bluuebunny/crossref_metadata_2025_split huggingface dataset:
Detection of sensory deficits in fine nerve fibres in leprosy diagnosis
Authors: Rodrigues Júnior Ismael Alves , Chaves Ana Thereza , de Andrade Luciana Cardoso , Lyon Sandra , de Faria Grossi Maria Aparecida , de Medeiros Brito Ramayana Morais , de Oliveira Ana Laura Grossi , de Figueiredo Villarroel Manoel , da Costa Rocha Manoel Otávio 
Published: January 2025

AbstractObjectivesThe purpose of this study was to determine reference points for thermal perception in cutaneous lesions of leprosy, a disease caused by Mycobacterium leprae characterised by hypoesthesia in skin lesions due to nerve and Schwann cell infection. Early diagnosis is essential to control transmission and effectively treat the disease.MethodsQuantitative thermal testing (QTT) has been proposed as a valuable tool for early detection of the disease, initiation of treatment, and monitoring of nerve damage. A thermal analyser was used to determine warm and cold perception thresholds (WPT and CPT, respectively) in skin lesions of 42 leprosy patients and 22 healthy controls.ResultsThe thresholds were determined using a 0.25 cm2 thermal stimulator, the method of limits, and the receiver operating characteristic (ROC) curve. Thermal thresholds were higher in patients’ skin lesions compared to unaffected areas and controls. The reference points calculated for the WPT and CPT were 36.55 and 26.35°C, respectively, with high sensitivity and specificity.ConclusionThe nerve fibres affected by leprosy caused altered thermal sensitivity in the patients’ lesions, especially in warm sensation. A smaller thermal stimulator and the method of limits were effective in detecting early sensory deficits in nerve fibres, demonstrating the potential for early detection of the disease.
Style or accent?: Gendered perceptions of English among young Bahrainis
Authors: Al‐Alawi Wafa 
Published: January 2025

AbstractAlthough both are recognized as different speech types, an accent is generally understood as unintentional, whereas style is performative. This study argues that with increasing rates of contact in globalization between people, resources, and cultures, ‘accent’ can be reconceptualized as closely intersected with ‘style’ in Expanding Circle contexts. My analysis of metacommentaries from English‐dominant young Bahrainis shows that the interaction of English with local (gendered) ideologies leads to the perception of English, especially with a foreign American(ized) accent, as ‘emasculating’ and the prevalence of locally accented English ideals in Bahraini men. Applying a scalar‐chronotopic approach, I show how the notion of a foreign English ‘accent’ may overlap with ‘style’ as opposed to being, as commonly understood, an unintentional manner of pronunciation. The analysis clearly shows that Expanding Circle contexts are not entirely norm‐dependent on Inner Circle contexts and has further implications for our understandings of prestige, language, and gender.
Effect of a Nurse‐Led Support Program Using Mobile Application Versus Nurse Phone Advice on Patients at Risk of Coronary Artery Disease: A Randomized Controlled Trial
Authors: Wong Eliza M. L. , Leung Doris Y. P. , Lam Simon C. , Suen Lorna K. P. , Tang Anson C. Y. , Ko Shuk Y. , Leung Angela Y. M. 
Published: January 2025

ABSTRACTBackgroundCoronary artery disease (CAD) is a major health problem of atherosclerotic cardiovascular (CV) disease and early intervention is regarded important. Given the proven effect of a lifestyle intervention with nursing telephone counselling and mHealth use in health care, yet the comparisons of both support are lacking, this study is proposed.ObjectivesThis study aimed to compare the effects of a coronary artery disease (CAD) support program using a mobile application versus nurse phone advice on exercise amount and physical and psychological outcomes for clients at risk of CAD.MethodsA prospective randomized controlled trial was conducted. Ethical approval was obtained. Two‐hundred and twenty‐six clients were screened, and a total of 168 clients who were at risk of CAD and routinely used smartphones were randomized into the app support group (App group) or the nurse phone advice (NPA) group. Although all participants received the same health talk delivered by a cardiac nurse at the community center, the App group received additional CAD app support, whereas the NPA group received nurse phone advice for 20 min monthly. The app content comprised (1) CAD knowledge in 10 modules, (2) individual exercise records with their own goals and health measures, and (3) a chest pain action list. The intervention lasted for 3 months. Health outcome data were collected at baseline (T0) and after 1 (T1) and 3 (T2) months. The outcomes were the total amount of exercise (primary outcome), self‐efficacy in illness management, perceived stress, and CAD risk profile (body weight, body mass index, and lipid concentration). Generalized estimating equation models were used to assess differential changes in all outcomes within 3 months.ResultsThe attrition rates at 3 months were 3.49% and 9.30% for the App and NPA groups, respectively. The App support group was superior to the NPA group in significantly increasing total exercise amount and reducing body weight, waist circumference, triglycerides, and increased self‐efficacy in illness management.Linking Evidence to ActionThe result provides further insights of app development to support health promotion programs for community‐dwelling adults at risk of CAD.
Avoidable factors associated with maternal death from postpartum haemorrhage: a national Malawian surveillance study
Authors: Riches Jennifer , Jafali James , Twabi Hussein H , Chimwaza Yamikani , Onrust Marthe , Bilesi Rosemary , Gadama Luis , Kachale Fannie , Kuyere Annie , Makhaza Lumbani , Makuluni Regina , Munthali Laura , Musopole Owen , Ndamala Chifundo , Phiri Deborah A , Coomarasamy Arri , Merriel Abi , Waitt Catriona , Odland Maria Lisa , Lissauer David 
Published: January 2025

BackgroundDespite strong evidence-based strategies for prevention and management, global efforts to reduce deaths from postpartum haemorrhage (PPH) have failed, and it remains the leading cause of maternal mortality. We conducted a detailed review of all maternal deaths from 33 facilities in Malawi to identify health system weaknesses leading to deaths from PPH.MethodsData were collected regarding every maternal death occurring across all district and central hospitals in Malawi. Deaths occurring from August 2020 to December 2022 were reviewed by multidisciplinary facility-based teams who compiled case narratives from clinical notes and then subsequently reviewed by obstetricians to confirm the cause of death according to international criteria. Data were summarised using proportions/frequencies, comparisons made using χ2or Wilcoxon rank sum tests, and logistic regression conducted to calculate ORs with CIs.ResultsPPH was the cause of 20.4% of maternal deaths. Most deaths from PPH occurred within 24 hours of birth (80.0%), among women who had been referred to a higher-level facility (57.0%) and were admitted in stable condition (60.0%). Vacuum births carried an increased risk of death from PPH (OR 4.25 (95% CI 1.15 to 20.13, p=0.039)). Detailed reviews identified that deaths from PPH were more likely to be associated with factors such as ‘lack of obstetric lifesaving skills’ (26.7% vs 10.1%, p<0.001), ‘inadequate monitoring’ (51.5% vs 40.7%, p=0.012) and ‘communication problems between facilities’ (11.5% vs 6.2%, p=0.019) than deaths from other causes.ConclusionsOur analysis represents the largest published review of maternal deaths from PPH. We demonstrate that key health system weaknesses are contributing to these preventable maternal deaths. Case reviews conducted by multidisciplinary facility-based teams identified common and recurrent avoidable factors associated with deaths from PPH. Global efforts must now be focused on strategies that address these weaknesses, strengthening health systems and empowering healthcare workers to reduce maternal deaths from PPH.
Virtual reality-based neuroproprioceptive physiotherapy in multiple sclerosis: a protocol for a double-arm randomised assessor-blinded controlled trial on upper extremity function, postural function and quality of life, with molecular and functional MRI assessment
Authors: Miznerova Barbora , Reissigova Jindra , Vasa Libor , Frank Jakub , Hudec Michael , Rodina Lubomir , Herynkova Anna , Havlik Jan , Tintera Jaroslav , Rydlo Jan , Ibrahim Ibrahim , O’Leary Valerie B , Cerna Marie , Jurickova Iva , Pokorna Marketa , Philipp Tom , Hlinovska Jana , Stetkarova Ivana , Rasova Kamila 
Published: January 2025

IntroductionUpper limb (UL) impairment is common in people with multiple sclerosis (pwMS), and functional recovery of the UL is a key rehabilitation goal. Technology-based approaches, like virtual reality (VR), are increasingly promising. While most VR environments are task-oriented, our clinical approach integrates neuroproprioceptive ‘facilitation and inhibition’ (NFI) principles. To advance this, we developed immersive VR software based on NFI principles targeting UL function and sit-to-stand ability. This study aims to evaluate the effectiveness of this VR therapy compared with conventional NFI-based physical therapy in pwMS. Our study uniquely applies advanced imaging techniques, along with biological molecular assessments, to explore adaptive processes induced by VR rehabilitation.Methods and analysisThis double-arm, randomised, assessor-blinded, controlled trial runs over 2 months (1 hour, 2 times per week). PwMS with mild to severe disability will receive either VR therapy or real-world physical therapy. Primary outcomes include the nine-hole peg test, box and block test, handgrip strength, tremor and five times sit-to-stand test. Secondary measures include the Multiple Sclerosis Impact Scale, the 5-level EQ-5D questionnaire and kinematic analysis. Adaptive processes will be monitored using imaging techniques (functional MRI and tractography), molecular genetic methods (long non-coding RNAs) and immune system markers (leukocytes, dendritic cells). The International Classification of Functioning, Disability and Health brief set for MS will map the bio-psycho-social context of participants.Ethics and disseminationThis project and its amendments were approved by the Ethics Committee of the Institute for Clinical and Experimental Medicine and Thomayer Hospital (1983/21+4772/21 (G-21–02) and the Ethics Committee of Kralovske Vinohrady University Hospital (EK-VP/38/0/2021) in Prague, Czechia (with single enrolment). The findings of this project will be disseminated through scientific publications, conferences, professional networks, public engagement, educational materials and stakeholder briefings to ensure a broad impact across clinical, academic and public domains.Trial registration numberclinicaltrials.gov (NCT04807738).
Exploring undergraduate medical students and faculty perspectives on blended learning: a qualitative study in China
Authors: Li Sisi , Zhang Chunhui , Chen Xi , Liao Xunchen , Yu Xi , Wu Shaoyu , Zhou Lei , Lv Lin 
Published: January 2025

ObjectivesThis study aimed to explore the views and expectations of medical students and faculty members on blended learning following university-wide teaching reforms, focusing on its influence on self-directed learning (SDL) and educational effectiveness.DesignA qualitative study employing grounded theory methodology with semistructured individual and group interviews.SettingA tertiary medical university after institution-wide educational reforms.ParticipantsOne administrator, 11 faculty members and 30 third-year preclinical medical students were recruited to participate in the study.ResultsThe analysis of faculty and student perceptions yielded two core categories from faculty and three from students. Faculty highlighted the comparison between face-to-face and online instruction, emphasising the influence of students’ learning attitudes, SDL abilities, teachers' beliefs and teaching strategies on blended learning outcomes. Students shared their learning preferences and challenges with SDL, identifying learning attitudes, teaching management and learning methods as key factors impacting blended learning success.ConclusionsThe study highlights that teachers’ positive beliefs enhance blended learning success, while fostering students’ self-directed skills and learning attitudes, along with addressing challenges and needs, is key to effective strategies.
Impact of pandemic service changes on ethnic inequalities in maternal and perinatal outcomes in England: a population-based study
Authors: Ibrahim Buthaina , Jardine Jennifer Elizabeth , Lenguerrand Erik , Judge Andrew , Khalil Asma , Draycott Tim , Iliodromiti Stamatina 
Published: January 2025

ObjectiveIn the UK and worldwide, there are substantial ethnic inequalities in maternal and perinatal care and outcomes. We aim to assess the impact of the unprecedented change in care provision during the COVID-19 pandemic on inequalities in adverse maternity outcomes.DesignRetrospective cohort study using structured electronic health record data.SettingEnglish hospital trusts providing maternity care.ParticipantsWomen giving birth and babies born in the National Health Service (NHS) in England between 1 April 2018 and 31 March 2021, in three time groups: prepandemic, the first pandemic wave (26 March 2020 to 30 June 2020) and second pandemic wave (1 July 2020 to 31 March 2021). Self-reported ethnicity was grouped into White, South-Asian, Black, Mixed and Other.Main outcome measuresComposite and component measures of maternal (emergency caesarean section, obstetric anal sphincter injury, hysterectomy, sepsis, anaesthetic complications and prolonged hospital stay) and perinatal (stillbirth, neonatal death, preterm birth, brain injury, small for gestational age and prolonged hospital stay). Poisson regression was used to compare relative risks between different ethnic groups.Findings1.54 million maternal and 1.43 million neonatal records were included. The overall incidence of adverse outcomes per 1000 births initially decreased maternal: from 308.0 (95% CI 307.0 to 309.0) to 291.0 (95% CI 311.4 to 314.9) (p<0.001); perinatal: from 133.0 (95% CI 132.3 to 133.7) to 111.9 (95% CI 110.1 to 113.7) (p<0.001)), but then increased in the second pandemic period (maternal: 313.2 (95% CI 311.4 to 314.9) (p<0.001); perinatal 118.9 (95% CI 117.7 to 120.0) (p<0.001)). The risk of adverse outcomes was higher in women and babies from all ethnic minority groups compared with White women in both pandemic periods. Black and South-Asian women and babies were approximately 25% more likely to sustain adverse outcomes. While similar overall changes in adverse outcomes were seen in all groups, existing inequalities were sustained throughout the pandemic periods.InterpretationExisting inequalities in adverse maternal and perinatal/neonatal outcomes were maintained, not tempered, during the pandemic, despite substantial changes to maternity services and care. Further research on possible interventions to reduce inequality is needed.
Study protocol for a single-centre non-inferior double-blinded randomised controlled trial in China comparing the efficacy and safety of high-frequency irreversible electroporation with transurethral resection of the prostate in treating lower urinary tract symptoms and benign prostatic obstruction (the GIANT trial)
Authors: He Bi-Ming , Shi Zhen-Kai , Chen Rui , Wang Hai-Feng 
Published: January 2025

IntroductionTransurethral resection of the prostate (TURP) is the gold standard surgical treatment to lower urinary tract symptoms and benign prostatic obstruction (LUTS/BPO). Although it has been proven to have substantial efficacy in improving functional outcomes, it has shown a high incidence of complications, including transurethral resection syndrome, massive bleeding, urinary incontinence and sexual dysfunction. High-frequency irreversible electroporation (H-FIRE) is a novel non-thermal ablation technique that delivers pulsed high-voltage but low-energy electric current to the cell membrane, thereby leading to cell death. H-FIRE has been reported to be tissue-selective, which leads to fewer side effects. However, no data are available on whether H-FIRE is non-inferior compared with TURP in treating patients with LUTS/BPO regarding safety and efficacy.Methods and analysisThis trial is a prospective, single-centre, randomised controlled, double-blinded and non-inferiority study in which all men with LUTS/BPO are included. This study aims to determine whether the HI-FIRE is non-inferior to TURP for achieving better functional outcomes as measured by the co-primary outcome of the change from baseline in maximal flow rate (Qmax) and the urinary symptoms by questionnaire of International Prostate Symptom Score (IPSS) scoring at 3 months after surgical treatment. The main inclusion criteria are men with prostatic volume range 30 to 100 mL, Qmax<15 mL/s and IPSS>8. A sample size of 118 participants is required, accounting for a 20% loss. All participants will be randomly allocated at a ratio of 1:1 to the H-FIRE arm (n=59) and the TURP arm (n=59). The primary outcome is to assess the change from baseline in Qmaxand IPSS scoring at 3 months after surgical treatment.Ethics and disseminationEthical approval was obtained from the ethics committee of Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China. The results of the study will be disseminated and published in international peer-reviewed journals.Trial registration numberClinicalTrials.gov:NCT05306145.
Leveraging International Health Regulations (2005) to enhance health security in the Eastern Mediterranean Region: a retrospective analysis from 2016 to 2023
Authors: Elhakim Mohamed , Hamid Mahgoub , Elkholy Amgad , Samhouri Dalia 
Published: January 2025

IntroductionThe WHO Eastern Mediterranean Region (EMR), consisting of 22 member states, faces significant health security challenges exacerbated by socioeconomic, political and environmental factors. This study aims to assess the efforts to enhance health security in the EMR from 2016 to 2023 through the implementation of the International Health Regulations (IHR) (2005) core capacities.MethodsA narrative review was conducted using IHR Monitoring and Evaluation Framework (MEF) tools, such as the State Party Self-Assessment Annual Report (SPAR) and the Joint External Evaluation (JEE), to evaluate the region’s preparedness and response capabilities. Other assessments, such as the Universal Health and Preparedness Review (UHPR), after-action and intra-action reviews and simulation exercises, were included.ResultsThe evaluations identified critical gaps in health security infrastructure, highlighting the need for comprehensive strategies and external support, including the Pandemic Fund and National Action Plans for Health Security. While progress has been made, challenges remain due to emerging and re-emerging diseases and regional humanitarian crises.ConclusionDespite improvements, the EMR continues to face significant health security challenges. Increased advocacy, capacity building and multisectoral collaboration, particularly through the One Health approach, are essential for future preparedness.
Cost-of-illness study among patients with diabetes mellitus and coping mechanisms in Northern Ghana
Authors: Ziblim Andrew Mpagwuni , Azaare John , Bio Robert Bagngmen , Inusah Abdul-Hanan Saani , Issah Abdul-Nasir , Hushie Martin 
Published: January 2025

IntroductionThe increasing prevalence of diabetes globally imposes financial burden on individuals, societies and health systems. However, not much is known about the treatment costs of diabetes and the coping mechanisms patients adopt in seeking care in the northern part of Ghana. In this study, we assessed the annual direct, indirect and intangible costs of diabetes mellitus care and related coping mechanisms of patients at the Tamale Teaching Hospital’s Diabetic Clinic.MethodsThis was a descriptive cross-sectional cost-of-illness study conducted between June and August 2023 among 385 patients with diabetes in the Tamale Teaching Hospital of Ghana. Participants were selected by systematic random sampling. Direct medical costs (summation of cost of medications, investigations and admissions) and direct non-medical costs (cost of food and water, and transportation during hospital visits) together made up direct costs per patient per year. Indirect costs (lost wages as a result of illness or hospital visits) were estimated using the human capital approach. Intangible costs were analysed using a 5-point Likert Scale. Cost-coping mechanisms were obtained from the perspectives of the participants.ResultsThe mean direct cost per person per year was found to be US$159.70 (95% CI 126.70 to 193.04), with direct medical costs being on average US$186.04 and direct non-medical costs being on average US$15.59, while the mean indirect cost per person per year was US$130.72. Average total cost of illness per person per year was found to be US$290.44 (95% CI 248.64 to 334.70). The study participants often experienced intangible costs such as physical pain, easy fatiguability and diet changes as a result of diabetes and adopted a number of cost-coping mechanisms which included the use of savings, borrowing and reducing medication use.ConclusionThe costs incurred for care of diabetes mellitus in Northern Ghana are substantial, especially in view of Ghana’s low minimum wage which was US$1.35 in 2023. This results in the adoption of adverse-cost-coping mechanisms that can drive families into further poverty with detrimental effects on the treatment of diabetes.
Non-singular anisotropic solutions for strange star model in $$f(\mathcal {R},\mathcal {T},\mathcal {R}_{\zeta \gamma }\mathcal {T}^{\zeta \gamma })$$ gravity theory
Authors: Feng Yihu , Naseer Tayyab , Mustafa G. , Maurya S. K. 
Published: January 2025

AbstractThis article focuses on different anisotropic models within the framework of a specific modified $$f(\mathcal {R},\mathcal {T}, \mathcal {R}_{\zeta \gamma }\mathcal {T}^{\zeta \gamma })$$

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gravity theory. The study adopts a static spherically symmetric spacetime to determine the field equations for two different modified models: (i) $$f(\mathcal {R},\mathcal {T},\mathcal {R}_{\zeta \gamma }\mathcal {T}^{\zeta \gamma })=\mathcal {R}+\eta \mathcal {R}_{\zeta \gamma }\mathcal {T}^{\zeta \gamma }$$

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, and (ii) $$f(\mathcal {R},\mathcal {T},\mathcal {R}_{\zeta \gamma }\mathcal {T}^{\zeta \gamma })=\mathcal {R}(1+\eta \mathcal {R}_{\zeta \gamma }\mathcal {T}^{\zeta \gamma })$$

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, where $$\eta $$
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is a constant parameter. To address the additional degrees of freedom in the field equations and obtain their corresponding unique solution, the Durgapal-Fuloria spacetime geometry and MIT bag model are utilized. Matching conditions are applied to determine unknown constants within the chosen spacetime geometry. We adopt a certain range of model parameters to analyze the physical characteristics of the developed models in the interior distribution of a particular compact star candidate 4U 1820-30. Energy conditions and some other tests are also implemented to ensure their viability and stability. Additionally, the disappearing radial pressure constraint is employed to find the values of the model parameter, aligning with the observed information of an array of stars. The study concludes that both of our models are well-behaved and satisfy all necessary conditions, and thus we observe them suitable for the modeling of astrophysical objects.