bluuebunny/crossref_metadata_2025_split huggingface dataset:
Feasibility and acceptability of a mobile model of environmental enrichment for patients with mixed medical conditions receiving inpatient rehabilitation: a mixed methods study
Authors: Fulton Sarah , Janssen Heidi , Salih Salih , James Alecia , Elphinston Rachel A 
Published: September 2022

ObjectivesTo investigate the feasibility and acceptability of a mobile model of environmental enrichment (EE), a paradigm that promotes activity engagement after stroke, in patients with mixed medical conditions receiving inpatient rehabilitation.DesignA mixed methods study design was used. An online qualitative survey assessed staff perspectives of acceptability of the mobile EE model including perceived barriers and enablers pre-implementation and post implementation. An A-B quasi-experimental case study of patient activity levels over a 2-week observational period provided feasibility data. This included recruitment and retention rates, completion of scheduled patient activity observations and validated baseline questionnaires, and number of adverse events.SettingA 30-bed mixed medical ward in a public hospital that services Brisbane’s southern bayside suburbs. The rehabilitation programme operates with patients co-located throughout the medical/surgical wards.ParticipantsNursing and allied health professionals working across the rehabilitation programme completed pre-implementation (n=19) and post implementation (n=16) qualitative questions. Patients admitted to the ward and who received the inpatient rehabilitation programme from June to November 2016 were also recruited.InterventionsThe mobile EE intervention included activities to primarily promote social and cognitive stimulation (eg, puzzles, board games) delivered by hospital volunteers and was designed to be moved throughout the wards.ResultsFour themes emerged from staff reports, suggesting that the role of patient, staff and intervention characteristics, and the ward environment were important barriers and enablers to implementation. Of the 12 eligible patients, six consented to the study, and five completed the intervention. All patients completed the baseline measures. No adverse events were reported.ConclusionsAs interest grows in human EE models, it will be important to tailor EE interventions to the unique demands of hospital rehabilitation services. A mobile EE model delivered in a small, mixed rehabilitation ward appears feasible and acceptable to study in a larger controlled feasibility trial.
Synergism between the metabolic syndrome components and cancer incidence: results from a prospective nested case–control study based on the China Health and Retirement Longitudinal Study (CHARLS)
Authors: Li Lin , Meng Fang , Xu Dongkui , Xu Lingkai , Qiu Junlan , Shu Xiaochen 
Published: September 2022

ObjectivesSynergism between the metabolic syndrome (MetSyn) components and cancer incidence still remains inconclusive. We aimed to investigate the unique or joint role of MetSyn components in cancer onset.DesignWe conducted a prospective nested case–control study based on the China Health and Retirement Longitudinal Study.SettingAn ongoing national representative longitudinal study included follow-up survey of people aged 45 years and older and their partners living in private households in China.ParticipantsThere were 17 708 individuals included at baseline. A total of 306 incident cancers was identified during the follow-up. For every case, we used incidence-density sampling to match three concurrent cancer-free controls by age, sex, and both duration and calendar time of follow-up. Exposure of interest was any MetSyn diagnosis at baseline.ResultsWe observed elevation in cancer risk associated with MetSyn in a significant way when the number of MetSyn components was over three (OR: 1.88; 95% CI: 1.19 to 2.97), or when components contained any of elevated triglycerides (OR: 1.61; 95% CI: 1.05 to 2.48), reduced high-density lipoprotein (HDL) cholesterol (OR: 2.33; 95% CI: 1.40 to 3.86) or elevated blood pressure (OR: 1.65; 95% CI: 1.04 to 2.59) after consistent multiple adjustments in different models. The highest cancer risk was in the female reproductive system and breast cancer (OR: 4.22; 95% CI: 1.62 to 10.95) followed by digestive system (OR: 1.67; 95% CI: 1.11 to 2.53). Sensitivity analyses showed similar results after first follow-up was excluded. However, any unique MetSyn component was not associated with increased cancer risk. Interestingly, the reduced HDL was observed to be widely associated with over twofold increased risk of cancer, only when together with other MetSyn components.ConclusionMetSyn components, in a collaborative manner rather than its unique component, were associated with elevated cancer risk. Not only obesity but even subtle metabolic disturbances may give rise to cancer.
Minimal disease activity and remission in patients with psoriatic arthritis with elevated body mass index: an observational cohort study in the Swiss Clinical Quality Management cohort
Authors: Vallejo-Yagüe Enriqueta , Burkard Theresa , Micheroli Raphael , Burden Andrea Michelle 
Published: September 2022

ObjectiveTo assess the impact of elevated body mass index (BMI) in the achievement of minimal disease activity (MDA) and several definitions of remission in patients with psoriatic arthritis (PsA) in Switzerland. Secondarily, to assess the overlapping across the study outcomes.MethodsThis observational cohort study in the Swiss Clinical Quality Management in Rheumatic Diseases (SCQM) registry included patients with PsA starting their first biologic or targeted synthetic disease-modifying antirheumatic drug (b/tsDMARD) from 1997 to 30 June 2018. Exposure was BMI category at b/tsDMARD start: overweight, obese, and normal weight (reference). Logistic regression was used to assess the achievement of MDA and remission at ≤12 months, as well as treatment persistence at 1 year, in overweight patients and patients with obesity compared with the normal weight group. Remission was defined by Disease Activity for Psoriatic Arthritis (DAPSA), clinical DAPSA (cDAPSA) and 28-joint Disease Activity Score (DAS28). Additionally, overlapping across study outcomes was investigated.ResultsThe study included 306 (39.5%) normal weight patients, 285 (36.8%) overweight patients and 183 (23.6%) patients with obesity. Compared with the normal weight group, patients with obesity had lower odds of achieving MDA at ≤12 months (adjusted OR (ORadj) 0.45, 95% CI 0.24 to 0.82). This was consistent with the observed reduced odds of achieving DAPSA-remission (ORadj 0.42, 95% CI 0.21 to 0.85), cDAPSA-remission (ORadj 0.51, 95% CI 0.27 to 0.96) and DAS28-remission (ORadj 0.51, 95% CI 0.32 to 0.81) in patients with obesity versus normal weight patients. Among the 125 patients achieving MDA, the majority (81.8% normal weight, 80.0% overweight, 78.9% obese) achieved cDAPSA-remission. No differences were observed in the odds to achieving treatment persistence between the BMI strata.ConclusionsObesity halved the likelihood of achieving MDA and remission in patients with PsA with b/tsDMARDs compared with those with normal weight, while it did not impact treatment persistence. High overlapping of patients achieving the outcomes MDA and cDAPSA-remission was observed across every BMI group.
Factors consistently associated with utilisation of essential maternal and child health services in Nigeria: analysis of the five Nigerian national household surveys (2003–2018)
Authors: Kawakatsu Yoshito , Adolph Christopher , Mosser Jonathan F , Baffoe Peter , Cheshi Fatima , Aiga Hirotsugu , Watkins David , Sherr Kenneth H 
Published: September 2022

ObjectiveThis study aims to identify the individual and contextual factors consistently associated with utilisation of essential maternal and child health services in Nigeria across time and household geolocation.Design, setting and participantsSecondary data from five nationally representative household surveys conducted in Nigeria from 2003 to 2018 were used in this study. The study participants are women and children depending on essential maternal and child health (MCH) services.Outcome measuresThe outcome measures were indicators of whether participants used each of the following essential MCH services: antenatal care, facility-based delivery, modern contraceptive use, childhood immunisations (BCG, diphtheria, tetanus, pertussis/Pentavalent and measles) and treatments of childhood illnesses (fever, cough and diarrhoea).MethodsWe estimated generalised additive models with logit links and smoothing terms for households’ geolocation and survey years.ResultsHigher maternal education and households’ wealth were significantly associated with utilisation of all types of essential MCH services (p<0.05). On the other hand, households with more children under 5 years of age and in poor communities were significantly less likely to use essential MCH services (p<0.05). Except for childhood immunisations, greater access to transport was positively associated with utilisation (p<0.05). Households with longer travel times to the most accessible health facility were less likely to use all types of essential MCH services (p<0.05), except modern contraceptive use and treatment of childhood fever and/or cough.ConclusionThis study adds to the evidence that maternal education and household wealth status are consistently associated with utilisation of essential MCH services across time and space. To increase utilisation of essential MCH services across different geolocations, interventions targeting poor communities and households with more children under 5 years of age should be appropriately designed. Moreover, additional interventions should prioritise to reduce inequities of essential MCH service utilisation between the wealth quantiles and between education status.
Short-term outcomes and intermediate-term follow-up ofHelicobacter pyloriinfection treatment for naïve patients: a retrospective observational study
Authors: Wang Yujing , Xiang Yu , Liao Oulan , Wu Yaoyi , Li Yan , Du Qin , Ye Jun 
Published: September 2022

ObjectivesTo explore the outcomes ofHelicobacter pyloriinfection treatments for naïve patients in the real-world settings.DesignA retrospective observational study.SettingSingle tertiary level academic hospital in China.ParticipantsWe identified patients initially receiving quadruple therapy forH. pyloriinfection from 2017 to 2020 in whom eradication was confirmed (n=23 470).Primary outcomeEfficacy of different initialH. pyloriinfection treatments.Secondary outcomeResults of urea breath test (UBT) afterH. pylorieradication.ResultsAmong 23 470 patients who received initialH. pyloritreatment, 21 285 (90.7%) were treated with amoxicillin-based regimens. The median age of the patients decreased from 2017 to 2020 (45.0 vs 39.0, p<0.0001). The main treatments were therapies containing amoxicillin and furazolidone, which had an eradication rate of 87.6% (14 707/16 784); those containing amoxicillin and clarithromycin had an eradication rate of 85.5% (3577/4182). The date of treatment, age, antibiotic regimen and duration of treatment showed correlations with the failure ofH. pylorieradication in a multivariable logistic regression analysis. Finally, positive UBT results after eradication clustered around the cut-off value, in both the13C-UBT and14C-UBT.ConclusionsThe majorH. pyloriinfection treatments for naïve patients were those containing amoxicillin and furazolidone, which offered the highest eradication rate. The date of treatment, age, antibiotic regimen and duration of treatment were risk factors for the failure ofH. pylorieradication. Additionally, positive UBT results after eradication clustered around the cut-off value.
mSep: investigating physiological and immune-metabolic biomarkers in septic and healthy pregnant women to predict feto-maternal immune health – a prospective observational cohort study protocol
Authors: Sharma Simran , Zaher Summia , Rodrigues Patrícia R S , Davies Luke C , Edkins Sarah , Strang Angela , Chakraborty Mallinath , Watkins W John , Andrews Robert , Parkinson Edward , Angelopoulos Nicos , Moet Linda , Shepherd Freya , Davies Kate Megan Megan , White Daniel , Oram Shaun , Siddall Kate , Keeping Vikki , Simpson Kathryn , Faggian Federica , Bray Maryanne , Bertorelli Claire , Bell Sarah , Collis Rachel E , McLaren James E , Labeta Mario , O’Donnell Valerie B , Ghazal Peter 
Published: September 2022

IntroductionMaternal sepsis remains a leading cause of death in pregnancy. Physiological adaptations to pregnancy obscure early signs of sepsis and can result in delays in recognition and treatment. Identifying biomarkers that can reliably diagnose sepsis will reduce morbidity and mortality and antibiotic overuse. We have previously identified an immune-metabolic biomarker network comprising three pathways with a >99% accuracy for detecting bacterial neonatal sepsis. In this prospective study, we will describe physiological parameters and novel biomarkers in two cohorts—healthy pregnant women and pregnant women with suspected sepsis—with the aim of mapping pathophysiological drivers and evaluating predictive biomarkers for diagnosing maternal sepsis.Methods and analysisWomen aged over 18 with an ultrasound-confirmed pregnancy will be recruited to a pilot and two main study cohorts. The pilot will involve blood sample collection from 30 pregnant women undergoing an elective caesarean section. Cohort A will follow 100 healthy pregnant women throughout their pregnancy journey, with collection of blood samples from participants at routine time points in their pregnancy: week 12 ‘booking’, week 28 and during labour. Cohort B will follow 100 pregnant women who present with suspected sepsis in pregnancy or labour and will have at least two blood samples taken during their care pathway. Study blood samples will be collected during routine clinical blood sampling. Detailed medical history and physiological parameters at the time of blood sampling will be recorded, along with the results of routine biochemical tests, including C reactive protein, lactate and white blood cell count. In addition, study blood samples will be processed and analysed for transcriptomic, lipidomic and metabolomic analyses and both qualitative and functional immunophenotyping.Ethics and disseminationEthical approval has been obtained from the Wales Research Ethics Committee 2 (SPON1752-19, 30 October 2019).Trial registration numberNCT05023954.
Systems approach to enhance Lynch syndrome diagnosis through tumour testing
Authors: Singh Vinit , Mezzacappa Catherine , Gershkovich Peter , Di Giovanna Jessica , Ganzak Amanda , Gibson Joanna , Sinard John , Xicola Rosa M , Llor Xavier 
Published: September 2022

BackgroundGuidelines recommend universal mismatch repair (MMR) tumour testing of colorectal adenocarcinomas (CRCs) to screen for Lynch syndrome (LS). However, its implementation remains disjointed and referral for genetic testing dismal, particularly among minorities. We aimed to increase referral, cancer genetic testing and eventually LS diagnosis by developing the CLEAR LS (Closed Loop Enhanced Assessment and Referral for Lynch Syndrome) intervention, a systems approach which in the second phase was automated.MethodsThis is a cohort study of all patients diagnosed with CRC at an academic centre between 1 January 2012, when implementation of universal CRC testing began, and 31 January 2021. The original cohort spanned through 31 May 2015. Tumour testing included MMR immunohistochemistry, followed byBRAFV600E/MLH1promoter methylation testing when indicated. The intervention included a manual phase (1 June 2015 through 31 July 2018), which systematised pathology screening and cancer genetics (CG) referral mechanisms, and an automated phase (1 August 2018 through 31 January 2021) using computer programming.ResultsA total of 249/1541 CRC (17.38%) had MMR loss of expression and 129 (8.37%) qualified for CG evaluation. Referral was 27.58% in the original cohort and 92.1% in the intervention (p<0.001). Patients seen by CG among referred were 27.58% in the original cohort and 74.3% in the intervention (p two-sided<0.001). The distribution of race/ethnicity among patients qualifying and referred for CG evaluation was not significantly different across cohorts. LS diagnosis increased from 0.56% (original cohort) to 1.43% (intervention). Cost per new diagnosis of LS decreased from US$173 675 to $87 960 from original cohort to intervention.ConclusionImplementation of systematic case identification and referral support mechanisms significantly increased the proportion of patients undergoing genetic testing and doubled the percentage of patients diagnosed with LS with no referral differences across racial/ethnic groups.
New wormhole models with stability analysis via thin-shell in teleparallel gravity
Authors: Javed Faisal , Mumtaz Saadia , Mustafa G. , Hussain Ibrar , Liu Wu-Ming 
Published: September 2022

AbstractThis study explores new wormhole solutions in the background of teleparallel gravity. All the energy conditions are investigated for two different new calculated shape functions. The presence of exotic matter is confirmed due to the violation of the energy conditions. Thin-shell around the wormhole geometry is obtained by using the cut and paste approach taking the Schwarzschild black hole as an exterior manifold. The stability of thin-shell is explored by using linearized radial perturbation about equilibrium shell radius for both choices of calculated shape functions. It is concluded that stable regions and the position of the expected event horizon depend on the choice of physical parameters.
Observational constraints on f(T) gravity from model-independent data
Authors: dos Santos F. B. M. , Gonzalez J. E. , Silva R. 
Published: September 2022

AbstractWe establish new constraints on f(T) gravity models by using cosmological data. In particular, we investigate the restrictions given by the gas mass fraction measurements of galaxy clusters and transversal BAO data. Both data sets are regarded as weakly dependent on a fiducial cosmology. In addition, we also include a CMB measurement of the temperature power spectrum first peak, along with H(z) values from cosmic chronometers and supernovae data from the Pantheon data set. We also perform a forecast for future constraints on the deviation of f(T) models from the $$\Lambda $$
Λ
CDM scenario by following the specifications of the J-PAS and Euclid surveys and find significant improvements on the constraints of the b-parameter, when compared to the results of the statistical analysis.
Epithelioid Hemangioendothelioma: Incidence, Mortality, Prognostic Factors, and Survival Analysis Using the Surveillance, Epidemiology, and End Results Database
Authors: Liu Zhen , He Shuting 
Published: September 2022

Background. Although epithelioid hemangioendothelioma (EHE) is a rare and aggressive vascular tumor, its demographic characteristics remain unclear. We used the surveillance, epidemiology, and end results (SEER) database to determine the clinical features, incidence, and prognostic factors associated with overall survival in patients with EHE. Methods. The demographic and clinical data of patients with EHE were extracted from the SEER database (1975-2019) to calculate the incidence of EHE and survival rate in these patients. The Cox proportional hazards model and Kaplan-Meier method were used to analyze the prognostic factors of overall survival in these patients. A nomogram and time-dependent receiver operating characteristic (ROC) curve were employed to predict the 3- and 5-year survival rate. Results. The overall incidence rate (IR) of EHE was 0.230 (

95
%
confidence

interval

CI

=
0.201
–
0.263

) per 1,000,000 person-years. According to the age-stratified IR, the highest age-adjusted IR was observed in patients aged 60–79 years (0.524 per 1,000,000 person-years,

95
%
CI
=
0.406
–
0.665

). The majority (30.8%) of the tumors were located in the soft tissue and skin, followed by lesions in the abdomen (28%), respiratory system (19%), bone and joint (8.6%), and others. The 5-year overall survival rate was 55.6% (

95
%
CI
=
32.8
–
73.5
%

). Multiple Cox regression analysis revealed that age >80 years (

hazard

ratio

HR

=
8.57

,

95
%
CI
=
2.32
–
31.63

,

P
<
0.001

), African-American race (

HR
=
2.52

,

95
%
CI
=
1.31
–
4.85

,

P
<
0.01

), “American Indian/Alaska Native” or “Asian or Pacific Islander” (

HR
=
2.99

,

95
%
CI
=
1.5
–
5.96

,

P
<
0.01

) race, and respiratory tumors (

HR
=
2.55

,

95
%
CI
=
1.37
–
4.75

,

P
<
0.01

) were distinctly related to worse overall survival. The calibration plots demonstrated good consistency between nomogram-predicted and actual survival. The area under the time-dependent ROC curve was 0.721 (

95
%
CI
=
0.63
–
0.81

) and 0.719 (

95
%
CI
=
0.63
–
0.81

) for the 3- and 5-year survival, respectively. For the convenience of researchers and clinicians, we designed an online dynamics nomogram to predict the survival rate. Conclusion. EHE is a relatively rare vascular tumor, which principally occurs in the soft tissue and skin. It most commonly occurs in patients aged 60–79 years and its incidence has increased in recent years. Age at diagnosis, race, and tumor location may affect the overall survival outcomes.
Reaping the Benefits of African Continental Free Trade Agreement (AfCFTA)
Authors: Aziegbe-Esho Ebes , Verhoef Grietjie 
Published: September 2022

Abstract
Africa’s Continental Free Trade Agreement (AfCFTA) aims to boost intra-Africa trade and to ultimately improve the lives and welfare of Africans. Through a discursive analysis of human capital theory and its relationship with gains to trade, this paper analyses the state of Africa’s human capital in readiness for AfCFTA and provides some policy recommendations. Gains to trade are theoretically and empirically more beneficial to countries with human capital accumulation. Most African countries still have low human capital levels and may not be able to reap the benefits of an integrated free trade area that AfCFTA portends, in terms of employment generation. African countries require a coherent human capital development strategy. This paper recommends a three-pronged approach that includes identifying specific areas of comparative advantage, shifting focus away from the export of natural resources and primary products and developing the knowledge and skills required in the areas of comparative advantage identified.
Hobbes’s Lesser Evil Argument for Political Authority
Authors: Jones Ben , Tian Manshu 
Published: September 2022

Abstract
This article identifies an argument in Hobbes’s writings often overlooked but relevant to current philosophical debates. Political philosophers tend to categorize his thought as representing consent or rescue theories of political authority. Though these interpretations have textual support and are understandable, they leave out one of his most compelling arguments – what we call the lesser evil argument for political authority, expressed most explicitly in Chapter 20 of Leviathan. Hobbes frankly admits the state’s evils but appeals to the significant disparity between those evils and the greater evils outside the state as a basis for political authority. More than a passing observation, aspects of the lesser evil argument appear in each of his three major political works. In addition to outlining this argument, the article examines its significance both for Hobbes scholarship and recent philosophical debates on political authority.