bluuebunny/crossref_metadata_2025_split huggingface dataset:
Practice of general pediatrics in Saudi Arabia: current status, challenges, and opportunities
Authors: Alnasser Yossef S. , Alabdali Alhanouf F. , Alshabri Rahaf I. , Albatati Sawsan M. 
Published: October 2022

Abstract
Background
In Saudi Arabia, general pediatrics serves children until they are 14 years old. It has contributed to improving the health of Saudi children.

Method
This study adopted a qualitative method and recruited pediatric physicians to investigate status, successes, challenges, and opportunities. Later, data were analyzed using thematic analysis and hermeneutic phenomenology.

Results
This study attracted 13 pediatric physicians for interviews. All participants appreciated the role of general pediatricians, but the trainees had a negative attitude regarding the general pediatrics specialty. They all agreed on providing primary care for all children and recommended that their first visit should occur earlier. Shortage of pediatricians, lack of community pediatricians, busy clinics, limited Arabic resources, and poor communication skills are significant barriers to children receiving adequate care. The majority of pediatricians favor extending the pediatric age to 18 years old. One pediatrician stated, “Youths between ages 14–18 years are lost, adults and we refuse to care for them…” Additionally, pediatricians have concerns about managing developmental delays and behavioral issues. They believe the current pediatric residency provides many opportunities for a brighter future.

Conclusion
General pediatrics is well established in Saudi Arabia. To continue thriving, we need to address some challenges that pediatricians face and attract more residency graduates. The current pediatric residency programs can provide opportunities to address deficit areas.
Neonatal hemochromatosis with εγδβ-thalassemia: a case report and analysis of serum iron regulators
Authors: Tsuge Mitsuru , Kodera Aya , Sumitomo Hiromi , Araki Tooru , Yoshida Ryuichi , Yasui Kazuya , Sato Hiroki , Washio Yosuke , Washio Kana , Shigehara Kenji , Yashiro Masato , Yagi Takahito , Tsukahara Hirokazu 
Published: October 2022

Abstract
Background
Neonatal hemochromatosis causes acute liver failure during the neonatal period, mostly due to gestational alloimmune liver disease (GALD). Thalassemia causes hemolytic anemia and ineffective erythropoiesis due to mutations in the globin gene. Although neonatal hemochromatosis and thalassemia have completely different causes, the coexistence of these diseases can synergistically exacerbate iron overload. We report that a newborn with εγδβ-thalassemia developed neonatal hemochromatosis, which did not respond to iron chelators and rapidly worsened, requiring living-donor liver transplantation.

Case presentation
A 1-day-old Japanese boy with hemolytic anemia and targeted red blood cells was diagnosed with εγδβ-thalassemia by genetic testing, and required frequent red blood cell transfusions. At 2 months after birth, exacerbation of jaundice, grayish-white stool, and high serum ferritin levels were observed, and liver biopsy showed iron deposition in hepatocytes and Kupffer cells. Magnetic resonance imaging scans showed findings suggestive of iron deposits in the liver, spleen, pancreas, and bone marrow. The total amount of red blood cell transfusions administered did not meet the criteria for post-transfusion iron overload. Administration of an iron-chelating agent was initiated, but iron overload rapidly progressed to liver failure without improvement in jaundice and liver damage. He underwent living-donor liver transplantation from his mother, after which iron overload disappeared, and no recurrence of iron overload was observed. Immunohistochemical staining for C5b-9 in the liver was positive. Serum hepcidin levels were low and serum growth differentiation factor-15 levels were high prior to living-donor liver transplantation.

Conclusions
We reported that an infant with εγδβ-thalassemia developed NH due to GALD, and that coexistence of ineffective erythropoiesis in addition to erythrocyte transfusions may have exacerbated iron overload. Low serum hepcidin levels, in this case, might have been caused by decreased hepcidin production arising from fetal liver damage due to neonatal hemochromatosis and increased hepcidin-inhibiting hematopoietic mediators due to the ineffective hematopoiesis observed in thalassemia.
Sleep duration and risk of high blood pressure in Thai adolescents: the Thai National Health Examination Survey V, 2014 (NHES-V)
Authors: Pirojsakul Kwanchai , Aekplakorn Wichai , Siwarom Sirinapa , Paksi Witchuri , Kessomboon Pattapong , Neelapaichit Nareemarn , Chariyalertsak Suwat , Assanangkornchai Savitree , Taneepanichskul Surasak 
Published: October 2022

Abstract
Background
Sleep duration has been proposed to be associated with high blood pressure. However, nationwide studies regarding this association in adolescents remain limited. This study aimed to explore the national prevalence of high blood pressure among Thai adolescents and to determine the association between sleep duration and high blood pressure.

Methods
Data from adolescents aged 10–19 years from the Thai National Health and Examination Survey V were included. We collected demographic data (including age and gender), height, weight, waist circumference, blood pressure, fasting blood chemistries and sleep duration data. Sleep durations were categorized as short, normal or long for each age group based on the United States National Sleep Foundation’s recommendations. High blood pressure was diagnosed using the 2017 guidelines of the American Academy of Pediatrics. Factors associated with high blood pressure were analyzed using multivariate logistic regression.

Results
A total of 3505 adolescents (1785 female) were included. The prevalence of high blood pressure was 9.4% (95% CI 8.5–10.4%). The high blood pressure group had higher BMI z-score, LDL-C, triglyceride and lower HDL-C than the normotensive group. In the multivariate analysis, BMI z-score, LDL-C and HDL-C were independently associated with high blood pressure. However, there was no association between sleep duration and high blood pressure.

Conclusions
High blood pressure risk was increased in adolescents with high BMI z-score. Neither short nor long sleep duration was associated with an increased risk of high blood pressure.
Sports activity participation and subjective health status of patients after total hip arthroplasty via the anterolateral-supine approach: a case series study
Authors: Takahashi Yoshiki , Takahira Naonobu , Uchiyama Katsufumi , Fukushima Kensuke , Moriya Mitsutoshi , Shibuya Manaka 
Published: October 2022

Abstract
Background
No reports have been published about participation in sports activity and subjective health status after total hip arthroplasty via the anterolateral approach in the supine position (ALS-THA) in Japanese patients. This study assessed sports activity participation and subjective health status, as well as factors potential associated with these variables, in patients who underwent ALS-THA.

Methods
Of 698 patients who underwent total hip arthroplasty at our institution between 2013 and 2018, questionnaires were sent to 355 patients under 80 years old who had undergone ALS-THA and 242 responded. Patients were asked about their subjective health status, participation in sports activity, the EuroQol 5-dimensions 5-level (EQ-5D-5L), the University of California Los Angeles (UCLA) activity scale score and the Forgotten Joint Score (FJS). Patient characteristics and hospitalization information were also collected. Patients’ subjective health status was categorized as “healthy” or “unhealthy”. Univariate and multivariate logistic regression analyses were performed to determine factors associated with participation in sports activity after ALS-THA and a “healthy” status.

Results
The pre- and postoperative sports activity participation rates were 54.0% and 57.8%, respectively. Most patients (76.8%, n = 182) were considered “healthy”. Age (P = .019) and UCLA activity score (P < .001) were significantly associated with sports activity after ALS-THA. FJS (P = .002) and EQ-5D-5L (P = .004) were significantly associated with a “healthy” status.

Conclusion
Patients participating in sports activity after ALS-THA are older and have higher UCLA activity scores and patients considered “healthy” have higher FJS and EQ-5D-5L scores.
Clinical and radiologic outcomes of the modified phemister procedure with coracoclavicular ligament augmentation using mersilene tape versus hook plate fixation for acute acromioclavicular joint dislocation
Authors: Chang Yu-Jui , Chou Wen-Yi , Ko Jih-Yang , Liu Hao-Chen , Yang Ya-Ju , Siu Ka-Kit 
Published: October 2022

Abstract
Background
The clinical superiority of surgical treatment for acromioclavicular (AC) joint dislocation remains controversial. The aim of this study was to compare the clinical and radiological outcomes of the modified Phemister procedure with CC ligament augmentation using Mersilene tape to those of hook plate fixation for acute AC joint dislocation.

Methods
In this study, patients who received modified Phemister surgery with CC ligament augmentation using Mersilene tape (PM group) or hook plate fixation (HK group) for acute unstable AC joint dislocation with a minimum 5-year follow-up period were retrospectively reviewed. The clinical outcomes were evaluated according to blood loss during surgery, surgical duration, visual analogue scale (VAS), Constant-Murley score (CMS), University of California at Los Angeles (UCLA) shoulder rating scale, and the occurrence of complications. Radiological outcomes were assessed from radiographs according to multiple parameters, including CC distance maintenance, acromion osteolysis, and the presence of distal clavicle osteolysis.

Results
A total of 35 patients completed follow-up for more than 5 years and were analyzed in this study (mean = 74.08 months). There were 18 patients in the PM group and 17 in the HK group. The PM group exhibited similar improvement in functional outcome to the HK group. Regarding radiological outcomes, the HK group had a superior performance in terms of CC distance maintenance, of statistical significance (CCDR: 94.29 ± 7.01% versus 111.00 ± 7.69%, p < 0.001) after a one-year follow-up period. However, there were 4 cases of acromion osteolysis and 2 cases of distal clavicle osteolysis in the HK group.

Conclusion
Hook plate fixation was found to be superior to the modified Phemister technique with CC ligament augmentation using Mersilene tape in terms of CC distance maintenance, but there was no significant difference in the functional outcome after 5 years of follow-up. Both surgical methods are reliable options for the treatment of acute AC joint dislocation. Modified Phemister surgery with CC ligament augmentation using Mersilene tape is a relatively lower-cost option for acute AC joint dislocation without the need of a second surgery for implant removal.
Preparation of a novel monoclonal antibody against active components of PHA-L from Phaseolus vulgaris and its functional characteristics
Authors: Wang Peipei , Hu Junmei , Duan Jiaqi , Min Shitong , Chen Congliang , Zhu Yue , Pan Yan , Wang Yitian , Wei Dapeng , Wang Xia 
Published: October 2022

Abstract
Background
Leukocyte phytohemagglutinin (PHA-L), derived from the L4 tetramer of PHA, has been frequently employed as a mitogen to induce T lymphocyte proliferation in vitro. The biological application of PHA-L in cancer diagnosis and treatment has gained traction in recent years. However, it has been noted that PHA-L obtained using traditional procedures has a massive amount of impurities or toxic components, which interfere with the activity of PHA-L. Preparation of a monoclonal antibody against active PHA-L is a significant tool for studying PHA-L's function and therapeutic potential.

Results
We successfully prepared monoclonal antibodies against the active components of PHA-L based on the whole PHA-L protein as an antigen, and found that monoclonal antibody 3C1C6G11 can be employed in western blot, immunofluorescence, and immunohistochemistry detection. Importantly, preliminary result shows that the mAb 3C1C6G11 may prevent PHA-L-induced cell aggregation and AICD (activation-induced cell death).

Conclusions
The monoclonal antibody mAb 3C1C6G11 prepared in this study can be used as an effective tool for detecting PHA-L active components, investigating PHA-L's function and antineoplastic application.
Evaluation of factors that influenced the length of hospital stay using data mining techniques
Authors: Eskandari Mehrnoosh , Alizadeh Bahmani Amir Hossein , Mardani-Fard Heydar Ali , Karimzadeh Iman , Omidifar Navid , Peymani Payam 
Published: October 2022

Abstract
Background
length of stay (LOS) is the time between hospital admission and discharge. LOS has an impact on hospital management and hospital care functions.

Methods
A descriptive, retrospective study was designed on about 27,500 inpatients between March 2019 and 2020. Required data were collected from six wards (CCU, ICU, NICU, General, Maternity, and Women) in a teaching hospital. Clinical data such as demographic characteristics (age, sex), type of ward, and duration of hospital stay were analyzed by the R-studio program. Violin plots, bar charts, mosaic plots, and tree-based models were used to demonstrate the results.

Results
The mean age of the population was 40.8 ± 19.2 years. The LOS of the study population was 2.43 ± 4.13 days. About 60% of patients were discharged after staying one day in the hospital. After staying one day in the hospital, 67% of women were discharged. However, 23% of men were discharged within this time frame. The majority of LOS in the CCU, ICU, and NICU ranged from 5 to 9 days.; In contrast, LOS was one day in General, Maternity, and Woman wards. Due to the tree plot, there was a different LOS pattern between Maternity-Women and the CCU-General-ICU-NICU wards group.

Conclusion
We observed that patients with more severe diseases hospitalized in critical care wards had a longer LOS than those not admitted to critical care wards. The older patient had longer hospital LOS than the younger. By excluding Maternity and Woman wards, LOS in the hospital was comparable between males and females and demonstrated a similar pattern.
Creating conditions for effective knowledge brokering: a qualitative case study
Authors: Burns Prue , Currie Graeme , McLoughlin Ian , Robinson Tracy , Sohal Amrik , Teede Helena 
Published: October 2022

Abstract
Background
Process improvement in healthcare is informed by knowledge from the private sector. Skilled individuals may aid the adoption of this knowledge by frontline care delivery workers through knowledge brokering. However, the effectiveness of those who broker knowledge is limited when the context they work within proves unreceptive to their efforts. We therefore need greater insight into the contextual conditions that support individuals to broker process improvement knowledge to the frontline of care delivery, and how policy makers and organizations might generate such conditions.

Methods
Our research took place in a healthcare system within an Australian State. We undertook a qualitative, embedded single case study over the four year period of a process improvement intervention encompassing 57 semi-structured interviews (with knowledge brokers, policy makers, and executive sponsors), 12 focus groups, and 137 h of observation, which included the frontline implementation of actual process improvement initiatives, where knowledge brokering took place.

Results
We identified four phases of the process improvement intervention that moved towards a more mature collaboration within which knowledge brokering by improvement advisors began to emerge as effective. In the first phase knowledge brokering was not established. In the second phase, whilst knowledge brokering had been initiated, the knowledge being brokered lacked legitimacy amongst frontline practitioners, resulting in resistance. Only in the fourth and final phase of the intervention did the collective experience of policy makers result in reflections on how they might engender a more receptive context for knowledge brokering.

Conclusion
We highlight a number of suggested actions that policy makers might consider, if they wish to engender contextual conditions that support knowledge brokering. Policy makers might consider: ensuring they respect local context and experience, by pulling good ideas upward, rather than imposing foreign knowledge from on high; facilitating the lateral diffusion of knowledge by building cultural linkages between people and organizations; strengthening collaboration, not competition, so that trans-organisational flow of ideas might be encouraged; being friend, not foe, to healthcare organizations on their knowledge integration journey. In sum, we suggest that top-down approaches to facilitating the diffusion and adoption of new ideas ought to be reconsidered.
Hospital managers’ views on the state of patient safety culture across three regions in Ghana
Authors: Tenza Immaculate Sabelile , Attafuah Priscilla Y. A. , Abor Patience , Nketiah-Amponsah Edward , Abuosi Aaron Asibi 
Published: October 2022

Abstract
Background
Improving patient safety culture in healthcare organisations contributes positively to the quality of care and patients’ attitudes toward care. While hospital managers undoubtedly play critical roles in creating a patient safety culture, in Ghana, qualitative studies focussing on hospital managers’ views on the state of patient safety culture in their hospitals remain scanty.

Objective
This study aimed to explore the views of hospital managers regarding compliance to patient safety culture dimensions in the selected hospitals in the Bono, Greater Accra, and Upper East regions of Ghana.

Methodology
This was a qualitative exploratory study. A purposive sampling of all hospital managers involved in patient safety practices was conducted. The sampled managers were then invited to a focus group discussion. Twelve focus group discussions with each consisting of a maximum of twelve participants were conducted. The ten patient safety culture dimensions adapted from the Agency for Healthcare Research and Quality’s patient safety culture composite measures framed the interview guide. Deductive thematic content analysis was done. Lincoln and Guba’s methods of trustworthiness were applied to ensure that the findings are valid and reliable.

Findings
Positive patient safety culture behaviours such as open communication, organisational learning, and strong teamwork within units, were an established practice in the selected facilities across Ghana. Lack of teamwork across units, fear of reporting adverse events, the existence of a blame culture, inconsistent response to errors, extreme shortage of staff, sub-standard handover, lack of management support with resources constrained the patient safety culture. The lack of standardised policies on reporting adverse events and response to errors encouraged managers to use various approaches, some resulting in a blame culture. Staff shortage contributed to poor quality of safety practices including poor handover which was also influenced by lateness to duty.

Conclusion
Prompt and appropriate responses by managers to medical errors require improvements in staffing and material resources as well as the enactment of standard policies across health facilities in the country. By so doing, hospital managers would contribute significantly to patient safety, and help build a patient safety culture in the selected hospitals.
Satisfactory breeding potential is transiently eliminated in beef bulls with clinical anaplasmosis
Authors: Lovett Anne C. , Reppert Emily J. , Jaeger John R. , Kang Qing , Flowers Macy R. , Bickmeier Naemi P. , Anantatat Tippawan , O’Day Shannon C. , Armstrong Chance L. , Reif Kathryn E. 
Published: October 2022

AbstractBackgroundNatural service breeding is common in U.S. cow-calf operations. Diseases impacting bull reproductive performance have significant economic consequences for producers. Anaplasmosis may be an underappreciated cause of poor reproductive performance in bulls. The primary systemic effects of bovine anaplasmosis including anemia, fever, and weight loss, can all result in unsatisfactory reproductive performance. The objective of this pilot study was to evaluate breeding soundness examination (BSE) outcomes and clinical changes in bulls during and upon resolution of clinical anaplasmosis.Anaplasma marginale-challenged bulls were observed for clinical disease and infection progression and changes in breeding soundness compared to uninfected control bulls for 16 weeks.ResultsAllAnaplasma marginale-challenged bulls were PCR-positive, seropositive, and showed clinical signs by 3-, 17-, and 24-days post-challenge, respectively. Clinical signs of anaplasmosis included pallor, icterus, fever (≥ 40.2 °C), and weight loss. Acute anemia was observed in all challenged bulls with PCV nadirs ≤ 18% and peak percent parasitized erythrocyte ≥ 50%. Decreased scrotal circumference and poor semen quality (e.g., increased percentage of abnormal spermatozoa, decreased progressively motile sperm), were initially observed within days after onset of clinical anaplasmosis signs and continued weeks beyond disease resolution. Control bulls remained negative forA. marginale.ConclusionThis pilot study demonstrates that clinical anaplasmosis reduces breeding soundness in beef bulls. Anaplasmosis should be considered as a differential for bulls with decreased semen quality, especially within endemic areas. A 90 day or greater retest window is recommended for bulls of unsatisfactory breeding potential recently recovered from clinical anaplasmosis.
Increasing the data on elasmobranch plasma protein electrophoresis: electrophoretogram reference values determination in the undulate skate (Raja Undulata) and the nursehound shark (Scyliorhinus stellaris) maintained under human care
Authors: Morón-Elorza Pablo , Rojo-Solís Carlos , Steyrer Christine , Álvaro-Álvarez Teresa , Valls-Torres Mónica , Ortega Javier , Encinas Teresa , García-Párraga Daniel 
Published: October 2022

Abstract
Background
This study determined plasma protein electrophoresis (PPE) reference intervals in two elasmobranch species: the undulate skate (Raja undulata) and the nursehound shark (Scyliorhinus stellaris), using a reference population of 48 undulate skates (27 males, 21 females) and 62 nursehounds (32 males, 30 females), considered to be clinically healthy. Plasma samples were analyzed using capillary zone electrophoresis (CZE).

Results
The undulate skate electrophoretogram resembled those previously reported in other batoids and could be divided into seven consistent fractions. No statistically significant differences were detected between sexes and developmental stages. The nursehound electrophoretogram was similar to that previously described in other shark species and could be divided into eight consistent fractions. Fraction 5% was significantly higher in juvenile nursehounds when compared to adults, while fraction 6 concentration and percentage were significantly higher in adults. Fraction 4% was higher in males than in females. Albumin band was not detected, and pre-albumin was negligible in both studied species. Alpha-globulins were predominant in the undulate skate, while beta-globulins were predominant in nursehounds. Statistically significant differences were found in all electrophoretogram fraction percentages and concentrations between the two species.

Conclusion
To the authors knowledge, this is the first study reporting PPE values in undulate skates and nursehounds, and the first study using CZE in elasmobranch plasma. These findings can serve as a primary reference for health monitoring in both species and will add to the limited data available on PPE in elasmobranchs.