bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Disruption of Patient Ambulation Care Processes by COVID-19
Authors: Jones-Hooker Christa , Tyndall Deborah E. , Forbes Thompson H. 
Published: September 2023

OBJECTIVE
To explore the impact of COVID-19 on care processes and ambulation outcomes.

BACKGROUND
COVID-19 forced hospital leaders to make systems-level changes that disrupted patient ambulation. The impact of these changes on the ambulation of hospitalized patients was unknown. The Systems Engineering Initiative for Patient Safety model was used to explore ambulation from a systems perspective.

METHODS
A single-case study research design was used to investigate patient ambulation in a major medical center. Data from 12 interviews with interdisciplinary leaders were analyzed.

RESULTS

Staff shortages and visitor restrictions were identified as the main work system barriers to ambulation. These barriers disrupted usual ambulation processes and supported the value of visitor assistance with ambulation.

CONCLUSIONS
This study provides a systems-level perspective of missed ambulation during COVID-19, which revealed the value of ambulation assistance provided by visitors. Findings may be used to support the continued and increased involvement of family members and visitors in the process of ambulation.
Leadership Styles and Nurses' Innovative Behaviors
Authors: Labrague Leodoro J. , Toquero Lei Marcelle 
Published: September 2023

OBJECTIVE
In an increasingly competitive healthcare climate, ensuring an innovative nursing workforce is essential for organizational success and survival.

BACKGROUND
The authors aimed to evaluate the literature examining the association between leadership styles and innovative behaviors in the nursing workforce.

METHODS
A systematic review of articles from 5 databases was conducted from August 2022 to October 2022.

RESULTS
A total of 21 articles published in the English language were included in the review. This study provides evidence for the vital role of “relationship-oriented” leadership styles in fostering innovative behaviors among nurses. However, more research is needed to examine how “task-oriented” leadership styles contribute to innovativeness in nurses. Twelve mediators linking leadership styles to healthcare workers' innovative behaviors were identified and clustered into motivation-based, relation-based, and affective mediators.

CONCLUSION
Organizational strategies to foster relationship-based leadership styles among healthcare leaders are vital to support nurses' innovative behaviors.
The Utility of the Schnur Sliding Scale in Adolescent Patients
Authors: Donnenfield Jonah I. , Nuzzi Laura C. , McNamara Catherine T. , White Ava G. , Labow Brian I. 
Published: September 2023

Background:
Although the Schnur Sliding Scale (SSS) was not intended to be used by third-party payors, it has become the national standard for coverage decisions regarding macromastia treatment in patients of all ages. Adolescents were neither included in the cohort that created the SSS nor represented in subsequent validation studies.

Methods:
In this prospective study, health-related quality of life surveys were administered to girls and young women 12 to 21 years of age before and after reduction mammaplasty to treat macromastia. The SSS was used preoperatively to estimate the amount of tissue to be resected. Before and after surgery, participants completed the Short Form–36, version 2 (SF-36); the Rosenberg Self-Esteem Scale (RSES); the Breast-Related Symptoms Questionnaire (BRSQ); and the Eating Attitudes Test–26. Demographic data were compared, and linear regressions were used to evaluate the effect of resection amounts meeting the SSS value on survey scores.

Results:
Resection amounts fell below the SSS for 39 patients and above the SSS for 255 patients. The 2 groups had no differences in mean age or body mass index. Both groups had significant postoperative survey score improvements on the RSES, BRSQ, and 7 of 8 SF-36 domains (all P < 0.05). The groups had comparable postoperative survey scores on the RSES, BRSQ, and 8 of 8 SF-36 domains (all P > 0.05).

Conclusions:
Adolescents undergoing reduction mammaplasty above and below the SSS experienced comparable physical and psychosocial benefits. These findings underscore the need for third-party payors to broaden coverage for adolescent reduction mammaplasty, as the common coverage cutoff has no effect on overall postoperative benefit.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, II.
Complications and Associated Risk Factors for Bimaxillary Osteotomies: A 15-Year Single-center Retrospective Study
Authors: Kotaniemi Karoliina V.M. , Suojanen Juho , Palotie Tuula 
Published: September 2023

Aim:
The aim of this study was to retrospectively investigate the risk factors and their association on bimaxillary osteotomies to be able to improve patient selection and bimaxillary osteotomy planning.

Material and Methods:
Patients treated with a bimaxillary osteotomy were included in the study. The complications were collected retrospectively from the patient data records. The effects of certain predictor variables on complication rates were also studied.

Results:
Sixty-one patients (48.0%) suffered from peri- or postoperative complications, or both. Twenty-five various perioperative complications were reported on 25 patients (19.6%) and 63 postoperative complications on 46 patients (36.2%). Ten patients (7.8%) suffered from both perioperative and postoperative complications. The effect of various predictor variables (sex, age, general health, type of malocclusion, surgery planning, use of bone grafts, and type of maxillary or mandibular movement) on complications was investigated, but we could not find any single factor to affect significantly on complication rate.

Conclusion:
Both perioperative and postoperative complications are common in bimaxillary surgery, which must be noted in patient preoperative information. However, life-threatening complications are rare. Patient profile, bone grafting, type of osteosynthesis, or segmentation of the maxilla do not seem to affect the complication risk.
Realgar toxicity in terms of its chemical characterization, pharmacological mechanisms, and metabolic profile: A review
Authors: Yi Yan , Li Chunying , Zhao Yong , Liang Aihua 
Published: September 2023

Abstract
Realgar is an arsenic-containing Chinese medicine known for its toxin-removing, phlegm-dispelling, and malaria-intercepting effects. It has proven to be effective in the treatment of acute promyelocytic leukemia. However, because of the harmful nature of arsenic to human health, realgar is considered a “poison” in many countries, raising concerns about the toxicity and safety of realgar and its preparations. The Shuifei process (grinding with water) of realgar plays a crucial role in ensuring its safety as a Chinese medicine. The major ingredient of realgar, As4S4, is water insoluble and poorly absorbed by the human body. Therefore, it is important to note that the toxicity and health risks of realgar to humans are overestimated by solely considering the amount of arsenic. Realgar processing is an indispensable method to ensure the quality of medicinal realgar, involving purification, powdering, detoxification, and synergism. This article not only highlights possible mechanisms through which realgar exerts pharmacological effects but also reviews the literature regarding its toxic features and potential mechanisms. Currently, realgar toxicity research primarily relies on animal experiments, and clinical data on its adverse reactions are relatively limited. The toxicity of arsenic is closely related to the form and valence of its major metabolites in the body. Animal studies have confirmed that, when realgar enters the body, the major form of arsenic metabolized is dimethylarsenic acid; therefore, it was considered that the toxicity of realgar induced by high doses might be associated with the accumulation of dimethylarsenic acid produced in the methylation pathway of inorganic arsenic. Realgar is generally less toxic when used in safe doses, but prolonged use may pose a significant risk. It is rarely used alone and is often combined with other Chinese medicines in an attempt to reduce toxicity. Scientifically and reasonably limiting the arsenic content of realgar-containing Chinese patent medicines is an effective way to improve the safety of realgar in clinical medication.
Qingjin Huatan decoction attenuates lipopolysaccharide-induced acute lung injury in mice by controlling platelet-associated formation of neutrophil extracellular traps
Authors: Xiao Shunli , Wang Yilin , Liu Lu , Sun Zhengxiao , Xu Jing , Yin Xiaojie , Wang Xin , Liao Fulong , You Yun , Zhang Huamin 
Published: September 2023

Abstract

Background
Acute lung injury (ALI) is a severe and life-threatening lung inflammation with high morbidity and mortality, underscoring the importance to develop effective drugs. Qingjin Huatan decoction (QJHTD), as a classic ancient prescription, has been widely used for treating respiratory diseases. However, the role and mechanism of QJHTD against ALI remain unclear.

Objective
This study aimed to explore the therapeutic effect of QJHTD on lipopolysaccharide (LPS)-induced ALI in mice and uncover its mechanism.

Methods
The therapeutic effect of QJHTD on LPS-induced ALI in mice was evaluated by the histopathological changes in the lung tissue, the lung wet/dry weight ratio, and the levels of inflammatory cytokines and thrombin-antithrombin complexes. Transcriptomics was used to predict the mechanism of QJHTD in treating ALI. The expression levels of citrullinated histone 3 in the lung tissue, the content of cell-free DNA in the bronchoalveolar lavage fluid (BALF), and the platelet-associated formation of neutrophil extracellular traps (NETs) in vitro were determined.

Results
Qingjin Huatan decoction exerted protective effect against LPS-induced ALI by suppressing interstitial edema, maintaining the alveolar-capillary barrier, inhibiting the infiltration of neutrophils and platelets in the lung tissue, and lowering the levels of tumor necrosis factor α, interleukin 1β, interleukin 6, and thrombin-antithrombin complexes in BALF. Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis indicated that the formation of NETs was the main regulatory pathway for QJHTD against ALI. Qingjin Huatan decoction could treat ALI by inhibiting the release of NETs via reducing the content of citrullinated histone 3 in lung tissue and cell-free DNA in BALF in vivo, and suppressing the NETs formation induced by LPS-stimulated platelets under flow and static conditions in vitro. The formation of NETs was considered to bridge the interactions between neutrophils and platelets.

Conclusions
This research demonstrated the effects of QJHTD in treating ALI and provided new insights for clarifying the complex regulation of neutrophils, platelets, and NETs in ALI.
Emerging trend of Vancomycin Resistant Enterococcal Bacteremia in a university hospital in Northern India – An observational analysis
Authors: Sarawat Deepika , Varghese Gerlin , Jamwal Ashima , Patel Sangram Singh , Tejan Nidhi , Sahu Chinmoy 
Published: September 2023

Introduction: Vancomycin Resistant Enterococcus (VRE) species has been increasing and is now of serious concern. timely analysis of VRE bacteremia must be done in every institution to find the pattern of VRE prevalence.
Aim: To find the prevalence of VRE bacteremia at our institution. Also, the demographic pattern, associated risk factors, sensitivity pattern and outcomes associated with bacteremia caused by VRE were also estimated.
Methods: This observational study was done in the Microbiology department of our institute from April 2022 to June 2023. All patients with blood cultures positive for Enterococcus species for the first time during the study period were included in the study. The Blood culture bottles were loaded in the BACT/ALERT system. Once the bottle flagged a positive signal, culture was done and Gram staining was done. Identification was done using MALDI-Tof MS. Antimicrobial Sensitivity Testing was done by Kirby Bauer disk diffusion method and interpreted using Clinical and Laboratory Standards Institute (CLSI) 2023 M-100 clinical breakpoints. The demographic details, risk factors, and the clinical outcome of the patients included in the study were collected and analyzed.
Results: During the study period, 29086 blood culture bottles were received. Of these, 2016 (6.93%) bottles flagged positive. Enterococcus species were isolated from 256 (12.69%) blood cultures. Of the 256 Enterococcus isolates, 45 (17.57%) isolates were Vancomycin Resistant Enterococcus (VRE). The most common species isolated were Enterococcus faecium (n=42; 93.33%), followed by Enterococcus faecalis (n=2; 4.44%) and Enterococcus gallinarum (n=1; 2.22%). Most of the patients belonged to the age group 41-60 years (n=14; 31.11%). Male:Female ratio was 1.25:1. Diabetes mellitus and neutropenia were found to be significant risk factors among patients with VRE bacteremia. All the isolates showed 100% resistance to Teicoplanin, Ampicillin, Ampicillin-sulbactam and Levofloxacin. In 29 (64.44%) patients, bacteremia was the cause of death. On univariate analysis, mortality was found to be significantly higher in patients with Vancomycin Resistant Enterococcal (VRE) bacteremia as compared to patients with Vancomycin Sensitive Enterococcal (VSE) bacteremia.
Conclusion: An increasing prevalence of VRE bacteremia was observed in the study. Proper implementation of antimicrobial stewardship rules in the hospital is the best way to overcome the increasing trend of resistance.
Automated Deep Learning-Based Diagnosis and Molecular Characterization of Acute Myeloid Leukemia using Flow Cytometry
Authors: Lewis Joshua E. , Cooper Lee A.D. , Jaye David L. , Pozdnyakova Olga 
Published: September 2023

ABSTRACTCurrent flow cytometric analysis of blood and bone marrow samples for diagnosis of acute myeloid leukemia (AML) relies heavily on manual intervention in both the processing and analysis steps, introducing significant subjectivity into resulting diagnoses and necessitating highly trained personnel. Furthermore, concurrent molecular characterization via cytogenetics and targeted sequencing can take multiple days, delaying patient diagnosis and treatment. Attention-based multi-instance learning models (ABMILMs) are deep learning models which make accurate predictions and generate interpretable insights regarding the classification of a sample from individual events/cells; nonetheless, these models have yet to be applied to flow cytometry data. In this study, we developed a computational pipeline using ABMILMs for the automated diagnosis of AML cases based exclusively on flow cytometric data. Analysis of 1,820 flow cytometry samples shows that this pipeline provides accurate diagnoses of acute leukemia [AUROC 0.961] and accurately differentiates AMLversusB- and T- lymphoblastic leukemia [AUROC 0.965]. Models for prediction of 9 cytogenetic aberrancies and 32 pathogenic variants in AML provide accurate predictions, particularly for t(15;17)(PML::RARA) [AUROC 0.929], t(8;21)(RUNX1::RUNX1T1) [AUROC 0.814], andNPM1variants [AUROC 0.807]. Finally, we demonstrate how these models generate interpretable insights into which individual flow cytometric events and markers deliver optimal diagnostic utility, providing hematopathologists with a data visualization tool for improved data interpretation, as well as novel biological associations between flow cytometric marker expression and cytogenetic/molecular variants in AML. Our study is the first to illustrate the feasibility of using deep learning-based analysis of flow cytometric data for automated AML diagnosis and molecular characterization.
Dynamics of endogenous and water cortisol release in Asian SeabassLates calcariferafter acute stress in a farm scale recirculating aquaculture system
Authors: Tan Marie Ruoyun , Aung Khin Moh Moh , Salleh Nur Asinah binte Mohamed , Tan Jolin Yean Ai , Chua Kai Xin , Doblado Gaynah Javier , Chua Kai Lin , Tham Valarie , Lin Jovian Jing , Chaganty Vindhya , Yusoff Dinah Mardhiana , Vij Shubha , Su Xiaodi , Sutarlie Laura , Wee Caroline Lei 
Published: September 2023

AbstractStress in farmed fish is associated with poor feeding, slow growth, disease, and mortality. Therefore, it is essential to closely monitor the stress levels in fish to optimize farming practices which could then enhance productivity and welfare in aquaculture operations. Cortisol, a stress hormone that can be found in the blood, is a reliable biomarker for evaluating fish stress. As blood sampling is highly invasive, alternative cortisol sampling methods such as fin, mucus, and the surrounding water which contains released cortisol, have been proposed as less invasive or non-invasive sampling methods. However, a comprehensive understanding of their temporal dynamics and associations with plasma cortisol levels is still lacking. In this study, we subjectedLates calcarifer, Asian sea bass within a farm-scale (3,000 L tank, 9,000 L system) high-flow rate (8,000 L/hour) Recirculating Aquaculture System (RAS) to an acute handling stress challenge specifically involving chasing and air exposure, and quantified cortisol dynamics both within different biological samples including blood, fin, and mucus and in tank water from multiple sampling points. We showed that handling stress induced an expected increase in plasma and mucosal cortisol, peaking at 1 hour and 24-48 hours, respectively, and that plasma and mucus cortisol were moderately correlated, especially during the stress period. Fin cortisol did not show consistent dynamics. Water cortisol similarly rose, but peaked within 40 minutes from the start of the stressor, in a pattern that was dependent on the site of sampling within the RAS system, likely due to RAS circulation dynamics. Our study is the first to examine the impact of stress on cortisol accumulation and release in Asian Sea bass in a farm-scale RAS, thus complementing existing research on the efficacy of fin, mucus, and water cortisol as stress indicators that could help optimize aquaculture productivity and welfare.
Disparities of Female Authorship in Colombia: A 5-year Cross-sectional Analysis
Authors: Gutierrez-Torres Maria Alejandra , Ruiz Silvana , Morales Karen , Serpa Frans , Rincon Laura , Gómez Camila , Ahrens Michelle M. , Duran Felipe , Manzano Abul Ariza , Callegari Santiago 
Published: September 2023

AbstractAccepted medical journal manuscripts serve as the primary currency of the scientific community. Over the past few decades, there has been a gradual increase in the number of women entering the medical field. However, women remain underrepresented as first and last authors in medical journals. This lack of representation makes it harder for them to reach leadership roles and advance in their academic careers. Therefore, this study aims to investigate the gender distribution among authors and explore disparities in authorship in relation to the type of publication (original research, case reports, and review articles) as well as the authors’ geographic locations. Our analysis included 6,088 articles from 54 research journals sourced from Colombia’s Ministry of Health official website. These articles were predominantly original research articles, although case reports and reviews were also present. The analysis specifically focused on published research articles, as they are extensively studied in existing literature. Until now, there has been no assessment of gender disparities in authorship within medical and surgical specialty journals in Colombia. We could evidence persistent gender disparity in primary authorship in Colombia, regardless of the timeframe, location, or field of study. This emphasizes the urgent need for enhanced support for female researchers and equitable resource allocation to rectify regional imbalances. Furthermore, our findings highlight the imperative need to address gender disparities in authorship in medical and surgical research articles in Colombia and other Latin American countries.
Sleep quality worsened in an evening chronotype compared to others: a year-long longitudinal cohort study with prolonged lockdowns and restriction relaxations in RECETOX MU university employees
Authors: Ráčková Lucie , Kuruczová Daniela , Štěpaníková Irena , Bienertová-Vašků Julie 
Published: September 2023

AbstractBackgroundIn 2020, people around the world were challenged by the outbreak of the COVID-19 pandemic. Countries responded with various restrictions, including lockdowns and stay-at-home orders, in an attempt to prevent the spread of the disease. Citizens were thus subjected to unprecedented uncertainty and stress. Prolonged exposure to such conditions may impact human health and well-being. One of the core aspects of proper physiological functioning is sleep. This prospective longitudinal study aims to investigate sleep quality and its relationship to chronotype over a year-long period from September 2020.Methods and findingsOur year-long longitudinal prospective study focused on an employee cohort (N=54) at the Research Centre for Toxic Compounds in the Environment (RECETOX) of Masaryk University in the Czech Republic. During the first half of this period, three lockdowns with a cumulative duration of 100 days were imposed. During the second half of this period, the imposed restrictions were relaxed. Individuals were measured quarterly, i.e. at five time points. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI) while chronotype was established using the Reduced Morningness-Eveningness Questionnaire (rMEQ). We also used Perceived Stress Scale (PSS-14), Beck Depression Inventory (BDI-II), and General Anxiety Disorder-7 (GAD-7) to address potential confounders. The response rates of valid measurements across time points ranged from 87.04 % to 61.11 %. Our results show that sleep quality significantly worsened across the year for the evening chronotype but improved for the neutral and early chronotypes. Overall, over the year the incidence of poor sleep decreased by 16.13 % with 95% CI [-6.10%; 37.16%]. We did not find any significant sex differences in sleep quality. Perceived stress, symptoms of anxiety and depression were positively significantly associated with sleep problems in all measurements except in June. This study is limited by the small sample, decreasing number of individuals in chronotype categories and the lack of information on napping behavior.ConclusionThese findings shed new light on the long-term influence of pandemic-related restrictions on individuals and particularly on the potentially more vulnerable evening chronotypes.