bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effectiveness of the WHO school mental health package in promoting mental health literacy among secondary school teachers in Qatar: a randomized controlled trial
Authors: Elyamani Rowaida , Nour Omer , Singh Rajvir , Saeed Khalid , Musa Afrah , Alkubaisi Noora , Bougmiza Mohammed Iheb 
Published: July 2024

AbstractTeachers’ mental health literacy (MHL) is fundamental for recognizing and assisting students with mental disorders. The aim of this study was to assess the effectiveness of the World Health Organization School Mental Health Program (WHO-SMHP) in promoting MHL among secondary schools’ teachers in Qatar. We conducted a two-arm randomized control trial. Teachers working in governmental secondary schools were eligible for selection. A total of 16 schools (8 intervention, 8 control) randomly selected and stratified by gender then randomly assigned (1:1). Participants and study team were aware of group assignment. Assessment of teachers’ MHL was at day 0, 3 then 3 months afterward. Bivariat analysis and Generalized Estimating Equations were used in analysis. The primary outcome was teachers MHL. Secondary outcome was the influence of sociodemographic characteristics on the level of MHL. Between October 30, 2018 and March 21, 2019, we randomly assigned 195 teachers from 16 schools to attend training workshop on WHO-SMHP (n = 95) or usual practice (n = 100). Compared with controls, teachers from intervention group demonstrated a significant improvement in the level of MHL at day three (mean difference = 19.1, 95% CI = 17.0–21.2, Cohen’s d = 2.63; p < 0.001).) and after three months (mean difference 16.61, 95% CI = 13.96–19.26, Cohen’s d = 1.86; p < 001). There were no significant differences related to influence of other variables on MHL. To our knowledge, this is the first trial to prove the effectiveness of the (WHO-SMHP) in promoting teachers MHL, which can be successfully implemented in a wider scale.
From traditional to transactional: exploration of khat use in Ethiopia through an interpretative phenomenological analysis
Authors: Wood Elizabeth A. , Case Stuart J. , Collins Sarah L. , Stark Heather , Wilfong Tara 
Published: July 2024

AbstractKhat, a naturally growing stimulant, has seen a significant increase in both consumption and cultivation in eastern Ethiopia. This reliance on khat in the region comes despite its known physiological complications, with users unable to restrict khat use due to its pervasive impact on their livelihood. This qualitative study sought to understand the meaning that those in eastern Ethiopia attribute to khat and explore their firsthand experiences with the substance. In June and July of 2023, six unstructured interviews were conducted among residents of the Haramaya District in Ethiopia. To promote a holistic comprehension of the participants’ lived experiences, an interpretative phenomenological analysis approach was employed when collecting and analyzing the data. Participant responses were coded independently from one another by two different researchers identifying superordinate and corresponding subordinate themes. Among the participants, six superordinate themes were captured: economic backbone of the region, market disruption & fluctuation, pesticide use, societal relationships around khat, applications of khat, and access to healthcare. The participants’ responses indicated that the normalization of khat use, coupled with the downplaying of its addictive potential, has established a framework where khat consumption is not only allowed but, in some cases, even encouraged. The unique interplay between communal practice and individual preservation creates a cyclical effect of using khat to supplement energy to farm khat and then sell or stimulate further work on their farm. This study illuminates the transitionfrom what was once the traditional or spiritual use of khat, to a more practical use for ensuring economic livelihood.
“A life-changing experience and the beginning of a lifelong commitment”: experiences and impact of Global Health Community Service-Learning in undergraduate dental curriculum in Canada
Authors: Jessani Abbas , Athanasakos Alexia , Kachwinya Samantha 
Published: July 2024

Abstract
Background
Global Health Community Service-Learning (GHCSL) can have a profound professional and personal impact on learners. This pedagogy provides understanding of unfamiliar environments and challenges learners to step out of their comfort zones, adapt to new cultures, and navigate unique situations. Yet, there are relatively few studies exploring the experiences of learners participating in community service-learning placements in global regions as part of undergraduate dental curriculum. This study aimed to explore the experiences and impact of the GHCSL program in East Africa among undergraduate dental learners at the Schulich School of Dentistry.

Methods
Eight undergraduate dental learners were enrolled in GHCSL pilot placements. Placement agreements were established with Makerere University in Kampala, Uganda, and the University of Rwanda in Kigali, Rwanda for the summer of 2022. Stakeholders from both institutions were engaged in the development and implementation of these placements. Learners were required to engage in weekly reflection through a ‘storytelling and incident-based narrative’ while carrying out their placement. A qualitative study design was employed, and an inductive interpretive approach was utilized to thematically analyze the learners’ reflective essays.

Results
Five major themes emerged from the learners’ reflective essays: (1) experiential clinical learning; (2) cultural humility and social awareness; (3) awareness of contrasting healthcare systems; (4) commitment to service; and (5) personal and professional growth. Most learners reflected on their engagement with diverse communities, being exposed to unique patient cases, and witnessing the adaptability exuded in resource-constrained environments. These experiences presented the learners with an opportunity to develop cultural humility and gain a newfound motivation to mitigate global oral health disparities in populations beyond that of their local communities. Learners also reflected on enhanced social awareness experiences and the awareness of contrasting healthcare systems in Canada and their placements, which encouraged the development of empathy, communication, and compassion skills, as well as an understanding of the disproportionate burden of conditions in low-resource settings.

Conclusion
The reflective essays concluded that the GHCSL placements had a positive impact on the learners, encouraging many to develop a heightened desire for lifelong learning to address oral health disparities within a global context.
Based case based learning and flipped classroom as a means to improve international students’ active learning and critical thinking ability
Authors: Yang Wanjing , Zhang Xiaoyan , Chen Xinhuan , Lu Jing , Tian Fang 
Published: July 2024

Abstract
Background
International student education has become an important part of higher education and an important symbol to measure the level of higher education. To change the traditional teaching model, here we introduced a combination of Case-Based Learning (CBL)and Flipped Classroom (FC) into the pathophysiology course for international students. This study aimed to explore whether the active learning ability and critical thinking ability of international students can be improved, based on this new teaching model, improving the innovation ability of teachers’ team and students’ attitude to the reform.

Methods
The two chapters of Cardiac Insufficiency and Apoptosis in Pathophysiology are designed as a CBL + FC teaching method. Distribute the Self-assessment Scale on Active Learning and Critical Thinking (SSACT) and satisfaction questionnaire to international students to evaluate teaching reform based on CBL + FC.

Results
Compared with the traditional classroom, the online flipped classroom based on CBL has significantly improved the learning enthusiasm, as these students are required to independently complete literature review, actively participate in classroom teaching, learn to use multiple learning strategies, and collaborate with other students to complete PowerPoint (PPT)production. At the same time, the students’ ability to raise problems and solve problems has been greatly improved by analyzing clinical cases; By consulting the literature, the theoretical knowledge learned can be better applied to clinical analysis. The results of the satisfaction survey also show that international students are more likely to accept the flipped classroom teaching mode.

Conclusions
This teaching mode will stimulate the learning motivation of international students, enhance teaching attraction and increase teaching interaction; At the same time, the CBL + FC teaching method can strengthen the evaluation of international students’ in and out of class and online learning, enhance students’ active learning ability and critical thinking ability, promote the development of personalized learning, and integrate with international medical education.
Psychometric testing of the training needs for advance care planning scale for clinicians and nurses
Authors: He Chunju , Dong Tiaoxia , Tan Jin , Yang Liu , Qiu Yeyin , Zhang Jianghui , Huang Yi , Zhou Aiting , Wang Xianlin , Huang Yuan , Zhu Minglan , LAM Simon Ching , Deng Renli 
Published: July 2024

Abstract
Background
Studies have shown that Chinese Clinicians and nurses have positive attitudes toward ACP, but no local tools exist to assess their need for ACP knowledge and skills training. resulting in their inability to initiate ACP conversations as well as poor end-of-life care for patients. Therefore, this study aims to assess the needs of Chinese Clinicians and nurses for ACP knowledge and skills training and assess the validity and reliability of a questionnaire on the Training Needs for Advance Care Planning (TNACP) scale.

Methods
From October to November 2021, 170 clinicians and nurses were pre-surveyed using a preliminary draft of the questionnaire. The responses were screened using item analysis, Cronbach’s alpha coefficient, and the intraclass correlation coefficient (ICC) to describe the internal consistency and stability of the questionnaire. The Content validity index (CVI), Exploratory factor analysis (EFA) and Confirmatory factor analysis (CFA) were used to test the validity of the questionnaire.

Results
After independent samples t-test analysis, Except for the entry “A2”, the critical ratio between the two groups of the remaining 23 items was statistically significant (p < 0.05). Based on the above screening methods, the “A2” item was deleted, and the final number of questionnaire items was 23. The I-CVI was 0.79–1.00, and the S-CVI/Ave was 0.90. Three common factors were extracted—the cumulative contribution rate was 69.969%, and the factor loading of all items was 0.506–0.843 (all > 0.40). The results of confirmatory factor analysis showed that the Training Needs for Advance Care Planning (TNACP) scale model fit well(X2/df = 2.504, RMSEA = 0.092, GFI = 0.809, AGFI = 0.745, CFI = 0.931, IFI = 0.932, TLI = 0.916); the Cronbach’s α = 0.888 for the total questionnaire, and the three dimensions of Cronbach’s α were 0.729 to 0.959; and the ICC for the overall scores between the test-retest evaluations was 0.884 (p < 0.001).

Conclusions
The TNACP scale has good reliability and validity and can be used to assess Chinese Clinicians and nurses’ training needs for implementing ACP.
Preliminary investigation of potential links between pigmentation variants and opioid analgesic effectiveness in horses during cerebrospinal fluid centesis
Authors: Bacon Elouise K. , Donnelly Callum G. , Bellone Rebecca R. , Haase Bianca , Finno Carrie J. , Velie Brandon D. 
Published: July 2024

Abstract

Background
The pleiotropic effects of the melanocortin system show promise in overcoming limitations associated with large variations in opioid analgesic effectiveness observed in equine practice. Of particular interest is variation in the melanocortin-1-receptor (MC1R) gene, which dictates pigment type expression through its epistatic interaction with the agouti signalling protein (ASIP) gene. MC1R has previously been implicated in opioid efficacy in other species; however, this relationship is yet to be explored in horses. In this study, analgesic effectiveness was scored (1-3) based on noted response to dura penetration during the performance of cerebrospinal fluid centisis after sedation and tested for association with known genetic regions responsible for pigmentation variation in horses.

Results
The chestnut phenotype was statistically significant (P < 0.05) in lowering analgesic effectiveness when compared to the bay base coat colour. The 11bp indel in ASIP known to cause the black base coat colour was not significant (P>0.05); however, six single nucleotide polymorphisms (SNPs) within the genomic region encoding the ASIP gene and one within MC1R were identified as being nominally significant (P<0.05) in association with opioid analgesic effectiveness. This included the location of the known e MC1R variant resulting in the chestnut coat colour.

Conclusions
The current study provides promising evidence for important links between pigmentation genes and opioid effectiveness in horses. The application of an easily identifiable phenotype indicating variable sensitivity presents a promising opportunity for accessible precision medicine in the use of analgesics and warrants further investigation.
Combination of graduated compression stockings and intermittent pneumatic compression is better in preventing deep venous thrombosis than graduated compression stockings alone for patients following gynecological surgery: a meta-analysis
Authors: Lu Limei , Shen Ya , Pan Yuping 
Published: July 2024

Abstract
Background
Deep vein thrombosis (DVT) is common in patients undergoing gynecological surgery. We aimed to investigate the preventive efficacy in DVT of graduated compression stockings (GCS) alone and in combination with intermittent pneumatic compression (GCS + IPC) after gynecological surgery.

Methods
In November 2022, studies on the use of GCS and GCS + IPC for the prevention of DVT after gynecological surgery were searched in seven databases. After literature screening and data extraction based on specific inclusion and exclusion criteria, preventive efficacies, including the risk of DVT and anticoagulation function, of GCS and GCS + IPC were compared. Finally, sensitivity analysis and Egger’s test were performed to evaluate the stability of the meta-analysis.

Results
Six publications with moderate quality were included in this meta-analysis. The results showed that GCS + IPC significantly reduced DVT risk (P = 0.0002) and D-dimer levels (P = 0.0005) compared with GCS alone. Sensitivity analysis and Egger’s test showed that the combined results of this study were stable and reliable.

Conclusions
Compared with GCS alone, GCS + IPS showed a higher preventive efficacy against DVT in patients following gynecological surgery.
Re-establishing immune tolerance in multiple sclerosis: focusing on novel mechanisms of mesenchymal stem cell regulation of Th17/Treg balance
Authors: Hu Huiru , Li Hui , Li Ruoyu , Liu Peidong , Liu Hongbo 
Published: July 2024

AbstractThe T-helper 17 (Th17) cell and regulatory T cell (Treg) axis plays a crucial role in the development of multiple sclerosis (MS), which is regarded as an immune imbalance between pro-inflammatory cytokines and the maintenance of immune tolerance. Mesenchymal stem cell (MSC)-mediated therapies have received increasing attention in MS research. In MS and its animal model experimental autoimmune encephalomyelitis, MSC injection was shown to alter the differentiation of CD4+T cells. This alteration occurred by inducing anergy and reduction in the number of Th17 cells, stimulating the polarization of antigen-specific Treg to reverse the imbalance of the Th17/Treg axis, reducing the inflammatory cascade response and demyelination, and restoring an overall state of immune tolerance. In this review, we summarize the mechanisms by which MSCs regulate the balance between Th17 cells and Tregs, including extracellular vesicles, mitochondrial transfer, metabolic reprogramming, and autophagy. We aimed to identify new targets for MS treatment using cellular therapy by analyzing MSC-mediated Th17-to-Treg polarization.
Graphical Abstract
Circadian rhythm disruption upregulating Per1 in mandibular condylar chondrocytes mediating temporomandibular joint osteoarthritis via GSK3β/β-CATENIN pathway
Authors: Wei Jiaming , Wang Yuxuan , Tu Shaoqin , Zhang Sai , Feng Yi , Hou Yuluan , Ai Hong , Chen Zheng 
Published: July 2024

Abstract
Background
Temporomandibular joint osteoarthritis (TMJOA) has a high incidence rate, but its pathogenesis remains unclear. Circadian rhythm is an important oscillation in the human body and influences various biological activities. However, it is still unclear whether circadian rhythm affects the onset and development of TMJOA.

Methods
We disrupted the normal rhythm of rats and examined the expression of core clock genes in the mandibular condylar cartilage of the jaw and histological changes in condyles. After isolating rat mandibular condylar chondrocytes, we upregulated or downregulated the clock gene Per1, examined the expression of cartilage matrix-degrading enzymes, tested the activation of the GSK3β/β-CATENIN pathway and verified it using agonists and inhibitors. Finally, after downregulating the expression of Per1 in the mandibular condylar cartilage of rats with jet lag, we examined the expression of cartilage matrix-degrading enzymes and histological changes in condyles.

Results
Jet lag led to TMJOA-like lesions in the rat mandibular condyles, and the expression of the clock gene Per1 and cartilage matrix-degrading enzymes increased in the condylar cartilage of rats. When Per1 was downregulated or upregulated in mandibular condylar chondrocytes, the GSK3β/β-CATENIN pathway was inhibited or activated, and the expression of cartilage matrix-degrading enzymes decreased or increased, which can be rescued by activator and inhibitor of the GSK3β/β-CATENIN pathway. Moreover, after down-regulation of Per1 in mandibular condylar cartilage in vivo, significant alleviation of cartilage degradation, cartilage loss, subchondral bone loss induced by jet lag, and inhibition of the GSK3β/β-CATENIN signaling pathway were observed. Circadian rhythm disruption can lead to TMJOA. The clock gene Per1 can promote the occurrence of TMJOA by activating the GSK3β/β-CATENIN pathway and promoting the expression of cartilage matrix-degrading enzymes. The clock gene Per1 is a target for the prevention and treatment of TMJOA.
Nuclear alpha-synuclein accelerates cell senescence and neurodegeneration
Authors: Du Tingfu , Li Guoxiang , Zong Qinglan , Luo Haiyu , Pan Yue , Ma Kaili 
Published: July 2024

Abstract
Background
The progression of Parkinson’s disease (PD) is related to ageing. The accumulation of nuclear alpha-synuclein (α-syn) may accelerate the occurrence of neurodegenerative diseases, but its role in PD remains poorly understood.

Methods
In the present study, α-syn expression was specifically targeted to the nucleus by constructing an adeno-associated virus (AAV) vector in which a nuclear localization sequence (NLS) was added to the α-syn coding sequence. Virus-mediated gene transfer, behavioural tests, RNA-Seq, immunohistochemistry, western blotting, and quantitative real-time PCR were then performed.

Results
In vivo experiments using a mouse model showed that nuclear α-syn increased the severity of the PD-like phenotype, including the loss of dopaminergic neurons concomitant with motor impairment and the formation of α-syn inclusions. These nuclear inclusions contained α-syn species of high molecular weights and induced strong transcriptional dysregulation, especially induced high expression of p21 and senescence-associated secretory phenotype (SASP)-related genes. In addition, the transcriptional alterations induced by nuclear α-syn were associated with gliosis, inflammation, oxidative and DNA damage, and lysosomal dysfunction, and they eventually accelerated neuronal loss and neurodegeneration.

Conclusions
Our results suggest that nuclear α-syn plays a crucial role in PD pathogenesis.
Establishing evidence criteria for implementation strategies in the US: a Delphi study for HIV services
Authors: McKay Virginia R. , Zamantakis Alithia , Pachicano Ana Michaela , Merle James L. , Purrier Morgan R. , Swan McKenzie , Li Dennis H. , Mustanski Brian , Smith Justin D. , Hirschhorn Lisa R. , Benbow Nanette 
Published: July 2024

Abstract
Background
There are no criteria specifically for evaluating the quality of implementation research and recommending implementation strategies likely to have impact to practitioners. We describe the development and application of the Best Practices Tool, a set of criteria to evaluate the evidence supporting HIV-specific implementation strategies.

Methods
We developed the Best Practices Tool from 2022–2023 in three phases. (1) We developed a draft tool and criteria based on a literature review and key informant interviews. We purposively selected and recruited by email interview participants representing a mix of expertise in HIV service delivery, quality improvement, and implementation science. (2) The tool was then informed and revised through two e-Delphi rounds using a survey delivered online through Qualtrics. The first and second round Delphi surveys consisted of 71 and 52 open and close-ended questions, respectively, asking participants to evaluate, confirm, and make suggestions on different aspects of the rubric. After each survey round, data were analyzed and synthesized as appropriate; and the tool and criteria were revised. (3) We then applied the tool to a set of research studies assessing implementation strategies designed to promote the adoption and uptake of evidence-based HIV interventions to assess reliable application of the tool and criteria.

Results
Our initial literature review yielded existing tools for evaluating intervention-level evidence. For a strategy-level tool, additions emerged from interviews, for example, a need to consider the context and specification of strategies. Revisions were made after both Delphi rounds resulting in the confirmation of five evaluation domains – research design, implementation outcomes, limitations and rigor, strategy specification, and equity – and four evidence levels – best, promising, more evidence needed, and harmful. For most domains, criteria were specified at each evidence level. After an initial pilot round to develop an application process and provide training, we achieved 98% reliability when applying the criteria to 18 implementation strategies.

Conclusions
We developed a tool to evaluate the evidence supporting implementation strategies for HIV services. Although specific to HIV in the US, this tool is adaptable for evaluating strategies in other health areas.