bluuebunny/crossref_metadata_2025 huggingface dataset:
Character strengths and turnover intention among primary health workers: a moderated mediation analysis
Authors: Huang Xianhong , Jia Jie , Chen Hanlin , Gao Yuan , Xu Chenjie , Zhu Hailong , Zhang Hao
Published: September 2023

Background
More than half of China’s primary healthcare workers express turnover intention, but the mechanisms driving this remain unclear. This study aimed to explore the impact of character strengths, career calling, and work motivation on turnover intention among primary healthcare workers in Zhejiang Province.
Methods
Data from 875 primary healthcare workers were collected using questionnaires. T-tests, factorial analysis of variance, and hierarchical linear regression were employed to analyze the factors influencing turnover intentions. The PROCESS Macro was used to explore and verify the influencing paths and mechanisms.
Results
The direct impact of character strengths on turnover intention was not significant. However, career calling had a complete mediating effect on the relationship between character strengths and turnover intention. Furthermore, intrinsic motivation had a negative moderating effect on the relationship between character strengths and career calling, while extrinsic motivation had a positive moderating effect on the relationship between career calling and turnover intentions.
Conclusions
Therefore, management personnel at basic medical institutions should offer character strengths training for employees and promote the application of character strengths in clinical work. Simultaneously, management personnel should use internal and external incentives to stimulate employees’ work enthusiasm, maintain adequate work motivation levels, strengthen career calling education, and guide primary healthcare workers to enhance their professional identity and sense of responsibility—thereby reducing turnover intention.
Agroforestry for improved food security: A case study in a cocoa-producing zone in Côte d'Ivoire
Authors: Atangana Alain R. , Adouko Edith Agbo , Kossia Prisca Kossonou , Kouassi Patrice Tehia , Kouamé Christophe
Published: September 2023

Food security is a pressing issue in tropical regions, where cash crop cultivation often competes with food crop production. This study evaluates the potential of agroforestry to enhance food security in a cocoa-producing zone in Côte d'Ivoire. A comprehensive survey identified commonly consumed foods, including pounded yam with okra sauce, rice with peanut sauce, rice with eggplant sauce, boiled yam with taro sauce, placali with palm fruit sauce, avocado, and guava. Analyses revealed varying characteristics among the foods, with pounded yam and okra sauce having the highest dry matter content (94.66%) and guava and placali with palm nut sauce exhibiting acidic pH values (4.13 and 4.61). Rice with eggplant sauce displayed the lowest titratable acidity, while avocado had the highest ash content. Rice with eggplant sauce and rice with peanut sauce were protein-rich, while guava, pounded yam with okra sauce, and rice with peanut sauce had low lipid content. Conversely, avocado, placali with palm fruit sauce, and boiled yam with taro leaves contained high lipid levels. All foods, except fruits, provided more than the recommended daily energy intake. Additionally, cocoa producers exhibited higher levels of food security (78.6%) and better food consumption scores (87.5%) compared to non-cocoa producers (82.5%).
Protocol of a Cluster Randomised Trial of BodyKind: A School-Based Body Image Programme for Adolescents
Authors: Mahon Ciara , Booth Ailbhe , Hamburger Denise , Yager Zali , Jennifer B. Webb , Fitzgerald Amanda , Howard Emma
Published: September 2023

Background
Poor body image is prevalent among adolescents and associated with several negative outcomes for their physical and psychological health. There is a pressing need to address this growing public health concern, yet there is a lack of evidence-informed universal programmes for older adolescents that address contemporary body image concerns (i.e., social media). BodyKind is a four lesson, school-based, teacher led, universal body image programme that incorporates empiricallysupported principles of cognitive dissonance, self-compassion, compassion for others and social activism, to support positive body image development. Building on previous pilot trials in the USA, this paper outlines the protocol for a cluster randomised control trial (RCT) and implementation evaluation of the BodyKind programme which was culturally adapted for the Irish cultural context.
Methods
We aim to recruit 600 students aged 15–17 years in Transition Year (4th year) across 26 second-level schools in Ireland. Using minimisation, schools will be randomly assigned to receive BodyKind (intervention condition, n = 300) or classes as usual (waitlist control, n = 300). Teachers in intervention groups will receive training and deliver the programme to students over four weeks, at a rate of one lesson per week. Primary outcomes of body appreciation, body dissatisfaction and psychological wellbeing and secondary outcomes of self-compassion, compassion for others, body ideal internalisation, social justice motives and appearance-based social media use will be assessed at pre-, post- and 2 month follow up. Mediation and moderation analyses will be conducted to identify how and for whom the intervention works best. An implementation evaluation will assess the quality of programme implementation across schools and how this may influence intervention outcomes. Waitlist control schools will receive the programme after the 2-month follow up.
Conclusion
This study will be the first to implement a cRCT and an implementation evaluation to assess the impact of this multicomponent school-based body image programme designed to support healthy body image development. If shown to be effective, BodyKind will have the potential to improve adolescent body image and wellbeing and inform efforts to implement sustainable and scalable programmes in schools.
Trial registration
The trial was retrospectively registered on 18/07/2023 on the OSF registry [osf.io/nhje4]]
Comparison of the effect of open and closed suction methods on the incidence of hypoxia and Ventilator-Associated Pneumonia (VAP) in the patients admitted to the ICU-A clinical trial study
Authors: Pakizeh Zeinab , Asadizaker Marziyeh , Shariati Abdolali , Savaie Mohsen , Saki Amel
Published: September 2023

Introduction:
various strategies are offered to prevent VAP, which include a wide and significant range of measures. The aim of this study was to compare the effect of open and closed suction methods on the incidence of hypoxia and Ventilator-Associated Pneumonia (VAP) in the patients admitted to the ICU.
Methods
In this clinical trial study, among the patients admitted to the ICU of Golestan and Amir Al-Momenin hospitals in Ahvaz, Iran, 184 patients with inclusion criteria were selected non-randomly divided into intervention and control groups. The data collection tools were demographic information questionnaire and medical checklist based on Modified Clinical Pulmonary Infection Score (MCPIS) and pulse oximetry device. In the intervention group, suctioning was performed by closed method and in the control group, open suctioning was performed. Data analysis was done using SPSS version 22 software.
Results
The mean age of participants was 50.07 ± 18 18.30. According to the findings, there was a significant difference between the two groups in terms of hypoxia changes (p < 0.001) so that the rate of hypoxia changes trend in the intervention group over time was more than the control group. The rate of fio2 changes during the first to fifth days in the intervention and control groups was statistically significant and the level of fio2 in the intervention group was higher than the control group. However, the results of GEE did not show a significant difference between the intervention and control groups in terms of VAP (P = 0.167).
Conclusions
While using both suction methods and proposing to conduct more studies in this field, it is recommended to use closed suction, due to the improvement of the hypoxia situation, the reduction of the need for disposable materials (gloves, etc.) and less manpower, as a preferred method is to be used.
Validation and Evaluation of School-Based Mental Health Literacy Training Program The Guide Cymru in Iranian Adolescent Students Aged 13-15: Study Protocol
Authors: zeidabadi Batool , Khodayarian Mahsa , Sadeghi Reza , Jambarsang Sara
Published: September 2023

Background
Schools are an ideal setting for enhancing mental health literacy, a crucial strategy for improving adolescents' mental health knowledge and attitudes and promoting help-seeking. "The Guide Cymru" program is an adaptation of the mental health literacy program" The Guide" that was developed in Canada. The program will be culturally adapted for 13- to 15-year-old Iranian adolescent students in the first secondary schools.
Methods
In this randomized controlled trial, using the stratified random sampling procedure, the whole eighth and ninth grade student body (aged 13 to 15) from Sirjan City's first secondary schools will be included in the study. Twenty first secondary schools will be randomly assigned to one of two groups: control or intervention. Finally, 562 students and 40 teachers will participate in the research. The tools of mental health literacy scale (MHLs), mental health general knowledge and attitudes related to mental disorders/illnesses are employed in this study.
Discussion
This trial aims to is to explore whether "The Guide Cymru", a mental health literacy program offered to students as part of the school curriculum, can decrease the stigma associated with mental health and promote help-seeking behaviors among students.
Comorbid health conditions and their impact on social isolation, loneliness, quality of life, and well-being in people with dementia: longitudinal findings from the IDEAL programme
Authors: Sabatini Serena , Martyr Anthony , Hunt Anna , Gamble Laura , Matthews Fiona E , Thom Jeanette , Jones Roy W. , Allan Louise , Knapp Martin , Victor Christina , Rusted Jennifer M , Morris Robin G , Clare Linda , Pentecost Claire
Published: September 2023

Background Most people with dementia have multiple health conditions. This study explores 1) number and type of health condition(s) in people with dementia overall and in relation to age, sex, dementia subtype, and cognition; 2) change in number of health conditions over two years; and 3) whether over time the number of health conditions at baseline is related to social isolation, loneliness, quality of life, and/or well-being.Methods Longitudinal data from the IDEAL (Improving the experience of Dementia and Enhancing Active Life) cohort were used. Participants comprised people with dementia (n = 1490) living in the community (at baseline) in Great Britain. Health conditions using the Charlson Comorbidity Index, cognition, social isolation, loneliness, quality of life, and well-being were assessed over two years. Mixed effects modelling was used.Results On average participants had 1.8 health conditions at baseline, excluding dementia; increasing to 2.5 conditions over two years. Those with vascular dementia or mixed (Alzheimer’s and vascular) dementia had more health conditions than those with Alzheimer’s disease. People aged ≥ 80 had more health conditions than those aged < 65 years. At baseline having more health conditions was associated with increased loneliness, poorer quality of life, and poorer well-being, but was either minimally or not associated with cognition, sex, and social isolation. Number of health conditions had either minimal or no influence on these variables over time.Conclusions People with dementia in IDEAL generally had multiple health conditions and those with more health conditions were lonelier, had poorer quality of life, and poorer well-being.
Equity and trend predictions of human resources for health allocation at the Centers for Disease Control and Prevention in China, 2005-2020
Authors: Chang Jingru , Xu Shuqian , Ma Guoliang , Wu Qifeng , Xu Xinpeng , Lu Hui
Published: September 2023

Background
Improving the accessibility and efficiency of human resources for health (HRH) at the Centers for Disease Control and Prevention (CDCs) is an important component of China's public health system. This study aimed to comprehensively analyze CDC HRH in terms of the quantity, quality and equity of allocation, and offer sound recommendations for strengthening HRH at the CDCs.
Method
This study provided a descriptive analysis of the quantity and quality of CDC HRH using indicators such as the total number of CDC staff, public health workforce density, age, education level and technical title. The Gini coefficient and agglomeration degree were used to measure the equity of CDC HRH allocation. The grey model first order one variable (GM (1,1)) was used to predict the number of HRH at the CDCs.
Results
From 2005 to 2020, the public health workforce density of CDCs was below the Chinese government's required standard of 1.75 per 10,000 residents. The CDCs have always faced the problem of understaffing and attrition. The GM (1,1) model showed that the number of CDC HRH will continue to decrease from 2021 to 2025. In addition, the quality of CDC HRH showed a gradual aging trend and a lack of high-quality talent. The Gini coefficient indicated that the overall equity of CDC HRH allocation by population was relatively better than that by geographical area. The aggregation degree showed significant differences in the equity of CDC HRH allocation in the eastern, central and western regions.
Conclusions
The findings indicate that it is necessary to further optimize the number and structure of CDC HRH and enhance the equity of resource allocation among different regions. However, these results were not due to a single cause. It is essential to improve existing policies and establish effective planning to strengthen the public health workforce at the CDCs and meet the needs of the public health system.
International Survey of People Living with Chronic Conditions (PaRIS survey): effects of general practitioner non-participation on the representativeness of the Norwegian patient data
Authors: Bjertnaes Øyvind A. , Skudal Kjersti E. , Berg Michael J. , Porter Ian , Holmboe Olaf , Norman Rebecka M. , Iversen Hilde H. , Ellingsen-Dalskau Lina H. , Valderas Jose M.
Published: September 2023

Background
The International Survey of People living with Chronic Conditions (OECD-PaRIS survey), aims to systematically gather patient-reported experiences (PREMs) and - outcomes (PROMs) and potential predictors for these outcomes for persons with chronic conditions as well as information from professionals about health care provided. In such patient surveys, the advantages of a multilevel (nested) approach in which patients are sampled ‘within providers’ need to be balanced against the potential for bias if patient populations from participating GPs significantly differ from those of non-participating GPs. The objective was to assess the effects of general practitioner (GP) non-participation on the representativeness of the Norwegian patient data of the International Survey of People living with Chronic Conditions (OECD-PaRIS survey).
Methods
For the Norwegian part of the field trial in 2022, we randomly sampled and surveyed 75 GPs and 125 patients 45 years and older for each GP, regardless of whether their GP were also participating in the study. We compared GP and patient characteristics as well as patient-reported experiences and outcomes according to GP participation status in bivariate analysis, supplemented with multiple linear regressions with PREMs/PROMs as dependent variables and participation status as independent adjusting for significant patient factors.
Results
17 of 75 sampled GPs participated (22.7%), of which 993 of 2,015 patients responded (49.3%). 3,347 of 7,080 patients of non-responding GPs answered (47.3%). Persons with chronic conditions from participating GPs reported significantly better patient-centred coordinated care (p = 0.017), overall experiences with the GP office the last 12 months (p = 0.004), mental well-being (p = 0.039) and mental health (p = 0.013) than patients from non-participating GPs. The raw differences between participating and non-participating GPs on the primary outcomes varied from 1.5 to 2.9 points on a 0-100 scale, and from 2.2 to 3.0 after adjustment for case-mix.
Conclusions
The Norwegian field trial indicates that estimates based on participants in the PaRIS survey may modestly overestimate patient-reported experiences and -outcomes at the aggregated level and the need for more research within and across countries to identify and address this potential bias.
A Markov network approach for reproducing purchase behaviours observed in convenience stores
Authors: Johansson Dan , Takayasu Misako , Takayasu Hideki
Published: September 2023

The convenience store industry in Japan holds immense significance, making a thorough comprehension of customer purchase behavior invaluable for companies aiming to gain insights into their customer base. In this paper, we propose a novel application of a Markov network model to simulate purchases which guided by stopping probabilities calculated from real data. Each node in the Markov network represents different product categories available for purchase. Additionally, we introduce the concept of a "driving force," quantifying the influence of purchasing product A on the likelihood of purchasing product B, compared to random purchasing. For instance, our analysis reveals that the inclusion of nutrient bars in a purchase set leads to, on average, a 13% reduction in tobacco purchases compared to random patterns. To validate our approach, we compare the simulated macro-level purchase behaviors with real Point of Sale (POS) data obtained from a prominent convenience store giant, 7-ELEVEN. The dataset is comprised off roughly 54 million receipts, in which we focus on the product categories existing in this dataset rather than individual products. Our model successfully replicates the purchase size distribution for 99.9% of all purchases and the purchase counts across various product categories, demonstrating its efficacy in capturing broad purchase patterns.
Prognostic analysis of hepatocellular carcinoma based on Cuproptosis - associated lncRNAs
Authors: Wei Weiming , Lu Libai , Luo Zongjiang , Ma Jiasheng , Wang Jianchu
Published: September 2023

Objectives
Cuproptosis is a novel form of copper-dependent non-apoptotic cell death, and the role of copper apoptosis-associated long non-coding RNAs (CRLncRNAs) in hepatocellular carcinoma (HCC) has not been elucidated. In this study, we aimed to investigate the significance of copper apoptosis-related lncRNAs in HCC in tumorigenesis and prognosis.
Methods
We analyzed gene transcriptomic data and clinical data of HCC cases by obtaining them from The Cancer Genome Atlas (TCGA). We combined Cuproptosis-related genes to establish prognostic Cuproptosis -related lncRNA features and further illustrated the mechanism of Cuproptosis-related LncRNAs in the prognosis and treatment of HCC through Lasso and Cox regression analyses, survival analyses of samples, and analyses of tumor mutation load as well as immune function。
Results
We established a prognosis-related model consisting of 6 Cuproptosis -related lncRNAs: AC026412.3, AC125437.1, AL353572.4, MKLN1-AS, TMCC1-AS1, SLC6A1-AS1. Both the training and validation sets had excellent results in the prognosis of tumor patients, and the survival time of the low-risk group based on the model was much higher than that of the high-risk group. Besides, the analysis of tumor mutation load difference, immune function analysis, GO/KEGG pathway enrichment analysis, and drug sensitivity analysis also demonstrated the possible mechanism of Cuproptosis-associated LncRNAs.
Conclusions
The model constructed based on Cuproptosis-related lncRNA has good predictions for the prognosis and immunotherapy of tumor patients, which may play an important role in patient management and immunotherapy, providing reference value for subsequent research.
Diagnostic Potential of MicroRNA-1, MicroRNA-21, and MicroRNA-29 as Novel Biomarkers for Early Development of Myocardial Fibrosis in Heart Failure with Preserved Ejection Fraction
Authors: Andrianto Andrianto , Al-Farabi Makhyan Jibril , Arifitrianto Muhammad Gani , Juwita Rahima Ratna , Firmansyah Okky Wahyu , Intan Ryan Enast , Fadila Asiyah Nurul , Tiyantara Muhammad Surya , Suryawan I Gde Rurus , Ardiana Meity , Rahmianti Nia Dyah , Pikir Budi Susetyo , Nugraha Ricardo Adrian
Published: September 2023

Background:
Currently, there is an unmet need for a minimally invasive diagnostic tool with less radiation for the early development of myocardial fibrosis and targeted treatment for preserved ejection fraction (HFpEF). This study aimed to investigate the diagnostic potential of circulating microRNAs (miRNAs) for detecting early myocardial fibrosis development in HFpEF patients.
Methods:
This observational study used a case-control research design. Peripheral blood samples were isolated from 25 HFpEF patients and 25 normal patients. They were measured for complete laboratory testing, NTproBNP levels using ELISA, as well as MicroRNA-1, 21, and 29 levels using RT-PCR. All patients also underwent echocardiography for global longitudinal strain (GLS) to measure the myocardial fibrosis progression. Data were analyzed using SPSS 25.0.
Results:
HFpEF patients had significantly higher GLS compared to the normal patients (-13±2.4% vs -19±3.2%; p < 0.05), suggesting HFpEF patients tended to have myocardial fibrosis. HFpEF patients also had significantly higher microRNA-1 and microRNA-21 compared to the normal patients (p < 0.05), but they had lower microRNA-1 (p < 0.05). There was a positive correlation between microRNA-1 (r = 0.753; p < 0.05) and microRNA-21 (r = 0.675; p < 0.05) and an inverse correlation with microRNA-29 (r = -0.653; p < 0.05) based on the GLS findings. By using a GLS cutoff of -15% for myocardial fibrosis, microRNA-1, microRNA-21, and microRNA-29 were found to be able to predict myocardial fibrosis based on GLS with a specificity of 78% and sensitivity of 75%.
Conclusion:
Increasing microRNA-1 and microRNA-21 followed by decreasing microRNA-29 in HFpEF patients suggest early myocardial fibrosis. Detection of those biomarkers can be beneficial for early myocardial fibrosis diagnosis, early aggressive HFpEF treatment, and targeted miRNA silencing therapy to prevent worsening HFpEF.
Anxiety and Depression Among Nigerian Undergraduates: a Cross- Sectional Study
Authors: Adeleke Olumide Thomas , Opadola Oluwafunbi , Ojo Modupe Mofoluke , Abiola Samuel-Ajayi Yetunde , Praise Nebechukwu , Adeleke Oludamola Victoria , Adedeji Afolabi Samson , Ayobami Taiwo Oladayo
Published: September 2023

Background
Globally, there is rising concern regarding the increased prevalence of mental disorders among university students, as studies have demonstrated a significant clinical measure of psychiatric morbidities among undergraduates worldwide. Sadly, there is a paucity of data on the burden of mental illness among undergraduates in Nigeria, and undergraduate students' mental health problems have not received the requisite public attention in Nigeria and many other countries. Therefore, this study aimed to determine the prevalence of anxiety disorders and depression among undergraduate students and the correlation between anxiety and depression among study participants.
Methods
We conducted a cross-sectional study of 877 undergraduates at Bowen University Hospital in Iwo Osun State, Nigeria, between October 2022 and May 2023.
Results
A total of 14.9%, 10.4%, and 1.9% of students had mild, moderate, and severe anxiety disorders, respectively. Similarly, 11.2%, 5.1%, and 0.5% of students had mild, moderate, and severe depression, respectively. The study showed a strong positive correlation between anxiety disorders and depression among undergraduate students.
Conclusion
This study revealed a high prevalence of anxiety and depression. There is a need for concerned authorities to have a blueprint for an efficient mental health support structure and ensure adequate training of personnel at university health centers.
Evaluating the Influence of Organic Waste Compost Amendments on Microbiome Richness and Diversity in Pre-Plantation and Post-Harvest Soils: Insights from 16S rRNA Metagenomic Profiling
Authors: Mahongnao Sophayo , Sharma Pooja , Ahamad Arif , Nanda Sarita
Published: September 2023

Understanding the dynamics of soil microbiomes is crucial for sustainable agriculture and developing effective soil management strategies. This study investigates the impact of leaf-based compost and other organic waste bio-compost amendments on the microbial richness and diversity in soils using 16S rRNA metagenomic profiling. Our results revealed significant variation of the microbiome richness and diversity on soil due to the bio-composts amendment. Interestingly, the bio-composts amendment resulted in a pronounced enrichment of beneficial microorganisms such as Achromobacter, Agromyces, Bacillus, Clostridium, Nitrospira, Planctomyces, Pseudomonas, Steroidobacter, Streptomyces, Alicyclobacillus, and Bdellovibrio, known for their roles in nutrient recycling, plant growth promotion, and disease suppression. The presence of pathogenic bacteria such as Flavobacterium, Leptolyngbya, Balneimonas, Geobacter, Nocardia, and Mycobacterium, were higher in the chemical fertilizer-amended soil sample than the bio-composts amended soils, which indicated the bioremediation of pathogens due to bio-compost amendment. Moreover, it was also observed that the microbiome population of the cultivars were affected by the bio-compost amendments. Generally, the organic cultivars produced using bio-compost amendments had higher beneficial microorganisms and lower pathogens than the conventional produce with chemical fertiliser amendment. Thus, leaf-based compost and other organic-waste compost could be used as bio-organic fertilizer for healthy sustainable productivity.
Locus of Decision-making and Treatment Preferences among Patients with Aplastic Anemia in China
Authors: Fa Cuiwen , Yang Fei , Jing Jun , Wu Jiahao , Chen Zhao
Published: September 2023

Aplastic Anemia (AA) is a non-malignant blood disorder characterized by anemia, bleeding, and increased susceptibility to infection, resulting in poor quality of life for patients. Despite extensive research, the disease remains challenging to cure, leaving patients with limited options for treatment. The incidence of AA in China is approximately 0.74 per 100,000 persons, posing a significant public health issue. Our study focused on investigating the decision-making process of AA patients in 16 provinces of China, utilizing both qualitative and quantitative research methods, including electronic questionnaire surveys and personal interviews. The study sample comprised 2155 participants from online patient organizations, and 186 valid responses were collected. The survey aims to identify the current treatment options utilized by AA patients, the source of medical decision-making, and other relevant information. The findings reveal that many treatments for AA are not covered by insurance, which results in significant financial burdens on patients and further diminishes their quality of life. Additionally, the social network surrounding AA patients significantly impacts their medical decisions, with many seeking input from healthcare providers, relatives, friends, and other AA patients, as well as media sources. In addition to biomedical treatment, patients with AA should explore alternative medical treatments, including traditional Chinese medicine, folk remedies, and other public medical practices.
Evaluation of a Virtual Reality Educational Program for Mindfulness and Emotional Management for Healthcare Professionals
Authors: Costa Jose Ferrer , Moran Nuria , Marti Carlos Garcia , Colmenares Leomar , Ciorba Florin Radu , Ciudad Maria Jose
Published: September 2023

Objective The main objective was to evaluate the impact of an 8-week virtual reality (VR) based educational program teaching mindfulness and emotional management techniques to healthcare professionals.
Methods Eighty-six healthcare professionals from two primary care centers and a palliative care team engaged in weekly 10-15 minute VR educational sessions. The sessions focused on teaching mindfulness techniques and emotional management tools. Burnout and work engagement levels were assessed using the Maslach Burnout Inventory (MBI) and Utrecht Work Engagement Scale (UWES) pre- and post-intervention.
Results Post-intervention data analysis revealed statistically significant reductions in emotional exhaustion and depersonalization, as well as enhancements in personal accomplishment, vigor, dedication, and absorption. Notably, professionals who exhibited elevated levels of work-related stress at baseline derived the most benefit from the educational content.
Conclusions The results emphasize the potential of employing VR as a medium to deliver educational content centered on mindfulness and emotional management, especially in the context of alleviating burnout among healthcare professionals. Such positive outcomes underscore the importance of investments in these programs, suggesting that they can contribute to superior patient outcomes and heightened service quality by reinforcing the emotional resilience of healthcare providers. To further comprehend the distinct advantages of VR in educational scenarios and ensure that all participants can avail its benefits, future research should contemplate more intricate experimental designs.
Perturbations in immune parameters Following Exposure to Manihot esculenta (Cassava)
Authors: Evbuomwan Lucky , Okojie Rachel Obhade , Anani Osikemekha Anthony
Published: September 2023

Cassava roots provide important sources of energy-rich food for millions of people. It is rich in two toxic cyanogenic glycosides. The study aimed to assess the impact of cyanide-containing food (Cassava) on hematological and histological parameters in experimental rats. Freshly prepared cassava products (fried garri and cassava paste) were obtained. Thirty-five (35) inbred male Swiss Rattus norvegicus were used for the study. There were two major animal groups, each divided into four other subgroups that contained five rats each. Subgroups were designated as A (only cassava form administration), B (cassava form and immunosuppressor), H (1mg/kg KCN), and I (only feed and water). All subgroups B received cyclophosphamide as a single dose on the 9th day. Animals were sacrificed on the 14th day. The data were analyzed using SPSS. Cyanide concentration was 133.16 ± 16.23 mg/kg in cassava paste and 59.40 ± 8.07 mg/kg in fresh fried garri. Results of white blood cell, red blood cell, monocyte, granulocyte, and neutrophil counts revealed lower levels in groups A, B, and H in rats exposed to freshly fried garri compared to group I. In rats exposed to fresh cassava paste, hematological parameters were similarly lower in groups A, B, and H compared to the normal control, where they were higher. When compared to the control group, there were various histological deformations observed in the liver, thymus, spleen, and kidney of the tested rat species like thickened centriole, adipose tissue, prominent dilated central artery, mild atrophic, and inflamed cells.
A case report of Graves Thyrotoxicosis associated with Pulmonary Hypertension
Authors: Wickramasinghe Malintha , Silva Shehan
Published: September 2023

Introduction
Pulmonary hypertension manifesting as a secondary cause has an extensive list of aetiology. Hyperthyroidism associated with pulmonary hypertension has been reported in a few case reports. Most of these have presented in an asymptomatic manner. A variety of mechanisms have been described in how thyrotoxicosis causes pulmonary hypertension.
Case Presentation
A 74-year-old woman with thyrotoxicosis due to Graves’ disease presented with bilateral pedal oedema and exertional shortness of breath suggestive of right heart failure. There was transthoracic echographic evidence of pulmonary hypertension. Commencement of oral carbimazole along with propranolol later once heart failure was controlled led to resolution complete resolution of pulmonary hypertension.
Conclusion
This case highlights the importance of considering thyrotoxicosis as a cause of pulmonary hypertension which can be completely resolved with the establishment of a euthyroid state. Although patients may present asymptomatic and are incidentally detected, the illness can manifest with features suggestive of right heart failure.
Network intervention analysis to assess the trajectory of chang and intervention effects associated with the use of self-control training for ego depletion aftereffects
Authors: Ying Junji , Zhang Xiaofang , Ren Lei , Wu Rihan , Xiao Wei , Liu Xufeng
Published: September 2023

Purpose: The purpose of this study was to use the advanced technique of Network Intervention Analysis (NIA) to investigate the trajectory of symptom change associated with the effects of self-control training on youth university students’ chronic ego depletion aftereffects.
Methods: The nine nodes of chronic ego depletion aftereffects and integrated self-control training were taken as nodes in the network and analyzed using NIA. Networks were computed at the baseline, at the end of treatment, at 1-, 3-, 6-, 9- and 12-month follow up.
Results: Self-control training interventions had a direct effect on low self-efficacy, low adherence, and work burnout, and had an indirect effect on fatigue, emotional regulation disorders, and other issues. Follow-up surveys showed that the intervention not only had immediate effects but also had long-term effects.
Conclusion: These findings indicate that self-control training has a direct intervention effect on low self-efficacy, low perseverance, and work fatigue of youth university students’ ego depletion aftereffects. This study is the first application of NIA in abnormal psychological state intervention research outside the field of mental disorder treatment. NIA is a promising method to evaluate the trajectories of intervention change and the direct and indirect effects of training interventions.
The application and influence of “Small Private Online Course” based on flipped classroom teaching model in the course of fundamental operations in surgery
Authors: Zhou Xiaoyi , Yu Guanyu , Li Xu , Zhang Wei , Nian Xinwen , Cui Jin , Wei Xianzhao , Sun Yu
Published: September 2023

Objective To investigate the influence of “Small Private Online Course” based on flipped classroom teaching model on the students in the course of fundamental operations in surgery.
Design A retrospective study.
ParticipantsThird-year undergraduates majored in clinical medicine in Navy medical university.
Main outcome measures The mastery of theoretical knowledge and operational skill of the students, the comparison of final test examination score between traditional teaching method and “SPOC + flipped classroom” model and the feedback completed by students.
Results Our study found that SPOC + flipped classroom could significantly increase the efficacy of the class and enhance the ability of the students compared with the traditional method.
Conclusions The new teaching model could have a positive influence for medical students on their basic knowledge and operational skill.
Automated Multi-Step Web Application Attack Analysis Using Reinforcement Learning and Vulnerability Assessment Tools
Authors: Hamidi Mohammad Sedigh , Doostari Mohammadali , Bijani Shahriar
Published: September 2023

Web applications remain persistently vulnerable to malicious attacks, necessitating a thorough exploration of adversarial strategies in multi-step web application attacks to proactively enhance preventive measures. Nonetheless, the complexity of such audits demands specialized expertise, and notably, the automation of this complicated process lacks practical methodologies. This paper presents an innovative approach that automates multi-step web application attacks by integrating reinforcement learning techniques with established tools like Metasploit, SQLmap, and Weevely. Within this framework, reinforcement learning agents exploit SQL injection and known vulnerabilities outlined in the OWASP Top Ten. A comparative analysis of two reinforcement learning models, Q-Learning and Deep Q-Network, reveals the superior reward accumulation prowess of the Q-Learning model during the training phase. Furthermore, the effectiveness of these trained agents is assessed using the vulnerable DVWA web application, demonstrating the Q-Learning-trained agent could gain persistent access to the web server and successfully extracting sensitive data.
Exploring the Temporal Dissolution of Gas Hydrates in the South Shetland Islands of Antarctica through Fluid Flow Simulations
Authors: Dogan Doga Dusunur , Turkdogan Selvican , Ocakoglu Neslihan , Tinivella Umberta , Giustiniani Michela , Altan Zehra , Gorum Tolga , Arik Sinan
Published: September 2023

Numerical models were used to study gas hydrates and free gas stability over time in gas hydrate-bearing sediments off the Antarctic Peninsula, South Shetland Islands, for the first time. Seismic data aided in creating a marine subsurface model, and ANSYS-Fluent was employed for multiphase simulations. Results revealed that in-situ faults played a crucial role in gas hydrate distribution, with CH4 being rapidly drained off, and CO2 and H2 emitted through the faults. Faults acted as fluid conduits, leading to high CO2 concentrations nearby. Dissolved methane accumulated in isolated clusters within marine sediments, with varying dissolution times depending on gas hydrate concentrations. This complex interplay of faults, fluid availability, bathymetry, and gas hydrate concentrations significantly influenced methane's fate and transport in marine environments.
Concordance of ALK fusion gene-rearrangement between immunohistochemistry and next-generation sequencing
Authors: Wakuda Kazushige , Morita Meiko , Sekikawa Motoki , Morikawa Noboru , Miura Keita , Doshita Kosei , Iida Yuko , Kodama Hiroaki , Mamesaya Nobuaki , Kobayashi Haruki , Ko Ryo , Ono Akira , Kenmotsu Hirotsugu , Naito Tateaki , Murakami Haruyasu , Muramatsu Koji , Kawata Takuya , Shimizu Tetsuo , Gon Yasuhiro , Takahashi Toshiaki
Published: September 2023

Background: Although various companion diagnostic tests of ALK fusion gene-rearrangement are approved, few reports have assessed the concordance of ALK fusion gene-rearrangement in two companion diagnostic tests: next-generation sequencing (NGS) testing and immunohistochemistry (IHC).
Methods: The samples evaluated for gene alterations using NGS testing between May 2019 and November 2021 were included in this study. The inclusion criteria were as follows: samples were diagnosed with non-small cell lung cancer; the results of the NGS analysis were informative; and samples had residual specimens for IHC. We performed IHC on the residual specimens and retrospectively collected sample characteristics from medical records.
Results: A total of 185 samples were analyzed using NGS. Twenty-six samples were excluded because of failure to analyze gene alterations using NGS, no residual samples, and inadequate IHC. We analyzed 159 samples. The major histological type was adenocarcinoma (115 samples). The number of surgical and transbronchial lung biopsy specimens was 59 and 56, respectively. ALK fusion gene-rearrangement was detected in four samples using NGS, and five were detected using IHC. The sensitivity and specificity of IHC referred to by NGS were 75.0% and 98.7%, respectively. The concordance rate between IHC and NGS was 98.1%. ALK rearrangement was detected in two patients using IHC but not using NGS. In addition, ALKrearrangement was detected in one patient using NGS but not using IHC.
Conclusions: Our results suggest that IHC and NGS might be complementary tests. In patients suspected of harboring ALK fusion gene-rearrangement, it should be analyzed using another diagnostic method.
Phosphoproteomic analysis reveals the role of A-Raf in regulating the apoptosis of porcine macrophages infected with Toxoplasma gondii
Authors: Su Dingzeyang , Zhu Shifan , Xu Kangzhi , Hou Zhaofeng , Hao Fuxing , Xu Fan , Zhu Yuyang , Liu Dandan , Xu Jinjun , Tao Jianping
Published: September 2023

Toxoplasma gondii is an obligate intracellular protozoan of severe threat to humans and livestock. Macrophages are the cell type preferentially infected by T. gondii in vivo. Protein phosphorylation is an important post-translational modification involved in diverse cellular functions. A-Raf is member of the Raf family of serine/threonine protein kinases that is necessary for MAPK activation. Our previous research found that A-Raf knockout could reduce the apoptosis of porcine alveolar macrophages (3D4/21 cells) caused by T. gondii infection. However, limited information is available about the level of protein phosphorylation variations and the roles of A-Raf in macrophages with T. gondii infection. Here, we used IMAC in combination with LC-MS/MS to profile the changes of phosphorylation in 3D4/21 cells and 3D4/21-ΔAraf cells upon Toxoplasma infection, respectively. A total of 1647 differentially expressed phosphorylated proteins (DEPPs) with 3876 differentially phosphorylated sites (DPSs) were identified in 3D4/21 cells with Toxoplasma infection (p3T group) when comparing 3D4/21 cells without parasite infection (pho3 group), and 959 DEPPs with1540 DPSs when comparing 3D4/21-ΔAraf cells with parasite infection (p3KT group). In addition, 552 DPSs corresponding to 406 DEPPs with the same phosphorylated sites were obtained in the comparison p3T/pho3 vs. p3T/p3KT, which was identified as the DPSs and DEPPs related with A-Raf. Remarkable functional properties of the DEPPs were discovered by GO analysis, KEGG pathway analysis, and STRING analysis. Of 406 DEPPs related with A-Raf, 40 DEPPs corresponding to 57 DPSs involved in the apoptosis of 3D4/21 cells during Toxoplasma infection. Further analysis showed that the phosphorylation levels of Med1at serine1418, Jun at serine 73, Myc at serine 154, Mcl1 at serine 65, and Bad at serine115 were upregulated in p3T, but downregulated in p3KT, suggesting that A-Raf regulate phosphorylation of these sites to modulate the apoptosis of macrophages induced by Toxoplasma infection. These results revealed distinct responses of macrophages to Toxoplasma infection and the potential roles of A-Raf in fighting against infection via phosphorylation of crucial proteins.
Economic aspects of prolonged home video-EEG monitoring: a simulation study
Authors: Vander Tatiana , Bikmulina Rozalyja , Froimovich Naomi , Stroganova Tatiana , Nissenkorn Andreea , Gilboa Tal , Eliashiv Dawn , Ekstein Dana , Medvedovsky Mordekhay
Published: September 2023

Introduction
Video EEG monitoring (VEM) is an important tool to characterize clinical events suspected as seizures. It is also used for pre-surgical workup in patients with drug-resistant epilepsy (DRE). The high cost and inconvenience of in-hospital VEM led to interest in home VEM (HVEM). However, because antiseizure medications cannot be reduced at home, HVEM may require longer monitoring. While the economic aspect is one of the main motivations for HVEM, the cost of HVEM lasting several weeks has not been assessed.
Methods
We modeled the cost of HVEM during eight weeks and compared it to the cost of one-week in-hospital VEM. Additionally, we modeled the per-patient cost for a combination of HVEM and in-hospital VEM, considering that if in a proportion of patients HVEM fails to achieve its goal, they should undergo in-hospital VEM with drug reduction.
Results
The average cost of HVEM up to 4–6 weeks of monitoring was lower than that for the one-week in-hospital VEM. The combination of the three-week HVEM with one-week in-hospital VEM (if needed) reduced the per-patient cost by 6.6–28.6% as compared to the situation when all the patients with DRE were referred to the in-hospital VEM.
Conclusions
A prolonged intermittent HVEM can be economically efficient, which justifies directing the efforts into clinical trials and technology development.
Ultrastructure of noise-induced cochlear synaptopathy
Authors: Moverman Daniel J. , Liberman Leslie D. , Kraemer Stephan , Corfas Gabriel , Liberman M. Charles
Published: September 2023

Overexposure to noise can eliminate synaptic connections between inner hair cells (IHCs) and auditory nerve fibers (ANFs), even if hair-cell function recovers. This noise-induced synaptopathy has been extensively studied in confocal microscopy of cochleas immunostained for pre- and post-synaptic markers, however, understanding the nature and sequence of damage requires ultrastructural analysis. Here, we used focused ion beam scanning electron microscopy to serially mill, image, segment and reconstruct the unmyelinated terminals of ANFs in mice, 1 day and 1 week after synaptopathic exposure. At both survivals, ANF terminals were normal in number, but synaptic counts were reduced by half. Most non-synapsing fibers remained in close proximity to IHCs and contained healthy-looking organelles. ANFs showed a transient increase in mitochondrial content and efferent innervation at 1 day. Fibers maintaining synaptic connections showed hypertrophy of pre-synaptic ribbons at both 1 day and 1 week. Non-synaptic fibers were lower in mitochondrial content and typically on the modiolar side of the IHC, consistent with selective damage to ANFs with high-thresholds and low spontaneous rates. Even 1 week post-exposure, most unmyelinated ANF terminals remained intact despite loss of synaptic specializations. Thus, the first step in the degenerative process is not explosion and retraction of the neuron.
The Effect of Core Stability Training on the Balance Ability of Young Male Basketball Players
Authors: gong jian
Published: September 2023

Background
Teenage male basketball players often struggle to adapt to high-intensity physical confrontations. This leads to decreased shooting accuracy and inadequate defensive capabilities.
Methods
This study primarily assessed the effects of a 10-week core stability training program compared to traditional strength training on the balance abilities of teenage male basketball players. Three balance assessment indicators were selected: dominant-side closed-eye single-leg stance, eight-point star excursion balance test, and core endurance test in four directions.
Results
The results showed that: (1) there were significant differences in the scores of both groups in the closed-eye single-leg stance test before and after training (p < 0.01), (2) in the eight-point star excursion balance test, except for no significant difference in the scores in direction C when using the left foot for support before and after training in the experimental group (p > 0.05), the scores when using both feet for support in other directions showed significant differences (p < 0.05) or highly significant differences (p < 0.01) before and after training; (3) in the core endurance test in four directions, there were no significant differences in the scores of the control group before and after training (p > 0.05), while significant differences existed in the scores of the experimental group before and after training (p < 0.05).
Conclusion
Core stability training significantly enhanced the balance abilities of teenage basketball players and proved to be superior to traditional strength training in improving balance capabilities.