bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cost-effectiveness Analysis of Colorectal Cancer Screening Strategies Using Active Learning and Monte Carlo Simulation
Authors: Fouladi Amirhossein , Asadi Amin , Sherer Eric A. , Madadi Mahboubeh 
Published: June 2024

Introduction Detection of colorectal cancer (CRC) in the early stages through available screening tests increases the patient’s survival chances. Multimodal screening policies can benefit patients by providing more diverse screening options and balancing the risks and benefits of screening tests. We investigate the cost-effectiveness of a wide variety of multimodal CRC screening policies. Methods We developed a Monte Carlo simulation framework to model CRC dynamics. We proposed an innovative calibration process using machine learning models to estimate age- and size-specific adenomatous polyps’ progression and regression rates. The proposed approach significantly expedites the model parameter space search. Results Two multimodal proposed policies (i.e., 1] colonoscopy at 50 y and fecal occult blood test annually between 60 and 75 y and 2] colonoscopy at 50 and 60 y and fecal immunochemical test annually between 70 and 75 y) are identified as efficient frontier policies. Both policies are cost-effective at a willingness to pay of $50,000. Sensitivity analyses were performed to assess the sensitivity of results to a change in screening test costs as well as adherence behavior. The sensitivity analysis results suggest that the proposed policies are mostly robust to the considered changes in screening test costs, as there is a significant overlap between the efficient frontier policies of the baseline and the sensitivity analysis cases. However, the efficient frontier policies were more sensitive to changes in adherence behavior. Conclusion Generally, combining stool-based tests with visual tests will benefit patients with higher life expectancy and a lower expected cost compared with unimodal screening policies. Colonoscopy at younger ages (when the colonoscopy complication risk is lower) and stool-based tests at older ages are shown to be more effective. Highlights We propose a detailed Markov model to capture the colorectal cancer (CRC) dynamics. The proposed Markov model presents the detailed dynamics of adenomas progression to CRC. We use more than 44,000 colonoscopy reports and available data in the literature to calibrate the proposed Markov model using an innovative approach that leverages machine learning models to expedite the calibration process. We investigate the cost-effectiveness of a wide variety of multimodal CRC screening policies and compare their performances with the current in-practice policies.
Design and motion control of a tendon-driven continuum robot for aerospace applications
Authors: Qi Qian , Qin Guodong , Yang Zhikang , Chen Guangming , Xu Jiajun , Lv Zhuhai , Ji Aihong 
Published: June 2024

Continuum robots are flexible and compliant. Compared to the case in conventional articulated manipulators, the driving unit can be placed outside the workspace of the robot, so that the motion orientation has a relatively complete linear configuration flow, which can be applied to a special environment with narrow and multiple obstacles such as aerospace. This study presents the development process of a tendon-driven continuum robot (TCR) with a high length-diameter ratio. The skeleton structure which imitates a snake is composed of continuous joints in series. The driving device is operated by using a tendon-driven method, which reduces the complexity of the driving box and control system significantly. The diameter of the robot is designed to be 5 mm, which enables it to work in a narrow and slender space with certain flexibility. Subsequently, a kinematic model of the robot is established. The mode function backbone method is applied to realize TCR trajectory planning. An idea of segmented solving is adopted to achieve trajectory tracking control of the continuum robot. Finally, a prototype of the continuum robot is produced, and the rationality of the robot design and the effectiveness of the motion control method are verified through trajectory simulations and experiments. The robot can perform inspection tasks within a narrow gap of 20 mm with good environmental adaptability.
Dignity in people with dementia: A concept analysis
Authors: Zhang Yuchen , Lingler Jennifer H , Bender Catherine M , Seaman Jennifer B 
Published: June 2024

Background: Dignity, an abstract and complex concept, is an essential part of humanity and an underlying guiding principle in healthcare. Previous literature indicates dignity is compromised in people with dementia (PwD), but those PwD maintain the capacity to live with dignity with appropriate external support. Alzheimer’s disease and related dementias (ADRDs) lead to progressive functional decline and increased vulnerability and dependence, leading to heightened risks of PwD receiving inappropriate or insufficient care that diminishes dignity. Considering the increased disease prevalence and the continuously escalating costs of dementia care, establishing a productive value-based guideline may prevent suffering, maximize dignity, and thus promote quality of life (QoL). Aim: The goal of this project is to identify actionable targets for integrating dignity harmoniously and practically into care planning and management for PwD. Research Design: We conducted a concept analysis using Walker and Avant’s eight-step process. A comprehensive literature search was conducted (PubMed and CINAHL) with the keywords “dignity,” “dementia,” “Alzheimer’s disease,” and “dementia care.” Results: A total of 42 out of 4910 publications were included. The concept of dignity in PwD is operationalized as the promotion of worthiness and the accordance of respect that allows the presence and expression of a person’s sense of self, regardless of physical, mental, or cognitive health. The concept has two subdimensions: absolute dignity which encompasses the inherent self and relative dignity characterized by its dynamic reflective nature. Worthiness and respect are the two main attributes, while autonomy is an underlying component of dignity. Specific antecedents of dignity in PwD are empowerment, non-maleficence, and adaptive environmental scaffolding. As a consequence of facilitating dignity in PwD, QoL may be enhanced. Conclusion: As a foundational and necessary humanistic value, incorporating dignity into dementia care can lead to efficient and effective care that optimizes QoL in PwD throughout their disease progression.
Adipokine Modulation in Endometrial Hyperplasia by Polyunsaturated Fatty Acids
Authors: Supriya Athuru , Kiran Ammu V. V. V. Ravi , Krishnamurthy Praveen Thaggikuppe 
Published: June 2024

Background Obesity is associated with a higher prevalence of endometrial hyperplasia, thereby increasing the risk of endometrial and ovarian cancers. The precise mechanisms linking obesity to endometrial hyperplasia remain unclear, but dysregulation of adipose tissue homeostasis is known to play a significant role. Hypertrophied adipocytes in obese individuals secrete various bioactive substances, including cytokines, growth factors, hormones, and metabolites. Additionally, hyperplastic adipocytes exhibit enhanced aromatase activity, leading to increased estrogen synthesis, which further promotes the development of endometrial hyperplasia. Purpose The purpose of this study is to explore the anti-inflammatory and anti-proliferative activities of the poly unsaturated fatty acids. Methodology An extensive literature survey has been performed to identify the role of adipokines and elevated endogenous estrogen levels in activating cell survival signaling pathways, such as PI3K/Akt/mTOR, MEK/ERK1, and JAK–STAT in endometrial cells and their possible role in Endometrial Hyperplasia. Further, the possible beneficial anti-inflammatory and anti-proliferative effects of polyunsaturated fatty acids (PUFAs) such as eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and arachidonic acid (AA) were explored. Results Numerous studies suggest the beneficial role of dietary fats, such as EPA, DHA, and AA in modulating the growth of endometrium in obesity-induced endometrial hyperplasia. PUFAs can activate adenosine monophosphate-activated protein kinase (AMPK), which inhibits gluconeogenesis and lipogenesis. It also phosphorylates acetyl-CoA, leading to a decrease in malonyl-CoA, which inhibits mitochondrial CPT1. Additionally, AMPK activation promotes β-oxidation, and PPAR-γ mechanisms by down regulating the NF-kB pathway involved in endometrial hyperplasia. Conclusion This review sheds light on the potential of PUFAs in mitigating estrogen synthesis, adipokine secretion, and endogenous aromatase activity in obesity induced endometrial hyperplasia. Furthermore, it critically evaluates the role and mechanisms of PUFAs in attenuating obesity-associated endometrial hyperplasia and reducing the risk of ovarian cancer.
Bionic low-frequency vibration isolator inspired by goat joints
Authors: Shi Xiaojie , Wang Shucheng , Wang Shaowei , Liu Huimin , Qu Huixing , Zhang Bo , Yang Huawei 
Published: June 2024

Joints are effective in absorbing the ground impact and isolating the vibrations caused by the impact when goats jump over the cliff to find food. A bionic vibration isolator for low-frequency vibration inspired by the goat hind limb joint is proposed. The quadrilateral mechanism of the bionic vibration isolator of varying sizes is used to mimic the vibration suppression effect of multiple joints in the hind limbs of goats. The rigid rods in the bionic mechanism are used to mimic the role of the bones in the joint, and the springs are used to mimic the function of the muscles or tendons near the joint. In addition, the slider mechanism of the bionic mechanism brings nonlinear damping and mass, which could effectively help the system to reduce the resonant frequency and enhance the vibration isolation performance. The natural frequency of the bionic mechanism is 1.2 Hz, while the natural frequency of the linear mechanism under the same conditions is 5.1 Hz. When the external vibration exceeds 2.4 Hz, the proposed bionic mechanism begins to perform vibration isolation performance. Compared with the linear vibration isolation device, the bionic mechanism has lower natural frequency, better vibration isolation performance, and wider vibration isolation frequency band. Therefore, this study creatively proposed a vibration control mechanism inspired by animal limbs and proposed a high-stability and low-cost bionic structures in the field of vibration control.
Decreased Alpha Klotho Expression in Placentas Exposed to Severe Maternal Vascular Malperfusion
Authors: Franklin Andrew , Freedman Alexa , Borders Ann , Keenan Devlin Lauren , Proctor Erin S. , Price Erica , Cole Steve , Miller Greg , Ernst Linda M. 
Published: June 2024

Background: Placental maternal vascular malperfusion (MVM) is characterized by accelerated villous maturation and has been associated with a decrease in the antiaging protein, alpha-klotho (AK). Our aim was to characterize AK protein and gene expression in the placenta and fetal organs. Methods: We utilized 2 cohorts. First, we characterized AK protein expression in an autopsy cohort where cases were defined as MVM as the cause of fetal death compared to a stillborn control population. Second, we characterized placental and umbilical cord blood AK gene expression in a liveborn population with and without MVM. Results: We found decreased protein expression in the villous trophoblastic cells of placentas exposed to severe MVM and decreased AK gene expression in placental tissue exposed to MVM. We did not see any statistically significant differences in fetal organ or umbilical cord blood AK expression based on the presence or absence of MVM. Furthermore, in liveborn infants, we also found increased odds of preterm birth with lower placental AK expression. Conclusions: Decreased AK gene and protein expression in the placenta in the setting of MVM is consistent with the theory of placental aging in MVM and is associated with increased odds of preterm birth.
Arrangement of Agricultural Reservoir Along Rill Erosion: Case Study in the Sumbing Volcanic Landscape, Java, Indonesia
Authors: Islami Jihan Dwi , Pulungan Nur Ainun Harlin Jennie , Sartohadi Junun 
Published: June 2024

Background and research aims: Most of volcanic landscapes on Java, Indonesia, are increasingly being used for agriculture. As a consequence, high rate of soil erosion due to agricultural cultivation cannot be avoided. Agricultural reservoir is one of methods to maintain soil loss due to erosion. Most research to date, however, have been based on the function of the reservoirs rather than on the arrangement of the reservoirs which are usually locally specific. Thus, an evaluation of the arrangement for agricultural reservoir becomes a crucial innovation. This study was aimed at examining the effectiveness of agricultural reservoir arrangement along rill erosion in reducing runoff volume as well as erosion rate, and increasing sediment trapped. Methods: The research was conducted using the field survey method at a key sampling area by considering the dominant relief and land cover on the volcanic landscape of the Sumbing Volcano. Data collected includes soil properties (texture, organic matter, porosity, soil pore distribution, permeability, and soil infiltration rate), runoff discharge, runoff volume, and sediment delivery. Research started by determining the points for placing the agricultural reservoirs along the rill erosion and continued with field and laboratory measurements. Results: Our results showed that placing agricultural reservoirs along the rill erosion effectively reduced erosion by 99.97%. Consequently, the erosion rate was only 5.5 × 10−4 ton ha−1. The effectiveness of agricultural reservoirs in reducing runoff volume and sediment delivery was 99.72% and 94.15%, respectively. Conclusion: Agricultural reservoirs that are placed along the rill erosion effectively trap sediment and reduce runoff so that erosion rates decrease. Implications for conservation: Placing agricultural reservoirs along rill erosion can improve the effectiveness of reservoirs in decreasing the erosion rate. This strategy helps reduce runoff and sediment to maintain the productivity of agricultural land. Finding a suitable strategy for the evaluation of erosion and sedimentation processes has important implications for soil and water conservation.
Usefulness of Neck Circumference, Waist-to-Height Ratio and Waist-to-Hip Ratio in Predicting Non-Alcoholic Fatty Liver Disease in Saudi Population Without Type 2 Diabetes
Authors: Alqahtani Saleh , Al-Raddadi Rajaa , Ajabnoor Ghada , Alraddadi Zeyad , Alahmadi Jawaher , Alhabash Adel , Hakim Rehad , Alseraihi Loojen , Bahijri Suhad 
Published: June 2024

Background: Early identification and treatment of non-alcoholic fatty liver disease (NAFLD) could reduce overall mortality. Anthropometric measurements offer a simple and cost-effective method to potentially improve early detection of NAFLD and prevent its complications. This study aims to estimate the prevalence of NAFLD using the fatty liver index (FLI) and evaluate the effectiveness of certain anthropometric measurements in predicting NAFLD as diagnosed by FLI. Method: A cross-sectional analytical study was conducted with 1264 Saudi population without Type 2 diabetes mellitus (T2DM) non-alcoholic individuals at primary health care centers (PHCCs) in Jeddah city. Measurements included triglycerides, gamma-glutamyl transferase (GGT), glycated hemoglobin (HbA1c), and fasting plasma glucose (FPG). Measurements for neck circumference (NC), and calculations for weight-to-height ratio (WHtR) and weight-to-hip ratio (WHpR), along with FLI, were performed. NAFLD was identified in individuals with an FLI ⩾60. The receiver operating characteristic (ROC) curve analysis was utilized to assess the accuracy of WHtR, WHpR, and NC in detecting NAFLD, with Youden’s index determining the optimal cutoff points for these 3 indices. Result: The prevalence of NAFLD was found to be 30.9%. Among the markers, WHtR emerged as the most significant in indicating NAFLD, achieving an area under the curve (AUC) of 0.916; whereas NC and WHpR exhibited identical AUC values of 0.783. WHtR demonstrated superior diagnostic efficacy for identifying elevated FLI, with gender-specific cutoff values established at >0.57 for females and >0.61 for males. In all 3 markers, females exhibited higher sensitivity, specificity, and negative predictive value (NPV) compared to males. Conclusion: WHtR could serve as a useful tool in the initial clinical screening for NAFLD among Saudi population without T2DM to identify those who may benefit from more comprehensive testing. Further local studies are warranted to confirm the levels of accuracy and the calculated cutoffs.
Chinese Herbal Medicine Combined With Liuzijue Exercise in Physiological Rehabilitation After Video-assisted Lung Lobectomy for Cancer: A Prospective Propensity Score Matching Study
Authors: Qi Ao , He Yiyun , Gu Yifeng , Zhang Congmeng , Qin Xiong , Wang Yichao , Yang Yong , Yao Jialin , Zhou Huiling , Yang Wenxiao , Su Lingzi , Wang Qin , Song Jiajun , Jiao Lijing , Gong Yabin , Li Jiaqi , Xu Ling 
Published: June 2024

Objective: To observe the clinical efficacy of Chinese herbal medicine combined with Liuzijue exercise on the physiological symptoms and quality of life (QoL) in postoperative patients with early-stage lung cancer. Methods: One hundred and eighty-three lung cancer patients who underwent video-assisted thoracoscopic surgery (VATS) were categorize into either a traditional Chinese medicine treatment group (CM) or a control group (non-traditional Chinese medicine treatment, NC), among whom 73 underwent Chinese herbal medicine and Liuzijue therapy, while 110 underwent no comprehensive treatment with traditional Chinese medicine. The propensity score matching (PSM) method with a 1:2 ratio was used to balance the baseline characteristics and evaluate the efficacy of CM in improving postoperative symptoms and QoL. Results: Cough, dyspnea, chest pain, and fatigue were the most common clinical symptoms after VATS. Except for chest pain, they were all correlated with the scope of operation ( P < .05). After PSM, 165 patients were identified in the matched cohort, and the covariates of gender, age, operative site, and scope of operation were balanced between the 2 groups ( P > .05). In the domain of global health status, the improvement in QoL in CM was greater than that in NC (6.06 ± 15.83 vs −1.06 ± 14.68, P = .005). In terms of symptoms, improvements in cough (1.69 ± 3.15 vs 0.38 ± 2.63, P = .006), dyspnea during climbing stairs (−10.30 ± 16.82 vs −1.82 ± 17.97, P = .004), and pain (−0.76 ± 1.32 vs −0.08 ± 1.31, P = .002) in CM were better than in NC. Conclusion: Comprehensive treatment with traditional Chinese medicine (TCM) can provide therapeutic benefits in physiological rehabilitation after VATS for cancer.
Comparison of outcomes of the 50-year follow-up of a randomized trial assessed by study questionnaire and by data linkage: The CONCUR study
Authors: Shahbaz Mohammad , Harding Jane E , Milne Barry , Walters Anthony , Underwood Lisa , von Randow Martin , Xu Lois , Gamble Greg D ,   for the ANCHOR Study Group
Published: June 2024

Background/Aims: Self-reported questionnaires on health status after randomized trials can be time-consuming, costly, and potentially unreliable. Administrative data sets may provide cost-effective, less biased information, but it is uncertain how administrative and self-reported data compare to identify chronic conditions in a New Zealand cohort. This study aimed to determine whether record linkage could replace self-reported questionnaires to identify chronic conditions that were the outcomes of interest for trial follow-up. Methods: Participants in 50-year follow-up of a randomized trial were asked to complete a questionnaire and to consent to accessing administrative data. The proportion of participants with diabetes, pre-diabetes, hyperlipidaemia, hypertension, mental health disorders, and asthma was calculated using each data source and agreement between data sources assessed. Results: Participants were aged 49 years (SD = 1, n = 424, 50% male). Agreement between questionnaire and administrative data was slight for pre-diabetes (kappa = 0.10), fair for hyperlipidaemia (kappa = 0.27), substantial for diabetes (kappa = 0.65), and moderate for other conditions (all kappa >0.42). Administrative data alone identified two to three times more cases than the questionnaire for all outcomes except hypertension and mental health disorders, where the questionnaire alone identified one to two times more cases than administrative data. Combining all sources increased case detection for all outcomes. Conclusions: A combination of questionnaire, pharmaceutical, and laboratory data with expert panel review were required to identify participants with chronic conditions of interest in this follow-up of a clinical trial.
RhPro-UK in acute ischemic stroke within 4.5 h of stroke onset trial-2 (the PROST-2 study): Rationale and design of a multicenter, prospective, randomized, open-label, blinded-endpoint, controlled phase 3 non-inferiority trial
Authors: Li Shuya , Gu Hong-Qiu , Feng Baoyu , Dong Qiang , Fan Dongsheng , Xu Yun , Zhu Suiqiang , Wang Yongjun 
Published: June 2024

Background: Recombinant prourokinase (rhPro-UK) is a specific plasmin activator, which has been approved to treat acute myocardial infarction in China. Aim: This phase 3 trial aimed to further demonstrate the efficacy and safety of rhPro-UK in patients with acute ischemic stroke (AIS) within 4.5 h of symptom onset. Methods and design: RhPro-UK in AIS within 4.5 h of stroke onset trial-2 (PROST-2) is a multicenter, prospective randomized, open-label, blinded end-point, non-inferiority, recombinant tissue plasmin activator (rt-PA)-controlled, phase 3 trial. A total of 1552 patients who are eligible for intravenous thrombolytic therapy from 72 clinical sites will be randomly assigned to receive either rhPro-UK 35 mg (15 mg bolus + 20 mg infusion/30 min) or rt-PA 0.9 mg/kg (10% bolus + 90% infusion/1 h). Study Outcomes: The primary outcome is the proportion of patients with a modified Rankin Scale (mRS) score of 0–1 at 90 days. Secondary efficacy outcomes include the proportion of patients with mRS score of 0–2, the distribution of mRS, self-care ability in daily life on the Barthel Index at 90 days, the proportion of subjects with ⩾ 4 points decrease in National Institutes of Health Stroke Scale (NIHSS) score or NIHSS score ⩽ 1 from baseline at 24 h and 7 days after treatment. Safety outcomes are symptomatic intracranial hemorrhage (sICH) and major systematic bleeding within 7 days as well as death from all causes within 90 days. Discussion: The results from the PROST-2 trial will comprehensively elucidate the efficacy and safety profile of rhPro-UK as a potential alternative agent for stroke thrombolysis. Clinical Trial Registration: URL: http://www.clinicaltrials.gov . Unique identifier: NCT05700591.