bluuebunny/crossref_metadata_2025_split huggingface dataset:
A study on the effectiveness of varying curative ratio to optimize performance of hydroxy terminated polybutadiene (HTPB) and hexamethylene diisocynate (HDI) based polyurethane elastomers
Authors: Tahir Naveed Ahmad , Othman Nadras , Zubir Syazana Ahmad 
Published: August 2024

Polyurethanes possess exceptional performance traits and are employed in almost every sphere of life. Extended pot life up to 6–8 h with acceptable performance to produce larger composite propellants is a pre-requisite. Aromatic diisocyanates being more reactive gives inadequate pot life (3–4 h) and aliphatic diisocyanates gives unrealistic pot life (20–24 h). Curative ratio (R = NCO/OH) is the most frequently used to tailor the performance properties of polyurethanes. In this research work, hexamethylene diisocyanate (HDI),an aliphatic diisocynate with symmetric structure and a moderate reactivity has been utilized as a curative to extend the pot life up to 6–8 h with acceptable performance traits by varying the curative ratio from 1.0 to 2.0. The synthesized PU elastomers showed a reasonable pot life of 437 min at NCO/OH = 1.0 that decreased to 305 min when curative ratio increased to 2.0. The effectiveness of curative ratio variation to fine tune physical, mechanical and thermal properties was gauged. With increasing curative ratio, the degree of hydrogen bonding and microphase separation increased. Moreover, for these polyurethanes, tensile strength increased from 0.519 MPa to 1.249 MPa, and elongation at break declined from 1068 % to 438 %. The structural integrity of composite propellants is dependent upon the mechanical properties and the curing ratio = 1.6 is considered as optimum because it provides a good balance between the soft segment and the hard segments and gives polyurethane elastomers a good combination of mechanical properties and hardness. Thermal stability in terms of onset degradation temperature (T5) also increased from 345 to 364°C.
Eye tracking during a simulated start of shift safety check: An observational analysis of gaze behavior of critical care nurses
Authors: van der Geest Yael , Chau Ivan , Wendel-Garcia Pedro David , Buehler Philipp K , Hautz Wolf , Filipovic Miodrag , Hofmaenner Daniel A , Pietsch Urs 
Published: August 2024

Background: The handover and associated shift start checks by nurses of critical care patients are complex and prone to errors. However, which aspects lead to errors remains unknown. Fewer errors might occur in a structured approach. We hypothesized that specific gaze behavior during handover and shift start safety check correlates with error recognition. Methods: In our observational eye tracking study, we analyzed gaze behavior of critical care nurses during handover and shift start safety check in a simulation room with built-in errors. Four areas of interest (AOI) were pre-defined (patient, respirator, prescriptions, monitor). The primary outcome were different gaze metrics (time to first fixation, revisits, first visual intake duration, average visual intake duration, dwell time) on AOIs. Parameters were analyzed by taking all errors in account, and by dividing them into minor and critical. Results: Forty-three participants were included. All participants committed at least a minor error ( n = 43, 100%), at least one critical error occurred in 29 participants (67%). Taking all errors into account, longer time to first fixation and more revisits were associated with an increased risk of missing errors (Time to First Fixation: OR 1.099 (95% CI 1.023–1.191, p = 0.0002), Revisits: OR 1.080 (95% CI 1.025–1.143, p = 0.0055)). Conclusion: Error detection during shift start safety check was associated with distinct gaze behavior. Nurses who recognized more errors had a shorter time to first fixation and less revisits. These gaze characteristics might correspond to a more structured approach. Further research is necessary, for example by implementing a checklist, to reduce errors in the future and improve patient safety.
Sex-specific risk of heart failure and acute myocardial infarction associated with osimertinib in older patients with non-small cell lung cancer
Authors: Byun Joo-Young , Han Sola , Liu Yan , Park Chanhyun 
Published: August 2024

Background: The cardiovascular risk associated with the newer epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI), osimertinib, in non-small cell lung cancer (NSCLC) is being reported. While more than half of patients with NSCLC are aged 65 or older, whether the cardiovascular risk increases in older patients treated with osimertinib compared to traditional EGFR-TKIs has not been clearly identified. Objectives: We aimed to identify the risk of major adverse cardiovascular events (MACEs) in older patients treated with osimertinib and traditional EGFR-TKIs, stratifying by sex, age, and race/ethnicity. Design: A retrospective cohort study. Methods: Using the 2006–2019 Surveillance, Epidemiology, and End Results (SEER)-Medicare, older patients with advanced NSCLC prescribed EGFR-TKIs were included. Hazard ratio (HR) and 95% confidence interval (CI) of incident MACEs were calculated using Cox proportional hazard model. Results: Osimertinib had a significantly higher risk of heart failure (HF) [HR, 1.20 (95% CI, 1.01–1.42)] and a lower risk of angina [HR, 0.36 (95% CI, 0.20–0.64)] than first/second-generation EGFR-TKI. The risk of HF and acute myocardial infarction (AMI) was significantly elevated in female [HR, 1.40 (95% CI, 1.13–1.73)] and male [HR, 1.98 (95% CI, 1.13–3.48)] subgroups, respectively, when used osimertinib than first/second-generation EGFR-TKIs. Within osimertinib users, the risk of HF was higher in patients aged ⩾75 ( versus aged 65–74) [HR, 1.71 (95% CI, 1.07–2.71)], White patients ( versus Asian/Pacific Islanders patients) [HR, 1.80 (95% CI, 1.04–3.12)]. The risk of AMI within osimertinib users was higher in White [HR, 3.23 (95% CI, 1.34–7.80)] and Black [HR, 5.63 (95% CI, 1.23–25.87)] than Asian/Pacific Islanders patients. Conclusion: Increased risk of HF was observed in patients who are female, White, and aged ⩾75 while male patients had a higher risk of AMI when treated with osimertinib than first/second-generation EGFR-TKIs. The in-depth examination of osimertinib-induced cardiotoxicity provides evidence for individualized cardiotoxicity surveillance, prevention, and treatment for osimertinib users.
Machine Learning–Driven Prediction of Comorbidities and Mortality in Adults With Type 1 Diabetes
Authors: Andersen Jonas Dahl , Stoltenberg Carsten Wridt , Jensen Morten Hasselstrøm , Vestergaard Peter , Hejlesen Ole , Hangaard Stine 
Published: August 2024

Background: Comorbidities such as cardiovascular disease (CVD) and diabetic kidney disease (DKD) are major burdens of type 1 diabetes (T1D). Predicting people at high risk of developing comorbidities would enable early intervention. This study aimed to develop models incorporating socioeconomic status (SES) to predict CVD, DKD, and mortality in adults with T1D to improve early identification of comorbidities. Methods: Nationwide Danish registry data were used. Logistic regression models were developed to predict the development of CVD, DKD, and mortality within five years of T1D diagnosis. Features included age, sex, personal income, and education. Performance was evaluated by five-fold cross-validation with area under the receiver operating characteristic curve (AUROC) and the precision-recall area under the curve (PR-AUC). The importance of SES was assessed from feature importance plots. Results: Of the 6572 included adults (≥21 years) with T1D, 379 (6%) developed CVD, 668 (10%) developed DKD, and 921 (14%) died within the five-year follow-up. The AUROC (±SD) was 0.79 (±0.03) for CVD, 0.61 (±0.03) for DKD, and 0.87 (±0.01) for mortality. The PR-AUC was 0.18 (±0.01), 0.15 (±0.03), and 0.49 (±0.02), respectively. Based on feature importance plots, SES was the most important feature in the DKD model but had minimal impact on models for CVD and mortality. Conclusions: The developed models showed good performance for predicting CVD and mortality, suggesting they could help in the early identification of these outcomes in individuals with T1D. The importance of SES in individual prediction within diabetes remains uncertain.
Developing cue-behavior association for habit formation: A qualitative study to explore the role of avatar in hypertension
Authors: Zhu Yujie , Long Yonghao , Wei Lai , Zhang Yaqi , Ma Zhengtao , Lee Kun-Pyo , Zhang Lie , Wang Stephen J. 
Published: August 2024

BackgroundElectronic health (eHealth) has been widely adopted in chronic disease management. Prior studies focused on time-based reminders as a cue to facilitate behavior change intentions, ignoring the development of automatic cue-behavior associations via other cue types.ObjectiveHence, this study utilized avatar appearance as a visual-based cue to help establish the automatic association between appearance transformation and health behavior to form habits without intention.MethodsTo better understand users’ attitudes and experiences toward applying changes in avatar appearance to develop cue-behavior associations for hypertensive patients. Fifteen participants were recruited in a 14-day experiment. After excluding one participant who dropped out of the experiment, others were randomly assigned to two groups. One group consisted of a visual-based cue (a virtual plant) and basic behavior change techniques (BCTs). The other group only included basic BCTs. Attitudes and experience outcomes were collected by interview, and qualitative data were analyzed using thematic analysis.Results57% of participants had been diagnosed with hypertension for more than five years, and more than 50% of participants have experience using mobile apps or wearables. 66% of participants did physical activity more than three times every week. The result shows that tailored time-based reminders, blood pressure monitoring, and daily dietary intake were the most attractive features. Additionally, hypertensive participants have positive attitudes toward avatar appearance as a visual-based cue to develop cue-behavior association, which enhances self-management motivation.ConclusionThis study proposes a visual-based cue design for habit formation and conducts a qualitative method to explore hypertensive patients’ perceptions. The findings offer insights from user's perspectives into hypertensive patients’ attitudes toward visual-based cues and perception of the connection between avatar appearance and health behavior for self-management. Subsequent discussions present eHealth design guidelines of habit formation from intention, automatic cue-behavior association, and self-management perspectives.
Utilizing the PDSA Cycle to Achieve Optimal Bed Utilization and Improve the Efficiency of a Chemotherapy Day Care Unit
Authors: Pathan Asma , Joshi Manjiri , Sugandhi Karishma , Ramani Vinod K. , Kannan Ravi , Sprujit Odette , Lewis Shirley 
Published: August 2024

Introduction Chemotherapy daycare units (CDU) routinely face difficulties, given the waiting time and work pressure. The study objectives include determining the feasibility of a multidisciplinary intervention in facilitating the growth in CDU bed utilization by ∼20%. Methods The quasi-experimental study was conducted during the period 1st May 2021 to 28th February 2022. The strategies of the healthcare improvement project are structured as per the Plan-Do-Study-Act (PDSA) cycle. ‘Lean thinking’ approach using the A3 sheet tool was applied, as its focus is on organization of processes. Benchmarking technique was used to attain more insight into the optimal performance levels. Results Plan phase: The tracks of CDU process were mapped using the ‘process flow diagram’ technique. The reasons for the perceived bed shortage and high work pressure were revealed by the Root cause analysis, which includes the 21 prioritized problem areas. Do phase: Various interventions were implemented in the domains of communication systems, developing standard operating protocols and human resource management. Study phase: 9 of the total 21 problem areas were cumulatively responsible for ∼80% of underutilization of CDU beds. Act phase: The planned intervention resulted in an increase in the proportion of CDU bed utilization from 60% (18-20 patients/day) to 75% (23-25 patients/day). Conclusion The PDSA cycle offered optimal structure to this efficiency improvement initiative. The project outcomes were enhanced by the combination of approaches such as lean thinking and benchmarking.
Pediatric adapted risk index to predict 2-year transplant-related mortality post-HSCT in children
Authors: Elfeky Reem , Builes Natalia , Pearce Rachel , Kania Soumya , Nademi Zohreh , Lucchini Giovanna , Chiesa Robert , Amrolia Persis , Sorror Mohamed , Veys Paul , Rao Kanchan 
Published: August 2024

Abstract
Several attempts have been made to optimize pretransplant risk assessment to improve hematopoietic stem cell transplantation (HSCT) decision-making and to predict post-HSCT outcomes. However, the relevance of pretransplant risk assessment to the pediatric population remains unclear. We report the results of revalidation of the hematopoietic cell transplantation comorbidity index (HCT-CI) in 874 children who received 944 HSCTs for malignant or nonmalignant diseases at a single center. After finding the HCT-CI invalid in our patient population, we proposed a modified pediatric adapted scoring system that captures risk factors (RFs) and comorbidities (CoMs) relevant to pediatrics. Each RF/CoM was assigned an integer weight based on its hazard ratio (HR) for transplant-related mortality (TRM): 0 (HR &lt; 1.2), 1 (1.2 ≥ HR &lt; 1.75), 2 (1.75 ≥ HR &lt; 2.5), and 3 (HR ≥ 2.5). Using these weights, the pediatric adapted risk index (PARI) for HSCT was devised, and patients were divided into 4 risk groups (group 1: without RF/CoM; group 2: score 1-2; group 3: score 3-4; and group 4: score ≥5). There was a linear increase in 2-year TRM from group 1 to 4 (TRM, 6.2% in group 1, 50.9% in group 4). PARI was successfully validated on an internal and external cohort of pediatric patients. Comparing models using c-statistics, PARI was found to have better performance than HCT-CI in predicting 2-year TRM in children, with Akaike and Schwarz Bayesian information criteria values of 1069.245 and 1073.269, respectively, using PARI, vs 1223.158 and 1227.051, respectively, using HCT-CI. We believe that PARI will be a valuable tool enabling better counseling and decision-making for pediatric patients with HSCT.
Effect of enhanced plane of nutrition in early life on the transcriptome and proteome of the anterior pituitary gland in Angus heifer calves
Authors: Keogh Kate , Kelly Alan K. , Kenny David A. 
Published: August 2024

Abstract
Background
Enhanced nutrition during the early calfhood period has been shown to lead to earlier pubertal development in heifer calves. This is of interest as earlier pubertal onset can subsequently facilitate earlier calving which can economically benefit production systems. Reproductive development in heifers is regulated by the hypothalamic-pituitary-ovarian signalling pathway. In particular the anterior pituitary gland is central to reproductive development, through the dynamics of gonadotropic pulsatility. However, despite clear knowledge of the influence of enhanced dietary intake on subsequent reproductive development, the molecular control governing this response in the pituitary gland within the hypothalamic-pituitary-ovarian signalling axis in heifer calves is not fully understood. The objective of this study was to examine the effect of an enhanced plane of nutrition during early life on the anterior pituitary gland of heifer calves through both transcriptomic and proteomic analyses. Between 3 and 21 weeks of age, heifer calves were offered either a high (HI, n = 14) or moderate (MOD, n = 14) plane of nutrition, designed to elicit target growth rates of 1.2 and 0.5 kg/d for HI and MOD groups, respectively. All calves were euthanised at 21 weeks of age and anterior pituitary tissue harvested for subsequent use in global transcriptomic and proteomic analyses.

Results
Average daily gain was affected by diet (P < 0.001) and was 1.18 and 0.50 kg/day, for HI and MOD calves, respectively. RNAseq analysis resulted in the identification of 195 differentially expressed genes (Padj<0.05; fold change > 1.5), with 277 proteins identified as differentially abundant (Padj<0.05; fold change > 1.5) between contrasting dietary treatment groups. Biochemical pathway analysis of differentially affected genes and proteins revealed an enrichment for both growth hormone and GnRH signalling pathways (Padj.<0.05). Additionally, pathway analysis predicted an effect of enhanced dietary intake on endocrine function within the anterior pituitary gland as well as on reproductive system development and function (Padj.<0.05).

Conclusions
Results from this study show that an enhanced dietary intake during early calfhood affected the molecular control of the anterior pituitary gland in heifer calves in early life.
Comorbidity in primary care – causal or casual? A longitudinal observational study in family medicine
Authors: Soler Jean K. , Buono Nicola , Okkes Inge 
Published: August 2024

Abstract
Background
Comorbidity is increasingly important in the medical literature, with ever-increasing implications for diagnosis, treatment, prognosis, management and health care. The objective of this study is to measure casual versus causal comorbidity in primary care in three family practice populations.

Methods
This is a longitudinal observational study using the Transition Project datasets. Transition Project family doctors in the Netherlands, Malta and Serbia recorded details of all patient contacts in an episode of care structure using electronic medical records and the International Classification of Primary Care, collecting data on all elements of the doctor-patient encounter, including diagnoses (1,178,178 in the Netherlands, 93,606 in Malta, 405,150 in Serbia), observing 158,370 patient years in the Netherlands, 43,577 in Malta, 72,673 in Serbia. Comorbidity was measured using the odds ratio of both conditions being incident or rest-prevalent in the same patient in one-year dataframes, as against not, corrected for the prior probability of such co-occurrence, between the 41 joint most prevalent (joint top 20) episode titles in the three populations. Specific associations were explored in different age groups to observe the changes in odds ratios with increasing age as a surrogate for a temporal or biological gradient.

Results
The high frequency of observed comorbidity with low consistency in both clinically and statistically significant odds ratios across populations indicates more casual than causal associations. A causal relationship would be expected to be manifest more consistently across populations. Even in the minority of cases where odds ratios were consistent between countries and numerically larger, those associations were observed to weaken with increasing patient age.

Conclusion
After applying accepted criteria for testing the causality of associations, most observed primary care comorbidity is due to chance, likely as a result of increasing illness diversity.

Trial registration
This study was performed on electronic patient record datasets made publicly available by the University of Amsterdam Department of General Practice, and did not involve any patient intervention.
The relationship between low and asymmetric handgrip strength and low muscle mass: results of a cross-sectional study on health and aging trends in western China
Authors: Huang Sha , Chen Xiaoyan , Ding Huaying , Dong Birong 
Published: August 2024

Abstract
Objective
The aim was to determine the relationship between low handgrip strength (HGS) only, asymmetric HGS only, and low HGS combined with asymmetric HGS and low muscle mass in the West China Health and Aging Trends Study (WCHAT) data.

Study design
Individuals aged at least 50 years old were included in this cross-sectional study using WCHAT data. Demographic characteristics, such as age, marital status, education level, ethnicity, and drinking and smoking history, as well as chronic diseases, were recorded for all participants. The HGS of both hands was tested three times using a grip dynanometer with the participant in a standing position with arms extended, before recording the maximum value for both hands. The maximum value referred to values < 28 kg and < 18 kg for males and females, respectively. HGS ratios (non-dominant HGS/dominant HGS) of < 0.90 or > 1.10 suggest asymmetric HGS. The subjects were then allocated to the low HGS, asymmetrical HGS, and combined low and asymmetrical HGS (BOTH group) groups, and those with neither low nor asymmetric HGS (the normal group). The InBody 770 instrument was used for the analysis of muscle mass, with low muscle mass defined as a skeletal muscle mass index (SMI) of < 7.0 kg/m2 or < 5.7 kg/m2 for males and females, respectively. The associations between the different HGS groups and low muscle mass were assessed by logistic regression analysis.

Results
The study included 1748 subjects, of whom 1272 (72.77%) were over the age of 60 years. The numbers of Han, Tibetan, and Qiang were 885 (50.63%), 217 (12.41%), and 579 (33.12%), respectively. A total of 465 individuals (26.60%) were classified as having low muscle mass, while 228 (13.04%), 536 (30.66%), and 125 (7.15%) participants were allocated to the low HGS, asymmetric HGS, and BOTH groups, respectively. The average SMI differed significantly between the normal group and the other groups (normal group vs. asymmetric HGS group vs. low HGS group vs. BOTH group: 6.627 kg/m2 vs. 6.633 kg/m2 vs. 6.492 kg/m2 vs. 5.995 kg/m2, respectively, P < 0.05). In addition, the prevalence of low muscle mass in the normal, asymmetric HGS, low HGS, and BOTH groups increased sequentially, with significant differences (normal group vs. asymmetric HGS group vs. low HGS group vs. BOTH group: 21.5% vs. 22.4% vs. 39.5% vs. 56%, respectively, P = 0.001). Further logistic regression analysis showed that the presence of low HGS (OR = 1.7, 95%CI: 1.203–2.402) and both low and asymmetric HGS (OR = 3.378, 95%CI: 2.173–5.252) were predictive of low muscle mass, with the chance being higher for the latter condition.

Conclusion
The findings suggest that although asymmetrical HGS itself does not increase the chances of low muscle mass. When low HGS and a combination of both features (low HGS combined with asymmetric HGS) is present in subjects, the chance of low muscle mass increases.