bluuebunny/crossref_metadata_2025_split huggingface dataset:
Attitudes toward Medically Assisted Dying Among the General Public in Slovenia
Authors: Rojs Lucia , Krohne Nina , Gomboc Vanja , Lavrič Meta , De Leo Diego , Poštuvan Vita 
Published: November 2024

The aim of this study was to explore public attitudes toward medically assisted dying, focusing on the role of socio-demographic factors, mental health conditions, and personal experiences. Data were collected via an online panel in Slovenia, which consisted of 567 participants (53.1% men) aged 18 years and older. The majority of respondents supported medically assisted dying for terminally ill individuals (76.4%) and expressed willingness to support a loved one’s decision (72.8%). The analysis indicated that psychosocial factors and personal experiences predict attitudes toward medically assisted dying. In particular, women, individuals with poorer physical and psychological health and individuals in better environmental conditions were more likely to have positive attitudes. In contrast, individuals who had experienced the loss of a loved one were more likely to oppose it. These findings suggest the need for further research to deepen understanding of the factors that predict attitudes toward medically assisted dying.
Teachers’ Insights on Cultivating Inclusive Education for Students with Complex Support Needs
Authors: Mansouri Mary Curran , Miller Amanda L. , Kurth Jennifer A. , Ruhter Lindsay , Wilt Courtney L. , Toews Samantha Gross , Morningstar Mary E. 
Published: November 2024

Background/Context: This qualitative study investigates teachers’ perspectives on providing inclusive services for students with complex support needs. Using a Disability Studies in Education (DSE) framework, the research focuses on understanding the challenges and strategies associated with promoting inclusive education, with attention to issues of social justice and equity. The study draws on the experiences of 11 teachers enrolled in a master’s program, exploring the relationship between teacher agency and its potential to foster inclusive educational environments for students with complex support needs. Purpose/Objective/Research Question/Focus of Study: The primary focus of the study is to explore teachers’ beliefs and practices related to inclusive education for students with complex support needs. The research seeks to answer the following questions: How do teachers navigate the cultural and systemic challenges in schools while promoting inclusive education? What strategies do they use, and how do their beliefs evolve within the context of promoting equity and social justice? Research Design: This study used narrative inquiry and thematic analysis to analyze data from focus group interviews with 11 teachers. A DSE lens guided the analysis, taking into account social justice and equity issues. Thematic analysis yielded two key themes: (1) beliefs and practices of school culture and (2) shifting perspectives within school systems Conclusions/Recommendations: Findings revealed challenges related to ingrained beliefs hindering inclusive practices, emphasizing the need for teacher education programs to prepare teachers to navigate contextual factors within schools and districts and address underlying beliefs about disability while promoting an understanding of and actions toward social justice in education. Overall, complexities were revealed surrounding inclusive education and the importance of teachers’ understanding of their beliefs and agency in promoting inclusive education for students with complex support needs. Implications for future practice and research included the need for systemic change, teacher education addressing ableism, and authentic partnerships between teacher preparation programs and schools.
Tell el-Amarna, Autumn 2023 to Summer 2024
Authors: Stevens Anna , Balestra Fabien , Driaux Delphine , Dabbs Gretchen R. , Docherty Paul , Boonstra Stephanie L. , Tully Gemma , Bos Jolanda E. M. F. , Lakin Tracy , Gasperini Valentina , Rose Pamela , Bertram Miriam 
Published: November 2024

Fieldwork at Amarna from autumn 2023 to summer 2024 included excavations at the Great Aten Temple, the launch of a new survey and site management project focused on Amarna’s housing areas, and the continuation of several post-excavation projects. The post-excavation work reported on here is the study of faience inlays from the Great Aten Temple, and skeletal materials and hair from the non-elite cemeteries. Ongoing community outreach associated with both the cemetery and housing work is also presented. [Formula: see text]
Alveolar Bone Graft Supplemented With Stromal Vascular Fraction in Patients With Permanent Dentition: A Randomized Study
Authors: Kurimori Kleber Tetsuo , Bastos Endrigo Oliveira , Camara Paulo Roberto Pelucio , Mascarenhas Dias Beatriz , Uyeda Giovanna Layse , Alonso Nivaldo 
Published: November 2024

Objective To evaluate bone development in patients with alveolar clefts and permanent dentition treated with alveolar bone graft supplemented with stromal vascular fraction (SVF). Design Clinical, prospective, randomized. Location Single tertiary care institution. Patients Eighteen participants with unilateral alveolar cleft and permanent dentition were included. Patients with other comorbidities were excluded. Intervention The control group underwent alveolar bone grafting (ABG) using iliac crest bone, while the experimental group underwent the same treatment, supplemented with SVF. Adipose tissue was collected by abdominal liposuction, and the SVF was processed using mechanical methods (decantation, microfragmentation, and filtration). Main Outcome Measurement Bone formation and bone graft integration rate in alveolar cleft at 6 months postsurgery using 3-dimensional tomographic methods and density measurements. Results The amount of bone graft correlated with an improvement in the relationship between the cleft and noncleft sides (R = 0.78, P < .001) and an improvement in alveolar cleft density (R = 0.69, P = .005), but did not correlate with the graft integration rate. The experimental group showed larger cleft sizes (0.83 × 1.74 cm3, P = .021) and older patients (17.35 × 27.6 years, P = .002), and did not differ in terms of bone development variables when compared to the control group. Conclusion ABG supplemented with SVF showed statistically similar bone development results, but with a better trend than conventional ABG. Additionally, the studied groups had asymmetric pre-existing characteristics, with greater severity in the experimental group. A larger study will be necessary to mitigate preoperative characteristic differences and to more accurately compare the results between the methods.
Change in hair texture with the use of pomalidomide for multiple myeloma: From straight to curly phenotype
Authors: Zahid Annam , Dasanu Constantin A. 
Published: November 2024

Introduction Pomalidomide is used for treating multiple myeloma in patients who have relapsed after prior treatment with lenalidomide and a proteasome inhibitor. Common side effects include mild cytopenias, and deep vein thrombosis. While papulo-erythematous rash has been described, hair effects are rare with this class of agents. Case Report We describe a 56-year-old man who was diagnosed with multiple myeloma type IgD lambda six years prior. He responded very well to initial treatment with bortezomib-lenalidomide-dexamethasone. After two years, he had a recurrence that was treated with daratumumab-pomalidomide-dexamethasone, and he entered a stringent complete response (CR) within six months. Daratumumab was discontinued after twelve months, and he subsequently remained on maintenance therapy with pomalidomide. Three months into the maintenance regimen, he noticed a change in hair texture to curly, which continued to progress. Causality assessment linked this change to pomalidomide use via the Naranjo nomogram questionnaire, by scoring 5. Management and Outcome Pomalidomide maintenance therapy was continued without any dose alterations given the excellent clinical outcome. A year later, multiple myeloma remains in stringent complete response. The patient remains with a curly hair phenotype, having fully embraced his new physical appearance. Discussion/Conclusion We report herein a unique hair texture alteration linked with pomalidomide use, not previously documented in literature. The observed hair texture change, from straight to curly, requires further investigation. Future studies may offer more insights into the mechanisms underlying this rare, yet intriguing side effect.
Scaling the Heights: Rates of Pelvic Floor Dysfunction in Female Rock-Climbing Enthusiasts
Authors: Altshuler Paulina C. , Burgard Iris M. , Poling James K. , Muffly Tyler 
Published: November 2024

Introduction Rock climbing has recently gained popularity, particularly among females. There are no current studies evaluating pelvic floor dysfunction among female climbers. This cross-sectional study seeks to investigate the prevalence of incontinence and pelvic floor disorders among female rock climbers in the United States. Methods This study utilized an online survey distributed via social media platforms to assess the prevalence of pelvic floor disorders. Participants were queried about demographic information, climbing habits, pregnancy history, and pelvic floor symptoms. Data analysis involved descriptive statistics and inferential analysis where applicable. Results A total of 343 participants completed the study, with a median age of 34 years, lean body mass, and the majority identifying as White or Caucasian. The most common pelvic floor disorder was overactive bladder ( n = 314, 91.5%), and the least common was pelvic organ prolapse ( n = 6, 1.7%). Rope climbers were significantly more bothered by pelvic organ prolapse and anal incontinence symptoms than boulderers (4, p < .01 and 1.44, p < .01, respectively). Parous climbers reported significantly higher bothersome symptoms of OAB and SUI (1.43, p = .01 and 2.71, p < .01, respectively) than their nulliparous counterparts. Conclusions Although rock climbing represents a relatively low-impact sport and our sample was largely comprised of young, healthy, nulliparous women, female rock climbers demonstrated higher rates of pelvic floor disorders than a normative population, with rope climbers at higher risk than boulderers. Clinicians should be aware of the need for more frequent pelvic floor disorder screening in active women.
Gradient 2D re-entrant cores for sandwich structures under low-velocity impact
Authors: Alavi Melikasadat , Hedayati Reza , Sadighi Mojtaba 
Published: November 2024

Auxetic metamaterials, known for their unusual properties, are being explored as cores for sandwich structures to improve impact resistance. This study investigated the low-velocity impact response of sandwich panels with various core designs using finite element method (FEM) and experiments on 3D-printed specimens. These cores include pure honeycomb, pure auxetic, and gradient variations with controlled gradients of Poisson’s ratio, transitioning from negative to positive (NTP), positive to negative (PTN), negative-to-positive-to-negative (NTPTN), and positive-to-negative-to-positive (PTNTP). These gradients were achieved by adjusting the unit cell angle within the core. Under quasi-static indentation, the gradient PTN design improved energy absorption by 26% compared to the honeycomb structure, while the gradient NTP structure showed a 9% improvement over the auxetic core. As for the impact tests, the gradient NTP and PTN structures significantly enhanced the indentation resistance of auxetic and honeycomb structures by 21.3% and 6.5%, respectively. Interestingly, while the optimal core for peak energy absorption varied with impact velocity, gradient structures generally provided superior energy absorption, particularly at lower velocities. FEM results at initial impact velocities of 10, 15, 20 m/s confirmed that structures having negative Poisson’s ratio at their top layer exhibited the lowest penetration depth. Additionally, gradient structures, particularly NTP and NTPTN, demonstrated superior energy absorption capability compared to purely auxetic or honeycomb structures, especially at lower velocities. The study highlights the benefits of utilizing gradient auxetic metamaterial cores in high-performance sandwich structures for impact resistance applications. These structures showed minimal localized damage, reduced densification risk due to uniform crushing, and lower penetration depth.
The impact of enhancing vascular access care quality through monitoring and training: A multicentre observational study
Authors: Casanova-Vivas Sonia , García-Molina Pablo , López-Guardiola Pablo , Gil-Carbonell María José , Hevilla-Cucarella Enrique Bernardo , Solaz-Martínez Vicenta , Valdelvira-Gimeno Beatriz , Fernández-Martínez Alicia , Visconti-Gijón José Vicente , Ballestar-Tarín M Luisa 
Published: November 2024

Aim: This study evaluates the impact of monitoring a primary quality indicator and the effect of training on improving the care and maintenance of vascular access devices. Design: A prospective, quasi-experimental, multicentre study with 10 periodical cross-sections from 2017 and 2020. Participants: Adult patients hospitalised over 24 h, with or without vascular access device, excluding those in emergency, psychiatry, outpatients or minor surgery units. Methods: The study included 10 cross-sections between 2017 and 2020 in all participating hospitals, using the INCATIV® (Quality Indicators in Intravenous Therapy and Vascular Access) questionnaire. Training sessions for nursing staff were conducted between cross-sections, involving face-to-face sessions in open classrooms and clinical sessions in the units, based on the study Care bundle. Results: 53,991 vascular accesses were analysed, with an average INCATIV Index score of 8.95 (SD: 1.32), showing improvement from 8.09 in the first cross-section to 9.21 in the last. Significant variability was observed between hospitals, with secondary hospitals scoring lower on the INCATIV® Index. Training interventions 1 and 2 showed significant improvement across all hospital categories, whereas intervention 5 did not show significant effects. Compliance with main recommendations was studied, with a notable decrease in phlebitis rates from 4.45% in the first cross-section to 1.23% in the tenth. Conclusion: The study developed a single indicator to assess and quantify vascular access care quality. It demonstrated that implementing a care bundle through serial training interventions and continuous assessment by nursing staff, supported by process indicators and data availability on the study platform, significantly reduces complications and enhances the quality and safety of vascular access care.
The trans-radial approach for endovascular intervention of the problem arterio-venous fistula: A single-centre case series and systematic review
Authors: Wijetunga Asanka Rohan , Wang Yunyi , Chan Conan Wai Hang , Elhindi James , Colbourne James 
Published: November 2024

Introduction: The arteriovenous fistula (AVF) is the gold standard access modality for haemodialysis, but due to patient and technical factors, it is prone to stenosis and thrombosis. The trans-radial approach offers multiple unique benefits, but its safety, efficiency and efficacy have not been rigorously studied in the context of the AVF. This study provides a case series of trans-radial AVF procedures, and a systematic review and meta-analysis of existing literature to solidify the role of the trans-radial approach in endovascular AVF surgery. Methods: Surgical records were interrogated to identify all trans-radial AVF interventions between 2019 and 2021. The primary endpoints were procedure time and complication rates. The secondary endpoints were primary assisted patency and increase in pre- and post-operative brachial artery blood flow. The systematic review was performed by searching MEDLINE, Embase and CENTRAL from 2000 to 2023. Results: The case series identified 76 consecutive procedures performed on 49 patients. Mean procedure time was 64 min, and only one complication, a puncture site haematoma, was identified. Mean postoperative AVF flow increase was 342 mL/min ( p < 0.001). Primary-assisted patency at 6 and 12 months was 91% and 82% respectively. The systematic review included 16 studies totalling 1163 procedures with a mean MINORS score of 69%. Mean procedure time was 44 min. Complications were rare: procedural failure (1.2%), haematoma (0.90%), radial artery occlusion (0.74%) and pseudoaneurysm (0.12%). Post-procedural flow increased by an average of 274 mL/min. Pooled primary-assisted patency rates at 6 and 12 months were 88% and 77% respectively. Conclusion: The trans-radial approach allows for expedient, safe and durable AVF endovascular surgery, however this technique would benefit from prospective evaluation.
Breast Cancer Knowledge and Attitude Toward Breast Cancer Screening Practice Among Catholic Nuns in Lake Zone—Tanzania
Authors: Marandu Gotfrida , Malale Kija , Laisser Rose , Mwanga Joseph , Rambau Peter 
Published: November 2024

Background: Breast cancer poses a significant public health challenge in Tanzania. Limited knowledge about breast cancer and negative attitudes toward screening practices contributes to delayed diagnoses and poorer patient outcomes. Catholic nuns, who are often nulliparous, represent a population with an increased risk of developing breast cancer. Despite this risk, they remain an understudied group regarding breast cancer awareness and screening practices. Objective: This study aimed to assess breast cancer knowledge and attitudes toward screening practices among Catholic nuns residing in Tanzania’s Lake Zone. Study design: The study was a cross-sectional design. Methods: A total of 385 Catholic nuns participated in the study. To ensure a representative sample, nuns were chosen through simple random sampling, giving each Catholic nun an equal probability of being selected. Data were collected using a self-administered questionnaire and then analyzed using STATA version 18.0. Both descriptive and inferential statistics were used to draw conclusions. In inferential statistics, logistic regression was used to test for associations between categorical variables. The test statistics were considered significant when the P-value was less than .05 at a 95% confidence interval (CI). Results: This study enrolled 385 catholic nuns. 57.1% (95% CI, 52.0%-62.1%) of all surveyed catholic nuns had inadequate knowledge of breast cancer. Misconceptions also emerged as significant risk factors for inadequate knowledge. Thus, lack of awareness of breast cancer risk factors increased the odds by 5.57 times (adjusted odds ratio [AOR]: 5.57; 95% CI: 2.84-10.92; P < .001). In addition, believing cancer was not inheritable (AOR: 2.65; 95% CI: 1.14-6.15; P = .024), misperceiving oneself as being in a low-risk group (AOR: 1.65; 95% CI: 1.03-2.66; P = .039), and underestimating the vulnerable age group (believing it is not above 40 years) (AOR: 2.60; 95% CI: 1.49-4.51; P = .001) were all significantly associated with higher odds of inadequate knowledge. Regarding the attitude toward breast cancer screening practices, 62.3% (95% CI, 57.3%-67.2%) of the catholic nuns had negative attitudes. Conclusion: These findings highlight the need for breast health intervention educational programs to improve breast cancer awareness among Catholic nuns. Such programs should address risk factors, symptoms, screening methods, and treatment options, dispelling misconceptions. By empowering nuns with knowledge, they can make informed decisions about their health and take charge of their well-being.
First-Line Camrelizumab Plus Rivoceranib in Advanced Hepatocellular Carcinoma: A China-Based Cost-Effectiveness Analysis
Authors: Xiang Guiyuan , Huang Yueyue , Zhang Ni , Du Xinyu , Wu Yuanlin , Gan Lanlan , Li Yanping , Jiang Tingting , Liu Yao 
Published: November 2024

Background: Hepatocellular carcinoma poses a significant public health burden in China, necessitating the economic evaluation of new therapeutic strategies for policy-makers and clinicians. The international, randomized phase 3 trial CARES-310 revealed that camrelizumab plus rivoceranib provided a substantial clinical benefit in patients with advanced hepatocellular carcinoma, but the economic outcome remains unclear. This study aimed to evaluate the cost-effectiveness of camrelizumab plus rivoceranib versus sorafenib as first-line treatment for unresectable hepatocellular carcinoma (CARES-310) from the perspective of the Chinese health care system. Methods: A partitioned survival model was developed to estimate the lifetime cost and clinical outcomes of camrelizumab plus rivoceranib versus sorafenib in first-line treatment of advanced hepatocellular carcinoma. Survival data from the CARES-310 trial were used to create a hypothetical cohort of 543 patients with advanced hepatocellular carcinoma for modeling disease progression. The life-year, quality-adjusted life-year (QALY), incremental cost-effectiveness ratio (ICER) was used to measure the model’s outcome, with the willingness-to-pay threshold set at 3 times China’s gross domestic product (GDP) per capita (US$36 780). Univariate, multivariable probabilistic sensitivity analyses, and subgroup analysis were performed to assess parameter uncertainty, complemented by a scenario analysis using health utilities reported in literature. Results: The camrelizumab group yielded an additional 0.239 QALYs at an added cost of US$8340 compared with sorafenib, resulting in an ICER of US$34 897/QALY. Univariate sensitivity analysis indicated that the model results were most sensitive to the utility of progression-free survival in the camrelizumab group, sorafenib cost, and camrelizumab cost. Probabilistic sensitivity analysis revealed a 56% probability of cost-effectiveness of camrelizumab plus rivoceranib among all patients. The results of the subgroup analysis demonstrated camrelizumab plus rivoceranib was the most cost-effective in the subgroup with albumin-bilirubin grade 2. Conclusions: At a willingness-to-pay threshold of US$36 780/QALY, camrelizumab plus rivoceranib is likely to be a cost-effective option compared with sorafenib as first-line treatment for advanced hepatocellular carcinoma in China.
Psychosocial screening, in-patient care, and disposition planning: Clinicians’ perspectives
Authors: Chong Alyssa , Virk Punit , Doan Quynh 
Published: November 2024

Objective Our objective was to explore clinicians’ views on the MyHEARTSMAP screening report; whether this report has impacted their patient care, and if so, how. MyHEARTSMAP is a psychosocial self-screening tool for youth to identify mental health concerns. Methods We conducted a cross-sectional study as a sub-study of the MyHEARTSMAP In-Patient randomized control trial. Eligible clinicians (nurses and physicians who have cared for patients in one of our partnered specialties and have seen a MyHEARTSMAP report in their patients’ charts) provided their perceptions of the screening report through a survey. Results Sixty-five clinicians were enrolled; 60 (92.3%; 95% CI 85.8–98.8%) believe psychosocial screening is beneficial, with many finding it helpful for building rapport with patients/families and providing additional mental health information. Thirty-seven clinicians (56.9%; 95% CI 44.9–69%) had previously read or used the MyHEARTSMAP report, and 31 (83.8%; 95% CI 71.9–95.7%) of these clinicians found the report helpful. Clinicians specifically found the report helpful for communicating with the patient, and guiding patient-centered care. Conclusion Clinicians’ perceptions towards the MyHEARTSMAP report were positive amongst those who had previously encountered it. While clinicians believe psychosocial screening is beneficial, exploring options for better accessibility to the screening results is necessary to increase utilization.