bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fast-Access Multidisciplinary Approach to Management of Diabetic Foot Ulcers: The Diabetic Rapid Evaluation and Lower Limb Amputation Management (DREAM) Clinic
Authors: Tang Fengjie , Abdul Razak Siti Nurfarahdillah Binte , Tan Jerilyn Xiling , Choke Edward Tieng Chek , Zainudin Sueziani Binte 
Published: September 2023

Background: Diabetic foot ulcers (DFUs) are debilitating to the patient and costly for the healthcare system. We set up the Diabetic Rapid Evaluation and lower limb Amputation Management (DREAM) clinic with the aim of providing early directed specialist care to patients with DFUs. With early management, we hope to treat DFUs in its early stages, reducing the need for and associated morbidity of major and minor lower limb amputations. Objectives: We evaluated the outcomes of the fast-access DREAM clinic with multi-disciplinary evaluation for patients with DFUs. Outcomes include time from the point of referral to DREAM clinic evaluation, amputation rates and wound healing rates. Design; Patients presenting with DFU to the DREAM clinic were enrolled. A podiatrist made the first assessment, followed by immediate specialist consultation with Endocrinologists, Vascular surgeons or Orthopaedic surgeons as required. Methods: Data on baseline demographics and DFU characteristics were collected. Outcomes evaluated were wound healing at 12 weeks, wound salvage rates, time to DREAM clinic access and time to specialist referral. Results: Sixty-eight patients were enrolled, with 57.3% males, and mean age of 63 ± 13.0 years. Majority of ulcers were classified as neuropathic (41.3%) and located at the digits (40%). At 12-weeks follow-up, 1 had undergone major amputation, 9 minor amputations and 4 surgical debridements. The median time to DREAM clinic evaluation from first presentation was 3 days (IQR 7). Eleven (16.2%) required >1 specialist consult. Twenty (29.4%) were hospitalised for treatment. Twelve underwent revascularisation within 4 days (IQR 3.5). Twenty-four patients (35.3%) continued podiatry follow-up, having 28 DFUs in which 20 (71.4%) healed within 12 weeks. Conclusion: The fast-access multidisciplinary DREAM clinic shows promising outcomes with lower major amputation rates and exemplary DFU healing outcomes.
Abnormal functional connectivity in radiologically isolated syndrome: A resting-state fMRI study
Authors: Benito-León Julián , del Pino Ana Belén , Aladro Yolanda , Cuevas Constanza , Domingo-Santos Ángela , Galán Sánchez-Seco Victoria , Labiano-Fontcuberta Andrés , Gómez-López Ana , Salgado-Cámara Paula , Costa-Frossard Lucienne , Monreal Enrique , Sainz de la Maza Susana , Matías-Guiu Jordi A , Matías-Guiu Jorge , Delgado-Álvarez Alfonso , Montero-Escribano Paloma , Martínez-Ginés María Luisa , Higueras Yolanda , Ayuso-Peralta Lucía , Malpica Norberto , Melero Helena 
Published: September 2023

Background: Radiologically isolated syndrome (RIS) patients might have psychiatric and cognitive deficits, which suggests an involvement of major resting-state functional networks. Notwithstanding, very little is known about the neural networks involved in RIS. Objective: To examine functional connectivity differences between RIS and healthy controls using resting-state functional magnetic resonance imaging (fMRI). Methods: Resting-state fMRI data in 25 RIS patients and 28 healthy controls were analyzed using an independent component analysis; in addition, seed-based correlation analysis was used to obtain more information about specific differences in the functional connectivity of resting-state networks. Participants also underwent neuropsychological testing. Results: RIS patients did not differ from the healthy controls regarding age, sex, and years of education. However, in memory (verbal and visuospatial) and executive functions, RIS patients’ cognitive performance was significantly worse than the healthy controls. In addition, fluid intelligence was also affected. Twelve out of 25 (48%) RIS patients failed at least one cognitive test, and six (24.0%) had cognitive impairment. Compared to healthy controls, RIS patients showed higher functional connectivity between the default mode network and the right middle and superior frontal gyri and between the central executive network and the right thalamus ( pFDR < 0.05; corrected). In addition, the seed-based correlation analysis revealed that RIS patients presented higher functional connectivity between the posterior cingulate cortex, an important hub in neural networks, and the right precuneus. Conclusion: RIS patients had abnormal brain connectivity in major resting-state neural networks and worse performance in neurocognitive tests. This entity should be considered not an “incidental finding” but an exclusively non-motor (neurocognitive) variant of multiple sclerosis.
Depression symptoms and cognition in multiple sclerosis: Longitudinal evidence of a specific link to executive control
Authors: Anderson Jordyn R , Fitzgerald Kathryn C , Murrough James W , Katz Sand Ilana B , Sorets Tali R , Krieger Stephen C , Riley Claire S , Fabian Michelle T , Sumowski James F 
Published: September 2023

Background: Depression symptoms are prevalent in multiple sclerosis (MS) and associated with poorer cognition in cross-sectional studies; it is unknown whether changes in depression symptoms track with cognitive changes longitudinally. Objective: Investigate whether changes in depression symptoms correspond with cognitive changes over time in MS, and identify specific cognitive functions related to depression symptoms. Method: Persons with early relapse-onset MS ( n = 165) completed a depression questionnaire (Beck Depression Inventory FastScreen) and tests of cognitive speed, executive control, and memory at baseline and 3-year follow-up. One-way ANOVAs assessed differences in cognitive change across participants with worsened, stable, or improved depression symptoms from baseline to year 3. Results: Change in depression symptoms was related to change in executive control ( p = 0.001, ηp2 = 0.08; worsened mood with worsened executive control; improved mood with improved executive control), even when adjusting for cognitive speed ( p = 0.002, ηp2 = 0.08). There were no links to cognitive speed ( p = 0.826) or memory ( p = 0.243). Regarding individual depression symptoms, executive control was related to loss of pleasure and suicidal thoughts. Conclusions: Executive control tracks with depression symptoms, raising hope that management of mood may improve executive control. The specific link between executive control and anhedonia implicates dysfunctional reward processing as a key component of MS depression.
Is Okun’s Law Valid in Bangladesh? A Time Series Analysis
Authors: Sakib Arfanul Ibna Mustafa 
Published: September 2023

Using the data from 1991 to 2019, this study attempts to verify Okun’s law by utilizing both ‘The difference and the dynamic versions’ of Okun’s law in Bangladesh and tries to find the value of Okun’s coefficient. The autoregressive-distribution lag (ARDL) bounds test is applied to determine the existence of a long-term relationship between the variables, and then the ordinary least squares (OLS) approach is used to estimate the findings. The findings show that Okun’s coefficient is –0.058 for the difference version of Okun’s law, which is statistically insignificant. In addition, for the dynamic version of Okun’s law, findings show that the effect of the ‘immediate past economic growth rate’ on ‘current change in the unemployment rate’ is 0.15, and it is statistically insignificant too. However, the effect of the ‘current economic growth rate’ on ‘current change in the unemployment rate’ is –0.22, and it is statistically significant at 10% significance level. In both versions of Okun’s law, R2 values, F-statistic and cumulative sum of squares show the instability of the models. Due to statistically insignificant coefficients and model instability, it can be concluded that Okun’s law is invalid in Bangladesh. JEL Codes: E24, C22, B23, C87
Artificial intelligence for treatment planning and soft tissue outcome prediction of orthognathic treatment: A systematic review
Authors: Salazar Daisy , Rossouw Paul Emile , Javed Fawad , Michelogiannakis Dimitrios 
Published: September 2023

Background: The accuracy of artificial intelligence (AI) in treatment planning and outcome prediction in orthognathic treatment (OGT) has not been systematically reviewed. Objectives: To determine the accuracy of AI in treatment planning and soft tissue outcome prediction in OGT. Design: Systematic review. Data sources: Unrestricted search of indexed databases and reference lists of included studies. Data selection: Clinical studies that addressed the focused question ‘Is AI useful for treatment planning and soft tissue outcome prediction in OGT?’ were included. Data extraction: Study screening, selection and data extraction were performed independently by two authors. The risk of bias (RoB) was assessed using the Cochrane Collaboration’s RoB and ROBINS-I tools for randomised and non-randomised clinical studies, respectively. Data synthesis: Eight clinical studies (seven retrospective cohort studies and one randomised controlled study) were included. Four studies assessed the role of AI for treatment decision making; and four studies assessed the accuracy of AI in soft tissue outcome prediction after OGT. In four studies, the level of agreement between AI and non-AI decision making was found to be clinically acceptable (at least 90%). In four studies, it was shown that AI can be used for soft tissue outcome prediction after OGT; however, predictions were not clinically acceptable for the lip and chin areas. All studies had a low to moderate RoB. Limitations: Due to high methodological inconsistencies among the included studies, it was not possible to conduct a meta-analysis and reporting biases assessment. Conclusion: AI can be a useful aid to traditional treatment planning by facilitating clinical treatment decision making and providing a visualisation tool for soft tissue outcome prediction in OGT. Registration: PROSPERO CRD42022366864.
Visual Exploration While Walking With and Without Visual Cues in Parkinson’s Disease: Freezer Versus Non-Freezer
Authors: Graham Lisa , Armitage Jordan , Vitorio Rodrigo , Das Julia , Barry Gill , Godfrey Alan , McDonald Claire , Walker Richard , Mancini Martina , Morris Rosie , Stuart Samuel 
Published: September 2023

Background Visual cues can improve gait in Parkinson’s disease (PD), including those experiencing freezing of gait (FOG). However, responses are variable and underpinning mechanisms remain unclear. Visuo-cognitive processing (measured through visual exploration) has been implicated in cue response, but this has not been comprehensively examined. Objective To examine visual exploration and gait with and without visual cues in PD who do and do not self-report FOG, and healthy controls (HC). Methods 17 HC, 21 PD without FOG, and 22 PD with FOG walked with and without visual cues, under single and dual-task conditions. Visual exploration (ie, saccade frequency, duration, peak velocity, amplitude, and fixation duration) was measured via mobile eye-tracking and gait (ie, gait speed, stride length, foot strike angle, stride time, and stride time variability) with inertial sensors. Results PD had impaired gait compared to HC, and dual-tasking made gait variables worse across groups (all P < .01). Visual cues improved stride length, foot strike angle, and stride time in all groups ( P < .01). Visual cueing also increased saccade frequency, but reduced saccade peak velocity and amplitude in all groups ( P < .01). Gait improvement related to changes in visual exploration with visual cues in PD but not HC, with relationships dependent on group (FOG vs non-FOG) and task (single vs dual). Conclusion Visual cues improved visual exploration and gait outcomes in HC and PD, with similar responses in freezers and non-freezers. Freezer and non-freezer specific associations between cue-related changes in visual exploration and gait indicate different underlying visuo-cognitive processing within these subgroups for cue response.
Combined Pericapsular Nerve Group Block and Intrapelvic Lateral Femoral Cutaneous Nerve Block Is Associated With Decreased Opioid Consumption After Hip Arthroscopy: A Retrospective Cohort Study
Authors: Kim David H. , Hong Genewoo , Lin Edward , Kim Sang Jo , Beathe Jonathan , Wetmore Douglas , Liu Jiabin 
Published: September 2023

Introduction: Ambulatory hip arthroscopies are associated with moderate-to-severe pain often requiring opioid analgesia. Novel motor-sparing blocks, the pericapsular nerve group (PENG) and lateral femoral cutaneous nerve (LFCN) block, have shown efficacy in hip surgery. Purpose: We sought to investigate the analgesic benefits of these novel blocks in terms of opioid-sparing and discharge efficiency. Methods: We conducted a retrospective cohort study with propensity score matching of 224 patients who underwent ambulatory elective unilateral hip arthroscopy. One group received a combined PENG and LFCN block (PENG/LFCN, n = 86), while a second group received only a PENG block (n = 26). A control group (n = 112) received no blocks. The primary outcome was postanesthesia care unit (PACU) mean opioid consumption. Secondary outcomes were maximum numeric rating scale (NRS) pain score, intravenous rescue analgesia, and PACU readiness-for-discharge times. Results: The PENG/LFCN-block group required significantly less opioids than the control group in the PACU (25.98 ± 13.04 vs 14.58 ± 5.77, respectively) and were discharged earlier 2.72 ± 1.16 vs 4.42 ± 1.63 hours, respectively). The combined PENG/LFCN group also used less intravenous rescue opioids than the control group (0.47 ± 1.18 vs 1.44 ± 2.1 mg, respectively) and showed a significant difference in the highest NRS pain scores than the control group (6.01 ± 2.38 vs 6.77 ± 2.1 respectively). The PENG block alone group did not show a significant difference in opioid reduction (21.95 ± 15.83 vs 27.72 ± 15.01, respectively). Conclusions: This retrospective study found that in patients who underwent ambulatory elective unilateral hip arthroscopy, a combined PENG and LFCN block was associated with expedited PACU discharge and a clinically significant reduction in postoperative opioid use. Further study is warranted.
Changes in anticoagulation practice in subjects admitted with stroke associated with atrial fibrillation, following introduction of direct oral anticoagulants over 2013–2021
Authors: Harbison Joseph , McCormack Joan , Brych Olga , Collins Ronan , O’Connell Niamh , Randles Mary , Kennedy Cormac , Kelly Peter J , Cassidy Tim 
Published: September 2023

Background: The adoption of direct oral anticoagulants (DOACs) has changed practice in prevention of stroke in atrial fibrillation (AF). We used Irish data national data on stroke and anticoagulation therapy over 9 years to investigate changes in anticoagulation practice and potential consequences on stroke prevalence and thrombolysis. Methods: AF, anticoagulation, thrombolysis, and stroke data from the Irish National Audit of Stroke (INAS) 2013–2021 were reviewed. The proportion of patients with ischemic stroke (IS) and intracerebral hemorrhage (IH) with known AF admitted on anticoagulation was determined. Effects on age distribution in the population and thrombolysis practice were assessed. Results: AF data were available on 34,630 of 35,241 individuals (98.3%) included in INAS; median age was 74 years and 56% were male. AF was found in 10,016 (28.9%, 9059 IS, 957 IH). 6313 had known AF prior to stroke (63.1%). The proportion all total IS due to AF decreased by 15.3% (31.3%−26.5%, chi-square = 24.6, p < 0.0001). The proportion of IH did not change significantly (21.6%–20.2%, chi-square = 1.8, p = 0.18). Over the 9 years, 3875 (38.6%) of the subjects with AF were recorded as receiving anticoagulants at admission. In 2013, 4.4% of AF-associated strokes were admitted on a DOAC and 21.4% on warfarin; by 2021, 44.1% were receiving a DOAC and 6.2% warfarin. There was a strong inverse correlation between the proportion of anticoagulated stroke patients and the total proportion of AF-associated strokes over time (r = −0.82, p = 0.006). In contrast, no correlation was found between increasing DOAC usage and IH (r = 0.14, p = 0.71). Increased anticoagulation usage correlated with a reduction in patients ⩾ 80 years (r = −0.83, p = 0.006) and also correlated with a relative reduction of 30.1% in subjects thrombolysed <4 h from onset (r = −0.89, p = 0.001) Conclusion: DOACs have led to increased use of anticoagulation, but warfarin use fell by two-thirds. There has been a reduction in the proportion of AF-associated IS without a noticeable increase in IH. Increased anticoagulation correlated with reduced numbers of strokes in those >80 years and in the proportion of patients thrombolysed.
Alterations of erythropoiesis in Covid-19 patients: prevalence of positive Coombs tests and iron metabolism
Authors: Schmitz Léa , Pirotte Michelle , Lebeau Alizée , Ernst Marie , Fillet Marianne , Devey Anais , Schmitt Justine , Cobraiville Gaël , Binsfeld Marilène , Gofflot Stéphanie , Beguin Yves , Vertenoeil Gaëlle 
Published: September 2023

Background: For more than 2 years medical practice has been dealing with the Covid-19 pandemic. Atypical symptoms, such as frostbites and acrosyndromes, have appeared, and autoimmune anemias (some of which with cold agglutinins) have been described. Objectives: We planned to study the prevalence of positive direct Coombs tests (DCTs) and hemolytic autoimmune anemia in patients infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and its correlation with complications, and then investigate the impact of the infection on iron metabolism. Design: This is an observational, cross-sectional, single-center, exploratory study. Methods: We obtained Coombs tests in a population of 179 infected patients at the CHU of Liège. We then studied iron metabolism in some of these patients, by measuring serum ferritin, erythropoietin (EPO), erythroferrone and hepcidin. Results: We did not identify any case of autoimmune hemolysis. However, there was a 20.3% prevalence of positive DCT, mainly with IgG (91.7%). These patients, compared to DCT-negative patients, were not only more anemic and transfused, but also required more transfers to intensive care units and had longer hospital stays and mechanical ventilation. The pattern of anemia was consistent with the anemia of inflammation, showing elevated hepcidin and ferritin levels, while EPO and erythroferrone values were lower than expected at this degree of anemia. Erythroferrone was higher and Hb was lower in DCT-positive patients. Finally, we identified a correlation between iron parameters and complicated forms of infection. Conclusion: Covid-19 patients suffered from inflammatory anemia with more severe forms of infection correlated to positive DCT status. This could potentially be of interest for future clinical practice.
Population-based assessment of the burden of COVID-19 infection in African countries: a first-year report card and public health implications
Authors: Mgbere Osaro , Nwabuko Ogbonna Collins , Olateju Olajumoke A. , Adepoju Omolola E. , Liaw Winston , Darkoh Charles , Essien Ekere James 
Published: September 2023

Background: The COVID-19 pandemic constitutes a global health threat and poses a major burden on the African continent. We assessed the real-world burden of COVID-19 infection in African Union (AU) member states to determine the distributional patterns of epidemiological measures during the first 1 year of the pandemic. Methods: This retrospective cross-sectional study utilized COVID-19 data from publicly available data repositories of the African Center for Disease Control and Prevention and Our World in Data for the period February 2020 to January 2021. AU member states were classified into low, medium, and high burdens based on COVID-19 morbidity. We conducted descriptive and inferential analyses of COVID-19-reported cases, deaths, recoveries, active cases, COVID-19 tests, and epidemiological measures that included morbidity and mortality rates, case fatality rate (CFR), and case ratios. Results: A total of 3.21 million cases were reported during the 1-year period, with 2.6 million recoveries, 536,784 cases remaining active, and 77,486 deaths. Most countries (49.1%, n = 26) in AU experienced a low burden of COVID-19 infection compared to 28.3% ( n = 15) with medium burden and 22.6% ( n = 12) with high burden. AU nations with a high burden of the disease were mainly in the northern and southern regions. South Africa recorded the highest number of cases (1.31 million), followed by Morocco with 457,625 and Tunisia with 175,065 cases. Correspondently, death tolls for these countries were 36,467, 7888, and 5528 deaths, respectively. Of the total COVID-19 tests performed (83.8 million) during the first 1 year, 62.43% were from high-burden countries. The least testing occurred in the medium-burden (18.42%) countries. The overall CFR of AU was 2.21%. A morbidity rate of 327.52/105 population and mortality rate of 5.96/105 population were recorded during the first 1-year period with significant variations ( p < 0.0001) across burden levels. Continental morbidity and mortality rates of 17,359/105 and 315.933/105 populations were recorded with significant correlation ( r = 0.863, p < 0.0001) between them and variations across selected epidemiological measures by COVID-19 burden levels. Conclusion: Understanding the true burden of the disease in AU countries is important for establishing the impact of the pandemic in the African continent and for intervention planning, preparedness, and deployment of resources during COVID-19 surges and future pandemics.
Understanding the use/non-use of an internet-based intervention complementing standard depression treatment: A qualitative study of user's experiences
Authors: Fernández Olga , Pérez J Carola , Fernández Sofía , Krause Mariane , Cáceres Cristián , Espinosa-Duque Daniel 
Published: September 2023

Introduction There is sufficient evidence about the effectiveness of internet-based interventions; however, the users’ level of adoption and utilization remains low, with this phenomenon requiring adequate explanation. Objective The aim of this qualitative study was to explore the users’ perceptions and experience of a web-based program (ASCENSO), designed to complement (usual) in-person depression treatment. Method Twelve participants of the ASCENSO program, comprised of adult individuals ( M = 44.3, SD = 13.4) of both genders (67% women) undergoing treatment for depression, were interviewed through semi-structured interviews. The data obtained from these interviews were analyzed utilizing a constructivist grounded theory approach. The interviews were transcribed and analyzed by trained coders. A constant comparative analysis of emergent themes was conducted. Results These show that users employ and appreciate the program when their interaction with it emulates a “humanized relationship,” that is, when the program is proactive in assisting users with their requests and when it responds in a pertinent and individualized manner to their emotional states and needs. Conclusions Our findings highlight the challenges associated with the development of algorithms capable of attracting different potential users. These should be designed to generate a virtual relationship that emulates human interaction and targets the characteristics of each user, for example, considering the specific phenomenology of their health condition, their present emotional states, and perceived needs. Elements that will vary as mental symptomatology evolve.