bluuebunny/crossref_metadata_2025_split huggingface dataset:
Phase 1B study of the safety and tolerability of the mineralocorticoid fludrocortisone acetate in patients with geographical atrophy
Authors: Hong Thomas , Chang Andrew , Maddess Ted , Provis Jan , Penfold Philip 
Published: July 2022

ObjectiveTo evaluate the safety and tolerability of a mineralocorticoid, in a single-dose intravitreal (IVT) injection of 1 mg/0.1 mL and 2 mg/0.1 mL fludrocortisone acetate (FCA) in subjects with geographical atrophy (GA) secondary to age-related macular degeneration.Methods and AnalysisThis phase 1b study was a two-part dose-escalation prospective study. Part 1 involved a single participant treated with 1 mg/0.1 mL and monitored up to 28 days before being reviewed by a safety review committee. Two subsequent participants were then dosed with the same dose. Part 2 involved a single participant dosed with 2 mg/0.1 mL and monitored up to 28 days when a further five participants were dosed. All participants were followed up for 6 months after baseline.A full ophthalmic assessment was performed at study visits which included GA area, best-corrected visual acuity (BCVA), low-luminance BCVA (LL-BCVA) and intraocular pressure (IOP). Adverse events (AEs) were reported from the first dose of FCA until the end-of-study visit.ResultsThere were no serious AEs (ocular or systemic) observed with IVT FCA at either 1 mg/0.1 mL or 2 mg/0.1 mL among nine participants. There was no evidence of increased IOP or cataract development.Neither BCVA or LL-BCVA changed significantly in the study-eye over the follow-up period (p=0.28 and 0.38, respectively). Mean GA area increased in the study (0.5 mm2, p=0.003) and fellow-eyes (0.62 mm2, p=0.02) over 6 months. Differences between eyes were not significant (p=0.64), and at the lower end of population norms.ConclusionIVT FCA is clinically safe and well tolerated and did not increase IOP.
Gender-related factors and out-of-hospital cardiac arrest incidence in women and men: analysis of a population-based cohort study in the Netherlands
Authors: Smits Robin L A , van Dongen Laura H , Blom Marieke T , Tan Hanno L , van Valkengoed Irene G M 
Published: July 2022

BackgroundThe incidence of out-of-hospital cardiac arrest (OHCA) differs consistently between women and men. Besides sex-related (biological) factors, OHCA risk may relate to gender-related (sociocultural) factors. We explored the association of selected gender-related factors with OHCA incidence in women and men.MethodsWe combined data on emergency medical services-attended OHCA with individual-level data from all women and men aged ≥25 years living in North Holland, the Netherlands. We estimated the associations between employment status, primary earner status, living with children and marital status and the OHCA incidence with Cox proportional hazards models stratified by sex and adjusted for age and socioeconomic status. To determine if metabolic factors explain the associations, we added hypertension, diabetes mellitus and dyslipidaemia to the models. Population attributable fractions (PAF) for all gender-related factors were calculated.ResultsAll four gender-related factors were associated with OHCA incidence (eg, unemployed vs employed; HR 1.98, 95% CI 1.67 to 2.35 in women; HR 1.60, 95% CI 1.44 to 1.79 in men). In both sexes, those unemployed, those who are not primary earners, those living without children, and married or divorced individuals had an increased OHCA risk. The PAF ranged from 4.9 to 40.3 in women and from 4.4 to 15.5 in men, with the highest PAF for employment status in both sexes. Metabolic risk factors did not explain the observed associations.ConclusionGender-related factors were associated with risk of OHCA and contributed substantially to the OHCA burden at the population level, particularly in women. Employment status contributed most to the OHCA burden.
Impact of an extrafascial versus intrafascial injection for supraclavicular brachial plexus block on respiratory function: a randomized, controlled, double-blind trial
Authors: Grape Sina , Kirkham Kyle , Zemirline Nadjib , Bikfalvi Alexis , Albrecht Eric 
Published: July 2022

IntroductionHemidiaphragmatic paresis after ultrasound-guided supraclavicular brachial plexus block is reported to occur in up to 67% of patients. We tested the hypothesis that an injection outside the brachial plexus sheath reduces the incidence of hemidiaphragmatic paresis compared with an intrafascial injection while providing similar analgesia.MethodsFifty American Society of Anesthesiologists I–III patients scheduled for elective upper limb surgery received a supraclavicular brachial plexus block using 30 mL of 1:1 mixture of mepivacaine 1% and ropivacaine 0.5%. The block procedures were randomized to position the needle tip either within the brachial plexus after piercing the sheath (intrafascial injection) or outside the brachial plexus sheath (extrafascial injection). The primary outcome was the incidence of hemidiaphragmatic paresis 30 min after the injection, measured by M-mode ultrasonography. Additional outcomes included time to surgery readiness, and resting and dynamic pain scores at 24 hours postoperatively (Numeric Rating Scale, 0–10).ResultsThe incidence of hemidiaphragmatic paresis 30 min after the injection was 9% (95% CI 1% to 29%) and 0% (95% CI 0% to 15%) in the intrafascial and extrafascial groups respectively (p=0.14). Extrafascial injection was associated with a longer time to surgery readiness (intrafascial: 18 min (95% CI: 16 to 21 min); extrafascial: 37 min (95% CI: 31 to 42 min); p<0.001). At 24 hours, resting and dynamic pain scores were similar between groups.DiscussionUltrasound-guided supraclavicular brachial plexus block with an extrafascial injection does not reduce the incidence of hemidiaphragmatic paresis although it provides similar analgesia, when compared with an intrafascial injection. The longer time to surgery readiness is less compatible with contemporary operating theater efficiency requirements.Trial registration numberNCT03957772.
Tobacco Smoking and Survival Following a Diagnosis with Ovarian Cancer
Authors: Wang Tianyi , Read Susan H. , Moino Daniela , Ayoubi Yasmin , Chern Jing-Yi , Tworoger Shelley S. 
Published: July 2022

Abstract

Background:
Little is known about the influence of smoking on ovarian cancer survival. We investigated this relationship in a hospital-based study.

Methods:
Analyses included 519 women with ovarian cancer. We used multivariable adjusted Cox proportional hazards regression models to estimate HRs and 95% confidence intervals (CI).

Results:
Risk of all-cause mortality was increased for current smokers (HR = 1.70; 95% CI: 1.09–2.63) versus never smokers, especially for those with ≥15 cigarettes per day (HR = 1.92; 95% CI: 1.15–3.20). Results were largely similar after additional adjustment for debulking status (current vs. never smokers, HR = 2.96; 95% CI: 1.07–8.21) or neoadjuvant chemotherapy (comparable HR = 2.87; 95% CI: 1.02–8.06). Compared with never smokers, smoking duration ≥20 years (HR = 1.38; 95% CI: 0.94–2.03) and ≥20 pack-years (HR = 1.35; 95% CI: 0.92–1.99) were suggestively associated with worse outcomes. Current smoking was also positively associated with the risk of mortality among patients with ovarian cancer recurrence (current vs. never/past smokers, HR = 2.79; 95% CI: 1.44–5.41), despite the null association between smoking and recurrence (HR = 1.46; 95% CI: 0.86–2.48). Furthermore, no association was observed for smoking initiation before age 18 (HR = 1.22; 95% CI: 0.80–1.85), or either environmental smoke exposure at home (HR = 1.16; 95% CI: 0.76–1.78) or at work (HR = 1.10; 95% CI: 0.75–1.60).

Conclusions:
Our results suggest active tobacco smoking is associated with worse ovarian cancer outcomes, particularly after a recurrence.

Impact:
Our findings support structured smoking cessation programs for patients with ovarian cancer, especially in recurrent settings. Further research to confirm these findings and examine the interplay between smoking and the tumor immune microenvironment may help provide insight into ovarian cancer etiology.
Catching Up with the World: Pepsinogen Screening for Gastric Cancer in the United States
Authors: Zhou Margaret J. , Huang Robert J. 
Published: July 2022

Abstract
Gastric cancer remains a deadly cancer with poor outcomes in the United States. There is a need for screening strategies for gastric cancer in the U.S. population. With progressive Helicobacter pylori–mediated inflammation of the gastric mucosa, pepsinogen I levels decrease and the pepsinogen I/II ratio decreases. Pepsinogen test positivity (PG+) has been evaluated as a promising screening test among Asian and European populations; however, its utility in multiethnic U.S. populations is poorly described. In this case-control study nested within the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial, In and colleagues evaluate the discrimination of PG+ in serum collected from individuals prior to the development of gastric cancer. The authors find that PG+ individuals were at nearly 10-fold increased risk for developing gastric cancer, and this effect remained robust after adjusting for Helicobacter pylori status, family history, education, smoking, and obesity. In subgroup analysis, the predictive ability of the test was particularly robust for noncardia gastric cancers, and nonpredictive of cardia gastric cancers. Serum pepsinogen testing holds promise as a noninvasive screening strategy to triage individuals at heightened risk for gastric cancer, and may help to improve early diagnosis in the United States.
See related article by In et al., p. 1426
Instrument evaluation of conspiracy theory about COVID-19: Exploratory factor analysis and confirmatory factor analysis
Authors: Fauzi Ahmad , Saefi Muhammad , Adi Widi Cahya , Kristiana Evi , Lestariani Nurlita 
Published: July 2022

<span>Students’ beliefs toward conspiracy theory (CT) of COVID-19 can be the indication of science education quality. However, a validated instrument to measure the level of students’ acceptance on the CT about COVID-19 still remains unexplored. This study aimed to evaluate the questionnaire of CT about COVID-19. The questionnaire consisted of 14 items and delivered online to the 400 students of Biology education in Indonesia. The data was analyzed using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). All items have standard deviation between 1.60 and 2.63, but one item was revealed to have insignificant correlation. The EFA result indicated that the other 13 items had loading factor 0.5 and were categorized into three dimensions. The third dimension was eliminated after the administration of CFA due to only one item in the dimension (λ&gt;0.5). There were three items in the first dimension and two items in the second dimension resulted in λ&lt;0.5. The correlated model from CFA disclosed good values of goodness of fit (GOF), χ<sup>2</sup>/df=2.527, root mean square error of approximation (RMSEA) standardized root mean square residual (SRMR)=0.014, comparative fit index (CFI)=0.964, goodness-of-fit index (GFI)=0.969, adjusted goodness of fit (AGFI)=0.940, Tucker-Lewis index (TLI)=0.947, and normed fit index (NFI)=0.943. Therefore, the questionnaire is strongly recommended to measure the level of students’ beliefs toward the CT of COVID-19. </span>
Santuário de São Sebastião: arquitetura sacra neocolonial em Porto Ferreira (SP)
Authors: Carvalho Beatriz Fernanda , Benincasa Vladimir 
Published: July 2022

Analisa elementos artísticos e arquitetônicos da Matriz de São Sebastião, Porto Ferreira (SP), tentando elucidar seu significado enquanto patrimônio cultural no contexto local. O atual templo neocolonial, de 1953, do arquiteto Benedito Calixto de Jesus Neto substituiu a primeira matriz (1886). Em novembro de 2013, foi elevada à categoria de Santuário Diocesano, por sua riqueza artística e pelas graças obtidas por intercessão de São Sebastião. O trabalho incluiu revisão bibliográfica, visitas à igreja para levantamento métrico e fotográfico; elaboração de material gráfico; análise dos elementos externos e internos; entrevistas; e consultas a arquivos locais.
Australian general practitioner perceptions to sharing clinical data for secondary use: a mixed method approach
Authors: Varhol Richard J. , Randall Sean , Boyd James H. , Robinson Suzanne 
Published: July 2022

Abstract
Objective
The potential for data collected in general practice to be linked and used to address health system challenges of maintaining quality care, accessibility and safety, including pandemic support, has led to an increased interest in public acceptability of data sharing, however practitioners have rarely been asked to share their opinions on the topic. This paper attempts to gain an understanding of general practitioner’s perceptions on sharing routinely collected data for the purposes of healthcare planning and research. It also compares findings with data sharing perceptions in an international context.

Materials and methods
A mixed methods approach combining an initial online survey followed by face-to-face interviews (before and during COVID-19), designed to identify the barriers and facilitators to sharing data, were conducted on a cross sectional convenience sample of general practitioners across Western Australia (WA).

Results
Eighty online surveys and ten face-to-face interviews with general practitioners were conducted from November 2020 – May 2021. Although respondents overwhelmingly identified the importance of population health research, their willingness to participate in data sharing programs was determined by a perception of trust associated with the organisation collecting and analysing shared data; a clearly defined purpose and process of collected data; including a governance structure providing confidence in the data sharing initiative simultaneously enabling a process of data sovereignty and autonomy.

Discussion
Results indicate strong agreement around the importance of sharing patient’s medical data for population and health research and planning. Concerns pertaining to lack of trust, governance and secondary use of data continue to be a setback to data sharing with implications for primary care business models being raised.

Conclusion
To further increase general practitioner’s confidence in sharing their clinical data, efforts should be directed towards implementing a robust data governance structure with an emphasis on transparency and representative stakeholder inclusion as well as identifying the role of government and government funded organisations, as well as building trust with the entities collecting and analysing the data.
General practitioners’ views on retaining Singapore’s primary care doctors: a cross-sectional survey and qualitative analysis
Authors: Fang Yang , Soljak Michael , Tan Shawn Lien Ler , Peckham Stephen , Tan Tze Lee , Smith Helen E. 
Published: July 2022

Abstract
Background
To support its ageing population and the increasing need for chronic care in the community, Singapore needs to boost the number of doctors in its primary care workforce. To better understand how to improve doctor retention and build a more robust primary care system, we conducted a cross-sectional survey with doctors in general practice and family medicine to explore their career satisfaction, their career plans, factors related to their plans to leave, and their view on retaining GPs in primary care.

Methods
An anonymous online survey was distributed to general practitioners working in the public and private sectors. The survey contained questions on career satisfaction, career plans in the next 5 years, and factors important for retaining doctors in primary care. In addition, there were open-ended questions for respondents to elaborate on retention initiatives and other factors that may improve engagement among primary care doctors. Quantitative data was analyzed with descriptive statistics, principal component analysis, χ2 tests, t-tests, and Pearson’s correlations; qualitative data was analyzed thematically.

Results
The survey was attempted by 355 general practitioners and completed in full by 303. The respondents were most satisfied with rapport with patients and their current professional role; they were least satisfied with the amount of paperwork and the status of general practice in society. In terms of their career plans in the next 5 years, 49/341 (14.4%) of the respondents plan to leave general practice permanently, 43/341 (12.6%) plan to take a career break, and 175/341 (51.3%) plan to reduce their clinical hours. Higher remuneration, recognizing general practice and family medicine as a medical specialty, and reducing the litigious pressures on medical practice were rated as the most important factors for retaining primary care. Free-text responses also revealed a growing dissatisfaction with the Third-Party Administrators that manage insurance arrangements.

Conclusion
While the proportion of doctors who intend to leave is smaller than that reported in overseas studies, our findings highlight an urgent need for targeted interventions to engage and retain primary care doctors. Increasing recognition and support for general practitioners and their professional practice may contribute to strengthening community care for the ageing population.
Decision support-tools for early detection of infection in older people (aged> 65 years): a scoping review
Authors: Masot Olga , Cox Anna , Mold Freda , Sund-Levander Märtha , Tingström Pia , Boersema Geertien Christelle , Botigué Teresa , Daltrey Julie , Hughes Karen , Mayhorn Christopher B. , Montgomery Amy , Mullan Judy , Carey Nicola 
Published: July 2022

Abstract
Background
Infection is more frequent, and serious in people aged > 65 as they experience non-specific signs and symptoms delaying diagnosis and prompt treatment. Monitoring signs and symptoms using decision support tools (DST) is one approach that could help improve early detection ensuring timely treatment and effective care.

Objective
To identify and analyse decision support tools available to support detection of infection in older people (> 65 years).

Methods
A scoping review of the literature 2010–2021 following Arksey and O’Malley (2005) framework and PRISMA-ScR guidelines. A search of MEDLINE, Cochrane, EMBASE, PubMed, CINAHL, Scopus and PsycINFO using terms to identify decision support tools for detection of infection in people > 65 years was conducted, supplemented with manual searches.

Results
Seventeen papers, reporting varying stages of development of different DSTs were analysed. DSTs largely focussed on specific types of infection i.e. urine, respiratory, sepsis and were frequently hospital based (n = 9) for use by physicians. Four DSTs had been developed in nursing homes and one a care home, two of which explored detection of non- specific infection.

Conclusions
DSTs provide an opportunity to ensure a consistent approach to early detection of infection supporting prompt action and treatment, thus avoiding emergency hospital admissions. A lack of consideration regarding their implementation in practice means that any attempt to create an optimal validated and tested DST for infection detection will be impeded. This absence may ultimately affect the ability of the workforce to provide more effective and timely care, particularly during the current covid-19 pandemic.
Building a new life: a qualitative study of how family carers deal with significant changes
Authors: Duggleby Wendy , O’Rourke Hannah M. , Baxter Pamela , Nekolaichuk Cheryl , Thompson Genevieve , Peacock Shelley , Ghosh Sunita , Holroyd-Leduc Jayna , McAiney Carrie , Dubé Véronique , Swindle Jennifer , Pagnucco-Renaud Madeleine , Sana Samina 
Published: July 2022

Abstract
Background
Family carers of persons living with dementia who are residing in long term care (LTC), often experience significant changes in their roles and relationships which affects mental and physical health. Research has focused on describing the carers’ experience, but not on how they deal with these changes or their perceptions of support needs. The purpose of this study was to explore how family carers of persons living with dementia residing in LTC deal with significant changes and to understand how best to support these carers.

Methods
Eight face-to-face audio-recorded focus group interviews were conducted with 45 participants from September 2019 to January 2020, as part of a larger study aimed at guiding the adaptation of an online toolkit to support family carers of persons living with dementia residing in LTC. Applied thematic analysis was used to analyze the focus group data.

Findings/results
Carers dealt with the significant changes they experienced through the process of “building a new life” consisting of two sub-processes: a) building new relationships (with their family member, LTC staff and others outside of LTC), and b) finding space for themselves (sharing of care and finding balance). Understanding dementia, support from others (staff, family and friends), connecting with resources, and being included in care decisions helped carers build a new life.

Conclusion
The process of building a new life describes the ways that family carers deal with the life-altering changes they experienced when a family member is admitted to LTC. Carers may be supported in building their new life, by providing them with information about dementia and how to relate to staff and their family member living with dementia. The quality of care being provided and the LTC environment may also play an important role in how carers deal with the significant changes they experience.
Metabolic obesity phenotypes and chronic kidney disease: a cross-sectional study from the RaNCD cohort study
Authors: Jam Samira Arbabi , Moloudpour Behrooz , Najafi Farid , Darbandi Mitra , Pasdar Yahya 
Published: July 2022

Abstract
Background
Investigating the effect of metabolic disorders on chronic kidney disease (CKD) in the presence or the absence of obesity is of great importance. This study aimed to examine the independent and joint relationships of obesity and metabolic syndrome (MetS) with CKD.

Methods
The present study was performed on 9,762 participants from the baseline phase of the Ravansar non- communicable diseases (RaNCD) study. Thereafter, the CKD was estimated by glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease (MDRD) equation. All the included participants were categorized into the following four phenotypes: metabolically healthy non-overweight/obesity (MHNO), metabolically unhealthy non-overweight/obesity (MUNO), metabolically healthy overweight/obesity (MHO), and metabolically unhealthy overweight/obesity (MUO). Finally, Logistic regression analysis was used to estimate the odds ratio (ORs).

Results
The mean age of the included participants was 47.33 ± 8.27 years old, %48.16 (4,701) of whom were men. As well, 1,058(10.84%) participants had CKD (eGFR less than 60 ml/min/1.73m2). The overweight/obesity was not significantly associated with odds of CKD. The odds of CKD in male subjects with MetS was 1.48 times higher than non-MetS ones (95% CI: 1.10, 2.01). After adjusting the confounders, the odds of CKD were 1.54 times (95% CI: 1.12, 2.11) higher in the MUNO and 2.22 times (95% CI: 1.44, 3.41) higher in the MUO compared to MHNO phenotype in male subjects. The odds of CKD in the MUNO and MUO was 1.31 times (95% CI: 1.10, 1.60) and 1.23 times (95% CI: 1.01, 1.54) higher than MHNO phenotype in female subjects, respectively.

Conclusion
The odds of CKD were higher in MUNO and MUO phenotypes. Therefore, lifestyle modification is recommended to control normal weight and healthy metabolism.