bluuebunny/crossref_metadata_2025_split huggingface dataset:
Working (out) with fitness influencers – benefits for the fitness influencer, user health, and the endorsed brand: Key factors and the role of gender and brand familiarity
Authors: Durau Julia , Diehl Sandra , Terlutter Ralf 
Published: June 2024

Objective Fitness influencers have become important digital health communicators with regard to influencing consumer health behaviours, such as physical activity. We investigate how working (out) with these new communicators can generate benefits for the fitness influencer, user health, and endorsed brands. Based on the source credibility, social identity theory, and gender congruity research, this paper aims to identify the main factors that affect users’ attitudes toward the fitness influencer (influencer benefit), users’ exercise intentions (user health benefit) and their purchase intentions (brand benefit), considering user and influencer gender. Methods Two studies were conducted, both with male and female influencers and users. In study 1 (n = 496), the fitness influencer endorsed an unfamiliar brand, and in study 2 (n = 529) a familiar brand was endorsed. To test the proposed models and to estimate the path coefficients, structural equation modelling was performed. Results Key influencing factors were identified in the two studies: For attitude toward the influencer, source credibility is the most important; for exercise intention, parasocial interaction and attitude toward the behaviour are crucial; and purchase intention is largely predicted by the brand attitude. The studies revealed gender-congruent and non-congruent tendencies for female and male respondents, and different effects of unfamiliar and familiar brands. Conclusions Working (out) with fitness influencers can improve user attitudes toward the influencer, increase users’ exercise intentions, and increase brand purchase intentions, for both unfamiliar and familiar brands. Some gender congruity and some gender incongruity effects exist. The paper discusses important implications for theory and practice.
The evolution of health system planning and implementation of maternal telehealth services during the COVID-19 Pandemic
Authors: Aijaz Monisa , Bozkurt Burcu , Planey Arrianna Marie , Cilenti Dorothy , Khairat Saif , Shea Christopher M 
Published: June 2024

Background Differential access to healthcare is associated with disparities in maternal outcomes. Telehealth is one approach for improving access to maternal services. However, little is known regarding how health systems leverage telehealth to close the access gap. Objective This study examines how health systems have approached decisions about using telehealth for maternal services before and during the COVID-19 public health emergency and what factors were considered. Methods We conducted semi-structured interviews with 15 health system leaders between July and October 2021 and June and August 2022. We used a rapid analysis followed by a content analysis approach. Results Five health systems did not provide maternal telehealth services before the PHE due to a lack of reimbursement. Two health systems provided limited services as research endeavors, and one had integrated telehealth into routine maternity care. During the PHE, all transitioned to telehealth, with the primary consideration being patient and staff safety. At the time of the interview, key considerations shifted to patient access, patient preferences, patient complexity, return on investment, and staff burnout. However, several barriers impacted telehealth use, including coverage of portable devices and connectivity. These issues were reported to be common among underinsured, low-income, and rural patients. Health systems with particularly advanced capabilities worked on approaches to fill access gaps for these patients. Conclusion Some health systems prioritized telehealth to improve access to high-quality maternal services for patients at the highest risk of adverse outcomes. However, policy and patient-level barriers to equitable implementation of these services persist.
The impact of automatic history-taking software on data quality in the cardiology outpatient clinic: Retrospective observational study
Authors: Erden Ismail , Sen Arda , Erden Ibrahim Emre 
Published: June 2024

Background Healthcare delivery now mandates shorter visits despite the need for more data entry, under-mining patient–provider interaction. Furthermore, enhancing access to the outcomes of prior tests and imaging conducted on the patient, along with accurately documenting medication history, will significantly elevate the quality of healthcare service delivery. Objective To enhance the efficiency of clinic visits, we have devised a patient–provider portal that systematically gathers symptom and clinical data from patients through a computer algorithm known as Automated Assessment of Cardiovascular Examination (AACE). We intended to assess the quality of computer-generated Electronic Health Records (EHRs) with those documented by physicians. Methods We conducted a cross-sectional study employing a paired-sample design, focusing on individuals seeking assessment for active cardiovascular symptoms at outpatient adult cardiovascular clinics. Participants initially completed the AACE, and subsequently, in the first protocol, patients were subjected to routine care without providing the AACE forms to examining physicians. In the second protocol, the AACE form was presented to the physician before the examination, and participants were subjected to routine care. We assessed the impact of AACE forms generated through computerized history-taking method on the examination, considering various clinical outcomes and satisfaction surveys. Results We included non-randomized eligible patients who visited seven general cardiology outpatient clinics between September 18, 2023, and October 27, 2023. These clinics were staffed by the same physicians who were unaware of the content and details of the study. A total of 762 patients (394 patients in protocol 1 and 368 patients in protocol 2) were included in the study. The mean overall impression score for computer-generated EHRs was higher versus physician EHRs (4.2 vs. 2.6; p < .001). Our study demonstrated that EHRs created by physicians’ exhibit inaccuracies or deficiencies in various pieces of information. In the second protocol, in which the AACE form was presented to the physician before the examination, it was determined that the examination time was shorter, the number of tests requested, and the number of new drugs prescribed were less. Conclusions We observed that the patient–provider portal, systematically collecting symptom and clinical data from patients through a computer algorithm known as AACE, yielded records that were of higher quality, more comprehensive, better organized, and more relevant compared to those documented by physicians.
Does Higher Grade Indicate More Complex Language Usage? Exploring Syntactic Complexity Development Among High School EFL Learners
Authors: Wang (王威然) Weiran , Qin (秦文娟) Wenjuan , Wang (王琳艺) Linyi 
Published: June 2024

Purpose This article aims to investigate the longitudinal Syntactic Complexity (SC) development of English as a Foreign Language (EFL) learners and the variations by grade level. Design/Approach/Methods This study conducts a longitudinal analysis of SC development among 199 high school EFL learners in eastern China. The corpus contains 920 argumentative essays on scientifically and socially contentious topics. We employ the Second Language Syntactic Complexity Analyzer (L2SCA) to examine syntactic features in these essays through 11 computerized indices measuring different dimensions of SC (i.e., coordination, subordination, phrasal complexity). Multi-level regression analyses are used to depict SC development and cross-level interactions are investigated to examine variations by grade. Findings Results suggest that all SC indices except T-units per sentence exhibit varying growing trends. The results align with Biber's hypothetical stages of syntactic development, indicating learners’ progression toward greater subordination and phrasal complexity. Negative cross-grade interactions suggest that lower-grade students show heightened improvements in phrasal sophistication over time. Originality/Value The study portrays the developmental patterns of SC within and across grade levels, highlighting both group trends and individual variability in language development. It conceptualizes SC as a multidimensional construct and informs more precise measurement of SC features in writing assessment and instruction.
Second-dose intravenous thrombolysis with tenecteplase in alteplase-resistant medium-vessel-occlusion strokes: A retrospective and comparative study
Authors: Chausson Nicolas , Olindo Stéphane , Laborne François-Xavier , Aghasaryan Manvel , Renou Pauline , Soumah Djibril , Debruxelles Sabrina , Altarcha Tony , Poli Mathilde , L’Hermitte Yann , Sagnier Sharmila , Toudou-Daouda Moussa , Aminou-Tassiou Nana Rahamatou , Bentamra Leila , Benmoussa Narimane , Alecu Cosmin , Imbernon Carole , Smadja Léonard , Ouanounou Gary , Rouanet François , Sibon Igor , Smadja Didier 
Published: June 2024

Introduction: In intracranial medium-vessel occlusions (MeVOs), intravenous thrombolysis (IVT) shows inconsistent effectiveness and endovascular interventions remains unproven. We evaluated a new therapeutic strategy based on a second IVT using tenecteplase for MeVOs without early recanalization post-alteplase. Patients and methods: This retrospective, comparative study included consecutively low bleeding risk MeVO patients treated with alteplase 0.9 mg/kg at two stroke centers. One center used a conventional single-IVT approach; the other applied a dual-IVT strategy, incorporating a 1-h post-alteplase MRI and additional tenecteplase, 0.25 mg/kg, if occlusion persisted. Primary outcomes were 24-h successful recanalization for efficacy and symptomatic intracranial hemorrhage (sICH) for safety. Secondary outcomes included 3-month excellent outcomes (modified Rankin Scale score of 0–1). Comparisons were conducted in the overall cohort and a propensity score-matched subgroup. Results: Among 146 patients in the dual-IVT group, 103 failed to achieve recanalization at 1 h and of these 96 met all eligible criteria and received additional tenecteplase. Successful recanalization at 24 h was higher in the 146 dual-IVT cohort patients than in the 148 single-IVT cohort patients (84% vs 61%, p < 0.0001), with similar sICH rate (3 vs 2, p = 0.68). Dual-IVT strategy was an independent predictor of 24-h successful recanalization (OR, 2.7 [95% CI, 1.52–4.88]; p < 0.001). Dual-IVT cohort patients achieved higher rates of excellent outcome (69% vs 44%, p < 0.0001). Propensity score matching analyses supported all these associations. Conclusion: In this retrospective study, a dual-IVT strategy in selected MeVO patients was associated with higher odds of 24-h recanalization, with no safety concerns. However, potential center-level confounding and biases seriously limit these findings’ interpretation. Trial Registration ClinicalTrials.gov Identifier: NCT05809921
Complete chloroplast genome structural characterization of two Aerides (Orchidaceae) species with a focus on phylogenetic position of Aerides flabellata
Authors: Tao Kaifeng , Tao Lei , Huang Jialin , Duan Hanning , Luo Yan , Li Lu 
Published: June 2024

Abstract
Background
The disputed phylogenetic position of Aerides flabellata Rolfe ex Downie, due to morphological overlaps with related species, was investigated based on evidence of complete chloroplast (cp) genomes. The structural characterization of complete cp genomes of A. flabellata and A. rosea Lodd. ex Lindl. & Paxton were analyzed and compared with those of six related species in “Vanda-Aerides alliance” to provide genomic information on taxonomy and phylogeny.

Results
The cp genomes of A. flabellata and A. rosea exhibited conserved quadripartite structures, 148,145 bp and 147,925 bp in length, with similar GC content (36.7 ~ 36.8%). Gene annotations revealed 110 single-copy genes, 18 duplicated in inverted regions, and ten with introns. Comparative analysis across related species confirmed stable sequence identity and higher variation in single-copy regions. However, there are notable differences in the IR regions between two Aerides Lour. species and the other six related species. The phylogenetic analysis based on CDS from complete cp genomes indicated that Aerides species except A. flabellata formed a monophyletic clade nested in the subtribe Aeridinae, being a sister group to Renanthera Lour., consistent with previous studies. Meanwhile, a separate clade consisted of A. flabellata and six Vanda R. Br. species was formed, as a sister taxon to Holcoglossum Schltr.

Conclusions
This research was the first report on the complete cp genomes of A. flabellata. The results provided insights into understanding of plastome evolution and phylogenetic relationships of Aerides. The phylogenetic analysis based on complete cp genomes showed that A. flabellata should be placed in Vanda rather than in Aerides.
Multi-arm multi-stage (MAMS) randomised selection designs: impact of treatment selection rules on the operating characteristics
Authors: Choodari-Oskooei Babak , Blenkinsop Alexandra , Handley Kelly , Pinkney Thomas , Parmar Mahesh K. B. 
Published: June 2024

Abstract
Background
Multi-arm multi-stage (MAMS) randomised trial designs have been proposed to evaluate multiple research questions in the confirmatory setting. In designs with several interventions, such as the 8-arm 3-stage ROSSINI-2 trial for preventing surgical wound infection, there are likely to be strict limits on the number of individuals that can be recruited or the funds available to support the protocol. These limitations may mean that not all research treatments can continue to accrue the required sample size for the definitive analysis of the primary outcome measure at the final stage. In these cases, an additional treatment selection rule can be applied at the early stages of the trial to restrict the maximum number of research arms that can progress to the subsequent stage(s).
This article provides guidelines on how to implement treatment selection within the MAMS framework. It explores the impact of treatment selection rules, interim lack-of-benefit stopping boundaries and the timing of treatment selection on the operating characteristics of the MAMS selection design.

Methods
We outline the steps to design a MAMS selection trial. Extensive simulation studies are used to explore the maximum/expected sample sizes, familywise type I error rate (FWER), and overall power of the design under both binding and non-binding interim stopping boundaries for lack-of-benefit.

Results
Pre-specification of a treatment selection rule reduces the maximum sample size by approximately 25% in our simulations. The familywise type I error rate of a MAMS selection design is smaller than that of the standard MAMS design with similar design specifications without the additional treatment selection rule. In designs with strict selection rules - for example, when only one research arm is selected from 7 arms - the final stage significance levels can be relaxed for the primary analyses to ensure that the overall type I error for the trial is not underspent. When conducting treatment selection from several treatment arms, it is important to select a large enough subset of research arms (that is, more than one research arm) at early stages to maintain the overall power at the pre-specified level.

Conclusions
Multi-arm multi-stage selection designs gain efficiency over the standard MAMS design by reducing the overall sample size. Diligent pre-specification of the treatment selection rule, final stage significance level and interim stopping boundaries for lack-of-benefit are key to controlling the operating characteristics of a MAMS selection design. We provide guidance on these design features to ensure control of the operating characteristics.
The impact of long-term care interventions on healthcare utilisation among older persons: a scoping review of reviews
Authors: Balqis-Ali Nur Zahirah , Jawahir Suhana , Chan Yee Mang , Lim Amanda Wei-Yin , Azlan Ummi Wahidah , Shaffie Sal Sabila Mohd , Fun Weng Hong , Lee Shaun Wen Huey 
Published: June 2024

AbstractBackgroundAs the ageing population grows, the demand for long-term care (LTC) services will rise, concurrently amplifying healthcare utilisation. This review aims to examine and consolidate information on LTC interventions that influence healthcare utilisation among older persons.MethodsA scoping review was performed through a systematic search in PubMed, EBSCO CINAHL, EBM Reviews - Cochrane Database of Systematic Reviews, Embase, APA PsycInfo, EBM Reviews - Health Technology Assessment, and EBM Reviews - NHS Economic Evaluation Database. Systematic reviews with meta-analyses published between 1 January 2010 and 2 June 2022 among older persons aged 60 and above were included. The characteristics of LTC interventions were mapped to the World Health Organization (WHO) Healthy Ageing Framework. The effect sizes of healthcare utilisations for LTC interventions were recalculated using a random-effects model. The methodological quality was assessed with the AMSTAR-2 checklist, while the quality of evidence for each association was evaluated using GRADE.ResultsThirty-seven meta-analyses were included. The most prominent domain of the healthy ageing framework was managing chronic conditions. One hundred twelve associations between various LTC interventions and healthcare utilisations were identified, with 22 associations impacting healthcare utilisation. Four interventions were supported by suggestive or convincing evidence. Preventive home visits were found to reduce hospital admission (OR: 0.73, 95% CI: 0.59, 0.91,p = 0.005), caregiver integration during discharge planning (OR: 0.68, 95% CI: 0.57, 0.81,p < 0.001), and continuity of care (OR: 0.76, 95% CI: 0.61, 0.95,p = 0.018) reduced hospital readmission, and perioperative geriatric interventions reduced the length of hospital stay (MD: -1.50, 95% CI: -2.24, -0.76,p < 0.001). None of the associations impacted emergency department visits, medication use, and primary care utilisations with convincing evidence. Most reviews received low methodological quality.ConclusionThe findings suggest that LTC interventions could benefit from transitioning to a community-based setting involving a multidisciplinary team, including carers. The spectrum of services should incorporate a comprehensive assessment to ensure continuous care.
The association between uric acid and erectile dysfunction in US adults: NHANES 2001–2004
Authors: jun Wang Yi , he Chen Ying , Fan Lai lai 
Published: June 2024

Abstract
Background
—Recent evidence suggests that hyperuricemia may act as independent risk factors for erectile dysfunction (ED), in addition to the already established factors. The current evidence supporting this relationship remains insufficient.

Methods and results
—A total of 3,810 participants from the NHANES pool between 2001 and 2004 were included in our study, comprising 1,093 individuals with ED and 2,717 individuals without ED. Univariable and multivariable logistic regression analyses were conducted to examine the relationship between uric acid (UA) and the prevalence of ED. In the fully adjusted model, no significant association was observed between UA and ED (OR = 1.02, 95% CI: 0.84–1.24), and no significant differences were noted among the various UA levels (p = 0.5). In our sensitivity analyses, employing a stricter definition for ED, no significant results were found in the fully adjusted model (OR = 0.85, 95% CI: 0.60–1.19). Furthermore, no significant differences were observed among the various UA levels (p = 0.083).

Conclusions
—Our study did not establish a correlation between UA levels and ED. Nonetheless, further research with larger sample cohorts is required to verify these findings.
Localized Merkel cell carcinoma treatment considerations: a response to the forty-year experience at the Peter MacCallum cancer centre
Authors: Leigh James , Gebauer Kurt 
Published: June 2024

AbstractMerkel cell carcinoma (MCC) is a rare but aggressive neuroendocrine tumour of the skin with poor prognosis and rising global incidence. A recently published article in BMC Cancer, titled “Merkel cell carcinoma: a forty-year experience at the Peter MacCallum Cancer Centre” (Wang et al.), provides a contemporary analysis of locoregional disease outcomes in Australia which highlights the comparative effectiveness of radiotherapy for excisions with involved margins versus wide local excision. There is a persistent lack of clear, well-defined guidelines to manage MCC in Australia despite experiencing the highest rates globally. The advanced age at onset also provides inherent challenges for optimal management and often, a case-by-case approach is necessary based on patient preferences, baseline function and fitness for surgery. This paper responds to the recently published article by Wang et al. and will expand the discourse regarding management of localized MCC. Specifically, we will discuss the surgical excision approaches; alternative treatment options for MCC including radiotherapy, Mohs micrographic surgery and novel immunotherapy agents being investigated through several clinical trials.
A randomized control trial to compare mortality in recipients of leucoreduced and non-leucoreduced whole blood transfusion in patients with cancer in Uganda
Authors: Okello Clement D. , Orem Jackson , Nabwana Martin , Kiwanuka Noah , Shih Andrew W. , Heddle Nancy , Mayanja-Kizza Harriet 
Published: June 2024

Abstract
Background
Mortality benefit of transfusion with leucoreduced whole blood has not been demonstrated in the sub-Saharan Africa (SSA). We compared mortality in patients with cancer transfused with leucoreduced and non-leucoreduced whole blood in a SSA setting.

Methods
An open-label randomized controlled trial was conducted at the Uganda Cancer Institute where participants were randomized in a 1:1 ratio into the leucoreduced and non-leucoreduced whole blood transfusion arms. Leucocyte filtration of whole blood was performed within 72 h of blood collection. Patients aged ≥ 15 years who were prescribed blood transfusion by the primary physicians were eligible for study enrolment. Mortality difference was analyzed using intention-to-treat survival analysis and cox proportional hazard model was used to analyze factors associated with mortality.

Results
There were 137 participants randomized to the leucoreduced and 140 to the non-leucoreduced arms. Baseline characteristics were similar between the two arms. The median number of blood transfusions received was 1 (IQR, 1–3) unit and 2 (IQR, 1–3) units in the leucoreduced and non-leucoreduced arms respectively, p = 0.07. The 30-day mortality rate in the leucoreduced arm was 4.6% (95% CI, 2.1–10) and was 6.2% (95% CI, 3.2–12.1) in the non-leucoreduced arm (p = 0.57), representing an absolute effect size of only 1.6%. Increasing age (HR = 0.92, 95% CI, 0.86–0.98, p = 0.02) and Eastern Co-operative Oncology Group (ECOG) performance score of 1 (HR = 0.03, 95% CI, 0.00–0.31, p < 0.01) were associated with reduced 30-day mortality.

Conclusions
The study failed to demonstrate mortality difference between cancer patients transfused with leucoreduced and non-leucoreduced whole blood. Although this study does not support nor refute universal leucoreduction to reduce mortality in patients with cancer in SSA, it demonstrates the feasibility of doing transfusion RCTs in Uganda, where a multi-center trial with an appropriate sample size is needed.

Trial registration
Pan African Clinical Trial Registry, https://pactr.samrc.ac.za/ (PACTR202302787440132). Registered on 06/02/2023.