bluuebunny/crossref_metadata_2025_split huggingface dataset:
The determinants of the quality of clinical management among diabetic and hypertensive patients in a context of fragility: A cross-sectional survey from Lebanon
Authors: Saleh Shadi , Muhieddine Dina , Hamadeh Randa , Dimassi Hani , Diaconu Karin , Arakelyan Stella , Ager Alastair , Alameddine Mohamad 
Published: July 2022

IntroductionThe management of NCDs is a growing challenge in low- and middle-income settings with the increasing prevalence and the associated demands that such conditions make on health systems. Fragile settings both exacerbate the risk of NCDs and undermine systems capacity. Lebanon is a setting where strategies to address rising NCDs burden have faced particularly acute contextual challenges.MethodsWe conducted a cross-sectional survey with patients accessing non-communicable disease across 11 primary care centers within the Greater Beirut and Beqaa areas. Response were received from 1,700 patients. We generated a Clinical Management Index Score as a measure of quality of care, and scores related to a range of socio-demographic characteristics and other context specific variables.ResultsSignificantly higher clinical management index scores (better quality of care) were associated with patients living in the semi-urban/rural context of Beqaa (compared to Greater Beirut), having health insurance coverage, aged above 60, having high levels of educational attainment, and making partial or full payment for their treatment. Relatively lower index scores (poorer quality of care) were associated with Syrian nationality (compared to Lebanese) and with patients suffering from diabetes or hypertension (compared to comorbid patients).ConclusionThe study identified a wide margin for improving quality of NCDs care in fragile contexts with particular gaps identified in referral to ophthalmology, accessing all prescribed medication and receiving counseling for smoking cessation. Additionally, findings indicate a number of predictors of comparatively poor quality of care that warrant attention, notably with regard to Syrian nationality/legal status, lack of health coverage, seeking free health provision and lower educational attachment. Although these are all relevant risk factors, the findings call on donor agencies, NGOs and provider institutions to design targeted programs and activities that especially ensure equitable delivery of services to diabetic and hypertensive patients with compounded vulnerability as a result of a number of these factors.
Estimation of Excess Deaths Associated With the COVID-19 Pandemic in Istanbul, Turkey
Authors: Ucar Abdullah , Arslan Seyma 
Published: July 2022

Background and ObjectivesThe official number of daily cases and deaths are the most prominent indicators used to plan actions against the COVID-19 pandemic but are insufficient to see the real impact. Official numbers vary due to testing policy, reporting methods, etc. Therefore, critical interventions are likely to lose their effectiveness and better-standardized indicators like excess deaths/mortality are needed. In this study, excess deaths in Istanbul were examined and a web-based monitor was developed.MethodsDaily all-cause deaths data between January 1, 2015- November 11, 2021 in Istanbul is used to estimate the excess deaths. Compared to the pre-pandemic period, the % increase in the number of deaths was calculated as the ratio of excess deaths to expected deaths (P-Scores). The ratio of excess deaths to official figures (T) was also examined.ResultsThe total number of official and excess deaths in Istanbul are 24.218 and 37.514, respectively. The ratio of excess deaths to official deaths is 1.55. During the first three death waves, maximum P-Scores were 71.8, 129.0, and 116.3% respectively.ConclusionExcess mortality in Istanbul is close to the peak scores in Europe. 38.47% of total excess deaths could be considered as underreported or indirect deaths. To re-optimize the non-pharmaceutical interventions there is a need to monitor the real impact beyond the official figures. In this study, such a monitoring tool was created for Istanbul. The excess deaths are more reliable than official figures and it can be used as a gold standard to estimate the impact more precisely.
A latent profile analysis of residents' knowledge, attitude, and practice toward common chronic diseases among ethnic minority area in China
Authors: Hu Huaqin , Xu Yihua , Shao Yingshan , Liang Yaxin , Wang Qionghua , Luo Shunmei , Lu Heyun , Meng Heng , Liu Chenxi 
Published: July 2022

BackgroundHealth literacy plays an important role in preventing and managing chronic diseases, while low levels of health literacy among ethnic minorities are a major manifestation of health inequities. We believe that before effective health literacy intervention strategies, it is preferable to understand the features of health literacy among ethnic minorities. The present study firstly updated insights on health literacy among ethnic minorities by investigating the knowledge, attitude, and practice (KAP) profile of common chronic diseases in ethnic minority areas, and secondly discussed the KAP profiles in detail to inspire future health education interventions.MethodsA cross-sectional, health-literacy-sensitive study was conducted in China's typical ethnic minority area. Participants included 801 adult residents who lived in the ethnic minority area. The primary outcome was participant scores on the KAP questionnaire of common chronic diseases, followed by latent profile analysis to identify participants with similar KAP score patterns and determine whether membership in specific groups was associated with demographic or clinical characteristics.ResultsThe participants included 496 ethnic minorities (61.9%) and 305 Han Chinese (38.1%). Three-profile solution was determined after the latent profile analysis: incomplete transfer [I.T.] (n = 215), better practice [B.P.] (n = 301), and average [A.V.] (n = 285). IT group (26.84%) was characterized by the highest level of knowledge and attitude toward common chronic diseases and below average level for practice. Participants in B.P. group performed poorly in both knowledge and attitude toward common chronic diseases but had the highest level of practice. A.V. group reflected average knowledge, attitude, and practice toward common chronic diseases among three subgroups. Ethnic minorities were the dominant population in A.V. group (68.8%). Compared with other groups, the A.V. group contained the largest proportions of married participants (84.2%), participants with no formal education (46.7%), and high annual out-of-pocket medical expense (33.3%).ConclusionA more specific and nuanced understanding of minority health literacy can enable service providers to provide more effective health education to their recipients, thereby improving health inequities.
Machine learning-based clustering in cervical spondylotic myelopathy patients to identify heterogeneous clinical characteristics
Authors: Zhou Chenxing , Huang ShengSheng , Liang Tuo , Jiang Jie , Chen Jiarui , Chen Tianyou , Chen Liyi , Sun Xuhua , Zhu Jichong , Wu Shaofeng , Ye Zhen , Guo Hao , Chen Wenkang , Liu Chong , Zhan Xinli 
Published: July 2022

BackgroundAnterior cervical decompression and fusion can effectively treat cervical spondylotic myelopathy (CSM). Accurately classifying patients with CSM who have undergone anterior cervical decompression and fusion is the premise of precision medicine. In this study, we used machine learning algorithms to classify patients and compare the postoperative efficacy of each classification.MethodsA total of 616 patients with cervical spondylotic myelopathy who underwent anterior cervical decompression and fusion were enrolled. Unsupervised machine learning algorithms (UMLAs) were used to cluster subjects according to similar clinical characteristics. Then, the results of clustering were visualized. The surgical outcomes were used to verify the accuracy of machine learning clustering.ResultsWe identified two clusters in these patients who had significantly different baseline clinical characteristics, preoperative complications, the severity of neurological symptoms, and the range of decompression required for surgery. UMLA divided the CSM patients into two clusters according to the severity of their illness. The repose to surgical treatment between the clusters was significantly different.ConclusionsOur results showed that UMLA could be used to rationally classify a heterogeneous cohort of CSM patients effectively, and thus, it might be used as the basis for a data-driven platform for identifying the cluster of patients who can respond to a particular treatment method.
Development and testing of a stifle function score in dogs
Authors: Gundersen Katie , Millis Darryl , Zhu Xiaojuan 
Published: July 2022

ObjectiveThe purpose of this study was to develop and test a quantitative stifle function score (SFS) in dogs with unilateral cranial cruciate ligament disease by combining clinical measures and functional tests. The objective of this study was to compare the proposed SFS to a symmetry index (SI) calculated from objective ground reaction forces (GRFs). We hypothesized that the SFS would have a strong correlation with SI.MethodsDogs with surgically and nonsurgically treated unilateral cranial cruciate ligament rupture and dogs with no known musculoskeletal problems were included in the study. Each dog was scored using the SFS and trotted across a force platform to obtain GRFs and calculate the SI, based on vertical GRFs. Fourteen items were included in the SFS: limb use at a walk, limb use at a trot, lameness at a walk, lameness at a trot, stair climbing, sit-to-stand, dancing, pain response, stifle effusion, thigh circumference/muscle atrophy, stifle extension, stifle flexion, and cranial drawer/tibial thrust, with each item scored based on previously determined criteria. A perfect SFS would receive a score of 100.ResultsTwenty-seven dogs were included in the study: twenty-one with unilateral cranial cruciate ligament disease and six control dogs. The mean SFS was 71.5 out of 100. To further characterize the association between SFS and SI the degree of gait asymmetry using SI was classified as &lt;5%, 5.1–10%, 10.1–20%, 20.1–25%, and &gt;25% difference between the pelvic limbs for all dogs. The mean SFS for each of the five categories were 97.8, 85.2, 65.4, 63, and 56.4, respectively. Correlation of SI and SFS was −0.863 (p&lt; 0.0001). All of the individuals evaluated tests in the score were significantly correlated with SI except for pain response and stifle flexion. The SFS is in strong agreement with the SI, as confirmed by Bland–Altman analysis.ConclusionThe SFS had a significant correlation and agreement with the SI calculated from GRFs. This SFS may be a useful, simple, and inexpensive tool to use in a clinical environment to monitor progression during the rehabilitation and recovery process following unilateral cranial cruciate ligament rupture.
1,4-Naphthoquinone (CNN1) Induces Apoptosis through DNA Damage and Promotes Upregulation of H2AFX in Leukemia Multidrug Resistant Cell Line
Authors: de Sousa Portilho Adrhyann Jullyanne , da Silva Emerson Lucena , Bezerra Emanuel Cintra Austregésilo , Moraes Rego Gomes Carinne Borges de Souza , Ferreira Vitor , de Moraes Maria Elisabete Amaral , da Rocha David Rodrigues , Burbano Rommel Mário Rodriguez , Moreira-Nunes Caroline Aquino , Montenegro Raquel Carvalho 
Published: July 2022

The multidrug resistance (MDR) phenotype is one of the major obstacles in the treatment of chronic myeloid leukemia (CML) in advantage stages such as blast crisis. In this scenario, more patients develop resistance mechanisms during the course of the disease, making tyrosine kinase inhibitors (TKIs) target therapies ineffective. Therefore, the aim of the study was to examine the pharmacological role of CNN1, a para-naphthoquinone, in a leukemia multidrug resistant cell line. First, the in vitro cytotoxic activity of Imatinib Mesylate (IM) in K-562 and FEPS cell lines was evaluated. Subsequently, membrane integrity and mitochondrial membrane potential assays were performed to assess the cytotoxic effects of CNN1 in K-562 and FEPS cell lines, followed by cell cycle, alkaline comet assay and annexin V-Alexa Fluor® 488/propidium iodide assays (Annexin/PI) using flow cytometry. RT-qPCR was used to evaluate the H2AFX gene expression. The results demonstrate that CNN1 was able to induce apoptosis, cell membrane rupture and mitochondrial membrane depolarization in leukemia cell lines. In addition, CNN1 also induced genotoxic effects and caused DNA fragmentation, cell cycle arrest at the G2/M phase in leukemia cells. No genotoxicity was observed on peripheral blood mononuclear cells (PBMC). Additionally, CNN1 increased mRNA levels of H2AFX. Therefore, CNN1 presented anticancer properties against leukemia multidrug resistant cell line being a potential anticancer agent for the treatment of resistant CML.
Comparing the Robustness of the Structural after Measurement (SAM) Approach to Structural Equation Modeling (SEM) against Local Model Misspecifications with Alternative Estimation Approaches
Authors: Robitzsch Alexander 
Published: July 2022

Structural equation models (SEM), or confirmatory factor analysis as a special case, contain model parameters at the measurement part and the structural part. In most social-science SEM applications, all parameters are simultaneously estimated in a one-step approach (e.g., with maximum likelihood estimation). In a recent article, Rosseel and Loh (2022, Psychol. Methods) proposed a two-step structural after measurement (SAM) approach to SEM that estimates the parameters of the measurement model in the first step and the parameters of the structural model in the second step. Rosseel and Loh claimed that SAM is more robust to local model misspecifications (i.e., cross loadings and residual correlations) than one-step maximum likelihood estimation. In this article, it is demonstrated with analytical derivations and simulation studies that SAM is generally not more robust to misspecifications than one-step estimation approaches. Alternative estimation methods are proposed that provide more robustness to misspecifications. SAM suffers from finite-sample bias that depends on the size of factor reliability and factor correlations. A bootstrap-bias-corrected LSAM estimate provides less biased estimates in finite samples. Nevertheless, we argue in the discussion section that applied researchers should nevertheless adopt SAM because robustness to local misspecifications is an irrelevant property when applying SAM. Parameter estimates in a structural model are of interest because intentionally misspecified SEMs frequently offer clearly interpretable factors. In contrast, SEMs with some empirically driven model modifications will result in biased estimates of the structural parameters because the meaning of factors is unintentionally changed.
Efektifitas Project Based Learning-STEM dan Pemecahan Masalah Matematis Siswa pada Materi Trigonometri
Authors: Priatna Nanang , Avip Bambang , Mulyati Mustika Sari Rika 
Published: July 2022

Tujuan dari penelitian ini adalah untuk menganalisis efektivitas Project Based Learning-STEM (PjBL-STEM) dikaitkan dengan variabel Kemampuan Pemecahan Masalah Mathematis (KPM) pada materi trigonometri. Metode penelitian menggunakan kuasi eksperimen dengan design Nonequivalent Control Group Design. Kemampuan pemecahan masalah yang diteliti meliputi : pemahaman masalah, perencanaan penyelesaian, penyelesaian sesuai rencana, pemeriksaan kembali hasil perhitungan. Hasil dan kesimpulan penelitian ini adalah (a) efektivitas proses pembelajaran guru dan siswa dapat dikategorikan baik berdasarkan hasil rata – rata pada lembar observasi yang telah dinilai oleh observer; (b) berdasarkan uji-t independent terdapat perbedaan peningkatan kemampuan pemecahan masalah matematis siswa yang memperoleh pembelajaran Project Based Learning berbasis STEM (PjBL-STEM) dengan pembelajaran konvensional, dimana pembelajaran Project Based Learning berbasis STEM (PjBL-STEM) memiliki rata-rata skor N-gain 0,53 lebih tinggi dari pembelajaran Konvensional dengan rata-rata N-Gain 0,31.
Few-ns, kW peak power Q-switched pulses from orange and red Pr:YLF lasers
Authors: Badtke Moritz , Tanaka Hiroki , Kalusniak Sascha , Demesh Maxim , Kuleshov Nikolay , Kränkel Christian 
Published: July 2022

Abstract
We report on the generation of few-ns pulses with kW peak power in the red and orange spectral range obtained from a passively Q-switched Pr3+:YLF laser. A compact resonator and thorough investigation of the Co:MgAl2O4 saturable absorber’s initial transmission enables peak powers in excess of 1.1 kW at pulse durations of 2.4 ns and 5.3 ns at 640 nm and 607 nm, respectively. These are the shortest pulse durations among any Q-switched Pr3+ laser and make this system a suitable front-end for efficient frequency doubling into the ultraviolet range.
Analisis Perbandingan Piutang Tidak Tertagih Pada CU. Bina Kasih Kota Pematangsiantar (Periode 2019 - 2020) Selama Pandemi Covid – 19
Authors: Manullang Mario , Purba Djuli Sjafei , Tarigan Vitryani 
Published: July 2022

Penelitian ini bertujuan untuk mengetahui faktor - faktor apa sajakah yang menyebabkan terjadinya piutang tidak tertagih pada CU. Bina Kasih selama masa pandemi covid 19 periode 2019 - 2020. Penelitian ini menggunakan desain penelitian dan lapangan. Populasi pada penelitian ini adalah laporan keuangan periode 2019 - 2020. Pengumpulan data dilakukan dengan wawancara dan dokumentasi. Jenis data yang digunakan data kualitatif dan data kuantitatif. Sumber data yang digunakan adalah data primer dan data sekunder. Faktor internal antara lain adalah lemahnya sistem adminstrasi dan pengawasan kredit, hal ini terjadi pada tahun 2020 dengan total piutang sebesar Rp. 567.000.00,- lemahnya sistem informasi total piutang pada tahun 2019 dan 2020 sebanyak Rp. 4.780.000.00,-, kredit pihak kurang teliti dalam melakukan analisis sehingga kelayakan kredit yang diberikan CU. diberikan dan penyimpangan dalam pelaksanaan prosedur pembenaan kredit tidak tepat diberikan koperasi kepada pihak debitur dengan total piutang pada tahun 2019 dan 2020 sebesar Rp. 2.970.000.00,-. Pada hal ini dapat disimpulkan bahwasanya faktor internal di CU. Bina Kasih di dominan pada indikator lemahnya sistem informasi di CU. Bina Kasih. Faktor eksternal yaitu penurunan kegiatan ekonorni karena nilai tingkat bunga naik sehingga debitur tidak mampu membayar cicilan pada hal ini piutang tak tertagih untuk CU Bina Kasih tahun 2019 dan 2020 sebesar Rp. 12.228.000.00,-. Kegagalan usaha debitur untuk hal ini jumlah piutang tak tertagih CU. Bina Kasih pada tahun 2019 sebesar Rp. 9.164.000.00,- dan tahun 2020 sebesar Rp. 13.090.000.00,-, dan adanya debitur mengalami musibah terjadi dikarenakan pihak debitur tidak dapat mengelola usahanya dengan baik, sehingga mengakibatkan debitur tidak bisa membayar atau melunasi kewajibannya untuk hal ini jumlah piutang tak tertagih CU. Bina Kasih pada tahun 2019 - 2020 sebesar Rp. 12.730.000.00,-. Dapat disimpulkan bahwa untuk faktor eksternal paling dominan adalah pada indikator kegagalan usaha debitur
Peluang DOAJ Sebagai Alternatif Open Educational Resources di Masa Pandemi Covid-19
Authors: Umam Khabibul , Prabowo Thoriq Tri 
Published: July 2022

Purpose. This study aims to describe the potential of DOAJ as an alternative to open source learning during a pandemic.Method. The method used in this research is the literature study.Result and discussion. Based on the literature search, DOAJ's potential as OER during the pandemic can be seen based on the characteristics of DOAJ which are digital, online, free, and free of copyright and licensing restrictions. This study concludes that DOAJ has the potential to be used as an alternative source of open learning during a pandemic because of its characteristics that support efforts to prevent Covid-19 transmission. Given the potential of DOAJ as an alternative to OER during the pandemic, the use of DOAJ as an alternative to OER can continue to grow after the pandemic period. Therefore, further studies regarding the level of use of DOAJ as an alternative to OER or the level of DOAJ compliance with user information needs will be an interesting study to be investigated in future studies.
The Fractality and Size Distributions of Astrophysical Self-Organized Criticality Systems
Authors: Aschwanden Markus J. 
Published: July 2022

Abstract
The statistics of nonlinear processes in avalanching systems, based on the self-organized criticality (SOC) concept of Bak et al. (1988), predicts power-law-like size (or occurrence frequency) distribution functions. Following up on previous work, we define a standard SOC model in terms of six assumptions: (i) area fractality, (ii) volume fractality, (iii) the flux–volume proportionality, (iv) classical diffusion, (v) the Euclidean maximum at the event peak time, and (vi) the spatiotemporal fluence or energy of an avalanche event. We gather data of the fractal dimension and power-law slopes from 162 publications and assemble them in 28 groups (for instance, solar flare energies, or stellar flare energies), from which we find that 75% of the groups are consistent with the standard SOC model. Alternative SOC models (Lévy flight, flat-world, nonfractal) are slightly less correlated with the data. Outliers are attributed to small number statistics, background definition problems, inadequate fitting ranges, and deviations from ideal power laws.
Modeling Evolution of Galactic Bars at Cosmic Dawn
Authors: Bi Da , Shlosman Isaac , Romano-Díaz Emilio 
Published: July 2022

Abstract
We study the evolution of galactic bars using a suite of very high-resolution zoom-in cosmological simulations of galaxies at z ∼ 9–2. Our models were chosen to lie within similar-mass dark matter (DM) halos, log(M
vir/M
⊙) ∼ 11.65 ± 0.05, at z = 6, 4, and 2, in high- and low-overdensity environments. We apply two galactic wind feedback mechanisms for each model. All galaxies develop subkiloparsec stellar bars differing in their properties. We find that (1) the high-z bars form in response to various perturbations: mergers, close flybys, cold accretion inflows along the cosmological filaments, etc.; (2) these bars account for the large mass fraction of galaxies; (3) bars display large corotation-to-bar size ratios, are weaker compared to their low-redshift counterparts by measuring their Fourier amplitudes, and are very gas-rich; (4) their pattern speed does not exhibit monotonic decline with time owing to braking against DM, as at low z; (5) bar properties, including their stellar population (star formation rates and metal enrichment), depend sensitively on prevailing feedback; and (6) bars can weaken substantially during cosmological evolution, becoming weak oval distortions—hence bars are destroyed and reformed multiple times, unlike their low-z counterparts. In all cases, bars in our simulations have been triggered by interactions. In summary, not only do stellar bars appear to be a contemporary phenomenon, but based on increased frequency of mergers, flybys, and the strength of cold accretion flows at high z, we also expect them to be ubiquitous at redshifts ≳2—the epoch of rapid galaxy growth and larger stellar dispersion velocities.