bluuebunny/crossref_metadata_2025_split huggingface dataset:
Unintended consequences of healthcare reform in South Korea: evidence from a regression discontinuity in time design
Authors: Kim Moon Joon 
Published: June 2023

Abstract
Background
To address concerns over the financial stability of South Korea’s National Health Insurance (NHI) programme, the government transitioned from an outpatient copayment system to a coinsurance system in 2007. This policy aimed to reduce healthcare overutilization by increasing patients’ financial responsibility for outpatient services.

Methods
Using comprehensive data on NHI beneficiaries, this study employs a regression discontinuity in time (RDiT) design to assess the policy’s impact on outpatient healthcare utilization and expenditures. We focus on changes in overall outpatient visits, average healthcare cost per visit and total outpatient healthcare expenditures.

Results
Our findings indicate that the transition from outpatient copayment to coinsurance led to a substantial increase in outpatient healthcare utilization (up to 90%) while decreasing medical expenditures per visit by 23%. The policy shift incentivized beneficiaries to seek more medical treatments during the grace period and enroll in supplemental private health insurance, which provided access to additional medical services at lower marginal costs.

Conclusions
The policy change and the emergence of supplemental private insurance contributed to moral hazard and adverse selection issues, culminating in South Korea becoming the country with the highest per capita utilization of outpatient health services worldwide since 2012. This study underscores the importance of carefully considering the unintended consequences of policy interventions in the healthcare sector.
Ogt-mediated O-GlcNAcylation inhibits astrocytes activation through modulating NF-κB signaling pathway
Authors: Dong Xiaoxue , Shu Liqi , Zhang Jinyu , Yang Xu , Cheng Xuejun , Zhao Xingsen , Qu Wenzheng , Zhu Qiang , Shou Yikai , Peng Guoping , Sun Binggui , Yi Wen , Shu Qiang , Li Xuekun 
Published: June 2023

AbstractPrevious studies have shown that Ogt-mediated O-GlcNAcylation is essential for neuronal development and function. However, the function of O-GlcNAc transferase (Ogt) and O-GlcNAcylation in astrocytes remains largely unknown. Here we show that Ogt deficiency induces inflammatory activation of astrocytes in vivo and in vitro, and impairs cognitive function of mice. The restoration of O-GlcNAcylation via GlcNAc supplementation inhibits the activation of astrocytes, inflammation and improves the impaired cognitive function of Ogt deficient mice. Mechanistically, Ogt interacts with NF-κB p65 and catalyzes the O-GlcNAcylation of NF-κB p65 in astrocytes. Ogt deficiency induces the activation of NF-κB signaling pathway by promoting Gsk3β binding. Moreover, Ogt depletion induces the activation of astrocytes derived from human induced pluripotent stem cells. The restoration of O-GlcNAcylation inhibits the activation of astrocytes, inflammation and reduces Aβ plaque of AD mice in vitro and in vivo. Collectively, our study reveals a critical function of Ogt-mediated O-GlcNAcylation in astrocytes through regulating NF-κB signaling pathway.
Utilisation of traditional healers among older people living with HIV in South Africa: a WHO SAGE well-being of older people study
Authors: Okyere Joshua , Ayebeng Castro , Owusu Bernard Afriyie , Agbemavi Wonder , Amoako Joseph Kwarteng , Dickson Kwamena Sekyi 
Published: June 2023

Abstract
Background
Within the African region, there are an estimated 8 million people living with HIV (PLHIV) in South Africa. Seeking healthcare services from traditional healers (TH) is one of the alternative and complementary approaches to HIV/AIDS treatment. Identifying the associated factors of TH utilisation among older PLHIV is crucial in developing healthcare interventions that cater to the unique needs of this vulnerable group. This study investigated the factors associated with TH utilisation among older PLHIV.

Methods
We studied 516 older PLHIV using data from the WHO SAGE Well-Being of Older People Study (2011–2013). Chi-square, bivariate and multivariate logistic regression were computed in STATA Version 14. The results were presented with both crude and adjusted odds ratio (AOR) and at 95% confidence interval (CI).

Results
Of the 516 participants, 15.89% utilised TH. The major reason for TH utilisation among older PLHIV was the perception of receiving better healthcare services from TH (51.2%) and the flexibility to pay with goods instead of money (14.6%). The factors associated with TH utilisation were age [AOR = 0.05; CI  0.01, 0.37], being hypertensive [AOR = 2.07; CI  1.04, 4.11], and having more than four servings of fruits [AOR = 10.64; CI  2.95, 38.34]. TH utilisation was significantly lower among those who visited the clinic once or twice [AOR = 0.17; CI  0.05, 0.63], three to six times [AOR = 0.16; CI  0.05, 0.56], and more than 6 times [AOR = 0.09; CI  0.03, 0.34] compared to those who had no clinic visits.

Conclusion
In conclusion, a low proportion of TH utilisation was reported among older PLHIV in South Africa. TH utilisation is associated with age, hypertension status, frequency of clinic visits and fruit servings consumed. Our study suggests that being hypertensive was a motivating factor for older PLHIV to utilise TH. Therefore, it is imperative for the South African health department to integrate the services of TH into the mainstream health system to manage non-communicable diseases, particularly hypertension, among older PLHIV.
Prognostic model on overall survival in elderly nasopharyngeal carcinoma patients: a recursive partitioning analysis identifying pre-treatment risk stratification
Authors: Li Ying , Weng Youliang , Huang Zongwei , Pan Yuhui , Cai Sunqin , Ding Qin , Wu Zijie , Chen Xin , Lu Jun , Hu Dan , Qiu Sufang 
Published: June 2023

Abstract
Background
We aimed to evaluate the optimal management for elderly patients with nasopharyngeal carcinoma (NPC) with intensity-modulated radiotherapy (IMRT).

Methods
A total of 283 elderly patients with NPC diagnosed from 2015 to 2019 were enrolled in the study. Overall survival (OS) was the primary endpoint. Univariate and multivariate Cox regression analyses were preformed to identify potential prognostic factors. The recursive partitioning analysis (RPA) was used for risk stratification. Kaplan-Meier survival curves were applied to evaluate the survival endpoints, and log-rank test was utilized to assess differences between groups. The prognostic index (PI) was constructed to further predict patients’ prognosis displayed by nomogram model. The area under the receiver operating characteristic (ROC) curves (AUC) and the calibration curves were applied to assess the effectiveness of the model.

Results
Based on RPA-based risk stratification, we demonstrated that elderly NPC patients who were treated with IC followed by RT had similar OS as those with induction chemotherapy (IC) combined with concurrent chemoradiotherapy (CCRT) in the middle- (stage I-III and pre-treatment EBV > 1840 copies/ml) and high-risk groups (stage IVA). IMRT alone may be the optimal treatment option for the low-risk group (stage I-III with pre-treatment EBV ≤ 1840 copies/ml). We established an integrated PI which was indicted with stronger prognostic power than each of the factors alone for elderly NPC patients (The AUC of PI was 0.75, 0.80, and 0.82 for 1-, 3-, 5-year prediction of OS, respectively).

Conclusion
We present a robust model for clinical stratification which could guide individual therapy for elderly NPC patients.
Three techniques for the determination of perindopril through derivatization with 4-chloro-7-nitrobenzo-2-oxa-1,3-diazole
Authors: Askar H. , Metwally Mohammed E.-S. , Tolba M. M. , Ali Fatma A. , Fathy M. E. 
Published: June 2023

AbstractIn addition to its pure form, three accurate, rapid, and simple methods have been established for determining perindopril (PRD) in its tablet form. At pH 9.0 using a borate buffer, developing the three designated methods was successful according to the reaction between PRD and 4-chloro-7-nitrobenzo-2-oxa-1,3-diazole (NBD-Cl) and the formation of a chromogen (with a yellow color) measurable at 460 nm using the spectrophotometric method (Method I). In addition, the produced chromogen was assessed using the spectrofluorimetric method (Method II) at 535 nm following excitation at 461 nm. Afterward, the same reaction product was separated and determined using the HPLC method with fluorescence detection (Method III). A Promosil C18stainless steel column (Q7 5 mm particle size, 250–4.6 mm) has proven suitable for separation. The mobile phase adjustment was made at pH 3.0, with a 1.0 mL min−1flow rate; its composition was methanol-sodium dihydrogen phosphate, 0.02 M (60: 40, v/v). Through concentration ranges of 5.0–60.0, 0.5–6.0, and 1.0–10.0 μg mL−1, the calibration curves were rectilinear for Methods I, II, and III, respectively, with limits of quantification (LOQ) of 1.08, 0.16 and 0.19 μg mL−1as well as limits of detection (LOD) of 0.36, 0.05 and 0.06 μg mL−1. The developed methods were implemented to estimate PRD in tablets, and a comparison between the obtained outcomes utilizing the developed methods as well as obtained from the official method revealed that they were comparable. The official BP method was based on dissolving PRD in anhydrous acetic acid and titrating with 0.1 M perchloric acid, then the potentiometric determination of the end-point. The designated methods were also implemented in content uniformity testing with satisfying results. The reaction pathway proposal was speculated, and according to ICH Guidelines, the statistical evaluation of the data was performed. The three proposed methods were confirmed to be green, eco-friendly and safe to environment using Green Analytical procedure index (GAPI) method.
Metabolic Dysfunction-associated fatty liver disease and incident heart failure risk: the Kailuan cohort study
Authors: Wei Zhihao , Huang Zhe , Song Zongshuang , Zhao Wenliu , Zhao Dandan , Tan Yizhen , Chen Shuohua , Yang Peng , Li Yun , Wu Shouling 
Published: June 2023

Abstract
Background
Recently, metabolic dysfunction-associated fatty liver disease (MAFLD) has been proposed to replace non-alcoholic fatty liver disease (NAFLD) to emphasize the pathogenic association between fatty liver disease and metabolic dysfunction. Studies have found that MAFLD independently increases the risk of myocardial infarction and stroke. But the relationship between MAFLD and heart failure (HF) is not fully understood.

Objectives
This study aimed to explore the association between MAFLD and the risk of HF.

Methods
The study included 98,685 participants without HF selected from the Kailuan cohort in 2006. All participants were divided into non-MAFLD group and MAFLD group according to MAFLD diagnostic criteria. After follow-up until December 31, 2020, the Cox regression analysis model was used to calculate the effect of MAFLD on the risk of HF.

Results
During the median follow-up of 14.01 years,3260 cases of HF were defined, the HF incidence density of non-MAFLD group and MAFLD group was 2.19/1000pys and 3.29/1000pys, respectively. Compared with the non-MAFLD group, participants with MAFLD had an increased risk of HF (HR: 1.40, 95% CI: 1.30–1.50); in addition, an exacerbation of fatty liver disease was associated with an increased risk of HF in people with MAFLD. We also observed a higher risk of HF among the different metabolic dysfunction of MAFLD in people with both fatty liver disease and type 2 diabetes (HR, 1.95; 95% CI, 1.73–2.20).

Conclusions
Our findings suggest that the risk of HF was significantly increased in participants with MAFLD, and an exacerbation of fatty liver disease was associated with an increased risk of HF in people with MAFLD. In addition, we should pay more attention to people with MAFLD with type 2 diabetes.
Acrolein adducts and responding autoantibodies correlate with metabolic disturbance in Alzheimer’s disease
Authors: Sanotra Monika Renuka , Kao Shu-Huei , Lee Ching-Kuo , Hsu Chun-Hsien , Huang Wen-Chung , Chang Tsuei-Chuan , Tu Fang-Yu , Hsu I-Uen , Lin Yung-Feng 
Published: June 2023

Abstract
Background
Alzheimer’s disease (AD) is caused by many intertwining pathologies involving metabolic aberrations. Patients with metabolic syndrome (MetS) generally show hyperglycemia and dyslipidemia, which can lead to the formation of aldehydic adducts such as acrolein on peptides in the brain and blood. However, the pathogenesis from MetS to AD remains elusive.

Methods
An AD cell model expressing Swedish and Indiana amyloid precursor protein (APP-Swe/Ind) in neuro-2a cells and a 3xTg-AD mouse model were used. Human serum samples (142 control and 117 AD) and related clinical data were collected. Due to the involvement of MetS in AD, human samples were grouped into healthy control (HC), MetS-like, AD with normal metabolism (AD-N), and AD with metabolic disturbance (AD-M). APP, amyloid-beta (Aß), and acrolein adducts in the samples were analyzed using immunofluorescent microscopy, histochemistry, immunoprecipitation, immunoblotting, and/or ELISA. Synthetic Aß1-16 and Aß17-28 peptides were modified with acrolein in vitro and verified using LC–MS/MS. Native and acrolein-modified Aß peptides were used to measure the levels of specific autoantibodies IgG and IgM in the serum. The correlations and diagnostic power of potential biomarkers were evaluated.

Results
An increased level of acrolein adducts was detected in the AD model cells. Furthermore, acrolein adducts were observed on APP C-terminal fragments (APP-CTFs) containing Aß in 3xTg-AD mouse serum, brain lysates, and human serum. The level of acrolein adducts was correlated positively with fasting glucose and triglycerides and negatively with high-density lipoprotein-cholesterol, which correspond with MetS conditions. Among the four groups of human samples, the level of acrolein adducts was largely increased only in AD-M compared to all other groups. Notably, anti-acrolein-Aß autoantibodies, especially IgM, were largely reduced in AD-M compared to the MetS group, suggesting that the specific antibodies against acrolein adducts may be depleted during pathogenesis from MetS to AD.

Conclusions
Metabolic disturbance may induce acrolein adduction, however, neutralized by responding autoantibodies. AD may be developed from MetS when these autoantibodies are depleted. Acrolein adducts and the responding autoantibodies may be potential biomarkers for not only diagnosis but also immunotherapy of AD, especially in complication with MetS.
PFDI: a precise fruit disease identification model based on context data fusion with faster-CNN in edge computing environment
Authors: Dhiman Poonam , Manoharan Poongodi , Lilhore Umesh Kumar , Alroobaea Roobaea , Kaur Amandeep , Iwendi Celestine , Alsafyani Majed , Baqasah Abdullah M. , Raahemifar Kaamran 
Published: June 2023

AbstractFruits significantly impact everyday living, i.e., Citrus fruits. Numerous fruits have a solid nutritious value and are packed with multivitamins and trace components. Citrus fruits are delicate and susceptible to many diseases and infections. Many researchers have suggested deep and machine learning-based fruit disease detection and classification models. This research presents a precise fruit disease identification model based on context data fusion with Faster-CNN in an edge computing environment. The goal is to develop an accurate, efficient, and trustable fruit disease detection model, a critical component of autonomous food production in a robotic edge platform. This research examines and explores four different diseases of Citrus fruits using CNN deep learning models to be adopted as edge computing solutions. Identification of citrus diseases such as cankers black spot, greening, scab, melanosis, and healthy citrus fruits are implemented using the proposed sequential model without pruning, with pruning having different sparsity levels followed by post quantization. Through the transfer learning method, this model is optimized for the assignment of fruit disease detection employing visuals from two patterns: Near-infrared (NIFR) and RGB. Early and late data fusion techniques for integrating multi-model (NIFR and RGB) facts are evaluated. The accuracy obtained from the proposed model for the canker disease is 97%, scab 95%, melanosis 99%, Greening 97%, Black spot 97% and healthy 97%. In this paper, the results of the proposed model are compared and evaluated with the sparsity levels of 50–80%, 60–90%, 70–90%, and 80–90% pruning and also obtained the results of post-quantization on each level. The results show that the model size with 60–90% pruning can be counteracted to the 47.64 of the baseline model without significant loss of accuracy. Moreover, post-quantization can reduce the 60–90% pruning from 28.16 to 8.72. In addition to enhanced precision, the above initiative is much faster to implement for new fruit diseases because it needs bounding box annotation instead of pixel-level annotation.
Realist review of community coalitions and outreach interventions to increase access to primary care for vulnerable populations: a realist review
Authors: Welch Vivian , Pottie Kevin , Gaudet Caroline , Thuku Micere , Mallard Ryan , Spenceley Shannon , Amjed Nida , Wadhwani Arpana , Ghogomu Elizabeth , Scott Cathie , Dahrouge Simone ,   The IMPACT Team
Published: June 2023

Abstract
Background
There are meaningful gaps in equitable access to Primary Health Care (PHC), especially for vulnerable populations after widespread reforms in Western countries. The Innovative Models Promoting Access-to-Care Transformation (IMPACT) research program is a Canadian-Australian collaboration that aims to improve access to PHC for vulnerable populations. Relationships were developed with stakeholders in six regions across Canada and Australia where access-related needs could be identified. The most promising interventions would be implemented and tested to address the needs identified. This realist review was conducted to understand how community coalition and outreach (e.g., mobile or pop-up) services improve access for underserved vulnerable residents.

Objective
To inform the development and delivery of an innovative intervention to increase access to PHC for vulnerable populations.

Methods
A realist review was conducted in collaboration with the Local Innovative Partnership (LIP) research team and the IMPACT research members who conducted the review. We performed an initial comprehensive systematic search using MEDLINE, EMBASE, PsycINFO, and the Cochrane Library up to October 19, 2015, and updated it on August 8, 2020. Studies were included if they focused on interventions to improve access to PHC using community coalition, outreach services or mobile delivery methods. We included Randomized Controlled Trials (RCTs), and systematic reviews. Studies were screened by two independent reviewers and the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used for data extraction and framework analysis to obtain themes. The LIP research team was also allowed to suggest additional papers not included at screening.

Results
We included 43 records, comprising 31 RCTs, 11 systematic reviews, and 1 case control study that was added by the LIP research team. We identified three main themes of PHC interventions to promote access for vulnerable residents, including: 1) tailoring of materials and services decreases barriers to primary health care, 2) services offered where vulnerable populations gather increases the “reach” of the interventions, 3) partnerships and collaborations lead to positive health outcomes. In addition, implementation designs and reporting elements should be considered.

Conclusion
Realist reviews can help guide the development of locally adapted primary health care interventions.
Exploring the effects of gender and sexual orientation on disordered eating: an EFA to CFA study of the Eating Disorder Examination Questionnaire
Authors: Knight Ruth , Preston Catherine 
Published: June 2023

AbstractSeveral problems limit our understanding of the ways that gender and sexual orientation influence disordered eating. These include the reliance on measures that have been developed and validated in samples of cisgender heterosexual women, and the lack of confirmed measurement invariance that allows us to meaningfully compare these experiences between groups. This study was an EFA to CFA exploration of the Eating Disorder Examination Questionnaire in a group of heterosexual, bisexual, gay, and lesbian men and women. In total 1638 participants were recruited via adverts in traditional and social media to complete an online survey. A 14-item, three-factor model of the EDE-Q was confirmed as best fitting the data and measurement invariance between groups was ascertained. Sexual orientation influenced disordered eating and muscularity-related thoughts and behaviours in men but not women. Heterosexual men reported more muscularity-related concerns and behaviours, whereas gay men showed more thinness-related concerns and behaviours. Bisexual participants showed a different pattern, highlighting the importance of treating this group individually and not collating all non-heterosexual participants together. Small but significant effects of sexual orientation and gender have an impact on the kinds of disordered eating thoughts and behaviours one might experience, and could influence prevention and treatment. Clinicians may be able to provide more effective and tailored interventions by taking into account gender and sexual orientation in sensitive ways.
Human VDAC pseudogenes: an emerging role for VDAC1P8 pseudogene in acute myeloid leukemia
Authors: Pappalardo Xena Giada , Risiglione Pierpaolo , Zinghirino Federica , Ostuni Angela , Luciano Daniela , Bisaccia Faustino , De Pinto Vito , Guarino Francesca , Messina Angela 
Published: June 2023

Abstract
Background
Voltage-dependent anion selective channels (VDACs) are the most abundant mitochondrial outer membrane proteins, encoded in mammals by three genes, VDAC1, 2 and 3, mostly ubiquitously expressed. As 'mitochondrial gatekeepers', VDACs control organelle and cell metabolism and are involved in many diseases. Despite the presence of numerous VDAC pseudogenes in the human genome, their significance and possible role in VDAC protein expression has not yet been considered.

Results
We investigated the relevance of processed pseudogenes of human VDAC genes, both in physiological and in pathological contexts. Using high-throughput tools and querying many genomic and transcriptomic databases, we show that some VDAC pseudogenes are transcribed in specific tissues and pathological contexts. The obtained experimental data confirm an association of the VDAC1P8 pseudogene with acute myeloid leukemia (AML).

Conclusions
Our in-silico comparative analysis between the VDAC1 gene and its VDAC1P8 pseudogene, together with experimental data produced in AML cellular models, indicate a specific over-expression of the VDAC1P8 pseudogene in AML, correlated with a downregulation of the parental VDAC1 gene.