bluuebunny/crossref_metadata_2025_split huggingface dataset:
Understanding Nurse Retention at a Mental Health and Addictions Facility During a Dual Pandemic
Authors: Rafferty Alyssa , Haase Kristen , Gagnon Michelle , Havaei Farinaz 
Published: September 2024

Background The COVID-19 pandemic exposed nurses to new and more severe workplace stressors; exposure to these workplace stressors has exacerbated nurse turnover. Nurses working in mental health and substance use (MHSU) have also experienced the unique stressor of the overdose crisis in British Columbia (BC). MHSU nurses have been at the forefront of working to manage these dual emergencies. There is limited evidence related to the compounding effect of COVID-19 and the overdose crisis on nursing turnover. Understanding the unique conditions that MHSU nurses are currently experiencing and what factors influence a nurse's intention to stay in or leave a healthcare facility is essential in developing strategies to minimize turnover and maximize retention. Purpose To explore the factors that affect nurse turnover while working through the dual emergencies within a MHSU facility in BC, Canada. Methods A qualitative descriptive approach with an inductive, descriptive thematic analysis guided this quality improvement project. Results Findings were grouped into two main themes: reasons for leaving and reasons for staying. Reasons for leaving included workplace safety, seeking new opportunities, lack of support, and being short-staffed. Reasons to stay encompassed connections with clients, leaders and colleagues, support from colleagues and leaders, and feeling valued, safe, and heard. Conclusions Perceived personal safety and protection from workplace violence were found to increase the likelihood of intent to leave and turnover among nurses. Further, psychosocial safety and connection among nurses and health leaders were found to decrease the likelihood of turnover.
When Fulfilling a Professional Obligation Causes Moral Distress: A New Evaluative Approach
Authors: Kim Daniel T. , Shelton Wayne , Breslin Linda , Applewhite Megan K. 
Published: September 2024

Purpose The term ‘moral distress’ was coined by Andrew Jameton to name the anguish that clinicians feel when they cannot pursue what they judge to be right because of institutional constraints. We argue that moral distress in critical care should also be addressed as a function of the constraints of ethics and propose an evaluative approach to the experience considering its implications for professional identity. Method We build on a selective review of the literature and analyze a paradigmatic example of moral distress, namely, clinicians who feel compelled to perform procedures on patients that seem futile. Such cases are commonly cited by clinicians as among the most morally distressing. Results Our analysis shows that (1) physicians’ experiences of moral distress can stem not only from toxic workplace cultures and institutional constraints on their time and resources for patient care but also from the limits of ethical reasoning and (2) an emotion-based evaluative approach to analyzing moral distress is needed to address its hazards for professional identity. Conclusion We propose a new evaluative approach to moral distress with implications for professional identity and the need for institutional education and support.
Very High Warfarin Dosing Requirements in a Patient With Tuberculosis and a Pulmonary Embolism: A Case Report
Authors: Mize Marcus , Baker Carrie , Bowers Riley D. 
Published: September 2024

Purpose: To describe a case of significantly increased warfarin requirements in a patient receiving rifampin for the management of tuberculosis. Summary: A 76-year-old male was admitted due to altered mentation, cough, and weight loss. He was diagnosed concurrently with tuberculosis and a pulmonary embolism. Given the profound effect of rifampin on CYP450 enzymes, direct oral anticoagulants were avoided and warfarin therapy was selected. Management was further complicated by a gastrointestinal bleed during admission, history of cancer, and low body weight. After several weeks of daily international normalized ratio monitoring, a stable regimen of 14 mg of warfarin daily was established, allowing for the patient’s safe discharge. Practice Implications: This report underscores the significance of tailored treatment plans, vigilant monitoring, and interdisciplinary collaboration which are necessary to navigate the complexities associated with these medications and optimize patient outcomes.
How Important are Commodity Terms of Trade Shocks in Explaining Government Tax Revenue Fluctuations? Evidence from Ethiopia
Authors: Nuru Naser Yenus 
Published: September 2024

Using a new database of commodity terms of trade and identifying country-specific commodity export and import price shocks separately, this article mainly aims to examine the importance of commodity export and import price shocks in explaining government tax revenue fluctuations using Ethiopia as an example over the sample period 1980–2019. This article employs a structural vector autoregressive model and forecast error variance decomposition analysis to address this objective. The results show that commodity export and import price shocks account for around 48% of government tax revenue fluctuations. While commodity export price shocks contribute to around 37% of fluctuations in government tax revenue, commodity import price shocks account for only 11% of government tax revenue fluctuations. These findings are discussed in terms of their policy implications. JEL Classification C32, F41, F44
Retinal displacement following direct versus indirect fluid exchange in pars Plana vitrectomy for rhegmatogenous retinal detachment
Authors: Abdi Fatemeh , Zand Amin , Mirzakhan Mohammad , Zarehosseinabadi Vahid , Anvari Pasha , Mirshahi Reza , Sedaghat Ahad , Taherian Mohammad Mahdi , Gordiz Arzhang , Alemzadeh Sayyed Amirpooya 
Published: September 2024

Purpose To compare the occurrence and characteristics of retinal displacement following direct perfluorocarbon liquid (PFCL)-silicone oil (SO) exchange versus indirect PFCL for air and air for SO exchange methods during pars plana vitrectomy (PPV) in patients with rhegmatogenous retinal detachment (RRD). Methods A comparative case series study was conducted on 58 eyes with recent RRD, undergoing standard three-port PPV with SO tamponade. Fluid exchange was performed using either direct or indirect methods. Postoperatively, a comprehensive ophthalmic examination and fundus autofluorescence (FAF) imaging were conducted at one month. The presence, amount, and direction of retinal displacement were assessed based on FAF imaging and compared between the direct and indirect fluid exchange groups. Results FAF imaging at one month revealed retinal displacement in 41.4% of eyes in the direct group and 62.1% in the indirect group, with no statistical difference between them ( P = 0.537). However, the mean displacement was significantly higher in the indirect group (282.61 ± 110.83 µm) compared to the direct group (220.33 ± 39.67 µm, P = 0.04). The direction of displacement (downward or upward) did not differ significantly between the groups ( P = 0.093). Conclusions While the occurrence and location of postoperative retinal displacement did not significantly differ between direct and indirect fluid exchange methods during PPV for RRD, eyes treated with the direct method exhibited lower mean displacement compared to the indirect method. These findings suggest potential benefits of the direct exchange approach in minimizing retinal displacement following surgery.
Multimodal imaging and histopathological evaluation in silicone oil keratopathy
Authors: Ferrara Mariantonia , Forbice Eliana , Segala Diego , Hau Scott , Beschi Giacomo , Morescalchi Francesco , Romano Mario R , Semeraro Francesco , Romano Vito 
Published: September 2024

Purpose To describe features in silicone oil keratopathy using multimodal imaging and histopathological examination. Methods Case report Result A 21-year-old male developed right corneal decompensation in the heavy SO (HSO)-filled eye. The patient underwent an initial lensectomy, pars plana vitrectomy (PPV) and HSO tamponade due open-globe injury with corneal wound, lens damage and in two retained intravitreal glass foreign bodies, followed by a revisional PPV with HSO tamponade due to tractional detachment associated with proliferative vitreoretinopathy and epiretinal membrane. One month after the removal of HSO, ophthalmic examination of the right eye showed corneal decompensation. The AS-OCT showed corneal thickening, intrastromal scattered hyperreflective dots and large rounded/oval hyporeflective space; the latter were suggestive of emulsified HSO microbubbles and larger bubbles, respectively. In vivo confocal microscopy showed multiple presumed SO-related corneal changes, including hyper-reflective fibrotic changes in the basal epithelium, reduced density ans altered morphology of keratocytes cell population, increased pleomorphism and polymegathism of the endothelium with reduced endothelial cell, and presence of inflammatory cells. The patient underwent a penetrating keratoplasty, pupilloplasty and retropupillary iris-claw IOL implantation. The histopathological examination of the host corneal button showed Descemet's membrane irregularity and thickened corneal stroma with focal intrastromal silicone oil vacuoles, surrounded by macrophages. Conclusion We described for the first time intrastromal hyperreflective dots as a sign associated with SO-related keratopathy. Moreover, this case report supports the ability of emulsified SO to penetrate the cornea inducing a local low-grade chronic inflammation.
Exploring the Correlation Between Hypoxia, HIF1A Variants, and Breast Cancer in Different Ethnicities, and Bangladeshi Women: Through ELISA and Integrative Multi-Omics Analysis
Authors: Islam Md. Shihabul , Jesmin  
Published: September 2024

Background: Hypoxia, a condition where there is a lack of oxygen, is known to play a role in cancer progression. Objective: This study investigates the correlation between HIF1A gene-altered expression and hypoxia in Bangladeshi breast cancer (BC) cases and TCGA_BC datasets. Design: This case-control study compares BC cases to healthy controls to understand the relationship between gene changes and cancer. Method: This study used advanced analysis methods to examine the transcriptional landscape of BC, and quantitatively assessed its correlation using integrated multi-omics analysis. Results: In Bangladeshi BC cases, the T allele of HIF1A rs1154946 correlates notably ( P-value < .001) with BC incidence. ELISA results confirmed a significant association ( P-value < .005) between elevated HIF1A expression and BC-related hypoxia. Bioinformatics eQTL analysis validated the correlation between increased HIF1A expression and rs11549465 T allele ( P-value < .01). Structural analyses suggested that rs11549465 (P582S) mutation may decrease protein stability (ΔΔG-value: −1.24 kcal/mole), potentially affecting HIF1A function. HIF1A enrichment analysis in BC underscores strong associations with oxygen levels, hypoxia, metabolic processes, apoptosis, and programed cell death ( P-value < .001). Transcriptomic data demonstrated a robust correlation ( P-value < .0001) between HIF1A expression and copy-number alterations, mutations, and abnormal methylation. Altered HIF1A expression showed strong negative correlations ( P-value < .00001) with methylation and the expression of the ER ( ESR1), in Whites. Survival analysis revealed marked differences in overall survival linked to high and low HIF1A expression ( P-value < .00001). Furthermore, HIF1A expression significantly correlated ( P-value < .000001) with hypoxia, TMB, MSI, and immune infiltration by CD8+ T cells, neutrophils, dendritic, and macrophages, providing deeper insights into the BC microenvironment. Conclusion: Thus, the HIF1A gene could serve as a promising biomarker for breast cancer progression, control, and survival across ethnicities, emphasizing its role in disease development and regulation.
Chemical Profiling and Antioxidant, Anti-Inflammatory, Cytotoxic, Analgesic, and Antidiarrheal Activities from the Seeds of Commonly Available Red Grape (Vitis viniferaL.)
Authors: Hossain Md. Jamal , Lema Khadija Rahman , Samadd Md Abdus , Aktar Rumi , Rashid Mohammad A. , Al-Mansur Muhammad Abdullah 
Published: September 2024

Objectives:The current study aimed to conduct a phytochemical screening of commonly known fruit red grape ( Vitis vinifera L.) seed methanolic extract through gas chromatography and mass spectrometry (GC-MS) to identify the bioactive compounds responsible for its health benefits and evaluate the pharmacological potentialities of the extract and its fractions against oxidation, inflammation, pain, and diarrhea.Methods:The in vitro antioxidant, anti-inflammatory, and cytotoxic characteristics of methanolic extracts and various solvent fractions of V. vinifera were evaluated using the DPPH free radical scavenging assay, membrane stabilizing, and brine shrimp lethality bioassay. Furthermore, the study assessed the effects of crude extracts (200, 400, and 600 mg/kg of body weight) on pain relief and reduction of diarrhea in animals using methods such as tail immersion, the acetic acid-induced writhing technique, and a diarrheal mouse model induced with castor oil.Results:A total of 73 phytoconstituents were predominantly found in the seed extract based on the GC-MS analysis. Among the identified compounds, 9-octadecenamide (13.7%), and ( 9E,11E)-octadeca-9,11-dienoate (11.07%) are most abundant. Several notable constituents, such as gamma-sitosterol, stigmasterol, paromomycin, 4,6-cholestadienol, gamma-tocotrienol, 24-Propylidenecholest-5-en-3beta-ol, and alpha-tocopherol acetate, are also present. The methanolic extract of V. vinifera seed and its different solvent fractions showed promising antioxidant properties (IC50 = 1.19-17.42 µg/mL) compared to the standard antioxidant butylated hydroxytoluene (IC50 = 20.46 µg/mL). Aqueous soluble fraction exerted inhibition of nearly 50% heat-induced hemolysis compared to the standard acetylsalicylic acid (42%). Besides, all the tested doses (200, 400, and 600 mg/kg bw) of the crude extract showed significant ( P < .05) analgesic and antidiarrheal effects.Conclusion:The current findings endorsed the health benefits of V. vinifera by revealing potent antioxidant, anti-inflammatory, analgesic, and antidiarrheal effects. Nevertheless, further in-depth analysis of the plant’s chemical constituents and pharmacological effects on health is warranted for novel drug discovery from V. vinifera.
Positive Association Between Family and Teachers’ Tobacco Use on the Smoking Behaviors of Iraqi Adolescents Attending Schools – A Cross Sectional Study Using the Global Youth Tobacco Survey
Authors: Al-Binali Fatima , Dargham Soha R. , Mahfoud Ziyad R. 
Published: September 2024

Objective: Adolescent tobacco and E-cigarette use have been rising globally in the past decade. Iraq’s post-war conflict and economic crises posed psychosocial and mental health trauma, contributing to increased vulnerability to drug and substance use among adolescents. This study looks to assess the potential relationship between current tobacco and E-cigarette smoking and exposure to smoking at home and school among Iraqi adolescents attending schools. Methods: Data analysis for the 2019 Iraq Global Youth Tobacco Survey, a cross-sectional study completed by 2560 Iraqi adolescents aged 11 to 17 years old was conducted. The survey tool which includes demographic, tobacco use, knowledge and attitudes towards tobacco use questions is anonymous and self-administered using paper-based bubble sheets that are scannable. Current tobacco and E-cigarette use (defined as past 30-days) were the main outcomes. Univariate and multivariate logistic regression models were used to assess the relationship between the main outcomes and the following variables: participants’ demographics, exposure to smoking, attitude and knowledge scores. Results: Current tobacco and E-cigarette smoking prevalence among Iraqi adolescents attending school were 14.9% (95% CI: 13.5%-16.4%) and 9.7% (95% CI: 8.6%-11.0%), respectively. Exposure to smoking at home was high among fathers (39.1%), mothers (13.9%), siblings smoke (23.9%), other individuals smoke (56.1%). The percentages of students who witnessed people smoking within school premises was 45.7% and observed teachers smoking in schools was 57.6%. The current use of tobacco smoking among Iraqi adolescents was significantly and positively associated with exposure to smoking by the father (AOR = 1.39; 95% CI: 1.05-1.85), mother (AOR = 1.84; 95% CI: 1.30-2.60), sibling (AOR = 3.50; 95% CI: 2.62-4.67), teacher (AOR = 1.48; 95% CI: 1.10-1.98), and people in school (AOR = 1.99; 95% CI: 1.57-2.53). Similarly, the current use of E-cigarettes was significantly associated with father smoking (AOR = 2.02; 95% CI: 1.29-3.16), sibling smoking (AOR = 3.09; 95% CI: 2.04-4.67), and people smoking in school (AOR2.02; 95% CI: 1.39-2.95). Conclusion: Stricter policies need to be enforced to ensure safer school environments that do not expose adolescents to smoking habits of teachers or other students.
Lobulated Hemangioma as a Rare Cause of Tricuspid Regurgitation
Authors: Liu Fang , Dong Mingliang , Li Qingbao 
Published: September 2024

Introduction: Cardiac hemangioma is one of the rarest tumors, with only a few cases described. Unlike other cardiac tumors, its symptoms are nonspecific, making misdiagnosis easy. Cardiac hemangioma can present with various clinical manifestations, including valve disorder, arrhythmia, pericardial effusion, and embolism. Echocardiography is the most direct examination, and surgical resection the simplest and most effective treatment. Patients and methods: We present a new case of lobulated cardiac hemangioma causing tricuspid regurgitation and discuss the clinical features, diagnosis, and treatment of this rare tumor. Results: After surgical resection and tricuspid valve replacement, the patient recovered well. Conclusion: For cardiac hemangiomas involving the tricuspid valve, tumor resection combined with valve surgery is an effective treatment option.
Corilagin Alleviates Ang II-Induced Cardiac Fibrosis by Regulating the PTEN/AKT/mTOR Pathway
Authors: Zhang Xiaogang , Tian Bei , Cong Xinpeng , Ning Zhongping 
Published: September 2024

This research aimed to evaluate the therapeutic effect of corilagin (Cor) against angiotensin II (Ang II)-induced cardiac fibrosis and its underlying mechanisms. C57BL/6 mice (male, 8-10 weeks) received saline or Ang II (2.0 mg/kg/day) via subcutaneous infusion and intraperitoneal injection of Cor (30 mg/kg) for 28 days. Ang II induction increased the fibrotic area, whereas Cor treatment inhibited the fibrotic area significantly. Cor markedly reduced the Ang II-induced cardiac fibroblasts. Cor significantly inhibited Ang II-induced increase in expressions of smooth muscle alpha-actin (α-SMA), collagen I, collagen III, transforming growth factor beta 1 (TGF-β1), fibronectin, and connective tissue growth factor (CTGF). Cor suppressed the intracellular reactive oxygen species (ROS) production. Cor therapy reduced Ang II-induced malondialdehyde (MDA) content, whereas superoxide dismutase (SOD) and catalase (CAT) activities were increased (all, P < .001). Moreover, Ang II induction elevated the expression of phosphorylated phosphatase and tensin homolog (p-PTEN), phosphorylated protein kinase B (p-AKT) (Ser473) and phosphorylated mammalian target of rapamycin (p-mTOR) (Ser 2448), whereas Cor reduced their expressions. Cor treatment inhibited the migration ability of the cardiac fibroblast, whereas a PTEN inhibitor, VO-ohpic, increased the migration capability. Cor could have a protective effect against Ang II-induced cardiac fibrosis via inhibition of the PTEN/AKT/mTOR pathway.
Anatomical variations of origin of the internal carotid artery: Report of two cases and systematic review of the literature
Authors: Ramputi Lucia , Mazzaccaro Daniela , Tissir Karima , Trevisan Manuel Bruno , Conte Gianluca , Nano Giovanni , Menicanti Lorenzo , Castelvecchio Serenella 
Published: September 2024

Background Anatomical variations of origin of the internal carotid artery (ICA) are very uncommon and may pose a diagnostic and therapeutic challenge. Objective We report a case of direct origin of the right ICA from the innominate artery (aplasia of common carotid artery) and a case of duplication of right ICA in healthy patients who performed duplex ultrasound (DUS) for primary cardiovascular prevention screening. Methods In both cases, the ultrasound scan was performed both in a transverse plane and on the longitudinal axis, and in one of the two cases, a computed tomography angiography was performed to confirm the diagnosis. A review of the current literature about anatomical variations of origin of carotid arteries was also performed. Results The most frequent congenital anomaly is represented by the aplasia of the CCA, followed by the agenesis and by the duplication of the ICA. In most cases, the anomaly is discovered occasionally and symptoms are aspecific. Diagnosis is usually confirmed through a multimodality imaging approach, including DUS of extracranial carotid arteries, magnetic resonance imaging (MRI), and computed tomographic angiography. In most cases, treatment was conservative, with pharmacological therapy aimed at the symptoms. Conclusion The recognition of such variations is mandatory, particularly when the patient needs a surgical treatment that may involve the vessel with the anatomical variations.
Environmentally sustainable opportunities for health systems: Metered-dose inhaler prescribing, dispensing, use and waste at a tertiary academic centre
Authors: Caron Carolanne , Sajwani Shellyza , Bateman Katherine , Degenhardt Owen , Gaudreau-Simard Mathilde , Pakhale Smita , Kanji Salmaan 
Published: September 2024

Background: The Canadian health sector’s carbon footprint is among the highest in the world and is responsible for 4.6% of Canada’s total greenhouse gas emissions, a quarter of which is linked to pharmaceuticals, with metered-dose inhalers (MDIs) contributing disproportionally high amounts. Objectives: To describe MDI prescribing, dispensing, use and waste patterns at a Canadian tertiary care academic hospital. Methods: In a retrospective point-prevalence cohort study, 100 consecutive patients discharged from medical and surgical services who were prescribed at least 1 MDI during their admission were included. Data were collected to describe patient demographics, MDI prescribing, dispensing, use and waste patterns. Use and waste data were applied to annual purchasing data to estimate annual usage and waste. Financial cost was computed using local purchasing estimates and carbon cost was calculated using published estimates. Results: In 100 consecutively discharged patients, 315 MDIs were dispensed in total, of which 96 were unused. This represents 61,440 actuations dispensed, with 56,773 (92%) of doses unused or wasted. Waste data were applied to annual estimates, with a calculated annual carbon footprint of 315.8 tons of carbon dioxide equivalent (tCO2e). We estimate that a 20% waste reduction would result in carbon savings of 68.5 tCO2e. If 20% of salbutamol prescriptions were switched to the dry powder inhaler alternative, terbutaline, a 14% reduction in waste would be required to offset the additional monetary cost. Conclusions: This study suggests that 92% of MDI doses are unused and wasted. Opportunities for waste reduction exist and would be associated with both financial and carbon savings.