bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of a Novel Large Language Model (LLM) Powered Chatbot for Oral-Boards Scenarios
Authors: Silvestri Caitlin , Roshal Joshua , Shah Meghal , Widmann Warren D. , Townsend Courtney , Brian Riley , L’Huillier Joseph C. , Navarro Sergio M. , Lund Sarah , Sathe Tejas S.
Published: June 2024

Introduction

While previous studies have demonstrated that generative artificial intelligence (AI) can pass medical licensing exams, AI’s role as an examiner in complex, interactive assessments remains unknown. AI-powered chatbots could serve as educational tools to simulate oral examination dialogues. Here, we present initial validity evidence for an AI-powered chatbot designed for general surgery residents to prepare for the American Board of Surgery (ABS) Certifying Exam (CE).

Methods

We developed a chatbot using GPT-4 to simulate oral board scenarios. Scenarios were completed by general surgery residents from six different institutions. Two experienced surgeons evaluated the chatbot across five domains: inappropriate content, missing content, likelihood of harm, extent of harm, and hallucinations. We measured inter-rater reliability to determine evaluation consistency.

Results

Seventeen residents completed a total of 20 scenarios. Commonly tested topics included small bowel obstruction (30%), diverticulitis (20%), and breast disease (15%). Based on two independent reviewers, evaluation revealed 11 to 25% of chatbot simulations had no errors and an additional 11% to 35% contained errors of minimal clinical significance. Chatbot limitations included incorrect management advice and critical omissions of information.

Conclusions

This study demonstrates the potential of an AI-powered chatbot in enhancing surgical education through oral board simulations. Despite challenges in accuracy and safety, the chatbot offers a novel approach to medical education, underscoring the need for further refinement and standardized evaluation frameworks. Incorporating domain-specific knowledge and expert insights is crucial for improving the efficacy of AI tools in medical education.
Listener effort quantifies clinically meaningful progression of dysarthria in people living with amyotrophic lateral sclerosis
Authors: Bingham Indu Navar , Norel Raquel , Roitberg Esteban G. , Peller Julián , Trevisan Marcos A , Agurto Carla , Shalom Diego E. , Aguirre Felipe , Embon Iair , Taitz Alan , Harris Donna , Wright Amy , Seaver Katie , Sullivan Stacey , Green Jordan R. , Ostrow Lyle W. , Fraenkel Ernest , Berry James D.
Published: June 2024

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative motor neuron disease that causes progressive muscle weakness. Progressive bulbar dysfunction causes dysarthria and thus social isolation, reducing quality of life. The Everything ALS Speech Study obtained longitudinal clinical information and speech recordings from 292 participants. In a subset of 120 participants, we measured speaking rate (SR) and listener effort (LE), a measure of dysarthria severity rated by speech pathologists from recordings. LE intra- and inter-rater reliability was very high (ICC 0.88 to 0.92). LE correlated with other measures of dysarthria at baseline. LE changed over time in participants with ALS (slope 0.77 pts/month; p<0.001) but not controls (slope 0.005 pts/month; p=0.807). The slope of LE progression was similar in all participants with ALS who had bulbar dysfunction at baseline, regardless of ALS site of onset. LE could be a remotely collected clinically meaningful clinical outcome assessment for ALS clinical trials.
Lung water density is increased in patients at risk of heart failure and is largely independent of conventional CMR measures
Authors: Iyer Nithin R. , Bryant Jennifer A. , Le Thu-Thao , Grenier Justin G. , Thompson Richard B. , Chin Calvin W-L. , Ugander Martin
Published: June 2024

Aims

Non-invasive methods to quantify pulmonary congestion are lacking in clinical practice. Cardiovascular magnetic resonance (CMR) lung water density (LWD) mapping is accurate, reproducible, and has prognostic value. However, it is not known whether LWD is associated with routinely acquired CMR parameters.

Methods and Results

This was a prospective, observational cohort including healthy controls and patients at risk of heart failure. Lung water density was measured using CMR with a free-breathing short echo time 3D cartesian gradient-echo sequence with a respiratory navigator at 1.5T. Associations were assessed between LWD, lung water volume (LWV) and cardiac volumes, left ventricular (LV) mass and function, myocardial native T1 and extracellular volume fraction (ECV). In patients at risk for heart failure (n=155), LWD was greater than in healthy controls (n=15) (30.4±5.0 vs 27.2±4.3%, p=0.02). Using receiver operating characteristic analysis, the optimal cut-off for LWD was 27.6% to detect at-risk patients (sensitivity 72%, specificity 73%, positive likelihood ratio 2.7, inverse negative likelihood ratio 2.6). LWD was univariably associated with body mass index (BMI), hypertension, right atrial (RA) area and LV mass (p<0.05 for all). In multivariable linear regression, only BMI remained associated with LWD (R2=0.32, p<0.001). In a separate multivariable analysis including only CMR markers, only RA area remained associated with LWD (R2=0.05, p=0.006).

Conclusion

LWD is increased in patients at risk for heart failure compared to controls, and is only weakly explained by conventional CMR measures. LWD provides diagnostic information which is largely independent of conventional CMR measures.
The Transition from adolescence to adulthood mental health services for young people with ADHD in Italy
Authors: Roberti E. , Clavenna A. , Basso E. , Bravaccio C. , Riccio M. P. , Pincherle M. , Duca M. , Giordani C. , Scarpellini F. , Campi R. , Giardino M. , Zanetti M. , Tessarollo V. , Costantino I. ,   TransiDEA Group, Bonati M.
Published: June 2024

Aims

Ensuring a successful transition to Adult Mental Health Services (AMHS) is fundamental for ADHD patients to prevent adverse scenarios in adults (e.g., psychiatric disorders, substance or alcohol abuse). Yet, most European nations do not have appropriate transition guidelines. This study aims to enquire about the current transition paths in Italy and the perceived experiences of the patients and their clinicians.

Methods

The present qualitative, observational study collected 36 interviews with young adults with ADHD who turned 18 between 2017 and 2021. Simultaneously, two questionnaires were filled in by the clinicians (both from pediatric and adult mental health services) who were involved in their transition paths. These tools collected information about the transition process, the services that cared for the young adults, and well-being indicators such as impairment in daily life, employment status, and the presence of sentinel events (e.g., critical stage accesses to the emergency room or hospitalizations). Successful and failed referrals were analyzed.

Results

A referral to an AMHS was attempted for sixteen young adults (8 before age 18 and 8 when turning 18), and 8 patients (22.2% overall) were successfully taken into the care of the AMHS. Twenty patients were not referred since it was deemed unnecessary (N=6) or because of the lack of specialized services or compliance (N=14). At the time of the interview, only nine participants were still under AMHS care. Of eleven individuals with a high need for care (identified by the level of impairment, support needs, or sentinel events), five were not followed by a mental health professional at the time of the interview.

Conclusions

For the majority of ADHD young adults, a transition path was never started or completed. While this is partly due to mild levels of impairment, in many cases it was difficult to find a service that could care for the adult patient. Only 1 out of 4 young adults are successfully transferred to AMHS care. Creating or improving evidence-based transition guidelines should be a priority of the public health system to ensure healthcare for as many patients as possible. The results of this study will converge towards the need for recommendations for the transition of services from adolescence to adulthood for young people with ADHD for Italian clinical practice.
A scoping review of the format, content, effectiveness and acceptability of reproductive life planning tools
Authors: Stewart C , Noh H , Pathak N , Hall JA
Published: June 2024

Introduction

A Reproductive Life Plan (RLP) is a set of questions that encourage patients to reflect on their reproductive goals and the actions needed to achieve them. This scoping review of the published and grey literature aims to map the evidence on currently available RLPs.

Methods

We searched four databases (Medline, Embase, PsycINFO and Scopus) and used Google to search the grey literature, the search terms were; “reproductive life plan$” OR “reproductive plans$” OR “pregnancy intention screening”. Data were extracted on target audience, format, content, behaviour change theory, features, effectiveness and acceptability.

Results

44 published papers and 18 grey literature sources were included. 21 RLPs were discussed in the published papers and 17 in the grey literature. Most RLPs came from the USA. Most RLPs in published papers were asked verbally, while all RLPs in the grey literature were self-completed; there were six digital RLPs. Most ask whether an individual wants children, some then ask about number and timing of children, and contraception. Grey literature RLPs also asked about lifestyle and health.

Discussion

The concept of developing an RLP is acceptable to people of reproductive age and healthcare professionals. There was a lot of consistency in the questions asked, however, there is limited data on effectiveness and only three tools, all digital, incorporated behaviour change theory.

Conclusion

A digital RLP that builds on the evidence for existing tools and integrates appropriate theory could result in the realisation of the potential that RLPs are theorised to deliver.
Assessing Excess Mortality Patterns in Argentina over the COVID-19 Pandemic (2020-2021): A Comprehensive National and Subnational Analysis
Authors: Pennini Velen , Santoro Adrian , Esteban Santiago , Volij Camila , Rubistein Adolfo
Published: June 2024

The COVID-19 pandemic has dramatically impacted global health metrics, with the World Health Organization (WHO) reporting over 732 million cases and 6.7 million deaths by the end of 2021. Additionally, approximately 14.8 million excess deaths were estimated globally through 2022, significantly surpassing reported COVID-19 deaths. In Argentina, recorded pandemic-related fatalities reached nearly 160,000 from March 2020 to December 2022, underlining the necessity for a detailed examination of excess mortality across national and subnational levels.

This study aims to describe excess mortality in Argentina in 2020 and 2021 and its subnational geographic areas, and to identify geographic and temporal disparities across sub-regionsusing publicly available monthly mortality and climate data from Argentina, spanning 2015 to 2021. Excess mortality was assessed using Generalized Additive Models (GAM) to account for long-term and annual trends, monthly climatic variations, and epidemiological reports of Influenza-like Illness (ILI). Data across various geographic regions was analyzed to identify temporal and spatial disparities in mortality.

Our analyses revealed significant regional disparities in mortality, identifying a total of 133,612 excess deaths across Argentina during the study period, with notable peaks coinciding with COVID-19 waves. These insights not only contribute to our understanding of the pandemic’s broader effects but also emphasize the critical need for enhanced public health responses informed by mortality data analyses. The development of an open-source, interactive platform further supports this initiative, enabling detailed exploration and informed decision-making to better manage future public health crises.
Costs of home-delivered antiretroviral therapy refills for persons living with HIV: evidence from a pilot randomized controlled trial in KwaZulu-Natal, South Africa
Authors: Tseng Ashley S. , Barnabas Ruanne V. , van Heerden Alastair , Ntinga Xolani , Sahu Maitreyi
Published: June 2024

Antiretroviral therapy (ART) is needed across the lifetime to maintain viral suppression for people living with HIV. In South Africa, obstacles to reliable access to ART persist and are magnified in rural areas, where HIV services are also typically costlier to deliver. A recent pilot randomized study (the Deliver Health Study) found that home-delivered ART refills, provided at a low user fee, effectively overcame logistical barriers to access and improved clinical outcomes in rural South Africa. In the present costing study using the payer perspective, we conducted retrospective activity-based micro-costing of home-delivered ART within the Deliver Health Study and when provided at-scale (in a rural setting), and compared to facility-based costs using provincial expenditure data (covering both rural and urban settings). Within the context of the pilot Deliver Health Study which had an average of three deliveries per day for three days a week, home-delivered ART cost (in 2022 USD) $794 in the first year and $714 for subsequent years per client after subtracting client fees, compared with $167 per client in provincial clinic-based care. We estimated that home-delivered ART can reasonably be scaled up to 12 home deliveries per day for five days per week in the rural setting. When delivered at scale, home-delivered ART cost $267 in the first year and $183 for subsequent years per client. Average costs of home delivery further decreased when increasing the duration of refills from three-months to six- and 12-month scripts (from $183 to $177 and $135 per client, respectively). Personnel costs were the largest cost for home-delivered refills while ART drug costs were the largest cost of clinic-based refills. When provided at scale, home-delivered ART in a rural setting not only offers clinical benefits for a hard-to-reach population but is also comparable in cost to the provincial standard of care.
Characterising People who inject drugs, and association with HIV infection: A Situation Analysis in Kampala city, Uganda
Authors: Mudiope Peter , Mathers Bradley , Nangendo Joanita , Samuel Mutyaba , Mutamba Byamah Brian , Alamo Stella , Nanyenya Nicholus , Makumbi Fredrick , Laker-Oketta Miriam , Wanyenze Rhoda
Published: June 2024

Background

Uganda has implemented targeted interventions to address the rising burden of injection drug use, yet barriers persist in reaching persons who inject drugs (PWID). This study describes the characteristics of people who inject drugs, physical and mental health states, and associated risk behaviors, to inform the designing of programs that are tailored to client’s needs and preferences.

Methods

A cross-sectional survey was conducted between August and December 2023 at selected hotspots in Kampala, interviewing 499 PWID aged ≥18 years. Data was collected using a semi-structured questionnaire administered by peer educators and Uganda Harm Reduction Network (UHRN) counselors. Measurements included socio-demographics, injecting drug use and sexual risk behaviors, and medical history. HIV serostatus was dtermined by self-report and testing for participants who had no recent history of testing and consented to be tested. Binary logistic regression was used to establish the relationship between HIV infection and risky drug- and sexual behaviors of PWID.

Results

Participants were predominantly Ugandan (95.2%), male (73.2%), unmarried (55.9%), unemployed (81.8%), with higher levels of education and varying ages. Mental disorders were prevalent, with 48.7% reporting at least one underlying condition, including depression (30.8%) and anxiety (9.6%). Physical health issues were also noted, with reported cases of fever (32.9%), cough (32.5%), malaria (22%) and sexually transmitted infections (STIs) (15%).

Regarding drug use patterns, the majority (82.6%) were introduced to drugs by close acquaintances, with 70.9% categorized as people who inject drugs. HIV prevalence among injecting drug users was 3.7%, with higher rates among females (8.4%) and non-Ugandans (16.7%). Being female and experiencing difficulty accessing sterile injection materials were associated with HIV-positive status, highlighting the complex interplay between socio-demographic factors, risk behaviors, and HIV infection among individuals with injecting drug use Disorder in Uganda.

Conclusion

Our study provides a comprehensive insight into the socio-demographic, mental, physical health, and HIV risk behavoir of PWID in Kampala, Uganda. The findings indicate significant vulnerabilities to injecting drug use, mental disorders, and high-risk behaviors that predispose this population to HIV infection. Despite a low HIV prevalence compared to previous estimates, the interplay between drug use, risky injecting practices, and sexual behaviors suggests an urgent need for targeted interventions to address these intertwined challenges.
Dispositional Goal Orientation and Perceptions of Coach Motivational Climate on Attitudes towards Doping among Kenyan Endurance Runners
Authors: Kipchumba Kevin K. , Rintaugu Elijah G. , Mwangi Francis M. , Gathoni Benson
Published: June 2024

Changing athletes’ attitudes towards doping has been shown as crucial in prevention efforts in combating doping in sports, with dispositional goal orientation and perceptions of coach motivational climate identified as factors shaping doping attitudes among athletes. The purpose of this study was to examine the relationships between dispositional goal orientation and motivational climate attitudes towards doping among Kenyan Endurance runners. A cross-sectional survey design was used to collect data from 323 Kenyan runners with 215 males (66.6%) and 108 females (33.3%). The study assessed athletes’ goal orientation through the Task and Ego Goal Orientation Sport Questionnaire, perceptions of coach motivational climate through Perceived Motivational Climate in Sport Questionnaire, and attitudes towards doping through Performance Enhancement Attitude Scale. Descriptive statistics, correlation analysis, Mann-Whitney U tests and Kruskall-Wallis H tests was used for data analysis. The study found significant inverse relationships between mastery climate and doping attitudes (rho = -.242; p < .001), as well as between task orientation and doping attitudes (rho = -.158; p < .004). Conversely, performance climate (rho = .362; p < .001) and ego orientation (rho = .362; p < .001) showed significant positive relationships with doping attitudes. There were no significant differences in doping attitudes based on age (U = 11582.500, p <.191), gender (U = 11437.500, p <.827) and athlete’s length of experience (χ2 (2) = 1.359, p < .507). The study concludes that fostering mastery-oriented coach motivational climate and promoting task-oriented goal orientation could effectively cultivate anti-doping attitudes among athletes and enhance clean sport.
Within-host dynamics of antiviral treatment for SARS-CoV-2 infection
Authors: Schuh Lea , Markov Peter V. , Voulgaridi Ioanna , Bogogiannidou Zacharoula , Mouchtouri Varvara A. , Hadjichristodoulou Christos , Stilianakis Nikolaos I.
Published: June 2024

The effectiveness of antiviral treatment with remdesivir against COVID-19 has been investigated in clinical trials suggesting earlier recovery. However, this effect seems to be rather modest. In this study, we assessed the clinical course of SARS-CoV-2 infections in 369 COVID-19 individuals across a spectrum of illness severities, including both untreated individuals and individuals who received antiviral treatment with remdesivir. Moreover, using a process-based mathematical model, we quantified and analyzed the within-host infection dynamics of 69 untreated and 19 antiviral-treated individuals. For untreated individuals, we found that those hospitalized exhibit significantly lower levels of early immune response and higher cumulative viral loads than those who were not. For treated individuals, we found that those who died were on average hospitalized later after symptom onset than those who survived, underscoring the importance of early medical intervention for severe COVID-19. Our model estimates a rather limited antiviral activity of remdesivir and, consequently, comparable viral load dynamics between individuals responding and not responding to antiviral treatment. Our results provide valuable insights into the clinical course of COVID-19 during antiviral treatment with remdesivir and suggest the need for alternative treatment regimens.
Characterizing preserved autonomic regulation following spinal cord injury: Methods of a novel concerted testing battery and illustrative examples of a new translationally focused data representation
Authors: Solinsky Ryan , Burns Kathryn , Hamner Jason W. , Singer Wolfgang , Taylor J. Andrew
Published: June 2024

Autonomic dysfunction is common after spinal cord injury, though differing from motor and sensory function, there are currently no established batteries of tests to comprehensively characterize these deficits. Further, while individual established autonomic tests have a long history and sound scientific background, translating these autonomic testing results to inform clinical understanding is a major barrier. Herein, we outline a battery of six laboratory autonomic tests which were carefully curated to collectively describe the ability of individuals with spinal cord injury to inhibit and recruit sympathetic activity through the injured spinal cord. Presenting normative control data in 23 uninjured individuals completing this testing battery, we further demonstrate the utility of extracting three key testing metrics for each test, comparing these control results to 11 individuals with spinal cord injury. Results demonstrate strong normality of data with testing psychometrics suggesting reliable reproducibility on repeat testing. Further, even in this preliminary sample of individuals with spinal cord injuries, clear differences begin to emerge. This illustrates the ability of this collective testing battery to characterize autonomic regulation after spinal cord injury. To aid in clinical translation, we further present a graphical representation, anautonomic phenotype, which serves as a snapshot of how normal or abnormal sympathetic inhibition and recruitment of activation may be after spinal cord injury. Utilizing theseautonomic phenotypes, three example cases of individuals with spinal cord injury highlight evidence of varied degrees of autonomically complete spinal cord injury. Together, this represents a key advancement in our understanding of autonomic function after spinal cord injury.
Effects of spinal stimulation and short-burst treadmill training on gait biomechanics in children with cerebral palsy
Authors: DeVol Charlotte R. , Shrivastav Siddhi R. , Landrum Victoria M. , Bjornson Kristie F. , Roge Desiree , Moritz Chet T. , Steele Katherine M.
Published: June 2024

Background

Children with cerebral palsy (CP) have an injury to the central nervous system around the time of birth that affects the development of the brain and spinal cord. This injury leads to changes in gait neuromechanics, including muscle activity and joint kinematics. Transcutaneous spinal cord stimulation (tSCS) is a novel neuromodulation technique that may improve movement and coordination in children with CP when paired with targeted physical therapy.

Research question

How does the combination of tSCS and short-burst interval locomotor treadmill training (SBLTT) affect individual gait neuromechanics in children with CP?

Methods

Four children with CP (4-13 years old), received 24 sessions each of SBLTT only and SBLTT with tSCS (tSCS+SBLTT). Clinical assessments of spasticity and passive range of motion (PROM), as well as biomechanical assessments of joint kinematics, musculotendon lengths, and muscle activity were recorded during overground, barefoot walking. Assessments were taken before and after each intervention, and 8-weeks later.

Results

The combination of tSCS+SBLTT led to greater increases in hip and knee extension than SBLTT only for three participants. Three children also became more plantarflexed at the ankle during stance after tSCS+SBLTT compared to SBLTT only. While tSCS+SBLTT reduced spasticity, these changes were only weakly correlated with changes in musculotendon lengths during gait or PROM, with the largest correlation between change in gastrocnemius operating musculotendon length during fast walking and gastrocnemius spasticity (R2= 0.26) and change in plantarflexor PROM and gastrocnemius spasticity (R2= 0.23).

Significance

Children with CP used a more upright, less crouched posture during gait after tSCS+SBLTT. Large reductions in spasticity after tSCS+SBLTT were only weakly correlated with changes in kinematics and PROM. Understanding the mechanisms by which tSCS may affect gait for children with CP is critical to optimize and inform the use of tSCS for clinical care.
Clinical Adherence to Concussion Practice Guidelines
Authors: Pelo Ryan , Godfrey Jonathan , Dibble Leland E.
Published: June 2024

Objective

This study aimed to assess common barriers to adherence to the Physical Therapy Concussion/Mild Traumatic Brain Injury Clinical Practice Guidelines (PTCPG) and design an action plan to address these barriers.

Setting

Single University Health System

Participants

Electronic medical record (EMR) data were collected over an initial 6-month period and then a follow-up 6-month period after the interventions. The initial period yielded an average of 129 patients with a concussion diagnosis, and the follow-up period yielded an average of 331 patients.

Design

Through the knowledge-to-action framework, it was identified that providers were often unaware of current practice guidelines, and some had a low comfort level with the diagnosis. Subsequent action items to address these barriers included education sessions, modification of a concussion documentation template to better align with PTCPG recommendations, and the design of a pop-up within the electronic medical records that allowed providers to create a referral to a concussion treatment network.

Main Measures

Frequency calculations were performed based on whether the outcome measure was performed at any time during a concussion episode of care. Selection of outcome measures was determined by what outcome measures were available for use within the EMR and aligned with the PTCPG recommended system domains. Data was collected from the following providers: physical therapists, occupational therapists, sports medicine physicians and physical medicine & rehab physicians.

Results

From the initial EMR query to the follow-up, the following increases in use of outcome measures were seen with each outcome measure, Post-Concussion Symptom Scale (PCSS) = 10.0%, Cervical & Thoracic Screen = 6.0%, Vestibular Ocular Motor Screen (VOMS) = 12.6%, Modified Orthostatic Vital Signs (MOVS) = 18.9%, Buffalo Concussion Treadmill Test (BCTT) = 3.5%, Balance Error Scoring System (BESS) = -4.8%, Sensory Organization Test (SOT) = 0.9%.

Conclusion

The improvement in adherence to recommendations was attributed to a knowledge to action approach that combined education along with structural changes to electronic medical record documentation.
The Impact of AI on Scientific Literature: A Surge in AI-Associated Words in Academic and Biomedical Writing
Authors: Masukume Gwinyai
Published: June 2024

Introduction

The debut of ChatGPT on 30 November 2022, marked a new era in artificial intelligence (AI) innovation, ushering transformative progress in science and research efficiency. Yet, AI’s exact influence on scientific and biomedical literature remains unclear. Words like “delve”, “realm” and “underscore” are linked with AI chatbots rather than human authors, potentially signalling AI utilisation.

Methods

An extensive search of the electronic databases PubMed and Scopus was conducted, spanning from their inception to 28 May 2024, covering a period of 175 years from 1849 to 2024. The search identified occurrences of the words “delve”, “realm” and “underscore” individually and in various combinations within the scientific literature.

Results

Between 1849 and 2024, the simultaneous occurrence of “delve”, “realm” and “underscore” was observed exclusively during 2023 and 2024. Notably, in 2023 and 2024, “delve” and “underscore”, appeared together in 1,284 out of 1,299 (98.8%) PubMed articles (p-value = 0.0002) and 546 out of 566 (96.5%) Scopus articles (p-value= 0.0006) where they were used since 1849. The co-usage of these words increased by up to 85-fold in 2023 and 2024 compared to 2022 and prior years.

Additionally, among articles since 1849, in 2023 and 2024, “delve” appeared in 7,714 out of 17,537 (44.0%) PubMed and 6,360 out of 13,707 (46.4%) Scopus articles, “realm” in 3,825 out of 16,288 (23.5%) PubMed and 16,360 out of 82,714 (19.8%) Scopus articles, and “underscore” in 27,653 out of 95,606 (28.9%) PubMed and 39,154 out of 111,803 (35.0%) Scopus articles.

Conclusion

The analysis reveals a surge in the use of “delve”, “realm” and “underscore”—words presently associated with AI chatbots—during 2023 and 2024, highlighting the growing influence of AI chatbots like ChatGPT, introduced in November 2022, on academic writing. This trend highlights the increasing integration of AI-generated text in scientific articles, prompting further exploration into broader implications on research practices and scholarly communication.
Comparison of tobacco index versus smoking status in the prevalence of elevated blood pressure levels
Authors: Vera-Ponce Víctor Juan , Zuzunaga-Montoya Fiorella E. , Maria Valladolid-Sandoval Lupita Ana , Milagros Vásquez-Romero Luisa Erika , Loayza-Castro Joan A. , Chenet Stella M. , Tejada Felix Llanos
Published: June 2024

Introduction

Smoking is a well-established risk factor for hypertension (HTN) and high blood pressure (HBP); however, there are controversies regarding whether it is merely the act of smoking that increases the risk of HTN or if it is the quantity of tobacco consumed that influences it.

Objective

To determine the relationship between different smoking statuses and the tobacco index (GTI) with the presence of HBP and HTN in the Peruvian population.

Methods

An analytical cross-sectional study based on data obtained from Peru’s Demographic and Family Health Survey (ENDES) from 2014-2022. The primary variable in this study is blood pressure level, which was classified into normotension, HBP, and HTN. Smoking status was categorized into smoker status (never, ex, current, daily smoker), daily smoker (yes versus no), and the GTI.

Results

Overall, daily smokers showed a higher prevalence of HTN, while those with a TI ≥ 20 showed a higher prevalence of both HBP and HTN. Significant discrepancies were observed regarding sex and the presence of these diseases, although GTI remained a consistent associated factor.

Conclusions

The tobacco index is highlighted as a more reliable indicator of the risk associated with smoking compared to simply categorizing individuals as smokers or non-smokers. This index, which quantifies both the frequency and duration of smoking habits, has proven to be a robust factor in the prevalence of these pathologies.
Deep neural networks detect regional wall motion abnormalities and preclinical cardiovascular disease from 12-lead ECGs
Authors: Carbonati Tanner , Eslami Parastou , Waks Jonathan W. , Fiorina Laurent , Chaudhari Ashish , Henry Christine , Johnson Alistair E.W. , Pollard Tom , Gow Brian , Mark Roger G. , Horng Steven , Greenbaum Nathaniel R.
Published: June 2024

Background

Identifying regional wall motion abnormalities (RWMAs) is critical for diagnosing and risk stratifying patients with cardiovascular disease, particularly ischemic heart disease. We hypothesized that a deep neural network could accurately identify patients with regional wall motion abnormalities from a readily available standard 12-lead electrocardiogram (ECG).

Methods

This observational, retrospective study included patients who were treated at Beth Israel Deaconess Medical Center and had an ECG and echocardiogram performed within 14 days of each other between 2008 and 2019. We trained a convolutional neural network to detect the presence of RWMAs, qualitative global right ventricular (RV) hypokinesis, and varying degrees of left ventricular dysfunction (left ventricular ejection fraction [LVEF] ≤50%, LVEF ≤40%, and LVEF ≤35%) identified by echocardiography, using ECG data alone. Patients were randomly split into development (80%) and test sets (20%). Model performance was assessed using area under the receiver operating characteristic curve (AUC). Cox proportional hazard models adjusted for age and sex were performed to estimate the risk of future acute coronary events.

Results

The development set consisted of 19,837 patients (mean age 66.7±16.4; 46.7% female) and the test set comprised of 4,953 patients (mean age 67.5±15.8 years; 46.5% female). On the test dataset, the model accurately identified the presence of RWMA, RV hypokinesis, LVEF ≤50%, LVEF ≤40%, and LVEF ≤35% with AUCs of 0.87 (95% CI 0.858-0.882), 0.888 (95% CI 0.878-0.899), 0.923 (95% CI 0.914-0.933), 0.93 (95% CI 0.921-0.939), and 0.876 (95% CI 0.858-0.896), respectively. Among patients with normal biventricular function at the time of the index ECG, those classified as having RMWA by the model were 3 times the risk (age- and sex-adjusted hazard ratio, 2.8; 95% CI 1.9-3.9) for future acute coronary events compared to those classified as negative.

Conclusions

We demonstrate that a deep neural network can help identify regional wall motion abnormalities and reduced LV function from a 12-lead ECG and could potentially be used as a screening tool for triaging patients who need either initial or repeat echocardiographic imaging.
Medical Costs, Health Care Utilization, and Productivity Losses Associated With Hypertension by COVID-19 Among US Commercial Enrollees
Authors: Lee Jun Soo , Zhang Yidan (Xue) , Wang Yu , Park Joohyun , Kumar Ashutosh , Donald Bruce , Luo Feijun , Roy Kakoli
Published: June 2024

Background

Hypertension is a major risk factor for cardiovascular and renal diseases, significantly contributing to morbidity and mortality. The COVID-19 pandemic has heightened concerns about the impact of hypertension on severe COVID-19 outcomes.

Methods

We conducted a cross-sectional analysis using the 2021 MarketScan Commercial and Health and Productivity Management databases. The study included adults aged 18-64 with continuous employer-sponsored private insurance, excluding those with pregnancy or capitated plans. We compared excess total medical costs, healthcare utilization (including the number of emergency department visits, inpatient admissions, outpatient visits, and outpatient prescription drugs), and productivity losses and related costs due to sick absences, short-term disability (STD), and long-term disability (LTD) between individuals with and without hypertension, further stratified by COVID-19 diagnosis. Multivariate regression models adjusted for demographics and comorbidities were used to estimate the differences in outcomes.

Results

Among 1,612,398 adults aged 18-64 years, 13% had hypertension in 2021. Those with hypertension were older, were less likely to be female or live in urban areas, and exhibited a higher prevalence of comorbidities. The total excess medical costs associated with hypertension were $8723 per patient (95% CI, $8352-$9093), which was significantly higher by $6117 (95% CI, $4780-$7453) among individuals diagnosed with COVID-19. Persons with hypertension had higher health care utilization, including a higher number of ED visits (0.21 per patient; 95% CI, 0.21-0.22), inpatient admissions (0.11; 95% CI, 0.10-0.12), outpatient visits (5.42; 95% CI, 5.36-5.49), and outpatient prescription drugs (10.85; 95% CI, 10.75-10.94). Moreover, they experienced a greater number of sick absences (1.22 days; 95% CI, 1.07-1.36) and STD occurrences (3.68 days; 95% CI, 3.38-3.98) per patient compared to those without hypertension. These trends were further exacerbated among individuals diagnosed with COVID-19.

Conclusions

Hypertension markedly increases medical costs, healthcare utilization, and productivity losses, which are further exacerbated by COVID-19. These findings highlight the substantial economic burden of managing hypertension in the context of the COVID-19 pandemic and underscore the importance of targeted interventions.
The Impact of Conventional Stroke Risk Factors on Early and Late Onset Ischemic Stroke: a Mendelian Randomization Study
Authors: Nguyen Kevin TK , Xu Huichun , Gaynor Brady , Adebamowo Sally N. , McArdle Patrick F. , O’Connor Tim , Worrall Bradford , Malik Rainer , Boncoraglio Giorgio B. , Zand Ramin , Kittner Steven J. , Mitchell Braxton D.
Published: June 2024

Objective

Although stroke incidence is decreasing in older ages, it is increasing in young adults. While these divergent trends in stroke incidence are at least partially attributable to diverging prevalence trends in stoke risk factors, age-dependent differences in the impact of stroke risk factors on stroke may also contribute. To address this issue, we utilized Mendelian Randomization (MR) to assess differences in the association of stroke risk factors between early onset ischemic stroke (EOS) and late onset ischemic stroke (LOS).

Methods

We employed a two-sample MR design with inverse variance weighting as the primary method of analysis. Using large publicly available genome-wide association summary results, we calculated MR estimates for conventional stroke risk factors (body mass index, total, HDL-and LDL-cholesterol, triglycerides, type 2 diabetes, systolic and diastolic blood pressure, and smoking) in EOS cases (onset 18-59 years, n = 6,728) and controls from the Early Onset Stroke Consortium and in LOS cases (onset ≥ 60 years, n = 9,272) and controls from the Stroke Genetics Network. We then compared odds ratios between EOS and LOS, stratified by TOAST subtypes, to determine if any differences observed between effect sizes could be attributed to differences in the distribution of stroke subtypes.

Results

EOS was significantly associated with all risk factors except for total cholesterol levels, and LOS was associated with all risk factors except for triglyceride and total cholesterol levels. The associations of BMI, DBP, SBP, and HDL-cholesterol were significantly stronger in EOS than LOS (all p < 0.004). The differential distribution of stroke subtypes could not explain the difference in effect size observed between EOS and LOS.

Conclusion

These results suggest that interventions targeted at lowering body mass index and blood pressure may be particularly important for reducing stroke risk in young adults.
Extracellular rRNA profiling reveals the sinking and cell lysis dynamics of marine microeukaryotes
Authors: Endo Hisashi , Yamagishi Yuki , Nguyen Thi Tuyen , Ogata Hiroyuki
Published: June 2024

Marine plankton communities consist of numerous species, and their composition and physiological states are closely linked to ecosystem functions. Understanding biogeochemical cycles requires measuring taxon-specific mortality due to viral lysis or sloppy feeding, as the dissolved organic matter released contributes to rapid nutrient recycling and long-term carbon sequestration following microbial transformation. This study introduces a quantitative and comprehensive analysis of microeukaryotes in the dissolved constituents of seawater by using Mortality by Ribosomal Sequencing (MoRS) method. Our experimental pipeline successfully recovered 83% of cell-free rRNA. The ratio of cell-free rRNA to cell-associated rRNA was more than 10-fold higher in the mesopelagic layer than in the upper epipelagic layer, suggesting the mesopelagic zone as a hotspot for eukaryotic cell lysis. Many protist lineages, including phytoplankton such as haptophytes, are less susceptible to cell lysis in the epipelagic layer yet are actively lysed in the mesopelagic zone. Notably, over 86% of the significantly lysed species in the mesopelagic layer showed a habitat preference for the epipelagic layer. These findings indicate that sinking from the surface and lysis in the mesopelagic are prevalent dynamics for various eukaryotes.
Using N2pc variability to probe functionality: Linear mixed modelling of trial EEG and behaviour
Authors: Hickey Clayton , Grignolio Damiano , Munasinghe Vinura , Acunzo David
Published: June 2024

This paper has two concurrent goals. On one hand, we hope it will serve as a simple primer in the use of linear mixed modelling (LMM) for inferential statistical analysis of multimodal data. We describe how LMM can be easily adopted for the identification of trial-wise relationships between disparate measures and provide a brief cookbook for assessing the suitability of LMM in your analyses. On the other hand, this paper is an empirical report, probing how trial-wise variance in the N2pc, and specifically its sub-component the NT, can be predicted by manual reaction time (RT) and stimuli parameters. Extant work has identified a link between N2pc and RT that has been interpreted as evidence of a direct and causative relationship. However, results have left open the less-interesting possibility that the measures covary as a function of motivation or arousal. Using LMM, we demonstrate that the relationship only emerges when the NTis elicited by targets, not distractors, suggesting a discrete and functional relationship. In other analyses, we find that the target-elicited NTis sensitive to variance in distractor identity even when the distractor cannot itself elicit consistently lateralized brain activity. The NTthus appears closely linked to attentional target processing, supporting the propagation of target-related information to response preparation and execution. At the same time, we find that this component is sensitive to distractor interference, which leaves open the possibility that NTreflects brain activity responsible for the suppression of irrelevant distractor information.
Evidence for direct control of neurovascular function by circulating platelets in healthy older adults
Authors: Rossetti Gabriella M.K. , Dunster Joanne L. , Sohail Aamir , Williams Brendan , Cox Kiera M. , Rawlings Suzannah , Jewett Elysia , Benford Eleanor , Lovegrove Julie A. , Gibbins Jonathan M. , Christakou Anastasia
Published: June 2024

Platelets play a vital role in preventing haemorrhage through haemostasis, but complications arise when platelets become overly reactive, leading to pathophysiology such as athero-thrombosis. Elevated haemostatic markers are linked to dementia and predict its onset in long-term studies. Despite epidemiological evidence, the mechanism linking haemostasis with early brain pathophysiology remains unclear. Here, we aimed to determine whether a mechanistic association exists between platelet function and neurovascular function in 52 healthy mid- to older-age adults. To do this we combined, for the first time, magnetic resonance imaging (MRI) of neurovascular function, peripheral vascular physiology, and in vitro platelet assaying. We show a direct association between platelet reactivity and neurovascular function that is both independent of vascular reactivity and mechanistically specific: Distinct platelet signalling mechanisms (Adenosine 5’-diphosphate, Collagen-Related Peptide, Thrombin Receptor Activator Peptide 6) were directly associated with different physiological components of the haemodynamic response to neural (visual) stimulation (full-width half-maximum, time to peak, area under the curve), an association that was not mediated by peripheral vascular effects. This finding challenges the previous belief that systemic vascular health determines the vascular component of neurovascular function, highlighting a specific link between circulating platelets and the neurovascular unit. Since altered neurovascular function marks the initial stages of neurodegenerative pathophysiology, understanding this novel association becomes now imperative, with the potential to lead to a significant advancement in our comprehension of early dementia pathophysiology.

Key points summary

Haemostasis (platelet function) has been linked to the early stages of dementia, but the precise mechanisms are not well understood.

This study asks whether a causal mechanism exists through athero-thrombotic effects on the vasculature which can in turn affect brain health, or through direct platelet effects on brain physiology.

Here we show that elevated platelet reactivity is associated with blunted (delayed, shorter, and smaller) blood flow responses to neural activation in healthy middle-aged and older adults.

However, the association between platelet reactivity and neurovascular function was not mediated by systemic vascular reactivity.

This finding challenges the previous belief that systemic vascular health determines the vascular component of neurovascular function, highlighting a specific link between circulating platelets and the neurovascular unit in early dementia pathophysiology.
Neural correlates of device-based sleep characteristics in adolescents
Authors: Ma Qing , Sahakian Barbara J , Zhang Bei , Li Zeyu , Yu Jin-Tai , Li Fei , Feng Jianfeng , Cheng Wei
Published: June 2024

Understanding the brain mechanisms underlying objective sleep patterns in adolescents and their implications for psychophysiological development is a complex challenge. Here, we applied sparse canonical correlation (sCCA) analysis on 3300 adolescents from Adolescent Brain Cognitive Development (ABCD) study, integrating extensive device-based sleep characteristics and multimodal imaging data. We revealed two sleep-brain dimensions: one characterized by later being asleep and shorter duration, linked to decreased subcortical-cortical network functional connectivities; the other showed higher heart rate and shorter light sleep duration, associated with lower brain volumes and decreased functional connectivities. Hierarchical clustering based on brain dimension associated with sleep characteristics revealed three biotypes of adolescents, marked by unique sleep profiles: biotype 1 exhibited delayed and shorter sleep, coupled with higher heart rate during sleep; biotype 3 with earlier and longer sleep, accompanied by lower heart rate; and biotype 2 with intermediate pattern. This biotypic differences also extended to cognition, academic attainment, brain structure and function in a gradient order. Longitudinal analysis demonstrated consistent biotypic differences from ages 9 to14, highlighting enduring cognitive and academic advantages in biotype3. The linked sleep-brain dimensions and the associated biotypes were well replicated in a longitudinal sample of 1271 individuals. Collectively, our novel findings delineate a linkage between objective sleep characteristics and developing brain in adolescents, underscoring their significance in cognitive development and academic attainment, which could serve as references for individuals with sleep difficulties and offer insights for optimizing sleep routines to enhance better cognitive development and school achievement.