bluuebunny/crossref_metadata_2025_split huggingface dataset:
Post-coronavirus disease 2019 functional impairments, limitations, and restrictions: A prospective cohort study based on the international classification of functioning, disability, and health
Authors: Monteiro Isabella Polo , Appelt Pablo Andrei , Sisconetto Angélica Taciana , Minaré Baldo Sucupira Kelly Savana , Bazan Rodrigo , Luvizutto Gustavo José , Pascucci Sande de Souza Luciane Aparecida 
Published: August 2023

Background Current knowledge regarding coronavirus disease 2019 (COVID-19) is constantly evolving, and the long-term functional impairments, limitations, and restrictions have not yet been well established. Objective to evaluate the impact of post-COVID condition on the human functioning through the International Classification of Functioning, Disability and Health (ICF) classification. Methods This is a prospective cohort study with 53 individuals with post-COVID condition at 3 time points: 0 to 3 (baseline), 3 to 6, and 6-12 months (follow-up). Outcomes were organized in dichotomous variable: No impairment (0); presence of impairment (≥1) in body function, structure, activities, and participation domains according to the ICF checklist. Chi-square test was used to determine the differences of 3 time points, and association with persistent symptoms. Results A statistically significant difference was observed between the periods, with greater disabilities at 6-12 than at 0-3 months in mental, sensory, pain, and movement-related functions; cardiovascular, immunological, and respiratory systems. In terms of activity and participation, a greater limitation at 6-12 months was observed than at 0-3 months in learning and applying knowledge, general tasks, and mobility. In the domain of interpersonal interactions and relationships, there was a statistically significant difference between the 6-12 and 3-6 months groups. Associations between COVID-19 symptoms and ICF components at the first follow-up were: anosmia and dysgeusia with weight maintenance, fatigue and irritability with pain, brain fog with watching and listening, walking difficulty with pain, and headache with pain, watching, and listening. At the second follow-up were: anosmia and dysgeusia with energy and drive functions, attention, memory, and emotional functions; dizziness with watching and listening; fatigue with emotional function, pain, undertaking multiple tasks, lifting and carrying objects, and driving; irritability with energy and drive, emotional function, undertaking multiple tasks, lifting and carrying objects, and walking; walking difficulty with energy and driving, emotional function, respiration, muscle power, cardiovascular system, undertaking multiple tasks, lifting and carrying objects, and walking; and headache with emotional function, watching, and listening. Conclusions Individuals with COVID-19 persistent symptoms showed impairments in structure and function, activity limitations, and participation restrictions during the 1-year follow-up period.
Measuring the value of solidarity: The abem financial assistance program for out-of-pocket payments on pharmacy medicines in Portugal
Authors: Gouveia Miguel , Borges Margarida , Costa João , Lourenço Francisco , Fiorentino Francesca , Rodrigues António Teixeira , Teixeira Inês , Guerreiro José Pedro , Caetano Patrícia , Carneiro António Vaz 
Published: August 2023

Objective Out-of-pocket payments for prescribed medicines are still comparatively high in Portugal. The abem program was launched in Portugal in May 2016 to aid vulnerable groups by completely covering out-of-pocket costs of prescribed medicines in community pharmacies. This study assesses the impact of the program on poverty and catastrophic health expenditures. Methods A longitudinal study was carried out with the analysis of several program databases (from the beginning of the program in May 2016 to September 2018) covering the cohorts of beneficiaries, daily data on medicines dispensed, social referencing entities, and solidarity pharmacies. The study provides estimates of standard poverty measures (intensity and severity) as well as the incidence of catastrophic health expenditures. Results More than 6000 beneficiaries were supported (56.8% female, 34.7% aged 65 or over), encompassing 127,510 medicines (mainly nervous system and cardiovascular system) with an average 26.9% co-payment (payments totalling €1.5 million). The program achieved substantial reductions in poverty (3.4% in intensity, 5.6% in severity), and eliminated cases with catastrophic health expenditures in medicines that would have affected 7.5% of the beneficiaries. Conclusions Findings confirm a continuous increase in the number of beneficiaries, enabling access to medicines especially for the vulnerable elderly, and a sizable impact on eliminating out-of-pocket payments for medicines in the target population.
Comorbidity and mortality in systemic sclerosis and matched controls: Impact of interstitial lung disease. A population based cohort study based on health registry data
Authors: Knarborg Malene , Hyldgaard Charlotte , Bendstrup Elisabeth , Davidsen Jesper Rømhild , Løkke Anders , Shaker Saher Burhan , Hilberg Ole 
Published: August 2023

Objective This population-based, matched cohort study evaluates the impact of comorbidities on mortality among systemic sclerosis (SSc) patients with and without interstitial lung disease (ILD). Method Patients with a first-time SSc diagnosis between 2002 and 2015 were identified in the Danish National Patient Registry, separated into two cohorts – with ILD (SSc-ILD) and without ILD (non-ILD SSc), and matched 1:4 with controls from the general population on age, sex, residency and marital status. Comorbidity and mortality data were obtained from national registries. The Deyo-Charlson comorbidity score (DCcs) was used for assessment of the burden of comorbidities. Results 1732 patients with SSc and 6919 controls were included; 258 (14.9%) patients had SSc-ILD. The hazard ratio (HR) for death was 2.8 (95% CI 2.4–3.3) in SSc, and especially increased in SSc-ILD (HR 4.2 (95% CI 3.2–5.4)), males (HR 3.1 95% CI 2.4–4.1) and younger adults (aged 18–40 (HR 6.9, 95% CI 3.4–14.2) and 41–50 (HR 7.7, 95% CI 3.8–15.6)). In non-ILD SSc, mortality increased with increasing DCcs. Cancer was the most frequent cause of death in SSc (24.9% of deaths) and in controls (33.5%), in SSc followed by musculoskeletal and connective tissue diseases (22.7%); the cause of only 0.8% of deaths among controls. Conclusion The high prevalence of comorbidities in SSc had extensive impact on mortality. Mortality was increased in males, in young adults and in SSc-ILD, underlining the excess mortality associated with ILD. These findings emphasise the importance of timely diagnosis and optimal management of organ involvement and comorbidities in SSc.
Recovery of Quiet Standing Balance and Lower Limb Motor Impairment Early Poststroke: How Are They Related?
Authors: Schröder Jonas , Saeys Wim , Embrechts Elissa , Hallemans Ann , Yperzeele Laetitia , Truijen Steven , Kwakkel Gert 
Published: August 2023

Background Recovery of quiet standing balance early poststroke has been poorly investigated using repeated measurements. Objective To investigate (1) the time course of steady-state balance in terms of postural stability and inter-limb symmetry, and (2) longitudinal associations with lower limb motor recovery in the first 3 months poststroke. Methods Forty-eight hemiparetic subjects (age: 58.9 ± 16.1 years) were evaluated at weeks 3, 5, 8, and 12 poststroke. Motor impairments concerned the Fugl-Meyer assessment (FM-LE) and Motricity Index total score (MI-LE) or ankle item separately (MI-ankle). Postural stability during quiet 2-legged stance was calculated as the net center-of-pressure area (COPArea) and direction-dependent velocities (COPVel-ML and COPVel-AP). Dynamic control asymmetry (DCA) and weight-bearing asymmetry (WBA) estimated inter-limb symmetries in balance control and loading. Linear mixed models determined (1) time-dependent change and (2) the between- and within-subject associations between motor impairments and postural stability or inter-limb symmetry. Results Time-dependent improvements were significant for FM-LE, MI-LE, MI-ankle, COPArea, COPVel-ML, and COPVel-AP, and tended to plateau by week 8. DCA and WBA did not exhibit significant change. Between-subject analyses yielded significant regression coefficients for FM-LE, MI-LE, and MI-ankle scores with COPArea, COPVel-ML, and COPVel-AP up until week 8, and with WBA until week 12. Within-subject regression coefficients of motor recovery with change in COPArea, COPVel-ML, COPVel-AP, DCA, or WBA were generally non-significant. Conclusions Postural stability improved significantly in the first 8 weeks poststroke, independent of lower limb motor recovery at the most affected side within subjects. Our findings suggest that subjects preferred to compensate with their less affected side, making metrics reflecting inter-limb asymmetries in balance invariant for change early poststroke. Clinical Trial Registration: Clinicaltrials.gov. unique identifier NCT03728036.
What is prenatal stress? A scoping review of how prenatal stress is defined and measured within the context of food insecurity, housing instability, and immigration in the United States
Authors: Patel Ishani , Dev Alka 
Published: August 2023

Background: Stress during pregnancy can lead to significant adverse outcomes for maternal mental health. Early evaluation of prenatal stress can help identify treatment needs and appropriate interventions. Disparities in the social determinants of health can contribute to stress, but what constitutes stress during pregnancy within the social determinants of health framework is poorly understood. Objective: To scope how prenatal stress is defined and measured among pregnant people exposed to three prominent social stressors in the United States: insecurity pertaining to food, housing, and immigration. Eligibility Criteria: We included all studies that focused on stress during pregnancy in the context of food insecurity, housing instability, and immigration, given their recent policy focus due to the COVID-19 pandemic and ongoing political discourse, in addition to their importance in American College of Obstetricians and Gynecologists (ACOG’s) social determinants of health screening tool. Sources of Evidence: We searched PubMed, Scopus, and Web of Science for articles published between January 2012 and January 2022. Charting Methods: Using a piloted charting tool, we extracted relevant study information from the selected articles and analyzed the content pertaining to stress. Results: An initial search identified 1,023 articles, of which 24 met our inclusion criteria. None of the studies defined prenatal stress, and only one used the Prenatal Distress Questionnaire, a prenatal stress-specific tool to measure it. The Perceived Stress Scale was the most common instrument used in seven studies. Fifteen studies measured over 25 alternative exposures that researchers theorized were associated with stress, and 4 of the 15 studies did not explain the association between the measure and stress. Conclusions: Our findings demonstrate a fundamental inconsistency in how prenatal stress is defined and measured in the context of social determinants of health, limiting the comparison of results across studies and the potential development of effective interventions to promote better maternal mental health.
Repair failure and associated factors among women who underwent obstetric fistula surgery in Southwest Ethiopia: A retrospective study
Authors: Gezimu Wubishet , Sime Tadesse , Diriba Aboma , Gemechu Diriba 
Published: August 2023

Background: Surgical repair is one of the management strategies for obstetric fistulae, which are associated with tragic obstetric morbidities. Objective: This study assessed the proportion of repair failures and associated factors among women who underwent obstetric fistula surgery at the Mettu Hamlin Fistula Center. Design: This study is an institution-based, retrospective, cross-sectional design. Methods: This study included 385 patients who underwent obstetric fistula repair surgery at the Mettu Hamlin Fistula Center between 2015 and 2020. Participants were selected using a simple random sampling technique. EpiData version 3.1 and STATA version 14.2 were used for data entry and analysis, respectively. The association between obstetric fistula failure and independent variables was tested using binary logistic regression analysis. In the bivariable analysis, a p-value of less than 0.25 was used as a cut-off point to include variables in the multivariable logistic regression analysis. The statistical significance was finally set at a p-value of less than 0.05. Results: Of the 385 participants who underwent obstetric fistula surgical repair, about 18.2% (95% confidence interval = 14.6–22.3) failed to close. Larger fistula size (>3 cm) (adjusted odds ratio (AOR) = 4.6; 95% confidence interval = 2.34–8.91), urethral damage (adjusted odds ratio = 2.8; 95% confidence interval = 1.47–5.44), home delivery (adjusted odds ratio = 5; 95% confidence interval = 2.56–9.77), and malnutrition (body mass index <18.5 kg/m2) (adjusted odds ratio = 2.7; 95% confidence interval = 1.10–6.79) were variables significantly associated with obstetric fistula repair failure. Conclusion: Obstetric fistula repair failure was lower in the area compared to the majority, but not all, of previous findings. Home delivery, damaged urethra, larger fistula size, and lower body mass index increased the probability of repair failure. To prevent repair failure early, it is necessary to strengthen pre- and post-operative care, including the assessment of women’s nutritional status, fistula size, and urethral injury. Moreover, maternal care providers should educate mothers about the negative outcomes of home deliveries.
Incidence of resting-state functional connectivity to secondary language areas and contralateral language areas in patients with brain tumors
Authors: Young Angela L , Kundu Suprateek , Tappa Karthik K , Hou Ping , Liu Ho-Ling , Kumar Vinodh A 
Published: August 2023

Purpose Secondary language areas, including the pre-supplementary motor area (pre-SMA), dorsolateral prefrontal cortex (DLPFC), and the visual word form area (VWFA) play important roles in speech, but have been under-evaluated in the realm of resting-state (rs)-fMRI. The purpose of this study is to determine the incidence that secondary language areas and contralateral language areas can be localized using seed-based correlation (SBC) rs-fMRI. Methods We retrospectively reviewed 40 rs-fMRIs for functional connectivity (FC) to secondary language areas in cases where FC to Broca’s or Wernicke’s area near tumor in the left hemisphere were successfully generated using SBC analysis. Logistical regression was used for statistical analysis. Results SBC rs-fMRI with a seed in the left Broca’s or Wernicke’s area ipsilateral to the tumor was performed in the 40 patients. 72.5% of cases showed FC to the left DLPFC, 67.5% to left pre-SMA, and 52.5% of cases had FC to right Broca’s area. In addition to other correlations, we found older patients have a lower incidence of FC to the right Wernicke’s area when seeded from both left Broca’s and left Wernicke’s area ( p-value = .016, odds ratio = 0.94). Conclusion SBC rs-fMRI can detect left hemispheric secondary language areas as well as right hemispheric primary and secondary language areas. The left DLPFC showed the highest incidence of FC, followed by the left pre-SMA when seeded from both left Broca’s and Wernicke’s area. Logistics regression also showed in some instances, differences in the incidence of FC to language areas was dependent on age, seed location, and gender.
Augmedix Bangladesh re-humanizing healthcare service
Authors: Huda SSM Sadrul , Nazmul Shahriar Bin , Mowla Syeda Madeha , Mowla Syeda Aida 
Published: August 2023

In 2012, Stanford University graduates “Ian Shakil” and “Pelu Tan” founded Augmedix in Silicon Valley (Augmedix Remote Documentation Services, 2019). Augmedix serves patients in the United States and three other countries. One of them is Bangladesh. This case is developed to present the operational framework of Augmedix Bangladesh based on secondary sources of information. To free up doctors’ time, this app instantly documents doctor-patient talks in the patient’s medical file. Augmedix’s platform uses NLP Technology and skilled staff to ensure correct and consistent documentation. In Bangladesh, this highly skilled group goes by the name “Scribe.” Using audio and visual input, a doctor in the United States and a scribe in Bangladesh (Augmedix BD) build a patient’s medical record in real-time. Clinicians using the Augmedix Ambient Automation Platform carry out Augmedix processes. This innovation will reduce the amount of time spent by doctors manually documenting patient information. This innovative technology might save doctors two to 3 hours per day. In this service, they provide live communication, notes, data service, etc.
Republication of “Assessment of Recovery From Geriatric Ankle Fracture Using the Life Space Mobility Assessment (LSA): A Pilot Study”
Authors: Ahearn Briggs , Mueller Claire , Boden Stephanie , Mignemi Danielle , Tenenbaum Shay , Bariteau Jason 
Published: August 2023

Background: The Life Space Assessment (LSA) is a validated outcomes measure that aims to assess the level of mobility and physical functioning within one’s own environment following a medical event. We sought to study the recovery of geriatric ankle fracture patients utilizing the LSA. We hypothesized that the LSA would provide improved assessment of these patients and help identify key differences in operative and nonoperatively treated patients. Methods: Prospective observational study of geriatric patients age 65 years and older with an ankle fracture with 1-year follow-up. Operative versus nonoperative intervention was determined by the attending physician on a patient-specific basis. The LSA, Short Form–36 (SF-36), and visual analog pain scale (VAPS) were administered at predetermined intervals postinjury and scores were analyzed for significance. Results: 20 patients were enrolled in this study. 11 underwent surgery whereas 9 were treated nonoperatively. Regardless of treatment, the preinjury LSA score was 86.7. This significantly dropped to 20.6 at 6 weeks and recovered to 73.6 at 12 months. In the operative cohort, the LSA scores preinjury were 91.4 and improved to 87.6 after 1 year. The nonoperative group recorded 80.9 preinjury and only improved to 59.5 at 1 year ( P = 0.007). There was no statistically significant difference when comparing the results of the SF-36 and VAPS to the LSA. Conclusion: The LSA was effective in assessing recovery in geriatric ankle fracture patients. A severe deficit in mobility was seen for the first 6 months of recovery regardless of treatment. Operative patients ultimately returned to their baseline LSA at 1 year while nonoperative patients did not. Outcomes from the VAS and SF-36 mirrored the LSA but were not found to be statistically significant. Level of Evidence: Level II.
An adaptive multi-modal hybrid model for classifying thyroid nodules by combining ultrasound and infrared thermal images
Authors: Zhang Na , Liu Juan , Jin Yu , Duan Wensi , Wu Ziling , Cai Zhaohui , Wu Meng 
Published: August 2023

Abstract
Background
Two types of non-invasive, radiation-free, and inexpensive imaging technologies that are widely employed in medical applications are ultrasound (US) and infrared thermography (IRT). The ultrasound image obtained by ultrasound imaging primarily expresses the size, shape, contour boundary, echo, and other morphological information of the lesion, while the infrared thermal image obtained by infrared thermography imaging primarily describes its thermodynamic function information. Although distinguishing between benign and malignant thyroid nodules requires both morphological and functional information, present deep learning models are only based on US images, making it possible that some malignant nodules with insignificant morphological changes but significant functional changes will go undetected.

Results
Given the US and IRT images present thyroid nodules through distinct modalities, we proposed an Adaptive multi-modal Hybrid (AmmH) classification model that can leverage the amalgamation of these two image types to achieve superior classification performance. The AmmH approach involves the construction of a hybrid single-modal encoder module for each modal data, which facilitates the extraction of both local and global features by integrating a CNN module and a Transformer module. The extracted features from the two modalities are then weighted adaptively using an adaptive modality-weight generation network and fused using an adaptive cross-modal encoder module. The fused features are subsequently utilized for the classification of thyroid nodules through the use of MLP. On the collected dataset, our AmmH model respectively achieved 97.17% and 97.38% of F1 and F2 scores, which significantly outperformed the single-modal models. The results of four ablation experiments further show the superiority of our proposed method.

Conclusions
The proposed multi-modal model extracts features from various modal images, thereby enhancing the comprehensiveness of thyroid nodules descriptions. The adaptive modality-weight generation network enables adaptive attention to different modalities, facilitating the fusion of features using adaptive weights through the adaptive cross-modal encoder. Consequently, the model has demonstrated promising classification performance, indicating its potential as a non-invasive, radiation-free, and cost-effective screening tool for distinguishing between benign and malignant thyroid nodules. The source code is available at https://github.com/wuliZN2020/AmmH.
Characteristics and potential clinical applications of the extracellular vesicles of human pathogenic Fungi
Authors: Ullah Amir , Huang Yiyi , Zhao Kening , Hua Yuneng , Ullah Shafi , Rahman Mujeeb ur , Wang Jingyu , Wang Qian , Hu Xiumei , Zheng Lei 
Published: August 2023

AbstractExtracellular vesicles (EVs) are a heterogeneous group of lipid membrane-enclosed compartments that contain different biomolecules and are released by almost all living cells, including fungal genera. Fungal EVs contain multiple bioactive components that perform various biological functions, such as stimulation of the host immune system, transport of virulence factors, induction of biofilm formation, and mediation of host–pathogen interactions. In this review, we summarize the current knowledge on EVs of human pathogenic fungi, mainly focusing on their biogenesis, composition, and biological effects. We also discuss the potential markers and therapeutic applications of fungal EVs.