bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of the COVID-19 pandemic on essential health and nutrition service utilisations in Ghana: interrupted time-series analyses from 2016 to 2020
Authors: Kawakatsu Yoshito , Osei Ivy , Debpuur Cornelius , Ayi Atsu , Osei-Sarpong Felix , Shetye Mrunal , Aiga Hirotsugu , Augusto Orvalho , Wagenaar Bradley 
Published: January 2023

ObjectivesThis study aimed to assess the national-level and subnational-level effects of the COVID-19 pandemic on essential health and nutrition service utilisation in Ghana.DesignInterrupted time-series.Setting and participantsThis study used facility-level data of 7950 governmental and non-governmental health facilities in Ghana between January 2016 and November 2020.Outcome measuresAs the essential health and nutrition services, we selected antenatal care (ANC); institutional births, postnatal care (PNC); first and third pentavalent vaccination; measles vaccination; vitamin A supplementations (VAS); and general outpatient care. We performed segmented mixed effects linear models for each service with consideration for data clustering, seasonality and autocorrelation. Losses of patient visits for essential health and nutrition services due to the COVID-19 pandemic were estimated as outcome measures.ResultsIn April 2020, as an immediate effect of the COVID-19 pandemic, the number of patients for all the services decreased except first pentavalent vaccine. While some services (ie, institutional birth, PNC, third pentavalent and measles vaccination) recovered by November 2020, ANC, VAS and outpatient services had not recovered to prepandemic levels. The total number of lost outpatient visits in Ghana was estimated to be 3 480 292 (95% CI: −3 510 820 to −3 449 676), followed by VAS (−180 419, 95% CI: −182 658 to −177 956) and ANC (−87 481, 95% CI: −93 644 to −81 063). The Greater Accra region was the most affected region by COVID-19, where four out of eight essential services were significantly disrupted.ConclusionCOVID-19 pandemic disrupted the majority of essential healthcare services in Ghana, three of which had not recovered to prepandemic levels by November 2020. Millions of outpatient visits and essential ANC visits were lost. Furthermore, the immediate and long-term impacts of the COVID-19 pandemic on service utilisation varied by service type and region.
Soreness or sng: a common symptom with differential clinical impact from pain in degenerative lumbar spine diseases
Authors: Chiu Hsiao-Yean , Su I-Wen , Yu Yu-Wen , Chen Yi-Chen , Chen Chih-Cheng , Lin Jiann-Her 
Published: January 2023

IntroductionSoreness is a common complaint in patients who receive lumbar spine surgery (LSS) for degenerative lumbar spine diseases (DLSD). However, soreness is not assessed independently and its impacts on outcomes of LSS remains largely unknown. Sng(pronounced sә-ng, 痠) in Chinese language is the word with the closest meaning to soreness, and Chinese-speaking people naturally use sng to describe their non-pain ‘soreness’ symptom. This study was aimed to investigate the prevalence and impacts of soreness or sng on outcome of LSS by introducing Visual Analogue Scale (VAS) of sng on back and leg.Materials and methodsThis prospective cohort study recruited patients who receive LSS for DLSD. Participants completed the patient-reported outcome measures at 1 week before and 1 years after LSS. The patient-reported outcome measures included (1) VAS for back pain, leg pain, back sng and leg sng, (2) Oswestry Disability Index (ODI) and (3) RAND 36-item Short Form Health Survey. The minimal clinical important difference (MCID) of ODI and physical component health-related quality of life (HRQoL) was used.ResultsA total of 258 consecutive patients were included and 50 dropped out at follow-up. Preoperatively, the prevalence of sng was comparable to pain both on back and leg; postoperatively, the prevalence of sng was higher than pain. Leg and back sng were associated with preoperative and postoperative mental HRQoL, respectively. The reduction of sng on back and leg were significantly less than pain postoperatively. Leg sng was the only symptom independently associated with attaining MCID.ConclusionSoreness or sng should be assessed independently from pain in patients receiving LSS for DLSD because soreness or sng had substantial clinical impacts on the outcome of LSS.
Integrative oncology for palliative care nurses: pre–post training evaluation
Authors: Ben-Arye Eran , Tapiro Yehudit , Baruch Ruth , Tal Ahuva , Shulman Bella , Gressel Orit , Israeli Pesi , Dagash Jamal , Yosipovich Alexander , Shalom Sharabi Ilanit , Zimmermann Patricia , Samuels Noah 
Published: January 2023

ObjectivesIntegrative oncology (IO) is increasingly being incorporated in supportive and palliative cancer care. This study examined an IO-palliative care training programme for nurses from community and hospital settings.MethodsA 120-hour course, attended by 24 palliative care nurses without IO training, included precourse/postcourse questionnaires examining knowledge, attitudes and level of IO-palliative care skills. Qualitative analysis examined precourse and postcourse narratives.ResultsMost (18; 75%) completed study questionnaires, with knowledge and attitudes towards IO changing only modestly and IO-related skills significantly for guidance on herbal medicine and lifestyle changes, manual-movement and mind-body modalities. Greater consultation skills were reported for fatigue, stomatitis, nausea, appetite, constipation/diarrhoea, insomnia, peripheral neuropathy and hot flashes. Trainees reported improved skills for pain (p=0.003), emotional (p<0.001) and informal caregiver-related concerns (p<0.001), with no change in palliative care-related skills. Qualitative analysis found both personal and professional attitude changes, with enhanced mindfulness and an expressed intent to implement the learnt skills in daily practice.ConclusionsThe IO-palliative care nurse training programme increased IO-related and palliative care-related consultation skills for a wide range of quality of life-related concerns. Further research is needed to explore both short-term and long-term effects and the implementation of the learnt skills in clinical practice.Trial registration numberNCT03676153.
Physiological selectivity and plant–environment feedbacks during Middle and Late Pennsylvanian plant community transitions
Authors: Wilson Jonathan Paul , Oppler Gabriel , Reikowski Elizabeth , Smart Jessica , Marquardt Charles , Keller Brian 
Published: January 2023

Abstract

A series of vegetation changes take place in tropical ecosystems during the Pennsylvanian Subperiod. The most notable change, recognizable from palynology and plant macrofossils at the Middle and Late Pennsylvanian boundary in the Illinois Basin, is the extirpation, or local extinction, of certain lineages of arborescent lycopsids, followed by their replacement by stem group marattialean tree ferns. The leading hypothesis suggests a significant change in precipitation regime as the cause. To test this hypothesis, we examine the vascular anatomy and physiology of key lineages of Pennsylvanian plants: the sphenopsids, tree ferns, cordaitaleans, medullosans, lycophytes and extrabasinal stem group coniferophytes. Using scanning electron and light microscopy of fossilized anatomy, we provide new data on these plants’ vascular systems, quantifying their physiological capacity and drought resistance. We find that three Pennsylvanian plant lineages – the medullosans, arborescent lycopsids and
Sphenophyllum
– contain high hydraulic conductivity but are vulnerable to drought-induced damage, whereas others are resistant, including stem group tree ferns and coniferophytes. Relative abundance changes among these plants were likely driven by drought, and differences in water use efficiency would have amplified drought events as plant communities changed. The interaction of physiological selectivity and positive feedback between aridity and drought tolerance likely played a significant role in Late Paleozoic floral changes.
Small-Molecule Polθ Inhibitors Provide Safe and Effective Tumor Radiosensitization in Preclinical Models
Authors: Rodriguez-Berriguete Gonzalo , Ranzani Marco , Prevo Remko , Puliyadi Rathi , Machado Nicole , Bolland Hannah R. , Millar Val , Ebner Daniel , Boursier Marie , Cerutti Aurora , Cicconi Alessandro , Galbiati Alessandro , Grande Diego , Grinkevich Vera , Majithiya Jayesh B. , Piscitello Desiree , Rajendra Eeson , Stockley Martin L. , Boulton Simon J. , Hammond Ester M. , Heald Robert A. , Smith Graeme C.M. , Robinson Helen M.R. , Higgins Geoff S. 
Published: January 2023

AbstractPurpose:DNA polymerase theta (Polθ, encoded by the POLQ gene) is a DNA repair enzyme critical for microhomology mediated end joining (MMEJ). Polθ has limited expression in normal tissues but is frequently overexpressed in cancer cells and, therefore, represents an ideal target for tumor-specific radiosensitization. In this study we evaluate whether targeting Polθ with novel small-molecule inhibitors is a feasible strategy to improve the efficacy of radiotherapy.Experimental Design:We characterized the response to Polθ inhibition in combination with ionizing radiation in different cancer cell models in vitro and in vivo.Results:Here, we show that ART558 and ART899, two novel and specific allosteric inhibitors of the Polθ DNA polymerase domain, potently radiosensitize tumor cells, particularly when combined with fractionated radiation. Importantly, noncancerous cells were not radiosensitized by Polθ inhibition. Mechanistically, we show that the radiosensitization caused by Polθ inhibition is most effective in replicating cells and is due to impaired DNA damage repair. We also show that radiosensitization is still effective under hypoxia, suggesting that these inhibitors may help overcome hypoxia-induced radioresistance. In addition, we describe for the first time ART899 and characterize it as a potent and specific Polθ inhibitor with improved metabolic stability. In vivo, the combination of Polθ inhibition using ART899 with fractionated radiation is well tolerated and results in a significant reduction in tumor growth compared with radiation alone.Conclusions:These results pave the way for future clinical trials of Polθ inhibitors in combination with radiotherapy.
Golden Hour Treatment With tPA (Tissue-Type Plasminogen Activator) in the BEST-MSU Study
Authors: Mackey Jason , Yamal Jose-Miguel , Parker Stephanie A. , Silnes Kelly , Rajan Suja S. , Jacob Asha P. , Wang Mengxi , Singh Noopur , Jones William J. , Spokoyny Ilana , Navi Babak B. , Saver Jeffrey L. , Grotta James C. ,   for the BEST-MSU Study Group
Published: January 2023

Background:
Treatment of patients with acute ischemic stroke on mobile stroke units (MSUs) improves outcomes compared with management by standard emergency medical services ambulances and is associated with more patients treated with intravenous tPA (tissue-type plasminogen activator) in the first golden hour after last known normal. We explored the predictors and outcomes of first-hour treatment (FHT) compared with later treatment in an alternating-week cluster-controlled trial of MSUs.

Methods:
We analyzed all patients treated with intravenous tPA in the BEST-MSU Study (Benefits of Stroke Treatment Delivered by a Mobile Stroke Unit Compared to Standard Management by Emergency Medical Services). After stratifying by treatment timeframe, we identified factors associated with FHT. We performed adjusted analyses of the association between FHT and clinical outcome and modeled the shape of the relationship between last known normal–to–treatment time and excellent outcome.

Results:

Among 941 tPA-treated patients, 206 (21.8%) had lytic started within 60 minutes. Treatment on the MSU, older age, male sex, alert by 911, faster arrival on-scene and imaging, more severe stroke, atrial fibrillation, and absence of heart failure and pretreatment antihypertensive treatment were associated with FHT. Compared with later treatment, FHT was associated with higher adjusted odds ratio for 90-day modified Rankin Scale score of 0 to 1 (odds ratio, 1.87 [95% CI, 1.25–2.84];
P
=0.003). Among FHT patients, 68% achieved a 90-day modified Rankin Scale of 0 or 1 or returned to their baseline status. FHT was not associated with higher risk of hemorrhage and was associated with reduced risk of treating neurovascular mimics.

Conclusions:
FHT almost doubles the odds of excellent clinical outcome without increased risk compared with later treatment, which supports the use of MSUs.
Symptomatic Intracranial Hemorrhage After Endovascular Stroke Treatment: External Validation of Prediction Models
Authors: van der Ende Nadinda A.M. , Kremers Femke C.C. , van der Steen Wouter , Venema Esmee , Kappelhof Manon , Majoie Charles B.L.M. , Postma Alida A. , Boiten Jelis , van den Wijngaard Ido R. , van der Lugt Aad , Dippel Diederik W.J. , Roozenbeek Bob ,   on behalf of the MR CLEAN Registry Investigators
Published: January 2023

Background:
Symptomatic intracranial hemorrhage (sICH) is a severe complication of reperfusion therapy for ischemic stroke. Multiple models have been developed to predict sICH or intracranial hemorrhage (ICH) after reperfusion therapy. We provide an overview of published models and validate their ability to predict sICH in patients treated with endovascular treatment in daily clinical practice.

Methods:
We conducted a systematic search to identify models either developed or validated to predict sICH or ICH after reperfusion therapy (intravenous thrombolysis and/or endovascular treatment) for ischemic stroke. Models were externally validated in the MR CLEAN Registry (n=3180; Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands). The primary outcome was sICH according to the Heidelberg Bleeding Classification. Model performance was evaluated with discrimination (c-statistic, ideally 1; a c-statistic below 0.7 is considered poor in discrimination) and calibration (slope, ideally 1, and intercept, ideally 0).

Results:
We included 39 studies describing 40 models. The most frequently used predictors were baseline National Institutes of Health Stroke Scale (NIHSS; n=35), age (n=22), and glucose level (n=22). In the MR CLEAN Registry, sICH occurred in 188/3180 (5.9%) patients. Discrimination ranged from 0.51 (SPAN-100 [Stroke Prognostication Using Age and National Institutes of Health Stroke Scale]) to 0.61 (SITS-SICH [Safe Implementation of Treatments in Stroke Symptomatic Intracerebral Hemorrhage] and STARTING-SICH [STARTING Symptomatic Intracerebral Hemorrhage]). Best calibrated models were IST-3 (intercept, −0.15 [95% CI, −0.01 to −0.31]; slope, 0.80 [95% CI, 0.50−1.09]), SITS−SICH (intercept, 0.15 [95% CI, −0.01 to 0.30]; slope, 0.62 [95% CI, 0.38−0.87]), and STARTING−SICH (intercept, −0.03 [95% CI, −0.19 to 0.12]; slope, 0.56 [95% CI, 0.35−0.76]).

Conclusions:
The investigated models to predict sICH or ICH discriminate poorly between patients with a low and high risk of sICH after endovascular treatment in daily clinical practice and are, therefore, not clinically useful for this patient population.
Ritual Syntax Revisited
Authors: Payne Richard K. 
Published: January 2023

Abstract
The syntactic analysis of ritual initiated by Frits Staal (1979) provides an effective means for the study of differences between rituals within a particular ritual culture, of changes to a ritual over time, and of changes as rituals are transmitted from one ritual culture to another. The utility of a syntactic approach continues to be obscured by Hans Penner’s critique (1985), which when examined in the first section of this article, “Clearing the Ground,” proves to be faulty. Despite Penner’s critique, some scholars have employed syntactic analyses, and the work of five of them is discussed in the second section, “Existing Constructive Projects.” The following section, “Foundations,” examines the methodological bases of ritual syntax – formalism and abstraction, the difference between production and analysis – and distinguishes three levels of syntactic analysis that parallel linguistic analyses of sentences and sentence structures. The final section, “Extending the Construction,” further develops the technical aspects of a syntactic analysis of ritual into new areas, including alternative diagramming of syntactic structures.
The effect of dietary patterns on maternal anaemia in North Shewa, Ethiopia: A case–control study with Propensity Score Analysis
Authors: Kibret Kelemu Tilahun , Chojenta Catherine , D’Arcy Ellie , Loxton Deborah 
Published: January 2023

Objective This study aimed to assess the effect of dietary patterns during pregnancy on anaemia. Design, Setting and Participants A case–control study with propensity score analysis was conducted among pregnant women selected from five health facilities in North Shewa Zone, Ethiopia from November 2018 to March 2019. A multivariable conditional logistic regression model was applied after propensity score matching to assess the effect of dietary patterns on anaemia, and a p < 0.05 was taken as significant. Four hundred and seventeen pregnant women were included (105 cases and 312 controls) with a 1:3 case-to-control ratio. Cases were pregnant women with a haemoglobin level <11 gram/Deci litter (g/dL), and controls were pregnant women with a haemoglobin level ≥11.0 g/dL. Results A low dietary diversity score (adjusted odd ratio (AOR) = 2.14; 95% confidence interval (CI): 1.24, 3.69), reducing food intake (AOR = 6.89; 95% CI: 3.23, 14.70) and having no formal education (AOR = 3.13; 95% CI: 1.18, 8.32) were associated with higher odds of anaemia among pregnant women. Conclusions During pregnancy, intake of a low diversified diet, reduced food intake and low educational status were associated with higher odds of anaemia. Dietary counselling should be emphasised and strengthened in the existing prenatal health service program, with women strongly encouraged to increase their diversified food intake instead of reducing it during pregnancy.
Effect of robot-assisted gait training on quality of life and depression in neurological impairment: A systematic review and meta-analysis
Authors: den Brave Meike , Beaudart Charlotte , de Noordhout Benoit Maertens , Gillot Vincent , Kaux Jean-Francois 
Published: January 2023

Objective Robot-assisted gait training (RAGT) is often used as a rehabilitation tool for neurological impairments. The purpose of this study is to investigate the effects of rehabilitation with robotic devices on quality of life and depression. Data sources Two electronic databases (MEDLINE and Scopus) were searched for studies from inception up to December 2022. Review methods Randomized controlled trials (RCTs) and non-RCTs were pooled separately for analyses, studying each one’s mental and physical health and depression. Random effect meta-analyses were run using standardized mean difference and 95% confidence interval (CI). Results A total of 853 studies were identified from the literature search. 31 studies (17 RCTs and 14 non-RCTs) including 1151 subjects met the inclusion criteria. 31 studies were selected for the systematic review and 27 studies for the meta-analysis. The outcome measure of mental health significantly improved in favor of the RAGT group in RCTs and non-RCTs (adjusted Hedges’g 0.72, 95% CI: 0.34–1.10, adjusted Hedges g = 0.80, 95% CI 0.21-1.39, respectively). We observed a significant effect of RAGT on physical health in RCTs and non-RCTs (adjusted Hedges’g 0.58, 95% CI 0.28, 0.88, adjusted Hedges g = 0.73, 95% CI 0.12, 1.33). After realizing a sensitivity analysis in RCTs, a positive impact on depression is observed (Hedges’ g of −0.66, 95% CI −1.08 to −0.24). Conclusion This study suggests that RAGT could improve the quality of life of patients with neurological impairments. A positive impact on depression is also observed in the short term. Further studies are needed to differentiate grounded and overgrounded exoskeletons as well as RCT comparing overground exoskeletons with a control group.
Stability of Stated Preferences: Vaccine Priority Setting before and during the First COVID-19 Lockdown
Authors: Luyten Jeroen , Kessels Roselinde 
Published: January 2023

Background Discrete choice experiments (DCEs) are frequently used to study preferences and quantify tradeoffs in decision making. It is important to understand how stable their results are. Objective To investigate to what extent an extreme change in context, the COVID-19 pandemic, affected preferences for vaccine priority setting, as observed in an earlier DCE. Methods We replicated a DCE in which participants had to prioritize vaccination programs for public funding. The initial DCE was executed in Flanders (Belgium) right before the onset of the SARS-CoV-2 pandemic (December 2019, N = 1,636). The replicated DCE was executed 6 months later when the population was in lockdown (April 2020, N = 1,127). A total of 612 respondents participated in both waves of the DCE. We used panel mixed logit models to quantify attribute and level importance and compared utility estimates for consistency. Results The number of vaccine-preventable deaths became less important during the pandemic than before, whereas the influential attributes, the vaccine’s contribution to disease eradication and certainty about vaccine effectiveness became even more important. Respondents attached equal importance to the number of patients with transient or permanent morbidity, to the disease’s economic impact as well as to its equity profile. Conclusion Different preferences for vaccine priority setting were observed during the first COVID-19 lockdown as compared with before, although these differences were, given the extreme nature of the changing circumstances, relatively small. Highlights We replicated a discrete choice experiment (DCE) about vaccine priority setting during the first COVID-19 lockdown and compared results with those from the original setting. The major attributes, contribution to disease eradication, and scientific certainty about vaccine effectiveness became even more important than they already were, whereas avoidable mortality became less important. Respondents attached equal importance to the number of patients with transient or permanent morbidity, to the disease’s economic impact as well as to its equity profile. An extreme change in directly related context to the choice assignment led to changes in stated preferences, although these changes were relatively small, given the extreme change in context. Priorities in the second DCE were even less aligned with cost-effectiveness analysis than those observed initially.
Re-imagining anti-racism as a core organisational value
Authors: Elias Amanuel , Ben Jehonathan , Hiruy Kiros 
Published: January 2023

Racism and anti-racism have received widespread attention in academic debates and public discourse. Having universal features, racism manifests differently nationally and locally, and has been met with diverse anti-racism efforts. Despite historical achievements of struggles against racial oppression, racism endures, and continues to evolve and adapt, posing challenges to racial justice and equity. Parallel to this, anti-racism scholarship and action have evolved over the past decade, targeting an increasing number of arenas of everyday life. However, the place of anti-racism within organisations remains overwhelmingly peripheral and often tokenistic. This article draws attention to this and argues for re-imagining anti-racism as a core organisational value. We critically evaluate current anti-racism practices, and call for broader, holistic, committed and well-funded anti-racism approaches within organisations. We then argue why establishing anti-racism as a core organisational value may help in addressing systemic/structural racism. JEL Classification: J15, J71, M14, Z13