bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of virtual reality training system for combat musculoskeletal trauma care
Authors: Qin Lincan , You Zhiwei , Liu Bo , Luo Chunmei 
Published: April 2024

Objective: A virtual reality (VR)-based training system for combat musculoskeletal trauma care (CMTC) was meticulously crafted to enhance trainees’ theoretical understanding, familiarity with care processes, and decision-making abilities in the realm of combat musculoskeletal trauma management. Method: Scenario scripts, descriptions of injuries, and foundational management plans for care under fire and tactical field care were constructed. Subsequently, the CMTC system was developed employing tools, such as Maya, Photoshop, Unity, SQLite, and Visual Studio. Finally, the system was tested by 30 civilian nurses. The trainees’ knowledge, satisfaction, and system usability were evaluated using the theoretical question bank module, questionnaire, and system usability scale (SUS). Results: This research resulted in the establishment of five types of processes for CMTC in the contexts of care under fire and tactical field care. The study indicated that the trainees’ scores after training (75.67 ± 6.91) was higher than before training (69.17 ± 10.91), p < 0.001, the t-statistic was −5.022. The resultant SUS score was 70.4 ± 9.40. An overwhelming 96.67% of the trainees expressed satisfaction with the teaching quality. Conclusion: The CMTC system, developed in alignment with Tactical Combat Casualty Care (TCCC) guidelines and infused with cutting-edge equipment and technologies, provides an interactive and modular simulation training experience. Its strengths include higher reality, enhanced safety, repeatability, cost-effectiveness, and the provision for performance analysis. Besides, it has good accessibility and reliability, and can cultivate students’ autonomous learning ability and deepen their understanding.
Does native vitamin D, or active vitamin D modulate the neutralising antibody responses to COVID-19 vaccination in haemodialysis patients?
Authors: Davenport Andrew 
Published: April 2024

Introduction: Several studies have reported that patients with low levels of Vitamin D3 have impaired responses to vaccination, including COVID-19 vaccines, so we reviewed the response to COVID-19 vaccination in haemodialysis patients, who typically have reduced Vitamin D3 levels. Methods: The inhibitory antibody (IC50) responses to several COVID-19 variants following vaccination in a cohort of United Kingdom haemodialysis patients receiving two vaccinations between March 2021 and May 2021 were reviewed. Results: A total of 183 haemodialysis patients, 65.5% male, mean age 65.6 ± 14.1 years, 46.4% diabetic, 42.1% white ethnicity, body mass index 26.9 ± 6.5 kg/m2 dialysis vintage 36.2 (18.3–69.3) months were studied. Following the first vaccination, the median IgG microneutralisation IC50 response was undetectable for all variants (wild-type, alpha, beta and delta). Follow-up after the second vaccination showed that the microneutralisation response to all variants increased and was greater for the wild-type variant compared to alpha, beta and delta, all p < 0.001, There were no differences comparing the IC50 responses according to 25-Vitamin D3 levels, and the prescription of activated Vitamin D. Although patients who had previously tested positive for COVID-19 prescribed higher doses of alfacalcidol had higher seroprotection responses to the alpha (χ2 = 15, p = 0.002) and beta variants. (χ2 = 13, p = 0.005). Conclusions: The response to COVID-19 vaccination was reduced in our elderly haemodialysis patients compared to younger less frail patients, however there was no overall demonstrable effect of either 25-Vitamin D3 levels or the prescription of activated forms of Vitamin D on the immune response following vaccination against COVID-19, unless patients had previously tested positive for COVID-19.
Improving the material extrusion processing of thermoplastic olefin/graphene nanoplatelet composites through control of the morphology
Authors: Ho Quang Binh , Abdi Roxana , Kontopoulou Marianna , Leelapornpisit Weawkamol 
Published: April 2024

The aim of this research is to develop thermoplastic olefin (TPO) composites containing polypropylene (PP), an elastomeric ethylene-octene copolymer (EOC) and graphene nanoplatelets (GNPs), suitable for material extrusion (MEX). A PP functionalized with amino-pyridine (PP-g-Py) was used as a compatibilizer. The composite blends had droplet-matrix morphology at compositions as high as 40 wt% EOC. Imaging by Transmission Electron Microscopy showed that the GNPs resided at the interface between the blend components. This microstructure promoted higher thermal conductivity of the TPO/GNP composite blends, as compared to the PP/GNP composite (1.54 W/m K, vs 1.3 W/m K respectively). PP/GNP composites processed by MEX exhibited inadequate interfacial fusion between the deposited strands, which resulted in severe delamination during tensile and flexural testing, and consequently poor mechanical properties. In the TPO/GNP composites containing 40 wt% EOC, the slower crystallization of the elongated EOC domains promoted interfacial adhesion between the strands, resulting in better part consolidation, more consistent mechanical properties and improved ductility compared to the PP/GNP composites.
Ultrasonography-Based Quantitative Evaluation of Second Metatarsophalangeal Joint Instability in Female Patients With Hallux Valgus
Authors: Shima Hiroaki , Togei Kosho , Hirai Yoshihiro , Tanaka Ken , Yasuda Toshito , Neo Masashi 
Published: April 2024

Background: Patients with moderate to severe hallux valgus (HV) sometimes exhibit second metatarsophalangeal (MTP) joint dislocation. Second MTP joint instability due to plantar plate (PP) injury has been suggested as one of the causes. However, there have been no reports that quantitatively evaluate this instability. This study aimed to evaluate second MTP joint instability in patients with HV without dislocation via ultrasonography and investigate its relationship with the presence of PP injury or foot form. Methods: Between May 2018 and July 2023, symptomatic female patients with HV without any lesser toe deformity were included in this study. Second MTP joint instability was defined as the dorsal displacement ratio (DDR) of the passively subluxated proximal phalangeal articular surface on the metatarsal head articular surface. The presence of PP injury was assessed using ultrasonography. Foot “form” was determined by measuring standard foot bony angles on weight-bearing foot-ankle radiographs. The relationship between DDR or PP injury and radiographic measurements was investigated. Results: Sixty-four patients (100 feet) were included. The average DDR of the second MTP joint in patients with HV without dislocation was 35.7%. There was an increase in the probability of PP injury, above a cutoff DDR value r of 35.4% (area under the curve = 0.712). The sensitivity, specificity, positive predictive value, and negative predictive value for the presence of PP injury based on this cutoff level were 63.9%, 74.4%, 79.6%, and 56.9%, respectively. Metatarsalgia was reported in 21 feet (21.0%), of which 15 feet (71.4%) showed PP injury. An increase in DDR was weakly associated with increased metatarsus adductus angle and decreased second metatarsal height. Conclusion: In female patients with HV without second MTP dislocation, we found ultrasonographic evidence of second MTP plantar plate injury and joint instability to be a relatively common finding with a high prevalence in those with localized metatarsalgia. Level of Evidence: Level II, development of diagnostic criteria based on consecutive patients.
Multimodal imaging in deferasirox-mediated retinopathy
Authors: Caranfa Jonathan , Carrera William , Marmalidou Anna , Desai Shilpa , Baumal Caroline 
Published: April 2024

Introduction Deferasirox is the only iron chelator available in oral formulation and a rare cause of pigmentary retinopathy. We report the first case of multimodal imaging in an adult with deferasirox retinopathy. Methods Case report and literature review, with search terms including deferasirox retinopathy and deferasirox toxicity. Results A 63-year-old man with end stage renal disease and transfusion-dependent anemia on deferasirox for one year presented with asymptomatic pigment epitheliopathy. Optical coherence tomography featured outer retinal and retinal pigment epithelial discontinuity corresponding to hypoautofluorescence on fundus autofluorescence and blocking on fluorescein angiography. Multifocal electroretinography revealed subtle reduction in all amplitudes. Conclusions Retinal examinations should be considered for patients requiring chronic administration of deferasirox.
Comparison of 3D Easy Box cone-beam computed tomography analysis with 2D Modified Easy Box on OPG as a prognostic tool for impacted maxillary canines: A pilot study
Authors: Dias Rochelle , Kanungo Himanshu , Gupta Mukesh , Mishra Kratika , Soni Akanksha , Jaiswal Aayush 
Published: April 2024

Objective: To assess and compare the validity of 2D modified Easy Box and measurement of the Beta angle on standard conventional orthopantomogram (OPG) versus 3D cone-beam computed tomography (CBCT) OPG-constructed view. Design: A retrospective agreement study. Methods: The aim of this study was to construct an Easy Box on a standard conventional OPG and to validate this novel method by comparing it with the Easy Box method on 3D CBCT. After approval from the Ethics Committee, OPG and CBCT radiographs were obtained for the study from departmental records and five private practices in the same location (Indore, India). The radiographs were selected based on record availability and with written consent from the participants before the commencement of the study. The records were analysed to enable a comparison and to assess the accuracy of Easy Box construction on both 3D CBCT and standard conventional OPG radiographs. The location of the impacted canine within the Easy Box boundaries and the measurement of the Beta angle were determined on both views. Results: A perfect agreement was obtained for the comparison of 3D Easy Box CBCT analysis with 2D modified Easy Box on OPG for impacted maxillary canines (Kappa = 1.0). A Bland–Altman (LoA) analysis showed no proportional bias in the comparison of the Beta angle on 3D and 2D OPG radiographs. Conclusion: Beta angle and 2D modified Easy Box on a conventional OPG yield similar results when compared to Easy Box on 3D CBCT OPG-constructed view. The standard OPG was valuable and cost-effective, particularly in the early stages of diagnosis and treatment planning, either as a substitute or when CBCT was unavailable.
Periodontal outcomes of surgically exposed and orthodontically aligned buccally impacted maxillary canines: A systematic review and meta-analysis
Authors: Corrente Marina Nogueira de Castro Galvão , do Amaral Guilherme Castro Lima Silva , Ribeiro Rafael Costa , Pannuti Cláudio Mendes , Cavalcanti Laura Grein , Villar Cristina Cunha 
Published: April 2024

Objective: To compare the periodontal outcomes of surgically exposed and orthodontically aligned buccally impacted maxillary canines to spontaneously erupted maxillary canines. Data sources: An unrestricted search was carried out of indexed databases (Medline, EMBASE, Web of Science and Scopus), reference lists of included studies, and grey literature published until December 2023. Data selection: Observational and experimental studies that addressed the focused question ‘Do periodontal outcomes of buccally impacted maxillary canines that were surgically exposed and subsequently extruded and aligned using orthodontic alignment, differ from those of spontaneously erupted maxillary canines?’ were included. Data extraction: Study screening, selection and data extraction were performed independently by two authors, with disagreement resolved by a third reviewer. The risk of bias was assessed using the JBI Critical Appraisal Checklist and GRADE approach. Results: A total of 857 citations were found and five studies were eligible for inclusion. Supragingival plaque accumulation and gingival inflammation were similar between impacted canines and their contralaterals in most studies. Meta-analyses revealed no significant differences in keratinised tissue width (prospective studies: MD = −0.28, 95% confidence interval [CI] = −1.13–0.56, I² = 78%; retrospective studies: MD = 0.61, 95% CI = −1.51–2.72, I² = 94%). However, a meta-analysis of prospective studies showed slightly greater mean probing depth for impacted canines compared to their contralateral canines (prospective studies: MD = 0.16, 95% CI = 0.04–0.28, I² = 0%). The evidence certainty for keratinised tissue width and probing depth outcomes was low. Conclusion: Surgically exposed and orthodontically aligned buccally impacted canines have slightly greater probing depths, potential bone loss and increased clinical crown length, compared to their counterparts. However, these small differences (<1 mm) are unlikely to be clinically significant.
Efficacy and safety of mechanochemical ablation versus laser ablation in the treatment of primary great saphenous vein reflux: A randomized, open, parallel controlled clinical trial
Authors: Chen Jie , Zhang Jianbin , Wang Qian , Chen Shu , Sun Mingsheng , Liu Peng , Ye Zhidong 
Published: April 2024

Objective To evaluate the efficacy of a new mechanochemical ablation (MOCA) device versus endovenous laser ablation (EVLA) for primary great saphenous vein (GSV) reflux. Materials and methods Prospectively analyze the demographics, treatment detail and outcomes data of 57 primary GSV reflux patients. Patients were randomly assigned to MOCA or EVLA group with random envelope method. Primary endpoint was 6-month closure rate of GSV. Secondary endpoint including technical success rate, the venous clinical severity score (VCSS), chronic venous insufficiency questionnaire (CIVIQ-20) score and visual analogue scale (VAS) for pain. Results The procedures were well tolerated according to the VAS score. The 6-month closure rate was 85.71% in MOCA and 96.55% in EVLA group ( p = .194). Significant changes were observed in regard of VCSS and CIVIQ-20 score at 6-month follow-up. Skin paresthesia occurred in 0 in MOCA and 5 in EVLA group. Conclusion The new MOCA device is safe and effective in treating primary great saphenous vein reflux. The 6-month closure rate is non-inferior compared with EVLA. However, the long-term results need further follow-up.
A preliminary analysis of “Passport to practice”: investigating development of core competencies in undergraduate health promotion students
Authors: Blackford Krysten , Della Bona Malena , Crawford Gemma 
Published: April 2024

Background: Equipping tertiary health promotion students with skills and knowledge to contribute meaningfully to the health promotion workforce begins with enhancing their health promotion competence via well-designed curriculum. This includes a focus on work-integrated learning, global citizenship, professional identity and competency mapping in line with the International Union for Health Promotion and Education Core Competencies and Professional Standards for Health Promotion. Methods: In this paper we report baseline results for the Passport to Practice project, a mixed-methods prospective cohort study to track undergraduate health promotion student progress across their degree, to evaluate a new approach for assessing student achievement of the Competencies and Standards developed by the International Union for Health Promotion and Education. Baseline data were collected from first-year students via document analysis of student reflection papers ( n = 40); and an online survey ( n = 29) to measure self-reported health promotion competence, development of global citizenship and professional identity, and PebblePad usability. Results: Findings suggest the Passport to Practice initiative positively contributed to professional identity and health promotion competence. Students appreciated work-integrated learning opportunities that enabled them to plan for future activities to address gaps in their competence; and students excelled in the social responsibility dimension of global citizenship but lagged in the political voice category of the global civic engagement dimension. Conclusion: Findings provide insights about strategies and concepts required to equip students with the skills and knowledge required for their role as health promotion practitioners to address complex public health challenges.
Innovate and Validate: Design-Led Simulation Optimization to Test Centralized Registration Feasibility in a Multispecialty Clinic
Authors: Hosseini Maryam , Gittler Alice M. , Hoak Michael , Cogswell Jonathan , Khasawneh Mohammad T. 
Published: April 2024

Objective: This study utilizes a design-led simulation-optimization process (DLSO) to refine a hybrid registration model for a free-standing outpatient clinic. The goal is to assess the viability of employing DLSO for innovation support and highlight key factors influencing resource requirements. Background: Manual registration in healthcare causes delays, impacting patient services and resource allocation. This study addresses these challenges by optimizing a hybrid centralized registration and adopting technology for efficiency. Method: An iterative methodology with simulation optimization was designed to test a proof of concept. Configurations of four and five registration options within a hybrid centralized system were explored under preregistration adoption rates of 30% and 50%. Three self-service kiosks served as a baseline during concept design and test fits. Results: Centralized registration accommodated a daily throughput of 2,000 people with a 30% baseline preregistration rate. Assessing preregistration impact on seating capacity showed significant reductions in demand and floor census. For four check-in stations, a 30%–50% preregistration increase led to a 32% seating demand reduction and a 26% decrease in maximum floor census. With five stations, a 50% preregistration reduced seating demand by 23% and maximum floor census by 20%. Conclusion: Innovating introduces complexity and uncertainties requiring buy-in from diverse stakeholders. DLSO experimentation proves beneficial for validating novel concepts during design.
Optimizing Nurse Workflow Efficiency: An Examination of Nurse Walking Behavior and Space Accessibility in Medical Surgical Units
Authors: Zamani Zahra , Joy Theresa , Worley Jennifer 
Published: April 2024

Objective: This study aimed to investigate the effect of spatial adjacencies on nurses’ walking patterns and the subsequent impact on staff satisfaction with perceived accessibility and adjacency-related issues. Background: Recognizing the crucial importance of spatial adjacencies in healthcare facilities is essential, as they significantly affect staff morale, fatigue management, operational efficiency, error reduction, and overall patient care excellence, highlighting the need for objective assessments to evaluate the impact of facility layout and space configuration on workflow patterns and staff satisfaction in patient care units. Methods: Integrating on-site observations with survey data, we explored how spatial adjacencies affect staff walking behavior and satisfaction in two med-surgical unit floors. Results: The findings highlighted a significant frequency of movements between nurse stations, patient rooms, and medication areas. Regression analysis identified several contributing factors to staff satisfaction, including the proximity of supplies, team visibility, ease of access across departments, and the location of equipment rooms. Specifically, satisfaction with the proximity of supplies was positively associated with increased provider satisfaction with workflow, quality of care, and workplace. Additionally, valuable feedback from staff revealed concerns regarding break room placement, medication area functionality, and disparities in the availability of supplies. Conclusion: This study highlighted the critical need for carefully planned spatial adjacency strategies to enhance workflow efficiency and raise clinical staff satisfaction within healthcare facilities. The actionable insights gleaned from this research offer valuable direction to architects, healthcare administrators, and design professionals, enabling the creation of environments that positively resonate with healthcare providers and improve healthcare operations.
Prevalence and predictors of persistent low-level HIV viraemia: a retrospective cohort study among people receiving dolutegravir-based antiretroviral therapy in Southern Nigeria
Authors: Onwah Ogheneuzuazo , Nwanja Esther , Akpan Uduak , Toyo Otoyo , Nwangeneh Chiagozie , Oyawola Babatunde , Idemudia Augustine , Olatunbosun Kolawole , Igboelina Onyeka , Ogundehin Dolapo , James Ezekiel , Onyedinachi Okezie , Adegboye Adeoye , Eyo Andy 
Published: April 2024

Background: Persistent low-level viraemia (PLLV) is a risk factor for virologic failure among people receiving antiretroviral therapy (ART). Objectives: We assessed the prevalence and predictors of PLLV among individuals receiving Dolutegravir-based ART in southern Nigeria. Design: This retrospective cohort study used routine program data from electronic medical records of persons receiving Dolutegravir-based first-line ART in 154 PEPFAR/USAID-supported health facilities in Akwa Ibom and Cross Rivers states, Nigeria. Methods: Clients on first-line Dolutegravir-based ART ⩾6 months, who had a viral load result in the 12 months preceding October 2021 (baseline), and a second viral load result by September 2022 were included. Persons with low-level viraemia (LLV) (viral load 51–999 copies/ml) received additional adherence support. The outcome analysed was PLLV (two consecutive LLV results). Indices were summarized using descriptive statistics, and predictors of PLLV were determined using multivariate logistic regression. Results: In total, 141,208 persons on ART were included, of which 63.3% ( n = 89,944) were females. The median age was 36 [29–44] years, median ART duration was 19 [11–42] months. At the end of the study, 10.5% (14,759/141,208) had initial LLV, 90.1% (13,304/14,759) of which attained undetectable viral load (⩽50 copies/ml), and 1.1% (163/14,759) transitioned to virologic failure (⩾1000 copies/ml) by the end of the study. PLLV prevalence was 0.9% (1292/141,208). Increasing ART duration [adjusted odds ratio (aOR) = 1.0; 95% confidence interval (CI): 1.005–1.008; p < 0.001] and viral suppression (<1000 copies/ml) before initial LLV (aOR = 1.7; 95% CI: 1.50–2.00; p < 0.001) were positively associated with PLLV, while receipt of tuberculosis preventive therapy reduced the likelihood of PLLV (aOR = 0.3; 95% CI: 0.10–0.94; p = 0.039). Conclusion: PLLV was uncommon among individuals receiving dolutegravir-based ART and was associated with longer ART duration, prior viral suppression, and non-receipt of tuberculosis preventive therapy. This strengthens recommendations for continuous adherence support and comprehensive health services with ART, to prevent treatment failure.