bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluating the generalisability of region-naïve machine learning algorithms for the identification of epilepsy in low-resource settings
Authors: Duta Ioana , Kariuki Symon M. , Ngugi Anthony K. , Mwesige Angelina Kakooza , Masanja Honorati , Mwanga Daniel M. , Owusu-Agyei Seth , Wagner Ryan , Cross J Helen , Sander Josemir W. , Newton Charles R. , Sen Arjune , Jones Gabriel Davis 
Published: February 2025

Objectives
Approximately 80% of people with epilepsy live in low- and middle-income countries (LMICs), where limited resources and stigma hinder accurate diagnosis and treatment. Clinical machine learning models have demonstrated substantial promise in supporting the diagnostic process in LMICs by aiding in preliminary screening and detection of possible epilepsy cases without relying on specialised or trained personnel. How well these models generalise to naïve regions is, however, underexplored. Here, we use a novel approach to assess the suitability and applicability of such clinical tools to aid screening and diagnosis of active convulsive epilepsy in settings beyond their original training contexts.

Methods
We sourced data from the Study of Epidemiology of Epilepsy in Demographic Sites dataset, which includes demographic information and clinical variables related to diagnosing epilepsy across five sub-Saharan African sites. For each site, we developed a region-specific (single-site) predictive model for epilepsy and assessed its performance at other sites. We then iteratively added sites to a multi-site model and evaluated model performance on the omitted regions. Model performances and parameters were then compared across every permutation of sites. We used a leave-one-site-out cross-validation analysis to assess the impact of incorporating individual site data in the model.

Results
Single-site clinical models performed well within their own regions, but generally worse when evaluated in other regions (p<0.05). Model weights and optimal thresholds varied markedly across sites. When the models were trained using data from an increasing number of sites, mean internal performance decreased while external performance improved.

Conclusions
Clinical models for epilepsy diagnosis in LMICs demonstrate characteristic traits of ML models, such as limited generalisability and a trade-off between internal and external performance. The relationship between predictors and model outcomes also varies across sites, suggesting the need to update specific model aspects with local data before broader implementation. Variations are likely to be particular to the cultural context of diagnosis. We recommend developing models adapted to the cultures and contexts of their intended deployment and caution against deploying region- and culture-naïve models without thorough prior evaluation.
Incidence of loiasis clinical manifestations in a rural area of the Republic of Congo: Results from a longitudinal prospective study (the MorLo project)
Authors: Campillo Jérémy T. , Pakat-Pambou Biam-Miveck , Sahm Bachiratou , Pion Sébastien D.S. , Hemilembolo Marlhand C. , Lebredonchel Elodie , Boussinesq Michel , Missamou François , Chesnais Cédric B. 
Published: February 2025

Background
Loiasis is endemic in Central Africa. Despite evidence of clinical complications and increased mortality, it remains excluded from the list of neglected tropical diseases. The main manifestations are Calabar swellings (CS), Eyeworm (EW) and non-specific general symptoms such arthralgia and pruritus. We calculated incidence rates for clinical manifestations of loiasis from a 13-month study on clinical manifestations in 991 individuals living in Loa loa-endemic areas in the Republic of Congo.

Methodology
From September 2022 to September 2023, community health workers collected weekly symptoms from cohort participants. Detailed data on symptom duration, intensity, associated pruritus, and impact on sleep were recorded. Laboratory procedures included thick blood smear for L. loa microfilaremia measurement, creatininemia measurement and eosinophilia counts. We used multiple failure analysis and frailty models to calculate incidence rates of EW, CS, arthralgia, pruritus and absence from work (AfW) and to analyses factors associated with increased incidence of each symptom. The population-attributable fractions (PAFs) associated with loiasis were also calculated for pruritus, AfW and arthralgia.

Principal findings
Among the studied manifestations, arthralgia had the highest incidence rate at 555.2 cases per 1000 Person-Year (PY), followed by pruritus (332.3 cases/1000 PY), AfW (298.6/1000 PY), EW (266.4/1000 PY), and CS (213.8/1000 PY). Notably, the incidence rates of CS, pruritus, arthralgia, and AfW were statistically significantly higher in the subgroup of individuals who experienced at least one episode of EW during the follow-up period. EW occurrence is more frequent when microfilaremia is present. The PAFs of AfW, pruritus and arthralgia, associated with loiasis was 18.0% [07.3–27.6], 20.8% [11.6–29.1] and 12.1% [3.1–20.1], respectively.

Conclusion/significance
This is the first study to provide incidence rates for the clinical manifestations of loiasis. These estimates are crucial for assessing the burden of loiasis. The findings highlight the disease’s impact on quality of life.
Correlates of tuberculosis in children under the age of 15 years
Authors: Siame Lukundo , Chama Gift C. , Masenga Sepiso K. 
Published: February 2025

Background
Tuberculosis (TB) remains a significant public health challenge, particularly among vulnerable populations like children. This is especially true in Sub-Saharan Africa, where the burden of TB in children is substantial. Zambia ranks 21st among the top 30 high TB endemic countries globally. While studies have explored TB in adults in Zambia, the prevalence and associated factors in children are not well documented. This study aimed to determine the prevalence and sociodemographic, and clinical factors associated with active TB disease in hospitalized children under the age of 15 years at Livingstone University Teaching Hospital (LUTH), the largest referral center in Zambia’s Southern Province.

Methods
This retrospective cross-sectional study of 700 pediatric patients under 15 years old, utilized programmatic data from the Pediatrics Department at LUTH. A systematic sampling method was used to select participants from medical records. Data on demographics, medical conditions, anthropometric measurements, and blood tests were collected. Data analysis included descriptive statistics, chi-square tests, and multivariable logistic regression to identify factors associated with TB.

Results
The median age was 24 months (interquartile range (IQR): 11, 60) and majority were male (56.7%, n = 397/700). Most participants were from urban areas (59.9%, n = 419/700), and 9.2% (n = 62/675) were living with HIV. Malnutrition and comorbidities were present in a significant portion of the participants (19.0% and 25.1%, respectively). The prevalence of active TB cases was 9.4% (n = 66/700) among hospitalized children. Persons living with HIV (Adjusted odds ratio (AOR) of 6.30; 95% confidence interval (CI) of 2.85, 13.89, p< 0.001), and those who were malnourished (AOR: 10.38, 95% CI: 4.78, 22.55, p< 0.001) had a significantly higher likelihood of developing active TB disease.

Conclusion
This study revealed a prevalence 9.4% active TB among hospitalized children under 15 years at LUTH. HIV status and malnutrition emerged as significant factors associated with active TB disease. These findings emphasize the need for pediatric TB control strategies that prioritize addressing associated factors to effectively reduce the burden of tuberculosis in Zambian children.
Trends of wealth-related inequality in stunting and its contributing factors among under-five children in Ethiopia: Decomposing the concentration index using Ethiopian Demographic Health Surveys 2011–2019
Authors: Tsega Yawkal , Endawkie Abel , Kebede Shimels Derso , Abeje Eyob Tilahun , Enyew Ermias Bekele , Daba Chala , Asmare Lakew , Bayou Fekade Demeke , Arefaynie Mastewal , Mekonen Asnakew Molla , Tareke Abiyu Abadi , Keleb Awoke , Abera Kaleab Mesfin , Kebede Natnael , Gebeyehu Endalkachew Mesfin , Ayres Aznamariam 
Published: February 2025

Background
Childhood stunting is a critical public health agenda that affects physical and cognitive development, leading to long-term health problems. Understanding its wealth related trends and contributing factors is essential for effective prospective interventions. Therefore, this study is aimed to assess the trends of childhood stunting inequality using Ethiopian Demographic Health Surveys (EDHS).

Methods
This study employed the three consecutive EDHS datasets collected in 2011, 2016, and 2019. Socioeconomic disparity of stunting among under-five children was estimated through concentration index (CIX). Moreover, Wagstaff approach was used to decompose the relative CIX to assess the contribution of explanatory variables for the overall wealth inequality in childhood stunting.

Results
The overall weighted prevalence of childhood stunting in Ethiopia was 40.76% (95%CI: 40.14%, 41.37%). The trend in the magnitude of childhood stunting decreased from 44.52% in 2011 to 37.08% in 2019. The magnitude of childhood stunting was higher (14.30%) among the poorest households than the richest households (4.70%). Moreover, the CIX of wealth inequality decreased from -0.064 in 2011 to -0.089 in 2019. Wealth index(103.38%), place of residence(34.55%), mother’s education(26.73%), place of delivery(12.16%) and utilization of recommended antenatal care(12.02%) were high contributor variables in increasing the inequality, whereas administrative regions (-7.15%) and number of under-five children in the household (-4.63%) were variables contributed in the reduction of wealth inequalities in childhood stunting.

Conclusion
This study revealed that children in the poorest households were more likely to experience childhood stunting than the children in the richest households. Factors such as wealth index, mothers education, place of residence, place of delivery, number of under-five children in the household were the contributing variables for the childhood stunting inequality. Therefore, the health decision makers better to improve the access and quality of nutritional services for the children in the poorest households in Ethiopia.
Efficacy of early enteral nutrition support on the nutritional status of patients after gallstone surgery
Authors: Wang Fang , Gao Yun 
Published: February 2025

Objective
To evaluate the overall efficacy of early enteral nutrition support on the nutritional status of patients following gallstone surgery, providing a theoretical basis for its application in postoperative care.

Methods
A retrospective analysis was conducted on 98 hospitalized patients who underwent gallstone surgery between February 2021 and March 2023. The patients were divided into two groups: the study group, which received early nutritional intervention, and the control group, which started nutritional support three days post-surgery. The primary objective was to assess nutritional status, while secondary objectives included gastrointestinal function, immune function markers, and the incidence of postoperative and gastrointestinal complications. Nutritional status, gastrointestinal function, immune function, and complications were compared between the two groups before and one week after intervention.

Results
After the intervention, the study group showed significantly higher levels of total protein (TP), prealbumin (PAB), albumin (ALB), transferrin (TF), and body mass index (BMI) compared to the control group (P<0.05). Additionally, the scores for Nutrition Risk Screening 2002 (NRS 2002) and the Malnutrition Universal Screening Tool (MUST) were notably lower in the study group (P<0.05). Postoperatively, the study group experienced shorter times to first exhaust, defecation, bowel sound recovery, first meal, and overall hospital stay compared to the control group (P<0.05). Although the pre-intervention levels of CD3+, CD4+, CD8+, and CD4+/CD8+ were comparable between the groups (P>0.05), these immune markers were significantly higher in the study group post-intervention (P<0.05). The incidence of both postoperative and gastrointestinal complications was significantly lower in the study group than in the control group (both P<0.05).

Conclusion
Early enteral nutrition support significantly improves the nutritional status of patients after gallstone surgery, enhances gastrointestinal and immune function, and reduces the occurrence of complications. These findings underscore its clinical significance and value in postoperative care.
Patterns of postnatal weight gain and its predictors among preterm very low birth weight neonates born in Bahir-Dar city public hospitals, 2022: A cross sectional study
Authors: Dessie Yihenew Ayehu , Abemie Worku , Nigussie Elda Mekonnen , Mengistu Bethelehem Taye , Mengstie Leweyehu Alemaw , Girma Bekahegn , Hailemeskel Solomon 
Published: February 2025

Introduction
Postnatal weight gain in very low birth weight infants remains a challenge during the neonatal period in low and middle-income countries like Ethiopia, where no feeding alternatives and follow-up charts are available. Although extrauterine growth retardation is a common problem in preterm very low birth weight infants, there is a lack of evidence in resource-limited countries regarding patterns of postnatal weight gain. Therefore, this study aimed to assess the patterns of postnatal weight gain and its predictors among preterm very low birth weight infants in Ethiopia.

Methods
A cross-sectional study was conducted on a randomly selected sample of 412 neonates in Ethiopia. Data were collected using structured questionnaires and analyzed with Stata version 14.0 software. Bivariable and multivariable logistic regression analyses were performed to identify significant predictors. Model fitness and assumptions were assessed. Associations were reported using adjusted odds ratios (AOR) with 95% confidence intervals.

Results
In the current study, 14.6% (95% CI: 10.4–20.1) of neonates had adequate postnatal weight gain at discharge. Spontaneous vaginal delivery [AOR: 2.54; 95% CI (1.17, 5.54)], birth Z-score > -1.29 [AOR: 4.51; 95% CI (1.43, 14.16)], early feeding initiation time [AOR: 3.36; 95% CI (1.63, 6.92)], and respiratory distress syndrome [AOR: 0.31; 95% CI (0.12, 0.78)] were significant predictors for postnatal weight gain among very low birth weight neonates in Ethiopia.

Conclusion
The postnatal weight gain reported in this study was low as compared to the national figure. Mode of delivery, birth z-score, initiation time of the first feeding, and respiratory distress syndrome were associated with postnatal weight gain. The Federal Ministry of Health, stakeholders, national neonatal associations, and non-governmental organizations should work collaboratively to promote vaginal delivery and early initiation of feeding and develop guidelines specifically tailored for this special population. Furthermore, healthcare providers should prioritize and focus on neonates who have respiratory distress and low Z-scores.
Upregulated LIMD1 alleviates pressure overload-induced cardiac hypertrophy via inhibits YAP1/AKT/GSK3β signaling
Authors: Xie Fengwen , Yuan Bin , Zhang Ye , Chen Liru , Zhong Yingmei , Xu Quan 
Published: February 2025

Objectives
Pathological cardiac hypertrophy plays a significant role in the development and progression of heart failure (HF). LIM Domain Containing 1 (LIMD1) serves as a crucial regulatory factor in protein-protein interactions during cellular signal transduction. This study aims to investigate the specific roles and mechanisms of LIMD1 in pathological cardiac remodeling.

Methods
We employed an adeno-associated virus 9 (AAV9) system to overexpress LIMD1 in the hearts through tail vein injection. C57BL/6 mice underwent transverse aortic constriction (TAC) for four weeks. Cardiac function was assessed using echocardiography, while cardiac remodeling was evaluated through histopathology and molecular techniques.

Results
Our findings demonstrated elevated levels of LIMD1 in murine hearts subjected to TAC treatment and H9c2 cells challenged with angiotensin II (Ang II). Compared with wild-type (WT) mice, those injected with AAV-9-LIMD1 exhibited significantly reduced TAC-induced cardiac dysfunction, hypertrophy, and fibrosis. Mechanistically, both in vitro and in vivo experiments suggested that the beneficial effects of LIMD1 might be associated with the inhibition of the YAP1/AKT/GSK3β signaling pathway.

Conclusion
In summary, this study is the first to demonstrate the protective effects of LIMD1 against TAC-induced pathological cardiac remodeling. These effects are attributed to the inhibition of the YAP1/AKT/GSK3β signaling pathway.
Association between dietary inflammation index and herpes simplex virus I and II: A cross-sectional study
Authors: Luo Jing , Liu En-Hui , Chen Hao-Kai , He Xiang-Ping , Chen Tong , Hu Yu-Qi , Guo Xu-Guang 
Published: February 2025

Introduction
We aimed to fill the research gap between DII and herpes simplex virus infection among adults in the US by analyzing the association between dietary inflammatory index and herpes simplex virus and to provide new ideas for herpes simplex virus prevention and treatment.

Method
We used data from 8636 participants in NHANES 2007–2016, which were statistically analyzed by participant baseline study, one-way analysis of variance, multiple regression equations, smoothed curve fitting, and stratified analysis.

Result
In the fully adjusted model, the DII high concentration group was positively associated with the prevalence of herpes simplex (1.15 (0.89, 1.48), p = 0.0027), and the results of the stratified analyses indicated that the positive association between DII and herpes simplex virus type II was stable in the population.

Conclusion
This study demonstrates a positive association between DII and herpes simplex virus II in US adults, suggesting that a proinflammatory diet may be an independent risk factor for herpes simplex virus II.
Participant experiences receiving acupuncture for acute musculoskeletal pain in an emergency department: A qualitative evaluation
Authors: Tupetz Anna , Frazier Madison , O’Regan Amy , Knisely Mitchell , TumSuden Olivia , Walker Erica , Sununu Charlotte , Glass Oliver , Miller-Maxwell Ann , Staton Catherine A. , Eucker Stephanie A. 
Published: February 2025

Objective
Acupuncture is an evidence-based pain treatment in clinic settings, but its optimal delivery has not been established in emergency departments (EDs). As part of an adaptive pragmatic randomized controlled trial of ED acupuncture for acute musculoskeletal pain (NCT04290741), we embedded a qualitative evaluation of acupuncture treatment acceptability and suggestions for improvement from study participants receiving acupuncture in the ED.

Methods
Semi-structured interviews conducted remotely evaluated factors impacting patients’ perspectives, willingness to participate in, and experiences with ED acupuncture. The codebook was iteratively developed, and recruitment and analysis continued until information saturation was reached.

Results
Twenty-eight participants receiving ED acupuncture between February 2020-March 2021 were interviewed, with median age 44 years, 46.4% female, and 61% having never previously received acupuncture. Overall, ED patients with acute musculoskeletal pain expressed interest in acupuncture and reported an overall positive experience. Most reported acupuncture met their expectations for pain improvement, and many reported additional improvements in stress, anxiety, and sleep quality. Participants with a positive experience were more likely to recommend acupuncture to others. Key positive aspects included open communication with compassionate and knowledgeable acupuncturists. Participants found the ED setting acceptable and convenient for receiving acupuncture. Furthermore, participants provided actionable feedback like addressing fear of needles to improve the ED acupuncture experience.

Conclusions
In conclusion, ED patients with acute musculoskeletal pain were interested in and had positive experiences with acupuncture treatment for pain and found the ED setting acceptable and convenient. Participant feedback can be used to improve acupuncture treatment in the ED.
Real-time assessment of triage nurse situational awareness (SA) using the situation awareness global assessment technique (SAGAT)
Authors: Alfuraydi Abeer Abdulaziz , Al-Moteri Modi 
Published: February 2025

Background
The emergency department (ED) is a complex, unpredictable, and distraction-filled environment. Within these challenging conditions, triage nurses are tasked with quickly assessing, identifying, and prioritizing patients who require urgent interventions. Studies from other safety-critical fields, such as aviation and the military, have highlighted that situational awareness (SA) is a critical skill for optimizing human performance during time-sensitive situations. In these fields, limitations in SA have been identified as significant risks to safety. However, despite its importance, SA in the context of EDs has been largely overlooked. Endsley’s SA theory and the Situation Awareness Global Assessment Technique (SAGAT) provide a framework to evaluate SA in dynamic and complex workspaces. This study aims to assess SA during real-time triage processes of patients in EDs, utilizing Endsley’s SA model.

Method
An observational cross-sectional study was conducted to assess SA. Forty real-time triaging processes were observed and evaluated in two ED sites, using the SAGAT to measure SA levels.

Results
A total of 40 triage nurses participated in the study across two ED sites. The findings revealed that the perception of patient cues was significantly reduced by workload (p = 0.048) and stress (p = 0.025), while playing video games was associated with enhanced perception of patient cues (p = 0.014). Additionally, a significant negative correlation was observed between the perception of patient cues and comprehension, indicating a cognitive trade-off between these two SA levels. Only 10% (n = 4) of participants achieved a good SA score, emphasizing the need for improvement.

Conclusion
The results underscore the importance of understanding and improving situational awareness in triage nurses using Endsley’s SA model. These findings offer valuable insights for enhancing future practice, education, and research focused on optimizing situational awareness in emergency nursing.