bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of Prior Stroke With Health Care Perceptions of Adequate Emergency Care in Women
Authors: Stamm Brian , Royan Regina , Madsen Tracy E. 
Published: November 2023

BACKGROUND:
Women with a history of stroke represent a vulnerable patient population due to their extant disability, morbidity, and risk of recurrence. The association between prior stroke with patient experience and perception of emergency medical care is unknown.

METHODS:
We utilized data from the Health Care Experiences and Perception cross-sectional, online survey from the American Heart Association Research Goes Red Registry. Ordinal logistic regression models were performed to assess the association between a self-reported history of stroke in the prior 10 years and the perception of not receiving adequate care in an emergency department because of gender or race. Models were adjusted for age at the time of enrollment, race/ethnicity, myocardial infarction within 10 years, and current smoking status.

RESULTS:
A total of 3498 women participants met inclusion criteria: 89 participants with a history of stroke in the past 10 years (mean age, 49.4 years; 10.1% Black participants and 5.6% Hispanic participants) and 3409 participants without such history (mean age, 45.8 years; 7.8% Black participants and 7.0% Hispanic participants). In multivariate logistic regression models, stroke history was significantly associated with greater odds of answering “to a great extent” that “I will not receive adequate care in an emergency room based on my gender” (odds ratio, 3.23 [95% CI, 1.69–6.17]) and “…race/ethnicity” (odds ratio, 3.88 [95% CI, 1.45–10.39]). Similar results were seen for secondary outcomes.

CONCLUSIONS:
Women patients with a stroke history felt less likely to receive adequate emergency care based on gender and race/ethnicity. Whether these negative health perceptions are associated with delays in presentation for stroke or other time-sensitive conditions should be the focus of future studies, given that these populations are known to less frequently receive advanced therapies for stroke, in part due to delays in presentation.
FastSurfer-HypVINN: Automated sub-segmentation of the hypothalamus and adjacent structures on high-resolutional brain MRI
Authors: Estrada Santiago , Kügler David , Bahrami Emad , Xu Peng , Mousa Dilshad , Breteler Monique M.B. , Aziz N. Ahmad , Reuter Martin 
Published: November 2023

Abstract
The hypothalamus plays a crucial role in the regulation of a broad range of physiological, behavioral, and cognitive functions. However, despite its importance, only a few small-scale neuroimaging studies have investigated its substructures, likely due to the lack of fully automated segmentation tools to address scalability and reproducibility issues of manual segmentation. While the only previous attempt to automatically sub-segment the hypothalamus with a neural network showed promise for 1.0 mm isotropic T1-weighted (T1w) magnetic resonance imaging (MRI), there is a need for an automated tool to sub-segment also high-resolutional (HiRes) MR scans, as they are becoming widely available, and include structural detail also from multi-modal MRI. We, therefore, introduce a novel, fast, and fully automated deep-learning method named HypVINN for sub-segmentation of the hypothalamus and adjacent structures on 0.8 mm isotropic T1w and T2w brain MR images that is robust to missing modalities. We extensively validate our model with respect to segmentation accuracy, generalizability, in-session test-retest reliability, and sensitivity to replicate hypothalamic volume effects (e.g., sex differences). The proposed method exhibits high segmentation performance both for standalone T1w images as well as for T1w/T2w image pairs. Even with the additional capability to accept flexible inputs, our model matches or exceeds the performance of state-of-the-art methods with fixed inputs. We, further, demonstrate the generalizability of our method in experiments with 1.0 mm MR scans from both the Rhineland Study and the UK Biobank—an independent dataset never encountered during training with different acquisition parameters and demographics. Finally, HypVINN can perform the segmentation in less than a minute (graphical processing unit [GPU]) and will be available in the open source FastSurfer neuroimaging software suite, offering a validated, efficient, and scalable solution for evaluating imaging-derived phenotypes of the hypothalamus.
MJO-Induced Warm Pool Eastward Extension Prior to the Onset of El Niño: Observations from 1998 to 2019
Authors: Jauregui Yakelyn R. , Chen Shuyi S. 
Published: November 2023

Abstract
The Madden–Julian oscillation (MJO) and El Niño–Southern Oscillation (ENSO) are the two most important tropical phenomena that affect global weather and climate on intraseasonal and interannual time scales. Although they occur on different time scales, the MJO-induced sea surface temperature (SST) anomalies over the equatorial Pacific have spatial scales similar to SST anomalies prior to El Niño. This study aims to address the question of whether the MJO plays an important role in the warm pool eastward extension (WPEE) leading up to El Niño. We use over 20 years of satellite observations, including optimum interpolated SST, TRMM-GPM precipitation, and the cross-calibrated multiplatform (CCMP) surface winds from 1998 to 2019, to quantify the spatial structure and duration of the MJO-induced warm SST anomalies over the equatorial Pacific (10°S–10°N, 130°E–180°). The intensity of the MJO is measured by the total rain volume and average surface westerly wind speed throughout its convectively active phase. Results show that 1) 61% of the 98 MJO events induced a WPEE over 1000–3000 km along the equator, which can last beyond 15–30 days after the MJO precipitation ended; 2) the MJO events prior to El Niño are generally stronger and produce significant WPEE far beyond its annual cycle and increasing SST warming in the Niño-3.4 region; 3) consecutive MJO events can produce much stronger WPEE prior to El Niño, which are observed in all El Niño events from 1998 to 2019; and 4) more frequent and stronger MJO-induced WPEE occurs in March–May than other seasons. These results can help better understand the MJO–ENSO interaction and, ultimately, improve the prediction of El Niño onset.
Imperfect cross-linking of xanthan for pH-responsive bio-based composite moist wound dressings by stencil printing
Authors: Wurm Florian , Lenninger Margit , Mayr Astrid , Lass-Floerl Cornelia , Pham Tung , Bechtold Thomas 
Published: November 2023

The work addresses the use of bio-based and –degradable materials for the production of a moist, adaptive and anti-microbial wound dressing. The dressing is targeted to exhibit a pH-dependent active agent release. Xanthan hydrogel structures are coated on cellulose fabrics via stencil printing and subsequently cross-linked using glyoxal. By alteration of the cross-linker content from 1 to 6% by mass, the hydrogel elasticity can be tuned within a range of 2–16 kPa storage modulus. Increasing initial glyoxal concentrations also result in higher amounts of glyoxal release. Glyoxal, an anti-microbial agent with approval in veterinary medicine, is mostly released upon wound application supporting infection management. As wound simulation, normal saline, as pH 5 and pH 8 buffer solutions, were used. The release profile and magnitude of approx. 65%–90% glyoxal is pH-dependent. Increased release rates of glyoxal are present in pH 8 fluids, which mostly base on faster hydrogel swelling. Higher total glyoxal release is present in pH 5 fluid and normal saline after 3 days. Accordingly, a pH-dependent release profile was encountered. As glyoxal attacks any cell unselectively, it is expected to be effective against antibiotic resistant bacteria. By stencil printing the dressing size can be adjusted to minimize healthy glyoxal tissue exposure.
Position statements of the Royal Australian and New Zealand College of Psychiatrists: An historical perspective
Authors: Bloch Sidney , Kenn Felicity , Bajurny Laura , Griffiths Morgan , Lim Izaak , Smith Jennifer , Wright Nicola 
Published: November 2023

Objective To review the concept, purpose, and subjects of Position Statements of the Royal Australian and New Zealand College of Psychiatrists since their inception in 1971, and to consider changes to enhance their value. Method We scrutinised the procedure in producing, revising, and rescinding Position Statements, and the nature of the subjects covered. Results Position Statements were initiated by the College Board, various College committees and members. The format and procedures of revising and rescinding them varied considerably. We identified 11 subject areas encompassing professional practice and research, their association with societal developments, and the implications for College policy. Conclusion Position Statements have proved to be a dynamic vehicle to keep abreast of significant changes in psychiatry. Methodical appraisal is required to optimise their objective in conveying College policies to members and relevant stakeholders.
Evaluation of the Change in Halitosis with the Improvement in Oral Health in Cleft Lip and Palate Patients
Authors: Aslan Belma Isık , Uzuner Fatma Denız , Taskaldıran Ezgi Sila , Tuter Gulay , Gulsen Ayse , Güngör Kahraman , Ucuncu Neslihan 
Published: November 2023

Aim This study aimed to assess the effects of hygiene education on periodontal health and mouth/nasal halitosis in patients with cleft. Materials and Methods 39 patients with cleft who were accepted for orthodontic treatment divided into two groups as with (Group1; n = 24) and without braces (Group2; n = 15). Plaque Index (PI), Gingival Index (GI), and Tongue coating Index (TCI) values were recorded. The BANA test microbiological kit, was used to determine the amount of anaerobic bacteria. Values of volatile sulfur components (VSC) for the measurement of oral and nasal halitosis were measured with a Halimeter device. After the initial measurements, oral hygiene instructions were given to eliminate the plaque production on teeth, periodontal structure, tongue and palate. All measurements were repeated 4 weeks after the hygiene instructions. Wilcoxon and Mann-Whitney U test were used for statistical analysis. Results In both groups, the PI, GI, values were significantly decreased ( P < .05). Tongue coating area, thickness and TCI were significantly reduced ( P < .05). Oral halitosis values decreased significantly ( P < .05). The PI values decreased significantly more in the Group 1 ( P < .05). Non significant difference was detected in nasal halitosis in both groups. In unilateral cleft lip and palate cases cases (n = 23), no significant difference was found in nasal halitosis values between the cleft and the healthy sides ( P > 0.05). Conclusion In patients with clet cases, periodontal health was improved and oral halitosis was reduced by the given hygiene education; brushing the teeth, especially the tongue and palate. However, hygiene education did not have a significant effect on nasal halitosis. Key Words: Cleft lip and palate, Halitosis, BANA test, Periodontal index.
A Novel Method for one-Stage Repair of the lip Vermilion Defects in Progressive Hemifacial Atrophy
Authors: Feng Shi , Ma Lun-kun , Zhang Zhi-yong , Tang Xiao-jun , Xu Xi , Zhao Shan-baga , Liu Bing-yang , Zang Tian-ying , Li Hong-wen , Liang Ying-xiang , Liu Wei 
Published: November 2023

Background Progressive hemifacial atrophy often causes lip vermilion defects in patients. In this study, we described a one-stage repair method for lip defects in progressive hemifacial atrophy using a lip vermilion mucosal flap or combined dermal fat flap graft. Patients and Methods Patients diagnosed with progressive hemifacial atrophy with lip vermilion defects from 2010 to 2022 were included in this study. Based on the severity and location of the patient's lip defect, a lip vermilion mucosal flap was designed and transferred to the lip defect or combined with a hip dermal fat flap for one-stage repair of the lip morphology. Lip morphology and function of patients were followed up after surgery. Results A total of 22 patients were enrolled in this study, including 15 patients with lip defects on the upper lip alone and 7 patients with both upper and lower lip defects. Follow-up six months to two years postoperatively, all patients recovered uneventfully without complications. The repaired lips of the patient had a full and symmetrical morphology with no visible scarring. Two patients experienced transient dysesthesia of the lips postoperatively and both returned to normal after three months. All patients had good lip closure with normal dietary and speech function. Conclusions The method we described for repairing lip defects in progressive hemifacial atrophy can achieve satisfactory aesthetic and functional lip results. The distinct advantage of this approach is that the patients undergo only one-stage operation and it can be used to repair both upper and lower lip defects.
Optimization and biodynamic modelling of a 3D-printed honeycomb cushion and double-diamond seating suspension system for vibration isolation
Authors: Guo Linchuan , Zhao Yuli , Wang Xu 
Published: November 2023

Extended periods of driving, lasting up to 8 hours, can have a severe impact on a driver's health due to the presence of low-frequency vibrations caused by uneven road surfaces. This paper presents a novel biodynamic system modelling method for investigating how the human body responds to low-frequency vibrations. The lumped biodynamic parameter model predicts time-domain head acceleration and frequency-domain transmissibility ratio. This paper's design innovation involves a three-dimensional printed cushion composed of honeycomb cells and a seating suspension system featuring six double-diamond isolators. Using the Design of Experiments, Response Surface Method, and Genetic Algorithm methods, the structural parameters of the seating suspension system and cushion in the model are optimized for the minimum peak transmissibility ratio. The uniqueness of this paper's approach lies in its sensitivity analysis and optimization of the seat cushion and seating suspension system design parameters within a quarter-vehicle suspension system environment, which sets it apart from other literature. Furthermore, this paper explores the connection between the negative Poisson's ratio and quasi-zero stiffness as a means of reducing vibration transmission.
Expected wait times for access to a disease-modifying Alzheimer’s treatment in England: A modelling study
Authors: Mattke Soeren , Tang Yu , Hanson Mark 
Published: November 2023

Objectives We previously analysed the preparedness to deliver a disease-modifying Alzheimer’s treatment in the United Kingdom and predicted substantial wait times. This study updates the prediction for the National Health Service (NHS) in England, using an improved model and newer data. Methods We reviewed published data on capacity for diagnosis of cognitive impairment combined with expert input and constructed a model for wait times to access from 2023 to 2043. The model tracks patients from initial evaluation in primary care, cognitive testing by a dementia specialist, confirmatory biomarker testing with positron emission tomography (PET) scans or examination of cerebrospinal fluid and infusion delivery. Capacity for specialist visits and PET scans are assumed to be capacity constrained, and cerebrospinal fluid testing and infusion delivery to be scalable. Results Capacity constraints were projected to result in substantial wait times: patients referred to specialists based on a brief cognitive test, which is the current standard of care, would expect an overall initial wait times of 56 months in 2023, increasing to 129 months in 2029 and then falling slowly to around 100 months. Use of a blood test for the confirmation of Alzheimer’s pathology as an additional triage step, would reduce wait times to around 17 to 25 months. Discussion The NHS England lacks capacity to provide timely access to a disease-modifying treatment, which is estimated to result in significant wait times and potentially avoidable disease progression. Better diagnostic tools at initial evaluation may reduce delays.
Role of C-Reactive Protein as a Predictor of Difficult Laparoscopic Cholecystectomy
Authors: Anees Khadija , Faizan Muhammad , Siddiqui Sarush Ahmed , Anees Ayesha , Faheem Komal , Shoaib Umer 
Published: November 2023

Introduction Cholelithiasis is one of the most common diseases encountered in gastroenterology. Laparoscopic cholecystectomy can be labelled as difficult if the surgery continues for more than 60 minutes or if the cystic artery is injured before ligation or clipping. Predicting difficult laparoscopic cholecystectomy can help the surgeon to be prepared for intraoperative challenges such as adhesions in triangle of Calot, injury to cystic artery or gall stone spillage; and improve patient counseling. Methods In this cross-sectional study, we evaluated 269 patients with diagnosed cholelithiasis and planned for laparoscopic cholecystectomy in the general surgery department of Civil Hospital Karachi. After approval of the institution review board of the Civil Hospital, the data of all the patients was collected along with informed consent. The patients were selected via nonprobability, consecutive sampling. Results The prevalence of difficult LC during procedure was 14.5% (39/269). Contingency table showed the true positive, negative and false positive and negative observation and using these observation to compute accuracy. Sensitivity, specificity, PPV, NPV and accuracy of serum c-reactive protein (CRP) in predicting the difficult laparoscopic cholecystectomy in patients of cholelithiasis was 87.2%, 97%, 82.9%, 97.8% and 95.5% respectively. Effect modifiers like age, gender and BMI were controlled by stratification analysis and observed that diagnostic accuracy was above 90% in all stratified groups as presented in the following tables. 175 (65.06%) of 279 patients were females indicating female predominance. In general, 41 patients (15.05%) had CRP serum levels greater than 11 mg/dL out of which 34 patients had to undergo difficult laparoscopic cholecystectomy (DLC), while 223 out of 228 patients with serum CRP levels of less than 11 mg/dL did not face any difficulty during their cholecystectomy. Similar results have been acquired across all age groups and both genders. Conclusion C Reactive Protein is a potent predictor of difficult laparoscopic cholecystectomy and its conversion preoperatively. Patients with preoperatively high C Reactive Protein CRP levels in serum have more chances of complication intraoperatively and increased chances of conversion from laparoscopic to open surgery. Preoperative C Reactive Protein (CRP) with values >11 mg/dL was associated with the highest odds of presenting difficult laparoscopic cholecystectomy (DLC) in our study. This value possesses good sensitivity, specificity, PPV, and NPV for predicting DLC in our population.
Unresolved issues with noninferiority pragmatic trials: Results of a literature survey
Authors: Ciarleglio Maria M , Li Jiaxuan , Peduzzi Peter 
Published: November 2023

Background Issues with specification of margins, adherence, and analytic population can potentially bias results toward the alternative in randomized noninferiority pragmatic trials. To investigate this potential for bias, we conducted a targeted search of the medical literature to examine how noninferiority pragmatic trials address these issues. Methods An Ovid MEDLINE database search was performed identifying publications in New England Journal of Medicine, Journal of the American Medical Association, Lancet, or British Medical Journal published between 2015 and 2021 that included the words “pragmatic” or “comparative effectiveness” and “noninferiority” or “non-inferiority.” Our search identified 14 potential trials, 12 meeting our inclusion criteria (11 individually randomized, 1 cluster-randomized). Results Eleven trials had results that met the criteria established for noninferiority. Noninferiority margins were prespecified for all trials; all but two trials provided justification of the margin. Most trials did some monitoring of treatment adherence. All trials conducted intent-to-treat or modified intent-to-treat analyses along with per-protocol analyses and these analyses reached similar conclusions. Only two trials included all randomized participants in the primary analysis, one used multiple imputation for missing data. The percentage excluded from primary analyses ranged from ∼2% to 30%. Reasons for exclusion included randomization in error, nonadherence, not receiving assigned treatment, death, withdrawal, lost to follow-up, and incomplete data. Conclusion Specification of margins, adherence, and analytic population require careful consideration to prevent bias toward the alternative in noninferiority pragmatic trials. Although separate guidance has been developed for noninferiority and pragmatic trials, it is not compatible with conducting a noninferiority pragmatic trial. Hence, these trials should probably not be done in their current format without developing new guidelines.
Observational study on the evolution of systemic treatments for advanced renal cell carcinoma in Southwest Finland between 2010 and 2021
Authors: Hölsä Olivia , Teittinen Kaisa , Anttalainen Anna , Ukkola-Vuoti Liisa , Summanen Milla , Mattila Kalle E 
Published: November 2023

Background: Novel receptor tyrosine kinase inhibitors and immune checkpoint inhibitors have been introduced to the treatment of advanced renal cell carcinoma (aRCC) during the past decade. However, the adoption of novel treatments into clinical practice has been unknown in Finland. Objectives: Our aim was to evaluate the use of systemic treatments and treatment outcomes of aRCC patients in Southwest Finland during 2010–2021. Design and Methods: Clinical characteristics, treatments for aRCC, healthcare resource utilization, and overall survival (OS) were retrospectively obtained from electronic medical records. Patients were stratified using the International Metastatic RCC Database Consortium (IMDC) risk classification. Results: In total, 1112 RCC patients were identified, 336 (30%) patients presented with aRCC, and 57% of them ( n = 191) had received systemic treatment. Pre-2018, sunitinib (79%) was the most common first-line treatment, and pazopanib (17%), axitinib (17%), and cabozantinib (5%) were frequently used in the second-line. Post-2018, sunitinib (52%), cabozantinib (31%), and the combination of ipilimumab and nivolumab (10%) were most commonly used in the first-line, and cabozantinib (23%) in the second-line. Median OS for patients with favorable, intermediate, and poor risk were 61.9, 28.6, and 8.1 months, respectively. A total of 73%, 74%, and 35% of the patients with favorable, intermediate, and poor risk had received second-line systemic treatment. In poor-risk patients, the number of hospital inpatient days was twofold higher compared to intermediate and fourfold higher compared to favorable-risk patients. Conclusion: New treatment options were readily adopted into routine clinical practice after becoming reimbursed in Finland. OS and the need for hospitalization depended significantly on the IMDC risk category. Upfront combination treatments are warranted for poor-risk patients as the proportion of patients receiving second-line treatment is low. Registration: Clinical trial identifier: ClinicalTrials.gov NCT05363072.