bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors associated with modern contraceptive utilization among reproductive age women in Kenya; evidenced by the 2022 Kenyan demographic and health survey
Authors: Mankelkl Gosa , Kassaw Altaseb Beyene , Kinfe Beletu 
Published: March 2024

Abstract
Background
Globally, sexual and reproductive health is a significant public health issue for women of the reproductive age group. A modern contraceptive method enables individuals and families to manage fertility by reducing unintended pregnancies, abortions, pregnancy-related morbidity, and death. A modern contraceptive method is a drug or medical treatment that prevents sexual activity from leading to pregnancy. However, there is limited reliable and updated data on factors associated with modern contraceptive utilization among reproductive-age women at the national level in Kenya. So, the major goal of this study was to evaluate factors associated with modern contraceptive utilization among women of reproductive age in Kenya at the national level, as evidenced by the 2022 Kenyan demographic and health survey.

Methods
The most recent datasets from the Kenyan Demographic and Health Survey were used for secondary data analysis. In all, 14,987 women of reproductive age participated in the investigation. Data for multivariable analysis on the factors influencing modern contraceptive utilization among Kenyan women of reproductive age can be obtained from the Kenyan Demographic and Health Survey. Finally, the odd ratio and percentages were presented along with their 95% confidence intervals.

Result
This study includes a total weighted sample of 14,987 reproductive-age women from the Kenyan demographic and health survey. Of the total contraceptive use, 90.1% of the study participants used modern contraceptives. Being married [AOR: 1.593, 95% CI (1.302, 1.948)], living in an urban area [AOR: 1.230, 95% CI (1.060, 1.428)], reading a magazine [1.002, 95% CI (0.921, 1.091)], listening to radio [AOR: 1.265, 95% CI (1.101, 1.454)], not breastfeeding [AOR: 1.296, 95% CI (1.114, 1.507), and having more than two children [AOR: 2.350, 95% CI (1.603, 3.445)] were the factors that promote modern contraceptive utilization. Conversely, having a history of terminated pregnancy [AOR: 0.767, 95% CI (0.657, 0.897), being Muslim [AOR: 0.566, 95% CI (0.418, 0.766)], and being in the 35–39 age range [AOR: 0.766, 95% CI (0.605, 0.971)] were all associated with a lower use of modern contraceptives.

Conclusion
Certain factors such as marriage, living in urban areas, having more than two children, having a female-led household, belonging to the middle class, reading magazines, listening to the radio, and not breastfeeding have a positive correlation with the use of modern contraceptives. Conversely, being a Muslim, aged between 35 and 39, and having a history of miscarriages are negatively correlated with the use of modern contraceptives. This indicates that addressing socioeconomic, geographic, and cultural barriers could improve the effectiveness of modern contraceptive.
Effect of walkability on the physical activity of hemodialysis patients: a multicenter study
Authors: Sato Yoichi , Usui Naoto , Abe Yoshifumi , Okamura Daisuke , Kuramochi Yota , Kojima Sho , Shinozaki Nobuto , Shimano Yu , Shirai Nobuyuki , Mikami Kenta , Yamada Yoji , Saitoh Masakazu 
Published: March 2024

Abstract
Introduction
Physical activity is an important prognostic factor in patients undergoing hemodialysis. Walkability also affects physical activity. This study aimed to examine the effects of walkability on the physical activity of patients undergoing hemodialysis.

Methods
This multicenter study included 372 outpatients (69.1 ± 11.9 years, 229 males) undergoing hemodialysis at eight facilities in Japan. Patients were classified into two groups according to the walk score (WS) at home: WS ≥ 50 (walkable area group) and WS < 50 (car-dependent area group). The effects of WS on total physical activity, moderate-to-vigorous physical activity (MVPA), and walking that was assessed using the International Physical Activity Questionnaire (IPAQ) were examined.

Results
In the multivariate analysis, WS ≥ 50 was positively associated with walking (β = 0.129, p = 0.013) and negatively associated with MVPA (β = −0.102, p = 0.045). Subgroup analysis stratified by the age of 65 years showed similar results in both groups.

Conclusions
Walkability is associated with various intensities of physical activity in Japanese patients undergoing hemodialysis. Exercise management should take into account the characteristics of physical activity, depending on the residential area.
Trial registration: UMIN, UMIN000050089. Registered 2023/01/20, https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000057060.
Branching out: species-specific canopy architecture limits live crown fuel consumption in Intermountain West USA conifers
Authors: Conrad Elliott T. , Jolly W. Matt , Brown Tegan P. , Hillman Samuel C. 
Published: March 2024

AbstractBackgroundAccurate estimates of available live crown fuel loads are critical for understanding potential wildland fire behavior. Existing crown fire behavior models assume that available crown fuels are limited to all tree foliage and half of the fine branches less than 6 mm in diameter (1 h fuel). They also assume that this relationship is independent of the branchwood moisture content. Despite their widespread use, these assumptions have never been tested, and our understanding of the physiochemical properties that govern live crown flammability and consumption remains limited. To test these assumptions, we sampled branches from 11 common Intermountain West USA conifers and determined the corrected available fuel estimates using physiochemical measurements, diameter subsize class distributions, and a bench-scale consumption experiment. Additional branches were air-dried to explore interaction between moisture content and consumption. Corrected available live crown fuel was compared to existing models across species and then used to determine potential differences in crown fire energy release.ResultsAcross the 11 common conifers, distinct patterns of sub 1 h fuel distributions were strong predictors of whether the existing available live crown fuel models overestimated, approximately correctly estimated, or underestimated available live fuel. Fine branchwood distributions generally fell into three archetypes: fine skewed, normally distributed, and coarse skewed. Based on our corrected estimates, existing models overestimated the potential canopy energy by 34% for an average-sized western larch and underestimated it by 18.8% for western hemlock. The critical fine branchwood consumption diameter varied with species and moisture content. Larger proportions of fine branches were consumed as the branchwood dried, and nearly all the 1 h fuel was consumed when the branches were completely dry.ConclusionsThese results suggest that available live canopy fuel load estimates should consider species and moisture content to accurately assess and map fuel loads across landscapes. This work has implications for forest and fire management in conifer-dominated forests throughout western North America, and in other similar forests worldwide.
Pheochromocytoma Diagnosed During First Trimester of Pregnancy
Authors: Beard Victoria , Ghawji Maher , Salman Fariha , Oktaei Hooman 
Published: March 2024

Abstract
Pheochromocytomas are rare catecholamine-secreting tumors that occur in 0.002% of pregnancies. These tumors result in high maternal and fetal morbidity and mortality unless diagnosed in early stages of development, because excess levels of catecholamines cause vasoconstriction of both maternal and uteroplacental vasculature. Paroxysmal hypertension is the most common manifestation, but its variability in presentation and similarity to other pregnancy-related conditions often make diagnosis of pheochromocytoma difficult. Thus, it is essential to consider underlying pathological causes of hypertension during gestation. Diagnosis and treatment of pheochromocytoma must be approached uniquely given the physiologic changes during pregnancy. The standard of care for diagnostic imaging during pregnancy is with magnetic resonance imaging. For these reasons, knowledge of therapy for pheochromocytomas in the pregnant patient is essential for clinical endocrinology practice.
1080 Preoperative Prealbumin Level as a Risk Factor for Pseudoarthrosis Following Lumbar Spine Surgery
Authors: Fernandez-de Thomas Ricardo Jose , Colan Jhair Alejandro , Sharma Nikhil , Fields Daryl , Nturibi Eric , Buell Thomas J. , Gerszten Peter C. , Hamilton D. Kojo , Okonkwo David O. , Agarwal Nitin 
Published: March 2024

INTRODUCTION:
Preoperative nutritional status is essential for predicting postoperative outcomes. Studies have shown that prealbumin levels can be a prognostic indicator for surgical outcomes in spine surgery.

METHODS:
A retrospective cohort study of 697 patients was conducted between April 1st, 2018, to October 31st, 2022. Collected data included patient demographics, PPL, chronic steroid use, index surgery, length of surgery, postoperative hospital length of stay, 30-day return, and pseudoarthrosis (verified by a board certified neuroradiologist via radiographic imaging). PPL were first analyzed as absolute values, and then categorized as binary values. The first cut point used for binary categorization was =30 and >30. We then repeated statistical analyses similarly using =25, =20, and =15 as additional cut points (all as binary values).

RESULTS:
Fifty-six patients had pseudoarthrosis (8%), while 641 (92%) did not. There was no statistical difference between patients who had pseudoarthrosis and patients who did not, in terms of age (62 vs. 62.9, p=0.298), BMI (29.9 vs. 29.8, p=0.441), and preoperative prealbumin level (26.6 vs 26.4, p=0.387). There was a significant difference regarding the length of surgery (337.9 mins vs. 253.8, p=0.008) and hospital length of stay (6.2 days vs. 4.2 days, p<0.001) in patients with pseudoarthrosis. Finally, there was no significant difference between PPL and developing pseudoarthrosis when the data was categorized as binary values with cut points at =30 (p=0.595), =25 (p=0.987), =20 (p=0.799), and =15 (p=0.333).

CONCLUSIONS:
Preoperative nutritional assessment is essential in spine surgery as it can predict postoperative outcomes and recovery. In our cohort of patients, low serum prealbumin levels did not correlate with a higher rate of pseudoarthrosis following lumbar spine surgery.
1082 Creation of a Spine Healthcare Resource Utilization Grouping (SHRUG) to Complement Patient-reported Outcome Measurements in Assessing Surgical Success
Authors: Habboub Ghaith , Huang Kevin T. , Shost Michael , Lapin Brittany , Patel Arpan A. , Salas-Vega Sebastian , Sundar Swetha J. , Steinmetz Michael P. , Mroz Thomas E. 
Published: March 2024

INTRODUCTION:
Patient-reported outcome measures (PROs) are increasingly utilized to assess surgical success. However, when taken as the sole measure of surgical success they have limitations due to the requirement of collection time and infrastructure, response bias, and inherently subjective nature. The large volume of digital data generated by modern health systems may instead offer a method to track healthcare utilization and surgical outcome.

METHODS:
We retrospectively reviewed a consecutive patients undergoing elective surgery to the cervical and lumbar spine for degenerative pathologies at our institution. Pre- and post-operative 12-month change in PROMIS Global Health was collected. Post-operative measures of healthcare utilization included clinic visits, inpatient encounters, telephone encounters, opioid use, physical therapy, injections, and imaging. A SHRUG metric was then constructed through latent profile analysis.

RESULTS:
A total of 8039 surgeries were included in our analysis. Four utilization groups were identified: 1) low utilizer group, representing 53.9% of all patients; 2) moderate utilizer group (13.2%); 3) heterogenous utilizer group (25.2%); and 4) high utilizer group (7.7%). Patients were placed into one of four groups with high average probability (97%, 92%, 95%, 93% respectively).

CONCLUSIONS:
Our study developed a novel method for defining surgical outcomes based on healthcare utilization. These groupings have the potential to add an objective measure of operative success to supplement the use of PROs clinically. SHRUG can approximates PROMIS, nonbiased, provides new insight on outcome and healthcare utilization, and finally clinically feasible to implement.
113 The Effect of Civilian Purchased Care on Military Neurosurgery Wartime Readiness
Authors: Dewar Callum , Woodle Samuel , Hooten Kristopher G. 
Published: March 2024

INTRODUCTION:
The current landscape of military neurosurgery reflects the relative peacetime for the US-World relationship - a problem of intrinsically low case volume compounded by patients being deferred away from Military Treatment Facilities (MTFs). TRICARE is the healthcare program of the US Department of Defense Military Health Care System, in which ‘Purchased Care’ or civilian based health care, is used to supplement healthcare needs when services are not readily available to TRICARE beneficiaries. Within military neurosurgery, case volume and complexity continue to be diverted via purchased case pathways, greatly affecting wartime readiness. Neurosurgery wartime readiness can be measured through the Knowledge, Skills and Abilities (KSA) metric based on case complexity and volume.

METHODS:
We analyzed case counts and KSA values of active-duty military neurosurgery capable MTFs and purchased care counterparts using the CarePoint Access portal. Residents, civilian contractors, and retirees were excluded.

RESULTS:
In 2022, the KSA total for 16 MTFs was 139005, a result of 2286 cases and 47 surgeons. The average KSA/surgeon/month was 393.8, extrapolating to 4725.5/surgeon/year - 59% of the KSA goal of 8000/surgeon/year. The purchased care KSA of 10 MTFs totaled 301535 in 2022 from 7324 cases. Purchased care out-performed MTF case volume by over 300%. Recovering full purchased care volume would increase the individual MTF neurosurgeon KSA by 135%.

CONCLUSIONS:
The military neurosurgical community cannot maintain wartime readiness as defined by the KSA metric with current trends in military neurosurgery case volume and high incidence of purchased care. The solution lies in either recovering purchased care patients or expanding military-civilian partnerships to base military neurosurgeons at local academic hospitals and trauma centers.
1133 Biologically Effective Dose and Prediction of Obliteration of Arteriovenous Malformations in Pediatric Patients Treated by Gamma Knife Radiosurgery
Authors: Grogan Dayton , Dumot Chloe , Tewari Anant , Mantziaris Georgios , Dayawansa Sam , Schlesinger David , Sheehan Jason P. 
Published: March 2024

INTRODUCTION:
Stereotactic radiosurgery (SRS) represents an effective treatment for pediatric arteriovenous malformations (AVMs). Biologic effective dose (BED) is recognized as a predictive variable for outcomes in the adult population, but its role has never been studied in pediatric outcomes.

METHODS:
Retrospective data for = 18 years old patients treated with single-session SRS for AVM was collected from 1989 – 2019. BED calculations were performed using an a/b ratio of 2.47. Kaplan-Meier analysis was used to evaluate obliteration, new hemorrhage, and radiation-induced changes (RIC). Cox-regression analysis was used for obliteration prediction using two models (margin dose versus BED).

RESULTS:
One-hundred-ninety-seven patients [median age = 13.1 years, Interquartile range (IQR) = 5.2] were included; 72.6% presented initially with spontaneous hemorrhage. A median margin dose of 22 Gy (IQ = 4.0) with a median BED of 183.2Gy (IQR = 70.54) was used to treat AVMs with a median volume of 2.8 cm3 (IQR = 2.9). Following SRS, obliteration was confirmed in 115 patients (58.4%) using MRI and angiography at a median follow-up of 2.85 years (IQR = 2.26). The cumulative obliteration probability was 43.6% (95% CI = 36.1-50.3), 60.5% (95% CI+=2.2-67.4), 66.0% (95% CI= 56.0-73.7) at 3, 5 and 10 years respectively. In multivariate analysis, a BED >180 Gy [HR = 2.11, 95% CI=1.30-3.40, p = 0.002] in model 1, and a margin dose >20 Gy [HR = 1.90, 95% CI = 1.15-3.13, p = 0.019] in model 2, were associated with obliteration. An AVM nidus volume >4 cm3 was associated with lower obliteration rates in both models. The probability of symptomatic RIC at 10 years was 8.6% (95% CI = 3.5-13.4). Neither BED nor margin dose were associated with RIC occurrence, with the only predictive factor being deep AVM location [HR = 3, 95% CI = 1-9.1, p = 0.048].

CONCLUSIONS:
This study confirms BED as a predictor for pediatric AVM obliteration. Optimization of BED in pediatric AVM SRS planning may improve cumulative obliteration rates.
122 Use of Automated Active and Continuous CSF Irrigation and Drainage for Treatment of Intraventricular Hemorrhage a Retrospective Comparative Study With Volumetric Analysis
Authors: Baig Ammad , Hess Ryan M. , Santo Briana , Donnelly Brianna M. , Turner Ryan C. , Lim Jaims , Hashmi Eisa , Tutino Vincent , Levy Elad I. , Siddiqui Adnan Hussain 
Published: March 2024

INTRODUCTION:
Intraventricular hemorrhage (IVH) is a common neurosurgical pathological conditon that can occur in isolation or along with intraparenchymal and subarachnoid hemorrhage and is associated with poor outcome. Hydrocephalus associated with IVH is often treated with external ventricular drain (EVD) placement, although occlusion and replacement of the drain are common.

METHODS:
A prospectively maintained database was retrospectively searched for consecutive patients who presented with IVH between September 2020 and Febuary 2023 who were treated with an EVD or the IRRAflow. Pretreatment and posttreatment noncontrast computed tomography scans were segmented to determine IVH volumes. Change in hematoma volume, catheter related conversion and infections, in-hospital mortality, shunt dependency, and symptom resolution or improvement were recorded for outcome assessment.

RESULTS:
A total of 51 patients were included (21 in the active irrigation and drainage [IRRAflow] group vs. 30 in the passive EVD group. Demographic, disease severity, and presenting variables betweeen the groups were statistically similar. Mean hematoma volume change (8.8 ± 11.3 vs. 17.7 ± 19.4 mL, p = 0.0459) of IVH was significantly lower in the EVD group than the IRRAflow group. No. of days catheter was put in was longer in the EVD group compared to IRRAflow (15.2 ± 10.0 vs. 9.4 ± 4.5; p = 0.0019). On multivaritate logistic regression, shunt dependency on follow-up was higher in the passive EVD group compared to active irrigation and drainage group (p = 0.0215).

CONCLUSIONS:
Active irrigation with drainage along with CSF exchange for IVH patients appears to be superor to passive drainage alone using EVD.
123 How Early Is Too Early for Cranioplasty Following Craniectomy? A Propensity-Matched Study
Authors: Sioutas Georgios , Salem Mohamed , Shekhtman Oleg , Srinivasan Visish M. , Jankowitz Brian T. , Burkhardt Jan-Karl 
Published: March 2024

INTRODUCTION:
Nearly 30% of patients experience complications following cranioplasty after decompressive craniectomy. However, the optimal timing for this procedure is not well established.

METHODS:
Using the TriNetX Research Network, we included patients who underwent either late cranioplasty (91 days to 1 year), or cranioplasty in the first (1-30 days), second (31-60 days), or third (61-90 days) month after craniectomy. Propensity score matching was used to match the late cranioplasty group separately with the other three cranioplasty groups based on demographics, comorbidities, anticoagulant/antiplatelet use, and laboratory values. Postoperative outcomes were assessed within six months after cranioplasty.

RESULTS:
We analyzed 2545 patients. After matching, 301 patients remained in the first-month, 314 in the second-month, and 406 in the third-month group. The prevalence of postoperative complications, including seizures/epilepsy, infections, wound disruption, intracranial/intraspinal abscess/granuloma, repeat craniectomy/craniotomy, removal/replacement of bone flap/prosthetic plate of skull, and dependence on wheelchair/care provider were similar across all groups. Compared to late cranioplasty, intracerebral hemorrhage was significantly more common in the first-month (p = 0.033) and second-month (p = 0.01) groups, but not in the third-month (p = 0.502) group. Epidural hemorrhage was significantly more common in the second-month (p = 0.0492) group, while subdural hemorrhage was significantly more common in all early cranioplasty groups. Meningitis/Encephalitis/myelitis/encephalomyelitis were significantly more common only in the first-month group (p = 0.009). Hydrocephalous was significantly more common only in the second-month group (p = 0.0046). The need for repeat cranioplasty was significantly higher in the first-month (p = 0.005) and second-month (p = 0.043) groups. Mortality rate was significantly higher in the first-month (p = 0.004) and second-month (p = 0.02) groups.

CONCLUSIONS:
Cranioplasty in the first 60 days following craniectomy is associated with increased postoperative morbidity and mortality. Prospective studies are needed to establish the best timing for cranioplasty.
1233 A Benchmark for Early Biochemical Success and Long-term Remission After Resection of Corticotroph Adenomas in Cushing Disease
Authors: Catalino Michael P. , Moore Dominic , Ironside Natasha , Kearns Kathryn , Min Le , Lee Vance Mary , Jane John Anthony , Laws Edward R. 
Published: March 2024

INTRODUCTION:
In Cushing disease, the definition of success after resection of corticotroph adenomas remains unclear given inconsistent pathology and high recurrence rates despite initial biochemical remission.

METHODS:
We collected 12 years of in-hospital cortisol data after the removal of pathology-confirmed corticotroph adenomas in patients with Cushing disease. A novel cortisol halving time analysis was performed using exponential decay modeling, results were dichotomized a priori, and then applied to an external cohort of patients. Halving time was compared to first post-operative cortisol and nadir cortisol variables by estimating long-term remission and time-to-recurrence using Cox regression modeling and the Kaplan-Meier method.

RESULTS:
A total of 320 patients met inclusion/exclusion criteria for the final analysis, and 26 of those patients developed recurrent disease. Median follow-up time was 2.1 years, although 62 patients had five years or longer follow-up time. Higher first post-operative cortisol and higher nadir were associated with increased risk of recurrence. Patients who had a first post-operative cortisol = 50 µd/dL were 4.1 times more likely to recur than those with a first post-operative cortisol < 50 µd/dL (HR 4.1, 1.8-9.2; p = 0.0003). Halving time was not associated with recurrence (HR 1.7, 0.8-3.8, p = 0.18). Patients with a nadir cortisol =2 µg/dL were 6.6 times more likely to recur than those with a nadir cortisol of < 2 µg/dL (HR 6.6, 2.6-16.6, p < 0.0001).

CONCLUSIONS:
Post-operative nadir serum cortisol is the most important cortisol variable associated with recurrence and time-to-recurrence. Compared to first post-operative cortisol and cortisol halving time, a nadir < 2 µg/dL occurring within the first three post-operative days showed the strongest association with long-term remission.