bluuebunny/crossref_metadata_2025_split huggingface dataset:
Estimating Change in Health-Related Quality of Life before and after Stroke: Challenges and Possible Solutions
Authors: Thompson Nicolas R. , Lapin Brittany R. , Katzan Irene L. 
Published: October 2024

Background Estimating change in health-related quality of life (HRQOL) from pre- to poststroke is challenging because HRQOL is rarely collected prior to stroke. Leveraging HRQOL data collected both before and after stroke, we sought to estimate the change in HRQOL from prestroke to early poststroke. Methods Stroke survivors completed the Patient-Reported Outcomes Measurement Information System Global Health (PROMIS-GH) scale at both pre- and early poststroke. Patient characteristics were compared for those who did and did not complete the PROMIS-GH. The mean change in PROMIS-GH T-score was estimated using complete case analysis, multiple imputation, and multiple imputation with delta adjustment. Results A total of 4,473 stroke survivors were included (mean age 63.1 ± 14.1 y, 47.5% female, 82.6% ischemic stroke). A total of 993 (22.2%) patients completed the PROMIS-GH at prestroke while 2,298 (51.4%) completed it early poststroke. Compared with those without PROMIS-GH, patients with PROMIS-GH prestroke had worse comorbidity burden. Patients who completed PROMIS-GH early poststroke had better early poststroke clinician-rated function and shorter hospital length of stay. Complete case analysis and multiple imputation revealed patients’ PROMIS-GH T-scores worsened by 2 to 3 points. Multiple imputation with delta adjustment revealed patients’ PROMIS-GH T-scores worsened by 4 to 10 points, depending on delta values chosen. Conclusions Systematic differences in patients who completed the PROMIS-GH at both pre- and early poststroke suggest that missing PROMIS-GH scores may be missing not at random (MNAR). Multiple imputation with delta adjustment, which is better suited for MNAR data, may be a preferable method for analysis of change in HRQOL from pre- to poststroke. Given our study’s large proportion of missing HRQOL data, future studies with less missing HRQOL data are necessary to verify our results. Highlights Estimating the change in health-related quality of life from pre- to poststroke is challenging because health-related quality-of-life data are rarely collected prior to stroke. Previously used methods to assess the burden of stroke on health-related quality of life suffer from recall bias and selection bias. Using health-related quality-of-life data collected both before and after stroke, we sought to estimate the change in health-related quality of life after stroke using statistical methods that account for missing data. Comparisons of patients who did and did not complete health-related quality-of-life scales at both pre- and poststroke suggested that missing data may be missing not at random. Statistical methods that account for data that are missing not at random revealed more worsening in health-related quality of life after stroke than traditional methods such as complete case analysis or multiple imputation.
Mast Cells Mediate Acute Inflammatory Responses After Glenoid Labral Tears and Can Be Inhibited With Cromolyn in a Rat Model
Authors: Co Cynthia M. , Vaish Bhavya , Hoang Le Q. , Nguyen Tam , Borrelli Joseph , Millett Peter J. , Tang Liping 
Published: October 2024

Background: Injuries to the glenoid labrum have been recognized as a source of joint pain and discomfort, which may be associated with the inflammatory responses that lead to the deterioration of labral tissue. However, it is unclear whether the torn labrum prompts mast cell (MC) activation, resulting in synovial inflammatory responses that lead to labral tissue degeneration. Purpose: To determine the potential influence of activated MC on synovial inflammatory responses and subsequent labral tissue degeneration and shoulder function deterioration in a rat model by monitoring MC behavior and sequential inflammatory responses within the synovial tissue and labral tissue after injury, suture repair, and MC stabilizer administration. Study Design: Controlled laboratory study. Methods: Anteroinferior glenoid labral tears were generated in the right shoulder of rats (n = 20) and repaired using a tunneled suture technique. Synovial tissue inflammatory responses were modulated in some rats with intraperitoneal administration of an MC stabilizer—cromolyn (n = 10). At weeks 1 and 3, MC activation, synovial inflammatory responses, and labral degeneration were histologically evaluated. Simultaneously, gait analysis was performed before and after surgical repair to assess the worsening of the shoulder function after the injury and treatment. Results: Resident MC degranulation after labral injury (50.48% ± 8.23% activated at week 1) contributed to the initiation of synovial tissue inflammatory cell recruitment, inflammatory product release, matrix metalloproteinase-13, and subsequent labral tissue extracellular matrix degeneration. The administration of cromolyn, an MC stabilizer, was found to significantly diminish injury-mediated inflammatory responses (inflammatory cell infiltration and subsequent proinflammatory product secretion) and improve shoulder functional recovery. Conclusion: MC activation is responsible for labral tear–associated synovial inflammation and labral degeneration. The administration of cromolyn can significantly diminish the cascade of inflammatory reactions after labral injury. Clinical Relevance: Our findings support the concept that MC stabilizers may be used as a complementary therapeutic option in the treatment and repair of labral tears.
Anterior Slope–Modifying Osteotomies Alter the Length Change Behavior of the Superficial Medial Collateral Ligament: A Biomechanical Study
Authors: Peez Christian , Ottens Carla , Deichsel Adrian , Raschke Michael J. , Briese Thorben , Herbst Elmar , Robinson James R. , Kittl Christoph 
Published: October 2024

Background: Increased tibial slope has been shown to lead to higher rates of anterior cruciate ligament graft failure. A slope-decreasing osteotomy can reduce in situ anterior cruciate ligament force and may mitigate this risk. However, how this procedure may affect the length change behavior of the medial ligamentous structures is unknown. Purpose/Hypothesis: The purpose of this study was to examine the effect of anterior slope–modifying osteotomies on the medial ligamentous structures. It was hypothesized that (1) decreasing the tibial slope would lead to shortening of the superficial medial collateral ligament (sMCL), (2) while the fibers of the posterior oblique ligament (POL) would be unaffected. Study Design: Descriptive laboratory study. Methods: Eight fresh-frozen cadaveric knee specimens underwent anatomic dissection to precisely identify the medial ligamentous structures. The knees were mounted in a custom-made kinematics rig with the quadriceps muscle and iliotibial tract loaded. An anterior slope–modifying osteotomy was performed and fixed using an external fixator, which allowed modification of the wedge height between −15 and +10 mm in 5-mm increments. Threads were mounted between pins positioned at the anterior, middle, and posterior parts of the tibial and femoral attachments of the sMCL and POL. For different tibial slope modifications, length changes between the tibiofemoral pin combinations were recorded using a rotary encoder as the knee was flexed between 0° and 120°. Results: All sMCL fiber regions shortened with slope reduction ( P < .001) and lengthened with slope increase ( P < .001), with the anterior sMCL fibers more affected than the posterior sMCL fibers. A 15-mm anterior closing-wedge high tibial osteotomy (ACWHTO) resulted in a 6.9% ± 3.0% decrease in the length of the anterior sMCL fibers compared with a 3.6% ± 2.3% decrease for the posterior sMCL fibers. A 10-mm anterior opening-wedge high tibial osteotomy (AOWHTO) increased anterior sMCL fiber length by 5.9% ± 2.3% and posterior sMCL fiber length by 1.6% ± 1.0%. The POL fibers were not significantly affected by a slope-modifying osteotomy. Conclusion: Tibial slope–modifying osteotomies changed the length change pattern of the sMCL such that an AOWHTO increased whereas an ACWHTO decreased the sMCL strain. This effect was most pronounced for the anterior fibers of the sMCL. The length change pattern of the POL remained unaffected by slope-modifying osteotomy. Clinical Relevance: Surgeons should be aware that anterior tibial slope–modifying osteotomies affect the biomechanics of the sMCL. After an extensive ACWHTO, patients may develop a medial or anteromedial instability, while an AOWHTO may overconstrain the medial compartment.
Factors Associated With Health-Related Quality of Life Among Community-Dwelling Older Adults Without Social Participation in Japan: A Cross-Sectional Study
Authors: Mutai Hitoshi , Obuchi Kohei , Yokoi Katsushi , Furukawa Tomomi 
Published: October 2024

This study aimed to identify the characteristics of community-dwelling older adults who exhibited high health-related quality of life (HRQOL) without social participation. This cross-sectional observational study collected data using a mailed questionnaire. This study included 1,183 community-dwelling older adults aged ≥65 years who lived in Japan. HRQOL was assessed via the EuroQol 5-Dimensions 5-Levels (EQ-5D-5L). Multivariate analysis was performed; full health status (EQ-5D-5L = 1) was used as the objective variable, and socio-demographic, lifestyle, and health-related variables were used as the explanatory variables. Driving (OR = 3.846), economic situation (1.938), purpose in life (2.211), primary illness (0.398), low physical function (0.051), and depressive symptoms (0.288) were associated with higher HRQOL among community-dwelling older adults without social participation. This exploratory study suggests the possibility of promoting and improving the HRQOL of community-dwelling older adults without social participation by strengthening specific factors among them.
Optimisation of bonded and hybrid step lap joints of thick carbon fibre/epoxy panels used in aircraft structures
Authors: Chowdhury Nabil M , Wang John , Chiu Wing Kong , Chang Paul 
Published: October 2024

The use of composite materials is widely spread across the Aerospace sector. Scarf and step lap joints are amongst the most commonly used methods for flush joint repairs; they restore original stiffness and nearly original strength. Prior investigations conducted by the authors have shown that bonded and hybrid step lap joints have superior static strength capabilities than bolted joints. Hybrid step lap joints have shown the highest fatigue resistance than its bolted and bonded counterparts. This investigation aims at optimising the previous step lap joint design containing five steps with a 90 mm long overlap length in order to improve joint efficiency. Four new step lap joint configurations are considered based on a parametric study conducted using Abaqus; two of which contain seven steps and a 130 mm long overlap (bonded and hybrid) whilst the other two contain six steps and a 105 mm long overlap (bonded and hybrid) with a tapered outer step region. Experimental tests right through to numerical modelling using three-dimensional (3D) finite element (FE) models have been investigated. Adhesive non-linear material properties, fastener contacts and friction forces were all included in the 3D FE models. The Multicontinuum Theory (MCT) is used to simulate the progressive failure process and determine the stress states in the four configurations. Overall the FE models are able to accurately predict the bonded and hybrid joint strengths and highlights the importance of not only optimising the number of steps and their lengths but also the individual step heights. This is a parameter which has often been overlooked by fellow researchers. Experimental results showed that all four step lap joint configurations have significant improvement under static and fatigue load cases; the greatest improvement is seen in the two bonded step lap joint configurations. Overall the hybrid joint configuration consistently outperformed the bonded joint configurations. The presence of fasteners supress crack propagation, minimise peak peeling stresses at the ends of the overlap and increase the durability of the joint. This enables early crack detection which can assist composite joint repair certification.
“Everything’s a Challenge”: An Interview Study of ADHD Individuals in the Midst of the Prescription Stimulant Shortage
Authors: Johnson Benjamin , Stjepanovic Daniel , Leung Janni , Chan Gary C. K. 
Published: October 2024

Background: The shortage of prescription stimulants is an ongoing issue that is impacting the ability of individuals with ADHD to access their medication. Amidst concerns that this shortage may have a substantial impact on individuals’ ability to manage their symptoms effectively, this research seeks to understand the experiences and consequences for those affected. Methods: In this study, we interviewed individuals with ADHD who have been directly impacted by the stimulant shortage. Thematic analysis focused on identifying common themes related to challenges with medication access and the resulting effects on daily living. Results: The study uncovered significant difficulties in accessing ADHD medication due to current shortages, leading to disruptions in the management of ADHD symptoms and subsequent detriments to individuals’ professional, educational, and personal lives. Systematic controls aimed at reducing non-medical use were found to exacerbate these access issues, inadvertently compounding the challenges faced by those using medication for legitimate medical needs. Individuals also described ways they coped with the shortage, with some seeking ADHD medication via unofficial channels. Conclusion: Our findings highlight the urgency of addressing stimulant shortages to safeguard the wellbeing of individuals with ADHD. This study also calls for a critical review of policy measures regulating stimulant medication access, and their effectiveness at reducing non-medical use given the unintended consequences these regulations appear to have on individuals prescribed these medications for therapeutic purposes.
Dietary phosphorus and renal disease in cats: where are we?
Authors: Stockman Jonathan 
Published: October 2024

Practical relevance: Phosphorus is an essential nutrient required for the normal function of every cell in the body and a deficiency in dietary phosphorus may lead to adverse effects. Conversely, high dietary phosphorus may cause kidney damage in otherwise healthy adult cats, particularly when provided in highly bioavailable forms and when the calcium-to-phosphorus ratio is low. For cats that have chronic kidney disease (CKD), phosphorus is the most important mineral in its pathogenesis and morbidity. As the disease progresses, elevated phosphorus may increase the risk of complications such as soft tissue mineralization, which can lead to a further decrease in renal function. Additionally, the hormones secreted in response to increased circulating phosphorus have harmful effects, such as bone resorption, and can cause cardiovascular pathology. Very low phosphorus diets can also be problematic in cats with early CKD, potentially leading to hypercalcemia. Clinical challenges: There is currently a lack of maximum safety limits for dietary phosphorus in accepted nutritional guidelines in North American and Europe, which makes it difficult to assess the safety of some higher phosphorus cat foods. Additionally, information regarding phosphorus bioavailability is unknown for many diets and there are no commercially available tests. Similarly, there is no consensus regarding phosphorus requirement and recommended intake in cats with International Renal Interest Society stage 1-4 CKD despite there being targets for serum phosphorus. Aims: This review evaluates dietary phosphorus in healthy cats and cats with renal disease, and describes how newer research is informing evolving clinical approaches in feline nutrition. Audience: The article is aimed at general practitioners, internal medicine specialists and veterinary nutritionists. Evidence base: Information provided in this article is drawn from the published literature.
Quality of Life in Female Breast Cancer Patients and Survivors in a South African Municipality
Authors: Wilkinson Rebecca , Smith Lynn 
Published: October 2024

Background: Breast cancer diagnosis and treatment processes affect patients physically and mentally, and have an impact on their quality of life, even years after receiving treatment. Objectives: The objective of this study was to determine the quality of life in female breast cancer patients and survivors in a South African context. The municipality within which participants were recruited for this study was Ekurhuleni, based in the Gauteng province, South Africa. Design: This study followed a cross-sectional research design. Quantitative data was collected. Methods: The Quality-of-Life Patient/Cancer Survivor Version (2012) was used to determine participants’ quality of life in 4 subscales, namely, physical, psychological, social, and spiritual. The questionnaire was accessible to participants via the online Google Forms platform as well as in hard-copy format at local medical facilities. The Statistical Package for Social Sciences (SPSS) was used to compute statistics, and the level of significance was set at 95% ( P < .05). Results: One hundred female breast cancer patients and survivors from the region of Ekurhuleni, South Africa, took part in this study. The findings demonstrate that the quality-of-life subscale with the highest score was spiritual well-being (6.66 ± 2.07) and the lowest was psychological well-being (4.91 ± 1.93). No significant difference was found between quality of life and type of facility attended. Significant differences were found in quality-of-life ratings between breast cancer patient and breast cancer survivor populations. Conclusion: Breast cancer can result in a compromised quality of life, and with the increased prevalence and survival rate of breast cancer patients, both the short- and long-term effects of the condition and its treatments are heightened.
Patterns of Antidepressant and Anxiolytic Use and Spending in 14 European Countries (2012-2021): A Comprehensive Time Series Analysis
Authors: Martella Manuela , Minutiello Ettore , Gianino Maria Michela 
Published: October 2024

Background: The assessment of antidepressant and anxiolytic consumption and expenditures represents a reliable barometer of the burden of such mental health disorders and the effectiveness of relative healthcare services. Objectives: The current analysis aims to evaluate trajectories of consumption and expenditures of antidepressant and anxiolytic drugs to define patterns of usage and spending across 14 European countries between 2012 and 2021. Methods: A retrospective longitudinal study was performed based on pooled time series secondary data analysis over 2012/2021. Defined Daily Doses (DDD) per 1000 inhabitants and health expenditure per capita were analysed. Linear and quadratic trends were computed to determine relationships between the variables of interest. Results: Only 2 patterns of consumption/expenditure of antidepressants can be identified: consumption and expenditure both grow; consumption grows, and spending decreases. Consumption and expenditures registered 2 main patterns, decreasing in most European countries and increasing only in 2 cases. Conclusion: Prevailing patterns of consumption and spending show an increase in antidepressants and a decrease in anxiolytics. The variation in consumption of such drugs during this timeframe is attributable to several reasons, such as the epidemiological characteristics of mental disease, for instance, the prevalence and incidence of disorders, the accessibility of drugs and alternative treatments, like psychotherapy, different clinical practices and national guidelines. However, such analyses deserve attention for targeted policies and strategies for promoting mental health.
Association between telehealth use in oncology and downstream utilization at a large academic health system
Authors: Kakani Preeti , Singer Adam E , Cui Manying , Villaflores Chad W , Vangala Sitaram , Cuevas Miguel A , Han Maria , Damberg Cheryl L , Mafi John N , Sarkisian Catherine A 
Published: October 2024

Background While telemedicine has been beneficial in oncology by reducing infectious exposure and improving access for patients with poor functional status, it also has intrinsic limitations, including the inability to perform a physical exam, which could lead to increased downstream utilization in this population at high risk of medical decompensation. We conducted a retrospective cohort study investigating the relationship between telemedicine use in oncology and subsequent outpatient oncology encounters, emergency department (ED) visits, and hospitalizations. Methods We included outpatient oncology encounters, including telemedicine and in-person visits, occurring between 1 January 2018 and 31 December 2022 at a large academic health system. Unadjusted descriptive statistics and multiple linear regressions were used to estimate subsequent outpatient oncology visits, ED visits, and hospitalizations within 30 days of an index visit based on modality (telemedicine versus in-person). The multiple regressions were adjusted for various demographic and clinical characteristics, including palliative care visits, baseline utilization, recent chemotherapy, and comorbidities. Results Our cohort included 63,722 patients with 689,356 outpatient encounters, of which 639,217 (92.7%) were in-person and 50,139 (7.3%) were telemedicine visits. Patients on average had 0.91 outpatient oncology visits, 0.04 ED visits, and 0.05 hospitalizations within 30 days following an index encounter. In our adjusted analyses, telemedicine was associated with 13.7 fewer downstream outpatient oncology visits (95% CI 12.5–14.9; p < 0.001) per 100 index encounters, 0.7 fewer ED visits (95% CI 0.4–1.0; p < 0.001) per 100 index encounters and 0.9 fewer hospitalizations (95% CI 0.6–1.3; p < 0.001) per 100 index encounters compared to in-person visits. Conclusions Contrary to our hypothesis, oncology patients who had a telemedicine visit had fewer follow-up outpatient oncology encounters, ED visits and hospitalizations after 30 days than those with in-person visits. Future studies should further investigate the efficacy of telemedicine in oncology and outline specific scenarios for appropriate use in this and other populations.