bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Digitally-Supported Shared Decision Making Approach for Patients during Cardiac Rehabilitation: Protocol for a Randomized Controlled Trial.
Authors: Kizilkilic Sevda Ece , Ramakers Wim , Falter Maarten , Scherrenberg Martijn , bonneux cindel , Hansen Dominique , Dendale Paul , Coninx Karin 
Published: January 2024

Abstract
Background: Physical activity is a key component of cardiac rehabilitation. However, EUROASPIRE V concluded that intending 48% of coronary artery disease (CAD) patients do not intend to do physical activity in the next six months. Patient involvement improves patient satisfaction, adherence, and health outcomes and is a prerequisite for good clinical practice. Unfortunately, patients currently have only limited input in their exercise prescription. We developed SharedHeart, a digitally-supported shared decision making (SDM) approach that assists patients with heart disease and their caregivers in collaboratively setting up exercise goals and creating an exercise plan for the patient.
Objective: The aim of the study is to determine the effectiveness and cost-effectiveness of the combination of center-based CR and shared decision making based telerehabilitation. The study investigates the influence of a SDM approach supported by digital applications on the patient’s quality of life, exercise capacity, motivation to exercise, perception of rehabilitation and engagement in the shared decision making process.
Methods: The study is a prospective double-arm, randomized controlled trial that includes a usability study of the applications. In the usability study, instantaneous user friendliness and patients’ motivation will be investigated by testing the designed applications with 10 CAD patients and 5 physiotherapists. In the RCT, 80 patients will be randomized 1:1 between an intervention group and a control group. The intervention group will follow the SharedHeart approach, consisting of SDM encounters with caregivers and using the digital tools during phase II cardiac rehabilitation (i.e. 3 months). The primary outcome measure is patients’ quality of life, assessed with the HeartQoL questionnaire. Secondary outcomes are related to patients’ exercise capacity, motivation to exercise, perception of rehabilitation and engagement in the shared decision-making process.
All methods were performed in accordance with the relevant guidelines and regulations by including a statement in the Ethics approval and consent to participate section to this effect.
Discussion: This will be one of the first study to investigate the effects of a digitally-supported shared decision making approach. If the SharedHeart approach and supporting applications are found to be effective in increasing patients’ quality of life, exercise capacity, motivation to exercise, perception of rehabilitation and/or engagement in the shared decision making process, this can be a cost-effective and accessible solution to increase patient outcomes and patient involvement during cardiac rehabilitation.
Trial registration: ClinicalTrials.gov NCT05026957.
Research on seismic isolation performance of nuclear power plant containment structures
Authors: Xue Zhicheng , Cui Xiujun , Pei Qiang , Zhong Jintu , He Yongyi , Zhang Yao , Qi Pengfei 
Published: January 2024

Abstract
Non isolated structures have problems such as strong destructiveness and poor isolation effect when encountering earthquakes. Setting isolation bearings can extend the natural vibration period of the structure, reduce the horizontal seismic response of the structure, and also enhance the overall seismic performance of the structure.The new material - epoxy plate thick layer rubber isolation bearing has unique advantages compared to other bearings, such as effective energy absorption, simple construction, and low cost.This study establishes a three-dimensional isolated nuclear power plant containment structure based on the principle of similarity ratio, and compares and analyzes the acceleration, base reaction, and displacement responses of non isolated and isolated structures. At the same time, the incremental dynamic analysis method (IDA) is used to analyze the seismic vulnerability of the structure, and the isolation performance of the nuclear containment structure using epoxy plate thick layer rubber isolation bearings is comprehensively and deeply explored.The results show that the epoxy plate thick layer rubber isolation bearing effectively prolongs the natural vibration period of the structure, reduces the horizontal seismic response of the structure, and reduces the dome acceleration response by 66.55%, and the base horizontal shear force by 55.51%.Therefore, setting epoxy plate thick layer rubber isolation bearings in the isolation layer can effectively enhance the seismic performance of the structure, thereby improving the redundancy of the nuclear power plant containment structure. Keywords: epoxy plate thick layer rubber isolation bearing; Time history analysis; Seismic performance; Incremental dynamic analysis method.
Complete transection of bilateral main bronchus in a 5-year-old: A case report
Authors: Wang Weimin , Yang Yanliang , Bi Siming , lv Xiaozheng , Xu Huihui 
Published: January 2024

Abstract

Background
Tracheobronchial injuries caused by blunt chest trauma are rare in children, and they usually involve multiple organs. Most cases involve respiratory failure on the way to the hospital, and the mortality rate is high. Here, we describe the case of a 5-year-old who fell from an electric vehicle, causing complete rupture of the bilateral main bronchus.
Case presentation:
Chest computed tomography (CT) failed to detect a bronchial rupture. Continuous closed thoracic drainage resulted in a large amount of bubble overflow. Tracheal rupture was suspected. Fiberoptic bronchoscopy revealed complete rupture of the right main bronchus and rupture of the left main bronchus. Emergency tracheoplasty was performed under cardiopulmonary bypass (CPB). During the operation, we found that the bilateral main bronchi were completely ruptured. Postoperative recovery was smooth. The traditional surgical method for treating these injuries is lateral thoracotomy. However, a median thoracotomy provides a better opportunity for selective repair. Extracorporeal circulation-assisted surgery is required for patients with unstable breathing.
Conclusion
The patient with completely fracture the bilateral main bronchi is rare. Extracorporeal circulation-assisted tracheoplasty is a relatively safe option in children with difficult respiratory system maintenance, ensuring oxygenation ventilation and a clear surgical field.
Posting on Social-Media Undermines Academic Performance and Well-Being
Authors: Sayag Maayan , Most Carmel , Katzir Maayan , Luria Roy , Kross Ethan , Sheppes Gal 
Published: January 2024

Abstract
Medical authorities and policymakers raise mounting concerns regarding the detrimental influence of social-media on students’ academic performance and well-being. Surprisingly, empirical evidence that supports these strong concerns is unclear. We provide a novel psychological framework that specifies fundamental elements of social-interaction to predict under which conditions social-media usage will have its most pernicious effects. Our framework argues that posting personal social-media content (relative to scrolling through others' content) elicits opportunities to receive strong social-feedback from others, which tempts individuals to procrastinate on social-media instead of studying, resulting in negative academic and well-being consequences. Three experimental studies causally test our framework using state-of-the-art methods, behavioral measures, and outcomes. Experiments 1 (Facebook) and 2 (Instagram) demonstrated that experimentally having participants post (vs scroll), leads to enhanced procrastinatory social-media usage, that in turn undermines academic performance and well-being. Experiment 3 directly demonstrated the detrimental role of opportunities to receive strong social-feedback following posting, in showing that experimentally blocking social-feedback opportunities following posting, eliminates subsequent procrastinatory social-media behavior and its maladaptive consequences. These findings advise professionals and policymakers to shift from making generic recommendations to reduce overall social-media usage, to customized warnings about the negative academic and well-being consequences of posting on social-media.
COVID-19 Vaccination and Lethality Reduction: A Prospective Cohort Study in Venezuela
Authors: Forero-Peña David A. , Leyva Jéssica L. , Valenzuela María V. , Omaña-Ávila Óscar D. , Mendoza-Millán Daniela L. , Sánchez-Ytriago Elisanny A. , Hachem Andrea C. Lahoud-El , Farro Katherine R. , Maita Ana K. , González Romina del C. , Rodriguez-Saavedra Carlis M. , Hernández-Medina Fernando , Camejo-Ávila Natasha A. , Nobrega Diana C. Freitas-De , Celis Rodrigo T. , Forero-Peña José L. , Martínez Alfonso , Grillet María E. , Landaeta María E. , Carrión-Nessi Fhabián S. 
Published: January 2024

Abstract
Background
While rigorous randomized clinical trials have substantiated the efficacy of COVID-19 vaccines in reducing hospitalization and mortality rates, there is a paucity of post-authorization analyses conducted in real-world settings. In Venezuela, the primary vaccines administered are BBIBP-CorV (Sinopharm) and Gam-COVID-Vac (Sputnik-V). However, the performance and effectiveness of these vaccines within this specific population remain to be thoroughly investigated.
Methods
A prospective cohort study was undertaken from October 5, 2021, to March 31, 2022, across four sentinel hospitals in Venezuela. The outcomes were evaluated at two time points: day 28 and day 48, utilizing the WHO’s COVID-19 Clinical Progression Scale. For the purpose of analysis, patients were classified into two groups: vaccinated and unvaccinated.
Results
The study included a total of 175 patients, of which 85 (48.6%) were categorized as vaccinated, with the majority (76.5%) having received two doses. The median age of the patients was 68 years, with a slight predominance of females (53.1%), and the majority being unemployed/retired (60.6%). Hypertension (53.1%) and diabetes (18.3%) were the most prevalent comorbidities. The median Charlson index of the patients was 3 points, with no statistically significant differences observed between the groups (p = 0.2). Upon admission, dyspnea was more commonly observed in unvaccinated patients compared to vaccinated patients (76.7% vs. 62.4%, p = 0.039). Almost all laboratory parameters were comparable in both groups, with the exception of the median D-dimer level, which was significantly higher in unvaccinated patients (7.6 vs. 1.4 µg/mL, p = 0.015). A total of 50 patients (28.6%) died of the disease, with a higher proportion of deaths observed in unvaccinated patients compared to vaccinated patients (35.6% vs. 21.2%, p = 0.035). Factors such as advanced age (OR = 1.043, 95%CI = 1.015–1.071, p = 0.002) were associated with increased odds of death, while factors such as vaccination against COVID-19 (OR = 0.428, 95%CI = 0.185–0.99, p = 0.047), high oxygen saturation (OR = 0.964, 95%CI = 0.934–0.995, p = 0.024), and enoxaparin administration (OR = 0.292, 95%CI = 0.093–0.917, p = 0.035) were associated with decreased odds of death.
Conclusion
In the course of the third and fourth waves of the pandemic, vaccination against COVID-19 was found to be associated with a 57% reduction in lethality among patients treated in four public hospitals in Venezuela.
Necrotising fasciitis with extensive necrosis caused by Lactobacillus: A case report
Authors: Nagayama Jun , Sao Takeo , Takanori Ishida , Kouji Koga , Mitsunobu Nakamura 
Published: January 2024

Abstract

Background
Necrotising fasciitis (NF) is a life-threatening soft-tissue infection that rapidly destroys the epidermis, subcutaneous tissue, and fascia. Despite their low virulence, Lactobacillus spp. can cause NF, and because of its rare incidence, there is limited knowledge about its molecular and clinicopathological characteristics. We report a rare case of NF in a patient with undiagnosed diabetes mellitus and severe obesity due to infection with two types of Lactobacillus spp. that manifested in extensive necrosis.
Case presentation
A 48-year-old woman was referred to our hospital with a complaint of difficulty in walking due to severe bilateral thigh pain. She presented with pale redness, swelling, and severe skin pain extending from the pubic region to the groin. The patient was morbidly obese, had renal dysfunction and had not been diagnosed having diabetes mellitus; her LRINEC (Laboratory Risk Indicator for Necrotising Fasciitis) score was 9, indicating a high risk of NF. An exploratory surgical incision was made and NF was diagnosed based on fascial necrosis. Emergent surgical debridement was performed, and cultures of the wound and abscess revealed two types of Lactobacillus spp.: Lactobacillus salivariusand L. iners. The patient was admitted to the intensive care unit (ICU), where antibiotics were administered and respiratory and circulatory managements were performed. Diabetic ketoacidosis was detected, which was treated by controlling the blood glucose level stringently via intravenous insulin infusion. The patient underwent a second debridement on day 11 and, skin suture and skin grafting on day 36. The patient progressed well, was transferred from the ICU to the general ward on day 41, and was discharged unassisted on day 73.
Conclusions
Lactobacillus spp. are rarely pathogenic to healthy individuals and can seldom trigger NF. However, these bacteria can cause rare infections such as NF in immunocompromised individuals, such as those with diabetes and obesity, and an early diagnosis of NF is imperative; surgical intervention may be required for prevention of extensive necrosis. The LRNEC score may be useful for the early diagnosis of NF even for less pathogenic bacteria such as the Lactobacillus.
Stability analysis and molecular profiling of Desi chickpea (Cicer arietinum L.)
Authors: kotegoudra Hanamantagouda , Aarya Madhuri , S HEMANTH , H Manoj S 
Published: January 2024

Abstract
A study was conducted during the 2021 rabi season to investigate and identify stable genotypes of desi Chickpea (Cicer arietinum L.). The investigation involved employing 15 SSR primers for screening and assessing thirty genotypes under three distinct sowing dates to evaluate their grain yield performance. The findings highlighted significant variance components associated with genotype, environment, and G x E interactions, signifying variability in both genotypes and environments and variations in performance among different genotypes. Linear components were also notable, suggesting the potential to anticipate variations in genotype performance. Particularly, genotype ICCV-18-1664 exhibited stability for grain yield per plant in favourable environments, while genotypes DC-17-1111 and DC-17-1115 showed stability in unfavourable environments. The dissimilarity index, derived from SSR data clustering, categorized the 30 genotypes into five primary clusters. Genetic structure analysis, based on 15 SSR primer loci, unveiled that the 30 desi chickpea genotypes comprise a blend of four major ancestral components in diverse combinations.
Post-COVID cognitive deficits at one year are global and associated with elevated brain injury markers and grey matter volume reduction: national prospective study
Authors: Michael Benedict , Wood Greta , Sargent Brendan , Ahmad Zain-Ul-Abideen , Tharmaratnam Kukatharamini , Dunai Cordelia , Egbe Franklyn , Martin Naomi , Facer Bethany , Pendered Sophie , Rogers Henry , Hübel Christopher , Wamelen Daniel van , Bethlehem Richard , Giunchiglia Valentina , Hellyer Peter , Trender William , Kalsi Gursharan , Needham Edward , Easton Ava , Jackson Thomas , Cunningham Colm , Upthegrove Rachel , Pollak Thomas , Hotopf Matthew , Solomon Tom , Pett Sarah , Shaw Pamela , Wood Nicholas , Harrison Neil , Miller Karla , Jezzard Peter , Williams Guy , Duff Eugene , Williams Steven , Zelaya Fernando , Smith Stephen , Keller Simon , Broome Matthew , Kingston Nathalie , Husain Masud , Vincent Angela , Bradley John , Chinnery Patrick , Menon David , Aggleton John , Nicholson Timothy , Taylor John-Paul , David Anthony , Carson Alan , Bullmore Edward , Breen Gerome , Hampshire Adam , Paddick Stella-Maria , corsortium COVID-CNS , Leek Charles 
Published: January 2024

Abstract

The spectrum, pathophysiology, and recovery trajectory of persistent post-COVID-19 cognitive deficits are unknown, limiting our ability to develop prevention and treatment strategies. We report the one-year cognitive, serum biomarker, and neuroimaging findings from a prospective, national longitudinal study of cognition in 351 COVID-19 patients who had required hospitalisation, compared to 2,927 normative matched controls. Cognitive deficits were global and associated with elevated brain injury markers and reduced anterior cingulate cortex volume one year after admission. The severity of the initial infective insult, post-acute psychiatric symptoms, and a history of encephalopathy were associated with greatest deficits. There was strong concordance between subjective and objective cognitive deficits. Treatment with corticosteroids during the acute phase appeared protective against cognitive deficits. Together, these findings support the hypothesis that brain injury in moderate to severe COVID-19 is immune-mediated, and should guide the development of therapeutic strategies.
Does pathologic type shape the hospitalization costs of advanced non- small cell lung cancer patients? A multicenter real-world data study
Authors: Yang Yi , Zhang Peng 
Published: January 2024

Abstract
Background:Lung cancer represents the highest incidence and mortality rates among all cancers in China. Limited studies have explored the hospitalization costs of advanced non-small cell lung cancer (NSCLC) among Chinese. This study aims to outline the hospitalization costs of NSCLC patients, differentiate influencing factors, examine different pathological types affecting hospitalization costs and evaluate influencing factors respectively.
Methods: In this real-world, multicenter, retrospective study, we collected electronic medical record data from January 2017 to December 2020 in two types of hospitals: comprehensive hospitals and specialized oncology hospitals. A total of 5362 patients were included. Patients' information on sociodemographic characteristics, disease-related characteristics, healthcare service utilization, and hospitalization costs were collected. Descriptive analysis, the Wilcoxon rank-sum test, and the generalized linear model were employed.
Results: The median hospitalization cost among advanced NSCLC patients was $17,254 per capita, with drug costs as the highest cost. The hospitalization cost among patients with non-squamous carcinoma ($18,003) was significantly higher than that among patients with squamous carcinoma ($15,024), and pathological type significantly influenced the costs (β=0.098, p<0.001). Common influencing factors of hospitalization costs for both types included health insurance, hospital type, department, hospitalization frequency, and average length of hospital stay. The varying significant factors comprised age, gender, and occupation type among non-squamous carcinoma patients, whereas these factors were not notable among squamous carcinoma patients.
Conclusion: Hospitalization costs pose a substantial economic burden on advanced NSCLC patients in China, particularly for the non-squamous carcinoma. The higher costs hinder adequate utilization and appropriate treatment among vulnerable populations.
Clustering What Matters in Constrained Settings (Improved Outlier to Outlier-Free Reductions)
Authors: Jaiswal Ragesh , Kumar Amit 
Published: January 2024

Abstract
Constrained clustering problems generalize classical clustering formulations, e.g., k-median, k-means, by imposing additional constraints on the feasibility of a clustering. There has been significant recent progress in obtaining approximation algorithms for these problems, both in the metric and the Euclidean settings. However, the outlier version of these problems, where the solution is allowed to leave out $m$ points from the clustering, is not well understood. In this work, we give a general framework for reducing the outlier version of a constrained k-median or k-means problem to the corresponding outlier-free version with only $(1+\varepsilon)$-loss in the approximation ratio. The reduction is obtained by mapping the original instance of the problem to $f(k,m, \varepsilon)$ instances of the outlier-free version, where $f(k, m, \varepsilon) = \left( \frac{k+m}{\varepsilon}\right)^{O(m)}$. As specific applications, we get the following results:\begin{itemize} \item First FPT ({\it in the parameters $k$ and $m$}) $(1+\varepsilon)$-approximation algorithm for the outlier version of capacitated k-median and k-means in Euclidean spaces with {\it hard} capacities. \item First FPT ({\it in the parameters $k$ and $m$}) $(3+\varepsilon)$ and $(9+\varepsilon)$ approximation algorithms for the outlier version of capacitated k-median and k-means, respectively, in general metric spaces with {\it hard} capacities. \item First FPT ({\it in the parameters $k$ and $m$}) $(2-\delta)$-approximation algorithm for the outlier version of the k-median problem under the Ulam metric.\end{itemize}
Our work generalizes the results of Bhattacharya et al. and Agrawal et al. to a larger class of constrained clustering problems. Further, our reduction works for arbitrary metric spaces and so can extend clustering algorithms for outlier-free versions in both Euclidean and arbitrary metric spaces.
Gender Related Differences in Clinical Presentation and Outcomes of Diabetic Ketoacidosis: A Retrospective Study
Authors: Salam Abdus , Ali Yasir , Rashid Owais , Ehsan Paghunda , Awuah Wireko Andrew , Abdul-Rahman Toufik , Khan Muhammad Salman , Islam Najmul 
Published: January 2024

Abstract
Background: Diabetic Ketoacidosis (DKA) is a well-known complication of Diabetes Mellitus (DM). Many studies have been conducted to observe the characteristics of DKA in both type 1 and type 2 DM. However, little is known about differences in the clinical features and outcomes of patients with DKA in relation to gender. In this study, we aimed to investigate whether there were any gender-related differences in the clinical presentation and outcomes of DKA patients. Methodology: We conducted this retrospective, descriptive study at the Aga Khan University Hospital (AKUH) Karachi, Pakistan, from July 2016 to July 2020. Data of patients above 16 years of age presented to the emergency department with DKA was reviewed. Information was collected regarding patient demographics, presenting symptoms, precipitating causes of DKA, vital signs, biochemical profiles, and outcomes at discharge.
Results: Of 234 patients, 120 (51.3%) were males (mean age=46.8±16.6), and 114 (48.7%) were females (mean age=44±18.8). Our results showed that females had a higher chance of having previous episodes of DKA (13.4% vs. 4.2%) than males (p=0.047). There was a higher proportion of New Onset type 1 (24.2%) and New Onset type 2 (5.8%) Diabetes at presentation in male patients, as compared to female patients (14.0 and 1.8%, respectively). More male patients presented with severely altered mental status (24.2%) than female patients (13.2%). The higher biochemical markers in males included Hemoglobin, BUN, Creatinine, and serum osmolality, while Amylase was significantly higher in females. Finally, there were no significant differences in the outcomes between the two groups.
Conclusion: As male patients in our population are more likely to present with New Onset type DM and are more likely to present with severe complications, preventive measures targeting male patients with risk factors for DM are paramount. Moreover, educational programs for both genders regarding complications and prevention are required. In order to form such plans, further studies at more centers need to be carried out so recommendations at a national level can be implemented.