bluuebunny/crossref_metadata_2025_split huggingface dataset:
Body Composition Measurements as Predictive Variables for Outcomes of Canine Appendicular Osteosarcoma Treated With Stereotactic Body Radiation Therapy
Authors: Altwal Johnny , Griffin Lynn , Martin Tiffany Wormhoudt 
Published: January 2025

ABSTRACTBody composition measurements (BCM), obtained via computed tomography (CT), have been used as predictors of survival, tumour recurrence, and post‐surgical infections in human oncology. There are no reports on using BCM to predict outcomes of dogs with cancer. Elevated BCM is hypothesised to place extra stress on bones weakened by cancer. Pathologic fracture following stereotactic body radiation therapy for canine appendicular osteosarcoma (OSA) frequently results in limb amputation or euthanasia. Additional tools are needed to better predict the risk of fracture development. Our objectives were to determine if any relationships could be identified between BCM and the occurrence of a pathologic fracture and/or survival time in dogs with naturally occurring OSA. Forty‐seven dogs with a confirmed OSA and whole‐body CT pre‐SBRT were included. Several BCM were evaluated, including abdominal volume, visceral adipose tissue volume, whole‐body volume, whole‐body adipose tissue volume, normalised cross‐sectional area of the epaxial muscles at the mid‐body of the 13th thoracic vertebra, and attenuations of adipose tissue and epaxial muscles. No BCMs were correlated with survival time. The volume of the entire body (cm3) was significantly positively associated with development of a fracture. No other BCM were correlated with the development of a fracture. The volume of the abdomen (cm3) among our patient subset was positively correlated with the volume of the entire body, and the volume of visceral adipose tissue (cm3) was positively correlated with the total body volume of adipose tissue (cm3). Additional research is needed to verify whether these findings are replicable in larger sample sizes and in prospective settings.
Healthcare professionals face ethical challenges in managing care for neurodevelopmental disorders: a qualitative study in Lebanon
Authors: Saleh Mustafa , Chanbour Hani , Saoudi Lara , Nader Ingrid , Hayek Maryse 
Published: January 2025

ObjectivesThis study aimed to explore the ethical challenges faced by healthcare professionals (HCPs) in managing children and adolescents with neurodevelopmental disorders (NDDs) in Lebanon. The primary research question addressed how HCPs navigate ethical dilemmas related to patient autonomy, surrogate decision-making and communication in the context of severe cognitive impairments.DesignQualitative, cross-sectional study using semi-structured interviews. Thematic analysis was applied to identify key ethical challenges in clinical practice.SettingParticipants recruited from a range of healthcare specialties, including paediatric neurology, general paediatrics and psychiatry, and registered with the Lebanese Order of Physicians.ParticipantsSixteen HCPs, including paediatric neurologists and psychiatrists, participated in the study. Participants were selected based on their experience in treating children and adolescents with NDDs. There were no exclusion criteria based on gender, ethnicity or years of experience.InterventionsNo formal interventions were applied. Participants were interviewed about their experiences and ethical challenges in managing patients with NDD.Primary and secondary outcome measuresThe primary outcome was the identification of ethical dilemmas faced by HCPs in clinical decision-making with patients with NDD. Secondary outcomes included insights into the strategies employed by HCPs to balance patient autonomy with surrogate decision-making and the communication challenges they face with patients’ families.ResultsThematic analysis revealed several key ethical challenges, including (1) balancing patient autonomy with the need for surrogate decision-making, (2) tailoring healthcare to individual cognitive abilities and (3) navigating the complexities of communication with patients and their families. Participants emphasised the importance of assessing decision-making capacity on a case-by-case basis. The study also highlighted the need for specialised, patient-centred approaches that respect autonomy while considering the practical limitations imposed by severe cognitive impairments.ConclusionsThis study provides critical insights into the ethical considerations faced by HCPs in managing children and adolescents with NDDs. Further research is needed to develop training programs for HCPs that address these ethical challenges and promote patient-centred decision-making.
Is economic inequality in maternal and child healthcare decreasing in India? Trends between 2005–2006, 2015–2016 and 2019–2021
Authors: Bajpai Rimjhim , Kumar Abhishek , Acharya Rajib , Saggurti Niranjan 
Published: January 2025

ObjectiveThis study examined economic inequality in coverage of selected maternal and child healthcare (MCH) indicators in India and its states over the last 15 years.DesignThe study analysed last three rounds of the National Family Health Survey data, conducted during 2005–2006, 2015–2016 and 2019–2021. Bivariate analyses, ratio of richest to poorest, slope index of inequality (SII) and multivariate binary logistic regression analyses were used to examine the coverage as well as inequalities in the outcome indicators for India and its states and at district level.Primary outcomesThe outcome variables analysed in the study were full antenatal care, institutional delivery, postnatal care of mothers within 48 hours of delivery, and full immunisation among children.ParticipantsWomen aged 15–49 who had given a birth in the last 5 years before the surveys were unit of analysis for the maternal healthcare indicators, and children aged 12–23 months were unit of the analysis for childhood immunisation.ResultsOver the last 15 years, coverage of the MCH indicators has increased in India and across socioeconomic segment of the population, and the absolute increase was higher among the worse-off segments than the better-off. This led to decline in the inequality in coverage of all the MCH indicators. For instance, the value of SII for institutional births decreased from 0.76 in 2005–2006 to 0.45 in 2015–2016 and further to 0.37 in 2019–2021. Although inequality has decreased, geographic disparities persist across states and districts.ConclusionThough substantial improvement was observed, coverage of MCH indicators increased and the economic inequality declined; certain geographies are still characterised with the low coverage and persistent high inequality. This suggests that adding a spatial perspective to the inequality research and targeted strategies is essential for achieving universal access to reproductive healthcare services by 2030 in India.
Effects of transcranial magnetic stimulation combined with extracorporeal shockwave therapy for poststroke spasticity: study protocol for a randomised controlled trial
Authors: Liao Ling-Yi , Wang Peng-Yu , Zhu Yang , Peng Qiu-Yi , Yang Man , Liu Lu , Tao Yong , Liu Jin-Jing , Fang Xiang-Qin , Gao Shi-Hao , Gao Chang-Yue 
Published: January 2025

IntroductionSpasticity is a common complication of stroke, which is related to poor motor recovery and limitations in the performance of activities. Both transcranial magnetic stimulation (TMS) and extracorporeal shockwave therapy (ESWT) are effective treatment methods for poststroke spasticity (PSS). However, there is no existing study exploring the safety and effectiveness of TMS combined with ESWT for PSS.Methods and analysisThis study will be a prospective, single-centre, randomised, factorial, controlled clinical trial. In this trial, 136 patients with PSS will be randomly divided into 4 groups: experimental group 1 (TMS), experimental group 2 (ESWT), experimental group 3 (ESWT+TMS) and control group, 34 patients in each group; all patients received routine rehabilitation. Outcome measures will be assessed by 4 time points: baseline (T0), 2 weeks after initiation of treatment (T1), 4 weeks after initiation of treatment (T2) and follow-up (4 weeks after the end of treatment, T3). The primary outcome is the modified Ashworth scale at T2. The secondary outcomes include the modified Tardieu scale for the degree of spasticity, the Fugl-Meyer assessment scale and range of motion (ROM) for motor function, the stroke-specific quality of life scale (SS-QOL) and modified Barthel index for activities of life, cortical excitability measured by TMS–surface electromyography (EMG), cerebral cortex oxygen concentrations measured by functional near-infrared spectroscopy (fNIRS) and Hmax/Mmaxratio measured by EMG.Ethics and disseminationThis study protocol was approved by the Ethics Committee of the Army Medical Center of PLA (Approval No. 2024-04) on 24 January 2024. The study will be disseminated through peer-reviewed publications and conference presentations.Trial registration numberThis study was registered in the Chinese Clinical Trial Registry (https://www.chictr.org.cn/; unique identifier: ChiCTR2400080862; data: 9 February 2024; study protocol V. 2.0).
Poly-skilling and advanced practice roles in perioperative care: protocol for a realist synthesis of evidence
Authors: Britton Carolina , Walker David , Griffin Ann , Freeth Della 
Published: January 2025

IntroductionAn ageing population and a workforce crisis have triggered an ambitious UK strategy for sustained delivery of healthcare. In perioperative care (the management of patients from contemplation of surgery until full recovery), it is recognised that interventions are needed to place the workforce on a more sustainable footing through cross-functionality and skill-shifting, namely with advanced practice roles. However, despite some reports and reviews in the literature, it is unclear how skills development efforts may potentially support workforce transformation for an effective and resilient perioperative care workforce. Thus, drawing causal inferences for policy-making that is both evidence based and rooted in theory is challenging. A scoping review, reported within this protocol, confirmed that ‘poly-skilling’ and ‘advanced practice roles’ are critical to this workforce transformation, but the mechanisms through which interventions in this area may work are not understood. A synthesis of evidence is, therefore, proposed in this protocol, to understand what works for whom and under what circumstances, in relation to poly-skilling and advanced practice roles in workforce transformation for sustained healthcare delivery.Methods and analysisThis protocol sets out the plan to undertake a realist synthesis of the related literature, with theory elicitation (step 1), search for empirical evidence (step 2), selection and appraisal of evidence (step 3) and programme theory refinement (step 4). Exploratory reviews of the literature and key informants’ inputs will produce initial hypotheses as to what it is about interventions in poly-skilling and advanced practice roles that work and why. Data from the literature will then be collected based on relevance, rigour and richness. The iterative analysis and synthesis of these data will produce causal links between contexts, mechanisms and outcomes. The results will inform a realist evaluation, to be undertaken as part of doctoral research, to better understand the mechanisms that support workforce transformation through poly-skilling and advanced practice roles.Ethics and disseminationAs a review of previously published literature, the evidence synthesis proposed in this protocol does not require formal ethical approval. Recommended ethical considerations regarding the involvement of key informants, who are not study participants but a consultative group, are presented in this protocol. A formal ethics approval will be sought ahead of the later empirical stage of the research. The results of the realist synthesis proposed in this protocol will be fed back to the local National Health Service organisation and Integrated Care Board and disseminated to the research community via presentations at conferences and a peer-reviewed journal article.PROSPERO registration numberCRD42024512164.
Impact of bone quality on surgical decision-making in total hip arthroplasty: a qualitative analysis in the UK
Authors: Karia Monil , Abouharb Alex , Sabharwal Sanjeeve , Mavroveli Stella , Cobb Justin 
Published: January 2025

IntroductionFor total hip arthroplasty (THA) to be successful, surgeons need to make several decisions ranging from implant choice to impaction force. It is unclear, however, whether and how bone quality affects surgeon’s decision-making and how surgeons evaluate bone quality.ObjectivesThis inductive/deductive qualitative hybrid study aims to explore the impact of bone quality on the decision-making of surgeons performing elective primary THA. This study will evaluate: (1) whether surgeons consider bone quality as an important factor for surgical decision-making; (2) how bone quality influences surgical decision-making; and (3) how surgeons assess bone quality preoperatively and intraoperatively.DesignThis is a qualitative study, involving inductive/deductive hybrid thematic analysis.SettingSemistructured interviews were conducted virtually via Microsoft Teams and on hospital premises.ParticipantsPurposive and snowball sampling methods were used to recruit consultant orthopaedic surgeons specialised in elective lower limb arthroplasty.Results10 surgeons from eight centres in the UK were interviewed. Thematic saturation was achieved after eight interviews. 5 main themes and 13 subthemes were identified. Bone quality impacted decisions around preoperative planning, surgical procedure, implant choice, concerns of iatrogenic injury and hip biomechanics. Many surgeons (7/10) described changing surgical procedure based on their intraoperative assessment of bone quality. There was consensus that cemented femoral fixation is superior in patients with poor bone quality and on the importance of assessing radiographs preoperatively. There was, however, a lack of consensus on optimal acetabular fixation method, the radiographs metrics used to measure bone quality and attitudes towards current guidelines.ConclusionsBone quality has a significant impact on the decision-making of experienced arthroplasty surgeons, though there are significant limitations and divergence in current methods of assessing bone quality. Further work to identify intraoperative and preoperative imaging metrics that correlate with bone mechanical properties could enhance surgical decision-making.
Readiness of adults with type 1 diabetes and diabetes caregivers for diabetes distress monitoring using a voice-based digital health solution: insights from the PsyVoice mixed methods study
Authors: Aguirre Vergara Franchesca , Pinker India , Fischer Aurélie , Seuring Till , Tichomirowa Maria A , de Beaufort Carine , Kamp Siri-Maria , Fagherazzi Guy , Aguayo Gloria A 
Published: January 2025

ObjectivesDiabetes distress can negatively affect the well-being of individuals with type 1 diabetes (T1D). Voice-based (VB) technology can be used to develop inexpensive and ecological tools for managing diabetes distress. This study explored the competencies to engage with digital health services, needs and preferences of individuals with T1D or caring for a child with this condition regarding VB technology to inform the tailoring of a co-designed tool for supporting diabetes distress management.DesignWe used a mixed methods design. We performed a qualitative reflexive thematic analysis of semistructured interviews of people living with T1D or caring for a child with T1D, complemented by quantitative analysis (descriptive statistics).Setting12 adults living with T1D who attended diabetes centres or cared for a child with this condition participated in semistructured interviews to collect opinions about voice technology. They also responded to three questionnaires on sociodemographics and diabetes management, diabetes distress and e-health literacy.Outcome measuresMain: Patient experiences and perceptions derived from the coded transcriptions of interview data. Secondary: Quantitative data generated from Socio-Demographic and Diabetes Management questionnaire; Problem Areas in Diabetes Scale and e-Health Literacy Questionnaire.ResultsFive major themes were generated from the participants’ interview responses: (1) Experience of T1D, (2) Barriers to VB technology use, (3) Facilitators of VB technology, (4) Expectations of VB technology management in T1D, (5) Role of healthcare professionals in implementing VB technology for T1D. Most participants expressed a favourable view of voice technology for diabetes distress management. Trust in technology and healthcare professionals emerged as the predominant sentiment, with participants’ current device type impacting anticipated barriers to adopting new technologies.ConclusionThe results highlighted positive participant views towards VB technology. Device use, previous experience and health professional endorsement were influential facilitators of novel VB digital health solutions. Further research involving younger people with T1D could further contribute to the successful development of these tools.Trial registration numberClinicalTrials.gov,NCT05517772.
Geographical equity in Ethiopian infant feeding practices: a secondary analysis of a birth cohort study
Authors: Tariku Amare , Persson Lars , Schellenberg Joanna , Marchant Tanya , Berhanu Della , Lemma Seblewengel , Defar Atkure , Zemedu Theodros Getachew , Denu Zewditu Abdissa , Delele Tadesse Guadu , Shiferaw Solomon , Zeleke Girum Taye , Zelalem Meseret , Gelaye Kassahun Alemu 
Published: January 2025

ObjectivesTo assess the geographical equity in Ethiopian infants’ exclusive breastfeeding at 5 months and dietary diversity at 12 months and whether social factors explained the spatial inequities.DesignSecondary analysis of a birth cohort study.SettingAnalysis of data from the Ethiopian Performance Monitoring for Action panel study conducted from July 2020 to August 2021 in five regions (ie, Oromia, Amhara, Afar and Southern Nations, Nationalities and Peoples regions and the Addis Ababa City administration). We analysed geographical autocorrelation to assess geographical variations in exclusive breastfeeding and dietary diversity. Areas with higher and lower coverage of appropriate infant feeding outcomes were analysed using hotspot analyses. We performed geographically weighted regression to investigate whether sociodemographic factors explained the geographical feeding differences.Participants1850 infants were prospectively followed from birth to 12 months.Outcome measuresExclusive breastfeeding at 5 months and minimum-level dietary diversity at 12 months.ResultsSixty-nine percent (95% CI 67 to 71) of infants were exclusively breastfed at 5 months, while at 12 months, only 16% (95% CI 13 to 19) had complementary feeding from five or more food groups. There were geographical variations in the coverage of exclusive breastfeeding and minimum dietary diversity. Higher proportions of infants were exclusively breastfed at 5 months in northern areas, and more 12-month-old infants in central parts of the country had complementary feeding from at least five food groups. Sociodemographic factors explained a quarter of the geographical variation in dietary diversity.ConclusionMost Ethiopian infants were exclusively breastfed, which was in line with global recommendations but with some geographical differences. There was prominent geographical variation in dietary diversity, partly explained by social factors, but overall, very few 12-month-old infants were fed from at least five food groups. This low dietary quality could impair Ethiopian children’s physical growth, development and health.
How sufficient economy philosophy contributes to sustainable resilience: a qualitative study on the COVID-19 pandemic response in Thailand
Authors: Samutachak Bhubate , Ford Kathleen , Tangcharoensathien Viroj , Satararuji Kullatip 
Published: January 2025

ObjectiveThis qualitative study sought to understand how sufficient economy philosophy (SEP) was applied to cope with and recover from the COVID-19 pandemic.DesignA qualitative study conducted through focus group discussions.Participants19 focus groups, with 161 participants, selected for the diverse backgrounds in gender, profession, education and region (urban/rural) and different levels of impact from the pandemic.SettingBangkok, the capital city, and the four regions of Thailand: north, northeast, south and central.FindingsParticipants highlighted the moderation, reasonableness and prudence as key themes that mitigated adverse economic impacts during the pandemic. Communities practising the SEP reported resilience through balanced consumption, prudent planning and social cooperation. Many participants mentioned that the SEP was crucial to their survival and should have been better practised. Though the market structure failed during the pandemic, they still could secure the essential items to maintain livelihood.ConclusionIn a society where changes are complicated by multiple factors, crises may occur more frequently, unsuspectedly and in various forms. Tools and a mechanism for resilience are increasingly needed. This study highlights the importance of the SEP, which incorporates five key concepts: moderation, reasonableness, prudence, knowledge and morality. These concepts help affected communities survive and become resilient, which is crucial for achieving several Sustainable Development Goals, such as poverty and hunger reduction, enhanced health and well-being and the sustainability of cities and communities.
Providing medically tailored groceries and food resource coaching through the charitable food system to patients of a safety-net clinic in Dallas, Texas: a randomised controlled trial protocol
Authors: Albin Jaclyn , Leonard Tammy , Wong Willis , Siler Milette , Haskins Carolyn , Turcios Jessica , Pruitt Sandi L , Bowen Michael , Pezzia Carla , Ford Alisha , Schinzer Bianca , Hollis-Hansen Kelseanna 
Published: January 2025

IntroductionLinking patients living with chronic, diet-related diseases and food insecurity to charitable food assistance, medically tailored groceries (MTGs) and food resource coaching may empower patients to better manage their health in a way that is economically sustainable. This protocol paper describes the implementation of a study evaluating MTGs and food resource coaching in a food pantry setting.Methods and analysisA randomised controlled trial whereby patients of a safety-net health centre will be screened for The Emergency Food Assistance Program (TEFAP) and study eligibility. Eligible patients will be randomised to receive 4 months of usual pantry services (control), MTGs (intervention 1) or MTGs and food resource coaching (intervention 2) from a colocated food pantry. Measures collected monthly include adherence, fidelity and food selections from the pantry. Measures collected at baseline and follow-up include food and nutrition security, diet quality, household resiliency, loneliness and overall well-being. Qualitative interviews (n=60) will be conducted preintervention and postintervention. Analyses will include multiple regression models to analyse changes from baseline to follow-up as well as changes between groups over time. Deductive thematic analysis of qualitative data will be conducted.Ethics and disseminationThis study was approved by the UT Southwestern Medical Center Institutional Review Board (STU-2023-1166) and the Parkland Health Office of Research Administration. This is protocol version two, modification approved on 3 June 2024. Findings will be disseminated through academic conferences, journals and to the public.Trial registration numberNCT06242808.