bluuebunny/crossref_metadata_2025_split huggingface dataset:
Regional Variation in HPV Knowledge and Awareness among American Indians and Alaska Natives: An Analysis of the Health Information National Trends Survey, 2011–2020
Authors: Sherman Bendu M. , Islam Jessica Y. , Gartner Danielle R. 
Published: August 2023

Abstract

Background:
American Indian and Alaskan Native (AIAN) people experience a disproportionately high incidence of human papillomavirus (HPV)-related cancers and mortality, and these rates vary across geographic regions. To address the unexplained regional differences among AIAN people, we describe regional variations and sociodemographic correlates of HPV-related knowledge and HPV vaccination awareness indicators.

Methods:
A cross-sectional study was implemented with data for 866 AIAN respondents pooled from eight cycles of the Health Information National Trends Survey. We used χ2 tests to determine whether there were regional differences in the indicators and then used multivariable, modified Poisson regression to explore associations between sociodemographic characteristics and HPV-related knowledge and vaccination awareness measures.

Results:
Of the 13 indicators, just one demonstrated regional variation. However, we observed a high level of uncertainty regarding HPV and HPV vaccine–related knowledge and experience. We also observed that women were more likely than men to have heard of HPV [adjusted prevalence ratio (aPR), 1.29; 95% confidence interval (CI):1.03–1.63], the HPV vaccine (aPR, 1.59; 95% CI: 1.15–2.22), and to have discussed it with their providers (aPR, 3.69; 95% CI: 1.47–9.28). There were also differences by age, education, and insurance status.

Conclusions:
High levels of uncertainty and lack of regional variation in indicators suggest that there may be missed opportunities across Indian Country for engagement between health care providers and AIAN in HPV-related conversations.

Impact:
Efforts toward improving HPV knowledge and vaccination should target all at-risk sexes (and genders), age groups, and education levels. Moreover, AIAN-serving health care providers should be empowered with sufficient understanding, so they are prepared for discussions with at-risk patients.
Temporal Trends of Stages and Survival of Biliary Tract Cancers in the United States and Associations with Demographic Factors
Authors: Wen Wanqing , Mumma Michael , Zheng Wei 
Published: August 2023

Abstract

Background:
The incidence of cholangiocarcinoma and gallbladder cancer has been increasing and decreasing respectively in the United States, whereas their mortality has been declining since 1980, which suggests improved overall survival of biliary tract cancers (BTC). We aimed to investigate temporal trends of BTC stages and survival and their associations with demographic factors.

Methods:
A total of 55,163 patients with BTC collected from 2000 to 2018 from the NCI Surveillance, Epidemiology, and End Results 18 registry were included in this study. We assessed the temporal trend of BTC stages with diagnosis years using the annual percentage of change (APC) in the proportion of the stages. We estimated the association of BTC survival and stages with diagnosis years and demographic factors using the Cox regression models.

Results:
While localized BTC proportion remained little changed from 2006 to 2018, the proportion of regional and distant BTCs significantly decreased (APC = −2.3%) and increased (APC = 2.7%), respectively, through the years. The overall and cancer-specific survival increased from 41.0% and 47.3% in 2000 to 2004 to 51.2% and 53.8% in 2015 to 2018, respectively. Patients with BTC who were older, Black, unmarried, or had lower socioeconomic status (SES) had significantly poorer overall survival.

Conclusions:
We found that distant and regional BTC significantly increased and decreased, respectively, and the BTC survival significantly improved over time. Age, sex, race, SES, and marital status were significantly associated with overall survival and less evidently with cancer-specific survival of patients with BTC.

Impact:
Our findings suggest that demographic factors were associated with BTC stages and BTC survival.
Comprehensive Analysis of Tumor Microenvironment Reveals Prognostic ceRNA Network Related to Immune Infiltration in Sarcoma
Authors: Leng Dongliang , Yang Ziyi , Sun Heng , Song Chengcheng , Huang Chen , Ip Ka U. , Chen Guokai , Deng Chu-Xia , Zhang Xiaohua Douglas , Zhao Qi 
Published: August 2023

Abstract

Purpose:
Sarcoma is the second most common solid tumor type in children and adolescents. The high level of tumor heterogeneity as well as aggressive behavior of sarcomas brings serious difficulties to developing effective therapeutic strategies for clinical application. Therefore, it is of great importance to identify accurate biomarkers for early detection and prognostic prediction of sarcomas.

Experimental Design:
In this study, we characterized three subtypes of sarcomas based on tumor immune infiltration levels (TIIL), and constructed a prognosis-related competing endogenous RNA (ceRNA) network to investigate molecular regulations in the sarcoma tumor microenvironment (TME). We further built a subnetwork consisting of mRNAs and lncRNAs that are targets of key miRNAs and strongly correlated with each other in the ceRNA network. After validation using public data and experiments in vivo and in vitro, we deeply dug the biological role of the miRNAs and lncRNAs in a subnetwork and their impact on TME.

Results:
Altogether, 5 miRNAs (hsa-mir-125b-2, hsa-mir-135a-1, hsa-mir92a-2, hsa-mir-181a-2, and hsa-mir-214), 3 lncRNAs (LINC00641, LINC01146, and LINC00892), and 10 mRNAs (AGO2, CXCL10, CD86, CASP1, IKZF1, CD27, CD247, CD69, CCR2, and CSF2RB) in the subnetwork were identified as vital regulators to shape the TME. On the basis of the systematic network, we identified that trichostatin A, a pan-HDAC inhibitor, could potentially regulate the TME of sarcoma, thereby inhibiting the tumor growth.

Conclusions:
Our study identifies a ceRNA network as a promising biomarker for sarcoma. This system provides a more comprehensive understanding and a novel perspective of how ceRNAs are involved in shaping sarcoma TME.
The Two- to Four-Day Predictability of Midlatitude Cyclones: Don’t Sweat the Small Stuff
Authors: Lloveras Daniel J. , Durran Dale R. , Doyle James D. 
Published: August 2023

Abstract
We use convection-permitting idealized simulations of moist midlatitude cyclones to compare the growth of synoptic-scale perturbations derived from an adjoint model with the growth of equal-energy-norm, monochromatic-wavelength perturbations at the smallest resolved scale. For initial magnitudes comparable to those of initial-condition uncertainties in present-day data assimilation systems, the adjoint perturbations produce a “forecast bust,” significantly changing the intensity and location of the cyclone and its accompanying precipitation. In contrast, the small-scale-wave perturbations project strongly onto the moist convection, but the upscale growth from the random displacement of individual convective cells does not significantly alter the cyclone’s development nor its accompanying precipitation through 2–4-day lead times. Instead, the differences in convection generated at early times become negligible because the development of subsequent convection is driven by the mostly unchanged synoptic-scale flow. Reducing the perturbation magnitudes by factors of 10 and 100 demonstrates that nonlinear dynamics play an important role in the displacement of the cyclone by the full-magnitude adjoint perturbations, and that the upscale growth of small-magnitude, small-scale perturbations is too slow to significantly change the cyclone. These results suggest that a sensitive dependence on the synoptic-scale initial conditions, analogous to that of the Lorenz (1963) system, may be more relevant to 2–4-day midlatitude-cyclone forecast busts than the upscale error growth in the Lorenz (1969) model.
High-flow nasal cannula therapy in patients with COVID-19 in intensive care units in a country with limited resources: a single-center experience
Authors: Phan Anh-Minh Vu , Hoang Hai-Yen Thi , Truong Do Thanh-Son , Hoang Trung Quoc , Phan Thuan Van , Huynh Nguyet-Anh Phuong , Minh Le Khoi 
Published: August 2023

Objective This study was performed to determine the outcomes of patients with coronavirus disease 2019 (COVID-19) who developed hypoxemic respiratory failure necessitating high-flow nasal cannula (HFNC) therapy and to identify the predictors of HFNC therapy success. Methods This retrospective observational study involved all patients treated with HFNC therapy at a center for COVID-19 in Viet Nam from August to October 2021. Results The study recruited 302 patients. Of these 302 patients, 171 (56.6%) underwent successful HFNC therapy, and the all-cause mortality rate was 33.44%. Non-critical COVID-19 and a higher respiratory rate–oxygenation (ROX) index at 48 hours after initiating HFNC therapy were independently correlated with HFNC therapy success. The statistically significant predictors of HFNC therapy success were younger age, non-critical COVID-19, a higher platelet count when starting HFNC therapy, and a higher ROX index at 24, 36, and 48 hours after HFNC therapy initiation. Conclusions HFNC therapy appears to be effective in patients with COVID-19 who develop respiratory failure requiring respiratory support. Non-critical COVID-19 and a higher ROX index measured 48 hours after HFNC therapy initiation might serve as predictive factors for the success of HFNC therapy.
Immediate effect of alpha-blockers in predicting LUTS improvement in BPH patients
Authors: Sevach Prashant , Sharma Govind , Priyadarshi Shivam , Faujdar Gaurav 
Published: August 2023

Introduction: Indications for treating Benign Prostatic Hyperplasia include reversing signs and symptoms or preventing the progression of the disease. Alpha-blockers are the most effective, least costly, and best tolerated of the drugs for relieving LUTS. The aim of the study is to investigate the immediate impact of alpha-blocker medications on lower urinary tract symptoms (LUTS). Materials and methodology: About 100 patients were included in the study—50 patients in each of the groups A (tamsulosin) and B (silodosin). The first visit was the baseline examination before starting alpha-blockers and included history, DRE, UFM, USG KUBP with PVR, IPSS, serum PSA, serum creatinine, urine analysis, urine culture, and sensitivity. All above parameters were also at 1 week, 1 month, and 3 months following starting of alpha-blockers respectively, and compared with baseline. Result: As of the first, second, third, and fourth visits, the mean Qmax in group A was 10.3 ± 3.3 s, 15.08 ± 2.80 s, 15.66 ± 3.18 s, and 15.12 ± 3.24 s, respectively, while in group B it was 10.1 ± 3.1 s, 14.88 ± 2.80 s, 15.18 ± 3.18 s, and 15.08 ± 3.24 s, respectively ( p < 0.001). The mean voiding time was 40.87 ± 23.91 s, 36.41 ± 20.73 s, 34.85 ± 21.37 s, and 32.07 ± 21.81 s, respectively in group A, and 41.27 ± 15.49 s, 37.23 ± 21.34 s, 38.59 ± 20.83 s, and 33.10 ±22.08. In group A, the mean PVR and IPSS scores were improved and also improved in group B. Conclusion: The first dose of tamsulosin and silodosin improves UFM and predicts the mid-term change in UFM as well as IPSS indices in the treatment of BPH-related LUTS.
Trade-Offs Faced by 2-and 4-Year College Students Experiencing Food Insecurity: An Analysis of Qualitative Data
Authors: McGuire Cydney M. , Stebleton Michael J. , Lenk Kathleen M. , Lust Katherine , Porta Carolyn M. , Laska Melissa N. 
Published: August 2023

Purpose To understand the trade-offs, defined as compromises or decisions students must make to prioritize one important need over another, as a result of economic constraints, food insecure (FI) college students experience and the perceived impact of these challenges on health, well-being, and academic achievement. Design 8 Semi-structured focus groups. Setting Seven 2- and 4-year Minnesota colleges. Participants 53 students initially screening positive for FI. Method The focus groups were audio-recorded and transcribed verbatim. Thematic analysis, a systematic approach for identifying and analyzing patterns across qualitative data, was used through four analysis phases to identify themes and categories. Results We identified five themes within trade-offs: sacrificing food, missing out on relationships, sacrificing academic studies, choosing between basic needs, and maintaining physical and mental well-being. The trade-offs students described were multifaceted, caused notable stress and worry, and presented challenges to students’ well-being. Conclusion This study provides evidence on the complexities of FI among students and details on what students may be sacrificing as a result of making trade-offs. Understanding the trade-offs students are experiencing can help college staff to prioritize which issues to focus on to improve student health and academic performance.
Palliative Care against Medically Assisted Death? Misunderstanding and Instrumental Objections
Authors: Patuzzo Sara , Pulice Elisabetta , Orsi Luciano 
Published: August 2023

Context Palliative Care (PC) and Medically Assisted Death (MAD), specifically assisted suicide and euthanasia, are distinct practices characterized by differing objectives, methods, implementation and outcomes. Representatives of PC, including scientific societies or physicians, may, in certain cases, adopt a critical stance towards MAD. Objectives The study aims to explore the underlying reasons for such opposition. Methods To this end, the philosophical underpinnings and legal conditions of PC and MAD will be analyzed. Results The ethical and philosophical landscape of PC and MAD leads us to identify, on one hand, the Hippocratic paradigm and, on the other hand, what we call Socratic medicine. From a legal analysis perspective, the presence of intolerable suffering serves as a common ground between the two practices, albeit risking being the subject of misunderstandings and instrumental objections. Conclusion Preventing an instrumental use of PC in relation to MAD is crucial to enable the respect and the coexistence of the two practices.
Dietary Diversity, Nutritional Status, and Associated Factors Among Pregnant Women in Their First Trimester of Pregnancy in Ambo District, Western Ethiopia
Authors: Gebremichael Mitsiwat Abebe , Belachew Lema Tefera 
Published: August 2023

Background: Poor dietary diversity and undernutrition is a major public health concern for pregnant mothers. Optimal dietary diversity is essential during pregnancy since nutritional deficiencies may have a significant impact on both the mother’s and the fetus’s health. Pregnant women in Ambo district had inadequate dietary diversity and were undernourished, but their status during the first trimester of pregnancy was not known. As a result, the objective of this research was to assess the dietary diversity, nutritional status, and associated factors among pregnant women in the Ambo district. Methods: A community-based cross-sectional study design and a multi-stage sampling technique were used among 750 pregnant women. Data was gathered using a semi-structured questionnaire. The Food and Nutrition Technical Assistance questionnaire was modified to collect data on dietary diversity. The nutritional status of pregnant women was assessed by measuring the mid-upper arm circumference. First, descriptive statistics like mean, Standard deviation, frequency and percentage were used, then bivariable and, finally, multivariable logistic regression analysis was used to assess the association of the predictors with the outcome variable. Result: The study revealed that 73.6% and 23.9% of pregnant women had low dietary diversity and were undernourished, respectively. Being in food secured household (AOR = 4.44, 95% CI: 2.14-9.15), having good knowledge (AOR = 3.32, 95% CI: 2.10-5.23) and favorable attitude toward nutrition and health (AOR = 1.71, 95% CI: 1.10-2.66) were significantly associated with dietary diversity, whereas household size (having 1-3 household members AOR = 6.59, 95% CI: 2.53-17.21, having 4-5 household members AOR = 5.62, 95% CI: 3.15-9.99), being in food secured household (AOR = 5.64, 95% CI: 2.79-11.38), having high dietary diversity (AOR = 8.49, 95% CI: 2.47-29.23), and having optimal practice on nutrition and health (AOR = 6.85, 95% CI: 3.23-14.55) were significantly associated with undernutrition ( P < .05). Conclusions: The current study revealed that pregnant women in the study area had inadequate dietary diversity practices and a high prevalence of undernutrition. Knowledge and attitude, and households’ food security status were the predictors of dietary diversity, while household size, household food security status, dietary diversity and nutrition and health practice were predictors of undernutrition. Hence, behavior change communication needs to be designed to improve the dietary diversity and nutritional status of pregnant women.
The arrival ward requiring help by wheelchair or medical cart, arterial oxygenation index, age, albumin and neutrophil count score: Predicting in-hospital mortality in Chinese patients with acute exacerbations of chronic obstructive pulmonary disease
Authors: Chen Dawei , Chen Caimei , Zhang Pan , Zhang Feng , Zhang Hao , Sun Qing , Sun Jian , Tan Yan , Pan Binbin , Wan Xin 
Published: August 2023

Background In this study, we will derive and validate a prognostic tool to predict in-hospital death based on Chinese acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients. Methods Independent predictors of in-hospital death were identified by logistic regression analysis and incorporated into a clinical prediction tool. Results The clinical prediction model was developed with data from 1121 patients and validated with data from 245 patients. The five predictors of in-hospital death from the development cohort (Arrival ward requiring help by wheelchair or medical cart, Arterial oxygenation index, Age, Albumin and Neutrophil count) were combined to form the AAAAN Score. The AAAAN Score achieved good discrimination (AUC = 0.85, 95% CI 0.81–0.89) and calibration (Hosmer-Lemeshow chi-square value was 3.33, p = 0.65). The AAAAN Score, which underwent internal bootstrap validation, also showed excellent discrimination for mortality (AUC = 0.85, 95% CI 0.81 to 0.89) and performed more strongly than other clinical prediction tools. Patients were categorized into 3 risk groups based on the scores: low risk (0–2 points, 0.7% in-hospital mortality), intermediate risk (3–4 points, 4.1% in-hospital mortality), and high risk (5–7 points, 23.4% in-hospital mortality). Predictive performance was confirmed by external validation. Conclusions The AAAAN Score is a prognostic tool to predict in-hospital death in Chinese AECOPD patients.
Impact of Preoperative Motor Status for the Positive Predictive Value of Transcranial Motor-Evoked Potentials Alerts in Thoracic Spine Surgery: A Prospective Multicenter Study by the Monitoring Committee of the Japanese Society for Spine Surgery and Related Research
Authors: Funaba Masahiro , Kanchiku Tsukasa , Yoshida Go , Machino Masaaki , Ushirozako Hiroki , Kawabata Shigenori , Ando Muneharu , Yamada Kei , Iwasaki Hiroshi , Shigematsu Hideki , Fujiwara Yasushi , Tadokoro Nobuaki , Takahashi Masahito , Taniguchi Shinichirou , Wada Kanichiro , Yamamoto Naoya , Yasuda Akimasa , Morito Shinji , Hashimoto Jun , Takatani Tsunenori , Kobayashi Kazuyoshi , Ando Kei , Kurosu Kenta , Segi Naoki , Nakashima Hiroaki , Nakanishi Kazuyoshi , Takeshita Katsushi , Matsuyama Yukihiro , Imagama Shiro 
Published: August 2023

Study Design Prospective multicenter study. Objective To investigate the validity of transcranial motor-evoked potentials (Tc-MEP) in thoracic spine surgery and evaluate the impact of specific factors associated with positive predictive value (PPV). Methods One thousand hundred and fifty-six cases of thoracic spine surgeries were examined by comparing patient backgrounds, disease type, preoperative motor status, and Tc-MEP alert timing. Tc-MEP alerts were defined as an amplitude decrease of more than 70% from the baseline waveform. Factors were compared according to preoperative motor status and the result of Tc-MEP alerts. Factors that showed significant differences were identified by univariate and multivariate analysis. Results Overall sensitivity was 91.9% and specificity was 88.4%. The PPV was significantly higher in the preoperative motor deficits group than in the preoperative no-motor deficits group for both high-risk (60.3% vs 38.3%) and non-high-risk surgery groups (35.1% vs 12.8%). In multivariate logistic analysis, the significant factors associated with true positive were surgical maneuvers related to ossification of the posterior longitudinal ligament (odds ratio = 11.88; 95% CI: 3.17–44.55), resection of intradural intramedullary spinal cord tumor (odds ratio = 8.83; 95% CI: 2.89–27), preoperative motor deficit (odds ratio = 3.46; 95% CI: 1.64–7.3) and resection of intradural extramedullary spinal cord tumor (odds ratio = 3.0; 95% CI: 1.16–7.8). The significant factor associated with false positive was non-attributable alerts (odds ratio = .28; 95% CI: .09–.85). Conclusion Surgeons are strongly encouraged to use Tc-MEP in patients with preoperative motor deficits, regardless of whether they are undergoing high-risk spine surgery or not. Knowledge of PPV characteristics will greatly assist in effective Tc-MEP enforcement and minimize neurological complications with appropriate interventions.
‘It was called a grab bag and nobody wanted to grab them’: Teachers’ perceptions of school lunches during the COVID-19 pandemic – a regional case study
Authors: Zaremba SMM , Cook WB , Anderson AS 
Published: August 2023

Background: The COVID-19 pandemic brought changes to primary school lunches leading to concerns over nutritional quality and uptake of lunches by vulnerable children. Regional data from Tayside, Scotland, showed that only 55% of children who were eligible for free school meals took these (normal uptake pre-pandemic was 66%). The current work aimed to identify teachers’ perceptions of meal provisioning in primary schools during the first year of the COVID-19 pandemic. Design and methods: A cross-sectional online survey was carried out among primary school teachers across Tayside, Scotland. Using an online survey (21 questions combining multiple choice formats and open text) and interviews, primary school teachers shared their views on food quality, quantity, meal choices and factors influencing uptake of primary school lunches. Interviews were recorded, transcribed and thematically analysed with respect to factors influencing consumption. Results: The survey was completed by 41 teachers and 8 participated in a follow up interview. Around one-third (29%) of primary school teachers believed the quality of lunches had decreased and cited poor appearance of food, use of takeaway containers and food wastage. The lunch format was viewed negatively principally relating to the substitution of hot lunches with cold sandwiches, portion sizes, choice and perceived value for money. Concerns were expressed about acceptability and how far the meals contributed to food security. Conclusions: Further work on food provisioning is needed in order to identify ways to provide a nutritional safety net for vulnerable children.