bluuebunny/crossref_metadata_2025_split huggingface dataset:
Youth suicidality risk relative to ambient temperature and heatwaves across climate zones: A time series analysis of emergency department presentations in New South Wales, Australia
Authors: Dey Cybele , Wu Jianyun , Uesi John , Sara Grant , Dudley Michael , Knight Katherine , Scott James G , Jay Ollie , Bowden Michael , Perkes Iain E 
Published: October 2024

Objective: Youth suicidality prevalence continues to rise alongside hot weather severity. Links between these two variables are underexplored. We examined associations between daily temperature and emergency department suicidality presentations by young people. We assessed these associations for five regions covering New South Wales as determined by ‘climate zone’ and analysed for heatwave effects as well as based on demographic subgroups. Methods: Daily emergency department presentations for suicidality by people aged 12–24 years across New South Wales, Australia, during warmer months (November to March) from 2012 to 2019 were examined in relation to daily mean temperature and heatwaves (⩾3 consecutive days ⩾ 95th percentile of long-term daily mean temperature) and by climate zone, using a generalised additive model with negative binomial distribution. Risks for age- and sex-based subgroups were also calculated. Results: New South Wales youth suicidality presentation rates were significantly higher on hotter days. For every 1°C rise above average daily mean temperature, youth suicidality presentations to New South Wales emergency departments increased by 1.3%. Heatwaves did not increase presentation rates beyond single-day daily mean temperature effects. These findings were predominantly replicated across climate zones and demographic subgroups, though the association between suicidality and ambient temperature was weaker in coastal regions including Eastern Sydney. Conclusion: There is a positive linear association between ambient temperature and youth suicidality presentations to emergency departments. Risks are increased on single hot days, not only during heatwaves. Public health, broader societal approaches to heat and health system planning should consider impacts on youth suicidality of predicted increases in hot weather severity and frequency.
All-Inside Endoscopic Classic Bröstrom-Gould Technique: Medium-term Results
Authors: Hong Choon Chiet , Charpail Christel , Kon Kam King Charles , Guillo Stephane 
Published: October 2024

Background: Short-term results after arthroscopic/endoscopic lateral ligament repair for chronic lateral ankle instability have been satisfactory, although medium- to longer-term results are lacking. Purpose/Hypothesis: The purpose of this study was to report the medium-term results of an all-inside endoscopic classic Bröstrom-Gould procedure where both the both lateral ligaments and the inferior extensor retinaculum can be approached directly, interchanging between arthroscopy for intracapsular structures and endoscopy for extracapsular structures. It was hypothesized that the all-inside endoscopic classic Bröstrom-Gould procedure would produce sustainable good outcomes at a medium term of 5 years. Study Design: Case series; Level of evidence, 4 Methods: A prospective database for 43 patients who underwent an all-inside endoscopic classic Bröstrom-Gould repair of the anterior talofibular ligament and calcaneofibular ligament with inferior extensor retinaculum augmentation was reviewed. Patient details, American Orthopaedic Foot & Ankle Society score, Karlsson score, ankle activity score (AAS), and patient satisfaction were collected and analyzed. Results: The study cohort of 43 patients with a mean age of 29.4 years (SD, 11.9 years) were reviewed at a mean follow-up of 63.1 months (SD, 8.5 months). The American Orthopaedic Foot & Ankle Society scores showed significant improvement from a mean of 69.6 (SD, 13.9) to 93.7 (SD, 10.7), while the Karlsson score improved from 59.7 (SD, 14.5) to 91.5 (SD, 14.5) at the final follow-up. The AAS showed that 32 (74.4%) patients maintained or had improvement in the AAS, from a mean of 5.38 (SD, 2.8) to 5.41 (SD, 2.8), with a mean satisfaction rate of 9.1 (SD, 1.3). Although the remaining 11 patients had a reduced AAS, at a mean of 4.6 (SD, 2.6), they reported a mean satisfaction rate of 7.4 (SD, 2.9). There were no surgical complications or reoperations reported in this cohort, although there were 3 patients with recurrent instability at their last follow-up, resulting in a failure rate of 7%. Conclusion: The current study is the first to report the medium-term outcomes of an all-inside endoscopic classic Bröstrom-Gould procedure. Overall, 93% of the patients had good functional outcomes, but approximately 25% of patients had decreased ankle activity levels at a mean of 5 years postoperatively, albeit with good satisfaction rates.
Reversal of Denervation Changes in Infraspinatus Muscle After Operative Management of Paralabral Cysts: An MRI-Based Study
Authors: Mun Ji Weon , Oh Sang Yun , Kim Yong Tae , Kim Sae Hoon 
Published: October 2024

Background: Paralabral cysts at the spinoglenoid notch are rare disorders that can potentially lead to compressive suprascapular neuropathy. Given their infrequency, a standard treatment protocol has not yet been established. Hypothesis/Purpose: This study aimed to assess changes in the infraspinatus muscle using magnetic resonance imaging (MRI) and to compare the outcomes of 2 different surgical methods. It was hypothesized that surgical intervention could alleviate compressive neuropathy, with comparable outcomes between the 2 surgical approaches. Study Design: Cohort study; Level of evidence, 3. Methods: This retrospective review encompassed 43 patients undergoing arthroscopic labral repair for a paralabral cyst at the spinoglenoid notch, with cyst decompression (27 patients; labral repair with cyst decompression [LRCD] group) or without cyst decompression (16 patients; labral repair only [LRO] group). Preoperative MRI focused on evaluating the condition of the infraspinatus and teres minor muscles. Electromyography (EMG) was conducted on 36 patients (21 in LRCD and 15 in LRO) to assess suprascapular nerve function. Postoperative evaluations were performed in 35 patients at postoperative 1 year, excluding those lost to follow-up. Postoperative MRI findings (24 patients in LRCD and 11 patients in LRO) and functional outcome scores including recovery of external rotation power were compared with preoperative status in both groups. Results: Preoperative MRI revealed denervation changes or atrophy of the infraspinatus in 26 of the 43 patients (60.4%). Among the 36 patients who underwent preoperative EMG, 21 patients (58.3%; 13 patients in LRCD and 8 patients in LRO) showed evidence of suprascapular neuropathy. A discrepancy between EMG and MRI findings was noted in 10 patients, with 5 patients showing suprascapular neuropathy according to EMG despite normal muscle status on MRI scans, and the remaining 5 vice versa. Notable atrophy of the infraspinatus was seen in 6 patients and teres minor hypertrophy in 5 patients, all of whom exhibited concurrent infraspinatus atrophy. Postoperatively, cyst disappearance was observed in all cases in both LRCD (24 patients) and LRO (11 patients) groups. Denervation changes in the infraspinatus were resolved in all patients. In patients with infraspinatus atrophy, some improvement was noted. Teres minor hypertrophy persisted in 2 of 4 patients. Improvements were similar in both groups (all P > .05). External rotation power improved postoperatively in both groups (from 39.1 ± 18.6 to 50.6 ± 17.7 N in LRCD, P < .001; from 45.1 ± 16.0 to 54.2 ± 10.7 N in LRO, P = .025). Conclusion: Both LRCD and LRO surgical approaches appear to be effective for paralabral cysts at the spinoglenoid notch. Suprascapular neuropathy can be successfully addressed by both methods. However, conditions with severe infraspinatus atrophy and teres minor hypertrophy warrant further investigation in larger series.
COVID-19 Pandemic and Vaccine Imperialism
Authors: Seretis Stergios A. , Mavroudeas Stavros D. , Aksu Tanık Feride , Benos Alexios , Kondilis Elias 
Published: October 2024

The COVID-19 pandemic revealed and exacerbated the global inequalities regarding the availability and access to vaccines. Many terms have appeared in the academic literature (“vaccine colonialism,” “vaccine nationalism,” “vaccine apartheid”) trying to capture and interpret these inequalities, failing in most cases to realistically explain the upstream causes of the observed injustices. A Marxist perspective on the contrary emphasizes the structural causes of inequalities in capitalism and attributes them to the existence of economic exploitation. “Vaccine imperialism,” which refers to the control that advanced industrialized countries exert on the development, production, and distribution of vaccines at the expense of less-developed economies, can describe and explain in a more realistic way the observed inequalities during the pandemic. Our study proposes a circuit of vaccine imperialism that explains how economic imperialist exploitation takes place via transfers of value from less-developed economies (vaccine recipient countries) to imperialist economies (vaccine producing and patent holder countries) using four different channels: (a) protection of intellectual property (IP) rights (patents), (b) earnings from royalty payments for the use of vaccines (monopolistic prices and profits), (c) exercise of monopoly power on the production and distribution of vaccines (control over the quantity of vaccines supplied, exclusion of competitors through vaccine licensing), and (d) public debt servicing. JEL Classification: I14, I18, D43, F54, F55, H51
Assessment of ethical sensitivity in nursing students: Tools, trends, and implications
Authors: Lyu Yaning , Liang Xifeng , Li Jing , Chi Cheng 
Published: October 2024

BackgroundRapid advances in medical technology, changing healthcare policies, and increasing patient diversity have exacerbated the ethical challenges. As nursing students are an integral part of the future nursing workforce, ethical sensitivity has a critical impact on their future careers.PurposeThis study aims to promote research in related fields by systematically reviewing the origin and development of the concept of ethical sensitivity in nursing students, comparing currently available tools for assessing ethical sensitivity in nursing students, and exploring their applicability and reliability.MethodsA literature review method was used in this study. A literature search was conducted for assessment tools published between 1995 and 2024. A total of six articles focusing on assessment tools they developed to measure ethical or moral sensitivity were included and analyzed.ResultsOur analysis revealed significant variations in the reliability and applicability of these assessment tools, particularly when used in diverse cultural settings. The study also identified a need for localized modifications of these tools to ensure their accuracy and relevance in different regions.ConclusionThe findings provide valuable guidance for nursing educators in selecting appropriate assessment tools and offer a foundation for developing new tools that are more contextually relevant. This study contributes to the advancement of ethical sensitivity education for nursing students worldwide, ultimately enhancing patient care and professional development.
Deciphering HER2-low breast cancer (BC): insights from real-world data in early stage breast cancer
Authors: Pous Anna , Bernat-Peguera Adrià , López-Paradís Assumpció , Cirauqui Beatriz , Quiroga Vanesa , Teruel Iris , Felip Eudald , Ferrando-Díez Angelica , Bergamino Milana , Boronat Laia , Romeo Margarita , Soler Gemma , Mariño Christian , Rodríguez-Martínez Paula , Pons Laura , Ballana Ester , Martinez-Cardús Anna , Margelí Mireia 
Published: October 2024

Background: Human epidermal growth factor receptor 2 (HER2)-low has emerged as a potential new entity in breast cancer (BC). Data on this subset are limited, and prognostic results are controversial, evidencing the need of further data in a BC real-world cohort. Methods: Patients with HER2-negative stage I–III BC diagnosed between 2006 and 2016 were retrospectively reviewed in a single cohort from the Catalan Institute of Oncology Badalona. Demographics and clinicopathological characteristics were examined via medical charts/electronic health records. We aim to describe and compare HER2-0/HER2-low populations through Chi-square or Fisher test, and explore its prognostic impact using Kaplan–Meier curves and Cox regression models. Results: From a cohort of 1755 BC patients, 1401 invasive HER2-negative, stage I–III cases were evaluated. 87% were hormone receptor (HR)-positive versus 13% triple negative (TNBC). Overall, 43% were HER2-0 and 57% HER2-low (61% immunohistochemistry (IHC) 1+ and 39% IHC 2+). Comparing HER2-low versus HER2-0, HER2-low showed higher proportion of estrogen receptor (ER)-positive (91.6% vs 79.9%, p ⩽ 0.001) and progesterone receptor (PR)-positive (79.8% vs 68.9%, p ⩽ 0.001) cases. HER2-0 exhibited higher proportion of TNBC (20.1% vs 8.4%, p = 0.001), grade III tumors (28.8% vs 23.5%, p = 0.039), and higher Ki67 median value (26.47% vs 23.88%, p = 0.041). HER2-low was associated with longer time to distant recurrence (TTDR) compared to HER2-0 (67.8 vs 54.1 months; p = 0.015) and better BC-related survival (19.2 vs 16.3 years; p = 0.033). In the multivariable analysis, HER2-low was not an independent prognostic factor for TTDR and BC-related survival. ER expression showed a strong association with longer TTDR (Hazard Ratio: 0.425, p ⩽ 0.001) and improved BC-related survival (Hazard Ratio: 0.380, p ⩽ 0.001). PR expression was also associated with longer TTDR (Hazard Ratio: 0.496, p ⩽ 0.001), and improved BC-related survival (Hazard Ratio: 0.488, p ⩽ 0.001). Histological grade III was significantly associated with shorter TTDR (Hazard Ratio: 1.737, p = 0.002). Positive nodal status was the strongest factor correlated with worse BC-related survival (Hazard Ratio: 2.747, p ⩽ 0.001). Conclusion: HER2-low was significantly associated with HR-positive disease, whereas HER2-0 group had higher incidence of TNBC, histological grade III and higher Ki67%. Although HER2-low group was associated with longer TTDR and improved BC-related survival, these findings could be explained by the greater proportion of favorable prognostic features in this subgroup compared to HER2-0.
Effectiveness of a Nurse-Led Workplace Intervention in Reducing Cardiovascular Risks Among Thai Workers: A Randomized Controlled Trial
Authors: Ritngam Arisara , Kalampakorn Surintorn , Lagampan Sunee , Jirapongsuwan Ann 
Published: October 2024

Background: The prevalence of cardiovascular diseases (CVD) is continuously increasing. A nurse-led workplace health promotion program (NWHPP) has demonstrated potential in reducing cardiovascular risks among employees. This study aimed to evaluate the effectiveness of the NWHPP in reducing CVD risks among at-risk workers. Methods: Sixty workers from 2 factories in Thailand, each with an estimated 10-year cardiovascular risk of 5% or higher (determined by the WHO/ISH cardiovascular risk prediction chart), were enrolled. Participants were randomly assigned to either the intervention or control group based on their factory. The intervention group received an 8-week program comprising 3 core components: redesigning healthcare services, strengthening self-management, and obtaining organizational support. Evaluations of the estimated 10-year CVD risk, systolic blood pressure (SBP), smoking status, and body mass index (BMI) were conducted at baseline and at 1- and 3-month follow-ups. Results: The intervention group showed significant improvements compared to the control group in CVD risk score ( F = 4.827, P = .017) and SBP ( F = 12.136, P < .001). Moreover, non-smokers were significantly higher in the intervention group (75.0%) compared with the control group (46.2%) after the 3-month follow-up (OR = 3.50; 95%CI 1.11-11.07; P = .030). However, BMI differences between the groups were not statistically significant. Conclusion: The nurse-led workplace health promotion program effectively improved cardiovascular risk scores among at-risk workers. Developing workplace policies and environments that promote healthy behaviors is essential for reducing CVD risks among at-risk workers.
The Knowledge and Perceptions of Patient Safety and Patient Safety Culture During Dental Training: A Caribbean Perspective
Authors: Marchan Shivaughn M. 
Published: October 2024

Introduction Patient safety and the culture of keeping patients safe are not well-researched concepts in dentistry. Research is lacking on patient safety culture in dental teaching hospitals. Objective This study examined the knowledge and perceptions of patient safety and patient safety culture in a Caribbean dental school among clinical faculty, dental surgery assistants and recent graduates. Method A qualitative research design using an anonymous online open-ended questionnaire, which underwent face validity by three subject matter experts, was used to acquire data to answer three developed research questions. Qualitative data was uploaded to QDA Miner and a five-stage thematic analysis using emergent coding was used to develop themes to answer the research questions. Results Qualitative data was obtained from 28 respondents, 12 clinical faculty, 10 recent graduates, and 6 dental surgery assistants. Four participants graduated in 2020, 1 graduated in 2021, and 5 graduated in 2022. The ages of participants ranged from 23 to 74 years. Themes used to answer the research questions included: the application of a clinical knowledge-based framework for the understanding of patient safety, understanding the individual elements of patient safety culture, gatekeepers of patient safety, and understanding personal limitations. Conclusion Clinical and curriculum leaders at this dental school should consider the introduction of a patient safety curriculum given respondents understand patient safety from a clinical experiential perspective only and many respondents perceive patient safety culture as being guided predominantly by rules and policies with clinical faculty bearing the ultimate responsibility for keeping patients safe
What helps or hinders intervention success in primary care? Qualitative findings with older adults and primary care practitioners during a feasibility study to address malnutrition risk
Authors: Payne Liz , Grey Elisabeth , Sutcliffe Michelle , Green Sue , Childs Caroline , Robinson Sian , Gudgin Bernard , Holloway Pam , Kelly Jo , Seely Jackie , Le Feuvre Rebekah , Aveyard Paul , Gill Paramjit , Stroud Mike , Little Paul , Lucy Yardley , Morrison Leanne 
Published: October 2024

Abstract
Background
In the UK, about 14% of community-dwelling adults aged 65 and over are estimated to be at risk of malnutrition. Screening older adults in primary care and treating those identified as ‘at risk’ may help reduce malnutrition risk and associated healthcare use, and improve quality of life. The aim of this study is to explore how primary care practitioners (PCPs) and older adults perceive, use and respond to an intervention to support those identified as ‘at risk’.

Methods
We developed and optimised an intervention (screen and treat protocol, online tools and printed materials) to support primary care practitioners to identify malnutrition risk among older adults, and intervene where necessary. We recruited older adults (described as ‘patients’ here) taking part in a feasibility study, and carried out semi-structured interviews to assess PCPs’ and patients’ engagement with the intervention, and identify any contextual issues that supported or undermined their engagement.

Results
Four themes were developed, encompassing patients’ and PCPs’ perceptions of undernutrition, study measures and appointments, constraints on PCPs’ enthusiasm to make a difference, and patients’ expectations of nutritional appointments. Key findings included patients commonly not accepting advice for undernutrition/malnutrition but welcoming support for their nutritional needs; checklists potentially distracting patients from recalling discussions about their nutritional needs; a tension between PCPs’ desire to recruit less-well patients and logistical difficulties in doing so; and patients compromising their nutritional needs to suit others.

Conclusions
Diverse factors influence whether an intervention succeeds in primary care. PCPs learn about an intervention/study in different ways, vary in how they understand and accept its aims, and desire to make a difference to their patients. Patients bring perceptions and expectations about the study’s aims, coloured by their habits and preferences, prior experience of research and healthcare, and pressure from social expectations. Each aspect must be considered when developing a successful primary care intervention that is viewed as relevant and meaningful, and presented using language that aligns with participants’ values and goals. Our findings suggest that references to ‘malnutrition risk’ should be avoided in any patient-facing materials/interactions as participants do not accept or identify with this label.
Initial symptoms and late complication in Lyme neuroborreliosis from the perspective of patients and relatives: a qualitative study
Authors: Nymark Anita , Huniche Lotte , Skarphedinsson Sigurdur , Christensen Helle Marie 
Published: October 2024

Abstract
Background
Lyme borreliosis is by far the most common vector-borne infection in Western Europe. The most severe manifestation of Lyme borreliosis is Lyme neuroborreliosis (LNB). In LNB symptoms vary from mild to severe and may include late complications that involve both physical and/or neurocognitive constraints. An estimated 25–28% of the LNB population suffers from late complications. This study investigates patient and relative perspectives on everyday life with LNB symptoms, diagnosis, and treatment to identify areas for improvement of healthcare.

Methods
A focus group was conducted at Odense University Hospital, Denmark. The focus group comprised 16 participants, nine patients diagnosed with LNB who had been treated at the Clinical Center for Emerging and Vector-borne Infections, and seven relatives of the patients’ choice. The focus group lasted 2 ½ hours and was audio recorded as well as documented in field notes.

Results
Data analysis was grounded in the conceptual framework of critical psychology and resulted in three main themes: (1) Burden of LNB symptoms in everyday life, (2) A break in the conduct of everyday life caused by LNB and (3) Need for transparent pathways to specialist knowledge.

Conclusions
Before diagnosis and treatment, each patient reported varying degrees of non-treatable pain, and cognitive and/or musculoskeletal symptoms. Visible physical symptoms were rare. All patients had experienced that their bodily symptoms remained unaddressed throughout numerous encounters with the healthcare system. The course of LNB comes with a break in patients’ everyday lives and self-understandings affecting their ability to work and manage everyday activities. Patients and relatives strongly recommend a specialised LNB clinic.