bluuebunny/crossref_metadata_2025 huggingface dataset:
253 Implementation and dissemination of physical activity-related health competence in nursing education: First results of a hybrid type 2 effectiveness-implementation study
Authors: Grüne Eva , Popp Johanna , Carl Johannes , Hartung Verena , Pfeifer Klaus
Published: September 2024

Background

Acknowledging the health-enhancing effects of physical activity (PA), the nursing education system in Bavaria, Germany, has recently integrated the promotion of physical activity-related health competence (PAHCO) into the curriculum. However, it cannot be assumed that PAHCO has sufficiently permeated the educational practices and routines of nursing schools. Therefore, the aim of the TakeCare! project is to evaluate the effectiveness and implementation of different intervention approaches to address PAHCO in nursing education.

Methods

Within a hybrid type 2 effectiveness-implementation study, we conduct a cluster-randomized controlled trial with 16 nursing schools allocated to four parallel study arms to determine the most appropriate approach to strengthen PAHCO. While intervention group 1 applies a bottom-up approach involving various stakeholders in the participatory development of PA-promoting interventions, intervention groups 2 and 3 follow a top-down approach in which the intervention is developed using intervention mapping and delivered by external PA professionals or nursing teachers respectively. The control group follows regular curriculum.

To investigate intervention implementation, questionnaires and protocol data are analysed using descriptive distributions and content analyses. To examine the short-term effectiveness, questionnaire-based data on nursing students’ PA and PAHCO collected before (T0/T1) and after intervention implementation (T2) are analysed via linear models.

Results

The implementation evaluation shows that interventions were implemented in each school across the different intervention groups. In intervention group 1, each school developed different intervention components (4≤n≤8), some of which were initiated (1≤n≤3). In the intervention groups 2 and 3, the intervention units developed (N=12) were largely implemented as planned. While six external PA professionals carried out all intervention units in the schools of intervention group 2, nine nursing teachers carried out the majority of intervention units (M=10.8) in the schools of intervention group 3. The effectiveness evaluation has not yet been finalised.

Discussion

The TakeCare! study provides valuable insights into the comparison of different intervention approaches to promote PAHCO and PA in terms of their effectiveness and implementation and enables evidence-based decision when choosing a suitable intervention approach. To spread PAHCO in all 185 Bavarian nursing schools, a systematic dissemination strategy must be developed based on the findings.
Expansion and functional divergence of terpene synthase genes in angiosperms: a driving force of terpene diversity
Authors: Wang Qi , Jiang Jie , Liang Yuwei , Li Shanshan , Xia Yiping , Zhang Liangsheng , Wang Xiuyun
Published: September 2024

Angiosperms are prolific producers of structurally diverse terpenes, which are essential for plant defense responses, as well as the formation of floral scents, fruit flavors, and medicinal constituents. Terpene synthase genes (TPSs) play crucial roles in the biosynthesis of terpenes. This study specifically focuses on the catalytic products of 222 functionally characterized TPSs in 24 angiosperms, which mainly comprise monoterpenes, sesquiterpenes, diterpenes, and sesterterpene. Our systematic analysis of these TPSs uncovered a significant expansion of the angiosperm-specific TPS-a, b, and g subfamilies in comparison to the TPS-e/f and c subfamilies. The expanded subfamilies can be further partitioned into distinct branches, within which considerable functional innovation and diversification have been observed. Numerous TPSs exhibit bifunctional or even trifunctional activities in vitro, yet they exhibit only a single activity in vivo, which may be largely determined by their inherent properties, subcellular localization, and the availabilities of endogenous substrates. Additionally, we explored the biological functions of terpenes in various organs and tissues of angiosperms. We propose that the expansion and functional divergence of TPSs contribute to the adaptability and diversity of angiosperms, facilitating the production of a broad spectrum of terpenes that enable diverse interactions with the environment and other organisms. Our findings provide a foundation for comprehending the correlation between the evolutionary features of TPSs and the diversity of terpenes in angiosperms, which is significant for terpene biosynthesis research.
The place of memory: Bildung in the North American African diaspora
Authors: Bartolucci Noemi
Published: September 2024

This article explores the relationship between place and Bildung, in the context of the North American African diaspora. In the process it raises questions of identity and the troubled concept of America itself, and the fatefully compromised roots of this modern democracy (‘We the People!’—but which people are we?). It begins by elaborating on the central concepts of place and Bildung in light of the classic formulations of Heidegger and the more recent critical discussions of the humanist geographer Edward Relph. The development of the idea of Bildung has connected substantially with the literary form of the novel, and experiments in the novel have shaped and reshaped the understanding of what Bildung can mean. Hence, the strands of thought I have established are brought to bear, in the latter part of the article, on a consideration of one of the outstanding 20th-century Bildungsromane by a Black author, Ralph Ellison’s Invisible Man. My discussion of Ellison is intertwined with reflections on William James Booth’s ‘The Color of Memory’—which deals more explicitly with the violence of self-formation in North American colonial contexts—generating thoughts that I thematize in relation to visibility. Consideration of the novel enables an exploration of the themes of insideness and outsideness, and hence, of alienation, as well as reflection on new ways of thinking and being, in which the relation between Bildung and place are altered and in some respects weakened.
Petersen’s space hernia as an immediate complication in a patient undergoing gastric bypass: a case report
Authors: Michel Macareno Alberto , Cobos Román Johanna Betzabe , Michel Esparza Rafael , Gil Gamez Jesús Antonio , Medina Estrada Ariana , Esparza Estrada Isaac
Published: September 2024

Petersen’s space hernias are common internal hernias following laparoscopic gastric bypass surgery, occurring when intestinal loops protrude through the space between the mesentery of the alimentary limb and the transverse mesocolon. A 43-year-old female with a history of hypertension underwent a revisional Roux-en-Y gastric bypass due to weight regain and severe gastroesophageal reflux disease. Postoperatively, she developed abdominal pain, and an urgent diagnostic laparoscopy was performed, revealing a nearly complete herniation of the alimentary limb through Petersen’s mesenteric defect. Based on these findings, an urgent laparotomy was subsequently performed to reduce the herniated bowel and close the defect. Her postoperative course was uneventful, and she was discharged without complications. Despite the closure of Petersen’s mesenteric defect, vigilance for hernia remains crucial due to the risk of severe complications. Advances in preventive techniques show promise, but prompt diagnosis and intervention are essential for improving patient outcomes.
Diagnosing Psychiatry
Authors: Aftab Awais , Frances Allen
Published: September 2024

Allen Frances, MD, is Professor Emeritus and former Chair of the Department of Psychiatry and Behavioral Science at Duke University School of Medicine. He was Chairman of the DSM-IV Task Force and a member of the leadership group for DSM-III and DSM-III-R. He is the author of Saving Normal (Mariner Books, 2013) and Essentials of Psychiatric Diagnosis (The Guilford Press, 2013). Frances has made an impassioned plea to curb diagnostic inflation in psychiatry and recognize the harms of medicalization of ordinary life. During the development of DSM-5, he emerged as the leading psychiatric critic of the manual’s revision process from within the psychiatric community. He used this as an opportunity to generate a collective discussion on clinical, philosophical, and scientific issues pertaining to psychiatric diagnosis and classification, which are explored in this interview.
The Structure of Psychiatric Revolutions
Authors: Aftab Awais , Harrington Anne
Published: September 2024

Franklin L. Ford Professor of the History of Science at Harvard University, Cambridge, MA, USA Anne Harrington, DPhil, is the Franklin L. Ford Professor of the History of Science at Harvard University, Director of Undergraduate Studies in History of Science, and Faculty Dean of Pforzheimer House, a resident community of Harvard College. Her 2019 book Mind Fixers (W. W. Norton & Company) explores the history of psychiatry’s tumultuous search for the biological foundations of mental illness. Harrington offers a stimulating and thought-provoking historical perspective on the evolution of ‘biological psychiatry’ from the German histopathologists to the present time, and teases out the implications of this history for the future of psychiatry. All this is discussed in the interview, where she also makes a case for pluralism and power-sharing in the mental health field.
Sense-Making and the Enactive Turn in Psychiatry
Authors: Aftab Awais , de Haan Sanneke
Published: September 2024

Sanneke de Haan, PhD, is Socrates Professor of Psychiatry and Philosophy at Erasmus University Rotterdam and Senior Researcher at Tilburg University, The Netherlands, working in philosophy of psychiatry. Her philosophical work has focused on the nature of psychiatric disorders, the existential dimension of psychiatry, and patients’ experiences and perspectives. She is the author of Enactive Psychiatry (Cambridge University Press, 2020). De Haan applies insights from enactivism to conceptualize and navigate the immensely complicated factors that contribute to psychiatric disorders, and conceptualizes psychiatric disorders as disorders of sense-making. This interview offers an introduction to the enactive framework, its application to psychiatry and mental disorders, the difference between psychiatric and neurological disorders, organizational causality, and the relationship between the experiential and the physiological.
From Classic and Critical to Integrative Psychiatry
Authors: Aftab Awais , Stein Dan J.
Published: September 2024

Dan J. Stein, MD, PhD, DPhil, is Professor and Chair of the Department of Psychiatry at University of Cape Town (UCT), Cape Town, South Africa. He has been interested in psychiatric research and philosophical writing since the early days of his training and has worked extensively in this area. In 2008, he brought together his interests in psychopharmacology and philosophy in Philosophy of Psychopharmacology (Cambridge University Press, 2008) and he has further extended his work in philosophy with the publication of Problems of Living: Perspectives from Philosophy, Psychiatry, and Cognitive-Affective Science (Academic Press, 2021). This interview explores his integrative approach to psychiatry and psychopharmacology, the influence of critical realism, the role of explanatory pluralism, and the use of metaphors in psychiatry.
Psychiatry and the Shores of Social Construction
Authors: Aftab Awais , Timimi Sami
Published: September 2024

Sami Timimi, MD, is a consultant child and adolescent psychiatrist in the UK National Health Service and Visiting Professor of Child Psychiatry and Mental Health Improvement at University of Lincoln. He has authored, co-authored, and co-edited numerous books, including Liberatory Psychiatry: Philosophy, Politics and Mental Health (co-edited with Carl Cohen, Cambridge University Press, 2008) and Insane Medicine (Kindle Direct Publishing, 2021). Timimi is among the fiercest critics of psychiatric diagnoses and the medical model in psychiatry (especially child psychiatry, his own area of specialization). Over the years he and his colleagues have argued that psychiatric conditions in their very nature reach beyond the brain to involve sociocultural dimensions and cannot be adequately understood through the epistemology of biomedicine. This interview explores his clinical approach to mental health problems, his views on the nature of psychiatric conditions, and the medical identity of psychiatry.
Palliative and Advance Care Planning in Dementia
Authors: Nagarajan Adithy S. , Donley Brian , Garcia-Pittman Erica C.
Published: September 2024

This chapter provides an overview of the role of palliative care and advance care planning in dementia. Palliative care is appropriate even in early dementia, with unique concerns and considerations at each stage as the condition progresses. This chapter also discusses advance care planning in people with dementia, an important but challenging and under-utilized process to help people voice their future healthcare preferences. Patient-centered and clinician-centered barriers to implementation of advance care planning are reviewed. Dementia-specific advance directives can help guide clinicians, patients, and families in discussing these difficult topics. Finally, this chapter provides practical recommendations and tools to facilitate engagement in advance care planning.
Conflict of Interest
Authors: Bulger Jeffrey W.
Published: September 2024

Abstract:A practitioner’s conflict of interest is a situation in which their personal interests may negatively impact the quality of patient care. Patients have the right to be informed of conflicts of interest to make informed decisions about their healthcare treatment. Practitioners must prioritize the patient’s welfare above their own interests and avoid engaging in activities that may create conflicts of interest, such as fee-splitting, self-referral, or providing care to themselves or their friends and family. Conflict of interest can arise from various sources, such as fee-for-service structures, company gifts, and personal relationships. The practitioner must recuse themself from any activity where a conflict of interest exists and disclose the conflict to those affected.
Gunshot Wounds
Authors: Bulger Jeffrey W.
Published: September 2024

Abstract: The United States has state-mandated reporting requirements for incidents such as gunshot wounds and child/elder abuse. Practitioners have a legal obligation to report such incidents, and failure to do so is a Class A misdemeanor. There is some concern about the impact of mandatory reporting on various aspects of the patient–practitioner relationship, including patient autonomy, the practitioner’s ethical principles of beneficence (do good) and nonmaleficence (do no harm), and public policy of justice. It is argued that mandatory reporting laws are part of the patient–practitioner social contract and are necessary for public safety and justice. However, they may have unintended consequences, such as deterring individuals from seeking healthcare. Practitioners must disclose their reporting obligations to patients and only provide the minimum amount of information necessary to authorized personnel. Interference by law enforcement in treating a patient in a healthcare emergency is not permissible.
Palliative Care
Authors: Bulger Jeffrey W.
Published: September 2024

Abstract:Palliative care is a healthcare approach that focuses on improving the quality of life and reducing the suffering of patients and families facing life-threatening illnesses. It is a recognized subspecialty of the healthcare profession and involves interprofessional collaboration and advanced care planning. The core principles of palliative care include patient autonomy (informed consent), beneficence (do good), nonmaleficence (do no harm), and justice (be fair). The aim of palliative care is to provide patient-centered care that maximizes the patient’s best interests in accordance with the patient’s reasonable goals, values, and priorities. Palliative care solves the challenge of end-of-life care and helps address healthcare disparities caused by technological advancements in the healthcare field.
Product Sales
Authors: Bulger Jeffrey W.
Published: September 2024

Abstract: There is a tension between the capitalistic doctrine of caveat emptor (let the buyer beware) and the healthcare profession’s patient-centered maxim of “patient’s best interests.” The sale of products by practitioners is considered a conflict of interest and is regulated legally, professionally, and ethically because it threatens the patient–practitioner relationship and public trust in the healthcare profession. The American College of Physicians Ethics Manual and the American Medical Association Code of Medical Ethics highlight concerns about financial conflicts of interest, patient trust erosion, and product sales’ ethical implications. The federal physician self-referral law (Stark law) prohibits practitioners from referring patients to receive designated health services payable by Medicare or Medicaid from entities with which the practitioner or an immediate family member has a financial relationship.
Triage
Authors: Bulger Jeffrey W.
Published: September 2024

Triage in medicine refers to sorting and prioritizing patients based on the severity of their healthcare conditions and available resources. Triage originates from the French word trier, meaning to sort or select. In some instances, treatment has been provided to those who would recover quickly to get back to their responsibilities, whereas in others, treatment has been given to patients in need of life-saving measures. However, the practitioner has a professional duty to prioritize their patient’s healthcare interests before those of any other individual, making it necessary for triage decisions to be socially determined by public policy, not the practitioner. To promote transparency, understanding, trust, and acceptance while ensuring justice and protecting vulnerable populations, public policy should determine triage policy decisions. The practitioner’s prime directive should always be patient-centered healthcare that promotes the patient’s best interests.
Suicide prevention in sub-Saharan Africa: Cultural considerations and opportunities to advance research and practice
Authors: Bantjes Jason , Breet Elsie , Kagee Ashraf , Stein Dan J.
Published: September 2024

There is a lack of data to enable context-sensitive and culturally informed suicide prevention strategies in sub-Saharan Africa. This chapter explores contextual and cultural factors which have an important bearing on suicide prevention in sub-Saharan Africa, and describes the opportunities for potential collaboration across the region to advance research and practice of culturally informed suicide prevention. The chapter argues for the establishment of a suicide prevention research network in the region to: establish a reliable suicide surveillance system; explore culturally situated meanings of suicide; identify high-risk groups within populations of migrants and refugees; investigate how traditional healers, religious leaders, and other non-professionals can be included in suicide prevention strategies; examine how processes such as urbanization and contexts such as living in an urban slum increase suicide risk; investigate the links between infectious diseases and suicide; and test culturally informed suicide prevention interventions.
Suicidal behaviour and sociocultural factors among immigrants of Turkish origin in Germany
Authors: Eylem-van Bergeijk Özlem , Eskin Mehmet
Published: September 2024

Turkish migrant populations are at an elevated risk of suicidal behaviours compared to their native counterparts in Europe and Germany. In particular, young Turkish women aged between 15 and 24 years seem to be at high risk of suicide in Eastern Turkey and Germany. This chapter aims to further the current understanding of social and cultural risks and precipitating factors for suicidal behaviours among Turkish migrants in Germany. The chapter outlines risk and precipitating factors in the research on suicidal behaviours among Turkish populations in Europe and Turkey. Additionally, how identified risk and precipitating factors lead to suicidal behaviours is discussed in the context of religion and migration. Finally, the chapter summarizes the gaps in the existing evidence base. It highlights the promising role of anti-stigma and e-mental interventions, customized to their needs and expectations, in preventing, caring, and treating suicidal behaviours.
Suicidality and trauma
Authors: Kastrup Marianne C.
Published: September 2024

Trauma experiences may be expected to increase the risk of suicidal ideation or suicide, but the literature is not clear. Persons with post-traumatic disorder (PTSD) do not have an increased risk of dying by suicide, although a meta-analysis has shown an increased incidence of suicidal ideation and prior suicide attempts. However PTSD is strongly associated with pre-trauma depressive disorders, and associated with an increased risk of dying by suicide. Adjusting for other psychiatric disorders, the association is weakened. Traumatic events are associated with subsequent suicidal behaviour, but factors, as pre-existing psychiatric morbidity and current psychiatric conditions, may act as confounders. The chapter provides an overview of the relation between experiencing a traumatic event and later suicidal risk, and discuss various prophylactic measures as well as therapeutic implications.
Suicide and psychiatric disorders
Authors: Berardelli Isabella , Rogante Elena , Lamis Dorian A. , Pompili Maurizio
Published: September 2024

Suicide is a complex and multifactorial phenomenon involving various interconnected factors, including psychiatric disorders. Psychiatric disorders often result in significant distress or impaired personal functioning, negatively affecting a patient’s mental health. However, most people with mental disorders do not die by suicide, demonstrating that a mental disorder is only one of the possible risk factors for suicide. In addition, other familial–genetic, personality, psychosocial, and demographic factors may also contribute to the genesis of suicide risk. Therefore, research on suicide risk factors among people with mental disorders is necessary to prevent suicide by adopting adequate suicide prevention strategies. This chapter summarizes current knowledge on the relationship between psychiatric disorders and suicide risk (suicide attempts and suicidal ideation), focusing on bipolar disorder, major depressive disorder, schizophrenia, personality disorders, anxiety disorders, dissociative disorders, and alcohol and substance abuse disorders.
Perioperative care
Authors: Tan Suyin G.M. , Smith Andrew F. , Cyna Allan M.
Published: September 2024

Anaesthetist’s communication can have a profound impact on the patient’s experience in the perioperative period. Patients are highly suggestible during induction of anaesthesia and it is important to avoid nocebo effects (e.g. using negatively valenced words such as sting and pain). Positive suggestions can be highly therapeutic and support enhanced recovery. The ‘GREAT’ template provides a structured approach that is particularly useful in communicating with a patient undergoing emergency surgery. Handover in post-anaesthetic care unit (PACU) should be a structured communication that recognizes the differing priorities of anaesthetists and nursing staff. The ‘GREAT’ template helps structure communication during the acute pain round. Communication should focus on generating positive expectations and avoidance of unintended negative suggestions. The use of therapeutic communication and generation of positive expectations is likely to help enhance analgesic efficacy as well as diminish side effects.
Common fractures and complications
Authors: Sharma Hemant , Sherman Kevin
Published: September 2024

The successful treatment of a patient with a fracture depends on selecting the most appropriate treatment method for the bony injury itself and the careful management of the inevitable associated soft tissue injuries. Many fractures can be treated in more than one way and the method chosen will depend upon many factors. These factors may include the patient’s occupation, general health, the configuration of the fracture, and the integrity of surrounding soft tissue structures. The individual patient’s attitude to relative risk is also important when obtaining informed consent. The management of a fracture involves taking a relevant history, assessing the nature and extent of the injury including both bony and the soft tissue components, dealing expeditiously with any findings that may threaten life or limb or that may lead to an eventual adverse outcome, initial and then definitive treatment. Consideration should also be given to prevention of future injuries.
Benign and malignant skin lesions
Authors: Kang Mandeep , Ward David
Published: September 2024

Early determination between the diagnosis of benign and malignant skin lesions allows for appropriate management regimes to achieve the best long-term prognosis. A presumptive diagnosis can be made by considering the patient’s risk factors, history of the lesion, and its location and appearance. The definitive diagnosis is made by histological examination of biopsy specimens. The three common types of malignant skin lesions are: basal cell carcinoma, squamous cell carcinoma, and malignant melanoma. BCC comprises 60% of primary skin neoplasms. It is slow-growing and rarely metastasizes, and carries the best long-term prognosis. SCC comprises 20% of malignant skin lesions and metastatic disease is more common. MM comprises 1% of malignant skin neoplasms but accounts for over 60% of skin cancer deaths. It metastasizes to remote sites early with a poor prognosis in latter stages. Benign skin lesions generally do not require definitive treatment. Treatment for primary skin malignancies includes surgical excision with adjuvant therapy if required.
Benign and malignant lesions of the head and neck
Authors: Mahmood Ashraf , Ramakrishnan Yujay , Hawthorne Maurice
Published: September 2024

Head and neck cancer is an interesting field, not only due its diverse pathology, but also because there is a myriad of treatment options aided by recent technologic advances (e.g. trans-oral lasers, robotic surgery, intensity modulated radiation treatment). Improved understanding of the biology of tumours on a molecular level has also added a new dimension to treatment through biological agents. To a novice, this area can be bewildering and complex, but underpinning the management of any lesion are certain key basic principles. Initial adequate assessment of the tumour and the patient are fundamental. The treatment options depend on a number of factors related to the tumour, patient and clinical expertise. The chapter describes the major head and neck cancer malignancies. National guidelines are discussed in the clinical context to convey the salient points to the reader. As a prelude, a summary of the clinical assessment is presented.
Prognostic importance of splicing-triggered aberrations of protein complex interfaces in cancer
Authors: Newaz Khalique , Schaefers Christoph , Weisel Katja , Baumbach Jan , Frishman Dmitrij
Published: September 2024

Aberrant alternative splicing (AS) is a prominent hallmark of cancer. AS can perturb protein–protein interactions (PPIs) by adding or removing interface regions encoded by individual exons. Identifying prognostic exon–exon interactions (EEIs) from PPI interfaces can help discover AS-affected cancer-driving PPIs that can serve as potential drug targets. Here, we assessed the prognostic significance of EEIs across 15 cancer types by integrating RNA-seq data with three-dimensional (3D) structures of protein complexes. By analyzing the resulting EEI network we identified patient-specific perturbed EEIs (i.e., EEIs present in healthy samples but absent from the paired cancer samples or vice versa) that were significantly associated with survival. We provide the first evidence that EEIs can be used as prognostic biomarkers for cancer patient survival. Our findings provide mechanistic insights into AS-affected PPI interfaces. Given the ongoing expansion of available RNA-seq data and the number of 3D structurally-resolved (or confidently predicted) protein complexes, our computational framework will help accelerate the discovery of clinically important cancer-promoting AS events.
A framework for the metaphysics of race
Authors: Korman Daniel Z
Published: September 2024

Philosophers have appealed to a wide variety of different factors in providing a metaphysics of race: appearance, ancestry, systems of oppression, shared ways of life, and so-called ‘racial essences’. I distinguish four importantly different questions about racial groups that one may be answering in appealing these factors. I then show that marking these distinctions proves quite fruitful, revealing ways of strengthening existing arguments for the non-existence of racial groups, new avenues for addressing challenges to biological and constructionist accounts of race, and a range of hybrid positions that have been largely overlooked in the literature.
Hygroscopic bioactive light-cured composite promoting dentine bridge formation
Authors: Long Yunzi , Huang Guibin , Liu Siyi , Xu Liju , Li Ailing , Qiu Dong , Dong Yanmei
Published: September 2024

A light-cured bioactive composite, TheraCal LC, is easy to handle and fast-setting. But poor water absorption restricted its bioactivity when applied in direct pulp capping (DPC). Enhancing the water absorption of resin-based bioactive materials may be key to optimizing biomineralization procedure of light-cured bioactive materials. We constructed a hygroscopic, light-cured bioactive composite made up of bioactive glass (BG), poly (ethylene glycol) (PEG) and resin in this study. BG was encapsulated into a porogen (i.e. PEG) and mixed into resin matrix. Inductively coupled plasma showed that light-cured BG (LC-BG) exhibited faster ion release and more ion exchange than TheraCal LC did. The formation of macropores and hydroxyapatite crystal coatings on the BG microparticles was observed using scanning electron microscopy. The shear bond strength between the resin and LC-BG group did not significantly differ from the TheraCal LC group. CCK-8 assay showed that the LC-BG extract was nontoxic. Real-time polymerase chain reaction revealed that LC-BG upregulated odontogenic gene expression in human dental pulp cells. DPC assay proved that the LC-BG group exhibited no significant difference in dentin tubule formation (P = 0.659) or odontoblast-like cell layer formation (P = 0.155) from the TheraCal LC group, but exhibited significantly better integrity of the calcified bridge than the TheraCal LC group (P = 0.039); more DSPP-positive and DMP-1-positive cells were detected in the LC-BG group than in the TheraCal LC group. Although no significant difference in pulpal inflammatory cell infiltration was observed between the LC-BG group and the TheraCal LC group (P = 0.476), fewer interleukin 1β-positive and tumor necrosis factor α-positive cells were detected in the LC-BG group than in the TheraCal LC group. In conclusion, the newly developed hygroscopic LC-BG composite showed better bioactivity and odontogenic differentiation than the TheraCal LC did in vitro and induced better integrity of the calcified bridge than the TheraCal LC did in vivo.
Employee Representation and the Manager-to-Worker Pay Ratio
Authors: Lin Chen , Schmid Thomas , Sun Yang
Published: September 2024

We study how involving employee board representatives in determining managerial compensation affects the within-firm pay ratio. The 2009 German Compensation Act shifted executive pay decisions to the entire supervisory board, amplifying employees’ influence at firms with parity employee representation. This reform resulted in increased manager-to-worker pay ratios, driven by higher managerial compensation, without corresponding changes in firm performance or manager turnover. The result is robust in matched samples and absent in falsification tests. Improved employee job security and weak wage increases point to a possible alliance between employees and managers, indicating shared governance may not necessarily reduce pay inequality.
Effects of night-to-night variations in objectively measured sleep on blood glucose in healthy university students
Authors: Ng Alyssa S C , Tai E Shyong , Chee Michael W L
Published: September 2024

Study Objectives

We examined associations between daily variations in objectively measured sleep and blood glucose in a sample of non-diabetic young adults to complement laboratory studies on how sleep affects blood glucose levels.

Methods

One hundred and nineteen university students underwent sleep measurement using an Oura Ring 2 and continuous glucose monitoring (CGM) for up to 14 days. In 69 individuals who consumed a standardized diet across the study, multilevel models examined associations between sleep duration, timing, efficiency, and daily CGM profiles. Separately, in 58 individuals, multilevel models were used to evaluate postprandial glycaemic responses to a test meal challenge on 7 days. Participants also underwent oral glucose tolerance testing once after a night of ad libitum sleep, and again following a night of sleep restriction by 1–2 hours relative to that individual’s habitual sleep duration. Between-condition glucose and insulin excursions, HOMA-IR and Matsuda index were compared.

Results

Nocturnal sleep did not significantly influence following-day CGM profiles, postprandial glucose, or nocturnal mean glucose levels (all ps > .05). Longer sleep durations were associated with lower same-night glucose variability (all ps < .001). However, the range of variation in sugar levels was small and unlikely to be of functional significance. Considering naps in the analysis did not alter the findings. Sleep restriction by an average of 1.73 hours (SD = 0.97) did not significantly impact excursions in glucose or insulin or insulin sensitivity the following morning (all ps > .05).

Conclusions

Glucose handling in young, healthy adults may be more resilient to real-life fluctuations in sleep patterns than previously thought.

Clinical Trial Information

Monitoring Sleep and Glucose Among University Students https://clinicaltrials.gov/study/NCT04880629, ID: NCT04880629
Factors associated with successful FLOW implementation to improve mental health access: a mixed-methods study
Authors: Hundt Natalie E , Kim Bo , Plasencia Maribel , Amspoker Amber B , Walder Annette , Yusuf Zenab , Nagamoto Herbert , Tsao Christie Ga-jing , Smith Tracey L
Published: September 2024

The FLOW program assists mental health providers in transitioning recovered and stabilized specialty mental health (SMH) patients to primary care to increase access to SMH care. In a recent cluster-randomized stepped-wedge trial, nine VA sites implemented the FLOW program with wide variation in implementation success. The goal of this study is to identify site-level factors associated with successful implementation of the FLOW program, guided by the Consolidated Framework for Implementation Research (CFIR). We used the Matrixed Multiple Case Study method, a mixed-methods approach, to compare key metrics hypothesized to impact implementation that were aligned with CFIR. Based upon the number of veterans transitioned at each site, we categorized two sites as higher implementation success, three as medium, and four as lower implementation success. Themes associated with more successful implementation included perceptions of the intervention itself (CFIR domain Innovation), having a culture of recovery-oriented care and prioritizing implementation over competing demands (CFIR domain Inner Setting), had lower mental health provider turnover, and had an internal facilitator who was well-positioned for FLOW implementation, such as having a leadership role or connections across several clinics (CFIR domain Characteristics of Individuals). Other variables, including staffing levels, leadership support, and organizational readiness to change did not have a consistent relationship to implementation success. These data may assist in identifying sites that are likely to need additional implementation support to succeed at implementing FLOW.
The Nonsilent Assault on Democracy
Authors: Coleman Christopher Lance
Published: September 2024

Ending voter disenfranchisement
Critical Appraisal of Evidence for DNP-Prepared Nurses
Authors: Fineout-Overholt Ellen , Hays Deana , Farus-Brown Susan , Zonsius Mary C. , Milner Kerry A.
Published: September 2024

This is the fourth article in a new series designed to provide readers with insight into educating nurses about evidence-based decision-making (EBDM). It builds on AJN's award-winning previous series—Evidence-Based Practice, Step by Step and EBP 2.0: Implementing and Sustaining Change (to access both series, go to https://links.lww.com/AJN/A133). This follow-up series on EBDM will address how to teach and facilitate learning about the evidence-based practice (EBP) and quality improvement (QI) processes and how they impact health care quality. This series is relevant for all nurses interested in EBP and QI, especially DNP faculty and students. The brief case scenario included in each article describes one DNP student's journey. To access previous articles in this EBDM series, go to https://links.lww.com/AJN/A256.
Thromboembolic Complications in Continuous Versus Interrupted Anticoagulation During Venovenous Extracorporeal Membrane Oxygenation: A Multicenter Study
Authors: Miller William , Braaten Jacob , Rauzi Anna , Wothe Jillian , Sather Kristiana , Phillips Angela , Evans Danika , Saavedra-Romero Ramiro , Prekker Matthew , Brunsvold Melissa E.
Published: September 2024

OBJECTIVES:

Continuous, therapeutic anticoagulation is the standard of care for patients on extracorporeal membrane oxygenation (ECMO). The risks of hemorrhage exacerbated by anticoagulation must be weighed with the thrombotic risks associated with ECMO. We hypothesized increased thrombotic events in patients who had interrupted (vs. continuous) anticoagulation during venovenous ECMO.

DESIGN:

This is a retrospective, observational study.

SETTING:

Enrollment of individuals took place at three adult ECMO centers in Minnesota from 2013 to 2022.

PATIENTS:

This study consists of 346 patients supported with venovenous ECMO.

INTERVENTIONS:

Anticoagulation administration was collected from electronic health records, including frequency and duration of anticoagulation interruptions (IAs) and timing and type of thrombotic events, and data were analyzed using descriptive statistics.

MEASUREMENTS AND MAIN RESULTS:

A total of 156 patients had IA during their ECMO run and 190 had continuous anticoagulation. Risk adjusted logistic regression demonstrated that individuals in the IA group were not statistically more likely to experience a thrombotic complication (odds ratio [OR], 0.69; 95% CI, 0.27–1.70) or require ECMO circuit change (OR, 1.36; 95% CI, 0.52–3.49). Subgroup analysis demonstrated greater frequency of overall thrombotic events with increasing frequency and duration of anticoagulation being interrupted (p = 0.001).

CONCLUSIONS:

Our multicenter analysis found a similar frequency of thrombotic events in patients on ECMO when anticoagulation was interrupted vs. administered continuously. Further investigation into the impact of the frequency and duration of these interruptions is warranted.
Re-visioning of a Nursing Informatics Course With Translational Pedagogy
Authors: DeGrande Heather , Perez Miguel
Published: September 2024

For nurse leaders to excel in leadership roles in the clinical world of informatics, a comprehensive understanding of nursing informatics as translated within the broader scope of health informatics including clinical informatics and business intelligence is necessary. The translation of nursing informatics in the comprehensive scope of health informatics is not consistently taught in graduate nursing leadership curricula. Collaboratively, from an interprofessional education stance, a graduate nurse informatics course was re-visioned using translational pedagogy: the idea of teaching related concepts by translating each and vice versa. Specifically, we translated nursing informatics amid health informatics concepts including business intelligence. Leadership students in the re-visioned course experienced the ability to visualize, conceptualize, and understand how work in information systems impacts broader aspects of clinical and business decision-making. Looking at nursing informatics through the lens of health informatics will develop students' ability to visualize, conceptualize, and understand how work in information systems has an impact on the broader aspects of clinical decision-making and support. Further, this paradigm shift will enhance students' ability to utilize information systems in leadership decision-making as future knowledge workers.
Impact of Needle Design and Suture Gauge on Tissue Tearing During Skin Suturing: A Comparative Analysis
Authors: Potter Christian T. , Maloney McKenzie E. , Riopelle Alexandria M. , Fudem Gary M. , Schanbacher Carl F.
Published: September 2024

BACKGROUND

Surgeons face numerous choices in selecting sutures for skin closure, with potential adverse effects such as tissue tearing.

OBJECTIVE

To investigate the influence of needle design and suture gauge on tissue tearing during suturing procedures.

MATERIALS AND METHODS

The authors tested the tear-through force in Newtons for 3 needle types and 3 suture gauges using an artificial skin model and a professional-grade tensiometer. Suture material was secured into the skin model, and force was applied to the suture at a constant rate, resulting in tearing. Force–displacement and force–time curves were generated. Evaluation included conventional cutting (PC-3), reverse cutting (PS-3), and taper point (BB) needles with a 5-0 polypropylene suture. In addition, nylon sutures with a reverse cutting needle (PS-2) were tested at 3 suture gauges (5-0, 4-0, 3-0).

RESULTS

The mean tear-through forces for PC-3, PS-3, and BB were 3.26 N, 3.75 N, and 4.07 N, respectively. For the 5-0, 4-0, and 3-0 nylon sutures, the mean tear-through forces were 3.44 N, 3.81 N, and 4.04 N, respectively. Statistical analysis revealed a significant impact of suture gauge size (p < .001) and needle geometry (p < .001) on tear-through force.

CONCLUSION

Larger suture diameter and taper needles minimize tissue tearing.
Associations of pre- and postnatal per- and polyfluoroalkyl substance exposure with adolescents’ eating behaviors
Authors: Vasil Taylor-Marie , Fleury Elvira S. , Walker Erica D. , Kuiper Jordan R. , Buckley Jessie P. , Cecil Kim M. , Chen Aimin , Kalkwarf Heidi J. , Lanphear Bruce P. , Yolton Kimberly , Braun Joseph M.
Published: September 2024

Background:

Per- and polyfluoroalkyl substances (PFAS), persistent environmental chemicals, may act as obesogens by interacting with neuroendocrine pathways regulating energy homeostasis and satiety signals influencing adolescent eating behaviors.

Methods:

In 211 HOME Study adolescents (Cincinnati, OH; recruited 2003–2006), we measured PFAS concentrations in serum collected during pregnancy, at delivery, and at ages 3, 8, and 12 years. Caregivers completed the Child Eating Behavior Questionnaire (CEBQ) at age 12, and we calculated food approach and food avoidance scores. Using quantile-based g-computation, we estimated covariate-adjusted associations between a mixture of four gestational PFAS and CEBQ scores. We identified high (n = 76, 36%) and low (n = 135, 64%) longitudinal PFAS mixture exposure profiles between delivery and age 12 years using latent profile analysis and related these to CEBQ scores. We examined whether child sex or physical activity modified these associations.

Results:

We observed no association of gestational PFAS mixture with food approach or food avoidance scores. Children in the higher longitudinal PFAS mixture profile had slightly higher food approach scores (β: 0.47, 95% CI: −0.27, 1.23) and similar food avoidance scores (β: −0.15, 95% CI: −0.75, 0.46) compared with children in the lower profile. We found some evidence that higher physical activity favorably modified the association between longitudinal PFAS mixture profiles and emotional overeating (interaction P value = 0.13). Child sex did not consistently modify any associations.

Conclusions:

Serum PFAS concentrations were not consistently linked to adolescent eating behaviors in this study, suggesting alternative pathways, such as metabolic rate, may underlie previously observed associations between PFAS exposure and childhood obesity.
Providing Physical Therapy Interventions for a Patient After Heart Transplantation in the Acute Care Setting
Authors: Lee Vanessa , MacFarlane Sheena , Romano Gabrielle
Published: September 2024

Background and Purpose:

Heart transplantation frequency is increasing in the United States with 4545 procedures in 2023. Most research for physical therapy interventions for heart transplant (HT) recipients addresses outpatient cardiac rehabilitation with limited research in phase I cardiac rehabilitation. This case report describes clinical decision-making related to physical therapy interventions and demonstrates effectiveness utilizing multiple outcome measures for a HT recipient in phase I cardiac rehabilitation.

Case Description:

A 60-year-old male received a HT. Physical therapy was initiated 3 days postoperatively with multiple impairments and activity limitations identified. The patient participated in 14 physical therapy sessions over 22 hospital days. In week 1, intervention prescription focused on functional and strength training. In week 2, improved functional status allowed for endurance training. In week 3, balance training and home safety education were added in anticipation of hospital discharge.

Outcomes:

The patient participated in 100% of sessions in which he was medically stable. The patient demonstrated clinically meaningful improvement in functional capacity on the JH-HLM (5-point improvement, exceeds MDC of 0.6) and in aerobic capacity on the 6MWT (80-meter improvement, exceeds MCID of 54 meters).

Discussion and Conclusion:

This case report provides a framework for physical therapists regarding intervention prescription, progression, use of outcome measures, and physiologic considerations for a HT recipient participating in phase I cardiac rehabilitation. More research is needed. In conclusion, this case report demonstrates that phase I cardiac rehabilitation is effective in improving functional and aerobic capacity in a HT recipient.