bluuebunny/crossref_metadata_2025_split huggingface dataset:
Analysis of factors influencing technical efficiency of public district hospitals in KwaZulu-Natal province, South Africa
Authors: Babalola Tesleem K. , Ojugbele Hammed O. , Shahwan Moyad , Moodley Indres 
Published: November 2022

Abstract
Background
District hospitals are crucial in supporting primary health care and serve as a gateway to more specialist care through a referral system. Majority of South Africans access health care services through the public sector district health system. Given the enormous task assigned to the public district hospital within the country, this study examined factors influencing their technical efficiency.

Method
Data were collected for 38 public district hospitals in KwaZulu-Natal province from 2014/15 to 2016/17. Data envelopment analysis (DEA) was used to determine the technical efficiency of the hospitals, adopting both the constant return to scale (CRS) and variable return to scale (VRS) models. Tobit regression model was used to determine factors related to the technical efficiency of the district hospitals.

Results
This study showed that a significant proportion of the district hospitals were technically inefficient. The Tobit regression model identified catchment population, the proportion of inpatients treated per medical personnel, the proportion of inpatients treated per nursing personnel and expenditure per patient day equivalent as factors influencing technical efficiency of the district hospitals.

Conclusion
Findings from this study suggest that the technical efficiency of the district hospitals can be enhanced through an effective referral system and improved peoples’ health-seeking behaviour. In addition, a standard mix of clinical staff toward efficient service delivery and periodic cost analysis of health services with the view to saving cost and maintaining the quality of health care should be considered.
Temporal regulation of notch activation improves arteriovenous fistula maturation
Authors: Guo Qunying , Chen Guang , Cheng Hunter , Qing Ying , Truong Luan , Ma Quan , Wang Yun , Cheng Jizhong 
Published: November 2022

Abstract
Background
Arteriovenous fistula (AVF) maturation is a process involving remodeling of venous arm of the AVFs. It is a challenge to balance adaptive AVF remodeling and neointima formation. In this study we temporally controlled Notch activation to promote AVF maturation while avoiding neointima formation.

Methods
Temporal Notch activation was controlled by regulating the expression of Notch transcription factor, RBP-Jκ, or dnMAML1 (dominant negative MAML2) in vascular smooth muscle cells (VSMCs). AVF mouse model was created and VSMC phenotype dynamic changes during AVF remodeling were determined.

Results
Activated Notch was found in the nuclei of neointimal VSMCs in AVFs from uremic mice. We found that the VSMCs near the anastomosis became dedifferentiated and activated after AVF creation. These dedifferentiated VSMCs regained smooth muscle contractile markers later during AVF remodeling. However, global or VSMC-specific KO of RBP-Jκ at early stage (before or 1 week after AVF surgery) blocked VSMC differentiation and neointima formation in AVFs. These un-matured AVFs showed less intact endothelium and increased infiltration of inflammatory cells. Consequently, the VSMC fate in the neointima was completely shut down, leading to an un-arterialized AVF. In contrast, KO of RBP-Jκ at late stage (3 weeks after AVF surgery), it could not block neointima formation and vascular stenosis. Inhibition of Notch activation at week 1 or 2, could maintain VSMC contractile markers expression and facilitate AVF maturation.

Conclusions
This work uncovers the molecular and cellular events in each segment of AVF remodeling and found that neither sustained increasing nor blocking of Notch signaling improves AVF maturation. It highlights a novel strategy to improve AVF patency: temporally controlled Notch activation can achieve a balance between adaptive AVF remodeling and neointima formation to improve AVF maturation.

Translational perspective
Adaptive vascular remodeling is required for AVF maturation. The balance of wall thickening of the vein and neointima formation in AVF determines the fate of AVF function. Sustained activation of Notch signaling in VSMCs promotes neointima formation, while deficiency of Notch signaling at early stage during AVF remodeling prevents VSMC accumulation and differentiation from forming a functional AVFs. These responses also delay EC regeneration and impair EC barrier function with increased inflammation leading to failed vascular remodeling of AVFs. Thus, a strategy to temporal regulate Notch activation will improve AVF maturation.
Clinical improvement of sepsis by extracorporeal centrifugal leukocyte apheresis in a porcine model
Authors: Zhou Lei , Zhang Dong , Kong Ling , Xu Xiaodong , Gong Dehua 
Published: November 2022

Abstract
Background
Extracorporeal blood purification therapies targeting removal of the downstream products of the inflammatory cascade in sepsis have failed to improve mortality. As an upstream process of the inflammatory cascade, activated white blood cells should be a potential therapeutic target for sepsis, and the effect of removing such cells by extracorporeal centrifugal leukocytapheresis (LCAP) is worth considering.

Methods
Fourteen peritonitis-induced septic pigs were randomly assigned to receive a sham operation (control group, n = 7) or one session of LCAP at 12 h after sepsis induction (treatment group, n = 7). Samples from peripheral blood at various time-points and from LCAP collection were tested. All pigs were euthanized at 48 h, and lung, kidney, liver and spleen tissues were obtained for histopathological examination.

Results
Two pigs died in accidents before the induction of sepsis, and 12 pigs were finally included for the statistical analysis. A significant clinical improvement was present in the treatment group relative to the control group in terms of the mean arterial blood pressure (MAP), oxygen tension (PaO2), lactic acid level, oxygenation index (PaO2/FiO2), and carbon dioxide tension (PaCO2, P < 0.05). Flow cytometry tests showed that a mixture of B cells, dendritic cells, T helper cells, cytotoxic T cells, monocytes and neutrophils were removed from the circulation by LCAP, resulting in sepsis-induced change trends in the control cells; these change trends were all flattened in the treatment group, although nonsignificantly.

Conclusions
LCAP may exert a wide-spectrum and bidirectional immunomodulatory effect on sepsis, accompanied by improvements in hemodynamics and oxygenation status.
Genetic variability in the E6 and E7 oncogenes of HPV52 and its prevalence in the Taizhou area, China
Authors: Yang Zhi , He Zhe-Hang , Zhang Yang , Di Xing-Hong , Zheng Die-Fei , Xu Hui-Hui 
Published: November 2022

Abstract
Background
Human papillomavirus (HPV) 52 is one of the prevalent oncogenic HPV genotypes in East Asia. Chinese women have the highest susceptibility to the HPV52 type, but research data on HPV52 genetic variability and its carcinogenicity in China is lacking.

Methods
The present study aimed to investigate the genetic variability of HPV52 currently circulating among Chinese women by PCR sequencing the entire E6 and E7 oncogenes. HPV52 sequence alignment, genetic heterogeneity analyses and maximum-likelihood phylogenetic tree construction were performed by BioEdit software and MEGA X software.

Results
Between 2016 and 2018, the overall HPV infection rate was 21.3%, of which HPV52 was the most prevalent high-risk type (17.2%) in the Taizhou area, China. A total of 339 single HPV52-positive samples were included in this study. We obtained 27 distinct variation patterns of HPV52 with the accession GenBank numbers ON529577-ON529603. Phylogenetic analysis showed that 96.6% of HPV52 variants belonged to lineage B, which seemed to be uniquely defined by G350T, A379G (K93R) in the E6 gene and C751T, A801G in the E7 gene. Due to the dominance of lineage B in our study population, the results could not be used to assess the association of the HPV52 (sub)lineage with the risk of cervical lesions. In addition, no significant trends were observed between the nucleotide substitutions of HPV52 variants and the risk of cervical carcinogenesis.

Conclusion
Our data showed that HPV52 variants were strongly biased towards lineage B. These results confirmed that cervical lesions in the Taizhou area are highly attributable to HPV52, which may be due to the high infection rate of lineage B in the population.
What’s in a name? A discussion on the definition of natural and unnatural causes of death
Authors: Woudenberg-van den Broek Cécile M. , van der Velden Koos , Duijst-Heesters Wilma L. J. M. 
Published: November 2022

AbstractWhen considering the manner of death, two categories can be distinguished, namely natural death and unnatural death. Though most physicians think that the distinction between the two is evident, this is not the case.When comparing the Netherlands, Belgium, England and Germany it is noticed that the terms natural and unnatural might be used in law but are not defined by law. In practice, the term unnatural death is used when there is an external cause of death, but even that turns out to not be sufficient in making an obvious difference between the two terms. Different countries may even label the same death differently. A, at times philosophical and semantic, discussion shows that when it comes to causes of death a very large grey area exists between natural and unnatural causes of death. The Netherlands, Belgium and Germany even have the possibility to label a death as natural (or unnatural) without actually knowing the cause of death.In conclusion, we recommend a new system in which the circumstances surrounding a death are properly investigated. This should lead to a report to an independent legal expert, who is able to decide if and what conclusion can be drawn, from a judicial and a public point of view, thereby, making the distinction and the use of the terms natural and unnatural/nonnatural obsolete.
Assessing the impact of a national clinical guideline for the management of chronic pain on opioid prescribing rates: a controlled interrupted time series analysis
Authors: Hébert Harry L. , Morales Daniel R. , Torrance Nicola , Smith Blair H. , Colvin Lesley A. 
Published: November 2022

Abstract
Background
Opioids can be effective analgesics, but long-term use may be associated with harms. In 2013, the first national, comprehensive, evidence-based pain management guideline was published, from the Scottish Intercollegiate Guideline Network (SIGN 136: Management of Chronic Pain) with key recommendations on analgesic prescribing. This study aimed to examine the potential impact on national opioid prescribing rates in Scotland.

Methods
Trends in national and regional community opioid prescribing data for Scotland were analysed from quarter one (Q1) 2005 to Q2 2020. Interrupted time series regression examined the association of SIGN 136 publication with prescribing rates for opioid-containing drugs. Gabapentinoid prescribing was used as a comparison drug.

Results
After a positive prescribing trend pre-publication, the timing of SIGN 136 publication was associated with a negative change in the trend of opioid prescribing rates (−2.82 items per 1000 population per quarter [PTPPQ]; P < 0.01). By Q2 2020, the relative reduction in the opioid prescribing rate was −20.67% (95% CI: −23.61, −17.76). This persisted after correcting for gabapentinoid prescribing and was mainly driven by the reduction in weak opioids, whereas strong opioid prescribing rates continued to rise. Gabapentinoid prescribing showed a significant rise in level (8.00 items per 1000 population; P = 0.01) and trend (0.27 items PTPPQ; P = 0.01) following SIGN 136 publication.

Conclusions
The publication of SIGN 136 was associated with a reduction in opioid prescribing rates. This suggests that changes in clinical policy through evidence-based national clinical guidelines may affect community opioid prescribing, though this may be partially replaced by gabapentinoids, and other factors may also contribute.
Stress response during early sedation with dexmedetomidine compared with usual-care in ventilated critically ill patients
Authors: Moore John P. R. , Shehabi Yahya , Reade Michael C. , Bailey Michael , Fraser John F. , Murray Lauren , Anstey Christopher , Singer Mervyn 
Published: November 2022

Abstract
Background
Sedative agents may variably impact the stress response. Dexmedetomidine is a sympatholytic alpha2-adrenergic agonist mainly used as a second-line sedative agent in mechanically ventilated patients. We hypothesised that early sedation with dexmedetomidine as the primary agent would result in a reduced stress response compared to usual sedatives in critically ill ventilated adults.

Methods
This was a prospective sub-study nested within a multi-centre randomised controlled trial of early sedation with dexmedetomidine versus usual care. The primary outcome was the mean group differences in plasma levels of stress response biomarkers measured over 5 days following randomisation. Other hormonal, biological and physiological parameters were collected. Subgroup analyses were planned for patients with proven or suspected sepsis.

Results
One hundred and three patients were included in the final analysis. Baseline illness severity (APACHE II score), the proportion of patients receiving propofol and the median dose of propofol received were comparable between groups. More of the usual-care patients received midazolam (57.7% vs 33.3%; p = 0.01) and at higher dose (median (95% interquartile range) 0.46 [0.20–0.93] vs 0.14 [0.08–0.38] mg/kg/day; p < 0.01). The geometric mean (95% CI) plasma level of the stress hormones, adrenaline (0.32 [0.26–0.4] vs 0.38 [0.31–0.48]), noradrenaline (4.27 [3.12–5.85] vs 6.2 [4.6–8.5]), adrenocorticotropic hormone (17.1 [15.1–19.5] vs 18.1 [15.9–20.5]) and cortisol (515 [409–648] vs 618 [491–776)] did not differ between dexmedetomidine and usual-care groups, respectively. There were no significant differences in any other assayed biomarkers or physiological parameters Sensitivity analyses showed no effect of age or sepsis.

Conclusions
Early sedation with dexmedetomidine as the primary sedative agent in mechanically ventilated critically ill adults resulted in comparable changes in physiological and blood-borne parameters associated with the stress-response as with usual-care sedation.
Effect of different weekly frequencies of Chen-style Tai Chi in elders with chronic non-specific low back pain: study protocol for a randomised controlled trial
Authors: Wan Ruihan , Shi Jian , Hu Kun , Wang Yafei , Jiang Xue , Yan Wangwang , Cao Mali , Wang Yuling 
Published: November 2022

Abstract
Background
Tai Chi (TC), as one of mild to moderate exercise therapies specifically recommended by clinical practice guideline from the American College of Physician, is a viable option for chronic non-specific low back pain (CNLBP) treatment. Nevertheless, limited studies focused on the effect of different weekly frequencies of TC in elders with CNLBP. This superiority study aims to compare the differences of TC with different weekly frequencies in elders with CNLBP on the premise of proving its effectiveness, and identifying whether mindfulness mediates the effect of TC on treatment outcomes.

Methods
In total, 284 senior citizens with CNLBP will be recruited in this single-centre, randomised, single-blinded (outcome assessors, data managers and the statistician), parallel controlled trial. Participants will be randomly divided into either one of three TC groups (1, 3, or 5 sessions/week, on the basis of weekly health educational lectures) or weekly health educational lectures, sustaining for 12 weeks, followed by 12 weeks of follow-up after the end of intervention. The primary outcome (the changes of LBP intensity at rest) will be measured at baseline before randomisation and immediately after the completion of weeks 4, 8 and 12 of the intervention, and the end of follow-up (week 24) using the visual analogue scale (VAS, 0–10 cm) to put a mark on the VAS scale to show how severities of their average low back pain have been over the past 24 h. Secondary outcomes, including Beck Depression Inventory-II, Pain Catastrophising Scale and Five Facet Mindfulness Questionnaire, Oswestry Disability Index and Short Form-36, will be measured at baseline and immediately after the completion of week 12 of the intervention and end of follow-up. The intention-to-treat and per-protocol principles will be used to analyse outcomes with a setting at α = 0.05 as statistical significance.

Discussion
This comprehensive and detailed protocol will be the first trial to compare the effectiveness of different weekly frequencies of TC in elders with CNLBP. The outcomes may provide valuable data about the choice of the ideal number of sessions to further normalise the application of exercise for clinicians.

Trial registration
Chinese clinical trial registry ChiCTR2200058190. Registered on 1 April 2022.
Hydrophilic gold nanospheres: influence of alendronate, memantine, and tobramycin on morphostructural features
Authors: Eissa Dina M. , Mabrouk Mokhtar M. , Ebeid El Zeiny M. , Abdel Hamid Mohamed A. 
Published: November 2022

AbstractTurkevich gold nanospheres are the original nanospheres that have been modified over time. Its combination with targeting medications such as alendronate, memantine, and tobramycin will provide additional benefits in targeting specific areas in the bone, brain, and microorganisms, respectively. Hence, The reactivity and stability of nanospheres with various drug concentrations (milli-,micro-, and nano-levels) have been studied. With alendronate, the absorbance spectra of nanospheres at $$\uplambda _{max}$$

λ

max

520 nm were always stable and no redshifts occurred. In contrast, the spectra with memantine and tobramycin were stable at the nano-level and redshifts occurred at the milli- and micro-levels. HRTEM and DLS revealed that the core diameter was relatively stable in all cases, whereas the hydrodynamic diameter and zeta potential varied with varying drug concentrations. Increasing concentration increased hydrodynamic diameter slightly with memantine (from 64.99 to 98.41 nm), dramatically with tobramycin (from 135.3 to 332.16 nm), and almost negligibly with alendronate (from 52.08 to 58.94 nm ). Zeta Potential, conversely, is reduced as concentration increases. Memantine had the greatest reduction in negativity, followed by tobramycin, but alendronate had a slight increase in negativity. Benefits from this research would be in targeted drug delivery, where stability and reactivity of gold nanospheres are critical.
Interspecific foraging association of a nurse shark (Ginglymostoma cirratum) with bottlenose dolphins (Tursiops truncatus)
Authors: White Connor F. , Pratt Harold. L. , Pratt Theo C. , Whitney Nicholas M. 
Published: November 2022

AbstractAnimals sometimes forage in mixed species groups, where an individual of a “follower” species actively trails a foraging individual of another “nuclear” species to benefit from the latter’s foraging strategy. Here, we report on a serendipitous observation of a large, benthic, reef-associated predator, the nurse shark (G. cirratum) following a pod of bottlenose dolphins (T. truncatus) in an apparent attempt to feed on benthic prey disturbed by dolphin foraging. Data from a shark-borne camera, accelerometer, depth, and temperature datalogger package show the nurse shark following the dolphin pod for a period of 15 min and performing multiple, rapid vertical ascents from a depth of 24 m to near the surface following dolphins. The shark performed gliding descents behind dolphins back to the benthos and repeatedly swam through clouds of sand that were produced from dolphin crater feeding behavior. The dolphins appeared to ignore the shark except for three occasions when they struck the shark in the head with their caudal flukes. The shark eventually appeared to locate a benthic prey item as it turned sharply, stopped swimming, and performed what appeared to be suction feeding near the bottom, with clouds of sand rapidly expelled from its gills. This is the first report of rapid vertical ascents and interspecific foraging in a nurse shark.
Evaluation of starting model approaches and effective source wavelet variations for high-frequency ground-penetrating radar full-waveform inversion
Authors: Hoven Dominik , Mester Achim , Vereecken Harry , Klotzsche Anja 
Published: November 2022

High-frequency ground-penetrating radar (GPR) full-waveform inversion (FWI) can enhance the characterization of small-scale structures in the subsurface below the decimeter scale. We have investigated the potential and requirements to use FWI for higher-frequency data. Thereby, we focus on the two most important criteria to achieve reliable FWI results: adequate starting models that fulfill the half-wavelength criterion and the accuracy of the effective source wavelet. Therefore, we have defined a realistic reference model, generated synthetic GPR data sets (200, 450, and 700 MHz), and tested different standard ray-based starting model methods and frequency-hopping approaches to derive results close to our reference model. Although standard starting models provide good parameter reconstruction for lower-frequency data, a frequency-hopping approach is required for the 700 MHz data. In addition, we have seen that the reconstruction of the conductivity results is more sensitive to the presence of noise (25 dB) than the permittivity tomograms. The definition of the effective source wavelets is directly linked to the accuracy of the starting models; therefore, we investigate the effect on the FWI results for high-frequency data by varying the source wavelets in terms of starting time and/or amplitude. Considering the multiparameter nature of FWI, we observe that time shifts have a greater influence on the performance of the FWI than amplitude variations. Large time shifts of approximately 0.1 ns for the 700 MHz data may lead to the failure of the inversion, whereas amplitude variations (±5% of the maximum amplitude) affect the quantitative conductivity results only (no effect on permittivity) with an increased root-mean-square error of the data of up to 20%. Using a stochastically perturbed synthetic model, we determine an improved parameter reconstruction for higher frequencies. On the basis of our findings, we develop a workflow to obtain reliable results for high-frequency GPR FWI for future users.