bluuebunny/crossref_metadata_2025_split huggingface dataset:
Characteristics of initiators of budesonide/glycopyrrolate/formoterol for treatment of chronic obstructive pulmonary disease (COPD) in the United States: the AURA study
Authors: Portillo Edward C. , Pollack Michael , Lee Inyoung , Sun Kainan , Zhao Xiaohui , Kruse Lisa , Feigler Norbert , Patel Sushma , Near Aimee M. 
Published: April 2023

Introduction: A twice-daily single inhaler triple therapy consisting of budesonide/glycopyrrolate/formoterol fumarate (BGF) was approved by the US Food and Drug Administration (FDA) in July 2020 as a maintenance treatment for patients with chronic obstructive pulmonary disease (COPD). The objective of this AURA study is to describe patient characteristics, exacerbation and treatment history, and healthcare resource utilization (HCRU) before BGF initiation to better inform treatment decisions for prescribers. Methods: This retrospective cohort study leveraged data of all payer types from IQVIA’s Longitudinal Prescription Data (LRx) linked to Medical Data (Dx). Patients with COPD who had ⩾1 LRx claim for BGF between 1 October 2020 and 30 September 2021 were included. The date of first BGF claim was the index date. Patient demographic and clinical characteristics, history of COPD exacerbation or related event, treatment history, and HCRU were assessed during the 12 months before index (baseline). Results: We identified 30,339 patients with COPD initiating BGF (mean age: 68.2 years; 57.1% female; 67.6% Medicare). Unspecified COPD (J44.9; 74.0%) was the most commonly coded COPD phenotype. The most prevalent respiratory conditions/symptoms were dyspnea (50.8%), lower respiratory tract infection (25.3%), and sleep apnea (19.0%). Uncomplicated hypertension (58.8%), dyslipidemia (43.9%), cardiovascular disease (41.4%), and heart failure (19.9%) were the most prevalent nonrespiratory conditions. During the 12-month baseline, 57.9% of patients had evidence of a COPD exacerbation or related event, and 14.9% had ⩾1 COPD-related emergency department (ED) visit; 21.0% of patients had evidence of prior triple therapy use, while 54.3% had ⩾1 oral corticosteroid (OCS) fill. Among OCS users, 29.9% had cumulative exposures >1000 mg [median [Q1–Q3] exposure: 520 (260–1183) mg]. Conclusion: This real-world data analysis indicates that BGF is being initiated in patients with COPD experiencing symptoms and exacerbations despite current therapy, and among patients who have various chronic comorbidities, most often cardiopulmonary-related.
Intersection of physical and mental health of youth with brachial plexus birth injuries: A qualitative study
Authors: Purther Halle , Nitert-Brown Cora , Vahidi Ferdosi Diba , Ho Emily S 
Published: April 2023

Introduction Youth with brachial plexus birth injuries (BPBI) have an increased risk of mental health issues such as depression, anxiety, and diminished self-confidence. Despite this evidence, current standards of care focus on physical interventions. Evaluation of psychological and emotional concerns is rarely prioritized in clinical settings. Therefore, mental health needs are unmet and poorly understood. Methods An interpretivist qualitative approach was used to understand the perspectives of youth with BPBI and their caregivers on the barriers and facilitators of addressing mental health concerns, to inform practice guidelines, and promote meaningful participation within this population. Results A purposeful sample of nine youth with BPBI between 10 to 20 years and eight caregivers participated in in-depth interviews. The interviews were semi-structured and an average of 60 min (35–85 min) long. Three themes emerged from these data: (i) physical disability identity and mental health; (ii) pursuit of “normal” body image; and (iii) paradox of advocacy. Findings illuminated the intersection of physical and mental health in these youth and provides actionable practice recommendations. Areas of need were identified including mental health support around the challenges of advocacy, body image, surgery, and preparation for the ‘aging out’ process for youth and their families. Conclusions The well-being of youth with BPBI is a result of the intersection between their physical and mental health. Further research on optimizing mental health resources within physical health settings is needed to better support the holistic needs of these youth and their families.
Metformin adherence and the risk of cardiovascular disease: a population-based cohort study
Authors: Yu Shun-Fan , Hong Chien-Tai , Chen Wan-Ting , Chan Lung , Chien Li-Nien 
Published: April 2023

Background: Metformin is a potent antiglycemic agent, but its importance has receded owing to the launch of novel antidiabetic medications. The benefit of metformin includes not only blood sugar control but also anti-inflammation, autophagy activation, and neuroprotection. This study investigated the risk of cardiovascular disease (CVD) in people with type II diabetes mellitus (T2DM) who adhered to metformin after adding on a second-line antiglycemic agent. Objectives: The purpose of this study was to investigate the benefits of metformin in CVD prevention in patients with T2DM. Design: We designed the study by comparing the incident rate of CVD events in patients with T2DM who received metformin continually and who ceased metformin during 2002–2014. Methods: Medical information was obtained from the National Health Insurance Research Database, and patients with T2DM receiving second-line antiglycemic agents were categorized into metformin-adherent and nonadherent groups according to prescription claims. The study outcomes were the incidence of CVD hospitalization, including stroke (ischemic and hemorrhagic) and myocardial infarction (MI). Results: A total of 31,384 patients with T2DM constituted the metformin-adherent group and were 1:1 matched to nonadherent patients. Metformin adherence was associated with a lower risk of hospitalization due to stroke [adjusted hazard ratio (aHR) = 0.51, 95% confidence interval (CI): 0.43–0.59, p < 0.001] and MI (aHR = 0.47, 95% CI: 0.43–0.53, p < 0.001). The risk reduction persisted in both ischemic and hemorrhagic strokes. Our subgroup analysis revealed that the protective effect on stroke and MI hospitalization persisted in metformin-adherent patients, both sexes, patients aged ⩽65 or >65 years, and patients with or without concurrent insulin treatment. Conclusions: This study revealed that metformin adherence in patients with T2DM who required a first-line treatment may reduce the risk of subsequent CVD. Despite the availability of numerous novel antiglycemic agents, metformin adherence by patients who require a combination of antiglycemic agents provides an additional benefit of CVD protection.
Effectiveness of rehabilitation strategies in primary fibromyalgia syndrome: A systematic review and meta-analysis
Authors: Pathak Akash , Rai Jyotsana , Rai Nirendra K. , Singh Ruchi , Bhatt Girish C. 
Published: April 2023

Objectives The aim of this review was to (1) summarize evidence on the effectiveness of rehabilitation strategies in fibromyalgia syndrome (FMS) and (2) determine the most effective rehabilitation strategy for reducing pain and depression in people with FMS. Data Sources PubMed, Ovid (Sp), and Cochrane search engines were used for identifying relevant studies done up to 1st of July 2022. Study Selection Randomized control trials (RCTs) that have a passive control group and an active control group were included in this review for primary and secondary aim, respectively. The primary outcome measures were pain and depression. Secondary outcome was one from the sleep or fatigue or healthy related quality of life (HRQOL). Data Extraction Two researchers independently selected the studies and extracted the key information. Data Synthesis A total of 25 RCTs were included. Studies with passive control group showed moderate to large positive effects on pain (standard mean difference –0.65, 95% confidence interval −0.93 to −0.38; I2 = 72%) and HRQOL (MD −5.40, 95% CI −10.17 to −0.62; I2 = 74%) but were not statistically significant for sleep, fatigue, and depression. Furthermore, on subgroup analysis studies with a short term protocol showed significant effects on pain only, whereas studies with long term protocols showed positive effects on pain and HRQOL only, but no statistical significance at the time of post-trial follow-up. Studies with active control groups gave non-significant results except where there was mixed exercises, which showed a positive effect (mean difference −4.78, 95% CI −7.98 to −1.57; I2 = 0%) for HRQOL. Conclusion All rehabilitation strategies were effective for pain and HRQOL, and had a marginal effect on depression, sleep, and fatigue but efficacy was not maintained at the time of post-trial follow-up. However, in this review, we could not differentiate any rehabilitation strategies for the best among those used in the included studies.
Assessment and associated factors of comprehensive HIV knowledge in an at-risk population: a cross-sectional study from 19,286 young persons in Nigeria
Authors: Kareem Yusuf Olushola , Dorgbetor Cyprian Issahaku , Ameyaw Edward Kwabena , Abubakar Zubaida , Adelekan Babatunde , Goldson Erika , Mueller Ulla , Adegboye Oyelola 
Published: April 2023

Background: The prevalence of HIV among young people aged 15–19 years in Nigeria is estimated as 3.5%, the highest among West and Central African countries. Comprehensive knowledge of HIV is associated with increased awareness of preventive interventions and a reduction in the spread of HIV. Therefore, this article seeks to assess and determine the associated factors of comprehensive HIV knowledge among youths in Nigeria. Methods: The study used the 2018 Nigerian Demographic Health Survey, a cross-sectional survey that employed a two-stage cluster sampling method. Comprehensive knowledge of HIV was assessed based on five questions. The data were analysed separately for men and women aged 15–24 years. A multivariable log-binomial regression model was used to determine factors associated with comprehensive HIV knowledge. All analysis was performed using Stata 15.0 and adjusted for weighting, clustering and stratification. Results: A total of 15,267 women and 4019 men aged 15–24 years were included in this study. The prevalence of comprehensive knowledge of HIV was higher among women than among men (42.6% versus 33.7%; p < 0.001) and lower among younger ages 15–17 years compared with other ages. The findings revealed that age, ethnicity, wealth, education and exposure to mass media were statistically significant factors associated with comprehensive knowledge of HIV. In addition, religion, place of residence, phone ownership, internet use, currently working and having initiated sex were significant factors among women and modern contraceptive use among men. Conclusion: Key findings from this study imply that public health programmes in Nigeria should focus on providing information on HIV/AIDS using different approaches, including comprehensive sex education as well as health promotion and education strategies in the formal and informal sectors. Because media exposure is a common and cost-effective way of public health promotion and education in modern times, emphasis could also be placed on using this channel to reach the target population.
A non-volitional skeletal muscle endurance test measures functional changes associated with impaired blood flow
Authors: Brandenberger Kyle J , Rawdon Chris L , Armstrong Erica , Lonowski Jacob , Cooper Lakee’dra 
Published: April 2023

Introduction: An electrically stimulated intermittent fatigue test using mechanomyography was recently proposed as a possible tool for detecting clinically relevant changes in muscle function. This study was designed to determine whether the proposed test can detect additional fatigue when it should be present. Methods: Subjects ( n = 10) underwent two trials each (occluded and normal blood flow) with a standardized fatigue protocol on the Ankle Dorsiflexors (AD) and Wrist Extensors (WE) using a clinical electrical stimulator. Results: Mean normalized twitch acceleration was strongly predictive of mean normalized torque ( R2 = 0.828). The WE experienced lower twitch magnitudes throughout the tourniquet trial (10.81 ± 1.25 m/s2) compared to normal blood flow (18.05 ± 1.06 m/s2). The AD twitches were overall reduced in the tourniquet trial (3.87 ± 0.48 m/s2) compared with the control trial (8.57 ± 0.91 m/s2). Conclusion: Occluding blood flow to a muscle should cause greater muscle fatigue. The ability to detect reduced contraction magnitudes during an electrically stimulated fatigue protocol resulting from low blood flow suggests the proposed test may be capable of detecting clinically relevant muscle deficits.
Effect of Enhanced Recovery After Surgery Protocol on Postoperative Outcomes of Women Undergoing Abdominal Hysterectomy
Authors: Mohamed Ibrahim Shimaa Mosad , Mahmoud El-Sheikh Mona Ahmed , Salama Abdelfattah Amira Mohammed 
Published: April 2023

Background Enhanced recovery after surgery protocol is a standardized, multidisciplinary approach for shorter hospital stay without negatively affecting patient outcomes. The aim of this research was to evaluate the effect of enhanced recovery after surgery protocol on postoperative outcomes of women undergoing abdominal hysterectomy. Design A quasi-experimental design was adopted to fulfil the aim of this research. Setting The research was conducted at Obstetric and Gynecological Department in Benha University Hospital. Sample A purposive sample of 148 women undergoing abdominal hysterectomy divided into two groups. Data collection Three tools were used: Tool (I) structured questionnaire sheet. Tool (II) post-operative pain assessment scale (numerical rating scale). Tool (III) post-operative outcomes assessment sheet. Results There was a highly statistically significant difference between the studied groups regarding all postoperative outcomes ( p = .000). The women in the study group experienced less mean score of pain compared to those in control group on both 2nd and 3rd day after surgery. Also, there was a statistically significant difference between the studied groups regarding postoperative complication and readmission ( p = .000). Conclusion Women undergoing abdominal hysterectomy who received enhanced recovery after surgery protocol had better postoperative outcomes than women who received routine perioperative care.
The contribution of competing mechanisms in stroke despite anticoagulation in patients with atrial fibrillation
Authors: Herlekar Rahul , Sur Roy Akangsha , Hajiev Saur , Induruwa Isuru , Agarwal Smriti , Evans Nicholas R , Khadjooi Kayvan , Markus Hugh , O’Brien Eoin , Warburton Elizabeth , Zachariah George , McCabe John J 
Published: April 2023

Background: For reasons poorly understood, strokes frequently occur in patients with atrial fibrillation (AF) despite oral anticoagulation. Better data are needed to inform randomised trials (RCTs) of new strategies to prevent recurrence in these patients. We investigate the relative contribution of competing stroke mechanisms in patients with AF who have stroke despite anticoagulation (OAC+) compared with those who are anticoagulant naïve (OAC−) at the time of their event. Patients and methods: We performed a cross-sectional study leveraging data from a prospective stroke registry (2015–2022). Eligible patients had ischemic stroke and AF. Stroke classification was performed by a single stroke-specialist blinded to OAC status using TOAST criteria. The presence of atherosclerotic plaque was determined using duplex ultrasonography, computerised tomography (CT) or magnetic resonance (MR) angiography. Imaging was reviewed by a single reader. Logistic regression was used to identify independent predictors of stroke despite anticoagulation. Results: Of 596 patients included, 198 (33.2%) were in the OAC+ group. A competing cause for stroke was more frequent in patients with OAC+ versus OAC− (69/198 (34.8%)) versus 77/398 (19.3%), p < 0.001). After adjustment, both small vessel occlusion (odds ratio (OR): 2.46, 95% CI: 1.20–5.06) and arterial atheroma (⩾50% stenosis) (OR: 1.78, 95% CI: 1.07–2.94) were independently associated with stroke despite anticoagulation. Discussion and conclusion: Patients with AF-associated stroke despite OAC are much more likely than patients who are OAC-naïve to have competing stroke mechanisms. Rigorous investigation for alternative stroke causes in stroke despite OAC has a high diagnostic yield. These data should be used to guide patient selection for future RCTs in this population.
Consensus on the assessment of systemic sclerosis–associated primary heart involvement: World Scleroderma Foundation/Heart Failure Association guidance on screening, diagnosis, and follow-up assessment
Authors: Bruni Cosimo , Buch Maya H , Djokovic Aleksandra , De Luca Giacomo , Dumitru Raluca B , Giollo Alessandro , Galetti Ilaria , Steelandt Alexia , Bratis Konstantinos , Suliman Yossra Atef , Milinkovic Ivan , Baritussio Anna , Hasan Ghadeer , Xintarakou Anastasia , Isomura Yohei , Markousis-Mavrogenis George , Mavrogeni Sophie , Gargani Luna , Caforio Alida LP , Tschöpe Carsten , Ristic Arsen , Plein Sven , Behr Elijah , Allanore Yannick , Kuwana Masataka , Denton Christopher P , Furst Daniel E , Khanna Dinesh , Krieg Thomas , Marcolongo Renzo , Pepe Alessia , Distler Oliver , Sfikakis Petros , Seferovic Petar , Matucci-Cerinic Marco 
Published: April 2023

Introduction: Heart involvement is a common problem in systemic sclerosis. Recently, a definition of systemic sclerosis primary heart involvement had been proposed. Our aim was to establish consensus guidance on the screening, diagnosis and follow-up of systemic sclerosis primary heart involvement patients. Methods: A systematic literature review was performed to investigate the tests used to evaluate heart involvement in systemic sclerosis. The extracted data were categorized into relevant domains (conventional radiology, electrocardiography, echocardiography, cardiac magnetic resonance imaging, laboratory, and others) and presented to experts and one patient research partner, who discussed the data and added their opinion. This led to the formulation of overarching principles and guidance statements, then reviewed and voted on for agreement. Consensus was attained when the mean agreement was ⩾7/10 and of ⩾70% of voters. Results: Among 2650 publications, 168 met eligibility criteria; the data extracted were discussed over three meetings. Seven overarching principles and 10 guidance points were created, revised and voted on. The consensus highlighted the importance of patient counseling, differential diagnosis and multidisciplinary team management, as well as defining screening and diagnostic approaches. The initial core evaluation should integrate history, physical examination, rest electrocardiography, trans-thoracic echocardiography and standard serum cardiac biomarkers. Further investigations should be individually tailored and decided through a multidisciplinary management. The overall mean agreement was 9.1/10, with mean 93% of experts voting above 7/10. Conclusion: This consensus-based guidance on screening, diagnosis and follow-up of systemic sclerosis primary heart involvement provides a foundation for standard of care and future feasibility studies that are ongoing to support its application in clinical practice.
Study on preparation of high-performance binderless board from Broussonetia papyrifera
Authors: Chen Muyang , Zheng Siqi , Wu Jiabiao , Xu Jianying 
Published: April 2023

AbstractBinderless particleboards were prepared without any resin adhesives fromBroussonetia papyriferatrunk by hot pressing. The effects of particle size, pressing time, pressing temperature and board density on the physical and mechanical properties of binderless boards were investigated. The effects of chemical changes inBroussonetia papyriferabinderless particleboards on the board properties were investigated by chemical, spectroscopic and cellulose crystallinity analyses. The bonding performance of the latex ofBroussonetia papyriferawas discussed. The results showed: (1) the smaller size of the particle, the higher internal bonding (IB) strength and lower thickness swelling (TS) of the binderless board had. The modulus of rupture (MOR), the modulus of elasticity (MOE) and the IB values of the boards increased with the increase of board density. Within a certain range, the binderless boards manufactured at higher temperature and longer pressing time had better properties. Under the optimum board manufacturing condition of 220 ℃/30 min/1.0 g/cm3, theBroussonetia papyriferabinderless board recorded a MOR 28 MPa, MOE 5.3 GPa, IB 2.74 MPa and 24 h TS of 7.4%, which met the performance requirements of Chinese national standard for heavy-duty particleboard. (2) The degradation of cellulose and hemicellulose during hot pressing resulted in decrease of cellulose and hemicellulose content and increase of extractives. Some of the degradation products form new bonding to increase the bonding strength and dimensional stability of the binderless boards. (3) The formation of pseudo-lignin and increased C–O–C and cellulose crystallinity of the boards during hot pressing contributed to high quality of the binderless boards. (4) The poplar veneers bonded with the latex ofBroussonetia papyriferahad a certain bonding strength (0.6 MPa), indicating the latex played a positive role in self-bonding of theBroussonetia papyriferaparticleboard.
A two-stage hybrid biomarker selection method based on ensemble filter and binary differential evolution incorporating binary African vultures optimization
Authors: Li Wei , Chi Yuhuan , Yu Kun , Xie Weidong 
Published: April 2023

Abstract
Background
In the field of genomics and personalized medicine, it is a key issue to find biomarkers directly related to the diagnosis of specific diseases from high-throughput gene microarray data. Feature selection technology can discover biomarkers with disease classification information.

Results
We use support vector machines as classifiers and use the five-fold cross-validation average classification accuracy, recall, precision and F1 score as evaluation metrics to evaluate the identified biomarkers. Experimental results show classification accuracy above 0.93, recall above 0.92, precision above 0.91, and F1 score above 0.94 on eight microarray datasets.

Method
This paper proposes a two-stage hybrid biomarker selection method based on ensemble filter and binary differential evolution incorporating binary African vultures optimization (EF-BDBA), which can effectively reduce the dimension of microarray data and obtain optimal biomarkers. In the first stage, we propose an ensemble filter feature selection method. The method combines an improved fast correlation-based filter algorithm with Fisher score. obviously redundant and irrelevant features can be filtered out to initially reduce the dimensionality of the microarray data. In the second stage, the optimal feature subset is selected using an improved binary differential evolution incorporating an improved binary African vultures optimization algorithm. The African vultures optimization algorithm has excellent global optimization ability. It has not been systematically applied to feature selection problems, especially for gene microarray data. We combine it with a differential evolution algorithm to improve population diversity.

Conclusion
Compared with traditional feature selection methods and advanced hybrid methods, the proposed method achieves higher classification accuracy and identifies excellent biomarkers while retaining fewer features. The experimental results demonstrate the effectiveness and advancement of our proposed algorithmic model.