bluuebunny/crossref_metadata_2025_split huggingface dataset:
Renin-angiotensin system inhibitors improve the survival of cholangiocarcinoma: a propensity score-matched cohort study
Authors: Zhu Xiao-Xu , Li Jian-Hui , Fang Peng , Qu Xiao-Fei , Liang Li-Jian , Lai Jia-Ming , Yin Xiao-Yu 
Published: September 2023

Abstract
Background
Hypertension is a risk factor for cholangiocarcinoma (CCA). The effect of anti-hypertensive drugs on the prognosis of CCA is not clear.

Methods
This is a retrospective study of 102 patients (56.9% males, median age 66 years) diagnosed with CCA and hypertension concurrently and received radical surgery (R0), with a median follow-up of 36.7 months. Kaplan-Meier analysis, Cox regressions, and propensity score (PS) matching were applied for statistical analysis.

Results
Results of multivariable cox analysis showed that renin-angiotensin system inhibitors (RASis) usage was a protective factor for progression-free survival (PFS) (hazard ratio [HR] = 0.55, 95% confidence interval [95% CI]: 0.32–0.96) and overall survival (OS) (HR = 0.40, 95% CI: 0.20–0.79), respectively. Calcium channel blockers, diuretics, and β-blockers didn’t show significant associations. The association of RASis usage and PFS and OS was derived by PS matching, with a cohort of 28 RASis users and 56 RASis non-users. The median PFS and OS of RASis users (PFS, 17.6 months (9.2–34.4); OS, 24.8 months (16.5–42.3)) were longer than RASis non-users (PFS, 10.5 months (4.1–24.1); OS, 14.6 months (10.6–28.4)). The 1 year, 2 years, and 3 years’ survival rates of RASis users (89.1%, 77.0%, and 65.5%) were higher than RASis non-users (70.9%, 54.0%, and 40.0%).

Conclusions
RASis usage improves the survival of patients with CCA and hypertension concurrently.
Using RegGAN to generate synthetic CT images from CBCT images acquired with different linear accelerators
Authors: Li Zhenkai , Zhang Qingxian , Li Haodong , Kong Lingke , Wang Huadong , Liang Benzhe , Chen Mingming , Qin Xiaohang , Yin Yong , Li Zhenjiang 
Published: September 2023

Abstract
Background
The goal was to investigate the feasibility of the registration generative adversarial network (RegGAN) model in image conversion for performing adaptive radiation therapy on the head and neck and its stability under different cone beam computed tomography (CBCT) models.

Methods
A total of 100 CBCT and CT images of patients diagnosed with head and neck tumors were utilized for the training phase, whereas the testing phase involved 40 distinct patients obtained from four different linear accelerators. The RegGAN model was trained and tested to evaluate its performance. The generated synthetic CT (sCT) image quality was compared to that of planning CT (pCT) images by employing metrics such as the mean absolute error (MAE), peak signal-to-noise ratio (PSNR), and structural similarity index measure (SSIM). Moreover, the radiation therapy plan was uniformly applied to both the sCT and pCT images to analyze the planning target volume (PTV) dose statistics and calculate the dose difference rate, reinforcing the model’s accuracy.

Results
The generated sCT images had good image quality, and no significant differences were observed among the different CBCT modes. The conversion effect achieved for Synergy was the best, and the MAE decreased from 231.3 ± 55.48 to 45.63 ± 10.78; the PSNR increased from 19.40 ± 1.46 to 26.75 ± 1.32; the SSIM increased from 0.82 ± 0.02 to 0.85 ± 0.04. The quality improvement effect achieved for sCT image synthesis based on RegGAN was obvious, and no significant sCT synthesis differences were observed among different accelerators.

Conclusion
The sCT images generated by the RegGAN model had high image quality, and the RegGAN model exhibited a strong generalization ability across different accelerators, enabling its outputs to be used as reference images for performing adaptive radiation therapy on the head and neck.
Personal determinants of change agents’ decision-making behavior in community health promotion: a qualitative study
Authors: Paulsen Lisa , Benz Lea , Müller Christina , Wallmann-Sperlich Birgit , Bucksch Jens 
Published: September 2023

Abstract
Background
Implementing environmental changes to promote healthier communities requires initial positive decisions by change agents from local politics and government. However, there is little research on what influences the change agents' decisions. This explorative, qualitative study aims to identify the personal determinants of the decision-making behavior of local change agents.

Methods
We conducted semi-structured interviews to assess the personal determinants of decision-making behavior among 22 change agents from local politics and government. Relevant determinants were identified through a structured content analysis of the interview transcripts using the software MAXQDA 2020.

Results
We found the following seven essential clusters of personal determinants of the decision-making behavior of change agents from local politics and government: Imprinting, socialization, and biography; experiences and involvement; attitudes and outcome expectations towards important issues and aspects; knowledge; emotions; personal benefits; and the perceived influences of others.

Conclusions
The identified personal determinants might serve as a source of understanding the decision-making behavior of change agents in community decision-making processes. Our findings can contribute to the effective planning and implementation of evidence-based multilevel interventions related to changing environmental conditions in communities and provide important information on which personal determinants should be considered when derive strategies for community health promotion within a systematic approach of developing an intervention program theory.
Socioeconomic status and lifestyle patterns in the most common cancer types-community-based research
Authors: Sandström Niclas , Johansson Mikael , Jekunen Antti , Andersén Heidi 
Published: September 2023

Abstract
Introduction
As the global burden of chronic cancer increases, its correlation to lifestyle, socioeconomic status (SES) and health equity becomes more important. The aim of the present study was to provide a snapshot of the socioeconomic and lifestyle patterns for different cancer types in patients at a Nordic tertiary cancer clinic.

Materials and methods
In a descriptive observational study, questionnaires addressed highest-attained educational level, occupational level, economy, relationship status, exposures, and lifestyle habits. The questionnaire was distributed to all cancer patients attending the cancer clinic. Treating physicians added further information about the cancer disease, including primary origin, pathology report, TNM-classification and stage.

Results
Patients with lung cancer had the lowest SES, and patients with gastrointestinal (GI) cancer, other cancer types and prostate cancer had the second, third and fourth lowest SES, respectively. However, breast cancer patients had the highest SES. Lifestyle and exposure patterns differed among the major cancer types. Lung cancer patients reported the highest proportion of unfavourable lifestyle and exposure patterns, and patients with GI cancer, prostate cancer and other cancer types had the second, third and fourth highest proportion of unfavourable lifestyle and exposure patterns, respectively. The most favourable exposure and lifestyle patterns were observed in breast cancer patients.

Conclusions
The present study indicated significant socioeconomic and lifestyle differences among cancer types at a Nordic cancer centre, with differences in lifestyle being more prominent than socioeconomic differences.
Comparison of microleakage under orthodontic brackets bonded with five different adhesive systems: in vitro study
Authors: Masarykova Nela , Tkadlec Emil , Chlup Zdenek , Vrbsky Jan , Brysova Alena , Cernochova Pavlina , Izakovicova Holla Lydie 
Published: September 2023

AbstractBackgroundOrthodontic treatment is associated with numerous adverse side effects, such as enamel discoloration, demineralization or even caries. The presence of microleakage between the enamel and the adhesive and between the adhesive and the base of the orthodontic bracket allows penetration of the bacteria, molecules, and liquids into the enamel and can lead to unpleasant “white spot lesions” or secondary caries beneath and around the brackets. The aim of this in vitro study was to evaluate microleakage in five adhesive systems commonly used in orthodontic practice for bonding brackets.MethodsOne hundred extracted premolars were divided into five groups of twenty teeth. Stainless steel Legend medium metal brackets were bonded to teeth using five adhesive systems: resin-reinforced glass ionomer cement GC Fuji Ortho LC (GCF) and composite materials Light Bond (LB), Transbond XT (TB), Trulock™ Light Activated Adhesive (TL), and GC Ortho Connect (GCO). The specimens were subjected to thermal cycling, stained with 2% methylene blue, sectioned with low–speed diamond saw Isomet and evaluated under a digital microscope. Microleakage was detected at the enamel-adhesive and adhesive-bracket interfaces from occlusal and gingival margins. Statistical analysis was performed using generalized linear mixed models with beta error distribution.ResultsMicroleakage was observed in all materials, with GCF showing the highest amount of microleakage. Composite materials GCO, TB, and LB exhibited the lowest amount of microleakage with no statistical difference between them, while TL showed a statistically significantly higher amount of microleakage (p < 0.001). The enamel–adhesive interface had more microleakage in all composite materials (GCO, LB, TB, and TL) than the adhesive bracket–interface (p < 0.001). The highest amount of microleakage occurred in the gingival region in all materials.ConclusionComposite materials showed better adhesive properties than a resin-reinforced glass ionomer cement. The presence of microleakage at the enamel-adhesive interface facilitates the penetration of various substances into enamel surfaces, causing enamel demineralization and the development of dental caries.
Barriers and facilitators of conducting research with team science approach: a systematic review
Authors: Ghamgosar Arezoo , Nemati-Anaraki Leila , Panahi Sirous 
Published: September 2023

Abstract
Background
The present review aimed to systematically identify and classify barriers and facilitators of conducting research with a team science approach.

Methods
PubMed, EMBASE, PsycINFO, Scopus, Web of Science, Emerald, and ProQuest databases were searched for primary research studies conducted using quantitative, qualitative, or mixed methods. Studies examining barriers and facilitators of research with a team science approach were included in search. Two independent reviewers screened the texts, extracted and coded the data. Quality assessment was performed for all 35 included articles. The identified barriers and facilitators were categorized within Human, Organization, and Technology model.

Results
A total of 35 studies from 9,381 articles met the inclusion criteria, from which 42 barriers and 148 facilitators were identified. Human barriers were characteristics of the researchers, teaming skills, and time. We consider Human facilitators across nine sub-themes as follows: characteristics of the researchers, roles, goals, communication, trust, conflict, disciplinary distances, academic rank, and collaboration experience. The barriers related to organization were institutional policies, team science integration, and funding. Organizational facilitators were as follows: team science skills training, institutional policies, and evaluation. Facilitators in the field of technology included virtual readiness and data management, and the technology barriers were complexity of techniques and privacy issues.

Conclusions
We identified major barriers and facilitators for conducting research with team science approach. The findings have important connotations for ongoing and future implementation of this intervention strategy in research. The analysis of this review provides evidence to inform policy-makers, funding providers, researchers, and students on the existing barriers and facilitators of team science research.

Trial registration
This review was prospectively registered on PROSPERO database (PROSPERO 2021 CRD42021278704).
Developing a virtual reality (VR) application for practicing the ABCDE approach for systematic clinical observation
Authors: Berg Helen , Prasolova-Førland Ekaterina , Steinsbekk Aslak 
Published: September 2023

Abstract
Background
The Airways, Breathing, Circulation, Disability, Exposure (ABCDE) approach is an international approach for systematic clinical observation. It is an essential clinical skill for medical and healthcare professionals and should be practiced repeatedly. One way to do so is by using virtual reality (VR). The aim was therefore to develop a VR application to be used by inexperienced health students and professionals for self-instructed practice of systematic clinical observation using the ABCDE approach.

Methods
An iterative human-centred approach done in three overlapping phases; deciding on the ABCDE approach, specifying the requirements, and developing the application.

Results
A total of 138 persons were involved. Eight clinical observations were included in the ABCDE approach. The requirements included making it possible for inexperienced users to do self-instructed practice, a high level of immersion, and a sense of presence including mirroring the physical activities needed to do the ABCDE approach, allowing for both single and multiplayer, and automatic feedback with encouragement to repeat the training. In addition to many refinements, the testing led to the development of some new solutions. Prominent among them was to get players to understand how to use the VR hand controllers and start to interact with the VR environment and more instructions like showing videos on how to do observations. The solutions in the developed version were categorised into 15 core features like onboarding, instructions, quiz, and feedback.

Conclusion
A virtual reality application for self-instructed practice of systematic clinical observation using the ABCDE approach can be developed with sufficient testing by inexperienced health students and professionals.
Barriers and facilitators of using health information technologies by women: a scoping review
Authors: Moulaei Khadijeh , Moulaei Reza , Bahaadinbeigy Kambiz 
Published: September 2023

Abstract
Background and aim
Health information technologies play a vital role in addressing diverse health needs among women, offering a wide array of services tailored to their specific requirements. Despite the potential benefits, the widespread utilization of these technologies by women faces numerous barriers and challenges. These barriers can cause women to either reduce their usage of health technologies or refrain from using them altogether. Therefore, this review was done with the aim of identifying and classifying barriers and facilitators.

Methods
Some databases, including PubMed, Web of Sciences, and Scopus were searched using related keywords. Then, according to the inclusion and exclusion criteria, the articles were evaluated and selected. Finally, the barriers and facilitators were identified and classified.

Results
Out of 14,399 articles, finally 35 articles were included in the review. In general, 375 barriers (232 items) and facilitators (143 items) were extracted from the studies. After merging similar items, 121 barriers (51 items) and facilitators (70 items) identified were organized into five main themes (management, technological, legal and regulatory, personal, and data and information management). The most important barriers were “privacy, confidentiality, and security concerns” (n = 24), “deficiencies and limitations of infrastructure, software, hardware, and network” (n = 19), “sociocultural challenges” (n = 15), and “poor economic status” (n = 15). Moreover, the most important facilitators were “increasing awareness, skills and continuous education of women” (n = 17, in personal theme), “providing training services” (n = 14, in management theme), “simple, usable, and user-friendly design of technologies” (n = 14, in technological theme), and “providing financial or non-financial incentives (motivation) for women” (n = 14, in personal theme).

Conclusion
This review showed that in order to use technologies, women face many barriers, either specific to women (such as gender inequality) or general (such as lack of technical skills). To overcome these barriers, policymakers, managers of organizations and medical centers, and designers of health systems can consider the facilitators identified in this review.
Standardized mortality ratios for regionalized acute cardiovascular care
Authors: den Hartog Sanne J. , Roozenbeek Bob , van der Bij Sjoukje , Amini Marzyeh , van Leeuwen Nikki , Boersma Eric , Dirven Clemens M.F. , Dippel Diederik W.J. , Lingsma Hester F. 
Published: September 2023

Abstract
Background
Standardized Mortality Ratios (SMRs) are case-mix adjusted mortality rates per hospital and are used to evaluate quality of care. However, acute care is increasingly organized on a regional level, with more severe patients admitted to specialized hospitals. We hypothesize that the current case-mix adjustment insufficiently captures differences in case-mix between non-specialized and specialized hospitals. We aim to improve the SMR by adding proxies of disease severity to the model and by calculating a regional SMR (RSMR) for acute cerebrovascular disease (CVD) and myocardial infarction (MI).

Methods
We used data from the Dutch National Basic Registration of Hospital Care. We selected all admissions from 2016 to 2018. SMRs and RSMRs were calculated by dividing the observed in-hospital mortality by the expected in-hospital mortality. The expected in-hospital mortality was calculated using logistic regression with adjustment for age, sex, socioeconomic status, severity of main diagnosis, urgency of admission, Charlson comorbidity index, place of residence before admission, month/year of admission, and in-hospital mortality as outcome.

Results
The IQR of hospital SMRs of CVD was 0.85–1.10, median 0.94, with higher SMRs for specialized hospitals (median 1.12, IQR 1.00-1.28, 71%-SMR > 1) than for non-specialized hospitals (median 0.92, IQR 0.82–1.07, 32%-SMR > 1). The IQR of RSMRs was 0.92–1.09, median 1.00. The IQR of hospital SMRs of MI was 0.76–1.14, median 0.98, with higher SMRs for specialized hospitals (median 1.00, IQR 0.89–1.25, 50%-SMR > 1 versus median 0.94, IQR 0.74–1.11, 44%-SMR > 1). The IQR of RSMRs was 0.90–1.08, median 1.00. Adjustment for proxies of disease severity mostly led to lower SMRs of specialized hospitals.

Conclusion
SMRs of acute regionally organized diseases do not only measure differences in quality of care between hospitals, but merely measure differences in case-mix between hospitals. Although the addition of proxies of disease severity improves the model to calculate SMRs, real disease severity scores would be preferred. However, such scores are not available in administrative data. As a consequence, the usefulness of the current SMR as quality indicator is very limited. RSMRs are potentially more useful, since they fit regional organization and might be a more valid representation of quality of care.
New investigation of anti-inflammatory activity of Polycladia crinita and biosynthesized selenium nanoparticles: isolation and characterization
Authors: Almurshedi Alanood S. , El-Masry Thanaa A. , Selim Hend , El-Sheekh Mostafa M. , Makhlof Mofida E. M. , Aldosari Basmah N. , Alfagih Iman M. , AlQuadeib Bushra T. , Almarshidy Salma S. , El-Bouseary Maisra M. 
Published: September 2023

Abstract
Background
Marine macroalgae have gained interest recently, mostly due to their bioactive components. Polycladia crinita is an example of marine macroalgae from the Phaeophyceae class, also known as brown algae. They are characterized by a variety of bioactive compounds with valuable medical applications. The prevalence of such naturally active marine resources has made macroalgae-mediated manufacturing of nanoparticles an appealing strategy. In the present study, we aimed to evaluate the antioxidant and anti-inflammatory features of an aqueous extract of Polycladia crinita and biosynthesized P. crinita selenium nanoparticles (PCSeNPs) via a carrageenan-induced rat paw edema model. The synthesized PCSeNPs were fully characterized by UV–visible spectroscopy, FTIR, XRD, and EDX analyses.

Results
FTIR analysis of Polycladia crinita extract showed several sharp absorption peaks at 3435.2, 1423.5, and 876.4 cm−1 which represent O–H, C=O and C=C groups. Moreover, the most frequent functional groups identified in P. crinita aqueous extract that are responsible for producing SeNPs are the –NH2–, –C=O–, and –SH– groups. The EDX spectrum analysis revealed that the high percentages of Se and O, 1.09 ± 0.13 and 36.62 ± 0.60%, respectively, confirmed the formation of SeNPs. The percentages of inhibition of the edema in pretreated groups with doses of 25 and 50 mg/kg, i.p., of PCSeNPs were 62.78% and 77.24%, respectively. Furthermore, the pretreated groups with 25, 50 mg/kg of P. crinita extract displayed a substantial decrease in the MDA levels (P < 0.00, 26.9%, and 51.68% decrease, respectively), indicating potent antioxidant effect. Additionally, the pretreated groups with PCSeNPs significantly suppressed the MDA levels (P < 0.00, 54.77%, and 65.08% decreases, respectively). The results of immune-histochemical staining revealed moderate COX-2 and Il-1β expressions with scores 2 and 1 in rats pre-treated with 25 and 50 mg/kg of free extract, respectively. Additionally, the rats pre-treated with different doses of PCSeNPs demonstrated weak COX-2 and Il-1β expressions with score 1 (25 mg/kg) and negative expression with score 0 (50 mg/kg). Both antioxidant and anti-inflammatory effects were dose-dependent.

Conclusions
These distinguishing features imply that this unique alga is a promising anti-inflammatory agent. Further studies are required to investigate its main active ingredients and possible side effects.