bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association between being breastfed and cardiovascular disease: a population cohort study of 320 249 participants
Authors: Nakada Shinya , Ho Frederick K , Celis-Morales Carlos , Pell Jill P 
Published: March 2023

AbstractBackgroundBeing breastfed is associated with lower cardiovascular risk factors but, to date, no studies have demonstrated a protective effect on cardiovascular disease (CVD). This study aims to address the limitations of previous studies, specifically insufficient statistical power and residual confounding, to determine if such association exists.MethodsThis is a population-based retrospective cohort study of 320 249 men and women aged 40–69 years. Breastfeeding status was self-reported. CVD and myocardial infarction (MI) events and deaths based via linkage to hospitalization and death records.ResultsOverall, 28 469 (8.4%) participants experienced a CVD event and 5174 (1.6%) experienced an MI. Following adjustment for sociodemographic, lifestyle and early life confounders, breastfeeding was associated with a reduced risk of CVD events (HR 0.97, 95% CI 0.94–1.00, P = 0.041), CVD deaths (HR 0.91, 95% CI 0.84–0.98, P = 0.017), MI events (HR 0.93, 95% CI 0.87–0.99, P = 0.033) and MI deaths (HR 0.81, 95% CI 0.67–0.98, P = 0.026).ConclusionsChild health benefits of breastfeeding are well established. However, the benefits of breastfeeding may extend into later life reinforcing the need to encourage and support breastfeeding.
Collagen-based injectable and self-healing hydrogel with multifunction for regenerative repairment of infected wounds
Authors: Gu Haojie , Li Han , Wei Liren , Lu Jian , Wei Qingrong 
Published: March 2023

AbstractAt present, the development trend of dressing materials is being multifunctional for convenient and long-term nursing care process of some complicated wounds. Here, basing on the theory of wound moist healing, an injectable and self-healing hydrogel comprising of collagen (COL), chitosan (CS) and oxidation modified Konjac glucomannan (OKGM), which acts as a macromolecular cross-linker to construct dynamic Schiff-base bonds was smartly designed. The strategy of introducing the silver nanoparticles (Ag NPs) into the COL–CS–OKGM hydrogel matrix achieved a markedly enhanced antibacterial activity derived from the synergistical effect between the Ag+ and the mild photothermal efficacy of Ag NPs, which also improved the local capillary blood circulation of the wound area to further facilitate wound healing process. The excellent syringeability and self-healing behaviors endowed the COL–CS–OKGM–Ag hydrogel with self-adapting ability for the wounds with irregular and large area needing frequent applying and changing without secondary injuries. In vitro and in vivo evaluations verified that so-designed COL–CS–OKGM–Ag hydrogel also with hemostatic performance is a promising multifunctional dressing for the treatments of infected wound with not only good biocompatibility and convenient use, but also with desired regenerative healing prognoses benefited from hydrogel moist environment and physiotherapy.
A Machine Learning Approach to Developing an Accurate Prediction of Maximal Heart Rate During Exercise Testing in Apparently Healthy Adults
Authors: Cundrič Larsen , Bosnić Zoran , Kaminsky Leonard A. , Myers Jonathan , Peterman James E. , Markovic Vidan , Arena Ross , Popović Dejana 
Published: March 2023

Purpose:
Maximal heart rate (HRmax) continues to be an important measure of adequate effort during an exercise test. The aim of this study was to improve the accuracy of HRmax prediction using a machine learning (ML) approach.

Methods:
We used a sample from the Fitness Registry of the Importance of Exercise National Database, which included 17 325 apparently healthy individuals (81% males) who performed a maximal cardiopulmonary exercise test. Two standard formulas for HRmax prediction were tested: Formula1 = 220 − age (yr), root-mean-squared error (RMSE) 21.9, relative root-mean-squared error (RRMSE) 1.1; and Formula2 = 209.3 − 0.72 × age (yr), RMSE 22.7 and RRMSE 1.1. For ML model prediction, we used age, weight, height, resting HR, and systolic and diastolic blood pressure. The following ML algorithms to predict HRmax were applied: lasso regression (LR), neural networks (NN), support vector machine (SVM) and random forests (RF). An evaluation was performed using cross-validation and by computing the RMSE and RRMSE, Pearson correlation, and Bland-Altman plots. The best predictive model was explained with Shapley Additive Explanations (SHAP).

Results:
The HRmax for the cohort was 162 ± 20 bpm. All ML models improved HRmax prediction and reduced RMSE and RRMSE compared with Formula1 (LR: 20.2%, NN: 20.4%, SVM: 22.2%, and RF: 24.7%). The predictions of all algorithms significantly correlated with HRmax (r = 0.49, 0.51, 0.54, 0.57, respectively; P < .001). Bland-Altman analysis demonstrated lower bias and 95% CI for all ML models in comparison with standard equations. The SHAP explanation showed a high impact of all selected variables.

Conclusions:
Machine learning, particularly the RF model, improved prediction of HRmax using readily available measures. This approach should be considered for clinical application to refine HRmax prediction.
Acute Sterile Keratolysis After Deep Anterior Lamellar Keratoplasty in a Patient With Keratoconus: A Case Report
Authors: Al-Swailem Samar A. , AlHilali Sara , Maktabi Azza M. Y. 
Published: March 2023

Purpose:
The purpose of this study was to report the outcomes of using gamma-irradiated sterile cornea (GISC) as a deep lamellar keratoplasty (DALK) graft in a patient with keratoconus.

Methods:
This is a case report.

Results:
A 33-year-old male patient diagnosed with keratoconus underwent DALK using a GISC and developed a persistent epithelial defect which eventually led to sterile keratolysis necessitating further surgical interventions. Management and slitlamp photography, anterior segment optical coherence tomography (AS-OCT), and histopathological examination of the explanted graft are described in detail.

Conclusions:
This is the first reported case of sterile keratolysis after the use of GISC lenticule in DALK in a healthy patient with keratoconus. The underlying pathophysiology is not clearly understood, and some theories have been proposed in this report. Surgeons need to be aware of this rare complication and are encouraged to have a low threshold for graft replacement to ensure good clinical and visual outcomes. Developing a prospective complication registry to document complications after the use of GISC lenticules in ophthalmic surgery is recommended.
A Landscape Analysis of Prevention of Vertical Transmission Program Data and Interventions From Fiscal Years 2019–2021
Authors: Okegbe Tishina , Amzel Anouk , Gunnala Rajni , Abuelgasim Khalda , Traub Ariana , Lenka Matjeko , Mirembe Justine , Thuku Jeri , Rurangwa Aimee ,   USAID/PEPFAR Preventing Vertical Transmission (PVT) Group
Published: March 2023

Introduction:
In 2020, an estimated 150,000 infants acquired HIV infection through vertical transmission. With pregnant and breastfeeding women facing numerous social and health system barriers, continuity of care for mother–infant pairs (MIPs) requires prioritized engagement for timely infant HIV testing and linkage to treatment.

Methods:
PEPFAR Monitoring, Evaluation, and Reporting indicators were analyzed from across 14 USAID-supported countries across 3 fiscal years (FYs) (October 2018–September 2021): number of HIV-exposed infants (HEIs) with a sample collected for an HIV test by age 2 months, percentage of HEI who received an HIV test by age 2 months (EID 2 mo coverage), and final outcome status of HEIs. Qualitative information on implementation of PVT interventions was gathered using a structured survey disseminated to USAID/PEPFAR country teams.

Results:
From October 2018 to September 2021, 716,383 samples were collected for infant HIV tests. EID 2 mo coverage increased across the FYs from 77.3% in FY19% to 83.5% in FY21. Eswatini, Lesotho, and South Africa demonstrated the highest EID 2 mo coverage across all 3 FYs. Burundi (93.6%), DRC (92%), and Nigeria (90%) had the highest percentage of infants with a known final HIV outcome. Qualitative survey data showed that the most implemented interventions used by the countries were mentor mothers, appointment reminders, cohort registers, and joint provision of MIP services.

Conclusions:
Achieving eVT requires a client-centered and multipronged approach, typically combining several PVT interventions. Country and program implementers should use person-centered solutions to best target MIPs to be retained in the continuum of care.
Food and Water Insecurity in Sexual and Gender Minority Groups Living With HIV in Lagos, Nigeria
Authors: Hamill Matthew M. , Hu Fengming , Adebajo Sylvia , Kokogho Afoke , Tiamiyu Abdulwasiu B. , Parker Zahra F. , Charurat Manhattan E. , Ake Julie A. , Baral Stefan D. , Nowak Rebecca G. , Crowell Trevor A. ,   for the TRUST/RV368 Study Group
Published: March 2023

Background:
Food and water insecurity are associated with poor health outcomes that may be exacerbated by social marginalization and barriers to health care experienced by sexual and gender minorities (SGM) in resource-limited settings. We explored factors associated with food and water insecurity in SGM with HIV.

Setting:
A longitudinal study of 357 men who have sex with men, transgender women, and other gender-identifying people in Lagos, Nigeria.

Methods:
Laboratory testing, interviews, food and water assessments, and anthropometry were performed quarterly. Robust Poisson regression with generalized estimating equations was used to evaluate factors potentially associated with food and water insecurity.

Results:
From 2014 to 2018, 357 SGM with HIV completed either the food or water assessments. At baseline, participants identified as cisgender men who have sex with men 265 (74.2%), transgender women 63 (17.7%), or as nonbinary/other gender 29 (8.1%). Food insecurity and water insecurity were reported by 63/344(18.3%) and 113/357(31.7%), respectively, at any visit. Food and water insecurity each decreased with ongoing study participation. Food insecurity was associated with nonpartnered relationship status, CD4 count <500 cells/mm3, and lack of access to piped water. Water insecurity was associated with age 25 years or older, living with a man, transactional sex, and food insecurity.

Conclusions:
Food and water insecurity were common among SGM in Nigeria and decreased with continued study participation, suggesting amenability to intervention when SGM are successfully engaged in care. Targeted interventions to support food and water security may improve HIV-related outcomes, such as CD4 count.
2-[18F]FDG PET/CT Flare-up Phenomena Following T-Cell Engager Bispecific Antibody in Multiple Myeloma
Authors: Jamet Bastien , Bodet-Milin Caroline , Moreau Philippe , Kraeber-Bodéré Françoise , Touzeau Cyrille 
Published: March 2023

Abstract
T-cell–redirecting bispecific antibodies represent a new standard of care for the treatment of triple-class refractory myeloma patients. Here, 2-[18F]FDG PET/CT imaging was performed on a 61-year-old woman with relapsed myeloma to determine metabolic response to talquetamab, a GPRC5DxCD3-bispecific antibody. At day 28, monoclonal (M) component assessment confirmed very good partial response (97% monoclonal protein reduction), whereas 2-[18F]FDG PET/CT imaging revealed early bone flare-up phenomena. At day 84, bone marrow aspirate, M-component assessment, and 2-[18F]FDG PET/CT demonstrated complete response, confirming the early flare-up hypothesis.
Increased Petrous Bone Uptake on 18F-PSMA-1007 PET/CT Due to Otospongiosis
Authors: Neveü Sophie , Becker Minerva , Guinand Nils , Mainta Ismini Charis , Lenoir Vincent 
Published: March 2023

Abstract
We report the case of a 74-year-old man who had undergone radical prostatectomy for prostatic cancer 6 months earlier. Elevated prostate-specific antigen during follow-up prompted 18F–prostate-specific membrane antigen (PSMA) ligand PET/CT (18F-PSMA-1007 PET/CT) to search for new manifestations of prostate cancer, revealing an increased focal uptake (SUVmax, 5.9) in the left cochlear/pericochlear temporal bone and equivocal PSMA-RADS-3a external iliac nodes. Comparison with cone-beam CT and MRI showed that the focal temporal bone uptake corresponded to the typical morphological features of active otospongiosis (otosclerosis) in the context of a previously known long-standing otospongiosis.
Uncommon Manifestation of Oligometastatic Prostate Cancer
Authors: Luna Cibele , Kryvenko Oleksandr N. , Martinez Jose , Singal Rakesh , Kuker Russ 
Published: March 2023

Abstract
A 76-year-old man with a history of prostate cancer diagnosed in 2008 developed biochemical recurrence in 2010 and started intermittent androgen deprivation therapy. In 2021, due to rising prostate-specific antigen, an 18F-piflufolastat PSMA PET/CT was performed. It showed a radiotracer-avid sclerotic lesion in the right iliac bone and an indeterminate radiotracer-avid nodule in the umbilical region, demonstrating progressive enlargement and increased uptake on subsequent imaging. Pathologic analysis of the umbilical nodule revealed metastatic prostate cancer—a finding eponymically referred to as a Sister Mary Joseph nodule.
Health Care Simulation as a Training Tool for Epidemic Management
Authors: Corvetto Marcia A. , Altermatt Fernando R. , Belmar Francisca , Escudero Eliana 
Published: March 2023

Summary Statement
The objective of this research was to identify and review studies that have evaluated the impact of simulation-based training on health care professionals during epidemics.
All studies in health care simulation-based training published during the last 5 epidemics with a global impact (SARS-CoV, H1N1, MERS, Ebola, SARS-CoV-2; through July 2021) were selected from a systematic search of PUBMED, EMBASE, and key journals.
The search strategy identified 274 studies; 148 met the inclusion criteria and were included. Most of the studies were developed in response to SARS-CoV-2 infection (n = 117, 79.1%), used a descriptive approach (n = 54, 36.5%), and were used to train technical skills (n = 82, 55.4%).
This review demonstrates a growing interest in publications related to health care simulation and epidemics. Most of the literature is marked by limited study designs and outcome measurements, although there is a trend toward the use of more refined methodologies in the most recent publications. Further research should seek the best evidence-based instructional strategies to design training programs in preparation for future outbreaks.
Current patterns of trauma center proliferation have not led to proportionate improvements in access to care or mortality after injury: An ecologic study
Authors: Amato Stas , Benson Jamie S. , Stewart Barclay , Sarathy Ashwini , Osler Turner , Hosmer David , An Gary , Cook Alan , Winchell Robert J. , Malhotra Ajai K. 
Published: March 2023

BACKGROUND
Timely access to high-level (I/II) trauma centers (HLTCs) is essential to minimize mortality after injury. Over the last 15 years, there has been a proliferation of HLTC nationally. The current study evaluates the impact of additional HLTC on population access and injury mortality.

METHODS
A geocoded list of HLTC, with year designated, was obtained from the American Trauma Society, and 60-minute travel time polygons were created using OpenStreetMap data. Census block group population centroids, county population centroids, and American Communities Survey data from 2005 and 2020 were integrated. Age-adjusted nonoverdose injury mortality was obtained from CDC Wide-ranging Online Data for Epidemiologic Research and the Robert Wood Johnson Foundation. Geographically weighted regression models were used to identify independent predictors of HLTC access and injury mortality.

RESULTS
Over the 15-year (2005–2020) study period, the number of HLTC increased by 31.0% (445 to 583), while population access to HLTC increased by 6.9% (77.5–84.4%). Despite this increase, access was unchanged in 83.1% of counties, with a median change in access of 0.0% (interquartile range, 0.0–1.1%). Population-level age-adjusted injury mortality rates increased by 5.39 per 100,000 population during this time (60.72 to 66.11 per 100,000). Geographically weighted regression controlling for population demography and health indicators found higher median income and higher population density to be positively associated with majority (≥50%) HLTC population coverage and negatively associated with county-level nonoverdose mortality.

CONCLUSION
Over the past 15 years, the number of HLTC increased 31%, while population access to HLTC increased only 6.9%. High-level (I/II) trauma center designation is likely driven by factors other than population need. To optimize efficiency and decrease potential oversupply, the designation process should include population level metrics. Geographic information system methodology can be an effective tool to assess optimal placement.

LEVEL OF EVIDENCE
Prognostic and Epidemiological; Level IV.
A systematic review and meta-analysis of sample size methodology for traumatic hemorrhage trials
Authors: Ghossein Jamie , Fernando Shannon M. , Rochwerg Bram , Inaba Kenji , Lampron Jacinthe , Tran Alexandre 
Published: March 2023

BACKGROUND
Trauma hemorrhage remains the most common cause of preventable mortality in trauma. To guide clinical practice, RCTs provide high-quality evidence to inform clinical decision making. The clinical relevance and inferences made by RCTs are dependent on assumptions made during sample size calculation.

METHODS
To describe the quality of methodology for sample size determination, we conducted a systemic review RCTs evaluating interventions that aim to improve survival in adults with trauma-related hemorrhage. Estimated and actual outcome data are compared, including components of sample size determination.

RESULTS
A total of 13 RCTs were included. We noted a high rate of negative trial results (11 of 13 studies). Most studies were multi-center and conducted in North America, evaluating patients with blunt and penetrating injuries. The criteria for hemorrhagic shock varied across studies. All studies did not accurately estimate the mortality rate during sample size calculation. All but one study overestimated the mortality reduction during sample size calculation; the median absolute mortality reduction was 3%, compared with a target of 10%. Only the CRASH-2 study used a minimal clinically important different for treatment effect target. No RCTs employed prognostic enrichment. Most studies were terminated (8 of 13), mainly for futility.

CONCLUSION
Taken together, this review highlights that current clinical trial methodology is limited by imprecise control group risk estimates, overly optimistic treatment effect estimates, and lack of transparent justification for such targets. These limitations result in studies at high risk for futility and potentially premature abandonment of promising therapies. Given the high morbidity and mortality of trauma-related hemorrhage, we recommend that future conduct of trauma RCTs incorporate (1) prognostic enrichment to inform baseline risk, (2) justify target treatment differences based on clinical importance and realistic estimates of feasibility, and (3) be transparent and provide justification for the assumptions made.

LEVEL OF EVIDENCE
Systematic Review/Meta-Analysis; Level III.
Multivariate prediction of cognitive performance from the sleep electroencephalogram
Authors: Ujma Péter P. , Bódizs Róbert , Dresler Martin , Simor Péter , Purcell Shaun , Stone Katie L. , Yaffe Kristine , Redline Susan 
Published: March 2023

AbstractHuman cognitive performance is a key function whose biological foundations have been partially revealed by genetic and brain imaging studies. The sleep electroencephalogram (EEG) is tightly linked to structural and functional features of the central nervous system and serves as another promising biomarker. We used data from MrOS, a large cohort of older men and cross- validated regularized regression to link sleep EEG features to cognitive performance in cross- sectional analyses. In independent validation samples 2.5-10% of variance in cognitive performance can be accounted for by sleep EEG features, depending on the covariates used. Demographic characteristics accounted for more covariance between sleep EEG and cognition than health variables, and consequently reduced this association by a greater degree, but even with the strictest covariate sets a statistically significant association was present. Sigma power in NREM and beta power in REM sleep were associated with better cognitive performance, while theta power in REM sleep was associated with worse performance, with no substantial effect of coherence and other sleep EEG metrics. Our findings show that cognitive performance is associated with the sleep EEG (r=0.283), with the strongest effect ascribed to spindle- frequency activity. This association becomes weaker after adjusting for demographic (r=0.186) and health variables (r=0.155), but its resilience to covariate inclusion suggest that it also partially reflects trait-like differences in cognitive ability.
Predicting Imminent Health Outcomes from Common Lab Results
Authors: Cerejo Jorge , Neves Bernardo , da Silva Nuno André , Moreira José Maria , Silva Mário J. 
Published: March 2023

AbstractIn recent years, most hospitals have implemented Electronic Health Records to manage and integrate a wide range of medical information, including diagnostics, medication admission and laboratory test results. Certain laboratory variables may serve as indicators of a patient’s clinical deterioration, making laboratory data a valuable tool for identifying high-risk patients. This work introduces a framework for predicting imminent health outcomes (IHO) of multimorbidity patients using laboratory test data. Our cohort includes 322,316 multimorbidity patients that performed laboratory tests in a large teaching hospital between January 2007 and August 2021. Two Imminent Health Outcomes predictive tools were developed. The first considers all patients in the dataset. The second was developed using a subset of patients with Heart Failure (HF) as the main comorbidity (5% of the entire dataset), considering that HF is a highly prevalent syndrome in multimorbidity patients. This predictive model achieved a reasonable predictive performance (AUROC= 0.718, 95% CI 0.708-0.756, andAUPRC= 0.663, 95% CI 0.630-0.701). C-reactive protein and NT-proBNP are the lab tests that most positively contribute to the prediction of IHO. The IHO predictive tool has the potential to help the medical team identify patients at high-risk of an imminent adverse event, highlighting the laboratory variables that are most contributing to the deterioration of the patient.