bluuebunny/crossref_metadata_2025_split huggingface dataset:
COVID-19 and mental well-being of nurses in a tertiary facility in Kenya
Authors: Ali Sayed K. , Shah Jasmit , Talib Zohray 
Published: July 2021

Background
The 2019 coronavirus disease (COVID-19) epidemic is a global health emergency which has been shown to pose a great challenge to mental health, well-being and resilience of healthcare workers, especially nurses. Little is known on the impact of COVID-19 among nurses in sub-Saharan Africa.

Methods
A cross sectional study was carried out between August and November 2020 among nurses recruited from the Aga Khan University Hospital, Nairobi. The survey questionnaire consisted of six components- demographic and work title characteristics, information regarding care of COVID-19 patients, symptoms of depression, anxiety, insomnia, distress and burnout, measured using standardized questionnaires. Multivariable logistic regression analysis was performed to identify factors associated with mental health disorders.

Results
Of 255 nurses, 171 (67.1%) consented to complete the survey. The median age of the participants was 33.47 years, 70.2% were females and 60.8% were married. More than half, 64.9% were frontline workers directly engaged in COVID-19 care. Only 1.8% reported a prior history or diagnosis of any mental health disorder. Depression, anxiety, insomnia, distress, and burnout were reported in 45.9%, 48.2%, 37.0%, 28.8% and 47.9% of all nurses. Frontline nurses reported experiencing more moderate to severe symptoms of depression, distress and burnout. Furthermore, females reported more burnout as compared to males. Multivariate logistic regression analysis showed that after adjustment, working in the frontlines was an independent risk variable for depression and burnout.

Conclusion
This is one of the few studies looking at mental health outcomes among nurses during the COVID-19 pandemic in Kenya. Similar to other studies from around the world, nurses directly involved with COVID-19 patients reported higher rates of mental health symptoms. Burnout threatens to exacerbate the pre-existing severe nursing workforce shortage in low-resource settings. Cost-effective and feasible mitigating strategies, geared to low-middle income countries, are urgently needed to help cope with mental health symptoms during such a pandemic.
Reaching skills in six-month-old infants at environmental and biological risk
Authors: Araújo Rohr Liz , Cabral Thais Invenção , Moraes Murilo Mageste de , Tudella Eloisa 
Published: July 2021

Objectives
To assess kinematic parameters and proximal and distal reaching adjustments of infants at biological or environmental risk and compare with reaching performance of six-month-old full-term infants without known risk factors.

Methods
This blinded cross-sectional study included 62 infants at six months of age divided into three independent groups: Group with no known risk factor (NRF), 28 full-terms with no risk factors; Low SES group (LSES):19 full-terms classified as low socioeconomic status and no biological risk; Very preterm group (VPT), 15 very preterm infants at six months corrected age and no environmental risk. Infants were placed in a reclined baby chair at 45°, and a malleable and unfamiliar object was presented to the infant at 5-second intervals to elicit reaching movements.

Results
Infants from LSES presented reaching duration (p = 0.032, Cohen’s f = 0.349) and movement unit (p = 0.033, Cohen’s f = 0.351) significantly higher than VPT group. Horizontal hand orientation was moderately associated with infants at environmental risk (p = 0.031; Cramer’s V = 0.30).

Conclusion
Infants of low socioeconomic status perform less functional reaching movements than very preterm infants at six months corrected age. Socioeconomic status may impact more on reaching skills than biological risk. Given the importance of reaching for infant development, low-cost public health strategies are needed to identify possible delays.
Postnatal infection surveillance by telephone in Dar es Salaam, Tanzania: An observational cohort study
Authors: Woodd Susannah L. , Kabanywanyi Abdunoor M. , Rehman Andrea M. , Campbell Oona M. R. , Kagambo Asila , Martiasi Warda , TinaDay Louise M. , Aiken Alexander M. , Graham Wendy J. 
Published: July 2021

Introduction
Maternal and newborn infections are important causes of mortality but morbidity data from low- and middle-income countries is limited. We used telephone surveillance to estimate infection incidence and risk factors in women and newborns following hospital childbirth in Dar es Salaam.

Methods
We recruited postnatal women from two tertiary hospitals and conducted telephone interviews 7 and 28 days after delivery. Maternal infection (endometritis, caesarean or perineal wound, or urinary tract infection) and newborn infection (umbilical cord or possible severe bacterial infection) were identified using hospital case-notes at the time of birth and self-reported symptoms. Adjusted Cox regression models were used to assess the association between potential risk-factors and infection.

Results
We recruited 879 women and interviewed 791 (90%). From day 0–7, 6.7% (49/791) women and 6.2% (51/762) newborns developed infection. Using full follow-up data, the infection rate was higher in women with caesarean childbirth versus women with a vaginal delivery (aHR 1.93, 95%CI 1.11–3.36). Only 24% of women received pre-operative antibiotic prophylaxis before caesarean section. Infection was higher in newborns resuscitated at birth versus newborns who were not resuscitated (aHR 4.45, 95%CI 2.10–9.44). At interview, 66% (37/56) of women and 88% (72/82) of newborns with possible infection had sought health-facility care.

Conclusions
Telephone surveillance identified a substantial risk of postnatal infection, including cases likely to have been missed by hospital-based data-collection alone. Risk of maternal endometritis and newborn possible severe bacterial infection were consistent with other studies. Caesarean section was the most important risk-factor for maternal infection. Improved implementation of pre-operative antibiotic prophylaxis is urgently required to mitigate this risk.
A prognostic index model for predicting long-term recurrence of uterine leiomyoma after myomectomy
Authors: Ming Xiu , Zhou Junying , Gou Jinhai , Li Na , Nie Dan , Xue Luqi , Li Zhengyu 
Published: July 2021

Introduction
Uterine leiomyoma (UL) is a common benign pelvic tumor in women that has a high recurrence rate. Our aim is to propose a prognostic index (PI) model for predicting the long-term recurrence risk of uterine leiomyoma (UL).

Methods
A total of 725 women who underwent myomectomy were enrolled in this retrospective multicenter study. Patients were contacted for follow-up. A PI model was proposed based on the multivariate Cox regression analysis in the model group. The predictive value of this model was tested in both internal and external validation group.

Results
PI formula = 1.5(if 3–5 leiomyomas) or 2(if >5 leiomyomas)+1(if residue)+1(if not submucosal)+1(if combined endometriosis). The PI value was divided into low-risk, intermediate-risk, and high-risk group by cut-off values 1.25 and 3.75. In the model group, the high-risk group had a significantly 4.55 times greater recurrence risk of UL than that in the low-risk group [cumulative recurrence rate (CR): 82.1% vs 29.5%, HR = 4.55, 95% CI 2.821–7.339]; the intermediate-risk group had a significantly 2.81 times greater recurrence risk of UL than that in the low-risk group (CR: 62.3% vs 29.5%, HR = 2.81, 95% CI 2.035–3.878). The differences between any two risk groups were also significant (P< 0.05) in both internal and external validation groups.

Conclusion
The model was proved to be effective in predicting recurrence of UL after myomectomy.
Incorporating physical activity in the comprehensive care of people living with HIV starting antiretroviral therapy: Insights from a specialized care setting in São Paulo, Brazil
Authors: Santos Ardiles Vitor , Santos Elisabete Cristina Morandi , Picone Camila Melo , Dias Tulio Gamio , Ribeiro Sandra Maria Lima , Florindo Alex Antonio , Segurado Aluisio Cotrim 
Published: July 2021

BackgroundManaging HIV infection as a chronic condition includes encouraging adoption of healthy behaviors and promotion of physical activity (PA). However, people living with HIV (PLH) are often under social and programmatic vulnerability that may compromise behavior change. Understanding such barriers is crucial for successful incorporation of PA in their comprehensive care.Methods and findingsIn this study, we describe PA, energy intake from diet, and anthropometry of a cohort of PLH starting antiretroviral therapy (ART) at a Brazilian reference clinic, report how PA was addressed in routine care and investigate association between PA, energy intake and psychosocial constructs that may facilitate PA (social support and self-efficacy for PA). Among 61 PLH (86.9% males, mean age = 32.5 years) anthropometry was normal, but 47.5% reported PA below recommendations. Despite presenting high social support scores, family encouragement for PA was low, and self-efficacy classified as medium. Chart reviews yielded infrequent reports concerning PA. After adjusting for gender and age, we found a negative association between energy intake from diet and self-efficacy, but none between PA and energy intake or between PA and psychosocial constructs.ConclusionsWe conclude that patients in our cohort were insufficiently active when starting ART, and that PA was poorly addressed by caretakers in routine HIV care. Nevertheless, social support and self-efficacy scores suggest potential for behavioral change. Caregivers should therefore start considering patients’ vulnerabilities and establishing strategies to help them overcome barriers to incorporate PA in their comprehensive care effectively.
Geographic variation in Alzheimer’s disease mortality
Authors: Topping Michael , Kim Jinho , Fletcher Jason 
Published: July 2021

Objective
Accumulating evidence suggests the possibility that early life exposures may contribute to risk of Alzheimer’s Disease (AD). This paper explores geographic disparities in AD mortality based on both state of residence in older age as well as state of birth measures in order to assess the relative importance of these factors.

Methods
We use a subset of a large survey, the NIH-AARP Diet and Health Study, of over 150,000 individuals aged 65–70 with 15 years of mortality follow-up, allowing us to study over 1050 cases of AD mortality. We use multi-level logistic regression, where individuals are nested within states of residence and/or states of birth, to assess the contributions of place to AD mortality variation.

Results
We show that state of birth explains a modest amount of variation in AD mortality, approximately 4%, which is consistent with life course theories that suggest that early life conditions can produce old age health disparities. However, we also show that nearly all of the variation from state of birth is explained by state of residence in old age.

Conclusions
These results suggest that later life factors are potentially more consequential targets for intervention in reducing AD mortality and provide some evidence against the importance of macro-level environmental exposures at birth as a core determinant of later AD.
The Motives and Challenges of developing and delivering MOOCs courses
Authors: Khlaif Zuheir N. , Ghanim Mustafa , Abu Obaid Arij , Salha Soheil , Affouneh Saida 
Published: July 2021

This paper described the experience of developing a MOOC at An Najah National University and how it was transferred into a SPOC from the perspective of its team developers. Learners' responses and participation had been analyzed in order to understand its content. The data collected described the motivation for developing the MOOC and then using it as a SPOC, in addition to presenting the challenges that face its development and implementation.
The development of the MOOC Genetic and Society at An Najah National University went through different stages starting from offering the course to students face to face and then developing the course online and then preparing it as a MOOC, finally using it as a SPOC to student university. The findings showed the main motives for developing the MOOC such as the well to increase the online Arabic content in this area. The main challenge that faced the course designers was the lack of technical support. The paper recommends developing more MOOCs in different languages in the medical field.
Oportunidades de visitação oferecidas em Áreas Naturais Protegidas: análise dos Parques Nacionais mais visitados no Brasil e nos Estados Unidos das América em 2017
Authors: Figueiredo Mucio do Amaral , Gomes Carolina Ribeiro , Salvio Geraldo Majela Moraes 
Published: July 2021

Parques Nacionais (PN) são estratégias de proteção da natureza e realização da atividade turística que demandam ferramentas para visitação adequada. Com o avanço do turismo nestas áreas, os PN assumem dupla responsabilidade: manter a qualidade da experiência dos visitantes e contribuir com todo seu potencial para sociedade. Nesse sentido, a ferramenta Recreation Opportunity Spectrum (ROS) categoriza as denominadas “Oportunidades de Visitação” em diferentes classes (Prístina, Primitiva, Natural, Rural e Urbana) para identificar atributos específicos para cada ambiente e público, organizando o turismo. Neste cenário, o objetivo foi analisar as oportunidades oferecidas em 10 Parques Nacionais, cinco no Brasil e cinco nos Estados Unidos da América e entender como as diferentes Classes de Oportunidades podem influenciar a visitação turística. Os dados foram obtidos a partir de pesquisa bibliográfica e documental. Identificado os potenciais turísticos de cada PN, aplicou-se a metodologia ROS. Os resultados mostraram que existe relação entre o número de oportunidades oferecidas e o número de visitantes que o Parque Nacional recebe, confirmando o pressuposto que, tanto nos Parques brasileiros quanto estadunidenses, diferentes oportunidades recreativas relaciona-se ao maior número visitantes. Dessa forma, a ferramenta Recreation Opportunity Spectrum apresenta-se como importante ferramenta de gestão da visitação turística. A possibilidade de criar classes de visitação em áreas naturais deve ser amplamente utilizada para garantir o turismo sustentável.
VACINAS CONTRA A COVID-19: TECNOLOGIAS E ANÁLISE TÉCNICA DE COMPOSIÇÃO E IMPLICAÇÕES NA IMUNIZAÇÃO
Authors: Oliveira Anselmo Gomes de , Silveira Dâmaris 
Published: July 2021

Desde a detecção e identificação, em dezembro de 2019, do virus SARS-CoV-2, causador da Síndrome Respiratória Aguda Grave (COVID-19), houve um imenso esforço mundial de especialistas e cientistas para entender a estrutura organizacional do virus, os processos de propagação e instalação da infecção e, principalmente, mecanismos para impedir sua disseminação e possíveis meios de tratamento da doença. Inicialmente, a mobilização de cientistas ocorreu em torno de possíveis fármacos já utilizados em outras infecções virais e que pudessem interromper ou pelo menos minimizar os marcantes efeitos da infecção no organismo humano, que implicavam em internações em Unidades de Terapia Intensiva (UTI), sendo muitas vezes letais.
TRANSTORNO DO ESPECTRO AUTISTA: UMA ABORDAGEM SOBRE AS POLÍTICAS PÚBLICAS E O ACESSO À SOCIEDADE
Authors: Nicoletti Maria Aparecida , Honda Fernanda Ramaglia 
Published: July 2021

Segundo a Organização Mundial da Saúde (OMS), o Transtorno do Espectro Autista (TEA) é um conjunto de condições caracterizadas por algum grau de dificuldade no convívio social, na comunicação verbal e não verbal e interesses específicos por algumas atividades realizadas de forma repetitiva. Essas características surgem ainda na infância, tendem a continuar na adolescência e permanecem quando o indivíduo se torna adulto. Devido à sua capacidade de gerar dificuldades ao indivíduo, é preciso avaliar o que a sociedade brasileira, entre outras, está fazendo para facilitar a rotina dessas pessoas. Portanto, o objetivo deste trabalho foi buscar por políticas públicas nacionais e internacionais relacionados ao TEA. Assim, foi realizada a revisão de leis nacionais e internacionais e consulta de artigos nas bases de dados, como SciELO, PubMed, Web of Science e Science Direct. Em todos os países pesquisados, há o que se evoluir em relação as políticas, bem como a disponibilização de informações aos cidadãos. Ainda, embora o farmacêutico não seja um profissional diretamente relacionado ao tratamento desses pacientes, o primeiro contato da família com uma criança com TEA pode-se dar nas farmácias e/ou Unidades Básicas de Saúde (UBS) espalhadas pelo Brasil, sendo o contato com o médico de acesso mais demorado, devido à complexidade do Sistema Único de Saúde (SUS). Assim, o farmacêutico precisa estar preparado para aconselhar a família e identificar sinais do TEA na criança. Também é de responsabilidade do farmacêutico integrar um grupo multiprofissional, a fim de elaborar um plano terapêutico para o paciente, avaliar todos os riscos e minimizar seus sintomas.
A Composite Model for Predicting the Coefficient of Thermal Contraction for Asphalt Concrete Mixtures
Authors: Keshavarzi Behrooz , Mocelin Douglas , Richard Kim Y. 
Published: July 2021

Abstract
Thermal cracking is one of the most prevalent types of distress found in asphalt concrete pavement sections. The coefficient of thermal contraction (CTC) is the intrinsic parameter that determines the thermal contraction of asphalt mixtures subjected to temperature drop. Thus, thermal stress and associated thermal damage are greatly affected by the CTC of the mixture. The direct measurement of a mixture’s CTC is the most reliable and at the same time cumbersome method for predicting the thermal contraction of asphaltic mixtures. In this study, for Level I analysis, we measured the CTCs of mixtures that have a wide range of properties and reported the data. In order to remedy the difficulties associated with directly measuring CTC, we herein propose a simple yet accurate composite model. The suggested approach enables pavement engineers to predict CTC values as the temperature drops. The formulation requires the mixture’s volumetric properties, elastic modulus, and CTC of the aggregate a priori. With regard to binder, the formulation requires the CTC and relaxation modulus as input parameters. This procedure constitutes the Level II analysis for which the binder CTC is required beforehand. A database that constitutes a basis for estimating binder CTC was developed from measurements reported in the literature. The database can be used to fill the value for binder CTC in the developed composite model for the sake of predicting mixture CTC. This procedure constitutes Level III analysis. Levels II and III only differ with respect to the input value for binder CTC. The CTC values from the measurements and predicted from the composite model (Levels II and III) are compared. In order to fully understand the effects of Level II and III errors in estimating mixture CTCs, we also compared the thermal stress obtained from the predicted and measured CTCs.
Comparisons of Caustics and Strain Gauge Methods for Determining Mixed Mode Fracture Toughness of PMMA
Authors: Song Yao , Yue Zhongwen 
Published: July 2021

Abstract
Both caustics and the strain gauge methods are considered to be effective approaches to study material mixed mode fracture toughness. However, not many studies have recorded quantitative comparisons between these two methods. In this paper, three-point-bend tests are conducted using caustics and the strain gauge method simultaneously to determine the critical mixed mode stress intensity factors of polymethyl methacrylate (PMMA) specimens. The mixed mode fracture toughness is then derived by employing both methods for a thorough comparison and analysis. Besides, the J-integral method in ABAQUS simulation software is also employed for a further illustration of these two methods. According to the results, there is a similar changing trend in toughness calculated by caustics and the strain gauge method when there is an increase in a/b ratio (a is the crack length; b is the specimen width) of PMMA specimens. The differences in terms of mixed mode fracture toughness values between these two methods are quite narrow. Besides, in comparison to KIc, the variations of KIIc obtained by both methods are shown to change drastically as the a/b ratio of the specimen increases. Additionally, by analyzing and comparing these two methods, it is found that the caustic method is more sensitive when measuring the mixed mode fracture toughness, whereas the strain gauge method can satisfy a rough and quick need for calculating key fracture parameters.
Physiologic Monitor Alarm Burden and Nurses’ Subjective Workload in a Children’s Hospital
Authors: Rasooly Irit R. , Kern-Goldberger Andrew S. , Xiao Rui , Ponnala Siddarth , Ruppel Halley , Luo Brooke , Craig Sansanee , Khan Amina , McLoone Melissa , Ferro Daria , Muthu Naveen , Won James , Bonafide Christopher P. 
Published: July 2021

BACKGROUND AND OBJECTIVESPhysiologic monitor alarms occur at high rates in children’s hospitals; ≤1% are actionable. The burden of alarms has implications for patient safety and is challenging to measure directly. Nurse workload, measured by using a version of the National Aeronautics and Space Administration Task Load Index (NASA-TLX) validated among nurses, is a useful indicator of work burden that has been associated with patient outcomes. A recent study revealed that 5-point increases in the NASA-TLX score were associated with a 22% increased risk in missed nursing care. Our objective was to measure the relationship between alarm count and nurse workload by using the NASA-TLX.METHODSWe conducted a repeated cross-sectional study of pediatric nurses in a tertiary care children’s hospital to measure the association between NASA-TLX workload evaluations (using the nurse-validated scale) and alarm count in the 2 hours preceding NASA-TLX administration. Using a multivariable mixed-effects regression accounting for nurse-level clustering, we modeled the adjusted association of alarm count with workload.RESULTSThe NASA-TLX score was assessed in 26 nurses during 394 nursing shifts over a 2-month period. In adjusted regression models, experiencing &gt;40 alarms in the preceding 2 hours was associated with a 5.5 point increase (95% confidence interval 5.2 to 5.7; P &lt; .001) in subjective workload.CONCLUSIONAlarm count in the preceding 2 hours is associated with a significant increase in subjective nurse workload that exceeds the threshold associated with increased risk of missed nursing care and potential patient harm.