bluuebunny/crossref_metadata_2025_split huggingface dataset:
Developing an Emergency Medical Services Resilience Assessment Tool in Climate Change: A Study Protocol
Authors: Mohammadi-Janbazloufar Kamran , Atighechian Golrokh , Ostadtaghizadeh Abbas , Rezaei Fatemeh , Hirshon Jon Mark 
Published: December 2024

Abstract

Background:
Climate change poses significant threats to the health and safety of communities worldwide. Extreme weather events can disrupt critical infrastructure and overwhelm emergency medical services (EMS) systems. As the frequency and intensity of these climate-related disasters continue to increase, it is essential that EMS organizations develop robust strategies to enhance their resilience. One important step in building climate-resilient EMS systems is the development of comprehensive assessment tools. Developing a comprehensive tool for assessing the resilience of EMS in the face of climate change.

Methods:
This research employs an applied, mixed-methods approach to investigate the development and validation of the Emergency Medical Services Resilience Assessment (EMSRA) tool. The study will be executed across four key phases: (a) A scoping review will be conducted to identify the global dimensions and components of EMS systems that demonstrate resilience to the impacts of climate change. (b) A qualitative study, involving semistructured interviews, will be undertaken to explore the specific dimensions and components of EMS resilience within the Iranian context. (c) Based on the findings from the scoping review and qualitative inquiry, assessment items related to EMS resilience in climate change will be extracted and synthesized to develop a pilot version of the EMSRA tool. (d) The pilot EMSRA tool will undergo a rigorous process of quantitative and qualitative validation, including an evaluation of its psychometric properties, to assess the resilience of EMS systems in the face of climate-related challenges.

Conclusions:
The development of EMSRA tool will enable the assessment and enhancement of climate change resilience within the national and provincial EMS systems, providing critical data to inform evidence-based strategies and plans for strengthening EMS against the impacts of severe climate changes.
Insulin Resistance Mediates the Association Between Vitamin D and Non-Alcoholic Fatty Liver Disease
Authors: Zou Caiyan , Liu Xuekui , He Maosheng , Sun Yan , Sang Yiquan , Peng Gangshan , Ma Yamei , Geng Houfa , Liang Jun 
Published: December 2024

Abstract

Background:
Vitamin D (VD) deficiency and insulin resistance (IR) increase the risk of non-alcoholic fatty liver disease (NAFLD), but few studies have explored the potential mechanisms by which IR mediates the association between VD and the pathogenesis of NAFLD at the genetic level using publicly available databases.

Methods:
This is a cross-sectional study, and we utilized the National Health and Nutrition Examination Survey (NHANES) dataset, as well as data from GSE200765 obtained from the Gene Expression Omnibus (GEO) website. A total of 723 individuals who had completed liver ultrasound examination and the detection of VD levels were included in the final analysis. A gene expression dataset, GSE200765, was also downloaded from the GEO website, to explore the potential mechanism of VD and NAFLD.

Results:
In the NHANES data, covariates significantly differed in four VD categories, and the controlled attenuation parameter (CAP), vibration-controlled transient elastography-liver stiffness measurement (VCTE-LSM), and IR were reduced with an increase in VD levels. Mediation analysis revealed that IR mediated the association between VD and both CAP and LSM, and the estimated mediation effects were 29.0% and 39.8%, respectively. Bioinformatics analysis showed that seven differentially expressed genes (DEGs) (solute carrier family 2 member 2 [SLC2A2], protein phosphatase 1 regulatory subunit 3E [PPP1R3E], CAMP responsive element binding protein 3-like 3 [CREB3L3], Interleukin-6 [IL-6], peroxisome proliferator-activated receptor gamma coactivator 1-alpha [PPARGC1A], nuclear factor kappa B inhibitor alpha [NFKBIA], and phosphoenolpyruvate carboxykinase 2 [PCK2]) were enriched in the IR pathway in comparison groups (VD group vs. lipid group), suggesting that VD improved NAFLD via changed IR.

Conclusions:
VD deficiency and IR were the risk factors for NAFLD, and increased VD levels improved the status of NAFLD. The underlying mechanism may be that elevated VD levels reduced IR, which improved the expression of DEGs involved in the IR pathway.
Dispositional Hope and Self-Regulation among Graduate Students in Karnataka
Authors: Gujjar Malasa , Shetty Kannappa V. , Prabhu G , Srivastava Prerna 
Published: December 2024

ABSTRACT

Background:
Dispositional hope and self-regulation have been hypothesized to be associated with each other. The current study aimed to assess the same in graduate students.

Materials and Methods:
One hundred and fifty-eight students were recruited. Sociodemographic Performa, Adult Hope Scale, and Self-Regulation Scale were administered to them.

Results:
The results indicated a significant relationship between dispositional hope and self-regulation. Thus, it can be said that there exists a mutual relationship between the two, with each one strengthening the other.

Conclusion:
The results thus indicate that there is a mutual relationship between the level of dispositional hope and self-regulation.
Cranial Base Growth and Its Relation with Sagittal Skeletal Discrepancies
Authors: Fatima Samar , Qamruddin Irfan , Bokhari Samra , Siddiqui Hina , Bibi Ayesha , Ahmed Hafiz Zuhair 
Published: December 2024

Abstract

Context:
The maxilla is connected to the anterior part of the basicranium and the mandible is related to the posterior part of it. The cranial base growth can be a factor in sagittal discrepancies of the jaws.

Aims:
To determine mean total, anterior and posterior cranial base lengths with mean cranial base angles amongst patients undergoing orthodontic treatment and to compare the mean total, anterior and posterior cranial base lengths and mean cranial base angles in patients with different skeletal sagittal discrepancies.

Settings and Design:
This cross-sectional study was conducted after obtaining approval from the Institutional Review Board of Jinnah Sindh Medical University (JSMU), Karachi, Pakistan. The study was carried out from June 1, 2021, to November 30, 2021, at the Department of Orthodontics, Sindh Institute of Oral Health Sciences, JSMU.

Materials and Methods:

A total of 93 cephalometric radiographs of patients presented with complaints of malaligned teeth from both genders aged between 13 and 30 years with class I, class II and class III maloccusions who underwent orthodontic treatment were included in the study. Measurements of anterior cranial base length, posterior cranial base length, total cranial base length and cranial base angles were taken. Articulare, basion, nasion, sella, point A and point B were the cephalometric landmarks used in the study.

Statistical Analysis:
Analysis of variance was used to compare mean differences, keeping a P value of ≤0.05 as statistically significant.

Results:
About 40.9% as class I, 53.8% were classified as class II and 5.4% with class III. Mean posterior, anterior and total cranial base lengths were 46.10 ± 5.42, 65.69 ± 4.36 and 102.74 ± 7.84 mm, respectively. Mean nasion–sella–articulare and nasion–sella–basion cranial base angles were 127.25 ± 5.97° and 133.45 ± 6.34°, whereas mean SNA, SNB and ANB were 82.41 ± 4.11, 100.97 ± 116.87 and 4.69 ± 2.80.

Conclusions:
There was no significant difference between mean values for cranial base angle and length between class I, class II and class III discrepancies.
Dental Caries in the Elderly with Diabetes Mellitus and the Use of Metagenomic Sequencing for Oral Microbiome Analysis
Authors: Osman Bibi Aisiah Babu , Zohdi Noorharliana Mohamed , Jaapar Mustaffa , Ahmad Rohana , Yusof Eleena Mohd 
Published: December 2024

Abstract
Dental caries amongst the elderly is on the rise due to increased life expectancy and the trend that older adults are retaining their teeth for longer. Diabetes mellitus is known to be associated with an increased risk of periodontal disease. However, the relationship between diabetes and dental caries amongst the elderly has received far less attention. Dental caries is a polymicrobial disease, where the eubiosis and dysbiosis of the oral microbiota are key in determining the strategies of diagnosis, prevention and treatment. Dysbiosis of the oral microbiota, for example in the presence of systemic diseases, plays a role in the pathogenesis of dental caries. The advancement of genomic techniques provides a greater understanding of how the oral microbiome is associated with oral and systemic health. Next-generation sequencing using targeted 16S ribosomal RNA gene sequencing allows analysis of the oral microbiota with a relatively lower cost and eliminating the need for culture or polymerase chain reaction amplification to study the broad genomic group of the oral microbiome in health and disease. The purpose of this narrative review is to provide an understanding on the use of metagenomic sequencing in the prediction and control of dental caries.
Three Faith-based Factors in Healing – A Need to Relook in Modern Medicine
Authors: Sethuraman K. R. 
Published: December 2024

Abstract
In the era of rational and evidence-based medicine, three belief or faith-based healing factors, namely placebo effect, Hawthorne factor, and spiritual beliefs, have been sidelined from mainstream medical practice. However, in the past four decades, these faith-based forces of healing are being studied using modern scientific tools to unravel how they promote positive healing responses and how these endogenous healing factors could be incorporated into scientific medical practice.
Comparison of intubating conditions in two different head elevations for direct laryngoscopy in stretcher – A prospective randomized controlled study
Authors: Ketireddy Tejasri , Jayaram Kavitha , Geetha Singam , Pathy Archana , Durga Padmaja 
Published: December 2024

Background and Aims:
Sniffing position for laryngoscopy is considered the gold standard for better glottic visualization. However, there are no studies regarding ideal positioning of head and neck for patients intubated in stretcher either in the operating room or in the emergency area. The aim of the study was to compare the glottic visualization and intubating conditions during direct laryngoscopy using conventional head cushion or Popitz Pillow for patients intubated in stretcher.

Methods:
This prospective randomized controlled study was conducted on patients with the age of 18 and 60 years, of any gender undergoing elective spine surgery in prone position. Study participants were divided into two groups (Group S – Conventional head cushion, Group P – Popitz Pillow). After induction of anesthesia in stretcher, they were positioned for direct laryngoscopy with either of the pillows as per the group. Preoperative airway parameters, intubation difficulty score (IDS), time taken for intubation were measured.

Results:
Hundred and fifty-six patients enrolled for the study were randomized into two groups. Almost 82.1% of the patients in Group P had Cormack–Lehane grading 1 when compared to 53.8% in Group S. Time taken for intubation was statistically significant between the two groups with P = 0.0001. In Group P, 64 (82.1%) patients had easy IDS, whereas only 43 (55.1%) patients had easy IDS in Group S.

Conclusion:
Popitz Pillow provided better intubating conditions, improved laryngeal view in patients intubated on stretcher for prone position surgeries when compared to conventional head cushion.
Impressions of acute pain services in a tertiary care center in India – Enhancing perioperative outcomes beyond pain
Authors: Agarwal Jyotsna , Khanuja Samiksha , Gupta Mahima , Panjiar Pratibha , Wadhwani Megha , Jain Mansi 
Published: December 2024

Background and Objective:
Acute pain services (APSs) in schema to its name primarily aim to manage acute postoperative pain. A meticulous and comprehensive APS leads to the prevention of acute pain developing into persistent chronic postsurgical pain. Good post operative pain relief helps in reduction of postoperative pulmonary complications. While a meaningful communication with the patient, assessment of general well being, facilitates eary discharge and functional recovery, thereby significantly contributing to the overall quality of recovery of the patient in the perioperative period.

Methodology:
An Anesthesia Consultant led APS team in our institute is responsible for daily clinical rounds. Effective communication with the patients facilitated early detection of detection of additional complaints such as restlessness, throat pain, nausea, vomiting, shoulder tip pain, increased drain output, urine retention, wound soakage and constipation to name a few. We could look beyond acute pain management.

Results:
One-year data from March 2023 to March 2024 were audited and subsequently findings were noted.

Conclusion:
APSs are an integral part of anesthesia management, primarily aiming at the management of perioperative pain in the best possible way. However, our study revealed other important aspects of this service, which could aid us in improving our perioperative outcomes.
Reversible renal dysfunction in hypothyroidism - A study on change in glomerular filtration rate and creatine phosphokinase with correction of hypothyroidism
Authors: Podimon Jasmine , Shallam Sharon , Rahim Surumi A , Philip Rajeev , Dev D Amal , Khadir CA Abdul 
Published: December 2024

Background:
Thyroid and kidney is known to have interelated functions. Hypothyroidism can cause renal dysfunction by altering renal hemodynamics. Hypothyroidism still remains an underrecognised cause of kidney dysfunction which is often overlooked. Most studies are looking at the prevalence of hypothyroidism patients with kidney disease than the prevalence of kidney disease in hypothyroid patients as done in our study.

Aims:
To evaluate changes in serum creatinine, estimated GFR and creatine phosphokinase in hypothyroid patients before and 6 weeks after treatment with levothyroxine.

Materials and Methods:
This prospective study was conducted over 6 months in the outpatient department of general medicine and endocrinology in pushpagiri medical college hospital, Thiruvalla. Patients with newly diagnosed hypothyroidism with TSH more than 10 and age more than 18 years were included. Patients with previous renal disease, on newly initiated RAAS inhibitor therapy and SGLT2 inhibitors were excluded.

Results:
Out of 147 newly diagnosed treatment naïve patients, mean age of our study population was 34.2 years (range: 18–72 years) with females predominant (70.2%). The mean TSH at diagnosis was 40.72 ± 9.8 mIU/L, and the mean free T4 value was 0.67 ± 0.24 ng/dl. The mean serum creatinine on the first consultation was 1.01±.21 mg/dl. The mean eGFR at diagnosis was 80.14 ± 19.6 mL/min/1.73 m2 and mean CPK at presentation was 243.75 ± 38.1 IU/L. There was a significant difference in TSH levels after treating hypothyroidism for 6 weeks, TSH value falling to 4.5+/- 1.8. Pearson correlation tests are done to explore the correlation between TSH, free T4, serum creatinine and eGFR. Serum creatinine and serum CPK had a positive correlation with serum TSH value among patients with primary hypothyroidism (P < 0.05). Free T4 and serum creatinine values had a strong negative correlation. The eGFR at diagnosis had a negative correlation with the initial TSH values (P < 0.01) and CPK (P = 0.021).

Conclusion:
There is indeed an improvement in the renal function when we treat hypothyroidism. Although the changes may be subtle, they are important for individual patients especially those who are on concomitant treatment with drugs associated with narrow therapeutic range. The improvement of the renal function was most apparent in the young adult age group perhaps reflecting their increased lean muscle mass, thus requiring a more careful assessment of thyroid function in this group. In addition, mild increase in GFR may lead to unnecessary investigations. Therefore, it is better to reassess the renal function in hypothyroid patients following restoration of euthyroidism. we can conclude that hypothyroidism can be a reversible cause of renal dysfunction.
Impact of setting distinct target blood glucose levels on endogenous insulin suppression and pharmacodynamics of insulin preparations
Authors: Liu Hui , Li Ting , Chen Xin-Lei , Yu Hong-Ling , Yu Ye-Rong 
Published: December 2024

BACKGROUND
Insulin therapy plays a crucial role in managing diabetes. Regulatory guidelines mandate assessing the pharmacokinetics (PK) and pharmacodynamics (PD) of new insulin formulations with euglycemic clamp techniques before entry into the market. Typically, blood glucose (BG) levels are maintained at 5% below baseline to suppress endogenous insulin secretion in healthy volunteers. However, in scenarios where BG baseline is relatively low, maintaining it at 5% below baseline can increase hypoglycemic risk. Consequently, we adjusted to maintain it at 2.5% below a baseline of < 4.00 mmol/L. It remains uncertain whether this adjustment impacts endogenous insulin inhibition or the PD of study insulin.
AIM
To evaluate and compare the PD and C-peptide status using two different target BG setting methods.
METHODS
Data came from euglycemic clamp trials assessing the PK/PD of insulin aspart (IAsp) in healthy participants. Target BG was set at 2.5% below baseline for those with a basal BG of < 4.00 mmol/L (group A), and at 5% below baseline for others (group B). The area under the curve (AUC) of IAsp (AUCIAsp, 0-8 h) and GIR from 0 to 8 hours (AUCGIR, 0-8 h) was used to characterize the PK and PD of IAsp, respectively. The C-peptide reduction and PK/PD of IAsp were compared between the two groups.
RESULTS
Out of 135 subjects, 15 were assigned to group A and 120 to group B; however, group B exhibited higher basal C-peptide (1.59 ± 0.36 vs 1.32 ± 0.42 ng/mL, P = 0.006). Following propensity score matching to adjust for basal C-peptide differences, 71 subjects (15 in group A and 56 in group B) were analyzed. No significant differences were observed in demographics, IAsp dosage, or clamp quality. Group B showed significantly higher baseline (4.35 ± 0.21 vs 3.91 ± 0.09 mmol/L, P < 0.001), target (4.13 ± 0.20 vs 3.81 ± 0.08 mmol/L, P < 0.001), and clamped (4.10 ± 0.17 vs 3.80 ± 0.06 mmol/L, P < 0.001) BG levels. Both groups exhibited comparable C-peptide suppression (32.5% ± 10.0% vs 35.6% ± 12.1%, P = 0.370) and similar IAsp activity (AUCGIR, 0-8 h: 1433 ± 400 vs 1440 ± 397 mg/kg, P = 0.952) under nearly equivalent IAsp exposure (AUCIAsp, 0-8 h: 566 ± 51 vs 571 ± 85 ng/mL × h, P = 0.840).
CONCLUSION
Maintaining BG at 2.5% below a baseline of < 4.00 mmol/L did not compromise the endogenous insulin suppression nor alter the observed pharmacodynamic effects of the study insulin.
Associations between food insecurity with gestational diabetes mellitus and maternal outcomes mediated by dietary diversity: A cross-sectional study
Authors: Hou Hong-Li , Sun Gui-Xia 
Published: December 2024

BACKGROUND
Food insecurity (FI) during pregnancy negatively impacts maternal health and raises the risk of gestational diabetes mellitus (GDM) and pregnancy-induced hypertension (PIH), resulting in adverse outcomes for both mother and baby.
AIM
To investigate the relationships between FI and pregnancy outcomes, particularly GDM and PIH, while also examining the mediating role of the dietary diversity score (DDS).
METHODS
A cross-sectional study was undertaken to examine this relationship, involving 600 pregnant women. Participants were women aged 18 years or older who provided complete data on FI and pregnancy outcomes. The FI was measured via the Household Food Security Survey Module, with GDM defined as fasting plasma glucose levels of ≥ 5.1 mmol/L or a 2-hour oral glucose tolerance test value of ≥ 8.5 mmol/L. The DDS is determined by evaluating one's food consumption based on nine distinct food groups. A logistic regression model was used to explore the relationship between FI and PIH, and GDM.
RESULTS
Seventeen percent of participants reported experiencing FI during pregnancy. The study found a significant association between FI and an elevated risk of GDM [odds ratio (OR) = 3.32, 95%CI: 1.2-5.4]. Once more, food-insecure pregnant women had higher rates of PIH (OR = 0.10, 95%CI: 0.02-0.45) and they also faced a higher likelihood of neonatal complications, such as neonatal intensive care unit’s admissions and the birth of infants with extremely low birth weight. The FI was further linked to metabolic disruptions, such as elevated fasting blood sugar (FBS), low-density lipoprotein cholesterol, and triglyceride levels. Our results indicate that the DDS acts as a significant mediator in the relationship between FI and the incidence of GDM. In particular, the mediation analysis showed that approximately 65% of the effect was mediated through DDS (P = 0.002).
CONCLUSION
These findings underscore the serious challenges that FI presents during pregnancy and its effects on maternal and infant health. Additionally, the study explored how DDS mediates the relationship between FI and the incidence of GDM.
Evaluating the effectiveness of ultrasound-assisted wound debridement in managing diabetic foot ulcers: A systematic review and meta-analysis
Authors: Yang Rui , Chen Geng , Pan Qing-Yun , Yao Yao , Li Yan-Fen , Chen Hai-Ting , Lei Chang-Jiang , Liang Xia 
Published: December 2024

BACKGROUND
Diabetic foot ulcers (DFUs) present a significant clinical challenge due to their high prevalence and profound impact on morbidity. Ultrasound-assisted wound debridement (UAWD) has emerged as a potential therapeutic modality to improve healing outcomes in DFU management.
AIM
To evaluate the efficacy of UAWD in treating DFUs on wound closure rates, treatment duration, and quality of life outcomes.
METHODS
This systematic review and meta-analysis followed PRISMA guidelines, systematically searching PubMed, Embase, Web of Science, and the Cochrane Library with no date restrictions. Randomized controlled trials (RCTs) that evaluated the efficacy of UAWD in DFU treatment were included. Data were independently extracted by two reviewers, with discrepancies resolved through consensus or third-party consultation. The risk of bias was assessed using the Cochrane tool. χ 2 and I 2 statistics assessed heterogeneity, informing the use of fixed or random-effects models for meta-analysis, supplemented by sensitivity analysis and publication bias assessment through funnel plots and Egger's test.
RESULTS
From 1255 articles, seven RCTs met the inclusion criteria. The studies demonstrated that UAWD significantly reduced DFU healing time (standardized mean difference = -0.78, 95%CI: -0.97 to -0.60, P < 0.001) and increased healing rates (odds ratio = 9.96, 95%CI: 5.99 to 16.56, P < 0.001) compared to standard care. Sensitivity analysis confirmed the stability of these results, and no significant publication bias was detected.
CONCLUSION
UAWD is a promising adjunctive treatment for DFUs, significantly reducing healing times and increasing healing rates. These findings advocate for the integration of UAWD into standard DFU care protocols.