bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exploring Obesity Treatment Potential of Neolamarckia cadamba Bioactive Fraction: A Multifaceted Investigation Combining In Vitro, 3T3-L1 Adipogenesis Differentiation, and HPTLC–MS Techniques to Identify Lead Compounds
Authors: Kumari Shivangi , Pattnaik Ashok Kumar 
Published: August 2024

Background The rising incidence of obesity and its related health issues demand novel approaches prioritizing safety and effectiveness. In light of concern about the side effects of pharmaceutical therapies, research into alternative medicines has accelerated. Neolamarckia cadamba (NC), a tropical medicinal plant with a diverse phytochemical profile, presents a promising avenue for obesity management. Purpose The objective of this research was to evaluate the possible role of isolated fractions in mitigating obesity using antioxidant and enzyme inhibition studies. Additionally, the 3T3-L1 adipogenesis differentiation assay was utilized further to understand the effect of these fractions on adipocyte behavior. Furthermore, we used analytical techniques, high-performance thin-layer chromatography in conjugation with mass spectrometry (HPTLC–MS), to evaluate the chemical characteristics of the bioactive fractions. Methods Cold maceration extraction followed by column chromatography was utilized to isolate the bioactive fraction which was subjected to meticulous phytochemical analysis as well as in vitro antioxidant assays. Enzyme inhibition assays were conducted to evaluate their impact on pancreatic lipase, alpha-glucosidase, and alpha-amylase followed by the 3T3-L1 adipogenesis study to assess adipocyte behavior. Finally, HPTLC–MS was utilized for chemical characterization. Results Fraction 1 demonstrated the most potent activity, also exhibited significant antioxidant potential, and effectively inhibited key enzymes involved in adipogenesis. In the 3T3-L1 cell line, the fraction notably reduced lipid accumulation and triglyceride levels. Chemical analysis revealed the presence of compounds including stigmasterol, gallic acid, quercetin, 4-hydroxycoumarin, and naringin. Conclusion The study underscores the potency of NC and offers a holistic approach to obesity management, providing a promising approach for the development of effective and safer therapeutic interventions.
Clinical Profile and Outcome of Neonates with Meconium Aspiration Syndrome at an Indian Tertiary Care: An Observational Study
Authors: Kandpal Jyoti , Kamalarathnam C. N. , Anitha Murugesan , Vaideeswaran Mariappan , Narayanan Ethirajan , Sangeetha T. 
Published: August 2024

Background Meconium aspiration syndrome (MAS) is still a major contributor to newborn respiratory morbidity and mortality. Many centres lack advanced modalities such as high-frequency oscillatory ventilation and inhaled nitric oxide. Very few studies in developing countries have focused on its clinical profile, management, respiratory morbidity and mortality. Objectives The aim of this study was to determine the incidence, risk factors, complications and outcomes in neonates with MAS. Methods A retrospective observational study was conducted in a level III neonatal intensive care unit of an outborn tertiary referral centre in South India. Case sheets of neonates, born out of meconium-stained liquor who had respiratory distress at admission and were diagnosed as MAS, were included. The primary outcome was to study the clinical profile of neonates with MAS. The secondary outcomes were to estimate the proportion of neonates who developed complications of MAS. Results The incidence of MAS over a 5-year period, out of total 8,990 neonates admitted at our centre, was 161 (1.79 %). Data of 161 neonates were analysed. The neonates were admitted at a median duration of 5 h of life (interquartile range 3–14). Mean gestational age and weight were 38.7 (1.41) weeks and 2900 (530) g, respectively. Associated morbidities like shock were seen in 55 (34.1%), persistent pulmonary hypertension of newborns in 40 (24.8 %), hypoxic ischemic encephalopathy in 23 (14.2%), seizures in 16 (9.9%), pneumothorax in 8 (4.96%) and sepsis in 34 (21.1%). On logistic regression analysis, age at admission >24 h, small for gestational age (SGA) and need for resuscitation at birth were risk factors associated with severe MAS. Mortality in MAS was 7 (4.34%). Conclusion Need for resuscitation, SGA at birth and age at admission >24 h were associated with severe MAS. Timely referral of neonates with a risk factor for severe MAS can improve outcomes.
What Free Flaps Are Surgeons Using for Palatal Fistula Repair in Patients with Cleft Palate? A Systematic Review
Authors: Zheng Eugene E. , Gates-Tanzer Lauren , Cherukuri Sai , Mardini Samir , Murad M. Hassan , Bite Uldis , Gibreel Waleed 
Published: August 2024

Objective Recalcitrant palatal fistulas in patients with cleft palate history sometimes require free flap reconstruction. This study reviews the literature on described flaps and outcomes. Design A systematic review was conducted per the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Setting All study designs were included. Non-English articles were excluded. Patients and Participants Patients with a history of cleft palate who underwent free flap reconstruction for a oronasal fistula. Interventions Free tissue transfer for a palatal fistula repair. Main outcomee measures Information regarding defect and flap characteristics were reviewed. Surgical outcomes such as flap loss rates, rates of recurrent fistula formation, and speech outcomes were also obtained. Results Our search returned 894 articles, of which 23 were included. All studies were retrospective case series and reports. A total of 65 patients were described with an average age of 19.3 (range 3–55) years and a median fistula size of 8.00 cm2 (range 2.54 cm2 – 24 cm2). The most common flap was the radial forearm flap (n = 37). Nine patients (13.8%) had recurrent fistula formation with surgical revision successful in all cases in which the patient returned to the operating room. There were two partial flap losses and no total flap losses. Speech outcomes showed improvement in 27 patients across 10 studies. Conclusions Palatal fistula repair with free tissue transfer is safe with an acceptable risk profile and low flap loss rate. Early recurrence due to partial flap necrosis and dehiscence are successfully managed with flap readvancement.
Recurrent ischemic stroke/transient ischemic attack after patent foramen ovale closure: A cohort study
Authors: Sørensen Henrik , Grove Erik L , Hojbjerg Johanne Andersen , Andersen Asger , Nielsen-Kudsk Jens Erik , Simonsen Claus Z 
Published: August 2024

Background: Patent foramen ovale (PFO) has been associated with ischemic stroke and transient ischemic attack (TIA). Guidelines recommend PFO closure for stroke prevention in selected patients, but the risk of recurrent stroke remains high compared to the background population. We aimed to evaluate the causes of recurrent stroke/TIA and post-interventional complications in patients after PFO closure. Methods: Patients from the Central Denmark Region who underwent PFO closure at Aarhus University Hospital between November 5, 2018, and May 12, 2023, following an ischemic stroke, TIA, amaurosis fugax, or retinal emboli were included. Data on patient demographics, risk factors, procedural details, post-interventional complications, and recurrent stroke/TIA were collected from electronic medical records. Results: PFO closure was performed in 310 patients (median age: 49 years). During a median follow-up of 2.6 years (interquartile range: 1.5–3.6, 814 total patient-years), recurrent stroke/TIA was observed in 8 patients (2.6%), or 0.98 recurrent strokes per 100 patient-years. Recurrent stroke/TIA was more frequent in patients with hypertension (50.0% vs. 16.9%, p = 0.039). Recurrent stroke/TIA was related to thrombophilia or hematologic conditions entailing hypercoagulability in 62.5% of patients. New-onset atrial fibrillation was observed in 9.4% of patients within 45 days after the procedure. None of these patients subsequently developed an ischemic event. Other adverse outcomes were uncommon. Conclusion: Rates of recurrent ischemic stroke/TIA after PFO closure were comparable to findings in previous trials. Pre-existing vascular risk factors (hypertension), and a hypercoagulable state were associated with recurrent ischemic stroke/TIA.
Clinical implications of six-minute walk test in patients with idiopathic pulmonary fibrosis: a retrospective cohort study
Authors: Kim Min Jee , Nathan Steven D. , Kim Hyeon Hwa , Kim Ho Cheol 
Published: August 2024

Background: A six-minute walk test (6MWT) is a reproducible, easily performed test, and is widely used to determine functional exercise capacity in patients with idiopathic pulmonary fibrosis (IPF). However, there is currently a paucity of data on the clinical significance of baseline and serial 6-minute walk tests in patients with IPF, especially in Asian patients. Objectives: We aimed to investigate the clinical significance of serial 6MWT in patients with IPF, especially in Asian patients. Design: This is a single-center retrospective cohort study. Methods: Clinical data of patients diagnosed with IPF at a tertiary center in Korea were retrospectively analyzed. IPF diagnosis was defined according to the clinical guidelines of the American Thoracic Society (ATS)/European Respiratory Society (ERS)/Japanese Respiratory Society/Latin American Thoracic Association. Results: There were 216 patients diagnosed with IPF from December 2012 to January 2022, of whom 198 had a baseline of 6MWT data. The mean age of the cohort was 66.9 ± 8.6, and 89% were male. The non-survivors showed significantly lower six-minute walk distance (6MWD), minimum saturation of peripheral oxygen (SpO2) during 6MWT, forced vital capacity, and diffusing capacity of the lung for carbon monoxide than survivors at baseline. A multivariate Cox analysis demonstrated that lower minimum SpO2 was independently associated with increased mortality rates (Hazard ratio (HR): 1.081, 95% confidence interval (CI): 1.024–1.142, p = 0.005). Higher mortality rates were also associated with echocardiographic-determined pulmonary hypertension (HR: 2.466, 95% CI: 1.149–5.296, p = 0.021) at diagnosis. Among 144 patients with 6MWT results at 12 months, patients with a decline of 50 m or more in the 6MWD showed poorer overall survival than others (median survival: 45.0 months vs 58.0 months, p < 0.001). Conclusions: Baseline lower minimum SpO2 during 6MWT was an independent prognostic factor in patients with IPF, and a decline in 6MWD in serial follow-up was also associated with a poorer prognosis. These findings suggest that both baseline 6MWT and follow-up data are important in the prognostication of patients with IPF.
Veterans Affairs Training Experiences During the COVID-19 Pandemic-Trainee Satisfaction and Interest in Future Veterans Affairs Employment: A National Survey
Authors: Griffin Anne R. , Bai Jia , Northcraft Heather , Dobalian Aram 
Published: August 2024

Introduction The emergence of COVID-19 caused a sudden, unexpected disruption in the clinical training experiences of nurse trainees at the US Department of Veterans Affairs (VA), the largest clinical training setting in the US for nurses. Purpose To understand associations between COVID-19 and nurse trainees’ satisfaction with their training experiences and the likelihood that they would consider future VA employment. Methods A cross-sectional design was used to assess 7,890 nurse responses from the VA's Trainee Satisfaction Survey for academic years 2018–2021. Results After the pandemic, trainees reported decreased training satisfaction (95.06% vs. 93.46%; P = .0028). Willingness to consider future VA employment was unchanged. Patient case mix, the onboarding process, and challenges with other staff were the most common reasons for dissatisfaction. Conclusion Nurse trainees expressed a small but statistically significant degree of dissatisfaction with their clinical learning environment during this study period but their willingness to seek employment with the VA remained high.
Measures to Prevent and Reduce Healthcare Worker Burnout During the COVID-19 Pandemic: A Scoping Review
Authors: Chaisurin Patcharin , Yodchai Natthawut 
Published: August 2024

Introduction In the COVID-19 era, burnout is a major occupational hazard among healthcare workers. This scoping review intended to investigate the pertinent literature concerning COVID-19 burnout among healthcare workers (HCWs) and the measures to prevent and reduce HCW burnout during the COVID-19 pandemic. Methods The databases CINAHL, PubMed, ScienceDirect, and Scopus were systematically searched and screened for relevant papers. Additionally, manual searching was employed to supplement the electronic database results. The researchers examined 21 publications to answer the research question, “What have been the measures to prevent and reduce healthcare worker burnout during the COVID-19 pandemic?” The PRISMA 2020 checklist was used to guide the reporting of this scoping review. Results It was found that to diminish healthcare workers’ burnout, it is vital to use multilevel, evidence-based approaches. These interventions may include increasing awareness of the risks and preparing for potential occupational stress and burnout; promoting mindfulness and self-care practices to enhance mental well-being; enhancing organizational policies and procedures to address burnout among healthcare workers; and ensuring the availability of optimal mental health services, including the use of digital technologies to address workplace stress and facilitate mental health interventions. Conclusion The interventions to prevent and reduce HCW burnout during the COVID-19 pandemic include supporting HCWs individually, improving work environments, and addressing health system factors contributing to burnout complemented by interventions aimed at enhancing work culture.
Experiences of Nurses and Midwives With Indecorously Structured Duty Rosters at Selected Health Facilities in Ho, Volta Region of Ghana: A Qualitative Study
Authors: Dartey Anita Fafa , Tackie Vivian , Lotse Comfort Worna , Lily Dodoo , Sagbo Francis Mawougnon 
Published: August 2024

Introduction Decent working time in the health sector is critical to providing quality care, and balancing health workers’ well-being with the requirements of 24/7 healthcare provision. Nursing and midwifery staff, comprising the largest group in the health workforce, play a crucial role. Understanding their experiences and challenges related to duty rosters is essential for improving work conditions, job satisfaction, and ultimately, the quality of care. Objective This study aims to explore the experiences of nurses and midwives with the hospital duty roster at selected health facilities in Ho, the Volta Region of Ghana. Method A qualitative research method with a phenomenological approach was employed to capture the nuanced experiences of nurses and midwives regarding the hospital duty roster. A semistructured interview guide facilitated data collection, ensuring a comprehensive exploration of participants’ experiences. Three selected health facilities in Ho, the Volta Region of Ghana, served as the study's location. The study recruited 20 participants (nurses and midwives) to reach data saturation. The collected data were transcribed verbatim and analyzed through thematic content analysis, using a deductive approach. Researchers reviewed the raw data, generating initial codes to capture new concepts of interest. Results The duty roster often demonstrated organizational flaws negatively impacting the health, well-being, and job performance of nurses and midwives, consequently affecting patient care quality. The study identified that these healthcare professionals faced significant risks of work-related stress, burnout, and mental health problems due to ineffective coping strategies toward the hospital duty roster. Findings from the study also demonstrated that nurses and midwives prefer day shift because of its short time and the availability of all groups of professionals to help manage cases as compared to a night shift. Conclusions The findings underscore factors influencing nurses’ choice of shift patterns, emphasizing the need for further research to explore the extent to which nurses’ preferences are considered when designing hospital duty rosters. Such insights can contribute to improving both the working conditions of healthcare professionals and the overall quality of patient care.
Less-deformable erythrocyte subpopulations biomechanically induce endothelial inflammation in sickle cell disease
Authors: Caruso Christina , Cheng Xiaopo , Michaud Marina E. , Szafraniec Hannah M. , Thomas Beena E. , Fay Meredith E. , Mannino Robert G. , Zhang Xiao , Sakurai Yumiko , Li Wei , Myers David R. , Joiner Clinton H. , Wood David K. , Bhasin Manoj , Graham Michael D. , Lam Wilbur A. 
Published: August 2024

Abstract
Sickle cell disease (SCD) is canonically characterized by reduced red blood cell (RBC) deformability, leading to microvascular obstruction and inflammation. Although the biophysical properties of sickle RBCs are known to influence SCD vasculopathy, the contribution of poor RBC deformability to endothelial dysfunction has yet to be fully explored. Leveraging interrelated in vitro and in silico approaches, we introduce a new paradigm of SCD vasculopathy in which poorly deformable sickle RBCs directly cause endothelial dysfunction via mechanotransduction, during which endothelial cells sense and pathophysiologically respond to aberrant physical forces independently of microvascular obstruction, adhesion, or hemolysis. We demonstrate that perfusion of sickle RBCs or pharmacologically-dehydrated healthy RBCs into small venule-sized “endothelialized” microfluidics leads to pathologic physical interactions with endothelial cells that directly induce inflammatory pathways. Using a combination of computational simulations and large venule-sized endothelialized microfluidics, we observed that perfusion of heterogeneous sickle RBC subpopulations with varying deformability, as well as suspensions of dehydrated normal RBCs admixed with normal RBCs, leads to aberrant margination of the less-deformable RBC subpopulations toward the vessel walls, causing localized, increased shear stress. Increased wall stress is dependent on the degree of subpopulation heterogeneity and oxygen tension and leads to inflammatory endothelial gene expression via mechanotransductive pathways. Our multifaceted approach demonstrates that the presence of sickle RBCs with reduced deformability leads directly to pathological physical (ie, direct collisions and/or compressive forces) and shear-mediated interactions with endothelial cells and induces an inflammatory response, thereby elucidating the ubiquity of vascular dysfunction in SCD.
The prevalence of headache disorders in children and adolescents in Benin: a schools-based study
Authors: Agbetou Houessou Mendinatou , Adoukonou Thierry , Tchuenga Fokom Willy , Dovoedo Nelly , Şaşmaz Tayyar , Bozdağ Fatma , Uluduz Derya , Steiner Timothy J. 
Published: August 2024

Abstract
Background
A global schools-based programme within the Global Campaign against Headache is estimating the burden of headache in children (6–11 years) and adolescents (12–17 years), cluster-sampling the world by conducting national studies in all world regions. Its purpose is to complement population-based studies in adults, adding to knowledge of the burden of headache and informing educational and health policies. This study in Benin was the third in the programme from sub-Saharan Africa (SSA).

Methods
We followed the generic protocol for the global study. In a cross-sectional survey, the child and adolescent versions of the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) structured questionnaire were administered to pupils within their classes in 16 schools selected from across the country to be representative of its diversities. Headache diagnostic questions were based on ICHD-3 criteria but for the inclusion of undifferentiated headache (UdH).

Results
Very large proportions of pupils were absent on the survey days. The sampled population defined by class registers totalled 11,802 pupils, of whom only 2,488 were present. A further 193 pupils (or their parents) declined the survey. The surveyed sampled (N = 2,295; males 1,156 [50.4%], females 1,139 [49.6%]) included 1,081 children (47.1%) and 1,214 adolescents (52.9%), with a non-participating proportion (193/2,488) of 7.8%. Headache ever was reported by 97.3% of the sample. Age- and gender-adjusted 1-year prevalences, according to responses given, were 53.4% for migraine (almost three quarters of this being probable migraine), 21.3% for tension-type headache, 8.2% for UdH, 1.0% for probable medication-overuse headache (pMOH) and 2.6% for other headache on ≥ 15 days/month (H15+). Both pMOH and other H15 + were substantially more prevalent among adolescents.

Conclusion
The finding for migraine is anomalous, but, within this series of studies, the same was found in Zambia and similar in Ethiopia, both in SSA. While many cases identified as probable migraine, especially among children, might better have been diagnosed as UdH, the true prevalence of migraine almost certainly exceeds 21%. Regardless of diagnosis, headache is very common among children and adolescents in Benin. The study sounds an alarm with regard to pMOH as a developing problem pre-adulthood.
RESTART: a stepped-care approach to facilitate return to work for employees with psychological distress: design of a randomized controlled trial
Authors: Lettinga Hanneke A.M. , van Oostrom Sandra H. , Zijlstra Hendrika P. , Anema Johannes R. , Proper Karin I. 
Published: August 2024

Abstract
Background
Common mental health problems, such as stress, anxiety and depression, are highly prevalent among workers and often lead to long-term absenteeism and work disability. Effective elements found in previous researched interventions were to explicitly focus on return to work (RTW) and not solely on symptom reduction, to take into account the employees’ cognition towards RTW and to include the workplace environment. Based on these elements, a stepped-care approach was developed. The aim of this paper is to present the study design of a randomized controlled trial (RESTART), evaluating the effectiveness of the stepped-care approach on lasting RTW and the implementation process.

Methods
RESTART is a randomized controlled trial with a 2 × 2 factorial design and a follow-up of one year. Employees eligible for this study are those who reported sick within 2 to 8 weeks with psychological distress based on a distress screener. Participants will be randomized to a group receiving a tailored e-Health app or usual care, as well as randomized to a group receiving a Participatory Approach (PA; conversational method) in the workplace or usual care. The PA will however only be provided in case of persistent sickness absence at 8 weeks. Measurements take place at baseline, after the e-Health intervention period (3 months), and after the PA intervention period (6 months) and 12 months. Primary outcome is lasting RTW, defined as full RTW in previous or equal work for at least four consecutive weeks. Secondary outcomes are (the severity of) stress-related symptoms, total number of sickness absence days, self-efficacy for RTW and self-reported health. A process evaluation including a realist evaluation will also be conducted.

Discussion
Early intervention that focuses on RTW, the cognition towards RTW despite symptoms and involves the workplace environment, plays a crucial role in managing sickness absence among employees with psychological distress. If effective, the stepped-care approach is relevant for employees, employers and society as a whole.

Trial Registration
ISRCTN: 90663076. Registered on 5 October 2023.