bluuebunny/crossref_metadata_2025_split huggingface dataset:
The impact of the Starting dialysis on Time, At home on the Right Therapy (START) project on the use of peritoneal dialysis
Authors: Quinn Robert R , Oliver Matthew J , Clarke Alix , Mohamed Farah , Klarenbach Scott W , Manns Braden J , Fox Danielle E , Scott-Douglas Nairne , Morrin Louise , Kozinski Anita , Schwartz Tracy , Pauly Robert 
Published: February 2024

Background: Peritoneal dialysis (PD) is actively promoted, but increasing PD utilisation is difficult. The objective of this study was to determine if the Starting dialysis on Time, At Home, on the Right Therapy (START) project was associated with an increase in the proportion of dialysis patients receiving PD within 6 months of starting therapy. Methods: Consecutive patients over age 18, with end-stage kidney failure, who started dialysis between 1 April 2015 and 31 March 2018 in the province of Alberta, Canada. Programmes were provided with high-quality data about the individual steps in the process of care that drive PD utilisation that were used to identify problem areas, design and implement interventions to address them, and then evaluate whether those interventions had impact. The primary outcome was the proportion of patients receiving PD within 6 months of starting dialysis. Secondary outcomes included hospitalisation, death or probability of transfer to haemodialysis (HD). Interrupted time series methodology was used to evaluate the impact of the quality improvement initiative on the primary and secondary outcomes. Results: A total of 1962 patients started dialysis during the study period. Twenty-seven per cent of incident patients received PD at baseline, and there was a 5.4% (95% confidence interval: 1.5–9.2) increase in the use of PD in the province immediately after implementation. There were no changes in the rates of hospitalisation, death or probability of transfer to HD after the introduction of START. Conclusions: The approach used in the START project was associated with an increase in the use of PD in a setting with high baseline utilisation.
Estimating the Sex Gap in Depression-Free Life Expectancy Among Widowed Americans Aged 50 and Older: An Application Using the Interpolated Markov Chain Approach
Authors: Feraldi Alessandro , Giudici Cristina , Brouard Nicolas 
Published: February 2024

Objectives Using Interpolated Markov Chain software, we compare the length of life with and without depression among married individuals and widowers, and the related sex differences. Methods We applied a multi-state life table approach to estimate depression-free life expectancy among recent cohorts of older married and widowed women and men in the United States, using data from the Health and Retirement Study over a 7-year period (2012–2018). Results The study revealed that the difference in life expectancy between sexes widens in the context of widowhood. At age 50, the sex gap in depression-free life expectancy is 0.8 years among married people, whereas the gap almost doubles to 1.7 years among widowed people. Discussion By quantifying disparities in the duration of life affected by depression between married and widowed women and men, policymakers could properly allocate resources specifically to address the mental health needs of these groups.
Prospective Evaluation of Health-Related Quality-of-Life in Children with Craniosynostosis
Authors: Gamarra Valeria , Pearson Gregory D. , Drapeau Annie , Pindrik Jonathan , Crerand Canice E. , Rabkin Ari N. , Khansa Ibrahim 
Published: February 2024

Objective To investigate health-related quality of life (HRQL) in children aged 2 to 7 years, who have undergone surgery for craniosynostosis. Design Cross-sectional survey. Setting A tertiary pediatric academic medical center. Participants Children with craniosynostosis who underwent surgical correction, and who were 2–7 years old at the time of the study. Children from families that did not speak English were excluded. Interventions Caregivers were asked to fill out the Pediatric Quality of Life Inventory (PedsQL) Core Parent Report and the PedsQL Cognitive Functioning Scale. Main outcome measures PedsQL: Psychosocial Health Summary Score, Physical Health Summary Score, Total Core Score, Cognitive Functioning Scale Score. Scores range from 0 to 100, with higher scores reflecting greater QoL Subject factors: comorbidities, syndromic status, type of craniosynostosis, type of surgery Results The study included 53 subjects, of whom 13.2% had a syndrome. Core and cognitive scores did not depend on presence of a syndrome or suture involved. Subjects who underwent posterior cranial distraction achieved higher Total Core Scores than subjects who underwent open vault remodeling. Among subjects with sagittal craniosynostosis, there was a tendency for higher scores among children who underwent minimally-invasive surgery compared to those who underwent open vault remodeling. Conclusions This study demonstrates similar HRQL among children with and without a syndrome, higher HRQL among children undergoing posterior cranial distraction than those undergoing open vault remodeling, and trends towards higher HRQL in children with sagittal craniosynostosis who underwent minimally-invasive surgery compared to those who underwent open vault remodeling.
The role of metalinguistic knowledge in third-language development among heritage and late bilinguals
Authors: Rosales Cesar , Torres Julio 
Published: February 2024

Aims and objectives: This study examined whether bilinguals’ metalinguistic knowledge (MK) across both of their languages as well as heritage/late bilingual experience contributed to the initial development of third-language (L3) morphosyntax using Japlish, a semi-artificial language. Methodology: 48 heritage and 63 late English-Spanish bilinguals were exposed aurally to Japlish sentences containing word order patterns and case markers. Participants completed an acceptability judgment task (AJT) and a picture-matching task (PMT) immediately after exposure and again 2 weeks later as well as English and Spanish MK tests. Data and analysis: Logistic mixed effects analyses were run on AJT and PMT accuracy scores, grammatical/ungrammatical items, linguistic structure, and time of testing. MK scores and heritage/late bilingual status were included as predictors in the statistical model. Findings: MK significantly contributed to overall AJT scores, including grammatical and ungrammatical items and time of testing. MK also contributed to ungrammatical word order and case markers. For the PMT, MK significantly contributed to scores, especially during delayed testing. A weak correlation emerged between participants’ MK across both of their languages and their rule-based knowledge of Japlish linguistic structures. Heritage and late bilingual experiences did not significantly contribute to these results. Originality: This study included two different bilingual groups to investigate how variation in bilingual experience shapes additional language learning. It also advances our knowledge on the role of MK in the learning of linguistic structures not involved in transfer. Furthermore, a more nuanced examination of MK is considered as it relates to type of assessment, linguistic structure, and time of testing. Significance: The findings highlight the critical role of MK for both bilingual populations and its facilitative role in the development of initial L3 morphosyntax. The results are interpreted under the lens of structural sensitivity theory.
The impact of the Covid-19 pandemic on mental health in Danish school children in 5th to 7th grade
Authors: Andreasen Sarah Munk , Nielsen Sandra , Fjorback Lone Overby , Jensen Tina Kold , Juul Lise 
Published: February 2024

Aim: We wanted to examine the impact of the Covid-19 pandemic on mental health in Danish school children in 5th to 7th grade (11 to 15 years), and whether the impact differed across age and sex. Methods: We included 793 and 391 school children from winter 2020 and winter 2021, respectively. Mental health was measured using the Short Warwick–Edinburgh Mental Well-Being Scale (SWEMWBS), Strengths and Difficulties Questionnaire (SDQ), and Brief Resilience Scale (BRS). Data were analyzed by sex using linear regression models adjusting for grade (age), cohabitation, geographical region, employment status of parents, and schools as clusters. Results: Girls in 5th grade and boys in 6th grade during Covid-19 had statistically significant lower well-being (SWEMWBS) compared with before Covid-19. Girls in 5th and 6th grade during Covid-19 had non-statistically significant lower scores on all subscales of SDQ compared with girls before Covid-19. Girls in 7th grade during Covid-19 had statistically significant lower total difficulty score (SDQ) and fewer conduct problems (SDQ) compared with girls before Covid-19. Boys in 5th grade during Covid-19 had statistically significant fewer conduct problems (SDQ) compared with boys before Covid-19. Conclusions: This study indicates that the Covid-19 pandemic impacted Danish school children differently across sex and grade (age). During Covid-19, mental health tended to be better among the oldest girls and worse among the youngest girls compared with girls before Covid-19. Boys in 6th grade had poorer mental well-being, and boys in 5th grade had fewer conduct problems during Covid-19 compared with before Covid-19.
Linking climate change adaptation and public health: perspectives of Norwegian policymakers
Authors: Budin-Ljøsne Isabelle , Nordeng Zuzana , Schwarze Per Everhard , Rao-Skirbekk Shilpa 
Published: February 2024

Aims: To explore the perspectives of selected Norwegian climate and health policymakers working at national and municipality level regarding how health is accounted for in climate change adaptation plans. Methods: Semi-structured digital interviews were conducted with representatives from eight municipalities participating in a national network for climate change adaptation, one political unit and five national public administrations working in climate, health, environment, preparedness, and civil protection. Results: Municipalities coordinate the development of climate change adaptation plans with support from key national actors. Although municipalities were experienced in preparing for extreme climate events and securing infrastructure, limited consideration was given to health in the climate change adaptation work. Such integration was hindered by lack of resources and knowledge regarding what to do, and lack of collaboration between municipality sectors. To connect climate change adaptation and health better, the representatives suggested providing evidence-based information regarding health impacts of climate change, developing concrete tools including warning systems, and implementing regional, national, and international projects to map the impact of climate change and raise capacity. The representatives called for more stringent national guidelines for the integration of health in climate change adaptation, and pinpointed that lessons learnt from the COVID-19 pandemic will enable municipalities to be better prepared and more adaptable in the future. Conclusions: Governmental authorities should provide more concrete guidance regarding the integration of health in climate change adaptation plans. Public health authorities have a central role to play in supporting such endeavours.
The drug-survival of low-dose thioguanine in patients with inflammatory bowel disease: a retrospective observational study
Authors: Gensmyr-Singer Helena , Werner Mårten , Karling Pontus 
Published: February 2024

Background: Thiopurines are commonly used to treat inflammatory bowel disease but withdrawal due to side effects are common. Thioguanine has been suggested to be better tolerated than conventional thiopurines. Objectives: We studied drug-survival of low dose of thioguanine in real-life clinical practice in comparison to conventional thiopurines. Design: Retrospective observational study. Methods: All patients born 1956 and later, and who at least once started thiopurine treatment between 2006 and 2022 were included. A medical chart review was performed that noted drug-survival for every thiopurine treatment attempt. The Mantel–Cox rank test was used to test differences in drug-survival for different thiopurines. Blood chemistry analysis and faecal calprotectin levels were registered for the first 5 years of treatment. Results: In the study population, there was 379 initiated thiopurine treatments (210 for Crohn’s disease and 169 for ulcerative colitis) in 307 patients with inflammatory bowel disease (IBD). Low-dose thioguanine (median dose 11 mg; 25–75th percentile 7–19 mg) had been initiated in 31 patients. Overall, when including all thiopurine attempts, thioguanine had the longest drug-survival [Mantel–Cox rank test: thioguanine versus azathioprine p = 0.014; thioguanine versus 6-mercaptopurine (6-MP) p < 0.001]. For second-line thiopurine treatment thioguanine had longer drug-survival than 6-MP (Mantel–Cox rank test: p = 0.006). At 60 months, 86% of the patients who started low-dose thioguanine were still on treatment compared to 42% of the patients who started 6-MP ( p = 0.022). The median 6-thioguanine nucleotide levels in patients treated with thioguanine was 364 pmol/8 × 108. Patients on thioguanine treatment showed significantly lower values of median mean corpuscular volume at follow-up than patients treated with azathioprine and 6-MP. Patients treated with 6-MP showed significantly lower levels of FC in the third year of treatment compared to patient treated with azathioprine (59 versus 109 µg/g; p = 0.023), but there was no significant difference in FC levels for thioguanine compared to azathioprine (50 versus 109 µg/g; p = 0.33). Conclusion: Treatment with a low dose of thioguanine is well-tolerated in patients with IBD and had a significantly higher drug-survival than conventional thiopurines.
Orbital Fractures Treated in Auckland From 2016 to 2020: Review of Patient Outcomes
Authors: Wang Darren , Sealey Christopher M. 
Published: February 2024

Orbital reconstruction is a complex procedure demanding accurate placement of implants to restore volume and anatomic shape to the orbits. Intra-operative computed-tomography (CT) and rapid-prototype (RP) biomodels have been recently introduced as surgical aids to improve outcomes. Investigation is required to determine if there is a reduction in post-operative ophthalmic complications. Study Design Retrospective cohort study. Objective To evaluate the impact of intra-operative CT and RP biomodels on the incidence of post-operative diplopia, paraesthesia, cosmetic issues and ability to return to work following orbital reconstruction surgery. Methods Adult (>18 years) patients treated at Counties Manukau District Health Board, Auckland, by the Department of Oral and Maxillofacial Surgery for isolated orbital fractures were retrospectively enrolled into this study. An audit of clinical records was undertaken to determine incidences of diplopia, altered sensation, cosmetic concerns and ability to return to work. These findings were compared against our previous audit which documented these findings in patients treated between 2010 and 2015, prior to the introduction of intra-operative CT and RP biomodels. Results Routine use of intra-operative CT and RP biomodels was associated with a reduced incidence of post-operative diplopia. No significant difference was observed with regards to paraesthesia and cosmetic deficits. Conclusions The relatively low radiation exposure and cost associated with intra-operative CT and RP biomodels is justified with improved outcomes in subjective diplopia. Titanium as a material for orbital reconstruction was confirmed to be associated with low complication rates.
Identifying metabolic dysfunction-associated steatotic liver disease in patients with hypertension and pre-hypertension: An interpretable machine learning approach
Authors: Chen Chen , Zhang Wenkang , Yan Gaoliang , Tang Chengchun 
Published: February 2024

ObjectiveMetabolic dysfunction-associated steatotic liver disease (MASLD) is one of the most prevalent liver diseases and is associated with pre-hypertension and hypertension. Our research aims to develop interpretable machine learning (ML) models to accurately identify MASLD in hypertensive and pre-hypertensive populations.MethodsThe dataset for 4722 hypertensive and pre-hypertensive patients is from subjects in the NAGALA study. Six ML models, including the decision tree, K-nearest neighbor, gradient boosting, naive Bayes, support vector machine, and random forest (RF) models, were used in this study. The optimal model was constructed according to the performances of models evaluated by K-fold cross-validation ( k = 5), the area under the receiver operating characteristic curve (AUC), average precision (AP), accuracy, sensitivity, specificity, and F1. Shapley additive explanation (SHAP) values were employed for both global and local interpretation of the model results.ResultsThe prevalence of MASLD in hypertensive and pre-hypertensive patients was 44.3% (362 cases) and 28.3% (1107 cases), respectively. The RF model outperformed the other five models with an AUC of 0.889, AP of 0.800, accuracy of 0.819, sensitivity of 0.816, specificity of 0.821, and F1 of 0.729. According to the SHAP analysis, the top five important features were alanine aminotransferase, body mass index, waist circumference, high-density lipoprotein cholesterol, and total cholesterol. Further analysis of the feature selection in the RF model revealed that incorporating all features leads to optimal model performance.ConclusionsML algorithms, especially RF algorithm, improve the accuracy of MASLD identification, and the global and local interpretation of the RF model results enables us to intuitively understand how various features affect the chances of MASLD in patients with hypertension and pre-hypertension.
Frailty Influence on Postoperative Surgical Site Infections After Surgery for Degenerative Spine Disease and Adult Spine Deformity. Can a Frailty Index be a Valuable Summary Risk Indicator? A Systematic Review and Metanalysis of the Current Literature
Authors: Manzetti Marco , Ruffilli Alberto , Viroli Giovanni , Traversari Matteo , Ialuna Marco , Salamanna Francesca , Neri Simona , Faldini Cesare 
Published: February 2024

Study Design Metanalysis. Objective Surgical site infections (SSI) is one of the commonest postoperative adverse events after spine surgery. Frailty has been described as a valuable summary risk indicator for SSI in spine surgery. The aim of this metanalysis is to evaluate the influence of frailty on postoperative SSI in this cohort and provide hints on which index can predict the risk of SSI. Methods Papers describing the postoperative SSI rate in adult degenerative spine disease or adult spine deformity patients with varying degrees of frailty were included in the analysis. The SSI rate in different grades of frailty was considered for outcome measure. Meta-analysis was performed on studies in whom data regarding patients with different levels of frailty and occurrence of postoperative SSI could be pooled. P < .05 was considered significant. Results 16 studies were included. The frailty prevalence measured using mFI-11 ranged from 3% to 17.9%, these values were inferior to those measured with mFI-5. Significant difference was found between frail and non-frail patients in postoperative SSI rate at metanalysis (z = 5.9547, P < .0001 for mFI-5 and z = 3.8334, P = .0001 for mFI-11). Conclusion This is the first meta-analysis to specifically investigate the impact of frailty, on occurrence of SSI. We found a relevant statistical difference between frail and non-frail patients in SSI occurrence rate. This is a relevant finding, as the ageing of population increases alongside with spine surgery procedures, a better understanding of risk factors may advance our ability to treat patients while minimizing the occurrence of SSI.
“The Water in Which We Swim:” A Unique, Post-Clerkship Multidisciplinary Course
Authors: Laird-Gion Jessica N. , Garabedian Laura F. , Conrad Rachel , Shaffer Adam C. , Witkowski Mary L. , Mateo Camila M. , Jones David S. , Hundert Edward , Kasper Jennifer 
Published: February 2024

OBJECTIVE To improve patient outcomes and promote health equity, medical students must be taught not only biomedicine, but also the social sciences to understand the larger contexts in which patients live and health care operates. Yet, most undergraduate medical education does not explicitly cover these topics in a required, longitudinal curriculum. METHODS In January 2015 at Harvard Medical School, we created a two-part sequence (pre- and post-clerkship) of required, 4-week multidisciplinary courses—“Essentials of the Profession I and II”—to fill this gap. “Essentials of the Profession II (EOP2)” is an advanced social sciences course anchored in patient narratives and the lived experiences of students and includes clinical epidemiology and population health, healthcare delivery and leadership, health policy, medical ethics and professionalism, and social medicine that engages students to conduct structural analyses to be effective healers, advocates, and leaders. RESULTS Per student course evaluations, the overall course rating was 1.7 (SD 0.9, 1 = excellent and 5 = poor); its overall rating has improved over time; and it has scored well even when run virtually. It was rated highly in application of critical thinking, integration of the disciplines, and relevance for clinical work. Qualitative analyses of student responses revealed the following key course strengths: breadth of topics, teaching faculty and guest speakers, and small group discussions. The weaknesses included workload, lack of diversity of opinions, repetition, and time spent in lectures. CONCLUSIONS We argue that EOP2 is “essential” for post-clerkship medical education. It offers an opportunity to re-ignite and enhance humanism and activism; remind students why they chose the medical profession; equip them with frameworks and toolkits to help them to overcome challenges; and devise solutions to improve health care and patient outcomes that are applicable to their future training and ongoing practice of medicine.