bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diet-induced changes in functional disability are mediated by fatigue in relapsing-remitting multiple sclerosis: A secondary analysis of the WAVES randomized parallel-arm trial
Authors: Crippes Landon J , Saxby Solange M , Shemirani Farnoosh , Bisht Babita , Gill Christine , Rubenstein Linda M , Ten Eyck Patrick , Carr Lucas J , Darling Warren G , Hoth Karin F , Kamholz John , Snetselaar Linda G , Titcomb Tyler J , Wahls Terry L 
Published: October 2023

Background People with multiple sclerosis (MS) often report dietary modifications; however, evidence on functional outcomes remains sparse. Objective Evaluate the impact of the low-saturated fat (Swank) and modified Paleolithic elimination (Wahls) diets on functional disability among people with relapsing-remitting MS. Methods Baseline-referenced MS functional composite (MSFC) scores were calculated from nine-hole peg-test (NHPT), timed 25-foot walk, and oral symbol digit modalities test (SDMT-O) collected at four study visits: (a) run-in, (b) baseline, (c) 12 weeks, and (d) 24 weeks. Participants were observed at run-in and then randomized at baseline to either the Swank ( n = 44) or Wahls ( n = 43) diets. Results Among the Swank group, MSFC scores significantly increased from −0.13 ± 0.14 at baseline to 0.10 ± 0.11 at 12 weeks ( p = 0.04) and 0.14 ± 0.11 at 24 weeks ( p = 0.02). Among the Wahls group, no change in MSFC scores was observed at 12 weeks from 0.10 ± 0.11 at baseline but increased to 0.28 ± 0.13 at 24 weeks ( p = 0.002). In both groups, NHPT and SDMT-O z-scores increased at 24 weeks. Changes in MSFC and NHPT were mediated by fatigue. Discussion Both diets reduced functional disability as mediated by fatigue. Trial Registration Clinicaltrials.gov Identifier: NCT02914964
Impact of Surgical Resection Without Spinal Fusion for Thoracic Dumbbell Tumors on Postoperative Global Spinal Sagittal Alignment and Clinical Outcomes
Authors: Okubo Toshiki , Nagoshi Narihito , Tsuji Osahiko , Ozaki Masahiro , Suzuki Satoshi , Takahashi Yohei , Matsumoto Morio , Nakamura Masaya , Watanabe Kota 
Published: October 2023

Study Design A retrospective comparative study. Objectives This study investigated radiographical changes in global spinal sagittal alignment (GSSA) and clinical outcomes after tumor resection without spinal fusion in patients with thoracic dumbbell tumors. Methods Thirty patients with thoracic dumbbell tumors who were followed up for at least 3 years were included in this study. Variations in the outcome variables were analyzed using individual GSSA parameters measured on radiography. Clinical outcomes were assessed using the modified McCormick scale (MMCS), Japan Orthopaedic Association (JOA) score, and visual analog scale (VAS). To assess the impact of the affected levels on these outcomes, we divided the patients into three groups according to the location of the tumor (upper [T1-4], middle [T5-8], or lower [T9-12] thoracic spine). Results The GSSA parameters (cervical lordosis, T1 slope, thoracic kyphosis [global, upper, middle, and lower], thoracolumbar kyphosis, lumbar lordosis, sacral slope, pelvic incidence, and pelvic tilt) of all the patients did not change significantly after surgery. Eleven of thirty patients had preoperative gait disturbances but they could walk without support (MMCS grade I or II) at the final follow-up. The JOA score and VAS showed significant postoperative improvements. No statistically significant differences were observed in each postoperative sagittal profile or clinical outcome between the upper, middle, and lower groups. Conclusions Tumor resection without spinal fusion did not affect the various GSSA parameters and resulted in satisfactory clinical outcomes, indicating that spinal fusion may not always be necessary when resecting thoracic dumbbell tumors.
Development and Implementation of a Medical School Course Integrating Basic, Clinical, and Health Systems Sciences
Authors: Miller Kathryn E. , Qua Kelli , Croniger Colleen M. , Mann Donald , Mulloy Karen B. , Painter Elizabeth , Rowland-Seymour Anastasia , Schirokauer Oliver , Singh Mamta K. , Wilson-Delfosse Amy L. 
Published: October 2023

OBJECTIVE In recent years, significant steps have been made in integrating basic science and clinical medicine. There remains a gap in adding the third pillar of education: health systems science (HSS). Core clerkships represent an ideal learning venue to integrate all three. Students can experience the value of integrating basic science as they learn clinical medicine in environments where HSS is occurring all around them. METHODS We outline the creation of Sciences and Art of Medicine Integrated (SAMI), a course that runs parallel with the clerkship year and integrates basic science and HSS with clinical medicine. A complete description of the planning and implementation of SAMI is provided. We include the participants and educational setting, the goals and objectives, and the structure of each session. To encourage the integration of basic science, HSS, and clinical medicine, students utilize a series of tools, described in detail. Examples of each tool are provided utilizing a case of a patient presenting with obstructive sleep apnea. RESULTS We successfully implemented this course with positive reception from students. CONCLUSION This course represents a step not only toward the integration of HSS with basic science and clinical medicine but also an advancement in training future clinicians to provide high-value care. Future curricular development must consider the validation of a measure of clinical reasoning that assesses a student's ability to think in a cognitively integrated fashion about basic science, HSS, and clinical medicine demonstrated by enhanced justification of clinical reasoning and a more holistic approach to planning patient care.
Efficacy of pneumatic retinopexy in young adults with rhegmatogenous retinal detachment
Authors: İpekli Zeynep , Pehlivanoğlu Seren , Artunay Özgür 
Published: October 2023

Background: In young adults with rhegmatogenous retinal detachment, pneumatic retinopexy can be a cost-effective and minimally invasive highly effective method in suitable cases. Objectives: To evaluate the role of pneumatic retinopexy in the treatment of young adults with rhegmatogenous retinal detachment (RRD) and the factors that may affect the success of pneumatic retinopexy. Design: Retrospective study. Methods: The study included 67 eyes of 67 patients aged between 21 and 40 who underwent pneumatic retinopexy (PR) between January 2015 and June 2021 for primary RRD. We retrospectively analyzed the prognostic factors that may affect the success of PR, such as preoperative age, best corrected visual acuity, tear site, lens condition, and axial length. Results: PR was successful in 61.2% of the patients, whereas 38.8% required secondary surgery. Between the group that had a single surgery (Group 1) and the group that required secondary surgery (Group 2) the tear location, axial length, and volumes of gases used were statistically different ( p = 0.04, p < 0.001, and p = 0.02, respectively). There was a significant difference in visual acuity before and after surgery in the group that was successful with a single surgery (Friedman χ2 = 40.051, p < 0.001). There was no significant difference between the two groups in terms of intraocular pressure ( p > 0.05), and glaucoma was not observed in the postoperative period. Conclusion: Since it is a minimally invasive and cost-effective method that provides rapid visual rehabilitation, it can be considered as first-line therapy in young adults who are suitable for PR.
Impact of a reimbursement policy change on treatment with erenumab in migraine – a real-world experience from Germany
Authors: Hong Ja Bin , Lange Kristin Sophie , Fitzek Mira , Overeem Lucas Hendrik , Triller Paul , Siebert Anke , Reuter Uwe , Raffaelli Bianca 
Published: October 2023

Abstract
Background
Monoclonal antibodies (mAbs) targeting the Calcitonin Gene-Related Peptide (CGRP) pathway are safe and effective treatments for migraine prevention. However, the high cost of these novel therapies has led to reimbursement policies requiring patients to try multiple traditional preventives before access. In Germany, a recent change in insurance policy significantly expanded coverage for the CGRP receptor mAb erenumab, enabling migraine patients who failed just one prior prophylactic medication to receive this mAb. Here, we compare the clinical response to treatment with erenumab in migraine patients treated using the old and new coverage policy.

Methods
In this retrospective cohort study, we included CGRP-mAb naïve patients with episodic or chronic migraine, who started erenumab at our headache center according to either the old or the new insurance policy and received at least 3 consecutive injections. Headache diaries and electronic documentation were used to evaluate reductions in monthly headache and migraine days (MHD and MMD) and ≥ 50% and ≥ 30% responder rates at month 3 (weeks 9–12) of treatment.

Results
We included 146 patients who received erenumab according to the old policy and 63 patients that were treated using the new policy. At weeks 9–12 of treatment, 37.7% of the old policy group had a 50% or greater reduction in MHD, compared to 63.5% of the new policy group (P < 0.001). Mean reduction in MHD was 5.02 days (SD = 5.46) and 6.67 days (SD = 5.32, P = 0.045) in the old and new policy cohort, respectively. After propensity score matching, the marginal effect of the new policy on treatment outcome was 2.29 days (standard error, SE: 0.715, P = 0.001) more reduction in MHD, and 30.1% (SE: 10.6%, P = 0.005) increase in ≥ 50% response rate for MHD.

Conclusions
Starting erenumab earlier in the course of migraine progression in a real-world setting may lead to a better response than starting after multiple failed prophylactic attempts. Continually gathering real-world evidence may help policymakers in deciding how readily to cover CGRP-targeted therapies in migraine prevention.
Relationship between myopia control and amount of corneal refractive change after orthokeratology lens treatment
Authors: Sun Lu , Song Hong-Xin , Li Zheng-Xuan , Chen Yun , He Zhi-Qiang 
Published: October 2023

Abstract
Background
To evaluate the relationship between amount of corneal refractive change (CRC) after wearing orthokeratology (Ortho-K) lenses and axial length (AL) growth.

Methods
We retrospectively enrolled 77 patients (77 eyes) aged 8–14 years who wore Ortho-K lenses more than 12 months. We divided the patients into 2 subgroups: spherical equivalent (SE) ≤ -3.0 D and SE > -3.0 D subgroup. The sagittal and tangential curvature maps and corneal topographic data within the 8-mm diameter ring at the baseline and during follow-up visits after wearing Ortho-K lens were recorded in addition to the area, height, and volume of the CRC region. The AL data were recorded at the baseline and during follow-up visits. Multivariate linear regression was conducted to analyze associations between the area, height, and volume of the CRC region, AL elongation, and SE.

Results
The average change in the CRC region was 9.77 ± 0.60 D in height, 16.66 ± 3.61 mm2 in area, and 87.47 ± 8.96 D*mm2 in volume on the tangential diagram after wearing Ortho-K lenses for 3 months. The AL showed a change of 0.19 ± 0.14 mm after 1 year of Ortho-K lens wear (P < 0.05). At 1 year, AL elongation was negatively correlated with the area (P = 0.019) and volume (P < 0.001) of the CRC region. At 1 year, for every 1-mm2 increase in the area and every 1-D*mm2 increase in the volume of the CRC region, the average AL elongation decreased by 0.01 mm and 0.002 mm, respectively, in the multivariate analysis. In patients with SE ≤ -3.0 D, AL elongation was negatively correlated with the CRC-region volume (β = -0.002, P = 0.018), and in patients with SE > -3.0 D, AL elongation was negatively correlated with the CRC-region area (β = -0.017, P = 0.016).

Conclusions
The AL elongation-control efficacy of Ortho-K lenses may be related to the area and volume of the CRC region.
Determinants of early discharge after birth among mothers delivered vaginally at health facilities: further analysis of the Ethiopian demographic health survey
Authors: Bitew Desalegn Anmut , Diress Mengistie , Gela Yibeltal Yismaw , Belay Daniel Gashaneh , Kibret Anteneh Ayelign , Chilot Dagmawi , Sinamaw Deresse , Seid Mohammed Abdu , Seid Abdulwase Mohammed , Simegn Wudneh , Eshetu Habitu Birhan , Andualem Amare Agmas 
Published: October 2023

Abstract
Introduction
The majority of maternal and newborn deaths take place during the first few hours and days after birth and thus postnatal contacts should begin as early as possible, especially within the first 24 h, then again within two to three days after delivery. Globally, early postnatal discharge has increased over the past 50 years and currently too. Even if Ethiopia has very low PNC coverage, there is no evidence on who is discharged early. Hence, the aim of this study was to determine the magnitude and the predictors for early postnatal discharge in Ethiopia.

Methods
This study was based on the secondary data analysis using the Ethiopian Demographic and Health survey (EDHS) 2016 data set. The weighted sample of 2,225 delivered mothers were included for the final analysis. The model was best fitted as assessed by Hosmer-Lemeshow test (p value = 0.1988). The variables with P-value ≤ 0.2 in the bi- variable binary logistic regression analysis were included in to the multi-variable binary logistic regression analysis. The Adjusted Odds Ratio (AOR) with 95% confidence interval (95% CI) was computed to assess the strength of association between the outcome and independent variables. The variables with a P-value of less than 0.05 in the multi-variable binary logistic regression analysis were declared as statistically significant predictors of the outcome variable.

Result
The overall magnitude of early discharge was 70.41% (CI: 68.48, 72.30). Residence (rural; AOR: 0.61, 95% CI: 0.46, 0.80), educational status (No education; AOR: 1.87, 95% CI: 1.19, 2.94), religion (Muslim; AOR: 0.69, 95% CI: 0.55, 0.87, Others; AOR: 0.24, 95% CI: 0.10, 0.57), wealth index (Poor; AOR: 0.77; 95% CI: 0.59, 0.99), marital status (Not married; AOR: 0.29; 95% CI: 0.13, 0.67), ANC visits (No ANC visits; AOR: 0.63; 95% CI: 0.46,0.86), parity (3rd parity; AOR: 1.48; 95% CI: 1.03, 2.11), and size of the child (larger size; AOR: 0.63;95% CI: 0.50,0.79, (smaller size; AOR: 0.72; 95% CI: 0.56,0.92) were independent determinants of early discharge.

Conclusion
A substantial proportions of mothers in Ethiopia had been discharged early (before 24 h). Residence, education, wealth index, religion, marital status, ANC follow up, parity and size of the child were predictors of early discharge. Adequate hospital stay should be promoted. Since the early discharge in Ethiopia is very high, home based postnatal visit should be strengthened focusing the identified predictors.
Synthesis and characterization of hydroxyapatite nanoparticles and their effects on remineralization of demineralized enamel in the presence of Er,Cr: YSGG laser irradiation
Authors: Maddah Fatemeh , Shirinzad Mehdi , Khalafi Zahra , Rezaei-Soufi Loghman , Mohammadi Younes , Eskandarloo Fatemeh , Farmany Abbas 
Published: October 2023

Abstract
Background
This study aims to synthesize and characterize hydroxyapatite nanoparticles (nano-HA) and evaluate their effects on the remineralization of demineralized enamel in the presence to Er,CR: YSGG laser irradiation.

Materials and methods
Enamel specimens from 44 human molars were divided into four groups: control, demineralized enamel, demineralized enamel treated with nano-HA, and demineralized enamel treated with nano-HA followed by Er,Cr:YSGG laser irradiation (0.5, 20 Hz, 60 µs, 20 s). Vickers microhardness test was used to evaluate the enamel surface hardness. The morphology and chemistry of enamel surfaces were assessed using scanning electron microscopy (SEM) and Raman spectroscopy, respectively.

Result
The result of this study showed that the application of Er,CR: YSGG laser irradiation to demineralized enamel treated with nano-HA had the highest impact on its microhardness.

Conclusion
ER,CR: YSGG laser irradiation promotes enamel remineralization after treatment with nano HA.
Using a novel virtual-reality simulator to assess performance in lumbar puncture: a validation study
Authors: Xie Sujun , Grimstrup Søren , Nayahangan Leizl Joy , Wang Zheng , Wan Xing , Konge Lars 
Published: October 2023

Abstract
Background
A lumbar puncture procedure’s success depends on a competent physician minimizing the risk of failing to get a sample and avoiding complications such as post-dural headache. A new virtual-reality simulator might be helpful in deciding when a physician is competent to perform lumbar puncture. We aimed to investigate validity evidence for a simulator-based test in lumbar puncture and establish a pass/fail standard to allow a mastery learning training program.

Methods
Validity evidence was investigated using Messick’s framework by including participants who were novices, intermediates, or experienced in lumbar puncture. Each participant performed two lumbar puncture procedures on the simulator, and fifty-nine predefined simulator metrics were automatically recorded. Cronbach’s alpha was used to explore internal consistency reliability. Intergroup comparisons were made using independent sample t-tests with Tukey’s correction for multiple comparisons. The learning effect was explored using paired sample t-test analysis, and a pass/fail standard was established using the contrasting groups’ method.

Results
73 novices, 18 intermediates, and 19 physicians performed the test resulting in a total of 220 procedures. 25 metrics (42.4%) had good discriminatory ability, and the reliability of these metrics was good, Cronbach’s α = 0.81. The experienced physicians were significantly better than the novices (18.3 vs. 13.3, p < 0.001), and the pass/fail standard was established at 16 points. This standard resulted in 22 (30.1%) novices passing (i.e., false positives) and 5 (26.3%) physicians failing (i.e., false negatives).

Conclusion
This study provides validity evidence for a simulator-based test of lumbar puncture competence. The test can help ensure basic competence at the end of a simulation-based training program for trainees, i.e., a mastery learning training program.
“Nurses and health professionals facing female genital mutilation: a qualitative study “
Authors: Ugarte-Gurrutxaga MIdoia , Mazoteras-Pardo Victoria- , de Corral Gonzalo Melgar , Molina-Gallego Brígida , Mordillo-Mateos Laura , Gómez-Cantarino Sagrario 
Published: October 2023

Abstract
Background
Transnational migratory movements make Spain a country with a very diverse population, including women and girls from countries where Female Genital Mutilation (FGM) is practiced. Given this reality, we set out to carry out a qualitative study to identify the knowledge, attitudes and skills of health professionals regarding FGM.

Method
Qualitative study with a content analysis approach. Forty-seven health professionals with the profiles of Nursing, Family Medicine, Pediatrics, Midwifery and Gynecology and Obstetrics were purposively selected. Data were collected through semi-structured in-depth interviews and focus groups. The qualitative content analysis approach was used for data analysis. The study was conducted in the years 2019 and 2022.

Results
Although most professionals are aware of the current legislation on FGM in Spain, only a few of them are aware of the existence of the FGM prevention protocol in Castilla-La Mancha. This lack of knowledge together with the perception that FGM belongs to the private sphere of women, contributes to the loss of opportunities to identify and prevent FGM.

Conclusion
Health professionals’ training, especially midwives and pediatricians, is essential to the identification and action against Female Genital Mutilation.
Application of whole-cell biosensors for analysis and improvement of L- and D-lactic acid fermentation by Lactobacillus spp. from the waste of glucose syrup production
Authors: Augustiniene Ernesta , Jonuskiene Ilona , Kailiuviene Jurgita , Mazoniene Edita , Baltakys Kestutis , Malys Naglis 
Published: October 2023

Abstract
Background
Lactic acid is one of the most important organic acids, with various applications in the food, beverage, pharmaceutical, cosmetic, and chemical industries. Optically pure forms of L- and D-lactic acid produced via microbial fermentation play an important role in the synthesis of biodegradable polylactic acid. Alternative substrates, including by-products and residues from the agro-food industry, provide a cost-effective solution for lactic acid production and are a promising avenue for the circular economy.

Results
In this study, the transcription factor (TF)-based whole-cell biosensor strategy was developed for the L- and D-lactic acid determination. It was cross validated with commonly used high-performance liquid chromatography and enzymatic methods. The utility of biosensors as an efficient analytical tool was demonstrated by their application for the lactic acid determination and fermentation improvement. We explored the ability of Lacticaseibacillus paracasei subsp. paracasei, Lactobacillus delbrueckii subsp. lactis, and Lactobacillus amylovorus to biosynthesize optically pure L-lactic acid, D-lactic acid or mixture of both from organic-rich residual fraction (ORRF), a waste of glucose syrup production from wheat starch. The fermentation of this complex industrial waste allowed the production of lactic acid without additional pretreatment obtaining yields from 0.5 to 0.9 Cmol/Cmol glucose.

Conclusions
This study highlights the utility of whole cell biosensors for the determination of L- and D-forms of lactic acid. The fermentation of L-lactic acid, D-lactic acid and mixture of both by L. paracasei, L. lactis, and L. amylovorus, respectively, was demonstrated using waste of glucose syrup production, the ORRF.