bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quasi‐invariance of modulus and quasisymmetry of weakly (L,M)‐quasisymmetric maps in metric spaces
Authors: Cheng Tao , Yang Shanshuang 
Published: November 2023

AbstractThis paper contributes to the study of a fundamental problem in the theory of quasiconformal analysis: under what conditions local quasiconformality of a homeomorphism implies its global quasisymmetry. We show that in general metric spaces local regularity and some connectivity together with the Loewner condition are necessary and sufficient for a quasiconformal map to be globally quasisymmetric with respect to the internal metrics. In this endeavor, two major new ingredients are used. One is the recently introduced concept of weakly ‐quasisymmetry, serving as a bridge between local quasiconformality and global quasisymmetry. Another is the quasi‐invariance of conformal modulus under weakly ‐quasisymmetric maps, which is developed in this paper.
Einstein vs Hawking: black hole binaries and cosmological expansion
Authors: Barrau Aurélien , Blachier Baptiste , Lahlou Maxime , Liu Andrew , Martineau Killian 
Published: November 2023

AbstractThis note aims at investigating two different situations where the classical general relativistic dynamics compete with the evolution driven by Hawking evaporation. We focus, in particular, on binary systems of black holes emitting gravitational waves and gravitons, and on the cosmological evolution when black holes are immersed in their own radiation bath. Several non-trivial features are underlined in both cases.
Kidney disease characteristics, prevalence, and risk factors in León, Nicaragua: a population-based study
Authors: Strasma Anna , Reyes Ángel Mejía , Aragón Aurora , López Indiana , Park Lawrence P. , Hogan Susan L. , Thielman Nathan , Wyatt Christina , González-Quiroz Marvin 
Published: November 2023

Abstract
Background
CKD of unknown etiology (CKDu) disproportionately affects young people in Central America who lack traditional CKD risk factors (diabetes and hypertension) and has instead been variably linked to heat stress, occupational and environmental exposures, nephrotoxic medications, and/or genetic susceptibility. This study aimed to estimate the prevalence of CKD and identify risk factors for traditional CKD and CKDu in Nicaragua.

Methods
Surveys and assessment for CKD markers in urine and serum were performed in 15–59 year olds in households of the León municipality of Nicaragua. The survey included questions on demographics, health behaviors, occupation, and medical history. Participants with CKD were subdivided into traditional CKD and suspected CKDu based on history of diabetes, hypertension, or other specified conditions. A multinomial logistic regression model was used to identify factors associated with traditional CKD and suspected CKDu, compared to the non-CKD reference group.

Results
In 1795 study participants, CKD prevalence was 8.6%. Prevalence in males was twofold higher than females (12% vs 6%). Of those with CKD, 35% had suspected CKDu. Both traditional CKD and CKDu were associated with male sex and increasing age. Traditional CKD was associated with a family history of CKD, history of urinary tract infections, and lower socioeconomic status, while CKDu was associated with drinking well water and a lower body mass index.

Conclusions
Both traditional CKD and CKDu are significant burdens in this region. Our study supports previous hypotheses of CKDu etiology and emphasizes the importance of CKD screening.
LGBTQI content on obstetrics and gynecology residency websites
Authors: Soltani Amythis , Baban Saman , French Katherine , Annand Kathryn , Pelle Annemarie , Stifani Bianca M. 
Published: November 2023

Abstract
Background
In the United States (US), many obstetrics & gynecology (OB-GYN) trainees feel unprepared to care for lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI) individuals, but interest in this topic is rising. Residency program websites are one way that directors can advertise whether this training is offered within their program. We aimed to describe the extent to which LGBTQI content is currently featured on OB-GYN residency websites across the country.

Methods
We identified all OB-GYN residency programs in the United States using a publicly available database. We systematically searched for select LGBTQI keywords on program websites. We collected data on mentions of LGBTQI didactics and rotations. We also searched whether LGTBQI keywords were included in diversity, equity, and inclusion (DEI) statements. We used multivariable logistic regression to compare the characteristics of programs that do and do not include this content. We used STATA SE Version 16.0 for all analyses and set the level of significance at 5%.

Results
We included 287/295 US OB-GYN residency programs in our analysis (97.3%) and excluded 8 that did not have websites. We identified any LGBTQI content on 50 program websites (17.4%), and specific mention of didactics or rotations on 8 websites (2.8%). On multivariable analysis, programs in the West were more likely to include any LGBTQI content compared to programs in the South (OR 2.81, 95%CI 1.04–7.63), as were programs with 1 or 2 fellowships (OR 3.41, 95%CI 1.43–8.14) or 3 or more fellowships (OR 4.85, 95%CI 2.03–11.57) compared to those without fellowships. Programs in departments led by female chairs were also more likely to include LBTQI content (OR 3.18, 95%CI 1.55–6.51).

Conclusions
Academic programs, West Coast programs, and those with departments led by female chairs are more likely to mention LGBTQI keywords on their websites. Given the increasing interest in LGBTQI education for OB-GYN trainees, program directors should consider providing training opportunities and including this content on their websites.
Short animated video increases knowledge and perceived comfort in clinical counseling on inequitable health impacts of air pollution among interprofessional health learners and clinicians
Authors: Doheny Brenna M. , Inglis Jack J. , Boll Karly A. , Lunos Scott , Surapaneni Vishnu Laalitha 
Published: November 2023

Abstract
Background
Air pollution is a major health risk contributing to global morbidity and mortality, yet clinicians do not routinely engage in counseling patients on this topic. Clinicians cite their lack of education as a common barrier. We developed a two-minute animated video on mitigating air pollution health risks and evaluated the efficacy of this video as an educational tool.

Methods
In March-June 2021, a convenience sample of Minnesota interprofessional health learners and clinicians viewed the video and completed an electronic survey that assessed pre-/post-video intervention changes in (a) didactic and clinically applied knowledge on health impacts of air pollution, (b) perceived comfort in identifying at-risk patients and counseling them on relevant preventive health behaviors, (c) intentions/barriers to counseling patients, (d) beliefs and attitudes related to the health harms of air pollution, and (e) perceptions of the overall acceptability of the intervention.

Results
The 218 participants included learners and clinicians in medicine, nursing, and advanced practice provision. Respondents’ knowledge scores and self-reported level of comfort in identifying high-risk patients and counseling them on preventative health behaviors increased significantly pre-/post-intervention. The video also effectively altered participants’ misperceptions about the health impacts of air pollution. While less than half of participants (43.6%) reported they intended to engage in counseling patients as a result of watching the video, 52.3% indicated they might do so. Lack of time during clinical encounters and lack of training were reported as persistent barriers to engaging in this counseling. Overall, participants found the video to be an effective educational tool, indicating that they wanted their colleagues and patients to watch the video and would like to see further short, animated videos on other environmental health topics.

Conclusions
A two-minute animated educational video significantly improved knowledge of inequitable health impacts of air pollution and improved perceived comfort in identifying and counseling at-risk patients among health professional learners and clinicians regardless of profession, level of training, or pre-intervention knowledge level. Academic health professional training programs and health systems should consider adopting this modality as a tool for educating learners, clinicians, and patients on environmental health risks.
Co-teaching in medicine and nursing in training nurse anesthetists: a before-and-after controlled study
Authors: Ma Xiaobei , Duan Yi , Ma Yanli , Gao Zhifeng , Zhang Huan 
Published: November 2023

Abstract
Background
Clarifying the effectiveness of co-teaching in medicine and nursing (CMN) is important as it is crucial in clinical practice to improve the quality of patient care and prognosis. In this study, we aimed to determine the efficacy of CMN in nurse anesthetist training.

Method
The study comprised a 6-month training session and a before-and-after controlled study. In total, 59 nurses were recruited. The first 30 nurses were enrolled in the conventional single-teaching in nursing (SN) group and only took nursing-related courses. The next 29 students were enrolled in the CMN group and received both general medical and nursing-specific curricula. Before and after training, medical and nursing collaboration competency scores and knowledge scores were compared between the two groups. At the end of the study, qualitative comments on teaching satisfaction and clinical reasoning skills improvement were queried, and content analysis was performed.

Results
Participants in the CMN group outperformed those in the SN group in tests of medical and nursing collaboration abilities as well as knowledge. The CMN group outperformed the SN group in terms of teaching satisfaction evaluation, particularly in terms of fostering learning in the anesthetist specialty, improving clinical practice, fostering motivation, and influencing how people think about challenges at work. Furthermore, participants in the CMN group felt that their clinical reasoning abilities had improved.

Conclusion
In comparison to the SN group, the CMN group had enhanced outcomes of patient care, medical and nursing collaboration, and clinical reasoning skills.
Deconstructing the masculinized assumption of the medical profession: narratives of Japanese physician fathers
Authors: Kamihiro Noriki , Taga Futoshi , Miyachi Junichiro , Matsui Tomoko , Nishigori Hiroshi 
Published: November 2023

Abstract
Background
Gender studies in the medical profession have revealed gender biases associated with being a doctor, a profession often regarded as more suitable for men. The path to gender equality inevitably involves deconstructing this masculinized assumption. Despite the decades-long expectation that ikumen–men who actively participate in childcare in Japan–would contribute to a change toward gender equality, Japanese society is still male dominated, and women suffer from a large gender gap. With the aim of exploring implicit gendered assumptions concerning being a caregiver and a doctor, the authors focused on the experience of individuals juggling the binary roles of a professional and a caregiver.

Methods
The authors conducted subjectivist inductive research, recruited ten Japanese physician fathers through purposive sampling, and collected data through one-to-one semi-structured interviews between October 2017 and December 2018. The authors recorded and transcribed the narrative data, and extracted themes and representative narratives.

Results
The study identified three themes about the reproduction and potential change of the gender gap: maintaining gendered assumptions of the medical profession without experiencing conflict, maintaining gendered assumptions of the medical profession while experiencing conflict, and deconstructing gendered assumptions of the medical profession through conflict. The authors found that these negotiations interplayed with the gendered division of labor between male doctors and their wives as well as the patriarchal family structure.

Conclusions
The study revealed how gendered assumptions of the medical profession, as well as gender stereotypes and gendered division of household labor, were reproduced in the course of male doctors’ negotiations when they became fathers. For male doctors to question their unconscious gender bias, the authors emphasize the importance of men gaining knowledge about gender stereotypes, and propose that educators create such opportunities. Moreover, the authors assert that increasing doctors’ awareness of how masculinized assumptions implicitly interact with ideas of being a doctor—an aspect rarely discussed among medical professionals—is crucial for deconstructing the gendered normativity in the medical field.
Impact of statin treatment on cardiovascular risk in patients with type 1 diabetes: a population-based cohort study
Authors: Yoo Joonsang , Jeon Jimin , Baek Minyoul , Song Sun Ok , Kim Jinkwon 
Published: November 2023

Abstract
Background
Cardiovascular disease (CVD) is a major complication in type 1 diabetes mellitus (T1D) patients. Previous studies have suggested that statins may be helpful for prevention of CVD in T1D, but there are limited data on the role of statins in T1D. We investigated the relationship between statin treatment and cardiovascular risk in T1D patients using a population-based cohort.

Methods
We conducted a retrospective cohort study using the Korean nationwide health insurance database from January 2007 to December 2017. This study included 11,009 T1D patients aged ≥ 20 years without a prior history of CVD. The primary outcome was a composite development of stroke or myocardial infarction. Statin use during follow-up was treated as a time-varying variable. We performed a multivariable time-dependent Cox regression analysis adjusting for sex, age, type of insurance, hypertension, renal disease, and use of antiplatelets and renin–angiotensin–aldosterone system inhibitors.

Results
During the mean follow-up of 9.9 ± 3.7 years of follow-up, 931 T1D patients (8.5%) suffered primary outcome. Statin treatment was associated with a reduced risk of the primary outcome (adjusted hazard ratio, 0.76; 95% confidence interval 0.66–0.88; p < 0.001). Statin use led to decreased risks of ischemic stroke and myocardial infarction, but was not related to hemorrhagic stroke. We also found that the risk of cardiovascular events decreased as the cumulative exposure duration of statins increased.

Conclusions
Statin use was associated with a lower risk of cardiovascular events in T1D patients. Further prospective studies are needed to confirm the potential role of statins in prevention of CVD in patients with T1D.
Reciprocal relations between cardiovascular disease, employment, financial insecurity, and post cardiac event recovery among Māori men: a case series
Authors: Lisipeki Samantha , Masters-Awatere Bridgette , Hodgetts Darrin , Liew Tze Vun 
Published: November 2023

Abstract
Background
Disparities in cardiovascular outcomes between Māori and non-Māori persist despite technological advances in the treatment of cardiovascular disease and improved service provision. Little is known about how social determinants of health, such as income [in]security affect Māori men’s access, treatment, and recovery from cardiovascular disease. This paper explores the contexts within which cardiovascular disease is experienced and healthcare becomes embedded.

Methods
This study utilized a case-comparative narrative approach to document and make sense of the patient experiences of four male Māori patients who, in the previous 6 months, had come through cardiac investigation and treatment at Waikato Hospital, a large tertiary cardiac center in New Zealand. Participant accounts were elicited using a culturally patterned narrative approach to case development, informed by Kaupapa Māori Research practices. It involved three repeat 1–3-hour interviews recorded with participants (12 interviews); the first interviews took place 5–16 weeks after surgery/discharge.

Results
Each of the four case studies firstly details a serious cardiac event(s) before describing the varying levels of financial worry they experienced. Major financial disruptions to their lives were at the forefront of the concerns of those facing financial insecurity—as opposed to their medical problems. Financial hardship within the context of an unresponsive welfare system impacted the access to care and access to funding contributed to psychological distress for several participants. Economic security and reciprocal relationships between employers and employees facilitated positive treatment experiences and recovery.

Conclusion
Findings suggest that although multiple factors influence participant experiences and treatment outcomes, financial [in]security, and personal income is a key determinant. The heterogeneity in participant narratives suggests that although general inequities in health may exist for Māori as a population group, these inequities do not appear to be uniform. We postulate diverse mechanisms, by which financial insecurity may adversely affect outcomes from treatment and demonstrate financial security as a significant determinant in allowing patients to respond to and recover from cardiovascular disease more effectively.
Fasciola hepatica soluble antigens (FhAg) induce ovine PMN innate immune reactions and NET formation in vitro and in vivo
Authors: Muñoz-Caro Tamara , Gómez-Ceruti Marcela , Silva Liliana M. R. , Gutiérrez-Expósito Daniel , Wagner Henrik , Taubert Anja , Hermosilla Carlos 
Published: November 2023

AbstractFasciola hepatica causes liver fluke disease, a worldwide neglected and re-emerging zoonotic disease, leading to hepatitis in humans and livestock. In the pathogenesis, flukes actively migrate through liver parenchyma provoking tissue damage. Here, parasites must confront leukocytes of the innate immune system in vivo. Polymorphonuclear neutrophils (PMN) are the most abundant granulocytes and first ones arriving at infection sites. PMN may display neutrophil extracellular traps (NETs), consisting of nuclear DNA, decorated with histones, enzymes, and antimicrobial peptides. We investigated for the first time whether F. hepatica soluble antigens (FhAg) can also trigger NETosis and innate immune reactions in exposed ovine PMN. Thus, isolated PMN were co-cultured with FhAg and NET formation was visualized by immunofluorescence and scanning electron microscopy analyses resulting in various phenotypes with spread NETs being the most detected in vitro. In line, NETs quantification via Picogreen®-fluorometric measurements revealed induction of anchored- and cell free NETs phenotypes. Live cell 3D-holotomographic microscopy revealed degranulation of stimulated PMN at 30 min exposure to FhAg. Functional PMN chemotaxis assays showed a significant increase of PMN migration (p = 0.010) and intracellular ROS production significantly increased throughout time (p = 0.028). Contrary, metabolic activities profiles of FhAg-exposed PMN did not significantly increase. Finally, in vivo histopathological analysis on F. hepatica-parasitized liver tissue sections of sheep showed multifocal infiltration of inflammatory cells within liver parenchyma, and further fluorescence microscopy analyses confirmed NETs formation in vivo. Overall, we hypothesized that NET-formation is a relevant host defence mechanism that might have a role in the pathogenesis of fasciolosis in vivo.
A qualitative study of infection prevention and control practices in the maternal units of two Ghanaian hospitals
Authors: Sunkwa-Mills Gifty , Senah Kodjo , Breinholdt Mette , Aberese-Ako Matilda , Tersbøl Britt Pinkowski 
Published: November 2023

Abstract
Introduction
Healthcare-associated infections (HAIs) remain a common challenge in healthcare delivery, with a significant burden in low- and middle-income countries. Preventing HAIs has gained enormous attention from policy makers and healthcare managers and providers, especially in resource-limited settings. Despite policies to enforce infection prevention and control (IPC) measures to prevent HAIs, IPC compliance remains a challenge in hospital settings. In this study, we explore the experiences of healthcare providers and women in the post-natal phase and investigate factors influencing IPC practices in two hospitals in Ghana.

Methods
The study used a qualitative approach involving semi-structured interviews, focus group discussions, and observations among healthcare providers and women in the postnatal phase in two maternity units from January 2019 to June 2019. Interviews were recorded and transcribed verbatim for thematic analysis. The data sets were uploaded into the qualitative software NVivo 12 to facilitate coding and analysis.

Findings
Healthcare providers were driven by the responsibility to provide medical care for their patients and at the same time, protect themselves from infections. IPC facilitators include leadership commitment and support, IPC training and education. Women were informed about IPC in educational talks during antenatal care visits, and their practices were also shaped by their background and their communities. IPC barriers include the poor documentation or ‘invisibility’ of HAIs, low prioritization of IPC tasks, lack of clear IPC goals and resources, discretionary use of guidelines, and communication-related challenges. The findings demonstrate the need for relevant power holders to position themselves as key drivers of IPC and develop clear goals for IPC. Hospital managers need to take up the responsibility of providing the needed resources and leadership support to facilitate IPC. Patient engagement should be more strategic both within the hospital and at the community level.
Size Reduction and Harmonics Suppression in Microwave Power Dividers
Authors: Roshani Sobhan , Salah I. Yahya  , Ghadi Yazeed Y. , Roshani Saeed , Parandin Fariborz , Yaghouti Behnam D. 
Published: November 2023

In this paper, several types of microstrip power divider are studied and compared in terms of harmonics suppression and size reductions. The importance of this research lies in the fact that power dividers are critical components in various communication systems, and their performance directly affects the overall system efficiency. The conventional structure of the power divider has an acceptable performance at operating frequency in terms of excellent output ports isolation, low insertion loss, and high return loss, but occupies large size and passes unwanted signals at higher frequencies along with desired signal without any suppression. Harmonics are popular distortion and has different distortion impacts in many different facilities. Recently, several techniques are introduced to overcome these drawbacks. Applied open stubs, applied resonators, lumped reactive components such as capacitors and inductors, coupled lines, defected ground structure (DGS), and electronic band gaps are common methods, which are widely used to overcome these drawbacks. Finally, the study results show that the resonator-based power dividers and coupled-line-based power dividers have good performances in terms of size reduction and harmonic suppression but increase insertion loss parameter. Furthermore, the lumped reactive component-based power dividers and applied DGS and electromagnetic bandgap cells suppress unwanted harmonics, but they need extra process to fabrication, which is undesirable. Moreover, the open-stub-based power dividers have moderate performance with simple structure, but size reduction and harmonics suppression are not so superior in this method.