bluuebunny/crossref_metadata_2025_split huggingface dataset:
Stroke types, risk factors, clinical features and outcomes in a tertiary hospital, Myanmar, a descriptive study
Authors: Tun Thant Zin , Han Su Myat , Moji Kazuhiko , Matsui Mitsuaki 
Published: January 2024

Abstract
Background
Stroke is one of the leading causes of death and majority of the stroke burden was observed in middle- and low-income countries. Understanding the risk factors, complications and outcomes is useful in healthcare planning and resource allocation. However, little information on stroke is available in Myanmar.
Methods
A review of medical records of stroke admission during 2017 in a tertiary hospital was conducted. Final diagnosis, risk factors, clinical features, complications and outcomes were systematically collected both from computer-based and from paper-based medical records.
Results
1153 cases were identified, and 977 cases were analysed. Haemorrhagic stroke was the most common type (48.8%), followed by ischaemic stroke (43.4%). Unimproved cases were 31.5%. Identified risk factors of unimproved were 'haemorrhagic stroke' [adjusted odds ratio (aOR): 1.67], 'having fever during hospitalisation' [aOR: 2.53], and 'Glasgow Coma Scale at the admission between 9 and 14 [aOR: 4.64], and less than 9 [aOR: 42.37].
Conclusion
Intracranial haemorrhage and unconsciousness were significantly associated with poor prognosis. Fever during the hospitalisation, which was also a risk factor of unimproved cases, could be associated with aspiration pneumonia. This could be an associated symptom of unconsciousness. The findings imply how to prevent and control fever among stroke patients during hospital stay is a key for better prognosis.
Behavioural Risk Factors for Non-Communicable Diseases Among Returnee Sri Lankan Migrant Workers from Middle East: A Cross-Sectional Study
Authors: WIJERATNE PASINDU DILSHAN , Pathmeswaran Arunasalam 
Published: January 2024

Abstract
Background: Non-Communicable Diseases (NCDs) are rising among South Asian migrant populations. Despite Sri Lanka’s over 1.5 million temporary migrant workforce, there’s insufficient data on Behavioural Risk Factors (BRFs) for NCDs among returnee migrant workers. This study aims to describe the prevalence of BRFs for NCDs and associated factors among returnee Sri Lankan migrant workers from Middle-East.
Methods: This community-based, cross-sectional study was conducted among 680 returnee Middle East migrant workers in the Kurunegala District, Sri Lanka selected using multi-staged cluster sampling. Pretested Interviewer-Administered Questionnaire was utilized for the data collection. The analysis encompasses descriptive statistics and logistic regression using SPSS version 26.
Results: Response rate was 94.4% (n=642). Estimated prevalence of BRFs included daily smoking 12.3% (95%CI 9.8-15.1), current alcohol uses 20.1% (95%CI 17.0-23.4), inadequate fruits and vegetables consumption 89.3% (95%CI 86.6-91.6), and physical inactivity 31.4% (95%CI 27.8-35.2). Significant associations were identified, such as daily smoking with extended post-return period (AOR 0.58, 95%CI 0.39-0.86), having accumulated savings (AOR 2.98, 95%CI 1.33-6.69), being diagnosed with NCDs (AOR 2.85, 95%CI 1.36-6.69). Current alcohol use correlated with - being currently employed (AOR 7.79, 95%CI 2.72-22.33), being male (AOR 46.49, 95%CI 13.10-164.95), having accumulated savings (AOR 2.75, 95%CI 1.30-5.82), higher education level (AOR 0.38, 95%CI 0.19-0.74). Insufficient fruits and vegetables consumption was associated with; over LKR50,000 household income (AOR 0.24, 95%CI 0.12-0.46), and having accumulated savings (AOR 0.38, 95%CI 0.19-0.74). Physical inactivity was correlated with; being male (AOR 0.23, 95%CI 0.14-0.40), having chronic disease/ disability (AOR 1.91, 95%CI 1.20-3.04).
Conclusion: Socio-economic and migration-related characteristics of returnee migrant workers were associated with the BRF for NCDs. Migrant-friendly, tailored interventions addressing these factors are recommended for promoting healthy lifestyles among returnee migrant workers.
A new way to avoid excessive damage to blood vessels from haemostatic clips
Authors: Ren Lizhi , Wang Qianqian , Zhang Zepeng , Wu Xiaofen , Wang Dan , Ji Hao , Zhang Wei , Sun Rui 
Published: January 2024

Abstract

Objective: Haemostatic clips are helpful for the successful completion of vascular anastomosis in microsurgery but may cause damage to blood vessels, which remains a concern of scholars.
Design: In the first phase, a total of 96 SD rats were randomly allocated into two groups: one treated with disposable haemostatic clips and another treated with metal haemostatic clips. Each group was further divided into four subgroups based on clamping force (30 g, 60 g, 90 g, and 120 g). Injury to the vascular intima was observed using scanning electron microscopy (SEM). The second phase involved measuring the minimum clamping force in the human body to validate the accuracy of the calculation formula.
Results: Under SEM, at a clamping force of 30 g, only a portion of the fold was flattened, and minimal damage to the intimal surface of the blood vessel was observed. However, at a clamping force of 90 g and 120 g, the damage inflicted by the two haemostatic clips became more severe, resulting in extensive exfoliation or even complete disappearance of the vascular intima. The measurement results for the minimum clamping force in human subjects indicated no significant difference between the theoretical and actual values (P > 0.05), suggesting a certain reliability of the formula.
Conclusions: The degree of injury caused during haemostasis is directly proportional to the clamping force applied by haemostatic clips used in clinical practice. Additionally, the material and surface characteristics of the clip can also impact vascular injury. Disposable haemostatic clips have an advantage over metal clips in terms of reducing vascular injury. The theoretical minimum clamping force calculation formula can be used as a reliable reference for selecting appropriate haemostatic clips.
Mesoscale Simulation of the Compression and Small-Strain Elastic Shear Behavior of Illite Nanoparticle Assemblies
Authors: Zhu Hejian , Whittle Andrew J. , Pellenq Roland J.-M. 
Published: January 2024

Abstract

The mechanical properties of clay minerals are largely dependent upon the chemical compositions and the mesoscale fabrics of the constituent particles. This paper describes results of a series of mesoscale molecular dynamics simulations of the hydrostatic compression and shear strain behavior for initially randomly-oriented assemblies of 10 3 Illite primary particles. The particles are simulated as rigid-body ellipsoids that interact through the single-site, Gay-Berne potential function. This corresponds to a coarse-grained model based on prior atomistic scale computation of the potential of mean force for water-mediated interactions between pairs of particles through free energy perturbation method. We investigate the mesoscale fabrics of the NPT-equilibrated assemblies for confining pressures ranging from 1.0 – 125 atm, including path dependence associated with unloading and reloading. We analyze and quantify the geometric arrangement including particle orientation, specific surface area, properties of particle stacks/aggregates, and inter-stack pair correlation functions. The compression of each particle assembly is associated with large irrecoverable changes in void ratio, while unloading and reloading involves much smaller, largely recoverable volu-metric strains. The results are qualitatively similar to macroscopic compression 1 behavior reported in laboratory tests. We simulate the uniaxial and shear behavior at each of the equilibrated pressure states through a series of strain-controlled steps, allowing full relaxation of the virial stresses computed at each step. The simulations investigate directional and path dependence of the shear behavior for strain deviations up to 0.2%. The results show the onset on non-linear stiffness properties at strain levels ∼0.01%, and hysteretic behavior upon unloading and reloading. Small strain stiffness properties of the particle assemblies are qualitatively in good agreement with quasi-static, elastic stiffness properties reported for Illitic clays.
Does health voucher intervention increase antenatal consultations and skilled birth attendances in Cameroon? Results from an interrupted time series analysis
Authors: Sieleunou Isidore , Bonong Roland Pascal Enok 
Published: January 2024

Abstract

Background:
Limited access to health services during the antenatal period and during childbirth, due to financial barriers, is an obstacle to reducing maternal and child mortality. To improve the use of health services in the three regions of Cameroon, which have the worst reproductive, maternal, neonatal, child and adolescent health indicators, a health voucher project aiming to reduce financial barriers has been progressively implemented since 2015 in these three regions. Our research aimed to assess the impact of the voucher scheme on first antenatal consultation (ANC) and skilled birth attendance (SBA).
Methods:
Routine aggregated data by month over the period January 2013 to May 2018 for each of the 33 and 37 health facilities included in the study sample were used to measure the effect of the voucher project on the first ANC and SBA, respectively. We estimated changes attributable to the intervention in terms of the levels of outcome indicators immediately after the start of the project and over time using an interrupted time series regression. A meta-analysis was used to obtain the overall estimates.
Results:
Overall, the voucher project contributed to an immediate and statistically significant increase, one month after the start of the project, in the monthly number of ANCs (by 26%) and the monthly number of SBAs (by 57%). Compared to the period before the start of the project, a statistically significant monthly increase was observed during the project implementation for SBAs but not for the first ANCs. The results at the level of health facilities (HFs) were mixed. Some HFs experienced an improvement, while others were faced with the status quo or a decrease.
Conclusions:
Unlike SBAs, the voucher project in Cameroon had mixed results in improving first ANCs. These limited effects were likely the consequence of poor design and implementation challenges.
Impact on mortality of haemodynamic changes during initial resuscitation in patients with inhalation injury
Authors: Cachafeiro Lucía , Agrifoglio Alexander , Flores Eva , Estébanez Belén , Sanchez-sanchez Manuel 
Published: January 2024

Abstract
Introduction: Inhalation injury remains a significant cause of morbidity and mortality in critically ill burn patients. To improve this prognosis, it might be useful to understand the haemodynamic impact of inhalation injury during the initial resuscitation phase. We studied the hemodynamic changes in patients with inhalation injury, as well as the fluid volume used during initial resuscitation and whether it was related to mortality.
Methods: We designed a prospective, single-centre observational 4-year study. Patients with criteria of major burns were included. Our Burns Resuscitation protocol was based on relatively permissive hypovolemia monitoring, employing both non-invasive and transpulmonary thermodilution parameters. We studied the differences in age, % total body surface area (%TBSA) burned, severity scores, lactate, troponin I, NTproBNP, resuscitation infused volume, urine output, complications and mortality between burn patients with and without inhalation injury.
Results: A total of 180 critically ill burn patients were admitted: 96 had TBSA burned ≥20% without suspected inhalation, and 84 had inhalation injury regardless of the %TBSA burned. Patients with inhalation injury were older (52 vs 44 years), had lower %TBSA burned (28.1 vs 34.8), lower initial cardiac index and higher lactate, initial stroke volume variation, late extravascular lung water (EVLWI) index and NTproBNP. They also had a greater need for mechanical ventilation (88% vs 59%) and slightly higher mortality (28% vs 18%, p=0.1). No differences in fluid requirements (4.7 vs. 4.2 ml/kg/%TBSA burned, p 0.4), were found. The inhalation injury patients who died had lower cardiac index, higher lactate, higher troponin, similar intrathoracic blood volume index and higher levels of EVLWI and NTproBNP (p 0.046). In the multivariate analysis, mechanical ventilation contributed significantly to the increased mortality (odds ratio 6.7).
Conclusions: Patients with inhalation injury exhibit a more pronounced haemodynamic pattern of lower cardiac index with an initial lower preload and a slightly later EVLWI increase; however, they did not need as much resuscitation fluid. Mortality in inhalation injury is associated with greater cardiac dysfunction and lower cardiac indexes and with higher levels of myocardial damage markers, such as troponin and NTproBNP. Mechanical ventilation is thus an important independent factor contributing to mortality, and NTproBNP could serve as a significant prognostic biomarker in these patients.
Estimating Minimal Important Change of the National Institutes of Health Research Task Force impact score using computer adaptive measures: A secondary analysis of two randomized clinical trials in a military population with chronic pain
Authors: Flynn Diane M. , Burke Larisa A , Steffen Alana D. , Ransom Jeffrey C. , Heartwick Kira , McQuinn Honor M. , Snow Tyler J. , Doorenbos Ardith Z. 
Published: January 2024

Abstract

Background
The National Institutes of Health (NIH) Research Task Force (RTF) on Research Standards for Chronic Low Back Pain impact score is a composite measure of Patient Reported Outcomes Measurement Information System (PROMIS) pain intensity, pain interference and physical function. PROMIS surveys are available in short-form and computer adaptive testing (CAT) formats. In order to calculate response rates for clinical trials in which the impact score is the primary outcome, its minimal important difference (MID) must be established. To date, four estimates of impact score MID ranging from 3 to 7.5 have been published, and all were based on data collected using PROMIS short-form surveys. None used CAT versions of PROMIS surveys.
Methods
Secondary analysis of data collected during the conduct of two randomized clinical trials of 6-week courses of nonpharmacological pain therapies. Research subjects were US active-duty service members referred to an interdisciplinary pain management center. Impact score was assessed at the beginning and end of treatment. The Patient Global Impression of Change (PGIC) questionnaire was administered at the end of treatment and asked respondents to report their status compared to the start of treatment using a 7-item Likert scale ranging from very much improved to very much worse. A PGIC response of “much” or “very much” improved was used as the threshold for MID. Receiver operating characteristic curve (ROC) analysis was used to determine meaningful clinical differences for the full combined sample and stratified by study sample and baseline impact score.
Results
A decrease of 3 points was the estimated minimal important difference for the impact score. A larger decrease in impact score was needed for participants with moderate and severe baseline pain impact to report “much” or “very much” improvement.
Conclusions
Using data collected with CAT surveys, we calculated an overall MID of 3 for the NIH RTF impact score, and estimates ranged from 1 to 9 depending on the study sample and baseline impact score. These findings are consistent with previous MID estimates that were based on non-adaptive short form surveys and have implications for reducing the survey burden of future impact score MID analyses.
Predictive factors of renal function after robot-assisted partial nephrectomy in clinical T1b tumors
Authors: Yamamoto Ryohei , Numakura Kazuyuki , Kobayashi Mizuki , Nara Taketoshi , Saito Mitsuru , Narita Shintaro , Habuchi Tomonori 
Published: January 2024

Abstract
Robot-assisted partial nephrectomy (RAPN) has been shown to be a safe and effective method for treatment of small renal tumors, including clinical T1b renal cell carcinoma (RCC); however, the impact of RAPN for cT1b renal tumors on renal function is not well understood. In this retrospective study, 50 patients who underwent RAPN for cT1b renal tumors were evaluated for pre- and post-operative renal function and perioperative clinical factors. Renal function was assessed using the estimated glomerular filtration rate (eGFR) at baseline and on postoperative days (POD) 1, 7, 30, and 180. A significant renal functional decline was defined as ≥ 15% reduction in eGFR at POD180 compared with eGFR at baseline. Logistic regression analyses were used to identify risk factors for renal function decline, including age, sex, RENAL nephrometry score, operative time, and estimated blood loss. The median patient age was 62 years, and the median tumor diameter and RENAL nephrometry score were 44 mm (IQR: 43–50) and 8 (IQR: 7–9), respectively. Of these patients, 16 (36%) showed a significant renal functional decline at POD 180. In the multivariate analysis, the L component of the RENAL nephrometry score and an estimated blood loss of 200 mL or more were identified as significant risk factors for renal functional decline. These findings suggest that the preoperatively definable L component of the RENAL nephrometry score and intraoperative blood loss, which may be modifiable factors, play significant roles in post-RAPN renal function decline.
The Impact of Teaching Support on Teachers' Online Teaching Experience: The Mediating Role of Teachers' Technological Innovation Awareness and Technological Acceptance
Authors: Liu Weitong , Hu Ke 
Published: January 2024

Abstract
Background:
The current evolution of technology and the pervasive access to the internet are catalyzing profound transformations in the field of education. While previous research in higher education has delved into how organizational resources impact teachers' teaching efficacy, there remains a dearth of studies investigating the influence of instructional support on teachers' experiences in online teaching.
Methods:
This study aimed to unravel the underlying mechanisms affecting teachers' online teaching experiences by leveraging survey data and employing structural equation modeling. Through this approach, the research sought to explore the relationships between technological acceptance, technological innovation awareness, and online teaching experience.
Results:
The findings revealed that technological acceptance significantly mediated the connection between teaching support and the online teaching experience. However, there was no significant mediating effect observed in technological innovation awareness. Notably, considering the standard total effect values, organizational factors emerged as pivotal determinants shaping the online teaching experience.
Conclusions:
This study contributes valuable insights into the complex interplay among teaching support, technological acceptance, and the online teaching experience. By offering empirical evidence, it sheds light on the factors influencing educators' experiences in online teaching, providing recommendations to enhance these experiences.
Factors associated with foreign-educated nurses’ willingness to continue working in Japan: A qualitative study
Authors: Tanaka Kazuko , Yoshimura Koichi 
Published: January 2024

Abstract

Background Japan has been accepting foreign nurse candidates since 2008 under Economic Partnership Agreements (EPAs). As globalisation progresses, nurses from diverse backgrounds are expected to play an active role in the medical field. Using an interview survey, this study examined the factors associated with EPA nurses’ willingness to continue working in Japan. Methods We conducted semi-structured interviews from January 2022 to July 2023 with eight EPA nurses and one EPA nurse candidate working in Japan to investigate the factors associated with foreign-educated nurses’ willingness to continue working in Japan. The interview guide included items on the status of the daily performance of their duties, what they found pleasurable in their nursing experience in Japan, difficulties they encountered in carrying out their nursing duties, and their expectations of the Japanese staff around them. Data were analysed using thematic analysis. Results From the interview data, seven themes were extracted. To continue working in Japan, it was important for EPA nurses to be able to communicate with patients and colleagues, maintain self-esteem and motivation, be resilient, have support from EPA peers and family members, be accepted by others such as patients and colleagues, and be satisfied with the support they received. Conclusion The EPA nurses experienced many difficulties after becoming nurses and tended to be isolated because of their non-Japanese status. The results suggest that not only support from colleagues and supervisors but also a general understanding of EPA nurses from Japanese society is necessary. As globalisation accelerates, the Japanese nursing field needs to understand the diversity of the nursing profession and build a support system that will enable them to continue to take pride and feel motivated in their work.
WITHDRAWN: Development of a 28-Day Mortality Risk Prediction Model for ICU Sepsis-Associated Encephalopathy Using Interpretable Machine Learning
Authors: YANG Yanjie , ZHAO Huiling , Zhang Xuesheng , Liu Shupeng , LING ge , ZHANG Li , Liu Juan , SUN Yue 
Published: January 2024

Abstract
In the ICU, patients with sepsis often develop sepsis-associated encephalopathy (SAE), which affects their prognosis. This study aims to construct a predictive model for the 28-day mortality risk of SAE patients using machine learning (ML) methods. We retrospectively collected clinical data of SAE patients admitted to our hospital's intensive care unit (ICU) from January 2018 to June 2023. The primary outcome was whether the patient died within 28 days. We employed six popular machine learning methods to build the predictive model for the 28-day mortality risk of SAE patients, including logistic regression (LR), Gaussian naive Bayes (GaussianNB), support vector machine (SVM), k-nearest neighbor (kNN), random forest (RF), and extreme gradient boosting (XGBoost). Various evaluation metrics were used to analyze the predictive performance of the models. The SHAP analysis method ranked the importance of features influencing the model's output and provided visual output and explanations for individual samples, meeting the need of clinicians to understand model outputs and personalized predictions. In total, this cohort study enrolled 506 SAE patients, with 243 cases (48.02%) resulting in death within 28 days. Overall, the XGBoost model demonstrated superior and stable performance, with the area under the receiver operating characteristic curve (AUC) for both the training and validation sets being higher than the other models, at 0.986 and 0.848, respectively. The SHAP summary plot revealed important clinical features associated with the risk of mortality within 28 days for SAE patients, with a strong dependence on age, SOFA score, and NEUT. Our study indicates that the XGBoost model has good predictive capability for the short-term prognostic outcomes of SAE patients in the ICU and can assist clinicians in the early identification of high-risk patients and the timely implementation of effective treatment strategies to improve the clinical outcomes of SAE patients.