bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of educational package and participatory consumer groups to improve food handling practices in food establishments in Sri Lanka
Authors: Hirimuthugoda Lasantha Krishan , De Silva Padmal , Abeykoon Palitha 
Published: February 2024

Objectives: Improper food handling contributes to many foodborne diseases and food outbreaks globally leading to witnessed morbidities and mortalities. The study aims to develop an educational package and participatory consumer groups to improve food handling practices among food handlers and in food establishments in the Regional Director of Health Services area, Kalutara, Sri Lanka. Methods: The study developed an educational package and participatory consumer groups to improve the food handling practices among food handlers and in food establishments. The critical knowledge gaps were identified during the first component of this study, which was conducted as a descriptive study, and the findings were further discussed in the Focus Group Discussion. Posters, info sheets, and workshops were used for educational packages, and four consumer groups were formed. The second component of the study following the development of the interventions was continued as a three-arm, non-randomized controlled community trial for 4 months in the Regional Director of Health Services, Kalutara. Results: The educational package for food handlers was introduced as a package of a workshop, info sheets, posters to display at workplaces, and short refresher training two weekly to direct good food handling practices in food establishments. Consumer groups were strengthened to exercise their legal rights on their purchases and the ratings showed improvements in the hygiene levels with repeated consecutive visits. Conclusions: The novel educational package and participatory consumer groups are designed and implemented to improve food handling practices among food handlers and in food establishments.
Splash of body fluids among healthcare support staff in Ghana: a cross-sectional study
Authors: Tawiah Philip Apraku , Appiah-Brempong Emmanuel , Okyere Paul , Ashinyo Mary Eyram 
Published: February 2024

Background: Exposure to splash of body fluids is one of the common ways of transmitting blood-borne infections from patients to healthcare practitioners. Globally, there is a paucity of evidence on exposure to splash of body fluids among hospital housekeepers. This study, therefore, investigated splash of body fluid and its predisposing factors among healthcare support staff in the Greater Accra region, Ghana. Methods: An analytic cross-sectional survey was conducted among support staff in 10 major hospitals between 30 January and 31 May 2023. A multi-stage sampling procedure was the overarching technique employed, and study participants were recruited through simple random and probability proportional-to-size sampling techniques. The data analyses were conducted using STATA 15 software. The preliminary association between exposure to splash of body fluids and predisposing factors was established through Chi-square, Fisher’s exact, and Mann–Whitney U tests. Log-binomial regression analyses were employed to validate the factors related to splash of body fluids at a significance level of p-value < 0.05. Results: The investigation was conducted among 149 healthcare support staff. The exposure to splash of body fluids over the past 1 year was 53.7% (95% CI: 45.3%–61.9%). The types of body fluids that were mostly encountered through these splash exposures were amniotic fluids (36.3%) and urine (23.8%). Several factors were found to be significantly associated with splash of body fluids, namely: employed as a healthcare assistant [APR = 1.61 (1.16, 2.22)], holding a supervisory position [APR = 0.24 (0.11, 0.51)], having a system in place for reporting body fluid splashes [APR = 0.61 (0.44, 0.85)], male healthcare support staff [APR = 0.62 (0.41, 0.93)], and adherence to standard precautions most of the time [APR = 1.66 (1.11, 2.48)]. Conclusion: Healthcare support staff were highly exposed to splash of body fluids. Gender, supervisory role, category of worker, reporting systems, and adherence to standard precautions were associated with exposure to splash of body fluids. Facility managers are advised to enhance the efficiency of reporting systems.
AO Spine Guideline for the Use of Osteobiologics (AOGO) in Anterior Cervical Discectomy and Fusion for Spinal Degenerative Cases
Authors: Meisel Hans Jörg , Jain Amit , Wu Yabin , Martin Christopher T. , Cabrera Juan Pablo , Muthu Sathish , Hamouda Waeel O. , Rodrigues-Pinto Ricardo , Arts Jacobus J. , Viswanadha Arun-Kumar , Vadalà Gianluca , Vergroesen Pieter-Paul A. , Ćorluka Stipe , Hsieh Patrick C. , Demetriades Andreas K. , Watanabe Kota , Shin John H. , Riew K. Daniel , Papavero Luca , Liu Gabriel , Luo Zhuojing , Ahuja Sashin , Fekete Tamás , Uz Zaman Atiq , El-Sharkawi Mohammad , Sakai Daisuke , Cho Samuel K. , Wang Jeffrey C. , Yoon Tim , Santesso Nancy , Buser Zorica 
Published: February 2024

Study design Guideline Objectives To develop an international guideline (AOGO) about the use of osteobiologics in anterior cervical discectomy and fusion (ACDF) for treating degenerative spine conditions. Methods The guideline development process was guided by AO Spine Knowledge Forum Degenerative (KF Degen) and followed the Guideline International Network McMaster Guideline Development Checklist. The process involved 73 participants with expertise in degenerative spine diseases and surgery from 22 countries. Fifteen systematic reviews were conducted addressing respective key topics and evidence was collected. The methodologist compiled the evidence into GRADE Evidence-to-Decision frameworks. Guideline panel members judged the outcomes and other criteria and made the final recommendations through consensus. Results Five conditional recommendations were created. A conditional recommendation is about the use of allograft, autograft or a cage with an osteobiologic in primary ACDF surgery. Other conditional recommendations are about the use of osteobiologic for single- or multi-level ACDF, and for hybrid construct surgery. It is suggested that surgeons use other osteobiologics rather than human bone morphogenetic protein-2 (BMP-2) in common clinical situations. Surgeons are recommended to choose 1 graft over another or 1 osteobiologic over another primarily based on clinical situation, and the costs and availability of the materials. Conclusion This AOGO guideline is the first to provide recommendations for the use of osteobiologics in ACDF. Despite the comprehensive searches for evidence, there were few studies completed with small sample sizes and primarily as case series with inherent risks of bias. Therefore, high-quality clinical evidence is demanded to improve the guideline.
Sex differences in clot, vessel and tissue characteristics in patients with a large vessel occlusion treated with endovascular thrombectomy
Authors: van der Meij Anne , Holswilder Ghislaine , Bernsen Marie Louise E , van Os Hendrikus JA , Hofmeijer Jeannette , Spaander Fianne HM , Martens Jasper M , van den Wijngaard Ido R , Lingsma Hester F , Konduri Praneeta R , BLM Majoie Charles , Schonewille Wouter J , Dippel Diederik WJ , Kruyt Nyika D , Nederkoorn Paul J , van Walderveen Marianne AA , Wermer Marieke JH 
Published: February 2024

Introduction: To improve our understanding of the relatively poor outcome after endovascular treatment (EVT) in women we assessed possible sex differences in baseline neuroimaging characteristics of acute ischemic stroke patients with large anterior vessel occlusion (LVO). Patients and methods: We included all consecutive patients from the MR CLEAN Registry who underwent EVT between 2014 and 2017. On baseline non-contrast CT and CT angiography, we assessed clot location and clot burden score (CBS), vessel characteristics (presence of atherosclerosis, tortuosity, size, and collateral status), and tissue characteristics with the Alberta Stroke Program Early Computed Tomography Score (ASPECTS). Radiological outcome was assessed with the extended thrombolysis in cerebral infarction score (eTICI) and functional outcome with the modified Rankin Scale score (mRS) at 90 days. Sex-differences were assessed with multivariable regression analyses with adjustments for possible confounders. Results: 3180 patients were included (median age 72 years, 48% women). Clots in women were less often located in the intracranial internal carotid artery (ICA) (25%vs 28%, odds ratio (OR) 0.85;95% confidence interval: 0.73–1.00). CBS was similar between sexes (median 6, IQR 4–8). Intracranial (aOR 0.73;95% CI:0.62–0.87) and extracranial (aOR 0.64;95% CI:0.43–0.95) atherosclerosis was less prevalent in women. Vessel tortuosity was more frequent in women in the cervical ICA (aOR 1.89;95% CI:1.39–2.57) and women more often had severe elongation of the aortic arch (aOR 1.38;95% CI:1.00–1.91). ICA radius was smaller in women (2.3vs 2.5 mm, mean difference 0.22;95% CI:0.09–0.35) while M1 radius was essentially equal (1.6vs 1.7 mm, mean difference 0.09;95% CI:−0.02–0.21). Women had better collateral status (⩾50% filling in 62%vs 53% in men, aOR 1.48;95% CI:1.29–1.70). Finally, ASPECT scores were equal between women and men (median 9 in both sexes, IQR 8–10vs 9–10). Reperfusion rates were similar between women and men (acOR 0.94;95% CI:0.83–1.07). However, women less often reached functional independence than men (34%vs 46%, aOR 0.68;95% CI:0.53–0.86). Discussion and conclusion: On baseline imaging of this Dutch Registry, men and women with LVO mainly differ in vessel characteristics such as atherosclerotic burden, extracranial vessel tortuosity, and collateral status. These sex differences do not result in different reperfusion rates and are, therefore, not likely to explain the worse functional outcome in women after EVT.
Severe asthma care trajectories: the French RAMSES cohort
Authors: Perotin Jeanne-Marie , Gauquelin Lisa , Just Nicolas , Devouassoux Gilles , Chenivesse Cécile , Bourdin Arnaud , Garcia Gilles , Saint Raymond Christel , Boudjemaa Amel , Bonniaud Philippe , Chanez Pascal , Barnig Cindy , Beurnier Antoine , Maurer Cyril , Freymond Nathalie , Didi Toufik , Tcherakian Colas , Russier Maud , Drucbert Mélanie , Guillo Sylvie , Estellat Candice , Taillé Camille 
Published: February 2024

BackgroundThe French RAMSES study is an observational prospective multicentre real-life cohort including severe asthmatic subjects. The objective of the study was to compare the characteristics of patients, in terms of phenotype and asthma care trajectories, between those managed by tertiary referral centres (TRCs) or secondary care centres (SCCs).MethodsPatients were prospectively recruited and enrolled for a 5-year follow-up. Patients’ characteristics were analysed at inclusion and compared between TRCs and SCCs.Results52 centres (24 TRCs and 28 SCCs) included 2046 patients: 1502 (73.4%) were included by a TRC and 544 (26.6%) by a SCC. Patients were mainly women (62%), 53±15 years old, 67% with Asthma Control Test <20; at inclusion, 14% received oral corticosteroids (OCS) and 66% biologics. Compared with the SCC group, the TRC group had more frequent comorbidities and lower blood eosinophil counts (262versus340 mm−3; p=0.0036). OCS and biologics use did not differ between groups, but patients in the TRC group benefited more frequently from an educational programme (26%versus18%; p=0.0008) and received more frequently two or more sequential lines of biologics (33%versus24%; p=0.0105). In-depth investigations were more frequently performed in the TRC group (allergy tests: 74%versus62%; p<0.0001; exhaled nitric oxide fraction: 56%versus21%; p<0.0001; induced sputum: 6%versus3%; p=0.0390).ConclusionsPhenotypes and care trajectories differed in the RAMSES cohort between SCCs and TRCs, probably related to different levels of asthma severity and differences in medical resources and practices among centres. This highlights the need for standardisation of severe asthma care.
Cluster analysis identifies novel real-world lung disease�pulmonary hypertension subphenotypes: implications for treatment response
Authors: Johnson Shelsey W. , Wang Rui-Sheng , Winter Michael R. , Gillmeyer Kari R. , Zeder Katarina , Klings Elizabeth S. , Goldstein Ronald H. , Wiener Renda Soylemez , Maron Bradley A. 
Published: February 2024

Background
Clinical trials repurposing pulmonary arterial hypertension (PAH) therapies to patients with lung disease- or hypoxia-pulmonary hypertension (PH) (classified as World Health Organization Group 3 PH) have failed to show a consistent benefit. However, Group 3 PH clinical heterogeneity suggests robust phenotyping may inform detection of treatment-responsive subgroups. We hypothesised that cluster analysis would identify subphenotypes with differential responses to oral PAH therapy.

Methods
Two k-means analyses were performed on a national cohort of US veterans with Group 3 PH; an inclusive model (I) of all treated patients (n=196) and a haemodynamic model (H) limited to patients with right heart catheterisations (n=112). The primary outcome was organ failure or all-cause mortality by cluster. An exploratory analysis evaluated within-cluster treatment effects.

Results
Three distinct clusters of Group 3 PH patients were identified. In the inclusive model (C1
I
n=43, 21.9%; C2
I
n=102, 52.0%; C3
I
n=51, 26.0%), lung disease and spirometry drove cluster assignment. By contrast, in the haemodynamic model (C1
H
n=44, 39.3%; C2
H
n=43, 38.4%; C3
H
n=25, 22.3%), right heart catheterisation data surpassed the importance of lung disease and spirometry. In the haemodynamic model, compared to C3
H
, C1
H
experienced the greatest hazard for respiratory failure or death (HR 6.1, 95% CI 3.2�11.8). In an exploratory analysis, cluster determined treatment response (p=0.006). Conclusions regarding within-cluster treatment responses were limited by significant differences between select variables in the treated and untreated groups.

Conclusions
Cluster analysis identifies novel real-world subphenotypes of Group 3 PH patients with distinct clinical trajectories. Future studies may consider this methodological approach to identify subgroups of heterogeneous patients that may be responsive to existing pulmonary vasodilatory therapies.
Overcoming genetic and cellular complexity to study the pathophysiology of X-linked intellectual disabilities
Authors: Martinez Dayne , Jiang Evan , Zhou Zhaolan 
Published: February 2024

AbstractX-linked genetic causes of intellectual disability (ID) account for a substantial proportion of cases and remain poorly understood, in part due to the heterogeneous expression of X-linked genes in females. This is because most genes on the X chromosome are subject to random X chromosome inactivation (XCI) during early embryonic development, which results in a mosaic pattern of gene expression for a given X-linked mutant allele. This mosaic expression produces substantial complexity, especially when attempting to study the already complicated neural circuits that underly behavior, thus impeding the understanding of disease-related pathophysiology and the development of therapeutics. Here, we review a few selected X-linked forms of ID that predominantly affect heterozygous females and the current obstacles for developing effective therapies for such disorders. We also propose a genetic strategy to overcome the complexity presented by mosaicism in heterozygous females and highlight specific tools for studying synaptic and circuit mechanisms, many of which could be shared across multiple forms of intellectual disability.
Characterization of indigenous populations of cannabis in Iran: a morphological and phenological study
Authors: Babaei Mehdi , Nemati Hossein , Arouiee Hossein , Torkamaneh Davoud 
Published: February 2024

AbstractBackgroundCannabis is a historically, culturally, and economically significant crop in human societies, owing to its versatile applications in both industry and medicine. Over many years, native cannabis populations have acclimated to the various environments found throughout Iran, resulting in rich genetic and phenotypic diversity. Examining phenotypic diversity within and between indigenous populations is crucial for effective plant breeding programs. This study aimed to classify indigenous cannabis populations in Iran to meet the needs of breeders and breeding programs in developing new cultivars.ResultsHere, we assessed phenotypic diversity in 25 indigenous populations based on 12 phenological and 14 morphological traits in male and female plants. The extent of heritability for each parameter was estimated in both genders, and relationships between quantitative and time-based traits were explored. Principal component analysis (PCA) identified traits influencing population distinctions. Overall, populations were broadly classified into early, medium, and late flowering groups. The highest extent of heritability of phenological traits was found in Start Flower Formation Time in Individuals (SFFI) for females (0.91) Flowering Time 50% in Individuals (50% of bracts formed) (FT50I) for males (0.98). Populations IR7385 and IR2845 exhibited the highest commercial index (60%). Among male plants, the highest extent of Relative Growth Rate (RGR) was observed in the IR2845 population (0.122 g.g− 1.day− 1). Finally, populations were clustered into seven groups according to the morphological traits in female and male plants.ConclusionsOverall, significant phenotypic diversity was observed among indigenous populations, emphasizing the potential for various applications. Early-flowering populations, with their high RGR and Harvest Index (HI), were found as promising options for inclusion in breeding programs. The findings provide valuable insights into harnessing the genetic diversity of indigenous cannabis for diverse purposes.
Quality of life in young patients with acute type a aortic dissection in China: comparison with Marfan syndrome and non-Marfan syndrome
Authors: Lin Xin-fan , Xie Lin-feng , Zhang Zhao-feng , He Jian , Xie Yu-ling , Dai Xiao-fu , Chen Liang-wan 
Published: February 2024

Abstract
Background
There is a paucity of Chinese studies evaluating the quality of life (QoL) in young acute type A aortic dissection (AAAD) patients with Marfan syndrome.

Methods
Young adult AAAD patients (younger than 45 years old) underwent surgical treatment at our institution from January 2017 to December 2020 were consecutive enrolled. The hospital survivors completed 1 year of follow up. Patients were divided into two groups according to the presence or absence of Marfan syndrome (MFS). A 1:1 propensity score matching (PSM) with a caliper 0.2 was conducted to balance potential bias in baseline. The follow-up data were analyzed primarily for change in quality of life and anxiety status.

Results
After PSM, 32 comparable pairs were matched. The baseline data were comparable and postoperative complications were similar between groups. In terms of SF-36 scale, the role physical, bodily pain, role emotional and mental health subscales were no significantly improved in MFS patients over time. At 1 year after discharged, the subscale of mental health and bodily pain were significantly lower in the MFS group than in the non-MFS group. In terms of HADS assessments, the level of anxiety in MFS patients was significantly higher than in non-MFS patients at 1 year after discharged.

Conclusions
The QoL in young AAAD patients with MFS is lower than those without MFS after surgery. This may be associated with the uncontrollable persistent chronic pain and the uncertainty and concerns for the disease’s progression.
Consequences of heterogeneity in aging: parental age at death predicts midlife all-cause mortality and hospitalization in a Swedish national birth cohort
Authors: Thalén Anna , Ledberg Anders 
Published: February 2024

Abstract
Background
The processes that underlie aging may advance at different rates in different individuals and an advanced biological age, relative to the chronological age, is associated with increased risk of disease and death. Here we set out to quantify the extent to which heterogeneous aging shapes health outcomes in midlife by following a Swedish birth-cohort and using parental age at death as a proxy for biological age in the offspring.

Methods
We followed a nationwide Swedish birth cohort (N = 89,688) between the ages of 39 and 66 years with respect to hospitalizations and death. Cox regressions were used to quantify the association, in the offspring, between parental age at death and all-cause mortality, as well as hospitalization for conditions belonging to the 10 most common ICD-10 chapters.

Results
Longer parental lifespan was consistently associated with reduced risks of hospitalization and all-cause mortality. Differences in risk were mostly evident from before the age of 50 and persisted throughout the follow-up. Each additional decade of parental survival decreased the risk of offspring all-cause mortality by 22% and risks of hospitalizations by 9 to 20% across the 10 diseases categories considered. The number of deaths and hospitalizations attributable to having parents not living until old age were 1500 (22%) and 11,000 (11%) respectively.

Conclusions
Our findings highlight that increased parental lifespan is consistently associated with health benefits in the offspring across multiple outcomes and suggests that heterogeneous aging processes have clinical implications already in midlife.