bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predicting necrotising soft tissue infections in people who inject drugs: poor performance of the Laboratory Risk Indicator for Necrotising Fasciitis score and development of a novel clinical predictive nomogram in a retrospective cohort with internal validation
Authors: MacLeod Caitlin S. , O’Neill Hannah L. , Shaalan Ramy , Nagy John , Flett Murray M. , Guthrie Graeme J.K. , McLeod Graeme , Suttie Stuart A. ,   on behalf of the East of Scotland Vascular Network (ESVN)
Published: April 2023

Introduction:
Necrotising soft tissue infections (NSTI) can threaten life and limb. Early identification and urgent surgical debridement are key for improved outcomes. NSTI can be insidious. Scoring systems, like the Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC), exist to aid diagnosis. People who inject drugs (PWID) are high risk for NSTI. This study aimed to assess the utility of the LRINEC in PWID with lower limb infections and develop a predictive nomogram.

Methods:
A retrospective database of all hospital admissions due to limb-related complications secondary to injecting drug use between December 2011 and December 2020 was compiled through discharge codes and a prospectively maintained Vascular Surgery database. All lower limb infections were extracted from this database, dichotomised by NSTI and non-NSTI with the LRINEC applied. Specialty management times were evaluated. Statistical analyses involved: chi-square; Analysis of “variance”; Kaplan–Meier, and receiver operating characteristic curves. Nomograms were developed to facilitate diagnosis and predict survival.

Results:
There were 557 admissions for 378 patients, with 124 (22.3%; 111 patients) NSTI. Time from admission to: theatre and computed tomography imaging respectively varied significantly between specialties (P=0.001). Surgical specialties were faster than medical (P=0.001). Vascular surgery received the most admissions and had the quickest time to theatre. During follow-up there were 79 (20.9%) deaths: 27 (24.3%) NSTI and 52 (19.5%) non-NSTI. LRINEC ≥6 had a positive predictive value of 33.3% and sensitivity of 74% for NSTI. LRINEC <6 had a negative predictive value of 90.7% and specificity of 63.2% for non-NSTI. Area under the curve was 0.697 (95% CI: 0.615–0.778). Nomogram models found age, C-reactive protein, and non-linear albumin to be significant predictors of NSTI, with age, white cell count, sodium, creatinine, C-reactive protein, and albumin being significant in predicting survival on discharge.

Conclusion:
There was reduced performance of the LRINEC in this PWID cohort. Diagnosis may be enhanced through use of this predictive nomogram.
Brain Science Learning Guides
Authors: Onello Rachel 
Published: April 2023

Background:
Students often struggle with how to synthesize course content during independent learning outside of class.

Problem:
Study strategies may be entrenched in ineffective methods that reinforce misperceptions of learning and undermine the development of metacognitive thinking.

Approach:
To promote the development of effective study skills, a scaffolded approach was developed to facilitate students actively engaging with course content outside of class time, based on best practices of brain science–based learning.

Outcomes:
Using evidence in the brain science of teaching and learning, Learning Guides were developed to shift the focus of study outside of class time from the “what” to the “how.” Preliminary feedback from students in multiple core nursing courses suggests that these guides are an effective tool for student learning.

Conclusion:
This brain science–based approach to learning can provide a road map for students to build the essential skills for effective study habits that can lead to durable learning.
Planetary Health
Authors: Vandenberg Shannon Y. 
Published: April 2023

Background:
Climate change around the globe is impacting human and planetary health at unprecedented rates. Nurses are well positioned to act as climate leaders, given their critical role globally.

Problem:
Current and future nurses must work to mitigate climate-related health effects. It is necessary that a planetary health approach is integrated into nursing education.

Approach:
Curricular modifications, using the Planetary Health Education Framework, are presented, which will promote awareness and understanding of climate health among future nurses. The framework is grounded in equity, which is well suited to nursing education, and can be readily adapted into current nursing curricula.

Outcomes:
Recommendations for nursing education are presented within the 5 domains of the framework.

Conclusions:
Future nurses are called on to be exemplary planetary health communicators, educators, advocates, and leaders. The Planetary Health Education Framework promotes nursing leadership in practice and in advocating for a climate-resistant future.
Measuring Nursing Student Development Through Computer-Based Simulation Activities
Authors: Aller Loretta , Shelestak Deb , Phillips Lynette , Reed Janet , Allen Betty 
Published: April 2023

Background:
New nurse attrition jeopardizes patient safety, devastates career plans, and negatively impacts costs to hospitals and patients. Employers and educators recognize the widening transition-to-practice gap in meeting expectations for practice-ready, resilient nurses.

Purpose:
The purpose of this study was to test the use of computer-based simulation activities (CBSAs) to measure processes in Aller's Development of Decision-Making and Self-Efficacy Model (ADD-SEM).

Methods:
BSN students (N = 50) in a multisite, cross-sectional study used CBSAs to provide data on decision making (Virtual Patient Lasater's Clinical Judgment Rubric), psychological capital (Nursing Anxiety and Self-Confidence in Decision-Making Scale©), and reflection.

Results:
Repeated-measures analysis of variance and reflexive thematic analysis revealed that decision-making (DM) scores were highest in noticing and lowest in interpreting with significant differences in cohorts (DM) (juniors: P < .001; seniors: P = .013) and self-confidence/anxiety (P < .001).

Conclusion:
The CBSAs are an effective means of measuring student development of DM and psychological capital needed to retain resilient nurses.
AORR DM Manuscript_MDC-D-23-00156.docx
Authors: Reddy Shivani M. , Kugley Shannon , Booth Graham , Dalton Jennie , Rodriguez Borja Ivette , Coker-Schwimmer Manny , Patel Sheila V. , Bonds Denise , Prum Soknorntha , Fujita Miku , Philbrick Sarah , Ruwala Richa , Albritton Jordan A. , Crotty Karen 
Published: April 2023

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Hospital Fire Outbreaks Before and During the COVID-19 Pandemic in Low- and Middle-Income Settings
Authors: Bayuo Jonathan , Duodu Precious Adade 
Published: April 2023

Objective
The aim of the study is to identify and synthesize existing published and gray literature reporting on hospital fire outbreaks before and during the coronavirus disease 2019 (COVID-19) pandemic.

Methods
A 2-phase narrative review approach was used. The search covered peer-reviewed, gray literature sources, and news outlets. The pre-COVID-19 hospital fire outbreak search period was January 2000–December 2019 while that for during COVID-19 was December 2019–July 2021 (repeated in December 2021).

Results
Thirteen and 24 media reports were identified for the pre-COVID-19 and during COVID-19 periods, respectively. Although varied fire risks existed before the emergence of the COVID-19, this article demonstrates that the incidence of hospital fires has increased more than two-folds in recent times in COVID-19 wards and intensive care units causing death, injuries, and extensive damage to properties. The main risk in the pre-COVID-19 era was identified as electrical faults. During the pandemic, other issues such as oxygen explosions, inefficient cooling systems, and lack of fire control measures in makeshift pre-COVID-19 centers were identified as additional risks/causes of the hospital fire outbreaks.

Conclusions
Additional risks have emerged during the COVID-19 era, which increased the occurrence of hospital fire outbreaks. Guidelines, protocols, and policies regarding the prevention of hospital fire outbreaks and strategies for attenuating its effects need to be highlighted across settings and adhered to. Existing policies need to evolve to help resolve these risks. Beyond the preventive strategies, context-specific psychosocial support is also required for healthcare staff, families, and patients who survive episodes of hospital fire outbreaks.
Influence of Perioperative COVID-19 Infection on Surgical Outcomes and Risk Adjustment for Quality Assessment in the American College of Surgeons NSQIP
Authors: Peters Xane D , Cohen Mark E , Meng Xiangiu , Hall Bruce L , Ko Clifford Y 
Published: April 2023

Background:
Surgical patients with perioperative COVID-19 infection experience higher rates of adverse events than those without COVID, which may lead to imprecision in hospital-level quality assessment. Our objectives were to quantify differences in COVID-19 associated adverse events in a large national sample and examine distortions in surgical quality benchmarking if COVID status is not considered.

Study Design:
Data included 793,280 patient records from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) from April 1, 2020 to March 31, 2021. Models predicting 30-day Mortality, Morbidity, Pneumonia, Ventilator Dependency > 48 hours, and unplanned intubation were constructed. Risk adjustment variables were selected for these models from standard NSQIP predictors and perioperative COVID status.

Results:
5,878 (0.66%) had preoperative COVID and 5,215 (0.58%) had postoperative COVID. COVID rates demonstrated some consistency across hospitals (median preoperative 0.84%, IQR=0.14%-0.84%; median postoperative 0.50%, IQR=0.24%-0.78%). Postoperative COVID was always associated with increased adverse events. For postoperative COVID among all cases, there was nearly a six-fold increase in Mortality (1.07% to 6.37%) and15-fold increase in Pneumonia (0.92% to 13.57%), excluding the diagnosis of COVID itself. The effects of preoperative COVID were less consistent. Inclusion of COVID in risk-adjustment models had minimal effects on surgical quality assessments.

Conclusion:
Perioperative COVID was associated with a dramatic increase in adverse events. However, quality benchmarking minimally affected. This may be the result of low overall COVID rates or balance in rates established across hospitals over the 1-year observational period. There remains limited evidence for restructuring ACS NSQIP risk-adjustment for the time-limited effects of the COVID pandemic.
Comparison of two measures of cognitive impairment on the 2015 Behavioral Risk Factor Surveillance System
Authors: Adams Mary 
Published: April 2023

AbstractOnly selected states have used an optional module to address subjective cognitive decline (SCD) on the Behavioral Risk Factor Surveillance System (BRFSS). This study compares SCD with a core measure of cognitive disability (CDis) that has been included on the BRFSS since 2013. Using 2015 BRFSS data from 35 states that asked the module we report the weighted prevalence of SCD and CDis by demographics, chronic conditions, and risk factors among 150,981 respondents ages 45 years or older. We also compare adults with SCD only, CDis only, both, or neither, plus all those reporting either measure on similar health related measures. In addition, results of logistic regression are presented. Weighted prevalence rates and 95% confidence intervals were 11.5% (11.1%-12.0%) for SCD and 10.6% (10.2%-11.0%) for CDis. Approximately half of those reporting one measure reported the other and about one-third of those reporting either fell into each of the 3 mutually exclusive groups. Comparisons indicated a consistent progression from SCD only, to CDis only, to those with both, for measures of chronic conditions, number of SCD-related risk factors, and poorer health status. Logistic regression results for CDis were more like those for adults with SCD who also reported functional difficulties than for all adults with SCD. Conclusion: Although it does not include a timeframe or capture the exact same respondents as SCD, the core measure of CDis appears to be a useful measure of cognitive impairment and may represent adults more adversely affected than those reporting SCD.
Knowledge, attitudes and practices towards antibiotic use and resistance in Kyegegwa district, Uganda – a questionnaire study
Authors: Kahunde Mary Ann , Odoch Terence , Owiny David Okello , Kankya Clovice , Kaelin Marisa B. , Hartnack Sonja 
Published: April 2023

AbstractBackgroundAntimicrobials are widely used to protect human and animal health. Wide scale misuse can lead to the development and spread of antimicrobial resistance (AMR). In low and middle-income countries, knowledge, attitudes and practices are assumed to contribute to AMR.ObjectiveTo provide empirical data on knowledge and attitudes towards antibiotic use and resistance in livestock farmers, human and animal health professionals in Kyegegwa district, Uganda. To assess which factors (farming, education, affiliation with health-related ministries, gender, keeping cattle, goats, pigs, poultry or sheep) are associated with poor knowledge.MethodsA questionnaire related to antibiotic usage (AMU) and AMR, as well as demographic data was developed and administered to health practitioners of both the humanmedical and the livestock sector, and (semi)-intensive livestock farmers. Polytomous latent class analysis was used to cluster respondents - based on their responses - in different classes of knowledge and attitudes. The association between the probability of belonging to latent classes and demographic data was assessed by multinomial regression models and conditional inference trees.ResultsIn total 1022 responses were available (response rate 68.1%). More than 50% of the cattle received antibiotics at least three times during the last six months and in 39.1% members of the respondents’ households of this study were on antibiotics. Three latent classes related to attitude towards antibiotic access, usage and disposal; and two classes regarding resistance have been revealed. Class membership was associated with a number of socio-demographic factors.ConclusionInadequate knowledge and inappropriate practices as evidenced in this study should support further policy formulations and strategies to regulate AMU. It will also be useful in refining the implementation of local and national action plans and efforts to control AMR. A key component of this will require promotion of One Health approach and effective communication to tackle prevailing misconceptions.
“A System Dynamics Model for Long-term Aspect of Caries Preventive Interventions”
Authors: Oo Tin Htet , Tianviwat Sukanya , Thitasomakul Songchai , Sontamino Phongpat 
Published: April 2023

AbstractObjectiveThe purpose of the study is to appraise the long-term effects of caries preventive interventions of the Ministry of Public Health (MOPH), Thailand: supervised toothbrushing (STB), dental sealant, and combined STB+sealant that are implemented for 6- to 15-year-olds by comparing with the base case using the System Dynamics Model (SDM).MethodThe System Dynamics Model (SDM) was analyzed to compare the interventions, supervised toothbrushing (STB), sealant, and combined STB+sealant as intervention scenarios with the base case scenario. The effectiveness data of interventions set in the model were retrieved from meta-analyses and experts’ opinions.ResultsThe model established that the no caries population increased by 36.2%, 25.5%, and 18.6% while the caries population decreased by 8.1%, 5.6%, and 3.3% under combined STB+sealant, sealant, and supervised toothbrushing (STB) respectively compared to the base case at the age of 15 years old. From the above 20 years old to the elderly age, both individual and combined interventions have no favorable effect on reducing caries. On the other hand, the no caries population under the interventions is not significantly different from the base case during the elderly age.ConclusionCombined STB+sealant is the most effective intervention among the interventions that are administered during the age of 6-15 years. The interventions given during these ages have effectiveness in caries reduction by about 15 years from when they are started. In addition, System Dynamics Model (SDM) would assist in comparing the interventions or policies as scenarios to indicate the most opportune one for the population.
Qualitative feasibility study of the mobile app Destroke for clinical stroke monitoring based on the NIH Stroke Scale
Authors: Noch Evan K , Pham Dan , Kitago Tomoko , Wuennemann Marissa , Wortman-Jutt Susan , Falo M. Cristina 
Published: April 2023

AbstractBackgroundStroke is a leading cause of severe disability in the United States, but there is no effective method for patients to accurately detect the signs of stroke at home. We developed a mobile app, Destroke, that allows remote performance of a modified NIH stroke scale (NIHSS) by patients.AimsTo assess the feasibility of a mobile app for stroke monitoring and education by patients with a history of strokeMaterials and MethodsWe enrolled 25 patients with a history of stroke in a prospective open-label study to evaluate the feasibility of the Destroke app in patients with stroke. Nineteen patients completed all study assessments, with a median time from stroke onset to enrollment of 5.6 years (range 0.1-12 years). We designed a modified NIHSS that assessed 12 out of 16 tasks on the NIHSS. Patients completed this test eight times over a 28-day period. We conducted pre-study surveys that assessed demographic information, stroke and cardiovascular history, baseline NIHSS, and experience using mobile technologies, and mid- and post-study surveys that assessed patient satisfaction on app usage and confidence in stroke detection.ResultsTen men and nine women participated in this study (median age of 64 (33-76)), representing ten US states and Washington D.C. Median baseline NIHSS was 0 (0-4). 15 patients reported using health apps. On a 5-point Likert scale, patients rated the app as 4.2 on being able to understand and use the app and 4.3 on using the app when instructed by their doctor. For eight patients with poor confidence in detecting the signs of a stroke before the study, six showed higher confidence after the study.ConclusionsThe use of an at-home stroke monitoring app is feasible by patients with a history of stroke and improves confidence in detecting the signs of stroke.
How do People with Multimorbidity Prioritise Healthcare when Faced with Financial Constraints? A Choice Experiment
Authors: Larkin James , Foley Louise , Timmons Shane , Hickey Tony , Clyne Barbara , Harrington Patricia , Smith Susan M. 
Published: April 2023

AbstractMultimorbidity is associated with increased out-of-pocket healthcare costs, making people with multimorbidity more vulnerable to cost-related non-adherence to recommended treatment. This study aimed to understand how people with multimorbidity would prioritise different healthcare services and chronic conditions when faced with potential budget constraints. A cross-sectional online survey incorporating a choice experiment was conducted in Ireland (December 2021 to March 2022). Participants were adults aged 40 years or over with at least one chronic condition. They were asked how they would prioritise their real-world healthcare utilisation if their monthly personal healthcare budget were reduced by 25%. The survey also included questions about real-life experiences of cost-related non-adherence and financial burden. Among the 962 participants, 64.9% (n=624) had multimorbidity. When presented with the hypothetical budget constraint, participants reduced expenditure on ‘other healthcare (hospital visits, specialist doctors, etc.)’, by the greatest percentage (50.2%), and medicines by the lowest percentage (24.5%). Participants with multimorbidity tended to have a condition they prioritised over others. On average, they reduced expenditure for their top-priority condition by 69% less than would be expected if all conditions were valued equally, compared to a reduction in expenditure of 59% more than expected for their least prioritised condition. Participants were asked how important several areas were when making their decisions (scale of 1 – ‘not important at all’ to 5 – ‘very important’). Independence, symptom control and staying alive were rated as the most important decision factors (median=5). Over one third (34.5%, n=332) of participants reported cost-related non-adherence as they had either not attended a healthcare professional or not paid for medication or both in the last year due to cost. Research and clinical care must take greater consideration of the different ways people with multimorbidity respond to high healthcare costs and the impact this has on treatment adherence and health outcomes.
The landscape of biomedical research
Authors: González-Márquez Rita , Schmidt Luca , Schmidt Benjamin M. , Berens Philipp , Kobak Dmitry 
Published: April 2023

AbstractThe number of publications in biomedicine and life sciences has rapidly grown over the last decades, with over 1.5 million papers now being published every year. This makes it difficult to keep track of new scientific works and to have an overview of the evolution of the field as a whole. Here we present a 2D map of the entire corpus of biomedical literature, and argue that it provides a unique and useful overview of the life sciences research. We based our atlas on the abstract texts of 21 million English articles from the PubMed database. To embed the abstracts into 2D, we used the large language model PubMedBERT, combined witht-SNE tailored to handle samples of our size. We used our atlas to study the emergence of the Covid-19 literature, the evolution of the neuroscience discipline, the uptake of machine learning, the distribution of gender imbalance in academic authorship, and the distribution of retracted paper mill articles. Furthermore, we present an interactive web version of our atlas that allows easy exploration and will enable further insights and facilitate future research.
Intravital Two-Photon Microscopy of the Native Thymus
Authors: Seyedhassantehrani N. , Burns C. S. , Verrinder R. , Okafor V. , Abbasizadeh N. , Spencer J. A. 
Published: April 2023

AbstractThe thymus, a key organ involved in the adaptive immune system, is damaged by a variety of insults including cytotoxic preconditioning. This damage can lead to atrophy and potentially to changes in the hemodynamics of the thymic blood vascular system. Although the thymus has an innate ability to regenerate, the production of T cells relies on the trafficking of lymphoid progenitors from the bone marrow through the altered thymic blood vascular system. Our understanding of thymic blood vascular hemodynamics is limited due to technical challenges associated with accessing the native thymus in live mice. To overcome this challenge, we developed an intravital two-photon imaging method to visualize the native thymus in vivo and investigated functional changes to the vascular system following sublethal irradiation. We were able to quantify blood flow velocity and shear rate in cortical blood vessels and identified a subtle but significant increase in vessel diameter and barrier function ~24 hrs post-sublethal irradiation. Ex vivo whole organ imaging of optically cleared thymus lobes confirmed a disruption of the thymus vascular structure, resulting in an increase in blood vessel diameter and vessel area, and concurrent thymic shrinkage. This novel two-photon intravital imaging method enables a new paradigm for directly investigating the thymic microenvironment in vivo.