bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health worker perspectives of Smart Triage, a digital triaging platform for quality improvement at a referral hospital in Uganda: a qualitative analysis
Authors: Novakowski Stefanie K , Kabajaasi Olive , Kinshella Mai-Lei Woo , Pillay Yashodani , Johnson Teresa , Dunsmuir Dustin , Pallot Katija , Rigg Jessica , Kenya-Mugisha Nathan , Opar Bernard Toliva , Ansermino J Mark , Tagoola Abner , Kissoon Niranjan 
Published: October 2022

Abstract
Background
Effective triage at hospitals can improve outcomes for children globally by helping identify and prioritize care for those most at-risk of death. Paper-based pediatric triage guidelines have been developed to support frontline health workers in low-resource settings, but these guidelines can be challenging to implement. Smart Triage is a digital triaging platform for quality improvement (QI) that aims to address this challenge. Smart Triage represents a major cultural and behavioural shift in terms of managing patients at health facilities in low-and middle-income countries. The purpose of this study is to understand user perspectives on the usability, feasibility, and acceptability of Smart Triage to inform ongoing and future implementation.

Methods
This was a descriptive qualitative study comprising of face-to-face interviews with health workers (n = 15) at a regional referral hospital in Eastern Uganda, conducted as a sub-study of a larger clinical trial to evaluate Smart Triage (NCT04304235). Thematic analysis was used to assess the usability, feasibility, and acceptability of the platform, focusing on its use in stratifying and prioritizing patients according to their risk and informing QI initiatives implemented by health workers.

Results
With appropriate training and experience, health workers found most features of Smart Triage usable and feasible to implement, and reported the platform was acceptable due to its positive impact on reducing the time to treatment for emergency pediatric cases and its use in informing QI initiatives within the pediatric ward. Several factors that reduced the feasibility and acceptability were identified, including high staff turnover, a lack of medical supplies at the hospital, and challenges with staff attitudes.

Conclusion
Health workers can use the Smart Triage digital triaging platform to identify and prioritize care for severely ill children and improve quality of care at health facilities in low-resource settings. Future innovation is needed to address identified feasibility and acceptability challenges; however, this platform could potentially address some of the challenges to implementing current paper-based systems.
The effect of salience of rewards on effort-based decision making in psychotic disorders
Authors: Renz Katharina E. , Lincoln Tania M. 
Published: October 2022

Abstract
Background
Although motivational negative symptoms account for reduced functioning and quality of life in individuals with psychotic disorders, the underlying mechanisms are yet not fully understood. Neuroimaging studies suggest that an impaired perception of reward cues could result in a lack of incentive value that then leads to a decrease in goal-directed behavior. Therefore, the aim of this study was to test the effect of increasing the salience of reward cues on goal-directed behavior.

Methods
We recruited a sample of n = 30 participants with a psychotic disorder and at least mild negative symptoms and n = 30 healthy controls. We used the Balloon Effort Task, an effort-based decision-making paradigm, to assess amotivation on a behavioral level. We manipulated the salience of rewards in the paradigm by highlighting the monetary rewards in half of the trials.

Results
Total effort expenditure did not differ between participants with and without psychotic disorders, but participants with psychotic disorders showed a significantly reduced effort allocation to the level of rewards. The salience of rewards manipulation significantly increased effort expenditure both in participants with psychotic disorders and in the healthy controls, but had no impact on effort allocation.

Conclusions
Increasing the salience of reward cues promotes goal-directed behavior. This opens up new possibilities for interventions addressing amotivation in individuals with negative symptoms by facilitating the perception of reward cues.
Implementation of a standardized surgical technique in robot-assisted restorative rectal cancer resection: a single center cohort study
Authors: Eriksen Jacob Damgaard , Thaysen Henriette Vind , Emmertsen Katrine Jøssing , Madsen Anders Husted , Tøttrup Anders , Nørager Charlotte Buchard , Ljungmann Ken , Thomassen Niels , Delaney Conor Patrick , Iversen Lene Hjerrild 
Published: October 2022

Abstract
Background
Despite increasing focus on the technical performance of total mesorectal excision over recent decades, anastomotic leakage (AL) continues to be a serious complication for many patients, even in the hands of experienced surgical teams. This study describes implementation of standardized surgical technique in an effort to reduce variability, decrease the risk of anastomotic leakage, and improve associated short-term outcomes for rectal cancer patients undergoing robot-assisted restorative rectal resection (RRR).

Methods
We evaluated all rectal cancer patients undergoing robot-assisted RRR at Aarhus University Hospital between 2017 and 2020. Six standardized surgical steps directed to improve anastomotic healing were mandatory for all RRR. Additional changes were made during the period with prohibition of systemic dexamethasone and limiting the use of endoscopic stapling devices.

Results
The use of the full standardization, including all six surgical steps, increased from 40.3% (95% CI, 0.28–0.54) to 86.2% (95% CI, 0.68–0.95). The incidence of AL decreased from 21.0% (95% CI, 0.12–0.33) to 6.9% (95% CI, 0.01–0.23). Length of hospital stay (LOS) decreased from 6 days (range 2–50) to 5 days (range 2–26). The rate of patients readmitted within 90 days decreased from 21.0% (95% CI, 0.12–0.33), to 6.9% (95% CI, 0.01–0.23).

Conclusion
The full standardization was effectively implemented for rectal cancer patients undergoing robot-assisted RRR. The risk of AL, LOS and readmission decreased during the study period. A team focus on high-reliability and peri-operative complications can improve patient outcomes.
The protective effect of L-carnitine on testosterone synthesis pathway, and spermatogenesis in monosodium glutamate-induced rats
Authors: Koohpeyma Farhad , Gholizadeh Fatemeh , Hafezi Hannaneh , Hajiaghayi Mehri , Siri Morvarid , Allahyari Shaghayegh , Maleki Mohammad Hasan , Asmarian Naeimehossadat , Bayat Elahe , Dastghaib Sanaz 
Published: October 2022

Abstract
Background
Monosodium glutamate (MSG) is a food ingredient that is increasingly used commercially. MSG leads to oxidative stress, consequently suppressing steroid hormone production that causes defects in male reproductive system. This study aimed to evaluate the effect of L-carnitine as an antioxidant on testicular damage in MSG-induced male rats.

Methods
Sixty adult male Spargue-Dawley rats were randomly divided into six groups of ten as follows: control (water), sham (normal saline), L-carnitine (200 mg/kg b.w), MSG (3 g/kg b.w), MSG + L-carnitine 100 (3 g/kg b.w of MSG and 100 mg/kg b.w of L-carnitine), and MSG + L-carnitine 200 (3 g/kg b.w of MSG and 200 mg/kg b.w of L-carnitine). The treatment was administered by oral gavage for six months. Serum levels of Malondialdehyde (MDA), Total Anti-oxidant Capacity (TAC), LH, FSH, testosterone, and mRNA expressions of Star, Cyp11a1, and Hsd17b3 genes, and histological and stereological changes were assessed.

Results
L-carnitine led to a significant decrease in the level of MDA and a significant rise in the serum levels of TAC, LH, FSH, and mRNA expression of Star and Cyp11a1 compared to the MSG group (p < 0.05). Furthermore, stereological results indicated a significant increment in the number of sexual lineage cells, the total volume of the testis, length, diameter, and volume of seminiferous tubules, the height of the germinal epithelium, sperm count, and sperm motility (p < 0.05) in MSG + L-carnitine 200 compare to MSG group.

Conclusion
The study’s findings demonstrated that L-carnitine due to its anti-oxidant properties, ameliorated the reproductive abnormalities in the male rats exposed to MSG.
Sleep postures monitoring based on capacitively coupled electrodes and deep recurrent neural networks
Authors: Peng Shun , Li Yang , Cui Rui , Xu Ke , Wu Yonglin , Huang Ming , Dai Chenyun , Tamur Toshiyo , Mukhopadhyay Subhas , Chen Chen , Chen Wei 
Published: October 2022

Abstract
Background
Capacitively coupled electrode (CC electrode), as a non-contact and unobtrusive technology for measuring physiological signals, has been widely applied in sleep monitoring scenarios. The most common implementation is capacitive electrocardiogram (cECG) that could provide useful clinical information for assessing cardiac function and detecting cardiovascular diseases. In the current study, we sought to explore another potential application of cECG in sleep monitoring, i.e., sleep postures recognition.

Methods
Two sets of experiments, the short-term experiment, and the overnight experiment, were conducted. The cECG signals were measured by a smart mattress based on flexible CC electrodes and sleep postures were recorded simultaneously. Then, a classifier model based on a deep recurrent neural network (RNN) was proposed to distinguish sleep postures (supine, left lateral and right lateral). To verify the reliability of the proposed model, leave-one-subject-out cross-validation was introduced.

Results
In the short-term experiment, the overall accuracy of 96.2% was achieved based on 30-s segment, while the overall accuracy was 88.8% using one heart beat segment. For the unconstrained overnight experiment, the accuracy of 91.0% was achieved based on 30-s segment, while the accuracy was 81.4% using one heart beat segment.

Conclusions
The results suggest that cECG could render valuable information about sleep postures detection and potentially be helpful for sleep disorder diagnosis.
Bioconversion of vitamin D3 to bioactive calcifediol and calcitriol as high-value compounds
Authors: Wang Zheyi , Zeng Yan , Jia Hongmin , Yang Niping , Liu Mengshuang , Jiang Mingyue , Zheng Yanning 
Published: October 2022

AbstractBiological catalysis is an important approach for the production of high-value-added compounds, especially for products with complex structures. Limited by the complex steps of chemical synthesis and low yields, the bioconversion of vitamin D3 (VD3) to calcifediol and calcitriol, which are natural steroid products with high added value and significantly higher biological activity compared to VD3, is probably the most promising strategy for calcifediol and calcitriol production, and can be used as an alternative method for chemical synthesis. The conversion efficiency of VD3 to calcifediol and calcitriol has continued to rise in the past few decades with the help of several different VD3 hydroxylases, mostly cytochrome P450s (CYPs), and newly isolated strains. The production of calcifediol and calcitriol can be systematically increased in different ways. Specific CYPs and steroid C25 dehydrogenase (S25DH), as VD3 hydroxylases, are capable of converting VD3 to calcifediol and calcitriol. Some isolated actinomycetes have also been exploited for fermentative production of calcifediol and calcitriol, although the VD3 hydroxylases of these strains have not been elucidated. With the rapid development of synthetic biology and enzyme engineering, quite a lot of advances in bioproduction of calcifediol and calcitriol has been achieved in recent years. Therefore, here we review the successful strategies of promoting VD3 hydroxylation and provide some perspective on how to further improve the bioconversion of VD3 to calcifediol and calcitriol.
Targeting hepatic sulfane sulfur/hydrogen sulfide signaling pathway with α-lipoic acid to prevent diabetes-induced liver injury via upregulating hepatic CSE/3-MST expression
Authors: Dugbartey George J. , Alornyo Karl K. , Adams Ismaila , Atule Stephen , Obeng-Kyeremeh Richard , Amoah Daniel , Adjei Samuel 
Published: October 2022

AbstractBackgroundDiabetes-induced liver injury is a complication of diabetes mellitus of which there are no approved drugs for effective treatment or prevention. This study investigates possible hepatoprotective effect of alpha-lipoic acid (ALA), and sulfane sulfur/hydrogen sulfide pathway as a novel protective mechanism in a rat model of type 2 diabetes-induced liver injury.MethodsThirty Sprague–Dawley rats underwent fasting for 12 h after which fasting blood glucose was measured and rats were randomly assigned to diabetic and non-diabetic groups. Type 2 diabetes mellitus (T2DM) was induced in diabetic group by administration of nicotinamide (110 mg/kg) and streptozotocin (55 mg/kg). Diabetic rats were treated daily with ALA (60 mg/kg/day p.o.) or 40 mg/kg/day DL-propargylglycine (PPG, an inhibitor of endogenous hydrogen sulfide production) for 6 weeks and then sacrificed. Liver, pancreas and blood samples were collected for analysis. Untreated T2DM rats received distilled water.ResultsHypoinsulinemia, hyperglycemia, hepatomegaly and reduced hepatic glycogen content were observed in untreated T2DM rats compared to healthy control group (p < 0.001). Also, the pancreas of untreated T2DM rats showed severely damaged pancreatic islets while liver damage was characterized by markedly increased hepatocellular vacuolation, sinusoidal enlargement, abnormal intrahepatic lipid accumulation, severe transaminitis, hyperbilirubinemia, and impaired hepatic antioxidant status and inflammation compared to healthy control rats (p < 0.01). While pharmacological inhibition of hepatic sulfane sulfur/hydrogen sulfide with PPG administration aggravated these pathological changes (p < 0.05), ALA strongly prevented these changes. ALA also significantly increased hepatic expression of hydrogen sulfide-producing enzymes (cystathionine γ-lyase and 3-mecaptopyruvate sulfurtransferase) as well as hepatic sulfane sulfur and hydrogen sulfide levels compared to all groups (p < 0.01).ConclusionsTo the best of our knowledge, this is the first experimental evidence showing that ALA prevents diabetes-induced liver injury by activating hepatic sulfane sulfur/hydrogen sulfide pathway via upregulation of hepatic cystathionine γ-lyase and 3-mecaptopyruvate sulfurtransferase expressions. Therefore, ALA could serve as a novel pharmacological agent for the treatment and prevention of diabetes-induced liver injury, with hepatic sulfane sulfur/hydrogen sulfide as a novel therapeutic target.
Classification accuracy of blood-based and neurophysiological markers in the differential diagnosis of Alzheimer’s disease and frontotemporal lobar degeneration
Authors: Benussi Alberto , Cantoni Valentina , Rivolta Jasmine , Archetti Silvana , Micheli Anna , Ashton Nicholas , Zetterberg Henrik , Blennow Kaj , Borroni Barbara 
Published: October 2022

Abstract
Background
In the last decade, non-invasive blood-based and neurophysiological biomarkers have shown great potential for the discrimination of several neurodegenerative disorders. However, in the clinical workup of patients with cognitive impairment, it will be highly unlikely that any biomarker will achieve the highest potential predictive accuracy on its own, owing to the multifactorial nature of Alzheimer’s disease (AD) and frontotemporal lobar degeneration (FTLD).

Methods
In this retrospective study, performed on 202 participants, we analysed plasma neurofilament light (NfL), glial fibrillary acidic protein (GFAP), and tau phosphorylated at amino acid 181 (p-Tau181) concentrations, as well as amyloid β42 to 40 ratio (Aβ1–42/1–40) ratio, using the ultrasensitive single-molecule array (Simoa) technique, and neurophysiological measures obtained by transcranial magnetic stimulation (TMS), including short-interval intracortical inhibition (SICI), intracortical facilitation (ICF), long-interval intracortical inhibition (LICI), and short-latency afferent inhibition (SAI). We assessed the diagnostic accuracy of combinations of both plasma and neurophysiological biomarkers in the differential diagnosis between healthy ageing, AD, and FTLD.

Results
We observed significant differences in plasma NfL, GFAP, and p-Tau181 levels between the groups, but not for the Aβ1–42/Aβ1–40 ratio. For the evaluation of diagnostic accuracy, we adopted a two-step process which reflects the clinical judgement on clinical grounds. In the first step, the best single biomarker to classify “cases” vs “controls” was NfL (AUC 0.94, p < 0.001), whilst in the second step, the best single biomarker to classify AD vs FTLD was SAI (AUC 0.96, p < 0.001). The combination of multiple biomarkers significantly increased diagnostic accuracy. The best model for classifying “cases” vs “controls” included the predictors p-Tau181, GFAP, NfL, SICI, ICF, and SAI, resulting in an AUC of 0.99 (p < 0.001). For the second step, classifying AD from FTD, the best model included the combination of Aβ1–42/Aβ1–40 ratio, p-Tau181, SICI, ICF, and SAI, resulting in an AUC of 0.98 (p < 0.001).

Conclusions
The combined assessment of plasma and neurophysiological measures may greatly improve the differential diagnosis of AD and FTLD.
Computational phenotyping of obstructive airway diseases: protocol for a systematic review
Authors: Bashir Muwada Bashir Awad , Basna Rani , Zhang Guo-Qiang , Backman Helena , Lindberg Anne , Ekerljung Linda , Axelsson Malin , Hedman Linnea , Vanfleteren Lowie , Lundbäck Bo , Rönmark Eva , Nwaru Bright I. 
Published: October 2022

Abstract
Background
Over the last decade, computational sciences have contributed immensely to characterization of phenotypes of airway diseases, but it is difficult to compare derived phenotypes across studies, perhaps as a result of the different decisions that fed into these phenotyping exercises. We aim to perform a systematic review of studies using computational approaches to phenotype obstructive airway diseases in children and adults.

Methods and analysis
We will search PubMed, Embase, Scopus, Web of Science, and Google Scholar for papers published between 2010 and 2020. Conferences proceedings, reference list of included papers, and experts will form additional sources of literature. We will include observational epidemiological studies that used a computational approach to derive phenotypes of chronic airway diseases, whether in a general population or in a clinical setting. Two reviewers will independently screen the retrieved studies for eligibility, extract relevant data, and perform quality appraisal of included studies. A third reviewer will arbitrate any disagreements in these processes. Quality appraisal of the studies will be undertaken using the Effective Public Health Practice Project quality assessment tool. We will use summary tables to describe the included studies. We will narratively synthesize the generated evidence, providing critical assessment of the populations, variables, and computational approaches used in deriving the phenotypes across studies

Conclusion
As progress continues to be made in the area of computational phenotyping of chronic obstructive airway diseases, this systematic review, the first on this topic, will provide the state of the art on the field and highlight important perspectives for future works.

Ethics and dissemination
No ethical approval is needed for this work is based only on the published literature and does not involve collection of any primary or human data.

Registration and reporting

Systematic review registration
PROSPERO CRD42020164898
Deep brain stimulation for neurological disorders: a protocol for a systematic review with meta-analysis and Trial Sequential Analysis of randomised clinical trials
Authors: Petersen Johanne Juul , Juul Sophie , Jørgensen Caroline Kamp , Gluud Christian , Jakobsen Janus Christian 
Published: October 2022

Abstract
Background
Deep brain stimulation has been used since the 1980s for neurological disorders and the USA and Europe have now approved it for Parkinson’s disease, essential tremor, dystonia, and epilepsy. Previous reviews have assessed the effects of deep brain stimulation on different neurological disorders. These reviews all had methodological limitations.

Methods
This is a protocol for a systematic review based on searches of major medical databases (e.g. MEDLINE, EMBASE, CENTRAL) and clinical trial registries. Two review authors will independently extract data and conduct risk of bias assessment. We will include published and unpublished randomised clinical trial comparing deep brain stimulation versus no intervention, usual care, sham stimulation, medical treatment, or resective surgery for Parkinson’s disease, essential tremor, dystonia, or epilepsy. The effects of deep brain stimulation will be analysed separately for each of the different diagnoses. Primary outcomes will be all-cause mortality, disease-specific symptoms, and serious adverse events. Secondary outcomes will be quality of life, depressive symptoms, executive functioning, level of functioning, and non-serious adverse events. Data will be analysed using fixed-effect and random-effects meta-analyses and Trial Sequential Analysis. Risk of bias will be assessed with the Cochrane Risk of Bias tool—version 2, an eight-step procedure to assess if the thresholds for clinical significance are crossed, and the certainty of the evidence will be assessed by Grading of Recommendations, Assessment, Development and Evaluations (GRADE).

Discussion
Deep brain stimulation is increasingly being used for different neurological diseases, and the effects are unclear based on previous evidence. There is a need for a comprehensive systematic review of the current evidence. This review will provide the necessary background for weighing the benefits against the harms when assessing deep brain stimulation as intervention for individual neurological disorders.

Systematic review registration
PROSPERO 306,556.