bluuebunny/crossref_metadata_2025_split huggingface dataset:
Repeated use of hospital-based services and delayed hospital discharges in a population-based cohort of autistic adults in Canada
Authors: Lunsky Yona , Balogh Robert , Chung Hannah , Durbin Anna , Lai Meng-Chuan , Tint Ami , Weiss Jonathan , Isaacs Barry , Lin Elizabeth 
Published: November 2024

Recognizing higher rates of co-occurring health conditions in autistic adults and the frequent use of hospital-based health care services, this study compared rates of repeat emergency visits, repeat hospitalizations, and delayed discharges in autistic adults to other adults with and without developmental disabilities matched for age and sex, living in Ontario, Canada. Returning to the hospital emergency department within a month, being readmitted to hospital within a month and experiencing a delayed discharge from hospital were each more likely to occur in autistic males and females than their counterparts without developmental disabilities, with the risk ratios being the highest for delayed discharges. Males and females with other developmental disabilities were more likely to return to the emergency department within a month than their autistic counterparts, and males with other developmental disabilities were more likely than autistic males to be readmitted to hospital, but the likelihood of delayed discharge in the two groups was similar. These findings suggest that more needs to be done to both improve hospital-based experiences of autistic adults and adults with other developmental disabilities, and to strengthen community-based care to reduce the likelihood of repeat and extended stays in hospital. Lay abstract We know that autistic people have more health problems and are more likely to go to the emergency department and get hospitalized than other people, but we know less about the problems they have once they get to the hospital. In this study, we looked at all autistic adults in Ontario and compared them to adults who were not autistic and to adults who had other kinds of developmental disabilities to see who came back to the emergency department in the month after an emergency department visit, who got re-hospitalized in the month after being sent home from hospital, and who stayed in the hospital longer than they needed to because there was no place appropriate for them to go to. We found that both autistic males and females were more likely to have these things happen to them than the same age- and sex-matched adults who did not have developmental disabilities. We also found that adults with other kinds of developmental disabilities had similar problems to autistic people. This makes us think that we need to work harder to improve health care for autistic adults and adults with other developmental disabilities when they come to hospital. We also need to make community services work better, and work more closely with hospital services, so that people only come to hospital when they need to and that they can go home when they are ready.
Effects of α-Particle Radiation on DNA Methylation in Human Hepatocytes
Authors: Xue Xiangming , Su Lixia , Zhang Teng , Zhan Jingming , Gu Xiaona 
Published: November 2024

Objective: This paper explores the role of DNA methylation in α-irradiation damage at the cellular level. Methods: Human normal hepatocytes L-02 were irradiated using a 241 Am α source at doses of 0, 1.0, and 2.0 Gy. The methylation levels of the six differentially methylated genes were examined by pyrophosphate sequencing, and the mRNA expression levels of the six differentially methylated genes were examined by real-time fluorescence quantitative PCR. Results: The rate of γH2AX foci positive cells was significantly higher than that of the control group after irradiation of cells in different dose groups for 1 h and 2 h respectively ( P < .05). The proportion of S-phase cells was significantly increased in the 1.0 Gy and 2.0 Gy dose groups compared with the control group ( P < .05). The methylation levels of CDK2AP1, PDGFRL, PCDHB16 and FAS genes were significantly increased, while the mRNA expression levels were significantly decreased ( P < .05). The expression levels of CDK2Apl, PCDHB16 and FAS were significantly negatively correlated with the methylation levels ( P < .05). Conclusion: The α-particle radiation can affect gene expression at the epigenetic level, which led to the speculation that altered methylation levels of CDK2AP1, PCDHB16, and FAS genes may be involved in the α radiation damage process.
The effect of the theory of planned behavior based hand hygiene intervention program on the health outcomes and school absenteeism of the primary school students: Quasi-experimental study
Authors: Uyanık Gülçin , Dağhan Şafak 
Published: November 2024

Background Acute upper respiratory tract infections are the most common infections among school children. Improving water, sanitation, and hygiene facilities in schools is an important intervention for the healthy development of children. The most important component of this intervention is hand washing, which is the primary infection control measure. Aim This study aims to test the effect of the Theory of Planned Behavior (TPB) based hand hygiene intervention program on the health outcomes and school absenteeism of students. Method The study is quasi-experimental with pretest-posttest control groups. The study was conducted with 159 students (intervention: 82, control: 77) in two separate primary schools that were assigned to intervention and control groups. The intervention group were applied a TPB-based hand hygiene intervention program for the school children. The data were collected using the Student Questionnaire, Hand Hygiene Assessment Question Form, and Surveillance Form. Findings The mean Hand Hygiene Assessment Question Form Hand Hygiene Behavior scores did not differ between the groups in the pre- and posttest ( p > .05). In the posttest, the frequency of encountering a ten-week-upper respiratory tract infection symptom (U = 5277.50 p < .0001), school absenteeism days ( p = .046) and absenteeism episodes ( p = .043) was lower in the intervention group than in the control group. Conclusions The findings suggest that was concluded that the TPB-based hand hygiene intervention program did not make a difference in creating hand hygiene behavior in school children compared to the classical education. The program was effective in reducing upper respiratory tract infections and school absenteeism due to these infections.
Racial disparities in early postoperative proximal humerus fracture outcomes: Do minorities face longer operative times, extended hospital stays, and higher risks?
Authors: Kishan Arman , Zhu Alexander R , Zhu Stanley , Moon Gyeongtae S , Kishan Ansh , Suresh Sukrit J , Best Matthew J , Srikumaran Umasuthan 
Published: November 2024

Background Racial disparities in orthopedic surgery outcomes have been extensively documented, highlighting systemic biases in care. Proximal humerus fractures (PHFs), about 6% of all fractures, are rising, especially among the elderly. Despite the prevalence of PHFs, a research gap exists regarding racial disparities in postoperative complications and outcomes. Methods Data from the American College of Surgeons NSQIP database from 2006 to 2021 were analyzed, including 41,285 patients with PHFs. CPT and ICD codes guided inclusion and exclusion criteria. Propensity-score matching balanced a cohort of 17,052 patients. Demographic variables, comorbidities, and outcomes were analyzed using univariate statistics, chi-square tests, and Fisher's exact tests. Results Post propensity-score matching, significant demographic disparities emerged between white and minority patients. Minority patients had longer operative times ( p < .001) and hospital stays ( p = .001) than white patients. Minority patients also exhibited higher rates of mortality ( p = .04) and unplanned re-intubation ( p = .04). Conclusion This study revealed significant racial disparities in early postoperative outcomes for PHFs. Despite surgical advancements, minorities have prolonged operative times, extended hospital stays, and heightened risks of adverse events. Action is needed to ensure healthcare equity and justice and to address disparities in PHF surgical management across diverse demographics. Level of evidence III
Phase II trial of dual anti-CTLA-4 and anti-PD-1 blockade in rare tumors SWOG/NCI experience: invasive mucinous or non-mucinous lepidic adenocarcinoma of the lung (formerly bronchioloalveolar carcinoma)
Authors: Chae Young Kwang , Othus Megan , Patel Sandip Pravin , Gerber David E. , Tanvetyanon Tawee , Kim Hye Sung , Chung Liam Il-Young , McLeod Christine M. , Lopez Gabby , Chen Helen X. , Sharon Elad , Streicher Howard , Ryan Cristopher W. , Blanke Charles D. , Kurzrock Razelle 
Published: November 2024

Background: Anti-programmed death-1 (PD-1)/cytotoxic T lymphocyte antigen-4 antibodies are efficacious in various malignancies. Objectives: This study presents the first results of ipilimumab–nivolumab in invasive mucinous or non-mucinous lepidic adenocarcinoma (invasive mucinous adenocarcinoma (IMA) or invasive non-mucinous lepidic adenocarcinomas (INLA), respectively) of the lung. Design: Dual anti-CTLA-4 and anti-PD-1 blockade in rare tumors (DART) is a prospective, open-label, multicenter (1016 US sites), multi-cohort phase II trial of ipilimumab (1 mg/kg intravenously (IV) every 6 weeks) plus nivolumab (240 mg IV every 2 weeks). Methods: Participants histologically diagnosed with advanced IMA or INLA, who had not responded to at least one line of therapy, were included in the bronchioloalveolar carcinoma cohort. The primary endpoint was the overall response rate (ORR) by Response Evaluation Criteria in Solid Tumors (confirmed complete and partial responses (CR and PR)). Secondary endpoints were progression-free survival (PFS), overall survival (OS), clinical benefit rate (CBR; stable disease (SD) ⩾ 6 months plus ORR), and toxicity. Results: Eight evaluable patients (median age: 77 years; the number of prior therapies ranged from 0 to 4; one patient with prior exposure to a PD-1 inhibitor; comprising six IMA and two INLA) were treated. One IMA had a 40% regression (PFS 45.2+ months, PD-L1 0%, KRAS G12C mutated, tumor mutational burden [TMB] 13 mut/Mb). One INLA had 66% regression (PFS 23.8 months, PD-L1 unknown, no actionable mutations, TMB 3 mut/Mb). Overall ORR was 25.0% (2/8) and CBR, 62.5% (5/8); PFS for the patients with SD > 6 months was 43.4+, 11.7+, and 8.3 months. The median PFS was 16 months (5.3–not reached) and the median OS was 32.2 months (14.6–not reached). The toxicity profile was similar to previous reports. Conclusion: Ipilimumab plus nivolumab in the bronchioloalveolar carcinoma cohort (IMA, INLA) resulted in a durable ORR of 25.0% and CBR of 62.5% (PFS, 8.3 11.7+. 23.8 (PR), 43.4+ and 45.2+ (PR) months). Correlative studies to determine response and resistance markers are ongoing. Expanded prospective studies are warranted. Trial registration: ClinicalTrials.gov registry: NCT02834013.
Small-Sided-Game-Induced Mechanical Load in Adolescent Soccer: The Need for Care and Consideration for Athlete Preservation
Authors: Salter Jamie 
Published: November 2024

Context: The logistical efficiency and flexibility of small-sided games (SSG) to develop various soccer-specific attributes simultaneously make them a staple component of contemporary training programs in youth soccer. Their high ecological validity and consequential high utilization mean that if not considerately prescribed, players may be exposed to frequent repetitive mechanical stress that may induce maladaptation in skeletally and/or load-naïve or sensitive athletes. The purpose of this clinical review is to summarize mechanical load adaptations associated with the manipulation of area per player in SSG to outline the mechanistic pathway of load-related injuries in skeletally maturing athletes and to offer practical guidelines for coaches for the preservation of athlete health. Evidence Acquisition: A nonsystematic search of computerized databases of peer-reviewed articles in English between 2010 and the present was used, and a critical appraisal of existing literature was subsequently conducted. Study Design: Clinical review. Level of Evidence: Level 4. Results: The temporary relative strength deficit and inefficiency of the musculotendinous system associated with accelerated growth increase the mechanical cost of activity. As a result, the load tolerance (ie, tolerant, naïve, or sensitive) of athletes is transiently reduced as the musculoskeletal system struggles to attenuate force absorption adequately. Repeated exposure to submaximal mechanical loads that stimulate the accumulation of “microdamage” in structural tissue may lead to aggravation and/or tissue failure at connective sites in skeletally fragile athletes. Conclusion: Coaches and practitioners need to individualize exposure to mechanical load for load-tolerant, naïve, and sensitive athletes during adolescence. Subtle changes to SSG prescription including modifying the area per player, inclusion of goalkeepers, constrained floaters, and management of work; rest ratios can offer practical and efficient methods to mitigate risk without derailing the development process. This, in turn, should contribute to reducing injury burden in this population and enhance developmental opportunities for young players. Strength of Recommendation: A. Recommendation based on consistent and good-quality evidence published from 2010 onwards.
Dupilumab Treatment for Aspirin-Exacerbated Respiratory Disease in a Real-World Setting: Impact on Quality of Life and Healthcare Utilization
Authors: Mullur Jyotsna , Maurer Rie , Ryan Tessa , McGill Alanna , Bensko Jillian C. , Laidlaw Tanya M. , Buchheit Kathleen M. 
Published: November 2024

Background Patients with aspirin-exacerbated respiratory disease (AERD) have difficult-to-treat asthma and chronic rhinosinusitis with nasal polyps (CRSwNP) and often require treatment with biologic therapy for asthma or CRSwNP. Healthcare utilization in patients with AERD has not been well described since the advent of respiratory biologics. Objective To determine real-world healthcare utilization and quality of life among patients with AERD and to understand the impact of dupilumab, a monoclonal antibody targeting the interleukin 4 receptor, on patient-reported health outcomes and healthcare utilization. Methods We conducted a longitudinal survey study of 98 patients with AERD recruited from the Brigham and Women's Hospital AERD registry. Patients completed online questionnaires describing their medication history, healthcare utilization, and quality of life every 3 months for 2 years. Results At the end of 24 months, participants who were on dupilumab at the start of the study and those who started dupilumab had a significant reduction in the number of reported poor health days in the preceding month compared to patients not on dupilumab ( P < .001 and P < .01, respectively). Participants on dupilumab and those who started dupilumab also had significantly lower overall sinonasal outcome test-22 and asthma control test scores compared to those not on dupilumab over 24 months ( P < .05 for both groups). Conclusion Dupilumab therapy significantly improves health-related quality of life in patients with AERD, specifically as it pertains to patient assessment of days of overall poor health and quality of life related to sinonasal and asthma symptoms.
Cangrelor use in a pediatric patient with aneurysmal subarachnoid hemorrhage
Authors: Russo Riccardo , Molinaro Stefano , Mistretta Francesco , Gava Umberto , Morana Giovanni , Peretta Paola , Del Borrello Giovanni , Zeppa Pietro , Bergui Mauro 
Published: November 2024

We herein report the case of a pediatric patient suffering from subarachnoid hemorrhage (SAH) due to a ruptured internal carotid artery (ICA) saccular aneurysm. Considering the unfavorable anatomy and irregular shape of the aneurysm, a flow diverter (FD) stent was positioned in addition to coils in an acute setting. Cangrelor (Kengreal, Chiesi, USA) IV bolus followed by maintenance IV infusion was administered in addition to ASA at the time of intervention. Transitioning from cangrelor to thienopyridine (clopidogrel) was done the day after the procedure without any ischemic or hemorrhagic complications. The patient was discharged symptom-free 24 days later. We discuss technical considerations focusing specifically on antiplatelet therapy management.
Enhancing recanalization success: Thrombectomy plus stent angioplasty by coaxial balloon technique for acute ischemic stroke with tandem occlusions
Authors: Yen Pao-Sheng , Kok Victor C. , Lin Yu-Hui , Wu Yu Tzu , Ko Li-Ying 
Published: November 2024

Recanalizing acute ischemic stroke with carotid tandem occlusion (CTO) is technically challenging because distal embolic migration during revascularization can significantly influence outcomes. In this study, we aimed to introduce our coaxial balloon technique using a balloon-guiding catheter (BCG), angioplasty catheter, and aspiration catheter sequentially to prevent thrombus migration to a new vascular territory. We used this technique for six patients with CTO. Technical success with good revascularization of the CTO was achieved in all six patients (100%) without neurological complications, including one and five cases of modified Thrombolysis in Cerebral Infarction 2b and 3, respectively. The median duration of the procedure was 61 (interquartile range, 52–90) min. The mean National Institutes of Health Stroke Scale score at discharge was 3.5 (2–8), with favorable clinical outcomes at 90 days for three of six patients (50%). The coaxial balloon technique for CTO is safe and effective for revascularization in patients with acute ischemic stroke. Thrombectomy before proximal stenting was associated with shorter reperfusion times and better clinical outcomes. Therefore, this approach is recommended for tandem occlusions requiring stent angioplasty.
All-Suture Anchor Onlay Fixation for Medial Patellofemoral Ligament Reconstruction: A Biomechanical Comparison of Fixation Constructs
Authors: Smith Benjamin L. , Bedi Asheesh , Hauck Oliver L. , Wijdicks Coen A. , Riboh Jonathan C. 
Published: November 2024

Background: The use of all-suture anchors (ASAs) for onlay patellar and femoral fixation of medial patellofemoral ligament (MPFL) grafts may provide clinical benefit, particularly in the small or pediatric knee; however, biomechanical data supporting the use of ASAs are lacking. Purpose/Hypothesis: The purpose of this study was to compare ASAs to larger interference implants for MPFL reconstruction in a time-zero biomechanical model. It was hypothesized that ASAs would have comparable cyclic elongation to interference fixation and would exceed published biomechanical values for the native human MPFL. Study Design: Controlled laboratory study. Methods: Eighteen fresh-frozen porcine patellas and femurs were divided into equal groups (n = 9 per group) for MPFL reconstructions. Patellar fixation utilized two 3.9-mm interference suture anchors (ISAs) or two 2.6-mm ASAs, while femoral fixation utilized one 6×20-mm interference screw (IS) or one 2.6-mm ASA. Human gracilis tendon grafts were used. Specimens were dynamically loaded for 100 cycles each in sequential 5- to 30-N (phase 1) and 5- to 50-N (phase 2) blocks at 1 Hz followed by load-to-failure testing at 305 mm/min. Results: No differences were found in cyclic elongation after phase 1 and phase 2 loading between ASA and interference implants on either the femoral or patellar side. On the femur, IS had significantly greater ultimate stiffness (54.2 vs 46.1 N/mm; P < .001) and ultimate load (366 vs 278 N; P = .019) compared to ASA. On the patella, ISAs had significantly greater ultimate stiffness (70.5 vs 53.1 N/mm; P < .001) but a significantly lower ultimate load (244 vs 307 N; P = .014) compared to ASAs. All groups significantly exceeded the published physiological values for native human MPFL stiffness and failure load. Conclusion: ASA onlay fixation had comparable cyclic elongation to that of interference fixation for femoral and patellar MPFL reconstruction. Although differences in ultimate stiffness and ultimate load were noted between implants, all of the values exceeded published values for the human MPFL. Clinical Relevance: This biomechanical study presents ASA cortical onlay fixation as a viable option for MPFL reconstruction. ASAs require less bone removal, potentially reducing the risk of patellar fracture and minimizing fixation complexity in the setting of open femoral growth plates. Future clinical studies will provide insight into successful tendon-to-bone healing, failure rates, and near- and long-term patient-reported outcomes.
Psychological Distress Associated With Suicidal Ideation Among Glaucoma Patients Attending at Tertiary Eye Care Clinic, Gondar, Ethiopia
Authors: Andualem Fantahun , Ali Dawed , Tinsae Techilo , Nakie Girum , Gedef Getachew Muluye , Demilew Demeke , Begashaw Tesfaye Derbie , Tegegn Lidiya Fasil , Seid Jemal 
Published: November 2024

Introduction Suicide is defined as the deliberate taking of one's own life with either implicit or explicit proof; however, it can also refer to the contemplation or actualization of suicide. Suicide is a mental illness with several contributing factors. It is frequently linked to sex, age, health problems, substance misuse, and traumatic life experiences. Objective The purpose of this study was to evaluate the prevalence of suicide thought and attempts among glaucoma patients and its contributing factors in Gondar, Ethiopia, 2022. Methods An observational cross-sectional study was conducted on 422 glaucoma patients at the Tertiary Eye Care Clinic, University of Gondar Comprehensive and Specialized Hospital. Suicidal ideation and attempts were assessed using the suicidality module of the World Mental Health Survey Initiative version of the World Health Organization's Composite International Diagnostic Interview. Bivariate and multivariate logistic regressions were conducted to identify factors associated with suicidal ideation and attempts. The variables with a p-value less than 0.05 and a 95% CI were considered statistically significant. Results The overall prevalence of suicidal ideation and attempt was 6.4% with a 95% CI of 4.3–9.2% and 2.4% with a 95% CI of 1.1–4.3%, respectively. In multivariate analysis, severe psychological distress, moderate psychological distress, mild psychological distress, and current substance use were identified as risk factors for suicidal ideation, whereas living alone, co-morbid chronic medical disease, and ever-present substance use were identified as risk factors for suicidal attempts. Conclusion Based on this study finding, the prevalence of suicidal ideation and attempts was high among glaucoma patients. This study may provide further information to pay much attention to the physical health care of patients with glaucoma. More representative samples, or rather, a cross-sectional study design, should be used in future studies aiming for more precise data.