bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trends in Veno‐Arterial Extracorporeal Life Support With and Without an Impella or Intra‐Aortic Balloon Pump for Cardiogenic Shock
Authors: Hendrickson Michael J. , Jain Vardhmaan , Bhatia Kirtipal , Chew Christopher , Arora Sameer , Rossi Joseph S. , Villablanca Pedro , Kapur Navin K. , Joshi Aditya A. , Fox Arieh , Mahmood Kiran , Birati Edo Y. , Ricciardi Mark J. , Qamar Arman 
Published: November 2022

Background
Mechanical circulatory support devices, such as the intra‐aortic balloon pump (IABP) and Impella, are often used in patients on veno‐arterial extracorporeal life support (VA‐ECLS) with cardiogenic shock despite limited supporting clinical trial data.

Methods and Results

Hospitalizations for cardiogenic shock from 2016 to 2018 were identified from the National Inpatient Sample. Trends in the use of VA‐ECLS with and without an IABP or Impella were assessed semiannually. Multivariable logistic regression and general linear regression evaluated the association of Impella and IABP use with in‐hospital outcomes. Overall, 12 035 hospitalizations with cardiogenic shock and VA‐ECLS were identified, of which 3115 (26%) also received an IABP and 1880 (16%) an Impella. Use of an Impella with VA‐ECLS substantially increased from 10% to 18% over this period (
P
<0.001), whereas an IABP modestly increased from 25% to 26% (
P
<0.001). In‐hospital mortality decreased 54% to 48% for VA‐ECLS only, 61% to 58% for VA‐ECLS with an Impella, and 54% to 49% for VA‐ECLS with an IABP (
P
<0.001 each). Most (57%) IABPs or Impellas were placed on the same day as VA‐ECLS. After adjustment, there were no differences in in‐hospital mortality or length of stay with the addition of an IABP or Impella compared with VA‐ECLS alone.

Conclusions
From 2016 to 2018 in the United States, use of an Impella and IABP with VA‐ECLS significantly increased. More than half of Impellas and IABPs were placed on the same day as VA‐ECLS, and the use of a second mechanical circulatory support device did not impact in‐hospital mortality. Further studies are needed to decipher the optimal timing and patient selection for this growing practice.
An Objective Weather Regime Classification for Aotearoa New Zealand Using a Two-Tiered K-Means Clustering Approach
Authors: Rampal Neelesh , Lorrey Andrew , Fauchereau Nicolas 
Published: November 2022

Abstract
Weather regimes (WRs), also known as synoptic types, are defined as recurrent patterns that have been used to categorize variability in atmospheric circulation. However, defining the optimal number of patterns can often be arbitrary, and there are common shortcomings when oversimplifying a wide range of synoptic conditions and weather outcomes. We build on previous work that has defined regional WRs and objectively ascribe an optimal number of once-daily weather patterns for Aotearoa New Zealand (ANZ) using affinity propagation combined with K-means clustering. Nine primary WRs for ANZ were classified based on once-daily geopotential height spatial patterns, but these patterns still retained a wide degree of spatial variability. Subsidiary clusters were subsequently defined within each primary WR by applying affinity propagation and K-means clustering to reveal the largest within-cluster differences based on joint daily temperature and precipitation anomalies. Up to three subsidiary patterns in each of the primary regimes were revealed, with a total of 21 unique daily patterns emerging from the two-tier classification. Subsidiary WRs reveal subtle differences in the location and intensity of regional-scale pressure anomalies, pressure gradients, and wind flow over both main islands that lead to large differences in surface weather anomalies. Impacts of atmospheric variability related to each subsidiary WR are exemplified by different spatial outcomes for rainfall and temperature (including intensity of anomalies) at regional and subregional levels. The approach presented in this study has utility for enhancing prediction of weather outcomes, including extreme weather, and can also be applied more widely over a range of time scales to improve understanding of weather and climate linkages.
Development and validation of a predictive model combining patient-reported outcome measures, spirometry and exhaled nitric oxide fraction for asthma diagnosis
Authors: Louis Gilles , Schleich Florence , Guillaume Michèle , Kirkove Delphine , Nekoee Zahrei Halehsadat , Donneau Anne-Françoise , Henket Monique , Paulus Virginie , Guissard Françoise , Louis Renaud , Pétré Benoit 
Published: November 2022

IntroductionAlthough asthma is a common disease, its diagnosis remains a challenge in clinical practice with both over- and underdiagnosis. Here, we performed a prospective observational study investigating the value of symptom intensity scales alone or combined with spirometry and exhaled nitric oxide fraction (FENO) to aid in asthma diagnosis.MethodsOver a 38-month period we recruited 303 untreated patients complaining of symptoms suggestive of asthma (wheezing, dyspnoea, cough, sputum production and chest tightness). The whole cohort was split into a training cohort (n=166) for patients recruited during odd months and a validation cohort (n=137) for patients recruited during even months. Asthma was diagnosed either by a positive reversibility test (≥12% and ≥200 mL in forced expiratory volume in 1 s (FEV1)) and/or a positive bronchial challenge test (provocative concentration of methacholine causing a 20% fall in FEV1≤8 mg·mL−1). In order to assess the diagnostic performance of symptoms, spirometric indices andFENO, we performed receiver operating characteristic curve analysis and multivariable logistic regression to identify the independent factors associated with asthma in the training cohort. Then, the derived predictive models were applied to the validation cohort.Results63% of patients in the derivation cohort and 58% of patients in the validation cohort were diagnosed as being asthmatic. After logistic regression, wheezing was the only symptom to be significantly associated with asthma. Similarly, FEV1(% pred), FEV1/forced vital capacity (%) andFENOwere significantly associated with asthma. A predictive model combining these four parameters yielded an area under the curve of 0.76 (95% CI 0.66–0.84) in the training cohort and 0.73 (95% CI 0.65–0.82) when applied to the validation cohort.ConclusionCombining a wheezing intensity scale with spirometry andFENOmay help in improving asthma diagnosis accuracy in clinical practice.
Impact of socioeconomic factors and health determinants on preterm birth in Brazil: a register-based study
Authors: de Andrade Luciano , Kozhumam Arthi S. , Rocha Thiago Augusto Hernandes , de Almeida Dante Grapiuna , da Silva Núbia Cristina , de Souza Queiroz Rejane Christine , Massago Miyoko , Rent Sharla , Facchini Luiz Augusto , da Silva Antônio Augusto Moura , Staton Catherine Ann , Vissoci João Ricardo Nickenig , Thomaz Erika Barbara Abreu Fonseca 
Published: November 2022

Abstract
Background
More than 15 million children are born preterm annually. While preterm survival rates have increased in high-income countries. Low- and middle-income countries, like Brazil, continue to battle high neonatal mortality rates due to a lack of adequate postnatal care. Globally, neonatal mortality is higher for preterm infants compared to those born at term. Our study aims to map and analyze the spatial, socioeconomic, and health coverage determinants related to preterm birth in Brazil in order to understand how spatial variations in demographics and access to primary care may affect preterm birth occurrences.

Methods
Using publicly available national-level data from the Brazilian health system for 2008–2017, we conducted an ecological study to visualize the spatial distributions of preterm birth along with socioeconomic status, the structure of health services, and primary care work process, each consisting of multiple variables reduced via principal component analysis. Regression models were created to determine predictive effects of numeric and spatial variation of these scores on preterm birth rates.

Results
In Brazil, preterm birth rates increased from 2008–2017, with small and rural municipalities frequently exhibiting higher rates than urban areas. Scores in socioeconomic status and work process were significant predictors of preterm birth rates, without taking into account spatial adjustment, with more positive scores in socioeconomic status predicting higher preterm birth rates (coefficient 0.001145) and higher scores in work process predicting lower preterm birth rates (coefficient -0.002416). Geographically weighted regression showed socioeconomic status to be a more significant predictor in the North, with the work process indicators being most significant in the Northeast.

Conclusions
Results support that primary care work process indicators are more significant in estimating preterm birth rates than physical structures available for care. These results emphasize the importance of ensuring the presence of the minimum human resources needed, especially in the most deprived areas of Brazil. The association between social determinants of health and preterm birth rates raises questions regarding the importance of policies dedicated to foster equity in the accessibility of healthcare services, and improve income as protective proxies for preterm birth.
STEAP3 can predict the prognosis and shape the tumor microenvironment of clear cell renal cell carcinoma
Authors: Wu Jiyue , Bi Qing , Zheng Xiang , Cao Huawei , Hao Changzhen , Sun Zejia , Wang Wei 
Published: November 2022

AbstractClear cell renal cell carcinoma (ccRCC) is a common malignant tumor of the urinary system characterized by poor prognosis and difficult treatment. It has been reported that iron metabolism dysregulation is a common phenomenon in ccRCC and is closely related to the process of ccRCC. But still now, the exact function and underlying mechanisms of iron metabolism dysregulation in ccRCC have not been fully elucidated. In this study, we comprehensively investigated the prognostic value and potential role of STEAP3 (an iron metabolism-related gene) in ccRCC. STEAP3 is significantly up-regulated in ccRCC. High STEAP3 expression is associated with gender, hemoglobin level, pathological grade, tumor stage and significantly predicts an unfavorable prognosis of ccRCC patients. Functional enrichment analysis and evaluation of the tumor microenvironment indicated that STEAP3 was involved in the remodeling of tumor extracellular matrix and the shaping of an immune-suppressive tumor microenvironment to promote tumor metastasis and evade immune killing. Besides, the expression of STEAP3 is also associated with the expression of various immune checkpoint molecules and the IC50 of targeted drugs. Finally, we verified STEAP3 by RT-qPCR and IHC staining. In conclusion, we found that STEAP3 can serve as a candidate prognostic biomarker for ccRCC, and targeting STEAP3 and its biological processes may provide new references for the individualized treatment of ccRCC.
A comparative study to determine the association of gut microbiome with schizophrenia in Zhejiang, China
Authors: Yan Fuyang , Xia Lehong , Xu Li , Deng Liyun , Jin Guolin 
Published: November 2022

AbstractBackgroundWith the rapid progress of high-throughput sequencing technology, characterization of schizophrenia (SZ) with underlying probing of the gut microbiome can explore pathogenic mechanisms, estimate disease risk, and allow customization of therapeutic and prophylactic modalities. In this study, we compared the differences in gut microbial diversity and composition between 50 SZ subjects and 50 healthy matched subjects in Zhejiang, China via targeted next-generation sequencing (16S rRNA amplicon).ResultsAccordingly, the alpha diversity indices (observed species index, Shannon index, and Simpson index) of the gut microbiome in the healthy control group were higher than those in the SZ group. Additionally, principal coordinate analysis and non-metric multidimensional scaling of beta diversity revealed that patients with SZ clustered more tightly than healthy controls. At the phylum level, we found that the abundance ofBacteroidetesandProteobacteriain the SZ group was significantly increased. At the genus level, the relative abundances ofPrevotella,Parabacteroides, andSutterellawere significantly higher, whereas the abundances ofFaecalibacterium,Blautia,Lachnospira,Clostridium,Ruminococcus, andCoprococcuswere lower than those in the healthy control group. Further analyses revealed thatSuccinivibrio,Megasphaera, andNesterenkoniamay serve as potential biomarkers for distinguishing patients with SZ from those in the control cohort.ConclusionsThis study profiled differences in gut microbiome diversity, taxonomic composition, and function between SZ and healthy cohorts, and the insights from this research could be used to develop targeted next-generation sequencing-based diagnoses for SZ.
Mental health challenges and perceived risks among female sex workers in Nairobi, Kenya
Authors: Panneh Mamtuti , Gafos Mitzy , Nyariki Emily , Liku Jennifer , Shah Pooja , Wanjiru Rhoda , Wanjiru Mary , Beksinska Alicja , Pollock James ,   The Maisha Fiti Study Champions, Gwala Demtilla , Oside Daisy , Kamene Ruth , Watata Agnes , Atieno Agnes , Njau Faith , Njeri Elizabeth , Orobi Evelyn , Lwingi Ibrahim , Jama Zaina , Babu Hellen , Kaul Rupert , Seeley Janet , Bradley John , Kimani Joshua , Beattie Tara 
Published: November 2022

Abstract
Background
Female sex workers (FSWs) in Kenya are at an increased risk of violence, poverty, police arrest, and problematic alcohol and other substance use, all of which are linked to poor mental health and suicidal ideation. Despite the psychological stressors experienced by FSWs, there is no published qualitative methods research investigating their mental health experiences in Kenya. In this paper, we draw on data from in-depth interviews to examine FSWs’ lifetime mental health experiences and perceived risk factors.

Methods
We used baseline in-depth interviews of the Maisha Fiti longitudinal study of FSWs in Nairobi. We randomly selected 40 FSWs from 1003 FSWs who attended a baseline behavioural-biological interview as part of the Maisha Fiti study. The interview guide was semi-structured, and participants were asked to detail their life stories, including narrating specific events such as entry into sex work, experiences of violence, mental health experiences, and use of alcohol and other substances. Interviews were recorded in Kiswahili/ English and transcribed in English. Data were coded and thematically analysed in Nvivo (v.12).

Results
Results indicated that the majority of participants understood ‘mental health’ as ‘insanity’, ‘stress’, ‘depression’, and ‘suicide’; nevertheless, a number described mental health symptomatically, while a few believed that mental health problems were caused by witchcraft. Interestingly, poverty, low levels of education, poor job opportunities, a lack of family support, harmful gender norms, intimate partner violence and subsequent relationship breakdowns, and family bereavement all contributed to poor mental health and subsequent entry into sex work. In addition, the consequences of sex work such as sexual risks, and ongoing violence from police and clients, further exacerbated poor mental health.

Conclusions
There is a need for both micro- and macro interventions to address poverty and violence against FSWs in Kenya, thereby reducing mental health problems. Addressing violence against women and girls may also reduce entry into sex work. Improving mental health literacy and providing mental health intervention services for ‘at-risk’ populations such as FSWs should enhance coping strategies and help-seeking efficacy.
Multilevel correlates of domain-specific physical activity among rural adults – a cross-sectional study
Authors: Beck Alan M. , Serrano Natalicio H. , Toler Audrey , Brownson Ross C. 
Published: November 2022

Abstract
Background
Increasing physical activity (PA) in rural communities is a vital prevention tactic in multiple chronic diseases; however, little is known on the multilevel correlates of PA rural areas. A better understanding of domain-specific PA adds context for promoting PA in rural communities. The current study sought to determine factors associated with domain-specific and overall moderate-vigorous physical activity (MVPA) in rural communities.

Methods
Surveys were conducted across 14 rural mid-Western communities, with the final analytical sample including 1241 adults (ages 19–96, M = 57.0 [SD = 16.7], 67.8% female, 83.8% white). Generalized linear models with negative binomial distributions examined the relation between demographics, trail use, and perceptions of the neighborhood environment, with domain-specific and overall MVPA, measured via the Global Physical Activity Questionnaire.

Results
Rural residents reported an average of 617 total minutes of weekly MVPA (SD = 1141), with 58.5% meeting MVPA guidelines. Higher age, female gender, and higher educated individuals had lower levels of overall and occupational MVPA. Females, higher education, and perceived indoor recreational access were associated with lower levels of transportation-related MVPA, while trail use was associated with increased transportation MVPA. Higher age and female gender respondents had lower levels of recreational MVPA, while trail users and those who perceived favorable indoor recreational access had higher levels of recreational MVPA.

Conclusions
PA primarily occurred in the occupational domain among this sample of rural mid-Western adults. Findings highlight the need for multilevel interventions to address PA across multiple domains in rural communities, especially among females and older adults.
Internal Hemipelvectomy for primary bone sarcomas using intraoperative patient specific instruments- the next step in limb salvage concept
Authors: Benady Amit , Gortzak Yair , Sofer Summer , Ran Yuval , Rumack Netta , Elias Avital , Efrima Ben , Golden Eran , Segal Ortal , Merose Omri , Sternheim Amir , Dadia Solomon 
Published: November 2022

Abstract
Background
During pelvic Sarcoma resections, Surgeons often struggle to obtain negative margins while minimizing collateral damage and maintaining limb function. These complications are usually due to the complex anatomy of the pelvis. Here we present an accurate 3D surgical approach, including pre-operative printing of models and intraoperative patient-specific instruments (PSIs) for optimizing pelvic sarcoma resections.

Methods
This single-center retrospective study (N = 11) presents surgical, functional, and oncological outcomes of patients (average age 14.6 +/− 7.6 years, 4 males) who underwent pelvic sarcoma resections using a 3D surgical approach between 2016 and 2021. All patients were followed up for at least 24 months (mean = 38.9 +/− 30.1 months).

Results
Our results show promising surgical, oncological, and functional outcomes. Using a 3D approach, 90.9% had negative margins, and 63.6% did not require reconstruction surgery. The average estimated blood loss was 895.45 ± 540.12 cc, and the average surgery time was 3:38 ± 0.05 hours. Our results revealed no long-term complications. Three patients suffered from short-term complications of superficial wound infections. At 24 month follow up 72.7% of patients displayed no evidence of disease. The average Musculoskeletal Tumor Society (MSTS) score at 12 months was 22.81.

Conclusion
3D technology enables improved accuracy in tumor resections, allowing for less invasive procedures and tailored reconstruction surgeries, potentially leading to better outcomes in function and morbidity. We believe that this approach will enhance treatments and ease prognosis for patients diagnosed with pelvic sarcoma and will become the standard of care in the future.
Learning from the implementation of clinical empathy training: an explorative qualitative study in search of the barriers and facilitators
Authors: Barak Luca C. , Kuijpers Giliam , Hoeijmakers Lotte , Scheele Fedde 
Published: November 2022

Abstract
Background
Amid concerns about the decline of empathy during the clinical training of medical clerks, evidence that empathy improves patient outcomes suggests some potential for teaching empathy in ways that will affect the knowledge, attitude and behaviour of medical clerks. This potential alone cannot, however, guarantee the success of educational innovations to introduce empathy to the medical curriculum. This research aims to identify the barriers and facilitators of the implementation of a specific clinical initiative to enhance the empathy skills of clerks, namely the training of clerks to act as a ‘MedGezel’ or ‘medical coach’.

Method
We conducted an explorative qualitative study based on interview data collected and analyzed using reflexive thematic analysis and the readiness for change theory. We conducted semi-structured interviews with relevant stakeholders in this particular qualitative study. Thematic analysis was based on open and axial coding using ATLAS.ti 9, which facilitated the emergence of common themes of interest and meaning for the study.

Results
A total of 13 relevant stakeholders participated as interviewees in our study. The data was collected from April to June 2021. Our analysis generated 6 main themes which can provide insights into why the implementation of the MedGezel educational innovation failed so far. The following themes emerged: the case for change: why change?; practical necessity; leadership; management and resources; staff culture; and alignment with the corporate strategy.

Discussion
The implementation failure can be partially explained as resulting from the personal attitudes and choices of participants, who struggled to reconcile a vision that they liked with side effects that they feared. While participants repeatedly mentioned management and leadership issues, these organizational issues seemed less important as they could be easily resolved in practice. What was more important and fatal for the initiative was its lack of alignment with staff culture, despite its alignment with corporate strategy.

Conclusion
This investigation into the barriers and facilitators influencing the implementation of the MedGezel program identified 6 explanatory themes, the most impactful one being staff culture.