bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidence of High Risk and Malignant Pathological Findings in Transgender and Gender Diverse Individuals Undergoing Gender-Affirming Mastectomy
Authors: McCaffrey Rachel L. , James Andrew J. , Torres-Guzman Ricardo A. , Addae Jamin K. , Sullivan Lauren E. , Dash Elianna , Slutsky Hanna , Finer Zoe R. , Assi Patrick E. , Al-Kassis Salam 
Published: August 2024

Abstract
Background
Concrete, data-driven guidelines for breast cancer screening among the transgender and gender diverse (TGD) population is lacking. The present study evaluates possible associations of gender-affirming hormone therapy (GAHT) on incidental breast pathology findings in trans-masculine patients to inform decision making about breast cancer screening.

Patients and Methods
This was a retrospective cohort study of patients who had gender-affirming mastectomy or breast reduction at a single center from July 2019 to February 2024. A total of 865 patients met the inclusion criteria. Gender-affirming testosterone therapy and length of exposure were evaluated to seek differences in post-operative pathology findings.

Results
The median age at the time of surgery was 27 years [interquartile range (IQR) 21–30]. Most participants identified as female to male (658, 75.6%). A significant portion of the participants (688, 79.2%) were undergoing testosterone therapy at the time of surgery, with the median duration of testosterone use prior to surgery being 14 months (IQR 4–29). High risk or malignant findings were noted in pathology results for 12 of 1730 breasts (0.7%). Ordered logistic regression found that duration of testosterone therapy was not associated with increasing severity of incidental breast pathology. Additionally, patients under 25 years of age were 70% less likely to have any incidental finding on pathological evaluation than older patients [odds ratio (OR) 0.3, p < 0.01, confidence interval (CI) 0.18–0.50].

Conclusions
The present study found that patients undergoing GAHT should not be screened for breast cancer with increased frequency compared with cis-gender women. Additionally, it may be appropriate for trans women under the age of 25 with normal breast cancer risk to forego pathological breast tissue examination.
Prevalence, contributing factors and consequences of workplace bullying against nurse managers
Authors: Aly Nagah Abd El-Fattah Mohamed , El-Shanawany Safaa M , Ghanem Maha , Fayad Elham Abd El Kader , Lotfy Wael M 
Published: August 2024

Background/Aims Research has indicated a high prevalence of bullying among nurses, but there has been limited research into bullying among nurse managers. This study aimed to identify prevalence and consequences of workplace bullying, as well as the environmental factors that can contribute to this behaviour, towards nurse managers. Methods A descriptive correlational study was conducted with 135 nurse managers. Data were collected using a self-reported questionnaire, including a workplace bullying scale, authentic leadership scale, workplace culture scale, workplace justice scale, workplace trust scale, job demand and control scales, job satisfaction scale and stress scale. Items were scored using 5-point Likert scales. Data were analysed using the SPSS version 15, with Spearman's rho correlation and logistic regression analyses performed to identify relationships between variables. Results Participants reported a high prevalence of workplace bullying from staff nurses, leaders and other colleagues (64.7%). Factors that contributed to this behaviour included ineffective leadership, high workload, low job control, injustice, distrust in the organisation and weak organisational culture. Stress and dissatisfaction were identified as consequences of bullying. Conclusions High rates of bullying against nurse managers may lead to adverse consequences, including stress and job dissatisfaction. Healthcare managers and leaders need to target environmental factors that could reduce the incidence of workplace bullying, such as strong authentic leadership, organizational culture and job demand.
Increasing the number of adults on a palliative care end‑of‑life register: a quality improvement project
Authors: Lawrence Emma , Massey Alison , Whatley Vanessa , Nicholls Lynn , Hay Fiona , Willis Derek 
Published: August 2024

Background/Aims Identifying patients at the end of life can facilitate easier access to support and reduce unnecessary emergency care admissions. This study aimed to increase the number of adults on the palliative and end-of-life care register by at least 10% in 20% of primary care practices in an English integrated care system. Methods A quality improvement project was carried out, using the Model for Improvement, with plan-do-study-act cycles. A hospice within a UK integrated care system added standard wording and system codes to letters sent to patients’ primary care provider. The number of patients on the palliative and end-of-life care register was monitored monthly between September 2022 and April 2023. Results By the end of the study period, the number of patients on the palliative and end-of-life care register had increased by >10% in 20% of practices. Conclusions Adding a recommendation to add a patient to palliative and end-of-life care registers on letters sent to primary care providers can lead to an increase in the number of patients being identified to be in the last year of their life.
“I CAN'T TAKE IT ANYMORE”: THE EXPERIENCE OF BEING MANAGED FOR SUSPECTED CAUDA EQUINA SYNDROME IN THE EMERGENCY DEPARTMENT
Authors: Karia R. , Roberts L.C. , Ryan C. 
Published: August 2024

Purpose and backgroundCauda equina syndrome (CES) leads to nerve compression in the lumbar spine, and requires immediate treatment to prevent permanent neurological dysfunction, including urinary/anorectal incontinence. The consequences for the patient are significant as, in the decade to 2018, CES has cost the NHS £186,134,049. No study has reported patients’ experiences of being managed with suspected CES in an emergency department (ED), and this study explores patients’ experiences and how the NHS can optimise care for patients experiencing this condition.Methods and ResultsIn this qualitative secondary analysis, 14 participants (aged 23–63 years) with suspected CES were purposively sampled from 4 EDs in England. Online, semi-structed interviews were undertaken (in 2021, during the pandemic), and were audio-recorded and transcribed verbatim. Data were managed using a Framework approach and analysed thematically.Three themes were identified: quality of care; environmental factors; and expectations. The quality of care included managing uncertainty, the importance of communication, appropriate assessment and follow-up care. Environmental factors, including the chairs, waiting times and the busy nature of the ED, negatively impacted patients’ experiences. Furthermore, an expectation gap was identified, as most individuals came to the ED expecting to receive a scan, an accurate diagnosis and a cure. Despite frustrations, patients expressed gratitude towards the ED staff.ConclusionThis study highlights the importance of empathically acknowledging the patient's pain and providing comprehensive assessments and management plans for people attending ED with suspected CES. Optimising the ED environment to minimise patients’ pain and distress while waiting to access care is paramount and overdue.No conflicts of interest Sources of fundingFunding for primary data: Health Education England & National Institute of Health and Care Research (ICA-CDRF-2018-04-ST2-040)
“YOU THINK YOU'VE GOT THEM ON BOARD AND THEN THEY'RE BACK”: PRIMARY CARE CLINICIANS’ EXPERIENCES OF OFFERING SELF-MANAGEMENT ADVICE TO PEOPLE WITH BACK PAIN
Authors: Osborn-Jenkins L. , Turnbull J. , Geraghty A.W.A. , Roberts L.C. 
Published: August 2024

Purpose and background of the studySelf-management and behaviour change is at the core of back pain management. Despite the high-rate of recurrence and healthcare utilisation, clinical guidelines do not include guidance for clinicians on return consultations. This project aimed to identify primary care clinicians’ reported practices and experiences of delivering self-management advice for people returning with persistent low back pain (LBP), to inform future delivery of self-management care.Methods and ResultsIn this qualitative study involving 27 primary care clinicians, four focus groups and two semi-structure interviews were conducted online. GPs (n=5) and physiotherapists working in primary care roles (First contact practitioners n=7, community and interface roles n=7, and mixed roles n=8) in England and Scotland shared their experience of delivering self-management advice to people returning with persistent LBP. Video recordings were transcribed verbatim and analysed with reflexive thematic analysis.Clinicians unanimously shared their frustrations identifying the challenges involved in supporting people who return with LBP. Helpful strategies to support self-management in return consultations were identified by clinicians in addition to service and system-level changes vital to optimise care. Patient-factors affecting delivery of care, lack of defined responsibility and challenges in meeting patients’ expectations illustrated the tensions that exist in return consultations.ConclusionThis novel study provides insight into the experiences and practices of the frontline primary care workforce seeing patients return with persistent or recurrent LBP. It identifies the tensions that exist between services, professional roles and between clinicians and patients regarding self-management. Important practice implications have been identified to improve information-sharing, agenda-setting, and exploring expectations.No conflicts of interest Source of fundingLisa Osborn-Jenkins is funded by University Hospital Southampton NHS Foundation Trust (UHS) Research & Development PhD Fellowship [GRT0723]
“I JUST WANTED TO GET THE PAIN OUT OF THE WAY”: WHY PEOPLE WITH SIGNS AND SYMPTOMS OF SUSPECTED CAUDA EQUINA SYNDROME ATTEND THE EMERGENCY DEPARTMENT
Authors: Wakefield B. , Roberts L.C. , Ryan C. 
Published: August 2024

Purpose and backgroundCauda Equina Syndrome (CES), a rare (<1 per 100,000) and potentially devasting condition, involves compression of the lumbosacral nerve roots. If not quickly identified and treated, it can lead to lasting disability, and high medicolegal costs (>£186 million in the decade to 2018). This study identified why people with suspected CES attend the emergency department (ED) and explored any delays in attending.Methods and ResultsThe design was a secondary analysis of a qualitative dataset comprising patients with back pain who attended the ED, undertaken using an interpretivist approach. Fourteen patients (8M:6F, aged 23–63 years) with suspected CES were purposively sampled from 4 EDs (2 Northern and 2 Southern) in England between August and December 2021. Semi-structured interviews were conducted online, audio-recorded, transcribed verbatim and analysed thematically.Acopia with pain was the biggest factor in a participant's decision to attend the ED, along with the need for a diagnosis. This pain was the worst ever experienced and debilitating, leaving people unable to cope and desperate for relief. 12/14 were advised to attend the ED following identification of red flags by: GPs (n=9); physiotherapists (n=2); surgical colleague (n=1); and 111 (n=1). Factors such as guilt, previous experience of being disregarded, and symptom misattribution were seen to cause delays in seeking care.ConclusionThis paper revealed a disconnect between the priorities of patients and clinicians prior to attending the ED. Clinicians need to validate the pain experience, communicate clearly why signs and symptoms are concerning, and convey the urgency and potential impact of CES.Conflicts of interestNoneSources of fundingFunding for primary data: Health Education England & NationalInstitute of Health and Care Research (ICA-CDRF-2018-04-ST2-040)
Towards improved 3D reconstruction of cystoscopies through real-time feedback for frame reacquisition: erratum
Authors: Eimen Rachel , Pillai Mayaank , Scarpato Kristen R. , Bowden Audrey K. 
Published: August 2024

In this erratum, we correct a small error in Fig. 5 of in Biomed. Opt. Express 15, 3394 (2024)10.1364/BOE.523361.
Spatial non-equilibrium and distribution dynamic evolution of the development level of national physical fitness in China’s provinces
Authors: Xiao Qin , Xiao Haiting 
Published: August 2024

Introduction
Physical health is fundamental to a country’s socio-economic advancement. An in-depth exploration of the spatial distribution and dynamic evolution of national physical fitness across China is crucial for enhancing the country’s overall physical health. This study aims to provide valuable insights into the geographical and temporal patterns of physical fitness, informing strategies for national physical fitness improvement.

Methods
Employing data from China’s national physical fitness monitoring of 31 provinces, cities, and districts for the years 2005, 2010, and 2015, this study utilizes the Gini coefficient, its decomposition, and nonparametric density estimation methods. These techniques are applied to analyze the spatial disparities and temporal trends in national physical fitness levels among different demographics, including the overall population, males, females, and urban and rural residents.

Results
The study reveals that the regional disparity in China’s national physical fitness initially narrowed and then expanded across the general population, females, and in both urban and rural areas, while consistently increasing among males. In terms of geographical distribution, the East, Middle, and West regions show significant heterogeneity, with the East-West gap being the most pronounced (Gini coefficients of 0.0249, 0.0230, 0.0263). The contribution rate of regional gaps was highest (54.40% -64.69%), followed by regional disparities (24.78% -27.15%), and the contribution of hypervariable density difference was the smallest (10.53% -19.75%). Despite a slight improvement in overall national physical fitness, the absolute regional disparities have further widened.

Conclusions
Provinces with lower levels of national physical fitness demonstrate a ’club convergence’ trend, indicating regional clustering of similar fitness levels. Additionally, a ’catch-up effect’ is evident in rural areas, particularly in provinces with historically lower levels of national physical fitness. These findings suggest the need for region-specific public health strategies to address the growing disparities in national physical fitness across China.
Reconstituted HDL ameliorated renal injury of diabetic kidney disease in mice
Authors: Tao Yu , Lacko Andras G. , Sabnis Nirupama A. , Das‐Earl Paromita , Ibrahim Deena , Crowe Nicole , Zhou Zhengyang , Cunningham Mark , Castillo Angie , Ma Rong 
Published: August 2024

AbstractDiabetic kidney disease (DKD) is a devastating kidney disease and lacks effective therapeutic interventions. The present study was aimed to determine whether reconstituted high‐density lipoprotein (rHDL) ameliorated renal injury in eNOS−/− dbdb mice, a mouse model of DKD. Three groups of mice, wild type C57BLKS/J (non‐diabetes), eNOS−/− dbdb (diabetes), and eNOS−/− dbdb treated with rHDL (diabetes+rHDL) with both males and females were used. The rHDL nanoparticles were administered to eNOS−/− dbdb mice at Week 16 at 5 μg/g body weight in ~100 μL of saline solution twice per week for 4 weeks via retroorbital injection. We found that rHDL treatment significantly blunted progression of albuminuria and GFR decline observed in DKD mice. Histological examinations showed that the rHDLs significantly alleviated glomerular injury and renal fibrosis, and inhibited podocyte loss. Western blots and immunohistochemical examinations showed that increased protein abundances of fibronectin and collagen IV in the renal cortex of eNOS−/− dbdb mice were significantly reduced by the rHDLs. Taken together, the present study suggests a renoprotective effect of rHDLs on DKD.
The assessment method of lip closure ability based on sEMG nonlinear onset detection algorithms
Authors: Zhu Wei , Zhao Cuilian 
Published: August 2024

Abstract

Objectives
To overcome the limitations of traditional diagnosis of orbicularis oris muscle function in mouth-breathing patients, this study aims to propose a surface electromyographic (sEMG) based method for reliable and accurate quantitative assessment of lip closure ability.

Methods
A total of 21 volunteers (16 patients and 5 healthy subjects, aged 8–16) were included in the study. Three nonlinear onset detection algorithms – Teager–Kaiser Energy (TKE) operator, Sample Entropy (SampEn), and Fuzzy Entropy (FuzzyEn) – were compared for their ability to identify lip closure in sEMG signals. Lip Closure EMG Activity Index (LCEAI) was proposed based on the action segments detected by the best performing algorithm for the quantitative assessment of lip closure.

Results
The results indicated that FuzzyEn had the highest lip closure identification rate at 93.78 %, the lowest average onset delay of 47.50 ms, the lowest average endpoint delay of 73.10 ms, and the minimal time error of 111.61 ms, exhibiting superior performance. The calculation results of the LCEAI closely corresponded with the actual degree of lip closure in patients.

Conclusions
The lip closure ability assessment method proposed in this study can provide a quantitative basis for the diagnosis of mouth breathing.
Creating a Sustainable Narrative: The Interplay of Ecological Agriculture, Cultural Heritage, and Community Efficacy in Contemporary China
Authors: Kuang Lanlan 
Published: August 2024

Abstract
Highlighting the situational, creative strategics implemented by local actors for encouraging dynamic interactions among culinary heritage, cultural tourism, and ecosystem, this study presents two case studies from southeast-central China: Dongjiao Center for Porcelain History and Cultural Exchange in Jingdezhen, Jiangxi Province, and Changsha Banquets, a restaurant chain in Changsha, Hunnan Province. Together, they embody the author’s ongoing research on heritage education, cultural tourism, and sustainable development in contemporary China. This article provides an overview and analysis of the developing forms of sustainable tourism and heritage education enacted by individual social actors since 1985, when China signed the UNESCO World Heritage Convention, against the backdrop of China’s economic growth, sustainable consumption, and most importantly, the rising public awareness of heritage protection. The author argues that these individual entities develop sustainable cultural tourism through social media and creative contents that are not a part of China’s mainstream state-funded food media.
Categorizing and Quantifying Doctors’ Extended Answers and their Strategies in Teleconsultations: A Corpus-based Study
Authors: Li Huaikui Kevin 
Published: August 2024

Abstract
This study examined 210 teleconsultations to analyze doctors’ extended answers and communication strategies using corpus software. The results revealed seven categories of extended answers, with explanations for diseases and treatments being the most frequent at 39 %. Proposals for medical treatment had a proportion at 29 %. The remaining categories had lower rates ranging from 3 % to 9 %. The corpus derived four types of communication strategies: baldly on-record strategies (BORSs), positive politeness strategies (PPSs), negative politeness strategies (NPSs), and off-record strategies (ORSs), with NPSs being the most commonly used at 84 %. Except ORSs, these strategies encompassed multiple classes, with NPSs having as much as seven categories, in which offering justifications for definitive minimal responses was the most prevalent at 33 %. Making fuzzy proposals had a share of 32 %. Each of the remaining categories made up a far low rate. But when it comes to the specific category of extended answers, the most commonly used strategy in it is not always the one from NPSs. The study underscores the significance of clear explanations and justifications in teleconsultations. Implications for training programs in teleconsultation settings are discussed, with potential areas for further research suggested to enhance teleconsultation practices.
Three Faces of Heroism: An Empirical Study of Indirect Literary Translation Between Chinese-English-Portuguese of Wuxia Fiction
Authors: Mengyuan Zhou 
Published: August 2024

Abstract
This paper conducts an empirical study using digital humanities to explore the indirect translation of Chinese contemporary literature, focusing on a Portuguese version of Jin Yong’s A Hero Born: The Legend of the Condor Heroes
derived from its English translation. Employing BERTopic modeling, it quantifies thematic changes related to heroism in the translation process from Chinese through English to Portuguese. This study examines how Chinese concepts of heroism are adapted or rewritten in translation, exploring the notion of intermediate translations as “secondhand” and “distorted” from digital humanities perspective. By applying the zero-shot BERTopic model, the research allows for a quantitative comparative analysis of topic distribution across the original, intermediate, and final translation texts. The findings aim to enrich translation studies by demonstrating how Chinese cultural concepts are transformed and circulated through indirect translation, providing a data-driven insight into the global dissemination and reception of Wuxia literature.
When Colleagues Come to See Each Other as Rivals: Does Internal Competition Affect Workplace Performance?
Authors: Braun Felia , Sonnabend Hendrik 
Published: August 2024

Abstract
We study workplace performance effects triggered by team-internal rivalry. Specifically, we focus on duos of goalkeepers in professional soccer competing for in-season playing time. Using performance data from the most prestigious European soccer leagues and tournaments, we provide evidence for asymmetric discouragement: While the ex ante underdog feels demotivated by internal rivalry, we cannot observe a comparable effect for the ex ante favourite. Moreover, we find that workplace competition generally works explicitly rather than implicitly, meaning that demonstrated performance outweighs pure skills when it comes to the emergence of peer effects. To address a potential endogeneity problem caused by non-random selection, we show that our results are robust to quasi-random rotations caused by (minor to moderate) injuries and bans.
Influence of high-reactivity energetic materials on microstructure and performance on iron-based cladding layer under low laser power
Authors: Liu Zheng , Yang Yong , Sun Dusheng , Han Jianyu , Ma Shutao , Xu Bin , Yuan Mingyu 
Published: August 2024

Abstract
Under low laser power conditions, the cladding layer is constrained by inadequate energy density, resulting in incomplete melting of certain powder particles and the occurrence of defects such as cracks and pores within the layer. This paper utilizes a QT500 substrate and synergistically integrates high-reactivity energetic materials (H-REMs) with metal powder. By external laser energy ignition, the localized combustion of the H-REMs (Al + Fe2O3) is induced, thereby providing additional heat input during the laser cladding process. Through in-depth analysis of extensive experimental data, the influence of H-REMson microstructure and performance of alloy cladding layerhas beenrevealed. The research results demonstrate that the inclusion of H-REMs leads to a 450 K increase in the maximum temperature of the molten pool. By incorporating high-reactivity energetic materials, the energy density utilization of the composite material increased from 0.2663 to 0.7375. The combustion wave generated by H-REMs induces mixing in the molten pool, resulting in cladding layer grain refinement and an average hardness increase of 80 HV1. The friction coefficient decreases from 0.71024 (prior to the addition of H-REMs) to 0.35809, representing a reduction of approximately 49 %.