bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ethical challenges during critical phases of the COVID-19 pandemic: An interpretive synthesis
Authors: Macpherson Ignacio , Roqué María V , Echarte Luis , Segarra Ignacio 
Published: February 2024

Background During the most critical phases of COVID-19 pandemic, dramatic situations were experienced in hospitals and care centers that nurses could hardly verbalize. Especially relevant were deep challenges related to terminal illness, situations of extreme sacrifice, as well as reflections on protective measures mixed with beliefs. We intend to analyze which problems had the greatest impact on professionals. Aim The aim is to explore the ultimate basis for action when making decisions and the orientation of their behavior in the face of moral conflicts. Method The methodological strategy is an interpretive synthesis. Narrative review of academic articles that analyzed ethical dilemmas during the pandemic was carried out by searching five databases (Pubmed, Scopus, Psycinfo, CINHAL, and WOS) between January 2020 and December 2022. Finally, 43 articles were selected. Ethical Considerations Ethical requirements were respected in all study phases. Results The reading and review of the 43 articles initiated the first phase of inductive coding which resulted in 14 initial sub-themes. Based on this structure, a second phase of coding was carried out, giving rise to six categories or emerging themes. To facilitate the process of identifying the central category, the authors agreed to carry out a phase of synthesis, grouping the six themes into three meta-themes: the identification and acceptance of human vulnerability; the discovery of positive paradigms in traumatic situations in society; the prevalence of the common good over the particular interest, as the core structure of any society. Conclusion The study has shown the need to consider healthcare benevolence as a new dimension of health care upon global vulnerability. Responsibility is required to ensure the well-being of a global society, prioritizing the common good over particular interests and building solutions on solid moral structures. A new ethical landscape is essential, starting with a humanistic curricular training of all healthcare professionals.
Limited English Proficiency and Outcomes in the Intensive Care Unit: An Integrated Review
Authors: Lehman Rachel , Moriarty Helene 
Published: February 2024

Introduction: Language barriers place patients at risk of substandard care. Hospitalized patients with limited English proficiency (LEP) face unique challenges, especially in the intensive care unit (ICU). The purpose of this review is to critique and synthesize quantitative evidence on LEP and ICU outcomes. Methodology: Quantitative studies published in English between 1999 and 2022 were queried using intentional terminology. Results: Searches yielded 138 results, with 12 meeting inclusion criteria. The analysis resulted in the extrapolation of five themes pertinent to outcomes of ICU patients or families with LEP: (a) knowledge deficit relating to conditions and care; (b) lack of language-appropriate care; (c) alienation from care process; (d) decreased confidence and ownership of care; and (e) relationship to clinical quality indicators. Discussion: Outcomes associated with LEP were largely negative and revealed unmet needs for ICU patients with LEP. More research is needed to improve linguistically and culturally congruent care in the ICU.
Bilateral Cleft lip Simulation
Authors: Zaga-Galante Jonathan , Tse Raymond , Hopper Richard A , Arnold Anne , Fisher David M , Wong-Riff Karen W , Podolsky Dale J 
Published: February 2024

Objective To evaluate the features, anatomic accuracy, and educational value of a high-fidelity bilateral cleft lip simulator. Design Evaluation of the simulator by expert cleft surgeons after performing a simulated bilateral cleft lip repair. Setting The simulator was evaluated by the surgeons during the Latin American Craniofacial Association meeting. Participants Eleven experienced cleft surgeons evaluated the simulator. The cleft surgeons were selected based on their availability during the meeting. Interventions The participants performed a simulated bilateral cleft lip repair. They were each provided with a questionnaire assessing the simulator's features, realism and value as a training tool. Main Outcome Measure (s) The main outcome measure are the scores obtained from a Likert-type questionnaire assessing the simulators features, realism and value. Results Overall, the surgeons agreed with the simulator's realism and anatomic accuracy (average score of 3.7 out of 5). Overall, the surgeons strongly agreed with the value of the simulator as a training tool (average score of 4.6 out of 5). Conclusions A high-fidelity bilateral cleft lip simulator was developed that is realistic and valuable as a training tool. The simulator provides a comprehensive training platform to gain hands-on experience in bilateral cleft lip repair before operating on real patients.
Interorganisational collaboration to improve accessibility of diagnostic evaluations for children with a developmental disability
Authors: Eva Cloet , Anna Jansen , Mark Leys 
Published: February 2024

Introduction: A timely integrated diagnostic and care trajectory for children with a developmental disability may prevent severe problems in later life. In Flanders, Belgium, different types of governmental regulated and subsidised settings offer diagnostic evaluations, as (part of) their mission. However, they operate in a non-coordinated way inducing severe accessibility problems for the public. This article studies the factors impacting on interorganisational collaboration and proposes an interorganisational conceptual model improving accessibility. Methods: Focus groups were performed per type of organisation. Qualitative data were categorised thematically in an iterative process of data- and researcher triangulation. A member check validation was organised. Results: Fifty-nine individuals participated in 6 focus groups. Structural and agency-related barriers for interorganisational collaboration were identified at micro, meso and macro level. Participants provided suggestions for better interorganisational collaboration. Discussion: To improve accessibility adapted to patients’ needs, a patient-centred, integrated and interorganisational network model grounded in a stepped care logic is proposed to adapt the current organisation-centred model. Conclusion: A timely, integrated, diagnostic and care trajectory for children with a developmental disability preventing severe problems in later life requires an integration of services during the overall care trajectory of children by means of interorganisational collaboration.
Dabigatran etexilate versus warfarin in cerebral venous thrombosis in Chinese patients (CHOICE-CVT): An open-label, randomized controlled trial
Authors: Ma Hongrui , Gu Yaqin , Bian Tingting , Song Haiqing , Liu Zhi , Ji Xunming , Duan Jiangang 
Published: February 2024

Background: The efficacy and safety of dabigatran etexilate for Chinese patients with cerebral venous thrombosis (CVT) has not been well established. Methods: CHOICE-CVT was an exploratory, single-center, randomized, open-label study in the National Center for Neurological Disorders involving Chinese patients with CVT aged 18 to 80 years who were randomly assigned (1:1) to either dabigatran etexilate or warfarin. Oral anticoagulants were initiated after 10–15 days of LMWH. The primary efficacy and safety endpoints included the number of patients with recurrent CVT and/or deep venous thrombosis (DVT) and major clinical bleeding within 180 days. Secondary efficacy endpoints included venous recanalization and change in papilledema at day 180. Secondary safety outcomes comprised death, clinical nonmajor bleeding, and any bleeding. The study was registered with ClinicalTrials.gov under NCT03930940. Results: Between October 2017 and February 2023, a total of 89 patients were enrolled and randomly assigned to receive either dabigatran etexilate (n = 44) or warfarin (n = 45). At day 180, the dabigatran etexilate group showed a statistically nonsignificant but likely clinically significant number of patients with recurrent CVT and/or DVT (8 (18.2%; 95% CI, 6.3–30.0) vs 3 (6.7%; 95% CI, 0.0–14.2), p = 0.099, with a power (1-β) of 38.401%) compared with the warfarin group. The dabigatran etexilate group showed a comparable number of patients with clinical major bleeding (0 (0) vs 0 (0) p = 1.000), and clinical nonmajor bleeding (1 (2.3%; 95% CI, 0.0–6.9) vs 1 (2.2%; 95% CI, 0.0–6.7)) but demonstrated a lower risk of any bleeding (1 (2.3%; 95% CI, 0.0–6.9) vs 9 (20.0%; 95% CI, 7.8–32.2)) compared with the warfarin group. Most patients in both groups achieved venous recanalization according to the Modified Qureshi scale (27 (75%; 95% CI, 60.1–89.9) in the dabigatran etexilate group vs 34 (82.9%; 95% CI, 70.9–95.0) in the warfarin group) and exhibited improvement in papilledema as per the Frisén classification (35 (97.2%; 95% CI, 91.6–100.0) in the dabigatran etexilate group vs 37 (88.1%, 95% CI, 77.9–98.3) in the warfarin group). Conclusions: These findings regarding efficacy and safety support the consideration of dabigatran etexilate therapy as a viable treatment option for Chinese patients with CVT.
Economic impact of inflammatory bowel disease in Catalonia: a population-based analysis
Authors: Brunet-Mas Eduard , Garcia-Sagué Belen , Vela Emli , Melcarne Luigi , Llovet Laura Patricia , Pontes Caridad , García-Iglesias Pilar , Puy Anna , Lario Sergio , Ramirez-Lazaro Maria Jose , Villoria Albert , Burisch Johan , Kaplan Gilaad G. , Calvet Xavier 
Published: February 2024

Background: Inflammatory bowel disease (IBD) has a major economic impact on healthcare costs. Objectives: The aim of this study was to evaluate the current healthcare expenditure associated with IBD in a population-wide study in Catalonia. Design: Retrospective observational study. Methods: All patients with IBD included in the Catalan Health Surveillance System (CHSS) were considered eligible. The CHSS compiles data on more than 7 million individuals in 2020 (34,823 with IBD). Data on the use of healthcare resources and its economic impact were extracted applying the International Classification of Diseases, 10th revision, Clinical Modification codes (ICD-10-CM codes). Health expenditure, comorbidities, and hospitalization were calculated according to the standard costs of each service provided by the Department of Health of the Catalan government. The data on the IBD population were compared with non-IBD population adjusted for age, sex, and income level. IBD costs were recorded separately for Crohn’s disease (CD) and ulcerative colitis (UC). Results: Prevalence of comorbidities was higher in patients with IBD than in those without. The risk of hospitalization was twice as high in the IBD population. The overall healthcare expenditure on IBD patients amounted to 164M€. The pharmacy cost represents the 60%. The average annual per capita expenditure on IBD patients was more than 3.4-fold higher (IBD 4200€, non-IBD 1200€). Average costs of UC were 3400€ and 5700€ for CD. Conclusion: The risk of comorbidities was twice as high in patients with IBD and their use of healthcare resources was also higher than that of their non-IBD counterparts. Per capita healthcare expenditure was approximately 3.4 times higher in the population with IBD. Trial registration: The study was not previously registered.
Immune checkpoint inhibitors or anti-claudin 18.2 antibodies? A network meta-analysis for the optimized first-line therapy of HER2-negative gastric cancer
Authors: Zhang Zhening , Xie Tong , Wang Yingxuan , Shen Lin , Zhang Xiaotian , Peng Zhi 
Published: February 2024

Background: Multiple anti-programmed cell death-1/programmed cell death-ligand 1 (PD-1/PD-L1) inhibitors and zolbetuximab, an anti-claudin 18.2 antibody, have shown efficacy in the first-line treatment of HER2-negative gastric cancers. How to choose the best regimen remains an unsolved question. Objectives: We aimed to conduct a comparative analysis of the therapeutic advantages between immunotherapy and anti-claudin-18.2-targeted therapies in the first-line treatment of HER2-negative, unresectable, or metastatic gastric cancers. Design: Network meta-analysis was employed to systematically compare efficacy and safety data derived from various clinical trials. Data sources and methods: We included phase III randomized controlled trials in PubMed, Embase, Web of Science, Cochrane Library, and major conference abstracts. Network meta-analysis was used to compare the efficacy of each first-line therapeutic agent and to indirectly compare immunotherapy with anti-claudin-18.2-targeted therapy. Results: Eight trials comprising a total of 6455 patients were included. For the overall survival (OS) analysis, no statistically significant differences were observed between pembrolizumab [hazard ratios (HR) = 1.00, 95% CI: 0.94–1.07], sintilimab (HR = 0.99, 95% CI: 0.89–1.09), sugemalimab (HR = 0.98, 95% CI: 0.87–1.10), tislelizumab (HR = 0.97, 95% CI: 0.87–1.09), zolbetuximab (HR = 0.98, 95% CI: 0.91–1.07), and nivolumab (HR = 1.00). For the progression-free survival (PFS) analysis, no statistically significant differences were observed between pembrolizumab (HR = 1.00, 95% CI: 0.93–1.06), sintilimab (HR = 0.91, 95% CI: 0.83–1.00), sugemalimab (HR = 0.92, 95% CI: 0.84–1.02), tislelizumab (HR = 0.93, 95% CI: 0.84–1.03), zolbetuximab (HR = 0.96, 95% CI: 0.88–1.05), and nivolumab (HR = 1.00). For the overall response rate analysis, all regimens presented similar effects on ORR. In addition, anti-claudin-18.2-targeted therapies presented similar OS (HR = 0.99, 95% CI: 0.95–1.04) and PFS (HR = 1.01, 95% CI: 0.91–1.12) compared to immunotherapy, although their toxicity profiles were distinct. Conclusions: Our network meta-analysis showed no significant difference in PFS, OS, or ORR between different checkpoint inhibitors or between immunotherapy and anti-claudin-18.2-targeted therapies in the first-line treatment of HER2-negative, unresectable, or metastatic gastric cancers.
The development and external validation of a web-based nomogram for predicting overall survival with Ewing sarcoma in children
Authors: Chen Yi , Liu Zirui , Wang Yaobin , Zhan Hongwei , Liu Jinmin , Niu Yongkang , Yang Ao , Teng Fei , Li Jinfeng , Geng Bin , Xia Yayi 
Published: February 2024

Background: Ewing sarcoma remains the second most prevalent primary aggressive bone tumor in teens and young adults. The aim of our study was to develop and validate a web-based nomogram to predict the overall survival for Ewing sarcoma in children. Methods: A total of 698 patients, with 640 cases from the Surveillance, Epidemiology, and End Results (the training set) and 58 cases (the external validation set), were included in this study. Cox analyses were carried out to determine the independent prognostic indicators, which were further included to establish a web-based nomogram. The predictive abilities were tested through the concordance index, calibration curve, decision curve analysis, and area under the receiver operating characteristic curve. Results: As suggested by univariate and multivariate Cox analyses, age, primary site, tumor size, metastasis stage (M stage), and chemotherapy were included as the independent predictive variables. The area under the receiver operating characteristic curve values, calibration curves, concordance index, and decision curve analysis from training and validation groups suggested the model has great clinical applications. Conclusion: We developed a convenient and precise web-based nomogram to evaluate overall survival for Ewing sarcoma in children. The application of this nomogram would assist physicians and patients in making decisions.
Case fatality and functional outcome after spontaneous subarachnoid haemorrhage: A systematic review and meta-analysis of time trends and regional variations in population-based studies
Authors: Ziebart Andreas , Dremel Judith , Hetjens Svetlana , Nieuwkamp Dennis J , Linn Francisca HH , Etminan Nima , Rinkel Gabriel JE 
Published: February 2024

Introduction: A previous systematic review of population-based studies from 1973 to 2002 found a decrease in case fatality for spontaneous subarachnoid haemorrhage, but could not find a sufficient number of studies to assess changes in functional outcome. Since then, treatment has advanced distinctly. We assessed whether case fatality has decreased further and whether functional outcome has improved. Patients and methods: We searched PubMed and Web of Science for new population-based studies using the same criteria as in our previous systematic review. We assessed changes in case fatality and functional outcome over time using linear regression. Results: We included 24 new studies with 827 patients and analysed 9542 patients described in 62 study periods between 1973 and 2017. Case fatality decreased by 0.3% (95% CI: −0.7 to 0.1) per year. In a sensitivity analysis excluding studies that did not provide 1-month outcome and outliers, the age and sex-adjusted decrease was 0.1% per year (95% CI: −0.9 to 0.6). The mean case fatality rate decreased from 47% (95% CI: 31–63) in the 1970s to 35% (95% CI: 30–39) in the 1990s, and remained stable in the 2000s (34%; 95% CI: 27–41) and 2010s (38%; 95% CI: 15–60). In 15 studies, the mean proportion of patients living independently increased by 0.2% per year (95%CI: −0.7 to 1.1) and the mean was 45% (95% CI: 39–50) in six studies that reported outcome after 12 months. Discussion and conclusion: From 1973 to 2017, the case-fatality rate of spontaneous subarachnoid haemorrhage declined overall by 13.5%, but remained stable over the last two decades. The data on time trends in functional outcome were inconclusive.
Lung cancer risk and occupational pulmonary fibrosis: systematic review and meta-analysis
Authors: Krabbe Julia , Steffens Katja Maria , Drießen Sarah , Kraus Thomas 
Published: February 2024

Background:Molecular pathways found to be important in pulmonary fibrosis are also involved in cancer pathogenesis, suggesting common pathways in the development of pulmonary fibrosis and lung cancer.Research question:Is pulmonary fibrosis from exposure to occupational carcinogens an independent risk factor for lung cancer?Study design and methods:A comprehensive search of PubMed, Embase, Web of Science and Cochrane databases with over 100 search terms regarding occupational hazards causing pulmonary fibrosis was conducted. After screening and extraction, quality of evidence and eligibility criteria for meta-analysis were assessed. Meta-analysis was performed using a random-effects model.Results:52 studies were identified for systematic review. Meta-analysis of subgroups identified silicosis as a risk factor for lung cancer when investigating odds ratios for silicosis in autopsy studies (OR 1.47, 95% CI 1.13–1.90) and for lung cancer mortality in patients with silicosis (OR 3.21, 95% CI 2.67–3.87). Only considering studies with an adjustment for smoking as a confounder identified a significant increase in lung cancer risk (OR 1.58, 95% CI 1.34–1.87). However, due to a lack of studies including cumulative exposure, no adjustments could be included. In a qualitative review, no definitive conclusion could be reached for asbestosis and silicosis as independent risk factors for lung cancer, partly because the studies did not take cumulative exposure into account.Interpretation:This systematic review confirms the current knowledge regarding asbestosis and silicosis, indicating a higher risk of lung cancer in exposed individuals compared to exposed workers without fibrosis. These individuals should be monitored for lung cancer, especially when asbestosis or silicosis is present.
Synergistic anticancer effect of Pistacia lentiscus essential oils and 5-Fluorouracil co-loaded onto biodegradable nanofibers against melanoma and breast cancer
Authors: Alabrahim Obaydah Abd Alkader , Azzazy Hassan Mohamed El-Said 
Published: February 2024

AbstractChemoresistance and severe toxicities represent major drawbacks of chemotherapy. Natural extracts, including the essential oils of Pistacia lentiscus (PLEO), exhibit substantial anticancer and anti-inflammatory activities where different cancers are reported to dramatically recess following targeting with PLEO. PLEO has promising antimicrobial, anticancer, and anti-inflammatory properties. However, the therapeutic properties of PLEO are restricted by limited stability, bioavailability, and targeting ability. PLEO nanoformulation can maximize their physicochemical and therapeutic properties, overcoming their shortcomings. Hence, PLEO was extracted and its chemical composition was determined by GC–MS. PLEO and 5-Fluorouracil (5FU) were electrospun into poly-ε-caprolactone nanofibers (PCL-NFs), of 290.71 nm to 680.95 nm diameter, to investigate their anticancer and potential synergistic activities against triple-negative breast cancer cells (MDA-MB-231), human adenocarcinoma breast cancer cells (MCF-7), and human skin melanoma cell line (A375). The prepared nanofibers (NFs) showed enhanced thermal stability and remarkable physical integrity and tensile strength. Biodegradability studies showed prolonged stability over 42 days, supporting the NFs use as a localized therapy of breast tissues (postmastectomy) or melanoma. Release studies revealed sustainable release behaviors over 168 h, with higher released amounts of 5FU and PLEO at pH 5.4, indicating higher targeting abilities towards cancer tissues. NFs loaded with PLEO showed strong antioxidant properties. Finally, NFs loaded with either PLEO or 5FU depicted greater anticancer activities compared to free compounds. The highest anticancer activities were observed with NFs co-loaded with PLEO and 5FU. The developed 5FU-PLEO-PCL-NFs hold potential as a local treatment of breast cancer tissues (post-mastectomy) and melanoma to minimize their possible recurrence.
Graphical Abstract
Torch-eCpG: a fast and scalable eQTM mapper for thousands of molecular phenotypes with graphical processing units
Authors: Kober Kord M. , Berger Liam , Roy Ritu , Olshen Adam 
Published: February 2024

Abstract
Background
Gene expression may be regulated by the DNA methylation of regulatory elements in cis, distal, and trans regions. One method to evaluate the relationship between DNA methylation and gene expression is the mapping of expression quantitative trait methylation (eQTM) loci (also called expression associated CpG loci, eCpG). However, no open-source tools are available to provide eQTM mapping. In addition, eQTM mapping can involve a large number of comparisons which may prevent the analyses due to limitations of computational resources. Here, we describe Torch-eCpG, an open-source tool to perform eQTM mapping that includes an optimized implementation that can use the graphical processing unit (GPU) to reduce runtime.

Results
We demonstrate the analyses using the tool are reproducible, up to 18 × faster using the GPU, and scale linearly with increasing methylation loci.

Conclusions
Torch-eCpG is a fast, reliable, and scalable tool to perform eQTM mapping. Source code for Torch-eCpG is available at https://github.com/kordk/torch-ecpg.