bluuebunny/crossref_metadata_2025_split huggingface dataset:
Device-worn measures of sedentary time and physical activity in South Asian adults at high risk for type 2 diabetes in Metro-Vancouver, Canada
Authors: Mahmood Bushra , Nettlefold Lindsay , Ashe Maureen C. , Puyat Joseph H. , Tang Tricia S. 
Published: May 2022

Background
South Asians have high incidence of chronic disease. Physical activity (PA) and sedentary time are modifiable risk factors for chronic disease but their assessment in South Asians has been primarily based on self-report. This study presents directly-measured PA and sedentary time in South Asian adults in Canada.

Methods
A subset of 100 South Asian participants from a larger study who were identified at being at a higher risk for type 2 diabetes wore Actical accelerometers for 7 days. Anthropometric measures were taken and socio-demographic factors including age, income, education level, years since immigration, presence of children under the age of 12 years in the household and employment status were self-reported.

Results
Ninety-one participants (mean age 65.6 years) provided valid accelerometer data. Participants accumulated mean 673.5 (95% CI: 656.6, 691.0) min/day sedentary time, 130.5 (95% CI: 117.3, 145.3) min/day light PA (LPA) and 2.3 (95% CI: 1.3, 4.2) min/day moderate-to-vigorous PA (MVPA). For sedentary time and LPA, sex and BMI explained 51% of variability. For MVPA, BMI, season of assessment and employment status explained 23% variability with those who were employed accumulating significantly higher mean min/day of MVPA compared to those who were unemployed; (5.8, 95% CI: 1.5, 21.7) vs (1.5, 95% CI: 5.3, 20.0) respectively.

Conclusion
High sedentary time, and low MVPA indicates the need to focus health promotion efforts on shifting sedentary time into LPA while trying to increase MVPA. Future studies need to be based on larger, representative samples of South Asians.
Notable paradoxical phenomena in associations between cardiovascular health score, subclinical and clinical cardiovascular disease in the community: The Framingham Heart Study
Authors: Bourdillon Maximillian T. , Gaye Bamba , Song Rebecca J. , Vasan Ramachandran S. , Xanthakis Vanessa 
Published: May 2022

Importance
Cardiovascular Health (CVH) scores are inversely associated with prevalent subclinical (SubDz) and incident cardiovascular disease (CVD). However, the majority of people who develop CVD have intermediate or ideal CVH scores, while many with poor CVH profiles escape CVD development.

Objective
To describe the prevalence of paradoxical relations among CVH, SubDz, and CVD.

Design
Cohort study, Framingham Study data collected prospectively (1995–2016).

Setting
Population-based.

Participants
7,627 participants (mean age 49 years, 53% women) attending Offspring examinations 6/7 and Third Generation examinations 1/2.

Exposures
CVH score (range 0–14) constructed from poor, intermediate, or ideal status for each metric (smoking, diet, physical activity, blood pressure, body mass index, fasting glucose, total cholesterol); and prevalent SubDz (≥1 of: increased carotid intimal media thickness, CIMT; left ventricular hypertrophy, LVH; microalbuminuria, MA; elevated ankle brachial index, ABI; coronary artery calcium score ≥100,CAC).

Main outcome(s) and measure(s)
Ideal CVH (scores 12–14), intermediate CVH (scores 8–11), and poor CVH (0–7). We described three distinct paradoxical phenomena, involving combinations of CVH, SubDz, and CVD, and generated CVD incidence rates and predicted CVD probabilities for all combinations.

Results
We observed 842 CVD events (median follow-up 13.7 years); 1,663 participants had SubDz. Most individuals with poor CVH (78%) or SubDz (57% for CIMT to 77% for LVH) did not develop CVD on follow-up. Among participants with incident CVD, the majority had intermediate or ideal CVH (68%) or absent SubDz (46% for CAC to 96% for ABI) at baseline. We observed similar paradoxical results in relations between CVH and prevalent SubDz. Poor CVH and prevalent SubDz were each associated with higher CVD incidence rates compared to intermediate or ideal CVH and absent SubDz, respectively. The predicted CVD probability was nearly three-times greater among participants with poor (22%) versus intermediate or ideal CVH (8%). Mean CVD predicted probabilities were nearly three (26% vs. 10% for MA) to six-times (29% vs. 5% for CAC) greater among participants with SubDz versus without SubDz. Findings were consistent within age and sex strata.

Conclusions and relevance
Although poor CVH and SubDz presence are associated with CVD incidence, paradoxical phenomena involving CVH, SubDz, and CVD are frequently prevalent in the community. Further studies to elucidate biological mechanisms underlying these phenomena are warranted.
Effects of aerobic and resistance exercise on glycosylated hemoglobin (HbA1c) concentrations in non-diabetic Taiwanese individuals based on the waist-hip ratio
Authors: Chou Ying-Hsiang , Cheng Yung-Yin , Nfor Oswald Ndi , Chen Pei-Hsin , Chen Che‐Hong , Chen Hsin-Lin , Chang Bo-Jiun , Tantoh Disline Manli , Huang Chien-Ning , Liaw Yung-Po 
Published: May 2022

Background
Glycosylated hemoglobin (HbA1c) reflects the average blood sugar over the past eight to twelve weeks. Several demographic and lifestyle factors are known to affect HbA1c levels. We evaluated the association of HbA1c with aerobic and resistance exercise in non-diabetic Taiwanese adults based on the waist-hip ratio (WHR).

Methods
We conducted this study based on TWB data collected from 90,958 individuals between 2008 and 2019. We estimated the Beta (β) coefficient and 95% confidence intervals (CI) for HbA1c using multivariate regression models.

Results
Based on the multivariate analysis, lower HbA1c levels were associated with both resistance exercise (β-coefficient = -0.027, 95% CI -0.037 to -0.017) and aerobic exercise (β-coefficient = 0.018, 95% CI, -0.023 to -0.013). Higher HbA1c levels were associated with abnormal WHR compared to normal WHR (β-coefficient = 0.091, 95% CI, 0.086 to 0.096). We detected an interaction between exercise and WHR (p for interaction = 0.0181). To determine the magnitude of the interaction, we performed additional analyses (with the reference group being ’abnormal WHR with no exercise’) and observed substantial decreases in HbA1c regardless of the WHR and exercise category. However, the largest reduction occurred in the ’normal WHR and resistance exercise’ group (β = -0.121, 95% CI, -0.132 to -0.109).

Conclusions
We found that normal resistance exercise, coupled with a normal WHR was significantly associated with lower HbA1c levels among non-diabetic individuals in Taiwan.
Evaluation of blood cell count parameters as predictors of treatment failure of malaria in Angola: An observational study
Authors: Sacomboio Euclides Nenga Manuel , dos Santos Sebastião Cruz , Salvador Silvana Teresa da Costa , João Joaquim António , Bapolo Daisy Viviana Sebastião , Francisco Ngiambudulu M. , Morais Joana , Valentim Eduardo Ekundi 
Published: May 2022

Background
Despite the guidelines provided by the World Health Organization for the treatment of malaria, treatment failure occurs in many hospitalized patients.

Objective
Evaluate whether blood cell count parameters may serve as predictors for malaria treatment.

Methodology
A cross-sectional study with a quantitative approach.

Results
Of the 219 patients, 21.5% showed failure to antimalarial treatment, Patient with 21 and 40 years (72.6%), male (53.4%), from peri-urban area (47.5%), with high parasitemia (59.8%), treated with Arthemeter (90.9%) and the mortality were 5.9%. Significant associations were observed between occupation, level of parasitemia and outcome with resistance to antimalarial treatment (p<0.05). Patients with normal Hb [OR: 0.75 (95% CI: 0.39–1.44), p = 0.393], RBC [OR: 0.83 (95% CI: 0.40–1.72), p = 0.632], RDW [OR: 0.54 (95% CI: 0.27–1.09), p = 0.088], MCV [OR: 0.61 (95% CI: 0.28–1.31), p = 0.204] were less likely to have malaria treatment failures after artemisinin-based therapy failure. In contrast, those with normal values of segmented neutrophils [OR: 0.32 (95% CI: 0.11–0.96), p = 0.042] and lymphocyte counts [OR: 0.24 (95% CI: 0.05–1.04), p = 0.055]. We also found that patients with significant low levels of Hct [OR: 0.31 (95% CI: 0.15–0.64) p = 0.002], and high leukocytes [OR: 8.88 (95% CI: 2.02–37.2), p = 0.004] and normal platelet values [OR: 1.42 (95% CI: 0.73–2.95), p = 0.280] demonstrated high probability of treatment failure.

Conclusion
The importance of blood cell count parameters in monitoring malaria therapy necessitates the urgent need to re-evaluate Artemether-based therapy. Future studies involving more participants in different settings are needed to provide further evidence.
Socio-economic and proximate determinants of under-five mortality in Guinea
Authors: Ahinkorah Bright Opoku , Budu Eugene , Seidu Abdul-Aziz , Agbaglo Ebenezer , Adu Collins , Osei Dorothy , Banke-Thomas Aduragbemi , Yaya Sanni 
Published: May 2022

Background
The death of children under-five years is one of the critical issues in public health and improving child survival continues to be a matter of urgent concern. In this paper, we assessed the proximate and socio-economics determinants of child mortality in Guinea.

Methods
Using the 2018 Guinea Demographic and Health Survey (GDHS), we extracted demographic and mortality data of 4,400 children under-five years. Both descriptive and multivariable logistic regression analyses were conducted.

Results
Under-five mortality was 111 deaths per 1,000 live births in Guinea. The likelihood of death was higher among children born to mothers who belong to other religions compared to Christians (aOR = 2.86, 95% CI: 1.10–7.41), smaller than average children compared to larger than average children (aOR = 1.97, 95% CI: 1.28–3.04) and those whose mothers had no postnatal check-up visits after delivery (aOR = 1.72, 95% CI: 1.13–2.63). Conversely, the odds of death in children with 2–3 birth rank & >2 years of birth interval compared to ≥4 birth rank and ≤2 years of birth interval were low (aOR = 0.53, 95% CI: 0.34–0.83).

Conclusion
We found that household/individual-level socioeconomic and proximate factors predict under-five mortality in Guinea. With just about a decade left to the 2030 deadline of the Sustainable Development Goals (SDGs), concerted efforts across all key stakeholders, including government and development partners, need to be geared towards implementing interventions that target these predictors.
Comparison of conventional versus customised Eurosil-4 Pink bolus for radiotherapy of the chest wall
Authors: Gill Ashlesha , Smith Warwick , Hirst Andrew , Sabet Mahsheed , Alkhatib Zaid , Gill Suki , Rowshanfarzad Pejman 
Published: May 2022

IntroductionIn radiotherapy,the presence ofair gaps near a tumour can lead to underdose to the tumour. In this study, the impact of air gaps on dose to the surface was evaluated. 3D-printing was used to construct a Eurosil-4 Pink bolus customised to the patient and its dosimetric properties were compared with that of Paraffin wax bolus.MethodsSurface dose was measured for flat sheets of Eurosil-4 Pink bolus with different thicknesses. Different air gap thicknesses were inserted between the bolus and the surface, and dose was measured for each air gap using 10 cm × 10 cm fields. This was repeated with the effective field size calculated from the patient plan. Surface dose was measured for varying angles of incidence. A customised chest phantom was used to compare dose for two customised Eurosil-4 Pink boluses, and commonly used Paraffin wax bolus.ResultsThe surface dose was found to be highest for 1.1 cm thick bolus. The decrease in surface dose for the Eurosil-4 Pink bolus was minimal for the 10 cm × 10 cm field, but higher for the effective field size and larger angles of incidence. For instance, the dose was reduced by 6.2% as a result of 1 cm air gap for the effective field size and 60 degree angle of incidence. The doses measured using Gafchromic film under the customised Eurosil-4 Pink boluses were similar to that of the Paraffin wax bolus, and higher than prescribed dose.ConclusionsThe impact of air gaps can be significant for small field sizes and oblique beams. A customised Eurosil-4 Pink bolus has promising physical and dosimetric properties to ensure sufficient dose to the tumour, even for treatments where larger impact of air gaps is suspected.
Perceived symptoms as the primary indicators for 30-day heart failure readmission
Authors: Anderson Kelley M. , Murphy Dottie , Groninger Hunter , Kolm Paul , Wang Haijun , Barton-Maxwel Vera 
Published: May 2022

Background
To identify 30-day rehospitalizations in patients discharged with heart failure (HF) based on clinical indications, physiologic measures and symptoms.

Methods
Fifty-six patients with heart failure participated. After discharge to home, clinical indicators of dyspnea, fatigue, orthopnea, dyspnea with exertion, daily weight, edema, heart rate, blood pressure, mental condition, medication adherence, and overall well-being were reported by participants daily for up to 30 days.

Results
Joint modeling of longitudinal and time-to-event approach was applied to assess the association of readmission with longitudinal measurements. There was no association between demographic, physiological, or laboratory variables and re-hospitalization within 30 days post discharge. Perceptions of dyspnea (p = .012) and feeling unwell (p < .001) were associated with rehospitalization. Patients struggling to breath were 10.7 times more likely to be readmitted than those not struggling to breath.

Conclusion
Perceived measures, particularly dyspnea and feeling unwell were more important factors than demographic, physiological, or laboratory parameters in predicting 30-day rehospitalizations in this racially diverse cohort. The symptomatic experience of heart failure is an important indicator of rehospitalization.
Retinal vessel multifractals predict pial collateral status in patients with acute ischemic stroke
Authors: Khan Adnan , De Boever Patrick , Gerrits Nele , Akhtar Naveed , Saqqur Maher , Ponirakis Georgios , Gad Hoda , Petropoulos Ioannis N. , Shuaib Ashfaq , Faber James E. , Kamran Saadat , Malik Rayaz A. 
Published: May 2022

ObjectivesPial collateral blood flow is a major determinant of the outcomes of acute ischemic stroke. This study was undertaken to determine whether retinal vessel metrics can predict the pial collateral status and stroke outcomes in patients.MethodsThirty-five patients with acute stroke secondary to middle cerebral artery (MCA) occlusion underwent grading of their pial collateral status from computed tomography angiography and retinal vessel analysis from retinal fundus images.ResultsThe NIHSS (14.7 ± 5.5 vs 10.1 ± 5.8,p= 0.026) and mRS (2.9 ± 1.6 vs 1.9 ± 1.3,p= 0.048) scores were higher at admission in patients with poor compared to good pial collaterals. Retinal vessel multifractals: D0(1.673±0.028vs1.652±0.025,p= 0.028), D1(1.609±0.027vs1.590±0.025,p= 0.044) and f(α)max (1.674±0.027vs1.652±0.024,p= 0.019) were higher in patients with poor compared to good pial collaterals. Furthermore, support vector machine learning achieved a fair sensitivity (0.743) and specificity (0.707) for differentiating patients with poor from good pial collaterals. Age (p= 0.702), BMI (p= 0.422), total cholesterol (p= 0.842), triglycerides (p= 0.673), LDL (p= 0.952), HDL (p= 0.366), systolic blood pressure (p= 0.727), HbA1c(p= 0.261) and standard retinal metrics including CRAE (p= 0.084), CRVE (p= 0.946), AVR (p= 0.148), tortuosity index (p= 0.790), monofractal Df(p= 0.576), lacunarity (p= 0.531), curve asymmetry (p= 0.679) and singularity length (p= 0.937) did not differ between patients with poor compared to good pial collaterals.ConclusionsThis is the first translational study to show increased retinal vessel multifractal dimensions in patients with acute ischemic stroke and poor pial collaterals. A retinal vessel classifier was developed to differentiate between patients with poor and good pial collaterals and may allow rapid non-invasive identification of patients with poor pial collaterals.
Advancing data to care strategies for persons with HIV using an innovative reconciliation process
Authors: Villanueva Merceditas , Miceli Janet , Speers Suzanne , Nichols Lisa , Carroll Constance , Jenkins Heidi , Altice Frederick 
Published: May 2022

Background
UN AIDS has set ambitious 95-95-95 HIV care continuum targets for global HIV elimination by 2030. The U.S. HIV Care Continuum in 2018 showed that 65% of persons with HIV(PWH) are virally suppressed and 58% retained in care. Incomplete care-engagement not only affects individual health but drives ongoing HIV transmission. Data to Care (D2C) is a strategy using public health surveillance data to identify and re-engage out-of-care (OOC) PWH. Optimization of this strategy is needed.

Setting
Statewide partnership with Connecticut Department of Public Health (CT DPH), 23 HIV clinics and Yale University School of Medicine (YSM). Our site was one of 3 participants in the CDC-sponsored RCT evaluating the efficacy of DPH-employed Disease Intervention Specialists (DIS) for re-engagement in care.

Methods
From 11/2016-7/2018, a data reconciliation process using public health surveillance and clinic visit data was used to identify patients eligible for randomization (defined as in-Care for 12 months and OOC for subsequent 6-months) to receive DIS intervention. Clinic staff further reviewed this list and designated those who would not be randomized based on established criteria.

Results
2958 patients were eligible for randomization; 655 (22.1%) were randomized. Reasons for non-randomizing included: well patient [499 (16.9%)]; recent visit [946 (32.0%)]; upcoming visit [398 (13.5%)]. Compared to non-randomized patients, those who were randomized were likely to be younger (mean age 46.1 vs. 51.6, p < .001), Black (40% vs 35%)/Hispanic (37% vs 32.8%) [(p < .001)], have CD4<200 cells/ul (15.9% vs 8.5%, p < .001) and viral load >20 copies/ml (43.8% vs. 24.1%, 0<0.001). Extrapolating these estimates to a statewide HIV care continuum suggests that only 8.3% of prevalent PWH are truly OOC.

Conclusions
A D2C process that integrated DPH surveillance and clinic data successfully refined the selection of newly OOC PWH eligible for DIS intervention. This approach more accurately reflects real world care engagement and can help prioritize DPH resources.
Warfarin sensitivity is associated with increased hospital mortality in critically Ill patients
Authors: Ma Zhiyuan , Wang Ping , Mahesh Milan , Elmi Cyrus P. , Atashpanjeh Saeid , Khalighi Bahar , Cheng Gang , Krishnamurthy Mahesh , Khalighi Koroush 
Published: May 2022

Background
Warfarin is a widely used anticoagulant with a narrow therapeutic index and large interpatient variability in the therapeutic dose. Warfarin sensitivity has been reported to be associated with increased incidence of international normalized ratio (INR) > 5. However, whether warfarin sensitivity is a risk factor for adverse outcomes in critically ill patients remains unknown. In the present study, we aimed to evaluate the utility of different machine learning algorithms for the prediction of warfarin sensitivity and to determine the impact of warfarin sensitivity on outcomes in critically ill patients.

Methods
Nine different machine learning algorithms for the prediction of warfarin sensitivity were tested in the International Warfarin Pharmacogenetic Consortium cohort and Easton cohort. Furthermore, a total of 7,647 critically ill patients was analyzed for warfarin sensitivity on in-hospital mortality by multivariable regression. Covariates that potentially confound the association were further adjusted using propensity score matching or inverse probability of treatment weighting.

Results
We found that logistic regression (AUC = 0.879, 95% CI: 0.834–0.924) was indistinguishable from support vector machine with a linear kernel, neural network, AdaBoost and light gradient boosting trees, and significantly outperformed all the other machine learning algorithms. Furthermore, we found that warfarin sensitivity predicted by the logistic regression model was significantly associated with worse in-hospital mortality in critically ill patients with an odds ratio (OR) of 1.33 (95% CI, 1.01–1.77).

Conclusions
Our data suggest that the logistic regression model is the best model for the prediction of warfarin sensitivity clinically and that warfarin sensitivity is likely to be a risk factor for adverse outcomes in critically ill patients.
Effectiveness of three delivery models for promoting access to pre-exposure prophylaxis in HIV-1 serodiscordant couples in Nigeria
Authors: Folayan Morenike Oluwatoyin , Aliyu Sani , Oginni Ayodeji , Ezechi Oliver , Kolawole Grace , Ezeama Nkiru , Dadem Nancin , Anenih James , Alagi Matthias , Ekanem Etim , Afiadigwe Evaristus , Aguolu Rose , Oyebode Tinuade , Babalola-Jacobs Alero , Sagay Atiene , Nweneka Chidi , Kamofu Hadiza , Idoko John 
Published: May 2022

Objectives
To evaluate the effectiveness of three models for pre-exposure prophylaxis (PrEP) service delivery to HIV-1 serodiscordant couples in Nigeria.

Methods
297 heterosexual HIV-1 serodiscordant couples were recruited into three PrEP delivery models and followed up for 18 months. The models were i) Outpatient clinic model providing PreP in routine outpatient care; ii) Antiretroviral therapy (ART) clinic model providing PrEP in ART clinics; and iii) Decentralized care model providing PrEP through primary and secondary care centres linked to a tertiary care centre. The primary effectiveness endpoint was incident HIV-1 infection. The HIV incidence before and after the study was compared and the incidence rate ratio computed for each model. Survival analysis was conducted, Cox regression analysis was used to compare the factors that influenced couple retention in each of the models. Kaplan-Meier survival analysis was used to estimate the median retention time (in months) of the study participants in each of the study models, and log-rank test for equality of survival functions was conducted to test for significant differences among the three models.

Results
There was no significant difference (p>0.05) in the couple retention rates among the three models. At months 3, 6 and 9, adherence of the HIV-1-infected partners to ART was highest in the decentralized model, whereas at months 9 and 12, the outpatient model had the highest proportion of HIV-1- uninfected partners adhering to PrEP (p<0.001). The HIV incidence per 100 person-years was zero in the general outpatient clinic and ART clinic models and 1.6 (95% CI: 0.04–9.1) in the decentralized clinic model. The difference in the observed and expected incidence rate was 4.3 (95% CI: 0.44–39.57) for the decentralized clinic model.

Conclusion
Although incidence of HIV seroconversion was highest in the decentralized clinic model, this difference may be due to the higher sexual risk behavior among study participants in the decentralized model rather than the type of service delivery. The study findings imply that any of the models can effectively deliver PrEP services.