bluuebunny/crossref_metadata_2025_split huggingface dataset:
The interplay between lying, sitting, standing, moving, and walking on obesity risk in older adults: A compositional and isotemporal substitution analysis
Authors: Pelclová Jana , Vindiš Jan , Jašková Paulína , Hron Karel 
Published: October 2024

Abstract

Introduction: Obesity in older adults is linked to various chronic conditions and decreased quality of life. Traditional physical activity guidelines often overlook the specific postures and movements that older adults engage in daily. This study aims to explore the compositional associations between posture-specific behaviours and obesity risk in younger (M = 67.35 ± 2.03 years) and older (M = 75.73 ± 4.17 years) seniors and investigate the differences in BMI associated with replacing time spent in lying, sitting and standing with moving or walking.
Methods: The study involved 309 older adults aged 65 and above from Czech Republic. Participants' movement behaviours, including lying, sitting, standing, moving, and walking, were measured using accelerometers. The data were analysed using compositional data analysis (CoDA) and isotemporal substitution models to assess the impact of reallocating time between different activities on body mass index (BMI).
Results: The younger group engaged in more overall movement (193.84 min/day vs. 172.41 min/day) and walking (92.15 min/day vs. 76.62 min/day) than the older group. Significant BMI increases were observed when 30 minutes were reallocated from movement to lying, sitting, or standing (up to +3.306 kg/m²), while reallocating the same amount of time from lying, sitting, or standing to movement led to BMI reductions (up to -2.537 kg/m²). In the older group, reallocating time from slow walking to lying or sitting led to BMI increases (up to +1.855 kg/m²), while increasing time spent slow walking at the expense of lying or sitting reduced BMI (up to -0.949 kg/m²).
Conclusions: Promoting movement and walking, particularly slow walking, is crucial in managing obesity risk in older adults. The findings emphasize the importance of reducing sedentary time and encouraging low-intensity physical activity tailored to the capabilities of seniors, especially those aged 70+, to effectively mitigate obesity risk.
Effect of a playful parenting programme on early childhood development and care outcomes of young children in vulnerable communities: Findings from a quasi-experimental study
Authors: Sargsyan Viktoria , Walea Harriet , Mahat Bal , Tamale Robert , Chaudhari Ramdhani , Birungi Janet , Marasini Sabina , Thapa Nisha , Kuikel Bihari , Karmacharya Biraj , Rasheed Muneera 
Published: October 2024

Abstract

Background: World Vision launched the Inclusive Playful Parenting for a Brighter Childhood (IPP4BC) project in identified vulnerable communities in Nepal and Uganda to mitigate risk for children at risk of poor development due to COVD 19. The intervention, based on the nurturing care framework, offered a customized parenting curriculum for young children, emphasizing holistic development through behavior change approaches tailored to local contexts.
Objective: To evaluate the effect of the IPP4BC project, on early childhood development (ECD) and care outcomes of children under 6 years in vulnerable communities in Nepal and Uganda, particularly those affected by the COVID-19 pandemic.
Methods: The intervention was delivered by trained facilitators over a 7-month period in different arms defined by the dosage: high (10 group sessions, 4 home visits) medium (5 group sessions, 2 home visits) or low (delivery of key messages through media) dose. An endline evaluation designed as quasi-experimental non-equivalent control groups post-test only study, assessed the effect of the project utilizing the Malawi Development Assessment Tool (MDAT) for child outcomes and the Multiple Indicator Cluster Survey (MICS) for caregiver outcomes. Additionally, an implementation survey was conducted to assess program fidelity and participant engagement.
Findings: In Nepal, higher intervention doses were associated with significantly better child development outcomes (High dose M = 1.20, SD = 2.22, Medium dose M = 1.01, SD = 1.99; Low dose M = 0.43, SD = 2.32, p < 0.001) whereas in Uganda, only medium dose (M = -0.03, SD = 1.28) showed significant improvement (High dose M = -0.30, SD = 1.30; Low dose M = -0.28, SD = 1.51, p = 0.015). A higher proportion of caregivers in both high and medium dose reported engagement with early learning practices compared to low dose. With respect to uptake, in Nepal, a higher number of families received home visits compared to group sessions, while in Uganda, more families reported attending group sessions than receiving home visits.
Conclusion: The study demonstrated that higher intervention doses were associated with better child development outcomes in Nepal and only with medium dose in Uganda, emphasizing the importance of implementation factors like dosage, quality and delivery modality in community-based interventions for improving ECD outcomes in vulnerable populations.
Using Deep Learning Neural Networks to Improve Dementia Detection: Automating Coding of the Clock-Drawing Test
Authors: Hu Mengyao , Qin Tian , Gonzalez Richard , Freedman Vicki , Zahodne Laura , Melipillan Edmundo , Murphey Yi 
Published: October 2024

Abstract

Alzheimer’s disease and related dementias (ADRD) is a growing public health concern. The clock-drawing test (CDT), where subjects draw a clock, typically with hands showing 11:10, has been widely used for ADRD-screening. A limitation of including CDT in large-scale studies is that the CDT requires manual coding, which could result in biases if coders interpret and implement coding rules differently. This study created and evaluated an intelligent CDT Clock Scoring system built with Deep Learning Neural Networks (DLNN) to automatically code CDT images. We used a large, publicly available repository of CDT images from the 2011–2019 National Health and Aging Trends Study (NHATS) and compared three advanced DLNN methods – ResNet101, EfficientNet and Vision Transformers (ViT) in coding CDT into binary and ordinal (0 to 5) scores. We extended beyond the traditional nominal classification approach (which does not recognize order) by introducing structured ordering into the coding system and compared DLNN-coded CDT images with manual coding. Results suggest that ViT outperforms ResNet101 and EfficientNet, as well as manual coding. The ordinal coding system has the ability to allow researchers to minimize either under- or over-estimation errors. Starting in 2022, our developed ViT-coding system has been used in NHATS’ annual CDT-coding.
Personalized Decision Making for Coronary Artery Disease Treatment using Offline Reinforcement Learning
Authors: Ghasemi Peyman , White James A. , Lee Joon 
Published: October 2024

Abstract

Choosing optimal revascularization strategies for patients with obstructive coronary artery disease (CAD) remains a clinical challenge. While randomized controlled trials offer population-level insights, gaps remain regarding personalized decision-making for individual patients. We applied off-policy reinforcement learning (RL) to a composite data model from 41,328 unique patients with angiography confirmed obstructive CAD. In an offline setting we estimated optimal treatment policies and evaluated these policies using weighted importance sampling. Our findings indicate that RL guided therapy decisions generally outperformed physician-based decision making, with the best RL policy achieving about a 38% improvement in expected rewards based on a composite major cardiovascular events outcome. Additionally, we introduced methods to ensure that RL CAD treatment policies remain compatible with locally achievable clinical practice models, presenting an interpretable RL policy with a limited number of states. Overall, this novel RL-based clinical decision support tool, called RL4CAD, demonstrates potential to provide clinical decision support for the optimization of care in patients with obstructive CAD referred for invasive coronary angiography.
Air in the left atrium? Right-to-left-shunts in patients scheduled for neurosurgical intervention in semi-sitting position – a literature review based on two case scenarios
Authors: Nikolic Marina , Eisner Christoph , Neumann Jan Oliver , Haux Daniel , Krieg Sandro M , Wielpütz Mark Oliver , Weigand Markus Alexander , Tochtermann Ursula , Fischer Dania 
Published: October 2024

Abstract

Background: Neurosurgery performed in the semi-sitting position provides advantages for certain procedures. However, this approach is associated with potential complications, particularly venous air embolism. Due to typically negative venous pressure at the wound site, air can be drawn into the veins. This risk is especially high in patients presenting with an intra- or extracardiac right-to-left-shunt. Trans-oesophageal echocardiography can be used to detect a patent foramen ovale or other possible pulmonary-systemic shunt before placing the patient in the sitting position.
Case presentation: In this report, we present two young patients undergoing scheduled microsurgical vestibular schwannoma removal in a semi-sitting position who were diagnosed with congenital heart defects due to routine preoperative assessment of possible intracardiac right-to-left shunts, using pre- and intraoperative transesophageal echocardiography (TEE) and additionally conducting an agitated saline bubble study under Valsalva manoeuvre – Patient A was diagnosed with a persistent left superior vena cava and Patient B with an unroofed coronary sinus (UCS). These findings left the anesthesiological and surgical teams confronted with rather difficult individual decisions of the further perioperative management proceeding.
Conclusions: Perioperative transesophageal echocardiography is a diagnostic tool to both detect intraoperative position-related air embolisms and to rule out intracardiac right-to-left shunts, e.g. a patent foramen ovale, in order to decide for or against a (semi-)sitting position. Depending on the surgical circumstances a semi-sitting positioning of patients presenting with an intracardiac right-to-left-shunt, e.g. a PFO, can be feasible in individual cases if there is an implemented therapeutic algorithm to immediately terminate significant venous air entry. However, since certain other intra- or extracardiac right-to-left-shunts, such as here presented PLSVC or UCS, are utterly rare, there is no definitive way of estimating the amount of entered air or even flow through detected anomalous more or less obliterated vessels. Therefore, it is recommended to avoid a (semi-)sitting positioning in favour of a lateral or prone positioning of the patient undergoing intracranial surgery once the preoperative TEE shows air bubbles in the left atrium or ventricle whose origins cannot be defined solely through TEE for certain in order to ensure patient safety by minimizing the risk of intraoperative paradoxical air embolisms.
Clinical trial number: not applicable.
Geriatric contribution to heart failure care: a retrospective review of patient records
Authors: Reimers-Wessberg Marianne , Fastbom Johan , Ugarph-Morawski Anna , Seiger Åke , Eriksdotter Maria 
Published: October 2024

Abstract

Background: Research on heart failure (HF) has often focused on younger patients. The aim of this study was to analyze extent of investigation and treatment changes among patients during inpatient geriatric care for worsening of HF as well as information given to next caregiver.
Methods: Data were retrospectively collected from 134 individuals treated for heart failure (HF) as main diagnosis in wards specialized in geriatric medicine. Data on referral content, Natriuretic peptide type B(NT-pro-BNP), echocardiography (ECHO) and drug treatment as well as length of care episode and information to the next caregiver, were collected.
Results: During the investigated geriatric care episode, 20 % of the patients were analyzed for NT-pro-BNP and 2 % were investigated with ECHO. No significant changes in drug treatment with angiotensin-converting-enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB) or beta blockers (BB) were made, but significant increase in treatment with furosemide (55 to 83 %, p<0.001) and spironolactone (19 to 28 %, p=0.033) was observed. Five patients were at discharge treated with target doses of both ACEI/ARB and BB.
A subgroup of patients was prescribed more spironolactone during the care episode (higher dose or new prescription). These patients had more weight loss (p<0.001), longer care episodes (p=0.002) and more NT-pro-BNP assessments (p=0.008) where the longer care episode seemed to influence the increase of spironolactone most.
There was a significant wash out of information in the referrals at discharge to primary care, compared to the referrals at admission to geriatric care. Information on etiology dropped from 31.4 % to 5.8 % (p<0.001) and information on ejection fraction (EF) dropped from 19.8% to 3.5% (p<0.001).
Conclusions: The contribution by geriatric care to investigations was modest or low. During the geriatric care episode, no net changes in pharmacological treatments for heart failure were made, except for spironolactone and furosemide.
The wash out of information about the patients in referrals from geriatricians to primary care physicians is worrying. More collaboration between cardiologists, geriatricians and primary care physicians may improve the health situation among geriatric HF patients.
A novel external-fixation technique for delayed, nonreducible Gartland type III supracondylar humerus fractures in children
Authors: Gao Chao , Zhu Huan Ye , Sun Jing Hua , Zheng Hua Jiang , Wu Yong Yao , Cao Jin 
Published: October 2024

Abstract

Background
Percutaneous pinning is widely recognized as the gold-standard approach for managing supracondylar humerus fractures (SHFs) in pediatric patients. However, manual reduction of delayed SHFs can present significant challenges, and repeated attempts may result in iatrogenic injuries. Additionally, immobilizing the edematous elbow joint with a cast carries the risk for Compartment Syndrome. To address these concerns, we implemented a medial mini-open approach combined with external fixation.
Materials and Methods
The treatment outcomes of 32 patients treated with external fixation frames between 2015 and 2023 were analyzed. These outcomes encompassed limb alignment, elbow movement, appearance, and patient satisfaction.
Results
The resetting process was more direct in the open reduction than in the closed reduction and resulted in satisfactory reductions in all the patients, who achieved a normal or good range of motion. According to Flynn’s criteria, 30 patients showed a favorable prognosis, and 20 of them were classified as excellent. Both the patients and their parents expressed that they would choose this treatment approach again.
Conclusion
To treat delayed SHFs, utilization of medial mini-open reduction alongside external fixation appears to be a safe and efficacious approach.
Hybrid Constructed Wetlands for Tertiary Treatment of Poultry Slaughter Wastewater to Meet Quality Standards of Discharge and Reuse: A Full-Scale Case Study in Vietnam
Authors: Dang Hung Viet , Lam Huy Quoc , Nguyen Linh My 
Published: October 2024

Abstract

The construction and operation of a small-scale hybrid constructed wetland (HCW) system for tertiary wastewater treatment was presented. The HCW system includes a vertical sub-surface flow CW (VFCW), a horizontal sub-surface flow CW (HFCW) and a free water surface flow CW (FWSCW) operated in series had a total area of 150 m2. It received 7.5 m3/day of secondary effluent wastewater from the existing treatment system of a poultry slaughter enterprise at the production capacity of 500 ducks per day in an on-site experiment of 12 months. The results showed that the removal efficiencies of biological oxygen demand (BOD5), chemical oxygen demand (COD), total suspended solids (TSS), ammonia nitrogen (NH4+-N), nitrate nitrogen (NO3--N), total nitrogen (TN), orthophosphate (PO43--P), total phosphorus (TP), Escherichia coli (E. coli) and total coliforms (T. coli) reached average values of 76.2, 78.7, 77.1, 83.9, 86.3, 84.9, 72.3, 73.9, 98.9 and 96.4%, respectively, while the effluent concentrations of the study system complied with the most difficult limits not only for discharge into the receiving water source but also for reusing wastewater to water plants. The function made by various configurations such as a VFCW, a HFCW and a FWSCW placed sequentially in the HCW system proved crucial to treat wastewater and make it reusable.
WITHDRAWN: Analysis of the efficacy of a new device-assisted mini-incision in the treatment of carpal tunnel syndrome：a retrospective study
Authors: Guo Tianhao , Li Chenfei , Tian Dehu , Gao Ruijiao , Yu Kunlun , Sun Naichao , Yang Jing , Bai Jiangbo 
Published: October 2024

Abstract

This study aimed to compare the efficacy and safety of a new device-assisted mini-incision approach for carpal tunnel release (CTR) with the conventional approach. Patients with primary carpal tunnel syndrome (CTS) who underwent surgical treatment at our hospital between January 2022 and July 2023 were included. A total of 109 patients were included in our study. Of these, 54 cases in the group A underwent treatment using a new device-assisted mini-incision approach, while 55 cases in the group B underwent treatment using the conventional approach. Objective testing and subjective evaluation were performed to assess the efficacy of both groups. And postoperative complications were compared between the two approaches. At the 6-month follow-up, all patients in both groups had recovered. There were no significant differences between the two groups in postoperative pinch strength, grip strength, 2-point discrimination (2-PD), visual analogue scale (VAS) score, Disabilities of the Arm, Shoulder and Hand (DASH) score, and Boston Carpal Tunnel Questionnaire (BCTQ) (P > 0.05). Statistically significant differences were observed between the two groups in operation time, incision length and return to work time (P < 0.01). The incidence of wound pain and pillar pain was lower in Group A compared to Group B. These results suggest that patients who underwent the new device-assisted mini-incision surgery experienced satisfactory results and few postoperative complications.
Body Mass Index Changes and Predictors among Adults Living with HIV/AIDS Who Are on Anti-Retroviral Therapy at Chiro General Hospital, Eastern Ethiopia: A facility-based retrospective cohort study
Authors: Amsalu Sintayehu , Gebremichael Berhe , Wilfong Tara , Amsalu Sewmehon , Oumer Abdu 
Published: October 2024

Abstract

Background: Human immunodeficiency virus continues to be a major global public health issue. Body mass index is a general indicator of nutritional status and has emerged as a powerful predictor of morbidity and mortality among adult PLHIV initiating antiretroviral therapy in resource-limited settings. However, there is a dearth of information regarding longitudinal changes in body mass index and its predictors among adult PLHIV in Ethiopia, particularly in the study area. This study aimed to assess body mass index changes and their predictors among adults living with HIV/AIDS who were receiving on antiretroviral therapy at Chiro General Hospital, Eastern Ethiopia from August 15, 2023 to September 30, 2023.
Methods: A Facility-based retrospective cohort study was implemented among 1049 randomly selected charts of adults living with HIV/AIDS. The data were collected by reviewing charts of clients and antiretroviral therapy registers. The data were entered into Epi data statistical software version 4.6 and exported to SPSS version 25 for analysis. Descriptive statistics were used to describe the characteristics of the patients. A linear mixed effect model was used to identify the predictors of body mass index change. A P value of less than 0.05 was considered statistically significant.
Results: Generally, in this study patients presented a linear increase in the mean BMI from 19 kg/m2 baseline to 21.2 kg/m2 at the 5th year of follow up. Moreover, the following variables were identified as independent predictors of BMI change: age (β = 0.58, 95% CI; 0.043, 0.072), marital status (β = -0.275, 95% CI: -0.457,-0.093 ), advanced WHO stage (β = -0.496, 95% CI: -0.548, -0.443 ), CD4 count (β = 0.001, 95% CI: 0.001, 0.001), duration of antiretroviral therapy (β = 0.005, 95% CI: 0.001,0.009), time of follow up (β = 0.205, 95% CI: 0.198,0.212), no ART shift (β = -0.844, 95% CI: -1.135, -0.552), no CPT (β =0.591, 95% CI: 0.365,0.817), urban residence (β=0.767, 95% CI:0.401,1.132) and good adherence to ART (β= 0.975, CI:0.302, 1.649).
Conclusion: There was a significant improvement in the mean BMI over time and a reduction in the rate of undernutrition during the follow-up period.
Comparison of the preoperative transpapillary unilateral biliary drainage methods for the future remnant liver in patients with hilar cholangiocarcinoma
Authors: Okuno Mitsuru , Iwata Keisuke , Iwashita Takuji , Mukai Tsuyoshi , Shimojo Kota , Ohashi Yosuke , Iwasa Yuhei , Senju Akihiko , Iwata Shota , Tezuka Ryuichi , Ichikawa Hironao , Mita Naoki , Uemura Shinya , Yoshida Kensaku , Maruta Akinori , Tomita Eiichi , Yasuda Ichiro , Shimizu Masahito 
Published: October 2024

Abstract

Object:
Transpapillary preoperative biliary drainage (PBD) only for the future remnant liver (FRL) in hilar cholangiocarcinoma (HCCA) can be performed minimally invasively, with the expectation of swelling of the FRL. However, verification of the appropriate transpapillary unilateral PBD method for FRL is limited.
Methods:
Twelve unilateral across-the-papilla plastic stent placement cases (PS group), 14 unilateral intraductal plastic stent placement cases (IS group), and 11 unilateral endoscopic nasobiliary drainage cases (ENBD group) met the inclusion criteria. Each group was compared regarding thehospital stay duration, recurrent biliary obstruction (RBO), time to RBO (TRBO), and surgical outcomes.
Results:
No significant differences were observed in the patient characteristics between the groups. Hospital stay for the endoscopic procedure was significantly longer in the ENBD group (50[33-163]days) than in the PS group (14[2-36]days; P<0.01) or IS group (21[6-118]days; P<0.01). There were no significant differences in the RBO, TRBO, surgical time, amount of intraoperative blood loss, or post-surgical adverse events (AEs) between the groups.
Conclusions:
PS, IS, and ENBD groups showed similar clinical outcomes in liver resection cases for HCCA, excluding the hospital stay duration for the endoscopic procedure. Considering the hospital stay duration, unilateral PS and IS placement can be considered acceptable for transpapillary PBD.
Clinical Trial Registration: UMIN000052598