bluuebunny/crossref_metadata_2025_split huggingface dataset:
Breathlessness in a virtual world: An experimental paradigm testing how discrepancy between VR visual gradients and pedal resistance during stationary cycling affects breathlessness perception
Authors: Finnegan Sarah L. , Dearlove David J. , Morris Peter , Freeman Daniel , Sergeant Martin , Taylor Stephen , Pattinson Kyle T. S. 
Published: April 2023

Introduction
The sensation of breathlessness is often attributed to perturbations in cardio-pulmonary physiology, leading to changes in afferent signals. New evidence suggests that these signals are interpreted in the light of prior "expectations". A misalignment between afferent signals and expectations may underly unexplained breathlessness. Using a novel immersive virtual reality (VR) exercise paradigm, we investigated whether manipulating an individual’s expectation of effort (determined by a virtual hill gradient) may alter their perception of breathlessness, independent from actual effort (the physical effort of cycling).

Methods
Nineteen healthy volunteers completed a single experimental session where they exercised on a cycle ergometer while wearing a VR headset. We created an immersive virtual cycle ride where participants climbed up 100 m hills with virtual gradients of 4%, 6%, 8%, 10% and 12%. Each virtual hill gradient was completed twice: once with a 4% cycling ergometer resistance and once with a 6% resistance, allowing us to dissociate expected effort (virtual hill gradient) from actual effort (power). At the end of each hill, participants reported their perceived breathlessness. Linear mixed effects models were used to examine the independent contribution of actual effort and expected effort to ratings of breathlessness (0–10 scale).

Results
Expectation of effort (effect estimate ± std. error, 0.63 ± 0.11, P < 0.001) and actual effort (0.81 ± 0.21, P < 0.001) independently explained subjective ratings of breathlessness, with comparable contributions of 19% and 18%, respectively. Additionally, we found that effort expectation accounted for 6% of participants’ power and was a significant, independent predictor (0.09 ± 0.03; P = 0.001).

Conclusions
An individuals’ expectation of effort is equally important for forming perceptions of breathlessness as the actual effort required to cycle. A new VR paradigm enables this to be experimentally studied and could be used to re-align breathlessness and enhance training programmes.
Developing a capacity building training model for public health managers of low and middle income countries
Authors: Upadhyay Kritika , Goel Sonu , John Preethi 
Published: April 2023

Background
The challenges faced by the low and middle-income countries (LMIC) in the field of public health management calls for the capacity building of qualified and trained public health managers in order to improve the effectiveness and efficiency of the health care delivery system. Most of the existing training programs for public health management are based in the settings of developed countries, which hinders their application in LMIC countries. The objective of this paper is to document the process of development and evaluation of a capacity building program for public health managers of various LMICs.

Material and methods
A training program was developed using Kern’s six-step framework with several innovative learning and assessment methodologies and evaluation using Kirkpatrick training evaluation model. Delphi technique was used for program development.

Results
This five to ten-day partly/fully funded six International Public Health Management Development Programs (IPHMDP) programs was conceptualized which enrolled 178 participants from 42 countries between years 2016 and 2019. Based upon the elaborative discussion in four rounds of Delphi technique, the problem and challenges faced by public health mangers and eight key competencies (viz. Leadership and governance, Project/ program planning, financial management, supply chain management, quality management, Human Resource management, monitoring and evaluation, and communication.) were identified. The group consensually agree upon a blended teaching methodology comprising of chalk and talk approach, inquiry based learning, participatory student based learning, small group instructions, gamification, project-based learning and field-based learning. There was a significant increase in participants’ knowledge score (P<0.0001) after all programs especially in the competencies of monitoring and evaluation, followed by project/ program planning, supply chain management and quality management. The majority (90%) submitted their action plan one week following the program, out of which 64% implemented their action plans within six months. A majority (54.7%) of participants were able to implement their learning once they went back by conducting similar training/ workshop/webinars in their settings.

Conclusion
The comprehensive public health management program in LMIC settings strengthens the competencies of public health managers which can be replicated in similar settings across LMIC to mitigate diverse challenges in public health management.
Acute effect of low-load resistance exercise with blood flow restriction on oxidative stress biomarkers: A systematic review and meta-analysis
Authors: Ferlito João Vitor , Rolnick Nicholas , Ferlito Marcos Vinicius , De Marchi Thiago , Deminice Rafael , Salvador Mirian 
Published: April 2023

Background
The purpose of this review was to analyze the acute effects of low-load resistance exercise with blood flow restriction (LLE-BFR) on oxidative stress markers in healthy individuals in comparison with LLE or high-load resistance exercise (HLRE) without BFR.

Materials and methods
A systematic review was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. These searches were performed in CENTRAL, SPORTDiscus, EMBASE, PubMed, CINAHL and Virtual Health Library- VHL, which includes Lilacs, Medline and SciELO. The risk of bias and quality of evidence were assessed through the PEDro scale and GRADE system, respectively.

Results
Thirteen randomized clinical trials were included in this review (total n = 158 subjects). Results showed lower post-exercise damage to lipids (SMD = -0.95 CI 95%: -1.49 to -0. 40, I2 = 0%, p = 0.0007), proteins (SMD = -1.39 CI 95%: -2.11 to -0.68, I2 = 51%, p = 0.0001) and redox imbalance (SMD = -0.96 CI 95%: -1.65 to -0.28, I2 = 0%, p = 0.006) in favor of LLRE-BFR compared to HLRE. HLRE presents higher post-exercise superoxide dismutase activity but in the other biomarkers and time points, no significant differences between conditions were observed. For LLRE-BFR and LLRE, we found no difference between the comparisons performed at any time point.

Conclusions
Based on the available evidence from randomized trials, providing very low or low certainty of evidence, this review demonstrates that LLRE-BFR promotes less oxidative stress when compared to HLRE but no difference in levels of oxidative damage biomarkers and endogenous antioxidants between LLRE.

Trial registration
Register number: PROSPERO number: CRD42020183204.
Existential suffering as a motive for assisted suicide: Difficulties, acceptability, management and roles from the perspectives of Swiss professionals
Authors: Gaignard Marie-Estelle , Pautex Sophie , Hurst Samia 
Published: April 2023

Background
Existential suffering is often a part of the requests for assisted suicide (AS). Its definitions have gained in clarity recently and refer to a distress arising from an inner realization that life has lost its meaning. There is however a lack of consensus on how to manage existential suffering, especially in a country where AS is legal and little is known about the difficulties faced by professionals confronted with these situations.

Objectives
To explore the perspectives of Swiss professionals involved in end-of-life care and AS on the management of existential suffering when it is part of AS requests, taking into account the question of roles, as well as on the difficulties they encounter along the way and their views on the acceptability of existential suffering as a motive for AS.

Methods
A qualitative study based on face-to-face interviews was performed among twenty-five participants from the fields of palliative and primary care as well as from EXIT right-to-die organization. A semi-structured interview guide exploring four themes was used. Elements from the grounded theory approach were applied.

Results
Almost all participants reported experiencing difficulties when facing existential suffering. Opinions regarding the acceptability of existential suffering in accessing AS were divided. Concerning its management, participants referred to the notion of being present, showing respect, seeking to understand the causes of suffering, helping give meaning, working together, psychological support, spiritual support, relieving physical symptoms and palliative sedation.

Conclusion
This study offers a unique opportunity to reflect on what are desirable responses to existential suffering when it is part of AS requests. Existential suffering is plural and implies a multiplicity of responses as well. These situations remain however difficult and controversial according to Swiss professionals. Clinicians’ education should further address these issues and give professionals the tools to better take care of these people.
Feasibility of extended cycles of neoadjuvant chemotherapy in patients with advanced ovarian cancer in terms of prognosis and surgical outcomes
Authors: Kim Nam Kyeong , Suh Dong Hoon , Kim Kidong , Kim Yong Beom , No Jae Hong 
Published: April 2023

Objective
We aimed to identify the effect of an extended number of neoadjuvant chemotherapy (NAC) cycles on prognosis and surgical morbidity after interval debulking surgery (IDS) in patients with newly diagnosed advanced ovarian cancer.

Methods
Medical records of patients with advanced ovarian cancer treated with NAC and having undergone IDS were retrospectively reviewed. Clinicopathological factors were compared between two groups: conventional (≤4 cycles) and extended (≥5 cycles) NAC groups. Kaplan–Meier analysis was performed to evaluate progression-free survival (PFS) and overall survival (OS).

Results
A total of 156 patients were included, 112 patients in the conventional group and 44 patients in the extended NAC group. The extended NAC group had a significantly higher frequency of cancer antigen (CA)-125 normalization after NAC (59.1% vs. 33.9%, P = 0.004), a lower rate of bowel surgery (18.2% vs. 34.8%, P = 0.042), and a lower rate of transfusion during or after IDS (36.4% vs. 59.8%, P = 0.008) as compared to the conventional group. The complete cytoreduction rate after IDS was similar between the groups. In multivariate Cox regression analysis for PFS, radiologically stable and progressive disease after NAC (Hazard ratio [HR], 1.983; 95% Confidence interval [CI], 1.141–3.446; P = 0.015) and gross residual tumor after IDS (HR, 2.054; 95% CI, 1.414–2.983; P < 0.001) were independent risk factors for poor PFS. However, extended NAC cycles were not significantly associated with poor PFS. The median PFS was 19.5 and 16.9 months (P = 0.830), and the 5-year OS was 71.4 and 63.2% (P = 0.677) in the conventional and extended NAC groups, respectively.

Conclusion
Our study showed that extended NAC cycles were not inferior to conventional NAC cycles in terms of survival in patients with advanced ovarian cancer and reduced surgical morbidity such as bowel surgery and transfusion during or after IDS.
Performance of digital morphology analyzer Medica EasyCell assistant
Authors: Kim Hanah , Lee Gun-Hyuk , Yoon Sumi , Hur Mina , Kim Hyeong Nyeon , Park Mikyoung , Kim Seung Wan 
Published: April 2023

Abstract

Objectives
The EasyCell assistant (Medica, Bedford, MA, USA) is one of the state-of-the-art digital morphology analyzers. We explored the performance of EasyCell assistant in comparison with manual microscopic review and Pentra DX Nexus (Horiba ABX Diagnostics, Montpellier, France).

Methods
In a total of 225 samples (100 normal and 125 abnormal samples), white blood cell (WBC) differentials and platelet (PLT) count estimation by EasyCell assistant were compared with the results by manual microscopic review and Pentra DX Nexus. The manual microscopic review was performed according to the Clinical and Laboratory Standards Institute guidelines (H20-A2).

Results
WBC differentials between pre-classification by EasyCell assistant and manual counting showed moderate correlations for neutrophils (r=0.58), lymphocytes (r=0.69), and eosinophils (r=0.51) in all samples. After user verification, they showed mostly high to very high correlations for neutrophils (r=0.74), lymphocytes (r=0.78), eosinophils (r=0.88), and other cells (r=0.91). PLT count by EasyCell assistant highly correlated with that by Pentra DX Nexus (r=0.82).

Conclusions
The performance of EasyCell assistant for WBC differentials and PLT count seems to be acceptable even in abnormal samples with improvement after user verification. The EasyCell assistant, with its reliable performance on WBC differentials and PLT count, would help optimize the workflow of hematology laboratories with reduced workload of manual microscopic review.
Low voltage ride through control strategy for grid-tied solar photovoltaic inverter
Authors: Daravath Ramesh , Sandepudi Srinivasa Rao 
Published: April 2023

Abstract
This paper presents a low voltage ride through (LVRT) control strategy using an active power oscillations based reference current generation approach for grid tied solar photo voltaic (SPV) system under line-to-ground (LG) and double line-to-ground (LLG) faults. Proposed control strategy minimizes the harmonics injected into the grid, as well as oscillations in injected reactive power and DC-link voltage. Further this control strategy provides a dynamic control of active and reactive powers, the flow of sinusoidal currents into the grid, and avoids the disconnection between the utility grid and SPV system during faults. A proportional resonant (PR) current controller is developed in a stationary reference frame to achieve the power quality by fulfilling the grid codes. Simulation and experimental results are presented to highlight the merits of the proposed control scheme.
Biophotonic sensor design for the detection of reproductive hormones in females by using a 1D defective annular photonic crystal
Authors: Gandhi Sakshi , Awasthi Suneet Kumar 
Published: April 2023

Abstract
In this research work, we have proposed a one-dimensional (1D) defective annular photonic crystal (DAPC) (AB)5
CDC(AB)5 to identify the presence of reproductive progesterone and estradiol hormones in women. The periodicity of the proposed biosensing design made up of 1D annular photonic crystal (APC) has been broken by introducing a cylindrical cavity D of porous gallium nitride (GaN) material. The inner and outer faces of cylindrical cavity D are surrounded by concentric cylindrical buffer layers of magnesium fluoride (MgF2) material. We have used a modified transfer matrix method with the help of MATLAB software to carry out investigations pertaining to the proposed theoretical work. The two distinct categories of blood samples containing reproductive hormones of different concentrations have been used in this work. The sensitivity of proposed 1D DAPC varies between 159.673 nm nmol−1 L−1 to 170.1525 nm nmol−1 L−1 when a cavity is infiltrated with a blood sample having progesterone hormone whose concentration varies between 0 and 200 nmol L−1. Moreover, the sensitivity of the structure varies between 158.7816 nm nmol−1 L−1 to 170 nm nmol−1 L−1 under the influence of blood samples having estradiol hormones of different concentrations. In order to evaluate the performance of the proposed biosensor in the true sense we have also computed quality factor (Q) and figure of merit (FoM) values of the biosensor corresponding to both categories of blood samples of different concentrations. Our study shows that biosensors made up of 1D annular photonic structures are more efficient in comparison to the biosensors made up of planar 1D photonic crystals. Apart from detecting the reproductive hormones in females such kind of APC-based specialized biosensing devices may be very useful in the field of medical engineering and technology.
Evaluation of mechanical properties of fiber-reinforced syntactic foam thermoset composites: A robust artificial intelligence modeling approach for improved accuracy with little datasets
Authors: Nawafleh Nashat , AL-Oqla Faris M. 
Published: April 2023

Abstract
Fiber accumulation due to printing ink inconsistency makes additive manufacturing (AM) of reinforced thermoset syntactic foam composites difficult. This study predicts and analyzes the mechanical properties of AM-made carbon fiber-reinforced syntactic thermoset composites to overcome experimental limitations. Thus, an adaptive neuro-fuzzy inference system (ANFIS)-based model creates an accurate mechanical behavior prediction under a variety of conditions without experimental inquiry. Compression and flexure tests assessed the ANFIS model’s validation. The model’s predictions were very close to reality, validating the approach taken to improve the technical assessment of the created composites, which are perfect for weight reduction, mechanical improvement, and product complexity.
Physician stress in the era of COVID-19 vaccine disparity: a multi-institutional survey
Authors: Zahl Sarah , Mondal Debasis , Tolentino David , Fischer Jennifer A. , Jimenez Sherry 
Published: April 2023

Abstract

Context
Healthcare workers are at a high risk of infection during infectious disease outbreaks, such as the COVID-19 pandemic. Despite the availability of several vaccines against COVID-19, the absence of vaccination in patients and colleagues remains a continuous source of stress in healthcare workers. We conducted a survey of physician preceptors, both MDs and DOs, to explore the impact of differences in the patients’ and colleagues’ vaccination status on their well-being, stress, and burnout.

Objectives
The objective of this study is to determine whether exposure to unvaccinated patients and/or colleagues increases stress and burnout in physician preceptors by utilizing a self-reported survey.

Methods
This multi-institutional study was carried out in the United States in 2022. An online survey questionnaire was utilized to collect data from physicians working as preceptors for multiple academic institutions. The anonymous Qualtrics® survey utilized a modified version of the questionnaire from the expanded Physician Well-being Index (ePWBI) designed by MedEd Web Solutions (MEWS). Statistical analysis on both descriptive and qualitative data were performed. Utilizing a threshold of p≤0.05, data analysis revealed many statistically significant relationships between the variables.

Results
A total of 218 physician preceptors completed the survey. The survey results showed that physicians overwhelmingly (p < 0.001) felt that all patients (and healthcare workers) should be vaccinated. The results also indicated that physicians experienced more stress when working with unvaccinated patients (p<0.001), and these stressors were often associated with the physician’s gender and age. Furthermore, physicians stated that both their assessment and treatment plans were significantly different for vaccinated vs unvaccinated patients (p=0.039 and p=0.0167, respectively). Most importantly, stress levels (p<0.001) and burnout characteristics (p=0.024) were noted by physicians, both in themselves and in their colleagues.

Conclusions
Findings suggest that physician stress and burnout is a common theme due to the differences in vaccination status of patients admitted to COVID-19 clinics. Due to a more rapid progression of COVID-19 in unvaccinated patients, treatment plans for vaccinated vs unvaccinated patients were also considerably different.
Potential therapeutic effects of adjunct osteopathic manipulative treatments in SARS-CoV-2 patients
Authors: Jacob Benna , Sawhney Mehak , Sridhar Aarthi , Jacob Berlin , Muller Jeffrey , Abu-Sbaih Reem , Yao Sheldon C. 
Published: April 2023

Abstract
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) affects various human organ systems, including the lymphatic, pulmonary, gastrointestinal, and neurologic systems. The utilization of osteopathic manipulative treatment (OMT) techniques has been clinically effective in the alleviation of various upper respiratory infection symptoms. Consequently, the use of osteopathic manipulative medicine (OMM) in SARS-CoV-2 patients as adjunct treatment can be beneficial in promoting overall recovery. This paper attempts to address the pathophysiology of SARS-CoV-2 infection at the cellular level and its downstream effects. Subsequently, osteopathic principles were investigated to evaluate potential therapeutic effects, providing a holistic approach in the SARS-CoV-2 treatment. Although the association between the benefits of OMT on clinical improvement during the 1918 Spanish influenza pandemic can be seen, further investigation is required to establish a direct correlation between OMT and symptom management in SARS-CoV-2.
Performance analysis of nuclear powered desalination unit based on MED-TVC: a case study for Saudi Arabia
Authors: Khan Salah Ud-Din , Najib Abdullah , Orfi Jamel 
Published: April 2023

Abstract
Nuclear desalination has been identified as an alternative option with much lower carbon dioxide emissions to provide fresh water by driving high capacity desalination plants. This work considers a theoretical analysis of using nuclear desalination to provide fresh water in three selected Saudi Arabian cities. It presents a theoretical model that integrates the characteristics of nuclear reactor, power cycle and desalination blocks. The power block includes three steam turbines and five feed water heaters. It is coupled via low pressure turbine to a multiple effect desalination unit integrated with a thermal vapor compressor encompassing eight effects, seven feed preheaters and a down condenser. The output includes work generated as function of fuel mass and reactor type, enrichment percentage, power and water production with different nuclear reactor type. Desalination performance indicators such as the fresh water production rate, gain output ratio (GOR), specific energy consumption (SEC) and specific cooling water mass flow rate have been evaluated and analyzed as function of sea water temperature for three specific Saudi cities. It was found that these indicators reflect better performance along a year for Jizan city than for Jubail and Tabuk. The case of Jizan city gives over the whole year more uniform values of water production rates, gain output ratio, specific energy consumption and cooling water mass flow rates.
The Objective Status of Subjective Facts
Authors: Sankey Howard 
Published: April 2023

Abstract
Some facts are objective. Some facts are subjective. Subjective facts are personal facts about individuals. It is the purpose of this short note to suggest that subjective facts are in fact objective facts about us. This applies not just to facts involving relations to entities that are independent of us, but to our tastes. It is an objective fact about us that we have the tastes that we do though there may be no objective matter of fact that our tastes reflect or fail to reflect.
Liquation Cracking in Row 3 Twin Turbine Vane Segment Caused by Malfunctioning Plasma Coating Gun
Authors: Neidel A. , Fischer B. , Gädicke T. , Ullrich T. 
Published: April 2023

Abstract
Transverse through-wall airfoil cracking was found in a row 3 twin turbine vane segment of a type used in heavy-duty gas turbine engines for power generation. A laboratory investigation determined liquation cracking (LC), a hot cracking mechanism, as the metallurgical cause of failure. As became apparent only after the investigation, the root cause of failure was a malfunctioning plasma gun used for thermal spraying the thermal barrier ceramic top coat onto the subject part.