bluuebunny/crossref_metadata_2025_split huggingface dataset:
Determining the cancer diagnostic interval using administrative data in a cohort of patients with pancreatic cancer.
Authors: Karim Safiya , Paterson Bailey , Kong Shiying , Mahar Alyson , Webber Colleen , Lee-Ying Richard M. , Cheung Winson Y. , Groome Patti 
Published: September 2021

336 Background: Pancreatic cancer is a leading cause of cancer death, largely due to vague presenting symptoms and late stage at diagnosis. Population-based administrative data can be a valuable resource for studying the diagnostic interval. The objective of this study was to determine the first encounter in the diagnostic interval and to calculate that interval in a cohort of patients with pancreatic cancer using an empirical approach. Methods: This is a retrospective, cohort study of patients diagnosed with pancreatic ductal adenocarcinoma (PDAC) from 2007 – 2015 in Alberta, Canada. We used the Alberta Cancer Registry (ACR), physician billing claims, hospital discharge and emergency room visits to identify health encounters that occurred more frequently in the 3 months prior to diagnosis compared to those in the 3-24 months prior to diagnosis. We used statistical control charts to define the lookback period for each encounter category and identify the earliest encounter that represented the start of the diagnostic interval (index contact date). The end of the interval was the diagnosis date. Quantile regression was used to determine factors associated with the diagnostic interval. Results: We identified 3142 patients with PDAC. Median age of diagnosis was 71 (IQR 61-80). We identified an index contact date in 96.5% of the patients. The median length of the diagnostic interval was 76 days (IQR 21-191; 90th percentile 276 days). A higher Elixhauser comorbidity score (+18.57 days/ 1 point increase, 95% CI 16.07-21.07, p < 0.001) and stage 3 disease (+22.55 days, 95% CI 5.02-40.08, p = 0.01) was associated with a longer diagnostic interval. Conclusions: In this cohort of patients with pancreatic cancer, there was a wide range in the diagnostic interval with 10% of patients having a diagnostic interval approaching one year. Diagnostic interval research using administrative databases can understand variations in diagnosis times, can inform early detection efforts and can improve quality of care.
Death Anxiety, Immortality Projects and Happiness: A Utilitarian Argument Against the Legalization of Euthanasia
Authors: Van der Haak Donovan 
Published: September 2021

The current, utilitarian debate on the relation between euthanasia and happiness focusses primarily on the subject of dying patients. Where some utilitarians stress how euthanasia may relieve suffering in the process of dying, others emphasize the importance of respecting the autonomy of others to make decisions like these themselves. However, less attention has been paid to how legalizing euthanasia may impact the human decision-making processes of those still in a healthy and mentally sound state. This paper aims to shed light on this relatively underdeveloped subject within utilitarian theory. In particular, I focus on euthanasia’s most contested form: active, voluntary euthanasia. I draw on Ernst Becker, who argues that moderate death anxiety stimulates people to work on ‘immortality projects,’ decisions that help them cope with the concept of death. Subsequently, I draw on several studies to defend the notion that immortality projects are indirectly conducive to happiness because they stimulate healthy decisions and long-term, human progress. Additionally, immortality projects counterbalance decisions that are based on an excessive drive for short-term pleasure. As euthanasia can make dying less painful, I argue it may diminish death anxiety to significant degree, and thereby also an incentive to work on immortality projects. This brings me to the conclusion that legalizing euthanasia is problematic from a utilitarian point of view, considering the observation that immortality projects are indirectly conducive to happiness.
Association of comorbidity between Opisthorchis viverrini infection and diabetes mellitus in the development of cholangiocarcinoma among a high-risk population, northeastern Thailand
Authors: Thinkhamrop Kavin , Khuntikeo Narong , Laohasiriwong Wongsa , Chupanit Pornpimon , Kelly Matthew , Suwannatrai Apiporn T. 
Published: September 2021

Background
Cholangiocarcinoma (CCA) is a category of lethal hepatobiliary malignancies. Previous studies have found that Opisthorchis viverrini infection and diabetes mellitus (DM) are closely correlated with CCA. However, few studies have discussed the association of CCA with a combination of both O. viverrini infection and DM. This study aimed to assess the correlation of CCA with various combinations of O. viverrini infection and DM among a high-risk population in northeastern Thailand.

Methodology
This study included participants from 20 provinces in northeastern Thailand who had been screened for CCA in the Cholangiocarcinoma Screening and Care Program (CASCAP) between 2013 and 2019. Histories of O. viverrini infection and DM diagnosis were obtained using a health questionnaire. CCA screening used ultrasonography with a definitive diagnosis based on histopathology. Multilevel mixed-effects logistic regression was performed to quantify the association, which is presented as adjusted odds ratios (aOR) and their 95% confidence intervals (CI).

Principal findings
Overall, 263,776 participants were included, of whom 32.4% were infected with O. viverrini, 8.2% were diagnosed with DM, and 2.9% had a history of both O. viverrini infection and DM. The overall rate of CCA was 0.36%. Of those infected with O. viverrini, 0.47% had CCA; among those with DM, 0.59% had CCA and among those infected with O. viverrini and had DM, 0.73% had CCA. Compared with participants who were not infected with O. viverrini and were non-DM, the aOR for those infected with O. viverrini and with DM was 2.36 (95% CI: 1.74–3.21; p-value <0.001).

Conclusions
The combination of O. viverrini infection and DM was highly associated with CCA, and these two conditions had a combined effect on this association that was greater than that of either alone. These findings suggest that CCA screening should have a strong focus on people with a combination of O. viverrini infection and DM.
Assessment of small-intestine permeability in healthy Nigerian children is altered by urinary volume and voiding status
Authors: Afolami Ibukun , Samuel Folake Olukemi , Mwangi Martin , Oderinde Michael , Diepeveen-de Bruin Marlies , Melse-Boonstra Alida 
Published: September 2021

Objective
This study aimed to uncover the effect of voided urinary volume on small intestine permeability ratios in healthy children.

Methods
We assessed small intestine permeability in 155 apparently healthy children, aged 3–5 years old, without any visible symptoms of disease, in a rural, malaria-endemic setting in Nigeria, using a multi-sugar test solution, comprising lactulose, sucrose, mannitol, and rhamnose. Children were categorized into low urinary volume (LV) and high urinary volume (HV), based on the volume of urine voided per kg body weight per hour. LV children voided less than 25th percentile of the total population, while HV children voided greater than 75th percentile of the total population. Urinary volume excreted over a 90-minute period after administration of the test solution was measured, and differences in sugar ratios were compared between children with high (HV) and low urinary volumes (LV), as well as between children who voided (VC) or who were not able to void (NVC) before administration of the test solution.

Results
Urinary mannitol and rhamnose recovery were 44% (p = 0.002) and 77% (p<0.001) higher in HV children compared to LV children respectively, while urinary lactulose recovery was 34% lower (p = 0.071). There was no difference in urinary sucrose recovery between groups (p = 0.74). Lactulose-mannitol ratio, lactulose-rhamnose ratio and sucrose-rhamnose ratio were all significantly higher in children in the LV group compared to children in the HV group (p<0.001). In a multiple regression analysis, urinary volume and voiding status combined, explained 13%, 23% and 7% of the variation observed in lactulose-mannitol, lactulose-rhamnose and sucrose-rhamnose ratios, respectively.

Conclusion
Sugar permeability ratios vary significantly with total urinary volume in multi-sugar small-intestine permeability tests. Voiding status before sugar administration appears to influence lactulose recovery, lactulose-rhamnose and sucrose-rhamnose ratios independently of total urinary volume. Evidence from this study suggests the need to take urinary volume into account when conducting multi-sugar small-intestine permeability tests.
Tooth retention predicts good physical performance in older adults
Authors: Musacchio Estella , Binotto Pierluigi , Perissinotto Egle , Sergi Giuseppe , Zambon Sabina , Corti Maria-Chiara , Frigo Anna-Chiara , Sartori Leonardo 
Published: September 2021

Background
Oral health is closely related to both physical and psychological well-being, as it enables individuals to eat, speak, and socialize. The number of teeth is the most used indicator of oral health. Several reports document a relationship of dental status with a variety of indicators of general health but longitudinal studies employing standardized physical performance tests are infrequent in the scientific literature.

Subjects and methods
The Italian elderly participating in the Pro.V.A. longitudinal Study (3099 subjects aged 65+ at baseline, 2196 at the 5-year follow-up 1 and 1641 at the 7-year follow- up 2) underwent detailed interview and extensive clinical and instrumental examination that included validated physical performance measures. Participants were classified into 4 groups according to the number of remaining teeth: 0, 1–7, 8–19, and 20+. To explore the association of the number of remaining teeth with physical function and disability, we performed logistic regression analyses with models progressively adjusted for a wide number of covariates, namely anthropometric (gender, age, BMI), comorbidity (cardio-vascular, osteoarticular, and neurological diseases including depression), muscle strength (assessed for upper and lower limbs), lifestyle (smoking status, alcohol use, leisure time activities) and socioeconomical status (education, income, marital status, loneliness).

Results
Dental status correlated with most comorbidities, lifestyle, and socio-economic variables at the univariate analysis at baseline and at follow-ups. A good dental status was significantly associated with better physical functioning and lower disability. The presence of 20+ teeth resulted significantly protective (reference group: 0 teeth) versus mobility-related disability (OR = 0.67), disability (OR = 0.54) and inability to perform heavy duties (OR = 0.62), at follow up 1 and low physical performance score (OR = 0.59) at follow up 2. Conversely, the detrimental effect of edentulism, explored in subjects with or without dentures, was present but not as straightforward. Conclusion. The assessment of a geriatric patient should include an oral evaluation as a good dental status is a crucial component of successful aging.
Replicating prediction algorithms for hospitalization and corticosteroid use in patients with inflammatory bowel disease
Authors: Gan Ryan W. , Sun Diana , Tatro Amanda R. , Cohen-Mekelburg Shirley , Wiitala Wyndy L. , Zhu Ji , Waljee Akbar K. 
Published: September 2021

IntroductionPrevious work had shown that machine learning models can predict inflammatory bowel disease (IBD)-related hospitalizations and outpatient corticosteroid use based on patient demographic and laboratory data in a cohort of United States Veterans. This study aimed to replicate this modeling framework in a nationally representative cohort.MethodsA retrospective cohort design using Optum Electronic Health Records (EHR) were used to identify IBD patients, with at least 12 months of follow-up between 2007 and 2018. IBD flare was defined as an inpatient/emergency visit with a diagnosis of IBD or an outpatient corticosteroid prescription for IBD. Predictors included demographic and laboratory data. Logistic regression and random forest (RF) models were used to predict IBD flare within 6 months of each visit. A 70% training and 30% validation approach was used.ResultsA total of 95,878 patients across 780,559 visits were identified. Of these, 22,245 (23.2%) patients had at least one IBD flare. Patients were predominantly White (87.7%) and female (57.1%), with a mean age of 48.0 years. The logistic regression model had an area under the receiver operating curve (AuROC) of 0.66 (95% CI: 0.65−0.66), sensitivity of 0.69 (95% CI: 0.68−0.70), and specificity of 0.74 (95% CI: 0.73−0.74) in the validation cohort. The RF model had an AuROC of 0.80 (95% CI: 0.80−0.81), sensitivity of 0.74 (95% CI: 0.73−0.74), and specificity of 0.72 (95% CI: 0.72−0.72) in the validation cohort. Important predictors of IBD flare in the RF model were the number of previous flares, age, potassium, and white blood cell count.ConclusionThe machine learning modeling framework was replicated and results showed a similar predictive accuracy in a nationally representative cohort of IBD patients. This modeling framework could be embedded in routine practice as a tool to distinguish high-risk patients for disease activity.
Association between vesicoureteral reflux, urinary tract infection and antibiotics exposure in infancy and risk of childhood asthma
Authors: Hsu Yu-Lung , Lin Cheng-Li , Wei Chang-Ching 
Published: September 2021

BackgroundThe use of antibiotics for treating infection in childhood and their association with increased risk of asthma remain controversial. Infants diagnosed with vesicoureteral reflux (VUR) belong to a unique population who are administered antibiotics for a long time and are susceptible to recurrent UTI. It is interesting to study the risk of asthma in these infants with or without VUR.MethodsTaiwanese children born between 2000 and 2007 were enrolled in population-based birth cohort study. Participants diagnosed with VUR and UTI within first year were classified into four groups (VUR, UTI, VUR and UTI, and control). We calculated follow-up person-years for each participant from the index date until the asthma diagnosis, their withdrawal from the insurance system (because of death or loss to follow-up), or till the end of 2008. The risk of asthma was compared between the 4 cohorts by using Cox proportional hazards model analysis, adjusted hazard ratio (aHR), and 95% confidence interval (95% CI).ResultsChildren diagnosed with VUR (n  =  350), UTI (n  =  15542), VUR and UTI (n  =  1696), and randomly selected controls (n  =  17588) were enrolled. The overall rate of incidence of asthma was found to be 1.64-fold, 1.45-fold, and 1.17-fold higher in the UTI, VUR/UTI, and VUR cohorts than in the controls (5.60, 5.07, and 4.10 vs. 3.17 per 100 person-years), respectively. After adjusting the potential factors, the overall risk of asthma remained the highest in UTI (aHR: 1.74, 95% CI : 1.65 to 1.80) followed by VUR/UTI (aHR: 1.56, 95% CI : 1.40 to 1.75) and VUR cohorts (aHR: 1.25, 95% CI: 0.96 to 1.62). The incidence of asthma was higher in boys than in girls.ConclusionThe nationwide retrospective cohort study demonstrated that short-term therapeutic dose of antibiotics for UTI in infants with or without VUR has a positive correlation with the prevalence of childhood asthma. Significant risk of childhood asthma was not observed when VUR cohort was exposed to long-term low-dose of prophylactic antibiotics.
Efficacy and safety of Qingre-Chushi therapies in active ulcerative colitis: A network meta-analysis
Authors: Zhang Ling , Wu Yun-bo , Dai Yun-kai , Liu Qi , Ren Yu-jie , Xu Shi-jie , Pan Huai-geng , Chen Wei-jing , Li Ru-liu , Hu Ling 
Published: September 2021

Background
Ulcerative colitis (UC) is a chronic inflammatory disease with an increasing incidence in the world. Qingre-Chushi therapies (QC) can alleviate clinical symptoms. Therefore, a network meta-analysis was conducted to systematically evaluate the efficacy and safety of QC in the treatment of active UC patients.

Methods
7 databases were screened and relevant randomized controlled trials were selected. The tools of Cochrane Handbook and the GRADE system were conducted to assess the quality of outcomes. Pooled risk ratio or standard mean difference was calculated with 95% credible interval for outcomes measurement using the random-effects model. The surface under the cumulative ranking curve (SUCRA) was performed to rank the treatments. The larger SUCRA scores, the more effective interventions.

Results
A total of 3560 articles were identified and 21 studies including 1829 participants were included for further analysis. Totally, 9 therapies regimens were compared: oral mesalazine, mesalazine enema, mesalazine suppository, oral mesalazine + mesalazine enema, oral QC, oral QC + oral mesalazine, QC enema, oral QC + QC enema, and oral mesalazine + QC enema. Based on the SUCRA plot, oral QC + oral mesalazine was the best treatment in inducing clinical response; oral QC + QC enema had the best efficacy in the improvement of Mayo scores and alleviating abdominal pain; oral mesalazine + mesalazine enema was the optimal therapy in the endoscopic improvement and reducing diarrhea; QC enema + oral mesalazine was the best option in preventing bloody stool.

Conclusion
This study confirmed the efficacy and safety of QC in treating active UC and suggested that the combination of oral medications with topical can achieve more benefits.
Prevalence and factors associated with family planning during COVID-19 pandemic in Bangladesh: A cross-sectional study
Authors: Roy Nitai , Amin Md. Bony , Maliha Maskura Jahan , Sarker Bibhuti , Aktarujjaman Md , Hossain Ekhtear , Talukdar Gourango 
Published: September 2021

Background and objectives
The COVID-19 pandemic has negatively impacted health systems worldwide, including in Bangladesh, limiting access to family planning information (FP) and services. Unfortunately, the evidence on the factors linked to such disruption is limited, and no study has addressed the link among Bangladeshis. This study aimed to examine the socioeconomic, demographic, and other critical factors linked to the use of FP in the studied areas during the COVID-19 pandemic.

Methods
The characteristics of the respondents were assessed using a cross-sectional questionnaire survey and descriptive statistics. The variables that were substantially linked with FP usage were identified using a Chi-square test. In addition, a multivariate logistic regression model was used to identify the parameters linked to FP in the study areas during the COVID-19 pandemic.

Results
The prevalence of FP use among currently married 15–49 years aged women was 36.03% suggesting a 23% (approximately) decrease compared to before pandemic data. Results also showed that 24.42% of the respondents were using oral contraceptive pills (OCP) which is lower than before pandemic data (61.7%). Multivariate regression analysis provided broader insight into the factors affecting FP use. Results showed that woman’s age, education level of the respondents, working status of the household head, locality, reading a newspaper, FP workers’ advice, currently using OCP, ever used OCP, husbands’ supportive attitude towards OCP use, duration of the marriage, ever pregnant, the number of children and dead child were significantly associated with FP use in the study areas during COVID-19 pandemic.

Conclusions
This study discusses unobserved factors that contributed to a reduction in FP use and identifies impediments to FP use in Bangladesh during the COVID-19 epidemic. This research further adds to our understanding of FP usage by revealing the scope of the COVID-19 pandemic’s impact on FP use in Bangladesh’s rural and urban areas.
Evaluation of thrombophilia testing in the inpatient setting: A single institution retrospective review
Authors: Siu Chun Ting , Wolfe Zachary , DelaTorre Martin , Rehim Erafat , Decker Robert , Zaffiri Kathryn , Lash Bradley 
Published: September 2021

Background
Thrombophilia workup is typically inappropriate in the inpatient setting as testing may be skewed by anticoagulation, acute thrombosis, or acute illness.

Objective
To determine adherence of inpatient thrombophilia testing with institutional guidelines.

Patients and methods
A retrospective study to evaluate thrombophilia testing practices of adult patients who were admitted to Lehigh Valley Hospital at Cedar Crest with either venous thromboembolism or ischemic stroke in 2019. Testing included inherited and acquired thrombophilia. Patient charts were individually reviewed for three measured outcomes: 1) the number of appropriate thrombophilia testing in the inpatient setting; 2) the indications used for thrombophilia testing; 3) the proportion of positive thrombophilia tests with change in clinical management.

Results
201 patients were included in our study. 26 patients (13%) were tested appropriately in accordance with institution guidelines and 175 (87%) patients were tested inappropriately. The most common reason for the inappropriate testing was testing during acute thrombosis. 28 of the 201 patients had positive thrombophilia tests, but the reviewers only noted 7 patients with change in clinical management—involving anticoagulation change.

Conclusion
Our study revealed that a majority of inpatient thrombophilia testing did not follow institutional guidelines for appropriate testing and did not change patient management. These thrombophilia tests are often overutilized and have minimal clinical utility in the inpatient setting.
Nature: Dune of Footprints for String Orchestra (2017); Nature (2012); What Did We See? (2018); Re-greening for Large Singing Orchestra (2015), Tansy Davies
Authors: Gowar Mick 
Published: September 2021

Review of: Nature: Dune of Footprints for String Orchestra (2017); Nature (2012); What Did We See? (2018); Re-greening for Large Singing Orchestra (2015), Tansy Davies
London: NMC, D260, Audio CD, £12.99.
Engineering the “Islamic personality”: Muslim Brotherhood education between theory and practice
Authors: Elsässer Sebastian 
Published: September 2021

Abstract
The Muslim Brotherhood’s ideological belief in Islam as a comprehensive system (šumūlīya) implies ambitious ideas about forming and re-forming the minds, spirits and bodies of Muslim individuals through educational activities within the organisational framework of the Brotherhood. Internal debates reveal that actual educational practice in the Muslim Brotherhood balances different priorities and goals and allows a range of different expressions of Muslim subjectivity. Tensions between different, sometimes contradictory goals are solved theoretically by the concept of balancing (tawāzun) and practically by a division of labour within the movement that only requires a small elite to reach the highest levels of an “Islamic personality” (šaḫṣīya islāmīya). This article traces debates in programmatic and educational writings, in memoirs and in weblogs and social media outlets in order to reach a critical assessment of Muslim Brotherhood education in the Arab world, primarily between the 1980s and the mid-2010s and focused on Egypt and the Arab East.