bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Diagnostic Dilemma: A Case of Angiosarcoma Presenting as Splenomegaly and Pathologic Fracture
Authors: Gilman Elizabeth A. , Ressler Steven W. , Fasolino John P. , Graham Rondell P. , Croghan Ivana T. , Hurt Ryan T. 
Published: October 2024

Background: Angiosarcomas are rare tumors that can be difficult to diagnose due to subtle changes in the vascular endothelium. When there is evidence to suggest malignancy, such as a pathologic fracture, further investigation is needed, and a high suspicion for angiosarcoma needs to be present so that appropriate immunohistochemical stains are utilized on biopsied tissue. In situations where such suspicion is high and prior biopsies have been negative, performance of splenectomy, can be both diagnostic and therapeutic when splenomegaly is present. Case Report: This is a case of a 52-year-old woman with splenomegaly, initially attributed to infection, in the setting of upper respiratory symptoms and thrombocytopenia. Three months later, however, she presented with back pain. Imaging showed lytic bone lesions with pathologic vertebral fracture and numerous liver lesions that were too small to characterize further. Initial biopsies of the liver and bone did not reveal a pathologic process. Several months later, still without a unifying diagnosis, she presented to our institution. MRI of the brain was done for neurologic concerns and showed pathologic enhancement in the calvarium. A PET scan showed diffuse avidity of the skeleton and spleen. After discussing the case with a hematologist, splenectomy was performed for both diagnostic and therapeutic purposes. Angiosarcoma was identified in the spleen and in a PET-directed bone biopsy. With a definitive diagnosis, she returned home and subsequently elected to pursue hospice care. Conclusion: When there is a high clinical suspicion for malignant angiosarcoma, a multidisciplinary approach is necessary to direct both tissue acquisition and necessary histochemical staining.
A Service Evaluation of More Than 27 000 Adults Referred to a Community Weight Management Program: 24-Month Outcomes
Authors: Toon Josef , Bennett Sarah-Elizabeth , Lavin Jacquie , Pallister Carolyn , Avery Amanda 
Published: October 2024

Background: Obesity has a significant impact on healthcare resources with limited accessible support available through the NHS. This service evaluation determines 24-month efficacy of referral to an open-group behavioral program by BMI category and socioeconomic status. Methods: This retrospective, longitudinal study examined weight outcomes of adults living in England referred by healthcare professionals to Slimming World during 2016 who recorded at least 1 weight change. Primary outcome was % weight change at 3, 6, 12, and 24 months. Socioeconomic status was measured using the Index of Multiple Deprivation (IMD). Data from a post-referral questionnaire investigated self-reported changes in dietary and activity behaviors. Results: Twenty-seven thousand five hundred sixty (15.6% male) records were analyzed. Mean (SD) age and BMI on joining were 48.6 (14.80) years and 37.1 (6.31) kg/m2; 91.7% had a BMI > 30 kg/m2. Mean (SD) % weight change was −5.6 (3.79), −7.1 (5.71), −7.5 (6.88), and −7.3 (6.88) at 3, 6, 12, and 24-months, respectively. At 24- months, differences in weight loss between BMI category were significant, ranging from 0.29% (35-<40 vs 40+) to 1.33% (25-<30 vs 40+). For IMD quintile only comparisons against Q1 and Q2 were significant, ranging between 0.36% (Q2 vs Q3) to 0.94% (Q1 vs Q5). Five thousand eight hundred sixty-two (21.2%) completed the post-referral questionnaire. There were no BMI category effects on dietary behaviors but changes in physical activity behaviors were lower within the higher categories albeit effect sizes were small (all ges < 0.001). IMD quintile influenced changes for sugary drinks, watching TV and avoiding moderate activity although effect sizes were small (all ges < 0.01). Conclusion: Following 12-week referral to a commercial weight management organization, a mean weight loss of over 7% was reported at 24-months. Adults with higher BMIs and a greater level of deprivation can benefit from the practical support offered as part of the referral, supporting weight loss and weight loss maintenance albeit with some inequality.
Summarizing Recommendations for the Prevention of Occupational Heat-Related Illness in Outdoor Workers: A Scoping Review
Authors: Edgerly Ashley , Gillespie Gordon Lee , Bhattacharya Amit , Hittle Beverly M. 
Published: October 2024

Background: Outdoor workers face unique challenges in preventing heat-related illnesses (HRI). Although preventable, HRI and death from heat exposure continue. A review of the most recent recommendation for HRI prevention in outdoor workers in the United States was warranted. A scoping review using PRISMA guidelines was conducted to compile policy statements and recommendations on the prevention of HRI and synthesize them into a three-step plan for prevention using the Haddon Matrix. Method: PubMed, CINAHL, Medline, and websites from organizations and regulating bodies were searched for sources. Key terms such as occupational OR workers OR employers OR policymakers, HRI OR heat stress OR heat, prevention, recommendations OR position statements were used. Inclusion criteria were articles published within the last 5 years written in English and containing recommendations for preventing HRI in outdoor workers. Research not based on U.S. workers was excluded from the review. Results: Twenty sources comprised the review. Several themes emerged, indicating deficient recommendations for secondary and tertiary prevention. Conclusion/Application to Practice: This review’s findings can be used by occupational health nurses (OHNs) in developing comprehensive interventions for preventing HRI and injury, using clear language, and following evidenced-based practices to increase workplace health and safety and promote equity.
How do Carbon  Emissions Spillovers Reshape Metal Market Dynamics? Time– Frequency Insights on Precious and Non-precious Metals
Authors: Gupta Himani , Katoch Rupinder 
Published: October 2024

Global disruptions, such as health crises and geopolitical tensions, significantly impact both climate and commodity dynamics. This study, well-grounded on environmental finance theory, input–output modelling, socio-transition philosophy and behavioural finance perspectives, explores the evolving interactions between carbon emissions (CE) and metal markets during COVID-19 pandemic and Russia–Ukraine war (RUW). The study uses time-varying parameter vector autoregressive model (TVP-VAR) technique to evaluate time and frequency varying connectedness between CE and metal markets from 3 January 2020 to 28 June 2024. During the COVID-19 pandemic, initial connectedness among selected markets peaked at 85%, averaging 46%, highlighting a significant CE–metal nexus that necessitates strategic responses. In the RUW period, connectedness averaged 47.82%. CE influence metal markets primarily in the short term. Wavelet coherence analysis reveals that palladium and platinum are highly sensitive to CE over the long term, while gold and silver may serve as effective diversifiers and hedges against carbon-related risks in metal investments. The study is relevant for investors in the metal sector with environmental considerations. JEL Classifications: G110, Q430, L720
Do Financial Community’s Tweet Sentiments  Affect the Stock Market? Evidence from an  Emerging Economy
Authors: Saini Shivani , Bodla Bhag Singh 
Published: October 2024

In the era of social media and internet, Twitter (presently ‘X’) has been recognized as the prominent factor for financial markets by multiple corporates and experts. The motivation of present research hinges on burgeoning popularity of Twitter in the financial community for sharing information and impact of their hidden sentiments on financial markets. Research on tweet-based sentiments and their influence on financial markets in India is still in the infancy stage. To cover this gap, the present study empirically investigates the predictive impact of financial tweet sentiments on the Indian stock Index’s returns over a short period. The paper scraped 22,816 tweets and Nifty 50 index’s intraday hour end values for January 2023. Using Natural Processing Technique, the overall sentiments of the financial community are found as highly positive for each trading hour. Next, it presents a low positive correlation between positive sentiments, sentiment polarity, and hourly returns. Lagged negative sentiments reflect the better ability to impact current period returns than positive sentiments and polarity. Additionally, sentiment polarity and returns reflect bi-directional causation for the future period impact. Investors, stock market traders, and other practitioners can employ the proven concept of linkage between tweet sentiments and returns for constructing effective investment and trading strategies. JEL Classifications: G41, D53, G17, G02, G19
Effects of SGLT2i and Pioglitazone on FIB-4 Index in Patients with Metabolic Dysfunction Associated Steatotic Liver Disease—A Real World Retrospective Study from India
Authors: Seshadri Krishna G. , Padhye Dakshata , Tippisetty Surekha , Polisetti Subhadra , Gadia Smriti 
Published: October 2024

Aims: Several studies support type 2 diabetes mellitus (T2DM) as one of the risk factors of metabolic dysfunction associated steatotic liver disease (MASLD). Recently, the use of pioglitazone and sodium-glucose co-transporter 2 inhibitors (SGLT2i) has been on the rise considering its beneficial effects in reducing liver dysfunction. We aim to determine the clinical effectiveness of these drugs in improving MASLD and T2DM. Materials and methods: We conducted a retrospective study of 279 T2DM patients with MASLD who were prescribed pioglitazone and/or SGLT2i from two clinics in India. The primary endpoint was change in fibrosis (FIB-4) index and the aspartate aminotransferase to platelet ratio index (APRI) score at one year follow-up. Appropriate statistical tests were applied to assess the significance of the outcomes. Results: Of the total (276) patients, 46% of patients were at low risk of advanced fibrosis, 11% were at high risk for advanced fibrosis, and the majority (50%) were on SGLT2i treatment. At follow-up, there is a statistically significant reduction in the mean (SD) FIB-4 index (1.92 [1.22] vs. 1.68 [0.99]) and APRI score (0.42 [0.34] vs. 0.33 [0.21]); p < .001. Among treatment groups, there is a significant difference in the mean FIB-4 index both at baseline (F: 4.23; p < .05) and follow-up (F: 3.45; p < .05). These scores were highly significant in the combination treatment with SGLT2i and pioglitazone ( p < .05). Conclusions: Our results indicate a combination therapy with SGLT2i and pioglitazone might be beneficial in managing MASLD, especially in reducing the FIB-4 index and APRI score in Indian T2DM patients with MASLD.
Perceptions of the 2D short animated videos for literacy against chronic diseases among adults with diabetes and/or hypertension: a qualitative study in primary care clinics
Authors: Pichayapinyo Panan , Sompopcharoen Malinee , Thiangtham Weena , Sillabutra Jutatip , Meekaew Phenchan , Bureerat Benyada , Somboonkaew Armote 
Published: October 2024

Abstract
Background
Animation has promise for teaching complex health content through smartphone applications. However, smartphones have had limited use in Thailand for health literacy improvement among adults with chronic diseases. This study aims to explore the perceptions of adults with diabetes and/or hypertension resulting from 2D short animated videos for literacy against chronic disease that are available via smartphones.

Methods
Four animated videos were initially developed based on clinical practice guidelines and nursing experience. Physicians, an expert in health education, and an animation team developed and revised scripts and storyboards of the animated videos. Lastly, videos were validated by physicians and health educators for content breadth and depth and by media experts for motion graphics and illustration. Each video presents a different situation in diabetes, hypertension, missing appointments, and obesity, ranging from 2.18 to 4.14 min in duration. The inclusion criteria were adults 35–70 years old with diabetes or hypertension who received care from primary care units. Thematic analysis was performed on the extracted data.

Results
Twenty participants with a mean age of 58.4 years (SD 6.7; ranged 41–68) were focus-group interviewed. Three animation elements were assessed, including presentation, impacts, and suggestions. Participants had positive responses regarding the presentation (suitability of images and smooth motion graphics, short length of videos, simple language, understandable content, and clear sound) and impacts (recalling information, enhancing engagement, and motivating health awareness and behavior change). Suggested improvements were for a bigger font size for subtitles and considering the use of spoken text instead of on-screen text for recommendations at the end of the animations.

Conclusions
Animated videos are acceptable for delivering health information. Pilot testing animated videos for promoting literacy against chronic diseases in adults with diabetes and hypertension is needed for optimal utility.
Risk factors of the antenatal depression in a sample of Italian pregnant women: a preliminary study
Authors: Sergi Maria Rita , Saggino Aristide , Balsamo Michela , Picconi Laura , Anchora Luigi , Tommasi Marco 
Published: October 2024

Abstract
Background
Antenatal depression is characterized by low mood, insomnia, disorganised behaviour, irritability, and agitation during the pregnancy. If underestimated, antenatal depression is untreated during the pregnancy. It is associated to higher levels of suicide, higher risk of depression after childbirth, preeclampsia, preterm birth, low birth weight, poor interactions between child and mother and severe obstetric outcomes. New data underlined the importance to prevent the risk of depression during the pregnancy. This study examines the predictive validity of potential risk factors, such as socio-demographic and psychological factors, in developing the antenatal depression.

Methods
The sample was composed by Italian pregnant women (N = 247, mean age of 33.77, SD = 4.78 years). This sample completed the Edinburg Postnatal Depression Scale (EPDS), the Teate Depression Inventory (TDI) and questionnaires about demographic variables. To study associations among variables examined bivariate correlations were computed. To analyse the role of socio-demographic factors and the psychological dimension to predict the severity of the antenatal depression a logistic regression was performed.

Results
Results showed significantly positive correlations between the EPDS and the TDI, and no associations among the EPDS and all socio-demographic factors. Therefore, only the psychological factors were significant predictive risk factors of antenatal period. Finally, higher score of the depression measured via TDI predicted higher score of the EPDS.

Conclusions
Our results had implications in clinical field. Indeed, the early diagnosis of depression during the pregnancy can help operators in the gynaecological field to prevent the depression in the post-partum period.
Factors associated with dementia-related stigma in British adolescents
Authors: Hassan Esra , Hicks Ben , Tabet Naji , Farina Nicolas 
Published: October 2024

Abstract
Background
Dementia-related stigma is a prominent barrier for people living with dementia, leading to poor well-being and social isolation. Adolescents are an under-researched group in society that may already have experience of dementia and are more susceptible to attitudinal change which makes them ideal targets for anti-stigma initiatives outlined by public health policy. For the development of evidence-based anti-stigma initiatives in adolescents, it is important to understand which socio-demographic groups are most likely to develop stigmatising attitudes and why. This study aims to identify factors of dementia-related stigma in adolescents.

Methods
A total of 1,044 adolescents (aged 11–18 years) from across six regions of England were included in the analysis of this cross-sectional, survey-based study. Descriptive statistics and multiple regressions were employed to explore the association between demographic variables, modifiable factors of dementia-related stigma and the outcome of dementia-related stigma. A path analysis via a structural equation model was employed to test for direct and mediatory effects.

Results
Multiple regression models revealed that younger adolescents, those with higher levels of contact with dementia, higher levels of empathy, higher levels of dementia knowledge, and higher affinity to older adults, are associated with more positive dementia attitudes in adolescents (p < 0.05). Within the accepted structural equation model, empathy, level of contact and dementia knowledge were key mediators of dementia-related stigma (p < 0.05).

Conclusion
This study highlights that modifiable factors such as level of contact, ageism, and empathy have a potentially important role in how dementia-related stigma may start to form in the adolescent years. Developing contact-based strategies that stimulate empathetic responses may be useful targets for stigma reduction initiatives for adolescents.
“I have learned that nothing is given for free”: an exploratory qualitative evaluation of a social norms edutainment intervention broadcast on local radio to prevent age-disparate transactional sex in Kigoma, Tanzania
Authors: Howard-Merrill Lottie , Pichon Marjorie , Witt Alice , Sono Revocatus , Gimunta Veronicah , Hofer Enrica , Kiluvia Fatina , Alfred Mengi , Yohanna Emmanuel , Buller Ana Maria 
Published: October 2024

Abstract
Background
Promising evidence supports the effectiveness of edutainment interventions in shifting norms to prevent violence against women and girls and other harmful practices, yet further research into mechanisms and pathways of impact is needed to inform intervention development, delivery and scale-up. This exploratory qualitative evaluation examined the feasibility and indications of change in attitudes, beliefs, norms and behaviours following the broadcast of a radio drama aired to prevent age-disparate transactional sex in Kigoma, Tanzania.

Methods
Over seven weeks, six episodes were broadcast on local radio weekly, between November and December 2021 in Kigoma, targeting adolescent girls (aged 13–15 years) and their caregivers. Reflection sessions were conducted twice a week with 70 girls across seven schools, supplemented by after-school Girls’ Club listening sessions for a subgroup of 30 girls. We conducted seven before and after focus group discussions, five with girls (n = 50), one with men caregivers (n = 9) and one with women caregivers (n = 9) and analysed them using thematic and framework analysis approaches.

Results
Overall, we found that while girls exhibited significant engagement with the drama, caregiver participation, particularly among men, was low. Thus, no clear changes were detected in men. We did not find any differences in impact based on listening sessions’ attendance vs. home listening. We detected positive changes among girls and women in four thematic areas after listening to the drama: (1) participant’s increasingly challenged perceptions about what kinds of girls and men take part in age-disparate transactional sex, what can be exchanged, and men’s motivations for engaging; (2) there was a shift from attributing blame for age-disparate transactional sex relationships from girls to men; (3) girl’s reported increased agency and confidence to avoid age-disparate transactional sex relationships; and (4) we found a heightened sense of responsibility and recognition for the role of parents, peers and community members in preventing age-disparate transactional sex.

Conclusions
These findings highlight the need for further implementation research to explore ways to effectively engage men. They also underscore the potential of engaging, evidence-based edutainment interventions in fostering spontaneous critical reflection about complex behaviours such as age-disparate transactional sex, and diffusing key messages among target populations without the use of organised diffusion activities.
Implementation of digital remote postoperative monitoring in routine practice: a qualitative study of barriers and facilitators
Authors: McLean Kenneth A. , Sgrò Alessandro , Brown Leo R. , Buijs Louis F. , Mozolowski Kirsty , Daines Luke , Cresswell Kathrin , Potter Mark A. , Bouamrane Matt-Mouley , Harrison Ewen M. 
Published: October 2024

Abstract
Introduction
Remote monitoring can strengthen postoperative care in the community and minimise the burden of complications. However, implementation requires a clear understanding of how to sustainably integrate such complex interventions into existing care pathways. This study aimed to explore perceptions of potential facilitators and barriers to the implementation of digital remote postoperative monitoring from key stakeholders and derive recommendations for an implementable service.

Methods
A qualitative implementation study was conducted of digital remote postoperative wound monitoring across two UK tertiary care hospitals. All enrolled patients undergoing general surgery, and all staff involved in postoperative care were eligible. Criterion-based purposeful sampling was used to select stakeholders for semi-structured interviews on their perspectives and experiences of digital remote postoperative monitoring. A theory-informed deductive-inductive qualitative analysis was conducted; drawing on normalisation process theory (NPT) to determine facilitators for and barriers to implementation within routine care.

Results
There were 28 semi-structured interviews conducted with patients (n = 14) and healthcare professionals (n = 14). Remote postoperative monitoring was perceived to fulfil an unmet need in facilitating the diagnosis and treatment of postoperative complications. Participants perceived clear benefit to both the delivery of health services, and patient outcomes and experience, but some were concerned that this may not be equally shared due to potential issues with accessibility. The COVID-19 pandemic demonstrated telemedicine services are feasible to deliver and acceptable to participants, with examples of nurse-led remote postoperative monitoring currently supported within local care pathways. However, there was a discrepancy between patients’ expectations regarding digital health to provide more personalised care, and the capacity of healthcare staff to deliver on these. Without further investment into IT infrastructure and allocation of staff, healthcare staff felt remote postoperative monitoring should be prioritised only for patients at the highest risk of complications.

Conclusion
The COVID-19 pandemic has sparked the digital transformation of international health systems, yet the potential of digital health interventions has yet to be realised. The benefits to stakeholders are clear, and if health systems seek to meet governmental policy and patient expectations, there needs to be greater organisational strategy and investment to ensure appropriate deployment and adoption into routine care.

Trial registration
NCT05069103.