bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Middle East and the Ukraine War: Between Fear and Opportunity
Authors: Mankoff Jeffrey 
Published: May 2024

AbstractWhile the ambivalence among Middle Eastern states about the war in Ukraine stems from multiple sources, Russian influence is a significant, if underappreciated, factor. Several of these countries see Moscow as an external balancer and hedge against the possibility of a broader US pullback from the region. At the same time, Russia maintains significant coercive capabilities thanks to its military presence in Syria and burgeoning strategic partnership with Iran. Many aspiring regional powers are also sympathetic to Moscow's calls for an international order less centered on the West. This article analyzes these concerns and perceptions, and it shows how they have shaped the way states in the region have responded to the invasion of Ukraine. Broadly speaking, these states see it as a peripheral concern—especially following the outbreak of war between Israel and Hamas in October 2023—though one that could destabilize the region by stoking inflation or further emboldening Iran. While they are wary of confronting Moscow or facing regional instability, many also directly benefit from Russia's economic decoupling from the West. These countries share President Vladimir Putin's assessment that the war in Ukraine is inaugurating a new age more friendly to middle powers.
Fecal incontinence patients categorized based on anal pressure and electromyography: Anal sphincter damage and clinical symptoms
Authors: Swartz Jessica L. , Zifan Ali , Tuttle Lori J. , Sheean Geoffrey , Tam Rowena M. , Mittal Ravinder K. 
Published: May 2024

AbstractBackgroundDisruption of external anal sphincter muscle (EAS) is an important factor in the multifactorial etiology of fecal incontinence (FI).ObjectivesWe categorize FI patients into four groups based on the location of lesion in neuromuscular circuitry of EAS to determine if there are differences with regards to fecal incontinence symptoms severity (FISI) score, age, BMI, obstetrical history, and anal sphincter muscle damage.MethodsFemale patients (151) without any neurological symptoms, who had undergone high‐resolution manometry, anal sphincter EMG, and 3D ultrasound imaging of the anal sphincter were assessed. Patients were categorized into four groups: Group 1 (normal)—normal cough EMG (>10 μV), normal squeeze EMG (>10 μV), and normal anal squeeze pressure (>124 mmHg); Group 2 (cortical apraxia, i.e., poor cortical activation)—normal cough EMG, low squeeze EMG, and low anal squeeze pressure; Group 3 (muscle damage)—normal cough EMG, normal squeeze EMG, and low anal squeeze pressure; and Group 4 (pudendal nerve damage)—low cough EMG, low squeeze EMG, and low anal squeeze pressure.ResultsThe four patient groups were not different with regards to the patient's age, BMI, parity, and FISI scores. 3D ultrasound images of the anal sphincter complex revealed significant damage to the internal anal sphincter, external anal sphincter, and puborectalis muscles in all four groups.ConclusionThe FI patients are a heterogeneous group; majority of these patients have significant damage to the muscles of the anal sphincter complex. Whether biofeedback therapy response is different among different patient groups requires study.
Short‐ and long‐term reproducibility of body surface gastric mapping using the Gastric Alimetry® system
Authors: Law Mikaela , Schamberg Gabriel , Gharibans Armen , Sebaratnam Gabrielle , Foong Daphne , Varghese Chris , Fitt India , Daker Charlotte , Ho Vincent , Du Peng , Andrews Christopher N. , O'Grady Greg , Calder Stefan 
Published: May 2024

AbstractBackgroundMany diagnostic tests for gastroduodenal symptoms, such as gastric emptying scintigraphy (GES), gastric emptying breath tests (GEBT), and electrogastrography (EGG) show variable intra‐individual reproducibility over time. This study investigated the short‐ and long‐term reproducibility of body surface gastric mapping (BSGM), a non‐invasive test for assessing gastric function, in controls and patients with chronic gastroduodenal disorders.MethodsParticipants completed three standardized BSGM tests using Gastric Alimetry® (Alimetry, New Zealand). The test encompassed a fasting baseline (30 min), a 482 kCal standard meal, and a 4 h postprandial recording. The first two tests were >6 months apart and the last occurred ~1 week after the second test, to evaluate long and short‐term reproducibility.ResultsFourteen patients with upper gastrointestinal symptoms and 14 healthy controls were recruited. There were no significant differences in any BSGM metrics between the tests at short and long term (all p > 0.180). Lin's concordance correlation coefficients (CCC) for the primary metrics were high, ranging from 0.58 to 0.96, with intra‐individual coefficients of variance (CVintra) ranging from 0.2% to 1.9%. Reproducibility was higher, and intra‐individual variation lower, than in previous studies of GES (CCC = 0.54–0.83, CVintra = 3%–77%), GEBT (CVintra = 8%–11%), and EGG (CVintra = 3%–78%).ConclusionsBSGM spectral metrics demonstrate high reproducibility and low intra‐individual variation at both short and long term, with superior results to comparable tests. The high reproducibility of Gastric Alimetry supports its role as a diagnostic aid for gastric dysfunction and a reliable tool for evaluating treatment outcomes and disease progression over time.
Reliability of pediatric Rome IV criteria for the diagnosis of disorders of gut–brain interaction
Authors: Ginton Lee , Budhathoki Rasmita , Saps Miguel 
Published: May 2024

AbstractBackgroundThe diagnosis of disorders of gut–brain interaction (DGBI) in children is exclusively based on clinical criteria called the Rome criteria. The inter‐rater reliability (IRR) measures how well two raters agree with a diagnosis using the same diagnostic tool. Previous versions of the Rome criteria showed only fair to moderate IRR. There have been no studies assessing the IRR of the current edition of the pediatric Rome criteria (Rome IV). This study sought to investigate the IRR of the pediatric Rome IV criteria and compare its reliability with the previous versions of the Rome criteria. We hypothesized that changes made to Rome IV would result in higher IRR than previous versions.MethodsThis study used the same methodology as the previous studies on Rome II and III, including identical clinical vignettes, number of raters, and levels of expertise. Participants included 10 pediatric gastroenterology fellows and 10 pediatric gastroenterology specialists. IRR was assessed using the percentage of agreement and Cohen's kappa coefficient to account for possible agreement by chance.ResultsThe average IRR percentage of agreement using the Rome IV criteria was 55% for pediatric gastroenterologists and 48.5% for fellows, indicating moderate agreement (k = 0.54 for specialists, k = 0.47 for fellows). The results demonstrated higher percentages of agreement and kappa coefficients compared to the Rome II and III criteria.ConclusionsThe findings demonstrate improved reliability in Rome IV compared to Rome II and III, suggesting that the changes incorporated into the Rome IV criteria have enhanced diagnostic consistency. Despite the advancements, the reliability is still moderate, indicating the need for further refinement of future versions of the Rome criteria.
Follicular Becker's nevi: A case series and review of literature
Authors: Gaurav Vishal , Ahuja Rhea , Chandra Akash Deep , Ahuja Sana , Bhagwat Abhishek , Lal Ankur , Danish Mohammad , Khan Ejaz , Taneja Neha 
Published: May 2024

AbstractThe follicular variant of Becker's nevus is an under‐reported entity. We present the rare occurrence of follicular Becker's nevus in 7 patients, confirmed through dermoscopy and histopathological examination. Dermoscopy shows perifollicular hypopigmentation surrounded by a well‐defined net‐like pigmentation corresponding clinically to the presence of folliculocentric macules. Histology shows prominent basal and suprabasal melanization surrounding the follicle, corresponding to well‐defined net‐like pigmentation seen on dermoscopy. However, the melanization does not extend along the entire length of the follicular epithelium leading to perifollicular hypopigmentation on dermoscopy. Though biopsy is confirmatory, it is not usually necessary.
Fungi: friends or foes—an outreach science initiative for the collection of airborne fungal spores by high school students
Authors: Piontkivska Daryna , Jorge João M. P. , Neves Rita , Crespo Pedro , Ramalho Renata , Silva Pereira Cristina 
Published: May 2024

ABSTRACT

Fungi mostly reproduce through spores that are adapted for airborne dispersal; hence, fungal spores (and fungi) are found virtually everywhere. Fungi can be “friends or foes.” Our friends include fungi used in the food and biotech industries, fungi that contribute to the cycling of carbon and nutrients, and those involved in the decontamination of polluted soils and/or water, to mention just a few examples. Many species, however, are foes—they are detrimental to plants, animals, and/or humans. Annually, >1.5 million people die due to invasive fungal infections. With the aim of enhancing microbiology literacy and the understanding of microbial concepts, we set up a project for the collection of airborne spores (the principal agent through which human airways are exposed to fungi). Students from five high schools in the Oeiras municipality partnered with us as citizen scientists; they carried out sampling by collecting fungal spores on adhesive stickers. The fungal spores collected by the students were subsequently processed in the schools and our research laboratory. Results obtained by the students themselves revealed a large variety of fungal species capable of growing in a rich medium at 30°C. In the research laboratory, using selective isolation conditions, 40 thermotolerant fungi were isolated, 32 of which were taxonomically identified as aspergilla, mostly from within the
Aspergillus fumigatus
taxa, yet exhibiting high genetic heterogeneity. The protocols and results were presented to the students, who were made aware of the local dispersal of airborne fungal spores, including some from potentially pathogenic fungi. Through carrying out scientific activities, the students developed both the interest and the self-confidence needed to implement future environmental investigations.
Anti-TNF (adalimumab) injection for the treatment of pain-predominant early-stage frozen shoulder: the Anti-Freaze-Feasibility randomised controlled trial
Authors: Hopewell Sally , Srikesavan Cynthia , Evans Alison , Er Fema , Rangan Amar , Preece Jane , Francis Anne , Massa M Sofia , Feldmann Marc , Lamb Sarah , Nanchahal Jagdeep 
Published: May 2024

ObjectiveThe Anti-Freaze-F (AFF) trial assessed the feasibility of conducting a definitive trial to determine whether intra-articular injection of adalimumab can reduce pain and improve function in people with pain-predominant early-stage frozen shoulder.DesignMulticentre, randomised feasibility trial, with embedded qualitative study.SettingFour UK National Health Service (NHS) musculoskeletal and related physiotherapy services.ParticipantsAdults ≥18 years with new episode of shoulder pain attributable to early-stage frozen shoulder.InterventionsParticipants were randomised (centralised computer generated 1:1 allocation) to either ultrasound-guided intra-articular injection of: (1) adalimumab (160 mg) or (2) placebo (saline (0.9% sodium chloride)). Participants and outcome assessors were blinded to treatment allocation. Second injection of allocated treatment (adalimumab 80 mg) or equivalent placebo was administered 2–3 weeks later.Primary feasibility objectives(1) Ability to screen and identify participants; (2) willingness of eligible participants to consent and be randomised; (3) practicalities of delivering the intervention; (4) SD of the Shoulder Pain and Disability Index (SPADI) score and attrition rate at 3 months.ResultsBetween 31 May 2022 and 7 February 2023, 156 patients were screened of whom 39 (25%) were eligible. The main reasons for ineligibility were other shoulder disorder (38.5%; n=45/117) or no longer in pain-predominant frozen shoulder (33.3%; n=39/117). Of the 39 eligible patients, nine (23.1%) consented to be randomised (adalimumab n=4; placebo n=5). The main reason patients declined was because they preferred receiving steroid injection (n=13). All participants received treatment as allocated. The mean time from randomisation to first injection was 12.3 (adalimumab) and 7.2 days (placebo). Completion rates for patient-reported and clinician-assessed outcomes were 100%.ConclusionThis study demonstrated that current NHS musculoskeletal physiotherapy settings yielded only small numbers of participants, too few to make a trial viable. This was because many patients had passed the early stage of frozen shoulder or had already formulated a preference for treatment.Trial registration numberISRCTN 27075727, EudraCT 2021-03509-23, ClinicalTrials.govNCT05299242(REC 21/NE/0214).
Role of virtual reality in examining the effect of fear of falling (FOF) on postural stability in individuals without and with Parkinson’s disease in Egypt: a mixed-methods feasibility study protocol
Authors: Gomaa Yasmine S , Awad Mohammed I , Emara Tamer , Elbokl Ahmed , Al-Yahya Emad , ElMeligie Mohamed Magdy 
Published: May 2024

BackgroundFalls are common in older people and individuals with neurological conditions. Parkinson’s disease (PD) is known for postural instability causing mobility disabilities, falls and reduced quality of life. The fear of falling (FOF), a natural response to unstable balance, can worsen postural control problems. Evaluating FOF relies largely on affected persons’ subjective accounts due to limited objective assessment methods available. The aim of this mixed-methods feasibility study is to develop an assessment method for FOF while in motion and walking within virtual environments. This study will assess a range of FOF-related responses, including cognitive factors, neuromuscular response and postural stability.Methods and analysisThis feasibility study will consist of four phases: the first two phases will include people without PD, while the other two will include people diagnosed with PD. Participants will be assessed for direct and indirect responses to real life, as well as virtual environment walking scenarios that may induce FOF. Data from questionnaires, different neurophysiological assessments, movement and gait parameters, alongside evaluations of usability and acceptability, will be collected. Semistructured interviews involving both participants and research assistants shall take place to elicit their experiences throughout different phases of the assessments undertaken. Demographic data, the scores of assessment scales, as well as feasibility, usability and acceptability of the measurement methods, will be illustrated via descriptive statistics. Movement and gait outcomes, together with neurophysiological data, will be extracted and calculated. Exploring relationships between different factors in the study will be achieved using a regression model. Thematic analysis will be the approach used to manage qualitative data.Ethics and disseminationThis feasibility study was approved by the Ethics Committee of the Faculty of Physical Therapy, Kafr El Sheikh University, Egypt (number: P.T/NEUR/3/2023/46). The results of this study will be published in a peer-reviewed journal.Trial registration numberClinicalTrials.gov Registry (NCT05931692).
Sensorineural hearing loss among type 2 diabetic patients and its association with peripheral neuropathy: a cross-sectional study from a lower middle-income country
Authors: Asghar Saba , Ali Zeeshan , Abdullah Ali , Naveed Shabnam , Ahmad Masroor Syed , Rafi Tariq Syed Muhammad 
Published: May 2024

IntroductionDespite potential links between diabetes and sensorineural hearing loss (SNHL), routine hearing assessments for diabetic patients are not standard practice. Our study aimed to investigate the prevalence of SNHL and its association with diabetes-related factors among patients with type 2 diabetes mellitus (T2DM).Research design and methodsThis cross-sectional study was conducted at the Diabetes Clinic, Jinnah Postgraduate Medical Centre, Karachi, Pakistan, from May to September 2021. A total of 396 patients fulfilling the inclusion criteria participated after informed consent. Data collection involved a sociodemographic profile, Michigan Neuropathy Screening Instrument examination followed by pure-tone audiometry and laboratory tests including haemoglobin A1C (HbA1c). HL was defined using better ear four-frequency pure-tone average of ≥26 dB HL and graded as per WHO criteria. Statistical analyses were performed using SPSS. χ2, independent t-test and multinomial logistic regression analyses were applied. P<0.05 at 95% CI was considered significant.ResultsOur study revealed a high prevalence of SNHL among patients with T2DM. Mild HL was seen in 55.8%, while 18.7% suffered from moderate HL. Common audiological symptoms included difficulty understanding speech in noisy surroundings (44.2%), balance problems (42.9%), sentence repetition (35.9%), tinnitus (32.3%) and differentiating consonants (31.1%). Hearing impairment predominantly affected low (0.25–0.5 kHz) and high (4–8 kHz) frequencies with a significant difference at 4 kHz among both sexes (t(394)=2.8, p=0.004). Peripheral neuropathy was significantly associated with SNHL on multinomial logistic regression after adjusting with age, sex, body mass index and the presence of any comorbidities. Diabetes duration, HbA1c or family history of diabetes was found unrelated to SNHL severity.ConclusionsThe study highlights the substantial prevalence of SNHL among patients with T2DM and emphasises the importance of targeted audiological care as part of a holistic approach to diabetes management. Addressing HL early may significantly improve communication and overall quality of life.
Implementation of a primary-tertiary shared care model to improve the detection of familial hypercholesterolaemia (FH): a mixed methods pre-post implementation study protocol
Authors: Birkenhead Karen , Sullivan David , Trumble Claire , Spinks Catherine , Srinivasan Shubha , Partington Andrew , Elias Luke , Hespe Charlotte Mary , Fleming Gabrielle , Li Stephen , Calder Madeline , Robertson Elizabeth , Trent Ronald , Sarkies Mitchell N 
Published: May 2024

IntroductionFamilial hypercholesterolaemia (FH) is an autosomal dominant inherited disorder of lipid metabolism and a preventable cause of premature cardiovascular disease. Current detection rates for this highly treatable condition are low. Early detection and management of FH can significantly reduce cardiac morbidity and mortality. This study aims to implement a primary-tertiary shared care model to improve detection rates for FH. The primary objective is to evaluate the implementation of a shared care model and support package for genetic testing of FH. This protocol describes the design and methods used to evaluate the implementation of the shared care model and support package to improve the detection of FH.Methods and analysisThis mixed methods pre-post implementation study design will be used to evaluate increased detection rates for FH in the tertiary and primary care setting. The primary-tertiary shared care model will be implemented at NSW Health Pathology and Sydney Local Health District in NSW, Australia, over a 12-month period. Implementation of the shared care model will be evaluated using a modification of the implementation outcome taxonomy and will focus on the acceptability, evidence of delivery, appropriateness, feasibility, fidelity, implementation cost and timely initiation of the intervention. Quantitative pre-post and qualitative semistructured interview data will be collected. It is anticipated that data relating to at least 62 index patients will be collected over this period and a similar number obtained for the historical group for the quantitative data. We anticipate conducting approximately 20 interviews for the qualitative data.Ethics and disseminationEthical approval has been granted by the ethics review committee (Royal Prince Alfred Hospital Zone) of the Sydney Local Health District (Protocol ID: X23-0239). Findings will be disseminated through peer-reviewed publications, conference presentations and an end-of-study research report to stakeholders.
Risk factors for asthma-related hospital and intensive care admissions in children, adolescents and adults: a cohort study using primary and secondary care data
Authors: Simms-Williams Nikita , Nagakumar Prasad , Thayakaran Rasiah , Adderley Nicola J , Hotham Richard , Mansur Adel H , Nirantharakumar Krishnarajah , Haroon Shamil 
Published: May 2024

BackgroundAsthma remains a common cause of hospital admissions across the life course. We estimated the contribution of key risk factors to asthma-related hospital and intensive care unit (ICU) admissions in children, adolescents and adults.MethodsThis was a UK-based cohort study using linked primary care (Clinical Practice Research Datalink Aurum) and secondary care (Hospital Episode Statistics Admitted Patient Care) data. Patients were eligible if they were aged 5 years and older and had been diagnosed with asthma. This included 90 989 children aged 5–11 years, 114 927 adolescents aged 12–17 years and 1 179 410 adults aged 18 years or older. The primary outcome was asthma-related hospital admissions from 1 January 2017 to 31 December 2019. The secondary outcome was asthma-related ICU admissions. Incidence rate ratios adjusted for demographic and clinical risk factors were estimated using negative binomial models. Population attributable fraction (PAF) was estimated for modifiable risk factors.ResultsYounger age groups, females and those from ethnic minority and lower socioeconomic backgrounds had an increased risk of asthma-related hospital admissions. Increasing medication burden, including excessive use of short-acting bronchodilators, was also strongly associated with the primary outcome. Similar risk factors were observed for asthma-related ICU admissions. The key potentially modifiable or treatable risk factors were smoking in adolescents and adults (PAF 6.8%, 95% CI 0.9% to 12.3% and 4.3%, 95% CI 3.0% to 5.7%, respectively), and obesity (PAF 23.3%, 95% CI 20.5% to 26.1%), depression (11.1%, 95% CI 9.1% to 13.1%), gastro-oesophageal reflux disease (2.3%, 95% CI 1.2% to 3.4%), anxiety (2.0%, 95% CI 0.5% to 3.6%) and chronic rhinosinusitis (0.8%, 95% CI 0.3% to 1.3%) in adults.ConclusionsThere are significant sociodemographic inequalities in the rates of asthma-related hospital and ICU admissions. Treating age-specific modifiable risk factors should be considered an integral part of asthma management, which could potentially reduce the rate of avoidable hospital admissions.