bluuebunny/crossref_metadata_2025_split huggingface dataset:
The role of digitalization, infrastructure, and economic stability in tourism growth: A pathway towards smart tourism destinations
Authors: Sun Dongling , Zhou Yang , Ali Qamar , Khan Muhammad Tariq Iqbal 
Published: March 2024

AbstractThis study shows the impact of information and communication technology (ICT), inflation, economic growth, foreign direct investment (FDI), infrastructural development, and financial development on the global tourism index across all income groups. We use a generalized method of moments technique, novel index of tourism, and ICT in 130 countries from 1995 to 2019. The empirical results infer an increase in tourism due to sustained growth in ICT (all panels), economic growth (all panels), FDI (all panels), financial development (all panels), and infrastructure development (all panels). This study highlights the importance of increasing 4G networking in remote areas and introducing reliable mobile applications to promote smart tourism, which involves setting up a Tourist Information Centre to guide tourists in terms of traveling, accommodation, food, shopping, parking, history of specific places, healthcare services, weather forecasting, and emergencies. The central bank could ensure price stability by using different tools of monetary and fiscal policy while encouraging FDI and ICT infrastructure in the tourism industry, especially in developing countries. Tourism is directly associated with foreign exchange earnings, which in turn increases the financial strength of an economy. Besides, prioritizing investment in infrastructure, particularly in sanitation and waste management, drinking water supply, clean fuel management, and generation of electricity, could bolster tourism. The contribution of this study employs multiple indicators in the form of a composite index (i.e., global tourism index, ICT index, and infrastructure index). In addition, we have developed a global ICT index using several related indicators.
Development and validation of a nomogram model for accurately predicting severe fatigue in maintenance hemodialysis patients: A multicenter cross‐sectional study in China
Authors: Zhou Xinyuan , Han Jiahui , Zhu Fuxiang 
Published: March 2024

AbstractIntroductionThis study aims to analyze the risk factors for severe fatigue in maintenance hemodialysis (MHD) patients and develop a clinical prediction model to help doctors and patients prevent severe fatigue.MethodsMulticentre MHD patients were included in this study. The objective was to investigate the risk factors for severe fatigue in MHD patients and develop a prediction model.ResultsA total of 243 MHD patients were included in the study, and the incidence of severe fatigue was found to be 20.99%. Using age, body mass index, total cholesterol, and albumin levels, a predictive nomogram for fatigue was constructed. In the training set, the nomogram had an area under the curve of 0.851, sensitivity of 82.86%, specificity of 81.76%, and c‐index of 0.851. The nomogram was accurate in calibration and proved to be clinically useful.ConclusionThe nomogram developed in this study is a practical and reliable tool for quickly identifying severe fatigue in MHD patients.
Setting a direction for continuing professional development in anesthesiology: A synthesis of the outcome from an Utstein style meeting
Authors: Petersen J. A. , Østergaard D. , Østergaard H. T. , Bray L. , Haug A. C. 
Published: March 2024

AbstractBackgroundAn Utstein style meeting of key stakeholders from the existing collaboration surrounding post‐graduate training was arranged to set a direction for continuing professional development (CPD) of anesthesiologists in Denmark. A 2‐day meeting was planned to guide discussions about competencies in anesthesiology, facilitate the development of a blueprint for a portfolio‐based CPD program and provide examples of how a portfolio can be used in practice.MethodsThe meeting agenda was based on an adaptation of Kern's six‐step approach to curriculum development. Twenty‐four participants from the university hospitals in Denmark were invited. Prior to the meeting participants were informed of the objectives and the Utstein style process.ResultsParticipants acknowledged a need for a more structured approach to CPD, preferably within the current organizational set up at the departmental level, and with a portfolio‐based, individualized curriculum. It was recognized that CPD should contain an array of possibilities to accommodate needs and wants of both the individual and the department. It was emphasized that, while anesthesiologists are used to give feedback to trainees, many are less familiar in providing the same to peers, and psychological safety was identified as a prerequisite to support a culture where specialists can reflect openly on each other's performance.ConclusionThe results provide an insight into the attitudes, opportunities, and challenges of anesthesiologists in relation to continuing professional development in Denmark. Generally, participant suggestions are in line with the shift in medical education toward workplace‐based learning, feedback and lifelong learning.
Generation of a virus‐like particles based vaccine against IgE
Authors: Gharailoo Zahra , Plattner Kevin , Augusto Gilles , Engeroff Paul , Vogel Monique , Bachmann Martin F. 
Published: March 2024

AbstractBackgroundAnti‐IgE immunotherapy with monoclonal antibodies represents a breakthrough in treatment of severe allergic diseases. However, drawbacks such as short half‐life and high price are not negligible. Our objective is to develop an anti‐IgE vaccine based on virus‐like particles (VLPs) which can induce long‐lasting neutralizing IgG anti‐IgE antibodies reducing allergic responses without causing intrinsic mast cell activation due to IgE cross‐linking.MethodsThe vaccines were made by chemically coupling three synthetic mouse IgE‐Fc fragments to plant‐derived immunologically optimized CuMVTT VLPs. The immunogenicity of the vaccines was tested by immunizing naive or allergic mice either with the coupled vaccines or the VLP control followed by systemic or local allergen challenge.ResultsMice immunized with the vaccines exhibited high titers of anti‐IgE antibodies in the sera and high levels of anti‐IgE secreting plasma cells in lymphoid organs. Moreover, free IgE in serum were reduced by the induced anti‐IgE antibodies; therefore, less IgE was bound to FcεRI on the surface of basophils. In line with these reduced IgE levels on effector cells after vaccination, immunized mice were protected from challenge with allergens. Importantly, despite presence of anti‐IgE antibodies, no signs of acute or chronic allergic response were seen in immunized allergic mice.ConclusionThe generated vaccines can effectively induce anti‐IgE antibodies that did not cause allergic responses in sensitized mice but were able to decrease the level of free and cell bound IgE and protected sensitized animals from allergic responses upon allergen challenge.
Pre‐admission virus detection during the COVID‐19 pandemic in children with and without symptoms of infection
Authors: Bennet Rutger , Rinder Malin Ryd , George Eric , Hertting Olof , Luthander Joachim , Åkefeldt Selma Olsson , Hammas Berit , Allander Tobias , Eriksson Margareta 
Published: March 2024

AbstractAimPre‐admission viral screening is used only in exceptional situations such as pandemics. We therefore evaluated pre‐admission screening for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), respiratory syncytial virus (RSV) and influenza during the COVID‐19 pandemic, comparing epidemiology and clinical features of admitted children.MethodsChildren were screened at a paediatric emergency department from 1 March 2020 to 30 June 2022 by nasopharyngeal sampling and polymerase chain reaction kit. We retrospectively retrieved positive results from the laboratory and scrutinised charts of admitted children.ResultsOut of 15 927 screened children, 522, 127 and 572 were positive and admitted with RSV, influenza A or SARS‐CoV‐2, respectively. Of these, 29 (5.6%), 26 (24.1%) and 245 (44.8%) were incidental findings, lacking symptoms of infection. RSV and influenza A were initially absent but re‐emerged in the autumn of 2021. The rate of COVID‐19 rose when the Omicron variant emerged in December 2021. The median age of children with RSV was 0.3 years, of those with influenza A 6.7 years and of those with COVID‐19 1.6 years. Major complications were rare.ConclusionFrequent incidental detections of SARS‐CoV‐2 likely reflected widespread presence of a mild infection. Clinically, COVID‐19 was like other viral respiratory infections in children.
When and how many: Factors associated with campus sexual assault reforms
Authors: Nelson Abbie , Moylan Carrie A. , Allen Jennifer , Hammock Amy 
Published: March 2024

AbstractInstitutions of higher education have faced increasing pressure to comply with federal regulations and reform their response to campus sexual assault. This study explores institutions of higher education employees’ perceptions on whether decoupling, or organizational resistance to change, is associated with the number and timing of campus sexual assault reforms adopted. Early captured reforms instituted before the “Dear Colleague Letter” in 2011, mid included reforms instituted after the Dear Colleague Letter in 2011 but before the 2015–2016 academic year and during the period of heightened attention to campus sexual assault, and late which included reforms instituted during or after the 2015–2016 academic year. A web‐based survey of institutions of higher education employees familiar with sexual assault policy implementation on their campuses asked about types of reforms, timing, decoupling, and campus characteristics. Correlations and t‐tests were run to examine the types of reforms across time periods, and regression assessed the degree to which decoupling was associated with the number and timing of reforms. Higher decoupling was associated with fewer reforms in the early period and more in the late period, though not with the overall number of reforms adopted. Findings highlight the importance of understanding factors that influence change on campuses.
COVID‐19 infection in patients with history of pediatric heart transplant in Germany, Austria, and Switzerland
Authors: Ulrich Sarah , Balmer Christian , Becker Kolja , Bruhs Josefin , Danne Friederike , Debus Volker , Dewein Leonie , Di‐Bernardo Stefano , Doll Ulrike , Fleck Thilo , Tirilomis Theodor , Glöckler Martin , Grafmann Maria , Greil Sabine , Grosser Urte , Saur Patrick , Skrzypek Susanne , Steinmetz Michael ,   the Working group thoracic organ transplantation DGPK
Published: March 2024

AbstractCOVID‐19 is a heterogenous infection—asymptomatic to fatal. While the course of pediatric COVID‐19 infections is usually mild or even asymptomatic, individuals after adult heart transplantation are at high risk of a severe infection. We conducted a retrospective, multicenter survey of 16 pediatric heart transplant centers in Germany, Austria and Switzerland to evaluate the risk of a severe COVID‐19 infection after pediatric heart transplantation between 02/2020 and 06/2021. Twenty‐six subjects (11 male) with a median age of 9.77 years at time of transplantation and a median of 4.65 years after transplantation suffered from COVID‐19 infection. The median age at time of COVID‐10 infection was 17.20 years. Fourteen subjects had an asymptomatic COVID‐19 infection. The most frequent symptoms were myalgia/fatigue (n = 6), cough (n = 5), rhinitis (n = 5), and loss of taste (n = 5). Only one subject showed dyspnea. Eleven individuals needed therapy in an outpatient setting, four subjects were hospitalized. One person needed oxygen supply, none of the subjects needed non‐invasive or invasive mechanical ventilation. No specific signs for graft dysfunction were found by non‐invasive testing. In pediatric heart transplant subjects, COVID‐19 infection was mostly asymptomatic or mild. There were no SARS‐CoV‐2 associated myocardial dysfunction in heart transplant individuals.
Immunohistochemical p16 overexpression and Rb loss correlate with high‐risk human papillomavirus infection in endocervical adenocarcinomas
Authors: Yasutake Nobuko , Yamamoto Hidetaka , Kuga Ryosuke , Jiromaru Rina , Hongo Takahiro , Katayama Yoshihiro , Sonoda Kenzo , Yahata Hideaki , Kato Kiyoko , Oda Yoshinao 
Published: March 2024

Aimsp16 is a sensitive surrogate marker for transcriptionally active high‐risk human papillomavirus (HR‐HPV) infection in endocervical adenocarcinoma (ECA); however, its specificity is not perfect.Methods and resultsWe examined p16 and Rb expressions by immunohistochemistry (IHC) and the transcriptionally active HR‐HPV infection by mRNA in‐situ hybridisation (ISH) with histological review in 108 ECA cases. Thirteen adenocarcinomas of endometrial or equivocal origin (six endometrioid and seven serous carcinomas) were compared as the control group. HR‐HPV was detected in 83 of 108 ECA cases (77%), including five HPV‐associated adenocarcinomas in situ and 78 invasive HPV‐associated adenocarcinomas. All 83 HPV‐positive cases showed consistent morphology, p16 positivity and partial loss pattern of Rb. Among the 25 cases of HPV‐independent adenocarcinoma, four (16%) were positive for p16, and of these four cases, three of 14 (21%) were gastric type adenocarcinomas and one of 10 (10%) was a clear cell type adenocarcinoma. All 25 HPV‐independent adenocarcinomas showed preserved expression of Rb irrespective of the p16 status. Similarly, all 13 cases of the control group were negative for HR‐HPV with preserved expression of Rb, even though six of 13 (46%) cases were positive for p16. Compared with p16 alone, the combination of p16 overexpression and Rb partial loss pattern showed equally excellent sensitivity (each 100%) and improved specificity (100 versus 73.6%) and positive predictive values (100 versus 89.2%) in the ECA and control groups. Furthermore, HR‐HPV infection correlated with better prognosis among invasive ECAs.ConclusionsThe results suggest that the combined use of p16 and Rb IHC could be a reliable method to predict HR‐HPV infection in primary ECAs and mimics. This finding may contribute to prognostic prediction and therapeutic strategy.
Association between gastrointestinal symptoms and insomnia in patients with type 2 diabetes: The KAMOGAWA‐DM cohort study
Authors: Minamida Megumi , Okada Hiroshi , Hamaguchi Masahide , Hironaka Junya , Kondo Yuriko , Nakajima Hanako , Okamura Takuro , Sennmaru Takafumi , Nakanishi Naoko , Ushigome Emi , Fukui Michiaki 
Published: March 2024

AbstractAims/IntroductionGastrointestinal disturbances and insomnia affect the quality of life of patients with diabetes. However, the relationship between gastrointestinal symptoms and insomnia in patients with diabetes has rarely been analyzed. Thus, aim of this study was to investigate the association between gastrointestinal symptoms and insomnia in patients with type 2 diabetes mellitus.Materials and MethodsThis cross‐sectional study of patients with type 2 diabetes was carried out from January 2014 to April 2022 using the database of the KAMOGAWA‐DM cohort study. Patient data were collected using a self‐administered questionnaire, and the Izumo Scale and the Athens Insomnia Scale were used to assess gastrointestinal symptoms and insomnia, respectively. Multivariate logistic regression analysis was carried out to determine the association between gastrointestinal symptoms and insomnia.ResultsA total of 175 patients with type 2 diabetes were included in this study. Patients with insomnia had higher Izumo scores than those without insomnia (P < 0.0001). Izumo scale score was significantly associated with insomnia in patients with type 2 diabetes, even after adjustment for age, body mass index, systolic blood pressure, glycated hemoglobin level, neuropathy, insulin therapy and nocturia (odds ratio 1.10, 95% confidence interval [CI] 1.06–1.16). Each gastrointestinal symptom assessed using the Izumo scale was associated with insomnia. The odds ratios of heartburn, stomach pain, lethargy, constipation and diarrhea for insomnia were 1.32 (95% CI 1.13–1.55), 1.38 (95% CI 1.16–1.63), 1.33 (95% CI 1.13–1.56), 1.21 (95% CI 1.08–1.36) and 1.29 (95% CI 1.12–1.47), respectively.ConclusionsGastrointestinal symptoms are strongly associated with sleep disturbances in patients with type 2 diabetes.
Prevalence and factors associated with the Minimum Dietary Diversity among HIV‐positive women receiving Antiretroviral Therapy in Kabale district, Uganda
Authors: Kihembo Pamelah , Lubogo David 
Published: March 2024

AbstractBackgroundMalnutrition and HIV form a vicious cycle and women are at an increased risk of malnutrition from HIV. The Food and Agriculture Organization (FAO) recommends a minimum dietary diversity for women (MDD‐W) of five food groups; however, paucity of information exists about the diet quality of this population in Uganda. The present study aimed to determine the prevalence and factors associated with the MDD among HIV positive women of reproductive age (15–49 years) receiving antiretroviral therapy in Kabale district, Uganda.MethodsThis was a cross‐sectional study. Probability proportional to size sampling was applied to select the number of participants per clinic and respondents were sampled systematically on a particular day in each clinic. A structured questionnaire was used to collect data on the respondent characteristics and the FAO's Individual Dietary Diversity questionnaire was used to collect the 24‐hour dietary intake. Data were analysed using appropriate software. Descriptive statistics were applied for univariate analysis. Modified Poisson was used to determine the factors associated with MDD. The study was approved by the Makerere University School of Public Health Institutional Review Board and informed consent was obtained from the respondents.ResultsSome 90.9% of the respondents were Bakiga, mean age was 34.8 ± 8.1 years, 47.6% were married and 98.0% came from nuclear families with 4.4 ± 1.9 members. The mean number of food groups consumed was 4.7 ± 1.7 with roots and tubers, pulses, and dark leafy and vitamin A vegetables, whereas milk and eggs were mostly consumed and fruits were least consumed. The prevalence of the MDD‐W was 48.2%. Factors associated with MDD score at multivariate level included; age, type of employment, having nausea, viral load status and HIV clinical stage.ConclusionsAlmost one half of the HIV positive women on antiretroviral therapy in the district achieve the MDD‐W, attributed to being middle aged, being casual employment and having an unsuppressed viral load.
Health professional competency building for the Baby‐Friendly Hospital Initiative in Malawi
Authors: Mukuria‐Ashe Altrena , Nyambo Kanji , Uyehara Malia , Guta Janet , Mtengowadula George , Nyirongo Godwin , Alvey Jeniece 
Published: March 2024

AbstractHealth professional competency building is one of nine national responsibilities (to achieve universal coverage and sustainability) described in the 2018 World Health Organization (WHO)/United Nations Children's Fund (UNICEF) implementation guidance for the Baby‐Friendly Hospital Initiative (BFHI). With stagnating rates of exclusive breastfeeding worldwide, skilled breastfeeding support as a standard of newborn care is critical to the establishment of lactation and exclusive breastfeeding. Few studies exist on how low‐income countries are integrating BFHI into their standards of care. This qualitative case study describes Malawi's experience. We interviewed 48 key informants and conducted a desk review of the literature on BFHI programming, national plans, policies and other related documents. We explored the findings using the seven key domains and 16 competencies to implement the Ten Steps to successful breastfeeding from the WHO and UNICEF Competency Verification Toolkit. The study found that although the focus of the guidance is on preservice training, continuing education and in‐service training remain important. To achieve universal coverage for health professional competency, Malawi uses preservice, in‐service and refresher training. However, their main limitations to aligning with the new guidance are a lack of preservice BFHI‐ and breastfeeding‐specific curricula, experienced lecturers and sufficient time to dedicate to practical skill development. Conducted during the coronavirus disease 2019 pandemic, this study confirmed disruptions to BFHI training and service delivery, while also documenting Malawi's resilient attempts to mitigate impacts on breastfeeding support through mentoring and coaching. Opportunities exist for strengthening and scaling up, including engaging preservice training institutions and standardizing mentoring, coaching and competency verification.
Ageing and mating status affect food utilization efficiencies and assimilation of macronutrients in adults of Parthenium beetle, Zygogramma bicolorata Pallister
Authors: Yadav Priyanka , Patel Priya , Patel Arvind Kumar , Chowdhury Ritabrata , Upadhyay Ankit , Kumar Bhupendra , Kumar Dinesh 
Published: March 2024

AbstractInvestigations of age‐based food conversion and utilization efficiencies in phytophagous insects are very few. Studies examining the effects of age, sex and mating status on biochemical assimilation of macronutrients by phytophagous insects are scarce as well. Hence, we designed the present study to evaluate the combined effect of age, sex and mating status on food consumption and utilization efficiencies, and the assimilation of macronutrients by the Parthenium beetle, Zygogramma bicolorata Pallister (Coleoptera: Chrysomelidae), on the invasive weed, Parthenium hysterophorus Linnaeus (Asterales: Asteraceae). We hypothesized that mated adults would consume and utilize more food than unmated adults, that assimilation of nutrients by old adults would be lower than young adults and that females would consume and utilize food more efficiently than males. However, our results revealed that as adults aged, their food consumption and utilization efficiencies decreased, and they assimilated less proteins and glucose in their body. Despite that, their mean body biomass and assimilation of triglycerides increased. While mated adults had higher food utilization efficiencies and increased assimilation of triglycerides and glucose, unmated adults assimilated more proteins. Females had higher food consumption rates and increased assimilation of nutrients, whereas males had higher food conversion efficiencies and growth rates. Furthermore, middle‐aged adults had higher food utilization efficiencies and they assimilated more nutrients than young and old adults. Our results therefore suggest compensatory feeding in adults of Z. bicolorata with ageing. We also recommend the release of more numbers of mated middle‐aged females to control P. hysterophorus in agro‐ecosystems.