bluuebunny/crossref_metadata_2025_split huggingface dataset:
Design and evaluation of an educational mobile program for liver transplant patients
Authors: Langarizadeh Mostafa , Moghbeli Fateme , Ahmadi Shamim , Langarizadeh Mohammad Hossein , Sayadi Mohammadjavad , Sarpourian Fatemeh , Fatemi Aghda Seyed Ali 
Published: September 2023

Abstract
Background
Liver transplantation, the last treatment for advanced liver failure, necessitates patient education due to its wide range of complications and subsequent disabilities. The present study was development-applied research and aimed to design a mobile-based educational program to provide liver transplant patients with critical health information.

Methods
In the first phase of the study, the crucial educational components were collected from the literature and organized in the form of a questionnaire using library studies and available global guidelines. The validity and reliability of this researcher-made questionnaire were confirmed by a panel of experts (n = 15), including gastroenterologists and liver specialists working in the Motahari liver clinic and AbuAli Sina Hospital in Shiraz. The application was designed followed by analyzing the data gathered from the first phase. To evaluate the mobile phone program’s usability, to evaluate the application, 30 liver transplant patients were randomly selected.

Results
Most educational components covered in the questionnaire were deemed necessary by experts in the first phase. As a result, the educational contents were classified under 10 categories. The application had a good level of usability since the participants’ satisfaction score was 8.1 (out of 9 points).

Conclusions
Due to the increase in liver transplantation and the use of mobile phones, applications increase the patient’s role in their health, and their awareness. It also leads to a better interaction and follow-up of the patient, the treatment staff of the medical centers.
Assessment of magnitude and associated factors of attitude towards time management among health professionals working in public hospitals of Dessie City, Northeast Ethiopia
Authors: Yimer Ali , Ahmed Mohammed , Zewdie Amare , Fenta Sefineh 
Published: September 2023

Abstract
Background
Good attitude towards to time management is the backbone to bring a change at individual and organizational levels in different sectors across the globe. But it has been ignored by different institutions, particularly in low and middle-income countries including Ethiopia. However, this can be alleviated if there are punctual, committed, and accessible health professionals that could translate the national aspirations and the desire of the community into reality. This study aims to determine the magnitude and associated factors of attitude towards time management among health professionals working in public hospitals of Dessie City, Northeast Ethiopia,

Methods
Institution-based cross-sectional study was conducted from March 24 –April 24, 2021 among 409 health professionals using a stratified sampling technique, Frequency and percentage were used to describe the study population. Multivariable logistic regression analysis was used to identify independent predictors. A p-value of < 0.05 with 95% CI were used to declare statistically significant associations.

Results
The overall good time management attitude among sample was 67%(95%CI:66.77–67.22%). Satisfaction with organizational policy and strategy (AOR: 2.69, 95%CI: 1.42–5.09), satisfaction with supervisor support (AOR: 2.12, 95% CI: 1.19–3.77), and managers’ good attitude towards time management (AOR: 2.00, 95%CI: 1.23–3.25) were significantly associated with good attitude towards time management among health professionals.

Conclusion
The attitude towards time management in public hospitals of Dessie City was low. Satisfaction with organizational policies and strategies, satisfaction with supervisor support, and managers’ good attitude towards time management were delineated factors. This low attitude towards time management could affect the practice and it compromise the health service coverage and quality unless timely and appropriate interventions should be taken. Strengthening strategies aimed at maximizing job satisfaction and emphasizing an attitude towards time might have a substantial contribution.
Cost-effective production of alginate oligosaccharides from Laminaria japonica roots by Pseudoalteromonas agarivorans A3
Authors: Sun Xiao-Hui , Chen Xiu-Lan , Wang Xiao-Fei , Zhang Xin-Ru , Sun Xiao-Meng , Sun Mei-Ling , Zhang Xi-Ying , Zhang Yu-Zhong , Zhang Yu-Qiang , Xu Fei 
Published: September 2023

Abstract
Background
Alginate oligosaccharides (AOs) are the degradation products of alginate, a natural polysaccharide abundant in brown algae. AOs generated by enzymatic hydrolysis have diverse bioactivities and show broad application potentials. AOs production via enzymolysis is now generally with sodium alginate as the raw material, which is chemically extracted from brown algae. In contrast, AOs production by direct degradation of brown algae is more advantageous on account of its cost reduction and is more eco-friendly. However, there have been only a few attempts reported in AOs production from direct degradation of brown algae.

Results
In this study, an efficient Laminaria japonica-decomposing strain Pseudoalteromonas agarivorans A3 was screened. Based on the secretome and mass spectrum analyses, strain A3 showed the potential as a cell factory for AOs production by secreting alginate lyases to directly degrade L. japonica. By using the L. japonica roots, which are normally discarded in the food industry, as the raw material for both fermentation and enzymatic hydrolysis, AOs were produced by the fermentation broth supernatant of strain A3 after optimization of the alginate lyase production and hydrolysis parameters. The generated AOs mainly ranged from dimers to tetramers, among which trimers and tetramers were predominant. The degradation efficiency of the roots reached 54.58%, the AOs production was 33.11%, and the AOs purity was 85.03%.

Conclusion
An efficient, cost-effective and green process for AOs production directly from the underutilized L. japonica roots by using strain A3 was set up, which differed from the reported processes in terms of the substrate and strain used for fermentation and the AOs composition. This study provides a promising platform for scalable production of AOs, which may have application potentials in industry and agriculture.
Natural diversity of lactococci in γ-aminobutyric acid (GABA) production and genetic and phenotypic determinants
Authors: Laroute Valérie , Aubry Nathalie , Audonnet Marjorie , Mercier-Bonin Muriel , Daveran-Mingot Marie-Line , Cocaign-Bousquet Muriel 
Published: September 2023

Abstract
Background
γ-aminobutyric acid (GABA) is a bioactive compound produced by lactic acid bacteria (LAB). The diversity of GABA production in the Lactococcus genus is poorly understood. Genotypic and phenotypic approaches were therefore combined in this study to shed light on this diversity. A comparative genomic study was performed on the GAD-system genes (gadR, gadC and gadB) involved in GABA production in 36 lactococci including L. lactis and L. cremoris species. In addition, 132 Lactococcus strains were screened for GABA production in culture medium supplemented with 34 mM L-glutamic acid with or without NaCl (0.3 M).

Results
Comparative analysis of the nucleotide sequence alignments revealed the same genetic organization of the GAD system in all strains except one, which has an insertion sequence element (IS981) into the PgadCB promoter. This analysis also highlighted several deletions including a 3-bp deletion specific to the cremoris species located in the PgadR promoter, and a second 39-bp deletion specific to L. cremoris strains with a cremoris phenotype. Phenotypic analysis revealed that GABA production varied widely, but it was higher in L. lactis species than in L. cremoris, with an exceptional GABA production of up to 14 and 24 mM in two L. lactis strains. Moreover, adding chloride increased GABA production in some L. cremoris and L. lactis strains by a factor of up to 16 and GAD activity correlated well with GABA production.

Conclusions
This genomic analysis unambiguously characterized the cremoris phenotype of L. cremoris species and modified GadB and GadR proteins explain why the corresponding strains do not produce GABA. Finally, we found that glutamate decarboxylase activity revealing GadB protein amount, varied widely between the strains and correlated well with GABA production both with and without chloride. As this protein level is associated to gene expression, the regulation of GAD gene expression was identified as a major contributor to this diversity.
Dolutegravir use over 48 weeks is not associated with worsening insulin resistance and pancreatic beta cell function in a cohort of HIV-infected Ugandan adults
Authors: Mulindwa Frank , Castelnuovo Barbara , Brusselaers Nele , Nabwana Martin , Bollinger Robert , Buzibye Allan , Agnes Odongpiny Eva Laker , Kiguba Ronald , Schwarz Jean-Marc 
Published: September 2023

Abstract
Background
The Uganda Ministry of Health issued restrictive guidelines on the use of dolutegravir (DTG) in persons stratified to have a heightened risk of diabetes mellitus. This followed multiple reports of persons with HIV (PWH) presenting with accelerated hyperglycemia after a few weeks to months of exposure to DTG. Having demonstrated a low incidence of diabetes mellitus and improving blood glucose trajectories in a cohort of ART naïve Ugandan PWH on DTG, we sought to determine whether the observed improvement in blood glucose did not mask background compensated insulin resistance.

Methods
In this analysis, 63 patients underwent serial oral glucose tolerance tests over 48 weeks. Using fasting serum insulin and glucose, we calculated insulin resistance and pancreatic beta cell function by homeostatic modelling (HOMA IR and HOMA%β respectively). Absolute mean changes between baseline and post-baseline blood glucose, pancreatic beta cell function and insulin resistance were computed by subtracting each post-baseline value from the baseline value and compared using student t-test. Multiple linear regression models were used to determine the factors associated with changes in pancreatic beta cell function and insulin resistance.

Results
Of the 63 participants, 37 (58%) were female. Median age was 31 (IQR: 28–37). Despite a trend towards an initial increase in both HOMA IR and HOMA%β at 12 weeks followed by a decline through 36 weeks to 48 weeks, the HOMA IR and HOMA%β at 48 weeks were not significantly different from baseline i.e. (difference in mean HOMA IR from baseline: 0.14, 95%CI: -0.46, 0.733, p = 0.648) and (difference in mean HOMA %β from baseline: 6.7, 95%CI: -13.4, 26.8, p = 0.506) respectively.

Conclusion
We demonstrated insignificant changes in both insulin resistance and pancreatic beta cell function in clinically stable young adult Ugandan PWH on dolutegravir for 48 weeks. We add to the body of evidence demonstrating glucose metabolic safety of dolutegravir in ART naïve patients. Ugandan guidelines should reconsider restricting DTG initiation in ART naive adults at high risk for diabetes.
The capacity to consent to treatment is altered in suicidal patients
Authors: Olié Emilie , Catanzaro Thomas , Malestroit Manon , Guija Julio A. , Giner Lucas , Courtet Philippe 
Published: September 2023

Abstract
Background
Many patients with depression refuse treatment. Moreover, suicide attempters often display low perceived need of treatment and impaired decision-making. These observations raise questions about the capacity to treatment consent in depressed suicide attempters (SA).

Methods
In patients with current depressive episode (N = 33 SAs and N = 27 non-SAs), consent capacity was evaluated with the MacArthur Competence Assessment Tool for Treatment (MacCAT-T), insight with the Beck Cognitive Insight Scale, and depression severity with the Beck Depression Inventory (BDI).

Results
The median BDI score in the whole sample (N = 60) was 21 [10;36], and was higher in SAs than non-SAs (27 [11;36] vs. 15 [10:33], p < 0.001). Consent capacity was impaired in 30% (appreciation), 53% (reasoning) and 60% (understanding) of all patients. MacCAT-T sub-scores were lower in SAs than non-SAs (understanding: 4.4 [2.35;5.8] vs. 5.3 [3.13;6]); appreciation: 3 [1;4] vs. 4 [2;4]); reasoning (4 [1;7] vs. 7 [3;8]), and ability to express a choice: 1 [0;2] vs. 2 [0;2]; all p < 0.001). In multivariate analyses, suicide attempt history and depression severity (but not insight) were negatively associated with MacCAT-T sub-scores.

Conclusion
More research is needed on the capacity to consent to treatment of patients with depression, particularly suicidal individuals, to make informed choices about their treatment.
Trial registration The Montpellier University Hospital Institutional Review Board approved the study (No. 202100714).
2023 WSES guidelines for the prevention, detection, and management of iatrogenic urinary tract injuries (IUTIs) during emergency digestive surgery
Authors: de’Angelis Nicola , Schena Carlo Alberto , Marchegiani Francesco , Reitano Elisa , De Simone Belinda , Wong Geoffrey Yuet Mun , Martínez-Pérez Aleix , Abu-Zidan Fikri M. , Agnoletti Vanni , Aisoni Filippo , Ammendola Michele , Ansaloni Luca , Bala Miklosh , Biffl Walter , Ceccarelli Graziano , Ceresoli Marco , Chiara Osvaldo , Chiarugi Massimo , Cimbanassi Stefania , Coccolini Federico , Coimbra Raul , Di Saverio Salomone , Diana Michele , Dioguardi Burgio Marco , Fraga Gustavo , Gavriilidis Paschalis , Gurrado Angela , Inchingolo Riccardo , Ingels Alexandre , Ivatury Rao , Kashuk Jeffry L. , Khan Jim , Kirkpatrick Andrew W. , Kim Fernando J. , Kluger Yoram , Lakkis Zaher , Leppäniemi Ari , Maier Ronald V. , Memeo Riccardo , Moore Ernest E. , Ordoñez Carlos A. , Peitzman Andrew B. , Pellino Gianluca , Picetti Edoardo , Pikoulis Manos , Pisano Michele , Podda Mauro , Romeo Oreste , Rosa Fausto , Tan Edward , Ten Broek Richard P. , Testini Mario , Tian Wei Cheng Brian Anthony , Weber Dieter , Sacco Emilio , Sartelli Massimo , Tonsi Alfredo , Dal Moro Fabrizio , Catena Fausto 
Published: September 2023

AbstractIatrogenic urinary tract injury (IUTI) is a severe complication of emergency digestive surgery. It can lead to increased postoperative morbidity and mortality and have a long-term impact on the quality of life. The reported incidence of IUTIs varies greatly among the studies, ranging from 0.3 to 1.5%. Given the high volume of emergency digestive surgery performed worldwide, there is a need for well-defined and effective strategies to prevent and manage IUTIs. Currently, there is a lack of consensus regarding the prevention, detection, and management of IUTIs in the emergency setting. The present guidelines, promoted by the World Society of Emergency Surgery (WSES), were developed following a systematic review of the literature and an international expert panel discussion. The primary aim of these WSES guidelines is to provide evidence-based recommendations to support clinicians and surgeons in the prevention, detection, and management of IUTIs during emergency digestive surgery. The following key aspects were considered: (1) effectiveness of preventive interventions for IUTIs during emergency digestive surgery; (2) intra-operative detection of IUTIs and appropriate management strategies; (3) postoperative detection of IUTIs and appropriate management strategies and timing; and (4) effectiveness of antibiotic therapy (including type and duration) in case of IUTIs.
Risk factors associated with prolonged intensive care unit stay following surgery for total anomalous pulmonary venous connection: a retrospective study
Authors: Huang Jinjin , Tang Jian , Fan Yong , Wang Dongpi , Ye Lifen 
Published: September 2023

Abstract
Background
Prolonged intensive care unit (ICU) stays consume medical resources and increase medical costs. This study identified risk factors associated with prolonged postoperative intensive care unit (ICU) stay in children with total anomalous pulmonary venous connection (TAPVC).

Methods
The medical records of 85 patients who underwent surgical repair of TAPVC were retrospectively analyzed. The patients were divided into prolonged-stay and standard-stay groups. The prolonged stay group included all patients who exceeded the 75th percentile of the ICU stay duration, and the standard stay group included all remaining patients. The effects of patient variables on ICU stay duration were investigated using univariate and logistic regression analyses.

Results
Patient median age was 41 (18–103) days, and median weight was 3.80 (3.30–5.35) kg.Postoperative duration of ICU stay was 11–68 days in the prolonged stay group (n = 23) and 2–10 days in the standard stay group (n = 62). Lower preoperative pulse oximetry saturation (SpO2), higher intraoperative plasma lactate levels, and prolonged postoperative mechanical ventilation were independent risk factors for prolonged ICU stay. Preoperative SpO2 < 88.5%, highest plasma lactate value > 4.15 mmol/L, and postoperative mechanical ventilation duration was longer than 53.5 h, were associated with increased risk of prolonged ICU stay. Young age, low body weight, subcardiac type, need for vasoactive drug support, emergency surgery, long anesthesia time, low SpO2 after anesthesia induction, long cardiopulmonary bypass (CPB) and aortic clamp times, high lactate level, low temperature, large volume of ultrafiltration during CPB, large amounts of chest drainage, large red blood cells (RBCs) and plasma transfusion, and postoperative cardiac dysfunction may be associated with prolonged ICU stay.

Conclusions
Lower preoperative SpO2, higher intraoperative plasma lactate levels, and prolonged postoperative mechanical ventilation were independent risk factors for prolonged ICU stay in children with TAPVC. When SpO2 was lower than 88.5%, the highest plasma lactate value was more than 4.15 mmol/L, and the postoperative mechanical ventilator duration was longer than 53.5 h, the risk of prolonged ICU stay increased. Improved clinical management, including early diagnosis and timely surgical intervention to reduce hypoxia time and protect intraoperative cardiac function, may reduce ICU stay time.
Concordance of a decision algorithm and multidisciplinary team meetings for patients with liver cancer—a study protocol for a randomized controlled trial
Authors: Ng Sharlyn S. T. , Oehring Robert , Ramasetti Nikitha , Roller Roland , Thomas Philippe , Chen Yuxuan , Moosburner Simon , Winter Axel , Maurer Max-Magnus , Auer Timo A. , Kamali Can , Pratschke Johann , Benzing Christian , Krenzien Felix 
Published: September 2023

Abstract
Introduction
Multidisciplinary team meetings (MDMs), also known as tumor conferences, are a cornerstone of cancer treatments. However, barriers such as incomplete patient information or logistical challenges can postpone tumor board decisions and delay patient treatment, potentially affecting clinical outcomes. Therapeutic Assistance and Decision algorithms for hepatobiliary tumor Boards (ADBoard) aims to reduce this delay by providing automated data extraction and high-quality, evidence-based treatment recommendations.

Methods and analysis

With the help of natural language processing, relevant patient information will be automatically extracted from electronic medical records and used to complete a classic tumor conference protocol. A machine learning model is trained on retrospective MDM data and clinical guidelines to recommend treatment options for patients in our inclusion criteria. Study participants will be randomized to either MDM with ADBoard (Arm A: MDM-AB) or conventional MDM (Arm B: MDM-C). The concordance of recommendations of both groups will be compared using interrater reliability. We hypothesize that the therapy recommendations of ADBoard would be in high agreement with those of the MDM-C, with a Cohen’s kappa value of ≥ 0.75. Furthermore, our secondary hypotheses state that the completeness of patient information presented in MDM is higher when using ADBoard than without, and the explainability of tumor board protocols in MDM-AB is higher compared to MDM-C as measured by the System Causability Scale.

Discussion
The implementation of ADBoard aims to improve the quality and completeness of the data required for MDM decision-making and to propose therapeutic recommendations that consider current medical evidence and guidelines in a transparent and reproducible manner.

Ethics and dissemination
The project was approved by the Ethics Committee of the Charité – Universitätsmedizin Berlin.

Registration details
The study was registered on ClinicalTrials.gov (trial identifying number: NCT05681949; https://clinicaltrials.gov/study/NCT05681949) on 12 January 2023.
Sustainable production of photosynthetic isobutanol and 3-methyl-1-butanol in the cyanobacterium Synechocystis sp. PCC 6803
Authors: Xie Hao , Kjellström Jarl , Lindblad Peter 
Published: September 2023

Abstract
Background
Cyanobacteria are emerging as green cell factories for sustainable biofuel and chemical production, due to their photosynthetic ability to use solar energy, carbon dioxide and water in a direct process. The model cyanobacterial strain Synechocystis sp. PCC 6803 has been engineered for the isobutanol and 3-methyl-1-butanol production by introducing a synthetic 2-keto acid pathway. However, the achieved productions still remained low. In the present study, diverse metabolic engineering strategies were implemented in Synechocystis sp. PCC 6803 for further enhanced photosynthetic isobutanol and 3-methyl-1-butanol production.

Results
Long-term cultivation was performed on two selected strains resulting in maximum cumulative isobutanol and 3-methyl-1-butanol titers of 1247 mg L−1 and 389 mg L−1, on day 58 and day 48, respectively. Novel Synechocystis strain integrated with a native 2-keto acid pathway was generated and showed a production of 98 mg isobutanol L−1 in short-term screening experiments. Enhanced isobutanol and 3-methyl-1-butanol production was observed when increasing the kivdS286T copy number from three to four. Isobutanol and 3-methyl-1-butanol production was effectively improved when overexpressing selected genes of the central carbon metabolism. Identified genes are potential metabolic engineering targets to further enhance productivity of pyruvate-derived bioproducts in cyanobacteria.

Conclusions
Enhanced isobutanol and 3-methyl-1-butanol production was successfully achieved in Synechocystis sp. PCC 6803 strains through diverse metabolic engineering strategies. The maximum cumulative isobutanol and 3-methyl-1-butanol titers, 1247 mg L−1 and 389 mg L−1, respectively, represent the current highest value reported. The significantly enhanced isobutanol and 3-methyl-1-butanol production in this study further pave the way for an industrial application of photosynthetic cyanobacteria-based biofuel and chemical synthesis from CO2.