bluuebunny/crossref_metadata_2025_split huggingface dataset:
Value for whom? Rethinking cost-effectiveness from young people’s perspective
Authors: Holmes Lisa , Lefevre Michelle 
Published: December 2024

Background: This article re-envisions the concept of value in relation to safeguarding and welfare services to young people who are experiencing adversity, risk and disadvantage. Current use of the terms ‘cost-effectiveness’ and ‘value for money’ within the policy and practice sectors is dominated by the concept of financial costs, most particularly with respect to the goals of producing organisational efficiencies and providing lower cost services. Analysis is often driven by outcomes that are easy to measure and can be monetised. Findings: The moral and societal costs associated with not providing the best possible support and services to some of the most vulnerable people in society are largely missing from these debates, as are young people’s views on what counts as value from their perspective. Drawing on learning from our recent and current research in the UK focused on young people at risk of extra-familial risks and harms, we use a case study to consider alternative approaches that would place young people’s views and concerns at the centre of analysis. We explore the integration of ‘softer outcomes’ (such as subjective well-being, educational engagement and qualitative inquiry into what matters to young people) into debates about ‘value for money’. Conclusion: We highlight the importance of exploring the lives of young people holistically and taking a life course perspective to understand and engage with the longer-term societal, moral and financial costs associated with providing the right services and support, at the right time, to the children and young people who need them most.
Efficacy of telerehabilitation in inpatients with stroke: A pilot randomized controlled trial
Authors: Lee Hsin-Chieh , Hsu Tzu-Yun , Yu Cheng-Chieh , Kuo Fen-Ling 
Published: December 2024

Background: Telerehabilitation could be a substitution for regular rehabilitation in an epidemic situation. Furthermore, there is no evidence of the effectiveness of telerehabilitation in stroke inpatients. Objectives: To assess the effects of telerehabilitation on daily life function, mobility, and quality of life in stroke inpatients. Methodology: Inpatients with stroke were randomly assigned to either the telerehabilitation group ( n = 12) or the control group ( n = 12) for 10 treatment sessions. Results: No significant differences were found in the outcome measures. However, both groups showed significant improvements in the Modified Barthel Index and Postural Assessment Scale for Stroke scores. The telerehabilitation group improved in Functional Ambulation Categories scores, while the control group showed improvement in Patient Health Questionnaire-9 scores. Conclusion: This pilot study suggests that telerehabilitation may be a feasible alternative during the pandemic. However, due to the small sample size and the potential influence of natural recovery, the findings remain preliminary. Larger studies are necessary to more definitively assess the effectiveness of telerehabilitation compared to conventional rehabilitation.
Out-of-Pocket Costs Burden in Marketplace Plans for People With Diabetes
Authors: Ruscitti Brielle , Kern Caroline , Bowser Diana 
Published: December 2024

Background: The Affordable Care Act (ACA) aims to expand coverage and increase access to health insurance. Despite the increase of insured individuals, there are a number of concerns about whether coverage and care are affordable. Prior studies document a growing concern with rising premiums and cost-sharing, including deductibles, particularly for those with chronic conditions. Objective: Compare the ACA marketplace plan availability and costs across 17 states for individuals with varying diabetic engagement profiles and their related medical needs. Design: Descriptive Cost Analysis. Methods: Using Healthcare.gov individual state marketplace websites, we utilized a descriptive cost analysis to compare plan availability and costs for premiums, deductibles, co-payments, and co-insurance for an individual aged 63 years old, who was either a non-diabetic, high-engagement or low-engagement diabetic in urban and rural areas. Using the second lowest monthly premium silver plan (the benchmark plan), we calculated annual costs for premiums, co-insurance, co-payments, and deductibles for these individual profiles. We assessed statistical differences between health care component costs, within and across urban and rural areas, using t-tests. Results: The findings highlight within and across states, individuals with diabetes, particularly low-engagement diabetics, spend a significantly higher percent of their income on additional health care costs, above their premium, than non-diabetic individuals. In some states, low-engagement diabetic patients spend upwards of 3 times more than high-engagement diabetic patients, highlighting an additional cost burden. For low-engagement diabetics, deductibles are driving health care spending with an average of 59% of health care spending coming from deductible payments. Results do not show statistically different costs across urban and rural diabetic patients. Conclusion: Despite the ACA’s success, results highlight variation in plan availability across states and disproportionate cost burden placed on moderate income individuals, especially related to deductible, and co-payments for those with chronic diseases.
Classifying cognitive impairment based on FDG-PET and combined T1-MRI and rs-fMRI: An ADNI study
Authors: Jahani Iman , Jahani Ali , Delrobaei Mehdi , Khadem Ali , MacIntosh Bradley J 
Published: December 2024

Background Mild cognitive impairment (MCI) refers to a memory impairment among non-demented adults. It is a condition that increases the risk of dementia, notably due to Alzheimer's disease (AD). MCI is heterogeneous and there is a need for novel diagnostic approaches. Fluorodeoxyglucose positron emission tomography (FDG-PET) imaging provides robust AD biomarker characteristics, while anatomical and functional magnetic resonance imaging (MRI) offer complementary information. Objective Classify MCI and cognitively normal (CN) adults using FDG-PET images; predict individuals with MCI that convert to AD dementia; determine if MRI can achieve comparable performance to FDG-PET classification. Methods Four ADNI cohorts were created. Cohort 1: 805 participants (MCI n = 455; CN n = 350) that underwent FDG-PET. FDG-PET images were inputs to a one-channel 3-dimensional (3D) DenseNet deep learning model. Cohort 2: 348 participants (MCI n = 174; CN n = 174) with MRI and functional MRI. Cohort 3: overlapping cases from cohorts 1 and 2 (MCI n = 70; CN n = 70). Cohort 4: 336 participants (MCI-converters n = 168; MCI-stable n = 168) with FDG-PET from cohort 1. The one/two-channel models’ inputs were T1-weighted MRI and/or amplitude of low-frequency fluctuations images, with classification metrics evaluated through 10-fold cross-validation. Results The FDG-PET model achieved 88.02%±3.82 accuracy for MCI versus CN classification, with 88.70%±4.70 sensitivity and 87.14%±5.03 specificity. Neither MRI model outperformed the FDG-PET model, as the highest MRI-based accuracy was 76.86%±1.95. The FDG-PET model achieved 63.23%±4.68 accuracy in classifying MCI-converters versus MCI-stable. Conclusions FDG-PET images produced the highest accuracy in classifying MCI versus CN. While MRI-based approaches were inferior to FDG-PET, multi-contrast MRI still offers value for neurodegeneration classification.
Using special APF to improve harmonic rate of MRT power system
Authors: Chen Chien-Hsu , Ko Li-Wei 
Published: December 2024

Most APFs use improved designs of active power filters of half-bridge and full-bridge circuits, their advantages and disadvantages are compared. International journals often use this filter circuit for small circuit boards. For large power systems, nonlinear loads still need to overcome harmonic pollution and magnetic pollution. Its disadvantage is that it will reduce the power of the system and requires power compensation. For nonlinear load harmonic filtering, RLC high-pass filter is not the best filtering method. Due to high-power rail high-voltage systems (22 KV–161 KV), the industry has not yet applied APF to remove harmonics. Previous research on nonlinear load harmonic filters for high-voltage systems was only 6.9 KV. Later, with the development of industry and the increase in electricity consumption, the high-voltage system increased to 22 KV–161 KV. Experimental data on high-voltage power systems are difficult to obtain. This study verified the feasibility of this method through simulation. Therefore, this study proposes to use a combination of two single-phase high-pass filters form a three-phase APF to filter nonlinear load harmonics in the track’s large power system and effectively increase the capacity of the large power load. APF filters harmonics through three phases to prevent train signal abnormalities and extend the service life of trains. Since the centralized power supply system must be used in conjunction with other loads, harmonic pollution will occur. Electric vehicles accept this kind of pollution source, which is detrimental to on-board equipment and on-board signals. In power electronics theory, the spirit of this article is to use APF to filter out harmonics of the power system through three-phase technology in the range of 22 KV–161 KV. This has not yet been done in the industry. I put forward this theory, which is also the meaning of this job.
A survey of practice on the use of condition-specific patient reported outcome measures with patients who have distal radius fractures
Authors: Nuttall Jocelyn , Rolls Catherine 
Published: December 2024

Introduction Distal radius fractures (DRF) are common injuries seen by therapists. Patient Reported Outcomes Measures (PROMs) are a way to measure recovery, yet previous research suggests PROM utilisation is low amongst therapists. This study looks at current use of condition specific PROMs amongst UK therapists treating patients with DRF and explores possible barriers and facilitators to their use. Methods An online anonymised cross-sectional survey hosted on Qualtrics software was distributed to UK physiotherapists, occupational therapists, and therapy technicians via special interest groups and social media. Analysis was carried out on Excel and Qualtrics Software. Results There were 60 responses to the survey. For therapists who use PROMs the Quick-Disabilities of the Arm, Shoulder and Hand questionnaire, and Patient Reported Wrist Evaluation were the most used, but many therapists reported never using a PROM. Barriers identified included not having enough time in a therapy session, already collecting generic PROMs, and current PROMs did not add to their clinical reasoning. Therapists reported current condition specific PROMs did not capture the psychosocial impact of a DRF or help to assess return to full function. Conclusion NHS managers should explore opportunities to collect generic PROMs in a way that has the least impact on clinician time. The development of a Core Outcome Set for hand and wrist trauma may help therapists to identify a toolkit of PROMs to measure different aspects of recovery from this injury but further research is needed to understand the utility of PROMs over individualised therapist assessment.
Association of cytochrome P450 CYP2C9 (rs1057910) gene polymorphism and ibuprofen response in preterm neonates diagnosed with patent ductus arteriosus
Authors: Said Reem Nabil , Mossalam Dalia , Abdel Massih Antoine Fekhry , Abdel Halim Radwa Marawan , Sweilam Maisa ElSayed Mohamed Morsi 
Published: December 2024

Background Patent ductus arteriosus (PDA) closure is one of the most significant changes necessary to transition to extrauterine life. The failure of closure in preterm infants has been associated with a variety of complications. Aim and objectives This study aim to investigate the correlation between cytochrome P450 CYP2C9 gene polymorphism and the response to ibuprofen treatment in preterm neonates with PDA. Subjects and methods This prospective study was conducted on 64 preterm neonates with patent ductus arteriosus (hsPDA). The neonates were treated with ibuprofen and diagnosed using clinical and echocardiographic examinations. The study was carried out at the Neonatal Intensive Care Unit (NICU), Pediatric Department, Kasr Alainy and ElMounira Pediatric Hospitals, Cairo University, in June 2018. Results A statistically significant difference in respiratory rate was observed between both groups ( p = 0.047). Additionally, there was a significant difference in the duration of treatment with ibuprofen ( p = 0.021). Treatment with ibuprofen had no impact on renal function parameters. The platelet count decreased after treatment with no statistical difference. Conclusion Use of Oral ibuprofen is a highly effective treatment for HsPDA in preterm neonates, demonstrating a remarkable success rate of 92.2% and fewer adverse effects. Whilst no correlation between the CYP2C9 (rs1057910) gene polymorphism and the efficacy of oral ibuprofen response, Other factors affecting the response of oral ibuprofen and subsequent PDA closure include gestational age, birth weight, Apgar score at 5 min, ductal diameter, RDS, and sepsis.
Role of lung ultrasound score in early prediction of bronchopulmonary dysplasia in preterm neonates
Authors: Khandelwal Shikha , Datta Vikram , Anand Rama , Devabathina Narendra Babu 
Published: December 2024

Background The use of lung ultrasound score (LUS) to predict bronchopulmonary dysplasia (BPD) is still evolving. While LUS is widely available and accurate, there is limited evidence from low- and middle-income countries. We aim to assess LUS’s predictive ability for BPD in preterm neonates less than 30 weeks gestation. Material and methods We enrolled 160 neonates born at <30 weeks of gestation, who required any form of respiratory support at least for 24 h. Six zone LUS was calculated for all the neonates first within 72 h and then weekly till 36 weeks of post-menstrual age (PMA) or discharge, whichever was earlier. After excluding death and missed scans, 112 neonates were categorized as BPD or non-BPD and were analysed for their LUS. Result Neonates who developed BPD ( n = 33) had higher LUS from the first assessment up to nine weeks. An LUS >5 could predict the development of BPD at one week with a sensitivity of 87.88%, specificity 89.87%, and area under ROC Curve (AUC) 0.93, and at two weeks with a sensitivity of 78.79%, specificity of 96.2%, and AUC 0.95. Likewise, at three and four weeks of life, the optimum cutoff of LUS >3 and >2, respectively, predicted the development of BPD with sensitivity 93.99%, specificity 94.94%, and AUC 0.97 at three weeks and sensitivity 87.88%, specificity 92.41 %, and AUC 91.07% at four weeks. Prediction for moderate-severe BPD was also reliable at all scan time points with AUC 0.84 at 1–3 days, 0.91 at one week, 0.92 at two weeks, 0.95 at three weeks, and 0.97 at four weeks, with LUS cutoff >8, >5, >6, >4, and >3, respectively. Conclusion LUS can reliably predict the future development of BPD as early as one week of life and can play an important role in optimizing BPD preventive strategies.
A quality improvement project on implementing a standardized pain assessment and opioid stewardship guidance at a level IV NICU
Authors: Durrani Naveed Ur Rehman , Badhawi Isam Abdulaziz , Kurian Simi , Vicente Melanda , Peligrino Melyndee , Sultan Naima , Manuzon Elnora , Yajamanyam Phani Kiran 
Published: December 2024

Background Balancing between adequate analgesia and preventing the harmful side effects of opioids in the NICU is an important clinical conundrum. Lack of awareness among caregivers and guidance on pain management are the key limiting factors. By initiating this quality improvement (QI) project, we aimed to reduce the usage of opioids in a quaternary NICU care by 5% within 1 year. Methods A multidisciplinary team developed standardized guidance focusing on regular pain assessment, appropriate initiation, and weaning of opioids for infants undergoing surgical procedures and those requiring mechanical ventilation. The Plan, Do, Study, Act (PDSA) methodology was used for improvement, beginning with a survey and Pareto analysis to identify key drivers. Data were collected for the baseline period and after implementing the QI interventions. Results We demonstrated a significant decrease in the cumulative opioid use measured as morphine equivalent (mg/kg) from a mean of 2.7 to below 0.85 mg/kg, demonstrating a reduction of >50%. There was no worsening in pain or opioid withdrawal scores within three and 5 days after weaning of opioids, a surrogate measure for appropriate weaning. Conclusion Implementation of standardized guidelines for initiating and weaning of opioids can reduce the overall opioid use and thus minimize opioid withdrawal in critically ill neonates.
Decreased prevalence and altered clinical phenotype of systemic sclerosis and other autoimmune connective tissue diseases in type 1 and type 2 diabetes: A cross-sectional observational study
Authors: Abugharbyeh Aya , Khuder Sadik , Kahaleh Bashar 
Published: December 2024

Introduction: Evidence has demonstrated that autoimmune diseases tend to coexist at a higher rate than expected, reflecting a common pathogenic pathway. In this study, we investigate the co-occurrence of systemic sclerosis, systemic lupus erythematosus, and Sjogren syndrome in patients with type 1 and type 2 diabetes mellitus. Methods: Our data were obtained using the 2019 Healthcare Cost and Utilization Project, and International Classification of Diseases, 10th Revision diagnosis codes were used to identify patients with systemic sclerosis, systemic lupus erythematosus, lupus nephritis, and Sjogren syndrome, as well as patients with type 1 and type 2 diabetes. We utilized Statistical Analysis System 9.4 for all analyses and included designated weight values to produce nationally representative estimates. Results: The prevalence of systemic sclerosis among patients with type 1 diabetes mellitus and type 2 diabetes mellitus was significantly lower than that for the non-diabetes mellitus control group (0.0007% vs 0.09%, p-value = 0.0064 and 0.01% vs 0.07%, p-value < 0.0001), respectively. Similarly, there was a significant decrease in the prevalence of systemic sclerosis with lung involvement in patients with type 1 and type 2 diabetes mellitus, with a statically significant difference in type 2 diabetes mellitus versus nondiabetic group (0.001% vs 0.006%, p-value < 0.0001). We noted a similar pattern regarding the prevalence of systemic lupus erythematosus and lupus nephritis in patients with type 1 and 2 diabetes. Similarly, there was a significant decrease in the prevalence of Sjogren syndrome in patients with type 1 diabetes and type 2 diabetes. Conclusion: The collected data demonstrates an inverse relation between some autoimmune connective tissue diseases and diabetes. This suggests that these diseases and diabetes mellitus may have different immune pathogenesis. There was also a significantly lower incidence of organ complications such as lupus nephritis and systemic sclerosis lung disease among patients with diabetes, suggesting that diabetes and treatment of diabetes may alter the clinical expression of these disorders.
Relapse-free survival is progressively shortened in a subset of Black patients with immune-mediated TTP treated in the rituximab era
Authors: Fatola Ayotola , Evans Michael D. , Brown Jenna , Davis Elizabeth , Johnson Andrew , Antun Ana G. , Farland Andrew M. , Woods Ryan , Metjian Ara , Park Yara A. , de Ridder Gustaaf , Gibson Briana , Kasthuri Raj S. , Liles Darla K. , Eubanks Susan , Akwaa Frank , Clover Todd , Kreuziger Lisa Baumann , Sadler J. Evan , Sridharan Meera , Go Ronald S. , McCrae Keith R. , Upreti Harsh Vardhan , Lim Ming Y. , Kocher Nicole K. , Gangaraju Radhika , Zheng X. Long , Raval Jay S. , Masias Camila , Cataland Spero R. , Mazepa Marshall , Chaturvedi Shruti 
Published: December 2024

Abstract
Immune thrombotic thrombocytopenic purpura (iTTP) is a chronically relapsing disorder caused by autoantibody-mediated deficiency of ADAMTS13. Rituximab is frequently administered to prevent relapses, but whether the durability of rituximab effect is maintained with subsequent treatment courses has not been studied. Using the United States Thrombotic Microangiopathy Consortium (USTMA) retrospective iTTP registry, we evaluated clinical relapse-free survival (RFS) with subsequent courses of rituximab treatment in multiply relapsing patients. Separately, we evaluated overall RFS (composite of time to clinical relapse, ADAMTS13 relapse, or preemptive rituximab) in a prospective iTTP cohort from the Johns Hopkins University and the University of Minnesota. In the USTMA registry, median clinical RFS was shorter after the second or subsequent rituximab-treated episode than the first (2.1 vs 6.0 years; P = .04). White patients’ clinical relapse risk after the second and subsequent rituximab courses was not significantly different compared with the first (hazard ratio [HR], 1.86; 95% confidence interval [CI], 0.22-15.80; P = .57), whereas for Black patients, clinical relapse risk was significantly higher after the second or subsequent courses (HR, 2.82; 95% CI, 1.52-5.24; P = .001). In the prospective cohort, overall RFS progressively shortened after each episode of rituximab treatment with the first episode having the longest RFS (2.8 years; interquartile range, 2.0-6.0) and this loss of response durability was most pronounced in Black patients. The durability of rituximab’s effect declines with subsequent treatments, which is more pronounced in Black patients, who may benefit from closer monitoring and alternative immunomodulatory approaches such as maintenance rituximab and consideration of other agents.
Antiviral potential of Vδ2 T cells in children given TCR αβ/CD19 cell-depleted HLA-haploidentical HSCT
Authors: Bordoni Veronica , Guarracino Federica , Galaverna Federica , Bertaina Valentina , Li Pira Giuseppina , Rosichini Marco , Pitisci Angela , Matusali Giulia , Maggi Fabrizio , Velardi Enrico , Merli Pietro , Locatelli Franco , Agrati Chiara 
Published: December 2024

Abstract
γδ T cells represent key players in immune surveillance after T-cell receptor α/β (αβ)/CD19-depleted HLA-haploidentical hematopoietic stem cell transplantation (haplo-HSCT). Although encouraging data are available on the impact of Vδ2-targeting therapy in improving HSCT clinical outcomes, their role in providing antimicrobial immunity is largely unexplored. This study aimed to investigate the antiviral protective profile of Vδ2 T cells in pediatric patients given haplo-HSCT. The characterization of γδ T cells was performed in pediatric recipients (n = 26) in the donor graft and at 30, 60, and 120 days after haplo-HSCT. The antiviral activity of Vδ2 T cells and the cytomegalovirus (CMV)-specific αβ T-cell immunity was analyzed. Early after HSCT, Vδ2 T cells was significantly higher in patients who did not experience viral reactivation (No-VR) than in patients with CMV reactivation. Interestingly, this difference was already present in the grafts. Clustering analysis identified a protective subset of Vδ2 T cells in patients with No-VR, expressing CD16, NKG2D, and CD107a, and producing Th1 cytokines. This subset directly correlated with interleukin-15 and inversely with the CMV DNA level. Stimulated Vδ2 T cells inhibit CMV replication, acquired CD86/HLA-DR molecules, induced HLA-DR on monocytes, and improved the αβ CMV–specific T-cell response. Altogether, these results identify an antiviral protective profile displayed by Vδ2 T cells early after HSCT, and define their ability to inhibit CMV replication, to induce antigen-presenting cell maturation and to improve αβ virus–specific T-cell response, opening a new application of Vδ2-targeting immunotherapy after HSCT, adding the antiviral to the antitumor potential.