bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of Baby-Friendly Hospital Initiative compliance on the association between the mode of birth and breastfeeding initiation in Sri Lanka
Authors: Lokeesan Laavanya , Martin Elizabeth , Byrne Rebecca , Miller Yvette
Published: January 2024

Background
In Sri Lanka, there is some evidence that the likelihood of breastfeeding initiation varies by exposure to Baby-Friendly Hospital Initiative [BFHI]-compliant care and mode of birth. Globally, there is some evidence that exposure to mother-baby skin-to-skin contact (BFHI Step 4) is lower in caesarean section births. Therefore, we aimed to determine how breastfeeding initiation varies by mode of birth in Sri Lanka, and the extent to which women’s exposure to BFHI practices practices explains any associations found.
Methods
A cross-sectional survey was conducted with women with a live baby across four government hospitals in Sri Lanka. Quantitative data were collected through participant interviews and extraction from medical records. Associations between BFHI practices, breastfeeding initiation, mode of birth, and women’s characteristics were assessed using binary logistic regression analysis applied in mediation and moderated mediation models.
Results
Women who received care compliant with Steps 4 and 6 of BFHI, regardless of their mode of birth, were more likely to initiate breastfeeding within the first hour after birth. BFHI Step 4 partially and completely mediated the effect of planned caesarean section and emergency caesarean section, respectively, on breastfeeding initiation within one hour of birth. Further, exposure to BFHI Step 6 partially mediated the effect of emergency caesarean section on breastfeeding initiation within one hour of birth. Women's age, pre-pregnancy BMI, parity status, and ethnic group, significantly influenced the relationship between planned or emergency caesarean section, exposure to Step 4 or Step 6 of BFHI, and breastfeeding initiation within one hour of birth. Specifically, being primiparous strengthened the likelihood that having a planned caesarean section decreased women's exposure to BFHI Step 4; and having a pre-pregnancy BMI categorized as overweight weakened the likelihood that planned caesarean section decreased exposure to BFHI Step 4.
Conclusions
Improving compliance with mother-baby skin-to-skin contact (BFHI Step 4) and no supplementation (BFHI Step 6) is critical for Sri Lankan health services to support all women to establish breastfeeding initiation within one hour of birth, as these practices attenuate the negative effect of caesarean sections on breastfeeding initiation.
Bamboo powders effectively reinforcing the modulus of PBAT composites and its reinforce mechanism
Authors: Ye Xiaojing , Ye Yanpeng , Han Yulong , Ren Fengmei , Ma Haihong , Xu Weibing , Zhou Zhengfa
Published: January 2024

Bamboo has a short growth cycle and exists in large quantities in nature. This paper uses bamboo powders (BP) to reinforce polybutylene adipate/terephthalate (PBAT) modulus. The BP was surface modified by γ-(2,3-epoxypropoxy)propyltrimethoxysilane (KH560), and compounded with PBAT in a twin-screw extruder. The results showed that the specific surface area and micropores of bamboo powders were considerably higher than that of common wood powders and cellulose. The tensile and flexural modulus of the composites increased 225% and 608%, respectively, when 25 wt% of modified bamboo powders (K-BP) was added, by comparing to that of pristine PBAT. The enhancement mechanism of K-BP was discussed, the large specific surface area and micropores of K-BP provided more anchoring sites, which effectively increased the interfacial binding force between K-BP and PBAT, and enhanced the nucleation ability of PBAT, thus improving the modulus of the composites. The results of this paper broadened the scope of application of PBAT.
The experiences and needs of older people receiving volunteer services in Chinese elderly care institutions: A qualitative study
Authors: Li Lin , Shen Qin , Wua Junxian
Published: January 2024

Background
Elderly people living in elderly institutions are eager to get volunteer help, but their satisfaction with volunteer services is not high. To better carry out volunteer services and improve the effectiveness of services, it is necessary to have a deep understanding of the real experience and needs of older people for volunteer services.
Methods
The purposive sampling method was used to select 14 older people from two elderly care institutions in Hangzhou and conduct semi-structured interviews. Collaizzi's seven-step method was used to analyze the data.
Results
Older people in nursing institutions have both positive and negative experiences in the process of accepting volunteer services; positive experiences include feeling the warmth of society and contributing to a better life, while negative experiences include the formalization of the service process, the lack of regularity in the frequency of services, and the mismatch between service supply and demand. The demand for volunteer services mainly focuses on emotional comfort, cultural entertainment, and knowledge learning.
Conclusion
Older people in elderly care institutions have varied volunteering experiences, and their volunteer demand is diversified. Volunteer service needs of older people should be accurately assessed, and volunteer service activities should be targeted.
Experience in the treatment of giant orbital intraconal teratoma: a case report
Authors: Li Ruimiao , Ren Mingyu , Wang Wenjing , Li Ruixin , Zhang Lili , Liu Limin
Published: January 2024

Background
Orbital teratoma is a relatively rare disease, often present at birth or detected within six months of life. As children are in the growth and development stage, giant orbital masses can affect orbital volumes, and conventional treatment may not be as effective as expected, with relatively many complications.
Case presentation:
A 2-year-old female child with proptosis, inwards, and upward eyeball displacement. Enhancing magnetic resonance imaging (MRI) revealed a well-circumscribed mass without significant improvement, which was hypointense signals on T1 weighted images(T1WI) and hyperintense signals on T2 weighted images(T2WI). A transconjunctival approach via the inferior fornix with canthotomy and cantholysis was performed. One month after surgery, the patient had enophthalmos, conjunctival hyperemia, and keratitis on ocular examination. A second operation was performed, with the implantation of an allogeneic sclera into the orbit to increase the orbital volume, improve the pitting of the fossa, and restore keratitis to normal. Histopathological examination showed that the fibrous capsule wall was covered with squamous and glandular epithelium, with visible brain tissue and cartilage-like matrix consistent with orbital teratoma.
Conclusions
Giant orbital teratomas in children are less common. This clinical case suggests that larger orbital masses occurring in childhood may result in markedly increased orbital volume and the possibility of postoperative enophthalmos and keratitis and that we need to increase the orbital volume and reduce the incidence of complications by timely implantation in orbit after excising the mass and defining its nature.
Neutrophil Extracellular Traps Formation: Effect of Leishmania major promastigotes and salivary gland homogenates of Phlebotomus papatasi in human neutrophil culture
Authors: Firouzjaie Fahimeh , Taghipour Niloofar , Akhavan Amir Ahmad , Tabaei Seyyed Javad Seyyed , Rouhani Soheila , Shirazian Maryam , Koochaki Ameneh , Fatemi Mahboubeh , Mossafa Nariman , Vaziri Vahideh Moin
Published: January 2024

Background
Leishmaniasis as a neglected tropical disease (NTD) is caused by the inoculation of Leishmania parasites via the bite of phlebotomine sand flies. After an infected bite, a series of innate and adaptive immune responses occurs, among which neutrophils can be mentioned as the initiators. Among the multiple functions of these fighting cells, neutrophil extracellular traps (NETs) were studied in the presence of Leishmania major promastigotes and salivary gland homogenates (SGH) of Phlebotomus papatasi alone, and in combination to mimic natural conditions of transmission.
Material & Methods
The effect of L. major and SGH on NETs formation was studied in three different groups: neutrophils + SGH (NS), neutrophils + L. major (NL), neutrophils + L. major + SGH (NLS) along with negative and positive controls in 2, 4 and 6 hours post-incubation. Different microscopic methods were used to visualize NETs comprising: fluorescence microscopy by Acridine Orange/ Ethidium Bromide staining, optical microscopy by Giemsa staining and scanning electron microscopy. In addition, the expression level of three different genes NE, MPO and MMP9 was evaluated by Real-Time PCR.
Results
All three microscopical methods revealed similar results, as in NS group, chromatin extrusion as a sign of NETosis, was not very evident in each three time points; but, in NL and especially NLS group, more NETosis was observed and the interaction between neutrophils and promastigotes in NL and also with saliva in NLS group, gradually increased over times. Real-time reveals that, the expression of MPO, NE and MMP9 genes increased during 2 and 4 hours after exposure, and then decreased at 6 hours in most groups.
Conclusion
Hence, it was determined that the simultaneous presence of parasite and saliva in NLS group has a greater impact on the formation of NETs compared to NL and NS groups.
The incidence of Acute Kidney Injury in preterm infants treated with early high dose caffeine
Authors: kasirer Yair , Schlesinger Noam , Tzvi-Behr Shimrit , Frishberg Yaacov , Ben-Shalom Efrat , Kasirer Yair
Published: January 2024

Background and Objectives
Acute kidney injury (AKI) is common in neonates and associated with increased morbidity and mortality, longer hospitalization, and a higher risk for future kidney damage. Caffeine treatment, commonly used to treat apnea of prematurity, was reported to be associated with decreased AKI occurrence. However, previous studies lack uniformity regarding the dosage and timing of the administration of the drug.
The objective of this study was to assess the incidence of AKI in VLBW preterm infants treated with early high dose caffeine, and to identify risk factors associated with AKI.
Methods
A retrospective cohort study of very low birth weight preterm infants admitted to the Neonatal Intensive Care Unit (NICU) at the Shaare Zedek Medical Center between Jan. 1, 2017 and Dec. 31, 2019. AKI was defined according to the neonatal AKI KDIGO classification, based on an elevation of serum creatinine levels or a decrease in urine output. High dose Caffeine (20 mg/kg bolus, administrated in the first hour of life, followed by a maintenance dose of 10 mg/kg/day) was universally administrated to all VLBW preterm infants born less than 32 weeks of gestation. Infants with inadequate data regarding urine output or less than two serum creatinine measurements were excluded.
Results
During the study period 311 VLBW infants were admitted, all had adequate serum creatinine and urine output data. 301 met the inclusion criteria, 41 infants (13.6%) were diagnosed with AKI, while only 12 (4%) during the first week of life, a significantly lower incidence in comparison to previous reports (p -value < 0.0001). Sixteen infants (5.1%) had more than one AKI episode. Seven infants (17%) had AKI stage 1 and 17 infants had stage 2 and 3 (41.5%).
AKI was associated with lower gestational age and male sex (p value = 0.002 and 0.03, respectively).
Conclusions
The incidence of AKI in a cohort of VLBW infants, treated with early high dose Caffeine was significantly lower as compared to previous studies, especially in the first week of life.
Spin practices and low reporting quality in studies on prediction model of diagnosis based on TCM information: A systematic review and evidence mapping
Authors: li Jieyun , Lin Jieqi , Xiao Xinang , Zhou Mi , Zhao-xia XU
Published: January 2024

Background Despite the abundance of published studies on prediction models for diagnosing Traditional Chinese medicine (TCM), there remains a lack of comprehensive assessment regarding reporting and methodological quality, as well as an absence of examination into the objectivity of linguistic aspects within these studies. Methods The PubMed, Cochrane Library, Web of Science, CNKI, VIP, and WANFANG databases were systematically searched from inception to October 30th, 2023, to identify studies developing and/or validating diagnostic and prognostic TCM prediction models using supervised machine learning. PROBAST and TRIPOD were employed to assess the reporting and methodological quality of identified studies. A previous article about spin in prognostic factor studies already identified several practices, which we modified for our data extraction The present study was registered on PROSPERO with the registration number CRD42023450907. Results 35 and 19 eligible studies published in Chinese and English were identified respectively from 1746 records. The clinical diseases with the most publications were diabetes (n = 7, 14.8%), coronary heart disease (n = 6, 11.1%), and lung cancer (n = 5, 9.26%). Primary analysis and sensitivity analysis confirmed that the reporting and methodological quality of included studies were correlated (rs= 0.504,p < 0.001). The quality of the CM prediction model requires improvement by including a structured title, participants and predictors selection, statistical analysis methods, model performance and interpretation. Two studies (4.55%) recommended the model to be used in daily practice lacked any external validation of the developed models. Six studies (13.63%) made recommendations for clinical use in their main text without any external validation. Reporting guidelines were only cited in one study (1.85%). Conclusion The available evidence indicated TCM information can provide predict information for different diseases, but the scientific quality of published studies needs to be improved.
Final results on effectiveness and safety of Ibrutinib in patients with chronic lymphocytic leukemia from the non-interventional FIRE study
Authors: DARTIGEAS Caroline , QUINQUENEL Anne , YSEBAERT Loïc , DILHUYDY Marie-Sarah , ANGLARET Bruno , SLAMA Borhane , DU Katell LE , TARDY Stéphanie , TCHERNONOG Emmanuelle , ORFEUVRE Hubert , VOILLAT Laurent , GUIDEZ Stéphanie , MALFUSON Jean-Valère , DUPUIS Sandrine , DESLANDES Marine , FEUGIER Pierre , LEBLOND Véronique
Published: January 2024

We conducted an observational study (FIRE) to understand the effectiveness and safety outcomes of ibrutinib in patients with chronic lymphocytic leukemia (CLL) in France, after a maximum follow-up of five years. Patients were included according to the French marketing authorization in 2016 (i.e. patients with relapsed or refractoryCLL or to previously untreated CLL patients with deletion 17p and/or TP53 mutations unsuitable for chemoimmunotherapy) and could have initiated ibrutinib more than 30 days prior their enrolment in the study (i.e. retrospective patients) or between 30 days before and 14 days after their enrolment (i.e. prospective patients). The results showed that in the effectiveness population (N=388), the median progression-free survival (PFS) was 53.1 (95% CI: 44.5-60.5) months for retrospective patients and 52.9 (95% CI: 40.3-60.6) months for prospective patients and no difference was shown between the PFS of patients who had at least one dose reduction versus the PFS of patients without dose reduction (p=0.7971 for retrospective and p=0.3163 for prospective patients). For both retrospective and prospective patients, the median overall survival was not reached. The most frequent treatment-emergent adverse event of interest was infections (57.6% retrospective; 71.4% prospective). A total of 14.6% of the retrospective patients and 22.4% of the prospective patients had an adverse event leading to death. Our findings on effectiveness were consistent with other studies and the fact that patients with dose reductions had similar PFS than patients without dose reduction is reassuring. No additional safety concerns than those already mentioned in previous studies could be noticed.
Trial registration
ClinicalTrials.gov, NCT03425591. Registered 1 February 2018 – Retrospectively registered.
Clinico–pathologic Factors and Survival of Patients with Breast Cancer Diagnosed with De Novo Brain Metastasis: A National Cancer Database Analysis
Authors: Hijazi Ali , Mohanna Mohamed , Sabbagh Saad , Montes Maria Jose Herran , Dominguez Barbara , Sarna Kaylee , Nahleh Zeina
Published: January 2024

Purpose
Patients with Breast Cancer (BC) with Brain Metastasis (BCBM) have poor survival outcomes. We aimed to explore the clinico–pathologic and therapeutic factors predicting the survival in patients with de novo BCBM using the National Cancer Database (NCDB).
Patients and Methods
The NCDB was queried for patients with BC between 2010–2020. Survival analysis with Kaplan–Meier curves and log rank tests were used to find median overall survival (OS) in months (95% CI) across the different variables. A multivariate cox regression model was computed to identify significant predictors of survival.
Results
Out of n=2,610,598 patients, n=9,005 (0.34%) had de novo BCBM. A trend of decreasing OS was observed with increasing age, Charlson–Deyo score (CDS), and number of extracranial metastatic sites. The highest median OS was observed in the Triple Positive and the lowest OS in the Triple Negative subgroup. Based on treatment regimen, combination of systemic therapy and local therapy achieved the highest OS. A positive trend in OS was observed in the BC subgroup analysis with targeted therapy demonstrating a survival benefit when added to systemic therapy.
The multivariate cox regression model showed that age, race, ethnicity, insurance, median income, facility type, CDS, BC subtype, metastatic location sites, and treatment combinations received were significantly associated with risk of death. Receiving only local treatment for BM without systemic therapy more than doubled the risk of death compared to combining it with systemic therapy.
Conclusions
This analysis suggests that treatment of systemic disease is the major factor influencing survival in patients with BCBM. Moreover, targeted therapy with anti–HER2 increased survival when added to systemic therapy explaining the highest median OS noted in the Triple Positive subgroup.
Revealing Connectivity Patterns of Deep Brain Stimulation Efficacy in Parkinson’s Disease
Authors: Bočková Martina , Vytvarova Eva , Lamoš Martin , Hlinka Jaroslav , Goldemundová Sabina , Rektor Ivan
Published: January 2024

The aim of this work was to study the effect of deep brain stimulation of the subthalamic nucleus (STN-DBS) on the subnetwork of subcortical and cortical motor regions using the functional connectivity analysis in Parkinson’s disease (PD). The high-density source space EEG was acquired and analyzed in 43 PD subjects in DBS on and DBS off stimulation states (off medication) during a cognitive-motor task. Increased connectivity within subcortical regions and between subcortical and cortical motor regions in the high gamma band (50-100Hz) was significantly associated with the Movement Disorders Society – Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) III improvement. Further, the whole brain connectivity patterns were evaluated to complement this finding. The connectivity patterns in low gamma (30-50Hz) and high gamma band (50-100Hz) significantly correlated with the movement improvement. Neural correlates of cognitive performance were detected in the beta (12-30Hz) and high gamma (50-100Hz) bands. Finally, a whole brain multifrequency connectivity profile was found to classify optimal and suboptimal responders to DBS with a positive predictive value of 0.77, negative predictive value of 0.55, specificity of 0.73, and sensitivity of 0.60. Specific connectivity patterns related to motor symptoms improvement after DBS and therapy responsiveness predictive connectivity profiles were uncovered.
Relationship between subtype-specific minimal residual disease level and long-term prognosis in children with acute lymphoblastic leukemia
Authors: 黄 筱彤 , Wang Chan-Juan , Gao Chao , Xue Tian-Lin , Zhao Zi-Jing , Wang Tian-You , Wu Min-Yuan , Cui Lei , Zhang Rui-Dong , Li Zhi-Gang
Published: January 2024

In childhood acute lymphoblastic leukemia (ALL), minimal residual disease (MRD) risk stratification criteria specific to common genetic subtypes are unclear. Among 723 children with newly diagnosed ALL treated with the Chinese Children Leukemia Group trial CCLG-2008 protocol, at time point 1 (TP1, the end of induction) and TP2 (before consolidation for standard risk and intermediate risk group, or before the second HR-I' block for high risk group), the MRD levels of children carrying different fusion genes or with T-ALL were significantly different (P all <0.001), and the prognostic significance of the same MRD level in the above subtypes was greatly different. For patients carrying BCR::ABL1 or KMT2A rearrangements, or ETV6::RUNX1, or with T-ALL, we defined those with both TP1 and TP2 MRD levels <10-2, TP1 MRD <10-3 and TP2 MRD-negative, TP1 MRD <10-3, as low MRD group respectively; the remaining children as high MRD group of each subtype. The 10-year relapse free survival (RFS) of low MRD group was significantly better than that of high MRD group. We verified the clinical value of the above MRD stratification criteria in patients treated with “Beijing Children’s Hospital BCH-ALL2003” protocol. In conclusion, subtype-specific MRD risk stratification may contribute to the precise treatment of childhood ALL.
Stroke types, risk factors, clinical features and outcomes in a tertiary hospital, Myanmar, a descriptive study
Authors: Tun Thant Zin , Han Su Myat , Moji Kazuhiko , Matsui Mitsuaki
Published: January 2024

Background
Stroke is one of the leading causes of death and majority of the stroke burden was observed in middle- and low-income countries. Understanding the risk factors, complications and outcomes is useful in healthcare planning and resource allocation. However, little information on stroke is available in Myanmar.
Methods
A review of medical records of stroke admission during 2017 in a tertiary hospital was conducted. Final diagnosis, risk factors, clinical features, complications and outcomes were systematically collected both from computer-based and from paper-based medical records.
Results
1153 cases were identified, and 977 cases were analysed. Haemorrhagic stroke was the most common type (48.8%), followed by ischaemic stroke (43.4%). Unimproved cases were 31.5%. Identified risk factors of unimproved were 'haemorrhagic stroke' [adjusted odds ratio (aOR): 1.67], 'having fever during hospitalisation' [aOR: 2.53], and 'Glasgow Coma Scale at the admission between 9 and 14 [aOR: 4.64], and less than 9 [aOR: 42.37].
Conclusion
Intracranial haemorrhage and unconsciousness were significantly associated with poor prognosis. Fever during the hospitalisation, which was also a risk factor of unimproved cases, could be associated with aspiration pneumonia. This could be an associated symptom of unconsciousness. The findings imply how to prevent and control fever among stroke patients during hospital stay is a key for better prognosis.
Behavioural Risk Factors for Non-Communicable Diseases Among Returnee Sri Lankan Migrant Workers from Middle East: A Cross-Sectional Study
Authors: WIJERATNE PASINDU DILSHAN , Pathmeswaran Arunasalam
Published: January 2024

Background: Non-Communicable Diseases (NCDs) are rising among South Asian migrant populations. Despite Sri Lanka’s over 1.5 million temporary migrant workforce, there’s insufficient data on Behavioural Risk Factors (BRFs) for NCDs among returnee migrant workers. This study aims to describe the prevalence of BRFs for NCDs and associated factors among returnee Sri Lankan migrant workers from Middle-East.
Methods: This community-based, cross-sectional study was conducted among 680 returnee Middle East migrant workers in the Kurunegala District, Sri Lanka selected using multi-staged cluster sampling. Pretested Interviewer-Administered Questionnaire was utilized for the data collection. The analysis encompasses descriptive statistics and logistic regression using SPSS version 26.
Results: Response rate was 94.4% (n=642). Estimated prevalence of BRFs included daily smoking 12.3% (95%CI 9.8-15.1), current alcohol uses 20.1% (95%CI 17.0-23.4), inadequate fruits and vegetables consumption 89.3% (95%CI 86.6-91.6), and physical inactivity 31.4% (95%CI 27.8-35.2). Significant associations were identified, such as daily smoking with extended post-return period (AOR 0.58, 95%CI 0.39-0.86), having accumulated savings (AOR 2.98, 95%CI 1.33-6.69), being diagnosed with NCDs (AOR 2.85, 95%CI 1.36-6.69). Current alcohol use correlated with - being currently employed (AOR 7.79, 95%CI 2.72-22.33), being male (AOR 46.49, 95%CI 13.10-164.95), having accumulated savings (AOR 2.75, 95%CI 1.30-5.82), higher education level (AOR 0.38, 95%CI 0.19-0.74). Insufficient fruits and vegetables consumption was associated with; over LKR50,000 household income (AOR 0.24, 95%CI 0.12-0.46), and having accumulated savings (AOR 0.38, 95%CI 0.19-0.74). Physical inactivity was correlated with; being male (AOR 0.23, 95%CI 0.14-0.40), having chronic disease/ disability (AOR 1.91, 95%CI 1.20-3.04).
Conclusion: Socio-economic and migration-related characteristics of returnee migrant workers were associated with the BRF for NCDs. Migrant-friendly, tailored interventions addressing these factors are recommended for promoting healthy lifestyles among returnee migrant workers.
A new way to avoid excessive damage to blood vessels from haemostatic clips
Authors: Ren Lizhi , Wang Qianqian , Zhang Zepeng , Wu Xiaofen , Wang Dan , Ji Hao , Zhang Wei , Sun Rui
Published: January 2024

Objective: Haemostatic clips are helpful for the successful completion of vascular anastomosis in microsurgery but may cause damage to blood vessels, which remains a concern of scholars.
Design: In the first phase, a total of 96 SD rats were randomly allocated into two groups: one treated with disposable haemostatic clips and another treated with metal haemostatic clips. Each group was further divided into four subgroups based on clamping force (30 g, 60 g, 90 g, and 120 g). Injury to the vascular intima was observed using scanning electron microscopy (SEM). The second phase involved measuring the minimum clamping force in the human body to validate the accuracy of the calculation formula.
Results: Under SEM, at a clamping force of 30 g, only a portion of the fold was flattened, and minimal damage to the intimal surface of the blood vessel was observed. However, at a clamping force of 90 g and 120 g, the damage inflicted by the two haemostatic clips became more severe, resulting in extensive exfoliation or even complete disappearance of the vascular intima. The measurement results for the minimum clamping force in human subjects indicated no significant difference between the theoretical and actual values (P > 0.05), suggesting a certain reliability of the formula.
Conclusions: The degree of injury caused during haemostasis is directly proportional to the clamping force applied by haemostatic clips used in clinical practice. Additionally, the material and surface characteristics of the clip can also impact vascular injury. Disposable haemostatic clips have an advantage over metal clips in terms of reducing vascular injury. The theoretical minimum clamping force calculation formula can be used as a reliable reference for selecting appropriate haemostatic clips.
Mesoscale Simulation of the Compression and Small-Strain Elastic Shear Behavior of Illite Nanoparticle Assemblies
Authors: Zhu Hejian , Whittle Andrew J. , Pellenq Roland J.-M.
Published: January 2024

The mechanical properties of clay minerals are largely dependent upon the chemical compositions and the mesoscale fabrics of the constituent particles. This paper describes results of a series of mesoscale molecular dynamics simulations of the hydrostatic compression and shear strain behavior for initially randomly-oriented assemblies of 10 3 Illite primary particles. The particles are simulated as rigid-body ellipsoids that interact through the single-site, Gay-Berne potential function. This corresponds to a coarse-grained model based on prior atomistic scale computation of the potential of mean force for water-mediated interactions between pairs of particles through free energy perturbation method. We investigate the mesoscale fabrics of the NPT-equilibrated assemblies for confining pressures ranging from 1.0 – 125 atm, including path dependence associated with unloading and reloading. We analyze and quantify the geometric arrangement including particle orientation, specific surface area, properties of particle stacks/aggregates, and inter-stack pair correlation functions. The compression of each particle assembly is associated with large irrecoverable changes in void ratio, while unloading and reloading involves much smaller, largely recoverable volu-metric strains. The results are qualitatively similar to macroscopic compression 1 behavior reported in laboratory tests. We simulate the uniaxial and shear behavior at each of the equilibrated pressure states through a series of strain-controlled steps, allowing full relaxation of the virial stresses computed at each step. The simulations investigate directional and path dependence of the shear behavior for strain deviations up to 0.2%. The results show the onset on non-linear stiffness properties at strain levels ∼0.01%, and hysteretic behavior upon unloading and reloading. Small strain stiffness properties of the particle assemblies are qualitatively in good agreement with quasi-static, elastic stiffness properties reported for Illitic clays.
Does health voucher intervention increase antenatal consultations and skilled birth attendances in Cameroon? Results from an interrupted time series analysis
Authors: Sieleunou Isidore , Bonong Roland Pascal Enok
Published: January 2024

Background:
Limited access to health services during the antenatal period and during childbirth, due to financial barriers, is an obstacle to reducing maternal and child mortality. To improve the use of health services in the three regions of Cameroon, which have the worst reproductive, maternal, neonatal, child and adolescent health indicators, a health voucher project aiming to reduce financial barriers has been progressively implemented since 2015 in these three regions. Our research aimed to assess the impact of the voucher scheme on first antenatal consultation (ANC) and skilled birth attendance (SBA).
Methods:
Routine aggregated data by month over the period January 2013 to May 2018 for each of the 33 and 37 health facilities included in the study sample were used to measure the effect of the voucher project on the first ANC and SBA, respectively. We estimated changes attributable to the intervention in terms of the levels of outcome indicators immediately after the start of the project and over time using an interrupted time series regression. A meta-analysis was used to obtain the overall estimates.
Results:
Overall, the voucher project contributed to an immediate and statistically significant increase, one month after the start of the project, in the monthly number of ANCs (by 26%) and the monthly number of SBAs (by 57%). Compared to the period before the start of the project, a statistically significant monthly increase was observed during the project implementation for SBAs but not for the first ANCs. The results at the level of health facilities (HFs) were mixed. Some HFs experienced an improvement, while others were faced with the status quo or a decrease.
Conclusions:
Unlike SBAs, the voucher project in Cameroon had mixed results in improving first ANCs. These limited effects were likely the consequence of poor design and implementation challenges.
Impact on mortality of haemodynamic changes during initial resuscitation in patients with inhalation injury
Authors: Cachafeiro Lucía , Agrifoglio Alexander , Flores Eva , Estébanez Belén , Sanchez-sanchez Manuel
Published: January 2024

Introduction: Inhalation injury remains a significant cause of morbidity and mortality in critically ill burn patients. To improve this prognosis, it might be useful to understand the haemodynamic impact of inhalation injury during the initial resuscitation phase. We studied the hemodynamic changes in patients with inhalation injury, as well as the fluid volume used during initial resuscitation and whether it was related to mortality.
Methods: We designed a prospective, single-centre observational 4-year study. Patients with criteria of major burns were included. Our Burns Resuscitation protocol was based on relatively permissive hypovolemia monitoring, employing both non-invasive and transpulmonary thermodilution parameters. We studied the differences in age, % total body surface area (%TBSA) burned, severity scores, lactate, troponin I, NTproBNP, resuscitation infused volume, urine output, complications and mortality between burn patients with and without inhalation injury.
Results: A total of 180 critically ill burn patients were admitted: 96 had TBSA burned ≥20% without suspected inhalation, and 84 had inhalation injury regardless of the %TBSA burned. Patients with inhalation injury were older (52 vs 44 years), had lower %TBSA burned (28.1 vs 34.8), lower initial cardiac index and higher lactate, initial stroke volume variation, late extravascular lung water (EVLWI) index and NTproBNP. They also had a greater need for mechanical ventilation (88% vs 59%) and slightly higher mortality (28% vs 18%, p=0.1). No differences in fluid requirements (4.7 vs. 4.2 ml/kg/%TBSA burned, p 0.4), were found. The inhalation injury patients who died had lower cardiac index, higher lactate, higher troponin, similar intrathoracic blood volume index and higher levels of EVLWI and NTproBNP (p 0.046). In the multivariate analysis, mechanical ventilation contributed significantly to the increased mortality (odds ratio 6.7).
Conclusions: Patients with inhalation injury exhibit a more pronounced haemodynamic pattern of lower cardiac index with an initial lower preload and a slightly later EVLWI increase; however, they did not need as much resuscitation fluid. Mortality in inhalation injury is associated with greater cardiac dysfunction and lower cardiac indexes and with higher levels of myocardial damage markers, such as troponin and NTproBNP. Mechanical ventilation is thus an important independent factor contributing to mortality, and NTproBNP could serve as a significant prognostic biomarker in these patients.
Estimating Minimal Important Change of the National Institutes of Health Research Task Force impact score using computer adaptive measures: A secondary analysis of two randomized clinical trials in a military population with chronic pain
Authors: Flynn Diane M. , Burke Larisa A , Steffen Alana D. , Ransom Jeffrey C. , Heartwick Kira , McQuinn Honor M. , Snow Tyler J. , Doorenbos Ardith Z.
Published: January 2024

Background
The National Institutes of Health (NIH) Research Task Force (RTF) on Research Standards for Chronic Low Back Pain impact score is a composite measure of Patient Reported Outcomes Measurement Information System (PROMIS) pain intensity, pain interference and physical function. PROMIS surveys are available in short-form and computer adaptive testing (CAT) formats. In order to calculate response rates for clinical trials in which the impact score is the primary outcome, its minimal important difference (MID) must be established. To date, four estimates of impact score MID ranging from 3 to 7.5 have been published, and all were based on data collected using PROMIS short-form surveys. None used CAT versions of PROMIS surveys.
Methods
Secondary analysis of data collected during the conduct of two randomized clinical trials of 6-week courses of nonpharmacological pain therapies. Research subjects were US active-duty service members referred to an interdisciplinary pain management center. Impact score was assessed at the beginning and end of treatment. The Patient Global Impression of Change (PGIC) questionnaire was administered at the end of treatment and asked respondents to report their status compared to the start of treatment using a 7-item Likert scale ranging from very much improved to very much worse. A PGIC response of “much” or “very much” improved was used as the threshold for MID. Receiver operating characteristic curve (ROC) analysis was used to determine meaningful clinical differences for the full combined sample and stratified by study sample and baseline impact score.
Results
A decrease of 3 points was the estimated minimal important difference for the impact score. A larger decrease in impact score was needed for participants with moderate and severe baseline pain impact to report “much” or “very much” improvement.
Conclusions
Using data collected with CAT surveys, we calculated an overall MID of 3 for the NIH RTF impact score, and estimates ranged from 1 to 9 depending on the study sample and baseline impact score. These findings are consistent with previous MID estimates that were based on non-adaptive short form surveys and have implications for reducing the survey burden of future impact score MID analyses.
Predictive factors of renal function after robot-assisted partial nephrectomy in clinical T1b tumors
Authors: Yamamoto Ryohei , Numakura Kazuyuki , Kobayashi Mizuki , Nara Taketoshi , Saito Mitsuru , Narita Shintaro , Habuchi Tomonori
Published: January 2024

Robot-assisted partial nephrectomy (RAPN) has been shown to be a safe and effective method for treatment of small renal tumors, including clinical T1b renal cell carcinoma (RCC); however, the impact of RAPN for cT1b renal tumors on renal function is not well understood. In this retrospective study, 50 patients who underwent RAPN for cT1b renal tumors were evaluated for pre- and post-operative renal function and perioperative clinical factors. Renal function was assessed using the estimated glomerular filtration rate (eGFR) at baseline and on postoperative days (POD) 1, 7, 30, and 180. A significant renal functional decline was defined as ≥ 15% reduction in eGFR at POD180 compared with eGFR at baseline. Logistic regression analyses were used to identify risk factors for renal function decline, including age, sex, RENAL nephrometry score, operative time, and estimated blood loss. The median patient age was 62 years, and the median tumor diameter and RENAL nephrometry score were 44 mm (IQR: 43–50) and 8 (IQR: 7–9), respectively. Of these patients, 16 (36%) showed a significant renal functional decline at POD 180. In the multivariate analysis, the L component of the RENAL nephrometry score and an estimated blood loss of 200 mL or more were identified as significant risk factors for renal functional decline. These findings suggest that the preoperatively definable L component of the RENAL nephrometry score and intraoperative blood loss, which may be modifiable factors, play significant roles in post-RAPN renal function decline.
The Impact of Teaching Support on Teachers' Online Teaching Experience: The Mediating Role of Teachers' Technological Innovation Awareness and Technological Acceptance
Authors: Liu Weitong , Hu Ke
Published: January 2024

Background:
The current evolution of technology and the pervasive access to the internet are catalyzing profound transformations in the field of education. While previous research in higher education has delved into how organizational resources impact teachers' teaching efficacy, there remains a dearth of studies investigating the influence of instructional support on teachers' experiences in online teaching.
Methods:
This study aimed to unravel the underlying mechanisms affecting teachers' online teaching experiences by leveraging survey data and employing structural equation modeling. Through this approach, the research sought to explore the relationships between technological acceptance, technological innovation awareness, and online teaching experience.
Results:
The findings revealed that technological acceptance significantly mediated the connection between teaching support and the online teaching experience. However, there was no significant mediating effect observed in technological innovation awareness. Notably, considering the standard total effect values, organizational factors emerged as pivotal determinants shaping the online teaching experience.
Conclusions:
This study contributes valuable insights into the complex interplay among teaching support, technological acceptance, and the online teaching experience. By offering empirical evidence, it sheds light on the factors influencing educators' experiences in online teaching, providing recommendations to enhance these experiences.
Factors associated with foreign-educated nurses’ willingness to continue working in Japan: A qualitative study
Authors: Tanaka Kazuko , Yoshimura Koichi
Published: January 2024

Background Japan has been accepting foreign nurse candidates since 2008 under Economic Partnership Agreements (EPAs). As globalisation progresses, nurses from diverse backgrounds are expected to play an active role in the medical field. Using an interview survey, this study examined the factors associated with EPA nurses’ willingness to continue working in Japan. Methods We conducted semi-structured interviews from January 2022 to July 2023 with eight EPA nurses and one EPA nurse candidate working in Japan to investigate the factors associated with foreign-educated nurses’ willingness to continue working in Japan. The interview guide included items on the status of the daily performance of their duties, what they found pleasurable in their nursing experience in Japan, difficulties they encountered in carrying out their nursing duties, and their expectations of the Japanese staff around them. Data were analysed using thematic analysis. Results From the interview data, seven themes were extracted. To continue working in Japan, it was important for EPA nurses to be able to communicate with patients and colleagues, maintain self-esteem and motivation, be resilient, have support from EPA peers and family members, be accepted by others such as patients and colleagues, and be satisfied with the support they received. Conclusion The EPA nurses experienced many difficulties after becoming nurses and tended to be isolated because of their non-Japanese status. The results suggest that not only support from colleagues and supervisors but also a general understanding of EPA nurses from Japanese society is necessary. As globalisation accelerates, the Japanese nursing field needs to understand the diversity of the nursing profession and build a support system that will enable them to continue to take pride and feel motivated in their work.
WITHDRAWN: Development of a 28-Day Mortality Risk Prediction Model for ICU Sepsis-Associated Encephalopathy Using Interpretable Machine Learning
Authors: YANG Yanjie , ZHAO Huiling , Zhang Xuesheng , Liu Shupeng , LING ge , ZHANG Li , Liu Juan , SUN Yue
Published: January 2024

In the ICU, patients with sepsis often develop sepsis-associated encephalopathy (SAE), which affects their prognosis. This study aims to construct a predictive model for the 28-day mortality risk of SAE patients using machine learning (ML) methods. We retrospectively collected clinical data of SAE patients admitted to our hospital's intensive care unit (ICU) from January 2018 to June 2023. The primary outcome was whether the patient died within 28 days. We employed six popular machine learning methods to build the predictive model for the 28-day mortality risk of SAE patients, including logistic regression (LR), Gaussian naive Bayes (GaussianNB), support vector machine (SVM), k-nearest neighbor (kNN), random forest (RF), and extreme gradient boosting (XGBoost). Various evaluation metrics were used to analyze the predictive performance of the models. The SHAP analysis method ranked the importance of features influencing the model's output and provided visual output and explanations for individual samples, meeting the need of clinicians to understand model outputs and personalized predictions. In total, this cohort study enrolled 506 SAE patients, with 243 cases (48.02%) resulting in death within 28 days. Overall, the XGBoost model demonstrated superior and stable performance, with the area under the receiver operating characteristic curve (AUC) for both the training and validation sets being higher than the other models, at 0.986 and 0.848, respectively. The SHAP summary plot revealed important clinical features associated with the risk of mortality within 28 days for SAE patients, with a strong dependence on age, SOFA score, and NEUT. Our study indicates that the XGBoost model has good predictive capability for the short-term prognostic outcomes of SAE patients in the ICU and can assist clinicians in the early identification of high-risk patients and the timely implementation of effective treatment strategies to improve the clinical outcomes of SAE patients.
A Novel Nomogram for Predicting the Risk of Coronary Atherosclerosis in Patients with Gastroesophageal Reflux Disease A Nomogram Predicting Coronary Atherosclerosis
Authors: Wu Ziyang , Wang Dong , Tang Chengchun
Published: January 2024

Aims
This study developed a novel nomogram to predict the incidence of coronary atherosclerosis (CA) in patients with gastroesophageal reflux disease (GERD) and evaluated the predictive value of the nomogram.
Methods
13658 patients of gastroesophageal reflux disease from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database were analysed. The patients were randomly divided into two groups in a seven-to-three ratio to form a training cohort (n = 9560) and a validation cohort (n = 4098). Least absolute shrinkage and selection operator (LASSO) regression analyses were used to identify associated risk variables. A nomogram was established to predict the rate of coronary atherosclerosis in patients with gastroesophageal reflux disease. The new model was assessed in terms of the concordance index (C-index), the area under the curve (AUC) of receiver operating characteristic (ROC) analysis, calibration curve, and decision curve analysis (DCA).
Results
Least absolute shrinkage and selection operator regression analysis identified nine potential predictors of coronary atherosclerosis. Multivariate logistic regression analysis was used to evaluate the effects of these predictors and create a final model. The concordance index values were 0.750. The areas under the curves for the training and validation sets were 0.7500 and 0.7297, respectively.
Conclusion
The age, white blood cells (WBC), hemoglobin, mean corpsular hemoglobin (MCH), mean corpuscular volume (MCV), sodium, bicarbonate, creatinine and chloride were identified as predictors. Our nomogram is a reliable convenient approach for predicting coronary atherosclerosis in patients with gastroesophageal reflux disease.