bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mental health emergencies attended by ambulances in the United Kingdom and the implications for health service delivery: A cross-sectional study
Authors: Moore Harriet Elizabeth , Siriwardena Aloysius Niroshan , Gussy Mark , Spaight Robert 
Published: August 2022

Objective In the context of increasing demand for ambulance services, emergency mental health cases are among the most difficult for ambulance clinicians to attend, partly because the cases often involve referring patients to other services. We describe the characteristics of mental health emergencies in the East Midlands region of the United Kingdom. We explore the association between 999 (i.e. emergency) call records, the clinical impressions of ambulance clinicians attending emergencies and the outcomes of ambulance attendance. We consider the implications of our results for optimizing patient care and ambulance service delivery. Methods We conducted a retrospective observational study of records of all patients experiencing mental health emergencies attended by ambulances between 1 January 2018 and 31 July 2020. The records comprised details of 103,801 ‘999’ calls (Dispatch), the preliminary diagnoses by ambulance clinicians on-scene (Primary Clinical Impression) and the outcomes of ambulance attendance for patients (Outcome). Results A multinomial regression analysis found that model fit with Outcome data was improved with the addition of Dispatch and Primary Clinical Impression categories compared to the fit for the model containing only the intercept and Outcome categories (Chi-square = 18,357.56, df = 180, p < 0.01). Dispatch was a poor predictor of Primary Clinical impression. The most common predictors of Outcome care pathways other than ‘Treated and transported’ were records of respiratory conditions at Dispatch and anxiety reported by clinicians on-scene. Conclusions Drawing on the expertise of mental health specialists may help ‘999’ dispatchers distinguish between physical and mental health emergencies and refer patients to appropriate services earlier in the response cycle. Further investigation is needed to determine if training Dispatch operatives for early triage and referral can be appropriately managed without compromising patient safety.
A Moderated Mediation Model to Explain Consistent Condom Use Intention Among Young Adults in South Africa
Authors: Nkwei Emile Saker , Roberts-Lombard Mornay , Maduku Daniel Kofi 
Published: August 2022

Background Behavioral sustenance is one of the main outcomes of social marketing programs to address health issues, such as HIV and AIDS prevention. However, academic research into consistent condom use is interestingly sparse, particularly in South Africa, the country with the highest HIV-infected population in the world. Young adults are particularly vulnerable because they often engage in unprotected sex. Focus of the Article This study explores the factors driving consistent condom use intention with theoretical considerations in the expectation confirmation theory. The study investigates whether factors within the condom product category such as brand satisfaction and brand value enhance or weaken the effect of met/unmet brand expectations on consistent condom use intention of young adults. It further tests whether this potential enhanced or weakened effect significantly differs between male and female condom users. Research Questions Does dis/confirmation influence consistent condom use in the presence of brand satisfaction and brand value or not? Does gender moderate the mediations found in the expectation confirmation model? Importance to the Social Marketing Field From a theoretical perspective, the study expands the expectancy confirmation theory by focusing on the indirect effects of dis/confirmation on continuance intention. The study also tests the mediated moderating role of gender. Methods The study was descriptive in nature and a quantitative survey was used to obtain data from 724 young adults in South Africa. Quota sampling was applied to select respondents. Finally, the structural equation modelling technique was used to assess the measurement and structural models. Results Findings indicate that perceived brand value determines consistent condom use intention. The mediating role of perceived brand value on the relationship between dis/confirmation and consistent condom use intention was more pronounced among males compared to females. Dis/confirmation and perceived brand value were significant determinants of condom brand satisfaction. However, the influence of brand satisfaction on consistent condom use intention was not supported. Recommendations for Research or Practice The concept of consistent condom use should be integrated in the brand message. A segmented approach based on gender should be used by condom companies to promote their products to young adults. These companies should provide condoms that meet the expectations of male and female young adult consumers as two different market segments. Limitations Only one province was investigated in South Africa. Social desirability bias was not controlled.
Disability and oral health in the Association of Southeast Asian Nations - A survey for conceptualisation and development
Authors: Lim Guang Xu David , Hamzah Siti Zaleha , Bernardino Ricca Rocco Mae , Sukhumalind Patcharawan , Ishak Nurul Sa’idah , Adiwoso Adiningrum Wiradidjaja 
Published: August 2022

Background All member states in the Association of Southeast Asian Nations (ASEAN) are ratified signatories of the UN Convention on the Rights of Persons with Disabilities. However, disability and oral health (DOH) can be an elusive ambition for developing nations. Objectives This survey aims to conceptualise ‘barriers’, ‘improvements’, ‘challenges in dental practice’, and ‘ways to collaborate’, to inform policy development for DOH within ASEAN. Methods The survey employed a novel quasi-qualitative design. It was electronically distributed to dentists with DOH specialty training in ASEAN within the International Association of Disability and Oral Health’s network from September 2018 to June 2020. The ‘barriers’ and ‘improvements’ would be categorised into five dimensions of healthcare - a framework by Levesque and colleagues (2013). Results 21 valid responses were received from Brunei, Indonesia, Malaysia, Philippines, Singapore and Thailand. From the care provider’s perspective, adequate training (appropriateness) was most prioritised. From the patient’s aspect, low oral health literacy (ability to perceive) was the most significant. ‘Social perception’ was collectively ranked as the key ‘challenge in dental practices’. Suggested ‘ways to collaborate’ could be categorised into five areas: engagement; advocacy; policies; specialty, and; upskilling. Conclusions The findings suggest an urgent need to address low oral health prioritisation, a drive to upskill providers, a challenge of ‘social perceptions’, and a consensual appeal for state-level support. A multi-sector collaboration is needed to align current strategies in order to achieve equity for DOH in ASEAN.
Compliance level and factors associated with iron–folic acid supplementation among pregnant women in Dangila, Northern Ethiopia: A cross-sectional study
Authors: Asres Abiyot Wolie , Hunegnaw Woldeamilak Adamu , Ferede Addisu Gasheneit , Azene Tamene Wolie 
Published: August 2022

Objectives: Iron–folic acid non-compliance is a major problem in the study area. Therefore, this study aimed to assess the level of iron–folic acid supplementation compliance and associated factors among pregnant women. Methods: A community-based cross-sectional study design was conducted among pregnant women from 1 to 30 November 2018 in Dangila, Northern Ethiopia. A multi-stage sampling technique was used to select the participants. The data were collected using a structured questionnaire. For data entry and analysis, Epi Info 7 and Statistical Package for Social Science (SPSS) 23.0 were used, respectively. Bivariable and multivariable logistic regression analyses were done. Descriptive statistics like mean and standard deviation, and odds ratios with their respective confidence intervals were calculated. Statistically significant was declared at a p value of less than 0.05. The results were presented using text, tables, and figures. Results: A total of 589 pregnant women were involved, yielding a response rate of 91.2%. The average age of the participants in the study was 30.90 ± 5.93 years. The average weekly iron–folic acid pill intake was 5.3. The iron-folic acid compliance rate was 76.9% (95% confidence interval: 73.5–80.6). Women who had four or fewer alive children (adjusted odds ratio = 2.68, 95% confidence interval: 1.37–5.23), took less than 30 min to get to the health facility (adjusted odds ratio = 1.90, 95% confidence interval: 1.16–3.10), being a government employee (adjusted odds ratio = 0.16, 95% confidence interval: 0.03–0.81), attended antenatal care conferences (odds ratio = 2,95% confidence interval: 1.16–3.42), and started iron–folic acid tablets in the first trimester (odds ratio = 2.3, 95% confidence interval: 1.39–3.87) were associated with iron–folic acid compliance. Conclusion: The level of iron–folic acid supplementation compliance was low. Attending antenatal care training and starting to take iron-folic acid pills early in the first trimester were both factors associated with iron–folic acid supplementation compliance. Health care and health extension workers should emphasize and monitor the iron pill–taking habits of pregnant women in home-to-home visits.
Endometrial cancer rate in Hormone replacement therapy users with postmenopausal bleeding: Retrospective cohort study
Authors: Buchanan Charlotte , Robinson Megan , Macdonald Madeleine C 
Published: August 2022

Objective To establish the endometrial cancer detection rate in women using hormone replacement therapy presenting with postmenopausal bleeding. Study Design Retrospective cohort study. Setting and population Rapid access gynaecology clinic at a tertiary hospital. Women aged under 60 years referred with postmenopausal bleeding. Methods Retrospective study of referrals received between 1 January 2019 and 31 December 2020 including Hormone replacement therapy (HRT) use and histological diagnosis. Main outcome measures Histological diagnosis of endometrial cancer, borderline ovarian tumour or endometrial intraepithelial neoplasia. Statistical analysis Chi squared test Results 1363 women were included. 214 women were using HRT when they experienced PMB and only one of these had endometrial cancer at histology (cancer detection rate 0.47%). 25 of the 1124 women who were not using HRT were diagnosed with endometrial cancer on histology (cancer detection rate 2.18%). Chi squared statistical analysis confirmed this was statistically significant ( p value .0156). Conclusions The endometrial cancer detection rate in women aged under 60 years using HRT with PMB is very low. Referral on a two-week wait pathway for suspected cancer diagnosis induces stress and anxiety for the woman and may lead to more invasive initial investigation even though other diagnoses are far more likely. Women aged under 60 years with postmenopausal bleeding that have either commenced HRT or had a change to their preparation within the last 6 months should be seen on a less urgent referral pathway if necessary given the very low probability of endometrial cancer.
Intra- and postoperative opioid-sparing analgesia in a cat undergoing pelvic limb amputation
Authors: Santoro Francesco , Castineiras Diego , Kaartinen Johanna 
Published: August 2022

Case summary A combination of preoperative epidurally administered morphine, peripheral nerve blocks and postoperative wound irrigation with ropivacaine is described as an opioid-sparing analgesic protocol for a feline immunodeficiency virus-positive cat with hypertrophic cardiomyopathy undergoing hindlimb amputation. The reported strategy resulted in a lack of intraoperative sympathetic response, haemodynamic stability and adequate postoperative analgesia. No rescue analgesia was needed at any point. Relevance and novel information This report represents an example of how several locoregional techniques can be effectively combined to minimise the perioperative use of systemic opioids and their potential side effects in selected cases.
Operative Management of Hip Fractures Within 24 Hours in the Elderly is Achievable and Associated With Reduced Opiate Use
Authors: Allahabadi Sachin , Roostan Mohammad , Roddy Erika , Ward Derek T. , Rogers Stephanie , Kim Candace 
Published: August 2022

Introduction Morbidity and mortality benefits have been associated with prompt surgical treatment of geriatric hip fractures. The purpose of this study was to evaluate the impact of early (≤24 hr) vs delayed (>24 hr) time to operating room (TTOR) on 1) hospital length of stay and 2) total and post-operative opiate use in geriatric hip fractures. Materials and Methods This study was a retrospective review of patients ≥65 years-old at the time of admission for surgery for hip fracture at a Level II academic trauma center. Outcome measures were length of stay (LOS), oral morphine equivalents (OME) throughout hospitalization. Patients were stratified into early and delayed TTOR groups and comparisons were made between groups. Results Between the early (n = 75, 80.6%) and late (n = 18, 19.4%) groups, there were no differences in age, fracture pattern, type of treatment, preoperative opiate use, and perioperative non-oral pain management. The early group trended toward shorter total LOS (108.0 ± 67.2 hours vs 144.8 ± 103.7 hours, P = .066), but not post-operative LOS. Total OME usage was less in the early intervention group (92.5 ± 188.0 vs 230.2 ± 296.7, P = .015), in addition to reduced post-operative OME (81.3 ± 174.9 vs 213.3 ± 271.3, P = .012). There were no differences in evaluated potential delay sources such as primary language, use of surrogate decision makers, or need for advanced imaging. Discussion Surgical treatment of geriatric hip/femur fractures in ≤24 hours from presentation is achievable and may be associated with reduced total inpatient opiate use, although daily use did not differ. Conclusion Establishing institutional TTOR goals as part of an interdisciplinary hip fracture co-management clinical pathway can facilitate prompt care and contribute to recovery and less opiate use in these patients with highly morbid injuries.
Anatomical Components Associated With Increased Tibial Tuberosity–Trochlear Groove Distance
Authors: Xu Chenyue , Cui Zhaoxia , Yan Lirong , Chen Zheng , Wang Fei 
Published: August 2022

Background: Increased tibial tuberosity–trochlear groove (TT-TG) distance is an important indicator of medial tibial tubercle transfer in the surgical management of lateral patellar dislocation (LPD). Changes to TT-TG distance are determined by a combination of several anatomical factors. Purpose: To (1) determine the anatomical components related to increased TT-TG distance and (2) quantify the contribution of each to identify the most prominent component. Study Design: Case-control study; Level of evidence, 3. Methods: Included were 80 patients with recurrent LPD and 80 age- and body mass index–matched controls. The 2 groups were compared in TT-TG distance and its related anatomical components: tibial tubercle lateralization (TTL), trochlear groove medialization, femoral anteversion, tibiofemoral rotation (TFR), tibial torsion, and mechanical axis deviation (MAD). The Pearson correlation coefficient ( r) was calculated to evaluate the association between increased TT-TG distance and its anatomical parameters, and factors that met the inclusion criteria of P < .05 and r ≥ 0.30 were analyzed via stepwise multivariable linear regression analysis to predict TT-TG distance. Results: The LPD and control groups differed significantly in TT-TG distance, TTL, TFR, and MAD ( P < .001 for all). Increased TT-TG distance was significantly positively correlated with TTL ( r = 0.376; P < .001), femoral anteversion ( r = 0.166; P = .036), TFR ( r = 0.574; P < .001), and MAD ( r = 0.415; P < .001), and it was signficantly negatively correlated with trochlear groove medialization ( r = −0.178; P = .024). The stepwise multivariable analysis revealed that higher TTL, excessive knee external rotation, and excessive knee valgus were statistically significant predictors of greater TT-TG distance ( P < .001 for all). The standardized estimates that were used for evaluating the predictive values were larger for TFR compared with those for TTL and MAD. Conclusion: TTL, TFR, and MAD were the main independent anatomical components associated with increased TT-TG distance, with the most prominent component being TFR. The association of TT-TG distance to each component analyzed in our study may help guide surgical planning.
Cultivating informatics capacity for multimorbidity: A learning health systems use case
Authors: Williams Tremaine B , Garza Maryam , Lipchitz Riley , Powell Thomas , Baghal Ahmad , Swindle Taren , Sexton Kevin Wayne 
Published: August 2022

Background The aim of this study was to characterize patterns of multimorbidity across patients and identify opportunities to strengthen the informatics capacity of learning health systems that are used to characterize multimorbidity across patients. Methods Electronic health record (EHR) data on 225,710 multimorbidity patients were extracted from the Arkansas Clinical Data Repository as a use case. Hierarchical cluster analysis identified the most frequently occurring combinations of chronic conditions within the learning health system’s captured data. Results Results revealed multimorbidity was highest among patients ages 60 to 74, Caucasians, females, and Medicare payors. The largest numbers of chronic conditions occurred in the smallest numbers of patients (i.e., 70,262 (31%) patients with two conditions, two (<1%) patients with 22 chronic conditions). The results revealed urgent needs to improve EHR systems and processes that collect and manage multimorbidity data (e.g., creating new, multimorbidity-centric data elements in EHR systems, detailed longitudinal tracking of compounding disease diagnoses). Conclusions Without additional capacity to collect and aggregate large-scale data, multimorbidity patients cannot benefit from the recent advancements in informatics (i.e., clinical data registries, emerging data standards) that are abundantly working to improve the outcomes of patients with single chronic conditions. Additionally, robust socio-technical system studies of clinical workflows are needed to assess the feasibility of integrating the collection of risk factor data elements (i.e., psycho-social, cultural, ethnic, and socioeconomic attributes of populations) into primary care encounters. These approaches to advancing learning health systems for multimorbidity could substantially reduce the constraints of current technologies, data, and data-capturing processes.
Lymphatic coagulation and neutrophil extracellular traps in lung-draining lymph nodes of COVID-19 decedents
Authors: MacDonald Margo E. , Weathered Rachel K. , Stewart Emma C. , Magold Alexandra I. , Mukherjee Anish , Gurbuxani Sandeep , Smith Heather , McMullen Phillip , Mueller Jeffrey , Husain Aliya N. , Salles Calixto M. , Briquez Priscilla S. , Rouhani Sherin J. , Yu Jovian , Trujillo Jonathan , Pyzer Athalia R. , Gajewski Thomas F. , Sperling Anne I. , Kilarski Witold W. , Swartz Melody A. 
Published: August 2022

Abstract
Clinical manifestations of severe COVID-19 include coagulopathies that are exacerbated by the formation of neutrophil extracellular traps (NETs). Here, we report that pulmonary lymphatic vessels, which traffic neutrophils and other immune cells to the lung-draining lymph node (LDLN), can also be blocked by fibrin clots in severe COVID-19. Immunostained tissue sections from COVID-19 decedents revealed widespread lymphatic clotting not only in the lung but also in the LDLN, where the extent of clotting correlated with the presence of abnormal, regressed, or missing germinal centers (GCs). It strongly correlated with the presence of intralymphatic NETs. In mice, tumor necrosis factor α induced intralymphatic fibrin clots; this could be inhibited by DNase I, which degrades NETs. In vitro, TNF-α induced lymphatic endothelial cell upregulation of ICAM-1 and CXCL8, among other neutrophil-recruiting factors, as well as thrombomodulin downregulation; in decedents, lymphatic clotting in LDLNs. In a separate cohort of hospitalized patients, serum levels of Myeloperoxidase-DNA (MPO-DNA, a NET marker) inversely correlated with antiviral antibody titers, but D-dimer levels, indicative of blood thrombosis, did not correlate with either. Patients with high MPO-DNA but low D-dimer levels generated poor antiviral antibody titers. This study introduces lymphatic coagulation in lungs and LDLNs as a clinical manifestation of severe COVID-19 and suggests the involvement of NETosis of lymphatic-trafficking neutrophils. It further suggests that lymphatic clotting may correlate with impaired formation or maintenance of GCs necessary for robust antiviral antibody responses, although further studies are needed to determine whether and how lymphatic coagulation affects adaptive immune responses.
Relationship between the xylem maturation process based on radial variations in wood properties and radial growth increments of stems in a fast-growing tree species, Liriodendron tulipifera
Authors: Nezu Ikumi , Ishiguri Futoshi , Ohshima Jyunichi , Yokota Shinso 
Published: August 2022

AbstractPromoting wood utilization from fast-growing tree species is one solution to address supply and demand issues relating to wood resources while sequestering carbon dioxide in large quantities. Information on the quality of wood from fast-growing tree species and its relationship with changes in stem size is essential for promoting the establishment of plantations and wood utilization of fast-growing tree species. To explore the relationship between the xylem maturation process and radial growth increments of stems in fast-growing tree species, we examined radial variations in annual ring widths and wood properties in Liriodendron tulipifera in Japan. The cambial ages at which current annual increment and mean annual increment values were greatest were 4.9 years and 7.4 years, respectively. Based on radial variations evaluated by mixed-effects modeling of wood properties, all properties increased or decreased near the pith before becoming stable towards the cambium. Changing ratios of multiple wood properties at 1-year intervals became stable after a cambial age of 9 years. These results point to an ecological strategy in L. tulipifera, in which there is a tradeoff between radial growth increments and wood properties. As part of this strategy, in response to competition among individual trees within a stand, the tree produces a large volume of xylem with lower physical and mechanical properties, allowing it to increase its volume faster than that of the surrounding trees. Subsequently, it produces xylem that is more stable, with greater physical and mechanical properties. This wood forms at a slower growth rate compared to the xylem that forms at the time of initial tree growth. Based on the ecological strategy adopted by L. tulipifera, wood that forms before a cambial age of 9 years can be used for utility applications, and wood that forms after a cambial age of 9 years can be used for structural applications.