bluuebunny/crossref_metadata_2025_split huggingface dataset:
Deep learning classification of uveal melanoma based on histopathological images and identification of a novel indicator for prognosis of patients
Authors: Wan Qi , Ren Xiang , Wei Ran , Yue Shali , Wang Lixiang , Yin Hongbo , Tang Jing , Zhang Ming , Ma Ke , Deng Ying-ping 
Published: June 2023

Abstract
Background
Deep learning has been extensively used in digital histopathology. The purpose of this study was to test deep learning (DL) algorithms for predicting the vital status of whole-slide image (WSI) of uveal melanoma (UM).

Methods
We developed a deep learning model (Google-net) to predict the vital status of UM patients from histopathological images in TCGA-UVM cohort and validated it in an internal cohort. The histopathological DL features extracted from the model and then were applied to classify UM patients into two subtypes. The differences between two subtypes in clinical outcomes, tumor mutation, and microenvironment, and probability of drug therapeutic response were investigated further.

Results
We observed that the developed DL model can achieve a high accuracy of >  = 90% for patches and WSIs prediction. Using 14 histopathological DL features, we successfully classified UM patients into Cluster1 and Cluster2 subtypes. Compared to Cluster2, patients in the Cluster1 subtype have a poor survival outcome, increased expression levels of immune-checkpoint genes, higher immune-infiltration of CD8 + T cell and CD4 + T cells, and more sensitivity to anti-PD-1 therapy. Besides, we established and verified prognostic histopathological DL-signature and gene-signature which outperformed the traditional clinical features. Finally, a well-performed nomogram combining the DL-signature and gene-signature was constructed to predict the mortality of UM patients.

Conclusions
Our findings suggest that DL model can accurately predict vital status in UM patents just using histopathological images. We found out two subgroups based on histopathological DL features, which may in favor of immunotherapy and chemotherapy. Finally, a well-performing nomogram that combines DL-signature and gene-signature was constructed to give a more straightforward and reliable prognosis for UM patients in treatment and management.
Administrative burden in Swiss nursing homes and its association with care workers’ outcomes—a multicenter cross-sectional study
Authors: Ausserhofer Dietmar , Tappeiner Waltraud , Wieser Heike , Serdaly Christine , Simon Michael , Zúñiga Franziska , Favez Lauriane 
Published: June 2023

Abstract
Background
Care workers in nursing homes often perform tasks that are rather related to organizational or management activities than ‘direct patient care’. ‘Indirect care activities’, such as documentation or other administrative tasks are often considered by care workers as a burden, as they increase overall workload and keep them away from caring for residents. So far, there is little investigation into what kind of administrative tasks are being performed in nursing homes, by which type of care workers, and to which extent, nor how administrative burden is associated with care workers’ outcomes.

Purpose
The objective of this study was to describe care workers’ administrative burden in Swiss nursing homes and to explore the association with four care worker outcomes (i.e., job dissatisfaction, emotional exhaustion, intention to leave the current job and the profession).

Methods
This multicenter cross-sectional study used survey data from the Swiss Nursing Homes Human Resources Project 2018. It included a convenience sample of 118 nursing homes and 2′207 care workers (i.e., registered nurses, licensed practical nurses) from Switzerland’s German- and French-speaking regions. Care workers completed questionnaires assessing the administrative tasks and burden, staffing and resource adequacy, leadership ability, implicit rationing of nursing care and care worker characteristics and outcomes. For the analysis, we applied generalized linear mixed models, including individual-level nurse survey data and data on unit and facility characteristics.

Results
Overall, 73.9% (n = 1′561) of care workers felt strongly or rather strongly burdened, with one third (36.6%, n = 787) reporting to spend 2 h or more during a "normal" day performing administrative tasks. Ratings for administrative burden ranged from 42.6% (n = 884; ordering supplies and managing stocks) to 75.3% (n = 1′621; filling out the resident’s health record). One out of four care workers (25.5%, n = 561) intended to leave the profession, whereby care workers reporting higher administrative task burden (OR = 1.24; 95%CI: 1.02–1.50) were more likely to intend to leave the profession.

Conclusion
This study provides first insights on care workers’ administrative burden in nursing homes. By limiting care workers’ burdensome administrative tasks and/or shifting such tasks from higher to lower educated care workers or administrative personnel when appropriate, nursing home managers could reduce care workers’ workload and improve their job satisfaction and retention in the profession.
The effects of sildenafil citrate on intrauterine growth restriction: a systematic review and meta-analysis
Authors: Rakhanova Yenlik , Almawi Wassim Y. , Aimagambetova Gulzhanat , Riethmacher Dieter 
Published: June 2023

Abstract
Background
An increase in vascular resistance of uterine vessels is associated with intrauterine growth restriction (IUGR). Sildenafil citrate, a phosphodiesterase-5 inhibitor that stabilizes cyclic guanosine monophosphate (cGMP) and increases nitric oxide levels, improves placental perfusion by dilation of spiral arteries and is beneficial in managing IUGR. This study aims to determine the effectiveness of sildenafil citrate in improving perinatal outcomes in IUGR pregnancies.

Methods
Meta-analysis was performed on data extracted from all studies specific to sildenafil citrate in IUGR management, searching relevant articles on PubMed, Medline, Google Scholar, Embase, and Cochrane databases. Publications identified by the manual search, based on references in reviews, were also included. Dichotomous results were presented as risk ratio (95% confidence interval), while continuous results were expressed as mean difference (MD); samples represented by the random effects model.

Results
Nine trials were included where the sildenafil citrate effect was compared with a placebo or no intervention. A significant increase in birth weight [SMD (95% CI), 0.69 (0.31, 1.07)] was seen in IUGR pregnancies managed with sildenafil. However, gestational age (SMD (95% CI), 0.44 (-0.05, 0.94], fetal death rate [RR (95% CI), 0.56 (0.17, 1.79)] in IUGR pregnancies was not changed by sildenafil. Neonatal death [RR (95% CI), 0.93 (0.47, 1.86)] and neonatal intensive care unit (NICU) admissions [RR (95% CI), 0.76 (0.50, 1.17)] were not significantly different between sildenafil and control groups.

Conclusion
Sildenafil citrate increases birth weight and prolonged pregnancies but did not affect stillbirth rate, neonatal death, and NICU admission.

Trial registration
The study was registered in PROSPERO on September 18, 2021 (CRD42021271992).
How frail is frail in oncology studies? A scoping review
Authors: Fletcher James A. , Logan Benignus , Reid Natasha , Gordon Emily H. , Ladwa Rahul , Hubbard Ruth E. 
Published: June 2023

Abstract
Aims
The frailty index (FI) is one way in which frailty can be quantified. While it is measured as a continuous variable, various cut-off points have been used to categorise older adults as frail or non-frail, and these have largely been validated in the acute care or community settings for older adults without cancer. This review aimed to explore which FI categories have been applied to older adults with cancer and to determine why these categories were selected by study authors.

Methods
This scoping review searched Medline, EMBASE, Cochrane, CINAHL, and Web of Science databases for studies which measured and categorised an FI in adults with cancer. Of the 1994 screened, 41 were eligible for inclusion. Data including oncological setting, FI categories, and the references or rationale for categorisation were extracted and analysed.

Results
The FI score used to categorise participants as frail ranged from 0.06 to 0.35, with 0.35 being the most frequently used, followed by 0.25 and 0.20. The rationale for FI categories was provided in most studies but was not always relevant. Three of the included studies using an FI > 0.35 to define frailty were frequently referenced as the rationale for subsequent studies, however, the original rationale for this categorisation was unclear. Few studies sought to determine or validate optimum FI categorises in this population.

Conclusion
There is significant variability in how studies have categorised the FI in older adults with cancer. An FI ≥ 0.35 to categorise frailty was used most frequently, however an FI in this range has often represented at least moderate to severe frailty in other highly-cited studies. These findings contrast with a scoping review of highly-cited studies categorising FI in older adults without cancer, where an FI ≥ 0.25 was most common. Maintaining the FI as a continuous variable is likely to be beneficial until further validation studies determine optimum FI categories in this population. Differences in how the FI has been categorised, and indeed how older adults have been labelled as ‘frail’, limits our ability to synthesise results and to understand the impact of frailty in cancer care.
College students’ learning stress, psychological resilience and learning burnout: status quo and coping strategies
Authors: Gong Zhen , Wang Huadi , Zhong Mingxia , Shao Yuling 
Published: June 2023

AbstractBackgroundThe relationships of college students’ learning stress, psychological resilience and learning burnout remain unclear. We aimed to investigate the status quo and relationship of college students’ learning stress, psychological resilience and learning burnout, to provide insights to the management and nursing care of college students.MethodsFrom September 1 to October 31, 2022, students in our college were selected by stratified cluster sampling and underwent survey with the learning stress scale, college students’ learning burnout scale and the psychological resilience scale of college students.ResultsA total of 1680 college students were surveyed in this study. The score of learning burnout was positively correlated with the score of learning stress (r = 0.69), and negatively correlated with the score of psychological resilience (r = 0.59), and the score of learning stress was negatively correlated with the score of psychological resilience (r = 0.61). Learning pressure was correlated with the age(r=-0.60) and monthly family income(r=-0.56), the burnout was correlated with the monthly family income(r=-0.61), and psychological resilience was correlated with the age(r = 0.66) (all P < 0.05). Psychological resilience played an intermediary role in the prediction of learning burnout by learning stress, with an total intermediary role of-0.48, accounting for 75.94% of the total effect.ConclusionsPsychological resilience is the mediating variable of the influence of learning stress on learning burnout. College managers should take various effective measures to improve college students’ psychological resilience to reduce college students’ learning burnout.
Predictors of suicide attempt within 30 days of first medically documented major depression diagnosis in U.S. army soldiers with no prior suicidal ideation
Authors: Mash Holly B. Herberman , Ursano Robert J. , Kessler Ronald C. , Naifeh James A. , Fullerton Carol S. , Aliaga Pablo A. , Dinh Hieu M. , Sampson Nancy A. , Kao Tzu-Cheg , Stein Murray B. 
Published: June 2023

Abstract
Background
Understanding mental health predictors of imminent suicide attempt (SA; within 30 days) among soldiers with depression and no prior suicide ideation (SI) can inform prevention and treatment. The current study aimed to identify sociodemographic and service-related characteristics and mental disorder predictors associated with imminent SA among U.S. Army soldiers following first documented major depression diagnosis (MDD) with no history of SI.

Methods
In this case-control study using Army Study to Assess Risk and Resilience in Servicemembers (STARRS) administrative data, we identified 101,046 active-duty Regular Army enlisted soldiers (2010–2016) with medically-documented MDD and no prior SI (MDD/No-SI). We examined risk factors for SA within 30 days of first MDD/No-SI using logistic regression analyses, including socio-demographic/service-related characteristics and psychiatric diagnoses.

Results
The 101,046 soldiers with documented MDD/No-SI were primarily male (78.0%), < 29 years old (63.9%), White (58.1%), high school-educated (74.5%), currently married (62.0%) and < 21 when first entering the Army (56.9%). Among soldiers with MDD/No-SI, 2,600 (2.6%) subsequently attempted suicide, 16.2% (n = 421) within 30 days (rate: 416.6/100,000). Our final multivariable model identified: Soldiers with less than high school education (χ23 = 11.21, OR = 1.5[95%CI = 1.2–1.9]); combat medics (χ22 = 8.95, OR = 1.5[95%CI = 1.1–2.2]); bipolar disorder (OR = 3.1[95%CI = 1.5–6.3]), traumatic stress (i.e., acute reaction to stress/not PTSD; OR = 2.6[95%CI = 1.4–4.8]), and “other” diagnosis (e.g., unspecified mental disorder: OR = 5.5[95%CI = 3.8-8.0]) diagnosed same day as MDD; and those with alcohol use disorder (OR = 1.4[95%CI = 1.0-1.8]) and somatoform/dissociative disorders (OR = 1.7[95%CI = 1.0-2.8]) diagnosed before MDD were more likely to attempt suicide within 30 days. Currently married soldiers (χ22 = 6.68, OR = 0.7[95%CI = 0.6–0.9]), those in service 10 + years (χ23 = 10.06, OR = 0.4[95%CI = 0.2–0.7]), and a sleep disorder diagnosed same day as MDD (OR = 0.3[95%CI = 0.1–0.9]) were less likely.

Conclusions
SA risk within 30 days following first MDD is more likely among soldiers with less education, combat medics, and bipolar disorder, traumatic stress, and “other” disorder the same day as MDD, and alcohol use disorder and somatoform/dissociative disorders before MDD. These factors identify imminent SA risk and can be indicators for early intervention.
Psychiatric morbidity among women in Norwegian prisons, 2010–2019: a register-based study
Authors: Svendsen Vegard G , Stavseth Marianne Riksheim , Skardhamar Torbjørn , Bukten Anne 
Published: June 2023

Abstract

Purpose
Research suggests that women in prison have more mental health problems than men and are prone to suffer from more severe psychiatric disorders. This study utilizes national registry data to describe demographic and psychiatric gender differences in Norwegian prisons, and to investigate comorbid psychiatric disorders and time trends in psychiatric morbidity among women.

Methods
Longitudinal data from the Norwegian Prison Release Study linked with the Norwegian Patient Registry and data from Statistics Norway provided information on health care utilization, socioeconomic status, and history of psychiatric disorders among all individuals (nwomen = 5,429; nmen = 45,432) who were incarcerated in a Norwegian prison between 2010 and 2019.

Results
Women were more likely than men to have a history of any psychiatric disorder (75% vs. 59%). Substance use disorders and dual disorders were highly prevalent in both genders, yet highest among women (56 and 38% respectively, versus 43 and 24% among men). From 2010 to 2019, we found a considerable increase in the 12-month prevalence of most diagnostic categories among women entering prison.

Conclusion
Psychiatric and dual disorders are highly prevalent in Norwegian prisons, and especially among women. The proportion of women entering prison with a recent history of mental health problems has increased rapidly over the last decade. Women’s prison institutions need to adjust health and social services, and awareness about substance use and other psychiatric disorders in order to meet the increasing proportion of women facing these challenges.
Risk factors for hamstring strain injury in male college American football players -a preliminary prospective cohort study-
Authors: Mizutani Yuri , Taketomi Shuji , Kawaguchi Kohei , Takei Seira , Yamagami Ryota , Kono Kenichi , Kage Tomofumi , Sameshima Shin , Inui Hiroshi , Fujiwara Sayaka , Tanaka Sakae , Ogata Toru 
Published: June 2023

Abstract
Background
Given the frequency of hamstring strain injuries (HSI) among male college American football players, several studies have attempted to determine whether certain risk factors can predict their occurrence. However, no consensus on modifiable risk factors for HSIs in male college American football players has yet been reached to prevent these injuries. This study aimed to clarify risk factors for HSI prospectively in college male American football players.

Methods
A total of 78 male college American football players, whose positions were limited to skill positions, were medically assessed for potential risk factors of HSI. The preseason medical assessment included anthropometric measurements, joint laxity and flexibility, muscle flexibility, muscle strength, and balance ability.

Results
HSI occurred in a total of 25 thighs from 25 players (32.1%). Injured players had significantly lower hamstring flexibility (p = 0.02) and hamstring to quadriceps strength ratio (H/Q) (p = 0.047) compared to uninjured players. Additionally, injured players had significantly lower general joint laxity scores, especially for the total (p = 0.04), hip (p = 0.007), and elbow (p = 0.04) scores, compared to uninjured players.

Conclusions
Lower hamstring flexibility, lower hamstring to quadriceps strength ratio, and lower general joint laxity score were identified as risk factors for HSI in male college American football players placed in skill positions. The muscle flexibility and H/Q ratio could be useful in preventing HSI in such players.
Economic impact of a more extensive use of FENO testing on the Italian population with asthma
Authors: Rognoni Carla , Milano Carlo , Heffler Enrico , Bonini Matteo , Brussino Luisa , Carpagnano Giovanna Elisiana , Ricciardolo Fabio Luigi Massimo , Costa Francesco , Armeni Patrizio 
Published: June 2023

Abstract
Background
Asthma is a common chronic inflammatory airway affecting over 260 million people worldwide, and characterized, in the large majority of cases, by the so-called “type 2 inflammation”. Fractional exhaled nitric oxide (FENO) testing is noninvasive point-of-care tool to assess type 2 inflammation and therefore improve asthma management. It has been suggested to determine eligibility for a specific biologic therapy and predict likelihood to respond. The aim of this study was to estimate the overall economic impact of an extensive use of FENO testing on the Italian population with asthma, including extra costs of testing and savings generated by more appropriate prescriptions, increased adherence and lower frequency of exacerbations.

Methods
A cost of illness analysis was firstly performed to estimate the yearly economic burden from the National Healthcare Service (NHS) perspective in Italy of the management of asthmatic patients with standard of care (SOC) according to the application of GINA (Global Initiative for Asthma) guidelines; then, we evaluated the changes in the economic burden in patient management by introducing FENO testing into clinical practice. The cost items considered were: visits/exams, exacerbations, drugs, management of adverse events caused by short-term oral corticosteroids use. Efficacy of FeNO test and SOC is based on literature evidence. Costs refer to published data or Diagnosis Related Group/outpatient tariffs.

Results
Considering one asthma visit every 6 months, the total yearly cost for the management of patients with asthma in Italy is 1,599,217,876€ (409.07€ per patient), while for FENO testing strategy this figure is 1,395,029,747€ (356.84€ per patient). An increased utilization rate of FENO testing from 50 to 100% of patients may lead to savings for the NHS from about 102 to 204 million € compared to SOC.

Conclusions
Our study showed that FeNO testing strategy may improve the management of asthmatic patients leading to significant savings for the NHS.
Synergistic apoptosis by combination of metformin and an O-GlcNAcylation inhibitor in colon cancer cells
Authors: Lee Da Eun , Lee Geun Yong , Lee Hae Min , Choi Soo Young , Lee Su Jin , Kwon Oh-Shin 
Published: June 2023

Abstract
Background
Although autophagy is an important mediator of metformin antitumor activity, the role of metformin in the crosstalk between autophagy and apoptosis remains unclear. The aim was to confirm the anticancer effect by inducing apoptosis by co-treatment with metformin and OSMI-1, an inhibitor of O-GlcNAcylation, in colon cancer cells.

Methods
Cell viability was measured by MTT in colon cancer cell lines HCT116 and SW620 cells. Co-treatment with metformin and OSMI-1 induced autophagy and apoptosis, which was analyzed using western blot, reverse transcription-polymerase chain reaction (RT-PCR) analysis, and fluorescence-activated cell sorting (FACS). Combined treatment with metformin and OSMI-1 synergistically inhibit the growth of HCT116 was confirmed by xenograft tumors.

Results
We showed that metformin inhibited mammalian target of rapamycin (mTOR) activity by inducing high levels of C/EBP homologous protein (CHOP) expression through endoplasmic reticulum (ER) stress and activating adenosine monophosphate-activated protein kinase (AMPK) to induce autophagy in HCT116 cells. Interestingly, metformin increased O-GlcNAcylation and glutamine:fructose-6-phosphate amidotransferase (GFAT) levels in HCT116 cells. Thus, metformin also blocks autophagy by enhancing O-GlcNAcylation, whereas OSMI-1 increases autophagy via ER stress. In contrast, combined metformin and OSMI-1 treatment resulted in continuous induction of autophagy and disruption of O-GlcNAcylation homeostasis, resulting in excessive autophagic flux, which synergistically induced apoptosis. Downregulation of Bcl2 promoted apoptosis via the activation of c-Jun N-terminal kinase (JNK) and CHOP overexpression, synergistically inducing apoptosis. The activation of IRE1α/JNK signaling by OSMI-1 and PERK/CHOP signaling by metformin combined to inhibit Bcl2 activity, ultimately leading to the upregulation of cytochrome c release and activation of caspase-3.

Conclusions
In conclusion, combinatorial treatment of HCT116 cells with metformin and OSMI-1 resulted in more synergistic apoptosis being induced by enhancement of signal activation through ER stress-induced signaling rather than the cell protective autophagy function. These results in HCT116 cells were also confirmed in xenograft models, suggesting that this combination strategy could be utilized for colon cancer treatment.