bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lenvatinib plus TACE versus Sorafenib plus TACE for advanced hepatocellular carcinoma: A systematic review and meta-analysis
Authors: Ma Luyao , Liu Haonan , Pan Di , Qin Xiaobing , Gao Ying , Ma Xiao , Yu Aoyang , Liu Duanjiao , Zhang Xinran , Han Zhengxiang 
Published: November 2023

Abstract
Objective
The goal of this systematic review was to compare the effectiveness and safety of the treatment of advanced hepatocellular carcinoma (HCC) with lenvatinib plus transarterial chemoembolization (TACE) versus sorafenib plus TACE.
Method
A comprehensive search was conducted across multiple databases, including PubMed, Web of Science, Cochrane Library, Embase, CNKI, Wangfangdate, and CBM. We computed pooled hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) to assess overall survival (OS), progression-free survival (PFS), and time to progression (TTP). Additionally, we determined pooled risk ratios (RRs) and their 95% CIs to evaluate the objective response rate (ORR), disease control rate (DCR), and adverse events (AEs).
Result
The analysis comprised a total of 7 studies with 682 patients as the sample size. The results of our study indicate that the combination of lenvatinib and TACE demonstrated significantly improved OS (HR = 0.594, 95% CI: 0.484–0.730, p < 0.001), PFS (HR = 0.417, 95% CI: 0.302–0.574, p < 0.001), TTP (HR = 0.603, 95% CI: 0.442–0.824, p = 0.001), ORR (RR = 1.820, 95% CI: 1.272–2.605, p = 0.001), and DCR (RR = 1.333, 95% CI: 1.040–1.708, p = 0.023) compared to the combination of sorafenib and TACE in patients with advanced HCC. Additionally, there was no significant difference found in the overall adverse events of all-grade (RR = 1.054, 95% CI: 0.984–1.128, p = 0.136) and grade 3/4 (RR = 1.062, 95% CI: 0.875–1.289, p = 0.542) between the two groups.
Conclusion
Lenvatinib plus TACE improved OS, PFS, TTP, ORR, and DCR compared with sorafenib plus TACE in advanced HCC with an acceptable safety profile.
High-strength Self-compacting Concrete incorporating high dosage of Fly ash and Quarry dust
Authors: Lim Hung Ling , Mannan Mohammad Abdul , Fakhri Rana Shamseldeen , Dawood Eethar Thanon 
Published: November 2023

Abstract
Locally, conventional concrete is still created utilizing river sand and crushed stone as filer materials. The massive quarry dust by-product remain untapped in the production of concrete. The coal-fired power station produce significant quantities of Type F fly ash. Self-compacting concrete (SCC) provides many advantages for creating high-quality concrete. Consequently, the main objective of this research is to create a mix design for high-strength SCC utilizing a binary blends , hybrid fibers and fine aggregates that meet both hardened and fresh concrete characteristics. The study is conducted in amendment of w/b ratio, superplasticizer, proportion of fine aggregate to coarse aggregate, optimumal cement replacing by fly ash, dosage of low macro fibre and micro fibre. Mix-50c-X is the best mix design that was produced. The mix quantity for 1m3 concrete was 315 kg Class F fly ash , 315 kg OPC , 630 kg quarry dust, 508 kg river sand, 400 kg coarse aggregate , 0.7% superplasticizer,0.32 % w/b , 0.10% macro fiber, and 0.01% micro fiber. This SCC mixture showed fresh characteristics as well as compressive strengths of more than 22 MPa and 62 MPa after 1 day and 28 days, respectively. The results of high-strength SCC demonstrated the enormous potential for the local construction, especially precast product.
Usability and user expectations of a HoloLens-based augmented reality application for learning clinical technical skills
Authors: Escalada-Hernández Paula , Soto-Ruiz Nelia , Ballesteros-Egüés Tomás , Larrayoz-Jiménez Ana , Martín-Rodríguez Leticia San 
Published: November 2023

Abstract

The application of augmented reality in training health science students is increasingly widespread. The aim of this work was to assess the usability and user expectations of an augmented reality application for smart glasses (Microsoft HoloLens) that can be used to train on four invasive procedures (i.e. intramuscular injection, nasogastric tube insertion, endotracheal intubation and suctioning via tracheostomy tube). A descriptive study was conducted with nursing students from three Spanish universities. Participants answered a questionnaire to assess the use of the ARSim2care application. This application offers the possibility of visualizing the internal anatomical structures during the training of the clinical technical skills for the performance of the mentioned invasive techniques. The questionnaire included demographic data, the System Usability Scale and questions about the user expectations in relation to learning with the use of augmented reality. In total, 61 participants responded to the questionnaire after using the ARSim2care application. The mean score of the System Usability Scale was 73.15 (standard deviation: 15.04) and 62.4% (n = 38) of the participants considered their experience with the application as excellent or good. In relation to user expectations, more than 90% of students indicated that the use of the application could improve their motivation and stimulation in learning, their content retention and their anatomical understanding. The developed ARSim2care application for Microsoft HoloLens showed a high level of usability and acceptance as a learning tool for training certain clinical procedures by visualizing the internal structures of the body.
Association between Lifelines Diet Score (LLDS) and some novel anthropometric indices, including BRI, ABSI, VAI, and BAI, in Iranian women: A cross-sectional study
Authors: Nazari Matin , Mirzaei Khadijeh , Keshavarz Seyedali 
Published: November 2023

Abstract
Background
Anthropometry is a reliable method to assess obesity status, and previous studies have shown the association of several dietary quality scores with obesity using anthropometric indices. This study aimed to evaluate the association between LLDS and anthropometric measurements.
Methods
A total of 217 women between the ages of 18 and 48 participated in the study. Anthropometric values, biochemical tests, and body composition were assessed for each participant using standard protocols and methods. The LLDS was determined based on 12 components using a reliable and valid food frequency questionnaire (FFQ) that contained 147 items.
Results
We detected a marginally significant inverse association between the LLDS and VAI scores in the second tertile. Study participants in the second tertile of LLDS had lower odds of having high VAI than those in the reference tertile after adjusting for age, energy intake, physical activity, education, and economic status (OR: -0.16; 95% CI: -0.8, 0.06; P = 0.06). There was no statistically significant trend for the association between LLDS and all assessed anthropometric indices, including BRI, ABSI, VAI, and BAI, across tertiles of LLDS in the crude and all adjusted models (P-trend > 0.05).
Conclusions
There was no significant association between LLDS and some novel anthropometric indices, including BRI, ABSI, VAI, and BAI. However, after adjusting for probable confounders, a marginally significant inverse association between LLDS and VAI was detected.
The role of women’s autonomy and empowerment in maternal health decision making: Implications on the implementation process of a service delivery reform in Kenya. A qualitative exploratory study
Authors: Olwanda Easter , Opondo Kennedy , Oluoch Dorothy , Croke Kevin , Maluni Justinah , Jepkosgei Joyline , Nzinga Jacinta 
Published: November 2023

Abstract
Background
A maternal and child health service delivery redesign (SDR) that aims to reorganize maternal and newborn health services is being implemented in Kakamega County in Kenya. Women's voice, agency, and autonomy are critical aspects of gender equality and women's empowerment since women’s ability to make decisions alone or in consultation with others in the household is an important determinant of access and utilization. As part of the process evaluation, this study sought to understand women’s process of decision-making in seeking maternal health care and how these affect women’s ability to access and use these services.
Methods
We adapted the International Centre for Research on Women (ICRW) conceptual framework for reproductive empowerment that combines the interrelated concepts of “female autonomy”, and “women’s agency” with the latter incorporating ‘voice’, ‘choice’ and ‘power’. We conducted key informant interviews, in-depth interviews, and focus group discussions with pregnant women attending Antenatal clinics, women who had delivered, and women attending post-natal clinics. A thematic analysis approach was used to analyze the data in NVivo 12.
Results
The results revealed significant findings across three dimensions of agency. Women with previous birthing experiences, high self-esteem, and support from their social networks exhibited greater agency. Additionally, positive previous birthing experiences were associated with increased confidence in making reproductive health choices. Women who had control over financial resources and experienced respectful communication with their partners exhibited higher levels of agency within their households. Distance relational agency demonstrated the impact of health system factors and socio-cultural norms on women's agency and autonomy. Finally, women who faced barriers such as long waiting times or limited staff availability experienced reduced agency in seeking healthcare.
Conclusions
Individual agency, immediate relational agency, and distance relational agency all play crucial roles in shaping women's decision-making power and control over their utilization of maternal health services. By identifying specific determinants within each dimension, this study provides valuable insights that can provide guidance for the ongoing implementation of an innovative service delivery redesign model by emphasizing the critical need for developing holistic and context-specific strategies to promote women's voices to ensure acceptability and sustained use.
Risk Model of Climate Change and Water Scarcity for Energy Resources of Iraq
Authors: Marcellin Megan C. , Pavur Gigi , Loose Davis C. , Cardenas John J. , Denehy David , Almashhadani Mustafa , Waheed Saddam Q. , Trump Benjamin D. , Polmateer Thomas L. , Linkov Igor , Lakshmi Venkataraman , Lambert James H. 
Published: November 2023

Abstract

Water security in arid and semi-arid Middle Eastern climates has been severely impacted by effects of climate change such as reduced precipitation, diminished storage, increased evapotranspiration, and prolonged heat waves. These climate effects are compounded in Iraq, where populations, agriculture, industry, and energy rely heavily on varying transboundary water flows to meet water demands. Iraq’s most profitable sector, energy, is especially threatened by insufficient water supply, which complicates government decision making in energy infrastructure development. The goal of this paper is to develop a scenario-based multi-criteria analysis framework to prioritize infrastructure investments in the context of climate change and scarcity of natural resources. Infrastructure facilities are evaluated against social, economic, climate, and hydrologic criteria across a set of disruptive climatological, economic, and social scenarios to identify robust initiatives and the most and least disruptive scenarios to the system. A particular innovation of this paper is the use of hydrology data derived from satellites in determining water scarcity impact on individual energy facilities. The methods are demonstrated for a critical sector of Iraq’s economy: oil and natural gas. The demonstration includes 13 system order criteria, 44 oil and gas initiatives within Iraq, and seven risk scenarios. The results include an accounting of the most and least disruptive scenarios to energy sector priorities and scenario-based system orderings to guide stakeholders in investment prioritization.
Opioid Use Following Cardio-thoracic Intensive Care – Risk Factors and Outcomes: a Cohort Study
Authors: von Oelreich Erik , Jalde Francesca , Rysz Susanne , Eriksson Jesper 
Published: November 2023

Abstract
Opioid misuse has become a serious public health problem. Patients admitted to cardio-thoracic critical care are usually exposed to opioids, but the incidence and effects of chronic opioid use are not known. The primary objective was to describe opioid use after admission to a cardio-thoracic intensive care unit. Secondary objectives were to identify factors associated with chronic opioid usage and analyze risk of death. This cohort study included all cardio-thoracic ICU care episodes in Sweden between 2010 and 2018. Among the 34,200 patients included in the final study cohort, 4,050 developed persistent opioid use after ICU care. Younger age, preadmission opioid use, female sex, presence of comorbidities and earlier year of ICU admission were all found to be associated with persistent opioid use. The adjusted hazard ratio for mortality between 6 to 18 months after admission among individuals with persistent opioid use was 2.2 (95% CI: 1.8–2.6; P < 0.001). For opioid-naïve patients before ICU admission, new onset of chronic opioid usage was significant during the follow-up period of 24 months. Despite the absence of conclusive evidence supporting extended opioid treatment, the average opioid consumption remains notably elevated twelve months subsequent to cardio-thoracic ICU care.
Longitudinal associations of depression, mild cognitive impairment, and quality of life with handgrip strength
Authors: Palazuelos-González Rosa , Salinas-Rodríguez Aarón , Manrique-Espinoza Betty 
Published: November 2023

Abstract
Background. Mental health and quality of life (QoL) are key components of healthy aging, and their deterioration may lead to a loss of health, dependence, and mortality among older adults. Handgrip strength (HGS) has been widely used given its practicality and reliability as an indicator of general health status and physical functioning and even as a biomarker of aging. This study aimed to estimate the longitudinal associations of handgrip strength (HGS) with depression, mild cognitive impairment (MCI), and quality of life (QoL).
Methods. Data come from the first three wave of the Study on Global Aging and Adult Health in Mexico (2009, 2014, 2017). 2,943 older adults aged 50 years or older were included. HGS was measured using a handheld dynamometer. We used the Composite International Diagnostic Interview for the diagnosis of depression based on DSM‐IV criteria. MCI was determined according to the recommendations of the National Institute on Aging and the Alzheimer's Association of the United States. Quality of life was assessed using the WHOQOL (WHO Quality of Life) instrument. HGS was considered as a time-varying exposure and the between- and within-person effects were disaggregated using the hybrid models with random intercept.
Results. Higher HGS values were significantly associated with the three outcomes, decreasing the probability of depression (OR=0.98, p=0.02) and MCI (OR=0.97, p<0.01), and increasing quality of life levels (β=0.10, p<0.01). Likewise, those with weak grip strength had a higher probability of depression (OR=1.36, 95% CI 1.01;1.82), MCI (OR=1.32, 95% CI 1.03;1.68) and lower quality of life (β= -1.21 95% CI -1.95;-0.47). a higher proportion of this association will be better explained by between-person differences than within-person differences. A predominance of between-person effects over within-person effects was observed.
Conclusion. Given the explanatory power of HGS, routine use of its measurement should be implemented, both in the community and in clinical settings, to identify older adults at risk for adverse health outcomes.
IFN-β plasmatic levels are best predictors of muscle disease activity than IFN-α in a longitudinal cohort of patients with juvenile dermatomyositis
Authors: Moreau Thomas RJ , Bondet Vincent , Ramos Juliette , Ouldali Naïm , Alyanakian Marie-Alexandra , Bodemer Christine , Dingulu Glory , Dumaine Cécile , Duong Ngoc-Bao , Charuel Jean-Luc , Eveillard Laurye-Anne , Fournier Benjamin , Frémond Marie-Louise , Herbeuval Jean-Philippe , Isapof Arnaud , Quartier Pierre , Vinit Caroline , Welfringer-Morin Anne , Gitiaux Cyril , Melki Isabelle , Duffy Darragh , Bader-Meunier Brigitte , Rodero Mathieu P 
Published: November 2023

Abstract
This study was conducted to identify the contribution of myositis-specific antibodies (MSAs) on the correlation between type I interferon (IFN-I) plasma levels and disease activity in juvenile dermatomyositis (JDM) patients. We prospectively obtained 198 samples from 49 JDM patients. Autoantibody levels were determined for all patients. Muscle activity was scored using Childhood Myositis Assessment Scale (CMAS) and Manual Muscle Testing in 8 muscles (MMT-8) and skin involvement with a Disease Activity Score (DAS). Three homebrew digital ELISA measuring respectively the IFN-α2 subtype, all 12 interferon alpha (IFN-α) subtype proteins (Pan-α), and interferon beta (IFN-β) were used to quantify IFN-I in patient’s plasma. Correlations between IFN-I titers and clinical scores were evaluated using linear mixed-effect models. In our entire cohort, Pan-α and IFN-β were associated with all three clinical scores. Correlations between IFN-β plasma levels and muscle disease activity were stronger than those with IFN-α levels. After stratification on MSAs expression, we found a relatively equal distribution for the most frequent MSAs phenotypes (MDA5+:n=13, NXP2+:n=12, TIF1g+:n=11, No MSAs:n=13). We observed an association between CMAS and IFN-β in all 4 subgroups. In contrast, Pan-α levels were associated with clinical scores only in MDA5+ patients. In this subgroup, IFN-α2 was also strongly associated with muscle scores. These findings underscore the potential role of IFN-β in blood as a reliable biomarker of muscle disease activity in JDM, irrespectively of MSAs positivity. The association of IFN-α subtypes plasma levels with clinical scores only in MDA5+ patients suggests a distinct pathophysiological mechanism in this subgroup.
Psychometric evaluation of the translated Chinese version of the Toxic Leadership Behaviors of Nurse Managers Scale (ToxBH-NM)
Authors: Wang Yuhan , Guo Xueqin , Li Xin , Xiong Lijuan , Wang Yumei , Wang Yangjing , He Jia , Jin Huan 
Published: November 2023

Abstract
Aim
To translate and psychometrically validate the Toxic Leadership Behaviors of Nurse Managers Scale in China.
Background
Toxic leadership is a negative or ineffective leadership style, the prevalence of which is rising in the field of nursing. Toxic leadership can manifest itself in different ways in different cultural contexts and we currently lack a specific and standard instrument to evaluate nurse managers' toxic leadership behaviors in China.
Methods
The Toxic Leadership Behaviors of Nurse Managers Scale was translated into Chinese based on Brislin's classical back translation model. Item analysis, content validity, exploratory and confirmatory factor analysis (EFA and CFA), internal consistency reliability, test-retest reliability were used to test the psychometric attributes of the scale.
Results
EFA yielded a four-factor scale structure with a cumulative variance contribution of 72.020%. CFA suggested acceptable indices which were consistent with the four-factor model of the original scale. Cronbach's α was 0.967 for the whole scale.
Conclusions
The Chinese version of ToxBH-NM (C-ToxBH-NM) was reliable and valid, and the scale was a potentially useful instrument to assess and present nurse managers' toxic leadership behaviors in China.
Wall shear stress measurement using a zero-displacement floating-element balance
Authors: Ferreira M. Aguiar , Ganapathisubramani B. 
Published: November 2023

Abstract
The floating element (FE) balance, introduced nearly a century ago, remains one of the most versatile direct wall shear stress measurement methods. Yet, its intrinsic sources of systematic error, associated with the flow-exposed gap, off-axis load sensitivity, signal-to-noise ratio, and calibration, have thus far limited its widespread application. In combination with the lack of standard designs and testing procedures, measurement reliability still hinges heavily on individual judgement and expertise. This paper presents a framework to curb these limitations, whereby the design and operation of a FE balance are leveraged by an analytical model that attempts to capture the behaviour and predict the relative contribution of the systematic error sources. The design is based on a parallel-shift linkage and a zero-displacement force-feedback system. The FE balance has a surface area of 200×200mm, and measurement sensitivity is adjustable depending on the surface condition and the Reynolds number. It is thus suitable for application in a wide range of low-speed, boundary-layer wind tunnels, from small to large scale. Measurements of the smooth-wall skin friction coefficient show a remarkable agreement with oil-film interferometry, especially for Reθ > 1.3 × 104. The discrepancy relative to the empirical Coles-Fernoholz relation (κ = 0.39 and C = 4.352) is within 0.5 %, and the level of uncertainty is below 1% for a confidence interval of 95 %.
Leveraging 3D Convolutional Neural Networks for Accurate Recognition and Localization of Ankle Fractures
Authors: Ying Jichong , Huang Dichao , Liu Jianlei , Yu Tianming , Wang Hua 
Published: November 2023

Abstract

Background
Ankle fractures are common injuries with substantial implications for patient mobility and quality of life. Traditional imaging methods, while standard, have limitations in detecting subtle fractures and distinguishing them from complex bone structures. The advent of 3D Convolutional Neural Networks (3D-CNNs) offers a promising avenue for enhancing the accuracy and reliability of ankle fracture diagnoses.
Methods
In this study, we acquired 1,453 high-resolution CT scans and processed them through three distinct 3D-CNN models: 3D-Mobilenet, 3D-Resnet101, and 3D-EfficientNetB7. Our approach involved rigorous preprocessing of images, including normalization and resampling, followed by a comparative evaluation of the models using accuracy, Area Under the Curve (AUC), and recall metrics. Additionally, the integration of Gradient-weighted Class Activation Mapping (Grad-CAM) provided visual interpretability of the models' predictive focus points.
Results
The 3D-EfficientNetB7 model demonstrated superior performance, achieving an accuracy of 0.91 and an AUC of 0.94 after 20 training epochs. Furthermore, Grad-CAM visualizations aligned closely with expert radiologists' assessments, validating the model's diagnostic precision. Spatial localization techniques further enhanced the interpretability of fracture detection, providing clear visual cues for medical professionals.
Conclusions
The implementation of 3D-CNNs, particularly the 3D-EfficientNetB7 model, significantly improved the detection and localization of ankle fractures. The use of Grad-CAM has also proved essential in providing transparency to AI-driven diagnostics. Our research supports the integration of 3D-CNNs in clinical settings, potentially revolutionizing the standard of care in fracture diagnosis and paving the way for their application in broader medical imaging tasks.