bluuebunny/crossref_metadata_2025_split huggingface dataset:
Breastfeeding mother’s experiences with breastfeeding counselling: a qualitative study
Authors: Hamnøy Ingvild Lande , Kjelsvik Marianne , Baerug Anne Bergljot , Dahl Berit Misund 
Published: May 2024

Abstract
Background
Mothers are recommended to breastfeed their children but can find it challenging and experience breastfeeding problems. Qualified breastfeeding counselling from healthcare professionals can help mothers master breastfeeding, but there is a need to explore mothers’ lived experiences with receiving breastfeeding counselling. We aimed to reveal breastfeeding mothers’ experiences with receiving breastfeeding counselling from midwives and public health nurses (PHNs) to provide a deeper insight into the phenomenon of breastfeeding counselling, which may improve breastfeeding counselling in practice.

Methods
A qualitative design with a hermeneutic phenomenological approach was used. Individual interviews of 11 breastfeeding mothers from Norway were conducted from September 2021 to 2022. Van Manen’s guided existential inquiry guided the reflective process to provide deeper insights into the phenomenon of breastfeeding counselling.

Results
The study captured the meaning of breastfeeding mothers’ lived experiences with breastfeeding counselling. Three themes and eight sub-themes were found. Breastfeeding was at stake for the mothers because breastfeeding could be reduced or stopped, and qualified breastfeeding counselling from midwives and PHNs was essential for them to establish and continue breastfeeding. They needed to be perceived as both breastfeeding mothers and as women with their own needs to master everyday life during the breastfeeding period.

Conclusions
This study offers insights to midwives, PHNs and others offering breastfeeding counselling by facilitating an understanding of being a breastfeeding mother receiving breastfeeding counselling. Qualified breastfeeding counselling and a trusting relationship with midwives and PHNs are essential for mothers to establish and continue breastfeeding, while deficient counselling may cause breastfeeding difficulties. Mothers need to be treated as whole and competent persons to avoid objectification and fathers/partners need to be included in breastfeeding counselling. The ‘Baby-Friendly Hospital Initiative’ should be continued, and guidelines should align with the mothers’ need to incorporate breastfeeding into their daily lives during the breastfeeding period.
Astaxanthin-mediated Nrf2 activation ameliorates glucocorticoid-induced oxidative stress and mitochondrial dysfunction and impaired bone formation of glucocorticoid-induced osteonecrosis of the femoral head in rats
Authors: Wang Weidan , Jiang Hongyi , Yu Jiachen , Lou Chao , Lin Jian 
Published: May 2024

Abstract
Background
Osteonecrosis of the femoral head caused by glucocorticoids (GIONFH) is a significant issue resulting from prolonged or excessive clinical glucocorticoid use. Astaxanthin, an orange-red carotenoid present in marine organisms, has been the focus of this study to explore its impact and mechanism on osteoblast apoptosis induced by dexamethasone (Dex) and GIONFH.

Methods
In this experiment, bioinformatic prediction, molecular docking and dynamics simulation, cytotoxicity assay, osteogenic differentiation, qRT-PCR analysis, terminal uridine nickend labeling (TUNEL) assay, determination of intracellular ROS, mitochondrial function assay, immunofluorescence, GIONFH rat model construction, micro-computed tomography (micro-CT) scans were performed.

Results
Our research demonstrated that a low dose of astaxanthin was non-toxic to healthy osteoblasts and restored the osteogenic function of Dex-treated osteoblasts by reducing oxidative stress, mitochondrial dysfunction, and apoptosis. Furthermore, astaxanthin rescued the dysfunction in poor bone quality, bone metabolism and angiogenesis of GIONFH rats. The mechanism behind this involves astaxanthin counteracting Dex-induced osteogenic damage by activating the Nrf2 pathway.

Conclusion
Astaxanthin shields osteoblasts from glucocorticoid-induced oxidative stress and mitochondrial dysfunction via Nrf2 pathway activation, making it a potential therapeutic agent for GIONFH treatment.
Impact of “hypotension on arrival” on required surgical disciplines and usage of damage control protocols in severely injured patients
Authors: Witzenhausen Moritz , Hossfeld Björn , Kulla Martin , Beltzer Christian 
Published: May 2024

Abstract
Background
For trauma patients with subsequent immediate surgery, it is unclear which surgical disciplines are most commonly required for treatment, and whether and to what extend this might depend on or change with “hypotension on arrival”. It is also not known how frequently damage control protocols are used in daily practice and whether this might also be related to “hypotension on arrival”.

Methods
A retrospective analysis of trauma patients from a German level 1 trauma centre and subsequent “immediate surgery” between 01/2017 and 09/2022 was performed. Patients with systolic blood pressure > 90 mmHg (group 1, no-shock) and < 90 mmHg (group 2, shock) on arrival were compared with regard to (a) most frequently required surgical disciplines, (b) usage of damage control protocols, and (c) outcome. A descriptive analysis was performed, and Fisher’s exact test and the Mann‒Whitney U test were used to calculate differences between groups where appropriate.

Results
In total, 98 trauma patients with “immediate surgery” were included in our study. Of these, 61 (62%; group 1) were normotensive, and 37 (38%, group 2) were hypotensive on arrival. Hypotension on arrival was associated with a significant increase in the need for abdominal surgery procedures (group 1: 37.1 vs. group 2: 54.5%; p = 0.009), more frequent usage of damage control protocols (group 1: 59.0 vs. group 2: 75.6%; p = 0.019) and higher mortality (group 1: 5.5 vs. group 2: 24.3%; p 0.027).

Conclusion
Our data from a German level 1 trauma centre proof that abdominal surgeons are most frequently required for the treatment of trauma patients with hypotension on arrival among all surgical disciplines (> thoracic surgery > vascular surgery > neurosurgery). Therefore, surgeons from these specialties must be available without delay to provide optimal trauma care.
Predicting outcome after aneurysmal subarachnoid hemorrhage by exploitation of signal complexity: a prospective two-center cohort study
Authors: Bögli Stefan Yu , Olakorede Ihsane , Veldeman Michael , Beqiri Erta , Weiss Miriam , Schubert Gerrit Alexander , Willms Jan Folkard , Keller Emanuela , Smielewski Peter 
Published: May 2024

Abstract
Background
Signal complexity (i.e. entropy) describes the level of order within a system. Low physiological signal complexity predicts unfavorable outcome in a variety of diseases and is assumed to reflect increased rigidity of the cardio/cerebrovascular system leading to (or reflecting) autoregulation failure. Aneurysmal subarachnoid hemorrhage (aSAH) is followed by a cascade of complex systemic and cerebral sequelae. In aSAH, the value of entropy has not been established yet.

Methods
aSAH patients from 2 prospective cohorts (Zurich—derivation cohort, Aachen—validation cohort) were included. Multiscale Entropy (MSE) was estimated for arterial blood pressure, intracranial pressure, heart rate, and their derivatives, and compared to dichotomized (1–4 vs. 5–8) or ordinal outcome (GOSE—extended Glasgow Outcome Scale) at 12 months using uni- and multivariable (adjusted for age, World Federation of Neurological Surgeons grade, modified Fisher (mFisher) grade, delayed cerebral infarction), and ordinal methods (proportional odds logistic regression/sliding dichotomy). The multivariable logistic regression models were validated internally using bootstrapping and externally by assessing the calibration and discrimination.

Results
A total of 330 (derivation: 241, validation: 89) aSAH patients were analyzed. Decreasing MSE was associated with a higher likelihood of unfavorable outcome independent of covariates and analysis method. The multivariable adjusted logistic regression models were well calibrated and only showed a slight decrease in discrimination when assessed in the validation cohort. The ordinal analysis revealed its effect to be linear. MSE remained valid when adjusting the outcome definition against the initial severity.

Conclusions
MSE metrics and thereby complexity of physiological signals are independent, internally and externally valid predictors of 12-month outcome. Incorporating high-frequency physiological data as part of clinical outcome prediction may enable precise, individualized outcome prediction. The results of this study warrant further investigation into the cause of the resulting complexity as well as its association to important and potentially preventable complications including vasospasm and delayed cerebral ischemia.
The benefits of leisure activities on healthy life expectancy for older people with diabetes
Authors: Huang I-Wen , Weng Shao-Jen , Liao Cheng-Hsi , Xu Yeong-Yuh , Hsieh Liang-Po , Liu Shih-Chia , Tsai Yao-Te 
Published: May 2024

Abstract
Purpose
The purpose of this study is to examine whether leisure activities can help reduce years lived with disability and increase healthy life expectancy of diabetics aged 50 years and above.

Methods
Analysis was based on five waves of follow-up survey data (Taiwan Longitudinal Study of Aging, TLSA) from 1996 to 2011. A total of 5131 participants aged 50 years and above in 1996 were included in the analysis, and gender, leisure activity participation, and diabetes mellitus were used as primary variables to examine the variation trend in health status in the participants. The health status in the various waves of surveys was measured using the activities of daily living scale, and nondisabled was defined as healthy. A multivariate logistic regression model was used to calculate the life expectancy (LE) and healthy life expectancy (HLE) of the people aged 50 years and above.

Results
The diabetes older people with a high frequency of leisure activities have longer HLE than those with lower activity frequency. Using 50-year-old diabetic women as an example, the LE (HLE) of those with six or more leisure activities and those with three or fewer leisure activities was 30.40 (25.34) and 24.90 (20.87), respectively. The LE (HLE) of men with the same conditions was 24.79 (22.68) and 20.30 (18.45), respectively.

Conclusions
This study used life expectancy and healthy life expectancy as markers to evaluate health benefits and provided evidence that leisure activities can help extend the life span and maintain the health status of middle-aged and older diabetics.
A phase I/II clinical trial of ex-vivo expanded human bone marrow derived allogeneic mesenchymal stromal cells in adult patients with perianal fistulizing Crohn’s Disease
Authors: Swaroop Shekhar , Vuyyuru Sudheer Kumar , Kante Bhaskar , Kumar Peeyush , Mundhra Sandeep Kumar , Arora Umang , Goyal Ankur , Kandasamy Devasenathipathy , Sharma Raju , Kabilan Kavirajan , Kedia Saurabh , Dash Nihar Ranjan , Ahuja Vineet 
Published: May 2024

Abstract
Background
Perianal fistulas (PF) affect one-third patients with Crohn’s disease (CD) with limited therapeutic options. There is dearth of literature on safety and efficacy of bone marrow-derived mesenchymal stromal cells (BMSCs) in this population.

Methods
An open-label, phase I/II, single-arm study was conducted involving local administration of human allogeneic bone marrow-derived mesenchymal stromal cells in perianal fistula of patients with Crohn’s disease refractory to standard therapies. Clinical severity and biomarkers were assessed at baseline and periodically until week 104 , and MRI at week 24 and 104. Primary and secondary objectives were to assess safety and efficacy respectively. Fistula remission was complete closure of fistula openings with < 2 cm perianal collection on MRI, and fistula response was decrease in drainage by ≥ 50%. Change in perianal disease activity index, quality-of-life and Van Assche index on MRI over time was assessed using mixed-effect linear regression model.

Results
Ten patients (male:8, mean age:27.4 ± 12.0years) were recruited. Self-resolving procedure-related adverse events occurred in three patients, with no follow-up adverse events. In intention to treat analysis at week 24, two patients (20%) achieved fistula remission and seven (70%) had fistula response. At week 52, two (20%) patients were in remission and seven (70%) maintained response. At 104 weeks, two (20%) patients maintained response and one (10%) was in remission. Statistically significant decrease in perianal disease activity index (P = 0.008), Van Assche Index (P = 0.008) and improvement in quality-of-life (P = 0.001) were observed over time.

Conclusions
Allogeneic BMSCs are safe and effective for the treatment of perianal fistulizing CD with significant improvement in clinical severity and radiological healing.

Trial registration
The study was prospectively registered on Clinical trials registry – India (CTRI), CTRI/2020/01/022743 on 14 January 2020, http://ctri.nic.in.
A bizarre synthesized cascaded optimized predictor (BizSCOP) model for enhancing security in cloud systems
Authors: Menezes R. Julian , Jayarin P. Jesu , Sekar A. Chandra 
Published: May 2024

AbstractDue to growing network data dissemination in cloud, the elasticity, pay as you go options, globally accessible facilities, and security of networks have become increasingly important in today's world. Cloud service providers, including AWS, Azure, GCP, and others, facilitate worldwide expansion within minutes by offering decentralized communication network functions, hence providing security to cloud is still remains a challenging task. This paper aims to introduce and evaluate the Biz-SCOP model, a novel intrusion detection system developed for cloud security. The research addresses the pressing need for effective intrusion detection in cloud environments by combining hybrid optimization techniques and advanced deep learning methodologies. The study employs prominent intrusion datasets, including CSE-CIC-IDS 2018, CIC-IDS 2017, and a cloud intrusion dataset, to assess the proposed model's performance. The study's design involves implementing the Biz-SCOP model using Matlab 2019 software on a Windows 10 OS platform, utilizing 8 GB RAM and an Intel core i3 processor. The hybrid optimization approach, termed HyPSM, is employed for feature selection, enhancing the model's efficiency. Additionally, an intelligent deep learning model, C2AE, is introduced to discern friendly and hostile communication, contributing to accurate intrusion detection. Key findings indicate that the Biz-SCOP model outperforms existing intrusion detection systems, achieving notable accuracy (99.8%), precision (99.7%), F1-score (99.8%), and GEO (99.9%). The model excels in identifying various attack types, as demonstrated by robust ROC analysis. Interpretations and conclusions emphasize the significance of hybrid optimization and advanced deep learning techniques in enhancing intrusion detection system performance. The proposed model exhibits lower computational load, reduced false positives, ease of implementation, and improved accuracy, positioning it as a promising solution for cloud security.
Improving alcohol and substance use screening in school-age children: translation, adaptation and psychometric evaluation of the CRAFFT tool for Lumasaaba, Uganda
Authors: Nalugya Joyce Sserunjogi , Engebretsen Ingunn Marie Stadskleiv , Nakasujja Noeline , Ndeezi Grace , Babirye Juliet N. , Bakken Victoria , Skar Ane-Marthe Solheim , Tumwine James K. , Skokauskas Norbert 
Published: May 2024

Abstract
Background
Children at risk of substance use disorders (SUD) should be detected using brief structured tools for early intervention. This study sought to translate and adapt the Car, Relax, Alone, Forget, Family/Friends, Trouble (CRAFFT) tool to determine its diagnostic accuracy, and the optimum cut-point to identify substance use disorders (SUD) risk in Ugandan children aged 6 to 13 years.

Methods
This was a sequential mixed-methods study conducted in two phases. In the first qualitative phase, in Kampala and Mbale, the clinician-administered CRAFFT tool version 2.1 was translated into the local Lumasaaba dialect and culturally adapted through focus group discussions (FGDs) and in-depth interviews, in collaboration with the tool’s authors. Expert reviews and translations by bilingual experts provided insights on linguistic comprehensibility and cultural appropriateness, while pilot testing with the target population evaluated the tool’s preliminary effectiveness. In the second phase, the CRAFFT tool, adapted to Lumasaaba, was quantitatively validated against the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) for diagnosing SUD in Mbale district, through a survey. Participants, chosen randomly from schools stratified according to ownership, location, and school size, were assessed for the tool’s reliability and validity, including comparisons to the MINI KID as the Gold Standard for diagnosing SUD. Data were analyzed using STATA-15. Receiver-operating-characteristic analysis was performed to determine the sensitivity, specificity, and criterion validity of the CRAFFT with the MINI-KID.

Results
Of the 470 children enrolled, 2.1% (n = 10) had missing data on key variables, leaving 460 for analysis. The median age and interquartile range (IQR) was 11 (9–12) years and 56.6% were girls. A total of 116 (25.2%) children had consumed alcohol in the last twelve-month period and 7 (1.5%) had used other substances. The mean CRAFFT score for all the children (n = 460) was 0.32 (SD 0.95). The prevalence of any alcohol use disorder (2 or more positive answers on the MINI KID) in the last 12 months was 7.2% (n = 32). The Lumasaaba version of the CRAFFT tool demonstrated good internal consistency (Cronbach’s α = 0.86) and inter-item correlation (Spearman correlation coefficient of 0.84 (p < 0.001). At a cut-off score of 1.00, the CRAFFT had optimal sensitivity (91%) and specificity (92%) (Area Under the Curve (AUC) 0.91; 95% CI 0.86–0.97) to screen for SUD. A total of 62 (13.5%) had CRAFFT scores of > 1.

Conclusion
The Lumasaaba version of the CRAFFT tool has sufficient sensitivity and specificity to identify school-age children at risk of SUD.
Application of improved DBN and GRU based on intelligent optimization algorithm in power load identification and prediction
Authors: Wu Jintao , Tang Xiling , Zhou Dongxu , Deng Wenyuan , Cai Qianqian 
Published: May 2024

AbstractNon intrusive load monitoring belongs to the key technologies of intelligent power management systems, playing a crucial role in smart grids. To achieve accurate identification and prediction of electricity load, intelligent optimization algorithms are introduced into deep learning optimization for improvement. A load recognition model combining sparrow search algorithm and deep confidence network is designed, as well as a gated recurrent network prediction model on the grounds of particle swarm optimization. The relevant results showed that the sparrow search algorithm used in the study performed well on the solution performance evaluation metrics with a minimum value of 0.209 for the inverse generation distance and a maximum value of 0.814 for the hyper-volume. The accuracy and recall values of the optimized load identification model designed in the study were relatively high. When the accuracy was 0.9, the recall rate could reach 0.94. The recognition accuracy of the model on the basis of the test set could reach up to 0.924. The lowest classification error was only 0.05. The maximum F1 value of the harmonic evaluation index of the bidirectional gated recurrent network optimized by particle swarm optimization converged to 90.06%. The loss function had been optimized by particle swarm optimization, and both the convergence value and convergence speed had been markedly enhanced. The average absolute error and root mean square error of the prediction model were both below 0.3. Compared to the bidirectional gated recurrent model before optimization, the particle swarm optimization strategy had a significant improvement effect on prediction details. In addition, the research method had superior recognition response speed and adaptability in real application environments. This study helps to understand the load demand of the power system, optimize the operation of the power grid, and strengthen the reliability, efficiency, and sustainability of the power system.
The Clock and Wavefront Self-Organizing model recreates the dynamics of mouse somitogenesis in vivo and in vitro
Authors: Klepstad Julie , Marcon Luciano 
Published: May 2024

ABSTRACT
During mouse development, presomitic mesoderm cells synchronize Wnt and Notch oscillations, creating sequential phase waves that pattern somites. Traditional somitogenesis models attribute phase waves to a global modulation of the oscillation frequency. However, increasing evidence suggests that they could arise in a self-organizing manner. Here, we introduce the Sevilletor, a novel reaction-diffusion system that serves as a framework to compare different somitogenesis patterning hypotheses. Using this framework, we propose the Clock and Wavefront Self-Organizing model that considers an excitable self-organizing region where phase waves form independent of global frequency gradients. The model recapitulates the change in relative phase of Wnt and Notch observed during mouse somitogenesis and provides a theoretical basis for understanding the excitability of mouse presomitic mesoderm cells in vitro.
Risk factors and comorbidities for psoriatic arthritis. Literature review
Authors: Pich-Czekierda Aleksandra , Kotowicz Zuzanna , Proszowska Patrycja , Orzeł Adrianna , Sieniawska Daria , Madoń Magda , Sieniawska Julia 
Published: May 2024

Introduction:
Psoriatic arthritis is a chronic disease involving peripheral arthritis, spondylitis, dactylitis (inflammation of the whole digit) and enthesitis. It is a disease equally prevalent in both genders. Psoriatic arthritis coexists with several conditions, including metabolic syndrome, obesity, cardiovascular disease, inflammatory bowel disease, and liver disease. The reciprocal effects of comorbidities with psoriatic arthritis are demonstrated by recent research. There are several risk factors associated with the condition that might hasten or worsen its symptoms.
Aim of the Study:
The purpose of this paper is to present a thorough analysis of the research that has been done on comorbidities and risk factors for psoriatic arthritis. With an emphasis on changeable elements that might impact the disease's progression, the goal is to illustrate the multifaceted nature of psoriatic arthritis. The intention is also to highlight comorbidities that need to be considered while treating a patient with the illness.
Materials and methods:
An analysis of papers available in PubMed and Google Scholar was performed using the following key words: psoriatic arthritis, psoriatic arthritis and lifestyle, psoriatic arthritis and comorbidities, psoriatic arthritis and cardiovascular risk, psoriatic arthritis and gastrointestinal diseases, psoriatic arthritis and physical activity, psoriatic arthritis and diet, psoriatic arthritis and alcohol, psoriatic arthritis and smoking.
Conclusions:
Psoriatic arthritis is a chronic disease that affects many areas of patients' lives. It is critical to consider the connections that exist between this illness and other comorbidities. In order to provide a patient with this ailment with the best care possible, variables that might exacerbate the illness's progression must also be taken into consideration. Patients' mental health should get particular attention, and lifestyle modifications should be promoted.