bluuebunny/crossref_metadata_2025_split huggingface dataset:
Paradoxical Embolism Is an Unusual Etiology of Acute Limb Ischemia in Patients Suffering from COVID-19 Infection
Authors: Lu Jeffrey , Morton Claire , Hall Michael , Nagarsheth Khanjan 
Published: June 2023

Acute limb ischemia (ALI) is a large contributor to morbidity and mortality annually and can be managed either operatively or medically. ALI is most often caused by arterial embolism or in situ thrombosis and treatment is often dependent upon the severity. Anticoagulation is considered standard of care and first line therapy. However, more severe cases of ALI require surgical intervention. Paradoxical emboli are a rare and potentially under-appreciated cause of ALI. They arise when venous emboli, from a variety of sources, traverse a patent foramen ovale (PFO) to enter the arterial system, compromising blood flow to the affected end organ. In most cases, they can only be proven if the thrombus is identified as it crosses the cardiac defect, at which point it is an indication for surgery requiring PFO closure, management for the ischemia itself, and possible intervention for the embolism. In this report, we identify and discuss management of a series of cases where ALI was precipitated by PFOs that were discovered in the context of a pulmonary emboli that developed into paradoxical emboli. All patients had a confirmed diagnosis of COVID-19 which has been associated with a state of hypercoagulability and subsequent thrombus formation.
A Researcher With Conclusions in Search of Questions: On Wandering Toward Ignorance
Authors: Corson Jordan 
Published: June 2023

Purpose The purpose of this paper is to provoke new understandings of the roles and uses of research. Specifically, I argue for the productive and creative potential of ignorance in educational research. Design/Approach/Methods This conceptual paper undertakes a playful experiment, beginning with conclusions and working backward to create a paper within a paper based on these conclusions. The paper then offers philosophical critiques on the generation and use of research. Findings It is a thinkable discourse that educational research begins with conclusions and works backward to justify those prefigured conclusions. It would make sense, therefore, to suggest a re-centering of inquiry. Yet, this approach to research remains grounded in stable understandings of knowledge. Rather than the transcendent approach to research, which moves from ignorance toward knowledge, this paper finds that ignorance resides in a plane of immanence, situated within and pursuing new questions. It calls for ignorance not as a means of research but as an ends. Originality/Value The paper contributes new understandings of how research can be conducted and used, welcoming new playful understandings of research, attending to shifting roles, and blurring the lines drawn between the researcher and research subjects or academic research and creative projects.
“Expectations and Perceptions of Medical Students From a 4-Week Research Module: A Longitudinal Cohort Survey”
Authors: Manzoor Shamaila , Minhas Rafia , Gulzar Zain , Sherwani Bushra , Shahid Noor 
Published: June 2023

OBJECTIVES Clinical decision-making revolves around evidence-based medicine. Evidence-based medicine entails research problems, their evaluation against available scientific literature and implementing the results into practice. Medical undergraduates lack experience in the research process. This study aimed to analyze the difference between the precourse expectations and postcourse perception of students after an interventive, mandatory research module. METHODS This longitudinal cohort survey was conducted at Azad Jammu Kashmir Medical College, Muzaffarabad. Fourth-year medical students were included in this study. After ethical review board approval, online survey questionnaires were circulated at 2 data points: before starting the research module and after it ended. Data were analyzed and nonparametric Mann-Whitney U test and Wilcoxon tests were applied to compare the difference in responses, regarding expectation and perception of the research module. RESULTS Total participants were 104; the response rate was 100% for the expectation questionnaire, whereas it dropped to 77% for the perception questionnaire. Female students had a higher response rate. In comparison of the 2 questionnaires, a statistically significant difference was observed in the student's ability to conduct literature search and critical literature appraisal ( P = .000 and .00, respectively). There was also a perceived improvement in scientific writing, problem-solving abilities, and communication skills. Overall, a significant difference was found between the expectation and perception of students. CONCLUSION Students had high expectations from the research module. After the course, their perception of their own communication skills, research abilities, scientific writing, and research aptitude has significantly improved.
Real-world experience of CAR T-cell therapy in older patients with relapsed/refractory diffuse large B-cell lymphoma
Authors: Chihara Dai , Liao Laura , Tkacz Joseph , Franco Anjali , Lewing Benjamin , Kilgore Karl M. , Nastoupil Loretta J. , Chen Lei 
Published: June 2023

Abstract
The emergence of chimeric antigen receptor (CAR) T-cell therapy has changed the treatment landscape for diffuse large B-cell lymphoma (DLBCL); however, real-world experience reporting outcomes among older patients treated with CAR T-cell therapy is limited. We leveraged the 100% Medicare fee-for-service claims database and analyzed outcomes and cost associated with CAR T-cell therapy in 551 older patients (aged ≥65 years) with DLBCL who received CAR T-cell therapy between 2018 and 2020. CAR T-cell therapy was used in third line and beyond in 19% of patients aged 65 to 69 years and 22% among those aged 70 to 74 years, compared with 13% of patients aged ≥75 years. Most patients received CAR T-cell therapy in an inpatient setting (83%), with an average length of stay of 21 days. The median event-free survival (EFS) following CAR T-cell therapy was 7.2 months. Patients aged ≥75 years had significantly shorter EFS compared with patients aged 65 to 69 and 70 to 74 years, with 12-month EFS estimates of 34%, 43%, and 52%, respectively (P = .002). The median overall survival was 17.1 months, and there was no significant difference by age groups. The median total health care cost during the 90-day follow-up was $352 572 and was similar across all age groups. CAR T-cell therapy was associated with favorable effectiveness, but the CAR T-cell therapy use in older patients was low, especially in patients aged ≥75 years, and this age group had a lower rate of EFS, which illustrates the unmet need for more accessible, effective, and tolerable therapy in older patients, especially those aged ≥75 years.
ERRα protects against sepsis-induced acute lung injury in rats
Authors: Xia Wenfang , Pan Zhou , Zhang Huanming , Zhou Qingshan , Liu Yu 
Published: June 2023

Abstract
Background
Sepsis-induced acute lung injury (ALI) is associated with poor survival rates. The identification of potential therapeutic targets for preventing sepsis-induced ALI has clinical importance. This study aims to investigate the role of estrogen-related receptor alpha (ERRα) in sepsis-induced ALI.

Methods
Lipopolysaccharide (LPS) was used to simulate sepsis-induced ALI model in rat pulmonary microvascular endothelial cells (PMVECs). The effects of ERRα overexpression and knockdown on LPS-induced endothelial permeability, apoptosis and autophagy were determined by horseradish peroxidase permeability assay, TdT-mediated dUTP Nick End Labeling (TUNEL) assay, flow cytometry, immunofluorescence staining, RT-PCR and Western Blotting. The rat model with sepsis-induced ALI was established by cecal ligation and puncture in anesthetized rats to verify the results of in vitro experiments. Animals were randomly assigned to receive intraperitoneal injection of vehicle or ERRα agonist. Lung vascular permeability, pathological injury, apoptosis and autophagy were examined.

Results
Overexpression of ERRα ameliorated LPS-induced endothelial hyperpermeability, degradation of adherens junctional molecules, upregulation of bax, cleaved caspase 3 and cleaved caspase 9 levels, downregulation of anti-apoptotic protein Bcl-2 level, and promoted the formation of autophagic flux, while the knockdown of ERRα exacerbated LPS-induced apoptosis and inhibited the activation of autophagy. Administration of ERRα agonist alleviated the pathological damage of lung tissue, increased the levels of tight junction proteins and adherens junction proteins, and decreased the expression of apoptosis-related proteins. Promoting the expression of ERRα significantly enhanced the process of autophagy and reduced CLP-induced ALI. Mechanistically, ERRα is essential to regulate the balance between autophagy and apoptosis to maintain the adherens junctional integrity.

Conclusion
ERRα protects against sepsis-induced ALI through ERRα-mediated apoptosis and autophagy. Activation of ERRα provides a new therapeutic opportunity to prevent sepsis-induced ALI.
RETRACTED ARTICLE: Associations of systemic oxygen consumption with age and body temperature under general anesthesia: retrospective cohort study
Authors: Kimura Satoshi , Shimizu Kazuyoshi , Morimatsu Hiroshi 
Published: June 2023

Abstract
Background
Body temperature (BT) is thought to have associations with oxygen consumption (VO2). However, there have been few studies in which the association between systemic VO2 and BT in humans was investigated in a wide range of BTs. The aims of this study were 1) to determine the association between VO2 and age and 2) to determine the association between VO2 and BT.

Methods
This study was a retrospective study of patients who underwent surgery under general anesthesia at a tertiary teaching hospital. VO2 was measured by the Dräger Perseus A500 anesthesia workstation (Dräger Medical, Lubeck, Germany). The associations of VO2 with age and BT were examined using spline regression and multivariable regression analysis with a random effect.

Results
A total of 7,567 cases were included in this study. A linear spline with one knot shows that VO2 was reduced by 2.1 ml/kg/min with one year of age (p < 0.001) among patients less than 18 years of age and that there was no significant change in VO2 among patients 18 years of age or older (estimate: 0.014 ml/kg/min, p = 0.08). VO2 in all bands of BT < 36.0 °C was not significantly different from VO2 in BT >  = 36 °C and < 36.5 °C. Multivariable linear regression analysis showed that compared with VO2 in BT >  = 36 °C and < 36.5 °C as a reference, VO2 levels were significantly higher by 0.57 ml/kg/min in BT >  = 36.5 °C and < 37 °C (p < 0.001), by 1.8 ml/kg/min in BT >  = 37 °C and < 37.5 °C (p < 0.001), by 3.6 ml/kg/min in BT >  = 37.5 °C and < 38 °C (p < 0.001), by 4.9 ml/kg/min in BT >  = 38 °C and < 38.5 °C (p < 0.001), and by 5.7 ml/kg/min in BT >  = 38.5 °C (p < 0.001). The associations between VO2 and BT were significantly different among categorized age groups (p = 0.03).

Conclusions
VO2 increases in parallel with increase in body temperature in a hyperthermic state but remains constant in a hypothermic state. Neonates and infants, who have high VO2, may have a large systemic organ response in VO2 to change in BT.
The correlation of hemoglobin and 28-day mortality in septic patients: secondary data mining using the MIMIC-IV database
Authors: Chen Yu , Chen Lu , Meng Zengping , Li Yi , Tang Juan , Liu Shaowen , Li Li , Zhang Peisheng , Chen Qian , Liu Yongmei 
Published: June 2023

Abstract
Background
Previous studies found minimal evidence and raised controversy about the link between hemoglobin and 28-day mortality in sepsis patients. As a result, the purpose of this study was to examine the association between hemoglobin and 28-day death in sepsis patients by analyzing the Medical Intensive Care IV (MIMIC-IV) database from 2008 to 2019 at an advanced medical center in Boston, Massachusetts.

Methods
We extracted 34,916 sepsis patients from the MIMIC-IV retrospective cohort database, using hemoglobin as the exposure variable and 28-day death as the outcome variable, and after adjusting for confounders (demographic indicators, Charlson co-morbidity index, SOFA score, vital signs, medication use status (glucocorticoids, vasoactive drugs, antibiotics, and immunoglobulins, etc.)), we investigated the independent effects of hemoglobin and 28-day risk of death by binary logistic regression as well as two-piecewise linear model, respectively.

Results
Hemoglobin levels and 28-day mortality were shown to be non-linearly related.The inflection points were 104 g/L and 128 g/L, respectively. When HGB levels were between 41 and 104 g/L, there was a 10% decrease in the risk of 28-day mortality (OR: 0.90; 95% CI: 0.87 to 0.94, p-value = 0.0001). However, in the range of 104–128 g/L, we did not observe a significant association between hemoglobin and 28-day mortality (OR: 1.17; 95% CI: 1.00 to 1.35, P value = 0.0586). When HGB was in the range of 128–207 g/L, there was a 7% increase in the risk of 28-day mortality for every 1 unit increase in HGB (OR: 1.07; 95% CI: 1.01 to 1.15, P value = 0.0424).

Conclusion
In patients with sepsis, baseline hemoglobin was related to a U-shaped risk of 28-day death. When HGB was in the range of 12.8–20.7 g/dL, there was a 7% increase in the risk of 28-day mortality for every 1 unit increase in HGB.
Determinants of partial and adequate maternal health services utilization in Nigeria: analysis of cross-sectional survey
Authors: Adedokun Sulaimon T. , Uthman Olalekan A. , Bisiriyu Luqman A. 
Published: June 2023

AbstractBackgroundAccess to health services during pregnancy, childbirth and the period after birth provides a substantial opportunity to limit cases of maternal mortality. In sub-Saharan Africa, the proportions of women who utilize health services remain below 70%. This study examined the factors associated with partial and adequate maternal health services utilization in Nigeria.MethodsThis paper used data from 2018 Nigeria Demographic and Health Survey (DHS) comprising 21,792 women aged 15–49 years who had given births within five years of the survey. The study focused on antenatal care attendance, place of birth and postnatal care using a combined model. Multinomial logistic regression was applied in the analysis.ResultsAbout 74% of the women attended antenatal care, 41% gave birth in health facilities and 21% attended postnatal care. While 68% of the women partially utilized health services, 11% adequately utilized the services. The odds of partially and adequately utilizing health services increased for ever married women, women with secondary or higher education, from richest households, living in urban area, having no problem either getting permission to visit health facility or reaching health facility.ConclusionsThis study has revealed the factors associated with partial and adequate utilization of maternal health services in Nigeria. Such factors include education, household wealth, marital status, employment status, residence, region, media exposure, getting permission to use health service, unwillingness to visit health facility without being accompanied and distance to health facility. Efforts aimed at improving maternal health services utilization should place emphasis on these factors.
Prevalence and correlates of low birth weight in India: findings from national family health survey 5
Authors: Singh Damini , Manna Sayantani , Barik Manish , Rehman Tanveer , Kanungo Srikanta , Pati Sanghamitra 
Published: June 2023

Abstract
Background
Childhood mortality and morbidity has become a major public health issue in low-middle-income countries. However, evidence suggested that Low birth weight(LBW) is one of the most important risk factors for childhood deaths and disability.This study is designed to estimate the prevalence of low birth weight (LBW) in India and to identify maternal correlates associated with LBW.

Methods
Data has been taken from National Family Health Survey 5 (2019–2021) for analysis. 149,279 women belonging to reproductive age group (15–49) year who had last recent most delivery preceding the NFHS-5 survey.

Results
Mother's age, female child, birth interval of less than 24 months, their low educational level, low wealth index, rural residence, lack of insurance coverage, women with low BMI, anaemia, and no ANC visits during pregnancy are predictors that contribute to LBW in India. After adjusting for covariates, smoking and alcohol consupmtion is strongly correlated with LBW.

Conclusion
Mother’s age, educational attainment and socioeconomic status of living has a highly significant with LBW in India. However, consumption of tobacco and cigarrettes are also associated with LBW.
Where is the father? Challenges and solutions to the inclusion of fathers in child feeding and nutrition research
Authors: Moura Andreia F. , Philippe Kaat 
Published: June 2023

AbstractDespite an increasing acknowledgement of fathers’ involvement in and impact on children’s lives, fathers remain underrepresented in child feeding and childhood obesity prevention research, interventions, and actions. Built on our own experiences with conducting research with fathers and recent evidence on this topic, this Research in Practice article has three aims. It will first substantiate the importance of including and studying fathers in the field of child feeding and childhood obesity prevention based on recent study results. Secondly, the article will present and discuss barriers to fathers' inclusion and participation (why isn't it happening?), among other issues, by drawing on sociological and gender ideological insights. Finally, it will provide recommendations and suggestions related to recruitment, focus and methods that can facilitate fathers’ involvement in future research, interventions, and practice. Taken together, this article aims to provide tools for giving fathers a voice in the field of child nutrition and by doing so, to decrease maternal-only “burden” of care. We hope our experiences and theoretical reflections will inspire and support researchers and practitioners to be as successful as possible in the realm of family care.
Widening the knowledge of non-employment as a risk factor for suicide: a Norwegian register-based population study
Authors: Øien-Ødegaard Carine , Hauge Lars Johan , Stene-Larsen Kim , Christiansen Solveig Tobie Glestad , Bjertness Espen , Reneflot Anne 
Published: June 2023

Abstract
Background
There is a known association between employment status and suicide risk. However, both reason for non-employment and the duration affects the relationship. These factors are investigated to a lesser extent. About one third of the Norwegian working age population are not currently employed. Due to the share size of this population even a small increase in suicide risk is of importance, and hence increased knowledge about this group is needed.

Methods
We used discrete time event history analysis to examine the relationship between suicide risk and non-employment due to either unemployment or health-problems, and the duration of these non-employment periods. We analyze data from the Norwegian population registry from 2004 to 2014, which includes all Norwegian residents in the ages 19–58 born between 1952 and 1989. In total the data consists of 1 063 052 men and 1 024 238 women, and 2 039 suicides.

Results
The suicide risk among the non-employed men and women is significantly higher than that of the employed. For the unemployed men, the suicide risk is significantly higher than the employed within the first 18 months. For the unemployed women we only find a significant association with suicide risk among those unemployed for six to twelve months. The suicide risk is especially increased among those with temporary health-related benefits. In the second year of health-related non-employment men have eightfold and women over twelvefold the OR for suicide, compared to the employed.

Conclusion
There is an association between non-employment and suicide risk. Compared to the employed both unemployed men and men and women with health-related non-employment have elevated suicide risk, and the duration of non-employment may be the driving force. Considering the large share of the working age population that are not employed, non-employment status should be considered in suicide risk assessment by health care professionals and welfare providers.
Pay-it-forward gonorrhea and chlamydia testing among men who have sex with men and male STD patients in China: the PIONEER pragmatic, cluster randomized controlled trial protocol
Authors: Marley Gifty , Tan Rayner Kay Jin , Wu Dan , Wang Tong , Sun Murong , Sheng Qilei , Holly Margaret Elizabeth , Hlatshwako Takhona Grace , Wang Cheng , Tang Weiming , Ramaswamy Rohit , Yang Ligang , Luo Danyang , Sylvia Sean S. , Gray Kurt , Van Duin David , Zheng Heping , Tucker Joseph D. 
Published: June 2023

Abstract
Background
Gonorrhea and chlamydia are the most common sexually transmitted diseases (STDs) among men who have sex with men (MSM) in China. Previous studies have shown pay-it-forward (PIF) interventions to be associated with a substantial increase in gonorrhea and chlamydia test uptake compared to standard-of-care. We propose a 'pay-it-forward' gonorrhea and chlamydia testing randomized controlled trial (PIONEER). The trial would evaluate the effectiveness of two pay-it-forward strategies in promoting testing uptake compared to the standard of care (in which men pay for their tests out-of-pocket) among MSM and male STD patients in China.

Methods
PIONEER will be a three-armed, pragmatic cluster randomized controlled trial (RCT), conducted across 12 clinics (six MSM-led and six public STD clinics) to compare the effectiveness of three implementation strategies. Each facility will be randomized to a standard pay-it-forward intervention of gonorrhea/ chlamydia testing with minimal encouragement for testing, a community-engaged pay-it-forward arm, or a control arm where men pay for their tests out-of-pockets. The primary outcome will be dual gonorrhea/chlamydia test uptake. Secondary outcomes will include syphilis testing, amount donated in pay-it-forward, number of positive gonorrhea and chlamydia tests, and measures of antimicrobial resistance. A sequential transformative mixed methods design will be used to evaluate the implementation process in type 2 effectiveness-implementation hybrid design. Data sources will include survey on acceptability, and feelings and attitudes towards the interventions among participants; testing and treatment uptake data from clinic records, WeChat records, and qualitative data to gain insights into men's perceptions and attitudes towards the pay-it-forward, mechanisms driving uptake, and donating behaviors. Implementers and organizers will be interviewed about fidelity and adherence to protocol, sustainability of pay-it-forward intervention, and barriers and facilitators of implementing the intervention.

Discussion
PIONEER will substantially increase gonorrhea/chlamydia testing among MSM in China, providing an innovative and new financial mechanism to sustain STD screening among sexual minorities in low- and middle-income countries. This study will answer compelling scientific questions about how best to implement pay-it-forward and the individual and organizational characteristics that moderate it.
Trial registration: The study with identification number NCT05723263 has been registered on clinicaltrials.gov/.