bluuebunny/crossref_metadata_2025_split huggingface dataset:
Telemedicine ultrasound in intensive care unit: A pilot diagnostic accuracy study
Authors: König Klever Emanuele , Silva Gabriela de Oliveira Laguna , da Silva Mariana Motta Dias , da Rocha Jacqueline Castro , da Silva Márcio Gustavo Santanna , Chagas Maria Eulália Vinadé , de Amorim Jerusa da Rosa , Pires Aristóteles de Almeida , Cunha Birriel Daniella , Constant Hilda Maria Rodrigues Moleda , Moreira Taís de Campos , Cabral Felipe Cezar 
Published: July 2024

Introduction: Digital health is an opportune way of facilitating the implementation of point-of-care ultrasound (POCUS) in intensive care units (ICUs) of the Brazilian Unified Health System (SUS) through remote tele-mentored ultrasound (RTMUS). Therefore, this pilot diagnostic accuracy study aims to evaluate the sensitivity and specificity of RTMUS, using POCUS as the gold standard for the diagnosis of pulmonary oedema. As a secondary objective, these metrics will be assessed for pneumonia, chronic obstructive pulmonary disease (COPD), pneumothorax, pulmonary embolism, and cardiac tamponade. Methods: The study was conducted in three adult ICUs, monitored by the TeleUTI project, and included 23 patients who underwent POCUS carried out by an ICU medical professional and RTMUS carried out by a tele-intensivist from the institution that proposed the project. Results: The accuracy in diagnosing pulmonary oedema was 71.43%, COPD 89.96%, and for pneumonia, the results showed an accuracy of 65.22%. Analyses demonstrated that RTMUS has the same capability as POCUS for detecting true positive cases of pulmonary oedema, the same results of true negative cases for COPD, and a limitation in performance for pneumonia. Conclusions: For COPD and pulmonary oedema, remote examination can support healthcare teams, suggesting that RTMUS has the potential to be a substitute for POCUS. We emphasise that the results should be interpreted within the context of the study, which is considered small and should be validated on a larger scale to consolidate the conclusions.
Ethical and informative trials: How the COVID-19 experience can help to improve clinical trial design
Authors: Law Emma , Smith Isabel 
Published: July 2024

During the COVID-19 pandemic, the race to find an effective vaccine or treatment saw an ‘extraordinary number’ of clinical trials being conducted. While there were some key success stories, not all trials produced results that informed patient care. There was a significant amount of waste in clinical research during the pandemic which is said to have hampered an evidence-based response. Conducting trials which could have been predicted to fail to answer the research question (e.g. because they are not large enough to provide a definitive result) is not only a waste of resources but also a breach of research participants’ trust and a violation of research ethics. The issues seen in COVID-19 clinical trials are symptomatic of a wider trial design crisis where many trials do not provide informative results. This paper examines the roles of key stakeholders in delivering ethical and informative trials and whether guidance published by ‘The Good Clinical Trials Collaborative’ could be used to align key stakeholder groups and enable a joined-up approach to improve clinical trial design.
Association of first-line thrombectomy technique and outcome in late-window large vessel occlusion strokes: A post hoc analysis of the MR CLEAN-LATE trial
Authors: Knapen Robrecht RMM , Olthuis Susanne GH , van Es Adriaan CGM , Emmer Bart J , Schonewille Wouter J , van der Leij Christiaan , van Zwam Wim H , van Oostenbrugge Robert J 
Published: July 2024

Background: This study aimed to compare direct aspiration, stent retriever, and the combined thrombectomy technique on clinical, safety, and technical outcomes in late-window stroke patients included in the MR CLEAN-LATE trial. Methods: This post hoc analysis of the MR CLEAN-LATE trial included patients treated with direct aspiration, stent retriever, or combined thrombectomy technique as first-line approach. Primary outcome was the modified Rankin Scale (mRS) score at 90 days follow-up, and compared between the three groups with ordinal logistic regression analysis. Secondary outcomes included mortality at 90 days, total technique switches, procedure time, recanalization rate measured with the expanded thrombolysis in cerebral infarction (eTICI) score, and symptomatic intracranial hemorrhage (sICH). Predefined variables were used for adjustments. Results: In the MR CLEAN-LATE trial, 258 patients underwent endovascular treatment and 232 were included in our analyses. The mRS at 90 days did not differ (stent retriever vs. direct aspiration: adjusted common odds ratio (acOR) = 1.35, 95% confidence interval (CI) = 0.73 to 2.50; stent retriever vs. combined: acOR = 1.13, 95% CI = 0.64 to 2.00; direct aspiration vs. combined: acOR = 1.19, 95% CI = 0.64 to 2.21). Direct aspiration thrombectomy was accompanied with more switches to another technique compared to the stent retriever (adjusted odds ratio (aOR) = 6.50, 95% CI = 2.52 to 16.8) or combined group (aOR = 4.67, 95% CI = 1.80 to 12.1) and with higher sICH rates compared to the combined technique (13% vs. 2.5%; aOR = 8.19, 95% CI = 1.49 to 45.1). Mortality, procedure time, and eTICI did not differ. Conclusion: Stent retriever, direct aspiration, or the combined thrombectomy technique as first-line approach showed no differences in clinical outcome in late-window stroke patients. Direct aspiration was accompanied with higher sICH rates and more switcher to another technique compared to the combined group.
Differences Between Glycated Hemoglobin and Glucose Management Indicator in Real-Time and Intermittent Scanning Continuous Glucose Monitoring in Adults With Type 1 Diabetes
Authors: Yoo Jee Hee , Moon Sun Joon , Park Cheol-Young , Kim Jae Hyeon 
Published: July 2024

Background: This study demonstrates the difference between glucose management indicator (GMI) and glycated hemoglobin (HbA1c) according to sensor mean glucose and HbA1c status using 2 continuous glucose monitoring (CGM) sensors in people with type 1 diabetes. Methods: A total of 275 subjects (117 Dexcom G6 [G6] and 158 FreeStyle Libre 1 [FL]) with type 1 diabetes was included. The G6 and FL sensors were used, respectively, over 90 days to analyze 682 and 515 glycemic profiles that coincide with HbA1c. Results: The mean HbA1c was 6.6% in Dexcom G6 and 7.2% in FL profiles. In G6 profiles, GMI was significantly higher than HbA1c irrespective of mean glucose (all P < .001, mean difference: 0.58% ± 0.49%). The GMI was significantly higher than the given HbA1c when HbA1c was below 8.0% (all P < .001). The discordance was the highest at 0.9% for lower HbA1c values (5.0%-5.9%). The proportion of discordance >0.5% improved from 60.1% to 30.9% when using the revised GMI equation in G6 profiles. In FL profile, the overall mean difference between GMI and HbA1c was 0 ( P = .966). The GMI was significantly lower by 0.9% than HbA1c of 9.0% to 9.9% and higher by 0.5% in HbA1c of 5.0% to 5.9% (all P < .001). Conclusions: The GMI is overestimated in G6 users, particularly those with well-controlled diabetes, but the GMI and HbA1c discordance improved with a revised equation from the observed data. The FL profile showed greater discordance for lower HbA1c levels or higher HbA1c levels.
Acute on chronic pancreatitis affecting the ectopic pancreas located in the jejunal mesentery: A case report
Authors: Okamura Kazuya , Ishibashi Emi , Araki Kazumi , Kanasaki Yoshiko , Kodama Koji , Kanazawa Akiyoshi , Onuma Hideyuki 
Published: July 2024

Ectopic pancreas within the mesentery is rare. In this case report, a 61-year-old man with an ectopic pancreas within the jejunal mesentery for over 20 years developed chronic pancreatitis that progressed to acute exacerbation. Our computed tomography (CT) performed for acute abdomen assessment suggested acute appendicitis or Meckel’s diverticulitis. However, a CT scan taken 20 years ago revealed a structure indicative of an ectopic pancreas in the mesentery, and further imaging findings taken 10 and 4 years ago confirmed progression to chronic pancreatitis. Furthermore, we found a pancreatic stone confined in the luminal structure that corresponded to the main pancreatic duct; this stone eventually caused acute exacerbation. In summary, we report a case of mesenteric ectopic pancreas that showed typical findings of progression and acute exacerbation of chronic pancreatitis on CT.
Screening for Autism Spectrum Disorder in Young Children: Still Not Enough Evidence
Authors: Grigore Bogdan , Peters Jaime , Williams Jessica , Russell Ginny , Coles Paula , Visintin Cristina , Rogers Morwenna , Hayward Robert , Zhelev Zhivko , Logan Stuart , Hyde Christopher 
Published: July 2024

Background: Early detection of autism spectrum disorder (ASD) has the potential to significantly reduce the impact of the condition, however previous reviews have found little evidence to support screening programs for ASD in young children. Methods: We conducted a review with the aim of updating evidence on 3 aspects: (a) diagnostic stability of ASD in young children; (b) accuracy of ASD screening tools in young children; and (c) the benefits of early interventions in screen-detected young children with ASD. Results: A total of 33 studies were included in our review. Five studies looking at diagnostic stability reported estimates ranging from 71.9% to 100%, however the majority only included a follow-up of 24 months and all studies raised concerns regarding the risk of bias due particularly to lack of blinding, sample size, and patient flow. A total of 25 studies, reported in 26 articles, were identified that reported accuracy data on 11 screening tools. Most of the reports were concerned with versions of M-CHAT, reporting sensitivity estimates from 0.67 to 1.0; however, many of these were deemed to be of high risk of bias due to lack of blinding and follow-up. Four studies reported on early interventions in screen-detected children; however, the majority did not find significant improvements on the relevant outcomes. Conclusions: Overall, the evidence on screening for ASD in young children captured by this review is not conclusive regarding the 3 aspects of screening in this population. Future studies should attempt to ensure blinded diagnostic assessments, include longer follow-up periods and limit attrition.
A Transtheoretical Model-Based Online Intervention to Improve Medication Adherence for Chinese Adults Newly Diagnosed With Type 2 Diabetes: A Mixed-Method Study
Authors: Zhang Baolu , Kalampakorn Surintorn , Powwattana Arpaporn , Sillabutra Jutatip , Liu Gang 
Published: July 2024

Background: Type 2 diabetes mellitus (T2DM) is increasing in China, with medication non-adherence being a significant contributor to uncontrolled T2DM. The Transtheoretical Model (TTM) has shown effectiveness in chronic disease management, but few studies have applied it in online interventions for T2DM medication adherence. Aim: The study aimed to develop and investigate the effects of a TTM-based online health education program on promoting positive stage of change (SOC) movement, improving self-efficacy and medication adherence, as well as reducing HbA1c levels in newly diagnosed patients with T2DM. Methods: This sequential mixed-method study was conducted from April 2023 to March 2024. Using the TTM framework, the study initially explored 32 participants’ experiences with hypoglycemic medications, health information acquisition, and perspectives on online programs. Then, a quasi-experimental study design was conducted. Two communities were randomly assigned as the intervention (n = 91) and comparison (n = 98) groups, with 189 newly diagnosed middle-aged T2DM patients from various SOC. The intervention group received short videos health education and participated in WeChat group discussions, compared with usual care in the comparison group. Data were collected at baseline, 3-month, and 6-month follow-ups. Results: The intervention group was more likely to achieve positive SOC movement ( P < .001, Adj OR = 13.69 95% CI = 6.76-27.71) compared to the comparison group. The intervention group also had significantly higher mean CDMSS-11 and MMAS-8 scores at 6 months ( P = .03 and <.001, respectively) and more likely to achieve clinically significant glycated Hemoglobin (HbA1c) change at 3 months ( P < .001, Adj OR = 3.91, 95% CI = 1.77-8.63) and at 6 months ( P < .001, Adj OR = 5.62, 95% CI = 2.70-11.69) compared to the comparison group. Conclusion: These findings support that applying the TTM to develop an online program could promote behavior change, improve self-efficacy and medication adherence, and could lead to better glycemic control in newly diagnosed T2DM patients.
Impact of COVID-19 on Healthcare Professionals at a Midwestern Quaternary Academic Urban Health Center
Authors: Sledge Jennifer A. , Prentice Donna , Arroyo Cassandra 
Published: July 2024

Background: Prior pandemic research has focused on physicians and nurses who provide direct patient care. Literature on the experiences of nonnurse/physician clinicians and nonclinical health care professionals is sparse. Methods: An observational, cross-sectional study was conducted over threetime points to examine the impact of COVID-19 on clinical and nonclinical healthcare professionals ( n = 464). Findings: There were no significant differences in distress across survey waves, except for anger ( p = .046). No significant differences in distress scores were found between job types. Multiple linear regression results varied. Both the threat and interrupted plans scores were significant predictors of distress. Resources available to healthcare providers (HCPs) were underutilized in all three waves. Conclusions: Healthcare professionals’ distress increases with exposure. Integrating self-care resources for staff may mitigate the impact and maintain a healthy work environment. Application to practice: Occupational health providers should incorporate these findings when developing opportunities to address the needs of health care professionals in the workplace.
Shape and Size of the Annulus Fibrosus Excision Alters the Biomechanics of the Intervertebral Disc
Authors: Nie Mao-dan , Huang Ze-bin , Cheng Rong-shan , Zhang Qiang , Zhang Ji-ping , Fu Ling-Jie , Cheng Cheng-Kung 
Published: July 2024

Study Design Biomechanical testings and finite element analysis. Objectives This study aims to investigate how annulus fibrosus (AF) incision size (RIS, Ratio of incision width to AF height) and shape affect intervertebral disc (IVD) biomechanics. Methods A validated finite element model of lumbar spines simulated various incisions in the middle-right posterior region of the AF, with different sizes and shapes. Simulations included axial compression, flexion, extension, bending, and rotation. Parameters assessed included stability, re-herniation, and IVD degeneration by analyzing stress, height, Intradiscal pressure (IDP), and the range of motion (ROM). Results Incision increased AF stress and ROM under 3 Nm moment, with values rising as RIS increased. RIS exceeding 40% resulted in a 20% AF stress increase during compression and extension, while RIS over 50% led to over 20% AF stress increase during other motions. Incision stress also increased with higher RIS, particularly surpassing 50% RIS. IDP rose across all incision shapes. Endplate stress increased (9.9%-48.9%) with larger incisions, with average increases of 12.8%, 12.7%, 30.5%, and 22.8% for circular, oval, square, and rectangular incisions. Compression and rotation minimally affected NP pressure (<15%), while flexion (19.8%-38.8%) and bending (18.5%-43.9%) had a more pronounced effect. ROM increased with RIS (20.0% ∼ 77.4%), especially with an incision RIS exceeding 40%. Conclusions AF injury elevates AF stress, reduces spine stability, heightens degeneration risk with increasing RIS. Reherniation risk rises when RIS exceeds 40%. Circular or oval incisions maintain spine biomechanics better than square or rectangular ones.
Outcome 1 year after ICH: Data from the Tranexamic acid for IntraCerebral Haemorrhage 2 (TICH-2) trial
Authors: Law Zhe Kang , Menon Chaamanti Sivakumar , Woodhouse Lisa J , Appleton Jason Philip , Al-Shahi Salman Rustam , Robinson Thompson , Werring David , Roffe Christine , Dineen Robert A , Bath Philip Michael , Sprigg Nikola 
Published: July 2024

Introduction: The Tranexamic acid for IntraCerebral Haemorrhage-2 (TICH-2) trial reported no significant improvement in death and dependency at day 90 despite reductions in haematoma expansion, early neurological deterioration and early death. However, significant recovery after stroke, particularly intracerebral haemorrhage (ICH), may take more than 3 months. Here we report the participant outcomes at 1 year after stroke. Patients and methods: TICH-2 was a prospective randomised controlled trial that tested the efficacy and safety of tranexamic acid in spontaneous ICH when given within 8 h of onset. Patients with ICH on anticoagulation were excluded. Centralised blinded telephone follow up was performed for patients from the United Kingdom at 1 year. The primary outcome was modified Rankin Scale at 1 year. Secondary outcomes included Barthel index, Telephone Interview Cognitive Status-modified, EuroQoL-5D and Zung Depression Scale. This was a prespecified secondary analysis of the TICH-2 trial. Results: About 2325 patients were recruited into the trial (age 68.9 ± 13.8 years; 1301 male, 56%). About 1910 participants (82.2%) were eligible for day 365 follow up. 57 patients (3.0%) were lost to follow up. Tranexamic acid did not reduce the risk of poor functional outcome at 1 year (adjusted OR 0.91 95% CI 0.77–1.09; p = 0.302). However, Cox proportional hazard analysis revealed significant survival benefit in the tranexamic acid group (adjusted HR 0.83, 95% CI 0.70–0.99; p = 0.038). Conclusion: There was no difference in functional outcome at 1 year after ICH. Tranexamic acid may reduce mortality at 1 year without an increase in severely dependent survivors. But this should be interpreted with caution as this is a result of secondary analysis in a neutral trial.
Genome-wide association study of trace elements in maize kernels
Authors: Chen Weiwei , Li Xuhui , Zhang Xiangbo , Chachar Zaid , Lu Chuanli , Qi Yongwen , Chang Hailong , Wang Qinnan 
Published: July 2024

AbstractMaize (Zea mays L.), a staple food and significant economic crop, is enriched with riboflavin, micronutrients and other compounds that are beneficial for human health. As emphasis on the nutritional quality of crops increases maize research has expanded to focus on both yield and quality. This study exploreed the genetic factors influencing micronutrient levels in maize kernels through a comprehensive genome-wide association study (GWAS). We utilized a diverse panel of 244 inbred maize lines and approximately 3 million single nucleotide polymorphisms (SNPs) to investigate the accumulation of essential and trace elements including cadmium (Cd), cobalt (Co), copper (Cu), nickel (Ni), selenium (Se) and zinc (Zn). Our analysis identified 842 quantitative trait loci (QTLs), with 12 QTLs shared across multiple elements and pinpointed 524 potential genes within a 100 kb radius of these QTLs. Notably ZmHMA3 has emerged as a key candidate gene previously reported to influence the Cd accumulation. We highlighted ten pivotal genes associated with trace element transport including those encoding heavy metal ATPases, MYB transcription factors, ABC transporters and other crucial proteins involved in metal handling. Additionally, haplotype analysis revealed that eight inbred linesaccumulated relatively high levels of beneficial elements while harmful elements were minimized. These findings elucidate the genetic mechanisms underlying trace element accumulation in maize kernels and provide a foundation for the breeding of nutritionally enhanced maize varieties.
National health insurance enrolment among elderly ghanaians: the role of food security status
Authors: Amoak Daniel , Braimah Joseph Asumah , Agyemang-Duah Williams , Sano Yujiro , Antabe Roger , Dassah Ebenezer 
Published: July 2024

AbstractOlder people with food insecurity in Ghana are often exposed to poor health conditions, highlighting the importance of the National health Insurance Scheme (NHIS) enrolment for ensuring they receive necessary medical attention through access to health care services. However, we know very little about the association between food insecurity and National Health Insurance Scheme enrolment among older people in Ghana. To address this void in the literature, this study uses a representative survey of adults aged 60 or older from three regions in Ghana (i.e., Upper West, Bono, and Greater Accra regions (n = 1,073)). We find that 77% of older adults reported not being enrolled into the NHIS. Results from logistic regression analysis show that older people who experienced severe household food insecurity were less likely to enroll in the National Health Insurance Scheme than those who did not experience any food insecurity (OR = 0.48 p < 0.001). Based on these findings, we argue that in addition to the traditional socioeconomic factors, addressing severe food insecurity may improve health insurance enrolment among older adults. Additionally, policymakers should also consider older people’s socioeconomic circumstances when formulating policies for them to enrol in health insurance.
Determinants of quality of life in French nursing home residents across cognitive levels: a comparative study using convergent mixed-methods
Authors: Cousi Christophe , Igier Valérie , Quintard Bruno 
Published: July 2024

Abstract
Background
The quality of life (QoL) of nursing home residents is multifaceted and influenced by relationships, health, and activities, as per research in international literature. However, studies exploring QoL predictors considering varying cognitive impairment levels are limited in the French context. This study examined the impact of sociodemographic factors and cognitive impairment on the QoL in Alzheimer’s Disease Nursing Homes (QoL-AD NH) scale scores among French nursing home residents. It further identified predictors through responses to qualitative semi-structured interviews. These elements were integrated and compared to understand more comprehensively the multifaceted determinants influencing residents’ QoL.

Methods
This mixed methods study used a cross-sectional convergent design, and quantitative and qualitative studies were carried out simultaneously. Using a generalised linear model and Kruskal–Wallis tests, the quantitative strand (N = 151) measured QoL with the QoL-AD NH scale and examined sociodemographic predictors of QoL. The qualitative strand (N = 78) involved semi-structured interviews with residents across four levels of cognitive functioning (no, mild, moderate, and severe impairment) and explored their QoL determinants through thematic analysis. Both strands were then integrated and analysed.

Results
Mild cognitive impairment and depression negatively predicted QoL-AD NH scores. For specific items, residents with mild cognitive impairment had lower “Ability to keep busy daily” and “Current life in general” scores than residents without cognitive impairment. Qualitatively, family relationships were indispensable for QoL across groups, but those with mild cognitive impairment complained about a lack of activities in nursing homes. The analysis identified convergent predictors and enriched our understanding of daily occupation. Theory comparisons revealed assessment limitations in psychological well-being.

Conclusions
A mixed approach provided a nuanced understanding of QoL, highlighting vulnerable groups and areas for improving assessment. Combining the results from standardised instruments with semi-structured interviews allowed us to capture a fuller range of experiences. The findings suggest a need to reconsider QoL assessment tools for nursing home residents and policies to address their needs regardless of their cognitive levels. They highlight the value of mixed methods for researching this multifaceted field.