bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multinational appraisal of the epidemiological distribution of opioid fatalities: a systematic review and meta-analysis
Authors: Onohuean Hope , Oosthuizen Frasia 
Published: January 2024

BackgroundThe global or multinational scientific evidence on the distribution of opioid fatality is unknown. Hence, the current study collects epidemiological characteristics to shed light on the ongoing global or multinational opioid crisis and to promote the development of public health prevention/management strategies.MethodAll documents on PRISMA standards were retrieved via electronic databases.ResultsAmong the 47 articles relevant to our studies, which depict a total population size of 10,191 individuals, the prevalence of opioid fatal overdose was 15,022 (14.74%). Among the 47 articles, 14 of them reported the gender of the participants, with 22,125 (15.79%) male individuals and 7,235 (5.17%) female individuals, and the age distribution of the participants that was most affected by the overdose was as follows: 29,272 (31.13%) belonged to the 18-34-year-old age group and 25,316 (26.92%) belonged to the less than 18-year-old age group. Eighteen studies qualified for the meta-analysis of the multinational prevalence of fatal opioid overdose, depicting an overall pooled prevalence estimate of 19.66%, with 95% CIs (0.13–0.29), I2 = 99.76% determined using the random-effects model, and Q statistic of 7198.77 (p &lt; 0.0001). The Egger test models of publication bias revealed an insubstantial level of bias (p = 0.015). The subgroup analysis of the study design (cohort or other) revealed that others have the highest prevalence estimate of 34.37, 95% CIs (0.1600–0.5901), I2 = 97.04%, and a sample size of less than 1,000 shows the highest prevalence of 34.66, 95% CIs (0.2039–0.5234), I2 = 97.82%, compared to that of more than 1,000 with a prevalence of 12.28, 95% CIs (0.0675–0.2131), I2 = 99.85%. The meta-regression analysis revealed that sample size (less-than or greater-than 1,000), (p = 0.0098; R2 = 3.83%) is significantly associated with the observed heterogeneity.ConclusionResearch-based findings of fatal opioid overdose are grossly lacking in middle- and low-income nations. We established that there is a need for opioid fatality surveillance systems in developing nations.
The impact of emotional dysregulation and comorbid depressive symptoms on clinical features, brain arousal, and treatment response in adults with ADHD
Authors: Huang Jue , Mauche Nicole , Ahlers Eike , Bogatsch Holger , Böhme Pierre , Ethofer Thomas , Fallgatter Andreas J , Gallinat Jürgen , Hegerl Ulrich , Heuser Isabella , Hoffmann Knut , Kittel-Schneider Sarah , Reif Andreas , Schöttle Daniel , Unterecker Stefan , Strauß Maria 
Published: January 2024

IntroductionThe role of emotional dysregulation (ED) in attention-deficit/hyperactivity disorder (ADHD) has become an important issue. This study, in which we analyzed data from a predictive pharmaco-EEG-trial, aimed to examine whether symptoms of ED in adult ADHD affect ADHD symptom severity, brain arousal regulation as measured by resting EEG, and the response to stimulant medication.MethodsED is defined as having a sex- and age-corrected T-score of &gt;70 on the emotional lability subscale of the German version of Conners’ Adult ADHD Rating Scale. A total of 115 participants were included in the study, 56 of whom had ED. Participants with ED were more impaired in terms of the severity of core ADHD symptoms, especially inattentive symptoms, comorbid depressive symptoms, interpersonal relationships, and quality of life. In addition, participants with ED were more likely to report a total score above 13 on the Beck Depression Inventory-II, which was considered to be the cutoff for mild depression.ResultsNo differences were found between the ED and non-ED groups in response to stimulant medication or in brain arousal regulation. In addition, there was no significant effect of ED with comorbid depressive symptoms on treatment response. There was a trend for subgroups that showed a change in brain arousal regulation associated with symptom improvement.DiscussionOur findings may support the assumption that ED may be an important feature of ADHD. The use of EEG-based brain arousal regulation as a diagnostic and predictive tool in ADHD in the presence of ED and comorbid depressive symptoms should be further investigated.
Enhancing resiliency and optimizing readiness in military personnel through psychological flexibility training: design and methodology of a randomized controlled trial
Authors: Peterson Alan L. , Moore Brian A. , Evans Wyatt R. , Young-McCaughan Stacey , Blankenship Abby E. , Straud Casey L. , McLean Christopher S. , Miller Tashina L. , Meyer Eric C. ,   for the STRONG STAR Consortium
Published: January 2024

BackgroundEnhancing resiliency and optimizing readiness in military personnel is a high priority for the U.S. Department of Defense. Most military resiliency-enhancement programs are evidence-informed interventions. However, few randomized studies have demonstrated efficacy of any intervention or training program to enhance resiliency and prevent the development of psychological health symptoms in military personnel when exposed to operational stressors. This manuscript provides an overview of the theoretical foundation, research design, and research methods of a preventive intervention trial designed to evaluate the efficacy of a training program to enhance resiliency and prevent psychological health symptoms in military personnel. The resiliency training intervention is based on Acceptance and Commitment Therapy (ACT), an evidence-based intervention with broad empirical support for improving functioning in those living with psychological and medical conditions.Method/designThis study will evaluate the efficacy of a two-day training program based on ACT for fostering psychological flexibility, the central target in ACT, for enhancing resiliency, and for preventing the development of psychological health symptoms. The research participants will be a non-clinical population of active duty military personnel (N = 600). The ACT-based training program (n = 300) will be compared to a military resiliency training as usual, known as Master Resilience Training (n = 300). Assessment measures will be administered at the baseline assessment, after training, prior to a military deployment, and after returning from a deployment. Qualitative interviews will be conducted to provide feedback on the training program.Clinical Trial Registration: NCT05094115.
Improving women’s experiences with gestational diabetes from culturally and linguistically diverse backgrounds in Australia: a qualitative study
Authors: Lau Hiu Wing Rachel , Dong Johnathon , Weir Tessa , Chopra Meenakshi , Olivetti Lyn , Fulcher Gregory , Glastras Sarah 
Published: January 2024

IntroductionGestational diabetes mellitus (GDM) is the fastest growing type of diabetes in many countries worldwide, including Australia. Although studies have explored the experiences of women with GDM from ethnic minority groups, few have compared their experiences with women from Anglosphere backgrounds.ObjectiveTo investigate the responses to diagnosis, the management of GDM, and the experiences of healthcare services among women with GDM from different culturally and linguistically diverse (CALD) backgrounds.MethodsParticipants were recruited via convenience sampling by advertisement posted around antenatal clinics of three hospitals in NSLHD: Royal North Shore, Hornsby, and Manly Hospitals. The interviews were semi-structured, one-on-one, and in-person conducted by a trained female volunteer. The interviews were audio-recorded, transcribed into text. The data was analyzed via an inductive and descriptive coding approach. The codes were then categorized into main themes and sub-themes.Results30 women (7 Australian-born, 11 Chinese, 8 Indians, and 4 Koreans) partook the semi-structured interviews and 5 themes were identified: (1) Reaction to diagnosis; (2) Management issues; (3) Roles of friends and family; (4) Information access; and (5) Experience with healthcare services. The lack of culturally tailored dietary information, social support and language barriers were the main factors underpinning the differences in GDM experiences among women from CALD backgrounds versus Australian-born.ConclusionHealthcare models should provide more emotional support upon diagnosis, culturally tailored guidelines for lifestyle modifications, and involve friends and family in care and management to enhance the experience of GDM for women from CALD backgrounds.
Incidence, antimicrobial resistance and mortality of Pseudomonas aeruginosa bloodstream infections among hospitalized patients in China: a retrospective observational multicenter cohort study from 2017 to 2021
Authors: Xiao Shuzhen , Liang Xianghui , Han Lizhong , Zhao Shengyuan 
Published: January 2024

BackgroundPseudomonas aeruginosa (P. aeruginosa) accounts for high antimicrobial resistance and mortality rates of bloodstream infections (BSIs). We aim to investigate incidence, antimicrobial resistance and risk factors for mortality of P. aeruginosa BSIs among inpatients.MethodsA retrospective cohort study were conducted at two tertiary hospitals in 2017–2021. Medical and laboratory records of all inpatients diagnosed with P. aeruginosa BSIs were reviewed. A generalized linear mixed model was used to identify risk factors for mortality.ResultsA total of 285 patients with P. aeruginosa BSIs were identified. Incidence of P. aeruginosa BSIs fluctuated between 2.37 and 3.51 per 100,000 patient-days over the study period. Out of 285 P. aeruginosa isolates, 97 (34.04%) were carbapenem-resistant (CR) and 75 (26.32%) were multidrug-resistant (MDR). These isolates showed low resistance to aminoglycosides (9.51–11.62%), broad-spectrum cephalosporins (17.19–17.61%), fluoroquinolones (17.25–19.43%), and polymyxin B (1.69%). The crude 30-day mortality rate was 17.89% (51/285). Healthcare costs of patients with MDR/CR isolates were significantly higher than those of patients with non-MDR/CR isolates (P &lt; 0.001/=0.002). Inappropriate definitive therapy [adjusted odds ratio (aOR) 4.47, 95% confidence interval (95% CI) 1.35–14.77; P = 0.014], ICU stay (aOR 2.89, 95% CI: 1.26–6.63; P = 0.012) and corticosteroids use (aOR 2.89, 95% CI: 1.31–6.41; P = 0.009) were independently associated with 30-day mortality.ConclusionIncidence of P. aeruginosa BSIs showed an upward trend during 2017–2020 but dropped in 2021. MDR/CR P. aeruginosa BSIs are associated with higher healthcare costs. Awareness is required that patients with inappropriate definitive antimicrobial therapy, ICU stay and corticosteroids use are at higher risk of death from P. aeruginosa BSIs.
Driving factors of urban community epidemic prevention and control capability: QCA analysis based on typical cases of 20 anti-epidemic communities in China
Authors: Shi Ruyi , Lu Bo , Zhong Yiwen 
Published: January 2024

IntroductionIn the wake of the COVID-19 outbreak, urban communities have emerged as the frontline defenders in epidemic prevention and control, providing the most effective means of curbing the spread of virus both inward and outward. This study attempts to explain the underlying factors and mechanisms that shape the community epidemic prevention and control capacity (CEPCC).MethodsWe adopted a resilience-based perspective and drew on a sample of 20 exemplary anti-epidemic communities in China. By constructing an analytical framework and employing the fuzzy set qualitative comparative analysis method (fsQCA), we explored how four conditional variables—infrastructure completeness, community self-organizing ability, redundancy of community resources, and stability of regional economic development—and their various configurations impact the CEPCC.ResultsOur findings reveal that the four conditional variables, when considered in isolation, cannot effectively enhance the CEPCC. Instead, four configuration pathways with mixed conditional variables exist. Notably, community self-organizing ability emerges as a vital condition for effectively strengthening the CEPCC.DiscussionThis study identifies four pathways to improve the CEPCC and confirms the validity of the data results through case studies. Conclusions of this research contribute to a more nuanced understanding of the factors influencing the CEPCC, which can help communities to better plan and prepare for future epidemics and ensure better response and adaptation to the impacts of future emergencies.
Coupling coordination of the provision of medical services and high-quality economic development in the Yangtze River Economic Belt
Authors: Yang Shipeng , Yan Hongtao , Gong Yefang , Zeng Siying 
Published: January 2024

BackgroundPromoting high-level coupling coordination between the provision of medical services (PMS) and high-quality economic development (HED) has emerged as a critical issue in China’s pursuit of high-quality development and is now a significant subject of concern in the area of welfare economics.Materials and methodsBased on panel data from 11 provinces and municipalities in the Yangtze River Economic Belt, covering the period from 2010 to 2020, this study conducted an empirical analysis of the coupling coordination between PMS and HED and its influencing factors. Methods combined a comprehensive evaluation model, a coupling coordination model, and a panel Tobit model.ResultsThe study found that: (1) Regarding the overall situation in the Yangtze River Economic Belt, the overall PMS demonstrates a fluctuating upward trend, while HED fluctuates within the lower range of 0.3 to 0.4. The coupling coordination degree between PMS and HED fluctuates within the moderate range of 0.5 to 0.6. (2) In terms of the spatiotemporal evolution trends, there still exists substantial spatial disparity among provinces and municipalities within the Yangtze River Economic Belt regarding PMS; nonetheless, this gap is gradually narrowing. Significant regional disparities are also observed in HED, with Shanghai, Jiangsu, and Zhejiang leading among the provinces and municipalities in the Yangtze River Economic Belt. The coupling coordination degree between PMS and HED displays notable spatial discrepancies, where downstream areas of the Yangtze River Economic Belt such as Shanghai, Jiangsu, and Zhejiang exhibit a higher coupling coordination degree compared to other provinces and municipalities. However, most provinces and municipalities outside this group remain at a moderately coordinated stage concerning the degree of coupling coordination between PMS and HED. (3) Economic development level and local government competition had a significant negative impact on coupling coordination between PMS and HED, whereas there was a significantly positive impact on the degree of fiscal autonomy and urbanization.DiscussionThis study contributes to comprehensively understanding the coupling and coordination relationship between the PMS and HED across provinces and municipalities in the Yangtze River Economic Belt. It provides empirical evidence for the collaborative evolution of PMS and HED.
Risk factors for hospitalization and pneumonia development of pediatric patients with seasonal influenza during February–April 2023
Authors: Zhang Yuqian , Huang Xing , Zhang Jianguo , Tao Zhimin 
Published: January 2024

ObjectivesIn China influenza remains a low activity for continuous 3 years due to COVID-19 controls. We here sought to study the clinical characteristics and risk factors of the influenza infection among children after the mandatory COVID-19 restrictions were lifted.MethodsWe included 1,006 pediatric patients with influenza A virus (IAV) infection, enrolled in one tertiary hospital in Zhenjiang, Jiangsu Province, China, during February to April 2023. Patients were divided into the outpatient (n = 798) and inpatient (n = 208) groups, and their baseline characteristics were compared between two groups to conclude the risk factors for pediatric hospitalization. Separately, pediatric inpatients (n = 208) were further divided into the pneumonia and non-pneumonia groups with comparison of their clinical characteristics, including their laboratory test results and representative radiological features, to derive the key determinants for pneumonia development after hospitalization.ResultsCompared to outpatients, IAV-infected pediatric inpatients exhibited younger age, higher female: male ratio, more co-infection of influenza B virus (IBV) and hematological abnormality. Multivariate regression analysis determined the independent risk factors of hospitalization to be the clinical symptom of abdominal pain (OR = 2.63, [95% CI, 1.05–6.57], p = 0.039), co-infection of IBV (OR = 44.33, [95% CI, 25.10–78.30], p = 0.001), elevated levels of lymphocytes (OR = 2.24, [95% CI,1.65–3.05], p = 0.001) and c-reactive proteins (CRPs) (OR = 1.06, [95% CI, 1.03–1.08], p = 0.001) upon hospital admission. Furthermore, the cough symptom (OR = 17.39, [95% CI, 3.51–86.13], p = 0.001) and hospitalization length (OR = 1.36, [95% CI, 1.12–1.67], p = 0.002) were determined to be risk factors of pneumonia acquirement for pediatric inpatients.ConclusionWhile the abdominal pain, viral co-infection and some hematological abnormality mainly contribute to hospitalization of pediatric patients with IAV infection, the length of hospital stay and clinical sign of coughing upon hospital admission constitute the key determinants for nosocomial pneumonia development.
Incentive mechanism for sharing and using EHR in medical consortiums based on performance evaluation
Authors: Tian Sheng Hu , Jiang Rong , Chen Yu 
Published: January 2024

BackgroundThe construction of medical consortiums not only promotes active cooperation among hospitals, but also further intensifies active competition among them. The shared use of electronic health records (EHR) breaks the original pattern of benefit distribution among hospitals.ObjectiveThe purpose of this paper is to establish an incentive mechanism for the shared use EHR, and to reveal the incentive effect and mechanism of key factors, and to put forward management suggestions for solving the real conflicts.MethodsWe constructed a basic incentive model and an incentive model that introduces performance evaluation as a supervisory signal, based on analyzing the hospital cost function, the hospital benefit function, and the incentive contract function. Finally, the incentive effects of key factors before and after the introduction of performance evaluation were verified and compared using MATLAB simulation method.ResultsThe profit level and incentive coefficient of hospitals sharing EHR are independent of the amount of one-time government subsidies. Regardless of whether a performance evaluation supervisory signal is introduced or not, the incentive coefficients are increasing functions with respect to ρ, τ, but decreasing functions with respect to β, δ, γ. After the inclusion of supervisory signal of performance evaluation in the model, the ability of hospitals to use EHR has a higher impact effectiveness on improving both incentive effects and benefit levels. The impact of the value-added coefficient on the level of earnings is consistently greater than it would have been without the inclusion of the performance evaluation supervisory signal.ConclusionsEnhancing the capacity of hospitals to use EHR and tapping and expanding the value-added space of EHR are 2 key paths to promote sustainable shared use of EHR. Substantive performance evaluation plays an important role in stabilizing incentive effects.
Network dynamics of positive energy districts: a coevolutionary business ecosystem analysis
Authors: Zapata Riveros Juliana , Scacco Paulet Michelle , Ulli-Beer Silvia 
Published: January 2024

IntroductionAmid the rising interest in sustainable urban development, Positive Energy Districts (PEDs) have become a focus of research. This study examines the dynamic processes that influence the development and scalability of PEDs from a co-evolutionary business ecosystem perspective.MethodsTo delve into the dynamics of Positive Energy Districts, we applied the business ecosystem framework to a real-world case study, namely the Hunziker Areal. Our research methodology involved the development and validation of a high-level conceptual model. This was achieved through workshops and guided interviews with experts engaged in pilot and research projects related to PEDs.ResultsThe study highlights the significance of employing a systemic approach to evaluate the potential of PEDs in enhancing housing sustainability while creating value for diverse stakeholders. Through the utilization of causal loop diagrams, key feedback loops explaining the diffusion of PEDs are identified. Moreover, the study reveals varying perceptions of PED utility among stakeholders, who assess the impact using different Key Performance Indicators (KPIs) such as CO2 target achievement and well-being. Key factors influencing technology adoption, such as low prosumer electricity unit cost, are also identified.DiscussionOur findings further shed light on crucial aspects affecting value capture and the attractiveness of the ecosystem to investors. Additionally, the study underscores the critical role of supportive policies and regulations in facilitating the diffusion and scalability of Positive Energy Districts.
Retroperitoneal laparoscopic adrenalectomy for large adrenal tumors—analysis of tumor size and adverse events: a retrospective single-center study
Authors: Tsai I-Chen , Hsieh Yu-Che , Tseng Wen-Hsin , Liu Chien-Liang , Ho Chung-Han , Li Chien-Feng , Chiu Allen W. , Huang Steven K. 
Published: January 2024

IntroductionAdrenal tumors are relatively common, and adrenalectomy is the third most common endocrine surgery. Patients with adrenal tumors were categorized into two groups for analysis: those with intermediate (4–6 cm, Group 1) and large (&gt;6 cm, Group 2) tumors undergoing Retroperitoneal Laparoscopic Adrenalectomy (RLA). The primary outcome is to compare the surgical outcomes between these two groups. The secondary outcome involves analyzing the relationship between tumor characteristics and the incidence of adverse events.MethodsData from 76 patients who underwent RLA for tumors of size ≥4 cm between 2005 and 2022 at a single tertiary referral center were analyzed retrospectively. Variables, including patients' age, hormone function, operation time, conversion to open approach, perioperative complications, and adverse surgical events (blood loss &gt;500 cc, conversion to open approach, and perioperative complications), were assessed.ResultsNo significant differences were observed between the two groups in terms of functional and histopathologic analysis, gender distribution, functioning factors, perioperative complications, and estimated blood loss. However, patients in Group 2 were younger (median age 50, IQR: 40–57, P = 0.04), experienced longer operative times (median 175 min, IQR: 145–230 min, P = 0.005), and had a higher rate of conversion to open surgery (12%, P = 0.033). For every 1 cm increase in tumor size, the odds ratio for adverse surgical events increased by 1.58.ConclusionsRLA is a safe and feasible procedure for adrenal tumors larger than 6 cm. While intraoperative and postoperative complications are not significantly increased in either group, larger tumors increase surgery times and are more likely to require conversion to open surgery. Therefore, caution and preparedness for potential adverse events are recommended when dealing with larger tumors. A tumor size of 5.3 cm may serve as a guide for risk stratification and surgical planning in large adrenal tumor management.