bluuebunny/crossref_metadata_2025 huggingface dataset:
Depthwise channel attention network (DWCAN): An efficient and lightweight model for single image super‐resolution and metaverse gaming
Authors: Yasir Muhammad , Ullah Inam , Choi Chang
Published: December 2023

Single image super‐resolution (SISR) has gained significant attention in image processing and computer vision, driven by deep learning‐based models like convolutional neural networks (CNN). Yet, the resource‐intensive nature of these models poses challenges when deploying them on edge devices. To address this issue, resource‐constrained models need to be developed. While recent models like the information distillation network (IDN), the information multi‐distillation network (IMDN), the residual feature distillation network (RFDN), and so on, have attempted to reduce parameters and computational complexity, further optimization remains vital. Therefore, this paper presents an approach to enhancing the efficiency and lightweight nature of the SISR. We introduce a novel lightweight SR model by building upon the RFDN architecture, the winner of the AIM2020 and NTIRE2022 SR challenges. The proposed depthwise channel attention network (DWCAN) model makes some key changes to RFDN. First, it replaces the main residual feature distillation block (RFDB) with a depthwise channel attention block (DWCAB). Additionally, DWCAN includes a shallow residual block (SRB) with depthwise separable convolution (DW) and a channel attention (CA) block. The primary goal of our work is to significantly reduce model parameters, computational operations, inference time, and memory size while maintaining or improving a peak signal‐to‐noise ratio (PSNR) of 29 dB. The experimental results demonstrate the effectiveness of the proposed model. By applying our modifications, we achieve a notable reduction in model complexity, leading to an improved PSNR of 29.07 dB, up from RFDN's 29.04 dB on a diverse 2 K resolution (DIV2K) dataset. This underscores the potential of our lightweight model to balance computational efficiency and SR quality. Additionally, the proposed work is essential for the metaverse for two key reasons: (1) Enhancing visual quality by adding complex details to textures and objects, making the digital world feel more like reality. (2) Ensuring device compatibility across a range of gadgets, from smartphones to VR headsets, optimizing the metaverse experience for all users. In short, a lightweight single image super‐resolution model for image reconstruction is proposed in this paper.
Caste and Black intergenerational racial trauma in the United States of America
Authors: Watson Marlene F.
Published: December 2023

The United States (U.S.) racial caste system and White dominance began in slavery, culminating in Black intergenerational racial trauma. Until recently, Black intergenerational racial trauma largely was ignored by family scholars and therapists. Given that Black intergenerational racial trauma is inseparable from racial caste in the United States, it should be regarded as a wider, systemic problem, requiring intervention at the micro (e.g., family) and macro (e.g., society) levels. The U.S. dominant White society's investment in conserving racial caste furthers the ideological (e.g., political) and sentimental (e.g., democratic ideals) nullification of Black intergenerational racial trauma. Therefore, Black intergenerational racial trauma is often disenfranchised and can hamper Black people's experience of racial trauma as a collective. As passive bystanders, family scholars and therapists are co‐conspirators in the long, enduring suffering of Black people. As advocates, family scholars and therapists are called upon to name the racial hierarchy in the United States as a caste system and to advance Black humanization. Specifically, Wilkerson's (Caste: The origins of our discontents. Random House, 2020) notion of the U.S. racial hierarchy as a functioning caste system frames the discussion of Black intergenerational racial trauma and includes the following topics: Black racial trauma, disenfranchised Black intergenerational racial trauma, collective Black intergenerational racial trauma, Black intergenerational racial trauma and the U.S. academy (traditionally White institutions of higher learning), history and its impact on Black intergenerational racial trauma, the Black body and racial trauma, intersectionality and the U.S. caste system, and collective hope and resilience.
Education‐migration brokers, international student mobilities and digital transformations in pre‐ and post‐pandemic times
Authors: Luk Shing Ho , Yeoh Brenda
Published: December 2023

Originating in the early 20th century, international education migration has undergone significant growth to become a sprawling industry responsible for managing substantial student mobility. This process encompasses more than just the students themselves, incorporating a diverse array of actors, regulations, and technologies. Within this multifaceted system, commercial brokers play a vital role by actively facilitating the intricate and interconnected interactions involved in international education migration. This review takes a critical look at the evolving role of commercial brokers in international student mobilities, with a particular focus on the COVID‐19 pandemic and its aftermath. Brokers are presented as key intermediaries, bridging the gap between state mechanisms and migrating students, and contributing significantly to economic development through education migration. The review explores the layered relationships between brokers and students, taking into account not only economic aspects but also the social, cultural, and interpersonal factors that shape these interactions. Additionally, it considers the impact of digital transformation on commercial brokers, revealing how digital platforms have necessitated a reevaluation of their roles in an increasingly globalized educational landscape. In underscoring the growing importance of commercial brokers in the post‐pandemic education‐migration landscape, the review concludes that brokerage is best conceived as a complex, technologically‐mediated social practice that bridges state policies, migrants' aspirations, and the overarching digital landscape.
Unpacking the black box of investor sentiment: Structured sentiment and unstructured sentiment
Authors: Xiang Lan , Ma Yong , Liu Zhiyu
Published: December 2023

This paper dissects investor sentiment into two distinct components: structured sentiment and unstructured sentiment, based on their underlying driving factors. Employing an extension of the classic noise trader model, our analysis reveals a negative relationship between market returns and both types of sentiment—structured and unstructured. Additionally, we find a positive association between market volatility and fluctuations in these sentiment components. Furthermore, the impact of fluctuations in unstructured sentiment on market volatility becomes more pronounced as the proportion of noise traders increases. Importantly, our theoretical assertions are robustly supported by empirical data.
Entry deterrence strategies for an incumbent supply chain in the presence of inertial consumer and optimistic entrant
Authors: Xu Peng , Xiao Tiaojun
Published: December 2023

When entering a new market, entrepreneurs generally hold an optimistic belief about the inertia of consumers (i.e., consumer's tendency to repurchase the incumbent product), leading to a high rate of failure. This paper constructs a supply chain with one manufacturer, one retailer, and one potential optimistic entrant who attempts to enter the wholesaling market. We characterize how the behaviors of the entrant's optimism and consumer's inertia jointly affect the pricing (deterrence) strategy of the incumbent manufacturer, entry strategy of the entrant, and equilibrium decisions in the post‐entry game. Interestingly, our results show that: (i) in the post‐entry game, both behaviors could benefit the two manufacturers but are detrimental to the retailer; (ii) in the entry strategy, when consumers are moderately inertial or the entrant is highly optimistic, the entrant will suffer from an incorrect entry decision and then has an unprofitable entry; (iii) in the pricing strategy, the incumbent manufacturer will set the normal wholesale price to blockade the entry if consumers have high inertia or the entrant has a low optimism; otherwise, he will set a new price to accommodate the entry. Furthermore, we discuss two different cases, finding that (iv) the existence of the retailer weakens the deterrent power of the incumbent manufacturer; and (v) the retailer will induce the manufacturer to accommodate the entry when the entrant is moderately optimistic.
Frontline nurse leaders' competences in evidence‐based healthcare: A scoping review
Authors: Koivunen Kirsi , Kaakinen Pirjo , Päätalo Kati , Mattila Outi , Oikarinen Anne , Jansson Miia , Mikkonen Kristina , Pölkki Tarja , Meriläinen Merja , Kääriäinen Maria , Holopainen Arja , Tuomikoski Anna‐Maria , Kanste Outi
Published: December 2023

Aim

To identify evidence on frontline nurse leaders' competences in evidence‐based healthcare (EBHC) and the instruments measuring these competences.

Design

A scoping review.

Data Sources

The search was conducted in June 2021 and complemented in June 2022. The CINAHL, ProQuest, Medline (Ovid), Scopus, Web of Science databases and MedNar along with the Finnish database Medic were searched.

Review Method

The scoping review was conducted in accordance with the Joanna Briggs institute methodology for scoping reviews. Titles, abstracts and full‐text versions were screened independently by two reviewers according to the inclusion criteria. Deductive‐inductive content analysis was used to synthesize data.

Results

A total of 3211 articles published between 1997 and 2022 were screened, which resulted in the inclusion of 16 articles. Although frontline nurse leaders had a positive attitude towards EBHC, they had a lack of implementing EBHC competence into practice. Part of the instruments were used in the studies, and only one focused especially on leaders. None of instruments systematically covered all segments of EBHC.

Conclusion

There is a limited understanding of frontline nurse leaders' competence in EBHC. It is important to understand the importance of EBHC in healthcare and invest in the development of its competence at all levels of leaders. Frontline nurse leaders' support is essential for direct care nurses to use EBHC to ensure the quality of care and benefits to patients. Leaders must enhance their own EBHC competence to become role models for direct care nurses. It is also essential to develop valid and reliable instruments to measure leaders' competence covering all EBHC segments. The results can be utilized in the assessment and development of frontline nurse leaders' EBHC competence by planning and producing education and other competence development methods.
Research Electronic Data Capture (REDCap) in an outpatient oncology surgery setting to securely email, collect, and manage survey data
Authors: Majumdar Jennifer R. , Fromkin Jillian B. , Yermal Stephen J. , Fatata‐Haim Alexandria M. , Barton‐Burke Margaret , Jairath Nalini N.
Published: December 2023

Background

Nursing interventions in the post‐operative time period including psychological and emotional support, adverse event education, and instructions for follow‐up care contribute patient satisfaction, safety, and quality of life. However, the time spent in the post‐anesthesia care unit (PACU) and hospital continues to shorten around the world to reduce health care spending and improve patient outcomes. Nurses conducting research during the important post‐operative recovery period need to utilize unique techniques and emerging technologies to contact, recruit and collect data outside of the hospital setting including the Research Electronic Data Capture (REDCap) platform.

Aims

This paper describes the feasibility and acceptability, facilitators and barriers of the software application, REDCap, to complete a repeated‐measures, descriptive correlational study in patients undergoing outpatient breast cancer surgeries.

Methods & Materials

The recruitment, data collection and storage were completed utilizing the secure REDCap Platform. The Institutional Research Board (IRB)‐approved study was a repeated‐measures, descriptive, correlational study with data collection at three time points. The data points aligned with important transitions and routine visits to improve data collection feasibility and increase relevance to clinical practice.

Results

The sample consisted of women diagnosed with breast cancer undergoing breast conserving surgery between August 15 and October 15, 2020. There were 123 potential participants, of which 76 started the surveys and 75 participated (61%) responded and participated in the study on Post‐operative Day 1. Fifty‐nine participants (78%) completed the surveys on post‐operative Day 14.

Discussion

As the frequency of outpatient treatment increases, nurses conducting post‐operative research will need to collect the data outside of the hospital setting.

Conclusion

Email provides a method of studying new phenomena by recruiting participants, providing information about the study, and collecting results in a non‐traditional setting. REDCap provides a method to facilitate nursing research through a securely encrypted integrated process.
The meaning of preparedness for informal caregivers of older adults: A concept analysis
Authors: Dal Pizzol Fernanda L. F. , O'Rourke Hannah M. , Olson Joanne , Baumbusch Jennifer , Hunter Kathleen
Published: December 2023

Aim

To examine the concept of preparedness over time in research with informal caregivers of older adults.

Design

Concept analysis.

Methods

Rodgers' evolutionary method of concept analysis was used to guide this theoretical paper due to the dynamic nature of preparedness, which is influenced by both context and time. Using Rodgers' inductive approach, concept elements were derived from a content analysis of included studies. In the final step, to generate hypotheses and implications regarding the concept, the conceptual structure of preparedness of informal caregivers of older adults was connected to a theoretical problem in the nursing discipline using the Caregiving Stress Process Framework.

Data Sources

Four databases (EBSCO CINAHL, Ovid MEDLINE, Ovid PsycINFO and Scopus) were searched in November 2022 and updated in September 2023. No date limits were set for searching, as the intent was to analyse possible variations of the concept over time.

Results

The attributes of preparedness include self‐confidence, having knowledge, skills and abilities to perform daily tasks, handling emotions and developed over time. These attributes can be compared with the stressors outlined in the Caregiving Stress Process Framework (i.e., the moment the caregiver identifies some ‘stressor’; something that prevents them from feeling confident in their preparedness).

Conclusion

The concept of preparedness of informal caregivers of older adults is defined as caregiver's self‐confidence about their current competence related to the knowledge, skills and abilities to perform daily tasks, and to handle emotions over time. To link the concept to a theoretical perspective, we propose adaptations to a well‐known theory, the Caregiving Stress Process Framework. Future research on caregiving preparedness needs to avoid circular definitions and work with the attributes of preparedness to support caregivers.

Implications for the Profession and/or Patient Care

This paper contributes to the development of interventions that focus on the health and preparedness of informal caregivers of older adults. Clarifying the concept of preparedness helps nurses to support caregivers since it is then known which aspects are included in the preparedness of caregivers (e.g., daily tasks and handling emotions). A more fulsome understanding of preparedness supports us to see beyond stressors of caregiving.

Impact

This study addresses informal caregivers of older adults' preparedness to provide care. We synthesized existing definitions that have been used in research with this population to propose a robust conceptualization of the concept of preparedness, which contributes to better understanding of how preparedness can be supported.

Reporting Method

We were unable to locate a reporting method related to this kind of work (concept analysis).

Patient or Public Contribution

Not applicable as no new data generated.
Researcher‐initiated role play, stimulated recall interview, storycrafting, painting and drawing as research methods to reach children's perspectives in health sciences
Authors: Ortju Laura , Kankkunen Päivi , Haaranen Ari , Karlsson Liisa
Published: December 2023

Aim

To describe the application of selected creative and participatory research methods in nursing science.

Design

Research methodology paper.

Methods

Researcher‐initiated role play, stimulated recall interviews, the Storycrafting method, painting and drawing. Altogether, 11 children (5–7 years old) and 12 parents participated in the research.

Results

Each small group (n = 3) acted differently during the data collection. Not every child wanted to play, draw or tell stories, but they all expressed their views through some method. Although the same themes emerged from children's narratives, they could not have been verified by just one method.

Conclusions

Using creative and participatory methods and the principles of studies of child perspectives are applicable ways of conducting research in nursing science. Children must be treated as individuals during the research process, and they must have opportunities to use several communication methods to express their views.

Implications for the profession and patient care

Understanding different ways to interact with children and hear children's views will help nurses to encounter children.

Impact

In this article, we present a valid way of conducting research with children. By following our protocol, nursing research from a child perspective can be implemented.

Reporting Method

Consolidated criteria for reporting qualitative research (COREQ).

Patient Contribution

The child participants were involved in choosing physical places for data collection and the usage and order of the selected methods. Both the children and the adult participants took part in interpreting the research data.
Exploring fear of cancer recurrence and related factors among breast cancer patients: A cross‐sectional study
Authors: Li Yang , Fang Chao , Xiong Meidi , Hou Hao , Zhang Yanting , Zhang Chunhua
Published: December 2023

Aims

Fear of cancer recurrence (FCR) is a multifaceted concept influenced by individual characteristics, social support, psychological factors. This study aims to identify distinct FCR profiles among breast cancer patients and explore the associated variables with these patterns.

Design

A cross‐sectional study was conducted from April 2022 to March 2023.

Methods

A convenience sample of 339 patients completed a questionnaire that assessed general and disease‐related data, including the Fear of Progression Questionnaire‐Short Form, Social Support Rating Scale, Medical Coping Modes Questionnaire. Statistical analysis involved latent profile analysis (LPA) and multinomial logistic regression.

Results

Three latent patterns of FCR were found: the low fear (28.9%), the moderate fear (51.3%), and the high fear (18.0%). The study identified the social support, family monthly income, employment status, utilization of confrontation coping mode and avoidance coping mode, as factors that impacted the FCR.

Conclusions

Social support, family monthly income, employment status, and medical coping modes have been found to impact the FCR among newly diagnosed breast cancer patients. Healthcare professionals should focus on addressing FCR at diagnosis and implement effective interventions, such as promoting social support and encouraging adaptive coping, to alleviate this concern.

Impact

Urgently addressing the FCR in Chinese breast cancer patients is imperative due to its profound influence on their holistic health. Through advanced LPA, we categorized the FCR progression, highlighting risks. These findings have implications for healthcare strategies, offering new insights to manage the FCR and improve patient well‐being. Our study adds a fresh perspective to the factors underlying the FCR in breast cancer patients, contributing to the broader comprehension and management of this complex survivorship issue.

Patient or Public Contribution

No patient or public contribution.
Impact of dementia special care units for short‐stay nursing home patients
Authors: Chen Amanda C. , Epstein Arnold M. , Joynt Maddox Karen E. , Grabowski David C. , Orav E. John , Barnett Michael L.
Published: December 2023

Background

Improving quality of care provided to short‐stay patients with dementia in nursing homes is a policy priority. However, it is unknown whether dementia‐focused care strategies are associated with improved clinical outcomes or lower utilization and costs for short‐stay dementia patients.

Methods

We performed a national survey of nursing home administrators in 2020–2021, asking about the presence of three dementia‐focused care services used for their short‐stay patients: (1) a dementia care unit, (2) cognitive deficiency training for staff, and (3) dementia‐specific occupational therapy. Using Medicare claims, we identified short‐stay episodes for beneficiaries residing in surveyed skilled nursing facilities (SNFs) with and without dementia. We compared clinical, cost, and utilization outcomes for dementia patients in SNFs, which did and did not offer dementia‐focused care services. As a counterfactual control, we compared these differences to those for non‐dementia patients in the same facilities. Our primary quantity of interest was an interaction term between a patients' dementia status and the presence of a dementia‐focused care tool.

Results

The study population included 102,860 Medicare episodes of care from 377 SNF survey respondents in 2018–2019. In adjusted comparisons of the interaction between dementia status and the presence of each dementia‐focused care tool, dementia care units were associated with a 1.5‐day increase in healthy days at home in the 90 days following discharge (p = 0.01) and a 3.1% decrease in the likelihood of a subsequent SNF admission (p = 0.001). Cognitive deficiency training was also associated with a 2.0% increase in antipsychotics (p = 0.03), whereas dementia‐specific occupational therapy was associated with a 1.2% increase in falls (p = 0.01) per patient episode.

Conclusions

Self‐reported use of dementia care units for short‐stay patients was associated with modestly better performance in some, but not all, outcome measures. This provides hypothesis‐generating evidence that dementia care units could be a promising mechanism to improve care delivery in nursing homes.
Macrocystis pyrifera ferment‐containing creams for optimizing facial skin rejuvenation
Authors: Gold Michael , Bae Yoon‐Soo Cindy , Goldberg David J. , Jamal Sumayah , Lewis Amy B. , Marchbein Shari , Ros Adriana , Santhanam Uma , DiNatale Lisa , Emmetsberger Jaime
Published: December 2023

Background

There is an increasing demand for facial skin rejuvenation. Specialized aesthetic skincare treatments may be one of the first steps to help prevent or treat facial signs of aging. This article discusses aesthetic skin care for facial skin rejuvenation, particularly data on two creams containing Macrocystis pyrifera ferment.

Methods

The authors convened a dermatology advisory board to discuss challenges and practices in using skincare for facial rejuvenation, combining their expert opinion and experience on facial rejuvenation with preclinical and clinical data on two creams containing Macrocystis pyrifera ferment and a review of the literature.

Results

Preclinical and clinical studies on Macrocystis pyrifera ferment and two creams containing the ferment exhibit anti‐inflammatory, anti‐aging, and healing properties. In preclinical studies, the ferment demonstrated collagen type I enhancing properties in ex vivo skin models, and skin cells treated with the ferment migrated faster than untreated cells in the in vitro study. In clinical studies measuring visible anti‐inflammatory activity, the ferment alone and the ferment‐containing products significantly decreased erythema, and in anti‐aging studies, they improved visible skin aging parameters. Finally, in clinical studies on the stratum corneum, the two creams increased moisture levels and decreased transepidermal water loss (TEWL), reflecting healing by enhancing barrier strength and recovery.

Conclusions

The Macrocystis pyrifera ferment and creams containing the ferment are effective skin care treatment products to decrease the visible effects of inflammation and signs of aging while promoting healing by enhancing barrier resilience and recovery.
Children's and young people's experiences of expressing their views and having them heard in health care: A deductive qualitative content analysis
Authors: Davies Clare , Waters Donna , Fraser Jennifer
Published: December 2023

Aim

To gain an understanding of children's experiences of expressing their views and having them heard in Australian healthcare settings.

Design

Child‐centred qualitative research. A deductive qualitative content analysis was undertaken.

Methods

Data were collected from 20 Australian children and young people between the ages of 7 and 18 years old using the ‘draw, write and tell’ method.

Results

Children's experiences of ‘space’ and ‘voice’, and therefore the opportunity to express their views in health care were, in the main, positive. At the same time, their experiences of ‘audience’ and ‘influence’, the situations in which those views are given due weight, were overwhelmingly described as negative.

Conclusion

Australian paediatric health services appear to have responded to calls to provide children with the opportunity to express their views and thus are delivering on the elements of ‘space’ and ‘voice’, whereas the realisation of ‘audience’ and ‘influence’ has some way to go. Due weight is not always given to children's views.

Implications for the Profession and/or Patient Care

The Lundy model can be used to facilitate a better understanding of the concept of voice, and the responsibility of health organisations in implementing the rights of children and young people, as articulated in Article 12.

Impact

Children and young people have a right to express their views and have them heard in health care, but their experiences in Australian health care are unknown.

While children's experiences of expressing their views in health care were mostly positive, their views are not always taken seriously or given due weight.

This research impacts child health professionals in Australia and internationally.

Reporting Method

The study is reported using the Standards for Reporting Qualitative Research (SRQR).

Patient or Public Contribution

Members of the Youth Advisory Council of two tertiary children's hospitals were consulted and invited to become members of the research team.
How gender shapes sibling tension in adulthood following parental death
Authors: Suitor J. Jill , Gilligan Megan , Ogle Destiny , Frase Robert T. , Hou Yifei , Stepniak Catherine , Bauldry Shawn
Published: December 2023

Objective

This study investigates gender differences in the effect of parents' deaths on sibling tension among bereaved adult children.

Background

Previous scholarship on adult sibling relations following the deaths of parents presents inconsistent results. These disparate findings may stem from past studies not taking into consideration the gender of both the deceased parent and the bereaved child.

Method

Analyses are based on three harmonized waves of quantitative and qualitative data collected from 654 adult children nested within 303 families as part of the Within‐Family Differences Study.

Results

Multilevel models revealed that for daughters, but not sons, mothers' deaths in the past 5 years were associated with increases in sibling tension, whereas fathers' deaths did not predict changes in either sons' or daughters' sibling tension, regardless of timing. Qualitative analyses showed marked differences by child's gender in perceptions of patterns of shared work and support surrounding parents' deaths. Typically, sons expressed solidarity with siblings when mothers died and felt that the division of caregiving prior to mothers' deaths and arrangements following their deaths were fair. In contrast, daughters expressed increased solidarity with sisters surrounding mothers' deaths and disdain toward brothers who failed to contribute caregiving, support, or instrumental tasks.

Conclusion

These findings underscore how gender of both parents and adult children differentially shape changes in adult children's relationships with their siblings in the face parental deaths, much as they do in other contexts across the life course.
Sustainable feed formulation to community‐based aquaculture: Oreochromis niloticus fingerlings performance and antioxidant status
Authors: Pires Sílvia F. S. , Vital Inês , Pereira Vitória , Bustani Henriques , Aragão Cláudia , Engrola Sofia , Cabano Miguel , Dias Jorge , Soares Amadeu M. V. M. , Rodrigues Andreia C. M. , Rocha Rui J. M.
Published: December 2023

Community‐based aquaculture can reduce dependence on natural resources, promote biodiversity conservation, and improve local economies and food security. However, this activity is highly dependent on local conditions regarding natural resources, such as the availability of produced organisms, adequate feeds, and environmental factors. As ectothermic organisms, fish are more susceptible to temperature fluctuations in culture conditions. A set of raw ingredients (e.g., cassava and local beans) produced or available in villages from Cabo Delgado (Mozambique) with nutritional potential for fish feed were selected to produce an experimental diet. The following objectives were defined: (1) evaluate growth performance of tilapia fingerlings fed a diet produced with local ingredients, compared with a commercial‐like diet; and (2) evaluate the response to thermal stress (18, 26, and 32°C) by tilapia fingerlings fed with tested diets. Tilapia fed with an experimental diet presented lower growth rates, lower DNA damage, higher neurophysiological, and antioxidant activity, leading to increased oxidative stress. Regarding energy budget, tilapia fed with the experimental diet presented higher protein content at 26°C and lipids at 18°C, leading to greater energy available at these temperatures. Overall, local ingredients can be successfully used as an additional feed source for tilapia production in community‐based aquaculture in earthen ponds.
A cluster randomized controlled trial of a community‐based initiative to reduce stunting in rural Indonesia
Authors: Beatty Amanda , Borkum Evan , Leith William , Null Clair , Suriastini Wayan
Published: December 2023

We evaluate the impacts of a $120 million project in Indonesia conducted between 2014 and 2018 that sought to reduce stunting through a combination of (1) community‐driven development grants targeted at health and education outcomes, (2) training for health providers on infant and young child feeding and growth monitoring and (3) training for sanitarians on a local variation of community‐led total sanitation. This cluster randomized controlled trial involved 95 treatment and 95 control subdistricts across South Sumatra, West Kalimantan, and Central Kalimantan provinces. Overall, we find no significant impacts on stunting, the study's primary outcome measure (0.5 pp; 95% confidence interval [CI]: −3.0 to 4.1 percentage points [pp]), or other longer‐term undernutrition outcomes about 1 year after the end of the project. The project had a modest impact on some secondary, more proximal outcomes related to maternal and child nutrition, including the percentage of mothers consuming the recommended number of iron‐folic acid pills during pregnancy (8.7 pp; 95% CI: 4.1–13.3 pp), 0–5‐month‐olds being exclusively breastfed (8.7 pp; 95% CI: 1.8–15.6 pp) and 6–23‐month‐olds receiving the number of recommended meals per day (8.5 pp; 95% CI: 3.8–13.2 pp). However, there were no significant impacts on other proximal outcomes like the number of pre‐natal and post‐natal checkups, child dietary diversity, child vitamin A receipt or the incidence of child diarrhoea. Our findings highlight that successfully implementing an integrated package of interventions to reduce child stunting may be challenging in practice. Project design needs to consider implementation reality along with best practice—for example, by piloting the synchronous implementation of multifaceted interventions or phasing them in more gradually over a longer timeframe.
Prenatal iron supplementation adjusted to maternal iron stores reduces behavioural problems in 4‐year‐old children
Authors: Iglesias‐Vázquez Lucía , Canals Josefa , Hernández‐Martínez Carmen , Voltas Núria , Arija Victoria
Published: December 2023

Prenatal iron supplementation improves children's health and cognitive performance, but few studies explore behavioural development. This study assessed the effects of adjusting prenatal iron supplementation to maternal iron stores during early pregnancy on children's behavioural problems. Randomized controlled trial conducted in Tarragona (Spain) involving 230 nonanaemic pregnant women and their children after a 4‐year follow‐up. Based on haemoglobin (Hb) levels before gestational week (GW) 12, women receive different iron doses: those with Hb = 110–130 g/L were randomized to receive 80 or 40 mg/day and those with Hb > 130 g/L were randomized to receive 20 or 40 mg/day. Maternal iron stores at GW12 were classified using serum ferritin (SF) as low (SF < 15 µg/L), normal (SF = 15–65 µg/L), and normal‐high (SF > 65 µg/L). Children's behaviour was assessed by parents using the Child Behaviour Checklist for ages 1.5–5 years and the Behaviour Rating Inventory of Executive Function‐Preschool Version, and by teachers using the Teacher's Report Form for ages 1.5–5 years. Multivariable regression models were performed. Taking 80 mg/day of iron improved child behaviour when women had low iron stores but worsened it when mothers had normal–high iron stores, except for depressive and attention/hyperactivity problems. Taking 20 mg/day of iron improved behaviour only in those children whose mothers had SF > 65 µg/L in early pregnancy. Additionally, executive functioning improved at high doses of prenatal iron when maternal baseline SF < 15 µg/L. Adjusting prenatal iron supplementation to both maternal baseline Hb levels and iron stores reduces behavioural problems in 4‐year‐old children.
Conduction velocity mapping in atrial fibrillation using omnipolar technology
Authors: Okubo Yousaku , Oguri Naoto , Sakai Takumi , Uotani Yukimi , Furutani Motoki , Miyamoto Shogo , Miyauchi Shunsuke , Okamura Sho , Tokuyama Takehito , Nakano Yukiko
Published: December 2023

Background

Recent studies have shown that atrial slow conduction velocity (CV) is associated with the perpetuation of atrial fibrillation (AF). However, the criteria of CV measurement have not been standardized. The aim of this study was to evaluate the relationship between the slow CV area (SCVA) measured by novel omnipolar technology (OT) and AF recurrence.

Methods

This study included 90 patients with AF who underwent initial pulmonary vein isolation (PVI). The segmented surface area of the SCVA was measured by left atrial (LA) electrophysiological mapping using OT before the PVI. The proportion of the SCVA at each cutoff value of CV (from < 0.6 to < 0.9 m/s) was compared between the patients with and without AF recurrence.

Results

During a mean follow‐up period of 516 ± 197 days, the recurrence of AF after the initial PVI was observed in 23 (25.5%) patients. In patients with AF recurrence, the proportion of the SCVA in the LA posterior, LA appendage (LAA), and LA anterior were significantly higher than those without AF recurrence. The multivariate analysis indicated that the proportion of the low voltage area and the SCVA in the LA anterior (local CV < 0.7 m/s) were independent predictors of AF recurrence (hazard ratio [HR], 1.07; 95% confidence interval [CI], 1.01–1.14; p = 0.03; HR, 1.40; 95% CI, 1.07–1.83; p = 0.01, respectively).

Conclusion

By evaluating the local CV using OT, it was indicated that SCVA with CV < 0.7 m/s in the LA anterior is strongly associated with AF recurrence after PVI.
Noninvasive respiratory support preventing reintubation after pediatric cardiac surgery—A systematic review
Authors: Kuitunen Ilari , Uimonen Mikko
Published: December 2023

Objective

To analyze the optimal postextubation respiratory support in pediatric cardiac surgery patients.

Design

Systematic review of randomized controlled trials.

Setting

Pediatric or neonatal intensive care units.

Participants

All aged children (<16 years) having cardiac surgery and postoperative invasive ventilation.

Intervention

Noninvasive respiratory support, including high flow nasal cannula (HFNC), conventional oxygen therapy (COT), noninvasive positive pressure ventilation (NIPPV), continuous positive pressure (CPAP), and noninvasive high‐frequency oscillatory ventilation (NHFOV).

Measurement and Main Results

Studies were not pooled for statistical synthesis due to the limited number and quality of the included studies. Risk ratios with 95% confidence intervals were calculated for individual studies. A total of 167 studies were screened and six were included. The risk of bias was low in one, high in one, and had some concerns in four of the studies. Extubation failure (defined as reintubation) was the main outcome of interest. Risk ratio for reintubation was 0.10 (CI 0.02–0.40) and 1.07 (CI 0.16–7.26) in HFNC versus COT, 0.49 (CI 0.05–5.28) in HFNC versus NIPPV, 0.40 (CI 0.08–1.94) in HFNOV versus CPAP, 0.75 (CI 0.26–2.18) in HFNOV versus NIPPV, and 1.37 (CI 0.33–5.73) in CPAP versus NIPPV. Treatment durations did not differ between the groups.

Conclusion

We did not find clear evidence of a difference in reintubation rates and other clinical outcomes between different noninvasive ventilation strategies. Evidence certainty was assessed to be very low due to the risk of bias, the small number of included studies, and high imprecision. Future quality studies are needed to determine the optimal postextubation support in pediatric cardiac surgery patients.
Molecular responses of agroinfiltrated Nicotiana benthamiana leaves expressing suppressor of silencing P19 and influenza virus‐like particles
Authors: Hamel Louis‐Philippe , Tardif Rachel , Poirier‐Gravel Francis , Rasoolizadeh Asieh , Brosseau Chantal , Giroux Geneviève , Lucier Jean‐François , Goulet Marie‐Claire , Barrada Adam , Paré Marie‐Ève , Roussel Élise , Comeau Marc‐André , Lavoie Pierre‐Olivier , Moffett Peter , Michaud Dominique , D'Aoust Marc‐André
Published: December 2023

The production of influenza vaccines in plants is achieved through transient expression of viral hemagglutinins (HAs), a process mediated by the bacterial vector Agrobacterium tumefaciens. HA proteins are then produced and matured through the secretory pathway of plant cells, before being trafficked to the plasma membrane where they induce formation of virus‐like particles (VLPs). Production of VLPs unavoidably impacts plant cells, as do viral suppressors of RNA silencing (VSRs) that are co‐expressed to increase recombinant protein yields. However, little information is available on host molecular responses to foreign protein expression. This work provides a comprehensive overview of molecular changes occurring in Nicotiana benthamiana leaf cells transiently expressing the VSR P19, or co‐expressing P19 and an influenza HA. Our data identifies general responses to Agrobacterium‐mediated expression of foreign proteins, including shutdown of chloroplast gene expression, activation of oxidative stress responses and reinforcement of the plant cell wall through lignification. Our results also indicate that P19 expression promotes salicylic acid (SA) signalling, a process dampened by co‐expression of the HA protein. While reducing P19 level, HA expression also induces specific signatures, with effects on lipid metabolism, lipid distribution within membranes and oxylipin‐related signalling. When producing VLPs, dampening of P19 responses thus likely results from lower expression of the VSR, crosstalk between SA and oxylipin pathways, or a combination of both outcomes. Consistent with the upregulation of oxidative stress responses, we finally show that reduction of oxidative stress damage through exogenous application of ascorbic acid improves plant biomass quality during production of VLPs.
The relationship between women's climate change awareness and concerns about climate change in Turkiye
Authors: Demir Rukiye , Yalazı Rüveyda Ölmez , DINÇ Ayten
Published: December 2023

Objectives

This study was conducted to examine the relationship between women's awareness of climate change and their worries about climate change in terms of women's health in Turkiye.

Study design

Cross‐sectional survey.

Methods

The research was conducted in a descriptive study design in the relational survey model. The sample of the study consisted of 321 women. Data were collected with the “Personal Information Form, Adaptation of Awareness to Climate Change Questionnaire, Climate Change Worry Scale.”

Results

The total mean score of the Awareness to Climate Change Scale for Women was 2.32 ± 0.61 (moderate awareness), and the total mean score of the Climate Change Worry Scale was 2.76 ± 0.84 (moderate anxiety). There was a statistically significant, positive but weak relationship between women's worries about climate change and their awareness to climate change (r = 0.373, p < .001).

Conclusions

As women's awareness to climate change increases, their worries about climate change increase.
Undergraduate nursing student's attitudes to learning during clinical practice in different semesters when using a conceptual learning model grounded in a caritative caring perspective – A cross‐sectional study
Authors: Koldestam Maria , Rolander Bo , Broström Anders , Lindqvist Gunilla , Knutsson Susanne
Published: December 2023

Aim

To describe undergraduate nursing students' attitudes to learning during clinical practice in different semesters when using the conceptual learning model, Model for Improvements in Learning Outcomes (MILO) grounded in a caritative caring perspective.

Background

With the intention to support interlinking between theory and praxis and offer understanding and structure to facilitate learning, MILO, theoretically grounded in hermeneutics and a caritative caring perspective based on ethical values, was implemented. MILO consists of four contextual concepts (peer learning, co‐clinical teachers, student‐centred and student‐active supervision) and four intrapersonal concepts (nursing, a reflective approach, a critical approach, quality and safety).

Methods

A descriptive comparative quantitative study design was applied at a Swedish university, 3 hospitals and 13 municipalities in one county. Cross‐sectional data collected via a questionnaire developed to assess attitudes to learning related to MILO's contextual and intrapersonal concepts and their applications were used.

Results

209 students in semester 3, 4 and 6 participated in 6 different clinical practice courses. In comparison, intrapersonal concepts, that is, the student's own characteristics and abilities were viewed to be of greater value for learning than contextual, that is, organisational‐related concepts in all semesters. Understanding the needs of others and reflective learning were rated to be of major importance. Students in semester 3 valued the use of the applications the highest. To be supervised in pairs was rated the lowest in semester 6. Some of the concepts and their applications were to great extent not applied.

Conclusions

In all semesters, fundamentals in caritative caring and characteristics and abilities related to the individual student were rated to be of greater importance for learning than environmental support. Providing students opportunities to develop independency seems essential. Use of a learning model such as MILO is dependent on a bearing of a caritative caring culture and a shared understanding between all involved in student learning during clinical practice.
Sedimentary environment and benthic oxygenation history of the Upper Cretaceous Austin Chalk Group, south Texas: An integrated ichnological, sedimentological and geochemical approach
Authors: Zheng Charlie Y. C. , Kerans Charles , Buatois Luis A. , Mángano M. Gabriela , Ko Lucy T.
Published: December 2023

Oxygen concentration in the ocean is vital for sustaining marine ecosystems. While the potential impacts of deoxygenation on modern oceans are hard to predict, lessons can be learned from better characterizing past geological intervals formed under a greenhouse climate. The greenhouse Cretaceous containing several oceanic anoxic events characterized by widespread oxygen‐deficient water is ideal in this regard. The Austin Chalk Group in south Texas (USA) shows organic‐rich intervals that can be linked to oxygen depletion in the ocean, but the exact bottom water oxygenation conditions have not been estimated. This study aims to reconstruct both sediment interstitial and bottom water oxygenation history during Austin Chalk Group deposition by integrating detailed ichnological, sedimentological and geochemical (X‐ray fluorescence and X‐ray diffraction) analyses, thereby providing a consistent model that may be applicable across a range of marine shelf settings. The 141.12 m Gise #1 core contains a continuous record of the Austin Chalk Group, providing an opportunity for unravelling oxygenation and deoxygenation events. Whereas the anaerobic–exaerobic deposits are essentially nonbioturbated, four oxygen‐related ichnocoenoses are defined, further refining the transition of aerobic to dysaerobic conditions in the sediment interstitial water. Omission surfaces and glauconitic grains, products of current‐induced scouring and condensation, suggest sporadic high‐energy events in the Austin Chalk Group ramp that drove elevated terrestrial inputs. Geochemical data further help to identify anoxic bottom water conditions within the anaerobic facies. Additionally, the lowermost part of the Austin Chalk Group illustrates redox cycles, whereas dilution events characterized by elevated terrestrial input are identified throughout the rest of the Austin Chalk Group. The evolution of oxygenation levels in sediment interstitial water and bottom water disputes the existence of a long‐lasting oxygen‐deficient sea in south Texas. The refined depositional model may be applicable to coeval shelfal settings. Moreover, the results provide insights into variable, evolving palaeoclimatic and palaeoceanographic conditions of the greenhouse Late Cretaceous.