bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early prediction of mortality upon intensive care unit admission
Authors: Yeh Yu-Chang , Kuo Yu-Ting , Kuo Kuang-Cheng , Cheng Yi-Wei , Liu Ding-Shan , Lai Feipei , Kuo Lu-Cheng , Lee Tai-Ju , Chan Wing-Sum , Chiu Ching-Tang , Tsai Ming-Tao , Chao Anne , Chou Nai-Kuan , Yu Chong-Jen , Ku Shih-Chi 
Published: December 2024

Abstract
Background
We aimed to develop and validate models for predicting intensive care unit (ICU) mortality of critically ill adult patients as early as upon ICU admission.

Methods
Combined data of 79,657 admissions from two teaching hospitals’ ICU databases were used to train and validate the machine learning models to predict ICU mortality upon ICU admission and at 24 h after ICU admission by using logistic regression, gradient boosted trees (GBT), and deep learning algorithms.

Results
In the testing dataset for the admission models, the ICU mortality rate was 7%, and 38.4% of patients were discharged alive or dead within 1 day of ICU admission. The area under the receiver operating characteristic curve (0.856, 95% CI 0.845–0.867) and area under the precision-recall curve (0.331, 95% CI 0.323–0.339) were the highest for the admission GBT model. The ICU mortality rate was 17.4% in the 24-hour testing dataset, and the performance was the highest for the 24-hour GBT model.

Conclusion
The ADM models can provide crucial information on ICU mortality as early as upon ICU admission. 24 H models can be used to improve the prediction of ICU mortality for patients discharged more than 1 day after ICU admission.
Psychological distress, suicidality and resilience of Lithuanian nurses
Authors: Kavaliauskas Povilas , Kazlauskas Evaldas , Smailyte Giedre 
Published: December 2024

Abstract
Background
Nurses, like other healthcare workers, are prone to poorer mental health, increased burnout, and may have an increased risk of suicide.

Purpose
This study aimed to evaluate mental health problems among Lithuanian nurses and explore factors associated with them.

Method
The survey was completed by 533 nurses. Mental health was assessed using the Depression, Anxiety, and Stress Scale—21, and suicidal ideation was measured with the Suicidal Behaviours Questionnaire—Revised (SBQ-R).

Findings
A large proportion of nurses in the study had high psychological distress, with 18% having high depression, 29.3% - high anxiety, and 17.1% - high stress. 21.2% of the sample had an increased suicide risk. 64.9% of nurses considered changing their careers to a non-medical profession in the last 12 months.

Discussion
Addressing mental health issues in the national healthcare system is critical to avoiding the loss of valued medical community members and ensuring that patients do not lose their critical caretakers.
Burden of invasive pneumococcal disease, non-invasive all-cause pneumonia, and acute otitis media in hospitalized US children: a retrospective multi-center study from 2015 to 2020
Authors: Mohanty Salini , Cossrow Nicole , White Meghan , Yu Kalvin C. , Ye Gang , Feemster Kristen A. , Gupta Vikas 
Published: December 2024

Abstract
Background
Despite effective pneumococcal vaccines, pneumococcal disease (PD) exerts a substantial burden on children. This study explored the clinical and economic burden of invasive PD (IPD), non-invasive all-cause pneumonia (ACP), and acute otitis media (AOM) in hospitalized children.

Methods
Data from the BD Insights Research Database of hospitalized children (< 18 years, including infants and children) in the US were analyzed retrospectively. The study cohort included patients with an ICD10 code for IPD, ACP, or AOM and/or a positive culture for S. pneumoniae. Descriptive statistics and multivariable analyses evaluated the following outcomes: length of stay [LOS], hospital cost per admission, hospital margin per admission [costs – payments], and in-hospital mortality.

Results
The study included 4575 pediatric patients with IPD (n = 36), ACP (n = 3,329), or AOM (n = 1,210) admitted to 57 US hospitals from October 2015 to February 2020. Approximately half (50.7%) were under 2 years of age. The in-hospital mortality rate was 0.6% (n = 28). The observed median (interquartile range) LOS was 4 (3, 5) days, cost per admission was $4,240 ($2,434, $8,311) US dollars, and hospital margin per admission was -$63 ($2,118, $2,025). LOS and costs were highly variable according to clinical characteristics and hospital variables. Key variables associated with poor outcomes were having a moderate- or high-risk condition (chronic or immunocompromising), intensive care unit admission, and prior 90-day admission.

Conclusions
The burden of PD among hospitalized pediatric patients in the US remains substantial. Our study highlights the burden of PD among young children (< 2 years) and children with underlying medical conditions that put them at greater risk for PD. The results support the need for ongoing prevention efforts including vaccination and antimicrobial stewardship programs to reduce the burden of PD in children.
Utility of colposcopy for the screening and management of cervical cancer in Africa: a cross-sectional analysis of providers’ training and practices
Authors: Fokom Domgue Joël , Dille Issimouha , Gnangnon Freddy , Kapambwe Sharon , Bouchard Celine , Mbatani Nomonde , Gauroy Elodie , Ambounda Nathalie Ledaga , Yu Robert , Sidibe Fatoumata , Kamgno Joseph , Traore Bangaly , Tebeu Pierre-Marie , Halle-Ekane Gregory , Diomande Mohenou Isidore , Dangou Jean-Marie , Lecuru Fabrice , Adewole Isaac , Plante Marie , Basu Partha , Shete Sanjay 
Published: December 2024

Abstract
Introduction
Cervical cancer is a public health issue in Africa with devastating socioeconomic consequences due to the lack of organized screening programs. The success of screening programs depends on the appropriate investigation and management of women who test positive for screening. Colposcopic assessment following positive screening results is a noteworthy issue in Africa. This study aimed to assess the utilization of colposcopy by providers in the region.

Methods
A cross-sectional study was conducted in 2021–2022 among healthcare providers involved in cervical cancer prevention activities in Africa. They were invited to report prior colposcopy training, whether they performed colposcopy and the indications of colposcopy in their practice.

Results
Of the 130 providers from 23 African countries who responded to the survey (mean age [SD]: 39.0 years [9.4]), half were female (65 [50.0%]), and 90.7% reported working in urban areas. Overall, only 12.6% of respondents indicated having received prior training on colposcopy, and 11.7% reported that they were performing colposcopy in their current practice. Among the providers who reported performing colposcopy in their practice, colposcopy was indicated for routine cervical cancer screening in 21.2% of clinicians, to better visualize the transformation zone in 15.2% of respondents, to further assess the vascularization of cervical mucosa in 33.3% of respondents, and to determine the appropriate treatment modality in 12.1% of respondents. Providers who performed colposcopy in their practice reported a median number of 30 (interquartile range: 19-65) colposcopic procedures in the past 6 months.

Conclusion
Providers’ training and practice of colposcopy for cervical cancer screening remain suboptimal in Africa. To increase utilization of colposcopy in the region, further training is needed to improve providers’ knowledge and engagement. With the development of lower-cost and portable colposcopes, efforts to equip cervical cancer prevention programs and facilities with colposcopy should be enhanced to ensure that women can be screened and managed appropriately in the clinical setting and communities.
Defining the transition from new to normal: a qualitative investigation of the clinical change process
Authors: Silver Santana R. , Jones Kayla Christine , Hook Kimberly , Crable Erika L. , George Emily R. , Serwint Janet R. , Austad Kirsten , Walkey Allan , Drainoni Mari-Lynn 
Published: December 2024

Abstract
Background
Understanding how and when a new evidence-based clinical intervention becomes standard practice is crucial to ensure that healthcare is delivered in alignment with the most up-to-date knowledge. However, rigorous methods are needed to determine when a new clinical practice becomes normalized to the standard of care. To address this gap, this study qualitatively explores how, when, and why a clinical practice change becomes normalized within healthcare organizations.

Methods
We used purposive sampling to recruit clinical leaders who worked in quality improvement and/or implementation science in diverse health contexts. Enrolled participants completed semi-structured interviews around implementing evidence-based practices. Qualitative data was inductively and deductively analyzed, and was guided by a modified version of the Normalization Process Theory (NPT) framework to identify salient themes. Additionally, identified normalization strategies were mapped to the Expert Recommendations for Implementation Change (ERIC) project.

Results
A total of 17 individuals were interviewed. Two categories of themes emerged: 1) signals of when a new clinical practice is considered to be normalized within clinical care; and 2) strategies utilized to normalize new clinical innovations. Participants described four key signals for identifying when a novel clinical practice becomes the new normal: 1) integrated seamlessly into existing workflows; 2) scaled across the entire organizational unit; 3) has strong staff buy-in and ownership; and 4) no longer needs monitoring and evaluation to be sustained. Major strategies to normalize new clinical interventions included: 1) taking a patient approach that starts slow and gains momentum; 2) identifying and using methods to gain staff buy-in and ownership; and 3) conducting ongoing measurement of progress towards normalization.

Conclusions
The results offer valuable insight into the indicators that signify when a novel clinical practice becomes normalized, and the strategies employed to facilitate this transition. These findings can inform future research to develop instruments that implementation leaders can use to systematically measure the clinical change process.
Client experiences of a task-shifting supported self-management intervention for depression in Vietnam
Authors: Chau Leena W. , Lou Hayami , Murphy Jill K. , Nguyen Vu Cong , Small Will , Samji Hasina , O’Neil John 
Published: December 2024

Abstract
Background
The global burden of mental illness is substantial, with depression impacting close to 300 million people worldwide. This has been exacerbated within the context of the COVID-19 pandemic. Yet, in many low- and middle-income countries including Vietnam, there is a substantial treatment gap, with many requiring mental health care unable to access it. Task-shifting is an evidence-based approach that seeks to address this gap by utilizing non-specialist providers to provide care. While there is a large body of literature exploring task-shifting, there is little that explores the client experience. This paper describes the facilitators and barriers impacting the client experience of a task-shifting supported self-management (SSM) intervention for depression in Vietnam. SSM involves a client workbook and supportive coaching by non-specialist providers.

Methods
This paper is situated within a randomized controlled trial that demonstrated the effectiveness of the SSM intervention in adult populations across eight provinces in Vietnam. Semi-structured interviews were conducted with a convenience sample of clients (recipients of the intervention) with depression caseness as measured by the Self-Report Questionnaire-20 depression screening measure, and providers (non-specialist “social collaborators”) to explore SSM’s acceptability and factors influencing participation and adherence. This paper presents the qualitative findings from an analysis of the interviews, focusing on the client perspective. Qualitative descriptive methods and thematic analysis were used.

Results
Forty-five clients were interviewed. Sub-themes reported for the facilitators and benefits for the client experience of the SSM intervention were client-provider relationship building and family and community connections. Sub-themes reported for the barriers were clients’ responsibilities, clients’ health conditions, and consequences of stigma.

Conclusions
Due to challenges with sustaining and scaling up the in-person SSM intervention in Vietnam, the research team has pivoted to delivering the SSM intervention digitally through a smartphone-based app adapted from SSM, with direction from the Government of Vietnam. Findings from this study suggest that while digital interventions may support accessibility and convenience, they may neglect the critical human contact component of mental health care. Ultimately, a model that combines digital delivery with some form of human contact by a support person may be important.
CRISPR in mobile genetic elements: counter-defense, inter-element competition and RNA-guided transposition
Authors: Koonin Eugene V. , Makarova Kira S. 
Published: December 2024

AbstractCRISPR are adaptive immunity systems that protect bacteria and archaea from viruses and other mobile genetic elements (MGE) via an RNA-guided interference mechanism. However, in the course of the host-parasite co-evolution, CRISPR systems have been recruited by MGE themselves for counter-defense or other functions. Some bacteriophages encode fully functional CRISPR systems that target host defense systems, and many others recruited individual components of CRISPR systems, such as single repeat units that inhibit host CRISPR systems and CRISPR mini-arrays that target related viruses contributing to inter-virus competition. Many plasmids carry type IV or subtype V-M CRISPR systems that appear to be involved in inter-plasmid competition. Numerous Tn7-like and Mu-like transposons encode CRISPR-associated transposases (CASTs) in which interference-defective CRISPR systems of type I or type V mediate RNA-guided, site-specific transposition. The recruitment of CRISPR systems and their components by MGE is a manifestation of extensive gene shuttling between host immune systems and MGE, a major trend in the coevolution of MGE with their hosts.
Sphingolipid profiling as a biomarker of type 2 diabetes risk: evidence from the MIDUS and PREDIMED studies
Authors: Berkowitz Loni , Razquin Cristina , Salazar Cristian , Biancardi Fiorella , Estruch Ramón , Ros Emilio , Fitó Montserrat , Corella Dolores , Coe Christopher L. , Ryff Carol D. , Ruiz-Canela Miguel , Salas-Salvado Jordi , Wang Daniel , Hu Frank B. , Deik Amy , Martínez-Gonzalez Miguel A. , Rigotti Attilio 
Published: December 2024

Abstract
Background
Type 2 diabetes (T2D) has become a worldwide pandemic. While ceramides may serve as intermediary between obesity-related lipotoxicity and T2D, the relationship with simple glycosphingolipids remains uncertain. The aim of this study was to characterize the associations between blood glycosphingolipid and ceramide species with T2D and to identify a circulating sphingolipid profile that could serve as novel biomarker for T2D risk.

Methods
Cross-sectional relationship between sphingolipid levels, insulin resistance, and T2D prevalence were evaluated in 2,072 American adults from MIDUS cohort. Prospectively, the association between sphingolipid species and the incidence of T2D was analyzed using a case-cohort design nested within the PREDIMED trial (250 cases and a random sample of 692 participants, with 3.8 years of median follow-up). Circulating levels of sphingolipid species in both populations were measured using LC/MS. Hazard ratios were estimated with weighted Cox regression models using Barlow weights.

Results
In American adults, only CER18:0 and CER22:0 were linked to insulin resistance and a higher prevalence of T2D. Conversely, three lactosylceramides (LCER 14:0, 16:0, and 24:1) showed a strong inverse relationship with both insulin resistance and T2D. These findings led to development of two sphingolipid scores. In the prospective analysis, these scores consistently predicted a reduced risk of T2D incidence in PREDIMED (HR: 0.64, 95% CI 0.44 to 0.94 and 0.58, 0.40 to 0.85 respectively) between extreme quartiles, with 5-year absolute risk differences of 9.6% (95% CI: 0.3–20.5%) and 11.4% (1.0–21.6%). They were validated in the same trial with samples obtained after 1 year of follow-up.

Conclusions
Our findings support the potential usefulness of circulating sphingolipid profiles as novel biomarkers for T2D risk. Moreover, this study opens the door for future research on the predictive value and possible protective roles of lactosylceramides in T2D.

Graphical abstract
Systematic review of evidence for the impact and effectiveness of the 1-3-7 strategy for malaria elimination
Authors: Sogandji Nihal , Stevenson Anna , Luo Michael Y. , Qi Gao , Maude Richard J. 
Published: December 2024

Abstract
Background
The 1-3-7 approach to eliminate malaria was first implemented in China in 2012. It has since been expanded to multiple countries, but no systematic review has examined the evidence for its use. A systematic review was conducted aiming to evaluate the impact and effectiveness of the strategy and identify key challenges and variations in its implementation across different countries.

Methods
PUBMED, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CABS Abstracts, LILACS, Global Health, Medrxiv, Biorxiv were searched for all studies containing 1-3-7 and articles included if they contained information on 1-3-7 impact, effectiveness, challenges and/or adaptations for implementation in different countries.

Results
31 studies were included from China (19), Thailand (6), Myanmar (2), Tanzania (1), Cambodia (1), India (1) and Vietnam (1). During 1-3-7 implementation, malaria cases in China decreased by 99.1–99.9%, in Thailand by 66.9% during 2013–19, 65,1% in Cambodia during 2015–17 and 30.3% in India during 2015–16, with some differences in implementation. It was not possible to separate the impact of 1-3-7 from that due to other contemporaneous interventions. Implementing the 1-3-7 policy was largely effective, with reporting within 1 day in 99.8–100% of individuals in China and 36–100% in other countries, investigation within 3 days in 81.5–99.4% in China and 79.4–100% in other countries, and foci investigation within 7 days in 90.1–100% in China and 83.2–100% in other countries. Adaptations to 1-3-7 were described in 5 studies, mostly adjustment of the timing and/or definitions of each component. Key challenges identified included those related to staffing, equipment, process, and patient-provided information.

Conclusion
Overall, the 1-3-7 approach was effectively implemented with a concomitant decrease in cases in malaria elimination settings, however, it was not possible to quantify impact as it was not implemented in isolation. Implementing adequate measures for testing, reporting, treatment, and containment is crucial for its success, which is dependent on the availability of resources, infrastructure, staffing, and consistent compliance across regions and throughout the year. However, achieving this nationally and maintaining compliance, especially at borders with malaria-affected countries, poses significant challenges.
Access to health insurance amongst people with disabilities and its association with healthcare use, health status and financial protection in low- and middle-income countries: a systematic review
Authors: Azizatunnisa’ Luthfi , Kuper Hannah , Banks Lena Morgon 
Published: December 2024

Abstract
Background
People with disabilities often incur higher costs for healthcare, due to higher needs, greater indirect costs, and the need for services not offered by the public system. Yet, people with disabilities are more likely to experience poverty and so have reduced capacity to pay. Health insurance is an important social protection strategy to meet healthcare needs and avoid catastrophic expenditures for this group. This systematic review synthesized evidence on health insurance coverage and potential effects among people with disabilities in low- and middle-income countries (LMICs).

Methods
This systematic review followed PRISMA Guidelines. We searched English peer-reviewed articles from nine databases (Medline, Embase, CINAHL, Web of Science, Scopus, Cochrane Library, PsyInfo, Global Health, and Econlit) from January 2000 to 24 January 2023. Two independent reviewers conducted the article selection, data extraction, and risk of bias assessment using NIH Guidelines. Studies were eligible for inclusion if they quantitatively assessed at least one of four key outcomes amongst people with disabilities: health insurance coverage/access, the association between health insurance and health care utilization, financial protection, or health status/outcome. Narrative synthesis was deployed due to high variety of outcome measurements.

Results
Out of 8,545 records retrieved and three from hand search, 38 studies covering data from 51 countries met the eligibility criteria. Over two-thirds (68.4%) focused on access/coverage, which was generally limited amongst people with disabilities. Seventeen studies (44.7%) examined healthcare utilization, with a positive association (9/12) found between health insurance and the use of disability-related services. However, its association with general healthcare utilization (5 studies) remained inconclusive. Financial protection, explored by six studies (15.8%), similarly yielded inconclusive results. Only four studies (10.5%) reported on health status, and the findings suggest a favourable association of health insurance with self-reported health among people with disabilities (2/4), despite the limited number of high-quality studies.

Conclusions
There is considerable variability and limited evidence regarding health insurance coverage and its potential impact among individuals with disabilities in LMICs. This gap highlights the pressing need for further evaluations of health insurance, with a specific focus on people with disabilities, aligning with the broader goal of achieving Universal Health Coverage (UHC).

Trial registration
PROSPERO CRD42023389533.