bluuebunny/crossref_metadata_2025_split huggingface dataset:
Meaning of sustainability of innovations in healthcare organizations: A systematic review
Authors: Gusmão Louredo Fernanda de Sousa , Raupp Eduardo , Araujo Cláudia Affonso Silva 
Published: January 2023

Background There is pressure on healthcare organizations to provide high-quality care to all patients while innovating the way care is delivered. As they take on the challenge of delivering high-quality, innovative services, any gains made tend to stall before a radical change impacts key outcomes given the difficulty in sustaining innovations over time. Methods A systematic search was performed in 5 electronic databases using the PRISMA structure that resulted in 1313 articles, of which 260 were duplicated, leaving 1053 articles. After reading their abstracts, 877 had an inadequate scope for analysis because they did not deal with research on the sustainability of innovations. After a full assessment of the remaining 176 articles, only 10 studies met the inclusion criteria with the snowball strategy generating one additional paper, leading to 11 empirical studies. A theoretical discussion and the proposition of a framework were used to analyze the data. Results Studies in university hospitals shed light on determining sustainability factors of innovations not yet fully explored such as the meaning given by individuals to innovation, culture, partnerships, and multidisciplinary collaboration, which complement the literature. This research sought to contribute to the dialogue between management theory and practice in studies on the sustainability of health innovations based on experiences observed in university hospitals. Health managers can verify how sustainability relates to the challenges presented and identify a path that helps them overcome the limitations imposed on the process. The literature shows that the understanding of sustainability as a mediating dimension can collaborate in sustained innovations in order to allow managers to identify actions related to the individual-organization dimension that may be compromising the process and thus act in a more efficient, assertive way in determining the factors that sustain ongoing innovations. Conclusions A relevant point is that innovation sustainability needs to be an objective to be achieved where managers/individuals must incorporate this perspective of innovation continuity since the beginning of the process, otherwise this may represent a greater propensity for discontinuity. This analysis can potentially be applied in university hospitals, but it can also be applicable to other types of hospitals and public or private institutions as long as it is an organization that adopts, implements, and seeks to sustain innovations in service delivery.
Assessment of the effectiveness of ventilation for gas turbine generator set safety
Authors: Dai Yunfan , Gao Chuang , Li Bao 
Published: January 2023

Increasing global warming problems appeal to the employment of clean power generation machineries such as gas turbines. Gas turbine is gas-fired engine which is usually enclosed in an acoustic enclosure for higher reliability and lower operating noise. However, it may face the risk of fuel gas accumulation inside the package which can be extremely dangerous. For the safety of a gas turbine generator set, proper ventilation system is crucial to prevent it from danger by diluting the potential leaked gas. Inspired by the significance of ventilation, this paper aims to present and propose study for the assessment of the effectiveness of ventilation for gas turbine packages in worst-case gas leak. A 2 MW ZK2000 gas turbine was chosen for the study. Method of assessment was introduced and numerical studies by Computational Fluid Dynamics (CFD) were adopted, including both transient and steady state analysis. Aiming to figure out the conditions for worst-case gas leak, the location of leak that may cause the most dangerous gas accumulation was obtained by identifying the poorly ventilated regions within the enclosure. After that, the leak rate was estimated that just to trigger the gas detector at the ventilation outlet according to ISO 21789. Worst-case gas leak simulations were performed in cold engine situation because of the possibility analysis of gas leak. The results at standard conditions show great compliance with the limited value in the code thus indicates that the capability of the current ventilation design. Effect of dilution was studied with various ambient temperatures and ventilation flow rates. One of the key findings is that the flow uniformity has the major impact on enhancing dilution of gas cloud. Structures improvements within enclosure and operation instructions were suggested for the safety of gas turbine unit in the event of gas leak.
Procyanidins Ameliorate Acetaminophen-induced Acute Liver Injury via Activating the Nrf-2/SOD-1 Signal Pathway
Authors: Xu Wanting , Liu Yan , Liu Qun , Chen Huan , Lei Langhuan , Shen Xiaojia , Liu Li 
Published: January 2023

Background and Objectives An overdose of acetaminophen (APAP) usually leads to acute liver injury, and oxidative stress is one of the fundamental mechanisms used to characterize it. Procyanidins (PCs) can reduce the oxidative stress in the liver of mice. This study aimed to investigate the potential protective role of PCs against APAP-induced acute liver injury. Materials and Methods Experiments were performed on male Kunming mice in six groups: phosphate-buffered saline, PCs, APAP, and PCs pretreated with 10, 50, and 100 mg/kg. The mice were peritoneally injected with PCs 30 min before the administration of APAP. First, survival rates of mice were scored every 12 hr for three days in succession. Furthermore, serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (T-Bil), total cholesterol (TC), triglyceride (TG), tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and interleukin-1 (IL-6) were determined. Additionally, histological analysis and hepatic oxidative stress including the levels of superoxide dismutase (SOD), malondialdehyde (MDA), and glutathione (GSH) were assessed. Finally, the protein expression of nuclear factor erythroid 2-related factor 2 (Nrf2) and SOD-1 was detected by Western blotting. Results The data indicated that PCs improved survival rates of APAP-induced liver injury in mice models. Moreover, PCs could reduce the elevated serum levels of ALT, AST, T-Bil, TC, TG, TNF-α, IL-1β, and IL-6 due to APAP exposure with a dose-dependent manner. Besides, PCs pretreatment attenuated hepatic histopathological damage and oxidative stress which manifested the increases of SOD and GSH, whereas the decrease of MDA. Furthermore, PCs enhanced the protein expression of Nrf2 and SOD-1 in the PCs pretreatment groups compared with the APAP group. Conclusion PCs ameliorated APAP-induced acute liver injury, and Nrf2 signaling pathway modulating antioxidative stress might be involved in it.
Real-world study of flash glucose monitoring among adults with type 2 diabetes within the Swedish National Diabetes Register
Authors: Eeg-Olofsson Katarina , Svensson Ann-Marie , Franzén Stefan , Ahmed Ismail Hodan , Törnblom Michael , Levrat-Guillen Fleur 
Published: January 2023

Background The Swedish National Diabetes Register (NDR) initiated registration of the FreeStyle Libre® system and other continuous glucose monitoring (CGM) systems in June 2016. We investigated change in HbA1c for people with type 2 diabetes (T2DM) using FreeStyle Libre in Sweden. Methods We included adults with T2DM, registered in the NDR after January 1, 2014, and an index date for first use of FreeStyle Libre of June 2016 or later. Methodology was a before/after comparison of HbA1c within 6 months before the index date versus HbA1c around 6 and 12 months after the index date. Results 711 adults with T2DM using FreeStyle Libre had HbA1c measurements within the study period . Mean HbA1c was significantly reduced at 6 months (−0.50%-unit) and at 12 months (−0.52%-unit) in this group. Degree of change was negatively correlated to baseline HbA1c. Reductions in HbA1c were observed in incident users of FreeStyle Libre with T2DM who were truly naïve to CGM or had unknown prior experience of CGM, and aged 25–74 years. Conclusions This real‐world study on the Swedish NDR shows that people with T2DM using FreeStyle Libre system for 6 and 12 months significantly reduced their HbA1c.
Open Surgery for Abdominal Aortic Aneurysm: 980 Consecutive Patient Outcomes from a High-Volume Centre in the United Kingdom
Authors: Blair Robert , Harkin Denis , Johnston Dorothy , Lim Adrian , McFetridge Lisa , Mitchell Hannah 
Published: January 2023

Background Controversy persists regarding the optimal treatment for large abdominal aortic aneurysm (AAA), highlighted by the publication of the National Institute for Health and Care Excellence (NICE) guideline (NG156) on March 2020. The pendulum of opinion swings once more from endovascular to open surgical treatment. We report our experience over the last 15 years in treating consecutive AAA by open surgery. Methods A retrospective review of a prospectively collected vascular database of all patients undergoing infra-renal open abdominal aortic aneurysm repair (OR) repair from 2004 to 2019 at the largest aneurysm centre in the United Kingdom. OR for elective and emergency (ruptured and symptomatic) outcomes included early morbidity and 30-day mortality, and long-term survival. Results 1017 patients underwent OR between 2004-2019, on application of our inclusion-criteria 994 patients formed our cohort for analysis (81.2% male) with a mean age 73.6 ± 7.8 years treated by OR for AAA. In that group 672 were elective and 308 were emergency (for ruptured or symptomatic). Overall 30 day mortality was 11.3%, elective 30 day mortality was 2.5%, and emergency 30 day mortality was 29.9%. 30 day re-intervention rate was 9.5%, (elective 7.0%, emergency 15.9%). Survival at 1000 days for elective repair was 72 v 46.7% for emergency and at 2000 days was 43.4% for elective v 25% for emergency. Conclusion Our data confirm that open surgery for AAA can be performed in large volume centres quite safely. Elective and Emergency surgery does affect early 30 day mortality but does not influence long-term outcome.
COVID-19-associated mental health impact on menstruation physiology: A survey study among medical students in Jordan
Authors: Aolymat Iman , Al-Tamimi Mohammad , Almomani Hafez , Abu-Hassan Diala Walid , Alzayadneh Ebaa M , Al-Husban Naser , Al Haj Mahmoud Sameer , Alsheikh Ayman 
Published: January 2023

Background: The coronavirus disease 2019 pandemic has been an extraordinarily stressful situation in recent years. Stress is a physiological reaction to negative stimuli that is regulated by different neuroendocrine pathways. The female reproductive function is maintained by the menstrual cycle, which is negatively affected by hyperstimulation of stress signals. Objectives: This study evaluates the effect of the coronavirus disease 2019 outbreak on menstrual function and mental health, exploring the relationship between them. Design: The current study uses a cross-sectional, survey-based design. Methods: During this cross-sectional study, an online self-completion questionnaire was conducted among a sample of 385 Jordanian female medical students during the pandemic. The survey compared menstrual characteristics, depression, anxiety, and stress 10 months after the coronavirus disease 2019 pandemic with 10 months prior. Paired t-test, McNemar’s test, Pearson’s correlation, and multiple linear regression model were employed to analyze data using SPSS software. Results: The mean age of female medical student respondents was 19.89 years. Data showed that the menstrual cycle length significantly increased during the coronavirus disease 2019 pandemic compared with 10 months prior (32.23 days versus 30.02 days, p = 0.019). The average number of heavy bleeding days also increased during the coronavirus disease 2019 pandemic (2.82 days versus 2.42 days, p = 0.002). The proportion of females with heavy bleeding amount was more than doubled during the pandemic of coronavirus disease 2019 compared with before (27.3% versus 10.4%, p = 0.000). Unpleasant menstrual signs such as nausea and/or vomiting, breast pain, and urinary urgency were significantly increased during the pandemic ( p = 0.000, p = 0.008, and p = 0.024, respectively). During coronavirus disease 2019, a positive association between total Depression, Anxiety, and Stress Scale-21 Questionnaire score and heavy bleeding was identified ( p < 0.05). The findings also indicated that mental disorders and the incidence of amenorrhea, nausea and/or vomiting, and urinary urgency were positively correlated during the coronavirus disease 2019 pandemic. The multiple regression analysis revealed associations between several menstrual characteristics such as amenorrhea and severity of bleeding with coronavirus disease 2019-related depression, anxiety, and stress. Conclusion: This study revealed that the stress related to the pandemic of coronavirus disease 2019 could affect the female menstrual cycle and hence the quality of women’s life. Therefore, this study could serve as a baseline for planning and introducing stress mitigation interventions in crisis situations to improve the physiological and mental well-being of females and improve their quality of life.
Higher Derived Time in Range With IDegLira Versus Insulin Glargine U100 in People With Type 2 Diabetes
Authors: Philis-Tsimikas Athena , Aroda Vanita R. , De Block Christophe , Billings Liana K. , Liebl Andreas , Sivarathinasami Ramsathish , D’Cruz John M. , Lingvay Ildiko 
Published: January 2023

Background: Derived time in range (dTIR), calculated from self-monitored blood glucose (SMBG-dTIR) profiles, has demonstrated correlation with risk of cardiovascular and microvascular complications. This post hoc analysis of the DUAL V and DUAL VIII trials aimed to compare dTIR with an insulin degludec/liraglutide fixed-ratio combination (IDegLira) versus insulin glargine 100 units/mL (glargine U100) in people with type 2 diabetes (T2D). Materials and Methods: Nine-point SMBG profiles were taken more than 24 hours at baseline and end of trial (EOT: 26 weeks [DUAL V] and 104 weeks [DUAL VIII]) and used to derive the percentage of readings within target range (70-180 mg/dL). Estimated treatment differences (ETDs, IDegLira–glargine U100) were analyzed using analysis of covariance, with treatment as fixed effects and baseline response as a covariate. Results: ETDs for change from baseline to EOT in dTIR were significantly greater with IDegLira versus glargine U100 in DUAL V (4.18%, P = .027) and DUAL VIII (5.17%, P = .001). The proportions of people achieving ≥70% dTIR at EOT with IDegLira and glargine U100, respectively, were 62% and 60% in DUAL V ( P = .7541), and 50% and 26% in DUAL VIII ( P < .0001). The proportion achieving a ≥5% increase in dTIR from baseline to EOT with IDegLira and glargine U100 was 63% in both groups in DUAL V ( P = .9043), and 44% and 25%, respectively, in DUAL VIII ( P < .0001). Conclusions: IDegLira was associated with significantly greater increases in dTIR versus basal insulin alone in people with T2D. Trial ID(s): ClinicalTrials.gov, NCT01952145 (DUAL V); ClinicalTrials.gov, NCT02501161 (DUAL VIII)
Macroeconomic Determinants of India’s Participation in Global Value Chains: An Empirical Evidence
Authors: Sharma Sharadendu , Arora Rahul 
Published: January 2023

Global value chains (GVCs) have significantly changed the world trade scenario. Many developed countries gained benefits through production fragmentation, and it has worked as hope for the developing world. India is also one of the participants but its share in global GVC space is very limited. The recent pandemic comes with a lot of opportunities for India to emerge as a new GVC hub in the Asia-Pacific region. This requires the study of factors determining the extent of India’s participation in GVCs. The present article is an attempt in this direction wherein various factors determining the forward and backward participation levels are identified. At a macro level, the study found the positive role of technology advancement, domestic capital and industrial capacity in promoting the level of participation in GVCs, while the role of net FDI inflows is found to be negative. This highlights the requirement for conducive policies to reap the maximum benefits associated with foreign capital. India is already observing the benefits and growing, but still, it has to cover a long path. The time has come to make an image of the brand India in the world and reap maximum benefits from the GVC participation. JEL Codes: F14, F40, O24
Evaluation of the Impact of Regional Trade Agreements on Indian Exports
Authors: Bharti Saurabh Kumar , Nisa Syeedun 
Published: January 2023

This article scrutinises the repercussion of the regional trade agreements on Indian exports. The gravity model has been used for the analysis of two decades of panel data from 30 countries, spanning from 2001 to 2019. The gravity equation is estimated by the Ordinary Least Square (OLS) and Poisson pseudo-maximum likelihood (PPML) techniques using panel data regression. The PPML approach addresses the heteroskedasticity bias that is typically present in the OLS method. The study has revealed that the PPML results are more encouraging than those obtained based on the traditional OLS approach. According to the empirical findings, India’s trading partners in South Asia benefit more from its economic integration than India does. However, the measurement of country-specific degrees of globalisation has a negligible effect on fostering trade across select nations. JEL Codes: C1, F1, F2, F6
Evaluation of inherited germline mutations in cancer susceptibility genes among pancreatic cancer patients: a single-center study
Authors: Tavano Francesca , Gioffreda Domenica , Fontana Andrea , Palmieri Orazio , Gentile Annamaria , Latiano Tiziana , Latiano Anna , Latiano Tiziana Pia , Scaramuzzi Matteo , Maiello Evaristo , Bazzocchi Francesca , Perri Francesco 
Published: January 2023

Abstract
Background
Germline mutations in cancer susceptibility genes were identified in pancreatic cancer (PanC) patients with a sporadic disease and in those unselected for family cancer history.

Methods
With the aim to determine the prevalence of germline predisposition genes mutations in PanC, and to evaluate whether they were associated with the presence of PanC, we profiled a custom AmpliSeq panel of 27 cancer susceptibility genes in 47 PanC patients and 51 control subjects by using the Ion Torrent PGM system.

Results
Multigene panel testing identified a total of 31 variants in 27 PanC (57.4%), including variants with pathogenic/likely pathogenic effect, those of uncertain significance, and variants whose clinical significance remains currently undefined. Five patients carried more than one variant in the same gene or in different genes. Eight patients (17.0%) had at least one pathogenic/likely pathogenic variant in four main genes: CFTR (10.6%), BRCA2 (8.5%), ATM and CHEK2 (2.1%). Pathogenic/likely pathogenic mutation were identified in patients with positive PanC family history (20%) or in patients without first-degree relatives affected by PanC (13.6%). All the BRCA2 mutation carriers were unselected PanC patients. The presence of mutations in BRCA2 was significantly associated with an increased occurrence of PanC and with positive family history for endometrial cancer (p = 0.018).

Conclusions
This study confirmed the potential remarkable contribution of BRCA2 in assessing the presence of PanC. Overall our findings supported the recommendation of offering the germline testing to all the PanC patients with the intent to reduce the number of underdiagnosed carriers of mutations in predisposition genes, and not to preclude their relatives from the opportunity to benefit from surveillance programs.
Alteration in branching morphogenesis via YAP/TAZ in fibroblasts of fetal lungs in an LPS-induced inflammation model
Authors: Ko Hung-Shuo , Laiman Vincent , Tsao Po-Nien , Chen Chung-Ming , Chuang Hsiao-Chi 
Published: January 2023

Abstract
Background
Chorioamnionitis is a common cause of preterm birth and leads to serious complications in newborns. The objective of this study was to investigate the role of the Hippo signaling pathway in lung branching morphogenesis under a lipopolysaccharide (LPS)-induced inflammation model.

Materials and methods
IMR-90 cells and ex vivo fetal lungs were treated with 0, 10, 30, or 50 μg/ml LPS for 24 and 72 h. Supernatant levels of lactate dehydrogenase (LDH), interleukin (IL)-6, IL-8, Chemokine (C-X-C motif) ligand 1(CXCL1), branching and the surface area ratio, Yes-associated protein (YAP), transcription coactivator with PDZ-binding motif (TAZ), fibroblast growth factor 10 (FGF10), fibroblast growth factor receptor II (FGFR2), SRY-box transcription factor 2 (SOX2), SOX9, and sirtuin 1 (SIRT1) levels were examined. Differentially expressed genes in fetal lungs after LPS treatment were identified by RNA-sequencing.

Results
LPS at 50 μg/ml increased IL-6 and IL-8 in IMR-90 cells and increased IL-6, CXCL1 and LDH in fetal lungs. The branching ratio significantly increased by LPS at 30 μg/ml compared to the control but the increased level had decreased by 50 μg/ml LPS exposure. Exposure to 50 μg/ml LPS increased phosphorylated (p)-YAP, p-YAP/YAP, and p-TAZ/TAZ in IMR-90 cells, whereas 50 μg/ml LPS decreased FGF10 and SOX2. Consistently, p-YAP/YAP and p-TAZ/TAZ were increased in fibronectin+ cells of fetal lungs. Moreover, results of RNA-sequencing in fetal lungs showed that SMAD, FGF, IκB phosphorylation, tissue remodeling and homeostasis was involved in branching morphogenesis following exposure to 50 μg/ml LPS. The p-SIRT1/SIRT1 ratio increased in IMR-90 cells by LPS treatment.

Conclusions
This study showed that regulation of the Hippo pathway in fibroblasts of fetal lungs was involved in branching morphogenesis under an inflammatory disease such as chorioamnionitis.
Data quality assessment in emergency medical services: an objective approach
Authors: Mashoufi Mehrnaz , Ayatollahi Haleh , Khorasani-Zavareh Davoud , Talebi Azad Boni Tahere 
Published: January 2023

Abstract
Background
In emergency medical services, high quality data are of great importance for patient care. Due to the unique nature of this type of services, the purpose of this study was to assess data quality in emergency medical services using an objective approach.

Methods
This was a retrospective quantitative study conducted in 2019. The research sample included the emergency medical records of patients who referred to three emergency departments by the pre-hospital emergency care services (n = 384). Initially a checklist was designed based on the data elements of the triage form, pre-hospital emergency care form, and emergency medical records. Then, data completeness, accuracy and timeliness were assessed.

Results
Data completeness in the triage form, pre-hospital emergency care form, and emergency medical records was 52.3%, 70% and 57.3%, respectively. Regarding data accuracy, most of the data elements were consistent. Measuring data timeliness showed that in some cases, paper-based ordering and computer-based data entry was not sequential.

Conclusion
Data quality in emergency medical services was not satisfactory and there were some weaknesses in the documentation processes. The results of this study can inform the clinical and administrative staff to pay more attentions to these weaknesses and plan for data quality improvement.