bluuebunny/crossref_metadata_2025_split huggingface dataset:
Anti-PD-1 combined sorafenib versus anti-PD-1 alone in the treatment of advanced hepatocellular cell carcinoma: a propensity score-matching study
Authors: Chen San-Chi , Huang Yi-Hsiang , Chen Ming-Huang , Hung Yi-Ping , Lee Rheun-Chuan , Shao Yu-Yun , Chao Yee 
Published: January 2022

Abstract
Background
Vascular endothelial growth factor (VEGF) plays a role in the tumor microenvironment. Sorafenib, which inhibits the VEGF pathway, has an immune-modulation function but lacks substantial clinical data. This study aims to explore the efficacy of anti-PD-1 combined sorafenib in advanced hepatocellular carcinoma (HCC).

Methods
HCC patients who underwent anti-PD-1 treatment at Taipei Veterans General Hospital (Taipei, Taiwan) between January 2016 and February 2019 were reviewed. The efficacy was compared between groups after propensity-score matching.

Results
There were 173 HCC patients receiving anti-PD-1. After excluding unsuitable cases, 140 patients were analyzed, of which 58 received combination therapy and 82 received anti-PD-1 alone. The combination therapy had a trend of higher CR rate (8.6% vs. 4.9%, ns.), ORR (22.4% vs. 19.5%, ns.) and significantly higher DCR (69.0% vs. 37.8%, p < 0.05) comparing to anti-PD-1 alone. After matching, combination group achieved longer progression-free survival (3.87 vs. 2.43 months, p < 0.05) and overall survival (not reached vs. 7.17 months, p < 0.05) than anti-PD-1 alone, without higher grade 3/4 AE (10.3% vs. 7.1%, p = 0.73). The tumor response varied among different metastatic sites, with high responses in adrenal glands, peritoneum and lungs. The more AFP declined (> 10, > 50 and > 66%), the higher the ORR (70, 80 and 92%) and CR rates (30, 35 and 58%) were achieved at day 28.

Conclusions
This is the first study to demonstrate the combination of anti-PD-1 and sorafenib had better efficacy and survival benefit. A prospective randomized study is needed to confirm this finding.
Which urban communities are susceptible to COVID-19? An empirical study through the lens of community resilience
Authors: Shi Chunyu , Liao Liao , Li Huan , Su Zhenhua 
Published: January 2022

Abstract
Background
After the lockdown of Wuhan on January 23, 2020, the government used community-based pandemic prevention and control as the core strategy to fight the pandemic, and explored a set of standardized community pandemic prevention measures that were uniformly implemented throughout the city. One month later, the city announced its first lists of “high-risk” communities and COVID-19-free communities. Under the standardized measures of pandemic prevention and mitigation, why some communities showed a high degree of resilience and effectively avoided escalation, while the situation spun out of control in other communities? This study investigated: 1) key factors that affect the effective response of urban communities to the pandemic, and 2) types of COVID-19 susceptible communities.

Methods
This study employs the crisp-set qualitative comparative analysis method to explore the influencing variables and possible causal condition combination paths that affect community resilience during the pandemic outbreak. Relying on extreme-case approach, 26 high-risk communities and 14 COVID-19 free communities were selected as empirical research subjects from the lists announced by Wuhan government. The community resilience assessment framework that evaluates the communities’ capacity on pandemic prevention and mitigation covers four dimensions, namely spatial resilience, capital resilience, social resilience, and governance resilience, each dimension is measured by one to three variables.

Results
The results of measuring the necessity of 7 single-condition variables found that the consistency index of “whether the physical structure of the community is favorable to virus transmission” reached 0.9, which constitutes a necessary condition for COVID-19 susceptible communities. By analyzing the seven condition configurations with high row coverage and unique coverage in the obtained complex solutions and intermediate solutions, we found that outbreaks are most likely to occur in communities populated by disadvantaged populations. However, if lacking spatial-, capital-, and governance resilience, middle-class and even wealthy communities could also become areas where COVID-19 spreads easily.

Conclusions
Three types of communities namely vulnerable communities, alienated communities, and inefficient communities have lower risk resilience. Spatial resilience, rather than social resilience, constitutes the key influencing factor of COVID-19-susceptible communities, and the dual deficiencies of social resilience and governance resilience are the common features of these communities.
Application effect of computer-aided design combined with three-dimensional printing technology in autologous tooth transplantation: a retrospective cohort study
Authors: Han Shuang , Wang Hui , Chen Jue , Zhao Jihong , Zhong Haoyan 
Published: January 2022

Abstract
Background
The activity of donor periodontal membrane is the key factor of autologous tooth healing. The application of digital aided design, 3D printing model and guide plate in autotransplantation of tooth (ATT) is expected to reduce the damage of periodontal membrane and preserve the activity of periodontal membrane, so as to improve the success rate of ATT. This study tried to prove the role of digital technology in improving the success rate of ATT, although there are differences in model accuracy in practice.

Methods
We included 41 tooth autotransplantation cases which assisted by 3D-printed donor models and surgical guides and divided them into two groups in accordance with whether the donor tooth could be placed successfully after the preparation of alveolar socket guided by the model tooth. Then, we compared and analyzed the preparation time of alveolar socket, extra-alveolar time, and number of positioning trials of the donor tooth between the two groups. We also included a comparison of the in vitro time of the donor tooth with that of 15 min. The incidence of complications was included in the prognostic evaluation.

Results
The mean preparation time of the alveolar socket, mean extra-alveolar time of donor tooth, and mean number of positioning trials with donor tooth of 41 cases were 12.73 ± 6.18 min, 5.56 ± 3.11 min, and 2.61 ± 1.00, respectively. The group wherein the donor tooth cannot be placed successfully (15.57 ± 6.14 min, 7.29 ± 2.57 min) spent more preparation time of alveolar socket and extra-alveolar time than the group wherein the donor tooth can be placed successfully (9.75 ± 4.73 min, 3.75 ± 2.57 min). The number of positioning trials with the donor tooth of the group wherein the donor tooth cannot be placed successfully (3.19 ± 0.75) was higher than that of the other group (2.00 ± 0.86). There was no significant difference in survival rates between the two groups.

Conclusions
Compared with the traditional tooth autotransplantation, the introduction of computer-aided design combined with 3D printing of the model tooth and surgical guides evidently shortens the preparation time of the alveolar socket and the extra-alveolar time of the donor tooth and reduces the number of positioning trials with the donor tooth regardless of the shape deviation between the model and actual teeth.
Euterpe oleracea fruit (Açai)-enriched diet suppresses the development of experimental cerebral malaria induced by Plasmodium berghei (ANKA) infection
Authors: Oliveira Karen Renata Herculano Matos , Torres Marjorie Lujan Marques , Kauffmann Nayara , de Azevedo Ataíde Brenda Jaqueline , de Souza Franco Mendes Nívia , dos Anjos Larissa Medeiros , dos Santos Borges Rosivaldo , Bahia Carlomagno Pacheco , Leão Luana Ketlen Reis , da Conceição Fonseca Passos Adelaide , Herculano Anderson Manoel , de Jesus Oliveira Batista Evander 
Published: January 2022

AbstractBackgroundCerebral malaria is one of the most severe complications attributed to protozoal infection byPlasmodium falciparum, gaining prominence in children mortality rates in endemic areas. This condition has a complex pathogenesis associated with behavioral, cognitive and motor sequels in humans and current antimalarial therapies have shown little effect in those aspects. Natural products with antioxidant and anti-inflammatory properties have become a valuable alternative therapeutic option in the treatment of distinct conditions. In this context, this study investigated the neuroprotective effect ofEuterpe oleracea(açai) enriched diet during the development of experimental cerebral malaria induced by the inoculation of Swiss albino mice withPlasmodium bergheiANKA strain.MethodsAfterPlasmodiuminfection, animals were maintained on a feeding withEuterpe oleraceaenriched ration and parameters such as survival curve, parasitemia and body weight were routinely monitored. The present study has also evaluated the effect of açai-enriched diet on the blood-brain barrier leakage, histological alterations and neurocognitive impairments in mice developing cerebral malaria.ResultsOur results demonstrate that between 7th–19th day post infection the survival rate of the group treated with açai enriched ration was higher when compared withPlasmodium-infected mice in which 100% of mice died until the 11th days post-infection, demonstrating that açai diet has a protective effect on the survival of infected treated animals. The same was observed in the brain vascular extravasation, where Evans blue dye assays showed significantly less dye extravasation in the brains ofPlasmodium-infected mice treated with açai enriched ration, demonstrating more preserved blood-brain barrier integrity. Açai-enriched diet also attenuate the histopathological alterations elicited byPlasmodium bergheiinfection. We also showed a decrease of the neurological impairments arising from the exposure of cerebral parenchyma in the group treated with açai diet, ameliorating motor and neuropsychiatric changes, analyzed through the SHIRPA protocol.ConclusionWith these results, we conclude that the treatment with açai enriched ration decreased the mortality of infected animals, as well as protected the blood-brain barrier and the neurocognitive deficits inPlasmodium-infected animals.
Operationalising a real-time research ethics approach: supporting ethical mindfulness in agriculture-nutrition-health research in Malawi
Authors: Matandika Limbanazo , Millar Kate , Umar Eric , Joy Edward , Mfutso-Bengo Joseph 
Published: January 2022

AbstractBackgroundThere have been notable investments in large multi-partner research programmes across the agriculture-nutrition-health (ANH) nexus. These studies often involve human participants and commonly require research ethics review. These ANH studies are complex and can raise ethical issues that need pre-field work, ethical oversight and also need an embedded process that can identify, characterise and manage ethical issues as the research work develops, as such more embedded and dynamic ethics processes are needed. This work builds on notions of ‘ethics in practice’ by developing an approach to facilitate ethical reflection within large research programmes. This study explores the application of a novel ‘real-time research ethics approach’ (RTREA) and how this can support ethical mindfulness. This involves embedding ethical analysis and decision-making within research implementation, with a continuous dialogue between participants and researchers. The aim is to improve ethical responsiveness and participant experience, which in turn may ethically support adherence and retention. In this case study, a bioethics team (BT) was embedded in a community-based randomised, controlled trial conducted in rural Malawi, titled the ‘Addressing Hidden Hunger with Agronomy’. To identify ethical issues, the researchers conducted ten focus group discussions, fourteen in-depth interviews with key informants, two workshops, observed two sensitisation and three activity meetings conducted by the trial team, and analysed fifteen reports from pre-trial to trial implementation.ResultsThe RTREA facilitated the identification of social and ethical concerns and made researchers aware of participants’ ‘lived research experience’. To address concerns and experiences, the BT worked with researchers to facilitate conversation spaces where social and ethical issues were discussed. Conversation spaces were designed to create partnerships and promote participatory methods to capture trial participants’ (TPs) perspectives and experiences.ConclusionsThe use of RTREA showed the value of real-time and continuous engagement between TPs and researchers. These real-time processes could be embedded to complement traditional ethical guidance and expert opinions. A deeper engagement appeared to support greater operationalising of principles of inclusion, empowerment, and participant autonomy and supported researchers ‘ethical mindfulness’ which in turn may support instrumental outcomes of high recruitment, retention, and adherence levels.
Village health workers as health diplomats: negotiating health and study participation in a malaria elimination trial in The Gambia
Authors: Masunaga Yoriko , Muela Ribera Joan , Jaiteh Fatou , de Vries Daniel H. , Peeters Grietens Koen 
Published: January 2022

AbstractBackgroundAlthough many success stories exist of Village Health Workers (VHWs) improving primary health care, critiques remain about the medicalisation of their roles in disease-specific interventions. VHWs are placed at the bottom of the health system hierarchy as cheap and low-skilled volunteers, irrespective of their highly valued social and political status within communities. In this paper, we shed light on the political role VHWs play and investigate how this shapes their social and medical roles, including their influence on community participation.MethodThe study was carried out within the context of a malaria elimination trial implemented in rural villages in the North Bank of The Gambia between 2016 and 2018. The trial aimed to reduce malaria prevalence by treating malaria index cases and their potentially asymptomatic compound members, in which VHWs took an active role advocating their community and the intervention, mobilising the population, and distributing antimalarial drugs. Mixed-methods research was used to collect and analyse data through qualitative interviews, group discussions, observations, and quantitative surveys.Results and discussionWe explored the emic logic of participation in a malaria elimination trial and found that VHWs played a pivotal role in representing their community and negotiating with the Medical Research Council to bring benefits (e.g. biomedical care service) to the community. We highlight this representative role of VHWs as‘health diplomats’, valued and appreciated by community members, and potentially increasing community participation in the trial. We argue that VHWs aspire to be politically present and be part of the key decision-makers in the community through their health diplomat role.ConclusionIt is thus likely that in the context of rural Gambia, supporting VHWs beyond medical roles, in their social and political roles, would contribute to the improved performance of VHWs and to enhanced community participation in activities the community perceive as beneficial.
What makes an effective Quality Improvement Manager? A qualitative study in the New Zealand Health System
Authors: Akmal Adeel , Podgorodnichenko Nataliya , Stokes Tim , Foote Jeff , Greatbanks Richard , Gauld Robin 
Published: January 2022

AbstractPurposeQuality improvement is an international priority, and health organisations invest heavily in this endeavour. Little, however, is known of the role and perspectives of Quality Improvement Managers who are responsible for quality improvement implementation. We explored the quality improvement managers’ accounts of what competencies and qualities they require to achieve day-to-day and long-term quality improvement objectives.DesignQualitative exploratory design using an interpretivist approach with semi-structured interviews analysed thematically.Setting and participants.Interviews were conducted with 56 quality improvement managers from 15 (out of 20) New Zealand District Health Boards. Participants were divided into two groups: traditional and clinical quality improvement managers. The former group consisted of those with formal quality improvement education—typically operations managers or process engineers. The latter group was represented by clinical staff—physicians and nurses—who received on-the-job training.ResultsThree themes were identified: quality improvement expertise, leadership competencies and interpersonal competencies. Effective quality improvement managers require quality improvement experience and expertise in healthcare environments. They require leadership competencies including sense-giving, taking a long-term view and systems thinking. They also require interpersonal competencies including approachability, trustworthiness and supportiveness. Traditional and clinical quality improvement managers attributed different value to these characteristics with traditional quality improvement managers emphasising leadership competencies and interpersonal skills more than clinical quality improvement managers.ConclusionsWe differentiate between traditional and clinical quality improvement managers, and suggest how both groups can be better prepared to be effective in their roles. Both groups require a comprehensive socialisation and training process designed to meet specific learning needs.
Exploring peer navigation and support in the quality of HIV care experiences of female sex workers in the Dominican Republic
Authors: Karver Tahilin Sanchez , Barrington Clare , Donastorg Yeycy , Perez Martha , Gomez Hoisex , Page Kathleen R. , Celentano David , Smith Katherine Clegg , Kerrigan Deanna 
Published: January 2022

AbstractBackgroundDespite evidence on peer navigation’s association with positive HIV outcomes, such as engagement in HIV care and antiretroviral therapy (ART) initiation, the mechanisms through which peer navigation may influence these outcomes have been less explored. The purpose of this study is to describe the role of peer navigation and support on enhancing the quality of HIV treatment and care services experienced by female sex workers (FSWs).MethodsSurvey data was derived from a quantitative cohort (n = 211) of FSWs living with HIV in the Dominican Republic and complemented with data from two rounds of in-depth interviews (IDIs) from a qualitative subsample (n = 20 per round). Descriptive statistics and multivariable logistic regressions were used to explore the association between peer navigation and relational aspects of care and overall satisfaction of the quality of HIV treatment and care. Thematic analysis was employed to code and synthesize textual data from IDIs.Results41.2% of the participants reported having had contact with a peer navigator in the last 6 months. Qualitative data revealed that peer navigation and support was instrumental in assisting FSWs linkage to HIV care after diagnosis, elevating FSWs’ ability to access more comprehensive clinical care facilities, and promoting agency by improving FSWs’ skills to more strategically and effectively engage with the clinic environment and health care providers. Peer navigation was positively associated with experiencing more respectful treatment by clinic staff (AOR: 6.65, 95% CI: 2.32–19.02), and greater satisfaction with overall HIV care services (AOR: 2.57, 95% CI: 1.77–3.74).ConclusionPromoting the full integration of peer navigation into healthcare structures is a strategic approach to enhance the quality of HIV care experienced by FSWs and improve their HIV-related outcomes.
A cost-minimisation analysis of performing point-of-care ultrasonography on patients with vaginal bleeding in early pregnancy in general practice: a decision analytical model
Authors: Kiritharan Swaathi , Johanson Mille Vang , Jensen Martin Bach , Thomsen Janus Nikolaj Laust , Andersen Camilla Aakjær , Jensen Cathrine Elgaard 
Published: January 2022

AbstractBackgroundSpotting and light vaginal bleeding are common and usually harmless symptoms in early pregnancy. Still, vaginal bleeding may be the first sign of an abortion and often causes distress to pregnant women and leads to an expectation of an ultrasonography examination of the uterus. As point-of-care ultrasonography (POCUS) is increasingly being integrated into general practice, these patients may be clinically evaluated and managed by general practitioners (GPs). This can potentially reduce referrals of patients from the primary to the secondary healthcare sector resulting in societal cost-savings.The primary purpose of this study was to investigate whether the accessibility of POCUS in general practice for patients with vaginal bleeding in early pregnancy is cost-saving compared to usual practice where GPs do not have access to POCUS. A secondary purpose of this study was to estimate a remuneration for GPs performing POCUS on these patients in general practice.MethodsA cost-minimisation analysis was based on a decision tree model reflecting the two alternatives: general practice with and without GPs having access to POCUS. The robustness of the model results was investigated using probabilistic sensitivity analysis and the following deterministic sensitivity analyses: one-way analyses for the model input parameters and a scenario analysis with a change from a societal to a healthcare sector perspective.An expected remuneration reflecting the add-on cost of Danish GPs performing POCUS was estimated based on the related costs: cost of an ultrasonography scanner, GP’s time consumption, ultrasonography training, and utensils per scanning.ResultsThe difference in average cost between the two alternatives from a societal perspective was estimated to be €110, in favour of general practice with GPs using POCUS. The deterministic sensitivity analyses demonstrated robustness of the results to plausible changes in the input parameters.The expected remuneration for performing POCUS in this specific setting was estimated to be €32 per examination.ConclusionHaving GPs perform POCUS on patients with vaginal bleeding in early pregnancy is cost-saving compared to usual practice. The results should be taken with caution as this study was based on early modelling with uncertainties associated with the input parameters in the model.