bluuebunny/crossref_metadata_2025_split huggingface dataset:
Influence of lip position on esthetics perception with respect to profile divergence using silhouette images
Authors: Alshammari Abdulrahman K. , Algharbi Muteb A. , Alshammari Sulaiman K. , Alenzi Ali A. , Malik Yasser R. , Abideen Malik Z. , Siddiqui Ammar A. , Madfa Ahmed A. 
Published: October 2023

Abstract
Background
The aim of the study was to determine the facial divergence and lip position combinations that are most and least preferred, and to investigate whether age or gender has an impact on these preferences.

Methods
The current investigation was carried out on a sample of 1077 individuals who were not experts in the field (253 men and 824 females). The research employed black silhouette photographs of profiles featuring different lip locations and profile divergences. The recruitment of participants was conducted in order to assess the attractiveness of the profiles, employing a Likert scale. The various positions of the lips and variations in facial profiles were thoroughly categorized. Results were analyzed using the Chi-square test.

Results
The findings of the research demonstrated that aesthetic perceptions displayed diversity when considering different lip locations and profile divergences. It was shown that neutral lip positions were predominantly favored, accounting for approximately 40.2% of the total frequencies in the anterior diverging group. It is noteworthy to highlight the aesthetically pleasing features exhibited by those with the most prominent lip position, occurring at a frequency of 10.9% in straight-diverging group. In the posterior divergent group, the most protruded lip position, showed very attractive aesthetics with frequency (7.1%). Gender, age, region, and level of education had significant influence on aesthetic perception.

Conclusions
The variety of aesthetic preferences is influenced by the location of the lips and the divergence of the facial profile, resulting in different outcomes within the categories of anterior, straight, and posterior divergence. Clinicians are advised to customize the treatment regimen in order to correspond with the unique desires and preferences of the patient.
Ovotesticular disorder of sex development in a 46 XY adolescent: a rare case report with review of the literature
Authors: Bbs Koui , Ad Abouna , Djiwa Toukilnan , B Traore , M Kouyate , Ke Kouame , Na Aman 
Published: October 2023

Abstract
Introduction
: Ovotestis is a rare cause of sexual ambiguity characterized by the presence in a patient of both testicular and ovarian tissue, leading to the development of both male and female structures. We report a case of ovotestis diagnosed in an adolescent, with a review of the literature.

Case Report
A 15-year-old patient presented with a right scrotal swelling associated with gynecomastia. Histology showed a juxtaposition of ovarian stroma with ovarian follicle and seminiferous tubules. Karyotype revealed a male subject (XY). We have therefore retained the diagnosis of ovotesticular disorders of sex development.

Conclusion
Ovotestis is a rare finding, heterogeneous in its genetic etiology and clinical presentation. While many patients are diagnosed during infancy or childhood, we presented a case diagnosed in a 15-year-old adolescent.
A single-institutional retrospective analysis of factors related to vaginal intraepithelial neoplasia
Authors: Zeng Hongmin , Dai Qianling , Jiang Dan 
Published: October 2023

Abstract
Background
To date, few studies on the factors related to vaginal intraepithelial neoplasia (VaIN) have been published. In this study, we aimed to analyze the features of VaIN and identify underlying risk factors.

Methods
Patients with VaIN or vaginitis histologically confirmed at the Industrial Street Branch of Chengdu Women’s and Children’s Central Hospital from July 2020 to December 2021 were included. We statistically analyzed their baseline clinical characteristics, human papillomavirus (HPV) infection status, cytology results, and pathology results. Categorical indicators were analyzed using the chi-square test or Fisher’s exact test, as appropriate. Differences were considered to be statistically different with p < 0.05.

Results
A total of 62 patients with VaIN (mean age: 39.06 ± 11.66 years) and 32 with vaginitis (mean age: 41.13 ± 13.43 years) were included. Synchronous cervical intraepithelial neoplasia (CIN) was histologically identified in 46 (74.2%) patients with VaIN and 7 (21.9%) with vaginitis (p < 0.001). Low-grade squamous intraepithelial lesions (LSILs) and atypical squamous cells of undetermined significance (ASC-US) were the most frequent cytological abnormalities in both groups. Patients with VaIN only (62.5%) were more likely to be negative for intraepithelial lesion or malignancy than patients with synchronous CIN (32.6%; p = 0.036). No statistically significant difference in HPV infection was noted between patients with VaIN and those with vaginitis (p = 0.439). The most prevalent HPV genotype in patients with VaIN or vaginitis was HPV16, whereas both HPV58 and HPV16 were the most common in patients with concurrent CIN.

Conclusions
Attention should be paid to HPV16- and HPV58-positive patients with cytological abnormalities such as ASC-US and LSILs (especially with synchronous CIN) to avoid misdiagnosis or underdiagnosis and to facilitate early interventions for VaIN.
Examining preconditions for integrated care: a comparative social network analysis of the structure and dynamics of strong relations in child service networks
Authors: Blanken Mariëlle , Mathijssen Jolanda , van Nieuwenhuizen Chijs , Raab Jörg , van Oers Hans 
Published: October 2023

Abstract
Background
To help ensure that children and families get the right support and services at the right time, strong and stable relationships between various child service organizations are vital. Moreover, strong and stable relationships and a key network position for gatekeepers are important preconditions for interprofessional collaboration, the timely and appropriate referral of clients, and improved health outcomes. Gatekeepers are organizations that have specific legal authorizations regarding client referral. However, it is largely unclear how strong relations in child service networks are structured, whether the gatekeepers have strong and stable relationships, and what the critical relations in the overall structure are. The aim of this study is to explore these preconditions for integrated care by examining the internal structure and dynamics of strong relations.

Methods
A comparative case study approach and social network analysis of three inter-organizational networks consisting of 65 to 135 organizations within the Dutch child service system. Multiple network measures (number of active organizations, isolates, relations, average degree centrality, Lambda sets) were used to examine the strong relation structure and dynamics of the networks. Ucinet was used to analyze the data, with use of the statistical test: Quadratic Assignment Procedure. Visone was used to visualize the graphs of the networks.

Results
This study shows that more than 80% of the organizations in the networks have strong relations. A striking finding is the extremely high number of strong relations that gatekeepers need to maintain. Moreover, the results show that the most important gatekeepers have key positions, and their strong relations are relatively stable. By contrast, considering the whole network, we also found a considerable measure of instability in strong relationships, which means that child service networks must cope with major internal dynamics.

Conclusions
Our study addressed crucial preconditions for integrated care. The extremely high number of strong relations that particularly gatekeepers need to build and maintain, in combination with the considerable instability of strong relations considering the whole network, is a serious point of concern that need to be managed, in order to enable child service networks to improve internal coordination and integration of service delivery.
Cross-validation of comorbidity items in two national databases in a sample of patients with end-stage kidney disease
Authors: Vanorio-Vega Isabella , Constantinou Panayotis , Hami Assia , Cellarier Eric , Rachas Antoine , Tuppin Philippe , Couchoud Cécile 
Published: October 2023

Abstract
Background
The use of national medico-administrative databases for epidemiological studies has increased in the last decades. In France, the Healthcare Expenditures and Conditions Mapping (HECM) algorithm has been developed to analyse and monitor the morbidity and economic burden of 58 diseases. We aimed to assess the performance of the HECM in identifying different conditions in patients with end-stage kidney disease (ESKD) using data from the REIN registry (the French National Registry for patients with ESKD).

Methods
We included all patients over 18 years of age who started renal replacement therapy in France in 2018. Five conditions with a similar definition in both databases were included (ESKD, diabetes, human immunodeficiency virus [HIV], coronary insufficiency, and cancer). The performance of each SNDS algorithm was assessed using sensitivity, specificity, positive predictive values (PPVs), negative predictive values (NPVs), and Cohen’s kappa coefficient.

Results
In total 5,971 patients were included. Among them, 81% were identified as having ESKD in both databases. Diabetes was the condition with the best performance, with a sensitivity, specificity, PPV, NPV, and Kappa coefficient all over 80%. Cancer had the lowest level of agreement with a Kappa coefficient of 51% and a high specificity and high NPV (94% and 95%). The conditions for which the definition in the HECM included disease-specific medications performed better in our study.

Conclusion
The HECM showed good to very good concordance with the REIN database information overall, with the exception of cancer. Further validation of the HECM tool in other populations should be performed.
Automated evaluation of typical patient–ventilator asynchronies based on lung hysteretic responses
Authors: Chen Yuhong , Zhang Kun , Zhou Cong , Chase J. Geoffrey , Hu Zhenjie 
Published: October 2023

Abstract
Background
Patient–ventilator asynchrony is common during mechanical ventilation (MV) in intensive care unit (ICU), leading to worse MV care outcome. Identification of asynchrony is critical for optimizing MV settings to reduce or eliminate asynchrony, whilst current clinical visual inspection of all typical types of asynchronous breaths is difficult and inefficient. Patient asynchronies create a unique pattern of distortions in hysteresis respiratory behaviours presented in pressure–volume (PV) loop.

Methods
Identification method based on hysteretic lung mechanics and hysteresis loop analysis is proposed to delineate the resulted changes of lung mechanics in PV loop during asynchronous breathing, offering detection of both its incidence and 7 major types. Performance is tested against clinical patient data with comparison to visual inspection conducted by clinical doctors.

Results
The identification sensitivity and specificity of 11 patients with 500 breaths for each patient are above 89.5% and 96.8% for all 7 types, respectively. The average sensitivity and specificity across all cases are 94.6% and 99.3%, indicating a very good accuracy. The comparison of statistical analysis between identification and human inspection yields the essential same clinical judgement on patient asynchrony status for each patient, potentially leading to the same clinical decision for setting adjustment.

Conclusions
The overall results validate the accuracy and robustness of the identification method for a bedside monitoring, as well as its ability to provide a quantified metric for clinical decision of ventilator setting. Hence, the method shows its potential to assist a more consistent and objective assessment of asynchrony without undermining the efficacy of the current clinical practice.
Influence of high altitude after a prior ascent on physical exhaustion during cardiopulmonary resuscitation: a randomised crossover alpine field experiment
Authors: Niederer Maximilian , Tscherny Katharina , Burger Josef , Wandl Bettina , Fuhrmann Verena , Kienbacher Calvin L. , Schreiber Wolfgang , Herkner Harald , Roth Dominik , Egger Alexander 
Published: October 2023

Abstract
Background
Performing cardiopulmonary resuscitation (CPR) inevitably causes significant physical, as well as psychological stress for rescuers. Physical activity at high altitude, a hypobaric and hypoxic environment, similarly adds to the level of stress and causes multiple physiological changes. Continuous measurement of pulse rate serves as an objective measure of fatigue during CPR. We therefore aimed to investigate rescuers’ heart rates as a measure of physical strain during CPR in a high-altitude alpine environment to provide a better understanding of the physiological changes under these very special conditions.

Methods
Twenty experienced mountaineers performed basic life support (BLS) on a manikin for 16 min, both at baseline altitude and at high altitude (3454 m) following a quick and exhausting ascent over 1200 m. Sequence of scenarios was randomised for analysis. Heart rate was continuously measured and compared between baseline and high altitude by absolute differences and robust confidence intervals.

Results
During CPR at baseline, the average heart rate increased from 87 bpm (SD 16 bpm) to 104 bpm [increase 17 bpm (95% CI 8.24–24.76)], compared to an increase from 119 bpm (SD 12 bpm) to 124 bpm [increase 5 bpm (95% CI − 1.59 to 12.19)] at high altitude [difference between two groups 32 bpm (95% CI 25–39)]. Differences between periods of chest compressions and ventilations were very similar at baseline [19 bpm (95%CI 16.98–20.27)] and at high altitude [20 bpm 95% CI 18.56–21.44)], despite starting from a much higher level at high altitude. The average heart rates of rescuers at high altitude at any point were higher than those at baseline at any other point.

Conclusion
Performing BLS CPR causes exhaustion both at base level and at a high altitude. A further increase during CPR might imply a physiological reserve for adapting to additional physical exertion at high altitude. Phases of ventilation are much needed recovery-periods, but heart rates remain very high. Subjective measures of exhaustion, such as the BORG-scale, might lead to rescuers’ overestimation of their own performance.
Association of cardiometabolic multimorbidity and adherence to a healthy lifestyle with incident dementia: a large prospective cohort study
Authors: Xiong Sizheng , Hou Ningxin , Tang Feifei , Li Jun , Deng Hongping 
Published: October 2023

Abstract
Background
The co-occurrence of cardiometabolic diseases (CMDs) is increasingly prevalent and has been associated with an additive risk of dementia in older adults, but the extent to which this risk can be offset by a healthy lifestyle is unknown. We aimed to examine the associations of cardiometabolic multimorbidity and lifestyle with incident dementia and related brain structural changes.

Methods
This prospective study extracted health and lifestyle data from 171 538 UK Biobank participants aged 60 years or older without dementia at baseline between 2006 and 2010 and followed up until July 2021, as well as brain structural data in a nested imaging subsample of 11 972 participants. Cardiometabolic multimorbidity was defined as the presence of two or more CMDs among type 2 diabetes, coronary heart disease, stroke, and hypertension. Lifestyle patterns were determined based on 7 modifiable lifestyle factors including smoking, alcohol consumption, physical activity, diet, sleep duration, sedentary behavior, and social contact.

Results
Over a median follow-up of 12.3 years, 4479 (2.6%) participants developed dementia. The presence of CMDs was dose-dependently associated with an increased risk of dementia. Compared with participants with no CMDs and a favourable lifestyle, those with ≥ 3 CMDs and an unfavourable lifestyle had a five times greater risk of developing dementia (HR 5.33, 95% CI 4.26–6.66). A significant interaction was found between CMD status and lifestyle (Pinteraction=0.001). The absolute difference in incidence rates of dementia per 1000 person years comparing favourable versus unfavourable lifestyle was − 0.65 (95% CI − 1.02 to − 0.27) among participants with no CMDs and − 5.64 (− 8.11 to − 3.17) among participants with ≥ 3 CMDs, corresponding to a HR of 0.71 (0.58–0.88) and 0.42 (0.28–0.63), respectively. In the imaging subsample, a favourable lifestyle was associated with larger total brain, grey matter, and hippocampus volumes across CMD status.

Conclusion
Our findings suggest that adherence to a healthy lifestyle might substantially attenuate dementia risk and adverse brain structural changes associated with cardiometabolic multimorbidity.
Knowledge and technology transfer in and beyond mineral exploration
Authors: Kesselring Michaela , Kirsch Moritz , Wagner Frank , Gloaguen Richard 
Published: October 2023

AbstractIn natural sciences, mineral exploration has a high network centrality. For industries with high technological- and knowledge proximity, transfer effects are an important function for innovation. Despite the high level of proximity between mineral exploration and other natural sciences, scholars hardly examine transfers from and to mineral exploration. This paper analyzes obstacles and mechanisms of transfer effects in and from mineral exploration and finds answers on how to institutionalize knowledge and technology transfer (KTT). The study employs a qualitative research design. The underlying database consists of 16 expert interviews, from the fields of natural science. The results show that KTT between areas as diverse as mineral exploration, healthcare, and arts are possible. A lack of interdisciplinary exchange and rigid scientific structures is the main inhibitor of KTT. Before this study, evidence for KTT from and to smaller industries is mostly anecdotal. The study is among the few, which investigates KTT concerning functional transfer opportunities.
Association of balance impairment with risk of incident cardiovascular diseases among older adults
Authors: Kim Hye Jun , Jeong Seogsong , Suh Michelle J. , Oh Yun Hwan 
Published: October 2023

Abstract
Background
Rapid decline in balance is a hallmark of aging, elevating the risk of falls and other age-related geriatric illnesses among older adults.

Objective
Our aim was to assess whether impairment in balance function is associated with the risk of incident CVD in older adults.

Design
Retrospective cohort analysis.

Participants
A total of 129,024 participants who had undergone health screening between 2002 and 2009 were derived from the National Health Insurance Service-Senior cohort.

Main measures
Balance impairment was evaluated using the open-eyes one-leg standing (OLS) test. The association between balance impairment and incident CVD was analyzed using the Cox proportional hazards regression model. All participants were followed up with until either the date of the first incident of CVD, death, or 31 December 2019.

Key results
Those with abnormal balance function (< 10 s in OLS test) had a higher risk of CVD (adjusted hazard ratio [aHR] 1.23, CI 1.16–1.31). The association was significant in both the obese and the non-obese, but it seemed to be more pronounced in the latter. Results were supported by sensitivity analyses that did not include cases of CVD development in the first 1, 2, or 3 years and that used a different criterion to define balance dysfunction (< 9 s in OLS test).

Conclusions
Older adults with balance impairment were found to have an increased risk of incident CVD. Patients with impaired balance function may be a high-risk population who require preventive managements against CVD.
Designing wearable capacitive pressure sensors with arrangement of porous pyramidal microstructures
Authors: Javidi Reza , Moghimi Zand Mahdi , Alizadeh Majd Sara 
Published: October 2023

AbstractCapacitive pressure sensors are essential for advanced applications like wearable medical devices, electronic skins, and biological signal detection systems. Enhancing sensitivity in these sensors is achieved by incorporating porous microstructures into the dielectric layer. The present research focuses on designing a capacitive pressure sensor comprising a porous micro-pyramidal dielectric layer featuring diagonally arranged pyramids. The effects of geometric parameters and material properties such as dielectric constant, porosity, base length, tip width, height, and the distance between the pyramidal microstructures were examined using the three-dimensional finite element simulations. A comparative analysis was conducted to evaluate the accuracy of the numerical solution. The simulation results were compared to experimental measurements, and the findings revealed a high level of agreement. The optimal quantity of data for this analysis was determined using the design of the experiment method, specifically the response surface model. The results show that arranging microstructures diagonally or laterally can impact sensitivity and initial capacitance. Specifically, employing a diagonal arrangement enhanced sensor sensitivity by up to 1.65 times while maintaining the initial capacitance relatively unaffected. Ultimately, this study derived mathematical equations from the collected data to estimate the initial capacitance and sensitivity of the sensor. The model predictions were compared to simulation results, and it was found that the models performed effectively.
Investigating the use of virtual reality to improve speaking skills: insights from students and teachers
Authors: Ironsi Chinaza Solomon 
Published: October 2023

AbstractThere is ongoing scientific discussion on the role of innovative technologies in enhancing teaching and learning. Technologies like augmented reality, virtual reality, mixed reality, artificial intelligence, and generative artificial intelligence have sparked debates in the broader literature. To contribute to ongoing discussions on these topics and to bridge gaps existing in works of literature on the potentials and challenges of innovative technologies like virtual reality, this paper provides insights from students and teachers on the use of virtual reality for teaching speaking skills so far lacking in academic prose in this domain. Given that this study only focused on obtaining student and teacher insights, a mixed-method research design that used questionnaires and interviews was implemented to investigate this study. After obtaining and analyzing data from 85 participants, the study found that although virtual reality could have improved students' speaking skills more efficiently, it was a fun and exciting learning experience for the students and teachers. Other novel findings of the study were instrumental in making pedagogic conclusions on the study's objective.