bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of N-Loaded Clinoptilolite on Soil Available Nutrients and Yield Under Water-Saving Irrigation
Authors: Sun Yang , Chen Hongyang , Wang Yanzhi , Li Yanqi , Gong Fuzheng , Wu Qi , Chi Daocai 
Published: August 2022

Highlights Clinoptilolite was used to adsorb ammonia from agricultural wastewater and as a nutrient carrier to cultivate crops. Nitrogen-loaded clinoptilolite (NZ) prolonged the N supply time, which met the N demand for plant growth. NZ under water-saving irrigation purified wastewater, saved irrigation water and increased grain yield.Abstract. The extensive application of nitrogen (N) fertilizer causes soil acidification and increases the risk of water eutrophication, especially in irrigated areas. To reduce the eutrophication level of the water body and improve the soil fertility, clinoptilolite (Z) was used to adsorb N in simulated eutrophic water bodies, and then as a nutrient carrier to supplement the soil N source and promote the reuse of N. The results show that the NH4+-N loading process caused ion bonds to break inside the Z, which increased the contact area for ion adsorption. Z successfully reduced the NH4+-N concentration by 36.25% in the simulated N-rich water. The soil NH4+-N and NO3--N contents of N-loaded clinoptilolite (NZ) under alternate wet-dry irrigation (AWD) were higher during the critical growth period, which enhanced the soil N pool and replenished N in time. The NZ as a slow-release fertilizer prolonged the N supply time under AWD, which increased rice tillers by 13.68% and yield by 11.24% compared with control (without NZ amendment). In conclusion, the approach of NZ combined with AWD is beneficial to the rice growth and improvement of the soil-water environment in irrigated areas. Keywords: Ammonium Adsorption, Clinoptilolite, Nitrogen Releaser, Paddy Soil, Water-saving Irrigation.
Universal healthcare coverage and health service delivery before and during the COVID-19 pandemic: A difference-in-difference study of childhood immunization coverage from 195 countries
Authors: Kim Sooyoung , Headley Tyler Y. , Tozan Yesim 
Published: August 2022

Background
Several studies have indicated that universal health coverage (UHC) improves health service utilization and outcomes in countries. These studies, however, have primarily assessed UHC’s peacetime impact, limiting our understanding of UHC’s potential protective effects during public health crises such as the Coronavirus Disease 2019 (COVID-19) pandemic. We empirically explored whether countries’ progress toward UHC is associated with differential COVID-19 impacts on childhood immunization coverage.

Methods and findings
Using a quasi-experimental difference-in-difference (DiD) methodology, we quantified the relationship between UHC and childhood immunization coverage before and during the COVID-19 pandemic. The analysis considered 195 World Health Organization (WHO) member states and their ability to provision 12 out of 14 childhood vaccines between 2010 and 2020 as an outcome. We used the 2019 UHC Service Coverage Index (UHC SCI) to divide countries into a “high UHC index” group (UHC SCI ≥80) and the rest. All analyses included potential confounders including the calendar year, countries’ income group per the World Bank classification, countries’ geographical region as defined by WHO, and countries’ preparedness for an epidemic/pandemic as represented by the Global Health Security Index 2019. For robustness, we replicated the analysis using a lower cutoff value of 50 for the UHC index. A total of 20,230 country-year observations were included in the study. The DiD estimators indicated that countries with a high UHC index (UHC SCI ≥80, n = 35) had a 2.70% smaller reduction in childhood immunization coverage during the pandemic year of 2020 as compared to the countries with UHC index less than 80 (DiD coefficient 2.70; 95% CI: 0.75, 4.65; p-value = 0.007). This relationship, however, became statistically nonsignificant at the lower cutoff value of UHC SCI <50 (n = 60). The study’s primary limitation was scarce data availability, which restricted our ability to account for confounders and to test our hypothesis for other relevant outcomes.

Conclusions
We observed that countries with greater progress toward UHC were associated with significantly smaller declines in childhood immunization coverage during the pandemic. This identified association may potentially provide support for the importance of UHC in building health system resilience. Our findings strongly suggest that policymakers should continue to advocate for achieving UHC in coming years.
Health extension workers contribution on tuberculosis case notification in Tigray region, Northern Ethiopia: A concurrent mixed method study
Authors: Gebretnsae Hailay , Hadgu Tsegay , Ayele Brhane Gebrekidan , Abraha Alemnesh , Gebre-egziabher Equbay , Woldu Mulugeta , Wellay Tsegay , Gebrekidan Gebregziabher Berihu , Gebregziabher Measho Gebreslassie 
Published: August 2022

BackgroundDespite the emphasis placed on Community Based Tuberculosis Care (CBTC) implementation by Health Extension Workers (HEWs) within the National Tuberculosis Program (NTP) in Ethiopia, there is little evidence on contribution of HEWs on TB case notification. Therefore, this study aimed to describe the contribution of HEWs on TB case notification and its associated factors in Tigray region, Northern Ethiopia.MethodsA concurrent mixed method (quantitative and qualitative) cross-sectional study design was conducted in three randomly selected districts in Tigray region, Northern Ethiopia. Quantitative data were collected using a pre-tested semi-structured questionnaire. Qualitative data were collected using Focused Group Discussions (FGDs) and Key Informant Interviews (KIIs) to further describe the community participation and presumptive TB identification and referral system. For the quantitative data, binary logistic regression analysis was done and all variables with P-value of < 0.25 in bivariate analysis were included in the multi-variable model to see predictors of HEWs contribution to TB notification. The qualitative data were thematically analyzed using Atlas.ti version 7.ResultsIn this study, a total of 68 HEWs were included. From March 1, 2017 to February 28, 2018, a total of 427 TB cases notified in the study areas and one-third (34%) of them were notified by the HEWs referral. Provision of Community Based-Directly Observed Treatment Short course (CB–DOTS) (Adjusted Odds Ratio (AOR) = 3.63, 95% Confidence Interval (CI) = 1.18–11.19) and involvement of community volunteers on CBTC (AOR = 3.31, 95% CI = 1.10–10.09) were significantly associated with the contribution of HEWs on TB case notification. The qualitative findings indicated that high workload of HEWs, inaccessibility of TB diagnostic services at nearby health facilities, and transportation and investigation costs were identified as factors affecting for presumptive TB referral by HEWs.ConclusionsProvision of CB-DOTS and involvement of community volunteers in CBTC activities should be strengthened to improve the HEWs contribution on TB case notification. Additionally, HEWs should be empowered and further interventions of TB diagnostic services at diagnostic health facilities are needed to improve presumptive TB referral by HEWs.
Using the Global Trigger Tool in surgical and neurosurgical patients: A feasibility study
Authors: Brösterhaus Mareen , Hammer Antje , Gruber Rosalie , Kalina Steffen , Grau Stefan , Roeth Anjali A. , Ashmawy Hany , Groß Thomas , Binnebösel Marcel , Knoefel Wolfram Trudo , Manser Tanja 
Published: August 2022

Background
The Global Trigger Tool (GTT) has become a worldwide used method for estimating adverse events through a retrospective patient record review. However, little is known about the facilitators and the challenges in the GTT-implementation process. Thus, this study followed two aims: First, to apply a comprehensive set of feasibility criteria to qualitatively and systematically assess the GTT-implementation process in three departments of German university hospitals. Second, to identify the facilitators and the obstacles met in the GTT-implementation process and to derive recommendations for supporting other hospitals in implementing the GTT in clinical practice.

Methods
The study used a qualitative documentary method based on process documentation, with written and verbal feedback from the reviewer, as well as evaluating the study sites during the implementation process. The study was conducted in three departments, each in a different German university hospital. The authors applied a comprehensive set of 22 feasibility criteria assessing the level of challenge in GTT implementation. The results were synthesized and they focused on the facilitators and the challenges.

Results
Of these 22 feasibility criteria, nine were assessed as a low-level challenge, eleven regarded as a moderate-level challenge, and two with a problematic level of challenge. In particular, the lack of time and staff resources, the quality of the information in the patient records, organizational procedures, and local issues, posed major challenges in the implementation process. By contrast, the use of local coordinators and an external expert made important contributions to the GTT implementation.

Conclusions
Considering the facilitators and the obstacles beforehand may help with the implementation of the GTT in routine practice. In particular, early and effective planning can reduce or prevent critical challenges in terms of time, staff resources, and organizational aspects.
Prune Juice Containing Sorbitol, Pectin, and Polyphenol Ameliorates Subjective Complaints and Hard Feces While Normalizing Stool in Chronic Constipation: A Randomized Placebo-Controlled Trial
Authors: Koyama Taishi , Nagata Naoyoshi , Nishiura Kengo , Miura Naoki , Kawai Takashi , Yamamoto Hirotaka 
Published: August 2022

INTRODUCTION:
The aim of this study was to determine the effectiveness of prune juice on chronic constipation.

METHODS:
We conducted a double-blind, randomized, placebo-controlled trial in Japanese subjects with chronic constipation.

RESULTS:
Prune intake significantly decreased hard and lumpy stools while increasing normal stool and not increasing loose and watery stools. Prune intake also ameliorated subjective complaints of constipation and hard stools, without alteration of flatulence, diarrhea, loose stools, or urgent need for defecation. There were no adverse events or laboratory abnormalities of liver or renal function after prune intake.

DISCUSSION:
Prune juice exerted an effective and safe natural food therapy for chronic constipation.
Evaluating the Role of Antibiotics in Patients Admitted to Hospital With Decompensated Cirrhosis: Lessons From the ATTIRE Trial
Authors: Kutmutia Rishen , Tittanegro Thais , China Louise , Forrest Ewan , Kallis Yiannis , Ryder Stephen D. , Wright Gavin , Freemantle Nick , O'Brien Alastair 
Published: August 2022

INTRODUCTION:
Hospital-acquired infections (HAI) are common in cirrhosis with antibiotics frequently used to prevent infections, but their efficacy for this role is unknown. To investigate this, we used Albumin to Prevent Infection in Chronic Liver Failure (ATTIRE) data to evaluate whether antibiotic use in patients without infection prevented HAI.

METHODS:
In ATTIRE patients without infection at baseline grouped by antibiotic prescription or not, we studied HAI during trial treatment period and mortality, with propensity score matching to account for differences in disease severity.

RESULTS:
Two hundred three of 408 patients prescribed antibiotics at enrollment did not have infection and they were more unwell than noninfected patients not given antibiotics. There were no differences in subsequent HAI comparing antibiotic treated (39/203, 19.2%) to nonantibiotic treated (73/360, 20.3%; P = 0.83). Twenty-eight-day mortality was higher in antibiotic-treated patients (P = 0.004) likely reflecting increased disease severity. Matching groups using propensity scoring revealed no differences in HAI or mortality. In noninfected patients at enrollment treated with/without rifaximin, there were no differences in HAI (P = 0.16) or mortality, confirmed with propensity matching. Patients given long-term antibiotic prophylaxis at discharge had no differences in 6-month mortality compared with nonantibiotic patients, although antibiotic-treated patients had more infections at trial entry, with numbers too small for matching.

DISCUSSION:
Half of antibiotics at study entry were given to patients without an infection diagnosis which did not reduce the overall risk of HAI or improve mortality. This supports prompt de-escalation or discontinuation of antibiotics guided by culture sensitivities at 24–48 hours after commencement if no infection and the patient is improving.
The Risk of Metachronous Advanced Neoplasia After Colonoscopy in Patients Aged 40–49 Years Compared With That in Patients Aged 50–59 Years
Authors: Ma Gene , Anderson Meredith , Liu Liyan , Li Dan 
Published: August 2022

INTRODUCTION:
This study investigated the risk of metachronous advanced neoplasia (AN) after colonoscopy in individuals aged 40–49 years compared with that in individuals aged 50–59 years.

METHODS:
A retrospective cohort study was performed among Kaiser Permanente Northern California members aged 40–59 years who had their first (index) colonoscopy in 2010–2013. Participants were followed up until death, disenrollment, AN on surveillance colonoscopy, or December 31, 2018. The risk for the development of AN was estimated using the Cox regression, adjusted for confounders.

RESULTS:
The study included 11,374 patients (2,396 aged 40–49 years and 8,978 aged 50–59 years). When comparing the 40–49 years group with the 50–59 years group, AN was detected in 2.2% vs 4.4% (P = 0.0003) on surveillance colonoscopy after index colonoscopy finding of no adenoma, in 4.6% vs 7.0% (P = 0.03) after a finding of nonadvanced adenoma (NAA), and in 7.9% vs 11.7% (P = 0.06) after a finding of advanced adenoma (AA), respectively. Compared with the 50–59 years group, the 40–49 years group had a lower risk of metachronous AN when no adenoma was detected on index colonoscopy (hazard ratio [HR] 0.58; 95% confidence interval [CI] 0.39–0.83) and no difference when NAA (HR 0.84; 95% CI 0.54–1.24) or AA (HR 0.83; 95% CI 0.51–1.31) was detected.

DISCUSSION:
Compared with patients aged 50–59 years, patients aged 40–49 years may have a lower risk of developing metachronous AN when no adenoma is detected on index colonoscopy and a similar risk when NAA or AA is detected. These data suggest current surveillance colonoscopy guidelines may be applicable to patients aged 40–49 years who undergo colonoscopy.
Diagnostic Delay in Patients With Eosinophilic Esophagitis Has Not Changed Since the First Description 30 Years Ago: Diagnostic Delay in Eosinophilic Esophagitis
Authors: Murray Fritz R. , Kreienbuehl Andrea S. , Greuter Thomas , Nennstiel Simon , Safroneeva Ekaterina , Saner Catherine , Schindler Valeria , Schlag Christoph , Schoepfer Alain M. , Schreiner Philipp , Straumann Alex , Biedermann Luc 
Published: August 2022

INTRODUCTION:
Eosinophilic esophagitis (EoE) is a chronic progressive disease. Diagnostic delay (DD) is associated with increased risk of esophageal strictures and food impactions. We aimed to assess the evolution of DD since the first description of EoE in 1993 until 2021.

METHODS:
We analyzed data from patients prospectively included in the Swiss EoE database. DD was calculated as the time interval between the first occurrence of EoE symptoms and the confirmed diagnosis. DD was analyzed annually over time (1989–2021) and according to milestone publications in the field (1993: first description; 2007: first consensus recommendations; and 2011: updated consensus recommendations). In addition, a Cox proportional hazards model has been used to describe the relation between DD and covariates.

RESULTS:
Complete data of 1,152 patients (857 male [74%]; median age at diagnosis: 38 years, interquartile range: 28–49, range: 1–86) were analyzed. Overall, median DD was 4 years (interquartile range: 1–11, range, 0–56), with DD ≥ 10 years in 32% of the population. Over time, DD did not significantly change, neither annually nor according to release dates of milestone publications with a persistently stable fraction of roughly one-third of all patients with a DD of ≥10 years. Both ages at diagnosis (P < 0.001, with an increase in DD up to the age of 31–40 years) and at symptom onset (younger patients had a longer DD; P < 0.001) were significantly associated with DD.

DISCUSSION:
DD has not changed since the first description of EoE almost 30 years ago and remains substantial. Even today, one-third of patients have a persistently high DD of ≥10 years. Substantial efforts are warranted to increase awareness for EoE and its hallmark symptom, solid food dysphagia, as an age-independent red-flag symptom among healthcare professionals and presumably the general population alike to lower risk of long-term complications.
External quality control in laboratory medicine. Progresses and future
Authors: Ricós Carmen , Fernández-Calle Pilar , Perich Carmen , Sandberg Sverre 
Published: August 2022

Abstract

Objectives
An external quality control program distributes same control samples to various laboratories and evaluates results obtained with a common criterion. The aim of this work is to summarize the evolution of various types of external programs, to point out the progresses ant to preclude practical consequences of the participant laboratories.

Content

The material consists on a brief revision of the different types of external programs that have been used for the last forty years. The method is the critical analysis of the strong and weak points of each program model, from the light of our experience. External quality assessment (EQA) programs were initiated at half the XX century, evidencing big discrepancies among laboratory results. EQA were developed in various countries and some mechanisms to harmonize them were proposed: to establish common performance specifications derived from biological variation, to use EQS as educational tool. Since the 2000 important advances were seen: to focus EQA to assure the adequate clinical use of laboratory tests, to use commutable controls, to harmonize the different EQA models, to promote a forum for co-operation and exchange of knowledge on quality-related matters for EQA organizers.

Summary and Outlook

To participate in an EQA with commutable-reference method assigned values controls allows to know the real inaccuracy of results and their impact on patient’ samples. To participate in a EQA with non commutable controls allows to know whether the individual laboratory performance agrees with that from other laboratories using same analytical method.
Mechanical response of different frameworks for maxillary all-on-four implant-supported fixed dental prosthesis: 3D finite element analysis
Authors: Güçlü Zekiye Begüm , Gürbüz Ayhan , Deste Gökay Gonca , Durkan Rukiye , Oyar Perihan 
Published: August 2022

Abstract
This study’s purpose is to assess the stress distribution in the peri-implant bone, implants, and prosthetic framework using two different posterior implant angles. All-on-four maxillary prostheses fabricated from feldspathic-ceramic-veneered zirconia-reinforced lithium silicate (ZLS) and feldspathic-ceramic-veneered cobalt-chromium (CoCr) were designed with 17 or 30-degree-angled posterior implants. Posterior cantilever and frontal vertical loads were applied to all models. The distribution of maximum and minimum principal stresses (σmax and σmin) and von Mises stress (σVM) was evaluated. Under posterior cantilever load, with an increase in posterior implant angle, σmax decreased by 4 and 7 MPa in the cortical bone when ZLS and CoCr were used as a prosthetic framework, respectively. Regardless of the framework material, 17-degree-angled posterior implants showed the highest σVM (541.36 MPa under posterior cantilever load; 110.79 MPa under frontal vertical load) values. Regardless of the posterior implant angle, ZLS framework showed the highest σVM (91.59 MPa under posterior cantilever load; 218.99 MPa under frontal vertical load) values. Increasing implant angle from 17 to 30° caused a decrease in σmax values in the cortical bone. Designs with 30-degree posterior implant angles and ZLS framework material may be preferred in All-on-four implant-supported fixed complete dentures.
A hybrid deep learning using reptile dragonfly search algorithm for reducing the PAPR in OFDM systems
Authors: Raveen Panchireddi , Ratna Kumari Uppalapati Venkata 
Published: August 2022

Abstract
Orthogonal frequency division multiplexing (OFDM) is a famous multi-carrier modulation technique as it has a vast range of features like robustness against multi-path fading, higher bandwidth efficiency, and higher data rates. Though, OFDM has its own challenges. Among them, high peak power to average power ratio (PAPR) of the transmitted signal is the major problem in OFDM. In recent years, deep learning has drastically enhanced the performance of PAPR. In addition, the excessive training data and high computational complexity lead to a considerable issue in OFDM system. Thus, this paper implements a new PAPR reduction scheme in OFDM Systems through hybrid deep learning algorithms. A new optimized hybrid deep learning termed O-DNN + RNN is implemented by integrating the deep neural networks (DNN) and recurrent neural networks (RNN), where the parameters of both DNN and RNN are optimized using Hybrid Reptile Dragonfly Search Algorithm (HR-DSA). The new deep learning model is adopted for determining the constellation mapping and demapping of symbols on each subcarrier. This new optimized hybrid deep learning helps in reducing the PAPR and maximizes the performance.
Computational fluid dynamics simulation of material testing reactor spent fuel cooling in wet storage
Authors: Abdel-Latif Salwa H. , Elnaggar Sayed A. 
Published: August 2022

Abstract
Safe and efficient storage of spent fuel elements is an important aspect of the safety and economy of nuclear reactors. The present work investigates the thermal-hydraulic behaviour of the cooling process for the nuclear spent fuel stored in the material testing reactor auxiliary pool. The parameters affected by the spent fuel cooling accuracy, the decay power of spent fuel and the initial temperature of the coolant pool are studied. These parameters are simulated by developing a model using thermal-hydraulic computational fluid dynamics, ANSYS FLUENT 17.2 Code. The developed model is evaluated by the previous measurements; an experimental test rig is designed and constructed to investigate the thermal-hydraulic behaviour of the natural circulation cooling of the nuclear spent fuel. The present study uses the validated model to simulate numerically the forced convection heat transfer for spent fuel pools. Various coolant velocities and decay powers are examined. Also, the thermal-hydraulic behaviour of the nuclear spent fuel is studied in transient mode; the initial temperature is raised to 338K. The results show the spent fuel cooling improves as the coolant velocity increases. A good agreement was identified after comparing experimental results with the investigated model.