bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exploratory study to document large-scale sulfur purification in Ayurveda pharmaceutics
Authors: Chandhiruthil Sathyan Anjana , Dasan Harisankar , Sasikumar Anand , Ruknuddin Galib 
Published: May 2024

AbstractBackgroundAyurvedic manuscripts describe five distinct techniques to purify sulfur, each designed to improve its purity, quality, and effectiveness. The complexity of these methods emphasizes the importance of being meticulous in ensuring the purification of sulfur, which is a crucial step in maintaining the high standards of quality and safety that are integral to the herbo mineral formulations in Ayurveda medicine.ObjectivesThe study was conducted to document the technological modifications implemented by Ayurvedic pharmaceutics to purify sulfur.MethodsA convenient sampling methodology was utilized for the selection of study sites. The study included pharmaceutical companies that employ mechanized processes. An in-depth interview was conducted with the production manager at each site, using a semi-structured questionnaire consisting of three domains.ResultsFour pharmaceutical companies that use mechanized processes were selected for the survey. These companies have innovatively modified the traditional melting and pouring (Dhalana) process to purify significant amounts of sulfur. The quantity of sulfur being purified is varied among the selected companies, ranging from 5 kg to 150 kg.ConclusionsImplementing appropriate optimization techniques can enhance the efficiency of mechanized manufacturing processes. Collaborating with interdisciplinary sectors is crucial in devising more effective mechanization solutions.
Medical Voluntarism and Orthopaedic Advancements: Lancashire and the Disabled Ex-Servicemen of the First World War
Authors: Smith Nicola 
Published: May 2024

Summary
This article explores the fundamental role of Lancashire’s medical voluntarism in providing restorative orthopaedic treatments to the region’s First World War, disabled ex-servicemen and assisting in their return to society. It offers a case study of orthopaedic treatments and schemes of rehabilitation provided at Grangethorpe Hospital, Rusholme, between 1914 and 1918. Forming a regional comparison to existing histories of First World War disabled ex-servicemen, which focus primarily on the interwar period, this article traces continuities in pioneering medicine and examples of Lancashire-based medical individuals and institutions. In doing so, this article demonstrates how the region’s response to disablement during the Industrial Revolution underpinned the construction of charities and the advancement of orthopaedic treatments required to provide rehabilitative care during the First World War. Moreover, this paper situates Lancashire and its commitment to medical voluntarism and the reconstruction of disabled ex-servicemen as a key site in the UK’s history of voluntarism.
Sequential Bayesian Phylogenetic Inference
Authors: Höhna Sebastian , Hsiang Allison Y 
Published: May 2024

Abstract
The ideal approach to Bayesian phylogenetic inference is to estimate all parameters of interest jointly in a single hierarchical model. However, this is often not feasible in practice due to the high computational cost. Instead, phylogenetic pipelines generally consist of sequential analyses, whereby a single point estimate from a given analysis is used as input for the next analysis (e.g., a single multiple sequence alignment is used to estimate a gene tree). In this framework, uncertainty is not propagated from step to step, which can lead to inaccurate or spuriously confident results. Here, we formally develop and test a sequential inference approach for Bayesian phylogenetic inference, which uses importance sampling to generate observations for the next step of an analysis pipeline from the posterior distribution produced in the previous step. Our sequential inference approach presented here not only accounts for uncertainty between analysis steps but also allows for greater flexibility in software choice (and hence model availability) and can be computationally more efficient than the traditional joint inference approach when multiple models are being tested. We show that our sequential inference approach is identical in practice to the joint inference approach only if sufficient information in the data is present (a narrow posterior distribution) and/or sufficiently many important samples are used. Conversely, we show that the common practice of using a single point estimate can be biased, for example, a single phylogeny estimate can transform an unrooted phylogeny into a time-calibrated phylogeny. We demonstrate the theory of sequential Bayesian inference using both a toy example and an empirical case study of divergence-time estimation in insects using a relaxed clock model from transcriptome data. In the empirical example, we estimate 3 posterior distributions of branch lengths from the same data (DNA character matrix with a GTR+Γ+I substitution model, an amino acid data matrix with empirical substitution models, and an amino acid data matrix with the PhyloBayes CAT-GTR model). Finally, we apply 3 different node-calibration strategies and show that divergence time estimates are affected by both the data source and underlying substitution process to estimate branch lengths as well as the node-calibration strategies. Thus, our new sequential Bayesian phylogenetic inference provides the opportunity to efficiently test different approaches for divergence time estimation, including branch-length estimation from other software.
Retained Tampon Fragment as an Unusual Cause of Vesicovaginal Fistula
Authors: Seitz Vienne , Davidson Emily R. W. 
Published: May 2024

BACKGROUND:
Vesicovaginal fistula (VVF) is an uncommon cause of urinary incontinence (UI). Iatrogenic etiologies, especially abdominal hysterectomy, are most common; however, a minority of VVFs are caused by retained foreign bodies. Objects associated with VVF include intrauterine devices, gauze, pessaries, bottle caps, and sexual aids, but retained tampons or other menstrual products have not been commonly reported.

CASE:
We present the case of a 53-year-old woman, gravida 0, with no prior pelvic surgery, with 2 months of intermittent UI and hematuria. Although initial diagnostic test results were negative, cystoscopy and vaginoscopy eventually confirmed the diagnosis of VVF associated with a retained foreign body. In the operating room, all debris was removed using vaginoscopy, and the VVF was repaired using a modified Latzko technique. At the patient’s 9-week follow-up appointment, she was found to have complete healing of the VVF and resolution of associated symptoms.

CONCLUSION:
This is a case of VVF secondary to a retained tampon fragment. In addition to this uncommon etiology, our patient's presenting symptoms were atypical, leading to a delay in diagnosis and treatment for which vaginoscopy was critical.
How Much Improvement in Oswestry Disability Index is Necessary to Make Your Patient Satisfied After Lumbar Surgery?
Authors: Hambrecht Jan , Köhli Paul , Chiapparelli Erika , Amoroso Krizia , Zhu Jiaqi , Lan Ranqing , Guven Ali E. , Evangelisti Gisberto , Burkhard Marco D. , Tsuchiya Koki , Duculan Roland , Shue Jennifer , Sama Andrew A. , Cammisa Frank P. , Girardi Federico P. , Mancuso Carol A. , Hughes Alexander P. 
Published: May 2024

Study Design.
Retrospective review of cohort studies.

Objective.
To clarify the necessary Oswestry Disability Index (ODI) improvement for patient satisfaction 2 years after lumbar surgery.

Background.
Evaluating elective lumbar surgery care often involves patient-reported outcomes. While postoperative functional improvement measured by ODI is theoretically linked to satisfaction, conflicting evidence exists regarding this association.

Material and Methods.
Baseline ODI and 2-year postoperative ODI were assessed. Patient satisfaction, measured on a scale from 1 to 5, with scores ≥4 considered satisfactory, was evaluated. Patients with incomplete follow-up were excluded. Statistical analyses included Mann-Whitney U and multivariable logistic regression adjusted for age, sex, and body mass index. Receiver operating characteristic analysis determined threshold values for ODI improvement and postoperative target ODI indicative of patient satisfaction.

Results.
A total of 383 patients were included (mean age: 65 ± 10 y, 57% females). ODI improvement was observed in 91% of patients, with 77% reporting satisfaction scores ≥4. Baseline ODI (median: 62, interquartile range: 46–74) improved to a median of 10 (interquartile range: 1–10) 2 years postoperatively. Baseline [odds ratio (OR): 0.98, P = 0.015] and postoperative ODI scores (OR: 0.93, P < 0.001), as well as the difference between them (OR: 1.04, P < 0.001), were significantly associated with patient satisfaction. Improvement of ≥38 ODI points or a relative change of ≥66% was indicative of patient satisfaction, with higher sensitivity (80%) and specificity (82%) for the relative change versus the absolute change (69%, 68%). With a sensitivity of 85% and a specificity of 77%, a postoperative target ODI of ≤24 indicated patient satisfaction.

Conclusion.
Lower baseline ODI and greater improvements in postoperative ODI are associated with an increased likelihood of patient satisfaction. A relative improvement of ≥66% or achieving a postoperative ODI score of ≤24 were the most indicative thresholds for predicting patient satisfaction, proving more sensitivity and specificity than an absolute change of ≥38 points.
Establishing a Benchmark for Iatrogenic Hemodilution and Blood Transfusion in Long-Segment Spine Fusion Surgery
Authors: Twitchell Spencer , Findlay Matthew C. , Nelson Jayson , Sherrod Brandon A. , Menacho Sarah T. , Dorsey David , Dailey Andrew T. , Mazur Marcus D. 
Published: May 2024

Study Design.
Single-center retrospective cohort study.

Objective.
To identify risk factors for transfusion during long-segment thoracolumbar fusion surgery and benchmark cutoffs that could be used by the operative team to guide the use of transfusion.

Summary of Background Data.
Perioperative transfusion for patients undergoing long-segment thoracolumbar fusion surgery is common. To date, no standardized intraoperative and perioperative management of transfusion administration has been defined.

Methods.
Patients who underwent thoracolumbar fusion surgeries of 8 or more levels between 2015 and 2020 were identified. Patient demographics, surgical details, anesthesia and critical care records, and laboratory data were compared between patients who received intraoperative and postoperative blood transfusions and those who did not. Univariate and multivariate propensity-matched analyses were performed to identify independent predictors for blood transfusion, and ordinal analysis was performed to identify possible benchmark cutoffs.

Results.
Among 233 patients identified who underwent long-segment fusions, 133 (57.1%) received a blood transfusion. Multivariate propensity-matched logistic regression showed that intravenous (IV) fluid volume was an independent predictor for transfusion (transfusion group 8051 mL vs. non-transfusion group 5070 mL, P<0.01). Patients who received ≥4 L total IV fluids were more likely to undergo transfusion than those who received <4 L (93.2% vs. 50.7%, P<0.01). Those receiving total IV fluids at a rate ≥60 mL/kg (OR 10.45; 95% CI, 2.62–41.72; P<0.01) or intraoperative IV fluids at a rate ≥9 mL/kg/hr (OR 4.46; 95% CI, 1.39–14.32; P<0.01) were more likely to require transfusions.

Conclusions.
IV fluid administration is an independent predictor for blood transfusion after long-segment fusion surgery. Limiting IV fluid administration may prevent iatrogenic hemodilution and decrease transfusion rates. These data can be used to create perioperative protocols with the goal of decreasing transfusion rates when not indicated and allowing earlier administration when indicated.
A Study on the Epidemiology of COVID-19–Related Guillain–Barré Syndrome in the United States
Authors: Sharma Aditya , Sharma Aditi , Soubani Ayman O. 
Published: May 2024

Abstract

Introduction:
Several neurological complications have been reported with COVID-19, including Guillain–Barré syndrome (GBS). We looked at incidence, baseline characteristics, and in-hospital outcomes of COVID-19–associated GBS in the United States.

Study design and methods:
We conducted a retrospective analysis using the US National Inpatient Sample database to identify hospitalizations for COVID-19 and GBS, using International Classification of Disease, 10th Revision, codes G610 and G650 for GBS and U071 for COVID-19. The codes used in this study are listed in Supplemental Digital Content 1 (see e Appendix, http://links.lww.com/JCND/A69).

Results:
In total, 13,705 GBS admissions were recorded nationwide in 2020; of these, 1155 (8.43%) were associated with COVID-19. The frequency of GBS in COVID-19 admissions was 0.07%, compared with 0.08% in non–COVID-19 admissions (P = 0.8166). COVID-19 cohort with GBS had higher utilization of invasive mechanical ventilation (20.8% vs. 11.8%, P < 0.001) in comparison with COVID-19 cohort without GBS. GBS admissions with COVID-19 exhibited significantly higher inpatient mortality (12.2% vs. 3%, P < 0.001) compared with GBS admissions without COVID-19.

Interpretation:
Our findings underscore GBS as a rare yet severe complication of COVID-19, highlighting a significant difference in mortality when compared with GBS not associated with COVID-19.
Representativeness of Participants in the ACCORD Trial Compared to Middle-aged and Older Adults Living with Diabetes in the United States
Authors: Ikesu Ryo , Wu Yingyan , Zimmerman Scott C. , Inoue Kosuke , Buto Peter , Power Melinda C. , Schaefer Catherine A. , Glymour M. Maria , Mayeda Elizabeth Rose 
Published: May 2024

Background:
We evaluated whether participants in the landmark Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial represent US adults aged ≥40 with diabetes.

Methods:
Using the nationally representative 2017–2020 prepandemic National Health and Nutrition Examination Survey data, we made operational definitions of ACCORD eligibility criteria. We calculated the percentage of individuals aged ≥40 with diabetes and HbA1c ≥ 6.0% or ≥ 7.5% who met operational ACCORD eligibility criteria.

Results:
Applying survey sampling weights to 715 National Health and Nutrition Examination Survey participants aged ≥40 with diabetes and HbA1c ≥ 6.0% (representing 29,717,406 individuals), 12% (95% confidence interval [CI] = 8%, 18%) met the operational ACCORD eligibility criteria. Restricting to HbA1c ≥ 7.5%, 39% (95% CI = 28%, 51%) of respondents met the operational ACCORD eligibility criteria.

Conclusions:
ACCORD represented a minority of US middle-aged and older adults with diabetes. Given the differential risk profile between ACCORD participants and the general population with diabetes, extrapolating the trial findings may not be appropriate.
Prognosis and assessment of the predictive value of severity scores in paediatric abdominal trauma
Authors: Hanna Sidonie , Montmayeur Juliette , Vergnaud Estelle , Orliaguet Gilles 
Published: May 2024

BACKGROUND
Paediatric closed abdominal trauma is common, however, its severity and influence on survival are difficult to determine. No prognostic score integrating abdominal involvement exists to date in paediatrics.

OBJECTIVES
To evaluate the severity and short-term and medium-term prognosis of closed abdominal trauma in children, and the performance of severity scores in predicting mortality.

DESIGN
Retrospective, cohort, observational study.

SETTING AND PARTICIPANTS
Patients aged 0 to 18 years presenting at the trauma room of a French paediatric Level I Trauma Centre over the period 2015 to 2019 with an isolated closed abdominal trauma or as part of a polytrauma.

MAIN OUTCOMES
Primary outcome was the six months mortality. Secondary outcomes were related complications and therapeutic interventions, and performance for predicting mortality of the scores listed. Paediatric Trauma Score (PTS), Revised Trauma Score (RTS), Shock Index Paediatric Age-adjusted (SIPA) score, Reverse shock index multiplied by Glasgow Coma Scale score (rSIG), Base Deficit, International Normalised Ratio, and Glasgow Coma Scale (BIG), Injury Severity Score (ISS) and Trauma Score and the Injury Severity (TRISS) score.

DATA COLLECTION
Data collected include clinical, biological and CT scan data at admission, first 24 h management and prognosis. The PTS, RTS, SIPA, rSIG, BIG and ISS scores were calculated and mortality was predicted according to BIG score and TRISS methodology.

RESULTS
Of 1145 patients, 149 met the inclusion criteria and 12 (8.1%) died. Of the 12 deceased patients, 11 (91.7%) presented with severe head injury, 11 (91.7%) had blood products transfusion and 7 received tranexamic acid. ROC curves analysis concluded that PTS, RTS, rSIG and BIG scores accurately predict mortality in paediatric closed abdominal trauma with AUCs at least 0.92. The BIG score offered the best predictive performance for predicting mortality at a threshold of 24.8 [sensitivity 90%, specificity 92%, negative-predictive value (NPV) 99%, area under the curve (AUC) 0.93].

CONCLUSION
PEVALPED is the first French study to evaluate the prognosis of paediatric closed abdominal trauma. The use of PTS, rSIG and BIG scores are relevant from the acute phase and the pathophysiological interest and accuracy of the BIG score make it a powerful tool for predicting mortality of closed abdominal trauma in children.
Peripapillary Retinoschisis in Glaucoma: A Systematic Review
Authors: Almeida Maria Carolina , Ribeiro Margarida , Barbosa-Breda João 
Published: May 2024

Précis:
Peripapillary retinoschisis (PPRS) may bias optical coherence tomography’s (OCT) monitoring of glaucoma progression. Its impact on glaucoma still remains uncertain. Only 2 out of the 10 included studies illustrated a correlation between PPRS and glaucoma progression.

Objectives:
The frequent use of OCT increased the detection of PPRS, which poses challenges in the follow-up of patients with glaucoma. This systematic review aims to summarize the literature regarding PPRS in glaucoma, exploring its prevalence, impact on disease, and clinical management implications.

Methods:
We searched PubMed, Embase, Web of Science, and Scopus with tailored search queries for each platform. All studies had to report PPRS in patients with glaucoma. Exclusion criteria included studies with <10 eyes, studies focusing on schisis outside the disc area, with concomitant retinal or optic nerve lesions, with animals, reviews, studies written in non-English language, and congress abstracts.

Results:
Ten studies were included, of which 7 were case-control, one was a cohort study, and 2 were case series.
Six studies showed that PPRS often overlapped preexisting retinal nerve fiber layer defects. One study reported that the de novo development of PPRS was more frequent in eyes with glaucoma progression than in eyes without progression.
Visual field findings were inconsistent, with just one study (out of 6) showing that patients with glaucoma with PPRS experienced faster visual field deterioration than those without it. Overall, solely 2 studies (out of 7) associated PPRS with faster glaucoma progression.

Conclusions:
PPRS biases OCT analysis in glaucoma. Caution is needed against overestimation of retinal nerve fiber layer thickness when PPRS develops and misinterpretation of its resolution as rapid progression. PPRS’ exact impact on glaucoma progression remains unclear.
Microbiome of the External Auditory Canal: Changes After Long-Term Hearing Aid Use
Authors: Sjövall Atte , Mustanoja Ella , Lyyski Annina , Auvinen Petri , Silvola Juha , Aarnisalo Antti , Pätäri-Sampo Anu , Laulajainen-Hongisto Anu 
Published: May 2024

Objective
To investigate the microbial changes of long-term hearing aid use culture independently.

Study design
Cross-sectional study.

Patients
Fifty long-term hearing aid users and 80 volunteer controls with asymptomatic ears.

Intervention
External auditory canal (EAC) sampling with DNA-free swabs.

Main Outcome Measures
Microbial communities in the samples were investigated with amplicon sequencing of the 16S rRNA gene.

Results
The final analysis contained 48 hearing aid users, 59 controls. Twenty-four samples were excluded because of low sequence count, recent use of antimicrobials and/or corticosteroids, recent cold, or missing health status. The groups showed significant differences in bacterial diversity (beta div., p = 0.011), and hearing aid users showed lower species richness than the control group (alpha div., p < 0.01). The most frequent findings in both groups were Staphylococcus auricularis, Alloiococcus otitis, Cutibacterium acnes, Corynebacterium otitidis, and Staphylococcus unclassified sp. Hearing aid users' samples presented more Corynebacterium tuberculostearicum than the control samples. Common EAC pathogens, such as Staphylococcus aureus or Pseudomonas aeruginosa were rare.

Conclusion
Long-term hearing aid use lowers bacterial diversity and modulates the EAC microbiome. The changes mostly affect commensals. Lowered diversity may predispose individuals to EAC conditions and needs more research.
Does enteral nutrition require continuity of management: a randomized controlled study
Authors: Du Jinlei , Wu Xiaoling , Liu Yan , Lei Ling , Zhao Hongxiang , Chen Yao , Nie Chencong 
Published: May 2024

Objective:
To explore a set of enteral nutrition therapy continuity management programs for intensive care unit patients based on the theoretical study of circadian rhythm mechanism.

Methods:
The control group followed routine nursing management. Patients in the experimental group were implemented with an enteral nutrition continuity management program, and their eating behavior was adjusted 3 days before the end of tube feeding. Food intake was intermittent at 2, 3, and 4 h on the first day, the second day, and the third day of intervention, respectively, and all patients stopped eating at night. Abdominal distension assessment, appetite assessment, application of gastric motility drugs, and patient satisfaction were compared between the two groups after tube feeding.

Results:
Three days after the end of tube feeding, abdominal distention assessment, bowel sound auscultation, and appetite assessment were statistically different (P<0.05) between the two groups. There were differences in the first day (15 vs. 6, P<0.05), the second day (9 vs. 3, P<0.05), and the cumulative number (17 vs. 7, P<0.05) of gastrointestinal drugs, but no differences in the third day (2 vs. 1, P>0.05). There was a statistical difference in nursing intervention (6.0 vs. 7.0, P<0.05) and psychological nursing (6.0 vs. 7.0, P<0.05), but no statistical difference in health education, medical environment, and nursing attitude (P>0.05).

Conclusion:
Enteral nutrition continuity management program has a good preventive effect on the gastrointestinal symptoms of intensive care unit patients after the end of tube feeding.