bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparing the diagnostic accuracy, reading time, and inter-rater agreement of breast MRI abbreviated and full protocols: a multi-reader study
Authors: Hellgren Roxanna , Tolocka Ernst , Saracco Ariel , Wilczek Brigitte , Sundbom Ann , Hall Per , Dickman Paul W 
Published: December 2023

Background Earlier studies have shown that abbreviated protocol magnetic resonance imaging (AB-MRI) has similar diagnostic accuracy as the full protocol (Full MRI). Purpose To compare the diagnostic accuracy, reading time, and inter-rater agreement of AB-MRI to Full MRI among women without known increased familial risk of breast cancer or prior biopsy. Material and Methods In total, 395 MRI examinations were included in this study. Three readers were blinded to all patient information. The AB-MRI and Full MRI were read separately and in a different random order for each of the readers. Scores 1–2 were considered test negative while scores 3–5 were test positive. A positive reference test was the diagnosis of malignancy; a negative reference test was the absence of a diagnosis of breast cancer within a two-year follow-up. We used a generalized estimating equations approach to compare sensitivity and specificity between the two protocols. We used t-tests to compare the average reading time and Krippendorff's alpha to compare inter-rater agreement. Results MRI examinations of 395 women (median age=56 years) were evaluated. For AB-MRI and Full MRI, respectively, the sensitivity was 93.0% (95% CI=90.6–95.0) vs. 92.0% (95% CI=89.4–94.1), the specificity was 91.7% (95% CI=90.3–92.9) vs. 94.3% (95% CI=93.2–95.3), average reading time was 67 vs. 126 s, and the inter-rater agreement 0.79 vs. 0.83. The difference in sensitivity was not statistically significant ( P=0.840), but the difference in specificity was significant ( P=0.003). Conclusion AB-MRI has similar sensitivity, but somewhat lower specificity. The average reading time for the abbreviated protocol is lower, as is inter-rater agreement.
Transfer learning for the generalization of artificial intelligence in breast cancer detection: a case-control study
Authors: Africano Gerson , Arponen Otso , Rinta-Kiikka Irina , Pertuz Said 
Published: December 2023

Background Some researchers have questioned whether artificial intelligence (AI) systems maintain their performance when used for women from populations not considered during the development of the system. Purpose To evaluate the impact of transfer learning as a way of improving the generalization of AI systems in the detection of breast cancer. Material and Methods This retrospective case-control Finnish study involved 191 women diagnosed with breast cancer and 191 matched healthy controls. We selected a state-of-the-art AI system for breast cancer detection trained using a large US dataset. The selected baseline system was evaluated in two experimental settings. First, we examined our private Finnish sample as an independent test set that had not been considered in the development of the system (unseen population). Second, the baseline system was retrained to attempt to improve its performance in the unseen population by means of transfer learning. To analyze performance, we used areas under the receiver operating characteristic curve (AUCs) with DeLong's test. Results Two versions of the baseline system were considered: ImageOnly and Heatmaps. The ImageOnly and Heatmaps versions yielded mean AUC values of 0.82±0.008 and 0.88±0.003 in the US dataset and 0.56 (95% CI=0.50–0.62) and 0.72 (95% CI=0.67–0.77) when evaluated in the unseen population, respectively. The retrained systems achieved AUC values of 0.61 (95% CI=0.55–0.66) and 0.69 (95% CI=0.64–0.75), respectively. There was no statistical difference between the baseline system and the retrained system. Conclusion Transfer learning with a small study sample did not yield a significant improvement in the generalization of the system.
Retrospective and FMECA analysis of failures in closed-system devices
Authors: El Medkouri Safaa , Bhirich Nihal , Belahcen Mohammed Jaouad , Rahali Younes 
Published: December 2023

Introduction Cytotoxic drugs can be hazardous to healthcare workers involved in their preparation and/or administration. Exposure occurs during routine handling of drug vials and ampoules, preparation, administration and disposal of cytotoxic waste. The use of closed-system devices provides protection against exposure to cytotoxics, but these devices are the subject of numerous incidents. Given the nature of the drugs they contain, these incidents can be dangerous for the personnel handling them. Objective The aim of our study is to analyze material vigilance data relating to problems frequently encountered with the various consumables of the closed system and to assess the risk of exposure of personnel to cytotoxic drugs when using these using the Failure Mode and Criticality Analysis (FMECA) method. Materials and methods Our study was conducted at the pharmacy of the National Institute of Oncology, the closed system drug transfer device (CSDT) used is a ChemoClave-ICU®, This device is mechanical and needleless For the materiovigilance study we carried out a retrospective study over the period from 2019 to 2022, analyzing materiovigilance data collected by National Institute of Oncology's materiovigilance and pharmacovigilance cell. Our team, trained in the FMECA method, conducted the study over a three-month period, between September and November 2022. The method was used to assess the risks incurred by staff when using the CSDT device to prepare cytotoxic drugs. Conclusion Our study revealed that the most frequent incident was linked to a manufacturing defect in the device in question. According to the FMECA analysis, this incident represents a major risk, as its occurrence hampers the cytotoxic preparation process. CSDT have the advantage of being easy to use and acceptable to staff, but standards need to be developed and validated to assess the performance of these devices.
A new approach for single-haptic retropupillary iris-claw lens subluxation - The “fencing” technique
Authors: Almeida Júlio , Costa Tomás R. , Vivas Maria , Monteiro Catarina , Vaz Fernando T. , Silva Diana S. , Prieto Isabel 
Published: December 2023

Introduction Single-haptic iris-claw intraocular lens (IOL) dislocation is not an uncommon complication. A few different surgical techniques are available for its refixation but usually involve a more invasive approach. We aim to demonstrate an original and simple approach for refixation of single haptic retropupillary iris-claw IOL subluxations. Methods We present a case of an 80-year-old male with a single haptic retropupillary iris-claw IOL subluxation in a previously vitrectomized eye. We used a new surgical approach to refix this type of subluxation. Results This new technique uses only two 30-gauge needles (one of them connected to a viscosurgical device) to re-enclavate the subluxated haptic of the retropupillary iris-claw IOL. By minimising surgical manipulation, the patient's postoperative period was uneventful. Conclusions We highlight a new, quick, safe, and unusual surgical approach to single-haptic retropupillary iris-claw IOL dislocation in vitrectomized eyes. Because of its characteristics, we named it the “fencing” IOL repositioning technique.
Acacetin Combined with Wortmannin Activated Insulin Signaling Pathway by Inhibiting the Induction Effect of PI3Kp110 on IRS-1 Serine Phosphorylation to Improve Myocardial Fibrosis in Fructose-Induced SHR Rats
Authors: Zhao Lirui , Yuan Peipei , Zhang Qi , Zhang Yan , Zheng Yajuan , Li Saifei , Chen Yi , Li Panying , Ruan Yuan , Feng Weisheng , Zheng Xiaoke 
Published: December 2023

Objective To explore the intervention mechanism of acacetin combined with wortmannin on myocardial fibrosis in fructose-induced SHR rats. Methods Using fructose-induced SHR rats combined with HUVEC cell induced by high-sugar DMEM, the intervention mechanism of acacetin combined with wortmannin on myocardial fibrosis in rats was explored. Results In fructose-induced SHR rats, the intervention results of acacetin on myocardial fibrosis showed that acacetin significantly downregulated serum REN, Ang II, ET-1 levels, and upregulated serum PGE2 and NO levels ( P < 0.05 or P < 0.01). The combination of wortmannin showed further enhanced effect on the level of ET-1 and PGE2 ( P < 0.05). Acacetin and wortmannin significantly increased the expression of CD31 protein and CD31, VE-cadherin mRNA levels in the heart, decreased the expression of CVF, α-SMA protein and CVF, α-SMA, Vimentin and Fibronectin mRNA levels, and enhanced the improvement effect after the combination of acacetin and wortmannin ( P < 0.05 or P < 0.01). Both acacetin and wortmannin significantly activated the level of PI3Kp85 in myocardium ( P < 0.05 or P < 0.01), and wortmannin significantly inhibited PI3Kp110 ( P < 0.01). While, acacetin combined with wortmannin, the activation effect on PI3Kp85 was enhanced, and the inhibitory effect on PI3Kp110 was weakened ( P < 0.01). In HUVEC endothelial mesenchymal transformation model, wortmannin significantly inhibited the phosphorylation of IRS-1 serine ( P < 0.01); After PI3Kp85 silencing, both acacetin and wortmannin inhibited the activation of PI3 K downstream protein AKT phosphorylation ( P < 0.01). Conclusion Acacetin synergistic with PI3 K inhibitor wortmannin inhibits the induction effect of PI3Kp110 on IRS-1 serine phosphorylation, indirectly activates insulin signaling pathway, modulates vasoactive factors, alleviates cardiac endothelial mesenchymal transformation in fructose-induced SHR rats, and improves myocardial fibrosis.
The impact of studies with no events in both arms on meta-analysis of rare events: A simulation study using generalized linear mixed model
Authors: Xu Chang , Lin Lifeng 
Published: December 2023

Objective The common approach to meta-analysis with double-zero studies is to remove such studies. Our previous work has confirmed that exclusion of these studies may impact the results. In this study, we undertook extensive simulations to investigate how the results of meta-analyses would be impacted in relation to the proportion of such studies. Methods Two standard generalized linear mixed models (GLMMs) were employed for the meta-analysis. The statistical properties of the two GLMMs were first examined in terms of percentage bias, mean squared error, and coverage. We then repeated all the meta-analyses after excluding double-zero studies. Direction of estimated effects and p-values for including against excluding double-zero studies were compared in nine ascending groups classified by the proportion of double-zero studies within a meta-analysis. Results Based on 50,000 simulated meta-analyses, the two GLMMs almost achieved unbiased estimation and reasonable coverage in most of the situations. When excluding double-zero studies, 0.00%–4.47% of the meta-analyses changed the direction of effect size, and 0.61%–8.78% changed direction of the significance of p-value. When the proportion of double-zero studies increased in a meta-analysis, the probability of the effect size changed the direction increased; when the proportion was about 40%–60%, it has the largest impact on the change of p-values. Conclusion Double-zero studies can impact the results of meta-analysis and excluding them may be problematic. The impact of such studies on meta-analysis varies by the proportion of such studies within a meta-analysis.
Treatable traits in asthma during pregnancy: a call for a shift towards a precision-based management approach
Authors: Joshi Esha , Gibson Peter G. , McDonald Vanessa M. , Murphy Vanessa E. 
Published: December 2023

Asthma is the most common chronic medical condition in pregnancy. Asthma exacerbations in pregnancy are unpredictable, and are associated with adverse maternal and fetal perinatal outcomes such as preterm birth and low birthweight. Goals of asthma management in pregnancy are to establish effective asthma control and prevent exacerbations. Optimising the management of asthma in pregnancy is an important goal of practice and future research.Treatable traits is a precision medicine paradigm proposed for the management of airways diseases, which holistically addresses the complexity and heterogeneity of airways disease. It is an individualised treatment approach that aims to improve outcomes. This makes treatable traits well suited for pregnant women with asthma, who have a high prevalence of obesity, mental health conditions, poor symptom perception and suboptimal asthma management skills including low treatment adherence. These traits are measurable and treatable. In this review, we explore current knowledge on the burden of asthma, maternal and perinatal consequences of asthma during pregnancy, the treatable traits paradigm, the prevalence of treatable traits in pregnant women with asthma, and consider how the treatable traits paradigm can be integrated into the management of asthma in pregnancy.
A comprehensive analysis of immune features and construction of an immune gene diagnostic model for sepsis
Authors: Xue Haiyan , Xiao Ziyan , Zhao Xiujuan , Li Shu , Wang Zhenzhou , Zhao Jie , Zhu Fengxue 
Published: December 2023

AbstractSepsis is a life-threatening syndrome resulting from immune system dysfunction that is caused by infection. It is of great importance to analyze the immune characteristics of sepsis, identify the key immune system related genes, and construct diagnostic models for sepsis. In this study, the sepsis transcriptome and expression profiling data were merged into an integrated dataset containing 277 sepsis samples and 117 non-sepsis control samples. Single-sample gene set enrichment analysis (ssGSEA) was used to assess the immune cell infiltration. Two sepsis immune subtypes were identified based on the 22 differential immune cells between the sepsis and the healthy control groups. Weighted gene co-expression network analysis (WCGNA) was used to identify the key module genes. Then, 36 differentially expressed immune-related genes were identified, based on which a robust diagnostic model was constructed with 11 diagnostic genes. The expression of 11 diagnostic genes was finally assessed in the training and validation datasets respectively. In this study, we provide comprehensive insight into the immune features of sepsis and establish a robust diagnostic model for sepsis. These findings may provide new strategies for the early diagnosis of sepsis in the future.
Machine learning and phylogenetic analysis allow for predicting antibiotic resistance in M. tuberculosis
Authors: Yurtseven Alper , Buyanova Sofia , Agrawal Amay Ajaykumar , Bochkareva Olga O. , Kalinina Olga V. 
Published: December 2023

Abstract
Background
Antimicrobial resistance (AMR) poses a significant global health threat, and an accurate prediction of bacterial resistance patterns is critical for effective treatment and control strategies. In recent years, machine learning (ML) approaches have emerged as powerful tools for analyzing large-scale bacterial AMR data. However, ML methods often ignore evolutionary relationships among bacterial strains, which can greatly impact performance of the ML methods, especially if resistance-associated features are attempted to be detected. Genome-wide association studies (GWAS) methods like linear mixed models accounts for the evolutionary relationships in bacteria, but they uncover only highly significant variants which have already been reported in literature.

Results
In this work, we introduce a novel phylogeny-related parallelism score (PRPS), which measures whether a certain feature is correlated with the population structure of a set of samples. We demonstrate that PRPS can be used, in combination with SVM- and random forest-based models, to reduce the number of features in the analysis, while simultaneously increasing models’ performance. We applied our pipeline to publicly available AMR data from PATRIC database for Mycobacterium tuberculosis against six common antibiotics.

Conclusions
Using our pipeline, we re-discovered known resistance-associated mutations as well as new candidate mutations which can be related to resistance and not previously reported in the literature. We demonstrated that taking into account phylogenetic relationships not only improves the model performance, but also yields more biologically relevant predicted most contributing resistance markers.
Empowering community health professionals for effective air pollution information communication
Authors: Tan Tricia , Junghans Cornelia , Varaden Diana 
Published: December 2023

Abstract
Background
Air pollution remains a significant public health risk, particularly in urban areas. Effective communication strategies remain integral to overall protection by encouraging the adoption of personal air pollution exposure reduction behaviours. This study aims to explore how community health professionals can be empowered to communicate air pollution information and advice to the wider community, to encourage the uptake of desired behaviours in the population.

Methods
The study adopted a qualitative methodology, where four homogenous Focus Group Discussions (FGDs) were held with a range of community health professionals, including Health Care Professionals, Community Health and Wellbeing Workers (CHWWs) and Social Prescribing Link Workers (SPLW). A classical content analysis was conducted with the Structural Empowerment Theory (SET) and Psychological Empowerment Theory (PET) as guiding concepts.

Results
Five key themes were identified: from a structural empowerment perspective: [1] resources and support, [2] knowledge. From a psychological empowerment perspective: [3] confidence as advisor, [4] responsibility as advisor, and [5] residents’ receptiveness to advice. It was concluded that advice should be risk stratified, clear, easy to follow and provide alternatives.

Conclusion
This study identified ways for community health professionals to be empowered by local councils or other organisations in providing advice on air pollution, through the provision of essential structural support and opportunities to enhance their knowledge and confidence in the subject. Implementing recommendations from this study would not only empower community health professionals to advise on air pollution to the wider community but also increase adherence to health advice.
Comparison of LASSO and random forest models for predicting the risk of premature coronary artery disease
Authors: Wang Jiayu , Xu Yikang , Liu Lei , Wu Wei , Shen Chunjian , Huang Henan , Zhen Ziyi , Meng Jixian , Li Chunjing , Qu Zhixin , he Qinglei , Tian Yu 
Published: December 2023

Abstract
Purpose
With the change of lifestyle, the occurrence of coronary artery disease presents a younger trend, increasing the medical and economic burden on the family and society. To reduce the burden caused by this disease, this study applied LASSO Logistic Regression and Random Forest to establish a risk prediction model for premature coronary artery disease(PCAD) separately and compared the predictive performance of the two models.

Methods
The data are obtained from 1004 patients with coronary artery disease admitted to a third-class hospital in Liaoning Province from September 2019 to December 2021. The data from 797 patients were ultimately evaluated. The dataset of 797 patients was randomly divided into the training set (569 persons) and the validation set (228 persons) scale by 7:3. The risk prediction model was established and compared by LASSO Logistic and Random Forest.

Result
The two models in this study showed that hyperuricemia, chronic renal disease, carotid artery atherosclerosis were important predictors of premature coronary artery disease. A result of the AUC between the two models showed statistical difference (Z = 3.47, P < 0.05).

Conclusions
Random Forest has better prediction performance for PCAD and is suitable for clinical practice. It can provide an objective reference for the early screening and diagnosis of premature coronary artery disease, guide clinical decision-making and promote disease prevention.
This needs to be a journey that we’re actually on together’—the introduction of integrated care systems for children and young people in England: a qualitative study of the views of local system stakeholders during winter 2021/22
Authors: Hope Steven , Stepanova Evgenia , Lloyd-Houldey Oliver , Hillier-Brown Frances , Hargreaves Dougal , Nicholls Dasha , Summerbell Carolyn , Viner Russell M. , Dedat Zainab , Owen Emily C. , Scott Stephanie 
Published: December 2023

Abstract
Background
Integrated care has become a central feature of health system reform worldwide. In England, Integrated Care Systems (ICS) are intended to improve integration across public health, the National Health Service (NHS), education and social care. By April 2021, England had been divided into 42 geographical areas, each tasked with developing local ICS provision. However, it was not clear how ICSs would address the specific needs of children and young people (CYP). This study elicited the views of senior professional stakeholders in the first year of the ICS national roll out, to learn how integrated care for CYP was being implemented within the ICSs and future plans for service provision.

Methods
A qualitative analysis of in-depth interviews with stakeholders, including healthcare professionals, NHS managers and local authority leaders (n = 25) selected from a diverse sample of ICSs (n = 7) across England, conducted during winter 2021/22. Reflexive thematic analysis involving a collaborative coding approach was used to analyse interview transcripts.

Results
Four themes were identified, indicating challenges and opportunities for ICSs in relation to the health of CYP: 1) Best start in life (a more holistic approach to health afforded by integrated care); 2) Local and national contexts (tensions between local and national settings and priorities); 3) Funding and planning (instituting innovative, long-term plans using limited existing CYP funding streams); 4) Organisational complexities (integrating the work of diverse organisations).

Conclusions
The views of stakeholders, provided at the beginning of the journey towards developing local ICS CYP provision, revealed a common aspiration to change focus from provision of acute, largely adult-orientated services towards one with a broader, population health remit, including prevention and early intervention. This would be delivered by integration of a range of local services, including health, education, housing and social care, to set CYP on a life-long path towards improved health and wellbeing. Yet there was an awareness that change would take place over time within existing national policy and funding frameworks, and would require overcoming organisational barriers through further developing local collaborations and partnerships. As ICSs mature, the experiences of stakeholders should continue to be canvassed to identify practical lessons for successful CYP integrated care.