bluuebunny/crossref_metadata_2025_split huggingface dataset:
Overcoming the challenges facing Nepal’s health system during federalisation: an analysis of health system building blocks
Authors: Wasti Sharada Prasad , van Teijlingen Edwin , Rushton Simon , Subedi Madhusudan , Simkhada Padam , Balen Julie ,   for the Nepal Federal Health System Team, Adhikari S. R. , Adhikary P. , Balen J. , Bajracharya B. , Bhandari S. , Bhattarai S. , Gautam S. , Karki A. , Karki J. K. , Koirala B. , Lee A. C. K. , Marahatta S. B. , Neupane R. , Panday S. , Paudel U. , Pohl G. , Rushton S. , Sapkota S. , Simkhada P. P. , Subedi M. , van Teijlingen E. , Vaidya A. , Wasti S. P. 
Published: November 2023

Abstract
Introduction
Nepal’s move to a federal system was a major constitutional and political change, with significant devolution of power and resources from the central government to seven newly created provinces and 753 local governments. Nepal’s health system is in the process of adapting to federalism, which is a challenging, yet potentially rewarding, task. This research is a part of broader study that aims to explore the opportunities and challenges facing Nepal’s health system as it adapts to federalisation.

Methods
This exploratory qualitative study was conducted across the three tiers of government (federal, provincial, and local) in Nepal. We employed two methods: key informant interviews and participatory policy analysis workshops, to offer an in-depth understanding of stakeholders’ practical learnings, experiences, and opinions. Participants included policymakers, health service providers, local elected members, and other local stakeholders. All interviews were audio-recorded, transcribed, translated into English, and analysed thematically using the six WHO (World Health Organization) health system building blocks as a theoretical framework.

Results
Participants noted both opportunities and challenges around each building block. Identified opportunities were: (a) tailored local health policies and plans, (b) improved health governance at the municipality level, (c) improved health infrastructure and service capacity, (d) improved outreach services, (e) increased resources (health budgets, staffing, and supplies), and (f) improved real-time data reporting from health facilities. At the same time, several challenges were identified including: (a) poor coordination between the tiers of government, (b) delayed release of funds, (c) maldistribution of staff, (d) problems over procurement, and (e) limited monitoring and supervision of the quality of service delivery and data reporting.

Conclusion
Our findings suggest that since federalisation, Nepal’s health system performance is improving, although much remains to be accomplished. For Nepal to succeed in its federalisation process, understanding the challenges and opportunities is vital to improving each level of the health system in terms of (a) leadership and
governance, (b) service delivery, (c) health financing, (d) health workforce, (e) access to essential medicines and technologies and (f) health information system.
Diagnostic accuracy of dual-energy CT for bone marrow edema in patients with acute knee injury: a systematic review and meta-analysis
Authors: Li Zhizhuo , Chen Xuelong , Fang Hui , Li Chengxin , Shi Lijun , Fan Xiaoyu , Xu Xin , Gao Fuqiang , Sun Wei , Qing Jiang 
Published: November 2023

Abstract
Background
Knee injuries are prevalent, and early diagnosis is crucial for guiding clinical therapy. MRI is the diagnostic gold standard for bone marrow edema (BME) in patients with acute knee injuries, yet there are still limitations. Dual-energy CT, a possible viable replacement, is being explored (DECT).

Methods
We systematically retrieved studies from EMBASE, Scopus, PUBMED, and the Cochrane Library and collected gray literatures. In accordance with the PRISMA-DTA standards, a systematic review was conducted between the study's initiation and July 31, 2021, utilizing an MRI reference standard and at least 10 adult patients with acute knee injuries to evaluate the diagnostic effectiveness of DECT for diagnosing BME. Two reviewers collected the study's details independently. For the meta-analysis, a bivariate mixed-effects regression model was utilized, and subgroup analysis was employed to determine the sources of variability.

Results
The research included nine studies that examined 290 individuals between the ages of 23 and 53 with acute knee injuries who had DECT and MRI. Overall, the sensitivity, specificity, and AUC of the BME were 85% (95% confidence interval [CI]: 77–90%), 96% (95% CI: 93–97%), and 0.97 (95% CI: 0.95–0.98), respectively. To account for the assumed diversity of research, there were no statistically significant differences between the comparison groups in terms of specificity and sensitivity.

Conclusion
DECT is a viable alternative to MRI for individuals with acute knee injuries when MRI is inappropriate or unavailable.
Determinants of fetomaternal complication of instrumental vaginal delivery among women who gave childbirth in Southern Ethiopia: a facility-based cross-sectional study
Authors: Israel Eskinder , Abayneh Samuel , Utalo Dawit , Geta Temesgen , Kassaw Tamirat , Shonde Tamirayehu , Gebre Merihun 
Published: November 2023

AbstractBackgroundIn Ethiopia, one in five instrumental deliveries among women giving birth resulted in an unfavourable outcome. This study aimed to assess the determinants of feto-maternal complications of instrumental delivery in selected public hospitals of Gamo and Gofa zones, Southern Ethiopia.MethodsAn institution-based cross-sectional study was conducted among 399 women attending selected public hospitals in the Gamo and Gofa zones. Data were collected using data extraction tools using a systematic random sampling technique. The collected data was entered into Epi-data version 3.1 and then analyzed using SPSS version 25. Logistic regression analysis was conducted to determine an association.ResultsOne hundred eighty-three (45.9%, n = 183/399) instrumental deliveries were found to be complicated. Primigravida women (AOR: 95% CI: 2.21 (1.35, 3.63), infant birth weight (AOR: 95% CI: 2.56 (1.37, 4.77), post-term pregnancy (AOR: 95% CI: 12.77 (2.92, 55.78), and maternal age (AOR: 95% CI: 7.00 (2.16, 22.64) were associated with fetomaternal complications in instrumental delivery among women who gave birth.Conclusions and recommendationA high proportion of women developed fetomaternal complications when compared to local studies. Promotion of antenatal care services, increasing women’s education and empowerment as well as working on capacity building of health care professionals through education and training is cost-effective to reduce the occurrence of fetomaternal complications.
Variant allelic frequencies of driver mutations can identify gliomas with potentially false-negative MGMT promoter methylation results
Authors: McCord Matthew , Jamshidi Pouya , Thirunavu Vineeth , Santana-Santos Lucas , Vormittag-Nocito Erica , Dittman David , Parker Stephanie , Baczkowski Joseph , Jennings Lawrence , Walshon Jordain , McCortney Kathleen , Galbraith Kristyn , Zhang Hui , Lukas Rimas V. , Stupp Roger , Dixit Karan , Kumthekar Priya , Heimberger Amy B. , Snuderl Matija , Horbinski Craig 
Published: November 2023

AbstractMGMT promoter methylation testing is required for prognosis and predicting temozolomide response in gliomas. Accurate results depend on sufficient tumor cellularity, but histologic estimates of cellularity are subjective. We sought to determine whether driver mutation variant allelic frequency (VAF) could serve as a more objective metric for cellularity and identify possible false-negative MGMT samples. Among 691 adult-type diffuse gliomas, MGMT promoter methylation was assessed by pyrosequencing (N = 445) or DNA methylation array (N = 246); VAFs of TERT and IDH driver mutations were assessed by next generation sequencing. MGMT results were analyzed in relation to VAF. By pyrosequencing, 56% of all gliomas with driver mutation VAF ≥ 0.325 had MGMT promoter methylation, versus only 37% with VAF < 0.325 (p < 0.0001). The mean MGMT promoter pyrosequencing score was 19.3% for samples with VAF VAF ≥ 0.325, versus 12.7% for samples with VAF < 0.325 (p < 0.0001). Optimal VAF cutoffs differed among glioma subtypes (IDH wildtype glioblastoma: 0.12–0.18, IDH mutant astrocytoma: ~0.33, IDH mutant and 1p/19q co-deleted oligodendroglioma: 0.3–0.4). Methylation array was more sensitive for MGMT promoter methylation at lower VAFs than pyrosequencing. Microscopic examination tended to overestimate tumor cellularity when VAF was low. Re-testing low-VAF cases with methylation array and droplet digital PCR (ddPCR) confirmed that a subset of them had originally been false-negative. We conclude that driver mutation VAF is a useful quality assurance metric when evaluating MGMT promoter methylation tests, as it can help identify possible false-negative cases.
Deforestation inhibits malaria transmission in Lao PDR: a spatial epidemiology using Earth observation satellites
Authors: Matsumoto-Takahashi Emilie Louise Akiko , Iwagami Moritoshi , Oyoshi Kei , Sasaki Yoshinobu , Hongvanthong Bouasy , Kano Shigeyuki 
Published: November 2023

Abstract
Background
The present study aimed to analyze the impact of deforestation on the malaria distribution in the Lao People’s Democratic Republic (Lao PDR), with consideration of climate change.

Methods
Malaria distribution data from 2002 to 2015 were obtained from the Ministry of Health of Lao PDR and each indicator was calculated. Earth observation satellite data (forested area, land surface temperature, and precipitation) were obtained from the Japan Aerospace Exploration Agency (JAXA). Structured equation modeling (SEM) was conducted to clarify the relationship between the malaria incidence and Earth observation satellite data.

Results
As a result, SEM identified two factors that were independently associated with the malaria incidence: area and proportion of forest. Specifically, malaria was found to be more prevalent in the southern region, with the malaria incidence increasing as the percentage of forested land increased (both p < 0.01). With global warming steadily progressing, forested areas are expected to play an important role in the incidence of malaria in Lao PDR. This is believed because malaria in Lao PDR is mainly forest malaria transmitted by Anopheles dirus.

Conclusion
To accelerate the elimination of malaria in Lao PDR, it is important to identify, prevent, and intervene in places with increased forest coverage (e.g., plantations) and in low-temperature areas adjacent to malaria-endemic areas, where the vegetation is similar to that in malaria-endemic areas.
On the Systematic and Historical Analysis of Concessionary Zones
Authors: Barkan Joshua 
Published: November 2023

Abstract
Recent scholarship has emphasized the importance of extractive zones and enclaves in contemporary capitalism. This article seeks to understand the form of authority within these zones. To do so, it charts a brief genealogy of the concession, the reciprocal agreements entered into by states and companies that govern many extractive enclaves. Because concessions have a long, convoluted, and underexamined history, they are an ideal object for examining the shifting configurations of law, sovereignty, property, and government that undergird contemporary extraction. Neither simply public law nor private right, concessions are a unique legal form designed to produce nonsystematic and exceptional legal spaces that remain central to capitalist societies today.
Uncovering key molecular mechanisms in the early and late-stage of papillary thyroid carcinoma using association rule mining algorithm
Authors: Hosseiniyan Khatibi Seyed Mahdi , Zununi Vahed Sepideh , Homaei Rad Hamed , Emdadi Manijeh , Akbarpour Zahra , Teshnehlab Mohammad , Pirmoradi Saeed , Alizadeh Effat 
Published: November 2023

ObjectiveThyroid Cancer (TC) is the most frequent endocrine malignancy neoplasm. It is the sixth cause of cancer in women worldwide. The treatment process could be expedited by identifying the controlling molecular mechanisms at the early and late stages, which can contribute to the acceleration of treatment schemes and the improvement of patient survival outcomes. In this work, we study the significant mRNAs through Machine Learning Algorithms in both the early and late stages of Papillary Thyroid Cancer (PTC).MethodDuring the course of our study, we investigated various methods and techniques to obtain suitable results. The sequence of procedures we followed included organizing data, using nested cross-validation, data cleaning, and normalization at the initial stage. Next, to apply feature selection, a t-test and binary Non-Dominated Sorting Genetic Algorithm II (NSGAII) were chosen to be employed. Later on, during the analysis stage, the discriminative power of the selected features was evaluated using machine learning and deep learning algorithms. Finally, we considered the selected features and utilized Association Rule Mining algorithm to identify the most important ones for improving the decoding of dominant molecular mechanisms in PTC through its early and late stages.ResultThe SVM classifier was able to distinguish between early and late-stage categories with an accuracy of 83.5% and an AUC of 0.78 based on the identified mRNAs. The most significant genes associated with the early and late stages of PTC were identified as (e.g., ZNF518B, DTD2, CCAR1) and (e.g., lnc-DNAJB6-7:7, RP11-484D2.3, MSL3P1), respectively.ConclusionCurrent study reveals a clear picture of the potential candidate genes that could play a major role not only in the early stage, but also throughout the late one. Hence, the findings could be of help to identify therapeutic targets for more effective PTC drug developments.
Association between the COVID-19 outbreak and opioid prescribing by U.S. dentists
Authors: Zhang Jason , Nalliah Romesh P. , Waljee Jennifer F. , Brummett Chad M. , Chua Kao-Ping 
Published: November 2023

Background
U.S. data on opioid prescribing by dentists are limited to 2019. More recent data are needed to understand the effect of the COVID-19 outbreak on dental opioid prescribing, characterize current practices, and determine if dental opioid stewardship initiatives are still warranted.

Objective
To evaluate the association between the COVID-19 outbreak and the rate of opioid prescribing by U.S. dentists

Methods
During February—April 2023, the authors conducted a cross-sectional analysis of the IQVIA Longitudinal Prescription Database, which reports 92% of prescriptions dispensed in U.S. retail pharmacies. The authors calculated the monthly dental opioid dispensing rate, defined as the monthly number of dispensed opioid prescriptions from dentists per 100,000 U.S. individuals, during January 2016-February 2020 and June 2020-December 2022. To prevent distortions in trends, data from March–May 2020, when dental opioid dispensing declined sharply, were excluded. Using linear segmented regression models, the authors assessed for level and slope changes in the dental opioid dispensing rate during June 2020.

Results
Analyses included 81,189,605 dental opioid prescriptions. The annual number of prescriptions declined from 16,105,634 in 2016 to 8,910,437 in 2022 (-44.7%). During January 2016-February 2020, the dental opioid dispensing rate declined -3.9 (95% CI: -4.3, -3.6) per month. In June 2020, this rate abruptly increased by 31.4 (95% CI: 19.3, 43.5) and the monthly decline in the dental opioid dispensing rate slowed to -2.1 (95% CI: -2.6, -1.6) per month. As a result, 6.1 million more dental opioid prescriptions were dispensed during June 2020-December 2022 than would be predicted had trends during January 2016-February 2020 continued.

Discussion
U.S. dental opioid prescribing is declining, but the rate of this decline slowed after the COVID-19 outbreak. Findings highlight the continued importance of dental opioid stewardship initiatives.
Physical exercise and its effects on people with Parkinson’s disease: Umbrella review
Authors: Padilha Cristiano , Souza Renan , Grossl Fernando Schorr , Gauer Ana Paula Maihack , de Sá Clodoaldo Antônio , Rodrigues-Junior Sinval Adalberto 
Published: November 2023

IntroductionParkinson’s disease is neurodegenerative, complex and progressive, manifesting in a slow and irreversible way. Physical exercise has been proposed as therapeutic alternative to people with Parkinson´s disease.ObjectiveTo synthesize knowledge about the effects of physical exercise on people with Parkinson´s Disease as presented by published systematic reviews.MethodsNine electronic databases and two grey literature databases were searched for systematic reviews reporting the effects of physical exercises on people with Parkinson´s Disease. Searches involved a two-phase process, by, at least, two independent reviewers. Methodological quality of the included systematic reviews was assessed using AMSTAR-2.ResultsFrom 2,122 systematic reviews, 139 were included. Motor outcomes were assessed in 91% of the studies, with balance being the most studied. Non-motor outcomes were assessed in 68% of the studies, with emphasis on quality of life. Physical exercises were classified into five categories: aerobic exercises, strength, combined, sensorimotor activities and other activity protocols. Findings of the systematic reviews suggest that all exercise categories can be prescribed to improve balance and mobility, while combined exercises, strength, and specific activities improve both motor and non-motor outcomes, and aerobic exercise and sensorimotor activities improve motor outcomes.ConclusionCurrent evidence from systematic reviews suggests that physical exercises impacts both motor and non-motor outcomes in people with Parkinson´s Disease. Limits in evidence provided by the systematic reviews were related to methodological issues and to the description of the interventions and must be considered to improve decision-making and clinical application.
Ultra high reach optical fiber systems based on CW laser and VCSEL laser operation performance signature
Authors: Prabu Ramachandran Thandaiah , Jeyaraj Josephine Pon Gloria , Ashwini Ramachandran , Balamurugan Kavitha , Muthulakshmi Ramachandran Vidhya , Jayanthi Anvar , Emam Hazem Hazem Ali 
Published: November 2023

Abstract
This study presented the possibility of the hybrid cooperation between continuous wave laser (CW) laser and vertical cavity surface emitting laser (VCSEL) laser operation performance signature for upgrading ultra high reach optical fiber systems. The total estimated lighted power spectrum configuration is simulated with wavelength ranges from 1.543 to 1.555 μm. Total estimated lighted power spectrum configuration is studied with spectral time variations. Total estimated lighted power spectrum is indicated and measured after fiber system length. The total electrical modulated signal amplitude spectrum variations are demonstrated with threshold value after receiver side. The total signal/noise modulated spectrum signal configuration is clarified with time after receiver side. Total estimated electronic power spectrum is measured and tested after receiver system. Also, the total estimated electronic power spectrum configuration is demonstrated with spectral frequency ranges from 200 to 800 GHz.
An assessment of surgery core rotation quality at osteopathic medical schools
Authors: Casey Taylor , Brennan Zachary , Pereira Kenneth , Young Grace , Paluri Sarin N. , Gudakunst Craig 
Published: November 2023

Abstract

Context
Osteopathic medical schools have traditionally placed a heavy emphasis on the field of primary care. While graduating osteopathic students continue to pursue family medicine, internal medicine, and pediatrics at higher rates than their allopathic counterparts, it is unknown whether students feel that surgical rotations are held to similar standards.

Objectives
The purpose of this study was to assess osteopathic medical student opinions of the quality of their surgical clerkships and to determine if good or poor experiences influenced their decision to continue pursuing surgery.

Methods
After Institutional Review Board approval, a voluntary and anonymous Qualtrics survey was sent to all nationally registered members of the American College of Osteopathic Surgeons, Medical Student Section (ACOS-MSS) in their final 2 years of medical school. Analyses were conducted utilizing R statistical software.

Results
A total of 345 responses were recorded from the Qualtrics survey sent to 2182 ACOS students from the national registry (response rate of 15.8 %). Students who found a mentor during their surgical rotations were more likely to consider a surgical career after they completed their rotations (odds ratio [OR]=1.43, p=0.003). Students at academic sites had more opportunities for research than those at community hospitals (p=0.019). Most students responded that they were still considering surgery as a career after rotation completion; a significant portion (OR=0.36, p<0.001) responded that they were no longer interested.

Conclusions
Medical students are most likely to review a surgical rotation favorably if they can connect with a mentor while on rotation. Osteopathic medical schools may benefit from instituting mentorship programs for students interested in surgery, as well as ensuring that their students have ample opportunity for research.
Judaica Librarianship: Back to the Future
Authors: Catanese Anthony 
Published: November 2023

Abstract
The Library of Congress Classification system was designed during the age of colonialism, and as such, poorly represents the information-seeking behavior of present-day users. Students of Judaica are especially hindered by the limited scope of the B class (Philosophy and Religion) of the Library of Congress Classification system, which extensively classifies Christian material, but limits the thematic classification of Judaic subjects. Qualitative data collected on students of Jewish thought via a proposed questionnaire is anticipated to shed light on the specialized information-seeking behavior of Judaic students. The thematic coding and analysis of such data would assist in selecting an appropriate classification system that will complement Judaica scholarship or facilitate the creation of a novel classification system. More inclusively, such an endeavor may contribute to the understanding of specialized efforts in librarianship.
Highly stable pulsed fiber laser generation modulated by chromium iodide film
Authors: Li Ning , Du Lin , Liu Dongyang , Wu Jiadong , He Yuan , Feng Yi , Wu Man , Miao Lili , Zhao Chujun 
Published: November 2023

Abstract
Highly stable pulsed fiber lasers are key optical components in optical communication, optical sensing, and precision micromachining systems due to the high beam quality, high peak power, and compact configurations. However, the available optical modulators in the fiber laser suffer from the operation bandwidth limitations and poor long-term physicochemical stability. Here, we have investigated the broadband nonlinear optical absorption behavior of the chromium iodide (CrI3) film, which exhibits broadband saturable absorption towards the mid-infrared regime and excellent long-term stability. The conventional soliton fiber laser operating at telecom wavelength has been obtained from an Er3+-doped fiber laser (EDFL) utilizing CrI3 film with a signal-to-noise ratio (SNR) of 92.4 dB and a pulse width of 492 fs. In addition, a passively Q-switched operation around 2.8 μm has also been obtained from an Er3+-doped ZBLAN fiber laser (EDZFL) modulated by the CrI3 film with a SNR of 46.8 dB and a pulse width of 766 ns. The demonstration shows that the CrI3 film exhibits robust broadband optical modulation, and may make inroads for developing highly stable ultrafast optoelectronic devices.