bluuebunny/crossref_metadata_2025_split huggingface dataset:
Leisure Participation of Autistic Adults: An Ecological Momentary Assessment Feasibility Study
Authors: Song Wei , Zheng Linda , Tichá Renáta , Abery Brian , Nguyen-Feng Viann N. 
Published: July 2023

Abstract
Autistic adults participate less and express lower satisfaction in leisure activities than nonautistic adults, although literature is limited. The multifaceted nature of leisure participation makes it challenging to measure, with most measures being retrospective. Ecological momentary assessments (EMA) can reduce recall bias. This pilot study assessed the feasibility and acceptability of EMA among autistic adults. Participants (N = 40) were recruited via email and online. After completing a baseline interview, participants were asked to complete a once-daily survey for 30 days, in which they received survey links through a text messaging smartphone app. Surveys asked participants to report whether they participated in any leisure activities during the day, their level of enjoyment, with whom they interacted, and where they participated. The EMA appeared feasible in this sample, as participants completed the daily survey on average 27.05 (SD = 3.92) days. Regarding acceptability, most agreed that survey timing was convenient, that it was easy to enter responses and answer questions daily, and that they had enough response time. Overall, this study supports the use of EMA methodology among autistic adults. Future research should follow and improve upon these EMA data collection practices to examine daily behavior and well-being among autistic adults.
“It reminds me and motivates me”: Human-centered design and implementation of an interactive, SMS-based digital intervention to improve early retention on antiretroviral therapy: Usability and acceptability among new initiates in a high-volume, public clinic in Malawi
Authors: Huwa Jacqueline , Tweya Hannock , Mureithi Maryanne , Kiruthu-Kamamia Christine , Oni Femi , Chintedza Joseph , Chiwaya Geldert , Waweru Evelyn , Kudzala Aubrey , Wasunna Beatrice , Ndhlovu Dumisani , Bisani Pachawo , Feldacker Caryl 
Published: July 2023

BackgroundEarly retention of people living with HIV (PLHIV) in antiretroviral therapy (ART) programs is critical to improve individual clinical outcomes and viral load suppression. Although many mobile health (mHealth) interventions aim to improve retention in care, there is still lack of evidence on mHealth success or failure, including from patient’s perspectives. We describe the human-centered design (HCD) process and assess patient usability and acceptability of a two-way texting (2wT) intervention to improve early retention among new ART initiates at Lighthouse Trust clinic in Lilongwe, Malawi.MethodsAn iterative HCD approach focused on patient and provider users’ needs, incorporating feedback from multidisciplinary teams to adapt 2wT for the local, public clinic context. We present mixed-methods usability and acceptability results from 100 participants, 50 at 3-months and 50 at 6-months, post 2wT enrollment, and observations of these same patients completing core tasks of the 2wT system.ResultsAmong the 100 usability respondents, 95% were satisfied with visit reminders, and 88% would recommend reminders and motivational messages to friends; however, 17% were worried about confidentiality. In observation of participant task completion, 94% were able to successfully confirm visit attendance and 73% could request appointment date change. More participants in 4–6 months group completed tasks correctly compared to 1–3 months group, although not significantly different (78% vs. 66%, p = 0.181). Qualitative results were overwhelmingly positive, but patients did note confusion with transfer reporting and concern that 2wT would not reach patients without mobile phones or with lower literacy.ConclusionThe 2wT app for early ART retention appears highly usable and acceptable, hopefully creating a solid foundation for lifelong engagement in care. The HCD approach put the local team central in this process, ensuring that both patients’ and Lighthouse’s priorities, policies, and practices were forefront in 2wT optimization, raising the likelihood of 2wT success in other routine program contexts.
A risk scoring model of COVID-19 at hospital admission
Authors: Gomes João José Ferreira , Ferreira António , Alves Afonso , Sequeira Beatriz Nogueira 
Published: July 2023

BackgroundThe COVID-19 pandemic has been the most serious public health crisis in recent times, a pandemic whose impact was felt across the globe in various groups and populations. Confronted with an urgent problem, people and governments were forced to make decisions without fully understanding the disease. The present work aims to reinforce our ever-growing knowledge of the illness, particularly in modelling the risk of death of a patient admitted to a hospital with a positive COVID-19 test.MethodsGiven the simplicity of using and programming logistic regression in any national healthcare unit and the ease of interpreting the results, we chose to use this technique over several other. Using scoring techniques, it is possible to associate the various diagnoses with a numerical value (score), making it possible therefore to integrate the patient’s multiple medical conditions as a single continuous variable in the model.ResultsIt is possible to establish with good discriminatory capacity (ROC AUC Test = 0.8) which COVID patients are at higher risk when admitted to the healthcare unit—people of advanced age with pre-existing conditions, such as diabetes and high blood pressure, or newly acquired conditions, such as pneumonia. Moreover, males and clinical episodes occurring in healthcare units with few available beds (high healthcare unit occupancy) are also at higher risk. The importance of each variable in predicting the target is: age (47%), sum of comorbidity scores (28%), healthcare unit score (12.0%), gender score (7%) and healthcare unit occupancy (6%).ConclusionsUsing a dataset with more than 52000 people, it was possible to successfully differentiate likelihood of death by COVID using age, comorbidity information, healthcare unit, healthcare unit occupancy and gender. The age and the comorbidities associated with each patient had a joint contribution of about 75% in explaining the COVID related mortality in Portuguese public hospitals in the period between March 2020 and May 2021.
Time to death and its predictors among under-five children on antiretroviral treatment in public hospitals of Addis Ababa, Addis Ababa, Ethiopia, a retrospective follow up study
Authors: Mekonnen Enyew , Arega Mikias , Belay Dawit Misganaw , Birhanu Dires , Tesfaw Tadlo , Ayele Habtamu , Bishaw Keralem Anteneh 
Published: July 2023

Background
Child mortality remains a global public health problem, particularly in Sub-Saharan Africa. After initiating ART, the mortality rate among HIV-infected children in Ethiopia was 12–17 deaths per 1000 child-year.

Objective
To determine the time to death and its predictors among under-five children on antiretroviral treatment in public hospitals of Addis Ababa, Ethiopia, from April 12, 2017, to May 12, 2022.

Method
An institution-based retrospective follow-up study was conducted among 415 HIV-infected children at selected public hospitals of the Addis Ababa town administration. Computer generated simple random sampling technique was used to select each sampling unit. Data was extracted using a structured data extraction checklist. Data were entered into EPI data 4.2 and analyzed using STATA 14. The child mortality rate was calculated. The Cox proportional hazards regression model was fitted to identify predictor factors. The result of the study was presented using text, tables, graphs, and charts. An adjusted hazard ratio with a 95% confidence interval and a p-value less than 0.05 was used to declare the level of significance.

Result
A total of 415 (97.42%) of the 426 children on ART were included for analysis. Of these, 41(9.88%) children were died during the following period. The study participants were followed for a total of 8237 person- months of risk time. The overall mortality rate was 4.98 (95% CI: 3.67–6.77) per 1000 child-months. The estimated survival after starting ART was 61.42% at 56 months of follow-up. Severe underweight (AHR = 3.19; 95% CI: 1.32–7.71), tuberculosis (AHR = 3.86; CI: 1.76–8.47), low hemoglobin level (AHR = 2.51; CI: 1.02–6.20), and advanced WHO clinical stages at enrolment (AHR = 3.38; CI: 1.08–10.58) were predictors of death among HIV-infected under-five children on ART.

Conclusion
The incidence of mortality was 4.98 per 1000 child-months. Severe underweight, tuberculosis infection, low hemoglobin level, and advanced WHO clinical stages at enrolment were predictors of death among under-five children on ART.
Long-term exposure to outdoor air pollution and asthma in low-and middle-income countries: A systematic review protocol
Authors: Abbah Achenyo Peace , Xu Shanshan , Johannessen Ane 
Published: July 2023

Background
Several epidemiological studies have examined the risk of asthma and respiratory diseases in association with long-term exposure to outdoor air pollution. However, little is known regarding the adverse effects of long-term exposure to outdoor air pollution on the development of these outcomes in low- and middle-income countries (LMICs). Our study aims to investigate the association between long-term exposure to outdoor air pollution and asthma and respiratory diseases in LMICs through a systematic review with meta-analysis.

Methods
This systematic review and meta-analysis will follow the PRISMA (Preferred Reporting for Systematic Reviews and Meta-Analyses) checklist and flowchart guidelines. The inclusion criteria that will be used in our study are 1) Original research articles with full text in English; 2) Studies including adult humans; 3) Studies with long-term air pollution assessment in LMICs, air pollutants including nitrogen oxide (NO2), sulfur oxide (SO2), particulate matter (PM2.5 and PM10), carbon monoxide (CO) and ozone (O3); 4) cohort and cross-sectional studies; 5) Studies reporting associations between air pollution and asthma and respiratory symptoms. A comprehensive search strategy will be used to identify studies published up till August 2022 and indexed in Embase, Medline, and Web of Science. Three reviewers will independently screen records retrieved from the database searches. Where there are enough studies with similar exposure and outcomes, we will calculate, and report pooled effect estimates using meta-analysis.

Systematic review registration
PROSPERO CRD42022311326.

Discussion
Findings from the health effects of long-term exposure to outdoor air pollution may be of importance for policymakers. This review will also identify any gaps in the current literature on this topic in LMICs and provide direction for future research.
Types of kindergarten and their relationship with parental and children’s socio-demographic characteristics in Denmark
Authors: Specht Ina Olmer , Larsen Sofus Christian , Nielsen Ann-Kristine , Rohde Jeanett Friis , Heitmann Berit Lilienthal , Jørgensen Tanja Schjødt 
Published: July 2023

In Danish outdoor kindergartens, children are spending most of the day outdoors often in forests or similar nature environments. These children are assumed to be healthier than children attending conventional kindergartens, however, factors related to choosing a specific type of kindergarten may explain the differences. To better understand this, we aimed to investigate parents reasons for choosing either outdoor or conventional kindergartens based on a mixed-method participatory Concept Mapping approach, and further if parental socio-demographics and early child characteristics differed prior to enrolling children to either type of kindergarten using a cohort register-based approach.
Parents of children attending outdoor kindergartens (n = 23) weighed reasons such as “physical setting, outdoor life, and freedom of movement” high, whereas “a good first impression of the kindergarten” was an important reason for parents choosing a conventional kindergarten (n = 22). In the register-based approach, 2434 and 2643 children attended outdoor or conventional kindergartens, respectively. The parents choosing outdoor kindergartens as well as their children differed according to most investigated characteristics, including origin (maternal non-Western: 4.2% vs. 21.9%, p < .0001), educational level (maternal long education: 45.6% vs. 33.0%, p < .0001), prematurity (5.1% vs. 7.1%, p = 0.004) and sex (females: 43.5% vs. 48.6%, p = <0.0013). In conclusion, parental reasons for choosing kindergarten as well as parental socio-demographics differed substantially among kindergarten type. These differences might cause selection bias if not considering when comparing health outcomes among children attending different kinds of kindergartens.
The Dutch chronic lower limb-threatening ischemia registry (THRILLER): A study protocol for popliteal and infrapopliteal endovascular interventions
Authors: Nugteren Michael J. , Hazenberg Constantijn E. V. B. , Akkersdijk George P. , Bakker Olaf J. , Dinkelman Maarten K. , Fioole Bram , van den Heuvel Daniel A. F. , Heyligers Jan M. M. , Hinnen Jan-Willem , Pierie Maurice , Schouten Olaf , Schreve Michiel A. , Verhoeven Bart A. N. , de Borst Gert J. , Ünlü Çağdaş 
Published: July 2023

Introduction
Chronic limb-threatening ischemia (CLTI) is the end stage of peripheral arterial disease (PAD) and is associated with high amputation rates, mortality and disease-related health care costs. In infrapopliteal arterial disease (IPAD), endovascular revascularization should be considered for the majority of anatomical and clinical subgroups of CLTI. However, a gap of high-quality evidence exists in this field. The aim of the Dutch Chronic Lower Limb-Threatening Ischemia Registry (THRILLER) is to collect real world data on popliteal and infrapopliteal endovascular interventions.

Methods
THRILLER is a clinician-driven, prospective, multicenter, observational registry including all consecutive patients that undergo a popliteal or infrapopliteal endovascular intervention in seven Dutch hospitals. We estimate that THRILLER will include 400–500 interventions annually. Standardized follow-up visits with wound monitoring, toe pressure measurement and duplex ultrasonography will be scheduled at 6–8 weeks and 12 months after the intervention. The independent primary endpoints are primary patency, limb salvage and amputation free survival. Patients must give informed consent before participation and will be included according to predefined reporting standards. A data log of patients who meet the inclusion criteria but are not included in the registry will be maintained. We intend to conduct the first interim analysis two years after the start of inclusion. The results will be published in a scientific journal.

Discussion
Despite innovations in medical therapy and revascularization techniques, patients with CLTI undergoing endovascular revascularization still have a moderate prognosis. Previous prospective cohort studies were hampered by small sample sizes or heterogeneous reporting. Randomized controlled trials (RCTs) have high costs, potential conflicts of interest and give a limited reflection of daily practice. THRILLER aims to provide the largest prospective well phenotyped up-to-date dataset on treatment outcomes in CLTI patients to answer multiple underexplored research questions regarding diagnostics, medication, patient selection, treatment strategies and post intervention follow-up.
Geographical and spatial variations in bowel cancer screening participation, Australia, 2015–2020
Authors: Dasgupta Paramita , Cameron Jessica K. , Goodwin Belinda , Cramb Susanna M. , Mengersen Kerrie , Aitken Joanne F. , Baade Peter D. 
Published: July 2023

Background
Participation in bowel cancer screening programs remains poor in many countries. Knowledge of geographical variation in participation rates may help design targeted interventions to improve uptake. This study describes small-area and broad geographical patterns in bowel screening participation in Australia between 2015–2020.

Methods
Publicly available population-level participation data for Australia’s National Bowel Cancer Screening Program (NBCSP) were modelled using generalized linear models to quantify screening patterns by remoteness and area-level disadvantage. Bayesian spatial models were used to obtain smoothed estimates of participation across 2,247 small areas during 2019–2020 compared to the national average, and during 2015–2016 and 2017–2018 for comparison. Spatial heterogeneity was assessed using the maximized excess events test.

Results
Overall, screening participation rates was around 44% over the three time-periods. Participation was consistently lower in remote or disadvantaged areas, although heterogeneity was evident within these broad categories. There was strong evidence of spatial differences in participation over all three periods, with little change in patterns between time periods. If the spatial variation was reduced (so low participation areas were increased to the 80th centile), an extra 250,000 screens (4% of total) would have been conducted during 2019–2020.

Conclusions
Despite having a well-structured evidence-based government funded national bowel cancer screening program, the substantial spatial variation in participation rates highlights the importance of accounting for the unique characteristics of specific geographical regions and their inhabitants. Identifying the reasons for geographical disparities could inform interventions to achieve more equitable access and a higher overall bowel screening uptake.
Grasping with a Twist: Dissociating Action Goals from Motor Actions in Human Frontoparietal Circuits
Authors: Rens Guy , Figley Teresa D. , Gallivan Jason P. , Liu Yuqi , Culham Jody C. 
Published: July 2023

In daily life, prehension is typically not the end goal of hand-object interactions but a precursor for manipulation. Nevertheless, functional MRI (fMRI) studies investigating manual manipulation have primarily relied on prehension as the end goal of an action. Here, we used slow event-related fMRI to investigate differences in neural activation patterns between prehension in isolation and prehension for object manipulation. Sixteen (seven males and nine females) participants were instructed either to simply grasp the handle of a rotatable dial (isolated prehension) or to grasp and turn it (prehension for object manipulation). We used representational similarity analysis (RSA) to investigate whether the experimental conditions could be discriminated from each other based on differences in task-related brain activation patterns. We also used temporal multivoxel pattern analysis (tMVPA) to examine the evolution of regional activation patterns over time. Importantly, we were able to differentiate isolated prehension and prehension for manipulation from activation patterns in the early visual cortex, the caudal intraparietal sulcus (cIPS), and the superior parietal lobule (SPL). Our findings indicate that object manipulation extends beyond the putative cortical grasping network (anterior intraparietal sulcus, premotor and motor cortices) to include the superior parietal lobule and early visual cortex.SIGNIFICANCE STATEMENTA simple act such as turning an oven dial requires not only that the CNS encode the initial state (starting dial orientation) of the object but also the appropriate posture to grasp it to achieve the desired end state (final dial orientation) and the motor commands to achieve that state. Using advanced temporal neuroimaging analysis techniques, we reveal how such actions unfold over time and how they differ between object manipulation (turning a dial) versus grasping alone. We find that a combination of brain areas implicated in visual processing and sensorimotor integration can distinguish between the complex and simple tasks during planning, with neural patterns that approximate those during the actual execution of the action.
Postsynaptic Calcium Extrusion at the Mouse Neuromuscular Junction Alkalinizes the Synaptic Cleft
Authors: Durbin Ryan J. , Heredia Dante J. , Gould Thomas W. , Renden Robert B. 
Published: July 2023

Neurotransmission is shaped by extracellular pH. Alkalization enhances pH-sensitive transmitter release and receptor activation, whereas acidification inhibits these processes and can activate acid-sensitive conductances in the synaptic cleft. Previous work has shown that the synaptic cleft can either acidify because of synaptic vesicular release and/or alkalize because of Ca2+extrusion by the plasma membrane ATPase (PMCA). The direction of change differs across synapse types. At the mammalian neuromuscular junction (NMJ), the direction and magnitude of pH transients in the synaptic cleft during transmission remain ambiguous. We set out to elucidate the extracellular pH transients that occur at this cholinergic synapse under near-physiological conditions and identify their sources. We monitored pH-dependent changes in the synaptic cleft of the mouse levator auris longus using viral expression of the pseudoratiometric probe pHusion-Ex in the muscle. Using mice from both sexes, a significant and prolonged alkalization occurred when stimulating the connected nerve for 5 s at 50 Hz, which was dependent on postsynaptic intracellular Ca2+release. Sustained stimulation for a longer duration (20 s at 50 Hz) caused additional prolonged net acidification at the cleft. To investigate the mechanism underlying cleft alkalization, we used muscle-expressed GCaMP3 to monitor the contribution of postsynaptic Ca2+. Activity-induced liberation of intracellular Ca2+in muscle positively correlated with alkalization of the synaptic cleft, whereas inhibiting PMCA significantly decreased the extent of cleft alkalization. Thus, cholinergic synapses of the mouse NMJ typically alkalize because of cytosolic Ca2+liberated in muscle during activity, unless under highly strenuous conditions where acidification predominates.SIGNIFICANCE STATEMENTChanges in synaptic cleft pH alter neurotransmission, acting on receptors and channels on both sides of the synapse. Synaptic acidification has been associated with a myriad of diseases in the central and peripheral nervous system. Here, we report that in near-physiological recording conditions the cholinergic neuromuscular junction shows use-dependent bidirectional changes in synaptic cleft pH—immediate alkalinization and a long-lasting acidification under prolonged stimulation. These results provide further insight into physiologically relevant changes at cholinergic synapses that have not been defined previously. Understanding and identifying synaptic pH transients during and after neuronal activity provides insight into short-term synaptic plasticity synapses and may identify therapeutic targets for diseases.