bluuebunny/crossref_metadata_2025_split huggingface dataset:
Explainable prediction of daily hospitalizations for cerebrovascular disease using stacked ensemble learning
Authors: Lu Xiaoya , Qiu Hang 
Published: April 2023

Abstract
Background
With the prevalence of cerebrovascular disease (CD) and the increasing strain on healthcare resources, forecasting the healthcare demands of cerebrovascular patients has significant implications for optimizing medical resources.

Methods
In this study, a stacking ensemble model comprised of four base learners (ridge regression, random forest, gradient boosting decision tree, and artificial neural network) and a meta learner (elastic net) was proposed for predicting the daily number of hospital admissions (HAs) for CD using the historical HAs data, air quality data, and meteorological data in Chengdu, China from 2015 to 2018. To solve the label imbalance problem, a re-weighting method based on label distribution smoothing was integrated into the meta learner. We trained the model using the data from 2015 to 2017 and evaluated its predictive ability using the data in 2018 based on four metrics, including mean absolute error (MAE), root mean square error (RMSE), mean absolute percentage error (MAPE), and coefficient of determination (R2). In addition, the SHapley Additive exPlanations (SHAP) framework was applied to provide explanation for the prediction of our stacking model.

Results
Our proposed model outperformed all the base learners and long short-term memory (LSTM) on two datasets. Particularly, compared with the optimal results obtained by individual models, the MAE, RMSE, and MAPE of the stacking model decreased by 13.9%, 12.7%, and 5.8%, respectively, and the R2 improved by 6.8% on CD dataset. The model explanation demonstrated that environmental features played a role in further improving the model performance and identified that high temperature and high concentrations of gaseous air pollutants might strongly associate with an increased risk of CD.

Conclusions
Our stacking model considering environmental exposure is efficient in predicting daily HAs for CD and has practical value in early warning and healthcare resource allocation.
The associations of continuity of care with inpatient, outpatient, and total medical care costs among older adults with urinary incontinence
Authors: Han Eunkyung , Chung Wankyo , Trujillo Antonio , Gittelsohn Joel , Shi Leiyu 
Published: April 2023

Abstract
Introduction
Urinary incontinence is a significant health problem with considerable social and economic consequences among older adults. The objective of this study was to investigate the financial impact of continuity of care (CoC) among older urinary incontinence patients in South Korea.

Methods
We used the NHIS-Senior cohort patient data between January 1, 2010, and December 31, 2010. Patients who were diagnosed with urinary incontinence in 2010 were included. Operational definition of CoC included referrals, number of providers, and number of visits. A generalized linear model (GLM) with γ-distributed errors and the log link function was used to examine the relationship between health cost and explanatory variables. Additionally, we conducted a two-part model analysis for inpatient cost. Marginal effect was calculated.

Results
Higher CoC was associated with a decrease in total medical cost (-0.63, P < .0001) and in outpatient costs (-0.28, P < .001). Higher Charlson Comorbidity Index (CCI) score was a significant predictor for increasing total medical cost (0.59, P < .0001) and outpatient cost (0.22, P < .0001). Higher CoC predict a reduced medical cost of $360.93 for inpatient cost (P = 0.044) and $23.91 for outpatient cost (P = 0.008) per patient.

Conclusion
Higher CoC was associated with decrease in total medical costs among older UI patients. Policy initiatives to promote CoC of older UI patients in the community setting could lead to greater financial sustainability of public health insurance in South Korea.
Distribution of serum uric acid concentration and its association with lipid profiles: a single-center retrospective study in children aged 3 to 12 years with adenoid and tonsillar hypertrophy
Authors: Yu Jiating , Liu Xin , Ji Honglei , Zhang Yawei , Zhan Hanqiang , Zhang Ziyin , Wen Jianguo , Wang Zhimin 
Published: April 2023

Abstract
Background
Presently, there is no consensus regarding the optimal serum uric acid (SUA) concentration for pediatric patients. Adenoid and tonsillar hypertrophy is considered to be closely associated with pediatric metabolic syndrome and cardiovascular risk and is a common condition in children admitted to the hospital. Therefore, we aimed to evaluate the relationship between SUA and dyslipidemia and propose a reference range for SUA concentration that is associated with a healthy lipid profile in hospitalized children with adenoid and tonsillar hypertrophy.

Methods
Preoperative data from 4922 children admitted for elective adenoidectomy and/or tonsillectomy surgery due to adenoid and tonsillar hypertrophy were collected. SUA concentrations were scaled to standard deviation (SD), and SUA deviations were expressed as SD from the mean SUA of children without dyslipidemia.

Results
The mean SUA concentration of the participants was 4.27 ± 1.01 mg/dL, and the prevalence of hyperuricemia was 1.6% when it was defined using an SUA of ≥ 7.0 mg/dL. Participants with dyslipidemia (856, 17.4%) had a higher prevalence of hyperuricemia (3.4% vs. 1.2%, P < 0.001) and higher SUA concentrations (4.51 ± 1.15 vs. 4.22 ± 0.97 mg/dL, P < 0.001) than those with ortholiposis. The circulating lipid status of participants with SUAs < 1 SD below the mean value for the participants with ortholiposis (range 1.80–3.28 mg/dL) was more normal. Each 1-SD increase in SUA was associated with a 27% increase in the risk of dyslipidemia (OR = 1.270, 95% CI, 1.185–1.361). Adjustment for a number of potential confounders reduced the strength of the relationship, but this remained significant (OR = 1.125, 95% CI, 1.042–1.215). The higher risk of dyslipidemia was maintained for participants with SUAs > 1 SD above the mean value of the participants with ortholiposis.

Conclusions
SUA was independently associated with dyslipidemia in children with adenoid and tonsillar hypertrophy, and an SUA < 1 SD below the mean value for patients with ortholiposis was associated with a healthy lipid profile.
Protein corona and exosomes: new challenges and prospects
Authors: Heidarzadeh Morteza , Zarebkohan Amir , Rahbarghazi Reza , Sokullu Emel 
Published: April 2023

AbstractRecent advances in extracellular vesicle (EVs) detection and isolation methods have led to the development of novel therapeutic modalities. Among different types of EVs, exosomes (Exos) can transfer different signaling biomolecules and exhibit several superior features compared to whole-cell-based therapies. Therapeutic factors are normally loaded into the Exo lumen or attached to their surface for improving the on-target delivery rate and regenerative outcomes. Despite these advantages, there are several limitations in the application of Exos in in vivo conditions. It was suggested that a set of proteins and other biological compounds are adsorbed around Exos in aqueous phases and constitute an external layer named protein corona (PC). Studies have shown that PC can affect the physicochemical properties of synthetic and natural nanoparticles (NPs) after introduction in biofluids. Likewise, PC is generated around EVs, especially Exos in in vivo conditions. This review article is a preliminary attempt to address the interfering effects of PC on Exo bioactivity and therapeutic effects.
Graphical Abstract
Assessments of functional outcomes and its determinants among bipolar disorder patients in Northwest Ethiopia comprehensive specialized hospitals: a multicenter hospital-based study
Authors: Mengistu Melak Erara , Berassa Simegnew Handebo , Kassaw Abebe Tarekegn , Dagnew Ephrem Mebratu , Mekonen Gizework Alemnew , Birarra Mequanent Kassa 
Published: April 2023

Abstract
Introduction
Bipolar disorder is a severe and chronic mental illness that could continue for a lifetime. Although it is a leading cause of disability and impairments for significant numbers of patients, the levels of functional outcomes have not been studied in Ethiopia. Therefore, this study aimed to assess the functional outcome levels and associated factors among bipolar disorder patients in Northwest Ethiopia.

Method
Hospital-based cross-sectional study was employed among bipolar disorder patients attending psychiatric clinics, in Northwest Ethiopia, from April to June 2021. Systematic random sampling was used to get respondents. Descriptive and inferential statistics were done. Data were entered into EpiData version 4.6.02 and exported to SPSS Version 22 for analysis. Bivariable and multivariable binary logistic regression analysis was used to identify the factors associated with functional outcome levels, and p value < 0.05 was considered significant with 95% CI.

Result
Of the total 423 study participants approached, only 411 completed the questionnaire, with a response rate of 97.2%. The median (IQR) level of functional outcome was 6 (0–22) and 40% of the study subjects were impaired. Leisure time was the most normal functioning domain (92.2%), whereas cognitive (43.5%) and occupational (41.6%) domains were the most impaired domains. Unemployment (AOR (95%CI) = 3.9 (1.46–10.49), obesity (AOR (95% CI) = 6.5 (1.22–34.58), depressed and manic mood phases (AOR (95%CI) = 5.2 (2.84–9.35) and (AOR (95%CI) = 7.8 (3.31–18.34) respectively, medication non-adherence (AOR (95% CI) = 3.2 (1.71–6.05), and relapsed once or ≥ twice (AOR (95%CI) = 2.2 (1.25–3.98) and (AOR (95%CI) = 8.3 (2.73–25.30), respectively, were some of the important predictor variables that were significantly associated to the functional impairments levels.

Conclusion
The median of functional outcomes levels was found in an acceptable range; however, significant numbers of bipolar patients were functionally impaired. Moreover, patients still need unrestricted interventions in the cognitive and occupational functional domains. Socio-demographic, clinical, medication, and psychosocial variables were significantly associated with functional outcomes. Bipolar patients need to be followed and managed to improve their functional outcome and all stakeholders should be involved to achieve the recommended levels.
Gendered traditional agroecological knowledge in agri-food systems: a systematic review
Authors: Ramirez-Santos Ana G. , Ravera Federica , Rivera-Ferre Marta G. , Calvet-Nogués Mar 
Published: April 2023

AbstractTraditional agroecological knowledge (i.e. TAeK) is gaining recognition for its potential contribution to climate change adaptation in food systems, ecosystems restoration and food insecurity. Despite the existing literature on Traditional Ecological Knowledge and its nexus with food security, how gender critically influences the distribution of such knowledge within agri-food systems has not yet been systematically analysed. In this regard, this systematic review attempts to answer four questions: 1) How does the literature on gender and TAeK in agri-food systems evolved temporally, geographically and in different agroecosystems? 2) How are gender and intersectionality mainly approached by such literature? 3) How do the articles address gendered dimensions in TAeK within the agri-food system activities? 4) What are the main drivers of change that influence TAeK and adaptive responses? The results show the gendered nature of TAeK in relation to food production, processing, and conservation activities, and how these activities are linked to tasks and activities, gender-specific knowledge, and spaces where gender discrimination is reproduced. The review also identifies elements that delimit and/or take part of the development of TAeK, such as gendered access to resources, gendered institutions, and the identification of the main drivers of change and impacts of TAeK erosion and biodiversity loss. These results are discussed in terms of power relations that interact with sociocultural norms and practices according to the specific geographical context and agroecosystem.
Goal-directed fluid therapy using uncalibrated pulse contour analysis and balanced crystalloid solutions during hip revision arthroplasty: a quality implementation project
Authors: Trauzeddel R. F. , Leitner M. , Dehé L. , Nordine M. , Piper S. K. , Habicher M. , Sander M. , Perka C. , Treskatsch S. 
Published: April 2023

Abstract
Background
To implement a goal-directed fluid therapy (GDFT) protocol using crystalloids in hip revision arthroplasty surgery within a quality management project at a tertiary hospital using a monocentric, prospective observational study.

Methods
Adult patients scheduled for elective hip revision arthroplasty surgery were screened for inclusion in this prospective study. Intraoperatively stroke volume (SV) was optimized within a previously published protocol using uncalibrated pulse contour analysis and balanced crystalloids. Quality of perioperative GDFT was assessed by protocol adherence, SV increase as well as the rate of perioperative complications. Findings were then compared to two different historical groups of a former trial: one receiving GDFT with colloids (prospective colloid group) and one standard fluid therapy (retrospective control group) throughout surgery. Statistical analysis constitutes exploratory data analyses and results are expressed as median with 25th and 75th percentiles, absolute and relative frequencies, and complication rates are further given with 95% confidence intervals for proportions using the normal approximation without continuity correction.

Results
Sixty-six patients underwent GDFT using balanced crystalloids and were compared to 130 patients with GDFT using balanced colloids and 130 controls without GDFT fluid resuscitation. There was a comparable increase in SV (crystalloids: 65 (54–74 ml; colloids: 67.5 (60–75.25 ml) and total volume infused (crystalloids: 2575 (2000–4210) ml; colloids: 2435 (1760–3480) ml; and controls: 2210 (1658–3000) ml). Overall perioperative complications rates were similar (42.4% (95%CI 30.3–55.2%) for crystalloids and 49.2% (95%CI 40.4–58.1%) for colloids and lower compared to controls: 66.9% (95%CI 58.1–74.9)). Interestingly, a reduced number of hemorrhagic complications was observed within crystalloids: 30% (95%CI 19.6–42.9); colloids: 43% (95%CI 34.4–52.0); and controls: 62% (95%CI 52.6–69.9). There were no differences in the rate of admission to the post-anesthesia care unit or intensive care unit as well as the length of stay.

Conclusions
Perioperative fluid management using a GDFT protocol with crystalloids in hip revision arthroplasty surgery was successfully implemented in daily clinical routine. Perioperative complications rates were reduced compared to a previous management without GDFT and comparable when using colloids.
Trial registration: ClinicalTrials.gov identifier: NCT01753050.
Left ventricular assist device exchange from HeartMate II to HeartMate 3 in an Asian patient—a case report and literature review
Authors: Chang Hsiao-Huang , Kuo Tzu-Ting , Chen Po-Lin , Kuo Chia-Cheng , Kuo Ching-Yuan , Wu Nai-Yuan 
Published: April 2023

Abstract
Background
Pump exchange surgery of left ventricular assist device (LVAD) has been demonstrated in several studies; however, information for Asian patients was limited.

Case presentation
A 63-year-old man underwent a pump upgrade from HeartMate II to HeartMate 3 for driveline damage through limited left anterior thoracotomy and lower partial sternotomy. He did not experience any hemodynamic adverse events or device malfunction during postoperative follow-ups of 12 months. We also reviewed all published cases with HeartMate II exchange to HeartMate 3.

Conclusions
The case demonstrated that it was safe and feasible to perform HMII LVAD exchange to HM3 through a limited approach for Asian patients.
Reliability and validity of the English, Chinese, Korean, Indonesian, and Vietnamese versions of the public health research foundation stress checklist short form
Authors: HAYASHI Yoko , IMAZU Yoshie , DENG Sixin , MURAKAMI Masato 
Published: April 2023

Abstract
Background
Foreign nationals residing in Japan account for approximately 2% of the total population (i.e., approximately 2.6 million people). Of these, 12% are not proficient in speaking Japanese and 25% experience difficulty reading Japanese. Therefore, a simple, convenient, and accurate scale in the native language of foreign nationals is required to support their mental health. In this study, the Public Health Research Foundation Stress Checklist Short Form (PHRF-SCL (SF)) was translated into five languages and the reliability and validity of the translations were confirmed.

Methods
The five translated versions of the PHRF-SCL (SF) have been reverse-translated into the original language, Japanese. The creator confirmed that there were no inconsistencies between the Japanese and reverse-translated versions. A total of 777 adults aged 18–64 years participated in the study. They were asked to complete the native language versions of the PHRF-SCL (SF) and Depression Anxiety Stress Scale 21 (DASS 21) online.

Results
An exploratory factor analysis yielded the same four-factor structure as the original. Internal consistency was confirmed by the alpha coefficients of the subscales. Participants were classified into two groups on the basis of the severity classification obtained from each subscale of the DASS 21. Scores of PHRF-SCL (SF) are significantly higher in groups classified as symptomatic by DASS 21, thereby confirming construct validity. Concomitant validity was confirmed based on correlations with the DASS 21.

Conclusions
English, Chinese, Korean, Indonesian, and Vietnamese versions of the PHRF-SCL(SF) have been prepared. Although these versions are subject to further statistical analysis, the results were sufficiently substantiated for practical use. This scale is expected to contribute to the promotion of mental health services for people from these countries.
Methodical control of the difficult pediatric airway: two case reports
Authors: Low A. , Hunter D. , Baboolal H. A. 
Published: April 2023

Abstract
Background
Management of children who present with a history of impossible mask ventilation or difficult tracheal intubation is fraught with challenges. Despite this, the “airway stress test” of an inhalational induction is frequently employed risking airway obstruction, breath holding, apnea, and laryngospasm.

Case presentations
We present two cases of children with anticipated difficult airway management. The first child (14-year-old African American boy) had severe mucopolysaccharidosis with a history of failed anesthetic induction and failed airway management. The second child (3-year-old African American girl) had progressive lymphatic infiltration of the tongue, resulting in severe macroglossia. We describe a technique that forgoes inhalational induction, incorporates recent pediatric airway guidelines, and provides a greater margin of safety. The technique encompasses the use of drugs that facilitate sedation for intravenous access, without respiratory depression or airway obstruction, titrated use of medications to achieve anesthetic depth while preserving ventilatory drive and airway tone, and the continuous provision of directed oxygen flow during airway manipulation. Propofol and volatile gases were avoided to preserve airway tone and respiratory drive.

Conclusions
We emphasize that an intravenous induction technique utilizing medications that preserve airway tone and ventilatory drive, and the use of continuous oxygen flow throughout airway manipulation, allows for successful management of children with a difficult airway. The common practice of volatile inhalational induction should be avoided in anticipated difficult pediatric airways.
How socioeconomic status affected the access to health facilities and malaria diagnosis in children under five years: findings from 19 sub-Saharan African countries
Authors: Ge Yue , Liang Di , Cao Jun , Gosling Roland , Mushi Vivian , Huang Jiayan 
Published: April 2023

Abstract
Background
Prompt and appropriate clinical management of malaria is critical for reducing the continued high burden of malaria among children under five years in sub-Saharan countries. However, more remains to be known about how a patient’s socioeconomic status (SES) would affect the access to diagnosis of malaria.

Methods
In this cross-sectional study using the Demographic and Health Survey and Malaria Indicators Survey, we pooled the data of 38,567 febrile under-five children in 2016–2018 from 19 sub-Saharan countries. Multivariable logistic regression was used to assess the associations between SES and two binary outcomes: the visit to a health facility and a blood test for fever. Stratified analyses were further conducted by the type of health facilities (public hospitals/public primary healthcare facilities/private hospitals/private primary healthcare facilities) for the latter outcome.

Results
Fifty-eight percent of the febrile children were taken to health facilities, among whom only 55% took blood tests. Compared to children from households in the highest wealth quintile, children in the lowest quintile were less likely to be taken to medical facilities [adjusted odds ratio (aOR) = 0.775, 95% confidence interval (CI): 0.675–0.889]. Parents with more than secondary education were more likely to seek care (aOR = 1.830, 95% CI: 1.561–2.145) and to have blood tests (aOR = 1.729, 95% CI:  1.436–2.082) for their febrile children than parents without formal education. The probabilities of receiving blood tests at public hospitals and public primary healthcare facilities stayed relatively high across parental education levels and wealth quintiles, while these probabilities remained the lowest at private primary healthcare facilities, ranging from 0.100 (95% CI: 0.074–0.127) to 0.139 (95% CI: 0.083–0.194) across parental education levels and from 0.104 (95% CI: 0.078–0.130) to 0.125 (95% CI: 0.090–0.160) across wealth quintiles.

Conclusions
Significant socioeconomic disparities existed both in the access to health facilities and laboratory diagnosis of malaria in children in sub-Saharan African countries. These disparities were particularly evident in the private sector. Universal health coverage needs to be further strengthened to make formal healthcare in general and the laboratory diagnosis of malaria more accessible and affordable.

Graphical abstract
How photo editing in social media shapes self-perceived attractiveness and self-esteem via self-objectification and physical appearance comparisons
Authors: Ozimek Phillip , Lainas Semina , Bierhoff Hans-Werner , Rohmann Elke 
Published: April 2023

Abstract
Background
As photo editing behavior to enhance one?s appearance in photos becomes more and more prevalent on social network sites (SNSs), potential risks are increasingly discussed as well. The purpose of this study is to examine the relationship between photo editing behavior, self-objectification, physical appearance comparisons, self-perceived attractiveness, and self-esteem.

Methods
403 participants completed self-report questionnaires measuring the aformentioned constructs. A parallel-sequential multiple mediation model was conducted to examine the relationship between photo editing behavior and self-esteem considering multiple mediators.

Results
The results indicate that photo editing behavior is negatively related to self-perceived attractiveness and self-esteem mediated via self-objectification and physical appearance comparisons.

Conclusions
The postulated mediation model was justified by our data. Thus, SNS users should be aware of potential negative consequences when using photo editing applications or filters.