bluuebunny/crossref_metadata_2025_split huggingface dataset:
Relationship between perceived physical literacy and obesity-related outcomes in adolescents: the EHDLA study
Authors: Domínguez-Martín Gabriel , Tárraga-López Pedro J. , López-Gil José Francisco 
Published: April 2024

PurposeThe aim of the present study was to examine the relationship between perceived physical literacy and obesity-related outcomes among adolescents from Spain.MethodsThis is a secondary cross-sectional analysis including a total sample of 845 Spanish adolescents (55.3% girls) aged 12–17 years from the Valle de Ricote (Region of Murcia) from the Eating Healthy and Daily Life Activities (EHDLA) project. Physical literacy was evaluated using the Spanish Perceived Physical Literacy Instrument for adolescents (S-PPLI). Body mass index was computed by taking the participants’ body weight in kilograms and dividing it by the square of their height in meters, and body mass index (z score) and overweight/obesity and obesity were computed by the World Health Organization age- and sex-specific thresholds. Waist circumference was measured using a constant tension tape. Moreover, the waist-to-height ratio was calculated, and therefore, abdominal obesity was determined. Skinfold measurements were taken at the triceps and medial calf using calibrated steel calipers.ResultsIn general, the overall trend was downward (i.e., the higher the PPLI score the lower the obesity-related indicators), with the approximate significance of smooth terms being statistically significant for all models examined (p &lt; 0.001). Adolescents with lower perceived physical literacy (PPL) showed the highest estimated marginal means of body mass index, body mass index z score, waist circumference, waist-to-height ratio, and skinfold (triceps and calf) and predictive probabilities of having excess weight, obesity, and abdominal obesity, while their counterparts with high PPL had the lowest. In addition, significant differences were observed for all the obesity-related indications between adolescents with low PPL and those with medium PPL (p-adjusted &lt; 0.05 for all indicators), as well as with those with high PPL (p-adjusted &lt; 0.05 for all indicators). Moreover, these significant differences were also shown for most indicators between adolescents with medium PPL and those with high PPL (except for obesity).ConclusionPhysical literacy could play a crucial role in maintaining more desirable obesity-related outcomes in adolescents. Adolescents with high perceived physical literacy showed lower obesity-related indicators (i.e., body mass index, body mass index z score, waist circumference, waist-to-height ratio, skinfolds), as well as a lower probability of having excess weight, obesity, and abdominal obesity.
Epidemiology of antibiotic consumption and resistance in Mauritius
Authors: Veerapa-Mangroo Lovena Preeyadarshini , Rasamoelina-Andriamanivo Harena , Issack Mohammad Iqbal , Cardinale Eric 
Published: April 2024

IntroductionThis study aims at determining the pattern of antibiotic consumption and resistance in Mauritius, a tropical island in the Indian Ocean.MethodologyAntibiotic consumption was measured in kilograms of purchased antibiotics and also in defined daily dose (DDD) in different health institutions from 2015 to 2017. Data on antibiotic resistance was collected at the Central Health Laboratory (CHL) at Victoria Hospital and at Jeetoo Hospital Laboratory, where antibiotic sensitivity testing is done for all public health institutions. For this study, Escherichia coli, Klebsiella species, Acinetobacter species, and Pseudomonas aeruginosa isolates from blood samples of patients from 2015 to 2023 were included. The resistance rate and prevalence of multi-drug-resistant (MDR) organisms were calculated.ResultsThe amount of antibiotics (in kilograms) distributed to the human sector was between 11,000 to 13,000 kg, compared to only 700 to 1,500 kg in the animal sector. The DDD per 1,000 inhabitants per day was 20.9, 22.1, and 21.7 in 2015, 2016, and 2017, respectively, with a greater consumption of WATCH and RESERVE group antibiotics in the private sector. In public health institutions, health centers in the northern region had the highest DDD per 1,000 outpatients per day for beta-lactams penicillins and quinolones. Concerning antibiotic resistance, the proportion of MDR Acinetobacter baumannii and Pseudomonas aeruginosa has increased from 58% to 74% and from 33% to 45%, respectively, from 2015 to 2023. During the same period, the proportion of E. coli and K. pneumoniae isolates sensitive to ceftriaxone decreased from 55% to 39% and from 37% to 22%, respectively, while the proportion of E. coli, Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa isolates sensitive to meropenem decreased from 98% to 94%, 83% to 53%, 45% to 28%, and 63% to 47%, respectively.ConclusionThis study provides valuable insights on antibiotic consumption and resistance in the country and emphasizes the significance of adopting a One Health approach to combat antimicrobial resistance (AMR) effectively. These findings will aid policymakers in formulating targeted strategies to address the challenge of AMR and should be integrated into the National Action Plan on AMR in Mauritius.
Prevalence of co-occurring conditions among youths receiving treatment with primary anxiety, ADHD, or depressive disorder diagnoses
Authors: Ware Orrin D. , Zerden Lisa D. , Duron Jacquelynn F. , Xu Yanfeng , McCarthy Lauren P. , Verbiest Sarah , Afkinich Jenny , Brown Qiana , Williams Denise Yookong , Goings Trenette 
Published: April 2024

IntroductionAnxiety disorders, depressive disorders, and attention-deficit/hyperactivity disorder (ADHD) are some of the most common conditions that youths (&lt;18 years old) receive mental health treatment for. These conditions are associated with high-risk substance use or substance use disorders (SUDs). This study sought to identify the proportion of youths (&lt;18 years old) with anxiety disorders, depressive disorders, or ADHD as a primary diagnosis in community mental health centers (CMHCs) having co-occurring high-risk substance use or a SUD.MethodsAnalysis included binary logistic regression models using the Mental Health Client-Level Data 2017–2019 datasets which contains annual cross-sectional administrative data from mental health treatment facilities. The final sample included n = 458,888 youths with an anxiety disorder as a primary diagnosis, n = 570,388 youths with a depressive disorder as a primary diagnosis, and n = 945,277 youths with ADHD as a primary diagnosis.ResultsIn the subsample with anxiety as a primary diagnosis, approximately 5% of youth had high-risk substance use or a SUD. Approximately 10% of youth with depression as a primary diagnosis had high-risk substance use or a SUD. Among youth with ADHD as a primary diagnosis, 5% had high-risk substance use or a SUD. Odds of having a co-occurring high-risk substance use or SUD differed based on the youth’s age, race and ethnicity, gender, and other mental health diagnoses.ConclusionsEffective care for this high-need youth population at CMHCs will require mental health clinicians to possess knowledge and skills related to substance use treatment.
Validity and reliability of the 2-min step test in individuals with stroke and lower-limb musculoskeletal disorders
Authors: Ishigaki Tomoya , Kubo Hiroki , Yoshida Keishi , Shimizu Natsuki , Ogawa Tatsuya 
Published: April 2024

IntroductionWe investigated the reliability and validity of the 2-min step test (2MST) for assessing the exercise endurance of individuals with stroke and lower-limb musculoskeletal disorders.Participants and methodsThe participants were 39 individuals with stroke and 42 with lower-limb musculoskeletal disorders (mainly hip fractures) from the convalescent rehabilitation wards of four hospitals. The concurrent validity and congruence between the 2MST and the 6-min walk test (6MWT) and construct validity by hypotheses testing, including mobility and lower limb muscle strength, were also confirmed. A subset of participants (stroke-group, n = 15; musculoskeletal-group, n = 19) underwent a retest 2MST for our evaluation of relative and absolute reliability using the intraclass correlation coefficient (ICC1,1) and Bland–Altman plot.ResultsBoth groups showed a moderate correlation between the 2MST and 6MWT (ρ = 0.55–0.60), but the congruence was not sufficient. The 6MWT was correlated with mobility in both groups and with muscle strength in the stroke group, whereas the 2MST did not show a significant correlation with mobility. The relative reliability was excellent in both groups (ICC1,1 &gt; 0.9). In terms of absolute reliability, the width of the limit of agreement was 18.8% for the stroke group and 15.4% for the musculoskeletal group, relative to their respective sample means of 2MST. A fixed bias was identified in the stroke group, in which step counts increased by 6.5 steps upon retesting.DiscussionOur analyses revealed that the 2MST is a valid and reliable tool for assessing the exercise endurance of individuals with stroke or lower-limb musculoskeletal disorders. However, it is necessary to validate the absolute reliability observed herein by using a larger sample size. In addition, when assessing the exercise endurance of individuals with stroke, it may be necessary to consider the potential bias of an increased step count during retesting.
Decentralized multi-agent reinforcement learning based on best-response policies
Authors: Gabler Volker , Wollherr Dirk 
Published: April 2024

Introduction: Multi-agent systems are an interdisciplinary research field that describes the concept of multiple decisive individuals interacting with a usually partially observable environment. Given the recent advances in single-agent reinforcement learning, multi-agent reinforcement learning (RL) has gained tremendous interest in recent years. Most research studies apply a fully centralized learning scheme to ease the transfer from the single-agent domain to multi-agent systems.Methods: In contrast, we claim that a decentralized learning scheme is preferable for applications in real-world scenarios as this allows deploying a learning algorithm on an individual robot rather than deploying the algorithm to a complete fleet of robots. Therefore, this article outlines a novel actor–critic (AC) approach tailored to cooperative MARL problems in sparsely rewarded domains. Our approach decouples the MARL problem into a set of distributed agents that model the other agents as responsive entities. In particular, we propose using two separate critics per agent to distinguish between the joint task reward and agent-based costs as commonly applied within multi-robot planning. On one hand, the agent-based critic intends to decrease agent-specific costs. On the other hand, each agent intends to optimize the joint team reward based on the joint task critic. As this critic still depends on the joint action of all agents, we outline two suitable behavior models based on Stackelberg games: a game against nature and a dyadic game against each agent. Following these behavior models, our algorithm allows fully decentralized execution and training.Results and Discussion: We evaluate our presented method using the proposed behavior models within a sparsely rewarded simulated multi-agent environment. Although our approach already outperforms the state-of-the-art learners, we conclude this article by outlining possible extensions of our algorithm that future research may build upon.
Model-based trajectory tracking of a compliant continuum robot
Authors: Pekris Solomon , Williams Robert D. , Atkins Thibaud , Georgilas Ioannis , Bailey Nicola 
Published: April 2024

Introduction: Compliant mechanisms, especially continuum robots, are becoming integral to advancements in minimally invasive surgery due to their ability to autonomously navigate natural pathways, significantly reducing collision severity. A major challenge lies in developing an effective control strategy to accurately reflect their behavior for enhanced operational precision.Methods: This study examines the trajectory tracking capabilities of a tendon-driven continuum robot at its tip. We introduce a novel feedforward control methodology that leverages a mathematical model based on Cosserat rod theory. To mitigate the computational challenges inherent in such models, we implement an implicit time discretization strategy. This approach simplifies the governing equations into space-domain ordinary differential equations, facilitating real-time computational efficiency. The control strategy is devised to enable the robot tip to follow a dynamically prescribed trajectory in two dimensions.Results: The efficacy of the proposed control method was validated through experimental tests on six different demand trajectories, with a motion capture system employed to assess positional accuracy. The findings indicate that the robot can track trajectories with an accuracy within 9.5%, showcasing consistent repeatability across different runs.Discussion: The results from this study mark a significant step towards establishing an efficient and precise control methodology for compliant continuum robots. The demonstrated accuracy and repeatability of the control approach significantly enhance the potential of these robots in minimally invasive surgical applications, paving the way for further research and development in this field.
Case Report: The molecular fingerprint and the clinical implication of an exceptional response to neoadjuvant therapy in a metastatic cardia adenocarcinoma
Authors: Lorenzon Laura , Campisi Andrea , Di Paolo Alessandra , Giuliante Felice , Buttitta Fiamma , D’Ugo Domenico 
Published: April 2024

BackgroundGlobally, gastric cancer holds the fifth position in terms of prevalence among malignant tumors and is the fourth leading cause of cancer-related mortality. Particular attention should be paid to cardia adenocarcinoma (CA) due to its increasing incidence and poor prognosis. Diagnosis of CA frequently occurs in advanced stages because of its late symptoms. In such cases, neoadjuvant chemotherapy is the primary treatment option. The response to chemotherapy depends on multiple variables including the tumor's molecular profile, the patient's performance status, and the feasibility of using targeted therapy. Patients exhibiting an exceptional response, defined as a complete response to medical therapy lasting more than 1 year, or a partial response or stable disease lasting more than 2 years, are rarely described. This case report presents one of the longest-lasting exceptional responses to chemotherapy in metastatic cardia adenocarcinoma and discusses its clinical implications.Case presentationA 49-year-old male patient presented with cardia adenocarcinoma (human epidermal growth factor receptor 2 negative, mismatch repair proficient) and liver metastases. Molecular profiling identified a pathogenic mutation in the TP53 gene (R123W; Arg123Trp) as the sole alteration found. Five months after initiating the neoadjuvant chemotherapy with fluorouracil–leucovorin–oxaliplatin–docetaxel, the patient achieved a complete clinical response. The molecular profile was compared with others previously documented in an international data portal, revealing a similar pattern. At 4 years and 3 months from diagnosis, the exceptional response was still confirmed. The patient underwent a cumulative number of 33 cycles of chemotherapy, leading to chemotherapy-induced liver damage.ConclusionsExceptional responses to neoadjuvant chemotherapy in cardia adenocarcinomas are rarely reported. The documentation of exceptional responses to cancer therapies should be included in large data repositories to explore the molecular fingerprint of these tumors. In such cases, the clinical implications of long-term chemotherapy should always be taken into account.
Navigating The Storm: ASEAN's Strategy Amidst Two Major Powers
Authors: Sekar Ayu Galuh Anissa 
Published: April 2024

This study aims to analyze ASEAN's stance and approach, particularly in managing confrontational politics amidst major power competition, this article will also demonstrate ASEAN's attitudes and policies in navigating confrontational politics, including how ASEAN leverages its regional community norms to respond to such competition. Through this exploration, the author seeks to delve into the role and theoretical implications of ASEAN as a regional actor grappling with the management of political competition in the rapidly evolving East Asian and Indo-Pacific regionalism. The author used an impartial enmeshment concept and a descriptive qualitative method. The results showed that the intense geostrategic competition between China and the United States has placed ASEAN in a dilemma. ASEAN strives to maintain its centrality in the region by fostering fair, impartial, and neutral cooperation relationships. ASEAN bases its approach on the norms and principles of the organization, such as transparency, openness, inclusivity, good conflict management, and the importance of sovereignty and non-intervention (ASEAN Way). The ASEAN Outlook on the Indo-Pacific (AOIP) is one policy that reflects ASEAN's efforts to build a new framework of cooperation based on its own rule in the region. However, this Southeast Asia organization faces several challenges that can threaten its position.
Keywords— ASEAN, Indo-Pacific, Impartial, Enmeshment, Geostrategies
Kerjasama Negara-Negara APEC dalam Mengatasi Ketimpangan Infrastruktur untuk Mencapai Pembangunan Internasional Pasca Pandemi Covid-19
Authors: Nugroho Naufal Hilmi , Aulia Shafira , Dewantoro Ridlo Bayu Alam , Sari Deasy Silvya , Heryadi R Dudy 
Published: April 2024

Selama pandemi COVID-19, negara-negara anggota APEC menghadapi tantangan besar dalam mencapai tujuan pembangunan infrastruktur dikarenakan pandemi COVID-19 yang berdampak pada berbagai aspek kehidupan masyarakat dan ekonomi, sehingga mereka mencari jalan keluar untuk isu ini. Artikel ini akan menggunakan teori Kerjasama Internasional, Pembangunan Internasional, dan Dependensi. Isu akan dibahas melalui metode penelitian kualitatif dan analisis sumber data sekunder. Dalam mengatasi hal tersebut, APEC melaksanakan kelanjutan dari APEC Putrajaya Vision 2040, Experience Exchange, dan Belt Road Initiative. Kerja sama yang dilakukan menghasilkan bantuan fasilitas kerjasama ekonomi dan integrasi regional. Meski begitu, kerja sama yang dilakukan sebenarnya telah direncanakan bahkan sebelum pandemi COVID-19 dan hanya dilakukan dengan lebih giat untuk mengatasi dampak pandemi COVID-19 yang hadir.
Kata kunci—APEC, Ketimpangan infrastruktur, Pembangunan internasional
Influência da rede de apoio social na promoção do aleitamento materno: percepção das nutrizes
Authors: Carvalho Maria Eduarda Santos , Diniz Luciana Pessoa Maciel , Silva Jamylle Brenda Araújo da , Santos Nadja Maria dos , Pereira Vanessa Cardoso 
Published: April 2024

Objetivo: Compreender a percepção de nutrizes acerca da influência da rede de apoio social na promoção do aleitamento materno. Método: Trata-se de um estudo descritivo com abordagem qualitativa, tendo como participantes as mães atendidas na Estratégia Saúde da Família. Para coleta de dados foi utilizada como técnica, a entrevista semiestruturada. Participaram da pesquisa 18 nutrizes que foram incluídas a partir dos critérios: ter filho de até 6 meses, estando em amamentação ou não, e ter realizado o pré-natal adequado. Resultados: A análise do material coletado permitiu o surgimento de 3 categorias: A amamentação: miscelânia de sentimentos e cultura; A rede de apoio familiar: desafios, dificuldades e limites; O papel da enfermagem dentro da rede de apoio e do sucesso da amamentação. Considerações finais: Demonstrou que as participantes, em sua maioria, não receberam uma orientação sobre amamentação durante o pré-natal, o que pode muitas vezes desestimular o processo após o parto.
Saúde da mulher e o uso de plantas medicinais e fitoterápicos: visão de usuárias e profissionais da Atenção Primária à Saúde de Mossoró/RN, Brasil
Authors: Costa Sabrina Santos Lourenço da , Queiroz Jônata Melo de , Brito Teresinha Silva de 
Published: April 2024

O estudo objetiva avaliar o uso, conhecimento e perfil de prescrição de plantas medicinais e fitoterápicos como intervenção em saúde da mulher por usuárias e profissionais da Atenção Primária à Saúde de Mossoró/RN. Os dados foram coletados, entre dezembro de 2021 e fevereiro de 2022, através da aplicação de questionários semiestruturados a 100 usuárias e 19 profissionais. Constatou-se que 74% das usuárias fazem uso de plantas medicinais e 54% as utilizam para enfermidades femininas. Foram citadas 21 espécies para saúde feminina, indicadas principalmente para infecção, inflamação, cólicas menstruais e cicatrização. A maioria está em concordância com o uso indicado na literatura, contudo, evidenciaram-se potenciais riscos, como uso de espécies contraindicadas na gestação e de garrafadas. Ameixa (Ximenia americana) foi a espécie mais citada e jucá (Caesalpinia ferrea) a de maior valor de uso. Apenas 26,2% dos profissionais tiveram disciplinas específicas de fitoterapia na graduação, contudo, 78,9% afirmaram prescrever plantas medicinais e fitoterápicos. Para prescrição, apenas 26,3% e 5,3% dos profissionais utilizam o Memento Fitoterápico e o Formulário de Fitoterápicos da Farmacopeia Brasileira, respectivamente. Plantas medicinais desempenham importante papel no tratamento de afecções femininas, todavia, evidenciam-se falhas no conhecimento sobre fitoterapia e a necessidade de qualificação profissional para seu uso seguro.
THE FIRST STEPS TOWARDS STRATEGIC ALLIANCE IN AZERBAIJANI-TURKISH RELATIONS BEFORE THE SECOND KARABAKH WAR
Authors: Yusibova Gunel 
Published: April 2024

Azerbaijan and Turkey are historically linked by many common cultural, linguistic and religious ties, which creates the basis for the development of strategic allied relations between these two countries. After President Ilham Aliyev came to power in 2003, relations between Azerbaijan and Turkey continued to strengthen, and both sides expressed interest in a deeper strategic partnership. In this article, we will consider the first steps towards strategic alliance in Azerbaijani-Turkish relations during the reign of Ilham Aliyev, especially in the context before the Second Karabakh War.
To analyze the first steps towards strategic alliance between Azerbaijan and Turkey during the reign of Ilham Aliyev, a comprehensive analysis of official statements, political documents and treaties, as well as acts of foreign policy of both countries was carried out. Data from studies and analytical reviews published in various scientific journals and reputable analytical publications were also used.
The purpose of this study is to identify the first steps taken by Azerbaijan and Turkey towards deepening strategic alliance during the reign of Ilham Aliyev before the Second Karabakh War. We strive to analyze the main stages and factors that contributed to the formation of closer ties between these two States.
During the reign of Ilham Aliyev, a number of events and political initiatives aimed at deepening strategic relations with Turkey were initiated in Azerbaijan. This included increased military cooperation, the signing of agreements on security and mutual support, as well as agreements on cooperation in the field of energy and transport. Azerbaijan's support of Turkey in various international issues also played a key role in strengthening diplomatic ties.
The first steps towards strategic alliance between Azerbaijan and Turkey during the reign of Ilham Aliyev turned out to be an important stage in the development of relations between these two states. The deepening of cooperation in various fields, including military, political, economic and cultural, contributed to the strengthening of mutual understanding and trust between Azerbaijan and Turkey. This process had a significant impact on the further development of relations and played a key role in the formation of a strategic alliance, which turned out to be especially important in the context of the Second Karabakh War and subsequent events.