bluuebunny/crossref_metadata_2025_split huggingface dataset:
On the Frontlines in Shanghai
Authors: Xu Zhimin , Liu Xia , Ghisi Gabriela Lima de Melo , Cui Lixian , Grace Sherry L. 
Published: March 2023

BackgroundCOVID-19 (COronaVIrus Disease-19) control measure stringency, including testing, has been among the highest globally in China. Psychosocial impact on pandemic workers in Shanghai and their pandemic-related attitudes were investigated.MethodsParticipants in this cross-sectional study were health care providers (HCPs) and other pandemic workers. A Mandarin online survey was administered between April and June 2022 during the omicron-wave lockdown. The Perceived Stress Scale and Maslach Burnout Inventory were administered.ResultsEight hundred eighty-seven workers participated, of which 691 (77.9%) were HCPs. They were working 6.25 ± 1.24 days per week for 9.77 ± 4.28 hours per day. Most participants were burned out, with 143 (16.1%) moderately and 98 (11.0%) seriously. The Perceived Stress Scale score was 26.85 ± 9.92 of 56, with 353 participants (39.8%) having elevated stress. Many workers perceived benefits: cohesive relationships (n = 581 [65.5%]), resilience (n = 693 [78.1%]), and honor (n = 747 [84.2%]). In adjusted analyses, those perceiving benefits showed significantly less burnout (odds ratio, 0.573; 95% confidence interval, 0.411 to 0.799), among other correlates.ConclusionsPandemic work, including among non-HCPs, is highly stressful, but some can derive benefits.
Diagnosis of invasive respiratory mycoses in the immunocompromised host
Authors: Houston Hamish , Wilson Andrew J. , Stone Neil 
Published: March 2023

Purpose of review
The burden of invasive fungal infection is increasing worldwide, largely due to a growing population at-risk. Most serious human fungal pathogens enter the host via the respiratory tract. Early identification and treatment of invasive fungal respiratory infections (IFRIs) in the immunocompromised host saves lives. However, their accurate diagnosis is a difficult challenge for clinicians and mortality remains high.

Recent findings
This article reviews IFRIs, focussing on host susceptibility factors, clinical presentation, and mycological diagnosis. Several new diagnostic tools are coming of age including molecular diagnostics and point-of-care antigen tests. As diagnosis of IFRI relies heavily on invasive procedures like bronchoalveolar lavage and lung biopsy, several novel noninvasive diagnostic techniques are in development, such as metagenomics, ‘volatilomics’ and advanced imaging technologies.

Summary
Where IFRI cannot be proven, clinicians must employ a ‘weights-of-evidence’ approach to evaluate host factors, clinical and mycological data. Implementation studies are needed to understand how new diagnostic tools can be best applied within clinical pathways. Differentiating invasive infection from colonization and identifying antifungal resistance remain key challenges. As our diagnostic arsenal expands, centralized clinical mycology laboratories and efforts to ensure access to new diagnostics in low-resource settings will become increasingly important.
Climate change, air pollution, pollen allergy and extreme atmospheric events
Authors: D’Amato Gennaro , D’Amato Maria 
Published: March 2023

Purpose of review
Respiratory allergy correlates strictly with air pollution and climate change. Due to climate change, the atmospheric content of trigger factors such as pollens and moulds increase and induce rhinitis and asthma in sensitized patients with IgE-mediated allergic reactions.
Pollen allergy is frequently used to evaluate the relationship between air pollution and allergic respiratory diseases. Pollen allergens trigger the release of immunomodulatory and pro-inflammatory mediators and accelerate the onset of sensitization to respiratory allergens in predisposed children and adults. Lightning storms during pollen seasons can exacerbate respiratory allergy and asthma not only in adults but also in children with pollinosis. In this study, we have focalized the trigger (chemical and biologic) factors of outdoor air pollution.

Recent findings
Environmental pollution and climate change have harmful effects on human health, particularly on respiratory system, with frequent impact on social systems.
Climate change is characterized by physic meteorological events inducing increase of production and emission of anthropogenic carbon dioxide (CO2) into the atmosphere. Allergenic plants produce more pollen as a response to high atmospheric levels of CO2. Climate change also affects extreme atmospheric events such as heat waves, droughts, thunderstorms, floods, cyclones and hurricanes. These climate events, in particular thunderstorms during pollen seasons, can increase the intensity of asthma attacks in pollinosis patients.

Summary
Climate change has important effects on the start and pathogenetic aspects of hypersensitivity of pollen allergy. Climate change causes an increase in the production of pollen and a change in the aspects increasing their allergenic properties. Through the effects of climate change, plant growth can be altered so that the new pollen produced are modified affecting more the human health. The need for public education and adoption of governmental measures to prevent environmental pollution and climate change are urgent. Efforts to reduce greenhouse gases, chemical and biologic contributors to air pollution are of critical importance. Extreme weather phenomena such as thunderstorms can trigger exacerbations of asthma attacks and need to be prevented with a correct information and therapy.
Daily Vitamin D Supplementation Improves Vitamin D Deficiency in Patients With Chronic Liver Disease
Authors: Mariano da Rocha Carolina Roos , Guaragna-Filho Guilherme , Kieling Carlos Oscar , Adami Marina Rossato , Guedes Renata Rostirola , Gonçalves Vieira Sandra Maria 
Published: March 2023

Objective:
The objective of this article is to evaluate the response to 6000 IU oral cholecalciferol (OC) treatment in children with chronic liver disease (CLD) and 25(OH)D deficiency.

Methods:
This historical cohort included non-transplanted CLD patients younger than 18 years old, which were analyzed for serum 25(OH)D, liver function, bone metabolism, Child-Pugh classification, and anthropometry. Patients with 25(OH)D deficiency (defined as 25(OH)D < 20 ng/mL) who received 6000 IU/day of OC were analyzed pre- and post-intervention, and considered responders if 25(OH)D > 20 ng/mL after at least 60 days. We compared clinical and laboratory data from patients with and without 25(OH)D deficiency, responders and nonresponders.

Results:
We studied 96 patients, of which 57.2% had biliary atresia. The prevalence of 25(OH)D deficiency was 67.7% (65/96). These patients were younger (P < 0.001), had higher Child-Pugh scores (P < 0.001), higher levels of total bilirubin (TB) (P < 0.001), gamma-glutamyl transferase (P < 0.001), and alkaline phosphatase (P = 0.002), as well as lower levels of phosphorus (P = 0.009) compared with patients without 25(OH)D deficiency. The median treatment length was 126 days (70–307 days). At the end of treatment, we observed a higher median of 25(OH)D (P < 0.001), and lower median of parathyroid hormone (PTH) (P = 0.023). Nine patients (29%) restored 25(OH)D to normal range; they had lower Child-Pugh score (P = 0.001), lower TB levels (P = 0.001), and higher level of phosphorus (P = 0.003) after treatment.

Conclusion:
Despite an increase in 25(OH)D and decrease in PTH levels, 6000 IU/day of OC was not sufficient to restore 25(OH)D deficiency in most of the patients in this study.
Development and Validation of a Questionnaire to Measure ICU Nurses' Knowledge, Attitudes, and Practices Related to Central Line Bloodstream Infection Practices
Authors: Dang Fangping , Zhai Tiantian , Ding Nannan , Gao Jing , Li Rao , Li Huiju , Ran Xingwu 
Published: March 2023

Background:
Currently, there is no instrument available to assess intensive care unit (ICU) nurses' knowledge, attitudes, and practices (KAP) of central line–associated bloodstream infection (CLABSI) prevention practices.

Purpose:
To develop and validate a CLABSI questionnaire to measure ICU nurses' KAP (CLABSI-KAP-Q).

Methods:
Data were collected from 255 nurses at 4 hospitals in Gansu Province, China. Questions on the CLABSI-KAP-Q were generated through a review of the literature, interviews with nurses, and multiple rounds of content validity evaluation by experts. The validity and reliability of the CLABSI-KAP-Q were assessed with exploratory factor analysis, confirmatory factor analysis, internal consistency, and correlation coefficients.

Results:
The final version of the CLABSI-KAP-Q consisted of 32 items. The reliability was represented by a Cronbach α of 0.946, while the test-retest reliability was 0.945. The overall content validity was 0.95.

Conclusions:
The CLABSI-KAP-Q is shown to be valid and reliable and recommended for use in clinical practice.
Upper Gastrointestinal Screening of Polyp Load in Children With Familial Adenomatous Polyposis: Is It Required?
Authors: Middleton Thomas , Sugarman Ian 
Published: March 2023

Objectives and study:
Patients with familial adenomatous polyposis (FAP) have a propensity to form not only large bowel polyps but also upper gastrointestinal (GI) polyps with malignant potential. International guidance suggests that upper GI screening need not begin until patients are at least into their twenties. It is our experience that patients develop upper GI polyps long before this point which have the potential for malignant change.

Methods:
A prospective record of all upper GI endoscopies in children (aged 9 to 17) with FAP was kept across a 12-year period by 1 surgeon in our center. For each scope performed, we recorded the location, histology, and treatment of upper GI polyps.

Results:
Twent-eight patients aged 9 to 17 underwent a total of 48 esophagogastroduodenoscopies across a 12-year period. Thirty-eight esophagogastroduodenoscopies (79%) identified at least 1 gastric or duodenal polyp in 22 (79%) patients; 10 (36%) patients had gastric adenomas. Eight (29%) patients showed very high numbers of polyps. All 21 patients who had duodenal polyps had adenomas. None had yet developed malignancy, but 1 patient required extensive polyp excision and one is awaiting endoscopic mucosal resection.

Conclusion:
Our results demonstrate that young people with FAP are at the risk of developing upper GI polyps long before current guidance suggests screening the upper GI tract. We advocate for screening of the upper GI tract to start along with colonoscopy and happen at the same sitting for pediatric and young adult patients with FAP.
The Community Cost of Maintaining Gastrostomies in Pediatric Patients
Authors: Makker Jasmine , Pardy Caroline , Kelly Veronica , Yardley Iain 
Published: March 2023

Background:
The use of gastrostomies in children is increasing and their need for long-term management following insertion presents a potentially significant financial and resource challenge to local healthcare systems.

Objectives:
The aim of this study was to determine the yearly cost of maintaining a gastrostomy in a pediatric patient.

Methods:
A retrospective, bottom-up cost-analysis was conducted in a cohort of 180 patients with gastrostomies aged 0–19 years. One in 5 patients were randomly selected for individual cost analysis (n = 36). Their electronic health record was interrogated from the period of March 1, 2019–March 1, 2020. Costs included in the analysis were staff contact time from the community nursing and nutrition teams, and equipment costs.

Results:
The mean cost of maintaining a pediatric gastrostomy across all ages was £709.87 (SD 403.18) per year. Mean annual cost varied by age, underlying diagnosis, and gastrostomy device, but this variation was only statistically significant for the type of device, with Mic-Key buttons having a mean annual cost of £834.66 (SD 307.85), Mini buttons £799.06 (SD 395.01), and percutaneous endoscopic gastrostomy tubes £279.34 (SD 297.45; P = 0.004).

Conclusion:
The mean cost of maintaining a gastrostomy in a pediatric patient is just over £700 per year. The cost is the highest as a child enters adulthood. Button devices have higher maintenance costs compared with percutaneous endoscopic gastrostomy tubes.
Care Bundle to Improve Oxygen Maintenance and Events
Authors: Shivananda Sandesh , Thomas Sumesh , Dutta Sourabh , Fusch Christoph , Williams Connie , Gautham Kanekal Suresh 
Published: March 2023

Introduction:
Prolonged periods spent outside the target range of oxygen saturation (SpO2) in preterm infants, along with frequent desaturation events, predispose them to retinopathy of prematurity (ROP) and long-term neurodevelopmental impairment. The primary aim of this study was to increase the mean time spent within the target SpO2 range (WTR) by 10% and to reduce the frequency of desaturation events by 5 events per patient day, respectively, within 18 months of implementing a care bundle.

Methods:
This study was completed in a 46-bed neonatal intensive care unit (NICU), involving 246 staff members and led by a quality improvement team. The change interventions included implementing new practice guidelines, reviewing daily summaries of SpO2 maintenance, daily infant wellness assessment, standardizing workflow, and responding to SpO2 alarms. In addition, we collected staff satisfaction and compliance with change interventions, resource use, and morbidity and mortality data at discharge.

Results:
The mean time spent WTR increased from 65.3% to 75.3%, and the frequency of desaturation events decreased from 25.1 to 16.5 events per patient day, respectively, with a higher magnitude of benefit in infants on days with supplemental oxygen. Postimplementation, the duration of high-frequency ventilation and supplemental oxygen were lower, but morbidity and mortality rates were similar. Staff satisfaction with training workshops, coaching, use of the infant wellness assessment tool, and SpO2 alarm management algorithms were 74%, 82%, 80%, and 74%, respectively.

Conclusion:
Implementing a care bundle to improve oxygen maintenance and reduce desaturation events increased the time spent WTR and reduced the frequency of desaturation events.
Reduced Computed Tomography for Appendicitis in Children after Implementation of Next-day Surgery Clinic Follow-up
Authors: Ryan Sydney , Dudley Nanette C. , Schunk Jeff E. , Weng Cindy , Skarda David E. , Glissmeyer Eric W. 
Published: March 2023

Introduction:
The use of computed tomography (CT) in the emergency department (ED) evaluation of pediatric patients for suspected appendicitis can be safely reduced. However, published examples of reduced CT use also report increased MRI utilization, ED length of stay, hospitalization rates, and in-ED surgical consultation. In addition, previous studies recommended follow-up for undifferentiated abdominal pain, yet none with pediatric surgeons. Therefore, we implemented a diagnostic algorithm that includes an option for next-day surgery clinic follow-up in cases where uncertainty remains after appendix ultrasound (US) to reduce CT utilization without increasing hospital-based resources.

Methods:
We implemented a diagnostic algorithm in January 2014. We retrospectively identified 4,577 patients who underwent an evaluation for suspected appendicitis from January 2012 to September 2015. CT utilization was compared before and after implementation using Statistical Process Control. In addition, we evaluated secondary outcomes, including US utilization, hospital admission, surgery clinic follow-up, ED surgery consultation, ED return visits within 7 days, and ED length of stay.

Results:
Following the implementation of the algorithm, CT utilization decreased significantly from 13.8% to 6%. Forty-eight patients were evaluated the next day in the optional pediatric surgery clinic for 21 months after implementation. There was no significant change in US utilization, hospital admission, ED surgery consultation, ED return visits within 7 days, or ED length of stay.

Conclusion:
We achieved decreased CT utilization without an increase in the utilization of other hospital-based resources after implementing a pediatric appendicitis evaluation algorithm that includes the option for next-day pediatric surgery clinic follow-up.
Epidemiology of Anterior and Lateral Basilar Skull Fractures With CSF Leak: A National Trauma Data Bank Analysis
Authors: Fritz Christian , Harris Jacob , De Ravin Emma , Xu Katherine , Parhar Harman S. , Davis Lauren , Moreira Alvaro , Rajasekaran Karthik 
Published: March 2023

Objective:
Cerebrospinal fluid (CSF) leaks are a complication from dural violations that can occur in the setting of skull base fractures. No prior study provides a nationwide epidemiological analysis of traumatic CSF leaks. The objective of this report is to characterize patient demographics, injury-related variables, and operative management.

Methods:
The national trauma data bank was queried for both anterior and lateral skull base fracture cases between 2008 and 2016. Clinical data were extracted.

Results:
A total of 242 skull base fractures with CSF leak were identified. Most patients were male (84.3%), and the median patient age was 39.7±17.6 years old. Glasgow Coma Scale was 14.0 [interquartile range (IQR): 6.5–10.6] for lateral fractures, 13.0 (IQR: 3.0–10.0) for anterior fractures, and severe range for combined fractures at 7.0 (IQR: 5.0–9.0) (analysis of variance, P=0.122). Common mechanisms of injury were motor vehicle accidents (107, 44.2%), followed by falls and firearms (65, 26.9% and 20, 8.3%, respectively). The median length of stay was 2 weeks, with a median of 14 days (IQR: 10–25) for the anterior fractures and 10 days (IQR 5–19) among the lateral fractures (P=0.592). Patients were most commonly discharged home in both the anterior (43.8%) and lateral (49.2%) groups.

Conclusions:
The prototypical patient tends to be a young adult male presenting with moderate-to-severe range neurological dysfunction after a vehicular accident. The overall prognosis of skull base fractures with CSF leak remains encouraging, with nearly half of these patients being discharged home within 2 weeks.
Expansion of modern humans over the world: The origin when considering non-linearity
Authors: Cenac Zarus 
Published: March 2023

AbstractTypes of diversity have been known to decline linearly with the rise of geographical distance from Africa. Declines have helped to suggest the area in Africa which holds the origin for the global expansion of modern humans. Research has, at times, explored if there is a non-linear relationship between diversity and distance from Africa. A previous suggestion was that non-linearity could affect where the expansion appears to have originated. Linear analysis with Y-chromosomal microsatellite heterozygosity has been contrary to the expansion from Africa, instead indicating an origin involving Asia; could this be attributable to non-linearity? The present study looked into whether there are non-linear relationships between distance and diversities, and approximated where the expansion began. This study used diversities from previous research – genetic (autosomal, X-chromosomal, Y-chromosomal, and mitochondrial) and cranial shape. The Bayesian information criterion was the statistic for comparing linear and non-linear (quadratic) models to indicate if there is a non-linear relationship. This criterion was also used to estimate where the expansion launched from. Autosomal microsatellite heterozygosity favoured a non-linear relationship. This may be due to South American populations. Mitochondrial diversity suggested non-linearity too, but not when minimum temperature was controlled for. Whilst non-linear relationships indicated that the expansion had its start in Africa, for autosomal microsatellite heterozygosity, the area of origin appeared to be rather affected by the type of model (linear or non-linear). Other diversities (e.g., Y-chromosomal) supported linear relationships. Therefore, non-linearity does not seem to explain Y-chromosomal microsatellite heterozygosity being unexpressive of the global expansion.
Predictive reward-prediction errors of climbing fiber inputs integrate modular reinforcement learning with supervised learning
Authors: Hoang Huu , Tsutsumi Shinichiro , Matsuzaki Masanori , Kano Masanobu , Toyama Keisuke , Kitamura Kazuo , Kawato Mitsuo 
Published: March 2023

AbstractAlthough the cerebellum is typically linked to supervised learning algorithms, it also exhibits extensive involvement in reward processing. In this study, we investigated the cerebellum’s role in executing reinforcement learning algorithms, with a particular emphasis on essential reward-prediction errors. We employed the Q-learning model to accurately reproduce the licking responses of mice in a Go/No-go auditory-discrimination task. This method enabled the calculation of reinforcement learning variables, such as reward, predicted reward, and reward-prediction errors in each learning trial. By tensor component analysis of two-photon Ca2+imaging data from more than 6,000 Purkinje cells, we found that climbing fiber inputs of the two distinct components, which were specifically activated during Go and No-go cues in the learning process, showed an inverse relationship with predictive reward-prediction errors. By assuming bidirectional parallel-fiber Purkinje-cell synaptic plasticity, we constructed a cerebellar neural-network model with 5,000 spiking neurons of granule cells, Purkinje cells, cerebellar nuclei neurons, and inferior olive neurons. The network model qualitatively reproduced distinct changes in licking behaviors, climbing-fiber firing rates and their synchronization during discrimination learning separately for Go/No-go conditions. We found that Purkinje cells in the two components could develop specific motor commands for their respective auditory cues, guided by the predictive reward-prediction errors from their climbing fiber inputs. These results indicate a possible role of context-specific actors in modular reinforcement learning, integrating with cerebellar supervised learning capabilities.
Integration of IoT into e-government
Authors: Shao Deo , Ishengoma Fredrick R. , Alexopoulos Charalampos , Saxena Stuti , Nikiforova Anastasija , Matheus Ricardo 
Published: March 2023

Purpose
The purpose of this paper is to highlight the drivers, barriers, benefits and risks affecting the integration of Internet of Things (IoT) into the e-government and to provide a future research agenda.

Design/methodology/approach
Existing literature examining the relationships between e-government and IoT is scanned and evaluated by conceptualizing the IoT concept in the e-government perspective.

Findings
The study shows that there are drivers to integrate IoT in e-government, such as ensuring the economy, efficiency and effectiveness of government operations, which would largely establish a relationship between the government and the citizens. Furthermore, there are barriers to such integration, given the lack of political will, the appropriate information technology infrastructure, the training of the stakeholders with a focus on the employee and the like.

Originality/value
The integration of IoT in e-government is a novel and weakly explored concept, particularly in the light of new advances such as blockchain in the e-government, which requires further exploration and conceptualization, thereby achieving a shared/common vision and body of knowledge for its further successful and sustainable adoption – to the best of the authors’ knowledge, the current study is one of these initial attempts.