bluuebunny/crossref_metadata_2025_split huggingface dataset:
La predicción del fracaso empresarial en el sector hotelero
Authors: Álvarez-Ferrer Antonio , Campa-Planas Fernando 
Published: July 2020

El objetivo de este estudio es analizar las empresas concursadas del sector hotelero en España,desde el año 2007 hasta el 2017, empleando fórmulas de predicción del fracaso empresarial que sean aplicables a este tipo de actividad económica. La elaboración de modelos de predicción de la insolvencia se inició en Estados Unidos con los trabajos pioneros de Beaver y Altman en la década de los años sesenta. Después de años de mejoras metodológicas y de estudios aplicados a diferentes sectores, no se ha conseguido unificar un método por la comunidad científica, por lo que para la realización de este estudio se utilizarán las fórmulas Z de Altman de los años 1968 y 1983 y se compararán con la fórmula de Amat et al. de 2017. Los dos métodos de Z-Score aplicados a las empresas del sector hotelero en concurso de acreedores en España nos muestran un alto porcentaje de coincidencias en los ejercicios previos a la declaración oficial del concurso, siendo el de Altman el que obtiene una mejor aproximación al número total de empresas concursadas.
The main goal of this study is to carry out an analysis about the bankrupt of companies in the hospitality sector in Spain from 2007 to 2017, applying prediction formulas of business failure. The development of models for insolvency prediction began in the United States with the pioneering works of Beaver and Altman in the 1960s. After years of methodological improvements and studies applied to different sectors, it has not been possible to unify amethod applicable bythe Academia. Therefore, the realization of this study has been using the formula Z of Altmanof 1968 and1983and compare them with the formula Z of Amat et al. of 2017. The two methods of Z-Score applied to the companies of the hospitality sector in Spain in bankruptcy process show us a highly percentage of matches in the exercises before the official bankruptcy process, being Altman the one that obtains a better approach to the total number of bankruptcy companies.
Percepción de congestión y dimensión social de la capacidad de carga en cenotes de Yucatán
Authors: Enseñat-Soberanis Fernando , Blanco-Gregory Rocío , Mondragón-Mejía Johnathan Alexander 
Published: July 2020

La visita masiva de turistas a los cenotes de Yucatán tiene impactos negativos sobre dos elementos: el recurso natural y la experiencia misma del visitante. Este estudio mide y compara, a través del indicador percepción de congestión, los impactos de la masificación en la experiencia del visitante en dos cenotes de Yucatán y entre tres tipos de visitantes: locales, nacionales y extranjeros. Los resultados muestran que la aceptabilidad de los visitantes a la congestión disminuye conforme aumenta el número de personas en ambos cenotes. Los visitantes extranjeros en los dos cenotes toleran menos la congestión mientras que los locales son el grupo que presentan niveles de tolerancia más altos.
The massive visit of tourists to the cenotes of Yucatán has negative impacts on two elements: the natural resource and the visitor's own experience. This study measures and compares, through the congestion perception indicator, the impacts of massification on the visitor's experience in two cenotes of Yucatán and among three types of visitors: local, national and foreign. The results show that the acceptability of visitors to congestion decreases as the number of people in both cenotes increases. Foreign visitors in the two cenotes tolerate less congestion while locals are the group with the highest tolerance levels.
Structural Discrimination in Nonprofit Hospital Community Benefit Spending
Authors: Hedquist Aaron , Blumenthal David , Dai Dannie , Phelan Jessica , Orav E. John , Figueroa Jose F. 
Published: February 2025

ImportanceNonprofit hospitals receive substantial tax exemptions to provide a community benefit. However, little is known about the distribution of community benefit spending (CBS) across US communities with varying degrees of social vulnerability beyond the hospital’s immediate geographic area.ObjectiveTo assess associations of CBS per capita with community-level characteristics and social determinants of health.Design, Setting, and ParticipantsThis cross-sectional study used Internal Revenue Service Series 990 Tax Forms from 2018 to 2023, to create a dataset of CBS for nonprofit hospitals in the US. Facility-level CBS allocation to counties was based on inpatient utilization to more accurately reflect a hospital’s community. Data were analyzed from January to December 2024.ExposuresCounty-level race and ethnicity characteristics and socioeconomic factors, including educational attainment, proportion living below 138% of the federal poverty level (FPL), and the Social Vulnerability Index (SVI) score.Main Outcomes and MeasuresThe primary outcome was total CBS per capita. Generalized linear regression models with a γ log-link function were used to assess the association of CBS per capita with community-level social determinants of health characteristics.ResultsA total of 2465 nonprofit hospitals across 3140 US counties were included. Allocation of CBS varied significantly across communities, with the counties in the highest quintile receiving a mean (SD) of $540 ($250) per capita compared with counties in the lowest quintile with $22 ($16) per capita. Communities in the highest quintile of CBS had a higher proportion of White residents, while communities in the lowest quintile had a higher proportion of residents who were non-Hispanic Black or Hispanic, had lower educational attainment, and were living with incomes below 138% of the FPL. For every 1% proportional increase in non-Hispanic Black or Hispanic residents in a community, there was 1.61% (95% CI, 1.38%-1.84%) and 0.88% (95% CI, 0.63%-1.14%) less CBS per capita, respectively. In addition, there was less allocation of CBS per capita among counties with a greater proportion of people with low educational attainment, greater levels of poverty, or higher SVI scores. These results were consistent before and during the COVID-19 pandemic.Conclusions and RelevanceThis cross-sectional study found that nonprofit hospitals’ CBS was regressively allocated across US communities, with more socially vulnerable or racially and ethnically minoritized communities receiving less benefit than more affluent, non-Hispanic White communities, suggesting that the nonprofit tax system may be structurally discriminatory and contributing to health disparities.
Medical Toxicology Consultations and Mortality Among Patients With Poisonings in the PICU
Authors: Wax Paul M. , Culbreth Rachel E. , Brent Jeffrey , Hantsch Christina , Mikhailov Theresa , Brundage Nancy , Aldy Kim 
Published: February 2025

ImportancePoisonings are a leading cause of preventable mortality and morbidity among children. Pediatric poisonings are commonly managed in pediatric intensive care units (PICUs) and may require complex treatment and specialized evaluation. Physicians specializing in medical toxicology are trained to treat poisoned patients of all ages; however, they are not universally part of the medical staff across hospital systems.ObjectiveTo determine if there is a difference in mortality and length of stay for patients with toxicological exposures who receive a medical toxicology consultation.Design, Setting, and ParticipantsThis is a secondary analysis of an ongoing, cross-sectional registry of patients admitted to PICUs from January 2019 to June 2023 as part of the Virtual Pediatric System (VPS), a database of PICU admissions across 135 medical sites in the US. Patients with toxicological exposure who were admitted to PICUs that participate in the VPS database were included. Data analysis occurred from May to August 2024.ExposuresMedical toxicology consultations.Main Outcomes and MeasuresThe primary outcome was mortality in the PICU and in the hospital overall. Secondary outcomes were length of stay in the PICU and in the hospital. Multilevel models were used to assess associations of toxicology consultations with the primary and secondary outcomes.ResultsThere were a total of 52 836 patients with toxicological exposures (29 867 aged 12 to &amp;lt;21 years [56.5%]; 29 401 female [55.6%]), including 2857 (5.4%) patients with medical toxicology consultations and 49 979 (94.6%) without a consultation. Patients who received medical toxicology consultations had similar risk of mortality at baseline, as measured by the Pediatric Risk of Mortality, compared with those without consultations. After adjusting for severity of illness, poisoning type, and other covariates, medical toxicology consultations were associated with 64% lower odds of death in the PICU (adjusted odds ratio, 0.36; 95% CI, 0.20 to 0.63) and 61% lower odds of mortality at any time during the hospitalization (aOR, 0.39; 95% CI, 0.24 to 0.64). Additionally, medical toxicology consultations were associated with a 15% reduced PICU length of stay (log estimate, −0.16; 95% CI, −0.21 to −0.11) and 10% reduced hospital length of stay (log estimate, −0.10; 95% CI, −0.14 to −0.06) after adjusting for all covariates and differences across hospital sites.Conclusions and RelevanceIn this study of patients with toxicological exposures requiring PICU care, having a medical toxicology consultation was associated with lower mortality and shorter LOS compared with not having a consultation, which suggests that medical toxicology consultations may provide life-saving treatment, particularly for the most severe poisonings in the PICU.
Changes in Food Insecurity Among US Adults With Low Income During the COVID-19 Pandemic
Authors: Wu Yingfei , Cheng Jessica , Thorndike Anne N. 
Published: February 2025

ImportanceRacial and ethnic minority groups disproportionately experience food insecurity. During the COVID-19 pandemic, the US enacted temporary food assistance policies, including emergency allotments for Supplemental Nutrition Assistance Program (SNAP) benefits. The effects of the pandemic and these policies on food insecurity by race and ethnicity are unclear.ObjectiveTo examine prevalence trends in food insecurity by racial and ethnic groups and SNAP use before and during the pandemic.Design, Setting, and ParticipantsThis cross-sectional survey study analyzed National Health Interview Survey data before (January 2019 to March 2020) and during the COVID-19 pandemic (April 2020 to December 2022). Participants were noninstitutionalized US adults (≥18 years) with low income (&amp;lt;200% federal poverty level). Statistical analysis was performed from September 25, 2023, to February 27, 2024.ExposureCOVID-19 pandemic time period.Main Outcomes and MeasuresFood insecurity was measured using the 10-item US Department of Agriculture Adult Food Security Survey module, categorizing participants as food secure (high or marginal food security) or insecure (low or very low food security). Survey-weighted Poisson regressions were modeled to examine changes in food insecurity prevalence over time by race and ethnicity (Asian, Black, Hispanic, and White) and by race and ethnicity and SNAP use (yes or no) including a 3-way interaction term (time × race and ethnicity × SNAP).ResultsAmong 30 396 adults with low income, approximately one-half were female (56.0% [95% CI, 54.7%-57.2%] during the pre–COVID-19 time period; 57.4% [95% CI, 56.4%-58.4%] during the COVID-19 time period). Food insecurity prevalence decreased from 20.9% (95% CI, 19.9%-22.0%) before the COVID-19 pandemic to 18.8% (95% CI, 17.9%-19.7%) during the pandemic (P &amp;lt; .001). SNAP use prevalence increased overall (from 31.5% [95% CI, 30.1%-32.9%] to 36.0% [95% CI, 34.8%-37.3%]; P &amp;lt; .001) and for each racial and ethnic group. There were no significant differences in food insecurity changes over time by racial and ethnic group (Wald test F = 1.29; P = .28 for 2-way interaction). Among SNAP participants, food insecurity decreased for Asian, Hispanic, and White adults but did not change for Black adults; among non-SNAP participants, food insecurity did not change for Black, Hispanic, and White adults but increased for Asian adults (Wald test F = 4.43; P = .02 for 3-way interaction).Conclusions and RelevanceDuring the COVID-19 pandemic, food insecurity decreased among SNAP participants in most racial and ethnic groups but did not decrease among non-SNAP participants in any group. These results suggest that during the pandemic, increased SNAP benefit amounts were associated with ameliorating food insecurity for many US adults who were able to access SNAP but did not reduce racial and ethnic disparities in food insecurity.
Physical Health Decline After Chemotherapy or Endocrine Therapy in Breast Cancer Survivors
Authors: Bodelon Clara , Masters Matthew , Bloodworth Den E , Briggs Peter J. , Rees-Punia Erika , McCullough Lauren E. , Patel Alpa V. , Teras Lauren R. 
Published: February 2025

ImportanceWomen with a history of breast cancer (BC) experience greater physical health decline compared with age-matched women without cancer. However, whether this decline differs in patients who received chemotherapy and endocrine therapy is not well understood.ObjectiveTo investigate physical health decline in BC survivors who received chemotherapy or endocrine therapy compared with age-matched women without cancer.Design, Setting, and ParticipantsThis prospective cohort study was conducted as part of the Cancer Prevention Study-3, a prospective US cohort study that enrolled participants in 35 states, the District of Columbia, and Puerto Rico between 2006 and 2013. Follow-up for this analysis was through April 1, 2020. Statistical analyses were conducted between May 2023 and December 2024. Female participants diagnosed with nonmetastatic BC who returned a survey at least 90 days after their diagnosis were matched on age and year of survey return with up to 5 women without cancer.ExposureCancer status and treatment information.Main Outcomes and MeasuresOutcomes of interest were measures of physical health, assessed using the Patient-Reported Outcomes Measurement Information System Global Health Scale instrument. Linear regression was used to estimate associations (β) and 95% CIs of treatment with physical health.ResultsThis analysis included 2566 individuals diagnosed with BC and 12 826 age-matched women without cancer. Median (IQR) age at diagnosis was 56.3 (49.9-61.9) years. Of women with BC, 1223 (47.7%) received endocrine therapy, 276 (10.8%) received chemotherapy, and 634 (24.7%) received both. Compared with women without cancer, there was a greater physical health decline within 2 years of diagnosis for BC survivors receiving endocrine therapy (β = −1.12; 95% CI, −1.64 to −0.60), chemotherapy (β = −3.13; 95% CI, −4.19 to −2.07), or both (β = −3.26; 95% CI, −3.97 to −2.55). The decline among endocrine therapy users was restricted to women receiving aromatase inhibitors. More than 2 years after diagnosis, the decline was only observed in women who received chemotherapy.Conclusions and RelevanceIn this cohort study of 15 392 BC survivors and age-matched women without cancer, BC survivors who received chemotherapy had a long-lasting physical health decline, unlike survivors who received endocrine therapy without chemotherapy. Further studies are needed to confirm these results and to better understand the health consequences of these treatments.
Knowledge Gradient for Multi-objective Bayesian Optimization with Decoupled Evaluations
Authors: Buckingham Jack M. , Rojas-Gonzalez Sebastian , Branke Juergen 
Published: February 2025

Abstract
Multi-objective Bayesian optimization aims to find the Pareto front of trade-offs between a set of expensive objectives while collecting as few samples as possible. In some cases, it is possible to evaluate the objectives separately, and a different latency or evaluation cost can be associated with each objective. This decoupling of the objectives presents an opportunity to learn the Pareto front faster by avoiding unnecessary, expensive evaluations. We propose a scalarization based knowledge gradient acquisition function which accounts for the different evaluation costs of the objectives. We prove asymptotic consistency of the estimator of the optimum for an arbitrary, D-dimensional, real, compact search space and show empirically that the algorithm performs comparably with the state of the art and significantly outperforms versions which always evaluate both objectives.
Time delay and risk of toxicity of intraosseous anaesthesia use for awake intraosseous access in children
Authors: Pfeiffer Daniel , Olivieri Martin , Lieftüchter Victoria , Hey Florian , Hoffmann Florian 
Published: February 2025

Abstract

Introduction
Intraosseous access (IO) is a crucial, life-saving alternative vascular access in paediatric emergency medicine. In awake paediatric patients, the pain of drilling and flushing the marrow cavity are barriers to the use of the IO method or prompt the use of an intraosseous anaesthetic agent, which introduces the risk of dosing errors and drug toxicity. This study aims to identify the frequency of use of anaesthetic agents and analyse the time delay caused by their use.

Methods
Prospective surveillance study analysing all patients, aged > 28 days to 18 years, who received one or more IO attempt(s) in and out of the hospital setting in Germany from 1 July 2017 to 30 June 2019 via the reporting mechanism of the German Paediatric Surveillance Unit (GPSU).

Results
Our analysis identified 74 patients who received an IO attempt while awake. All patients were younger than 6 years old. Almost every third child (31.6%) was awake during IO use. In 18.9% of all awake patients, an intraosseous anaesthetic was used before the IO was drilled or the marrow cavity was flushed, introducing a significant time delay of approximately 3 min (p = 0.001) compared to IO attempts without intraosseous anaesthesia.

Conclusions
Intraosseous anaesthesia prolongs the establishment of working vascular access in an emergency and introduces the risk of drug toxicity. To prevent adverse events, particular emphasis must be placed on placement without intraosseous anaesthesia, and alternative pain management (intranasal) must be considered if necessary. Training courses and guidelines should reflect the advised current practice.
Die Kasai-Hepatoportoenterostomie zur Behandlung der Gallengangatresie – Worauf kommt es an?
Authors: Madadi-Sanjani Omid , Herden Uta , Uecker Marie 
Published: February 2025

Zusammenfassung
Die Gallengangatresie (biliäre Atresie, BA) ist ein seltenes Krankheitsbild des Neugeborenen unklarer Ätiologie. Die BA definiert sich über das Ausmaß der extra- und intrahepatischen Gallenwegsdestruktion, die innerhalb der ersten Lebensjahre zum Bild der Leberzirrhose führt. Die Lebertransplantation (LT) ist die einzige kurative Therapie der BA, einhergehend mit LT-assoziierten Risiken und Komplikationen. Doch auch über 60 Jahre nach ihrer Erstbeschreibung hat die Kasai-Hepatoportoenterostomie (KPE) einen wichtigen Stellenwert in der sequenziellen Behandlung der BA als primäre chirurgische Therapieoption, die ein längeres Überleben mit eigener Leber ermöglichen kann. Wir beleuchten chirurgische Schlüsselschritte der KPE und diskutieren relevante Aspekte.
Beobachtungsstudie zur Koinzidenz von Alzheimer-Erkrankung und idiopathischem Normaldruckhydrozephalus: Analyse von Koinzidenz, deren Einfluss auf das Ansprechen im Liquorablassversuch und zerebrovaskulärer Kopathologie
Authors: Beeke M. , Sauer C. , Petzold J. , Schneider S. , Frenzen K. , Donix M. , Reiß G. , Brandt M. , Haußmann R. 
Published: February 2025

Zusammenfassung

Ziel der Arbeit
Analyse der Häufigkeit einer komorbiden Alzheimer-Erkrankung (AD) bei Patienten mit Verdacht auf idiopathischen Normaldruckhydrozephalus (iNPH) und deren Effekt auf das Ansprechen im Liquorablassversuch sowie Analyse der Häufigkeit einer vaskulären Kopathologie bei Patienten mit iNPH-Verdacht.

Material und Methoden
Prospektiv beobachtende Analyse von Patienten mit iNPH-Verdacht, die sich im Rahmen der klinischen Routinediagnostik zwischen dem 01.07.2022 und dem 30.06.2023 einer leitliniengerechten NPH-Routinediagnostik inklusive Liquorablassversuch unterzogen. Die Rekrutierung erfolgte aus den Kliniken für Neurologie, Neurochirurgie und Psychiatrie des Universitätsklinikums Carl Gustav Carus in Dresden. NPH-typische Bildbefunde wurden anhand vorliegender MRT- bzw. CT-Schnittbilder erhoben. Relevante soziodemografische, klinische, kognitive und liquordiagnostische Parameter wurden mittels Aktendurchsicht erfasst. Die Patienten wurden hinsichtlich des Liquorbefundes gemäß ATN-Klassifikation kategorisiert.

Ergebnisse
Im Beobachtungszeitraum wurden 33 Patienten (14 weiblich, 19 männlich, Durchschnittsalter 74,6 ± 8,1 Jahre) mit iNPH-Verdacht analysiert. 19 Patienten (57,6 %) wiesen eine komplette und 14 Patienten (42,4 %) eine inkomplette Hakim-Trias auf. Die Differenz des MoCA-Scores vor und nach Liquorablass unterschied zwischen Patienten mit und ohne Ansprechen im Liquorablass (F[1;22] = 5,725; p = 0,026). Es bestand ein Trend, dass Patienten mit pathologischem Corpus-callosum-Winkel und auffälligem Evans-Index (p = 0,052) sowie Patienten mit pathologischem Corpus-callosum-Winkel, Evans-Index und kompletter Hakim-Trias (p = 0,055) häufiger ansprechen. Der durchschnittliche Fazekas-Score betrug 1,7. Es bestand kein Zusammenhang zwischen Fazekas-Score und Ansprechen auf den Liquorablass. Insgesamt wurden bei 25 Patienten (75,8 %) Demenz- und Destruktionsmarker bestimmt. Gemäß ATN-Klassifikation wurden 20 Patienten (80 %) als A+T−, 3 (12,0 %) als A+T+ und 2 (8,0 %) als A−T−klassifiziert. A+T+- und A+T−-Patienten sprachen nicht häufiger auf den Liquorablass an (p = 0,600).

Diskussion
Die kombinierte Bestimmung von CCW und Evans-Index sowie deren Kontextualisierung mit klinischen Charakteristika verbessern möglicherweise die prognostische Einschätzung eines Ansprechens im Liquorablassversuch. Insbesondere eine komorbide Amyloidpathologie, aber auch eine zerebrale Mikroangiopathie stellen häufige Kopathologien beim iNPH dar, wobei der Einfluss einer komorbiden Amyloidpathologie auf das Ansprechen im Liquorablassversuch noch ungeklärt ist.