bluuebunny/crossref_metadata_2025_split huggingface dataset:
Self-care practices and health-seeking behaviours in patients with dengue fever: A qualitative study from patients’ and physicians’ perspectives
Authors: Ng Wei Leik , Toh Jia Yong , Ng Chirk Jenn , Teo Chin Hai , Lee Yew Kong , Loo Kim Kee , Abdul Hadi Haireen , Noor Azhar Abdul Muhaimin 
Published: April 2023

IntroductionOutpatient management for dengue fever is the mainstay of treatment for most dengue cases. However, severe dengue can develop rapidly while patients are at home. Understanding the self-care practices and healthcare-seeking behaviours among dengue patients managed as outpatients will help improve the delivery of care to these patients.ObjectiveThis study aimed to explore the self-care practices, health-seeking behaviour and outpatient management of dengue fever from the perspectives of patients and primary care physicians.MethodologyThis qualitative study used in-depth interviews and focus group discussions to obtain information from laboratory-confirmed dengue patients who received outpatient care and primary care physicians who cared for them. Patients and physicians shared their experiences and perceptions of self-care practices, decisions to seek urgent care, and outpatient management procedures and visit frequency. Data were coded and analysed using thematic analysis.Results13 patients and 11 physicians participated. We discovered that the use of traditional remedies was common with patients perceiving no harm from it, whereas physicians did not see a benefit. Dengue patients’ knowledge of warning signs was inadequate despite the information being provided by physicians during clinical follow-up visits. Regarding the decision to seek urgent medical care, physicians assumed patients would seek help immediately once they experienced warning signs. However, for the patients, other factors influenced their health-seeking behaviour, such as their personal perceptions of symptom severity and often more importantly, their social circumstances (e.g., availability of childcare). Patients also described regular outpatient follow-up for dengue as inconvenient. There was variation in the prescribed outpatient follow-up interval recommended by participating physicians who complained about the lack of clear guidelines.ConclusionPerceptions around self-care practices, health-seeking behaviour and outpatient management of dengue often differed between physicians and patients, especially on comprehension of dengue warning signs. Addressing these gaps between patient and physician perceptions and recognition of patient drivers of health-seeking behaviour are needed to improve the safety and delivery of outpatient care for dengue patients.
Cholera past and future in Nigeria: Are the Global Task Force on Cholera Control’s 2030 targets achievable?
Authors: Charnley Gina E. C. , Yennan Sebastian , Ochu Chinwe , Kelman Ilan , Gaythorpe Katy A. M. , Murray Kris A. 
Published: May 2023

Background
Understanding and continually assessing the achievability of global health targets is key to reducing disease burden and mortality. The Global Task Force on Cholera Control (GTFCC) Roadmap aims to reduce cholera deaths by 90% and eliminate the disease in twenty countries by 2030. The Roadmap has three axes focusing on reporting, response and coordination. Here, we assess the achievability of the GTFCC targets in Nigeria and identify where the three axes could be strengthened to reach and exceed these goals.

Methodology/Principal findings
Using cholera surveillance data from Nigeria, cholera incidence was calculated and used to model time-varying reproduction number (R). A best fit random forest model was identified using R as the outcome variable and several environmental and social covariates were considered in the model, using random forest variable importance and correlation clustering. Future scenarios were created (based on varying degrees of socioeconomic development and emissions reductions) and used to project future cholera transmission, nationally and sub-nationally to 2070. The projections suggest that significant reductions in cholera cases could be achieved by 2030, particularly in the more developed southern states, but increases in cases remain a possibility. Meeting the 2030 target, nationally, currently looks unlikely and we propose a new 2050 target focusing on reducing regional inequities, while still advocating for cholera elimination being achieved as soon as possible.

Conclusion/Significance
The 2030 targets could potentially be reached by 2030 in some parts of Nigeria, but more effort is needed to reach these targets at a national level, particularly through access and incentives to cholera testing, sanitation expansion, poverty alleviation and urban planning. The results highlight the importance of and how modelling studies can be used to inform cholera policy and the potential for this to be applied in other contexts.
Membranous nephropathy in the UK Biobank
Authors: Hamilton Patrick , Blaikie Kieran , Roberts Stephen A. , Gittins Matthew , Downie Mallory L. , Gupta Sanjana , Voinescu Catalin , Kanigicherla Durga , Stanescu Horia , Kleta Robert , Brenchley Paul 
Published: April 2023

Background
Despite MN being one of the most common causes of nephrotic syndrome worldwide, its biological and environmental determinants are poorly understood in large-part due to it being a rare disease. Making use of the UK Biobank, a unique resource holding a clinical dataset and stored DNA, serum and urine for ~500,000 participants, this study aims to address this gap in understanding.

Methods
The primary outcome was putative MN as defined by ICD-10 codes occurring in the UK Biobank. Univariate relative risk regression modelling was used to assess the associations between the incidence of MN and related phenotypes with sociodemographic, environmental exposures, and previously described increased-risk SNPs.

Results
502,507 patients were included in the study of whom 100 were found to have a putative diagnosis of MN; 36 at baseline and 64 during the follow-up. Prevalence at baseline and last follow-up were 72 and 199 cases/million respectively. At baseline, as expected, the majority of those previously diagnosed with MN had proteinuria, and there was already evidence of proteinuria in patients diagnosed within the first 5 years of follow-up. The highest incidence rate for MN in patients was seen in those homozygous for the high-risk alleles (9.9/100,000 person-years).

Conclusion
It is feasible to putatively identify patients with MN in the UK Biobank and cases are still accumulating. This study shows the chronicity of disease with proteinuria present years before diagnosis. Genetics plays an important role in disease pathogenesis, with the at-risk group providing a potential population for recall.
Psychometric assessment of HIV stigma in patients attending a tertiary facility: An initial validation of the Berger HIV stigma scale in a Ghanaian perspective
Authors: Thomford Nicholas Ekow , Dampson Fiifi Ndom , Adjei George , Eliason Sebastian , Ekor Martins , Kyei George Boateng 
Published: April 2023

BackgroundHIV-related stigma and discrimination are major challenges to people living with HIV (PLWHIV) and are due to misconceptions. Due to socioeconomic variations, there is increased stigma experienced by PLWHIV in sub-Saharan Africa (SSA). Stigma affects adherence to antiretroviral medications by PLWHIV and defeats the goal of achieving viral suppression. This study evaluated the Bergers HIV stigma scale in PLWHIV in Ghana regarding construct validity and reliability and assessed which aspect of stigma is critical for immediate redress.MethodsThe Bergeret al. HIV stigma scale (39 items) and some selected questions from HIV stigma and discrimination measurement tool of the International Centre for Research on Women, Washington, DC were administered to a cohort of PLWHIV in Ghana (n = 160). Clinico- demographic data was collected from their folders and verbally. The psychometric assessment included exploratory factor analysis whiles scale reliability was evaluated as internal consistency by calculating Cronbach’s α.ResultsThe exploratory factor analysis suggested a four-factor solution which is like the original Berger HIV scale with sub-scalespersonalised stigma,disclosure concerns,negative self- image, and concernswith public attitudes. Items in the sub-scalespersonalised stigma(15- items),disclosure concerns(6),negative self-image(7) andconcerns with public attitudes(6) were reduced compared to the original scale. Cronbach’s α for the overall HIV stigma scale (34-items) was 0.808 whiles the sub-scales α ranged from 0.77 to 0.89. Analysis suggested the prevalence of a fundamental one-dimensional factor solution which yielded a 34-item scale after removing items for low factor loadings. Disclosure concerns was the highest ranked subscale although our study also found that about 65% of PLWHIV among our study participants had disclosed their status.ConclusionOur 34-item abridged Berger HIV stigma scale showed sufficient reliability with high Cronbach’s α and construct validity. Disclosure concerns ranked high among the sub-scales on the scale. Exploring specific interventions and strategies to address stigma concerns in our population will aid in the reduction of HIV-related stigma and associated consequences.
Lived experiences of people living with HIV—A qualitative exploration on the manifestation, drivers, and effects of internalized HIV stigma within the Malawian context
Authors: Kumwenda Moses Kelly , Kamkwamba David Black , Chirwa Maureen Leah , Kasoka Kasoka , Taegtmeyer Miriam , Oraro-Lawrence Tessa , Stackpool-Moore Lucy 
Published: April 2023

Introduction
HIV-related internalized stigma remains a major contributor to challenges experienced when accessing and providing HIV diagnosis, care and treatment services. It is a key barrier to effective prevention, treatment and care programs. This study investigated experiences of internalized stigma among people living with HIV in Malawi.

Methodology
A participatory cross-sectional study design of participants from eight districts across the three administrative regions of Malawi. Data were collected using Key Informant Interviews (n = 22), Focus Group Discussions (n = 4) and life-stories (n = 10). NVIVO 12 software was used for coding applying both deductive and inductive techniques. Health Stigma and Discrimination Framework was used as a theoretical and analytical framework during data analysis.

Results
Overt forms of stigma and discrimination were more recognizable to people living with HIV while latent forms, including internalized stigma, remained less identifiable and with limited approaches for mitigation. In this context, manifest forms of HIV-related stigma intersected with latent forms of stigma as people living with HIV often experienced both forms of stigma concurrently. The youths, HIV mixed-status couples and individuals newly initiated on ART were more susceptible to internalized stigma due to their lack of coping mechanism, unavailability of mitigation structures, and lack of information. Broadly, people living with HIV found it difficult to identify and describe internalized stigma and this affected their ability to recognize it and determine an appropriate course of action to deal with it.

Conclusion
Understanding the experiences of internalized stigma is key to developing targeted and context specific innovative solutions to this health problem.
Adapting an intervention to support young caregivers of cancer survivors: A study protocol
Authors: Njelesani Janet , Kavanaugh Melinda S. , Hunleth Jean 
Published: April 2023

Introduction
Of the family members providing care, in the United States over 5.4 million are young people (<18 years of age) and they are the caregivers receiving the least support overall. Given the need to support cancer survivors through a family-centered practice approach, this lack of support and intervention for young caregivers represents a substantial gap in cancer care. In this study, we will adapt a young caregivers intervention, YCare, with young caregivers in families affected by cancer in order to advance support for families in cancer settings. YCare is an intervention that improves the support young caregivers provide through a peer-engaged, multidisciplinary model but has previously not been studied in the cancer care setting.

Methods
Guided by the updated Consolidated Framework for Implementation Research (CFIR) we will engage stakeholders (i.e., young caregivers, cancer survivors, health care providers) using qualitative (i.e., one-on-one semi-structured interviews) and arts-based methods. Stakeholders will be recruited via cancer registries and community partners. Data will be analyzed descriptively using deductive (e.g., CFIR domains) and inductive (e.g., cancer practice settings) approaches.

Discussion
The results will indicate the critical components for adapting the YCare intervention to the cancer practice context including new intervention elements and key characteristics. Adapting YCare to a cancer context will address a critical cancer disparity issue.
Validation of Myc-Associated Protein X (MAX) regulation in growth hormone secreting and nonfunctional pituitary adenoma
Authors: Tucker Douglass W. , Pangal Dhiraj J. , Du Robin , Gogia Angad S. , Tafreshi Ali , Ruzevick Jacob , Hurth Kyle T. , Triche Tim , Micko Alexander , Carpten John D. , Shiroishi Mark S. , Carmichael John D. , Rhie Suhn K. , Zada Gabriel 
Published: April 2023

Introduction
Many patients with growth hormone-secreting pituitary adenoma (GHPA) fail to achieve biochemical remission, warranting investigation into epigenetic and molecular signatures associated with tumorigenesis and hormonal secretion. Prior work exploring the DNA methylome showed Myc-Associated Protein X (MAX), a transcription factor involved in cell cycle regulation, was differentially methylated between GHPA and nonfunctional pituitary adenoma (NFPA). We aimed to validate the differential DNA methylation and related MAX protein expression profiles between NFPA and GHPA.

Methods
DNA methylation levels were measured in 52 surgically resected tumors (37 NFPA, 15 GHPA) at ~100,000 known MAX binding sites derived using ChIP-seq analysis from ENCODE. Findings were correlated with MAX protein expression using a constructed tissue microarray (TMA). Gene ontology analysis was performed to explore downstream genetic and signaling pathways regulated by MAX.

Results
GHPA had more hypomethylation events across all known MAX binding sites. Of binding sites defined using ChIP-seq analysis, 1,551 sites had significantly different methylation patterns between the two cohorts; 432 occurred near promoter regions potentially regulated by MAX, including promoters of TNF and MMP9. Gene ontology analysis suggested enrichment in genes involved in oxygen response, immune system regulation, and cell proliferation. Thirteen MAX binding sites were within coding regions of genes. GHPA demonstrated significantly increased expression of MAX protein compared to NFPA.

Conclusion
GHPA have significantly different DNA methylation and downstream protein expression levels of MAX compared to NFPA. These differences may influence mechanisms involved with cellular proliferation, tumor invasion and hormonal secretion.
Industry involvement in evidence production for genomic medicine: A bibliometric and funding analysis of decision impact studies
Authors: Parker Gillian , Hunter Sarah , Hogarth Stuart , Miller Fiona A. 
Published: April 2023

Background
Decision impact studies have become increasingly prevalent in genomic medicine, particularly in cancer research. Such studies are designed to provide evidence of clinical utility for genomic tests by evaluating their impact on clinical decision-making. This paper offers insights into understanding of the origins and intentions of these studies through an analysis of the actors and institutions responsible for the production of this new type of evidence.

Methods
We conducted bibliometric and funding analyses of decision impact studies in genomic medicine research. We searched databases from inception to June 2022. The datasets used were primarily from Web of Science. Biblioshiny, additional R-based applications, and Microsoft Excel were used for publication, co-authorship and co-word analyses.

Results
163 publications were included for the bibliometric analysis; a subset of 125 studies were included for the funding analysis. Included publications started in 2010 and increased steadily over time. Decision impact studies were primarily produced for proprietary genomic assays for use in cancer care. The author and affiliate analyses reveal that these studies were produced by ‘invisible colleges’ of researchers and industry actors with collaborations focused on producing evidence for proprietary assays. Most authors had an industry affiliation, and the majority of studies were funded by industry. While studies were conducted in 22 countries, the majority had at least one author from the USA.

Discussion
This study is a critical step in understanding the role of industry in the production of new types of research. Based on the data collected, we conclude that decision impact studies are industry-conceived and -produced evidence. The findings of this study demonstrate the depth of industry involvement and highlight a need for further research into the use of these studies in decision-making for coverage and reimbursement.
Characteristics of Facilities With Early and Rapid Ustekinumab Adoption for Patients With Inflammatory Bowel Disease
Authors: Cohen-Mekelburg Shirley , Van Tony , Berinstein Jeffrey A. , Yu Xianshi , Costa Deena Kelly , Wallace Beth I. , Saini Sameer , Admon Andrew J. , Higgins Peter D.R. , Zhu Ji , Waljee Akbar K. 
Published: April 2023

INTRODUCTION:
To examine which facility characteristics, including teamwork, are associated with early or rapid inflammatory bowel disease-related ustekinumab adoption.

METHODS:
We examined the association between ustekinumab adoption and the characteristics of 130 Veterans Affairs facilities.

RESULTS:
Mean ustekinumab adoption increased by 3.9% from 2016 to 2018 and was higher in urban compared with rural facilities (β = 0.03, P = 0.033) and among facilities with more teamwork (β = 0.11, P = 0.041). Compared with nonearly adopters, early adopters were more likely be high-volume facilities (46% vs 19%, P = 0.001).

DISCUSSION:
Facility variation in medication adoption provides an opportunity for improving inflammatory bowel disease care through targeted dissemination strategies to improve medication uptake.
The potential use of giant reed from Portugal as a thermal insulation material
Authors: Malheiro Raphaele , Morilla Aurora , Ansolin Adriana , Fernandes Jorge , Silva Sandra , Mateus Ricardo 
Published: April 2023

The construction sector plays an important role in climate change. Thus, there is a pressing need to construct buildings that reduce heat losses, use natural and local materials, exploit renewable sources and ensure high comfort levels with a minimum environmental impact. Reed, considered carbon-neutral and a carbon dioxide sink material, has been used for centuries for diverse uses. Its properties and high availability made it a popular building material, as seen in Portuguese vernacular architecture. Knowing the properties of the reed is a crucial step to ensure successful heritage conservation, optimising these materials, and developing innovative solutions. This paper studies the potential of using giant reed from different Portuguese regions as a thermal insulation material. Giant reed board prototypes (15 x 15 x 5 cm, about 235 kg/m3) were built. Their thermal performance was tested in a hotbox, according to ASTM C1363‑19. The results show that the giant reed harvested on the northern coast of Portugal has better thermal performance than reeds from other regions. However, regardless of the region of the country where the giant reed was harvested, it has a satisfactory thermal resistance (Re ≥ 0.30 (m2.ºC)/W), allowing its use as a thermal insulation material in the buildings.
Measuring circularity from buildings to neighbourhoods
Authors: Gomes Vanessa , Valdivia Sara , Pulgrossi Lizzie , Gomes da Silva Maristela 
Published: April 2023

The circular economy (CE) aims to eliminate the concept of pollution and waste generation, maintain the integrity of the product over several use cycles, and focus on closing material and energy loops. Circularity metrics are relevant for monitoring, reporting and communicating CE implementation progress. Applied to buildings, these metrics deliver structured assessments through standardized indicators, which establish a common language among the agents involved, help implement strategies to assess the circular potential of technical options. Studies dealing with circularity metrics for buildings are still scarce and somewhat variable within an overall common framework. Applications to neighbourhoods are even more incipient. This study applied selected metrics to two building cases with different constructive characteristics, to improve the understanding on how information on circularity is conveyed. The selected metrics highlighted the circularity challenges for the two building designs. However, such metrics disregard the environmental impacts required to induce circular flows and loop closure. It is herein proposed that such metrics are paired with environmental performance profiles produced by e.g., life cycle assessments (LCA). The concept of "nested indicators" could be applied to neighbourhood and city scales by referring to the LCA concept of functional equivalency as the "relevance" weighting criterion.
A mathematical model of vascular and hemodynamics changes in early and late forms of preeclampsia
Authors: Sedaghati Farbod , Gleason Rudolph L. 
Published: April 2023

AbstractPreeclampsia–eclampsia syndrome is a leading cause of maternal mortality. The precise etiology of preeclampsia is still not well‐defined and different forms exist, including early and late forms or preeclampsia, which may arise via distinctly different mechanisms. Low‐dose aspirin administered at the end of the first trimester in women identified as high risk has been shown to reduce the incidence of early, but not late, preeclampsia; however, current risk factors show only fair predictive capability. There is a pressing need to develop accurate descriptions for the different forms of preeclampsia. This paper presents 1D fluid, solid, growth, and remodeling models for pregnancies complicated with early and late forms of preeclampsia. Simulations affirm a broad set of literature results that early forms of preeclampsia are characterized by elevated uterine artery pulsatility index (UA‐PI) and total peripheral resistance (TPR) and lower cardiac output (CO), with modestly increased mean arterial blood pressure (MAP) in the first half of pregnancy, with elevation of TPR and MAP beginning at 20 weeks. Conversely, late forms of preeclampsia are characterized by only slightly elevated UA‐PI and normal pre‐term TPR, and slightly elevated MAP and CO throughout pregnancy, with increased TPR and MAP beginning after 34 weeks. Results suggest that preexisting arterial stiffness may be elevated in women that develop both early forms and late forms of preeclampsia; however, data that verify these results are lacking in the literature. Pulse wave velocity increases in early‐ and late‐preeclampsia, coincident with increases in blood pressure; however, these increases are mainly due to the strain‐stiffening response of larger arteries, rather than arterial remodeling‐derived changes in material properties. These simulations affirm that early forms of preeclampsia may be associated with abnormal placentation, whereas late forms may be more closely associated with preexisting maternal cardiovascular factors; simulations also highlight several critical gaps in available data.