bluuebunny/crossref_metadata_2025_split huggingface dataset:
Enhancing intercultural competence of German medical students through innovative teaching on medical ethics with a focus on Muslim patients – a pilot study
Authors: Tekbaş Aysun , Mauntel Arian , Lehmann Thomas , Tautenhahn Hans-Michael , Settmacher Utz , Festl-Wietek Teresa , Herrmann-Werner Anne 
Published: December 2024

Abstract
Background
Effective healthcare delivery in today's diverse society necessitates healthcare providers' adeptness in navigating cultural and religious nuances in patient care. However, the integration of cultural competence training into medical education remains inadequate, particularly concerning the care of Muslim patients. In response, we introduce a novel educational intervention aimed at enhancing intercultural proficiency among medical students, emphasizing care for Muslim patients.

Methods
The intervention comprised interactive seminars and simulated patient sessions. With a bespoke and the Cross-Cultural Competence of Healthcare Professionals (CCCHP-27) questionnaire the pre- and post-course intercultural competencies of n = 31 medical students of the Medical Faculty of Jena University were assessed. Additionally, there was a control group consisting of 34 students. Statistical analyses including descriptive statistics, paired samples t-tests, Wilcoxon tests, correlation analysis, Mann–Whitney U-tests, and multiple regression analysis were employed for data analysis.

Results
Results of the bespoke questionnaire reveal significant improvements in intercultural knowledge (median pre 1.0 (0.6 – 1.6), median post 2.2 (2.4-2.8), p < 0.001) and in knowledge regarding Muslim patients (median pre 1.0 (0.5 – 1.5), median post 2.5 (2-3), p < 0.001) following the course. Regarding the CCCHP-27, students demonstrated a significant improvement in their skills, with pre-assessment score of 4.10 (± 0.47) and post-assessment score of 4.38 (± 0.40), p = 0.001. Female participants and those with limited prior experience demonstrated greater gains (p = 0.005 and p = 0.053). Notably, the incorporation of a session with a simulated patient garnered favorable feedback, affirming the efficacy of practical application in consolidating learning outcomes.

Discussion
Our study emphasizes the importance of integrating intercultural competencies training into medical education and our findings underscore the efficacy of targeted educational interventions in enhancing intercultural competencies among medical students. For the assessment of intercultural competence, our bespoke questionnaire serves as a valuable addition to the German healthcare system.

Conclusion
Implementation of similar interventions into medical curricula nationwide is imperative to address the needs of diverse patient populations effectively.
Risk of mortality between warfarin and direct oral anticoagulants: population-based cohort studies
Authors: Wang Zixuan , Matthewman Julian , Tazare John , Yu Qiuyan , Cheung Ka Shing , Chui Celine S. L. , Chan Esther W. Y. , Bhaskaran Krishnan , Smeeth Liam , Wong Ian C. K. , Douglas Ian J. , Wong Angel Y. S. 
Published: December 2024

Abstract
Background
Direct oral anticoagulants (DOACs) have been reported to be associated with a higher risk of mortality compared with an older alternative, warfarin using primary care data in the United Kingdom (UK). However, other studies observed contradictory findings. We therefore aimed to investigate the association between mortality and warfarin, compared with DOACs.

Methods
We conducted cohort studies using UK Clinical Practice Research Datalink (CPRD) Aurum and Hong Kong Clinical Data Analysis and Reporting System (CDARS) to identify the association between warfarin and hazard of mortality, compared to DOACs. Individuals with non-valvular atrial fibrillation aged ≥ 18 years who had first anticoagulant therapy (warfarin or DOAC) during 1/1/2011–31/12/2019 were included.

Results
Compared with DOAC use, a lower hazard of all-cause mortality was found in warfarin users (hazard ratio (HR) = 0.81, 95% confidence interval (CI) = 0.77–0.86) in CPRD; while a higher hazard was observed in warfarin users (HR = 1.31, 95% CI = 1.24–1.39) in CDARS, versus DOAC users. In our exploratory analysis, consistent results were seen in both databases when stratified warfarin users by time in therapeutic range (TTR) using post-baseline measurements: a lower hazard of all-cause mortality in warfarin users with TTR ≥ 65% (CPRD: HR = 0.68, 95% CI = 0.65–0.72; CDARS: HR = 0.86, 95% CI = 0.77–0.96) and increased hazard in warfarin users with TTR < 65% (CPRD: HR = 1.14, 95% CI = 1.05–1.23; CDARS: HR = 1.59, 95% CI = 1.50–1.69), versus DOAC users.

Conclusions
The differences in hazard of all-cause mortality associated with warfarin compared with DOAC, in part may depend on anticoagulation control in warfarin users. Notably, this study is unable to establish a causal relationship between warfarin and mortality stratified by TTR, versus DOACs, requiring future studies for further investigation.
Effectiveness and feasibility of a theory-informed intervention to improve Mediterranean diet adherence, physical activity and cognition in older adults at risk of dementia: the MedEx-UK randomised controlled trial
Authors: Jennings A. , Shannon O. M. , Gillings R. , Lee V. , Elsworthy R. , Bundy R. , Rao G. , Hanson S. , Hardeman W. , Paddick S-M. , Siervo M. , Aldred S. , Mathers J. C. , Hornberger M. , Minihane A. M. 
Published: December 2024

Abstract
Background
Despite an urgent need for multi-domain lifestyle interventions to reduce dementia risk, there is a lack of interventions which are informed by theory- and evidence-based behaviour change strategies, and no interventions in this domain have investigated the feasibility or effectiveness of behaviour change maintenance. We tested the feasibility, acceptability and cognitive effects of a personalised theory-based 24-week intervention to improve Mediterranean diet (MD) adherence alone, or in combination with physical activity (PA), in older-adults at risk of dementia, defined using a cardiovascular risk score.

Methods
Participants (n = 104, 74% female, 57–76 years) were randomised to three parallel intervention arms: (1) control, (2) MD, or (3) MD + PA for 24 weeks and invited to an optional 24-week follow-up period with no active intervention. Behaviour change was supported using personalised targets, a web-based intervention, group sessions and food provision. The primary outcome was behaviour change (MD adherence and PA levels), and the secondary outcomes included feasibility and acceptability, cognitive function, cardiometabolic health (BMI and 24-h ambulatory blood pressure) and process measures.

Results
The intervention was feasible and acceptable with the intended number of participants completing the study. Participant engagement with group sessions and food provision components was high. There was improved MD adherence in the two MD groups compared with control at 24 weeks (3.7 points on a 14-point scale (95% CI 2.9, 4.5) and 48 weeks (2.7 points (95% CI 1.6, 3.7)). The intervention did not significantly change objectively measured PA. Improvements in general cognition (0.22 (95% CI 0.05, 0.35), memory (0.31 (95% CI 0.10, 0.51) and select cardiovascular outcomes captured as underpinning physiological mechanisms were observed in the MD groups at 24 weeks.

Conclusions
The intervention was successful in initiating and maintaining dietary behaviour change for up to 12 months which resulted in cognitive benefits. It provides a framework for future complex behaviour change interventions with a range of health and well-being endpoints.

Trial registration
ClinicalTrials.gov NCT03673722.
Prostanoid signaling in retinal cells elicits inflammatory responses relevant to early-stage diabetic retinopathy
Authors: Stark Amy K. , Penn John S. 
Published: December 2024

AbstractInflammation is a critical driver of the early stages of diabetic retinopathy (DR) and offers an opportunity for therapeutic intervention before irreversible damage and vision loss associated with later stages of DR ensue. Nonsteroidal anti-inflammatory drugs (NSAIDs) have shown mixed efficacy in slowing early DR progression, notably including severe adverse side effects likely due to their nonselective inhibition of all downstream signaling intermediates. In this study, we investigated the role of prostanoids, the downstream signaling lipids whose production is inhibited by NSAIDs, in promoting inflammation relevant to early-stage DR in two human retinal cell types: Müller glia and retinal microvascular endothelial cells. When cultured in multiple conditions modeling distinct aspects of systemic diabetes, Müller glia significantly increased production of prostaglandin E2 (PGE2), whereas retinal endothelial cells significantly increased production of prostaglandin F2α (PGF2α). Müller glia stimulated with PGE2 or PGF2α increased proinflammatory cytokine levels dose-dependently. These effects were blocked by selective antagonists to the EP2 receptor of PGE2 or the FP receptor of PGF2α, respectively. In contrast, only PGF2α stimulated adhesion molecule expression in retinal endothelial cells and leukocyte adhesion to cultured endothelial monolayers, effects that were fully prevented by FP receptor antagonist treatment. Together these results identify PGE2-EP2 and PGF2α-FP signaling as novel, selective targets for future studies and therapeutic development to mitigate or prevent retinal inflammation characteristic of early-stage DR.
From ductal carcinoma in situ to invasive breast cancer: the prognostic value of the extracellular microenvironment
Authors: Hulahan Taylor S. , Angel Peggi M. 
Published: December 2024

AbstractDuctal carcinoma in situ (DCIS) is a noninvasive breast disease that variably progresses to invasive breast cancer (IBC). Given the unpredictability of this progression, most DCIS patients are aggressively managed similar to IBC patients. Undoubtedly, this treatment paradigm places many DCIS patients at risk of overtreatment and its significant consequences. Historically, prognostic modeling has included the assessment of clinicopathological features and genomic markers. Although these provide valuable insights into tumor biology, they remain insufficient to predict which DCIS patients will progress to IBC. Contemporary work has begun to focus on the microenvironment surrounding the ductal cells for molecular patterns that might predict progression. In this review, extracellular microenvironment alterations occurring with the malignant transformation from DCIS to IBC are detailed. Not only do changes in collagen abundance, organization, and localization mediate the transition to IBC, but also the discrete post-translational regulation of collagen fibers is understood to promote invasion. Other extracellular matrix proteins, such as matrix metalloproteases, decorin, and tenascin C, have been characterized for their role in invasive transformation and further demonstrate the prognostic value of the extracellular matrix. Importantly, these extracellular matrix proteins influence immune cells and fibroblasts toward pro-tumorigenic phenotypes. Thus, the progressive changes in the extracellular microenvironment play a key role in invasion and provide promise for prognostic development.
Vector competence of Culex quinquefasciatus from Santiago Island, Cape Verde, to West Nile Virus: exploring the potential effect of the vector native Wolbachia
Authors: da Moura Aires Januário Fernandes , Tomaz Filipe , Melo Tiago , Seixas Gonçalo , Sousa Carla A. , Pinto João 
Published: December 2024

Abstract
Background
Culex quinquefasciatus plays a crucial role as a vector of West Nile virus (WNV). This mosquito species is widely distributed in Cape Verde, being found in all inhabited islands of the archipelago. However, no data are currently available on the susceptibility of the local mosquito population to WNV. This study aimed to assess the vector competence of Cx. quinquefasciatus mosquitoes from Santiago Island, Cape Verde, for WNV and to explore the potential impact of its native Wolbachia on virus transmission.

Methods
Wolbachia-infected and uninfected Cx. quinquefasciatus female mosquitoes were exposed to WNV lineage 1 PT6.39 strain using a Hemotek membrane feeding system. Mosquito samples, including the body, legs, wings and saliva, were collected at days 7, 14 and 21 post-infection (dpi) to assess WNV infection through one-step quantitative real-time PCR (RT-qPCR).

Results
Culex quinquefasciatus from Cape Verde exhibited high susceptibility to the tested strain of WNV. Also, treated females without their native Wolbachia exhibited significantly higher WNV load in their bodies and greater dissemination rate at 7 dpi than their wild-type counterparts carrying Wolbachia.

Conclusions
The high susceptibility to WNV of Cx. quinquefasciatus from Cape Verde poses a potential risk for virus transmission in the archipelago. However, Wolbachia infection in this mosquito species seems to confer protection against WNV dissemination in the early stages of viral infection. Additional research is required to uncover the mechanisms driving this protection and its potential impact on WNV transmission.

Graphical abstract
Establishing a unified global framework for studying dementia knowledge: insights from a narrative review
Authors: Lazarova Sophia , Petrova-Antonova Dessislava 
Published: December 2024

Abstract
Background
With the global population aging rapidly, dementia has become a pressing public health challenge, affecting the cognitive functions and daily activities of older adults worldwide. Enhancing literacy about dementia is a proactive prevention strategy, yet the effectiveness of educational programs can vary based on the target population’s background. Thus, understanding dementia knowledge levels across different communities and countries is essential for successful educational interventions. Despite the large аmount of studies, there is no common framework for studying dementia knowledge, leading to significant variability in methods and poor data comparability.

Methods
A narrative review is conducted to examine the methodological variability in studies of dementia knowledge and to propose a unified framework for future investigations. We hypothesize that significant differences will be evident in the methodologies employed, particularly regarding knowledge domains, research designs, influencing factors, and assessments of attitudes toward dementia.

Results
A total of 59 research publications published after 2000 were selected, revealing significant variability in approaches to studying dementia knowledge and confirming our hypothesis. We identified eight dementia knowledge domains and various sociodemographic and experiential correlates, along with commonly used complementary assessments. These findings were organized into a unified global framework comprising two core components—dementia knowledge domains and correlates—supplemented by a component addressing affective dispositions towards dementia and an action list to guide future research. The framework aims to provide a foundational basis for enhancing inter-study comparisons and deepening our understanding of dementia knowledge and attitudes across diverse communities.

Conclusion
Aligning methodologies for surveying dementia knowledge through a common framework can empower stakeholders to implement effective educational programs, fostering an informed and supportive environment for individuals affected by dementia.
Exploring the behavioural determinants of compliance in resilient high-caries-risk patients who improved caries severity
Authors: Wang Min Ching , Wu Ching Yi , Chen Wei Han , Liu Chieh Yu , Ho Yi Ching 
Published: December 2024

Abstract
Background
The caries severity in childhood may predict caries conditions in the future and even in adulthood in caries risk models. Nevertheless, the rate of recurrent caries after treatment of severe early childhood caries is high and correlated with behavioural factors, rather than clinical indicators. Compliance with the caries control programme has been demonstrated to prevent root caries development in head and neck cancer patients, suggesting that compliance with treatment protocols is a more important key to bringing about successful outcomes than treatment protocols themselves. However, only few studies defined the triggers of compliance in patients with long-term successful treatment outcomes, especially in children. Furthermore, driven forces of compliant behaviours from patients’ aspects have not been described in the dental literature before. Regarding the need to improve current caries control interventions for children, in this study, behavioural determinants that shaped compliance of resilient children were investigated with a qualitative study design, for its advantage in revealing what an individual really feels which incorporates their experience without restriction from previous literature. Resilience was defined as improvement in caries conditions between primary and mixed or permanent dentitions.

Methods
Interviews were performed with the patient group, including eight resilient children (M/F = 5/3) and their ten caregivers (M/F = 2/8), and the dentist group, including ten paediatric dentists (M/F = 6/4; clinical experience mean = 26.9 years, minimum = 16 years). Thematic analysis was used to identify main themes.

Results
Four themes were identified: (1) dental things/teeth are their priority, (2) normalising, (3) tiger parenting/conscientiousness, and (4) trust. These determinants were identically described by both the patient and dentist groups. Dentists' suggestions were the priority, providing the norms in daily life of resilient patients and their caregivers. These patients found no excuses for failing to take dentists' advice, not only because they trusted their dentists, but also because they and their caregivers were conscientious about putting dentists' orders into practice.

Conclusions
It is implementing suggested oral health behaviours daily, but not merely agreeing with professional advice, that alters the fate of teeth in these resilient patients.
Innovative silicon nanoparticle-based patches for athlete sweat analysis: exploring implications for training optimization
Authors: Ma Zengyu 
Published: December 2024

AbstractThis study introduces a groundbreaking approach in sports science through the development of silicon nanoparticle-enhanced patches for real-time sweat analysis in athletes. Central to this innovation is the synthesis of silicon nanoparticles (SiNPs) with a 60 nm average diameter, ensuring uniformity and effectiveness in sweat monitoring applications. The patches demonstrate exceptional biocompatibility and robust performance under the demanding conditions of athletic activity. In practical tests, they accurately detected sodium and potassium in sweat, showcasing a linear response with an R2 value close to 1 for concentration measurements. During on-body trials with athletes, the patches effectively monitored Na+ concentrations ranging from 0.02 to 2.95 mM, demonstrating sensitivity suitable for physiological monitoring. Notably, dermatological tests affirmed a 97% rate of non-reactivity among athletes, highlighting the patches’ safety for extended wear during training sessions. This technology marks a substantial leap in athlete monitoring, offering detailed, real-time insights into physiological states for optimizing training regimens and performance assessment.
Leveraging the Louvain algorithm for enhanced group formation and collaboration in online learning environments
Authors: Lee Minkyung , Sharma Priya 
Published: December 2024

AbstractThis study explores the dynamics of student interaction networks within an online asynchronous discussion forum, focusing on both whole group discussions and subgroup interactions distinguished by the Louvain algorithm, a renowned community detection method. Analyzing 2481 posts from 154 undergraduate students across three sections of a communications course centered on discussions about movie clips or social phenomena to enhance media literacy, this research aims to interpret the interaction patterns in these virtual spaces. Traditional methods of group formation, such as teacher intervention and self-selection, often fail to create balanced and effective groups, especially in large online courses. The Louvain algorithm, known for its efficiency in modularity optimization, identifies clusters based on actual student interaction patterns. By leveraging both global and local network analyses, this study provides a comprehensive understanding of interaction structures. The global network analysis offers a macro view of overall interaction structures, revealing diverse patterns despite identical course designs, suggesting the influence of unique group dynamics. The local analysis, focusing on the intricacies of node and edge connections, underscores that the Louvain algorithm's classifications correlate with heightened cohesiveness and collaborative potential. The results indicate that algorithmically detected groups exhibit strong internal communication and cohesiveness, as evidenced by high clustering coefficients, density values, and weighted degrees. These findings underscore the potential of network analysis to optimize online student interactions, providing valuable insights for refining educational design to promote student engagement and collaborative problem-solving. This research highlights the transformative potential of integrating advanced data-driven techniques in educational technology to improve group formation and collaborative learning outcomes, offering empirical insights for educators to enhance online interactions and expand pedagogical understanding.
„Bottoms-up“ portal venous recanalization TIPS (PVR-TIPS) utilizing a re-entry catheter
Authors: Loizides Alexander , Freund Martin , Zoller Heinz , Schäfer Benedikt 
Published: December 2024

Abstract
Background
Three patients with portal hypertension and gastrointestinal bleeding due to non-cirrhotic portal vein thrombosis were treated with portal venous recanalization transjugular intrahepatic portosystemic shunt (PVR-TIPS) via a trans-splenic access.

Main body
A “bottoms-up” retrograde puncture of the right hepatic vein was performed using a re-entry catheter to gain access to the right hepatic vein. In all patients a successful retrograde puncture of the right hepatic vein was achieved, thereby restoring the splenoportal tract.

Conclusion
Our cases present an alternative approach to treat chronic portal vein thrombosis expanding the possibilities of the PVR-TIPS procedure.