bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does Distraction Lower Risk of VPI Compared to Conventional Maxillary Advancement? A Retrospective Cohort Study of Adolescents with Cleft Palate
Authors: Kinter Sara , Susarla Srinivas , Delaney Joseph Christopher , Chapman Kathy , Kapadia Hitesh , Weiss Noel 
Published: November 2022

Objective To determine whether method of maxillary advancement in adolescents with cleft palate with or without cleft lip (CP ± L) influences post-operative velopharyngeal function. Design Retrospective cohort. Setting Pediatric Tertiary Care Hospital. Participants One hundred and ninety-nine patients with CP ± L after LeFort I osteotomy for maxillary advancement at our institution between January 2007 and June 2019. Interventions LeFort I osteotomy via distraction osteogenesis (DO) or conventional osteotomy (CO). Main Outcome Measures Patients who underwent DO or CO were compared for the presence of new velopharyngeal insufficiency (VPI), as measured by perceptual rating by a craniofacial speech-language pathologist. Of the 199 patients who underwent maxillary advancement, 126 were available for analysis. The DO group was younger, male, and had more severe maxillary hypoplasia. Following surgery, 17/41 (41.5%) of the DO group had new VPI, compared to just 23/85 (27.1%) of the CO group. After adjusting for cleft type and predicted maxillary advancement, however, there was not sufficient evidence to reject the null hypothesis of no difference in risk of post-operative VPI between the two surgical groups (prevalence ratio [PR] 1.40, 95% CI 0.68-2.90). Increased prevalence of VPI after DO versus CO was primarily observed among patients with a pre-operative velopharyngeal need ratio < 0.8 (PR = 2.01, 95% CI 0.79-5.10) and patients with normal velopharyngeal function pre-operatively (PR = 2.86, 95% CI 0.96-8.50). Our results suggest an increased rather than decreased risk of VPI following DO relative to CO. This association is primarily seen among those with a smaller velopharyngeal ratio or perceptually normal velopharyngeal function pre-operatively.
Dermal Matrix Graft Effects on Facial Growth in a Veau–Wardill–Kilner Palatoplasty Model: An Experimental Study in Rats
Authors: Zanin Eduardo Madalosso , Arpini Nícolas Endrigo , Roth Julia Caletti , Avalos Galo Verdugo , Duarte Daniele Walter , Martins Collares Marcus Vinicius 
Published: November 2022

The primary goal of palatoplasty is the restoration of normal speech, that can be aimed by, among many procedures, lengthening the palate through the pushback technique; one of its complications is abnormal maxillary growth. The main factor affecting facial growth in CLP patients is believed by many to be the palatoplasty—due to the large scar retraction resulting from some surgical techniques. The non-crosslinked two-layer bioabsorbable collagen matrix Mucograft™ (Geistlich Pharma AG, Wolhusen, Switzerland) is a potential tool to aid in wound closure in a second-intention healing situation. The objective of this work was to test the use of an acellular dermal matrix (Mucograft®) in an experimental model of Veau–Wardill–Kilner palatoplasty, as a tool to reduce scar retraction of the denuded palatine mucosa. Twenty-four 3-week-old male Wistar rats were used. The animals were randomly divided into two groups. In the control group, an excision was made with bone exposure in the palate, simulating the defect left in the Veau–Wardill–Kilner palatoplasty. In the intervention group, the same procedure was performed, and the area of denuded palatine bone was treated with a bioabsorbable collagen matrix (Mucograft®). For data collection, 9 weeks after surgery (12 weeks of life), the animals were euthanized by excessive anesthetic dosage. Maxillary growth, macroscopic appearance of the scar, pain, and bleeding were evaluated. There were significant statistical differences between the groups for palate length growth (7.6 mm + −0.38 mm vs 5.5 mm + −0.36 mm, P = .009) and for palate width growth (1.47 mm + −0.8 mm vs −0.09 mm + −0.55 mm, P = .001), favoring dermal matrix group compared to controls. Whereas for pain and bleeding, there were no differences between the groups. The use of dermal matrix in rats with an area of bone denudation on the palate increases maxillary length and width growth patterns. Besides, it does not increase pain, bleeding, or post-operative complications.
Looking through rainbow-rimmed glasses: Taking neurodiversity perspective is related to subjective well-being of autistic adults
Authors: Ferenc Kinga , Płatos Mateusz , Byrka Katarzyna , Król Magdalena Ewa 
Published: November 2022

Finding new ways of supporting the well-being of autistic adults is an essential goal for research and practice. We tested the predictive value of attitudes towards autism (as neurodiversity or as a disorder) and identification with other autistic people, on the psychological distress and self-esteem of autistic adults ( n = 109). Adopting a neurodiversity attitude not only predicted higher self-esteem but also served as a protective factor against the negative impact of identification with other autistic people on psychological distress. These findings show that clinicians should be sensitive to the way autistic people understand autism and the extent to which they identify with the autism community, as these factors relate to their well-being. Lay abstract Autistic adults experience a high level of distress. Finding new ways to support their well-being is an important goal for researchers and clinicians. We assessed the way autistic adults view their autism, as a disorder or as a type of mind (neurodiversity), and the level they integrate with other autistic people, and we checked how those factors contribute to their well-being. People who see autism rather as a type of mind than as a disorder had higher self-esteem. People who view themselves as more similar to other autistic people felt more stressed, but this result was not accurate for people who view autism as a type of mind. Clinicians should be sensitive to the way autistic people understand autism and to what extent they identify with the autism community, because it may relate to their well-being.
Moral judgements in a foreign language: Expressing emotions and justifying decisions
Authors: Kyriakou Andreas , Foucart Alice , Mavrou Irini 
Published: November 2022

Aim: Previous evidence suggests that language influences bilinguals’ moral judgements. One explanation for this phenomenon is that using a second language (L2) attenuates emotional arousal, thus leading to more rational decisions. This study examined whether bilinguals’ moral arguments and emotional vocabulary are influenced by the language – first language (L1) or L2 – in which a moral dilemma is presented. Methodology and data analysis: A mixed-methods design was employed. We analysed the emotional vocabulary used by 204 Spanish-English bilinguals when making moral judgements and expressing their emotions in response to a highly emotional moral dilemma, as well as the type of arguments they employed to justify their moral decisions in L1 and L2. Findings: The participants were more emotional in their L1, as reflected in the arguments they used to justify their decisions. This finding was supported by a significantly lower number of emotional words in their L2. Moreover, the effect of language on moral judgements was mediated by the participants’ emotions. Originality: This study is the first to qualitatively examine the types of arguments underlying bilinguals’ moral decision-making in their L1 and in their L2. Moreover, the analysis of verbal emotional expressions in relation to moral decisions adds to the findings of previous research that was based almost exclusively on forced-choice measures and further supports the hypothesis that the reduction of emotional arousal in an L2 modulates individuals’ moral judgements. Implications: The results have implications for L2 teaching and pedagogy. The L2 curriculum should include instruction in emotional vocabulary and should engage learners in discussions that require argumentation and critical thinking about strong emotional content. This may assist bilinguals not only to express their internal affective states more efficiently, but also to experience the intensity of L2 emotionally charged words in a similar way as they do in their L1.
Randomized controlled trials of biomarker targets
Authors: Erlendsdottir Margret , Crawford Forrest W 
Published: November 2022

Introduction: Randomized controlled trials are used to estimate the causal effect of a treatment on a health outcome of interest in a patient population. Often the specified treatment in a randomized controlled trial is a medical intervention—such as a drug or procedure—experienced directly by the patient. Sometimes the “treatment” in a randomized controlled trial is a target—such as a goal biomarker measurement—that the patient’s physician attempts to reach using available medications or procedures. Large randomized controlled trials of biomarker targets are common in clinical research, and trials have been conducted to compare targets in the management of hypertension, diabetes, anemia, and acute respiratory distress syndrome. However, different randomized controlled trials intended to evaluate the same biomarker targets have produced conflicting recommendations, and meta-analyses that aggregate results of trials of biomarker targets have been inconclusive. Methods: We use causal reasoning to explain why randomized controlled trials of biomarker targets can arrive at conflicting or misleading conclusions. We describe four key threats to the validity of trials of targets: (1) intention-to-treat analysis can be misleading when a direct effect of target assignment on the outcome exists due to lack of blinding; (2) incomparability in results across trials of targets; (3) time-varying adaptive treatment strategies; and (4) Goodhart’s law, “when a measure becomes a target, it ceases to be a good measure.” Results: We illustrate these findings using evidence from 15 randomized controlled trials of blood pressure targets for management of hypertension. Randomized trials of blood pressure targets exhibit substantial variation in the trial patient populations and antihypertensives used to achieve the blood pressure targets assigned in the trials. The trials did not compare or account for time-varying treatment strategies used to reach the randomized targets. Possible “off-target” effects of antihypertensive medications needed to reach lower blood pressure targets may explain the absence of a clear benefit from intensive blood pressure control. Discussion: Researchers should critically assess meta-analyses of trials of targets for variation in the types, distributions, and off-target effects of therapies studied. Trial investigators should release detailed information about the biomarker targets compared in new randomized trials, as well as confounders, treatments delivered, and outcomes. New randomized controlled trials should experimentally compare treatment algorithms incorporating biomarkers, rather than targets alone. Causal inference methodology that adjusts for time-varying confounding should be used to compare time-varying treatment strategies in observational settings.
Efficacy and safety of therapies for advanced prostate cancer in Asia: Evidence from a systematic literature review
Authors: Saad Marniza , Umbas Rainy , Chiong Edmund , Kanesvaran Ravindran 
Published: November 2022

Objectives: Several therapies are available for the treatment of advanced/metastatic prostate cancer (PC). However, the systematic assessment of evidence pertaining to the use of these therapies in Asian patients is lacking. Methods: A systematic literature review (SLR) was conducted using PubMed/Medline search in May 2021 to identify the randomized/nonrandomized controlled trials (RCTs/non-RCTs) and real-world observational studies (prospective/retrospective). Only studies published as full manuscripts in English were included if reporting the efficacy, effectiveness, and/or safety of treatments in Asian patients with advanced/metastatic PC. Results: Of the 1,898 retrieved publications, 24 studies were included. These studies had patients with nonmetastatic castration-resistant PC (n = 2), metastatic castration-sensitive PC ( n = 4), and metastatic castration-resistant PC ( n = 18). Study designs included RCTs ( n = 7), non-RCTs ( n = 2), and real-world studies ( n = 15). Treatments used in included studies were abiraterone acetate plus prednisone (AAP; n = 6), enzalutamide, lutetium-177 prostate-specific membrane antigen (177Lu-PSMA; n = 4 each), docetaxel ( n = 3), apalutamide, radium-223 ( n = 2 each), darolutamide, cabazitaxel, and pembrolizumab ( n = 1 each). The evidence from RCTs (i.e., ARAMIS, SPARTAN, ARCHES, TITAN, LATITUDE, PREVAIL) demonstrated the clinical benefits of apalutamide, darolutamide, enzalutamide, and AAP in terms of overall, disease-free, and metastasis-free survival in Asian patients. These treatments were reported to be well tolerated, with no new safety signals identified in Asian population. The efficacy and safety profiles in Asian patients were consistent with the overall trial population. Data from real-world studies supported the effectiveness and tolerability of AAP, enzalutamide, radium-223, docetaxel, cabazitaxel, 177Lu-PSMA, and pembrolizumab in patients with advanced/metastatic PC. Conclusions: This SLR of the Asian data on therapies for advanced PC from the pivotal and real-world studies confirms similar efficacy and safety outcomes, consistent with the results from the pivotal clinical trials. These findings will help clinicians make better treatment decisions in clinical practice for patients with advanced/metastatic PC.
Deep learning-based classification of infectious keratitis on slit-lamp images
Authors: Zhang Zijun , Wang Haoyu , Wang Shigeng , Wei Zhenyu , Zhang Yang , Wang Zhiqun , Chen Kexin , Ou Zhonghong , Liang Qingfeng 
Published: November 2022

Background: Infectious keratitis (IK) is an ocular emergency caused by a variety of microorganisms, including bacteria, fungi, viruses, and parasites. Culture-based methods were the gold standard for diagnosing IK, but difficult biopsy, delaying report, and low positive rate limited their clinical application. Objectives: This study aims to construct a deep-learning-based auxiliary diagnostic model for early IK diagnosis. Design: A retrospective study. Methods: IK patients with pathological diagnosis were enrolled and their slit-lamp photos were collected. Image augmentation, normalization, and histogram equalization were applied, and five image classification networks were implemented and compared. Model blending technique was used to combine the advantages of single model. The performance of combined model was validated by 10-fold cross-validation, receiver operating characteristic curves (ROC), confusion matrix, Gradient-wright class activation mapping (Grad-CAM) visualization, and t-distributed Stochastic Neighbor Embedding (t-SNE). Three experienced cornea specialists were invited and competed with the combined model on making clinical decisions. Results: Overall, 4830 slit-lamp images were collected from patients diagnosed with IK between June 2010 and May 2021, including 1490 (30.8%) bacterial keratitis (BK), 1670 (34.6%) fungal keratitis (FK), 600 (12.4%) herpes simplex keratitis (HSK), and 1070 (22.2%) Acanthamoeba keratitis (AK). KeratitisNet, the combination of ResNext101_32x16d and DenseNet169, reached the highest accuracy 77.08%. The accuracy of KeratitisNet for diagnosing BK, FK, AK, and HSK was 70.27%, 77.71%, 83.81%, and 79.31%, and AUC was 0.86, 0.91, 0.96, and 0.98, respectively. KeratitisNet was mainly confused in distinguishing BK and FK. There were 20% of BK cases mispredicted into FK and 16% of FK cases mispredicted into BK. In diagnosing each type of IK, the accuracy of model was significantly higher than that of human ophthalmologists ( p < 0.001). Conclusion: KeratitisNet demonstrates a good performance on clinical IK diagnosis and classification. Deep learning could provide an auxiliary diagnostic method to help clinicians suspect IK using different corneal manifestations.
Coronavirus disease–2019 morbidity and mortality among health care workers in Uganda
Authors: Ssetaba Leoson Junior , Mirembe Joy , Omega Jotham , Okot Jerom , Kiguli Sarah , Nakwagala Frederick Nelson , Bongomin Felix 
Published: November 2022

Background: Health care workers (HCWs) are at increased risk of acquiring coronavirus disease 2019 (COVID-19). This study aimed to determine and compare the morbidity and mortality rates due to COVID-19 among the HCWs and the general population (non-HCWs). Methods: We conducted a retrospective chart review. We accessed electronic database of participants admitted at Mulago National Referral Hospital COVID-19 Treatment Unit (CTU) between March 2020 and September 2021. Participants with missing occupations were excluded. Results: Of 594 eligible participants, 6.4% ( n = 38) were HCWs. Compared with non-HCWs, HCWs were much younger (48 versus 55 years, p = 0.020). The proportion of participants with severe disease (73.7% versus 77.6%, p = 0.442), who had not received COVID-19 vaccine (91.2% versus 94.7%, p = 0.423), mortality rate (44.7% versus 54.8%, p = 0.243) and the median length of hospitalization (6 versus 7 days, p = 0.913) were similar among HCWs and non-HCWs, respectively. A higher proportion of HCWs required oxygen therapy (24.3% versus 9.7%, p < 0.01). At admission, the presence of cough ( p = 0.723), breathlessness ( p = 0.722), fever ( p = 0.19), sore throat ( p = 0.133), comorbidities ( p = 0.403) and headache ( p = 0.162) were similar across groups. Rhinorrhoea was more common among HCWs (34.4% versus 16.6%, p = 0.017). Among HCWs, nurses had the highest morbidity (52.6%) and mortality (58.8%). Conclusion: The morbidity and mortality among HCWs in Uganda were substantial, with a low COVID-19 vaccination rate and a higher requirement for oxygen therapy despite a younger age.
Growth monitoring service utilization and its associated factors among mothers of children less than 2 years in Muhir Aklil district, Gurage zone, Southern Ethiopia, 2020
Authors: Endale Getu , Melis Tamirat , Dendir Andamlak , Lentiro Kifle , Sahle Tadesse 
Published: November 2022

Introduction: United Nations International Children’s Emergency Fund recommends a 100% growth monitoring and promotion coverage, but the prevalence of growth monitoring and promotion service utilization rate in Ethiopia is only 16.9%. Even though Ethiopia is attempting different strategies to cope up with this low rate, the problem is still unresolved. Objective: The aim of this study is to assess the prevalence of growth monitoring service utilization and its associated factors among mothers of children less than 2 years in Muhir Aklil district. Methods: A community-based cross-sectional study was conducted on 443 study participants from 10 February to 8 March 2020. The study participants in the study were selected using simple random sampling technique. The collected data were entered in to EpiData3.1 and exported to SPSS version 23. Bivariate and multi-variable logistic regression analysis was used to identify factors associated with growth monitoring service utilization. Statistically significance was declared at p value < 0.05% and 95% confidence interval. Results: In this study, the overall growth monitoring and service utilization was 32.9%. Fully empowered mothers adjusted odds ratio: 2.7, 95% confidence interval: 1.5–4.3), receiving counseling (adjusted odds ratio: 2.8; 95% confidence interval: 2.0–4.7) and regularly participating on community conversation (adjusted odds ratio: 2.8, 95% confidence interval: 1.8–7.6) were significantly associated with growth monitoring service utilization. Conclusion: Growth monitoring services utilization was 32.9%. Maternal empowerment on decision-making, engaging women on financial control, knowledge of mothers receiving counseling and regularly participating on community conversation were the independent factors for growth monitoring service utilization. The health extension workers should strengthen maternal empowerment and community conversation through increasing maternal awareness.
Open science and conflict of interest policies of medical and health sciences journals before and during the COVID-19 pandemic: A repeat cross-sectional study
Authors: Gardener Antoni D. , Hick Ellen J. , Jacklin Chloe , Tan Gifford , Cashin Aidan G. , Lee Hopin , Nunan David , Toomey Elaine C. , Richards Georgia C. 
Published: November 2022

Objectives To audit the transparent and open science standards of health and medical sciences journal policies and explore the impact of the COVID-19 pandemic. Design Repeat cross-sectional study. Setting 19 journals listed in Google Scholar's Top Publications for health and medical sciences. Participants Blood, Cell, Circulation, European Heart Journal, Gastroenterology, Journal of Clinical Oncology, Journal of the American College of Cardiology, Nature Genetics, Nature Medicine, Nature Neuroscience, Neuron, PLoS ONE, Proceedings of the National Academy of Sciences, Science Translational Medicine, The British Medical Journal, The Journal of the American Medical Association, The Lancet, The Lancet Oncology, and The New England Journal of Medicine. Main outcome measures We used the Transparency and Openness Promotion (TOP) guideline and the International Committee of Medical Journal Editors (ICMJE) requirements for disclosing conflicts of interest (COIs) to evaluate journals standards. Results TOP scores slightly improved during the COVID-19 pandemic, from a median of 5 (IQR: 2–12.5) out of a possible 24 points in February 2020 to 7 (IQR: 4–12) in May 2021, but overall, scores were very low at both time points. Journal policies scored highest for their adherence to data transparency and scored lowest for preregistration of study protocols and analysis plans and the submission of replication studies. Most journals fulfilled all ICMJE provisions for reporting COIs before (84%; n  =  16) and during (95%; n  =  18) the COVID-19 pandemic. Conclusions The COVID-19 pandemic has highlighted the importance of practising open science. However, requirements for open science practices in audited policies were overall low, which may impede progress in health and medical research. As key stakeholders in disseminating research, journals should promote a research culture of greater transparency and more robust open science practices.