bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association Between Serum Aminotransferases and Risk of New-Onset Cardiometabolic Disease in a Healthy Chinese Population: A Cohort Study
Authors: Lan Qin , Zhang Yuming , Lin Fang , Meng Qingshu , Buys Nicholas Jan , Fan Huimin , Sun Jing 
Published: June 2022

PurposeThis study aimed to investigate the association between serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), and incident metabolic disease in a cohort of community-based older Chinese people.Patients and MethodsFive thousand healthy Gaohang residents who attended community health checks at the Shanghai East Hospital in 2013 were recruited. Biological, biochemical, and lifestyle variables were collected. The cohort was followed for new-onset metabolic disease in 2014 and 2017, with a final study population of 3,123 (63%) after follow-up. The study outcome included type-2 diabetes mellitus and metabolic syndrome.ResultsBaseline AST and ALT were associated with incident type-2 diabetes mellitus (HR 1.019, 95% CI 1.006–1.032, p = 0.003 and HR 1.016, 95% CI 1.008–1.025, p &lt; 0.001 respectively). These associations persisted after adjusting for traditional risk factors including age, sex, income, waist circumference, systolic blood pressure, diastolic blood pressure, HbA1c, triglyceride, cholesterol, HDL and eGFR. Baseline AST and ALT were associated with incident metabolic syndrome in the crude analysis (HR 0.980, 95% CI 0.965–0.996, p = 0.012 and HR 0.992, 95% CI 0.988–0.997, p = 0.001, respectively). However, the association between AST and ALT with metabolic syndrome was non-significant after adjusting for biochemical parameters such as the lipid profile.ConclusionThis study demonstrated that serum AST and ALT are associated with new-onset type-2 diabetes mellitus, independent of traditional risk factors, in a cohort of older Chinese people. These findings may contribute to disease risk stratification and management in type-2 diabetes.
Impact of Falls and Fear of Falling on Participation, Autonomy and Life Satisfaction in the First Year After Spinal Cord Injury
Authors: Chan Katherine , Habib Perez Olinda , Singh Hardeep , Marinho-Buzelli Andresa R. , Hitzig Sander L. , Musselman Kristin E. 
Published: June 2022

IntroductionIndividuals with spinal cord injury (SCI) experience reduced participation in meaningful activities, leading to reduced social engagement and negative psychological impact. Two factors that may affect participation post-SCI are fall status (e.g., having experienced a fall) and having a fear of falling. Our objective was to examine if and how fall status and fear of falling impact participation, autonomy and life satisfaction in the first year post-injury.MethodsAdult inpatients of a SCI rehabilitation hospital were recruited. Following discharge, falls were tracked for 6 months and participants who fell at least once were categorized as “fallers”. At the end of the 6-month period, the Impact on Participation and Autonomy Questionnaire and Life Satisfaction Questionnaire 9 were administered, and participants were asked if they had a fear of falling (i.e., an ongoing concern about falling leading to the avoidance of activities they are capable of doing). Falls were reported using descriptive statistics. Ordinary least squares regression was used to evaluate the relationships between the independent variables (i.e., fall status and fear of falling) and each dependent variable (i.e., questionnaire scores).ResultsSeventy-one individuals were enrolled in the study; however, 11 participants were lost to follow-up. The included participants (n = 60) were 58.4 ± 14.6 years old and 99 ± 60.3 days post-injury. Over one third (38.3%) of participants fell over the 6-month tracking period. Twenty-seven participants (45%) reported a fear of falling and 14 (51.9%) of these participants were fallers. Fear of falling significantly predicted scores of autonomy indoors (β = 3.38, p = 0.04), autonomy outdoors (β = 2.62, p = 0.04) and family role (β = 3.52, p = 0.05).ConclusionIndividuals with subacute SCI and a fear of falling experienced reduced participation and autonomy, but with no differences in life satisfaction compared to those without a fear of falling. In contrast, having experienced a fall did not impact participation, autonomy or life satisfaction. In the first year after SCI, rehabilitation programs should place specific attention on the presence of fear of falling to help individuals with SCI prepare for everyday mobility challenges.
Predict Postoperative Anemia of Patients: Nomogram Construction and Validation
Authors: Dai Yimin , Han Chang , Weng Xisheng 
Published: June 2022

IntroductionThe loss of blood is a significant problem in Total Knee Arthroplasty (TKA). Anemia often occurs after such surgeries, leading to serious consequences, such as higher postoperative infection rates and longer hospital stays. Tools for predicting possible anemia can provide additional guidance in realizing better blood management of patients.Methods2,165 patients who underwent TKA from 2015 to 2019 in the same medical center were divided into training and validation cohorts. Both univariate and multivariate logistic regression analyses were performed to identify independent preoperative risk factors for anemia. Based on these predictors, a nomogram was established using the area under the curve (AUC), calibration curve (AUC), and the area under the curve (AUC). The model was then applied to the validation cohort, and decision curve analyses (DCA) were also plotted.ResultsThrough analysis of both univariate and multivariate logistic regression, five independent predictors were found in the training cohort: female, relatively low BMI, low levels of preoperative hemoglobin, abnormally high levels of ESR, and simultaneously two sides of TKA in the same surgery. The AUCs of the nomogram were 74.6% (95% CI, 71.35%–77.89%) and 68.8% (95% CI, 63.37%–74.14%) of training and the validation cohorts separately. Furthermore, the calibration curves of both cohorts illustrated the consistency of the nomogram with the actual condition of anemia of patients after TKA. The DCA curve was higher for both treat-none and treat-all, further indicating the relatively high practicality of the model.ConclusionFemale, lower BMI, lower levels of preoperative Hb, simultaneous bilateral TKA, and high levels of preoperative ESR were figured out as five independent risk factors for postoperative anemia (&lt;9.0 g/dL) in patients undergoing TKA. Based on the findings, a practical nomogram was constructed to predict risk of postoperative anemia. The evidence level should be level 4 according to guideline.
The Effect of Examined Lymph Nodes and Lymph Node Ratio on Pathological Nodal Classification in the Lung Adenosquamous Carcinoma After Lobectomy
Authors: Feng Shoujie , Liu Xiangming , Huang Bing , Shi Jing , Zhang Hao 
Published: June 2022

ObjectiveThe effects of examined lymph nodes (LNs) and lymph node ratio (LNR) on pN classification and the prognosis are unclear in lung adenosquamous carcinoma (ASC) patients. Thus, this study aimed to investigate the significance of LNs and LNR in the prognosis of ASC and the impact of the abovementioned factors on the pN classification.MethodsPatients diagnosed with pathological stage T1-4N0-2M0 ASC from the Surveillance Epidemiology and End Results database were included in the study. The primary clinical endpoint was cancer-specific survival (CSS). The optimal cutoff values of the LNs and LNR were determined. An LN indicator, including pN0 #LNs ≤9, pN0 #LNs &gt;9, pN+ #LNR ≤0.53, and pN+ #LNR &gt; 0.53, was developed. Concordance index (C-index) was used to compare the prognostic predictive ability between N classification and LN indicator. The univariable and multivariable Cox regression analyses were used in this study.ResultsThe cohort of 1,416 patients were included in the study. The level of LNs stratified the patients without metastasis of lymph nodes (pN0 #LNs ≤9 vs. pN0 #LNs &gt;9, unadjusted hazard ratio [HR] = 1.255, P = 0.037). Two groups based on the cutoff value of LNR differentiated prognosis of patients with metastasis of lymph nodes (pN+ #LNR &gt;0.53 vs. pN+ #LNR ≤0.53, unadjusted HR = 1.703, P = 0.001). The LN indicator had a much better predictive ability over N classification in this cohort (LN indicator: C-index = 0.615; N classification: C-index = 0.602, P = 0.001).ConclusionsWe explored clinicopathological factors affecting prognosis in resected lung ASC patients. Besides, the LN indicator was confirmed to be played an essential role in affecting the survival rate in ASC patients. The high-level LNs or low-level LNR might be corelated to improved survival outcomes.
Lung Inflammation Is Associated with Preeclampsia Development in the Rat
Authors: Curtis Katrina , Clarke Derek , Hanegan Makayla , Stapley Brendan , Wendt Ryan , Beckett Nathan , Litchfield Cade , Campbell Kennedy , Reynolds Paul , Arroyo Juan 
Published: June 2022

Preeclampsia (PE) is an obstetric complication associated with significant health implications for the fetus and mother. Studies have shown a correlation between lung disease development and PE. Gas6 protein is expressed in the lung and placenta, and binds to the AXL Tyrosine kinase receptor. Recently, our laboratory utilized Gas6 to induce preeclamptic-like conditions in rats. Our objective was to determine the role of Gas6/AXL signaling in the maternal lung during PE development. Briefly, pregnant rats were divided into control, Gas6, or Gas6 + R428 (an AXL inhibitor). Immunofluorescence was performed to determine AXL expression. Bronchoalveolar lavage fluid (BALF) was procured for the assessment of inflammatory cell secretion. Western blot was performed to detect signaling molecules and ELISA determined inflammatory cytokines. We observed increased proteinuria and increased blood pressure in Gas6-treated animals. AXL was increased in the lungs of the treated animals and BALF fluid revealed elevated total protein abundance in Gas6 animals. Extracellular-signal regulated kinase (ERK) and protein kinase B (AKT) signaling in the lung appeared to be mediated by Gas6 as well as the secretion of inflammatory cytokines. We conclude that Gas6 signaling is capable of inducing PE and that this is associated with increased lung inflammation.
HUBUNGAN KEPATUHAN DAN DUKUNGAN KELUARGA DENGAN CLINICAL OUTCOME PASIEN TB
Authors: Mustaming Mustaming 
Published: June 2022

Background: Tuberculosis is an infectious disease caused by mycobacterium tuberculosis. The low compliance of tuberculosis treatment caused resistance and affected clinical outcomes. Purpose: This study aimed to determine the relationship between medication compliance and family support with clinical outcomes in tuberculosis patients. Method: This analytical study used a cross-sectional design. The population was tuberculosis patients who used intensive phase of tuberculosis treatment at several primary health care. This study used a consecutive sampling technique. After we met the criteria and the patient signed informed consent, then microscopic smear and measurement of body weight were done to find clinical outcomes. After that, we gave a Medication Adherence Report Scale (MARS-5) questionnaire to measure medication compliance and a family support questionnaire to measure family support. The collected data were analyzed by fisher-test.Results: This study showed a relationship between medication compliance and clinical outcome with a p-value of 0.003 0.05. Respondents with high adherence had 16.625 times the possibility of achieving clinical outcomes compared to respondents who had low compliance. In addition, it was also found that there was a relationship between family support with clinical outcomes with a p-value of 0.006 0.05, and respondents with good family support had 11.333 times the possibility to achieve good clinical outcomes compared to respondents with sufficient family support. Conclusion: Hight medication compliance on treatment and good family support is essential in achieving good clinical outcomes at the end of the intensive phase.
Cybersecurity Threats to and Cyberattacks on Critical Infrastructure: a Legal Perspective
Authors: Watney Murdoch 
Published: June 2022

Over the years cybersecurity threats to and cyberattacks on the critical infrastructure by state and non-state actors have escalated in intensity and sophistication. Cyberattacks, such as the 2017 NotPetya ransomware attack, the 2020 SolarWinds software supply chain attack and the 2021 Colonial Pipeline ransomware attack, illustrate the vulnerability of critical infrastructure to cyberattacks.

Most cyberattacks are committed across borders involving criminal hackers or state supported hackers. Furthermore, critical infrastructure is increasingly interconnected and interdependent. Connectivity brings about the risk of a cyberattack, demonstrated by the 2021 Colonial Pipeline ransomware attack. Interconnectedness also means that the compromise of one critical infrastructure asset can have a domino effect that degrades or disrupts others and results in cascading consequences across the economy and national security. Operational continuity is essential and this may have been one of the reasons why Colonial Pipeline paid a ransom to cyber-attackers.

A cyberattack on the critical infrastructure of a state cannot be seen in isolation as the consequences of the attack may impact other states, this was illustrated by the 2017 WannaCry and NotPetya ransomware attacks. The level of sophistication of cyberattacks has increased over the years as shown by the 2020 SolarWinds software supply chain attack. The escalation of attacks has served as a catalyst for governments to address the risk to critical infrastructure. Countries need to have strong government bodies which supervise cybersecurity in their country and work together with their counterparts in other countries by sharing information regarding threats and attacks against critical infrastructure.

The discussion focuses on the challenges that threats to and attacks on critical infrastructure present, the possible solutions a government may implement in addressing cyberattacks on critical infrastructure and the accountability of state and non-state actors of cyberattacks on critical infrastructure. The issues are discussed from a legal perspective.
Pengaruh Motivasi Kerja Dan Sikap Profesi Terhadap Kinerja Perawat Di Pelayanan Rawat Inap Rumah Sakit Umum GMIM Pancaran Kasih Manado Melalui Kepuasan Kerja Sebagai Variabel Intervening
Authors: Porotu'o Andreano Christian , Kairupan Bernabas H.R. , Wahongan Greta J.P. 
Published: June 2022

Abstract: Performance is a work achievement in the form of achieving work plans made by an organization carried out by leaders and employees who work in the organization, both government and private to achieve organizational goals. Nurse performance is a reference for health services, so it is necessary to conduct an assessment of performance in improving the quality of health services provided to patients. The purpose of this study is to analyze work motivation and professional attitude on nurse performance in the Inpatient Services of the General Hospital GMIM Pancaran Kasih Manado through job satisfaction as an intervening variable. This research is a type of quantitative research that is an analytic survey with a cross sectional study approach. The population of this research is all nurses who work in Inpatient Services at GMIM Pancaran Kasih Hospital Manado. The research sample used purposive sampling technique, namely 80 nurses. Data analysis consisted of univariate analysis using IBM SPSS Statistics 22 data analysis tools and multivariate analysis using Structural Equation Modeling (SEM) using the Smart PLS 3.0 data analysis tool. The results showed that Job Satisfaction had a direct effect on Nurse Performance and Professional Attitude had an indirect effect on Nurse Performance in Inpatient Services at GMIM Pancaran Kasih General Hospital through Job SatisfactionAbstrak: Kinerja merupakan prestasi kerja yang berupa pencapaian rencana kerja yang dibuat oleh suatu organisasi yang dilakukan oleh pimpinan dan karyawan yang bekerja di organisasi itu baik pemerintah maupun swasta untuk mencapai tujuan organisasi. Kinerja perawat merupakan suatu acuan pelayanan kesehatan, sehingga perlu dilakukan pengkajian mengenai kinerja dalam meningkatkan kualitas pelayanan kesehatan yang diberikan kepada pasien. Tujuan penelitian ini yaitu menganalisis motivasi kerja dan sikap profesi terhadap kinerja perawat di Pelayanan Rawat Inap Rumah Sakit Umum GMIM Pancaran Kasih Manado melalui kepuasan kerja sebagai variabel intervening. Penelitian ini merupakan jenis penelitian kuantitatif yang bersifat survei analitik dengan pendekatan cross sectional study. Populasi penelitian ini merupakan seluruh perawat yang bekerja di Pelayanan Rawat Inap Rumah Sakit GMIM Pancaran Kasih Manado. Sampel penelitian ini menggunakan teknik purposive sampling yaitu 80 orang perawat. Analisis data terdiri dari analisis univariat dengan menggunakan alat bantu analisis data IBM SPSS Statistics 22 dan analisis multivariat menggunakan Structural Equation Modeling (SEM) dengan menggunakan alat bantu analisis data Smart PLS 3.0. Hasil penelitian menunjukkan bahwa Kepuasan Kerja berpengaruh langsung terhadap Kinerja Perawat dan Sikap Profesi berpengaruh tidak langsung terhadap Kinerja Perawat di Pelayanan Rawat Inap Rumah Sakit Umum GMIM Pancaran Kasih Manado melalui Kepuasan Kerja.
FAKTOR-FAKTOR YANG MEMPENGARUHI LOYALITAS PASIEN KLINIK KESEHATAN KOPERASI KARYAWAN PLN BATAM
Authors: Iswara Bunga Divi , Rustam Triana Ananda 
Published: June 2022

Abstract: This research aimed to find out the effect of the facilities, service, and both of them simultaneously on patient loyalty at the health clinic of the State Electricity Company Batam cooperative. This study used a quantitative research design with a total population and sample was 148 patients who visited the Health Clinic of the State Electricity Company Batam City Employees Cooperative. The data analysis techniques applied in this study were the data quality test, classical assumption test, influence test, and hypothesis test which will be assisted by the application of SPSS version 25. This study found that: (1) The facility variable has a positive and significant impact on patient loyalty at the State Electricity Company Batam employee cooperative health clinic. The more complete the facilities provided meant that the loyal patients would check themselves, (2) The service variable has a positive and significant effect on patient loyalty at the State Electricity Company Batam employee cooperative health clinic. The greater the opportunity for service indicators, the patient would be loyal to visit or health control, and (3) The service and facility variables simultaneously affect patient loyalty significantly and positively at the State Electricity Company Batam employee cooperative health clinic. Abstrak: Penelitian ini bertujuan untuk mengetahui pengaruh fasilitas, pelayanan, dan keduanya secara simultan terhadap loyalitas pasien di poliklinik kesehatan koperasi PLN Batam. Penelitian ini menggunakan desain penelitian kuantitatif dengan jumlah populasi dan sampel sebanyak 148 pasien yang berkunjung ke Klinik Kesehatan Koperasi Pegawai Perusahaan Listrik Negara Kota Batam. Teknik analisis data yang digunakan dalam penelitian ini adalah uji kualitas data, uji asumsi klasik, uji pengaruh, dan uji hipotesis yang akan dibantu dengan aplikasi SPSS versi 25. Penelitian ini menemukan bahwa: (1) Variabel fasilitas berpengaruh positif dan berpengaruh signifikan terhadap loyalitas pasien di poliklinik kesehatan koperasi pegawai PLN Batam. Semakin lengkap fasilitas yang diberikan berarti pasien yang setia akan memeriksakan diri, (2) Variabel pelayanan berpengaruh positif dan signifikan terhadap loyalitas pasien pada klinik kesehatan koperasi pegawai PT PLN Batam. Semakin besar peluang indikator pelayanan maka pasien akan loyal berkunjung atau kontrol kesehatan, dan (3) Variabel pelayanan dan fasilitas secara simultan berpengaruh signifikan dan positif terhadap loyalitas pasien pada klinik kesehatan koperasi pegawai PLN BatamKeywords: Patient Loyalty , Service, Facilities, Health Clinic, Kopkar State Electricity Company Batam.
Apply a TADF emitter with twist configuration for high-performance green OLEDs
Authors: Qin Feng , Zhang Shaoli , Ding Yuan , Niu Jinghua , Lin Yafei , Hua Wanming , Wang Jianyun , Ye Jiandong , Gu Shulin 
Published: June 2022

Abstract
Due to the strong concentration quenching effect, the development of non-doped devices with excellent performance is limited. Herein, a novel thermally activated delayed fluorescence (TADF) emitter which contain Spiro[anthracene-9(10H),9’-[9H]fluoren]-10-one (9-FAO) and 9,9-dimethyl-9,10-dihydroacridine (DMAC) was designed and synthesized. The compound shows TADF characteristics which can be observed by transient PL decay tests. By introducing DMAC into the para-position of the 9-FAO which has a highly twisted structure, the distance between the molecules increases to inhibit concentration quenching. The non-doped OLED device by using 2-(9, 9-dimethylacridin-10(9H)-yl)-10H-spiro[anthracene-9,9’- fluoren]-10-one (DMTO-DMAC) as emitter achieved a superior current efficiency of 35.6 cd A−1 and maximum external quantum efficiency of 11.3% with an emission peak at 516 nm. This work demonstrates the feasibility of increasing intermolecular distance to obtain highly efficient non-doped devices.
Interconnected crises and design complexity
Authors: Losasso Mario 
Published: June 2022

Crisi, futuro, progresso
Crisi e nuove generazioni, insieme ad ambiente e tecnologia, sono le parole chiave di un dibattito che, dagli anni ’70, affronta il tema delle crisi periodiche che attraversano la nostra contemporaneità: nel presente la crisi ormai si manifesta con molteplici crisi fra loro intrecciate, poiché i confini tra quella ambientale, quella sociale e quella sanitaria sono labili e impongono la necessità di una risposta che abbia analoghi gradi di complessità e di multipolarità (Scomodo, 2021). L’accumulazione di criticità transnazionali e locali ha condotto a una saturazione del sistema globalizzato planetario, mentre la fase di incertezza definisce tendenze verso una de-standardizzazione, una crescente eterogeneità, un’instabilità sociale e sempre maggiori disuguaglianze (Mingione, 2019). La stessa ideologia della globalizzazione ha subito una profonda ridefinizione con un aumento dei divari a causa del liberismo economico incontrollato e della nascita di movimenti che apportano radicalizzazioni estreme nella società (Piketty, 2020).