bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adulterants present in the San Diego county fentanyl supply: a laboratory analysis of seized law enforcement samples
Authors: Galust Henrik , Seltzer Justin A. , Hardin Jeremy R. , Friedman Nathan A. , Salamat Jeff , Clark Richard F. , Harmon Jennifer 
Published: March 2024

Abstract
Background
The opioid overdose crisis is one of the worst public health crises ever to face the US and emerging evidence suggests its effects are compounded by the presence of drug adulterants. Here we report our efforts to characterize the adulterants present within the local fentanyl supply of San Diego County, obtained from undifferentiated drug samples seized by local law enforcement over the calendar year 2021.

Methods
Thirty-two participating local law enforcement agencies across San Diego submitted 4838 unknown individual illicit drug samples (total of 312 kg) to the San Diego County Sheriff’s Department Regional Crime Laboratory for identification.

Results
Qualitative analysis of these samples via FTIR and GC-MS identified methamphetamine (38.7%), fentanyl (20.8%), diacetylmorphine (heroin) (10.2%), codeine (5.8%) and alprazolam (4.3%) as the most common illicit substances and the presence of 52 unique adulterants. The most common adulterants included 4-methylaminoantipyrine (4-MAAP) (10.9%), mannitol (9%), acetaminophen (8.5%), methamphetamine (4.2%), diacetylmorphine (heroin) (3.6%), tramadol (1.9%), and xylazine (1.7%). Several additional pharmacologically active adulterants and contaminants of interest were also identified.

Conclusion
This analysis is vital for public health use and harm reduction efforts at the level of the individual consumer. Continued direct surveillance of the drug supply is necessary for the detection of potentially harmful adulterants that may pose serious threats to the public.
Impact of simulation-based training on bougie-assisted cricothyrotomy technique: a quasi-experimental study
Authors: Zhou Ying , Gao Huibin , Wang Qianyu , Zhi Juan , Liu Quanle , Xia Weipeng , Duan Qirui , Yang Dong 
Published: March 2024

Abstract
Background
Cricothyrotomy is a lifesaving surgical technique in critical airway events. However, a large proportion of anesthesiologists have little experience with cricothyrotomy due to its low incidence. This study aimed to develop a multisensory, readily available training curriculum for learning cricothyrotomy and evaluate its training effectiveness.

Methods
Seventy board-certificated anesthesiologists were recruited into the study. Participants first viewed an instructional video and observed an expert performing the bougie-assisted cricothyrotomy on a self-made simulator. They were tested before and after a one-hour practice on their cricothyrotomy skills and evaluated by a checklist and a global rating scale (GRS). Additionally, a questionnaire survey regarding participants’ confidence in performing cricothyrotomy was conducted during the training session.

Results
The duration to complete cricothyrotomy was decreased from the pretest (median = 85.0 s, IQR = 72.5–103.0 s) to the posttest (median = 59.0 s, IQR = 49.0–69.0 s). Furthermore, the median checklist score was increased significantly from the pretest (median = 30.0, IQR = 27.0-33.5) to the posttest (median = 37.0, IQR = 35.5–39.0), as well as the GRS score (pretest median = 22.5, IQR = 18.0–25.0, posttest median = 32.0, IQR = 31.0-33.5). Participants’ confidence levels in performing cricothyrotomy also improved after the curriculum.

Conclusion
The simulation-based training with a self-made simulator is effective for teaching anesthesiologists to perform cricothyrotomy.
Access to continuous professional development for capacity building among nurses and midwives providing emergency obstetric and neonatal care in Rwanda
Authors: Gakwerere Mathias , Ndayisenga Jean Pierre , Ngabonzima Anaclet , Uhawenimana Thiery Claudien , Yamuragiye Assumpta , Harindimana Florien , Rwabufigiri Bernard Ngabo 
Published: March 2024

Abstract
Background
Nurses and midwives are at the forefront of the provision of Emergency Obstetric and Neonatal Care (EmONC) and Continuous Professional Development (CPD) is crucial to provide them with competencies they need to provide quality services. This research aimed to assess uptake and accessibility of midwives and nurses to CPD and determine their knowledge and skills gaps in key competencies of EmONC to inform the CPD programming.

Methods
The study applied a quantitative, cross-sectional, and descriptive research methodology. Using a random selection, forty (40) health facilities (HFs) were selected out of 445 HFs that performed at least 20 deliveries per month from July 1st, 2020 to June 30th, 2021 in Rwanda. Questionnaires were used to collect data on updates of CPD, knowledge on EmONC and delivery methods to accessCPD. Data was analyzed using IBM SPSS statistics 27 software.

Results
Nurses and midwives are required by the Rwandan midwifery regulatory body to complete at least 60 CPD credits before license renewal. However, the study findings revealed that most health care providers (HCPs) have not been trained on EmONC after graduation from their formal education. Results indicated that HCPs who had acquired less than 60 CPD credits related to EmONC training were 79.9% overall, 56.3% in hospitals, 82.2% at health centres and 100% at the health post levels. This resulted in skills and knowledge gaps in management of Pre/Eclampsia, Postpartum Hemorrhage and essential newborn care. The most common method to access CPD credits included workshops (43.6%) and online training (34.5%). Majority of HCPs noted that it was difficult to achieve the required CPD credits (57.0%).

Conclusion
The findings from this study revealed a low uptake of critical EmONC training by nurses and midwives in the form of CPD. The study suggests a need to integrate EmONC into the health workforce capacity building plan at all levels and to make such training systematic and available in multiple and easily accessible formats.

Implication on nursing and midwifery policy
Findings will inform the revision of policies and strategies to improve CPD towards accelerating capacity for the reduction of preventable maternal and perinatal deaths as well as reducing maternal disabilities in Rwanda.
Barriers and facilitators to implementing a multilevel, multicomponent intervention promoting colorectal cancer screening in health centers: a qualitative study of key informant perspectives
Authors: Telles V. M. , Rodriguez S. , Torres M. , Schneider J. , Haughton J. , Maldonado M. , Arredondo E. 
Published: March 2024

Abstract
Background
Colorectal cancer (CRC) continues to be a major cause of death in the U.S. despite the availability of effective screening tools. U.S. Latinos have lower rates of CRC screening and higher rates of death due to colorectal disease compared to non-Hispanic whites. Federally Qualified Health Centers (FQHCs) serve medically underserved populations, including many Latino patients. Given the low CRC screening rates, identifying culturally sensitive and cost-effective methods of promoting screening is a priority for many FQHCs.

Methods
We interviewed FQHC leaders and providers using the Consolidated Framework for Implementation Research (CFIR) to identify barriers and facilitators to implementation of a multilevel, multicomponent (ML-MC) CRC screening intervention (i.e., promotor navigation and group-based education) in FQHCs. A rapid qualitative analysis approach was used to identify themes organized according to the following CFIR constructs: intervention characteristics, outer and inner settings, and characteristics of the individual.

Results
We completed interviews with 13 healthcare professionals in leadership positions at six FQHCs. The participating FQHCs perceived the ML-MC screening CRC program as feasible and expressed interest in implementing the program at their sites. Facilitators included financial incentives for increasing screening rates, the need for patient education programming, and involving promotores to support the work of clinical teams. Barriers included concerns about available resources to implement new programs, lack of federal reimbursement for health education, competing priorities of other health concerns, and the need for more resources for confirmatory screening and treatment following a positive screen.

Conclusions
FQHCs provide essential primary care to millions of underserved patients in the U.S. and have the ability and motivation to provide screenings for colorectal cancer. Partnering with an academic institution to deliver a group-based, promotor-led CRC screening intervention for patients not up to date with screening could help increase screening rates. By identifying the specific barriers and facilitators to implementing CRC intervention, findings suggest that group-based, promotor-led interventions are a promising approach.
Factors influencing the length of stay in forensic psychiatric settings: a systematic review
Authors: Dima Aikaterini , Wazir Adonis , Clark-Castillo Raquel , Zakopoulos Iordanis , Smith Shubulade , Gaughran Fiona 
Published: March 2024

Abstract
Background
Forensic psychiatry is often associated with long admissions and has a high cost of care. There is little known about factors influencing length of stay (LOS), and no previous systematic review has synthesised the available data. This paper aims to identify factors influencing the LOS in forensic psychiatry hospitals to inform care and interventions that may reduce the length of admissions.

Methodology
A systematic review was conducted by searching major databases, including PubMed, EMBASE and PsycInfo, from inception until May 2022. Observational studies conducted in forensic hospitals that examined associations between variables of interest and LOS were included. Following data extraction, the Newcastle‒Ottawa Scale was used for quality appraisal. No meta-analysis was conducted due to heterogeneity of information; a quantitative measure to assess the strength of evidence was developed and reported.

Results
A total of 28 studies met the inclusion criteria out of 1606 citations. A detailed quantitative synthesis was performed using robust criteria. Having committed homicide/attempted homicide, a criminal legal status with restrictions, and a diagnosis of schizophrenia-spectrum disorders were all associated with longer LOS. Higher Global Assessment of Functioning (GAF) scores were associated with a shorter LOS.

Conclusion
High-quality research examining factors associated with LOS in forensic psychiatry is lacking, and studies are heterogeneous. No modifiable characteristics were identified, and thus, practice recommendations were not made. There is an increasing necessity to understand the factors associated with longer admissions to inform care and increase success in reintegration and rehabilitation. This paper provides recommendations for future research.
Association between the ROX index and mortality in patients with acute hypoxemic respiratory failure: a retrospective cohort study
Authors: Liu Kai , Ma Xin-Yi , Xiao Hua , Gu Wan-Jie , Lyu Jun , Yin Hai-Yan 
Published: March 2024

Abstract
Background
Although ROX index is frequently used to assess the efficacy of high-flow nasal cannula treatment in acute hypoxemic respiratory failure (AHRF) patients, the relationship between the ROX index and the mortality remains unclear. Therefore, a retrospective cohort study was conducted to evaluate the ability of the ROX index to predict mortality risk in patients with AHRF.

Method
Patients diagnosed with AHRF were extracted from the MIMIC-IV database and divided into four groups based on the ROX index quartiles. The primary outcome was 28-day mortality, while in-hospital mortality and follow-up mortality were secondary outcomes. To investigate the association between ROX index and mortality in AHRF patients, restricted cubic spline curve and COX proportional risk regression were utilized.

Result
A non-linear association (L-shaped) has been observed between the ROX index and mortality rate. When the ROX index is below 8.28, there is a notable decline in the 28-day mortality risk of patients as the ROX index increases (HR per SD, 0.858 [95%CI 0.794–0.928] P < 0.001). When the ROX index is above 8.28, no significant association was found between the ROX index and 28-day mortality. In contrast to the Q1 group, the mortality rates in the Q2, Q3, and Q4 groups had a substantial reduction (Q1 vs. Q2: HR, 0.749 [0.590–0.950] P = 0.017; Q3: HR, 0.711 [0.558–0.906] P = 0.006; Q4: HR, 0.641 [0.495–0.830] P < 0.001).

Conclusion
The ROX index serves as a valuable predictor of mortality risk in adult patients with AHRF, and that a lower ROX index is substantially associated with an increase in mortality.
Efficacy of artesunate-amodiaquine for treatment of uncomplicated Plasmodium falciparum malaria in mainland Tanzania
Authors: Ngasala Billy , Bushukatale Samwel , Chiduo Mercy , Makene Twilumba , Mkony Lilian , Mohamed Ally , Molteni Fablizio , Chacky Frank , Njau Ritha J. A. , Mwaiswelo Richard 
Published: March 2024

Abstract
Background
Diversification of artemisinin-based combination therapy (ACT) is suggested as one of the strategies that can be used to contain artemisinin resistance. Artesunate-amodiaquine (ASAQ) is one of the artemisinin-based combinations that can be used in the diversification strategy as an alternative first-line treatment for uncomplicated malaria in mainland Tanzania. There is however limited data on the efficacy of ASAQ in mainland Tanzania. This study assessed the efficacy of ASAQ for treatment of uncomplicated Plasmodium falciparum malaria in selected sentinel sites for therapeutic efficacy studies in mainland Tanzania.

Methods
Between December 2018 and March 2020, children aged between 6 months and 10 years, attending at Nagaga, Mkuzi, and Mlimba primary health facilities, and with suspected uncomplicated malaria infection were screened for eligibility to participate in the study. Malaria infection was screened using microscopy. Children with uncomplicated P. falciparum monoinfection and who fulfilled all other inclusion criteria, and had none of the exclusion criteria, according to the World Health Organization (WHO) guidelines, were treated with ASAQ. Follow-up visits were scheduled on days 0, 1, 2, 3, 7, 14, 21, and 28 or on any day of recurrent infection for clinical and laboratory assessment. Polymerase chain reaction (PCR)-corrected cure rate on day 28 was the primary outcome.

Results
A total of 264 children, 88 in each of the three study sites (Mlimba, Mkuzi and Nagaga health facilities) were enrolled and treated with ASAQ. The ASAQ PCR-corrected cure rate was 100% at all the three study sites. None of the participants had early treatment failure or late clinical failure. Furthermore, none of the participants had a serious adverse event.

Conclusion
ASAQ was highly efficacious for the treatment of uncomplicated P. falciparum malaria in mainland Tanzania, therefore, it can be deployed as an alternative first-line treatment for uncomplicated malaria as part of diversification strategy to contain the spread of partial artemisinin resistance in the country.
Association between dietary antioxidant capacity and type 2 diabetes mellitus in Chinese adults: a population-based cross-sectional study
Authors: Li Xiaoxia , Xue Yixuan , Zhang Yadi , Wang Qingan , Qiu Jiangwei , Zhang Jiaxing , Yang Chan , Zhao Yi , Zhang Yuhong 
Published: March 2024

Abstract
Background
Higher intakes of dietary antioxidants have been linked to a lower type 2 diabetes mellitus (T2DM) risk. However, few studies have comprehensively examined the overall dietary antioxidant capacity, assessed by dietary antioxidant quality scores (DAQS) and dietary total antioxidant capacity (DTAC), related to T2DM risk, especially in populations consuming relatively monotonous diets. This study aimed to evaluate the associations of DAQS, DTAC, and T2DM among rural Chinese adults.

Methods
Data from 12,467 participants from the Natural Population Cohort of Northwest China: Ningxia Project was analyzed. Dietary intake was assessed using a validated semi-quantitative food frequency questionnaire. DAQS were calculated based on vitamins A, C, and E, zinc (Zn), and selenium (Se) intake. DTAC was estimated using the ferric-reducing ability of plasma assay. Logistic regression models were used to evaluate the associations of DAQS and DTAC with T2DM risk. Restricted cubic splines were used to assess potential non-linear relationships between DTAC and T2DM.

Results
T2DM was observed in 1,238 (9.9%) participants. After adjusting for confounders, compared to the lowest tertiles (T1) of DAQS, the odds ratios (ORs) for T2DM were 1.03 (95% CI 0.82–1.30) in T2 and 0.85 (95% CI 0.68–1.06) in T3 (P = 0.010). Compared to T1, the ORs for T2DM in the highest T3 were 0.78 (95% CI 0.67–0.91, P-trend = 0.008) for vitamin A, 1.34 (95% CI 1.15–1.56, P-trend < 0.001) for vitamin E, 0.83 (95% CI 0.71–0.97, P-trend = 0.007) for Se, and 0.86 (95% CI 0.74–1.01, P-trend = 0.033) for Zn. Compared to the lowest quartile(Q1) of DTAC, the OR in the highest Q4 was 0.96 (95% CI 0.80–1.17, P-trend = 0.024) for T2DM. A non-linear relationship was observed between DATC and T2DM.

Conclusion
Higher DAQS and DATC were associated with a lower T2DM risk, suggesting that consuming antioxidant-rich foods may reduce the T2DM risk.
Parental conscription and cumulative adverse experiences in war-affected children and adolescents and their impact on mental health: a comment following Russia’s invasion of Ukraine in 2022
Authors: Erlewein Katrin , Gossmann Emily , Fegert Jörg M. 
Published: March 2024

Abstract
Background
With Russia’s invasion of the Ukraine on February 2022, Ukrainian children and adolescents have been exposed to several stressful life events. In addition to the confrontation with war, flight and parent-child separation due to flight and forced displacement, the majority underwent another challenge at the initial phase of the war: the fatherly separation due to conscription.

Main body
In the literature, the negative effects of exposure to war and flight/refuge, parent-child separation due to flight or forced displacement and parental deployment are well established. In the context of self-experienced war, the effects of parent-child separation caused by compulsory military service have not yet been sufficiently taken into account. However, the findings of the literature on the impact of these events on the mental health of children and adolescents show that they are at high risk for developing numerous psychological and behavioral problems.

Conclusion
As children’s and adolescents’ mental health might be severely affected by war and its consequences, interventional programs that address the special needs of those children and adolescents are crucial.
Pancreaticopleural fistula causing pleural effusion: a case report and review of the literature
Authors: Khadka Milan , Bhusal Suzit , Pantha Binod , Gautam Rabin , Gautam Kapil , Chaudhary Ashlesha 
Published: March 2024

Abstract
Background
Pancreaticopleural fistula is a rare complication of pancreatitis and poses diagnostic and therapeutic challenges. This case report sheds light on the unique challenges posed by pancreaticopleural fistula as a rare complication of pancreatitis. The aim is to contribute valuable insights to the scientific literature by presenting a case involving a middle-aged man with acute necrotizing pancreatitis and associated pleural effusion.

Case presentation
A 41-year-old Asian male with a history of pancreatitis and chronic alcohol use presented with severe dyspnea, chest pain, and left-sided pleural effusion. Elevated serum amylase lipase levels and imaging confirmed acute necrotizing pancreatitis with a computed tomography severity index of 8/10. Magnetic resonance cholangiopancreatography revealed pancreatic necrosis and pseudocyst formation and findings suggestive of pancreaticopleural fistula. The patient was then treated with octreotide therapy.

Conclusion
The management of pancreaticopleural fistula demands a comprehensive and individualized approach. Recognition guided by high clinical suspicion coupled with appropriate investigations and a careful balance between medical, endoscopic, and surgical interventions is crucial for achieving favorable outcomes. This case report adds to the scientific literature by providing insights into the complexities of pancreaticopleural fistula and emphasizing the importance of personalized strategies in its management.
Matrix representation of Toeplitz operators on Newton spaces
Authors: Ko Eungil , Lee Ji Eun , Lee Jongrak 
Published: March 2024

AbstractIn this paper, we study several properties of an orthonormal basis $\{N_{n}(z)\}$
{

N
n

(
z
)
}
for the Newton space $N^{2}({\mathbb{P}})$

N
2

(
P
)
. In particular, we investigate the product of $N_{m}$

N
m

and $N_{m}$

N
m

and the orthogonal projection P of $\overline{N_{n}}N_{m}$

N
n

‾

N
m

that maps from $L^{2}(\mathbb{P})$

L
2

(
P
)
onto $N^{2}(\mathbb{P})$

N
2

(
P
)
. Moreover, we find the matrix representation of Toeplitz operators with respect to such an orthonormal basis on the Newton space $N^{2}({\mathbb{P}})$

N
2

(
P
)
.
Nutrient recycling of source-separated human faeces using biochar immobilized indigenous psychrotrophic bacteria for sustaining the agroecosystems of north-western Himalaya
Authors: Borker Shruti Sinai , Thakur Aman , Pandey Krishna Kanta , Sharma Pallavi , Manyapu Vivek , Khatri Abhishek , Kumar Rakshak 
Published: March 2024

AbstractThe Himalayan composting toilets (CTs) offer a sustainable solution for converting human faeces (HF) into compost, supplementing the low-fertile land of the region. However, CTs face challenges such as delayed composting processes (6–8 months), increased heavy metal content, and foul odour. Therefore, the current study evaluated biochar-amended psychrotrophic bacteria for HF degradation under low-temperature conditions (10 ± 2 °C). Out of 153 psychrotrophic bacteria isolated from HF compost, 17 bacterial strains were selected based on highest and two or more hydrolytic activities. Furthermore, considering the isolation source, bacterial strains were examined for haemolytic activity, biofilm formation, cytotoxicity and seed germination assay. In total, 14 potential strains belonging to Pseudomonas, Microbacterium, Arthrobacter, Streptomyces, Glutamicibacter, Rhodococcus, Serratia, Exiguobacterium, and Jeotgalicoccus genera were considered safe for both human handling and plants. The composting process was conducted in modified plastic drums at 10 ± 2 °C for 90 days through two treatments: Treatment 1 (T1) involving HF, non-immobilized biochar and cocopeat, and Treatment 2 (T2) involving HF, consortium-immobilized biochar and cocopeat. The consortium-immobilized biochar (T2) degraded HF within 90 days with hemicellulose and cellulose degradation ratios of 73.9% and 62.4%, respectively (p ≤ 0.05). The compost maturation indices like C/N ratio (16.5 ± 1.85), total nitrogen (2.66 ± 0.07), total phosphate (0.4 ± 0.005), total potassium (1.8 ± 0.05) also improved in T2 treatment (p ≤ 0.05). Additionally, T2 was more effective in achieving safe levels of faecal coliforms (< 1000 MPN g−1) and reducing heavy metal content compared to T1. 16S rRNA amplicon-based analysis demonstrated an enhancement of bacterial community diversity in T2, with the presence of Rhodococcus, Pseudomonas, Arthrobacter, and Streptomyces at the end of the composting period promoting HF degradation. Furthermore, T2-fertilized soil showed a germination index (121 ± 0.4, p ≤ 0.05) and stimulated root, shoot and yield by 110%, 45.2%, and 288%, respectively, in pea (Pisum sativum var. AS-10) compared to T1 (49.6%, 19%, and 5.8%, respectively) (p ≤ 0.05). In conclusion, the developed biochar-based formulation proved effective in degrading HF at low temperatures, mitigating foul odours, reducing heavy metals, and enhancing the agronomic value of the final compost. This study presents a promising approach for the sustainable management of HF that can supplement the non-nutritive soil of high-altitude regions.