bluuebunny/crossref_metadata_2025 huggingface dataset:
Developing cue-behavior association for habit formation: A qualitative study to explore the role of avatar in hypertension
Authors: Zhu Yujie , Long Yonghao , Wei Lai , Zhang Yaqi , Ma Zhengtao , Lee Kun-Pyo , Zhang Lie , Wang Stephen J.
Published: August 2024

Background

Electronic health (eHealth) has been widely adopted in chronic disease management. Prior studies focused on time-based reminders as a cue to facilitate behavior change intentions, ignoring the development of automatic cue-behavior associations via other cue types.

Objective

Hence, this study utilized avatar appearance as a visual-based cue to help establish the automatic association between appearance transformation and health behavior to form habits without intention.

Methods

To better understand users’ attitudes and experiences toward applying changes in avatar appearance to develop cue-behavior associations for hypertensive patients. Fifteen participants were recruited in a 14-day experiment. After excluding one participant who dropped out of the experiment, others were randomly assigned to two groups. One group consisted of a visual-based cue (a virtual plant) and basic behavior change techniques (BCTs). The other group only included basic BCTs. Attitudes and experience outcomes were collected by interview, and qualitative data were analyzed using thematic analysis.

Results

57% of participants had been diagnosed with hypertension for more than five years, and more than 50% of participants have experience using mobile apps or wearables. 66% of participants did physical activity more than three times every week. The result shows that tailored time-based reminders, blood pressure monitoring, and daily dietary intake were the most attractive features. Additionally, hypertensive participants have positive attitudes toward avatar appearance as a visual-based cue to develop cue-behavior association, which enhances self-management motivation.

Conclusion

This study proposes a visual-based cue design for habit formation and conducts a qualitative method to explore hypertensive patients’ perceptions. The findings offer insights from user's perspectives into hypertensive patients’ attitudes toward visual-based cues and perception of the connection between avatar appearance and health behavior for self-management. Subsequent discussions present eHealth design guidelines of habit formation from intention, automatic cue-behavior association, and self-management perspectives.
Music Listening for Self-Management of Anxiety: A Qualitative Survey
Authors: Taipale Marianne , Peltola Henna-Riikka , Saarikallio Suvi , Minkkinen Gulnara , Randall William M. , Carlson Emily
Published: August 2024

Anxiety is among the most commonly experienced affective states—prominent in both everyday emotions, and a range of mood disorders. Music seems to be an effective tool for managing negative mood states, but recent research indicates that anxiety may be a particularly challenging state to self-regulate, even for those without diagnosed anxiety disorders. In this study, the use of music for anxiety self-management in everyday life is explored. Data consist of free descriptions by adult participants ( N = 36), collected through an online survey and analyzed with data-led thematic analysis. Findings indicate that music listening is often considered helpful with milder states of anxiety—particularly when an individual has control over the choice of music—and that different regulatory strategies are required to deal with different forms of anxiety. These strategies can provide help in a number of ways, such as recognizing or validating emotions, or positive refocusing. In future research, the possibility of unrecognized maladaptive strategies in music listening should be addressed, as well as the mechanisms behind avoidance of music related to high levels of anxiety.
Development and Validation of the Chinese Trust Scale: A Culturally Appropriate Measure Based on the Three-Factor Model of Chinese Trust
Authors: Xie Yunzi , Zhang Zhengmin , Wu Jixia , He Wenjing
Published: August 2024

Numerous studies have shown that trust has cross-cultural differences. Currently, China has limited tools and scales for measuring trust. Referring to Wu and Huang’s three-factor model of Chinese trust, we develop a Chinese Trust Scale (CTS) for Chinese people and measure its reliability and validity. This scale contains 20 items and three factors: (1) public awareness, (2) trust from others, and (3) trust in others. We explore the dimensions and preliminary items of the CTS using item analysis and exploratory factor analysis on one sample ( N = 551) and confirmatory factor analysis on a second sample ( N = 831) to replicate the suggested factor structure and validate the scale’s reliability and validity. Both the overall and subscale scores of the CTS were significantly correlated with inclusive general trust, belief in a just world, social capital, and satisfaction with life. The results suggest that newly developed CTS could be an effective tool for Chinese trust measurement.
Gender Order, Microcelebrities, and the COVID-19 Pandemic: A Corpus-Assisted Discourse Analysis of the Representation of Wanghong Women in China’s English-Language Newspapers
Authors: Yilei Wang , William Dezheng Feng , Hua Wang
Published: August 2024

The term “ wanghong women” has been in a state of flux in China’s public discourse since its inception in 2015. In particular, the COVID-19, while causing major economic setbacks across the world, has, to some extent, boosted the growth of the wanghong industry and altered public attitude towards wanghong women in China. Against this background, this study aims to investigate how wanghong women are linguistically represented in the six leading official English language newspapers in China. A corpus-assisted discourse analysis of 156 English news articles (i.e., 140,931 words), covering the years between 2015 and 2022, was conducted. The study revealed a significant attitudinal shift in the editorial stance on China’s wanghong women phenomenon since the COVID-19 epidemic: the semantic prosodies of the word “ wanghong” has shifted from women who are stereotypically young, fashionable, and attract online attention by using pretty face and sexualized body shape to women who can boost the national digital economy, contribute to the state’s agenda of rural regeneration, and help spread timely instructions regarding the pandemic. The findings shed new light on the evolving Chinese gender politics which is shaped by the entangled forces of traditional patriarchy, commercialization, and the government’s crisis management strategies during the pandemic.
Navigating Perioperative Pain: Interventions and Recommendations for Surgical Nurses
Authors: Shank Bettina , Black Amy
Published: August 2024

The pediatric surgical nurse has the unique opportunity to serve the pediatric population whose care needs vary across the span from neonatal to adolescence. The skillset and unique understanding of the individual pediatric patient and associated age are crucial. Ensuring the patient has an optimal experience with effective pain management is essential while providing care. Education and counseling begin during the perioperative phase and continue through each phase. Effective communication among the team is essential and the pain experience can be optimized through education, reduction of anxiety, effective communication, and the implementation of nonpharmacological and pharmacological interventions.
Utilizing the PDSA Cycle to Achieve Optimal Bed Utilization and Improve the Efficiency of a Chemotherapy Day Care Unit
Authors: Pathan Asma , Joshi Manjiri , Sugandhi Karishma , Ramani Vinod K. , Kannan Ravi , Sprujit Odette , Lewis Shirley
Published: August 2024

Introduction

Chemotherapy daycare units (CDU) routinely face difficulties, given the waiting time and work pressure. The study objectives include determining the feasibility of a multidisciplinary intervention in facilitating the growth in CDU bed utilization by ∼20%.

Methods

The quasi-experimental study was conducted during the period 1st May 2021 to 28th February 2022. The strategies of the healthcare improvement project are structured as per the Plan-Do-Study-Act (PDSA) cycle. ‘Lean thinking’ approach using the A3 sheet tool was applied, as its focus is on organization of processes. Benchmarking technique was used to attain more insight into the optimal performance levels.

Results

Plan phase: The tracks of CDU process were mapped using the ‘process flow diagram’ technique. The reasons for the perceived bed shortage and high work pressure were revealed by the Root cause analysis, which includes the 21 prioritized problem areas. Do phase: Various interventions were implemented in the domains of communication systems, developing standard operating protocols and human resource management. Study phase: 9 of the total 21 problem areas were cumulatively responsible for ∼80% of underutilization of CDU beds. Act phase: The planned intervention resulted in an increase in the proportion of CDU bed utilization from 60% (18-20 patients/day) to 75% (23-25 patients/day).

Conclusion

The PDSA cycle offered optimal structure to this efficiency improvement initiative. The project outcomes were enhanced by the combination of approaches such as lean thinking and benchmarking.
Detention, death, and deportation: (Re)bordering Brazilian migrants under Bolsonarism and the pandemic
Authors: Dias Gustavo , Ribeiro Bruno Nzinga , França Isadora Lins
Published: August 2024

This paper addresses the relations between migrants, (im)mobility, the COVID-19 pandemic, and the Bolsonaro administration (2019–2022). It particularly explores the extent to which his government endorsed the rise of abusive US border control policies against Brazilian immigrants during the COVID-19 pandemic. The empirical focus of the paper analyses how Brazilians struggled with the implementation of the US’s controversial Title 42 expulsions during the Bolsonaro administration and the Coronavirus pandemic. There has been a sharp increase in deaths, arbitrary detentions, and deportations of Brazilians from the US since the Trump administration, which was aggravated by the alignment of the Brazilian government with US border control policies towards Latin America. This combined with Bolsonaro’s closure of embassies, secretariats, and councils that had been dedicated to representing Brazilians abroad, had strong impacts, especially among those who migrated to escape the historical socioeconomic crisis in Brazil since 2015, intensified by COVID-19. The empirical data presented in this study comes from a digital and press archive we compiled using official data provided by the Confins International Airport, the US Yearbook of Immigration Statistics, news from digital media, and a critical literature review focused on migration, mobility, and border controls. In addition to not seeking solutions for the economic and social motives driving the departure of Brazilians, the Bolsonaro government endorsed the US’s anti-migration agenda and cut programs to meet the needs of Brazilians abroad.
Storytelling dreams and life: Traveling across worlds in the Amazon of Ecuador
Authors: Noroña María Belén
Published: August 2024

In response to the expansion of the mining frontier in the Ecuadorian Amazon, rural and Indigenous women are leading processes that resist mining-related violence while reconfiguring colonial power dynamics. Although women's efforts have become visible through regional grassroots organizing, public protests, marches, political manifestos, and bodily organized resistance to mining, little is written about the long-term processes, social relations, and epistemologies women use to contest power. This article illuminates “Storytelling Dreams and Life,” a Kichwa epistemology aimed at communicating and networking across colonial differences while building support networks across scales. It relies on dreams and testimonies that speak of women's relationships with the forest, including more than humans: animals, insects, and bodies of water. Women understand their bodies and livelihoods as intrinsically tied to the forest. Defense struggles are about upholding relational forest interdependences and politicizing domestic and reproductive care practices that make life possible. Women's storytelling provides us with an epistemology and a decolonial and communications methodology that requires sharing intimate accounts of mining-related violence and resistance. The sharing is emotional and vivid as it aims at bringing interlocutors as close as possible to the teller's experience. I argue women's epistemic practices enable intersubjective understandings of each other's experiences and, therefore, a way to travel into each other's worlds across bodies while furthering women's support networks across scales. Women's storytelling adds to Communitarian Feminisms and its efforts to decolonize hierarchization in organized struggles, and it adds to Body-Territory epistemology by specifying how knowledge and struggles both shaped and are shaped by forest relational worldviews.
Accessibility to Health Care Services and Treatment for People with Noncommunicable Diseases in Northwest Syria
Authors: Ballout Kassem , Mehmet Orhun Nimetcan
Published: August 2024

We assessed the accessibility to health care services and treatment for people with noncommunicable diseases (NCDs) in Northwest Syria after more than eleven years of the worst humanitarian crisis in Syria. Included in this cross-sectional study were people with one or more of cardiovascular diseases, diabetes, cancer, or chronic obstructive pulmonary diseases; people from both Aleppo and Idleb governorates; and residents from both inside and outside the camp. Data were collected in November 2022 via face-to-face interviews. The findings were obtained from 674 respondents (52.8% female). Respondents in Idleb were 6.5 times more likely to access health care services than Aleppo ( p = 0000). In-camp residents were 1.5 times more likely to access outreach health services ( p = 0.020). Respondents with higher income were three times more likely to access health care services compared to respondents with lower income ( p = 0.000). Having any of the surveyed NCDs made the respondents less likely to get the required services. The study findings added more evidence about the inequity in terms of accessing health care services in Northwest Syria and identified the barriers. It was clear that a perceived group of people with NCDs do not have access to the health care services, including outreach health services and free medications.
Pediatric adapted risk index to predict 2-year transplant-related mortality post-HSCT in children
Authors: Elfeky Reem , Builes Natalia , Pearce Rachel , Kania Soumya , Nademi Zohreh , Lucchini Giovanna , Chiesa Robert , Amrolia Persis , Sorror Mohamed , Veys Paul , Rao Kanchan
Published: August 2024

Several attempts have been made to optimize pretransplant risk assessment to improve hematopoietic stem cell transplantation (HSCT) decision-making and to predict post-HSCT outcomes. However, the relevance of pretransplant risk assessment to the pediatric population remains unclear. We report the results of revalidation of the hematopoietic cell transplantation comorbidity index (HCT-CI) in 874 children who received 944 HSCTs for malignant or nonmalignant diseases at a single center. After finding the HCT-CI invalid in our patient population, we proposed a modified pediatric adapted scoring system that captures risk factors (RFs) and comorbidities (CoMs) relevant to pediatrics. Each RF/CoM was assigned an integer weight based on its hazard ratio (HR) for transplant-related mortality (TRM): 0 (HR < 1.2), 1 (1.2 ≥ HR < 1.75), 2 (1.75 ≥ HR < 2.5), and 3 (HR ≥ 2.5). Using these weights, the pediatric adapted risk index (PARI) for HSCT was devised, and patients were divided into 4 risk groups (group 1: without RF/CoM; group 2: score 1-2; group 3: score 3-4; and group 4: score ≥5). There was a linear increase in 2-year TRM from group 1 to 4 (TRM, 6.2% in group 1, 50.9% in group 4). PARI was successfully validated on an internal and external cohort of pediatric patients. Comparing models using c-statistics, PARI was found to have better performance than HCT-CI in predicting 2-year TRM in children, with Akaike and Schwarz Bayesian information criteria values of 1069.245 and 1073.269, respectively, using PARI, vs 1223.158 and 1227.051, respectively, using HCT-CI. We believe that PARI will be a valuable tool enabling better counseling and decision-making for pediatric patients with HSCT.
Effect of enhanced plane of nutrition in early life on the transcriptome and proteome of the anterior pituitary gland in Angus heifer calves
Authors: Keogh Kate , Kelly Alan K. , Kenny David A.
Published: August 2024

Background

Enhanced nutrition during the early calfhood period has been shown to lead to earlier pubertal development in heifer calves. This is of interest as earlier pubertal onset can subsequently facilitate earlier calving which can economically benefit production systems. Reproductive development in heifers is regulated by the hypothalamic-pituitary-ovarian signalling pathway. In particular the anterior pituitary gland is central to reproductive development, through the dynamics of gonadotropic pulsatility. However, despite clear knowledge of the influence of enhanced dietary intake on subsequent reproductive development, the molecular control governing this response in the pituitary gland within the hypothalamic-pituitary-ovarian signalling axis in heifer calves is not fully understood. The objective of this study was to examine the effect of an enhanced plane of nutrition during early life on the anterior pituitary gland of heifer calves through both transcriptomic and proteomic analyses. Between 3 and 21 weeks of age, heifer calves were offered either a high (HI, n = 14) or moderate (MOD, n = 14) plane of nutrition, designed to elicit target growth rates of 1.2 and 0.5 kg/d for HI and MOD groups, respectively. All calves were euthanised at 21 weeks of age and anterior pituitary tissue harvested for subsequent use in global transcriptomic and proteomic analyses.

Results

Average daily gain was affected by diet (P < 0.001) and was 1.18 and 0.50 kg/day, for HI and MOD calves, respectively. RNAseq analysis resulted in the identification of 195 differentially expressed genes (Padj<0.05; fold change > 1.5), with 277 proteins identified as differentially abundant (Padj<0.05; fold change > 1.5) between contrasting dietary treatment groups. Biochemical pathway analysis of differentially affected genes and proteins revealed an enrichment for both growth hormone and GnRH signalling pathways (Padj.<0.05). Additionally, pathway analysis predicted an effect of enhanced dietary intake on endocrine function within the anterior pituitary gland as well as on reproductive system development and function (Padj.<0.05).

Conclusions

Results from this study show that an enhanced dietary intake during early calfhood affected the molecular control of the anterior pituitary gland in heifer calves in early life.
Comorbidity in primary care – causal or casual? A longitudinal observational study in family medicine
Authors: Soler Jean K. , Buono Nicola , Okkes Inge
Published: August 2024

Background

Comorbidity is increasingly important in the medical literature, with ever-increasing implications for diagnosis, treatment, prognosis, management and health care. The objective of this study is to measure casual versus causal comorbidity in primary care in three family practice populations.

Methods

This is a longitudinal observational study using the Transition Project datasets. Transition Project family doctors in the Netherlands, Malta and Serbia recorded details of all patient contacts in an episode of care structure using electronic medical records and the International Classification of Primary Care, collecting data on all elements of the doctor-patient encounter, including diagnoses (1,178,178 in the Netherlands, 93,606 in Malta, 405,150 in Serbia), observing 158,370 patient years in the Netherlands, 43,577 in Malta, 72,673 in Serbia. Comorbidity was measured using the odds ratio of both conditions being incident or rest-prevalent in the same patient in one-year dataframes, as against not, corrected for the prior probability of such co-occurrence, between the 41 joint most prevalent (joint top 20) episode titles in the three populations. Specific associations were explored in different age groups to observe the changes in odds ratios with increasing age as a surrogate for a temporal or biological gradient.

Results

The high frequency of observed comorbidity with low consistency in both clinically and statistically significant odds ratios across populations indicates more casual than causal associations. A causal relationship would be expected to be manifest more consistently across populations. Even in the minority of cases where odds ratios were consistent between countries and numerically larger, those associations were observed to weaken with increasing patient age.

Conclusion

After applying accepted criteria for testing the causality of associations, most observed primary care comorbidity is due to chance, likely as a result of increasing illness diversity.

Trial registration

This study was performed on electronic patient record datasets made publicly available by the University of Amsterdam Department of General Practice, and did not involve any patient intervention.
The relationship between low and asymmetric handgrip strength and low muscle mass: results of a cross-sectional study on health and aging trends in western China
Authors: Huang Sha , Chen Xiaoyan , Ding Huaying , Dong Birong
Published: August 2024

Objective

The aim was to determine the relationship between low handgrip strength (HGS) only, asymmetric HGS only, and low HGS combined with asymmetric HGS and low muscle mass in the West China Health and Aging Trends Study (WCHAT) data.

Study design

Individuals aged at least 50 years old were included in this cross-sectional study using WCHAT data. Demographic characteristics, such as age, marital status, education level, ethnicity, and drinking and smoking history, as well as chronic diseases, were recorded for all participants. The HGS of both hands was tested three times using a grip dynanometer with the participant in a standing position with arms extended, before recording the maximum value for both hands. The maximum value referred to values < 28 kg and < 18 kg for males and females, respectively. HGS ratios (non-dominant HGS/dominant HGS) of < 0.90 or > 1.10 suggest asymmetric HGS. The subjects were then allocated to the low HGS, asymmetrical HGS, and combined low and asymmetrical HGS (BOTH group) groups, and those with neither low nor asymmetric HGS (the normal group). The InBody 770 instrument was used for the analysis of muscle mass, with low muscle mass defined as a skeletal muscle mass index (SMI) of < 7.0 kg/m2 or < 5.7 kg/m2 for males and females, respectively. The associations between the different HGS groups and low muscle mass were assessed by logistic regression analysis.

Results

The study included 1748 subjects, of whom 1272 (72.77%) were over the age of 60 years. The numbers of Han, Tibetan, and Qiang were 885 (50.63%), 217 (12.41%), and 579 (33.12%), respectively. A total of 465 individuals (26.60%) were classified as having low muscle mass, while 228 (13.04%), 536 (30.66%), and 125 (7.15%) participants were allocated to the low HGS, asymmetric HGS, and BOTH groups, respectively. The average SMI differed significantly between the normal group and the other groups (normal group vs. asymmetric HGS group vs. low HGS group vs. BOTH group: 6.627 kg/m2 vs. 6.633 kg/m2 vs. 6.492 kg/m2 vs. 5.995 kg/m2, respectively, P < 0.05). In addition, the prevalence of low muscle mass in the normal, asymmetric HGS, low HGS, and BOTH groups increased sequentially, with significant differences (normal group vs. asymmetric HGS group vs. low HGS group vs. BOTH group: 21.5% vs. 22.4% vs. 39.5% vs. 56%, respectively, P = 0.001). Further logistic regression analysis showed that the presence of low HGS (OR = 1.7, 95%CI: 1.203–2.402) and both low and asymmetric HGS (OR = 3.378, 95%CI: 2.173–5.252) were predictive of low muscle mass, with the chance being higher for the latter condition.

Conclusion

The findings suggest that although asymmetrical HGS itself does not increase the chances of low muscle mass. When low HGS and a combination of both features (low HGS combined with asymmetric HGS) is present in subjects, the chance of low muscle mass increases.
Pathways to experienced coercion during psychiatric admission: a network analysis
Authors: Silva Benedetta , Morandi Stéphane , Bachelard Mizue , Bonsack Charles , Golay Philippe
Published: August 2024

Background

In mental health care, experienced coercion, also known as perceived coercion, is defined as the patient’s subjective experience of being submitted to coercion. Besides formal coercion, many other factors have been identified as potentially affecting the experience of being coerced. This study aimed to explore the interplay between these factors and to provide new insights into how they lead to experienced coercion.

Methods

Cross-sectional network analysis was performed on data collected from 225 patients admitted to six psychiatric hospitals. Thirteen variables were selected and included in the analyses. A Gaussian Graphical Model (GGM) using Spearman’s rank-correlation method and EBICglasso regularisation was estimated. Centrality indices of strength and expected influence were computed. To evaluate the robustness of the estimated parameters, both edge-weight accuracy and centrality stability were investigated.

Results

The estimated network was densely connected. Formal coercion was only weakly associated with both experienced coercion at admission and during hospital stay. Experienced coercion at admission was most strongly associated with the patients’ perceived level of implication in the decision-making process. Experienced humiliation and coercion during hospital stay, the most central node in the network, was found to be most strongly related to the interpersonal separation that patients perceived from staff, the level of coercion perceived upon admission and their satisfaction with the decision taken and the level of information received.

Conclusions

Reducing formal coercion may not be sufficient to effectively reduce patients’ feeling of being coerced. Different factors seemed indeed to come into play and affect experienced coercion at different stages of the hospitalisation process. Interventions aimed at reducing experienced coercion and its negative effects should take these stage-specific elements into account and propose tailored strategies to address them.
Treatment options for impacted maxillary canines and occurrence of ankylotic and resorptive processes: a 20-year retrospective study
Authors: Cernochova Pavlina , Cernoch Cenek , Klimo Kanovska Karin , Tkadlec Emil , Izakovicova Holla Lydie
Published: August 2024

Background

This 20-year retrospective study aimed to evaluate the treatment methods used in patients with impacted maxillary permanent canines and to determine the occurrence of ankylotic and resorptive processes and their association with potential risk factors.

Methods

The cohort consisted of 351 consecutive Caucasian patients (120 males and 231 females, mean age 18.4 and 19.9 years, respectively) with 420 impacted maxillary permanent canines. CT and CBCT findings were subsequently confirmed during surgery. Statistical analyses were performed by the generalized linear models, Pearson x2 and Fisher exact tests using the statistical programs R and Statistica v. 14.

Results

A total of 273 (65.0%) impacted canines were aligned in the dental arch by orthodontic traction after surgical exposure, this treatment was predominant in patients under 20 years of age. Surgical extraction was performed in 115 (27.2%) impacted canines and was more common in older patients. Ankylotic changes were recorded in 61 (14.5%) impacted canines. The probability of ankylosis increased with age, particularly after the patient’s 20th year of life (p < 0.001). Patients were 1.2% likely to develop ankylosis at age 15 years, 4.3% at age 20 years, 14.1% at age 25 years, and 96.8% at age 45 years. Invasive cervical root resorption (ICRR) was found in 8 (1.9%) canines. In 4 canines (1.0%), root ankylosis in addition to ICRR was observed. In contrast to ankylosis, whose frequency of occurrence increased with age, the occurrence of ICRR resulting from PDL damage during surgery was more typical in younger patients. Canines in a high position above the root apices of the adjacent teeth, with a horizontal inclination of the longitudinal axis, with the crown located deep in the center of the alveolar bone and with labiopalatal position, should be considered critically impacted canines with a high risk to failure of orthodontic traction.

Conclusion

In conclusion, the treatment of impacted canines depends mainly on the age of the patient, and the position and inclination of the longitudinal axis of the impacted tooth. To select an adequate treatment method, we recommend CBCT examination, which allows a precise analysis of the position of impacted canines.
Moral courage level of nurses: a systematic review and meta-analysis
Authors: Li Hang , Guo JuLan , Ren ZhiRong , Bai Dingxi , Yang Jing , Wang Wei , Fu Han , Yang Qing , Hou Chaoming , Gao Jing
Published: August 2024

Background

Moral distress occurs in daily nursing work and plagues nurses. Improving the level of moral courage is one of the main strategies to reduce moral distress, and low levels of moral courage may lead to nurse burnout, increased turnover, and reduced quality of care.

Methods

Nine electronic databases in Chinese and English were searched for the level of moral courage among nurses, including PubMed, Web of Science, EMBASE, CINAHL, CNKI, Wan fang, Wei pu, CBM and Cochrane Library, for the period from the date of database creation to April 5, 2023. The Agency for Healthcare Research and Quality (AHRQ) was used to assess the methodological quality of the included studies, followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Meta-analysis and Systematic Reviews of Observational Studies guidelines, and data from the included studies were meta-analyzed in STATA version 15 using a fixed-effects model.

Results

Seventeen cross-sectional studies of moderate or high quality met the eligibility criteria and involved 7718 nurses, and the Nurses’ Moral Courage Scale (NMCS) was used to measure the self-assessed moral courage level of nurses. Eleven of these studies reported total scores for nurses’ moral courage, and the meta-analysis results showed a pooled mean score of 78.94 (95% CI: 72.17, 85.72); Fourteen studies reported mean entry scores for nurses’ moral courage, and the meta-analysis results showed a pooled mean score of 3.93 (95% CI: 3.64, 4.23).

Conclusion

The results of the meta-analysis showed that nurses’ moral courage levels were in the medium to high range, among the nurses who seemed to be male, non-nursing managers, high school education, had not experienced ethical issues, and considering resignation had lower levels of moral courage. The results of the meta-analysis may provide some reference for nursing managers and even hospital administrators to develop strategies to optimize nursing quality.
The role of workday characteristics on perceived stress and time pressure among nurses in Finnish long-term care – a cross-sectional study
Authors: Väisänen Visa , Ruotsalainen Salla , Hietapakka Laura , Sulander Juhani , Sinervo Timo
Published: August 2024

Background

Aging populations and nursing workforce issues are causing challenges for long-term care globally, and therefore, improving the work-related wellbeing and retention of nurses is crucial. As such, gaining a further understanding of the factors that affect work strain in long-term care is important. Previously, the effect of job demands on the wellbeing of nurses has been researched principally by subjective instruments. In this study, we examined the relationship between indirectly measured workday characteristics and perceived stress and time pressure among nurses working in Finnish long-term care (assisted living facilities with 24-hour assistance).

Methods

A total of 503 nurses from 44 assisted living facilities across Finland completed time measurement surveys and wellbeing questionnaires. The data were linked with client characteristics from the Resident Assessment Instrument register. The relationships between the measured number of care events during the workday, clients’ care needs, and the amount of breaktime and perceived stress and time pressure were analyzed using multivariate logistic regression.

Results

Nurses who had more care events and clients with greater care needs were at higher odds of having high stress. More care events and reduced breaktime were associated with high time pressure. Disruptions during the workday were strongly associated with both high stress and time pressure. Last, nurses who were under high stress and time pressure worked more often in teams with lower team autonomy.

Conclusions

Our findings on indirectly measured job demands indicate that dividing the workload equally among nurses through better work division can help reduce the stress and time pressure of nurses in long-term care. In addition, ensuring sufficient breaktime and preventing unnecessary disruptions is important. To help recruit and retain the care workforce, fair management of work that accounts for varying client care needs and workload is needed. In addition, legislative and governance tools, such as staffing level regulation, and further consideration of job demands might aid in reducing the job strain of nurses.

Patient or public contribution

Patients or nurses were not involved in the design of the study, analysis, or interpretation of the results, or in the preparation of the manuscript.
Exosomes as therapeutic and drug delivery vehicle for neurodegenerative diseases
Authors: Nouri Zeinab , Barfar Ashkan , Perseh Sahra , Motasadizadeh Hamidreza , Maghsoudian Samane , Fatahi Yousef , Nouri Keyvan , Yektakasmaei Mohaddese Pourashory , Dinarvand Rassoul , Atyabi Fatemeh
Published: August 2024

Neurodegenerative disorders are complex, progressive, and life-threatening. They cause mortality and disability for millions of people worldwide. Appropriate treatment for neurodegenerative diseases (NDs) is still clinically lacking due to the presence of the blood-brain barrier (BBB). Developing an effective transport system that can cross the BBB and enhance the therapeutic effect of neuroprotective agents has been a major challenge for NDs. Exosomes are endogenous nano-sized vesicles that naturally carry biomolecular cargoes. Many studies have indicated that exosome content, particularly microRNAs (miRNAs), possess biological activities by targeting several signaling pathways involved in apoptosis, inflammation, autophagy, and oxidative stress. Exosome content can influence cellular function in healthy or pathological ways. Furthermore, since exosomes reflect the features of the parental cells, their cargoes offer opportunities for early diagnosis and therapeutic intervention of diseases. Exosomes have unique characteristics that make them ideal for delivering drugs directly to the brain. These characteristics include the ability to pass through the BBB, biocompatibility, stability, and innate targeting properties. This review emphasizes the role of exosomes in alleviating NDs and discusses the associated signaling pathways and molecular mechanisms. Furthermore, the unique biological features of exosomes, making them a promising natural transporter for delivering various medications to the brain to combat several NDs, are also discussed.
Quantitative phenotyping of crop roots with spectral electrical impedance tomography: a rhizotron study with optimized measurement design
Authors: Michels Valentin , Chou Chunwei , Weigand Maximilian , Wu Yuxin , Kemna Andreas
Published: August 2024

Background

Root systems are key contributors to plant health, resilience, and, ultimately, yield of agricultural crops. To optimize plant performance, phenotyping trials are conducted to breed plants with diverse root traits. However, traditional analysis methods are often labour-intensive and invasive to the root system, therefore limiting high-throughput phenotyping. Spectral electrical impedance tomography (sEIT) could help as a non-invasive and cost-efficient alternative to optical root analysis, potentially providing 2D or 3D spatio-temporal information on root development and activity. Although impedance measurements have been shown to be sensitive to root biomass, nutrient status, and diurnal activity, only few attempts have been made to employ tomographic algorithms to recover spatially resolved information on root systems. In this study, we aim to establish relationships between tomographic electrical polarization signatures and root traits of different fine root systems (maize, pinto bean, black bean, and soy bean) under hydroponic conditions.

Results

Our results show that, with the use of an optimized data acquisition scheme, sEIT is capable of providing spatially resolved information on root biomass and root surface area for all investigated root systems. We found strong correlations between the total polarization strength and the root biomass ($$R^2 = 0.82$$

R
2

=
0.82

) and root surface area ($$R^2 = 0.8$$

R
2

=
0.8

). Our findings suggest that the captured polarization signature is dominated by cell-scale polarization processes. Additionally, we demonstrate that the resolution characteristics of the measurement scheme can have a significant impact on the tomographic reconstruction of root traits.

Conclusion

Our findings showcase that sEIT is a promising tool for the tomographic reconstruction of root traits in high-throughput root phenotyping trials and should be evaluated as a substitute for traditional, often time-consuming, root characterization methods.
Combination of pemetrexed with bevacizumab for non-small-cell lung cancer: a meta-analysis study
Authors: Fang Wei , Peng Xingqiao , Zhou Qun
Published: August 2024

Background

Combining pemetrexed with bevacizumab may have some potential in improving the efficacy in patients with non-small-cell lung cancer (NSCLC), and this meta-analysis aims to explore the impact of pemetrexed addition to bevacizumab on treatment efficacy for NSCLC.

Methods

PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched, and we included randomized controlled trials (RCTs) assessing the effect of pemetrexed addition to bevacizumab on treatment efficacy in patients with NSCLC. Overall survival and progression-free survival were included in this meta-analysis.

Results

Four RCTs were finally included in the meta-analysis. Overall, compared with bevacizumab for NSCLC, pemetrexed addition showed significantly improved overall survival (hazard ratio [HR] = 0.87; 95% confidence interval [CI] = 0.76 to 0.99; P = 0.03), survival rate (odd ratio [OR] = 1.41; 95% CI = 1.06 to 1.86; P = 0.02), progression-free survival (HR = 0.63; 95% CI = 0.55 to 0.72; P < 0.00001) and progression-free survival rate (OR = 1.92; 95% CI = 1.38 to 2.67; P < 0.00001), but led to the increase in grade ≥ 3 adverse events (OR = 2.15; 95% CI = 1.62 to 2.84; P < 0.00001).

Conclusions

Pemetrexed addition may be effective to improve treatment efficacy for NSCLC compared to bevacizumab treatment.
The effect of farm size and farmland use on agricultural diversification: a spatial analysis of Brazilian municipalities
Authors: Parré José Luiz , Chagas André Luis Squarize , Arends-Kuenning Mary Paula
Published: August 2024

Brazilian agriculture is characterized by the prevalence of small farms and regions with a high degree of rurality and dominance of the agricultural sector in the economy. These two characteristics affect the diversity of agricultural production in the country. Specifically, the article aims to analyze the effects of size farm and farmland use on agricultural diversification and the effects of demand and technology adopted by farmers. The database encompasses 4298 Brazilian municipalities from 1996 to 2017 (the last three agricultural censuses). Empirically, we consider spillover effects by estimating spatial models at the municipal level using panel data, highlighting the importance of location and neighborhood. The study’s findings indicate a tendency toward local concentration of agricultural production in the country, despite the balance between municipalities with diversified and concentrated production. The results showed a significant effect of small farms and the municipalities’ rurality degree on the agricultural output diversification. The study provides insights into the discussion on measures to strengthen support for small properties and regions that diversify crops to ensure economic efficiency and food security.
Dynamically documenting archaeological excavations based on 3D modeling: a case study of the excavation of the #3 fossil of hominin cranium from Yunxian, Hubei, China
Authors: Niu Wenyuan , Lu Chengqiu , Zou Qiushi , Luo Yunbing , Wang Xuan , Xiang Hanyu , Zhang Fan , Gao Xing , Xing Song , Wei Xuan , Lou Wentai , Huang Dailong , Wang Cheng , Jiang Dongqing , Wan Xiaofeng , Zhang Zhongyun , Yin Huanghao , Lu Jiayang , Wang Feng , Huang Xianfeng , Li Yinghua
Published: August 2024

Documenting tangible cultural heritage using 3D modeling techniques is gradually becoming an indispensable component of archaeological practice. The 3D modeling techniques based on photogrammetry and LiDAR scanning enable high-accuracy and high-realistic reconstruction of archaeological sites, and have been proven a powerful tool for documenting archaeological excavations. However, dynamically documenting an ongoing excavation using these techniques is still considered tedious, time-consuming, expensive, and dependent on expertise. Moreover, the application of 3D modeling techniques in archaeological excavations still faces some technical challenges, such as modeling with multi-source and multi-scale data, fusing local models at different times into a whole, achieving fast modeling while GPU workstations are not available in the field, and evaluating the quality of 3D models. As a result, there are still very few archaeological teams deeply engaged in dynamic documentation with 3D modeling techniques, and traditional drawing sketches and taking photographs still dominate. In these senses, documenting the archaeological excavation at the Yunxian Man site (located in Hubei, China) is an invaluable opportunity for exploration and practice. Archaeologists determined to conduct dynamically documenting at the beginning of the 6th excavation project for the site, and established a rotation system to reconcile physical excavation with digital preservation. Through repeated practice and communication, we proposed a workflow and pursued several new methods to enhance the feasibility of dynamically documenting, and obtained 4D models of the ongoing archaeological excavations. In 2022, the Yunxian Man site unearthed the most intact fossil of hominin cranium from about one million years ago in the Eurasian continent, preserving important and scarce anatomical features of early humans in Asia. As the original taphonomic context of the fossil corroded away during physical excavations, the digital documentation consisting of 4D models serves as permanent original data source in subsequent archaeological research. Moreover, we obtained cross-scale 3D models from geographical environment to archaeological site, excavation area, and cultural remains, and all of these 3D models are in an actual, unified coordinate framework. Thus, we can contribute to multidisciplinary cross-collaborative research through data sharing. Considering that digital documentations serve a great value in archaeological research, this paper focuses on sharing the workflow and methods to facilitate digital preservation for more archaeological projects.
Epoxidized fatty acid tri-ester bio-plasticizer with anti-fogging performance comparable to diisodecyl phthalate
Authors: Pan Siyu , Liu Demeng , Sun Xianchong , Hou Delong , Yan Jun , Zeng Qi , Chen Yi
Published: August 2024

The global scenario on PVC plasticizer is experiencing a drastic change from petroleum-based, toxic di-(2-ethylhexyl) phthalate (DEHP) toward renewable, non-toxic bio-alternatives. However, replacing diisodecyl phthalate (DIDP), a DEHP analogue specifically intended for plasticizing PVC automotive upholstery, with bio-alternative remains a challenge as few bio-plasticizer volatilizes from PVC as slowly as DIDP, a crucial aspect compulsorily required by automotive industry. Here, we demonstrate that covalently attaching two short esters at the α-position of all components of a traditional epoxidized fatty acid methyl ester via a two-step, hydrogen-to-ester nucleophilic substitution in a one-pot procedure yields an epoxidized fatty acid tri-ester bio-plasticizer with remarkably suppressed volatilization from PVC, and hence an extremely low fogging value comparable to DIDP. With this strategy in hand, DIDP, long deemed irreplaceable despite its toxicity and non-renewable nature, may ultimately be phased out.

Graphical Abstract
Himalayan fruit and circular economy: nutraceutical potential, traditional uses, challenges and opportunities
Authors: Ritika  , Bora Birinchi , Ismail Balarabe B. , Garba Umar , Mishra Sadhna , Jha Avinash Kumar , Naik Bindu , Kumar Vijay , Rather Muzamil Ahmad , Rizwana  , Preet Manpreet Singh , Rustagi Sarvesh , Kumar Himanshu , Gupta Arun Kumar
Published: August 2024

The Himalayas, globally acknowledged as one of the four biodiversity hotspots, underscore their ecological significance, boasting abundant flora and fauna. Among these, a diverse array of wild fruits such as Aegle marmelos, Artocarpus lakoocha, Baccaurea spp., Carissa spp., and others provide essential nutrition for local populations. These fruits, rich in bioactive compounds, offer nutraceutical potential, contributing to health aspects like antidiabetic, anti-inflammatory, and anticancer properties. The integration of Himalayan wild fruits into circular practices supports sustainable livelihoods. The responsible harvesting, efficient processing, and value addition of these fruits align with circular principles, striking a balance between conservation and progress. Technologies such as anaerobic digestion, waste-to-energy conversion, and composting can harness waste generated during cultivation and processing, contributing to a circular economy and rural Himalayan community development. Preserving, accessing, and commercializing underutilized fruits can significantly enhance economic prosperity and the quality of life for inhabitants. However, integrating these fruits into agriculture faces multifaceted challenges, spanning social, economic, environmental, agronomic, and political dimensions. Addressing these challenges is crucial for sustainable development, aiming to eradicate poverty, malnutrition, and hidden hunger. Moreover, addressing these challenges is not only vital for sustainable development in the Himalayan region but also for mitigating carbon footprints and tackling issues like poverty, malnutrition, hidden hunger, and climate change. The exploration of these concepts within the Himalayan context holds immense promise for sustainable development and ecological conservation.

Graphical Abstract