bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of musculoskeletal pain and associated factors among professional orchestra musicians in Norway
Authors: Eliassen Irem , Trouli Hara , Steder Frank Brundtland 
Published: June 2024

Background: Orchestra musicians have a high risk of experiencing musculoskeletal problems. These problems may lead to sleep and psychological disturbance. Objectives: This study investigated the occurrence of musculoskeletal pain (MSP) among orchestra musicians and the coherence between pain and predictors such as gender, age and instrument. Further, the impact of pain on sleep and mental health was analysed to assess pain as a predictor threatening musicians’ wellbeing. Methods: Some 358 musicians in eight different professional orchestras in Norway completed a questionnaire. Questions about pain experienced within the last 30 days were based on a national survey. Standardised screening tools like the Hopkins Symptom Checklist-25 (HSCL-25) and Bergen Insomnia Scale (BIS) were used to assess psychological distress and sleeping problems. Kruskal–Wallis tests were used to analyse the differences in the pain-related variables: experienced pain severity (EPS), number of pain areas, and work being perceived as the source of pain based on age. Mann–Whitney U tests were conducted to evaluate the statistical significance between gender and the pain-related variables. Spearman’s rank correlations were used to examine the relationship between EPS and BIS, HSCL-25 and pain area. Additionally, simple linear regression models were employed to determine whether EPS can predict higher scores on the HSCL-25 and BIS scales. Results: The prevalence of MSP experienced in the last 30 days among orchestra musicians in Norway was 85%. Musicians experienced frequent pain regardless of their gender, age or instrument group. Neck, shoulders and upper back represented the most reported pain areas. Further, it was observed that increased EPS was correlated with an increase in the number of pain areas and in work being perceived as the source of pain. EPS significantly predicted sleep- and psychological distress. Conclusions: Orchestra musicians have a high risk of encountering MSP. Furthermore, their psychological distress and sleeping problems seem to be related to experienced MSP. To deliver optimal health, these problems should be handled simultaneously.
The correlations between angiopoietin like 8 and cardiometabolic risk factors in Saudi women with type 2 diabetes mellitus: A pilot study
Authors: Mohammedsaeed Walaa , Binjawhar Dalal 
Published: June 2024

Purpose This study examines whether Angiopoietin Like 8 (ANGPTL8) is linked to cardiometabolic risk factors (CMRFs) in Saudi women with type 2 diabetes (T2DM). Methods Case-control investigation compared 150 women aged 30–60 with T2DM to 140 healthy women of the same age and gender. Results ANGPTL8 levels differed significantly between T2DM and non-diabetics. Fasting blood glucose (FBG), insulin resistance (IR), triglycerides (TG), high-sensitivity C-reactive protein (hs-CRP), body mass index (BMI), and atherogenic index (AIP) of plasma all correlated positively with ANGPTL8 concentrations. Insulin levels correlated negatively with ANGPTL8. Multiple linear regression models showed that elevated ANGPTL8 independently predicted higher FBG, hs-CRP, IR, TG, and AIP in T2DM patients. Conclusion The study found a significant association between ANGPTL8 levels and IR, hs-CRP, TG, AIP, and BMI in women with T2DM. These components are classified as CMRFs and have the potential to contribute to the development of cardiovascular disease (CVD).
Comparison of Doses to Parotid, Temporomandibular Joint, and Pharyngeal Constrictor Muscles Using Different Techniques in Radiotherapy for Oropharyngeal Cancer
Authors: Yamic Ferda , Koca Timur , Tuncel Nina , Aksoy Rahmi Atil , Korcum Aylin Fidan 
Published: June 2024

Objective The purpose of this research was to compare two treatment techniques for oropharyngeal cancers: conventional linac-based static intensity-modulated radiotherapy (sIMRT) and helical tomotherapy (HT). The study examined several parameters, including target coverage, organs at risk, integral dose, and beam on time. Additionally, the study evaluated the doses to the parotid, temporomandibular joint, and pharyngeal constrictor muscles, which are important for swallowing. Method The present study retrospectively analyzed the data of 13 patients with oropharyngeal cancer who underwent radiotherapy between 2019 and 2021. The treatment plans for each patient were regenerated using both sIMRT and HT treatment planning systems with the sequential boost method. The techniques were evaluated and compared based on dose-volume histogram, homogeneity index, and conformity index parameters. The target coverage and organs at risk were statistically compared for two techniques. Additionally, the doses received by the healthy tissue volume were obtained for integral dose evaluation. The beam on time for each technique was assessed. Results When considering planning target volume evaluation, there was no difference in Dmeans between the two techniques and sIMRT demonstrated higher D2% values compared to the HT. The HT technique had better results for all organs at risk, such as the parotid, temporomandibular joint, and pharyngeal constrictor muscle. As for integral dose, it has been shown that the sIMRT technique provides better protection compared to HT. In addition, the beam on time was also longer with the HT technique. Conclusion Both techniques may provide optimal target coverage for patients with oropharyngeal cancer. HT conferred notable advantages, especially with regard to critical structures implicated in swallowing, such as the parotid, temporomandibular joint, and pharyngeal constrictor muscle, in comparison to sIMRT.
A Novel Video-Based Methodology for Automated Classification of Dystonia and Choreoathetosis in Dyskinetic Cerebral Palsy During a Lower Extremity Task
Authors: Haberfehlner Helga , Roth Zachary , Vanmechelen Inti , Buizer Annemieke I. , Jeroen Vermeulen Roland , Koy Anne , Aerts Jean-Marie , Hallez Hans , Monbaliu Elegast 
Published: June 2024

Background Movement disorders in children and adolescents with dyskinetic cerebral palsy (CP) are commonly assessed from video recordings, however scoring is time-consuming and expert knowledge is required for an appropriate assessment. Objective To explore a machine learning approach for automated classification of amplitude and duration of distal leg dystonia and choreoathetosis within short video sequences. Methods Available videos of a heel-toe tapping task were preprocessed to optimize key point extraction using markerless motion analysis. Postprocessed key point data were passed to a time series classification ensemble algorithm to classify dystonia and choreoathetosis duration and amplitude classes (scores 0, 1, 2, 3, and 4), respectively. As ground truth clinical scoring of dystonia and choreoathetosis by the Dyskinesia Impairment Scale was used. Multiclass performance metrics as well as metrics for summarized scores: absence (score 0) and presence (score 1-4) were determined. Results Thirty-three participants were included: 29 with dyskinetic CP and 4 typically developing, age 14 years:6 months ± 5 years:15 months. The multiclass accuracy results for dystonia were 77% for duration and 68% for amplitude; for choreoathetosis 30% for duration and 38% for amplitude. The metrics for score 0 versus score 1 to 4 revealed an accuracy of 81% for dystonia duration, 77% for dystonia amplitude, 53% for choreoathetosis duration and amplitude. Conclusions This methodology study yielded encouraging results in distinguishing between presence and absence of dystonia, but not for choreoathetosis. A larger dataset is required for models to accurately represent distinct classes/scores. This study presents a novel methodology of automated assessment of movement disorders solely from video data.
How to improve epidemiological trustworthiness concerning abdominal aortic aneurysms
Authors: Zecca Fabio , Faa Gavino , Sanfilippo Roberto , Saba Luca 
Published: June 2024

BackgroundResearch on degenerative abdominal aortic aneurysms (AAA) is hampered by complex pathophysiology, sub-optimal pre-clinical models, and lack of effective medical therapies. In addition, trustworthiness of existing epidemiological data is impaired by elements of ambiguity, inaccuracy, and inconsistency. Our aim is to foster debate concerning the trustworthiness of AAA epidemiological data and to discuss potential solutions.MethodsWe searched the literature from the last five decades for relevant epidemiological data concerning AAA development, rupture, and repair. We then discussed the main issues burdening existing AAA epidemiological figures and proposed suggestions potentially beneficial to AAA diagnosis, prognostication, and management.ResultsRecent data suggest a heterogeneous scenario concerning AAA epidemiology with rates markedly varying by country and study cohorts. Overall, AAA prevalence seems to be decreasing worldwide while mortality is apparently increasing regardless of recent improvements in aortic-repair techniques. Prevalence and mortality are decreasing in high-income countries, whereas low-income countries show an increase in both. However, several pieces of information are missing or outdated, thus systematic renewal is necessary. Current AAA definition and surgical criteria do not consider inter-individual variability of baseline aortic size, further decreasing their reliability.ConclusionsSwitching from flat aortic-size thresholds to relative aortic indices would improve epidemiological trustworthiness regarding AAAs. Aortometry standardization focusing on simplicity, univocity, and accuracy is crucial. A patient-tailored approach integrating clinical data, multi-adjusted indices, and imaging parameters is desirable. Several novel imaging modalities boast promising profiles for investigating the aortic wall. New contrast agents, computational analyses, and artificial intelligence-powered software could provide further improvements.
Enhancing client engagement and alleviating period product insecurity: A cross-sectional study of community-based period supply banks’ distribution of free period products through intermediary partner agencies in the United States
Authors: Massengale Kelley EC , Comer Lynn H , Bowman Kelsey M , Van Ness Susan 
Published: June 2024

Background: Period products like pads, tampons, and a variety of disposable and reusable hygiene supplies constitute just one facet essential for effectively managing menstruation in a way that allows an individual to feel comfortable carrying out their daily routine. Given the absence of comprehensive public policies ensuring access to period products for economically disadvantaged menstruating individuals, community-based basic needs banks, particularly period supply banks, were established to alleviate the challenges faced by those experiencing period product insecurity. These initiatives specifically aim to furnish essential menstrual products to individuals in need. Objectives: This study aimed to assess any organizational benefits experienced by community-based organizations distributing period products on behalf of period supply banks. Design: This cross-sectional study is a formative evaluation of the distribution of free period products by period supply banks, which provide access to essential menstrual hygiene products for individuals in need through partnership with community-based partner agencies. Methods: Staff members at agencies distributing period products were invited to complete an anonymous web-based survey at two different time points about their agency’s experiences distributing free period products. All participants provided informed consent via the web-based survey. Results: Agency staff reported that since they started providing period products, clients were more likely to: start a conversation about other needs (66.7%), extend the length of their relationship with the agency (60.0%), keep scheduled appointments (62.1%), ask for assistance with another need (75.0%), communicate between visits (42.4%), participate in other agency programming (55.9%), and seek other agency services (73.5%). Due to a shortage of period products, 41% of agencies have had to turn away clients needing period supplies. Conclusion: Period supply banks, in collaboration with community-based partner agencies, enhance access to both menstrual products and the associated support, fostering engagement with diverse resources and opportunities among recipients. However, addressing unmet needs necessitates policies and additional funding to ensure universal access to essential hygiene supplies for everyone to thrive and actively participate in society.
Endoscopic resection for esophageal gastrointestinal stromal tumors: a multi-center feasibility study
Authors: Lian Jingjing , Ji Yingjie , Chen Tao , Wang Guoxiang , Wang Mizhu , Li Shengxi , Cao Jia , Shen Li , Lu Wei , Xu Meidong 
Published: June 2024

Background: Esophageal gastrointestinal stromal tumors (E-GISTs) are highly uncommon and have not been thoroughly examined. Objectives: The objective of this multi-center study was to assess the viability of endoscopic resection (ER) in the treatment of E-GISTs and to explore its clinical implications. Design: This was a multi-center retrospective study. Consecutive patients referred to the four participating centers. Methods: E-GISTs among the consecutive subepithelial tumors (SETs) treated by ER methods were enrolled from April 2019 to August 2022. Clinicopathological, endoscopic, and follow-up data were collected and analyzed. Results: A total of 23 patients with E-GISTs were included for analysis, accounting for 1.9% of all the esophageal SETs (1243 patients). The average size of the tumor lesions was 2.3 cm (range 1.0–4.0 cm). We observed that tumors larger than 2.0 cm were more likely to grow deeper, with a statistically significant difference ( p < 0.001). End bloc resection was achieved in all 23 patients. The mean operation time was 53.6 min (range 25–111 min). One patient experienced significant intraoperative bleeding, which was promptly managed endoscopically without necessitating surgery. The average hospital stay was 4.5 days (range 3–8 days). The overall median follow-up period was 31 months (range 13–47 months). No tumor recurrence, residual tumor, distal metastasis, or death was observed during the follow-up period. Conclusion: Based on our limited data, our study indicates that ER may be a feasible and effective option for treating esophageal GISTs measuring 4 cm or less. We suggest submucosal tunnel endoscopic resection as the preferred approach, as all E-GISTs in our study were situated in the muscularis propria layer. Additionally, tumors larger than 2 cm were more prone to deeper growth or extraluminal extension.
Effects of virtual reality on anxiety and pain in adult patients undergoing wound-closure procedures: A pilot randomized controlled trial
Authors: Ko SY , Wong Eliza ML , Ngan TL , Leung HK , Kwok Kennis TY , Tam HF , Chan CC 
Published: June 2024

Background In emergency departments, suturing is a typical procedure for closing lacerated wounds but is invasive and often causes anxiety and pain. Virtual reality (VR) intervention has been reported as a relaxing measure. Objective The study aims to examine the effects of VR intervention on anxiety, pain, physiological parameters, local anesthesia requirements and satisfaction in Chinese adult patients undergoing wound closure in emergency departments in Hong Kong. Methods Adult patients who had lacerated wounds and were undergoing wound closure by suturing can communicate in Chinese and were hemodynamically stable were invited for this trial. Eighty patients were randomly assigned to the VR group, which received VR intervention and standard care, or to the control group, which received standard care only. The primary outcome was anxiety, and the secondary outcomes included pain, blood pressure, pulse rate, satisfactory with pain management, service satisfactory, and extra local analgesia requirement. Outcomes were conducted at baseline, during the procedure and 5 min after the procedure. Results The VR group had a significantly greater reduction in anxiety ( p < 0.001), pain ( p < 0.001), systolic blood pressure ( p < 0.001), diastolic blood pressure ( p < 0.001), pulse rate ( p = 0.003) and requested less amount of additional local anesthesia ( p = 0.025). The satisfactory level with pain management ( p = 0.019) and service ( p = 0.002) were significantly higher in participants who received VR intervention. In addition, most participants preferred to have VR in the future, and no major adverse events associated with the use of VR were reported. Conclusion This pilot study provides insight into the use of VR and the direction of future studies. It may effectively improve psychological and physiological outcomes in adult patients during wound-closure procedures in emergency departments.
Proposal for A Set of Standards and Indicators for JCI, SKS, and HIMSS EMRAM Quality Assessment Models
Authors: Cece Sinem , Köse İlker 
Published: June 2024

Objective The Joint Commission International (JCI) and the Health Information Management System Society (HIMSS) are global accreditation groups for healthcare. JCI focuses on overall care quality, while HIMSS-Electronic Medical Record Adoption Model (EMRAM) looks at digital processes. Meanwhile, the Health Quality Standards (SKS) is Turkey's own system. It aligns with JCI and evaluates healthcare similarly. When a health institution wants to be accredited with one of these models, similar scope, process and criteria are repeatedly reviewed from different perspectives. However, it is not known whether the scope, process and criteria included in these models are related to the postmodern management approach (PMMA), which is one of today's business approaches. It is observed that today's businesses are dominated by PMMAs. Similarly, healthcare organizations are also influenced by PMMAs since they are qualified as businesses. Methods This study investigated the compatibility of the concepts, processes and criteria covered by SKS, JCI and HIMSS-EMRAM models with PMMAs. Using the Delphi technique, PMMAs were explained to subject-matter experts (SMEs) in the form of written texts delivered. SMEs evaluated whether the standards/criteria are compatible with PMMAs. During this evaluation, they examined whether the standard/criteria included in the relevant model are directly or indirectly indicative of these approaches. SMEs developed their standards/criteria for the approaches which no standards/criteria could be matched with. The binary pairwise comparison method was used to determine the weighted value of the proposed standards/criteria. Results SMEs proposed a total of 24 standards and 18 indicators for nine postmodern organizational management approaches. Conclusion The literature presented a proposal for new standards and indicators. They would be unique. They would address how well these three models fit the PMMA.
Automated facial recognition system using deep learning for pain assessment in adults with cerebral palsy
Authors: Sabater-Gárriz Álvaro , Gaya-Morey F Xavier , Buades-Rubio José María , Manresa-Yee Cristina , Montoya Pedro , Riquelme Inmaculada 
Published: June 2024

Objective Assessing pain in individuals with neurological conditions like cerebral palsy is challenging due to limited self-reporting and expression abilities. Current methods lack sensitivity and specificity, underlining the need for a reliable evaluation protocol. An automated facial recognition system could revolutionize pain assessment for such patients. The research focuses on two primary goals: developing a dataset of facial pain expressions for individuals with cerebral palsy and creating a deep learning-based automated system for pain assessment tailored to this group. Methods The study trained ten neural networks using three pain image databases and a newly curated CP-PAIN Dataset of 109 images from cerebral palsy patients, classified by experts using the Facial Action Coding System. Results The InceptionV3 model demonstrated promising results, achieving 62.67% accuracy and a 61.12% F1 score on the CP-PAIN dataset. Explainable AI techniques confirmed the consistency of crucial features for pain identification across models. Conclusion The study underscores the potential of deep learning in developing reliable pain detection systems using facial recognition for individuals with communication impairments due to neurological conditions. A more extensive and diverse dataset could further enhance the models’ sensitivity to subtle pain expressions in cerebral palsy patients and possibly extend to other complex neurological disorders. This research marks a significant step toward more empathetic and accurate pain management for vulnerable populations.
Navigating moral and ethical dilemmas in digital transformation processes within healthcare organizations
Authors: Naamati-Schneider Lior , Arazi-Fadlon Mirit , Daphna-Tekoah Shir 
Published: June 2024

Objective Healthcare systems around the world face a turbulent and unstable global and local ecosystem that changes daily and impacts the healthcare organization and its workforce. This challenging environment, coupled with economic pressures, is forcing healthcare systems to change and adopt strategic and technological processes to adapt to change at all levels of the system (macro-holistic multi-systemic, mezzo-organizational, and micro-personal). Methods In this study, through 32 in-depth, semi-structured interviews with healthcare professionals working in public general hospitals in central Israel, we examined, mapped, and highlighted the conflicts and moral dilemmas they have faced in recent years, alongside the processes of strategic, technological, and digital changes that the healthcare system has undergone. Results The findings from both a categorical–deductive approach and an inductive approach analysis reveals four main themes: innovation paradox, quality and treatment conflict, information and knowledge conflict, and personal needs and values. The themes and sub-themes are sorted across the three levels of the healthcare system. Conclusions These findings represent a wide range of conflicts and moral dilemmas that arise from the implementation of strategic change and digital transformation, adding to the already numerous ethical issues and moral dilemmas in healthcare and bioethics that are associated with three levels of the system. These challenges and moral conflicts can be barriers to implementing the necessary changes, as well as challenging individuals’ internal values, potentially leading to burnout and moral distress. Given the importance of this issue and the intensification of change processes over the next few years, it is up to the management and key stakeholders to implement these processes in a way that addresses the conflicts and challenges that health professionals face. Minimizing the level of challenges and moral distress in the health sector will be to the benefit of the system, its workers, and the patients it serves.