bluuebunny/crossref_metadata_2025_split huggingface dataset:
Foveal Avascular Zone development by OCTA: weighing the influence of Gestational Age and neonatal early growth independently of Retinopathy of Prematurity
Authors: Campo-Gesto Ana , Rodríguez-Fernández Carmen Antía , Baltazar Sara T. , Concheiro-Guisán Ana 
Published: December 2024

Purpose:
Focusing the premature birth and its potential complications, this study analyzes Foveal Avascular Zone (FAZ) measured by Optical Coherence Tomography Angiography (OCTA) and its correlation with the severity of prematurity and neonatal growth.

Methods:
A cross-sectional comparative study was performed, involving 71 children school-age with history of prematurity and a full-term children control group. Several variables from the neonatal period were collected, such as Gestational Age (GA), Birth Weight (BW), initial Weight Gain (WG) and Retinopathy of Prematurity (ROP). OCTA scans determined FAZ perimeter, circularity, and area on both Superficial Capillary Plexus (SCP) and Deep Capillary Plexus (DCP).

Results:
A positive correlation between GA and FAZ area and perimeter was identified, with a smaller FAZ (p<0.001) in preterm children. Furthermore, scatter plots showed a rising trend for all FAZ values based on GA and BW. Thus, children with greater WG during the first 15 days of life had a larger FAZ (p<0.05). GA was also predictive (p<0.001) for FAZ area and perimeter, while the ROP stage was a better predictor (p<0.0232) for its circularity.

Conclusions:
OCTA finds discrepancies in FAZ between premature and full-term children, with GA and neonatal growth having a greater influence than ROP itself.
Endocrinologic Dysfunctions and Neuropsychiatric Sequelae in Pediatric Patients With a History of Central Nervous System Infection (ENDLESS): A Prospective Monocentric Study
Authors: Sodero Giorgio , Cipolla Clelia , Camporesi Anna , Martino Laura , Costa Simonetta , Cannioto Zemira , Frassanito Paolo , Tamburrini Gianpiero , Veredice Chiara , Maggio Luca , Munblt Daniel , Raffaelli Francesca , Piastra Marco , Zampino Giuseppe , Valentini Piero , Buonsenso Danilo 
Published: December 2024

Introduction:
Central nervous system (CNS) infections represent some of the most critical pediatric health challenges, characterized by high mortality rates and a notable risk of long-term complications. Despite their significance, standardized guidelines for endocrinological follow-up of CNS infection survivors are lacking, leading to reliance on the expertise of individual centers and clinicians.

Materials and Methods:
Prospective monocentric observational study conducted at the Fondazione Policlinico Universitario Agostino Gemelli in Rome, Italy. It included patients with a history of CNS infection, admitted to various pediatric departments of the hospital. The participants were selected based on a coded diagnosis of CNS infection and had completed their follow-up at the Pediatric Endocrinology Day Hospital after October 2019.

Results:
Eighty participants were included, comprising 53 patients with a prior CNS infection and 27 healthy controls, with a median age of 7.4 years (range 3.6–12.3 years). Endocrinologic alterations were detected in 13 patients, with 8 cases in those who had meningitis, 4 in encephalitis survivors, and 1 in a patient with a cerebral abscess. Patients with a history of CNS infections were shorter compared with healthy controls (P = 0.027). Moreover, those who had meningitis exhibited an increased risk of developing epilepsy (P = 0.01), neurosensory disabilities (P = 0.034) and the need for ventriculoperitoneal shunt insertion (P = 0.006). Patients with bacterial CNS infections were more prone to neurosensory and endocrine dysfunctions compared to those with viral or other infections. Significant differences were observed in hormone levels between previously infected patients and controls, specifically in TSH (P < 0.001), ACTH (P = <0.001), and cortisol (P = 0.019). IGF-1 levels were considerably lower in the infection group, both in absolute terms and when adjusted for sex and age (P < 0.001). The regression analysis suggested that the reduction in IGF-1 was more pronounced the earlier the CNS infection occurred, irrespective of infection type.

Conclusions:
Our study found several endocrinologic imbalances in children who survived CNS infections.
Changes in Emergency Department Practices After Implementation of a Standardized Heavy Menstrual Bleeding Guideline
Authors: Isaacson Erin E. , Isa Rabab S. , Monge Maria C. , Pike Jordyn , Compton Sarah , Afriyie-Gray Akua , Salazar Christina 
Published: December 2024

Objective
The aim of the study is to assess the effect of an emergency department (ED) standardized clinical guideline for adolescent heavy menstrual bleeding on the rate of return ED visits and ED provider history-taking and management of this condition.

Methods
This was a retrospective cohort study. Patients less than 18 years old presenting to a single academic children's hospital ED between 2010 and 2020 with a chief complaint of heavy menstrual bleeding were included. Patient demographics were collected, along with a 10-point scale of provider documentation of specific medical and menstrual history components and required laboratory workup. Planned treatment plans were collected, as well as hospital admissions and return ED visits (within 3 weeks).

Results
Total number of patients was 267 (n = 106 pre- and n = 161 post-), with similar distribution of age ranges between groups (14.6 [2.2] and 14.5 [2.0], P = 0.73). On the 10-point scale of required history and laboratory evaluations, postimplementation patients received 1.9 more points than the precohort (P < 0.001). Age (−0.22 [95% confidence interval {CI} −0.36 to −0.08]) and evaluation by a trainee physician (0.75, [95% CI 0.09 to 1.41]) were also associated with significant differences in point totals. Documentation of outpatient follow-up with primary care physician or an adolescent medicine/gynecology specialist significantly increased (50% and 90% P < 0.001). Implementation was associated with a decrease in ED return visits in multivariate analysis (odds ratio 0.27, [95% CI 0.08 to 0.92], P = 0.036).

Conclusions
Implementation of a clinical guideline pathway improved provider documentation and history taking, increased referrals to specialist care, and significantly decreased return ED visits within 3 weeks for heavy menstrual bleeding complaints.
Improved Adherence to Lipid Screening in the Pediatric Cardiology Clinic: A Quality Improvement Project
Authors: Magnan Rachel A. , Murphy Thomas , Rosenthal Lauren , Prasad Aparna , Chelliah Anjali , Kaufman Stuart , Timchak Donna , McPhillips Lindsey , Siddiqui Saira 
Published: December 2024

Introduction:
Lipid screening identifies at-risk patients to facilitate cardiovascular risk reduction. National pediatric guidelines recommend universal lipid screening between 9–11 and 17–21 years of age. We aimed to improve adherence to lipid screening for all age-appropriate outpatient pediatric cardiology visits from a baseline of 35% to 90% between November 2021 and July 2023.

Methods:
All outpatient visits for patients 9–11 and 17–21 years were included. Chart review and an Epic electronic health record report identified patients screened, lipid test results, and need for further testing. A P-chart was generated. After establishing a baseline for 8 weeks, interventions, including an Epic dot phrase, group and individual feedback, and Epic best practice alert (BPA), were incorporated via plan-do-study-act cycles. Balancing measures included anonymous provider surveys on visit length and experience.

Results:
More than 1,700 patient visits were included. At baseline, 35% of all age-appropriate patients were screened. The Epic dot phrase prompted a positive shift with a new mean of 59% screened. Another change occurred after the BPA alert, with an increase in screening to 84%. Lipid screening prompted by this initiative found that 38% of those with testing results in Epic had abnormal results requiring follow-up. Providers did not report a significant change in visit length due to screening.

Conclusions:
Quality improvement interventions improved adherence to universal lipid screening guidelines. The Epic dot phrase and BPA facilitated positive shifts. These simple interventions can be spread to other practices to improve adherence to lipid screening and other guidelines.
Evidence for spinal disinhibition as a pain-generating mechanism in fibromyalgia syndrome
Authors: Marshall Anne , Burgess Jamie , Goebel Andreas , Frank Bernhard , Alam Uazman , Marshall Andrew 
Published: December 2024

Abstract

Introduction:
Pain phenomenology in patients with fibromyalgia syndrome (FMS) shows considerable overlap with neuropathic pain. Altered neural processing leading to symptoms of neuropathic pain can occur at the level of the spinal cord, and 1 potential mechanism is spinal disinhibition. A biomarker of spinal disinhibition is impaired H-reflex rate-dependent depression (HRDD).

Objectives:
This study investigated whether patients with FMS exhibit evidence of spinal disinhibition.

Methods:
Thirty-one individuals with FMS and 20 healthy volunteers underwent testing of Hoffman reflex including HRDD, along with assessment of clinical signs and symptoms, pressure pain thresholds, temporal summation of pain (wind-up), and conditioned pain modulation (CPM). Small nerve fibre structure was quantified using intraepidermal nerve fibre density and corneal confocal microscopy.

Results:
Patients with FMS had significantly impaired HRDD at 1 Hz (P = 0.026) and 3 Hz (P = 0.011) and greater wind-up ratio (P = 0.008) compared with healthy controls. Patients with the most impaired HRDD also had the most inefficient CPM but HRDD was not associated with wind-up. Both HRDD and CPM were most impaired in patients with a shorter duration of disease.

Conclusion:
We demonstrate for the first time that people with FMS show evidence of spinal disinhibition, which is most dominant in shorter duration of disease and may represent a putative mechanism of pain generation in FMS. Identifying people with impairment of central pain processing at an early stage may provide opportunities for targeted mechanistically directed interventions. Longitudinal studies are warranted to tease out the precise contribution of these mechanisms.
Diagnostic Value of the Color Doppler Ultrasound Standardized Semiquantitative Score Combined With Sound Touch Elastography in Liver Fibrosis in Patients With Chronic Hepatitis B: A Retrospective Cohort Study
Authors: Wu Yali , Dai Huiying , Li Dan , Li Li , Ou Liang 
Published: December 2024

Purpose
This study aims to evaluate the diagnostic value of standardized semiquantitative scoring of color Doppler ultrasound combined with liver stiffness measurement (LSM) of sound touch elastography (STE) in chronic hepatitis B (CHB) patients, providing a reference for the liver fibrosis diagnosis.

Methods
We performed ultrasound and STE on CHB patients, with liver biopsies as the benchmark. We compared the differences in ultrasound standardized semiquantitative scoring and LSM among patients with different stages of liver fibrosis, and evaluated the diagnostic efficacy of significant liver fibrosis using receiver operating characteristic (ROC) curves and the area under the ROC curve alone or in combination.

Results
The total scores of ultrasound semiquantitative scoring and LSM showed statistically significant differences among patients with different stages of liver fibrosis (P < 0.05). There was no statistically significant difference in the total scores of S0 and S1 stages or in the LSM values (P > 0.05). However, the total scores and LSM values for patients at stages S2 and S3 were both higher than those at stage S0, and increased with the severity of fibrosis staging, with statistically significant differences (P < 0.05). The results of the ROC curve analysis showed that the combined diagnosis of significant liver fibrosis with ultrasound standardized semiquantitative scoring and STE had an area under the curve of 0.807, which was significantly greater than using ultrasound standardized semiquantitative scoring (0.694, P < 0.05) or shear wave elastography alone (0.706, P < 0.05).

Conclusions
Color Doppler ultrasound with standardized semiquantitative scoring combined with STE examination can detect significant liver fibrosis (≥S2) in CHB patients.
FDG PET/CT in a Case of Gardner Syndrome
Authors: Shan Lili , Dong Aisheng , Han Yan 
Published: December 2024

Abstract
Gardner syndrome is characterized by multiple intestinal polyps and extraintestinal lesions. We describe FDG PET/CT findings of the extraintestinal lesions in a patient with Gardner syndrome. FDG PET/CT showed 2 hypermetabolic desmoid tumors in the abdominal wall, sclerotic areas with multifocal activity in the maxilla and mandible, multiple osteomas in the bilateral parietal, left frontal, sphenoid and ethmoid bones, an impacted tooth in the right maxilla, and bone islands in the T2 and T5 vertebral bodies. Extraintestinal involvements in Gardner syndrome can precede intestinal polyposis. Therefore, familiarity with FDG PET/CT findings of extraintestinal manifestations is helpful for early diagnosis.
Measuring Residents' Competence in Chest Tube Insertion on Thiel-Embalmed Bodies
Authors: De Mol Leander , Van Herzeele Isabelle , Van de Voorde Patrick , Vanommeslaeghe Hanne , Konge Lars , Desender Liesbeth , Willaert Wouter 
Published: December 2024

Introduction
Chest tube insertions (CTIs) have a high complication rate, prompting the training of technical skills in simulated settings. However, assessment tools require validity evidence prior to their implementation. This study aimed to collect validity evidence for assessment of technical skills in CTI on Thiel-embalmed human bodies.

Methods
Invitations were sent to residents and staff from the departments of surgery, pulmonology, and emergency medicine. Participants were familiarized with the Thiel body and the supplied equipment. Standardized clinical context and instructions were provided. All participants performed 2 CTIs and were assessed with the Assessment for Competence in Chest Tube InsertiON (ACTION) tool, consisting of a 17-item rating scale and a 16-item error checklist. Live and post hoc video-based assessments by 2 raters were performed. Generalizability analysis was performed to evaluate reliability. Mean scores and errors were compared using a mixed-model repeated measures analysis of variance (ANOVA). A pass/fail score was determined using the contrasting groups' method.

Results
Ten novices and 8 experienced participants completed the study. The Generalizability coefficients were moderate for the rating scale (0.75), and low for the error checklist (0.4). Novices scored lower on the rating scale?? (44±6.7/68 vs 50.8 ± 5.7/68, P = 0.024), but did not commit significantly more errors (1.6 ± 1.1/16 vs 1.0 ± 0.6/16, P = 0.066). A pass/fail score of 47/68 was established.

Conclusion
The rating scale in the Assessment for Competence in Chest Tube InsertiON tool has a robust validity argument for use on Thiel-embalmed bodies, allowing it to be used in simulation-based mastery learning curricula. In contrast, its error checklist has insufficient reliability and validity to be used for summative assessment.
Sacral Neuromodulation Reprogramming Rates: Understanding Office-Based Requirement
Authors: Query Helen , Morgan Tyler , Klausner Adam P. , Burkett Linda S. 
Published: December 2024

Importance
Sacral neuromodulation (SNM) is a procedure with the advantage of reprogramming for discomfort or inadequate symptom control.

Objectives
The aims of this study were to investigate the rates of office-based SNM programming in a large multisite cohort and to examine differences based on implantation indication.

Study Design
The TriNetX database was utilized for retrospective cohort comparison using International Classification of Diseases, Tenth Revision, and Current Procedural Terminology (CPT) codes. Cohort selection included female adults with a diagnosis of urinary retention, urgency urinary incontinence, and/or fecal incontinence (FI) at time of implantation. The primary outcome was the rate of SNM reprogramming CPT per individual from 6 weeks to 5 years postimplantation. Secondary outcomes included demographic comparisons, incidence, and survival curves for patients with SNM reprogramming identified with CPT codes. Further comparisons were completed between implantation diagnoses of grouped urinary (urgency and retention) versus fecal indications.

Results
A total of 9,501 patients meet inclusion criteria with a mean of age 62.1 ± 14.9 years (range, 18–90). Office-based SNM reprogramming was identified in 31.5%. The probability of never having reprogramming at 5 years was 52.5%. The mean number of reprogramming sessions was 2.5 ± 2.1. Approximately half (48%) of the patients with FI also had a diagnosis of urgency urinary incontinence, and approximately 25% had urinary retention. The probability of never having reprogramming was 55% and higher in patients with a fecal incontinence indication than those with only urinary indications at 50%, P < 0.001.

Conclusions
Office-based SNM reprogramming occurs in 31.5% of patients with implants, and rates are likely underreported. Patients with any FI diagnosis have a higher risk of requiring reprogramming.
The effects of capital grants to subnational governments under fiscal stress: evidence from the Spanish regions
Authors: Lago-Peñas Santiago , Vaquero García Alberto , Cadaval Sampedro María , Sanchez-Fernandez Patricio 
Published: December 2024

Purpose
This paper aims to examine the impact of capital grants on the fiscal choices of Spanish regional governments from 1984 to 2021.

Design/methodology/approach
After running a battery of tests to verify the integration order of variables, joint cointegration and causality direction, the authors estimate a series of vector autoregressive models.

Findings
The results show that capital grants were highly effective until 2007, boosting capital expenditure and generating a significant crowding-in effect on capital expenditure in the long run. Then, the authors specifically analyze structural changes due to the deep impact of the Great Recession in Spain since 2008. However, the crowding-in effect still holds. Conditionality and matching rates are relevant elements of a sound definition of grant programs to subcentral governments.

Originality/value
The findings contribute significantly to the existing literature on fiscal federalism and regional economics.
Scale development and validation of green country image: focusing on Chinese consumers
Authors: Lee You-Kyung , Li Yi , Liu Yu 
Published: December 2024

PurposeThis study aims to develop and validate a new scale for measuring green country image (GCI). The current country image (CI) concept is recognized as limited in capturing the complexities of consumer perceptions today. By building a GCI scale, this study can provide a more nuanced understanding of how consumers evaluate a country’s image beyond traditional measures. This scale will be a valuable tool for international marketers to develop effective strategies in the 21st century’s dynamic global business landscape.Design/methodology/approachThis study adopts a mixed-methods approach to develop and validate a new scale for measuring GCI. This approach leverages the strengths of both qualitative and quantitative methods to gain a comprehensive understanding of the concept and develop a reliable measurement tool.FindingsA reliable and valid scale was developed to measure the six dimensions of GCI: social green country image (SOGCI), economic green country image (ECGCI), environmental green country image (ENGCI), technological green country image (TEGCI), leadership green country image (LEGCI) and people green country image (PEGCI). In results, the new GCI scale is a six-dimensional, 23-item, five-point scale. An important finding was that these six factors were statistically significant reflective scales.Originality/valueBy developing a validated GCI scale, this study offers valuable insights for international marketers navigating the evolving consumer perceptions of importing countries. This novel scale empowers the international marketers to tailor strategies and target specific markets based on GCI. The mixed-methods approach strengthens the GCI scale’s robustness, making it a significant contribution to both academic research and international marketing practice.
Resilience in maritime chokepoint disruption and its implications
Authors: Lim Hoong Keat , Chiu Sai Hoi 
Published: December 2024

PurposeWith global attention on the increasing disruptions in primary maritime chokepoints, such as the Suez Canal Blockage incident that happened in March 2021, it has come to our realization that disruptions in maritime chokepoints may be detrimental to all maritime stakeholders. This research project aims to study and verify the factors of disruptions and their implications on maritime chokepoints from the industrial players’ perspective. Information contained in this report should interest maritime professionals from fleet ownership and management, and commercial freight owners of the tramp and liner shipping.Design/methodology/approachThis research project uses questionnaire surveys and semi-structured interviews to collect primary data targeted at professionals and industrial players from the maritime industry. Qualitative and quantitative assessments are applied in data analysis. Secondary information via credible industry and news reports, research papers and other related literature and materials are gathered to support and add on to the analysis in the discussion section.FindingsOur literature review has categorized maritime chokepoint disruptions into (1) chokepoint risk, (2) maritime security and (3) ship loss risk. The information and data from primary research not only complemented our research and affirmed that chokepoint risk as the primary concern for our interviewed maritime professionals, but at the same time covered the research gap for the lack of information in those new emerging chokepoint disruption factors, for example increased vessel size, cyber-security and the COVID-19 pandemic. The findings from the primary and secondary research reflected the implications of chokepoint disruptions as economic losses from operations and market loss. Although primary research reflected slight effectiveness in combating emergencies faced by maritime chokepoint disruptions through proactive strategies, they still serve the merit in raising awareness for the maritime industry. Nevertheless, the findings highlighted the importance of having reactive strategies to engage in volatility faced during such disruptive events.Originality/valueThis empirical research study provides fresh insights into the new emerging factors of maritime chokepoint disruptions and their implications via the perspective from the industrial players in the maritime industry.