bluuebunny/crossref_metadata_2025_split huggingface dataset:
Methodological aspects of a randomized within-patient concurrent controlled design for clinical trials in spine surgery
Authors: Lehr A Mechteld , Jacobs Wilco CH , Stellato Rebecca K , Castelein René M , Cumhur Oner F , Kruyt Moyo C 
Published: March 2022

Introduction: Randomized controlled trials are considered the highest level of evidence, but their feasibility in the surgical field is severely hampered by methodological and practical issues. Concurrent comparison between the experimental and control conditions within the same patient can be an effective strategy to mitigate some of these challenges and improve generalizability, mainly by the elimination of between-patient variability and reduction of the required sample size. This article aims (1) to describe the methodological aspects of a randomized within-patient controlled trial and (2) to quantify the added value of this design, based on a recently completed randomized within-patient controlled trial on bone grafts in instrumented lumbar posterolateral spinal fusion. Methods: Boundary conditions for the application of the randomized within-patient controlled trial design were identified. Between-patient variability was quantified by the intraclass correlation coefficient and concordance in the primary fusion outcome. Sample size, study duration and costs were compared with a classic randomized controlled trial design. Results: Boundary conditions include the concurrent application of the experimental and control conditions to identical but physically separated sites. Moreover, the outcome of interest should be local, uncorrelated and independently assessable. The spinal fusion outcomes within a patient were found to be more similar than between different patients (intraclass correlation coefficient 32% and concordance 64%), demonstrating a clear effect of patient-related factors. The randomized within-patient controlled trial design allowed a reduction of the sample size to one-third of a parallel-group randomized controlled trial, thereby halving the trial duration and costs. Conclusion: When suitable, the randomized within-patient controlled trial is an efficient design that provides a solution to some of the considerable challenges of a classic randomized controlled trial in (spine) surgery. This design holds specific promise for efficacy studies of non-active bone grafts in instrumented posterolateral fusion surgery.
Work-related Stress Management Behaviors of Nurses During COVID-19 Pandemic in the United Arab Emirates
Authors: Dabou Eman Abdelaziz Rashad , Ilesanmi Rose Ekama , Mathias Carol Avil , Hanson Victoria Funmilayo 
Published: March 2022

Introduction Intense psychological and emotional stress experienced by nurses during the COVID-19 pandemic interferes with their wellbeing and work efficiency. Stress-management behaviors are required to enhance coping and ameliorate stress effects. Therefore, it is necessary to examine the management behavior of nurses during the pandemic to suggest ways to improve their wellbeing. Objective The study aimed to examine nurses’ work-related stress management behaviors during the COVID-19 pandemic in UAE. Methods This was a cross-sectional survey of 64 nurses working in the Isolation and Intensive care units of two selected hospitals in the United Arab Emirates. A convenience sampling technique was used for sample selection. Each participant completed an online survey via Google forms of two validated instruments: a 10-item scale to measure perceived stress levels and a 15-item Stress management inventory. The completed questionnaires were analyzed on SPSS version 25. Results Respondents (78.1%) reported a moderate level of stress (Mean = 18.03 and SD = 5.33). Stress management behaviors utilized included four elements (eliminating stressors, developing resilience, using short-term coping, and effective delegating) and the mean and SD were 17.62 ± 2.6, 17.42 ± 3.3, 8.88 ± 1.47, and 23.98 ± 3.54 respectively. There was a significant positive correlation between these four elements of stress management inventory (p = 0.00). Findings also showed a significant inverse correlation between the scores on perceived stress, short-term coping, and effective delegation. The overall regression of demographic covariates on stress management behaviors was not statistically significant [F = (1.015), (0.602), (0.909), (1.286), p >0.05]. Conclusions Effective delegating and developing resilience were effective stress management behavior among nurses. Regular assessment of the psychological needs of nurses is essential to enhance overall wellbeing during stressful situations.
Clinical relevance of lung transplantation for COVID-19 ARDS: a nationwide study
Authors: Lang Christian , Ritschl Valentin , Augustin Florian , Lang Gyoergy , Moser Bernhard , Taghavi Shahrokh , Murakoezy Gabriella , Lambers Christopher , Flick Holger , Koestenberger Markus , Brooks Roxane , Muhr Tina , Knotzer Johann , Mydza Daniel , Kaufmann Marc , Staudinger Thomas , Zauner Christian , Krenn Claus , Schaden Eva , Bacher Andreas , Rössler Bernhard , Faybik Peter , Tschernko Edda , Anwar Maria , Markstaller Klaus , Hoefer Daniel , Stamm Tanja , Jaksch Peter , Hoetzenecker Konrad 
Published: March 2022

BackgroundAlthough the number of lung transplantations (LTx) performed worldwide for coronavirus disease 2019 (COVID-19)-induced acute respiratory distress syndrome (ARDS) is still low, there is general agreement that this treatment can save a subgroup of the most severely ill patients with irreversible lung damage. However, the true proportion of patients eligible for LTx, the overall outcome and the impact of LTx on the pandemic are unknown.MethodsA retrospective analysis was performed using a nationwide registry of hospitalised patients with confirmed severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection admitted between 1 January 2020 and 30 May 2021 in Austria. Patients referred to one of the two Austrian LTx centres were analysed, and grouped into patients accepted and rejected for LTx. Detailed outcome analysis was performed for all patients who received a LTx for post-COVID-19 ARDS and compared with patients who underwent LTx for other indications.ResultsBetween 1 January 2020 and 30 May 2021, 39 485 patients were hospitalised for COVID-19 in Austria. 2323 required mechanical ventilation and 183 received extracorporeal membrane oxygenation (ECMO) support. 106 patients with severe COVID-19 ARDS were referred for LTx. Of these, 19 (18%) underwent LTx. 30-day mortality after LTx was 0% for COVID-19 ARDS transplant recipients. At a median follow-up of 134 (47–450) days, 14 out of 19 patients were alive.ConclusionsEarly referral of ECMO patients to a LTx centre is pivotal in order to select patients eligible for LTx. Transplantation offers excellent midterm outcomes and should be incorporated in the treatment algorithm of post-COVID-19 ARDS.
Spatial distribution characteristics of the dust emitted at different cutting speeds during MDF milling by image analysis
Authors: Cui Yunqi , Yin Jian , Cai Yitong , Wang Huimin , Zhu Nanfeng , Ding Tao 
Published: March 2022

AbstractWood dust produced in medium-density fiberboard (MDF) processing is a major occupational hazard in wood industry and may damage processing equipment. In many wood processing factories, dust collecting systems need to be optimized for the distributional and morphological characteristics of dust in the workshop so that economical and efficient dust control can be achieved. In this study, weighting, image analysis and scanning electron microscopy (SEM) were applied to explore the effects of different cutting speeds on the distribution and morphology of dust generated in MDF milling. The results showed that most dust particles were less than 100 μm and that the aspect ratios (AR) were between 0.6 and 0.7. There was significant difference in particle number size distribution (PNSD) between the dust at different sampling positions. Less amount of dust was located close to cutting center, and fine dust was more likely to appear far away from cutting center. Cutting speed was associated with PNSD, but had little effect on AR. The findings provide spatial distribution characteristics of MDF dust during milling, which can be helpful for optimizing cutting parameters and locating dust collecting hoods to minimize dust exposure.
An emerging role of microplastics in the etiology of lung ground glass nodules
Authors: Chen Qiqing , Gao Jiani , Yu Hairui , Su Hang , Yang Yan , Cao Yajuan , Zhang Qun , Ren Yijiu , Hollert Henner , Shi Huahong , Chen Chang , Liu Haipeng 
Published: March 2022

AbstractBackgroundMicroplastic pollution has become a serious global environmental threat. The abundance of microplastics in the air is an order of magnitude higher than that in other media, which means that all living animals breathing with lungs (including humans) cannot escape the fate of inhaling microplastics. However, there is no direct evidence to demonstrate what type and abundance of microplastics exist in lung tissue. In addition, whether the retention of microplastics and the long-term friction between microplastics and lung tissue are related to some respiratory diseases is largely unknown. Ground glass nodules (GGNs) are areas of lesions of homogeneous density and with hazy increase in density in the lung field that do not obscure the bronchovascular structure, which have been increasingly identified in past decades. Although their etiology is broad, the correlation of microplastics with GGNs remains elusive.ResultsIn this study, we identified the presence of 65 microfibers, including 24 microplastics (> 20 μm) in 100 human lung tissues with μ-FTIR. The detection rate of microfibers in tumor was 58%, higher than that in normal tissue (46%), and 2/3 of microplastics were found in tumor. Microfibers seemed to be embedded in lung tissues, which was suggested by the in situ observation via LDIR. Additionally, sub-micron-sized plastic particles were also detected in some lung tissues with Raman. The abundance of microfibers in lung tissue gradually accumulated with the increase of age. Moreover, the detection rate in tumor of patients with higher microfiber exposure risk history was significantly higher than those with a relatively lower one, implying microfiber inhalation could be related to the formation of GGN. Further, serious weared surface of microfibers isolated from lung tissue emphasized a possible link of surface roughness to the disease progression.ConclusionsCollectively, the existence of microplastics in human lung tissues was validated, and their correlation with GGN formation was preliminarily explored, which laid a foundation for future research on microplastic exposure in the etiology of lung cancer and other related respiratory diseases.Graphical Abstract
Threshold effects of environmental regulation types on green investment by heavily polluting enterprises
Authors: Wang Zhenhua , Wang Ning , Hu Xingqiu , Wang Hongpeng 
Published: March 2022

Abstract
Background
In the stage of sustainable development, enterprises should not only focus on economic efficiency, but also on ecological protection, for which the governments of various countries has adopted various environmental regulation methods to promote green investment by enterprises. However, there are many types of environmental regulations, and the relationship between policy formulation and implementation effects is complicated. Heavily polluting enterprises as the main carrier of resource consumption and pollutant emissions is the main target of environmental regulation. Based on this, we took China's heavily polluting listed companies as examples to explore the impact of different types of environmental regulations on green investment in heavily polluting enterprises.

Results
In this paper, environmental regulations were divided into formal and informal types, of which formal environmental regulations (FER) were subdivided into command-control and market-incentive types. The empirical results showed that the relationship between command-control environmental regulations and green investment by heavily polluting enterprises presents an inverted “U” shape, and market-incentive environmental regulations first have no effect on and then promote green investment by heavily polluting enterprises. Besides, informal environmental regulations (IER) have maintained a positive effect on green investment by heavily polluting enterprises.

Conclusions
Heavily polluting enterprises, respectively, employ passive, active and voluntary green investment strategies under the three types of environmental regulations, providing a reference for the government to promote green investment by enterprises by environmental regulations more effectively.
Tensions in the therapeutic relationship: emotional labour in the response to child abuse and neglect in primary healthcare
Authors: Kuruppu Jacqueline , Humphreys Cathy , McKibbin Gemma , Hegarty Kelsey 
Published: March 2022

Abstract
Background
Child abuse and neglect (child abuse) is a prevalent public health issue linked to survivors experiencing a higher risk of health issues such as obesity, heart disease and major depression. Given the significant impact of child abuse on health, general practitioners (GPs) and primary care nurses (nurses) are well-placed to respond to child abuse. However, research shows that responding to child abuse is difficult for health practitioners, especially the act of reporting child abuse. The present study aimed to understand how GPs and nurses experience the response to child abuse in primary healthcare.

Methods
This study employed qualitative methods. Twenty-six in-depth individual and group interviews were conducted with 30 GPs and nurses. The interviews were audio recorded with consent, transcribed verbatim and thematically analysed.

Results
The participants were mostly metropolitan-based female GPs. Participants were sampled from two settings: private general practice and community health; and Doctors in Secondary Schools, a program that places GPs and nurses in high schools. Thematic analysis generated four themes: blowing trust out of the water; riding the reaction wave; opening a hornet’s nest; and battling emotions. Participants felt that, in considering child abuse, they were betraying the trust of the therapeutic relationship and thus, had to manage their patients’ reactions to preserve the therapeutic relationship. They used strategies that created shifts in perception in both themselves and their patients to help maintain the therapeutic relationship. Participants often felt that they had to compromise their professional code of ethics to fulfil their mandatory reporting obligations. Thus, they experienced internal emotional battles when responding which led to some experiencing burnout or vicarious trauma and others resilience. This complex interplay of relationship and emotional management was placed in the context of emotional labour theory. We contend that our participants undertook emotional labour across three levels: internal, organisational and systemic.

Conclusions
We conclude that the emotional labour exerted in the response to child abuse can be diminished by: developing strategies for therapeutic relationship management; undertaking an internal, organisational and systemic values assessment; and facilitating communication between health professionals and the child protection system.
Urinary metabolomics using gas chromatography-mass spectrometry: potential biomarkers for autism spectrum disorder
Authors: Khan Zaib Un Nisa , Chand Prem , Majid Hafsa , Ahmed Sibtain , Khan Aysha Habib , Jamil Azeema , Ejaz Saba , Wasim Ambreen , Khan Khaleel Ahmad , Jafri Lena 
Published: March 2022

Abstract
Background
Diagnosis of autism spectrum disorder (ASD) is generally made phenotypically and the hunt for ASD-biomarkers continues. The purpose of this study was to compare urine organic acids profiles of ASD versus typically developing (TD) children to identify potential biomarkers for diagnosis and exploration of ASD etiology.

Methods
This case control study was performed in the Department of Pathology and Laboratory Medicine in collaboration with the Department of Pediatrics and Child Health, Aga Khan University, Pakistan. Midstream urine was collected in the first half of the day time before noon from the children with ASD diagnosed by a pediatric neurologist based on DSM-5 criteria and TD healthy controls from August 2019 to June 2021. The urine organic acids were analyzed by Gas Chromatography-Mass Spectrometry. To identify potential biomarkers for ASD canonical linear discriminant analysis was carried out for the organic acids, quantified in comparison to an internal standard.

Results
A total of 85 subjects were enrolled in the current study. The mean age of the ASD (n = 65) and TD groups (n = 20) was 4.5 ± 2.3 and 6.4 ± 2.2 years respectively with 72.3% males in the ASD group and 50% males in the TD group. Parental consanguinity was 47.7 and 30% in ASD and TD groups, respectively. The common clinical signs noted in children with ASD were developmental delay (70.8%), delayed language skills (66.2%), and inability to articulate sentences (56.9%). Discriminant analysis showed that 3-hydroxyisovalericc, homovanillic acid, adipic acid, suberic acid, and indole acetic were significantly different between ASD and TD groups. The biochemical classification results reveal that 88.2% of cases were classified correctly into ASD& TD groups based on the urine organic acid profiles.

Conclusion
3-hydroxy isovaleric acid, homovanillic acid, adipic acid, suberic acid, and indole acetic were good discriminators between the two groups. The discovered potential biomarkers could be valuable for future research in children with ASD.
Effectiveness and perinatal outcomes of history-indicated, ultrasound-indicated and physical examination-indicated cerclage: a retrospective study
Authors: Golbasi Ceren , Golbasi Hakan , Bayraktar Burak , Sever Baris , Vural Tayfun , Ekin Atalay 
Published: March 2022

Abstract
Objective
To evaluate the effectiveness and perinatal outcomes of cerclage procedure according to indication.

Methods
The pregnancy and neonatal outcomes of the patients who underwent cerclage with the diagnosis of cervical insufficiency between January 2016 and December 2020 were retrospectively analyzed. Patients were categorized into three groups: a history-indicated group, an ultrasound-indicated group and a physical examination-indicated group.

Results
Seventy-three patients who underwent cerclage were included in the study. Of these, 41 (56.2%) had history-indicated, 17 (23.3%) had ultrasound-indicated and 15 (20.5%) had physical examination-indicated cerclages. Compared to history- and ultrasound-indicated cerclage group, duration from cerclage to delivery (18.6 ± 6.9 weeks vs 17.8±5.9 weeks vs 11 ± 5.3 weeks, p = 0.003) was significantly lower and delivery < 28 weeks (9.8% vs 5.9% vs 33.3%, p = 0.042) and delivery < 34 weeks of gestation (26.8% vs 11.8% vs 60%, p = 0.009) were significantly higher in physical examination-indicated cerclage group. In physical examination-indicated cerclage, compared with history- and ultrasound-indicated cerclage low birth weight, low APGAR score, neonatal intensive care unit admission and neonatal mortality were higher, although not statistically significant (p > 0.05).

Conclusion
Pregnant women who underwent physical examination-indicated cerclage had higher risks for preterm delivery < 28 weeks and < 34 weeks than history- and ultrasound–indicated cerclage.
Implementation of a strategy to facilitate effective medical follow-up for Australian First Nations children hospitalised with lower respiratory tract infections: study protocol
Authors: Schultz André , Chang Anne B. , Gill Fenella , Walker Roz , Barwick Melanie , Munns Sarah , Cooper Matthew N. , Norman Richard , Laird Pamela 
Published: March 2022

Abstract
Background
First Nations children hospitalised with acute lower respiratory infections (ALRIs) are at increased risk of future bronchiectasis (up to 15–19%) within 24-months post-hospitalisation. An identified predictive factor is persistent wet cough a month after hospitalisation and this is likely related to protracted bacterial bronchitis which can progress to bronchiectasis, if untreated. Thus, screening for, and optimally managing, persistent wet cough one-month post-hospitalisation potentially prevents bronchiectasis in First Nations’ children. Our study aims to improve the post-hospitalisation medical follow-up for First Nations children hospitalised with ALRIs and thus lead to improved respiratory health. We hypothesize that implementation of a strategy, conducted in a culturally secure manner, that is informed by barriers and facilitators identified by both parents and health care providers, will improve medical follow-up and management of First Nations children hospitalized with ALRIs.

Methods
Our trial is a multi-centre, pseudo-randomized stepped wedge design where the implementation of the strategy is tailored for each study site through a combined Participatory Action Research and implementation science approach informed by the Consolidated Framework of Implementation Research. Outcome measures will consist of three categories related to (i) health, (ii) economics and (iii) implementation. The primary outcome measure will be Cough-specific Quality of Life (PC-QoL). Outcomes will be measures at each study site/cluster in three different stages i.e., (i) nil-intervention control group, (ii) health information only control group and (iii) post-intervention group.

Discussion
If our hypothesis is correct, our study findings will translate to improved health outcomes (cough related quality of life) in children who have persistent wet cough a month after hospitalization for an ALRI.
Trial registration ACTRN12622000224729, prospectively registered 8 February 2022, URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382886&isReview=true.
Effects of experimental pain on the cervical spine reposition errors
Authors: Wang Xu , Qu Ning , Wang Yang , Dong Jian , Jiao Jianhang , Wu Minfei 
Published: March 2022

Abstract
Background
Healthy subjects showed normal variance of cervical spine reposition errors of approximately 2 degrees. Effects of experimental pain on cervical spine reposition errors were unknown; thus, the purpose of this study was to investigate the effects of experimental pain on cervical spine reposition errors.

Methods
A repeated measured study design was applied. Thirty healthy subjects (12 males) were recruited. Reposition errors were extracted from upright cervical positions before and after cervical flexion movement in healthy subjects before and during experimental neck pain. Cervical spine reposition errors were calculated based on anatomical landmarks of each cervical joint. Reposition errors were extracted in degrees as constant errors and absolute errors for further statistical analysis. Repeated measures analysis of variance (RM-ANOVA) was applied to analyse experimental pain effects on either constant errors or absolute errors of different cervical joints.

Results
The cervical spine showed non-significant difference in reposition errors regarding the constant errors (P>0.05) while larger reposition errors regarding the absolute errors during experimental pain compared to before experimental pain (P<0.001). In addition, the pain level joint (C4/C5) and its adjacent joints (C3/C4 and C5/C6) indicated larger reposition errors regarding absolute errors (P=0.035, P=0.329 and P=0.103, respectively).

Conclusions
This study firstly investigated the cervical spine reposition errors in experimental neck pain and further found the joints adjacent to the pain level showed larger errors compared to the distant joints regarding absolute errors. It may imply that the larger reposition errors in specific cervical joint indicate probable injury or pain existed adjacent to the joints.