bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of Neutrophil-to-Lymphocyte Ratio with the Risk of Fatal Stroke Occurrence in Older Chinese
Authors: Hu Zhi-bing , Zhong Qiong-qiong , Lu Ze-xiong , Zhu Feng 
Published: May 2022

Background Associations of neutrophil-to-lymphocyte ratio (NLR) and its longitudinal change with risk of fatal strokes are unclear in older populations. Methods In this retrospective analysis, a total of 27,799 participants were included and followed up for a mean of 14.3 years (standard deviation = 3.2). 838 stroke deaths were recorded. Cox proportional hazards regression was used to assess associations of NLR with fatal strokes. Results Compared to those in the first quartile and after adjustment for a series of factors, the participants in the highest neutrophil quartile had an increased risk of fatal all stroke (adjusted hazard ratio (aHR) = 1.45, 95% confidence interval (CI), 1.18–1.79) and fatal ischaemic stroke (aHR = 1.58, 95% CI, 1.17–2.12). Restricted cubic splines showed an increased trend of relationship between the NLR and fatal all stroke. The participants with the highest NLR quartile had an increased risk of fatal all stroke (aHR = 1.52, 95% CI, 1.23–1.88) and fatal ischaemic stroke (aHR = 1.59, 95% CI, 1.13–2.26), respectively; Similar associations repeated after further C-reactive protein adjustment; a 21% and a 32% increased risk of fatal all stroke and fatal ischaemic stroke showed in a continuous variable model. Those in NLR change with 5% increase had a 70% increased risk of fatal all stroke (aHR = 1.70, 95%CI, 1.13–2.57), compared to those in stable (−5%∼5%). Conclusions Higher NLR was associated with an increased risk of fatal all stroke and fatal ischaemic stroke, and its longitudinal change increase of ≥ 5% was associated with an increased risk of fatal all stroke in a relatively healthy older population.
The clinical journey and healthcare resources required for dialysis access of end-stage kidney disease patients during their first year of hemodialysis
Authors: Ho Pei , Binte Taufiq Chong Ah Hoo Nur Nabila Farhana , Cheng Yi Xin , Meng Lingyan , Chai Min Shen Darryl , Teo Boon Wee , Ma Valerie , Hargreaves Carol Anne 
Published: May 2022

Background: Creation and maintenance of dialysis vascular access (VA) is a major component of healthcare resource utilization and cost for patients newly started on hemodialysis (HD). Different VA format arises due to patient acceptance of anticipatory care versus late preparation, and clinical characteristics. This study reviews the clinical journey and resource utilization required for different VA formats in the first year of HD. Method: Data of patients newly commenced on HD between July 2015 and June 2016 were reviewed. Patients were grouped by their VA format: (A) pre-emptive surgically created VA (SCVA), (B) tunneled central venous catheter (CVC) followed by SCVA creation, (C) long-term tunneled CVC only. Clinical events, number of investigations and procedures, hospital admissions, and incurred costs of the three groups were compared. Results: In the multivariable analysis, the cost incurred by the group A patients had no significant difference to that incurred in the group B patients ( p = 0.08), while the cost of group C is significantly lower ( p < 0.001). Both the 62.7% of group A with successful SCVA who avoided tunneled CVC usage, and those with a functionally matured SCVA in group B (66.1%), used fewer healthcare resources and incurred less cost for their access compared to those did not ( p = 0.01, p = 0.02, respectively) during the first year of HD. Conclusion: With comparable cost, a pre-emptive approach enables avoidance of tunneled CVC. Tunneled CVC only access format incurred lower cost and is suitable for carefully selected patients. Successful maturation of SCVA greatly affects patients’ clinical journey and healthcare cost.
Impact of insulin therapy on outcomes of diabetic patients with heart failure: A systematic review and meta-analysis
Authors: Liu Jingxing , Hu Xinhua 
Published: May 2022

Objective: To compare clinical outcomes in diabetic patients with heart failure managed by insulin with those managed by non-insulin (oral hypoglycemic agents and/or lifestyle modification) based therapy. Methods: PubMed and Scopus databases were searched for studies conducted on diabetic patients with heart failure. Studies were to compare outcomes of patients managed by insulin versus non-insulin therapies. Results: 15 studies were included. Compared to those who were managed using non-insulin therapy, insulin-treated patients had increased risk of all-cause mortality (RR 1.46, 95% CI: 1.14, 1.88) and cardiovascular specific mortality (RR 1.62, 95% CI: 1.33, 1.96). Those managed using insulin also had increased risk of hospitalization (RR 1.45, 95% CI: 1.09, 1.93) and readmission (RR 1.49, 95% CI: 1.32, 1.67). There was no additional risk for stroke (RR 1.07, 95% CI: 0.91, 1.27) or myocardial infarction (MI) (RR 1.10, 95% CI: 0.96, 1.27) between the two groups of patients. Conclusions: Receipt of insulin among diabetic patients with heart failure was associated with an increased risk of mortality, hospitalization and readmission compared to management using oral hypoglycemic agents and/or lifestyle modification. Such patients should be closely monitored for any adverse events.
Social-Ecological Correlates of Loneliness Among Young Adult U.S. Males
Authors: Rovito Kathy E. , Herring R. Patti , Beeson W. Lawrence , Gamboa-Maldonado Thelma , Lee Jerry W. 
Published: May 2022

Purpose Social disconnection, such as loneliness, is recognized as a significant public health concern in the United States, and young adult males may carry the greater burden of this issue when compared with their female peers. Little is known about the correlates of loneliness for this population. This study examines the social-ecological correlates of loneliness in young adult males. Methods Males, aged 18 to 25 years, in the United States were recruited to take part in a cross-sectional electronic survey. Loneliness was assessed as a composite measure. The social-ecological correlates consisted of intrapersonal-level (e.g., social-demographic characteristics), interpersonal-level (e.g., adverse childhood experiences), community-level (e.g., life expectancy at the county level), and societal-level (e.g., idealized masculine gender) variables. A four-block hierarchical regression was performed with each block representing the respective social-ecological level. Results Among the study sample ( n = 495), the intra- and interpersonal variables significantly shared 10% and an incremental 3%, respectively, of the explained variance in loneliness. Mental health diagnosis (β = 1.06, 95% confidence interval [CI]: [0.54, 1.59]), childhood physical and emotional abuse (β = 0.21, 95% CI: [0.02, 0.39]), and childhood sexual abuse (β = 0.30, 95% CI: [0.01, 0.60]) were significantly associated with greater loneliness. Conclusion The findings highlight that the micro-level (intra- and interpersonal) correlates may be most important in predicting loneliness in young adult males. Specifically, young males with a mental health diagnosis and those with greater experiences of childhood adversity are at potentially greater risk for loneliness. Implications for research, programming, and policy are highlighted.
Use of Google Analytics to Explore Dissemination Activities for an Online CKD Clinical Pathway: A Retrospective Study
Authors: Chong Christy , Smekal Michelle , Hemmelgarn Brenda , Elliott Meghan , Allu Selina , Wick James , McBrien Kerry , Jackson Wes , Bello Aminu , Jindal Kailash , Scott-Douglas Nairne , Manns Braden , Tonelli Marcello , Donald Maoliosa 
Published: May 2022

Background: Data on dissemination strategies that generate awareness of clinical pathways for kidney care are limited. Objective: This study reports the application of Google Analytics to describe the reach and use of the Chronic Kidney Disease Pathway (CKD-P) using a multi-faceted dissemination strategy. Design: The design of this study is a retrospective descriptive study. Setting: This study was conducted in Alberta, Canada. Patients: Individuals who accessed the CKD-P Web site between November 5, 2014, and May 31, 2019. Measurements: Dissemination activities included print, electronic, in-person meetings, and a laboratory prompt. We used Google Analytics over a 5-year period to evaluate the following CKD-P Web site user metrics: number of sessions, pageviews, visit duration, user path, and bounce rate (when an individual visits a single page of the Web site and leaves the Web site without interacting with additional pages). Methods: We plotted dissemination activities alongside Web site metrics using control charts and described the data using means and percentages. We performed chi-square test for trends to evaluate year-over-year usage. Results: There were 83 294 users, 90 805 sessions, and 231 684 pageviews. The overall bounce rate was 45.7%. Each user had an average of 1.5 sessions and a session duration of 2 minutes and 8 seconds. There was a significant positive trend for total annual users ( P = .008), new users ( P = .009), number of sessions ( P = .006), and pageviews per day ( P = .016). Limitations: We were unable to confirm if users were primary care providers and if word-of-mouth dissemination among providers/researchers drove people to use the CKD-P. Conclusions: Google Analytics was a useful and accessible tool for evaluating CKD-P reach and use trends. It was challenging to identify how individual dissemination activities contributed to CKD-P reach; however, repeated dissemination appeared to play a role in increasing CKD-P use. Trial registration: Not applicable—observational study design.
Validation of the Romanian Communication Skills Ability Scale – CSAS-RO – A Tool for Medical Schools
Authors: Steriu Andreea , Bratu Eugenia Claudia , Cioran Nicoleta Valentina , Brînduşe Lăcrămioara Aurelia 
Published: May 2022

In medicine ability to communicate requires training and continuous development. Aim To validate the Communication Skills Ability Scale in Romanian. Study design: cross-sectional observational interrupted large case series. Sample and setting: all year 5 medical undergraduate students enrolled at UMF Carol Davila, Bucharest (UMFCD). A two field tests study: 1) 2nd semester of the 2017/2018 academic year (n = 361); 2) 2018/2019 academic year (n = 703). Methodology The Romanian translation of CSAS® was used. Results The CSAS-RO confirms the 2-Factor scale; internal consistency: Cronbach-α coefficient was 0.894 for the PAS (0.870 CSAS®) and 0.754 for the NAS (0.805 CSAS®) All item-total and item-rest correlations satisfied the criterion of more than 0.30, ranging from 0.32 to 0.71 with the exception of items 17 (field test 1) and item 11 (field test 2) Conclusion CSAS-RO is valid to use with medical students. The reuse of the scale with a longitudinal study design will allow to assess any new educational needs for communication ability in medical students plus add the remaining property to test (the test-retest reliability).
COVID-19 in patients with hematologic malignancy
Authors: Langerbeins Petra , Hallek Michael 
Published: May 2022

Abstract
The coronavirus infectious disease (COVID-19) shows a remarkable symptomatic heterogeneity. Several risk factors including advanced age, previous illnesses, and a compromised immune system contribute to an unfavorable outcome. In patients with hematologic malignancy, the immune response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is significantly reduced explaining why the mortality rate of hematologic patients hospitalized for a SARS-CoV-2 infection is about 34%. Active immunization is an essential pillar to prevent SARS-CoV-2 infections in patients with hematologic malignancy. However, the immune response to SARS-CoV-2 vaccines may be significantly impaired, as only half of patients with hematologic malignancy develop a measurable antiviral antibody response. The subtype of hematologic malignancy and B cell–depleting treatment predict a poor immune response to vaccination. Recently, antiviral drugs and monoclonal antibodies for pre-exposure or postexposure prophylaxis and for early treatment of COVID-19 have become available. These therapies should be offered to patients at high risk for severe COVID-19 and vaccine nonresponders. Importantly, as the virus evolves, some therapies may lose their clinical efficacy against new variants. Therefore, the ongoing pandemic will remain a major challenge for patients with hematologic malignancy and their caregivers who need to constantly monitor the scientific progress in this area.
Exploring attractor bifurcations in Boolean networks
Authors: Beneš Nikola , Brim Luboš , Kadlecaj Jakub , Pastva Samuel , Šafránek David 
Published: May 2022

Abstract
Background
Boolean networks (BNs) provide an effective modelling formalism for various complex biochemical phenomena. Their long term behaviour is represented by attractors–subsets of the state space towards which the BN eventually converges. These are then typically linked to different biological phenotypes. Depending on various logical parameters, the structure and quality of attractors can undergo a significant change, known as a bifurcation. We present a methodology for analysing bifurcations in asynchronous parametrised Boolean networks.

Results
In this paper, we propose a computational framework employing advanced symbolic graph algorithms that enable the analysis of large networks with hundreds of Boolean variables. To visualise the results of this analysis, we developed a novel interactive presentation technique based on decision trees, allowing us to quickly uncover parameters crucial to the changes in the attractor landscape. As a whole, the methodology is implemented in our tool AEON. We evaluate the method’s applicability on a complex human cell signalling network describing the activity of type-1 interferons and related molecules interacting with SARS-COV-2 virion. In particular, the analysis focuses on explaining the potential suppressive role of the recently proposed drug molecule GRL0617 on replication of the virus.

Conclusions
The proposed method creates a working analogy to the concept of bifurcation analysis widely used in kinetic modelling to reveal the impact of parameters on the system’s stability. The important feature of our tool is its unique capability to work fast with large-scale networks with a relatively large extent of unknown information. The results obtained in the case study are in agreement with the recent biological findings.
Opioid prescribing practices at hospital discharge for surgical patients before and after the Centers for Disease Control and Prevention’s 2016 opioid prescribing guideline
Authors: Langnas Erica , Bishara Andrew , Croci Rhiannon , Rodriguez-Monguio Rosa , Wick Elizabeth C. , Chen Catherine L. , Guan Zhonghui 
Published: May 2022

Abstract
Background
The Centers for Disease Control and Prevention’s (CDC) March 2016 opioid prescribing guideline did not include prescribing recommendations for surgical pain. Although opioid over-prescription for surgical patients has been well-documented, the potential effects of the CDC guideline on providers’ opioid prescribing practices for surgical patients in the United States remains unclear.

Methods
We conducted an interrupted time series analysis (ITSA) of 37,009 opioid-naïve adult patients undergoing inpatient surgery from 2013–2019 at an academic medical center. We assessed quarterly changes in the discharge opioid prescription days’ supply, daily and total doses in oral morphine milligram equivalents (OME), and the proportion of patients requiring opioid refills within 30 days of discharge.

Results
The discharge opioid prescription declined by -0.021 (95% CI, -0.045 to 0.003) days per quarter pre-guideline versus -0.201 (95% CI, -0.223 to -0.179) days per quarter post-guideline (p < 0.0001). Likewise, the mean daily and total doses of the discharge opioid prescription declined by -0.387 (95% CI, -0.661 to -0.112) and -7.124 (95% CI, -9.287 to -4.962) OME per quarter pre-guideline versus -2.307 (95% CI, -2.560 to -2.055) and -20.68 (95% CI, -22.66 to -18.69) OME per quarter post-guideline, respectively (p < 0.0001). Opioid refill prescription rates remained unchanged from baseline.

Conclusions
The release of the CDC opioid guideline was associated with a significant reduction in discharge opioid prescriptions without a concomitant increase in the proportion of surgical patients requiring refills within 30 days. The mean prescription for opioid-naïve surgical patients decreased to less than 3 days’ supply and less than 50 OME per day by 2019.
Functional limitations before and after cancer diagnosis and contributing factors: findings from the China health and retirement longitudinal study
Authors: Yang Rumei , Liu Yin , Jiang Yun , Fleming Daniel J. M. , Fauth Elizabeth B. 
Published: May 2022

Abstract
Background
Although there is a general trend of functional decline with age, there lacks an understanding of how cancer diagnosis and other factors may contribute to this trend. This study aimed to examine functional limitation trajectories among adults with and without cancer, and before versus after the cancer diagnosis, and to explore potential contributing factors associated with functional trajectories among cancer survivors.

Methods
The sample were middle-aged and older Chinese adults who participated in all 3 waves of the China Health and Retirement Longitudinal Study (CHARLS, 2011–2015). Ordinary and multiphase growth curve analyses were conducted to examine (1) differences in functional trajectories between participants with (n = 139) and without cancer (n = 7,313), (2) pre-and post-cancer diagnosis changes in functional limitations among those who reported a cancer diagnosis over the 4-year timeframe, and (3) contributing factors associated with functional trajectories among cancer survivors, guided by the Disablement Process Models, including psychological (depressive symptoms), physical (pain and falls), cognitive (self-reported memory problems), and environmental (social contact and available support) factors.

Results
There was a trend of increased functional limitations among all participants over time (unstandardized β = 0.17, p < .0001). However, participants with cancer did not differ from non-cancer participants in neither the level (unstandardized β = 0.77, p = .08) nor the rate of functional decline (unstandardized β = -0.43, p = .07). Functional limitation trajectories were different pre- versus post-cancer diagnosis, although not in expected directions (unstandardized β = -0.48, p < .05). Cancer survivors with greater pain had higher levels of functional limitations which were sustained over time compared to those with less pain (unstandardized β = 0.93, p < .001).

Conclusions
The study confirmed that Chinese middle-aged and older adults had overall decreased functional decline over time. A novel finding that cancer survivors experienced less rapidly functional decline after the cancer diagnosis suggested that cancer diagnosis might serve as an inflection point at which early intervention is promising to slow the functional decline. In addition, findings that within-person contributing factors, such as pain, can be influential in functional limitation trajectories suggested that more attention is needed to pay to patients with cancer-pain. These findings demonstrated the heterogeneity of functional limitation trajectories and needs for person-centered interventions among Chinese cancer survivors.
A suspected case of hyponatraemia induced rhabdomyolysis: a case report
Authors: Reakes Edward , Drak Douglas , Gracey David 
Published: May 2022

Abstract
Background
Hyponatraemia is a documented but under-recognised cause of rhabdomyolysis, with the contrasting treatment strategies for the two conditions posing a unique challenge. Balancing the need for aggressive fluid replacement for the treatment of rhabdomyolysis, with the risk of rapidly correcting hyponatraemia is imperative.

Case presentation
A 52-year-old gentleman with a background of HIV infection and hypertension presented with seizures following methamphetamine use, acute water intoxication, and thiazide use. He was found to have severe hyponatraemia, and following initial correction with hypertonic saline, was commenced on a fluid restriction. After two days he developed abdominal wall and thigh pain, along with oliguria. Laboratory data demonstrated markedly elevated creatine kinase levels and deteriorating renal function. A diagnosis of rhabdomyolysis and severe acute kidney injury was made and aggressive fluid replacement commenced, leading to full resolution of the hyponatraemia, rhabdomyolysis and acute kidney injury.

Conclusion
Hyponatraemia-induced rhabdomyolysis is rare but can cause significant morbidity and mortality if left untreated. Physicians should consider measuring creatine kinase levels in all patients presenting with severe hyponatraemia, particularly in the presence of other risk factors for rhabdomyolysis. Fluid replacement strategies must be considered in relation to the relative onset and risk of over-correcting hyponatraemia.
Functional status and its related factors among stroke survivors in rehabilitation departments of hospitals in Shenzhen, China: a cross-sectional study
Authors: Zhou Jing , Liu Fang , Zhou Mingchao , Long Jianjun , Zha Fubing , Chen Miaoling , Li Jiehui , Yang Qingqing , Zhang Zeyu , Wang Yulong 
Published: May 2022

Abstract
Background
Many stroke survivors have multiple chronic diseases and complications coupled with various other factors which may affect their functional status. We aimed to investigate the factors associated with poor functional status in hospitalized patients with stroke in Shenzhen, China.

Methods
In this cross-sectional study, four urban hospitals were selected using convenient sampling, and all stroke patients in these four hospitals were included using cluster sampling. The functional status of stroke survivors was evaluated using Longshi Scale. Explanatory variables (factors affecting functional status comprising age, sex, body mass index, smoking, alcohol consumption, complications, and chronic conditions) were collected. Ordinal logistic regression was used to examine which factors were associated with poor functional status.

Results
Stroke survivors with poor functional status accounted for 72.14% and were categorised as the bedridden group based on Longshi scale, 21.67% of patients with moderate functional limitation were categorised as the domestic group, and 6.19% of the patients with mild functional restriction were categorised as the community group. The highest dependence scores were noted for feeding (73.39%), bowel and bladder management (69.74%) and entertainment (69.53%) among the bedridden group, and housework (74.29%) among the domestic group. In the adjusted model, the odds of poor functional status were higher among stroke patients with older age (odds ratio [OR] = 2.39, 95% CI: 1.55–3.80), female sex (OR = 1.73, 95% CI: 1.08–2.77), duration of stroke more than 12 months (OR = 1.94, 95% CI: 1.28–2.95), with pulmonary infection (OR = 10.91, 95% CI: 5.81–20.50), and with deep venous thrombosis (OR = 3.00, 95% CI: 1.28–7.04).

Conclusions
Older adults (age ≥ 60 years) and women were more likely to exhibit poor functional status post-stroke. Pulmonary infection and deep venous thrombosis were related to an increased risk of being dependent on activities of daily living. Therefore, clinical and rehabilitation interventions aimed at preventing or treating these common complications should be addressed to deal with subsequent dysfunction post-stroke. Since all data were obtained in metropolitan areas where the economy is well developed, future studies should be conducted in rural areas and economically less developed cities.