bluuebunny/crossref_metadata_2025_split huggingface dataset:
Knowledge and willingness to donate kidney for transplantation among general population in Saudi Arabia
Authors: Alshehri Mohammed , Tawhari Ibrahim , Alqahtani Thekra S. , Alqahtani Alhanouf Y. , Al Jallal Marwah S. , Asiri Ghufran B. , Alshahrani Maymunah A. , Majrashi Maryam A. , Khuzayyim Ahmed A. , Albishri Fai D. , Alshahrani Wajan A. 
Published: August 2024

Abstract
Introduction
Kidney transplantation is the preferred treatment for end-stage renal disease (ESRD), offering a superior quality of life and extended survival compared to other renal replacement therapies. As the number of ESRD patients grows, so does the demand for organ transplants. The prevalence of ESRD is anticipated to escalate further due to the rising rates of diabetes mellitus (DM), hypertension (HTN), and obesity. Organ donation, particularly from living donors, remains the main source of transplants in the region, despite the notable underutilization of potential deceased donors’ organs. The objective of this research is to assess the level of knowledge, attitudes, and willingness to donate kidneys among the general population, a pivotal step in addressing the organ shortage crisis.

Methods
This cross-sectional study was conducted in the Aseer region of Saudi Arabia using a previously validated questionnaire. The questionnaire collected demographic data and insights into general attitudes, knowledge, and beliefs about organ donation. Logistic regression was used to identify predictors of knowledge and willingness to donate.

Results
The study involved 705 participants, predominantly young adults with a high level of education. Awareness of kidney donation was high, and knowledge about donation was broad, especially regarding religious permissibility and awareness of the donor registry. However, only 25% expressed willingness to donate their kidneys, and a 4% were already registered as donors. Furthermore, higher educational level was not associated with higher odds of knowledge or willingness to donate.

Conclusion
Despite the considerable awareness, actual donor registration rates were low, highlighting the necessity for targeted educational interventions and a deeper understanding of the cultural and socioeconomic barriers that exist.
Co-producing an intervention to prevent mental health problems in children and young people in contact with child welfare services
Authors: McGovern Ruth , Balogun-Katung Abisola , Artis Benjamin , Alderson Hayley , Brown Eric , Diggle Tim , Lingam Raghu , McArdle Paul , Rankin Judith , Thomason Paige , Kaner Eileen 
Published: August 2024

Abstract
Background
Children and young people (CYP) in contact with child welfare services are at high risk of developing mental health problems. There is a paucity of evidenced-based preventative interventions provided to this population.

Objective
This project worked in partnership with CYP, their parents/caregivers and the professionals who support them to co-produce a preventative mental health intervention for CYP in contact with child welfare services.

Participants and setting
We recruited a purposive sample of CYP in contact with child welfare services (n = 23), parents/caregivers (n = 18) and practitioners working within child welfare services and mental health services (n = 25) from the North East of England and convened co-production workshops (n = 4).

Methods
This project followed the established principles for intervention development, applying the six steps to quality intervention development (6SQUID) approach. The mixed method research consisted of four work packages with continuous engagement of stakeholders throughout the project. These were: a systematic review of reviews; focus groups with practitioners; interviews with parents/caregivers and CYP; co-production workshops.

Results
We identified that the primary risk factor affecting CYP in contact with child welfare services is the experience of childhood adversity. The quality of relationships that the CYP experiences with both their parent/caregivers and the professionals involved in their care are considered to be the main factors amenable to change.

Conclusions
We found that a trauma-informed, activity-based intervention with an embedded family-focused component provided to CYP who have experienced adversity is most likely to prevent mental health problems in those in contact with child welfare services.
Comparison of univariate and bivariate Poisson regression methods in the analysis of determinants of female schooling and fertility in Malawi
Authors: Mponda Eneles , Kaombe Tsirizani Mwalimu 
Published: August 2024

AbstractRecent research has established existence of a correlation between women’s education and fertility, suggesting that they share similar risk factors. However, in many studies, the two variables were analysed separately, which could bias the conclusions by undermining the apparent correlations of such paired outcomes. In this article, the univariate and bivariate Poisson regression models were applied to nationally representative sample of 24,562 women from the 2015-16 Malawi demographic and health survey to examine the risk factors of women’s education levels and fertility. The R software version 4.1.2 was used for the analyses. The results showed that estimates from the bivariate Poisson model were consistent with those obtained from the separate univariate Poisson models. The sizes of estimates of coefficients, their standard errors, p-values, and directions were comparable in both bivariate and univariate Poisson models. Using either the univariate or bivariate Poisson model, it was found that the age of a woman at first sexual experience, her current age, household wealth index, and contraceptive usage were significantly associated with both the woman’s schooling and fertility. The study further revealed that ethnicity, religion, and region of residence impacted education level only and not fertility. Similarly, marital status and occupation impacted fertility only and not education. The study also found that higher education levels were linked to a lower number of children, with a strong negative correlation of -0.62 between the two variables. The study recommends using bivariate Poisson regression for analysing paired count response data, when there is an apparent covariance between the outcome variables. The results suggest that efforts by policymakers to achieve the desired women’s sexual and reproductive health in sub-Saharan Africa should be intertwined with improving women’s and girls’ education attainment in the region.
The influence of care home registration type and size on senior care leader’s confidence to provide palliative and end-of-life care: an explanatory sequential mixed methods study
Authors: Tunnard India , Sleeman Katherine E. , Bradshaw Andy , Bone Anna E. , Evans Catherine J. 
Published: August 2024

Abstract
Background
Care home staff are key providers of palliative and end-of-life care. Yet, little is known about how care home characteristics can influence care leader’s confidence in their ability to provide optimal palliative and end-of-life care.

Aim
To understand the influence of care home registration type (nursing, residential or dual registered) and size on senior care leader’s confidence to provide palliative and end-of-life care.

Design
An explanatory sequential mixed methods study comprising an online cross-sectional survey (including the Palliative Care Self-Efficacy Scale) and qualitative individual interviews. Analysis of survey data used a multivariate logistic regression and qualitative interview data used Framework Analysis. A ‘Following the Thread’ method was undertaken for data integration.

Setting/participants
UK care home senior care leaders, purposively sampled by registration type, size and geographical location.

Results
The online survey (N = 107) results indicated that nursing home senior care leaders had higher confidence scores on the Palliative Care Self-Efficacy Scale than residential care home leaders (aOR: 3.85, 95% CI 1.20-12.31, p = 0.02). Care home size did not show effect when adjusting for registration type (medium - aOR 1.71, 95% CI 0.59–4.97, p = 0.33; large – aOR 0.65, 95% CI 0.18–2.30, p = 0.5). Interviews (n = 27) identified three themes that promote confidence, (1) ‘feelings of preparedness’ stemming from staff expertise and experience and care home infrastructure, (2) ‘partnership working’ with external services as a valued member of the multidisciplinary team, and (3) a shared language developed from end-of-life care guidance.

Conclusion
Care home senior care leader’s confidence is influenced by care home characteristics, particularly availability of on-site registered nurses and the infrastructure of large care homes. All care home leaders benefit from training, working with external, multidisciplinary teams and use of guidance. However, mechanisms to achieve this differed by care home type and size. Further exploration is needed on successful integration of palliative care services and interventions to enhance confidence in residential care homes.
An online training and feedback module enhances the musculoskeletal examination performance of medical interns
Authors: Arteaga Matías , Vidal Catalina , Ruz Cristián , Zilleruelo Raúl , Pino Ernesto , Dauvergne Javier , Besa Pablo , Irarrázaval Sebastián 
Published: August 2024

Abstract
Background
Pathologies of the locomotor system are frequent and can cause disability and impact the quality of life of the people affected. In recent years, online training and feedback have emerged as learning tools in many fields of medicine.

Objective
This study aims to evaluate medical interns’ musculoskeletal examination performance after completing an online training and feedback module.

Methods
This study employed a quasi-experimental design. Medical interns were invited to complete a 4-week musculoskeletal physical examination training and feedback module via an e-learning platform. The course included written and audiovisual content pertaining to medical history, physical examination, and specific tests for the diagnosis of the most common knee, spine, shoulder, ankle, and foot conditions. Before and after completing the module, their ability to perform the physical examination was evaluated using an objective structured clinical examination (OSCE) with simulated patients that took place face-to-face. A control group of experts was assessed using the OSCE, and their performance was compared to that of the interns before and after the training. At the end of the module feedback on the OSCE was provided to participants through the platform asynchronously and two evaluation questions about the user experience were conducted at the end of the study.

Results
A total of 35 subjects were assessed using the OSCE, including 29 interns and 6 experts. At the beginning of the training module, the group of interns obtained an average score of 50.6 ± 15.1. At the end of the module, 18 interns retook the OSCE, and their performance increased significantly to an average of 76.6 ± 12.8 (p < 0.01). Prior to the training, the experts performed significantly better than the interns (71.2 vs. 50.6; p = 0.01). After the interns received the training and feedback, there were no significant differences between the two groups (71.2 vs. 76.6; p = 0.43). Two evaluation questions were conducted at the end of the study, revealing that 93% of the participants affirm that the training module will be useful in their clinical practice, and 100% of the participants would recommend the training module to a colleague.

Conclusion
The online training and feedback module enhances the musculoskeletal examination performance of medical interns.
Implementing care-related services in care units - an interview study
Authors: Reichert Dorothea , Gummesson Karl , Wallin Lars , Dahlström Tobias 
Published: August 2024

Abstract
Background
The growing concern about a dwindling healthcare workforce, exacerbated by demographic changes, calls for innovative solutions. One viable approach involves implementing new professional roles and restructuring existing healthcare teams within hospital care units.

Objectives
To evaluate the implementation of an innovative task-shifting concept, care-related services (CRS), from the managers’ perspective in somatic care units across the hospitals in a region in Sweden.

Methods
The qualitative study was conducted in 2022, after the implementation of CRS. Individual interviews were conducted with 24 key stakeholders, including 14 care unit managers, six CRS managers, and four process managers. A qualitative content analysis was performed, utilizing the Consolidated Framework of Implementation Research (CFIR).

Results
The implementation of CRS involved collaboration between care unit managers, CRS managers, and project managers, alongside CRS staff, registered nurses (RNs), and licensed vocational nurses (LVNs). In particular, their roles encompassed defining boundaries, establishing routines, and managing personnel. Throughout the implementation process, challenges emerged, stemming from undefined goals, difficulties in recruiting qualified CRS staff, and issues associated with seamlessly integrating CRS into existing work routines. These challenges arose due to a constrained timeframe, widespread team apprehension, shortcomings in the training of CRS staff, unclear task allocation, and an increased workload for care unit managers. Factors associated with successful CRS implementation included effective cooperation among managers and an open-minded approach.

Conclusions
Our findings highlight the crucial role of clear communication, effective recruitment, integration of CRS staff, clarification of roles, responsibilities, and defined goals for successful CRS implementation.
Machine learning enabled classification of lung cancer cell lines co-cultured with fibroblasts with lightweight convolutional neural network for initial diagnosis
Authors: Germain Adam , Sabol Alex , Chavali Anjani , Fitzwilliams Giles , Cooper Alexa , Khuon Sandra , Green Bailey , Kong Calvin , Minna John , Kim Young-Tae 
Published: August 2024

Abstract
Background
Identification of lung cancer subtypes is critical for successful treatment in patients, especially those in advanced stages. Many advanced and personal treatments require knowledge of specific mutations, as well as up- and down-regulations of genes, for effective targeting of the cancer cells. While many studies focus on individual cell structures and delve deeper into gene sequencing, the present study proposes a machine learning method for lung cancer classification based on low-magnification cancer outgrowth patterns in a 2D co-culture environment.

Methods
Using a magnetic well plate holder, circular pattern lung cancer cell clusters were generated among fibroblasts, and daily images were captured to monitor cancer outgrowth over a 9-day period. These outgrowth images were then augmented and used to train a convolutional neural network (CNN) model based on the lightweight TinyVGG architecture. The model was trained with pairs of classes representing three subtypes of NSCLC: A549 (adenocarcinoma), H520 (squamous cell carcinoma), and H460 (large cell carcinoma). The objective was to assess whether this lightweight machine learning model could accurately classify the three lung cancer cell lines at different stages of cancer outgrowth. Additionally, cancer outgrowth images of two patient-derived lung cancer cells, one with the KRAS oncogene and the other with the EGFR oncogene, were captured and classified using the CNN model. This demonstration aimed to investigate the translational potential of machine learning-enabled lung cancer classification.

Results
The lightweight CNN model achieved over 93% classification accuracy at 1 day of outgrowth among A549, H460, and H520, and reached 100% classification accuracy at 7 days of outgrowth. Additionally, the model achieved 100% classification accuracy at 4 days for patient-derived lung cancer cells. Although these cells are classified as Adenocarcinoma, their outgrowth patterns vary depending on their oncogene expressions (KRAS or EGFR).

Conclusions
These results demonstrate that the lightweight CNN architecture, operating locally on a laptop without network or cloud connectivity, can effectively create a machine learning-enabled model capable of accurately classifying lung cancer cell subtypes, including those derived from patients, based upon their outgrowth patterns in the presence of surrounding fibroblasts. This advancement underscores the potential of machine learning to enhance early lung cancer subtyping, offering promising avenues for improving treatment outcomes in advanced stage-patients.
Fluctuations in serum lipid levels during neoadjuvant treatment as novel predictive and prognostic biomarkers for locally advanced breast cancer: a retrospective analysis based on a prospective cohort
Authors: Chen Xinru , Zhao Yingying , Wang Yaohui , Ye Yumei , Xu Shuguang , Zhou Liheng , Lin Yanping , Lu Jingsong , Yin Wenjin 
Published: August 2024

AbstractBackgroundWith increasing attention given to host-specific lipid metabolism status, it is of urgent need to identify lipid metabolism indices with predictive or prognostic value in locally advanced breast cancer patients treated with neoadjuvant chemotherapy (NAC), and to evaluate the performance improvement by incorporating them into the existing Neo-Bioscore staging system.MethodsPatients from a prospectively maintained database of locally advanced breast cancer patients who received radical surgery after NAC between January 2014 to December 2020 were enrolled in this study. The enrolled patients were randomly divided into a training set and a test set at a ratio of 6:4. The random forest algorithm was applied to rank the importance of prognostic factors, top-ranked lipid metabolism indices of which were then incorporated into Neo-Bioscore to construct an updated prognostic model. The performances of these two models were compared in both training set and test set from multiple perspectives. Study outcomes included disease-free survival (DFS), relapse-free survival (RFS), distance-recurrence-free survival (DRFS), locoregional-recurrence-free survival (LRFS) and overall survival (OS).ResultsA total of 200 eligible patients were included in this study. After a median follow-up of 4.73 years, it was demonstrated that the relative increase in total cholesterol (TC; DFS: HR = 4.782, 95%CI 1.410 ~ 16.217,P = 0.012) and low-density lipoprotein (LDL; DFS: HR = 4.622, 95%CI 1.517 ~ 14.088,P = 0.007) during NAC led to poorer survival outcomes. Patients with either a higher body mass index (BMI) or elevated LDL during NAC had a worse prognosis (DFS: HR = 6.351, 95%CI 1.938 ~ 20.809,P = 0.002; OS, HR = 6.919, 95%CI 1.296 ~ 36.932,P = 0.024). Incorporating BMI and LDL fluctuations during NAC into Neo-Bioscore improved the prognostic stratification, especially in terms of LRFS (P = 0.046 vs.P = 0.65) and OS (P = 0.013 vs.P = 0.61). Multidimensional evaluation confirmed the improvement in model fit and clinical use for the updated model in both training set and test set.ConclusionsThis is the first study to illustrate the relative elevation of LDL and TC levels during NAC as independent prognosticators for locally advanced breast cancer. This is also the first attempt to incorporate lipid metabolism indices into the original Neo-Bioscore staging system, which further improves the prognostic stratification of patients receiving NAC.
Patterns of health workforce turnover and retention in Aboriginal Community Controlled Health Services in remote communities of the Northern Territory and Western Australia, 2017–2019
Authors: Veginadu Prabhakar , Russell Deborah J. , Zhao Yuejen , Guthridge Steven , Ramjan Mark , Jones Michael P. , Mathew Supriya , Fitts Michelle S. , Murakami-Gold Lorna , Campbell Narelle , Tangey Annie , Boffa John , Rossingh Bronwyn , Schultz Rosalie , Humphreys John , Wakerman John 
Published: August 2024

Abstract
Background
Aboriginal Community Controlled Health Services (ACCHSs) in Australia aim to optimise access to comprehensive and culturally safe primary health care (PHC) for Aboriginal populations. Central to quality service provision is the retention of staff. However, there is lack of published research reporting patterns of staff turnover and retention specific to ACCHSs. This study quantified staff turnover and retention in regional and remote ACCHSs in the Northern Territory (NT) and Western Australia (WA), and examined correlations between turnover and retention metrics, and ACCHSs’ geographical and demographic characteristics.

Methods
The study used 2017–2019 payroll data for health workers in 22 regional and remote PHC clinics managed by 11 ACCHSs. Primary outcome measures included annual turnover and 12-month stability rates, calculated at both clinic and organisation levels.

Results
There was a median of five client-facing (Aboriginal health practitioners, allied health professionals, doctors, nurses/midwives, and ‘other health workers’ combined) and two non-client-facing (administrative and physical) staff per remote clinic, at any timepoint. Mean annual turnover rates for staff were very high, with 151% turnover rates at the clinic level and 81% turnover rates at the organisation level. Mean annual turnover rates for client-facing staff were 164% and 75%, compared to 120% and 98% for non-client-facing staff, at clinic and organisational levels, respectively. Mean 12-month stability rates were low, with clinic-level stability rates of only 49% and organisation-level stability rates of 58%. Mean annual clinic-level turnover rates were 162% for non-Aboriginal staff and 81% for Aboriginal staff. Both workforce metrics were moderately to highly correlated with the relative remoteness of clinics, size of regular clients serviced, and average annual headcount of employees in each clinic (p values < 0.01).

Conclusions
Participating ACCHSs in remote NT and WA have very high turnover and low retention of healthcare staff. Overall, clinic-level turnover rates increase as distance from regional centres increases and are lower for Aboriginal staff, suggesting that greater employment of Aboriginal staff could help stabilise staffing. Improved retention could reduce burden on ACCHSs’ resources and may also support quality of service delivery due to improved cultural safety and continuity of care.
Facilitating co-research: lessons learned from reflection forms within three participatory action research projects
Authors: Emke Helga , Vandendriessche Ann , Chinapaw Mai , Deforche Benedicte , Verloigne Maïté , Altenburg Teatske , Anselma Manou 
Published: August 2024

Abstract
Background
Mutual learning and shared decision-making are key elements of Participatory Action Research (PAR), highlighting the important role of the facilitator to support this. This study aims to illustrate how a facilitator can contribute to successful PAR sessions based on the reflection of three PAR projects.

Methods
Participatory sessions took place with adolescents for 3–4 school years. After each session (n = 252 sessions across three projects), facilitators filled in a reflection form that assessed the group process and their facilitating role. Facilitators independently coded a selection of 135 reflection forms partly deductive and partly inductive based on core PAR principles derived from a pragmatic literature search.

Results
A well-prepared session – for example, including active and creative participatory methods and a clearly stated goal – contributed to efficiency and the necessary flexibility. Making agreements, making sure everyone is heard and taking 'fun-time' appeared important for creating and maintaining a safe, functional and positive atmosphere. Finally, facilitators needed to encourage co-researchers to take the lead and adapt to the group dynamics, to ensure ownership and shared decision-making.

Conclusion
In-depth qualitative analyses of a standardized reflection form used in three different PAR projects resulted in various lessons to support facilitators in collaborating with co-researchers in PAR projects.