bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exposure to wildfire-related PM2.5 and site-specific cancer mortality in Brazil from 2010 to 2016: A retrospective study
Authors: Yu Pei , Xu Rongbin , Li Shanshan , Yue Xu , Chen Gongbo , Ye Tingting , Coêlho Micheline S. Z. S. , Saldiva Paulo H. N. , Sim Malcolm R. , Abramson Michael J. , Guo Yuming 
Published: September 2022

Background
Long-term exposure to fine particles ≤2.5 μm in diameter (PM2.5) has been linked to cancer mortality. However, the effect of wildfire-related PM2.5 exposure on cancer mortality risk is unknown. This study evaluates the association between wildfire-related PM2.5 and site-specific cancer mortality in Brazil, from 2010 to 2016.

Methods and findings
Nationwide cancer death records were collected during 2010–2016 from the Brazilian Mortality Information System. Death records were linked with municipal-level wildfire- and non-wildfire-related PM2.5 concentrations, at a resolution of 2.0° latitude by 2.5° longitude. We applied a variant difference-in-differences approach with quasi-Poisson regression, adjusting for seasonal temperature and gross domestic product (GDP) per capita. Relative risks (RRs) and 95% confidence intervals (CIs) for the exposure for specific cancer sites were estimated. Attributable fractions and cancer deaths were also calculated. In total, 1,332,526 adult cancer deaths (age ≥ 20 years), from 5,565 Brazilian municipalities, covering 136 million adults were included. The mean annual wildfire-related PM2.5 concentration was 2.38 μg/m3, and the annual non-wildfire-related PM2.5 concentration was 8.20 μg/m3. The RR for mortality from all cancers was 1.02 (95% CI 1.01–1.03, p < 0.001) per 1-μg/m3 increase of wildfire-related PM2.5 concentration, which was higher than the RR per 1-μg/m3 increase of non-wildfire-related PM2.5 (1.01 [95% CI 1.00–1.01], p = 0.007, with p for difference = 0.003). Wildfire-related PM2.5 was associated with mortality from cancers of the nasopharynx (1.10 [95% CI 1.04–1.16], p = 0.002), esophagus (1.05 [95% CI 1.01–1.08], p = 0.012), stomach (1.03 [95% CI 1.01–1.06], p = 0.017), colon/rectum (1.08 [95% CI 1.05–1.11], p < 0.001), larynx (1.06 [95% CI 1.02–1.11], p = 0.003), skin (1.06 [95% CI 1.00–1.12], p = 0.003), breast (1.04 [95% CI 1.01–1.06], p = 0.007), prostate (1.03 [95% CI 1.01–1.06], p = 0.019), and testis (1.10 [95% CI 1.03–1.17], p = 0.002). For all cancers combined, the attributable deaths were 37 per 100,000 population and ranged from 18/100,000 in the Northeast Region of Brazil to 71/100,000 in the Central-West Region. Study limitations included a potential lack of assessment of the joint effects of gaseous pollutants, an inability to capture the migration of residents, and an inability to adjust for some potential confounders.

Conclusions
Exposure to wildfire-related PM2.5 can increase the risks of cancer mortality for many cancer sites, and the effect for wildfire-related PM2.5 was higher than for PM2.5 from non-wildfire sources.
Hospitalizations due to gastrointestinal Chagas disease: National registry
Authors: Bierrenbach Ana Luiza , Quintino Nayara Dornela , Moreira Carlos Henrique Valente , Damasceno Renata Fiúza , Nunes Maria do Carmo Pereira , Baldoni Nayara Ragi , de Oliveira da Silva Lea Campos , Ferreira Ariela Mota , Cardoso Clareci Silva , Haikal Desirée Sant’Ana , Sabino Ester Cerdeira , Ribeiro Antonio Luiz Pinho , Oliveira Claudia Di Lorenzo 
Published: September 2022

Objectives
Analyze the hospitalizations of patients admitted for Chagas disease with gastro-intestinal involvement (CD-GI) in the Brazilian Unified Health System, describe the epidemiological profile, mortality and costs.

Methods
This is an observational study that uses secondary data from the National Hospital Information System (SIH-SUS) for the years 2017–2019. CD-GI admissions were defined by specific ICD-10 codes that identify the main diagnosis.

Results
From 2017 to 2019, there were 4,407 hospitalizations for CD-GI in Brazil, considering only public hospitals and those associated with the SUS. This corresponds to an average of 1,470 hospitalizations per year, or 0.6 per 100,000 inhabitants, with significant regional variation. Hospitalizations increased with age and were slightly higher in men. More than 60% were emergencies and in 50% the procedure performed was surgical. The most used code was the one for megaesophagus followed by megacolon. In-hospital mortality was 5.8% and 17.2% went to intensive care units. The median cost was USD$ 553.15 per hospitalization, and an overall cost of USD$ 812,579.98 per year to the SUS budget.

Conclusion
The numbers, rates and costs presented here are possibly underestimated but they give us an idea of the overall profile of hospitalizations due to CD-GI, which are not rare and are related to significant in-hospital mortality. CD-GI is a neglected manifestation of a neglected disease.
Efficacy and safety of temperature-sensitive acellular dermal matrix in prevention of postoperative adhesion after thyroidectomy: A randomized, multicenter, double-blind, non-inferiority study
Authors: Kim Jin Kyong , Lee Cho Rok , Kang Sang-Wook , Jeong Jong Ju , Nam Kee-Hyun , Cho Sung-Rae , Jo Seongmoon , Kim Eun Young , Yun Ji-Sup , Park Hee Jin , Kim Mi Sung , Kim Kwangsoon , Lee Sohee , Bae Ja Seong , Jun So Yeon , Park Jihye , Kim Jeong Soo 
Published: September 2022

IntroductionMegaShield®is a newly developed temperature-sensitive anti-adhesive containing micronized acellular dermal matrix. The aim of this study was to investigate the efficacy and safety of MegaShield®compared with Guardix-SG®in the prevention of adhesions in patients undergoing bilateral total thyroidectomy.MethodWe conducted a multicenter trial between October 2018 and March 2020 in patients undergoing total thyroidectomy. The patients were randomly assigned to either the MegaShield®group or the Guardix-SG®group. The primary outcome was the esophageal movement using marshmallow six weeks after the surgery and the secondary outcome was the assessed adhesion score. The safety assessment was also evaluated.ResultsThe study included 70 patients each in the MegaShield®and control (Guardix-SG®) groups. Baseline clinical characteristics, the mean score of marshmallow esophagography, and the sum of adhesion scores were not statistically different between the two groups. Inferiority test demonstrated that the efficacy of MegaShield®is not inferior to that of Guardix-SG®. There were no device-related complications in both groups.ConclusionThe efficacy and safety of MegaShield®were not inferior than those of Guardix-SG®. MegaShield®demonstrated the potential of ADM as a potential future anti-adhesive agent.Trial registrationThe name of trial registry CRIS (Clinical Research Information Service)https://cris.nih.go.kr/cris/index.jsp. (The full trial protocol can be accessed) Registration number:KCT0003204.
Relationship between knowledge, attitude, and practice of COVID-19 precautionary measures and the frequency of infection among medical students at an Egyptian University
Authors: Wassif Ghada O. , El Din Dina Ahmed Gamal 
Published: September 2022

Background
Medical undergraduates are at high risk of COVID-19 infection. Thus, conformance to healthy practices is advised to reduce disease transmission and control the current epidemic. The present study aimed to explore the relationship of knowledge, attitude, and practice (KAP) related to COVID-19 precautionary measures with the frequency of infection among medical students at an Egyptian University.

Methods
A comparative cross-sectional study was conducted on 404 undergraduate medical students from different grades using a web-based self-administered anonymous questionnaire.

Results
More than one-third of medical students (37.4%) were previously infected with COVID-19, where the majority (60.5%) were diagnosed with relevant signs and symptoms. Medical students with low levels of KAP experienced higher frequencies of infection than did other students. A statistically significant negative correlation was observed between the number of previous COVID-19 infections among medical students and their knowledge and attitude scores toward COVID-19. In addition, a statistically significant positive correlation was noted among KAP scores (P < 0.01).

Conclusion
Improving the knowledge, attitude, and conformance of medical students to precautionary measures toward COVID-19 may substantially reduce the risk and frequency of infection and, hence, reduce community transmission.
Understanding factors influencing uptake and sustainable use of the PINCER intervention at scale: A qualitative evaluation using Normalisation Process Theory
Authors: Laing Libby , Salema Nde-eshimuni , Jeffries Mark , Shamsuddin Azwa , Sheikh Aziz , Chuter Antony , Waring Justin , Avery Anthony , Keers Richard N. 
Published: September 2022

Introduction
Medication errors are an important cause of morbidity and mortality. The pharmacist-led IT-based intervention to reduce clinically important medication errors (PINCER) has demonstrated improvements in primary care medication safety, and whilst now the subject of national roll-out its optimal and sustainable use across health contexts has not been fully explored. As part of a qualitative evaluation we aimed to identify factors influencing successful adoption, embedding and sustainable use of PINCER across primary care settings in England, UK.

Methods
Semi-structured face-to-face or telephone interviews, including follow-up interviews and an online survey were conducted with professionals knowledgeable of PINCER. Interview recruitment targeted four early adopter regions; the survey was distributed nationally. Initial data analysis was inductive, followed by analysis using a coding framework. A deductive matrix approach was taken to map the framework to the Normalisation Process Theory (NPT). Themes were then identified.

Results
Fifty participants were interviewed, 18 participated in a follow-up interview. Eighty-one general practices and three Clinical Commissioning Groups completed the survey. Four themes were identified and interpreted within the relevant NPT construct: Awareness & Perceptions (Coherence), Receptivity to PINCER (Cognitive Participation), Engagement [Collective Action] and Reflections & Adaptations (Reflexive Monitoring). Variability was identified in how PINCER awareness was raised and how staff worked to operationalise the intervention. Facilitators for use included stakeholder investment, favourable evidence, inclusion in policy, incentives, fit with individual and organisational goals and positive experiences. Barriers included lack of understanding, capacity concerns, operational difficulties and the impact of COVID-19. System changes such as adding alerts on clinical systems were indicative of embedding and continued use.

Conclusions
The NPT helped understand motives behind engagement and the barriers and facilitators towards sustainable use. Optimising troubleshooting support and encouraging establishments to adopt an inclusive approach to intervention adoption and utilisation could help accelerate uptake and help establish ongoing sustainable use.
Is there a place for a molecular diagnostic test for pelvic inflammatory disease in primary care? An exploratory qualitative study
Authors: Bittleston Helen , Hocking Jane S. , Goller Jane L. , Coombe Jacqueline , Bateson Deborah , Sweeney Sally , Fleming Kirsteen , Huston Wilhelmina M. 
Published: September 2022

IntroductionThere is currently no test for pelvic inflammatory disease (PID) that is non-invasive and sufficiently sensitive and specific. Clinicians must therefore diagnose PID clinically, ruling out medical emergencies and conducting pelvic examinations where possible. While guidelines state that clinicians should be prepared to over-diagnose PID, it remains an under-diagnosed condition, with severe reproductive health impacts when left untreated. This research is the first to consider the perspectives of end-users on the development of a diagnostic test for PID.MethodsSemi-structured live video feed online (Zoom) interviews were conducted with 11 clinicians and nine women (aged 18–30 years) in Australia to understand how a diagnostic test might be used, and what characteristics a test would need for it to be acceptable to clinicians and young women. Participants were recruited via researcher and university student networks. Reflexive thematic analysis was used to identify key themes relating to the acceptability and characteristics of a diagnostic test for PID.ResultsSeven general practitioners, four clinicians working in sexual health clinics, and nine young women (aged 21–27 years) were interviewed. Clinicians were aged between 31–58 years and were predominantly female. Clinicians recognised that the development of an accurate test to diagnose PID would be valuable to themselves and other clinicians, particularly those who lack experience diagnosing PID, and those working in certain settings, including emergency departments. They discussed how they might use a test to enhance their clinical assessment but highlighted that it would not replace clinical judgement. Clinicians also considered how a test would impact the patient experience and time to treatment, emphasising that it should be minimally invasive and have a quick turnaround time. Young women said a test would be acceptable if endorsed by a trustworthy clinician.ConclusionsPID remains a challenging diagnosis. Development of a minimally invasive and sufficiently accurate diagnostic test would be acceptable to young women and benefit some clinicians, although no test would completely replace an experienced clinician’s judgement in making a PID diagnosis.
Why maternal continuum of care remains low in Northwest Ethiopia? A multilevel logistic regression analysis
Authors: Hailemariam Tesfahun , Atnafu Asmamaw , Gezie Lemma Derseh , Tilahun Binyam 
Published: September 2022

Background
Non-adherence to the maternal continuum of care remains a significant challenge. Though early initiation and continuum of care are recommended for mothers’ and newborns’ well-being, there is a paucity of evidence that clarify this condition in resource-limited settings. This study aimed to assess the level of women’s completion of the maternal continuum of care and factors affecting it in Northwest Ethiopia.

Methods
A community-based cross-sectional study was conducted from October to November, 2020. Data were collected from 811 women who had a recent history of birth within the past one year. The random and fixed effects were reported using an adjusted odds ratio with a 95% confidence interval. The p-value of 0.05 was used to declare significantly associated factors with women’s completion of the maternal continuum of care.

Results
The study revealed that 6.9% (95%CI: 5.3–8.9%) of women were retained fully on the continuum of maternal care, while 7.89% of women did not receive any care from the existing healthcare system. Attending secondary and above education (AOR = 3.15; 95%CI: 1.25,7.89), membership in the women’s development army (AOR = 2.91; 95%CI: 1.56,5.44); being insured (AOR = 2.59; 95%CI: 1.33,5.01); getting health education (AOR = 2.44; 95%CI: 1.33,4.45); short distance to health facility (AOR = 4.81; 95%CI: 1.55,14.95); and mass-media exposure (AOR = 2.39; 95%CI: 1.11,5.15) were significantly associated with maternal continuum of care.

Conclusions
The maternal continuum of care is low in rural northwest Ethiopia compared to findings from most resource-limited settings. Therefore, the existing health system should consider multilevel intervention strategies that focus on providing maternal health education, facilitating insurance mechanisms, encouraging women’s participation in health clubs, and ensuring physical accessibility to healthcare facilities to be more effective in improving maternal health services.
Preventive health resource allocation decision-making processes and the use of economic evidence in an Australian state government—A mixed methods study
Authors: Ananthapavan Jaithri , Sacks Gary , Moodie Marj , Nguyen Phuong , Carter Rob 
Published: September 2022

Context
Recommended best practice for resource allocation decisions by governments include a stepwise process guided by economic evidence. However, the use of economic evidence in preventive health decision-making, which often impacts on multiple sectors of government, is under-researched. This study aimed to explore the resource allocation decision-making processes for preventive health interventions in the New South Wales (NSW) Government in Australia, and specifically examined the barriers and facilitators to the use of economic evidence from the perspective of multiple government departments.

Methods
This mixed methods study was conducted using semi-structured interviews with NSW Treasury representatives (n = 4), a focus group of NSW Ministry of Health representatives (n = 9), and a quantitative questionnaire of all participants. The schedule for the interviews and focus group was based on resource allocation guidance documents from Australian government agencies. Deductive content analysis was undertaken, guided by the Multiple Streams Framework.

Findings
NSW Treasury participants believed that decision-making processes where economic efficiency was the key guiding principle was the ideal approach. However, the NSW Ministry of Health participants identified that for preventive health decision-making, economic evidence was not used to inform their own choices but was typically only used to convince other agencies of the merits of proposed initiatives when seeking approval. The key barriers to the use of economic evidence were the lack of capacity within the NSW Ministry of Health to understand and undertake economic evaluations; a lack of collaboration between NSW Treasury and preventive health decision-makers within the NSW Ministry of Health; and deficient processes and governance mechanisms that do not facilitate or incentivise effective inter-sectoral decision-making.

Conclusions
Institutional structures for resource allocation decision-making regarding preventive health result in processes that contrast with best practice recommendations. The multiple challenges to collaborative decision-making across agencies require organisational change to promote a whole-of-government approach.
Anticipating need for intensive care in the healthcare trajectory of patients with chronic disease: A qualitative study among specialists
Authors: Taha Alicia , Jacquier Marine , Meunier-Beillard Nicolas , Ecarnot Fiona , Andreu Pascal , Roudaut Jean-Baptiste , Labruyère Marie , Rigaud Jean-Philippe , Quenot Jean-Pierre 
Published: September 2022

Introduction
We investigated the reflections and perceptions of non-ICU physicians about anticipating the need for ICU admission in case of acute decompensation in patients with chronic disease.

Methods
We performed a qualitative multicentre study using semi-structured interviews among non-ICU specialist physicians. The interview guide, developed in advance, focused on 3 questions: (1) What is your perception of ICU care? (2) How do you think advance directives can be integrated into the patient’s healthcare goals? and (3) How can the possibility of a need for ICU admission be integrated into the patient’s healthcare goals? Interviews were recorded, transcribed and analysed by thematic analysis. Interviews were performed until theoretical saturation was reached.

Results
In total, 16 physicians (8 women, 8 men) were interviewed. The main themes related to intensive care being viewed as a distinct specialty, dispensing very technical care, and with major human and ethical challenges, especially regarding end-of-life issues. The participants also mentioned the difficulty in anticipating an acute decompensation, and the choices that might have to be made in such situations. The timing of discussions about potential decompensation of the patient, the medical culture and the presence of advance directives are issues that arise when attempting to anticipate the question of ICU admission in the patient’s healthcare goals or wishes.

Conclusion
This study describes the perceptions that physicians treating patients with chronic disease have of intensive care, notably that it is a distinct and technical specialty that presents challenging medical and ethical situations. Our study also opens perspectives for actions that could promote a pluridisciplinary approach to anticipating acute decompensation and ICU requirements in patients with chronic disease.
Digital Editing and “Experience [. . .] looked upon as a kind of text”
Authors: Ohge Christopher 
Published: September 2022

This provocation argues for a form of digital creative-critical editing to serve as a pragmatic complement to the dominant “depth” models of traditional scholarly editing. What results is a pan-relational praxis of editing that focuses on connecting edited texts to new contexts and literary experiences with new tools, instead of using a depth model to offer the correct description, representation, or data model of those texts. Creative textual criticism could then be considered ongoing and incomplete, partaking of an iterative process of close reading and distant analysis, and redescriptions of textual criticism that are embedded in the creative process and other aesthetic experiences. These ideas are demonstrated in three brief exhibitions of Thomas Hardy, Herman Melville, and the abolitionist Mary Anne Rawson, all of whom are loosely connected to Arthur Schopenhauer, who once posited in Counsels and Maxims that “Experience of the world may be looked upon as a kind of text, to which reflection and knowledge form the commentary”. Such “commentary” inspires a new mode of pan-relational “reflection” and networked discourse which can only be implemented with digital technologies. What digital editing can do, then, is to give space to competing and alternative discourses and processes of the same text and to connect that text to other aesthetic contexts.
Clinical comprehensive and experimental assessment of the radioprotective effect of Annona muricata leaf extract to prevent cellular damage in the ileum tissue
Authors: Elmas Ozlem , Sahin Havva Hande Keser , Keskin Emrah , Guven Berrak , Uslu Erdemir Rabiye , ALMisned Ghada , Zakaly Hesham M. H. , Ene Antoaneta , Tekin Huseyin Ozan 
Published: September 2022

Abstract
We report the radioprotective attitude of Annona muricata (AM) leaf extract as antioxidant material to prevent cellular damage in the ileum tissue. The protective effects of an ethyl acetate extract of AM leaves are comprehensively investigated against radiation-induced ileal damage in numerous rats. Thirty-two adult female rats were separated into 4 groups (3 intervention groups and 1 control) as follows: controls received 0.01 mL/kg distilled water, the AM group received 300 mg/kg AM leaf extract, the ionizing radiation (IR) group received a single dose of whole body radiation (8.3 Gy) after 0.01 mL/kg saline treatment, and the AM + IR group received 300 mg/kg AM leaf extract treatment and were subjected to whole body radiation (8.3 Gy) 1 h after the last gavage. All treatments are administered by oral gavage once a day for 9 days. At the end of the experiment, biochemical total oxidant status (TOS, interleukin-6, and caspase) and histological examinations are performed on blood samples as well as ileum tissue. TOS levels are found to be significantly high in rats, which received irradiation, and those in the AM group when compared to controls. These findings suggest that AM has radioprotective effects on ileum tissue, likely because of its antioxidative properties. The findings of this research may contribute to the minimizing of major side effects induced by excessive radiation exposure in patients undergoing radiotherapy and may serve as a significant impetus for further assessments. However, future studies are highly recommended to confirm safety and to determine extraction technique and dosage before human use can be considered.