bluuebunny/crossref_metadata_2025_split huggingface dataset:
System- and Individual-Level Barriers to Accessing Medical Care Services Across the Rural-Urban Spectrum, Washington State
Authors: Graves Janessa M , Abshire Demetrius A , Alejandro Art G 
Published: June 2022

Background: Residents of rural areas face barriers beyond geography and distance when accessing medical care services. The purpose of this study was to characterize medical care access barriers across several commonly used classifications of rurality. Methods: Washington State household residents completed a mixed-mode (paper/online) health care access survey between June 2018 and December 2019 administered to a stratified random sample of ZIP codes classified as urban, suburban, large rural, and small rural (4-tier scheme). For analyses, rurality was also classified into 2-tier schemes (rural/urban) based on ZIP code and county. Respondents reported availability of medical care services and system- and individual-level barriers to accessing services. Logistic regression models estimated the odds of reporting system- or individual-level barriers in accessing medical care services across rurality (4- and 2-tier schemes), adjusting for respondent characteristics, and weighted to account for survey design. Results: About 617 households completed the survey (25.7% response rate). Compared to urban residents (across all 3 schemes), more rural residents reported traveling to a distant city or town for medical care ( P < .001). Rurality was significantly associated with increased odds of facing system-level barriers. Respondents from small rural areas had greater odds access barriers for primary care (OR 7.31, 95% CI 1.84-29.09) and having no primary care provider (OR 11.37, 95% CI 3.03-42.75) compared to urban respondents. Individual-level barriers were not associated with rurality. Conclusions: To improve healthcare access across the rural-urban spectrum, policymakers must consider system-level barriers facing rural populations.
Late Onset Symptomatic Enlargement of Treated Spinal Intradural Neurocysticercosis Cyst
Authors: Gorjian Mehrnoush , Ricks Christian 
Published: June 2022

Cyst enlargement with progressive symptoms in spinal intradural Neurocysticercosis (NCC) is an uncommon finding after effective treatment of NCC. Neither imaging nor clinical presentation is sufficient to differentiate a sterile arachnoid cyst from recurrence of NCC. We present a case of symptomatic spinal intradural cyst enlargement 16 years after successful treatment of intracranial and spinal NCC with anti-helminthics.
Characteristics of Oscillation in Cavity of Helmholtz Nozzle Generating Self-excited Pulsed Waterjet
Authors: Yuan Miao , Li Deng , Kang Yong , Shi Hanqing , Pan Haizeng 
Published: June 2022

AbstractCavity flow oscillations in the axisymmetric cavity are critical to the operating efficiency of self-excited pulsed waterjets, which are widely employed in many practical applications. In this study, the behaviors of a turbulent flow in axisymmetric cavities causing cavity flow oscillations are investigated based on wall pressure characteristics. Experiments are performed using four Helmholtz nozzles with varying length-to-radius ratios at flow velocities of 20–80 m/s. Three orders of hydrodynamic modes in axisymmetric cavity are obtained through the spectral analysis of wall pressure. Based on the experimental results, the empirical coefficient of Rossiter’s formula is modified, and the values of the parameter phase lag and the ratio of convection velocity to free stream velocity are obtained as 0.061 and 0.511, respectively. In addition, the spectral peak with a relatively constant frequency shows that the flow-acoustic resonance is excited significantly. A modified model is introduced based on the fluidic networks to predict the lock-on frequency. The results obtained can provide a basis for the structural optimization of the nozzle to improve the performance of self-excited pulsed waterjets.
Vibration Characteristics of Rotor System with Loose Disc Caused by the Insufficient Interference Force
Authors: Li Zhinong , Qiao Fang , Lu Wenxiu , Liu Jie , Wang Dong , Chu Fulei 
Published: June 2022

AbstractThe rotating parts looseness is one of the common failures in rotating machinery. The current researches of looseness fault mainly focus on non-rotating components. However, the looseness fault of disc-shaft system, which is the main work part in the rotor system, is almost ignored. Here, a dynamic model of the rotor system with loose disc caused by the insufficient interference force is proposed based on the contact model of disc-shaft system with the microscopic surface topography, the vibration characteristics of the system are analyzed and discussed by the number simulation, and verified by the experiment. The results show that the speed of the shaft, the contact stiffness, the clearance between the disc and shaft, the damping of the disc and the rotational damping have an influence on the rotation state of the disc. When the rotation speed of the disc and the shaft are same, the collision frequency is mainly composed of one frequency multiplication component and very weak high frequency multiplication components. When the rotation speed of the disc and the shaft is close, the vibration of the disc occurs a beat vibration phenomenon in the horizontal direction. Simultaneously, a periodical similar beat vibration phenomenon also occurs in the waveform of the disc-shaft displacement difference. The collision frequency is mainly composed of a low frequency and a weak high frequency component. When the rotation speed of the disc and the shaft has great difference, the collision frequency is mainly composed of one frequency multiplication, a few weak high frequency multiplication components and a few low frequency multiplication component. With the reduction of the relative speed of the disc, the trajectory of the disc changes from circle-shape to inner eight-shape, and then to circle-shape. In the inner eight-shape, the inner ring first gradually becomes smaller and then gradually becomes larger, and the outer ring is still getting smaller. The obtained research results in this paper has important theoretical value for the diagnosis of the rotor system with the loose disc.
European Headache Federation guideline on the use of monoclonal antibodies targeting the calcitonin gene related peptide pathway for migraine prevention – 2022 update
Authors: Sacco Simona , Amin Faisal Mohammad , Ashina Messoud , Bendtsen Lars , Deligianni Christina I. , Gil-Gouveia Raquel , Katsarava Zaza , MaassenVanDenBrink Antoinette , Martelletti Paolo , Mitsikostas Dimos-Dimitrios , Ornello Raffaele , Reuter Uwe , Sanchez-del-Rio Margarita , Sinclair Alexandra J. , Terwindt Gisela , Uluduz Derya , Versijpt Jan , Lampl Christian 
Published: June 2022

Abstract
Background
A previous European Headache Federation (EHF) guideline addressed the use of monoclonal antibodies targeting the calcitonin gene-related peptide (CGRP) pathway to prevent migraine. Since then, randomized controlled trials (RCTs) and real-world evidence have expanded the evidence and knowledge for those treatments. Therefore, the EHF panel decided to provide an updated guideline on the use of those treatments.

Methods
The guideline was developed following the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach. The working group identified relevant questions, performed a systematic review and an analysis of the literature, assessed the quality of the available evidence, and wrote recommendations. Where the GRADE approach was not applicable, expert opinion was provided.

Results
We found moderate to high quality of evidence to recommend eptinezumab, erenumab, fremanezumab, and galcanezumab in individuals with episodic and chronic migraine. For several important clinical questions, we found not enough evidence to provide evidence-based recommendations and guidance relied on experts’ opinion. Nevertheless, we provided updated suggestions regarding the long-term management of those treatments and their place with respect to the other migraine preventatives.

Conclusion
Monoclonal antibodies targeting the CGRP pathway are recommended for migraine prevention as they are effective and safe also in the long-term.
Two approaches to account for genotype-by-environment interactions for production traits and age at first calving in South African Holstein cattle
Authors: Ducrocq Vincent , Cadet Astrid , Patry Clotilde , van der Westhuizen Lene , van Wyk Jacob B. , Neser Frederick Wilhelm Cornelius 
Published: June 2022

Abstract
Background
If not accounted for, genotype x environment (G×E) interactions can decrease the accuracy of genetic evaluations and the efficiency of breeding schemes. These interactions are reflected by genetic correlations between countries lower than 1. In countries that are characterized by a heterogeneity of production systems, they are also likely to exist within country, especially when production systems are diverse, as is the case in South Africa. We illustrate several alternative approaches to assess the existence of G×E interactions for production traits and age at first calving in Holsteins in South Africa. Data from 257,836 first lactation cows were used. First, phenotypes that were collected in different regions were considered as separate traits and various multivariate animal models were fitted to calculate the estimates of heritability for each region and the genetic correlations between them. Second, a random regression approach using long-term averages of climatic variables at the herd level in a reaction norm model, was used as an alternative way to account for G×E interactions. Genetic parameter estimates and goodness-of-fit measures were compared.

Results
Genetic correlations between regions as low as 0.80 or even lower were found for production traits, which reflect strong G×E interactions within South Africa that can be linked to the production systems (pasture vs total mixed ration). A random regression model including average rainfall during several decades in the herd surroundings gave the best goodness-of-fit for production traits. This can be related to a preference for total mixed ration on farms with limited rainfall. For age at first calving, the best model was based on a random regression on maximum relative humidity and maximum temperature in summer.

Conclusions
Our results indicate that G×E interactions can be accounted for when genetic evaluations of production traits are performed in South Africa, by either considering production records in different regions as different correlated traits or using a reaction norm model based on herd management characteristics. From a statistical point of view, climatic variables such as average rainfall over a long period can be included in a random regression model as proxies of herd production systems and climate.
Genetic liability between COVID-19 and heart failure: evidence from a bidirectional Mendelian randomization study
Authors: Wang Huachen , Guo Zheng , Zheng Yulu , Chen Bing 
Published: June 2022

Abstract
Background
Previous studies have observed inconsistent associations between coronavirus disease 2019 (COVID-19) and heart failure (HF), but these studies were prone to bias based on reverse causality and residual confounding factors. We aimed to investigate genetic liability between COVID-19 and heart failure using a bidirectional Mendelian randomization study.

Methods
The causal relationship between COVID-19 (including COVID-19, hospitalized COVID-19 compared with the general population, and severe COVID-19) and HF are determined by using a bidirectional Mendelian randomization analysis. We drew on summary statistics from the largest HF genome-wide association study (GWAS) meta-analysis on individuals of European ancestry, which included 47,309 HF patients and 930,014 controls. The inverse variance weighted (IVW), an adaption of the Egger regression (MR-Egger), the weighted median, and weighted model were conducted for the Mendelian randomization analysis to estimate a causal effect. To confirm the stability, we performed a “leave-one-out” approach for the sensitivity analysis.

Results
Genetically predicted severe COVID-19 was not significantly associated with the risk of HF [odds ratio (OR), 1.003; 95% confidence interval (CI), 0.969–1.037; p = 0.867]. The IVW demonstrated that there was no association between genetically hospitalized COVID-19 infection and HF risk [OR, 1.009; 95% CI, 0.939–1.085; p = 0.797]. There was no evidence to support the association between genetically determined COVID-19 and the risk of HF [OR, 1.066; 95% CI, 0.955–1.190; p = 0.253]. In addition, genetically predicted HF was also not causally associated with COVID-19 [OR, 1.162; 95% CI, 0.824–1.639; p = 0.393]. MR-Egger analysis indicated no evidence of directional pleiotropy.

Conclusion
The current bidirectional Mendelian randomization analysis overcomes the limitations of observational studies. Our findings indicated that there is no causal association between COVID-19 and HF.
Dynamic changes of emergency visits: a retrospective observational study
Authors: Liu Qihui , Xin Ranran , Zhao Yibo , Yu Muming , Jin Chunjie , Shou Songtao , Chai Yanfen , Jin Heng 
Published: June 2022

Abstract
Background
With more emergency visits, there is increasing pressure to provide emergency medical services globally and locally. This study aimed to investigate the epidemiological characteristics and the disease spectrum of patients presenting in the last three years to the Department of Emergency Medicine of Tianjin Medical University General Hospital, a tertiary hospital in Tianjin, China, to improve the services of the emergency medicine department.

Methods
A retrospective study was conducted on all patients in the Department of Emergency Medicine of Tianjin Medical University General Hospital from Jan 1, 2017, 00:00:00 to Dec 31, 2020, 23:59:59, including variables like medical record number, gender, age, date of admission, principal diagnosis. The data were analyzed by SPSS statistical software; statistical charts were prepared by GraphPad Prism9.0 and SPSS 20.0; statistical tables were made by Microsoft Excel.

Results
A total of 1,314,916 patients presented to the Department of Emergency Medicine of Tianjin Medical University General Hospital from Jan 1, 2017, 00:00:00 to Dec 31, 2020, 23:59:59. In terms of gender distribution, the male–female ratio was 0.78∶1. As for age distribution, patients aged 60–69 were the most (23.47%), and patients younger than 20 years were the least (2.80%). Concerning monthly data, the number of visits peaked during January and December. The distribution of daily visits showed the feature of three highs and a low. The top three prevalence diseases in the emergency disease spectrum were respiratory, cardiovascular, and digestive diseases. The respiratory system was the most common in patients with infectious diseases (200,912, accounting for 86.97%). Among the patients suffering from infectious diseases, the number of patients with respiratory infections peaked in 2019 (73,530) and was the lowest in 2020 (20,078).

Conclusions
From 2017 to 2019, the demand for emergency services in Tianjin Medical University General Hospital continued to increase, but it was greatly affected by COVID-19 in 2020. This emergency department is mainly for patients with respiratory system, circulatory system and digestive system diseases, and its treatment time is relatively centralized. The prevention of diseases for people of all ages, especially female patients and the elderly, should be strengthened, and emergency medical resources should be allocated reasonably according to the peak months and crowed periods of patients.
Accuracy of ct evaluation for cervical spine clearance in the ground level fall population – a retrospective cohort study
Authors: Culhane John , Parr Alan , Mercier Philippe 
Published: June 2022

Abstract
Background
Clinically occult cervical spine (CS) injuries are well described in blunt trauma, however delay in identifying these injuries and clearing the CS can result in morbidity. Our study examines the ground level fall (GLF) population to analyze whether computed tomography (CT) alone can rule out unstable injury in this group with lower force mechanism.

Methods
This is a single center, retrospective cohort study. All GLF patients in the institutional trauma registry between 6/1/2012 through 12/31/2019 were included. These comprise all trauma patients evaluated in the emergency department with Injury Severity Score (ISS) > 0, including both activations and consults with both clinical and radiological spine evaluation. Patients who could not be cleared by National Emergency X-ray Utilization Study (NEXUS) criteria underwent CT. Patients with CT or clinical suspicion of cord or ligamentous injury underwent MRI. CT occult injuries were identified by MRI and clinical exam, with MRI identifying all unstable injuries.

Results
Sixty-nine (2.0%) of patients had CS injury without acute CT abnormality. Of these, 11 (0.3%) required surgery and were considered unstable. All patients who required surgery had a neurologic deficit. Negative predictive value (NPV) of CT for unstable CS injury was 99.7%. The combination of acute CT findings and neurologic deficit ruled out unstable CS injury with 100% NPV.

Conclusion
In the GLF population, CT alone rules out unstable CS injury with high, but not perfect NPV. The combination of absence of acute CT findings and acute neurologic deficits rules out unstable CS injury with 100% NPV.
Clinical manifestations and treatment management of hospitalized patients with zinc phosphide poisoning, Mazandaran Province, Northern Iran
Authors: Ghasempouri Seyed Khosro , Zakariaei Zakaria , Hoseininejad Seyed Mohammad , Chinian Fatemeh , Soleymanii Mostafa , Pashaei Seyedeh Masoumeh , Sadeghi Mahdieh 
Published: June 2022

Abstract
Background
Zinc phosphide (ZnP) is a dark gray crystalline compound used as a rodenticide against rodents such as mice. ZnP poisoning may be accidental or suicidal. The aim of this study was to investigate the clinical manifestations and treatment management of hospitalized patients with ZnP poisoning in Mazandaran Province, northern Iran.

Methods
Between 2013 and 2017, a cross-sectional study was performed on hospitalized patients with ZnP poisoning who were referred to two training hospitals in Mazandaran Province, northern Iran.

Results
A total of 127 patients participated in this trial, including 71 (55.9%) men and 56 (44.1%) women. The patients’ average (standard deviation) age was 25.5 (±16.82) years, and it took 2.18 (±2.23) hours to refer them to the hospital. There were 42 (33%) cases with less than one package, 9 (7%) cases with several packages, and 76 (60%) cases with no particular usage.

Conclusions
This study has shown that ZnP poisoning may be asymptomatic initially or with mild clinical symptoms that may gradually worsen. Therefore, hospitalization and obtaining a history and a careful physical examination should be considered.
Threshold heterogeneity of perioperative hemoglobin drop for acute kidney injury after noncardiac surgery: a propensity score weighting analysis
Authors: Zhou Yan , Liu Si 
Published: June 2022

AbstractBackgroundPerioperative hemoglobin drop after noncardiac surgery is associated with acute kidney injury (AKI). However, opinion on the tolerable difference in postoperative hemoglobin drop in patients with different preoperative hemoglobin levels does not reach a consensus. This study aimed to identify hemoglobin drop thresholds for AKI after noncardiac surgery stratified by preoperative hemoglobin levels.MethodThis was a single-center retrospective cohort study for elective noncardiac surgery from January 1, 2012, to December 31, 2018. The endpoint was the occurrence of AKI 7 days postoperatively in the hospital. The generalized additive model described the non-linear relationship between hemoglobin drop and AKI occurrence. The minimumP-value approach identified cut-off points of hemoglobin drop within postoperative 7 days for patients with or without preoperative anemia. Stratified by preoperative anemia, hemoglobin drop’s odds ratio as continuous, quintile and dichotomous variables by various cut-off points for postoperative AKI were calculated in multivariate logistic regression models before and after propensity score weighting (PSW).ResultsOf the 35,631 surgery, 5.9% (2105 cases) suffered postoperative AKI. Non-linearity was found between hemoglobin drop and postoperative AKI occurrence. The thresholds and corresponding odds ratio of perioperative hemoglobin drop for patients with and without preoperative anemia were 18 g/L (1.38 (95%CI 1.14 -1.62),P < .001; after PSW: 1.42 (95%CI 1.17 -1.74),P < .001) and 43 g/L (1.81 (95%CI 1.35—2.27),P < .001; after PSW: 2.88 (95%CI 1.85—4.50),P < .001) respectively. Overall thresholds and corresponding odds ratio were 43 g/L (1.82 (95%CI 1.42—2.21)),P < .001; after PSW: 3.29 (95%CI 2.00—5.40),P < .001). Sensitivity analysis showed similar results. Heterogeneity subgroup analysis showed that intraoperatively female patients undergoing intraperitoneal surgery without colloid infusion seemed to be more vulnerable to higher hemoglobin drop. Further analysis showed a possible linear relationship between preoperative hemoglobin and perioperative hemoglobin drop thresholds. Additionally, this study found that the creatinine level changed simultaneously with hemoglobin level within five postoperative days.ConclusionsHeterogeneity of hemoglobin drop endurability exists after noncardiac non-kidney surgery. More care and earlier intervention should be put on patients with preoperative anemia.
Psychosocial barriers and facilitators for adherence to a healthy lifestyle among patients with chronic kidney disease: a focus group study
Authors: Cardol Cinderella K. , Boslooper-Meulenbelt Karin , van Middendorp Henriët , Meuleman Yvette , Evers Andrea W. M. , van Dijk Sandra 
Published: June 2022

Abstract
Background
Progression of chronic kidney disease (CKD) may be delayed if patients engage in healthy lifestyle behaviors. However, lifestyle adherence is very difficult and may be influenced by problems in psychosocial functioning. This qualitative study was performed to gain insights into psychosocial barriers and facilitators for lifestyle adherence among patients with CKD not receiving dialysis.

Methods
Eight semi-structured focus groups were conducted with a purposive sample of 24 patients and 23 health care professionals from four Dutch medical centers. Transcripts were analyzed using thematic analysis. Subsequently, the codes from the inductive analysis were deductively mapped onto the Theoretical Domains Framework (TDF).

Results
Many psychosocial barriers and facilitators for engagement in a healthy lifestyle were brought forward, such as patients’ knowledge and intrinsic motivation, emotional wellbeing and psychological distress, optimism, and disease acceptance. The findings of the inductive analysis matched all fourteen domains of the TDF. The most prominent domains were ‘social influences’’and ‘environmental context and resources’, reflecting how patients’ environments hinder or support engagement in a healthy lifestyle.

Conclusions
The results indicate a need for tailored behavioral lifestyle interventions to support disease self-management. The TDF domains can guide development of adequate strategies to identify and target individually experienced psychosocial barriers and facilitators.