bluuebunny/crossref_metadata_2025_split huggingface dataset:
Facilitators and barriers for implementation of a novel resuscitation quality improvement package in public referral hospitals of Nepal
Authors: Ekström Niina , Gurung Rejina , Humagain Urja , Basnet Omkar , Bhattarai Pratiksha , Thakur Nishant , Dhakal Riju , KC Ashish , Axelin Anna 
Published: September 2023

Abstract
Background
Improving the healthcare providers (HCP) basic resuscitation skills can reduce intrapartum related mortality in low- and middle-income countries. However, the resuscitation intervention’s successful implementation is largely dependent on proper facilitation and context. This study aims to identify the facilitators and barriers for the implementation of a novel resuscitation package as part of the quality improvement project in Nepal.

Methods
The study used a qualitative descriptive design. The study sites included four purposively chosen public hospitals in Nepal, where the resuscitation package (Helping Babies Breathe [HBB] training, resuscitation equipment and NeoBeat) had been implemented as part of the quality improvement project. Twenty members of the HCP, who were trained and exposed to the package, were selected through convenience sampling to participate in the study interviews. Data were collected through semi-structured interviews conducted via telephone and video calls. Twenty interview data were analyzed with a deductive qualitative content analysis based on the core components of the i-PARiHS framework.

Results
The findings suggest that there was a move to more systematic resuscitation practices among the staff after the quality improvement project’s implementation. This positive change was supported by a neonatal heart rate monitor (NeoBeat), which guided resuscitation and made it easier. In addition, seeing the positive outcomes of successful resuscitation motivated the HCPs to keep practicing and developing their resuscitation skills. Facilitation by the project staff enabled the change. At the same time, facilitators provided extra support to maintain the equipment, which can be a challenge in terms of sustainability, after the project. Furthermore, a lack of additional resources, an unclear leadership role, and a lack of coordination between nurses and medical doctors were barriers to the implementation of the resuscitation package.

Conclusion
The introduction of the resuscitation package, as well as the continuous capacity building of local multidisciplinary healthcare staff, is important to continue the accelerated efforts of improving newborn care. To secure sustainable change, facilitation during implementation should focus on exploring local resources to implement the resuscitation package sustainably.

Trial Registration
Not applicable.
Establishment of a new prognostic risk model of GNG7 pathway-related molecules in clear cell renal cell carcinoma based on immunomodulators
Authors: Zheng Jun , Zhang Weili , Zhang Junyong 
Published: September 2023

AbstractClear cell renal cell carcinoma (CCRCC) is a common tumor of the urological system for which surgery is the preferred treatment, but there is a lack of therapeutic options after surgery. This study aims to explore the biological role of GNG7 on CCRCC from a genetic perspective. Differences in mRNA expression and patient survival of GNG7 in patients with CCRCC and healthy patients were analyzed using the TCGA database. It was observed that GNG7 gene expression was downregulated in CCRCC tissue compared with healthy tissue, and high GNG7 predicted better prognosis for patients, and GNG7 also showed strong variability in clinical and TMN staging. The immune relevance of GNG7 and related genes was explored using renal cancer data from CCLE and TISIDB database. It was verified that the risk score constructed by 7 GNG7-related regulators might be used as an independent prognostic risk factor for CCRCC. A CCRCC prognostic model that involved 7 immune genes was further established to predict the survival probabilities of patients. At last, the GEO database and immunochemical tissue staining were used to validate GNG7 expression in CCRCC. Our study proposed a novel panel of genes to predict CCRCC OS based on GNG7-related immune genes, which may help to accurately predict the prognosis of CCRCC patients and make better clinical decisions for individual treatment.
Diagnosis and treatment challenges of autism spectrum disorder at a reference hospital in Douala, Cameroon
Authors: Koum Daniele Christiane Kedy , Enyama Dominique , Foko Loick Pradel Kojom , Noukeu Diomede , Nguedia Belviane , Mbono Rhita , Eposse Charlotte , Eboumbou Patricia Epee , Engome Cathy Bebey , Mapoure Yacouba Njankouo 
Published: September 2023

Abstract
Background
Autism spectrum disorder (ASD) is a neurodevelopmental disability associated with deficiency in social interaction, unusual development of social communication, and restricted or repetitive behaviors, interests and activities. This study aimed to describe management of pediatric ASD in Cameroon, a resource-constrained Central Africa country.

Methods
A retrospective study was conducted between December 2021 and May 2022 at the Pediatrics department of a reference hospital in the town of Douala. Data of interest of children with ASD were collected through eligible medical records and telephone discussions with their parents/guardians.

Results
Medical records of 145 children with ASD aged 2–15 years were included in the study, giving a hospital ASD prevalence of 3.7%. Time delay between parental concerns and hospital management was specified in 69 (47.58%) children, and among them 38 (55.07%) had a mean delay ± SD was less than five months. Children were mainly males (76%) and aged 4–5 years (37.93%), with mean age ± SD of 44.4 ± 22.2 months old. The main consultation reason was delayed language development (100%). Mean time delay between parental concerns and the first medical consultation was 18 months (range 1–60 month). Attention deficit hyperactivity disorder were found in 68.18% of children aged ≥ 6 years old. Neuropsychology (66.2%) was the most frequently used intervention. Some children were treated using traditional medicine.

Conclusions
Management of pediatric ASD is strongly influenced by socioeconomic and cultural context. It is crucial to implement behavioral change campaigns in community, organize training sessions to medical staff on diagnosis and treatment of ASD, and provide specialized centers with skilled staff and equipped material.
Initial experience of thoracoscopic segmentectomy of basal segment through the inferior pulmonary ligament approach in treating congenital lung malformations in children
Authors: Guo Rui , Liu Jike , Zhai Yunpeng , Zhao Huashan , Xu Hongxiu , Lv Longfei , Zhang Shisong 
Published: September 2023

Abstract
Purpose
This study aimed to evaluate the feasibility and limitations of thoracoscopic segmentectomy of the basal segment (S10).

Methods
Clinical data of 15 children with congenital lung malformations (CLM) who underwent thoracoscopic segmentectomy of S10 via the inferior pulmonary ligament approach from January to October 2022 were retrospectively analyzed. The demographics, clinical presentation, intraoperative time, blood loss, postoperative events, and follow-up duration were assessed.

Results
There were 15 patients in this group (nine males and six females). Age ranges from 4.3 to 96.0 months (median, 7.7 months). Fourteen patients underwent S10 segmentectomy, with one undergoing right S10 segmentectomy and right S6 partial wedge resection. The surgical time was 57–125 min (median, 80 min), intraoperative bleeding volume (5–20 ml; median, 10 ml), postoperative drainage tube indwelling (2–4 d; median, 3 d), and postoperative hospitalization time (4–7 d; median, 5 d). No intraoperative conversions, surgical mortalities, or major complications were observed among these patients. Subcutaneous emphysema appeared in three patients; however, it disappeared following conservative observation without pneumothorax or bronchopleural fistula occurrence.

Conclusions
Thoracoscopic segmentectomy of S10 via the inferior pulmonary ligament approach is technically feasible for treating CLM; however, this surgical approach may have certain limitations for CLM with large cysts.
The relationship in early childhood body composition and physical activity levels regarding fundamental motor skill development
Authors: Spring Katherine E. , Carroll Alexandra V. , Wadsworth Danielle D. 
Published: September 2023

Abstract
Background
Fundamental motor skills (FMS) are considered essential for sport participation and might be deficit in obese children. While evidence indicates that physical activity (PA) levels impact motor skill development, the relationship between body composition, PA, and motor competence, particularly in early childhood, is not thoroughly understood. We aimed to determine if PA, fat mass (FM), and fat-free mass (FFM) are predictors of FMS.

Methods
Preschoolers (n = 47) from two preschools were assessed for FMS, PA, and body composition. Peabody Developmental Motor Scales (PDMS-2) subscale scores were used to assess FMS. PA was assessed with a wrist-worn accelerometer for five days during school. FM and FFM were measured with foot-to-foot bioelectrical impedance.

Results
Linear regressions indicate significant models for stationary skills (SS) (F = 4.57, p = .004) and object manipulation skills (OMS) (F = 4.66, p = .003). FFM was the only significant predictor of SS (t = 3.98, p < .001) and OMS (t = 3.50, p = .001). FM and all intensities of PA were nonsignificant predictors in all models.

Conclusions
These results indicate that interventions that target improving or maintaining FFM may improve FMS.
Barriers and facilitators for sustainable weight loss in the pre-conception period among Danish women with overweight or obesity – a qualitative study
Authors: Pico Majken Lillholm , Grunnet Louise Groth , Vinter Christina Anne , Aagaard-Hansen Jens , Kragelund Nielsen Karoline 
Published: September 2023

AbstractBackgroundThe prevalence of overweight or obesity in women of reproductive age continues to increase. A high pre-pregnancy body mass index (BMI) has been shown to increase the risk of pregnancy complications and predispose offspring to childhood obesity. However, little is known about factors affecting women’s ability to achieve sustainable weight management and very few studies have applied behavior change theory to qualitative data.AimThis study aimed to explore barriers and facilitators for weight management among women with overweight or obesity, who wanted to lose weight before pregnancy.MethodsWe conducted semi-structured interviews with 17 women with a BMI ≥ 27 kg/m2, who planned to become pregnant in the near future. Data were analyzed using an abductive approach and the Capability, Opportunity, Motivation, and Behavior model was applied as a conceptual framework.ResultsThe women’s strongest motivator for pre-conception weight loss was their ability to become pregnant. Barriers to successful weight management included their partners’ unhealthy behaviors, mental health challenges, competing priorities, and internalized weight stigmatization. The women described careful planning, partners’ health behaviors, social support, and good mental health as facilitators for sustainable weight management.ConclusionOur study provides insights into factors affecting weight management among women with overweight or obesity in the pre-conception period. Future interventions on weight management require a holistic approach, including a focus on social support, especially from the partner, and mental health, as well as an effort to limit internalized weight stigma.
Variability of serum CYFRA 21 − 1 and its susceptibility to clinical characteristics in individuals without cancer: a 4-year retrospective analysis
Authors: Minamibata Asami , Kono Yoshihito , Arimoto Taichiro , Marunaka Yoshinori , Takayama Koichi 
Published: September 2023

Abstract
Background
CYFRA 21 − 1 is a useful marker for diagnosing and monitoring lung cancer. However, its stability remains unclear. Moreover, while its applicability to screening is now being investigated, CYFRA 21 − 1 levels in individuals without cancer, who are targets for cancer screening, have not yet been the focus of research. Therefore, the present study investigated variability in and the factors increasing serum CYFRA 21 − 1 levels.

Methods
This retrospective study recruited 951 individuals undergoing annual medical examinations for six years. We used data obtained in the first four years. Variability in serum CYFRA 21 − 1 levels over a period of four years were investigated. CYFRA 21 − 1 was categorized as normal (≤ 3.5 ng/ml) or elevated (> 3.5 ng/ml). The rate of an elevated level in one visit and the transition from an elevated to normal level between visits were visualized. A multiple logistic regression model was used to study the relationships between the frequency of elevated CYFRA 21 − 1 levels and clinical characteristics, such as age, sex, body mass index, weight changes, and the smoking status.

Results
Approximately 5% of subjects had elevated CYFRA 21 − 1 levels once in five tests over four years, while 15% had elevated CYFRA 21 − 1 levels once or more. Among subjects with elevated CYFRA 21 − 1 levels in one blood test, between 63 and 72% had normal levels in the next test. The median CYFRA 21 − 1 level in subjects with elevations in one blood test significantly decreased in the next test at all four time points. The frequency of elevated CYFRA 21 − 1 levels was associated with an older age [odds ratio (OR) = 6.99, 95% confidence interval (CI) = 3.01–16.2], current heavy smoking (OR = 3.46, 95% CI = 1.52–7.9), and weight loss (OR = 1.86, 95% CI = 1.07–3.24).

Conclusions
Variability in and the factors increasing serum CYFRA 21 − 1 levels beyond the cut-off value need to be considered when interpretating CYFRA 21 − 1 test results. The future application of CYFRA 21 − 1 to lung cancer screening may require more than a single measurement.
Location and extent of cavernous transformation of the portal vein dictates different visceral side revascularization in Meso-Rex bypass
Authors: Tang Rui , Wu Guangdong , Yu Qiang , Tong Xuan , Meng Xiangfei , Hou Yucheng , Huang Xin , Aini Abudusalamu , Yu Lihan , Duan Weidong , Lu Qian , Yan Jun 
Published: September 2023

Abstract
Background
As an emerging standard of care for portal vein cavernous transformation (PVCT), Meso-Rex bypass (MRB) has been complicated and variated. The study aim was to propose a new classification of PVCT to guide MRB operations.

Methods
Demographic data, the extent of extrahepatic PVCT, surgical methods for visceral side revascularization, intraoperative blood loss, operating time, changes in visceral venous pressure before and after MRB, postoperative complications and the condition of bypass vessels after MRB were extracted retrospectively from the medical records of 19 patients.

Results
The median age of the patients (13 males and 6 females) was 32.5 years, while two patients were underage. Causes of PVCT can be summarized as follows: thrombophilia such as dysfunction of antithrombin III or proteins C; secondary to abdominal surgeries; secondary to abdominal infection or traumatic intestinal obstruction, and unknown causes. Intraoperatively, the median operation time was 9.5 h (7–13 h), and the intraoperative blood loss was 300 mL (100-1,600 mL). Ten cases used autologous blood vessels while 10 used allogeneic blood vessels. The vascular anastomosis was divided into the following types according to the site and approach: Type (T) 1-PV pedicel type, T2-confluence type, T3-major visceral vascular type; and T4-collateral visceral vascular type. Furthermore, the visceral venous pressure before and after MRB dropped significantly from 36 cmH2O (28–44) to 24.5 cmH2O (15–31) (P < 0.01). Postoperatively, one patient had delayed wound healing, two developed biochemical pancreatic fistulae, one experienced lymphatic leakage, the former caused by heat damage of the pancreatic tissues, the latter by cutting lymphatic vessels in the mesentery or removing the local lymph nodes during the process of separating the superior mesenteric vein, and one was re-operated on for an intervening intestinal fistulae. Postoperative enhanced CT scans revealed a significant improvement in abdominal varix in the patients with patent bypass, and at the 1-year postoperative follow-up, enhanced CT scans of six patients showed that the long axis of the spleen was reduced by ≥ 2 cm.

Conclusions
MRB can effectively reduce visceral venous pressure in patients with PVCT. It is feasible to determine the PVCT type according to the extent of involvement and to choose individualized visceral side revascularization performances.
A cross-sectional study from NHANES found a positive association between obesity with bone mineral density among postmenopausal women
Authors: Yuan Yu , Liao Jiaxin , Luo Zhiyuan , Li Dingshuang , Hou Lei 
Published: September 2023

Abstract
Purpose
Obesity has been demonstrated to improve bone mineral density (BMD), according to previous research. Nevertheless, there is a dearth of clarity regarding the optimal body mass index (BMI) and waist circumference (WC) for achieving the highest beneficial BMD in postmenopausal women. The objective of this study was to establish the correlation between obesity and BMD.

Methods
The relationship between BMI, WC, and BMD was examined by using multivariate logistic regression models, fitting smoothing curves and utilizing the latest data from the National Health and Nutrition Examination Survey (NHANES) survey conducted between 2007 and 2018. Furthermore, the analysis of saturation effects was employed to examine the association of nonlinear connections among BMI, WC, and BMD.

Results
The research examined information from a combination of 564 participants. A significant correlation between BMD and BMI as well as WC was observed in our findings. The enduring correlation between BMI and WC with BMD was demonstrated across subgroup analyses categorized by age and race, except among other Hispanic and other race. Furthermore, the smoothing curve fitting indicated that there existed not just a linear correlation among BMI, WC, and BMD, but also a saturation threshold in the association of these three factors.

Conclusions
Based on our study, we have found a strong and positive relationship between obesity and BMD. According to the results of this research, maintaining obesity at a moderate level in postmenopausal women would result in achieving an optimal equilibrium between obesity and BMD.
Application of a practice-based approach in variable selection for a prediction model development study of hospital-induced delirium
Authors: Snigurska Urszula A. , Ser Sarah E. , Solberg Laurence M. , Prosperi Mattia , Magoc Tanja , Chen Zhaoyi , Bian Jiang , Bjarnadottir Ragnhildur I. , Lucero Robert J. 
Published: September 2023

Abstract
Background
Prognostic models of hospital-induced delirium, that include potential predisposing and precipitating factors, may be used to identify vulnerable patients and inform the implementation of tailored preventive interventions. It is recommended that, in prediction model development studies, candidate predictors are selected on the basis of existing knowledge, including knowledge from clinical practice. The purpose of this article is to describe the process of identifying and operationalizing candidate predictors of hospital-induced delirium for application in a prediction model development study using a practice-based approach.

Methods
This study is part of a larger, retrospective cohort study that is developing prognostic models of hospital-induced delirium for medical-surgical older adult patients using structured data from administrative and electronic health records. First, we conducted a review of the literature to identify clinical concepts that had been used as candidate predictors in prognostic model development-and-validation studies of hospital-induced delirium. Then, we consulted a multidisciplinary task force of nine members who independently judged whether each clinical concept was associated with hospital-induced delirium. Finally, we mapped the clinical concepts to the administrative and electronic health records and operationalized our candidate predictors.

Results
In the review of 34 studies, we identified 504 unique clinical concepts. Two-thirds of the clinical concepts (337/504) were used as candidate predictors only once. The most common clinical concepts included age (31/34), sex (29/34), and alcohol use (22/34). 96% of the clinical concepts (484/504) were judged to be associated with the development of hospital-induced delirium by at least two members of the task force. All of the task force members agreed that 47 or 9% of the 504 clinical concepts were associated with hospital-induced delirium.

Conclusions
Heterogeneity among candidate predictors of hospital-induced delirium in the literature suggests a still evolving list of factors that contribute to the development of this complex phenomenon. We demonstrated a practice-based approach to variable selection for our model development study of hospital-induced delirium. Expert judgement of variables enabled us to categorize the variables based on the amount of agreement among the experts and plan for the development of different models, including an expert-model and data-driven model.
Fat mass: a novel digital biomarker for remote monitoring that may indicate risk for malnutrition and new complications in decompensated cirrhosis
Authors: Gananandan K. , Thomas V. , Woo W. L. , Boddu R. , Kumar R. , Raja M. , Balaji A. , Kazankov K. , Mookerjee R. P. 
Published: September 2023

Abstract
Background
Cirrhosis is associated with sarcopaenia and fat wasting, which drive decompensation and mortality. Currently, nutritional status, through body composition assessment, is not routinely monitored in outpatients. Given the deleterious outcomes associated with poor nutrition in decompensated cirrhosis, there is a need for remotely monitoring this to optimise community care.

Methods
A retrospective analysis was conducted on patients monitored remotely with digital sensors post hospital discharge, to assess outcomes and indicators of new cirrhosis complications. 15 patients had daily fat mass measurements as part of monitoring over a median 10 weeks, using a Withing’s bioimpedance scale. The Clinical Frailty Score (CFS) was used to assess frailty and several liver disease severity scores were assessed.

Results
73.3% (11/15) patients were male with a median age of 63 (52–68). There was a trend towards more severe liver disease based on CLIF-Consortium Acute Decompensation (CLIF-C AD) scores in frail patients vs. those not frail (53 vs 46, p = 0.072). When the cohort was split into patients who gained fat mass over 8 weeks vs. those that lost fat mass, the baseline CLIF-C AD scores and WBC were significantly higher in those that lost fat (58 vs 48, p = 0.048 and 11.2 × 109 vs 4.7 × 109, p = 0.031).

Conclusions
This proof-of-principle study shows feasibility for remote monitoring of fat mass and nutritional reserve in decompensated cirrhosis. Our results suggest fat mass is associated with greater severity of acute decompensation and may serve as an indicator of systemic inflammatory response. Further prospective studies are required to validate this digital biomarker.