bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Systematic Review of Clinical Practice Guidelines for Managing Pulmonary Toxicities Caused by Immune Checkpoint Inhibitors: Quality of Treatment Recommendations and Differences in Management Strategies Between Guidelines
Authors: Donkor Kofi N , Jang Hyeree , Sail Reena 
Published: November 2023

Background: Pulmonary toxicities caused by immune checkpoint inhibitors are a prominent concern for clinicians. Clinical Practice Guidelines (CPGs) are critical for managing these toxicities. Methods: A systematic search of CPGs on checkpoint-associated pulmonary toxicities (ca-PT) was conducted in October 2022. PubMed, Embase, Cochrane Library, CINAHL, and Web of Science were searched. AGREE II and AGREE-REX were used to appraise CPGs and recommendations quality, respectively. Descriptive statistics, intraclass correlation coefficient, Kruskal-Wallis (H) test, and Spearman’s correlation were used for analyses. P-values < .05 were considered statistically significant. Matrices were used to determine recommendation differences between CPGs. The study’s design was based on the PRISMA 2020 checklist for systematic reviews. Protocol registration number: CRD42022358435. Results: Eight CPGs (two high-quality, three moderate-quality, and three low-quality) were identified. All CPGs covered pneumonitis. One CPG covered pleural effusions and pneumonitis/SARs-CoV-2-infection. Three CPGs covered sarcoidosis-like-reactions. CPGs for pulmonary fibrosis, airway disease, bronchiolitis, and diffuse alveolar damage, were unavailable. No CPG recommendation was based on a prospective study, and none were appraised as high-quality. Also, recommendations were not specific to histopathologic subtypes. AGREE II’s “rigor of development,” the domain that evaluates a guideline’s methodological approach and strategies in gathering scientific evidence, correlated strongly with AGREE-REX’s “overall quality” pneumonitis recommendations, r = .952; P < .01. Approximately 73% of recommendations on pneumonitis were similar between high-quality CPGs. About 16% to 74% of low-quality CPGs were similar to those recommended by high-quality CPGs. Conclusion: Prospectively designed research projects focusing on all types of ca-PT and their histopathologic subtypes are urgently needed. Due to the lack of high-quality recommendations in available CPGs, the disparities in treatment recommendations between high-quality CPGs, and the similarities in recommendations that exists between high-quality and low-quality CPGs, clinicians should thoroughly assess and responsibly appraise all available CPG recommendations in formulating treatment strategies for ca-PT.
Cognitive phenotypes predict response to restorative cognitive rehabilitation in multiple sclerosis
Authors: Ziccardi Stefano , Fuchs Tom , Dwyer Michael G , Zivadinov Robert , Hulst Hanneke E , Calabrese Massimiliano , Benedict Ralph HB 
Published: November 2023

Background: Cognitive phenotyping may be useful for predicting rehabilitation response in multiple sclerosis. Objective: To evaluate the association between cognitive phenotype(s) and response to restorative cognitive rehabilitation (RRCR). Methods: In a post hoc retrospective analysis of the RRCR study including 51 multiple sclerosis patients, we evaluated both impairment within specific cognitive domains as well as overall global impairment severity to investigate their relationship to improvement following rehabilitation. Results: Greater improvement in executive function was predicted by impairment within this domain as well as by having fewer impaired cognitive domains overall. Similar results were observed for visuospatial memory. Conclusions: Patients most likely to benefit from restorative cognitive rehabilitation may exhibit impairment within the domain of interest yet lower cognitive burden overall.
Inclusion of optic neuritis in dissemination in space improves the performance of McDonald 2017 criteria in Hispanic people with suspected multiple sclerosis
Authors: Amezcua Lilyana , Robers Michael V , Soneji Deepak , Manouvakhova Olga , Martinez Andrea , Islam Talat 
Published: November 2023

Background: Hispanic people compared to White people with multiple sclerosis (MS) are two times more likely to present with optic neuritis (ON). ON in dissemination in space (DIS) after a single attack is not part of the current McDonald 2017 criteria. Objective: To evaluate if adding ON in DIS (ON-modified criteria) improves the performance of the McDonald 2017 criteria in the diagnosis of MS after a single attack of ON. Methods: Retrospective study of 102 patients of Hispanic background. Cases were reviewed between 2017 and 2021. Clinical ON was reported for 35 cases. ON in DIS was verified for 28 patients via MRI, optical coherence tomography, and/or visual evoked potential. We investigated the performance of the McDonald 2017 criteria and ON-modified criteria and calculated sensitivity, specificity, positive and negative predictive values, and accuracy. Results: The ON-modified criteria significantly improved the performance of the McDonald 2017 criteria ( p = 0.003) and identified an additional nine patients. Both sensitivity and accuracy increased from 64% to 74% and 62% to 71%, respectively, while specificity remained unchanged (40% (95% confidence interval (CI): 0.10, 0.70)). Conclusion: This study provides evidence that the inclusion of ON in DIS improved the overall performance of the McDonald 2017 criteria among Hispanic people.
Age-related difference in acute type B aortic dissection
Authors: Zhang Zhigong , Lin Feng , Huang Xiaoci , He Zhipeng , Wang Haoran , Cheng Tingting 
Published: November 2023

Objective The objective is to compare the characteristics of clinical data, imaging data, and treatment methods of young and old patients with acute type B aortic dissection (ABAD). Methods ABAD patients admitted to the Department of Vascular Surgery of the First Affiliated Hospital of Anhui Medical University from January 2012 to December 2018 were retrospectively reviewed. Patient demographics, such as gender, age, diabetes, hypertension, presenting symptoms, imaging characteristics, laboratory data on admission, hemodynamics on admission and in-hospital management, and mortality of different age groups were compared and analyzed. Categorical variables were compared using χ2 tests or Fisher’s exact test. Continuous variables were compared using Student’s t-test or Mann–Whitney U-test. Results A total of 141 ABAD patients were included in this study. Old ABAD patients were more likely to have a prior history of hypertension (88.6% vs 70.4%, p = 0.037) and atherosclerosis (29.8% vs 7.4%, p = 0.016). In the young group, Marfan syndrome was significantly higher (14.8% vs 0.9%; p = 0.005). Compared with the old group, the number of distal tears in the young group was significantly higher (62.3% vs 39.5%, p = 0.027). The proportion of patients with malperfusion of lower limbs in the young group was significantly higher than that in the old group (22.2% vs 6.1%, p = 0.026). There was no significant difference in the treatment methods and in-hospital mortality between the two groups. Conclusion Compared with old ABAD patients, young ABAD patients had more distal tears and a higher proportion of lower limbs malperfusion.
Feasibility of using the Automated Self-Administered 24-hour (ASA-24) dietary assessment tool in older adults
Authors: Spangler Hillary B , Driesse Tiffany , Fowler Michael , Lynch David H , Liang Xiaohui , Gross Danae , Petersen Curtis , Batsis John A 
Published: November 2023

Background Dietary patterns can impact the trajectories of healthy aging. However, dietary assessment tools can be challenging to use. With the increased use of technology in older adults, we aimed to evaluate the feasibility of older adults completing the online, Automated Self-Administered 24-h (ASA-24) dietary assessment tool. Methods We conducted a randomized, two-period, two-sequence, crossover design of twenty community-dwelling older adults (≥65 years) comparing their preference for completing the ASA-24 alone versus with a research assistant (RA). Participants were recruited via ResearchMatch.com and randomly allocated 1:1 to a sequence of completing both an ASA-24 alone or with an RA, separated by one week. After each session, participants completed an online 11-item feasibility survey (Likert-scale range of 1–5, strongly disagree to strongly agree). Mean and standard deviations were reported for each question. Results Mean age was 69 ± 3.5 years (90% females), with no differences were observed for sex, age, race, ethnicity, education, or income. Neither group felt a need for RA assistance ( p = 0.34). However, both groups felt the system was easier to follow with the help of an RA (RA: 4.4 ± 1.3, vs. SA 4.6 ± 0.5, p = 0.65), particularly when they completed the ASA-24 alone, first ( p = 0.04). When conducting the ASA-24 alone, there was less confidence the system could be learned quickly (SA 4.5 ± 0.5→3.4 ± 1.0 vs RA 3.4 ± 1.0→3.4 ± 0.7, p = 0.001). The ASA-24 was thought to be less cumbersome after repeated exposure in those concluding with the RA. Conclusion While older adults were able to complete the ASA-24 independently, the use of an RA led to improved confidence. Enhancing the sample diversity in a larger number of participants could provide helpful data to improve the science of dietary assessment.
Risk Factors for Radiotherapy Failure in the Treatment of Spinal Metastases
Authors: McKibben Natasha S. , MacConnell Ashley E. , Chen Yiyi , Gao Lina , Nguyen Thuy M. , Brown Simon A. , Jaboin Jerry J. , Lin Clifford , Baksh Nikolas H. 
Published: November 2023

Study Design Retrospective cohort study. Objective To build a predictive model for risk factors for failure of radiation therapy, hypothesizing a higher SINS would correlate with failure. Methods Patients with spinal metastasis being treated with radiation at a tertiary care academic center between September 2014 and October 2018 were identified. The primary outcome measure was radiation therapy failure as defined by persistent pain, need for re-irradiation, or surgical intervention. Risk factors were primary tumor type, Karnofsky and ECOG scores, time to treatment, biologically effective dose (BED) calculations using α/β ratio = 10, and radiation modality. A logistic regression was used to construct a prediction model for radiation therapy failure. Results One hundred and seventy patients were included. Median follow up was 91.5 days. Forty-three patients failed radiation therapy. Of those patients, 10 required repeat radiation and 7 underwent surgery. Thirty-six patients reported no pain relief, including some that required re-irradiation and surgery. Total SINS score for those who failed reduction therapy was <7 for 27 patients (62.8%), between 7-12 for 14 patients (32.6%), and >12 for 2 patients (4.6%). In the final prediction model, BED (OR .451 for BED > 43 compared to BED ≤ 43; P = .174), Karnofksy score (OR .736 for every 10 unit increase in Karnofksy score; P = .008), and gender (OR 2.147 for male compared to female; P = .053) are associated with risk of radiation failure (AUC .695). A statistically significant association between SINS score and radiation therapy failure was not found. Conclusions In the multivariable model, BED ≤ 43, lower Karnofksy score, and male gender are predictive for radiotherapy failure. SINS score was among the candidate risk factors included in multivariable model building procedure, but it was not selected in the final model. Level of Evidence: Prognostic level III
Performance and Efficiency of Public Sector in Independent Namibia
Authors: Kumar De Utpal , Shafuda Christopher P. P. 
Published: November 2023

An analysis of the performance and efficiency of the Namibian government’s interventions after the end of the colonial era has been made in this study for the period 1990 to 2015. Using the Afonso et al. public sector performance (PSP) and public sector efficiency (PSE) method and the Stochastic frontier analysis (SFA), the findings reveal a sluggishly improving efficiency in the public sector in Namibia. However, some performance indicators showed significant improvement, while others did not record any substantial improvement. Progress is recorded in government efforts and programmes to reduce inequality and poverty, but the outputs moved at a plodding pace. Programmes and policies to reduce unemployment failed to produce the expected outcomes. Additionally, technical progress has been very slow since independence, as reflected by the technical efficiency parameter. The findings suggest a need to improve the public sector’s performance and efficiency to ensure stability and accelerate growth in the previously colonized economies with the same features as Namibia. JEL Classification: H00, H11, H89, L38
Treatment patterns for patients initiating novel acute migraine specific medications (nAMSMs) in the context of monoclonal antibodies (mAbs) targeting the calcitonin gene-related peptide (CGRP) pathway
Authors: Zhou Zifan , Urman Robert , Gill Karminder , Park Andrew S. , Vuvu Fiston , Patel Leah B. , Lu Jingsong , Wade Rolin L. , Frerichs Lindsay , Bensink Mark E. 
Published: November 2023

Abstract
Background
New acute and preventive migraine medications are available, but data on current treatment patterns are limited. This study describes migraine treatment patterns among patients initiating novel acute migraine specific medications (nAMSMs), overall and by prior use of anti-calcitonin gene-related peptide (CGRP) pathway monoclonal antibodies (mAbs).

Methods
In this retrospective cohort study using IQVIA open-source pharmacy and medical claims data, we identified patients with ≥ 1 claim for a nAMSM (ubrogepant, rimegepant, lasmiditan) between 01/01/2020 and 09/30/2020 (index period). Patients were indexed on their first nAMSM claim and stratified into 2 cohorts: patients with prior mAb use (≥ 1 claim for erenumab, fremanezumab, galcanezumab in the 6-month pre-index period) or patients without prior mAb use. Treatment patterns were assessed during the 6-month post-index period.

Results
Overall, 78,574 patients were identified (63% indexed on ubrogepant, 34% on rimegepant, and 3% on lasmiditan) with 26,656 patients (34%) having had prior mAb use. In the pre-index period, 79% of patients used non-mAb preventive medications and 75% of patients used acute medications. Following the index nAMSM claim, 65% of patients had ≥ 1 refill and 21% had ≥ 4 refills of their index nAMSM; 10% of patients switched to another nAMSM. Post-index mAb use was observed in 82% of patients with a prior mAb and 15% of patients without. Among patients with pre- and post-index use of acute medications, 38% discontinued ≥ 1 acute medication class in the post-index period. Among patients with concomitant use of traditional preventive medications at index, 30% discontinued ≥ 1 concomitant preventive anti-migraine medication in the post-index period.

Conclusions
Most patients initiating nAMSMs had prior treatment with acute and preventive medications. Approximately one-third of patients had prior treatment with anti-CGRP pathway mAbs. After starting nAMSMs, more than one-third of patients discontinued at least one traditional acute medication and one-third of patients discontinued at least one traditional preventive medication.
Despite nAMSM initiation, most patients with prior anti-CGRP pathway mAb use continued mAb use. Around 15% of patients without a prior mAb newly started a mAb. These results provide insight into how nAMSMs and mAbs have been integrated into clinical management of migraine in the real-world.
Extracellular Vesicles for Drug Delivery in Cancer Treatment
Authors: Wang Li , Yu Xin , Zhou Juan , Su Chunxia 
Published: November 2023

AbstractExtracellular vesicles (EVs) are nanoscale vesicles derived from cells that mediate intercellular communication by transporting bioactive molecules. They play significant roles in various physiological and pathological conditions. EVs hold great potential as novel biomarkers of diseases, therapeutic agents, and drug delivery vehicles. Furthermore, EVs as novel drug delivery vehicles have demonstrated significant advantages in preclinical settings. In this review, we discussed the biogenesis and characteristics of EVs and their functions in cancer. We summarize the therapeutic applications of EVs as a natural delivery vehicles in cancer therapy. We highlight the existing challenges, illuminate vital questions, and propose recommendations to effectively address them effectively.
Male contraception: narrative review of ongoing research
Authors: Louwagie Eli J. , Quinn Garrett F.L. , Pond Kristi L. , Hansen Keith A. 
Published: November 2023

Abstract
Background
Since the release of the combined oral contraceptive pill in 1960, women have shouldered the burden of contraception and family planning. Over 60 years later, this is still the case as the only practical, effective contraceptive options available to men are condoms and vasectomy. However, there are now a variety of promising hormonal and non-hormonal male contraceptive options being studied. The purpose of this narrative review is to provide clinicians and laypeople with focused, up-to-date descriptions of novel strategies and targets for male contraception. We include a cautiously optimistic discussion of benefits and potential drawbacks, highlighting several methods in preclinical and clinical stages of development.

Results
As of June 2023, two hormonal male contraceptive methods are undergoing phase II clinical trials for safety and efficacy. A large-scale, international phase IIb trial investigating efficacy of transdermal segesterone acetate (Nestorone) plus testosterone gel has enrolled over 460 couples with completion estimated for late 2024. A second hormonal method, dimethandrolone undecanoate, is in two clinical trials focusing on safety, pharmacodynamics, suppression of spermatogenesis and hormones; the first of these two is estimated for completion in December 2024. There are also several non-hormonal methods with strong potential in preclinical stages of development.

Conclusions
There exist several hurdles to novel male contraception. Therapeutic development takes decades of time, meticulous work, and financial investment, but with so many strong candidates it is our hope that there will soon be several safe, effective, and reversible contraceptive options available to male patients.
Effects of xenon anesthesia on postoperative neurocognitive disorders: a systematic review and meta-analysis
Authors: Yang Yu-Shen , Wu Shan-Hu , Chen Wei-Can , Pei Meng-Qin , Liu Yi-Bin , Liu Chu-Yun , Lin Shu , He He-Fan 
Published: November 2023

AbstractThe latest clinical trials have reported conflicting outcomes regarding the effectiveness of xenon anesthesia in preventing postoperative neurocognitive dysfunction; thus, this study assessed the existing evidence. We searched the PubMed, Embase, Cochrane Library, and Web of Science databases from inception to April 9, 2023, for randomized controlled trials of xenon anesthesia in postoperative patients. We included English-language randomized controlled studies of adult patients undergoing surgery with xenon anesthesia that compared its effects to those of other anesthetics. Duplicate studies, pediatric studies, and ongoing clinical trials were excluded. Nine studies with 754 participants were identified. A forest plot revealed that the incidence of postoperative neurocognitive dysfunction did not differ between the xenon anesthesia and control groups (P = 0.43). Additionally, xenon anesthesia significantly shortened the emergence time for time to opening eyes (P < 0.001), time to extubation (P < 0.001), time to react on demand (P = 0.01), and time to time and spatial orientation (P = 0.04). However, the Aldrete score significantly increased with xenon anesthesia (P = 0.005). Postoperative complications did not differ between the anesthesia groups. Egger’s test for bias showed no small-study effect, and a trim-and-fill analysis showed no apparent publication bias. In conclusion, xenon anesthesia probably did not affect the occurrence of postoperative neurocognitive dysfunction. However, xenon anesthesia may effectively shorten the emergence time of certain parameters without adverse effects.
Identifying and managing apathy in people with dementia living in nursing homes: a qualitative study
Authors: Nijsten Johanna M. H. , Smalbrugge Martin , Plouvier Annette O. A. , Koopmans Raymond T. C. M. , Leontjevas Ruslan , Gerritsen Debby L. 
Published: November 2023

Abstract
Background
Although apathy is common in people with dementia and has profound negative effects, it is rarely diagnosed nor specifically treated in nursing homes. The aim of this study is to explore experiences in identifying and managing apathy from the perspectives of people with dementia and apathy (PwA), family caregivers (FCs) and professional caregivers (PCs).

Methods
Descriptive qualitative study with purposive sampling, comprising eleven semi-structured in-depth interviews with PwA, FCs or PCs and focus groups with twelve PCs in Dutch nursing homes. Seventeen additional in-depth interviews with caregivers were held, after signals of increasing apathy during the first Covid-19 lockdown. Using an inductive approach, data was analysed thematically to explore the experiences in identifying and managing apathy from the perspective of different stakeholders.

Results
Three themes were identified: 1) the challenge to appraise signals, 2) the perceived impact on well-being, 3) applied strategies to manage apathy. Although participants described apathy in line with diagnostic criteria, they were unfamiliar with the term apathy and had difficulties in appraising signals of apathy. Also, the perceived impact of apathy varied per stakeholder. PwA had difficulties reflecting on their internal state. FCs and PCs experienced apathy as challenging when it reduced the well-being of PwA or when they themselves experienced ambiguity, frustration, insecurity, disappointment or turning away. Dealing with apathy required applying specific strategies that included stimulating meaningful contact, adjusting one’s expectations, and appreciating little successes.

Conclusions
When addressing apathy in nursing homes, it is important to consider that a) all stakeholders experience that appraising signals of apathy is challenging; b) apathy negatively influences the well-being of people with dementia and especially their FCs and PCs; and c) FCs and PCs can successfully, albeit temporarily, manage apathy by using specific strategies.