bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparative effectiveness of alternative spontaneous breathing trial techniques: a systematic review and network meta-analysis of randomized trials
Authors: Burns Karen E. A. , Sadeghirad Behnam , Ghadimi Maryam , Khan Jeena , Phoophiboon Vorakamol , Trivedi Vatsal , Gomez Builes Carolina , Giammarioli Benedetta , Lewis Kimberley , Chaudhuri Dipayan , Desai Kairavi , Friedrich Jan O. 
Published: June 2024

Abstract
Background
The spontaneous breathing trial (SBT) technique that best balance successful extubation with the risk for reintubation is unknown. We sought to determine the comparative efficacy and safety of alternative SBT techniques.

Methods
We searched Medline, EMBASE, and the Cochrane Central Register of Controlled Trials from inception to February 2023 for randomized or quasi-randomized trials comparing SBT techniques in critically ill adults and children and reported initial SBT success, successful extubation, reintubation (primary outcomes) and mortality (ICU, hospital, most protracted; secondary outcome) rates. Two reviewers screened, reviewed full-texts, and abstracted data. We performed frequentist random-effects network meta-analysis.

Results
We included 40 RCTs (6716 patients). Pressure Support (PS) versus T-piece SBTs was the most common comparison. Initial successful SBT rates were increased with PS [risk ratio (RR) 1.08, 95% confidence interval (CI) (1.05–1.11)], PS/automatic tube compensation (ATC) [1.12 (1.01 –1.25), high flow nasal cannulae (HFNC) [1.07 (1.00–1.13) (all moderate certainty), and ATC [RR 1.11, (1.03–1.20); low certainty] SBTs compared to T-piece SBTs. Similarly, initial successful SBT rates were increased with PS, ATC, and PS/ATC SBTs compared to continuous positive airway pressure (CPAP) SBTs. Successful extubation rates were increased with PS [RR 1.06, (1.03–1.09); high certainty], ATC [RR 1.13, (1.05–1.21); moderate certainty], and HFNC [RR 1.06, (1.02–1.11); high certainty] SBTs, compared to T-piece SBTs. There was little to no difference in reintubation rates with PS (vs. T-piece) SBTs [RR 1.05, (0.91–1.21); low certainty], but increased reintubation rates with PS [RR 2.84, (1.61–5.03); moderate certainty] and ATC [RR 2.95 (1.57–5.56); moderate certainty] SBTs compared to HFNC SBTs.

Conclusions
SBTs conducted with pressure augmentation (PS, ATC, PS/ATC) versus without (T-piece, CPAP) increased initial successful SBT and successful extubation rates. Although SBTs conducted with PS or ATC versus HFNC increased reintubation rates, this was not the case for PS versus T-piece SBTs.
A randomised controlled trial of the Learning Skills Together (LST) intervention to improve dementia family caregivers’ self-efficacy with complex care
Authors: Meyer Kylie , Lee Kyungmi , Thorngthip Sutthinee , Burant Patricia , Lippe Megan , Neidre Daria , White Carole , Norman Rocio , Choi Byeong Yeob , Glover Crystal M. , Bell Janice , Hepburn Kenneth 
Published: June 2024

Abstract
Background
Nearly two-thirds of family caregivers of persons living with Alzheimer’s disease or related dementias (AD/ADRD) provide complex care, including medical care. Family caregivers typically receive little to no training on how to provide this care. Furthermore, family caregivers simultaneously grapple with the presence of behavioral and psychological symptoms of dementia (BPSD), diminished communication abilities, and comorbidities such as diabetes. We developed Learning Skills Together (LST), a 6-week digitally delivered psychoeducational program, to facilitate family caregiver abilities to administer complex care tasks. The goal of the present study is to test the efficacy of LST and to reduce adverse outcomes associated with caregiving, such as depressive symptomology and negative appraisal of BPSD.

Methods
To test the efficacy of LST, we will conduct a two-arm single-site randomized controlled trial (RCT) with N = 200 family caregivers of persons living with AD/ADRD. Eligible family caregivers will be randomly assigned to participate in either the LST intervention or a structurally equivalent control condition focused on healthy living. All family caregivers will complete four surveys, including a baseline survey administered prior to randomization, a post-intervention survey, and a 3- and 6-month follow-up survey to assess change in study outcomes. Between-group comparisons of each outcome will be evaluated using generalized estimating equation models. Mediation analyses will assess family caregiver self-efficacy as the intervention’s mechanism of change in depressive symptomology and BPSD. We will also examine caregiver race, ethnicity, and gender as effect modifiers of the intervention.

Discussion
LST findings will inform the field of AD/ADRD and caregiving regarding optimally supporting family caregivers in managing complex care tasks. If efficacious, the LST intervention will support family caregivers in preserving their own mental health while providing complex care.

Trial registration
Clinical Trials.gov NCT05846984. This study was registered on May 6, 2023.
Carbon-wise utilization of lignin-related compounds by synergistically employing anaerobic and aerobic bacteria
Authors: Meriläinen Ella , Efimova Elena , Santala Ville , Santala Suvi 
Published: June 2024

Abstract
Background
Lignin is a highly abundant but strongly underutilized natural resource that could serve as a sustainable feedstock for producing chemicals by microbial cell factories. Because of the heterogeneous nature of the lignin feedstocks, the biological upgrading of lignin relying on the metabolic routes of aerobic bacteria is currently considered as the most promising approach. However, the limited substrate range and the inefficient catabolism of the production hosts hinder the upgrading of lignin-related aromatics. Particularly, the aerobic O-demethylation of the methoxyl groups in aromatic substrates is energy-limited, inhibits growth, and results in carbon loss in the form of CO2.

Results
In this study, we present a novel approach for carbon-wise utilization of lignin-related aromatics by the integration of anaerobic and aerobic metabolisms. In practice, we employed an acetogenic bacterium Acetobacterium woodii for anaerobic O-demethylation of aromatic compounds, which distinctively differs from the aerobic O-demethylation; in the process, the carbon from the methoxyl groups is fixed together with CO2 to form acetate, while the aromatic ring remains unchanged. These accessible end-metabolites were then utilized by an aerobic bacterium Acinetobacter baylyi ADP1. By utilizing this cocultivation approach, we demonstrated an upgrading of guaiacol, an abundant but inaccessible substrate to most microbes, into a plastic precursor muconate, with a nearly equimolar yields (0.9 mol/mol in a small-scale cultivation and 1.0 mol/mol in a one-pot bioreactor cultivation). The process required only a minor genetic engineering, namely a single gene knock-out. Noticeably, by employing a metabolic integration of the two bacteria, it was possible to produce biomass and muconate by utilizing only CO2 and guaiacol as carbon sources.

Conclusions
By the novel approach, we were able to overcome the issues related to aerobic O-demethylation of methoxylated aromatic substrates and demonstrated carbon-wise conversion of lignin-related aromatics to products with yields unattainable by aerobic processes. This study highlights the power of synergistic integration of distinctive metabolic features of bacteria, thus unlocking new opportunities for harnessing microbial cocultures in upgrading challenging feedstocks.
Effect of zinc supplementation on glycemic biomarkers: an umbrella of interventional meta-analyses
Authors: Daneshvar Maziar , Ghaheri Mohammad , Safarzadeh Diba , Karimi Fatemeh , Adib-Hajbagheri Parisa , Ahmadzade Mohadese , Haedi Amir 
Published: June 2024

Abstract
Background
Several studies have evaluated the effects of zinc supplementation on glycemic biomarkers in humans and have demonstrated varying results. We systematically evaluated the literature and performed an umbrella meta-analysis of the effects of zinc supplementation on type 2 diabetes biomarkers.

Methods
A comprehensive literature search was conducted in the following databases; PubMed, Embase, Embase, Cochrane Library, Scopus, and Web of Science for studies published up to March 10, 2024.

Results
Zinc supplementation was effective in reducing serum FBS (WMD: − 13.58, 95% CI: − 17.38, − 9.77; p < 0.001; SMD: − 0.52, 95% CI − 0.79, − 0.25; p =  < 0.001), insulin (SMD: − 0.67, 95% CI − 0.96, − 0.38; p < 0.001), HOMA-IR levels (WMD − 0.52, 95% CI − 0.66, − 0.38; p < 0.001; SMD: − 0.78, 95% CI − 1.02, − 0.42; p < 0.001), and HbA1c (WMD: − 0.35, 95% CI − 0.43, − 0.27; p < 0.001).

Conclusion
Zinc supplementation significantly reduced FBS, HOMA-IR, insulin and HbA1c. These findings suggest that zinc is potentially an effective complementary intervention to improve type 2 diabetes biomarkers.
Identification of nutrition factors in the metabolic syndrome and its progression over time in older adults: analysis of the TUDA cohort
Authors: Lyons Oonagh C. , Kerr Maeve A. , Flynn Mary A. T. , Hoey Leane , Hughes Catherine F. , Caffrey Aoife , Laird Eamon , Moore Katie , Porter Kirsty M. , Cunningham Conal , McCarroll Kevin , Molloy Anne M. , Tracey Fergal , O’Kane Maurice , Strain J. J. , Ward Mary , McNulty Helene 
Published: June 2024

Abstract
Background
Nutrition is recognized as playing an important role in the metabolic syndrome (MetS), but the dietary components involved are unclear. We aimed to investigate nutrition factors in relation to MetS and its progression in older adults over a follow-up period of 5.4 years.

Methods
Community-dwelling adults (≥ 60y) from the Trinity-Ulster-Department-of-Agriculture study, sampled at baseline (2008–12) and follow-up (2014–18; n 953), were classified as ‘with MetS’ by having three or more of: waist circumference (≥ 102 cm, males; ≥ 88 cm, females); HDL-cholesterol (< 1.0 mmol/L, males; < 1.3 mmol/L, females); triglycerides (≥ 1.7 mmol/L); blood pressure (systolic ≥ 130 and/or diastolic ≥ 85 mmHg); and hemoglobin A1c (≥ 39 mmol/mol).

Results
MetS was identified in 67% of participants, increasing to 74% at follow-up. Predictors at baseline for the development of metabolic syndrome (MetS) at follow-up were higher waist circumference (odds ratio [95%CI]; 1.06 [1.01–1.11]), but not BMI, and increased triglyceride concentrations (2.01 [1.29–3.16]). In dietary analysis (at follow-up), higher protein (g/kg bodyweight/day) and monounsaturated fatty acid (g/day) intakes were each associated with lower risk of MetS (0.06 [0.02–0.20] and 0.88 [0.78–1.00], respectively), whilst higher protein was also associated with lower abdominal obesity (0.10 [0.02–0.51]) and hypertension (0.22 [0.00–0.80]). Furthermore, participants with, compared to without, MetS consumed less high-quality protein foods (P = 0.006) and more low-quality protein foods (P < 0.001), as defined by the protein digestibility-corrected amino acid score.

Conclusions
Dietary interventions targeting protein quantity and quality may have specific benefits in preventing or delaying the progression of MetS in at-risk older people, but this requires investigation in the form of randomized trials.
A multi-method exploration of a cardiac rehabilitation service delivered by registered Clinical Exercise Physiologists in the UK: key learnings for current and new services
Authors: Crozier Anthony , Graves Lee E. , George Keith P. , Richardson David , Naylor Louise , Green Daniel J. , Rosenberg Michael , Jones Helen 
Published: June 2024

Abstract
Background
Cardiac rehabilitation has been identified as having the most homogenous clinical exercise service structure in the United Kingdom (UK), but inconsistencies are evident in staff roles and qualifications within and across services. The recognition of Clinical Exercise Physiologists (CEPs) as a registered health professional in 2021 in the UK, provides a potential solution to standardise the cardiac rehabilitation workforce. This case study examined, in a purposefully selected cardiac exercise service that employed registered CEPs, (i) how staff knowledge, skills and competencies contribute to the provision of the service, (ii) how these components assist in creating effective service teams, and (iii) the existing challenges from staff and patient perspectives.

Methods
A multi-method qualitative approach (inc., semi-structured interviews, observations, field notes and researcher reflections) was employed with the researcher immersed for 12-weeks within the service. The Consolidated Framework for Implementation Research was used as an overarching guide for data collection. Data derived from registered CEPs (n = 5), clinical nurse specialists (n = 2), dietitians (n = 1), service managers/leads (n = 2) and patients (n = 7) were thematically analysed.

Results
Registered CEPs delivered innovative exercise prescription based on their training, continued professional development (CPD), academic qualifications and involvement in research studies as part of the service. Exposure to a wide multidisciplinary team (MDT) allowed skill and competency transfer in areas such as clinical assessments. Developing an effective behaviour change strategy was challenging with delivery of lifestyle information more effective during less formal conversations compared to timetabled education sessions.

Conclusions
Registered CEPs have the specialist knowledge and skills to undertake and implement the latest evidence-based exercise prescription in a cardiac rehabilitation setting. An MDT service structure enables a more effective team upskilling through shared peer experiences, observations and collaborative working between healthcare professionals.
Multiple evanescent white dot syndrome associated with COVID-19 infection: a case report
Authors: Ting Michael , Hsueh Jessica , Noori Jila 
Published: June 2024

Abstract
Background
To report a case of Multiple Evanescent White Dot Syndrome (MEWDS) one month after a COVID-19 infection in a female patient at an age unusual for the occurrence of this disease.

Case presentation
A 69-year-old Caucasian female reported the presence of floaters, photopsia, and enlarging vision loss in her left eye following the COVID-19 infection. Clinical and multimodal imaging was consistent with the MEWDS diagnosis. Fluorescein angiography examination revealed characteristic hyperfluorescent spots around the fovea in a wreath-like pattern. An extensive lab workup to rule out other autoimmune and infectious etiologies was inconclusive. Visual acuity and white dots resolved after a course of corticosteroids, which was confirmed on follow-up dilated fundus exam and multimodal imaging.

Conclusions
MEWDS is a rare white dot syndrome that may occur following COVID-19 infection in addition to other reported ophthalmic disorders following this infection.
Does hospital competition improve the quality of outpatient care? - empirical evidence from a quasi-experiment in a Chinese city
Authors: Peng Zixuan , Laporte Audrey , Wei Xiaolin , Sha Xinping , Coyte Peter C. 
Published: June 2024

AbstractBackgroundAlthough countries worldwide have launched a series of pro-competition reforms, the literature on the impacts of hospital competition has produced a complex and contradictory picture. This study examined whether hospital competition contributed to an increase in the quality of outpatient care.MethodsThe dataset comprises encounter data on 406,664 outpatients with influenza between 2015 and 2019 in China. Competition was measured using the Herfindahl-Hirschman index (HHI). Whether patients had 14-day follow-up encounter for influenza at any healthcare facility, outpatient facility, and hospital outpatient department were the three quality outcomes assessed. Binary regression models with crossed random intercepts were constructed to estimate the impacts of the HHI on the quality of outpatient care. The intensity of nighttime lights was employed as an instrumental variable to address the endogenous relationship between the HHI and the quality of outpatient care.ResultsWe demonstrated that an increase in the degree of hospital competition was associated with improved quality of outpatient care. For each 1% increase in the degree of hospital competition, an individual’s risk of having a 14-day follow-up encounter for influenza at any healthcare facility, outpatient facility, and hospital outpatient department fell by 34.9%, 18.3%, and 20.8%, respectively. The impacts of hospital competition on improving the quality of outpatient care were more substantial among females, individuals who used the Urban and Rural Residents Basic Medical Insurance to pay for their medical costs, individuals who visited accredited hospitals, and adults aged 25 to 64 years when compared with their counterparts.ConclusionThis study demonstrated that hospital competition contributed to better quality of outpatient care under a regime with a regulated ceiling price. Competition is suggested to be promoted in the outpatient care market where hospitals have control over quality and government sets a limit on the prices that hospitals may charge.
Impact of extended lung protection during mechanical ventilation on lung recovery in patients with COVID-19 ARDS: a phase II randomized controlled trial
Authors: Costa Eduardo L. V. , Alcala Glasiele C. , Tucci Mauro R. , Goligher Ewan , Morais Caio C. , Dianti Jose , Nakamura Miyuki A. P. , Oliveira Larissa B. , Pereira Sérgio M. , Toufen Carlos , Barbas Carmen S. V. , Carvalho Carlos R. R. , Amato Marcelo B. P. 
Published: June 2024

Abstract
Background
Protective ventilation seems crucial during early Acute Respiratory Distress Syndrome (ARDS), but the optimal duration of lung protection remains undefined. High driving pressures (ΔP) and excessive patient ventilatory drive may hinder lung recovery, resulting in self-inflicted lung injury. The hidden nature of the ΔP generated by patient effort complicates the situation further. Our study aimed to assess the feasibility of an extended lung protection strategy that includes a stepwise protocol to control the patient ventilatory drive, assessing its impact on lung recovery.

Methods
We conducted a single-center randomized study on patients with moderate/severe COVID-19-ARDS with low respiratory system compliance (CRS < 0.6 (mL/Kg)/cmH2O). The intervention group received a ventilation strategy guided by Electrical Impedance Tomography aimed at minimizing ΔP and patient ventilatory drive. The control group received the ARDSNet low-PEEP strategy. The primary outcome was the modified lung injury score (mLIS), a composite measure that integrated daily measurements of CRS, along with oxygen requirements, oxygenation, and X-rays up to day 28. The mLIS score was also hierarchically adjusted for survival and extubation rates.

Results
The study ended prematurely after three consecutive months without patient enrollment, attributed to the pandemic subsiding. The intention-to-treat analysis included 76 patients, with 37 randomized to the intervention group. The average mLIS score up to 28 days was not different between groups (P = 0.95, primary outcome). However, the intervention group showed a faster improvement in the mLIS (1.4 vs. 7.2 days to reach 63% of maximum improvement; P < 0.001), driven by oxygenation and sustained improvement of X-ray (P = 0.001). The intervention group demonstrated a sustained increase in CRS up to day 28 (P = 0.009) and also experienced a shorter time from randomization to room-air breathing (P = 0.02). Survival at 28 days and time until liberation from the ventilator were not different between groups.

Conclusions
The implementation of an individualized PEEP strategy alongside extended lung protection appears viable. Promising secondary outcomes suggested a faster lung recovery, endorsing further examination of this strategy in a larger trial.
Clinical trial registration This trial was registered with ClinicalTrials.gov (number NCT04497454) on August 04, 2020.
A multi path routing protocol with efficient energy consumption in IoT applications real time traffic
Authors: Abujassar Radwan S. 
Published: June 2024

AbstractThe extensive utilization of IoT applications leads to the aggregation of a substantial volume of data, presenting a crucial challenge in terms of data routing within these networks. RPL intentionally surpasses the limitations sometimes observed in low-power and lossy networks, which are particularly prevalent in IoT networks. The RPL protocol is designed specifically for static networks that do not involve mobility or topological changes. The RPL protocol guarantees continuous connectivity between nodes and mitigates the risk of data loss in stationary IoT applications that do not involve mobility or alterations in network configuration. The article utilizes a mobility aid technology known as network performance stability using the intelligent routing protocol (nPSIR), which expands upon RPL. The Mobility Support Entity (nPSIR) facilitates the displacement of all nodes, with the exception of the root node, and ensures uninterrupted connection during mobility. Moreover, it deals with the situation where there is a physical barrier between two interconnected nodes in a changing environment. In order to achieve this objective, it employs a dynamic trickle timer that operates within two distinct ranges. Furthermore, it utilizes a neighbor link quality table, a mechanism for selecting the most beneficial parent node in the event of migration, a measure of confidence, the identification of crucial regions, and a blacklist. Multiple simulations validate that nPSIR effectively decreases hand-off delay and improves packet delivery, despite the minor drawbacks of increased signaling costs and power consumption. The delivery ratio decreases the quantity of lost data packets and surpasses both RPL as a responsive protocol and mRPL as a proactive protocol in relation to mobility.
The brain–bone axis: unraveling the complex interplay between the central nervous system and skeletal metabolism
Authors: Shi Haojun , Chen Min 
Published: June 2024

AbstractThe brain–bone axis has emerged as a captivating field of research, unveiling the intricate bidirectional communication between the central nervous system (CNS) and skeletal metabolism. This comprehensive review delves into the current state of knowledge surrounding the brain–bone axis, exploring the complex mechanisms, key players, and potential clinical implications of this fascinating area of study. The review discusses the neural regulation of bone metabolism, highlighting the roles of the sympathetic nervous system, hypothalamic neuropeptides, and neurotransmitters in modulating bone remodeling. In addition, it examines the influence of bone-derived factors, such as osteocalcin and fibroblast growth factor 23, on brain function and behavior. The therapeutic potential of targeting the brain–bone axis in the context of skeletal and neurological disorders is also explored. By unraveling the complex interplay between the CNS and skeletal metabolism, this review aims to provide a comprehensive resource for researchers, clinicians, and students interested in the brain–bone axis and its implications for human health and disease.