bluuebunny/crossref_metadata_2025_split huggingface dataset:
When the first try fails: re-implementation of SIMPL in a general surgery residency
Authors: Hsu Phillip J. , Wnuk Gregory , Leininger Lisa , Peterson Samantha , Hughes David T. , Sandhu Gurjit , Zwischenberger Jay B. , George Brian C. , Aubry Staci 
Published: September 2024

Abstract
Background
Workplace-based assessment (WBA) can facilitate evaluation of operative performance; however, implementation of WBA is sometimes unsuccessful. The American Board of Surgery Entrustable Professional Activities WBA project was launched in July 2023. Some programs will face the challenge of re-implementation of a WBA following previous failures. It is unknown what interventions are most effective for WBA re-implementation. Our goal is to identify barriers and facilitators to re-implementing SIMPL, an operative performance WBA.

Methods
The System for Improving and Measuring Procedural Learning (SIMPL) was implemented at our residency in 2018, but usage rates were low. We interviewed residents and faculty to identify barriers to usage and opportunities for improvement. Residents reported that SIMPL usage declined because of several factors, including a low faculty response rate, while some faculty reported not responding because they were unable to login to the app and because usage was not mandated. We then re-implemented SIMPL using a plan based on Kotter’s Model of Change. To evaluate impact, we analyzed rates of SIMPL usage when it was first implemented, as well as before and after the date of re-implementation.

Results
In September 2022, we re-implemented SIMPL at our program with measures addressing the identified barriers. We found that, in the six months after re-implementation, an average of 145.8 evaluations were submitted by residents per month, compared with 47 evaluations per month at the start of the original implementation and 5.8 evaluations per month just prior to re-implementation. Faculty completed 60.6% of evaluations and dictated feedback for 59.1% of these evaluations, compared with 69.1% at implementation (44% dictated) and 43% prior to re-implementation (53% dictated).

Conclusions
After identifying barriers to implementation of a WBA, we re-implemented it with significantly higher usage by faculty and residents. Future opportunities exist to implement or re-implement assessment tools within general surgery programs. These opportunities may have a significant impact in the setting of national standardization of workplace-based assessment among general surgery residencies.
Marginal adaptation of customized gutta percha cone with calcium silicate based sealer versus MTA and biodentine apical plugs in simulated immature permanent teeth (an in vitro study)
Authors: Mina Mary M. , Moussa Sybel M. , Aboelseoud Mahmoud R. 
Published: September 2024

Abstract
Background
This study aimed to compare the marginal adaptation of a single customized gutta percha cone with calcium silicate-based sealer versus mineral trioxide aggregate (MTA) and Biodentine apical plugs in simulated immature permanent teeth.

Methods
Thirty-nine extracted human maxillary anterior teeth were selected, prepared to simulate immature permanent teeth with an apical diameter 1.1 mm, placed in moist foam and divided into three groups. Group 1: Obturation with a single customized gutta percha cone and calcium silicate sealer. Group 2: MTA apical plug. Group 3: Biodentine apical plug. After incubation, teeth were horizontally sectioned at 1 mm and 3 mm from the apex and marginal adaptation was evaluated using scanning electron microscope (SEM).

Results
Biodentine showed the least mean gap size at both 1 and 3 mm from the apex with no statistically significant differences compared to MTA (p > 0.05). The single customized cone with calcium silicate based sealer showed the greatest mean gap size at both 1 and 3 mm from the apex with a statistically significant difference compared to the other groups (p < 0.001).

Conclusion
Biodentine and MTA apical plugs provide a significantly better marginal adaptation to the dentinal walls than a single customized gutta percha cone with calcium silicate based sealer in simulated immature permanent teeth.
Trajectories of peripheral white blood cells count around the menopause: a prospective cohort study
Authors: Dai Qiaoyun , Zhang Yaya , Zhao Xiujuan , Yang Xueying , Sun Huayu , Wu Shouling , Chen Shuohua , Wang Jianmei , Cao Zongfu , Ma Xu 
Published: September 2024

Abstract
Background
Menopause significantly impacts the immune system. Postmenopausal women are more susceptible to infection. Nonetheless, the pattern of change in peripheral white blood cell counts around the menopause remains poorly understood.

Methods
We conducted a prospective longitudinal cohort study with repeated measurements using Kailuan cohort study of 3632 Chinese women who participated in the first checkup (2006–2007) and reached their final menstrual period (FMP) by the end of the seventh checkup (2018–2020). Peripheral WBC count indicators included total white blood cells (TWBC), neutrophils (NEUT), lymphocytes (LYM), and monocytes (MON). Multivariable mixed effects regressions fitted piece-wise linear models to repeated measures of WBC count indicators as a function of time before or after the final menstrual period (FMP). Interaction and subgroup analysis were used to explore the effects of age and body mass index (BMI) on changes in WBC indicators around FMP.

Results
WBC count indicators decreased before the FMP, and the reduction in TWBC, NEUT, and MON continued for 2 years following the FMP. LYM and NEUT declined during < -1 years and − 4 ∼ + 2 years relative to FMP, respectively. A reduction in MON was observed pre-FMP, extending continuously through the two-year period post-FMP. TWBC declined from − 3 to + 2 years relative to FMP, but both MON and TWBC increased during > + 2 years. The baseline age had an interaction effect on changes in WBC indicators during specific menopausal stages, except for TWBC. Individuals in different age subgroups showed distinct trajectories for NEUT, LYM and MON around the FMP. High baseline BMI had a synergistic effect on changes in specific menopause segments for TWBC, LYM, and MON. The impact of menopause on TWBC and LYM was postponed or counterbalanced in high BMI individuals. Individuals in three BMI subgroups experienced similar MON changes around FMP, and there were slight variations during < -4 years.

Conclusions
Menopause was associated with count changes of peripheral WBC. The trajectories of various WBC types differ around menopause. Age and BMI affected WBC trajectory around menopause. The menopause period may represent a window of opportunity to promote immune health in middle-aged women.
Too stressed to think? A scoping review of the literature for healthcare educators utilising high acuity clinical scenarios
Authors: Betson Jason , Fein Erich C. , Long David , Horrocks Peter 
Published: September 2024

Abstract
Background
The practise of paramedicine can be highly stressful particularly where urgent lifesaving decisions need to be made. Traditionally, educators have adopted the approach of placing students in simulated stressful situations as a way of learning to cope with these challenges. It is unclear from the literature whether traditional stress inoculation enhances or hinders learning. This scoping review aims to identify and examine both the peer-reviewed and grey literature reporting physiological stress responses to high-acuity scenarios in paramedicine and cognate healthcare disciplines.

Methods
Adhering strictly to JBI Evidence Synthesis Manual for conducting a scoping review, medical subject headings and areas, keywords and all other possible index terms were searched across EBSCOhost (Medline, CINAHL and APA PsycInfo), Scopus and, PubMed. English language articles both published (peer-reviewed academic papers, reports and conference proceedings) and unpublished (grey literature, Google Scholar reports) were included, and publications citing retrieved articles were also checked.

Results
Searches performed across five electronic databases identified 52 articles where abstracts indicated potential inclusion. From this, 22 articles which reported physiological or psychophysiological responses to stressful scenario-based education were included.

Conclusion
This review identified that an acceptable level of stress during simulation can be beneficial, however a point can be exceeded where stress becomes a hinderance to learning resulting in underperformance. By identifying strategies to moderate the impact of acute stress, educators of paramedic and other healthcare students can utilise high-acuity clinical scenarios to their andragogical armamentarium which has the potential to improve real-world clinical outcomes.
Putting patients first: when home-based care staff prioritise loyalty to patients above the system and themselves. An ethnographic study
Authors: Hertzberg Cecilie Knagenhjelm , Magelssen Morten , Heggestad Anne Kari Tolo 
Published: September 2024

Abstract
Background
The growing number of older people worldwide poses challenges for health policy, particularly in the Global North, where policymakers increasingly expect seniors to live and receive care at home. However, healthcare professionals, particularly in home-based care, face dilemmas between adhering to care ideals and meeting external demands. Although they strive to uphold ethical care standards, they must deal with patients’ needs, cooperation with colleagues and management guidelines. Home-based care is an essential part of healthcare services in Norway, but staff struggle with high patient numbers and time management. This article focuses on how staff deal with ethical challenges related to contextual and organisational constraints.

Methods
An ethnographic fieldwork in three municipalities in South-East Norway. The first author conducted three to four months of participant observation in each municipality. In addition, she conducted in-depth interviews with key informants in two municipalities and a focus group interview with seven home-based care workers in one municipality. The data was analysed by using a reflexive thematic analysis.

Results
Staff in home-based care are frequently more loyal to the patient than to the system and to their own needs. To provide good care, all informants disregarded the patient’s formal decision, i.e. they provided more care than the formalised decision stipulated. To prioritise beneficence to patients, informants also disregarded some of the rules applicable in home-based care. In addition, staff accepted risks to their own safety and health to provide care in the patient’s home.

Conclusion
The loyalty of home-based care staff to their patients can go beyond their loyalty to the rules of the system and even their own safety. This commitment might be attributed to a sense of doing meaningful work, to providing relationship-based and individualised care, and to strong moral courage. However, the staff’s emphasis on flexibility and individualised care also brings challenges related to unclear boundaries related to patient care.
Sparking nurses’ creativity: the roles of ambidextrous leadership and psychological safety
Authors: El-Gazar Heba Emad , Baghdadi Nadiah A. , Abdelaliem Sally Mohammed Farghaly , Zoromba Mohamed Ali 
Published: September 2024

Abstract
Background
The leadership practices of nurse managers significantly impact the creativity of staff nurses; however, the effects of ambidextrous leadership on nurses’ creativity are not yet clear. Additionally, the underlying mechanism of this relationship remains to be identified.

Aim
The study aimed to examine the effect of ambidextrous leadership on nurses’ creativity, directly and indirectly through psychological safety.

Methods
In this cross-sectional study, data were collected from October 2023 to January 2024 involving 241 nurses working at three hospitals in Port Said, Egypt. The Ambidextrous Leadership Scale, Psychological Safety Scale, and the Individual Creativity Scale were employed. Descriptive analysis, correlation analysis, and structural equation modeling were conducted.

Results
Nurse managers’ ambidextrous leadership was positively associated with nurses’ creativity. Psychological safety fully mediated the association between ambidextrous leadership and nurses’ creativity.

Conclusion
The study suggests that enhancing the ambidexterity of nurse leaders can foster a sense of psychological safety, which, in effect, contributes to increased creativity among nurses.

Implication for nursing policymaking
There is a need for healthcare policies and strategies that are supportive of the implementation of ambidextrous leadership practices and promote psychological safety among nurses.
Implementing peer support into practice in mental health services: a qualitative comparative case study
Authors: Gillard Steve , Foster Rhiannon , White Sarah , Bhattacharya Rahul , Binfield Paul , Eborall Rachel , Gibson Sarah L , Harnett Daniella , Simpson Alan , Lucock Mike , Marks Jacqueline , Repper Julie , Rinaldi Miles , Salla Anthony , Worner Jessica 
Published: September 2024

Abstract
Background
Peer workers are people with personal experience of mental distress, employed within mental health services to support others with similar experiences. Research has identified a range of factors that might facilitate or hinder the introduction of new peer worker roles into mental health services. While there is mixed evidence for the effectiveness of peer worker delivered interventions, there are no studies exploring how implementation might be associated with effect.

Methods
This was a qualitative comparative case study using data from interviews with 20 peer workers and their five supervisors. Peer workers delivered peer support for discharge from inpatient to community mental health care as part of a randomised controlled trial. In the trial, level of participant engagement with peer support was associated with better outcome (hospital readmission). Study sites with higher levels of engagement also had higher scores on a measure of fidelity to peer support principles. We compared data from sites with contrasting levels of engagement and fidelity using an analytical framework derived from implementation theory.

Results
In high engagement-high fidelity sites, there was regular work with clinical teams preparing for working alongside peer workers, and a positive relationship between staff on inpatient wards and peer workers. The supervisor role was well resourced, and delivery of peer support was highly consistent with the intervention manual. In low engagement-low fidelity sites peer workers were employed in not-for-profit organisations to support people using public mental health services and in rural areas. Supervisors faced constrained resources and experienced barriers to joint working between organisations. In these sites, peer workers could experience challenging relationships with ward staff. Issues of geography and capacity limited opportunities for supervision and team-building, impacting consistency of delivery.

Conclusions
This study provides clear indication that implementation can impact delivery of peer support, with implications for engagement and, potentially, outcomes of peer worker interventions. Resourcing issues can have knock-on effects on consistency of delivery, alongside challenges of access, authority and relationship with clinical teams, especially where peer workers were employed in not-for-profit organisations. Attention needs to be paid to the impact of geography on implementation.

Trial registration
ISRCTN registry number ISRCTN10043328, registered 28 November 2016.
Helicobacter pylori seropositivity associates with hyperglycemia, but not obesity, in Danish children and adolescents
Authors: Kløve Sigri , Stinson Sara E. , Romme Fie O. , Butt Julia , Graversen Katrine B. , Lund Morten A. V. , Fonvig Cilius E. , Waterboer Tim , Perez-Perez Guillermo I. , Hansen Torben , Holm Jens-Christian , Andersen Sandra B. 
Published: September 2024

Abstract
Background
Helicobacter pylori colonizes the human stomach and may affect the inflammatory response, hormone production related to energy regulation, and gastrointestinal microbiota composition. Previous studies have explored a potential association between H. pylori infection and pediatric obesity with varying results. Considering the immunomodulatory effects of early-life infection with H. pylori that can confer beneficial effects, we hypothesized that we would find an inverse relationship between H. pylori seropositivity and obesity among Danish children and adolescents.

Methods
We assessed H. pylori seroprevalence in 713 subjects from an obesity clinic cohort and 990 subjects from a population-based cohort, aged 6 to 19 years, and examined its association with obesity and other cardiometabolic risk factors.

Results
No association was found between H. pylori and body mass index standard deviation score (BMI SDS). H. pylori seropositivity was, however, significantly associated with higher fasting plasma glucose levels and the prevalence of hyperglycemia.

Conclusion
While we did not find an association between H. pylori seropositivity and BMI SDS, we observed a significant association with higher fasting plasma glucose levels and increased prevalence of hyperglycemia, suggesting that H. pylori infection may contribute to impaired glucose regulation in Danish children and adolescents.

Graphical abstract
Evaluation of comparative effect between aluminum hydroxide gel and montanide (ISA 70) in potency and protection of locally prepared rabbit hemorrhagic disease virus 2 (RHDV2) vaccines in rabbits
Authors: Ahmed Doha Abd Alrahman , Sadiek Yasmin , Eldin Mostafa Saif , Ibrahim Ragab S. , Amen Omar , Abodalal Samah El Sayed Ali 
Published: September 2024

Abstract
Background
Rabbit hemorrhagic disease (RHD) is an acute infectious disease that damages the rabbit industry by producing significant mortality rates in young and adult rabbits. RHD is better controlled by vaccination.

Objective
The current study's goal was to prepare and evaluate the immuno-enhancing effect of montanide ISA70 and aluminum hydroxide (Al(OH)3) gel incorporated within the inactivated RHDV2 vaccine and assess the vaccine's protective efficacy against the homologous and heterologous local RHDV2 strains in rabbits.

Methods
Inactivated RHDV vaccines were prepared using Montanide ISA70 oil or Al(OH)3 gel adjuvants and submitted to sterility, safety, and potency tests. 200 rabbits were equally divided into 4 groups: G1 (control), G2 (vaccinated with gel-incorporated vaccine), G3 (vaccinated with montanide-incorporated vaccine), and G4 (vaccinated with gel- and montanide-incorporated vaccines). Individual blood samples were collected from one week to six months from all groups. The vaccine's potency was measured by the HI test and protection percentage post challenge.

Results
Data revealed slightly increasing HI titer means reaching the 1st peak at 4 weeks post-vaccination (7.33, 7.67, and 7.33 log2 in the 2nd, 3rd, and 4th groups, respectively), then slightly decreasing and peaked again, giving 9.33 log2 for the2nd group at 3 months post-vaccination (MPV), 10.67 log2 for 3rd the group, and 10.33 log2 for the 4th group at 5 months post-vaccination. Titer gradually decreased but remained protective. The protection rate ranged from 80–100% and 80–90% for homologous and heterologous local RHDV2 vaccines, respectively, within 3 weeks and 6 months post-challenge. The montanide oil RHDV2 vaccine induced better protection than the aluminum gel RHDV2 vaccine.

Conclusion
The results demonstrated evidence of cross-protection between RHDV2 strains. The oil emulsion vaccine induced higher and longer-lasting antibody titers than those obtained with the RHDV2 aluminum gel vaccine.
Decreased plasma gelsolin fosters a fibrotic tumor microenvironment and promotes chemoradiotherapy resistance in esophageal squamous cell carcinoma
Authors: Hsieh Chih-Hsiung , Ho Pei-Shiuan , Wang Wen-Lun , Shih Fu-Hsuan , Hong Chen-Tai , Wang Pei-Wen , Shieh Dar-Bin , Chang Wei-Lun , Wang Yi-Ching 
Published: September 2024

Abstract
Background
Stromal fibrosis is highly associated with therapeutic resistance and poor survival in esophageal squamous cell carcinoma (ESCC) patients. Low expression of plasma gelsolin (pGSN), a serum abundant protein, has been found to correlate with inflammation and fibrosis. Here, we evaluated pGSN expression in patients with different stages of cancer and therapeutic responses, and delineated the molecular mechanisms involved to gain insight into therapeutic strategies for ESCC.

Methods
Circulating pGSN level in ESCC patients was determined by enzyme-linked immunosorbent assay analysis, and the tissue microarray of tumors was analyzed by immunohistochemistry staining. Cell-based studies were performed to investigate cancer behaviors and molecular mechanisms, and mouse models were used to examine the pGSN-induced tumor suppressive effects in vivo.

Results
Circulating pGSN expression is distinctively decreased during ESCC progression, and low pGSN expression correlates with poor therapeutic responses and poor survival. Methylation-specific PCR analysis confirmed that decreased pGSN expression is partly attributed to the hypermethylation of the GSN promoter, the gene encoding pGSN. Importantly, cell-based immunoprecipitation and protein stability assays demonstrated that pGSN competes with oncogenic tenascin-C (TNC) for the binding and degradation of integrin αvβ3, revealing that decreased pGSN expression leads to the promotion of oncogenic signaling transduction in cancer cells and fibroblasts. Furthermore, overexpression of pGSN caused the attenuation of TNC expression and inactivation of cancer-associated fibroblast (CAF), thereby leading to tumor growth inhibition in mice.

Conclusions
Our results demonstrated that GSN methylation causes decreased secretion of pGSN, leading to integrin dysregulation, oncogenic TNC activation, and CAF formation. These findings highlight the role of pGSN in therapeutic resistance and the fibrotic tumor microenvironment of ESCC.