bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hygienic Disposal of Children’s Stools Practices Among Women of Children With Diarrhoea in Sub-Saharan Africa
Authors: Essuman Mainprice Akuoko , Storph Rebecca Peniel , Ahinkorah Bright Opoku , Budu Eugene , Yaya Sanni 
Published: October 2023

Background: Diarrhoea stools contain infectious agents and pose a public health threat to children and members of the entire family when exposed to them. Therefore, their hygienic disposal is essential. Empirical data are needed to stir the needed public health interventions to encourage or enforce proper disposal practices to curb associated clinical issues. This study assessed the prevalence and correlates of hygienic stool disposal practices by mothers of children with diarrhoea in sub-Saharan Africa (SSA). Methods: The Demographic and Health Surveys (DHS) data of 16 sub-Saharan African countries from 2015 to 2021 involving 22 590 mother-child pairs were analysed. Multilevel binary logistic analysis was conducted to assess the individual- and household-level factors associated with the hygienic disposal of stool practices by mothers of children with diarrhoea. The results were presented using adjusted odds ratios (AOR) and 95% confidence intervals (CI) at a statistical significance of P < .05. Results: The overall prevalence of hygienic disposal of children’s stools among women of children with diarrhoea was 49.01% (95% CI: 48.40-49.62) and ranged from 15.70% in Liberia to 86.6% in Rwanda. The practice of hygienic disposal of stools of children with diarrhoea was likely to increase among mothers who are working (AOR: 1.19; 95% CI: 1.09-1.30), those with partners with primary level of education (AOR: 1.18; 95% CI: 1.06-1.31), Muslims (AOR: 1.69; 95% CI: 1.49-1.91) and widowed/divorced (AOR: 8.94, 95% CI: 3.55-22.53). Again, mothers in the richer (AOR: 1.23; 95% CI: 1.08-1.39) wealth index had increased odds of disposing of stools hygienically compared to those in the poorest wealth index. Women who were 20 years and above, to who belonged to Traditional Religions (AOR: 0.57; 95% CI: 0.43-0.74), and those with unimproved sources of water (AOR: 0.89; 95% CI: 0.82-0.98) and toilet facilities (AOR: 0.63; 95% CI: 0.58-0.69) were less likely to dispose of child’s diarrhoea stool hygienically than their counterparts. Conclusion: The study reveals that the unhygienic disposal of the stool of children with diarrhoea is prevalent in SSA and requires a concerted effort to curb it. Sanitation practices such as educating mothers about hygienic disposal of children’s stool and improving water and sanitation facilities are crucial in lowering the high prevalence of unhygienic disposal of the diarrhoeic stool of children. Additional country-level research is needed to assess children’s defecation behaviours and the disposal of diarrhoeic stools using different methodologies.
Safety of exercise training in multiple sclerosis: An updated systematic review and meta-analysis
Authors: Learmonth Yvonne C , P Herring Matthew , Russell Daniel I , Pilutti Lara A , Day Sandra , Marck Claudia H , Chan Bryan , Metse Alexandra P , Motl Robert W 
Published: October 2023

Background: A review of the safety profile of exercise training in multiple sclerosis (MS) has not been conducted since 2013. Objective: We undertook a systematic review and meta-analysis of randomised controlled trials (RCTs) of exercise training published since 2013 and quantified estimated population risks of clinical relapse, adverse events (AE) and serious adverse event (SAE). Methods: Articles reporting safety outcomes from comparisons of exercise training with non-exercise among persons with MS were identified. The risk of bias was established from study’s internal validity assessed using Physiotherapy Evidence Database (PEDro). Rates and estimated mean population relative risks (RRs; 95% confidence interval (CI)) of safety outcomes were calculated, and random-effects meta-analysis estimated the mean RR. Results: Forty-six interventions from 40 RCTs ( N = 1780) yielded 46, 40 and 39 effects for relapse, AE, adverse effects and SAE, respectively. The mean population RRs ((95% CI), p-value) for relapse, AE and SAE were 0.95 ((0.61, 1.48), p = 0.82), 1.40 ((0.90, 2.19), p = 0.14) and 1.05 ((0.62, 1.80), p = 0.85), respectively. No significant heterogeneity is observed for any outcome. Conclusion: In studies that reported safety outcomes, there was no higher risk of relapse, AE, adverse effects or SAE for exercise training than the comparator. Exercise training may be promoted as safe and beneficial to persons with MS.
Outcomes of Castor Single-Branched Stent Graft for Reconstruction of Multiple Supra-Aortic Branches in Aortic Arch Disease
Authors: Wang Zibin , He Xinqi , Liu Boyu , Liu Peng , Jiang Xia , Yang Yan , Zhang Lei 
Published: October 2023

Purpose: To report the outcomes of a combination of Castor single-branched stent grafts with other techniques for the reconstruction of multiple supra-aortic branches in aortic arch disease. Materials and methods: Between December 2019 and December 2021, 20 patients with aortic arch disease underwent thoracic endovascular aortic repair (TEVAR) at our institution using a Castor single-branched stent graft combined with the fenestration, chimney, or bypass techniques. Thoracic endovascular aortic repair is indicated for complicated or acute type B aortic dissection (TBAD), nonruptured aneurysms with a maximum aneurysm diameter >5.5 cm or showing rapidly expanded, ruptured, or threatened aneurysms, and penetrating aortic ulcers (PAUs) with a maximal aortic diameter >5.5 cm or with PAUs >10 mm deep or >20 mm in diameter. Preoperative, intraoperative, and postoperative clinical data were recorded. Results: The median age of the patients was 56 (range=52-69 years) years, and 19 patients were men. Seven patients underwent the Castor single-branched stent graft and left common carotid artery (LCCA) chimney technique, 8 patients underwent the Castor single-branched stent graft and fenestration technique, and 5 patients underwent the Castor single-branched stent graft and bypass technique. The technical success rate was 100%. Major adverse events included 2 endoleaks, 1 spinal cord ischemia, and 1 early-stage retrograde type A aortic dissection. No cerebral stroke–related complications were observed. The mortality rate was 10% (2/20 patients). One patient with thoracic aortic aneurysm (TAA) died because of a sudden decrease in oxygen saturation and blood pressure after surgery. Relatives declined autopsy, and the cause of death was not determined. Another patient died of a retrograde type A dissection after surgery. The median follow-up period was 6 months (range=3.5-12 months). During follow-up, 1 patient with type I endoleak underwent thoracotomy again after a year. The remaining patients recovered well. Conclusions: The combination of a Castor single-branched stent graft with fenestration, chimney, or bypass techniques may be an effective treatment for preserving multiple supra-aortic branches in aortic arch disease. Clinical Impact This study introduced three methods of reconstruction of multiple supra-aortic branches using a Castor single-branched stent graft (Castor single-branched stent graft combined with fenestration, chimney, or bypass technique) and analysed their advantages and shortcomings to provide experience for the future treatment of aortic arch diseases.
Clinical Outcomes and Factors Associated With Aortic Shrinkage After Thoracic Endovascular Aortic Repair for Aneurysmal Chronic Aortic Dissection
Authors: Shijo Takayuki , Shimamura Kazuo , Maeda Koichi , Yamashita Kizuku , Ide Toru , Yamana Fumio , Takahara Mitsuyoshi , Kuratani Toru , Miyagawa Shigeru 
Published: October 2023

Purpose: The effectiveness of thoracic endovascular aortic repair (TEVAR) for chronic aortic dissection (AD) with aneurysmal degeneration remains controversial. We retrospectively investigated clinical outcomes and assessed predictors of aortic shrinkage after TEVAR for chronic aneurysmal AD. Materials and Methods: Between January 2010 and December 2021, 70 patients with double-barrel-type chronic AD were enrolled. Major intimal tears in thoracic aorta were covered by stent graft. Early and late clinical outcomes, and diameter change of downstream aorta during follow-up period were reviewed. Subsequently, factors associated with aortic shrinkage were assessed by logistic regression analysis. Results: Mean age was 63 (interquartile range [IQR]: 54–68) years, 54 (80%) men, median duration from AD onset was 4 (IQR: 1–10) years, and maximum aortic diameter was 53 (IQR: 49–58) mm. Supra-aortic debranching procedure was required in 57 (81%) patients. Early aorta-related death occurred in 2 (3%) patients. Both stroke and spinal cord ischemia occurred in 1 (2%) patient. Five-year freedom rates from aorta-related death and reintervention were 96% and 51%, respectively. Sixty-four patients underwent follow-up computed tomography (84%) 1 year after TEVAR, with 33 (52%) achieving aortic shrinkage. In multivariable analysis, duration from AD onset (per year) (odds ratio [OR]: 0.82, 0.70–0.97; p=0.017) and maximum aortic-diameter ratio between aortic arch and descending aorta (per 0.1) (morphologic index; OR: 1.34, 1.04–1.74; p=0.023) were independent aortic shrinkage predictors. Conclusions: Thoracic endovascular aortic repair for chronic AD with aneurysmal degeneration achieved satisfactory survival outcomes, but with a considerable reintervention rate. Duration from AD onset and preoperative aortic morphology could affect post-TEVAR aortic shrinkage. Earlier intervention could lead to better aortic shrinkage. Clinical Impact Thoracic endovascular aortic repair for chronic aortic dissection with aneurysmal degeneration showed low incidence of early and late aorta-related death. By contrast, aortic shrinkage rate was low with high incidence of reintervention to the residual downstream aorta. According to the assessment of preoperative variables, chronicity and aortic morphology could predict postoperative aortic shrinkage.
Near-Infrared Spectroscopy for Continuous Noninvasive Monitoring of Free Flap in Head and Neck Reconstruction: Systematic Review of the Literature and Personal Experience
Authors: Festa Bianca Maria , Costantino Andrea , Pace Gian Marco , Spriano Giuseppe , De Virgilio Armando 
Published: October 2023

Background Buried free flaps represent a reconstructive challenge concerning monitoring of vitality, which is fundamental for an early detection of flap failure and prompt surgical salvage. Many flap monitoring techniques have been developed over time, and there is still no consensus concerning the best monitoring technique for buried reconstructions. Methods We performed a systematic review of the literature on NIRS monitoring for head and neck free flaps. Moreover, we presented a case of orbital reconstruction through a buried free myo-fascial anterolateral tight flap (ALTF) in which postoperative monitoring was performed by means of NIRS. Results Four studies were included with a total of 200 monitored head and neck free flap reconstructions. Flap survival was reported in 96.5% of studies (n = 193/200) with a 3.5% of total flap failure rate (n = 7/200). We monitored the buried myo-fascial ALTF for 7 post-operative days measuring a regional oxygen saturation (rSO2) ranging from 55% to 72% (mean = 66%). Conclusions This device appeared to be an efficient choice for monitoring buried flaps, thanks to its ability to measure tissue perfusion deep under the skin, to the continuous availability of recorded data on the monitor, and to its low impact on the patient. Further prospective studies are advised in order to standardize this monitoring technique and define warning values.
Natural history of neonatal radial nerve palsy
Authors: Orellana Kevin J. , Buttrick Eliza , Belardo Zoe E. , Schmieg Sandra , Pehnke Meagan , Shah Apurva S. 
Published: October 2023

This retrospective case series analysed the presentation, risk factors, and natural history of neonatal radial nerve palsy. A total of 28 patients with a diagnosis of radial nerve palsy and aged less than 12 months at original presentation were identified at our institution. Patient demographics, relevant risk factors and physical examination findings were recorded, including active movement scale scores to track neurological recovery over time. In total, 18 patients had a history of prolonged or difficult delivery and 15 patients had skin markings consistent with fat necrosis of the posterolateral arm as anticipated from previous studies. Significant improvement was seen between active movement scale scores at the first and final visits ( p < 0.001). Of the 26 patients with active movement scale scores available at the last visit, all had neurologic resolution by the age of 9 months. Excellent outcomes and complete resolution can be expected in newborns with radial nerve palsy. Level of evidence IV
Biofeedback training using a hybrid assistive limb after brachial plexus injury
Authors: Kubota Shigeki , Shimizu Yukiyo , Hara Yuki , Yamazaki Masashi 
Published: October 2023

This study investigated the use of an upper limb hybrid assistive limb for elbow flexion biofeedback training in recovery from brachial plexus injury in both the postoperative and chronic phases. No adverse events were observed in any patient. Level of evidence: IV
Arthroscopic Tenotomy of the Flexor Hallucis Longus to Treat Checkrein Deformity
Authors: Mudarra García Jesús , Saus Milán Natalia , Blasco Mollá María Carmen , Forriol Brocal Francisco , Martin-Gorgojo Victor 
Published: October 2023

Checkrein deformity is a rare entity that results in alteration of the normal flexion and extension of the hallux, caused by a retraction or adhesion of the flexor hallucis longus (FHL) in its tendinous or muscular portion. It is usually caused by the sequelae of ankle and tibia fractures, such as adhesions and neuropathies, and often undiagnosed compartment syndromes. Its treatment is mainly surgical, and different techniques of release or lengthening of the FHL have been described. We present the clinical case of a 61-year-old patient treated by a simple arthroscopic tenotomy of the FHL at the retromalleolar level of the ankle, with complete functional recovery and absence of recurrence after 2 years of evolution. We recommend that this procedure should be considered for this pathology due to its technical simplicity, low iatrogenicity, early recovery, and theoretical absence of recurrence. Level of Evidence: Level V: Expert opinion, case report
Investigation of factors associated with mental health during the early part of the COVID-19 pandemic in South Korea based on machine learning algorithms: A cohort study
Authors: Choi Junggu , Han Sanghoon 
Published: October 2023

Objective The coronavirus disease 2019 (COVID-19) pandemic is among the most critical public health problems worldwide in the last three years. We tried to investigate changes in factors between pre- and early stages of the COVID-19 pandemic. Methods The data of 457,309 participants from the 2019 and 2020 Community Health Survey were examined. Four mental health-related variables were selected for examination as a dependent variable (patient health questionnaire-9, depression, stress, and sleep time). Other variables without the aforementioned four variables were split into three groups based on the coefficient values of lasso and ridge regression models. The importance of each variable was calculated and compared using feature importance values obtained from three machine learning algorithms. Results Psychiatric and sociodemographic variables were identified, both during the pre- and early pandemic periods. In contrast, during the early pandemic period, average sleep time variables ranked the highest with the dependent variables regarding the experience of depression. The difference in sleep time before and after the pandemic was validated by the results of paired t-tests, which were statistically significant ( p-value < 0.05). Conclusions Changes in the importance of mental health factors in the early pandemic period in South Korea were identified. For each mental health-dependent variable, average sleep time, experience of depression, and experience of accidents or addictions were found to be the most important factors. House type and type of residence were also found in regions with larger populations and a higher number of confirmed cases.
Exploring the Association between Trust in Healthcare Entities and Exposure to Emerging Health Misinformation in Nebraska: A Pilot Study
Authors: Arambul Natalie , Sraboni Syeda , Chukwunweike Josephine , Olagoke Ayokunle 
Published: October 2023

Introduction: This pilot study investigated the association between trust in healthcare entities and exposure to emerging health misinformation in rural Nebraska. Methods: We surveyed 42 residents of Nebraska to assess their trust in healthcare entities (i.e., the healthcare system, clinicians, Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA), and local health departments) and their exposure to emerging health misinformation. Results: Most participants with decreased trust in healthcare entities also reported exposure to health misinformation in the last week. Specifically, 62.5% of participants who reported decreased trust in the healthcare system, 75% in the CDC, 83.3% in the FDA, and 62.5% in the local health department also reported exposure to at least misinformation. Conclusion: The findings suggest that trust is a crucial human factor and is critical in exposure to health misinformation. This highlights the need to prioritize effective communication strategies to build trust.
Biomechanical Comparison of 1.2-mm Suture Tape, 2.0-mm Suture Tape, and 0.5-mm Suture Using Various Arthroscopic Knot Techniques
Authors: Baek Samuel , Shin Myung Ho , Kim Tae-Min , Kim Seok , Lee Geum-Ho , Oh Kyung-Soo , Chung Seok Won 
Published: October 2023

Background: The biomechanical properties of the 1.2-mm suture tape have outperformed conventional sutures in previous studies. Purpose: To compare the loop and knot security of 2 tape-type and 1 cord-type sutures using different arthroscopic knot techniques. Study Design: Controlled laboratory study. Methods: The biomechanical characteristics of the 1.2-mm tape, 2.0-mm tape, and 0.5-mm No. 2 suture were compared using 4 different knot types: 2 sliding knots (Samsung Medical Center [SMC] and Tennessee) and 2 nonsliding knots (2-throw surgeon’s and 2-throw square) with 2 and 3 additional reverse half-hitches on alternating posts (RHAPs) in a closed-loop system on a materials testing device. Each configuration was tested for loop security (maximal load applied between 0 and 3 mm of displacement), knot security (ultimate failure load), and failure mode with cyclical loading (30 N load for 20 cycles at 1 cycle per sec until failure). Loop and knot security among the configurations were compared using an analysis of variance. Results: With 2 RHAPs, the 2.0-mm tape showed significantly greater loop security than the 1.2-mm tape and suture ( P = .001). With 3 RHAPs, the loop security of the suture was significantly superior compared with the 1.2-mm tape ( P = .010). Regarding knot security, with 2 RHAPs, the 2.0-mm tape was significantly better than the 1.2-mm tape and suture ( P < .001), while with 3 RHAPs, the suture was significantly superior to the 1.2-mm tape ( P = .012). Using a square knot with 2 RHAPs, the 2.0-mm tape had significantly greater loop security ( P = .001) and better knot security ( P = .001) to the 1.2-mm tape and suture. Using the Tennessee knot with 2 RHAPs, the 1.2-mm tape had less loop security ( P = .011) and knot security ( P = .005) than the suture. Using the SMC knot with 3 RHAPs, the 2.0-mm tape and suture were significantly superior in loop security ( P = .001) and knot security ( P < .001) to the 1.2-mm tape. There was no significant difference in the failure mode between tapes and sutures with 2 and 3 RHAPs. Conclusion: With 2 RHAPs, the 2.0-mm tape demonstrated greater resistance to suture loop displacement and better knot security compared with the 1.2-mm tape and suture. However, with 3 RHAPs, the 1.2-mm tape manifested weaker loop and knot security compared with the suture.
Effect of the COVID-19 Pandemic on Injuries Related to Individual and Team Sports: An Analysis of the NEISS Database Between 2017 and 2021
Authors: Leipman Jessica , Shahriar Rajin 
Published: October 2023

Background: The first 2 years of the coronavirus 2019 (COVID-19) pandemic had a profound effect on youth sports participation. Purpose: The primary aim of this study was to explore the effect of the COVID-19 pandemic on youth sports injury patterns, with a secondary aim of comparing organized team and individual sport–related injuries in diverse age groups. Study Design: Descriptive epidemiology study. Methods: The National Electronic Injury Surveillance System (NEISS) was searched to identify injuries sustained by patients aged 11 to 23 years while playing organized team or individual sports from 2017 to 2021. We investigated reports of concussions, dislocations, fractures, and sprains/strains. Results: Between 2017 and 2021, there were 58,721 and 3778 team and individual sport–related injuries, respectively. When compared with the prepandemic years, there was a 57.07% decrease in 2020 and 22.31% decrease in 2021 for the number of organized team sport–related injuries. Organized individual sport–related injuries had a 56.24% and 35.18% decrease in number in 2020 and 2021, respectively. Male patients were most likely to be injured in team sports (81.0%), and female patients were most likely to be injured in individual sports (67.1%). High school athletes sustained the majority of injuries in team (57.0%) and individual (51.2%) sports. The years 2020 and 2021 saw a decrease in proportion of sprains/strains and an increase in proportion of fractures. Conclusion: The number of organized sport–related injuries reported to emergency departments decreased in 2020, and despite vaccinations and easing of social distancing, the 2021 value did not return to what it was prepandemic. As coronavirus-related restrictions have eased, there should be careful monitoring of sports injuries among youth athletes.
How to improve quality investing
Authors: Otero González Luis , Durán Santomil Pablo , Vieito João Paulo da Torre , Reboredo Juan Carlos 
Published: October 2023

In this article, we evaluate the relationship between quality investing combined with Economic Moat, ESG (Environmental, Social and Governance) and analyst opinions over the period 2014–2020 based on a data set comprising 803 US stocks. Performance is evaluated using several metrics (returns and alphas). Our results show that quality stocks measured by return on invested capital (ROIC) exhibit superior performance. The incorporation of competitive advantages allows a better discrimination among the classic high-quality strategies. Investment in stocks with quality and high ESG entails the payment of a premium but buying quality companies with Economic Moat makes up for this negative aspect. The results show how quality companies that have competitive advantages obtain a better future performance and are recognized by the market with a higher valuation. However, the markets may take time to recognize this value since the incorporation of the average Price-to-Price target (Analyst consensus) increases the future performance. JEL classification: G11; G14; G23