bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment-related mortality in head and neck cancer patients receiving chemotherapy and radiation: results of a meta-analysis of published trials
Authors: Gurizzan Cristina , Cinquini Michela , Legramandi Lorenzo , Resteghini Carlo , Siano Marco , Bergamini Cristiana , Lorini Luigi , Smussi Davide , Paderno Alberto , Licitra Lisa , Bossi Paolo 
Published: January 2025

Objectives: A combination of chemotherapy and radiotherapy is employed in the curative and postoperative treatment of locally advanced head and neck cancers (HNC). Integrated chemoradiation (CRT) treatments result in a non-negligible rate of severe toxic effects. Treatment-related death (TRD) is a crucial topic for physicians involved in the curative treatment of HNC. This meta-analysis aimed to better address TRD in locally advanced HNC patients treated with CRT through available and relevant literature. Methods: We performed a systematic review of the literature according to the PRISMA statement. The studies fulfilling these criteria included the following: concurrent or alternating CRT; both radical and postoperative settings; published from 2000 to 2020; involving 100+ patients; and available toxicity data. TRD was defined as death occurring from CRT start until a month from the end of CRT. Potential TRD predictors were evaluated. Results: In all, 65 studies were retrieved, with a total of 235 TRDs reported accounting for an overall risk rate of 1.4%. At meta-regression analysis, T stage and neutropenia grade >3 were potential predictors of higher TRD risk, both in univariate and multivariate analyses. Considering only the studies reporting at least one event, laryngeal/hypopharyngeal, oral cavity subsites and renal failure were significant predictors for TRD. The oropharyngeal subsite was protective in both analyses. None of the predictors proved to be independently correlated with TRD at multivariable analysis. Conclusion: CRT in HNC resulted in 1.4% of TRDs. TRD rate reduction may imply better patient selection and more intensive supportive care programs.
Supine Traction vs Fulcrum Bending Radiographs in Preoperative Imaging of Scoliosis Patients Treated With Magnetically Controlled Growing Rods (MCGR) – which Technique is Better to Predict Surgical Correction of the Main Curve?
Authors: Hemmer Stefan , Trefzer Raphael , Renkawitz Tobias , Pepke Wojciech 
Published: January 2025

Study Design Retrospective Cohort Study. Objectives Flexibility radiographs such as traction or bending radiographs are essential in preoperative imaging to assess for curve flexibility and to estimate the amount of operative correction in order to determine the type and length of instrumentation in growth-accompanying scoliosis treatment. Both traction and bending radiographs are controversially discussed in the literature. The predictability of flexibility radiographs of postoperative main curve correction specifically in patients treated with magnetically controlled growing rods (MCGR) has not yet been studied. Methods Juvenile patients with idiopathic or neuromuscular scoliosis that were surgically treated with a primary MCGR implant with pedicle screw fixation between 2018-2022 were retrospectively registered. Patients that underwent prior spine surgery, with supine lying-down radiograph and patients with missing traction or bending radiographs available were excluded. Image analysis was conducted using Surgimap® software. For statistical analysis, t test and ANOVA analysis were used to compare the means between groups with a significance level set at P < 0.05. Results A total of 50 patients, 34 diagnosed with idiopathic scoliosis (IS) and 16 diagnosed with neuromuscular scoliosis (NMS), were included. Globally, main curve Cobb angles were significantly higher in supine traction compared to fulcrum bending images (44.8° vs 39.6°; P < 0.001) and in the IS subgroup (42.4° vs 37.3°; P < 0.001). Compared to postoperative images, significant differences of supine traction but not fulcrum bending radiographs were detected in total ( P < 0.001; P = 0.20) as well as IS ( P < 0.001; P = 0.32) and NMS ( P < 0.001; P = 0.44) subgroups. Fulcrum bending images displayed significantly higher flexibility rates (FR) and flexibility index (FI) compared to traction images in total (FR: 42.9 vs 35.2, P < 0.001; FI: 1.08 vs 1.58, P = 0.024) and the IS subgroup (FR: 44.2 vs 35.8, P < 0.001; FI: 1.19 vs 1.43, P = 0.033). Conclusions Fulcrum bending radiographs showed better flexibility and prediction of operative main curve correction compared to supine traction radiographs in total and IS subgroup. Fulcrum bending might be more precise for predicting the postoperative main curve correction potential of primary MCGR surgery in IS patients.
How Has the COVID-19 Pandemic Impacted Addiction Services? A Study of the Different Periods of the Pandemic and Patient Treatment Follow-up Over 1 Year
Authors: Narváez-Camargo Marta , Mancheño-Velasco Cinta , Díaz-Batanero Carmen , Fernández-Calderón Fermín , Lozano Oscar M. 
Published: January 2025

Background: Various studies have provided evidence of the impact of COVID-19 and the measures adopted by governments on drug use and its treatment. After 4 years, a more precise assessment of the evolution of patients and addiction treatment services can be made. The objective of this study is to compare different periods during the COVID-19 pandemic to identify changes in patient profiles and the care activity of addiction treatment centres. Methods: A retrospective observational study was conducted using data from March 14, 2019 to June 22, 2022, from addiction centres of Andalusia (Spain). Information related to the treatment of each patient was collected during 1 year after the initiation of treatment (until June 22, 2023). Electronic health records of 29 740 outpatients were analysed and divided into 4 periods (pre-pandemic, lockdown, return to normal and post-lockdown). Results: Differences were found across the analysed periods. Admissions declined during the lockdown period but subsequently increased, without reaching pre-pandemic levels. Admission to treatment due to opioid dependence increased during the lockdown. In contrast, the percentage of patients with dual pathology decreased. An increase in the dropout rate of patients from treatment was observed compared to the pre-pandemic period. Conclusions: The results revealed a similar patient profile across the different analysed periods. The most notable changes are observed in healthcare activity, which appears to have decreased. Therefore, a greater investment is likely required for the reformulation of addiction centres and increased funding to provide adequate assistance to these patients.
Can voluntary adult education reduce unemployment? Causal evidence from East Germany after reunification
Authors: Rupieper Li Kathrin Kaja , Thomsen Stephan L. 
Published: January 2025

Abstract
After the German reunification in 1990, East Germany transitioned from a centrally planned economic system to a market economy. To tackle surging unemployment, upskilling through adult education was deemed essential at the time. Besides substantial mandatory training programs provided by active labor market policies, Volkshochschulen (VHS) were the most important providers of voluntary adult education. Based on newly digitized data, we estimate how VHS courses affected unemployment in a county-level analysis of East Germany between 1991 and 2002. Our identification strategy employs the decentralized expansion of courses, which led to substantial, quasi-random variation in their regional supply. We do not find any significant effects of VHS courses on subsequent unemployment. Lacking labor demand and low market dynamics may have restricted the realization of education effects. Regional disparities support this notion: In counties bordering West Germany, courses reduced unemployment. Our results hint towards multiple mechanisms at play, as both work-related and recreational courses were found to be effective in border counties.
Not seeing the trees for the forest. The impact of neighbours on graph-based configurations in histopathology
Authors: Fourkioti Olga , De Vries Matt , Naidoo Reed , Bakal Chris 
Published: January 2025

Abstract
Background
Deep learning (DL) has set new standards in cancer diagnosis, significantly enhancing the accuracy of automated classification of whole slide images (WSIs) derived from biopsied tissue samples. To enable DL models to process these large images, WSIs are typically divided into thousands of smaller tiles, each containing 10–50 cells. Multiple Instance Learning (MIL) is a commonly used approach, where WSIs are treated as bags comprising numerous tiles (instances) and only bag-level labels are provided during training. The model learns from these broad labels to extract more detailed, instance-level insights. However, biopsied sections often exhibit high intra- and inter-phenotypic heterogeneity, presenting a significant challenge for classification. To address this, many graph-based methods have been proposed, where each WSI is represented as a graph with tiles as nodes and edges defined by specific spatial relationships.

Results
In this study, we investigate how different graph configurations, varying in connectivity and neighborhood structure, affect the performance of MIL models. We developed a novel pipeline, K-MIL, to evaluate the impact of contextual information on cell classification performance. By incorporating neighboring tiles into the analysis, we examined whether contextual information improves or impairs the network’s ability to identify patterns and features critical for accurate classification. Our experiments were conducted on two datasets: COLON cancer and UCSB datasets.

Conclusions
Our results indicate that while incorporating more spatial context information generally improves model accuracy at both the bag and tile levels, the improvement at the tile level is not linear. In some instances, increasing spatial context leads to misclassification, suggesting that more context is not always beneficial. This finding highlights the need for careful consideration when incorporating spatial context information in digital pathology classification tasks.
Prevalence and contributors to anaemia among children aged 6 to 59 months in Kyangwali Refugee settlement, Western Uganda: a cross-sectional study
Authors: Nakimera Christine , Bwajojo Philip Bright , Kaweesa William , Nampiima Joan , Chebet Faith , Namuwawu Sharifah , Bwemage Martin , Nuwabasa Moses , Ndagire Regina , Lugaajju Allan , Tumwebaze Joel , Lwanira Catherine Nassozi 
Published: January 2025

Abstract
Background
Anaemia is a major cause of morbidity among children under five years in Uganda. However, its magnitude among refugee populations is marginally documented. In this study, the prevalence and contributors to anaemia among children 6 to 59 months in Kyangwali refugee settlement in Western Uganda was determined.

Methods
This was a cross-sectional study that was carried out among 415 mother- child dyads at Kwangwali refugee settlement. Anaemia was determined by measuring haemoglobin concentration using the HaemoCue method, while nutritional status was examined using standard World Health Organisation (WHO) nutritional indices. Data abstraction forms, pretested questionnaires and face to face interviews were used to collect patient data. Associations between the independent variables and anaemia were examined using modified Poisson regression with robust standard errors. In all statistical tests, a P- value of < 0.05 was considered as significant.

Results
The proportion of children with anaemia was 49.2% (95% CI: 44.4–53.9). Anaemia was 1.4 times (95% CI = 1.13–1.82; p = 0.003) more prevalent among wasted children than the normal children. The prevalence of anaemia was also higher among underweight children than those with normal weight (aPR = 1.37, 95% CI = 1.11–1.70; p = 0.004). Additionally, the prevalence of anaemia was higher among children of birth order of 6 or above (aPR = 2.00, 95% CI = 1.22–3.29; p = 0.006), while anaemia prevalence was lower among children whose mothers’ had attained secondary level of education (aPR = 0.19, CI = 0.04–0.98; p = 0.048) and those who fed on fish (aPR = 0.75, 95% CI = 0.57–0.99; p = 0.039) and meals prepared with oils and fats (aPR = 0.70, 95% CI = 0.51–0.97; p = 0.029). There was no significant relationship between anaemia occurrence and the household dietary diversity score.

Conclusions
About half of the study children were found to be anaemic. The most significant contributors to anaemia in the study population were malnutrition, maternal education, feeding practices and birth order. The study findings suggest need of screening of children for anaemia at all nutritional clinics, promotion of education, addressing barriers to sustainable food supply and accessibility of nutrient-dense foods, treating anaemia in children alongside other micronutrient deficiencies and addressing the nutritional needs of multiparous mothers in refugee communities.
Optimal outpatient training for resident physicians’ general medicine in-training examination score: a cross-sectional study
Authors: Miyagami Taiju , Nishizaki Yuji , Shimizu Taro , Yamamoto Yu , Shikino Kiyoshi , Kataoka Koshi , Nojima Masanori , Deshpande Gautam , Naito Toshio , Tokuda Yasuharu 
Published: January 2025

Abstract
Background
Outpatient training for resident physicians has been attracting attention in recent years. However, to our knowledge, there have only been a few surveys on outpatient training, particularly in Japan. This study evaluates outpatient care among Japanese resident physicians by determining how the volume of outpatient encounters and length of outpatient training correlate with residents’ clinical competence.

Methods
This study utilised the results of the General Medicine In-Training Examination (GM-ITE; resident clinical competency assessment) for 2,554 post-graduate year 2 (PGY 2) resident physicians in Japan, as well as a self-reported questionnaire regarding their educational training environments conducted after the examination. We investigated whether GM-ITE scores correlated with daily outpatient volume and duration of outpatient training.

Results
Regarding outpatient volume, having 1–5 new patient encounters per day was significantly associated with higher GM-ITE scores by multilevel analysis [0 patients: average score 43.7, 1–5 patients: adjusted estimated coefficient (aEC) 1.99, 95% confidence interval (CI) 0.44 to 3.55, P = 0.01]. Regarding the duration of outpatient training, residents trained for one month had the highest GM-ITE scores (one month: average score 46.9; two months: aEC -1.44, 95% CI -2.29 to -0.60, P < 0.001; three months: aEC -1.44, 95% CI -2.22 to -0.65, P < 0.001).

Conclusion
Minimal daily new outpatient visits and one month of outpatient training effectively correlated with residents’ basic clinical competence.

Trial registration
This study was approved by the Ethics Committee of the Japan Institute for Advancement of Medical Education Program (JAMEP; No. 22–30) and retrospectively registered.
Developing a decision support tool to predict delayed discharge from hospitals using machine learning
Authors: Pahlevani Mahsa , Rajabi Enayat , Taghavi Majid , VanBerkel Peter 
Published: January 2025

Abstract
Background
The growing demand for healthcare services challenges patient flow management in health systems. Alternative Level of Care (ALC) patients who no longer need acute care yet face discharge barriers contribute to prolonged stays and hospital overcrowding. Predicting these patients at admission allows for better resource planning, reducing bottlenecks, and improving flow. This study addresses three objectives: identifying likely ALC patients, key predictive features, and preparing guidelines for early ALC identification at admission.

Methods
Data from Nova Scotia Health (2015-2022) covering patient demographics, diagnoses, and clinical information was extracted. Data preparation involved managing outliers, feature engineering, handling missing values, transforming categorical variables, and standardizing. Data imbalance was addressed using class weights, random oversampling, and the Synthetic Minority Over-Sampling Technique (SMOTE). Three ML classifiers, Random Forest (RF), Artificial Neural Network (ANN), and eXtreme Gradient Boosting (XGB), were tested to classify patients as ALC or not. Also, to ensure accurate ALC prediction at admission, only features available at that time were used in a separate model iteration.

Results
Model performance was assessed using recall, F1-Score, and AUC metrics. The XGB model with SMOTE achieved the highest performance, with a recall of 0.95 and an AUC of 0.97, excelling in identifying ALC patients. The next best models were XGB with random oversampling and ANN with class weights. When limited to admission-only features, the XGB with SMOTE still performed well, achieving a recall of 0.91 and an AUC of 0.94, demonstrating its effectiveness in early ALC prediction. Additionally, the analysis identified diagnosis 1, patient age, and entry code as the top three predictors of ALC status.

Conclusions
The results demonstrate the potential of ML models to predict ALC status at admission. The findings support real-time decision-making to improve patient flow and reduce hospital overcrowding. The ALC guideline groups patients first by diagnosis, then by age, and finally by entry code, categorizing prediction outcomes into three probability ranges: below 30%, 30-70%, and above 70%. This framework assesses whether ALC status can be accurately predicted at admission or during the patient’s stay before discharge.
Nasal food challenge with hen's egg white allergen
Authors: Krzych-Fałta Edyta , Namysłowski Andrzej , Białek Sławomir , Czerwińska Monika E. , Furmańczyk Konrad , Tylewicz Aleksandra , Sybilski Adam , Samoliński Bolesław , Wojas Oksana 
Published: January 2025

Abstract

Background
Nasal allergen provocation tests are an important part of the diagnostics of allergic diseases triggered by environmental factors. Recently, increased attention has been paid to the potential use of this method in the diagnosis of food allergy. The objective of the study was to evaluate the usefulness of the nasal allergen provocation test in a group of subjects allergic to hen's egg white allergens.

Methods
The material consisted of a group of 57 subjects (32 subjects with hen's egg white allergy and 25 healthy controls). The method consisted in a nasal allergen provocation test carried out with the use of hen's egg white allergen and assessed using the visual analog scale and optical rhinometry as well as by determination of sIgE and tryptase levels in nasal lavage fluid.

Results
Subjective nasal symptoms and objective evaluations following the application of 100 µg of hen's egg white allergen revealed a moderately positive nasal mucosal response in optical rhinometry tests (ΔE = 0.34 OD).

Conclusions
Nasal food challenge with hen's egg white allergen is a good diagnostic alternative in the group of food allergy patients. Due to the insufficient number of studies carried out so far, further attempts at standardization of the method are required.
Comparison of the efficacy and safety of Landiolol and Esmolol in critically ill patients: a propensity score-matched study
Authors: Si Xiang , Yuan Hao , Shi Rui , Song Wenliang , Guo Jiayan , Jiang Jinlong , Yang Tao , Ma Xiaoxun , Wang Huiming , Chen Minying , Wu Jianfeng , Guan Xiangdong , Monnet Xavier 
Published: January 2025

Abstract

Background
Excessive tachycardia is associated with impaired hemodynamics and worse outcome in critically ill patients. Previous studies suggested beneficial effect of β-blockers administration in ICU patients, including those with septic shock. However, comparisons in ICU settings are lacking. Our study aims to compare Landiolol and Esmolol regarding heart rate control and hemodynamic variables in general ICU patients.

Methods
This retrospective, observational study was conducted in a 56-bed ICU at a university hospital. A propensity score matching (PSM) was employed to balance baseline differences. Generalized estimating equations (GEE) were used to compare heart rate between two drugs. The primary outcome was heart rate control, while secondary outcomes included hemodynamic response, hospital length of stay (HLOS) and ICU length of stay (ICULOS).

Results
From June 2016 to December 2022, 438 patients were included after PSM, (292 in the Esmolol group and 146 the in Landiolol group). Baseline heart rate was similar between groups (Landiolol:120.0 [110.2, 131.0] bpm vs. Esmolol:120.0 [111.0, 129.0] bpm, p = 0.925). During 72 h. of β-blocker infusion, Landiolol reduced heart rate by 4.7 (1.3, 8.1) bpm, more than Esmolol (p = 0.007), while preserving a comparable proportion of patients able to stabilize vasopressor doses within the first 24 h. (82.9 vs. 80.8%, respectively, p = 0.596). Norepinephrine doses and lactate levels were similar between groups over 72 h., while the Landiolol group exhibited notably higher minimal ScvO2 levels (72% [63%, 78%] vs 68% [55%, 73%], respectively, p = 0.006) and a lower maximal PCO2 gap compared to the Esmolol group (7.0 [6.0, 9.0] vs. 8.0 [6.0, 10.0] mmHg, respectively, p = 0.040). Patients in the Landiolol group were observed to experience shorter HLOS than patients in the Esmolol group (26.5 [13.0, 42.0] vs 30.0 [17.0, 47.2] days, respectively, p = 0.044) and ICULOS (4.9 [2.8, 10.0] vs.6.7 [3.4, 13.1] days, respectively, p = 0.011).

Conclusion
Landiolol provides superior heart rate control in critically ill patients with tachycardia compared to Esmolol, without increasing vasopressor requirements during the first 24 h. Findings from ScvO2 levels and PCO2 gap suggest that Landiolol may exert less impact on cardiac output than Esmolol. Further studies, incorporating comprehensive hemodynamic monitoring, are warranted to clarify the clinical implications of heart rate control with β-blockers in ICU patients with tachycardia.