bluuebunny/crossref_metadata_2025_split huggingface dataset:
Phishing simulation exercise in a large hospital: A case study
Authors: Rizzoni Fabio , Magalini Sabina , Casaroli Alessandra , Mari Pasquale , Dixon Matt , Coventry Lynne 
Published: March 2022

BackgroundPhishing is a major threat to the data and infrastructure of healthcare organizations and many cyberattacks utilize this socially engineered pathway. Phishing simulation is used to identify weaknesses and risks in the human defences of organizations. There are many factors influencing the difficulty of detecting a phishing email including fatigue and the nature of the deceptive message.MethodA major Italian Hospital with over 6000 healthcare staff performed a phishing simulation as part of its annual training and risk assessment. Three campaigns were launched at approx. 4-month intervals, to compare staff reaction to a general phishing email and a customized one.ResultsThe results show that customization of phishing emails makes them much more likely to be acted on. In the first campaign, 64% of staff did not open the general phish, significantly more than the 38% that did not open the custom phish. A significant difference was also found for the click rate, with significantly more staff clicking on the custom phish. However, the campaigns could not be run as intended, due to issues raised within the organization.ConclusionsPhishing simulation is useful but not without its limitations. It requires contextual knowledge, skill and experience to ensure that it is effective. The exercise raised many issues within the Hospital. Successful, ethical phishing simulations require coordination across the organization, precise timing and lack of staff awareness. This can be complex to coordinate. Misleading messages containing false threats or promises can cause a backlash from staff and unions. The effectiveness of the message is dependent on the personalization of the message to current, local events. The lessons learned can be useful for other hospitals.
Public opinion of the Irish “COVID Tracker” digital contact tracing App: A national survey
Authors: O’Callaghan Michael E , Abbas Manzar , Buckley Jim , Fitzgerald Brian , Johnson Kevin , Laffey John , McNicholas Bairbre , Nuseibeh Bashar , O’Keeffe Derek , Beecham Sarah , Razzaq Abdul , Rekanar Kaavya , Richardson Ita , Simpkin Andrew , O’Connell James , Storni Cristiano , Tsvyatkova Damyanka , Walsh Jane , Welsh Thomas , Glynn Liam G 
Published: March 2022

ObjectiveThis study aims to gather public opinion on the Irish “COVID Tracker” digital contact tracing (DCT) App, with particular focus on App usage, usability, usefulness, technological issues encountered, and potential changes to the App.MethodsA 35-item online questionnaire was deployed for 10 days in October 2020, 3 months after the launch of the Irish DCT App.ResultsA total of 2889 completed responses were recorded, with 2553 (88%) respondents currently using the App. Although four in five users felt the App is easy to download, is easy to use and looks professional, 615 users (22%) felt it had slowed down their phone, and 757 (28%) felt it had a negative effect on battery life. Seventy-nine percent of respondents reported the App's main function is to aid contact tracing. Inclusion of national COVID-19 trends is a useful ancillary function according to 87% of respondents, and there was an appetite for more granular local data. Overall, 1265 (44%) respondents believed the App is helping the national effort, while 1089 (38%) were unsure.ConclusionsDCT Apps may potentially augment traditional contact tracing methods. Despite some reports of negative effects on phone performance, just 7% of users who have tried the App have deleted it. Ancillary functionality, such as up-to-date regional COVID-19, may encourage DCT App use. This study describes general positivity toward the Irish COVID Tracker App among users but also highlights the need for transparency on effectiveness of App-enabled contact tracing and for study of non-users to better establish barriers to use.
Flexible Versus Rigid Reaming Systems for Independent Femoral Tunnel Reaming During ACL Reconstruction: Minimum 2-Year Clinical Outcomes
Authors: Moran Thomas E. , Ignozzi Anthony J. , Taleghani Eric R. , Bruce Amelia S. , Hart Joseph M. , Werner Brian C. 
Published: March 2022

Background: Radiographic and cadaveric studies have suggested that anatomic anterior cruciate ligament reconstruction (ACLR) femoral tunnel drilling with the use of a flexible reaming system through an anteromedial portal (AM-FR) may result in a different graft and femoral tunnel position compared with using a rigid reamer through an accessory anteromedial portal with hyperflexion (AAM-RR). No prior studies have directly compared clinical outcomes between the use of these 2 techniques for femoral tunnel creation during ACLR. Purpose: To compare revision rates at a minimum of 2 years postoperatively for patients who underwent ACLR with AM-FR versus AAM-RR. The secondary objectives were to compare functional testing and patient-reported outcomes between the cohorts. Study Design: Cohort study; Level of evidence, 3. Methods: Included were consecutive patients at a single academic institution between 2013 and 2018 who underwent primary ACLR without additional ligamentous reconstruction. Patients were separated into 2 groups based on the type of anatomic femoral tunnel drilling: AM-FR or AAM-RR. Graft failure, determined by revision ACLR, was assessed with a minimum 2 years of postoperative follow-up. The authors also compared patient-reported outcome scores (International Knee Documentation Committee [IKDC] and Knee injury and Osteoarthritis Outcome Score [KOOS]) and functional performance testing performed at 6 months postoperatively. Results: A total of 284 (AAM-RR, 232; AM-FR, 52) patients were included. The mean follow-up time was 3.7 ± 1.5 years, with a minimum 2-year follow-up rate of 90%. There was no significant difference in the rate of revision ACLR between the AAM-RR and AM-FR groups (10.8% vs 9.6%, respectively; P = .806). At 6 months postoperatively, there were no significant between-group differences in peak knee extension strength, peak knee flexion strength, limb symmetry indices, or hop testing, as well as no significant differences in IKDC (AAM-RR, 81.1; AM-FR, 78.9; P = .269) or KOOS (AAM-RR, 89.0; AM-FR, 86.7; P = .104). Conclusion: In this limited study, independent femoral tunnel drilling for ACLR using rigid or flexible reaming systems resulted in comparable rates of revision ACLR at a minimum of 2 years postoperatively, with no significant differences in strength assessments or patient-reported outcomes at 6 months postoperatively.
Effects of glutamate and aspartate on prostate cancer and breast cancer: a Mendelian randomization study
Authors: Lin Yindan , Yang Ze , Li Jingjia , Sun Yandi , Zhang Xueyun , Qu Zihao , Luo Yan , Zhang Lihong 
Published: March 2022

Abstract
Background
Respectively, prostate cancer (PCa) and breast cancer (BC) are the second most and most commonly diagnosed cancer in men and women, and they account for a majority of cancer-related deaths world-wide. Cancer cells typically exhibit much-facilitated growth that necessitates upregulated glycolysis and augmented amino acid metabolism, that of glutamine and aspartate in particular, which is tightly coupled with an increased flux of the tricarboxylic acid (TCA) cycle. Epidemiological studies have exploited metabolomics to explore the etiology and found potentially effective biomarkers for early detection or progression of prostate and breast cancers. However, large randomized controlled trials (RCTs) to establish causal associations between amino acid metabolism and prostate and breast cancers have not been reported.

Objective
Utilizing two-sample Mendelian randomization (MR), we aimed to estimate how genetically predicted glutamate and aspartate levels could impact upon prostate and breast cancers development.

Methods
Single nucleotide polymorphisms (SNPs) as instrumental variables (IVs), associated with the serum levels of glutamate and aspartate were extracted from the publicly available genome-wide association studies (GWASs), which were conducted to associate genetic variations with blood metabolite levels using comprehensive metabolite profiling in 1,960 adults; and the glutamate and aspartate we have chosen were two of 644 metabolites. The summary statistics for the largest and latest GWAS datasets for prostate cancer (61,106 controls and 79,148 cases) were from the Prostate Cancer Association Group to Investigate Cancer Associated Alterations in the Genome (PRACTICAL) consortium, and datasets for breast cancer (113,789 controls and 133,384 cases) were from Breast Cancer Association Consortium (BCAC). The study was performed through two-sample MR method.

Results
Causal estimates were expressed as odds ratios (OR) and 95% confidence interval (CI) per standard deviation increment in serum level of aspartate or glutamate. Aspartate was positively associated with prostate cancer (Effect = 1.043; 95% confidence interval, 1.003 to 1.084; P = 0.034) and breast cancer (Effect = 1.033; 95% confidence interval, 1.004 to 1.063; P = 0.028); however, glutamate was neither associated with prostate cancer nor with breast cancer. The potential causal associations were robust to the sensitivity analysis.

Conclusions
Our study found that the level of serum aspartate could serve as a risk factor that contributed to the development of prostate and breast cancers. Efforts on a detailed description of the underlying biochemical mechanisms would be extremely valuable in early assessment and/or diagnosis, and strategizing clinical intervention, of both cancers.
Diversification of the aquaporin family in geographical isolated oyster species promote the adaptability to dynamic environments
Authors: Jia Yanglei , Liu Xiao 
Published: March 2022

Abstract
Background
The diversified aquaporin (AQP) family that was derived from gene duplication and subsequent functional differentiation play critical roles in multiple physiological processes and in adaptation to the dynamic environments during the evolutionary process. Oysters are a group of bivalve fauna in Mollusca that were widely distributed around the world and show extraordinary adaptation to harsh environments. However, knowledge is lacking with the diversity and evolution of the AQP family in oysters, even in molluscs.

Results
Here, we performed a comprehensive analysis of the AQP family in three geographical isolated oyster species that are native to different environments. Genome distribution and phylogenetic analysis revealed that the expansion of the AQP family in oysters were attributed to tandem duplication. Synteny analysis indicated that large-scale inversions lead to the independent duplication or deletion of the AQPs after speciation. As a consequence, these independent duplication events contributed to the diversification of the AQP family in different oysters. Pore pattern analysis suggested that the duplicated AQPs in oysters were highly diversified in inner surface profiles, implying the subsequent functional differentiation. The comparison conducted based on the transcriptome data demonstrated that the functional differentiated AQP family members in oysters may play critical roles in maintaining the balance between the stationary homeostasis and dynamic environments.

Conclusions
Our observation provides evidence for the correlation between the duplicated and functional differentiated AQP family and the adaptation to stationary life under dynamic environments in oysters. Additionally, it also broadens our knowledge of the evolution of AQP family in molluscs.
Efficacy and safety of rhomboid intercostal block for analgesia in breast surgery and thoracoscopic surgery: a meta-analysis
Authors: Chen Ruirong , Su Sheng , Shu Haihua 
Published: March 2022

AbstractBackgroundRhomboid intercostal block (RIB) is a new regional anesthesia technique that provides postoperative analgesia for breast surgery and thoracoscopic surgery. The published papers are not yet fully integrated and do not adequately address the impact and safety of the RIB on postoperative pain.MethodsThe PubMed, Web of Science and Embase were searched from 2016 to 2021 for all available randomized controlled trials (RCTs) that evaluated the analgesic efficacy and safety of RIB after thoracic surgery and breast surgery. Random and fixed-effects meta-analytical models were used where indicated, and between-study heterogeneity was assessed. The primary outcome was Postoperative Numerical Rating Scale (NRS) scores of patients at rest recorded 0–1, 6–8, 24 h after surgery. The secondary outcomes included rate of postoperative nausea and vomiting (PONV), postoperative fentanyl consumption and presence of complications of the block.ResultsFrom 81 records identified, four studies met our inclusion criteria, including 216 patients (RIB:108 patients; no block: 108 patients). In the primary outcome, RIB group showed significantly lower postoperative NRS at rest at first 0–1 h and 6–8 h (weighted mean difference [WMD] = -1.55; 95% confidence internal [CI] = -2.92 to -0.19;p < 0.05), (WMD = -0. 69; 95% CI = -1.29 to -0. 09; p < 0. 05). And there was no significant difference between groups in NRS at rest at 24 h (WMD = -0.78; 95% CI = -1.64 to -0.08;p = 0.77). Also, RIB group showed significantly lower postoperative NRS of breast surgery and thoracoscopic surgery at 0-1 h (WMD = -3.00; 95% CI = -3.13 to -2.87;p < 0.01), (WMD = -1.08; 95% CI = -1.98 to -0.18;p < 0.05). In the secondary outcome, the analysis also showed RIB group had significant lower of POVN rates (summary relative risk (RR) = 0.212;95%CI = 0.10 to 0.45;p < 0. 01) and the postoperative consumption of fentanyl (WMD = -57.52;95%CI = -106.03 to -9.02;p < 0. 05).ConclusionThis review shows that RIB was more effective in controlling acute pain after breast surgery and thoracoscopic surgery than general analgesia. And it is a trend that RIB may be a kind of effective and safe nerve bock technology and it requires further studies.
Cognitive decline, sensory impairment, and the use of audio-visual aids by long-term care facility residents
Authors: Kwan Rick Yiu Cho , Kwan Chi Wai , Kor Patrick Pui Kin , Chi Iris 
Published: March 2022

Abstract
Background
Hearing and vision impairments and the use of audio-visual aids are associated with cognitive decline in community-dwelling older people, but effects in long-term care facilities (LFCF) are unclear. We hypothesize that visual and hearing impairment are associated with cognitive decline and these relationships are mediated by using visual and hearing aids.

Methods
Secondary data analysis of a longitudinal study was conducted in the 7 government-subsidized LTCF operated by one of the largest non-governmental organizations in Hong Kong using data between 2005 and 2016. Eligible residents were ≥ 60 years of age without severe cognitive impairment at baseline who had stayed in the facilities for more than 3 years. All variables were measured by using the Minimum Data Set-Resident Assessment Instrument Version 2.0, Hong Kong version. The outcome was cognitive decline. Predictors were visual and hearing impairments. Mediators were the use of visual and hearing aids. General linear models were employed to test the hypotheses.

Results
Results for 2,233 residents were analyzed, with a mean age of 82.1 ± 8.2 years and a mean follow-up period of 4.4 ± 0.8 years. Results showed that those who had visual impairment (p = 0.004) and hearing impairments (p = 0.022) had a higher risk of cognitive decline. Using hearing aids (coefficient = 0.0186, p < 0.05) positively mediates the effect of hearing impairment on cognitive decline. Using visual aids (coefficient = -0.0881, p < 0.05) negatively mediates the effects of visual impairment on cognitive decline.

Conclusion
In LTCF, hearing and visual impairments are associated with a higher risk of cognitive decline. Hearing aids often-users were associated with a higher risk of cognitive decline. LTCF residents with visual impairment did not use visual aids. Use of visual aids demonstrated potential effects in slowing cognitive decline. A future study with a larger and more diverse sample with attention to quality of devices is proposed to confirm its effects.
Seroprevalence of SARS-CoV-2 antibodies, associated factors, experiences and attitudes of nursing home and home healthcare employees in Switzerland
Authors: West Erin A. , Kotoun Olivia J. , Schori Larissa J. , Kopp Julia , Kaufmann Marco , Rasi Manuela , Fehr Jan , Puhan Milo A. , Frei Anja ,   the Corona Immunitas Research Group
Published: March 2022

Abstract
Background
Many studies in hospital settings exist and have shown healthcare employees to be particularly exposed to SARS-CoV-2. While research focused on hospital staff, little evidence exists for employees in nursing homes and home care. The aims of this study were to assess the seroprevalence in nursing homes and home care employees in the Canton of Zurich, compare it to the general population, assess factors associated with seropositivity and explore the perspective of the employees regarding how the pandemic changed their daily work.

Methods
This cross-sectional study is part of the national Corona Immunitas research program of coordinated, seroprevalence studies in Switzerland. Six nursing homes and six home healthcare organizations providing at home care services in Zurich were selected and 296 and 131 employees were recruited, respectively. Assessments included standardized questionnaires, blood sampling for antibodies, and additional work-specific questions. All participants were recruited between 21st September and 23rd October 2020, before the second wave of the pandemic hit Switzerland, and were possibly exposed to SARS-CoV-2 at their work during the first wave in spring 2020.

Results
Seroprevalence of SARS-CoV-2 was 14.9% (95% CI 11.1%-19.6%; range 3.8% to 24.4%) for nursing home employees and 3.8% (95% CI 1.4–9.1%; range 0% to 10%) for home healthcare employees, compared to the general population of Zurich at 3.5% in September 2020 for those aged 20–64. Nurses were 2.6 times more likely to have SARS-CoV-2 antibodies than those employees who were not nurses (95% CI 1.1–6.2). The employees (nursing homes vs. home healthcare) perceived the implementation of general safety measures (44.9% vs. 57.3%) and wearing masks during work (36.8% vs. 43.5%), especially due to the limited communication with residents/clients, as the most crucial changes.

Conclusions
Nursing home employees who worked through SARS-CoV-2 outbreaks at their work were substantially more affected by SARS-CoV-2 infection compared to the general population and to home healthcare employees who similarly worked through outbreaks in their communities. Employees reported that important resources to cope with the burdensome changes they perceived in their daily work were personal resources and team support.

Trial registration

Current Controlled Trials ISRCTN18181860 dated 09/07/2020.
Retrospectively registered.
Clinical-demographic markers for improving diabetes mellitus diagnosis in people with tuberculosis in Tanzania
Authors: Byashalira Kenneth Cleophace , Chamba Nyasatu Godfrey , Alkabab Yosra , Mbelele Peter Masunga , Ntinginya Nyanda Elias , Ramaiya Kaushik Laxmidas , Alimohamed Mohamed Zahir , Heysell Scott Kirkland , Mmbaga Blandina Theophil , Bygbjerg Ib Christian , Christensen Dirk Lund , Mpagama Stellah George , Lillebaek Troels ,   ADEPT Consortium, Byashalira Kenneth Cleophace , Chamba Nyasatu Godfrey , Alkabab Yosra , Mbelele Peter Masunga , Ntinginya Nyanda Elias , Ramaiya Kaushik Laxmidas , Alimohamed Mohamed Zahir , Heysell Scott Kirkland , Mmbaga Blandina Theophil , Bygbjerg Ib Christian , Christensen Dirk Lund , Mpagama Stellah George , Lillebaek Troels , Affenaar Jan-Willem 
Published: March 2022

Abstract
Background
Tuberculosis (TB) control is threatened by an increasing prevalence of diabetes mellitus (DM), particularly in endemic countries. Screening for DM is not routinely implemented in Tanzania; therefore, we aimed to screen for DM at TB diagnosis using clinical-demographic markers.

Methods
Our cross-sectional study recruited TB patients who received anti-TB treatment between October 2019 and September 2020 at health care facilities in three regions from Tanzania. Patients were screened for DM using DM symptoms (polydipsia, polyphagia and polyuria) and random blood glucose (RBG) testing. Patients with a history of DM and those with no history of DM but an RBG ≥ 7.8 mmol/L had point-of-care glycated haemoglobin (HbA1c) testing, and were considered to have DM if HbA1c was ≥ 48 mmol/mol.

Results
Of 1344 TB patients, the mean age was 41.0 (± 17.0) years, and 64.7% were male. A total of 1011 (75.2%) had pulmonary TB, and 133 (10.4%) had at least one DM symptom. Overall, the prevalence of DM was 7.8%, of which 36 (2.8%) TB patients with no history of DM were newly diagnosed with DM by RBG testing. TB/DM patients were older than those with only TB (50.0 ± 14.0 years vs 40.0 ± 17.0 years, p < 0.001). Patients with RBG ≥ 7.8 mmol/L were more likely to have pulmonary TB (p = 0.003), age ≥ 35 years (p = 0.018), and have at least one DM symptom (p < 0.001). There was a substantial agreement (Kappa = 0.74) between the on-site glucometer and point-of-care HbA1c tests in detecting DM range of hyperglycemia.

Conclusion
The implementation of clinical-demographic markers and blood glucose screening identified the overall prevalence of DM and those at risk of DM in TB patients. Clinical-demographic markers are independent predictors for DM range hyperglycemia and highlight the importance of further diagnostic testing and early co-management of TB and DM.
Evaluating the variety of GNAS inactivation disorders and their clinical manifestations in 11 Chinese children
Authors: Chang Guoying , Li Qun , Li Niu , Li Guoqiang , Li Juan , Ding Yu , Huang Xiaodong , Shen Yongnian , Wang Jian , Wang Xiumin 
Published: March 2022

Abstract
Background
The GNAS gene on chromosome 20q13.3, encodes the alpha-subunit of the stimulatory G protein, which is expressed in most tissues and regulated through reciprocal genomic imprinting. Disorders of GNAS inactivation produce several different clinical phenotypes including pseudohypoparathyroidism (PHP), pseudopseudohypoparathyroidism (PPHP), progressive osseous heteroplasia (POH), and osteoma cutis (OC). The clinical and biochemical characteristics overlap of PHP subtypes and other related disorders presents challenges for differential diagnosis.

Methods
We enrolled a total of 11 Chinese children with PHP in our study and analyzed their clinical characteristics, laboratory results, and genetic mutations.

Results
Among these 11 patients, nine of them (9/11) presented with resistance to parathyroid hormone (PTH); and nine (9/11) presented with an Albright′s hereditary osteodystrophy (AHO) phenotype. GNAS abnormalities were detected in all 11 patients, including nine cases with GNAS gene variations and two cases with GNAS methylation defects. These GNAS variations included an intronic mutation (c.212 + 3_212 + 6delAAGT), three missense mutations (c.314C > T, c.308 T > C, c.1123G > T), two deletion mutations (c.565_568delGACT*2, c.74delA), and two splicing mutations (c.721 + 1G > A, c.432 + 1G > A). Three of these mutations, namely, c.314C > T, c.1123G > T, and c.721 + 1G > A, were found to be novel. This data was then used to assign a GNAS subtype to each of these patients with six cases diagnosed as PHP1a, two cases as PHP1b, one as PPHP, and two as POH.

Conclusions
Evaluating patients with PTH resistance and AHO phenotype improved the genetic diagnosis of GNAS mutations significantly. In addition, our results suggest that when GNAS gene sequencing is negative, GNAS methylation study should be performed. Early genetic detection is required for the differential diagnosis of GNAS disorders and is critical to the clinician’s ability to distinguish between heterotopic ossification in the POH and AHO phenotype.