bluuebunny/crossref_metadata_2025_split huggingface dataset:
299 Impact of a dedicated fracture liaison service candidate ANP on wait times in a geriatrician-led specialist bone health service
Authors: Steen G , Maher N , Fallon N , O'Carroll C , Carragher J , McCarroll K , Lannon R 
Published: September 2023

Abstract

Background
A specialist osteoporosis and bone health service was founded in 2003 in our institution. It sees a range of patients—providing DXA alone to giving specialist opinion on complex cases from all Ireland. Dedicated flow for hip fractures is well established however the advent of the fracture liaison database audit brought challenges providing DXA and reviewing specific acute fractures within the 12 week standard. Fracture liaison services target those who’ve just fractured with the aim of reducing risk of further imminent fracture by screening for osteoporosis and initiating bone protection measures.

Methods
Wait times for unselected direct review in the nurse led pre-assessment clinic with DXA were compared to the direct identification, review of DXA and subsequent follow up if indicated by a newly appointed candidate ANP (cANP).

Results
Average wait time for initial review of acute Colles/vertebral/humeral fractures prior to the cANP appointment was 10 months with further waits for consultant led bone clinic. Following the cANP appointment 318 relevant fractures were identified from September 2022 to May 2023. A 3 month lag was applied. Initial DXA took place on average 10 weeks post fracture (range 2–24). After this 169 patients were discharged back to GP with recommendations as scores above −2.0 on DXA as per locally agreed protocol for fractures and osteopenia; 111 seen in FLS by cANP for detailed assessment including bloods and risk factor review under supervision of their clinical mentor. 6 have not attended; the remainder await review. Average time from fracture to review by cANP is already 18 weeks.

Conclusion
Appointment of a dedicated cANP for fracture liaison has already streamlined bone health assessment for acute fractures attending our hospital as well as freed appointments in the specialist bone service. As the FLS service establishes we expect to reach the 12 week target consistently.
302 The educational experiences and perceived educational needs of multidisciplinary healthcare professionals in advanced care planning: a focus group study
Authors: Gannon E , Foley T , Creed S 
Published: September 2023

Abstract

Background
Advanced Care Planning (ACP) is the process by which patients, their families and healthcare professionals discuss and document patient preferences regarding future healthcare decisions if an individual loses decision making capacity regarding their care. ACP has been shown to reduce hospitalisations, admission to the intensive care unit, and increase patient and family satisfaction with medical care. Despite the benefits of quality ACP, healthcare professionals continue to report inadequate training and knowledge in this area. Using multidisciplinary healthcare professional focus groups, we intended to gather descriptions from different disciplines about their educational experiences in ACP both formal and informal, and their perceived educational needs.

Methods
We used a qualitative focus group methodology consisting of six focus groups in total. Two focus groups of each discipline were carried out—medical, nursing, Health and Social Care Practitioners (HSCPs) working in an acute tertiary hospital. We sought to explore the differing perspectives of multidisciplinary healthcare professionals’ involvement with ACP, their educational experiences, unique educational needs, and how multidisciplinary learning could be supported. Thematic analysis was used to analyse the findings.

Results
There was familiarity of ACP among multidisciplinary healthcare professionals, and a consensus that varied disciplines could have a role in ACP. Participants described a lack of formal education in ACP, with skills developed through informal means primarily through experience and learning from more senior colleagues. Concerns regarding the legal aspects of ACP was commonly stated as an educational need, as were communication skills, and ACP frameworks. Time was a perceived barrier to education in ACP, as well as lack of resources.

Conclusion
With the enactment of the Assisted Decision-Making Act formal education in advanced care planning and advanced health care directives is essential. This education should be multidisciplinary and needs to consider the perceived educational needs of its intended learners.
Silicone Shell Breast Implants in Patients Undergoing Risk-Reducing Mastectomy With a History of Breast-Conserving Surgery and Adjuvant Radiotherapy: A Long-term Study
Authors: Couto-González Ivan , Fernández-Marcos Adrián Ángel , Brea-García Beatriz , González-Giménez Nerea , Canseco-Díaz Francisco , García-Arjona Belén , Mato-Codesido Cristina , Taboada-Suárez Antonio 
Published: September 2023

Abstract

Background
Indications for breast-conserving surgery and adjuvant radiotherapy (BCSAR) in patients with breast carcinoma are increasing, as are indications for risk-reducing mastectomy (RRM) in healthy subjects. Most of these cases are reconstructed with silicone shell breast implants (SSBIs).

Objectives
The aim of this work was to study complications of SSBIs in breast reconstruction in patients undergoing RRM with previous BCSAR.

Methods
A prospective cohort study was designed. The study group included cases of RRM reconstructed with SSBI in patients who had previously undergone BCSAR in the same breast. The control group consisted of patients with high-risk breast cancer who had undergone RRM and immediate SSBI reconstruction without previous BCSAR.

Results
There was a history of BCSAR in 15.8% of cases. The first SSBI used in immediate reconstruction after RRM was replaced in 51.5% of cases with a mean [standard deviation] survival of 24.04 [28.48] months. BCSAR was significantly associated with pathological capsular contracture (P = .00) with this first SSBI (37.5% vs 5.9%). Of the cases requiring the replacement of the first SSBI, 44.23% suffered failure of the second SSBI, with a mean survival of 27.95 [26.53] months. No significant association was found between the consecutive development of capsular contracture in the second SSBI and a previous history of BCSAR (P = .10).

Conclusions
BCSAR prior to RRM reconstructed with an SSBI is associated with a significant increase in pathological capsular contracture. Patients should be warned of the high rate of SSBI complications and reconstruction failure. Polyurethane-coated implants may provide an alternative in cases in which alloplastic reconstruction is considered in patients with previous BCSAR.

Level of Evidence: 3
Early-life behavior, survival, and maternal personality in a wild marsupial
Authors: Menário Costa Weliton , King Wendy J , Bonnet Timothée , Festa-Bianchet Marco , Kruuk Loeske E B 
Published: September 2023

Abstract
Individual behavior varies for many reasons, but how early in life are such differences apparent, and are they under selection? We investigated variation in early-life behavior in a wild eastern gray kangaroo (Macropus giganteus) population, and quantified associations of behavior with early survival. Behavior of young was measured while still in the pouch and as subadults, and survival to weaning was monitored. We found consistent variation between offspring of different mothers in levels of activity at the pouch stage, in flight initiation distance (FID) as subadults, and in subadult survival, indicating similarity between siblings. There was no evidence of covariance between the measures of behavior at the pouch young versus subadult stages, nor of covariance of the early-life behavioral traits with subadult survival. However, there was a strong covariance between FIDs of mothers and those of their offspring tested at different times. Further, of the total repeatability of subadult FID (51.5%), more than half could be attributed to differences between offspring of different mothers. Our results indicate that 1) behavioral variation is apparent at a very early stage of development (still in the pouch in the case of this marsupial); 2) between-mother differences can explain much of the repeatability (or “personality”) of juvenile behavior; and 3) mothers and offspring exhibit similar behavioral responses to stimuli. However, 4) we found no evidence of selection via covariance between early-life or maternal behavioral traits and juvenile survival in this wild marsupial.
E-values as unnormalized weights in multiple testing
Authors: Ignatiadis Nikolaos , Wang Ruodu , Ramdas Aaditya 
Published: September 2023

Summary
We study how to combine p-values and e-values, and design multiple testing procedures where both p-values and e-values are available for every hypothesis. Our results provide a new perspective on multiple testing with data-driven weights: while standard weighted multiple testing methods require the weights to deterministically add up to the number of hypotheses being tested, we show that this normalization is not required when the weights are e-values that are independent of the p-values. Such e-values can be obtained in meta-analysis where a primary dataset is used to compute p-values, and an independent secondary dataset is used to compute e-values. Going beyond meta-analysis, we showcase settings wherein independent e-values and p-values can be constructed on a single dataset itself. Our procedures can result in a substantial increase in power, especially if the nonnull hypotheses have e-values much larger than one.
Global epidemiology of atopic dermatitis: a comprehensive systematic analysis and modelling study
Authors: Tian Jingru , Zhang Dingyao , Yang Yi , Huang Yaqing , Wang Lu , Yao Xu , Lu Qianjin 
Published: September 2023

Abstract

Background
Atopic dermatitis (AD) is the leading cause of the global burden from skin disease; no study has provided global and country-specific epidemiological estimates of AD.

Objectives
To quantify global, regional and country-specific estimates of the epidemiology of AD.

Methods
A comprehensive search for epidemiological studies in AD was conducted in four electronic databases (PubMed, Embase, Web of Science and China National Knowledge Infrastructure). A Bayesian hierarchical linear mixed model was constructed to calculate epidemiological estimates of AD considering the heterogeneity of regions, countries, type of diagnoses and age strata.

Results
In total, 344 studies met the inclusion criteria. Incidence varied substantially with the location and age of the surveyed participants. The global prevalence of AD and the population affected by AD were estimated to be 2.6% [95% uncertainty interval (UI) 1.9–3.5] and 204.05 million people, respectively. Around 101.27 million adults and 102.78 million children worldwide have AD, corresponding to prevalence rates of 2.0% (95% UI 1.4–2.6) and 4.0% (95% UI 2.8–5.3), respectively. Females were more likely to suffer from AD than males: the global prevalence of AD in females was 2.8% (95% UI 2.0–3.7%) and affected 108.29 million people, while in males the corresponding estimates were 2.4% (95% UI 1.7–3.3%) and 95.76 million people.

Conclusions
Epidemiological AD data are lacking in 41.5% of countries worldwide. The epidemiology of AD varies substantially with age and sex and is distributed unequally across geographical regions.
Angiosarcoma in the breast: a population-based cohort from Sweden
Authors: Olander Susanne , Wennstig Anna-Karin , Garmo Hans , Holmberg Lars , Nilsson Greger , Blomqvist Carl , Karlsson Fredrik , Wickberg Åsa , Wärnberg Fredrik , Sund Malin , Wadsten Charlotta 
Published: September 2023

Abstract

Background
Breast angiosarcoma is a rare disease mostly observed in breast cancer (BC) patients who have previously received radiotherapy (RT). Little is known about angiosarcoma aetiology, management, and outcome. The study aim was to estimate risk and to characterize breast angiosarcoma in a Swedish population-based cohort.

Methods
The Swedish Cancer Registry was searched for breast angiosarcoma between 1992 and 2018 in three Swedish healthcare regions (population 5.5 million). Information on previous BC, RT, management, and outcome were retrieved from medical records.

Results
Overall, 49 angiosarcomas located in the breast, chest wall, or axilla were identified, 8 primary and 41 secondary to BC treatment. Median age was 51 and 73 years, respectively. The minimum latency period of secondary angiosarcoma after a BC diagnosis was 4 years (range 4–21 years). The cumulative incidence of angiosarcoma after breast RT increased continuously, reaching 1.4‰ after 20 years. Among 44 women with angiosarcoma treated by surgery, 29 developed subsequent local recurrence. Median recurrence-free survival was 3.4 and 1.8 years for primary and secondary angiosarcoma, respectively. The 5-year overall survival probability for the whole cohort was 50 per cent (95 per cent c.i., 21 per cent–100 per cent) for primary breast angiosarcoma and 35 per cent (95 per cent c.i., 23 per cent–54 per cent) for secondary angiosarcoma.

Conclusion
Breast angiosarcoma is a rare disease strongly associated with a history of previous BC RT. Overall survival is poor with high rates of local recurrences and distant metastasis.
Mental health interventions for atopic dermatitis: knowledge gaps, pilot programmes and future directions
Authors: Chatrath Sheena , LeBovidge Jennifer , Jack Carolyn , Abuabara Katrina , Schneider Lynda C , Capozza Korey , Kelley Keri , Silverberg Jonathan I 
Published: September 2023

Abstract
Atopic dermatitis (AD) is associated with high levels of psychosocial burden, often resulting in poor mental health outcomes. Despite this association, few studies have evaluated the efficacy of mental health interventions within this population. Utilization of multidisciplinary and peer-led support, in addition to equipping patients with psychological tools, may be beneficial in improving mental health outcomes. Future research is needed to determine which interventions and formats are desired by, effective in and accessible to patients and caregivers with AD.
Effects of probiotic supplementation in adult with atopic dermatitis: a systematic review with meta-analysis
Authors: Husein-ElAhmed Husein , Steinhoff Martin 
Published: September 2023

Abstract

Background
Atopic dermatitis (AD) is one of the most common chronic inflammatory skin diseases. The effect of probiotic administration on the severity of AD in adults has shown inconsistent results.

Objectives
To determine the effectiveness of probiotic supplementation as a therapeutic tool for adult AD.

Methods
PubMed, Scopus and Embase were systematically searched to collect data from studies in which probiotics were administered to treat adult AD.

Results
Out of 413 publications, 9 papers were included in the meta-analysis. Significant differences in the ScORing Atopic Dermatitis tool favouring probiotics were observed [relative risk (RR) –5.93, 95% confidence interval (CI) –8.43 to –3.43]. Lactobacillus salivarius presented with largest effect size (RR –9.79, 95% CI –13.04 to –6.54), followed by L. acidophilus (RR –5.77, 95% CI –10.82 to –0.72) and L. plantarum (RR –3.76, 95% CI –6.36 to –1.16). No benefit was observed with L. fermentum. Based on the severity of AD, probiotics showed better results in people with moderate-to-severe AD (RR –9.12, 95% CI –12.17 to –6.08) than in individuals with mild disease (RR –2.67, 95% CI –4.67 to –0.66). Serum levels of IgE and eosinophil count remained significantly unchanged after the probiotic intervention (RR 0.25, 95% CI –0.10 to 0.60; RR –0.27, 95% CI –0.68 to 0.13, respectively).

Conclusions
Current evidence supports a role for some probiotics as a therapeutic tool for the treatment of adult AD, particularly in patients with severe AD. The efficacy of probiotics is strain specific, with L. salivarius and L. acidophilus having the largest clinical benefit. Such benefit is apparently independent of IgE levels and eosinophil count. Despite these encouraging results, the decrease in AD severity did not translate into a clinically meaningful better quality of life as assessed by the Dermatology Life Quality Index. There currently is not enough reliable data to reach conclusions about the optimal dose and duration for probiotic treatment.
Applications of Artificial Intelligence in Urinalysis: Is the Future Already Here?
Authors: De Bruyne Sander , De Kesel Pieter , Oyaert Matthijs 
Published: September 2023

Abstract

Background
Artificial intelligence (AI) has emerged as a promising and transformative tool in the field of urinalysis, offering substantial potential for advancements in disease diagnosis and the development of predictive models for monitoring medical treatment responses.

Content
Through an extensive examination of relevant literature, this narrative review illustrates the significance and applicability of AI models across the diverse application area of urinalysis. It encompasses automated urine test strip and sediment analysis, urinary tract infection screening, and the interpretation of complex biochemical signatures in urine, including the utilization of cutting-edge techniques such as mass spectrometry and molecular-based profiles.

Summary
Retrospective studies consistently demonstrate good performance of AI models in urinalysis, showcasing their potential to revolutionize clinical practice. However, to comprehensively evaluate the real clinical value and efficacy of AI models, large-scale prospective studies are essential. Such studies hold the potential to enhance diagnostic accuracy, improve patient outcomes, and optimize medical treatment strategies. By bridging the gap between research and clinical implementation, AI can reshape the landscape of urinalysis, paving the way for more personalized and effective patient care.
Evolution of the viral genomes of SARS-CoV-2 in association with the changes in local condition: a genomic epidemiological study of a suburban city of Japan
Authors: Kashima Yukie , Mizutani Taketoshi , Okimoto Yuki , Maeda Minami , Musashino Kaoru , Nishide Ryo-ichi , Matsukura Akira , Nagase Jison , Suzuki Yutaka 
Published: September 2023

Abstract
Understanding the factors driving the spread and evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at the local, regional, national, and international levels is important in protecting against future pandemics. By exploring their viral genomes, we attempted to analyse the spread of SARS-CoV-2 and its evolutionary convergence in Kashiwa City, as an example of a representative commuter town in Japan. From September 2020 to January 2023, a total of 47,134 nasopharyngeal swab and saliva specimens were collected from patients in 47 local clinics and hospitals, covering the vast majority of healthcare facilities. All SARS-CoV-2-positive samples were subjected to whole genome sequencing. Based on the analysis of 5,536 identified genomes, all major strains were represented. Unique regional mutations were occasionally identified in each strain. Inspection of these mutations revealed that the overall base substitution rate increased with progressive waves of the pandemic, at an overall rate of 2.56 bases/year. Interestingly, the spread and evolutionary patterns appeared to be distinct between regions and between individual clinics. Further analysis of the synonymous base substitution rate showed that the speed of viral evolution accelerated coincident with the beginning of public vaccination. Comprehensive genomic epidemiological studies, as presented here, should be useful in precisely understanding the pandemic and preparing for possible future pandemics.
Deliberate Surrender? The Impact of Interwar Indian Protection
Authors: Arthi Vellore , Lampe Markus , Nair Ashwin , O’Rourke Kevin Hjortshøj 
Published: September 2023

Abstract
What is the role of trade policy in promoting intra-Empire trade? We address the question in the context of interwar India, whose trade policies have been accused of harming British export interests. We quantify the impact of trade policy on the value and composition of Indian imports, using novel disaggregated data on both trade policies and imports for 114 commodity categories coming from 42 countries. We find that, even though Indian protection lowered total imports, it substantially boosted imports from the United Kingdom. Despite the rising tariff barriers facing British exporters, trade diversion from other countries ensured that Indian trade policy benefited them overall.
Moodle as online platform for cardiac nurses’ competency: nursing staff experiences
Authors: El-Khatib Mohamed , Helmy Ibrahim , Eltayyeb Mahmoud 
Published: September 2023

Abstract

Background
Aswan Heart Centre competency project were started in 2017, nurse’s competency were tillered and implemented within the nursing units.
Self-assessment and preceptor grading ideationally to constrictive comment should be documented in the competency tool for every staff, was no unified way to keep tracking these documentations and very hard to secure the hard copy.

Aim
Is to establish an online platform where the competencies are accessible and high secured that also controls and facilitates the use of nursing competencies.

Process
Moodle as a cloud-based learning management system (LMS) selected to be the new Online competency platform. Moodle expert were contacted by the nursing education department to assist and support the process. Online could server to host and upload the platform were established by the information technology department. After competencies and users uploaded pilot phase were started to identify the gap in the Moodle platform. After 4 months of use survey were conducted to get a clear view from the staff.

Data analysis
Most of the staff were satisfied about Moodle use, but the form still need farther support from the information technology department to host the Moodle cloud in stable server to avoid the browser render.

Recommendation
The use of cloud-based learning management system like Moodle will maintain the easy accessibility and the high security of the data also will facilitate the data audit for further plans.