bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing Technical Efficiency in the Provision of Elementary Education Across Indian States
Authors: Rosario Jyotsna , Shanmugam K. R. 
Published: November 2024

This article assesses the technical efficiency of 28 Indian states in delivering elementary education between 2009–2010 and 2020–2021, using the stochastic frontier model developed by Battese and Coelli. The findings indicate that technical inefficiency accounts for 82 per cent of the interstate disparities in elementary education output. Factors such as public expenditure, schooling infrastructure and the presence of qualified teachers positively impact output. However, the effect of public expenditure diminishes beyond a certain threshold. Higher literacy rates, increased urbanisation and a greater proportion of government schools improve efficiency. Conversely, a higher percentage of scheduled caste and scheduled tribe children and the appointment of contractual teachers decrease efficiency. The overall technical efficiency stands at 79 per cent. Efficiency varies widely across states, ranging from 52 per cent to 94.5 per cent. Goa, Haryana and Kerala demonstrate the highest efficiency, while Arunachal Pradesh, Meghalaya and Manipur rank the lowest. Some states have seen improvements in efficiency, while others have experienced declines. These findings suggest that resource-poor states can benefit from increased public expenditure, whereas efficient resource utilisation is crucial for states facing inefficiencies. This article provides essential insights for policymakers to address regional imbalances and enhance elementary education outcomes. JEL Codes : H52, I21, I22, I28, C14, D24
Development and Validation of the South African Diet Quality Index for Pregnancy: The NuEMI Study
Authors: Robb Liska , Joubert Gina , Jordaan Elizabeth Margaretha , Ngounda Jennifer , van den Berg Louise , Walsh Corinna May 
Published: November 2024

Background Diet quality indexes (DQIs) consist of combinations of foods and/or nutrient components that represent adherence to dietary guidelines. A high-quality diet during pregnancy contributes to optimal birth outcomes. Objective We developed and validated the first DQI for pregnancy for South African women. Methods The South African Food Based Dietary Guidelines and pregnancy dietary guidelines were used as theoretical basis for the a priori development of the South African Diet Quality Index for Pregnancy (SA-DQI-P). To validate the SA-DQI-P, we applied it to data collected for the Nutritional status of Expectant Mothers and their newborn Infants (NuEMI) study ( N = 682). We determined the associations between SA-DQI-P scores in tertiles with nutrient intakes, sociodemographic factors, household food security level, and biochemical values. Results A lower household density ratio, household access to a toilet, refrigerator, and microwave, a higher educational level, being employed and being food secure were significantly associated with a higher score. After correcting for energy intake, higher scores were significantly associated with higher intakes of protein, total fat, saturated fat, cholesterol, calcium, vitamin A, vitamin E, folic acid, vitamin B12, and vitamin C. Significantly more participants who were vitamin A deficient scored in the lowest tertile than those in higher tertiles. Conclusion The SA-DQI-P is the first DQI developed for a South African population and has proven to be valid in ranking diet quality in pregnant women in our sample. Information regarding diet quality of this vulnerable group can assist with planning nutrition intervention programs to improve nutritional status.
The funnel effect of reserves prompted by leisure activities across the Alzheimer's disease continuum
Authors: Serra Laura , Bonarota Sabrina , Di Domenico Carlotta , Caruso Giulia , Giulietti Giovanni , Rizzuti Martina , Assogna Martina , Rodini Marta , Mencarelli Lucia , Di Lorenzo Francesco , Koch Giacomo , Fadda Lucia , Caltagirone Carlo , Bozzali Marco 
Published: November 2024

Background Reserves' mechanisms explain inconsistencies between accumulation of neuropathological damage and clinical manifestations. Leisure activities are believed to promote reserves. Objective This study evaluates whether cognitive, social, and physical leisure activities performed over life-span predict current cognitive functioning in normal aging and Alzheimer's disease (AD) continuum. Methods 35 AD, 24 amnestic-Mild Cognitive Impairment (a-MCI) patients, 21 individuals with subjective cognitive complaint (SCD), and 25 controls underwent a questionnaire developed to quantify leisure activities in different life periods, the Addenbrooke's Cognitive Examination-Revised (ACE-R), and T1-weighted 3T-MRI scans for brain volumetrics and cortical thickness quantification. Partial/total leisure activities' scores and demographic and brain variables were entered as predictors, while ACE-R scores as dependent variables in linear regression analyses. Results Current level of cognition was predicted by (i) social and physical activities performed in middle age and current cognitive activity in AD; (ii) cognitive and social activities performed in middle age, current age and cortical thickness in a-MCI; (iii) recreational activities the set of lifetime, current age, and brain features in SCD; (iv) education and the set of lifetime leisure activities over lifespan in controls. Conclusions This study shows a funnel effect due to gradual reduction of stimulatory activities in the transition from healthy aging to AD. Reserve indices taking into account different types of stimulatory activities allow to capture even smallest residual effects of reserves accumulated over lifespan, until their complete depletion at advanced AD stages. These results may help target tailored interventions during normal and pathological aging.
Dietary protein intake interacts with weak handgrip strength and cognitive impairment
Authors: Zhou Lingling , Zhang Cui 
Published: November 2024

Background Handgrip strength correlates with cognitive function, but how gender and dietary protein interact with it is unclear. Objective To investigate the relationship between handgrip strength and cognitive function among non-stroke elders, and potential interaction effects of gender and dietary protein. Methods Non-stroke older adults with handgrip strength and cognitive tests available were included from National Health and Nutrition Examination Survey (NHANES) database. Multivariable linear regression analyses were used to explore the association between grip strength and cognitive performance. Multivariable logistic regression analyses were to investigate the effect of weak handgrip strength on cognitive impairment. Subgroup analyses were conducted to explore differences among sub-populations. Interaction effects of gender and protein intake were investigated by interaction analyses. Results Larger handgrip strength was associated with preferable memory function in men (CERAD Word Learning sub-test: p = 0.005; CERAD Delayed Recall: p = 0.009), better verbal fluency (Animal Fluency test: p = 0.005) and executive function in women (Digit Symbol Substitution Test: p = 0.017). Weak handgrip strength was associated with cognitive impairment, especially in older, female, obese participants or elders with low protein consumption. Participants with weak grip strength, compared to normal strength, were twice as likely to perform poorly in complex cognition evaluations (odds ratio = 2.01, p = 0.028). Interaction effect of protein intake was observed (p-interaction = 0.022). Compared to conditions of low protein intake, high protein intake significantly offset the impact of weak handgrip on cognitive impairment. Conclusions The association between grip strength and cognitive performance varies by gender. Non-stroke elders with weak handgrip strength are vulnerable to cognitive impairment. Improving muscle strength and increasing protein intake may be effective to mitigate decline in executive function.
Pre-existing dementia is associated with 2–3 folds risk for in-hospital mortality and complications after intracerebral hemorrhage stroke
Authors: Zuo Lijun , Hu Yang , Dong YanHong , Seet Raymond CS , Li Zixiao , Wang Yongjun , Zhao Xingquan 
Published: November 2024

Background Pre-existing dementia was related to poor functional outcome after intracerebral hemorrhage (ICH), and its commonly underlying pathologies were considered as cerebral amyloid angiopathy. But the impact of pre-existing dementia on in-hospital mortality in Chinese ICH patients has not been well characterized. Objective To investigate the association between pre-existing dementia and in-hospital mortality after ICH. Methods Data were extracted from the China Stroke Center Alliance database. Information about the existence of prior to stroke dementia was obtained from next of kin informants and registered in clinical charts. Patients’ characteristics, in-hospital mortality, home discharge and complications were compared between ICH patients with and without pre-existing dementia. Results Out of the 72,318 ICH patients, we identified 328 patients with pre-existing dementia. Patients with pre-existing dementia were more likely to experience greater stroke severity as measured by the National Institute of Health Stroke Scale and Glasgow Coma Scale. In the adjusted models, the presence of pre-existing dementia was associated with an increased risk of in-hospital mortality (OR 2.31, 95% CI 1.12–4.77), more frequent in-hospital complications of pulmonary embolism (OR 5.41, 95% CI 1.16–25.14), pneumonia (OR 1.58, 95% CI 1.08–2.33), urinary tract infection (OR 2.37, 95% CI 1.21–4.64), gastrointestinal bleeding (OR 2.39, 95% CI 1.27–4.49) and lower home discharge (OR 0.59, 95% CI 0.38∼0.93). Conclusions ICH patients with pre-existing dementia are more likely to suffer from greater stroke severity, poorer outcomes and lower home discharge. Future studies should evaluate the value of intensive risk factor control among individuals with pre-existing dementia for stroke prevention.
Economic evaluations of technology-based interventions used to provide care support for people with mild dementia or mild cognitive impairment and their caregivers: A systematic review
Authors: Vargas-Martínez Ana Magdalena 
Published: November 2024

Background The cost-effectiveness of interventions is a key issue owing to the limited resources of healthcare services. Objective To conduct a systematic review of economic evaluations of technology-based healthcare interventions in care support for people with dementia or mild cognitive impairment (MCI) and their caregivers, and of the tools used to assess effectiveness and costs. Methods The following databases were used: PubMed, National Health Service Economic Evaluation Database, and Health Technology Assessment. A total of 207 articles from 2012 to 2024 were identified and then screened. Results Seventeen studies were included, of which nine were study protocols. Almost half (n = 8) the interventions were multicomponent. The most common components used in the interventions were cognitive stimulation, physical functioning and continuing support. Regarding the efficiency results of these interventions, only three studies provided a full economic evaluation. The most frequent tools in the economic evaluations used to measure effectiveness (measured in quality-adjusted life years) and costs were the European Quality of Life-5 Dimensions and Resource Utilization in Dementia instruments, respectively. Conclusions Most of the interventions evaluated were cost-effective. However, these results should be interpreted with caution, given the scarcity of the literature, and further economic evaluations of technology-based healthcare interventions for people with mild dementia or MCI care support and their caregivers are therefore needed. Additionally, a meta-analysis could not be performed due to the heterogeneity of the data.
Altered neurovascular coupling in semantic variant primary progressive aphasia
Authors: Zhang Yanxin , Ji Chunxue , Meng Yaping , He Yong , Su Xiao , Qin Wen , Zhang Nan 
Published: November 2024

Background Semantic variant primary progressive aphasia (svPPA) is one of the main clinical phenotypes of frontotemporal lobar degeneration. Changes in both neuronal activity and cerebral perfusion have been observed in svPPA, suggesting a possible breakdown of neurovascular coupling (NVC). Objective To investigate alterations in NVC and their correlations with clinical manifestations in svPPA patients. Methods In this study, a cohort consisting of 19 subjects diagnosed with svPPA and 36 cognitively unimpaired controls (CUCs) have been enrolled for analysis. All participants underwent multimodal magnetic resonance imaging (MRI) scans, resting-state functional MRI and arterial spin labelling, and neuropsychological assessments. The amplitude of low-frequency fluctuations (ALFF) and cerebral blood flow (CBF) were obtained to measure neural activity and perfusion, respectively. The calculation of voxel CBF-ALFF correlation and CBF/ALFF ratio enables the assessment of global NVC and regional NVC, respectively. Correlations between the CBF/ALFF ratios and cognitive scores of the svPPA patients were analyzed. The relationships between the CBF/ALFF ratios and the cognitive performance of the svPPA patients were investigated through correlational analyses. Results Compared with CUCs, svPPA patients had decreased global CBF-ALFF correlation coefficients ( p < 0.001) and lower CBF/ALFF ratios in bilateral inferior temporal gyrus, fusiform gyrus, left temporal pole and middle temporal gyrus ( p < 0.05). In svPPA patients, the CBF/ALFF ratios in the left inferior and middle temporal gyrus correlated positively with naming ability and general cognition, respectively. Conclusions The study indicate that NVC is disrupted in svPPA patients and is relevant to cognitive and language function.
Real-world assessment of caregiver preference and compliance to treatment with twice-weekly versus daily rivastigmine patches in Alzheimer's disease
Authors: García-Alberca José María , De La Guía Paz , Gris Esther , Mendoza Silvia , López De La Rica María , López-Trigo José Antonio , López-Mongil Rosa , García-López Teresa , López-García Raquel , Rodríguez Del Rey Teresa , Gay-Puente Javier , García-Castro Jesús , Casales Federico , Morato Xavier , Boada Mercè , González-Velasco Gemma , Marín-Carmona José Manuel , Páez Nora Inés , León María , Carrillejo Rosario , Rius Francisca , Barbancho Miguel Ángel , Lara José Pablo , Blanco-Reina Encarnación 
Published: November 2024

Background Adherence is critical in patients with Alzheimer's disease (AD) in order to achieve optimal benefit from therapy. However, patient compliance with the treatment remains a challenge. Objective To evaluate, in a real-world clinical setting, caregiver preference and treatment compliance with twice-weekly versus daily transdermal rivastigmine patch in mild-to-moderate AD. Methods 92 patients who had been treated with daily rivastigmine patch for at least six months prior to switching to twice-weekly patch were evaluated. The change in therapeutic regimen was decided by the treating physician in accordance with standard practice. Caregivers’ satisfaction with daily rivastigmine patch was assessed at study entry. Caregiver's preference and satisfaction with twice-weekly patch as well as patient compliance were evaluated at weeks 12 and 24 using the Alzheimer's Disease Caregiver Preference Questionnaire. Results A significantly higher proportion of caregivers expressed a preference for the twice-weekly patch over the daily patch ( p < 0.001), and this preference was found to be associated with ease of use ( p < 0.001), ease of following the schedule ( p < 0.001), and ease of compliance ( p < 0.001). Furthermore, caregivers were more satisfied with the twice-weekly patch ( p < 0.0001). At 24 weeks, patient compliance was significantly better with the twice-weekly patch than with the daily patch ( p = 0.002). Caregiver burden significantly improved at the end of the treatment ( p = 0.003). No serious adverse events were reported. Conclusions The twice-weekly rivastigmine patch offers a convenient and straightforward dosing regimen for caregivers, with potential to enhance adherence with treatment in AD patients without causing serious adverse events.
Documentation of prodromal features and risk factors of dementia disease in primary care practice
Authors: Michalowsky Bernhard , Teipel Stefan , Riedel-Heller Steffi , Kostev Karel , Bohlken Jens 
Published: November 2024

Background Documented risk factors and prodromal features of dementia in primary care practices may support dementia prevention and early detection in routine care. Objective To identify documented prodromal features and risk factors of dementia before the incident dementia diagnosis in German primary care practices. Methods This case-control study used documented diagnoses (risk factors, prodromal features) and prescriptions of primary care practices for 73,717 patients with dementia disease and 73,717 matched controls (ratio 1:1). Logistic regression models were used to assess the associations between these documentations and the development of dementia diseases within 12 (1 year), 12–60 (1–5 years), and 60–120 months (5–10 years) before the incident dementia diagnosis. Results Mild cognitive impairment, depression, symptoms involving the emotional state, dizziness, and age-related physical debility were documented prodromal features associated with developing dementia diagnosis across all periods. Difficulties in gait and mobility and conduct disorders occurred significantly more often five years before the diagnosis. In terms of documented risk factors, hearing loss, visual disturbances, diabetes mellitus, and cerebrovascular diseases were associated with dementia across all periods. Mental and behavioral disorders due to the use of alcohol, intracranial injury, Parkinson's disease, chronic fatigue, intellectual disabilities, pneumonia, and epilepsy were also more often documented 60 months before the diagnosis. Conclusions Next to mild cognitive deficits, several factors, such as disorders of conduct and emotions, gait, mobility, and mental health, can be identified and monitored in primary care practices, helping physicians focus on potential consequences for cognitive decline and subsequent dementia.
Deep-learning assessment of hippocampal magnetic susceptibility in Alzheimer's disease
Authors: Shibata Haruto , Uchida Yuto , Kan Hirohito , Sakurai Keita , Madokoro Yuta , Iwano Sayaka , Maurya Sunil Kumar , Muñoz-González Ángel , Ardakani Ilya , Yamada Kentaro , Matsukawa Noriyuki 
Published: November 2024

Background Quantitative susceptibility mapping (QSM) is pivotal for analyzing neurodegenerative diseases. However, accurate hippocampal segmentation remains a challenge. Objective This study introduces a method for extracting hippocampal magnetic susceptibility values using a convolutional neural network (CNN) model referred to as 3D residual UNET. Methods The model was pre-trained on whole QSM images and hippocampal segmentations from 3D T1-weighted images of 297 patients with Alzheimer's disease and mild cognitive impairment. Fine-tuning was conducted through manually annotated hippocampal segmentations from the QSM images of 60 patients. The performance was assessed using the Dice similarity coefficient (DSC) and Pearson correlation coefficient. Results The developed model was applied to another 98 patients, 49 with AD and 49 with mild cognitive impairment (MCI), and the correlation between the hippocampal magnetic susceptibility and volume was evaluated. The mean DSC for the hippocampal segmentation model was 0.716 ± 0.045. The correlation coefficient between the magnetic susceptibility values derived from manual segmentation and the CNN model was 0.983. The Pearson correlation coefficient between magnetic susceptibility and hippocampal volume from the CNN model was −0.252 ( p = 0.012) on the left side and −0.311 ( p = 0.002) on the right. Conclusions The 3D residual UNET model enhances hippocampal analysis precision using QSM, which is capable of accurately extracting magnetic susceptibility.
Assessing the accuracy gap in early postoperative complication surveillance: ICD-10 codes versus manual curation—clinical and economic implications
Authors: Dencker Emilie Even , Bonde Alexander , Lorenzen Stephan Sloth , Troelsen Anders , Sillesen Martin 
Published: November 2024

Background and objective: Assessing surgical outcomes, notably postoperative complications (PCs), is crucial for healthcare systems. However, reliance on International Classification of Diseases, 10th revision (ICD-10) codes, may be suboptimal. This study aims to compare the accuracy of ICD-10 codes against manual curation of electronic healthcare records (EHRs) for identifying 13 individual PCs and evaluate associated resource utilization. Methods: EHR data from 11,827 surgical cases across 18 Danish hospitals in November 2021 were analyzed. PCs were identified and extracted through both manual curation and ICD-10 codes. Outcomes such as readmission, admission days, intensive care unit (ICU) stays, reoperations, and radiology procedures were assessed as proxies for resource consumption. Statistical and economic analyses quantified resource utilization and associated costs. Results: In total, 1047 PCs were found through manual curation and 439 PCs were found through ICD-10 codings. Only 218 of the PCs found through ICD-10 codes were retrieved during manual curation—corresponding to a correct ICD-10 coding of 20.8% of PCs. Patients with PCs experienced significantly higher resource utilization, including a 6.6 times higher readmission rate, 6 additional admission days, 2 extra ICU days, 7.7 times more reoperations. PCs incurred substantial economic costs, with additional admission days alone accounting for €25.5 million annually, over four times higher than estimates from ICD-10 codes. Conclusions: ICD-10 codes inadequately capture early PCs highlighting the need for improved detection strategies. The actual costs associated with PCs far exceed current estimates, emphasizing the necessity for enhanced monitoring for informed decision-making. In the Danish healthcare system, ICD-10 codes only capture approximately 21% of PCs, making it inadequate for surgical quality monitoring. The actual costs related to PCs, based on study assumptions, are more than four times higher than estimated from current standard. This calls for novel strategies for PC detection to improve healthcare as well as political and financial decision-making.