bluuebunny/crossref_metadata_2025_split huggingface dataset:
A functional near-infrared spectroscopy study on hemodynamic changes of patients with prolonged disorders of consciousness responding to different auditory stimuli
Authors: Lu Haitao , Jiang Jin , Si Juanning , Wang Yizheng , Huang Fubiao 
Published: June 2023

AbstractTreating prolonged disorders of consciousness (pDoC) is challenging. Thus, accurate assessment of residual consciousness in patients with pDoC is important for the management and recovery of patients. Functional near-infrared spectroscopy (fNIRS) can be used to detect brain activity through changes of oxygenated hemoglobin/deoxygenated hemoglobin (HbO/HbR) concentrations changes and has recently gained increasing attention for its potential applications in assessing residual consciousness. However, the number of fNIRS studies assessing residual awareness in patients with pDoC is still limited. In this study, fNIRS was used to evaluate the brain function in 18 patients with pDoC, including 14 vegetative states (VS) and 4 minimally conscious states (MCS), and 15 healthy controls (HC). All participants accepted two types of external stimuli, i.e., active stimulation (motor imagery, MI) and passive stimulation (subject’s own name, SON). The results showed that the mean concentrations of HbO/HbR in the prefrontal cortex of the HC during the passive stimulation were significantly lower than those of the active stimulation, and the fitting slope was high. However, the hemodynamic responses of the patients with pDoC were opposite to those of the HC. Additionally, the mean concentrations of HbO/HbR increased as the level of consciousness decreased during passive stimulation. Our findings suggest that the residual level of consciousness in pDoC patients can be assessed by measuring brain responses to different stimulations using fNIRS. The present study further demonstrates the feasibility and reliability of fNIRS in assessing residual consciousness in patients with pDoC, providing a basis for its expanded clinical application.
Tumor necrosis is an underappreciated histopathologic factor in the grading of chondrosarcoma
Authors: Lazarides Alexander L. , Abar Bijan , Leckey Bruce , Martin John T. , Kliassov Evelyna G. , Brigman Brian E. , Eward William C. , Cardona Diana M. , Visgauss Julia D. 
Published: June 2023

Abstract
Background
Cartilaginous neoplasms can be challenging to grade; there is a need to create an evidence-based rubric for grading. The goal of this study was to identify histopathologic features of chondrosarcoma that were associated with 5-year survival and to compare these to traditional patient, tumor and treatment variables.

Methods
This was a retrospective review of all patients undergoing surgical resection of a primary chondrosarcoma with at least 2 years of follow up. All specimens were independently reviewed by two pathologists and histopathologic features scored. Univariate and multivariate analyses were performed utilizing Kaplan Meier and proportional hazards methods to identify variables associated with 5-year disease specific survival (DSS) and disease free survival (DFS).

Results
We identified 51 patients with an average follow up of 49 months eligible for inclusion. 30% of tumors were low grade, 45% were intermediate grade, and 25% were high grade. In a univariate analysis considering histopathologic factors, higher tumor mitotic rate (HR 8.9, p < 0.001), tumor dedifferentiation (HR 7.3, p < 0.001), increased tumor cellularity (HR 5.8, p = 0.001), increased tumor atypia (HR 5.8, p = 0.001), LVI (HR 4.7, p = 0.04) and higher tumor necrosis (HR 3.7, p = 0.02) were all associated with worse 5-year DSS. In a multivariate analysis controlling for potentially confounding variables, higher tumor necrosis was significantly associated with disease specific survival survival (HR 3.58, p = 0.035); none of the factors were associated with DFS.

Conclusions
This study provides an evidence-based means for considering histopathologic markers and their association with prognosis in chondrosarcoma. Our findings suggest that necrosis and LVI warrant further study.
Intact revision rotator cuff repair stabilizes muscle atrophy and fatty infiltration after minimum follow up of two years
Authors: Lacheta Lucca , Siebenlist Sebastian , Scheiderer Bastian , Beitzel Knut , Woertler Klaus , Imhoff Andreas B. , Buchmann Stefan , Willinger Lukas 
Published: June 2023

Abstract
Background
The extent of fatty infiltration and rotator cuff (RC) atrophy is crucial for the clinical results after rotator cuff repair (RCR). The purpose of this study was to evaluate changes in fatty infiltration and RC atrophy after revision RCR and to correlate them with functional outcome parameters.

Methods
Patients who underwent arthroscopic revision RCR for symptomatic recurrent full-thickness tear of the supraspinatus tendon between 2008 and 2014 and were retrospectively reviewed with a minimum follow up of 2 years. Magnetic resonance imaging (MRI) was performed pre- and postoperatively to assess 1) tendon integrity after revision RCR according to Sugaya classification, (2) RC atrophy according to Thomazeau classification, and (3) fatty infiltration according to Fuchs MRI classification. Constant score (CS) and the American Shoulder and Elbow Surgeon (ASES) score were used to correlate functional outcome, tendon integrity, and muscle degeneration.

Results
19 patients (17 males and 2 females) with a mean age of 57.5 years (range, 34 to 72) were included into the study at a mean follow-up of 50.3 months (range, 24 – 101). At final evaluation, 9 patients (47%) presented with intact RCR and 10 patients (53%) suffered a re-tear after revision repair. No progress of fatty infiltration was observed postoperatively in the group with intact RC, atrophy progressed in only 1 out of 9 patient (11%). Fatty infiltration progressed in 5/10 patients (50%) and RC atrophy increased in 2/10 patients (20%) within the re-tear group. CS (42.7 ± 17.7 preop, 65.2 ± 20.1 postop) and ASES (47.7 ± 17.2 preop, 75.4 ± 23.7 postop) improved significantly from pre- to postoperatively (p < 0.001). A positive correlation between fatty infiltration and RC integrity was detected (r = 0.77, p < 0.01). No correlation between clinical outcome and tendon integrity or RC atrophy was observed.

Conclusion
Arthroscopic revision RCR leads to reliable functional outcomes even in case of a recurrent RC retear. An intact RCR maintains the preoperative state of fatty infiltration and muscle atrophy but does not lead to muscle regeneration.

Level of evidence
Level IV; Therapeutic study.
Medical care costs at the end of life among older adults with cancer: a national health insurance data-based cohort study
Authors: Jo Minjeong , Lee Yunji , Kim Taehwa 
Published: June 2023

Abstract
Objective
Along with aging, the elderly population with cancers is increasing. The costs of end-of-life (EOL) care are particularly high among cancer patients. The purpose of this study was to investigate the trends in medical costs in the last year of life among older adults with cancer.

Design, setting, and participants
Using the Health Insurance Review and Assessment Services (HIRA) database for the period 2016–2019, we identified older adults aged ≥ 65 years who had a primary diagnosis of cancers and high-intensity treatment at least once in the intensive care unit (ICU) of tertiary hospitals.

Main outcomes and measures
High-intensity treatment was defined as receiving at least one of the following treatments: cardiopulmonary resuscitation, mechanical ventilation, extracorporeal membrane oxygenation, hemodialysis, and transfusion. The EOL medical treatment costs were calculated by dividing periods 1, 2, 3, 6, and 12 months from the time of death, respectively.

Results
The mean total EOL medical expense per older adult during the year before death was $33,712. The cost of EOL medical expenses for three months and one month before subjects’ death accounted for 62.6% ($21,117) and 33.8% ($11,389) of total EOL costs, respectively. Among subjects who died while receiving high-intensity treatment in the ICU, the costs associated with medical treatments that occurred during the last month before death were 42.4% ($13,841) of the total EOL expenses during the year.

Conclusion
The findings indicate that EOL care expenditures for the older population with cancer are highly concentrated until the last month. The intensity of medical care is an important and challenging issue in terms of care quality and cost suitability. Efforts are needed to properly use medical resources and provide optimal EOL care for older adults with cancer.
Availability and accessibility of HIV self-tests and self-sample kits at community pharmacies in the Netherlands
Authors: Kandil Chaima , Hugtenburg Jacqueline , Heijman Titia , Bos Hanna , Teichert Martina , Finkenflügel Renee , de Coul Eline Op 
Published: June 2023

Abstract
Background
In 2016 the WHO declared HIV self-testing and self-sampling an effective and safe test option that can reduce testing barriers. HIV self-tests and self-sampling kits (HIVST/HIVSS) are available for purchase at Dutch community pharmacies since 2019. We investigated the availability and accessibility of HIVST/HIVSS in community pharmacies, and factors associated with test availability.

Methods
An online survey among all Dutch community pharmacies (n = 1,987) was conducted between April and June 2021. Availability of HIVST/HIVSS and experiences of pharmacists with the test offer were analyzed with descriptive statistics. The association of pharmacy and pharmacists’ characteristics with HIVST/HIVSS availability was explored by logistic regression analysis.

Results
In total, 465 pharmacists completed the questionnaire. Of the responding pharmacists, 6.2% (n = 29) offered HIVST/HIVSS. The majority (82.8%) sold between 0 and 20 tests per year. In total, pharmacies sold an estimated 370 HIVST/HIVSS per year. Pharmacies having HIVST/HIVSS available were less often located in moderately-urbanized to rural neighborhoods (OR 0.35, 95%CI 0.16–0.77 versus highly-urbanized), and were less often located in moderate-to-low SES neighborhoods (OR 0.40, 95%CI 0.18–0.88 versus high-SES). Reasons for not offering HIVST/HIVSS by pharmacists were no or little demand (69.3%), and not being familiar with these tests (17.4%). 52% of the pharmacists provided information about testing to test buyers. Reported options to improve the test offer were giving advice about (performing) the test to test buyers (72.4%), placing tests visible on the counter (51.7%), and advertisement (37.9%).

Conclusion
HIVST/HIVSS have a limited practical availability in Dutch community pharmacies since their introduction in 2019, especially in lower-urbanized and lower-SES areas. Further research is needed to explore how to expand access to HIVST/HIVSS through community pharmacies in the Netherlands, and how to tailor it to the needs of pharmacy clients.
Estimated costs for Duchenne muscular dystrophy care in Brazil
Authors: Schneider Nayê Balzan , Roos Erica Caetano , Staub Ana Lúcia Portella , Bevilacqua Isabela Possebon , de Almeida Ana Carolina , de Camargo Martins Tamiê , Ramos Natalia Bergamelli , Loze Priscilla , Saute Jonas Alex Morales , Etges Ana Paula Beck da Silva , Polanczyk Carisi Anne 
Published: June 2023

Abstract
Background
The economic burden of rare diseases on health systems is still not widely measured, with the generation of accurate information about the costs with medical care for subjects with rare diseases being crucial when defining health policies. Duchenne Muscular Dystrophy (DMD) is the most common form of muscular dystrophy, with new technologies recently being studied for its management. Information about the costs related to the disease in Latin America is scarce, and the objective of this study is to evaluate the annual hospital, home care and transportation costs per patient with DMD treatment in Brazil.

Results
Data from 27 patients were included, the median annual cost per patient was R$ 17,121 (IQR R$ 6,786; 25,621). Home care expenditures accounted for 92% of the total costs, followed by hospital costs (6%) and transportation costs (2%). Medications and loss of family, and patient’s productivity are among the most representative consumption items. When disease worsening due to loss of the ability to walk was incorporated to the analysis, it was shown that wheelchair users account for an incremental cost of 23% compared with non-wheelchair users.

Conclusions
This is an original study in Latin America to measure DMD costs using the micro-costing technique. Generating accurate information about costs is crucial to provide health managers with information that could help establish more sustainable policies when deciding upon rare diseases in emerging countries.
Geo-hazards assessment of the new-found industrial communities: an example from the 10th of Ramadan Industrial Region, Egypt
Authors: El-Rayes Ahmed E. , Arnous Mohamed O. , Green David R. , Gouda Norhan F. 
Published: June 2023

AbstractThe impacts of Geo-hazard events are main obstacles to the use of land in numerous arid and semi-arid provinces of the World. Furthermore, the various activities of industrial communities, such as Egypt's 10th Ramadan Industrial Region (10th RIR), are the most dangerous examples of waste's impact on soil, surface water, and groundwater. The current study uses image processing and GIS tools to identify, delineate, monitor, and assess some of the environmental hazards caused by both human and natural activities in the 10th RIR. The findings revealed that there are rapid changes in land cover, which could be attributed to both anthropogenic and natural activities. Furthermore, the results revealed that waterlogging, salt-affected soils, water pollution, and flash floods were the most serious environmental threats to the 10th RIR. The obtained geo-hazard map showed that the 10th RIR has high flash flood hazards zones that are geospatially distributed in the southern parts of the Wadi Gafra basin and the western parts of 10th of Ramadan City. Furthermore, salinized soil zones are viewed as geospatially restricted zone in the eastern portion of 10th of Ramadan City and/or near the oxidation ponds. Additionally, vast areas of highly contaminated groundwater exist beneath industrial, urban, and oxidation pond zones. The current work provides decision-makers with numerous mitigation measures and recommendations required to minimize the impacts of geo-environmental hazards endangering the 10th RIR.
Availability of adequate iodized salt at household level in rural communities in Farta district, Northwest, Ethiopia: a cross-sectional study
Authors: Shiferaw Yalelet Fentaw , Negash Wubshet Debebe , Belay Daniel Gashaneh , Birhan Haileyesus , Asmamaw Desale Bihonegn 
Published: June 2023

Abstract
Introduction
Iodine is a crucial trace element for thyroid hormone synthesis. All age groups are affected by iodine deficiency disorders (IDD), especially pregnant women, young women, and children. Iodine deficiency disorder has been recognized as a serious public health issue in Ethiopia. Therefore, the aim of the current study was to assess the availability of iodized salt and associated factors at the household (HH) level in the Farta district, northwest, Ethiopia.

Methods
A community-based cross-sectional study was conducted involving 704 participants in Farta District, Northwest Ethiopia, between February and March 2021. A multi-stage sampling technique was employed to recruit participants. Data were collected using pretested and structured questionnaires administered by face-to-face interviewers. The data were entered into Epi-data version 4.6 software and exported into Stata version 14 for the purpose of analysis. Both bivariable and multivariable logistic regression analyses were used to identify factors associated with the availability of iodized salt. Statistical significance was declared at a p-value ≤ 0.05 with a corresponding 95% confidence interval.

Results
The availability of adequately iodized salt in the study area was 26.6% (CI = 23.8%, 29.4%) of households. Good knowledge about iodine deficiency disorder (IDD) and iodized salt (AOR = 3.85, 95% CI: 3.65, 6.11); short-term storage of salt at the HH [AOR = 2.76, 95% CI: 1.98, 3.23); and stored in covered containers (AOR = 1.57, 95% CI: 1.11, 1.78) were significantly associated with the outcome variable.

Conclusion
The availability of adequate iodized salt at the HH level was far below the WHO target (more than 90%) in the study area. Knowledge about IDD and iodized salt, stored in covered containers, and short-term storage of salt at the HH were significantly associated with the availability of iodized salt. Hence, at the household level, increasing awareness and disseminating information about the benefits of using iodized salt could be effective. Moreover, education about the proper storage and handling of iodized salt, as well as the recommended storage duration of salt in the home, should be provided as part of our community outreach programs.
Game-based assessment framework for virtual reality, augmented reality and digital game-based learning
Authors: Udeozor Chioma , Chan Philippe , Russo Abegão Fernando , Glassey Jarka 
Published: June 2023

AbstractImmersive learning technologies such as virtual reality (VR), augmented reality (AR) and educational digital games offer many benefits to teaching and learning. With their potential to immerse learners in realistic environments and facilitate higher-order cognitive learning, these technologies could be used to complement current classroom pedagogical practices. However, given that these learning environments differ from conventional classroom learning activities, current assessment practices may be insufficient for assessing learning in immersive environments. This paper develops the concept of a game-based assessment framework (GBAF) for educators interested in the assessment of learning in digital games, VR or AR. Importantly, this paper also presents the application of the framework to the design and implementation of assessments for a VR game during the game design phase. Grounded in the principles of Constructive Alignment and the Evidence-Centred Design (ECD) framework, this assessment framework describes the steps to consider for assessments and outlines the components that must be aligned for the design of assessments. To illustrate the application of the GBAF to the design of assessments for immersive learning environments, a stepwise design of assessments for a VR game is presented. The results of the outcome of the assessment of laboratory health and safety competencies of six engineering students is also presented. The GBAF offers simple and useful guidelines for the design of assessments around game tasks. It could serve as a structured basis for educators and researchers to design assessments to measure lower and higher-order cognitive learning in complex immersive environments.
Psychıatrıc dısorders among chıldren and adolescents suffered from COVID-19 ınfectıon
Authors: Yurumez Esra , Celık Ozge , Akgul Aysegul , Ozturk Humeyra Hilal , Uytun Merve Cıkılı , Vatansever Goksel , Kılıc Birim Gunay , Oztop Didem Behice 
Published: June 2023

Abstract
Background
It was aimed to investigate the psychological effects of the Coronavirus disease 2019 (COVID-19) pandemic on children and adolescents. The effects of disease process on development of psychiatric disorders, the course of pre-existing disorders, and peer relationships of children who have had COVID-19 infection were evaluated. Fifty three patients (28 girls and 25 boys) who were aged 12 ± 2.64 years and diagnosed with COVID-19 infection within the last 3–9 months, were randomly selected and included. Sociodemographic form, Beck Depression Inventory/Children’s Depression Scale, Symptom Checklist 90-Revised were given to the participants, and a semi-structured interview was used to establish psychiatric disorders before and after COVID-19 infection. Parents were asked to fill in Conner’s Rating Scale-Parents and Behavioral Rating Inventory of Executive Function.

Results
Compared to pre-pandemic, duration of physical activity and time spent with peers were decreased, while screen exposure was found to be increased. Subclinical psychiatric symptoms were exacerbated after infection and most affected area was eating problems with loss of appetite and weight.

Conclusions
In conclusion, our data showed that COVID-19 is associated with an increase in psychiatric disorders among children and adolescents, and further studies are needed in a larger population to investigate the causes and consequences of these effects.
Sound levels and its effect on physiology of low birth weight newborns in a special care newborn unit — a prospective observational study
Authors: Das Saptasikha , Chakraborty Pinaki , Bora Reeta , Chakraborty Priyanko 
Published: June 2023

Abstract
Background
From quiet environment in uterus, neonates in special care newborn units (SCNU) get exposed to a stressful technology-driven environment. Noise level in neonatal intensive care units (NICU) depends on social and psychological realm of people working there. In NICU, an hourly Leq (median equivalent continuous sound level) of sound should be 45 dB, Lmax, 60 dB, and L10 not exceeding 50 dB (AAP, 2007). Noise level in SCNUs of northeast India has not been studied.

Aim
Create awareness among health workers (HW) regarding noise.

Objective
To study (a) noise level in special care newborn unit and (b) its effect on neonatal physiology.

Methodology
A prospective observational study was conducted in a teaching hospital in northeast India for 1 month. After IEC approval, ambient sound levels in intensive care unit (ICU) (levels 2 & 3) and kangaroo mother care (KMC) area were measured using inVH by Bosch Engineering Solution (android app) in 3 shifts. Forty hemodynamically stable quiet low birth weight neonates (level 2: 16, level 3: 14, KMC: 10) were evaluated for heart rate and respiratory rate at same time. Acutely sick neonates were excluded. Statistical analysis was done using SPSS.

Results
Average sound at 10 am, 5 pm, and 11 pm in level 2 was 70.2 (+ 3.78) dB, 71.9 (+ 4.21) dB, and 54.6 (+ 5.38) dB; in level 3: 66.4 (+ 3.71) dB, 64.9 (+ 3.88) dB, and 63.5 (+ 2.52) dB; and KMC: 55.06 (+ 5), 54.66 (+ 5.38), and 47.7 (+ 5.1) dB (p = 0.0052). Of included neonates, mean birthweight in intensive vs KMC area was 1.378 (+ 0.017) vs 1.337 (+ 0.02) kg (p = 0.1) and gestational age 35.45 (+ 0.25) weeks and 34.8 (+ 0.91) weeks (p = 0.2). The mean neonatal heart rate and respiratory rates in level 2 were 154/min and 44 cycles/min, level 3: 148/min and 47 cycles/min; and KMC: 124/min and 40 cycles/min.

Conclusion
Significant noise pollution is detected in levels 2 and 3 neonatal intensive care units and minimal in kangaroo mother care area. Raised neonatal heart rates and respiratory rates in intensive care units with respect to KMC area may be related to noise. The social and psychological realm of healthcare workers and caregivers needs urgent improvement so as to reduce ambient noise pollution in special care newborn units.