bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association between early blood urea nitrogen-to-albumin ratio and one-year post-hospital mortality in critically ill surgical patients: a propensity score-matched study
Authors: Nguyen Khoi Nguyen , Chuang Tzu-I , Wong Li-Ting , Chan Ming-Cheng , Chao Wen-Cheng 
Published: July 2023

Abstract
Background
Blood urea nitrogen to albumin ratio (BAR) is increasingly recognized as an early predictor for short-term outcomes in critically ill patients, but the association of BAR with long-term outcomes in critically ill surgical patients remains underexplored.

Methods
We enrolled consecutive patients who were admitted to surgical intensive care units (ICUs) at Taichung Veterans General Hospital between 2015 and 2020, and the dates of death were retrieved from Taiwan’s National Health Insurance Research Database. In addition to Cox regression, we also used propensity score matching to determine the hazard ratios (HRs) and 95% confidence intervals (CIs) for one-year post-hospital mortality of the variables.

Results
A total of 8,073 eligible subjects were included for analyses. We found that age, male gender, high Charlson Comorbidity Index, high Acute Physiology and Chronic Health Evaluation II score, positive microbial culture, and leukocytosis were predictors for mortality, whereas high body mass index, scheduled surgery, and high platelet counts were protective factors against long-term mortality. The high BAR was independently associated with increased post-hospital mortality after adjustment for the aforementioned covariates (adjHR 1.258, 95% CI, 1.127–1.405). Notably, the association tended to be stronger in females and patients with fewer comorbidities and lower disease severity of critical illness. The propensity score matching, dividing subjects by BAR higher or lower than 6, showed a consistent association between week-one BAR and post-hospital mortality (adjHR 1.503, 95% CI 1.247–1.811).

Conclusions
BAR is a newly identified predictor of short-term outcome, and we identified long-term outcome-relevant factors, including BAR, and the identified factors may be useful for risk stratification of long-term outcomes in patients discharged from surgical ICUs.
Pregnancy loss following miscarriage and termination of pregnancy for medical reasons during the COVID-19 pandemic: a thematic analysis of women’s experiences of healthcare on the island of Ireland
Authors: Heaney Suzanne , Galeotti Martina , Aventin Áine 
Published: July 2023

Abstract
Background
Losing a baby during pregnancy can be a devastating experience for expectant parents. Many report dedicated, compassionate healthcare provision as a facilitator of positive mental health outcomes, however, healthcare services have been severely impacted during the COVID-19 pandemic.

Aim
To explore women’s experiences of healthcare service provision for miscarriage and termination of pregnancy for medical reasons (TFMR) on the island of Ireland during the COVID-19 pandemic.

Methods
Findings combine data from elements of two separate studies. Study 1 used a mixed methods approach with women who experienced miscarriage and attended a hospital in Northern Ireland. Study 2 was qualitative and examined experiences of TFMR in Northern Ireland and Ireland. Data analysed for this paper includes open-ended responses from 145 women to one survey question from Study 1, and semi-structured interview data with 12 women from Study 2. Data were analysed separately using Thematic Analysis and combined for presentation in this paper.

Results
Combined analysis of results indicated three themes, (1) Lonely and anxiety-provoking experiences; (2) Waiting for inadequate healthcare; and (3) The comfort of compassionate healthcare professionals.

Conclusions
Women’s experiences of healthcare provision were negatively impacted by COVID-19, with the exclusion of their partner in hospital, and delayed services highlighted as particularly distressing. Limited in-person interactions with health professionals appeared to compound difficulties. The lived experience of service users will be helpful in developing policies, guidelines, and training that balance both the need to minimise the risk of infection spread, with the emotional, psychological, and physical needs and wishes of parents. Further research is needed to explore the long-term impact of pregnancy loss during a pandemic on both parents and health professionals delivering care.
“Figuring stuff out myself” – a qualitative study on maternal vaccination in socially and ethnically diverse areas in England
Authors: Berendes Sima , Mounier-Jack Sandra , Ojo-Aromokudu Oyinkansola , Ivory Alice , Tucker Joseph D. , Larson Heidi J. , Free Caroline 
Published: July 2023

Abstract
Background
Maternal vaccinations against Influenza, Pertussis, and Covid-19 are recommended in the UK, and vaccines against further infections may become available soon. However, many pregnant women, especially in socially and ethnically diverse areas, have low vaccine uptake. Qualitative studies on the reasons and possible solutions are needed that are inclusive of disadvantaged and minority ethnic groups. We therefore aimed to understand the complex interplay between structural and behavioural factors contributing to the low maternal vaccine uptake in socially and ethnically diverse areas in London in the Covid-19 context.

Methods
In 2022, we conducted semi-structured interviews and a focus group discussion among a purposive sample of 38 pregnant/recently pregnant women and 20 health service providers, including 12 midwives. Participants were recruited in ethnically diverse London boroughs. We followed a critical realist paradigm and used a thematic analysis approach.

Results
The sample included participants who took all, some or none of the maternal vaccines, with some participants unsure whether they had taken or been offered the vaccines. Decision-making was passive or active, with the expectation for pregnant women to do their 'own research'. Participants described various individual, social and contextual influences on their decision-making as they navigated the antenatal care system. Missing or conflicting information from providers meant knowledge gaps were sometimes filled with misinformation from unreliable sources that increased uncertainties and mistrust. Both pregnant women and providers described structural and organisational factors that hindered access to information and vaccinations, including lack of training, time and resources, and shortcomings of health information systems and apps. Some participants described factors that facilitated vaccination uptake and many made recommendations for improvements.

Conclusions
Our study showed how structural and organisational factors can compound uncertainties around maternal vaccination among socially and ethnically diverse populations. Results highlight the need for more reliable resources, streamlined workflows, improved electronic information systems and training in their use. Roles and responsibilities should be clarified with potential greater involvement of nurses and pharmacists in vaccine provision. Education and communication should consider individual (language/digital) skills and needs for information and reassurance. Further research is needed to co-produce solutions with service users and providers.
A scoping review on hyposalivation associated with systemic conditions: the role of physical stimulation in the treatment approaches
Authors: Melo Jéssica Luiza de Mendonça Albuquerq , Coelho Camila Pinho e Souza , Nunes Fernanda de Paula e Silva , Heller Debora , Grisi Daniela Corrêa , Guimarães Maria do Carmo Machado , Dame-Teixeira Naile 
Published: July 2023

Abstract
Background
Several systemic conditions can result in distinct degrees of salivary gland damage and consequent hypofunction. The development of successful management schemes is highly challenging due to the complexity of saliva. This study aimed to systematically map the literature on the physical stimulation of salivary glands for hyposalivation management and the response of individuals according to different systemic conditions causing salivary impairment.

Methods
A systematic search in the literature was performed. Two reviewers independently selected clinical trials, randomized or not, that used physical stimulation to treat hyposalivation caused by systemic conditions. Studies evaluating healthy subjects without hyposalivation were included as controls. Single-arm clinical studies or case series were also included for protocol mapping (PRISMA extension for scoping reviews).

Results
Out of 24 included studies, 10 evaluated healthy subjects, from which 9 tested transcutaneous electrical nerve stimulation (TENS) and 1 tested acupuncture and electroacupuncture. Fourteen studies evaluated individuals with hyposalivation: 6 applied TENS, 6 applied low-level laser therapy (LLLT), and 2 applied acupuncture, carried out in post-chemotherapy, medication use, postmenopausal women, hemodialysis patients, smokers, diabetics, Sjögren's syndrome (SS). All showed increased salivation after treatment, except for two LLLT studies in individuals with SS.

Conclusions
Among the different patient groups, individuals with Sjögren's syndrome (SS) exhibited the poorest responses, while those with medication-induced hyposalivation demonstrated the most favorable treatment outcomes, independently of the management strategy for saliva stimulation. It means that physical stimulation of salivary glands holds promise as an alternative for managing hyposalivation in cases of reversible gland damage. However, to make informed decisions in current practice, it is necessary to conduct new well-designed randomized clinical trials with appropriate methodologies.
An intelligent decision support system for acute postoperative endophthalmitis: design, development and evaluation of a smartphone application
Authors: Shaeri Mahdi , Shoeibi Nasser , Hosseini Seyedeh Maryam , Jeddi Fatemeh Rangraze , Farrahi Razieh , Nabovati Ehsan , Salehzadeh Azam 
Published: July 2023

Abstract
Background
Today, clinical decision support systems based on artificial intelligence can significantly help physicians in the correct diagnosis and quick rapid treatment of endophthalmitis as the most important cause of blindness in emergency diseases. This study aimed to design, develop, and evaluate an intelligent decision support system for acute postoperative endophthalmitis.

Methods
This study was conducted in 2020–2021 in three phases: analysis, design and development, and evaluation. The user needs and the features of the system were identified through interviews with end users. Data were analyzed using thematic analysis. The list of clinical signs of acute postoperative endophthalmitis was provided to ophthalmologists for prioritization. 4 algorithms support vector machine, decision tree classifier, k-nearest neighbors, and random forest were used in the design of the computing core of the system for disease diagnosis. The acute postoperative endophthalmitis diagnosis application was developed for using by physicians and patients. Based on the data of 60 acute postoperative endophthalmitis patients, 143 acute postoperative endophthalmitis records and 12 non-acute postoperative endophthalmitis records were identified. The learning process of the algorithm was performed on 70% of the data and 30% of the data was used for evaluation.

Results
The most important features of the application for physicians were selecting clinical signs and symptoms, predicting diagnosis based on artificial intelligence, physician–patient communication, selecting the appropriate treatment, and easy access to scientific resources. The results of the usability evaluation showed that the application was good with a mean (± SD) score of 7.73 ± 0.53 out of 10.

Conclusion
A decision support system with accuracy, precision, sensitivity and specificity, negative predictive values, F-measure and area under precision-recall curve 100% was created thanks to widespread participation, the use of clinical specialists' experiences and their awareness of patients' needs, as well as the availability of a comprehensive acute postoperative endophthalmitis clinical dataset.
Lipopolysaccharide-binding protein and future Parkinson’s disease risk: a European prospective cohort
Authors: Zhao Yujia , Walker Douglas I. , Lill Christina M. , Bloem Bastiaan R. , Darweesh Sirwan K. L. , Pinto-Pacheco Brismar , McNeil Brooklyn , Miller Gary W. , Heath Alicia K. , Frissen Myrthe , Petrova Dafina , Sánchez Maria-Jose , Chirlaque María-Dolores , Guevara Marcela , Zibetti Maurizio , Panico Salvatore , Middleton Lefkos , Katzke Verena , Kaaks Rudolf , Riboli Elio , Masala Giovanna , Sieri Sabina , Zamora-Ros Raul , Amiano Pilar , Jenab Mazda , Peters Susan , Vermeulen Roel 
Published: July 2023

Abstract
Introduction
Lipopolysaccharide (LPS) is the outer membrane component of Gram-negative bacteria. LPS-binding protein (LBP) is an acute-phase reactant that mediates immune responses triggered by LPS and has been used as a blood marker for LPS. LBP has recently been indicated to be associated with Parkinson’s disease (PD) in small-scale retrospective case–control studies. We aimed to investigate the association between LBP blood levels with PD risk in a nested case–control study within a large European prospective cohort.

Methods
A total of 352 incident PD cases (55% males) were identified and one control per case was selected, matched by age at recruitment, sex and study center. LBP levels in plasma collected at recruitment, which was on average 7.8 years before diagnosis of the cases, were analyzed by enzyme linked immunosorbent assay. Odds ratios (ORs) were estimated for one unit increase of the natural log of LBP levels and PD incidence by conditional logistic regression.

Results
Plasma LBP levels were higher in prospective PD cases compared to controls (median (interquartile range) 26.9 (18.1–41.0) vs. 24.7 (16.6–38.4) µg/ml). The OR for PD incidence per one unit increase of log LBP was elevated (1.46, 95% CI 0.98–2.19). This association was more pronounced among women (OR 2.68, 95% CI 1.40–5.13) and overweight/obese subjects (OR 1.54, 95% CI 1.09–2.18).

Conclusion
The findings suggest that higher plasma LBP levels may be associated with an increased risk of PD and may thus pinpoint to a potential role of endotoxemia in the pathogenesis of PD, particularly in women and overweight/obese individuals.
The European experience with testing and surveillance during the first phase of the COVID-19 pandemic
Authors: Stoto Michael A. , Reno Chiara , Tsolova Svetla , Fantini Maria Pia 
Published: July 2023

Abstract
Background
COVID-19 pandemic provides a unique opportunity to learn the challenges encountered by public health emergency preparedness systems, both in terms of problems encountered and adaptations during and after the first wave, as well as successful responses to them.

Results
This work draws on published literature, interviews with countries and institutional documents as part of a European Centre for Disease Prevention and Control project that aims to identify the implications for preparedness measurement derived from COVID-19 pandemic experience in order to advance future preparedness efforts in European Union member states. The analysis focused on testing and surveillance themes and five countries were considered, namely Italy, Germany, Finland, Spain and Croatia. Our analysis shown that a country’s ability to conduct testing at scale was critical, especially early in the pandemic, and the inability to scale up testing operations created critical issues for public health operations such as contact tracing. Countries were required to develop new strategies, approaches, and policies under pressure and to review and revise them as the pandemic evolved, also considering that public health systems operate at the national, regional, and local level with respect to testing, contact tracing, and surveillance, and involve both government agencies as well as private organizations. Therefore, communication among multiple public and private entities at all levels and coordination of the testing and surveillance activities was critical.

Conclusion
With regard to testing and surveillance, three capabilities that were essential to the COVID-19 response in the first phase, and presumably in other public health emergencies: the ability to scale-up testing, contact tracing, surveillance efforts; flexibility to develop new strategies, approaches, and policies under pressure and to review and revise them as the pandemic evolved; and the ability to coordinate and communicate in complex public health systems that operate at the national, regional, and local level with respect and involve multiple government agencies as well as private organizations.
Predicting disease severity in metachromatic leukodystrophy using protein activity and a patient phenotype matrix
Authors: Trinidad Marena , Hong Xinying , Froelich Steven , Daiker Jessica , Sacco James , Nguyen Hong Phuc , Campagna Madelynn , Suhr Dean , Suhr Teryn , LeBowitz Jonathan H. , Gelb Michael H. , Clark Wyatt T. 
Published: July 2023

Abstract
Background
Metachromatic leukodystrophy (MLD) is a lysosomal storage disorder caused by mutations in the arylsulfatase A gene (ARSA) and categorized into three subtypes according to age of onset. The functional effect of most ARSA mutants remains unknown; better understanding of the genotype–phenotype relationship is required to support newborn screening (NBS) and guide treatment.

Results
We collected a patient data set from the literature that relates disease severity to ARSA genotype in 489 individuals with MLD. Patient-based data were used to develop a phenotype matrix that predicts MLD phenotype given ARSA alleles in a patient’s genotype with 76% accuracy. We then employed a high-throughput enzyme activity assay using mass spectrometry to explore the function of ARSA variants from the curated patient data set and the Genome Aggregation Database (gnomAD). We observed evidence that 36% of variants of unknown significance (VUS) in ARSA may be pathogenic. By classifying functional effects for 251 VUS from gnomAD, we reduced the incidence of genotypes of unknown significance (GUS) by over 98.5% in the overall population.

Conclusions
These results provide an additional tool for clinicians to anticipate the disease course in MLD patients, identifying individuals at high risk of severe disease to support treatment access. Our results suggest that more than 1 in 3 VUS in ARSA may be pathogenic. We show that combining genetic and biochemical information increases diagnostic yield. Our strategy may apply to other recessive diseases, providing a tool to address the challenge of interpreting VUS within genotype–phenotype relationships and NBS.
Hyperactivity in patients with narcolepsy and idiopathic hypersomnia: an exploratory study
Authors: Dodson Caroline , Spruyt Karen , Considine Ciaran , Thompson Emily , Ipsiroglu Osman S. , Bagai Kanika , Silvestri Rosalia , Couvadelli Barbara , Walters Arthur S. 
Published: July 2023

Abstract
Introduction
Patients with either Idiopathic Hypersomnia or Narcolepsy demonstrate excessive daytime somnolence (EDS) with resultant inattention mimicking Attention Deficit Hyperactivity Disorder (ADHD). Patients with ADHD also often express sleep problems including EDS. Thus, patients with ADHD and patients with idiopathic hypersomnia or narcolepsy may share inattention and daytime drowsiness as common features. However, it is not known whether EDS patients with idiopathic hypersomnia or narcolepsy also have increased movement (hyperactivity) like ADHD patients, the determination of which is the purpose of this study.

Methods
We studied 12 patients (7 Narcolepsy type 2 and 5 Idiopathic Hypersomnia) with EDS as shown by Multiple Sleep Latency Test which served as the gold standard for entry into the study. Twelve subjects without symptoms of EDS served as the control group. None of the participants had a previous history of ADHD. Each participant underwent a one-hour session laying at 45 degrees with surveys about the need to move and actigraphy as an objective measure of movement.

Results
Sleep-disordered patients with EDS reported more symptoms of inattention and hyperactivity on the ADHD Self-Report Scale. At each of the time points patients with EDS had a clear trend to express the need to move more than controls on the Suggested Immobilization Test (SIT). For the total 60 min, a large effect size for the need to move during the SIT test was found between patients and controls (Cohen’s d = 0.61, p = 0.01). Patients with EDS did not express a need to move more to combat drowsiness than controls, nor did actigraphy show any difference in objective movement between patients and controls during the SIT.

Conclusion
Patients with EDS express inattention and a need to move more than controls. However, hyperactivity was not verified by objective measurement, nor did the EDS patients express a need to move to combat drowsiness more than controls. Thus, a hypothesis to be further tested, is whether narcolepsy and idiopathic hypersomnia may be more a model of the inattentive form of ADHD rather than the combined or inattentive/hyperactive form of ADHD. Further studies are needed to explore the relationship between EDS and hyperactivity.
Stress-Dependent Behavior of Lightly Stabilized Industrial Waste Subbase Using Falling Weight Deflectometer
Authors: Bakare Mayuresh Dhanraj , Shahu Jagdish Telangrao , Patel Satyajit 
Published: July 2023

Abstract
Pavement layers exhibit stress-dependent behavior, characterized by using a laboratory resilient modulus (Mr) test. However, the field behavior of such materials seldom matches with the laboratory because of changes in the state of stress, material matrix, and loading patterns. In this study, the nonlinear behaviors of three innovative fly ash-based lightly stabilized industrial waste mixes that are proposed to replace the granular subbase of flexible pavement are characterized and compared in the laboratory and field for the first time. Nine full-scale pavement test sections were constructed with three varying thicknesses of waste mix subbase layers, namely, fly ash +  5 % lime (FAL), 70 % copper slag +  30 % fly ash (CFA) and 80 % fly ash +  20 % granulated blast furnace slag (FAG). Repeated load triaxial tests on lab samples and multiload falling weight deflectometer (FWD) tests (40 kN, 55 kN and 70 kN) on test sections conducted for three years post-construction were used to extract the nonlinear behavior of Mr and the FWD backcalculated modulus (EFWD) of subbase layers. Effects of curing and traffic damage on the nonlinear parameters of EFWD were investigated. Stress-dependent conversion factors based on two different constitutive models were established to convert Mr to EFWD at different points of the subbase service life. Stabilized waste mixes exhibited stress hardening with increasing bulk and deviatoric stresses both in the field and laboratory. Curing increased EFWD and reduced the effect of stresses on the EFWD. In contrast, traffic damage imparted the opposite effect, as the stabilized waste mixes transformed into a cracked and blocky mass. The results of this study will allow practitioners to predict the field performance of waste mix subbase with great accuracy, resulting in a reliable design and possible cost savings.