bluuebunny/crossref_metadata_2025_split huggingface dataset:
Knowledge, attitude, and practice towards bacterial multidrug-resistance and structural equation modeling analysis among intensive care unit nurses and physicians
Authors: Ai Zhongping , Fang Yaping , Gao Xiaolan , Wang Li , Yu Min 
Published: June 2024

Background
The intensive care unit (ICU) is a department with a high risk of MDR bacteria, and ICU nurses and physicians play critical roles in bacterial multidrug resistance (MDR) prevention.

Objectives
To explore the knowledge, attitudes, and practice (KAP) towards bacterial MDR among ICU nurses and physicians.

Methods
A self-designed questionnaire was administered to collect data. Structural equation modeling (SEM) was applied to assess the associations among study variables.

Results
A total of 369 questionnaires were collected; 43 questionnaires were excluded due to self-contradictory on the trap question or the obviously repeated pattern. Finally, 326 (88.35%) valid questionnaires were included in the analysis. The knowledge, attitudes, and practice were 13.57 ± 1.69 (90.47%, possible range: 0–15), 38.75 ± 2.23 (96.88%, possible range: 8–40), and 47.40 ± 3.59 (94.80%, possible range: 10–50). The SEM showed that knowledge had a direct effect on attitude with a direct effect value of 0.61 (P < 0.001) and a direct negative effect on practice with a direct effect value of -0.30 (P = 0.009). The direct effect of attitude on practice was 0.89 (P < 0.001); the indirect effect of knowledge through attitude on practice was 0.52 (P < 0.001). Job satisfaction had a direct effect on attitude and practice, with an effect value of 0.52 (P = 0.030) and 0.75 (P = 0.040). Being a physician (OR = 0.354, 95%CI: 0.159–0.790, P = 0.011), 5–9.9 years of practice (OR = 4.534, 95%CI: 1.878–8.721, P < 0.001), and ≥ 10 years of practice (OR = 3.369, 95%CI: 1.301–8.721, P = 0.012) were independently associated with good knowledge. The attitude scores (OR = 1.499, 95%CI: 1.227–1.830, P < 0.001), male gender (OR = 0.390, 95%CI: 0.175–0.870, P = 0.022), and 5–9.9 years of experience (OR = 0.373, 95%CI: 0.177–0.787, P = 0.010) were independently associated with proactive practice.

Conclusion
Nurses and physicians in the ICU showed good knowledge, positive attitudes, and proactive practice toward bacterial MDR. Nurses and physicians’ knowledge had a direct effect on their attitude, while attitude might directly influence the practice and also play a mediating role between knowledge and practice. Job satisfaction might directly support the positive attitude and practice toward bacterial MDR.
Health system strengthening in fragile and conflict-affected states: A review of systematic reviews
Authors: Bogale Birke , Scambler Sasha , Mohd Khairuddin Aina Najwa , Gallagher Jennifer E. 
Published: June 2024

Background
Globally, there is growing attention towards health system strengthening, and the importance of quality in health systems. However, fragile and conflict-affected states present particular challenges. The aim of this study was to explore health system strengthening in fragile and conflict-affected states by synthesising the evidence from published literature.

Methods
We conducted a review of systematic reviews (Prospero Registration Number: CRD42022371955) by searching Ovid (Medline, Embase, and Global Health), Scopus, Web of Science, and the Cochrane Library databases. Only English-language publications were considered. The Joanna Briggs Institute (JBI) Critical Appraisal Tool was employed to assess methodological quality of the included studies. The findings were narratively synthesised and presented in line with the Lancet’s ‘high-quality health system framework’.

Results
Twenty-seven systematic reviews, out of 2,704 identified records, considered key dimensions of health systems in fragile and conflict-affected states, with the ‘foundations’ domain having most evidence. Significant challenges to health system strengthening, including the flight of human capital due to safety concerns and difficult working conditions, as well as limited training capacities and resources, were identified. Facilitators included community involvement, support systems and innovative financing mechanisms. The importance of coordinated and integrated responses tailored to the context and stage of the crisis situation was emphasised in order to strengthen fragile health systems. Overall, health system strengthening initiatives included policies encouraging the return and integration of displaced healthcare workers, building local healthcare workers capacity, strengthening education and training, integrating healthcare services, trust-building, supportive supervision, and e-Health utilisation.

Conclusion
The emerging body of evidence on health system strengthening in fragile and conflict-affected states highlights its complexity. The findings underscore the significance of adopting a comprehensive approach and engaging various stakeholders in a coordinated manner considering the stage and context of the situation.
Acute internal medicine physicians’ clinical intuition based on acute care telephone referral: A prospective study
Authors: van Dam Paul M. E. L. , Lasso Peña Roberto E. , Mommertz Jody A. , Borggreve Hella F. , van Loon Nicole P. H. , Zelis Noortje , Westerman Dewa , Henry Ronald M. A. , Posthouwer Dirk , Cals Jochen W. L. , Stassen Patricia M. 
Published: June 2024

Introduction
In the Netherlands, most emergency department (ED) patients are referred by a general practitioner (GP) or a hospital specialist. Early risk stratification during telephone referral could allow the physician to assess the severity of the patients’ illness in the prehospital setting. We aim to assess the discriminatory value of the acute internal medicine (AIM) physicians’ clinical intuition based on telephone referral of ED patients to predict short-term adverse outcomes, and to investigate on which information their predictions are based.

Methods
In this prospective study, we included adult ED patients who were referred for internal medicine by a GP or a hospital specialist. Primary outcomes were hospital admission and triage category according to the Manchester Triage System (MTS). Secondary outcome was 31-day mortality. The discriminatory performance of the clinical intuition was assessed using an area under the receiver operating characteristics curve (AUC). To identify which information is important to predict adverse outcomes, we performed univariate regression analysis. Agreement between predicted and observed MTS triage category was assessed using intraclass and Spearman’s correlation.

Results
We included 333 patients, of whom 172 (51.7%) were referred by a GP, 146 (43.8%) by a hospital specialist, and 12 (3.6%) by another health professional. The AIM physician’s clinical intuition showed good discriminatory performance regarding hospital admission (AUC 0.72, 95% CI: 0.66–0.78) and 31-day mortality (AUC 0.73, 95% CI: 0.64–0.81). Univariate regression analysis showed that age ≥65 years and a sense of alarm were significant predictors. The predicted and observed triage category were similar in 45.2%, but in 92.5% the prediction did not deviate by more than one category. Intraclass and Spearman’s correlation showed fair agreement between predicted and observed triage category (ICC 0.48, Spearman’s 0.29).

Conclusion
Clinical intuition based on relevant information during a telephone referral can be used to accurately predict short-term outcomes, allowing for early risk stratification in the prehospital setting and managing ED patient flow more effectively.
Lāuga: Understanding Samoan Oratory, Sadat Muaiava (2022)
Authors: Kölling Angela 
Published: June 2024

Review of: Lāuga: Understanding Samoan Oratory, Sadat Muaiava (2022)
Wellington: Te Papa Press, 336 pp.,
ISBN 978 0 99513 844 5 (hbk), NZ$45
Mind the Gap: An Evaluation of Indicator Discrepancies between Sustainability Standards and Certifications in the Built Asset Industry
Authors: Jaberi Meisam , Poirier Erik 
Published: June 2024

The built asset industry impacts our global environment significantly, contributing notably to environmental degradation. Various sustainability standards and certifications, such as LEED, DGNB, BREEAM, ISO 14001, and GRI 200 series, have been established to guide the industry toward sustainable practices. Despite their intended purpose, the diversity of these systems has led to a complex and inconsistent landscape. This paper undertakes a review of 25 certifications and 26 standards in the built asset industry, identifying and analyzing gaps and discrepancies in their measuring indicators. Using a rigorous process, we consolidated the diverse measuring indicators from each scheme into a list of 189 specific indicators, for comparative analysis. This analysis revealed notable gaps and inconsistencies within these schemes, illuminating differences in their emphasis and coverage of sustainability indicators. These findings highlight the need for increased standardization and inclusiveness in sustainability assessments within the industry. This study contributes to the discourse on industry standardization, policy decisions, sector transparency, and further research, marking a crucial step towards a more integrated approach to sustainability in the built asset industry.

Keywords: Sustainability, built asset industry, Sustainability standards, Green Building Certification
International Business Strategy: Ensuring Enterprise Stability Amidst Turmoil
Authors: Tanasiichuk Alona , Kovalchuk Svitlana , Sokoliuk Serhii , Kovtun Eduard , Dodon Oksana , Sakun Hanna , Serednytska Liudmila 
Published: June 2024

The study determined stages of the formation of international marketing strategies in modern conditions of globalization were considered, and the classification of the goals of entering international markets by Ukrainian enterprises in the conditions of war was carried out. Approaches to forming international marketing strategies for Ukrainian enterprises, which carry out economic activities in war conditions, have been developed. The advantages and disadvantages of various international marketing strategies, which should be taken into account by domestic enterprises when choosing strategic directions for the development of international activities, are determined. The procedure for choosing an international marketing strategy for the business development of domestic enterprises is substantiated, and a graph-analytical model of the process of making a management decision on choosing a strategic direction for the development of international activities of Ukrainian enterprises is proposed. To demonstrate approaches to the selection of international markets for assessing their convergence, the following indicators have been defined: GDP per capita, purchasing power parity, inflation rate, corruption rate, rule of law index, carbon dioxide emissions, natural resource income, agricultural value added, food production index, business freedom index, and industrial value added. The results of a comprehensive study have led to the conclusion that the markets of Germany, Ireland, Sweden, Denmark, Belgium, the Netherlands, Austria, Finland, Luxembourg, and France have favorable conditions for the strategic development of international activities of Ukrainian enterprises in them. It has been determined that the markets of Slovenia, Malta, Czech Republic, Portugal, Italy, Lithuania, Cyprus, and Spain may become promising for the strategic development of international activities of Ukrainian enterprises, provided that a significant gap in their main indicators is overcome, namely: "Control of Corruption" and "Rule of Law Index".
Keywords: strategic directions of international activity development, business sustainability, international marketing strategies, model of the management decision-making process, new offers in world markets, integration into the world economy, assessment of market convergence, business freedom index, industrial value added
Regional Policies for Sustainable Attractivity of the Euregio
Authors: Klotz Renate 
Published: June 2024

In the literature, quality of life is increasingly emphasised as a determinant for the location choice of highly qualified individuals. There is no doubt that the Euregio, which is ecologically, economically, and culturally rich, offers great potential for the settlement of highly qualified professionals. Statistical data show an increasing rate of migration from the Trentino-South Tyrol region in the last 10 years. In this research, causal factors are identified that encourage highly qualified professionals to move out of or settle in the Euregio. The importance of sustainable, attractive communities for their decision-making is identified.
Methods of the research mixed methods in exploratory design starting with open interviews with out-migrants, in-migrants, and return migrants.
Results of the qualitative data collection: High quality of life is not the primary determinant for staying in the Euregio1. The economic aspect has no clear primary relevance in the decision to leave, but it does in the decision to migrate and return. Closed mentality and cultural realities have a notable influence on the emigration of highly qualified professionals. A series of sustainable recommendations for action can be presented. Their implementation is necessary on a political and primarily a societal or community level.
Keywords: 'quality of life and migration'; 'Euregio migration data'; 'professional workers in the Euregio'; 'sustainable attractivity in Alpine area'
Do young sustainable tourists build better relationships with destinations?
Authors: Sato Mitsuru , Onbhuddha Ruethai , Ma Bingying , Ogata Seiichi 
Published: June 2024

Sustainable tourists play a crucial role in achieving sustainable tourism in destinations. Previous studies have identified a segment of sustainability-friendly tourists. In recent years, some studies have focused on the youth generation as sustainable tourists. It is a useful strategy for destinations to build better relationships with sustainable youth tourists in order to construct a competitive advantage in the long term. However, it remains unclear that the characteristics and behaviors of young sustainable tourists and how they relate to destinations. The aim of this study is to examine sustainable young generation tourists who contribute to a destination’s sustainability. The study was based on data from a web-based survey of Japanese respondents aged between 20 and 39 years, who had experienced domestic travel. We conducted exploratory factor analysis and cluster analysis and identified a segment of sustainable youth tourists. The intention to build relationships with destinations was analyzed using the chi-square and Kruskal-Wallis tests. The results confirmed that young sustainable tourists were highly loyal to the destinations they visited and intended to involve the destination after their trip. They are actors who actively seek to increase the sustainability of their destinations.
Keywords: sustainable tourism, destination management, sustainable tourist, youth tourism, tourist loyalty
From Hearts to Carts: Understanding the Impact of Comments, Likes, and Share Functions on Consumer Purchase Intentions in a Social Media Landscape
Authors: Rosli Nadzirah , Johar Elaina Rose , Bin Mad Lazim Muhammad Luqman Hannan , Hashim Sharizal , Juhari Noor Faezah 
Published: June 2024

In recent years, considerable attention has been devoted to studying how social media engagement, encompassing actions such as likes, comments, and shares, shapes consumer purchasing decisions. While previous research acknowledges the significance of social media engagement, there remains a dearth of thorough analysis regarding the explicit effects of likes, comments, and shares on consumer behaviour, particularly in terms of examining how these engagements affect diverse consumer groups. Thus, this study aims to enhance our comprehension of how activities on social networking platforms, such as comments, likes, and shares, impact consumer purchasing decisions. Employing a cross-sectional approach, the study utilized purposive sampling to collect data from Malaysian university students who had previously made purchases through social media platforms like Instagram. A total of 134 valid responses were analyzed. The research outcomes significantly contribute to the existing literature in several respects. Firstly, the study constructed a research framework based on signalling theory to explore how social network activities, such as comments, likes, and shares, influence consumer purchasing decisions. The findings revealed insightful observations, indicating that likes and shares exert a substantial direct influence on purchase decisions within the Instagram ecosystem. However, contrary to expectations, the study found no significant association between comments and consumers' purchasing decisions on Instagram. These discoveries offer valuable insights into the specific impact of different social media engagement metrics on consumer behaviour, particularly within the context of Instagram.
Keywords: social media, like, share, comment, consumer behaviour, purchase decision, Instagram
Self-Reported Nonceliac Gluten Sensitivity in Italian Young Adults: A Cross-Sectional Study. A Dietary Fad?
Authors: Brindicci Viviana Fara , Franceschini Simone , Gnasso Ilaria , Alcini Paride , Tassi Emanuele Abondio , Santarelli Lorenzo , Cristofori Fernanda , Dargenio Vanessa Nadia , Castellaneta Stefania ,   the NCGS study group*, Francavilla Ruggiero 
Published: June 2024

INTRODUCTION:
In different countries, the exact prevalence of people that refer symptoms after gluten ingestion is increasing and the unavailability of reliable laboratory tests to diagnose the condition known as nonceliac gluten sensitivity (NCGS) has opened the door to the spread of survey-based studies to hypothesize a prevalence of this condition with highly discordant results. We aim to describe the attitude toward gluten consumption in a large population of young adults in Italy.

METHODS:
A questionnaire-based cross-sectional study was conducted in 13 Italian cities to investigate the dietary attitudes of more than 9,400 people distributed throughout the country about gluten consumption. Only those referring to gluten-related symptoms with a frequency equal to “always” or “most of the time” were considered self-reported NCGS (SR-NCGS) patients.

RESULTS:
Five thousand two hundred thirty-four of 9,432 eligible participants (55.5%) fully completed the questionnaire. Excluding those with previous gastrointestinal diagnoses of celiac disease and wheat allergy, we have finally analyzed 4,987 questionnaires. Four hundred eighty-seven participants indicated gluten-related symptoms always or most of the time (SR-NCGS subjects), while 121 already had a medical diagnosis of NCGS. The minimum prevalence figure of SR-NCGS is 6.4% (95% confidence interval 6.0–6.9), with a higher prevalence in women (79.9%). The most frequent gluten-related symptoms were bloating, abdominal pain, and tiredness.

DISCUSSION:
The high prevalence of people reporting symptoms after gluten ingestion requires that the diagnosis of NCGS should be ascertained with a double-blind controlled study to limit the number of people who improperly approach a gluten-free diet.
Sirolimus Use in Refractory Crohn's Disease
Authors: Siu Rex K. , Karime Christian , Hashash Jana G. , Kinnucan Jami , Picco Michael F. , Farraye Francis A. 
Published: June 2024

ABSTRACT
Treatment options for patients with inflammatory bowel disease are constantly evolving; however, medication-refractory disease remains an issue. Pediatric case series show the potential benefit of sirolimus therapy in refractory Crohn's disease (CD); however, limited data exist in adult patients. As such, we retrospectively identified and report clinical outcomes for 4 patients prescribed sirolimus for treatment of refractory CD. Despite a median sirolimus therapy duration of 524 days and some therapeutic benefits, all patients discontinued therapy due to adverse effects. Our findings suggest that while sirolimus may have clinical utility, its role may be limited by treatment-derived adverse effects.
Therapy-Associated Polyposis, Late Presentation of a Childhood-Treated Disease
Authors: McGarrity Thomas J. , Aynardi Jason , Peiffer Laurie , Ashktorab Hassan , Razjouyan Hadie 
Published: June 2024

ABSTRACT
Therapy-associated polyposis (TAP), an acquired gastrointestinal polyposis in childhood cancer survivors, poses diagnostic challenges resembling hereditary syndromes. Four TAP patients were studied, revealing upper gastrointestinal lesions after radiotherapy in 2 patients, managed by endoscopic resection. Two underwent total colectomy; 1 had adenocarcinoma from a polyp. Next-generation sequencing on diseased tissue revealed no alteration in mismatch repair genes with stable microsatellite status; however, there was somatic mutation in APC gene altering Wnt signaling pathway in all 3 precancerous lesions. Integrating endoscopic and surgical interventions is crucial, although ongoing studies aim to elucidate pathophysiology for potential targeted therapies in TAP management.
PENGENALAN PAKAIAN TRADISIONAL JEPANG YUKATA DI SMU NEGERI 4 SEMARANG
Authors: Hastuti Nur , Nur Ridha Dian Annisa , Agusta Nisia Dwi Nur 
Published: June 2024

ABSTRAKPenelitian ini mengenai pengenalan pakaian tradisional Jepang. Tujuan dari penelitian ini untuk meneliti bagaimana sejarah yukata, bahan yang digunakan dalam yukata dan lain-lain. Penelitian ini menggunakan media ceramah. Metode yang digunakan adalah deskriptif analisis. Sumber data dalam penelitian ini adalah pakaian tradisional Jepang Yukata. Data kemudian dianalisis dan diinterpretasikan, setelah itu data disajikan dalam bentuk uraian kemudian disimpulkan.Kata kunci: budaya tradisional, sejarah yukata, bahan yukata. ABSTRACTThis research is about the introduction of traditional Japanese clothing. The purpose of this research is to examine how the history of yukata, the materials used in yukata and others. This research uses lecture media. The method used is descriptive analysis. The source of data in this study is traditional Japanese clothing Yukata. The data is then analyzed and interpreted, after which the data is presented in the form of a description and then concluded.Keywords: traditional culture, yukata history, yukata materials.
Stability of steroid hormones in dried blood spots (DBS)
Authors: Olthof Anouk , Hillebrand Jacquelien J. , Wickenhagen Wjera V. , Boelen Anita , Heijboer Annemieke C. 
Published: June 2024

Abstract

Objectives
Steroid hormone levels of patients may be monitored via dried blood spot (DBS) sampling at home. Stability of steroid hormones in DBS samples, however, needs to be established.

Methods
DBS samples from healthy volunteers were collected and stored at various temperatures. Steroid hormone concentrations in DBS were measured directly, at day 2, day 7 and day 14 following storage at 37 °C and after 7 days, 14 days, 3 months and 6 months following storage at −20 °C, 4 °C and room temperature (RT). Cortisol, cortisone, corticosterone, testosterone, androstenedione, and 17-hydroxyprogesterone (17-OHP) were assessed using LC-MS/MS.

Results
All steroids were stable (±15 %) up to 14 days when stored at 37 °C, except for cortisone (only stable until 2 days). All steroids were stable up to 6 months when stored at −20 °C, 4 °C and RT. However, there were some exceptions, for androstenedione at RT (only stable until 7 days), for 17-OHP when stored at −20 °C (only stable until 3 months), for cortisone at RT and 4 °C (only stable until 14 days), and cortisol at RT (only stable until 3 months).

Conclusions
Overall, we demonstrated stability of steroid hormone concentrations in DBS under various conditions which may be encountered during shipping to the diagnostic laboratory and during long-term storage before analysis.