bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reporting and managing ethical issues in intensive care using the critical incident reporting system
Authors: Hiltunen Tina , Suhonen Riitta , Inkilä Jaana , Leino-Kilpi Helena 
Published: June 2024

Background Intensive care nurses frequently encounter ethical issues with potentially severe consequences for nurses, patients, and next of kin. Therefore, ethical issues in intensive care units (ICU) should be recognized and managed. Research objectives To analyze ethical issues reported by intensive care nurses and how reported issues were managed within the organization using register data from the HaiPro critical incident reporting system (CIRS), and to explore the suitability of this system for reporting and managing ethical issues. Research design This was a retrospective descriptive register study. CIRS reports on ethical issues in adult ICUs ( n = 12) in one hospital district in Finland over 25 months (2019–2021) were analyzed through inductive content analysis and descriptive quantification. The CIRS’s suitability for reporting and managing ethical issues was evaluated through a strengths, weaknesses, opportunities, and threats (SWOT) analysis. Ethical considerations The study was approved by the University Ethics Committee, and permission to conduct the research was granted before data collection within the organization. Results CIRS reports on ethical issues ( n = 35) made by nurses were found in seven of the 12 ICUs. The CIRS managers of these units managed these reports. The ethical issues described by the nurses were divided into four main categories: nature, situational information, consequences, and contributing factors. Management of reported ethical issues was divided into three main categories: preventive actions proposed by nurses, proposals for actions by CIRS managers, and actions taken by CIRS managers. Conclusions Systematic register data broadly describe ethical issues and their management, indicating that the CIRS could be suitable for reporting and managing ethical issues, thereby enabling the monitoring and development of ethical quality at the unit and organizational levels.
Productivity Spillovers from Foreign Direct Investment to Ethiopian Manufacturing Sector
Authors: Wajebo Temesgen Woldamanuel 
Published: June 2024

The study investigates productivity spillover from foreign direct investment (FDI) to domestic firms in the Ethiopian manufacturing industries. The system generalised method of moments (SYS-GMM) estimator using panel data of manufacturing firms for the years 2011–2016 with 12,006 observations grouped under 102 industries was employed. The results show a coexistence of both negative and positive productivity spillover effects from FDI to domestically owned firms at a moderate level of absorptive capacity. Specifically, foreign presence in the industries contributed to a positive and significant horizontal and backward productivity spillover effect on domestic firms on an average level. The horizontal productivity spillover is transmitted to local firms through demonstration and competition effects at a moderate level. Likewise, vertical productivity spillover occurred through the channel of sales of intermediate goods and services to foreign firms. We have observed that the technology gap is a critical factor among those factors that determine the productivity spillover occurrence. Finally, policy measures aimed at minimising the technology gap between foreign and domestic firms to maximise the productivity spillover effect are suggested. Since the result shows that the spillover effects in all firms are not equal, prioritisation as per their promise is recommendable in an FDI-attracting framework. JEL: C33, D29
Outcomes Following Surgical Correction of Talocalcalcaneal Joint Dislocation in Diabetes Associated Charcot Foot Arthropathy
Authors: Cho Elizabeth , Pinzur Michael S. , Schiff Adam P. , Hamid Kamran 
Published: June 2024

Background: Growing clinical interest in the treatment of acquired foot deformity due to diabetes-associated Charcot foot arthropathy has led to multiple reports of favorable clinical outcomes in patients when their acquired deformity is at the midfoot level. Clinical failures and less than optimal clinical outcomes are achieved when the deformity is at the hindfoot or ankle levels. Methods: A retrospective review was performed of all patients who underwent surgical correction of diabetes-associated Charcot foot arthropathy with talocalcaneal dislocation over an 18-year period. Reduction of the talocalcaneal dislocation, and maintenance of the correction with percutaneous pins and circular external fixation after subtalar joint preparation for fusion, was used as the method of surgically achieving a clinically plantigrade foot. Clinical outcomes were based on resolution of infection, limb salvage, and the ability to ambulate with commercially available therapeutic footwear. Results: Forty-three feet in 39 patients were included. A favorable clinical outcome was achieved in 32 of 43 feet (74%) with 26 (60%) considered to have an “excellent” result with minimal shoeing issues and 6 (14%) considered to have a “good” outcome based on their need for a custom shoe modification and/or some form of short ankle-foot orthosis. Eleven feet (26%) were judged to have a “poor” clinical outcome and among those 11 feet, 6 underwent partial, or whole-foot amputation, 2 had persistent wounds, and 5 required the use of a standard ankle foot orthosis or Charcot Restraint Orthotic Walker (CROW). Conclusion: Subtalar dislocation in Charcot arthropathy is a complex clinical problem. In our series, reduction and maintenance of the reduction after subtalar dislocation was essential for a favorable clinical outcome.
Condition monitoring of impact vibrations using observed signals and estimated principal Lyapunov exponents
Authors: Lee June-Yule 
Published: June 2024

An efficient algorithm for the condition monitoring of a system experiencing impact vibrations is proposed. The condition monitoring of the system is achieved using only observed signals. Delay embedding techniques are used to construct an equivalent system. The Jacobian matrix is approximated using different neighbourhood matrices, and principal Lyapunov exponents are calculated using the QR decomposition method (where Q represents an orthogonal matrix and R represents an upper triangular matrix). The proposed algorithm is then validated using impact velocity series and displacement data. Numerical bifurcation diagrams and the corresponding principal Lyapunov exponents are plotted with respect to various control parameters. The results indicate that sudden changes in impact vibrations can be detected successfully. The principal Lyapunov exponents align with the bifurcation diagram across the entire region. To assess the robustness of the proposed algorithm, the numerical bifurcation diagram is masked by transient noise or noise with a signal-to-noise ratio of 20 dB. Furthermore, the results indicate that the primary regions of stable and unstable impact vibrations can still be detected successfully.
Orbital cavernous venous malformation shrinkage during fractionated stereotactic radiotherapy contributing to the development of radiation retinopathy
Authors: Hughes Laura , Cohn Amy C , Haghighi Neda , McNab Alan A 
Published: June 2024

Background Posterior movement of ocular tissue secondary to orbital cavernous venous malformation shrinkage from fractionated stereotactic radiotherapy can allow healthy structures to move into the radiation field during treatment. This may carry an increased risk of radiation-induced retinopathy. Methods We present a case of a young female whose radiotherapy treatment for an orbital cavernous venous malformation resulted in a 3 mm reduction in proptosis and subsequent retinopathy. Results The severity of the patient's radiation-induced radiotherapy exceeded expectations. The venous malformation shrinkage during treatment and ensuing posterior movement of the globe suggested an increased involvement of ocular tissue in the radiation field, prompting consideration of interval neuroimaging and tumour mapping. Conclusions We describe and suggest a protocol of onboard neuroimaging during the radiation therapy course to better target tumour volumes and minimise collateral tissue damage. To our knowledge, this has not been previously described in the ophthalmic literature.
Endoscopic ultrasound-guided gastroenterostomy versus enteral stenting for gastric outlet obstruction: a systematic review and meta-analysis
Authors: Asghar Muhammad , Forcione David , Puli Srinivas Reddy 
Published: June 2024

Background: The symptoms of gastric outlet obstruction have traditionally been managed surgically or endoscopically. Enteral stenting (ES) is a less invasive endoscopic treatment strategy for this condition. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) has recently become a potential alternative technique. Objectives: We conducted a systematic review and meta-analysis of the effectiveness and safety profile of EUS-GE compared with ES. Design: Meta-analysis and systematic review. Data sources and methods: We searched multiple databases from inception to August 2023 to identify studies that reported the effectiveness and safety of EUS-GE compared with ES. The outcomes of technical success, clinical success, and adverse events (AEs) were evaluated. Pooled proportions were calculated using both fixed and random effects models. Results: We included 13 studies with 1762 patients in our final analysis. The pooled rates of technical success for EUS-GE were 95.59% [95% confidence interval (CI), 94.01–97.44, I2 = 32] and 97.96% (95% CI, 96.06–99.25, I2 = 63) for ES. The pooled rate of clinical success for EUS-GE was 93.62% (95% CI, 90.76–95.98, I2 = 54) while for ES it was lower at 85.57% (95% CI, 79.63–90.63, I2 = 81). The pooled odds ratio (OR) of clinical success was higher for EUS-GE compared to ES at 2.71 (95% CI, 1.87–3.93). The pooled OR of clinical success for EUS-GE was higher compared to ES at 2.72 (95% CI, 1.86–3.97, I2 = 0). The pooled rates of re-intervention for EUS-GE were lower at 3.77% (95% CI, 1.77–6.46, I2 = 44) compared with ES, which was 25.13% (95% CI, 18.96–31.85, I2 = 69). The pooled OR of the rate of re-intervention in the ES group was higher at 7.96 (95% CI, 4.41–14.38, I2 = 13). Overall, the pooled rate for AEs for EUS-GE was 8.97% (95% CI, 6.88–11.30, I2 = 15), whereas that for ES was 19.63% (95% CI, 11.75–28.94, I2 = 89). Conclusion: EUS-GE and ES are comparable in terms of their technical effectiveness. However, EUS-GE has demonstrated improved clinical effectiveness, a lower need for re-intervention, and a better safety profile compared to ES for palliation of gastric outlet obstruction.
Incidence of mortality and risk factors among adult stroke patients in public hospitals Jigjiga town Somali region, Ethiopia: Cohort study design
Authors: Ibrahim Ahmed Mohammed , Abdi Abdirasak Abdulahi , Yusuf Ramadan Budul , Osman Mohamed Omar , Muse Abdilahi Ibrahim , Wadajo Girma Tadesse , Hailu Afework , Roble Abdurahman Kedir , Issack Mohamed Ali , Mahamed Ali Ahmed 
Published: June 2024

Background: A stroke is a sudden loss of blood supply to the brain, leading to permanent tissue damage caused by embolism, thrombosis, or hemorrhagic events. Almost 85% of strokes are ischemic strokes. Objective: To assess the incidence of mortality and risk factors among adult stroke patients in public hospitals of Jigjiga town, Somali Region, Ethiopia. Methods: An institution-based retrospective cohort study was conducted from 25 May to 15 June 2022 at Sheikh Hassen Yabare Referral Hospital and Karamara Hospital. Data were entered using Epi-Data version 4.3 and exported to be analyzed using SPSS 20 statistical software. Kaplan-Meier was used to estimate mean survival time, and a predictor with a p-value < 0.05 was considered to have a significant in multivariate Cox regression. Results: About 480 stroke patients’ charts were included in this study; among those, 229 (53.3%) were male stroke patients, and 259 (60.2%) had an ischemic stroke. The overall incidence rate was 7.15 deaths per 1000 person-day observations. The overall median survival time for adult stroke patients was 120 days. GCS level b/n 3–8 has a lower survival time with a mean survival time of 57 days (95% CI: 48.8–66.7) as compared to those who had GCS level 9–12 with a mean survival time of 103 days (95% CI: 93.4–112.9). Age ⩾ 71 (AHR = 1.9; 95% CI: 1.02–3.45), presence of pneumonia (AHR = 2.7; 95% CI: 1.52–4.63), and history of hypertension (AHR = 2.07; 95% CI: 1.08–3.89) were the predictors of mortality among stroke patients. Conclusion: According to the findings of this study, the incidence of mortality was high, at 7.15 per 1000 person-years. The presence of pneumonia, decreased GCS, age ⩾ 7, and history of hypertension were predictors of mortality in adult stroke patients.
Assessing usability of intelligent guidance chatbots in Chinese hospitals: Cross-sectional study
Authors: Yang Yanni , Liu Siyang , Lei Ping , Huang Zhengwei , Liu Lu , Tan Yiting 
Published: June 2024

Objective This study aimed to assessing usability of intelligent guidance chatbots (IGCs) in Chinese hospitals. Methods A cross-sectional study based on expert survey was conducted between August to December 2023. The survey assessed the usability of chatbots in 590 Chinese hospitals. One-way ANOVA was used to analyze the impact of the number of functions, human-like characteristics, number of outpatients, and staff size on the usability of the IGCs. Results The results indicate that there are 273 (46.27%) hospitals scoring above 45 points. In terms of function development, 581(98.47%) hospitals have set the number of functions between 1 and 5. Besides, 350 hospitals have excellent function implementation, accounting for 59.32%. In terms of the IGC's human-like characteristic, 220 hospitals have both an avatar and a nickname. Results of One-way ANOVA show that, the number of functions( F = 202.667, P < 0.001), human-like characteristics( F = 372.29, P < 0.001), staff size( F = 9.846, P < 0.001), and the number of outpatients( F = 5.709, P = 0.004) have significant impact on the usability of hospital IGCs. Conclusions This study found that the differences in the usability of hospital IGCs at various levels of the number of functions, human-like characteristics, number of outpatients, and staff size. These findings provide insights for deploying hospital IGCs and can inform improvements in patient's experience and adoption of chatbots.
An Assessment of Clinical Research Self-Efficacy among Researchers at the Largest Healthcare Institute in Qatar: Recommendations and Future Actions
Authors: Qussini Seba , Shahbal Saad , MacDonald Ross , Hammoudeh Samer , Al-Ghoul Zeina , Dierickx Kris 
Published: June 2024

OBJECTIVES Clinical research professionals must be equipped with adequate training in sound scientific methods and appropriate ethics. In this study, we aimed to assess the current clinical research self-efficacy of researchers at Hamad Medical Corporation (HMC). We also evaluated the effects of training courses on researchers’ self-efficacy. METHODS Utilizing a cross-sectional design, we used the shortened Clinical Research Appraisal Inventory (CRAI-12) through an online survey to assess the current clinical research self-efficacy of 600 researchers at HMC, Doha, Qatar. After conducting descriptive analyses, unpaired t test and ANOVA were used to determine significant mean percentages between variables. Pearson correlation coefficients were also calculated to measure the association among the interval variables. All tests were 2-sided, and significance was defined as P < .05. RESULTS For all questions, except those related to “funding,” most participants scored on the upper half of the scale (>5), reflecting higher self-efficacy for the topics covered in CRAI. Gender differences were significant across all factors, with males reporting higher levels of self-assessed efficacy and in clinical research. Other factors such as higher education degrees and previous (external) clinical research training were also associated with higher self-reported clinical research efficacy. CONCLUSIONS The findings of this study indicate that researchers at HMC possess high clinical research self-efficacy overall, but lower self-efficacy in securing funding. Gender and education level positively influence self-efficacy across CRAI factors. Notably, clinical research training boosts self-efficacy, especially when obtained outside HMC. In conclusion, healthcare providers are strongly encouraged to engage in effective clinical research training courses, both within and outside of their healthcare institutions, to improve their clinical research efficacy and enhance clinical practice.
Predictive value of thrombus enhancement sign for stroke subtype and recanalization in acute basilar-artery occlusion
Authors: He Guangchen , Guo Sheng , Fang Hui , Xu Haoyang , Ling Runjianya , Lu Haitao , Zhu Yueqi 
Published: June 2024

Background: Thrombus enhancement sign (TES) is associated with cardioembolic stroke and first-pass angiographic failure in anterior ischemic stroke. However, the relationship between TES and stroke subtype and recanalization status after endovascular treatment (EVT) in basilar artery occlusion (BAO) remains unknown. Methods: This retrospective study included consecutive patients with acute BAO who underwent EVT between January 2020 and September 2023. Each patient underwent baseline non-contrast computed tomography (CT) and CT angiography. Two independent readers assessed the presence of TES. Stroke types were classified according to the Trial of ORG 10172 for Acute Stroke Treatment. Successful recanalization was defined as a modified Thrombolysis in Cerebral Infarction score of 2b–3 after EVT. Clinical and interventional parameters, along with histopathological thrombi examination results, were compared between the TES-positive and TES-negative groups. The associations between TES and stroke subtype and recanalization status were analyzed using univariate and multivariate analyses. Results: A total of 151 patients were included in the analysis, among whom 116 (77%) exhibited TES. TES showed a significant correlation with cardioembolic and cryptogenic strokes (odds ratio [OR]: 8.56; 95% confidence interval: 3.49–22.4; p < 0.001), whereas the TES-positive thrombi were characterized by a higher fibrin/platelet proportion ( p = 0.002) and lower erythrocyte proportion ( p = 0.044). The TES-positive group demonstrated favorable outcomes compared to the TES-negative group, including a shorter procedure time ( p < 0.001), lower number of thrombectomy attempts ( p = 0.010), higher incidence of first pass success ( p = 0.022), and lower rate of requiring rescue angioplasty and/or stenting ( p < 0.001). In multivariate analysis, TES remained independently associated with successful recanalization (OR: 9.63; 95% CI: 2.33, 47.7; p = 0.003) after adjusting for baseline confounders. Conclusions: Visualization of TES serves as a reliable and easily accessible marker for identifying cardioembolic and cryptogenic strokes and predicting recanalization success in thrombectomy for basilar artery occlusion.
“How to Make it Out Alive”: A Strengths-Based Analysis of Latinas’ Adolescent Sexual Health Experiences
Authors: Lilly Jenn M. , Emerick Maddox C. , Tice-Brown Derek , Pace Susan R. 
Published: June 2024

Background Ample evidence demonstrates Latina adolescents’ elevated risk for sexual health disparities, but knowledge of how they manage their sexual health during this critical period of sexual development is limited. Countering the overfocus on Latina adolescents as “at-risk” girls in extant research, this study uses a strengths-based perspective to explore this topic. Methods This study used a narrative research design to gather and analyze the stories of 18 Latina young people who attended school in New York. We employed holistic-content and categorical-content approaches to identify themes and interpret findings through a strengths-based view of sexual health. Results We identified three major themes across participants’ narratives: (1) agency in gaining sexual health information; (2) self-protection; and (3) obtaining sexual healthcare despite barriers. Conclusions Findings underscore the need for more inclusive, culturally relevant sexual health education initiatives, youth-centered services, and interventions that capitalize on the strengths of Latina adolescents.
A modern view of LGL leukemia
Authors: Marchand Tony , Lamy Thierry , Loughran Thomas P. 
Published: June 2024

Abstract
Large granular lymphocytic leukemia (LGLL) is a rare lymphoproliferative chronic disorder characterized by expansion of either T or natural killer (NK) cytotoxic cells. In contrast to Epstein-Barr virus–induced aggressive NK-LGLL, chronic T-LGLL and NK-LGLL are indolent diseases affecting older patients with a median age of 66.5 years. LGLL is frequently associated with autoimmune disorders, most frequently rheumatoid arthritis. An auto-/alloantigen is tentatively implicated in disease initiation. Large granular lymphocyte expansion is then triggered by proinflammatory cytokines such as interleukin-15, macrophage inflammatory protein 1 (MIP-1), and RANTES (regulated upon activation, normal T cell expressed, and secreted). This proinflammatory environment contributes to deregulation of proliferative and apoptotic pathways. After the initial description of the JAK-STAT pathway signaling activation in the majority of patients, recurrent STAT3 gain-of-function mutations have been reported. The JAK-STAT pathway plays a key role in LGL pathogenesis by promoting survival, proliferation, and cytotoxicity. Several recent advances have been made toward understanding the molecular landscapes of T- and NK-LGLL, identifying multiple recurrent mutations affecting the epigenome, such as TET2 or KMT2D, and cross talk with the immune microenvironment, such as CCL22. Despite an indolent course, published series suggest that the majority of patients eventually need treatment. However, it is noteworthy that many patients may have a long-term observation period without ever requiring therapy. Treatments rely upon immunosuppressive drugs, namely cyclophosphamide, methotrexate, and cyclosporine. Recent advances have led to the development of targeted approaches, including JAK-STAT inhibitors, cytokine targeting, and hypomethylating agents, opening new developments in a still-incurable disease.