bluuebunny/crossref_metadata_2025_split huggingface dataset:
ASPECTS evolution after endovascular successful reperfusion in the early and extended time window
Authors: Anadani Mohammad , Finitsis Stephanos , Pop Raoul , Darcourt Jean , Clarençon Frédéric , Richard Sébastien , de Havenon Adam , Liebeskind David , Marnat Gaultier , Bourcier Romain , Sibon Igor , Dargazanli Cyril , Arquizan Caroline , Blanc Raphaël , Lapergue Bertrand , Consoli Arturo , Eugène François , Vannier Stéphane , Caroff Jildaz , Denier Christian , Boulanger Marion , Gauberti Maxime , Saleme Suzana , Macian Francisco , Rosso Charlotte , Turc Guillaume , Ozkul-Wermester Ozlem , Papagiannaki Chrysanthi , Olivot Jean-Marc , Le Bras Anthony , Evain Sarah , Wolff Valérie , Timsit Serge , Gentric Jean-Christophe , Bourdain Frédéric , Veunac Louis , Maïer Benjamin , Ben Hassen Wagih , Gory Benjamin ,   On behalf of the ETIS Registry Investigators
Published: September 2023

Background The Alberta Stroke Program Early CT scan Score (ASPECTS) is a reliable imaging biomarker of infarct extent on admission but the value of 24-hour ASPECTS evolution in day-to-day practice is not well studied, especially after successful reperfusion. We aimed to assess the association between ASPECTS evolution after successful reperfusion with functional and safety outcomes, as well as to identify the predictors of ASPECTS evolution. Methods We used data from an ongoing prospective multicenter registry. Stroke patients with anterior circulation large vessel occlusion treated with endovascular therapy (EVT) and achieved successful reperfusion (modified thrombolysis in cerebral ischemia (mTICI) 2b-3) were included. ASPECTS evolution was defined as one or more point decrease in ASPECTS at 24 hours. Results A total of 2366 patients were enrolled. In a fully adjusted model, ASPECTS evolution was associated with lower odds of favorable outcome (modified Rankin Scale (mRS) score 0-2) at 90 days (adjusted odds ratio (aOR) = 0.46; 95% confidence interval (CI) = 0.37–0.57). In addition, ASPECTS evolution was a predictor of excellent outcome (90-day mRS 0-1) (aOR = 0.52; 95% CI = 0.49–0.57), early neurological improvement (aOR = 0.42; 95% CI = 0.35–0.51), and parenchymal hemorrhage (aOR = 2.64; 95% CI, 2.03–3.44). Stroke severity, admission ASPECTS, total number of passes, complete reperfusion (mTICI 3 vs. mTICI 2b-2c) and good collaterals emerged as predictors of ASPECTS evolution. Conclusion ASPECTS evolution is a strong predictor of functional and safety outcomes after successful endovascular therapy. Higher number of EVT attempts and incomplete reperfusion are associated with ASPECTS evolution at day 1.
Safety and efficacy of the fourth-generation Acandis Acclino flex plus stent for the treatment of complex intracranial aneurysms
Authors: Goertz Lukas , Zopfs David , Pennig Lenhard , Zaeske Charlotte , Timmer Marco , Laukamp Kai R , Schönfeld Michael , Schlamann Marc , Kabbasch Christoph 
Published: September 2023

Objective The low-profile Acandis Acclino flex plus (AFP) is a fourth-generation laser-cut microstent with a flexible structure designed for the treatment of a wide variety of aneurysms. We report our single-center experience with this device in the treatment of complex aneurysms. Methods Twenty-eight patients were treated with the Acclino flex plus for 28 aneurysms. Aneurysm characteristics, technical success, complications, clinical outcome, and angiographic results were retrospectively analyzed. Results The cohort included 8 unruptured untreated aneurysms, 9 unruptured recurrent aneurysms, and 12 ruptured aneurysms with aneurysm diameters ranging from 3 to 23 mm. The anterior communicating artery was the most common location (52%). Stent deployment was successful in 28 cases (97%) with an average of 1.3 stents per aneurysm. The overall procedural complication rate was 17%, including 2 (6.8%) major clinical events (one ischaemic stroke and one aneurysm perforation) and one (3.4%) minor clinical event (one seizure). Angiographic results of 23 aneurysms at a mean of 6 months were complete occlusion in 74%, neck remnants in 13% and aneurysm remnants in 13%. Three patients were retreated. Conclusions Given the complexity of the aneurysms, the use of the Acclino flex plus was feasible and associated with a favourable safety and efficacy profile. Further studies are needed to evaluate Acclino flex plus in other aneurysm subsets and to define its role in endovascular aneurysm treatment.
Beliefs and misconceptions about hypertension disease: A qualitative study among patients in a peri-urban community in Ghana
Authors: Otemah Jemima , Ohene Lillian Akorfa , Kyei Josephine , Owusu-Darkwa Irene 
Published: September 2023

Objective This study aims to explore beliefs and perceptions about hypertension among patients living with hypertension in a local district in the Eastern region of Ghana. Methods A descriptive qualitative approach was adopted, and the Health Belief Model was used to guide the data collection, analysis, and organization of the study findings. Overall, seventeen participants were interviewed. In-depth interviews were conducted using a semistructured interview guide. Participants were conveniently selected from a district local Government Hospital. Data gathered were transcribed verbatim and analyzed using thematic analysis. Results Almost all the participants acknowledged hypertension as a severe but chronic illness that can cause sudden death. They also identified that lifestyle practices and individual attitudes were associated with the hypertension condition's causes, management, and control. The findings revealed several unscientific misconceptions and beliefs about hypertension, which could influence their disease management and control decisions. Discussion Patients’ decisions on alternative treatment for hypertension are primarily based on beliefs and misconceptions based on the information they receive from unregulated media and peers. The prevention and control of hypertension should focus on behavior and lifestyle modification which needs reinforcement through health education and promotion.
The Effect of Insulin Degludec Versus Insulin Glargine U100 on Glucose Metrics Recorded During Continuous Glucose Monitoring in People With Type 1 Diabetes and Recurrent Nocturnal Severe Hypoglycemia
Authors: Brøsen Julie Maria Bøggild , Agesen Rikke Mette , Alibegovic Amra Ciric , Andersen Henrik Ullits , Beck-Nielsen Henning , Gustenhoff Peter , Hansen Troels Krarup , Hedetoft Christoffer , Jensen Tonny Joran , Juhl Claus Bogh , Stolberg Charlotte Røn , Lerche Susanne Søgaard , Nørgaard Kirsten , Parving Hans-Henrik , Tarnow Lise , Thorsteinsson Birger , Pedersen-Bjergaard Ulrik 
Published: September 2023

Aim: Comparing continuous glucose monitoring (CGM)-recorded metrics during treatment with insulin degludec (IDeg) versus insulin glargine U100 (IGlar-100) in people with type 1 diabetes (T1D) and recurrent nocturnal severe hypoglycemia. Materials and methods: This is a multicenter, two-year, randomized, crossover trial, including 149 adults with T1D and minimum one episode of nocturnal severe hypoglycemia within the last two years. Participants were randomized 1:1 to treatment with IDeg or IGlar-100 and given the option of six days of blinded CGM twice during each treatment. CGM traces were reviewed for the percentage of time-within-target glucose range (TIR), time-below-range (TBR), time-above-range (TAR), and coefficient of variation (CV). Results: Seventy-four participants were included in the analysis. Differences between treatments were greatest during the night (23:00-06:59). Treatment with IGlar-100 resulted in 54.0% vs 49.0% with IDeg TIR (70-180 mg/dL) (estimated treatment difference [ETD]: –4.6%, 95% confidence interval [CI]: –9.1, –0.0, P = .049). TBR was lower with IDeg at level 1 (54-69 mg/dL) (ETD: –1.7% [95% CI: –2.9, –0.5], P < .05) and level 2 (<54 mg/dL) (ETD: –1.3% [95% CI: –2.1, –0.5], P = .001). TAR was higher with IDeg compared with IGlar-100 at level 1 (181-250 mg/dL) (ETD: 4.0% [95% CI: 0.8, 7.3], P < .05) and level 2 (> 250 mg/dL) (ETD: 4.0% [95% CI: 0.8, 7.2], P < .05). The mean CV was lower with IDeg than that with IGlar-100 (ETD: –3.4% [95% CI: –5.6, –1.2], P < .05). Conclusion: For people with T1D suffering from recurrent nocturnal severe hypoglycemia, treatment with IDeg, compared with IGlar-100, results in a lower TBR and CV during the night at the expense of more TAR.
Development of a food handling practices assessment tool based on the Sri Lanka food regulations
Authors: Hirimuthugoda Lasantha Krishan , De Silva Padmal , Abeykoon Palitha , Tunio Sameer Altaf , Madarasinghe Hasadari Pamoda 
Published: September 2023

Objectives: Neither the current assessment tool of Sri Lanka for food establishments is based on prevailing Food Regulations 2011 nor did its focus cover serious adaptions for precautions upon prevention of the diseases. The study aims to develop a food handling practices assessment tool based on the Sri Lanka Food Regulations 2011 and to assess food handling practices using a developed tool in the Regional Director of Health Services area, Kalutara. Methods: The study consisted of developing food establishments’ assessment tool (FEAT) in accordance with Food (Hygiene-1742/26) Regulations of Sri Lanka 2011 and assessing the food establishments using the developed tool in the Regional Director of Health Services area, Kalutara, Sri Lanka. The development of FEAT was carried out to mark inspection scores for food establishments conforming to Food Regulations, others reviewed international food safety protocols and agreements following key informant interviews and focus group discussions. Fully developed FEAT was transferred to a mobile application for ease of use, and assessments were conducted among 421 food establishments in three Medical Officer of Health areas. Results: FEAT contained 11 domains including 75 items with more than 100 assessment points including a guide to conducting an assessment of food handling, compared to the current version of the assessment tool in Sri Lanka. The majority of participants included in the qualitative assessment agreed to include a 1–5 scoring scale to report hygiene levels and to use hygiene regulation to develop FEAT as a legal basis. The highest percentage of food establishments (69.4%) in the “Good” category were in the Bandaragama Medical Officer of Health Area and the highest percentage of food establishments (54.5%) in the “very poor” category were in the Walallawita Medical Officer of Health Area. Food establishments taking precautionary measures, which are not assessed in the current tool, were good, but maintenance of processing area and installation of overhead structures and fitting were poor in food establishments in all three Medical Officer of Health Areas. Conclusions: The novel food assessment tool FEAT is a completely valid instrument for food establishments. It is designed for easy administration and supports reliable assessments. Overall food handling practices of food establishments in the Kalutara Regional Director of Health Services area following assessment with FEAT were in the “satisfactory” category.
Development of an integrative empowerment model to care for patients with schizophrenia disorder
Authors: Indah Iswanti Dwi , Nursalam Nursalam , Fitryasari Rizki , Kusuma Dewi Rian 
Published: September 2023

Background: The main factor that causes a family the inability to care for patients with schizophrenia disorder is inadequate family-centered empowerment. Nevertheless, the family-integrated empowerment model has not been developed yet. This study aims to develop a integrative empowerment model to care for patients with schizophrenia disorder. Design and methods: The mixed methods research design was divided into two stages. The first stage used a cross-sectional method with a questionnaire to 135 families who cared for patients with schizophrenia disorder using purposive sampling. Data analysis was obtained using Partial Least Squares (PLS). The second stage is a focused group discussion (FGD) conducted with six families, seven health workers, and six social workers, and discussions with two experts for model development. Results: The integrative empowerment-based family empowerment model is developed from Outside-in empowerment (path coefficient = 0.309; t = 3.292) and Inside-out empowerment (path coefficient = 0.478; t = 4.850). Family factors is the most potent variable in shaping Inside-out empowerment (path coefficient = 0.217; t = 2.309). Moreover, re-meaning of caregiving is the strongest indicator that builds the Inside-out empowerment variable ( t = 42.643). The value of Q2 is 0.433 indicates that this model can be generalized, since 61% of family ability to provide care for schizophrenia patients. Conclusions: Re-meaning of caregiving is the most potent indicator in shaping Inside-out empowerment, which is the strongest factor forming this model. Nurses assist families to be able to find activities that can generate positive meaning when caring for patients with schizophrenia disorder.
Opportunities for Patient Participation in Perioperative Malnutrition Care: A Qualitative Study
Authors: Berg Gerda van den , Schueren Marian de van der , Vermeulen Hester , Huisman-de Waal Getty 
Published: September 2023

Introduction In the perioperative period of hospitalization, barriers to food intake are common due to special nutritional needs, compromised nutritional status, and metabolic stress. Good nutritional care call for an interdisciplinary approach. And patients themselves may also play an essential role in managing nutritional care. Objective This study aimed to explore how patients with malnutrition experience nutritional care, their perspectives on patient participation, and their own role in malnutrition care in the perioperative period of hospitalization. Methods A qualitative study was conducted using an interpretive phenomenological approach. To follow patients’ experiences, in-depth longitudinal interviews were undertaken before, during, and after hospitalization. Interview transcripts were analyzed thematically using open, axial, and selective coding and interpreted in an iterative process. Results Fifty-six interviews were undertaken with 26 patients with malnutrition scheduled for surgery and during the perioperative period of hospitalization. Four themes were identified: (1) unawareness and stigmata about being malnourished, (2) feasibility of optimal nutritional care, (3) needs and expectations for self-management, and (4) barriers and facilitators of taking own responsibilities in nutritional care. Conclusion Awareness and responsiveness to patients’ perspectives, motivation, and compliance are prerequisites for patient participation in malnutrition care. This requires good communication between healthcare professionals and patients in all phases of hospitalization.
Structural Relationships Between Cognitive Function, Depressive Symptoms, Self-Care Confidence, and Maintenance in Patients With Heart Failure
Authors: Kim JinShil , Hwang Seon Young , Kim Sun Hwa , Shim Jae Lan 
Published: September 2023

Introduction In order to promote self-care maintenance behavior in patients with heart failure (HF), it is necessary to identify the direct and indirect effects of major latent variables. Objective This study aimed to identify structural relationships between different domains of cognitive function, depression and self-care confidence, and self-care maintenance. Methods This descriptive study involved a secondary analysis using data of 201 patients with HF from two observational studies in three hospitals in Korea. The structural equation model using AMOS version 24.0 was constructed to assess the relationships among the variables. The Seoul Neuropsychological Screening Battery was used to assess global cognition, immediate/delayed memory, and executive function, and the Self-Care of HF Index v.6.2. was used for self-care confidence and maintenance. Results Self-care maintenance was affected by memory function with a significant direct effect (β=.43, p = .006), as well as self-care confidence (β=.70, p < .001). Memory function and global function indirectly affected self-care maintenance through self-care confidence (β = −.37, p = .002; β = .14, p = .030). Depressive symptoms also had an indirect effect through self-care confidence on self-care maintenance (β = −.21, p = .005). Conclusion This study confirmed that it is important to increase self-care confidence through supportive care and to maintain memory function for maintaining self-care in the chronic course of HF patients. In particular, this study suggests that it is necessary to perform periodic memory check-ups for chronic HF patients on an outpatient basis, and counseling and education are needed to improve memory and increase confidence in self-care.
Professional Identity Formation, Professionalism, Leadership and Resilience (PILLAR) in Medical Students: Methodology and Early Results
Authors: Ryan Aine , Hickey Anne , Harkin Denis , Boland Fiona , Collins Mary E. , Doyle Frank 
Published: September 2023

Objectives The fundamental role of medical education is the transformation of students to doctors, through a process of education and professional identity formation (PIF), which can be informed by several educational, behavioural and emotional factors. PIF has been deemed to be of equal importance to the acquisition of clinical knowledge and skills and includes constructs such as professionalism, leadership and resilience. We aimed to assess professional identity formation, professionalism, leadership and resilience (PILLAR) in the junior years of medical school in the 2020/2021 academic year and illustrate the potential role of quantitative assessment to demonstrate progression in these areas. In this research, we provide the methods and baseline results for the PILLAR study. Methods We implemented a compulsory assessment in pre-clinical years of graduate entry and direct entry medicine at the Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland. Validated scales were used to assess students’ PILLAR. Descriptive and univariable statistical techniques were used to compare student scores between respective years. Results A total of 1311 students (92% response rate) provided their consent for research. For the psychometric scales, there were no evident trends among the years on these assessment measures. Results indicated significant differences in all measures, however, these did not correspond to ascending years of seniority. Conclusion The PILLAR methodology provides important information on the challenges of quantitatively assessing medical students in the four key areas of PIF, professionalism, leadership, and resilience. Our cross-sectional results point to cohort effects, without the expected progression per year in the cross-sectional data, or suggest that the chosen quantitative measures may be problematic for these constructs in pre-clinical students. Therefore, while we believe that PILLAR has potential as a progress test for these constructs, this will only truly be elucidated by repeated measures of each cohort over time.
The role of vaccination in COPD: influenza, SARS-CoV-2, pneumococcus, pertussis, RSV and varicella zoster virus
Authors: Simon Susanne , Joean Oana , Welte Tobias , Rademacher Jessica 
Published: September 2023

Exacerbations of COPD are associated with worsening of the airflow obstruction, hospitalisation, reduced quality of life, disease progression and death. At least 70% of COPD exacerbations are infectious in origin, with respiratory viruses identified in approximately 30% of cases. Despite long-standing recommendations to vaccinate patients with COPD, vaccination rates remain suboptimal in this population.Streptococcus pneumoniaeis one of the leading morbidity and mortality causes of lower respiratory tract infections. The Food and Drug Administration recently approved pneumococcal conjugate vaccines that showed strong immunogenicity against all 20 included serotypes. Influenza is the second most common virus linked to severe acute exacerbations of COPD. The variable vaccine efficacy across virus subtypes and the impaired immune response are significant drawbacks in the influenza vaccination strategy. High-dose and adjuvant vaccines are new approaches to tackle these problems. Respiratory syncytial virus is another virus known to cause acute exacerbations of COPD. The vaccine candidate RSVPreF3 is the first authorised for the prevention of RSV in adults ≥60 years and might help to reduce acute exacerbations of COPD. The 2023 Global Initiative for Chronic Lung Disease report recommends zoster vaccination to protect against shingles for people with COPD over 50 years.
Comparative transcriptomes reveal geographic differences in the ability of the liver of plateau zokors (Eospalax baileyi) to respond and adapt to toxic plants
Authors: Tan Yuchen , Wang Yanli , Liu Qianqian , Wang Zhicheng , Shi Shangli , Su Junhu 
Published: September 2023

Abstract
Background
Environmental changes are expected to intensify in the future. The invasion of toxic plants under environmental changes may change herbivore feeding environments. Herbivores living long-term in toxic plant-feeding environments will inevitably ingest plant secondary metabolites (PSMs), and under different feeding environments are likely to have unique protection mechanisms that support improved adaptation to PSMs in their habitat. We aimed to compare different subterranean herbivore population responses and adaptations to toxic plants to unveil their feeding challenges.

Results
Here, we investigated the adaptive capacity of the liver in two geographically separated populations of plateau zokors (Eospalax baileyi) before and after exposure to the toxic plant Stellera chamaejasme (SC), at the organ, biochemical, and transcriptomic levels. The results showed no significant liver granules or inflammatory reactions in the Tianzhu (TZ) population after the SC treatment. The transaminase level in the TZ population was significantly lower than that in the Luqu population. Transcriptome analysis revealed that the TZ population exhibited interactions with other detoxification metabolic pathways by oxytocin pathway-associated genes, including diacylglycerol lipase alpha (Dagla), calcium/calmodulin dependent protein kinase II Alpha (Camk2a), and CD38 molecule (Cd38). The phase II process of liver drug metabolism increased to promote the rate of metabolism. We found that alternative splicing (AS) and the expression of the cyclin D (Ccnd1) gene interact—a TZ population hallmark—reduced liver inflammatory responses.

Conclusion
Our study supports the detoxification limitation hypothesis that differences in liver detoxification metabolism gene expression and AS are potential factors in herbivore adaptation to PSMs and may be a strategy of different herbivore populations to improve toxic plant adaptability.