bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is emergency doctors’ tolerance of clinical uncertainty on a novel measure associated with doctor well-being, healthcare resource use and patient outcomes?
Authors: Budworth Luke , Wilson Brad , Sutton-Klein Joanna , Basu Subhashis , O'Keeffe Colin , Mason Suzanne M , Ang Andrew , Anne-Wilson Sally , Reynard Kevin , Croft Susan , Shah Anoop D , Bank Sakarias , Conner Mark , Lawton Rebecca 
Published: November 2024

IntroductionEmergency doctors routinely face uncertainty—they work with limited patient information, under tight time constraints and receive minimal post-discharge feedback. While higher uncertainty tolerance (UT) among staff is linked with reduced resource use and improved well-being in various specialties, its impact in emergency settings is underexplored. We aimed to develop a UT measure and assess associations with doctor-related factors (eg, experience), patient outcomes (eg, reattendance) and resource use (eg, episode costs).MethodsFrom May 2021 to February 2022, emergency doctors (specialty trainee 3 and above) from five Yorkshire (UK) departments completed an online questionnaire. This included a novel UT measure—an adapted Physicians’ Reaction to Uncertainty scale collaboratively modified within our team according to Hillenet al’s (2017) UT model. The questionnaire also included well-being-related measures (eg, Brief Resilience Scale) and assessed factors like doctors’ seniority. Patient encounters involving prespecified ‘uncertainty-inducing’ problems (eg, headache) were analysed. Multilevel regression explored associations between doctor-level factors, resource use and patient outcomes.Results39 doctors were matched with 384 patients. The UT measure demonstrated high reliability (Cronbach’sα=0.92) and higher UT was significantly associated with better psychological well-being including greater resilience (Pearson’s r=0.56; 95% CI=0.30 to 0.74) and lower burnout (eg, Cohen’s d=−2.98; −4.62 to −1.33; mean UT difference for ‘no’ vs ‘moderate/high’ burnout). UT was not significantly associated with resource use (eg, episode costs: β=−0.07; −0.32 to 0.18) or patient outcomes including 30-day readmission (eg, OR=0.82; 0.28 to 2.35).ConclusionsWe developed a reliable UT measure for emergency medicine. While higher UT was linked to doctor well-being, its impact on resource use and patient outcomes remains unclear. Further measure validation and additional research including intervention trials are necessary to confirm these findings and explore the implications of UT in emergency practice.
Relationship between high-resolution computed tomography quantitative imaging analysis and physiological and clinical features in antisynthetase syndrome-related interstitial lung disease
Authors: Bae Sangmee Sharon , Abtin Fereidoun , Kim Grace , Markovic Daniela , Chan Cato , Moghadam-Kia Siamak , Oddis Chester V , Sullivan Daniel , Marder Galina , Venuturupalli Swamy , Dellaripa Paul F , Doyle Tracy J , Hunninghake Gary Matt , Falk Jeremy , Charles-Schoeman Christina , Tashkin Donald P , Goldin Jonathan , Aggarwal Rohit 
Published: November 2024

ObjectivesTo explore the association between the extent of CT abnormalities by quantitative imaging analysis (QIA) and clinical/physiological disease parameters in patients with antisynthetase syndrome associated interstitial lung disease (ARS-ILD).MethodsWe analysed 20 patients with antisynthetase antibodies and active ILD enrolled in the Abatacept in Myositis-Associated Interstitial Lung Disease study. High-resolution chest CT was obtained at weeks 0, 24 and 48 and QIA scored the extent of ground glass (quantitative score for ground glass), fibrosis (quantitative score for lung fibrosis, QLF) and total ILD (quantitative ILD, QILD). Mixed-effects models estimated longitudinal QIA scores over time. Associations between QIA scores with clinical/physiological parameters were analysed longitudinally using repeated-measures mixed-effects models.ResultsPatients were median age 57 years, 55% males and 85% white. Higher (worse) baseline QIA scores correlated with lower baseline forced vital capacity (FVC) and diffusing capacity adjusted for haemoglobin (DLCO). Longitudinal QIA trajectories trended towards improving scores during the trial, and patients on O2at baseline had worsening QIA trajectories which were different from patients who were not on O2. Longitudinal QIA scores demonstrated strong associations with both FVC and DLCO over time. Higher QILD scores over time were also associated with worse dyspnoea scores, pulmonary visual analogue scale, physician and patient global disease activity, health status in 6/8 domains of the Short Form-36 and higher oxygen requirements. Patients with significant radiographic improvement at 48 weeks had higher baseline QLF, QILD and worse DLCO.ConclusionsLongitudinal QIA scores associate with lung physiology, patient perception of respiratory status, overall disease activity and quality of life over time in ARS-ILD. QIA may allow reproducible monitoring of disease progression and response to therapy over time.Trial registration numberNCT03215927.
Identification of a machine learning-based diagnostic model for axial spondyloarthritis in rheumatological routine care using a random forest approach
Authors: Redeker Imke , Tsiami Styliani , Eicker Jan , Kiltz Uta , Kiefer David , Andreica Ioana , Sewerin Philipp , Baraliakos Xenofon 
Published: November 2024

ObjectivesIn axial spondyloarthritis (axSpA), early diagnosis is crucial, but diagnostic delay remains long and diagnostic criteria do not exist. We aimed to identify a diagnostic model that distinguishes patients with axSpA from patients without axSpA with chronic back pain based on clinical data in routine care.MethodsClinical data from patients with chronic back pain were used, with information on rheumatological examinations based on clinical indications. The total dataset was randomly divided into training and test datasets at a 7:3 ratio. A machine learning-based model was built to distinguish axSpA from non-axSpA using the random forest algorithm. Overall accuracy, sensitivity, specificity and the area under the receiver operating characteristic curve-area under the curve (ROC-AUC) in the test dataset were calculated. The contribution of each variable to the accuracy of the model was assessed.ResultsData from 939 randomly selected patients were available: 659 diagnosed with axSpA and 280 with non-axSpA. In the test dataset, the model reached an accuracy of 0.9234, a sensitivity of 0.9586, a specificity of 0.8438 and a ROC-AUC of 0.9717. Human leucocyte antigen B27 (HLA-B27) contributed most to the accuracy of the model; that is, the accuracy would suffer most from not using HLA-B27, followed by insidious onset of back pain and erosions in the sacroiliac joint.ConclusionsWe provide a machine learning-based model that reveals high performance in diagnosing patients with chronic back pain with axSpA versus without axSpA based on information from a tertiary rheumatology practice. This model has the potential to improve diagnostic delay in patients with axSpA in daily routine settings.
IRIS, a randomised, double-blind, placebo-controlled trial of interleukin-6 receptor inhibition undergoing endovascular treatment in acute anterior circulation ischaemic stroke: study rationale and design
Authors: Chu Xuehong , Ma Zhengfei , Liu Yifeng , Sun Jun , Wang Ning , Li Chaoqun , Feng Xiangyang , Li Jianqiao , Wang Benxiao , Zhou Chen , Li Chuanhui , Zhao Wenbo , Ji Xunming , Wu Chuanjie 
Published: November 2024

RationaleNeuroprotective strategies based on reperfusion therapy hold substantial promise for acute ischaemic stroke (AIS). Preclinical research indicates that tocilizumab, an interleukin-6 receptor antagonist, can attenuate ischaemia-reperfusion damage by exerting anti-inflammatory and neuroprotective effects.AimTo determine tocilizumab’s efficacy and safety when combined with endovascular thrombectomy (EVT) in patients with acute anterior circulation large vessel occlusion (LVO).Sample size estimatesTo determine a 30% decrease in average infarct core volume comparing the intervention and historical control groups (mean increase of 18.7 mL (SD=9.7 mL) post-thrombectomy) via a two-sided test (alpha=0.05, power=80%), accounting for a 10% drop-out rate, we plan to recruit 108 participants.Methods and designThis trial is designed as a randomised, multicentre, double-blind, placebo-controlled trial. Patients will be randomly and evenly allocated to the tocilizumab or placebo groups.Study outcomesThe primary endpoint is the change in infarct core volume between baseline and 72 hours post-treatment. Secondary outcomes include the 90-day modified Rankin scale score (0–2, indicating functional independence). The key safety endpoints include 90-day mortality and symptomatic intracerebral haemorrhage within 72 hours after EVT.DiscussionAdministering tocilizumab within 24 hours of stroke as an adjunct to EVT may effectively reduce the infarct core volume for patients experiencing AIS with anterior circulation LVO, potentially improving functional outcomes in these patients.
Peak V̇O2 during handcycling in spinal cord injured athletes: incremental versus verification testing
Authors: Rosa Caio de Araújo , Antunes Diego , Ventura Thiago Pereira , Fischer Gabriela , Brickley Gary , de Lucas Ricardo Dantas , Turnes Tiago 
Published: November 2024

The present study aimed to compare peak oxygen uptake (V̇O2peak), peak heart rate (HRpeak), and peak O2pulse during an incremental and a verification test performed on the same day in hand-cyclists with spinal cord injury (SCI). Eight competitive SCI hand-cyclists (age: 23 ± 2.7 years; V̇O2peak: 36.3 ± 14.0 mL.kg−1.min−1) performed a maximal incremental handcycling test and a verification test to exhaustion at 100% of the peak speed on an oversized treadmill. The V̇O2peak, HRpeak, and peak O2pulse (i.e., VO2/HR) were compared between incremental and verification tests. Absolute and relative V̇O2peak obtained in the verification test (2.51 ± 0.96 L.min−1; 36.3 ± 14.0 mL.kg.min−1) were significantly higher than values obtained in the incremental test (2.24 ± 0.79 L.min−1; 33.5 ± 12.9 mL.kg.min−1; P < 0.05). The mean differences (95% CL) of absolute and relative V̇O2peak between tests were 8.2% (3.3%–13.2%) and 10.9% (4.3%–18.1%), respectively. There was no difference in HR peak (incremental: 169 ± 24 bpm; verification 167 ± 25 bpm; P = 0.130). Peak O2pulse from the verification test (14.6 ± 4.7 mL.beat−1) was higher than incremental test (13.0 ± 3.8 mL.beat−1; P = 0.007). In conclusion, the verification test elicited greater V̇O2peak and O2pulse than a two-phase incremental test despite the similar HRpeak. This indicates that for this progressive protocol lasting ≥25 min, the verification phase adds value to determining V̇O2peak in SCI athletes.
Phonon dispersion of nanoscale honeycomb phononic crystal: gigahertz and terahertz spectroscopy comparison
Authors: Diego Michele , Anufriev Roman , Yanagisawa Ryoto , Nomura Masahiro 
Published: November 2024

AbstractPhonons—quantized vibrational modes in crystalline structures—govern phenomena ranging from thermal and mechanical transport to quantum mechanics. In recent years, a new class of artificial materials called phononic crystals has emerged, aiming to control phononic properties. These materials are created by introducing a superlattice structure on top of an already-existing atomic lattice. Typically, phononic crystals are described using a continuous model, in which effective elastic constants approximate potentials between atoms. This approximation, however, assumes the wavelengths of vibrations to be significantly greater than the interatomic distance. In this work, we experimentally investigate the behavior of a honeycomb silicon phononic crystal in the gigahertz range, where the continuum approximation holds, and in the terahertz range, where the phonon wavelengths are comparable to interatomic distances. Using Brillouin light scattering, we investigate the phonon dispersion of the phononic crystal in the gigahertz range, finding a close match with simulations based on the continuous model. Conversely, Raman spectroscopy reveals no difference between the phononic crystal, an unpatterned membrane, and a bulk silicon structure in the terahertz range, showing that the continuous model no longer holds at these higher frequencies.
Mathematical modeling and analysis of leptospirosis–COVID-19 co-infection with real data
Authors: Said Muhammad , Roh Yunil , Jung Il Hyo 
Published: November 2024

AbstractIn this paper, we present a mathematical model to analyze the dynamics of leptospirosis and COVID-19 co-infection. The model used actual data, and estimation of the parameters via the MLE method is performed, which includes the rates of disease transmission, progression of the disease, disease-related death, and recovery rates for each disease and their co-infection. Key parameters: $$\beta _1$$

β
1

, $$\beta _2$$

β
2

, $$\phi _1$$

ϕ
1

, $$\phi _2$$

ϕ
2

, and $$\mu _c$$

μ
c

are used to characterize the dynamics of the co-infection burden of leptospirosis and COVID-19. The results reveal a notable contrast in transmission dynamics and clinical outcomes between the two diseases, with leptospirosis demonstrating a higher transmission rate and increased morbidity. Co-infections showed more severe clinical outcomes, with higher mortality and delayed recovery than single infections. These findings highlight the importance of targeted public health strategies for managing co-infected populations.
Structural and Optical Characteristic of Fe10+ Ion Implanted Nanostructured WO3 Film for Gas Sensing Application
Authors: Kumar Ashutosh , Rajput Shailendra , Parida Sabyasachi 
Published: November 2024

300 keV Fe10+ ions with fluences of 1×1015, 3 × 1016, and 1 × 1017 ions cm−2 were used to implant

W

O

3

films, developed by thermal evaporation method. After implantation, all samples were characterized for structural, morphological and optical study for gas sensing application. Furthermore, a thorough investigation and discussion of the gas sensing characteristics of pristine and Fe ion implanted

W

O

3

gas sensors was conducted. Dynamic gas-sensing performance were tested at room temperature for

C

H

4

gas at various concentrations of 50 ml min−1, 100 ml min−1, and 150 ml min−1. Sensitivity of all gas sensors to

C

H

4

gas was calculated by the static gas response curve within and without methane environment. The obtained results indicate the Fe-ion implanted

W

O

3

gas sensor (1 × 1017 ion/cm2) possess better sensing properties than that of pure

W

O

3

films. This outcome might be related to the development of active sites and structural defects created by Fe ion implantation. These findings suggested that metal oxide sensitivity could be enhanced by ion implantation.
Gliomatosis Cerebri Manifested as Parkinsonism Syndrome: A Case Report
Authors: Garcia Debora González , Casas Miguel Ángel González , Martínez Martin Heisi Gómez 
Published: November 2024

Introduction: Gliomatosis cerebri (GC) is a diffuse neoplastic process, whose presentation is extremely rare and lacks a characteristic clinical pattern. The objective of this case is to describe the clinical aspects of a patient with GC, in whom symptoms of parkinsonism and neurocognitive issues predominate.Case Report: A 78‐year‐old patient with no significant medical history was referred to the neurology consultation due to balance disturbances accompanied by head tremor. Symptoms of parkinsonism progressively worsened, adding cognitive and neuropsychiatric disorders. Cranial magnetic resonance imaging (MRI) showed diffuse and generalized white matter hyperintensity. Under the suspicion of GC, a frontal lobe biopsy was performed, with a pathology report of diffuse astrocytoma, thus confirming the diagnosis of GC.Conclusion: GC is a disease that presents with nonspecific clinical manifestations, making a clinical diagnosis challenging. It should be suspected in cases of parkinsonism accompanied by other focal neurological disorders. This leads to delayed diagnosis and consequently low incidence. The importance of MRI as a diagnostic aid is highlighted, with biopsy being necessary to confirm the diagnosis.
Cardiovascular Outcomes Associated With Hypoplastic Left Heart Syndrome Versus Other Types of Single Right Ventricle: A Multicenter Study
Authors: Dib Nabil , Poirier Nancy , Samuel Michelle , Hermann Honfo Sewanou , Zaidi Ali , Opotowsky Alexander R. , Mongeon François‐Pierre , Mondésert Blandine , Kay Joseph , Ibrahim Reda , Hamilton Robert M. , Fournier Anne , Jameson Susan M. , Dore Annie , Cook Stephen , Cohen Scott , Chaix Marie‐A. , Broberg Craig S. , Aboulhosn Jamil , Khairy Paul 
Published: November 2024

Background
The univentricular heart with a predominant right ventricle morphology (uRV) has been associated with a higher rate of adverse cardiovascular events. It remains to be determined whether the specific type of uRV influences outcomes.

Methods and Results

A North American multicenter retrospective cohort study was conducted by the Alliance for Adult Research in Congenital Cardiology on individuals with a uRV and total cavopulmonary connection Fontan. The incidence of a composite outcome consisting of all‐cause mortality, cardiac transplantation, atrial arrhythmias, or thromboembolic events was compared among patients with Fontan palliation who had hypoplastic left heart syndrome (HLHS) versus other forms of uRV (non‐HLHS). All components of the composite outcome were classified by a blinded adjudicating committee. Competing risks were taken into account in time‐to‐event analyses. A total of 171 patients with uRV of whom 76 (44.4%) had HLHS were followed for 10.2±5.7 years. The composite outcome occurred in 7.1 versus 2.1 cases per 100 person‐years in patients with HLHS versus non‐HLHS (
P
<0.0001). In multivariable analyses, HLHS was associated with a significantly higher risk of the composite outcome (hazard ratio [HR], 6.13 [95% CI, 2.92–12.69],
P
<0.001). Moreover, HLHS was associated with significantly higher rates of all components of the primary outcome.

Conclusions
Among patients with a uRV and Fontan palliation, HLHS is associated with a significantly higher rate of adverse cardiovascular events.
Risk Factors, Treatments, and Outcomes of Adults Aged <55 Years With Acute Ischemic Stroke With Undetermined Versus Determined Pathogenesis: A Nationwide Swiss Cohort Study
Authors: Dittrich Tolga D. , Schneider Thomas , Katan Mira , Luft Andreas R. , Mono Marie‐Luise , Bolognese Manuel , Nedeltchev Krassen , Kahles Timo , Arnold Marcel , Heldner Mirjam , Michel Patrik , Carrera Emmanuel , Rodic Biljana , Cereda Carlo W. , Peters Nils , Bonati Leo H. , Renaud Susanne , Humm Andrea M. , Medlin Friedrich , Albert Sylvan , Sturzenegger Rolf , Tarnutzer Alexander A. , Siebel Philip , Baumgärtner Markus , Berger Christian , Mordasini Pasquale , Vehoff Jochen , De Marchis Gian Marco ,   the Swiss Stroke Registry Investigators
Published: November 2024

Background
The rising prevalence of acute ischemic stroke (AIS) in young adults, particularly with undetermined pathogenesis, is a growing concern. This study assessed risk factors, treatments, and outcomes between young AIS patients with undetermined and determined pathogeneses.

Methods and Results

This was a retrospective cohort study including AIS patients aged 18 to 55 years in Switzerland, treated between 2014 and 2022. Stroke pathogeneses were classified using a modified TOAST (Trial of ORG 10172 in Acute Stroke Treatment) classification, with undetermined pathogenesis defined as no identified cause (including patent foramen ovale and cervical artery dissection). We examined vascular risk factors, acute treatments, 3‐month functional outcomes, and AIS recurrence within 3 months using logistic regression and Fine–Gray proportional hazards models. Of 3995 patients, 863 (22%) had undetermined pathogenesis. Compared with patients with determined pathogenesis, those with undetermined pathogenesis had a higher prevalence of dyslipidemia (54% versus 59%,
P
=0.007) and smoking (37% versus 43%,
P
=0.001), and were more likely to receive intravenous thrombolysis (27% versus 31%,
P
=0.046). Despite higher 3‐month AIS recurrence risk for the undetermined group (adjusted hazard ratio, 1.72 [95% CI, 1.01–2.94]), favorable functional outcomes at 3 months were more frequent (modified Rankin Scale score, 0–2: 90% versus 87%,
P
=0.033). Patients aged 46 to 55 years with undetermined pathogenesis had better outcomes than those with determined pathogenesis (modified Rankin Scale score, 0–1: 70% versus 64%,
P
=0.013; modified Rankin Scale score, 0–2: 89% versus 85%,
P
=0.023), while those aged 18 to 45 years showed higher recurrence rates (4.5% versus 1.8%,
P
<0.05) but similar functional outcomes.

Conclusions
Young adults with AIS exhibit a considerable vascular risk burden. Those with undetermined pathogenesis displayed age‐related outcome disparities, with better short‐term outcomes in older and higher recurrence rates in younger patients.
Bail Out Procedures in Acute Cholecystitis: Risk Factors and Optimal Approach
Authors: Ugarte Chaiss , Ugarte Ramsey , Gallagher Shea , Park Stephen , Kagan Odeya , Murphy Ryan , Matsushima Kazuhide , Inaba Kenji , Martin Matthew J. , Schellenberg Morgan 
Published: November 2024

Background For difficult cholecystectomies, bail out procedures (BOP) are performed to mitigate risk of patient harm. Objective This study sought to identify risk factors for BOP for acute cholecystitis and to compare outcomes by type of BOP performed. Methods: Patients with acute cholecystitis who underwent cholecystectomy were included (2020-2022). Demographics, clinical data, and outcomes were collected. Primary outcome was <30-day complication rate. Groups were defined by surgery performed: BOP vs Laparoscopic Complete Cholecystectomy (LCC). BOPs were defined as any deviation from laparoscopic complete cholecystectomy. Univariate analyses compared outcomes between groups. Multivariable analysis identified independent factors associated with BOP. Subgroup analysis compared outcomes of laparoscopic BOP vs open BOP. Results Of 728 patients, 659 (91%) underwent LCC and 69 (9%) underwent BOP: 34 (49%) laparoscopic BOP and 35 (51%) open BOP. Independent predictors of BOP included admission total bilirubin >0.2 mg/dL (OR 5.80, P = .017), >7 days of symptoms at time of cholecystectomy (OR 1.96, P = .019), and arrival heart rate >100 bpm (OR 1.82, P = .032). On subgroup analysis, laparoscopic vs open BOP demonstrated no difference in operative time ( P = .536) and overall ( P = .733) or gallbladder-related complications ( P = .364), including bile leaks ( P = .090). Laparoscopic BOP was associated with shorter postoperative lengths of stay ( P = .005). Conclusion The risk factors for BOP identified in this study may help inform patient consent and operative planning. Laparoscopic BOP incurred equivalent complications to open BOP but with shorter hospital stays, challenging conventional dogma that conversion to open is the optimal approach for complicated acute cholecystitis.