bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association Between the Ultrasound Evaluation of Muscle Mass and Adverse Outcomes in Critically Ill Patients: A Prospective Cohort Study
Authors: Umbrello Michele , Formenti Paolo , Artale Alessandro , Assandri Maddalena , Palandri Chiara , Ponti Silvia , Venco Roberto , Waccher Giulia , Muttini Stefano 
Published: July 2024

BACKGROUND:
Computed tomography (CT)-derived low muscle mass is associated with adverse outcomes in critically ill patients. Muscle ultrasound is a promising strategy for quantitating muscle mass. We evaluated the association between baseline ultrasound rectus femoris cross-sectional area (RF-CSA) and intensive care unit (ICU) mortality. Secondary outcomes were the determinants of RF-CSA, and the diagnostic performance of RF-CSA after adjustment for body size.

METHODS:
A prospective, single-center, observational cohort study was conducted in 3 ICUs (general, neuroscience, coronavirus disease-2019 [COVID-19]) of a university-affiliated hospital. Consecutive, mechanically ventilated patients with predicted length of stay >72 hours were included. RF-CSA was assessed at the dominant leg by ultrasound. Association with ICU mortality was tested using multivariable logistic regression. Diagnostic performance of RF-CSA was compared after adjustment by sex (CSA-sex), body surface area (CSA-BSA), and squared height (CSA-H2).

RESULTS:
A total of 316 patients were enrolled: age 69 [60–76], 211 men and 183 ICU survivors. Older age (odds ratio, OR [95% confidence interval, CI], 1.03 [1.01–1.05]), the type of ICU (neuroscience: 0.82 [0.38–1.79], COVID-19: 4.1 [2.01–8.38]), a higher modified Nutrition and Rehabilitation Investigators Consortium (NUTRIC) score (1.43 [1.21–1.70]), and a lower RF-CSA (0.41 [0.29–0.58]) were associated with ICU mortality. Baseline RF-CSA was lower in women, with higher nutritional risk, older age, and larger body size. Unadjusted RF-CSA had an area under the receiver operating characteristic (ROC) curve for ICU mortality of 0.720 [0.663–0.776], and this value was not significantly different from that of CSA-sex, CSA-BSA, and CSA-H2 (P = .1487).

CONCLUSIONS:
Low baseline RF-CSA was associated with increased ICU mortality. Admission RF-CSA was lower in women, with high nutritional risk, in older subjects and with lower body size. Absolute muscle mass was significantly associated with mortality, with no significant increase in this relationship when adjusting for sex or body size.
Capacity of Anesthesiology Residency Programs in Four East African Countries: Can Supply Meet the Demand?
Authors: Nekyon David O. , Mung’ayi Vitalis O. , Kasumba John M. , Nizeyimana Francoise , Lugazia Edwin R. , Harakandi Stanislas 
Published: July 2024

BACKGROUND:
By 2015, 4 East African countries (Kenya, Uganda, Rwanda, and Burundi) had identified a deficit in the number of anesthesiologists, with a mean density of 0.30 physician anesthesia providers (PAP) per 100,000 population, which was significantly lower than the World Federation of Societies of Anaesthesiologists (WFSA) recommended minimum of 5.0/100,000 population. This workforce shortfall has been recognized as 1 factor that may negatively affect surgical outcomes. This survey sought to assess the capacity of anesthesia residency programs to meet recommended human resource standards in these countries.

METHODS:
This retrospective cross-sectional study surveyed heads of anesthesia departments, principals of medical colleges that host residency programs and registrars of national medical councils in 4 East African countries. A descriptive analysis of the infrastructural characteristics, human resources, cost of training, enrollment, and output from the programs over 5 years (2015–2020) was conducted. The growth in the number of registered PAP and trends in workforce density were determined. The 2020 needs deficit was calculated based on the WFSA benchmark, and the projected workforce needs in 2030 were estimated based on the population growth trajectory.

RESULTS:
There were 7 accredited university-based anesthesia residency programs in 2020, with median (range) enrollment and graduation rates of 10.5 (2–18) and 5.5 (0–13) residents/country/year, respectively. Enrollment was unstable with some countries having years with no enrollment at all. Only 1 country had new programs planned. There was a median resident to supervisor ratio of 1.44 (0.89–7):1 and 50.3 (21.4–100)% of residency training supervisors had no academic faculty appointment. The median university tuition was $1677 (600–6165)/year. The number of PAP increased in all 4 countries median 5-year growth of 79.3 (22.7–150)%, with minimal impact on the low workforce density, median of 0.23 (0.04–0.35)/100,000 in 2020. The median deficit in PAP in 2020 was an estimated 1410 (589–2499) PAP, with a median need for 1763 (763–2911) new specialists per country by 2030.

CONCLUSIONS:
The PAP workforce deficits significantly outstripped the annual output of all residency programs. Anesthesia societies need to raise awareness about this deficit and engage policymakers to increase investment in anesthesia training, including providing scholarships and employment of PAP in training institutions. Integrating nonuniversity-based residency programs may support an increased output. The attainability of the 2030 workforce goals will need review. National strategies are needed to increase the total anesthesia workforce, which includes nonphysician anesthesia providers (NPAPs) as part of the task-sharing framework.
Physicochemical characteristics of Pangasius sp. skin-gelatin-based-edible film enriched with silver nanoparticles
Authors: Nurdiani Rahmi , Prihanto Asep A. , Firdaus Muhamad , Aini Faridatul Nur , Nabilah Fajrin Adin , Talib Rosnita A , Huda Nurul 
Published: July 2024

Background: Edible films intended for food packaging have been produced from hydrocolloids, lipids, resins, and composites, including gelatin. Gelatin is known to have a good filming ability and has been suggested as an alternative to non-biodegradable plastics. Naturally active compounds incorporated into film packaging may not only protect the food product from oxidation and microbial contamination, but they may also alter the physicochemical properties of the film. Silver nanoparticles have been used in food packaging as active agents due to their antibacterial and antifungal properties. The addition may affect the characteristics of the packaging. Therefore, this study aims to determine the effect of the addition of silver nanoparticles on the physicochemical characteristics of edible film from Pangasius sp. skin gelatin. Methods: Mangrove extract of Bruguiera gymnorrhiza was used to synthesize silver into nanoparticle size. In this study, silver nanoparticles (AgNPs) with different concentrations (0, 2, 4 and 8%) were added into gelatin-based edible film. The edible films produced were observed for their physicochemical characteristics, including thickness, tensile strength, elongation, water vapour transmission, moisture content, pH, and colour. Results: AgNPs affected the colour of the fish-gelatin-based edible film, as an increased concentration of AgNPs resulted in a darker film. Nevertheless, the addition of AgNPs showed no significant effect on the thickness (145–216 µm), tensile strength (14.58–19.72 MPa), elongation (21.86–54.19%), water vapour transmission (30.91–42.55 g/m2/day), moisture content (9.57–11.16%) or pH (5.92–6.01) of the fish-gelatin-based edible film. Conclusions: The addition of AgNPs has no significant effect on gelatin-based edible film physicochemical properties except colour. Therefore, the incorporated edible film has the potential to be developed further.
Association between SII and markers of liver injury: A cross-sectional study from the NHANES (2017–2020)
Authors: Zhang Xu-Feng , Qin Yu-Yan 
Published: July 2024

Introduction
A novel indicator of inflammation is the systemic immune-inflammation index (SII), and liver dysfunction is linked to the advancement of inflammation. In light of this, this study aims to look into any potential connections between SII and markers of liver injury.

Methods
A cross-sectional study was conducted using the National Health and Nutrition Examination (NHANES) dataset for 2017–2020. The linear relationship between SII and markers of liver injury was examined using multiple linear regression models. Examining threshold effects and fitted smoothed curves were utilized to describe nonlinear connections.

Results
A total of 8213 adults aged 18–80 years participated in this population-based study. In the fully adjusted model, SII maintained a negative association with ALT(β = -0.003, 95%CI:-0.005, -0.002, P<0.00001), AST(β = -0.004, 95% CI:-0.005, -0.002, P<0.00001), and GGT(β = -0.004, 95% CI:-0.007, -0.000, P = 0.03791) and a positive association with ALP (β = 0.005, 95% CI:0.003, 0.007, P<0.00001). In subgroup analyses, it was found that SII remained negatively correlated with ALT, AST and GGT in gender, age and body mass index. SII was positively correlated with ALP at BMI≥25(kg/m2)(β = 0.005, 95% CI:0.003, 0.008, P = 0.00001), and was negatively correlated with ALT(β = -0.004, 95% CI:-0.005, -0.002, P<0.00001), AST(β = -0.004, 95% CI:-0.005, -0.003, P<0.00001) and GGT(β = -0.004, 95% CI:-0.008, -0.000, P = 0.02703) at BMI≥25, whereas no significant correlation was observed at BMI<25 (all P-values>0.05). Furthermore, the association between SII and markers of liver injury was nonlinear. By using a two-stage linear regression model for analysis, a U-shaped relationship was found to exist between SII and ALT with a turning point of 818.40(1,000 cells/μl). The inflection points of SII with AST and GGT were 451.20 (1,000 cells/μl) and 443.33 (1,000 cells/μl), respectively, and no significant inflection point with ALP was observed. Interaction tests demonstrated that SII correlation with ALT, AST, ALP, and GGT was not significantly different between strata (all p for interaction>0.05).

Conclusions
The research findings suggested that there was a negative correlation between SII and ALT, AST and GGT, and a positive correlation with ALP. However, larger prospective investigations are still greatly needed to confirm the findings.
An exploration of the journey to diagnosis of Ehlers-Danlos Syndrome (EDS) for women living in Australia
Authors: Trudgian Rachel , Flood Terri 
Published: July 2024

Introduction
Ehlers-Danlos syndromes (EDS) is an umbrella term for a group of hereditary connective tissue disorders usually featuring hyperextensible skin, easy bruising, poor healing, and joint hypermobility. According to international Ehlers-Danlos support groups, the average time to diagnosis of this rare genetic condition is 10–12 years. Consequently, the journey to diagnosis can potentially be traumatic. This pilot study aims to explore female patients’ journey to a diagnosis of EDS while living in Australia.

Materials and methods
Over six weeks, from January to February 2023, a survey was distributed on EDS social media platforms including Facebook and LinkedIn. Ethical approval was obtained through the Ulster University Institute of Nursing and Health Research Ethics Filter Committee (FCNUR). Thematic and statistical analysis of the anonymous data was completed during March 2023.

Results
152 women completed the survey. More than half of the respondents first noticed symptoms of EDS more than 15 years prior to diagnosis and more than three quarters of respondents received other diagnoses prior to their EDS diagnosis. Most respondents saw their general practitioner, a physiotherapist and/or a rheumatologist prior to being correctly diagnosed with the condition. While some respondents had positive experiences with these health professionals, many felt that they were not listened to and, after doing their own research, had to educate their health professional/s about EDS.

Conclusion
This pilot survey demonstrated that the journey to diagnosis of EDS for women in Australia is frequently long and traumatic. Participants indicated that more EDS education and training is needed for health professionals, especially GPs, to improve the diagnostic process.

Implications for practice
Participants called for their self-reported symptoms to be listened to by health professionals and to be met with empathy and an open mind instead of being dismissed. Additional education and training to health professionals about connective tissue disorders including EDS may aid earlier diagnosis in Australia.
Definitive radio(chemo)therapy versus upfront surgery in the treatment of HPV-related localized or locally advanced oropharyngeal squamous cell carcinoma
Authors: Baude Jérémy , Guigou Caroline , Thibouw David , Vulquin Noémie , Folia Mireille , Constantin Guillaume , Boustani Jihane , Duvillard Christian , Ladoire Sylvain , Truc Gilles , Bertaut Aurélie , Chevalier Cédric 
Published: July 2024

Background
The treatment of stage I-III HPV+ oropharyngeal squamous cell carcinoma (HPV-OPSCC) is based on either surgery ± adjuvant therapy or exclusive radio±chemotherapy. We sought to compare these two therapeutic strategies in terms of efficacy, tolerance and quality of life (QoL).

Methods
Patients treated for stage I-III HPV-OPSCC from 2010 to 2021 in 3 academic centers were included and sorted according to the treatment strategy: surgery or exclusive radio±chemotherapy. Efficacy and tolerance were retrospectively assessed, and a transversal exploratory QoL assessment was performed using QoL instruments.

Results
A total of 83 patients were included, with 21 undergoing non-minimally invasive surgery and 62 receiving definitive radio-±chemotherapy. 2-year progression-free survival (PFS) and overall survival (OS) were respectively 80% and 86% in the surgical group and 92% and 95% in the non-surgical group, with no significant difference. At the end of treatment, 64.5% of patients presented with a grade III toxicity, without significant difference between the two groups. No patient had late grade III toxicity at 24 months. Forty-five patients (11 in the surgical group, 34 in the non-surgical group) participated in an exploratory quality-of-life analysis. Patients reported significantly more fatigue and loss of appetite after surgery, whereas patients in the radio±chemotherapy group described significantly more salivary and oral problems and difficulty swallowing, but the median time between treatment completion and the response to the questionnaires.

Conclusion
There was no significant difference in efficacy, physician-reported toxicity and overall patient-reported quality of life was found between non-minimally invasive surgery and radio±chemotherapy in the treatment of stage I-III HPV-OPSCC.
Nas águas do passado: a nostalgia nas utopias da série Electric dreams
Authors: Borges Felipe 
Published: July 2024

Este artigo analisa os episódios The hook maker e Impossible planet, da série de TV Philip K. Dick’s Electric dreams, a fim de observar o papel utópico da memória nostálgica em narrativas nas quais o futuro não oferece perspectivas de mudança. A nostalgia, nesse sentido, se aproximaria da utopia, ao projetar imagens de felicidade em lugares específicos. A partir do estudo de cenas nas quais os personagens sonham acordados, analisamos as possibilidades e limitações oferecidas pelo sentimento de nostalgia como elemento transformador. Na conclusão, debatemos a tensão envolvendo projetos utópicos que transitam entre impulsos individuais e coletivos e as resoluções propostas pelas narrativas.
Severe Cholestasis Predicts Recurrent Primary Sclerosing Cholangitis Following Liver Transplantation
Authors: Aziz Bishoi , Kok Beverley , Cheah Matthew , Lytvyak Ellina , Moctezuma-Velazquez Carlos , Wasilenko Shawn , Tsochatzis Emmanuel , Ravikumar Reena , Jose Sophie , Allison Michael , Gunson Bridget , Manas Derek , Monaco Andrea , Mirza Darius , Fusai Giuseppe , Owen Nicola , Thorburn Douglas , Roberts Keith , Srinivasan Parthi , Wigmore Stephen , Athale Anuja , Creamer Felicity , Fernando Bimbi , Iyer Vikram , Madanur Mansoor , Sen Gourab , Montano-Loza Aldo J. , Hansen Bettina , Mason Andrew L. 
Published: July 2024

INTRODUCTION:
Primary sclerosing cholangitis (PSC) may reoccur following liver transplantation (LT), and the diagnosis established once imaging studies demonstrate the diagnostic cholangiographic appearance. To evaluate whether the development of recurrent PSC (rPSC) is associated with cholestasis soon after LT, we studied whether changes in hepatic biochemistry within the first 12 months were linked with the development of rPSC and graft loss.

METHODS:
We conducted a retrospective cohort analysis of 158 transplant recipients with PSC in Canada and 549 PSC transplant recipients from the United Kingdom. We evaluated serum liver tests within 12 months after LT and the subsequent development of a cholangiographic diagnosis of rPSC as a time-dependent covariate using Cox regression. Severe cholestasis was defined as either alkaline phosphatase > 3× upper limit of normal or total bilirubin > 100 μmol/L.

RESULTS:
Patients who developed rPSC were more likely to have severe cholestasis vs those without at 3 months (20.5% vs 8.2%, P = 0.011), at 6 months (17.9% vs 10.0%, P = 0.026), and 12 months (15.4% vs 7.8%, P = 0.051) in the Canadian cohort and at 12 months in the UK cohort (27.9% vs 12.6%, P < 0.0001). By multivariable analysis, development of severe cholestasis in the Canadian cohort at 3 months (hazard ratio [HR] = 2.41, P = 0.046) and in the UK cohort at 12 months (HR = 3.141, P < 0.0001) was both associated with rPSC. Severe cholestasis at 3 months in the Canadian cohort was predictive of graft loss (HR = 3.88, P = 0.0001).

DISCUSSION:
The development of cholestasis within 3–12 months following LT was predictive of rPSC and graft loss.
Delivery of Outpatient Cirrhosis Care Through Tele-Visit Is Not Associated With Increased Mortality as Compared With Traditional In-Person Visits
Authors: Shenoy Abhishek , Valicevic Autumn N. , Lin Allison , Su Grace L. , Saini Sameer D. , Kim Hyungjin Myra , Adams Megan A. 
Published: July 2024

INTRODUCTION:
Providers and patients have expressed concern that care provided through telehealth results in poorer outcomes than traditional in-person care. On the contrary, we hypothesized that patients with cirrhosis engaging in video/phone-based outpatient gastroenterology/hepatology tele-visits do not differ in mortality from those receiving in-person outpatient clinic visits.

METHODS:
This was a retrospective, case-control study using Veterans Health Administration administrative data of veterans with a cirrhosis diagnosis. Cases were patients who died between April 2021 and July 2022 and had a cirrhosis diagnosis for ≥1 year before death. For each case, a control was randomly selected from the pool of patients alive on the date of death of the case (index date) and matched on age, average Model for End-Stage Liver Disease, and number of gastroenterology/hepatology clinic visits in the prior year. Primary exposure variable was % tele-visits (video/phone) out of total visits in the year before the index date, scaled in 10% increments. Conditional logistic regression was used to assess the association between mortality and % tele-visits. A secondary analysis matched on electronic Child-Turcotte-Pugh score rather than Model for End-Stage Liver Disease.

RESULTS:
Two thousand nine hundred thirty-three cases were identified and matched with 2,933 controls. After adjusting for covariates, tele-visit-based outpatient care was associated with a small reduction in mortality (odds ratioTH = 0.95, 95% confidence interval = 0.94–0.97). Matching on electronic Child-Turcotte-Pugh score did not change the results.

DISCUSSION:
Our findings suggest that outpatient cirrhosis care by tele-visit is associated with outcomes no worse than traditional in-person visits. This should reassure providers who hesitate to provide virtual care to patients with cirrhosis due to concerns for poorer outcomes.
Design-based RCT estimators and central limit theorems for baseline subgroup and related analyses
Authors: Schochet Peter Z. 
Published: July 2024

Abstract
There is a growing literature on design-based (DB) methods to estimate average treatment effects (ATEs) for randomized controlled trials (RCTs) for full sample analyses. This article extends these methods to estimate ATEs for discrete subgroups defined by pre-treatment variables, with an application to an RCT testing subgroup effects for a school voucher experiment in New York City. We consider ratio estimators for subgroup effects using regression methods, allowing for model covariates to improve precision, and prove a new finite population central limit theorem. We discuss extensions to blocked and clustered RCT designs, and to other common estimators with random treatment-control sample sizes or summed weights: post-stratification estimators, weighted estimators that adjust for data nonresponse, and estimators for Bernoulli trials. We also develop simple variance estimators that share features with robust estimators. Simulations show that the DB subgroup estimators yield confidence interval coverage near nominal levels, even for small subgroups.
Zugänge zu § 153a Abs. 1 StPO und ihre Wechselwirkung mit Bedingungen von Akzeptanz
Authors: Schmitt-Leonardy Charlotte , Klarmann Max , Faltinat Elisabeth 
Published: July 2024

Zusammenfassung
Konsensuale Verfahrenserledigungen in einem frühen Stadium des Strafverfahrens haben – tatsächlich sowie durch normative Erweiterungen – an Bedeutung gewonnen. Insbesondere bei der Einstellung des Strafverfahrens gegen Auflagen gemäß. § 153a StPO steht jedoch die Art und Weise dieser Erledigung infrage. Diese wird ohne Beweisaufnahme in einem von Informalität geprägten Kommunikationsraum verhandelt, der Strafverfolgungsbehörden und Strafverteidigung einen erheblichen Gestaltungsspielraum bei der Mitbestimmung des Verhandlungsergebnisses ermöglicht. Individuelle Kompetenzen der Verfahrensbeteiligten erlangen in Ermangelung formeller Strukturen erhöhte Relevanz.
Trotz signifikanter empirischer Forschung seit der Einführung des § 153a StPO im Jahr 1974 ist Forschungsbedarf erkennbar, der eine neue Perspektive auf privilegierte Zugänge zur Anwendungspraxis der Norm und die bestimmenden Faktoren des der Einstellung zugrundeliegenden Narrativs erwarten lässt. Die Ergebnisse könnten dann in den größeren Kontext der Akzeptanz strafrechtlicher Entscheidungen und deren Interdependenz mit den Zugängen zum Strafrecht gestellt werden.