bluuebunny/crossref_metadata_2025_split huggingface dataset:
The digital health landscape at children’s hospitals in Canada
Authors: Le Cathie-Kim , Mousseau Sarah , Zipursky Amy R , Jessa Karim , Rosenfield Daniel , Yarahuan Julia , Parsons Chase , Yan Adam P 
Published: November 2024

ABSTRACT

Objectives
Canadian hospitals have historically lagged behind peer nations in terms of adoption of digital health tools. The aim of this study was to assess the current state of adoption of digital health tools at children’s hospitals in Canada.

Methods
We conducted an online survey of Canadian pediatric tertiary-care hospitals between January and July 2023. The 35-item questionnaire was administered in English and French. Hospital characteristics, informatics infrastructure data and electronic health record (EHR) functionality data were summarized using descriptive statistics.

Results
The survey was completed by 15 of the 17 (88.2%) pediatric hospitals in Canada. All institutions had an EHR with 10 (66.6%) being fully digitized and five (33.3%) being partially digitized. Funding and availability of clinicians with expertise in clinical informatics were cited as barriers to implementing digital health tools. The availability of core EHR functionalities ranged from 53.3% for medication to 100% for the presence of a laboratory and radiology information system. Only five (33.3%) institutions reported that they had a patient portal.

Discussion
While all hospitals in this study had an EHR, functionalities varied greatly between centers. Canada lags behind the United States in terms of adoption of digital health tools such as patient portals likely due to governmental mandates and incentives, and a focus on cultivating a physician informatics workforce.

Conclusion
Canadian pediatric hospitals lag behind peer institutions in digital maturity. This study highlights the perceived need from hospitals for policies, funding, and resources from the Canadian government to help increase the uptake of comprehensive EHRs.
Ecological role of a cosmopolitan testate rhizopod, Paulinella ovalis, in the microbial food web of a eutrophic estuary
Authors: Townsend Luke , Hall Nathan S 
Published: November 2024

Abstract
Paulinella ovalis is a heterotrophic, nanoplanktonic rhizopod that is poorly studied yet cosmopolitan and abundant in coastal waters. Heterotrophic nanoplankton ecology has focused primarily on heterotrophic nanoflagellates that are important picoplankton consumers and prey for larger heterotroph–recycling nutrients and transferring energy to higher trophic levels. We hypothesized a similar role for P. ovalis and assessed it by examining P. ovalis’s spatial and seasonal distribution relative to picocyanobacterial prey and potential microzooplankton predators in the Neuse River Estuary (North Carolina, USA), measuring its growth rate and estimating its potential grazing pressure on picocyanobacteria. P. ovalis abundance paralleled picocyanobacteria with higher abundance in warmer, saltier waters. Negative temporal correlations between P. ovalis and ciliate abundance and significant P. ovalis mortality at high ciliate biomass suggested that ciliates are important predators of P. ovalis. Based on an ~11 000 cells mL−1 average summertime abundance, estimated 0.37 d−1 growth rate and assumed growth efficiency of 0.3, P. ovalis potentially consumes ~60% of the picocyanobacteria and ~30% of total primary production in the summer per day. Results demonstrate P. ovalis’s potential importance within the microbial food web and should motivate future studies of grazing rates by and on P. ovalis to assess its role more quantitatively.
Strong long ties facilitate epidemic containment on mobility networks
Authors: Mou Jianhong , Tan Suoyi , Zhang Juanjuan , Sai Bin , Wang Mengning , Dai Bitao , Ming Bo-Wen , Liu Shan , Jin Zhen , Sun Guiquan , Yu Hongjie , Lu Xin 
Published: November 2024

Abstract
The analysis of connection strengths and distances in the mobility network is pivotal for delineating critical pathways, particularly in the context of epidemic propagation. Local connections that link proximate districts typically exhibit strong weights. However, ties that bridge distant regions with high levels of interaction intensity, termed strong long (SL) ties, warrant increased scrutiny due to their potential to foster satellite epidemic clusters and extend the duration of pandemics. In this study, SL ties are identified as outliers on the joint distribution of distance and flow in the mobility network of Shanghai constructed from 1 km × 1 km high-resolution mobility data. We propose a grid-joint isolation strategy alongside a reaction–diffusion transmission model to assess the impact of SL ties on epidemic propagation. The findings indicate that regions connected by SL ties exhibit a small spatial autocorrelation and display a temporal similarity pattern in disease transmission. Grid-joint isolation based on SL ties reduces cumulative infections by an average of 17.1% compared with other types of ties. This work highlights the necessity of identifying and targeting potentially infected remote areas for spatially focused interventions, thereby enriching our comprehension and management of epidemic dynamics.
In vivo functional significance of direct physical interaction between Period and Cryptochrome in mammalian circadian rhythm generation
Authors: Kawabe Junko , Kajihara Kohhei , Matsuyama Yohei , Mori Yukiya , Hamano Teruki , Mimaki Mai , Kitamura Yukari , Matsumura Ritsuko , Matsuyama Makoto , Sato Masahiro , Ohtsuka Masato , Node Koichi , Akashi Makoto 
Published: November 2024

Abstract
In the current model, the auto-negative feedback action of Period (Per) and Cryptochrome (Cry) on their own transcription is the hallmark mechanism driving cell-autonomous circadian rhythms. Although this model likely makes sense even if Per and Cry undertake this action in a mutually independent manner, many studies have suggested the functional significance of direct physical interaction between Per and Cry. However, even though the interaction is a biochemical process that pertains to the fundamentals of the circadian oscillator, its in vivo contribution to circadian rhythm generation remains undefined. To answer this question, we focused on zinc coordination between Per and Cry, whose contribution to circadian rhythm generation remains undefined. Specifically, we aimed to impair endogenous Per–Cry association by introducing an amino acid substitution to zinc-coordinating residues located at the Per1 and Per2 C-terminal facing Cry in mice. These mice did not show severe impairment in the Per–Cry physical interaction, but rather a shortened period and decreased robustness in circadian rhythms at the tissue-autonomous and whole-body levels. Furthermore, these mice also showed a decrease in Per half-life, suggesting that impaired fine-tuning of Per half-life caused abnormal circadian period and robustness in vivo. We also found a minor but significant impact of a reindeer-specific Per2 mutation located in the Per–Cry interface on circadian rhythms in vivo. These lines of evidence indicate that only partial impairment of the Per–Cry physical interaction produces a substantial effect on circadian period and robustness, supporting the in vivo functional significance of the interaction.
Estimating time-to-total knee replacement on radiographs and MRI: a multimodal approach using self-supervised deep learning
Authors: Cigdem Ozkan , Chen Shengjia , Zhang Chaojie , Cho Kyunghyun , Kijowski Richard , Deniz Cem M 
Published: November 2024

Abstract

Purpose
Accurately predicting the expected duration of time until total knee replacement (time-to-TKR) is crucial for patient management and health care planning. Predicting when surgery may be needed, especially within shorter windows like 3 years, allows clinicians to plan timely interventions and health care systems to allocate resources more effectively. Existing models lack the precision for such time-based predictions. A survival analysis model for predicting time-to-TKR was developed using features from medical images and clinical measurements.

Methods
From the Osteoarthritis Initiative dataset, all knees with clinical variables, MRI scans, radiographs, and quantitative and semiquantitative assessments from images were identified. This resulted in 895 knees that underwent TKR within the 9-year follow-up period, as specified by the Osteoarthritis Initiative study design, and 786 control knees that did not undergo TKR (right-censored, indicating their status beyond the 9-year follow-up is unknown). These knees were used for model training and testing. Additionally, 518 and 164 subjects from the Multi-Center Osteoarthritis Study and internal hospital data were used for external testing, respectively. Deep learning models were utilized to extract features from radiographs and MR scans. Extracted features, clinical variables, and image assessments were used in survival analysis with Lasso Cox feature selection and a random survival forest model to predict time-to-TKR.

Results
The proposed model exhibited strong discrimination power by integrating self-supervised deep learning features with clinical variables (eg, age, body mass index, pain score) and image assessment measurements (eg, Kellgren-Lawrence grade, joint space narrowing, bone marrow lesion size, cartilage morphology) from multiple modalities. The model achieved an area under the curve of 94.5 (95% CI, 94.0-95.1) for predicting the time-to-TKR.

Conclusions
The proposed model demonstrated the potential of self-supervised learning and multimodal data fusion in accurately predicting time-to-TKR that may assist physicians to develop personalize treatment strategies.
The frequency and clinical associations of opioid use in systemic sclerosis
Authors: Fairley Jessica L , Hansen Dylan , Proudman Susanna , Sahhar Joanne , Ngian Gene-Siew , Apostolopoulos Diane , Walker Jennifer , Host Lauren V , Stevens Wendy , Ferdowsi Nava , Tabesh Maryam , Nikpour Mandana , Ross Laura 
Published: November 2024

Abstract

Objective
To define the frequency and associations of opioid use in SSc.

Methods
Australian Scleroderma Cohort Study participants meeting ACR/EULAR criteria for SSc were included. Current or previous opioid use was recorded at each visit, with long-term use defined as use on two or more consecutive visits. Groups were compared using two-sample t-test, Wilcoxon rank sum test or chi-squared test. Generalised estimating equations were used to model longitudinal data.

Results
Of 1951 participants with a mean age of 46.7 years (s.d. 14.4), 88% were female and 12% had ever received any opioids since SSc onset. Of these, 46% recorded opioid use across multiple consecutive study visits. Digital ulcers (63% vs 52%), synovitis (57% vs 38%), interstitial lung disease (37% vs 27%), gastrointestinal (GI) symptoms (upper 97% vs 88%, lower 90% vs 80%) and immunosuppression (59% vs 46%) were all more frequent in opioid-exposed groups (P &lt; 0.05). In multivariable modelling, current opioid use at each study visit was associated with digital ulcers [odds ratio (OR) 1.5 (95% CI 1.1, 2.0), P = 0.01], synovitis [OR 1.5 (95% CI 1.1, 2.1), P = 0.02], lower GI symptoms [OR 1.8 (95% CI 1.3, 2.6), P &lt; 0.01] and poorer physical [OR 1.8 (95% CI 1.3, 2.4), P &lt; 0.01] and mental [OR 1.8 (95% CI 1.1, 3.0), P = 0.02] quality of life (QoL). Current opioid use was associated with worse fatigue [regression coefficient (RC) 3.0 units (95% CI 1.2, 4.8), P &lt; 0.01], functional disability [RC 0.2 (95% CI 0.2, 0.3), P &lt; 0.01], dyspnoea [RC 2.0 (95% CI 0.8, 3.1), P &lt; 0.01], depression [RC 2.5 (95% CI 0.9, 4.0), P &lt; 0.01] and anxiety [RC 2.5 (95% CI 0.9, 4.0), P &lt; 0.01].

Conclusions
Opioid use in SSc was associated with musculoskeletal, GI and lung involvement. Opioid prescription was associated with poorer QoL and physical function.
Simulated nitrogen deposition and precipitation events alter microbial carbon cycling during early stages of litter decomposition
Authors: Kroeger Marie E , Wang Renée Z , Suazo Dennis , Yoshida Thomas , Albright Michaeline B N , Dunbar John 
Published: November 2024

Abstract
Plant litter decomposition is a major nutrient input to terrestrial ecosystems that is primarily driven by microorganisms. Litter quality is considered a key drive of decomposition; however, human-induced global disturbance like nitrogen deposition and increasing extreme precipitation events will shift nutrient availability during litter decomposition. Little is known about how shifting nutrient availability will impact dissolved organic matter concentrations and microbially driven carbon cycling that are critical to soil organic matter formation. This study investigated the effect of simulated nitrogen deposition and repeated precipitation events on microbially driven carbon flow during short-term litter decomposition using a ‘common garden’ experiment with microcosms containing sand and blue grama grass litter inoculated with different microbial communities. Overall, nitrogen deposition decoupled respiration and dissolved organic carbon (DOC) by increasing respiration and not affecting DOC concentrations. Moreover, nitrogen deposition had no effect on microbial carbon use efficiency (CUE). Repeated simulated precipitation events significantly increased DOC concentrations, decreased microbial CUE, increased the microbial metabolic quotient (qCO2), and altered microbial composition and diversity. These findings highlight the complex interactions and responses of surface litter decomposers to shifting nutrient availability and contradicts previous findings that nitrogen deposition will increase soil carbon sequestration from a larger supply of DOC and reduced respiration.
Examining the influence of intolerance of uncertainty on (occupational) future time perspective and retirement-related outcomes in working adults
Authors: Laguerre Rick A , Barnes-Farrell Janet L 
Published: November 2024

Abstract
Uncertainty regulation models have recently challenged the assumption that uncertainty is inherently negative, describing ways that uncertainty regulation can lead to effectiveness. The goal of this study was to empirically test a small component of these dynamic frameworks. We accomplished this through measuring intolerance of uncertainty—a predisposition towards fearing an uncertain future—as a predictor of retirement-related outcomes, via future time perspective and occupational future time perspective. In Study 1, based on a heterogenous two-wave sample of working adults, (T1 N = 975, T2 N = 875), we tested intolerance of uncertainty as a predictor of financial risk tolerance towards retirement, retirement saving behaviors, and motivation to continue working, via future time perspective. Study 1 revealed that intolerance of uncertainty had a significant indirect effect on motivation to continue working and financial risk tolerance towards retirement, via future time perspective—suggesting that tolerating uncertainty is beneficial for aging workers through shaping an open-ended future time perspective. In Study 2, we used a heterogenous three-wave sample of working adults (T1 N = 587, T2 N = 454, T3 N = 406) and evaluated intolerance of uncertainty as a predictor of perceived work ability, via occupational future time perspective. Consistent with expectations, Study 2 reinforced the conclusions of Study 1. Overall, we provide empirical support for aspects of these uncertainty regulation frameworks. We discuss our findings in the context of uncertainty regulation, (occupational) future time perspective, and successful workplace aging.
Bone phenotyping of murine hemochromatosis models with deficiencies of Hjv, Alk2, or Alk3: The influence of sex and the bone compartment
Authors: Dogan Deniz Y. , Hornung Isabelle , Pettinato Mariateresa , Pagani Alessia , Baschant Ulrike , Seebohm Guiscard , Hofbauer Lorenz C. , Silvestri Laura , Rauner Martina , Steinbicker Andrea U. 
Published: November 2024

AbstractOsteopenia is frequently observed in patients with iron overload, especially in those with HFE‐dependent hereditary hemochromatosis (HH). Interestingly, not all mouse models of HH show bone loss, suggesting that iron overload alone may not suffice to induce bone loss. In this study, the bone phenotypes of Hjv−/− and hepatocyte‐specific Alk2‐ and Alk3‐deficient mice as additional mouse models of HH were investigated to further clarify, how high iron levels lead to bone loss and which signaling mechanisms are operational. Neither male nor female 12‐week‐old Hjv−/− mice had an altered trabecular or cortical bone mass or bone turnover, despite severe iron overload. Male 12‐month‐old Hjv−/− mice even presented with a higher femoral trabecular bone volume compared to wildtype mice. Similarly, female mice with hepatocyte‐specific Alk2 or Alk3 deficiency did not show an altered bone phenotype at 3, 6, and 12 months of age. Male hepatocyte‐specific Alk3‐deficient mice also had a normal trabecular bone mass at all ages analyzed, despite showing increased bone resorption and decreased bone formation parameters. Interestingly, hepatocyte‐specific Alk2‐deficient mice showed reduced femoral trabecular bone at 6 months of age due to suppressed bone formation. Cortical thickness at the femur was reduced in both, 6‐month‐old male hepatocyte‐specific Alk2‐ and Alk3‐deficient mice. Raising hepatocyte‐specific Alk2‐deficient male mice on an iron‐deficient diet rescued the bone phenotype. Taken together, despite iron overload, trabecular bone microarchitecture was not altered in mice deficient of Hjv or Alk3. Only male hepatocyte‐specific Alk2‐deficient mice showed site‐specific lower trabecular and cortical bone mass at the femur, which was dependent on iron. Thus, bone loss does not correlate with the extent of iron overload in these mouse models, but may relate to the amount of iron‐loaded macrophages, as precursors of osteoclasts, in the bone marrow.
Trends in Cervical Laminoplasty Incidence in the United States
Authors: Rajan Prashant V. , Heo Kevin , Heller John G. , Yoon Sangwook Tim 
Published: November 2024

Study Design:
Retrospective database study.

Objective:
To leverage a commercial insurance claims database to explore trends in laminoplasty utilization and reimbursement in the United States. Secondarily, volume estimates were compared with data from the industry and from the Centers for Medicare and Medicaid (CMS).

Summary of Background Data:
With purported benefits of motion preservation and lower complication rates than fusion, cervical laminoplasty is an important surgical technique. However, current commercial database studies suggest that laminoplasty adoption in the United States has been slow.

Methods:
The primary outcome was the total volume of laminoplasty procedures performed in the United States per year. Truven, a large commercial insurance claims database, was used to estimate laminoplasty volume from 2009 to 2019. Volume estimates for posterior cervical fusions were also generated as a comparator. Reimbursement data for laminoplasty adjusted for inflation were also generated. Trends in national procedural volumes and reimbursement over time were assessed with the Pearson correlation test. CMS Part B national summary statistics from 2000 to 2022 and market data from laminoplasty device manufacturers from 2017 to 2024 were qualitatively compared with volume estimates from Truven.

Results:
Truven volume of laminoplasty remained stable throughout the study period with an estimated annual volume of 944–1590 cases. Posterior cervical fusion volume was much higher, ranging from 7930 to 11,874 cases with increased trend. When compared qualitatively, Truven volume estimates were similar to those from CMS data, although industry volume estimates were comparatively higher (estimated total volume of 8352–11,428 cases). There was no statistically significant trend in Truven reimbursement values for laminoplasty from 2009 to 2019.

Conclusions:
Industry market data suggest more laminoplasty procedures are being performed nationally than what is estimated by commercial/CMS databases. This suggests possible growth in laminoplasty usage, given purported advantages to fusion in the properly indicated patient, and possibly calls into question the epidemiological accuracy of commercial claims databases.

Level of Evidence:
IV—Retrospective study.
An Analysis of the Association of Whole Blood Transfusion With the Development of Acute Respiratory Distress Syndrome
Authors: Moreno Arianna R. , Fisher Andrew D. , Long Brit J. , Douin David J. , Wright Franklin L. , Rizzo Julie A. , April Michael D. , Cohen Mitchell J. , Getz Todd M. , Schauer Steven G. 
Published: November 2024

OBJECTIVES:
To determine the association of whole blood and other blood products (components, prothrombin complex concentrate, and fibrinogen concentrate) with the development of acute respiratory distress syndrome (ARDS) among blood recipients.

DESIGN:
Retrospective cohort study.

SETTING:
American College of Surgeons Trauma Quality Improvement Program (TQIP) database between 2020 and 2021.

PATIENTS:
Patients 15 years old or older in the TQIP database between 2020 and 2022 who received at least one blood product.

INTERVENTIONS:
We compared characteristics and blood product administration between patients who developed ARDS versus those who did not.

MEASUREMENTS AND MAIN RESULTS:
There were 134,863 that met inclusion for this analysis. Within the included population, 1% (1927) was diagnosed with ARDS. The no ARDS group had a lower portion of serious injuries to the head/neck (31% vs. 46%), thorax (51% vs. 78%), abdomen (34% vs. 48%), and extremities (37% vs. 47%). The median composite Injury Severity Score was 21 (11–30) in the no ARDS group vs. 30 (22–41) in the ARDS group. Unadjusted survival of discharge was 74% in the no ARDS group vs. 61% in the ARDS group. In our multivariable model, we found that whole blood (unit odds ratio [uOR], 1.05; 95% CI, 1.02–1.07), male sex (odds ratio, 1.44; 95% CI, 1.28–1.63), arrival shock index (uOR, 1.03; 95% CI, 1.01–1.06), and composite Injury Severity Score (uOR, 1.03; 95% CI, 1.03–1.04) were associated with the development of ARDS. These persisted on sensitivity testing.

CONCLUSIONS:
We found an association between whole blood and the development of ARDS among trauma patients who received blood transfusions. Contrary to previous studies, we found no association between ARDS and fresh frozen plasma administration. The literature would benefit from further investigation via prospective study designs.
Rocking Motion Therapy for Delirious Patients in the ICU: A Multicenter Randomized Clinical Trial
Authors: Collet Marie Oxenbøll , Nielsen G. M. , Thorn Linette , Laerkner Eva , Fischer Susanne , Bang Benita , Langvad Anne , Granholm Anders , Egerod Ingrid 
Published: November 2024

OBJECTIVES:
Rocking motion therapy has been shown to calm people with dementia but has never been investigated in delirious patients in the ICU. The aim of this clinical trial was to investigate the efficacy and safety of a rocking motion vs. nonrocking motion chair on the duration of delirium and intensity of agitation in ICU patients with delirium. We hypothesized that rocking motion therapy would increase the number of days alive without coma or delirium at 2 weeks of follow-up.

DESIGN:
This was a multicenter, investigator initiated, parallel-group randomized controlled trial.

SETTING/PATIENTS:
ICU patients 18 years or older with a positive delirium assessment.

INTERVENTIONS:
Participants were assigned to either a minimum of 20 minutes rocking motion therapy or a minimum of 20 minutes in the same chair without rocking motion therapy turned on daily.

MEASUREMENTS AND MAIN RESULTS:
The primary outcome was days alive without coma or delirium 2 weeks after randomization. We enrolled 149 patients; 73 were randomly assigned to rocking motion therapy and 76 to nonrocking motion therapy. Primary outcome data were available in 141 patients.

CONCLUSIONS:
Among patients with delirium in the ICU, the use of rocking motion therapy did not lead to a statistically significantly greater number of days alive without coma or delirium at the 2 weeks of follow-up than nonrocking motion therapy.