bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors contributing to the development of health-promoting schools, applying Fullan’s triple change model – A qualitative study
Authors: Zak Yehuda Ayala , Baron-Epel Orna 
Published: September 2024

Objective: Schools and the education system are powerful tools for cultivating healthy lifestyles. This research focuses on characterising the factors contributing to the development of health-promoting schools in Israel, and understanding how schools can offer a framework for improving students’ health. Fullan’s triple change model with its focus on three phases in the change process in schools – the initiation phase, the implementation phase and the institutionalisation phase – served as a framework for analysis. Design and setting: This qualitative-constructivist study involved the analysis of data collected from 26 elementary school principals in Israel, 15 of whom belonged to the health promotion school network (HPSN) and 11 who did not. In addition, 10 health promotion leaders from within the schools were interviewed. Methods: Data collection took place by means of semi-structured interviews. in which the questions asked referred to the three phases identified in Fullan’s process of change model. We analysed the data using thematic content analysis. Results: Each identified theme was associated with one of the phases proposed in Fullan’s model of change. The initiation phase included collaboration with key stakeholders, principals’ personal commitment, and dissemination of ideas through personal connections. The implementation phase included gaining access to appropriate tools and materials, action to deal with barriers to change, and the creation of a holistic health promotion environment. The institutionalisation phase included the development of administrative strategies such as adherence to routines, the inclusion of regular events in the school calendar, and the allocation of time frames for the activities undertaken. Conclusion: Fullan’s model proved useful in analysing efforts to develop health-promoting schools. The model signalled the importance of using a structured approach throughout the institutionalisation phase in a manner attuned to the unique nature of the school. Alongside identifying key factors that support assimilation, it is crucial to assess their integration into the school culture. The school principal’s role is critical throughout all the phases of the development process.
Assessment of Sodium Butyrate’s Pharmacological Effects on Gentamicin-induced Nephrotic Disorders in a Rat Model
Authors: Kumar Sunil , Sindhu Rakesh Kumar 
Published: September 2024

Background Sodium butyrate (SB) used to increase oxidative stress was reduced and the glutathione redox pathway was boosted. It inhibits proliferation, induction of differentiation, and induction or repression of gene expression and it has also anti-inflammatory action. This is endorsed for suppression of nephrotic symptoms. Objectives The present study was carried out to evaluate the nephroprotective activity of SB on gentamicin-induced nephrotoxicity in rats. Materials and Methods Present research work was designed to estimate pharmacological potential of SB in gentamicin-induced nephrotic disorder. The pharmacological prospective was estimated in gentamicin-induced rats through the oral administration of SB formulation 200 mg/kg and 300 mg/kg BW. Results The study observed that the SB significantly protects the kidneys from gentamicin-induced nephrotic disorders. Gentamicin 100 mg/kg for 7 days was used for induction of nephrotoxicity in Wistar rats by intraperitoneal administration. The administration of SB was observed to decrease the occurrence of glomerular congestion, vascular congestion, epithelial desquamation, inflammatory cell build-up, and kidney cell necrosis induced by gentamicin. The dose of SB maintained the gentamicin-induced increased creatinine (0.62±0.05), serum urea (18.10±0.79), uric acid (2.10±0.28), and blood urea nitrogen (BUN) (17.56±0.55) levels. This fact is further sustained by the histopathological examinations. Conclusion Sodium butyrate formulation with antinephrotic activity in maintaining uremic solutes such as urea, uric acid, creatinine, BUN, ketone, urobilinogen, glucose, specific gravity, and urine pH in Wistar rats with gentamicin-induced glomerulonephritis (GN). The SB was administered to the animals at doses of 200 and 300 mg/kg body weight. Pretreatment with the drug showed promising results in maintaining elevated parameters in nephritic rats within a short duration.
Historical trends in daily smoking and quitting by relationship status in Norway, 1973–2022
Authors: Lund Marianne , Lund Ingeborg 
Published: September 2024

Aims: This study aims to investigate trends in self-reported daily smoking and quitting by relationship status in 1973–2022. Methods: Repeated and representative cross-sectional tobacco surveys of the adult population in Norway were analysed in the age group 25–74 years. Logistic regression was used to estimate the adjusted predicted probability of daily smoking and former smoking for persons in a formalised relationship (married or cohabitant) and persons not in a formalised relationship. Results: Since the 1970s, the decline in daily smoking has been present for men regardless of relationship status, but with more smoking among men not in a relationship from the 2000s onward. For women not in a relationship, daily smoking increased among those not in a relationship from the mid-1980s, surpassing the smoking rate among men in a relationship. From the 1990s, daily smoking was higher in women not in a relationship compared with women in a relationship. In the past decade (2013–2022), the adjusted odds ratio of daily smoking was 0.49 for people in a relationship compared with those not in a relationship. Conclusions: Downward trends in daily smoking have been substantial the past 50 years, but differences by relationship status persist. Continued monitoring of smoking behaviour at the population level is crucial to uncover which demographic groups are lagging in the last phase of the tobacco epidemic.
Surgical Treatment of Superior Vena Cava Syndrome in a Preterm Neonate
Authors: Alpat Safak , Alma Melih 
Published: September 2024

Superior vena cava syndrome is rare and challenging clinical entity in neonates. Medical treatment options are usually effective. However, when failed, surgery is warranted. Herein, we present a preterm neonate with SVC syndrome and associated chylothorax. When 2 weeks old, he underwent successful open thrombectomy and SVC reconstruction under cardiopulmonary bypass. Immediately after the operation findings of SVC syndrome and chylotorax were completely resolved. To our knowledge, this patient is the smallest baby underwent open SVC reconstruction with cardiopulmonary bypass.
Hemorrhagic complications after stroke treatment with intravenous thrombolysis despite use of direct oral anticoagulants: an observational study
Authors: Kleeberg Antonia , Ringleb Peter A. , Huber Ioana , Jesser Jessica , Möhlenbruch Markus , Purrucker Jan C. 
Published: September 2024

Background: For patients experiencing ischemic stroke despite receiving therapy with direct oral anticoagulants (DOAC) and without endovascular treatment options, therapeutic prospects are currently dismal. Current guidelines recommend intravenous thrombolysis (IVT) only for patients who have received DOAC in very restricted settings, as an increased risk of bleeding is suspected. However, recent retrospective observational studies suggest that IVT is safe despite DOAC pretreatment. Objectives: To provide further evidence that IVT despite previous DOAC treatment is not associated with an increased risk of bleeding. Design: Observational retrospective study. Methods: Demographic, clinical, and radiological data of patients who received IVT (+/− endovascular thrombectomy) despite DOAC pretreatment between June 2021 and January 2024 were analyzed using descriptive statistics, including DOAC plasma concentration at admission. Secondary intracranial hemorrhages and functional outcomes at 3 months were assessed. Since 2023, patients have been treated according to a modified local standard operating procedure at our hospital, allowing for IVT despite DOAC pretreatment regardless of DOAC plasma levels or the use of reversal agents. Results: Of 1821 patients treated with acute recanalization procedures during the study period, N = 35 had received IVT with (18) or without (17) additional endovascular therapy. Among these patients with a wide age range (42–97 years) and DOAC plasma concentrations up to 369 ng/ml, only one developed symptomatic intracranial hemorrhage. A favorable outcome (modified Rankin scale score 0–2) after 3 months was observed in 57% (20) of the patients. Conclusion: IVT despite direct oral anticoagulation seems to be safe, even at advanced age and high DOAC plasma levels.
Risk Factors for Sacroiliac Joint Fusion after Instrumented Spinal Fusion
Authors: Du Peter Z , Singh Gurmit , Smith Spencer , Philipp Travis , Kark Jonathan , Lin Clifford , Yoo Jung U 
Published: September 2024

Study Design Retrospective Cohort Study. Objective To identify risk factors for sacroiliac (SI) joint fusion after instrumented spinal fusion. Methods Patients were identified from the PearlDiver BiscayneBay database. Patients who underwent 1 level (CPT: 22840), 3-6 vertebral segment (22842), and 7+ vertebral segment spinal fusions (22843 and 22844) were identified. Patients were separated based on whether they received an SI joint fusion (27280 and 27279) after their spinal fusion. A univariate analysis and multivariate logistic regression was performed to evaluate the associations between patient factors and incidence of SI joint fusion. Results 549,625 patients who underwent posterior spinal fusions were identified, 6068 of whom underwent subsequent SI joint fusion (1.1%). Factors associated with future SI joint fusion included female gender, patients with obesity, fibromyalgia, diabetes, tobacco use, increased construct length, and prior SI joint injection. Prior SI joint injection had the highest odds ratio (OR: 8.70; 95% CI: 8.25-9.16; P < 0.001), followed by 7+ vertebral segment (OR: 2.17; 95% CI: 2.03-2.33; P < 0.001) and 3-6 vertebral segment fusion (OR: 1.49; 95% CI: 1.42-1.57; P < 0.001). Conclusions The highest predictor of requiring subsequent SI joint fusion is a prior SI joint injection. We also found that longer fusion constructs are associated with increased risk for future SI joint fusion.
Exogenous putrescine application imparts salt stress-induced oxidative stress tolerance via regulating antioxidant activity, potassium uptake, and abscisic acid to gibberellin ratio in Zinnia flowers
Authors: Mohammadi Meisam , Nezamdoost Delaram , Khosravi Far Fatemeh , Zulfiqar Faisal , Eghlima Ghasem , Aghamir Fatame 
Published: September 2024

AbstractThis research was conducted to investigate the efficacy of putrescine (PUT) treatment (0, 1, 2, and 4 mM) on improving morphophysiological and biochemical characteristics of Zinnia elegans “State Fair” flowers under salt stress (0, 50, and 100 mM NaCl). The experiment was designed in a factorial setting under completely randomized design with 4 replications. The results showed that by increasing the salt stress intensity, the stress index (SSI) increased while morphological traits such as plant height decreased. PUT treatments effectively recovered the decrease in plant height and flower quality compared to the not-treated plants. Treatment by PUT 2 mM under 50 and 100 mM salt stress levels reduced the SSI by 28 and 35%, respectively, and increased plant height by 20 and 27% compared to untreated plants (PUT 0 mM). 2 mM PUT treatment also had the greatest effect on increasing fresh and dry biomass, number and surface area of leaves, flower diameter, internodal length, leaf relative water content, protein contents, total chlorophyll contents, carotenoids, leaf potassium (K+) content, and K+/Na+ ratio in treated plants compared to untreated control plants. The treatment of 2 mM PUT decreased the electrolyte leakage, leaf sodium (Na+) content, H2O2, malondialdehyde, and proline content. Furthermore, PUT treatments increased the activity of defense-related enzymes including catalase (CAT), peroxidase (POD), superoxide dismutase (SOD), and phenylalanine ammonium lyase (PAL), and reduced the abscisic acid (ABA) content while increased the level of gibberellin (GA) content compared to untreated samples under all different levels of salinity stress. In this research, enhancing the plant’s antioxidant system, increasing K+ absorption, K+/Na+ ratio, and reducing the ABA/GA ratio are likely the most important mechanisms of PUT treatment, which improved growth, and maintained the visual quality of zinnia flowers under salt stress conditions.
Developing a novel calcium silver zeolite for caries management
Authors: Li Laura Jiaxuan , Lung Christie Ying-Kei , Ge Kelsey Xingyun , Song Ke , Chu Chun-Hung , Yu Ollie Yiru 
Published: September 2024

Abstract
Objective
To develop a novel calcium silver zeolite (Ca-Ag-Zeo) and assess its biocompatibility, physiochemical properties and antimicrobial effects.

Methods
Ca-Ag-Zeo was synthesized using ion-exchange method with calcium chloride, silver nitrate and Zeolite X (Zeo). Silver zeolite X (Ag-Zeo) and Zeo were set as control. The chemical structure, morphology, crystal structure and elemental composition of Ca-Ag-Zeo was characterized by X-ray diffraction spectrum, scanning electron microscopy, transmission electron microscopy and energy dispersive spectroscopy, respectively. Its biocompatibility on the human gingival fibroblasts was assessed by cell counting kit-8 assay. Its physiochemical properties were determined by the released calcium and silver ion using Inductive Coupled Plasma Emission Spectrometry for up to 12 weeks. The antimicrobial properties on Streptococcus mutans, Lactobacillus acidophilus, Lactobacillus casei, and Candida albicans were assessed by minimum bactericidal concentration (MBC) or minimum fungicidal concentration (MFC) assay.

Results
Ca-Ag-Zeo with a hexagonal cage structure was synthesized. As for biocompatibility, the half-maximal inhibitory concentration (± SD in mg/mL) of Ca-Ag-Zeo, Ag-Zeo and Zeo in human gingival fibroblasts were 0.52 ± 0.05, 0.15 ± 0.01 and 3.35 ± 0.58, respectively (Zeo > Ca-Ag-Zeo > Ag-Zeo; p < 0.05). As for physiochemical properties, the accumulated ion release (± SD in mg) of Ca-Ag-Zeo, Ag-Zeo and Zeo were 0.011 ± 0.003, 0 and 0 for calcium ion, respectively (Ca-Ag-Zeo > Ag-Zeo, Zeo; p < 0.001), and 0.213 ± 0.032, 0.209 ± 0.019 and 0 for silver ion, respectively (Ca-Ag-Zeo, Ag-Zeo > Zeo; p < 0.001). As for anti-microbial ability, the MBC/MFC (mg/mL) of Ca-Ag-Zeo, Ag-Zeo and Zeo were 32, 16 and > 256 against Streptococcus mutans; 32, 16, > 256 against Lactobacillus acidophilus; 16, 16, and 256 against Lactobacillus casei; 0.25, 0.125; and 2, 1, > 256 against Candida albicans, respectively.

Conclusion
A novel Ca-Ag-Zeo was developed. It presented better biocompatibility compared to Ag-Zeo. It released calcium and silver ions sustainably, and it could inhibit the growth of common cariogenic microorganisms.
Real-world impact of acupuncture on analgesics and healthcare resource utilization in breast cancer survivors with pain
Authors: Ng Ding Quan , Lee Sanghoon , Lee Richard T. , Wang Yun , Chan Alexandre 
Published: September 2024

Abstract
Background
This study evaluated the real-world impact of acupuncture on analgesics and healthcare resource utilization among breast cancer survivors.

Methods
From a United States (US) commercial claims database (25% random sample of IQVIA PharMetrics® Plus for Academics), we selected 18–63 years old malignant breast cancer survivors experiencing pain and ≥ 1 year removed from cancer diagnosis. Using the difference-in-difference technique, annualized changes in analgesics [prevalence, rates of short-term (< 30-day supply) and long-term (≥ 30-day supply) prescription fills] and healthcare resource utilization (healthcare costs, hospitalizations, and emergency department visits) were compared between acupuncture-treated and non-treated patients.

Results
Among 495 (3%) acupuncture-treated patients (median age: 55 years, stage 4: 12%, average 2.5 years post cancer diagnosis), most had commercial health insurance (92%) and experiencing musculoskeletal pain (98%). Twenty-seven percent were receiving antidepressants and 3% completed ≥ 2 long-term prescription fills of opioids. Prevalence of opioid usage reduced from 29 to 19% (P < 0.001) and NSAID usage reduced from 21 to 14% (P = 0.001) post-acupuncture. The relative prevalence of opioid and NSAID use decreased by 20% (P < 0.05) and 19% (P = 0.07), respectively, in the acupuncture-treated group compared to non-treated patients (n = 16,129). However, the reductions were not statistically significant after adjustment for confounding. Patients receiving acupuncture for pain (n = 264, 53%) were found with a relative decrease by 47% and 49% (both P < 0.05) in short-term opioid and NSAID fills compared to those treated for other conditions. High-utilization patients (≥ 10 acupuncture sessions, n = 178, 36%) were observed with a significant reduction in total healthcare costs (P < 0.001) unlike low-utilization patients.

Conclusions
Although adjusted results did not show that patients receiving acupuncture had better outcomes than non-treated patients, exploratory analyses revealed that patients treated specifically for pain used fewer analgesics and those with high acupuncture utilization incurred lower healthcare costs. Further studies are required to examine acupuncture effectiveness in real-world settings.
Network analysis of Tourette syndrome and attention-deficit/hyperactivity disorder symptoms in children and adolescents
Authors: Zhang Wenyan , Jiang Zhongliang , Zhang Anyi , Yu Liping , Wang Xianbin , Hong Xu , Cui Yonghua , Lei Tianyuan 
Published: September 2024

Abstract
Background
While Tourette syndrome (TS) and attention-deficit/hyperactivity disorder (ADHD) often co-occur, the nature of the relationship between their symptoms is not well understood. Network analysis of psychopathology allow for detailed examinations of symptom interactions, providing an effective approach to explore the patterns of comorbidity between TS and ADHD symptoms.

Methods
This study included 3,958 participants (male/female = 3,004/954, age mean ± SD = 8.60 ± 2.25 years). We collected data on TS symptoms using the Motor Tic, Obsessions and Compulsions, Vocal Tic Evaluation Survey (MOVES), and ADHD symptoms using the Swanson, Nolan, and Pelham Rating Scale-IV (SNAP-IV). Network analysis was employed to construct a combined network of TS and ADHD symptoms at the symptom level. We utilized the expected influence (EI) and bridge EI metrics to explore the core and bridge symptoms within the network.

Results
The network structure demonstrated a moderate number of non-zero connections between TS and ADHD symptoms, constituting 23.06% of all potential connections. Core symptoms in the comorbidity network included “Often has difficulty sustaining attention in tasks or play activities,” “Certain bad words or thoughts keep going through my mind,” and “Words come out that I can’t stop or control.” Bridging symptoms identified were “Words come out that I can’t stop or control,” “I do certain things like jumping or clapping over and over,” “I can’t control all my movements,” and “Often talks excessively.”

Conclusion
The core and bridging symptoms identified in this study serve as potential therapeutic targets for the treatment of TS and ADHD comorbidity in clinical children and adolescents.
Chronically ill patients’ perspectives on support services and activities of patient organizations
Authors: Zigdon Avi , Eckhaus Eyal , Rosenfeld Michal , Zigdon Ofek 
Published: September 2024

Abstract
Background
Patient Organizations (POs) are an important support factor in helping chronically ill patients cope with their illness. Patient involvement in the management of their disease helps to achieve the best possible care for the patient, streamline the work of healthcare providers, shape healthcare policy, and even influence the structures of healthcare systems. The perspective of chronically ill patients on the activities and services provided by patient organizations has not been evaluated yet. This study aimed to identify and map the services and activities of all types of non-profit patient organizations from the perspective of chronically ill patients so that they can be integrated as an integral part of the healthcare system.

Methods
Nineteen services and activities of patient organizations were sampled from Israeli patient organizations and scientific literature. These services and activities were evaluated by chronically ill patients in Israel. Patient-Oriented Questionnaires (POQ) were distributed among patients with chronic diseases (N = 1395) using snowball sampling.

Results
Exploratory factor analysis (EFA) was performed, followed by confirmatory factor analysis (CFA) for convergent and discriminant validity. Findings showed that twelve services and activities suggested by patient organizations were found to represent chronically ill patients’ needs and categorized into three groups: Interpersonal support (five items), patients’ rights (four items), and medical information (three items). CFA showed a good fit for the observed data. CFI = 0.98, NFI = 0.97, TLI = 0.96, RMSEA = 0.058.

Conclusions
Well-organized patient organizations are an important pillar in reformed healthcare systems. They can serve as the social arm of the healthcare system and as an intermediary between patients and healthcare institutions. We narrowed down twelve services and activities given by patient organizations that were important to chronically ill patients in Israel. patient organizations can utilize patient needs or preferences into clinical practice and influence health policy planning, patient-caregiver relationships, research and even healthcare costs. patient organizations recognition by the healthcare system, and establishment of a national patient council will help to realize these processes.