bluuebunny/crossref_metadata_2025_split huggingface dataset:
Strategies Australian junior doctors use to maintain their mental, physical and social well-being: a qualitative study
Authors: Hobi Melanie , Yegorova-Lee Sonya , Chan Christopher Chun-lin , Zhao Hailin , Jiang Stephen , Tran Dan , Nair Gayathri , Borkoles Erika 
Published: September 2022

ObjectivesThis study aimed to uncover the strategies that junior doctors implement to maintain their mental, physical and social well-being, and the barriers they experience in practising these strategies.ParticipantsFifteen junior doctors in their postgraduate year 1 or 2 currently practising in Australia were recruited.Outcome measuresSemistructured interviews were conducted, and the transcripts underwent thematic analysis.ResultsThree key themes emerged from thematic analysis, namely: well-being strategies, barriers to well-being and and future interventions. Exercise, a healthy and balanced diet, quality sleep, and workplace organisations were frequently reported well-being strategies. High workload, unpredictable routines, lack of familiarity with the healthcare system and ongoing stigma surrounding mental health were seen as barriers to well-being. Suggested interventions included increased control over rosters, subsidised access to facilities such as gyms and increased internship preparedness programmes organised by the medical schools.ConclusionsThe findings from this study may assist in developing more personalised and targeted methods to help junior doctors maintain their mental, physical and social well-being. Future studies may address the structural and systemic changes required to develop a workforce that fosters the well-being of junior doctors and reduces the institutional barriers to practising well-being strategies.
Does comorbidity burden explain the higher COVID-19 mortality risk among men? A retrospective cross-sectional analysis of a well-defined cohort of patients in Bronx, New York
Authors: Vasa Aastha , Kini Maya , Neugarten Joel , Bellin Eran , Golestaneh Ladan 
Published: September 2022

ObjectivesMen have a higher mortality rate and more severe COVID-19 infection than women. The mechanism for this is unclear. We hypothesise that innate sex differences, rather than comorbidity burden, drive higher male mortality.DesignRetrospective cohort.SettingMontefiore Health System (MHS) in Bronx, New York, USA.ParticipantsA cohort population of 364 992 patients at MHS between 1 January 2018 and 1 January 2020 was defined, from which individuals hospitalised during the pre-COVID period (1 January 2020–15 February 2020) (n=5856) and individuals hospitalised during the COVID-19 surge (1 March 2020–15 April 2020) (n=4793) were examined for outcomes. A subcohort with confirmed COVID-19+ hospitalisation was also examined (n=1742).Primary and secondary outcome measuresHospitalisation and in-hospital mortality.ResultsMen were older, had more comorbidities, lower body mass index and were more likely to smoke. Unadjusted logistic regression showed a higher odds of death in hospitalised men than women during both the pre-COVID-19 and COVID-19 periods (pre-COVID-19, OR: 1.66 vs COVID-19 OR: 1.98). After adjustment for relevant clinical and demographic factors, the higher risk of male death attenuated towards the null in the pre-COVID-19 period (OR 1.36, 95% CI 1.05 to 1.76) but remained significantly higher in the COVID-19 period (OR 2.02; 95% CI 1.73 to 2.34).In the subcohort of COVID-19+ hospitalised patients, men had 1.37 higher odds of in-hospital death (95% CI 1.09 to 1.72), which was not altered by adjustment for comorbidity (OR remained at 1.38 (95% CI 1.08 to 1.76)) but was attenuated with addition of initial pulse oximetry on presentation (OR 1.26, 95% CI 0.99 to 1.62).ConclusionsHigher male mortality risk during the COVID-19 period despite adjustment for comorbidity supports the role of innate physiological susceptibility to COVID-19 death. Attenuation of higher male risk towards the null after adjustment for severity of lung disease in hospitalised COVID-19+ patients further supports the role of higher severity of COVID-19 pneumonia in men.
Knowledge and factors associated with obstetric danger signs among married men in Dessie town, South Wollo, North-East Ethiopia: a community-based cross-sectional study
Authors: Shitie Anguach , Dilnessa Tenagnework , Ayalew Sindu , Tadesse Betelhem 
Published: September 2022

ObjectiveThe aim of this study was to assess knowledge and factors associated with obstetrics danger signs among married men in Dessie town, North-East Ethiopia in 2020.DesignCommunity-based cross-sectional study.SettingDessie town, North-East Ethiopia.ParticipantsThe study was conducted on selected 824 men. The data were collected through face-to-face interviews using pretested questionnaires and then the data were entered into Epi-Data V.3.1 software, and analysis was carried out using Statistical Package for the Social Sciences V.20. Bivariable and multivariable logistic regression analyses were used to determine the association between each independent variable with the dependent variable, and those variables with a value of p≤0.25 in bivariable analysis were candidates for multivariable analysis. Finally those variables with a value of p<0.05 with 95% CI in multivariable analysis were reported as statistically significant.ResultThis study revealed that the overall knowledge of obstetric danger signs was 53.8% (95% CI 50.2 % to 57.2%). Respondents aged 35–40 years (AOR=4.92, 95% CI 2.6 to 9.0), exposure to media (AOR=10.4, 95% CI 4.19 to 25.9), wife’s age ≤35 years (AOR=4.16, 95% CI 2.25 to 7.69), wife who attended secondary education (AOR=1.59, 95% CI 1.06 to 2.39), participation in the Health Development Army (AOR=4.74, 95% CI 1.8 to 12.5), previous obstetric complication (AOR=4.27, 95% CI 2.0 to 9.14) and number of pregnancy ≤2 (AOR=0.42, 95% CI 0.05 to 3.38) and 3–4 (AOR=0.22 95% CI 0.06 to 0.83) were significantly associated with knowledge of obstetric danger signs.ConclusionMen’s knowledge about obstetric danger signs was low. Age of respondents, wives’ age, and respondents’ media exposure, participation in the Health Development Army, wives’ educational status, previous obstetrics complication and gravidity were significantly associated knowledge of obstetrics danger sign.
An intersectional analysis of historical and contemporary structural racism on non-fatal shootings in Baltimore, Maryland
Authors: Uzzi Mudia , Aune Kyle T , Marineau Lea , Jones Forrest K , Dean Lorraine T , Jackson John W , Latkin Carl A 
Published: September 2022

IntroductionNon-fatal shooting rates vary tremendously within cities in the USA. Factors related to structural racism (both historical and contemporary) could help explain differences in non-fatal shooting rates at the neighbourhood level. Most research assessing the relationship between structural racism and firearm violence only includes one dimension of structural racism. Our study uses an intersectional approach to examine how the interaction of two forms of structural racism is associated with spatial non-fatal shooting disparities in Baltimore, Maryland.MethodsWe present three additive interaction measures to describe the relationship between historical redlining and contemporary racialized economic segregation on neighbourhood-level non-fatal shootings.ResultsOur findings revealed that sustained disadvantage census tracts (tracts that experience contemporary socioeconomic disadvantage and were historically redlined) have the highest burden of non-fatal shootings. Sustained disadvantage tracts had on average 24 more non-fatal shootings a year per 10 000 residents compared with similarly populated sustained advantage tracts (tracts that experience contemporary socioeconomic advantage and were not historically redlined). Moreover, we found that between 2015 and 2019, the interaction between redlining and racialized economic segregation explained over one-third of non-fatal shootings (approximately 650 shootings) in sustained disadvantage tracts.ConclusionThese findings suggest that the intersection of historical and contemporary structural racism is a fundamental cause of firearm violence inequities in Baltimore. Intersectionality can advance injury prevention research and practice by (1) serving as an analytical tool to expose inequities in injury-related outcomes and (2) informing the development and implementation of injury prevention interventions and policies that prioritise health equity and racial justice.
Proposal to distinguish HER2-low from HER2-normal breast cancer by in situ hybridisation
Authors: Chen Yen-Ying , Yang Ching-Fen , Hsu Chih-Yi 
Published: September 2022

Aims‘HER2-low’ breast cancer is an emerging issue as the clinical trials for anti-HER2 antibody–drug conjugates (trastuzumab deruxtecan) are making progress. A reliable method to identify HER2-low cancers is needed. This study aimed to evaluate immunohistochemistry (IHC) and in situ hybridisation (ISH) in detecting HER2-low status.MethodsWe evaluated the HER2 ISH data grouped by the IHC consensus in proficiency tests (PTs), and compared the HER2 ISH results between HER2 IHC scored 0 (IHC-0) and IHC scored 1+ (IHC-1+) tumours from in-house tissue microarrays (TMAs). Since benign/normal glands have HER2 expression and ideally should not be affected by targeted therapy, we evaluated HER2 ISH results in peritumoural benign glands of 52 breast cancers as reference values.ResultsNone of the 565 tissue cores in PTs achieved an 80% participant agreement of IHC-1+. In PTs and in-house TMAs,HER2signals of the IHC-1+cores (median: 2.6 and 2.0, respectively) were significantly higher than those of IHC-0 cores (median: 2.0 and 1.7, respectively). But the ranges ofHER2signals had a considerable overlap between IHC-1+and IHC-0 cores. TheHER2signals andHER2:CEP17 ratios of peritumoural benign glands exhibited normal distributions, and their upper bounds of the 95% reference intervals were 2.10 and 1.30, respectively.ConclusionsCurrent HER2 testing algorithms are unsatisfactory in detecting HER2-low cases. Using ISH to detect tumour withHER2signals andHER2:CEP17 ratio higher than the upper bound of the benign glands can be an alternative method.
MOONLIGHT study: the design of a comparative study of the effectiveness of belimumab in patients with a history of lupus nephritis from the post-Marketed effectiveness of belimumab cOhOrt and JapaN Lupus NatIonwide reGistry (LUNA) coHorT
Authors: Sada Kenei , Kurita Noriaki , Noma Hisashi , Matsuki Taizo , Quasny Holly , Levy Roger A , Jones-Leone Angela R , Gairy Kerry , Yajima Nobuyuki 
Published: September 2022

IntroductionLupus nephritis (LN) is more prevalent in patients with SLE of Asian ethnicity than in Caucasian patients. Belimumab became available in Japan in 2017 to treat patients with SLE, including those with LN. In the BLISS-LN trial (NCT01639339), belimumab showed a favourable effect on renal outcomes when combined with standard therapy (ST) starting at the induction treatment phase for active LN, but real-world effectiveness of belimumab in LN has not been extensively studied. Here we describe the protocol for the MOONLIGHT (post-Marketed effectiveness of belimumab cOhOrt and JapaN Lupus NatIonwide ReGistry (LUNA) coHorT) study, which will use data from a Japan postmarketing surveillance study and the Lupus Registry of Nationwide Institutions (LUNA) to evaluate the real-world effectiveness of belimumab plus ST versus ST alone in patients with a history of active LN who are not in the induction phase.Methods and analysisThis multicentre, retrospective, observational study (GSK Study 214710) will enrol adults with SLE and a history of active LN, holding ≥3 years of complete follow-up data from the initiation of belimumab (no continuous treatment required). Data for patients with belimumab plus ST treatment (postmarketing registry data, belimumab cohort) will be compared with those for patients with ST only treatment (LUNA data, comparison cohort). Patients who discontinue/initiate belimumab after the start of the follow-up may be included in the comparison/belimumab cohort, respectively. The primary endpoint will be the occurrence of renal flares, for which belimumab’s effectiveness will be estimated using a marginal structural model to consider time-dependent treatment and confounding factors. Secondary endpoints will include change in corticosteroid dose, renal disease activity, extrarenal disease activity, disease severity/activity biomarkers, LN class changes, end-stage kidney disease events and hospitalisations.Ethics and disseminationThis study will be conducted according to the Declaration of Helsinki and the local ethical guidelines. Findings will be submitted to peer-reviewed journals and presented at scientific meetings.
NIH stroke scale and unfavourable outcomes in acute ischaemic stroke: retrospective study
Authors: Tramonte Maiara Silva , Carvalho Ana Claudia Pires , Fornazari Ana Elisa Vayego , Villas Boas Gustavo Di Lorenzo , Modolo Gabriel Pinheiro , Ferreira Natalia Cristina , Lange Marcos Christiano , Minicucci Marcos Ferreira , Bazan Rodrigo , Lopes Laura Cardia Gomes 
Published: September 2022

ObjectivesTo evaluate the determining factors of severe functional impairment (SFI) outcome at discharge and in-hospital mortality in patients who had an acute ischaemic stroke and thus favouring early implementation of primary palliative care (PC).MethodsA retrospective descriptive study by the analysis of 515 patients who had an acute ischaemic stroke admitted at stroke unit, aged≥18 years, from January 2017 to December 2018. Previous clinical and functional status data, National Institute of Health Stroke Scale (NIHSS) on admission, and data related to the evolution during hospitalisation were evaluated, relating them to the SFI outcome at discharge and death. The significance level was set at 5%.ResultsOf 515 patients included, 15% (77) died, 23.3%(120) had an SFI outcome and 9.1% (47) were evaluated by the PC team. It was observed that NIHSS Score≥16 is responsible for a 15.5-fold increase in the occurrence of death outcome. The presence of atrial fibrillation was responsible for a 3.5-fold increase in the risk of this outcome.ConclusionNIHSS Score is an independent predictor of in-hospital death and SFI outcomes at discharge. Knowledge about the prognosis and risk of developing unfavourable outcomes is important for planning the care of patients affected by a potentially fatal and limiting acute vascular insult.
Hydromorphone for dyspnoea in terminally ill patients with cancer: case series
Authors: Sakaguchi Tatsuma , Kajiyama Toru 
Published: September 2022

ObjectiveOpioids can mitigate dyspnoea, but the efficacy of hydromorphone use for dyspnoea in patients with cancer is not well known.MethodsPatients with cancers with more than mild dyspnoea treated with subcutaneous injection of hydromorphone between March 2020 and February 2022 at Kitano Hospital (Osaka, Japan) were reviewed retrospectively. Only patients who could self-report their symptoms ≥3 days after the start of hydromorphone therapy were included. Dyspnoea severity was rated on a five-point scale (0: ‘not bothersome'; 1: ‘mild’; 2: ‘moderate’; 3: ‘severe’; 4: ‘overwhelming’).ResultsFifteen patients (2 with moderate, 12 with severe and 1 with overwhelming dyspnoea) were deemed eligible. The median interval from the start of hydromorphone initiation to death was 19 (IQR, 11–37) days. Thoracic drainage and palliative sedation after the start of hydromorphone therapy was undertaken in three and two patients, respectively. At 3 days, the median score of the Dyspnoea Rating Scale was improved significantly from 3 to 2 compared with that at baseline (p=0.0023). The intensity of dyspnoea was improved in 11 patients (73%). Opioid-related adverse events were not observed within 3 days.ConclusionsUsing hydromorphone for dyspnoea in patients with cancer seems to be appropriate if morphine use is contraindicated.
Accuracy of Xpert Ultra for the diagnosis of paediatric tuberculosis in a low TB burden country: a prospective multicentre study
Authors: Aguilera-Alonso David , Solís-García Gonzalo , Noguera-Julian Antoni , González-Martín Julián , Román Cobeña Angely , Baquero-Artigao Fernando , Toro Rueda Carlos , Rodríguez-Molino Paula , Bloise Sánchez Iván , Vallmanya Teresa , Bernet-Sánchez Albert , Minguell Domingo Laura , Rubio Adriana , Saavedra-Lozano Jesús , Ruiz-Serrano María Jesús , Blázquez-Gamero Daniel , López-Roa Paula , Gomez-Pastrana David , López Prieto María Dolores , López Medina Eva María , Gil-Brusola Ana , Martín Nalda Andrea , Soriano-Arandes Antonio , Tórtola Teresa , Falcon-Neyra Lola , González Galán Verónica , Tebruegge Marc , Santiago-García Begoña 
Published: September 2022

IntroductionChildhood pulmonary tuberculosis (TB) remains a diagnostic challenge. This study aimed to evaluate the performance of Xpert Ultra for the diagnosis of pulmonary TB in children in a low TB prevalence setting.MethodsProspective, multicentre, diagnostic accuracy study. Children with clinical or radiological suspicion of pulmonary TB were recruited at 11 paediatric units in Spain. Up to three gastric or sputum specimens were taken on 3 consecutive days, and analysed by Xpert MTB/RIF, Xpert Ultra and culture in parallel.Results86 children were included (median age 4.9 years, IQR 2.0–10.0; 51.2% male). The final diagnosis was pulmonary TB in 75 patients (87.2%); 33 (44.0%) were microbiologically confirmed. A total of 219 specimens, comprising gastric aspirates (n=194; 88.6%) and sputum specimens (n=25; 11.4%), were analysed. Using culture as reference standard and comparing individual specimens, the sensitivity was 37.8% (14/37) for Xpert MTB/RIF and 81.1% (30/37) for Xpert Ultra (p<0.001); specificity was 98.4% (179/182) and 93.4% (170/182), respectively (p=0.02). In the per-patient analysis, considering positive results on any specimen, the sensitivity was 42.9% (9/21) for Xpert MTB/RIF and 81.0% for Xpert Ultra (17/21, p=0.01); specificity was 96.9% (63/65) and 87.7% (57/65, p=0.07), respectively.ConclusionsIn children with pulmonary TB in a low burden setting, Xpert Ultra has significantly higher sensitivity than the previous generation of Xpert assay and only marginally lower specificity. Therefore, in children undergoing evaluation for suspected pulmonary TB, Xpert Ultra should be used in preference to Xpert MTB/RIF whenever possible.
Shadow of the Kerr-like black hole
Authors: Sarikulov Furkat , Atamurotov Farruh , Abdujabbarov Ahmadjon , Ahmedov Bobomurat 
Published: September 2022

AbstractThe detailed study of horizon structure and the shadow cast by a Kerr-like black hole (BH) is performed. The trajectory of light rays forming the shadow of BH is found using the solutions of geodesic equation for the motion and effective potential of a photon around Kerr-like BH for different values of deviation parameter l in Kerr-like spcetime metric. It is observed that with an increase in the parameter l the size of the shadow of the BH is decreased. Additional, we have consider effect of plasma on BH shadow and the plasma influence on the shadow of Kerr-like BH, the size of observable radius of BH shadow and oblateness are explored with more details.
Mutational Signature 3 Detected from Clinical Panel Sequencing is Associated with Responses to Olaparib in Breast and Ovarian Cancers
Authors: Batalini Felipe , Gulhan Doga C. , Mao Victor , Tran Antuan , Polak Madeline , Xiong Niya , Tayob Nabihah , Tung Nadine M. , Winer Eric P. , Mayer Erica L. , Knappskog Stian , Lønning Per E. , Matulonis Ursula A. , Konstantinopoulos Panagiotis A. , Solit David B. , Won Helen , Eikesdal Hans P. , Park Peter J. , Wulf Gerburg M. 
Published: September 2022

AbstractPurpose:The identification of patients with homologous recombination deficiency (HRD) beyond BRCA1/2 mutations is an urgent task, as they may benefit from PARP inhibitors. We have previously developed a method to detect mutational signature 3 (Sig3), termed SigMA, associated with HRD from clinical panel sequencing data, that is able to reliably detect HRD from the limited sequencing data derived from gene-focused panel sequencing.Experimental Design:We apply this method to patients from two independent datasets: (i) high-grade serous ovarian cancer and triple-negative breast cancer (TNBC) from a phase Ib trial of the PARP inhibitor olaparib in combination with the PI3K inhibitor buparlisib (BKM120; NCT01623349), and (ii) TNBC patients who received neoadjuvant olaparib in the phase II PETREMAC trial (NCT02624973).Results:We find that Sig3 as detected by SigMA is positively associated with improved progression-free survival and objective responses. In addition, comparison of Sig3 detection in panel and exome-sequencing data from the same patient samples demonstrated highly concordant results and superior performance in comparison with the genomic instability score.Conclusions:Our analyses demonstrate that HRD can be detected reliably from panel-sequencing data that are obtained as part of routine clinical care, and that this approach can identify patients beyond those with germline BRCA1/2mut who might benefit from PARP inhibitors. Prospective clinical utility testing is warranted.
Endoscopic Screening and Risk of Colorectal Cancer according to Type 2 Diabetes Status
Authors: Wang Kai , Ma Wenjie , Hu Yang , Knudsen Markus Dines. , Nguyen Long H. , Wu Kana , Ng Kimmie , Wang Molin , Ogino Shuji , Sun Qi , Giovannucci Edward L. , Chan Andrew T. , Song Mingyang 
Published: September 2022

Abstract

Current recommendations for colorectal cancer screening have not accounted for type 2 diabetes (T2D) status. It remains unknown whether the colorectal cancer–preventive benefit of endoscopic screening and the recommended age for screening initiation differ by T2D. Among 166,307 women (Nurses’ Health Study I and II, 1988–2017) and 42,875 men (Health Professionals Follow-up Study, 1988–2016), endoscopic screening and T2D diagnosis were biennially updated. We calculated endoscopic screening-associated hazard ratios (HR) and absolute risk reductions (ARR) for colorectal cancer incidence and mortality according to T2D, and age-specific colorectal cancer incidence according to T2D. During a median of 26 years of follow-up, we documented 3,457 colorectal cancer cases and 1,129 colorectal cancer deaths. Endoscopic screening was associated with a similar HR of colorectal cancer incidence in the T2D and non-T2D groups (P-multiplicative interaction = 0.57). In contrast, the endoscopic screening-associated ARR for colorectal cancer incidence was higher in the T2D group (2.36%; 95% CI, 1.55%–3.13%) than in the non-T2D group (1.73%; 95% CI, 1.29%–2.16%; P-additive interaction = 0.01). Individuals without T2D attained a 10-year cumulative risk of 0.35% at the benchmark age of 45 years, whereas those with T2D reached this threshold risk level at the age of 36 years. Similar results were observed for colorectal cancer mortality. In conclusion, the absolute benefit of endoscopic screening for colorectal cancer prevention may be substantially higher for individuals with T2D compared with those without T2D. Although T2D is comparatively rare prior to the fifth decade of life, the rising incidence of young-onset T2D and heightened colorectal cancer risk associated with T2D support the consideration of earlier endoscopic screening in individuals with T2D.

Prevention Relevance:
The endoscopic screening-associated ARRs for colorectal cancer incidence and mortality were higher for individuals with T2D than those without T2D. Endoscopic screening confers a greater benefit for colorectal cancer prevention among T2D individuals, who may also benefit from an earlier screening than the current recommendation.