bluuebunny/crossref_metadata_2025_split huggingface dataset:
Which Matters More for Out‐of‐Hospital Cardiac Arrest Survival: Witnessed Arrest or Bystander Cardiopulmonary Resuscitation?
Authors: Fan Cheng‐Yi , Liang Ya‐Ting , Huang Edward Pei‐Chuan , Chen Jiun‐Wei , Chiang Wen‐Chu , Wang Charlotte , Sung Chih‐Wei 
Published: February 2025

Background
Despite the well‐known importance of witnessed arrest and bystander cardiopulmonary resuscitation (CPR) for out‐of‐hospital cardiac arrest outcomes, previous studies have shown significant statistical inconsistencies. We hypothesized an interaction effect and conducted stratified analyses to investigate whether witnessed arrest is more important than bystander CPR.

Methods
This study enrolled patients with out‐of‐hospital cardiac arrest between January 2010 and December 2022 in 3 emergency medical service (systems in Taiwan). Data were extracted from emergency medical service dispatch reports, including patient characteristics, witnessed arrest, bystander CPR, time for each dispatch, and prehospital interventions. The outcome measure was prehospital return of spontaneous circulation (ROSC). Patients were categorized into 4 groups: witnessed and bystander CPR present (W+B+), witnessed present but bystander CPR absent (W+B−), witnessed absent but bystander CPR present (W−B+), and witnessed and bystander CPR absent (W−B−). Multiple logistic regression on prehospital ROSC were performed in the 4 subgroups separately.

Results
A total of 14 737 patients with out‐of‐hospital cardiac arrest were identified, of whom 977 (6.6%) achieved prehospital ROSC. The W+B+ group exhibited the highest prehospital ROSC rate (14.0%). Stratification confirmed a statistically significant interaction between witnessed arrest and bystander CPR. Defibrillation, endotracheal intubation, and epinephrine administration were significantly associated with prehospital ROSC in all subgroups. Most explanatory variables significant in the witnessed arrest group were adjusted for in the nonwitnessed arrest group. Younger age was associated with prehospital ROSC only in the W+B+ group.

Conclusions
Witnessed arrest and bystander CPR may interact to predict prehospital ROSC in out‐of‐hospital cardiac arrest, with witnessed arrest likely having more significant impact on outcomes.
Association Between Inflammatory Arthritis, Genetic Risk, and the Long‐Term Risk of Degenerative Aortic Stenosis: A Prospective Cohort Study
Authors: Peng Baohua , Zha Lihuang , Juaiti Mukamengjiang , Lin Wenchao , Zhou Xinyi , Ou Ziwei , Zhang Mengqiu , Yu Zaixin , Tang Yiyang 
Published: February 2025

Background
Inflammatory arthritis is recognized to increase cardiovascular disease risk, but its association with degenerative aortic stenosis is not well understood.

Methods
This prospective cohort study used participants from the UK Biobank, focusing on 4 major types of inflammatory arthritis, including rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and gout. The primary outcome was the incidence of degenerative aortic stenosis. The primary analysis used Cox proportional hazards models to evaluate the association between inflammatory arthritis and the long‐term risk of degenerative aortic stenosis, as well as to explore potential effect modifiers. Genetic risk was evaluated using polygenic risk scores and self‐reported family history of cardiovascular diseases.

Results

The study included 497 567 participants, with 271 129 women (54.5%) and 468 015 White individuals (94.1%). The median age was 58 years. Over a median follow‐up of 12.58 years, 4571 cases (0.9%) of degenerative aortic stenosis were identified. Compared with the control group, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and gout were associated with increased risks of degenerative aortic stenosis by 54% (hazard ratio [HR], 1.54 [95% CI, 1.28–1.85]), 72% (HR, 1.72 [95% CI, 1.19–2.50]), 176% (HR, 2.76 [95% CI, 1.43–5.32]), and 36% (HR, 1.36 [95% CI, 1.20–1.54]), respectively. These associations were independent of genetic risk (
P
for interaction>0.05). Additionally, we identified significant interactions between sex (
P
for interaction=0.036), age (
P
for interaction<0.001), and socioeconomic status (
P
for interaction=0.014) with rheumatoid arthritis, ankylosing spondylitis, and gout on the incidence of degenerative aortic stenosis, respectively.

Conclusions
Inflammatory arthritis is significantly associated with an increased long‐term risk of degenerative aortic stenosis, underscoring the need for enhanced risk assessment for degenerative aortic stenosis in these populations.
The Politics of Regional International Organizations
Authors: Besson Samantha 
Published: February 2025

Abstract
International lawyers can no longer afford to ignore the growth of regional orderings under the umbrella of international law and their political consequences. There are, the author argues, at least two concerns rio s may help us address when thinking about the future of the international institution of (States) peoples and organising it to secure more political legitimacy: sovereignty and democracy. With respect to sovereignty qua ultimate political authority, first, rio s enable us to consider the virtues of multiple and shared external sovereignty in international relations and the possibility of a regional ordering of dispersed sovereignty as a shield to protect the same albeit multiply reinstituted peoples qua publics against domination, and this both inside their States and in their international relations. Second, with respect to democracy, rio s enable us to approach international democracy, and especially international democratic representation, in a pluralistic albeit systemic way: peoples may be reinstituted into different publics by multiple institutions over time, such as their States, but also by one or more rio s in their region, and giving those representative institutions a role in international law-making could strengthen political equality by compensating demographic and power imbalances between States while also requiring those rio s to become more egalitarian and accountable in return.
Individualized Occupational Therapy in Severe Mental Illness—A Recovery Model Approach from a Tertiary care Centre in South India
Authors: George Joseph Rachna , James Farah CJ , Ninan Elizabeth , Rachana Arun , Kurian Suja 
Published: February 2025

Background: The Recovery Model for mental illness explores a broad range of domains for individuals with severe mental illness (SMI) which is not merely the absence from illness but attaining self-sufficiency. The individualized occupational therapy intervention which is part of the recovery model approach includes any or a combination of trainings like Social Skills training, Vocational training, Assertiveness training, Anger Management training, Life Skills training, Stress Management, Study Skills training, Cognitive retraining and Anxiety management. Aims: The objective of the current study was to evaluate the effectiveness in terms of functioning of individuals with (SMI) who had undergone individualized OT intervention. Method: Patients who had undergone individualized OT intervention were evaluated at designated time points i.e. at discharge, at 3 months and further at 6 months. The outcome measure of functional capacity was scored using the Global Assessment of Functioning instrument. Result: A total of 31 patients were sampled. The diagnosis of Schizophrenia was seen in 77.4% ( n-24) of the sample, Bipolar Affective Disorder in 12.9% ( n-4) and Schizoaffective Disorder 9.7% ( n-3). The mean GAF for the sample showed improvement and the increment in GAF was maintained on follow up. Conclusions: In services with limited skilled human resources and where community-based services are not established, culturally adapted interventions with individualized OT interventions can ensure positive gains in terms of socio-occupational functioning.
Assessment of collateral circulation in patients with anterior circulation stroke treated with mechanical thrombectomy as a predictor of long-term clinical outcomes
Authors: Bąk Marcin , Antończak Justyna , Frąszczak Michał , Leus Marcin , Mazgaj Maciej , Gawłowicz Jacek , Pietura Radosław 
Published: February 2025

Background Mechanical thrombectomy (MT) is the most effective treatment for large vessel occlusion (LVO) stroke. Despite this treatment, clinical outcomes are highly variable. Purpose To evaluate the role of collateral circulation in patients undergoing MT as a determinant of clinical outcome, especially in the long term. Material and Methods The study included 80 patients who underwent MT for LVO of the anterior cerebral circulation. Patient data were collected on demographics, baseline neurological status, imaging studies (including ASPECTS and collateral circulation score), and clinical status of the patients as determined by NIHSS at discharge and by modified Rankin Scale (mRS) score at 3 and 12 months postoperatively. Results Patients with good collateral circulation were compared to the group with poor collateral circulation: they had significantly lower NIHSS at 24 h (median NIHSS 8 vs. 16; P < 0.001) and at the time of discharge (median NIHSS 3.5 vs. 13; P < 0.001). At 3 months, patients with good collateral circulation had a significantly higher chance of achieving a good functional outcome (mRS = 0–2) (62.75% vs. 10.34%; P < 0.001) and had a lower mortality (13.73% vs. 41.38%; P = 0.005). The benefits of good collateral circulation extended into the long term. At 12 months, patients with good collateral circulation were significantly more likely to have good functional outcome (mRS = 0–2) (60.78% vs. 10.34%; P < 0.001) and lower mortality (19.61% vs. 44.83%; P = 0.017). Conclusion Good collateral circulation increases the likelihood of favorable outcome in MT-treated stroke patients at discharge, 3 months, and 12 months.
The Effect of Concavity Restoration on Glenohumeral Stability in a Glenoid Bone Loss Model: Comparing Distal Tibial Allograft Reconstruction to Classic Latarjet
Authors: Fury Matthew S. , Cirino Carl M. , Jahandar Amirhossein , Rauck Ryan C. , Gulotta Lawrence V. , Dines David M. , Dines Joshua S. , Blaine Theodore A. , Fu Michael C. , Warren Russell F. , Kontaxis Andreas , Taylor Samuel A. 
Published: February 2025

Background: Distal tibial allograft (DTA) reconstruction for glenoid bone loss (GBL) has gained popularity. While recent studies have demonstrated that glenoid concavity is an important factor in native glenohumeral stability, there remains a paucity of data regarding concavity restoration during reconstructive procedures for GBL and its biomechanical effect. Purpose: To compare the restoration of anterior glenohumeral stability and glenoid concavity after DTA and classic Latarjet procedures. Study Design: Controlled laboratory study. Methods: Nine human cadaveric specimens (mean age, 62.2 years; range, 52-69 years) underwent pretesting computed tomography (CT) to assess native glenoid concavity as determined by the glenoid depth and bony shoulder stability ratio (BSSR). GBL was created so the DTA and Latarjet graft could restore 100% of the native glenoid width. The rotator cuff tendons were loaded, and anterior stability testing was performed using a KUKA robot to apply a controlled anterior force with the shoulder in 90° of abduction and neutral external rotation. A motion capture system recorded humeral head translation. The following conditions were tested: intact, soft tissue Bankart lesion; bone loss model with DTA reconstruction; classic Latarjet procedure without conjoint tendon loaded; and classic Latarjet procedure with conjoint tendon loaded (sling effect). All specimens underwent posttesting CT to measure the BSSR of the DTA and Latarjet reconstructions. A repeated-measures analysis of variance was performed to compare the BSSR and anterior translations between the DTA and Latarjet reconstructions. Results: DTA produced greater concavity than the Latarjet procedure (BSSR: 0.45 vs 0.35; P < .001). There was no difference in anterior translation between the DTA and Latarjet procedures with the sling effect (5.1 mm vs 4.7 mm; P > .999). However, maximum anterior translation was decreased after the DTA procedure when compared with the Latarjet technique without the sling effect (5.1 mm vs 10.3 mm; P = .045). Conclusion: DTA produces a more concave reconstruction and decreased anterior translation compared with the flatter reconstruction produced by the classic Latarjet procedure without the sling effect. DTA and the classic Latarjet procedure with conjoint tendon loading, however, yielded equivalent reductions in anterior translation. Clinical Relevance: Distal tibial allograft reconstruction is a biomechanically equivalent alternative to the classic Latarjet due to the restoration of glenoid concavity in addition to glenoid width. Surgeons should consider the role of concavity when addressing glenohumeral instability with bone loss.
INF-γ/TGF-β1-primed umbilical cord mesenchymal stem cells boost the T-lymphocytes activity: Modulation of CD25 expression and IL-6 secretion
Authors: Almaeen Abdulrahman H , Saad-Eldien Heba M , Gabr Hala 
Published: February 2025

Background: Mesenchymal stromal/stem cells (MSCs) have potent immunomodulatory abilities, particularly in a milieu of hyperactive immune system, through secreting a number of cytokines, growth factors, bioactive compounds and peptides, and by cell-cell contact. During viral infection, failure of immuno-neutralization of the viral particles, recruits T-lymphocytes (T-cells) that clear the virally-infected cells. MSCs greatly potentiate T-cells anti-viral activity. Objective: The objective of this study is to assess the ability of the cytokine-primed MSCs to activated T-cells, towards an antiviral application. Method: Human umbilical cord MSCs (UC-MSCs) were isolated from Wharton Jelly of a consented donor. UC-MSCs were primed with interferon (INF)-γ and transforming growth factor (TGF)-β1. Peripheral blood T-cells were isolated using mini-max and CD3+ population was purified using anti-CD3 immuno-magnetic beads. Naïve or primed MSCs were co-cultured with naïve and phytohemagglutinin (PHA)-activated CD3+ T-cells. T-cell activation was evaluated by changes in their rate of proliferation by cell count, flowcytometric immuno-phenotyping for CD25 expression, and IL-6 secretion in the conditioned medium. Results: The findings revealed that CD3+ T-cells count nonsignificant differed comparing the five experimental groups; Naïve MSCs, Naïve T cells, coculture with naïve MSCs, coculture with primed MSCs, and upon phytohemagglutinin-activation, despite a nonsignificant reduction of proliferation in the last two groups’ coculture. Only the coculture with the primed MSCs showed significant activation of T-cells assessed as CD25 expression compared to the other groups ( p < 0.001 and p = 0.002, respectively). The undetectable levels of IL-6 in the conditioned medium of naïve MSCs, turned markedly high after their cytokine-priming ( p < 0.001), reaching nonsignificant difference compared to naïve T-cells. Compared to naïve MSCs, naïve T-cells secreted considerable amounts of IL-6 ( p < 0.001). Incubation of naïve MSCs with phytohemagglutinin-activated T-cells further the secretion of IL-6, to a level significantly higher than all of the aforementioned three groups; naïve MSCs, naïve T-cells and primed MSCs ( p < 0.001, p = 0.0194, and p < 0.001, respectively). However, coculture of the cytokine-primed MSCs with phytohemagglutinin-activated T-cells dampened IL-6 secretion to a level that was significantly lower than that observed with naïve MSCs-phytohemagglutinin-activated T-cells coculture ( p < 0.001). Conclusion: The cytokine-primed UC-MSCs significantly upregulated CD25+ expression on T-cells, while hindering IL-6, without affecting their proliferation rate. This may point to potentially stronger antiviral effects, while alleviating the viral infection-induced cytokine storm.
The Effects of Inspiratory Muscle Training in Critically ill Adults: A Systematic Review and Meta-Analysis
Authors: Farley Christopher , Oliveira Ana , Brooks Dina , Newman Anastasia N. L. 
Published: February 2025

Purpose The onset of diaphragmatic weakness begins within hours of commencing invasive mechanical ventilation (IMV), which may contribute to the physical disability that can persist at five years after intensive care unit (ICU) discharge. Inspiratory muscle training (IMT) has the potential to alleviate the negative effects of IMV. Methods We conducted a systematic review and meta-analysis with an approach consistent with Cochrane methods. We registered our review a priori (PROSPERO: CRD 42023451809) and published our protocol. Randomized controlled trials (RCTs) which enrolled adults (≥18 years) admitted to ICU who required IMV for ≥24 h were eligible if they delivered an IMT intervention using an external device that provided airway resistance (eg, threshold device, tapered flow resistive device) compared to usual care. Our primary outcome was physical function. Secondary outcomes included respiratory muscle strength, mortality, length of stay, IMV weaning time, reintubation rate, dyspnea and endurance. We searched Medline, Embase, Emcare, AMED, CINAHL, CENTRAL and clinicaltrials.gov from inception and used the Covidence platform for study selection and data extraction. We reported results as standardized mean difference (SMD) if outcome measures were similar. We used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) to assess the certainty of evidence. Results We screened 12 945 studies and 18 met the inclusion criteria. Three studies reported the effects of IMT on physical function. IMT may have no effect on physical function (SMD = −0.05, 95% confidence interval: −0.46 to 0.36) however results are very uncertain. Conclusion Our results suggest physical function is not impacted by IMT; however, our results are based on a limited number of studies with small samples sizes. High quality, appropriately powered RCTs are needed to improve the precision of the effect estimate.
Knowledge About HIV/AIDS and its Transmission and Misconception Among Women in Thailand: A Structural Equation Modelling Approach
Authors: Bhowmik Jahar , Gunarathne Lakma , Bhar Sunil , Bhowmik Udayan , Apputhurai Pragalathan 
Published: February 2025

Purpose Asian and pacific region countries are considered to be high risk countries for Human Immunodeficiency Viruses (HIV). There is little literature quantifying the relationship between education of HIV/AIDS and its principal socioeconomic determinants through a spatial analysis. The purpose of this study was to assess the knowledge and awareness about HIV among the women in Thailand, and its direct and indirect association with sociodemographic factors including sexual education, level of education, area of living and wealth index through a structural equation modelling approach. Design Cross-sectional analysis using data from the 2022 UNICEF Multiple Indicator Cluster Survey (MICS). Setting Thailand. Subjects A total of 3671 women from the 2022 MICS dataset. Measures Key variables included knowledge and misconceptions about HIV, sexual education, education level, area of residence, marital status, and wealth index. Analysis Structural equation modeling was used to assess direct and indirect effects of sociodemographic factors on HIV-related knowledge and misconceptions. Results The direct effect of sexual education on knowledge, transmission and misconception about HIV/AIDS is significant (β = 0.051, P = .002). The mediation effect test found that the sexual education and education indirectly affected knowledge, transmission and misconceptions about HIV/AIDS through the mediation effect of women’s marital status (β = −0.068, P = .018) and wealth index (β = 0.007, P = <.001). Conclusion Sexual education alone is insufficient to improve health literacy on HIV/AIDS, as other mediating factors such as education level, wealth index, marital status and area of residence are also key drivers. To achieve Sustainable Development Goal (SDG) 3 by 2030, it is essential to enhance HIV/AIDS related health education for women through multifaceted intervention programs that address these mediating factors.
Acceptability of Telerehabilitation Among Stroke Survivors in Nigeria
Authors: Olaleye Olubukola A. , Abiodun Adesola Oyinkansola , Adepoju Ayomide Daniel 
Published: February 2025

Background The Covid-19 pandemic has accelerated the adoption of telerehabilitation as a tool to overcome geographical barriers, scarcity of care providers, and improve access to rehabilitation services. However, limited studies exist on its acceptability among care recipients particularly in low-and-middle-income countries. Objective This mixed-methods study explored the perception and acceptability of telerehabilitation among stroke survivors in Ibadan, Nigeria. Methods A convenient sample of 44 stroke survivors was surveyed, and six participated in a focus group discussion (FGD). Quantitative data was analyzed using inferential statistics at p < 0.05. Qualitative data was thematically analysed. Results Participants (61.4% males) were aged 60.93 ± 13.10 years. 19(43.3%) of them were favorably disposed to receiving treatment via telerehabilitation. Acceptability differed significantly across marital status, level of education, and socioeconomic status (p < 0.05). Qualitative findings indicated positive perceptions, although participants preferred telerehabilitation as an adjunct to face-to-face physiotherapy. Barriers included unstable internet connectivity, high costs of data, and lack of personal contact with physiotherapists. Facilitators included using telerehabilitation for additional or missed sessions, and the provision of necessary equipment and data by the government. Conclusion Our findings revealed limited acceptability of telerehabilitation among stroke survivors in Ibadan, Nigeria. This underscores the need to address the identified concerns and barriers, to enhance acceptability. A contextualized and multifaceted approach can help create awareness about the effectiveness of telerehabilitation and improve its acceptability.
Association of body weight and serum uric acid with Alzheimer's disease biomarkers and cognitive impairment
Authors: Tian Qing , Dong Qing , Su Zhumin , Liu Yingying , Ma Lili , Dong Huimin , Xu Yiru , Ma Zhan , Chen Xiaohong , Ma Xiaomeng 
Published: February 2025

Background Given the limited effective treatments for Alzheimer's disease (AD), obesity and serum uric acid (SUA) levels which are considered modifiable risk factors for dementia are of interest. However, research indicates conflicting results. Objective We aimed to further investigate the association of body weight (BW) and SUA with AD biomarkers and cognitive impairment. Methods Clinical data were collected from 139 adults (mean age 66.9 years) with chronic cognitive impairment. Cerebrospinal fluid (CSF) biomarkers and PET imaging were used to assess amyloid-β (A) and Tau (T) tangles load, classifying participants into AT profiles based on the results. The association of BW and SUA with AT profiles was evaluated using multivariable logistic regression, and their relationship with cognitive function (Mini-Mental State Examination (MMSE) scores) were analyzed using multivariable linear regression. Results Lower BW levels significantly influenced the presence of Aβ positive state (A+) (p = 0.007), while SUA levels did not (p = 0.263). Higher dementia proportion (p = 0.021), lighter BW (p = 0.019), and lower mean arterial pressure (MAP) levels (p = 0.025) were associated with AD pathological progress (A-T-→A+T-→A+T+), but SUA was not observed statistically significant. Among all participants regardless of Aβ state, high education levels (p < 0.001), high BW (p = 0.010), and high SUA (p=0.036) were associated with high MMSE scores, and high serum creatinine (p = 0.003) was associated with low MMSE scores. Conclusions Lower BW may accelerate AD pathology and cause cognitive impairment, while SUA is not linked to AD pathological progression but protects cognitive function.