bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors associated with HIV testing in people aged ⩾50 years: an integrated qualitative analysis of patients and healthcare providers
Authors: Youssef Elaney , Wright Juliet , Davies Kevin , Delpech Valerie , Brown Alison , Cooper Vanessa , Sachikonye Memory , de Visser Richard 
Published: July 2023

Background: Older people continue to be disproportionately affected by late HIV diagnosis, which results in increased morbidity and mortality. Despite high acceptance of HIV testing generally, older people are less likely to undergo testing than younger people. Two previous studies have been conducted, one focussing on patient-related and one focussing on clinician-related factors associated with HIV testing in older age (⩾50 years) Objective: This study is an integrated analysis from two linked studies – one focussed on patients, and one focussed on clinicians – to understand overlap in views and experiences of HIV testing in older age, to outline the clinical implications of the findings, and to highlight potential interventions to improve testing in this group. Methods: This qualitative study utilised semi-structured interviews conducted with 20 clinicians who were not HIV care specialists, but who had recently seen an older person prior to their HIV diagnosis, and 20 people who had been diagnosed late with HIV aged 50+. Interviews were audio recorded, transcribed verbatim and thematically analysed. The combined synthesis reported here was planned a priori as part of a sequential design. Results: Seven clinician- and seven patient-related themes were associated with undergoing HIV testing in older age. This article discusses the four themes that were common to both groups: poor knowledge, incorrect symptom attribution, inaccurate perception of risk, and stigma. Conclusion: Both clinician and patient factors associated with testing will have to be addressed in order to increase HIV testing in older people, and reduce the likelihood of late diagnosis. Findings from overlapping themes suggest several areas for intervention: (1) routine screening as part of existing clinical contacts aimed at older people to eliminate the need to attribute symptoms to HIV or assess risk; (2) specific and tailored education materials for clinicians and older people which utilise appropriate modalities; (3) tailored HIV testing services: either specific clinics for older people at existing sexual health services, or dedicated services in primary care.
Prevalence and associated risk factors for failed obstetric fistula repair in East African countries: A systematic review and meta-analysis
Authors: Ejigu Neway , Seyoum Kenbon , Kene Chala , Gomora Degefa , Mengistu Shelema , Geta Girma , Eshetu Derese , Tadesse Shimelis , Mesfin Telila , Tekalign Yohannes , Atlaw Daniel 
Published: July 2023

Objective: Obstetric fistula repair failure is a combination of unsuccessful fistula closure and/or incontinence following a successful closure. There is an inconsistent finding on the failure of obstetric fistula repair in East Africa. Therefore, this systematic review and meta-analysis aimed to determine the pooled prevalence of failed obstetric fistula repair and its associated factors among women who have undergone fistula repair in East Africa. Methods: This systematic review and meta-analysis were written following the PRISMA guideline protocol. A web-based electronic search of PubMed, Google Scholar, and HINARI was performed to find primary studies. Additional articles were searched by cross-referencing references. A random-effects model was used to estimate the pooled prevalence of failed obstetric fistula repair. The heterogeneity of studies was weighed using I2 test statistics. Publication bias was assessed by Eggers and funnel plot test. Results: The 16 studies that met the inclusion criteria for this systematic review and meta-analysis of failed obstetric fistula repair were included. Nonetheless, one study was used for factor analysis but not in pooled prevalence analysis. The pooled prevalence of obstetric fistula repair failure in East Africa was 26.89% (95% confidence interval: 21.71, 32.07). Labor duration > 48 h (Pooled odds ratio = 2.46; 95% confidence interval 1.58, 3.82), fistula size >3 cm (Pooled odds ratio = 3.92; 95% confidence interval 2.19, 7.05), previous fistula repair (Pooled odds ratio = 3.20; 95% confidence interval 1.94, 5.29), Goh Type 4 fistulas (Pooled odds ratio = 6.07; 95% confidence interval 2.50, 14.75), completely destructed urethra (Pooled odds ratio = 3.35; 95% confidence interval 1.69, 6.65), and severe vaginal scaring (Pooled odds ratio = 3.89; 95% confidence interval 1.99, 7.62) were significantly associated with obstetric fistula repair failure. Conclusions: One in four women with obstetric fistula repair experienced repair failure. To fight the problem The Ministry of Health in every part of the country, in collaboration with obstetric care providers, shall intervene on factors affecting obstetric fistula repair failure to reduce or prevent the failure of obstetric fistula repair.
A quasi-experimental study on adult weight loss using a multidimensional approach among a rural population
Authors: Burrell Chelsea 
Published: July 2023

Objectives: The study aimed to investigate the effectiveness of a yearlong digital multidimensional weight-loss intervention among residents in a southern rural community. The intervention utilized a quasi-experimental design to assess weight loss and lifestyle habit changes in volunteer individuals living in a rural community in western North Carolina. Methods: The quasi-experimental design featured pre- and post-in-person health assessments, including anthropometric measures such as body composition, blood pressure, and lifestyle habits, through a health risk questionnaire. Upon completion of the in-person pre-assessment, participants received digital health education and challenges via email and challenge runner for 1 year. Following 12 months, participants were asked to complete the post-assessment to review their results. The multidimensional weight-loss intervention was communicated via newspaper and social media to promote participation among community members, utilizing a volunteer sample. Univariate analyses were conducted to determine age, weight, BMI, and body fat percentage. A paired sample t-test was conducted on pre- and post-weight as well as pre- and post-health scores. The health score was derived from the health risk questionnaire. A bivariate Pearson correlation was conducted for post-weight and post-health score analyses. Results: The average participant was female in their mid-40s ( N = 67). Results showed insignificant statistical mean differences between pre- and post-weight and pre- and post-health scores. A Pearson correlation indicated a moderate correlation r = −0.36, p = 0.003) between post-weight and post-health score. The negative correlation indicates changes in health behavior reflected in the health score improving as weight decreased. Conclusion: The weight-loss intervention proved unsuccessful in clinical weight loss but demonstrated an association between healthy behavior changes and weight loss. However, further research is needed to solidify the current findings, as there were limitations identified in COVID-19.
Pre-operative risk stratification of high-risk prostate cancer patients can predict risk of biochemical recurrence for individual patients post radical surgery: A multi-institutional study
Authors: Devlin Conor M , Raslan Mutie , Deytrikh Andrew , Sinha Shacheesh , Murgatroyd Samuel , Yates David , Dooldeniya Mohantha , Smith Nicholas , Simms Matthew , Beekharry Ramprakash , Singh Rajindra , Molokwu Chidi , Chahal Rohit 
Published: July 2023

Introduction: The aim of this study was to identify which high-risk prostate cancer (HRPCa) patients would suffer biochemical recurrence (BCR) after radical prostatectomy (RP), providing a personalised % risk at initial consultation. BCR is more likely in HRPCa; however, the incidence is not equal in this cohort. Method: A total of 850 patients underwent RP for HRPCa in four institutions between 2013 and 2019. Immediate additional treatment post RP was exclusion criteria, leaving 832 patients. Patient demographics, pre-operative, histological features and incidence of BCR (PSA ⩾ 0.2 ng/mL) were recorded. Patients were risk-stratified patients according to having one, two or three high-risk factors. Chi-square test was used for categorical variables. Univariate analysis was performed, and BCR-free survival between groups was explored with Kaplan–Meier method. Results: Median follow-up was 48 months. Overall rate of BCR was 19.8%. Median time to BCR was 19 months. In the risk stratification analysis, 75% of patients had one risk feature. Multiple risk features carried a significantly higher risk of positive surgical margin and incidence of BCR ( p < 0.001), but not time to BCR ( p = 0.06) compared with single features. Univariate analysis demonstrated that the risk of BCR was greater with a PSA ⩾ 20 ng/mL compared to GS ⩾ 8 ( p = 0.05). Limitations of the study include limited follow-up time and BCR numbers for analysis. Conclusion: Overall, one in five high-risk patients will develop BCR by 4 years. However, those with multiple risk factors have a significantly increased risk. This aids the consultation regarding potential additional therapies alongside surgery in the treatment of HRPCa. Level of evidence: Not applicable
Symptomatic Carotid Atheroma Inflammation Lumen-stenosis score compared with Oxford and Essen risk scores to predict recurrent stroke in symptomatic carotid stenosis
Authors: Gorey Sarah , McCabe John J , Camps-Renom Pol , Giannotti Nicola , McNulty Jonathan P , Barry Mary , Cassidy Tim , Cronin Simon , Dolan Eamon , Fernández-León Alejandro , Foley Shane , Harbison Joseph , O’Connell Martin , Williams David J , Marnane Michael , Martí-Fabregas Joan , Kelly Peter J 
Published: July 2023

Background: The Oxford Carotid Stenosis tool (OCST) and Essen Stroke Risk Score (ESRS) are validated to predict recurrent stroke in patients with and without carotid stenosis. The Symptomatic Carotid Atheroma Inflammation Lumen stenosis (SCAIL) score combines stenosis and plaque inflammation on fluorodeoxyglucose positron-emission tomography (18FDG-PET). We compared SCAIL with OCST and ESRS to predict ipsilateral stroke recurrence in symptomatic carotid stenosis. Patients and methods: We pooled three prospective cohort studies of patients with recent (<30 days) non-severe ischaemic stroke/TIA and internal carotid artery stenosis (>50%). All patients had carotid 18FDG-PET/CT angiography and late follow-up, with censoring at carotid revascularisation. Results: Of 212 included patients, 16 post-PET ipsilateral recurrent strokes occurred in 343 patient-years follow-up (median 42 days (IQR 13–815)). Baseline SCAIL predicted recurrent stroke (unadjusted hazard ratio [HR] 1.96, CI 1.20–3.22, p = 0.007, adjusted HR 2.37, CI 1.31–4.29, p = 0.004). The HR for OCST was 0.996 (CI 0.987–1.006, p = 0.49) and for ESRS was 1.26 (CI 0.87–1.82, p = 0.23) (all per 1-point score increase). C-statistics were: SCAIL 0.66 (CI 0.51–0.80), OCST 0.52 (CI 0.40–0.64), ESRS 0.61 (CI 0.48–0.74). Compared with ESRS, addition of plaque inflammation (SUVmax) to ESRS improved risk prediction when analysed continuously (HR 1.51, CI 1.05–2.16, p = 0.03) and categorically ( ptrend = 0.005 for risk increase across groups; HR 3.31, CI 1.42–7.72, p = 0.006; net reclassification improvement 10%). Findings were unchanged by further addition of carotid stenosis. Conclusions: SCAIL predicted recurrent stroke, had discrimination better than chance, and improved the prognostic utility of ESRS, suggesting that measuring plaque inflammation may improve risk stratification in carotid stenosis.
Plant economic strategies in two contrasting forests
Authors: Sun Kuo , Sun Ruojun , Li Yibo , Ji Hongchao , Jia Bingrui , Xu Zhenzhu 
Published: July 2023

AbstractBackgroundPredicting relationships between plant functional traits and environmental effects in their habitats is a central issue in terms of classic ecological theories. Yet, only weak correlation with functional trait composition of local plant communities may occur, implying that some essential information might be ignored. In this study, to address this uncertainty, the objective of the study is to test whether and how the consistency of trait relationships occurs by analyzing broad variation in eight traits related to leaf morphological structure, nutrition status and physiological activity, within a large number of plant species in two distinctive but comparable harsh habitats (high-cold alpine fir forest vs. north-cold boreal coniferous forest).ResultsThe contrasting and/or consistent relationships between leaf functional traits in the two distinctive climate regions were observed. Higher specific leaf area, photosynthetic rate, and photosynthetic nitrogen use efficiency (PNUE) with lower N concentration occurred in north-cold boreal forest rather than in high-cold alpine forest, indicating the acquisitive vs. conservative resource utilizing strategies in both habitats. The principal component analysis illuminated the divergent distributions of herb and xylophyta groups at both sites. Herbs tend to have a resource acquisition strategy, particularly in boreal forest. The structural equation modeling revealed that leaf density had an indirect effect on PNUE, primarily mediated by leaf structure and photosynthesis. Most of the traits were strongly correlated with each other, highlighting the coordination and/or trade-offs.ConclusionsWe can conclude that the variations in leaf functional traits in north-cold boreal forest were largely distributed in the resource-acquisitive strategy spectrum, a quick investment-return behavior; while those in the high-cold alpine forest tended to be mainly placed at the resource-conservative strategy end. The habitat specificity for the relationships between key functional traits could be a critical determinant of local plant communities. Therefore, elucidating plant economic spectrum derived from variation in major functional traits can provide a fundamental insight into how plants cope with ecological adaptation and evolutionary strategies under environmental changes, particularly in these specific habitats.
Diagnostic accuracy of the peripheral venous pressure variation induced by an alveolar recruitment maneuver to predict fluid responsiveness during high-risk abdominal surgery
Authors: Desebbe Olivier , Vallier Sylvain , Gergelé Laurent , Alexander Brenton , Marx Alexandre , Ben Jaoude Elias , Kato Hiromi , Toubal Leila , Berna Antoine , Duranteau Jacques , Vincent Jean-Louis , Joosten Alexandre 
Published: July 2023

Abstract
Background
In patients undergoing high-risk surgery, it is recommended to titrate fluid administration using stroke volume or a dynamic variable of fluid responsiveness (FR). However, this strategy usually requires the use of a hemodynamic monitor and/or an arterial catheter. Recently, it has been shown that variations of central venous pressure (ΔCVP) during an alveolar recruitment maneuver (ARM) can predict FR and that there is a correlation between CVP and peripheral venous pressure (PVP). This prospective study tested the hypothesis that variations of PVP (ΔPVP) induced by an ARM could predict FR.

Methods
We studied 60 consecutive patients scheduled for high-risk abdominal surgery, excluding those with preoperative cardiac arrhythmias or right ventricular dysfunction. All patients had a peripheral venous catheter, a central venous catheter and a radial arterial catheter linked to a pulse contour monitoring device. PVP was always measured via an 18-gauge catheter inserted at the antecubital fossa. Then an ARM consisting of a standardized gas insufflation to reach a plateau of 30 cmH2O for 30 s was performed before skin incision. Invasive mean arterial pressure (MAP), pulse pressure, heart rate, CVP, PVP, pulse pressure variation (PPV), and stroke volume index (SVI) were recorded before ARM (T1), at the end of ARM (T2), before volume expansion (T3), and one minute after volume expansion (T4). Receiver-operating curves (ROC) analysis with the corresponding grey zone approach were performed to assess the ability of ∆PVP (index test) to predict FR, defined as an ≥ 10% increase in SVI following the administration of a 4 ml/kg balanced crystalloid solution over 5 min.

Results
∆PVP during ARM predicted FR with an area under the ROC curve of 0.76 (95%CI, 0.63 to 0.86). The optimal threshold determined by the Youden Index was a ∆PVP value of 5 mmHg (95%CI, 4 to 6) with a sensitivity of 66% (95%CI, 47 to 81) and a specificity of 82% (95%CI, 63 to 94). The AUC’s for predicting FR were not different between ΔPVP, ΔCVP, and PPV.

Conclusion
During high-risk abdominal surgery, ∆PVP induced by an ARM can moderately predict FR. Nevertheless, other hemodynamic variables did not perform better.
Effect of nalbuphine plus ropivacaine on vaginal labor in epidural analgesia
Authors: Liu Guo-hua , Liu Li-wen , Ou Lian-chun , Cao Xiao-sheng , Pang Zhao , Wen Xue-jin , He Quan-yan , Yin Biao 
Published: July 2023

Abstract
Background
Various approaches using epidural analgesia have been employed for relieving labor pain and promoting spontaneous delivery. We aimed to evaluate the effect of nalbuphine and ropivacaine versus fentanyl and ropivacaine on the duration of delivery in parturients.

Methods
Clinical data of 160 full-term primiparous women who received either nalbuphine or fentanyl in combination with ropivacaine infusion for epidural labor analgesia in our hospital from December 2020 to May 2022 were retrospectively analyzed. The participants were divided into two groups based on anesthesia methods: nalbuphine group (NR group, n = 78) received 0.2 mg/mL nalbuphine combined with 0.1% ropivacaine hydrochloride for patient-controlled epidural analgesia (PCEA) and fentanyl group (FR group, n = 82) received 2 ug/mL fentanyl citrate and 0.1% ropivacaine hydrochloride for PCEA. Both groups received an epidural blockade for labor analgesia at lumbar 2–3 interspace. The duration of the first, second, and third stages of labor, the onset of analgesia, and time before delivery (T0), 15 min of analgesia (T1), 30 min of analgesia (T2), full opening of the uterine opening (T3),exerts force during childbirth(T4), heart rate (HR), blood pressure (BP), blood saturation (SpO2), visual analogue pain scale (VAS) score, Ramsay sedation score, and modified Bromage score, and 5 min were recorded at 2 h postpartum (T5). The neonatal Apgar score, neonatal behavioral neurological assessment (NBNA) score, maternal nausea, vomiting, and itchy skin were recorded.

Results
Compared with the FR group, the first stage of labor duration (p < 0.05) and total duration of labor (p < 0.05) were shortened and the onset of analgesia (p < 0.05) was increased in the NR group. NR group had lower incidence of urinary retention than FR group (p < 0.05). The maternal and neonatal investigational parameters and scores had no significant difference between the two groups.

Conclusions
Nalbuphine combined with ropivacaine in epidural block labor has a faster onset of analgesia and has a lower incidence of urinary retention than fentanyl combined with ropivacaine, and nalbuphine shortens the duration of the first and total stages of labor. Both nalbuphine and fentanyl can reduce pain during labor, have little effect on maternal hemodynamics, and have no significant effect on neonatal Apgar or NBNA scores.
The correlation between different antihypertensive treatments and prognosis of cardiovascular disease in hypertensive patients
Authors: Liu Shengnan , Li Fei , Zhang Chao , Wei Baozhu , Wan Jing , Shao Hua 
Published: July 2023

Abstract
Objective
To determine the association between different antihypertensive regimens and cardiovascular disease (CVD) outcomes in hypertensive patients.

Method
This single center retrospective cohort study analyzed 602 hypertensive patients with complete medical records at Zhongnan Hospital of Wuhan University, China, from January 2016 to November 2022. Baseline data and follow-up data of the included patients were collected, including demographic and clinical characteristics and laboratory results.

Results
During the 5-year follow-up period, CVD outcomes occurred in 244 hypertensive patients (40.53%). Compared with patients receiving regular antihypertensive treatment, the incidence of adverse cardiovascular events in patients receiving irregular antihypertensive treatment was significantly higher (62 [55.86%] vs 182 [37.07%], HR 1.642, 95% CI 1.227–2.197, p < 0.001). In subgroup analysis, the results showed that the incidence of CVD was not identical (χ2 = 9.170, p = 0.010). The incidence of adverse cardiovascular events was highest in the single-drug antihypertensive treatment group (43.60%), followed by the multi-drug combination group (41.51%), and lowest in the two-drug combination group (29.58%). Kaplan–Meier curve showed that hypertensive patients treated with two-drug combination antihypertensive had longer overall survival time. We further compared the incidence of CVD between standard blood pressure and intensive blood pressure control, and found no significant difference in the incidence of adverse cardiovascular events between treatment to a systolic blood pressure (SBP) target of less than 140 mmHg compared with a SBP target of less than 120 mmHg (105 [43.93%] vs 35 [29.66%], HR 1.334, 95% CI 0.908–1.961, p = 0.142).

Conclusion
The incidence of adverse cardiovascular events was significantly different among different antihypertension treatments. Kaplan–Meier survival curve showed that hypertensive patients receiving two-drug combination antihypertensive treatment had longer overall survival time.