bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changes in alpha-fetoprotein across the systemic therapy continuum in advanced hepatocellular carcinoma—a real-world, multicenter study
Authors: Li Michael , Hannan Lindsay M. , Goyal Lipika , Bocobo Andrea G. , Parks Anna L. , Bauer Kelly , Baiev Islam , Dinicola Caroline , Gordan John D. , Venook Alan P. , Harris William P. , Bracci Paige , Kelley Robin K. 
Published: November 2024

Background: Early changes in alpha-fetoprotein (AFP) are a promising surrogate endpoint for systemic treatment outcomes in hepatocellular carcinoma (HCC). Objectives: We sought to investigate the utility of AFP response across first-line sorafenib (1L SOR) and later-line checkpoint inhibitor (CPI) therapies. Design: We conducted a multicenter, retrospective cohort study of patients with advanced HCC who received 1L SOR and any subsequent CPI. Methods: The primary outcomes were overall survival (OS) and time on treatment (TOT). Pre-treatment AFP and the lowest AFP within 3 months of treatment initiation were used to calculate the percent change in AFP for each treatment. AFP response was defined as an AFP reduction by ⩾20% within 3 months, and AFP progression was defined as an increase in AFP by ⩾20% within 3 months. Patients with baseline AFP < 20 ng/mL were considered not evaluable for AFP change. Results: Of 176 study patients, 46 (28%) received CPI after SOR, and 125 (71%) had a baseline AFP ⩾ 20. Patients who experienced AFP response on SOR had significantly longer OS and TOT than those who did not and those who were not evaluable (OS: median 689 vs 320 vs 452 days, log-rank p < 0.001; TOT: median log of days 5.2 vs 4.5 vs 4.9, p < 0.001). Patients with AFP progression following SOR had significantly shorter OS than those who did not and those who were not evaluable (median 304 vs 557 vs 452, log-rank p = 0.008). Similarly, patients with AFP response following CPI therapy had a significantly reduced risk of death compared with those who did not have an AFP response (hazard ratio 0.13, 95% confidence interval 0.03–0.60, p = 0.009). Conclusion: Early AFP response with 1L SOR and any subsequent CPI was associated with longer OS and TOT, and early AFP progression was associated with shorter OS and TOT. These data support utilizing longitudinal AFP changes as a surrogate endpoint in HCC systemic therapy.
How does urology work? Evaluation of activity trackers in the assessment of workload and stress burden among employees in the Department of Urology of a German University Hospital: A prospective pilot study
Authors: Pohlmann Philippe Fabian , Glienke Maximilian , Ehrmann Christian , Gratzke Christian , Miernik Arkadiusz , Schoeb Dominik Stephan 
Published: November 2024

Introduction Workload and stress in excess can lead to work disability. The aim of our study was to determine whether commercially available “activity trackers” can be used to make statements about the work – or stress load of different occupational groups. Material and methods The study was conducted at the University Hospital Freiburg, Germany. Four occupational groups with a total of 32 subjects were studied: senior physicians (SP, 4), assistant physicians (AP, 11), nursing staff (NS, 12) and administrative staff (AS, 5). The activity trackers were worn on five working days and one day off. Step frequency, distance and heart rate (HR) were measured, and workload was assessed using a visual analog scale. Results The highest workload was reported by SP, the lowest by AS. Male employees feel higher workload than female employees ( p = 0.009). NS covered the greatest daily distance, AP the least ( p = 0.001). There was a significant difference in average HF between AP and NS ( p = 0.008). AS showed higher daily distance and maximum HF on days off compared to work days, and NS showed the opposite behavior. With increasing patient volume for ambulatory care, the average HF increased ( p = 0.037) in NSs. Conclusion “Activity trackers” reliably provide body data during work. In our small sample, interesting differences and results on workload emerged. More data would require more subjects and more study variables.
Effect of a metaverse multimodal rehabilitation intervention on quality of life and fear of recurrence in patients with colorectal cancer survivors: A randomized controlled study protocol
Authors: Hu Yuru , Peng Huan , Su Guoqiang , Chen Bo , Yang Zhiping , Ye Yafang , Zhou Beiyun , Lin Sumin , Deng Huili , Zhang Jiajun , Xie Yaojie , He Honggu , Ruan Zheng , Shen Qu 
Published: November 2024

Background Regular rehabilitation during or after cancer treatment can bring numerous benefits to colorectal cancer survivors. However, there is a lack of convenient and mobile rehabilitation support systems tailored specifically for this group. The metaverse, as a virtual reality environment, offers an innovative platform for implementing rehabilitation. Hence, our study aims to develop a metaverse-based multimodal rehabilitation program and assess its effects on enhancing outcome measures such as quality of life in colorectal cancer patients. Methods and analysis This study was designed as a randomized, single-blind controlled trial design featuring two arms: a rehabilitation group and a conventional care group. Sixty colorectal cancer survivors who have undergone curative surgery followed by adjuvant chemotherapy will be recruited for this study. The intervention will take place within the metaverse over a 4-week period. Assessments will be conducted at baseline and after 4 weeks. The intervention is grounded in the behavior change wheel framework and encompasses dietary intervention, exercise intervention, psychological support, and behavior management. Through the implementation of diverse strategies such as training, education, and motivation, our objective is to enhance patients’ capacity, opportunities, and motivation, ultimately fostering healthy behaviors. Outcome measures will encompass quality of life, fear of recurrence, and lifestyle. Results The analysis includes statistical description and inference. Quantitative data will be summarized using mean ± standard deviation for normally distributed data and medians with percentiles for non-normally distributed data. Categorical data will be presented as frequencies and percentages. Statistical tests will detect significant differences between pre- and post-intervention periods. Subgroup analysis will explore CRC stage, age, and gender in relation to outcome measures to identify factors affecting intervention efficacy. Conclusions The findings from this research will offer valuable insights and practical implications for the implementation of remote interventions and family-based interventions in the context of colorectal cancer survivorship. Trial Registration NCT05956990 (Registered 21 July 2023)
Despite a Multifactorial Etiology, Rates of Distal Junctional Kyphosis After Adult Cervical Deformity Corrective Surgery Can be Dramatically Diminished by Optimizing Age Specific Radiographic Improvement
Authors: Mir Jamshaid M. , Onafowokan Oluwatobi O. , Jankowski Pawel P. , Krol Oscar , Williamson Tyler , Das Ankita , Thomas Zach , Padon Benjamin , Schoenfeld Andrew J. , Janjua Muhammad Burhan , Passias Peter G. 
Published: November 2024

Study Design Retrospective cohort study of a prospectively collected single-center database. Objective Distal Junctional Kyphosis (DJK) is one of the most common complications in adult cervical deformity (ACD) correction. The utility of radiographic alignment alone in predicting and minimizing DJK occurrence warrants further study. To investigate the impact of post-operative radiographic alignment on development of DJK in ACD patients. Methods ACD patients (≥18 yrs) with complete baseline (BL) and two-year (2Y) radiographic data were included. DJF was defined as DJK greater than 15° (Passias et al) or DJK with reop. Multivariable logistic regression (MVA) identified 3-month predictors of DJK. Conditional inference tree (CIT) machine learning analysis determined threshold cutoffs. Radiographic predictors were combined in a model to determine predictive value using area under the curve (AUC) methodology. “Match” refers to ideal age-adjusted alignment. Results 140 cervical deformity patients met inclusion criteria (61.3 yrs, 67% F, BMI: 29 kg/m2, CCI: 0.96 ± 1.3). Surgically, 51.3% had osteotomies, 47.1% had a posterior approach, 34.5% combined approach, 18.5% anterior approach, with an average 7.6 ± 3.8 levels fused and EBL of 824 mL. Overall, 33 patients (23.6%) developed DJK, and 11 patients (9%) developed DJF. MVA controlling for age, and baseline deformity, followed by CIT found 3M cSVA <3.7 cm (OR: .2, 95% CI:.06-.6), and TK T4-T12 <50 (OR:.17, 95% CI:.05-.5, both P < .05) were significant predictors of a lower likelihood of DJK. Receiver operator curve AUC using age, T1S match, TS-CL match, LL-TK match, cSVA <3.7 cm, and T4-T12 <50 predicted DJK with an AUC of .91 for DJK by 2Y, and .88 for DJF by 2Y. Conclusion These findings suggest post-operative radiographic alignment is strongly associated with distal junctional kyphosis. When utilizing age-adjusted realignment in addition to newly developed thresholds, a suggested post-operative cSVA target of 3.7 cm and thoracic kyphosis less than 50, it is possible to substantially reduce the occurrence of distal junctional kyphosis and distal junctional failure.
Association Between Tibiofemoral Bone Shape Features and Retears After Anterior Cruciate Ligament Reconstruction
Authors: Bailey Karsyn N. , Gao Kenneth T. , Halvorson Ryan T. , Oeding Jacob F. , Majumdar Sharmila , Pedoia Valentina , Lansdown Drew A. 
Published: November 2024

Background: A retear after anterior cruciate ligament (ACL) reconstruction remains a common and devastating complication. Knee bone morphology is associated with the risk of ACL injuries, ACL retears, and osteoarthritis, and a combination of tools that derive bone shape from clinical imaging, such as magnetic resonance imaging (MRI) and statistical shape modeling, could identify patients at risk of developing these joint conditions. Purpose: To identify bone shape features before primary ACL reconstruction in patients with an eventual retear compared to those with a known intact ACL graft. Study Design: Case-control study; Level of evidence, 3. Methods: Bone was automatically segmented on 2-dimensional proton density–weighted MRI of the knee in patients at the time of the initial ACL injury using deep convolutional neural networks. Patients with a subsequent retear after reconstruction within 3 years (22 femurs, 19 tibias) were compared with those with an intact ACL graft at 3 years (20 femurs, 22 tibias) using statistical shape modeling to identify preoperative bone shape features predictive of a retear after ACL reconstruction. Results: Statistical shape modeling revealed 2 specific bone shape features (modes) in the femur and 1 mode in the tibia that demonstrated significant differences at the time of the initial injury in patients with subsequent retears. In the femur, a narrower intercondylar notch width, a widened medial condylar width, an increased femoral condylar offset ratio, increased surface area along the lateral femoral condyle relative to the medial condyle, and a more prominent trochlear sulcus at the time of the initial injury were associated with retears after ACL reconstruction. In the tibia, a diminished ACL facet prominence, a squared lateral and medial tibial plateaus, and a broader and flattened tibial spine at the time of the initial injury were associated with retears after ACL reconstruction. Conclusion: Using the automatic bone segmentation pipeline on preoperative MRI, the authors identified bone shape features associated with a retear after ACL reconstruction. The use of this pipeline enables large-scale studies of bone shape on MRI and could predict patients at risk of ACL retears to alter treatment decisions.
Attitudes toward Adolescent Mental Health Screening in a Dental Setting: A Mixed-Methods Study
Authors: Ticku S. , Nath S. , Ramesh N. , Riedy C.A. 
Published: November 2024

Introduction: Adolescents have experienced increasing levels of anxiety (AD) and depressive disorders (DD) in recent years. This study assessed the current attitudes of pediatric dentists and orthodontists on incorporating screenings for mental health disorders for their adolescent patients. Methods: A sequential mixed-methods approach was used. A 35-item survey was sent to 5,538 pediatric dentists and orthodontists that included questions about attitudes and current screening practices for AD and DD. Multivariate logistic regression analysis was performed to examine factors associated with dentists’ willingness to incorporate screening and discuss results with patients for AD and DD. Subsequently, we interviewed 16 orthodontists and pediatric dentists, conducted thematic analysis, and identified themes and subthemes. Results: Based on 305 responses, >80% of respondents viewed screening for AD and DD as important, but <15% conducted screenings for them. Moreover, for those not screening, the odds of future screening for AD (odds ratio [OR]: 0.18, confidence interval [CI]: 0.08–0.43) and DD (OR: 0.23; CI: 0.09–0.56) were lower as the perceived importance of screening increased. Their willingness to screen for both AD (OR: 0.26, CI: 0.08–0.82) and DD (OR: 0.18, CI: 0.05–0.71) was also lower if they perceived this to negatively affect their patients’ perception of them. The thematic analysis identified 3 main themes: (1) provider attitudes around mental health, (2) barriers to incorporating mental health screening, and (3) opportunities to integrate screening. Barriers included lack of training, access to mental health resources, and provider and patient stigma. Conclusions: Our study showed that while most pediatric dentists and orthodontists understand the importance of screening their adolescent patients for AD and DD, many are unlikely to conduct screenings in the future. Obstacles such as inadequate training and stigma must be addressed for wider adoption. Further research and initiatives are crucial to tackle these challenges. Knowledge Transfer Statement: The findings of this study offer insights to clinicians and policy makers into the attitudes, barriers, and facilitators among dentists—specifically pediatric dentists and orthodontists—who regularly treat adolescent patients, regarding mental health screenings for these individuals. This information can guide the development of initiatives, policy changes, and future research aimed at creating a more integrated dental care system that emphasizes the overall health of adolescent patients.
California School Nurses’ Knowledge in Identifying Common Dental Conditions and Making Appropriate Dental Referrals
Authors: Neapole C. , Bhoopathi V. 
Published: November 2024

Introduction: In 2011, the Institute of Medicine (IOM) recommended a minimum of 4 clinical oral health competencies for nondental professionals to promote optimal oral health, including (1) recognizing risk for oral disease through competent oral examinations and (2) making and tracking referrals. Objectives: We determined whether California school nurses (SNs) knew about specific components of the 2 IOM competencies mentioned above using 3 clinical case scenarios following the Association of State and Territorial Dental Directors Basic Screening Survey Methodology. Methods: In this cross-sectional study, a 23-item pilot-tested online survey was completed by 358 active California School Nurses Organization members between April and June 2023. We conducted univariate, bivariate, and multivariable linear regression analyses. Results: For the first scenario, 61% of SNs correctly identified the condition as “root tips,” with 93% indicating correctly that such a case should be referred immediately. In the second scenario, almost 77% of SNs correctly identified “untreated tooth decay,” with 50% correctly suggesting that a child with untreated tooth decay without dental pain should visit a dental office within several weeks. In the third scenario, almost 50% correctly identified an abscessed tooth, with 75% indicating that a child with this condition should be referred immediately. Multivariable adjusted linear regression analysis showed that SNs with a bachelor’s degree or lower had significantly lower overall knowledge in accurately identifying dental conditions and choosing appropriate dental referrals ( P = 0.02). Conclusions: At least half of the participating SNs accurately identified the dental conditions and chose the appropriate dental referrals. The educational status of SNs was a strong predictor of SNs’ overall knowledge of identifying oral health conditions and appropriate dental referrals. SNs, when adequately trained, can assess oral health needs and make appropriate dental referrals as part of school-linked dental programs. Knowledge Transfer Statement: SNs can identify common dental conditions in children and appropriately refer them to a dental professional. When adequately trained, they can be a valuable resource in implementing school-linked dental programs.
Oral Health Recovery: Randomized Evaluation of an Oral-Behavioral Health Integration Approach
Authors: Lapidos A. , Henderson J. , Cullen J. , Pasiak S. , Hershberger M. , Rulli D. 
Published: November 2024

Introduction: This study implemented a single-session oral health education and referral program in behavioral health settings serving people with psychiatric disabilities. The program was led by peer specialists (“peers”)—lay community behavioral health workers with personal experience of mental health challenges who are trained and certified to support others. Methods: Investigators collaborated with peers, state government, and clinical leadership to design and implement the program. Randomized parallel assignment was used to compare 2 arms: (1) group viewing of an oral health educational video (VC) and (2) a peer-led 1-time class providing education and motivation to access dental care (the Oral Health Recovery Group; OHRG). In both arms, peers followed up with participants to encourage accessing dental care and reinforce at-home care goals. Oral health knowledge, at-home care, motivation, appointment scheduling, and utilization were assessed at baseline, postintervention, and 2 mo. Qualitative interviews assessed barriers and facilitators. Results: More than half of participants reported oral pain in the previous year. Pre-/postintervention survey results did not significantly improve in either arm or differ between arms. At follow-up, 25 (68%) in OHRG and 14 (56%) in VC reported meeting a dental at-home care goal because of the program. Ten (27%) in OHRG and 9 (36%) in VC reported making a dental appointment because of the program. Most were satisfied with the program. Interviewed participants were comfortable with peers in this role, yet access barriers remained. Conclusions: Single-session oral health interventions were implemented in behavioral health settings. The fact that surveys did not significantly improve suggests that more intensive interventions may be needed. Nevertheless, peers successfully scheduled dental appointments for vulnerable patients. Given that dental appointments were scheduled after only a 1-time class and light-touch peer navigation, oral health integration in behavioral health settings shows promise as a financially sustainable approach that merits further research. Knowledge Transfer Statement: The results of this study can be used by staff in behavioral health settings who wish to consider peer-led financially sustainable approaches to providing oral health education and linkages to dental care for their clients.
Diagnostic Accuracy of Subjective Features and Physical Examination Tests for Morton Neuroma: A Systematic Review
Authors: Pitcher Mark , Moulson Andrea , Pitcher David , Herbland Anthony , Cert Grad , Cairns Mindy C. 
Published: November 2024

Background: Morton neuroma (MN) is a common pathology with many reported subjective features and physical examination tests. The objective of this systematic review was to examine the diagnostic accuracy of subjective features and physical examination tests for MN. Methods: CINAHL, CENTRAL, EMBASE, MEDLINE, PubMed, Opengrey, PEDro, PsycINFO, Scopus and Trials register were searched in January 2021. Two reviewers independently screened studies for inclusion using the following criteria: (1) prospective or retrospective cohort studies, (2) participants aged ≥18 years with suspected MN, (3) primary data allowing construction of 2 × 2 diagnostic table or reported sensitivity and specificity figures, (4) diagnosis of MN using magnetic resonance imaging, ultrasonography, surgery, positive response to steroid and/or anesthetic injection, and (5) in English or translatable. Quality of included studies was assessed using the Quality Assessment for Diagnostic Accuracy Studies version-2 (QUADAS-2) tool. Results: The search yielded 1170 results, of which 9 were included in this systematic review. Narrative synthesis revealed that subjective clicking reported by a patient was highly specific (0.96) and had a high positive likelihood ratio (13.14). The modified webspace tenderness test (thumb index finger squeeze test) was highly sensitive (0.96) with a low negative likelihood ratio (0.04). The commonly reported feeling of “walking on a pebble” and “burning pain” had sensitivities of 43% to 53% and 54% to 57% and associated specificities of 52% and 48%, respectively. Only 1 study had low risk of bias. The review was limited by the number of studies that included few or no patients without MN, and the impact this had on the ability to calculate diagnostic accuracy. Conclusion: There is strong evidence that clicking reported by a patient rules in MN and that the modified webspace tenderness test rules out MN when negative.