bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-Term Outcomes Following Manipulation Under Anaesthetic for Patients with Primary and Secondary Frozen Shoulder
Authors: Fairclough Anna , Waters Christopher , Davies Thomas , Dacombe Peter , Woods David 
Published: December 2021

Background Frozen Shoulder (FS) is a common, debilitating condition for which manipulation under anaesthetic (MUA) is a non-invasive and effective treatment option. Current literature evaluates short to medium-term outcomes, but there is a paucity of long-term (>10 years) studies. Knowledge of long-term outcomes is also needed to evaluate whether FS or its treatment pre-disposes to other shoulder pathology in the long-term. Methods A retrospective analysis of 398 shoulders undergoing MUA for FS between Jan 1999 and Jan 2010; 240 complete datasets were obtained. Outcomes were Oxford Shoulder Score (OSS), recurrence and development of other shoulder pathology (arthritis or rotator cuff tear). Results At long-term follow-up (mean 13.2 years), 71.3% had no symptoms (OSS 48), 16.6% had minor symptoms (OSS 42–47) and 12.1% had significant symptoms (OSS < 42). There were 4/240 (1.7%) self-reported recurrences > 5 years after initial MUA and 2/240 (0.8%) repeat MUAs. In the long-term 6.7% developed rotator cuff pathology and 3.8% shoulder OA. Discussion This study suggests that long-term outcome after MUA for FS is favourable. Late recurrence of FS is uncommon and the development of OA or rotator cuff pathology is no greater than that of the general population.
Amputation as a First Treatment is Highly Associated With Late Presentation: An Underestimated Modifiable Major Risk Factor for Diabetic Foot Ulcer
Authors: Yammine Kaissar , Akiki Sandra , Assi Chahine , Hayek, MD Fady 
Published: December 2021

Purpose Several risk factors for lower extremity amputation in diabetic patients have been identified; however, late presentation has been poorly investigated. Very few studies looked at the impact of such risk factor. As none has investigated the link between admission to amputation and late presentation in this population, we investigated such association. Methods The study is a retrospective comparative cohort of continuous series of patients admitted for amputation related to diabetic foot ulcer (DFU) as a first treatment. A late presentation was defined as a period of 3 weeks or more from the onset of the ulcer. Results Forty-six patients admitted for amputation and all wounds were infected and located on the plantar forefoot in 32 cases (69.5%), on the toes in 10 cases (21.7%), and in the heel area in 4 cases (8.8%). The mean duration to admission was 5.2 ±1.8 weeks (range 4-10 weeks). Late presentation was recorded in 42 (91.3%) patients. Conclusion This study demonstrates that amputation due to DFU is highly associated with late presentation. Educational campaigns targeting patient and first-line health care providers and highlighting the urgency of diabetic ulcers are needed to impact this major modifiable risk factor. Levels of Evidence Therapeutic, Level III: Retrospective Comparative
New insights into the evolution of SPX gene family from algae to legumes; a focus on soybean
Authors: Nezamivand-Chegini Mahnaz , Ebrahimie Esmaeil , Tahmasebi Ahmad , Moghadam Ali , Eshghi Saeid , Mohammadi-Dehchesmeh Manijeh , Kopriva Stanislav , Niazi Ali 
Published: December 2021

Abstract
Background
SPX-containing proteins have been known as key players in phosphate signaling and homeostasis. In Arabidopsis and rice, functions of some SPXs have been characterized, but little is known about their function in other plants, especially in the legumes.

Results
We analyzed SPX gene family evolution in legumes and in a number of key species from algae to angiosperms. We found that SPX harboring proteins showed fluctuations in domain fusions from algae to the angiosperms with, finally, four classes appearing and being retained in the land plants. Despite these fluctuations, Lysine Surface Cluster (KSC), and the third residue of Phosphate Binding Sites (PBS) showed complete conservation in almost all of SPXs except few proteins in Selaginella moellendorffii and Papaver sumniferum, suggesting they might have different ligand preferences. In addition, we found that the WGD/segmentally or dispersed duplication types were the most frequent contributors to the SPX expansion, and that there is a positive correlation between the amount of WGD contribution to the SPX expansion in individual species and its number of EXS genes. We could also reveal that except SPX class genes, other classes lost the collinearity relationships among Arabidopsis and legume genomes. The sub- or neo-functionalization of the duplicated genes in the legumes makes it difficult to find the functional orthologous genes. Therefore, we used two different methods to identify functional orthologs in soybean and Medicago. High variance in the dynamic and spatial expression pattern of GmSPXs proved the new or sub-functionalization in the paralogs.

Conclusion
This comprehensive analysis revealed how SPX gene family evolved from algae to legumes and also discovered several new domains fused to SPX domain in algae. In addition, we hypothesized that there different phosphate sensing mechanisms might occur in S. moellendorffii and P. sumniferum. Finally, we predicted putative functional orthologs of AtSPXs in the legumes, especially, orthologs of AtPHO1, involved in long-distance Pi transportation. These findings help to understand evolution of phosphate signaling and might underpin development of new legume varieties with improved phosphate use efficiency.
Barriers and attitudes towards cervical cancer screening in primary healthcare in Poland - doctors’ perspective
Authors: Nessler Katarzyna , Ball Francis , Chan Sze Kay Florence , Chwalek Michal , Krztoń-Królewiecka Anna , Windak Adam 
Published: December 2021

Abstract
Background
Healthcare systems have adopted different strategies to reduce the burden of cervical cancer. In Poland, a population-based screening program was implemented in 2006, leading to a downward trend in cervical cancer burden. However, screening rates are still low in relation to other EU member states. In Poland, Pap smears are mainly performed by gynecologists rather than Primary Health Care (PHC) physicians. Little is known about the experiences and attitudes of the latter regarding cervical cancer screening in a PHC setting.

Methods
A cross-sectional questionnaire-based survey was carried out among 43 PHC physicians from the Malopolska region in Poland. Barriers and attitudes towards cytology in a PHC setting were evaluated.

Results
Approximately 35% of surveyed physicians reported having experience in performing cytology. Almost 75% of PHC physicians lacked the necessary equipment in their office to perform the screening. None of the studied physicians performed Pap smears in their office at the time. The reasons included: shortage of competence (78.57%) and time (69.05%), the perception of Pap smears as a task for gynecologists (69.05%), the lack of financial incentives (61.90%), and the belief that their patients would be unwilling to undergo the test in their PHC physician’s office (33.33%). More than three quarters (76.74%) declared they would be ready to perform Pap smears if the tests were additionally paid. No significant associations between PHC physicians’ characteristics and their willingness to perform cytology screening were found.

Conclusion
The primary barrier to perform Pap smears by PHC physicians does not lie in their personal reluctance but in the organization of the healthcare system. Provision of required training and proper funding allocation can likely improve the screening rate of cervical cancer in Poland.
Joint spatio-temporal modelling of adverse pregnancy outcomes sharing common risk factors at sub-county level in Kenya, 2016–2019
Authors: Odhiambo Julius Nyerere , Sartorius Benn 
Published: December 2021

AbstractBackgroundAdverse pregnancy outcomes jointly account for a high proportion of mortality and morbidity among pregnant women and their infants. Furthermore, the burden attributed to adverse pregnancy outcomes remains high and inadequately characterised due to the intricate interplay of its etiology and shared set of important risk factors. This study sought to quantify and map the underlying risk of multiple adverse pregnancy outcomes in Kenya at sub-county level using a shared component space-time modelling framework.MethodsReported sub-county level adverse pregnancy outcomes count from January 2016 – December 2019 were obtained from the Kenyan District Health Information System. A Bayesian hierarchical spatio-temporal model was used to estimate the joint burden of adverse pregnancy outcomes in space (sub-county) and time (year). To improve the precision of our estimates over time and space, information across the outcomes were combined via the shared and the outcome-specific components using a shared component model with spatio-temporal interactions.ResultsOverall, the total number of adverse outcomes in pregnancy increased by 14.2% (95% UI: 14.0–14.5) from 88,816 cases in 2016 to 101,455 cases in 2019. Between 2016 and 2019, the estimated low birth weight rate and the pre-term birth rate were 4.5 (95% UI: 4.4–4.7) and 2.3 (95% UI: 2.2–2.5) per 100 live births. The stillbirth and neonatal death rates were estimated to be 18.7 (95% UI: 18.0–19.4) and 6.9 (95% UI: 6.4–7.4) per 1000 live births. The magnitude of the spatio-temporal variation attributed to shared risk was high for pre-term births, low birth weight, neonatal deaths, stillbirths and neonatal deaths, respectively. The shared risk patterns were dominant in sub-counties located along the Indian ocean coastline, central and western Kenya.ConclusionsThis study demonstrates the usefulness of a Bayesian joint spatio-temporal shared component model in exploiting specific and shared risk of adverse pregnancy outcomes sub-nationally. By identifying sub-counties with elevated risks and data gaps, our estimates not only assert the need for bolstering maternal health programs in the identified high-risk sub-counties but also provides a baseline against which to assess the progress towards the attainment of Sustainable Development Goals.
Women’s experiences of safety apps for sexualized violence: a narrative scoping review
Authors: Doria Nicole , Ausman Christine , Wilson Susan , Consalvo Annalisa , Sinno Jad , Boulos Leah , Numer Matthew 
Published: December 2021

Abstract
Background
Sexualized violence against women is a significant human rights problem worldwide. Safety apps have the capacity to provide women with resources to prevent or respond to experiences of sexualized violence.

Methods
The aim of the following study was to review the scope of the literature on women’s experiences of safety apps related to sexualized violence. The databases Embase, MEDLINE, PsycINFO, and Scopus were systematically searched, and seven studies were included in this review.

Results
Thematic analysis identified the following themes in the literature: (1) security; (2) accessibility; and (3) knowledge.

Conclusion
The gaps in the literature are identified and implications and recommendations for future research is discussed.
Social determinants and spatio-temporal variation of Ischemic Heart Disease in Manitoba
Authors: Dyck Justin , Tate Robert , Uhanova Julia , Torabi Mahmoud 
Published: December 2021

Abstract
Introduction
The aim was to study any spatial and/or temporal patterns of ischemic heart disease (IHD) prevalence and measure the effects of selected social determinants on these spatial and space-time patterns.

Methods
Data were obtained from the Population Research Data Repository housed at the Manitoba Centre for Health Policy to identify persons who were diagnosed with IHD between 1995 and 2018. These persons were geocoded to 96 geographic regions of Manitoba. An area-level socioeconomic factor index (SEFI-2) and the proportion of the population who was Indigenous were calculated for each geographic region using the 2016 Canadian Census data. Associations between these factors and IHD prevalence were measured using Bayesian spatial Poisson regression models. Temporal trends and spatio-temporal trends were measured using Bayesian spatio-temporal Poisson regression models.

Results
Univariable models showed a significant association with increased regional Indigenous population proportion associated with a higher prevalence of IHD (RR: 0.07, 95% CredInt: (0.05, 0.10)) and for SEFI-2 (RR: 0.17, 95% CredInt: (0.11, 0.23)). Using a multivariable model, after accounting for the proportion of the population that was Indigenous, there was no evidence of an association between IHD prevalence and area-level socioeconomic factor. Spatio-temporal models showed no significant overall temporal trend in IHD prevalence, but there were significant spatially varying temporal trends within the 96 regions.

Conclusions
Association between Indigenous population proportion and IHD is consistent with previous research. No significant overall temporal trend was measured. However, regions with significantly increasing trends and significantly decreasing trends in IHD prevalence were identified.
Associations of sickness absence and disability pension due to mental and somatic diagnoses when aged 60–64 with paid work after the standard retirement age; a prospective population-based cohort study in Sweden
Authors: Martikainen Aleksiina , Svensson Alavi Alice , Alexanderson Kristina , Farrants Kristin 
Published: December 2021

Abstract
Background
The proportion of people working beyond age 65 is increasing. We aimed to explore whether sickness absence (SA) and disability pension (DP) due to mental, somatic, or both diagnoses when aged 60–64 were associated with being in paid work when aged 66–71.

Methods
This prospective population-based cohort study included all 98,551 individuals who in 2010 turned 65 years, lived in Sweden, and were in paid work at some point when aged 60–64. Data from three nationwide registers were used with 2010 as baseline, with SA or/and DP as the exposure variables (2005–2009) and paid work as the outcome variable (2011–2016). Logistic regression was conducted to calculate odds ratios (OR) with 95% confidence intervals (CI) for the association between exposures and outcome, controlling for sociodemographic factors. The analyses were also stratified by sex.

Results
Nearly half were in paid work during follow-up. Those with SA due to mental diagnoses had lower likelihood of being in paid work among both sexes (women OR: 0.76; 95% CI: 0.69–0.84; men 0.74; 0.65–0.84), while this association was smaller for SA due to somatic diagnoses (women 0.87; 0.84–0.91; men 0.92; 0.89–0.96). SA due to both mental and somatic diagnoses was associated with a lower likelihood of paid work for men (0.77; 0.65–0.91), but not women (0.98; 0.88–1.09). Regardless of diagnosis group and sex, DP had the strongest association with not being in paid work (women mental DP 0.39; 0.34–0.45; women somatic DP 0.38; 0.35–0.41; women mental and somatic DP 0.28; 0.15–0.56; men mental DP 0.36; 0.29–0.43; men somatic DP 0.35; 0.32–0.38; men mental and somatic DP 0.22; 0.10–0.51). Combined SA and/or DP demonstrated ORs in-between the diagnosis groups of SA and DP alone (e.g., mental SA and/or DP women and men combined 0.61; 0.57–0.65).

Conclusions
SA and DP were negatively associated with being in paid work after the standard retirement age of 65. The association was especially strong for DP, irrespective of diagnosis group. Moreover, compared to somatic diagnoses, SA due to mental diagnoses had a stronger association with not being in paid work. More knowledge is needed on how mental SA impedes extending working life.
Psychological distress, burnout, and coping strategies among Nigerian primary school teachers: a school-based cross-sectional study
Authors: Ozoemena Eyuche Lawretta , Agbaje Olaoluwa Samson , Ogundu Levi , Ononuju Amaka Harry , Umoke Prince Christian Iheanachor , Iweama Cylia Nkechi , Kato George Usman , Isabu Augustina Chikaodili , Obute Akor John 
Published: December 2021

Abstract
Background
The teaching profession is highly stressed job. A high level of stress is associated with poor health outcomes, such as burnout and psychological distress. Therefore, teachers’ use of coping styles becomes imperative. However, relatively little is known about primary school teachers’ psychological distress, burnout, coping strategies, and associated factors in Nigeria. The study investigated psychological distress, burnout, coping strategies among primary schools, and associated factors in Nigeria.

Methods
A total of 264 teachers aged 20–59 years participated in the study between May 2019 to October 2019. Questionnaires on psychological distress, burnout, coping strategies, and demographic profile form were used for data collection. Factors associated with psychological distress, burnout, and coping strategies were identified using t-test, univariate ANOVA, Pearson’s correlation, Chi-square test, and hierarchical linear regression analysis.

Results
Of 264 participants enrolled for the study, 253 responded, giving a response rate of 95.8%. The prevalence of psychological distress and burnout was 69.9% (176/253) and 36.0% (91/253), respectively. Sex (β = 0.158), a high level of emotional exhaustion (β = 0.193) and reduced personal accomplishment (β = 0.358), adoption of problem-focused strategies (β = 0.904), and dysfunctional strategies (β = 0.340) were positively associated with psychological distress. Age (β = − 0.338), academic qualification (β = − 0.210), and income level (β = − 0.146) were inversely associated with psychological distress, which together explained 51.5% of the total variance. Psychological distress (β = 0.275 vs. β = 0.404) was significantly associated with emotional exhaustion (EE) and reduced personal accomplishment (PA) and explained 11.4 and 24.2% of the variance in EE and reduced PA, respectively.

Conclusions
The high prevalence of psychological distress and burnout among teachers should receive urgent attention. Teachers’ training curricula should include developing interpersonal skills, stress management abilities, and resilience to equip them for the job. Also, teacher training curricula should integrate mental health promotion interventions.
Document-level medical relation extraction via edge-oriented graph neural network based on document structure and external knowledge
Authors: Li Tao , Xiong Ying , Wang Xiaolong , Chen Qingcai , Tang Buzhou 
Published: December 2021

Abstract
Objective
Relation extraction (RE) is a fundamental task of natural language processing, which always draws plenty of attention from researchers, especially RE at the document-level. We aim to explore an effective novel method for document-level medical relation extraction.

Methods
We propose a novel edge-oriented graph neural network based on document structure and external knowledge for document-level medical RE, called SKEoG. This network has the ability to take full advantage of document structure and external knowledge.

Results
We evaluate SKEoG on two public datasets, that is, Chemical-Disease Relation (CDR) dataset and Chemical Reactions dataset (CHR) dataset, by comparing it with other state-of-the-art methods. SKEoG achieves the highest F1-score of 70.7 on the CDR dataset and F1-score of 91.4 on the CHR dataset.

Conclusion
The proposed SKEoG method achieves new state-of-the-art performance. Both document structure and external knowledge can bring performance improvement in the EoG framework. Selecting proper methods for knowledge node representation is also very important.
Persistent SARS-CoV-2 infection in patients with secondary antibody deficiency: successful clearance following combination casirivimab and imdevimab (REGN-COV2) monoclonal antibody therapy
Authors: Taha Yusri , Wardle Hayley , Evans Adam B. , Hunter Ewan R. , Marr Helen , Osborne Wendy , Bashton Matthew , Smith Darren , Burton-Fanning Shirelle , Schmid Matthias L. , Duncan Christopher J. A. 
Published: December 2021

Abstract
Background
There is growing evidence that antibody responses play a role in the resolution of SARS-CoV-2 infection. Patients with primary or secondary antibody deficiency are at increased risk of persistent infection. This challenging clinical scenario is associated with adverse patient outcome and potentially creates an ecological niche for the evolution of novel SARS-CoV-2 variants with immune evasion capacity. Case reports and/or series have implied a therapeutic role for convalescent plasma (CP) to secure virological clearance, although concerns have been raised about the effectiveness of CP and its potential to drive viral evolution, and it has largely been withdrawn from clinical use in the UK.

Case presentation
We report two cases in which persistent SARS-CoV-2 infection was cleared following administration of the monoclonal antibody combination casirivimab and imdevimab (REGN-COV2, Ronapreve). A 55-year-old male with follicular lymphoma, treated with B cell depleting therapy, developed SARS-CoV-2 infection in September 2020 which then persisted for over 200 days. He was hospitalised on four occasions with COVID-19 and suffered debilitating fatigue and malaise throughout. There was no clinical response to antiviral therapy with remdesivir or CP, and SARS-CoV-2 was consistently detected in nasopharyngeal swabs. Intrahost evolution of several spike variants of uncertain significance was identified by viral sequence analysis. Delivery of REGN-COV2, in combination with remdesivir, was associated with clinical improvement and viral clearance within 6 days, which was sustained for over 150 days despite immunotherapy for relapsed follicular lymphoma. The second case, a 68-year-old female with chronic lymphocytic leukaemia on ibrutinib, also developed persistent SARS-CoV-2 infection. Despite a lack of response to remdesivir, infection promptly cleared following REGN-COV2 in combination with remdesivir, accompanied by resolution of inflammation and full clinical recovery that has been maintained for over 290 days.

Conclusions
These cases highlight the potential benefit of REGN-COV2 as therapy for persistent SARS-CoV-2 infection in antibody deficient individuals, including after failure of CP treatment. Formal clinical studies are warranted to assess the effectiveness of REGN-COV2 in antibody-deficient patients, especially in light of the emergence of variants of concern, such as Omicron, that appear to evade REGN-COV2 neutralisation.