bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development, Validity and Reliability of Objective Structured Clinical Examination in Nursing Students
Authors: Chabrera Carolina , Diago Eva , Curell Laura 
Published: October 2023

Introduction The adoption of measurement instruments such as the Objective Structured Clinical Examination (OSCE) is essential to assess clinical competencies in nursing students. Objective The purpose of this study is to develop an OSCE, analyze its validity and reliability in the nursing curriculum and measure self-assessment, stress and satisfaction. Methods The observational validation study of a measurement instrument was carried out in two phases: the design and development of the OSCE and validity and reliability analysis. Results A total of 118 students participated in the study. Ten scenarios were designed that incorporated six competency components extracted from the curriculum. Good results were obtained in face validity, content validity (CVI .82-.95), criterion validity (r = .71, p < .001), and reliability (α Cronbach .84). Satisfaction and stress scores were high, and self-assessment scores were lower than the scores obtained. Conclusion A rigorously designed OSCE provides a reliable and valid method for assessing the clinical competence of nursing students.
Safe discharge for patients admitted for lower gastrointestinal bleeding (LGITB): derivation and validation of a novel scoring system
Authors: Zhao Yue , Chee Madeline Yen Min , Sultana Rehena , Tan Winson Jianhong 
Published: October 2023

Abstract

Aim
Bleeding from the lower gastrointestinal tract (LGITB) is a common clinical presentation. Recent guidelines have recommended for incorporation of clinical risk assessment tools in the management for LGITB. We derived and validated a novel clinical scoring system to predict safe discharge after LGITB admission, and compared it to other published scoring systems in current literature.

Methods

A retrospective cohort of 798 patients with LGITB from August 2018 to March 2021 was included in the derivation cohort. Multivariate binary logistic regression was performed to identify significant clinical variables predictive of safe discharge. A clinical scoring system was developed based on the results, and validated on a prospective cohort of 312 consecutive patients with LGITB from April 2021 to March 2022. The performance of the novel scoring system was compared to other LGITB clinical risk assessment scores via area under the receiver operating characteristics curve (AUROC) analysis.

Results

Variables predictive of safe discharge included the following; absence of previous LGITB admission, absence of ischemic heart disease, absence of blood on digital rectal examination, absence of dizziness or syncope at presentation and the systolic blood pressure and haemoglobin levels at presentation. The novel score had an AUROC of 0.907. A cut-off point of 4 provided a sensitivity of 41.9%, specificity of 97.5%, positive predictive value of 96.4% and negative predictive value of 51.5% for prediction of safe discharge. The score performs comparably to the Oakland score.

Conclusion
The novel LGITB clinical risk score has good predictive performance for safe discharge in patients admitted for LGITB.
DMF-Net: a deep multi-level semantic fusion network for high-resolution chest CT and X-ray image de-noising
Authors: Nayak Tapan Kumar , Annavarappu Chandra Sekhara Rao , Nayak Soumya Ranjan , Gedefaw Berihun Molla 
Published: October 2023

AbstractMedical images such as CT and X-ray have been widely used for the detection of several chest infections and lung diseases. However, these images are susceptible to different types of noise, and it is hard to remove these noises due to their complex distribution. The presence of such noise significantly deteriorates the quality of the images and significantly affects the diagnosis performance. Hence, the design of an effective de-noising technique is highly essential to remove the noise from chest CT and X-ray images prior to further processing. Deep learning methods, mainly, CNN have shown tremendous progress on de-noising tasks. However, existing CNN based models estimate the noise from the final layers, which may not carry adequate details of the image. To tackle this issue, in this paper a deep multi-level semantic fusion network is proposed, called DMF-Net for the removal of noise from chest CT and X-ray images. The DMF-Net mainly comprises of a dilated convolutional feature extraction block, a cascaded feature learning block (CFLB) and a noise fusion block (NFB) followed by a prominent feature extraction block. The CFLB cascades the features from different levels (convolutional layers) which are later fed to NFB to attain correct noise prediction. Finally, the Prominent Feature Extraction Block(PFEB) produces the clean image. To validate the proposed de-noising technique, a separate and a mixed dataset containing high-resolution CT and X-ray images with specific and blind noise are used. Experimental results indicate the effectiveness of the DMF-Net compared to other state-of-the-art methods in the context of peak signal-to-noise ratio (PSNR) and structural similarity measurement (SSIM) while drastically cutting down on the processing power needed.
Post-stroke limitations in daily activities: experience from a tertiary care hospital in Ethiopia
Authors: Mohammed Salhadin , Haidar Jemal , Ayele Biniyam A. , Yifru Yared Mamushet 
Published: October 2023

Abstract
Background
The disability of stroke patients remains an important global health problem; yet information on the extent of restriction from basic and instrumental activities of daily living is limited, particularly in lower-and middle-income (LMIC) countries. Therefore, we examined the issue under the caption, since it is the first step in planning several rehabilitation services.

Method
A facility-based cross-sectional study was done to assess the magnitude and predictors of post-stroke limitations in basic activities of daily living (BADL) using the Barthel Index (BI) scale and instrumental activities of daily living (IADL) using the Frenchay Activities Index (FAI) scale among patients who visited Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia, Neurology Clinic from April-October, 2022. All patients having a diagnosis of stroke for more than six months duration were enrolled. Descriptive and inferential statistical analyses were done, and measures of estimated crude and adjusted odds ratio with 95% CI were constructed and a p-value less than 0.05 was considered statistically significant. The results are presented in figures and tables.

Results
A total of 150 stroke patients were enrolled in the present study. The mean age of participants was 53 (14.9) years with slight male preponderance (51.3%). Ischemic stroke was present in 106 (70.7%) of them, while 44 (29.3%) had hemorrhagic stroke. Of this, 57 (38%) and 115 (79.3%) of them had limitations in basic and instrumental ADL, respectively. Comorbid cardiac disease (AOR = 6.9; 95%CI = 1.3–37.5) and regular substance use (AOR = 11.1; 95%CI = 1.1–115) were associated with limitations in BADL, while an increase in age (AOR = 1.1; 95%CI = 1.04–1.15) was associated with severe limitations in BADL. Initial stroke severity (AOR = 7.3; 95%CI = 1.2–44.7) was associated with limitations in IADL, whereas depression (AOR = 5.1; 95%CI = 1.1–23.2) was identified as a predictor of severe limitation in IADL.

Conclusion
Limitation in activities of daily living (ADL) after stroke is common among Ethiopian patients. Therefore, screening for post-stroke limitations in daily activities is essential for further management and rehabilitative plans.
Preoperative anxiety and associated factors among women admitted for elective obstetric and gynecologic surgery in public hospitals, Southern Ethiopia: a cross-sectional study
Authors: Dibabu Abera Mamo , Ketema Teklemariam Gultie , Beyene Maechel Maile , Belachew Dereje Zeleke , Abocherugn Hailegiyorgis Geleta , Mohammed Abdu Seid 
Published: October 2023

Abstract
Background
Preoperative anxiety is a major mental health problem during the preoperative period. Admission of women to surgery is stressful, and a high level of anxiety was associated with increased perioperative morbidity and mortality, poor treatment satisfaction, and bad obstetric outcomes, including long-term cognitive impairment in children. Despite its negative consequences, little is known on this area, particularly in the study area.

Objective
To assess preoperative anxiety and associated factors among women admitted for elective obstetrics and gynecologic surgeries in public hospitals in Southern Ethiopia, 2022.

Methods and Materials
An institution-based cross-sectional study design was conducted among 389 women using structured interviewer-administered samples who were selected by systematic random sampling from May 20th to June 20th, 2022. The Amsterdam preoperative anxiety and information scale (APAIS) was used to assess the level of anxiety. Data were collected electronically using the Open Data Kit version 2022.2.3 and analyzed with the Statistical Package for Social Sciences version 26.0. Bivariate and multivariable logistic regression analyses were done. The strength of the association was declared by using an adjusted odds ratio (AOR) with a 95% confidence interval, and a statistical significance of P < 0.05.

Results
The magnitude of preoperative anxiety was 57.1% (95% CI = 51.4–61.5), and 48.1% of women required an average amount of information. Being a gynecologic patient (AOR = 2.0, 95% CI = 1.21, 3.32), having previous anesthesia and surgery (AOR = 2.09, 95% CI = 1.10, 3.96), having fear of postoperative pain (AOR = 1.96, 95% CI = 1.08, 3.53), having concern for family (AOR = 2.56, 95% CI = 1.49, 4.37), having poor social support (AOR = 3.75, 95% CI = 1.99, 7.09), and moderate social supports (AOR = 3.27, 95% CI = 1.74, 6.17), and having a high information requirement about anesthesia and surgery (AOR = 4.68, 95%CI = 2.16, 10.13) were statistically associated with preoperative anxiety.

Conclusion
Preoperative anxiety was often high in the region. Associated factors were the type of surgery, previous anesthesia and surgery, fear of postoperative pain, fear for family, social support, and a high information need. So the national and regional health bureau should develop guidelines and implement strategies to reduce women preoperative anxiety as part of midwifery care. The women should be assessed regularly during the preoperative visits; and appropriate anxiety reduction and information regarding surgery, and anesthesia should be provided.
Model development of dose and volume predictors for esophagitis induced during chemoradiotherapy for lung cancer as a step towards radiobiological treatment planning
Authors: He Rui , Duggar William N. , Yang Claus Chunli , Vijayakumar Srinivasan 
Published: October 2023

Abstract
Background
Currently, radiation therapy treatment planning system intends biological optimization that relies heavily upon plan metrics from tumor control probability (TCP) and normal tissue complication probability (NTCP) modeling. Implementation and expansion of TCP and NTCP models with alternative data is an important step towards reliable radiobiological treatment planning. In this retrospective single institution study, the treatment charts of 139 lung cancer patients treated with chemo-radiotherapy were reviewed and correlated dosimetric predictors with the incidence of esophagitis and established NTCP model of esophagitis grade 1 and 2 for lung cancer patients.

Methods
Esophagus is an organ at risk (OAR) in lung cancer radiotherapy (RT). Esophagitis is a common toxicity induced by RT. In this study, dose volume parameters Vx (Vx: percentage esophageal volume receiving ≥ x Gy) and mean esophagus dose (MED) as quantitative dose-volume metrics, the esophagitis grade 1 and 2 as endpoints, were reviewed and derived from the treatment planning system and the electronic medical record system. Statistical analysis of binary logistic regression and probit were performed to have correlated the probability of grade 1 and 2 esophagitis to MED and Vx. IBM SPSS software version 24 at 5% significant level (α = 0.05) was used in the statistical analysis.

Results
The probabilities of incidence of grade 1 and 2 esophagitis proportionally increased with increasing the values of Vx and MED. V20, V30, V40, V50 and MED are statistically significant good dosimetric predictors of esophagitis grade 1. 50% incidence probability (TD50) of MED for grade 1 and 2 esophagitis were determined. Lyman Kutcher Burman model parameters, such as, n, m and TD50, were fitted and compared with other published findings. Furthermore, the sigmoid shaped dose responding curve between probability of esophagitis grade 1 and MED were generated respecting to races, gender, age and smoking status.

Conclusions
V20, V30, V40 and V50 were added onto Quantitative Analysis of Normal Tissue Effects in the clinic, or QUANTEC group’s dose constrains of V35, V50, V70 and MED. Our findings may be useful as both validation of 3-Dimensional planning era models and also additional clinical guidelines in treatment planning and plan evaluation using radiobiology optimization.
Fotagliptin monotherapy with alogliptin as an active comparator in patients with uncontrolled type 2 diabetes mellitus: a randomized, multicenter, double-blind, placebo-controlled, phase 3 trial
Authors: Xu Mingtong , Sun Kan , Xu Wenjie , Wang Chuan , Yan Dewen , Li Shu , Cong Li , Pi Yinzhen , Song Weihong , Sun Qingyuan , Xiao Rijun , Peng Weixia , Wang Jianping , Peng Hui , Zhang Yawei , Duan Peng , Zhang Meiying , Liu Jianying , Huang Qingmei , Li Xuefeng , Bao Yan , Zeng Tianshu , Wang Kun , Qin Li , Wu Chaoming , Deng Chunying , Huang Chenghu , Yan Shuang , Zhang Wei , Li Meizi , Sun Li , Wang Yanjun , Li HongMei , Wang Guang , Pang Shuguang , Zheng Xianling , Wang Haifang , Wang Fujun , Su Xiuhai , Ma Yujin , Zhang Wei , Li Ziling , Xie Zuoling , Xu Ning , Ni Lin , Zhang Li , Deng Xiangqun , Pan Tianrong , Dong Qijuan , Wu Xiaohong , Shen Xingping , Zhang Xin , Zou Qijing , Jiang Chengxia , Xi Jue , Ma Jianhua , Sun Jingchao , Yan Li 
Published: October 2023

Abstract
Background
Dipeptidyl peptidase-4 inhibitors (DPP-4i) have become firmly established in treatment algorithms and national guidelines for improving glycemic control in type 2 diabetes mellitus (T2DM).To report the findings from a multicenter, randomized, double-blind, placebo-controlled phase 3 clinical trial, which was designed to assess the efficacy and safety of a novel DPP-4 inhibitor fotagliptin in treatment-naive patients with T2DM.

Methods
Patients with T2DM were randomized to receive fotagliptin (n = 230), alogliptin (n = 113) or placebo (n = 115) at a 2:1:1 ratio for 24 weeks of double-blind treatment period, followed by an open-label treatment period, making up a total of 52 weeks. The primary efficacy endpoint was to determine the superiority of fotagliptin over placebo in the change of HbA1c from baseline to Week 24. All serious or significant adverse events were recorded.

Results
After 24 weeks, mean decreases in HbA1c from baseline were -0.70% for fotagliptin, -0.72% for alogliptin and -0.26% for placebo. Estimated mean treatment differences in HbA1c were -0.44% (95% confidence interval [CI]: -0.62% to -0.27%) for fotagliptin versus placebo, and -0.46% (95% CI: -0.67% to -0.26%) for alogliptin versus placebo, and 0.02% (95%CI: -0.16% to 0.19%; upper limit of 95%CI < margin of 0.4%) for fotagliptin versus alogliptin. So fotagliptin was non-inferior to alogliptin. Compared with subjects with placebo (15.5%), significantly more patients with fotagliptin (37.0%) and alogliptin (35.5%) achieved HbA1c < 7.0% after 24 weeks of treatment. During the whole 52 weeks of treatment, the overall incidence of hypoglycemia was low for both of the fotagliptin and alogliptin groups (1.0% each). No drug-related serious adverse events were observed in any treatment group.

Conclusions
In summary, the study demonstrated improvement in glycemic control and a favorable safety profile for fotagliptin in treatment-naive patients with T2DM.

Trial registration
ClinicalTrail.gov NCT05782192.
The association between social integration and utilization of primary health care among migrants in China: a nationwide cross-sectional study
Authors: Wang Xueyao , Liu Jue , Zhu Jingmin , Bai Yang , Wang Jun 
Published: October 2023

Abstract
Background
Migrants is a large population in China. To improve the health and wellbeing of migrants is a critical policy and social issue in China, and to enhance the utilization of primary health care by migrants is one of the most important approaches in promoting equity in health. However, there exists little research about the association between social integration and the utilization of primary health care. To address the research gap, this research aims at exploring the relation between social integration and the utilization of primary health care among migrants in China.

Methods
Using the national data from China Migrants Dynamic Survey (CMDS) in 2017, 169,989 migrants were included in this study. Social integration was measured by social communication, acculturation and self-identity, with 8 indicators. The utilization of primary health care was measured by the receiving of health education on infectious diseases (ID) and noncommunicable diseases (NCD) as well as the first visit institution when migrants were sick. After the descriptive statistical analysis, binary logistic regression was employed to evaluate the association between social integration and the utilization of primary health care.

Results
65.99% of the migrants received health education on infectious diseases (ID), 40.11% of the migrants received health education on noncommunicable diseases (NCD) and 8.48% of the migrants chose to go to Community Health Center (CHC) seeking for health services. There was a positive effect of social organization participation, the influence of hometown customs, differences of hygiene habits between migrants and local people, integration willingness and evaluation of identity on the receiving of health education on ID and NCD, as well as a positive effect of civil activities engagement and differences of hygiene habits between migrants and local people on the utilization of CHC after getting sick.

Conclusions
Social integration was associated with the utilization of primary health care among migrants in China. Generally speaking, greater social integration was associated with higher possibility of receiving health education on ID and NCD. However, the effect of social integration on the utilization of CHC was more complex among different indicators. There should be more policy interventions to improve the social integration of migrant which help them to get familiar with the health resource available, as well as improve the capacity of CHC.
Blockade of TGF-β signalling alleviates human adipose stem cell senescence induced by native ECM in obesity visceral white adipose tissue
Authors: Han Xueya , Li Weihong , He Xu , Lu Xin , Zhang Yu , Li Yaqiong , Bi Guoyun , Ma Xuqing , Huang Xiaowu , Bai Rixing , Zhang Haiyan 
Published: October 2023

Abstract
Background
Abdominal obesity is appreciated as a major player in insulin resistance and metabolically dysfunctional adipose tissue. Inappropriate extracellular matrix (ECM) remodelling and functional alterations in human adipose stromal/stem cells (hASCs) have been linked with visceral white adipose tissue (vWAT) dysfunction in obesity. Understanding the interactions between hASCs and the native ECM environment in obese vWAT is required for the development of future therapeutic approaches for obesity-associated metabolic complications.

Methods
The phenotypes and transcriptome properties of hASCs from the vWAT of obese patients and lean donors were assessed. The hASC-derived matrix from vWAT of obese or lean patients was generated in vitro using a decellularized method. The topography and the major components of the hASC-derived matrix were determined. The effects of the obese hASC-derived matrix on cell senescence and mitochondrial function were further determined.

Results
We showed that hASCs derived from the vWAT of obese patients exhibited senescence and were accompanied by the increased production of ECM. The matrix secreted by obese hASCs formed a fibrillar suprastructure with an abundance of fibronectin, type I collagen, and transforming growth factor beta 1 (TGF-β1), which resembles the native matrix microenvironment of hASCs in vWAT derived from obese patients. Furthermore, the obese hASC-derived matrix promoted lean hASC ageing and induced mitochondrial dysfunction compared to the lean hASC-derived matrix. Blockade of TGF-β1 signalling using an anti-TGF-β1 neutralizing antibody alleviated the lean hASC senescence and mitochondrial dysfunction induced by the obese hASC-derived matrix.

Conclusions
Native ECM in obesity vWAT initiates hASC senescence through TGF-β1-mediated mitochondrial dysfunction. These data provide a key mechanism for understanding the importance of cell-ECM interactions in hASCs senescence in obesity.
The impact of salps (Salpa thompsoni) on the Antarctic krill population (Euphausia superba): an individual-based modelling study
Authors: Pietzsch Bruno Walter , Schmidt Aaron , Groeneveld Jürgen , Bahlburg Dominik , Meyer Bettina , Berger Uta 
Published: October 2023

Abstract
Background
Krill (Euphausia superba) and salps (Salpa thompsoni) are key macrozooplankton grazers in the Southern Ocean ecosystem. However, due to differing habitat requirements, both species previously exhibited little spatial overlap. With ongoing climate change-induced seawater temperature increase and regional sea ice loss, salps can now extend their spatial distribution into historically krill-dominated areas and increase rapidly due to asexual reproduction when environmental conditions are favorable. Understanding the potential effects on krill is crucial, since krill is a species of exceptional trophic significance in the Southern Ocean food web. Negative impacts on krill could trigger cascading effects on its predators and prey. To address this question, we combined two individual-based models on salps and krill, which describe the whole life cycle of salp individuals and the dynamic energy budget of individual krill. The resulting new model PEKRIS (PErformance of KRIll vs. Salps) simulates a krill population for 100 years under varying chlorophyll-a concentrations in the presence or absence of salps.

Results
All of the investigated krill population properties (abundance, mean length, and yearly egg production) were significantly impacted by the presence of salps. On the other hand, salp density was not impacted if krill were present. The medians of krill population properties deviated during variable maximum chlorophyll-a density per year when salps were introduced by − 99.9% (− 234 individuals per 1000 m3) for krill density, − 100% (− 22,062 eggs per 1000 m3) for krill eggs and − 0.9% (− 0.3 mm) for mean length of krill.

Conclusions
If both species compete for the same food resource in a closed space, salps seem to inhibit krill populations. Further simulation studies should investigate whether this effect prevails if different phytoplankton sizes and consumption preferences of krill are implemented. Furthermore, direct predation of the two species or consumption of krill fecal pellets by salps could change the impact size of the food competition.