bluuebunny/crossref_metadata_2025_split huggingface dataset:
An Online Pediatric Palliative Care Education and Mentoring (Project ECHO) in Nepal: A Program Implementation Case Study and Assessment of Changes in Healthcare Providers’ Knowledge, Confidence, and Attitudes
Authors: Lynch-Godrei Anisha , Sapkota Sudhir , Rowe Jennifer , Paudel Bishnu Dutta , Aryal Garima , Doherty Megan 
Published: February 2024

OBJECTIVES The goal of this implementation study was to describe the implementation and evaluation of the impact of an online pediatric palliative care training program in Nepal, using the Project ECHO model. METHODS The study used mixed methods, including a program case study describing the online learning program and before-and-after surveys of program participants, assessing learning through changes in knowledge, comfort, and attitudes. An end-of-program survey was used to evaluate participants’ overall experiences with the learning program and use of the learning resources. RESULTS A literature review, stakeholder surveys, and expert input informed the design of the intervention. The course used the Project ECHO model of online education, with modifications based on the leadership team's previous ECHO experiences and local stakeholder input. The intervention occurred over 9 months, with 22 online teaching sessions. Each session consisted of a didactic lecture, case presentation, and interactive discussion with expert clinical teachers. Fifty-five clinicians in Nepal participated, including physicians (47%), nurses (44%), and psychotherapists (5%). Clinicians reported improvements in knowledge, skills, and attitudes after program participation. Program acceptability scores were high, with 93% of participants reporting that the course provided effective learning. CONCLUSIONS Project ECHO can be successfully implemented to deliver continuing professional development in Nepal. Delivering palliative care education online using the Project ECHO model, leads to improved knowledge, skills, and attitudes for clinicians. Project ECHO suggests an innovative solution which can provide training and support to clinicians in settings where educational opportunities in palliative care are limited.
Cross-Cultural Validation of the Arabic Short-Form McGill Pain Questionnaire (SF-MPQ): Libyan Version in Patients With Musculoskeletal Pain
Authors: Jahan Alhadi M , Rwaiha Ali E , Anaiba Salima M , Alghoul Rasha A 
Published: February 2024

Background: The Short-form McGill Pain Questionnaire (SF-MPQ) is a widely used tool for assessing musculoskeletal pain, both in research and clinical practice. However, a culturally appropriate Arabic version for the Libyan context has not been available. This study aims to translate the SF-MPQ, and to examine its reliability and validity for assessing musculoskeletal pain in Libya. Methods: The SF-MPQ was cross-culturally adapted into Arabic using a forward-backward method. A total of 151 patients (Mean age ± SD = 40.66 ± 14) with musculoskeletal pain completed the SF-MPQ and other measures. Of these, 148 patients completed the second round of questionnaire completion two days after the first visit. The intraclass correlation coefficient (ICC) was used to examine relative test-retest reliability and Bland-Altman plots was performed to examine absolute agreement between the two assessments. Spearman’s correlation was applied to assess construct validity. Results: The Arabic translation of the SF-MPQ was linguistically equivalent, without significant discrepancies. All but two of the Arabic descriptors were used by more than 33% of the participants, indicating good item measurement equivalency. The results showed a satisfactory Cronbach’s α (0.74 for the total score), which indicates good internal consistency. The ICC for the total score revealed a high correlation for the test-retest (0.91), suggesting excellent relative reliability. Bland-Altman analyses showed no significant systematic bias between the repeated measurements. There were positive statistically significant correlations among the SF-MPQ, the Visual Analog Scale, and the Fatigue Severity Scale ( P < 0.001), demonstrating good construct validity. Conclusion: These results suggest that the Arabic SF-MPQ is reliable, valid, and cross-culturally equivalent to the original SF-MPQ for evaluating musculoskeletal pain among Arabic-speaking patients in Libya. Clinicians and researchers may therefore consider using this scale, as it is easy to use and understand by different age groups. Further research is needed to confirm our findings and to test the developed Arabic version of the SF-MPQ on different patient populations.
Daratumumab, carfilzomib, lenalidomide, and dexamethasone with tandem transplant for high-risk newly diagnosed myeloma
Authors: Touzeau Cyrille , Perrot Aurore , Hulin Cyrille , Manier Salomon , Macro Margaret , Chretien Marie-Lorraine , Karlin Lionel , Escoffre Martine , Jacquet Caroline , Tiab Mourad , Leleu Xavier , Avet-Loiseau Herve , Jobert Alexandra , Planche Lucie , Corre Jill , Moreau Philippe 
Published: February 2024

Abstract
High-risk (HR) cytogenetics are associated with poor outcomes in newly diagnosed multiple myeloma (NDMM), and dedicated studies should address this difficult-to-treat population. The phase 2 study 2018-04 from the Intergroupe Francophone du Myelome evaluated feasibility of an intensive strategy with quadruplet induction and consolidation plus tandem transplant in HR transplant-eligible (TE) NDMM. HR cytogenetics were defined by presence of del(17p), t(4;14), and/or t(14;16). Treatment consisted of daratumumab-carfilzomib-lenalidomide-dexamethasone (D-KRd) induction, autologous stem cell transplantation (ASCT), D-KRd consolidation, second ASCT, and daratumumab-lenalidomide maintenance. The primary end point was feasibility. Fifty patients with previously untreated NDMM were included. Median age was 57. Del(17p), t(4;14), and t(14;16) were found in 40%, 52%, and 20% of patients, respectively. At data cutoff, the study met the primary end point with 36 patients completing second transplant. Twenty patients discontinued the study due to stem cell collection failure (n = 8), disease progression (n = 7), adverse event (n = 4), or consent withdrawal (n = 1). Grade 3 to 4 D-KRd induction/consolidation–related adverse events (&gt;5% of patients) were neutropenia (39%), anemia (12%), thrombocytopenia (7%), and infection (6%). The overall response rate was 100% for patients completing second transplant, including 81% complete response. Premaintenance minimal residual disease (MRD) negativity rate (10–6) was 94%. After a median follow-up of 33 months, the 30-month progression-free survival (PFS) and overall survival were 80% and 91%, respectively. In conclusion, D-KRd with tandem transplant is feasible in patients with HR TE-NDMM and resulted in high response rates and PFS. This trial was registered at www.clinicaltrials.gov as #NCT03606577.
Spatial–temporal evolution and land use transition of rural settlements in mountainous counties
Authors: Chen Song , Wang Xiyue , Qiang Yi , Lin Qing 
Published: February 2024

Abstract
Background
Rural settlements are undergoing significant changes under the rapid urbanisation, and understanding their evolution characteristics and surrounding land use will provide a basis for land spatial planning. This study takes Pingnan County, Fujian Province, China as study area, reveals the characteristics of spatial–temporal evolution and surrounding land use transition of settlements during 1985–2020 through landscape metrics, spatial “hot spot” analysis, scale classification statistics, rank-size model, Gini index, land use transition matrix.

Results
The results show that: (1) Concerning the size and morphological characteristics, the settlements have witnessed a considerable increase in number and scale while remaining stable in shape. (2) Regarding spatial distribution characteristics, the settlements became more evenly spread, forming three main hotspot clusters. (3) Concerning scale structure characteristics, there are significant differences in scale, growth rates, and polarisation of settlements; the polarisation of large settlements shifted from a marked divergence before 2010 to a more balanced trend after 2010. (4) The land use transition around settlements differed in buffer zones and periods. During 1985–2010, settlement expansion heavily depended on cropland, depleting nearby resources, with an increase of woodland and grassland. During 2010–2020, expansion integrated cropland, woodland, and grassland, with cropland growth mainly encroaching on woodland and grassland.

Conclusions
The study's findings are significant for optimising rural settlement structure in mountains and promoting sustainable land resource use.
Mining and functional characterization of NADPH-cytochrome P450 reductases of the DNJ biosynthetic pathway in mulberry leaves
Authors: Liao Yangzhen , Du Wenmin , Wan Jingqiong , Fan Jiahe , Pi Jilan , Wu Min , Wei Yuan , Ouyang Zhen 
Published: February 2024

Abstract
Background
1-Deoxynojirimycin (DNJ), the main active ingredient in mulberry leaves, with wide applications in the medicine and food industries due to its significant functions in lowering blood sugar, and lipids, and combating viral infections. Cytochrome P450 is a key enzyme for DNJ biosynthesis, its activity depends on the electron supply of NADPH-cytochrome P450 reductases (CPRs). However, the gene for MaCPRs in mulberry leaves remains unknown.

Results
In this study, we successfully cloned and functionally characterized two key genes, MaCPR1 and MaCPR2, based on the transcriptional profile of mulberry leaves. The MaCPR1 gene comprised 2064 bp, with its open reading frame (ORF) encoding 687 amino acids. The MaCPR2 gene comprised 2148 bp, and its ORF encoding 715 amino acids. The phylogenetic tree indicates that MaCPR1 and MaCPR2 belong to Class I and Class II, respectively. In vitro, we found that the recombinant enzymes MaCPR2 protein could reduce cytochrome c and ferricyanide using NADPH as an electron donor, while MaCPR1 did not. In yeast, heterologous co-expression indicates that MaCPR2 delivers electrons to MaC3'H hydroxylase, a key enzyme catalyzing the production of chlorogenic acid from 3-O-p-coumaroylquinic acid.

Conclusions
These findings highlight the orchestration of hydroxylation process mediated by MaCPR2 during the biosynthesis of secondary metabolite biosynthesis in mulberry leaves. These results provided a foundational understanding for fully elucidating the DNJ biosynthetic pathway within mulberry leaves.
Molecular hydrogen attenuates sepsis-induced cardiomyopathy in mice by promoting autophagy
Authors: Cui Yan , Li Yingning , Meng Shuqi , Song Yu , Xie Keliang 
Published: February 2024

Abstract
Background
Approximately 40 to 60% of patients with sepsis develop sepsis-induced cardiomyopathy (SIC), which is associated with a substantial increase in mortality. We have found that molecular hydrogen (H2) inhalation improved the survival rate and cardiac injury in septic mice. However, the mechanism remains unclear. This study aimed to explore the regulatory mechanism by which hydrogen modulates autophagy and its role in hydrogen protection of SIC.

Methods
Cecal ligation and puncture (CLP) was used to induce sepsis in adult C57BL/6J male mice. The mice were randomly divided into 4 groups: Sham, Sham + 2% hydrogen inhalation (H2), CLP, and CLP + H2 group. The 7-day survival rate was recorded. Myocardial pathological scores were calculated. Myocardial troponin I (cTnI) levels in serum were detected, and the levels of autophagy- and mitophagy-related proteins in myocardial tissue were measured. Another four groups of mice were also studied: CLP, CLP + Bafilomycin A1 (BafA1), CLP + H2, and CLP + H2 + BafA1 group. Mice in the BafA1 group received an intraperitoneal injection of the autophagy inhibitor BafA1 1 mg/kg 1 h after operation. The detection indicators remained the same as before.

Results
The survival rate of septic mice treated with H2 was significantly improved, myocardial tissue inflammation was improved, serum cTnI level was decreased, autophagy flux was increased, and mitophagy protein content was decreased (P < 0.05). Compared to the CLP + H2 group, the CLP + H2 + BafA1 group showed a decrease in autophagy level and 7-day survival rate, an increase in myocardial tissue injury and cTnI level, which reversed the protective effect of hydrogen (P < 0.05).

Conclusion
Hydrogen exerts protective effect against SIC, which may be achieved through the promotion of autophagy and mitophagy.
Limited incremental predictive value of the frailty index and other vulnerability measures from routine care data for mortality risk prediction in older patients with COVID-19 in primary care
Authors: la Roi-Teeuw Hannah M. , Luijken Kim , Blom Marieke T. , Gussekloo Jacobijn , Mooijaart Simon P. , Polinder-Bos Harmke A. , van Smeden Maarten , Geersing Geert-Jan , van den Dries Carline J. 
Published: February 2024

AbstractBackgroundDuring the COVID-19 pandemic, older patients in primary care were triaged based on their frailty or assumed vulnerability for poor outcomes, while evidence on the prognostic value of vulnerability measures in COVID-19 patients in primary care was lacking. Still, knowledge on the role of vulnerability is pivotal in understanding the resilience of older people during acute illness, and hence important for future pandemic preparedness. Therefore, we assessed the predictive value of different routine care-based vulnerability measures in addition to age and sex for 28-day mortality in an older primary care population of patients with COVID-19.MethodsFrom primary care medical records using three routinely collected Dutch primary care databases, we included all patients aged 70 years or older with a COVID-19 diagnosis registration in 2020 and 2021. All-cause mortality was predicted using logistic regression based on age and sex only (basic model), and separately adding six vulnerability measures: renal function, cognitive impairment, number of chronic drugs, Charlson Comorbidity Index, Chronic Comorbidity Score, and a Frailty Index. Predictive performance of the basic model and the six vulnerability models was compared in terms of area under the receiver operator characteristic curve (AUC), index of prediction accuracy and the distribution of predicted risks.ResultsOf the 4,065 included patients, 9% died within 28 days after COVID-19 diagnosis. Predicted mortality risk ranged between 7–26% for the basic model including age and sex, changing to 4–41% by addition of comorbidity-based vulnerability measures (Charlson Comorbidity Index, Chronic Comorbidity Score), more reflecting impaired organ functioning. Similarly, the AUC of the basic model slightly increased from 0.69 (95%CI 0.66 – 0.72) to 0.74 (95%CI 0.71 – 0.76) by addition of either of these comorbidity scores. Addition of a Frailty Index, renal function, the number of chronic drugs or cognitive impairment yielded no substantial change in predictions.ConclusionIn our dataset of older COVID-19 patients in primary care, the 28-day mortality fraction was substantial at 9%. Six different vulnerability measures had little incremental predictive value in addition to age and sex in predicting short-term mortality.
Experiences of Boosting Inpatient Exercise After HipFracture Surgery Using An Alternative Workforce - A Qualitative Study
Authors: Lau Benny , March Marie K. , Harmer Alison R. , Caruana Sarah , Mahony Christopher , Dennis Sarah 
Published: February 2024

Abstract
Background
Thrice-daily physiotherapy immediately following surgical repair of hip fracture has been shown to be safe and to reduce total hospital length of stay. However, implementing this is challenging with respect to health service funding and staffing. A novel approach may be to utilize an alternative workforce (allied health staff and student physiotherapists) to deliver two of the three daily treatments. However, how patients and staff may view such an approach is unknown. Thus, the aim of this qualitative study was to explore the views of inpatients with surgical repair of a hip fracture, their carers, health care professionals, and physiotherapy students about the implementation and acceptability of thrice-daily physiotherapy, with two sessions delivered by the alternative workforce (the BOOST study).

Methods
Semi-structured interviews and focus groups with patients, carers, health professionals and physiotherapy students. All interviews were digitally recorded and transcribed via verbatim. The transcripts were coded, and the data analysed via inductive thematic analysis.

Results
A total of 37 interviews (32 one-to-one interviews and five focus group interviews) were analysed. Five main themes were identified: (1) individual perceptions of the intervention: inpatients/carer/staff/student, (2) implementation within the service and organisational context, (3) implementation strategies that were effective, (4) improvements to implementation strategies/barriers to implementation/unsuccessful strategies and (5) future directions of BOOST.

Conclusions
The qualitative data revealed that higher frequency physiotherapy was well-received by inpatients and that staff/students involved in providing care perceived it as a safe, acceptable and valuable practice. Implementation of higher daily frequency of physiotherapy using an alternative workforce may feasibly be adopted for inpatients following hip fracture surgery.

Trial registration
This study was approved by the Human Research Ethics Committee (HREC) of the Western Sydney Local Health District (2020/ETH02718). Mutual recognition of approval was subsequently obtained from Northern Sydney Local Health District HREC.
Budget impact analysis of a Lifestyle-integrated Functional Exercise (LiFE) program for older people in Germany: a Markov model based on data from the LiFE-is-LiFE trial
Authors: Dams Judith , Gottschalk Sophie , Schwenk Michael , Nerz Corinna , Becker Clemens , Klenk Jochen , Jansen Carl-Philipp , König Hans-Helmut 
Published: February 2024

Abstract
Background
Fall prevention is important for healthy ageing, but the economic impact of fall prevention are scarcely investigated. A recent cost-effectiveness analysis compared a group-delivered Lifestyle-integrated Functional Exercise Program (gLiFE) with an individually-delivered program (LiFE) in community-dwelling people (aged ≥ 70 years) at risk of falling. In addition, the current study aimed to analyze the budget impact of LiFE and gLiFE, compared with standard care in Germany.

Methods
A Markov model was developed to reflect falls and associated care needs for community-dwelling persons over 5 years. The intervention effects of LiFE and gLiFE were shown to be equivalent in a non-inferiority trial, although the costs differed. Outpatient, inpatient, and intervention costs were assessed from a payer’s perspective. The effect of parameter uncertainty was assessed in sensitivity analyses.

Results
The budget impact due to intervention costs was €510 million for LiFE and €186 million for gLiFE. Over five years, health care expenditures were €35,008 million for those receiving standard care, €35,416 million for those receiving LiFE, and €35,091 million for persons receiving gLiFE. Thereby, LiFE and gLiFE could prevent 2700 deaths and 648,000 falls over 5 years. Parameter uncertainties in the risk of falling, uptake of an intervention offer, and in the intervention effects had a major influence; thus cost savings for LiFE and gLiFE compared with standard care could be achieved for individuals with a high risk of falling.

Conclusions
The results revealed that cost savings for LiFE and gLiFE compared with standard care could only be achieved for individuals at high risk of falling, with gLiFE being superior to LiFE. Future research should consider benefits and aspects of fall prevention beyond falls (e.g., physical activity, social aspects, and personal preferences of participants).

Trial registration
The study was preregistered under underclinicaltrials.gov (identifier: NCT03462654) on 12th March 2018; https://clinicaltrials.gov/ct2/show/NCT03462654.
Influence of spectral shaping and tube voltage modulation in ultralow-dose computed tomography of the abdomen
Authors: Feldle Philipp , Grunz Jan-Peter , Kunz Andreas Steven , Pannenbecker Pauline , Patzer Theresa Sophie , Pichlmeier Svenja , Sauer Stephanie Tina , Hendel Robin , Ergün Süleyman , Bley Thorsten Alexander , Huflage Henner 
Published: February 2024

Abstract
Purpose
Unenhanced abdominal CT constitutes the diagnostic standard of care in suspected urolithiasis. Aiming to identify potential for radiation dose reduction in this frequent imaging task, this experimental study compares the effect of spectral shaping and tube voltage modulation on image quality.

Methods
Using a third-generation dual-source CT, eight cadaveric specimens were scanned with varying tube voltage settings with and without tin filter application (Sn 150, Sn 100, 120, 100, and 80 kVp) at three dose levels (3 mGy: standard; 1 mGy: low; 0.5 mGy: ultralow). Image quality was assessed quantitatively by calculation of signal-to-noise ratios (SNR) for various tissues (spleen, kidney, trabecular bone, fat) and subjectively by three independent radiologists based on a seven-point rating scale (7 = excellent; 1 = very poor).

Results
Irrespective of dose level, Sn 100 kVp resulted in the highest SNR of all tube voltage settings. In direct comparison to Sn 150 kVp, superior SNR was ascertained for spleen (p ≤ 0.004) and kidney tissue (p ≤ 0.009). In ultralow-dose scans, subjective image quality of Sn 100 kVp (median score 3; interquartile range 3–3) was higher compared with conventional imaging at 120 kVp (2; 2–2), 100 kVp (1; 1–2), and 80 kVp (1; 1–1) (all p < 0.001). Indicated by an intraclass correlation coefficient of 0.945 (95% confidence interval: 0.927–0.960), interrater reliability was excellent.

Conclusions
In abdominal CT with maximised dose reduction, tin prefiltration at 100 kVp allows for superior image quality over Sn 150 kVp and conventional imaging without spectral shaping.