bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of oncological outcomes of T1-3 N1 rectal cancer patients treated with neoadjuvant radiotherapy versus no radiotherapy: A retrospective cohort study
Authors: Marjasuo Suvi , Koskenvuo Laura , Lepistö Anna 
Published: February 2025

Background and aims: Neoadjuvant short-course radiotherapy (SCRT) prior to surgery has been used to reduce local recurrences in moderately advanced rectal cancer (RC). Total mesorectal excision (TME) surgery by itself can reduce the local recurrence rate in these patients. The objective was to assess whether discontinuing neoadjuvant SCRT had a negative impact on survival and local recurrence rates of moderately advanced RC. Methods: This retrospective study examined 137 consecutive patients (67 neoadjuvant SCRT, 70 TME without neoadjuvant therapy) treated for rT1-3N1M0 RC without extramural venous invasion (EMVI) or a threatened surgical margin between January 2016 and March 2020 in a tertiary rectal surgery referral center. The primary objective was the impact of neoadjuvant therapy on overall, cancer-specific, and disease-free survival, and local recurrence rate. Secondary outcomes were risk factors affecting survival. The analyses were conducted on the total study cohort as well as a propensity score matched cohort of the same patient group, with the matching predicated upon age, gender, and histological T score. Results: The oncological outcomes were similar between the two different treatment groups. The 5-year cumulative overall survival rate, calculated using the Kaplan–Meier method, was 89.6% in the neoadjuvant SCRT group and 83.5% in the surgery-only group ( p = 0.570), with the corresponding cancer-specific survival rates at 97.0% and 98.4% ( p = 0.219) and disease-free survival rates at 97.0% and 91.9% ( p = 0.438). No local recurrencies were detected in either group during the 5-year follow-up period. Conclusion: The omission of neoadjuvant SCRT in rT1-3N1M0 RC with no EMVI and no threatened resection margin caused no adverse effects on the survival of the patients. Based on this series, it appears that avoiding SCRT does not compromise the oncological outcome in these patients.
Comparison of Telephone and In-Person Interview Modalities: Duration, Richness, and Costs in the Context of Exploring Determinants of Equitable Access to Community Health Services in Meru, Kenya
Authors: Allen Luke N. , Karanja Sarah , Tlhajoane Malebogo , Tlhakenelo John , Macleod David , Bastawrous Andrew 
Published: February 2025

Background Our research team conducted phenomenological interviews in Kenya with people who were not able to access community eye health services, aiming to explore the barriers and ideas for potential service modifications. We conducted an embedded study that compared in-person and telephone interview modalities in terms of time requirements, costs, and data richness. Methods A team of six interviewers conducted 31 in-person interviews and 31 telephone interviews using the same recruitment strategy, topic guide, and analytic matrix for each interview. We compared the mean duration; mean number of themes reported by each participant; total number of themes reported; interviewer rating of perceived richness; interviewer rating of perceived ease of building rapport; number of days taken by the team to complete all interviews; and all costs associated with conducting the interviews in each modality. Results In-person interviews were 44% more expensive and took 60% longer to complete than our telephone interviews (requiring 5 days and 3 days respectively). The average in-person interview lasted 110 seconds longer than the average telephone interview ( p = .05) and generated more words and themes. However, the full set of interviews from both approaches identified similar numbers of barriers ( p = .14) and the same number of solutions ( p = .03). Interviewers universally felt that the in-person approach was associated with better rapport and higher quality data ( p = .01). Triangulation of themes revealed good agreement, with 88% of all solutions occurring in both sets of interviews, and no areas of thematic dissonance. Conclusions The in-person approach required more time and financial resources, but generated more words and themes per person, and was perceived to afford richer data by interviewers. However, this additional richness did not translate into a greater number of themes that our team can act upon to improve services.
Risk factors of blood transfusion following primary total hip replacement
Authors: Askar Mohamed , Zedan Yasmine , Davies Owain , John Alun 
Published: February 2025

Background: Total hip replacement is a quality of life–enhancing procedure. Postoperative blood transfusion is a risk factor compromising the outcome of total hip replacement and increasing the risk of deep infection. The aim of this study is to determine the risk factors for postoperative blood transfusion after total hip replacement. Methods: In this retrospective study, 3901 patients underwent primary total hip replacement, in the period between January 2015 and December 2023. The mean age of the participants was 67.3 (SD: 12.6) years, and 61% of them were females. Participants were divided into ‘transfusion’ and ‘non-transfusion’ groups. Results: Forty-two patients (1.1%) received blood transfusion after total hip replacement. In a multivariable logistic regression analysis, preoperative haemoglobin was the only independent risk factor that reduced the odds of postoperative transfusion by 0.3 (95% confidence interval: 0.23–0.39) for every 1 g/dL increase. Conclusion: Postoperative blood transfusion is a rare, yet potentially serious, occurrence after total hip replacement. In this study, preoperative haemoglobin level was the only independent risk factor associated with postoperative transfusion. We recommend aiming to achieve minimum preoperative haemoglobin level of 13 g/dL to minimise the risk of postoperative transfusion.
Factors Influencing Nursing Students’ Willingness to Participate in Patient Safety: The Role of Patient Safety Confidence and Campaign Participation
Authors: Baek On-Jeon , Shin Sun-Hwa 
Published: February 2025

Introduction Patient safety is a critical competency for nursing students, highlighting the need to equip them with the knowledge and skills required to foster a culture of safety in healthcare systems. Aim This study aimed to examine the mediating effect of patient safety confidence, moderated by campaign participation, on the relationship between nursing students’ patient safety attitude and their willingness to participate in patient safety. Methods This study utilized a secondary data analysis approach, analyzing data from a patient safety study conducted in South Korea. The participants included 245 fourth-year undergraduate nursing students recruited using nonprobability convenience sampling. Data were collected in April 2023 through an online survey distributed to members of nursing student-focused online communities. The collected data were analyzed using SPSS PROCESS Macro (models 4 and 14) and bootstrapping method. Results The findings underscore the critical role of patient safety confidence as a mediating factor and highlight the positive impact of campaign participation in strengthening nursing students’ engagement in patient safety activities. These insights emphasize the interplay between nursing students’ patient safety attitudes, confidence, and experiential learning opportunities. Conclusion To enhance nursing students’ willingness to actively participate in patient safety, fostering positive attitudes and confidence through a well-structured educational strategy is essential. Integrating patient safety topics into the nursing curriculum and providing experiential learning opportunities can prepare students to advocate for safety and contribute to a culture of safety in healthcare.
Prevalence of post-pandemic SARS-CoV-2 in patients with respiratory syndrome in Brazzaville, Republic of the Congo
Authors: Demboux Lyelet Jordy Exaucé , Mayengue Pembe Issamou , Koukouikila-Koussounda Félix , Doniama Essialaba Ahmed Jordy , Vembe Mahounga Christ Marty Stéphane , Mandiangou Aldi Fred , Fila-Fila Grâce Petula Urielle , Lenguiya Léadisaelle Hosanna , Bobouaka Bonguili Novy Charel , Elguero Eric , Leroy Eric M. , Becquart Pierre , Niama Fabien Roch 
Published: February 2025

Abstract
The first confirmed case of COVID-19 was detected in the Republic of the Congo in March 2020. Several control measures were implemented during the pandemic period. As a result, the number of reported cases decreased significantly, leading to the gradual lifting of barrier measures and the declaration of the end of the outbreak on 14 October 2022. The present study aimed to determine the post-pandemic prevalence of SARS-CoV-2 in the referral hospitals of Talangaï (HRT) and Makélékélé (HRM) in Brazzaville between October 2022 and April 2023. Nasopharyngeal samples collected from patients with respiratory syndrome were analyzed via qRT‒PCR to detect SARS-CoV-2. An overall prevalence of 5% of SARS-CoV-2 infection was found, with monthly fluctuations in cases during the study period, likely reflecting the endemic nature of the infection. The monthly proportion of SARS-CoV-2 infection cases did not correlate with the number of patients with respiratory syndrome-related symptoms. Although the post-pandemic prevalence of SARS-CoV-2 has remained low, laboratory confirmation of COVID-19, which accounts for both clinical suspicion and detection of SARS-CoV-2, using at least one rapid diagnostic test (RDT) is needed to improve case-by-case management in health centers.
Exploring the value and acceptability of a patient navigator program for people who inject drugs and are hospitalized for bacterial infections: patients’, community organization and healthcare workers’ perspectives
Authors: Bédard Karine , Boisvert Isabelle , Rochette Marianne , Racine Eric , Martel-Laferrière Valérie 
Published: February 2025

Abstract

Background
Hospitalizations for bacterial infections are often difficult for people who inject drugs (PWID) and healthcare workers, in part due to biases and stigma associated with substance use, patients’ competing needs, such as pain and withdrawal management, and strict antibiotic treatment protocols. In recent years, peer navigators have been introduced as a strategy to reduce stigma and bridge the gap between patients and healthcare workers, but little is known about their involvement in hospitalization settings. The aim of this study was to assess the value of adding a peer navigator program and to evaluate the elements that key stakeholders identified as essential for the program to be successful.

Methods
This was a qualitative study using focus groups. The interview guide was collaboratively developed by ethicists, physicians, and a person with lived experience and validated with a PWID and a community worker. Three two-hour focus groups were conducted in February 2022 with PWID, community organizations and healthcare workers. Descriptive and interpretive thematic analyses were carried out.

Results
Nineteen people (5 PWID, 6 community organization workers, 8 healthcare workers) participated in the focus groups. The final coding strategy involved 4 main themes: challenges in current care, positive aspects of current care, aspirations for quality care, the contribution of peer navigators as a solution to current challenges and the realization of aspirations. Improvements in the quality of care should focus on an approach centered on patients’ values and aspirations; improving the current hospital environment, particularly in terms of training and communication; and encouraging collaborative partnerships with all parties involved. The integration of peer navigators seems to be a promising strategy for improving communication and trust and, consequently, to facilitate shared decision-making and adapted care.

Conclusions
Our study showed that any innovative model should be centered on patients’ needs and values and therefore co-constructed with them and other parties involved, notably the community organizations offering services to these patients. The inclusion of well-trained and well-supported peer navigators has the potential to improve care and work toward achieving aspirations of quality care.
Neutralizing and binding antibody dynamics following primary and booster COVID-19 vaccination among healthcare workers
Authors: Güzel Irmak , Öztürk Gamze , Appak Özgür , Çağlayan Derya , Süner Ahmet F. , Irmak Çağlar , Türe Neslişah , Işik Elif , Çelik Muammer , Ergör Gül , Ergör Alp , Demiral Yücel , Alp Çavuş Sema , Kilic Bulent , Sayiner Arzu 
Published: February 2025

Abstract

Background
Vaccine-induced neutralizing antibodies (NAbs) are key for COVID-19 protective-immunity. As the efficacy of SARS-CoV-2 vaccines declines over time and variants of the virus continue to emerge, the need for booster doses of vaccine remains on the agenda. The aim of this study was to assess NAbs dynamics and its correlation with anti-RBD IgG levels during the nine-month follow-up period after primary-CoronaVac vaccination and booster vaccinations to evaluate vaccination strategies.

Methods
This prospective longitudinal observational study followed 226 healthcare workers who received primary (two doses CoronaVac) and booster (CoronaVac or BNT162b2) immunization. Serum samples were collected at four different time points, two after primary vaccination and two after booster. Anti-RBD IgG antibody levels were assessed with the SARS CoV-2 IgG-II-QUANT kit (Abbott, USA) and neutralizing antibody levels were determined with the ACE2-RBD-Neutralization-Assay (Dia-Pro, Italy) using a surrogate virus neutralization method. Factors affecting antibody response were analyzed. Statistical analysis was performed with IBM-SPSS-22.0.

Results
One month after the second dose of CoronaVac, 79.2% of participants had NAb, but this had decreased to 49.7% by the fourth month and was influenced by smoking, BMI and chronic diseases. Boosters, regardless of type, significantly raised NAb levels. Heterologous vaccination yielded higher NAb and anti-RBD IgG responses. Both single or double-BNT162b2 boosters resulted in similar NAb responses. There was a strong correlation between anti-RBD IgG and NAb levels following CoronaVac vaccination, leading to the identification of predictive IgG threshold for the presence of NAb. The type of booster influenced the correlation strength and threshold-value.

Conclusions
NAbs levels decreased rapidly after primary CoronaVac vaccination. Boosters significantly increased levels while the heterologous vaccine combination induced a greater response. Anti-RBD IgG levels were able to predict the NAb response, however the correlation varied by the vaccine type, NAb response strength and the time since vaccination.
Knowledge, attitudes, and practices of Lebanese licensed dietitians regarding hyperphosphatemia management in patients undergoing hemodialysis in a Lebanese Governorate
Authors: Mannan H. , Issa E. , Attieh R. , Sacre Y. 
Published: February 2025

Abstract

Background
Hyperphosphatemia is deemed to be an asymptomatic silent killer, its high prevalence in patients undergoing hemodialysis (HD) is correlated mainly with malnutrition and mortality. Dietitian’s renal nutrition education has a major impact on chronic kidney disease patients’ knowledge, and attitude towards nutrition guidelines. However, a large number of factors are acting as barriers to the appropriate practices of Lebanese dietitians in renal therapy. This study evaluated the knowledge, attitudes, and practices (KAP) of licensed dietitians (LDs) regarding hyperphosphatemia management in patients undergoing HD.

Methods
A total of 408 LDs from Mount-Lebanon Governorate in Lebanon participated in this study. A 52-item online questionnaire was used to assess nutritional phosphorus’ KAP of all LDs, in compliance with dietetic practices with KDOQI guidelines updated version 2020 and identified the factors preventing dietitians from dealing with renal patients undergoing HD, e.g., nutrition care. The data was analyzed using SPSS version 25.

Results
There was a significant association between KAP levels, and almost all sociodemographic characteristics evaluated. Only 2% of dietitians applied all KDOQI guidelines, 64% attained poor and moderate knowledge, and 60% had a positive attitude towards renal care. Working in a clinical field was a common predictor of positive knowledge (adjusted OR = 2.453, 95% CI 1.244–4.836), positive attitude (adjusted OR = 1.900, 95% CI 1.300–2.541) and positive practice (adjusted OR = 0.192, 95% CI 0.184–0.491) while HD/hospital-based field increased the odds for positive knowledge (adjusted OR = 4.520, 95% CI 1.189–17.182). LDs, compared to registered dietitians, had lower odds of positive knowledge (adjusted OR = 0.390, 95% CI 0.231–0.658) and positive attitude (adjusted OR = 0.270, 95% CI 0.154–0.471). Lack of training was the main reason preventing the appropriate dietetic practices regarding hyperphosphatemia management in patients undergoing HD.

Conclusion
The Ministry of Public Health (MOPH) should be asked to endorse the integration of renal nutrition programs in the Lebanese curriculum, to aid in the empowerment of dietitians from different backgrounds towards renal therapy, in order to enhance the knowledge and attitude regarding nutritional guidelines of poorly supported Lebanese patients undergoing HDhemodialysis. Other stakeholders may include the Syndicate of Dietitians in Lebanon.
The association of low-level air pollution with birth weight in a register-based study: potential effects below WHO AQ guidelines
Authors: Rumrich Isabell K. , Korhonen A. , Forsberg B. , Frohn L. M. , Geels C. , Brandt J. , Hänninen O. 
Published: February 2025

Abstract

Background
Air pollution exposure during pregnancy has been associated with adverse birth outcomes. Uncertainties remain about the effect at very low exposure levels. The aim of this study was to explore the association of maternal exposure to air pollutants during pregnancy at very low exposure levels with birth weight and estimate the health impact.

Methods
The MATEX birth cohort (226,551 singleton births in 2012–2016) was linked with eight modelled air pollutants (PM2.5, PM10, PMcoarse, NO2, NOx, CO, SO2, O3) at home address during pregnancy. Multiple regression was used to estimate the change in birth weight (in g) associated with individual-level mean exposure during pregnancy. We tested different adjustment models and conducted sensitivity analyses. We also estimated the potential number of low birth weight cases attributable to PM2.5 to quantify the public health issues at the prevailing low exposure levels.

Results
PM2.5 was associated with the largest reduction of birth weight (-6.5 g per 1 µg/m3) followed by PMcrs (-4.9 g) and PM10 (-3.0 g). Among the gaseous pollutants the strongest reduction in birth weight was observed for NO2 (-0.8 g), followed by CO (-0.5 g), NOx (-0.4 g) and SO2 (-0.2 g). On the contrary, O3 was associated with a modest increase in birth weight (+ 0.9 g). Effects on births weight were observed also below WHO guideline values. When accounting for the prevailing exposure levels in Finland, CO was associated with the biggest reduction in birth weight. The effect of PM2.5 exposure on birthweight corresponds to a loss of 30 g at mean exposure. Assuming a causal relationship, about 700 cases of low birth weight could be attributable to PM2.5 in Finland during the study period.

Conclusions
No clear evidence on safe exposure level was found in this study. All pollutants were associated with reduced birthweight except ozone. Causality and confounding due to correlations warrant specific attention.
Effect of printing orientation and resin thickness on flexural strength of direct 3D-printed aligners
Authors: Khalil Ahmed S. , Zaher Abbas R. 
Published: February 2025

Abstract

Background
Direct 3D-printed aligners served as a breakthrough era in clear aligner fabrication. Yet, there is a scarcity of studies evaluating their mechanical properties. The aim of this study was to compare direct 3D-printed aligners derived from different printing orientations (vertically, horizontally, 30, and 45 degrees) and thickness (0.5 and 0.7 mm) in terms of flexural strength.

Methods
This laboratory-based comparative study utilized 96 aligner flat specimens. They were designed, supported, and directly printed using shape memory resin, then randomly allocated into 8 groups. Group 1 (A, B, C, and D): 0.5 mm thickness printed vertically, horizontally, 30, and 45 degrees, respectively. Group 2 (A, B, C, and D): 0.7 mm thickness printed vertically, horizontally, 30, and 45 degrees, respectively. Each aligner specimen was placed on a custom-made bending jig, with the whole setup enclosed in a temperature-controlled water bath. Three-point bending test was performed using a universal testing machine, and the resulting force was recorded. Statistical analysis was performed using Student t-test for resin thickness comparison and one-way ANOVA with Tukey post-hoc test for comparison between printing orientations. Statistical significance was set at p ≤ 0.05.

Results
No statistically significant differences were found between vertically, horizontally, 30, and 45 degrees printed aligner specimens. Aligner specimens of 0.7 mm thickness demonstrated significantly higher flexural strength values compared to those of 0.5 mm thickness.

Conclusions
Printing orientation did not alter the flexural strength of the direct 3D-printed aligner flat specimens, regardless of whether they were printed vertically, horizontally, or at angles of 30 or 45 degrees relative to the printer build plate. Additionally, specimens with a thickness of 0.7 mm exhibited higher bending resistance compared to those with a thickness of 0.5 mm.