bluuebunny/crossref_metadata_2025_split huggingface dataset:
The design of the Deaf in Touch Everywhere (DITE)TM mobile application with Deaf and interpreter communities in Malaysia
Authors: Chong Vee Yee , Yong Chong Chun , Ng Jennifer , Thanabalasingam Dhaanyah , Watterson Jessica L , Palanisamy Uma Devi 
Published: February 2024

Background Ineffective communication with Deaf individuals in healthcare settings has led to poor outcomes including miscommunication, waste, and errors. To help address these challenges, we developed a mobile app, Deaf in Touch Everywhere (DITETM) which aims to connect the Deaf community in Malaysia with a pool of off-site interpreters through secure video conferencing. Objectives The aims of this study were to (a) assess the feasibility and acceptability of measuring unified theory of acceptance and use of technology (UTAUT) constructs for DITETM with the Deaf community and Malaysian sign language (BIM) interpreters and (b) seek input from Deaf people and BIM interpreters on DITETM to improve its design. Methods Two versions of the UTAUT questionnaire were adapted for BIM interpreters and the Deaf community. Participants were recruited from both groups and asked to test the DITE app features over a 2-week period. They then completed the questionnaire and participated in focus group discussions to share their feedback on the app. Results A total of 18 participants completed the questionnaire and participated in the focus group discussions. Ratings of performance expectancy, effort expectancy, facilitating conditions and behavioural intention were high across both groups, and suggestions were provided to improve the app. High levels of engagement suggest that measurement of UTAUT constructs with these groups (through a modified questionnaire) is feasible and acceptable. Conclusions The process of engaging end users in the design process provided valuable insights and will help to ensure that the DITETM app continues to address the needs of both the Deaf community and BIM interpreters in Malaysia.
Linguistic Disparities in Diabetes Care Quality in California Community Health Centers Before and During the COVID-19 Pandemic
Authors: Ramos Oscar V. , Brown Timothy T. , Rodriguez Hector P. 
Published: February 2024

Background: Disparities in diabetes care quality may have increased for patients with limited English language proficiency (LEP) compared to non-LEP patients during the COVID-19 pandemic. Changes in diabetes care quality for adult LEP and non-LEP patients of community health centers (CHCs) were examined from 2019 to 2020. Methods: Adults with Type 2 diabetes (n = 15 965) of 88 CHC sites in California and with 1+ visit/year in 2019 and 2020 from OCHIN electronic health record data were included. Multivariable regression models estimated the association of LEP status and changes in diabetes care quality from 2019 to 2020, controlling for patient sociodemographic and clinical characteristics. Interaction terms (LEP × 2020) were used to estimate differential over time changes in (1) blood pressure screening, (2) blood pressure control (<140/90 mm Hg), and (3) hemoglobin A1c control (HbA1c <8%) for LEP versus non-LEP patients. Results: LEP and non-LEP patients with diabetes had comparable blood pressure screening and control in 2019 and in 2020. LEP patients were less likely than non-LEP patients to have their HbA1c under control in 2019 (OR = 0.85, 95% CI = 0.77, 0.96, P = .006) and 2020 (OR = 0.83, 95% CI = 0.75, 0.92, P = .001). There were no differential changes in HbA1c control over time for LEP and non-LEP patients. Discussion: Although LEP patients were less likely than non-LEP patients to have their HbA1c under control, CHCs maintained quality of care equally for LEP and non-LEP patients with diabetes during the early pandemic period.
Impact of Healthcare Location Concordance on Receipt of Preventive Care Among Children Whose Parents have a Substance Use and/or Mental Health Diagnosis
Authors: Martwick Joshua , Kaufmann Jorge , Bailey Steffani , Angier Heather , Huguet Nathalie , Heintzman John , O’Malley Jean , Moreno Laura , DeVoe Jennifer E. 
Published: February 2024

Aims: Children of parents with substance use and/or other mental health (SU/MH) diagnoses are at increased risk for health problems. It is unknown whether these children benefit from receiving primary care at the same clinic as their parents. Thus, among children of parents with >1 SU/MH diagnosis, we examined the association of parent-child clinic concordance with rates of well-child checks (WCCs) and childhood vaccinations. Design: Retrospective cohort study using electronic health record (EHR) data from the OCHIN network of community health organizations (CHOs), 2010-2018. Setting: 280 CHOs across 17 states. Participants/Cases: 41,413 parents with >1 SU/MH diagnosis, linked to 65,417 children aged 0 to 17 years, each with >1 visit to an OCHIN clinic during the study period. Measurements: Dependent variables: rates of WCCs during (1) the first 15 months of life, and (2) ages 3 to 17 years; vaccine completeness (3) by the age of 2, and (4) before the age of 18. Estimates were attained using generalized estimating equations Poisson or logistic regression. Findings: Among children utilizing the same clinic as their parent versus children using a different clinic (reference group), we observed greater WCC rates in the first 15 months of life [adjusted rate ratio (aRR) = 1.06; 95% confidence interval (CI) = 1.02-1.10]; no difference in WCC rates in ages 3 to 17; higher odds for vaccine completion before age 2 [adjusted odds ratio (aOR) = 1.12; 95% CI = 1.03-1.21]; and lower odds for vaccine completion before age 18 (aOR = 0.88; 95% CI = 0.81-0.95). Conclusion: Among children whose parents have at least one SU/MH diagnosis, parent-child clinic concordance was associated with greater rates of WCCs and higher odds of completed vaccinations for children in the youngest age groups, but not the older children. This suggests the need for greater emphasis on family-oriented healthcare for young children of parents with SU/MH diagnoses; this may be less important for older children.
Does Technological Innovation Promote Renewable Energy Investment?
Authors: Zhao Qian , Su Chi-Wei , Guo Jun-Mo 
Published: February 2024

Technological innovation ( TI) is conducive to economic growth, but whether it promotes the development of renewable energy remains controversial. This study aims to analyze the interrelation between TI and renewable energy investment ( REI) to see how to promote the coordinated development of TI and REI. By using the bootstrap rolling-window subsample Granger causality test and the sample from January 2010 to July 2022 in China, we find that the influence of a country’s overall TI level on REI is twofold. On the one hand, the increase in a country’s overall TI level has a positive influence on REI by reducing the renewable energy risk. On the other hand, TI can reduce REI by bringing more demand for relatively stable non-renewable energy. Conversely, REI has both positive and negative influences on a country’s overall TI level. Additional REI promotes renewable energy-related TI, but it may crowd out the investment in other fields and impede TI. Based on these results, policymakers intended to achieve sustainable development should encourage renewable energy TI, which is conducive to reducing the risk of renewable energy. In addition, policymakers should pay attention to REI’s role in crowing out the investment in other fields, and take measures to promote TI of the whole society. JEL Classification: C32, O32, Q2.
Baldia Factory Fire Tragedy: A Black Spot for Workplace Safety Standards in Pakistan
Authors: Rafay Abdul 
Published: February 2024

Background: The Baldia Factory (BF) fire incident in Pakistan was among the most tragic workplace fires in the world claiming the lives of more than 259 people. Methods: A case study was conducted to evaluate the state of the safety measures, firefighting systems, building regulations, employees’ documentation, and compensation structures. Results: The case study found many deficiencies in the fire safety program and lack of adherence to and enforcement of existing fire regulations. Conclusion: Findings are discussed in the context of fire safety regulations and enforcement in low- and middle-income countries such as Pakistan.
The AO Spine Thoracolumbar Injury Classification System and Treatment Algorithm in Decision Making for Thoracolumbar Burst Fractures Without Neurologic Deficit
Authors: Kweh Barry T. S. , Tee Jin Wee , Dandurand Charlotte , Vaccaro Alexander R. , Lorin Benneker M. , Schnake Klaus , Vialle Emiliano , Rajasekaran Shanmuganathan , El-Skarkawi Mohammad , Bransford Richard J. , Kanna Rishi M. , Aly Mohamed M. , Holas Martin , Canseco Jose A. , Muijs Sander , Popescu Eugen C. , Camino-Willhuber Gaston , Joaquim Andrei F. , Chhabra Harvinder S. , Bigdon Sebastian Frederick , Spiegel Ulrich , Dvorak Marcel , Öner Cumhur F. , Schroeder Gregory 
Published: February 2024

Study Design Prospective Observational Study. Objective To determine the alignment of the AO Spine Thoracolumbar Injury Classification system and treatment algorithm with contemporary surgical decision making. Methods 183 cases of thoracolumbar burst fractures were reviewed by 22 AO Spine Knowledge Forum Trauma experts. These experienced clinicians classified the fracture morphology, integrity of the posterior ligamentous complex and degree of comminution. Management recommendations were collected. Results There was a statistically significant stepwise increase in rates of operative management with escalating category of injury ( P < .001). An excellent correlation existed between recommended expert management and the actual treatment of each injury category: A0/A1/A2 (OR 1.09, 95% CI 0.70-1.69, P = .71), A3/4 (OR 1.62, 95% CI 0.98-2.66, P = .58) and B1/B2/C (1.00, 95% CI 0.87-1.14, P = .99). Thoracolumbar A4 fractures were more likely to be surgically stabilized than A3 fractures (68.2% vs 30.9%, P < .001). A modifier indicating indeterminate ligamentous injury increased the rate of operative management when comparing type B and C injuries to type A3/A4 injuries (OR 39.19, 95% CI 20.84-73.69, P < .01 vs OR 27.72, 95% CI 14.68-52.33, P < .01). Conclusions The AO Spine Thoracolumbar Injury Classification system introduces fracture morphology in a rational and hierarchical manner of escalating severity. Thoracolumbar A4 complete burst fractures were more likely to be operatively managed than A3 fractures. Flexion-distraction type B injuries and translational type C injuries were much more likely to have surgery recommended than type A fractures regardless of the M1 modifier. A suspected posterior ligamentous injury increased the likelihood of surgeons favoring surgical stabilization.
Interobserver Reliability in the Classification of Thoracolumbar Fractures Using the AO Spine TL Injury Classification System Among 22 Clinical Experts in Spine Trauma Care
Authors: Canseco Jose A. , Paziuk Taylor , Schroeder Gregory D. , Dvorak Marcel F. , Öner Cumhur F. , Benneker Lorin M. , Vialle Emiliano , Rajasekaran Shanmuganathan , El-Sharkawi Mohammad , Bransford Richard J. , Kanna Rishi M. , Holas Martin , Muijs Sander , Popescu Eugen Cezar , Dandurand Charlotte , Tee Jin W. , Camino-Willhuber Gaston , Aly Mohamed M. , Joaquim Andrei Fernandes , Keynan Ory , Chhabra Harvinder Singh , Bigdon Sebastian , Spiegl Ulrich J. , Schnake Klaus , Vaccaro Alexander R. 
Published: February 2024

Study Design Reliability study utilizing 183 injury CT scans by 22 spine trauma experts with assessment of radiographic features, classification of injuries and treatment recommendations. Objectives To assess the reliability of the AOSpine TL Injury Classification System (TLICS) including the categories within the classification and the M1 modifier. Methods Kappa and Intraclass correlation coefficients were produced. Associations of various imaging characteristics (comminution, PLC status) and treatment recommendations were analyzed through regression analysis. Multivariable logistic regression modeling was used for making predictive algorithms. Results Reliability of the AO Spine TLICS at differentiating A3 and A4 injuries (N = 71) (K = .466; 95% CI .458 – .474; P < .001) demonstrated moderate agreement. Similarly, the average intraclass correlation coefficient (ICC) amongst A3 and A4 injuries was excellent (ICC = .934; 95% CI .919 – .947; P < .001) and the ICC between individual measures was moderate (ICC = .403; 95% CI .351 – .461; P < .001). The overall agreement on the utilization of the M1 modifier amongst A3 and A4 injuries was fair (K = .161; 95% CI .151 – .171; P < .001). The ICC for PLC status in A3 and A4 injuries averaged across all measures was excellent (ICC = .936; 95% CI .922 – .949; P < .001). The M1 modifier suggests respondents are nearly 40% more confident that the PLC is injured amongst all injuries. The M1 modifier was employed at a higher frequency as injuries were classified higher in the classification system. Conclusions The reliability of surgeons differentiating between A3 and A4 injuries in the AOSpine TLICS is substantial and the utilization of the M1 modifier occurs more frequently with higher grades in the system.
Predictive Algorithm for Surgery Recommendation in Thoracolumbar Burst Fractures Without Neurological Deficits
Authors: Dandurand Charlotte , Fallah Nader , Öner Cumhur F. , Bransford Richard J. , Schnake Klaus , Vaccaro Alexander R. , Benneker Lorin M. , Vialle Emiliano , Schroeder Gregory D. , Rajasekaran Shanmuganathan , El-Skarkawi Mohammad , Kanna Rishi M. , Aly Mohamed , Holas Martin , Canseco Jose A , Muijs Sander , Popescu Eugen Cezar , Tee Jin Wee , Camino-Willhuber Gaston , Joaquim Andrei Fernandes , Keynan Ory , Chhabra Harvinder Singh , Bigdon Sebastian , Spiegel Ulrich , Dvorak Marcel F 
Published: February 2024

Study design Predictive algorithm via decision tree Objectives Artificial intelligence (AI) remain an emerging field and have not previously been used to guide therapeutic decision making in thoracolumbar burst fractures. Building such models may reduce the variability in treatment recommendations. The goal of this study was to build a mathematical prediction rule based upon radiographic variables to guide treatment decisions. Methods Twenty-two surgeons from the AO Knowledge Forum Trauma reviewed 183 cases from the Spine TL A3/A4 prospective study (classification, degree of certainty of posterior ligamentous complex (PLC) injury, use of M1 modifier, degree of comminution, treatment recommendation). Reviewers’ regions were classified as Europe, North/South America and Asia. Classification and regression trees were used to create models that would predict the treatment recommendation based upon radiographic variables. We applied the decision tree model which accounts for the possibility of non-normal distributions of data. Cross-validation technique as used to validate the multivariable analyses. Results The accuracy of the model was excellent at 82.4%. Variables included in the algorithm were certainty of PLC injury (%), degree of comminution (%), the use of M1 modifier and geographical regions. The algorithm showed that if a patient has a certainty of PLC injury over 57.5%, then there is a 97.0% chance of receiving surgery. If certainty of PLC injury was low and comminution was above 37.5%, a patient had 74.2% chance of receiving surgery in Europe and Asia vs 22.7% chance in North/South America. Throughout the algorithm, the use of the M1 modifier increased the probability of receiving surgery by 21.4% on average. Conclusion This study presents a predictive analytic algorithm to guide decision-making in the treatment of thoracolumbar burst fractures without neurological deficits. PLC injury assessment over 57.5% was highly predictive of receiving surgery (97.0%). A high degree of comminution resulted in a higher chance of receiving surgery in Europe or Asia vs North/South America. Future studies could include clinical and other variables to enhance predictive ability or use machine learning for outcomes prediction in thoracolumbar burst fractures.
What Factors Influence Surgeons in Decision-Making in Thoracolumbar Burst Fractures? A Survey-Based Investigation of a Panel of Spine Surgery Experts
Authors: Schnake Klaus J. , Dvorak Marcel F. , Öner Cumhur F. , Dandurand Charlotte , Muijs Sander , Bigdon Sebastian F. 
Published: February 2024

Study Design Cross-sectional survey study. Objective To investigate factors affecting decision-making in thoracolumbar burst-fractures without neurologic deficit. Methods A 40-question survey addressing expert-related, economic, and radiological factors was distributed to 30 international trauma experts. Descriptive statistics were used to assess the impact of these factors on operative or non-operative management preferences. Results Out of 30 experts, 27 completed the survey. The majority of respondents worked at level 1 trauma centers (81.5%) within university settings (77.8%). They were primarily orthopedic surgeons (66.7%) and had over 10 years of experience (70.4%). About 81% found distinguishing between A3 and A4 fractures relevant for decision-making. Most experts (59%) treated A3 fractures non-surgically, while only 30% treated A4 fractures conservatively. Compensation systems did not influence treatment recommendations, and hospital measures promoting surgeries did not significantly affect distribution. Radiological factors, such as local kyphosis (25/27), fracture comminution (23/27), overall sagittal balance (21/27), and spinal canal narrowing (20/27), influenced decisions. Conclusion Incomplete burst fractures (A3) are predominantly treated non-surgically, while complete burst fractures (A4) are primarily treated surgically. Compensation, third-party incentives, and outpatient care did not significantly impact decision-making. Radiological factors beyond the AO Spine thoracolumbar classification system seem to be essential and warrant further evaluation.
Pedicle Dysplasia in Proximal Thoracic Adolescent Idiopathic Scoliosis Curves: What are We Missing and What are its Possible Surgical Implications? An Observational Retrospective Study on 104 Patients
Authors: Viroli Giovanni , Ruffilli Alberto , Barile Francesca , Manzetti Marco , Traversari Matteo , Faldini Cesare 
Published: February 2024

Study Design Retrospective cohort study. Objectives To assess if pedicle dysplasia is present in proximal thoracic (PT), both structural and nonstructural, compared to main thoracic (MT) curves; and to assess if it is predictive of radiographic outcomes at minimum 2 years of follow-up. Methods A retrospective review of surgically-treated Adolescent Idiopathic Scoliosis (AIS) patients with Lenke 1-2-3-4 curves was performed. On preoperative CT-scan, at the apical vertebra, pedicle width on the concavity (PWc) and on the convexity (PWv) and Pedicle Dysplasia Index (PDI, defined as PWc/PWv) were measured. Preoperative and last follow-up (at least 2 years) x-rays were reviewed. Results 104 patients meeting the inclusion criteria were divided into Structural-PT (S-PT) and Nonstructural-PT (NS-PT) groups based on Lenke criteria. PWc ( P < .001). And PDI ( P < .001 for S-PT, P = .004 for NS-PT) were significantly smaller in the PT than in MT curves for both groups. PT-PWc significantly correlated with follow-up PT Cobb for both groups ( P < .001 and P = .015 respectively). PT-PDI significantly correlated with follow-up PT-Cobb ( P < .001), CA ( P < .040) and T1 tilt ( P < .002), only for NS-PT group. NS-PT patients with PWc PT <1 mm had higher RSHD ( P = .021) and T1 tilt ( P = .025) at follow-up. NS-PT patients with PDI PT <.3 had higher RSHD ( P < .001), CA ( P = .002) and T1 tilt ( P = .003) at follow-up. Conclusion S-PT and NS-PT curves show significant pedicle dysplasia on the concavity. Pedicle dysplasia significantly correlated with shoulder balance at follow-up, for NS-PT patterns. Patients with a PWc <1 mm or PDI <.30 are at particular risk of postoperative shoulder imbalance.
Are Supra-Physiological Plant-Based Antioxidants Ready for the Clinic? A Scoping Review of Hormetic Influences Driving Positive Clinical Outcomes
Authors: Wendt Julie , Knudsen Benjamin , Frame Leigh A. 
Published: February 2024

Background: A pro-inflammatory metabolic state is key to the chronic disease epidemic. Clinicians’ ability to use nutrients to balance inflammation via oxidant homeostasis depends on the quality of antioxidants research. Understanding the intersection of two prominent theories for how antioxidants quell inflammation—nutritional hormesis and oxidant scavenging—will enable therapeutic antioxidant use in clinical practice. Purpose: We sought to survey the literature to answer the question: has the hormetic response of exogenous antioxidants been studied in humans and if so, what is its effect Research Design: This review investigates the less well-established theory, nutritional hormesis. To understand the state of hormetic response research, we conducted a literature review describing the relationship between exogenous antioxidants, hormesis, and chronic disease. We used an adaptive search strategy (PubMed and Scopus), retrieving 343 articles, of which 218 were unique. Most studies reviewed the hormetic response in plant and cell models (73.6%) while only 2.2% were in humans. Results: Given the limited robust evidence, clinicians lack research-based guidance on the appropriate therapeutic dose of exogenous antioxidants or, more concerning, supra-physiological dosing via supplements. A critical hurdle in searching the literature is the lack of standardized nomenclature describing the hormetic effect, challenging the ability of clinicians to make informed decisions. Conclusion: Non-human research shows a biphasic, hormetic relationship with antioxidants but observational studies have yet to translate this into the complexities of human biochemistry and physiology. Therefore, we cannot accurately translate this into clinical care. To remedy this insufficiency, we suggest: (1) Improved data collection quality: controlled diet, standardized antioxidant measurements, bioavailability assessed via biomarkers; (2) Larger, harmonized datasets: research subject transparency, keyword standardization, consensus on a hormesis definition.