bluuebunny/crossref_metadata_2025_split huggingface dataset:
Investigation of the distribution of inguinal lymph nodes and delineation of the inguinal clinical target volume using 18F-FDG PET/CT
Authors: Han Jia-Li , Qi Yan-Ge , Liu Jia-Ling , Yan Xia , Zhang Wan-Chun , Yuan Ling , Hao Xin-Zhong , Song Jian-Bo , Li Si-Jin 
Published: October 2024

Abstract
Objective
Radiotherapy is a crucial treatment modality for pelvic cancers, but uncertainties persist in defining the clinical target volume (CTV) for the inguinal lymphatic drainage region. Suboptimal CTV delineation may compromise treatment efficacy and result in subpar disease control. This study aimed to investigate and map the distribution of lymph node metastases (LNM) in the groin area to facilitate an improved and detailed CTV definition using 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT).

Methods
Inguinal LNM in patients with biopsy-proven pelvic malignancies were identified using 18F-FDG PET/CT scan. The longitudinally nearest axial plane was determined based on six typical bony landmarks, and the axial direction relative to the femoral artery of LNM was recorded. The distances from the LNM to the nearest edge of the femoral artery were measured on the axial plane. An optimal margin to cover 95% of LNM was estimated to develop contouring recommendations.

Results
In this study, 500 positive LNM were identified by 18F-FDG PET/CT among 185 patients with primary pelvic malignancies. Relative to the femoral artery, lymph nodes were distributed laterally (10:00–11:00, n = 35), anteriorly (12:00–1:00, n = 213), and medially (2:00–4: 00, n = 252). For CTV delineation, the recommended distances from the femoral artery on the SFH were lateral 19 mm, anterior 19 mm, and medial 25 mm; on the SGT were lateral 26 mm, anterior 20 mm, and medial 25 mm; on the SPS were lateral 28 mm, anterior 29 mm, and medial 26 mm; on the IPS were anterior 29 mm and medial 28 mm; on the IIT were anterior 27 mm and medial 27 mm; on the ILT were anterior 25 mm and medial 23 mm. Use interpolation to contour the area between six axial slices, including any radiographically suspicious LNM.

Conclusions
Using 18F-FDG PET/CT, we investigated the distribution pattern of inguinal LNM and propose a more comprehensive guideline for inguinal CTV delineation.
The relationship between the ages and stages questionnaire, 3rd edition scores in early childhood and future cognitive abilities in young Nepalese children
Authors: Shrestha Merina , Kvestad Ingrid , Hysing Mari , Ranjitkar Suman , Ulak Manjeswori , Chandyo Ram K. , Strand Tor A. 
Published: October 2024

Abstract
Background
The Ages and Stages Questionnaire 3rd edition (ASQ-3) could be a feasible tool in resource-poor settings. Little is known on the relationship between scores on the ASQ-3 and later intellectual abilities in these settings.

Aims
To examine the relationship between ASQ-3 scores during the first and second year of life and intellectual abilities at 4 years of age in Nepalese children.

Methods
In a cohort of 600 children at-risk of stunting, the ASQ-3 was performed at 6–11 and 18–23 months, and the Wechsler Preschool and Primary Scales of Intelligence, fourth edition (WPPSI-IV) at 4 years. We examined the relationship between the ASQ-3 scores and WPPSI-IV full scale IQ (FSIQ) using Spearman correlation coefficients and linear regression models.

Results
Correlations between ASQ-3 total scores and FSIQ was 0.17 (95% CI 0.07, 0.27) at 6–11 and 0.34 (95% CI 0.26, 0.44) at 18–23 months explaining 2 and 12% of the variance respectively. Except for the communication subscale at 18–23 months with moderate correlations, correlations between the ASQ-3 subscales and FSIQ were weak.

Conclusion
Our findings suggest a modest relationship between ASQ-3 scores in early childhood and intellectual abilities at 4 years.
Factors affecting unusual postoperative vertical downward movement of mandible after surgery-first approach using intraoral vertical ramus osteotomy
Authors: Nam Soo-Hyun , Cha Jung-Yul , Lee Kee-Joon , Lee Sang-Hwy , Choi Sung-Hwan , Yu Hyung-Seog 
Published: October 2024

Abstract
Background
In very rare cases, patients who have undergone surgery-first approach with intraoral vertical ramus osteotomy (IVRO) exhibit unusual downward movements of mandible even up to 1-year post surgery, which makes it difficult for orthodontists to stabilize the occlusion during the postoperative orthodontic period. The aim of this study was to identify factors affecting the unusual downward movement of the mandible 1-year after the surgery-first approach using IVRO, while focusing on cephalometric values.

Methods
This retrospective cohort study sample was divided into two groups based on the amount of vertical movement of the B-point 1-year post surgery (Group S, predictable upward movement; Group U, unpredictable downward movement greater than 2 mm). To evaluate cephalometric changes between the two groups, cephalograms were obtained before surgery, 1 day after surgery, 1 month after surgery, and 1 year after surgery. The data were analyzed using the independent t-test, Mann–Whitney U test with Bonferroni correction, Pearson correlation analysis, and multiple regression analysis.

Results
At the initial examination, Group U showed a shallower anterior overbite. The vertical surgical change in the B-point was statistically different between the two groups (p < 0.001), indicating that group U exhibited more upward movement of the mandible during surgery. Group U showed significant downward movement of the mandible 1 month after surgery, and this finding persisted until 1 year postoperatively. Clockwise rotation of the mandible was also observed. Surgical vertical movement of the B-point showed a strong correlation with postoperative vertical movement of mandible (r = -0.674; p < 0.001) along a linear relationship, indicating that the amount of postoperative vertical downward movement of the mandible increased as the amount of surgical upward movement of the B-point increased (R2 = 0.449; p < 0.001).

Conclusions
This study revealed that unusual downward movement of the mandible after a surgery-first approach using IVRO is correlated with the amount of upward movement during the surgery. When planning surgery, in cases in which a significant upward movement of the mandible is anticipated, orthodontists should prepare for the possibility of subsequent unusual downward movement and a tendency for the anterior overjet to decrease during the postoperative orthodontic period.
A prospective cohort study on the role of surgical mentorship on medical students’ surgical experience and attitudes towards surgery
Authors: Kerdegari Nikki , Tandanu Edelyne , Lee Karen , Zakri Rhana , Dasgupta Prokar , Chandak Pankaj 
Published: October 2024

Abstract
Background
Exposure to surgery during medical school is limited. We ran a mentorship scheme pairing students at a medical school with local surgeons to improve undergraduate insight. We evaluated the effectiveness of mentorship in increasing surgical exposure and drivers for students seeking surgical mentorship.

Methods
35 surgeons across 7 specialties were recruited and matched with 37 students in years 2–4 for 7 months. Quantitative and qualitative evaluation was done with pre-, mid- and post-scheme questionnaires. Students rated confidence across pursuing a career in surgery, surgical exposure, career insight, understanding the application process, contacts, portfolio development, research knowledge and pursuing extra-curricular activities related to surgery using a 5-point Likert scale. Paired t-tests were performed to measure students’ confidence before and after the scheme.

Results
Of students that completed all 3 questionnaires (n = 21), conducting research/audit was most frequently selected as a main goal (81.0%), followed by theatre experience (66.7%) and career progression support (28.6%). The number of students that had assisted in theatre increased by 50.0%. Confidence ratings across all domains increased with 7/8 (87.5%) exhibiting a statistically significant improvement (p < 0.05). The greatest improvement was seen in having adequate contacts in surgery from 2.05 to 3.33 (p = 0.00). 95.2% would recommend the scheme.

Conclusions
Students gained significantly more surgical experience and were better equipped with the knowledge required to pursue a surgical career. Mentorship schemes are invaluable in supplementing the undergraduate curriculum and empowering students.

Trial registration
Ethical clearance granted by King’s College London Research Ethics Committee, Reference Number MRSU-22/23-34530. .
Not taught in medical school but needed for the clinical job – leadership, communication and career management skills for final year medical students
Authors: Behling Felix , Adib Sasan Darius , Haas Patrick , Becker Hannes , Oberle Linda , Weinbrenner Eliane , Nasi-Kordhishti Isabella , Roder Constantin , Griewatz Jan , Tatagiba Marcos 
Published: October 2024

Abstract
Background
Starting the first job as a young physician is a demanding challenge. Certain skills are important to master this transformation that go beyond the theoretical knowledge and practical skills taught in medical school. Competencies such as communication, leadership and career management skills are important to develop as a young physician but are usually not sufficiently taught in medical school in a structured and comprehensive way.

Methods
We performed an online survey among final year medical students regarding how they perceive their current competency level in communication, leadership and career management skills. We also assessed how they rate the importance to acquire these competencies and the current emphasis during their medical school education regarding these topics.

Results
Of 450 final year medical students 80 took part in the voluntary survey and 75 complete datasets were returned (16.7%). The majority of respondents rated different communication skills, leadership skills and career management skills as important or very important for their later clinical work. However, most students felt to be poorly or very poorly prepared by the current medical school curriculum, especially for certain leadership and career management skills. Overall, 90.7% of participants expressed interest in an additional educational course that covers subjects of communication, leadership and career management skills during the later stage of medical school, preferably as a hybrid in-person session that also offers synchronous online participation.

Conclusions
The results of the survey express the need to address communication, leadership and career management skills in the medical curriculum to be better prepare students for the demands of residency and their further course as physicians. An educational format during the final year of medical school may be suitable to address mentioned topics in the framework of clinical practical exposure.
Large-scale identification of social and behavioral determinants of health from clinical notes: comparison of Latent Semantic Indexing and Generative Pretrained Transformer (GPT) models
Authors: Roy Sujoy , Morrell Shane , Zhao Lili , Homayouni Ramin 
Published: October 2024

Abstract
Background
Social and behavioral determinants of health (SBDH) are associated with a variety of health and utilization outcomes, yet these factors are not routinely documented in the structured fields of electronic health records (EHR). The objective of this study was to evaluate different machine learning approaches for detection of SBDH from the unstructured clinical notes in the EHR.

Methods
Latent Semantic Indexing (LSI) was applied to 2,083,180 clinical notes corresponding to 46,146 patients in the MIMIC-III dataset. Using LSI, patients were ranked based on conceptual relevance to a set of keywords (lexicons) pertaining to 15 different SBDH categories. For Generative Pretrained Transformer (GPT) models, API requests were made with a Python script to connect to the OpenAI services in Azure, using and models. Prediction of SBDH categories were performed using a logistic regression model that included age, gender, race and SBDH ICD-9 codes.

Results
LSI retrieved patients according to 15 SBDH domains, with an overall average PPV $$\ge$$
≥
83%. Using manually curated gold standard (GS) sets for nine SBDH categories, the macro-F1 score of LSI (0.74) was better than ICD-9 (0.71) and GPT-3.5 (0.54), but lower than GPT-4 (0.80). Due to document size limitations, only a subset of the GS cases could be processed by GPT-3.5 (55.8%) and GPT-4 (94.2%), compared to LSI (100%). Using common GS subsets for nine different SBDH categories, the macro-F1 of ICD-9 combined with either LSI (mean 0.88, 95% CI 0.82-0.93), GPT-3.5 (0.86, 0.82-0.91) or GPT-4 (0.88, 0.83-0.94) was not significantly different. After including age, gender, race and ICD-9 in a logistic regression model, the AUC for prediction of six out of the nine SBDH categories was higher for LSI compared to GPT-4.0.

Conclusions
These results demonstrate that the LSI approach performs comparable to more recent large language models, such as GPT-3.5 and GPT-4.0, when using the same set of documents. Importantly, LSI is robust, deterministic, and does not have document-size limitations or cost implications, which make it more amenable to real-world applications in health systems.
Churning the tides of care: when nurse turnover makes waves in patient access to primary care
Authors: Arredondo Kelley , Hughes Ashley M. , Lester Houston F. , Pham Trang N.D. , Petersen Laura A. , Woodard LeChauncy , SoRelle Richard , Jiang Cheng , Oswald Frederick L. , Murphy Daniel R. , Touchett Hilary N. , Hamer Joshua , Hysong Sylvia J. 
Published: October 2024

Abstract
Background
Team-based primary care (PC) enhances the quality of and access to health care. The Veterans Health Administration (VHA) implements team-based care through Patient Aligned Care Teams (PACTs), consisting of four core members: a primary care provider, registered nurse (RN) care manager, licensed vocational nurse, and scheduling clerk. RNs play a central role: they coordinate patient care, manage operational needs, and serve as a patient point of contact. Currently, it is not known how varying levels of RN staffing on primary care teams impact patient outcomes.

Objective
This study aims to empirically assess how the stability of RN staffing within team-based primary care affects patient access to care.

Methods
A retrospective database review using clinical and administrative data from the VHA over 24 months. Participants included 5,897 PC PACTs across 152 VHA healthcare facilities in the United States and its territories. The stability of personnel in the RN role was categorized as: RN continuous churn, RN staffing instability and RN vacancy. All 3 categories were compared to teams with RN stability (i.e., same person in the role for the entire 24-month period). Access measures included: average third-next-available appointment, established patient average wait time in days, urgent care utilization, emergency room utilization, and total inbound-to-outbound PC secure messages ratio.

Results
RN continuous churn within PACTs had a significant impact on third-next-available appointment (b = 3.70, p < 0.01). However, RN staffing instability and vacancy had no significant relationship with any of the access measures. Several risk adjustment variables, including team full-time equivalency, team stability, relative team size, and average team size, were significantly associated with access to health care.

Conclusions
Teams are impacted by churn on the team. Adequate staffing and team stability significantly predict patient access primary care services. Healthcare organizations should focus on personnel retention and strategies to mitigate the impact(s) of continuous RN turnover. Future research should examine the relative impact of turnover and stability of other roles (e.g., clerks) and how team members adapt to personnel changes.
Understanding Ixodes ricinus occurrence in private yards: influence of yard and landscape features
Authors: Mazaleyrat Anna , Durand Jonas , Carravieri Irene , Caillot Christophe , Galley Cyril , Capizzi Sandrine , Boué Franck , Frey-Klett Pascale , Bournez Laure 
Published: October 2024

Abstract
Background
Lyme borreliosis is the most frequent zoonotic disease in the northern hemisphere and is transmitted by ticks of the genus Ixodes. Although many people are bitten by ticks in private yards, our understanding of the factors associated with their presence in these areas remains limited. To address this gap, we used a citizen science approach to identify the local and landscape features associated with tick presence in yards.

Methods
This study was conducted near Nancy, a city in northeastern France, from 2020 to 2022. Citizen scientists collected ticks in their yard on a single event (n = 185) and measured 13 yard features. Additionally, we computed 11 features related to the landscape composition and spatial configuration surrounding these yards. Using generalized linear mixed models, we determined the yard and landscape features associated with the presence of ticks and nymphal Ixodes ricinus (hereafter nymphs), the life stage, and species that mostly bite humans.

Results
Despite a low density, ticks were found in 32% of the yards, including yards in urbanized areas. At the transect level, the likelihood of finding a nymph was nearly three times higher in transects shaded by vegetation compared to those in open areas, with no relationship between nymph occurrence and transect location or grass height. At the yard level, the occurrence of ticks and nymphs was related to both yard and landscape characteristics. Nymph and tick occurrence were more than twice as high in yards with signs of deer and a wood/brush pile compared to those without these characteristics, and increased with the connectivity of vegetation areas and the percentage of forest areas in the landscape.

Conclusions
Our study reveals that private yards across an urbanization gradient are locations of tick exposure with tick presence linked to both yard and landscape factors. These findings emphasize the importance of public awareness regarding tick exposure in yards and provide crucial insights for future public health prevention campaigns.
Insight of autonomic dysfunction in CLN3 disease: a study on episodes resembling paroxysmal sympathetic hyperactivity (PSH)
Authors: Baekmann C. , Handrup M. M. , Molgaard H. , Ejerskov C. , Jensen H. K. , Ostergaard J. R. 
Published: October 2024

Abstract
Background
Recurrent non-epileptic episodes resembling paroxysmal sympathetic hyperactivity (PSH) have been observed in adolescents with Juvenile Ceroid Lipofuscinosis (CLN3-disease) and a possible association to an autonomic dysfunction has been suggested. The objective of the present study was to investigate the dynamics of the autonomic activity up to, during, and in the time after individual attacks. We include all seven suitable CLN3 patients in Denmark ≥ 15 years of age. HRV parameters were assessed from continuous heart rate monitoring during seven consecutive days and a particular focus of HRV parameters was obtained in close temporal context to clinically recurrent PSH-like episodes. In addition, the likelihood of PSH was assessed by caregiver’s description and by video documentation.

Results
Respectively eight and five episodes were recorded in two patients (18 and 20 years of age). The episodes were all safely superior to the cut off values of the clinical assessment score to be considered PSH-like episodes. During all 13 episodes, HRV revealed a statistically significant decrease in root mean square of successive differences (RMSSD) and standard deviation of the Poincaré-Plot interval (SD1) in the minutes prior to the clinical onset of the episodes, both indicating a sudden decrease in parasympathetic activity in advance of the onset. The reduced activity remained low during the episodes, and 15–30 min following the attack cessation, the parasympathetic activity had returned to pre-attacks levels. The sympathetic HRV parameters were unchanged resulting in a sympathetic overactivity during the episodes. In a third participant (32 years of age), in whom severity of PSH-like episodes had been gradually reduced during the last years, five episodes were registered. A similar temporally related reduction of the parasympathetic activity was found, but because the sympathetic activity decreased as well, no sympathetic dominance developed, which most reasonable is the reason to the clinically reduced expression of the episodes.

Conclusion
The documented transient withdrawal of parasympathetic activity leading to a paroxysmal unbalanced sympathetic hyperactivity most probably accounts for the PSH-like episodes occurring in post-adolescent CLN3 patients. The findings shed new light on both aetiology and possible preventative and therapeutic measures.
Prevalence and long-term change in alcohol consumption: results from a population-based cohort in Southern India
Authors: Gowri S. Mahasampath , Belavendra Antonisamy , Vasan Senthil K. , Keerthi S. , Andreasson Sven 
Published: October 2024

Abstract
Background
Alcohol consumption in India is below the global average, with limited data on long-term effects. The current study aims to examine changes over time among alcohol consumers, the pattern of drinking and help-seeking for alcohol problems among South Indian men.

Method
Data on the intake of various alcohol types were collected through standard questionnaires in two adult follow-ups [Baseline: 1998–2002, Follow-up: 2016–2019] from male participants in the Vellore birth cohort (VBC). Alcohol intake was converted to weekly standard drink units for analysis. Data on drinking patterns using the Alcohol Use Disorder Identification Test (AUDIT) and information on help-seeking among problem drinkers were collected during follow-up. Socio-demographic associations with alcohol consumption were determined using logistic regression.

Results
The prevalence of alcohol consumption was 54.5% and 47.7% at the baseline and follow-up, respectively. Over two decades, 12% of men reported to have newly started drinking and 18% quit drinking. Lower education and lower socio-economic status (SES) were the strongest predictors of alcohol consumption. The AUDIT assessment among drinkers reported hazardous drinking of 38.4%, harmful drinking of 4.7% and 3.7% probable alcohol dependence. Among the persons with high AUDIT scores, 25% were concerned about high consumption, and 9% sought help to stop their alcohol consumption.

Conclusion
Our results showed a decline in alcohol consumption in this cohort over two decades. Among drinkers, a high proportion report hazardous and harmful consumption. Low levels of education and SES are significant predictors of alcohol consumption. A low proportion of help-seeking reflects alcohol-related stigma in the community.