bluuebunny/crossref_metadata_2025_split huggingface dataset:
History of Suicidality and Pandemic Outcomes: Longitudinal Associations with Anxiety Symptoms, Depressive Symptoms, and Problematic Drinking
Authors: Luk Jeremy W. , Thompson Matthew F. , Novak Laura A. , Stangl Bethany L. , Schwandt Melanie L. , Goldman David , Ramchandani Vijay A. , Diazgranados Nancy 
Published: May 2024

ObjectiveIndividuals with a history of suicidality may be especially vulnerable to the adverse impact of COVID‐related stressors, but this vulnerability has not been demonstrated. This study examined the longitudinal effects of suicidality history (ideation only or attempt vs. none) and interactions with COVID‐related stressors (e.g., work interruptions, childcare challenges, and financial stress) on anxiety symptoms, depressive symptoms, and problematic drinking.MethodsLongitudinal data from 517 participants were drawn from the National Institute on Alcohol Abuse and Alcoholism Natural History Protocol and COVID‐19 Pandemic Impact on Alcohol Study. Lifetime history of suicidality was assessed using the clinician administered Columbia‐Suicide Severity Rating Scale. Multiple regressions tested the interaction between suicidality history and COVID‐related stressors on clinical outcomes.ResultsCompared to individuals without any history of suicidality (79.9%; n = 413), individuals with a history of suicide ideation only (14.5%; n = 75) and suicide attempt (5.6%; n = 29) had higher anxiety symptoms, depressive symptoms, and problematic drinking during the pandemic. Significant interaction effects showed the associations between COVID‐related stressors and mental disorder symptoms were stronger among individuals with suicide attempt history than individuals without suicidality history.ConclusionsHistory of suicide attempt in combination with high COVID‐related stressors put individuals at the greatest risk for pandemic mental disorder symptoms. Individuals with suicide attempt history may have lower coping resources to handle COVID‐related stressors. Suicide risk assessment and intervention to increase cognitive flexibility and emotional regulation skills may help these individuals manage emotional distress experienced during the COVID‐19 pandemic and beyond.
Impact of aortic root geometry and degree of aortic calcification on outcomes of patients undergoing TAVI procedure
Authors: Emini Ramiz , Gaisendrees Christopher , Kreft Marie , Liebold Andreas , Bauernschmitt Robert , Merkle-Storms Julia 
Published: May 2024

Aims Adequate differentiation of calcifications in contrast-enhanced CT scans remains difficult to assess TAVI parameters. The size of the aortic leaflets has not been taken into account so far in present studies. The aim of our study was to establish a new method for optimized quantification of the aortic valve calcification degree in contrast-enhanced CT scans for better preoperative prediction of postoperative paravalvular leak after TAVI. Methods and results We retrospectively analyzed preoperative contrast-enhanced CT scans of patients who underwent TAVI in our institution between 2014 and 2017. Calcium volume was quantified by a method using contrast enhanced computer tomography (3mensio-Structural Heart-7.2 software) with different iodine contents for better discrimination of contrast agent from calcium and by an individually set Houndsfield Unit (HU) threshold with 50HU above the individually determined reference value. Calcium volume was correlated with surface area of each aortic cusp. Perioperative variables were analyzed. All patients ( n = 150) with severe aortic stenosis were treated with TAVI implantation. Overall incidence of postoperative trace to moderate PVL was 37%. The amount of calcium correlated with the incidence of PVL. In a logistic regression analysis total volume of calcification ( p = .032) as well as calcification of each aortic cusp (NC_ p = .001; RC_ p < .001; LC_ p = .001) were independent predictors. Conclusions Calcification degree as well as its correlation with the surface area of each aortic cusp significantly influence incidence of PVL. Our new method improves preoperative quantification of the calcification degree by use of contrast agents with different iodine contents and thereby helps to improve patients’ outcomes.
Effects of linear periodized and non-periodized combined training on body image perception of adults with obesity: A randomized clinical trial
Authors: Streb Anne Ribeiro , Vieira Carolina Graef , Leonel Larissa dos Santos , Bertuol Cecília , Tozetto Willen Remon , Benedet Jucemar , Del Duca Giovani Firpo 
Published: May 2024

Objective Verify the effect of non-periodized and linear periodized combined training on body image perception and body dissatisfaction in adults with obesity. Design A randomized clinical trial on the effect of two types of combined training periodization was carried out on people with grade I and II obesity. Setting Participants were allocated into three groups: non-periodized periodization group, linear periodization group, and control group, with 23 participants in each. Subjects Adults with obesity, with a body mass index between 30 kg/m² and 40 kg/m². Interventions The intervention lasted 16 weeks (separated into three mesocycles of 4 weeks and 1 week of familiarization), in 3 weekly sessions of 1 hour each, composed of aerobic (30 min) and muscle strength exercises (six exercises) in the same session. The group with non-periodized model maintained uniform intensity, volume, and workload throughout the mesocycles. The group with the linear periodization model started with low initial intensity, subsequently introducing a gradual increase of intensity in the mesocycles. Main measures Body image perception (current and ideal silhouette) and body dissatisfaction were assessed using the Stunkard silhouette scale. Results The perception of the current silhouette increased only in the control group (Δ = 1.16; p = 0.04). There was a significant reduction in the ideal silhouette over time ( p = 0.001), especially in non-periodized group (Δ = −1.26). Body dissatisfaction increased significantly only over time ( p = 0.001), especially for control group (Δ = 1.47). Conclusions Regardless of periodization, combined training effectively maintained the perception of the current silhouette and reduced the ideal silhouette in adults with obesity. Trial registration Brazilian Registry of Clinical Trials (RBR-3c7rt3).
Emotional Experiences in Online, Text-Based Tabletop Role-Playing Games
Authors: Winardy Gary Collins Brata , Septiana Eva , Pranawati Santy Yanuar 
Published: May 2024

Background This study explores the emotional experiences of players in online, text-based tabletop role-playing games (TTRPGs) and their potential impact on players. The goal is to understand the therapeutic and educational possibilities arising from these emotional experiences. Methods Through qualitative analysis, themes were identified based on participants' narratives. Eight participants who engaged in online, text-based TTRPGs were interviewed to gather data on their emotional experiences and effects outside the game. Result The study identified three main categories of emotions experienced by players: emotions related to the community, emotions associated with the game world and characters, and emotions linked to game mechanics. These emotions were found to impact players beyond the gaming environment, influenced by the players' emotional immersion. Additionally, the study revealed two distinct approaches to immersion among players and highlighted emotions as motivating factors for gameplay. Discussion The findings emphasize the role of TTRPGs in providing creative outlets, social interaction, and recreation, facilitating skill development, and broadening perspectives based on players' emotional experiences. Additionally, this study highlights the potential for immersion in online, text-based TTRPGs linked to therapeutic and educational uses. Limitations This study employs an in-depth phenomenological qualitative interview method. While this approach yields detailed and nuanced data, it may not provide extensive generalizability. Future research endeavors could benefit from more significant and diverse participant pools to enhance the understanding of emotional experiences in TTRPG players. Furthermore, exploring additional factors such as genres, narrative structures, and player-character relationships could offer more profound insights. Conclusion This study demonstrates that online, text-based TTRPGs allow players to experience various emotions with implications beyond the game's boundaries. The findings suggest that interventions based on role-playing activities may benefit from the online text-based method due to its accessibility and lower barriers to entry.
Administrators and Mergers: A Study of Administrators’ Perceptions
Authors: Feldheim Mary Ann 
Published: May 2024

Health care mergers have become the organizational strategy of choice in the 20th century to contain costs and to survive economically. Several studies have been conducted on the economic impact of mergers on the organization and on the managerial staff of merged organizations. Areas where there has been limited research are in the realm of the impact of mergers on the employees, the industry, and the public. To address these areas, a study was conducted of the perceptions of health care administrators of both merged and non-merged organizations in the state of Florida A primary finding of the study was that administrators of merged organizations held a higher opinion of the benefits of mergers in their organizations and in the industry than did administrators in non-merged organizations. An unanticipated finding of the impact of mergers was that the increased competition has created a wary, hostile environment for administrators, many of whom refused to participate in this study believing it was being conducted by their competition. The rationale for mergers in health care is based on the market value of competition and future research needs to focus more on the unintended consequences of competition in health care to which this study points.
A Population Ecology Study of Hospital Closures in Florida Between 1965 and 1995
Authors: Nyhan Ronald , Ferrando Mary Beth , Clare Donald 
Published: May 2024

The population ecology literature argues that at the macro level, organizations experience various liabilities to their continued survival. This study examined the effect of size, age, and niche density on the closure of acute care hospitals in Florida between 1965 and 1999. The primary data for the study was created using information about Florida hospitals found in the annual reports of the American Hospital Association (n = 427). Using the technique of survival analysis, it was found that newer hospitals and hospitals originally established in organizationally dense areas (five or more hospitals within a five mile radius) experienced a significantly greater incidence of closure than did those which were older or founded in less dense areas. Small hospitals (<100 beds) were also shown to be significantly more likely to close than large ones (>300 beds), as were hospitals located in organizationally sparse areas (no other hospitals in 5 mile radius) compared to those in organizationally dense areas (>5 hospitals in 5 mile radius). The study concludes with an examination of the policy and management implications of the results.
Does A Flat Rate Individual Income Tax Reduce Tax Progressivity? A Simulation for the Netherlands
Authors: Caminada Koen , Goudswaard Kees 
Published: May 2024

Throughout the last couple of decades the individual income tax systems of most industrialized countries have been (repeatedly) the subject of considerable reform efforts. Although the reform packages vary to a wide extent across countries, the direction of change is roughly similar. Most tax reforms are characterized by base broadening, reduction of tax rates, flattening of the rate structure, and lower tax to GDP-ratios. Implementing a flat rate individual income tax seems to be in line with these reforms, although several steps further along. In this paper, we construct a flat rate/broad base individual income tax system and we compare the distribution of the current personal income tax in the Netherlands to the distribution of the simulated flat rate tax. Using extended data, the effects are simulated of eliminating deductions in exchange for a reduction in tax rates, sufficient to keep personal income tax revenue constant. Our simulations indicate that: ■ After drastic base broadening, a proportional rate of 27.7% balances the budget (ex ante). Such a flat rate causes only relatively small changes in average tax ratios. ■ Overall tax progressivity is mainly caused by the fixed personal exemption, which we maintained in the simulated flat rate tax. We calculated only a 6 percent lower income elasticity in the flat rate system; the concentration (Gini) index of taxes indicates a modest 4 percent decline in progressivity.
No Infant Left Behind: Public Finance Arguments for Mandated Leave and Income Supports for Parents
Authors: Trzcinski Eileen 
Published: May 2024

This article constructs a theoretical and evidence-based argument concerning why maternity and parental leave policy must be viewed as human capital investment policy. It is argued that income support schemes which allow for (1) parental choice in terms of care and (2) inclusion of different income groups offer relative advantages over other alternatives in terms of both equity and political feasibility. Skill formation is a dynamic process with strong synergistic components. Skill begets skill. Early investment promotes later investment. At current levels of investment, American society underinvests in the very young. When offered choices and the opportunity to experiment, most parents generally choose wisely, at least after they have gained some experience.
Reforming Canada's Retirement Savings System – Solutions for a Non-Existent Problem?
Authors: Jog Vijay , Lee Ian 
Published: May 2024

During the past five years in Canada, issues concerning the adequacy of the Canadian retirement system has been debated with increasing intensity amongst politicians, economists, academics, policy analysts, think tanks and unions. This paper contributes to this important theoretical and public policy debate by reviewing and analysing existing research and presenting and reviewing additional empirical evidence. The central issue in this debate is whether or not Canadians are saving and investing enough through government, employer and private savings to provide an adequate income in retirement. And if a retirement income adequacy problem does exist, is it a universal problem for most Canadians or does it only affect some income groups or age cohorts? The third major question concerns the appropriate policy response. The paper also reviews and questions whether the current and proposed policies properly address the challenge and provides some recommendations. The paper shows that the larger part of this debate actually hinges on assumptions surrounding savings and the definition of savings. Those who claim that Canada faces a national pension and savings crisis only consider government and private savings pension plans whose assets are approximately only one third of total household wealth in Canada. However, this narrow definition of savings exclude all savings and investments held outside of recognized pension plans and thus exclude investments in stocks, bonds etc. as well as private homes and secondary residences which can provide for an important source of retirement income. However, there are a small number of Canadians that are or will be below the poverty line and this calls for a targeted policy response rather than an across the board reform of the Canada Pension Plan or provincial programs such as the newly proposed Ontario Retirement Pension Plan (ORPP) which may actually be viewed as a payroll tax. Based on the evidence and analysis, the paper concludes that most Canadians do not face an inadequate income during retirement and no new government policy response is needed.
Comparison of aspiration catheter performance using adaptive pulsatile aspiration in an in vitro thrombectomy model
Authors: Silva Michael A , Sanikommu Sai , Bartkevitch Rodrigues Pedro , Hanser Manning , Ortiz Ryan , Gamez Victor , Starke Robert M 
Published: May 2024

Objective Aspiration with a pump or syringe is a mainstay of mechanical thrombectomy (MT) for acute ischemic stroke (AIS), but this technology has seen minimal evolution. Non-continuous adaptive pulsatile aspiration (APA) has been proposed as a potential alternative to standard continuous aspiration as a means of improving revascularization efficiency. Methods Using a pathophysiological flow bench model with a synthetic clot, we performed in vitro thrombectomies using the ALGO® Von Vascular, Inc. (Sunrise, FL) APA pump. A total of 25 FDA-approved aspiration catheters were tested, representing inner diameters (ID) from 0.035 in. to 0.088 in. The pump was used in 30 trials with each catheter to remove a simulated M1 occlusion. Revascularization, clot ingestion, time to clot removal, and distal embolization were measured. Results Among catheters tested using APA, first-pass TICI 3 revascularization was achieved in 100% of the 750 thrombectomy trials using 25 different catheters. There were no distal emboli detected in any trial run. Complete clot ingestion into the pump collection chamber was achieved in 87% to 100% of trials (overall 95%) with clot in the remaining trials corking within the catheter and removed from the model. Time from clot contact to clot removal ranged from 11 s to 90 s (mean 22.6 s, SD 16.8 s), which was negatively correlated with catheter ID ( p = 0.007). Conclusion APA via the Von Vascular, Inc. ALGO® pump achieved a high success rate in an in vitro MT model. All catheters tested with the pump achieved complete reperfusion in all trials, and complete clot ingestion into the pump was seen in a majority of trials. The promising in vitro performance of APA using multiple catheters warrants future in vivo investigation.
Improved interpretable machine learning emergency department triage tool addressing class imbalance
Authors: Look Clarisse SJ , Teixayavong Salinelat , Djärv Therese , Ho Andrew FW , Tan Kenneth BK , Ong Marcus EH 
Published: May 2024

Objective The Score for Emergency Risk Prediction (SERP) is a novel mortality risk prediction score which leverages machine learning in supporting triage decisions. In its derivation study, SERP-2d, SERP-7d and SERP-30d demonstrated good predictive performance for 2-day, 7-day and 30-day mortality. However, the dataset used had significant class imbalance. This study aimed to determine if addressing class imbalance can improve SERP's performance, ultimately improving triage accuracy. Methods The Singapore General Hospital (SGH) emergency department (ED) dataset was used, which contains 1,833,908 ED records between 2008 and 2020. Records between 2008 and 2017 were randomly split into a training set (80%) and validation set (20%). The 2019 and 2020 records were used as test sets. To address class imbalance, we used random oversampling and random undersampling in the AutoScore-Imbalance framework to develop SERP+-2d, SERP+-7d, and SERP+-30d scores. The performance of SERP+, SERP, and the commonly used triage risk scores was compared. Results The developed SERP+ scores had five to six variables. The AUC of SERP+ scores (0.874 to 0.905) was higher than that of the corresponding SERP scores (0.859 to 0.894) on both test sets. This superior performance was statistically significant for SERP+-7d (2019: Z = −5.843, p < 0.001, 2020: Z = −4.548, p < 0.001) and SERP+-30d (2019: Z = −3.063, p = 0.002, 2020: Z = −3.256, p = 0.001). SERP+ outperformed SERP marginally on sensitivity, specificity, balanced accuracy, and positive predictive value measures. Negative predictive value was the same for SERP+ and SERP. Additionally, SERP+ showed better performance compared to the commonly used triage risk scores. Conclusions Accounting for class imbalance during training improved score performance for SERP+. Better stratification of even a small number of patients can be meaningful in the context of the ED triage. Our findings reiterate the potential of machine learning-based scores like SERP+ in supporting accurate, data-driven triage decisions at the ED.
CAR T cells vs bispecific antibody as third- or later-line large B-cell lymphoma therapy: a meta-analysis
Authors: Kim Jinchul , Cho Jinhyun , Lee Moon Hee , Yoon Sang Eun , Kim Won Seog , Kim Seok Jin 
Published: May 2024

Abstract
This meta-analysis evaluates the efficacy and safety of chimeric antigen receptor (CAR) T-cell therapy and bispecific antibodies for relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL). We searched MEDLINE, Embase, and Cochrane databases until July 2023 for trials assessing CAR T-cell therapies and CD20×CD3 bispecific antibodies as third or subsequent lines in R/R DLBCL. Random-effects models estimated the complete response (CR) rate and secondary outcomes, with meta-regressions adjusting for relevant covariates. Sixteen studies comprising 1347 patients were included in the pooled analysis. The pooled CR rate for bispecific antibodies was 0.36 (95% confidence interval [CI], 0.29-0.43), compared with 0.51 (95% CI, 0.46-0.56) for CAR T-cell therapy (P &lt; .01). This superiority persisted when comparing the CAR T-cell–naive patients within the bispecific antibody group, with a CR rate of 0.37 (95% CI, 0.32-0.43). Multivariable meta-regression also revealed better efficacy of CAR T cells with adjustment for the proportion of double-hit lymphoma. The pooled 1-year progression-free survival rate mirrored these findings (0.32 [95% CI, 0.26-0.38] vs 0.44 [95% CI, 0.41-0.48]; P &lt; .01). For adverse events of grade ≥3, the bispecific antibody had incidences of 0.02 (95% CI, 0.01-0.04) for cytokine release syndrome, 0.01 (95% CI, 0.00-0.01) for neurotoxicity, and 0.10 (95% CI, 0.03-0.16) for infections. The CAR T cell had rates of 0.08 (95% CI, 0.03-0.12), 0.11 (95% CI, 0.06-0.17), and 0.17 (95% CI, 0.11-0.22), respectively, with significant differences observed in the first 2 categories. In summary, CAR T-cell therapy outperformed bispecific antibody in achieving higher CR rates, although with an increase in severe adverse events.