bluuebunny/crossref_metadata_2025_split huggingface dataset:
Willingness to pay for diabetic retinopathy screening in Qujiang District, rural Guangdong, southern China: a cross-sectional study
Authors: Xiao Baixiang , Gu Xuejun , Jin Ling , Chan Ving Fai , Li Yanping , Price-Sanchez Carlos , Liu Yuanping , Wang Yanfang , Fu Haoxiang , Li Dongfeng , Congdon Nathan 
Published: April 2023

ObjectiveTo determine willingness to pay for a diabetic retinopathy screening, and its determinants, among people with diabetes mellitus in Qujiang District of Shaoguan City, rural Guangdong, southern China.DesignThis cross-sectional study was conducted through a large-scale screening programme in 2019. We randomly selected 575 (21.5%) among 2677 people over 18 years old with known diabetes who attended the screening. Participants elected to pay nothing or RMB10–RMB120 (US$1.6–US$18.8), in RMB10 intervals, displayed on printed cards. One trained interviewer collected all the data.SettingTen primary health centres in Qujiang District of Shaoguan City, Guangdong.Participants545 from the 575 randomly selected people (94.8%) agreed to participate in the study.Outcome measuresProportion of participants willing to pay anything for screening, mean amount they were willing to pay and determinants of these figures.ResultsAmong 545 participants (mean age 64.6 years (SD±10.4), 40.7% men), 327 (60.0%) were willing to pay something for screening, of whom 273 (83.5%) would pay RMB10–RMB30 (US$1.6–US$4.7). People living in rural areas and those from lower-income families were more likely to be willing to pay anything, while men, urban residents and those covered by employer-linked insurance were willing to pay larger sums (p<0.05 for all).ConclusionNearly two-thirds of participants were willing to pay for screening in this screening programme organised at the primary care level in rural China. This finding offers the potential that such activities can be sustained and scaled up through user fees.
Estimating the cost-effectiveness and return on investment of the Victorian Cardiac Outcomes Registry in Australia: a minimum threshold analysis
Authors: Lee Peter , Brennan Angela L , Stub Dion , Dinh Diem T , Lefkovits Jeffrey , Reid Christopher M , Zomer Ella , Liew Danny 
Published: April 2023

ObjectivesWe sought to establish the minimum level of clinical benefit attributable to the Victorian Cardiac Outcomes Registry (VCOR) for the registry to be cost-effective.DesignA modelled cost-effectiveness study of VCOR was conducted from the Australian healthcare system and societal perspectives.SettingObserved deaths and costs attributed to coronary heart disease (CHD) over a 5-year period (2014–2018) were compared with deaths and costs arising from a hypothetical situation which assumed that VCOR did not exist. Data from the Australian Bureau of Statistics and published sources were used to construct a decision analytic life table model to simulate the follow-up of Victorians aged ≥25 years for 5 years, or until death. The assumed contribution of VCOR to the proportional change in CHD mortality trend observed over the study period was varied to quantify the minimum level of clinical benefits required for the registry to be cost-effective. The marginal costs of VCOR operation and years of life saved (YoLS) were estimated.Primary outcome measuresThe return on investment (ROI) ratio and the incremental cost-effectiveness ratio (ICER).ResultsThe minimum proportional change in CHD mortality attributed to VCOR required for the registry to be considered cost-effective was 0.125%. Assuming this clinical benefit, a net return of $A4.30 for every dollar invested in VCOR was estimated (ROI ratio over 5 years: 4.3 (95% CI 3.6 to 5.0)). The ICER estimated for VCOR was $A49 616 (95% CI $A42 228 to $A59 608) per YoLS. Sensitivity analyses found that the model was sensitive to the time horizon assumed and the extent of registry contribution to CHD mortality trends.ConclusionsVCOR is likely cost-effective and represents a sound investment for the Victorian healthcare system. Our evaluation highlights the value of clinical quality registries in Australia.
Efficacy of continuous intravenous remimazolam versus midazolam in the extraction of impacted wisdom teeth: protocol of a randomised controlled trial
Authors: Wang Lejunzi , Jing Quan , Pei Lijian , Li Mohan , Ruan Xia , Chen Shaohui , Zhang Yuelun , Wan Kuo , Huang Yuguang 
Published: April 2023

IntroductionBenzodiazepines such as midazolam are widely used to moderately sedate patients during impacted wisdom tooth extraction to reduce anxiety in outpatient surgery. This present protocol was designed to determine whether continuous intravenous remimazolam, a new ultrashort-acting benzodiazepine, produces superior postoperative recovery quality to that of midazolam in patients undergoing extraction of impacted wisdom teeth.Methods and analysisThis study is a multicentre randomised controlled trial conducted at Peking Union Medical College Hospital, Beijing Anzhen Hospital and Beijing Shijitan Hospital in China. Approximately 150 participants undergoing extraction of impacted mandibular wisdom teeth will be randomly allocated to two groups (remimazolam and midazolam). The participants will be administered standard interventions to ensure they achieve a sedation level of III on the Ramsay sedation scale during the treatment. Preoperative and anaesthesia management and surgical techniques will be standardised for all participants. The primary outcome is recovery time for complete alertness and the secondary outcomes are anterograde amnesia during and after surgery, and interruption during operation for poor compliance or safety concerns.Ethics and disseminationThis study has been approved by the Ethics Review Committee of Peking Union Medical College Hospital (approval number: ZS-3142), Beijing Anzhen Hospital (approval number: KS2022082) and Beijing Shijitan Hospital (approval number: 2023-4).Trial registration numberNCT05350085.
Digital technologies for motor rehabilitation in children: protocol for a cross-sectional European survey
Authors: Pons Christelle , Brochard Sylvain , Grigoriu Anca , Newman Christopher J , Monbaliu Elegast , Mensah-Gourmel Johanne , Gaudin-Drouelle Delphine , Toumi Anis , Konings Marco , de la Cruz Javier 
Published: April 2023

IntroductionDigital technologies can be used as part of paediatric motor rehabilitation to remediate impairment, promote recovery and improve function. However, the uptake of digital technologies in this clinical field may be limited.The aim of this study is to describe and explain digital technology use for paediatric motor rehabilitation. The specific objectives will be: (1) to describe the access to, acceptance of and use of digital technologies as a function of individual factors related to professionals practicing motor rehabilitation with children, and of environmental factors related to paediatric rehabilitation practice and (2) to explain digital technology use with a causal model based on the ‘unified theory of acceptance and use of technology’.Methods and analysisRehaTech4child (Rehabilitation Technologies For children) is a cross-sectional study involving an online survey, that is sponsored by the European Academy of Childhood Disability (EACD). The survey protocol follows the Strengthening the Reporting of Observational Studies in Epidemiology and CHERRIES (Checklist for Reporting Results of Internet E-Surveys) guidelines. The survey includes 43 questions about (1) respondents’ individual and environmental characteristics; (2) the ease of access to digital technologies, and the frequency, type and purpose of use of those technologies and (3) acceptance of technologies and barriers to their use. The survey is intended for professionals involved in paediatric motor rehabilitation. It is disseminated across Europe by the EACD network in 20 languages. Participation is anonymous and voluntary. We aim to include 500 respondents to ensure sufficient precision for the description of study outcomes and to perform stratified analyses by the main determinants.Ethics and disseminationEthics approval was waived by the Brest CHRU Institutional Review Board. The study is conducted according to current French legislation (loi Jardé (n°2012-300)) and the survey is GDPR compliant. Study findings will be presented at national and international meetings and submitted for publication in a peer-reviewed journal.Trial registration numberNCT05176522.
‘I never leave my house without praying’: a qualitative exploration of the psychospiritual experiences of ethnically diverse healthcare staff during the COVID-19 pandemic
Authors: Gill Harmandeep Kaur , Chastney Juliet , Patel Riya , Nyatanga Brian , Henshall Catherine , Harrison Guy 
Published: April 2023

ObjectivesThe study aimed to understand the psychospiritual experiences and support needs of ethnically diverse healthcare staff during the COVID-19 pandemic.DesignA qualitative study using focus groups conducted remotely on Microsoft Teams.SettingThe study took place across 10 National Health Service Trusts in England: 5 were Acute Hospital Trusts and 5 were Community and Mental Health Trusts.ParticipantsFifty-five participants were recruited to the study across 16 focus group meetings. Participants were all National Health Service staff from ethnically diverse backgrounds.ResultsPsychospiritual concerns were central to participants’ understanding of themselves and their work in the National Health Service. Participants felt there was limited recognition of spirituality within the health service. They described close links between their spirituality and their ethnicities and felt that the psychospiritual support offered within the healthcare setting was not reflective of diverse ethnic and spiritual needs. Improved psychospiritual care was viewed as an opportunity to connect more deeply with other colleagues, rather than using the more individualistic interventions on offer. Participants requested greater compassion and care from leadership teams. Participants described both positive and negative changes in their spirituality as a result of the COVID-19 pandemic.ConclusionsCulturally sensitive psychospiritual support is a key aspect of healthcare staff’s well-being, despite identified gaps in this area. Aside from affecting physical, psychological, social and financial aspects of healthcare staff’s lives, the pandemic has also had a significant impact on the ways that people experience spirituality.
Association between extreme rainfall and acute respiratory infection among children under-5 years in sub-Saharan Africa: an analysis of Demographic and Health Survey data, 2006–2020
Authors: Uttajug Athicha , Ueda Kayo , Seposo Xerxes , Francis Joel Msafiri 
Published: April 2023

ObjectiveDespite an increase in the number of studies examining the association between extreme weather events and infectious diseases, evidence on respiratory infection remains scarce. This study examined the association between extreme rainfall and acute respiratory infection (ARI) in children aged <5 years in sub-Saharan Africa.SettingStudy data were taken from recent (2006–2020) Demographic and Health Survey data sets from 33 countries in sub-Saharan Africa.Participants280 157 children aged below 5 years were included.Outcome measuresThe proportions of ARI according to individual, household and geographical characteristics were compared using the χ2test. The association between extreme rainfall (≥90th percentile) and ARI was examined using multivariate logistic regression for 10 of 33 countries with an adequate sample size of ARI and extreme rainfall events. The model was adjusted for temperature, comorbidity and sociodemographic factors as covariates. Stratification analyses by climate zone were also performed.ResultsThe prevalence of ARI in children aged <5 years ranged from 1.0% to 9.1% across sub-Saharan Africa. By country, no significant association was observed between extreme rainfall and ARI, except in Nigeria (OR: 2.14, 95% CI 1.06 to 4.31). Larger effect estimates were observed in the tropical zone (OR: 1.13, 95% CI 0.69 to 1.84) than in the arid zone (OR: 0.72, 95% CI 0.17 to 2.95), although the difference was not statistically significant.ConclusionWe found no association between extreme rainfall and ARI in sub-Saharan Africa. Effect estimates tended to be larger in the tropical zone where intense rainfall events regularly occur. Comprehensive studies to investigate subsequent extreme climate events, such as flooding, are warranted in the future.
Evaluating the optimised font size and viewing time of online learning in young children: a multicentre cross-sectional study
Authors: MA LU , Yu Xi , Gong Ling , Wei Lili , Peng Zisu , Wang Kai , Li Yan , Zhou Jiawei , Zhao Mingwei 
Published: April 2023

ObjectivesNear viewing distance (VD) and longer viewing times are associated with myopia. This study aimed to identify the font size and viewing time that guarantee the appropriate VD and pixels per degree (PPD) for children’s online learning.DesignThis cross-sectional study comprised two experiments. In experiment A, participants read text in five font sizes on three backlit displays (a personal computer, a smartphone and a tablet), an E-ink display and paper for 5 min per font size. In experiment B, participants watched videos for 30 min on three backlit displays.SettingThe Peking University People’s Hospital in Beijing (China) and the School of Ophthalmology and Optometry, Wenzhou Medical University (Zhejiang Province, China).ParticipantsThirty-five participants completed experiment A. Ten of them participated in experiment B.Primary and secondary outcome measuresVDs were measured by Clouclip. The corresponding PPD was calculated.ResultsIn experiment A, font size and display type significantly affected VD (F(4840)=149.44, p<0.001, ES (Effect size)=0.77; F(4840), p<0.001, ES=0.37). VDs were >33 cm for all five font sizes on the PC, the tablet and paper and for 18-pt on the smartphone and 16-pt on E-ink. PPD for 16-pt on the PC, 14-pt on the tablet and all five font sizes on the phone were >60. In experiment B, VD increased over the four previous 5 min periods but decreased slightly on tablets and PCs in the fifth 5 min period. PPD was >60.ConclusionChildren demonstrated different VDs and PPDs based on font size and display type. To ensure a 33 cm VD and 60 PPD, the minimum font size for online reading should be 18-pt on smartphones, 16-pt on PCs and E-ink, 10.5-pt on tablets and 9-pt on paper. More attention should be given to children’s VD with continuous video viewing of more than 25 min.Trial registration numberChiCTR2100049584.
Quadratic convection on the radiative flow of ternary nanofluid Gr–Ag–TiO2–H2O subjected to velocity slip and temperature jump
Authors: Puneeth V. , Anandika R. , Manjunatha S. , Makinde O. D. 
Published: April 2023

This paper deals with the analysis of the flow and heat transfer performance of ternary nanofluid flowing past a stretching sheet under the influence of quadratic convection. The ternary nanofluid is formed by suspending three different nanoparticles, namely, titanium dioxide (TiO2), silver (Ag) and graphene (Gr) in the base fluid water (H2O). Thus, the ternary nanofluid obtained is Gr–Ag–TiO2/H2O where the hybrid nanofluid Ag–TiO2/H2O forms the base fluid for the resulting ternary nanofluid. The addition of TiO2 nanoparticles enhances the photocatalytic nature of the base fluid and makes it useful in various applications concerning the medicinal field. The presence of Gr helps in intensifying the thermal conductivity of water while the suspension of silver nanoparticles ensures chemical stability. Meanwhile, the thermophysical properties of the ternary nanofluid are mathematically defined and the system of equations that describe the flow of a ternary nanofluid past a stretching sheet is framed using differential equations. The outcomes of this study are interpreted through graphs for velocity and temperature profiles of the ternary nanofluid. It was mainly observed that the thermal conductance of ternary nanofluid was higher than the monophase and hybrid nanofluid. Also, the presence of quadratic convection had a prominent impact on the ternary nanofluid flow. The Nusselt number was found to be greater for spherical nanoparticles and it was found to be least for blade-shaped nanoparticles.
Dietary Riboflavin Requirement of Pacific White Shrimp (Litopenaeus vannamei)
Authors: Sanjeewani Kokila , Lee Kyeong-Jun 
Published: April 2023

This study was conducted to determine the dietary riboflavin requirement and its effects on growth performance, feed utilization, innate immunity, and diet digestibility of Litopenaeus vannamei. A riboflavin-free basal diet (R0) was formulated as a control, and six other diets were prepared by adding riboflavin of 10, 20, 30, 40, 50, and 60 mg/kg to the basal diet (designated as R10, R20, R30, R40, R50, and R60, respectively). Quadruplicate groups of shrimp (initial average weight

0.17
±
0.00

g

) were fed the diets six times a day for 8 weeks. Weight gain, specific growth rate, and protein efficiency ratio were significantly increased by riboflavin (

p
<
0.05

). The maximum values were observed in shrimp fed R40 diet. The highest activities of phenoloxidase, nitro blue tetrazolium, superoxide dismutase, and glutathione peroxidase were observed in shrimp fed R40 diet. Lysozyme activity was significantly higher in shrimp fed R30 and R40 diets than that of shrimp fed R60 diet (

p
<
0.05

). Intestinal villi were significantly longer in shrimp fed R50 and R60 diets compared to those of all other groups while the shortest villi were observed in R0 group (

p
<
0.05

). Intestinal villi were clearly distinguished in shrimp fed higher levels of riboflavin compared to those of shrimp fed R0 and R10 diets. Apparent digestibility coefficients of dry matter and protein in diets were not significantly affected by riboflavin levels (

p
<
0.05

). Whole-body proximate composition and hemolymph biochemical parameters were not significantly altered by dietary riboflavin (

p
<
0.05

). Therefore, the results of this study indicate that riboflavin is essential to enhance growth performance, feed utilization, nonspecific immunity, and intestine morphology of shrimp. An optimal riboflavin requirement for the maximum growth of L. vannamei seems to be approximately 40.9 mg/kg diet.
Coupled Dufour and Soret Effects on Hybrid Nanofluid Flow through Gyrating Channel Subject to Chemically Reactive Arrhenius Activation Energy
Authors: Raizah Zehba , Khan Arshad , Gul Taza , Saeed Anwar , Bonyah Ebenezer , Galal Ahmed M. 
Published: April 2023

This study explores the magnetohydrodynamic fluid flow through two rotating plates subjected to the impact of microorganisms. The nanoparticles of copper and alumina are mixed with water for formulating hybrid nanofluid with new combination

C
u

+

A
l

2

O

3

+

H

2

O

. This new combination augments the thermal conductivity of pure fluid. The flow is influenced by the coupled effects of Dufour and Soret diffusions. The joined effects of chemically reactive activation energy have been incorporated in the mass transportation equation. A constant magnetic field has been employed to the flow field with strength

B

0

in normal direction to the plates. The equations that controlled fluid flow have been transferred to dimension-free form by implementing suitable set of variables. The influence of the different factors has been examined theoretically by employing the graphical view of different flow profiles. It has been concluded in this work that, linear velocity has declined by augmentation in magnetic factor and rotational parameter whereas these factors have enhanced microrotational profiles of fluid. Higher values of radiation parameter, Dufour number, and volumetric fractions have augmented fluid’s thermal profiles. The concentration of fluid has been retarded with upsurge in Soret number and chemical reaction parameter whereas growth in activation energy parameter has supported the upsurge in concentration. The rate of motile microorganisms has retarded by upsurge in the values of Lewis and Peclet numbers. It has been noticed that when

K

r

,

M

, and

R
e

varies from 0.2 to 0.6 then in case of nanofluid, skin friction changes from 0.288 to 0.633 at

ϕ

1

=
0.01

and from 0.292 to 0.646 at

ϕ

1

=
0.02

and in case of hybrid nanofluid the variations in skin friction are from 0.328 to 0.646 at

ϕ

1

,

ϕ

2

=
0.01

and from 0.335 to 0.703 at

ϕ

1

,

ϕ

2

=
0.02

.
Serum and Pulmonary Expression Profiles of the Activin Signaling System in Pulmonary Arterial Hypertension
Authors: Guignabert Christophe , Savale Laurent , Boucly Athénaïs , Thuillet Raphaël , Tu Ly , Ottaviani Mina , Rhodes Christopher J. , De Groote Pascal , Prévot Grégoire , Bergot Emmanuel , Bourdin Arnaud , Howard Luke S. , Fadel Elie , Beurnier Antoine , Roche Anne , Jevnikar Mitja , Jaïs Xavier , Montani David , Wilkins Martin R. , Sitbon Olivier , Humbert Marc 
Published: April 2023

Background:
Activins are novel therapeutic targets in pulmonary arterial hypertension (PAH). We therefore studied whether key members of the activin pathway could be used as PAH biomarkers.

Methods:
Serum levels of activin A, activin B, α-subunit of inhibin A and B proteins, and the antagonists follistatin and follistatin-like 3 (FSTL3) were measured in controls and in patients with newly diagnosed idiopathic, heritable, or anorexigen-associated PAH (n=80) at baseline and 3 to 4 months after treatment initiation. The primary outcome was death or lung transplantation. Expression patterns of the inhibin subunits, follistatin, FSTL3, Bambi, Cripto, and the activin receptors type I (ALK), type II (ACTRII), and betaglycan were analyzed in PAH and control lung tissues.

Results:

Death or lung transplantation occurred in 26 of 80 patients (32.5%) over a median follow-up of 69 (interquartile range, 50–81) months. Both baseline (hazard ratio, 1.001 [95% CI, 1.000–1.001];
P
=0.037 and 1.263 [95% CI, 1.049–1.520];
P
=0.014, respectively) and follow-up (hazard ratio, 1.003 [95% CI, 1.001–1.005];
P
=0.001 and 1.365 [95% CI, 1.185–1.573];
P
<0.001, respectively) serum levels of activin A and FSTL3 were associated with transplant-free survival in a model adjusted for age and sex. Thresholds determined by receiver operating characteristic analyses were 393 pg/mL for activin A and 16.6 ng/mL for FSTL3. When adjusted with New York Heart Association functional class, 6-minute walk distance, and N-terminal pro-B-type natriuretic peptide, the hazard ratios for transplant-free survival for baseline activin A <393 pg/mL and FSTL3 <16.6 ng/mL were, respectively, 0.14 (95% CI, 0.03–0.61;
P
=0.009) and 0.17 (95% CI, 0.06–0.45;
P
<0.001), and for follow-up measures, 0.23 (95% CI, 0.07–0.78;
P
=0.019) and 0.27 (95% CI, 0.09–0.78,
P
=0.015), respectively. Prognostic values of activin A and FSTL3 were confirmed in an independent external validation cohort. Histological analyses showed a nuclear accumulation of the phosphorylated form of Smad2/3, higher immunoreactivities for ACTRIIB, ALK2, ALK4, ALK5, ALK7, Cripto, and FSTL3 in vascular endothelial and smooth muscle layers, and lower immunostaining for inhibin-α and follistatin.

Conclusions:
These findings offer new insights into the activin signaling system in PAH and show that activin A and FSTL3 are prognostic biomarkers for PAH.