bluuebunny/crossref_metadata_2025_split huggingface dataset:
Levers of Change: How to Help Build the Public Health Workforce of the Future
Authors: Meredith Genevive R. , Welter Christina R. , Risley Kris , Seweryn Steven M. , Altfeld Susan , Jarpe-Ratner Elizabeth A. 
Published: September 2022

Context:
Public health leaders are working to rebuild the US public health workforce. Master of Public Health (MPH) programs have a stake in this, given their role in educating and training public health practitioners. Over the last 10 years, MPH programs have implemented changes to program structure, content, and approach, but workforce gaps persist.

Objective:
This study sought to explore the factors that inform and influence MPH program design and changes they make in order to elucidate how MPH programs may be further engaged to help address current and future public health workforce needs.

Design:
Sequential mixed-methods study.

Setting:
US MPH programs accredited by the Council on Education for Public Health (CEPH), and applicants approved to seek accreditation.

Participants:
In total, 115 representatives representing at least 43% of the 215 accredited/applicant MPH programs in the United States.

Main Outcome Measures:
Factors that inform and influence programmatic and curricular changes within MPH programs.

Results:
The shifts that MPH programs have made to program focus and the approaches used to support student competence development are influenced by individual, programmatic, institutional, and national factors, including faculty and staff background, access to resources, program team/faculty culture, access to resources, program placement, university priorities, and national policies. Most influential in catalyzing changes made by MPH programs between 2015 and 2020 were CEPH MPH accreditation standards, feedback from interested parties, learning best practices, university initiatives, and access to resources including funding and faculty. Identified factors served as facilitators and/or as barriers, depending on the context.

Conclusions:
There are multiple levers at different levels that may be utilized by national public health leaders, university administrators, and program constituents to effect change within MPH programs, helping them to be even better positioned to help address public health workforce needs of today and tomorrow.
Effects of high-intensity strength training in adults with knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials
Authors: Hua Jiong , Sun Lin , Teng Yue 
Published: September 2022

Abstract

Objective
To assess the effects of high-intensity strength training versus low-intensity strength training or routine care in adults with knee osteoarthritis.

Design
PubMed, Embase, Cochrane Library, and Web of Science were searched up to March 10, 2021. The outcomes were knee pain, knee function, quality of life and adverse events.

Results
Ten studies of 892 subjects with knee osteoarthritis were included. No significant differences were found between the high-intensity strength training group and the low-intensity strength training or routine care group in the WOMAC pain score, KOOS pain score, WOMAC stiffness score, WOMAC physical function score, KOOS symptom score, KOOS activities of daily living score, KOOS sport & recreation score, TUG result, gait velocity, walking time, peak torque of the knee extensors, KOOS quality of life score, and adverse event incidence (all P > 0.05). The peak torque of the knee flexors at 120°/s contraction (pooled WMD: 7.520, 95% CI: 1.256 to 13.784, P = 0.019) in the high-intensity group was improved significantly than that in the low-intensity training or routine care group.

Conclusion
High-intensity strength training may have similar effects in improving knee pain, knee function and quality of life, with comparable safety to low-intensity strength training and routine care.
Amputation and prosthetics of the lower extremity: The 2020 Dutch evidence-based multidisciplinary guideline
Authors: Fard Behrouz , Persoon Saskia , Jutte Paul C. , Daemen Jan-Willem H.C. , Lamprou D-A A. , Hoope Werner Ten , Prinsen Erik C. , Houdijk Han , Olsman Jeroen , Holling Tobias , De Wever Heike P.P.R. , Schrier Ernst , Donders Nadine , Rietman Johan S. , Geertzen Jan H.B. 
Published: September 2022

Background:Lower-limb amputations are rare but debilitating events in the lives of affected persons. Treatment of persons with amputation inherently involves many different health care professions at different stages leading to and after an amputation. There are prevailing clinical questions within the work field related to different facets of care including peri/postoperative aspects, prosthetic components, rehabilitation treatment, and health care processes.Objectives:To provide an up-to-date multidisciplinary evidence-based guideline for health care professionals involved in the treatment of persons with lower-limb amputation in the Netherlands.Methods:Identification of key questions in a focus group, systematic review of the evidence (up to March 2019, using Embase and MEDLINE databases), and weighing considerations, culminating in clinical recommendations.Results:Twelve key questions were formulated. Recommendations of two key questions were upheld in line with the previous 2012 guideline. Ten systematic literature searches were performed, leading to the inclusion of 59 studies.Conclusion:A summary of evidence-based conclusions, considerations, and recommendations of the 2020 guideline is presented.
The Role of Apparent Diffusion Coefficient Values in Glioblastoma: Differentiating Tumor Progression Versus Treatment-Related Changes
Authors: Kamali Arash , Gandhi Anusha , Nunez Luis C. , Lugo Andrea E. , Arevalo-Espejo Octavio , Zhu Jay-Jiguang , Esquenazi-Levy Yoshua , Zhang Xu , Riascos Roy F. 
Published: September 2022

Objective
Glioblastoma represents the most common primary brain malignancy with a median survival of 15 months. Follow-up examinations are crucial to establish the presence of tumor recurrence, as well as treatment-associated changes such as ischemic infarction and radiation effects. Even though magnetic resonance imaging is a valuable tool, a histopathological diagnosis is often required because of imaging overlap between tumor recurrence and treatment associated changes. We set out to measure the apparent diffusion coefficient (ADC) values of the lesions in magnetic resonance imaging scans of treated glioblastoma patients to investigate if ADC values could accurately differentiate between tumor progression, radiation-related changes, and ischemic infarctions.

Methods
We evaluated ADC values among 3 groups, patients with tumor progression, radiation necrosis, and ischemic infarctions. The regions of interest were placed in the areas of greatest hypointensity among solid lesions using the ADC maps, excluding areas with necrotic, cystic, or hemorrhagic changes. The ADC values of the contralateral normal appearing white matter were also measured as the reference value for each patient. The relative ADC (rADC) values were measured for all 3 groups. Comparison between lesions and normal white matter was evaluated by Wilcoxon signed test.

Results
A total of 157 patients were included in the study; 49 patients classified as tumor progression, 58 patients as radiation necrosis, and 50 patients as ischemic infarctions. The mean ± SD ADC value was 752.8 ± 132.5 for tumor progression, 479.0 ± 105.2 for radiation-related changes, and 250.1 ± 57.2 for ischemic infarctions. The mean ± SD rADC value was 1.07 ± 0.22 for tumor progression, 0.66 ± 0.14 for radiation necrosis, and 0.34 ± 0.08 for ischemic infarctions. The mean rADC values were significantly higher in tumor progression, compared with both radiation necrosis and ischemic changes (P < 0.001).

Conclusions
The present study demonstrates that ADC values are a helpful tool to differentiate between tumor progression, radiation necrosis, and posttreatment ischemic changes.
Beyond In-hospital Mortality
Authors: Zogg Cheryl K. , Cooper Zara , Peduzzi Peter , Falvey Jason R. , Tinetti Mary E. , Lichtman Judith H. 
Published: September 2022

Objective:
To identify the distributions of and extent of variability among 3 new sets of postdischarge quality-metrics measured within 30/90/365 days designed to better account for the unique health needs of older trauma patients: mortality (expansion of the current in-hospital standard), readmission (marker of health-system performance and care coordination), and patients’ average number of healthy days at home (marker of patient functional status).

Background:
Traumatic injuries are a leading cause of death and loss of independence for the increasing number of older adults living in the United States. Ongoing efforts seek to expand quality evaluation for this population.

Methods:
Using 100% Medicare claims, we calculated hospital-specific reliability-adjusted postdischarge quality-metrics for older adults aged 65 years or older admitted with a primary diagnosis of trauma, older adults with hip fracture, and older adults with severe traumatic brain injury. Distributions for each quality-metric within each population were assessed and compared with results for in-hospital mortality, the current benchmarking standard.

Results:
A total of 785,867 index admissions (305,186 hip fracture and 92,331 severe traumatic brain injury) from 3692 hospitals were included. Within each population, use of postdischarge quality-metrics yielded a broader range of outcomes compared with reliance on in-hospital mortality alone. None of the postdischarge quality-metrics consistently correlated with in-hospital mortality, including death within 1 year [r=0.581 (95% CI, 0.554–0.608)]. Differences in quintile-rank revealed that when accounting for readmissions (8.4%, κ=0.029) and patients’ average number of healthy days at home (7.1%, κ=0.020), as many as 1 in 14 hospitals changed from the best/worst performance under in-hospital mortality to the completely opposite quintile rank.

Conclusions:
The use of new postdischarge quality-metrics provides a more complete picture of older adult trauma care: 1 with greater room for improvement and better reflection of multiple aspects of quality important to the health and recovery of older trauma patients when compared with reliance on quality benchmarking based on in-hospital mortality alone.
Persistent Circulating Tumor Cells at 1 Year After Oncologic Resection Predict Late Recurrence in Pancreatic Cancer
Authors: Javed Ammar A. , Ding Ding , Hasanain Alina , van Oosten Floortje , Yu Jun , Cameron John L. , Burkhart Richard A. , Zheng Lei , He Jin , Wolfgang Christopher L. 
Published: September 2022

Objective:
The aim of the study was to assess the association between persistent circulating tumor cells (CTCs) and subsequent recurrence in patients who were clinically recurrence free ~12 months postoperatively.

Background:
Circulating tumor cells have been proposed as biomarkers to predict survival in pancreatic cancer. Some patients demonstrate persistent CTCs postoperatively, which could represent minimal residual disease.

Methods:
Patients from previously published prospective circulating tumor cell in pancreatic cancer trial without clinical evidence of recurrence 12 months postoperatively and CTC testing performed 9 to 15 months postoperatively were included. The presence of epithelial and transitional CTCs (trCTCs) was evaluated as predictor of recurrence. Kaplan-Meier curve, log-rank test, and Cox model were used for survival analysis.

Results:
Thirty-three of 129 eligible patients (circulating tumor cell in pancreatic cancer trial) were included. The trCTC-positive and negative patients were well balanced in clinicopathologic features. Patients with trCTCs had a recurrence rate per-person-month of 10.3% compared with 3.1% in trCTCs-negative patients with a median time to recurrence of 3.9 versus 27.1 months, respectively. On multivariable analysis, trCTCs positivity was associated with higher risk of late recurrence (hazard ratio: 4.7, 95% CI, 1.2–18.3, P=0.024). Fourteen (42.4%) patients recurred during the second postoperative year. One-year postoperative trCTCs positivity was associated with a higher rate of recurrence during the second year (odds ratio:13.1, 95% CI, 1.6–1953.4, P=0.028, area under curve=0.72). Integrating clinicopathologic features with trCTCs increased the area under curve to 0.80. A majority of trCTCs-positive patients (N=5, 62.5%) had multisite recurrence, followed by local-only (N=2, 25.0%) and liver-only (N=1, 12.5%) recurrence. This was in striking contrast to trCTCs-negative patients, where a majority (N=6, 66.7%) had a local-only recurrence, followed by liver-only (N=2, 22.2%) and multisite (N=1, 11.1%) recurrence.

Conclusions:
In patients deemed to be clinically disease-free 12 months postoperatively, trCTCs positivity is associated with higher rates of subsequent recurrence with distinct patterns of recurrence. CTCs could be used a putative biomarker to guide patient prognostication and management in pancreatic cancer.
Effect estimates can be accurately calculated with data digitally extracted from interrupted time series graphs
Authors: Turner Simon Lee , Korevaar Elizabeth , Cumpston Miranda S , Kanukula Raju , Forbes Andrew B , McKenzie Joanne E 
Published: September 2022

AbstractBackgroundInterrupted Time Series (ITS) studies are frequently used to examine the impact of population-level interventions or exposures. Systematic reviews with meta-analyses including ITS designs may inform public health and policy decision-making. Re-analysis of ITS may be required for inclusion in meta-analysis. While publications of ITS rarely provide raw data for re-analysis, graphs are often included, from which time series data can be digitally extracted. However, the accuracy of effect estimates calculated from data digitally extracted from ITS graphs is currently unknown.MethodsForty-three ITS with available datasets and time series graphs were included. Time series data from each graph was extracted by four researchers using digital data extraction software. Data extraction errors were analysed. Segmented linear regression models were fitted to the extracted and provided datasets, from which estimates of immediate level and slope change (and associated statistics) were calculated and compared across the datasets.ResultsAlthough there were some data extraction errors of time points, primarily due to complications in the original graphs, they did not translate into important differences in estimates of interruption effects (and associated statistics).ConclusionsUsing digital data extraction to obtain data from ITS graphs should be considered in reviews including ITS. Including these studies in meta-analyses, even with slight inaccuracy, is likely to outweigh the loss of information from non-inclusion.
Health services for Aboriginal and Torres Strait Islander children in remote Australia: a scoping review
Authors: Dossetor PJ , Freeman JM , Thorburn K , Oscar J , Carter M , Jeffery HE , Harley D , Elliott EJ , Martiniuk ALC 
Published: September 2022

AbstractIn Australia, there is a significant gap between health outcomes in Indigenous and non-Indigenous children, which may relate to inequity in health service provision, particularly in remote areas. The aim was to conduct a scoping review to identify publications in the academic and grey literature and describe 1) Existing health services for Indigenous children in remote Australia and service use, 2) Workforce challenges in remote settings, 3) Characteristics of an effective health service, and 4) Models of care and solutions. Electronic databases of medical/health literature were searched (Jan 1990 to May 2021). Grey literature was identified through investigation of websites, including of local, state and national health departments. Identified papers (n=1775) were screened and duplicates removed. Information was extracted and summarised from 116 papers that met review inclusion criteria (70 from electronic medical databases and 45 from the grey literature). This review identified that existing services struggle to meet demand. Barriers to effective child health service delivery in remote Australia include availability of trained staff, limited services, and difficult access. Aboriginal and Community Controlled Health Organisations are effective and should receive increased support including increased training and remuneration for Aboriginal Health Workers. Continuous quality assessment of existing and future programs will improve quality; as will measures that reflect aboriginal ways of knowing and being, that go beyond traditional Key Performance Indicators. Gold standard models for service delivery have community leadership and collaboration. Increased resources with a focus on primary prevention and health promotion are essential.
Fast Adaptation to Rule Switching using Neuronal Surprise
Authors: Barry Martin , Gerstner Wulfram 
Published: September 2022

AbstractIn humans and animals, surprise is a physiological reaction to an unexpected event, but how surprise can be linked to plausible models of neuronal activity is an open problem. We propose a self-supervised spiking neural network model where a surprise signal is extracted from an increase in neural activity after an imbalance of excitation and inhibition. The surprise signal modulates synaptic plasticity via a three-factor learning rule which increases plasticity at moments of surprise. The surprise signal remains small when transitions between sensory events follow a previously learned rule but increases immediately after rule switching. In our model, previously learned rules are protected against overwriting when learning a new rule. Our surprise-modulated spiking network model makes a step towards solving the stability-plasticity dilemma in neuroscience and the problem of continual learning in machine learning.
Behind the scene of body mass allometries
Authors: Witting Lars 
Published: September 2022

AbstractI use data based life history models for 9,488 species of birds and 4,865 species of mammals to illustrate natural selection causes for the evolution of inter-specific body mass allometries. Each model integrates the growth and demography of individuals with the life history energetics and population ecology of the species. I show i) how the primary selection of resource handling and mass-specific metabolism generates the net energy of individuals, ii) how the selected net energy generates a population dynamic feedback selection where intra-specific interactive competition selects body masses that scale in proportion with net energy on the timescale of natural selection, iii) how the primary selection of metabolism selects an allometric curvature where the residual mass-specific metabolism—relative to the expectation of the mass-rescaling allometry—is an initially declining function of mass in terrestrial placentals and birds, but not in marsupials and bats, iv) how the selection of body mass buffers ecological variation in survival, and v) how the joint selection of mass and optimal foraging selects the exponents of body mass allometries from the dominant spatial dimensionality of the foraging ecology.
Kinetic modeling of transaminase values distinguishes active liver inflammation from resolution independent of absolute enzyme levels
Authors: Sherman Marc S , Goessling Wolfram 
Published: September 2022

AbstractThe biomarkers alanine (ALT) and aspartate (AST) aminotransferase serve an indispensable role in the diagnosis and management of liver diseases where patients often have no symptoms until organ function is threatened. Despite 70 years of widespread clinical use, the exact kinetic behavior of AST and ALT during liver injury in humans has never been quantified. Here, we used mathematical modeling to examine the individual trajectories of > 6.5 million AST and ALT levels over time in 91,086 patients with acute liver injury. Candidate mechanistic differential equation models fitted to these trajectories revealed that 40.1% of ALT and 37.5% of AST curves were well-fit by a single-exponential model, indicating a single rate-limiting step governs transaminase decline. The mechanism of this rate-limiting step was found to be transaminase clearance from the blood, rather than ongoing liver injury, highlighting that AST and ALT are lagging biomarkers of liver injury. We use this observation to infer the plasma clearance rate of AST (t1/2=15.8h) and ALT (t1/2=34.6h) in humans, and derive a calculator of real-time liver injury, the Hepatocyte Injury indeX HIX (hix.massgeneral.org) that accounts for lag due to clearance of serum transaminase. We demonstrate that this index distinguishes active from resolved liver injury on histopathology assessment, even when the absolute AST or ALT value remains markedly elevated. These observations sharply refine how transaminase patterns are interpreted in the practical care of patients with acute liver injury.One Sentence SummaryKinetic modeling of >6 million individual AST and ALT values from 91,000 patients enables biomarker half-life estimation and a real-time liver injury assessment.
Malaria; risk factors within urban and rural settings in the Sahelian region of Cameroon and the role of insecticide resistance in mosquitoes
Authors: Ngwa Samuel Fru , Nyasa Raymond Babila , Esemu Seraphine Nkie , Titanji Vincent P. K. 
Published: September 2022

ABSTRACTBackgroundCameroon is among the 11 countries that account for 92 % of malaria infection in sub-Saharan-Africa in 2018, and Maroua III Health District and her environs witnessed a malaria outbreak in 2013 with hundreds of deaths. This study was aimed at understanding the risk factors of malaria in the urban and rural population and to investigate the level of mosquito’s resistance to Deltamethrin and Permethrin.MethodsIt was a cross-sectional community-based study carried out from August to October 2019, in which questionnaires were administered to 500 participants, to obtain information on demographics, socioeconomic, behavioral, and environmental factors thought to be associated with malaria infection in both rural and urban settings. Blood samples were collected for the diagnosis of malaria. Logistic regression analysis was used to identify risk factors for malaria. Mosquito resistance to Deltamethrin and Permethrin were investigated using the CDC Bottle Bioassay test.ResultsMalaria prevalence was 52.2%, which was significantly higher (p = 0.016) in rural areas (57.6%) as compared to urban areas (46.8%). The overall prevalence of asymptomatic malaria parasitemia in the population was 43.4% in contrast to symptomatic malaria which was 8.8%. In rural areas, risk factors were households using treated bed nets older than 3 years (AOR: 2.45 95% CI: 1.30 to 4.61 P-value: 0.006); households whose water source are unprotected wells (AOR: 3.04 95% CI: 1.21 to 7.64 P-value: 0.018). In urban areas, risk factors were households surrounded by farmland with crops (AOR: 2.08 95% CI: 1.14 to 3.80 P-value 0.017) and households using treated bed nets older than 3 years (AOR: 2.70 95% CI: 1.52 to 4.78 P-value 0.001). The age group 2-10years was significantly associated (p<0.001) with malaria in both rural and urban settings of the district. The geometric mean parasite density was found to decrease with increasing age of participants in the entire health district. The overall mortality of Anopheles species was 93.57% (91.19% in rural and 95.83% in urban areas) for deltamethrin, which was more sensitive than 83.85% (85.24% in rural and 82.46% in urban areas) for permethrin.ConclusionRelevant data for malaria control in Maroua III health district, a typical Sahelian environment, has been generated, and indicates that most of the burden of malaria is borne by school children. Deltamethrine was more effective than permethrine in the control of mosquito populations within these areas.