic stable intramedullary nails and the results of using this tool by surgeons. Methods: A designed case of femoral shaft fracture was provided to the participants. All participants were divided into three groups according to their experience with the elastic stable intramedullary nail technique: resident, fellow, and attending groups. The time of completing the pre-bending and coronal plane deviation of the nails after pre-bending was recorded. Statistical analysis compared the data in a conventional way and with the new tools in each group. Results: A total of 30 physicians were recruited in this study. The pre-bending duration with the new tool was significantly shorter than that of the conventional method for all physicians ( p < 0.001). The coronal plane deviation of nails after pre-bending by the new tool was significantly smaller than that of the conventional method for all physicians ( p < 0.001). Conclusion: This novel tool for elastic stable intramedullary nail pre-bending was convenient and easy to use in achieving the principal role of the elastic stable intramedullary nail technique. Physicians could reduce the coronal plane deviation when pre-bending elastic stable intramedullary nails, especially for physicians with less experience with the elastic stable intramedullary nail technique. Level of evidence: IV.
Exploring Loneliness in Emerging Adulthood: A Qualitative Study
Authors: Kirwan Emma M. , O’Súilleabháin Páraic S. , Burns Annette , Ogoro Mamobo , Allen Eoghan , Creaven Ann-Marie 
Published: August 2023

Loneliness, the distressing feeling that accompanies the perception of a person’s social relationships as inadequate, is common in emerging adulthood. This qualitative study explored the experiences and views of loneliness, and the causes of loneliness from the perspective of emerging adults. A youth Research Advisory Group was consulted during the design of the study. Semi-structured interviews were conducted with 27 emerging adults (18–25 years old, M = 20.81, SD = 1.78). Using framework analysis, two key themes were identified; loneliness and development “ a part of growing up”, and expectations about a typical emerging adult’s life “ that’s how my life should be”. Results suggested that social transitions and expectations for an emerging adults’ life contributed to feelings of loneliness. Our findings suggest that future efforts to understand and prevent loneliness in emerging adulthood should consider that loneliness may be transient in nature and a more complex experience during this life-stage.
The 5-Factor Modified Frailty Index is Associated With Increased Risk of Reoperations and Adjacent Level Disease Following Single-Level Transforaminal Lumbar Interbody Fusion
Authors: Patel Neil , Coban Daniel , Changoor Stuart , Sinha Kumar , Hwang Ki Soo , Emami Arash 
Published: August 2023

Study Design Retrospective Cohort Study. Objectives To determine the predictive capability between the 5-factor modified frailty index (mFI-5) scores and adverse clinical and radiographic outcomes following single-level transforaminal lumbar interbody fusion (TLIF). Methods All patients over the age of 50 undergoing single-level open or minimally invasive TLIF from 2012 to 2021 with a minimum follow-up of 1 year were identified. Deformity, trauma, emergency, and tumor cases were excluded as were patients undergoing revision surgeries. An mFI-5 score was computed for each patient using a set of five factors which included hypertension requiring medication, chronic obstructive pulmonary disease, diabetes mellitus, congestive heart failure, and partially or fully dependent functional status. Univariate and multivariate logistic regression analysis were performed to evaluate the impact of mFI-5 scores on readmissions, reoperations, and postoperative complications. Results 156 patients were included and grouped according to their level of frailty: no-frailty (mFI = 0, n = 67), mild frailty (mFI = 1, n = 59), and severe frailty (mFI = 2+, n = 30). Multivariate analysis found high levels of frailty (mFI = 2+) to be independent predictors of reoperation (OR: 16.9, CI: 2.7 - 106.9, P = .003) and related readmissions (OR = 16.5, CI: 2.6 - 102.7, P = .003) as compared to the no-frailty group. An mFI-5 score of 2+ was also predictive of any complication (OR = 4.5, CI: 1.4 - 14.3, P = .01) and adjacent segment disease (ASD) (OR = 12.5, CI: 1.2 - 134.0, P = .037). Conclusion High levels of frailty were predictive of related readmissions, reoperations, any complications, and ASD in older adult patients undergoing single-level TLIF.
Sample size requirements are not being considered in studies developing prediction models for binary outcomes: a systematic review
Authors: Dhiman Paula , Ma Jie , Qi Cathy , Bullock Garrett , Sergeant Jamie C , Riley Richard D , Collins Gary S 
Published: August 2023

Abstract
Background
Having an appropriate sample size is important when developing a clinical prediction model. We aimed to review how sample size is considered in studies developing a prediction model for a binary outcome.

Methods
We searched PubMed for studies published between 01/07/2020 and 30/07/2020 and reviewed the sample size calculations used to develop the prediction models. Using the available information, we calculated the minimum sample size that would be needed to estimate overall risk and minimise overfitting in each study and summarised the difference between the calculated and used sample size.

Results
A total of 119 studies were included, of which nine studies provided sample size justification (8%). The recommended minimum sample size could be calculated for 94 studies: 73% (95% CI: 63–82%) used sample sizes lower than required to estimate overall risk and minimise overfitting including 26% studies that used sample sizes lower than required to estimate overall risk only. A similar number of studies did not meet the ≥ 10EPV criteria (75%, 95% CI: 66–84%). The median deficit of the number of events used to develop a model was 75 [IQR: 234 lower to 7 higher]) which reduced to 63 if the total available data (before any data splitting) was used [IQR:225 lower to 7 higher]. Studies that met the minimum required sample size had a median c-statistic of 0.84 (IQR:0.80 to 0.9) and studies where the minimum sample size was not met had a median c-statistic of 0.83 (IQR: 0.75 to 0.9). Studies that met the ≥ 10 EPP criteria had a median c-statistic of 0.80 (IQR: 0.73 to 0.84).

Conclusions
Prediction models are often developed with no sample size calculation, as a consequence many are too small to precisely estimate the overall risk. We encourage researchers to justify, perform and report sample size calculations when developing a prediction model.
The current status of stimuli-responsive nanotechnologies on orthopedic titanium implant surfaces
Authors: Han Jingyuan , Ma Qianli , An Yanxin , Wu Fan , Zhao Yuqing , Wu Gaoyi , Wang Jing 
Published: August 2023

AbstractWith the continuous innovation and breakthrough of nanomedical technology, stimuli-responsive nanotechnology has been gradually applied to the surface modification of titanium implants to achieve brilliant antibacterial activity and promoted osteogenesis. Regarding to the different physiological and pathological microenvironment around implants before and after surgery, these surface nanomodifications are designed to respond to different stimuli and environmental changes in a timely, efficient, and specific way/manner. Here, we focus on the materials related to stimuli-responsive nanotechnology on titanium implant surface modification, including metals and their compounds, polymer materials and other materials. In addition, the mechanism of different response types is introduced according to different activation stimuli, including magnetic, electrical, photic, radio frequency and ultrasonic stimuli, pH and enzymatic stimuli (the internal stimuli). Meanwhile, the associated functions, potential applications and developing prospect were discussion.
Photosensitizing deep-seated cancer cells with photoprotein-conjugated upconversion nanoparticles
Authors: Park Sung Hyun , Han Soohyun , Park Sangwoo , Kim Hyung Shik , Kim Kyung-Min , Kim Suyeon , Lee Dong Yun , Lee Joonseok , Kim Young-Pil 
Published: August 2023

AbstractTo resolve the problem of target specificity and light transmission to deep-seated tissues in photodynamic therapy (PDT), we report a cancer cell-targeted photosensitizer using photoprotein-conjugated upconversion nanoparticles (UCNPs) with high target specificity and efficient light transmission to deep tissues. Core-shell UCNPs with low internal energy back transfer were conjugated with recombinant proteins that consists of a photosensitizer (KillerRed; KR) and a cancer cell-targeted lead peptide (LP). Under near infrared (NIR)-irradiating condition, the UCNP-KR-LP generated superoxide anion radicals as reactive oxygen species via NIR-to-green light conversion and exhibited excellent specificity to target cancer cells through receptor-mediated cell adhesion. Consequently, this photosensitizing process facilitated rapid cell death in cancer cell lines (MCF-7, MDA-MB-231, and U-87MG) overexpressing integrin beta 1 (ITGB1) receptors but not in a cell line (SK-BR-3) with reduced ITGB1 expression and a non-invasive normal breast cell line (MCF-10A). In contrast to green light irradiation, NIR light irradiation exhibited significant PDT efficacy in cancer cells located beneath porcine skin tissues up to a depth of 10 mm, as well as in vivo tumor xenograft mouse models. This finding suggests that the designed nanocomposite is useful for sensing and targeting various deep-seated tumors.
Rivaroxaban treatment for asymptomatic venous thromboembolism: insights from the J’xactly study
Authors: Migita Shohei , Okumura Yasuo , Fukuda Ikuo , Nakamura Mashio , Yamada Norikazu , Takayama Morimasa , Maeda Hideaki , Yamashita Takeshi , Ikeda Takanori , Mo Makoto , Yamazaki Tsutomu , Hirayama Atsushi ,   on behalf of the J’xactly Investigators
Published: August 2023

Abstract
Background
An established treatment strategy for asymptomatic pulmonary embolism (PE) or deep vein thrombosis (DVT) remains uncertain in Japan; therefore, in this study, we clarify the characteristics and outcomes of symptomatic compared to asymptomatic patients with PE or DVT.

Methods
This prospective, multicenter sub-analysis of the J’xactly study in Japan included 1,016 patients (mean age, 68; 41% male) with venous thromboembolism (VTE) treated with rivaroxaban.

Results
Asymptomatic PE patients (47% of PE patients) were more likely to have active cancer and asymptomatic proximal DVT at lower severity than symptomatic PE patients, despite no differences in age, sex, or the proportion receiving intensive 30 mg/day-rivaroxaban. Patients with asymptomatic DVT (34% of DVT patients) were older, had higher rates of female sex, active cancer, and distal DVT, and received shorter, less intense rivaroxaban treatment. Incidences did not differ between asymptomatic and symptomatic PE patients for recurrent symptomatic VTE (hazard ratio [HR], 0.60; 95% confidence interval [CI], 0.22–1.62; P = 0.31) or major bleeding (HR, 0.68; 95% CI, 0.20–2.33; P = 0.58), nor between asymptomatic and symptomatic DVT patients for recurrent symptomatic VTE (HR, 0.56; 95% CI, 0.23–1.40; P = 0.21) and major bleeding (HR, 1.47; 95% CI, 0.54–3.97; P = 0.45).

Conclusions
The real-world composite adverse event rate for treatment with rivaroxaban, as physician-adjusted for dose and duration, was similar for asymptomatic and symptomatic patients regardless of the presence of PE or DVT, suggesting a favorable safety profile for potential rivaroxaban treatment for asymptomatic VTE.
Uplifts and hassles are related to worsening in chronic fatigue syndrome: a prospective study
Authors: Friedberg Fred , Adamowicz Jenna L. , Bruckenthal Patricia , Milazzo Maria , Ramjan Sameera , Zhang Xiaoyue , Yang Jie 
Published: August 2023

Abstract
Background
Limited published data suggests that absence of uplifts (minor pleasant events) is associated with clinical worsening in patients with chronic fatigue syndrome (CFS). The current study aimed to assess the relation of illness worsening to the trajectories of social and non-social uplifts and hassles in a six-month prospective study in CFS.

Methods
Participants were primarily in their 40s, female, white, and ill for over a decade. All participants (N = 128) met criteria for CFS. The interview-based global impression of change rating was used to classify individual outcomes as improved, unchanged, or worsened at six- month follow-up. Uplifts and hassles, both social and non-social, were assessed with the Combined Hassles and Uplifts Scale (CHUS). The CHUS was administered weekly in online diaries over six months. Linear mixed effect models were utilized to examine linear trends for hassles and uplifts.

Results
No significant differences were found between the three global outcome groups for age, sex, or illness duration; however, work status was significantly lower for the non-improved groups (p < 0.001). Non-social hassles intensity showed an increasing slope for the worsened group (p = 0.03) and a decreasing slope (p = 0.05) for the improved group. For the worsened group, a downward trend was found for frequency of non-social (p = 0.01) uplifts.

Conclusion
Individuals with worsening as compared to improving illness in CFS show significantly different six-month trajectories for weekly hassles and a deficit in uplifts. This may have clinical implications for behavioral intervention.
Trial registration ClinicalTrials.gov ID: NCT02948556.
Pancancer network analysis reveals key master regulators for cancer invasiveness
Authors: Jethalia Mahesh , Jani Siddhi P. , Ceccarelli Michele , Mall Raghvendra 
Published: August 2023

AbstractBackgroundTumor invasiveness reflects numerous biological changes, including tumorigenesis, progression, and metastasis. To decipher the role of transcriptional regulators (TR) involved in tumor invasiveness, we performed a systematic network-based pan-cancer assessment of master regulators of cancer invasiveness.Materials and methodsWe stratified patients in The Cancer Genome Atlas (TCGA) into invasiveness high (INV-H) and low (INV-L) groups using consensus clustering based on an established robust 24-gene signature to determine the prognostic association of invasiveness with overall survival (OS) across 32 different cancers. We devise a network-based protocol to identify TRs as master regulators (MRs) unique to INV-H and INV-L phenotypes. We validated the activity of MRs coherently associated with INV-H phenotype and worse OS across cancers in TCGA on a series of additional datasets in the Prediction of Clinical Outcomes from the Genomic Profiles (PRECOG) repository.ResultsBased on the 24-gene signature, we defined the invasiveness score for each patient sample and stratified patients into INV-H and INV-L clusters. We observed that invasiveness was associated with worse survival outcomes in almost all cancers and had a significant association with OS in ten out of 32 cancers. Our network-based framework identified common invasiveness-associated MRs specific to INV-H and INV-L groups across the ten prognostic cancers, including COL1A1, which is also part of the 24-gene signature, thus acting as a positive control. Downstream pathway analysis of MRs specific to INV-H phenotype resulted in the identification of several enriched pathways, including Epithelial into Mesenchymal Transition, TGF-β signaling pathway, regulation of Toll-like receptors, cytokines, and inflammatory response, and selective expression of chemokine receptors during T-cell polarization. Most of these pathways have connotations of inflammatory immune response and feasibility for metastasis.ConclusionOur pan-cancer study provides a comprehensive master regulator analysis of tumor invasiveness and can suggest more precise therapeutic strategies by targeting the identified MRs and downstream enriched pathways for patients across multiple cancers.Graphical Abstract
The connexin hemichannel inhibitor D4 produces rapid antidepressant-like effects in mice
Authors: Li Huanhuan , Guo Anni , Salgado Magdiel , Sáez Juan C. , Lau Chunyue Geoffrey 
Published: August 2023

AbstractDepression is a common mood disorder characterized by a range of clinical symptoms, including prolonged low mood and diminished interest. Although many clinical and animal studies have provided significant insights into the pathophysiology of depression, current treatment strategies are not sufficient to manage this disorder. It has been suggested that connexin (Cx)-based hemichannels are candidates for depression intervention by modifying the state of neuroinflammation. In this study, we investigated the antidepressant-like effect of a recently discovered selective Cx hemichannel inhibitor, a small organic molecule called D4. We first showed that D4 reduced hemichannel activity following systemic inflammation after LPS injections. Next, we found that D4 treatment prevented LPS-induced inflammatory response and depressive-like behaviors. These behavioral effects were accompanied by reduced astrocytic activation and hemichannel activity in depressive-like mice induced by repeated low-dose LPS challenges. D4 treatment also reverses depressive-like symptoms in mice subjected to chronic restraint stress (CRS). To test whether D4 broadly affected neural activity, we measured c-Fos expression in depression-related brain regions and found a reduction in c-Fos+ cells in different brain regions. D4 significantly normalized CRS-induced hypoactivation in several brain regions, including the hippocampus, entorhinal cortex, and lateral septum. Together, these results indicate that blocking Cx hemichannels using D4 can normalize neuronal activity and reduce depressive-like symptoms in mice by reducing neuroinflammation. Our work provides evidence of the antidepressant-like effect of D4 and supports glial Cx hemichannels as potential therapeutic targets for depression.
Contraceptive preferences and adoption following female genital fistula surgery in Uganda: a mixed-methods study
Authors: El Ayadi Alison M. , Nalubwama Hadija , Painter Caitlyn , Kakaire Othman , Miller Suellen , Barageine Justus , Byamugisha Josaphat , Obore Susan , Korn Abner , Harper Cynthia C. 
Published: August 2023

Abstract
Background
Female genital fistula, largely caused by prolonged obstructed labour, is treated by surgical repair. Preventing pregnancy for a minimum period post-repair is recommended to ensure adequate healing and optimize post-repair outcomes.

Methods
We examined contraceptive preferences and use among Ugandan fistula patients (n = 60) in the year following genital fistula surgery using mixed-methods. Sexual activity, contraceptive use and pregnancy status were recorded quarterly for 12 months after surgery. In-depth interviews among purposively selected participants (n = 30) explored intimate relationships, sexual experiences, reproductive intentions, and contraceptive use.

Results
Median participant age was 28 years and almost half (48%) were married or living with partners. Counselling was provided to 97% of participants on delaying sexual intercourse, but only 59% received counselling on contraception. Sexual activity was reported by 32% after 6 months and 50% after 12 months. Eighty-three percent reported not trying for pregnancy. Among sexually active participants, contraceptive use was low at baseline (36%) but increased to 73% at 12 months. Six (10%) women became pregnant including two within 3 months post-repair. Interview participants who desired children immediately were young, had fewer children, experienced stillbirth at fistula development, and felt pressure from partners. Women adopted contraception to fully recover from fistula surgery and avoid adverse outcomes. Others simply preferred to delay childbearing. Reasons cited for not adopting contraception included misconceptions related to their fertility and to contraceptive methods and insufficient or unclear healthcare provider advice on their preferred methods.

Conclusions
A high proportion of patients were not counselled by healthcare providers on contraception. Provision of comprehensive patient-centred contraceptive counselling at the time of fistula surgery and beyond is important for patients to optimize healing from fistula and minimize recurrence, as well as to meet their own reproductive preferences.