bluuebunny/crossref_metadata_2025_split huggingface dataset:
National health expenditure per capita is associated with CRT implantation practice: findings from the ESC CRT Survey II with 11 088 patients
Authors: Normand Camilla , Bogale Nigussie , Linde Cecilia , Tsintzos Stelios , Ihara Zenichi , Dickstein Kenneth 
Published: November 2024

Abstract

Aims
Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in selected patients with heart failure (HF) and electrical dyssynchrony. This treatment receives class IA recommendations in European Society of Cardiology (ESC) guidelines. However, despite these strong recommendations, CRT implantation practice varies greatly in Europe. The purpose of the sub-analysis of CRT Survey II data was to describe how countries’ health per capita expenditure affects CRT implantation practice.

Methods and results
Between 2015 and 2016, two ESC associations, European Heart Rhythm Association and Heart Failure Association, conducted the CRT Survey II, a survey of CRT implantations in 11 088 patients in 42 ESC member states. We analysed CRT patient selection and guideline adherence in those countries according to high or low health expenditure per capita. There were 21 high health expenditure countries (n = 6844 patients) and 21 (n = 3852) with low health expenditure. The countries with the lowest health expenditure were more likely to implant CRT in patients who had strong guideline recommendations for implantation, younger patients and those recently hospitalized for HF or with symptomatic HF (67% vs. 58%, P &lt; 0.001). The ratio of CRT-Pacemaker (CRT-P) to CRT-Defibrillator (CRT-D) was similar in both spending groups, as was the percentage of CRT implantation in women.

Conclusion
CRT Survey II has demonstrated a non-uniform delivery of healthcare. Countries with low health expenditure per capita appear to be reserving CRT therapy for younger patients, those with class IA indication and patients with more severe symptoms of heart failure.
Clinical stage IA non-small cell lung cancer with occult pathologic N1 and N2 disease after segmentectomy: does a completion lobectomy justify?
Authors: Luo Xun , Hayanga Jeremiah William Awori , Mehaffey James Hunter , Lamb Jason , Campbell Stuart , Reddy Shalini , Badhwar Vinay , Toker Alper 
Published: November 2024

Abstract

OBJECTIVES
When final pathology shows pathologic N1 or N2 disease after a pulmonary segmentectomy for early stage non-small cell lung cancer (NSCLC), completion of lobectomy could be considered and recommended as an option for treatment. We explored outcomes after segmentectomy for clinical stage IA NSCLC with occult pN1 or pN2 disease.

METHODS
We identified clinical stage IA NSCLC undergoing segmentectomy or lobectomy from the National Cancer Database (NCDB) between 2010 and 2020. We categorized patients by pathologic N diseases (pN0/pN1/pN2). We compared segmentectomy to lobectomy adjusting for patient and clinical characteristics. We explored survival using time-varied Cox regression, 30-day, 90-day mortality and unplanned 30-day readmission using logistic regression, and length of stay using Poisson regression.

RESULTS
Of 123 085 clinical IA NSCLC, 7.9% underwent segmentectomy. Pathology showed 2.8% pN1 and 1.9% pN2 after segmentectomy, and 6.5% pN1 and 3.7% pN2 after lobectomy. For pN1, segmentectomy conferred 33% better survival within 2 years (aHR = 0.67, P = 0.03), but similar survival after 2 years (aHR = 1.06, P = 0.7). For pN2, segmentectomy had similar survival with lobectomy (aHR = 0.96, P = 0.7). For all clinical IA NSCLC, segmentectomy was associated with lower 30-day mortality (aOR = 0.55, P &lt; 0.001), 90-day mortality (aOR = 0.57, P &lt; 0.001), readmission (aOR = 0.86, P = 0.01) and shorter length of stay (aRR = 0.76, P &lt; 0.001) than lobectomy.

CONCLUSIONS
Outcomes after segmentectomy for clinical stage IA NSCLC may be associated with better short-term mortality, readmission rate and length of stay. Survival with occult pN1 and pN2 after segmentectomy is at least equivalent to lobectomy in completely resected clinical stage IA patients. A completion lobectomy may not be needed after pN1 and N2 findings after the permanent pathology was released.
Prone position in obese patients with acute respiratory distress syndrome after cardio-thoracic surgery
Authors: Bouteau Astrid , Sarfati Celine , Cachanado Marine , Perrier Johann , Imbert Audrey , Genty Thibaut , Stéphan François 
Published: November 2024

Abstract

OBJECTIVES
Prone positioning (PP) has benefits in patients with acute respiratory distress syndrome. The objective of this study was to compare the effects and complications of PP in obese versus non-obese patients with moderate-to-severe acute respiratory distress syndrome after cardiothoracic surgery.

METHODS
We retrospectively analysed a database established in 2014–2021 in an intensive care unit. The primary end point was the change in PaO2/FiO2 induced by PP. Secondary end points included pressure ulcers, mediastinitis and intensive care unit mortality. The groups with versus without obesity (body mass index &gt;30 kg/m2) were compared, and a mixed linear model was built to identify factors associated with the PaO2/FiO2 change.

RESULTS
81 patients with acute respiratory distress syndrome (36 with vs 45 without obesity) and 189 PP sessions were included. PP duration was 17.2 ± 4.5 h in obese and 18.0 ± 3.8 h in non-obese patients (P = 0.23). Mean number of sessions was 2.6 ± 1.4 in obese and 2.1 ± 1.3 in non-obese patients (P = 0.10). Median PaO2/FiO2 increase after the 1st PP session was 75.0% [14.5–123.0] and 72% [15.5–130.5] in the groups with versus without obesity (P = 0.67). Stage 3/4 pressure ulcers were more common in the obese group (44.4% vs 22.2%; P = 0.03) and occurred chiefly on the face. No significant differences between the obese and non-obese groups were found for mediastinitis (16.7% vs 8.9%, P = 0.33) or intensive care unit mortality (22% vs 20%, P = 0.81).

CONCLUSIONS
Improvement of oxygenation was not statistically different between patients with versus without obesity. Pressure ulcers were more common in the obese group, whereas mediastinitis was not. No patient experienced wound dehiscence.
Cardiovascular magnetic resonance imaging in mitral valve disease
Authors: Garg Pankaj , Pavon Anna Giulia , Penicka Martin , Uretsky Seth 
Published: November 2024

Abstract
This paper describes the role of cardiovascular magnetic resonance (CMR) imaging in assessing patients with mitral valve disease. Mitral regurgitation (MR) is one of the most prevalent valvular heart diseases. It often progresses without significant symptoms, leading to left ventricular overload, dysfunction, frequent decompensated heart failure episodes, and excess mortality. Cardiovascular magnetic resonance assessment is recommended for MR when routine ultrasound imaging information is insufficient or discordant. A well-planned CMR can provide an in-depth assessment of the mitral valve apparatus, leaflet morphology, and papillary muscles. In addition, it can precisely inform the impact of MR on left atrial and ventricular remodelling. The review aims to highlight established and emerging techniques for morphological assessment, flow assessment (including regurgitation and stenosis), myocardial assessment, and haemodynamic assessment of mitral valve disease by CMR. It also proposes a simplified clinical flow chart for CMR assessment of the mitral valve.
Hill-Robertson interference may bias the inference of fitness effects of new mutations in highly selfing species
Authors: Daigle Austin , Johri Parul 
Published: November 2024

Abstract
The accurate estimation of the distribution of fitness effects (DFE) of new mutations is critical for population genetic inference but remains a challenging task. While various methods have been developed for DFE inference using the site frequency spectrum of putatively neutral and selected sites, their applicability in species with diverse life history traits and complex demographic scenarios is not well understood. Selfing is common among eukaryotic species and can lead to decreased effective recombination rates, increasing the effects of selection at linked sites, including interference between selected alleles. We employ forward simulations to investigate the limitations of current DFE estimation approaches in the presence of selfing and other model violations, such as linkage, departures from semidominance, population structure, and uneven sampling. We find that distortions of the site frequency spectrum due to Hill-Robertson interference in highly selfing populations lead to mis-inference of the deleterious DFE of new mutations. Specifically, when inferring the distribution of selection coefficients, there is an overestimation of nearly neutral and strongly deleterious mutations and an underestimation of mildly deleterious mutations when interference between selected alleles is pervasive. In addition, the presence of cryptic population structure with low rates of migration and uneven sampling across subpopulations leads to the false inference of a deleterious DFE skewed towards effectively neutral/mildly deleterious mutations. Finally, the proportion of adaptive substitutions estimated at high rates of selfing is substantially overestimated. Our observations apply broadly to species and genomic regions with little/no recombination and where interference might be pervasive.
The presentation and treatment of Dupuytren’s disease in Dutch general practitioner care
Authors: van Straalen Roel J M , Broekstra Dieuwke C , Werker Paul M N , de Boer Michiel R 
Published: November 2024

Abstract

Background
When research and management of Dupuytren’s disease (DD) shift from symptom relief to preventing contractures, general practitioner (GP) care may become more central to treatment. However, the presentation and course of DD in GP care are underexplored and this has been recognized as a knowledge gap that hinders effective treatment decisions. This study is the first to map the trajectory of DD patients in GP care.

Methods
Using electronic health records from Dutch general practices in a regional research network, we conducted a registration-based cohort study in a dynamic population. Descriptive statistics detailed patient demographics, number of contacts, and symptoms per contact. The time and number of contacts before diagnosis were also analysed. Sankey diagrams illustrated the relationship between management options and symptoms.

Results
Over a 16-year period, 84% of patients with a DD diagnosis had visited their GP for this reason, with 73% only having one GP contact. The diagnosis was made at first contact for 93% of patients. Initial contacts often reported a lump (57.3%), but this symptom was less frequent in subsequent visits. ‘Daily life impairment’ increased after the first contact. The most common management options were referral to secondary care (37.7%) and watchful waiting (35.1%).

Conclusion
The diagnosis and management of DD in GP care are in line with the current guidelines. Less than half of the DD patients were referred to secondary care during follow-up. This may give room for preventive treatment that limits progression. Future studies should focus on the accuracy of diagnosis and the feasibility of effective treatments in GP care.
Proper counseling for diagnosis and management of cannabinoid hyperemesis syndrome: a case report
Authors: Cholette-Tétrault Samuel , Grad Roland 
Published: November 2024

Abstract

Background
Cannabinoid hyperemesis syndrome (CHS) is an increasingly recognized condition linked to chronic cannabis use, yet it remains frequently overlooked in clinical practice. The syndrome is characterized by cyclic episodes of severe nausea, vomiting, and abdominal pain, often relieved temporarily by hot showers or baths. With the rising prevalence of cannabis use following its legalization, the incidence of CHS has surged, presenting a significant challenge in both diagnosis and management within primary healthcare settings. Understanding the epidemiology, risk factors, and potential long-term sequelae of CHS is crucial for timely identification and intervention. This case report highlights the challenge of diagnosis and management of CHS in primary healthcare.

Objective(s)
To emphasize the importance of proper counseling and the use of Rome IV criteria in diagnosing CHS. To illustrate how this may reduce patient suffering and unnecessary investigation.

Case
A 22-year-old female with chronic, daily cannabis use presented with recurrent episodes of intense nausea, vomiting, and abdominal pain over a 2-year period. Extensive diagnostic evaluations were inconclusive. A tentative diagnosis of CHS was made by a medical student and family doctor based on published criteria. The Rome IV criteria were then applied for confirmation of diagnosis and management. In so doing, the patient was advised to cease cannabis use for a minimum of 3 months. Initially, symptom improvement was reported with cannabis cessation. However, symptoms recurred following a relapse in cannabis use.

Conclusion
To confirm the diagnosis of CHS, counseling should specify the need for a minimum of 3 months of cannabis cessation to achieve symptom relief. Increased physician and patient awareness of this minimal time period for drug cessation can help to avoid unnecessary investigations, and prolonged patient suffering. This case emphasizes the need for vigilance in recognizing CHS and consideration of cannabis as a potential cause of cyclic vomiting.
Modelling of two-dimensional seismic waves in double-porosity media using the frequency-domain finite-element method
Authors: Jiang Yaochang , Gao Yongxin , Wang Dongdong , Song Yongjia , Zhou Guanqun , Yao Cheng 
Published: November 2024

SUMMARY
We present a frequency-domain finite-element (FDFE) method for simulating PSV-mode seismic waves (including two slow compressional waves) in 2-D double-porosity media. A functional, whose extremum corresponds to the governing equations with boundary conditions for 2-D PSV waves, is constructed. Solving the boundary value problem of the governing equations is thus equivalent to finding the extremum of the associated functional. We use structured rectangular elements to discretize the computational domain and employ perfectly matched layers (PMLs) to absorb the seismic waves. The FDFE method is validated by comparing the results with those from a semi-analytic method. Numerical simulations are conducted to investigate the propagation of seismic waves in double-porosity media. Assuming a non-viscous pore fluid, we simulate the propagation of slow P waves (P2 and P3 waves) in a two-layer model consisting of double-porosity media. We observe the reflection and transmission of the P2 and P3 waves at the interface. Additionally, we simulate the propagation of seismic waves in a model with irregular interfaces. Seismic signals collected from horizontal and vertical receiver arrays have demonstrated that the P1 wave experiences higher attenuation in a double-porosity medium.
Weather at the core: defining and categorizing geomagnetic excursions and reversals
Authors: Constable Catherine , Morzfeld Matthias 
Published: November 2024

SUMMARY
Paleomagnetic records provide us with information about the extreme geomagnetic events known as excursions and reversals, but the sparsity of available data limits detailed knowledge of the process and timing. To date there are no agreed on criteria for categorizing such events in terms of severity or longevity. In an analogy to categorizing storms in weather systems, we invoke the magnitude of the global (modified) paleosecular variation index $P_{i_D}$ to define the severity of the magnetic field state, ranging in level from 0 to 3, and defined by instantaneous values of $P_{i_D}$ with level 0 being normal ($P_{i_D}\lt 0.5$) to extreme ($P_{i_D}\ge 15$). We denote the time of entry to an excursional (or reversal) event by when $P_{i_D}$ first exceeds 0.5, and evaluate its duration by the time at which $P_{i_D}$ first returns below its median value, termed the end of event threshold. We categorize each excursional event according to the peak level of $P_{i_D}$ during the entire event, with a range from Category-1 (Cat-1) to Cat-3. We explore an extended numerical dynamo simulation containing more than 1200 events and find that Cat-1 events are the most frequent (72 per cent), but only rarely lead to actual field reversals where the axial dipole, $g_1^0$, has reversed sign at the end of the event. Cat-2 account for about 20 per cent of events, with 34 per cent of those leading to actual reversals, while Cat-3 events arise about 8 per cent of the time but are more likely to produce reversals (43 per cent). Higher category events take as much as 10 times longer than Cat-1 events. Two paleomagnetic field models separately cover the Laschamp excursion and Matuyama–Brunhes (M-B) reversal which are Cat-2 events with respective durations of 3.6 and 27.4 kyr. It seems likely that Cat-2 may be an underestimate for M-B due to limitations in the paleomagnetic records. Our overall results suggest no distinction between excursions and reversals other than a reversal having the ending polarity state opposite to that at the start.
Indonesian medical interns’ intention to practice in rural areas
Authors: Findyartini Ardi , Qorina Fona , Putera Azis Muhammad , Anugrapaksi Eghar , Khumaini Aulia Nafi Syifa Putri , Putera Ikhwanuliman , Syahmar Ikrar , Samarasekera Dujeepa D 
Published: November 2024

Abstract
The maldistribution of physicians, especially in rural areas, remains a global public health challenge. The internship programme for medical doctors is one of the efforts undertaken to address this issue. However, evidence aiming to disentangle this persistent challenge in the Indonesian context has been scant. This study aims to identify factors influencing medical doctors’ intentions to practise in rural areas and how these factors affect their decisions. We adopted a sequential explanatory mixed-method design using a validated questionnaire. Then, focus group discussions were conducted with medical doctors from three different regions (West, Central, and East) to gain in-depth understanding of motivations, intentions, and barriers to practicing in rural areas. Participants were intern doctors who had been practising for at least 6 months in their internship locations. Quantitative analysis was based on a questionnaire addressing each factor, rated using five-point Likert scales, with bivariate and multivariate logistic regression analyses. The qualitative results were analysed using thematic analysis. In total, 498 respondents completed the questionnaire where 9.6%, 49%, and 40.9% intend to practise in rural, suburban, and urban areas, respectively. Three factors were positively associated with a preference for rural practice: prior living experience in rural areas, accessibility to cultural centres and events, and personal savings as funding resources during medical school. However, the importance of ‘internet accessibility’ was negatively associated with a preference for rural practice. Furthermore, the qualitative study involving 18 participants resulted in four main themes: the role of the internship programme in enhancing motivation as medical doctors, factors generally influencing the intention to practise, factors influencing the intention to practise in rural areas, and policy recommendations to increase the intention to practise in rural areas. Addressing the challenge of attracting and retaining medical doctors in rural areas requires multisectoral approaches involving both personal and professional factors.
Managing medicines in decentralization: discrepancies between national policies and local practices in primary healthcare settings in Indonesia
Authors: Fanda Relmbuss Biljers , Probandari Ari , Kok Maarten Olivier , Bal Roland A 
Published: November 2024

Abstract
In Indonesia, primary health centres (PHCs) are mandated to provide essential medicines to ensure equal access to medication for all Indonesians, as stated in the national medicine policy. However, limited information is available regarding the actual practices of health workers within the context of decentralized governance. This paper investigates the discrepancies between national policies and local practices in two Indonesian districts, shedding light on coping mechanisms employed in each phase of medicine management within PHCs. The mixed-method study began by identifying pertinent policies addressing medicine management in PHCs. Subsequently, panel data on patient visits to tuberculosis, maternal and neonatal health (MNH), and noncommunicable disease (NCD) services were collected from 2019 to 2022. After analysing the panel data, interviews were conducted with 56 health workers including physicians, nurses, pharmacists, midwives, and public health programme managers regarding their views on fluctuations in medicine stocks and the patient visit data. These participants included pharmacists and programme managers specializing in tuberculosis, MNH, and NCD care and were affiliated with PHCs and district health offices. Our findings highlight the occasional unavailability of essential medicines in PHCs, with stockouts being attributed to supplier shortages at provincial and national levels and to variations in the capacity of the local health system. Low-skilled pharmaceutical staff are a contributing factor in each phase of medicine management. Additionally, health workers employ coping mechanisms, such as deviating from policy on the use of capitation funds to purchase medicines, to manage temporary stockouts. To tackle systemic stockouts, central government should prioritize capacity-building among health workers, by establishing a continuous and easily accessible local learning system.
The regulation of miRNAs using curcumin and other polyphenols during the prevention and treatment of Alzheimer’s disease
Authors: Wang XiYun , Zhang Sale , Li Ying , Zhang Yu 
Published: November 2024

Abstract
Alzheimer’s disease (AD), a prevalent neurodegenerative disorder, predominantly affects individuals over the age of 65 and poses significant challenges in terms of effective management and treatment. The disease’s pathogenesis involves complex molecular pathways including misfolded proteins accumulation, neuroinflammation, and synaptic dysfunction. Recent insights have highlighted the role of microRNAs (miRNAs) as critical regulators within these pathways, where they influence gene expression and contribute to the pathophysiological landscape of AD. Notably, emerging research has demonstrated that polyphenols, including curcumin, might modulate miRNA activity, thus offering a novel approach to mitigate AD symptoms and progression. This review explores the potential mechanisms through which polyphenols regulate miRNA expression and activity, specifically focusing on autophagy enhancement and inflammation reduction in the context of AD. We provide a detailed examination of key studies linking miRNA dysregulation to AD pathogenesis and discuss how polyphenols might correct these aberrations. The findings presented here underscore the therapeutic potential of polyphenols in AD treatment via miRNA modulation, pointing to new directions in disease management strategies and highlighting the need for targeted research into miRNA-based interventions.