bluuebunny/crossref_metadata_2025_split huggingface dataset:
Telemedicine-based antibiotic stewardship program in pediatrics: study protocol of a stepped wedge cluster randomized trial—the TeleKasper study
Authors: Diexer Sophie , Ihling Angelika , Gomes Delphina , Moritz Stefan , Simon Arne , Dohna-Schwake Christian , Mikolajczyk Rafael , Huebner Johannes , von Both Ulrich ,   the TeleKasper Consortium
Published: October 2024

Abstract

Background

Overuse and misuse of antibiotics is one of the driving factors of antimicrobial resistance, a growing global health threat. The use of antibiotics is particularly high in children. Even though the implementation of antibiotic stewardship programs (ASP) in pediatrics has been shown to reduce antibiotic use, this implementation has been limited to large university hospitals in Germany. Telemedicine applications might be an effective approach to implement ASP in non-university settings.

Methods
This protocol details the TeleKasper study (Telemedical Competence Network “Antibiotic Stewardship in Pediatrics”). Tele-Kasper is a stepped-wedge cluster-randomized trial that will be conducted across non-university children’s hospitals in Germany. The intervention consists of a telemedical consultation service in the form of a network in different German areas, using an app as a communication tool. The primary outcome will be a 20% reduction in overall antibiotic consumption measured using defined daily doses per 100 patient days.

Discussion
The TeleKasper study aims to implement and evaluate a prototype for a nationwide antibiotic stewardship program by telemedical means in pediatric departments in non-university hospitals in Germany to promote rational antibiotic use and improve medical care for infections.

Trial registration
German Clinical Trials Register (DRKS) DRKS00028534. Registered on 22nd of April 2022.
Effect of serum 25-hydroxyvitamin D level on quadriceps strength: a systematic review and meta-analysis
Authors: Ong Michael Tim-yun , Tsang Kitson Chun-Kit , Lu Victor Yan Zhe , Yam Stacy Lok Sze , Shen Wei , Man Gene Chi-Wai , Yung Patrick Shu-hang 
Published: October 2024

Abstract
Background
Vitamin D deficiency has been linked to poor muscle function, cartilage degeneration, and the development of knee osteoarthritis. However, the impact of serum 25-hydroxyvitamin D [25(OH)D] level on quadriceps muscle strength remains inconclusive, largely due to variations in study designs, differences in study populations, and the influence of confounding factors such as co-supplementation with other vitamins. The existing literature presents mixed findings, highlighting the need for a comprehensive evaluation of the available evidence.

Purpose
This systematic review and meta-analysis aim to summarise.

Study design
Systematic review; Level of evidence, 4.

Methods
Searches were conducted using Medline (Ovid), Embase (Ovid), CINAHL (EBSCOhost), and SPORTDiscus (EBSCOhost), which aimed to summarise recent (published after 2000 and before March 1st, 2024) studies reporting the effects of serum 25(OH)D levels on quadriceps strength. Appraisal tool for Cross-Sectional Studies (AXIS) for cross-sectional studies and Quality in Prognosis Studies (QUIPS) for longitudinal studies. Results from the AXIS and QUIPS tools were used for GRADE quality assessment. The review was carried out using PRIMSA guidelines and registered in PROSPERO (ID: CRD42022313240).

Results
Four hundred studies were screened and 28 studies with 5752 participants were included. 28 published studies (24 cross-sectional and 4 longitudinal) were identified. Key results supported the significant positive correlation between serum 25(OH)D levels and isokinetic quadriceps strength at 180°/s in elderly and athletic populations with a correlation coefficient of 0.245 (95%CI: 0.078–0.398, p = 0.004). However, no significant correlation was found with isometric quadriceps strength or isokinetic strength at 60°/s (r = 0.190, p = 0.085). There was only a weak negative correlation with MVC.

Conclusion
This review found a statistically significant positive correlation between serum 25(OH)D levels and isokinetic quadriceps strength. This has important clinical implications, especially in the elderly cohort, with higher 25(OH)D levels being associated with a reduced incidence of falls and fragility fractures.
Chronic ankle instability: a cadaveric anatomical and 3D high-resolution MRI study for surgical reconstruction procedures
Authors: Dai Meng , Zhao Hu , Sun Peng , Wang Jiazheng , Kong Caixia , Liu Xiaoming , Duan Deyu , Liu Xi 
Published: October 2024

Abstract
Objectives
To quantitatively investigate the anatomy of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) for surgical reconstruction procedures in chronic ankle instability (CAI).

Methods
3D MRI was performed on five fresh-frozen cadaveric ankles using six different spatial resolutions (0.3 × 0.3 × 0.3 mm3, 0.45 × 0.45 × 0.45 mm3, 0.6 × 0.6 × 0.6 mm3, 0.75 × 0.75 × 0.75 mm3, 0.9 × 0.9 × 0.9 mm3, 1.05 × 1.05 × 1.05 mm3). After comparing the MRI results with cadaver dissection, a resolution of 0.45 × 0.45 × 0.45 mm³ was selected for bilateral ankles MRI on 24 volunteers. Classification of the ATFL and four distances of surgically relevant bony landmarkers were analyzed (distance 1 and 3, the fibular origin of the ATFL and CFL to the tip of fibula, respectively; distance 2, the talar insertion of the ATFL to the bare zone of talus; distance 4, the calcaneal insertion of the CFL to the peroneal tubercle).

Results
In subjective evaluation, the interobserver ICC was 0.95 (95% confidence interval (CI): 0.94–0.97) between two readers. The spatial resolution of 0.3 × 0.3 × 0.3 mm3 and 0.45 × 0.45 × 0.45 mm3 received highest subjective score on average and demonstrated highest consistency with autopsy measurements in objective evaluation. Measurements on the 48 volunteer ankles, distance 1 in type I and II were 12.65 ± 2.08 mm, 13.43 ± 2.06 mm (superior-banded in Type II) and 7.69 ± 2.56 mm (inferior-banded in Type II) (means ± SD), respectively. Distance 2 in type I and II were 10.90 ± 2.24 mm, 11.07 ± 2.66 mm (superior-banded in Type II), and 18.44 ± 3.28 mm (inferior-banded in Type II), respectively. Distance 3 and 4 were 4.71 ± 1.04 mm and 14.35 ± 2.22 mm, respectively.

Conclusion
We demonstrated the feasibility of quantifying the distances between bony landmarkers for surgical reconstruction surgery in CAI using high-resolution 3D MRI.

Critical relevance statement
High-resolution 3D MRI examination may have a guiding effect on the preoperative evaluation of chronic ankle instability patients.

Key Points

Spatial resolutions of 0.3 × 0.3 × 0.3 mm3 and 0.45 × 0.45 × 0.45 mm3 demonstrated highest consistency with autopsy measurements.

The spatial resolution of 0.45 × 0.45 × 0.45 mm3 was conformed more to clinical needs.

3D MRI can assist surgeons in developing preoperative plans for chronic ankle instability.

Graphical Abstract
Body composition as a potential imaging biomarker for predicting the progression risk of chronic kidney disease
Authors: Liao Zhouyan , Yuan Guanjie , He Kangwen , Li Shichao , Gao Mengmeng , Liang Ping , Xu Chuou , Chu Qian , Han Min , Li Zhen 
Published: October 2024

Abstract
Purpose
To investigate whether the body composition parameters can be employed as potential biomarkers for predicting the progression risk of chronic kidney disease (CKD).

Materials and methods
Four hundred sixteen patients diagnosed with CKD were included in this retrospective study. Patients with a greater than 50% decline in estimated glomerular filtration rate or progression to end-stage kidney disease were in the high-risk group, otherwise, they were in a low-risk group. Body composition area, the index, and radiodensities in the Hounsfield unit (HU), which reflect the degree of X-ray absorption, were measured on abdominal CT images. Risk factors in body composition and clinical parameters of CKD were identified by Cox regression and utilized to construct the nomogram. The performance of the nomogram was assessed using time receiver operating characteristics curves, calibration curves, and decision curve analysis.

Results
There were 254 patients in low-risk group and 162 in high-risk group (268 males, 148 females, mean age: 55.89 years). Urea, diabetes, 24 h-urinary protein, mean arterial pressure, and subcutaneous adipose tissue radiodensity (SATd) were valuable indicators for predicting the high-risk group. The area under curve values for the nomogram of training/validation set at 1 year, 2 years, and 3 years were 0.805/0.753, 0.784/0.783, and 0.846/0.754, respectively. For diabetic CKD patients, extra attention needs to be paid to visceral to subcutaneous fat ratio and renal sinus fat radiodensity.

Conclusion
SATd was the most valuable noninvasive indicator of all body composition parameters for predicting high-risk populations with CKD. The nomogram we constructed has generalization with easily obtainable indicators, good performance, differentiation, and clinical practicability.

Critical relevance statement
Radiodensity rather than an area of adipose tissue can be used as a new biomarker of prognosis for CKD patients, providing new insights into risk assessment, stratified management, and treatment for CKD patients.

Key Points

Obesity is an independent risk factor for the development and prognosis of CKD.

Adipose tissue radiodensity is more valuable than fat area in prognosticating for kidney disease.

Parameters that prognosticate in diabetic CKD patients are different from those in other CKD patients.

Graphical Abstract
Protocol for a systematic review and meta-analysis of interventions aimed at delabeling low-risk penicillin allergies with consideration for sex and gender
Authors: Maximos Mira , Elsayed Sameer , Maxwell Colleen , Houle Sherilyn K. D. , Pelletier Ryan , McConnell Brie , Pylypiak Andrew , Gamble John-Michael 
Published: October 2024

Abstract
Background
Approximately, 10% of people report a penicillin allergy; however, more than 90% can safely undergo delabeling after a detailed history, oral challenge, or other investigations such as penicillin skin testing (PST). Although PST is the gold standard, the results can be heterogeneous, and awaiting specialist assessment may take an inordinate amount of time. Therefore, oral provocation challenge has become acceptable for individuals with low-risk penicillin allergy histories. There also appears to be an association with increased prevalence of adverse drug reaction reporting in female individuals, which may translate to penicillin allergy prevalence; however, the evidence has not been assessed through a sex and gender lens. This systematic review will identify and synthesize the findings from studies that report measures of effectiveness and safety of interventions aimed at delabeling penicillin allergies in low-risk individuals. Information related to sex and gender will be extracted, where available, to understand potential differences in allergy reporting and patient outcomes.

Methods
The Cochrane Handbook for Systematic Reviews of Interventions and the Centre for Review and Dissemination’s Guidance for Undertaking Reviews in Health Care will be used as frameworks for conducting this systematic review. The literature search will be conducted by a medical librarian (B. M. M.) and will consist of a search strategy to identify and retrieve published studies that meet our inclusion criteria. Studies that require penicillin skin testing (PST) as a step prior to other interventions will be excluded. Integrated knowledge translation involving co-design was carried out for this systematic review protocol creation. Data extraction will be conducted at four levels: (1) study level, (2) patient level, (3) intervention level, and (4) outcome level. A narrative descriptive synthesis of results and risk of bias of all included studies will be provided, and, if relevant, a meta-analysis will be performed.

Discussion
The dissemination of findings from this knowledge synthesis to various stakeholders is intended to inform on options for evidence-based interventions to aid in delabeling penicillin allergies in individuals with a low risk of experiencing a hypersensitivity reaction. Detailed reporting on the characteristics of delabeling interventions as well as the effectiveness of similar interventions will benefit policy makers considering the implementation of a penicillin allergy delabeling protocol. Additionally, findings from this systematic review will report on the current evidence regarding the role of sex and gender in both the prevalence and outcomes associated with the presence of penicillin allergies.

Systematic review registration
PROSPERO CRD42022336457.
Historical Geographical Information System (HGIS): social trajectories of two Chinese historical figures Su Shi and Zuo Zongtang in spatial context
Authors: Fu Jing , Chen Kangsheng , Qin Jianxin , Yang Liguo , Liu Peilin , Zheng Wenwu 
Published: October 2024

Abstract
Historical figures have important significance worldwide. This paper introduces the concept of historical Geographical Information System (HGIS) using the lives of two personalities from Chinese history as case studies: Su Shi, a literary figure of the Northern Song Dynasty, and Zuo Zongtang, a military strategist from the late Qing era. By studying the geographical points marking their life activities, their migratory patterns were explored, along with the dynamics of their social networks within time and space, examining the distinctive phases and characteristics of their individual journeys. Kernel density estimation, standard deviation ellipse, location-based distance analysis, and social network graphs were employed in this work. Our findings reveal that Su Shi’s migrations were largely dictated by official appointments, ultimately rooted in imperial successions and factional strife, with his intellectual pursuits significantly influenced by the humanistic milieu. Conversely, Zuo Zongtang’s migrations were predominantly shaped by war, reflecting the challenges of the late Qing era in relation to governance, sovereignty, and diplomacy. The military encampments selected by Zuo Zongtang tended to be situated near water sources, illustrating how his migratory trajectory was influenced by natural geographic conditions. The social circles of these figures are tied to their social and political stature. Through the socio-historic context, the characteristics of these historical figures’ behavioral trajectories relate to the unfolding process of societal and historical development. These insights offer a glimpse into the life journey behind historical figures, implicitly highlighting their perseverance and resilience in adversity, thereby describing innovative approaches to inheriting and disseminating the cultural legacy.
Dynamic correction of forest fire spread prediction using observation error covariance matrix estimation technique based on FLC-GRU
Authors: Wu Tianyu , Zhang Qixing , Zhu Jiping , Wu Jinhong , Dai Jinyang , Zhang Yongming 
Published: October 2024

Abstract
Background
Data assimilation (DA) techniques have played a significant role in improving the prediction accuracy of forest fire spread. The dynamic correction technique weights the predicted and observed values to obtain an analytical value that better reflects the position of the fire perimeter. The weighted importance of each contribution is determined by the magnitude of its associated error. However, as a crucial parameter affecting prediction accuracy, the covariance matrix of observation errors is often inaccurate and neglects its own temporal correlation. This is unfriendly to spread prediction results. To address this issue, we proposed a targeted technique for estimating the observation error covariance matrix (R matrix) based on the Fire Line Convolutional Gated Recurrent Unit (FLC-GRU).

Results
We integrated this method into the DA framework and validated its applicability and accuracy using Observing System Simulation Experiment (OSSE). Through comparisons with traditional methods, the results indicate that using the FLC-GRU estimated R matrix for correction calculations leads to wildfire prediction locations that are closer to the true values.

Conclusions
The proposed approach learns the covariance matrix directly from time-series observed fire line data, without requiring any prior knowledge or assumptions about the error distribution, in contrast to classical posterior tuning methods. The proposed method significantly improves the rationality and accuracy of R matrix estimation, enhances the utility of observational data, and thereby improves the correction accuracy of forest fire spread predictions. Moreover, the study also demonstrates the applicability of the proposed method within the DA framework.
Measuring clinical outcomes in adult ADHD clinics: psychometrics of a new scale, the adult ADHD Clinical Outcome Scale
Authors: Adamis Dimitrios , Singh Jasmin , Coada Iulian , Wrigley Margo , Gavin Blánaid , McNicholas Fiona 
Published: October 2024

Background
Adult attention-deficit hyperactivity disorder (ADHD) clinics are in their infancy in Ireland and internationally. There is an urgent need for clinical evaluation of these services. Until now, clinical outcomes have relied mainly on functional scales and/or quality of life. However, adult ADHD is a longstanding disorder with many comorbidities. Although medication for ADHD symptoms can have immediate effects, co-occurring problems may take considerably longer to remediate.

Aims
To present the psychometrics of a short outcome measure of key clinical areas including symptoms.

Method
The ADHD Clinical Outcome Scale (ACOS), developed by the authors, is a clinician-rated scale and was administered in consecutive adults attending an ADHD clinic. A modified version was completed by the participant. A second clinician independently administered the scale in a subsample. ACOS consists of 15 items rated on a Likert scale. Two self-report scales, the Adult ADHD Quality of Life Questionnaire (AAQoL) and Weiss Functional Impairment Rating Scale (WFIRS), were also administered.

Results
The mean age of 148 participants was 30.1 years (s.d. = 9.71), and 81 were female (54.7%). The correlation for interrater reliability was r = 0.868, and that between the participant and clinician versions was r = 0.663. The intraclass correlation coefficient for the internal consistency was 0.829, and the correlations for concurrent validity with total AAQoL and WFIRS scores were r = −0.573 and r = 0.477, respectively. Factor analysis revealed four factors: (a) attentional/organisational problems; (b) hyperactivity/impulsivity; (c) comorbidities; and (d) alcohol/drug use, self-harm and tension in relationships.

Conclusions
The psychometrics of the ACOS are promising, and the inclusion of typically co-occurring clinical domains makes it suitable for use as a clinician-rated outcome measure in every contact with patients attending adult ADHD clinics.
Cancer-related Fear and Worry in Patients With Low-risk Thyroid Cancer: A Longitudinal Cohort Study
Authors: Lee Stephanie S , Antunez Alexis G , Sinco Brandy , Saucke Megan C , Bushaw Kyle J , Dream Sophie , Fingeret Abbey , Livhits Masha J , Mathur Aarti , McDow Alexandria D , Roman Sanziana , Voils Corrine I , Pitt Susan C 
Published: October 2024

Abstract

Context
Little is known about how patients’ emotions impact the choice between hemi- and total thyroidectomy (TT) for low-risk thyroid cancer (LR-TC) and how these emotions change after treatment.

Objective
To investigate thyroid cancer-specific fear and worry both before and after treatment of LR-TC with hemi- or TT.

Methods
This prospective cohort study enrolled adults with confirmed or likely LR-TC at 15 institutions. Participants completed measures of thyroid cancer-related fear and worry at the time of their treatment decision and 9 months later. Participants were categorized as having low, medium, or high levels of fear and worry in accordance with the literature. Those choosing hemithyroidectomy were compared to those choosing TT.

Results
Of 177 eligible patients, 125 (70.6%) enrolled and 114 completed both surveys (91.2% retention). Overall, 41 (36.0%) participants chose hemithyroidectomy and 73 (64.0%) chose TT. Across all participants, thyroid cancer-related fear and worry both decreased significantly after surgery (fear, 25.8 ± 6.4 to 23.1 ± 7.4; worry, 8.2 ± 2.4 to 5.4 ± 2.1, P &lt; .001). The proportion of participants with high fear decreased from 64.9% to 50.9%, whereas the proportion with high worry decreased from 75.4% to 41.2% (P &lt; .001 for both). At both time points, no differences existed between those choosing hemi- and TT in levels of worry or fear.

Conclusion
Patients with LR-TC report lower levels of fear and worry 9 months after surgery regardless of the extent of surgery, suggesting that both surgeries provide an emotional benefit to some patients. Thyroid cancer-related fear and worry do not appear to influence patients’ decisions to undergo hemi- or TT.
Approach to the Patient With Thyroid Nodules: Considering GLP-1 Receptor Agonists
Authors: Kelly Clare A , Sipos Jennifer A 
Published: October 2024

Abstract
Glucagon-like peptide 1 receptor agonists (GLP1RAs) have rapidly changed the landscape of diabetes and obesity treatment. Enthusiasm for their use is tempered with concerns regarding their risk for inducing C-cell tumors based on preclinical studies in rodents. A black-box warning from the US Food and Drug Administration recommends against using GLP1RA in patients with a personal or family history of medullary thyroid carcinoma (MTC) or multiple endocrine neoplasia syndrome type 2A or 2B (MEN2), providing clear guidance regarding this cohort of patients. However, emerging data also suggest an increased incidence of differentiated thyroid cancer (DTC) in patients treated with these agents. Other studies, though, have not confirmed an association between GLP1RAs and DTC. With conflicting results concerning thyroid cancer risk, there is no clear consensus regarding the optimal approach to screening patients prior to initiating the medications and/or evaluating for thyroid cancer during GLP1RA treatment. Within the context of patient cases, this review will summarize the existing data, describe ongoing controversies, and outline future areas for research regarding thyroid cancer risk with GLP1RA use.
Prepregnancy and Gestational Interventions to Prevent Childhood Obesity
Authors: Kampmann Ulla , Suder Louise Birk , Nygaard Malene , Geiker Nina Rica Wium , Nielsen Henriette Svarre , Almstrup Kristian , Bruun Jens Meldgaard , Magkos Faidon , Ovesen Per , Catalano Patrick 
Published: October 2024

Abstract
Childhood obesity is a significant global health issue with complex and multifactorial origins, often beginning before conception and influenced by both maternal and paternal health. The increased prevalence of prepregnancy obesity and gestational diabetes mellitus in women of reproductive age contributes to a heightened risk of metabolic dysfunction in offspring. Current clinical practices often implement lifestyle interventions after the first trimester and have limited success, implying that they miss a critical window for effective metabolic adjustments. This review examines the limitations of lifestyle interventions during pregnancy in improving perinatal outcomes and highlights the importance of initiating such interventions before conception to positively impact parental health and fetal development. A re-evaluation of strategies is needed to enhance the metabolic health of prospective parents as a preventive measure against childhood obesity.