bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sensitivity to clinical change in patients with syncope measured by the specific scale impact of syncope on quality of life
Authors: Alves S , Oliveira M , Ferreira R 
Published: July 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): CHULC (Centro Hospitalar Universitário de Lisboa Central), Hospital de Santa Marta.

Summary
Recurrent syncope has a significant impact on the quality of life (QL). Patients (P) identify better with specific scales to report their perception of their QL. We believe that sensitivity to changes in the clinical condition is an asset of this type of scale.

Objective
To assess the sensitivity of the specific scale "Impact of Syncope on Quality of Life" (ISQL) for measuring QL in P with syncope who have undergone changes in their clinical condition. Population and methodology: 57 P, 21 men and 36 women, mean age 54.4±17.3 (19 to 83 years), most married (65%) working (36.2%) or retired (46, 6%) whose answers to the ISQL were used to analyze the psychometric properties of this instrument (18 more individuals than in the preliminary validation) and 22 P who performed a tilt training program (TTr), 9 men and 11 women, with a mean age of 50.3±18,1 (18 to 78 years), mostly married (55%) working (50%) or retired (35%) who reported perception of their QL before TTr and 6 months after, responding to the ISQL.

Results
Regarding fidelity, convergent validity and divergent validity, the statistically significant results measured in the validation of the scale for the Portuguese population that had 39 P are maintained, which strengthens this measure in relation to psychometric properties and its use in clinical context. The stability in time was tested in the preliminary validation by the test-retest method of the instrument at six months after tilt test with 22 P (from the initial sample of 39 P) not submitted to clinical intervention, which did not show statistically significant changes in QL. Sensitivity to clinical change was tested in a group of 20 P who integrated and completed a TTr, with statistically significant changes in QL reported using this specific measure referring worry, fear, doing less than they wanted and avoiding certain locations.

Conclusions
The results obtained reinforce the use of the ISQL in the evaluation of QL in the P with syncope and indicate that the ISQL identifies the alteration of the clinical condition, being a fundamental measure for the evaluation of the results of clinical interventions in these patients, as well as in others.
Lay and general practitioner attitudes towards endometrial cancer prevention: a cross-sectional study
Authors: Kitson Sarah J , Khan Urwaa , Crosbie Emma J 
Published: July 2023

Abstract

Background
Effective and targeted endometrial cancer prevention strategies could reduce diagnoses by 60%. Whether this approach is acceptable to individuals and general practitioners (GPs) is currently unknown. This study sought to determine attitudes towards the provision of personalised endometrial cancer risk assessments and the acceptability of potential prevention strategies.

Methods
Specific online questionnaires were developed for individuals aged 45–60 years with a uterus and UK-practising GPs, with social media, charity websites, and email used to advertise the study. Individuals completed the questionnaires between February and April 2022.

Results
Of 660 lay questionnaire respondents, 90.3% (n = 596) thought that undergoing an endometrial cancer risk assessment was a good or very good idea and 95.6% (n = 631) would be willing to undergo such an assessment. The commonest reasons for wanting to participate were “to try and reduce my risk” (n = 442, 67.0%), “to be informed” (n = 354, 53.6%), and “it could save my life’ (n = 315, 47.7%). Over 80% of respondents would make lifestyle changes to reduce their endometrial cancer risk (n = 550), with half accepting a pill, Mirena, or hysterectomy for primary prevention. GPs were similarly engaged, with 93.0% (n = 106) willing to offer an endometrial cancer risk assessment if a tool were available, potentially during a Well Woman screen.

Conclusion
Personalised endometrial cancer risk assessments are acceptable to potentially eligible individuals and GPs and could be accommodated within routine practice. Clinical trials to determine the effectiveness of lifestyle modification and Mirena for endometrial protection are urgently required and should be targeted at those at greatest disease risk.
Health and health system impacts of China’s comprehensive primary healthcare reforms: a systematic review
Authors: Cai Chang , Xiong Shangzhi , Millett Christopher , Xu Jin , Tian Maoyi , Hone Thomas 
Published: July 2023

Abstract
China’s comprehensive primary healthcare (PHC) reforms since 2009 aimed to deliver accessible, efficient, equitable and high-quality healthcare services. However, knowledge on the system-wide effectiveness of these reforms is limited. This systematic review synthesizes evidence on the reforms’ health and health system impacts. In 13 August 2022, international databases and three Chinese databases were searched for randomized controlled trials, quasi-experimental studies and controlled before-after studies. Included studies assessed large-scale PHC policies since 2009; had a temporal comparator and a control group and assessed impacts on expenditures, utilization, care quality and health outcomes. Study quality was assessed using Risk of Bias In Non-randomized Studies of Interventions, and results were synthesized narratively. From 49 174 identified records, 42 studies were included—all with quasi-experimental designs, except for one randomized control trial. Nine studies were assessed as at low risk of bias. Only five low- to moderate-quality studies assessed the comprehensive reforms as a whole and found associated increases in health service utilization, whilst the other 37 studies examined single-component policies. The National Essential Medicine Policy (N = 15) and financing reforms (N = 11) were the most studied policies, whilst policies on primary care provision (i.e. family physician policy and the National Essential Public Health Services) were poorly evaluated. The PHC reforms were associated with increased primary care utilization (N = 17) and improved health outcomes in people with non-communicable diseases (N = 8). Evidence on healthcare costs was unclear, and impacts on patients’ financial burden and care quality were understudied. Some studies showed disadvantaged regions and groups that accrued greater benefits (N = 8). China’s comprehensive PHC reforms have made some progress in achieving their policy objectives including increasing primary care utilization, improving some health outcomes and reducing health inequalities. However, China’s health system remains largely hospital-centric and further PHC strengthening is needed to advance universal health coverage.
Assessing the impact of anaesthetic and surgical task-shifting globally: a systematic literature review
Authors: Bognini Maeve S , Oko Christian I , Kebede Meskerem A , Ifeanyichi Martilord I , Singh Darshita , Hargest Rachel , Friebel Rocco 
Published: July 2023

Abstract
The global shortage of skilled anaesthesiologists, surgeons and obstetricians is a leading cause of high unmet surgical need. Although anaesthetic and surgical task-shifting are widely practised to mitigate this barrier, little is known about their safety and efficacy. This systematic review seeks to highlight the existing evidence on the clinical outcomes of patients operated on by non-physicians or non-specialist physicians globally. Relevant articles were identified by searching four databases (MEDLINE, EMBASE, CINAHL and Global Health) in all languages between January 2008 and February 2022. Retrieved documents were screened against pre-specified inclusion and exclusion criteria, and their qualities were appraised critically. Data were extracted by two independent reviewers and findings were synthesized narratively. In total, 40 studies have been included. Thirty-five focus on task-shifting for surgical and obstetric procedures, whereas four studies address anaesthetic task-shifting; one study covers both interventions. The majority are located in sub-Saharan Africa and the USA. Seventy-five per cent present perioperative mortality outcomes and 85% analyse morbidity measures. Evidence from low- and middle-income countries, which primarily concentrates on caesarean sections, hernia repairs and surgical male circumcisions, points to the overall safety of non-surgeons. On the other hand, the literature on surgical task-shifting in high-income countries (HICs) is limited to nine studies analysing tube thoracostomies, neurosurgical procedures, caesarean sections, male circumcisions and basal cell carcinoma excisions. Finally, only five studies pertaining to anaesthetic task-shifting across all country settings answer the research question with conflicting results, making it difficult to draw conclusions on the quality of non-physician anaesthetic care. Overall, it appears that non-specialists can safely perform high-volume, low-complexity operations. Further research is needed to understand the implications of surgical task-shifting in HICs and to better assess the performance of non-specialist anaesthesia providers. Future studies must adopt randomized study designs and include long-term outcome measures to generate high-quality evidence.
Drug Resistance Assessed in a Phase 3 Clinical Trial of Maribavir Therapy for Refractory or Resistant Cytomegalovirus Infection in Transplant Recipients
Authors: Chou Sunwen , Alain Sophie , Cervera Carlos , Chemaly Roy F , Kotton Camille N , Lundgren Jens , Papanicolaou Genovefa A , Pereira Marcus R , Wu Jingyang J , Murray Rose Ann , Buss Neil E , Fournier Martha 
Published: July 2023

Abstract

Background
This drug resistance analysis of a randomized trial includes 234 patients receiving maribavir and 116 receiving investigator-assigned standard therapy (IAT), where 56% and 24%, respectively, cleared cytomegalovirus DNA at week 8 (treatment responders).

Methods
Baseline and posttreatment plasma samples were tested for mutations conferring drug resistance in viral genes UL97, UL54, and UL27.

Results
At baseline, genotypic testing revealed resistance to ganciclovir, foscarnet, or cidofovir in 56% of patients receiving maribavir and 68% receiving IAT, including 9 newly phenotyped mutations. Among them, 63% (maribavir) and 21% (IAT) were treatment responders. Detected baseline maribavir resistance mutations were UL27 L193F (n = 1) and UL97 F342Y (n = 3). Posttreatment, emergent maribavir resistance mutations were detected in 60 (26%) of those randomized to maribavir, including 49 (48%) of 103 nonresponders and 25 (86%) of the 29 nonresponders where viral DNA initially cleared then rebounded while on maribavir. The most common maribavir resistance mutations were UL97 T409M (n = 34), H411Y (n = 26), and C480F (n = 21), first detected 26 to 130 (median 56) days after starting maribavir.

Conclusions
Baseline maribavir resistance was rare. Drug resistance to standard cytomegalovirus antivirals did not preclude treatment response to maribavir. Rebound in plasma cytomegalovirus DNA while on maribavir strongly suggests emerging drug resistance.

Clinical Trials Registration
NCT02931539.
Impact of Metagenomic Next-Generation Sequencing of Bronchoalveolar Lavage Fluid on Antimicrobial Stewardship in Patients With Lower Respiratory Tract Infections: A Retrospective Cohort Study
Authors: Yan Mengwei , Zou Xiaohui , Wang Yeming , Wang Chenhui , Wang Yimin , Liu Zhibo , Shang Lianhan , Cui Xiaojing , Cao Bin 
Published: July 2023

Abstract

Background
The impact of metagenomic next-generation sequencing (mNGS) on antimicrobial stewardship in patients with lower respiratory tract infections (LRTIs) is still unknown.

Methods
This retrospective cohort study included patients who had LRTIs diagnosed and underwent bronchoalveolar lavage between September 2019 and December 2020. Patients who underwent both mNGS and conventional microbiologic tests were classified as the mNGS group, while those with conventional tests only were included as a control group. A 1:1 propensity score match for baseline variables was conducted, after which changes in antimicrobial stewardship between the 2 groups were assessed.

Results
A total of 681 patients who had an initial diagnosis of LRTIs and underwent bronchoalveolar lavage were evaluated; 306 patients were finally included, with 153 in each group. mNGS was associated with lower rates of antibiotic escalation than in the control group (adjusted odds ratio, 0.466 [95% confidence interval, .237–.919]; P = .02), but there was no association with antibiotic de-escalation. Compared with the control group, more patients discontinued the use of antivirals in the mNGS group.

Conclusions
The use of mNGS was associated with lower rates of antibiotic escalation and may facilitate the cessation of antivirals, but not contribute to antibiotic de-escalation in patients with LRTIs.
International Norms as Emergent Properties of Complex Adaptive Systems
Authors: Winston Carla 
Published: July 2023

AbstractThis theory note argues that international norms, as currently understood by scholars of international relations, can be seen as emergent properties of a complex adaptive system (the international political system). Arising from the microlevel interactions of agents within and across various levels of analysis, they have the potential to become system properties that (a) influence the constitution, relationships, and behavior of agents within that system and (b) are not analytically reducible to the sum of the interactions between those agents. They also exhibit evolutionary dynamics common to complex, rather than merely complicated, systems. Thinking of norms in this manner helps point norms scholars toward particular spaces and methodologies of research. After a brief resume of complexity theory in IR, the note proceeds with an introduction to complex systems theory. It then explores the conceptual nexus between norms theory and complexity. It finishes by suggesting the ways in which understanding norms as complex emergent phenomena might influence norms research more broadly.
Fate of microbial contamination in a South European Coastal Lagoon (Ria Formosa) under the influence of treated effluents dispersal
Authors: Caetano Sandra , Correia Cátia , Vidal Ana Flor Torres , Matos André , Ferreira Cristina , Cravo Alexandra 
Published: July 2023

Abstract

Aim
Assessment of the fate of microbial contamination driven from treated wastewater disposal at a highly productive zone on a South European coastal lagoon (Ria Formosa).

Methods and results
Microbial indicators of contamination (Total coliforms, Escherichia coli, and Enterococci) were evaluated monthly during September 2018–September 2020 at three study areas (Faro, Olhão, and Tavira) under different wastewater discharge flows and hydrodynamic conditions. Additional data on E. coli monitoring in bivalves, available from the national institution responsible for their surveillance was also considered. The maximum microbial contamination was found at Faro, the highest-load and less-flushed study area, contrasting the lowest contamination at Olhão, a lower-load and strongly flushed area. The wastewater impact decreased along the spatial dispersal gradients and during high water, particularly at Faro and Tavira study areas, due to a considerable dilution effect. Microbial contamination at Olhão increased during the summer, while at the other study areas seasonal evidence was not clear. Data also indicate that E. coli in bivalves from bivalve production zones next to the three study areas reflected the differentiated impact of the wastewater treatment plants effluents on the water quality of those areas.

Conclusions
Effluent loads together with local hydrodynamics, water temperature, solar radiation, precipitation, and land runoff as well as seabirds populations and environmentally adapted faecal or renaturelized bacterial communities, contributed to microbial contamination of the study areas.
How to Recognize and Correct Artifacts on Contrast-Enhanced Mammography
Authors: Harper Laura K , Faulk Ellen A , Patel Bhavika , Collins Patricia , Rochman Carrie 
Published: July 2023

Abstract
Contrast-enhanced mammography (CEM) has emerged as an important new technology in breast imaging. It can demonstrate a number of imaging artifacts that have the potential to limit interpretation by either obscuring or potentially mimicking disease. Commonly encountered artifacts on CEM include patient motion artifacts (ripple and misregistration), pectoral highlighting artifact, breast implant artifact, halo artifact, corrugation artifact, cloudy fat artifact, contrast artifacts (retention and contamination), skin artifacts (skin line enhancement and skin overexposure), and skin lesions. Skin lesions may demonstrate a variety of imaging appearances and have both benign and malignant etiologies. It is important that the technologist, radiologist, and physicist be aware of potential artifacts and skin enhancement on CEM that may affect interpretation and understand their causes and potential solutions.
Too close for comfort: leveraging identity-based relevance through targeted health information backfires for Black Americans
Authors: Derricks Veronica , Earl Allison 
Published: July 2023

Abstract
Communicators frequently make adjustments to accommodate receivers’ characteristics. One strategy for accommodation is to enhance the relevance of communication for receivers. The current work uses information targeting—a communication strategy where information is disseminated to audiences believed to experience heightened risk for a health condition—to test whether and why targeting health information based on marginalized racial identities backfires. Online experimental findings from Black and White adults recruited via MTurk (Study 1) and Prolific Academic (Study 2) showed that Black Americans who received targeted (vs. nontargeted) health messages about HIV or flu reported decreased attention to the message and reduced trust in the message provider. White Americans did not differentially respond to targeting. Findings also demonstrated that (a) these negative consequences emerged for Black Americans due to social identity threat, and (b) these consequences predicted downstream cognitive and behavioral responses. Study 2 showed that these consequences replicated when the targeting manipulation signaled relevance directly via marginalized racial identities. Collectively, findings demonstrate that race-based targeting may lead to overaccommodation, thus precluding the expected benefits of relevance.
Salicylic acid regulates phenolic acid biosynthesis via SmNPR1–SmTGA2/SmNPR4 modules in Salvia miltiorrhiza
Authors: Ding Meiling , Xie Yongfeng , Zhang Yuhang , Cai Xiaona , Zhang Bin , Ma Pengda , Dong Juane 
Published: July 2023

Abstract
Phenolic acids are the main active ingredients in Salvia miltiorrhiza, which can be used for the treatment of many diseases, particularly cardiovascular diseases. It is known that salicylic acid (SA) can enhance phenolic acid content, but the molecular mechanism of its regulation is still unclear. Nonexpresser of PR genes 1 (NPR1) plays a positive role in the SA signaling pathway. In this study, we identified a SmNPR1 gene that responds to SA induction and systematically investigated its function. We found that SmNPR1 positively affected phenolic acid biosynthesis. Then, we identified a novel TGA transcription factor, SmTGA2, which interacts with SmNPR1. SmTGA2 positively regulates phenolic acid biosynthesis by directly up-regulating SmCYP98A14 expression. After double-gene transgenic analysis and other biochemical assays, it was found that SmNPR1 and SmTGA2 work synergistically to regulate phenolic acid biosynthesis. In addition, SmNPR4 forms a heterodimer with SmNPR1 to inhibit the function of SmNPR1, and SA can alleviate this effect. Collectively, these findings elucidate the molecular mechanism underlying the regulation of phenolic acid biosynthesis by SmNPR1–SmTGA2/SmNPR4 modules and provide novel insights into the SA signaling pathway regulating plant secondary metabolism.
The potential of microalgal sources as coating materials: A case study for the development of biocompatible surgical sutures
Authors: Tokgöz Merve , Yarkent Çağla , Köse Ayşe , Oncel Suphi S 
Published: July 2023

Abstract
Sutures are considered as surgical materials that form excellent surfaces to integrate the postoperative parts of the body. These materials present suitable platforms for potential bacterial penetrations. Therefore, coating these biomedical materials with biocompatible compounds is seen as a potential approach to improve their properties while avoiding adverse effects. The aim of this study was to evaluate Arthrospira platensis, Haematacoccus pluvialis, Chlorella minutissima, Botyrococcus braunii, and Nostoc muscorum as potential surgical suture coating materials. Their crude extracts were absorbed into two different sutures as poly glycolic (90%)-co-lactic acid (10%) (PGLA) and poly dioxanone (PDO); then, their cytotoxic effects and antibacterial activities were examined. Both N. muscorum-coated sutures (PGLA and PDO) and A. platensis-coated (PGLA and PDO) sutures did not induce any toxic effect on L929 mouse fibroblast cells (&gt;70% cell viability). The highest antibacterial activity against Staphylococcus aureus was achieved with N. muscorum-coated PGLA and A. platensis-coated PGLA at 11.18 ± 0.54 mm and 9.52 ± 1.15 mm, respectively. These sutures were examined by mechanical analysis, and found suitable according to ISO 10993-5. In comparison with the commercial antibacterial agent (chlorohexidine), the results proved that N. muscorum extract can be considered as the most promising suture coating material for the human applications.
Simulation and experiment of gas diffusion in a granular bed
Authors: Güttler C , Rose M , Sierks H , Macher W , Zivithal S , Blum J , Laddha S , Gundlach B , Kargl G 
Published: July 2023

ABSTRACTThe diffusion of gas through porous material is important to understand the physical processes underlying cometary activity. We study the diffusion of a rarefied gas (Knudsen regime) through a packed bed of monodisperse spheres via experiments and numerical modelling, providing an absolute value of the diffusion coefficient and compare it to published analytical models. The experiments are designed to be directly comparable to numerical simulations, by using precision steel beads, simple geometries, and a trade-off of the sample size between small boundary effects and efficient computation. For direct comparison, the diffusion coefficient is determined in Direct Simulation Monte Carlo (DSMC) simulations, yielding a good match with experiments. This model is further-on used on a microscopic scale, which cannot be studied in experiments, to determine the mean path of gas molecules and its distribution, and compare it against an analytical model. Scaling with sample properties (particle size and porosity) and gas properties (molecular mass and temperature) is consistent with analytical models. As predicted by these, results are very sensitive on sample porosity and we find that a tortuosity q(ε) depending linearly on the porosity ε can well reconcile the analytical model with experiments and simulations. Mean paths of molecules are close to those described in the literature, but their distribution deviates from the expectation for small path lengths. The provided diffusion coefficients and scaling laws are directly applicable to thermophysical models of idealized cometary material.