bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of a remotely supervised physical training program combined with cognitive training for older individuals at increased risk of clinical-functional vulnerability: study protocol for a randomized clinical trial
Authors: Berní Franciele Costa , Kanitz Ana Carolina , Miranda Camila , de Oliveira Dener Budziarek , Bergamin Marco , Bullo Valentina , Schaun Gustavo Zaccaria , Alberton Cristine Lima 
Published: August 2023

Abstract
Background
Despite the robust body of evidence for the benefits of home-based physical exercise, there is still a paucity of data on the benefits of home-based cognitive training for older adults, especially in those at increased risk of clinical-functional vulnerability. As such, the present study aims to compare the chronic effects of a telehealth-delivered physical training intervention alone or combined with a cognitive training program in older adults at increased clinical-functional vulnerability risk.

Methods
A randomized clinical trial will be conducted including 62 sedentary older individuals classified as at increased risk of clinical-functional vulnerability based on their Clinical-Functional Vulnerability Index score. Participants will be randomly allocated in a 1:1 ratio to one of two groups, an intervention group including physical training combined with cognitive training, or an active control group including physical training alone. Both groups will receive home-based supervised training remotely for 12 weeks and will be assessed for the primary and secondary outcomes of the study before and after the training period. Primary outcomes include cognitive function and dynamic balance with a dual task. Secondary outcomes encompass physical, cognitive, and occupational performance, functional capacity, quality of life, and anxiety and depression symptoms, as well as hemodynamic measures. Data analysis will be performed by intention-to-treat and per protocol using mixed linear models and Bonferroni’s post hoc (α = 0.05).

Discussion
Our conceptual hypothesis is that both groups will show improvements in the primary and secondary outcomes. Nevertheless, we expect physical combined with cognitive training to improve cognitive function, dual task, and occupational performance to a greater degree as compared to physical training alone.

Trial registration
NCT05309278. Registered on April 4, 2022.
Antibiotic utilisation and resistance over the first decade of nationally funded antimicrobial stewardship programmes in Singapore acute-care hospitals
Authors: Ng Tat Ming , Ang Li Wei , Heng Shi Thong , Kwa Andrea Lay-Hoon , Wu Jia En , Seah Xue Fen Valerie , Lee Siok Ying , Seah Jonathan , Choo Robin , Lim Poh Lian , Thoon Koh Cheng , Chlebicki Maciej Piotr , Somani Jyoti , Lee Tau Hong , Lye David C. 
Published: August 2023

Abstract
Objective
The aim of this study was to describe the time series of broad-spectrum antibiotic utilisation and incidence of antibiotic-resistant organisms during the implementation of antimicrobial stewardship programmes (ASP) in Singapore.

Methods
An observational study was conducted using data from 2011 to 2020 in seven acute-care public hospitals. We applied joinpoint regressions to investigate changes in antibiotic utilisation rate and incidence density of antibiotic-resistant organisms.

Results
Across the seven hospitals, quarterly broad-spectrum antibiotic utilisation rate remained stable. Half-yearly incidence density of antibiotic-resistant organisms with two joinpoints at first half (H1) of 2012 and second half (H2) of 2014 decreased significantly in the second and third period with a half-yearly percentage change (HPC) of -2.9% and − 0.5%, respectively. Across the five hospitals with complete data, half-yearly broad-spectrum antibiotic utilisation rate with one joinpoint decreased significantly from H1 of 2011 to H2 of 2018 (HPC − 4.0%) and H2 of 2018 to H2 2020 (HPC − 0.5%). Incidence density of antibiotic-resistant organisms decreased significantly in the two joinpoint periods from H1 of 2012 to H2 of 2014 (HPC − 2.7%) and H2 of 2014 to H2 of 2020 (HPC − 1.0%). Ceftriaxone with one joinpoint decreased significantly from H1 of 2011 to H1 of 2014 (HPC − 6.0%) and H1 of 2014 to H2 of 2020 (HPC − 1.8%) and ceftriaxone-resistant E. coli and K. pneumoniae decreased significantly in later periods, from H2 of 2016 to H2 of 2020 (HPC − 2.5%) and H1 of 2012 to H2 of 2015 (HPC − 4.6%) respectively. Anti-pseudomonal antibiotics with one joinpoint decreased significantly from H1 of 2011 to H2 of 2014 (HPC − 4.5%) and H2 of 2014 to H2 of 2020 (HPC − 0.8%) and that of quinolones with one joinpoint at H1 of 2015 decreased significantly in the first period. C. difficile with one joinpoint increased significantly from H1 of 2011 to H1 of 2015 (HPC 3.9%) and decreased significantly from H1 of 2015 to H2 of 2020 (HPC − 4.9%).

Conclusions
In the five hospitals with complete data, decrease in broad-spectrum antibiotic utilisation rate was followed by decrease in incidence density of antibiotic-resistant organisms. ASP should continue to be nationally funded as a key measure to combat antimicrobial resistance in acute care hospitals.
Structural, functional, nutritional composition and analytical profiling of Triticum aestivum L.
Authors: Ammar Mai K. , Hanafi Rasha S. , Choucry Mouchira A. , Handoussa Heba 
Published: August 2023

AbstractWheat is considered as the most important cereal grain globally. It has a vast economic importance as it is used in producing bread, pastries, and household flour and serving as food for livestock among other uses. Different biological activities of wheat were correlated with the presence of polyphenols due to their antioxidant activities and other preventative capabilities. Wheat can also be used as an antidiabetic, anti-inflammatory, anticancer, antimicrobial, and antiaging agent. Omics has established itself during the past 20 years as a crucial tool for comprehending the internal systems of various plant systems including wheat using LC–MS, GC–MS, and UV spectrophotometry as analytical techniques. The current review represents in depth search regarding wheat cultivation, botanical description, economic significance, quantitative phytochemical characterization, and biological importance. Additionally, a critical assessment of the cited omics research on wheat was conducted with an emphasis on the analytical instrument, methods of analysis and results interpretation.
Laboratory Investigation on Preplaced Ballast Aggregate Concrete Deterioration over Freezing–Thawing Cycles
Authors: Esmaeili Morteza , Behnajad Sajad , Hossein Esfahani Milad 
Published: August 2023

AbstractOne of the major gaps in previous research on the mechanical behavior of ballasted railway tracks converted into slab tracks using the preplaced aggregate concrete technique is its durability against freezing and thawing cycles. The present study pioneers at investigating the Preplaced Ballast Aggregate Concrete (PBAC) deterioration during freezing–thawing cycles, in which several freeze–thaw tests were carried out to measure the weight loss of PBAC samples during various freezing–thawing cycles, as well as the reduction in both compressive/tensile strengths and the relative dynamic modulus of elasticity. Moreover, the image acquisition of the PBAC samples was performed using a digital microscope and subsequently, an image processing technique was utilized to find a relation between the surface defect area at each imposed cycle and the number of cycles as a lifetime representative. As a result, an equation was developed to predict the defect frequency versus imposed cycles and the defect area generated to find the serviceability lifetime of PBAC in aggressive weather conditions. It was concluded that such PBAC can tolerate 6.16 years in the regions with full freezing–thawing weather conditions.
Assessment of urbanization impact on cultural heritage based on a risk-based cumulative impact assessment method
Authors: Fu Li , Zhang Qingping , Tang Yizhou , Pan Jie , Li Qun 
Published: August 2023

Abstract
Urbanization is inevitable in both developing and developed countries. However, this growth and transformation of the urban area can pose a significant threat to urban cultural heritage, which is a sensitive component of the urban environment. As cities modernize and change, a risk of irreparable loss of cultural heritage exists. Therefore, taking steps to protect and preserve these sites for posterity is crucial. To better protect urban cultural heritage, decision-makers must rapidly assess the impact of urbanization on cultural heritage while maintaining a balance between cultural heritage preservation and urban growth. This study developed a risk-based cumulative impact assessment (CIA) method that integrates a set of quantifiable indicators to address these issues. This method generates standardized assessment results based on game theory and set pair analysis theory. In contrast to other CIA methods, this risk-based approach effectively manages scientific complexity and uncertainties, thus enhancing the quality of the assessment results. This method was applied to 21 classical gardens in Suzhou, China. The results show that Suzhou classical gardens are impacted by urbanization. This study confirmed that adopting a risk-based CIA method that considers the impact of adverse urbanization on cultural heritage sites is an efficient approach. Successful implementation of the proposed method can provide decision-making support for different types of cultural heritage in other areas.
Effect of norepinephrine on the vascular waterfall and tissue perfusion in vasoplegic hypotensive patients: a prospective, observational, applied physiology study in cardiac surgery
Authors: Andrei Stefan , Bar Stéphane , Nguyen Maxime , Bouhemad Bélaid , Guinot Pierre-Grégoire 
Published: August 2023

Abstract
Background
Norepinephrine is a commonly used drug for treating vasoplegic acute circulatory failure in ICU. The prediction of norepinephrine macro- and micro-circulatory response is complicated by its uneven receptors’ distribution between the arterial and the venous structures, and by the presence of a physiological vascular waterfall (VW) that disconnects the arterial and the venous circulation in two pressure systems. The objectives of this study were to describe the VW in patients with arterial hypotension due to vasodilatory circulatory shock, and its behavior according to its response to norepinephrine infusion.

Methods
A prospective, observational, bi-centric study has included adult patients, for whom the physician decided to initiate norepinephrine during the six first hours following admission to the ICU after cardiac surgery, and unresponsive to a fluid challenge. The mean systemic pressure (MSP) and the critical closing pressure (CCP) were measured at inclusion and after norepinephrine infusion.

Results
Thirty patients were included. Norepinephrine increased arterial pressure and total peripheral resistances in all cohort. The cohort was dichotomized as VW responders (patients with a change of VW over the least significant change (≥ 93% increase in VW)), and as VW non-responders. In 19 (63%) of the 30 patients, VW increased from 3.47 [− 14.43;7.71] mmHg to 43.6 [25.8;48.1] mmHg, p < 0.001) with norepinephrine infusion, being classified as VW responders. The VW responders improved cardiac index (from 1.8 (0.6) L min−1 m−2 to 2.2 (0.5) L min−1 m−2, p = 0.002), capillary refill time (from to 4.2 (1.1) s to 3.1 (1) s, p = 0.006), and pCO2 gap (from 9 [7;10] mmHg to 6 [4;8] mmHg, p = 0.04). No baseline parameters were able to predict the VW response to norepinephrine. In comparison, VW non-responders did not significantly change the VW (from 5 [-5;16] mmHg to -2 [-12;15] mmHg, p = 0.17), cardiac index (from 1.6 (0.3) L min−1 m−2 to 1.8 (0.4) L min−1 m−2, p = 0.09) and capillary refill time (from 4.1 (1) s to 3.7 (1.4), p = 0.44).

Conclusions
In post-cardiac surgery patients with vasoplegic arterial hypotension, the vascular waterfall is low. Norepinephrine did not systematically restore the vascular waterfall. Increase of the vascular waterfall was associated with an improvement of laboratory and clinical parameters of tissue perfusion.
Effect of coupling primary sedimentation tank (PST) and microscreen (MS) to remove particulate organic carbon (POC): a study to mitigate energy demand in municipal wastewater treatment plants
Authors: Lasaki Behnam Askari , Maurer Peter , Schönberger Harald 
Published: August 2023

AbstractParticulate Chemical Oxygen Demand (COD) removal is one of the first and foremost steps in a wastewater treatment plant (WWTP). It is a highly essential step that supports subsequent biological steps to achieve discharge limits. However, the energy demand for subsequent biological steps is significant due to the requirement of physical processes such as aeration. As a part of the project: WWTP of the future, it was expected that by coupling primary sedimentation tank (PST) and microscreen (MS) as advanced primary treatment (APT), around 60 to 70% removal of total COD and more than 90% of total suspended solids could be achieved which can replace such energy-intensive steps. To achieve this, a pilot plant set up including two different types of rotatory drum sieves (8 and 20 μm) was coupled with a PST in the WWTP Büsnau, Stuttgart, Germany, and the efficiency of APT was undergone for deeper investigations. The results showed that applying APT processes is an innovative and robust approach for removing more solids in municipal WWTPs so that retrofitting treatment plants comes true with a marginal footprint. However, the long-term performance of the APT system demonstrated that the system’s ability to remove solids is highly limited by MS capacity and strength of produced flocs/filter-cakes inside the MS against shear forces, which makes it easier for flocs to be detained by MS. Therefore, additional auxiliary steps like flocculation are recommended to be synchronized with APT system to enhance its efficiency. Additionally, applying a middle mesh size sieve, for instance, a 15 μm, along with changing the backwashing regime, could be considered the next alternative.
Predicting missed delirium diagnosis in a tertiary care center: the Consultation-Liaison at the American University of Beirut (CLAUB) analysis
Authors: Bizri Maya , Zalzale Hussein , Khalil Elissa , Kassir Ghida , El Hayek Rawad , El Hayek Samer , Ibrahim Nour 
Published: August 2023

Abstract
Background
Delirium is a very common occurrence in hospital settings and is frequently missed by the primary care team. It remains, however, poorly studied in the Middle East despite abundant global reports. In this study, we aimed to estimate the prevalence of missed delirium diagnosis in a tertiary care center in Lebanon and investigate potential predictors of this missed diagnosis. This was a retrospective study of adult patients admitted to the American University of Beirut Medical Center between March 2019 and December 2019 and assessed by the consultation-liaison psychiatry (CLP) team. The primary endpoint was the rate of missed delirium diagnosis among CLP consultations. Relevant statistical tests were performed to assess the association between the missed diagnosis of delirium and characteristics of patients.

Results
Five hundred fifty-three patients were included with a mean age of 69.19 ± 14.79 years. 86.13% of the patients received a delirium diagnosis by the CLP team that had been missed prior to the CLP referral. A missed delirium diagnosis was more likely to be found in patients with a history of depression (OR = 24, p < 0.01) and a longer hospital stay [in days] (OR = 1.04, p = 0.04).

Conclusion
The alarmingly high prevalence of missed delirium diagnosis is the first evidence of its kind in the Middle East. This urges the implementation of educational interventions to increase the detection of delirium among healthcare providers and ultimately improve patient outcomes.
Sedation in pediatric intensive care unit and its impact on outcomes of ventilated children: a prospective observational study
Authors: Shajan Nidhie , Sharma Monika , Kaur Gurmeet 
Published: August 2023

Abstract
Background
Sedation is an integral part in the management of critical patients in the pediatric intensive care unit (PICU). Optimum sedation is when the child is asleep but easily arousable. The patient should be able to breathe synergistically with the ventilator and should tolerate or be compliant with other therapeutic procedures. Undersedation can make the children hypertensive, tachycardic, and agitated. Conversely, oversedation can cause increased tolerance and prolonged ventilation. Both undersedation and oversedation have negative impacts on patient outcomes such as prolonged mechanical ventilation and ICU stay and increased risk of contracting ventilator-associated pneumonia, thus contributing to significant morbidity and mortality. This study aims to assess sedation levels in ventilated children using RASS in the first 48hrs of ventilation and study their correlation with patient outcomes.

Results
Of the 111 children enrolled in the study, 2 were excluded because the sedation was discontinued before 48 h, and 9 were excluded because they were ventilated for more than 7 days. Majority of the children receiving ventilation in PICU were oversedated (40%). Adequately sedated children were observed to have significantly lesser duration of mechanical ventilation (p-value: 0.022) and PICU stay (p-value: 0.01). Undersedated children were noted to have significantly higher incidence of self extubation (p-value: < 0.001), reintubation (p-value: < 0.001), and higher requirement of restraints (p-value: < 0.001). Oversedated had a higher incidence of VAP and mortality (p-value: < 0.001).

Conclusion
The findings of this study highlight the importance of achieving adequate sedation in PICU which is associated with better outcomes with respect to duration of ventilation, PICU stay, hospital stay, and mortality. This study also reflects the impact of absence of sedation protocols and emphasizes the need for monitoring of sedation and having protocols to guide clinical practice in order to improve patient outcome.
Phytocompounds, antioxidant potential, and inhibitory actions of ethanolic leaf fraction of Sida linifolia Linn. (Malvaceae) on enzymes linked to inflammation, diabetes, and neurological disorders
Authors: Ezeako Emmanuel Chimeh , Nworah Florence Nkechi , Osuji Dionysius Obinna 
Published: August 2023

Abstract
Background
Sida linifolia L. is a weed ubiquitously found in Africa with several folkloric applications. Traditional healers in the Southeastern part of Nigeria employ the alcoholic concoction of S. linifolia leaves as antidepressants, anti-malaria, antihypertensive, anti-abortifacients, and for managing painful whitlow; however, these claims lack scientific validation. The present study was aimed to explore the phytochemical profile of the plant, S. linifolia with special emphasis to its antioxidant and inhibitory actions on enzymes linked to inflammation, diabetes, and neurological disorders. Phytochemical profiling and in vitro antioxidant and enzyme inhibition assays were employed to assess the pharmacological profile of S. linifolia ethanolic leaf fraction (SLELF).

Results
Preliminary phytochemical screening of SLELF revealed appreciable amounts of total phenolics (91.64 ± 7.61 mg GAE/g), total tannins (62.44 ± 3.86 mg TAE/g), and total flavonoids (27.35 ± 1.48 mg QE/g) present in SLELF. Results of HPLC analysis of SLELF revealed rich composition in bioactive compounds such as ellagic acid, quercetin, ferulic acid, 3,4-dimethoxy benzoic acid, gallic acid, 4-methoxy cinnamic acid, sinapic acid, vanillic acid, and chlorogenic acid. Enzymatic antioxidants (catalase and superoxide dismutase), non-enzymatic antioxidants (reduced glutathione (GSH), Vit A, C, and E), elemental minerals (Cu, Mn, Zn, Cr, Fe, and Ca), and γ-aminobutyric acid (GABA) were present in SLELF in appreciable levels. At various concentrations (0.2–1.0 mg/ml), SLELF exhibited potent and concentration-dependent hydrogen peroxide (H2O2) and 2,2′-azinobis-(3-ethylbenzothiazoline-6-sulfonic) acid (ABTS) radical scavenging activities and exerted moderate inhibitory actions on enzymes associated with inflammation (cyclooxogenase-2 (COX-2) and lipoxygenases (LOXs), diabetes (α-amylase, α-glucosidase), and neurological disorders (butyrylcholinesterase (BChE) and γ-aminobutyric acid transaminase (GABA-T), compared to respective standards (ascorbic acid, acarbose, indomethacin, galanthamine, and vigabatrin). Perhaps, the observed potent pharmacological activities of SLELF could be anchored to its phytoconstituents. Furthermore, the slightly higher ranges of IC50 values (0.57–0.87 mg/ml) of SLELF compared to standards (0.44–0.68 mg/ml) suggest moderation in enzyme inhibition that may preclude adverse side effects.

Conclusion
This study lends credence to the folklore claims of S. linifolia leaves and revealed its potential as possible source of bioactive compounds for medicinal and pharmaceutical exploration.
The Essential Network (TEN): engagement and mental health insights from a digital mental health assessment tool for Australian health professionals during COVID-19
Authors: Coleshill M. J. , Alagirisamy D. , Patki S. , Ronksley M. , Black M. J. , Yu S. , Phillips M. , Newby J. M. , Cockayne N. , Tennant J. , Harvey S. B. , Christensen H. , Baldwin P. A. 
Published: August 2023

Abstract
Background
Health professionals are at risk of poor mental health outcomes due to the COVID-19 pandemic. The Essential Network (TEN) is a blended care mental health support service for Australian health professionals, funded by the Australian Federal Department of Health. TEN comprises both digital and face-to-face components. We examined completed digital mental health assessments (Digital Mental Health Check-Up) to understand usage of TEN and the demographics and mental health of users.

Methods
A total of 9889 completed assessments from a community sample of help-seeking health professionals who engaged with the Digital Mental Health Check-Up between May 2020 and December 2021 were examined. Users had the option to complete the Distress Questionnaire (DQ-5), Patient Health Questionnaire (PHQ-9), Generalised Anxiety Disorder (GAD-7), Oldenburg Burnout Inventory (OLBI-16), Work and Social Adjustment Scale (WSAS), Post-traumatic Stress Disorder Checklist (PCL-5), as well as provide demographic information on their gender, age, and profession.

Results
Users were mostly women (85.7%) aged between 25 and 54 (73.7%). Nursing was the most reported profession (32.6%), followed by allied health (27.5%) and doctors (21.9%). Notably, 8.1% of users reported being in medical administration roles. Mental health measures were poor across all measures and professions and worse than would be expected from the general population. Disengagement (92.5%) from burnout and impaired social and occupational functioning (75%) were also notably high. Use of the DQ-5 as a screening tool in the Digital Mental Health Check-Up was confirmed through correlation with clinically significance scoring on all other measures and increased likelihood of opting to complete other optional measures following clinically significant scoring on the DQ-5.

Conclusions
The present study indicates good usage of the TEN digital components among Australian health professionals, with use across all professional categories. While self-selection bias is inherent in the sample, mental health measures were notably poor – particularly for burnout. Such findings highlight the continued need to provide mental health support to health professionals both during and after the eventual resolution of the COVID-19 pandemic, as well as to develop better support for health professionals experiencing burnout.