bluuebunny/crossref_metadata_2025_split huggingface dataset:
What information sources do Dutch medical specialists use in medical decision-making: a qualitative interview study
Authors: Weller Floris S. , Hamming Jaap F. , Repping Sjoerd , van Bodegom-Vos Leti 
Published: October 2023

ObjectiveTo explore what information sources medical specialists currently use to inform their medical decision-making.DesignQualitative, semistructured interviews.Setting and participantsA total of 20 semistructured interviews were conducted with 10 surgeons and 10 internal medicine specialists who work in academic and/or regional hospitals in the Netherlands.ResultsMedical specialists reported that they primarily rely on their general knowledge and experience, rather than actively using information sources. The sources they use to update their knowledge can be categorised into ‘scientific publications’, ‘guidelines or protocols’, and ‘presentations and meetings’. When medical specialists feel their general knowledge and experience are insufficient, they use three different approaches to find answers in response to clinical questions: consulting a colleague, actively searching the literature and asking someone else to search the literature.ConclusionMedical specialists use information sources to update their general knowledge and to find answers to specific clinical questions when they feel their general knowledge and experience are insufficient. An important finding is that medical specialists prefer accessible information sources (eg, consulting colleagues) over existing evidence-based medicine tools.
Malaria vaccine-related adverse events among children under 5 in sub-Saharan Africa: systematic review and meta-analysis protocol
Authors: Ohene-Adjei Kennedy , Asante Kwaku Poku , Akuffo Kwadwo Owusu , Tounaikok Narcisse , Asiamah Morrison , Owiredu David , Manu Alexander Ansah , Danso-Appiah Anthony 
Published: October 2023

IntroductionThe RTS,S vaccine has been approved for use in children under 5 living in moderate to high malaria transmission areas. However, clinically important adverse events have been reported in countries in sub-Saharan Africa. This systematic review aims to assess the frequency, severity and clinical importance of vaccine-related adverse events.Methods and analysisThis systematic review protocol has been prepared following robust methods and reported in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses for protocols guidelines. We will search PubMed, CINAHL, LILACS, Google Scholar, SCOPUS, WEB OF SCIENCE, Cochrane library, HINARI,African Journals Online, Trip Pro and TOXNET from 2000 to 30 September 2023, without language restrictions. We will also search conference proceedings, dissertations, World Bank Open Knowledge Repository, and WHO, PATH, UNICEF, Food and Drugs Authorities and European Medicines Agency databases, preprint repositories and reference lists of relevant studies for additional studies. Experts in the field will be contacted for unpublished or published studies missed by our searches. At least two reviewers will independently select studies and extract data using pretested tools and assess risk of bias in the included studies using the Cochrane risk of bias tool. Any disagreements will be resolved through discussion between the reviewers. Heterogeneity will be explored graphically, and statistically using the I2statistic. We will conduct random-effects meta-analysis when heterogeneity is appreciable, and express dichotomous outcomes (serious adverse events, cerebral malaria and febrile convulsion) as risk ratio (RR) with their 95% CI. We will perform subgroup analysis to assess the impact of heterogeneity and sensitivity analyses to test the robustness of the effect estimates. The overall level of evidence will be assessed using Grading of Recommendations Assessment, Development and Evaluation.Ethics and disseminationEthical approval is not required for a systematic review. The findings of this study will be disseminated through stakeholder forums, conferences and peer-review publications.PROSPERO registration numberCRD42021275155.
Building lean improvement skills at scale: an evaluation of a massive open online course in the English NHS
Authors: Smith Iain M 
Published: October 2023

BackgroundInternationally, healthcare systems face challenges from population demographics and rising care costs. Systematic methods of quality improvement (QI) are considered key to delivering needed transformation and change. Large-scale training in QI skills is required.Massive open online courses (MOOCs) are an inexpensive strategy for QI training across large regions and countries. TheLean FundamentalsMOOC was developed in the English NHS to train health and care staff in Lean QI methods. It supported participants to learn and apply process improvement skills through a free-to-access, practical, learning-in-action approach.MethodsLean Fundamentals’cost-effectiveness and its impact on participants’ knowledge and confidence to apply Lean to improve processes were assessed. Using the Kirkpatrick framework, participant reaction, knowledge and confidence change, results and overall return-on-investment (ROI) were evaluated. Quantitative data were collected via pre and postcourse surveys to analyse participants’ knowledge and confidence change using the Wilcoxon signed rank test. Qualitative learning platform and postcourse survey data demonstrated participants’ results from application.ResultsOver 18 months,Lean Fundamentalsattracted 6617 enrolments and supported 3462 active participants. 97.6% (n=829) of participants completing the postcourse survey indicatedLean Fundamentalsmet their expectations and 97.2% (n=823) indicated they would recommend it. Self-reported changes in knowledge and confidence to apply Lean showed significant differences (p<0.001). Learning was applied to operational healthcare priorities (such as post-COVID recovery of services) and participants shared 511 project improvement reports.ConclusionLean Fundamentalshelped large numbers of participants to develop Lean process improvement skills—avoiding costs associated with commercial Lean training in the range £1.7 m to £3.4 m and generating ROI of between £11 and £23 per every pound spent on delivery. This demonstrates that massive online is an effective and efficient method for building improvement knowledge and skills at scale.
Safety culture survey among medical residents in Japan: a nationwide cross-sectional study
Authors: Watari Takashi , Kurihara Masaru , Nishizaki Yuji , Tokuda Yasuharu , Nagao Yoshimasa 
Published: October 2023

PurposeThis study aimed to examine safety culture among Japanese medical residents through a comparative analysis of university and community hospitals and an investigation of the factors related to safety culture.MethodThis nationwide cross-sectional study used a survey to assess first and second-year medical residents’ perception of safety culture. We adapted nine key items from the Safety Awareness Questionnaire to the Japanese training environment and healthcare system. Additionally, we explored specific factors relevant to safety culture, such as gender, year of graduation, age, number of emergency room duties per month, average number of admissions per day, incident experience, incident reporting experience, barriers to incident reporting and safety culture. We analysed the data using descriptive statistics and multivariate logistic regression analysis.ResultsWe included 5289 residents (88.6%) from community training hospitals and 679 residents (11.4%) from university hospitals. A comparative analysis of safety culture between the two groups on nine representative questions revealed that the percentage of residents who reported a positive atmosphere at their institution was significantly lower at university hospitals (81.7%) than at community hospitals (87.8%) (p<0.001). The other items were also significantly lower for university hospital residents. After adjusting for multivariate logistic analysis, university hospital training remained significantly and negatively associated with all nine safety culture items. Furthermore, we also found that university hospital residents perceived a significantly lower level of safety culture than community hospital residents.ImplicationsFurther research and discussion on medical professionals’ perception of safety culture in their institutions as well as other healthcare professionals’ experiences are necessary to identify possible explanations for our findings and develop strategies for improvement.
Changing prevalence of chronic hepatitis B virus infection in China between 1973 and 2021: a systematic literature review and meta-analysis of 3740 studies and 231 million people
Authors: Liu Zhenqiu , Lin Chunqing , Mao Xianhua , Guo Chengnan , Suo Chen , Zhu Dongliang , Jiang Wei , Li Yi , Fan Jiahui , Song Ci , Zhang Tiejun , Jin Li , De Martel Catherine , Clifford Gary M , Chen Xingdong 
Published: October 2023

ObjectiveChina concentrates a large part of the global burden of HBV infection, playing a pivotal role in achieving the WHO 2030 global hepatitis elimination target.MethodsWe searched for studies reporting HBV surface antigen (HBsAg) seroprevalence in five databases until January 2023. Eligible data were pooled using a generalised linear mixed model with random effects to obtain summary HBsAg seroprevalence. Linear regression was used to estimate annual percentage change (APC) and HBsAg prevalence in 2021.Results3740 studies, including 231 million subjects, were meta-analysed. HBsAg seroprevalence for the general population decreased from 9.6% (95% CI 8.4 to 10.9%) in 1973–1984 to 3.0% (95% CI 2.1 to 3.9%) in 2021 (APC=−3.77; p<0.0001). Decreases were more pronounced in children <5 years (APC=−7.72; p<0.0001) and 5–18 years (−7.58; p<0.0001), than in people aged 19–59 years (−2.44; p<0.0001), whereas HBsAg seroprevalence increased in persons ≥60 years (2.84; p=0.0007). Significant decreases were observed in all six major Chinese regions, in both men (APC=−3.90; p<0.0001) and women (−1.82; p<0.0001) and in high-risk populations. An estimated 43.3 million (95% uncertainty interval 30.7–55.9) persons remained infected with HBV in China in 2021 (3.0%), with notable heterogeneity by region (<1.5% in North China to>6% in Taiwan and Hong Kong) and age (0.3%, 1.0%, 4.7% and 5.6% for <5 years, 5–18 years, 19–59 years and≥60 years, respectively).ConclusionsChina has experienced remarkable decreases in HBV infection over the last four decades, but variations in HBsAg prevalence persist in subpopulations. Ongoing prevention of HBV transmission is needed to meet HBV elimination targets by 2030.Trial registration numberPROSPERO (CRD42021284217)
Whole exome sequencing of 491 individuals with inherited retinal diseases reveals a large spectrum of variants and identification of novel candidate genes
Authors: Hayman Tamar , Millo Talya , Hendler Karen , Chowers Itay , Gross Menachem , Banin Eyal , Sharon Dror 
Published: October 2023

Background
Inherited retinal diseases (IRDs) include a range of vision loss conditions caused by variants in different genes. The clinical and genetic heterogeneity make identification of the genetic cause challenging. Here, a cohort of 491 unsolved cases from our cohort of Israeli and Palestinian families with IRDs underwent whole exome sequencing (WES), including detection of CNVs as well as single nucleotide variants (SNVs).

Methods
All participants underwent clinical examinations. Following WES on DNA samples by 3 billion, initial SNV analysis was performed by 3 billion and SNV and CNV analysis by Franklin Genoox. The CNVs indicated by the programme were confirmed by PCR followed by gel electrophoresis.

Results

WES of 491 IRD cases revealed the genetic cause of disease in 51% of cases, of which 11% were due wholly or in part to CNVs. In two cases, we clarified previously incorrect or unclear clinical diagnoses. This analysis also identified
ESRRB
and
DNM1
as potential novel genes.

Conclusion
This analysis is the most extensive one to include CNVs to examine IRD causing genes in the Israeli and Palestinian populations. It has allowed us to identify the causative variant of many patients with IRDs including ones with unclear diagnoses and potential novel genes.
Incidence of intracranial hemorrhagic complications after anterior circulation endovascular thrombectomy in relation to occlusion site: a nationwide observational register study
Authors: Hall Emma , Ullberg Teresa , Andsberg Gunnar , Wasselius Johan 
Published: October 2023

BackgroundIntracranial hemorrhage (ICH) is a potentially severe complication of endovascular thrombectomy (EVT). However, the relationship between the incidence and severity of ICH and vascular occlusion location is not well described.ObjectiveTo present a comprehensive analysis of subtypes of ICHs and their relationship to the occlusion site following EVT in the anterior circulation.MethodsAll patients with anterior circulation vessel occlusion stroke (internal carotid (ICA) and middle cerebral artery’s first (M1) and later segments (M2 and beyond)) registered in the two Swedish national quality registers for stroke care and endovascular therapy during 2015–2020 were included. Hemorrhagic complications identified on imaging within 36 hours post-EVT were classified according to Heidelberg Bleeding Classification and further divided into symptomatic (sICH) or non-symptomatic (non-sICH).ResultsOf the 3077 patients, ICH frequency was 24.2%, which included 4.5% sICH. Subarachnoid hemorrhage (SAH) was the most frequent subtype of hemorrhage (10.9%). The hemorrhagic subtypes differed significantly by occlusion site, but the frequency of any bleed did not. EVT performed in and beyond the M2 more often resulted in SAH, frequently classified as non-sICH. EVT performed in the ICA was associated with more severe hemorrhages, such as intraventricular and large parenchymal hematomas, that were more often classified as sICH.ConclusionIn this nationwide unselected EVT cohort we found that ICH severity significantly differed between different vessel occlusion sites.
Current development status of accelerator-based neutron source for boron neutron capture therapy
Authors: Kumada Hiroaki , Sakae Takeji , Sakurai Hideyuki 
Published: October 2023

AbstractRecently, progress in technology for accelerator-based neutron sources has increased attention regarding boron neutron capture therapy (BNCT). BNCT is a type of radiotherapy that combines neutrons and boron drugs and is expected to be used in the treatment of refractory and recurrent cancers. Owing to the need for high-intensity neutrons in treatment, compact accelerator-based neutron sources applicable to BNCT are being developed worldwide. These current projects utilize cyclotrons, linear accelerators, and electrostatic accelerators as accelerators for BNCT devices. Beryllium and lithium are the main target materials for neutron generation. The accelerators for BNCT device are required to accelerate charged particles with an average current ranging from a few milliamperes to a few tens of milliamperes in order to generate neutrons of sufficient intensity for the treatment. Moreover, the target systems require technologies and mechanisms that can withstand the large heat load produced by high-power beam irradiation and prevent blistering. This review outlines and explains the accelerator neutron sources for BNCT and the requirements for the components of each device, such as the accelerator, target material, and beam shaping assembly. In addition, various development projects for accelerator-based BNCT devices worldwide are introduced.
Dynamics of a Rotated Orthogonal Gravitational Wedge Billiard
Authors: Anderson Keegan D. 
Published: October 2023

We investigate a rotated, orthogonal gravitational wedge billiard — a special case of the asymmetric gravitational wedge billiard — in which the dynamics are integrable. We derive equations and conditions under which periodic orbits may be constructed for this model, and show that any other trajectory will be dense in the configuration space.
Influence of Heat Loss on the Chaotic Dynamics of Reaction Waves in the Model with Chain-Branching Reaction
Authors: Kuznetsov Maxim , Kolobov Andrey , Gubernov Vladimir , Polezhaev Andrey 
Published: October 2023

In this paper, the complex dynamics of the pulsating regime of combustion waves propagation is numerically investigated within the Zel’dovich–Barenblatt–Dold model with two-step chain-branching reaction mechanism. It is shown that there exists a remarkable similarity in the dynamics of oscillations in this system and one-dimensional discrete-time maps such as the logistic map. In particular, both systems exhibit the period doubling route to chaos and the appearance of windows of stability as the bifurcation parameter is increased. For the first time for a model of combustion wave propagation the sequence of windows of stability is demonstrated and classified. Nevertheless, as the activation energy, which is taken as a bifurcation parameter, reaches a critical value corresponding to the dynamical quenching scenario the dynamics of the flame oscillations becomes multidimensional and therefore it cannot be described by a one-dimensional map anymore. The effect of the heat losses is also studied and it is demonstrated that the number of windows of stability decreases, the order of their appearance changes and the dynamical quenching appears for smaller values of the activation energy as the heat losses are increased.
Effect of Pretreatments on Releasing of Bound Phenolics from Dried Bamboo Shoots during Simulated In Vitro Colonic Fermentation
Authors: Xiao Jianping , Li Anping , Tang Yumei , Cheng Hexingzi , Yang Pei , Liu Hanze 
Published: October 2023

Salt-dried bamboo shoots (SDBS), steamed dried bamboo shoots (TDBS), fumigation-dried bamboo shoots (UDBS), and fermentation-dried bamboo shoots (FDBS) are four popular types of dried bamboo shoots (DBS) enjoyed by Chinese people. In this work, we aimed at investigating the release pattern of bound phenolics from DBS prepared by different processes on simulated in vitro colonic fermentation. The results showed that nine phenolic compounds were identified from DBS, including seven phenolic acids and two flavonoids. Also, the contents of chlorogenic acid, p-coumaric acid, and ferulic acid were higher. Among the four types of DBS, FDBS exhibited the highest release of bound phenolics during colonic fermentation, with a value of 3.619 mg GAE/g DW. In addition, all the DBS produced four short-chain fatty acids (SCFAs), with the highest content of acetic acid at 7.721 mmol/L, followed by propionic acid and valeric acid, and the lowest content of butyric acid at only 0.023 mmol/L, along with a gradual decrease in their cellulose, hemicellulose, and lignin contents. Concurrently, confocal laser scanning microscopy (CLSM) observation images showed that reduced red fluorescence exhibited a decrease in bound phenolics content, while reduced green fluorescence indicated a decrease in fiber content. A significant positive correlation (

P

< 0.05) was observed between the release of bound phenolics and total SCFA production during colonic fermentation of SDBS, TDBS, UDBS, and FDBS, with correlation coefficients of 0.632, 0.844, 0.717, and 0.916, respectively, and a significant negative correlation (

P

< 0.05) with the IC50 values for the inhibition of α-amylase and α-glucosidase, with correlation coefficients of −0.643, −0.613, −0.823, and −0.839, respectively. The four DBS were ranked in descending order of bound phenolic release, SCFA production, dietary fiber reduction, and inhibitory activity associated with the metabolic syndrome: FDBS, TDBS, SDBS, and UDBS. DBS released large amounts of bound phenolics and produced SCFAs during colonic fermentation, which might be potentially beneficial for maintaining intestinal microbiota balance.
Neutrophil Elastase Remodels Mammary Tumors to Facilitate Lung Metastasis
Authors: Lulla Amriti R. , Akli Said , Karakas Cansu , Caruso Joseph A. , Warma Lucas D. , Fowlkes Natalie W. , Rao Xiayu , Wang Jing , Hunt Kelly K. , Watowich Stephanie S. , Keyomarsi Khandan 
Published: October 2023

Abstract
Metastatic disease remains the leading cause of death due to cancer, yet the mechanism(s) of metastasis and its timely detection remain to be elucidated. Neutrophil elastase (NE), a serine protease secreted by neutrophils, is a crucial mediator of chronic inflammation and tumor progression. In this study, we used the PyMT model (NE+/+ and NE−/−) of breast cancer to interrogate the tumor-intrinsic and -extrinsic mechanisms by which NE can promote metastasis. Our results showed that genetic ablation of NE significantly reduced lung metastasis and improved metastasis-free survival. RNA-sequencing analysis of primary tumors indicated differential regulation of tumor-intrinsic actin cytoskeleton signaling pathways by NE. These NE-regulated pathways are critical for cell-to-cell contact and motility and consistent with the delay in metastasis in NE−/− mice. To evaluate whether pharmacologic inhibition of NE inhibited pulmonary metastasis and phenotypically mimicked PyMT NE−/− mice, we utilized AZD9668, a clinically available and specific NE inhibitor. We found AZD9668 treated PyMT-NE+/+ mice showed significantly reduced lung metastases, improved recurrence-free, metastasis-free and overall survival, and their tumors showed similar molecular alterations as those observed in PyMT-NE−/− tumors. Finally, we identified a NE-specific signature that predicts recurrence and metastasis in patients with breast cancer. Collectively, our studies suggest that genetic ablation and pharmacologic inhibition of NE reduces metastasis and extends survival of mouse models of breast cancer, providing rationale to examine NE inhibitors as a treatment strategy for the clinical management of patients with metastatic breast cancer.
Embodied, Everyday Systemic Design - A Pragmatist
Perspective
Authors: Vink Josina 
Published: October 2023

Abstract
Systemic design is gaining popularity as an emerging professional design practice that works to address complex societal problems. This elitist view of systemic design reinforces the difficulty of grappling with complexity and the need for specialized design knowledge, skills, and methods to do so. Such an understanding emphasizes the power of the designer, feeds the underlying business model through which systemic design is bought and sold in a capitalist market, and limits its transformative potential. Taking a pragmatist perspective of systemic design, this article brings forward an alternative view of systemic design as an embodied, everyday experience of shaping social structures amid communities. It repositions systemic design as a pervasive, mundane, and pluralistic practice central to autonomous communities. The article calls for an emphasis on cultivating the reflexivity of collectives so that people can continue to shape their own worlds in respectful relations with others.
Pre-Reflection-in-Action: Rethinking Schön's Reflective Practice Through the “Habits of Design Artistry”
Authors: Eklund Anna Rylander , Dixon Brian , Wegener Frithjof 
Published: October 2023

Abstract
This article examines Donald Schön's positioning of reflective practice in relation to design. In particular, the focus is directed toward his presentation of the acting–thinking relationship. Questioning this presentation we turn to the work of philosopher John Dewey, who acted as one of Schön's key inspirational sources. Here, we consider Dewey's presentation of thought-in-action, artistry, and importantly, habit. We argue that a wider referencing of this material—most especially the art–habits relationship—holds the potential to expand the Schönian presentation of design, providing the field with a more nuanced modeling of what it means both to design and to become a designer.