bluuebunny/crossref_metadata_2025_split huggingface dataset:
The ALMA REBELS Survey: The Cosmic H i Gas Mass Density in Galaxies at z ≈ 7
Authors: Heintz K. E. , Oesch P. A. , Aravena M. , Bouwens R. J. , Dayal P. , Ferrara A. , Fudamoto Y. , Graziani L. , Inami H. , Sommovigo L. , Smit R. , Stefanon M. , Topping M. , Pallottini A. , van der Werf P. 
Published: August 2022

Abstract
The neutral atomic gas content of individual galaxies at large cosmological distances has until recently been difficult to measure due to the weakness of the hyperfine H i 21 cm transition. Here we estimate the H i gas mass of a sample of main-sequence star-forming galaxies at z ∼ 6.5–7.8 surveyed for [C ii] 158 μm emission as part of the Reionization Era Bright Emission Line Survey (REBELS), using a recent calibration of the [C ii]-to-H i conversion factor. We find that the H i gas mass excess in galaxies increases as a function of redshift, with an average of M
Hi
/M
⋆ ≈ 10, corresponding to H i gas mass fractions of f
Hi
= M
Hi
/(M
⋆ + M
Hi
) = 90%, at z ≈ 7. Based on the [C ii] 158 μm luminosity function (LF) derived from the same sample of galaxies, we further place constraints on the cosmic H i gas mass density in galaxies (ρ
Hi
) at this redshift, which we measure to be

ρ

H
I

=

7.1

−
3.0

+
6.4

×

10

6

M

⊙

Mpc

−
3

. This estimate is substantially lower by a factor of ≈10 than that inferred from an extrapolation of damped Lyα absorber (DLA) measurements and largely depends on the exact [C ii] LF adopted. However, we find this decrease in ρ
Hi
to be consistent with recent simulations and argue that this apparent discrepancy is likely a consequence of the DLA sight lines predominantly probing the substantial fraction of H i gas in high-z galactic halos, whereas [C ii] traces the H i in the ISM associated with star formation. We make predictions for this buildup of neutral gas in galaxies as a function of redshift, showing that at z ≳ 5, only ≈10% of the cosmic H i gas content is confined in galaxies and associated with the star-forming ISM.
Water Shielding in the Terrestrial Planet-forming Zone: Implication for Inner Disk Organics
Authors: Duval Sara E. , Bosman Arthur D. , Bergin Edwin A. 
Published: August 2022

Abstract
The chemical composition of the inner region of protoplanetary disks can trace the composition of planetary-building material. The exact elemental composition of the inner disk has not yet been measured and tensions between models and observations still exist. Recent advancements have shown UV shielding to be able to increase the emission of organics. Here, we expand on these models and investigate how UV shielding may impact chemical composition in the inner 5 au. In this work, we use the model from Bosman et al. and expand it with a larger chemical network. We focus on the chemical abundances in the upper disk atmosphere where the effects of water UV shielding are most prominent and molecular lines originate. We find rich carbon and nitrogen chemistry with enhanced abundances of C2H2, CH4, HCN, CH3CN, and NH3 by >3 orders of magnitude. This is caused by the self-shielding of H2O, which locks oxygen in water. This subsequently results in a suppression of oxygen-containing species like CO and CO2. The increase in C2H2 seen in the model with the inclusion of water UV shielding allows us to explain the observed C2H2 abundance without resorting to elevated C/O ratios as water UV shielding induced an effectively oxygen-poor environment in oxygen-rich gas. Thus, water UV shielding is important for reproducing the observed abundances of hydrocarbons and nitriles. From our model result, species like CH4, NH3, and NO are expected to be observable with the James Webb Space Telescope (JWST).
10 Yr Transformation of the Obscuring Wind in NGC 5548
Authors: Mehdipour Missagh , Kriss Gerard A. , Costantini Elisa , Gu Liyi , Kaastra Jelle S. , Landt Hermine , Mao Junjie 
Published: August 2022

Abstract
A decade ago, the archetypal Seyfert-1 galaxy NGC 5548 was discovered to have undergone major spectral changes. The soft X-ray flux had dropped by a factor of 30 while new broad and blueshifted UV absorption lines appeared. This was explained by the emergence of a new obscuring wind from the accretion disk. Here we report on the striking long-term variability of the obscuring disk wind in NGC 5548 including new observations taken in 2021–2022 with the Swift Observatory and the Hubble Space Telescope’s Cosmic Origins Spectrograph. The X-ray spectral hardening as a result of obscuration has declined over the years, reaching its lowest in 2022, at which point we find the broad C iv UV absorption line to have nearly vanished. The associated narrow low-ionization UV absorption lines, produced previously when shielded from the X-rays, are also remarkably diminished in 2022. We find a highly significant correlation between the variabilities of the X-ray hardening and the equivalent width of the broad C iv absorption line, demonstrating that X-ray obscuration is inherently linked to disk winds. We derive for the first time a relation between the X-ray and UV covering fractions of the obscuring wind using its long-term evolution. The diminished X-ray obscuration and UV absorption are likely caused by an increasingly intermittent supply of outflowing streams from the accretion disk. This results in growing gaps and interstices in the clumpy disk wind, thereby reducing its covering fractions.
Early Abnormal Nailfold Capillary Changes Are Predictive of Calcinosis Development in Juvenile Dermatomyositis
Authors: Nozawa Tomo , Bell-Peter Audrey , Marcuz Jo-Anne , Whitney Kristi , Vinik Ophir , Shupak Rachel , Dover Saunya , Feldman Brian M. 
Published: August 2022

Objective The long-term outcomes of juvenile dermatomyositis (JDM) are more favorable in recent years. However, calcinosis is still among the complications that can cause serious functional impairment. Little is known about the pathogenesis and risk factors of calcinosis. The aim of this study is to determine risk factors for the development of calcinosis in JDM. Methods This was a single-center, retrospective cohort study. All patients were diagnosed and followed at the multidisciplinary JDM clinic of The Hospital for Sick Children, from January 1, 1989, until May 31, 2018. To investigate predictors of incident calcinosis, Cox regression analysis was performed. Results A total of 172 patients met inclusion criteria, with a median age at diagnosis of 7.7 years (IQR 4.9-12.1), and a median follow-up of 8.5 years (IQR 3.4-12.6, range 0.1-28.3). The only risk factor significantly associated with the development of calcinosis in the univariate analysis was nailfold abnormality at baseline (hazard ratio [HR] 4.86, P = 0.03). In multivariable analysis, including nailfold abnormality, age of diagnosis, sex, and duration from onset to diagnosis, the only statistically significant risk factor for calcinosis was the presence of nailfold abnormalities (HR 4.98, P = 0.03). Further, calcinosis was significantly increased in patients with a chronic course (chi-square 25.8, P < 0.001). Conclusion The presence of abnormal nailfold capillary changes at baseline is predictive for the development of calcinosis in children with idiopathic inflammatory myopathies.
Assessing Discomfort in Critically Ill Patients: A Narrative Review of the Literature
Authors: Luckhardt Emily M. , Gunnels Marshall S. , Chlan Linda L. 
Published: August 2022

Background
The intensive care unit environment exposes patients to stressful conditions contributing to distressing symptoms. Discomfort is an infrequently and inconsistently described symptom experienced by intensive care unit patients.

Objective
To complete a narrative literature review to summarize the currently available literature on discomfort assessment in critical care practice and identify knowledge gaps to direct future intervention research.

Methods
A review of the currently available literature was guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses. No parameters were set for publication years or specific study designs. Inclusion criteria were patients aged at least 18 years, description of patient reports of discomfort in the intensive care unit, and English language.

Results
This narrative review includes 10 studies that used 4 distinct self-reported, discomfort-related symptom assessment instruments. Two studies assessed overall discomfort. Only 1 assessment instrument, Inconforts des Patients de Reanimation, is validated for use in the intensive care unit.

Conclusion
The reviewed literature highlights the current gap in discomfort symptom assessment during the intensive care unit stay. An assessment instrument specific for intensive care unit–related discomfort, such as the Inconforts des Patients de Reanimation, would allow for prompt recognition and mitigation of intensive care unit–related patient discomfort.
Minimizing Post–Intensive Care Syndrome to Improve Outcomes for Intensive Care Unit Survivors
Authors: Mulkey Malissa A. , Beacham Pamela , McCormick Megan A. , Everhart D. Erik , Khan Babar 
Published: August 2022

Topic
Post–intensive care syndrome is a collection of symptoms that more than half of patients who survive a critical illness, and their family caregivers, experience after the illness. Those symptoms include weakness/ fatigue, sleep disturbances/insomnia, cognitive dysfunction, posttraumatic stress disorder, other mental health conditions, and a lack of effective coping strategies.

Clinical Relevance
To minimize the risk of a patient developing post–intensive care syndrome, intensive care unit nurses must adopt practices that reduce the severity of disability and optimize patient outcomes. They must also advocate for patients who need additional expert care.

Purpose
To describe interventions that critical care nurses can implement to minimize a patient’s risk for post–intensive care syndrome.

Content Covered
This article describes patients who have a high risk of developing post–intensive care syndrome and interventions that are within nurses’ purview.
Decreasing 30-Day Readmission Rates in Patients With Heart Failure
Authors: Rizzuto Nancy , Charles Greg , Knobf M. Tish 
Published: August 2022

Background
Heart failure affects approximately 6.2 million adults in the United States and has an estimated national cost of $30.7 billion annually. Despite advances in treatment, heart failure is a leading cause of hospital readmissions. Nonadherence to treatment plans, lack of education, and lack of access to care contribute to poorer outcomes.

Local Problem
For patients with heart failure, the mean readmission rate is 21% nationally and 23% in New York State. Before the pilot heart failure program began, the 30-day readmission rate in the study institution was 28.6%.

Methods
A multidisciplinary team created a heart failure self-care pilot program that was implemented on a hospital telemetry unit with 47 patients. Patients received education on their disease process, medications, diet, exercise, and early symptom recognition. Patients received a follow-up telephone call 48 to 72 hours after discharge and were seen by a cardiologist within a week of discharge.

Results
The 30-day readmission rate for heart failure decreased by 16.6% after implementation of the pilot program, which improved patient adherence to their medication and treatment plan and resulted in a reduction of readmissions.

Discussion
Patients in the pilot program represented diverse backgrounds. Socioeconomic factors such as the lack of affordable, healthy food choices and easy access to resources were associated with worse outcomes.

Conclusions
The evidence-based heart failure program improved knowledge, early symptom recognition, lifestyle modification, and adherence to medication, treatment plan, and follow-up appointments. The multidisciplinary team approach to the heart failure program reduced gaps in care and improved coordination and transition of care.
A sustainable business strategy framework for small and medium enterprises
Authors: Bugwandin Vinay , Bayat Mohamed S. 
Published: August 2022

Orientation: Business sustainability in today’s world is primarily arduous owing to global economic and financial crises. In the first quarter of 2019, according to Statistics South Africa, the Gross Domestic Product deteriorated by 3.2%. Similarly, in KwaZulu-Natal, the state of sustainability of small and medium enterprises (SMEs) was on the decline and the majority (75%) of SMEs failed after operating for 3 years.Research purpose: To formulate a business strategy to assist SMEs achieve sustainability.Motivation for the study: Small and medium enterprises in KwaZulu-Natal do not sustain themselves for long-term periods, the underlying problem being poor strategy formulation and hence, the need for a strategy to achieve sustainability.Research design, approach and method: A mixed methodology approach was used in this empirical study. A target population of 488 000 SME’s were considered with a sample size of 384 expected respondents. A total of 200 responses ( 52% of the target sample size) were obtained from the questionnaire within a capped period of 30 days. The Social Package for Social Sciences software was used for the quantitative aspect. In particular cross tabulations, central tendencies, and group difference techniques were used to analyse the data. In addition, the grounded theory was employed on a target of 20 individuals who were interviewed to investigate opinions towards strategy development and sustainability in KZN and NVivo software was used for the qualitative aspect.Main findings: The core element of ‘Strategy’ and the sub-elements of ‘Change’, ‘Purpose’ and ‘Leadership’ were investigated. It was found that ‘Change’, ‘Purpose’ and ‘Leadership’ were the main contributors towards achieving sustainability. Furthermore, a systems thinking model was used successfully to indicate the interdependencies to purport the goal of achieving sustainability. Ultimately it was found that ‘Strategy’, ‘Change’, ‘Purpose’ and ‘Leadership’ were required to achieve a ‘sustainable business strategy’.Practical/managerial implications: Due cognisance should be taken by leaders, from the perspectives of ‘Change’, ‘Purpose’ and ‘Leadership’, to formulate a strategy that sustains the business.Contribution/value-add: A conceptual framework to achieve a sustainable business strategy was developed for small to medium enterprises.
Prevalence of hepatitis B virus core antibodies among blood donors in Nigeria: Implications for blood safety
Authors: Fasola Foluke A. , Fowotade Adeola A. , Faneye Adedayo O. , Adeleke Adeyeni 
Published: August 2022

Background: Anti-hepatitis B core antibody (anti-HBc) testing improves transfusion safety by detecting past and current hepatitis B virus (HBV) infection while detecting hepatitis B surface antigen (HBsAg) in serology-negative HBV infection. However, occult HBV infection (OBI) (serum or liver HBV DNA-positive but HBsAg-negative) remains unaddressed among replacement blood donors – family members or friends who donate to replace blood transfused to a relative.Objective: This study assessed risk factors for a positive anti-HBc test among donors with OBI and determined the anti-HBc-positive status of replacement donors.Methods: The study was conducted at the University College Hospital Blood Bank, Ibadan, Nigeria, using blood samples collected from blood donors between April 2019 and May 2019. Donors were screened for HBsAg by rapid diagnostic test (RDT) and enzyme-linked immunosorbent assay (ELISA) and anti-HBc by ELISA, while HBV DNA was detected using a semi-nested polymerase chain reaction.Results: Of the 274 participants, 15 (5.5%) were HBsAg-positive by RDT and 36 (13.1%) by ELISA, while 133 (48.5%) were anti-HBc positive. Out of 232 HBsAg-negative donors, 107 (46.1%) were anti-HBc positive. Of the 107 HBsAg-negative but anti-HBc-positive samples, only one (0.93%) was HBV DNA-positive. The HBV DNA-positive donor was HBsAg-negative by both RDT and ELISA tests.Conclusion: This study establishes a potential risk for HBV transmission from isolated anti-HBc-positive donors to blood recipients. HBc immunoglobulin (antibody) M testing to identify blood units requiring further screening with polymerase chain reaction to detect OBI can prevent HBV transmission through blood transfusion.
Experiences of spinal cord injury patients admitted to the rehabilitation unit at the national referral hospital in Khomas region, Namibia
Authors: Ashipala Daniel O. , Langendorf Lettie 
Published: August 2022

AbstractBackground: Spinal cord injury (SCI) remains one of the major causes of disability globally. It results in permanent physical disability secondary to devastating neurological defects. When a person sustains SCI, substantial changes and challenges in their lives occur, regardless of their age or socioeconomic status. In Namibia, the knowledge on SCI experiences could be used to improve the care rendered to patients with this injury.Objectives: The purpose of this study was to explore and describe the experiences of patients with SCIs admitted to the rehabilitation unit at the national referral hospital in Khomas region, Namibia.Method: A qualitative, explorative and descriptive study design was used. Data were collected by means of in-depth, semi-structured, face-to-face interviews with 15 participants from the rehabilitation unit. Data were analyzed using thematic analysis.Results: Analysis of the data in this study identified three themes: negative experiences, positive experiences and measures to improve the lives of people living with SCI in the community. Participants experienced varied emotions from anger, stress, disbelief, frustration and sadness, which led to depression. In addition, participants experienced discrimination due to lack of community acceptance hence, improving awareness remains key.Conclusion: This study provided insight into the lived experiences of those living with SCI as they narrated their struggle from the onset of SCI to their reintegration into the community. The study’s findings can be used to develop self-care strategies and ongoing interventions that focus on maintaining physical and psychological health for spinal-cord injured persons throughout the course of living with disability.
Challenges of caregivers providing care to children with disabilities at non-governmental organisations in Tshwane townships, South Africa
Authors: Moosa-Tayob Sharifa , Risenga Patrone R. 
Published: August 2022

AbstractBackground: Caregivers of children with disabilities are vital stakeholders when it comes to safeguarding the health, well-being and overall survival of the children that they care for. Caregivers, however, face many challenging conditions that make it difficult for them to optimally fulfil their caregiving role. Understanding these challenges is crucial for developing empowerment programmes for caregivers, which will ensure that children with disabilities receive comprehensive, optimal care and that caregivers experience a good quality of life.Objectives: The aim of this study was to explore and describe the experiences of caregivers providing care to children with disabilities at non-governmental organisations (NGOs) in townships of Tshwane, South Africa.Method: This study followed an exploratory, descriptive and contextual research design within a qualitative methodology. The population in this study included caregivers who care for children with disabilities at NGOs (n = 10). Participants for the study were selected using the purposive sampling technique. Data were collected by conducting semistructured interviews with caregivers. Data were analysed according to the six phases of thematic analysis proposed by.Results: The study revealed six themes that represent the challenges experienced by caregivers, namely (1) initial impressions, (2) rendering care, (3) stress, (4) lack of outside support, (5) coping and (6) poor community recognition.Conclusion: Support from the Departments of Health and Social Development and other institutions providing community rehabilitation services to townships should be provided to caregivers in order to empower them with skills and knowledge to effectively address the challenges they face so that they can render optimal care to the children they care for.Contribution: Results of this study could assist in ensuring improved recognition, resilience and supportive resources for caregivers in collaboration with community based rehabilitation stakeholders in the community that would ultimately lead to improved care for children with disabilities in townships within South Africa.
Management of paediatric ectopia lentis at an Indonesian referral hospital: A retrospective review
Authors: Barliana Julie D. , Yulia Dian E. , Soeharto Diajeng A. 
Published: August 2022

Background: Ectopia lentis in children is rare and often associated with systemic conditions. Left untreated, it can lead to visually debilitating complications. Although there are various techniques available, no current consensus for treatment of paediatric ectopia lentis exists.Aim: To describe the management and visual outcomes of paediatric ectopia lentis in an academic referral hospital.Setting: This study was conducted at Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia.Methods: A retrospective review was conducted on the medical records of all paediatric ectopia lentis patients treated at our hospital, from 2011 to 2020. Primary outcomes include uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), treatment, surgical technique, selection of intraocular lens (IOL), and postoperative complications.Results: This study included 66 eyes of 39 patients. Average age at initial presentation was 7.8 (2–17) years. Aetiology was mostly non-traumatic, whilst four were secondary to trauma. All eyes except one underwent surgery, and IOLs were inserted in 57.4% of the non-traumatic cohort, with iris-claw IOL as the most popular choice (85.7%). Uncorrected visual acuity and BCVA significantly improved in pseudophakic and aphakic groups (p 0.05). Nearly 60% achieved a BCVA of 6/12 or greater, and the proportion was higher amongst pseudophakic group. Ten eyes had post-operative complications, with a median onset of 393 (1–1095) days after surgery.Conclusion: With varied techniques used to manage paediatric ectopia lentis, the choice of technique was dependent on individual patient condition and surgeon preference. Whilst the proportion of eyes with BCVA of ≥ 6/12 was higher amongst the pseudophakic eyes than aphakic eyes, IOL implantation entails the risk of complications, whereas no complications occurred in those left aphakic. Therefore, no particular technique can be considered marginally superior to the other, and larger studies are needed.