bluuebunny/crossref_metadata_2025_split huggingface dataset:
Upregulated keratin 15 links to the occurrence of lymphovascular invasion, stromal cervical invasion as well as unfavorable survival profile in endometrial cancer patients
Authors: Yang Hongxiang , Li Aijing , Li Aili , Zhao Fei , Zhang Tongyan 
Published: July 2022

Keratin 15 (KRT15) overexpression links with tumor initiation, metastasis, and poor survival in several solid carcinomas. While its clinical relevance is scarcely reported in endometrial cancer (EC). Therefore, the current study aimed to investigate the abnormal expression of KRT15 and its correlation with clinical characteristics, survival in EC patients.
Totally, 135 surgical EC patients were enrolled. KRT15 protein expression in formalin-fixed and paraffin-embedded tumor and adjuvant tissues was detected by immunohistochemical staining; meanwhile, KRT15 mRNA expression in fresh-frozen tumor and adjacent tissues was detected by reverse transcription-quantitative polymerase chain reaction.
KRT15 protein and mRNA expressions were higher in tumor tissue compared with adjacent tissue (both P < .001). Elevated KRT15 protein expression was correlated with the occurrence of lymphovascular invasion (P = .010) and more advanced International Federation of Gynecology and Obstetrics stage (P = .018); meanwhile, elevated KRT15 mRNA expression was linked with more advanced International Federation of Gynecology and Obstetrics stage (P = .038) and marginally associated with the occurrence of stromal cervical invasion (P = .052). Besides, KRT15 protein and mRNA expressions were not correlated with other clinical features (all P > .05). KRT15 protein high was marginally correlated with poor accumulating disease-free survival (DFS) (P = .091) and overall survival (OS) (P = .059); meanwhile, the correlation of KRT15 mRNA expression with accumulating DFS (P = .212) and OS (P = .092) was even weaker. However, multivariate Cox’s regressions showed that tumor KRT15 protein (high vs low) was independently correlated with poor DFS (P = .045) and OS (P = .043).
KRT15 is abnormally increased in EC tissue, meanwhile, its upregulation links to the occurrence of lymphovascular invasion, stromal cervical invasion, and poor prognosis in EC patients.
Aortic calcification is associated with coronary artery calcification and is a potential surrogate marker for ischemic heart disease risk: A cross-sectional study
Authors: Hata Yoshiki , Mochizuki Junji , Okamoto Shuichi , Matsumi Hiroaki , Hashimoto Katsushi 
Published: July 2022

Coronary artery calcification, an established marker of atherosclerotic plaque burden associated with increased risk of coronary artery disease, is routinely evaluated using electron beam computerized tomography or multidetector computed tomography (CT). However, aortic calcification, which is also a risk factor for adverse cardiac events, is not frequently assessed, despite being easily detected via standard chest radiography. We therefore sought to clarify the association between aortic calcification and significant coronary artery calcification to determine the feasibility of performing chest radiography to evaluate the risk of future cardiovascular events.
Data from 682 consecutive patients who underwent cardiac CT scanning at our institution from May to September 2012 were included in this cross-sectional analysis. Electrocardiographic-gated CT was used to qualitatively evaluate calcification in 6 aortic segments. Cardiac contrast-ehnanced CT was performed to identify significant calcification of the coronary artery. Calcification was quantified by calculating the Agatston score, and the relationship between significant coronary artery calcification and calcification at each aortic site was evaluated.
Among the aortic sites, calcification was most commonly observed in the aortic arch (77.4% of patients). Significant coronary artery calcification was observed in 267 patients (39.1%). Calcification in the ascending aorta, aortic arch, descending aorta, abdominal aorta, and aortic valve were significantly associated with the presence of coronary artery calcification after adjustment for cardiovascular risk factors and statin use (odds ratios [95% confidence intervals] 4.21 [2.55, 6.93], 1.65 [1.01, 2.69], 2.14 [1.36, 3.36], 2.87 [1.83, 4.50], and 3.32 [2.02, 5.46], respectively). Mitral valve calcification was weakly but nonsignificantly associated with coronary artery calcification (odds ratio 1.84 [95% confidence interval 0.94, 3.62]). Calcification of each aortic segment assessed was significantly associated with Agatston score ≥ 100.
Aortic calcification was associated with coronary artery calcification. Calcification of the aortic arch, which can be readily detected by routine chest radiography, may be associated with coronary artery calcification and its assessment should therefore be considered to identify patients at increased risk of cardiovascular events. Further studies are warranted to confirm these findings.
Mendelian randomization study indicates lack of causal associations between iron status and lung cancer
Authors: Qin Hong , Zeng Weibiao , Lou Yongfu 
Published: July 2022

Observational studies provided conflicting results on the association between iron status and the risk of lung cancer. The aim of our study was to investigate the effect of genetically determined iron status on lung cancer risk using a mendelian randomization (MR) approach.
Single-nucleotide polymorphisms for iron status were selected from a genome-wide meta-analysis of 48,972 subjects. Genetic association estimates for risk of lung cancer were derived from a Genome-Wide Association Study (GWAS) summary performed by the International Lung Cancer Consortium. The inverse-variance weighted method was used for the main analyses and sensitivity analyses.
MR analysis demonstrated that increased genetically-predicted iron status did not causally increase risk of lung cancer. The odds ratios were 1.11 (95% CI, 0.92, 1.34; P = .26), 0.76 (95% CI, 0.52, 1.12; P = .17), 1.09 (95% CI, 0.86, 1.38; P = .47), and 0.91 (95% CI, 0.81, 1.02; P = .11) per 1 standard deviation increment of serum iron, ferritin, transferrin saturation, and transferrin levels, respectively. No observed indication of heterogeneity (P for Q > 0.05) or pleiotropy (P for intercept > 0.05) were found from the sensitivity analysis.
The MR study indicated that genetic iron status was not causally associated with the risk of lung cancer, the causal relationship between iron status and lung cancer needs to be further elucidated by additional studies that strictly control for confounding factors.
Learning to Lead: 3 Models to Support Public Health Leadership Development
Authors: Brandert Kathleen , Alperin Melissa , Lloyd Laura M. , Rose Barbara , Bekemeier Betty , Rogers Megan , Grimm Brandon 
Published: July 2022

Context:
The current public health system is underresourced and understaffed, which has been exacerbated by the coronavirus pandemic. In addition, there has been a decline in the public health workforce at both state and local levels during the last decade. While workforce numbers dwindle, public health systems have to address increasingly complex challenges—such as climate change, chronic diseases, and health equity—challenges that require skilled, adaptive leaders. This article describes the importance of leadership development and how 3 public health training centers (PHTCs) are building leadership skills in the public health workforce.

Program:
To address the need for public health leadership training, the PHTCs in the Health & Human Services (HHS) Regions 4, 7, and 10 all offer public health leadership institutes (PHLIs).

Implementation:
The 3 PHLIs discussed in this article vary in longevity (3-18 years), cohort length (8-12 months), and format (virtual, in-person, and hybrid); yet, all 3 emphasize adaptive leadership through a health equity lens and intentional opportunities to apply skills in practice.

Evaluation:
Each PHLI conducts extensive evaluation based on Kirkpatrick's levels of evaluation and collects common metrics collected by all PHTCs. Data from the PHLIs illustrate high levels of satisfaction with learning, presentation of data, identification of workplace actions, and improvement of subject matter understanding. Each PHLI also has numerous stories of impact.

Discussion:
With public health leaders leaving the workforce and the complexities of practice increasing, leadership training is critical to the current workforce and succession planning. These PHTCs provide a significant, enduring resource toward the development of our nation's public health leaders, as well as meeting the unique needs of their regions' workforces.
Training Public Health Professionals on Adaptive Challenges—An Innovative Approach Using Remote Learning Modalities
Authors: Scallan Walter Elaine J. , Mousavi Christine T. , Elnicki Jill , Davis Sarah 
Published: July 2022

Context:
Remote learning opportunities increase access to public health training. Innovative approaches are needed to promote active engagement and learning when tackling more complex, adaptive challenges that are nuanced, lack quick and easy solutions, and require a transformation of values and beliefs.

Program:
The Rocky Mountain Public Health Training Center's (RM-PHTC's) training framework considers the complexity of the challenge (technical to adaptive) when selecting the learning modality. Remote learning opportunities on adaptive challenges are addressed using virtual workshops, online courses, ECHO (Extension for Community Healthcare Outcomes) series, and communities of practice that include a combination of multiple sessions, cohort-based learning, peer learning, practice-based application, and live, interactive sessions. The specific modality chosen depends on the audience and amount of content delivery.

Implementation:
Virtual workshops are single events that encourage peer learning using a blend of instruction and practice-based work. Online courses deliver content to learning cohorts through an online platform combined with multiple, facilitated “live learning sessions.” ECHO series include a short delivery of content, combined with multiple, facilitated, face-to-face, case-based learning sessions with a cohort of peers. Communities of practice encourage a bidirectional peer exchange of resources, approaches, and challenges through online sharing platforms and virtual meetings.

Evaluation:
Using the Kirkpatrick training evaluation model, learners of public health reported that their understanding of the subject matter improved and that they had identified actions that they would apply to their work. In qualitative feedback, learners shared feedback on elements that facilitated learning on adaptive challenges, including interactive breakout groups with peers and practice-based applications.

Discussion:
Remote learning opportunities increase access for public health professionals in rural areas and encourage knowledge exchange region-wide. The RM-PHTC's training framework matches learning opportunities that address adaptive challenges with modalities that include elements that encourage the sharing of ideas and cocreation of solutions.
Creating a Vision for a Healthier Workforce Using a Systems-Based Approach
Authors: Walkner Laurie , May Kathleen , Goldman Bailey , Shultz Hannah , Armbruster Sonja , Grimm Brandon , Hawley Suzanne , Menke Abigail , Orr Shirley , Wilson Kristin , Moody Jeneane , Uden-Holman Tanya , Ginn Kaci 
Published: July 2022

Context:
The public health system faces unprecedented challenges due to the pandemic, racism, health inequity, and the politicization of public health. At all levels of the system, the workforce is experiencing distress, burnout, safety issues, and attrition. Public health is being challenged to demonstrate and justify its impact and value, while also leveraging opportunities for learning and system strengthening.

Program:
To explore the current state and identify opportunities to strengthen the public health system, the Region 7 Midwestern Public Health Training Center (MPHTC), with support from Engaging Inquiry, embarked on a distinctive type of systems analysis, called “dynamic systems mapping.”

Implementation:
This approach brought together diverse sectors of public health partners in the region to develop a rich contextual narrative and system-level understanding to highlight and align existing and emergent strengths, areas for growth, and tangible goals for the immediate- and long-term sustainability of local and regional health.

Evaluation:
Focus groups and workshops were conducted with diverse practitioners to identify upstream causes and downstream effects of 11 key forces driving system behavior. These focus groups resulted in the development of a visual map that MPHTC is utilizing to identify opportunities for leverage, develop strategies to maximize the potential impact of these leverage points, as well as facilitate continuous learning.

Discussion:
Public health utilization of systems mapping is a valuable approach to strengthening local and national system responses to current and future public health needs. Outcomes and lessons learned from the systems mapping process are discussed.
Public Health Training Centers' Support for Community Health Workers: Case Studies of Needs Assessment, Training, and Student Field Placement Initiatives
Authors: Lederer Alyssa M. , Barrett Karla Todd , Shorter Charles , Kenefick Hope W. , Kulik Phoebe K. G. , Morales Marcia , Reinschmidt Kerstin M. , Shrestha Sweta 
Published: July 2022

Context:
Community health workers (CHWs) are vital frontline public health workers. Given their trusted roles and connection to and understanding of the communities they serve, CHWs are able to link underserved communities to resources and public health agencies. With CHWs' increased prominence in the public health workforce, calls have been made for expanding and supporting CHW training and career development opportunities.

Program:
Public health training centers (PHTCs) are mandated to assess public health workforce needs, provide evidence-based professional development trainings, and increase students' aptitude for working with underserved and underresourced communities through applied practice experiences. Public health training centers can support CHWs in each of these areas.

Design:
Case studies from 3 PHTCs are provided to exemplify how PHTCs are well positioned to support the critical CHW workforce via assessment, training, and student field placements.

Implementation:
A regional needs assessment survey with a designated section for CHWs, the provision of accessible and relevant CHW training, and CHW-focused student field placements were implemented in PHTC Regions 6/South Central, 1/New England, and 5/Great Lakes, respectively.

Evaluation:
The Region 6 needs assessment found that CHWs in Oklahoma had multiple core roles and training interests. A crosswalk of needs and available training in the region guided the creation of tailored CHW trainings. Across 35 CHW-targeted trainings in Region 1, 88.5% of trainees were satisfied with the trainings and identified actions they could take to apply information they learned to their work. Significant improvements (P < .001) in knowledge occurred across the 13 trainings that had pre-/posttests. In Region 5, students engaged with CHW-based organizations in Wisconsin to inform statewide CHW priority action items and deliverables and found the field placements meaningful for their academic experience.

Discussion:
Public health training centers' strengths in workforce development can complement and extend existing efforts to support the CHW workforce.
“Hot Topics in Practice” Webinars: Best Practices for Public Health Webinar Development
Authors: Bekemeier Betty , Rogers Megan H. , Rose Barbara A. , Manchanda Sarah , Andersen Katherine O. 
Published: July 2022

Context:
Online education is well researched in some professions; yet, little evidence exists regarding related quality standards for public health practice—particularly with regard to popular webinar offerings. Our objective was to identify and disseminate best practices in public health webinar development for use in development of high-quality, timely webinars for public health practice.

Program:
We assessed data from the Hot Topics in Practice monthly webinar series that included public health professionals primarily from US Northwest states as regular webinar participants.

Implementation:
We conducted a secondary analysis, using participant evaluation data from 9 years of online questionnaires. Subsequent recommendations were developed using participants' responses to postwebinar questionnaires. Thematic analysis of qualitative quarterly reports, as well as 12 years of webinar production team knowledge, supplemented development of best practice recommendations that were not recognized through secondary analysis of respondent questionnaires alone.

Evaluation:
Participant responses tended to be positive when specific practices were followed. These best practices were identified as follows: Address timely topics on current events; Feature only 1 to 2 speakers; Use a limited number of consistently formatted slides; Stay on schedule and make time for audience questions; Minimize technical difficulties; Use effective storytelling to share lessons and key data; Intentionally foster audience engagement (eg, through audience polling, question and answer); Develop clear learning objectives; Provide appropriate resources for continued learning; and Consider audience feedback for continuous improvements.

Discussion:
Our team identified essential elements for creating high-quality, engaging webinars for public health learning. Best practice recommendations resulting from this study address gaps in quality standards and provide knowledge needed for making effective learning accessible to public health practice and supportive of advancing the field. Findings were synthesized into a practice guide, And We're Live: Creating Engaging Public Health Webinars, to aid public health learning.
Engaging Youth in Public Health: Evaluation of Short-term and Long-term Participation in the PATCH Youth Advocacy Fellowship
Authors: Aeschbach Chelsea J. , Kusch Mary M. , Olejniczak Amy B. , Koepsel Erica R. 
Published: July 2022

Context:
Authentic youth engagement is widely recognized as an efficacious strategy to promote adolescent health.

Program:
The Providers and Teens Communicating for Health (PATCH) Youth Advocacy Fellowship was created to support Wisconsin's Adolescent Health Program. It strives to bring youth voice to the forefront of adolescent health conversations while also providing young people the knowledge, skills, and opportunities to thrive into adulthood.

Implementation:
The Fellowship hires and trains Wisconsin youth, aged 12 to 21 years, to be a part of community- and state-based adolescent health conversations. Youth meet regularly as a team for ongoing enrichment and are provided opportunities to consult on adolescent-focused projects and initiatives. They are also responsible for independently completing an advocacy learning series, which culminates in an advocacy plan on a topic of personal interest. The Fellowship has been implemented as an extended 9-month program, as well as an expedited 8-week pilot.

Evaluation:
An evaluation was conducted to compare the 8-week pilot (summer 2018) with 51 youth and the sequential 9-month Fellowship (2018-2019) with 12 youth. Based on the quantitative analysis of 2 programmatic evaluations (posttraining and postprogram), both program models showed success. Yet, there were distinct differences among self-reported youth outcomes as well as depth and extent of engagement. Across all 14 domains, the 9-month cohort demonstrated consistently higher mean scores. Half of the domains (7) showed statistically significant differences.

Discussion:
When considering youth engagement, it is important for practitioners to determine the goals, needs, capacity, and resources of both youth and the organization. Engaging youth for shorter-term commitments may serve as an important health education strategy, providing youth important knowledge and skills. Yet, engaging youth for extended periods of time may result in more meaningful engagement, fruitful projects, and substantial changes in positive youth development.
Using Healthy People as a Tool to Identify Health Disparities and Advance Health Equity
Authors: Hoyer Deborah , Dee Elizabeth 
Published: July 2022

Background:
As research into the health of different segments of the American population continues to advance, data show inequalities in health outcomes depending on a variety of characteristics, including income and education levels, gender identity, race and ethnicity, and disability status. The Healthy People initiative explores how specific population groups perform for 10-year objectives, including the Leading Health Indicators, which are a broad set of metrics that track issues from health behaviors to determinants of one's health.

Findings:
The data show that, when it comes to health, the playing field for all Americans is not even. At the close of Healthy People 2020, an assessment of the Healthy People 2020 Leading Health Indicators showed that threats to the health of every American vary dependent on who they are, where and how they live, and the community they were born into.

Discussion:
Healthy People 2030 places an emphasis on continued research into these health indicators to uncover how different these realities are for different population groups and to inform and guide effective health policies and interventions in the years ahead.
How Do We Define and Measure Health Equity? The State of Current Practice and Tools to Advance Health Equity
Authors: Hoyer Deborah , Dee Elizabeth , O'Leary Meghan S. , Heffernan Megan , Gelfand Katherine , Kappel Rachel , Fromknecht Catharine Q. 
Published: July 2022

Introduction:
Healthy People establishes national goals and specific measurable objectives to improve the health and well-being of the nation. An overarching goal of Healthy People 2030 is to “eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all.” To inform Healthy People 2030 health equity and health disparities content and products, the US Department of Health and Human Services (HHS) Office of Disease Prevention and Health Promotion (ODPHP), in collaboration with NORC at the University of Chicago, conducted a review of peer-reviewed and gray literature to examine how health equity is defined, conceptualized, and measured by public health professionals.

Methods:
We reviewed (1) peer-reviewed literature, (2) HHS and other public health organization Web sites, and (3) state and territorial health department plans. We also conducted targeted searches of the gray literature to identify tools and recommendations for measuring health equity.

Results:
While definitions of health equity identified in the scan varied, they often addressed similar concepts, including “highest level of health for all people,” “opportunity for all,” and “absence of disparities.” Measuring health equity is challenging; however, strategies to measure and track progress toward health equity have emerged. There are a range of tools and resources that have the potential to help decision makers address health equity, such as health impact assessments, community health improvement plans, and adapting a Health in All Policies approach. Tools that visualize health equity data also support data-driven decision making.

Discussion:
Using similar language when discussing health equity will help align and advance efforts to improve health and well-being for all. Healthy People objectives, measures, and targets can help public health professionals advance health equity in their work. HHS ODPHP continues to develop Healthy People tools and resources to support public health professionals as they work with cross-sector partners to achieve health equity.