bluuebunny/crossref_metadata_2025 huggingface dataset:
The Role of Company Size Moderating the Effect of Capital Structure and Profitability to Firm Value in Consumer Non-Cyclicals Businesses on the Indonesian Stock Exchange
Authors: Sulistiyo Heru , Sitawati Riana , Sutono
Published: January 2025

Aims: Study this is about the firm value, aiming to test company size to moderate the influence of capital structure and profitability on the firm value in consumer non-cyclical business listed on the Indonesia Stock Exchange (IDX).
Study Design:  The design of this research study is correlational.
Place and Duration of Study: Consumer non-cyclical business on the Indonesia Stock Exchange (IDX) issuers in 2018-2022.
Methodology: This study's population was 122 non-cyclical consumer companies listed on the Indonesia Stock Exchange from 2018 to 2022. From the population, a sample of 56 was selected based on the purposive sampling method with 5 years of observation (2018-2022), so the number of samples was 280. However, there were 18 outlier data, so the final sample was 262. Data were collected using documentary methods and analyzed using a quasi-moderation model, which was processed with SPSS 24.
Results: The study's results indicate that company size can moderate the effect of capital structure and profitability on company value. This means that capital structure and profitability on a larger company scale can strengthen the increase in company value. However, partially or individually, company size, capital structure, and profitability do not affect company value.
Conclusion: The top-based results of the contribution study support the signalling theory and prove that empirical improvement in the size of a company can moderately influence the capital structure and profitability on increased firm value.
Assessing Land Use Land Cover of Srinagar Municipal Region Using Sentinel-2 Data for Urban Planning and Management
Authors: Kaif Mohammad , Wani Akhlaq Amin , Islam Mohammad Aijazul , Murtaza Shah , Gatoo Aasif Ali , Sofi Khursheed Ahmad , Jeelani Mohammad Iqbal , Nazir Sabreena , Gulzar Humera
Published: January 2025

Understanding the changes in land use land cover mostly due to urbanization is crucial in the context of urban planning and management. LULC studies are also important in socioeconomic development, natural resource management, planning and preservation of green spaces, water and land resources. This study attempts mapping and analyzing LULC in the municipal region of Srinagar, Jammu & Kashmir to gain a better understanding of the patterns and drivers of changes. Sentinel-2 satellite data of2022 was used to delineatethe study area into 13 classes viz., agriculture, aquatic vegetation, barren land, built-up, forest, forest scrub, grassland, horticulture, institutional Farm, mixed green space, TOF, waterbody and wetland. Built up occupied the maximum area (8920.73 ha) forming 36.25% of the area, while Institutional farm class took up the least space of 30.74 ha (0.12%). Among other classes that that occupy prominent area include Agriculture (18.8%), Trees outside Forests (9.62%) and Waterbody (7.15%). The overall classification accuracy was observed as 94% with a kappa statistic of 0.93. This study shows that Srinagar city has experienced fast urbanization and loss of green space to builtup.The results of this study could help devise strategy for urban planning under smart city mission to enhance green spaces and ensure a balanced its balanced distribution.
CORPORAÇÕES, ESTRATÉGIAS E INSTITUIÇÕES: uma análise da Nissan no Brasil
Authors: Jonathas da Costa Lima Raphael , Assis Dulci João
Published: January 2025

Este artigo analisa a trajetória da Nissan com o propósito de avançar na construção de um modelo de análise das estratégias tendenciais de lucro das Original Equipment Manufacturers (OEMs) automotivas, as quais vêm passando, nas últimas décadas, por um profundo processo de desverticalização da manufatura e de reestruturação do seu modelo de negócios. A questão de fundo a ser respondida é entender como processos de inovação e diversificação de produtos são definidos e incluídos no âmbito das estratégias de lucro das corporações automotivas e de que forma isso se coaduna com a restruturação do mercado automotivo. Os resultados apontam que as multinacionais automotivas não se reorganizam e não se valem das mesmas estratégias de ação e que elas, em contextos de regulação institucional, como na fase de vigência do programa Inovar-Auto no Brasil, demonstram capacidade de se adaptar às conjunturas e regras locais.
PODER FINANCEIRO E AÇÃO ESTATAL: o Banco Central do Brasil e os imbricamentos público-privados de interesses, ideias e infraestruturas
Authors: Mouallem Pedro
Published: January 2025

O artigo joga luz às formas de exercício de poder por atores financeiros sobre a ação estatal no Brasil, mapeando os distintos imbricamentos público-privados concentrados no Banco Central do Brasil. O interesse em tais intersecções e interdependências intensificou-se após a crise financeira de 2008, desmistificando análises tradicionais que tratavam Estados e mercados financeiros como domínios estanques. A pesquisa apresenta a literatura emergente sobre o tema, argumentando que, no contexto brasileiro, dois tipos de vínculos têm sido mais explorados: a complementaridade entre interesses e macroinstituições, e as conexões pessoais no sistema financeiro. Buscando contribuir com esses esforços, o artigo joga luz a um terceiro tipo de imbricamento, chamado infraestrutural, que começa a ser discutido internacionalmente. Por fim, o trabalho classifica três dimensões infraestruturais das finanças no Brasil, visando orientar futuras pesquisas sobre as minúcias institucionais, técnicas e políticas do poder infraestrutural.
LA MEGARREGIÓN TEXAS-NORESTE DE MÉXICO, EL EJE WINNIPEG-MEGARREGIÓN DE LOS GRANDES LAGOS Y EL CORREDOR T-MEC
Authors: Manuel Sandoval Palacios Juan , Orozco Contreras Marcela
Published: January 2025

Nos interesa mostrar cómo se están configurando las Zonas Específicas de Intensa Acumulación (ZEIAs) de la Megarregión Binacional Texas-Noreste de México y el eje Winnipeg-Megarregión de Los Grandes Lagos, considerando la ciudad de Chicago como punto neurálgico de dicho eje. Ambas ZEIAs serán articuladas por medio del Corredor T-MEC. A nivel teórico, nos cobijamos en la perspectiva teórica del capitalismo global elaborada por William I. Robinson y en los avances conceptuales que los autores han desarrollado en el Grupo de Trabajo Fronteras, Regionalización y Globalización de CLACSO para explicar la conformación de ZEIAs y espacios globales para la expansión del capital transnacional en el continente americano. Consideramos que la formación de megarregiones y el reciente fortalecimiento de la infraestructura física en los países de América del Norte que las articula, son resultado de un proceso histórico que inició con la reestructuración del sistema capitalista en la década de 1970.
Perfil clínico e funcional dos pacientes com Deficiência Cinético Funcional Respiratória por Obstrução Crônica em reabilitação pulmonar
Authors: Nunes Denise  Helen Lima , Afonso Gomes Vinicius , Gonzalez Nogueira Iura , Silva Cássio Magalhães
Published: January 2025

Objetivo: Descrever o Perfil clínico e funcional dos pacientes com Deficiência Cinético Funcional Respiratória por Obstrução Crônica em reabilitação pulmonar. Métodos: Trata-se de um estudo transversal, de caráter descritivo, e com base em dados secundários coletados dos prontuários dos pacientes atendidos pelo serviço de fisioterapia no período de agosto de 2014 a agosto de 2019. Assim, dados relacionados ao Teste De Caminhada De Seis Minutos (TC6), relação Volume Expiratório Forçado no 1° segundo sobre a Capacidade Vital Forçada (VEF1/CVF), Pressão Inspiratória Máxima (PImáx), Pressão Expiratória Máxima (PEmáx) e escala de dispneia Medical Research Council modificada (mMRC), foram coletados. Foram incluídos todos os pacientes admitidos no período supracitado sem restrição de idade ou gênero e diagnóstico de deficiência do sistema respiratório excluídos os prontuários com dados. Resultados: O estudo analisou o prontuário de 57 pacientes, dos quais 30 foram do gênero masculino (52,63 %) e a idade média foi 65,59 ± 16,1 anos. O diagnóstico Fisioterapêutico com maior prevalência foi o de Deficiência Cinético Funcional Respiratória por Obstrução Crônica (DCFROC) grau GOLD 2 e os percentuais de comprometimento funcional, pela CIF, foram principalmente entre 25-65%. Conclusão: Com base nos achados conclui-se que o perfil dos pacientes estudados foram idosos de ambos os sexos, com diagnóstico de DCFROC moderado e comprometimento funcional de moderado a grave pela CIF.
VIVÊNCIAS, ANSEIOS E PRECONCEITOS ENTRE PESSOAS COM HANSEÍNSE E SEUS FAMILIARES
Authors: Queiroz Tassio Danilo Rego de , Silva Natanias Macson da , Maia Allyssandra Maria Lima Rodrigues , Vale e Silva Jennifer , Nascimento Ellany Gurgel Cosme do
Published: January 2025

Introdução. A hanseníase é uma patologia infectocontagiosa crônica fortemente atravessada por imaginários sociais que afetam vivências e práticas coletivas e individuais de cuidados em saúde. Os avanços tecnocientíficos de controle da doença não parecem ser proporcionalmente acompanhados de mudanças nas suas representações e simbologias a fim de minorar estigmas e preconceitos historicamente acumulados. Objetivo. O estudo analisou vivências, anseios e preconceitos vividos por pessoas com hanseníase em seu âmbito familiar. Metodologia. Estudo qualitativo realizado por meio de 18 entrevistas com pessoas com hanseníase e seus familiares, moradores do munícipio de Mossoró, no Rio Grande do Norte, residentes em bairros com maior incidência e prevalência da doença e atendidos em um Centro de Especialidades Médicas. Resultados. Contatou-se que o cenário familiar influencia amplamente o modo de vida da pessoa com hanseníase, sendo esta compreensão fundamental para a produção dos cuidados exigidos pela doença. Predomina o desconhecimento da doença em seus aspectos biológicos, o que favorece anseios e medos relativos à transmissão. A família, por ser decisiva no cotidiano da pessoa doente, pode configurar-se como apoio relevante ou, na direção inversa, como amplificadora de barreiras e preconceitos sociais. A religiosidade aparece como aspecto de grande influência nas vivências em torno da hanseníase. Já os preconceitos são os instrumentos que conduzem a pessoa doente a processos de exclusão social, impactando sua qualidade de vida. Conclusão. Explorar as vivências de pessoas com hanseníase e familiares possibilita intervenções mais eficazes, pois permite elaborar com maior precisão o suporte social de que necessitam e as estratégias de manejo da doença.
ANÁLISE ANATOMOPATOLÓGICA DE PLACENTAS DE GESTANTES COM COVID-19
Authors: Ribeiro André , Vilela Ana Carolina Tubaldini , Reis Leonardo Frasson dos , Vasconcelos Maria Paula Moraes , Batista de Oliveira Rafael , Almeida Vitor Ribeiro Rodrigo
Published: January 2025

Introdução: Sabe-se que em outras infecções virais no período gestacional, há a associação entre a doença e achados placentários específicos, entretanto, em relação à COVID-19, o conhecimento ainda é limitado. Objetivo: analisar a existência de alterações placentárias em gestantes que contraíram a COVID-19, como também avaliar a correlação com manifestações clínicas e comorbidades da binômio. Metodologia: trata-se de um estudo observacional analítico transversal retrospectivo, que analisou 81 placentas de gestantes que atendiam aos critérios de elegibilidade, além de ter sido realizada a análise de dados estatísticos valendo-se dos softwares Software Microsoft Excel® e JAMOVI®. Resultados:  46,91% das gestantes apresentaram a doença no terceiro trimestre da gestação, enquanto que 33,33%, no segundo trimestre; e 9,8%, no primeiro trimestre. No anatomopatológico, a maioria das placentas apresentaram calcificações grosseiras e níveis de fibrina subcoriônica aumentado. Conclusão: observou-se a existência de alterações anatomopatológicas nas placentas de gestantes infectadas pela COVID-19, entretanto outros estudos são necessários para testar a associação direta.
Avaliação da disfunção temporomandibular e condições biopsicossociais em pacientes pós-Covid-19
Authors: Sehnem Elizabete Marlene , Lima Juliano Luiz de , Oliveira Letícia Sousa de , Silva Bruna Fernanda da , Cunha Natalia Veronez da
Published: January 2025

Objetivo: identificar casos de disfunção temporomandibular (DTM) em pacientes pós-COVID-19, bem como os níveis de ansiedade e estresse apresentados. Metodologia: trata-se de uma pesquisa quantitativa e transversal, realizada com 26 indivíduos selecionados intencionalmente, que foram avaliados com o Protocolo Clínico e Instrumentos de Avaliação (DC/TMD), para identificar casos de DTM e níveis de ansiedade, e ainda com o instrumento de Percepção de Estresse-10, para avaliar o nível de estresse percebido. Resultados: a partir da avaliação, constatou-se que, dos 26 pacientes que já haviam sido acometidos por COVID-19, 13 (50%) apresentaram diagnóstico de DTM, sendo a maioria constituída por mulheres (77%), com idade média de 24±7 anos. A DTM de origem muscular foi a mais prevalente (54%). Os hábitos parafuncionais estavam presentes. Os níveis de ansiedade entre os participantes foi de 9,7±5,6 (moderado) e o de estresse percebido foi de 19,5±5,6 (moderado). Conclusão: conclui-se que houve alta prevalência de casos de DTM em pacientes pós-COVID-19. Os níveis moderados de ansiedade e o estresse percebido sugerem uma possível correlação entre esses fatores psicológicos e a DTM nos pacientes estudados. Isso pode indicar a importância de serem avaliados não apenas os aspectos físicos, mas também os fatores emocionais em pacientes pós-COVID-19 com DTM.
INFLUÊNCIA DO CONTATO DE BEBIDAS PIGMENTADAS COM O ESMALTE DENTAL DURANTE O CLAREAMENTO: ESTUDO IN VITRO
Authors: Soares Santos Caroline , Dias Nogueira Ruchele , Penazzo Lepri Cesar , Angélica Hueb de Menezes Oliveira Maria , Rangel Geraldo-Martins Vinicius
Published: January 2025

Introdução: o clareamento dental caseiro é um dos procedimentos mais requisitados nos consultórios odontológicos. Contudo, ainda há dúvidas se a exposição dos dentes a bebidas ou alimentos pigmentados durante o clareamento pode influenciar o resultado do tratamento. Objetivo: verificar o efeito do contato de bebidas pigmentadas sobre o esmalte dental durante o clareamento, no resultado do tratamento. Metodologia: Foram obtidos 80 fragmentos de esmalte dental bovino, que foram aleatoriamente distribuídos em 8 grupos experimentais (n=10), de acordo com a solução utilizada para manchamento: saliva artificial (Grupos 1 e 5), refrigerante do tipo cola (Grupos 2 e 6), café (Grupos 3 e 7) e vinho tinto (Grupos 4 e 8). Após 14 dias de manchamento, as amostras foram submetidas ao clareamento dental caseiro (peróxido de carbamida a 16%) durante 21 dias. Durante o tratamento clareador, as amostras dos grupos 5, 6, 7 e 8 foram imersas diariamente em suas respectivas soluções de manchamento por 5 minutos. A análise de cor dos fragmentos de esmalte foi realizada antes e depois do manchamento, e após o clareamento dental. Os dados foram analisados pelo teste t de Student (α=5%). Resultados: Observou-se que a variação de cor para as amostras dos grupos 1 e 5, 2 e 6, e 3 e 7 foi similar. Contudo, a utilização de vinho tinto alterou a cor do esmalte dental ao final do tratamento. Conclusão: embora o uso do refrigerante e do café durante o clareamento não tenha interferido no tratamento, o vinho alterou o resultado do clareamento dental.
Características sociodemográficas e qualidade de vida de pessoas com hipertensão arterial sistêmica atendidas em unidades básicas de saúde: um estudo de associação
Authors: Souza Graciete Pereira de , Santos Luama Araújo dos , Souza Lana Mércia Santiago de , Araújo Edilene Maria Queiroz
Published: January 2025

Introdução: a hipertensão arterial sistêmica (HAS) é uma doença silenciosa, de alta prevalência, que prejudica a qualidade de vida relacionada à saúde (QVRS). Objetivo: avaliar a QVRS de indivíduos com HAS acompanhados em Unidades Básicas de Saúde de Salvador, nos anos de 2022 e 2023, e associá-la com fatores sociodemográficos, tempo de diagnóstico, estágio da HAS e estilo de vida. Metodologia: trata-se de um estudo observacional, analítico, transversal, realizado em 205 indivíduos, maiores de 20 anos, com diagnóstico prévio de HAS e pressão arterial sistólica ≥ 140 mmHg e/ou diastólica ≥ 90 mmHg. Foram coletados dados sociodemográficos, clínicos e de estilo de vida, os quais foram associados aos domínios mental e somático do Mini Cuestionario de Calidad de Vida en Hipertensión Arterial.  O estudo foi aprovado pelo Comitê de Ética da Universidade do Estado da Bahia (UNEB), sob o número 43203121.5.3005.5662. Resultados: a QVRS da população estudada apresentou pior escore no domínio mental, comparado ao somático (mediana 7,0 e 5,0, respectivamente). O gênero feminino apresentou pior QV no domínio somático (mediana. 7,0; IC: 4,0-9,0; p = 0,012), se comparado ao masculino (mediana. 3,0; IC:2,5-4,0; p = 0,157). Pessoas sedentárias obtiveram pior score (mediana. 7,0; IC:6,51-9,0; p = 0,045) no domínio mental, se comparadas a indivíduos ativos (mediana 6,0; IC:4,0-8,0; p = 0,119). Estágio da PA e tempo de diagnóstico não apresentaram associação significativa com a QVRS. Conclusão: a QVRS da amostra estudada é moderada. Mulheres apresentaram pior escore no domínio somático, e a prática adequada de exercícios físicos demonstrou uma associação positiva com a QVRS, no domínio mental.
O valor da comunicação que deve ser estabelecida entre os programas de pós-graduação stricto sensu e a sociedade
Authors: Lima Sarah Souza , Araújo Roberto Paulo Correia de
Published: January 2025

O valor da comunicação que deve ser estabelecida entre os programas de pós-graduação stricto sensu e a sociedade
A Review Of Domination Strategies In Fuzzy Graphs
Authors: A Lekha
Published: January 2025

This article presents a review of domination strategies in fuzzy graphs, with a focus on recent developments in
the field. It summarizes outcomes from both foundational and recent developments in the literature. Numerous
advancements have emerged in recent years, expanding its theoretical and practical applications. This review
consolidates the most relevant and recent findings, providing an overview of current strategies and
methodologies in domination theory for fuzzy graphs. The article also elaborate on the concept of fzdomination in fuzzy graphs. The fz-domination framework considers both vertex and edge membership values, ensuring a more realistic and effective measure of domination in fuzzy environments.
Elementary Number Theory: Foundations, Applications, And Recent Developments
Authors: Rosangliana Dr. David
Published: January 2025

Elementary number theory is a key branch of mathematics focuses on integer properties and relationships. This
review comprehensively covers the key concepts, theorems, and applications. It examines integer properties like
divisibility, primality, and congruences, and introduces the division and Euclidean algorithms as essential
tools. The paper explores prime numbers, their infinitude, and the prime number theorem. The fundamental
theorem of arithmetic, stating that every positive integer has a unique prime factorization, is discussed with its
proof and significance. Diophantine equations, polynomial equations involving integers, are investigated with
solutions methods. Applications in various fields are highlighted, including the RSA algorithm and DiffieHellman key exchange in cryptography, error-correcting codes like Hamming and Reed-Solomon in coding theory, and algorithm studies in computer science. This review is a valuable resource for students and researchers of elementary number theory and its modern implications
Small Signal Stability Enhancement Of Power System Using Adaptive Control Based Power System Stabilizer
Authors: Ishag Ahmed Mohammed , Abdalla Elnazeer Ai Hamid , A/Alla Mohammed Elnour , Mohamed Tamador Elhansaa J.
Published: January 2025

Power systems are subjected to low frequency disturbances that might cause loss of synchronism and an
eventual breakdown of entire system. The oscillations, which are typically in the frequency range of 0.2 to 3.0
Hz, might be excited by the disturbances in the system or, in some cases, might even build up spontaneously.
These oscillations limit the power transmission capability of a network and, sometimes, even cause a loss of
synchronism and an eventual breakdown of the entire system. For this purpose, Power system stabilizers (PSS)
are used to generate supplementary control signals for the excitation system in order to damp these low
frequency power system oscillations.
The use of power system stabilizers has become very common in operation of large electric power systems. The
conventional PSS which uses lead-lag compensation, where gain settings designed for specific operating
conditions, is giving poor performance under different loading conditions. The constantly changing nature of
power system makes the design of CPSS a difficult task. Therefore, it is very difficult to design a stabilizer that
could present good performance in all operating points of electric power systems. To overcome the drawback of
conventional power system stabilizer (CPSS).In an attempt to cover a wide range of operating conditions,
adaptive control based technique has been suggested as a possible solution to overcome the above problem, thereby using this technique complex system mathematical model can be avoided, while giving good performance under different operating conditions
Hot Spot Temperature Prediction Models Including Loss Of Life Of Transformers Using Asaba Transmission SubStation As A Case Study
Authors: Adiotomre Clement A. , Ubeku Emmanuel U. , Utuagoma Smith Orode , Ebisine Ebimene E.
Published: January 2025

This study is on hot spot temperature (HST) prediction models, including loss of life (LoL) of transformers, and
uses the Asaba transmission substation as a case study. One year loading profile data was collected from the
substation while Artificial Neural Network (ANN) and Bagging Regression (BR) algorithms were modeled using
this data on MATLAB and Python to predict the HST for Day-Ahead (24-Hours), Week-Ahead (120-Hours), and
Weekend (48-Hours). The results show the nonlinear relation between Load and HST, as an increase in load
values from 305.8A – 328.9A resulted in an increase in HST from 52.23oC – 54.88oC. Model performance was
compared using Mean Absolute Percentage Error (MAPE) and Root Mean Square Error (RMSE). Using
MATLAB indicated ANN had MAPE values of 2.51, 2.74, and 2.48 with RMSE values of 1.83, 1.71, and 1.85,
respectively, for Day-Ahead, Week-Ahead, and Weekend prediction. In contrast, BR had MAPE values of 5.93,
5.83, and 5.77 with RMSE values of 4.30,4.86, and 4,43, respectively, for the same prediction period. Using
Python indicated ANN had MAPE values of 6.67, 7.29, and 6.96 with RMSE values of 3.34, 4.27, and 1.95,
respectively, for Day-Ahead, Week-Ahead, and Weekend prediction, while BR had MAPE values of 6.16, 6.07,
and 6.5 with RMSE values of 5.7, 5.85 and 4.5 respectively for same prediction period. MATLAB software gave
better results than Python, which had a higher percentage error for the ANN and BR models, likely due to the
model's ability to better capture consistent thermal responses during sustained high loads. LoL for a 24-hour
load cycle gave a cumulative age hour of 0.029959 hours, revealing how the HST significantly impacts the
transformer’s insulation and life expectancy. It is recommended that different modeling techniques be explored
for prediction analysis for medium-term transformer HST prediction if better results are desired. Also, operators
should incorporate monitoring systems like Arduino to shut down the network and protect the transformer anytime the temperature exceeds set limits. This study presents the following contribution to knowledge: Data bank of a 60 MVA transformer can be obtained; Correlation between HST and Load demand has been established.
Validation Of Analytical Methodologies: Context And Guidelines For And Safety And Innocuity Of Residues In Brazilian Food
Authors: Valério Pedro Prates , Pereira Margarete Aparecida , Grande Salvador Carlos , Vitor Tamara Gomes , Moreira Wagner Aveino
Published: January 2025

Background: Analytical information is critical for decision-making processes, including product quality
control, consumer health protection, and compliance with regulatory standards. Analytical methods for
analyzing raw materials and food must undergo rigorous validation to ensure reliability. This study examines
the evolution of validation guidelines for analytical methodologies, emphasizing their role in ensuring food
safety and consumer protection.
Materials and Methods: The research involved a comprehensive literature review on the development of
validation guidelines for analytical methods assessing residue safety and innocuity in raw materials and food. A
discursive analysis was conducted to contextualize these guidelines within Brazil's role as a significant food
exporter and a signatory to international agreements, such as the Codex Alimentarius. The study also examined
the standards established by international organizations, including Eurochem and NIST, to validate analytical
methods used in reference laboratories.
Results: The findings highlight the importance of rigorous validation procedures for analytical methods,
ensuring traceability, comparability, and reliability of analyses. The study identifies Brazil’s increasing
alignment with global food safety demands, addressing the control of chemical substances in production
processes to meet international market expectations.
Conclusion: Validation guidelines play a vital role in supporting food safety and regulatory compliance,
particularly in global markets with high demands for quality and reliability. Brazil’s adherence to international standards and agreements reinforces its commitment to safe and sustainable food production, with validated analytical methods serving as a cornerstone for achieving these objectives.
Design And Implementation Of A Decision System For Chatbot Applications
Authors: Seyi Olanrewaju, Babatunde , Kevin Pius, Chinedu , Adekunle Okunade, Oluwasogo , Oluwaseyitanfunmi Osunade,
Published: January 2025

Information should be shared effectively and securely to protect users' personal identifiable information. Using
a chatbot, or a computer application to share information presents a likelihood of identity theft if not properly
secured. In communicating with chatbots, the user’s information is held in the chatbot application database. The
availability of user information on this application may give opportunity to attackers to hijack personal user
information to perpetrate crime. Unfortunately, current chatbot applications do not have a mechanism to delete
or remove personal identifiable information of users. Some chatbots accept users' personal identifiable
information with no recourse to the user on what happens after the chat session. To prevent a third party from
trading, selling, or hacking the data, this research designed a decision system to be added to the chatbot
application that will enable the user to consciously decide on how their personal identifiable information should
be treated or kept. The chatbot was implemented in Hypertext Markup Language (HTML), using PHP and MySQL
for standard web development. Also, a PHP server was installed for the system to relate properly with the
database server in fetching and storing the data. The system was tested using likelihoods that may lead to the success of the program. This was done repeatedly with different test data. The new system provides users consent on whether their personal information is left on the chatbot app or removed completely.
A Simplified Method For Analyzing Regional Competitiveness And Its Application To The Mexican Northwest Economic Region
Authors: Mendoza-Acosta Alexander , Esquivel-López Monserrat , Zavala-Buitimea Bertha L. , Cota-Apodaca J.D. , Moreno-Osuna Florencio
Published: January 2025

This paper presents a simplified method for regional competitiveness analysis, designed to enhance the
understanding of economic disparities across regions. The proposed methodology organizes regions based on key
economic indicators, focusing on competitiveness, and employs quartile-based classification to highlight regional
homogeneity, relative positions, and internal disparities. By utilizing box-and-whisker plots, the method allows
for a clear identification of outliers and the detection of significant gaps in competitiveness within well-defined
regions. The approach combines interregional analysis using general economic indicators and intraregional
evaluation with sub-indices, enabling a more nuanced understanding of regional dynamics. The methodology
involves ranking states by competitiveness sub-indices, followed by the creation of graphical representations such
as box plots to visualize regional patterns and potential outliers. The analysis proceeds from an interregional
perspective, moving toward a more detailed intraregional examination. This step-by-step process reveals the
regions leading in competitiveness and those requiring greater attention for development. In addition, the radial
graph is suggested as a tool to further clarify the data, offering a clearer visualization of competitiveness
disparities. To demonstrate the effectiveness of this method, a practical application is provided using the "Índice
para la Competitividad Estatal 2024" from the Instituto Mexicano para la Competitividad A.C. (IMCO), which
allows for a comprehensive assessment of Mexico's regions. The results showcase the regions with the highest
competitiveness and those facing challenges, offering actionable insights for policymakers, regional planners, and researchers. This approach serves as a valuable tool in regional economic analysis, providing an accessible, data-driven framework for identifying key areas for intervention and investment.
Obstacles to Care Mount 1 Year After Dobbs Decision
Authors: Verma Nisha , Grossman Daniel
Published: June 2023

This Viewpoint discusses the ramifications of the Dobbs v Jackson Women’s Health Organization decision by the US Supreme Court and the state of reproductive health care in the US.
Once-Weekly Insulin Icodec vs Once-Daily Insulin Degludec in Adults With Insulin-Naive Type 2 Diabetes
Authors: Lingvay Ildiko , Asong Marisse , Desouza Cyrus , Gourdy Pierre , Kar Soumitra , Vianna André , Vilsbøll Tina , Vinther Siri , Mu Yiming
Published: June 2023

Importance

Once-weekly insulin icodec could provide a simpler dosing alternative to daily basal insulin in people with type 2 diabetes.

Objective

To evaluate the efficacy and safety of once-weekly icodec vs once-daily insulin degludec in people with insulin-naive type 2 diabetes.

Design, Setting, and Participants

Randomized, double-masked, noninferiority, treat-to-target, phase 3a trial conducted from March 2021 to June 2022 at 92 sites in 11 countries in adults with type 2 diabetes treated with any noninsulin glucose-lowering agents with hemoglobin A1c (HbA1c) of 7%-11% (53-97 mmol/mol).

Interventions

Participants were randomly assigned in a 1:1 ratio to receive either once-weekly icodec and once-daily placebo (icodec group; n = 294) or once-daily degludec and once-weekly placebo (degludec group; n = 294).

Main Outcomes and Measures

The primary end point was change in HbA1c from baseline to week 26 (noninferiority margin, 0.3% percentage points). Secondary end points included change in fasting plasma glucose from baseline to week 26, mean weekly insulin dose during the last 2 weeks of treatment, body weight change from baseline to week 26, and number of level 2 (clinically significant; glucose level <54 mg/dL) and level 3 (severe; requiring external assistance for recovery) hypoglycemic episodes.

Results

Among 588 randomized participants (mean [SD] age, 58 [10] years; 219 [37%] women), 564 (96%) completed the trial. Mean HbA1c level decreased from 8.6% (observed) to 7.0% (estimated) at 26 weeks in the icodec group and from 8.5% (observed) to 7.2% (estimated) in the degludec group (estimated treatment difference [ETD], −0.2 [95% CI, −0.3 to −0.1] percentage points), confirming noninferiority (P < .001) and superiority (P = .002). There were no significant differences between the icodec and degludec groups for fasting plasma glucose change from baseline to week 26 (ETD, 0 [95% CI, −6 to 5] mg/dL; P = .90), mean weekly insulin dose during the last 2 weeks of treatment, or body weight change from baseline to week 26 (2.8 kg vs 2.3 kg; ETD, 0.46 [95% CI, −0.19 to 1.10] kg; P = .17). Combined level 2 or 3 hypoglycemia rates were numerically higher in the icodec group than the degludec group from week 0 to 31 (0.31 vs 0.15 events per patient-year exposure; P = .11) and statistically higher in the icodec group from week 0 to 26 (0.35 vs 0.12 events per patient-year exposure; P = .01).

Conclusions and Relevance

Among people with insulin-naive type 2 diabetes, once-weekly icodec demonstrated superior HbA1c reduction to once-daily degludec after 26 weeks of treatment, with no difference in weight change and a higher rate of combined level 2 or 3 hypoglycemic events in the context of less than 1 event per patient-year exposure in both groups.

Trial Registration

ClinicalTrials.gov Identifier: NCT04795531
Growth of Medicare Advantage After Plan Payment Reductions
Authors: Schwartz Aaron L. , Kim Seyoun , Navathe Amol S. , Gupta Atul
Published: June 2023

Importance

Various policy proposals would reduce federal payments to Medicare Advantage (MA) plans. However, it is unclear whether payment reductions would compromise beneficiary access to the MA program.

Objective

To quantify the association between MA payment reductions under the Affordable Care Act (ACA) and MA enrollment growth.

Design, Setting, and Participants

This retrospective cohort study examined the MA market before and after the ACA, which mandated cuts to MA benchmark payment rates. Using 2008 to 2019 county-level enrollment and payment data, a difference-in-differences analysis was conducted comparing MA enrollment changes between counties with larger vs smaller benchmark reductions, before vs after the ACA.

Main Outcomes and Measures

The primary outcome was the MA enrollment rate, defined as the proportion of a county’s Medicare beneficiaries enrolled in MA. A secondary analysis examined MA plan payments per member per month.

Results

Among 3138 counties with 37 639 county-year observations, ACA-induced benchmark cuts were sizeable and varied, ranging from 0% to 42.9% (mean [SD], 5.9% [6.6%]). Counties with benchmark cuts above the 75th percentile had population-weighted average benchmark cuts of 14.9% compared with 4.4% in other counties. In the 8 years following the ACA, there was no differential change in MA enrollment between counties with larger vs smaller benchmark cuts (difference-in-differences estimate, 0.02 [95% CI, −1.18 to 1.21] percentage points; P = .98). Plan payments differentially fell in counties with larger benchmark cuts by $78.35 (95% CI, $62.21-$94.48) per member per month (P < .001).

Conclusion and Relevance

This cohort study found no evidence that the MA benchmark and ensuing payment cuts imposed by the ACA were associated with reduced MA enrollment, compromising access to MA. This evidence can inform ongoing policy debates regarding the growth of MA, concerns about excess payments to MA plans, and proposed Medicare reforms, including further reductions in MA payments.
Obstetric Volume and Severe Maternal Morbidity Among Low-Risk and Higher-Risk Patients Giving Birth at Rural and Urban US Hospitals
Authors: Kozhimannil Katy Backes , Leonard Stephanie A. , Handley Sara C. , Passarella Molly , Main Elliott K. , Lorch Scott A. , Phibbs Ciaran S.
Published: June 2023

Importance

Identifying hospital factors associated with severe maternal morbidity (SMM) is essential to clinical and policy efforts.

Objective

To assess associations between obstetric volume and SMM in rural and urban hospitals and examine whether these associations differ for low-risk and higher-risk patients.

Design, Setting, and Participants

This retrospective cross-sectional study of linked vital statistics and patient discharge data was conducted from 2022 to 2023. Live births and stillbirths (≥20 weeks’ gestation) at hospitals in California (2004-2018), Michigan (2004-2020), Pennsylvania (2004-2014), and South Carolina (2004-2020) were included. Data were analyzed from December 2022 to May 2023.

Exposures

Annual birth volume categories (low, medium, medium-high, and high) for hospitals in urban (10-500, 501-1000, 1001-2000, and >2000) and rural (10-110, 111-240, 241-460, and >460) counties.

Main Outcome and Measures

The main outcome was SMM (excluding blood transfusion); covariates included age, payer status, educational attainment, race and ethnicity, and obstetric comorbidities. Analyses were stratified for low-risk and higher-risk obstetric patients based on presence of at least 1 clinical comorbidity.

Results

Among more than 11 million urban births and 519 953 rural births, rates of SMM ranged from 0.73% to 0.50% across urban hospital volume categories (high to low) and from 0.47% to 0.70% across rural hospital volume categories (high to low). Risk of SMM was elevated for patients who gave birth at rural hospitals with annual birth volume of 10 to 110 (adjusted risk ratio [ARR], 1.65; 95% CI, 1.14-2.39), 111 to 240 (ARR, 1.37; 95% CI, 1.10-1.70), and 241 to 460 (ARR, 1.26; 95% CI, 1.05-1.51), compared with rural hospitals with greater than 460 births. Increased risk of SMM occurred for low-risk and higher-risk obstetric patients who delivered at rural hospitals with lower birth volumes, with low-risk rural patients having notable discrepancies in SMM risk between low (ARR, 2.32; 95% CI, 1.32-4.07), medium (ARR, 1.66; 95% CI, 1.20-2.28), and medium-high (ARR, 1.68; 95% CI, 1.29-2.18) volume hospitals compared with high volume (>460 births) rural hospitals. Among hospitals in urban counties, there was no significant association between birth volume and SMM for low-risk or higher-risk obstetric patients.

Conclusions and Relevance

In this cross-sectional study of births in US rural and urban counties, risk of SMM was elevated for low-risk and higher-risk obstetric patients who gave birth in lower-volume hospitals in rural counties, compared with similar patients who gave birth at rural hospitals with greater than 460 annual births. These findings imply a need for tailored quality improvement strategies for lower volume hospitals in rural communities.
Association of Size Matching Using Predicted Heart Mass With Mortality in Heart Transplant Recipients With Obesity or High Pulmonary Vascular Resistance
Authors: Tao Ran , Hess Timothy M. , Kuchnia Adam , Hermsen Joshua , Raza Farhan , Dhingra Ravi
Published: June 2023

Importance

Pretransplant obesity and higher pulmonary vascular resistance (PVR) are risk factors for death after heart transplant. However, it remains unclear whether appropriate donor-to-recipient size matching using predicted heart mass (PHM) is associated with lower risk.

Objective

To investigate the association of size matching using PHM with risk of death posttransplant among patients with obesity and/or higher PVR.

Design, Setting, and Participants

All adult patients (>18 years) who underwent heart transplant between 2003 and 2022 with available information using the United Network for Organ Sharing cohort database. Multivariable Cox models and multivariable-adjusted spline curves were used to examine the risk of death posttransplant with PHM matching. Data were analyzed from October 2022 to March 2023.

Exposure

Recipient’s body mass index (BMI) in categories (<18.0 [underweight], 18.1-24.9 [normal weight, reference], 25.0-29.9 [overweight], 30.0-34.9 [obese 1], 35-39.9 [obese 2], and ≥40.0 [obese 3]) and recipient’s pretransplant PVR in categories of less than 4 (29 061 participants), 4 to 6 (2842 participants), and more than 6 Wood units (968 participants); and less than 3 (24 950 participants), 3 to 5 (6115 participants), and 5 or more (1806 participants) Wood units.

Main Outcome

All-cause death posttransplant on follow-up.

Results

The mean (SD) age of the cohort of 37 712 was 52.8 (12.8) years, 27 976 (74%) were male, 25 342 were non-Hispanic White (68.0%), 7664 were Black (20.4%), and 3139 were Hispanic or Latino (8.5%). A total of 12 413 recipients (32.9%) had a normal BMI, 13 849 (36.7%) had overweight, and 10 814 (28.7%) had obesity. On follow-up (median [IQR] 5.05 [0-19.4] years), 12 785 recipients (3046 female) died. For patients with normal weight, overweight, or obese 2, receiving a PHM-undermatched heart was associated with an increased risk of death (normal weight hazard ratio [HR], 1.20; 95% CI, 1.07-1.34; overweight HR, 1.12; 95% CI, 1.02-1.23; and obese 2 HR, 1.07; 95% CI, 1.01-1.14). Moreover, patients with higher pretransplant PVR who received an undermatched heart had a higher risk of death posttransplant in multivariable-adjusted spline curves in graded fashion until appropriately matched. In contrast, risk of death among patients receiving a PHM-overmatched heart did not differ from the appropriately matched group, including in recipients with an elevated pretransplant PVR.

Conclusion and Relevance

In this cohort study, undermatching donor-to-recipient size according to PHM was associated with higher posttransplant mortality, specifically in patients with normal weight, overweight, or class II obesity and in patients with elevated pretransplant PVR. Overmatching donor-to-recipient size was not associated with posttransplant survival.
Characteristics of Medical Evacuation by Train in Ukraine, 2022
Authors: Walravens Stig , Zharkova Albina , De Weggheleire Anja , Burton Marie , Cabrol Jean-Clément , Lee James S.
Published: June 2023

Importance

The 2022 war in Ukraine severely affected access to health care for patients in the conflict-affected regions and limited options for medical evacuation. Air transport, a common method of medical evacuation in war zones, was unsafe due to the conflict of 2 modernized military forces that were in possession of aircraft and surface-to-air weapons; therefore, Médecins Sans Frontières, in collaboration with the Ukrainian railway company and Ukrainian health agencies, addressed this by initiating medical evacuation via medically customized trains.

Objective

To describe the implementation of medical evacuation trains aimed at improving the access to health care for war-affected patients.

Design, Setting, and Participants

This case series describes the remodeling of 2 trains used for medical evacuation in a conflict zone during the war in Ukraine. The study was conducted from March 30 to November 30, 2022. One train had minimal adjustments and could be rapidly deployed to address the most pressing humanitarian needs, while the other underwent major structural modifications to provide intensive care capacity. The report details the medical capabilities of the trains, the organization of referrals, and operational challenges encountered. Additionally, it includes a case series on the characteristics of patients transported in the initial 8 months, based on routinely collected programmatic descriptive data of all patients transported by the medical trains.

Results

In 8 months, 2481 patients (male-female ratio, 1.07; male, 1136 [46%]; female 1058 [43%]; missing data, 287 [12%]; median age, 63 years [range, 0-98 years]) were evacuated from 11 cities near the Ukrainian conflict frontline to safer areas. Initially, the trains predominantly evacuated trauma patients, but over the course of the war, the patient characteristics changed with more medical and nonacute conditions, and fewer trauma patients. The main reason for entry into the intensive care unit train carriage was for close monitoring and observation, and the main interventions performed were primarily for respiratory failure.

Conclusions and Relevance

The findings of this study suggest that medical evacuation in a war zone by converted trains is possible and can improve access to health care for war-affected patients. The presence of intensive care capacity on board allows for transport of more severely ill or injured individuals. However, the target population should not be limited to trauma patients, as health care institutions affected host a much broader population whose needs and urgency for evacuation may change over time.
Risk of Cardiovascular Events Among Patients With Head and Neck Cancer
Authors: Sun Lova , Brody Robert , Candelieri Danielle , Lynch Julie A. , Cohen Roger B. , Li Yimei , Getz Kelly D. , Ky Bonnie
Published: June 2023

Importance

Cardiovascular (CV) disease is a substantial cause of morbidity and mortality in cancer due to shared risk factors and exposure to potentially cardiotoxic cancer therapy. However, our understanding of CV risk in patients with head and neck squamous cell carcinoma (HNSCC) is limited.

Objective

To define CV risk profiles, incident stroke, myocardial infarction (MI), and mortality in patients with HNSCC.

Design, Setting, and Participants

This retrospective, population-based cohort study included 35 897 US veterans with newly diagnosed HNSCC from January 1, 2000, to December 31, 2020. Data were analyzed from May 2022 to January 2023.

Exposures

Demographic, cancer-specific, and treatment characteristics.

Main Outcomes

Prevalence of CV risk factors, medication use, and control at HNSCC diagnosis; cumulative incidence of stroke and MI; and all-cause death.

Results

Of 35 857 US veterans with HNSCC (median [IQR] age, 63 [58-69] years; 176 [0.5%] American Indian or Alaska Native, 57 [0.2%] Asian, 5321 [16.6%] Black, 207 [0.6%] Native Hawaiian or Other Pacific Islander, and 26 277 [82.0%] White individuals), there were high rates of former or current smoking (16 341 [83%]), hypertension (24 023 [67%]), diabetes (7988 [22%]), and hyperlipidemia (18 421 [51%]). Although most patients were taking risk-lowering medications, 15 941 (47%) had at least 1 uncontrolled CV risk factor. Black race was associated with increased risk of having uncontrolled CV risk factor(s) (relative risk, 1.06; 95% CI, 1.03-1.09), and patients with larynx cancer had higher rates of prevalent and uncontrolled risk factors compared with other cancer subsites. Considering death as a competing risk, the 10-year cumulative incidence of stroke and MI was 12.5% and 8.3%, respectively. In cause-specific hazards models, hypertension, diabetes, carotid artery stenosis, coronary artery disease, and presence of uncontrolled CV risk factor(s) were significantly associated with stroke and MI. In extended Cox models, incident stroke and MI were associated with a 47% (95% CI, 41%-54%) and 71% (95% CI, 63%-81%) increased risk of all-cause death, respectively.

Conclusion

The results of this cohort study suggest that in HNSCC, the burden of suboptimally controlled CV risk factors and incident risk of stroke and MI are substantial. Modifiable CV risk factors are associated with risk of adverse CV events, and these events are associated with a higher risk of death. These findings identify populations at risk and potentially underscore the importance of modifiable CV risk factor control and motivate strategies to reduce CV risk in HNSCC survivorship care.