bluuebunny/crossref_metadata_2025_split huggingface dataset:
Parents’ experiences of postmortem tumor donation for high-grade gliomas: benefits and suggested improvements
Authors: Robertson Eden G , Wakefield Claire E , Tsoli Maria , Kellie Stewart J , Alvaro Frank , Gifford Andrew J , Weber Martin A , Rodriguez Michael , Kirby Maria , Ziegler David S 
Published: August 2021

Abstract

Background
Pediatric high-grade glioma is a devastating diagnosis. There has been no improvement in outcomes for several decades, with few children surviving 2 years postdiagnosis. Research progress has been hampered by a lack of tumor samples, which can be used to develop and test novel therapies. Postmortem tumor donations are therefore a valuable opportunity to collect tissue. In this study, we explored Australian parents’ experiences of donating their child’s tumor for research after their child had died.

Methods
We collected qualitative data from 11 bereaved parents who consented to donate samples of their child’s high-grade glioma for research postmortem. We asked parents about their perceived benefits/burdens of the autopsy, recommendations for improving consent discussions, and decision regret.

Results
Parents hoped that their donation would help to find a cure for future children with high-grade glioma. They described feeling comforted knowing that their child’s suffering may help others. Some parents also felt that the donation would help them better understand their child’s tumor. Although some parents described discomfort about procedures leading up to the autopsy, parents reported minimal regret regarding their decision to donate their child’s tumor. Parents provided recommendations to improve consent discussions, such as providing more information about the autopsy logistics and why the donation was needed.

Conclusion
Parents consented to autopsy for altruistic reasons, although donation may also assist parents in their grieving. There is a strong need to improve access to tumor donations for any family who wishes to donate.
Cigarette Smoking Trajectories in Adolescent Smokers: Does the Time Axis Metric Matter?
Authors: Sylvestre Marie-Pierre , Lauzon Béatrice , Dugas Erika N , Mesidor Miceline , O’Loughlin Jennifer L 
Published: August 2021

Abstract

Introduction
Most studies modeling adolescent cigarette smoking trajectories use age as the time axis, possibly obscuring depiction of the natural course of cigarette smoking. We used a simulated example and real data to contrast smoking trajectories obtained from models that used time since smoking onset or calendar time (age) as the time axis.

Methods
Data were drawn from a longitudinal investigation of 1293 grade 7 students (mean age 12.8 years) recruited from 10 high schools in Montreal, Canada in 1999–2000, who were followed into young adulthood. Cigarette consumption was measured every 3 months during high school, and again at mean ages 20.4 and 24.0. Analyses using time since onset of smoking as the time metric was restricted to 307 incident smokers; analysis using calendar time included 645 prevalent and incident smokers. Smoking status and nicotine dependence (ND) were assessed at mean ages 20.4 and 24.0. Simulated data mimicked the real study during high school.

Results
Use of different time metrics resulted in different numbers and shapes of trajectories in the simulated and real datasets. Participants in the calendar time analyses reported more ND in young adulthood, reflecting inclusion of 388 prevalent smokers who had smoked for longer durations.

Conclusions
Choosing the right time metric for trajectory analysis should be balanced against research intent. Trajectory analyses using the time since onset metric depict the natural course of smoking in incident smokers. Those using calendar time offer a snapshot of smoking across ages during a given time period.

Implications
This study uses simulated and real data to show that trajectory analyses of cigarette smoking that use calendar time (e.g., age) versus time since onset as the time axis metric tell a different story. Trajectory analyses using the time since onset metric depict the natural course of smoking in incident smokers. Those using calendar time offer a snapshot of smoking across ages during a given time period. Choosing the right time metric should be balanced against research intent.
Reduced tongue mobility: an unrecognized risk factor of childhood obstructive sleep apnea
Authors: Yuen Hoi Man , Au Chun Ting , Chu Winnie Chiu Wing , Li Albert Martin , Chan Kate Ching-ching 
Published: August 2021

AbstractStudy ObjectivesChildhood obstructive sleep apnea (OSA) is an important and prevalent disease. A short lingual frenulum is a risk factor for OSA, but whether tongue mobility also plays a role in OSA etiology remains unknown. This study aimed to examine tongue mobility in children with and without OSA. We hypothesized that reduced tongue mobility was associated with OSA. We also evaluated the relationship between tongue mobility and craniofacial profile.MethodsThis was a cross-sectional case-control study. Prepubertal Chinese children aged 5–12 years, suspected to have OSA were recruited from our sleep disorder clinic. All subjects underwent overnight polysomnography. The lingual frenulum was evaluated based on tongue mobility and free tongue length. Craniofacial measurements were assessed by lateral cephalometry.ResultsEighty-two subjects (mean age: 8.32 ± 1.70 years, 57 males) were recruited. The mean tongue mobility was 58.2 (±19)% and 67.4 (±15)% (p = 0.019) in subjects with and without OSA, respectively. Tongue mobility was inversely correlated with OAHI (r = −0.218, p = 0.049). In multivariate logistic regression, low tongue mobility was independently associated with a higher risk of OSA after adjustment for age, sex, body mass index z-score, presence of large tonsils and turbinates, and nocturnal oral breathing (odds ratio = 3.65, 95% CI = 1.22 to 11.8). Tongue mobility was found to correlate with the cranial base angle (Ba-S-N) (r = 0.262, p = 0.018), which determines the relative position of the mandible.ConclusionsIn prepubertal children, reduced tongue mobility is associated with the occurrence and severity of OSA. Assessing tongue mobility is recommended in childhood OSA management.
A trait of mind: stability and robustness of sleep across sleep opportunity manipulations during simulated military operational stress
Authors: LaGoy Alice D , Cashmere J David , Beckner Meaghan E , Eagle Shawn R , Sinnott Aaron M , Conkright William R , Miller Eric , Derrow Carson , Dretsch Michael N , Flanagan Shawn D , Nindl Bradley C , Connaboy Christopher , Germain Anne , Ferrarelli Fabio 
Published: August 2021

AbstractStudy ObjectivesWithin-subject stability of certain sleep features across multiple nights is thought to reflect the trait-like behavior of sleep. However, to be considered a trait, a parameter must be both stable and robust. Here, we examined the stability (i.e. across the same sleep opportunity periods) and robustness (i.e. across sleep opportunity periods that varied in duration and timing) of different sleep parameters.MethodsSixty-eight military personnel (14 W) spent 5 nights in the sleep laboratory during a simulated military operational stress protocol. After an adaptation night, participants had an 8-hour sleep opportunity (23:00–07:00) followed by 2 consecutive nights of sleep restriction and disruption which included two 2-hour sleep opportunities (01:00–03:00; 05:00–07:00) and, lastly, another 8-hour sleep opportunity (23:00–07:00). Intra-class correlation coefficients were calculated to examine differences in stability and robustness across different sleep parameters.ResultsSleep architecture parameters were less stable and robust than absolute and relative spectral activity parameters. Further, relative spectral activity parameters were less robust than absolute spectral activity. Absolute alpha and sigma activity demonstrated the highest levels of stability that were also robust across sleep opportunities of varying duration and timing.ConclusionsStability and robustness varied across different sleep parameters, but absolute NREM alpha and sigma activity demonstrated robust trait-like behavior across variable sleep opportunities. Reduced stability of other sleep architecture and spectral parameters during shorter sleep episodes as well as across different sleep opportunities has important implications for study design and interpretation.
Costs and Economic Impacts of Physician Continuous Professional Development: A Systematic Scoping Review
Authors: Cook David A. , Stephenson Christopher R. , Wilkinson John M. , Maloney Stephen , Baasch Thomas Barbara L. , Prokop Larry J. , Foo Jonathan 
Published: August 2021

Purpose
Nearly all health care professionals engage in continuous professional development (CPD), yet little is known about the cost and cost-effectiveness of physician CPD. Clarification of key concepts, comprehensive identification of published work, and determination of research gaps would facilitate application of existing evidence and planning for future investigations. The authors sought to systematically map study themes, methods, and outcomes in peer-reviewed literature on the cost and value of physician CPD.

Method
The authors conducted a scoping review, systematically searching MEDLINE, Embase, PsycInfo, and Cochrane Library databases for comparative economic evaluations of CPD for practicing physicians through April 2020. Two reviewers, working independently, screened all articles for inclusion. Three reviewers iteratively reviewed all included articles to inductively identify key features including participants, educational interventions, study designs, cost ingredients, and cost analyses. Two reviewers then independently reexamined all included articles to code these features.

Results
Of 3,338 potentially eligible studies, 111 were included. Physician specialties included internal, family, or general medicine (80 studies [72%]), surgery (14 studies [13%]), and medicine subspecialties (7 studies [6%]). Topics most often addressed general medicine (45 studies [41%]) or appropriate drug use (37 studies [33%]). Eighty-seven studies (78%) compared CPD with no intervention. Sixty-three studies (57%) reported the cost of training, and 79 (71%) evaluated the economic impact (money saved/lost following CPD). Training cost ingredients (median 3 itemized per study) and economic impact ingredients (median 1 per study) were infrequently and incompletely identified, quantified, or priced. Twenty-seven studies (24%) reported cost–impact expressions such as cost-effectiveness ratio or net value. Nineteen studies (17%) reported sensitivity analyses.

Conclusions
Studies evaluating the costs and economic impact of physician CPD are few. Gaps exist in identification, quantification, pricing, and analysis of cost outcomes. The authors propose a comprehensive framework for appraising ingredients and a preliminary reference case for economic evaluations.
COVID-19 Significantly Impacted Hospital Length of Stay and Discharge Patterns for Adult Spinal Deformity Patients
Authors: Wang Kevin Y. , McNeely Emmanuel L. , Dhanjani Suraj A. , Raad Micheal , Puvanesarajah Varun , Neuman Brian J. , Cohen David , Khanna Akhil J. , Kebaish Floreana , Hassanzadeh Hamid , Kebaish Khaled M. 
Published: August 2021

Study Design.
Retrospective review.

Objective.
The primary aim was to compare length of stay (LOS) and discharge disposition of adult spinal deformity (ASD) patients undergoing surgery before and during the pandemic. Secondary aims were to compare the rates of 30-day complications, reoperations, readmissions, and unplanned emergency department (ED) visits.

Summary of Background Data.
ASD patients often require extended LOS and non-routine discharge. Given resource limitations during the Coronavirus Disease 2019 (COVID-19) pandemic and caution regarding hospital stays, surgeons modified standard postoperative protocols to minimize patient exposure.

Methods.
We identified all patients who underwent elective thoracolumbar ASD surgery with more than or equal to five levels fusion at a tertiary care center during two distinct time intervals: July to December 2019 (Pre-COVID, N = 60) and July to December 2020 (During-COVID, N = 57). Outcome measures included LOS and discharge disposition (home vs. non-home), as well as 30-day major complications, reoperations, readmissions, and ED visits. Regression analyses controlled for demographic and surgical factors.

Results.
Patients who underwent ASD surgery during the pandemic were younger (61 vs. 67 yrs) and had longer fusion constructs (nine vs. eight levels) compared with before the pandemic (P < 0.05 for both). On bivariate analysis, patients undergoing surgery during the pandemic had shorter LOS (6 vs. 9 days) and were more likely to be discharged home (70% vs. 28%) (P < 0.05 for both). After controlling for age and levels fused on multivariable regression, patients who had surgery during the pandemic had shorter LOS (IRR = 0.83, P = 0.015) and greater odds of home discharge (odds ratios [OR] = 7.2, P < 0.001). Notably, there were no differences in major complications, reoperations, readmissions, or ED visits between the two groups.

Conclusion.
During the COVID-19 pandemic, LOS for patients undergoing thoracolumbar ASD surgery decreased, and more patients were discharged home without adversely affecting complication or readmission rates. Lessons learned during the pandemic may help improve resource utilization without negatively influencing short-term outcomes.

Level of Evidence: 3
A MULTITASK DEEP-LEARNING SYSTEM FOR ASSESSMENT OF DIABETIC MACULAR ISCHEMIA ON OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IMAGES
Authors: Yang Dawei , Sun Zihan , Shi Jian , Ran Anran , Tang Fangyao , Tang Ziqi , Lok Jerry , Szeto Simon , Chan Jason , Yip Fanny , Zhang Liang , Meng Qianli , Rasmussen Martin , Grauslund Jakob , Cheung Carol Y. 
Published: August 2021

Purpose:
We aimed to develop and test a deep-learning system to perform image quality and diabetic macular ischemia (DMI) assessment on optical coherence tomography angiography (OCTA) images.

Methods:
This study included 7,194 OCTA images with diabetes mellitus for training and primary validation and 960 images from three independent data sets for external testing. A trinary classification for image quality assessment and the presence or absence of DMI for DMI assessment were labeled on all OCTA images. Two DenseNet-161 models were built for both tasks for OCTA images of superficial and deep capillary plexuses, respectively. External testing was performed on three unseen data sets in which one data set using the same model of OCTA device as of the primary data set and two data sets using another brand of OCTA device. We assessed the performance by using the area under the receiver operating characteristic curves with sensitivities, specificities, and accuracies and the area under the precision-recall curves with precision.

Results:
For the image quality assessment, analyses for gradability and measurability assessment were performed. Our deep-learning system achieved the area under the receiver operating characteristic curves >0.948 and area under the precision-recall curves >0.866 for the gradability assessment, area under the receiver operating characteristic curves >0.960 and area under the precision-recall curves >0.822 for the measurability assessment, and area under the receiver operating characteristic curves >0.939 and area under the precision-recall curves >0.899 for the DMI assessment across three external validation data sets. Grad-CAM demonstrated the capability of our deep-learning system paying attention to regions related to DMI identification.

Conclusion:
Our proposed multitask deep-learning system might facilitate the development of a simplified assessment of DMI on OCTA images among individuals with diabetes mellitus at high risk for visual loss.
Rapid eye movement predominant obstructive sleep apnoea: prognostic relevance and clinical approach
Authors: Pirzada Abdul Rouf , BaHammam Ahmed S. 
Published: August 2021

Purpose of review
Rapid eye movement (REM) obstructive sleep apnoea (OSA) is a stage-specific OSA, in which obstructive events occur primarily during REM sleep. This review discusses REM-OSA definitions, its cardiometabolic correlates, associated comorbidities and treatment, and addresses diagnostic ambiguities and therapeutic pitfalls.

Recent findings
Current evidence indicates that REM-OSA is prevalent among younger age groups and women and is independently associated with cardiometabolic complications, particularly hypertension, metabolic complications such as insulin resistance and metabolic syndrome. However, currently, there is no consensus on the accepted diagnostic criteria for REM-OSA. Available data suggest that adherence to positive airway pressure (PAP) therapy in patients with REM-OSA is suboptimal. Moreover, the currently accepted criteria for good adherence to PAP therapy of 4 h/night, 70% of the days may not be suitable for REM-OSA, as it will not cover most of the REM sleep periods. In addition, further research is needed to assess the impact of REM-OSA treatment on cardiometabolic outcomes.

Summary
Patients with REM-OSA are at an increased risk of cardiometabolic complications. A high index of suspicion is needed to diagnose this disorder, and close follow-up is required to enhance adherence to therapy.
Hydroxychloroquine for pre-exposure prophylaxis of COVID-19 in health care workers: a randomized, multicenter, placebo-controlled trial (HERO-HCQ)
Authors: Naggie Susanna , Milstone Aaron , Castro Mario , Collins Sean P. , Seetha Lakshmi , Anderson Deverick J. , Cahuayme-Zuniga Lizbeth , Turner Kisha Batey , Cohen Lauren W. , Fraulo Elizabeth , Friedland Anne , Garg Jyotsna , George Anoop , Mulder Hillary , Olson Rachel E. , O’Brien Emily C. , Rothman Russell L. , Shenkman Elizabeth , Shostak Jack , Woods Christopher W. , Anstrom Kevin J. , Hernandez Adrian F. 
Published: August 2021

ABSTRACTObjectiveTo determine whether hydroxychloroquine (HCQ) is safe and effective at preventing COVID-19 infections among health care workers (HCW).DesignMulticenter, 1:1 randomized, placebo-controlled, double-blind, parallel-group, superiority trial.Setting34 clinical centers in the United States.Participants1360 HCW at risk for COVID-19 infection enrolled between April and November 2020.InterventionsA loading dose of HCQ 600 mg twice on Day 1 followed by 400 mg daily for 29 days or matching placebo taken orally.Main Outcome MeasureComposite of confirmed or suspected COVID-19 clinical infection by Day 30 defined as new onset fever, cough, or dyspnea and either a positive SARS-CoV-2 PCR test (confirmed) or a lack of confirmatory testing due to local restrictions (suspected).ResultsEnrollment for the study was closed before full accrual due to difficulties recruiting additional participants. The primary composite endpoint occurred in 41 (6.0%) participants receiving HCQ and 53 (7.8%) participants receiving placebo. No statistically significant difference in the proportion of participants experiencing clinical infection (estimated difference of -1.8%, 95% confidence interval -4.6% to 0.9%, p=0.20). We identified no significant safety issues.ConclusionOral HCQ taken as prescribed appeared to be safe in a group of HCW. No significant clinical benefits were observed. The study was underpowered to rule out a small but potentially important reduction in COVID-19 infections.Trial RegistrationNCT04334148
Factors associated with self-reported health among New Zealand military Veterans: a cross-sectional study
Authors: McBride David , Samaranayaka Ari , Richardson Amy , Gardner Dianne , Wyeth Emma , De Graaf Brandon , Derrett Sarah 
Published: August 2021

ABSTRACTObjectiveTo identify factors associated with better or poorer self-reported health status in New Zealand Military Veterans.DesignAn online cross-sectional survey.ParticipantsThe total number of eligible Veterans is unknown, but a total of 1,817 Veterans responded, including 1009 serving personnel providing a 26% response rate from that group.Study variablesHealth status was self-reported using the EQ-5D-5L, which asks about problems across five dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression), with five levels of severity (e.g. no, slight, moderate, severe or extreme problems). The EQ-5D-5L also contains a visual analogue scale (EQ-VAS), scaled from 0 (worst) to 100 (best) imagined health. Hypothetical relationships with better health were positive social support, sleep and psychological flexibility; with poorer health, exposure to psychological trauma, distress and hazardous drinking.ResultsThe proportion of Veterans reporting ‘any problems’ compared to ‘no problems’ with the five EQ-5D dimensions, was similar to those found in the general NZ population, although a higher proportion of Veterans reported problems with mobility, self-care, usual activities and pain/discomfort. Psychological flexibility and better sleep quality were associated with higher EQ-VAS scores; distress was associated with lower EQ-VAS scores.ConclusionIn this sample of New Zealand Veterans, psychological flexibility and good sleep are associated with better self-rated health, and distress and poor sleep with diminished health. These factors might be used as sentinel health indicators in assessing Veteran health status. As distress, psychological flexibility and sleep are closely related, cognitive behavioural therapy encompassing these domains may be useful in improving the health of New Zealand Veterans.Strengths and limitations of this studyMany studies of Veterans have focused on adverse outcomes, but we have been able to focus on a holistic measure of ‘health’.The study was sufficiently powered to detect important relationships indicating opportunities for intervention.The exact response rate is unknown, and possible bias may be a limitation.The cross-sectional design means that we cannot explore cause and effect relationships.
An evaluation of community-based comprehensive vision care for the ageing population
Authors: Yang She Chiu , Law Tsz Kin , Lucas Leung Yan Lok , Tam Yim Ying , Sum Rita , Lian Jinxiao , Yap Maurice 
Published: August 2021

ABSTRACTObjectiveThis study was conducted to evaluate the real-world effectiveness and potential cost-effectiveness of a community-based vision care programme for the ageing population aged 60 years or above.MethodsData from a total of 8899 subjects participating in a community based comprehensive vision care programme from 2015 to 2019 were extracted and analyzed to evaluate the effectiveness of the programme in terms of the prevalence of visual impairment (VI), the change in the prevalence of VI after refractive error correction, and the types of ocular disorders detected. VI was defined by a) visual acuity (VA) worse than 6/18 in any eye (worse eye) and b) VA worse than 6/18 in the better eye. The cost-effectiveness from the funder’s perspective was also estimated in terms of cost per VI avoided from such a programme.ResultsThe study found that referenced to VA of the worse eye, the prevalence of VI was 39.1% (3482/8899, 95% CI: 38.1%-40.1%) based on presenting VA and reduced to 13.8% (1227/8899, 95% CI: 13.1%-14.5%) based on best-corrected VA. Referenced to the VA in the better eye, the prevalence of VI was 17.3% (1539/8899, 95% CI: 16.5%-18.1%) based on presenting VA and decreased to 4.2% (373/8899, 95% CI: 3.8%-4.6%) after best-corrected VA. Uncorrected refractive error was the major cause of presenting VI. From the funder’s perspective, the cost per VI case prevented was HK$1921 based on VA in the worse eye and HK$3715 based on the better eye.ConclusionA community-based programme was effective to detect the VI and reduced a relative 65% to 76% VI after refractive error correction for the community-dwelling ageing population. The ageing population can benefit from regular comprehensive vision care.