bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sociodemographic Factors and the Risk of Pediatric Out‐of‐Hospital Cardiac Arrest in Ontario, Canada: A Province‐Wide Case–Control Study
Authors: Idrees Samina , Anderson Kelly K. , Choi Yun‐Hee , Tijssen Janice A. 
Published: November 2023

Background
Pediatric out‐of‐hospital cardiac arrest (POHCA) is associated with significant mortality and poor neurological outcomes. We aimed to describe the association between sociodemographic factors and POHCA risk in Ontario, Canada.

Methods and Results
We conducted a province‐wide case–control study at ICES, where patient records are linked across administrative databases. The case group included children (aged 1 day to 17 years) who experienced an out‐of‐hospital cardiac arrest between 2004 and 2020. Controls were matched up to 1:4 on age, sex, index date, and key comorbidities. We used conditional logistic regression to measure the association between sociodemographic indicators and POHCA risk. The case and control groups included 1826 and 7254 children, respectively. Children living in areas with the highest levels of material deprivation (adjusted odds ratio [aOR], 2.35 [95% CI, 1.94–2.85]) and dependency (aOR, 1.22 [95% CI, 1.01–1.48]) had a higher odds of POHCA, relative to children living in regions with the lowest levels of material deprivation and dependency, respectively. Children living in neighborhoods with the lowest levels of ethnic diversity had a higher odds of POHCA (aOR, 1.62 [95% CI, 1.30–2.01]), relative to children living in neighborhoods with the highest levels of ethnic diversity. The odds of POHCA were lower in immigrants (aOR, 0.67 [95% CI, 0.47–0.95]), relative to the general population. Northern urban residence was associated with a higher odds of POHCA (aOR, 1.45 [95% CI, 1.13–1.87]), relative to southern urban residence.

Conclusions
Children living in neighborhoods with high levels of marginalization may have an elevated risk of experiencing POHCA. These findings highlight the importance of addressing disparities through targeted prevention and intervention efforts.
Non-Operative Approach to Contained Perforated Marginal Ulcers: A Systematic Review and Case Series
Authors: Pope Rand , English Wayne , Walden Rachel L. , Bradley Emma , Spann Matthew , Ardila-Gatas Jessica , Broucek Joseph , Williams Brandon , Samuels Jason M. 
Published: November 2023

Background Perforated marginal ulcers (PMUs) are a rare but known complication of bariatric surgery. Management typically involves prompt surgical intervention, but limited data exists on non-operative approaches. This study reviews published data on non-operative management of PMUs and presents a case series of patients who were managed non-operatively. Our hypothesis is that certain patients with signs of perforation can be successfully managed non-operatively with close observation. Methods We completed a systematic review searching PubMed, Embase, Web of Science, Cochrane, and clinicaltrials.gov. Ultimately 3 studies described the presentation and non-operative management of 5 patients. Additionally, we prospectively collected data from our institution on all patients who presented between Dec. 2022 and Dec. 2023 with PMUs confirmed on imaging and managed non-operatively. Results In our literature review, three patients had Roux-en-Y gastric bypass (RYGB), while two had one anastomosis gastric bypass. One patient required surgery two days after admission. Another underwent elective conversion surgery weeks later for a non-healing ulcer. Two received endoscopic interventions. One patient recovered with nil-per-os (NPO) status, and intravenous proton pump inhibitor (PPI) treatment. The patients in our case series presented with normal vital signs, an average of 30 months after RYGB, and with CT scan signs of perforation. None of these patients required surgical or endoscopic intervention. Conclusion In conclusion, while perforated marginal ulcers have traditionally been considered a surgical emergency, some patients can be successfully treated with non-operative management. More research is needed to identify the clinical presentation features, comorbidities, and imaging findings of this group.
Mitigating Infection Risk in Upper Airway Stimulation
Authors: Ali Naushin S. , Fitzpatrick IV Thomas H. , Islam Albina S. , Nord Ryan S. 
Published: November 2023

Objective: This study aims to define the incidence of infection with upper airway stimulation (UAS) devices requiring explantation in a single academic center and identify factors that may influence the risk of infection. Methods: A database of patients who underwent UAS at a single tertiary referral academic center from 2017 to 2021 was retrospectively reviewed to identify patients who developed surgical site infections, with and without subsequent explantation. Additional data for cases complicated by infection was extracted from the electronic medical record (EMR) and included: demographic information, medical history, complications and management, and overall outcomes. In March 2021, 2 modifications to infection control protocols were implemented: double skin preparation with Betadine and chlorhexidine, and MRSA decolonization. Statistical analysis was performed to compare infectious risk before and after these protocol changes. Results: In the study period, 215 patients underwent UAS in the specified time period and 3 cases (1.4%) of postoperative infections were identified, all of which required explantation. The infection rate did not significantly change after modifications to the surgical prep protocol ( P = .52). Conclusions: While no significant difference in infection risk was noted after modifying infection control protocols, additional longer-term study is warranted to elucidate effective infection reduction strategies.
Role of Lymphovascular Invasion in Oral Cavity Squamous Cell Carcinoma Regional Metastasis and Prognosis
Authors: Moore Abigail E. , Alvi Sameer A. , Tarabichi Osama , Zhu Vivian L. , Buchakjian Marisa R. 
Published: November 2023

Objective: The overall 5-year survival for oral squamous cell carcinoma (OSCC) has not changed in the last 20 years despite advances in treatment. Lymphovascular invasion (LVI) has been shown to be a negative prognostic factor in other cancers, however its role in the prognosis of OSCC remains unclear. This study aims to determine if LVI is a predictor of cervical lymph node metastasis and/or recurrence in OSCC. Methods: We conducted a retrospective cohort review of patients from our institutional cancer registry who were treated for OSCC between 2004 and 2018. Patient demographics, surgical pathology results, and clinical outcome data were collected. A multivariable logistic regression analysis was performed to determine if LVI was an independent predictor of cervical lymph node metastasis and/or recurrence. Results: 442 patients were included, 32.8% were female and median age at time of diagnosis was 61.2 years. LVI was present in 32.8% of patients. When controlled for age, sex, t-classification, perineural invasion, depth of invasion (DOI), and margin status, LVI was a significant predictor of the presence of cervical node metastasis (OR: 3.42, CI: 2.17-5.39, P < .001). There was no significant association found between LVI and local recurrence (OR: 1.03, CI: 0.57-1.84, P = .92), regional recurrence (OR: 1.10, CI: 0.57-2.11, P = .78), or distant recurrence (OR: 1.59, CI: 0.87-2.94, P = .13). Conclusion: The results of this study suggest that LVI is a significant predictor of the presence of cervical lymph node metastasis at presentation independent of other known prognostic factors. LVI, however, was not found to be a significant independent predictor of locoregional or distant recurrence. Level of Evidence: Level III
Alternative metrics for characterizing longer-term clinical outcomes in difficult-to-treat depression: II. Sensitivity to treatment effects
Authors: Aaronson Scott T , Sackeim Harold A , Jiang Mei , Badejo Sarah , Greco Teresa , Bunker Mark T , Conway Charles R , Demyttenaere Koen , Young Allan H , McAllister-Williams R Hamish , Rush A John 
Published: November 2023

Objective: Characteristics of difficult-to-treat depression (DTD), including infrequent symptom remission and poor durability of benefit, compel reconsideration of the outcome metrics historically used to gauge the effectiveness of antidepressant interventions. Methods: Self-report and clinician assessments of depression symptom severity were obtained regularly over a 2-year period in a difficult-to-treat depression registry sample receiving treatment as usual (TAU), with or without vagus nerve stimulation (VNS). Alternative outcome metrics for characterizing symptom change were compared in effect size and discriminating power in distinguishing the vagus nerve stimulation + treatment as usual and treatment as usual treatment groups. We expected metrics based on remission status to produce weaker between-group separation than those based on the classifications of partial response or response and metrics that integrate information over time to produce greater separation than those based on single endpoint assessment. Results: Metrics based on remission status had smaller effect size and poorer discrimination in separating the treatment groups than metrics based on partial response or response classifications. Metrics that integrated information over the 2-year observation period had stronger performance characteristics than those based on symptom scores at single endpoint assessment. For both the clinician-rated and self-report depression ratings, the metrics with the strongest performance characteristics were the median percentage change in symptom scores over the observation period and the proportion of the observation period in partial response or better. Conclusion: In difficult-to-treat depression, integrative symptom severity-based and time-based measures are sensitive and informative outcomes for assessing between-group treatment effects, while metrics based on remission status are not.
Apna Store and E-commerce: Meeting Consumer Needs During COVID-19
Authors: Kapoor Sheetal , Sivadas Eugene 
Published: November 2023

Apna Store, a family-owned ‘kirana’ neighbourhood grocery store in suburban New Delhi, India, offers a diverse selection of 15,000 products. This case revolves around its owner, Mr Jagmohan Trehan, who faces a pivotal decision due to the ongoing COVID-19 pandemic: whether to revamp the store’s product range and venture into e-commerce. The pandemic has dramatically altered consumer behaviour, with a surge in online grocery shopping. E-commerce vendors’ enticing promotions and the entry of Reliance Jio with a unique business model have presented opportunities and challenges to Mr Trehan and the kirana store industry, the backbone of India’s retail sector. In March 2020, the pandemic prompted panic buying and shifts in consumer preferences, compelling Apna Store to adapt during the lockdown. As online grocery shopping gained traction, the idea of entering e-commerce emerged, but with reservations. In April 2021, as India faced another pandemic wave, consumers became more comfortable with online grocery shopping, and e-commerce operators improved supply chains and delivery. This case centres on whether Apna Store should embrace e-commerce and the associated costs and benefits.
Availability and Readability Level of Online Patient Education Materials Provided by Cleft Lip and Palate Teams
Authors: Powell Lauren E. , Bien Erica M. , Cohen Jade M. , Barta Ruth J. 
Published: November 2023

Objectives Evaluate the readability of online English and Spanish cleft lip and palate patient education materials. Design Review of free online materials Setting English and Spanish language online patient education materials on cleft lip and palate were collected from American Cleft Palate-Craniofacial Association (ACPA) approved teams. Participants American Cleft Palate-Craniofacial Association (ACPA) approved teams Interventions English materials were analyzed using the Flesch-Kincaid, SMOG, and Coleman-Liau readability calculators. Spanish materials were analyzed using the Fry Graph, Fernandez Huerta, and INFLESZ calculators. A one-way analysis of variance (ANOVA) was used to test for variability between the readability tools. Outcomes Readability levels were examined for both sets of materials. Results 171 (90.5%) teams provided English language materials online, with an average readability score calculated as 10.5 ± 2.9 (10th-11th grade). A total of 44 (23.2%) teams listed Spanish language materials online, with average readability score of 7.9 ± 1.2 (8th grade). ANOVA demonstrated statistically significant variability between the readability assessment tools ( P < .01). Conclusion Online cleft lip and palate patient education material provided by ACPA craniofacial teams were more available in English than in Spanish. Both sets of materials demonstrated readability levels above the recommended 6th-7th grade. Refining readability is associated with lowered healthcare costs and increased patient satisfaction.
Efficacy of facemasks in preventing transmission of COVID-19 in non-healthcare settings: A scoping review
Authors: Enright Chloe , Gilbourne Claire , Kiersey Rachel , Parlour Randal , Flanagan Paula , McGowan Emer , Boland Mairin , Mulholland Deirdre 
Published: November 2023

Background During the COVID-19 pandemic, an abundance of literature relating to the efficacy of face masks on reducing transmission of COVID-19 in non-healthcare settings emerged. Aim/objective The aim of this scoping review was to allow the identification of: types of evidence conducted in this area; knowledge gaps and common concepts relating to mask efficacy in non-healthcare settings. Methods A comprehensive literature search was conducted in PubMed, CINAHL, MEDLINE, Embase and the Irish Management Institute bibliographic database on December 15th, 2021. All types of face masks were included. Of 722 records, 16 were included after full text screening. Findings/results Themes from an adapted model of Howard et al. framework were used to group results and identify common concepts. The grouped thematic results were then applied to the socio-ecological model. This illustrated the multifactorial elements determining the efficacy of masks themselves while also illustrating how other factors such as individual behaviours, social interactions, settings and national policy can influence the degree of the protective effect. Discussion The findings from this scoping review indicate that an abundance of experimental literature is available indicating that masks are effective at preventing COVID-19 transmission but their degree of efficacy is impacted by external factors. This review highlights that the quality of the evidence available is low.
Detecting the most critical clinical variables of COVID-19 breakthrough infection in vaccinated persons using machine learning
Authors: Daramola Olawande , Kavu Tatenda Duncan , Kotze Maritha J , Kamati Oiva , Emjedi Zaakiyah , Kabaso Boniface , Moser Thomas , Stroetmann Karl , Fwemba Isaac , Daramola Fisayo , Nyirenda Martha , van Rensburg Susan J , Nyasulu Peter S , Marnewick Jeanine L 
Published: November 2023

Background COVID-19 vaccines offer different levels of immune protection but do not provide 100% protection. Vaccinated persons with pre-existing comorbidities may be at an increased risk of SARS-CoV-2 breakthrough infection or reinfection. The aim of this study is to identify the critical variables associated with a higher probability of SARS-CoV-2 breakthrough infection using machine learning. Methods A dataset comprising symptoms and feedback from 257 persons, of whom 203 were vaccinated and 54 unvaccinated, was used for the investigation. Three machine learning algorithms – Deep Multilayer Perceptron (Deep MLP), XGBoost, and Logistic Regression – were trained with the original (imbalanced) dataset and the balanced dataset created by using the Random Oversampling Technique (ROT), and the Synthetic Minority Oversampling Technique (SMOTE). We compared the performance of the classification algorithms when the features highly correlated with breakthrough infection were used and when all features in the dataset were used. Result The results show that when highly correlated features were considered as predictors, with Random Oversampling to address data imbalance, the XGBoost classifier has the best performance (F1 = 0.96; accuracy = 0.96; AUC = 0.98; G-Mean = 0.98; MCC = 0.88). The Deep MLP had the second best performance (F1 = 0.94; accuracy = 0.94; AUC = 0.92; G-Mean = 0.70; MCC = 0.42), while Logistic Regression had less accurate performance (F1 = 0.89; accuracy = 0.88; AUC = 0.89; G-Mean = 0.89; MCC = 0.68). We also used Shapley Additive Explanations (SHAP) to investigate the interpretability of the models. We found that body temperature, total cholesterol, glucose level, blood pressure, waist circumference, body weight, body mass index (BMI), haemoglobin level, and physical activity per week are the most critical variables indicating a higher risk of breakthrough infection. Conclusion These results, evident from our unique data source derived from apparently healthy volunteers with cardiovascular risk factors, follow the expected pattern of positive or negative correlations previously reported in the literature. This information strengthens the body of knowledge currently applied in public health guidelines and may also be used by medical practitioners in the future to reduce the risk of SARS-CoV-2 breakthrough infection.
Novel method combining multiscale attention entropy of overnight blood oxygen level and machine learning for easy sleep apnea screening
Authors: Liang Zilu 
Published: November 2023

Objective Sleep apnea is a common sleep disorder affecting a significant portion of the population, but many apnea patients remain undiagnosed because existing clinical tests are invasive and expensive. This study aimed to develop a method for easy sleep apnea screening. Methods Three supervised machine learning algorithms, including logistic regression, support vector machine, and light gradient boosting machine, were applied to develop apnea screening models at two apnea–hypopnea index cutoff thresholds: [Formula: see text] 5 and [Formula: see text] 30 events/hours. The SpO2 recordings of the Sleep Heart Health Study database ( N = 5786) were used for model training, validation, and test. Multiscale entropy analysis was performed to derive a set of multiscale attention entropy features from the SpO2 recordings. Demographic features including age, sex, body mass index, and blood pressure were also used. The dependency among the multiscale attention entropy features were handled with the independent component analysis. Results For cutoff [Formula: see text] 5/hours, logistic regression model achieved the highest Matthew’s correlation coefficient (0.402) and area under the curve (0.747), and reasonably good sensitivity (75.38%), specificity (74.02%), and positive predictive value (92.94%). For cutoff [Formula: see text] 30/hours, support vector machine model achieved the highest Matthew’s correlation coefficient (0.545) and area under the curve (0.823), and good sensitivity (82.00%), specificity (82.69%), and negative predictive value (95.53%). Conclusions Our models achieved better performance than existing methods and have the potential to be integrated with home-use pulse oximeters.
The Art of Asking Good Questions in the Classroom: A Phenomenographic Study of Teacher Educators’ Recommendations
Authors: Soysal Yilmaz , Soysal Somayyeh 
Published: November 2023

Purpose This study has two objectives. The first is to describe the conceptual diversification embedded in reported documentation of teacher educators regarding the conception/phenomenon of good question-asking. Second, based on systematically observed and qualitatively analyzed diversifications, this study aims to portray the conceptual sophistication of participants’ experience-based awareness of good question-asking by constructing a hierarchical illustration. Design/Approach/Methods A total of 56 participants were selected based on a maximum variation strategy to capture more diversified conceptions of good question-asking. Qualitative data were collected through one-on-one phenomenographic interviews. Inductive data analysis was conducted in three phases: open coding (extracting ways of experiencing), axial coding (collapsing categories of descriptions), and diagrammatizing (establishing an outcome space). Findings Seven conceptual meaning clusters were gathered around four hierarchically sophisticated themes: monological (level-1 sophistication, “lowest”) (diagnostic tool), declarative (level-2 sophistication) (cognitive-emotional, pre-organizer), dialogical (level-3 sophistication) (structural qualities, typological qualities, multivocality, negotiation, internalization), and metacognitive (level-4 sophistication, “highest”) (pedagogical content knowledge of question-asking and teachers’ meta-noticing regarding question-asking). Originality/Value Participants’ conceptions of good question-asking showed monological and dialogical dimensions in addition to transitional (declarative) and metacognitive comprehensions. Educational recommendations are offered, especially for developing teacher educators’ question-asking noticing.
Exploring Compatibility Issues Between International Faculty and Their Host Environment: A Case of a Local National University in Japan
Authors: Kotake (小竹雅子) Masako 
Published: November 2023

Purpose The number of international faculty members in universities is increasing worldwide, and Japan is no exception. However, despite this quantitative expansion, these faculty remain peripheral. Though recent studies have identified various challenges faced by international faculty, they have focused on international faculty's individual experiences and have lacked perspectives from the host institution. To more accurately understand the challenges facing international faculty, this study aims to uncover compatibility issues between these faculty and their host environment. Design/Approach/Methods In this study, I adopted a qualitative case study approach targeting a local national university in Japan. Seven international and six Japanese faculty members were interviewed. Findings The analysis revealed various issues underlying the problems faced by international faculty, including new challenges arising from recent national university reforms. The compatibility issues they experienced can be categorized into the following six areas: organizational goals, systems and practices for hiring and evaluating faculty, division of roles between international and Japanese faculty, organizational support for international faculty, organizational culture and atmosphere, and Japanese society's overall system and values. Originality/Value This study responds to a crucial academic need to understand the host institution's perspective on international faculty recruitment by providing new evidence of the challenges facing international faculty and their host institution in a low-resource environment in the midst of reforms.