bluuebunny/crossref_metadata_2025 huggingface dataset:
Validation of a hand-held Ultrasound device in the evaluation of Aortic Stenosis
Authors: Zubiaur Jon , de Castro Adrián Margarida , Pérez-Barquín Raquel , González Manuel Lozano , Gorria Gonzalo Martin , Guerrero Luis Javier Ruiz , Calderon Andrea Teira , Setien Ignacio Santiago , Lozano David Serrano , Vilchez Francisco González , de Prada Jose Antonio Vázquez
Published: November 2024

Purpose
Hand-held ultrasound devices (HHUD) are increasingly used in routine clinical practice, though they lacked continuous (CW) Doppler capability until recently. There is limited evidence on the utility of HHUD in assessing aortic stenosis (AS) in real-world settings. Our goal is to validate a new HHUD with CW Doppler assessing AS hemodynamic severity.
Methods
An observational, single-center study was conducted with patients diagnosed with AS. Following a reference echocardiographic study in the cardiac imaging laboratory, a HHUD with CW Doppler (Kosmos, EchoNous™) was used by an operator with intermediate echocardiography experience (American Society of Echocardiography, level II). The focus was on measuring aortic transvalvular Doppler velocities. Agreement between the mean trans-aortic gradient (mAG) was assessed using the intraclass correlation coefficient (ICC) test. A total of 101 patients were included.
Results
The reference test obtained a mAG of 29 mmHg (19.8–42.2), while the HHUD test showed 27.2 mmHg (16.2–43.9). A strong correlation was observed (r = 0.89), with an ICC value of 0.87 and no significant bias (1.61 ± 0.9). The HHUD demonstrated excellent ability to identify severe AS (kappa = 0.81, 95% CI 0.68–0.94; global agreement 92.1%). Agreement was lower in patients with obesity, poor acoustic windows, or atrial fibrillation.
Conclusions
The HHUD showed good agreement with standard echocardiography in assessing AS. While it slightly underestimated mAG, it was accurate enough to reliably quantify AS severity.
Rheumatic Disorders and Autoimmune Thyroid Disease. A Common Co-occurrence With an Unusual Presentation- A Case Report
Authors: Manzoor Tehreem , Ali Aiman , Masood Rida , Kashif Syed Muhammad , Alam Muhammad Tanveer
Published: November 2024

Introduction
Graves’ disease (GD) and systemic lupus erythematosus (SLE) are two autoimmune disorders well known for their co-existence. Shared genetic susceptibility loci are being increasingly identified, confirming the causal bidirectional association between the two.
Case Presentation
Our case involves a young woman who presented with chronic symptoms of hyperthyroidism along with anemia, goitre, respiratory distress, and a recent onset of rheumatism. Diagnostic investigations fulfilled the criteria of GD along with SLE and Sjogren’s overlap. Pulmonary arterial hypertension (PAH) was detected via echocardiography, likely indicating the complex interplay between SLE and GD. Significant fetal and embryonic mortality raised the suspicion of anti-phospholipid syndrome, leading to the detection of anti-phospholipid antibodies. The likelihood of adrenal insufficiency and Autoimmune Polyglandular syndrome type 2 was also addressed. The patient was managed with anti-thyroid medications, steroids, and PAH-specific therapy. Our case is unique, as it involves multiple autoimmune disorders of rheumatic and endocrine origin in the same patient. The uniqueness also lies in the temporal sequence of the disorders, with GD being antecedent to SLE, contrary to what the literature suggests.
Conclusion
Although the patient tragically died, the goal here was to reinforce the idea that autoimmune disorders are complex, revealing themselves in various forms. Scouting for comorbidities and adapting a holistic treatment approach is prudent when dealing with these ailments. The social and financial dilemmas leading to noncompliance with treatment and its detrimental effects are also highlighted.
Gender-Specific Patterns in Social Visual Attention Among Individuals with Autistic Traits
Authors: Zhang Ludan , Guan Xin , Xue Huiqin , Liu Xiaoya , Zhang Bo , Liu Shuang , Ming Dong
Published: November 2024

Background
Autism is a neurodevelopmental condition with more prevalent in males, and its gender differences emerge in prevalence and core symptoms. However, most studies investigating the behavioral and cognitive features of autism tend to include more male samples, leading to a male-biased understanding. The gender imbalance limits the specificity of these features, especially considering female individuals with autism. Hence, it is necessary to explore gender-related differences with behavioral–cognitive traits linked to autism in the general population.
Methods
In this study, we designed a dynamic emotion-discrimination task to investigate gender differences in attention to emotional stimuli in general population with autistic traits. Behavioral and eye movement data were recorded during the task, and the Autism-Spectrum Quotient (AQ) was used to assess autistic traits. We drew heat maps and quantified the proportion of fixation time to analysis the gaze patterns of male and female groups.
Results
It was observed that there were significant differences in attention to the eye regions, particularly with females focus more to eyes than males. Moreover, we conducted correlation analyses between AQ scores and proportional fixation time to the eye region in two groups separately. Lower eye-looking was associated with higher level of autistic traits in males, but not in females.
Conclusions
Overall, the above results reveal the pattern of scanning faces differed in females and males, and autistic traits predicted trend of eye-looking in males. These findings suggest that the gender-related stratification in social attention among individuals with autistic traits, and these differences need to be considered during clinical diagnosis.
Load Identification with Photovoltaic Distributed Generation and a Novel Public High-Frequency Dataset
Authors: Aguiar Everton L. , Bernardi Ricardo , Lazzaretti André E. , Pipa Daniel R. , Carati Emerson G. , Cardoso Rafael
Published: November 2024

This paper addresses the identification and classification of Distributed Generation (DG) connected to the secondary distribution network based on the Non-Intrusive Load Monitoring framework. We built a new public dataset with real-world data comprising samples of electrical variables aggregating loads and distributed generation data. Traditionally, NILM methods are concerned with disaggregating, identifying, and classifying electrical loads. On the other hand, Behind the Meter (BTM) estimation methods separate the consumption of electrical loads from the DG power generated by prosumers. Our work expands the traditional NILM and BTM analysis, presenting an ablation study of DG’s impact on the identification of electrical loads and the impact that aggregate loads represent for the identification of DG. We use state-of-the-art deep learning-based methods for disaggregation and classification on our new dataset and achieved up to 100% F1-Score for DG identification and up to 98% F1-Score for load disaggregation with the presence of DG.
“I’ve seen it work elsewhere… where you can’t get staff”: Clinicians’ and healthcare leaders’ perspectives on the suitability of virtual healthcare in metropolitan versus rural and remote areas.
Authors: McGrath Kelly , Grogan Caroline , Barron Andrew , Smith Ian , Kanagarajah Shanthi , Smith Sue-Ellen , Fisher Olivia
Published: November 2024

Introduction
Australia has a geographically tiered health system which is reinforced by a long-term pattern of urban-centric policymaking. As a result, people living in rural and remote areas have poor health outcomes, a high rate of preventable hospitalisations, and premature death. Virtual healthcare has been proposed as a strategy for improving geographical health equity, but many clinicians and health service leaders consider telehealth and virtual healthcare to be substandard compared with traditional face-to-face delivery. It is important to ensure that new services for people in rural and remote areas are designed and delivered to the same standard as traditional health services in metropolitan areas.
Methods
This was a qualitative thematic study with a focus on identification of hidden meaning representing unconscious bias. Interviews were conducted with clinicians and health service leaders (February-July 2023, Queensland, Australia) to inform the design and delivery of a new private virtual hospital. Three rounds of analysis were conducted by three coders using reflexive practices.
Results
26 participants: 5 health service leaders, 3 clinicians, and 18 who were both a leader and clinician. Three themes were identified: 1) traditional face-to-face healthcare is better than telehealth; 2) virtual healthcare offers an opportunity for rural and remote residents with limited access to face-to-face healthcare; 3) telehealth is better than nothing. Theme three focused on participants’ acceptance of substandard healthcare when the alternative is no healthcare at all.
Discussion
Taken together, the three themes indicate a tacit acceptance of a lower standard of healthcare for people living in rural and remote areas. This reflects a known urban-centric bias of healthcare policy makers. If a lower standard is considered acceptable because it is ‘better than nothing’ this may negatively influence the design/ delivery of virtual healthcare services in rural and remote areas. This urban-centric bias must be addressed to ensure equitable access to appropriate health services and health outcome equivalency.
Imposter Syndrome Across Surgical Subspecialties: Scratching the Surface
Authors: Brown Rebecca F , Posid Tasha , Lund Sarah , Cooper Amanda B , L'Hullier Joseph C , Sheppard Olabisi Ololade , Wu Esther , Zhang Jeannette , McKinley Sophia K , Zoumpou Theofano , Wieck Minna M , Bialowas Christie , Hendershot Kimberly M
Published: November 2024

Purpose Imposter syndrome (IS) is a “behavioral health phenomenon described as self-doubt of intellect, skills, or accomplishments among high-achieving individuals” that has been associated with psychological distress, burnout, anxiety, and depression, and has also been shown to negatively impact career retention and job performance. Previous studies, while rare, have demonstrated remarkably high rates of IS amongst surgical trainees, but include little information on contributing factors. The purpose of this study was to broadly explore IS in surgical trainees across specialties.Methods An anonymous electronic survey aimed at identifying the prevalence, severity, and underlying factors contributing to IS in surgical trainees was developed by members of the ASE Graduate Surgical Education Committee and distributed to list servs of surgical residents across specialties at twelve institutions. Descriptive statistics, univariate analysis, and multivariable analysis were performed to identify differences in and factors contributing to IS.Results A total of 155 survey responses were received. Seventy-one percent of respondents report significant or intense IS, with women demonstrating more severe IS. Residents identified interactions with peers or other residents as triggering more feelings of IS compared to faculty or patients. Prior IS training, feeling a sense of belonging in residency, and lower incidence of microaggressions were associated with less severe IS.Conclusions IS remains prevalent and severe amongst surgical trainees. Although previous work has identified many personal factors that contribute to IS, this study is one of the first of its kind to identify environmental and experiential (context-dependent) factors associated with more severe IS.
Different straw lengths and burial modes affect the salt distribution in coastal saline soil and the regulation of salt stress resistance in tomato
Authors: Huang Da , Guo Yugeng , Chen Sheng , Wang Zhenchang , Sun Boming , Niu yingyuan , Dong Shiquan
Published: November 2024

Aims Soil salinization poses a significant threat to global agricultural development. To enhance the effectiveness of saline soil improvement, the study innovatively utilized a combination of powder straw interlayer and topsoil mixing for straw returning to the field. Methods A tomato pot experiment was conducted to compare the effects of different straw lengths (S50: 50 mm, S10: 10 mm, S2: 2 mm) and burial modes (Wi: interlayer, Wm: topsoil mixing, Wim: interlayer and topsoil mixing) on the soil salt distribution, tomato root biochemical indexes, fruit yield and dry matter weight of above-ground. Results The study found that: (1) The salt distribution was significantly influenced by the method of straw returning. Straw burial mode had a greater impact than straw length. (2) The S50Wim, S10Wim, and S2Wim treatments exhibited more significant differences on the vertical non-uniform distribution of salt, thereby promoting the regulation of tomato roots in response to salt stress and effectively mitigating its adverse effects. (3)The S2Wim treatment can significantly improve tomato fruit yield and dry matter weight of above-ground. Compared to the CK treatment, tomato fruit yield and dry matter weight of above-ground increased significantly by 89.03% (P < 0.05) and 59.28% (P < 0.05), respectively. Conslusion It was concluded that the straw returning method that combined a 2 mm straw interlayer and topsoil mixing (S2Wim) can effectively optimize the salt distribution of coastal saline soil, promote the regulation of tomatoes to salt stress, alleviate the adverse effects of salt stress, and ultimately improve tomato fruit yield.
­­­Utilizing cloud-based BIM platforms for sustainable decision making in educational architecture design
Authors: Abbas Zahraa Mustafa , Rizko Nawfal Joseph
Published: November 2024

With the search for a sustainable construction process, building information modeling (BIM) emerged as a powerful agent. BIM is an innovative technology and technique that evolved the perspective of buildings like how they are planned, imagined, managed, and created. Designers are using BIM expertise to improve quality, save costs, and even create solutions to tackle the above-mentioned issues the study aims to propose the utilization of cloud-based BIM platforms for sustainable decision making in educational architectural design. The following methods are used for cloud-based BIM technology Data Collection. In this method, architectural designs, structural characteristics, material specifications, and energy use of educational buildings will be generated using cloud-based BIM systems. After collecting the data, accuracy, and consistency should be ensured by cleaning and standardizing the collected data which is called pre-processing. Moving on to the next step is reducing dimensionality with the use of “Principal Component Analysis (PCA)”, to overcome the issue which focuses on important factors that have a major influence on energy usage and sustainability. Following dimensionality reduction comes the Regression analysis which is done by Light Gradient Boosting Machine - Neural Network - Model Predictive Control (LightGBM-NN based MPC) is used in this case for Analyzing. For Classification, a hybrid technique Support Vector Machine - Neural Network - Genetic Algorithm (SVM-NN-GA) is used here. At last, ultimately, we create Sustainable decision-making frameworks that include classification outcomes while considering sustainability in the long term. Finally, the performance of this work is measured through the following performance metrics, Accuracy, Precision, Recall, F-1 Score, Root Mean Square Error.
Acetoacetate Ameliorates Skin Fibrosis by Modulating TGF-β1/Smad2/3 Signaling Pathway
Authors: Shang Ting , Li Linxiao , Miao Xiaohui , Huang Jieshen , Jiang Yu , Lu Wuyan , Cai Zixin , Lu Yishu , Kang Hui , Li Shuaijun , Huang Jiefeng
Published: November 2024

Skin fibrosis is a progressive pathologic outcome of prolonged healing of cutaneous wound which has been well accepted as a metabolic disease in recent study. However, the impact of ketone body metabolism on the development of cutaneous fibrosis remains largely unknown. Here, we found that ketone body metabolism was impaired in both human scars and bleomycin induced skin fibrogenesis of mouse by bioinformatics analysis, which was further evidenced by downregulated expression of key modulators of ketone metabolism including BDH1, OXCT1, and ACAT1. With knockdown of OXCT1, a spontaneous onset of fibrosis in normal skin and exacerbation of bleomycin induced skin fibrogenesis was observed. In dermal fibroblasts treated with TGF-β1, knockdown of OXCT1 improved their phenotype transition to myofibroblasts. Mechanistic studies indicated that phosphorylation of Smad2/3 signaling was markedly suppressed by acetoacetate (AcAc) supplementation. More importantly, we found that local administration remarkably alleviated fibrosis of bleomycin treated skin in mouse. Thus, our findings underscore the therapeutic potential of AcAc as an alternative intervention for skin fibrosis.
Prevalence and associated factors of atrial fibrillation among acute stroke patients at public referral hospitals, Bahir Dar, Ethiopia, 2024. A multicenter, four years retrospective cross-sectional study.
Authors: Molla Elias , Ayele Yihealem Yabebal , Ayenew Tewodros , Mekonen Alemtsehay , Yirdaw Agreye Kassa
Published: November 2024

Background
The prevalence of stroke and daily adjusted life-years lost is increasing in Sub Saharan African countries, where valvular heart disease is common. However, adequate data is lacking regarding the association of atrial fibrillation in acute stroke patients.
Objective
To assess the prevalence of atrial fibrillation and associated factors in acute stroke patients admitted to public referral hospitals from 2020 to 2023, Bahir Dar, Ethiopia.
Methods
Institution based retrospective cross-sectional study was conducted, using sample size of 326, among acute stroke patients who were admitted to two public hospitals, from January 2020 to December 2023, Bahir Dar, Ethiopia. Pre-developed check list was used to extract data from the medical registry. Data were entered using Epidata manager version 4.6 and analyzed using SPSS version 27. Multivariate logistic regression analysis was used, considering a p-value of < 0.05 as statically significant, with a 95% confidence interval.
Results
The proportion of atrial fibrillation among acute stroke patients was 29.1% (95% CI, 24.3–34.4%). The mean age of the participants was 61.63 years [SD ± 16.24]. Age ≥ 65 years (AOR = 4.37, 95% CI 1.618–11.8), hypertension (AOR = 2, 95% CI 1.12–3.5), heart failure (AOR = 4.95, 95% CI 1.7–14.3) and rheumatic heart disease (AOR = 5.7, 95% CI 1.7–18.8) were significant factors associated with atrial fibrillation in acute stroke patients.
Conclusion
The prevalence of atrial fibrillation in acute stroke patients was high, particularly in the elderly, hypertensive, heart failure and rheumatic heart disease patients. Efficient work has to be conducted in addressing these risk factors.
Blood culture positive sepsis in England, 2017-2018: epidemiological assessment of the Commissioning for Quality and Innovation (CQUIN) sepsis indicator
Authors: Mulchandani Ranya , Packer Simon , Howkins Joshua , Robinson Carla , Lamagni Theresa , Bhattacharya Alex , Reynolds Rosy , Charlett Andre , Brown Colin , Hope Russell , Hopkins Susan , Oliver Isabel
Published: November 2024

Background
Sepsis remains a significant clinical and public health concern, necessitating timely identification and targeted management for improved patient outcomes. This study describes the epidemiology of sepsis in emergency department attendees across England by analysing a unique multi-site linked dataset to inform approaches to strengthen surveillance and understanding of clinical outcomes.
Methods
An existent study dataset was utilised comprising a sample of paediatric and adult emergency admissions screened for sepsis in the Commissioning for Quality and Innovation (CQUIN) program in the 2017/18 financial year linked to Hospital Episode Statistics and Office for National Statistics death registrations. This was linked to the United Kingdom Health Security Agency’s Second-Generation Surveillance System for microbiological data; descriptive analyses were conducted to characterise sepsis screen positives and negatives in CQUIN, including demographic characteristics, clinical presentations, microbiological profiles, and clinical outcomes.
Results
Of the 4027 sepsis-screened emergency admissions included, 2454 (60.9%) were sepsis screen positive under the CQUIN indicator. Only 11.2% had a positive blood culture taken within 2 days of hospital admission. Blood culture positivity rates were 15.2% for sepsis screen positive and 5.1% for screen negatives in CQUIN. Monomicrobial episodes predominated (86.5%), with Escherichia coli and Staphylococcus species being the most isolated bacteria. The study showed a case fatality rate of sepsis of 17.1% (420/2454) but revealed no significant difference in all-cause 30-day mortality between sepsis screen positives in CQUIN with and without positive blood cultures. However, sepsis screen positives in CQUIN with a focal site of infection code were more likely to have positive blood cultures, except for respiratory infections.
Conclusions
This study provides novel insights into the epidemiology of sepsis screening in emergency departments across England, highlighting variability in blood culture positivity rates and microbial profiles. The findings underscore the importance of enhanced surveillance strategies, optimised screening protocols, tailored antimicrobial stewardship practices, and quality improvement initiatives to optimise sepsis management and outcomes. Systemic approaches are needed to address knowledge gaps and inform evidence-based interventions for sepsis care.
JND-Based Illumination Compensationand DoG-Mask RCNN Optimization forAccurate Radish Image Segmentation
Authors: 冠宗 莫
Published: November 2024

The widespread application of deep learning in the agricultural field has advanced radish segmentation and detection technologies. However, the issue of high dynamic range in backlit images captured by smartphones affects the monitoring of radish growth. Deep learning-based methods tend to perform poorly in complex lighting conditions, struggling with background interference, overexposure, and information loss. In this paper, we propose a new DoG-Mask RCNN network based on JND (Just Noticeable Difference) visual contrast compensation preprocessing. The network incorporates data preprocessing techniques for challenging environments as input, where the DoG layer is used to suppress overexposure in special conditions and filter out irrelevant background information. This layer retains spot details through its filtering capabilities, while the increment layer ensures the integrity of the feature information. We conducted experiments on radish mixed with traditional crops in different challenging environments to demonstrate the effectiveness of our method in detecting radish parts under various conditions. Compared to the latest monitoring methods, our approach shows better detection stability.
Three-dimensional theoretical and experimental researches on quarter circular corner cracks in finite bodies
Authors: Feng Zhou , She Chongmin , Li Binchao , Yang Runze , Kang Jianming
Published: November 2024

The corner crack is a typical crack widely existing in three-dimensional(3D) structures, especially for the quarter circular corner crack. For a curved 3D crack such as the corner crack, the fracture prediction results will usually be imprecise if the plane-strain fracture criterion is used. In order to improve the accuracy of fracture prediction, a 3D fracture prediction method induced a new Tz-based equivalent thickness model is adopted to deal with the fracture strength for a circular corner crack in a finite body. It is found that the strongest Tz constraint plane will shift far from the mid-plane (45° normal plane along the crack front line) with increasing c/W (ratio of crack depth c to plate width W) in finite bodies. Based on systematic finite element analyses, a new equivalent thickness equation for the circular corner crack in a finite body is obtained. A new stress intensity factor equation is developed based on the Newman's equation, the upper limit of the c/W is extended from 0.2 to 0.95. In order to verify the 3D fracture prediction method, a new fracture test on the circular corner crack is conducted. The experimental results show that the new 3D method is more accurate than the traditional 2D fracture criterion. For a given specimen with a circular corner crack, the prediction error decreases from 35.3–2.2% under tensile loading.
Trends and variation of PM2.5 in Antananarivo in the capital city of Madagascar
Authors: Mbolanjara Hélène , Rakotomavo Zo , Geiser Linda , Marline Lovanomenjanahary
Published: November 2024

This study aims to evaluate the temporal variations of PM2.5 concentration , as well as its daily variation during the fire season in 2023 in tropical settings like Antananarivo Madagascar. PM2.5 concentrations were recorded in 8 localities using PurpleAir low-cost devices for one year. We then establish air quality patterns in conjunction with meteorological and environmental factors that may influence variations in PM2.5 concentrations. The annual PM2.5 concentrations ranged between 21.6 μg/m3-31.9 μg/m3, exceeding the World Health Organization annual threshold (5 μg/m3), where the daily PM2.5 concentrations were in the range 8.4 –130.42 μg/m3. During May-June the percentage of days where the air quality was unhealthy for sensitive groups is above 30%. It increased to 70% in October and November. A bimodal pattern with higher concentration during the morning (02:00 - 07:00 a.m) and evening (05:00-09:00 pm) were found. Dry weather, rainfall and atmospheric stability influenced the daily PM2.5 variations. Low wind speed and atmospheric stability favor its accumulation and increase the concentration of PM2.5.
The effect of TeamSTEPPS@ mobile based learning on operating room efficiency
Authors: Amiri Fardin , Sohrabi Mohammad Reza , Hannani Seddigheh , Azadi Nemam Ali
Published: November 2024

Introduction:
Optimizing the operating room (OR) utilization is critical to maximize production and minimize cost by increasing efficiency in the OR. This research was conducted with the aim of determining the effect of TeamSTEPPS® mobile-based learning on OR efficiency.
Methods:
The present study was a semi-experimental study that the researcher conducted to measure the efficiency of ORs before and after the intervention in 2024. The research sample included all ORs and 105 OR staff of six medical education centers of IUMS. The research tool included a demographic characteristics and a researcher-made form to determine OR efficiency.
To conduct the research, the training content of the TeamSTEPPS® course was sent to the research participants through mobile phone messengers during five sessions, Then, the data related to the efficiency of the OR was collected from two months before and two months after the educational intervention from the medical records archive unit. Finally, the data before and after the intervention were compared. Statistical analysis was done using paired t-test. The significance level was considered 0.05.
Results:
The results showed that TeamSTEPPS® mobile learning was not effective on OR efficiency indicators such as the The start time of the first surgery (p>0/05), The rate of surgery cancellation (p>0/09), Case duration accuracy (p>0/08), Off-hour surgery (p>0/12), OR utilization (p>0/33), Surgeon time (p>0/49) and Turnover (p>0/67).
Conclusion:
Considering that TeamSTEPPS® mobile phone learning does not affect OR efficiency indicators, it is suggested not to use this training method to increase OR efficiency.
Inflammatory Burden Index as a predictor of mortality in septic patients: A retrospective study using the MIMIC-IV Database
Authors: Zhong Zhitao , Fan Mingyan , Lv Lukai , Long Qiong , Li Kefeng , Xu Ping
Published: November 2024

Purpose
Previous studies have identified the Inflammatory Burden Index (IBI) as a potential predictor of mortality risk in inflammatory diseases. However, its relationship with mortality rates specifically in septic patients has not been thoroughly investigated. This study aimed to explore the association between IBI and mortality risk in patients with sepsis.
Patients and methods:
We sourced clinical records of 1,828 septic patients from the MIMIC-IV (3.0) dataset. The primary endpoint was mortality within 28 days, with secondary endpoints including mortality during ICU stays and throughout hospitalization. Patients were categorized into quartiles based on their LnIBI levels. Binary logistic regression was utilized to examine the independent influence of IBI on mortality outcomes, adjusting for confounders. Additionally, the association between IBI and these outcomes was explored using restricted cubic splines and Kaplan-Meier analysis.
Results
The study involved 1,828 septic patients, including 1,047 males. The all-cause mortality rates were 17.78% (325/1828) within 28 days, 17.34% (317/1828) during ICU stays, and 18.22% (333/1828) over the course of hospitalization. In the adjusted model, a positive correlation was found between Ln IBI and mortality at 28 days (OR 1.093[1.014, 1.179], P = 0.021), during ICU stay (OR 1.106[1.025, 1.195], P = 0.01), and throughout hospitalization (OR 1.1[1.022, 1.187], P = 0.012). The analysis using restricted cubic splines showed a linear correlation between LnIBI and mortality risks. Kaplan-Meier plots revealed significantly lower survival rates for patients in the highest quartile of Ln IBI (P < 0.001).
Conclusion
Elevated IBI values are significantly linked with higher mortality risks within 28 days, during ICU, and throughout the hospitalization period in septic patients.
Dual Polarised Surface Plasmon Coupled Emission Tuning of Rhodamine B on SPR Metal Sensors
Authors: Vijayan Ajeesh P , Sreelak A. , Sharin Fasna , Dhandapani Kuppathil R. , Kannan Pradeesh
Published: November 2024

Surface plasmon coupled emission steering and emission tuning (SPCET) were demonstrated from metal-dielectric bi-layered structures in Reverse Kretschmann configuration. Rhodamine B dye doped Poly Vinyl Alcohol emissive layer was deposited on top of metal thin films (Silver, gold and copper) to realise bi-layered SPCET sensors. Apart from conventional p-polarised emissions, all sensor chips showed s-polarised emissions as well. These dual polarised emissions indicate a strong correlation between surface plasmon resonance and SPCET. Thickness of the dielectric layer show a major impact on the correlation between surface plasmon resonance and SPCET. Both p- and s- polarised emissions showed spectral narrowing. For thicker dielectrics, a decrease of 42% in the emission peak width was observed for p-polarised modes and was observed to be a constant for all metal sensors.
Cyber victimization experience, uncertainty stress, and internet self-efficacy as predictors of negative bystander behavior in cyberbullying among adolescents: a moderated mediation model
Authors: Chen Rui , Ming Dan , Hao Xin , Hu Zhen , Zhao Min , Fan Cuiying
Published: November 2024

Background
The prevalence of cyberbullying has become an alarming social issue among adolescents and has brought about a variety of negative outcomes on adolescents’ mental health. Bystanders’ behavior has been shown to be related to the outcomes of cyberbullying incidents. Although previous studies have demonstrated cyber victimization experience as a vital predictor of negative bystander behavior in cyberbullying, the underlying mechanism of the relationship between the two remains relatively unclear. This study investigated the association between cyber victimization experience and negative bystander behavior in cyberbullying among adolescents and the role of uncertainty stress and internet self-efficacy underlying this relationship.
Methods
A total of 826 Chinese high school students (Mage=15.82 years, SDage=0.68, 49.88% female) completed the Cyber Victimization Scale, the Uncertainty Stress Scale, the Internet Self-Efficacy Questionnaire, and the subscale of the Bystander Behavioral Intention Questionnaire in Cyberbullying. Moderated mediation effect analysis was used to test the hypothesis.
Results
The results revealed a significant positive correlation between cyber victimization experience and negative bystander behavior in cyberbullying among adolescents. Uncertainty stress mediated the relationship between cyber victimization experience and negative bystander behavior in cyberbullying, whereas internet self-efficacy moderated the latter half of the mediation pathway. Specifically, compared to adolescents with higher internet self-efficacy, the association between uncertainty stress and negative bystander behavior in cyberbullying is greater for adolescents with lower internet self-efficacy.
Conclusions
These findings broaden our understanding of the psychological processes that underlie the association between cyber victimization experience and negative bystander behavior in cyberbullying among adolescents and provide practical guidance on reducing the risks of cyberbullying.
High temperature induced brittle-ductile transition of monocrystalline silicon via in-situ indentation
Authors: Zhao Zerui , Li Xianke , Yang Xinhang , Wu Hao , Zhang Chi , Wang Shunbo , Zhao Hongwei
Published: November 2024

Monocrystalline silicon is difficult to molding process due to the unknown mechanism of temperature-influenced brittle-plastic transition. Indentation test of monocrystalline silicon from room temperature (RT) to 500 ℃ was carried out within scanning electron microscope (SEM). Evolution of surface damage mode at elevated temperatures were in-situ observed. Cracking and extrusion occurred during indentation of monocrystalline silicon from RT to 200 ℃, while shallow scallop-shell lateral peeling was found to be generated by a combination of secondary radial crack and shallow lateral crack. The phenomenon of surface peeling disappeared at 300 ℃. The plasticity of the material significantly increased. Dislocation motion coexists but competes with microcrack nucleation-expansion with temperature increasing. The completion of the brittle-plastic transition is evident at 500 °C. Cracks are no longer generated on the surface and pile-up phenomenon is enhanced. This discovery demonstrates the feasibility of plastic molding processing of monocrystalline silicon at high temperatures.
Global Burden Of Chronic Kidney Disease Due To Hypertension From Year 1990 To 2021 and Implications From Disparities Across Regions
Authors: Rao Xin , Luo Li , Huang Wenxia , Wang Zhuo , Zhou Xiaoyuan , Wang Xingyue
Published: November 2024

Background:
Chronic Kidney Disease due to hypertension poses a growing global diseaseburden, with significant disparities across regions. Comprehensive analysis and effective strategies should be provided to tackle the increasing issue.
Methods:
Using data from the Global Burden of Disease 2021, this study conducted descriptive and statistical analyses to evaluate the CKD burden due to hypertension across different SDI regions. EAPC,risk factors and decomposition were used to analyse the tread and distributional difference
Findings:
Globally, ASMR increased from 4.29 (95% UI: 3.55–5.11) per 100,000 in 1990 to 5.54 (95% UI: 4.68–6.41) in 2021, with a 0.97% annual increase. High SDI regions saw a sharp rise, with ASMR climbing from 2.4 (95% UI: 1.95–2.86) to 4.09 (95% UI: 3.34–4.71) and an EAPC of 2.23%. Low SDI regions experienced a slight decline in ASMR from 8.69 (95% UI: 7.03–10.73) to 8.62 (95% UI: 7.09–10.51). High systolic blood pressure and kidney dysfunction have consistently been the leading risk factors, female have a higher risk of high body-mass index than men, especially in high SDI regions.Decomposition highlights aging and epidemiological shifts，East Asia demonstrated a unique trend, with a 49.59% reduction in ASMR, ASDR and ASPR despite an aging population, reflecting successful interventions.
A Bibliometric Study of Blended Learning in Higher Education (2001- 2024)
Authors: Li Xin , Huang Malaysia Zexun
Published: November 2024

This study presents a comprehensive bibliometric analysis of blended learning in higher education (BLHE) research from 2001 to 2024. Using CiteSpace, we analyzed 2,125 publications from the Web of Science Core Collection to map the intellectual structure and evolution of the field. Our findings reveal a significant increase in BLHE research from 2013 onwards, with peak productivity in 2018 and 2019. Conference proceedings emerged as dominant publication venues, reflecting the field's dynamic nature. Document co-citation analysis identified influential works, with Garrison and Kanuka's (2004) Community of Inquiry framework emerging as particularly impactful. Cluster analysis revealed 11 distinct research areas, including blended learning foundations, self-regulated learning, game-based learning, and work-integrated learning. These clusters highlight the multifaceted nature of BLHE research and its integration with various pedagogical approaches and technologies. Our analysis also uncovered several research gaps, including a need for more diverse cultural perspectives, longitudinal studies examining long-term impacts, and research on innovative assessment strategies in blended environments. While the field has made significant progress in understanding BLHE implementation, challenges remain in addressing cultural diversity and long-term effectiveness. This study provides researchers, educators, and policymakers with insights into the field's intellectual structure, emerging trends, and future directions. As blended learning continues to shape higher education, addressing identified research gaps will be crucial for developing more effective, inclusive, and transformative learning experiences.
Managerial intelligence, quality of work life and job performance: the experience of nurses in selected public hospitals in Tehran- Iran
Authors: Ahmadi Fatemeh Zahra , Mosadeghrad Ali Mohammad , Ranjbaran Simin , Takian Amirhossein
Published: November 2024

Background
The quality of work life and managerial Intelligence are important determinants of nurses’ job performance. This study aimed to investigate the relationship between managerial Intelligence and quality of work life and nurses’ job performance in selected referral hospitals affiliated with the Tehran University of Medical Sciences (TUMS), in 2022, in Tehran-Iran.
Methods
This is a descriptive-analytical and cross-sectional research. Our samples were 348 nurses from four selected referral hospitals, affiliated with TUMS. We collected data through a questionnaire covering demographic details, managerial intelligence, quality of work life, and job performance and used SPSS 24 software to conduct descriptive and inferential data analysis.
Results
The average managerial intelligence and quality of work life scores were both 2.42 out of 5 (average), while job performance scored 3.90 (good). There was a significant positive correlation between managerial intelligence and job performance (r = 0.435, p = 0.000). Age and work experience were significantly correlated with managerial intelligence, while job category, income, and hospital were linked to quality of work life. Job performance was related to age, job category, and work experience (p < 0.05).
Conclusions
Enhancing managerial intelligence may directly improve nurses' job performance and indirectly influence their performance through better quality of work life. We propose capacity-building courses and continuous education to improve the nurses’ managerial intelligence and job performance.
Hair Cortisol Concentration and Mental Health During Childhood and Adolescence: evidence of higher cortisol concentration in ADHD symptoms in a large Brazilian population-based birth cohort
Authors: Tovo-Rodrigues Luciana , Bierhals Isabel Oliveira , Goularte Laura Moreira , Santos Iná S , Rohde Luis Augusto , Oliveira Isabel Oliveira , Gonzalez Andrea , Matijasevich Alicia , Murray Joseph
Published: November 2024

Background: Childhood and adolescence are pivotal for mental health. The hypothalamic-pituitary-adrenal axis is the primary stress system, with chronic activation measurable via hair cortisol concentration (HCC), indicating long-term stress exposure. While elevated HCC is linked to adult mental health, its role in youth remains unclear. This study aims to assess the association between mental health symptoms in childhood and adolescence and HCC levels at age 15 in a Brazilian population-based cohort.
Methods: We analyzed data from the 2004 Pelotas Birth Cohort, which includes 4,231 children followed from birth. At ages 6, 11 and 15 years, mental health symptoms were assessed using the Strengths and Difficulties Questionnaire (SDQ). At age 15, HCC was measured from 3 cm hair samples, and analyzed as ln (pg/mg). Linear regression models examined associations between HCC and SDQ scores, adjusting for perinatal variables, demographic factors, family income, maternal characteristics, maternal depression, harsh parenting exposure, hair traits, and corticosteroid use. The regression coefficient was exponentiated to improve interpretability.
Results: SDQ total difficulties and conduct problems at age 6 were associated with HCC at age 15 in adjusted models (p<0.05). Hyperactivity/inattention symptoms at ages 6 (β=1.009 [1.001;1.018]) and 11 (β=1.013 [1.004;1.022]) were associated with HCC in the adjusted models. At age 15, the association between hyperactivity/inattention and HCC was associated with HCC in the partially adjusted model. (β=1.009 [1.000;1.017]).
Conclusions: These associations emphasize the links between mental health and chronic stress over time, mainly an association between Attention-Deficit/Hyperactivity Disorder symptoms and higher concentration of HCC.
Larvicidal and Cytotoxic Activities of Exopolysaccharides Produced by Thermophilic Bacteria
Authors: AYTAR Mehmet , Bingül Demet Yalçın , Touray Mustafa , Uygun Deniz Aktaş , BAŞBÜLBÜL GAMZE
Published: November 2024

EPSs synthesized by thermophilic bacteria are natural biopolymers that have recently garnered attention due to their potential applications in areas such as pharmaceuticals and biomedicine. In this study, EPSs produced by five distinct thermophilic bacterial isolates from hot springs in Turkey were purified using ion exchange and gel chromatography, and the larvicidal and cytotoxic effects of these EPSs were examined. While Geobacillus thermodenitrificans HBB111 produces the highest quantity (650,9 µg/mL) of EPS, the protein content of crude EPS samples ranges from 0.3–1.5%. EPS111 and EPS261 showed the most effective larvicidal action, eliminating 72% and 62.7% of Ae. albopictus larvae after 48 hours, respectively. Among the purified samples, EPS111 exhibited the most significant effect on the proliferation of PC3 cells, resulting in a 68% inhibition (IC50 of 0,23 mg/mL) followed by EPS106 in a 55% (IC50 of 0,45 mg/mL). According to the results of our study, thermophilic EPSs demonstrate potential due to their insecticidal and anticancer properties.
The present situation of family rearing cost of infants aged 0-3 Years in Jiaxing and its Influence on fertility willingness: a cross-sectional study
Authors: Sun Xiaoyan , Xu Yan , Gu Shuiqin , Xu Jianping
Published: November 2024

Background
The government of China announced the three-child policy on May 31st, 2021, allowing all couples to have up to three children. At present, there is a lack of multi-dimensional investigation on the cost of parenting and fertility willingness of women and men under the three-child policy in China. The purpose of this study is to explore the present situation of parenting cost of 0-3-year-old infant families in Jiaxing city and its influence on fertility willingness.
Methods
The questionnaire survey was conducted by using the unified questionnaire of the whole province, namely, the questionnaire on the cost of raising infants under 3 years old in Zhejiang Province. In the form of sampling survey, the subjects were families with infants born after February 1, 2018 in Jiaxing, with a total of 21,104 households participating in the survey. Conduct a one-month online survey through the platform of Questionnaires.
Results
Households' daily expenses include housing loans, children's education, recreation and medicine, while the expenses for supporting parents are relatively small. In terms of family care expenditure, food and household facilities for infants and young children are the main expenses. The survey also found that the main problem faced by parents in the process of raising infants is the cultivation of sleep habits. As far as the willingness to give birth to the next child is concerned, the number of children in the family, the age of parents and other factors have an impact on it, but there is no significant correlation between the gender of children and the educational level of parents. The main reason for not wanting to give birth again is the economic pressure, especially the high cost of buying a house and education. The survey data showed that the differences of family annual income, father's age, mother's age and the number of children had statistical significance (P < 0.05). The data showed that the number of families with two children was the highest among the reasons for not wanting to have children again, with statistical significance (P < 0.01). The survey found that economic reasons were the primary reasons for not wanting to have children in families with one child, two children, three children and above (P < 0.05).
Conclusion
This study provides data support for formulating relevant policies. It can be seen that seeking targeted policy support, building a sound social parenting system, alleviating the economic cost of parenting, improving the environment for raising infants and promoting rational fertility decision-making will become a crucial fertility promotion strategy in the future.
Experimental study on instability and failure mechanism of sandstone under freeze-thaw and load
Authors: Lv Wenyu , You Ru , Wang Chuangye , Wang Zhihe , Wu Yongping , Xie Panshi , Lyu Chao , Luo Sheng , Yichen Li
Published: November 2024

In order to study the influence of loading rate and freeze-thaw cycles on the mechanical properties of sandstones, uniaxial compression tests were conducted on sandstone samples subjected to various freeze-thaw cycles and loading rates. Both internal and external damages were monitored throughout the tests using an acoustic emission (AE) detection system and a high-speed camera system. The effects of loading rate and freeze-thaw cycle on the typical mechanical properties, failure modes, and AE characteristics of sandstone were analyzed. In addition, attenuation models were established for the strength indices of freeze-thaw affected sandstone under different loading rates. Based on the results of the analyses, the following main conclusions are drawn: With the increase in freeze-thaw cycles and the decrease in loading rate, the uniaxial compressive strength(UCS) and elastic modulus(E) of sandstone decrease and the ductility increases, whereas the attenuation constant λ decreases as the loading rate increases. Upon complete failure, the number of tensile cracks in the sandstone exceeds that of shear cracks. As the number of freeze-thaw cycles increases and the loading rate decreases, the proportion of shear cracks gradually increases. With the increase in the loading rate, sandstone damage is primarily due to tension, and with more freeze-thaw cycles, damage is mainly due to both tension and shear. When the internal cracks in sandstone start to extend, the AE events rate and b-value signals become active. The absence of low AE events rate and a sharp decline in AE b-value can serve as precursors for predicting instability and failure of sandstones subjected to varying loading rates and freeze-thaw cycles.