bluuebunny/crossref_metadata_2025_split huggingface dataset:
Identifying and costing common gaps in Central and West Africa pharmaceutical regulation
Authors: Alfonso Claudia P. , N’Jambong Guy B. , Magdy Alaa , Di Trapani Laura , Kuwana Rutendo , Kahsay Abraham G. , Maïga Diadié , Ossei-Agyeman-Yeboah Sybil N. A. , Djitafo Fah Aimé B. , Ndomondo-Sigonda Margareth 
Published: April 2024

BackgroundRegulatory systems strengthening is crucial for catalyzing access to safe and effective medical products and health technologies (MPHT) for all. Identifying and addressing common regulatory gaps through regional approaches could be instrumental for the newly incepted African Medicine Agency.AimsThis original study sheds light on common gaps among 10 national regulatory authorities (NRAs) and ways to address them regionally.ObjectivesThe study used NRA self-assessment outcomes to identify common gaps in four critical regulatory pillars and estimate the cost of addressing them from regional perspectives that aimed at raising the maturity level of regulatory institutions.MethodsA cross-sectional study, using the WHO Global Benchmarking Tool (GBT), was conducted between 2020 and 2021 with five NRAs from ECCAS and ECOWAS member states that use French and Spanish as lingua franca.ResultsThe 10 NRAs operated in a non-formal-to-reactive approach (ML1-2), which hinders their ability to ensure the quality of MPHT and respond appropriately to public health emergencies. Common gaps were identified in four critical regulatory pillars—good regulatory practices, preparedness for public health emergencies, quality management systems, and substandard and falsified medical products—with overall cost to address gaps estimated at US$3.3 million.ContributionWe elaborated a reproducible method to strengthen regulatory systems at a regional level to improve equitable access to assured-quality MPHT. Our bottom-up approach could be utilized by RECs to address common gaps through common efforts.
Diaphragm ultrasonography as a monitor in assessing antagonistic effect of sugammadex on rocuronium in patients with Child-Pugh grades A and B
Authors: Sun Yan , Sun Shujun , Chen Rui , Shen Jiwei , Chen Xiangdong , Lin Yun , Yao Shanglong 
Published: April 2024

BackgroundAlthough diaphragm ultrasound can be used for detecting residual neuromuscular blockade post-surgery, there exists notable dearth in contemporary research exploring the correlation between preoperative Child-Pugh classification and the effectiveness of sugammadex in reversing rocuronium-induced blockade as evaluated by diaphragmatic ultrasonography.MethodsThis was a prospective, double-blind, non-randomized controlled clinical trial conducted on patients scheduled for laparoscopic liver resection surgery. The participants were categorized into two groups, A and B, based on their preoperative Child-Pugh classification. Prior to anesthesia induction, baseline diaphragm thickness was evaluated using ultrasonography. Throughout the surgical procedure, a deep neuromuscular blockade was maintained with rocuronium. Post-surgery, sugammadex (2 mg/kg) was intravenously administered to patients in both groups upon reaching a train-of-four ratio of 0.2. Diaphragm thickness was assessed at 0, 10, and 30 min, as well as 2 h after extubation, to analyze thickening fractioning (TF) and thickness recovery fractioning (TRF).ResultsNo significant differences in TF or TRF were observed between the two groups at 0, 10, and 30 min, as well as 2 h after extubation. Furthermore, there were no significant variances in hemodynamic stability following sugammadex administration. However, patients in the Child-Pugh B group experienced a significantly prolonged time from sugammadex administration to tracheal extubation (19 ± 8.0 min vs. 11 ± 6.1 min) and an extended post-anesthesia care unit stay (123 ± 28.3 min vs. 103 ± 26.0 min) compared to those in the Child-Pugh A group.ConclusionThe preoperative Child-Pugh grades may not exhibit a significant association with the reversal effect of sugammadex on rocuronium, as evaluated through diaphragmatic ultrasonography.Clinical trial registrationRegistered in the ClinicalTrials.gov (NCT05028088) on July 18, 2021.
Concomitant lithium increases radioiodine uptake and absorbed doses per administered activity in graves’ disease: comparison of conventional versus lithium-augmented radioiodine therapy
Authors: Khreish Fadi , Schaefer-Schuler Andrea , Roth Leonie , Burgard Caroline , Rosar Florian , Ezziddin Samer 
Published: April 2024

BackgroundLithium inhibits iodine and thyroid hormone release from thyroid cells, possibly increasing radioiodine retention and anti-hyperthyroid efficacy when given adjunctively to radioiodine therapy (RAI) of Graves’ disease (GD). However, the literature contains limited dosimetric data regarding the influence of concomitant lithium in this setting.MethodsWe retrospectively compared dosimetric variables in patients undergoing RAI with/without adjunctive lithium (n = 52 each). We assessed two low-dose, short-duration oral lithium carbonate regimens, 450 mg/d (n = 22) or 900 mg/d (n = 30), for a mean of 4.7 ± 1.4 d starting upon RAI administration. Patients underwent diagnostic testing to measure thyroidal radioiodine uptake (RAIU) 24 h ± 2 h after ingesting up to 5 MBq radioiodine, receiving individualized RAI activities 24 h later. Using ≥3 RAIU daily measurements starting 24 h post-RAI, researchers were able to determine the effective radioiodine half-life and absorbed dose to the thyroid; we also calculated the absorbed dose per administered activity concentration within that organ. Rates of GD cure, defined as reaching euthyroidism or hypothyroidism post-RAI, were evaluated in patients with ~6 months or longer post-RAI follow-up.ResultsThe lithium dosage subgroups had similar dosimetric values and thus are considered together. Lithium patients and controls had similar average “diagnostic” RAIU (51.1% ± 15.7% vs. 50.6% ± 13.8%, p = 0.820), but the former had significantly higher RAIU post-RAI (56.3% ± 13.5% vs. 49.1% ± 13.5%, p = 0.002), reflecting significantly greater change in the former (+16.2% ± 30.4% vs. -1.8% ± 16.1%, p = 0.001). Radioiodine effective half-life was non-significantly longer in lithium patients (5.43 ± 1.50 d vs. 5.08 ± 1.16 d, p = 0.192). The mean RAI administered activity was 27% less in lithium patients (677 ± 294 MBq vs. 930 ± 433 MBq, p = 0.001), but GD cure rates were similar (83% [39/47] vs. 82% [33/40], p = 0.954), possibly due to the significantly higher thyroid dose in the lithium patients, especially in thyroid gland with a volume ≤ 20 mL (1.04 ± 0.44 Gy/MBq vs. 0.76 ± 0.30 Gy/MBq, p = 0.020). Day 3 serum lithium concentrations were low (450 mg/d: 0.26 ± 0.12 mmol/L, 900 mg/d: 0.50 ± 0.18 mmol/L); no lithium toxicity was noted.ConclusionLithium augmentation may increase the RAIU and thyroid absorbed dose, permitting potentially decreased RAI activities without sacrificing efficacy. Our observations should be confirmed in a prospective, randomized trial.
Safety and immunogenicity of Vi-diphtheria toxoid typhoid conjugate vaccine among children below 2 years: a systematic review and meta-analysis
Authors: Mohamed Taha Amira , Abouelmagd Khaled , Mahmoud Abdelrahman Mohamed , Elkasaby Mohamed Hamouda , Nguyen Dang , Ahmed Ryan , Patel Pari , Bonilla-Aldana D. Katterine , Luna Camila , Rodriguez-Morales Alfonso J. 
Published: April 2024

BackgroundThe Vi-diphtheria toxoid typhoid conjugate vaccine (Vi-DT) has shown promising results in preventing typhoid fever in children under 2 years of age. However, a thorough assessment of its safety and immunogenicity is required to inform vaccination strategies. This systematic review and meta-analysis aimed to determine the safety and immunogenicity of Vi-DT in children below 2 years.MethodsWe systematically searched multiple databases, including PubMed, Web of Science, and Scopus, for relevant studies published up to September 2023. We included studies reporting on the safety and immunogenicity outcomes of Vi-DT compared to the control or Vi-tetanus toxoid conjugated vaccine (Vi-TT) in children below 2 years. We applied a random-effects model for meta-analysis using RevMan 5.4. We expressed the results as risk ratio (RR) with a 95% confidence interval (95%CI).ResultsIn this analysis, five studies were selected, encompassing 1,292 children under 2 years who received the Vi-DT vaccine. No significant difference in immediate reactions was observed within 30 min post-vaccination between Vi-DT and control groups (RR: 0.99 [95% CI: 0.19, 5.26]), nor between Vi-DT and Vi-TT groups. For solicited adverse events within 4 weeks, the VI-DT group showed no significant increase in adverse events compared to control (RR: 0.93 [95% CI: 0.78, 1.12]) or Vi-TT (RR: 0.86 [95% CI: 0.69, 1.07]). Similarly, within 7 days post-vaccination, risk ratios indicated no significant differences in adverse events between the groups. The 4-week seroconversion rate was significantly higher in the Vi-DT group compared to the control (RR: 1.99 [95% CI: 1.07, 3.69]), but no difference was found between Vi-DT and Vi-TT. Adverse events associated with typhoid conjugate vaccines were predominantly non-serious, including fever and injection site reactions. Serious adverse events were rare but included conditions like pneumonia and gastroenteritis.ConclusionThis meta-analysis highlights Vi-DT safety and immunogenicity in six to 24-month-old children. The findings support the use of this Vi-DT to expand typhoid vaccination in endemic regions, in line with WHO’s strategy.
The application prospects of robot pose estimation technology: exploring new directions based on YOLOv8-ApexNet
Authors: Tang XianFeng , Zhao Shuwei 
Published: April 2024

IntroductionService robot technology is increasingly gaining prominence in the field of artificial intelligence. However, persistent limitations continue to impede its widespread implementation. In this regard, human motion pose estimation emerges as a crucial challenge necessary for enhancing the perceptual and decision-making capacities of service robots.MethodThis paper introduces a groundbreaking model, YOLOv8-ApexNet, which integrates advanced technologies, including Bidirectional Routing Attention (BRA) and Generalized Feature Pyramid Network (GFPN). BRA facilitates the capture of inter-keypoint correlations within dynamic environments by introducing a bidirectional information propagation mechanism. Furthermore, GFPN adeptly extracts and integrates feature information across different scales, enabling the model to make more precise predictions for targets of various sizes and shapes.ResultsEmpirical research findings reveal significant performance enhancements of the YOLOv8-ApexNet model across the COCO and MPII datasets. Compared to existing methodologies, the model demonstrates pronounced advantages in keypoint localization accuracy and robustness.DiscussionThe significance of this research lies in providing an efficient and accurate solution tailored for the realm of service robotics, effectively mitigating the deficiencies inherent in current approaches. By bolstering the accuracy of perception and decision-making, our endeavors unequivocally endorse the widespread integration of service robots within practical applications.
Could early life DHA supplementation benefit neurodevelopment? A systematic review and meta-analysis
Authors: Hu Ruolan , Xu Juan , Hua Yimin , Li Yifei , Li Jinrong 
Published: April 2024

BackgroundDocosahexaenoic acid (DHA) plays a crucial role in the growth and functional development of the infant brain. However, the impact of additional DHA supplementation on neurodevelopment in infants remains controversial in randomized controlled trials. In this systematic review and meta-analysis, we aimed to investigate the effects of prenatal and postnatal DHA supplementation on neurodevelopment.MethodsWe systematically searched the MEDLINE, EMBASE, and Cochrane Library electronic databases using a predefined strategy until 8 February 2024. We extracted relevant study characteristics and outcomes related to the nervous system. Two independent reviewers critically evaluated the included studies to assess their validity and risk of bias.ResultsA total of 21 studies met our inclusion criteria, one study was removed after quality assessment, and the meta-analysis included 9 randomized controlled trials. The meta-analysis results indicated that there was no statistically significant difference between the DHA supplementation group and the placebo group, as assessed by the Mental Development Index [MDI; mean difference (MD), 0.41; 95% confidence interval (CI), −0.91 to 1.73; p = 0.55]. However, the DHA group had a significantly higher Psychomotor Development Index (PDI) than the placebo group (MD, 1.47; 95% CI, 0.23 to 2.72; p = 0.02). Subgroup analyses based on populations showed that DHA supplementation was superior to placebo for infants in both MDI (language score conversion; MD, 2.05; 95% CI, −0.16 to 4.26; p = 0.07) and PDI (MD, 1.94; 95% CI, 0.23 to 3.65; p = 0.03). Other subgroup analyses indicated no statistical differences between the two groups. The remaining assessments that could not be summarized quantitatively underwent a narrative evaluation.ConclusionBased on the BSID assessments, DHA supplementation in infants may have potential neurodevelopmental benefits. Because the meta-analysis included few high-quality articles and had some limitations, more relevant articles are needed to address the need for separate DHA supplementation in infants, pregnant women, and lactating mothers.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022348100, identifier: CRD42022348100.
Efficacy and safety of low-dose esketamine for painless gastrointestinal endoscopy in adults: a systematic evaluation and meta-analysis
Authors: Deng Juan , Yu Yun-Feng , Tang Zheng-Guo , Lei Hua-Juan , Tan Chuan-Chuan 
Published: April 2024

Object: The benefits of low-dose esketamine for painless gastrointestinal endoscopy remain unclear. As such, the present study aimed to investigate the efficacy and safety of low-dose esketamine for this procedure.Methods: Seven common databases were searched for clinical studies investigating low-dose esketamine for painless gastrointestinal endoscopy. Subsequently, a meta-analysis was performed to synthesize and analyze the data extracted from studies fulfilling the inclusion criteria.Results: Meta-analysis revealed that, compared with propofol, low-dose esketamine in combination with propofol significantly reduced recovery time by 0.56 min (mean difference [MD] −0.56%, 95% confidence interval (CI) −1.08 to −0.05, p = 0.03), induction time by 9.84 s (MD −9.84, 95% CI −12.93 to −6.75, p &lt; 0.00001), propofol dosage by 51.05 mg (MD −51.05, 95% CI −81.53 to −20.57, p = 0.01), and increased mean arterial pressure by 6.23 mmHg (MD 6.23, 95% CI 1.37 to 11.08, p = 0.01). Meanwhile, low-dose esketamine reduced injection pain by 63% (relative risk [RR] 0.37, 95% CI 0.28 to 0.49, p &lt; 0.00001), involuntary movements by 40% (RR 0.60, 95% Cl 0.42 to 0.85, p &lt; 0.005), choking by 42% (RR 0.58, 95% Cl 0.38 to 0.88, p = 0.01), bradycardia by 68% (RR 0.32, 95% Cl 0.18 to 0.58, p = 0.0002), hypotension by 71% (RR 0.29, 95% Cl 0.21 to 0.40, p &lt; 0.00001), respiratory depression by 63% (RR 0.37, 95% 0.26 to 0.51, p &lt; 0.00001), additional cases of propofol by 53% (RR 0.47, 95% Cl 0.29 to 0.77, p = 0.002), and increased hypertension by 1000% (RR 11.00, 95% Cl 1.45 to 83.28, p = 0.02). There were no significant differences in mean heart rate, mean oximetry saturation, delirium, dizziness, vomiting, tachycardia, and hypoxemia. Subgroup analyses revealed that, compared with other dose groups, 0.25 mg/kg esketamine afforded additional benefits in recovery and induction time, mean arterial pressure, involuntary movements, hypoxemia, and respiratory depression.Conclusion: Low-dose esketamine was found to be safe and effective for providing anesthesia during gastrointestinal endoscopy, with 0.25 mg/kg identified as the optimal dose within the dosage ranges examined. However, caution should be exercised when administering this drug to patients with inadequate preoperative blood pressure control.
Long-range air-host plasmonic propagation with subwavelength confinement
Authors: Yue Kun , Feng Xialian , Yu Jiaxin , Gu Fuxing 
Published: April 2024

Confining light at a subwavelength scale is important for building ultracompact opto-electronic networks. Plasmonic waveguides are good candidate devices for this purpose. However, the oscillation of electrons relating to surface plasmon polaritons causes energy dissipation, which limits the propagation length and thus reduces the waveguide performance. Here, we design a low-loss plasmonic waveguide composed of a nanowire dimer structure on a metal substrate, in which the dominant modes are localized within the air gap between the nanowires and referred to as air-host plasmonic modes. The use of air instead of dielectric materials as the host medium can reduce ohmic loss and avoid the dispersion effect of dielectric. When the constructed nanowires have a diameter less than 100 nm, the air-host mode has subwavelength-scale confinement and a propagation length of ∼100 μm, which has broad application prospects for the construction of ultracompact plasmonic devices.
Understanding optimal cadence dynamics: a systematic analysis of the power-velocity relationship in track cyclists with increasing exercise intensity
Authors: Dunst Anna Katharina , Hesse Clemens , Ueberschär Olaf 
Published: April 2024

Background:This study aimed to investigate the changes in force-velocity (F/v) and power-velocity (P/v) relationships with increasing work rate up to maximal oxygen uptake and to assess the resulting alterations in optimal cadence, particularly at characteristic metabolic states.Methods:Fourteen professional track cyclists (9 sprinters, 5 endurance athletes) performed submaximal incremental tests, high-intensity cycling trials, and maximal sprints at varied cadences (60, 90, 120 rpm) on an SRM bicycle ergometer. Linear and non-linear regression analyses were used to assess the relationship between heart rate, oxygen uptake (V.O2), blood lactate concentration and power output at each pedaling rate. Work rates linked to various cardiopulmonary and metabolic states, including lactate threshold (LT1), maximal fat combustion (FATmax), maximal lactate steady-state (MLSS) and maximal oxygen uptake (V.O2max), were determined using cadence-specific inverse functions. These data were used to calculate state-specific force-velocity (F/v) and power-velocity (P/v) profiles, from which state-specific optimal cadences were derived. Additionally, fatigue-free profiles were generated from sprint data to illustrate the entire F/v and P/v continuum.Results:HR, V.O2demonstrated linear relationships, while BLC exhibited an exponential relationship with work rate, influenced by cadence (p&lt; 0.05, η2≥ 0.655). Optimal cadence increased sigmoidally across all parameters, ranging from 66.18 ± 3.00 rpm at LT1, 76.01 ± 3.36 rpm at FATmax, 82.24 ± 2.59 rpm at MLSS, culminating at 84.49 ± 2.66 rpm at V.O2max(p&lt; 0.01, η2= 0.936). A fatigue-free optimal cadence of 135 ± 11 rpm was identified. Sprinters and endurance athletes showed no differences in optimal cadences, except for the fatigue-free optimum (p&lt; 0.001, d = 2.215).Conclusion:Optimal cadence increases sigmoidally with exercise intensity up to maximal aerobic power, irrespective of the athlete’s physical condition or discipline. Threshold-specific changes in optimal cadence suggest a shift in muscle fiber type recruitment toward faster types beyond these thresholds. Moreover, the results indicate the need to integrate movement velocity into Henneman’s hierarchical size principle and the critical power curve. Consequently, intensity zones should be presented as a function of movement velocity rather than in absolute terms.
Knowledge, attitude, and practice toward the prevention of occupational exposure in public health emergencies among nurses in Wuhan
Authors: Liu Yan , Zhang Zhili , Liu Ying 
Published: April 2024

Background and objectiveNurses have an essential role in dealing with public health emergencies (PHE). This study explored the knowledge, attitude, and practice (KAP) towards preventing occupational exposure in PHE among nurses in Wuhan.MethodsThis cross-sectional study was conducted in May 2023 to assess the KAP of nurses in Wuhan, China. Questionnaires were created and distributed to evaluate the KAP of nurses and explore the factors associated with KAP. Univariate and multivariate logistic regression analyses were used to assess the association between baseline demographic characteristics and KAP, and structural equation modeling (SEM) was used to explore complex relationships and causal pathways among relevant factors.ResultsA total of 440 valid questionnaires were collected. The mean knowledge, attitude, and practice scores were 11.84 ± 2.37, 39.87 ± 3.10, and 44.05 ± 3.76, respectively. The univariate and multivariate logistic regression analyses revealed that age &gt;50 years old (p = 0.039), working experience of 1–3 years (p = 0.060) and 4–6 years (p = 0.024), participation in PHE training, and scene rescue (p &lt; 0.001) were significantly associated with knowledge score. In addition, the attitude of the nurses was significantly related to knowledge scores (p = 0.002). Moreover, practice was significantly associated with knowledge scores (p = 0.005) and attitude scores (p &lt; 0.001). The correlation analysis showed that the practice was significantly associated with knowledge (r = 0.336, p &lt; 0.001) and attitude (r = 0.449, p &lt; 0.001).ConclusionNurses exhibited moderate knowledge, relatively positive attitude, and practice, which needed to be improved regarding occupational exposure in PHE. The practice of the nurses could be promoted by paying more attention to the working experience, participation in training and scene rescue in PHE, and their knowledge and attitude.