bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Sharks Are Circling: A Qualitative Study of Living with Metastatic Breast Cancer
Authors: Visovsky Constance , Marshall Victoria K. , Moreno Maria , Advani Pooja , Mussallem Dawn , Tofthagen Cindy 
Published: April 2023

Abstract
Purpose: The purpose of this phenomenological study was to gain an understanding of the intersection of continued treatment and quality of life in women living with metastatic breast cancer (MBC).
Methods: This was a qualitative study in which women with MBC were interviewed about their perceptions how MBC affected their physical, emotional, and role functioning.
Results: Participants (n=16) were mostly Caucasian (86.7%) and non-Hispanic (93.3%). The mean age was 55.62 years. Most women were on their third or greater line of treatment (68.5%). Themes identified from analysis of the transcripts revealed: 1) shock and devastation of the initial diagnosis; 2) feeling as if the sharks are circling; 3) cancer is a rollercoaster with never-ending treatments; 4) individual definitions of quality of life and; 5) you are not the person you once were.
Conclusions: Symptoms, ongoing treatments, treatment changes, and disease progression negatively influence physical, emotional, and role function. Women with MBC define quality of life in different ways, and while symptoms and functional limitations are present, the cancer experience causes some to reevaluate their lives and focus on their individual priorities and values.
Implications for Cancer Survivors: Although newly developed treatments increase survival among women with MBC, the symptoms, concerns, and issues surrounding QOL remain unresolved. The relatively high price of continuous treatment and disease exacerbation is indicative of the need for multi-pronged intervention strategies that address physical, mental and emotional aspects of living with MBC.
Development of a Hereditary Breast and Ovarian Cancer and Genetics Training for Community Health Workers:  KEEP IT (Keeping Each other Engaged Program via IT) Community Health Worker Training
Authors: Allen Caitlin , Hatch Ashley , Qanungo Suparna , Ford Marvella , Price Sarah Tucker , Umemba Quisha 
Published: April 2023

Abstract
We developed a curriculum for community health workers (CHWs) using an innovative, community-engaged focus group and Delphi process approach. Equipping CHWs with knowledge of Hereditary Breast and Ovarian Cancer (HBOC) and genetics could help enhance identification of women at risk for HBOC, referral, and navigation through genetic services. Focus groups of five CHWs were conducted on two separate occasions. A three round Delphi process study involving eight experts was conducted. In Round 1 participants rated and commented on draft modules. The second round involved live video discussion to highlight points of confusion and concern in the modules. The third round followed the same process as Round 1. Eight individuals participated in the Delphi process. The curriculum was revised and refined based on quantitative and qualitative data and reassessed by the experts in Round 3. Agreement was achieved on eight of 10 modules when assessing for clarity of learning objectives, seven out of 10 when assessing for adult learning theory, and nine out of 10 when assessing for participants’ ability to learn desired knowledge and the Delphi process concluded. High levels of agreement were attained for most modules, and if not, they were altered accordingly. We plan to virtually deliver this curriculum to CHWs to enhance their HBOC and genomic competencies. By equipping CHWs to understand and participate in genomics education, we can enable more equitable participation in genomics-informed clinical care and research. Beyond this curriculum, the Delphi methodology can further be used to design content for new CHW curriculums.
Differences in Directives to Limit Treatment and Discontinue Mechanical Ventilation Between Elderly and Very Elderly Patients: A Multinational Observational Study
Authors: Burns Karen E , Cook Deborah J , Xu Keying , Dodek Peter , Villar Jesus , Jones Andrew , Kapadia Farhad N , Gattas David J. , Epstein Scott K , Pelosi Paolo , Kefala Kalliroi , Meade Maureen , Rizvi Leena 
Published: April 2023

Abstract
Purpose: To characterize differences in directives to limit treatments and discontinue invasive mechanical ventilation (IMV) in elderly (65 - 80 years) and very elderly (> 80 years) intensive care unit (ICU) patients.
Measurements: We prospectively described new orders to limit treatments, IMV discontinuation strategies [direct extubation, direct tracheostomy, spontaneous breathing trial (SBT), NIV use], and associations between initial failed SBT and outcomes in 142 ICUs from 6 regions (Canada, India, United Kingdom, Europe, Australia/New Zealand, United States).
Results: We evaluated 788 (586 elderly; 202 very elderly) patients. Very elderly (vs. elderly) patients had similar withdrawal orders but significantly more withholding orders, especially cardiopulmonary resuscitation and dialysis, after ICU admission [67 (33.2%) vs. 128 (21.9%); p=0.002]. Orders to withhold reintubation were written sooner in very elderly (vs. elderly) patients [4 (2-8) vs. 7 (4-13) days, p=0.02]. Very elderly and elderly patients had similar rates of direct extubation [39 (19.3%) vs. 113 (19.3%)], direct tracheostomy [10 (5.0%) vs. 40 (6.8%)], initial SBT [105 (52.0%) vs. 302 (51.5%)] and initial successful SBT [84 (80.0%) vs. 245 (81.1%)]. Very elderly patients experienced similar outcomes, but had higher hospital mortality. Direct tracheostomy and initial failed SBT were associated with worse outcomes. Regional differences existed in withholding orders at ICU admission and in withholding and withdrawal orders after ICU admission.
Conclusions: Very elderly (vs. elderly) patients had more orders to withhold treatments after ICU admission and higher hospital mortality, but similar ICU outcomes and IMV discontinuation. Significant regional differences existed in withholding and withdrawal practices.
Unsupervised machine learning models reveal predictive markers of glioblastoma patient survival using white blood cell counts prior to initiating chemoradiation
Authors: Wang Wesley , Kumm Zeynep Temerit , Ho Cindy , Zanesco-Fontes Ideli , Texiera Gustavo , Reis Rui Manuel , Martinetto Horacio , Khan Javaria , Anderson Mark D. , Chohan M Omar , Beyer Sasha , Elder J Brad , Giglio Pierre , Otero José Javier 
Published: April 2023

Abstract
Purpose: Glioblastoma is a malignant brain tumor requiring careful clinical monitoring even after primary management. Personalized medicine has suggested use of various molecular biomarkers as predictors of patient prognosis or factors utilized for clinical decision making. However, the accessibility of such molecular testing poses a constraint for various institutes requiring identification of low-cost predictive biomarkers to ensure equitable care.
Methods: We collected retrospective data from patients seen at Ohio State University, University of Mississippi, Barretos Cancer Hospital (Brazil), and FLENI (Argentina) who were managed for glioblastoma—amounting to nearly 600 patient records documented using REDCap. Patients were evaluated using an unsupervised machine learning approach comprised of dimensionality reduction and eigenvector analysis to visualize the inter-relationship of collected clinical features.
Results: We discovered that white blood cell count of a patient during baseline planning for treatment was predictive of overall survival with an over 6-month median survival difference between the upper and lower quartiles of white blood cell count. By utilizing an objective PDL-1 immunohistochemistry quantification algorithm, we were further able to identify an increase in PDL-1 expression in glioblastoma patients with high white blood cell counts.
Conclusion: These findings suggest that in a subset of glioblastoma patients the incorporation of white blood cell count and PDL-1 expression in the brain tumor biopsy as simple biomarkers predicting glioblastoma patient survival. Moreover, use of machine learning models allows us to visualize complex clinical datasets to uncover novel clinical relationships.
A muti-substrate flavonol O-glucosyltransferases from safflower
Authors: Qi Shuyi , He Beixuan , Wang Haotian , Duan Yaqian , Wang Lunuan , Gao Yue , Guo Meili 
Published: April 2023

Abstract
A glycosyltransferase CtUGT4 with flavonoid-O-glycosyltransferase activity was identified in safflower. The fusion protein of CtUGT4 was heterologously expressed in Escherichia coli, and the target protein was purified. The recombinant protein can catalyze quercetin to form quercetin-7-O-glucoside and kaempferol to form kaempferol-3-O in vitro, and a series of flavones, flavonols, dihydroflavones, chalcones, and chalcone glycosides were used as substrates to generate new products. CtUGT4 was expressed in the tobacco transient expression system, and the enzyme activity results showed that it could catalyze kaempferol to kaempferol-3-O-glucoside, and quercetin to quercetin-7-O-glucoside. After overexpressing CtUGT4 in safflower, the content of quercetin-3-O-rutinoside in the florets of safflower increased significantly, and the content of quercetin-3-O-glucoside also tended to increase, which preliminarily proved the function of CtUGT4 flavonoid-O-glycosyltransferase. This work demonstrated the flavonoid-O-glycosyltransferase function of safflower CtUGT4 and showed differences in affinity for different flavonoid substrates and regioselectivity of catalytic sites in safflower in vivo and in vitro, which provides clues for further research on the function of UGT genes and new ideas for the cultivation engineering of directional improvement of effective metabolites in safflower.
A biologically inspired computational trust model for open multi-agent systems which is resilient to unwillingness and dishonesty in reporting of trust information
Authors: Lygizou Zoi , Kalles Dimitris 
Published: April 2023

Abstract
Selfish agents in highly dynamic and open multi-agent systems are usually unwilling to exchange information with each another and usually dishonest when doing so. Thus, the use of trust information provided by other agents makes most trust and reputation systems susceptible to various sorts of disinformation. To deal with this issue, we have proposed a computational trust model from the perspective of the trustee, inspired by aspects of the synaptic plasticity of the brain, in which the trustor does not choose a trustee to delegate a task, but it is the trustee who decides whether it has the skills to perform the task or not. The proposed trust model follows the decentralized approach, it is developed so as to deal with the requirements of highly dynamic and open multi-agent systems, and since agents do not exchange trust information, it is immune to various sorts of disinformation. We conducted an extensive empirical evaluation of our model comparing it with FIRE, an established trust and reputation model for open multi-agent systems, and observed that our model was able to perform consistently in various dynamic conditions, maintaining a high level of utility gain for the agents and being immune to unwillingness and dishonesty in reporting of trust information.
Identification of novel phytochemicals from Hibiscus rosa sinensis flower as a prospective inhibitor targeting the 3CLpro enzyme of SARS-CoV-2 using computational approaches.
Authors: Das Subhadeep , Satapathy Sagarika , Acharya Diptikanta , Sahu Sushil Kumar 
Published: April 2023

Abstract
Hibiscus rosa sinensis has an infinite resources of phytochemicals, which have emerged as solutions for different health-related issues such as anti-diabetic, anti-microbial and wound healing activity as proved in past clinical studies. Focusing on the current situation, an incessant increase in daily COVID-19 cases and struggles to discover effective treatment measures for SARS-CoV-2 have led to the global health catastrophe. Upsurge in COVID-19 cases has revealed a pattern characterised as a first, second, third wave and beyond, this cycle of new SARS-CoV-2 variant transmission needed to be terminated by selecting a propitious effective target, and the 3CL protease enzyme (3CLpro or Mpro) of SARS-CoV-2 acts as a possible target. The objective of this study is to investigate the phytochemicals identified from Hibiscus rosa sinensis flower for their potential anti-SARS-CoV-2 properties virtually, targeting the 3CLpro or Mpro, which regulates viral pathogenesis. The present research protocol includes molecular docking of 34 phytochemicals identified from Hibiscus rosa sinensis flower and targeted against the active site of the 3CLpro enzyme. Computational analysis revealed that the top 3 ligands, cyanidin-3-sophoroside-5-glucoside (-10.9 kcal/mol), 1,2-Benzenedicarboxylic acid isodecyl octyl ester (-10.1 kcal/mol) and rutin (-9.3 kcal/mol) have better binding affinity as compared to the control inhibitor remdesivir (-8 kcal/mol). Further investigation in terms of ligand-protein interaction, physiochemical, ADMET and drug-likeness parameters showed that cyanidin-3-sophoroside-5-glucoside possessed promising properties and could act as a potential effective drug candidate. However, our study needs to be supported by in vitro and in vivo evaluation to determine the precise mechanism of inhibitory action.
Factors Predicting Recurrence After Left‑Sided Pancreatectomy for Pancreatic Ductal Adenocarcinoma
Authors: Xia Tao , Xu Peng , Mou Yiping , Zhang Xizhou , Song Shihao , Zhou Yucheng , Lu Chao , Zhu Qicong , Xu Yunyun , Jin Weiwei , Wang Yuanyu 
Published: April 2023

Abstract
Background Recurrence after resection is the main factor for poor survival. The relationship between clinicopathological factors and recurrence after curative distal pancreatectomy for PDAC has rarely been reported separately.Methods Patients with PDAC after left‑sided pancreatectomy between May 2015 and August 2021 were retrospectively identified.Results 141 patients were included. Recurrence was observed in 97 patients (68.8%), while 44 (31.2%) patients had no recurrence. The median RFS was 8.8 months. The median OS was 24.9 months. Local recurrence was the predominant first detected recurrence site (n = 36, 37.1%), closely followed by liver recurrence (n = 35, 36.1%). Multiple recurrences occurred in 16 (16.5%) patients, peritoneal recurrence in 6 (6.2%) patients, and lung recurrence in 4 (4.1%) patients. High CA19-9 value after surgery, poor differentiation grade, and positive lymph nodes were found to be independently associated with recurrence. The patients receiving adjuvant chemotherapy had a decreased likelihood of recurrence. In the high CA19-9 value cohort, the median PFS and OS of the patients with or without chemotherapy were 8.0 VS. 5.7 months and 15.6 VS. 13.8 months, respectively. In the normal CA19-9 value cohort, there was no significant difference in PFS with or without chemotherapy (11.7 VS. 10.0 months, P = 0.147). However, OS was significantly longer in the patients with chemotherapy (26.4 VS. 13.8 months, P = 0.019).Conclusions Tumor biologic characteristics, such as T stage, tumor differentiation and positive lymph nodes, affecting CA19-9 value after surgery are associated with patterns and timing of recurrence. Adjuvant chemotherapy significantly reduced recurrence and improved survival. Chemotherapy is strongly recommended in patients with high CA199 after surgery.
Evaluation of the mechanisms acting on the Atlantic Meridional Overturning Circulation in CESM2 for the 1pctCO2 experiment
Authors: Sancho Lívia , Passos Elisa , Assad Luiz Paulo de Freitas , Landau Luiz 
Published: April 2023

Abstract

The Atlantic Meridional Overturning Circulation (AMOC) is a crucial component of the Earth’s climate system due to its fundamental role in the uptake and distribution of important tracers such as heat, carbon, and oxygen. Evaluating changes in AMOC in a warming climate is paramount to understanding the potential influence on global climate. In this study, we utilized outputs produced by the Community Earth System Model for Phase 6 of the Coupled Model Intercomparison Project, in addition to in situ data, to investigate changes in AMOC and the associated physical processes. Two experiments were carried out: a control experiment and an experiment with an annual increase of 1% CO2. Our analysis revealed a significant decrease in AMOC, with the upper branch weakening more than 60% and shallowing more than 600 m, compared to in situ data, leading to a reduction in heat transport to high latitudes in the North Atlantic. This decline was associated with changes in mixed layer depth and buoyancy in high latitudes of the North Atlantic, resulting in the shutdown of deep convection and potentially affecting the formation of North Atlantic Deep Water and Antarctic Bottom Water. Furthermore, the increase in CO2 levels altered the pattern of several parameters and the way they determine the flow of freshwater to the North Atlantic Ocean. Our findings suggest that continued warming may further weaken AMOC, with significant implications for global climate.
Potential zoonotic malaria transmission in five areas inhabited by non-human primate in Indonesia
Authors: Permana Dendi Hadi , Hasmiwati Hasmiwati , Suryandari Dwi Anita , Rozi Ismail Ekoprayitno , Syahrani Lepa , Setiadi Wuryantari , Irawati Nuzulia , Rizaldi Rizaldi , Wangsamuda Suradi , Yusuf Yenni , Irdayanti Irdayanti , Aswad Hijral , Syafruddin= Din , Asih Puji Budi Setia 
Published: April 2023

Abstract
Background Indonesia is home for many species of non-human primate (NHP). The current deforestation has substantially reduced the habitat of the NHPs and intensifies interaction with human being and thus open the possibility of pathogen spill over. The present study aims to determine the prevalence of malaria parasite infection among the NHPs in five provinces of Indonesia during the period of 2022 through the capture and release of wild NHPs using a trap installed in several localities surrounding the sanctuary that border the human settlement. The potential Anopheles sp. mosquito that may transmit the pathogen to human was also explored.Methods Epidemiologic surveys were conducted through the capture and release of wild NHPs using a trap installed in several localities surrounding the wildlife sanctuary that border the human settlement. Captured NHP was anesthetized and blood samples were aseptically drawn using phlebotomy to make blood smear and dried blood spot (DBS) on filter paper. Infection of the captured NHPs with malaria was determined using light microscopy on Giemsa-stained blood smears and PCR amplification and DNA sequencing of the amplicons using the rPLU oligos. The species of the NHP was determined using the barcoding DNA markers, mitochondrial DNA (mtDNA) Cytochrome Oxidase Subunit I (COI) and Internal transcribed spacer 2 (ITS2) gene of the nuclear ribosomal DNA. Mosquito surveillance included larval collection on breeding sites and adult collection using human landing catch (HLC) and light traps.Results Analysis of the DNA extracted from the DBS of the 110 captured NHPs, revealed positive Plasmodium, namely P. cynomolgi, P.coatneyi, P. inui, P. knowlesi and Plasmodium sp. at the prevalence rate of 42% and 50% by microscopy and PCR, respectively. Molecular analysis on the captured NHPs identified several species of Macaca sp. and Hylobates sp. Mosquito surveillance identified several common breeding sites such as ditch, piddle, and natural ponds. Anopheles letifer was found during HLC carried sporozoites of primate malaria.Conclusion The findings indicate a high prevalence of primate malaria infection among the NHPs and in certain areas the Anopheles sp. vector that potentially transmit zoonotic malaria such as An. letifer were identified during HLC. Overall, the zoonotic malaria transmission in several areas is immense.
Employment Prospects and Health Insurance Among Legal Permanent Residents: a Longitudinal Assessment of the Influence of Visa Type and Job Skill Level
Authors: Kibibi Niclette , Story William , Oleson Jacob , Platt Jonathan , Charlton Mary , Ryckman Kelli 
Published: April 2023

Abstract
Background Immigrants have disparate access to employment and health insurance, but it is unclear whether differences in access exist by visa types and job skill. We examined the relationship between visa type and employment, and the association between job skill and health insurance.Methods We conducted a retrospective cohort study using the 2003 to 2004 and 2007 to 2009 longitudinal data from the New Immigrant Survey. Using logistic regression, we compared the odds of employment by visa type (immediate relatives/family sponsored; diversity; refugee/asylee/parolee; and legalization) and the odds of insurance by job skill level (high, medium, and low), at each survey wave and assessed the change in each outcome over time.Results More immigrants were employed in wave 2 than in wave 1 (74% vs. 58%). Those with refugee/asylee/parolee visas had the highest rate of employment (82%) in wave 1 but decreased in wave 2 (76.4% ). Those with diversity visas had the highest increase in employment over time (56.6% in wave 1 vs. 85.5% in wave 2). The odds of insurance were consistently high among immigrants in high skill level jobs compared to those in lower skill level jobs over time.Conclusion Those with the diversity visa may be most vulnerable to unemployment and those in medium and low skill level jobs may be most vulnerable to uninsurance. They may benefit the most from job placement support in industries offering skill building, career advancement and health insurance to ensure best use of their human capital and continued upward mobility.
Epidemiological Dynamics of SARS-CoV-2 in White-tailed Deer
Authors: Hewitt Joshua , Wilson-Henjum Grete , Collins Derek , Linder Timothy , Lenoch Julianna , Heale Jonathon , Quintanal Christopher , Pleszewski Robert , McBride Dillon , Bowman Andrew , Chandler Jeffrey , Shriner Susan , Bevins Sarah , Kohler Dennis , Chipman Richard , Gosser Allen , Bergman David , DeLiberto Thomas , Pepin Kim 
Published: April 2023

Abstract
Understanding pathogen emergence in new host species is fundamental for developing prevention and response plans for human and animal health. We leveraged a large-scale surveillance dataset coordinated by United States Department of Agriculture, Animal and Plant Health Inspection Service and state natural resources agencies to quantify infection of SARS-CoV-2 in North American white-tailed deer (Odocoileus virginianus; WTD) using a hierarchical epidemiological model in the eastern half of the United States. Our model found that male deer had higher positivity than female deer, and positivity was higher in counties with higher human population density or deer habitat. Estimated SARS-CoV-2 local epidemiological reproduction numbers were between 1 and 2.5 in most well-sampled counties, with local epidemics in WTD peaking earlier in the northeast and mid-Atlantic relative to the Midwest and Southeast. Similar peak infection prevalence times across many counties provided indirect evidence for widespread transmission via human-to-deer spillover, while the widespread high estimates of local epidemiological reproduction number suggested that sustained deer-to-deer transmission is also probable. The model estimated 10% of infected WTD were infected due to human infection pressure.