bluuebunny/crossref_metadata_2025_split huggingface dataset:
New ways to impact primary palliative care practices using online continuing education
Authors: Berke Charlene , Mollman Sarah , Skoglund Amy , Pravecek Brandi , Perrenoud Mari , Stewart Carol 
Published: July 2023

Background: Healthcare professionals trained in palliative care (PC) improve satisfaction and decrease healthcare overutilization for patients with serious illness and their families. A continuing education (CE) series on primary PC aligned to the National Clinical Practice Guidelines for Quality PC was developed by local, interdisciplinary experts for a target audience of rural, primary care healthcare professionals. The modules were accessed on an online learning management system platform. Objective: The study objectives were to assess differences in participants’ knowledge, competence, performance, and ability to improve patient care as well as commitment to change practice after taking each of the CE modules. Design and Methods: To achieve these objectives, a descriptive design was used with a convenience sample of healthcare professionals who registered for the CE series and completed at least one module. Participants completed demographic questions and an evaluation survey after completing each module. Results: So far, 158 healthcare professionals have registered for the series with the majority being nurses and social workers. Although the professionals reported having extensive healthcare experience, they did not report having the same level of PC experience. The professionals represent nine different states. All the CE modules increased teamwork skills for most participants. The CE modules on cultural aspects and self-care had the biggest influence on participants’ ability to improve patient outcomes. Cultural aspects, care of the actively dying, and advance care planning had the greatest impact on participants’ knowledge, competence, and performance. Conclusion: The primary PC education series improved self-reported skills in teamwork, practice habits, and meeting goals of healthcare professionals from a variety of disciplines and settings. These enhanced primary PC skills will improve the incorporation of PC into a variety of practice settings, by multiple disciplines to enhance access to PC outside of, and potentially referrals to, specialty PC programs. Palliative care (PC) is an emerging field of healthcare aimed at positively affecting patients living with serious illness and their families. An important factor that influences a health professional’s successful delivery of PC may be their knowledge, experiences, and confidence. PC training provided to healthcare professionals improves patients’ and healthcare professionals’ satisfaction and reduces healthcare expenditures through cost savings and cost avoidance.1,2
Discrete Optimization on Unsteady Pressure Fluctuation of a Centrifugal Pump Using ANN and Modified GA
Authors: Wang Wenjie , Deng Qifan , Pei Ji , Chen Jinwei , Gan Xingcheng 
Published: July 2023

AbstractPressure fluctuation due to rotor-stator interaction in turbomachinery is unavoidable, inducing strong vibration in the equipment and shortening its lifecycle. The investigation of optimization methods for an industrial centrifugal pump was carried out to reduce the intensity of pressure fluctuation to extend the lifecycle of these devices. Considering the time-consuming transient simulation of unsteady pressure, a novel optimization strategy was proposed by discretizing design variables and genetic algorithm. Four highly related design parameters were chosen, and 40 transient sample cases were generated and simulated using an automatic program. 70% of them were used for training the surrogate model, and the others were for verifying the accuracy of the surrogate model. Furthermore, a modified discrete genetic algorithm (MDGA) was proposed to reduce the optimization cost owing to transient numerical simulation. For the benchmark test, the proposed MDGA showed a great advantage over the original genetic algorithm regarding searching speed and effectively dealt with the discrete variables by dramatically increasing the convergence rate. After optimization, the performance and stability of the inline pump were improved. The efficiency increased by more than 2.2%, and the pressure fluctuation intensity decreased by more than 20% under design condition. This research proposed an optimization method for reducing discrete transient characteristics in centrifugal pumps.
A higher probability of subsequent stroke and ischemic heart disease in migraine patients: a longitudinal follow-up study in Korea
Authors: Kwon Mi Jung , Choi Hyo Geun , Kim Yoo Hwan , Kim Joo-Hee , Rim Hyun Taek , Lee Heui Seung , Oh Jae Keun , Chang In Bok , Song Joon Ho , Kim Ji Hee 
Published: July 2023

Abstract
Background
Whether migraine is related to the risk of cardiovascular diseases (CVDs) remains unclear. Therefore, we conducted a longitudinal follow-up study to address the association between migraine and the development of CVDs in Korea.

Methods
Using data from the national health screening cohort, we included 45,246 patients diagnosed with migraine between 2002 and 2019 and age-, sex-, income-, and residential region-matched nonmigraine participants at a ratio of 1:4. Participants with previous CVDs were excluded. Cox proportional hazards regression models were used to estimate the hazard ratios of three CVDs, stroke, ischemic heart disease, and heart failure, in patients with migraine after adjusting for potential cardiovascular risk factors.

Results
The incidence rate differences of stroke, ischemic heart disease, and heart failure among patients with migraine were 2.61, 1.69, and 0.11, respectively. The probability of developing stroke and ischemic heart disease in patients with migraine was significantly higher than that in controls after controlling for multiple confounders (adjusted hazard ratio [HR] = 1.35, 95% confidence interval [CI] = 1.31–1.39 and adjusted HR = 1.31, 95% CI = 1.26–1.35, respectively). However, when compared with the patients without migraine, patients with migraine did not have an increased HR of developing heart failure (adjusted HR = 1.01, 95% CI = 0.95–1.08). The overall migraine group, as well as groups stratified by migraine subtypes with and without aura, each showed a significantly higher probability of subsequent stroke and ischemic heart disease than the control group.

Conclusions
Our longitudinal follow-up study demonstrated a significant association between the presence of migraine and the development of stroke and ischemic heart disease in Korea, even after adjusting for cardiovascular risk factors.
Anesthesia quality indicators to measure and improve your practice: a modified delphi study
Authors: Yee May-Sann , Tarshis Jordan 
Published: July 2023

Abstract
Background
Implementation of the new competency-based post-graduate medical education curriculum has renewed the push by medical regulatory bodies in Canada to strongly advocate and/or mandate continuous quality improvement (cQI) for all physicians. Electronic anesthesia information management systems contain vast amounts of information yet it is unclear how this information could be used to promote cQI for practicing anesthesiologists. The aim of this study was to create a refined list of meaningful anesthesia quality indicators to assist anesthesiologists in the process of continuous self-assessment and feedback of their practice.

Methods
An initial list of quality indicators was created though a literature search. A modified-Delphi (mDelphi) method was used to rank these indicators and achieve consensus on those indicators considered to be most relevant. Fourteen anesthesiologists representing different regions across Canada participated in the panel.

Results
The initial list contained 132 items and through 3 rounds of mDelphi the panelists selected 56 items from the list that they believed to be top priority. In the fourth round, a subset of 20 of these indicators were ranked as highest priority. The list included items related to process, structure and outcome.

Conclusion
This ranked list of anesthesia quality indicators from this modified Delphi study could aid clinicians in their individual practice assessments for continuous quality improvement mandated by Canadian medical regulatory bodies. Feasibility and usability of these quality indicators, and the significance of process versus outcome measures in assessment, are areas of future research.
Comparison of outcomes of self-expanding versus balloon-expandable valves for transcatheter aortic valve replacement: a meta-analysis of randomized and propensity-matched studies
Authors: Wang Baiqiang , Mei Zeyuan , Ge Xiao , Li Yunyi , Zhou Quan , Meng Xiao , An Guipeng 
Published: July 2023

Abstract
Background
The postoperative outcomes of transcatheter aortic valve replacement (TAVR) with the new generation of self-expanding valves (SEV) and balloon-expandable valves (BEV) remain uncertain.

Methods
We conducted a meta-analysis based on randomized controlled trials (RCTs) and propensity score-matched (PSM) studies to evaluate the performance of the new generation TAVR devices, with a focus on Edwards SAPIEN 3/Ultra BEV, Medtronic Evolut R/PRO SEV, and Boston ACURATE neo SEV. Our primary endpoints were mortality and complications at both 30 days and one year post-operation.

Results
A total of 4 RCTs and 14 PSM studies were included. Our findings showed no significant difference between SEV and BEV regarding 30-day and 1-year mortality rates. ACURATE SEV required less permanent pacemaker implantation (PPI) at 30-day as compared to SAPIEN BEV, while Evolut SEV required a higher rate of PPI than SAPIEN BEV. The incidence of stroke, major or life-threatening bleeding (MLTB), major vascular complications (MVC), coronary artery obstruction (CAO) and acute kidney injury (AKI) did not differ significantly between the two groups. SEV had a larger effective orifice area (EOA) and lower mean transvalvular gradients (MPG) compared to BEV. However, there was an increased risk of paravalvular leakage (PVL) associated with SEV.

Conclusions
In terms of 30-day mortality, stroke, bleeding, MVC, AKI, CAO, and one-year mortality, there was comparability between the two valve types following TAVR. SEV was associated with better hemodynamic outcomes, except for a higher incidence of PVL. Compared to SAPIEN BEV, ACURATE SEV had a lower risk of PPI at 30 days, while Evolut SEV was associated with a higher risk of PPI. These findings underscore the importance of personalized valve selection.
Parallel administration of nanoliposomal irinotecan and levo-leucovorin for pancreatic cancer
Authors: Takada Ryoji , Ikezawa Kenji , Yamai Takuo , Watsuji Ko , Seiki Yusuke , Kawamoto Yasuharu , Hirao Takeru , Higashi Sena , Urabe Makiko , Kai Yugo , Nakabori Tasuku , Uehara Hiroyuki , Kotani Michiyo , Yagi Toshinari , Kimura Miho , Nozaki Keisuke , Takagi Mari , Ohkawa Kazuyoshi 
Published: July 2023

Abstract
Background
Nanoliposomal irinotecan (nal-IRI) plus 5-fluorouracil (5-FU)/levo-leucovorin (Levo-LV) was approved for unresectable pancreatic cancer (UR-PC) in March 2020 in Japan. Levo-LV is administered by intravenous infusion over 120 min following 90 min intravenous infusion of nal-IRI (conventional method), causing a significant burden on both patients and the outpatient chemotherapy room owing to the prolonged administration time. Thus, from July 2021, we introduced the simultaneous intravenous administration of nal-IRI and Levo-LV (parallel method) with the approval of the institutional regimen committee.

Methods
We retrospectively reviewed the data of 69 patients with UR-PC who received nal-IRI plus 5-FU/Levo-LV at our hospital between June 2020 and October 2021. We examined the safety of the parallel method and compared the treatment outcomes and administration times between the two methods.

Results
The median age was 66 years (54%, male). Disease statuses were locally advanced, metastatic, and postoperative recurrence after pancreatectomy in 7, 50, and 12 patients, respectively. Nal-IRI plus 5-FU/Levo-LV treatment was second and third-line or later in 35 and 34 patients, respectively. No intravenous line problems were observed during the parallel administration of nal-IRI and Levo-LV. Although there were no significant differences in response rates and adverse events between the two methods, the administration time was significantly shorter in the parallel method than in the conventional method.

Conclusion
The parallel administration of nal-IRI and Levo-LV is clinically safe and not inferior in efficacy. Moreover, parallel administration may offer convenience to patients and healthcare workers by reducing administration time.
Predictors of Pediatric COVID-19 vaccination: a case-control study in Tabriz, Iran
Authors: Sarbakhsh Parvin , Jafari Nasrin , Salemi Saman , Akbarnejad Reza 
Published: July 2023

Abstract
Introduction
COVID-19 vaccination of children can help reduce the severity of the infection and the death rate caused by it and also helps achieve herd immunity. The level of acceptance and high vaccination coverage is the main elements in the success of immunization programs. Children’s vaccination is dependent on their parent’s decision. This study aims to identify predictors of the children’s COVID-19 vaccination accomplishment by their parents.

Method
In this case-control study, 577 vaccinated children as cases and 366 un-vaccinated children as controls were randomly selected from the general population of Tabriz, Iran 2022, and their data were collected by telephone calls and interviews with the children’s parents. Cases and controls were compared in terms of clinical and demographic factors of the child as well as the socioeconomic status (SES) of their parents by using a multivariable mixed-effect logistic regression model.

Results
According to the results of the multivariable logistic regression, the age of the child (OR = 1.26 95% CI (1.14, 1.40), p-value < 0.001), previous COVID-19 infection of the child (OR = 1.92, 95% CI (1.21, 3.04), p-value < 0.001), having no underlying disease in the child (OR = 1.76, 95% CI (1.02, 3.02), p-value = 0.04), the dwelling place of the household (the high-level dwelling in compared to a low level (OR = 3.34, 95% CI (1.6, 6.64), p-value = 0.001), the middle level of dwelling compared with low level (OR = 4.87, 95% CI (2.46, 9.51), p-value < 0.001)), and Father’s job (Employee and technician Fathers compared to worker fathers (OR = 2.99, 95% CI (1.55, 5.77), p-value = 0.001)) were significant independent predictors of children COVID-19 vaccination.

Conclusion
Several demographic and socioeconomic factors were associated with children’s vaccination. Older children, children without any underlying disease, children with a history of COVID-19 infection, and children of parents with higher levels of SES were more likely to receive the COVID-19 vaccine. This finding can be considered in children’s vaccination policymaking.
Changes in dietary and lifestyle behaviors and mental stress among medical students upon Ramadan diurnal intermittent fasting: a prospective cohort study from Taif/Saudi Arabia
Authors: Alotaibi Mohammed I. , Elsamad Ghadir , Aljardahi Abdulaziz N. , Alghamdi Ahmed N. , Alotaibi Abdulrahman I. , Alorabi Hibah M. , Alzahrani Khalid M. , Abdel-Moneim Ahmed S. 
Published: July 2023

Abstract
Background
Intermittent fasting (IF) is a popular dietary plan for weight loss. In fact, fasting is a common practice in different religions such as Buddhism, Hinduism, Judaism, Christianity, and Islam. During the month of Ramadan, more than 1.5 billion Muslims worldwide fast from dawn to sunset. Ramadan diurnal intermittent fasting (RDIF) has health benefits, including a reduction in cardiovascular disease (CVD) risk and an improvement in mood. However, little is known about the effects of RDIF on lifestyle behaviors, such as regular exercise, consuming healthy diet, and avoiding harmful substances, as well as mental stress, and academic performance in high school and university students.

Methods
In this prospective cohort study, two self-reported questionnaires were sent one week before and during the last week of Ramadan (April 2022; Ramadan 1443 in Hijri Islamic Calendar) to assess changes in lifestyle, perceived stress, and academic achievement of medical students at Taif University in Taif city, Saudi Arabia. Healthy lifestyle components data were collected to calculate healthy lifestyle scores, including body mass index, physical activity, adherence to a Mediterranean diet, smoking status, and sleep duration.

Results
RDIF was associated with a healthier lifestyle in both female and male participants (pre-RDIF mean score: 2.42 vs post-RDIF mean score: 2.74; statistical power = 0.99; P-value < 0.05). They were more active and adherent to the Mediterranean diet during RDIF. Additionally, the post-RDIF smoking rate declined by 53.4%. Male participants showed higher perceived stress scores during RDIF (pre-RDIF mean score: 19.52 vs post-RDIF mean score: 22.05; P-value < 0.01). No changes in academic performance were observed upon RDIF.

Conclusion
Medical students show healthier dietary and lifestyle behaviors and their academic performance is not affected during RDIF. However, perceived stress is higher among male students.
Are flat feet a disadvantage in performing unilateral and bilateral explosive power and dynamic balance tests in boys? A school-based study
Authors: Sagat Peter , Bartik Peter , Štefan Lovro , Chatzilelekas Vangelis 
Published: July 2023

AbstractBackgroundLittle evidence has been provided regarding physical performance and flat-footedness in school-age children. Although flat feet may decrease the level of motor performance, findings remain inconsistent. Therefore, the main purpose of the study was to determine whether children with flat feet had poorer physical task performance, compared to normal-footed children.MethodsA total of 208 primary school boys were included in the study (107 normal-footed and 101 flatfooted boys). Flat footedness (< 42°) was determined using Clark’s method. The children were tested by a set of unilateral and bilateral tests selected from the area of ​​explosive power and dynamic balance which included: (i) countermovement jump, (ii) standing broad jump, (iii) the triple crossover hop for distance test, (iv) maximal sprinting speed over 10, 20 and 40 m and (v) the Star Excursion Balance Test. Differences were adjusted for age, body mass index, peak height velocity and physical activity.ResultsFlat footed children exhibited significantly poorer results in bilateral standing broad jump (effect size [ES] = 0.34), unilateral standing broad jump for dominant (ES = 0.31) and non-dominant leg (ES = 0.20), the triple crossover hop for distance test for dominant (ES = 0.24) and non-dominant leg (ES = 0.23) and the Star Excursion Balance Test (ES = 0.23–0.43) and were slower in maximal sprinting speed test over 20 m (ES = 0.25) and 40 m (ES = 0.30).ConclusionsThis study shows that children with flat feet performed poorer in some physical performance tasks, compared to the normal feet counterparts.
Potentilla reptans L. preconditioning regulates H19 and MIAT long noncoding RNAs in H9C2 myoblasts Ischemia/Reperfusion model
Authors: Mirzaei Hassan , Salehi Aref , Javan Bita , Enayati Ayesheh , nabi Morteza Olad , Zahedi Mehdi , Zengin Gokhan 
Published: July 2023

AbstractThe present study aimed to evaluate the effect of the ethyl acetate fraction of P. reptans root (PEF) preconditioning on expressions of lncRNAs H19 and MIAT in H9C2 myoblasts I/R injury.H9C2 cells were treated with different concentrations ranging from (10–400 µg/ml) of PEF for 24 h, followed by simulation of I/R condition. For I/R experiments, H9C2 cells were subjected with the oxygen and glucose deprivation for 2 h.H9C2 cell viability was significantly enhanced by PEF preconditioning under I/R condition in a concentration-dependent manner up to 200 µg/ml as a EC50. The PEF significantly diminished the expression of lncRNA MIAT and rate of apoptosis against the I/R group. In addition, PEF pretreated before stimulation I/R condition increased H19 expression compared to the normal PEF group with no statistically significant differences between groups. Hence, the results suggest that PEF can protect cardiomyocytes during hypoxia-induced myocardial cell injury by targeting specific involved genes.
Evaluation of a blended learning approach on stratified care for physiotherapy bachelor students
Authors: Adje Mishael , Steinhäuser Jost , Laekeman Marjan , Rogan Slavko , Karstens Sven 
Published: July 2023

Abstract
Background
Stratified models of care are valuable for addressing psychosocial factors which influence the outcome of patients with musculoskeletal disorders. Introducing such models in undergraduate training has the potential to propagate this knowledge with evidence and foster its implementation. The objective of this paper is to explore the perception and changes in the fear-avoidance beliefs of physiotherapy students participating in a developed blended learning course on stratified care.

Methodology
A mixed-methods with a convenient sample of two consecutive cohorts were given a blended learning course on stratified care for patients with low back pain. The blended learning course comprised scientific rudiments and application of stratified care in clinical practice conceptualised using the KERN’ 6-step approach. The exam scores, perceptions, performance on self-reflection-tests and pre- and post-scores on The Tampa Scale for Kinesiophobia for Physiotherapists’ (TSK-PT) were obtained. After gaining clinical experience, participants were invited to discuss their clinical experiences and perceptions in workshops. The quantitative data was analysed explorative-descriptively. The qualitative data was analysed following an inductive coding system with constant comparisons.

Results
Ninety-one participants consented to the evaluation (mean age = 22.9 ± 1.6 years), 66% were female. Exam scores correlated with time spent in training (r = 0.30) and scores on self-reflection-tests 1 and 2 (r = 0.40 and r = 0.41). Participants in both cohorts described the learning resources as promoting their interest in the subject (72% and 94%), up-to-date (91% and 93%) and helpful (91% and 97%). The fear-avoidance scores for participants decreased from 53.5 (± 9.96) to 40.1 (± 12.4) with a large effect size (d = 1.18). The regression model [F (2, 49) = 1151.2, p < 0.001] suggests that pre-TSK-PT and the interest of participants in the training predicted post-TSK-PT. The workshop participants (n = 62) all worked in clinical practice. Emerging from the analysis were 4 categories (evolving to maturity in practice, perceiving determinants of stratified care, strategising for implementation and adopting an outlook for future practice).

Conclusion
The quality of engagement in learning, training strategy and interest in the subject contributes immensely to learning outcomes. This blended learning course was successful in reducing kinesiophobia and influencing the participants’ attitude towards care with the potential of being translated into long-term practice.