bluuebunny/crossref_metadata_2025_split huggingface dataset:
Schools Often Fail to Expect Trans and Nonbinary Elementary Children: What Gender Independent, Nonbinary, and Trans Children Desire
Authors: skelton j wallace 
Published: September 2022

Background/Context: This article is drawn from a doctoral research study that involved co-research between as adult trans academic and their child, a nonbinary 11-year-old. It mounts an epistemic challenge to education that assumes children to be cis, and either boys or girls. GIaNT children (Gender Independent, and Nonbinary, Trans) are often talked about but seldom directly engaged about their wants and desires in education, but my study addresses this problem and centers their agency. Purpose/Research Question/Focus of Study: The purpose of the study was to generate knowledge and insight into how 2SLGBTQ children, and children from 2SLGBTQ families, envision education spaces and programs that meet their needs. It also investigates the potentiality and significance of a parent-and-child researcher team to engage caregivers and children in co-imagining liberatory education spaces as 2SLGBTQ cultural spaces. Participants: Participants were 17 children (ages 4–12 years) and 12 adults from 11 households; the focus in this article is on the 12 children who identified their gender as other than cis. Research Design: A qualitative, arts-based participatory research methodology was employed. While the parent-child research team of a trans adult and a nonbinary 11-year-old conducted semi-structured interviews with both children and parents, the focus in this article is on the former. Participants were also invited to draw their ideal learning space. Interviews were video recorded, transcribed, and coded. Findings/Results: GIaNT children in this study desired learning spaces that are ready for them, that affirm their self-assigned genders, and that understand that people define their own genders. They wanted to be believed as who they said they were. They wanted safe access to bathrooms and schools to be communities, not just places of learning, and they recognized that learning happens outside of school. They desired an end to gender policing in schools, and in online learning, participants wanted schools that were safe and celebratory of all their identities and of all their peers. They wanted schools that are antiracist and decolonizing, that practice universal access, that teach queer and trans history and culture, and that provide meals and transportation. Conclusions/Recommendations: The study highlighted the creative potentialities of GIaNT children to provide generative insights into gender-affirming school spaces. It advocates for children to be engaged in processes of creating their own learning experiences. GIaNT children called for schools to be more equitable, antiracist, and decolonizing, committed to practicing universal access, teaching queer and trans history and culture, and providing meals and transportation.
Using EHR Data to Identify Patient Frailty and Risk for ICU Transfer
Authors: Lekan Deborah , McCoy Thomas P. , Jenkins Marjorie , Mohanty Somya , Manda Prashanti 
Published: September 2022

The predictive properties of four definitions of a frailty risk score (FRS) constructed using combinations of nursing flowsheet data, laboratory tests, and ICD-10 codes were examined for time to first intensive care unit (ICU) transfer in medical-surgical inpatients ≥50 years of age. Cox regression modeled time to first ICU transfer and Schemper–Henderson explained variance summarized predictive accuracy of FRS combinations. Modeling by age group and controlling for sex, all FRS measures significantly predicted time to first ICU transfer. Further multivariable modeling controlling for clinical characteristics substantially improved predictive accuracy. The effect of frailty on time to first ICU transfer depended on age, with highest risk in 50 to <60 years and ≥80 years age groups. Frailty prevalence ranged from 25.1% to 56.4%. Findings indicate that FRS-based frailty is a risk factor for time to first ICU transfer and should be considered in assessment and care-planning to address frailty in high-risk patients. Frailty prevalence was highest med-surg pts 60 to <70 years (56%); highest risk for time to first ICU transfer was in younger (50 to <60 years) and older (≥80 years) groups.
Epidemiological Study of Parental Obstructive Sleep Apnea and Subsequent Risk of ADHD in Their Children: A Nationwide Population-Based Study
Authors: Chen Iwen , Huang Jing-Yang , Chang Renin , Hung Yao-Min , Wei James Cheng-Chung 
Published: September 2022

Objective: Obstructive sleep apnea (OSA), with daytime drowsiness, nocturnal hypoxia, could result in systemic inflammation and oxidative damage. We hypothesize that parental OSA, with chronic systemic inflammation and oxidative stress, might contribute to children’s neurodevelopmental disorders, such as ADHD. Method: By linking National Birth Registry with the National Health Insurance Research Database, Taiwan, we identified 2006–2015 birth cohort, which comprised 1,723,873 singleton live births, and conducted a nested case-control study. We included children with ADHD and compared them with non-ADHD controls matched with ADHD case on index date. Conditional logistic regression was utilized to calculate adjusted odds ratio (aOR) when investigating the association between parental diseases with risk of ADHD in their offspring. Results: The aOR (95% CI) of offspring’s ADHD was 1.758 (1.458–2.119) with paternal OSA and 2.159 (1.442–3.233) with maternal OSA. The subgroup analysis revealed different effects of parental diseases among children’s gender. Conclusion: Our study demonstrates an association in parental OSA and offspring ADHD, which could inspire further research to clarify the mechanisms.
Implementation of the infection control estimate: A case study on the use of a newly developed digital tool for outbreak management in the acute setting
Authors: Wynn Matthew Oliver , Brady Sandra , McKenna Josh , Swanson Linda , George Ryan 
Published: September 2022

Aim An Infection Control Estimate (ICE) Tool was developed based on a previously published concept of applying military planning techniques to Infection Prevention and Control (IPC) management strategies in the acute healthcare setting. Methods Initial testing of the outbreak management tool was undertaken in a large acute hospital in the North-West of England during a localised outbreak of COVID-19. The tool, developed using Microsoft Excel, was completed by trained IPC practitioners in real-time to log outbreak details, assign and manage meeting actions and to generate surveillance data. Results The ICE tool was utilised across five outbreak control meetings to identify and allocate tasks to members of the outbreak control team and to monitor progress. Within the meetings, the tool was used primarily by the trained IPC Specialist Nurses who were guided by and entered data into the relevant sections. Feedback indicated that the tool was easy to use and useful as the sole repository of outbreak information and data. Suggested improvements following the testing period were made and additional functionality was added. Conclusion Utilisation of the ICE tool has the potential to improve our understanding of the efficacy of currently employed outbreak management interventions and provides a cognitive support and targeted education for teams responsible for the management of outbreaks. It is hoped that by guiding teams through an outbreak with prompts and guidance, as well as facilitating collection and presentation of surveillance data, outbreaks will be resolved sooner and risks to patients will be reduced.
First-line nivolumab plus ipilimumab or chemotherapy versus chemotherapy alone for advanced esophageal cancer: a cost-effectiveness analysis
Authors: Cao Xueqiong , Cai Hongfu , Li Na , Zheng Bin , Zheng Zhiwei , Liu Maobai 
Published: September 2022

Background: This study evaluated the cost-effectiveness of nivolumab plus chemotherapy (NC) or ipilimumab versus chemotherapy as a first-line treatment for advanced esophageal squamous cell carcinoma (ESCC) in the United States and China. Methods: A partitioned survival model was constructed from the perspective of the US third-party payers and Chinese healthcare system. Health states and transition probabilities were modeled based on the survival data from the CheckMate-648 clinical trial (NCT03143153). The time horizon for the model was 10 years. Only direct medical costs were considered. One-way and probabilistic sensitivity analyses were conducted to assess the robustness of the results. Results: In the United States, nivolumab plus ipilimumab (NI) led to an incremental cost-effectiveness ratio (ICER) of $155,159.82/quality-adjusted life year (QALY) and $104,297.07/QALY gained in the overall population and in patients with tumor cell programmed death-ligand 1 (PD-L1) expression of ⩾1% (subgroup), respectively. The ICER for the subgroup was between the willingness-to-pay (WTP) threshold values of $100,000/QALY and $150,000/QALY, and the other case was higher than $150,000/QALY. NC led to an ICER of $518,062.85/QALY and $193,169.49/QALY gained in the overall population and the subgroup, respectively. Both ICERs were significantly higher than the WTP threshold of $150,000/QALY. In China, the ICERs for patients treated with the addition of nivolumab were >$90,000/QALY in all cases, significantly exceeding the WTP threshold of $37,654/QALY. Conclusions: NI is more cost-effective than NC or chemotherapy alone for treating advanced ESCC with PD-L1 expression ⩾1% in the United States. Chemotherapy alone is the only cost-effective option in China.
Prospective Assessment of Clinical Tests Used to Evaluate Tibial Stress Fracture
Authors: Rosenthal Michael D. , Rauh Mitchell J. , Cowan James E. 
Published: September 2022

Background: Tibial stress fracture (SFx) is the most common SFx of the lower extremity. Presently, diagnostic accuracy of clinical examination techniques for tibial SFx remains suboptimal. Purpose: To assess the diagnostic effectiveness of 5 clinical tests for tibial SFx individually versus a test item cluster. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: A total of 50 patients with tibial pain (17 with bilateral symptoms) were assessed with 5 clinical examination tests (tibial fulcrum test, focal tenderness to palpation, heel percussion test, therapeutic ultrasound test, and 128-Hz tuning fork test) before they underwent diagnostic imaging (radionuclide bone scan). The application of the clinical tests was counterbalanced to minimize the likelihood of carryover effects. Patients provided a pain rating immediately before and after the application of each clinical test. Results: The prevalence of tibial SFx among the study participants was 52.2%. High levels of specificity were produced by the therapeutic ultrasound test (93.8%), tuning fork test (90.6%), and percussion test (90.6%). The fulcrum test had moderate to high specificity (84.4%). All tests demonstrated low levels of sensitivity, with the highest levels found for focal tenderness to palpation (48.6%) and fulcrum (45.7%). The fulcrum test provided the highest positive likelihood ratio (2.93), followed by the therapeutic ultrasound test (2.30). The fulcrum test had the lowest negative likelihood ratio (0.64), with the focal tenderness to palpation and tuning fork tests having negative likelihood ratios >1.0. Combinations of these clinical tests did not improve the prediction of tibial SFx above that observed among the individual tests. Conclusion: The clinical tests evaluated were generally highly specific, but all had low sensitivity. The fulcrum test provided the highest level of diagnostic accuracy; however, it was inadequate for definitive clinical management. Combining tests did not improve the diagnostic accuracy of tibial SFx.
Difficult Decisions for Older Canadians Receiving Home Care, and Why They Are So Difficult: A Web-Based Decisional Needs Assessment
Authors: Toi Alfred Kodjo , Ben Charif Ali , Lai Claudia , Ngueta Gérard , Plourde Karine V. , Stacey Dawn , Légaré France 
Published: September 2022

Background. Older adults receiving home care services often face decisions related to aging, illness, and loss of autonomy. To inform tailored shared decision making interventions, we assessed their decisional needs by asking about the most common difficult decisions, measured associated decisional conflict, and identified factors associated with it. Methods. In March 2020, we conducted a cross-sectional survey with a pan-Canadian Web-based panel of older adults (≥65 y) receiving home care services. For a difficult decision they had faced in the past year, we evaluated clinically significant decisional conflict (CSDC) using the 16-item Decisional Conflict Scale (score 0–100) with a >37.5 cutoff. To identify factors associated with CSDC, we performed descriptive, bivariable, and multivariable analyses using the stepwise selection method with an assumed entry and exit significance level of 0.15 and 0.20, respectively. Final model selection was based on the Bayesian information criterion. Results. Among 460 participants with an average age of 72.5 y, difficult decisions were, in order of frequency, about housing and safety (57.2%), managing health conditions (21.8%), and end-of-life care (8.3%). CSDC was experienced by 14.6% (95% confidence interval [CI]: 11.5%, 18.1%) of respondents on all decision points. Factors associated with CSDC included household size = 1 (OR [95% CI]: 1.81 [0.99, 3.33]; P = 0.27), household size = 3 (2.66 [0.78, 8.98]; P = 0.83), and household size = 4 (6.91 [2.23, 21.39]; P = 0.014); preferred option not matching the decision made (4.05 [2.05, 7.97]; P < 0.001); passive role in decision making (5.13 [1.78, 14.77]; P = 0.002); and lower quality of life (0.70 [0.57, 0.87]; P<0.001). Discussion. Some older adults receiving home care services in Canada experience CSDC when facing difficult decisions. Shared decision-making interventions could mitigate associated factors. Highlights This is the first study in Canada to assess the decisional needs of older adults receiving care at home and to identify their most common difficult decisions. Difficult decisions most frequently made were about housing and safety. The most significant decisional conflict was experienced by people making decisions about palliative care. When their quality-of-life score was low, older adults experienced clinically significant decision conflict.
Optimization of alternative breeding schemes for the genetic improvement of common Tigray highland sheep in northern Ethiopia
Authors: Haileselassie Kiflay Welday , Kebede Solomon Abgaz , Letta Mengistu Ugre , GebreMichael Solomon Gizaw 
Published: September 2022

Abstract
Background
Genetic improvement is one of the major means to enhance the productivity of livestock, and well-designed animal genetic improvement schemes are necessary to achieve genetic gains. The objective of the current study was to design an alternative breeding program to improve the productivity of common Tigray highland sheep. Two village- and two central nucleus-based breeding schemes were simulated and evaluated in terms of genetic gain, bio-economic efficiency and operational feasibility.

Methods
Four breeding schemes were simulated: scheme 1, a one-tier cooperative village-based breeding scheme, scheme 2, a two-tier cooperative village breeding scheme (dispersed village-based nuclei scheme), scheme 3, a central open nucleus-based scheme with 5% nucleus size; and scheme 4, a three-tier breeding schemes (central open nucleus-based linked with multiplier units). Simulation analyses were performed using the ZPLAN computer program, which is based on a deterministic approach to estimate genetic and economic gains in the breeding programs.

Results
Between the two village-based breeding schemes, scheme 2 showed higher genetic gain and economic efficiency in the breeding traits analysed than scheme 1. The central nuclei schemes were more efficient than the village breeding schemes. Scheme 3 was the most efficient with a genetic gain in the breeding objective of US $ 1.03 and a profit of US $ 2.73/ewe/year, but operationally it is also the most difficult to implement as it requires a big central nucleus. A central nucleus linked with the village-based nuclei would be a feasible option to overcome the operational difficulties of the conventional central nucleus schemes. If a village-based breeding program is considered it should be the first step in most low-input systems. In this case, scheme 2 is the most efficient.

Conclusions
With some support from the public sector at the outset and a strong collaboration among the stakeholders including smallholders, scheme 4 could lead to substantial genetic gains in the common Tigray highland sheep breed within its habitat that covers large areas of the Tigray region. Therefore, we recommend a long-term breeding program which should include cross-breeding, genomic selection, updated estimates of genetic and economic values for the common Tigray highland sheep breed.
ATP-citrate lyase B (ACLB) negatively affects cell death and resistance to Verticillium wilt
Authors: Liu Fujie , Ma Zhifeng , Cai Sheng , Dai Lingjun , Gao Jianbo , Zhou Baoliang 
Published: September 2022

Abstract
Background
ATP-citrate lyase (ACL) plays a pivotal role in histone acetylation and aerobic glycolysis. In plant, ACL is a heteromeric enzyme composed of ACLA (45 kD) and ACLB (65 kD). So far, the function of ACL genes in cotton still remains unknown.

Results
Here, we identified three ACLA homologous sequences and two ACLB homologous in each genome/sub-genome of cotton species. Silencing ACLB in cotton led to cell death at newly-grown leaves and stem apexes. Simultaneously, in ACLB-silenced plants, transcription factors related to senescence including SGR, WRKY23 and Osl57 were observed to be activated. Further investigation showed that excessive H2O2 was accumulated, salicylic acid-dependent defense response and pathogenesis-related gene expressions were evidently enhanced in ACLB-silenced plants, implying that knockdown of ACLB genes leads to hypersensitive response-like cell death in cotton seedlings. However, as noted, serious cell death happened in newly-grown leaves and stem apexes in ACLB-silenced plants, which led to the failure of subsequent fungal pathogenicity assays. To confirm the role of ACLB gene in regulating plant immune response, the dicotyledonous model plant Arabidopsis was selected for functional verification of ACLB gene. Our results indicate the resistance to Verticillium dahliae infection in the Arabidopsis mutant aclb-2 were enhanced without causing strong cell death. Ectopic expression of GausACLB-2 in Arabidopsis weakened its resistance to V. dahliae either in Col-0 or in aclb-2 background, in which the expression level of ACLB is negatively correlated with the resistance to V. dahliae.

Conclusions
These results indicate that ACLB has a new function in negatively affecting the induction of plant defense response and cell death in cotton, which provides theoretical guidance for developing cotton varieties with resistance against Verticillium wilt.
Erector spinae plane block versus its combination with superficial parasternal intercostal plane block for postoperative pain after cardiac surgery: a prospective, randomized, double-blind study
Authors: Dost Burhan , Kaya Cengiz , Turunc Esra , Dokmeci Hilal , Yucel Semih Murat , Karakaya Deniz 
Published: September 2022

Abstract
Background
We aimed to compare the effectiveness of bilateral erector spinae plane (ESP) block and superficial parasternal intercostal plane (S-PIP) + ESP block in acute post-sternotomy pain following cardiac surgery.

Methods
Forty-seven patients aged between 18 and 80 years of age with American Society of Anesthesiologists class II–III due to undergo median sternotomy for cardiac surgery were included in this prospective, randomized, double-blinded study. Following randomization into two groups, one group received bilateral ultrasound-guided ESP and the other S-PIP plus ESP block. Morphine consumption within the first 24 h after surgery was the primary outcome of the study while NRS scores at rest, NRS scores when coughing, time taken until extubation, use of rescue analgesic, presence of nausea/vomiting, length of hospital and intensive care unit (ICU) stay, and patient satisfaction were secondary outcome measures.

Results
Morphine use up to 24 h following surgery was statistically significantly different between the ESP block and ESP + S-PIP block groups (18.63 ± 6.60 [15.84–21.41] mg/24 h vs 14.41 ± 5.38 [12.08–16.74] mg/24 h, p = 0.021). The ESP + S-PIP block group had considerably reduced pain scores compared to the ESP block group across all time points. Rescue analgesics were required in 21 (87.5%) patients in the ESP block group and seven (30.4%) in the ESP + S-PIP group (p < 0.001). PONV, length of stay in the ICU and hospital, and time to extubation were similar between groups.

Conclusions
In open cardiac surgery, the combination of ESP and S-PIP blocks lowers pain scores and postoperative morphine requirement of patients.

Trial registration
Clinicaltrials Registration No: NCT05191953, Registration Date: 14/01/2022.
Effect of differences in extubation timing on postoperative pneumonia following meningioma resection: a retrospective cohort study
Authors: Guo Minna , Shi Yan , Gao Jian , Yu Min , Liu Cunming 
Published: September 2022

Abstract
Background
This study was designed to examine extubation time and to determine its association with postoperative pneumonia (POP) after meningioma resection.

Methods
We studied extubation time for 598 patients undergoing meningioma resection from January 2016 to December 2020. Extubation time was analysed as a categorical variable and patients were grouped into extubation within 21 minutes, 21–35 minutes and ≥ 35 minutes. Our primary outcome represented the incidence of POP. The association between extubation time and POP was assessed using multivariable logistic regression mixed-effects models which adjusted for confounders previously reported. Propensity score matching (PSM) was also performed at a ratio of 1:1 to minimize potential bias.

Results
Among 598 patients (mean age 56.1 ± 10.7 years, 75.8% female), the mean extubation time was 32.4 minutes. Extubation was performed within 21 minutes (32.4%), 21–35 minutes (31.2%) and ≥ 35 minutes (36.4%), respectively, after surgery. Older patients (mean age 57.8 years) were prone to delayed extubation (≥ 35 min) in the operating room, and more inclined to perioperative fluid infusion. When extubation time was analysed as a continuous variable, there was a U-shaped relation of extubation time with POP (P for nonlinearity = 0.044). After adjustment for confounders, extubation ≥35 minutes was associated with POP (odds ratio [OR], 2.73 95% confidence interval [CI], 1.36 ~ 5.47). Additionally, the results after PSM were consistent with those before matching.

Conclusions
Delayed extubation after meningioma resection is associated with increased pneumonia incidence. Therefore, extubation should be performed as early as safely possible in the operation room.