bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessment of industrial-scale green hydrogen production using renewable energy
Authors: Hassan Qusay , Algburi Sameer , Sameen Aws Zuhair , Salman Hayder M 
Published: November 2023

The global pivot towards sustainable energy solutions necessitates a closer examination of green hydrogen production using renewable energy sources. This study aimed to assess the feasibility and efficiency of green hydrogen production on an industrial scale using solar and wind energy in Diyala city, Iraq. Experimental weather data, including solar irradiance, ambient temperature, and wind speed, were meticulously collected throughout 2022. The analysis indicated that, for wind energy, the optimum electrolyser capacity that matched a 1.5 MW wind turbine achieved a hydrogen production of 11,963 kg/year, with associated costs of $8.87/kg. In contrast, when focusing on solar energy, the ideal electrolyser capacity harmonizing with a 2 MW solar photovoltaic generated a notably higher hydrogen output of 94,432 kg/year at a more competitive cost of $6.33/kg. These findings underscore the potential economic advantages of solar-based green hydrogen production over wind-based methods in Diyala city. Furthermore, the significant difference in hydrogen production yields between the two methods emphasizes the need to optimize renewable infrastructure based on location-specific renewable resources. This study offers valuable insights into tailoring green hydrogen production strategies in regions with similar climatic conditions to Diyala and serves as a blueprint for future renewable energy-driven hydrogen production initiatives.
Undocumented migrants’ access to healthcare in Sweden, and the impact of Act 2013:407
Authors: O’Sullivan Anna 
Published: November 2023

Background Research shows that undocumented migrants have difficulties in accessing healthcare. Act 2013:407 came into force in 2013 and entitled undocumented migrants to healthcare that cannot be deferred. To date, studies about undocumented migrants’ access to care in Sweden and the impact of Act 2013:407 are sparse. Hence, the aim of this study was to describe professionals’ experiences of access to healthcare for undocumented migrants in Sweden and the impact of Act 2013:407. Methods A qualitative design with semi-structured interviews was employed. Nine interviews were carried out in 2015 with nurses at two NGO healthcare centres for undocumented migrants – and an additional seven interviews in 2022 with staff at an NGO healthcare centre for undocumented migrants and personnel at a regional health and medical care administration. Interpretive description was used for the analyses. Ethical considerations Permission to carry out the study was obtained from managers at the participating NGOs and the regional health and medical care administration. Participants received verbal and written information about the study, and informed consent was obtained from all participants. Findings Six categories emerged from the analysis: Changes since the Act was introduced, General problems with healthcare access, Care for undocumented migrants – politics and social economy, Lack of knowledge, ‘Healthcare that cannot be deferred’ and Being an undocumented migrant. Conclusion Undocumented migrants’ social needs are as great as their needs for healthcare. Healthcare staff are burdened with healthcare cost considerations which affect their judgement of care provision and prioritization. Healthcare staff attitudes towards undocumented migrants affect their access to healthcare. Undocumented migrants in need of healthcare are especially vulnerable due to their legal status, being ill and the fear of being reported and deported. To assure undocumented migrants’ access to healthcare and maintain healthcare ethics, the only possible solution is to provide healthcare based on needs.
Ethical dilemmas faced by healthcare teachers during the COVID-19 pandemic
Authors: Koskinen Monika , Hilli Yvonne , Keskitalo Tuulikki , Talvik Merle , Sandvik Ann-Helen , Thorkildsen Kari Marie , Skyvell-Nilsson Maria , Koivula Meeri , Šteinmiller Jekaterina 
Published: November 2023

Background Previous studies have shown that the rapid transition to emergency remote teaching due to the COVID-19 pandemic was challenging for healthcare teachers in many ways. This sudden change made them face ethical dilemmas that challenged their values and ethical competence. Research aim This study aimed to explore and gain a deeper understanding of the ethical dilemmas healthcare teachers faced during the COVID-19 pandemic. Research design This was an inductive qualitative study using a hermeneutic approach. Semi-structured interviews were conducted and analysed thematically. Participants and research context Healthcare teachers ( n = 20) from eight universities and universities of applied sciences in the Nordic and Baltic countries participated. Ethical considerations This study was based on the research ethics of the Norwegian National Research Ethics Committee for Medicine and Health Sciences and approved by the Norwegian Agency for Shared Services in Education and Research. Findings Healthcare teachers faced several ethical dilemmas due to restrictions during the COVID-19 pandemic. The analysis revealed three main themes: How should I deal with students’ ill-being, and what can I as a teacher do?; What can I demand from myself and my students, what is good teaching?; How do I manage the heavy workload and everyone’s needs, and who gets my time? Conclusions This study highlights the importance of healthcare teachers’ continuous need for pedagogic and didactic education, especially considering new technology and ethical issues. During the pandemic, the ethical consequences of remote teaching became evident. Ethical values and ethical dilemmas should be addressed in healthcare education programmes at different levels, especially in teacher education programmes. In the coming years, remote teaching will grow. Therefore, we need more research on this issue from an ethical perspective on its possible consequences for students and healthcare teachers.
Medication Use Evaluation of Docusate Sodium in Constipation Prophylaxis and Opioid Induced Constipation at the WPB VA HCS Community Living Center
Authors: Faulkner Wesley , DiScala Sandra , Vartan Christine , Dakroub Belal , Silverman Michael , Bharadwaj Mythili 
Published: November 2023

Introduction Docusate sodium’s efficacy is widely debated. Several studies on opioid induced constipation (OIC) concluded that docusate sodium vs either placebo or in combination with sennosides provided no benefit. Objective This medication use evaluation aimed to investigate constipation treatment trends within the West Palm Beach VA Healthcare System Community Living Center, and to assess the therapeutic effectiveness of docusate sodium. Methods This was a retrospective review of data extracted from April 1, 2022, to September 30, 2022. Patients were included if they had oral orders for docusate sodium, sennosides, lactulose, and/or polyethylene glycol. Patients without active bowel regimen medications were excluded. Requirements for rescue constipation medication was evaluated. Results A total of 98 patients were reviewed. Docusate sodium was used in 43% (n = 42/98) of patients. Rescue medications were needed in 58% (n = 22/38) of patients receiving oral docusate sodium. 52% (n = 29/56) of patients without docusate sodium required rescue medications. For OIC treatment, when docusate sodium was added to other bowel regimens, 59% (n = 17/29) of patients needed a rescue medication, while 66% (n = 19/29) of patients without docusate sodium required a rescue medication. Patients on morphine were given the greatest quantity of rescue constipation medications (73%, n = 16/22). Conclusion Oral docusate sodium did not reduce the requirement for rescue constipation medications in the WPB VAHCS CLC population. When evaluating constipation treatment, docusate sodium may supply minimal benefit and could be identified as nonessential for deprescribing efforts. Morphine was the most constipating opioid used in this patient population, requiring more aggressive bowel regimens.
Analysis of Atypical Antipsychotics-Induced Adverse Events Related to Diabetes Mellitus in Patients With Dementia Using the Japanese Adverse Drug Event Report Database
Authors: Habuchi Fuga , Ishida Natsuko , Matsushita Ryo , Ishizaki Junko , Suga Yukio 
Published: November 2023

Background: Patients with dementia are prescribed low-dose atypical antipsychotics (AAPs) to treat psycho-behavioral symptoms. Although AAPs are known to cause diabetes mellitus–related adverse events (DMAEs), information regarding AAPs-induced DMAEs experienced by patients with dementia is lacking. Objective: To use the Japan Adverse Drug Event Report (JADER) database to assess the onset tendencies and patterns of DMAEs attributable to AAPs prescribed to patients with dementia. Methods: We performed an analysis using dementia cases from the JADER database that were registered from April 2004 to December 2022. Data in the JADER database are completely anonymized; thus, we did not require institutional review board approval for using the JADER database in our study. The reporting odds ratio and proportional reporting ratio (PRR) were used to assess the onset tendencies of DMAEs with AAPs. In addition, Weibull shape parameters were used to assess the patterns of DMAEs that occur with the use of AAPs. Results: We identified AAPs associated with DMAEs. In particular, low doses of quetiapine showed the potential to induce DMAEs. An analysis of the onset of DMAEs showed the early failure patterns for AAPs (median onset = 38 days). Conclusion and Relevance: The AAPs may cause DMAEs in patients with dementia. Low doses of quetiapine may induce DMAEs. Health care workers should focus on the development of DMAEs during the early administration period of AAPs. These results may assist with the safe management of patients with dementia who use AAPs.
A novel track guidance ultrasound facilitates radial arterial cannulation: A prospective randomized controlled trial
Authors: Liu Yongzhe , Dong Yuyan , Liu Yi , Xu Longhe 
Published: November 2023

Background: Ultrasound guidance for radial arterial cannulation is currently considered a best practice approach despite its clear advantages over the blind and palpation technique, the success rate is related to several factors, including clinician’s experience and technical ability. The study aimed to explore the use of a novel track guidance ultrasound that may increase the success rate of radial arterial cannulation. Methods: A randomized controlled trial was conducted, in which 80 adults scheduled for elective surgery requiring radial arterial cannulation were recruited and randomly assigned to either the experimental group, which utilized novel track ultrasound guidance (group T, n = 40), or the control group, which utilized traditional ultrasound guidance (group U, n = 40). The novel track guidance ultrasound comprises a positioning track and a guided track. The radial artery could be positioned at the center of the positional track on the ultrasound image, and the direction and angle of needle are fixed and toward the center of the positioning track. The primary endpoint of the study was the first-pass cannulation success rate, while the secondary endpoints included the failure rate of cannulation, the number of radial artery punctures, the time of cannulation, and the incidence of hematoma. Results: The success rate of cannulation at the first attempt in group T (35 of 40 (87.5%)) was significantly higher than that in group U (23 of 40 (57.5%); p = 0.003). Although seven patients in Group U (7 of 40 (17.5%)) experienced failed cannulation compared to one in Group T (1 of 40 (2.5%)), the difference in failure rate between the two groups did not reach statistical significance ( p = 0.06). Conclusions: The implementation of novel track ultrasound guidance has demonstrated a notable improvement in the success rates at the first attempt while reducing the frequency of punctures and cannulation times.
Similar outcomes of arteriovenous fistulae created under general or regional anesthesia
Authors: Drouven Johannes W , Fernhout Meine H , de Bruin Cor , van Roon Arie M , Bokkers Reinoud PH , Zeebregts Clark J 
Published: November 2023

Background: There is growing evidence that type of anesthesia can significantly change vascular access surgery outcomes. Still, there is limited evidence on the impact of regional anesthesia (RA) on patency and failure rates compared to general anesthesia (GA). The aim of this study was to compare the outcomes of RA and GA in patients who underwent vascular access creation at our center. Methods: Data collected in our prospectively maintained database of patients with chronic renal dysfunction requiring hemodialysis were analyzed, 464 patients were included. Outcome parameters such as maturation, primary failure, postoperative flow measurements, patency rates, and survival outcomes were compared between RA and GA groups. Results: In this study 489 vascular access procedures were performed in 464 patients, 318 included in the RA group and 171 in the GA group. Median follow-up time was 29.9 (IQR 37.3) months in the RA group versus 33.0 (IQR 40.7) in the GA group ( p = 0.252). Anesthesia type did not significantly affect patient survival (HR, 1.01; CI, 0.70–1.45; p = 0.976). No significant differences were found in vascular access flow volume, primary failure, or time to cannulation between the RA and GA groups for both radiocephalic arteriovenous fistulae and brachiocephalic arteriovenous fistulae. Anesthesia type did not significantly change patency outcomes. Conclusions: Based on our results, both RA and GA demonstrate similar results regarding patient survival, maturation, failure, or patency after vascular access creation. Still, patient-specific factors for each type of anesthesia as well as patient preference should be considered.
Clinicopathologic Features and Prognosis of Female Early Breast Cancer With HER2 Low Expression: A Propensity Score Matched Analysis
Authors: Dai Lanyi , Huang Qiyuan , Guo Rong , Zhu Keying , Tang Yiyin , Chen Dedian , Huang Sheng 
Published: November 2023

Background: Metastatic breast cancer (MBC) patients with low expression of human epidermal growth factor 2 (HER2) have been proven to benefit from HER2 targeted therapy. We aimed to determine how HER2-low status affected survival and metastatic risk as well as how it affected pathological complete response (pCR) in neoadjuvant chemotherapy (NAC) patients. Methods: According to the results of immunohistochemistry (IHC) and in situ hybridization (ISH) testing, 321 female patients were sorted into HER2-low (IHC 1+/2+ with ISH negative) and HER2-zero (IHC 0) groups using propensity score matching (PSM). Overall survival (OS), disease-free survival (DFS), and distant disease-free survival (DDFS) were compared for both groups, while pCR was only analyzed for NAC patients. Results: In total, 97 patients in each group after PSM were included. We discovered that pCR was not associated with HER2 expression status in 45 patients who underwent NAC. Five-year OS in the HER2-low group was significantly higher (98.99%) than in the HER2-zero group (95.87%, P = .044); however, this difference was not reflected in the 5-year DFS (90.61 vs 90.52%, P = .868) and 5-year DDFS (93.67 vs 91.53%, P = .757). Meanwhile, multivariate analysis revealed that HER2-low expression could indicate better OS ( P = .047, hazard ratios [HRs] = 16.121, 95% confidence interval [CI] = 1.035-251.046), but it had no prognostic value for DFS or DDFS. Conclusion: When compared with HER2-zero expression, HER2-low expression was not connected to pCR and could not modify metastasis risk in female patients with early-stage breast cancer (BC), but it may prolong patient survival.
“Fast First and Then Slowly” Steroid-Tapering Regimen in Managing Corticoid-Sensitive Patients With Severe Immunotherapy Complications After Anti-PD-(L)1 Therapy for Cancer
Authors: Gui Qi , Xie Liping , Cheng Shaoqi , Xu Chengcheng 
Published: November 2023

Background: We aimed to assess the efficacy of the “fast first and then slowly” steroid-tapering regimen used in managing corticoid-sensitive patients with severe irAE after anti-PD-(L)1 therapy. Corticosteroids are the primary therapy for severe immune-related adverse events (irAEs). Less is known about the standard steroid-tapering regimen for corticoid-sensitive patients. Methods: This study was a single-center, retrospective medical record review of patients with severe irAE after anti-PD-(L)1 treatment for cancer from October 13, 2021 to October 20, 2022. The efficacy was assessed by Common Terminology Criteria for Adverse Events (CTCAE) grading system. Results: Among the 187 patients with severe irAEs associated with immune checkpoint inhibitors (ICIs), 136 (72.7%) cases were corticoid-sensitive, and 96 (51.3%) cases were scheduled “fast first and then slowly” steroid-tapering regimen. And of these, 87 (90.6%) cases got irAEs solution. Conclusions: The “fast first and then slowly” steroid-tapering regimen stayed shorter in the hospital. More studies are needed to confirm this efficacy and find more details about the steroid-tapering regimen.
Evidence-Based Practice: Implementing REIS Findings in South African Aged Care Facilities
Authors: Kilian Melissa , Van der Merwe Tania Rauch , du Toit Sanetta H. J. 
Published: November 2023

Background: Older adults living in Residential Aged Care Facilities (RACFs) in South Africa are often exposed to environments that fail to provide adequate occupational opportunities. Practitioners in developing economies are challenged to provide therapeutic services in environments that emphasize occupational deprivation. Objectives: This study investigated barriers and enablers to implementing recommendations derived from the findings generated by the Residential Environment Impact Scale (REIS). Method: A two-phased embedded mixed methodology was employed. Phase 1 was the administration of the REIS. In Phase 2, leadership staff considered factors to implementing findings of the REIS, using the nominal discussion group technique. Data were thematically analyzed. Findings: Findings indicated an organizational culture characterized by top-down management and a medically dominated care approach, constrained by financial and operational concerns. Conclusion: Using the REIS to holistically assess, RACFs are an applicable tool that could promote collaborative approaches to enhance organizational culture change, cultivating more occupational opportunities.
Totally Endoscopic Atrial Septal Defect Repair on Beating Heart: Clinical Outcome and Single-Surgeon Learning Curve Experience
Authors: Dang Huy Q. , Nguyen Huu C. , Le Thanh N. 
Published: November 2023

Objective: To evaluate the safety and efficacy of the Hanoi ASD procedure, which is totally endoscopic surgery for atrial septal defect (ASD) repair on beating heart. In addition, the present study also aimed to analyze the learning curve for this procedure. Methods: From May 2016 to February 2023, 198 consecutive ASD patients weighing ≥20 kg were enrolled in the retrospective study. The Hanoi ASD procedure includes (1) unilateral or bilateral femoral arterial cannulation; (2) two or three 5 mm trocars and a 15 mm port; (3) ASD repair on beating heart, preventing air embolism with CO2 insufflation and keeping the left atrium full of blood; and (4) not snaring the inferior vena cava. Cumulative sum (CUSUM) analysis was used to evaluate the cardiopulmonary bypass (CPB) and operation time learning curves. Variables among the learning curve phases were compared. Results: The CPB and operation times were 90 (72 to 115) min and 180 (150 to 220) min, respectively. Total drainage volume was 190 (120 to 290) mL. No endoscopic failure or major complications were complications were excluding factors causing bias, the CUSUMCPBtime analysis for the remaining 131 patients included 3 phases. Phase 1 was the initial learning period (cases 1 to 34), phase 2 represented the technical competence period (cases 35 to 54), and phase 3 was the challenging period (cases 55 to 131). Conclusions: The Hanoi ASD procedure is safe and feasible for repairing ASD in patients weighing ≥20 kg. According to the learning curve analysis, 34 cases were required to achieve technical efficiency, and 54 cases were required to address highly challenging cases.
Outcomes Comparison of Robot-Assisted and Video-Assisted Thoracoscopic Cardiac Sympathetic Denervation
Authors: Melinosky Kelsey , Leng Albert , Johnson Christopher R. , Giuliano Verdi Katherine , Etchill Eric W. , Tandri Harikrishna , Brock Malcolm V. , Ha Jinny S. 
Published: November 2023

Objective: Cardiac sympathetic denervation (CSD) is a surgical antiadrenergic procedure that can reduce sustained ventricular tachyarrhythmia (VT). Video-assisted thoracoscopic surgery (VATS) is currently the standard approach used in CSD, and the practicality for robot-assisted thoracoscopic surgery (RATS) has yet to be investigated. Methods: We conducted a single-center retrospective study of all adult patients ( N = 67) who underwent CSD from 2015 to 2021. We compared short-term outcomes of those treated with RATS versus VATS thoracic sympathectomy. For patients with VT, we examined the effectiveness of a RATS approach in reducing implantable cardioverter defibrillator (ICD) shock burden. Results: A total of 34 patients underwent RATS cardiac denervation, and 33 underwent VATS cardiac denervation. Those undergoing RATS denervation had a significantly shorter procedure duration with a median of 129 min ( P = 0.008). Patients receiving the VATS approach were significantly more complicated by pneumothorax ( P = 0.004) and overall complications ( P = 0.01) when compared with the RATS approach. At 1 year after surgery, both groups had significant reductions in ICD shocks compared with before surgery, both decreasing from a median of 4 to 0 shocks ( P < 0.001). In addition, at 1 year after surgery, the percentage of patients with persistent ICD shocks and the median of ICD shocks were similar between the groups. Conclusions: The RATS approach to cardiac denervation has similar 1-year follow-up outcomes in reducing recurrent VT as the VATS approach. However, patients undergoing RATS denervation experienced better perioperative outcomes. This shows promise for robotic CSD to be an effective and safe therapeutic option for patients with malignant arrhythmias.