bluuebunny/crossref_metadata_2025_split huggingface dataset:
An alternative Ensemble Streamflow Prediction approach using improved subseasonal precipitation forecasts from the North America Multi-Model Ensemble Phase II
Authors: Zhang Lujun , Yang Tiantian , Gao Shang , Fan Ming , Lu Dan , Xu Hongmei , Xiao Chan 
Published: February 2025

Abstract
Streamflow forecasting at a subseasonal timescale (10 to 30 days into the future) is important for various human activities. The Ensemble Streamflow Prediction (ESP) is a widely applied technique for subseasonal streamflow forecasting. However, ESP’s reliance on the randomly resampled historical precipitation limits its predictive capability. Available dynamical subseasonal precipitation forecasts provide an alternative to the randomly resampled precipitation in ESP. Prior studies found the predictive performance of raw subseasonal precipitation forecast is limited in many regions such as the central south of the U.S., which raises questions about its effectiveness in assisting streamflow forecasting. To further assess the hydrologic applicability of dynamical subseasonal precipitation forecasts, we test the subseasonal precipitation forecast from North America Multi-Model Ensemble Phase II (NMME-2) at four watersheds in the central south region of the U.S. The subseasonal precipitation forecasts are post-processed with Bias Correction and Spatial Disaggregation (BCSD) to correct bias and improve spatial resolution before replacing the randomly resampled precipitation in ESP for streamflow predictions. The performance of the resulting streamflow predictions is benchmarked with ESP. Evaluation is conducted using Kling-Gupta Efficiency (KGE), Continuous Ranked Probability Score (CRPS), probability of detection (POD), false alarm ratios (FAR), as well as reliability diagrams. Our results suggest that BCSD-corrected subseasonal precipitation forecasts lead to overall improved streamflow predictions due to added skills in winter and spring. Our results also suggest that BCSD-corrected subseasonal precipitation forecasts lead to improved predictions on the occurrence of high-percentile streamflow values above 75%. Overall, BCSD-corrected subseasonal precipitation has shown promising performance, highlighting its potential broader applications for river and flood forecasting.
Patient experience of discharge opioid analgesia and care provision following spine surgery: A mixed methods study
Authors: Allen Megan L , Pastor Adam , Leslie Kate , Fitzpatrick Brennan , Hogg Malcolm , Lau Hui , Manski-Nankervis Jo-Anne 
Published: February 2025

Background Perioperative opioid stewardship programs are increasingly being introduced to guide responsible use around the time of surgery to reduce opioid-related harm to patients. However, patient experiences of perioperative opioid stewardship programs are underexplored. Methods We designed a mixed methods study to explore patients’ experiences of perioperative opioid stewardship in the post-operative period following spine surgery. We performed evaluative action research, combining quality improvement and ethnographic methodologies. Our quantitative methods were retrospective medical record review and targeted survey research. Our qualitative methods were online focus groups. The quantitative data were analysed using descriptive statistics, chi-square, and rank sum testing. The focus group data underwent inductive thematic analysis. Results Our spine surgery cohort for the four-month study period included 101 patients. The median total discharge opioid dispensed was 75 mg [interquartile range 75–150 mg], with 30% of patients prescribed modified release opioids on discharge. A subset of patients ( N = 14) participated in the online focus groups. The key themes that emerged from these sessions were (1) Supportive care delivery and rescue mechanisms were universally important to patient participants, providing great reassurance during their recovery; (2) Participants commonly believed opioid analgesia had an important role in recovery following spine surgery. Some patients were keen to dispose of surplus opioids whilst others intended to retain them; (3) Opioid analgesia access was variable, but established community prescriber relationships were important for post-discharge opioid re-prescription, and (4) The key future improvement suggestions included routine post-discharge contact and enhanced communication options back to the hospital if needed. Discussion and conclusions Our mixed methods approach provided rich insights into the pain and opioid analgesia experiences of patients following spine surgery. These insights are useful when seeking to optimise perioperative opioid stewardship programs including better meeting the needs of patient consumers. Limitations included potential response and selection bias for the online focus groups towards younger, higher socioeconomic status patients.
Clinical characteristics and outcome of non-cystic fibrosis bronchiectasis in children: A tertiary care perspective
Authors: Sitthikarnkha Phanthila , Anekvorakul Apichaya , Niamsanit Sirapoom , Techasatian Leelawadee , Saengnipanthkul Suchaorn , Uppala Rattapon 
Published: February 2025

Introduction: Bronchiectasis is a chronic respiratory disease caused by various respiratory and systemic conditions. It is now considered a potentially reversible disease, particularly when diagnosed early and managed with appropriate respiratory care strategies. Although rare in children, it typically develops in patients with recurrent lower respiratory tract infections. The etiology of bronchiectasis in children differs from that in adults. This study aims to identify the clinical features, causes, and outcomes of non-cystic fibrosis bronchiectasis in children at a tertiary center. Methods: A retrospective review was conducted among children with non-cystic fibrosis bronchiectasis who attended a university-affiliated hospital between January 2007 and December 2021. Clinical outcomes were assessed based on pulmonary function tests, exacerbation, and mortality. Results: The study included 35 children with non-cystic fibrosis bronchiectasis. The median age at diagnosis was 36 months (IQR: 24–170 months). Bronchiectasis was linked to underlying conditions in 22 cases (62.9%), such as primary immunodeficiency, chronic aspiration, and primary ciliary dyskinesia. Thirteen children had infectious-associated bronchiectasis (37.1%), with four cases related to pulmonary tuberculosis. At diagnosis, cystic bronchiectasis was most common ( n = 17, 48.6%), followed by varicose ( n = 13, 37.1%) and cylindrical bronchiectasis ( n = 5, 14.3%). Pulmonary exacerbation occurred in 28 (80%) children, with a higher rate in noninfectious bronchiectasis than postinfectious bronchiectasis (90.9% vs 61.5%, p = 0.036). Hospitalization was required for 26 (77.1%) children, with a higher rate of noninfectious bronchiectasis than postinfectious bronchiectasis (86.3% vs 53.8%, p = 0.033). Conclusions: Primary immune deficiency and chronic aspiration are the most common non-infective causes of non-cystic fibrosis bronchiectasis. Noninfectious bronchiectasis leads to higher exacerbation and hospitalization rates.
Reason Profiles for not Returning to Preinjury Activity Level Following Anterior Cruciate Ligament Reconstruction— A Latent Class Analysis With Subgroup Comparison of Patient-Reported Outcome Measures
Authors: Lamplot Joseph D. , Petushek Erich J. , Petit Camryn B. , Warren Shayla M. , Barber Foss Kim D. , Slutsky-Ganesh Alexis B. , Valencia Melanie , Kenyon Charles D , McPherson April L. , Xerogeanes John W. , Myer Gregory D. , Diekfuss Jed A. 
Published: February 2025

Background: Given the high proportion of athletes who do not return to sports (RTS) after anterior cruciate ligament reconstruction (ACLR), strategies are needed to identify at-risk patients and optimize rehabilitation for successful RTS after ACLR. Purpose/Hypothesis: This study used latent class analysis (LCA) to characterize a unique clustering of reasons why athletes do not return to their preinjury activity level after ACLR. We hypothesized that patients with high pain scores and high levels of fear would be less likely to return to their preinjury activity level. Study Design: Cohort study; Level of evidence, 3. Methods: All patients at a single institution who underwent primary ACLR between 2005 and 2021 were contacted to complete a survey via REDCap. Patients’ ability to RTS and their preinjury activity level, reasons for inability to return to the preinjury activity level, and patient-reported outcome scores were collected from 981 patients. LCA was performed to identify and compare patterns among patients’ reasons for not returning to the preinjury activity level. Results: Of the 981 patients included, only 446 (45.5%) were fully able to return to their preinjury activity level. LCA categorized patients into 3 groups based on their reasons for not returning to preinjury activity levels: a high-function group (75.5%), which reported no barriers; a multisymptom group (16.1%), which cited pain, lack of strength, and instability; and a fear-limited group (8.4%), which reported fear as the sole reason. Among the high-function group, 86.2% reported RTS compared with <36.7% in the other classes. There was no difference in Knee injury and Osteoarthritis Outcome Score (KOOS) subscales—including Pain, Symptoms, or Activities of Daily Living—between the high-function and fear-limited groups; however, the multisymptom group presented with the lowest scores in all KOOS subscales ( P < .001). In addition, patient characteristics, the time from the index ACLR to the follow-up, and subsequent revision ACLR were similar between groups; however, the multisymptom profile demonstrated the highest proportion of allograft ACLR ( P = .04) and secondary ipsilateral surgery ( P < .001). Overall subjective knee grade (1-100) and Marx scores were highest in the high-function group, followed by fear-limited and multisymptom groups ( P < .001). Conclusion: Patients were differentiated into 3 distinct classes after primary ACLR. Furthermore, those with patient-reported characteristics of pain, lack of strength, instability, or fear were significantly less likely to return to their preinjury activity level or sport.
Development and validation of a diagnostic prediction model for heart failure-related pleural effusions: the BANCA score
Authors: Porcel José M. , Trujillano Javier , Porcel Laura , Esquerda Aureli , Bielsa Silvia 
Published: February 2025

BackgroundHeart failure (HF) is a common cause of pleural effusion (PE); however, its diagnosis can be challenging owing to overlapping clinical features with other causes. Measuring NT-proBNP levels is diagnostically useful, but the optimal cut-off point must be determined. This study aimed to optimize NT-proBNP cutoffs for diagnosing HF-related PEs and develop a scoring model to improve diagnostic precision.MethodsA retrospective analysis was conducted on 2005 patients with PEs, who were divided into derivation and validation cohorts. ROC curve analysis identified the optimal cutoff point for NT-proBNP in pleural fluid and serum. A scoring system was developed based on logistic regression (TRIPOD statement) that included both clinical and laboratory variables. Its diagnostic accuracy was compared with that of existing methods using the area under the curve (AUC).ResultsNT-proBNP≥2500 pg·mL−1was found to be the optimal cut-off for identifying HF-related effusions. Pleural fluid NT-proBNP levels tended to have superior diagnostic accuracy compared to serum NT-proBNP levels. A scoring system, denominated as BANCA, for Bilateral effusions on chest radiographs, Age, NT-proBNP levels in pleural fluid, Cholesterol in pleural fluid, and Albumin gradient, demonstrated an AUC of 0.957, outperforming existing diagnostic criteria for identifying cardiac effusions. In cases misclassified as exudates by Light's criteria, the BANCA score accurately identified 80% of the HF-related PEs.ConclusionsThe BANCA score is a reliable tool for diagnosing HF-related PEs, offering superior accuracy compared to conventional methods. It is particularly useful for identifying cardiac effusions that are misclassified using traditional criteria.
Ramadan fasting for patients with chronic respiratory diseases: a systematic review and consensus recommendations for healthcare professionals
Authors: Khan F , Toor S , Abdulqawi R , Adamali H , Chalmers J , Chaudhuri N , Ghouri N , Jenkins RG , Murphy A , Rahman N , Rashid R , Satia I , Siddiqui S , Waqar S 
Published: February 2025

BackgroundRamadan, observed by nearly two billion Muslims worldwide, involves fasting from dawn to sunset, which can present challenges for individuals with chronic respiratory diseases due to altered medication regimens and oral intake restrictions. This study aimed to synthesise current evidence and develop consensus recommendations for managing asthma, chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD), and bronchiectasis during Ramadan.MethodsA comprehensive search of electronic databases including MEDLINE, EMBASE, and Google Scholar was conducted following a pre-specified protocol (PROSPERO CRD42024532759) to identify studies on Ramadan fasting outcomes in individuals with chronic respiratory diseases. The findings informed consensus recommendations stratified by the risk of adverse outcomes using IDF-DAR risk assessment criteria. An international expert group of medical and religious experts refined these guidelines, achieving consensus approval.ResultsEleven studies met the inclusion criteria, primarily addressing asthma and COPD, with no relevant studies on ILD or bronchiectasis. The studies indicated that fasting did not significantly impact hospitalisation rates or lung function tests in individuals with stable asthma and COPD. However, small sample sizes and methodological limitations restricted generalizability. Nineteen recommendations were developed to support patients considering fasting, emphasising pre-Ramadan consultations, individualised risk assessments, and medication regimens adjustments.ConclusionThis systematic review highlights the need for larger, well-designed studies to understand Ramadan fasting implications across chronic respiratory diseases. The developed recommendations provide a structured approach to assess fasting risks, ensuring informed and safe guidance during Ramadan. Future research should address identified gaps, supporting evidence-based guidelines that reconcile medical and religious considerations.
Measles in Canada: modelling outbreaks with variable vaccine coverage and interventions
Authors: McNichol Jennifer , Valizadeh Javad , Chaudhury Samara , Colijn Caroline 
Published: February 2025

Abstract

Background
The global incidence of measles has increased markedly since 2023. In Canada, where measles has had elimination status for more than two decades, most cases can typically be traced to travel. While the majority of Canadians are vaccinated against the measles virus, or considered immune due to previous infection, there are communities with low vaccination coverage.

Methods
In this study, we develop a stochastic Susceptible-Exposed-Infectious-Recovered model to explore what measles outbreaks could look like upon importation into Canada under a number of scenarios, vaccination coverage levels, and public health interventions. We collect reports of real-world measles outbreaks and compare them to our model outbreaks’ size and duration.

Results
Our model suggests that community level outbreaks can be controlled at or above 85% vaccination coverage with public health interventions and that above 95% coverage, 99% of measles introductions do not result in an outbreak. Below 85% coverage, outbreaks in small communities (size 1000) with relatively strong public health measures range from median size of under 4 (80% coverage) to 186 (55%), comparable to reported outbreaks in Canada and elsewhere. Outbreaks very often last under 60 days. We characterize how outbreak sizes and durations depend on the strength of interventions, community size and vaccination coverage. We make the model available as a web-based ‘shiny’ application.

Conclusions
Since the vast majority of measles cases in Canada can be traced to imported cases, our model serves as a last step in the chain of actions needed to bridge from global measles outbreaks to local scenarios within Canada. Given cases entering Canada, we are able to project the duration and size of an outbreak, helping to inform the public of the measles-related risk.
Medical deserts in Finland: measuring the accessibility and availability of primary health care services
Authors: Väisänen Visa , Satokangas Markku , Huhtakangas Moona , Antikainen Harri , Sinervo Timo 
Published: February 2025

Abstract

Background
Well-functioning primary health care (PHC) systems are needed to meet the challenges of aging populations and increasing care needs. However, “medical deserts”, areas with poor accessibility and availability of PHC services, remain a significant issue throughout Europe, contributing to regional inequalities. Identifying the location of these areas is crucial for effective policymaking and for improving health outcomes. Our aim was to locate underserved areas in Finland by developing a medical desert index. In addition, we examined the impact of telehealth, care needs, and multiple funding sources on the index and analyzed its association with key quality indicators.

Methods
The index was calculated using routinely collected municipality-level PHC consultation data from 2022 adjusted for population care needs (availability) and the average travel time to the nearest PHC center (accessibility). Telehealth and occupational healthcare consultations were included separately. Standardized index values were mapped and categorized using descriptive analysis, and compared with indicators of healthcare utilization, care accessibility and availability, care satisfaction, and continuity of care using correlation analysis.

Results
The index displayed clear patterns of medical deserts, primarily in the rural areas of northern and eastern Finland. Approximately 13% of the Finnish population resided in medical deserts, defined as a standard score of -0.5 or lower. The inclusion of telehealth consultations appeared to improve the index values especially in some rural areas. Better accessibility and availability of PHC services, as indicated through the index, was significantly correlated with lower proportion of acute care consultations, fewer hospital care days, and lower continuity of care among clients aged 65 years and older.

Conclusions
We were able to identify medical deserts in Finland utilizing novel methodology distinct from previous indicators, and thus providing important considerations for future research on regional inequalities in accessibility and availability of PHC services. Our findings demonstrated the potential of telehealth services in mitigating medical deserts, though its appropriateness for some population groups and care needs remains unclear. We call for health policy addressing PHC service provision especially in rural areas.
CircRNA hsa_circ_0004781 promoted cell proliferation by acting as a sponge for miR-9-5p and miR-338-3p and upregulating KLF5 and ADAM17 expression in pancreatic ductal adenocarcinoma
Authors: Lee Kun-Lin , Liu Jun-Jen , Huang Wei-Jan , Hung Ching-Sheng , Liang Yu-Chih 
Published: February 2025

Abstract

Background
Pancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive types of solid tumor, and novel strategies must be developed for treating it. Previous studies predominantly utilized circular RNA (circRNA) expression plasmids incorporating Alu elements to facilitate the indirect expression of circRNA.

Methods
Public databases and bioinformatics tools were used to identify hsa_circ_0004781 that is highly expressed in PDAC and its potential microRNA (miRNA) targets and corresponding mRNA targets. Real hsa_circ_0004781, which is identical to the native form of hsa_circ_0004781 without any exogenous sequences, was prepared through in vitro transcription by using a ribozyme and ion-pair reversed-phase high-performance liquid chromatography (IP-RP HPLC). The biological functions of hsa_circ_0004781 were evaluated using loss-of-function and gain-of-function approaches with circRNA expression plasmids and real hsa_circ_0004781.

Results
Knockdown of hsa_circ_0004781 inhibited the proliferation and migration of PDAC cells, whereas its overexpression produced opposite effects. Hsa_circ_0004781 was identified as a sponge for miR-9-5p and miR-338-3p, and its expression was negatively correlated with that of these miRNAs. Among the targets of miR-9-5p and miR-338-3p, Kruppel-like factor 5 (KLF5) and a disintegrin and metalloproteinase domain 17 (ADAM17) were negatively correlated with survival in patients with PDAC and were inversely regulated by these miRNAs. Furthermore, real hsa_circ_0004781 exhibited the same effects as those of the circRNA expression plasmids.

Conclusions
This study is the first to use real circRNAs to validate results obtained using circRNA expression plasmids. The results suggest that hsa_circ_0004781 functions as an oncogene, promoting the proliferation of PDAC cells through the miR-9-5p/KLF5 and miR-338-3p/ADAM17 axes. Therefore, hsa_circ_0004781 might be a therapeutic target for PDAC.