bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Economic Burden of Management of Pituitary Adenomas: A Propensity-Score-Matched Cost Analysis
Authors: Caulley Lisa , Lasso Andrea , Zagorski Brandon , Wilton Andrew S. , Saskin Refik , Sahlollbey Nick , Séguin Jeanne M. , Thavorn Kednapa , Doyle Mary-Anne , Malcolm Janine , Alkherayf Fahad , Johnson-Obaseki Stephanie , Schramm David , Kilty Shaun 
Published: January 2025

Importance Pituitary adenomas (PAs) present a notable economic burden on healthcare systems due to their management’s reliance on multimodal, often costly interventions. Objective To determine total and relative healthcare costs for PAs at Ontario-based institutions. Design A retrospective, propensity-score-matched cohort analysis. Setting Ontario, Canada, encompassing public healthcare facilities and covering costs over a 6-year study period. Participants Adults diagnosed with PA (n = 1675) between April 1, 2013, and March 31, 2019, compared to a general population cohort and a hospitalized control cohort matched on demographics and health factors. Intervention/Exposures Analysis of healthcare cost components (inpatient, outpatient, and diagnostic services) and cost trajectories postsurgery for PAs. Main Outcome Measures Primary outcome was total annualized healthcare costs for patients with PA relative to the general and hospitalized cohorts. Relative costs were estimated using a negative binomial regression model. Results Of 1675 patients with PA, total annualized costs were $49,992. Highest total costs were associated with inpatient hospitalization ($24,796) and physician services/diagnostic evaluations ($20,075). After propensity score matching, patients with PA had 12.7 times higher costs [95% confidence interval (CI) (10.9, 14.8), P < .0001] during the preadmission/admission period, which remained elevated postoperatively ( P < .05). Total costs did not differ between patients with PA and the hospitalized cohort [RR 0.97, 95% CI (0.92, 1.03); P = .3271] in the preadmission/admission period; however, follow-up costs were 37% lower for patients with PA in the 1st follow-up year [RR 0.63, 95% CI (0.51, 0.77); P < .0001], and up to 50% lower by the 5th year [RR 0.50, 95% CI (0.36, 0.68); P < .0001]. Conclusions This study provided a comprehensive assessment of the economic burden of PAs on the publicly-funded healthcare system. Patients with PA had higher annualized total costs across all observed time periods compared to the general population and lower annualized total costs compared to patients admitted to a surgical ward. Relevance This study highlights the financial impact of PA management on healthcare resources and provides a basis for future research aimed at cost-efficiency improvements in long-term PA care.
Coke zero for the zero: A randomized controlled trial examining coke zero consumption on night call inpatient course and mortality
Authors: Kwan Yu Heng , Tang Haoming , Qi Lihua , Yap Angela Frances Hui Wen , Yan Linxuan , Li Yi Xin , Lee Andrea Zhe Ern , Fong Antoinette Shui Wen , Chan Yarn Kit , Low Feng Yi , Sum Charmaine Wai Yan , Seng Benjamin Jun Jie , Yoon Sungwon , Østbye Truls , Gan Sheryl Shien Wen , Lee Haur Yueh , Fong Warren 
Published: January 2025

Background Coca-Cola and Cola-Cola Zero Sugar are commonly consumed beverages by healthcare professionals. Medical superstitions abound about whether Cola-Cola Zero sugar consumption affects night call outcomes. Objectives The current study aimed to determine whether Coca-Cola Zero Sugar, compared to regular Coca-Cola, is associated with any differences in inpatient admissions and mortality of patients on night calls. Methods A double-blinded randomized controlled trial was conducted in the Division of Medicine, Singapore General Hospital, Singapore involving junior doctors from January 2024 to February 2024.The primary outcome was the number of ward admissions under the night call doctor’s care. Secondary outcomes involved the number of inpatient deaths, high-dependency or intensive care admissions, the number of hours slept by the doctor, the number of steps walked by the doctor, and the level of sleepiness of the doctor on call. Results 203 participants consented and were randomized (44.9%). The data of 198 participants were included for analysis (97.5%). No significant differences were detected in the number of ward admissions between the Coca-Cola Zero Sugar group and the regular Coca-Cola group. For secondary outcomes, a significant difference was present between the two groups in the Karolinska Sleepiness Scale score ( p-value = .0413). Other secondary outcomes did not demonstrate significant differences between the two groups. Conclusions No convincing evidence was present to support the consumption of Coca-Cola Zero Sugar versus the regular Coca-Cola had significant differences in the number of inpatient admissions and mortality in night call duties.
Can the number of confirmed COVID-19 cases be predicted more accurately by including lifestyle data? An exploratory study for data-driven prediction of COVID-19 cases in metropolitan cities using deep learning models
Authors: Jung Sungwook 
Published: January 2025

Objective The COVID-19 outbreak has significantly impacted human lifestyles and life patterns. Therefore, data related to human social life may tell us the increase or decrease in the number of confirmed COVID-19 cases. However, although the number of confirmed cases is affected by social life, it is difficult to find studies that attempt to predict the number of confirmed cases using various lifestyle data. This paper attempted an exploratory data analysis to see if the number of confirmed cases could be predicted more accurately by including various lifestyle data. Methods We included taking public transportation, watching a movie at the cinema, and accommodation at a motel in the lifestyle data. Finally, a ‘lifestyle addition’ set was constructed that added lifestyle data to the number of past confirmed cases and search term frequency data. The deep learning algorithms used in the analysis are deep neural networks (DNNs) and recurrent neural networks (RNNs). Performance differences across data sets and between deep learning models were tested to be statistically significant. Results Among metropolitan cities in South Korea, Seoul (9.6 million) with the largest population and Busan (3.4 million) with the second largest population had the lowest error rate in ‘lifestyle addition’ set. When predicting with the ‘lifestyle addition’ set, in Seoul, the error rate was reduced to 20.1%, and in Busan, the graph of the actual number of confirmed cases and the predicted graph were almost identical. Conclusions Through this study, we were able to identify three notable results that could contribute to predicting the number of patients infected with epidemic in the future.
Short- and Long-Term Outcomes of Patients Who Underwent the Arterial Switch Operation at Siriraj Hospital—Thailand’s Largest National Tertiary Referral Center
Authors: Hannarong Juthamas , Tocharoenchok Teerapong , Sriyoschati Somchai , Thongcharoen Punnarerk , Tantiwongkosri Kriangkrai , Nitiyarom Ekarat , Subtaweesin Thaworn 
Published: January 2025

Objective The aim of this study was to assess the short- and long-term outcomes of patients who underwent the arterial switch operation (ASO) at Siriraj Hospital in Thailand, and to identify postoperative complications and factors that significantly affect patient survival. Materials and Methods We retrospectively studied all patients with dextro-transposition of the great arteries and anatomic variants who underwent the ASO from January 1995 to December 2020. Twenty-year overall survival and 15-year freedom from reoperation/reintervention were estimated using the Kaplan-Meier method. Univariate and multivariate Cox regression analyses were used to identify factors independently associated with 30-day mortality. Results Of the 171 patients included, there were 116 males (67.84%). The median (minimum, maximum) age at operation was 33.5 (3-4,499) days, and the median (minimum, maximum) bodyweight was 3.4 (2.2-44.9) kg. Most patients (115/171, 67.25%) had an intact ventricular septum, whereas 48/171 (28.07%), had ventricular septal defects. The typical coronary anatomic pattern (1LCx-2R) was found in 120 patients (70.1%). Early mortality was 8.7% ± 4.4%, and there was no late death up to 20 years postoperatively with a median follow-up of five years. Fifteen-year freedom from reoperation or reintervention was 85.7%. Atypical coronary pattern was an independent factor for survival with an adjusted hazard ratio of 5.1 (95% confidence interval: 1.22-21.4; P = .026). Conclusions The results of this study revealed excellent short- and long-term outcomes of the ASO at our center. Atypical coronary anatomy was found to be the only factor that independently predicted 30-day mortality.
Cranioplasty infection in porous hydroxyapatite: Potential antibacterial properties
Authors: Zaed Ismail , Iaccarino Corrado , Faedo Francesca , Grillini Laura , Galassi Elisabetta , Dotti Alessandro , Nataloni Angelo , Mannella Francesca Carolina , Cardia Andrea 
Published: January 2025

Introduction: Intensive research is dedicated to the development of novel biomaterials and medical devices to be used as grafts in reconstructive surgery, with the purpose of enhancing their therapeutic effectiveness, safety, and durability. A variety of biomaterials, from autologous bone to polymethylmetacrylate, polyether ether ketone, titanium, and calcium-based ceramics are used in cranioplasty. Porous hydroxyapatite (PHA) is reported as a possible material for bone reconstruction, with good signs of biocompatibility, osteoconductive and osteointegrative properties. In the present paper we studied the possible antibacterial properties of PHA in a laboratory test in order to provide a possible overview of the occurrence of post-operative infections in PHA cranioplasty. Method: The test method has been designed to evaluate the potential antimicrobial activity of specimens under dynamic contact conditions to overcome difficulties in ensuring contact of inoculum to the specimen surface. The test was conducted using Staphylococcus aureus ATCC6538 as a bacterial strain. Results: Two experimental sets were performed to evaluate the antimicrobial properties of the specimens against two different Staphylococcus aureus concentrations. The first preliminary test (a) verified the antibacterial property at 0, 1, 2, and 4 h of contact time; the second confirmatory test (b) was repeated to verify the antibacterial property at 0, 4, 8 h. In the first experiment, after the first hour of contact, the bacterial inoculum was reduced by 7.96% compared to “inoculum only,” which increased to 26.11% at the second hour, and up to 52.33% after 4 h. In the second experiment, the confirmation test showed that bacterial growth reaches maximum inhibition after 4 h of contact. At 4 h, there was a higher bacterial reduction of 72.93%, which decreased at 8 h (36.45%). Conclusion: Analyzing the growth trend of viable microorganisms under Dynamic Contact Conditions it can be seen that PHA cranioplasty appears to inhibit exponential growth by inducing bacterial stasis in the early hours of contact, reaching a maximum reduction within 4 h, in this adopted experimental condition.
Evaluating the Mechanical Axis for Detection of Posterior Tibial Slope Malalignment in ACL-Deficient Knees on Lateral Radiographs
Authors: Mayer Philipp , Hielscher Lotta , Schuster Philipp , Schlumberger Michael , Rolvien Tim , Geßlein Markus , Beel Wouter , Richter Jörg 
Published: January 2025

Background: Distal tibial deformities are not assessed using the proximal anatomical axis (PAA) to determine the posterior tibial slope (PTS). Therefore, it seems advantageous to measure PTS on full-length lateral tibial radiographs using the mechanical axis (MA). Purposes: To (1) compare the PTS measurements using the MA and the PAA and (2) determine whether using the PAA fails to detect a certain number of significantly elevated PTS values compared with using the MA. Study Design: Cohort study (Diagnosis); Level of evidence, 3. Methods: Full-length lateral tibial radiographs of 218 consecutive cases were reviewed. Radiographs were checked for malrotation. Therefore, the distance between the posterior tibial condyles was measured in millimeters. Patients with a difference of ≥7 mm between the posterior tibial condyles were excluded, leaving 196 cases for the final statistical analysis. The PTS was measured using the MA and the PAA. Differences between these 2 techniques were analyzed. The sensitivity and specificity of the PAA as a screening method for pathological PTS were calculated, with the MA as the standard for comparison. Four subgroups were formed, all with PAA <12° and different lower limits for the MA: group 1, MA ≥10°; group 2, MA ≥10.5°; group 3, MA ≥11°; and group 4, MA ≥11.5°. Results: Radiographs with ≥7 mm between the posterior tibial condyles showed an increased inconsistency between the PTS measurement with the MA and the PAA. In the group with a distance of <7 mm between the posterior tibial condyles (n = 196), the mean PTS measured with the MA was 9.4°± 3.8° (range, 0.4° to 21.9°), and the mean PTS was 10.5°± 3.5° (range, 1.7° to 20.9°) according to the PAA. The mean difference in PTS between the PAA and the MA was 1.1°± 1.2° (range, –2.4° to 4.1°; P < .001). Group 1 had a sensitivity of 73% and specificity of 98%; group 2, sensitivity of 84% and specificity of 97%; group 3, sensitivity of 87% and specificity of 93%; and group 4, sensitivity of 95% and specificity of 89%. Conclusion: Measuring the PTS using the MA was advantageous, as the measurement with the PAA did not correctly identify all cases with sagittal alignment changes. The proportion of patients with pathologically increased PTS not identified with the proximal anatomical measurement, reflected by the sensitivity, depended on the threshold value defined for the MA. Lateral radiographs, showing an increased distance between the posterior tibial condyles, indicated malrotation of the tibia leading to measurement inaccuracy.
Knowledge, attitude, practices, and associated factors toward cervical cancer among female health sciences students of Addis Ababa University, Addis Ababa, Ethiopia
Authors: Endale Sisay , Delelegn Kalkidan , Negash Zenebe 
Published: January 2025

Background: Cervical cancer is the most common cancer in women worldwide. Early screening and vaccination can prevent cervical cancer; however, the low levels of knowledge, attitude, and practice among the young can contribute to the high prevalence of cervical cancer. Objective: This study aimed to assess the level of knowledge, attitude, and practice of cervical cancer and associated factors among female Health Sciences students of the College of Health Sciences at Addis Ababa University. Design: A descriptive cross-sectional study was conducted from February 2022 to June 2022 among regular undergraduate female Health Sciences students of Addis Ababa University. Methods: Data was collected using a self-administered questionnaire and analyzed using SPSS. Results were presented using descriptive statistics and bivariate analysis was conducted to look at the existence of significant associations and determine adjusted odds ratio. Statistical significance was declared at p-value ⩽0.05. Results: The majority of the study participants were within the age range of 18–24 years. From the 305 female Health Sciences students, almost all had heard about cervical cancer and 93.4% of them reported that human papillomavirus is the causative agent. About 75% of the respondents recognized at least one possible symptom of cervical cancer. Furthermore, nearly 70% and 78.3% of the participants showed positive attitudes toward taking and recommending human papillomavirus vaccines respectively. Only 16.1% and 48.9% of the respondents have good knowledge, and a positive attitude respectively. Surprisingly only 1.6% and 0.3% of the respondents have taken the human papillomavirus vaccine and undergone cervical screening respectively. Radiography technology students are about 86% less likely to have good knowledge compared to students in other fields of study ( p = 0.04). Furthermore, year 4 and above students have significantly higher knowledge (89.2%) compared to those in years 1–3 (58%; AOR: 0.14, 95% CI: 0.05, 0.35). Conclusion: The knowledge of female Health Sciences students on cervical cancer was moderate, and about half had a positive attitude. However, their practice of human papillomavirus screening and vaccination was very low. Level of education and field of study were significantly associated with the knowledge of cervical cancer. Addressing gaps through awareness programs, and enhancing accessible health services can help empower these future health professionals.
The usefulness of Charlson Comorbidity Index (CCI) scoring in predicting all-cause mortality in Outpatients with Clinical Diagnoses of COPD
Authors: Ly Kevin , Wakefield Dorothy , ZuWallack Richard 
Published: January 2025

Background Since comorbid conditions are frequently present in chronic obstructive pulmonary disease (COPD) and affect outcome, a composite scoring system to quantify comorbidity might be helpful in assessing mortality risk. Methods We tested the hypothesis that the Charlson Comorbidity Index (CCI) score at the time of an outpatient medical clinic encounter for COPD predicts all-cause mortality. Cox Proportional Hazards analyses were used in 200 randomly selected patients to relate CCI scores to all-cause mortality out to 5 years. Results Mean age was 62 ± 10 years, 56% were female, FEV1 was 62%, CCI was 3.08 ± 2.30, and 30% had a CCI ≥ 4, indicating 3 or more comorbid conditions. All-cause mortality was 8.5% and 20% at 3 and 5 years, respectively. In univariate testing, the CCI score and hospitalizations predicted mortality, but FEV1 did not. In multivariable testing, which included covariates of age, sex, socioeconomic status, race, FEV1 percent-predicted, and all-cause hospitalizations in the preceding year, CCI expressed as a continuous variable strongly predicted mortality: hazard ratio (HR) 1.38 for each unit increase in the score (p < 0.0001). While 1 or 2 comorbid conditions were not significantly related to mortality, 3 or more comorbid conditions (compared to none) strongly predicted mortality: HR 9.80, 95% CI 3.80 to 25.00. Conclusion Comorbidity, assessed with the CCI, is strongly predictive of mortality in outpatients with a clinical diagnosis of COPD, and this relationship appears to be non-linear. This instrument may be useful in determining prognosis in this population.
Unsupervised detection of novel SARS-CoV-2 mutations and lineages in wastewater samples using long-read sequencing
Authors: Garcia Ignacio , Riis Rasmus K. , Moen Line V. , Rohringer Andreas , Madslien Elisabeth H. , Bragstad Karoline 
Published: January 2025

Abstract
The COVID-19 pandemic has underscored the importance of virus surveillance in public health and wastewater-based epidemiology (WBE) has emerged as a non-invasive, cost-effective method for monitoring SARS-CoV-2 and its variants at the community level. Unfortunately, current variant surveillance methods depend heavily on updated genomic databases with data derived from clinical samples, which can become less sensitive and representative as clinical testing and sequencing efforts decline.
In this paper, we introduce HERCULES (High-throughput Epidemiological Reconstruction and Clustering for Uncovering Lineages from Environmental SARS-CoV-2), an unsupervised method that uses long-read sequencing of a single 1 Kb fragment of the Spike gene. HERCULES identifies and quantifies mutations and lineages without requiring database-guided deconvolution, enhancing the detection of novel variants.
We evaluated HERCULES on Norwegian wastewater samples collected from July 2022 to October 2023 as part of a national pilot on WBE of SARS-CoV-2. Strong correlations were observed between wastewater and clinical sample data in terms of prevalence of mutations and lineages. Furthermore, we found that SARS-CoV-2 trends in wastewater samples were identified one week earlier than in clinical data.
Our results demonstrate HERCULES’ capability to identify new lineages before their detection in clinical samples, providing early warnings of potential outbreaks. The methodology described in this paper is easily adaptable to other pathogens, offering a versatile tool for environmental surveillance of new emerging pathogens.
Clinical integration of germline findings from a tumor testing precision medicine program
Authors: Sanabria-Salas Maria Carolina , Anggala Nina C. , Gillies Brittany , Farncombe Kirsten M. , Hofstedter Renee , Peck Larissa , Purnaghshband Helia , Redondo Laura , Thain Emily , Xu Wei , Sabatini Peter , Bedard Philippe L. , Kim Raymond H. 
Published: January 2025

Abstract

Background
Integrating germline genetic testing (GGT) recommendations from tumor testing into hereditary cancer clinics and precision oncology trials presents challenges that require multidisciplinary expertise and infrastructure. While there have been advancements in standardizing molecular tumor boards, the implementation of tumor profiling for germline-focused assessments has only recently gained momentum. However, this progress remains inconsistent across institutions, largely owing to a lack of systematic approaches for managing these findings. This study outlines the development of a clinical pathway for identifying potential germline variants from an institutional tumor-sequencing research program at Princess Margaret Cancer Centre.

Methods
Between August 2022 and August 2023, a clinical pathway led by a germline Molecular Tumor Board (gMTB) was established to review tumor genetic variants (TGVs) flagged as potential germline findings in patients with advanced cancer via a multigene panel. Eligibility for hereditary cancer syndrome investigation (‘germline criteria’) followed Cancer Care Ontario’s Hereditary Cancer Testing Criteria and clinical judgment. Germline-focused analysis of TGVs followed the European Society of Medical Oncology guidelines and similar published criteria (‘tumor-only criteria’).

Results
Of 243 tumor profiles, 83 (34.2%) had at least one TGV flagged by the genetic laboratory as potentially germline and were therefore referred to the gMTB for further review. Among these 83 cases, 47 (56.6%) met ‘germline criteria’ for GGT, regardless of the TGV assessment. A total of 127 TGVs were assessed in these 83 cases, of which 44 (34.6%) were considered germline relevant. Tier I TGVs, interpreted as pathogenic/likely pathogenic (P/LP) and found in most- or standard-actionable genes with high germline conversion rates (GCRs) in any context, were more likely to be considered germline relevant (p-value < 0.05). One confirmed germline variant was identified in nine patients meeting solely ‘tumor-only criteria’. Overall, 27/44 germline relevant TGVs underwent germline testing. We found a germline P/LP variant in 9 cases of the entire cohort, with a GCR of 33% (9/27).

Conclusions
Incorporating genetic counselors into gMTBs enhanced the integration of research findings into clinical care and improved the detection of disease-causing variants in patients outside traditional testing criteria.