bluuebunny/crossref_metadata_2025_split huggingface dataset:
Erector spinae plane block improves postoperative recovery after laminectomy and discectomy surgery: a retrospective cohort study
Authors: van den Broek Renee J. C. , van Meegen Valerie M. M. , Al Khawaja Hazem , Bouwman R. Arthur , Versyck Barbara 
Published: September 2023

Abstract
Background
There is still room for improvement of pain management after spinal surgery. The goal of this study was to evaluate adding the erector spinae block to the standard analgesia regimen. Our hypothesis was that the erector spinae plane block will decrease length of hospital stay, reduce opioid need and improve numeric rating scale pain scores.

Methods
This was a single center retrospective cohort study. We included 418 patients undergoing laminectomy or discectomy from January 2019 until December 2021. The erector spinae plane block was introduced in 2016 by Forero and colleagues and added to our clinical practice in October 2020. Patients who did not receive an erector spinae plane block prior to its implementation in October 2020 were used as control group. The primary outcome measure was functional recovery, measured by length of hospital stay. Secondary outcome measures were perioperative opioid consumption, need for patient-controlled analgesia and numeric rating scale pain scores. Postoperative data collection time points were: at the PACU and after 3, 6, 12 and 24 h postoperatively.

Results
There was a significant shorter length of hospital stay in patients undergoing single level laminectomy (with erector spinae plane block 29 h (IQR 27–51), without block 53 h (IQR 51–55), p < .001), multiple level laminectomy (with erector spinae plane block 49 h (IQR 31–54), without block 54 h (IQR 52–75), p < .001) and discectomy (with erector spinae plane block 27 h (IQR 25–30), without block 29 h (IQR 28–49), p = .04).

Conclusions
Erector spinae plane block reduces length of stay after laminectomy surgery.
The STEPWISE study: study protocol for a smartphone-based exercise solution for people with Parkinson’s Disease (randomized controlled trial)
Authors: Schootemeijer Sabine , de Vries Nienke M. , Macklin Eric A. , Roes Kit C.B. , Joosten Hilde , Omberg Larsson , Ascherio Alberto , Schwarzschild Michael A. , Bloem Bastiaan R. 
Published: September 2023

Abstract
Background
Exercise has various health benefits for people with Parkinson’s disease (PD). However, implementing exercise into daily life and long-term adherence remain challenging. To increase a sustainable engagement with physical activity of people with PD, interventions that are motivating, accessible, and scalable are needed. We primarily aim to investigate whether a smartphone app (STEPWISE app) can increase physical activity (i.e., step count) in people with PD over one year. Our second aim is to investigate the potential effects of the intervention on physical fitness, and motor- and non-motor function. Our third aim is to explore whether there is a dose-response relationship between volume of physical activity and our secondary endpoints.

Methods
STEPWISE is a double-blind, randomized controlled trial. We aim to include 452 Dutch people with PD who can walk independently (Hoehn & Yahr stages 1–3) and who do not take more than 7,000 steps per day prior to inclusion. Physical activity levels are measured as step counts on the participant’s own smartphone and scaled as percentage of each participant’s baseline. Participants are randomly assigned to an active control group with an increase of 5–20% (active controls) or any of the three intervention arms with increases of 25–100% (intermediate dose), 50–200% (large dose), or 100–400% (very large dose). The primary endpoint is change in step count as measured by the STEPWISE smartphone app from baseline to 52 weeks. For our primary aim, we will evaluate the between-group difference in average daily step count change from baseline to 52 weeks. For our second aim, measures of physical fitness, and motor- and non-motor function are included. For our third aim, we will associate 52-week changes in step count with 52-week changes in secondary outcomes.

Discussion
This trial evaluates the potential of a smartphone-based intervention to increase activity levels in people with PD. We envision that motivational apps will increase adherence to physical activity recommendations and could permit conduct of remote clinical trials of exercise for people with PD or those at risk of PD.

Trial registration
ClinicalTrials.gov; NCT04848077; 19/04/2021. Clinicaltrials.gov/ct2/show/NCT04848077.
Developing an evaluation indicators of health literacy for cervical cancer among Chinese women: a modified Delphi method study
Authors: He Chanchan , Pei Chenyang , Ma Jing 
Published: September 2023

Abstract
Background
Increasing women’s health literacy is the key to preventing cervical cancer, and various tools have been developed to assess women’s cancer health literacy. However, many of these tools come from other countries and have not been adapted to Chinese requirements. Furthermore, a system for evaluating cervical cancer health literacy among Chinese women has not been developed. Therefore, we sought to establish an evaluation index system for cervical cancer health literacy among Chinese women and to provide an effective evaluation tool for tertiary prevention of cervical cancer in China.

Methods
We invited 20 recognized experts to participate in two rounds of Delphi expert consultation, and the modified Delphi process with percentage weighting and multiplication was used. A literature review identified 67 potential indicators. Subsequent discussions within our research team led to the retention of 48 indicators following a rigorous screening process. On this basis, two rounds of Delphi expert consultation were conducted to rate and screen the indexes. Percentage weighting and multiplication were used to determine index weights.

Results
Twenty experts participated in the first-round Delphi consultations (95.23% recovery rate). In the second-round Delphi consultations, 20 questionnaires were returned (100%), and the expert authority coefficient was 0.93 ± 0.02. After both rounds of Delphi consultation, 4 first-level indicators, 9 second-level indicators, and 32 third-level indicators were identified for cervical cancer literacy among Chinese women. On a five-point scale, importance ratings ranged from 3.76 to 4.95 points, with variation coefficients ranging from 0.06 to 0.25, while sensitivity ratings ranged from 3.71 to 4.83 points, with variation coefficients ranging from 0.08 to 0.24. Across both rounds, Kendall’s W coefficients ranged from 0.168 to 0.248. The weights of first-level indicators of basic knowledge and attitudes about cervical cancer, primary prevention of cervical cancer literacy, secondary prevention of cervical cancer literacy, and tertiary prevention of cervical cancer literacy were 0.257, 0.249, 0.251, and 0.243, respectively.

Conclusions
We have developed the first tertiary prevention-based, comprehensive evaluation index system for cervical cancer literacy among Chinese women, which will provide theoretical support for cervical cancer prevention and health education programs.
Integrative analysis of the prognostic value and immune microenvironment of mitophagy-related signature for multiple myeloma
Authors: Jia Yachun , Liu Rui , Shi Luyi , Feng Yuandong , Zhang Linlin , Guo Ni , He Aili , Kong Guangyao 
Published: September 2023

Abstract
Background
Multiple myeloma (MM) is a fatal malignant tumor in hematology. Mitophagy plays vital roles in the pathogenesis and drug sensitivity of MM.

Methods
We acquired transcriptomic expression data and clinical index of MM patients from NCI public database, and 36 genes involved in mitophagy from the gene set enrichment analysis (GSEA) database. Least absolute shrinkage and selection operator (LASSO) Cox regression analysis was conducted to construct a risk score prognostic model. Kaplan–Meier survival analysis and receiver operation characteristic curves (ROC) were conducted to identify the efficiency of prognosis and diagnosis. ESTIMATE algorithm and immune-related single-sample gene set enrichment analysis (ssGSEA) was performed to uncover the level of immune infiltration. QRT-PCR was performed to verify gene expression in clinical samples of MM patients. The sensitivity to chemotherapy drugs was evaluated upon the database of the genomics of drug sensitivity in cancer (GDSC).

Results
Fifty mitophagy-related genes were differently expressed in two independent cohorts. Ten out of these genes were identified to be related to MM overall survival (OS) rate. A prognostic risk signature model was built upon on these genes: VDAC1, PINK1, VPS13C, ATG13, and HUWE1, which predicted the survival of MM accurately and stably both in training and validation cohorts. MM patients suffered more adverse prognosis showed more higher risk core. In addition, the risk score was considered as an independent prognostic element for OS of MM patients by multivariate cox regression analysis. Functional pathway enrichment analysis of differentially expressed genes (DEGs) based on risk score showed terms of cell cycle, immune response, mTOR pathway, and MYC targets were obviously enriched. Furthermore, MM patients with higher risk score were observed lower immune scores and lower immune infiltration levels. The results of qRT-PCR verified VDAC1, PINK1, and HUWE1 were dysregulated in new diagnosed MM patients. Finally, further analysis indicated MM patients showed more susceptive to bortezomib, lenalidomide and rapamycin in high-risk group.

Conclusion
Our research provided a neoteric prognostic model of MM based on mitophagy genes. The immune infiltration level based on risk score paved a better understanding of the participation of mitophagy in MM.
Association of waist-calf circumference ratio, waist circumference, calf circumference, and body mass index with all-cause and cause-specific mortality in older adults: a cohort study
Authors: Dai Miao , Xia Bin , Xu Jiangqi , Zhao Weiyun , Chen Dongdong , Wang Xiang 
Published: September 2023

Abstract
Background
Waist circumference (WC), calf circumference (CC), and body mass index (BMI) have been independently linked to mortality. However, it's not yet clear how the waist-calf circumference ratio (WCR) relates to mortality. This study aims to investigate the relationship between WCR, WC, CC, and BMI with all-cause and cause-specific mortality in older adults.

Methods
In the 2014 Chinese Longitudinal Healthy Longevity Survey, 4627 participants aged 65 years and older were included, and they were subsequently followed up in 2018. Cox proportional hazards models were utilized to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and cause-specific mortality, based on WCR, WC, CC, and BMI.

Results
During a median follow-up of 3.4 years, 1671 deaths (36.1%) occurred. Compared to the second quartile of WCR, the highest quartile had a higher risk of mortality from all causes (HR 1.42, 95%CI 1.24–1.64), cardiovascular disease (CVD) (HR 1.88, 95%CI 1.38–2.56), and other causes (HR 1.37, 95%CI 1.15–1.63). The first and fourth quartiles of WC had HRs of 2.19 (1.00–4.79) and 2.69 (1.23–5.89), respectively, for cancer mortality. The highest quartile of CC was associated with a lower risk of all-cause and other-cause mortality, whereas the lowest quartile was associated with a higher risk of all-cause, CVD, and other-cause mortality compared to the second CC quartile. Additionally, the lowest quartile of BMI was associated with a higher risk of all-cause and respiratory disease mortality. Interaction analyses showed that the effects of CC on all-cause and CVD mortality were more pronounced in adults aged ≥ 80 years (P-interaction < .05).

Conclusions
Higher WCR and lower CC increased the risk of all-cause, CVD, and other-cause mortality. Lower BMI was associated with higher all-cause and respiratory disease mortality risk, while WC only predicted cancer mortality.
A prospective study of extraesophageal reflux and potential microaspiration in patients hospitalized with COVID-19 in Jordan
Authors: Al-Momani Hafez , Mashal Safaa , Al Balawi Dua’a , Almasri Muna , AL-Shudifat Abdel-Ellah , Khasawneh Ashraf I , Pearson Jeffrey , Ward Christopher 
Published: September 2023

Abstract
Background
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) lung infection has represented a global challenge. Intriguingly, it has been shown that the alveolar lung epithelium expresses little Angiotensin Converting Enzyme receptor protein (ACE2), the entry receptor for SARS-CoV-2. Upper airway establishment of infection and translocation to the lung is well documented but other anatomical niches may be relevant to potentially serious lung infection. ACE2 is heavily expressed in the gastrointestinal tract and gastrointestinal symptoms support a clinical diagnosis of Coronavirus disease 2019 (COVID-19). This suggests a research question and the need to gather patient data exploring potential aerodigestive links in SARS-CoV-2 tranlocation and infection which may be relevant in the peripheral lung. This recognizes anatomical proximity and concepts of bi-directional movement between the Gastrointestinal and lung systems in normal physiology and disease. We have therefore explored the potential for gastro oesophageal reflux disease (GORD) micro aspiration and aeorodigestive pathophysiology in a novel prospective investigation of patients hospitalized with COVID-19.

Methods
This is a prospective descriptive cohort study of 210 patients who were hospitalized with a confirmed diagnosis of COVID-19. The cohort was divided into three groups of patients based on symptom severity and radiological results. The Reflux Symptom Index (RSI) was used to evaluate the presence and severity of GOR. An RSI greater than 13 is considered to be abnormal. Patients’ saliva samples were tested using enzyme-linked immunosorbent assay (ELISA) to determine the level of salivary pepsin among the cohort of patients.

Results
A total of 210 patients with COVID-19 were enrolled in the study with 55.2% (116/210) classified as mildly ill, 31.9% (67/210) moderately ill and 12.9% (27/210) as severely ill. 34% (72/210) of the patients had an RSI score of over 13 and a median salivary pepsin value of 54 ± 29 ng/ml which suggested an incidence of extraesophageal reflux (EOR) in around a third of patients. The presence of respiratory comorbid conditions, an RSI score of over 13 and a salivary pepsin level of > 76ng/ml increased the risk of developing a more severe COVID-19 infection.

Conclusion
The study showed a high prevalence of EOR among the study cohort and provide the first prospective evidence suggesting the potential for aerodigestive pathophysiology including microaspiration in COVID-19 disease. We believe that the results of our study support the need for more extensive research.
Implementing One-at-a-Time Therapy in community addiction and mental health centres: a retrospective exploration of the implementation process and initial outcomes
Authors: Harris-Lane Laura M. , Keeler-Villa Natalie R. , Bol Alexa , Burke Katie , Churchill AnnMarie , Cornish Peter , Fitzgerald Sarah F. , Goguen Bernard , Gordon Kristina , Jaouich Alexia , Lang Rino , Michaud Mylène , Mahon Kaitlyn N. , Rash Joshua A. 
Published: September 2023

Abstract
Background
The Department of Health of the Government of New Brunswick and Regional Health Authorities elected to implement Stepped Care 2.0 (SC2.0) in 2021, and began with One-at-a-Time (OAAT) therapy in Community Addiction and Mental Health Centres (CAMHCs) to facilitate rapid access to addiction and mental healthcare. This study: 1) explicated the process of implementing OAAT therapy as it aligned to evidence-based implementation frameworks and strategies; 2) assessed readiness for change among providers during the implementation; and 3) evaluated initial client and system outcomes.

Methods
The process of implementing OAAT therapy within CAMHCs was documented and retrospectively aligned with the Active Implementation Frameworks-Stages of Implementation, Consolidated Framework for Implementation Research, and incorporated strategies endorsed by the Expert Recommendations for Implementing Change. Providers working in CAMHCs completed online asynchronous courses in OAAT therapy and SC2.0, and were recruited to participate in research on perceptions of organizational readiness. Initial outcomes of the implementation were evaluated through client satisfaction surveys administered in CAMHCs and system performance indicators.

Results
Aligning with implementation stages, key strategies included: 1) continuously monitoring readiness and soliciting stakeholder feedback for iterative improvement; 2) building a representative implementation team with engaged leaders; 3) creating a comprehensive implementation plan on staff training, communication, and system changes; and 4) supporting sustainability. Providers who participated in research (N = 170, ~ 50% response rate) agreed that their organization was ready for implementation, and that OAAT therapy delivered within a SC2.0 framework was acceptable, appropriate, and feasible. More than 3,600 OAAT therapy sessions were delivered during the initial implementation stage, and waitlists were reduced by 64.1%. The majority of clients who completed surveys (N = 1240, ~ 35% response rate) reported that their OAAT therapy session was helpful, with a minority reporting that additional intervention was needed.

Conclusions
Thoughtful planning and execution, aligned with evidence-based implementation frameworks and strategies, played an important role in this provincial change initiative. Implementation steps outlined can help inform others looking to enact large-scale change.
Effects of different running intensities on the micro-level failure strain of rat femoral cortical bone structures: a finite element investigation
Authors: Fan Ruoxun , Liu Jie , Jia Zhengbin 
Published: September 2023

Abstract
Background
Running with the appropriate intensity may produce a positive influence on the mechanical properties of cortical bone structure. However, few studies have discussed the effects of different running intensities on the mechanical properties at different levels, especially at the micro-level, because the micromechanical parameters are difficult to measure experimentally.

Methods
An approach that combines finite element analysis and experimental data was proposed to predict a micromechanical parameter in the rat femoral cortical bone structure, namely, the micro-level failure strain. Based on the previous three-point bending experimental information, fracture simulations were performed on the femur finite element models to predict their failure process under the same bending load, and the micro-level failure strains in tension and compression of these models were back-calculated by fitting the experimental load–displacement curves. Then, the effects of different running intensities on the micro-level failure strain of rat femoral cortical bone structure were investigated.

Results
The micro-level failure strains of the cortical bone structures expressed statistical variations under different running intensities, which indicated that different mechanical stimuli of running had significant influences on the micromechanical properties. The greatest failure strain occurred in the cortical bone structure under low-intensity running, and the lowest failure strain occurred in the structure under high-intensity running.

Conclusions
Moderate and low-intensity running were effective in enhancing the micromechanical properties, whereas high-intensity running led to the weakening of the micromechanical properties of cortical bone. Based on these, the changing trends in the micromechanical properties were exhibited, and the effects of different running intensities on the fracture performance of rat cortical bone structures could be discussed in combination with the known mechanical parameters at the macro- and nano-levels, which provided the theoretical basis for reducing fracture incidence through running exercise.
Self-reported continuing professional development needs of medical laboratory professionals in Ghana
Authors: Essuman Mainprice Akuoko , Addy Nii Armah , Essien-Baidoo Samuel , Donkoh Irene Esi , Botchway Felix A. , Afrifa Justice , Agyeman Prince , Amaama Leticia Awontayami , Amoah Samuel , Sorvor Felix B. K. , Ephraim Richard K. D. 
Published: September 2023

Abstract
Background
Because of the essential nature of the work of medical laboratory professionals, continuing development in knowledge and skills is indispensable. The study aimed at identifying and prioritizing the development and training needs of medical laboratory professionals in Ghana. This is expected to help in developing focused continuing professional development (CPD) that meets the needs of practitioners as well as the changing medical trends.

Methods
An online cross-sectional survey in February 2022 using a structured questionnaire was conducted. Respondents were asked questions that collected demographic and work-related data about them, their participation, preference, and challenges in being part of CPDs. Finally, a list of topics based on (i) quality management systems, (ii) technical competence, (iii) laboratory management, leadership, and coaching, (iv) pathophysiology, and (iv) data interpretation and research were asked with the option to rate them on a 3-point scale (most, moderate, and least) in order of importance.

Results
A total of 316 medical laboratory professionals participated in the study. Overall, the most frequently selected topics for training based on domains for CPD training and ranking as most important were (i) quality management systems, (mean = 80.59 ± 9.024; 95% CI = 73.04–88.13); (ii) pathophysiology, data interpretation, and research (mean = 78.0 ± 6.973; 95% CI = 73.97–82.03); (iii) technical competence (mean = 73.97 ± 10.65; 95% CI = 66.35–81.59); and (iv) laboratory management, leadership, and coaching (mean = 72.82 ± 9.719; 95% CI = 67.44–78.2). The factors affecting the choice of training needs included the medical laboratory professionals’ current place of work, years in service, the reason for attending CPD activities, the period for attending the last CPD, being in a supervisory role, and the number of staff being supervised. Face-to-face presentations, training workshops, and hands-on workshops were the most preferred modes of CPD delivery with financial implications and workload/time constraints being the main challenges impeding CPD participation.

Conclusion
The identified needs will help in developing CPD programs that address what medical laboratory professionals prioritize as training needs. Stakeholders should incorporate these training needs into future programs and address the challenges highlighted in this study to have more relevant training for medical laboratory professionals.