bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing the usefulness of policy brief and policy dialogue as knowledge translation tools towards contextualizing the accountability framework for routine immunization at a subnational level in Nigeria
Authors: Ogbonnaya Lawrence Ulu , Okedo-Alex Ijeoma Nkem , Akamike Ifeyinwa Chizoba , Azuogu Benedict , Urochukwu Henry , Ogbu Ogbonnaya , Uneke Chigozie Jesse 
Published: December 2021

Abstract
Background
Evidence suggests that implementing an accountability mechanism such as the accountability framework for routine immunization in Nigeria (AFRIN) will improve routine immunization (RI) performance. The fact that the AFRIN, which was developed in 2012, still had not been operationalized at the subnational level (Ebonyi State) by 2018 may in part account for the poor RI coverage (33%) in 2017. Knowledge translation (KT) is defined as the methods for closing the gaps from knowledge to practice. Policy briefs (useful in communicating research findings to policy-makers) and policy dialogues (that enable stakeholders to understand research evidence and create context-resonant implementation plans) are two KT tools. This study evaluated their usefulness in enabling policy-makers to contextualize AFRIN in Ebonyi State, Nigeria.

Methods
The study design was cross-sectional descriptive with mixed-methods data collection. A policy brief developed from AFRIN guided deliberations in a 1-day multi-stakeholder policy dialogue by 30 policy actors. The usefulness of the KT tools in contextualizing policy recommendations in the AFRIN was assessed using validated questionnaires developed at McMaster University, Canada.

Results
At the end of the policy dialogue, the policy options in the policy brief were accepted but their implementation strategies were altered to suit the local context. The respondents’ mean ratings (MNR) of the overall usefulness of the policy brief and the policy dialogue in contextualizing the implementation strategies were 6.39 and 6.67, respectively, on a seven-point Likert scale (very useful). The MNR of the different dimensions of the policy brief and policy dialogue ranged from 6.17 to 6.60 and from 6.10 to 6.83, respectively (i.e. moderately helpful to very helpful).

Conclusion
The participants perceived the KT tools (policy brief and policy dialogue) as being very useful in contextualizing policy recommendations in a national policy document into state context-resonant implementable recommendations. We recommend the use of these KT tools in operationalizing AFRIN at the subnational level in Nigeria.
Risk factors for low back pain in active military personnel: a systematic review
Authors: To Daphne , Rezai Mana , Murnaghan Kent , Cancelliere Carol 
Published: December 2021

Abstract
Purpose
Low back pain (LBP) is prevalent in military personnel. We aimed to systematically review the literature regarding risk factors for first-time LBP during military service among active duty military personnel.

Methods
We searched six electronic databases (inception-April 2020) for randomised controlled trials, cohort studies, and case–control studies published in English in peer-reviewed journals. Eligible studies were independently critically appraised by paired reviewers and a descriptive synthesis was conducted.

Results
We screened 1981 records, reviewed 118 full-text articles, and synthesised data from eight acceptable quality cohort studies. Studies assessed physical (n = 4), sociodemographic (n = 2), and/or occupational factors (n = 5) associated with LBP. Two studies reported prior LBP was associated with a greater than twofold increased risk of LBP compared to those without prior LBP. Other factors consistently associated with LBP included previous musculoskeletal injury (n = 2), less time spent on physical training (n = 2), female sex (n = 2), and lower rank (n = 2). Factors associated with LBP from single studies included marital status, lower education level, blast injury, job duties, and service type. We found inconsistent associations for performance on physical fitness tests, age, and occupation type. Psychological risk factors were not assessed in any included studies.

Conclusion
In active duty personnel, prior history of LBP, previous musculoskeletal injury, less time in physical training, female sex, and lower rank were consistent risk factors for LBP. This information is relevant for researchers, active duty military personnel, and other decision makers. Future studies should explore causal relationships for LBP in this population.
PROSPERO registration number: CRD42018084549.
An infant with 49XXXXY syndrome: a case report
Authors: Naotunna N. P. G. C. R. , Liyanage C. , Atapattu N. 
Published: December 2021

Abstract
Background
49XXXXY syndrome is the rarest X chromosome aneuploidy, with approximate incidence of 1:85,000–100,000 male births. Worldwide, around 100 cases have been reported. In this report, we describe one such case seen in Sri Lanka.

Case presentation
A 10-day-old Sri Lankan neonate born in a tertiary care center was referred to the pediatric endocrinology unit of Lady Ridgeway Hospital due to detection of ambiguous genitalia at birth. He was the first child born to nonconsanguineous healthy parents following an uncomplicated antenatal period. He was born at term via normal vaginal delivery, with a birth weight of 2.385 kg. The baby was active, and there was no documented hypoglycemia or alteration in basic biochemical investigations. On examination, the child had hypertelorism, upslanting palpebral fissures, flat occiput, and mild webbing of the neck. System examination was normal. Genitalia examination revealed bifid scrotum, perineal urethra, 2 cm phallus, and bilateral testis in situ. Hormonal analysis, including dehydroepiandrosterone sulfate, testosterone, and 17-OH progesterone levels, was normal except for an elevated level of follicle-stimulating hormone, indicating gonadal dysgenesis. Ultrasound of the abdomen detected testis located at bilateral inguinal canal, and no Müllerian structures were visible. Echocardiography showed a small patent foramen ovale with otherwise normal heart. Chromosome analysis revealed 49XXXXY syndrome.

Conclusion
49XXXXY syndrome should be entertained as a rare possibility for ambiguous genitalia, and karyotyping is an essential investigation for evaluation of such patients.
Non-intrusive nonlinear model reduction via machine learning approximations to low-dimensional operators
Authors: Bai Zhe , Peng Liqian 
Published: December 2021

AbstractAlthough projection-based reduced-order models (ROMs) for parameterized nonlinear dynamical systems have demonstrated exciting results across a range of applications, their broad adoption has been limited by their intrusivity: implementing such a reduced-order model typically requires significant modifications to the underlying simulation code. To address this, we propose a method that enables traditionally intrusive reduced-order models to be accurately approximated in a non-intrusive manner. Specifically, the approach approximates the low-dimensional operators associated with projection-based reduced-order models (ROMs) using modern machine-learning regression techniques. The only requirement of the simulation code is the ability to export the velocity given the state and parameters; this functionality is used to train the approximated low-dimensional operators. In addition to enabling nonintrusivity, we demonstrate that the approach also leads to very low computational complexity, achieving up to$$10^3{\times }$$103×in run time. We demonstrate the effectiveness of the proposed technique on two types of PDEs. The domain of applications include both parabolic and hyperbolic PDEs, regardless of the dimension of full-order models (FOMs).
The involvement of local communities in the conservation process of earthen architecture in the Sahel-Sahara region – the case of Djenné, Mali
Authors: Sacko Oussouby 
Published: December 2021

AbstractRecently, many cultural aspects of some African countries have been in danger of being lost due to cultural disruptions, nonadaptive construction techniques and a lack of adequate conservation systems and strategies. These include the well-known manuscripts of Timbuktu (Tombouctou) as well as architecture, languages, beads, textiles, costumes and other cultural objects. Immaterial heritage, such as oral history, traditional music, instruments and dance, is also affected.In the northwestern part of Africa, the so-called Sahel-Sahara region, earthen architecture has played an important role in cultural identity and has been a key means of community establishment. This architectural heritage includes a wide variety of creations ranging from simple houses, granaries, and palaces to religious buildings, urban centres, cultural landscapes and archaeological sites. By studying northwestern African cultural heritage and cultural exchanges during trans-Saharan trade, we can benefit from traditional knowledge and use these teachings to build a sustainable knowledge system for earthen architecture conservation. This work is urgent since these structures are in danger of being lost, destroyed, badly conserved, or not documented.The aim of this research is to point out, through an anthropological approach, the importance of local community involvement in the conservation process. This research is based on a comparative study of different earthen architecture conservation spaces within the abovementioned region that have been important and were influenced by cultural exchanges during trans-Saharan trade. In these historical towns, some architectural heritage sites have been abandoned and are in ruins, while others have been preserved solely as tourist attractions. In this paper, I introduce the case of Djenné to share our research approach. This paper provides insight into earthen architecture conservation issues and how local communities have used tangible and intangible methods to preserve cultural heritage.
State-of-the-art and annual progress of bridge engineering in 2020
Authors: Zhao Renda , Zheng Kaifeng , Wei Xing , Jia Hongyu , Liao Haili , Li Xiaozhen , Wei Kai , Zhan Yulin , Zhang Qinghua , Xiao Lin , Zhou Lingyuan , Shen Ruili , Gou Hongye , Pu Qianhui , Zhang Fang , Xu Ziyi , Yu Chuanjin 
Published: December 2021

AbstractBridge construction is one of the cores of traffic infrastructure construction. To better develop relevant bridge science, this paper introduces the main research progress in China and abroad in 2020 from 16 aspects. The content consists of four major categories in 16 aspects. The first part is about the bridge structure, including concrete bridge and high-performance materials, steel bridges, composite girders. The second part is about the bridge disaster prevention and mitigation, including bridge seismic resistance, wind resistance of bridge, train-bridge coupling vibration research, bridge hydrodynamics, the durability of the concrete bridges, fatigue of steel bridge, temperature field and temperature effect of bridge; The third part is about the bridge analyses, including numerical simulation of bridge structure, box girder and cable-stayed bridge analysis theories. The last part is concerning the bridge emerging technologies, including bridge informatization and intelligent bridge, the technology in bridge structure test, bridge assessment and reinforcement, prefabricated concrete bridge structure.
Beige Adipocyte as the Flame of White Adipose Tissue: Regulation of Browning and Impact of Obesity
Authors: Altınova Alev Eroğlu 
Published: December 2021

AbstractBeige adipocyte, the third and relatively new type of adipocyte, can emerge in white adipose tissue (WAT) under thermogenic stimulations that is termed as browning of WAT. Recent studies suggest that browning of WAT deserves more attention and therapies targeting browning of WAT can be helpful for reducing obesity. Beyond the major inducers of browning, namely cold and β 3-adrenergic stimulation, beige adipocytes are affected by several factors, and excess adiposity per se may also influence the browning process. The objective of the present review is to provide an overview of recent clinical and preclinical studies on the hormonal and nonhormonal factors that affect the browning of WAT. This review further focuses on the role of obesity per se on browning process.
Challenges of Pediatric Anesthesia Services and Training Infrastructure in Tertiary Care Teaching Institutions in Pakistan: A Perspective From the Province of Sindh
Authors: Khan Fauzia A. , Haider Saeeda , Abbas Nighat , Akhtar Navaid , Haq Nur Ul , Khaskheli M. Saleh , Khatri Younis , Munir Nadeem , Raza Hamid , Siddiqui Maqsood Ahmed , Soomro Ahmed Uddin , Siddiqui Safia Zafar 
Published: December 2021

BACKGROUND:
Pakistan is a lower middle–income country located in South Asia with a population of nearly 208 million. Sindh is its second largest province. The aim of this survey was to identify the current setup of pediatric services, staffing, equipment, and training infrastructure in the teaching hospitals of Sindh.

METHODS:
The survey was conducted between June 2018 and September 2018. A questionnaire was designed with input from experts and pretested. One faculty coordinator from each of 12 of the 13 teaching hospitals (7 government and 5 private) completed the form. Information was exported into Statistical Package for the Social Sciences (SPSS) version 22. Frequency and percentages were computed for all variables. Confidentiality was ensured by anonymizing the data.

RESULTS:
Anesthesia services are provided by consultants with either membership or fellowship in anesthesia of the College of Physicians and Surgeons of Pakistan (CPSP). All drugs on the World Health Organization (WHO) essential medication list were available, although narcotic supply was often inconsistent. Weak areas identified were absence of standardization of practice regarding premedication, preoperative laboratory testing, pain assessment, and management. No national practice guidelines exist. Pulse oximeters and capnometers were available in all private hospitals but in only 86% and 44% of the government hospitals, respectively. Some training centers were not providing the training as outlined by the CPSP criteria.

CONCLUSIONS:
Several gaps have been identified in the practice and training infrastructure of pediatric anesthesia. There is a need for national guidelines, standardization of protocols, provision of basic equipment, and improved supervision of trainees. One suggestion is to have combined residency programs between private and government hospitals to take advantage of the strengths of both. Recommendations by this group have been shared with all teaching hospitals and training bodies.
An Intensity-dependent Slow Component of HR Interferes with Accurate Exercise Implementation in Postmenopausal Women
Authors: TESO MASSIMO , COLOSIO ALESSANDRO L. , POGLIAGHI SILVIA 
Published: December 2021

ABSTRACT
Heart rate (HR) targets are commonly used to administer exercise intensity in sport and clinical practice. However, as exercise protracts, a time-dependent dissociation between HR and metabolism can lead to a misprescription of the intensity ingredient of the exercise dose.

Purpose
We tested the hypothesis that a slow component of HR (i.e., scHR) occurs in all intensity domains, greater than the slow component of oxygen uptake (scV˙O2), and we developed an equation to predict it across exercise intensities.

Method
Eighteen healthy, postmenopausal women (54 ± 4 yr) performed on a cycle ergometer: i) a ramp incremental test for thresholds and V˙O2max detection; ii) 30-min constant work exercise at 40%, 50%, 60%, 70%, and 80% V˙O2max for the measurement of scHR, scV˙O2, stroke volume, and body temperature (T°). scHR and scV˙O2 were compared by two-way repeated-measures ANOVA (intensity and variable). Pearson correlation was calculated between the slow component of all variables, relative intensity, and domain. scHR (in beats per minute) was predicted with a linear model based on exercise intensity relative to the respiratory compensation point (RCP).

Results
A positive scHR was present in all domains, twice the size of scV̇O2 (P < 0.001), and significantly correlated with the slow components of V̇O2 (r
2 = 0.46), T° (r
2 = 0.52), and relative intensity (r
2 = 0.66). A linear equation accurately predicts scHR based on %RCP (r
2 = 0.66, SEE = 0.15).

Conclusions
A mismatch exists between the slow components of HR and metabolic intensity. Whenever exercise is prescribed based on HR, target values should be adjusted over time to grant that the desired metabolic stimulus is maintained throughout the exercise session.
Physiological Adaptations to High-Intensity Interval Training Combined with Blood Flow Restriction in Masters Road Cyclists
Authors: TANGCHAISURIYA PATCHARIN , CHUENSIRI NAPASAKORN , TANAKA HIROFUMI , SUKSOM DAROONWAN 
Published: December 2021

ABSTRACT

Purpose
High-intensity interval training (HIIT) and blood flow restriction (BFR) training have been used to enhance athletic performance and cardiovascular health. Combining these training modalities might be an effective training modality for masters athletes who seek to enhance athletic performance and to reduce cardiovascular risks.

Methods
Fifty masters road cyclists age 35–49 yr were randomly assigned to the continuous exercise training (n = 16), continuous plus HIIT (n = 17), and continuous plus BFR training combined with HIIT (BFRIT; n = 17) for 12 wk. Both HIIT and BFRIT were performed on a cycle ergometer twice a week.

Results
Maximal oxygen consumption (V̇O2max) increased in the HIIT and BFRIT groups (P < 0.05). This was accompanied by significant improvements in maximal cardiac output and stroke volume (P < 0.05). Forty-kilometer time trial performance improved in all three groups (P < 0.05). Peak power output increased in both HIIT and BFRIT groups (P < 0.05). Flow-mediated dilation in both brachial and popliteal arteries increased in all three groups (all P < 0.05). There were no significant changes in carotid intima-media thickness and arterial stiffness in any of the groups. Total lean mass, muscle cross-sectional area and thickness in rectus femoris and vastus lateralis, and peak torque of isokinetic knee extension increased only in the BFRIT group (all P < 0.05). Tissue saturation index decreased only in the BFRIT group (P < 0.05). Changes in 40-km time trial performance were associated with corresponding changes in V̇O2max (r = −0.312, P = 0.029) and peak isokinetic extensor torque (r = −0.432, P = 0.002).

Conclusions
Including HIIT particularly with BFR in the routine continuous training may be more effective in enhancing performance and physiological functions in masters road cyclists.
Intravenous ketamine as an analgesia in prehospital adult trauma patients
Authors: Critchley Anya 
Published: December 2021

Background: Prehospital traumatic pain is common, but the quality of pain management in these patients is poor. Current practice recommends morphine as the first-line analgesia in major trauma but this carries high risks and is often contraindicated. Alternative paramedic-administered analgesia does not provide adequate pain relief or may be contraindicated. As a result, many patients remain in pain. Analgesic ketamine is used safely and effectively in international civilian and military settings and by paramedics with additional training, education and qualifications. Aim: The study had two aims. Namely, these were to find out whether intravenous ketamine: provides effective relief of prehospital traumatic pain in adults; and is safe for prehospital administration by non-specialist paramedics. Method: Three databases, CINAHL, MEDLINE and AMED, were searched to identify articles published between 2009 and 2021. Exclusion criteria were applied and results subjected to critical appraisal and evaluation. Findings: Four studies were included in the review. Two themes were identified for thematic analysis: therapeutic effectiveness; and the safety of IV ketamine administration by paramedics. The evidence drew predominantly homogenous conclusions, but was substandard regarding external validity, which limited the quality of these conclusions. Conclusion: Ketamine provides effective pain relief in line with morphine and is safe for paramedics to administer. However, clear gaps in the evidence mean the research questions are not fully answered, so changes to current paramedic practice cannot be recommended.
The challenge of involving old patients with polypharmacy in their medication during hospitalization in a medical emergency department: An ethnographic study
Authors: Fabricius Pia Keinicke , Andersen Ove , Steffensen Karina Dahl , Kirk Jeanette Wassar 
Published: December 2021

BackgroundMore than 70% of patients admitted to emergency departments (EDs) in Denmark are older patients with multimorbidity and polypharmacy vulnerable to adverse events and poor outcomes. Research suggests that patient involvement and shared decision-making (SDM) could optimize the treatment of older patients with polypharmacy. The patients become more aware of potential outcomes and, therefore, often tend to choose less medication. However, implementing SDM in clinical practice is challenging if it does not fit into existing workflows and healthcare systems.AimThe aim was to explore the determinants of patient involvement in decisions made in the ED about the patient’s medication.MethodsThe design was a qualitative ethnographic study. We observed forty-eight multidisciplinary healthcare professionals in two medical EDs focusing on medication processes and patient involvement in medication. Based on field notes, we developed a semi-structured interview guide. We conducted 20 semi-structured interviews with healthcare professionals to elaborate on the findings. Data were analyzed with thematic analyses.FindingsWe found five themes (determinants) which affected patient involvement in decisions about medicine in the ED: 1) blurred roles among multidisciplinary healthcare professionals, 2) older patients with polypharmacy increase complexity, 3) time pressure, 4) faulty IT- systems, and 5) the medicine list as a missed enabler of patient involvement.ConclusionThere are several barriers to patient involvement in decisions about medicine in the ED and some facilitators. A tailored medication conversation guide based on the SDM methodology combined with the patient’s printed medicine list and well-functioning IT- systems can function as a boundary object, ensuring the treatment is optimized and aligned with the patient’s preferences and goals.