bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Unilateral Alveolar Bone Grafting on Nasal Volume and Nasolabial Surface: A 3D Analysis
Authors: Sijmons W.J.L. , Krijt L.L. , Bruggink R. , Ongkosuwito E.M. , Kuijpers M.A.R. 
Published: December 2023

Objective To determine possible effects of unilateral alveolar cleft closure on internal nasal volume and external nasolabial surface. Design Retrospective, single-arm, cohort study. Setting Institutional, tertiary care. Patients Patients with complete unilateral cleft lip, alveolus, and palate (CUCLAP), who underwent closure of the alveolar cleft with autologous bone graft (ABG) at the age of 9–11 years, with cone beam computed tomography (CBCT) and/or three-dimensional (3D) stereophotogrammetry images taken before and one year after the ABG procedure. Interventions ABG-pocedure in patients with CUCLAP. Main Outcome Measures The influence of ABG on the internal and external nasal morphology. Results A total of 28 patients (21M/7F, 14R/14L) were divided into internal (CBCT) and external (3D-stereophotogrammetry) measurement subgroups. The external nasolabial surface showed a significant decrease of the angle alar curvature right–subnasale–alar curvature left (−1.99°; P = .02; 95% CI −2.61, −0.36) and an increase of the linear measurement between these points (+1.01 mm; P = .03; 95% CI: 0.11, 1.91). No significant differences were found when comparing the distance maps of the affected side with the non-affected side ( P = .50, 95% CI: −0.20, 0.29). Conclusions Closure of the alveolar cleft in CUCLAP patients with ABG did not affect the internal nasal volume, but significantly affected the external nasal surface. The procedure resulted in the nose becoming wider because both alar curvatures moved caudally and laterally relative to the subnasale.
Evaluation of a Novel Objective Method for The Assessment of Nasal Symmetry Among Patients with Unilateral Cleft Lip
Authors: Ezra Liron , Bar Droma Eitan , Baransi Aamer , Friger Michael , Silberstein Eldad 
Published: December 2023

Objective This is a cross sectional study aimed to asses novel semi objectve compter assisted method to asses the symmetry amog unilateral cleft lip patients. Design using Standard inferior view nose photos that were uploaded to Digimizer© Version 4.6.1 (2005–2016 MedCalc Software) Image Analysis, symmetry percentage was calculated and compared between cleft and non-cleft neonates. This method was compared to two subjective methods of rating symmetry. Setting This a cross sectional pilot study performed in the Univresity Medical Center using standard inferior views of unilateral cleft patients which were compared to non-cleft neonates. Patients Photographs of 71 neonates with unilateral complete and incomplete cleft lip and 30 neonates without facial cleft, which were born at the university medical center, Beer Sheba, Israel, were analyzed in a standard manner to determine nasal symmetry. Main measures the novel method proposed produced a nominal value for percentage of symmetry. Results Using Pearson's correlation test we found intra-rater reliability of 91.2% (p < 0.001) and Inter-rater reliability of 82.9% (p < 0.001). The analysis correlated with the surgeons subjective scores in both the numerical ranking method at 73% (p < 0.001) and 72.6% (p < 0.001) and the Ordinal ranking method at 87.6% (p < 0.001) and 77.7% (p < 0.001). The ability of the method to discriminate healthy from Cleft Lip patients overall was 92.3% With high sensitivity and specificity. Conclusions This method accurately distinguishes healthy patients from cleft lip patients. We have achieved High levels of inter and intra-rater reliability. Significant correlations were found between our semiobjective method and the subjective scores.
Recasting the gold standard – part I of II: delineating healthcare options across a continuum of care
Authors: Englar Ryane E 
Published: December 2023

Aim This is the first part of a two-part series on spectrum of care that encourages practitioners to embrace a non-binary approach to healthcare delivery. When care is not framed as all-or-none, either/or or best versus lesser, the provider and client can agree to diagnostic and/or treatment plans that individualize the practice of veterinary medicine. Care is tailored to the patient along a continuum of acceptable options. Care may also be intentionally incremental, with plans to reassess the patient and revise case management as needed. Relevance Acknowledgment and ultimately acceptance that patient care journeys can be distinct, yet equitably appropriate, offers providers the flexibility to adapt case management competently and confidently to the patient based upon contextualized circumstances including client needs, wants and expectations for healthcare outcomes. Thinking outside the box to recast the historic gold standard with a continuum of care strategically offers feline practitioners a means by which they can overcome barriers to healthcare delivery. Series outline This first article introduces spectrum of care as an appropriate approach to case management and broadens its definition beyond cost of care. Part II explores communication strategies that enhance veterinary professionals’ delivery of spectrum of care through open exchange of relationship-centered dialogue.
Comparison of optical aberrations in keratoconus with scleral versus rigid gas permeable lenses
Authors: Knoeri Juliette , Mhenni Rania , Friquet Chloé , Hage Alexandre , Cuyaubère Roxane , Borderie Marie , Leveziel Loïc , Bouheraoua Nacim , Borderie Vincent 
Published: December 2023

Purpose to assess optical aberrations under scleral (SL) versus rigid gas permeable (RGP) lenses in patients with keratoconus. Methods A prospective study including 25 eyes of 14 patients. The best-corrected visual acuity (BCVA) with corrective glasses, RGP and SL, stage of keratoconus (Amsler-Krumeich classification), minimum pachymetry, maximum keratometry, and corneal higher-order aberrations (i.e, total HOAs, coma, and trefoil) with RGP and with SL were collected. Aberrometry was performed using iTrace® aberrometer (Tracey Technologies, USA). Results 80% of the included keratoconus patients were stage 4, with a mean age of 34.3 years (±8.8). There were no significant differences in mean BCVA (logMAR) between SL and RGP. The mean BCVAs were significantly better both with SL (p < 0.0001) and RGP (p < 0.0001) compared with corrective glasses. Total HOAs (p = 0.01), coma (p = 0.003) and trefoil (p = 0.008) were significantly lower with SL compared with RGP. The BCVA decreased with the stage of keratoconus in SL (p = 0.01) and RGP (p = 0.02). The BCVA decreased with decreasing minimum pachymetry in SL (p = 0.02) and RGP (p = 0.002), and with increasing maximum keratometry in SL (p = 0.02) and RGP (p = 0.01). Significant correlations were found between BCVA, total HOAs (p = 0.008), and coma (p = 0.02) in SL. Conclusion For the same keratoconus patients, total higher order, coma and trefoil optical aberrations were reduced with scleral lenses compared to rigid gas permeable lenses.
Investigation of the safety and effectiveness of accelerated contact lens-assisted corneal cross-linking (A-CACXL) in thin corneas
Authors: Karaca Gulderen , Yurttaser Ocak Serap 
Published: December 2023

Purpose To determine the safety and effectiveness of accelerated contact lens-assisted corneal crosslinking (A-CACXL) as an alternative method in progressive keratoconus patients with thin corneas. Methods In our retrospective study, 31 eyes from 25 patients with progressive keratoconus that with a minimum corneal thickness of 400 µm or less after epithelial debridement underwent A-CACXL with a follow-up 6 months or more were included. The main outcome measures were uncorrected distance(UDVA) and corrected distance(CDVA) visual acuities, manifest sphere(D) and manifest cylinder(D) refraction values, K1(D), K2(D), Kmax(D), mean keratometry(D) values, minimum corneal thickness(μm) and endothelial cell count(cells/mm2). These outcome measurements were statistically analyzed at preoperative and postoperative 1 month, 3 months, and 6 months follow-ups. Results 31 eyes from 25 patients with the mean follow-up period of 7.7 ± 2.7 months were included. Data revealed a significant increase in CDVA(p = 0.053). There is no statistically significant change in UDVA, K1, mean keratometry, mean manifest sphere value, minimum corneal thickness and endothelial cell count .(respectively p:0.053, p: 0.333, p: 0,129, p:0.490, p: 0,467, p:0.035, p:0.102). There is a statistically significant decrease in the K2, Kmax and mean manifest cylinder values.(respectively p: 0,030, p < 0,001, p < 0,001). Conclusion A-CACXL method is a safe and effective method to stop keratoconic progression and improve functional vision in patients with thin corneas. However, larger randomised controlled studies are needed to validate these findings.
A phase 2a open-label clinical trial to determine the effect of famciclovir on EBV activity as measured by EBV shedding in the saliva of patients with multiple sclerosis
Authors: Dobson Ruth , Holden David , Vickaryous Nicola , Bestwick Jonathan , George Katila , Sayali Tatiana , Bianchi Lucia , Wafa Mohammad , Gold Julian , Giovannoni Gavin 
Published: December 2023

Background: Despite increasing evidence that Epstein–Barr virus (EBV) plays a causal role in MS, no treatments have been shown to reduce EBV turnover. We studied the effect of famciclovir on salivary EBV shedding in people with MS (NCT05283551) in a pilot, proof-of-concept study. Methods: People with MS receiving natalizumab provided weekly saliva samples for 12 weeks before starting famciclovir 500 mg twice daily for 12 weeks. Twelve saliva samples were provided on treatment and 12 following treatment. A real-time qPCR Taqman assay was used to detect EBV DNA in saliva. The proportion of saliva samples containing EBV DNA was compared using the Friedman test. Results: Of 30 participants (19 F; mean age 41 years; median EDSS 3.5), 29 received famciclovir, and 24 completed the 12-week course. Twenty-one participants provided at least one usable saliva sample in all epochs. Ten of the 21 had shedding in at least one sample pre-drug; 7/21 when taking famciclovir (not significant). No difference in EBV DNA copy number was seen. There were no drug-related serious adverse events. Conclusion: No significant effect of famciclovir on EBV shedding was seen in this small pilot study. Given the low numbers, a small effect of famciclovir cannot be excluded. Salivary EBV shedding in this natalizumab-treated cohort was lower than in previous studies, which requires replication.
Drivers of telemedicine in primary care clinics at a large academic medical centre
Authors: Parameswaran Vijaya , Koos Harrison , Kalwani Neil , Qureshi Lubna , Rosengaus Leah , Dash Rajesh , Scheinker David , Rodriguez Fatima , Johnson Cati-Brown , Stange Kurt , Aron David , Lyytinen Kalle , Sharp Christopher 
Published: December 2023

Background COVID-19 disrupted healthcare routines and prompted rapid telemedicine implementation. We investigated the drivers of visit modality selection (telemedicine versus in-person) in primary care clinics at an academic medical centre. Methods We used electronic medical record data from March 2020 to May 2022 from 13 primary care clinics ( N = 21,031 new, N = 207,292 return visits), with 55% overall telemedicine use. Hierarchical logistic regression and cross-validation methods were used to estimate the variation in visit modality explained by the patient, clinician and visit factors as measured by the mean-test area under the curve (AUC). Results There was significant variation in telemedicine use across clinicians (ranging from 0–100%) for the same visit diagnosis. The strongest predictors of telemedicine were the clinician seen for new visits (mean AUC of 0.79) and the primary visit diagnosis for return visits (0.77). Models based on all patient characteristics combined accounted for relatively little variation in modality selection, 0.54 for new and 0.58 for return visits, respectively. Amongst patient characteristics, males, patients over 65 years, Asians and patient's with non-English language preferences used less telemedicine; however, those using interpreter services used significantly more telemedicine. Conclusion Clinician seen and primary visit diagnoses were the best predictors of visit modality. The distinction between new and return visits and the minimal impact of patient characteristics on visit modality highlights the complexity of clinical care and warrants research approaches that go beyond linear models to uncover the emergent causal effects of specific technology features mediated by tasks, people and organisations.
The experiences of people living with dementia and their care partners participating in an online therapeutic songwriting program
Authors: Clark Imogen , Christopher Neha , Stretton-Smith Phoebe , Lawson Kathleen 
Published: December 2023

Background and Aim Despite the impact of dementia on close care relationships, accessible therapeutic services for people living with dementia and their care partners remain scarce. Further, there is an increasing demand for online services, highlighting the need for ongoing telehealth research. This study aimed to explore the experiences of people living with dementia and their informal and formal care partners following participation in a 10-week online therapeutic songwriting program. Methods The songwriting program included four duo and six group sessions facilitated by a music therapist. Post-program semi-structured interviews were analysed using thematic analysis. Findings Nine people with dementia and six care partners (nine duos) participated in the program. Five duos were in spousal relationships and four people with dementia participated with a formal care partner. Participants attended an average of four duo sessions and three group sessions. Six people with dementia and five care partners participated in post-program interviews. Four themes were developed: (1) No one else does this; (2) It’s all about us as people; (3) After the sessions we’d come out buzzing; and (4) The journey was as important as the product. Conclusions Participants highlighted songwriting as a unique opportunity to connect with music, experience welcomed challenges, and spend ‘real time’ together. The program drew on participants’ lived experience and promoted connection with others, resulting in feelings of enjoyment, enhanced mood, and achievement. Participants valued both the songwriting process and song product, emphasising the importance of sensitive and skilful facilitation. Our findings suggest that these distinct benefits were not available through other support services. Further, online songwriting is a viable option for people living with dementia and their care partners where in-person sessions are not available or accessible.
Enhancement of hydrophobicity in natural rubber vulcanizates using diatomaceous earth
Authors: Dissanayake Sachini Narmada , De Silva Kanishka , Egodage Shantha Maduwage , Blum Frank Dennis , Maddumaarachchi Madhubhashini 
Published: December 2023

This study discusses an approach that gives the Natural Rubber (NR) vulcanizates an elevated hydrophobic character. The method used a chemically treated filler called diatomaceous earth (DE) to deliver the hydrophobic characteristics to NR. DE has a nanoscale roughness. It was chemically treated with hexadecyltrimethoxy silane to obtain low surface energy. The combination of nanoscale roughness and low surface energy gave superhydrophobic properties to DE. A series of treated-DE was made with varying silane percentages to find an optimum silane to DE ratio to get the maximum possible hydrophobicity. The optimum ratio was recorded as 38% w/w, and the treated DE displayed a superhydrophobic water contact angle (WCA) of 152°. The treated-DE was added to the rubber as a filler during the compounding process. The filler was added in varying amounts of 5 phr, 10 phr, 15 phr, and 20 phr to observe the changes in the hydrophobic property. The wettability and morphology of developed vulcanizates were measured using WCA measurements and scanning electron microscope (SEM) analysis, respectively. NR compounded with 20 phr filler exhibited an enhanced WCA of 136°, compared to the WCA of 92° of the NR vulcanizate with no treated-DE, and displayed improved tensile, and tear properties.
Integrating long-acting reversible contraceptives into primary care internal medicine practices: A clinical innovation to reduce wait time
Authors: Quinn Sheila M , Goldfarb Terry Rebecca , Boock Shelby , Shea Judy A 
Published: December 2023

Background: Long-acting reversible contraception (LARC) has long been regarded as highly effective and safe. However, access is limited and lengthy when specialty referrals are required. Objectives: To integrate LARC services into an urban internal medicine primary care practice to decrease wait time for LARC procedures. Design/methods: This pre–post with control group study took place at two large urban academic primary care practices (Practices A and B) and included patients ages 18 to 45 years assigned female sex at birth. Pre-implementation baseline data were collected retrospectively from 2019 to 2020 by identifying subjects who requested LARC insertion or removal via their primary care practice and were referred to Obstetrics and Gynecology (Ob/Gyn) for the procedure. Wait time was noted from time of initial request in the medical record to time of procedure. Practice A developed an integrated primary care LARC program in which one of their LARC-trained providers began offering these procedures within their own practice. All other providers within the practice were educated on how to counsel patients about the devices and procedures. Practice B did not have an in-house LARC provider and continued referring patients to Ob/Gyn. Post-implementation data were collected prospectively 2021–2022. Results: Ninety-one patients in Practice A experienced a significant decrease in wait time (87 vs 21 days, p < 0.001) over the observation period, with a majority undergoing procedures on their first visit with the in-house LARC provider. Wait time for the 54 patients in Practice B remained unchanged (57 vs 47 days, p = .59), often requiring multiple specialty visits. Conclusion: Integrating LARC services into a primary care internal medicine practice can significantly reduce wait times for these procedures with the potential to contribute to increased reproductive and menstrual autonomy.
A diagnostic model for distinguishing between active tuberculosis and latent tuberculosis infection based on the blood expression profiles of autophagy-related genes
Authors: Wang Chengbin , Hua Jie , He Xiaopu , Chen Liang , Lv Shuhan 
Published: December 2023

Background: Autophagy is closely involved in the control of mycobacterial infection. Objectives: Here, a diagnostic model was developed using the levels of autophagy-related genes (ARGs) in the blood to differentiate active tuberculosis (ATB) and latent tuberculosis infection (LTBI). Design: Secondary data analysis of three prospective cohorts. Methods: The expression of ARGs in patients with ATB and LTBI were analyzed using the GSE37250, GSE19491, and GSE28623 datasets from the GEO database. Results: Twenty-two differentially expressed ARGs were identified in the training dataset GSE37250. Using least absolute shrinkage and selection operator and multivariate logistic regression, three ARGs ( FOXO1, CCL2, and ITGA3) were found that were positively associated with adaptive immune-related lymphocytes and negatively associated with myeloid and inflammatory cells. A nomogram was constructed using the three ARGs. The accuracy, consistency, and clinical relevance of the nomogram were evaluated using receiver operating characteristic curves, the C-index, calibration curves, and validation in the datasets GSE19491 and GSE28623. The nomogram showed good predictive performance. Conclusion: The nomogram was able to accurately differentiate between ATB and LTBI patients. These findings provide evidence for future study on the pathology of autophagy in tuberculosis infection.
Clinicopathological insights into an outbreak of foodborne botulism in Hamadan, Iran, in 2023: A microbiological and laboratory findings
Authors: Sadeghian Zohre , Torkaman Asadi Fatemeh 
Published: December 2023

Background and Objective: Foodborne botulism is one of the potentially fatal forms of food poisoning, usually caused by ingestion of home-canned vegetables, fruits, and dairy and fish products. This study aimed to assess the frequency of signs and symptoms in patients with botulism following the ingestion of homemade Doogh, a traditional milk-based beverage, in Hamadan, Iran in 2023. We also examined the general characteristics of the recruited patients. Methods: During an outbreak, 21 patients were referred to the hospital because of food poisoning. All patients had a history of consumption of Doogh. After careful physical examination, all of them were hospitalized. Botulism was suspected in all patients except for the first patient. Results: The mean age of admitted patients was 33.09 ± 18.44 years, with 23.80% being males and 76.20% females. Incubation period in our patients was 68 ± 28.48 h. Notable symptoms included diplopia (95.23%), nausea and vomiting (85.71%), blurred vision (80.95%), and dizziness (61.90%). The laboratory results were within the normal range. No deaths occurred in this patient cohort. Furthermore, botulinum spores were detected in Doogh samples collected from the outbreak, confirming the presence of Clostridium botulinum spores as a source of the outbreak. Conclusions: This study highlights that the initial manifestations of botulism predominantly involved ophthalmologic abnormalities in most patients. Additionally, symptoms such as nausea, vomiting, and dizziness may manifest in cases of foodborne botulism. Timely diagnosis and treatment of botulism following the consumption of homemade Doogh played a crucial role in achieving positive outcomes, with no fatalities recorded in this patient cohort.
Acute Anaplasma phagocytophilum infection in a pediatric domestic cat
Authors: Graham Molly , Ewing Patty , Whelan Megan 
Published: December 2023

Case summary A domestic shorthair cat estimated to be 4–6 weeks old was presented to a referral center for evaluation of lethargy, anorexia and diarrhea for a duration of 24 h. A feline vector-borne PCR panel, as well as a blood smear, examined by a board-certified pathologist, confirmed an Anaplasma phagocytophilum infection. Morulae were identified in both feline neutrophils and eosinophils. Treatment consisted of a 21-day course of liquid doxycycline. Clinical signs rapidly resolved and were not noted to recur. Relevance and novel information This case demonstrates that A phagocytophilum can infect cats as young as 4–6 weeks old. Doxycycline, as the antibiotic of choice for the treatment of A phagocytophilum infections, was used. Consistent with the literature, a rapid clinical improvement was detected. Anaplasmosis should be listed as a differential diagnosis in pediatric cats suffering from acute febrile illness with potential previous tick exposure (history of living outdoors) in order to provide proper treatment.