bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementation strategies for decentralized management of multidrug-resistant tuberculosis: insights from community health systems in Zambia
Authors: Zulu Joseph Mumba , Maritim Patricia , Halwiindi Hikabasa , Chavula Malizgani Paul , Munakampe Margarate , Matenga Tulani Francis L. , Mweemba Chris , Sinyangwe Ntazana N. , Habib Batuli , Musukuma Mwiche , Silumbwe Adam , Wang Bo , Kaonga Patrick , Chewe Mwimba , Fisa Ronald , Banda Jeremiah , Mubanga Angel , Phiri Henry 
Published: September 2024

Abstract
Background
Decentralized management approaches for multi-drug-resistant tuberculosis (MDR TB) have shown improved treatment outcomes in patients. However, challenges remain in the delivery of decentralized MDR TB services. Further, implementation strategies for effectively delivering the services in community health systems (CHSs) in low-resource settings have not been fully described, as most strategies are known and effective in high-income settings. Our research aimed to delineate the specific implementation strategies employed in managing MDR TB in Zambia.

Methods
Our qualitative case study involved 112 in-depth interviews with a diverse group of participants, including healthcare workers, community health workers, patients, caregivers, and health managers in nine districts. We categorized implementation strategies using the Expert Recommendations for Implementing Change (ERIC) compilation and later grouped them into three CHS lenses: programmatic, relational, and collective action.

Results
The programmatic lens comprised four implementation strategies: (1) changing infrastructure through refurbishing and expanding health facilities to accommodate management of MDR TB, (2) adapting and tailoring clinical and diagnostic services to the context through implementing tailored strategies, (3) training and educating health providers through ongoing training, and (4) using evaluative and iterative strategies to review program performance, which involved development and organization of quality monitoring systems, as well as audits. Relational lens strategies were (1) providing interactive assistance through offering local technical assistance in clinical expert committees and (2) providing support to clinicians through developing health worker and community health worker outreach teams. Finally, the main collective action lens strategy was engaging consumers; the discrete strategies were increasing demand using community networks and events and involving patients and family members.

Conclusion
This study builds on the ERIC implementation strategies by stressing the need to fully consider interrelations or embeddedness of CHS strategies during implementation processes. For example, to work effectively, the programmatic lens strategies need to be supported by strategies that promote meaningful community engagement (the relational lens) and should be attuned to strategies that promote community mobilization (collective action lens).
In-Vitro evaluation of antidiabetic, antioxidant, and anti-inflammatory activities in Mucuna pruriens seed extract
Authors: Yadav Jagat Pal , Pathak Prateek , Yadav Seema , Singh Abhishek , Palei Narahari N. , Verma Amita 
Published: September 2024

Abstract
Background
Mucuna pruriens var. utilis (Wall. ex Wight) belonging to the family Fabaceae. Renowned for its diverse array of phytochemicals, this plant has been historically employed in the treatment of various ailments. The objectives of this study are to evaluate the anti-diabetic, anti-inflammatory, and antioxidant properties of the optimized M. pruriens var. utilis seed extract.

Methods
The in-vitro anti-inflammatory activity of M. pruriens var. utilis ethanolic extracts was scrutinized using the Human Red Blood Cell (HRBC) method. To evaluate antioxidant activity, ABTS and DPPH assays were employed. Furthermore, the antidiabetic activity was assessed through α-amylase and α-glucosidase inhibition assays.

Results
In the ethanolic extract of M. pruriens var. utilis numerous phytoconstituents were found by doing a phytochemical analysis (alkaloids, flavonoids, phenols, saponins, steroids, glycosides, tannins). The total phenolic and flavonoid content were determined to be 112.07 ± 1.21 mg of gallic acid equivalents GAE/g and 101.41 ± 1.08 mg of quercetin equivalents QE/g respectively. In this investigation ethanolic extract of M. pruriens var. utilis exhibited a high anti-inflammatory, antioxidant and antidiabetic activities in a dose-dependent manner. The M. pruriens var. utilis extract shows that anti-inflammatory activity 32.26 ± 3.23%, potent antioxidant effect by ABTS radical scavenging assay IC50 67.46 ± 1.45 µg/mL and DPPH radical scavenging assay IC50 63.34 ± 2.27 µg/mL and in addition, showed promising antidiabetic potential by inhibiting α-amylase IC50 33.42 ± 1.35 µg/mL and α-glucosidase IC50 28.34 ± 1.41 µg/mL.

Conclusion
These findings provide additional support for the traditional medicinal use of M. pruriens var. utilis in treating inflammation, oxidative stress, and diabetes mellitus.
Enhancing nurse competence in early recognition of cardiotoxicity
Authors: Kolbus Jeff , Adeola Mopelola T. , Tipton Janelle M. , Luebcke Caitlin E. D. 
Published: September 2024

Abstract
Background
Preliminary research reveals that many nurses feel inadequate and possess limited knowledge when it comes to managing cardiotoxicity, underscoring the necessity for educational programs to enhance nursing skills in this area.

Methods
The aim of the study was to assess the impact of an educational intervention on nurses perceived self-efficacy in recognizing patients exhibiting symptoms of cancer treatment-related cardiotoxicity. The study was set in a 16-bed cardiac critical care unit (CCU) within a 462-bed hospital. The sample group was comprised of registered nurses (RNs) working on or floating to the CCU. The study used a within-subjects design. Participants completed a pre-education survey, attended one of six 30-minute education interventions, and completed a post-education survey. The outcome variables were 7 self-confidence questions from the Nursing Self-Efficacy Scale for Managing Cancer Treatment-Related Cardiotoxicity (NSS-CTC) on a 5-point Likert scale and one yes or no self-efficacy question. Descriptive statistics and paired T-tests were applied to analyze pre- and post-education surveys.

Results
The pre-and post-education comparative analysis for each of the 7 NSS-CTC self-confidence questions was statistically significant with test statistics ranging from t = 3.43 to t = 8.69 and p-values ranging from 0.0021 to less than 0.0001. All 26 RNs answered “yes” in their ability to detect symptoms of cancer therapy-related cardiotoxicity after the education.

Conclusions
The lack of education for cardiac nurses against the backdrop of increasing cardiotoxicity in cancer patients showcases the essential need for cardiac nurse early symptom recognition education.
A rare differential diagnosis of aortic stenosis with a black aortic valve: A case report
Authors: Rangwala Zarin S. , Radhakrishnan Bineesh K. , Patel Pruthvi S. , Dash Prasanta K. , Gayathri G. , Pillai Vivek V. 
Published: September 2024

Abstract
Background
Cardiac ochronosis, presenting as a rare manifestation of alkaptonuria, an autosomal recessive disorder, is characterised by black pigmentation of calcified cardiac valves and atherosclerotic plaques. We report an intraoperative dilemma on the discovery on the black aortic valve in a case of an old lady with degenerative calcific aortic stenosis.

Case presentation
A 60-year-old lady was electively admitted for valve replacement with a bioprosthetic valve for severe aortic stenosis. She was symptomatic with complaints of headache and giddiness and had a pressure gradient of 113/17mmhg across the aortic valve. Intraoperatively, she was found to have cardiac ochronosis on the discovery of pigmented aortic intima extending to the valve leaflets and underwent valve replacement with a mechanical prosthetic valve. She was post-operatively evaluated for the same and diagnosed with alkaptonuria. Though the surgery went uneventful and the patient was discharged without any complication, she was advised to be on regular follow-up to assess valve gradients, paravalvular leaks and to monitor the disease progression.

Conclusion
The presented case sheds light on the rare cardiac manifestation of alkaptonuria. In the absence of definitive pre-operative diagnosis, intraoperative findings played a pivotal role in guiding the surgical approach and choice of prosthetic valve. The decision to use a mechanical valve was influenced by the potential risks associated with bioprosthetic valves in the setting of ochronosis. Ongoing follow-up and monitoring are essential to assess the durability of the chosen prosthetic valve and to manage any long-term consequences of the underlying metabolic condition.
Isolated diastolic hypertension and cardiovascular outcomes across different diagnostic guidelines: a systematic review and meta-analysis
Authors: Agarwal Abhimanyu , Mostafa Mohamed A. , Ahmad Muhammad Imtiaz , Soliman Elsayed Z. 
Published: September 2024

Abstract
Background
This systematic review aims to determine the impact of isolated diastolic hypertension (IDH) on cardiovascular outcomes.

Methods
We searched only English language articles on PubMed and SCOPUS until July 31, 2023 to investigate the association between IDH and cardiovascular outcomes.

Results
This meta-analysis of 19 studies evaluated the impact of different hypertension diagnostic guidelines (ACC/AHA: American Heart Association/American College of Cardiology; JNC7: Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; NICE/ESC: National Institute for Health and Care Excellence/European Society of Cardiology) on hypertension-related outcomes. Studies had varying sample sizes (173 to 2,969,679 participants) and study designs. In cohort studies using JNC7 guidelines, IDH was linked to increased cardiovascular disease (CVD) risk (HR: 1.45, 95% CI 1.17, 1.74), CVD mortality (HR: 1.54, 95% CI 1.23, 1.84), and coronary heart disease (CHD) risk (HR: 1.65). In studies using ACC/AHA guidelines, associations with CVD risk and CVD mortality were weaker [HR: 1.16 (95% CI 1.06, 1.25) and 1.10 (95% CI 0.95, 1.25), respectively]. Subgroup analysis revealed differences in outcomes on the basis of age and sex. Cross-sectional studies did not show significant associations with JNC7 and ACC guidelines; NICE guidelines were not used in cross-sectional studies.

Conclusion
IDH is associated with an increased risk of CVD. Higher diastolic blood pressure cutoffs were associated with higher cardiovascular risk. This association varied by study design and effect modification by sex and race influenced the association.
Exploring farmers attitudes towards genetically modified crops in northwest Bangladesh on the ground of epistemic emotions and cognitions
Authors: Iqbal Md. Hafiz 
Published: September 2024

Abstract
All GM crops fall into either the herbicide-tolerant (HT) or insect-resistant (IR) category. These crops play a crucial role in feeding the global population and ensuring food security for a larger number of population. However, the extent to which current assessments of supply-side effects inform food policy and cultivation decisions remains unclear. To advance knowledge in this area, it is essential to address existing evidence gaps and methodological design issues, which will influence the direction of future research. This study focuses on epistemological preferences among farmers in nortwest Bangladesh, aiming to modestly guide some direction for GM crops cultivation. The findings from the study reveal three distinct attitudinal discourses among investigated farmers. Some farmers are inclined to be positive toward the cultivation of GM crops, expecting benefits. Another group is more cautious, wary of the potential risks associated with GM crops but still likely to be reluctant adopters. A third group demonstrates a somewhat fatalistic perspective toward adopting GM crop cultivation, as revealed through the use of Q methodology. These findings contribute significantly to the ongoing GM debate by elaborating on the views of farmers from these three distinct groups and informing the design of policies related to GM crops.
The Effect of SGLT2 Inhibition on Brain-related Phenotypes and Aging: A Drug Target Mendelian Randomization Study
Authors: Chen Zhihe , Wu Xueyan , Yang Qianqian , Zhao Huiling , Ying Hui , Liu Haoyu , Wang Chaoyue , Zheng Ruizhi , Lin Hong , Wang Shuangyuan , Li Mian , Wang Tiange , Zhao Zhiyun , Xu Min , Chen Yuhong , Xu Yu , Lu Jieli , Ning Guang , Wang Weiqing , Luo Shan , Au Yeung Shiu Lun , Bi Yufang , Zheng Jie 
Published: September 2024

Abstract

Introduction
An observational study suggested sodium-glucose cotransporter 2 (SGLT2) inhibitors might promote healthy aging. However, whether brain-related phenotypes mediate this association is still a question. We applied Mendelian randomization (MR) to investigate the effect of SGLT2 inhibition on chronological age, biological age, and cognition and explore the mediation effects of brain imaging-derived phenotypes (IDPs).

Methods
We selected genetic variants associated with both expression levels of SLC5A2 (Genotype-Tissue Expression and eQTLGen data; n = 129 to 31 684) and hemoglobin A1c (HbA1c) levels (UK Biobank; n = 344 182) and used them to proxy the effect of SGLT2 inhibition. Aging-related outcomes, including parental longevity (n = 389 166) and epigenetic clocks (n = 34 710), and cognitive phenotypes, including cognitive function (n = 300 486) and intelligence (n = 269 867) were derived from genome-wide association studies. Two-step MR was conducted to explore the associations between SGLT2 inhibition, IDPs, and aging outcomes and cognition.

Results
SGLT2 inhibition was associated with longer father's attained age [years of life increase per SD (6.75 mmol/mol) reduction in HbA1c levels = 6.21, 95% confidence interval (CI) 1.27-11.15], better cognitive function (beta = .17, 95% CI 0.03-0.31), and higher intelligence (beta = .47, 95% CI 0.19-0.75). Two-step MR identified 2 IDPs as mediators linking SGLT2 inhibition with chronological age (total proportion of mediation = 22.6%), where 4 and 5 IDPs were mediators for SGLT2 inhibition on cognitive function and intelligence, respectively (total proportion of mediation = 61.6% and 68.6%, respectively).

Conclusion
Our study supported that SGLT2 inhibition increases father's attained age, cognitive function, and intelligence, which was mediated through brain images of different brain regions. Future studies are needed to investigate whether a similar effect could be observed for users of SGLT2 inhibitors.
Circadian Regulatory Networks of Glucose Homeostasis and Its Disruption as a Potential Cause of Undernutrition
Authors: Onuma Shinsuke , Kawai Masanobu 
Published: September 2024

Abstract
The circadian clock system, an evolutionarily conserved mechanism, orchestrates diurnal rhythms in biological activities such as behavior and metabolism, aligning them with the earth's 24-hour light/dark cycle. This synchronization enables organisms to anticipate and adapt to predictable environmental changes, including nutrient availability. However, modern lifestyles characterized by irregular eating and sleeping habits disrupt this synchrony, leading to metabolic disorders such as obesity and metabolic syndrome, evidenced by higher obesity rates among shift workers. Conversely, circadian disturbances are also associated with reduced nutrient absorption and an increased risk of malnutrition in populations such as the critically ill or the elderly. The precise mechanisms of these disturbances in leading to either overnutrition or undernutrition is complex and not yet fully understood. Glucose, a crucial energy source, is closely linked to obesity when consumed excessively and to weight loss when intake is reduced, which suggests that circadian regulation of glucose metabolism is a key factor connecting circadian disturbances with nutritional outcomes. In this review, we describe how the biological clock in various tissues regulates glucose metabolism, with a primary focus on studies utilizing animal models. Additionally, we highlight current clinical evidence supporting the association between circadian disturbance and glucose metabolism, arguing that such disruption could predominantly contribute to undernutrition due to impaired efficient utilization of nutrients.
Experience of caregivers and healthcare professionals using a telemedicine programme in a paediatric palliative care unit
Authors: Carrasco Ana Suárez , Cantero María José Peláez , Piñero Jose Miguel García , Rodriguez Aurora Madrid 
Published: September 2024

Background: Telemedicine is a means of providing efficient treatment for children with complex chronic conditions and/or subsidiary palliative paediatric care. Aim: To evaluate how satisfied families and healthcare professionals are with a telemedicine programme. Methodology: This is a qualitative study of narrative design. Ten interviews were conducted with family members and professionals who had been using telemedicine for a year. Sampling was intentional and a discourse and content analysis was conducted. Results: Six thematic categories emerged from the analysis of the interviews: degree of satisfaction; usefulness; benefits according to patient needs and attention; technical and human difficulties; and implantation of the system and proposals for improvement. Conclusions: The study shows that telemedicine is a very useful complementary tool for healthcare professionals in a palliative care context. It is necessary to take into account the perception and needs of both families and healthcare professionals with regard to this tool since it can improve patient care.
Iranian Muslim women's adaptation after mastectomy
Authors: Shamloo Marzieh Beigom Bigdeli , Elahi Nasrin , Shamsi Aziz 
Published: September 2024

Background: Breast cancer is the most common malignancy among women. Women with breast cancer need to adapt all aspects of their life following their diagnosis. Aim: To investigate how women with breast cancer make adaptations in their lives to cope with the condition. Methods: A directed content analysis was used for this study and 23 participants were interviewed. The participants included women undergoing a mastectomy and their husbands, oncologists, oncology ward nurses and psychologists. Questions were asked regarding the participants' experiences of their adaptation to a mastectomy and cancer. Results: Data analysis led to the emergence of four dimensions; the physical dimension, self-concept, role-playing and interdependence. These four dimensions consisted of 21 main categories, 59 subcategories and 111 codes. Conclusion: The present study showed that despite the emergence of different coping approaches, women undergoing mastectomy have had various physical and mental problems that lead to role disruption. It is recommended that solutions be adopted to increase the adaptation of these patients.
Mengenali Potensi Anak
Authors: Latipah Eva 
Published: September 2024

Pada dasarnya manusia memiiiki dua kemampuan besar yaitu kemampuan aktual dan kemampuan potensial. Kemampuan aktual merupakan kemampuan yang ada saat ini, kemampuan yang telah nampak. Ini dapat dilihat (sebagian) misalnya dari skor IQ, skor TOEFL, dan nilai akademik. Kemampuan potensiai merupakan kemampuan yang belum nampak, kemampuan yang memiliki kesempatan untuk berkembang; Oleh karenanya untuk mengembangkannya memerlukan stimulan-stimuian dari lingkungan (pendidikan, orang tua, guru, nutrisi), misalnya talenta. Artikel ini mencoba untuk mengidentifikasi beberapa potensi dan bagaimana cara untuk mengidentifikasinya. Untuk mengidenifikasi potensi diperlukan bagi para guru untuk memahami anak-anaknya yaitu dengan memahami pertumbuhan anak dan tugas-tugas perkembangan untuk setiap tahapannya. Cara untuk mengidetifikasi potensi anak dapat menggunakan dua hal yaitu dengan mengidentifikasi bakat anak dan mengetahui minatnya (kepribadian anak). Bakat anak dapat diidentifikasi dari kemampuan umum (inteligensi), kreativitas, dan motivasi.
Penanaman Sikap dan Nilai pada Pembelajaran IPS di Sekolah Dasar
Authors: Yuliati Ika Kurnia 
Published: September 2024

Tidak dapat dipungkiri bahwa dewasa ini terlihat gejala-gejala dan masalah sosial yang terus bergejolak, yang meresahkan kehidupan bermasyarakat, berbangsa dan bernegara, Di Indonesia, gejala tersebut diduga sebagai akibat dari penyimpangan terhadap cultural heritage (pewarisan kebudayaan), Ada beberapa tindakan dalam mengaktualisaikan pemilikan karakter dimensi-dimensi dari para pelaku sosial yaitu dmgan cara atau melaluiprosespendidikan maupun pengajaran. Penyimpangan perilaku sosial dapat terjadi salah satunya karena kita gagal menumbuh kembangkan penanaman nilai, baik di lingkungan keluarga, sekolah maupun masyarakat, Pada institusi pendidikan penanaman nilai dituangkan dalam pendidikan nilai yang dapat diintegrasikan pada setiap mata pelajaran di sekolah, termasuk dalam mata pelajaran Ilmu Pengetahuan Sosial yang materi ajarnya memang sarat akan nilai-nilai, Masa usia sekolah dasar merupakan masa-masa keemasan bagi setiap anak karena character building sedang dimulai dan dibentuk, Oleh karena itu masa ini merupakan saat yang tepat bagi kita untuk menanamkan pendidikan nilai karena akan lebih mudah bagi anak untuk menyerapnya, Diharapkan dengan penanaman nilai sejak usia dini, akan terbawa terus sampai masa dewasanya sehingga dapat mengembangkan perilaku yang terpuji dan menghindari penyimpangan-penyimpangan sosial
Active Learning untuk Mewujudkan Pembelajaran Efektif Runtut Prih Utami
Authors: Utami Runtut Prih 
Published: September 2024

Kualitas pendidikan merupakan salah satu aspek penting dari suatu bangsa, karena maju tidaknya suatu bangsa bisa dilihat dari kualitas pendidikannya. Kualitas pendidikan tidak terlepas dari kualitas pembelajaran dan kualitas tenaga pengajar/gurunya. Oleh sebab itu kedua aspek tersebut harus ditingkatkan. Pembelajaran yang berlangsung selama ini umumnya menggunakan metode pengajaran yang cenderung sama setiap kali pertemuan di kelas. Pembelajaran masih berpusat pada guru ini mengakibatkan siswa cenderung pasif dan pembelajaran tidak efektif. Kondisi pembelajaran yang tidak memperhatikan perbedaan peserta didik, teacher centered, monoton, tidak efektif dan jauh dari ketuntasan belajar pada saat ini membuktikan terjadinya kegagalan dalam proses pembelajaran di sekolah. Oleh sebab itu perlu inovasi pembelajaran yang merubah paradigma teacher centered menjadi student centered, dari mengajar (to teach/ instructor) menjadi memfasilitasi (to help student learn facilitator). Strategi pembelajaran yang ditawarkan adalah strategi belajar aktif (active learning strategy). Active learning memberikan kesempatan yang lebih banyak pada peserta didik untuk melakukan aktivitas belajar daripada sekedar menerima pelajaran yang diberikan. Agar pembelajaran lebih bermakna maka siswa harus terlibat aktif dalam pembelajaran untuk mengkonstruk pengetahuannya melalui pengalaman belajar yang dimilikinya. Dalam active learning ini guru bertindak sebagai fasilitator, oleh sebab itu guru harus profesional yang menguasai materi dan mampu berkomunikasi dengan baik, inovatif serta mampu mengelola kelas dengan baik. Implementasi active learning ini dapat meningkatkan kualitas pembelajaran secara khusus dan kualitas pendidikan secara umum.