bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Down Syndrome on Survival Among Patients With Congenital Heart Disease
Authors: Engsner Stella , Giang Kok Wai , Dellborg Mikael , Fedchenko Maria , Eriksson Peter , Mandalenakis Zacharias 
Published: January 2024

Background
Increasing survival among patients with congenital heart disease (CHD) has recently been reported. However, the impact of Down syndrome (DS) in patients with CHD is still debated. We aimed to estimate survival in patients with CHD with versus without DS compared with matched controls from the general population without CHD or DS.

Methods and Results
We linked data from Swedish health registries to identify patients with CHD born between 1970 and 2017. Data from the Total Population Register were used to match each patient with CHD by sex and birth year with 8 controls without CHD or DS. A Cox proportional regression model was used to estimate mortality risk, and Kaplan–Meier curves were analyzed for the survival analysis. We identified 3285 patients with CHD‐DS, 64 529 patients with CHD without DS, and 26 128 matched controls. The mortality risk was 25.1 times higher (95% CI, 21.3–29.5) in patients with CHD‐DS versus controls. The mortality rate was 2 times higher (95% CI, 1.94–2.31) for patients with CHD with versus without DS. Lower mortality was found during the second versus first birth periods in patients with CHD‐DS compared with controls; hazard ratio: 46.8 (95% CI, 29.5–74.0) and 17.7 (95% CI, 12.8–24.42) in those born between 1970 and 1989 versus 1990 and 2017, respectively.

Conclusions
In this retrospective cohort study, the mortality risk among patients with CHD‐DS was 25 times higher compared with matched controls and 2 times higher compared with patients with CHD without DS. Survival was higher in patients with CHD‐DS born after versus before 1990, coinciding with the modern era of congenital heart care.
The Impact of Large-Scale Environments and a Southwest Vortex on Heavy Rainfall in Southern Taiwan in Late May 2020
Authors: Chien Fang-Ching , Chiu Yen-Chao 
Published: January 2024

Abstract
This paper investigates the impact of the environmental conditions during the first half of the 2020 mei-yu season (Y20) and the southwest vortex (SWV), as well as their interaction, on heavy precipitation in southern Taiwan during late May 2020, based on a quantitative approach through ensemble simulations. The control experiment successfully replicates observed heavy precipitation in southern and central Taiwan and reveals a positive spatial correlation between precipitation occurrence probabilities and mean accumulated precipitation, emphasizing continuous rainfall accumulation over intermittent extreme events. Comparative analyses with sensitivity experiments elucidate that the Y20, featuring an extended western North Pacific subtropical high, intensify pressure gradients and southwesterly flow near Taiwan, favoring precipitation in windward regions but hindering it in the east. The SWV creates a moist and vortical environment near Taiwan, amplifying moisture supply and westerly winds, promoting precipitation in southern Taiwan, and enhancing frontal activity. The interaction between the SWV and the Y20, though limited in its impact on providing favorable wind and moisture conditions for precipitation southwest of Taiwan, significantly contributes to precipitation in southern Taiwan. The reason is that although the SWV primarily enhances moisture and the Y20 predominantly boost southwesterly flow, creating favorable conditions for rainfall, substantial precipitation occurs only when both factors converge in a nonlinear interaction. The interaction increases frontal activity over the Taiwan Strait and influences the movement and strength of the SWV, enhancing southwesterly flow and moisture flux in southwestern Taiwan.
Utilization and Outcomes of Roux-en-Y Gastric Bypass Surgery Following the Affordable Care Act in the United States
Authors: Weldeslase Terhas A. , Akinyemi Oluwasegun A. , Keeling Darien J. , Enchill Kobina A. , Cornwell Edward E. , Fullum Terrence M. 
Published: January 2024

Background The passage of the Affordable Care Act (ACA) in 2010 marked a pivotal moment in American health care policy, significantly expanding access to health care services. This study aims to explore the relationship between the ACA and the utilization and outcomes of Roux-en-Y Gastric Bypass (RYGB) surgery. Methods Using data from the National Inpatient Sample (NIS) Database, this retrospective study compares the pre-ACA period (2007-2009) with the post-ACA period (2017-2019), encompassing patients who had RYGB. Multivariable logistic analysis was done accounting for patient’s characteristics, comorbidities, and hospital type. Results In the combined periods, there were 158 186 RYGB procedures performed, with 30.0% transpiring in pre-ACA and 70.0% in the post-ACA. Post-ACA, the proportion of uninsured patients decreased from 4.8% to 3.6% ( P < .05), while Black patients increased from 12.5% to 18.5% ( P < .05). Medicaid-insured patients increased from 6.8% to 18.1% ( P < .05), and patients in the poorest income quartile increased from 20% to 26% ( P < .05). Patients in the post-ACA period were less likely to have longer hospital stays (OR = .16: 95% CI .16-.17, P < .01), in-hospital mortality (OR = .29: 95% CI .18-.46, P < .01), surgical site infection (OR = .25: 95% CI .21-.29, P < .01), postop hemorrhage (OR = .24: 95% CI .21-.28, P < .01), and anastomotic leak (OR = .14: 95% CI .10-.18, P < .01) than those in the pre-ACA period. Discussion Following the implementation of the ACA, utilization of bariatric surgery significantly increased, especially among Black patients, Medicaid beneficiaries, and low-income patients. Moreover, despite the inclusion of more high-risk surgical patients in the post-ACA period, there were better outcomes after surgery.
Impact of COVID-19 Pandemic Surge on Surgical Outcomes: A Retrospective Study
Authors: Yoshida Takuto , Chude-Sokei Rosemary , Araji Tarek , Adra Souheil 
Published: January 2024

Background The COVID-19 pandemic posed significant challenges to healthcare systems worldwide, including surgical care. While many studies examined the effect of the pandemic on different patient outcomes, there are none to date examining the impact of the pandemic surge on surgical outcomes. Our aim is to evaluate the impact of the COVID-19 surges on surgical outcomes using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Methods A single-center retrospective analysis of 7436 patients who underwent surgery between February 2020 and December 2022 was conducted. Patients were divided into those who underwent surgery during the surge of the pandemic (n = 1217) or outside that period (n = 6219). Primary outcomes were 30-day mortality and morbidity. Secondary outcomes included 30-day mortality, operation time, transfusion, reoperation, and specific postoperative complications. Multivariable logistic regression was used in our analysis. All analyses were conducted using the software “R” version 4.2.1. Statistical significance was set at α = .05 level. Results After adjusting for confounders, we found no significant difference in 30-day mortality and morbidity (OR: 1.06, 95% CI: .89-1.226, P = .5173) or 30-day mortality only (OR: 1.39, 95% CI: .788-2.14, P = .1364) between the two groups. No significant differences were observed in secondary outcomes. Sensitivity analyses yielded similar results to the multivariable logistic regression. Conclusion We found no evidence of increased 30-day mortality and morbidity in patients undergoing surgery during the COVID-19 surges compared to those undergoing surgery outside that period. Our results suggest that surgical care was maintained despite the challenges of the pandemic surges.
Factors Affecting Workers’ Mental Stress in Handover Activities During Human–Robot Collaboration
Authors: Lu Lu , Xie Ziyang , Wang Hanwen , Su Bingyi , Jung Sehee , Xu Xu 
Published: January 2024

Objective This study investigated the effects of different approach directions, movement speeds, and trajectories of a co-robot’s end-effector on workers’ mental stress during handover tasks. Background Human–robot collaboration (HRC) is gaining attention in industry and academia. Understanding robot-related factors causing mental stress is crucial for designing collaborative tasks that minimize workers’ stress. Methods Mental stress in HRC tasks was measured subjectively through self-reports and objectively through galvanic skin response (GSR) and electromyography (EMG). Robot-related factors including approach direction, movement speed, and trajectory were analyzed. Results Movement speed and approach direction had significant effects on subjective ratings, EMG, and GSR. High-speed and approaching from one side consistently resulted in higher fear, lower comfort, and predictability, as well as increased EMG and GSR signals, indicating higher mental stress. Movement trajectory affected GSR, with the sudden stop condition eliciting a stronger response compared to the constrained trajectory. Interaction effects between speed and approach direction were observed for “surprise” and “predictability” subjective ratings. At high speed, approach direction did not significantly differ, but at low speeds, approaching from the side was found to be more surprising and unpredictable compared to approaching from the front. Conclusion The mental stress of workers during HRC is lower when the robot’s end effector (1) approaches a worker within the worker’s field of view, (2) approaches at a lower speed, or (3) follows a constrained trajectory. Application The outcome of this study can serve as a guide to design HRC tasks with a low level of workers’ mental stress.
The Effect of Alexithymia, Attention, and Pain Characteristics on Mentalizing Abilities Among Adults With Chronic Pain
Authors: Šalčiūnaitė-Nikonovė Laura , Leonas Linas , Sapranavičiūtė-Zabazlajeva Laura 
Published: January 2024

Introduction: Impaired mentalizing abilities are found among persons with chronic pain, yet it is still unknown why. The current study focuses on mentalizing abilities and how these could be affected by different pain factors, alexithymia traits, and other aspects of psychological functioning (depression, anxiety, attention) in persons experiencing chronic pain. Methods: 71 participants (80.3% female; mean age 56.1 (SD = 13.1)) with subjectively reported chronic pain conditions participated in the study. Mentalizing abilities were assessed using an objective assessment of the Frith-Happé animations test. Alexithymia was measured using Toronto Alexithymia Scale. Subjectively reported data on various pain characteristics and other related psychological factors (depression, anxiety, attention) were collected. Bivariate linear regression analyses were used to identify variables that had statistically significant relationships with Frith-Happé test scores as dependent variables, which were then used to build multivariate models. Results: Mentalization task scores had no significant associations with alexithymia. However, in bivariate models, greater Frith-Happé animations categorisation score was associated with higher attention task scores (βs = .332, p = .005), higher education (βs = .317, p = .007), and lower level of depressiveness (βs = −.234, p = .049). Greater animations feelings scores were associated with less severe pain intensity (βs = −.322, p = .006), younger age (βs = −.399, p = .001), and better attention (βs = .383, p = .001). In multivariate analysis models predicting both animations categorisation and feelings scores, attention was found to be the only statistically significant factor (respectively, βs = .257, p = .029 and βs = .264, p = .035). Conclusions: No significant correlations were found between mentalizing abilities and alexithymic features in persons with chronic pain. Disruptions of attention was the most significant factor leading to lower mentalizing abilities in persons with chronic pain.
Sensory approaches for adults with severe or profound and multiple learning disabilities: A systematic literature review
Authors: Humpheson Jennifer 
Published: January 2024

Introduction: Sensory approaches are often used by Occupational Therapists working with clients with a severe or profound and multiple learning disabilities (SLD/PMLD). The aims of this review were to synthesise the outcomes of sensory approaches for adults with an SLD/PMLD and describe the key intervention components. Method: A mixed methods literature review of three databases was completed to identify studies where sensory approaches were used for clients with an SLD/PMLD. Peer-reviewed research articles published between January 1990 and April 2021 were included. Data quality was assessed using the Mixed Methods Appraisal Tool. A convergent-segregated approach to synthesis was taken, including thematic analysis of qualitative data and a narrative review of quantitative data. Results: Eighteen studies were included. Positive outcomes were reductions in challenging behaviour, stress and improved engagement, attention and communication. Three themes emerged, suggesting important components of sensory approaches for clients with an SLD/PMLD: matching sensory stimuli to the needs of the individual, sensory integration therapists and caregivers as facilitators and increased intervention duration and frequency. Conclusion: Evidence suggests that sensory approaches support positive social, emotional and cognitive outcomes for individuals with an SLD/PMLD. Essential features of sensory approaches for this client group are sensitive use of sensory stimuli, skilled facilitators and more intensive intervention protocols.
No wearing-off effect of erenumab or fremanezumab for chronic migraine prevention: a single-center, real-world, observational study
Authors: Florescu Anna Maria , Lannov Lærke Vig , Younis Samaira , Cullum Christopher Kjaer , Chaudhry Basit Ali , Do Thien Phu , Amin Faisal Mohammad 
Published: January 2024

Background The present study investigates the wearing-off effect in adults with chronic migraine treated with erenumab or fremanezumab. Methods This real-world observational study was based on pre-collected headache diaries from chronic migraine patients in treatment with either monthly injections of 140 mg of erenumab or 225 mg of fremanezumab. Consistent wearing-off was defined as an increase of ≥2 weekly migraine days in the last week compared to the second week over two consecutive 4-week treatment periods. The primary endpoint was wearing-off in the total population. The secondary endpoints were difference in wearing-off in (i) a subgroup of patients treated with erenumab and fremanezumab and (ii) consistent wearing-off in patients with a ≥30% reduction in monthly migraine days, compared to baseline, in the two consecutive treatment months. Results In total, 100 patients (erenumab: n = 60, fremanezumab: n = 40) were included. Sixty-two out of 100 (62%) patients had consistent ≥30% treatment response on antibody therapy in both months (erenumab: n = 36, fremanezumab: n = 26). There was no consistent wearing-off over the two consecutive months from week 2 to week 4 (3.04%, p = 0.558). There was no wearing-off within the erenumab ( p = 0.194) or the fremanezumab ( p = 0.581) groups. Among the ≥30% treatment responders, there was no consistent wearing-off over the two consecutive months (2.6%, p = 0.573). Conclusions There was no wearing-off in treatment responders, which is in alignment with premarketing data from placebo-controlled phase III studies. These data suggest that patients should be informed upfront that no wearing-off effect is expected because anxiety for attacks at the end of the month per se may generate migraine attacks.
Childhood primary stabbing headache: A double center study
Authors: Monte Gabriele , Papetti Laura , Ursitti Fabiana , Sforza Giorgia , Tarantino Samuela , Checchi Proietti Martina , D'Agnano Daniela , Sciruicchio Vittorio , Valeriani Massimiliano 
Published: January 2024

Background Primary stabbing headache (PSH) is an idiopathic headache disorder characterized by head pain occurring as a transient and localized single stab or a series of stabs. The present study aimed to examine the characteristics of childhood PSH and whether they fit the International Classification of Headache Disorders, 3rd edition (ICHD-3) criteria. We also investigated the association with migraine and episodic syndromes. Methods In this retrospective study, we included 60 patients seen at two headache clinics (Rome and Bari) between 2016 and 2022. A headache-focused history was obtained. All patients had normal neurological examination. PSH was defined according to ICHD-3 criteria. Results Twenty-three patients were male (38%) and median (range) age at disease onset was 8 (3–17) years. Stabs recurred with irregular frequency and their duration varied from a few seconds up to 30 minutes. Stabs were located in different head regions. Twenty-five patients (42%) underwent neuroimaging exams. Five children reported a limitation of daily activities and none had a chronic pattern. Forty-seven patients (78%) reported a family history of primary headache, especially migraine, and forty-three had episodic syndromes (i.e. infantile colic, benign paroxysmal vertigo, motion sickness, recurrent abdominal pain, cyclic vomiting). Twenty patients had an associated primary headache: 16 suffered from migraine and four suffered from tension type-headache. According to ICHD-3 criteria, thirty-one patients had a diagnosis of probable PSH as a result of a duration of stabs longer than a few seconds (>3 seconds). Conclusions Features of childhood PSH can vary widely. As seen in previous studies, several patients reported a stab duration longer than a few seconds and this might suggest that current ICHD-3 criteria may need adjustments to be suitable for children. High frequency of associated migraine and episodic syndromes could suggest a common pathophysiological mechanism between PSH and migraine. We can hypothesize that PSH and migraine attacks may be part of a spectrum of the same disease, although further evidence is needed. Larger studies with long-term follow-up are needed to improve understanding of this condition.
The long-term effect of work schedule, shift work disorder, insomnia and restless legs syndrome on headache among nurses: A prospective longitudinal cohort study
Authors: Kristoffersen Espen Saxhaug , Pallesen Ståle , Waage Siri , Bjorvatn Bjørn 
Published: January 2024

Background The preset study aimed to explore whether work schedules and sleep disorders predict the onset of headache. Methods A longitudinal study was conducted with questionnaire data from 2014 (baseline) and 2017 (follow-up) on work schedule, number of night shifts, number of quick returns, insomnia, shift work disorder (SWD), restless legs syndrome (RLS) and validated headache diagnoses among 1560 Norwegian nurses. Associations were explored by multivariate regression analyses. Results Work related factors at baseline did not predict onset of headache three years later. In the adjusted logistic regressions, insomnia at baseline predicted increased risk of new onset of migraine (odds ratio (OR) = 1.58; 95% confidence interval (CI) = 1.08–2.33), chronic headache (OR = 2.02; 95% CI = 1.04–4.66) and medication-overuse headache (OR = 3.79; 95% CI = 1.26–11.42) at follow-up. SWD at baseline predicted new onset of migraine (OR = 1.64; 95% CI = 1.07–2.50) and RLS at baseline predicted new onset of headache ≥1 day per month (OR = 1.55; 95% CI = 1.01–2.36) and migraine (OR = 1.55; 95% CI = 1.03–2.32) at follow-up. No factors predicted tension-type headache. Conclusions Overall, work related factors did not predict the onset of headache three years later, whereas insomnia, SWD and RLS at baseline all increased the risk of future headaches.
Firm-Level and Public-Sector Costs Make Small-Scale Maize Flour Fortification Challenging in Uganda
Authors: Vosti Stephen , Baker Emily , Moorthy Denish , Mazinga Mike , Dary Omar 
Published: January 2024

Background: Maize flour in Uganda is milled by hundreds of enterprises, mostly small- (5-20 metric tons [MT]/day) and micro-scale (<5 MT/day) mills or firms. A mandatory maize flour fortification program exists for medium-scale mills (>20 MT/day) and policymakers are considering including smaller-scale millers. Objective: We estimated the private and public costs of maize flour fortification at different scales and explored their implications for extending the mandatory fortification to include smaller-scale mills. Methods: We used secondary data on the structure of the maize flour market and primary data on milling and fortification costs to estimate mill and regulatory costs at 3 scales of flour production: micro, small, and medium. Results: For micro-, small-, and medium-size operations, respectively, operational costs of fortification were US$13, US$9, and US$7 per metric ton (MT) of maize flour, which represented 20%, 16%, and 16% of annual operating costs, and the ratio of fortification equipment cost to mill equipment costs was higher for micro-scale mills (2.7) than for small- (0.38) and medium-scale (0.54) maize mills. Governmental regulatory costs rise if smaller-scale mills are included due to the increased number of facility inspections. Conclusions: Fortification and regulatory costs increase as production scale decreases. Up-front capital costs of fortification would be daunting for micro- and small-scale mills. Medium-scale mills, which supply social protection programs, might be able to manage fortification costs and other challenges. Decision-makers should consider all costs and cost burdens, and the realities of enforcement capabilities before expanding fortification programs to include smaller-scale operations.
Short time (10 min) Catheter Traction Following TURP: IS it helpful with less morbidity?
Authors: Maiti Krishnendu , Dey Pankaj Kanti , Pal Dilip Kumar 
Published: January 2024

Introduction: Transurethral Resection of Prostate (TURP) is the most common treatment for Benign Prostatic Hyperplasia (BPH). Blood loss during and after transurethral resection of the prostate (TURP) is a potential cause of morbidity and clot retention. Usual practise is to apply traction in every case of TURP to reduce early postoperative hematuria and clot retention. There are very few studies in the literature and they have mainly concentrated on the effect of traction on reducing blood loss but there is scanty data regarding the morbidity associated with the use of traction. Various authors have described their method of traction application. So, in this study, we will compare the result of short term (10 min) traction with standard (4–6 h) traction. Materials and methods: It is a prospective comparative study with 50 participants, conducted at the department of Urology of a tertiary care hospital in eastern India after taking ethical clearance and consent from the patient. The patients attending urology O.P.D. with LUTS and diagnosed as BPH and planned for elective TURP and who had prolonged traction after TURP were excluded. Study period was one and the half year. Results: Post operatively 25 patients were managed with catheter traction while 25 patients were managed with short term traction of 10 min. Pain which is assessed by visual analog scale (VAS) at 2 and 4 h post operatively is statistically significant with p value of <0.05 and cut off of 65 g prostate volume is drawn below which the successful outcome of short term traction is feasible without any complications. Conclusion: If hemostatsis is done properly then short term traction is preferable, safe and had fewer complications for prostate volume <65 g in comparison to standard traction TURP comparing the overall factors. Although, VAS score at 2 and 4 h post operatively shows patient experienced less pain even in prostate volume >65 g.