bluuebunny/crossref_metadata_2025_split huggingface dataset:
Two-stage matching-adjusted indirect comparison
Authors: Remiro-Azócar Antonio 
Published: August 2022

Abstract
Background
Anchored covariate-adjusted indirect comparisons inform reimbursement decisions where there are no head-to-head trials between the treatments of interest, there is a common comparator arm shared by the studies, and there are patient-level data limitations. Matching-adjusted indirect comparison (MAIC), based on propensity score weighting, is the most widely used covariate-adjusted indirect comparison method in health technology assessment. MAIC has poor precision and is inefficient when the effective sample size after weighting is small.

Methods
A modular extension to MAIC, termed two-stage matching-adjusted indirect comparison (2SMAIC), is proposed. This uses two parametric models. One estimates the treatment assignment mechanism in the study with individual patient data (IPD), the other estimates the trial assignment mechanism. The first model produces inverse probability weights that are combined with the odds weights produced by the second model. The resulting weights seek to balance covariates between treatment arms and across studies. A simulation study provides proof-of-principle in an indirect comparison performed across two randomized trials. Nevertheless, 2SMAIC can be applied in situations where the IPD trial is observational, by including potential confounders in the treatment assignment model. The simulation study also explores the use of weight truncation in combination with MAIC for the first time.

Results
Despite enforcing randomization and knowing the true treatment assignment mechanism in the IPD trial, 2SMAIC yields improved precision and efficiency with respect to MAIC in all scenarios, while maintaining similarly low levels of bias. The two-stage approach is effective when sample sizes in the IPD trial are low, as it controls for chance imbalances in prognostic baseline covariates between study arms. It is not as effective when overlap between the trials’ target populations is poor and the extremity of the weights is high. In these scenarios, truncation leads to substantial precision and efficiency gains but induces considerable bias. The combination of a two-stage approach with truncation produces the highest precision and efficiency improvements.

Conclusions
Two-stage approaches to MAIC can increase precision and efficiency with respect to the standard approach by adjusting for empirical imbalances in prognostic covariates in the IPD trial. Further modules could be incorporated for additional variance reduction or to account for missingness and non-compliance in the IPD trial.
Development and validation of a machine learning-derived radiomics model for diagnosis of osteoporosis and osteopenia using quantitative computed tomography
Authors: Xie Qianrong , Chen Yue , Hu Yimei , Zeng Fanwei , Wang Pingxi , Xu Lin , Wu Jianhong , Li Jie , Zhu Jing , Xiang Ming , Zeng Fanxin 
Published: August 2022

Abstract
Background
To develop and validate a quantitative computed tomography (QCT) based radiomics model for discriminating osteoporosis and osteopenia.

Methods
A total of 635 patients underwent QCT were retrospectively included from November 2016 to November 2019. The patients with osteopenia or osteoporosis (N = 590) were divided into a training cohort (N = 414) and a test cohort (N = 176). Radiomics features were extracted from the QCT images of the third lumbar vertebra. Minimum redundancy and maximum relevance and least absolute shrinkage and selection operator were used for data dimensional reduction, features selection and radiomics model building. Multivariable logistic regression was applied to construct the combined clinical-radiomic model that incorporated radiomics signatures and clinical characteristics. The performance of the combined clinical-radiomic model was evaluated by the area under the curve of receiver operator characteristic curve (ROC–AUC), accuracy, specificity, sensitivity, positive predictive value, and negative predictive value.

Results
The patients with osteopenia or osteoporosis were randomly divided into training and test cohort with a ratio of 7:3. Six more predictive radiomics signatures, age, alkaline phosphatase and homocysteine were selected to construct the combined clinical-radiomic model for diagnosis of osteoporosis and osteopenia. The AUC of the combined clinical-radiomic model was 0.96 (95% confidence interval (CI), 0.95 to 0.98) in the training cohort and 0.96 (95% CI 0.92 to 1.00) in the test cohort, which were superior to the clinical model alone (training-AUC = 0.81, test-AUC = 0.79). The calibration curve demonstrated that the radiomics nomogram had good agreement between prediction and observation and decision curve analysis confirmed clinically useful.

Conclusions
The combined clinical-radiomic model that incorporates the radiomics score and clinical risk factors, can serve as a reliable and powerful tool for discriminating osteoporosis and osteopenia.
Quality of intrapartum care at Public Health Institutions of North Achefer District, North West Ethiopia: a mixed method study
Authors: Asmare Yinebeb , Tilahun Tizta , Debela Yamrot , Eshetie Yeshiambew , Minuye Biniam , Yalew Zemen Mengesha , Tsegaye Dejen 
Published: August 2022

Abstract
Background
Ending preventable maternal, and neonatal morbidity and mortality cannot be achieved without quality care interventions during the intrapartum and postpartum period. Poor quality care during the intrapartum and postpartum period contributes high burden of maternal and neonatal morbidity. Therefore, the current study aimed to assess the quality of intrapartum care and its associated factors in public health facilities in North Achefer District, North West Ethiopia.

Method
A mixed-type institution-based cross-sectional study design was conducted from November 7 to December 6, 2019. Simple random sampling and purposive sampling were used to select study participants for quantitative and qualitative studies respectively. Data were coded and entered into Epi data version 4.4.2 software and exported to SPSS version 25 for analysis. Variables with a p-value of less than and equal to 0.25 were entered into multivariable regression analysis and variables with p values < 0.05 were considered statistically significant factors of the quality of intrapartum care. The qualitative data were analyzed by using thematic content analysis. Finally, qualitative findings were used to supplement the quantitative result.

Result
The finding showed that, 27.3% (95% CI: 26.6–28) of mothers received good quality intrapartum care. Presence of long-distance (AOR = 0.19; 95% CI = 0.06, 0.66), health care facility (AOR = 0.07; 95% CI = 0.02, 0.20), and partograph utilization (AOR = 4.9; 95% CI = 1.82, 13.14) were factors associated with the quality of intrapartum care.

Conclusion
The proportion of intrapartum quality care was low. Distance, partograph utilization, and type of health facility were factors associated with quality of intrapartum care. The district, zonal health offices, and regional health bureau should provide capacity building and follow up on partograph utilization, and increase the accessibility of ambulances.
Factors influencing exclusive breastfeeding practice among under-six months infants in Ethiopia
Authors: Mekebo Gizachew Gobebo , Argawu Alemayehu Siffir , Likassa Habte Tadesse , Ayele Wondimu , Wake Senahara Korsa , Bedada Dechasa , Hailu Belema , Senbeto Temesgen , Bedane Ketema , Lulu Kebede , Daraje Sagni , Lemesa Reta , Aga Gudeta , Alemayehu Endale , Kefale Bizunesh , Bechera Terefa , Tadesse Getachew , Galdassa Agassa , Olani Jiregna , Hemba Geribe , Teferi Girma , Argaw Abebe , Irana Tariku , Tilahun Tsigereda , Diriba Gezahagn 
Published: August 2022

Abstract
Background
World Health Organization recommends exclusive breastfeeding (EBF) for the first 6 months of life. EBF has sustainable long-term health benefits for both infants and mothers. Despite its benefits, the practice of EBF in Ethiopia is lower than the internationally recommended one. This study aimed at identifying factors influencing EBF practice among under-6 month infants in Ethiopia.

Methods
This study used data drawn from the 2019 Ethiopian Mini Demographic and Health Survey (2019 EMDHS) data. A multivariable logistic regression model was employed to investigate factors significantly associated with EBF practice among under-6 month infants in Ethiopia. An adjusted odds ratio with 95% confidence interval was used to measure the association of factors with EBF practice.

Results
A total of 566 infants under the age of 6 months were included in the study. The prevalence of exclusive breastfeeding practice was 83% (95% CI: 79.70–86%). Urban residences (AOR: 0.40, 95% CI: 0.22–0.73), mothers having secondary education (AOR: 1.54, 95% CI: 1.29–1.84) and higher education (AOR: 3.18, 95% CI: 0.68–15.02), mothers having ANC visits of 1 to 3 times (AOR: 1.52, 95% CI: 1.24–1.88) and ANC visits of 4 and more times (AOR: 4.27, 95% CI: 1.06–17.25), family size of more than 5 (AOR: 0.45, 95% CI: 0.26–0.88), caesarean births (AOR: 0.63, 95% CI: 0.42–0.95), and deliveries at health facilities (AOR: 2.51, 95% CI: 1.12–5.63) were factors significantly associated with EBF practice among under-6 month infants.

Conclusion
In this study, EBF practice among under-6 month infants was significantly associated with place of residence, maternal educational level, ANC visits, family size, mode of delivery, and place of delivery. Therefore, encouraging ANC visit and promotion of institutional (health facility) delivery are recommended. Furthermore, special attention has to be given to mothers with no or less education to make them better aware of the EBF and its benefits to enhance exclusive breastfeeding practice.
Early prediction of noninvasive ventilation failure after extubation: development and validation of a machine-learning model
Authors: Wang Huan , Zhao Qin-Yu , Luo Jing-Chao , Liu Kai , Yu Shen-Ji , Ma Jie-Fei , Luo Ming-Hao , Hao Guang-Wei , Su Ying , Zhang Yi-Jie , Tu Guo-Wei , Luo Zhe 
Published: August 2022

Abstract
Background
Noninvasive ventilation (NIV) has been widely used in critically ill patients after extubation. However, NIV failure is associated with poor outcomes. This study aimed to determine early predictors of NIV failure and to construct an accurate machine-learning model to identify patients at risks of NIV failure after extubation in intensive care units (ICUs).

Methods
Patients who underwent NIV after extubation in the eICU Collaborative Research Database (eICU-CRD) were included. NIV failure was defined as need for invasive ventilatory support (reintubation or tracheotomy) or death after NIV initiation. A total of 93 clinical and laboratory variables were assessed, and the recursive feature elimination algorithm was used to select key features. Hyperparameter optimization was conducted with an automated machine-learning toolkit called Neural Network Intelligence. A machine-learning model called Categorical Boosting (CatBoost) was developed and compared with nine other models. The model was then prospectively validated among patients enrolled in the Cardiac Surgical ICU of Zhongshan Hospital, Fudan University.

Results
Of 929 patients included in the eICU-CRD cohort, 248 (26.7%) had NIV failure. The time from extubation to NIV, age, Glasgow Coma Scale (GCS) score, heart rate, respiratory rate, mean blood pressure (MBP), saturation of pulse oxygen (SpO2), temperature, glucose, pH, pressure of oxygen in blood (PaO2), urine output, input volume, ventilation duration, and mean airway pressure were selected. After hyperparameter optimization, our model showed the greatest accuracy in predicting NIV failure (AUROC: 0.872 [95% CI 0.82–0.92]) among all predictive methods in an internal validation. In the prospective validation cohort, our model was also superior (AUROC: 0.846 [95% CI 0.80–0.89]). The sensitivity and specificity in the prediction group is 89% and 75%, while in the validation group they are 90% and 70%. MV duration and respiratory rate were the most important features. Additionally, we developed a web-based tool to help clinicians use our model.

Conclusions
This study developed and prospectively validated the CatBoost model, which can be used to identify patients who are at risk of NIV failure. Thus, those patients might benefit from early triage and more intensive monitoring.
Trial registration: NCT03704324. Registered 1 September 2018, https://register.clinicaltrials.gov.
Ewing’s sarcoma of the male external genitalia: a case report and review of the literature
Authors: Rachapudi Sruti , Srinivasan Aditya , Gorman Brendan , Wilhelm Alyeesha B. , Eyzaguirre Eduardo , Orihuela Eduardo 
Published: August 2022

Abstract
Background
Ewing’s sarcoma (ES) within the genitourinary tract are relatively unheard of and those within the external male genitalia are even rarer. To our knowledge, this is the first known case of primary ES within the paratesticular region in an adult.

Case presentation
We present a case of a 24-year-old man with a right sided testicular mass on examination that was initially characterized as an adenomatoid tumor on ultrasound. After the patient was lost to follow up over the course of 9 months, the testicular mass grew significantly and was excised with pathology revealing primary paratesticular Ewing’s sarcoma. This rare case emphasizes the importance of elucidating between the broad differentials of paratesticular masses, including the rare presentation of primary ES and adds a review of the literature of ES in the external male genitalia.

Conclusions
Rare differentials such as this case should be considered in patients with paratesticular masses. Further diagnostic and management algorithms for extraosseous Ewing Sarcoma, particularly in the adult population, are warranted.
Factors associated with higher falling risk in elderly diabetic patients with lacunar stroke
Authors: Jin Jianlan , Wen Song , Li Yanyan , Zhou Mingyue , Duan Qingqing , Zhou Ligang 
Published: August 2022

Abstract
Purpose
The aim of this study is to explore the factors associated with the fall risk in type 2 diabetes (T2D) patients with a lacunar stroke.

Materials and methods
We compiled data of 146 T2D patients (mean age 68 years), including the Morse fall scale data (MFS), nutrition score, self-care scale, laboratory data, and data from continuous glucose monitoring system (CGMS) from 2019 to 2021 in Shanghai Pudong Hospital. Thereby, we evaluated the associations between MFS and other clinical parameters.

Results
The analyses showed that there were significantly increased size and numbers of lacunar infarction (p < 0.05). Furthermore, the greater risk group had an older mean age (p < 0.05), and significant decreased estimated glomerular filtration rate (eGFR), total triglyceride (TG), while increased microalbuminuria, magnesium, lipoprotein A (LP(a)), anti-thyroid peroxidase antibody (TPOAb) (p < 0.05). However, the time in range (TIR) was very comparable (p > 0.05). The correlational study revealed the higher score of MFS was associated with the age (r = 0.41), number of lacunar infarction (r = 0.18), nutrition score (r = 0.20), self-care score (r = − 0.43), serum creatine level (r = 0.19), eGFR (r = − 0.26) (p < 0.05). The total numbers of lacunar infarction were associated with age (r = 0.36), eGFR (r = − 0.40), homocysteine level (r = 0.33) (p < 0.05).

Conclusions
Age, nutrition, self-care ability, and renal function are all critical factors associated with the risk of fall in T2D with lacunar infarction. The age, eGFR, and homocysteine are closely associated with lacunar infarction, suggesting that in T2D, evaluation of kidney dysfunction, homocysteine level in the elderly can predict lacunar infarcts and falls.
Evaluation of associations between condylar morphology, ramus height, and mandibular plane angle in various vertical skeletal patterns: a digital radiographic study
Authors: Türker Gökhan , Öztürk Yaşar Meriç 
Published: August 2022

Abstract
Background
To evaluate condylar morphology, ramus height, and asymmetry indexes in patients with different vertical skeletal patterns and to determine the association between condylar and ramal measurements with the mandibular plane angle.

Methods
Dental panoramic radiographs of 60 patients with different skeletal patterns were evaluated. According to the cranial base (Sella-Nasion)-mandibular plane (SN-MP) angle, the patients were divided into three groups: normal angle (NA), low angle (LA), and high angle (HA). The condylar area, condylar perimeter, condylar heights, and ramus height were measured, and the asymmetry index value of each measurement was calculated. A one-way analysis of variance as well as a post hoc Tukey and Kruskall-Wallis tests were used to determine intergroup differences. Pearson’s correlation coefficient was used to determine the relationship between all measurements and SN-MP.

Results
The intergroup comparison of condylar area, condylar perimeter, condylar heights, and ramus height measurements showed that the patients in the LA group have statistically significantly greater values compared to those in the HA group. A statistically significant difference was detected between the NA and LA groups only in the condylar area measurements. There was no statistical difference only in the ramus height measurements between the NA and HA groups. Asymmetry index values of the groups were similar. The negative correlations were found between all measurements and the SN-MP angle.

Conclusion
HA individuals have lower ramus heights and smaller condylar morphologies than NA and LA individuals. In addition, as the SN-MP angle increases, the condyle dimensions and ramus height decrease, and this is a clinically important finding.
Investigation of three-rooted deciduous mandibular second molars in a Chinese population using cone-beam computed tomography
Authors: Jiang Chengfeng , Pei Fan , Wu Yihan , Shen Yifen , Tang Ying , Feng Xingmei , Gu Yongchun 
Published: August 2022

Abstract
Background
To investigate the anatomic features of three-rooted deciduous mandibular second molars (DMSMs) in Chinese children by using cone-beam computed tomography (CBCT).

Methods
A total of 247 CBCT scans of Chinese children were selected and retrospectively analyzed. The occurrence, gender and side predilection of three-rooted DMSMs were examined. The pattern of concurrence of bilateral three-rooted DMSMs, and concurrence of three-rooted DMSM and three-rooted permanent mandibular first molar (PMFM) was analyzed by the concurrence rate and Spearman’s rank correlation test. The geometric parameters of the disto-buccal (DB) and disto-lingual (DL) roots, including the vertical root length, level and angle of distal root furcation, angle of root curvature (by Schneider technique) and the spreading angle, were measured and compared to the three-rooted PMFMs (n = 42) from 100 randomly selected adult subjects.

Results
The occurrence of three-rooted DMSMs was 24.0% (54/225) calculated by individual, and 18.6% (88/472) by tooth. A significant right-side predilection was detected (23.0% vs 14.2%, p < 0.05), while gender predilection was not detected (p > 0.05). The bilateral concurrence rate was 49.0%, and Spearman’s correlation test indicated a significant relationship between the antimetric teeth (rho = 0.609, p < 0.01); whereas a weak but significant co-relationship was detected between the three-rooted DMSM and three-rooted PMFM (right side: concurrence rate = 31.6%, rho = 0.325, p < 0.01; left side: concurrence rate = 23.0%, rho = 0.260, p < 0.01). The length of DL roots in the DMSMs was 7.4 ± 1.5 mm, and the curvature angle was 16.4 ± 11.3 degrees, which was significantly (both p < 0.01) lower than that of the three-rooted PMFMs (root length = 11.0 ± 1.3 mm; degrees of curvature = 34.2 ± 16.1 degrees), whereas the spreading angle of the DL root in DMSMs (34.6 ± 8.4 degrees) was significantly (p < 0.01) greater than in the PMFMs (26.8 ± 6.5 degrees).

Conclusions
Three-rooted DMSMs have a high occurrence rate in the Chinese children with a right-side predilection, and they have a weak but statistically significant correlation with three-rooted PMFMs. The DL roots of DMSMs are shorter, less curved, and spreading more widely as compared with those in the three-rooted PMFMs.
Sociodemographic factors associated with HPV awareness/knowledge and cervical cancer screening behaviors among caregivers in the U.S
Authors: Kim Jiyeong , Dove Melanie S. , Dang Julie H. T. 
Published: August 2022

Abstract
Background
Family caregivers may be at a higher risk for several chronic diseases, including cancer. Cervical cancer is one of the most common causes of cancer death among women. Despite family caregivers’ vulnerability, the status of their HPV awareness, knowledge, and preventive health behaviors, including cervical cancer screening, has been understudied. Thus, this study aimed to examine the sociodemographic factors associated with HPV awareness and knowledge and adherence to the cervical cancer screening guidelines among caregivers in the U.S.

Methods
Nationally representative cross-sectional survey data were obtained from the Health Information National Trends Survey (HINTS 5, 2017–2020). Female caregivers aged 21–65 were included (N = 1190). Weighted multivariable logistic regression was performed to identify factors associated with HPV awareness (heard of HPV), knowledge (HPV can cause cervical cancer), and adherence to the United States Preventive Service Task Force 2018 cervical cancer screening guidelines by sociodemographic factors (age, race/ethnicity, education, household income, marital status,) and the intensity of caregiving.

Results
An estimated 79% of female caregivers were aware of HPV and 84% adhered to the cervical cancer screening guidelines. Caregivers who were older than 50 (OR = 3.62, 1.91–6.85, adherence of aged 21–50 vs. 51–65), Hispanics of race/ethnicity compared with Black/African Americans (OR = 3.14, 1.31–7.52, adherence of Black/African Americans vs. Hispanics), with a high school education or less (OR = 2.34, 1.14–4.82, adherence of Some college or more vs. High school education or less), and with intense caregiving duty (spending 35 h/week or more on caregiving) compared with light-duty (OR = 2.34, 1.10–5.00, adherence of 5–14 h vs. 35 h or more, weekly) had poor adherence to the cervical cancer screening guidelines. Caregivers who were older, racial minorities (Asian, Native Hawaiian/Pacific Islander, American Indian/Alaska Native, Multiple races), and less educated showed lower HPV awareness (Heard of HPV) than their counterparts.

Conclusions
There are caregiving populations whose HPV awareness and cervical cancer screening adherence are low. To improve their awareness and knowledge of HPV and support their cervical cancer screening behaviors, we need to consider interventions that target those specific populations.