bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using instrumental variables to correct for bias in real-world cohort studies of the effects of disease-modifying treatment in MS
Authors: Koch-Henriksen Nils Iørgen , Thygesen Lau Caspar , Sørensen Per Soelberg , Magyari Melinda 
Published: October 2023

Background: Estimating the effect of disease-modifying treatment of MS in observational studies is impaired by bias from unmeasured confounders, in particular indication bias. Objective: To show how instrumental variables (IVs) reduce bias. Methods: All patients with relapsing onset of MS 1996–2010, identified by the nationwide Danish Multiple Sclerosis Registry, were followed from onset. Exposure was treatment index throughout the first 12 years from onset, defined as a cumulative function of months without and with medium- or high-efficacy treatment, and outcomes were hazard ratios (HRs) per unit treatment index for sustained Expanded Disability Scale Score (EDSS) 4 and 6 adjusted for age at onset and sex, without and with an IV. We used the onset cohort (1996–2000; 2001–2005; 2006–2010) as an IV because treatment index increased across the cohorts. Results: We included 6014 patients. With conventional Cox regression, HRs for EDSS 4 and 6 were 1.15 [95% CI: 1.13–1.18] and 1.17 [1.13–1.20] per unit treatment index. Only with IVs, we confirmed a beneficial effect of treatment with HRs of 0.86 [0.81–0.91] and 0.82 [0.74–0.90]. Conclusion: The use of IVs eliminates indication bias and confirms that treatment is effective in delaying disability. IVs could, under some circumstances, be an alternative to marginal structural models.
Cannabis Use in Patients With Distal Radius Fractures: A Moment of Unity?
Authors: Livesey Michael G. , Bains Sandeep S. , Stern Jonathan M. , Chen Zhongming , Dubin Jeremy A. , Monárrez Rubén , Remily Ethan A. , Ingari John V. 
Published: October 2023

Background: As legalization of cannabis spreads, an increasing number of patients who use cannabis are being seen in the clinical setting. This study examined the impact of cannabis and tobacco use on postoperative complications following open reduction and internal fixation (ORIF) of distal radius fractures. Methods: A national, all-payer database was queried to identify patients who underwent ORIF of a distal radius fracture between 2015 and 2020 (n = 970 747). Patients were stratified into the following groups: (1) tobacco use (n = 86 941), (2) cannabis use (n = 898), (3) tobacco and cannabis use (n = 9842), and (4) neither tobacco nor cannabis use (“control”, 747 892). Multivariable logistic regression was used to identify risk factors for infection, nonunion, and malunion within the first postoperative year. Results: Concomitant use of tobacco and cannabis was associated with a higher rate of nonunion (5.0%) compared to tobacco or cannabis use alone ( P < .001). Multivariate analysis identified cannabis-only use (odds ratio [OR] 1.25), tobacco-only use (OR 2.17), and concurrent tobacco and cannabis use (OR 1.78) as risk factors for infection within the first postoperative year. Similarly, cannabis-only use (OR 1.47), tobacco-only use (OR 1.92), and concurrent tobacco and cannabis use (OR 2.52) were associated with an increased risk of malunion. Conclusions: Cannabis use is associated with an elevated risk of infection and malunion following operative management of a distal radius fracture. Concomitant use of cannabis and tobacco poses an elevated risk of nonunion and malunion compared to tobacco use alone.
Needs assessment in community-dwelling older adults toward digital interventions to promote physical activity: Cross-sectional survey study
Authors: Weber Manuel , Schmitt Kai-Uwe , Frei Anja , Puhan Milo A , Raab Anja M 
Published: October 2023

Background Tackling physical inactivity represents a key global public health challenge. Strategies to increase physical activity (PA) are therefore warranted. Despite the rising availability of digital interventions (DIs), which offer tremendous potential for PA promotion, there has been inadequate attention to the special needs of older adults. Objective The aim was to investigate community-dwelling older adults’ needs, requirements, and preferences toward DIs to promote PA. Methods The target population of this cross-sectional study was community-dwelling older adults (≥60 years old) within German-speaking Switzerland. Potential respondents were informed about the study and sent a link to a self-developed and self-administered online survey by our cooperating institutions. Results Overall, 922 respondents who completed the online survey were included in the final analysis. The mean age of the sample was 72 years (SD 6.4, range 60–98). The preferred delivery mode of DIs to promote PA was a website (428/922, 46.4%) and 80.3% (740/922) preferred video-based structures. Most respondents expressed the need for personal access, personal goals, personal messages, and a personal contact in case of problems or questions (585/817, 71.6%; 546/811, 67.3%; 536/822, 65.2%; 536/822, 65.2%). Memory training, psychological wellbeing, and nutrition were mainly rated as relevant additional content of DIs to promote PA (690/849, 81.2%; 661/845, 78.2%, 619/849, 72.9%). Conclusion Community-dwelling older adults may be willing to use DIs to promote PA in the long term, but this study identified particular needs and requirements in terms of design, technological realization, delivery mode, support, and individualization/personalization among the sample. Our results can inform future developments of DIs to promote PA specifically tailored to older adults. However, caution is warranted in interpreting the findings due to the sample's high PA and education levels.
Cervical cancer detection using K nearest neighbor imputer and stacked ensemble learningmodel
Authors: Chen Xiaoyuan , Aljrees Turki , Umer Muhammad , Saidani Oumaima , Almuqren Latifah , Mzoughi Olfa , Ishaq Abid , Ashraf Imran 
Published: October 2023

Objective Cervical cancer stands as a leading cause of mortality among women in developing nations. To ensure the reduction of its adverse consequences, the primary protocols to be adhered to involve early detection and treatment under the guidance of expert medical professionals. An effective approach for identifying this form of malignancy involves the examination of Pap smear images. However, in the context of automating cervical cancer detection, many of the existing datasets frequently exhibit missing data points, a factor that can substantially impact the effectiveness of machine learning models. Methods In response to these hurdles, this research introduces an automated system designed to predict cervical cancer with a dual focus: adeptly managing missing data while attaining remarkable accuracy. The system's core is built upon a stacked ensemble voting classifier model, which amalgamates three distinct machine learning models, all harmoniously integrated with the KNN Imputer to address the issue of missing values. Results The model put forth attains an accuracy of 99.41%, precision of 97.63%, recall of 95.96%, and an F1 score of 96.76% when incorporating the KNN imputation method. The investigation conducts a comparative analysis, contrasting the performance of this model with seven alternative machine learning algorithms in two scenarios: one where missing values are eliminated, and another employing KNN imputation. This study offers validation of the effectiveness of the proposed model in comparison to current state-of-the-art methodologies. Conclusions This research delves into the challenge of handling missing data in the dataset utilized for cervical cancer detection. The findings have the potential to assist healthcare professionals in achieving early detection and enhancing the quality of care provided to individuals affected by cervical cancer.
A virtual reality physical activity pattern assessment: Mixed crossover experiments and cluster analysis
Authors: Zhang Texi , Xiao Xiaoyue , Mao Jie 
Published: October 2023

Objective The subjects’ physical activity levels and enjoyment of exercise after 15 min of virtual reality (VR) physical activity of different intensities were compared. Methods Thirty-two subjects were selected for a mixed crossover experiment. They were randomly assigned to exercise in three VR games with different exercise intensities. Acceleration data of the subjects were collected and subjects’ exercise enjoyment and exercise levels were compared. The subjects’ emotional efficacy and arousal during exercise were measured and evaluated using the Feeling Scale (FS) and the Felt Arousal Scale (FAS), and the acceleration data were evaluated by clustering using the fuzzy c-mean (FCM) clustering algorithm. Results A one-way ANOVA was performed on FS and FAS before and after VR physical activity, P overall p = .003 in FS, before and after low-intensity (LI), medium-intensity (MI), and high-intensity (HI) VR physical activity, the p-values were.087, p = .027, and p = .021, respectively. p < .001 in FAS, before and after LI, MI, and HI VR physical activity, the p-values were .029, < .001, < .001. According to the FCM clustering of acceleration activity counts by LI, MI, and HI, the clustering centers of the right arm acceleration counts were 2016.77, 6118.31, and 9923.45; the clustering centers of the right thigh acceleration counts were 248.30, 1895.22, and 3485.60; and the clustering centers of the combined upper and lower limb acceleration counts were 1443.83, 4415.47, and 7149.13. Conclusion VR physical activity enhances subjects’ sense of enjoyment of exercise and emotional arousal, with moderate intensity VR physical activity having the best effect. VR physical activity is skewed toward high upper-extremity activity and low lower-extremity activity. The combined intensity of VR physical activity matches that of traditional exercise, and it can achieve the workout effect of the traditional workout modality.
Occlusal Contact Changes With Traumatic Occlusion After Orthodontic Treatment: A Prospective Study
Authors: Sowmithra Devi S  , Sundari Shantha 
Published: October 2023

Aim: The aim of this study was to evaluate trauma from occlusion in patients undergoing orthodontic treatment through assessment of fremitus, pocket depth, gingival biotype, and occlusal contacts pre-orthodontic treatment (T0) and post-orthodontic treatment (T1). Materials and Methods: This prospective randomized trial included 40 participants selected based on a simple random sampling method, of which 27 were women and 13 were men with ages ranging from 25 to 40 years. All the participants were clinically checked for gingival recession, fremitus, pocket depth, gingival biotype, and occlusal contacts obtained via digital intraoral scans and fed to 3Shape software to perform the occlusal mapping analysis for pre-orthodontic treatment (T0) and post-orthodontic treatment (T1). T-Scan occlusal analysis was performed to check the force levels pertaining to each tooth. A paired t-test was done to find out the changes in fremitus, pocket depth, gingival biotype, and number of occlusal contacts between T0 and T1. Results: Results of paired t-tests showed a statistically significant difference for fremitus between T0 and T1 ( p < .05). Gingival biotype and pocket depth did not show any improvement post-orthodontic treatment (T1) ( p > .05). Number of traumatic occlusal contacts reduced at T1 for incisors and canines showing a statistically significant difference between T0 and T1 ( p < .05). Conclusion: Orthodontic treatment helps in relieving the traumatic occlusal contacts, especially in the incisors and canine regions. As the teeth are relieved from traumatic occlusal contacts, fremitus also has shown to have drastically improved at the end of orthodontic treatment. Gingival biotype and pocket depth might take a longer time to regenerate and improve, which requires long-term observation.
Beyond the Workshop: Results From a Longitudinal, Interprofessional Teaching Certificate Program
Authors: Winn Ariel S , Huth Kathleen , Leichtner Alan M , Newman Lori R 
Published: October 2023

OBJECTIVES While most hospital-based, healthcare professionals are expected to teach and supervise, few receive training in education. We designed, implemented, and evaluated an interprofessional, hospital-based teaching certificate program based on experiential learning and reflective practice for healthcare professionals with little or no formal training in education. METHODS Participants attended educational seminars; incorporated new concepts, skills, and behaviors in their teaching; and submitted written reflections. Participants also met with an education coach, received feedback from a trained observer, and observed a “master teacher.” We used descriptive statistics to analyze a survey distributed to the 2017–2019 cohort. We also analyzed written reflections to determine whether participants described a new teaching skill, concept, or behavior, and how they applied these to their teaching. RESULTS Survey completion rate was 15/20 (75%). Participants described feeling connected to an educator community, establishing educational alliances with senior educators, and learning teaching strategies from other certificate members outside their own profession. Participants indicated they are more likely to pursue educational innovation, leadership, and scholarship. In the reflections, 88% described incorporating a new concept in their teaching. CONCLUSION Participants in an interprofessional teaching certificate program engaged in a curriculum of professional development in education. Graduates of the program reported knowledge gain, behavior change, and establishment of educational alliances and a community of practice.
Implementation of a bundle to improve HIV testing during hospitalization for people who inject drugs
Authors: D. Grussing Emily , Pickard Bridget , Khalid Ayesha , Smyth Emma , Childs Victoria , Zubiago Julia , Nunez Hector , Jung Amanda , Morales Yoelkys , Daudelin Denise H. , Wurcel Alysse G. 
Published: October 2023

Background Increased HIV testing is essential to ending the HIV epidemic. People who inject drugs (PWID) are among the highest risk for HIV infection. Previous research at Tufts Medical Center identified low HIV testing rates in hospitalized PWID. Our research team aimed to identify and overcome barriers to inpatient HIV screening of PWID using implementation science methods. Methods Stakeholders were engaged to gather perspectives on barriers and facilitators of HIV testing. A PWID care bundle was developed and implemented, which included (1) HIV screening; (2) hepatitis A, B, and C testing and vaccination; (3) medications for opioid use disorder; and (4) naloxone prescription. Strategies from all nine Expert Recommendations for Implementing Change (ERIC) clusters guided the implementation plan. Stakeholder feedback was gathered throughout implementation, and implementation outcomes of acceptability and feasibility were assessed. Results PWID overall felt comfortable with HIV testing being offered while hospitalized. Clinicians cited that the main barriers to HIV testing were discomfort and confusion around consenting requirements. Many resident physicians surveyed reported that, at times, they forgot HIV testing for PWID. Overall, though, resident physicians felt that the PWID bundle was useful and did not distract from other patient care responsibilities. Conclusions Engagement of key stakeholders to increase HIV testing in an inpatient setting led to the implementation of a PWID bundle, which was feasible and acceptable. Bundling evidence-informed care elements for inpatient PWID should be investigated further.
Antioxidant system was triggered to alleviate salinity stress by cytokinin oxidase/dehydrogenase gene GhCKX6b-Dt in cotton
Authors: Liu Mengyue , Cui Yupeng , Peng Fanjia , Wang Shuai , Cui Ruifeng , Liu Xiaoyu , Zhang Yuexin , Huang Hui , Fan Yapeng , Jiang Tiantian , Feng Xixian , Lei Yuqian , Ni Kesong , Han Mingge , Chen Wenhua , Meng Yuan , Wang Junjuan , Chen Xiugui , Lu Xuke , Wang Delong , Guo Lixue , Zhao Lanjie , Jiang Jing , Ye Wuwei 
Published: October 2023

AbstractCytokinin oxidase/dehydrogenase (CKX) is a key regulatory enzyme for the irreversible degradation of the plant hormone cytokinin (CK), which is important in growth and development and response to abiotic stresses in cotton. In this study, 27, 28, 14 and 14 CKXs were screened by FAD structural domain and cytokinin binding structural domain in Gossypium hirsutum, Gossypium barbadense, Gossypium arboreum and Gossypium raimondii, respectively. Their phylogenetic relationships and expression patterns were analyzed, and most GhCKXs were found to be tissue-specific and responsive to various abiotic stresses such as cold, heat, salt and PEG. GhCKX6b-Dt was selected for gene silencing in evolutionary branch II for salt stress, because its expression increased after salt stress in cotton plants. An increase in PRO and MDA content and a decrease in SOD activity due to this gene were found after inducing salt stress, contributing to oxidative damage and decreased salt tolerance. In this study, CKXs were analyzed to reveal the possible role of GhCKXs against abiotic stresses in cotton, which provides a basis for further understanding of the biological functions of CK in plants such as growth and development and stress resistance.
DrugRep-HeSiaGraph: when heterogenous siamese neural network meets knowledge graphs for drug repurposing
Authors: Ghorbanali Zahra , Zare-Mirakabad Fatemeh , Salehi Najmeh , Akbari Mohammad , Masoudi-Nejad Ali 
Published: October 2023

AbstractBackgroundDrug repurposing is an approach that holds promise for identifying new therapeutic uses for existing drugs. Recently, knowledge graphs have emerged as significant tools for addressing the challenges of drug repurposing. However, there are still major issues with constructing and embedding knowledge graphs.ResultsThis study proposes a two-step method called DrugRep-HeSiaGraph to address these challenges. The method integrates the drug-disease knowledge graph with the application of a heterogeneous siamese neural network. In the first step, a drug-disease knowledge graph named DDKG-V1 is constructed by defining new relationship types, and then numerical vector representations for the nodes are created using the distributional learning method. In the second step, a heterogeneous siamese neural network called HeSiaNet is applied to enrich the embedding of drugs and diseases by bringing them closer in a new unified latent space. Then, it predicts potential drug candidates for diseases. DrugRep-HeSiaGraph achieves impressive performance metrics, including an AUC-ROC of 91.16%, an AUC-PR of 90.32%, an accuracy of 84.63%, a BS of 0.119, and an MCC of 69.31%.ConclusionWe demonstrate the effectiveness of the proposed method in identifying potential drugs for COVID-19 as a case study. In addition, this study shows the role of dipeptidyl peptidase 4 (DPP-4) as a potential receptor for SARS-CoV-2 and the effectiveness of DPP-4 inhibitors in facing COVID-19. This highlights the practical application of the model in addressing real-world challenges in the field of drug repurposing. The code and data for DrugRep-HeSiaGraph are publicly available athttps://github.com/CBRC-lab/DrugRep-HeSiaGraph.
Profiles and integration of the gut microbiome and fecal metabolites in severe intrahepatic cholestasis of pregnancy
Authors: Li Xiang , Xie Han , Chao Jia-jing , Jia Yuan-Hui , Zuo Jia , An Yan-peng , Bao Yi-Rong , Jiang Xiang , Ying Hao 
Published: October 2023

Abstract
Background
The pathogenesis of intrahepatic cholestasis of pregnancy (ICP) remains unknown. The gut microbiome and its metabolites play important roles in bile acid metabolism, and previous studies have indicated the association of the gut microbiome with ICP.

Methods
We recruited a cohort of 5100 participants, and 20 participants were enrolled in the severe ICP group, matched with 20 participants in the mild ICP group and 20 controls. 16S rRNA sequencing and nontargeting metabolomics were adapted to explore the gut microbiome and fecal metabolites.

Results
An increase in richness and a dramatic deviation in composition were found in the gut microbiome in ICP. Decreased Firmicutes and Bacteroidetes abundances and increased Proteobacteria abundances were found in women with severe but not mild ICP compared to healthy pregnant women. Escherichia-Shigella and Lachnoclostridium abundances increased, whereas Ruminococcaceae abundance decreased in ICP group, especially in severe ICP group. The fecal metabolite composition and diversity presented typical variation in severe ICP. A significant increase in bile acid, formate and succinate levels and a decrease in butyrate and hypoxanthine levels were found in women with severe ICP. The MIMOSA model indicated that genera Ruminococcus gnavus group, Lachnospiraceae FCS020 group, and Lachnospiraceae NK4A136 group contributed significantly to the metabolism of hypoxanthine, which was significantly depleted in subjects with severe ICP. Genus Acinetobacter contributed significantly to formate metabolism, which was significantly enriched in subjects with severe ICP.

Conclusions
Women with severe but not mild ICP harbored a unique gut microbiome and fecal metabolites compared to healthy controls. Based on these profiles, we hypothesized that the gut microbiome was involved in bile acid metabolism through metabolites, affecting ICP pathogenesis and development, especially severe ICP.
Comparison of different ratios of propofol-ketamine admixture in rapid-sequence induction of anesthesia for emergency laparotomy: a randomized controlled trial
Authors: Elsherbiny Mona , Hasanin Ahmed , Kasem Sahar , Abouzeid Mohamed , Mostafa Maha , Fouad Ahmed , Abdelwahab Yaser 
Published: October 2023

Abstract
Background
We aimed to compare the hemodynamic effect of two ratios of propofol and ketamine (ketofol), namely 1:1 and 1:3 ratios, in rapid-sequence induction of anesthesia for emergency laparotomy.

Methods
This randomized controlled study included adult patients undergoing emergency laparotomy under general anesthesia. The patients were randomized to receive either ketofol ratio of 1:1 (n = 37) or ketofol ratio of 1:3 (n = 37). Hypotension (mean arterial pressure < 70 mmHg) was managed by 5-mcg norepinephrine. The primary outcome was total norepinephrine requirements during the postinduction period. Secondary outcomes included the incidence of postinduction hypotension, and the intubation condition (excellent, good, or poor).

Results
Thirty-seven patients in the ketofol-1:1 and 35 patients in the ketofol 1:3 group were analyzed. The total norepinephrine requirement was less in the ketofol-1:1 group than in the ketofol-1:3 group, P-values: 0.043. The incidence of postinduction hypotension was less in the ketofol-1:1 group (4 [12%]) than in ketofol-1:3 group (12 [35%]), P-value 0.022. All the included patients had excellent intubation condition.

Conclusion
In patients undergoing emergency laparotomy, the use of ketofol in 1:1 ratio for rapid-sequence induction of anesthesia was associated with less incidence of postinduction hypotension and vasopressor consumption in comparison to the 1:3 ratio with comparable intubation conditions.

Clinical trial registration
NCT05166330. URL: https://clinicaltrials.gov/ct2/show/NCT05166330.