bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictors of fuel poverty and the equity of local fuel poverty support: secondary analysis of data from Bradford, England
Authors: Little E , Barnes A , Power M 
Published: April 2024

Aims: Addressing fuel poverty is a critical public health issue given its recent rise in prevalence across Europe. Although previous research identifies national risk markers of fuel poverty, evidence is lacking on whether these are consistent across local geographies, and the equity of local interventions. In the UK’s current economic climate, it is more crucial than ever that services benefit households in greatest need. This study aimed to determine significant predictors of fuel poverty among households in Bradford, England, comparing them to national-level predictors, and evaluate if households possessing significant fuel poverty predictors were equitably referred to a local fuel poverty service (Warm Homes Healthy People, WHHP). Methods: A multivariate logistic regression model determined significant fuel poverty predictors in Bradford using household-level data from the Energy Saving Trust and the Low Income High Costs fuel poverty definition. Statistical testing highlighted significant differences in predictors of fuel poverty between households referred to WHHP and all Bradford households. Results: Significant ( p < .05) predictors of fuel poverty included: living in an area with lower average household incomes and higher proportion of ethnic minority individuals, and living in a property with a lower energy efficiency rating. Households living in a detached or older property, and homeowners were more likely to be fuel poor. Differences in the direction of the relationship with fuel poverty were identified between some national and local predictors. Most predictors were significantly ( p < .05) overrepresented among WHHP households, suggesting equitable service reach. Ethnic minorities, younger people, and multiperson households were underrepresented. Conclusions: Local fuel poverty predictors were similar to many national-level predictors, but identified differences in the direction of the relationship between some national and local predictors reaffirm the value of locally focused research. WHHP successfully targeted households possessing key predictors, but should ensure that ethnic minorities, younger people, and multiperson households are equitably referred.
First Accuracy and User-Experience Evaluation of New Continuous Glucose Monitoring System for Hypoglycemia Due to Hyperinsulinism
Authors: Worth Chris , Worthington Sarah , Auckburally Sameera , O’Shea Elaine , Ahmad Sumera , Fullwood Catherine , Salomon-Estebanez Maria , Banerjee Indraneel 
Published: April 2024

Introduction: Patients with congenital hyperinsulinism (HI) require constant glucose monitoring to detect and treat recurrent and severe hypoglycemia. Historically, this has been achieved with intermittent self-monitoring blood glucose (SMBG), but patients are increasingly using continuous glucose monitoring (CGM). Given the rapidity of CGM device development, and increasing calls for CGM use from HI families, it is vital that new devices are evaluated early. Methods: We provided two months of supplies for the new Dexcom G7 CGM device to 10 patients with HI who had recently finished using the Dexcom G6. Self-monitoring blood glucose was performed concurrently with paired readings providing accuracy calculations. Patients and families completed questionnaires about device use at the end of the two-month study period. Results: Compared to the G6, the G7 showed a significant reduction in mean absolute relative difference (25%-18%, P < .001) and in the over-read error (Bland Altman +1.96 SD; 3.54 mmol/L to 2.95 mmol/L). This resulted in an improvement in hypoglycemia detection from 42% to 62% ( P < .001). Families reported an overall preference for the G7 but highlighted concerns about high sensor failure rates. Discussion: The reduction in mean absolute relative difference and over-read error and the improvement in hypoglycemia detection implies that the G7 is a safer and more useful device in the management of hypoglycemia for patients with HI. Accuracy, while improved from previous devices, remains suboptimal with 40% of hypoglycemia episodes not detected.
In-Season Training Load Variation - Heart Rate Recovery, Perceived Recovery Status, and Performance in Elite Male Water Polo Players: A Pilot Study
Authors: Botonis Petros G. , Arsoniadis Gavriil G. , Smilios Ilias , Toubekis Argyris G. 
Published: April 2024

Background: Increased training and competition demands of the in-season period may disturb athlete fatigue and recovery balance. The aim of this study was to describe the training load distribution applied in a competitive period and the training adaptations and fatigue/recovery status of elite water polo players. Hypothesis: Effective workload management during tapering (TAP) would restore player recovery and enhance performance. Study Design: Case series. Level of Evidence: Level 4. Methods: Training load, perceived recovery, maximal speed in 100- and 200-meter swim, heart rate (HR) during submaximal swimming (HRsubmax) and HR recovery (HRR) were assessed in 7 outfield water polo players a week before starting a normal training microcycle (NM), after NM, and after congested (CON) and TAP training blocks in the lead-up to the Final Eight of the European Champions League. Results: Training load was higher in NM compared with CON and TAP by 28.9 ± 2.6% and 42.8 ± 2.1% ( P < 0.01, d = 11.54, and d = 13.45, respectively) and higher in CON than TAP by 19.4 ± 4.2% ( P < 0.01, d = 3.78). Perceived recovery was lower in CON compared with NM and TAP ( P < 0.01, d = 1.26 and d = 3.11, respectively) but not different between NM and TAP ( P = 0.13, d = 0.62). Both 100- and 200-meter swim performance was improved in TAP compared with baseline ( P < 0.01, d = 1.34 and d = 1.12, respectively). No differences were detected among other training blocks. HRsubmax and most HRR were similar among the training periods. Conclusion: Effective management of training load at TAP can restore recovery and improve swimming performance without affecting HR responses. Clinical Relevance: Despite lower workloads, CON training impairs perceived recovery without affecting performance; however, a short-term training load reduction after a CON fixture restores recovery and improves performance.
Expression of Chondrogenic Potential Markers in Cultured Chondrocytes from the Human Knee Joint
Authors: Bonello John-Peter , Tse M. Yat , Robinson Trevor J. G. , Bardana Davide D. , Waldman Stephen D. , Pang Stephen C. 
Published: April 2024

Objectives While substantial progress has been made in engineering cartilaginous constructs for animal models, further research is needed to translate these methodologies for human applications. Evidence suggests that cultured autologous chondrocytes undergo changes in phenotype and gene expression, thereby affecting their proliferation and differentiation capacity. This study was designed to evaluate the expression of chondrogenic markers in cultured human articular chondrocytes from passages 3 (P3) and 7 (P7), beyond the current clinical recommendation of P3. Methods Cultured autologous chondrocytes were passaged from P3 up to P7, and quantitative polymerase chain reaction (qPCR) was used to assess mRNA expression of chondrogenic markers, including collagen type I (COLI), collagen type II (COLII), aggrecan (AGG), bone morphogenetic protein 4 (BMP4), transcription factor SOX-9 (SOX9), proteoglycan 4 (PGR4), and transformation-related protein 53 (p53), between P3 and P7. Results Except for AGG, no significant differences were found in the expression of markers between passages, suggesting the maintenance of chondrogenic potential in cultured chondrocytes. Differential expression identified between SOX9 and PGR4, as well as between COLI and SOX9, indicates that differences in chondrogenic markers are present between age groups and sexes, respectively. Conclusions Overall, expression profiles of younger and male chondrocytes exhibit conversion of mature cartilage characteristics compared to their counterparts, with signs of dedifferentiation and loss of phenotype within-group passaging. These results may have implications in guiding the use of higher passaged chondrocytes for engineering constructs and provide a foundation for clinical recommendations surrounding the repair and treatment of articular cartilage pathology in both sexes.
eCLIPs bifurcation remodeling system for treatment of wide-neck bifurcation aneurysms: A systematic review and meta-analysis of safety and efficacy
Authors: Ghozy Sherief , Ramzan Abdullah , Kobeissi Hassan , Motawei Ahmed Sallam , Abdelghaffar Mariam , Dmytriw Adam A , Kallmes David F , Kadirvel Ramanathan 
Published: April 2024

Background Wide neck bifurcation aneurysms (WNBAs) are a subtype of aneurysms that are especially complex to treat. We aim to conduct a systematic review and meta-analysis to synthesize the available literature on the safety and efficacy of employing endovascular clip system (eCLIPs) in the treatment of WNBAs. Methods We report this study in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 guidelines. PubMed, Embase, Web of Science, and Scopus were queried for this review. Screening and extraction were performed by at least two authors to ensure accuracy and completeness, and a senior author arbitrated any discrepancies. All data were analyzed using R software version 4.3.0. and random-effects model. Results Four studies were finally included, of which three were prospective and one was retrospective. Successful adjunctive coiling occurred in 91.38% (95% CI = 70.71–97.9) of cases and overall technical success was achieved in 88.61% (95 CI = 75.54–95.15) of cases. The pooled complete occlusion (Raymond-Roy Class I) was 50.65% (95% CI = 39.63–61.60) and adequate occlusion (Raymond-Roy Class I/II) was 84.42% (95% CI = 74.53–90.93). Thrombo-embolic complication had a pooled rate of 1.22% (95% CI = 0.17–8.15), retreatment rate was 6.10% (95% CI = 2.56–13.83), and mortality reported in 3.66% (95% CI = 1.18–10.74) of patients. Conclusion The use of eCLIPs may be a safe and efficacious treatment for WNBAs. Future randomized controlled trials are needed for further validation of the findings.
Use of virtual reality exercises in disaster preparedness training: A scoping review
Authors: Alshowair Abdulmajeed , Bail Jean , AlSuwailem Fatima , Mostafa Asmaa , Abdel-Azeem Amro 
Published: April 2024

Background: The scope and number of disasters have increased over the years. This has called for more robust disaster preparedness training and plans. The use of virtual reality exercises in addition to tabletop exercises is considered a new approach to the preparation of disaster preparedness plans. Virtual reality exercises are being developed to either replace or complement current traditional approaches to disaster preparedness training. Objectives: To review and summarize the current existing literature regarding the effectiveness, advantages and limitations of using virtual reality exercises in disaster preparedness as a complementary/replacement mechanism for real-time drills and tabletop exercises. Methods: In this scoping review, we searched PubMed, Cochrane, EMBASE, PLOS, and Google Scholar for research publications involving virtual reality exercises in disaster training from 2008 to 2022 using “AND” and “OR” operators for the keywords “disaster,” “preparedness,” “virtual reality,” and “tabletop.” From a total of 333 articles that resulted in our search and were then evaluated by the authors, 55 articles were finally included in this review. Results: Virtual reality exercises are found to be better in the formulation of disaster preparedness plans compared to tabletop exercises. Virtual reality exercises can be used as the primary means of creating a real-life-like experience in disaster preparedness training and proved at least as better complementary to tabletop exercises. Virtual reality exercises have many advantages over traditional real-life or tabletop exercises and are more cost-effective, but some drawbacks are still identified. Conclusion: The advantages of virtual reality exercises are remarkable and underline their benefits and uses versus costs. We highly encourage decision-makers and institutions dealing in disaster preparedness to adopt using virtual reality exercises in training for disaster preparedness.
Prolonged grief in relatives of deceased patients due to COVID-19 is associated with anxiety and depressive symptoms: A survey-based study in Peru
Authors: Moya-Salazar Jeel , Soto Elizabeth , Cañari Betsy , Goicochea Eliane A , Zuñiga Nahomi , Jaime-Quispe Alexis , Contreras-Pulache Hans 
Published: April 2024

Objective: Funeral practices have undergone significant changes during the COVID-19 pandemic. Thus, the death of a family member from this disease has altered the typical course of the bereavement process. Therefore, this study seeks to determine the relationship between the levels of grief, anxiety, and depression in relatives of patients who died from COVID-19 in Peru. Methods: A total of 250 volunteers were obtained, but after applying the inclusion criteria and not being able to contact five of them, the sample consisted of 115 participants over 18 years of age who lost a family member to COVID-19 between 2020 and 2021. They developed the Prolonged Grief Questionnaire-13 and the Zung Anxiety and Depression Questionnaires, in virtual surveys using Google FormTM (Google, CA). Results: Our analysis revealed that all cases of anxiety (18.3%) were present in individuals experiencing prolonged grief (76.5%), while 49.5% (57/115) of participants exhibited symptoms of depression. Furthermore, we identified a significant association between prolonged grief and both anxiety ( p = 0.005) and depression ( p < 0.001). Prolonged grief predominantly affected females (45.2%) and individuals aged 31–40 years (28.7%) ( p < 0.001). Regarding predictors of anxiety symptoms, we found that both age group ( p = 0.035) and grief ( p < 0.001) played significant roles. Gender ( p = 0.019) and grief ( p < 0.001) emerged as predictors of depression, while gender alone predicted grief in relatives of individuals who succumbed to COVID-19 ( p = 0.019). Conclusion: Our results suggest a clear association between prolonged grief and mental health issues among relatives of COVID-19 patients who have passed away. Consequently, it is imperative to provide comprehensive psychological and spiritual support throughout the grieving process, aiming to mitigate the negative impact of traumatic events.
Nurse-led UTI service provides consistent care and reduces pressure on consultant clinics
Authors: De Silva Supun , Rashid Mustafa , Seymour Coral , Hussain Paulette , Eylert Maike 
Published: April 2024

Objectives: To publish the five-year outcomes of the nurse-led urinary tract infection (UTI) clinic, which is the first-ever outpatient nurse-led service for women with recurrent urinary tract infections. Materials and Methods: This report is on a single UK centre review of outcomes including patients seen in a nurse-led UTI clinic between January 2017 and December 2021. Results: A total of 1425 patients were audited. The median wait from referral time was 18 weeks. Standard ultrasound of kidneys, ureter and bladder (KUB) was offered to most patients which detected an abnormality in 17.5% (n = 240/1374) of scans, and flexible cystoscopy (selective) was positive in 11.9% (n = 46/386) mainly for benign pathologies. At 6 months, 80.6% of patients were discharged, with only 10.9% of patients requiring referral to the consultant urology clinic. Four urothelial cancers were picked up in the absence of red-flag symptoms on the referral, each one much quicker than the average wait for general consultant clinics at the point of referral. Conclusions: A well-run, protocol-driven nurse-led UTI clinic provides consistent care to women with recurrent UTIs. More than 80% of patients can be successfully discharged at 6 months which reduces pressure on consultant clinics. Level of evidence: Not applicable
A locally optimised machine learning approach to early prognostication of long-term neurological outcomes after out-of-hospital cardiac arrest
Authors: Pey Vincent , Doumard Emmanuel , Komorowski Matthieu , Rouget Antoine , Delmas Clément , Vardon-Bounes Fanny , Poette Michaël , Ratineau Valentin , Dray Cédric , Ader Isabelle , Minville Vincent 
Published: April 2024

Background Out-of-hospital cardiac arrest (OHCA) represents a major burden for society and health care, with an average incidence in adults of 67 to 170 cases per 100,000 person-years in Europe and in-hospital survival rates of less than 10%. Patients and practitioners would benefit from a prognostication tool for long-term good neurological outcomes. Objective We aim to develop a machine learning (ML) pipeline on a local database to classify patients according to their neurological outcomes and identify prognostic features. Methods We collected clinical and biological data consecutively from 595 patients who presented OHCA and were routed to a single regional cardiac arrest centre in the south of France. We applied recursive feature elimination and ML analyses to identify the main features associated with a good neurological outcome, defined as a Cerebral Performance Category score less than or equal to 2 at six months post-OHCA. Results We identified 12 variables 24 h after admission, capable of predicting a six-month good neurological outcome. The best model (extreme gradient boosting) achieved an AUC of 0.96 and an accuracy of 0.92 in the test cohort. Conclusion We demonstrated that it is possible to build accurate, locally optimised prediction and prognostication scores using datasets of limited size and breadth. We proposed and shared a generic machine-learning pipeline which allows external teams to replicate the approach locally.
Complex left appendage morphology is associated with Embolic Stroke of Undetermined Source
Authors: Nardi Agmon Inbar , Barnea Rani , Levi Amos , Murad Omar , Shafir Gideon , Naftali Jonathan , Schellekes Nadav , Shiyovich Arthur , Kornowski Ran , Auriel Eitan , Hamdan Ashraf ,   Cardiac CT for Undetermined Source of Embolic Stroke (CaCTUSES) Working Group
Published: April 2024

Introduction: Variations in the left atrial appendage (LAA) morphology are associated with different embolic risk in patients with atrial fibrillation (AF). Data are scarce regarding the association between LAA morphology and Embolic stroke of undetermined source (ESUS). Patients and methods: Using cardiac computed tomography (CCT) scans, LAA morphology was categorized as either chicken wing (CW), cactus, windsock, or cauliflower. Furthermore, we examined the presence of large secondary lobes arising from the main lobe, considering their existence as indicative of a complex LAA morphology. LAA morphologies were compared between ESUS ( n = 134) and AF patients ( n = 120); and between ESUS patients with ( n = 24) and without ( n = 110) subsequent AF diagnosis during long-term follow-up. Results: ESUS patients had a significantly higher prevalence of cauliflower morphology compared to AF group (52% vs 34%, respectively, p = 0.01); however, no significant difference was found between the groups when categorizing LAA morphology to either CW or non-CW. ESUS patients had significantly higher prevalence of large secondary lobes compared with AF patients (50% vs 29%, respectively, p = 0.001). When comparing ESUS patients with and without AF diagnosis during follow-up (20–48 months of follow-up, median 31 months), there were no significant differences in the prevalence of the “classical” morphologies, but large secondary lobes were significantly more prevalent among those without subsequent AF diagnosis. Conclusion: ESUS patients have a high prevalence of complex LAA morphology, which might be associated with an increased risk for thrombus formation even in the absence of AF.
Evaluation of ChatGPT’s Response to Common Patient Questions for Total Ankle Arthroplasty
Authors: Gauthier Chase , Kung Justin , Bakaes Yianni , Gonzalez Tyler , Strasser Nicholas L. , Park Joseph , Jackson J. Benjamin 
Published: April 2024

Introduction/Purpose: Many patients use the internet as a source for medical information regarding their medical condition. However, the accuracy and reliability of the information is variable. The recent release of general population facing artificial intelligence (AI) chatbot programs has created a potential alternative medical information source for patients. Our study examined the accuracy of the information provided by ChatGPT for total ankle arthroplasty (TAA), as determined by four fellowship-trained foot and ankle orthopedic surgeons. Methods: GPT-4, the latest ChatGPT model, was asked the 12 of the most common questions patients have regarding TAA. Its responses were recorded and evaluated by four fellowship-trained foot and ankle orthopedic surgeons on a scale of 1 – 4, with 1 representing an excellent response not requiring clarification and 4 representing an unsatisfactory response requiring significant clarification. Averages of scores for each question were recorded and an average of every score was used to develop an overall accuracy score. Results: The overall accuracy score of GPT-4 was 1.35. The responses by GPT-4 received a score of 1 for 32 of 48 (66.7%) responses. There was found to be no significant difference in scores for any of GPT-4’s responses. Conclusion: Our study found that GPT-4 performed well in providing accurate and near complete information to commonly questions asked to physicians by patients regarding TAA. Our results suggest that AI models, like GPT-4, may be an effective alternative source of medical information for patients. Further study with subsequent AI models and direct patient interaction may shed further light on the utility of this potential patient education modality. ChatGPT Response Accuracy Score Accuracy scores for ChatGPT, as determined by four foot and ankle fellowship-trained orthopedic surgeons