bluuebunny/crossref_metadata_2025_split huggingface dataset:
Contributions of internal and external factors to bilingual development: Evidence from Kurdish-English adolescents
Authors: Faraj Ismael 
Published: November 2024

Aims: This study examined the role of internal and external factors in bilingual language outcomes in a societal/first language (L1) and minority/foreign language (FL) context. Methodology: Participants were 98 Kurdish-English adolescents, living in the Kurdistan Region of Iraq. The data collected through a detailed questionnaire and a battery of standardized and researcher-developed measures. Data and analysis: Data were analyzed using backward regression and hierarchical regression models. Findings: Richness of the Kurdish and English environment contributed to language outcomes, of which parental Kurdish proficiency, Kurdish input from media, and paternal English proficiency were the best predictors of greater Kurdish morphosyntactic knowledge and faster lexical access ability in Kurdish and English. Cognitive and age factors predicted language outcomes, of which nonverbal analytic reasoning and older age of English exposure were the best predictors of greater English morphosyntactic knowledge and larger vocabulary size in both languages. As two different sets, external factors outweighed internal factors in terms of vocabulary size and lexical access abilities in both languages as well as Kurdish morphosyntax. The contribution of two sets was alike for English morphosyntax. Conclusions: Sensitivity to variation in individual difference factors varies depending on the linguistic domains. External factors are more essential for bilingual development, but at the same time, the role of internal factors in dual language learning should not be underestimated. Originality: With valuable insights offered by previous research, this study contributes to the field of bilingual development through examining a large number of individual difference factors in one of the most under-studied bilingual populations.
The diagnostic accuracy of intraoperative near-infrared spectroscopy in carotid artery endarterectomy under general anesthesia: A systematic review with meta-analysis
Authors: Duarte-Gamas Luís , Fragão-Marques Mariana , Zlatanovic Petar , Andrade José P. , Rocha-Neves João 
Published: November 2024

Background: Carotid endarterectomy (CEA) carries a risk of perioperative stroke, particularly during carotid cross-clamping. While neurological monitoring is reliable for patients under regional anesthesia, alternative options are needed for those unsuitable for regional anesthesia. Near-infrared spectroscopy (NIRS) is commonly used during CEA, but its diagnostic accuracy varies, particularly under general anesthesia. Methods: A systematic review with meta-analysis was performed to assess the diagnostic accuracy of intraoperative NIRS in detecting clamp-associated hemodynamic cerebral ischemia in patients under general anesthesia. MEDLINE, Google Scholar, and Web of Science were searched for studies that compared NIRS with the occurrence of immediate or early postoperative neurological deficits in patients undergoing CEA under GA. Meta-regression was performed to explore causes of heterogeneity. Results: A total of 28 studies involving 5729 patients were included. The results show that NIRS has a summary sensitivity of 47.5% and a summary specificity of 90.3% in diagnosing clamp-associated cerebral ischemia under general anesthesia, with an area under the ROC curve (AUC-ROC) of 0.85. The presence of a contralateral carotid occlusion (CCO) increased summary sensitivity while smoking history the presence of CCO and smoking history decreased summary specificity. For postoperative stroke prediction, NIRS has a summary sensitivity of 49.5% and summary specificity of 88.5%, with an AUC-ROC of 0.85. Conclusions: NIRS is a specific but not highly sensitive tool for detecting cerebral ischemia during CEA, and its use in combination with more sensitive neuromonitoring methods is recommended, in order to guide intraoperative neuroprotective strategies.
Exploring the role of irisin as a potential biomarker in adolescents and young adults with polycystic ovarian syndrome
Authors: Majeed Sadaf , Moin Hira , Shafi Riffat , Fatima Sampana , Zahra Tatheer , Zafar Sarim 
Published: November 2024

Background: Irisin is a myokine potentially linked to insulin sensitivity. Polycystic ovarian syndrome (PCOS) is a prevalent hormonal condition defined by insulin resistance. Previous studies have reported elevated circulating irisin levels in adult females with PCOS. Objective: To examine the differences in serum irisin levels between lean and obese adolescents and young adults with PCOS and their respective lean and obese controls and to explore the relationship between irisin levels and the metabolic and reproductive characteristics of the participants. Design: Cross-sectional study design. Methods: The study included 60 cases of PCOS and 60 controls. These participants were categorized based on their body mass index (BMI) into lean and obese. Fasting serum irisin levels, physical, metabolic, hormonal, and reproductive characteristics of the participants were measured. Results: Lean cases of PCOS had significantly elevated levels of fasting serum irisin (PCOS = 17.07 ± 5.61 ng/ml vs lean controls = 11.04 ± 7.51 ng/ml; p = 0.002), glucose, insulin, homeostasis model of assessment-insulin resistance index (HOMA-IR), luteinizing hormone (LH), estradiol, and testosterone and significantly lower levels of quantitative insulin sensitivity check index (QUICKI) compared to the lean controls. Obese cases of PCOS had significantly higher levels of fasting serum irisin (PCOS = 22.06 ± 3.83 ng/ml vs obese controls = 16.86 ± 6.74 ng/ml; p = 0.011), glucose, insulin, HOMA-IR, LH, estradiol, and testosterone and significantly lower levels of follicle-stimulating hormone (FSH) and QUICKI compared to obese controls. The findings revealed a significant positive correlation of serum irisin levels with BMI, glucose, insulin, HOMA-IR, LH, estradiol, and testosterone(all p-values < 0.001). There was also a significant positive correlation with triglycerides (TAGs) ( p = 0.001), total cholesterol ( p = 0.005), and low-density lipoprotein cholesterol ( p = 0.024). Additionally, there was a significant negative correlation with high-density lipoprotein cholesterol ( p = 0.001) and QUICKI ( p < 0.001) in the entire study cohort. Fasting serum glucose (β = 0.337, p = 0.029), TAGs (β = 0.249, p = 0.006), and LH (β = 0.382, p = 0.004) were positive predictors of serum irisin concentrations in the overall sample. Conclusion: Lean and obese adolescent and young adult cases of PCOS had significantly higher fasting serum irisin levels than their respective controls. Metabolic and reproductive traits of the participants also correlated with irisin.
Demographic and lifestyle factors associated with perception about risk of passive smoking in the Malaysian adolescent population
Authors: Cheah Yong Kang , Lim Kuang Kuay , Kee Chee Cheong , Tan Lay Kim 
Published: November 2024

Aims: Exposure to passive smoking among adolescents is a public health concern. This study aims to explore demographic and lifestyle factors associated with perception of passive smoking risk and the mediating effects of exposure to anti-smoking advertisements and education about the dangers of smoking on the relationship between grade levels and the perception. Method: Data from the Tobacco and E-Cigarette Survey among Malaysian Adolescents ( n = 13,117) were analysed. Ordered probit models were used to assess factors associated with passive smoking risk perception (i.e. not harmful, probably not harmful, probably harmful, harmful). Results: About one-third of adolescents did not perceive that passive smoking was harmful (30.4%). Adolescents with the perception that passive smoking was not harmful were more likely to be students at low grade levels, be males, be non-Malays and be low-pocket-money recipients and those who used e-cigarettes and who smoked. Being aware of anti-smoking advertisements (direct effect = 0.174; indirect effect = 0.012) and taught on the dangers of smoking (direct effect = 0.179; indirect effect = 0.003) partially mediated the positive relationship between grade levels and perceived risk of passive smoking. Conclusion: Policies implemented to reduce exposure to passive smoking should highlight the important role of demographic factors, lifestyle profiles, anti-smoking advertisements and education about the dangers of smoking in improving passive smoking risk perception among adolescents.
From data collection to downstream data use: Malaysia’s experience with ICD-11
Authors: Ooi Erwyn Chin Wei , Md Isa Zaleha , Abdul Manaf Mohd Rizal , Ahmad Fuad Ahmad Soufi , Sidek Hammad Fahli , Mustapa Mimi Nurakmal , Ahmad Azman , Ali Fawzi Zaidan , Kharie Mohamad Fadli , Shith Shahidah Adilah , Mohd Marzuki Nuraidah 
Published: November 2024

Background: The transition of systems to the International Statistical Classification of Diseases 11th Version (ICD-11) allows access to comprehensive data that accurately portray the complexity of morbidity and mortality data in Malaysia. Objective: To demonstrate Malaysia’s experience in implementing ICD-11, from data collection to downstream data use applications. Method and implementation: We describe improvements to existing data source systems and downstream data applications. For non-HIS and HIS (ICD-10) systems, data were manually entered into the health management information system equipped with ICD-11 or automatically mapped from ICD-10 to ICD-11. Following these system improvements, we collected and reported ICD-11 data from all hospitals nationwide, regardless of the individual systems’ status in ICD-11 use. Discussion: Lessons learnt related to legacy systems; ICD-11 releases and system updates; mapping; reporting; human resources and related applications. Conclusion: With careful planning, standardisation of the collection and use of ICD-11 data can be accomplished with limited resources and in a complex environment with heterogeneous systems. Implications: Use of ICD-11 data in downstream data applications improves data quality to answer specific business or research questions.
System-wide analysis of qualitative hospital incident data: Feasibility of semi-automated content analysis to uncover insights
Authors: Engstrom Teyl , Kenny Danelle , Grimmett Wallace , Ramis Mary-Anne , Foley Chris , Sullivan Clair , Pole Jason D. 
Published: November 2024

Background: Advances in technology have increased the ease of reporting hospital incidents, resulting in large amounts of qualitative descriptive data. Health services have little experience analysing these data at scale to incorporate into routine reporting. Objective: We aimed to explore the feasibility of applying a semi-automated content analysis (SACA) tool (Leximancer™) to qualitative descriptions of system-wide hospital incidents to provide insights into safety issues at all health service levels. Method: Data from 1245 incidents reported across a network of hospitals in Australia were analysed using the SACA tool. Summaries were generated using a variety of techniques, including inductive and deductive approaches to extract key concepts in the data. Results: The analysis was feasible and provided an actionable summary of the types of incidents reported in the data; the visual interface allowed users to explore the underlying text for a deeper understanding. Deductive analysis was utilised to explore specific areas of interest, and stratified analysis revealed more detailed concepts. The SACA tool was more efficient than manual processes; however, due to the context present in the incident descriptions, significant time, reading and subject matter expertise is still required to refine the analysis. Conclusion: Semi-automated tools provide an opportunity for improving patient safety culture and practices by providing rapid content analysis of vast datasets that can be customised for specific organisational contexts and deployed at scale. Further research is required to assess usefulness with system users. Implications: Qualitative data abound and system-wide analysis is essential to creating actionable insights.
Artificial Intelligence to Diagnose Complications of Diabetes
Authors: Ayers Alessandra T. , Ho Cindy N. , Kerr David , Cichosz Simon Lebech , Mathioudakis Nestoras , Wang Michelle , Najafi Bijan , Moon Sun-Joon , Pandey Ambarish , Klonoff David C. 
Published: November 2024

Artificial intelligence (AI) is increasingly being used to diagnose complications of diabetes. Artificial intelligence is technology that enables computers and machines to simulate human intelligence and solve complicated problems. In this article, we address current and likely future applications for AI to be applied to diabetes and its complications, including pharmacoadherence to therapy, diagnosis of hypoglycemia, diabetic eye disease, diabetic kidney diseases, diabetic neuropathy, diabetic foot ulcers, and heart failure in diabetes. Artificial intelligence is advantageous because it can handle large and complex datasets from a variety of sources. With each additional type of data incorporated into a clinical picture of a patient, the calculation becomes increasingly complex and specific. Artificial intelligence is the foundation of emerging medical technologies; it will power the future of diagnosing diabetes complications.
Knowledge, Local Uses, and Vulnerability of the African Ebony Tree (Diospyros crassiflora Hiern, Ebenaceae) Among Communities Around the Campo-Ma'an National Park (Southern Cameroon)
Authors: Yves Komo Mbarga , Moksia Froumsia , Mongombe Aaron Manga , François Malan Djah , Bruno Jacques Ngotta Biyon , Éric-Moïse Bakwo Fils 
Published: November 2024

Background The African ebony tree is a multipurpose tree native to the Guinea-Congolese forest. Its long-term viability and sustainability are threatened by the conversion of primary forest to agricultural land. To conserve the species, it is necessary to evaluate the local community's understanding of its usage and conservation strategies to identify the factors that could potentially influence the species' long-term viability in the study area. Methods Data was collected between June and August 2022. The random sampling method was used to administer structured and semi-structured interview questionnaires to 301 villages living within three to nine kilometers of the Campo-Ma'an National Park's boundaries. Results Several parts of the plant are used by the locals, notably the wood and bark, with a citation frequency of 49% and 20.4%, respectively. Cutting is the most important collection method, with a relative frequency of citation of 49.1%. These parts are valued in six categories of uses; timber was the most cited (UV = 38.9%), followed by traditional medicine (UV = 36.9%). Wood was the only part of the plant that generated considerable annual income for the local communities (52.537 USD). The vulnerability index showed that the ebony tree is highly vulnerable (IV = 2.5) in the study area. Conclusion The results obtained show strong pressure from local populations on D. crassiflora, leading to a decrease in the tree population. Conservation Implications Given the ongoing threat to D. crassiflora in the study area, this research will assist in valorising the species usage in traditional medicine and as a commercial wood. In addition, we have proposed conservation strategies like assisted regeneration and community-led planting projects to promote long-term plantation-based D. crassiflora production to mitigate the effects of deforestation.
Stroke knowledge in Malta: A mixed methods study
Authors: Grech Reuben , Grech Paulann 
Published: November 2024

Background Stroke is a major cause of morbidity and mortality worldwide. Despite advances in acute treatments, timely intervention remains crucial. This study assessed stroke knowledge in Malta to identify gaps that could contribute to treatment delays. Methods A mixed methods approach was used, starting with qualitative interviews of stroke patients, relatives, and bystanders, followed by a quantitative survey among the general Maltese population and healthcare workers. The online survey included demographics, stroke knowledge, and stroke response questions. Data were analysed using descriptive and inferential statistics to identify knowledge gaps and influencing factors. Results The study surveyed 1872 participants, representing the Maltese population. Significant knowledge gaps were found in stroke symptoms, risk factors, and appropriate responses. Younger participants, males, non-Maltese, urban residents, those with higher education, and higher-income individuals showed better stroke knowledge and response. Healthcare workers scored higher than the general public. A strong positive correlation was found between stroke knowledge and appropriate response actions. Conclusions The study highlights the need for targeted educational interventions to improve stroke awareness and response, especially among older adults, women, rural residents, and lower-income groups. Recommendations include comprehensive public education campaigns, culturally tailored materials, and ongoing professional development for healthcare workers. Addressing these gaps could enhance stroke prevention and management, reducing stroke-related morbidity and mortality.
DsbA-L activates TGF-β1/SMAD3 signaling and M2 macrophage polarization by stimulating AKT1 and NLRP3 to promote pulmonary fibrosis
Authors: Wang Juan , Xia Zhenkun , Qing Bei , Chen Ying , Gu Linguo , Chen Hongzuo , Ge Zhenglian , Yuan Yunchang 
Published: November 2024

Abstract
Background
Pulmonary fibrosis (PF) is a progressive and difficult-to-heal lung disease that poses a significant threat to human life and health. This study aimed to investigate the potential pathological mechanisms of PF and to identify new avenues for the treatment of PF.

Methods
Clinical samples were collected to assess the effect of disulfide-bond A oxidoreductase-like protein (DsbA-L) on PF. TGF-β1-induced MLE-12 cell model and bleomycin (BLM)-induced mice model were established. Changes in physiological morphology and fibrosis were observed in the lung tissues. The degree of apoptosis and the mitochondrial function was analyzed. The expression of relative cytokines was examined. The CD68+/CD206+ ratio was determined to indicate M2 macrophage polarization.

Results
The expression of DsbA-L was upregulated in patients with PF and PF-like models. In vitro, DsbA-L overexpression exacerbated TGF-β1-induced the deposition of extracellular matrix (ECM), apoptosis, inflammation, and mitochondrial damage, whereas DsbA-L silencing exerted the opposite effects. DsbA-L silencing inhibited the activation of AKT1, NLRP3, and SMAD3 by TGF-β1. MLE-12 cells silencing DsbA-L limited the polarization of RAW264.7 cells towards the M2 phenotype. AKT1 agonist or NLRP3 agonist reversed the role of DsbA-L silencing in inhibiting the TGF-β1/SMAD3 pathway and M2 macrophage polarization. In vivo, DsbA-L knockout protected mice from PF-like pathological damage caused by BLM.

Conclusion
DsbA-L exhibited a significant profibrotic effect in lung epithelial cells and mice, which increased the levels of AKT1 and NLRP3 to activate the TGF-β1/SMAD3 pathway and M2 macrophage polarization. These findings could shed light on new clues for comprehension and treatment of PF.
The most effective combination of pharmacological therapy for heart failure with reduced ejection fraction: a network meta-analysis of randomized controlled trials
Authors: Tang Huilin , Germinal Kimberly , Milfort Alexandra , Chen Wei-Han , Chang Shao-Hsuan , Huang Wenxi , Li Yujia , Lu Ying , Ahmed Mustafa M. , Kimmel Stephen E. , Bian Jiang , Guo Jingchuan 
Published: November 2024

Abstract
Background
Evidence for the efficacy of pharmacological therapies for heart failure with reduced ejection fraction (HFrEF) is growing. However, there is no consensus on the most effective treatment for HFrEF. This study aimed to evaluate the most effective combination of pharmacological therapy in patients with HFrEF.

Methods
We systematically searched Medline, Embase, and CENTRAL up to Feb 2022, to include randomized controlled trials (RCTs) that evaluated the efficacy of pharmacological treatment among adults (≥ 18 years) with a diagnosis of HFrEF (defined by a left ventricular ejection fraction ≤ 45%). The outcomes of interest included all-cause death, cardiovascular (CV) death, and hospitalization for heart failure (HHF). A random network meta-analysis using a frequentist framework model was employed to calculate the pooled risk ratio (RR) with 95% confidence interval (CI) and rank the treatments.

Results
We included 49 RCTs involving 90,529 participants with HFrEF. For reducing all-cause mortality, the combination of angiotensin-converting enzyme inhibitors (ACEI), beta-blockers (BB), mineralocorticoid receptor antagonists (MRA), and sodium-glucose co-transporter-2 inhibitors (SGLT2i) was most effective (RR, 0.46; 95% CI, 0.32–0.66). For CV death, the combination of ACEI, BB, MRA, and Vericiguat showed the highest efficacy (RR, 0.34; 95% CI, 0.12–0.90). Regarding reducing HHF, the combination of ACEI, BB, MRA, and SGLT2i as well as the combination of ACEI, BB, MRA, and Ivabradine were equally the most effective (both RR, 0.27; 95% CI, 0.18–0.39).

Conclusion
This study provides robust evidence supporting the use of combination therapies in HFrEF management, with newer agents offering incremental benefits when added to established guideline-directed medical therapy.