bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Role of Feedback Training on Early Postoperative Recovery and Anxiety Scores in an Ambulatory Surgical Unit: A Secular Trend Study
Authors: Dukhan Alexander , Yusupov Teymur , Kabra Naama , Ezri Tiberiu , Boaz Mona 
Published: January 2025

Abstract

Background
We used a ten-item postoperative quality of recovery score (QoR-10) to assess the perioperative quality of care in an in-hospital ambulatory surgical unit.

Methods
In Phase 1 of this secular trend study (n=300 patients, 3-months duration), we collected QoR-10 scores and potential confounders, including type of anesthesia and surgery; co-morbidities; and anesthesia components of the Amsterdam scale-measured anxiety scores. Phase 2 was the one-month performance feedback learning phase in which modifiable variables identified in Phase 1 were translated to actionable steps, reinforcing the already existing routine of our department’s clinical practices, including pain, shivering and anxiety. The anesthesiology team was instructed and reminded of these steps using performance feedback methods. In Phase 3 (n=300 patients, 3-month duration) we evaluated the efficacy of this performance feedback instruction. QoR-10 scores were compared between Phase 1 and Phase 3.

Results
Phase 1 identified three modifiable variables as targets for improvement: postoperative shivering; percentage of patients with numerical rating pain scale (NRS)<4; and preoperative anxiety from anesthesia scores. Compared to Phase 1, significantly fewer Phase 3 patients had severe shivering (2.3% vs. 7.3%, p = 0.023), and a greater percentage had NRS < 4 points (79% vs. 49.7%, p <0.001). The percentage of patients with a high anxiety score did not differ between phases. A direct association between anxiety score and QoR-10 score was not detected. The QoR-10 score (median (IQR)) was significantly higher in Phase 3 than Phase 1: 50 (49–50) vs. 49(49–50), p<0.001. In a multivariable logistic regression analysis, odds for a QoR-10 score of 49–50 were 1.92 higher in Phase 3 than Phase 1.

Conclusion
Considering the study limitations, team feedback education contributed to improvement of the QoR-10 score, reduced the proportion of patients with severe shivering and increased the percentage of patients with low pain scores.
Outcomes of Patients Transferred to Tertiary Center by Life-Saving System in Saudi Arabia. A Propensity Score Matching Observational Study
Authors: Soliman Mohammed , Alenzi Hanan , Alfenaikh Rehab , Aletreby Ahmed , Alenzi Malak , Alenzi Hend , Gano Jennifer , Alrashed Rana , Altaymani Yasmeen , Al-Odat Mohammed , Aletreby Waleed 
Published: January 2025

Abstract

Background
Inter-hospital transfer is intended to provide access to centralized special care for critically ill patients, when resources in their hospitals are not available. However, an empirical gap exists in available evidence, as outcomes of transferred patients to higher centers are inconsistent.

Method
Single center propensity score matching retrospective observational study. Life-Saving transfers during 2023 were matched to direct admissions to the ICU. Hospital mortality, ICU length of stay, and costs of both groups were compared.

Results
During the study period, 328 Life-Saving transfers were matched to 656 direct admissions. Propensity score matching eliminated all imbalances between groups. Hospital mortality was not different between groups, there were 114 (34.8%) hospital mortalities of Life-Saving transfers, while there were 216 (32.9%) hospital mortalities of direct admissions, with a percent difference of 1.9% (95% CI: −4.5%, 8.4%); p value = 0.6, this result persisted in the sensitivity analysis. There were no differences in mortality risks for all the studied subgroups except pediatric patients. ICU length of stay of direct admissions and Life-Saving transfers were 10 ± 13.1 and 11.6 ± 12.4 days respectively, mean difference was statistically significant (−1.6 [95% CI: −3.2, 0.1]; p = 0.005). Life-Saving transfers entailed significantly higher costs per admission by 28,200 thousand SAR (95% CI: 26,400 – 30,000; p < 0.001).

Conclusion
Our study shows no difference in hospital mortality between Life-Saving transfers and direct admissions to ICU, however, Life-Saving transfers had a longer ICU length of stay, and higher costs per admission.
The Analgesic Effect of Morphine on Peripheral Opioid Receptors: An Experimental Research
Authors: Jafal Nader-Mugurel , Stoleru Smaranda , Zugravu Aurelian , Orban Carmen , Popescu Mihai , Marin Ruxandra Cristina , Fulga Ion-Gigel 
Published: January 2025

Abstract
Opioids represent one of the key pillars in postoperative pain management, but their use has been associated with a variety of serious side effects. Thus, it is crucial to investigate the timing and course of opioid administration in order to ensure a best efficacy to side-effect profile. The aim of our article was to investigate the analgesic effects of locally administered morphine sulfate (intraplantar) in a carrageenan-induced inflammation model in rats. After carrageenan administration, the rats were divided into 10 equal groups and were injected with either morphine 5 mg/kg or 0.9% saline solution at different time intervals, depending on the assigned group. The analgesic effect was assessed through thermal stimulation. Our results showed that paw withdrawal time was significantly higher in rats treated with morphine compared to those in the control group 9.18 ± 3.38 compared to 5.14 ± 2.21 seconds, p=0.012). However, differences were more pronounced at certain time intervals post-carrageenan administration (at 180 minutes compared to 360 minutes, p=0.003 and at 180 minutes compare to 1440 minutes p<0.001), indicating that efficacy varies depending on the timing of treatment. In conclusion, our findings support the hypothesis that locally administered morphine may alleviate pain under inflammatory conditions and underscores the importance of considering treatment timing when evaluating the analgesic effect.
Exploring where and why rural tourism occurs: The case of Croatia and the Ravni Kotari region
Authors: Blaće Ante , Brkić-Vejmelka Jadranka , Pejdo Ana 
Published: January 2025

Abstract
The paper examines factors influencing the development and spatial distribution of rural tourism in Croatia according to the EU classifications of municipalities as urban, rural and proper rural areas. The tourist traffic figures for selected years were computed and the association of socio-economic variables and tourism development index (dependent variable) within these three areas were considered. Semi-structured interviews with stakeholders in Ravni Kotari, a rural region in Littoral Croatia, supplemented the quantitative analysis. The findings indicate that proximity to the coast and overall economic development emerge as the primary factors associated with rural tourism development. The interviews reveal a trend in rural tourism development, specifically in the form of luxury holiday homes, while highlighting the lack of other tourist facilities.
A Comprehensive Analysis of Epilepsy in Kashmir: Application of the ILAE 2017
Authors: Raina Adnan Firdous , Nazir Muzaffer , Kawoosa Atif , Hilal Sheikh , Baba Tanveer , Paul Shabeer , Sanie Bashir 
Published: January 2025

Introduction: Recently, the International League Against Epilepsy (ILAE) has proposed new classification schemes for seizures and epilepsy. The applicability of these classification schemes has not been studied in resource-poor countries. Our aim was to find the relative frequency of different types of epilepsies in Kashmiri population presenting to the Department of Neurology, Superspeciality hospital.
Materials and Methods: The data collected during the first visit included clinical details including details of seizure semiology. All patients had EEG and MRI BRAIN. All these data were used to classify seizure type and epilepsy using ILAE classification schemes. The ILAE 2017 epilepsy definition was used to diagnose epilepsy. The average annual incidence rates (AAIR) and 95% confidence intervals (CI) were calculated for epilepsies by onset and by etiology.
Results: The present study was done on 500 patients with a mean age of 34.1±12.89 years. Majority of patients i.e. 151 (30.2%) were <10 years followed by ≥ 60 years in 138 (27.6%) patients, 10-20 in 118 (23.6%) patients. There were 60 (12%) patients who were aged between 40-60 years while 33 (6.6%) patients aged between 20-40. In our study participants, about 59.6% [n=298] had focal epilepsy, whereas 38.2% [n=191] had generalized epilepsy. About 2.2% [n=11] had unknown onset epilepsy. About 37% [n=185] of our participants had focal motor epilepsy, 22.6% [n=113] had focal non-motor epilepsy, 32.6% [n=163] had generalized motor epilepsy, and 28 [5.6%] patients had generalized nonmotor epilepsy.
Conclusions: This study demonstrates that the ILAE 2017 classification of epilepsies can be applied in resource-poor countries with limited workup. Lesional epilepsies seen in this study is geographically specific to resource-poor countries.
Use of Artificial Intelligence in Teaching and Learning Environment: A case of using Chat GPT
Authors: Dhakal Aishwarya Prashad , Devkota Bipana 
Published: January 2025

This paper review and analyzed research paper to examine how artificial intelligence (AI) is incorporated into teaching and learning environment. The integration of Artificial Intelligence in teaching and learning environments offers significant opportunities to enhance educational experiences for both students and educators. AI technologies, such as adaptive learning systems, intelligent tutoring, and automated administrative tools, are transforming traditional teaching methods by providing personalized, data-driven learning experiences. The results demonstrate AI's innovatory impending to improve teaching strategies, elevate student interest, and make difficult subject matter easier to understand and perform their duty and response. Intellectual tutoring systems, robotics, and generative AI models like Chat GPT are some of the solution; AI technologies that have been investigated. These solutions address long-standing issues in teaching and learning by enabling interactive problem-solving settings, real-time feedback, and individualized learning experiences. It has also point out certain drawbacks, such as moral dilemmas, difficulties in putting the plan into practice, and contextual restrictions in various learning environments. The purpose of this paper is to identify the use of artificial intelligence in academia especially in teaching and learning environment. In order to gain optimize the advantages of artificial intelligence in educational field while minimizing its drawbacks, the study emphasizes the significance of a well-rounded strategy that blends technological innovation with flourishing pedagogical approaches. This thorough analysis lays the groundwork for further study and real world implementations, especially in underserved areas, to promote the widespread use of AI in educational learning and teaching.
A hierarchical Quality of Service control architecture for configurable multimedia applications
Authors: Li Baochun , Kalter William , Nahrstedt Klara 
Published: January 2025

In order to achieve the best application‐level Quality‐of‐Service (QoS), multimedia applications need to be dynamically tuned and reconfigured to adapt to fluctuating computing and communication environments. QoS‐sensitive adaptations are critical when applications run in general‐purpose systems, with no mechanisms provided for supporting resource reservations and real‐time guarantees. Such adaptations are triggered by resource availability variations caused by best‐effort resource allocations in unpredictable open environments. In this paper, we argue that adaptations are most effective to achieve a better QoS when performed within applications, where they may be optimized towards the best performance tradeoffs across various application parameters with different semantics. However, we believe that decisions about when and how adaptations should occur need to be coordinated, and formalized as a generic algorithm to be applied to a wide range of applications. For this purpose, we first identify an application model to focus on a set of application‐specific tuning ‘knobs’ and critical parameters, then propose a polynomial‐complexity QoS probing algorithm to quantitatively capture the run‐time relationships between the two sets of parameters. Finally, we present a hierarchical adaptive QoS control architecture to bridge the gap between original ‘triggers’ of adaptation and actual tuning ‘knobs’ to be invoked. To prove the validity of our architecture and algorithms, we present Agilos, a middleware implementation of our hierarchical architecture. Under its control, we show that a configurable multimedia tracking application is able to deliver optimal performance even when operating in unpredictable open environments.
Pengaruh Promosi dan Harga terhadap Keputusan Pembelian Online di Shopee Lincois
Authors: Maryana Dina , Ariyanto Aris 
Published: January 2025

Penelitian ini bertujuan untuk mengetahui pengaruh promosi dan harga terhadap keputusan pembelian online di Shopee Lincois. Metode yang digunakan adalah menggunakan metode asosiatif kuantitatif. Populasi dalam penelitian ini adalah konsumen Shopee Lincois dengan jumlah 6020 orang pada tahun 2023. Teknik sampling yang digunakan adalah accidental sampling, Dengan rumus slovin didapat sampel penelitian adalah 98 responden. Metode analisis data yang digunakan dalam penelitian meliputi uji instrumen terdiri dari uji validitas, uji reliabilitas, uji asumsi klasik yang terdiri dari uji normalitas, uji multikolinieritas, uji heteroskedastisitas dan autokorelasi, uji regresi linier berganda, koefisien korelasi, uji hipotesis yang terdiri dari uji t secara parsial dan uji f secara simultan, dan uji koefisien determinasi. Dari hasil penelitian ini disimpulkan bahwa promosi memiliki pengaruh positif dan signifikan terhadap keputusan pembelian dengan nilai > atau (13,542 > 1,985) dan diperkuat dengan nilai signifikansi 0,000 < 0,05. Harga memiliki pengaruh positif dan signifikan terhadap keputusan pembelian dengan nilai > atau (15,578 > 1,985) dan diperkuat dengan nilai signifikansi 0,000 < 0,05. Promosi dan harga dan memiliki pengaruh positif dan signifikan terhadap kepuasan pelanggan dengan nilai > atau ((134,789> 3,090) dan diperkuat dengan nilai signifikansi 0,000 < 0,05 dan di dapat persamaan regresi linier berganda Y = 5,927 + 0,305 X1 + 0,568 X2 + α. Hasil nilai R-square (koefisien determinasi) sebesar 0,739, maka dapat disimpulkan bahwa variabel kualitas produk (X1) dan kualitas pelayanan (X2) secara bersama sama memiliki kontribusi pengaruh terhadap variabel kepuasan pelanggan (Y) sebesar 73,9% sedangkan sisanya sebesar (100%-73,9% ) yaitu 26,1% dipengaruhi oleh faktor-faktor atau variabel lain yang tidak diteliti.
Mars Mission Communication Delays and Impact on Mission Controller Performance, Workload, and Stress
Authors: Diamond Madison , Leon Gloria R. , de León Pablo 
Published: January 2025

BACKGROUND: Mission Controllers (MCs) are the main point of contact for space crews and are vital for successful human spaceflight. On a mission to Mars, there will be as long as 22-min one-way communication delays between the ground and the crew, causing major changes to current communication infrastructures.
METHODS: This exploratory study assessed the impact of a 20-min one-way communication delay on MCs’ task performance, workload, and stress levels under nominal and off-nominal conditions, conducted during a 21-d analog mission.
RESULTS: Decrements in performance were noted on both nominal and off-nominal task completion in time-delay conditions [100% of real-time (rt) tasks complete, 16.7% of time-delay (td) tasks incomplete; 12.50% of nominal tasks and 33.33% of off-nominal tasks were incomplete]; more errors on task record forms (td = 6 forms, rt = 1 form); higher ratings of workload burden (nominal, td workload = 38.64; off-nominal, td workload = 58.72; nominal, rt workload = 34.00, off-nominal, rt workload = 52.78). No significant changes in MC stress levels were detected in rt compared to td, but MCs did report greater stress during off-nominal tasks compared to nominal tasks. The crew, however, were unable to detect these changes in MC stress levels.
DISCUSSION: Overall, these findings point to the importance of future research focused on MC training and adapting MC’s operations for time-delayed missions. Further studies of time-delayed analog missions could help determine additional solutions focused on technology advances.
Diamond M, Leon GR, de León P. Mars mission communication delays and impact on mission controller performance, workload, and stress. Aerosp Med Hum Perform. 2025; 96(1):67–70.
The association between white blood cell counts and metabolic health obesity among US adults
Authors: Li Zhanbin , Yao Zhenyu , Liu Qiaoran 
Published: January 2025

BackgroundThe correlation between white cell count and metabolically healthy obesity (MHO) remains elusive among obese American adults. This study endeavors to elucidate this association.MethodsThis study enrolled 6,580 obese patients from the National Health and Nutrition Examination Survey (NHANES). Obesity phenotypes were defined by presence/absence of metabolic syndrome components. Weighted multivariate logistic regression analyses were used to assess the association between white cell count and MHO occurrence. Restricted cubic spline analysis characterized dose–response relationships, and stratified analyses explored these relationships across sociodemographic and lifestyle factors.ResultsIn this study, MHO prevalence is 11.9% among obese adults. The risk of MHO was inversely correlated with WBC [OR (95%): 0.81 (0.76, 0.86), p &lt; 0.001], lymphocytes [OR (95%): 0.56 (0.47, 0.68), p &lt; 0.001], monocytes [OR (95%): 0.41 (0.22, 0.75), p = 0.004], and neutrophils count [OR (95%): 0.82 (0.76, 0.88), p &lt; 0.001]. WBC and neutrophils showed L-shaped associations, while lymphocytes, monocytes, and RBCs had linear patterns. Furthermore, stratified analyses demonstrated blood cell counts consistently predicted MHO risk across subgroups.ConclusionIn this study, we provide novel insights into the association between blood cell count and the presence of MHO among obese individuals. Blood cell count is an accessible biomarker for dynamically tracking the presence of MHO.
Comparative study on the bioavailability and bioequivalence of rifapentine capsules in humans
Authors: Qi Ying , Zhao Pengfei 
Published: January 2025

Introduction: Rifapentine, a potent semi-synthetic member of the rifamycin class, is approved for the treatment of tuberculosis due to its effective bactericidal properties. It is essential to assess the bioequivalence and bioavailability of different rifapentine formulations to ensure consistent clinical outcomes. This study compares the pharmacokinetic profiles of test and reference rifapentine capsules in healthy male volunteers.MethodsIn this single-dose, randomized, crossover study, 19 healthy male volunteers aged 18–40 received 0.6 g of either the test or reference rifapentine capsules. The reference is an NMPA-approved product, while the test is a modified version intended to match it in safety and efficacy; both contain the same active ingredient but may differ in excipients or manufacturing processes. Blood samples were collected at predefined intervals over a 84-h period following administration to measure rifapentine plasma concentrations using UPLC. Key pharmacokinetic parameters, including maximum concentration (Cmax), time to maximum concentration (Tmax), and area under the concentration-time curve (AUC), were calculated and analyzed for bioequivalence.ResultsThe pharmacokinetic analysis demonstrated that both formulations of rifapentine had similar absorption rates and extent of exposure. The mean Cmax, Tmax, and AUC values were closely aligned between the two formulations. Statistical analysis, including ANOVA and bioequivalence testing, confirmed that the 90% confidence intervals for the primary pharmacokinetic parameters (Cmax, AUC0-t, and AUC0-∞) fell within the acceptable range of 80%–125% for bioequivalence. Both formulations were well-tolerated with no serious adverse events reported.DiscussionThe results of this study confirm the bioequivalence of the test and reference formulations of rifapentine under the conditions tested. These findings support the interchangeable use of these formulations in clinical practice for the treatment of tuberculosis. This study contributes to the body of evidence needed to ensure that patients receive a consistent therapeutic effect when administered either formulation of rifapentine.ConclusionThe bioequivalence demonstrated between the test and reference rifapentine capsules supports their use in clinical settings where rifapentine is indicated for tuberculosis therapy. This study provides a robust foundation for the regulatory approval of generic formulations of rifapentine, ensuring that patients have access to effective and lower-cost medication options.
Perceived stress and family adaptability in head and neck cancer patients receiving radiotherapy: the chain-mediated effect of social support and family resilience
Authors: Li Xiaoru , Zhu Yu , Wan Hongwei 
Published: January 2025

ObjectivePatients with head and neck tumors undergoing radiotherapy are burdened with a variety of disease-related stressors that may affect their family adaptability. The aim of the present study was to investigate the relationship between perceived stress and family adaptability in patients with head and neck tumors and to analyze whether social support and family resilience play a mediating role in this relationship.MethodsThe convenience sample approach was utilized to recruit 316 patients with head and neck tumors who received radiation. Self-developed general information questionnaires, the Chinese Perceived Stress Scales, Social Support Rating Scale, the Shortened Chinese Version of the Family Resilience Assessment Scale, and Family Adaptability Scale were used to collect data. Bootstrap methods to analyze independent and chained mediation effects between variables.ResultsThe research participants had a mean age of 43.63 ± 12.78 years, were mostly male (61.7%), married (85.8%), had a university education (51.6%), were uninsured (50.9%), had ear, nose, and throat tumors (56.3%), and had an illness duration of 1-6 months (43.4%). The findings of the chain mediation effect research indicate that the direct negative effect of perceived stress on family adaptability (-0.163) accounted for 45.63% of the overall effect (-0.355), while the indirect effect (-0.194) accounted for 54.37%. Perceived stress independently mediated family adaptability through social support (effect: -0.062) and family resilience (effect: -0.080), with the independent mediator effect accounting for 32.12% and 41.45% of the indirect effect, respectively, and chain-mediated mediation of social support and family resilience, with the chain effect (-0.051) accounting for 31.30%.ConclusionPerceived stress in patients with head and neck cancer receiving radiotherapy directly or indirectly negatively affects family adaptability. Clinical staff should meet the patient’s health care service needs while also utilizing the family’s internal and external resources to reduce disease-related stress and improve family adaptability.