bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prenatal Androgen Excess Induces Multigenerational Effects on Female and Male Descendants
Authors: Abruzzese Giselle Adriana , Ferreira Silvana Rocio , Ferrer Maria José , Silva Aimé Florencia , Motta Alicia Beatriz 
Published: September 2023

Background: It is still unelucidated how hormonal alterations affect developing organisms and their descendants. Particularly, the effects of androgen levels are of clinical relevance as they are usually high in women with Polycystic Ovary Syndrome (PCOS). Moreover, it is still unknown how androgens may affect males’ health and their descendants. Objectives: We aimed to evaluate the multigenerational effect of prenatal androgen excess until a second generation at early developmental stages considering both maternal and paternal effects. Design And Methods: This is an animal model study. Female rats (F0) were exposed to androgens during pregnancy by injections of 1 mg of testosterone to obtain prenatally hyperandrogenized (PH) animals (F1), leading to a well—known animal model that resembles PCOS features. A control (C) group was obtained by vehicle injections. The PH-F1 animals were crossed with C males (m) or females (f) and C animals were also mated, thus obtaining 3 different mating groups: Cf × Cm, PHf × Cm, Cf × PHm and their offspring (F2). Results: F1-PHf presented altered glucose metabolism and lipid profile compared to F1-C females. In addition, F1-PHf showed an increased time to mating with control males compared to the C group. At gestational day 14, we found alterations in glucose and total cholesterol serum levels and in the placental size of the pregnant F1-PHf and Cf mated to F1-PHm. The F2 offspring resulting from F1-PH mothers or fathers showed alterations in their growth, size, and glucose metabolism up to early post-natal development in a sex-dependent manner, being the females born to F1-PHf the most affected ones. Conclusion: androgen exposure during intrauterine life leads to programing effects in females and males that affect offspring health in a sex-dependent manner, at least up-to a second generation. In addition, this study suggests paternally mediated effects on the F2 offspring development.
The impact of medical insurance on health care access and quality for people with multiple sclerosis in the United States: A scoping review
Authors: Moghavem Nuriel , Castañeda Gloria del Rosario , Chatfield Amy J , Amezcua Lilyana 
Published: September 2023

Background: In the United States, health insurance coverage and quality mediate access to health care, a key social determinant of health. Objective: To perform a scoping review regarding the impact of insurance coverage and benefit design on health care access and both clinical and quality of life outcomes in people with MS (pwMS). Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines were followed. A literature search was conducted from January 2010 to February 2022. Included studies were in English, peer-reviewed, US-based, and evaluated elements of insurance and their relationship with access and quality outcomes for adult pwMS. Results: Our search identified 1619 articles, of which 32 met inclusion criteria. Privately insured pwMS were more likely to be on disease-modifying therapy (DMT). Increased out-of-pocket spending was associated with lower DMT adherence and greater discontinuation rates. Access to specialty pharmacy programs was associated with improved DMT adherence. Conclusion: Health insurance coverage and design strongly influences health care for pwMS in the United States and may be a modifiable social determinant of health. Increased pharmaceutical cost-sharing is associated with declines in DMT utilization and adherence. Further study is needed to better characterize the impacts of other core elements of health insurance, including prior authorization requirements and step therapy.
The added effects of cold spells on stroke admissions: Differential effects on ischemic and hemorrhagic stroke
Authors: Liu Peilin , Chen Zhuangzhuang , Han Suqin , Xia Xiaoshuang , Wang Lin , Li Xin 
Published: September 2023

Background: Epidemiological evidence suggests an association between low ambient temperature and stroke risk, but available data are limited particularly on associations with different stroke subtypes. Aims: The aim of this study is to estimate the relationship between cold spells and stroke admissions, including the effect of cold spells on different stroke subtypes (ischemic stroke and intracerebral hemorrhage (ICH)). Methods: A total of 144,405 stroke admissions from the Tianjin Centre for Health and Meteorology Multidisciplinary Innovation in China, covering the period from January 2016 to December 2020, were studied, as well as meteorological and air pollutant data. A generalized additive model with a distributed lag nonlinear model was employed to assess the relationship, considering 12 different definitions of a cold spell based on various temperature thresholds and durations. The analysis controlled for lagged and nonlinear effects of temperature. Analyses were performed on all strokes as well as ischemic stroke and ICH. Results: There was a significant increase in stroke admissions during cold spells. Generally, the increased risk during cold spells increased as the temperature threshold decreased, but was not significantly affected by the duration. The optimal model was obtained using the cold-spell definition based on an average daily temperature below the 10th percentile (0.11°C) for 2 or more consecutive days. According to this model, the effect of cold spells on ischemic stroke admissions had a significant lag effect and was long-lasting, with a single-day effect occurring on lag 7d, peaking on lag 13d (relative risk (RR) = 1.05; 95% confidence interval (CI) = 1.02 to 1.09), and lasting until lag 20d. In contrast, the effect on ICH was immediate and short-lived, with the most significant single-day effect occurring on the current day (RR = 1.17; 95% CI = 1.06 to 1.29) and limited within 3 days. 14.15% of stroke cases could be attributed to cold spells, with ICH exhibiting a higher burden than ischemic stroke except for strict temperature threshold definitions. Conclusion: Cold spells are associated with an increased stroke risk. Different patterns of association were seen for different stroke subtypes. The effect on ischemic stroke had a lag effect and a longer duration, whereas the effect on ICH had an immediate effect and a shorter duration. These findings support the development and improvement of stroke cold-spell early warning systems and highlight the importance of public health interventions to mitigate the adverse health impacts of cold spells.
Assessment of atrial septal defects using 3-dimensional transthoracic echocardiography prior to percutaneous device closure: first report from Bangladesh
Authors: Saha Santosh Kumar , Ahmed Chaudhury Meshkat , Haque Tuhin , Al Mamun Mohammad Abdullah , Hussain Mohd. Zahid 
Published: September 2023

Background: Secundum atrial septal defect (ASD) is treated following trans-catheter closure in alternative to surgical treatment. Per-intervention selection of device size with balloon occlusive diameter (BOD) often cause tearing or enlarging, causing arrhythmias and hypotension. We assessed the suitability of percutaneous device closure for ASD using 3-dimensional transthoracic echocardiography (3DTTE). Objectives: This study was conducted to investigate if 3DTTE could be an alternative of balloon sizing for selection of device size in atrial septal defect device closure. Design: It was a cross-sectional comparative study. Methods: This study was conducted at the department of Pediatric Cardiology, Bangabandhu Sheikh Mujib Medical University for a period of 2 years. Thirty-three purposively selected secundum ASD patients suitable for device closure were included in the study. Ethical permission was taken from the Institutional Review Board and written consent was taken from each patient’s guardian. In this study, 3DTTE derived ASD diameter and BOD were compared with that of deployed device size using correlation analysis. Results: Out of 33 patients, 63.6% were female and 36.4% were males had a mean age of 18.07 ± 14.58 years (range 2–55 years). Mean diameter of ASD measured by 2-dimensional (2D) and 3-dimensional (3D) echocardiography were 17.09 ± 6.08 mm and 21.30 ± 6.56 mm, respectively, yielding a significant difference ( p < 0.001). 3D echocardiography derived ASDs diameter were highly correlated with device size than BOD and 2D echocardiography derived diameter (2D echocardiography: r = 0.796, p = <0.001, 3D echocardiography: r = 0.960, p = <0.001, BOD: r = 0.840, p = <0.001). Conclusion: 3DTTE can accurately measure ASD diameter and can be used as an alternate, effective, and safe method to select device size.
Loneliness in Relation to Social Factors and Self-Reported Health Among Older Adults: A Cross-Sectional Study
Authors: Axén Anna , Taube Elin , Sanmartin Berglund Johan , Skär Lisa 
Published: September 2023

Background: Loneliness is described as a public health problem and can be both a consequence of aging and a cause of ill health. Lonely older adults tend to have difficulties making new social connections, essential in reducing loneliness. Loneliness often varies over time, but established loneliness tends to persist. Maintaining good health is fundamental throughout the life course. Social connections change with aging, which can contribute to loneliness. Aim: This study aimed to investigate loneliness in relation to social factors and self-reported health among older adults. Method: A cross-sectional research design was used based on data from the Swedish National Study on Aging and Care, Blekinge (SNAC-B), from February 2019 to April 2021. Statistical analysis consisted of descriptive and inferential analysis. Results: Of n = 394 participants, 31.7% (n = 125) stated loneliness. Close emotional connections were necessary for less loneliness. Loneliness was more common among those who did not live with their spouse or partner and met more rarely. Furthermore, seeing grandchildren and neighbors less often increased loneliness, and a more extensive social network decreased loneliness. Conclusion: This study underlined the importance of social connections and having someone to share a close, emotional connection with to reduce loneliness.
An Automatized Deep Segmentation and Classification Model for Lumbar Disk Degeneration and Clarification of Its Impact on Clinical Decisions
Authors: Soydan Zafer , Bayramoglu Emru , Karasu Recep , Sayin Irem , Salturk Serkan , Uvet Huseyin 
Published: September 2023

Study Design Cross-sectional database study Objective The purpose of this study was to develop a successful, reproducible, and reliable convolutional neural network (CNN) model capable of segmentation and classification for grading intervertebral disc degeneration (IVDD), as well as quantify the network's impact on doctors' clinical decision-making. Methods 5685 discs from 1137 patients were graded separately by four experienced doctors according to the Pfirrmann classification. A ground truth (GT) was established for each disc in accordance with the decision of the majority of doctors. The U-net model is used for segmentation. 1815 discs from 363 patients were used to train and test the U-net. The Inception V3 model is employed for classification. All discs were separated into two distinct sets: 90% in a training set and 10% in a test set. The performance metrics of these models were measured. Reliability tests were performed. The impact of CNN assistance on doctors was assessed. Results Segmentation accuracy was .9597 with a .8717 Jaccard Index and a .9314 Sorensen Dice coefficient. Classification accuracy is .9346, and the F1 score is .9355. The intraclass correlation coefficient (ICC) and kappa values between CNN and GT were .95-.97. With CNN's assistance, the success rates of doctors increased by 7.9% to 22%. Conclusions The fully automated network outperformed doctors markedly in terms of accuracy and reliability. The results of CNN were comparable to those of other recent studies in the literature. It was determined that CNN’s assistance had a substantial positive effect on the doctor’s decision.
Perceived policy-related barriers to palliative care implementation: a qualitative descriptive study
Authors: Aregay Atsede , O’Connor Margaret , Stow Jill , Ayers Nicola , Lee Susan 
Published: September 2023

Background: Ethiopia has a national palliative care guideline, and palliative care is explicitly recognised in the country’s healthcare policy and health sector transformation plans. However, palliative care is not fully delivered in the regional public hospitals and primary health care units. Objective: This study explores perceived policy barriers to deliver palliative care services in rural and regional healthcare settings, which primary healthcare units largely serve. Design: Face-to-face interviews were conducted in a rural region of Ethiopia. Methods: Forty-two participants were recruited from a variety of health settings including primary, secondary and tertiary levels across the region. Interviews were conducted with policymakers from the regional health bureau, pharmacists, medical doctors, health officers (clinical officers) and nurses, including chief nursing officers in leadership roles at all levels of healthcare institutions. Data analysed using thematic analysis. Results: Participants described several barriers related to healthcare policy, including lack of government priority and focus on palliative care; lack of health professionals’ awareness of the national palliative care plans and guidelines; and lack of palliative care integration into the existing healthcare system and the national budget. Participants remarked that palliative care services in the region were mainly limited to HIV patients, often managed with external support and, hence unsustainable. Conclusions: Policy priority and focus is a fundamental component for the provision of palliative care because lack of focus and support from the government have led to inadequate access to palliative care for all in need. Hence, as participants suggested, palliative care should be integrated into all healthcare levels, particularly into the primary health care units and the health extension programme, to facilitate health extension workers to support millions living in rural areas.
Assessing the impact of palliative care admission of end-of-life cancer adults
Authors: Díez-Concha Jose F. , Gómez-García Diego Mauricio , Agudelo Julián Alberto , Lizarazo Herrera Edwin Alexander 
Published: September 2023

Background: There is evidence that early admission to the palliative care (PC) program in adult cancer patients improves symptoms management, reduces unplanned hospital admissions, minimizes aggressive cancer treatments, and enables patients to make decisions about their end-of-life (EOL) care. Objectives: This retrospective cohort study aimed to determine whether late admission to a PC program is associated with aggressive treatment at the EOL in adult patients with oncological diseases from their admission until death. Design/Methods: The study evaluated the aggressiveness in EOL management in patients with advanced stage oncological diseases who died between 2017 and 2019. The study population was divided into two groups based on the time of admission to the PC program. Aggressiveness at the EOL was measured using five criteria: treatment, hospital admission and duration, emergency department care, and/or intensive care unit utilization. Results: The study found a significant difference in the rate of aggressive EOL treatments between late admission to PC care and early admission [adjusted EOL 79.6% versus 70.4%; relative risk (RR): 1.98, 90% CI: 1.08–3.59, p: 0.061]; In the analysis of secondary variables, a significant association was observed between early admission to PC and the suspension of active treatments at the EOL, leading to a decrease in aggressiveness (77% versus 55.8%; RR: 1.38, 95% CI: 1.14–1.67, p: 0.004). Conclusion: Our findings suggest that early referral to PC services is associated with less aggressive treatment at the EOL, including suspension of active treatments.
Perception of Subtle Energy “Prana”, and Its Effects During Biofield Practices: A Qualitative Meta-Synthesis
Authors: Belal Manasa , Vijayakumar Vinu , Prasad K Nagendra , Jois Srikanth N. 
Published: September 2023

Background The idea of “life force” or “subtle pranic energy,” sometimes referred to as prana, ki, qi, vital force, and scientifically accepted as biofield, is prevalent across many cultures. Objectives This review's objective is to synthesize data from studies that looked at a range of physical, psychological, and biofield sensations while experiencing prana and receiving biofield therapies. Method We looked for qualitative, exploratory, and mixed-method studies on subtle pranic energy perceptions, as well as the physical and emotional experiences connected to biofield therapeutic procedures, through searches in 3 electronic databases, including PubMed, Web of Science, and Scopus. Based on inclusion and exclusion criteria, ninteen studies were appropriate for this review. The results were synthesized using the 6 steps of the thematic analysis approach. Results The first concept, “energy experiences,” comprises 4 themes that describe participants’ sensations of prana (awareness of temperature variation; presence of energy; physical sensation of energy; and magnetic sensation). The second concept, “positive experiences,” consists of 3 themes that describe the benefits of undergoing biofield therapy on the physical and emotional conditions of the participants (positive affective experiences; positive physical sensations; and positive valued experiences). The third concept, “experience of awareness,” describes how participants become aware of their mental activities (awareness of mental activities). Conclusion Our knowledge of perceptions and experiences related to biofield therapy is enhanced by this meta-synthesis. It gave a comprehensive picture of the enormous sensations and advantages that were felt when engaging in biofield practices.
Ferric iron in chrome-bearing spinels: implications for microprobe correction procedures
Authors: Rollinson Hugh , Adetunji Jacob 
Published: September 2023

AbstractWe investigated the compositions of a suite of 361 chrome-bearing spinels from spinel peridotites, ophiolitic mantle chromitites and from layered igneous intrusions in which the Fe2+/Fe3+ratio has been determined by Mössbauer spectroscopy. We explore the crystal-chemical controls on the distribution of Fe3+and on mineral stoichiometry with regard to electron-probe correction procedures for estimating Fe3+in spinel. We find that chrome-bearing spinels can be subdivided into three groups: a Cr–Al-rich group; a high-Fe group; and a highly oxidised group. Spinels of the Cr–Al group are found in spinel peridotites and ophiolitic mantle chromitites. They are normal spinels with a low Fe3+content and compositions that are close to stoichiometric. Spinels in the high-Fe group are found in layered igneous intrusions. They are also normal spinels which have higher concentrations of Fe3+on the octahedrally coordinated site than is found for the Cr–Al group. Stoichiometric calculations tend to overestimate the Fe3+content and their compositions do not conform to the MgO–cr# correlation found in the Cr–Al group. Spinels in the highly oxidised group are found in layered intrusions and ophiolitic mantle chromitites. They have (Fe3+/ΣFe)Möss> 0.4 and high Cr (cr# > 0.5), but relatively low Fe2+(fe# 0.24–0.56). Stoichiometric calculations tend to underestimate the Fe3+content. They represent normal spinels in which tetrahedrally coordinated Fe2+has been oxidised to Fe3+.Our data show that spinels with greater Cr and Fe are sufficiently different in their crystal chemistry from the aluminous spinels to indicate that the EPMA correction procedures developed for Fe3+in aluminous spinels on the basis of the Cr/Al ratio, and used in oxy-thermobarometry, are inappropriate for Cr-rich and Fe-rich compositions.
Eleven years of alloimmunization in 6496 patients with sickle cell disease in France who received transfusion
Authors: Floch Aline , Viret Sophie , Malard Lucile , Pakdaman Sadaf , Jouard Alicia , Habibi Anoosha , Galacteros Frédéric , François Anne , Pirenne France 
Published: September 2023

Abstract
Red blood cell (RBC) transfusion is a major therapy for sickle cell disease (SCD). Patients are at risk of forming antibodies to RBC antigens, which can result in the impossibility to find compatible units and can cause hemolytic transfusion reactions. This retrospective study investigates the evolution of RBC consumption and the frequencies, specificities, and chronology of the appearance of antibodies in a population of patients consistently receiving RH (C, D, E, c, e) and K–matched RBC units (RBCus) from a predominantly European donor population. Over the 11-year period in the Paris area, 6496 patients received transfusion at least once for a total of 239 944 units. Antibodies were made by 1742 patients. The first antibodies of a patient were predictive of subsequent immunization. By the 17th RBCu transfused (by the 20th, excluding warm autoantibodies), 75% of the patients who would make antibodies had made their first. By the 16th, 90% who would make antibodies to a high frequency antigen had made their first antibody to these antigens. Females made their first antibodies slightly earlier than males. Patients who received multiple transfusions (&gt;50 units) had a higher immunization prevalence than those who rarely received transfusion (&lt;12 units) but fewer clinically significant antibodies. Patients with SCD and prophylactic RH-K matching not immunized by the 20th RBCu are likely to have a low alloimmunization risk (to antigens other than RH-K), that is, be low responders, especially relative to the most clinically significant antibodies. This number of 20 units is a point before which close monitoring of patients is most important but remains open to future adjustment.