bluuebunny/crossref_metadata_2025_split huggingface dataset:
Endobronchial ultrasound-guided transbronchial needle aspiration in patients with previously treated malignancies: diagnostic performance and predictive value
Authors: Yan Yan , Wang Zhilong , Yan Wanpu , Li Shijie , Wu Qi 
Published: December 2022

Abstract
Background
Endobronchial ultrasound-guided transbronchial needle aspiration is a minimally invasive and effective sampling approach for patients with mediastinal or hilar lymphadenopathy. Increased recognition of the ultrasonographic features revealed the value of its images in predicting mediastinal lymph node malignancy. However, its diagnostic validity and the predictive value of its ultrasonographic features have not been demonstrated well in patients after systemic anti-tumor therapy. This study aimed to evaluate the efficiency of endobronchial ultrasound-guided transbronchial needle aspiration in patients with suspicious lymph nodes after anti-tumor therapy.

Methods
We retrospectively reviewed cases of endobronchial ultrasound-guided transbronchial needle aspiration performed between January 2019 and August 2021 at a single tertiary hospital center. Patients with suspected mediastinal or hilar lymph nodes within 5 years of systemic anti-tumor therapy were enrolled. Final diagnoses were determined by pathologic diagnoses of samples from transbronchial needle aspiration, surgery, or follow-up for at least 6 months. Ultrasonographic features were analyzed to assess the predictive value of malignant lymph nodes after treatment.

Results
Overall, 168 lymph nodes of 138 patients were analyzed. Among 110 (65.5%) malignant lymph nodes, 75 originated from lung cancers; the other 35 were from other malignancies. No complications related to endobronchial ultrasound-guided transbronchial needle aspiration were observed. Of 58 negative results of transbronchial needle aspiration, 51 were proven to be true negatives; 7 were false. The overall sensitivity and the negative predictive value were 94.02% and 87.93%, respectively. Univariate and multivariate analysis revealed the absence of central hilar structure and short axis > 10 mm as independent predictive factors for malignancy.

Conclusions
Endobronchial ultrasound-guided transbronchial needle aspiration performs satisfactorily in diagnosing mediastinal and hilar lymphadenopathy even after anti-tumor treatment.
Current concepts in acromioclavicular joint (AC) instability – a proposed treatment algorithm for acute and chronic AC-joint surgery
Authors: Berthold Daniel P. , Muench Lukas N. , Dyrna Felix , Mazzocca Augustus D. , Garvin Patrick , Voss Andreas , Scheiderer Bastian , Siebenlist Sebastian , Imhoff Andreas B. , Beitzel Knut 
Published: December 2022

Abstract
Background
There exists a vast number of surgical treatment options for acromioclavicular (AC) joint injuries, and the current literature has yet to determine an equivocally superior treatment. AC joint repair has a long history and dates back to the beginning of the twentieth century.

Main body
Since then, over 150 different techniques have been described, covering open and closed techniques. Low grade injuries such as Type I-II according to the modified Rockwood classification should be treated conservatively, while high-grade injuries (types IV-VI) may be indicated for operative treatment. However, controversy exists if operative treatment is superior to nonoperative treatment, especially in grade III injuries, as functional impairment due to scapular dyskinesia or chronic pain remains concerning following non-operative treatment. Patients with a stable AC joint without overriding of the clavicle and without significant scapular dysfunction (Type IIIA) may benefit from non-interventional approaches, in contrast to patients with overriding of the clavicle and therapy-resistant scapular dysfunction (Type IIIB). If these patients are considered non-responders to a conservative approach, an anatomic AC joint reconstruction using a hybrid technique should be considered. In chronic AC joint injuries, surgery is indicated after failed nonoperative treatment of 3 to 6 months. Anatomic AC joint reconstruction techniques along with biologic augmentation (e.g. Hybrid techniques, suture fixation) should be considered for chronic high-grade instabilities, accounting for the lack of intrinsic healing and scar-forming potential of the ligamentous tissue in the chronic setting. However, complication and clinical failure rates remain high, which may be a result of technical failures or persistent horizontal and rotational instability.

Conclusion
Future research should focus on addressing horizontal and rotational instability, to restore native physiological and biomechanical properties of the AC joint.
Relationship between geriatric nutritional risk index and osteoporosis in type 2 diabetes in Northern China
Authors: JI Yuanyuan , Geng Nan , Niu Yingchun , Zhao Hang , Fei Wenjie , Chen Shuchun , Ren Lu ping 
Published: December 2022

Abstract
Background
Osteoporosis is a very common bone disease in the elderly population and can lead to fractures and disability. Malnutrition can lead to osteoporosis. The geriatric nutritional risk index (GNRI) is a tool used to assess the risk of malnutrition and complications associated with nutritional status in older patients and is a crucial predictor of many diseases. Hence, this study investigated the association between the GNRI and the presence of osteoporosis and assessed the value of this index for predicting osteoporosis in patients with type 2 diabetes mellitus (T2DM).

Methods
This cross-sectional study enrolled 610 elderly patients with T2DM. General and laboratory data of the patients were collected, along with their measurements of bone mineral density (BMD). The GNRI was calculated based on ideal body weight and serum albumin (ABL) levels. Correlation analysis was performed to determine the relationship between the GNRI and BMD and bone metabolism indices. The GNRI predictive value for osteoporosis development was analyzed through logistic regression analysis and by creating a receiver operating characteristic curve (ROC), calculating the area under the curve (AUC).

Results
All patients were divided into the no-nutritional risk and nutritional risk groups. Compared with the no-nutritional risk group, the nutritional risk group had a longer diabetes course, older age, higher HbA1c levels, higher prevalence of osteoporosis; lower BMI, ABL,triglyceride (TG),Calcium (Ca),25-hydroxy-vitamin-D(25(OH)D),and parathyroid hormone(PTH) and lower femoral neck BMD,total hip BMD (P < 0.05).
All patients were also assigned to the non-osteoporosis and osteoporosis groups. The non-osteoporosis group had higher GNRI values than the osteoporosis group (P < 0.05).
Correlation analysis revealed a positive correlation between the GNRI and lumbar BMD, femoral neck BMD, and total hip BMD (P < 0.05). After the adjustment for confounding factors, Spearman’s correlation analysis revealed that the GNRI was positively correlated with Ca, 25(OH)D, and PTH and negatively correlated with alkaline phosphatase (ALP) and procollagen of type-1 N-propeptide (P1NP). Regression analysis exhibited that the GNRI was significantly associated with osteoporosis.
The ROC curve analysis was performed using the GNRI as the test variable and the presence of osteoporosis as the status variable. This analysis yielded an AUC for the GNRI of 0.695 and was statistically significant (P < 0.05).

Conclusions
A lower GNRI among T2DM patients in northern China is associated with a higher prevalence of osteoporosis.
In vitro surface and color changes of tooth-colored restorative materials after sport and energy drink cyclic immersions
Authors: Tanthanuch Saijai , Kukiattrakoon Boonlert , Thongsroi Thanyathorn , Saesaw Premkamol , Pongpaiboon Naphat , Saewong Supharadee 
Published: December 2022

Abstract
Background
There has not been any research conducted on surface properties and color changes from sport and energy drinks on bulk-fill resin composite, nanohybrid resin composite and glass ionomer restorative material. The aim of this in vitro study was to investigate the effect of sport and energy drinks on surface hardness, roughness and color changes of bulk-fill resin composite, nanohybrid resin composite and glass ionomer restorative material, and to also evaluate the acidity and titratable acidity of the drinks.

Methods
One hundred and forty-seven specimens of each tooth-colored restorative material were prepared in a polytetrafluoroethylene mold (10 mm. in diameter and 2 mm. in thickness). Before immersion, baseline data of hardness, roughness, and color value were recorded. Each material was divided into 3 groups for sport drink, energy drink, and deionized water (serving as a control). The specimens were immersed in a storage agent for 5 s, then in artificial saliva for 5 s alternately for 24 cycles, and then stored in artificial saliva for 24 h. The immersion cycle was repeated for 14 days and hardness, roughness and color values were measured at 7 and 14 days.

Results
After immersion, the glass ionomer restorative material had statistically less hardness, more roughness and more color changes than the others (P < 0.05). Energy drink groups statistically caused more surface and color changes than sport drink groups (P < 0.05).

Conclusion
Sport and energy drinks affected hardness, roughness, and color changes in all the tooth-colored restorative materials evaluated.
Do electronic and economic empowerment protect women from intimate partner violence (IPV) in India?
Authors: Dalal Koustuv , Yasmin Masuma , Dahlqvist Heléne , Klein Gunnar O. 
Published: December 2022

Abstract
Background
Intimate partner violence (IPV) is a major public health problem. Electronic empowerment has several positive impacts on health. No study has examined whether electronic empowerment prevents intimate partner violence. Economic empowerment has positive and negative effects on IPV victimization. The current study was conducted to investigate whether economic and electronic empowerment of women act as protective factors against IPV in India.

Methods
A national representative sample of 66,013 ever-married women from 36 member states and union territories of India has been used from the National Family Health Survey 2015 to 2016. Emotional, physical and sexual violence against women by husbands were target variables. We used bivariate and multivariate analyses.

Results
The prevalence of emotional violence was 13%, physical violence was 28% and sexual violence was 7%. IPV against women was as follows: The prevalence was higher among women living in rural areas, belonging to Hindu religion and those belonging to Scheduled Castes. Higher education and higher socio-economic status were found to be protective factors against IPV. The prevalence of IPV was higher among the working women, among those having knowledge of business loans for women and the recipients of such business loans. Exposure to media was found to reduce IPV. The women who used mobile phones and SMS facility experienced less violence.

Conclusion
Economic independence of women was found to be a risk factor for IPV in India, whereas electronic empowerment was a protective factor. In the Indian context, policymakers should make use of mobile phones and support SMS use in the IPV awareness programs. Women empowerment, combined with gender equity, can reduce the prevalence of violence against women.
Supervisor experiences of extended clinical placements in optometry: a mixed methods study
Authors: Kirkman Jacqueline M , Bentley Sharon A , Wood-Bradley Ryan J , Woods Craig A , Armitage James A 
Published: December 2022

Abstract
Background
In Australia, optometry students have traditionally undertaken their clinical training in short-block rotations at University-led teaching clinics in metropolitan locations. Demand for clinical placements is growing as the number of optometry students steadily increases. As such, universities and clinical education providers must look for more diverse methods of student placement. Extended clinical placements in community-based settings are one alternative: a model similar to the longitudinal clerkships in medicine. This study aimed to explore the experience of extended clinical placements from the perspective of the optometrists who supervised students. It also sought to determine whether there were differences in views between metropolitan and rural practitioners.

Methods
This mixed methods study included a survey and interviews with optometrists who had previously supervised Deakin University optometry students on an extended 26-week (2 x 13-weeks) clinical placement. Lines of enquiry focused on; the benefits and challenges associated with extended placements; areas for improvement; duration of the placement; and willingness to supervise further students. Interviews were transcribed verbatim and analysed using Braun and Clarke’s 6 step method of thematic analysis with a qualitative descriptive approach.

Results
Supervisors felt that hosting a student prompted greater reflective practice and critical appraisal of clinical decisions. The extended nature of the placement was thought to foster greater immersion in the clinical setting and community for the students and establish a stronger relationship between supervisor and student. Supervisors recognised the importance of role-modelling and mentoring the next generation of optometrists however noted that taking on a student was a sizeable commitment. Willingness to host a student was not dependent on the supervisor’s location (rural vs metropolitan) p = 0.57. However, interviews uncovered motivations that were unique to supervisors residing in rural locations, such as succession planning.

Conclusion
Overall, supervisors were positive about the value of student extended clinical placement in optometry and felt that it was a fulfilling and professionally beneficial experience. Lack of time and financial remuneration were the key downsides highlighted. Schools of optometry might carefully consider engaging in discussion about the duration of such placements, but 26 weeks was considered appropriate by supervisors.
Impact of the COVID-19 pandemic on student experiences during rural placements in Australia: findings from a national multi-centre survey
Authors: Martin Priya , McGrail Matthew , Fox Jordan , Ostini Remo , Doyle Zelda , Playford Denese , Beattie Jessica , Isaac Vivian , Fuller Lara , Allen Penny , Kondalsamy-Chennakesavan Srinivas 
Published: December 2022

Abstract
Background
The aim of this national study was to explore the learning experiences of Australia’s medical students who trained rurally during the COVID-19 pandemic in 2020.

Methods
A cross-sectional, national multi-centre survey was conducted in 2020, through the Federation of Rural Australian Medical Educators (FRAME). Participants were medical students who had completed an extended Rural Clinical School (RCS) training placement (≥ 12 months). A bespoke set of COVID-19 impact questions were incorporated into the annual FRAME survey, to capture COVID-19-related student experiences in 2020. Pre-pandemic (2019 FRAME survey data) comparisons were also explored.

Results
FRAME survey data were obtained from 464 students in 2020 (51.7% response rate), compared with available data from 668 students in 2019 (75.6% response rate). Most students expressed concern regarding the pandemic’s impact on the quality of their learning (80%) or missed clinical learning (58%); however, students reported being well-supported by the various learning and support strategies implemented by the RCSs across Australia. Notably, comparisons to pre-pandemic (2019) participants of the general RCS experience found higher levels of student support (strongly agree 58.9% vs 42.4%, p < 0.001) and wellbeing (strongly agree 49.6% vs 42.4%, p = 0.008) amongst the 2020 participants. Students with more than one year of RCS experience compared to one RCS year felt better supported with clinical skills learning opportunities (p = 0.015) and less affected by COVID-19 in their exam performance (p = 0.009).

Conclusions
This study has provided evidence of both the level of concern relating to learning quality as well as the positive impact of the various learning and support strategies implemented by the RCSs during the pandemic in 2020. RCSs should further evaluate the strategies implemented to identify those that are worth sustaining into the post-pandemic period.
Evidence-based family planning services among publicly funded providers in Texas
Authors: Vohra-Gupta Shetal , Ela Elizabeth , Vizcarra Elsa , Petruzzi Liana J. , Hopkins Kristine , Potter Joseph E. , White Kari 
Published: December 2022

Abstract
Background
Healthy Texas Women (HTW) is a fee-for-service family planning program that excludes affiliates of abortion providers. The HTW network includes providers who participate in Title X or the state Family Planning Program (FPP) and primary care providers without additional family planning funding (HTW-only). The objective of this study is to compare client volume and use of evidence-based practices among HTW providers.

Methods
Client volume was determined from administrative data on unduplicated HTW clients served in fiscal year (FY) 2017. A sample of 114 HTW providers, stratified by region, completed a 2018 survey about contraceptive methods offered, adherence to evidence-based contraceptive provision, barriers to offering IUDs and implants, and counseling/referrals for pregnant patients. Differences by funding source were assessed using t-tests and chi-square tests.

Results
Although HTW-only providers served 58% of HTW clients, most (72%) saw < 50 clients in FY2017. Only 5% of HTW providers received Title X or FPP funding, but 46% served ≥ 500 HTW clients. HTW-only providers were less likely than Title X providers to offer hormonal IUDs (70% vs. 92%) and implants (66% vs 96%); offer same-day placement of IUDs (21% vs 79%) and implants (21% vs 83%); and allow patients to delay cervical cancer screening when initiating contraception (58% vs 83%; all p < 0.05). There were few provider-level differences in counseling/referrals for unplanned pregnancy (p > 0.05).

Conclusions
HTW-only providers served fewer clients and were less likely to follow evidence-based practices. Program modifications that strengthen the provider network and quality of care are needed to support family planning services for low-income Texans.
Effect of wealth inequality on child and infant mortality in Togo
Authors: Pelenguei Essohanam , Pilo Mikémina 
Published: December 2022

AbstractAt birth, individual has a health capital that depends on family, environmental and personal characteristics which depreciates over time requiring investment. It’s in this sense that this article aims to analyze the effect of wealth inequality on infant and child mortality in Togo. This effect is accessed by a semi-parametric proportional hazard duration model of Cox. According to the model estimation which is based on data from the Multiple Indicator Cluster Survey (MICS) carried out in Togo in 2017, the results obtained show in one hand that coming from a less wealthy household increases the risk of death for children. On other hand, the results show that the possession of a source of drinking water, the possession of health insurance by the mother, and the mastery of the use of new information technologies and communication reduce the risk of infant and child mortality. In view of these results, policies to reduce wealth inequalities could help reduce the risk of infant and child mortality in proportions ranging from 0.075 to 0.264.
Management of type 2 diabetes with a treat-to-benefit approach improved long-term cardiovascular outcomes under routine care
Authors: Morieri Mario Luca , Longato Enrico , Di Camillo Barbara , Sparacino Giovanni , Avogaro Angelo , Fadini Gian Paolo 
Published: December 2022

Abstract
Background
Results of cardiovascular outcome trials enabled a shift from “treat-to-target” to “treat-to-benefit” paradigm in the management of type 2 diabetes (T2D). However, studies validating such approach are limited. Here, we examined whether treatment according to international recommendations for the pharmacological management of T2D had an impact on long-term outcomes.

Methods
This was an observational study conducted on outpatient data collected in 2008–2018 (i.e. prior to the “treat-to-benefit” shift). We defined 6 domains of treatment based on the ADA/EASD consensus covering all disease stages: first- and second-line treatment, intensification, use of insulin, cardioprotective, and weight-affecting drugs. At each visit, patients were included in Group 1 if at least one domain deviated from recommendation or in Group 2 if aligned with recommendations. We used Cox proportional hazard models with time-dependent co-variates or Cox marginal structural models (with inverse-probability of treatment weighing evaluated at each visit) to adjust for confounding factors and evaluate three outcomes: major adverse cardiovascular events (MACE), hospitalization for heart failure or cardiovascular mortality (HF-CVM), and all-cause mortality.

Results
We included 5419 patients, on average 66-year old, 41% women, with a baseline diabetes duration of 7.6 years. Only 11.7% had pre-existing cardiovascular disease. During a median follow-up of 7.3 years, patients were seen 12 times at the clinic, and we recorded 1325 MACE, 1593 HF-CVM, and 917 deaths. By the end of the study, each patient spent on average 63.6% of time in Group 1. In the fully adjusted model, being always in Group 2 was associated with a 45% lower risk of MACE (HR 0.55; 95% C.I. 0.46–0.66; p < 0.0001) as compared to being in Group 1. The corresponding HF-CVM and mortality risk were similar (HR 0.56; 95%CI 0.47–0.66, p < 0.0001 and HR 0.56; 95% C.I. 0.45–0.70; p < 0.0001. respectively). Sensitivity analyses confirmed these results. No single domain individually explained the better outcome of Group 2, which remained significant in all subgroups.

Conclusion
Managing patients with T2D according to a “treat-to-benefit” approach based international standards was associated with a lower risk of MACE, heart failure, and mortality. These data provide ex-post validation of the ADA/EASD treatment algorithm.