bluuebunny/crossref_metadata_2025_split huggingface dataset:
Performance of CHA2DS2-VASc and HAS-BLED in predicting stroke and bleeding in atrial fibrillation and cancer
Authors: Ajabnoor Alyaa M , Zghebi Salwa S , Parisi Rosa , Ashcroft Darren M , Faivre-Finn Corinne , Mamas Mamas A , Kontopantelis Evangelos 
Published: June 2024

Abstract

Aims
To compare the predictive performance of CHA2DS2-VASc and HAS-BLED scores in atrial fibrillation (AF) patients with and without cancer.

Methods and results
Using data from the Clinical Practice Research Datalink in England, we performed a retrospective cohort study of patients with new diagnoses of AF from 2009 to 2019. Cancer was defined as history of breast, prostate, colorectal, lung, or haematological cancer. We calculated the CHA2DS2-VASc and HAS-BLED scores for the 1-year risk of stroke and major bleeding events. Scores performance was estimated by discrimination [area under the receiver operating characteristic curve (AUC)] and calibration plots. Of 141 796 patients with AF, 10.3% had cancer. The CHA2DS2-VASc score had good to modest discrimination in prostate cancer AUC = 0.74 (95% confidence interval: 0.71, 0.77), haematological cancer AUC = 0.71 (0.66, 0.76), colorectal cancer AUC = 0.70 (0.66, 0.75), breast cancer AUC = 0.70 (0.66, 0.74), and lung cancer AUC = 0.69 (0.60, 0.79), compared with no-cancer AUC = 0.73 (0.72, 0.74). HAS-BLED discrimination was poor in prostate cancer AUC = 0.58 (0.55, 0.61), haematological cancer AUC = 0.59 (0.55, 0.64), colorectal cancer AUC = 0.57 (0.53, 0.61), breast cancer AUC = 0.56 (0.52, 0.61), and lung cancer AUC = 0.59 (0.51, 0.67), compared with no-cancer AUC = 0.61 (0.60, 0.62). Both the CHA2DS2-VASc score and HAS-BLED score were well calibrated across all study cohorts.

Conclusion
Amongst certain cancer cohorts in the AF population, CHA2DS2-VASc performs similarly in predicting stroke to AF patients without cancer. Our findings highlight the importance of cancer diagnosis during the development of risk scores and opportunities to optimize the HAS-BLED risk score to better serve cancer patients with AF.
Heart failure with preserved ejection fraction management: a systematic review of clinical practice guidelines and recommendations
Authors: Mahmood Adil , Dhall Eamon , Primus Christopher P , Gallagher Angela , Zakeri Rosita , Mohammed Selma F , Chahal Anwar A , Ricci Fabrizio , Aung Nay , Khanji Mohammed Y 
Published: June 2024

Abstract
Multiple guidelines exist for the diagnosis and management of heart failure with preserved ejection fraction (HFpEF). We systematically reviewed current guidelines and recommendations, developed by national and international medical organizations, on the management of HFpEF in adults to aid clinical decision-making. We searched MEDLINE and EMBASE on 28 February 2024 for publications over the last 10 years as well as websites of organizations relevant to guideline development. Of the 10 guidelines and recommendations retrieved, 7 showed considerable rigour of development and were subsequently retained for analysis. There was consensus on the definition of HFpEF and the diagnostic role of serum natriuretic peptides and resting transthoracic echocardiography. Discrepancies were identified in the thresholds of serum natriuretic peptides and transthoracic echocardiography parameters used to diagnose HFpEF. There was agreement on the general pharmacological and supportive management of acute and chronic HFpEF. However, differences exist in strategies to identify and address specific phenotypes. Contemporary guidelines for HFpEF management agree on measures to avoid its development and the consideration of cardiac transplantation in advanced diseases. There were discrepancies in recommended frequency of surveillance for patients with HFpEF and sparse recommendations on screening for HFpEF in the general population, use of diagnostic scoring systems, and the role of newly emerging therapies.
Chromosome-scale Elaeis guineensis and E. oleifera assemblies: comparative genomics of oil palm and other Arecaceae
Authors: Low Eng-Ti Leslie , Chan Kuang-Lim , Zaki Noorhariza Mohd , Taranenko Elizaveta , Ordway Jared M , Wischmeyer Corey , Buntjer Jaap , Halim Mohd Amin Ab , Sanusi Nik Shazana Nik Mohd , Nagappan Jayanthi , Rosli Rozana , Bondar Eugeniya , Amiruddin Nadzirah , Sarpan Norashikin , Ting Ngoot-Chin , Chan Pek-Lan , Ong-Abdullah Meilina , Marjuni Marhalil , Mustaffa Suzana , Abdullah Norziha , Azizi Norazah , Bacher Blaire , Lakey Nathan , Tatarinova Tatiana V , Manaf Mohamad Arif Abd , Sambanthamurti Ravigadevi , Singh Rajinder 
Published: June 2024

Abstract
Elaeis guineensis and E. oleifera are the two species of oil palm. E. guineensis is the most widely cultivated commercial species, and introgression of desirable traits from E. oleifera is ongoing. We report an improved E. guineensis genome assembly with substantially increased continuity and completeness, as well as the first chromosome-scale E. oleifera genome assembly. Each assembly was obtained by integration of long-read sequencing, proximity ligation sequencing, optical mapping, and genetic mapping. High interspecific genome conservation is observed between the two species. The study provides the most extensive gene annotation to date, including 46,697 E. guineensis and 38,658 E. oleifera gene predictions. Analyses of repetitive element families further resolve the DNA repeat architecture of both genomes. Comparative genomic analyses identified experimentally validated small structural variants between the oil palm species and resolved the mechanism of chromosomal fusions responsible for the evolutionary descending dysploidy from 18 to 16 chromosomes.
Simplified single-session EUS-guided transhepatic antegrade stone removal for management of choledocholithiasis in patients with surgically altered anatomy
Authors: Yu Tingting , Hou Suning , Du Haiming , Zhang Wei , Tian Jiao , Hou Yankun , Yao Jun , Hou Senlin , Zhang Lichao 
Published: June 2024

Abstract

Background
Endoscopic ultrasound (EUS)-guided transhepatic antegrade stone removal (TASR) has been reserved for choledocholithiasis after failed endoscopic retrograde cholangiopancreatography (ERCP) in recent years. The aim of this study was to evaluate the techniques, feasibility, and safety of simplified single-session EUS-TASR for choledocholithiasis in patients with surgically altered anatomy (SAA).

Methods
A retrospective database of patients with SAA and choledocholithiasis from the Second Hospital of Hebei Medical University (Shijiazhuang, China) between August 2020 and February 2023 was performed. They all underwent single-session EUS-TASR after ERCP failure. Basic characteristics of the patients and details of the procedures were collected. The success rates and adverse events were evaluated and discussed.

Results
During the study period, 13 patients underwent simplified single-session EUS-TASR as a rescue procedure (8 males, median age, 64.0 [IQR, 48.5–69.5] years). SAA consisted of four Whipple procedures, one Billroth II gastrectomy, four gastrectomy with Roux-en-Y anastomoses, and four hepaticojejunostomy with Roux-en-Y anastomoses. The technical success rate was 100% and successful bile duct stone removal was achieved in 12 of the patients (92.3%). Adverse events occurred in two patients (15.4%), while one turned to laparoscopic surgery and the other was managed conservatively.

Conclusions
Simplified single-session EUS-TASR as a rescue procedure after ERCP failure appeared to be effective and safe in the management of choledocholithiasis in patients with SAA. But further evaluation of this technique is still needed, preferably through prospective multicenter trials.
Comparing Artificial Intelligence Guided Image Assessment to Current Methods of Burn Assessment
Authors: Lee Justin J , Abdolahnejad Mahla , Morzycki Alexander , Freeman Tara , Chan Hannah , Hong Collin , Joshi Rakesh , Wong Joshua N 
Published: June 2024

Abstract
Appropriate identification of burn depth and size is paramount. Despite the development of burn depth assessment aids [eg, laser Doppler imaging (LDI)], clinical assessment, which assesses partial-thickness burn depth with 67% accuracy, currently remains the most consistent standard of practice. We sought to develop an image-based artificial intelligence system that predicts burn severity and wound margins for use as a triaging tool in thermal injury management. Modified EfficientNet architecture trained by 1684 mobile-device-captured images of different burn depths was previously used to create a convoluted neural network (CNN). The CNN was modified to a novel boundary attention mapping (BAM) algorithm using elements of saliency mapping, which was used to recognize the boundaries of burns. For validation, 144 patient charts that included clinical assessment, burn location, total body surface area, and LDI assessment were retrieved for a retrospective study. The clinical images underwent CNN-BAM assessment and were directly compared with the LDI assessment. CNN using a 4-level burn severity classification achieved an accuracy of 85% (micro/macro-averaged receiver operating characteristic scores). The CNN-BAM system can successfully highlight burns from surrounding tissue with high confidence. CNN-BAM burn area segmentations attained a 91.6% accuracy, 78.2% sensitivity, and 93.4% specificity, when compared to LDI methodology. Results comparing the CNN-BAM outputs to clinical and LDI assessments have shown a high degree of correlation between the CNN-BAM burn severity predictions to those extrapolated from LDI healing potential (66% agreement).
CNN-BAM algorithm gives equivalent burn-depth detection accuracy as LDI with a more economical and accessible application when embedded in a mobile device.
Functions of Diplomatic Missions and Consulates
Authors: Roberts Ivor 
Published: June 2024

Abstract
This chapter tackles the functions of diplomatic missions and consulates. It explores the establishment of diplomatic relations between States and the establishment of permanent diplomatic missions that take place by mutual consent. According to Article 3 of the Vienna Convention on Diplomatic Relations, the functions of a diplomatic mission include the representation of the State to protect its interests, negotiate with the receiving State's government, and promote friendly relations between the States. Additionally, a diplomatic mission is required to carry out all of its functions in accordance with international law and the laws and regulations of the receiving State. The chapter discusses the performance of consular functions by diplomatic missions.
Terrorism and Diplomacy
Authors: Roberts Ivor 
Published: June 2024

Abstract
This chapter examines the notions of terrorism and diplomacy. Due to the increasing globalization of terror, diplomats can anticipate being centrally involved in the negotiation of international conventions suppressing terrorism and the establishment of networks of multilateral cooperation and intelligence-sharing. The nature of terrorism requires cooperation between countries, and many international bodies and organizations adopt policies to combat the scourge. The chapter then discusses destructive attacks on diplomatic missions, such as the attack on the British mission during the Chinese Cultural Revolution and a suicide bomber in the US embassy of Beirut. It considers the sensitivity and controversy of the policy of no concessions to terrorists.
The G8/G7, G20, BRICS, WTO, OECD, IMF, and World Bank
Authors: Roberts Ivor 
Published: June 2024

Abstract
This chapter explores the emergence of various financial institutions. It cites the impact of globalization and multinational enterprises on the global economy. The Group of Seven (G7), composed of the world’s leading industrialized nations, is an informal international forum, so it does not have permanent headquarters, secretariat, or budget despite holding annual summits to coordinate economic and financial policies. The leaders of these countries meet annually at summits to coordinate loosely their economic and financial policies. The chapter then details the origin, work and significance of G20, WTO, Organisation for Economic Cooperation and Development, International Monetary Fund, International Energy Agency, and World Bank.
Antimicrobial Stewardship Practices in Outpatient Parenteral Antimicrobial Therapy Programs in the United States
Authors: Azimi Sara F , Golnabi Esther , Mynatt Ryan P , Burgess Donna , Logan Ashley , Wrenn Rebekah H , Parisi Mercado Michael , Boeser Kimberly , Plauche Ardath , Sexton Mary Elizabeth , Walraven Carla 
Published: June 2024

Abstract

Background
Outpatient parenteral antimicrobial therapy (OPAT) regimens typically prioritize ease of antimicrobial administration, tolerability, safety, and accessibility over using the narrowest-spectrum antimicrobial. In light of this, OPAT providers often utilize different techniques to promote antimicrobial stewardship (AMS) in their OPAT programs. This study aims to characterize the AMS practices of OPAT programs across the United States that might meet The Joint Commission requirements for outpatient AMS metrics.

Methods
This is a cross-sectional electronic survey of the Vizient AMS network. A total of 95 possible questions were designed to inquire about demographics, OPAT program structure, AMS initiatives, performance metrics, and resources.

Results
Seventy-four survey responses were received, with 58 (78.4%) of the respondents indicating their institution offered OPAT services. Respondents reported having at least 1 AMS protocol and tracking at least 1 metric in 91% and 74% of OPAT programs, respectively. Only 40% of programs reported billing for OPAT-related services. Approximately 45% of respondents disagreed or strongly disagreed that their OPAT program had the resources needed to care for the population it serves. Respondents identified data analytics (69%), funding for expansion of services (67%), and pharmacists (62%) as resources of greatest need for their OPAT programs.

Conclusions
This survey collectively describes the AMS practices currently employed by OPAT programs across the United States. The results provide specific examples of AMS initiatives, metrics, and resources that institutions may reference to advance the practices of their OPAT programs to meet The Joint Commission Outpatient Antimicrobial Stewardship standards.
Mid–Upper Arm Circumference Is a Strong Predictor of Mortality Among Ugandan Adults With HIV-Associated Cryptococcal Meningitis: A Prospective Cohort Study
Authors: Hale Gila , Adzemovic Tessa , Huppler Hullsiek Kathy , Mulwana Suzan , Ndyetukira Jane Francis , Sadiq Alisat , Kabahubya Mable , Ayebare Peruth , Nankungu Lydia , Namudde Alice , Namanda Sylvia , Menya Grace , Nakitto Grace , Muzoora Conrad , Nuwagira Edwin , Rhein Joshua , Meya David B , Boulware David R , Ellis Jayne , Abassi Mahsa 
Published: June 2024

Abstract

Background
Mortality among adults diagnosed with HIV-associated cryptococcal meningitis remains high (24%–40%). We hypothesized that nutritional state, as measured by mid–upper arm circumference (MUAC), is a potentially modifiable risk factor for mortality.

Methods
Ugandan adults hospitalized with HIV-associated cryptococcal meningitis had MUAC measurements performed at baseline. We compared MUAC measurements with baseline clinical and demographic variables and investigated associations with survival using Cox regression.

Results
Of 433 participants enrolled, 41% were female, the median CD4 T-cell count (interquartile range [IQR]) was 15 (6–41) cells/μL, and 37% were antiretroviral therapy naïve. The median MUAC (IQR) was 24 (22–26) cm, the median weight (IQR) was 53 (50–60) kg, and MUAC correlated with weight (Pearson r = 0.6; P &lt; .001). Overall, 46% (200/433) died during the 18-week follow-up. Participants in the lowest MUAC quartile (≤22 cm) had the highest mortality: 39% (46/118) at 2 weeks and 62% (73/118) at 18 weeks. A baseline MUAC ≤22 cm was associated with an 82% increased risk of 18-week mortality as compared with participants with an MUAC &gt;22 cm (unadjusted hazard ratio, 1.82; 95% CI, 1.36–2.42; P &lt; .001). Following adjustment for antiretroviral therapy status, CD4 count, hemoglobin, amphotericin dose, and tuberculosis status, the adjusted hazard ratio was 1.84 (95% CI, 1.27–2.65; P &lt; .001). As a continuous variable, 18-week mortality was reduced by 10% for every 1-cm increase in MUAC. CSF Th17 immune responses were positively associated with MUAC quartile.

Conclusions
MUAC measurement is a simple bedside tool that can identify adults with HIV-associated cryptococcal meningitis at high risk for mortality for whom an enhanced bundle of care, including nutritional supplementation, should be further investigated.
The Looming Threat of Dengue Fever: The Africa Context
Authors: Mercy Kyeng , Youm Eric , Aliddeki Dativa , Faria Nuno R , Kebede Yenew , Ndembi Nicaise 
Published: June 2024

Abstract
In Africa, compared to 2019, dengue infections have surged ninefold by December 2023, with over 270 000 cases and 753 deaths reported across 18 African Union (AU) Member States. This commentary synthesises the context of dengue outbreaks in Africa and provides recommendations for sustainable control. In 2023, 18 African Union Member States reported outbreaks of dengue, among which seven had ongoing armed conflicts. These countries were amongst the top 15 African countries contributing to the most displaced persons on the continent and accounted for 98% of all dengue cases reported in the continent in 2023. Climate change remains an important driver, both through the displacement of people and global warming. The continent continues to face several challenges in detection, reporting and management, such as the lack of local laboratory capacity, misclassification of dengue cases and lack of medical countermeasures. Solutions targeting the strengthening of cross-border surveillance and early warning systems using a multisectoral one-health approach, local research and development for therapeutics and diagnostics and community engagement empowering communities to protect themselves and understand the gravity of the threat could help curb the spread of the disease in Africa.
Fabricating and examining nanocomposite of P3HT- Graphene- MoS2 by laser ablation method
Authors: Obaid Nagham M , Al-Nafiey Amer , Majeed Hassan A , Ali Al-Dahash Ghaleb 
Published: June 2024

Abstract
This study presents the first successful synthesis of a nanocomposite comprising Poly (3-hexylthiophene) (P3HT), graphene (G), and molybdenum disulfide (MoS2) via laser ablation, using a Q-switch Nd-YAG laser with a repetition rate of 1 (Hz) and different laser pulses of 200, 500, and 800 for both graphene and MoS2, the morphological and optical properties of the samples was thoroughly investigated by various analytical techniques including Transmission electron microscopy (TEM), atomic force microscopy (AFM), Fourier transform infrared (FTIR), and spectrophotometer UV-Vis. Transmission electron microscopy showed that the graphene and molybdenum nanoparticles were semispherical or ball-shaped, with diameters ranging from 6.7 to 61.7 nm. The UV-Vis findings show that the absorbance and absorption coefficient increase with the number of pulses due to the increased concentration of nanoparticles. The FTIR results confirm strong bonding between the P3HT-G800P/MoS2 800P nanocomposite bonds. The indirect energy gap of the Nanocomposite is estimated to be 1.99 (eV), making it attractive for optoelectronic applications.
Implementation of standardized patient safety and quality improvement rounds in a tertiary care paediatric centre
Authors: Pianosi Kiersten D , McKelvie Brianna L , Kilgar Jennifer , Abdulsatar Farah , Strychowsky Julie E 
Published: June 2024

Abstract

Introduction
Patient safety is increasingly becoming a major priority for healthcare institutions, and various models of these rounds exist. The Ottawa M&M Model (OM3) is a structured and standardized approach to patient safety and quality improvement rounds that has been implemented at other institutions across Canada with good success.

Methods
This quality improvement project invited divisions within the Children’s Hospital in London, Ontario to participate in the implementation of the OM3 for M&M rounds. The project aligned with the Institute for Health Improvement’s Model for Improvement. Baseline needs assessments and facilitator training were performed. The main outcome was implementation of a version of the OM3 for PSQI rounds, action items generated from these rounds, and systemic hospital changes.

Results
The baseline needs assessment showed that 18 (66.7%) respondents were members of divisions with pre-existing M&M rounds. Most found their rounds at least valuable, but only two-thirds found that action items were generated following each meeting. After implementation of the OM3, 58.3% (21 of 36) of action items submitted to the CH-QCC were partially or completed actioned by the end of 2022. A post-implementation survey showed that of the 11 division representatives who responded, 7 (64%) were still participating in PSQI rounds and using the new OM3 format, which they agreed was more organized.

Conclusions
We were able to successfully implement a new standardized approach to Patient Safety and Quality Improvement Rounds that has led to systemic changes within the paediatrics hospital and continues to be used today.
Sleep deprivation in adolescent mice impairs long-term memory till early adulthood via suppression of hippocampal astrocytes
Authors: Kang Ji-Yun , Lee Jin-Seok , Wang Jing-Hua , Son Chang-Gue 
Published: June 2024

Abstract
Sleep deficiency is a rampant issue in modern society, serving as a pathogenic element contributing to learning and memory impairment, with heightened sensitivity observed in children. Clinical observations suggest that learning disabilities associated with insufficient sleep during adolescence can persist through adulthood, but experimental evidence for this is lacking. In this study, we examined the impact of early-life sleep deprivation (SD) on both short-term and long-term memory, tracking the effects sequentially into adulthood. We employed a modified multiple-platform method mouse model to investigate these outcomes. SD induced over a 14-day period, beginning on postnatal day 28 (PND28) in mice, led to significant impairment in long-term memory (while short-term memory remained unaffected) at PND42. Notably, this dysfunction persisted into adulthood at PND85. The specific impairment observed in long-term memory was elucidated through histopathological alterations in hippocampal neurogenesis, as evidenced by bromodeoxyuridine (BrdU) signals, observed both at PND42 and PND85. Furthermore, the hippocampal region exhibited significantly diminished protein expressions of astrocytes, characterized by lowered levels of aquaporin 4 (AQP4), a representative molecule involved in brain clearance processes, and reduced protein expressions of brain-derived neurotrophic factors. In conclusion, we have presented experimental evidence indicating that sleep deficiency-related impairment of long-term memory in adolescence can endure into adulthood. The corresponding mechanisms may indicate that the modification of astrocyte-related molecules has led to changes in hippocampal neurogenesis.
“Healthy Points” Gaming to Teach Social Determinants of Health
Authors: Campbell Suzie 
Published: June 2024

Abstract
Social determinants of health (SDOH) and population health are critical to prelicensure nursing education. Game-based learning is a strategy to increase student engagement. A gaming activity was created by faculty to increase student interaction and have students gain a deeper understanding of the SDOH. The game has students experience events that impact health, represented by “healthy points.” Faculty observed deeper student engagement and more robust discussion in class when using the game, with students reporting that the game was fun and engaging. Teaching methods such as gaming can be effective for teaching SDOH and preparing students to promote health equity.