bluuebunny/crossref_metadata_2025_split huggingface dataset:
Kangaku and the State: Colonial Collaboration between Korean and Japanese Traditional Sinologists
Authors: Lee (Yi Yongbŏm) Yongbeom 
Published: November 2024

Abstract
This article examines the response of kangaku 漢学, or traditional sinological study, to modernity in Japan and colonial Korea by focusing on institutionalization and the interactions between scholars of traditional sinology in Japan and colonized Korea. In the Japanese Empire, kangaku actively demonstrated that it could contribute to the nation-state and became a part of the modern educational system, including the Imperial University. The favorable atmosphere toward kangaku in the Japanese Empire also enabled the institutionalization of kangaku in colonial Korea. The process of institutionalization there was deeply influenced by the traditional network of Japanese sinologists. Traditional sinologists in Japan and colonial Korea were able to cooperate based on a shared “shibun (斯文 “This Culture of Ours”) consciousness,” a kind of consciousness of crisis that originated in the Analects. The shibun consciousness was rooted in the traditional literary world, where borders and contemporaneity were relatively ambiguous. Within the university system, kangaku gradually faced the pressure of specialization and elaboration of modern scholarship and the demands of the nation-state. Thus, successive generations of Korean and Japanese sinologists moved toward a new modern ideology that went beyond “shibun consciousness.”
Mid-Tang Exchange Poetry, the Kingdom of Parhae, and the Reception of Bai Juyi in Early Heian Japan, Part 1: Parhae Envoys and the Yuan-Bai Style of Exchange Poetry
Authors: Minguzzi Dario 
Published: November 2024

Abstract
Scholars have long been puzzled as to why the poetry of mid-Tang poet Bai Juyi 白居易 (772–846) enjoyed tremendous popularity at the Heian court (794–1185), while the poetry of other Tang poets, which is known to have reached Japan, received relatively little attention. In this essay, Heian appreciation of Bai Juyi is placed in the context of the “Yuan-Bai style,” which was propagated across East Asia through the corpus of the poetic exchanges between Bai Juyi and Yuan Zhen 元稹 (779–831), and to the popularity of this model within the poetry regularly exchanged between Heian poets and the envoys from the Kingdom of Parhae 渤海 (698–926) during the ninth and early tenth centuries. Thus, this essay first traces the role of Parhae as the driving force behind the Heian reception of Bai Juyi's work and then explores the effects of this connection in the practice of early Heian Sinitic poetry.
Reviving medical tourism in Pakistan - A narrative review
Authors: Mumtaz Nazia , Saqulain Ghulam 
Published: November 2024

Medical and health care traverse geographical boundaries in the form of “Medical Tourism” with patients travelling from low and middle-income countries to developed nations and vice versa as well. Affordable medical care is also attracting patients from developed nations to countries like India, Thailand, UAE and others with international accreditation playing a key role. This also yields economic benefits for the recipient countries. Pakistan unfortunately lags behind in acquiring “destination of choice” status for medical tourism which undisputedly can benefit its constrained economy. There being a dearth of literature current narrative review was conducted to highlight the integrity and benefits of medical tourism. For this, literature search was conducted using google, Bing, google scholar, PubMed, web of science to search engines and data bases. One hundred eighty articles, reports & publications were downloaded of which 25 non-English & duplicates, and 75 irrelevant records were excluded. Hence, 34 references of relevant English language articles, publications, reports and online resources were utilized for the review.
doi: https://doi.org/10.12669/pjms.40.11.8673
How to cite this: Mumtaz N, Saqulain G. Reviving medical tourism in Pakistan - A narrative review. Pak J Med Sci. 2024;40(11):2720-2725. doi: https://doi.org/10.12669/pjms.40.11.8673
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Frailty and body composition predict adverse outcomes after emergency general surgery admission: a multicentre observational cohort study
Authors: May-Miller P , Ligthart MAP , Darbyshire AR , Rahman S , Pucher PH , Curtis NJ , West MA ,   for the Wessex Research Collaborative
Published: November 2024

Introduction Emergency surgical admissions represent the most unwell patients admitted to any hospital. Frailty and body composition independently identify risk of adverse outcomes but are seldom combined to predict outcomes in emergency patients. We aim to determine the relationships between frailty, body composition analyses (BCA) and mortality in an undifferentiated emergency general surgical patient population. Method A prospective, multicentre observational cohort study of patients admitted with emergency surgical pathology was conducted in eight hospitals. BCA were performed at L3 vertebrae using computed tomography images to quantify sarcopenia and myosteatosis. Sex-specific BCA cut-off values were determined by our previous study. Reported Edmonton Frail Scale (REFS) values ≥8 identified frailty. The primary outcomes were all-cause 30-day and 1-year mortality. Multivariable logistic regression was utilised to explore predictive relationships between frailty, BCA, mortality and independent discharge. Results A total of 194 patients were included; 24% were frail, 25% were sarcopenic and 23% myosteatotic. Some 61% of patients underwent an emergency laparotomy. Frail patients were more likely to be sarcopenic (20.4% vs 40.4%; p = 0.011) and myosteatotic (27.2% vs 51.1%; p = 0.004). Thirty-day and 1-year mortality was 5.2% and 15.5%, respectively; 30-day mortality was two times higher in the frail group (4.1% vs 8.5%; p = 0.414), and three times higher at 1 year (10.2% vs 31.9%; p = 0.001). Age (odds ratio [OR] 1.06; p = 0.001), sarcopenia (OR 2.88; p = 0.047) and frailty (OR 4.13; p = 0.001) were associated with 1-year mortality. Only 55.3% of frail patients were discharged home independently compared with 88.4% non-frail patients (p < 0.001). One-year mortality was greater in those with frailty and/or BCA abnormalities than in those without (28.8% vs 9.6%; p = 0.003). Conclusion Frailty, sarcopenia and myosteatosis contribute significantly to adverse outcomes. Study registration NCT 03534765
Population-based cohort data used to assess trends in early resumption of sexual activity after voluntary medical male circumcision in Rakai, Uganda
Authors: Daama Alex , Nalugoda Fred , Kankaka Edward , Kasango Asani , Nantume Betty , Kigozi Grace Nalwoga , Ssekubugu Robert , Namutundu Juliana , Ssettuba Absalom , Lutalo Tom , Kagaayi Joseph , Nakigozi Gertrude , Alamo Stella , Mills Lisa A. , Kabuye Geoffrey , Gray Ron , Wawer Maria , Serwadda David , Sewankambo Nelson , Kigozi Godfrey 
Published: November 2024

Introduction
Voluntary medical male circumcision (VMMC) reduces the risk of heterosexual acquisition of HIV by 50%–60%. The Uganda Ministry of Health recommends abstinence of sex for 42 days after VMMC to allow complete wound healing. However, some men resume sex early before the recommended period. We estimated trends in prevalence and risk factors of early sex resumption (ESR) among VMMC clients in Rakai, Uganda, from 2013–2020.

Methods
Data from the Rakai Community Cohort Study (RCCS), a cross-sectional study, were analyzed. Data included consenting males aged 15–49 years in RCCS who self-reported having received VMMC between the period of 2013 to 2020. ESR prevalence and associated risk factors were assessed using modified Poisson regression to estimate adjusted prevalence ratios (aPR).

Results
Overall, 1,832 participants were included in this study. ESR decreased from 45.1% in 2013 to 14.9% in 2020 (p<0.001). Across the first three surveys, ESR prevalence was consistently higher among the married participants than the never married participants, aPR = 1.83, 95% CI: [1.30,2.57]; aPR = 2.46, 95% CI: [1.50,4.06]; aPR = 2.22, 95% CI: [1.22,4.03]. ESR prevalence was higher among participants who reported to have more than one sexual partner than participants with one partner, aPR = 1.59, 95% CI: [1.16,2.20]. In the fourth survey from 2018–2020, ESR prevalence was significantly higher among participants with primary education than participants with post-primary, aPR = 2.38, 95% CI: [1.31, 4.30]. However, ESR prevalence was lower among participants aged at least 45 years than participants aged 15–19 years, aPR = 0.0, 95% CI: [1.86e-07, 2.69e-06]. Overall, participants who reported primary school as their highest level of education reported ESR more often than those with post-primary education aPR = 2.38, 95% CI: [1.31, 4.30]. Occupation and known HIV status were not associated with ESR.

Conclusions
Self-reported ESR after VMMC declined between 2013 and 2020. Targeted efforts for counseling focusing on married men, men who had multiple sex partners, and men with lower levels of education may decrease ESR.
Prevalence of COVID-19 and associated factors among healthcare workers in the war-torn Tigray, Ethiopia
Authors: Abera Bisrat Tesfay , Gebrecherkos Teklay , Weledegebriel Migbnesh Gebremedhin , Abreha Girmatsion Fisseha 
Published: November 2024

Background
The Coronavirus disease 2019 (COVID-19) has put an enormous encumbrance on the healthcare system and healthcare workers (HCWs) worldwide, particularly in war-torn areas. As the world strives to end the pandemic, knowing the magnitude of the infection and its contributing factors in fragile settings is critical to prevent further waves of the pandemic.

Methods
Using rapid diagnostic tests (RDTs), a facility-based cross-sectional study was conducted to assess the prevalence of COVID-19 and its associated factors. The study was conducted among 326 unvaccinated HCWs in two hospitals in Tigray, Ethiopia from. The study period was from June 26 to December 31, 2021. Descriptive statistics were used to analyze the characteristics of study participants and the magnitude of COVID-19 while multivariate logistic regression was applied to assess factors affecting COVID-19 infection among HCWs.

Results
The seroprevalence of COVID-19 among HCWs in the war-torn region of Tigray was 52.4% and 56.5% using Cellex and INNOVA antibody RDTs, respectively. The point prevalence, using Abbot Antigen test, was 14.2%. The overall infection prevention and control practice (IPC) and facility preparedness was poor with >85% of the HCWs reporting not wearing eye goggle/face shield and respirator in activities that needed transmission-based precautions; none of the participants reporting as having separate waste disposal system for COVID-19 cases; and only 56.8% reporting as having an isolation area during the time of testing. In the multivariate analysis, not having isolation area (AOR = 19.6, 95% CI: 7.57–50.78), re-using of personal protective equipment (PPE) (AOR = 3.23, 95% CI: 1.54–6.77), being symptomatic (AOE = 2.4, 95% CI: 1.02–5.67), and being a medical doctor, doctor of dental surgery, and anesthetist (AOR = 3.64, 95% CI: 1.05–12.66) were significantly associated with having at least one positive result.

Conclusions
Shortage of PPE supply, poor IPC practice, suboptimal facility preparedness, and low vaccination coverage in the region contributed to the high rate of COVID-19 infection among HCWs observed in this study.
Exploring physician leadership perceptions: Insights from first- and final-year medical students
Authors: Huikko-Tarvainen Sari , Tuovinen Timo , Kulmala Petri 
Published: November 2024

Background
Leadership competence is increasingly recognized as a critical priority for all physicians, but new graduates often feel only partially prepared for leadership roles. However, integrating more leadership education into the already saturated medical curriculum poses challenges regarding timing and implementation. This study explores this issue by comparing perceptions of medical students during their academic journey to determine if leadership education could begin at the onset of medical studies.

Methods
In 2021, internet-based questionnaires were administered to first- and final-year medical students at the University of Oulu, Finland. Participation rates were 100% (116/116) for first-year students and 98% (107/109) for final-year students. Responses to the open-ended question, "How should physicians be led?" were analyzed using qualitative inductive content analysis with thematization.

Results
The study identified three main thematic categories common to both groups: (1) traits, (2) leadership approach, and (3) healthcare culture. The theme of leadership approach was further divided into two subcategories: science-oriented leadership based on practice approach and goal-oriented leadership with support as needed. The theme of traits was divided into seven subcategories: education, role model, communication, empowerment, ethics, autonomy, and collegiality. No notable differences emerged between the two groups.

Conclusions
Consistent perceptions about physician leadership throughout medical education suggest that leadership education could commence from the first year. It can thus be integrated throughout the existing longitudinal learning of the medical curriculum. Integration into the existing curriculum could facilitate the development of leadership skills without extending the curriculum’s content.
Dietary folate intake and all-cause mortality and cardiovascular mortality in American adults with non-alcoholic fatty liver disease: Data from NHANES 2003 to 2018
Authors: Dong Jinsheng , Li Zhiqiang , Wang Chenlu , Zhang Runshun , Li Yilin , Liu Mingkun , Chen Qiuye , Bai Yuning , Lv Wenliang 
Published: November 2024

Background
The relationship between dietary folate intake and prior mortality in adult patients with Non-alcoholic Fatty Liver Disease (NAFLD) has not been clearly studied. We aimed to examine the relationship between dietary folate intake and all-cause and cardiovascular (CVD) mortality in adult NAFLD patients in the US.

Methods
Using data from National Health and Nutrition Examination Survey (NHANES) 2003–2018 and associated mortality data we conducted a cohort study of US adult NAFLD subjects. Multivariable Cox proportional hazards regression models were used to evaluate the relationship between dietary folate intake and both all-cause mortality and CVD mortality, accounting for potential confounders. The study employed restricted cubic spline analysis to investigate the non-linear association between dietary folate levels and mortality from all causes and cardiovascular disease.

Results
Our final cohort consisted of 3,266 NAFLD patients, with a median follow-up of 10.3 years, 691 deaths were observed, including 221 cardiovascular deaths. Compared to participants with a folate intake in Quartile 1 (≤250 μg/d), those in Quartile 4 (≥467.5 μg/d) had multivariable-adjusted hazard ratios of 0.69 (95% CI, 0.51–0.94) for all-cause mortality (p for trend = 0.028) and 0.55 (95% CI, 0.29–1.04) for CVD mortality (p for trend = 0.107). A non-linear relationship between dietary intake and risk of death was not observed.

Conclusion
Greater dietary folate intake is associated with a reduced risk of all-cause in American adults with NAFLD. Higher dietary folate intake not found to be associated with lower CVD mortality. These findings suggest that dietary folate may improve the prognosis of adult NAFLD patients. The measured-response relationship between dietary folate intake and mortality in patients with NAFLD requires further investigation.
Complex regional pain syndrome after distal radius fracture: A survey of current practices
Authors: Wang Alice (Wei Ting) , Lefaivre Kelly A. , Potter Jeffrey , Sepehri Aresh , Guy Pierre , Broekhuyse Henry , Roffey Darren M. , Stockton David J. 
Published: November 2024

Introduction
Complex regional pain syndrome (CRPS) is a common complication following distal radius fractures that is difficult to diagnose and can lead to permanent disability. While various proposed prophylaxis and treatment modalities exist, high-quality evidence guiding practice is limited. This survey of Orthopaedic Trauma Association (OTA) and Canadian Orthopaedic Association (COA) members was conducted with the primary aim of assessing practice patterns in distal radius fractures complicated with CRPS.

Methods
An electronic survey was distributed to practicing orthopaedic surgeons in the COA and OTA. Questions assessed practice setting, preference in management of distal radius fractures and CRPS, comfort level in managing CRPS, and identification of gaps in management. Responses were anonymized and collected over 8 months. Response data was analyzed using descriptive statistics; thematic analysis was used on free text response.

Results
134 survey responses were completed. 84% of respondents felt the incidence of CRPS in distal radius fractures was 1–10%, while 15% felt it was closer to 11–20%. 24% of respondents utilized the “Budapest Criteria” to diagnose CRPS. 40% offered prophylaxis in patients felt to be at high risk of developing CRPS. 66% of surgeons felt neutral, uncomfortable, or very uncomfortable managing CRPS in distal radius fractures. When asked to consider adopting a prophylactic therapy, 38% of surgeons indicated that a therapy that reduced the absolute risk of CRPS by 6–10% would change their practice. Gaps in current practice included lack of evidence-based treatment and prevention strategies and diagnostic uncertainty.

Conclusion
This study identified that amongst orthopaedic surgeons in the COA and OTA, diagnosis, treatment, and prophylaxis strategies for CRPS in distal radius fractures are heterogeneous. Surgeons are not confident in their treatment of CRPS. Future studies using rigorous research methods are warranted to improve management.
A Matter of Minutes: Unexpected FOMC Communication and Fed Credibility
Authors: Venade João , Grilo Filipe 
Published: November 2024

Abstract
Unexpected revelations in the Federal Open Market Committee (FOMC) meeting minutes may provide critical information and hinder the Federal Reserve’s (Fed) credibility. Our analysis explores the impact of unanticipated content on FOMC policy discussions, revealing that more-hawkish-than-expected minutes reduce daily stock market returns by raising the risk premium. We also find a non-linear relationship between the unexpected minutes’ sentiment and the Fed’s credibility: surprise hawkish revelations can worsen credibility, with larger deviations further de-anchoring long-term inflation expectations from the 2 % target. Our findings suggest that the Fed should continue refining its communication strategies to avoid the damage of unexpectedly hawkish minutes in its credibility.
Enhancing IoT device security: CNN-SVM hybrid approach for real-time detection of DoS and DDoS attacks
Authors: Al-Na’amneh Qais , Aljaidi Mohammad , Nasayreh Ahmad , Gharaibeh Hasan , Al Mamlook Rabia Emhamed , Jaradat Ameera S. , Alsarhan Ayoub , Samara Ghassan 
Published: November 2024

Abstract
The Internet of Things (IoT) has expanded into a realm of cutting-edge integrated solutions across numerous applications, following three stages of development: communication, authentication, and computing. However, each layer inside the three tier IoT architecture faces a spectrum of security concerns due to the IoT’s openness, scope, and resource limits. Therefore, developing a secure IoT system is vital, shielding against attackers leveraging IoT devices to obtain network access and maintaining data security during transmission between these devices. Despite developments in Intrusion Detection Systems, identifying Denial-of-Service (DoS) and Distributed Denial-of-Service (DDoS) attacks in real-time remains a significant issue, especially in the environment of IoT devices, which are diverse and resource restricted. This study provides a Convolutional Neural Network-Support Vector Machine (CNN-SVM) hybrid technique, targeted at overcoming these limits by enhancing detection speed and accuracy, thus addressing this substantial gap in the area. This research offers a hybrid model that combines CNN for feature extraction with SVM as a classifier. This model employs a CNN to extract essential elements from the data and classifies attacks as either DDoS or benign. Our results highlight the potential performance of our model, which was trained on the real Canadian institute for cybersecurity (CIC) IoT dataset in 2023. Notably, our hybrid model outperformed classic machine learning (ML) alternatives such as CNN, SVM, K-nearest neighbors, Naïve Bayes, and Logistic Regression. During testing, our model attained a remarkable accuracy rate of 99% and an F1-score of 99%, outperforming the highest-performing SVM ML model with an accuracy of 98% and the other ML methods.
Utilization of deep learning in ideological and political education
Authors: Cai Sulong 
Published: November 2024

Abstract
As society develops and educational needs continue to change, the traditional way of teaching ideology and politics is facing challenges in terms of efficiency and effectiveness evaluation. In response to the low efficiency of ideological and political education (IPE) methods and the difficulty in accurately and comprehensively evaluating students’ ideological and political literacy and moral qualities, this article used the Long Short-Term Memory with Self-Attention Mechanism (LSTM-SAM) model to conduct experiments on the evaluation of IPE effectiveness. First, by collecting information on IPE from a research center of a certain university in 2023, and then using the LSTM (Long Short-Term Memory) model to catch the long-term dependencies of IPE, the learning trajectory and changing trends of students can be better understood. The self-attention mechanism was applied to dynamically learn and distinguish the importance of different parts in the input sequence, better weighting key features such as student learning behavior and participation level, thereby enhancing the accuracy and robustness of effectiveness evaluation. Finally, the splicing method was adopted to integrate the LSTM model and self-attention mechanism for the experiment, and the teaching efficiency of different teaching methods was statistically analyzed through a questionnaire survey. The test results indicated that the classification accuracy of the LSTM-SAM model reached 98.41%, which was 1.61% higher than the LSTM model. The teaching efficiency was the highest under the gamified teaching method, providing an effective method for evaluating the effectiveness of IPE and providing useful reference for optimizing teaching methods.
Analyzing the performance of the SD-WDM system with varying channel spacing
Authors: Kumar Ghanendra , Kumar Chakresh 
Published: November 2024

Abstract
In this paper, the performance of 300 × 10 super dense wavelength division multiplexing (SD-WDM) system has been evaluated with unequal channel spacing. Further, evaluation is carried out for the proposed system to consider the effect of different modulation formats, input power, and high speed data rate. Massive impression is recorded by RZ modulation format with the support of Raman-EDFA hybrid optical amplifier (HOA) for acceptable characteristics of super dense communication system.