bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health Expenditure Among the Outpatient of Type 2 Diabetes in Selected Hospital of Kathmandu District: A Cross‐Sectional Study
Authors: Shrestha Rasmita , Shakya Aditya , Sapkota Vishnu Prasad 
Published: October 2024

Background: Out‐of‐pocket (OOP) expenditure is the dominant financing mechanism in low‐ and middle‐income countries. In these countries, the prevalence of diabetes has been rising more rapidly leading to various microvascular complications thus increasing the risk of dying prematurely.Methods: A cross‐sectional hospital‐based study was carried out to compare the OOP expenditure of diabetic patients treating in public and private hospitals. A total of 154 diabetic patients, that is, 77 in each type of hospital were selected for face‐to‐face interviews using structured questionnaires. Lorentz curve and concentration curve were prepared using the income and expenditure of the patients.Results: Among 154 patients, 97.4% of patients paid OOP for the treatment of diabetes. The mean direct cost per month was NPR 7312.17 (about 55 USD) in public and NPR 10,125.31 (around 76 USD) in private hospitals. Direct medical cost had a higher share in total direct cost, that is, 60.5% in public and 69.3% in private hospitals.Conclusion: Direct medical cost was higher in private hospital compared to public hospital. All the income groups paid a similar amount of money for the treatment, placing a higher economic burden on poor patients, as there was no financial protection mechanism fully covering their health expenditure.
Trends in Gaps of Care for Patients With Congenital Heart Disease: Implications for Social Determinants of Health and Child Opportunity Index
Authors: Zaidi Abbas H. , Alberts Adam , Chowdhury Devyani , Beaty Claude , Brewer Benjamin , Chen Ming Hui , de Ferranti Sarah D. 
Published: October 2024

Background
Lifelong continuity of care is essential for patients with congenital heart disease (CHD) to maximize health outcomes; unfortunately, gaps in care (GIC) are common. Trends in GIC and of social determinants of health factors contributing to GIC are poorly understood.

Methods and Results

This retrospective cohort study included patients with CHD, aged 0 to 34 years, who underwent surgery between January 2003 and May 2020, followed up at a pediatric subspeciality hospital. Patients were categorized as having simple, moderate, and complex CHD based on 2018 American Heart Association and American College of Cardiology guidelines. Social determinants of health, such as race, ethnicity, language, insurance status, and Child Opportunity Index, based on home address zip code, were analyzed. Of 2012 patients with CHD, a GIC of ≥3 years was identified in 56% (n=1119). The proportion of patients with GIC per year increased by 0.51% (
P
<0.001). Multivariable longitudinal models showed that the odds of GIC were higher for patients who were ≥10.5 years old, had simple CHD, lived out of state, lived farther from care site, received public insurance, had less protection with additional insurance plans, and with low Child Opportunity Index. A separate model for patients with only moderate/complex CHD showed similar findings. Race and ethnicity were not associated with the odds of experiencing GIC over time.

Conclusions
GIC have increased over time for patients with CHD. Social determinants of health, like insurance, access, and neighborhood opportunity, are key risk factors for increasing GIC. Efforts to reduce GIC in patients with CHD should focus on addressing the impact of specific social determinants of health.
Primate focused conservation education in Paraguay: Doing something Para La Tierra
Authors: Smith Rebecca L. , Ayala Santacruz Jorge Damián 
Published: October 2024

Abstract
Over 91% of the Paraguayan Upper Paraná Atlantic Forest has been cleared and the Gran Chaco is the fastest disappearing habitat on the continent. One of the compounding issues for conservation in Paraguay is the lack of knowledge of the importance of nature amongst the population. Fundación Para La Tierra (PLT) began the country’s first Eco-Club program, “Voces de la Naturaleza” (Voices of Nature), in 2016. Three of the curriculums participatory lessons focus on primate conservation. These lessons formed the basis of PLT’s Atlantic Forest education programme in 2018 when the team began visiting 22 schools around San Rafael (Tekoha Guasu). To date 26 schools (1,500+ children) across two political departments and four districts have participated in this programme which is now entering its 6th year. The biggest challenges have included the COVID-19 pandemic and the logistics and costs involved in reaching rural and remote schools. Though it is too soon to record observable behavioural change ongoing monitoring over the six year period indicates that children remember the information gained through the participatory methods for several years. We believe that the main reasons for the success of this programme are the collaborations that we have built with the teachers of the schools based on open communication and mutual respect. Though costs can be an issue when beginning, or running, a long-term project we recommend that potential educators not be put off trying and that a lot of good can be achieved with a small amount of funding.
Replacing soybean meal with house cricket (Acheta domesticus) meal in ruminant diet: effects on ruminal fermentation, degradation, and biohydrogenation
Authors: Hervás G. , Toral P.G. , Labbouz Y. , Baila C. , Boussalia Y. , Frutos P. 
Published: October 2024

Abstract
Insect meals could be a sustainable protein source in ruminant diets to overcome the environmental, market, and feed-food-fuel issues associated with the widespread use of soybean meal (SBM). However, research on this topic is still very scarce. This study was conducted to examine the possibility of replacing SBM with house cricket (Acheta domesticus) meal (HCM) in ruminant feeding. Four cannulated sheep were fed a total mixed ration containing either 10% SBM (Control diet) or 10% of non-defatted HCM (Insect diet) over two consecutive periods. Effects on ruminal fermentation, degradation, and biohydrogenation were evaluated. Despite some differences in rumen dry matter and N degradation kinetics, replacing dietary SBM with HCM did not affect the ruminal disappearance of dry matter, N and, neutral detergent fibre of in situ incubated feedstuffs. Nor were there differences between the meals in the in vitro intestinal digestibility of rumen non-degraded nitrogen. The replacement had no negative effects on rumen pH or ammonia concentrations, but resulted in lower total and individual (i.e. acetate, propionate, butyrate, and minor) volatile fatty acid concentrations. This adverse effect was probably due, at least in part, to the unexpectedly high content of fat in HCM and its relatively high degree of unsaturation. Inclusion of HCM in the diet facilitated modulation of the fatty acid profile of the rumen digesta without negative effects on biohydrogenation pathways (e.g. it increased trans-11 18:1 and cis-9 trans-11 CLA concentrations, with only a small variation in the trans-10:trans-11 18:1 ratio). Replacing SBM with HCM in ruminant diets could be a promising alternative to address the challenges related to SBM and to improve the lipid composition of ruminant-derived products. However, further research is still needed to investigate, for example, the most appropriate level of inclusion of HCM in the diet or the use of defatted meal.
The Role of Constitutional Review to Determine the Emergency Operation of Parliaments
Authors: Szentgáli-Tóth Boldizsár 
Published: October 2024

Abstract
Based on a recently published English-language global database on constitutional case law linked to the global pandemic, my contribution aims at analysing the currently underestimated link between constitutional review and the emergency operation of parliaments. Although the fact, that huge research endeavors have been devoted to the evaluation of parliamentary solutions adapting to the Covid-19 pandemic, the role of constitutional review has not been understood more deeply in this process until now. However, several constitutional constitutional courts have heard significant matters of parliamentary law during and shortly after the public health emergency, and despite the mostly deferential character of constitutional/supreme courts, the relevant rulings from around the world provided meaningful orientations how to describe rliamentary margin of movement to regulate internal structure and organisation during such extraordinary periods. This contribution will enumerate such constitutional/supreme court decisions and will assess their added value to maintain effective parliamentary work under the shadow of unprecedented challenges.
3. Reconstituer les décors d’un théâtre de la première moitié du XIXe siècle. Enjeux de la recherche en scénographie
Authors: Bortolotti Raphaël 
Published: October 2024

Les décors de théâtre ont la particularité d’être conçus pour le contexte spécifique de la représentation théâtrale. Les chercheurs en scénographie sont donc amenés à considérer les décors comme partie intégrante de l’événement théâtral, prenant en compte l’espace théâtral, l’éclairage, la présence des acteurs, la machinerie et les machinistes, etc. À partir de décors originaux du milieu du XIXe siècle conservés au théâtre de Feltre en Italie du Nord, cet article examine les composantes de l’événement théâtral relevant de la scénographie, en croisant des sources de natures diverses, telles que des traités, des comptes rendus de périodiques ou de spectateurs, des traités de gestion théâtrale, des documents d’archives théâtrales (inventaires, contrats avec des peintres ou des machinistes, etc.).
Theatre sets have the particularity of being designed for the specific context of theatrical performance. Research on scenography is therefore led to consider sets as an integral part of the theatrical event, and take into account the theatrical space, the lighting, the presence of the actors, the machinery and the stagehands, etc. Based on original stage sets from the mid-nineteenth century preserved in the theatre of Feltre in northern Italy, this article examines the components of theatrical events relating to scenography, by cross-referencing sources of various kinds, such as treatises, reports from periodicals or spectators, treatises on theatrical management, and documents from theatrical archives (inventories, contracts with painters or stagehands, etc.).
6. Étudier les wauxhalls parisiens (1766–1798)
Authors: Piquart-Vesperini Magaly 
Published: October 2024

Dans la seconde moitié du XVIIIe siècle, les wauxhalls, salles de bal semi-éphémères, apparaissent à Paris, issus d’un transfert culturel. Ces nouveaux lieux de loisirs sont importés par des artificiers qui tentent d’adapter au goût parisien les pleasure gardens londoniens éponymes. Leur durée d’existence relativement courte, environ une dizaine d’années, laisse au chercheur peu de sources pour les étudier. En fonction de leurs commanditaires, qu’ils soient artificiers-entrepreneurs, hommes de spectacle ou grands du royaume, le traitement de leurs archives est assez inégal. L’étude de ces sources primaires prend alors des formes variées, allant du traditionnel dépouillement de fonds d’archives à la lecture de périodiques, d’almanachs ou tout autre document issu de la littérature contemporaine faisant mention de ces édifices. Nous proposons de donner ici un aperçu des sources utilisées pour l’étude des wauxhalls parisiens, enrichissant les sources visuelles exploitées en histoire de l’art. Cela nous permet d’étudier l’histoire matérielle de ces édifices et ainsi de tenter de reconstituer ces architectures disparues.
During the second part of the eighteenth century, wauxhalls, ephemeral ballrooms, began to be built in Paris. These venues generally remained in business for around ten years, which explains the paucity of resources available to researchers. The diversity of wauxhall owners, who included pyrotechnicians, theatre professionals or even the kingdom’s upper nobility, is another reason why archives on these buildings are of widely divergent quality. In order to study wauxhalls, researchers must draw on primary sources that come in different forms, ranging from traditional archival collections to contemporary periodicals, almanacs and other literary sources touching on these structures. This article presents an overview of the kinds of sources used in this research, enriching the visual resources traditionally used in art history. As well as allowing us to study the material history of wauxhalls, they enable us to attempt to reconstitute this lost architectural heritage.
The Clinical Value of Computed Tomography of Facial Bone Injuries in Pediatric Trauma Patients
Authors: Butchy M. Virginia , Williamson John , Lou Johanna , Williams Jennifer , Kota Rasagnya , Kazmi Khuram S. , Katz Douglas , Moront Matthew , Lindholm Erika B. 
Published: October 2024

Background Head trauma is responsible for significant morbidity and mortality in the pediatric trauma population. There are validated guidelines which indicate the necessity for computed tomography of the head (CTH), but the indication for a dedicated CT of the facial bones (CTF) is less clear. We sought to identify our population of head trauma patients who would clinically benefit from the addition of CTF. Methods Using the electronic medical record, pediatric trauma patients who underwent CTH and/or CTF from 2016 to 2021 were identified. We collected information on demographics, traumatic mechanism, subspecialty consultation, and operative and procedural interventions. Results 2117 pediatric patients were evaluated. A total of 372 patients received CTH and 173 patients received both CTH + CTF. Patients with CTH + CTF were older ( P < 0.001), involved in high-velocity blunt trauma ( P < 0.001), and had a longer length of stay ( P < 0.001). There were no fractures identified in 73 (42.2%) patients with both CTH + CTF. Of patients with fractures, there were 204 fractures identified and 73.0% (149/204) of fractures were seen on both the CTH + CTF. There were 19.6% (40/204) read only on CTF and 10 patients (5.7%) had a fracture requiring intervention. 8 of the 10 fractures requiring operative intervention were mandibular bone fractures. Discussion Computed tomography of the head can be used as a screening tool for facial fractures. A negative CTH can eliminate the need for additional radiation from a CTF. Computed tomography of the facial bones will identify more fractures, but few requiring intervention. We suggest that CTF be limited to a subset of pediatric trauma patients with facial injury.
Medical misinformation in social media: Representations of gastrointestinal disorders on a short video platform
Authors: Bell Matthew T , Stephan Alicia , Cumpian Nicholas , Alao Hawwa , Atla Pradeep R , Srivastava Neetika , Fleischman Wayne M , Eysselein Viktor E , Reicher Sofiya 
Published: October 2024

Background and Objectives: Short video platforms have become one of the most common methods for disseminating medical information on social media. We analysed gastrointestinal (GI)-related content on TikTok, focusing on the creators’ background, patterns of content utilisation and overall content quality and understandability, using validated metrics to quantify the degree of misinformation. Methods: Twelve hashtags related to common GI conditions on TikTok and the 20 most engaging posts associated with each hashtag were selected for review. The ‘most engaging’ status was determined by the application’s internal algorithm. Six GI board-certified physicians evaluated the videos using two validated instruments: DISCERN quality criteria and Patient Education Materials Assessment Tool (PEMAT-A/V) survey. Results: In total, 253 videos were reviewed with 18.6 billion likes, 191,000 comments, 935,000 saves and 927,000 shares. IBS hashtag had the greatest number of views (2.2 billion), while videos on haemorrhoids had the most likes (4.3 million), comments (59,000) and shares (288,000). Most videos 177/253 (70%) were created by non-healthcare workers. The median video quality was 2/5 on DISCERN Likert-type scale with 23/75 DISCERN score. Of 186 videos, 114 (61.3%) were rated ‘very poor’; 58/186 (31.2%) ‘poor’, 13/186 (7%) ‘fair’ and only one video (0.5%) was rated ‘excellent’ on DISCERN grading system. The median PEMAT-A/V scores were 7/12 (73.9%) for understandability and 1/3 (33.3%) for actionability. Conclusion: Our study highlights significant public interest in common GI disorders. However, most posts lacked substantive information and did not have verifiable sources.
Key elements of Goal-Directed Training for children with cerebral palsy: A qualitative content analysis
Authors: Ogilvie Louise , Garbellini Simon , Sakzewski Leanne , Davidson Sue-Anne , Elliottt Catherine 
Published: October 2024

Background: Goal-directed training is an evidence-based occupational therapy intervention for children with cerebral palsy targeting motor performance and goal attainment. There is variability and limited description on goal-directed training delivery within the studies who found it a successful intervention. The aim of this study was to establish the who, what, why and how of goal directed training according to practicing occupational therapists. Methods: Occupational therapists currently delivering goal-directed training to children with cerebral palsy were recruited. Qualitative data were collected from structured, open-ended interviews and analysed through content analysis. Themes and consensus answers were elicited and mapped to the Template for Intervention Description and Replication checklist. Results: Four key elements were identified as essential for goal-directed training: goal setting, task analysis, active intervention and evaluation. Within each area, occupational therapists provided rich descriptions of what these elements looked like in practice. Despite having a clear understanding of goal-directed training, some barriers to implementation were identified. Conclusion: Occupational therapists identified key elements and barriers to implementing goal-directed training in their practice. It is recommended that further support and training is provided to ensure that occupational therapists deliver goal-directed training with high fidelity.
Identifying idiopathic intracranial hypertension in a hospital-based chronic headache population: Utility of magnetic resonance imaging, magnetic resonance venography and trans-orbital sonography
Authors: Rehab Mennatallah Mohamed , Farag Sherien Mohamed , Swelam Mahmoud Saad , Salem Haitham Hamdy , Moustafa Ramez Reda 
Published: October 2024

Background One of the most underestimated types of chronic headaches is headaches as a result of cerebro-spinal fluid dysregulation disorders. Idiopathic intracranial hypertension (IIH) presents with headache and visual symptoms and usually is associated with papilledema. We identified patients with IIH in a chronic headache population presenting to a hospital-based headache clinic, and studied its associations with clinical, sonographic and magnetic resonance imaging (MRI) findings. Methods Of 168 patients, 141 chronic headache patients were identified and completed the study procedures (semi-structured medical interview, fundus examination, MRI brain with magnetic resonance venography (MRV) and trans-orbital sonography (TOS)). Patients with abnormal findings underwent lumbar puncture for opening pressure. Results The prevalence of IIH was 27%. IIH patients were of higher age, had gnawing/throbbing headache in the vertex in most cases, and had higher body mass index. Fundus examination had a sensitivity of 79% and a specificity of 98% for the detection of IIH cases. Approximately 23% of IIH patients had no papilledema. The most sensitive MR sign was found to be transverse sinus stenosis. TOS showed optic nerve sheath dilation in 35.7% of IIH without papilledema cases. Conclusions The prevalence of IIH is high in the chronic headache population and should be suspected in the headache clinic setting, particularly because there is significant overlap with migraine symptomatology. MRI/MR venography and TOS can be useful adjunct tests to identify IIH patients.
Engineered Tendon-Fibrocartilage-Bone Composite With Mechanical Stimulation for Augmentation of Rotator Cuff Repair: A Study Using an In Vivo Canine Model With a 6-Month Follow-up
Authors: Long Zeling , Nakagawa Koichi , Wang Zhanwen , Shi Guidong , Sanchez-Sotelo Joaquin , Steinmann Scott P. , Zhao Chunfeng 
Published: October 2024

Background: Rotator cuff repair augmentation using biological materials has become popular in clinical practice to reduce the high retear rates associated with traditional repair techniques. Tissue engineering approaches, such as engineered tendon-fibrocartilage-bone composite (TFBC), have shown promise in enhancing the biological healing of rotator cuff tears in animals. However, previous studies have provided limited long-term data on TFBC repair outcomes. The effect of mechanical stimulation on TFBC has not been explored extensively. Purpose: To evaluate functional outcomes after rotator cuff repair with engineered TFBC subjected to mechanical stimulation in a 6-month follow-up using a canine in vivo model. Study Design: Controlled laboratory study. Methods: A total of 40 canines with an acute infraspinatus (ISP) tendon transection model were randomly allocated to 4 groups (n =10): (1) unilateral ISP tendon undergoing suture repair only (control surgery); (2) augmentation with engineered TFBC alone (TFBC); (3) augmentation with engineered TFBC and bone marrow-derived stem cells (BMSCs) (TFBC+C); and (4) augmentation with engineered TFBC and BMSCs, as well as mechanical stimulation (TFBC+C+M). Outcome measures—including biomechanical evaluations such as failure strength, stiffness, failure mode, gross appearance, ISP tendon and muscle morphological assessment, and histological analysis—were performed 6 months after surgery. Results: As shown in the mechanical test, the TFBC+C+M group exhibited higher failure strength compared with other repair techniques. The most common failure mode was avulsion fracture in the TFBC+C+M group, but tendon-bone junction rupture was observed predominantly in different groups. Engineered TFBC with mechanical stimulation showed over 70% relative failure strength compared with normal ISP, and the other groups showed about 50% relative failure strength. Histological analysis revealed less fat infiltration and closer-to-normal muscle fiber structure in the mechanical stimulation group. Conclusion: This study provides evidence that mechanical stimulation of engineered TFBC promotes rotator cuff regeneration, thus supporting its potential for rotator cuff repair augmentation. Clinical Relevance: This study provides valuable evidence supporting the use of a novel tissue-engineered material (TFBC) in rotator cuff repair and paves the way for advancements in the field of rotator cuff regeneration.