bluuebunny/crossref_metadata_2025_split huggingface dataset:
Race and Ethnicity and Fracture Prediction Among Younger Postmenopausal Women in the Women’s Health Initiative Study
Authors: Crandall Carolyn J. , Larson Joseph C. , Schousboe John T. , Manson JoAnn E. , Watts Nelson B. , Robbins John A. , Schnatz Peter , Nassir Rami , Shadyab Aladdin H. , Johnson Karen C. , Cauley Jane A. , Ensrud Kristine E. 
Published: May 2023

ImportanceThe best approach to identify younger postmenopausal women for osteoporosis screening is uncertain. The Fracture Risk Assessment Tool (FRAX), which includes self-identified racial and ethnic information, and the Osteoporosis Self-assessment Tool (OST), which does not, are risk assessment tools recommended by US Preventive Services Task Force guidelines to identify candidates for bone mineral density (BMD) testing in this age group.ObjectiveTo compare the ability of FRAX vs OST to discriminate between younger postmenopausal women who do and do not experience incident fracture during a 10-year follow-up in the 4 racial and ethnic groups specified by FRAX.Design, Setting, and ParticipantsThis cohort study of Women’s Health Initiative participants included 67 169 women (baseline age range, 50-64 years) with 10 years of follow-up for major osteoporotic fracture (MOF; including hip, clinical spine, forearm, and shoulder fracture) at 40 US clinical centers. Data were collected from October 1993 to December 2008 and analyzed between May 11, 2022, and February 23, 2023.Main Outcomes and MeasuresIncident MOF and BMD (in a subset of 4607 women) were assessed. The area under the receiver operating characteristic curve (AUC) for FRAX (without BMD information) and OST was calculated within each racial and ethnic category.ResultsAmong the 67 169 participants, mean (SD) age at baseline was 57.8 (4.1) years. A total of 1486 (2.2%) self-identified as Asian, 5927 (8.8%) as Black, 2545 (3.8%) as Hispanic, and 57 211 (85.2%) as White. During follow-up, 5594 women experienced MOF. For discrimination of MOF, AUC values for FRAX were 0.65 (95% CI, 0.58-0.71) for Asian, 0.55 (95% CI, 0.52-0.59) for Black, 0.61 (95% CI, 0.56-0.65) for Hispanic, and 0.59 (95% CI, 0.58-0.59) for White women. The AUC values for OST were 0.62 (95% CI, 0.56-0.69) for Asian, 0.53 (95% CI, 0.50-0.57) for Black, 0.58 (95% CI, 0.54-0.62) for Hispanic, and 0.55 (95% CI, 0.54-0.56) for White women. For discrimination of femoral neck osteoporosis, AUC values were excellent for OST (range, 0.79 [95% CI, 0.65-0.93] to 0.85 [95% CI, 0.74-0.96]), higher for OST than FRAX (range, 0.72 [95% CI, 0.68-0.75] to 0.74 [95% CI, 0.60-0.88]), and similar in each of the 4 racial and ethnic groups.Conclusions and RelevanceThese findings suggest that within each racial and ethnic category, the US FRAX and OST have suboptimal performance in discrimination of MOF in younger postmenopausal women. In contrast, for identifying osteoporosis, OST was excellent. The US version of FRAX should not be routinely used to make screening decisions in younger postmenopausal women. Future investigations should improve existing tools or create new approaches to osteoporosis risk assessment for this age group.
Assessment of Screening Tools to Identify Substance Use Disorders Among Adolescents
Authors: Levy Sharon , Brogna Melissa , Minegishi Machiko , Subramaniam Geetha , McCormack Jennifer , Kline Margaret , Menzin Eleanor , Allende-Richter Sophie , Fuller Alyssa , Lewis Mitra , Collins Julia , Hubbard Zach , Mitchell Shannon G. , Weiss Roger , Weitzman Elissa 
Published: May 2023

ImportanceEfficient screening tools that effectively identify substance use disorders (SUDs) among youths are needed.ObjectiveTo evaluate the psychometric properties of 3 brief substance use screening tools (Screening to Brief Intervention [S2BI]; Brief Screener for Tobacco, Alcohol, and Drugs [BSTAD]; and Tobacco, Alcohol, Prescription Medication, and Other Substances [TAPS]) with adolescents aged 12 to 17 years.Design, Setting, and ParticipantsThis cross-sectional validation study was conducted from July 1, 2020, to February 28, 2022. Participants aged 12 to 17 years were recruited virtually and in person from 3 health care settings in Massachusetts: (1) an outpatient adolescent SUD treatment program at a pediatric hospital, (2) an adolescent medicine program at a community pediatric practice affiliated with an academic institution, and (3) 1 of 28 participating pediatric primary care practices. Participants were randomly assigned to complete 1 of the 3 electronic screening tools via self-administration, followed by a brief electronic assessment battery and a research assistant–administered diagnostic interview as the criterion standard measure for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnoses of SUDs. Data were analyzed from May 31 to September 13, 2022.Main Outcomes and MeasuresThe main outcome was a DSM-5 diagnosis of tobacco/nicotine, alcohol, or cannabis use disorder as determined by the criterion standard World Mental Health Composite International Diagnostic Interview Substance Abuse Module. Classification accuracy of the 3 substance use screening tools was assessed by examining the agreement between the criterion, using sensitivity and specificity, based on cut points for each tool for use disorder, chosen a priori from previous studies.ResultsThis study included 798 adolescents, with a mean (SD) age of 14.6 (1.6) years. The majority of participants identified as female (415 [52.0%]) and were White (524 [65.7%]). High agreement between screening results and the criterion standard measure was observed, with area under the curve values ranging from 0.89 to 1 for nicotine, alcohol, and cannabis use disorders for each of the 3 screening tools.Conclusions and RelevanceThese findings suggest that screening tools that use questions on past-year frequency of use are effective for identifying adolescents with SUDs. Future work could examine whether these tools have differing properties when used with different groups of adolescents in different settings.
Survival Trends in Children With Tetralogy of Fallot in Sweden From 1970 to 2017
Authors: Persson Johanna , Gyllencreutz Castellheim Albert , Dellborg Mikael , Giang Kok Wai , Karazisi Christina , Rawshani Araz , Mandalenakis Zacharias 
Published: May 2023

ImportanceMortality in patients with tetralogy of Fallot (TOF) has decreased substantially since the start of surgical correction of this abnormality in the 1950s. However, nationwide data in Sweden comparing survival trends among pediatric patients with TOF with the general population are still limited.ObjectiveTo study survival trends in pediatric patients with TOF and compare them with matched controls.Design, Setting, and ParticipantsA Swedish registry-based, nationwide, matched cohort study was conducted; data were collected from national health registers from January 1, 1970, to December 31, 2017. Patients with a registered diagnosis of TOF as well as controls without TOF matched by birth year and sex were included in the study. Follow-up data were collected from birth to age 18 years, death, or the end of follow-up (December 31, 2017), whichever occurred first. Data analysis was performed from September 10 to December 20, 2022. Survival trends among patients with TOF were compared with matched controls using Cox proportional hazards regression and Kaplan-Meier survival analyses.Main Outcomes and MeasuresAll-cause mortality during childhood in patients with TOF and matched controls.ResultsThe population included 1848 patients (1064 [57.6%] males; mean [SD] age, 12.4 [6.7] years) with TOF and 16 354 matched controls. The number of patients who underwent congenital cardiac surgery (henceforth, surgery group) was 1527 (897 [58.7%] males). In the whole TOF population from birth until age 18 years, 286 patients (15.5%) died during a mean (SD) follow-up time of 12.4 (6.7) years. In the surgery group, 154 of 1527 patients (10.1%) died during a follow-up time of 13.6 (5.7) years with a mortality risk of 21.9 (95% CI, 16.2-29.7) compared with matched controls. When stratified by birth period, a substantial decrease in the mortality risk was noted in the surgery group, from 40.6 (95% CI, 21.9-75.4) in those born in the 1970s to 11.1 (95% CI, 3.4-36.4) in those born in the 2010s. Survival increased from 68.5% to 96.0%. The risk of mortality for surgery decreased from 0.52 in the 1979s to 0.19 in the 2010s.Conclusions and RelevanceThe findings of this study suggest there has been substantial improvement in survival in children with TOF who underwent surgery from 1970 to 2017. However, the mortality rate is still significantly higher in this group compared with matched controls. Predictors of good and poor outcomes in this group need to be further explored, with the modifiable ones evaluated for further outcome improvements.
Clinical Utility of Tau Positron Emission Tomography in the Diagnostic Workup of Patients With Cognitive Symptoms
Authors: Smith Ruben , Hägerström Douglas , Pawlik Daria , Klein Gregory , Jögi Jonas , Ohlsson Tomas , Stomrud Erik , Hansson Oskar 
Published: May 2023

ImportanceIt is important to determine the added clinical value for tau positron emission tomography (PET) in the diagnostic workup of patients with cognitive symptoms before widespread implementation in clinical practice.ObjectiveTo prospectively study the added clinical value of PET detecting tau pathology in Alzheimer disease (AD).Design, Setting, and ParticipantsThis prospective cohort study (Swedish BioFINDER-2 study) took place from May 2017 through September 2021. A total of 878 patients with cognitive complaints were referred to secondary memory clinics in southern Sweden and then recruited to the study. In total, 1269 consecutive participants were approached, but 391 did not meet inclusion criteria or did not complete the study.ExposuresParticipants underwent a baseline diagnostic workup, including clinical examination, medical history, cognitive testing, blood and cerebrospinal fluid sampling, magnetic resonance imaging of the brain, and a tau PET ([18F]RO948) scan.Main Outcomes and MeasuresThe primary end points were change in diagnosis and change in AD drug therapy or other drug treatment between the pre- and post-PET visits. A secondary end point was the change in diagnostic certainty between the pre- and post-PET visits.ResultsA total of 878 participants with a mean age of 71.0 (SD, 8.5) years (491 male [56%]) were included. The tau PET result led to a change in diagnoses in 66 participants (7.5%) and a change in medication in 48 participants (5.5%). The study team found an association with overall increased diagnostic certainty after tau PET in the whole data set (from 6.9 [SD, 2.3] to 7.4 [SD, 2.4]; P &amp;lt; .001). The certainty was higher in participants with a pre-PET diagnosis of AD (from 7.6 [SD, 1.7] to 8.2 [SD, 2.0]; P &amp;lt; .001) and increased even further in participants with a tau PET positive result supporting an AD diagnosis (from 8.0 [SD, 1.4] to 9.0 [SD, 0.9]; P &amp;lt; .001). The association with tau PET results had the largest effect sizes in participants with pathological amyloid-β (Aβ) status, whereas no significant change in diagnoses was seen in participants with normal Aβ status.Conclusions and RelevanceThe study team reported a significant change in diagnoses and patient medication when tau PET was added to an already extensive diagnostic workup that included cerebrospinal fluid AD biomarkers. Including tau PET was associated with a significant increase in certainty of underlying etiology. The effect sizes for certainty of etiology and diagnosis were largest in the Aβ-positive group and the study team suggests that clinical use of tau PET be limited to populations with biomarkers indicating Aβ positivity.
MAPTkit: An environmental management decision‐tool for inclusive, equitable and representative stakeholder attribute mapping
Authors: Hoare Victoria , Hinson Caitlin E. , Reyniers Bethany M. , O'Shea Ryan , Howe Caroline 
Published: May 2023

Abstract

Inclusive, comprehensive Stakeholder Identification and Mapping processes are vital for successful environmental management. This is relevant as multi‐disciplinary collaboration becomes increasingly popular, and the diversity of people influenced by, or involved in, the management of most projects is greater than ever before. Understanding how relevant parties are analysed in environmental management programmes is required to enable robust and considered methodologies as well as successful, just and equitable outcomes.

The aim of this study was to improve the attribute mapping process, increasing transparency and ensuring representation is both comprehensive and equitable. A rapid scoping review of Scopus and Web of Science was undertaken to collate and analyse peer‐reviewed, published evidence on stakeholder analysis, with a focus on the mapping processes involved in identifying stakeholders and their attributes.

Of the Initial 359 identified papers, 61 were included after three stages of screening. Our results indicate that there is little consistency among practitioners to ensure that Identifying and Mapping Stakeholders is representative: <20% of Case Studies (n = 9) checked the relevancy of their stakeholders after identification. Additionally, definitions at all stages of the stakeholder analysis process were inconsistent across the case studies. Fewer than half of the Case Studies included a definition of Stakeholder (n = 22) or of stakeholder analysis (n = 25).

Capturing a representative sample of relevant parties, without compromising on efficiency, financial or practical constraints, is difficult. Having consistent definitions for the term Stakeholders and stakeholder analysis within environmental management is an important step. Based on the scoping review, we formalise the Analysis process into six stages.

Through the scoping review findings, a decision support tool, MAPTkit (Mapped Attribute Profiling Toolkit) was developed to visualise the heterogeneity and representation of stakeholders across several user‐determined attributes. This tool is non‐prescriptive, drawing attention to potential issues with stakeholder analysis, such as misrepresentation of real‐world stakeholder communities. This ensures engagement across the full range of people to ensure that environmental management projects are multi‐disciplinary and collaborative, while promoting fair and equitable representation.
AI Autonomy: Self‐initiated Open‐world Continual Learning and Adaptation
Authors: Liu Bing , Mazumder Sahisnu , Robertson Eric , Grigsby Scott 
Published: May 2023

AbstractAs more and more AI agents are used in practice, it is time to think about how to make these agents fully autonomous so that they can (1) learn by themselves continually in a self‐motivated and self‐initiated manner rather than being retrained offline periodically on the initiation of human engineers and (2) accommodate or adapt to unexpected or novel circumstances. As the real‐world is an open environment that is full of unknowns or novelties, the capabilities of detecting novelties, characterizing them, accommodating/adapting to them, and gathering ground‐truth training data and incrementally learning the unknowns/novelties become critical in making the AI agent more and more knowledgeable, powerful and self‐sustainable over time. The key challenge here is how to automate the process so that it is carried out continually on the agent's own initiative and through its own interactions with humans, other agents and the environment just like human on‐the‐job learning. This paper proposes a framework (called SOLA) for this learning paradigm to promote the research of building autonomous and continual learning enabled AI agents. To show feasibility, an implemented agent is also described.
Refining the radiation and contrast medium dose in weight‐grouped scanning protocols for coronary CT angiography
Authors: Zhang Yan , Wang Ying , Li Jing , Zhang Guozhi , Di Aihui , Yuan Huishu 
Published: May 2023

AbstractPurposeTo refine the currently used, weight‐grouped protocol for coronary computed tomography angiography (CCTA), in terms of the radiation and contrast medium dose, through clinical evaluation.MethodsFollowing the current routine setting that varies between three weight groups (group A: 55–65 kg, group B: 66–75 kg, group C: 76–85 kg), three additional reduction protocols were proposed to each group, with different combinations of lowered tube voltage (70–100 kVp), tube current (100–220 mAs), and iodine delivery rate (0.8–1.5 gI/s). A total of 321 patients scheduled for CCTA due to suspected coronary artery disease were enrolled, who were randomly assigned to one of the four subgroups of settings under the corresponding weight group. The resulting objective image quality was compared by measuring the contrast‐to‐noise ratio and signal‐to‐noise ratio. Subjective image quality was graded by two radiologists using a 4‐point Likert scale, on a total of 3848 segments. The optimal protocol for each weight group was determined with respect to the image quality and the applied radiation dose.ResultsFor all three groups, no significant difference was noticed in objective images quality between subgroups of dose settings (all p > 0.05). The average score on subjective image quality was ≥3 for every subgroup, while the percentage of score 4 showed greater dependence on the setting, ranging from 83.2% to 91.5%, and was chosen to be the determining factor. The optimal dose settings were found to be 80 kVp, 150 mAs, and 1.0 gI/s for patients of 55–75 kg in weight, and 100 kVp, 170 mAs, and 1.5 gI/s for those of 76–85 kg.ConclusionIt is feasible to refine the currently used, weight‐grouped protocol for CCTA in terms of radiation and contrast medium dose, by use of an optimization strategy where the balance between dose and image quality can be improved in a routine clinical setting.
Mortality of myasthenia gravis: a national population‐based study in China
Authors: Zhang Chen , Wang Fei , Long Zheng , Yang Jia , Ren Yi , Ma Qingfeng , Li Jiajian , Wen Xinmei , Wang Lijun , Da Yuwei , Zhou Maigeng , Yin Peng , Hao Junwei 
Published: May 2023

AbstractObjectiveAs a potentially life‐threatening condition, myasthenia gravis (MG) has limited epidemiological studies on mortality. We aim to provide demographic distribution, geographical variation, and temporal trend of MG‐related mortality in China.MethodsThe national population‐based analysis was conducted based on records derived from the National Mortality Surveillance System of China. All deaths related to MG were identified from 2013 to 2020, and MG‐related mortality was evaluated by sex, age, location, and year.ResultsA total of 4224 deaths were related to MG during 2013–2020, and the median age at death of MG was 59.45 years, significantly lower than that in the general population (75.47 years, P < 0.05). In 2020, the age‐standardized mortality rate of MG was 1.86 per million people and markedly higher in males than in females (2.37 vs. 1.31 per million). The mortality rate per million was lower than 1 in young children, peaking at 2.83 only in males (vs. 0.36 in females) aged 10–19 years, and substantially increased with age, reaching the highest rate of 13.31 for males and 10.58 for females aged 80 years and older. Geographical disparity across China was observed with the highest age‐standardized mortality rate in Southwest (2.53 per million). From 2013 to 2020, MG‐related mortality rate showed an increasing trend with the average annual percentage change of 3.5% (95% CI, 1.4–5.6). The notable increases occurred in age 10–19 years and over 70 years.InterpretationIn China, MG‐related mortality was notably high among adolescent males and the elderly. The increasing death burden due to MG highlight challenges to disease management.
Unfolding the Mystery Behind the Onset of Chondrocyte Hypertrophy during Chondrogenesis: Toward Designing Advanced Permanent Cartilage‐mimetic Biomaterials
Authors: Majumder Nilotpal , Ghosh Sourabh 
Published: May 2023

AbstractSuccessful recapitulation of the anatomical microarchitecture and biomechanics of the native articular cartilage under in vitro culture conditions is still an elusive topic of research. The major roadblock lies in maintaining the stable chondrogenic phenotype in vivo or under long‐term in vitro conditions. Tissue engineers worldwide has coined this aberrant loss of permanent cartilage characteristics to transient cartilage form as “chondrocyte hypertrophy”. Although the following has been validated through the expression of a few known markers but very little is understood regarding the molecular mechanism that dwells underneath. This review summarizes the precise aetiology behind the development and progression of the hypertrophic phenotype in chondrocytes under in vitro chondrogenic conditions. Based on the current literature survey, it is deciphered that the type of cell utilized (chondrocytes or stem cells), the chondrogenic culture conditions (growth factors/biochemical mediators) and the culture microenvironment (oxygen tension, mechanical loading) during chondrogenesis have a direct correlation with the dysregulated activity of the chondrogenic signaling pathways corroborating the onset of hypertrophic maturation of chondrocytes. Furthermore, it is critically analyzed whether to completely inhibit these hypertrophy‐inducing signaling pathways or apply a brake in terms of time‐dependent dose due to their functional duality role in chondrogenesis.
Manipulating Ion Transfer and Interface Stability by A Bulk Interphase Framework for Stable Lithium Metal Batteries
Authors: Liang Hongmei , Wang Li , Song Youzhi , Ren Dongsheng , Wang Aiping , Yang Yang , Xu Hong , Sun Yongming , He Xiangming 
Published: May 2023

AbstractLithium metal batteries (LMBs) have attracted widespread concern as the next‐generation energy storage devices with high energy density. At the surface of lithium metal anodes (LMAs) toward electrolytes, lithium plating always competes with interfacial reactions. This makes interfacial reactions light shadow right behind lithium plating, leading to performance degradation. Herein, lithium plating is spatially decoupled from interfacial reactions by constructing a 3D solid electrolyte interphase framework (3D‐SEIF) inside LMAs. Spontaneous while mild chemical reactions between lithium metal and lithium bisfluorosulfonimide/lithium nitrate form the robust 3D‐SEIF, mainly consisting of LiF, Li3N, and LiNxOy. The built‐in 3D‐SEIF avoids electrolyte contact but enables the diffusion and reduction of Li+ ions in the bulk phase, thus isolating the plating sites and electrolyte contact interface. The 3D‐SEIF facilitates large granular plating and the generation of thin, inorganic‐rich SEI. When assembled with high‐loading LiNi0.6Co0.2Mn0.2O2 cathode (3 mAh cm−2), the cells present capacity retention of 92.0% after 130 cycles with barren electrolyte (≈30 µL) at 0.5 C. The conception of 3D inner interphase allows breaking the coupling of interfacial reactions with electrochemical reactions, which is taken for granted in electrochemical consortium. It also desires to inspire new thoughts to develop scalable solutions for the early industrialization of LMBs.