bluuebunny/crossref_metadata_2025_split huggingface dataset:
Physician assistant/associate retirement intent: seeking the exit ramp
Authors: Hooker Roderick S. , Kozikowski Andrzej , Cawley James F. , Puckett Kasey 
Published: September 2022

Abstract
Background
Retirement patterns for American physician assistants/associates (PAs) are in flux as the first substantial cadre trained in the 1970s makes their retirement choices. The growing and aging of the US population is increasing the demand for healthcare services. At the same time, provider retirement can decrease patient access to care, disrupt continuity of care and lead to poorer health outcomes. Knowing PA intentions to retire and the retirement patterns can be useful to health system employers and workforce policymakers. The purpose of this study was to investigate the retirement patterns of PAs within the United States. We investigated their characteristics, career roles, and intent to depart from clinical practice.

Methods
Drawing on the National Commission on Certification of Physician Assistants (NCCPA) 2020 health workforce data (N = 105,699), the associations of demographics (age, gender, US region, and years certified), and practice attributes (specialty and practice setting) of clinically active PAs were assessed with intending to retire in the next five years. Analyses for this national cross-sectional study included descriptive statistics, Chi-square, and Fisher’s Exact test, as appropriate. A p-value of 0.05 or less was considered statistically significant for all analyses where a comparison was made.

Results
Overall, 5.8% of respondents indicated that they intend to retire within five years. We detected significant differences (all p < 0.001) on intentions to retire by age group, gender, US region, years certified, specialty, and practice setting. Respondents 70 years and older compared to those 60–69 were more likely (66.5% vs. 48.9%), males compared to females (8.8% vs. 4.4%), those who have been certified for more than 21 years compared to 11–20 years (25.6% vs. 4.0%), PAs practicing in family medicine compared to dermatology (7.7% vs. 3.4%) and those in the federal government practice setting compared to rural health clinic (13.6% vs. 9.8%) reported they were more likely to retire in the next five years.

Conclusions
Our study provides a comprehensive snapshot of PA retirement intentions using a robust national dataset. Among the most important factors associated with intent to retire in this study were older age and duration of PA career. Most PAs are remaining clinically active into their seventh decade—suggesting that they are integrated into medical systems that value them and they, in turn, value their role.
Challenges for implementation of inter-sectoral efforts to improve outbreak response using consolidated framework for implementation research; Iran’s COVID-19 experience
Authors: Mirzania Marjan , Shakibazadeh Elham , Ashoorkhani Mahnaz 
Published: September 2022

Abstract
Background
The recurrence of emerging infectious diseases reminds us that rapid response to related outbreaks require coordinated inter-sectoral/ organizational and trans-disciplinary approaches. This study examined the challenges for implementation of inter-sectoral efforts to improve COVID-19 pandemic response in Iran using the consolidated framework for implementation research (CFIR).

Methods
We conducted a qualitative content analysis of in-depth interviews between March 2020 and February 2021 in Tehran, Iran. Participants included health professionals and experts involved in the prevention, treatment and control of COVID-19 pandemic from different levels of the health system (macro: Ministry of Health and Iranian National Institute of Health Research; meso: universities of medical sciences and health services; and micro: hospitals), selected using purposive sampling. Recorded interviews were transcribed verbatim and coded using a deductive approach (CFIR constructs).

Results
In total, 12 interviews with the participants were conducted; and eight themes emerged as the most important challenges for implementation of inter-sectoral efforts to improve outbreak response in COVID-19. These challenges include lack of proper intervention sources, complexity, poor networking with external organizations, cultural issues, inadequate availability of resources, inadequate access to knowledge and information about inter-sectoral collaboration implementation, and planning issues for it.

Conclusions
Implementing inter-sectoral efforts to improve outbreak response require addressing several implementation challenges. There should be effective leadership and command system, prioritizing the problem, having proper intra-sector collaboration, adequate supervisory, strong social capital, managers and officials’ positive beliefs and organizational culture towards inter-sectoral collaboration, sufficient knowledge and information about the implementation, and providing proper programs to implement inter-sectoral collaboration. These findings recall the need to develop and in particular, implement a specific infra-structure through a well-designed program at the government level to strengthen this approach.
Sarcopenia in idiopathic pulmonary fibrosis: a prospective study exploring prevalence, associated factors and diagnostic approach
Authors: Faverio Paola , Fumagalli Alessia , Conti Sara , Madotto Fabiana , Bini Francesco , Harari Sergio , Mondoni Michele , Oggionni Tiberio , Barisione Emanuela , Ceruti Paolo , Papetti Maria Chiara , Bodini Bruno Dino , Caminati Antonella , Valentino Angela , Centanni Stefano , Lanzi Paola , Della Zoppa Matteo , Crotti Silvia , Grosso Marco , Sukkar Samir Giuseppe , Modina Denise , Andreoli Marco , Nicali Roberta , Suigo Giulia , Busnelli Sara , Paciocco Giuseppe , Lettieri Sara , Mantovani Lorenzo Giovanni , Cesana Giancarlo , Pesci Alberto , Luppi Fabrizio 
Published: September 2022

Abstract
Background
Sarcopenia gained importance in the evaluation of patients with chronic respiratory diseases, including idiopathic pulmonary fibrosis (IPF), since it may impact negatively on clinical outcomes.

Aim
Aim of this study is to evaluate the prevalence and factors associated with sarcopenia, defined according to the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) 2019 definition, and to evaluate the prevalence of the single criteria that define the EWGSOP2 definition (muscle strength, muscle quantity and physical performance), in a cohort of consecutive patients with IPF prospectively followed up in 9 hospitals in Northern Italy between December 2018 and May 2021.

Methods
Enrolled patients underwent an extensive pulmonary and nutritional assessment, including bioelectrical impedance analysis, dynamometry and 4-m gait speed test, both at IPF diagnosis and at 6-month follow-up.

Results
Out of the 83 patients (81% males, mean age 72.5 years) with IPF at disease diagnosis enrolled in the study, 19 (22.9%) showed sarcopenia, including 2 (2.4%) with severe sarcopenia, 5 (6.0%) with confirmed sarcopenia and 12 (14.5%) with probable sarcopenia. Sarcopenia was associated with a significantly higher severity of the disease and sedentary lifestyle, while no differences were observed in regards to body mass index, history of weight loss and comorbidities between patients with and without sarcopenia. Out of the 64 patients without sarcopenia at baseline, 16 cases showed alteration of muscle quantity and/or physical performance. In the 51 patients with complete data at 6-month follow-up, there were no cases of severe sarcopenia, 1 case (2.0%) showed confirmed sarcopenia, while the prevalence of probable sarcopenia was 19.6% (10 cases). No differences in regards to antifibrotic treatment received and onset of gastrointestinal side effects were observed between patients with and without sarcopenia at follow-up.

Conclusions
The prevalence of sarcopenia in patients with IPF both at diagnosis and at 6-month follow-up was low but not negligible and was associated with higher severity of the disease and sedentary lifestyle. In IPF patients, a comprehensive diagnostic work-up including all the criteria defining the EWGSOP2 definition might be more useful than a series testing for prompt recognition of nutritional and physical performance abnormalities.
The neighbourhood environment and profiles of the metabolic syndrome
Authors: Barnett Anthony , Martino Erika , Knibbs Luke D. , Shaw Jonathan E. , Dunstan David W. , Magliano Dianna J. , Donaire-Gonzalez David , Cerin Ester 
Published: September 2022

Abstract
Background
There is a dearth of studies on how neighbourhood environmental attributes relate to the metabolic syndrome (MetS) and profiles of MetS components. We examined the associations of interrelated aspects of the neighbourhood environment, including air pollution, with MetS status and profiles of MetS components.

Methods
We used socio-demographic and MetS-related data from 3681 urban adults who participated in the 3rd wave of the Australian Diabetes, Obesity and Lifestyle Study. Neighbourhood environmental attributes included area socio-economic status (SES), population density, street intersection density, non-commercial land use mix, percentages of commercial land, parkland and blue space. Annual average concentrations of NO2 and PM2.5 were estimated using satellite-based land-use regression models. Latent class analysis (LCA) identified homogenous groups (latent classes) of participants based on MetS components data. Participants were then classified into five metabolic profiles according to their MetS-components latent class and MetS status. Generalised additive mixed models were used to estimate relationships of environmental attributes with MetS status and metabolic profiles.

Results
LCA yielded three latent classes, one including only participants without MetS (“Lower probability of MetS components” profile). The other two classes/profiles, consisting of participants with and without MetS, were “Medium-to-high probability of high fasting blood glucose, waist circumference and blood pressure” and “Higher probability of MetS components”. Area SES was the only significant predictor of MetS status: participants from high SES areas were less likely to have MetS. Area SES, percentage of commercial land and NO2 were associated with the odds of membership to healthier metabolic profiles without MetS, while annual average concentration of PM2.5 was associated with unhealthier metabolic profiles with MetS.

Conclusions
This study supports the utility of operationalising MetS as a combination of latent classes of MetS components and MetS status in studies of environmental correlates. Higher socio-economic advantage, good access to commercial services and low air pollution levels appear to independently contribute to different facets of metabolic health. Future research needs to consider conducting longitudinal studies using fine-grained environmental measures that more accurately characterise the neighbourhood environment in relation to behaviours or other mechanisms related to MetS and its components.
A progressive and refractory case of breast cancer with Cowden syndrome
Authors: Sueta Aiko , Takeno Masako , Goto-Yamaguchi Lisa , Tomiguchi Mai , Inao Toko , Yamamoto-Ibusuki Mutsuko , Yamamoto Yutaka 
Published: September 2022

Abstract
Background
Cowden syndrome is a rare autosomal-dominant disease with a high risk of malignant tumors of the breast, commonly caused by germline mutations in the PTEN gene. Most breast cancers related to Cowden syndrome showed typically a slow-growing and favorable clinical course. Here, we report a progressive case of triple-negative breast cancer in a patient who was diagnosed with Cowden syndrome.

Case presentation
A 35-year-old female with breast cancer was referred to our hospital. Histopathological examination of the tumor showed that it was triple-negative breast cancer with high proliferation marker. Preoperative positron emission tomography-computed tomography showed abnormal uptake in the left cerebellar hemisphere in addition to the right breast and axillary lymph node. Brain T2-weighted magnetic resonance imaging revealed hyperintense bands in the left cerebellar hemisphere lesion, which demonstrated a “tiger-stripe” appearance. The patient’s mother had died of endometrial cancer. Subsequently, she underwent genetic testing, leading to a diagnosis of Cowden syndrome with a pathogenic variant c.823_840del.18 at exon 8 in PTEN. She was treated with neoadjuvant chemotherapy of eribulin and cyclophosphamide followed by adriamycin and cyclophosphamide. However, her tumors increased after these treatments. She was immediately surgically treated and received adjuvant chemotherapy of capecitabine. Unfortunately, the cancer recurred in the lung nine months after surgery. We then administered paclitaxel and bevacizumab therapy, but the disease rapidly progressed. Consequently, the patient died due to breast cancer about three months after recurrence.

Conclusion
We report an aggressive case of cancer with Cowden syndrome which was resistant to standard chemotherapy. Alteration of the phosphatidylinositol-3 kinase/Akt/mammalian target of rapamycin pathway due to inactivating PTEN protein may be associated with chemoresistance and serves as a candidate for therapeutic intervention in PTEN-related cancers.
Risky anatomical variations of sphenoid sinus and surrounding structures in endoscopic sinus surgery
Authors: Fadda Gian Luca , Petrelli Alessio , Urbanelli Anastasia , Castelnuovo Paolo , Bignami Maurizio , Crosetti Erika , Succo Giovanni , Cavallo Giovanni 
Published: September 2022

Abstract
Purpose
This study aimed to examine the relationship between the sphenoid sinus (SS) and surrounding vital structures such as the internal carotid artery (ICA) and optic nerve canal (ONC) as well as the types of attachment of the sphenoidal septa onto these structures.

Methods
In total, 230 computed tomography (CT) scans were reviewed to study the type of sphenoid sinus pneumatization (SSP), the protrusion and dehiscence of the ICA and ONC, the relationship between the sphenoidal septa and surrounding vital structures as well as pterygoid recess pneumatization (PRP).

Results
The most common SSP was sellar type (58.7%). The rates of protrusion and dehiscence of the ICA were 26.3 and 0.4%, and for the ONC, they were 13 and 1.5%, respectively. The ICA and ONC were most protruded and dehiscent in more extensive SSP. In 21.6% of patients, the intersphenoidal septa (IS) were attached to the wall of the ICA and in 8.6% they were attached to the wall of the ONC. The attachment of IS to the ICA correlated statistically significantly (p < 0.0001) with protrusion of the ICA. Accessory septa were detected in 30.4% of cases with various sites of attachment.

Conclusion
To reduce the risk of injury and complications during endoscopic sinus surgery (ESS), surgeons should consider using CT to identify possible bulging and dehiscence of the ICA/ONC and their relationship to the extent of SSP and also to establish the presence of deviation of the sphenoid septum, and the presence of accessory septa.
Prognostic value of combined preoperative phase angle and handgrip strength in cardiac surgery
Authors: Panagidi Mairi , Papazoglou Αndreas S. , Moysidis Dimitrios V. , Vlachopoulou Elpiniki , Papadakis Marios , Kouidi Evangelia , Galanos Antonios , Tagarakis Georgios , Anastasiadis Kyriakos 
Published: September 2022

Abstract
Objectives
Phase angle (PA) constitutes a bioelectrical impedance measurement, indicating cell membrane health and integrity, hydration, and nutritional status. Handgrip strength (HS) has been also associated with body composition, nutritional status, inflammation, and functional ability in several chronic diseases. Although their prognostic significance as independent biomarkers has been already investigated regarding the outcomes of a cardiac surgery, our study is the first one to assess the combined predictive value of preoperative PA and HS.

Design and methods
HS and PA measurements were performed preoperativelyin 195 patients undergoing cardiac surgery. The association ofthe combination of HS and PAwith all-cause mortality rates was the primary study outcome, while its association with the intensive care unit (ICU) length of stay (LOS) was the secondary one.

Results
PA was positively correlated with HS (r = 0.446, p < 0.005) and negatively with EuroSCORE II (r = − 0.306 p < 0.005). The combination of PA < 5.15 and HS < 25.5 was associated with higher one-year all-cause mortality (OR = 9.28; 95% CI 2.50–34.45; p = 0.001) compared to patients with PA > 5.15 and HS > 25.5, respectively. Patients with combined lower values of PA and HS (PA < 5.15 and HS < 30.7) were at higher risk of prolonged ICU LOS (OR = 4.02; 95% CI 1.53–10.56; p = 0.005) compared to those with higher PA–HS (PA > 5.15–HS > 30.7). The combination of PA–HS was also significantly linked with EuroSCORE II.

Conclusion
The combination of low preoperative PA and HS values was significantly associated with higher risk of all-cause mortality at 12 months and prolonged ICU LOS; thereby it might serve as a clinically useful prognostic biomarker after cardiac surgery procedures.
Delayed diagnosis of thoracic esophageal rupture due to blunt abdominal trauma without chest trauma: A case report
Authors: Kim Jae Jun , Han Jung Wook 
Published: September 2022

Abstract
Background
Thoracic esophageal rupture due to blunt trauma is very rare. Moreover, there have been no reports of thoracic esophageal rupture due to blunt abdominal trauma without chest trauma.

Case presentation
We describe a rare case of esophageal rupture due to blunt abdominal trauma in a young female patient. Operation was delayed due to a misdiagnosis of chylothorax, and esophageal repair was performed six days after trauma. Postoperative esophageal leak developed and was treated with esophageal stent. She was discharged two months after surgery without sequelae.

Conclusions
It is important to consider esophageal rupture as a differential diagnosis even in patients with only abdominal trauma, when in doubt.
Profiling symptom burden and its influencing factors at discharge for patients undergoing lung cancer surgery: a cross-sectional analysis
Authors: Liao Jia , Wang Yaqin , Dai Wei , Wei Xing , Yu Hongfan , Yang Pu , Xie Tianpeng , Li Qiang , Liu Xiaoqin , Shi Qiuling 
Published: September 2022

Abstract
Background
Following lung cancer surgery, patients often experience severe symptoms which are not properly assessed at discharge. The aim of this study was to identify the clinical presentation at discharge and the influencing factors of postoperative symptoms in patients who have undergone lung cancer surgery.

Methods
This cross-sectional study analysed data from patients who participated in a prospective cohort study that enrolled patients who underwent lung cancer surgery at six tertiary hospitals in the People’s Republic of China, from November 2017 to January 2020. Patient symptoms at discharge were measured using the MD Anderson Symptom Inventory Lung Cancer module. The five core symptoms were defined according to ratings of moderate to severe symptoms (≥ 4 on a 0–10 scale). A multivariate linear regression model was used to identify the influencing factors of each symptom at discharge.

Results
Among the 366 participants, 51.9% were male and the mean (SD) age was 55.81 (10.43) years. At discharge, the core symptoms were cough (36.4%), pain (28.2%), disturbed sleep (26.3%), shortness of breath (25.8%), and fatigue (24.3%), and more than half of the participants (54.6%) had one to five of the core symptoms, with moderate to severe severity. A low annual income and the use of two chest tubes were significantly associated (P = 0.030 and 0.014, respectively) with higher mean scores of the core symptoms.

Conclusion
Though clinically eligible for discharge, more than half of the participants had severe symptoms at discharge after lung cancer surgery. Special attention should be given to patients who have two chest tubes after surgery and those who have a low annual income.
Effects of Let-7c on the processing of hepatitis B virus associated liver diseases
Authors: Zhang Like , Jiang Xia , Wang Guiqi , Kanda Tatsuo , Yokosuka Osamu , Zhai Congjie , Zhang Lei , Liu Peng , Zhao Zengren , Li Zhongxin 
Published: September 2022

Abstract
Background
The most common type of cancer of the digestive system is hepatocellular carcinoma. In China, many patients harbour HBV. The lin28B/Let-7c/MYC axis is associated with the occurrence of many cancers. Therefore, we aimed to illuminate the function of the lin28B/Let-7c/MYC axis in hepatocellular carcinoma. We aimed to evaluate the critical involvement of lin28B and Let-7c in the carcinogenesis of human hepatocellular carcinoma (B-HCC).

Methods
Data from the GEO database were used to analyse differentially expressed genes and IRGs. A protein − protein interaction (PPI) network and Venn diagram were generated to analyse relationships. Real-time RT-PCR, Western blotting, and cell counting kit-8 assays were used to examine the association of lin28B, Let-7c, and MYC with cell proliferation.

Results
A total of 2552 functionally annotated differentially expressed RNAs were analysed in HBV patients from the GSE135860 database. In addition, 46 let-7c target genes were screened in HBV patients, and the interactions were analysed through PPI network analysis. The results confirmed that Let-7c and its target genes play a key role in HBV-related diseases. Next, we discovered a gradual decrease in Let-7c expression during the progression from HBV-associated chronic hepatitis (B-CH) and HBV-associated liver cirrhosis (B-LC) to B-HCC. We found evidence for a negative association between lin28B expression and Let-7c expression. The expression of MYC was obviously upregulated when Let-7c was inhibited.

Conclusion
Our results highlight that Let-7c and lin28B participate in the carcinogenesis of HBV-associated diseases through the lin28B/Let-7c/MYC axis.
In situ carbon dioxide capture to co-produce 1,3-propanediol, biohydrogen and micro-nano calcium carbonate from crude glycerol by Clostridium butyricum
Authors: Wang Xiao-Li , Zhou Jin-Jie , Liu Sheng , Sun Ya-Qin , Xiu Zhi-Long 
Published: September 2022

Abstract
Background
Climate change caused by greenhouse gas emission has become a global hot topic. Although biotechnology is considered as an environmentally friendly method to produce chemicals, almost all biochemicals face carbon dioxide emission from inevitable respiration and energy metabolism of most microorganisms. To cater for the broad prospect of biochemicals, bioprocess optimization of diverse valuable products is becoming increasingly important for environmental sustainability and cleaner production. Based on Ca(OH)2 as a CO2 capture agent and pH regulator, a bioprocess was proposed for co-production of 1,3-propanediol (1,3-PDO), biohydrogen and micro-nano CaCO3 by Clostridium butyricum DL07.

Results
In fed-batch fermentation, the maximum concentration of 1,3-PDO reached up to 88.6 g/L with an overall productivity of 5.54 g/L/h. This productivity is 31.9% higher than the highest value previously reports (4.20 g/L/h). In addition, the ratio of H2 to CO2 in exhaust gas showed a remarkable 152-fold increase in the 5 M Ca(OH)2 group compared to 5 M NaOH as the CO2 capture agent. Green hydrogen in exhaust gas ranged between 17.2% and 20.2%, with the remainder being N2 with negligible CO2 emissions. During CO2 capture in situ, micro-nano calcite particles of CaCO3 with sizes in the range of 300 nm to 20 µm were formed simultaneously. Moreover, when compared with 5M NaOH group, the concentrations of soluble salts and proteins in the fermentation broth of 5 M Ca(OH)2 group were notably reduced by 53.6% and 44.1%, respectively. The remarkable reduction of soluble salts and proteins would contribute to the separation of 1,3-PDO.

Conclusions
Ca(OH)2 was used as a CO2 capture agent and pH regulator in this study to promote the production of 1,3-PDO. Meanwhile, micro-nano CaCO3 and green H2 were co-produced. In addition, the soluble salts and proteins in the fermentation broth were significantly reduced.

Graphical Abstract