bluuebunny/crossref_metadata_2025_split huggingface dataset:
Advancing reliability and medical data analysis through novel statistical distribution exploration
Authors: Oluyede Broderick , Schröder Leon , Fang Sean , Cohen Achraf , Moakofi Thatayaone , Zhang Yuhao , Pu Shusen 
Published: February 2025

Abstract
This comprehensive study delves into the examination and application of novel statistical distributions, namely the Ristić-Balakrishnan-Topp-Leone-Exponentiated half Logistic-G (RB-TL-EHL-G) family of distributions, emphasizing their paramount importance in reliability and medical data modeling. We meticulously explore a multitude of this family of novel distributions, accentuating their respective features, properties, and real-world applicability. The probability density, the cumulative distribution, the hazard rate, and the quantile functions are provided. The density functions of the RB-TL-EHL-G family are expanded, enabling a deeper understanding of their statistical properties, including various moments, generating functions, order statistics, stochastic orderings, probability weighted moments, and the Rényi entropy. A significant portion of the investigation is dedicated to the intensive analysis of various data sets, to which these distributions are fitted, unveiling noteworthy insights into their behavior and performance. Furthermore, the discussions extend to a comparative study, delineating the advantages and limitations of each distribution, fostering a deeper understanding and selection criteria for practitioners.
Perioperative Neuroprotection with Systemic Hypothermia During Carotid Endarterectomy
Authors: Syrovatsky Alexey A. , Simutis Ionas S. , Svetlikov Alexey V. , Lebedinsky Konstantin M. , Shcheglov Alexey N. , Ratnikov Vyacheslav A. , Reznichek Daria E. , Khaldina Evgenia V. 
Published: February 2025

Prevention of brain injury during carotid endarterectomy (CEA) remains a significant challenge. Moderate controlled systemic hypothermia may serve as a potential neuroprotective measure during these procedures.Aim of the study. To investigate the neuroprotective effects of moderate systemic hypothermia during CEA.Materials and methods. Fifty-nine patients undergoing CEA under combined anesthesia were included. Patients were divided into two groups: the hypothermia group (N=33) and the normothermia control group (N=26). Both groups received standard measures to prevent cerebral ischemia. The hypothermia group received additional moderate systemic hypothermia aimed at a temperature range of 34–35°C. Cognitive function was assessed preoperatively and at 2, 5, and 30 days postoperatively using neurocognitive tests. Statistical analysis was performed with IBM SPSS Statistics.Results. The incidence of cognitive impairment was 21.1% in the hypothermia group and 26.9% in the normothermia group. Postoperative cognitive impairment was more common in the normothermia group: 15.38% on day 5 and 11.5% on day 30 postoperatively compared to 12.1% and 6.1% in the hypothermia group (P<0.05).Conclusion. This study demonstrated the neuroprotective effects of hypothermia, manifested by a reduced severity of cognitive impairment in the hypothermia group. Further research is needed to identify high-risk patients who would benefit most from this neuroprotective strategy and to optimize hypothermia protocols.
Efficacy of Scoring Systems for Routing and Predicting Length of ICU Stay in Severe Community-Acquired Pneumonia
Authors: Ruslyakova Irina A. , Shamsutdinova Elvina Z. , Mityuchenko Galina A. , Orlova Alexandra O. , Avalueva Elena B. 
Published: February 2025

Scoring systems based on assessment of disease severity and patient condition are widely used for routing and predicting length of stay in the ICU. However, their effectiveness varies in patients with sepsis.The aim of the study. To evaluate the effectiveness of scoring systems in routing and predicting ICU length of stay in patients with severe community-acquired pneumonia (CAP).Materials and methods. Medical records of 664 patients from the Intensive Care for Severe CAP database of I. I. Mechnikov Northwestern State Medical University (2013–2023) were analyzed using the following scoring scales: CURB-65, PSI/PORT, SMART-COP, SCAP, REA-ICU, NEWS2, IDSA/ATS criteria, APACHE IV, CFS, and CCI. Statistical analysis was performed using Statistica 10.0, SPSS, and Stat Research (Center for Statistical Research) software.Results. Among the study cohort, 96 patients (15%) had bacterial severe CAP (bCAP) and 568 patients (85%) had viral severe CAP (vCAP), all of whom were admitted to the ICU. A NEWS2 score ≥2 was observed in 74 (77.1%) bCAP patients and all vCAP patients (P<0.001). In contrast, 437 (76.9%) vCAP patients and 74 (77.1%) bCAP patients were classified as high risk according to SMART-COP (P=0.966). Delayed ICU admission (>7 days) was observed in older patients with severe bCAP, but did not significantly affect ICU length of stay or outcomes. A strong correlation was found between adverse outcome and predicted mortality using APACHE IV (η=0.966 for vCAP and η=0.807 for bCAP). However, no correlation was observed between predicted and actual ICU length of stay for both vCAP and bCAP patients (R²=0.0257, Kendall's W=0.018 for vCAP; R²=0.0294, Kendall's W=0.050 for bCAP). The predictive model accuracy for ICU stay >1 day or >14 days was not satisfactory. Model with vCAP patients adjusted for age (≥60 years) and APACHE IV exhibited moderate predictive accuracy for prolonged ICU stay (AUROC 0.610).Conclusion. Differences were found in the applicability of the NEWS2, REA-ICU, and IDSA/ATS major criteria scoring systems for ICU routing of bCAP and vCAP patients. APACHE IV showed a strong correlation between predicted and actual mortality, but no correlation between predicted and actual ICU length of stay in severe CAP patients was found.
Prediction of Local Infectious and Inflammatory Complications After Reconstructive Surgery of Aorta
Authors: Grin Oksana O. , Beloborodova Natalia V. , Grekova Marina S. , Pautova Aliсa K. , Charchyan Eduard R. , Akselrod Boris A. , Dymova Olga V. , Rizun Lyubov I. , Eremenko Alexander A. , Babaev Maxim A. 
Published: February 2025

Aim. To identify biomarkers for prediction and early diagnosis of infectious and inflammatory complications in patients after aortic surgery.Materials and methods. The study included 57 patients who underwent surgical procedures on the aorta and its branches under cardiopulmonary bypass and myocardial ischemia. The cohort was divided into two groups: patients with an uneventful postoperative period (group 1, N=35) and patients with local infectious and inflammatory complications after surgery (group 2, N=22). Serum levels of procalcitonin (PCT), interleukins (IL-6 and IL-10), and aromatic microbial metabolites (AMM) were measured before surgery, upon admission, and six hours after admission to the ICU. On postoperative days 3 and 6 neutrophil, lymphocyte, and platelet counts were assessed, and neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were calculated.Results. There were no significant differences in sex, age, or comorbidities between groups 1 and 2. Patients in group 2 had a more severe intraoperative period and required a longer ICU stay. Predictive markers of complications included IL-6143.35 pg/mL at ICU admission (sensitivity 42.9%, specificity 90.9%, AUC 0.789, 95% CI 0.669–0.909, P0.001); PCT0.12 ng/mL 6 hours after ICU admission (sensitivity 90.9%, specificity 54.3%, AUC 0.762, 95% CI 0.634–0.891, P0. 001); NLR 7.8 on postoperative day 3 (sensitivity 72.7%, specificity 68.6%, AUC 0.710, 95% CI 0.571–0.850, P=0.003); and AMM (before and after surgery) 0.185 (sensitivity 77.3%, specificity 71.4%, AUC 0.780, 95% CI 0.651–0.909, P0.001).Conclusion. Values of IL-6, PCT, NLR, and AMM reflect different features of the inflammation and can be used for prediction and early diagnosis of infectious and inflammatory complications in cardiac surgery patients.
Pediatric Randomized Clinical Trials in Community Hospitals: Strategies to Enhance Site Participation and Engagement
Authors: McDaniel Corrie E. , Coon Eric R. , Paciorkowski Natalia , Morton Kayce , Grimshaw Meg , Ganem Jorge F. , Nicholson Karee , Edwards Yeelen , Marek Rachel , Kaiser Sunitha V. 
Published: February 2025

OBJECTIVE
Community hospitals provide the majority of inpatient pediatric care in the United States but face significant barriers to conducting research. More equitable research participation across the spectrum of hospital types that deliver inpatient pediatric care can improve pediatric care quality and generalizability of research findings. Thus, we sought to identify strategies to promote community hospital participation in pediatric randomized clinical trials (RCTs).

METHODS
We convened an interdisciplinary group of 33 panelists with expertise across clinical roles (eg, physicians, nurses), nonclinical partners (eg, parents, clinical trialists), and practice environments (eg, children’s and community hospitals). We conducted 2 rounds of consensus building using the nominal group technique. Panelists brainstormed, discussed, and scored strategies in each round. Round 1 was conducted within small groups to broadly identify potential strategies. Round 2 was conducted as a large group to refine and rescore top strategies. We performed descriptive analyses of scores and qualitative content analysis of identified strategies (including member checking).

RESULTS
Panelists identified 119 ideas in round 1. The 20 highest scoring ideas from round 1 were presented in round 2, where 19 strategies were scored then refined into 14 specific strategies. We identified 3 overarching domains: (1) policy changes in funding prioritization and scientific review guidelines, (2) systems for providing centralized resources, and (3) research design and planning tailored to community hospital participation.

CONCLUSION
We identified 14 strategies for supporting the conduct of pediatric RCTs in community hospitals. Implementing these strategies will require structural changes to RCT design and recruitment for hospitals, funders, and investigators.
Reducing Antibiotic Use for Culture-Negative Sepsis in a Level IV Neonatal Intensive Care Unit
Authors: Lewis Jessica M. , Hodo Laura Nell , Duchon Jennifer , Juliano Courtney E. 
Published: February 2025

BACKGROUND AND OBJECTIVES
Antibiotic use for suspected infection without a source occurs frequently in neonatal intensive care units (NICUs). Prolonged antibiotic use is associated with increased risk for late-onset sepsis, death, and emergence of multidrug-resistant bacteria. Our aim was to reduce antibiotic use for culture-negative sepsis (CNS) through interventions designed to decrease the number and length of antibiotic courses for CNS.

METHODS
Our team used the Model for Improvement with sequential Plan-Do-Study-Act cycles to implement interventions in our level IV NICU. These included the creation of Antibiotic Guidelines, case audits, weekly antibiotic stewardship rounds, and biweekly review of CNS cases at staff meetings. All patients who received any dose of antibiotic and who had no major congenital anomalies were included. The primary outcome measures were CNS courses and antibiotic days of therapy (DOTs) per 1000 patient days (PDs). We tracked the number of antibiotic initiation events, re-initiation events, and antibiotic spectrum index as balancing measures.

RESULTS
Antibiotic DOTs for CNS decreased significantly (81%) compared with baseline after study interventions. Subgroup analysis revealed this change was driven by a decrease in early-onset sepsis DOTs, with a reduction from 18.3 to 3.9 DOTs/1000 PDs. Overall antibiotic DOTs for the unit decreased from 232.5 to 176.7 DOTs/1000 PDs. There was no change in any of the prespecified balancing measures.

CONCLUSIONS
This quality-improvement initiative, which prioritized case review and stewardship rounds to promote guideline adherence and reduce the treatment of CNS, resulted in a decrease in antibiotic use in a level IV NICU.
Using Ecological Momentary Assessment to Redefine Postdialysis Fatigue in Patients with Kidney Failure
Authors: Kallem Cramer J. , Alghwiri Alaa A. , Yabes Jonathan , Erickson Sarah , Han Zhuoheng , Roumelioti Maria-Eleni , Steel Jennifer L. , Unruh Mark , Jhamb Manisha 
Published: February 2025

Background:
Patients with kidney failure have a high symptom burden and many report an acute exacerbation of symptoms immediately following in-center hemodialysis (HD). Very few studies have used ecological momentary assessment (EMA) to examine post-HD patient-centered outcomes.

Methods:
Participants in the Technology Assisted Collaborative Care (TĀCcare) trial completed an automated telephone-administered Daytime Insomnia Symptom Scale (DISS) at 4 time points daily for 7 consecutive days. The DISS yields 4 symptom domain scores: Positive Mood, Negative Mood, Alert Cognition, and Sleepiness/Fatigue. Post-HD symptom domains and item-level scores were compared to similar time points on non-HD days using linear mixed models analyses. Mixed models were also used to explore the association of post-dialysis symptom burden with demographic, psychosocial, hemodialysis treatment, and disease-specific characteristics. All analyses were adjusted for age, race, sex, and Charlson Comorbidity Index

Results:
156 HD patients with available EMA data were evaluated [mean age=58±14 years, 55% men, 51% White]. In the post-HD period, patients reported significantly lower Positive Mood [mean difference (MD)= -0.22, 95% CI (-0.29, -0.14)] and Alert Cognition [MD= -0.13, 95% CI (-0.18, -0.08)] and higher Negative Mood [MD=0.12, 95% CI (0.05, 0.19)] and Sleepiness/Fatigue [MD=0.51, 95% CI (0.42, 0.61)] compared to non-HD days. The mean post-dialysis symptom exacerbation total score was 0.70 ± 1.21, representing an increase of 6% of the maximum scale range. In the post-dialysis period, relative to non-dialysis days, the mean decrease in Positive Mood and Alert Cognition scores equaled 4% and 2% of the maximum scale range respectively; the mean increase in Negative Mood and Sleepiness/Fatigue scores equaled 2% and 9% of the maximum scale range respectively.

Conclusions:
Patients with kidney failure reported worsening of both fatigue and mood symptoms post- HD.
The effects of foster care backlog on prospective beneficiaries in Thulamela Municipality, Limpopo Province, South Africa
Authors: Mafela Livhuwani , Sekgobela Tumelo 
Published: February 2025

Foster care is a fundamental alternative care service available for children in need of care and protection. It is aimed at nurturing the development and welfare of children who are declared to be in need of care and protection in South Africa. Over the years, foster care services in South Africa have experienced a significant amount of backlog, disadvantaging the potential or prospective beneficiaries. Children are considered part of the vulnerable groups in South Africa as considered by global organizations/institutions such as the United Nations and the African Union. Globally, foster care is one of the mechanisms considered alternative care for children who have been declared to be in need of care and protection. The paper aimed to explore the effects of the foster care backlog on the prospective beneficiaries in the Vhembe region of Limpopo Province, South Africa. The paper further seeks to provide an understanding of the foster care backlog on the prospective foster children and the prospective foster parents. The study employed the qualitative research approach to achieve the aims of the study and have an understanding of the perceptions of the participants. An exploratory research design was adopted for the paper to understand better the phenomenon from the perspectives of the participants. The objective of this study was to describe the effects of foster care backlog and how it affects the beneficiaries. The study used semi-structured and unstructured interviews to collect data with a sample of 11 participants used for the study. The study used purposive sampling because of the understanding and knowledge of the participants. Thematic content analysis using Creswell’s methods of data analysis was used in this study. Considerations were made for the use of systems theory to provide a foundation and background for the study and to understand the effects of the foster care backlog on the prospective beneficiaries. The study found that peer group pressure, poor school attendance and drop in academic performance, lack of satisfaction with basic needs, and high levels of burnout and stress are some of the effects of this phenomenon.
Lexical reiteration as the English First Additional Language learners’ strategic approach to achieve cohesion in essay writing
Authors: Khosa Mzamani , Maswanganyi Khazamula , Zitha Innocent 
Published: February 2025

The capacity of authors to generate coherent articles largely relies on their proficient use of cohesive devices. This chapter examines the utilisation of reiteration by Grade 12 English First Additional Language (EFAL) learners in the Malamulele South Circuit to attain cohesiveness in their written English essays. Cohesion is an essential characteristic employed by educators when evaluating students' essays. Thus, a deficiency in consistency in writing may result in diminished grades or outright failure. The appropriate use of cohesive devices improves the logical progression and interrelation of phrases, paragraphs, and entire writings. This study employed a qualitative research methodology, sampling fifteen essays from a designated school in the Malamulele South Circuit. These essays have been assessed, reviewed, and finalised. Document analysis functioned as the principal method for data collecting. The results indicated that Grade 12 EFAL students in the Malamulele South Circuit employed many forms of reiteration, including repetition, synonyms, and antonyms, to construct cohesive writings. Nevertheless, the study emphasised that these learners frequently generated repetitive and redundant sentences due to their propensity to excessively repeat words and phrases for emphasis. Furthermore, they faced challenges in the proficient use of synonyms and antonyms.
Admission Neutrophil-to-Lymphocyte Ratio Is Superior to WBC Count at Predicting the Presence and Severity of Pediatric Musculoskeletal Infection
Authors: Hou Brian Q. , Chandrashekar Anoop S. , Jamal Naadir H. , Hefley William F. , Anand Malini , Hajdu Katherine S. , Chenard Stephen W. , Greenberg Michael , Nian Hui , Pennings Jacquelyn S. , Seltzer Ryan A. , Cassat James E. , Moore-Lotridge Stephanie N. , Schoenecker Jonathan G. 
Published: February 2025

Background:
Accurately determining the presence and severity of pediatric musculoskeletal infection (MSKI) is crucial for effective triage and treatment. Although the white blood-cell (WBC) count is often used as a marker for MSKI, we hypothesized that the use of the WBC count is limited by age-related variability in children. We proposed that the absolute neutrophil-to-lymphocyte ratio (NLR), which has less age-related variability, is a more reliable indicator for both diagnosing and assessing the severity of MSKI. The present study aims to compare the utility of WBC against that of the NLR, as well as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), for predicting MSKI presence and severity in children.

Methods:
A retrospective cohort study was conducted with use of a database of pediatric orthopaedic consultations for suspected MSKI between January 2013 and July 2022. Diagnoses were categorized as MSKI or no infection, and the severity of any present infection was stratified as local or disseminated. Admission laboratory values were collected. Statistical modeling was performed to assess the capabilities of the WBC, NLR, CRP, and ESR to diagnose MSKI and to assess infection severity, with cutoff thresholds established for clinical use.

Results:
This study included 650 patients (median age, 5.2 years; 63% male; 75% White). Of these, 247 patients had no infection, while 403 were diagnosed with an MSKI. Median WBC count, NLR, CRP, and ESR were all significantly higher in pediatric cases of confirmed MSKI. WBC was a poor predictor of infection severity, whereas NLR, CRP, and ESR each positively correlated with infection severity. At the time of admission, an NLR of 4 was highly specific for detecting the presence of infection, and an NLR of 5.8 was highly specific for predicting infection dissemination. CRP was the best predictor of both infection presence and severity, demonstrating the highest specificity and sensitivity, followed by NLR, which outperformed ESR and WBC.

Conclusions:
Because of considerable age-related variability, the predictive value of the WBC count for pediatric MSKI presence and severity is limited. NLR, which is less affected by age-related variability, is superior at predicting MSKI severity. Although CRP remains the benchmark, the NLR offers a valuable alternative to the WBC. Our study provides a comparative framework for these biomarkers, enhancing MSKI assessment across various clinical settings.

Level of Evidence:
Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
An Enduring Paradigm of Resistance
Authors: Olugbuyiro Ayodeji Richard 
Published: February 2025

While Negritude is certainly the major ideological underpinning that inspired poetry of Black intellectuals opposing racial subjugation in the twentieth century, its relevance in postcolonial times has been a subject of contention. The reasons for this include harsh criticisms of its essentialist character in the latter part of the twentieth-century, and the presupposition of an improved reality for Blacks globally with the conclusion of colonialism. However, I argue in this article that considering the unfavorable racial experiences of Blacks in the white-dominated Portuguese society, Negritude-informed tropes have seen a resurgence in contemporary Black Portuguese poetry—even though its perspective has changed from strict focus on an essentialized Africa to an assertion of African identity within the space of the former metropole. Analyzing Djidiu: A herança do ouvido(2017), I demonstrate the reappearance and overlap of themes of older-generation Negritude to confirm that the Negritude ethos continues to inspire contemporary Black Portuguese poetry.
Reclaiming Legitimacy through Performance
Authors: Sanchez Kathryn 
Published: February 2025

Grada Kilomba’s performance-installation O barco/The Boat (2021) is a denunciation of the legacies of colonialism, racism, and social injustices in contemporary society. In these times of perpetual crises, race crimes, discrimination, and the mediation of collective trauma, this study understands how the performance of Blackness, centered around an ever-present past evoked by a slave ship hold in Grada Kilomba’s multidimensional art installation, constructs a forum to confront the silences inherent in the inequalities of power and privilege in Portuguese history. I examine how performance “in the wake” (Sharpe) is a powerful tool to address these perpetuated silences, feelings of loss and vulnerability, and the aftermath of colonial violence. I discuss the way in which performance can be a powerful tool to celebrate, verbalize, and embody racial difference and expose the normalization of racism while forging a new conceptualization of the Black Atlantic.
Cartas para Angola
Authors: Da Costa Bezerra Kátia 
Published: February 2025

This article examines the documentary Cartas para Angola (2011) directed by Julio Matos and Coraci Ruiz. The documentary has as its leitmotif the correspondence exchanged between a set of people whose lives are traced between Angola, Brazil, and Portugal. Taking as a point of departure the notions of home and belonging and in dialogue with Fernando Arenas’s work, I investigate people’s relationship to places, expanding earlier conceptions on the ways places work to create a web of meanings in people’s lives. I argue that the existence of hybrid locations enables us to interrogate essentializing paradigms around notions of home and nation, exploring some of the tensions that characterize life in a globally interconnected world.