bluuebunny/crossref_metadata_2025_split huggingface dataset:
3D-auxetic elastomeric cellular structures for impact protection
Authors: Blake Peter , El Hawary Omar , Myronidis Konstantinos , Pinto Fulvio , Fallon Chanel 
Published: September 2024

Lightweight protective armour solutions have potential applications ranging from infrastructure cladding and damage tolerant aerospace composites to sports helmets and body armour. Elastomeric cellular structures are a promising candidate solution and with advances in 3D-printing technology, ever more complex geometries can be explored in the pursuit of enhanced performance. Auxetic structures, which exhibit negative Poisson’s ratio behaviour and reported improved mechanical properties are of interest. Recently, 3D-auxetic structures have demonstrated the potential to outperform their 2D counterparts. This work investigates the performance of four candidate elastomeric cellular structures, 3D-printed in thermoplastic polyurethane (TPU): one non-auxetic, two 2D-auxetic and one 3D-auxetic. The structures are subjected to quasi-static compression, cyclic compression and low-velocity impact tests. Energy absorption diagrams, based on quasi-static compression data, are produced which demonstrate that the choice of most efficient energy absorbing structure depends on the specific energy of the threat. It is found that the 3D-auxetic re-entrant honeycomb structure outperforms all others for specific energies greater than 13.3 mJ/cm3. Cyclic compression tests demonstrate excellent recoverability, and thus reusability of all structures. Hysteresis is observed for all specimens, increasing with increasing maximum strain. Generally, the 3D-auxetic structure provides the greatest energy dissipation. The behaviour observed in the low-velocity impact tests appear consistent with the trends identified in the quasi-static tests. The 3D-auxetic structure is the best choice for absorbing high impact energies since it results in a lower stress being transferred when subject to an impact energy which causes densification. This work demonstrates the potential for 3D-auxetic elastomeric cellular structures to provide superior protective performance.
Sun protection knowledge and behaviors of agricultural workers in Turkey: a cross-sectional study
Authors: Asil Elif Uner , Dagli Ayşe , Aygun Ozcan 
Published: September 2024

Abstract
Background
Agricultural workers are at risk of developing skin cancer due to prolonged exposure to the sun during their daily work. This study was conducted to determine sun protection knowledge and behaviours of agricultural workers in Turkey.

Methods
The cross-sectional study was conducted with 460 participants working in agriculture. The data were collected using a sociodemographic form, Skin Cancer and Sun Knowledge Scale and Sun Protection Behaviour Scale. The data were analysed using One Way ANOVA and Independent Samples t Test.

Results
Participants mean total score on the Skin Cancer and Sun Knowledge Scale was 15.24 ± 2.47 (max-min 0–25) and the mean total score on the Sun Protection Behaviour Scale was 24.10 ± 4.46 (max-min 8–40). Statistically significant disparities were observed between the SCBS, SPBS and their sub-divisions along with the working period, age, marital status, gender, level of education, income status, skin type and agricultural working status of the participants (p < .05).

Conclusion
The study found that people working in the agriculture had inadequate sun protection behaviours and knowledge. Based on the study’s results, it is proposed to create intervention programmes that specifically target single, male, middle-aged or older individuals with extended working hours and low levels of education and income.
Social comparison feedback in online teacher training and its impact on asynchronous collaboration
Authors: Lu Yao , Ma Ning , Yan Wen-Yu 
Published: September 2024

AbstractIn the area of online teacher training, asynchronous collaboration faces several challenges such as limited learner engagement and low interaction quality, thereby hindering its overall effectiveness. Drawing on social comparison theory, providing social comparison feedback to teacher-learners in online asynchronous collaborative learning offers benefits, but also has drawbacks. While social comparison has been explored in diverse fields, its role in education remains unclear. In this study, we selected 95 primary and secondary school teachers participating in an online training course. Using randomized controlled trial design, we provided the experimental group with social comparison feedback, while the control group received only self-referential feedback. We used epistemic network analysis, lag sequential analysis, and social network analysis to identify the impact of social comparison feedback on group-regulated focus, group-interactive behaviors, and social network structures. The results showed that social comparison feedback significantly enhanced teachers’ online asynchronous collaborative learning.
Aphasia outcome: the role of diffusion tensor tractography in patients with acute ischemic stroke
Authors: Alloush Taha K. , Emara Tamer H. , Mahmoud Mostafa K. Ramadan , Abdulghani Khaled O. , Alloush Adel T. , El-Sudany Ayman H. 
Published: September 2024

Abstract
Backgrounds
Recovery for poststroke aphasia has a decelerating trajectory, with the greatest improvement is within weeks and the slope of change decreasing over time. Therefore, it is essential to predict the prognosis of aphasia at an early stage as it could provide useful data in specific plans for management strategies. The aim of this work was to assess the arcuate fasciculus in stroke patients with aphasia and its impact on predicting the outcome. A prospective study was performed including 25 patients with acute ischemic stroke and aphasia and 10 healthy control subjects with no history of neurologic or psychiatric disease. All patients underwent language assessment using an Arabic version of the Comprehensive Aphasia Test (Arabic CAT), with the resultant mean T-score aphasia quotient (AQ). Early assessment of stroke and delayed assessment at three months. All patients had diffusion-weighted magnetic resonance imaging (DWI-MRI) of the brain to localize the lesion and 3D diffusion tensor imaging (DTI) of the arcuate fasciculus (AF) within 30 days of stroke.

Results
Patients in whom the AF could not be reconstructed had a poor score in early and late AQ and a poor prognosis compared to those in whom the AF could be reconstructed. Preservation of the left AF on DTI could mean the potential recovery of aphasia after stroke.

Conclusion
The prognosis of aphasia in patients whose left AF could be reconstructed was better than those whose left AF could not be reconstructed, irrespective of the AF's integrity. That is why, we can assume that evaluation of the DTI of the left AF at early stages of stroke can help in predicting outcome of aphasia.
Influence of self-compassion on fatigue and psychological wellbeing among psychiatric nurses
Authors: Behilak Sahar , Abdullah Saleh , Ahmed Gellan K. , Saraya Ola Ali Abd El-Fatah Ali 
Published: September 2024

Abstract
Background
Psychiatric mental health nurses often work in highly demanding environments and situations and are exposed to multiple work-based stressors simultaneously. We aimed to explore the influence of self-compassion on fatigue and psychological wellbeing, and to evaluate the possible contributing factors for self-compassion, fatigue, and psychological wellbeing among psychiatric nurses. A descriptive correlational study using a convenience sample was used to employ 50 psychiatric nurses. Participants categorized into three groups based on their scores on The Self-Compassion Scale (SCS-SF): Group 1: low self-compassion, Group 2: moderate self-compassion, and Group 3: high self-compassion. All participants were assessed by socio-demographic data questionnaire, Fatigue Assessment Scale (FAS), and Psychological Wellbeing Scale.

Results
Regarding FAS and wellbeing, group 1 had the highest mean of both scores, whereas group 3 had the lowest mean of both scores. Psychiatric nurses with high self-compassion were significantly more likely to be male, have a lower overall fatigue score, and have better psychological wellbeing. Psychiatric nurses with high fatigue scores were more likely to be female, married, have diploma, have less self-compassion, and have poorer psychological wellbeing.

Conclusions
Psychiatry nurses with higher self-compassion had lower fatigue score and better psychological wellbeing. Gender and education level were significant factors for self-compassion and fatigue.
The burden of suicide across different altitudes: 11-year geodemographic analysis conducted in 221 cantons in Ecuador ranging from 0 to 4300 m of elevation
Authors: Ortiz-Prado Esteban , Izquierdo-Condoy Juan S. , Fernandez-Naranjo Raul , Vásconez-González Jorge , Encalada Sebastián , Mosquera Johanna , Cordovez Simone , Camino Nicole , Montenegro-Salazar Daniela , Viscor Ginés , Diaz Ana María , Paz Clara 
Published: September 2024

Background
The World Health Organization and the Global Burden of Disease study estimate that almost 800 000 people die from suicide yearly. The role of non-traditional risk factors such as climate and high-altitude exposure are poorly understood.

Aims
This study aims to determine a potential relationship between altitude exposure and suicide rates among 221 cantons located at different altitudes ranging from 0 to 4300 m.

Method
We conducted an 11-year, country-wide, population-based analysis on age- and gender-standardised suicide rates in Ecuador, based on the official data from the National Institute of Statistics, using all available self-harm death codes (ICD-10 codes X60–X84).

Results
A total of 11 280 cases of suicide were reported during 2011–2021. Suicide rates were higher among men (11.48/100 000). In terms of elevation, suicide rates were significantly higher among people from high-altitude cantons (3.7/100 000) versus those from low-altitude cantons. When applying the International Society Mountain Medicine categorisation, suicide rates were significantly higher at moderate- (4.3/100 000), high- (3.6/100 000) and very-high-altitude cantons (4.4/100 000) when compared with low-altitude locations (2.5/100 000).

Conclusions
Ecuador is one of the few countries that has a vast range of cantons located at different altitudes. We found that living at higher elevations is positively associated with greater suicide rates. Although the rates are significantly greater as elevation increases, a clear linear relationship is not apparent, likely because of the interplay of socioeconomic factors, including urbanicity. The effect of chronic hypobaric hypoxia on mood cannot be ruled out, although the existence of causal mechanisms remains to be elucidated.
The minimal important difference in obsessive-compulsive disorder: An analysis of double-blind SSRI trials in adults
Authors: Cohen Sem E. , Zantvoord Jasper B. , Mattila Taina K. , Storosum Bram W.C. , de Boer Anthonius , Denys Damiaan 
Published: September 2024

Abstract

Background
The change in symptoms necessary to be clinically relevant in obsessive-compulsive disorder (OCD) is currently unknown. In this study, we aimed to create an empirically validated threshold for clinical significance or minimal important difference (MID).

Methods
We analyzed individual participant data from short-term, double-blind, placebo-controlled registration trials of selective serotonin reuptake inhibitors in adult OCD patients. Data were collected from baseline to week 12. We used equipercentile linking to equate changes in the Clinical Global Impression (CGI) scale to changes in the Yale-Brown Obsessive-Compulsive Scale (YBOCS). We defined the MID as the YBOCS change linked to a CGI improvement of 3 (defined as “minimal improvement”).

Results
We included 7 trials with a total of 1216 patients. The CGI-scores and YBOCS were moderately to highly correlated. The MID corresponded to 4.9 YBOCS points (95% CI 4.4–5.4) for the full sample, or a 24% YBOCS-decrease compared to baseline. The MID varied with baseline severity, being lower in the group with mild symptoms and higher in the group with severe symptoms.

Conclusions
By linking the YBOCS to the CGI-I, this is the first study to propose an MID in OCD trials. Having a clearly defined MID can guide future clinical research and help interpretation of efficacy of existing interventions. Our results are clinician-based; however, there is further need for patient-reported outcomes as anchor to the YBOCS.
A qualitative review of adolescent childbirth experiences, its impact on development and the need for age-specific care
Authors: Füzy Elizabeth , Fouché Nicola , Clow Sheila Elizabeth 
Published: September 2024

Background/Aims Treatment and interventions for adolescent mothers during birth are often informed by research conducted with adult women. This approach does not consider the fact that adolescents are still in a developmental phase with age-specific needs and the consequent effect on their birth experiences. This review's aim was to explore the available literature in relation to the need for age-specific care for adolescents during birth. Methods An aggregated qualitative review was conducted using narrative synthesis with comprehensive searches of EBSCOhost, Scopus, JSTOR, Pubmed, Science Direct and Cochrane. Thematic analysis and a narrative synthesis were used to present the results based on the research objectives. Results A total of seven studies were included, published between 2002 and 2022. Eight elements of age-specific care for adolescent mothers were identified: be sensitive to her needs, manage her pain, treat her with respect, provide information, include her in decision making, guide her, have empathy for her needs and offer non-judgmental care. Conclusions There is a dearth of research on the experiences and needs of adolescent mothers during birth. Birth impacts developmental tasks for adolescents and age-specific care is vital for more positive birth experiences. Implications for practice More training and research are required to develop and implement a framework for age-specific care during pregnancy and birth.
Clinical and non-clinical team collaboration to develop breast referral triage to improve service delivery in secondary care
Authors: Halliday Suzanne , Townsend Sean , Beech Nicola , Greeno Kellie , Myers Ayrton , Cockell Heliose , Lowe Joanne 
Published: September 2024

Aims: This evaluation combines clinical and non-clinical collaborative breast referral triage to gain an understanding relating to the value of triage, by identifying ‘suspected cancer’ and ‘cancer not suspected’ populations, improve the patient pathway, and facilitate optimised resource availability. Method: An iterative service improvement method was used, with distinct phases of the process outlined to facilitate testing of ideas. The evaluation ran for 13 weeks in 2022. Regular team member meetings were arranged to discuss and agree improvement aims and outcomes. Findings: A triage flowchart was developed collaboratively, and subsequently adopted by the non-clinical booking team. Bespoke clinics were established, demonstrating no evidence of increased risk to patients, and meeting 28-day Faster Diagnosis Standard (FDS) requirements. Conclusion: breast referral triage of ‘suspected cancer’ and ‘cancer not suspected’ patients, using a clinical and non-clinical collaborative approach facilitates improved service visibility, prioritisation, management, and measurement. This also supports delivery of the 2019 NHS Long Term Plan to enhance earlier and faster cancer diagnosis by optimising access to diagnostic resources where required.
Virtual reality with artificial intelligence-led scenarios in nursing education: a project evaluation
Authors: Teixeira Luis , Mitchell Aby , Martinez Neus Carlos , Salim Behnam Jafari 
Published: September 2024

Aim: To provide insights into the optimal use of virtual reality (VR) in nursing education by evaluating pre-registration nursing students' experiences in conducting holistic patient assessments while interacting with artificial intelligence (AI)-led patients. Specifically, this project evaluation compares the use of two different VR scenarios, one employing a menu-based interface and another using AI voice-controlled technology. Methods: Eleven pre-registration adult nursing students from two UK universities were selected through purposeful sampling to participate in the two VR simulations. Data collection and analysis: This included qualitative insights gathered from three focus group sessions, audio-recorded and thematically analysed to classify and describe students' experiences. Findings: Four key themes emerged: technological literacy, VR as a learning tool, the road of learning, and transition to independence. Advantages across both methods of VR-AI interaction and their particular challenges were identified and described for each key theme. Conclusion: VR with AI-led patient technology in pre-registration nursing education positively contributes to the curriculum by exposing students to problem-based learning situations and use of a multiplicity of skills in a safe environment. Although both methods are relevant for developing proficiencies around holistic patient assessment, there are advantages and limitations to each. Students perceived the voice-controlled technology as more intuitive with a more natural method of communication, whereas the menu-based interaction gave students more structure and guidance.
Lymphatic embolization for early post-operative lymphatic leakage after radical cystectomy for bladder cancer
Authors: Shin Yoo Sub , Han Kichang , Lee Jongsoo , Han Hyun Ho , Jang Won Sik , Kim Gyoung Min , Heo Ji Eun 
Published: September 2024

Background and objective
Although radical cystectomy (RC) with pelvic lymph node dissection (PLND) is the standard treatment of muscle invasive bladder cancer, it may cause lymphatic leakage. Recent studies describe lymphatic embolization (LE) as an option to manage post-operative lymphatic leakage. Hence, this study evaluated the outcome of LE in patients receiving RC and analyzed factors associated with outcomes.

Methods
This was a retrospective analysis of patients who underwent LE after RC for bladder cancer between August 2017 and June 2023. The data was assessed for analysis at January 2024. The patients were divided into a clinical success group and a clinical failure group. Clinical failure was defined as the following: 1) those who required drainage catheter placement >7 days after LE, 2) those who needed re-intervention before catheter removal, and 3) those who experienced adverse events associated with LE. Logistic regression analysis was performed to identify the factors associated with outcomes of LE.

Key findings and limitations
We analyzed 45 patients who underwent LE after RC. Twenty-eight (62.2%) patients were identified as clinically successful. Four patients required re-embolization, but none required more than two sessions of intervention. Three patients experienced lymphatic complications after LE. In multivariable analysis, maximal daily drainage volume of >1,000 mL/day (odds ratio [OR] = 4.729, 95% confidence interval [CI]: 1.018–21.974, p = 0.047) and diabetes mellitus (DM) (OR = 4.571, 95% CI: 1.128–18.510, p = 0.033) were factors associated with LE outcome.

Conclusions and clinical implications
Our results suggest LE as a potentially effective procedure for controlling post-operative lymphatic leaks after RC, with few minor side effects. Patients exceeding a daily drainage of 1,000mL/day or with a medical history of DM have a higher risk for re-intervention and clinical failure after LE.
Demonstrating Agency in Uncertain Times
Authors: Mollet Amanda , Black Wayne , Shelton Leslie 
Published: September 2024

Purpose
The purpose of this study is to understand education Ph.D. candidates’ experiences while navigating pathways to faculty careers during the COVID-19 pandemic. This study presents the opportunity for learning about obtaining faculty positions during a particularly precarious time for the academic labor market.

Design/Methodology/Approach
This exploratory longitudinal qualitative study examined doctoral candidates’ career development during what they anticipated as their final year of doctoral study during the 2020-2021 academic year. Data includes 33 total interviews, representing three interviews each from 11 diverse doctoral students who all shared a common career goal of becoming full-time faculty. Data analysis was rooted in the grounded theory analysis technique of the constant comparative method and also holistic coding.

Findings
Guided by career development theory, we highlighted participants demonstrating agency despite limited control that encompassed participants’ career self-management. Participants demonstrated coping with uncertainty and creating spaces of joy.

Originality
This study fulfills an identified need to examine the experiences of graduating Ph.D. students in education as they navigated the academic job market seeking faculty positions during the COVID-19 pandemic. Learning about the ways students navigate barriers in the faculty search process has the potential for identifying strategies for success and support for students and their faculty mentors. Another main contribution of this study is working towards understanding the career pathways of today’s generation of doctoral students as they navigate the realities of faculty careers that have again changed markedly from the experiences studied in prior generations.
Evaluating Equity in Clinical Trial Accessibility: An Analysis of Demographic, Socioeconomic, and Educational Disparities in Irritable Bowel Syndrome Drug Trials
Authors: Kerbage Anthony , Loesch Jack , Hamza Eyad , Khan Sulman , Nero Neil , Simons Madison , Lembo Anthony 
Published: September 2024

INTRODUCTION:
Irritable bowel syndrome (IBS), a disorder of gut-brain interaction, imposes a significant economic burden because of its high prevalence and the chronic nature of its symptoms. IBS currently has 7 United States Food and Drug Administration–approved treatments. Despite efforts to improve diversity in randomized controlled trials' participation, significant disparities remain in various medical fields; yet, these have not been thoroughly examined within the context of IBS. We aimed to investigate the demographic, socioeconomic, educational, and geographic disparities in IBS drug trials.

METHODS:
We conducted a systematic review of phase 3 randomized controlled trials on United States Food and Drug Administration–approved drugs for the treatment of IBS with constipation and IBS with diarrhea in the United States. Data on participant demographics and trial site locations were extracted and analyzed to identify disparities.

RESULTS:
Our analysis included 17 studies encompassing 21 trials with 17,428 participants. Approximately 77.3% of participants were female, with a mean age of 45.4 years. Race was reported in 95% of the trials, but only 35% disclosed ethnicity. White participants constituted the majority at 79.3%. Hispanics accounted for only 5.9%. Counties without trial sites had smaller average population sizes compared with trial and trial-adjacent counties. Socioeconomic indicators such as poverty rates, median household income, educational attainment, and broadband internet access were lower in counties without trial sites, with higher average Area Deprivation Index scores indicating greater deprivation.

DISCUSSION:
The findings highlight significant disparities in IBS trial participation across race, ethnicity, gender, and socioeconomic backgrounds. This raises potential concerns about generalizability of trial outcomes and underscores the need for strategies to enhance inclusivity in clinical research.