bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epidemiology and risk factors of oral frailty among older people: an observational study from China
Authors: Yin Yueheng , Zhao Yue , Fei Yang , Liu Ying , Ji Yun , Shan Enfang , Niu Shuzhen , Xing Ying , Ding Jingjing , Li XianWen 
Published: March 2024

Abstract
Objectives
This study aimed to compare the prevalence of oral frailty among community-dwelling older people in Nanjing, China with the usage of different measurements, and to investigate the potential risk factors of oral frailty.

Design
Cross-sectional study.

Setting and participants
A total of 338 community-dwelling older people in Nanjing, China were recruited.

Methods
Oral frailty was measured based on the Oral Frailty Index-8 (OFI-8) scale and other measurement methods including the number of natural teeth (TN), repetitive saliva-swallowing test (RSST), and oral diadochokinesis (ODK). The chi-square test and the binary logistic regression analysis were performed to identify potential risk factors for oral frailty.

Results
There were 310 participants included in the analysis. Prevalence of oral frailty by using the OFI-8, OFI-8 + TN, OFI-8 + ODK, OFI-8 + TN + ODK and RSST measurement methods were 69.0%, 27.4%, 51.9%, 21.0% and 2.9%, respectively. Passive smoking (OR = 2.04; 95%CI 1.03–4.03), being widowed/unmarried (OR1 = 2.53; 95%CI 1.25–5.10; OR2 = 2.94; 95%CI 1.12–7.77), pre-frailty (OR = 1.76; 95%CI 1.03–3.01), frailty (OR = 3.01; 95%CI 1.39–6.54), and aged 80 years and above (OR = 3.99; 95%CI 1.35–11.81) were found to be risk factors of oral frailty by the usage of the four kinds of measurement methods.

Conclusions and implications
The definition and diagnostic criteria of oral frailty are strongly needed to be unified in future research. Only subjective assessment is not enough for assessing oral frailty. Among objective indicators, RSST is not suitable as a screening method for oral frailty. In addition, objective indicators including TN and ODK should be valued for early screening and preventive interventions. The risk factors of oral frailty include physical frailty, passive smoking, and being widowed.
Measuring patients’ medical treatment preferences in advance care planning: development and validation of the Treat-Me-ACP instrument – a secondary analysis of a cluster-randomized controlled trial
Authors: Jaschke Julia , Schnakenberg Rieke , Silies Katharina , Berg Almuth , Kirchner Änne , Hoffmann Falk , Meyer Gabriele , Köpke Sascha , Köberlein-Neu Juliane 
Published: March 2024

Abstract
Background
Advance Care Planning interventions should be evaluated as broadly as possible to gain a holistic understanding of the Advance Care Planning process. However, validated early stage outcome instruments are lacking. Therefore, the Treatment-Preference-Measure-Advance Care Planning (Treat-Me-ACP) instrument was developed and validated as part of the cluster-randomized controlled trial STADPLAN (Study on Advance Care Planning in care-dependent community-dwelling older persons) to assess the effects of Advance Care Planning interventions on patients’ medical treatment preferences.

Methods
The design of Treat-Me-ACP is based on the Emanuel Medical Directive and the Life Support Preferences Questionnaires. Using a multi-stage team approach a preliminary version of the Treat-Me-ACP was developed and pre-tested. The pre-tested instrument consists of one global medical care goal-item, five hypothetical scenarios with five hypothetical treatments, and one how would you feel-item within each scenario. A total of five scenario preference scores and five treatment preference scores can be formed. This version was subsequently applied to a subsample of the STADPLAN project (n = 80) to assess patient’s preferences at baseline (T0) and at 12-month follow-up (T2). The further validation steps were based on this subsample and included: (1) acceptance by using completion rate and frequencies of missing data, (2) internal consistency by using Cronbach’s α to test whether it was possible to create preference scores by scenario and treatment, (3) concurrent validation examining the association between the global medical care goal-item and the preference scores and the association between the how would you feel-items and the scenario preference scores, and (4) responsiveness of the instrument to changes in preferences for life-sustaining treatments by comparing preference scores from T0 to T2 between study groups.

Results
Acceptance of the instrument was high. Results of concurrent validation indicate that the five scenarios represent the global medical care goal well. The preference scores showed an average tendency for decreasing preferences for life-sustaining treatments across all scales for the intervention group during study follow-up.

Conclusions
The Treat-Me-ACP can be used to evaluate the dynamics of patients’ medical treatment preferences in Advance Care Planning. It has been validated for care-dependent community-dwelling older persons and can be used as an additional outcome measure in evaluating the effectiveness of ACP interventions.

Trial registration
German Clinical Trials Register: DRKS00016886 on 04/06/2019.
Evaluation of patient health outcomes of a student-run free clinic in East Harlem
Authors: Jiang Joy J. , Link Katie , Mellgard George , Silvestri Francesca , Qian Daniel , Chennareddy Susmita , Tran Michelle , Goldstein Yoni , Frid Gabriela , Band Isabelle , Saali Alexandra , Thomas David C. , Jasti Harish , Meah Yasmin S. 
Published: March 2024

Abstract
Background
Most United States medical schools have affiliated student-run free clinics, but the quality of services provided in such contexts compared to national metrics is unknown. This study determines whether a student-run, attending-supervised free clinic servicing a low-income and minority race patient population in New York City can meet national metrics of care.

Methods
Through chart review from January 1, 2020 to December 31, 2020, patient outcomes and service utilization in the Healthcare Effectiveness Data and Information Set were examined and compared to national rates of patients using Medicaid HMO or Medicare. Patients are ≥ 21 years of age, residents of East Harlem, and ineligible for health insurance because of legal residency requirements. The majority identify as Hispanic and speak Spanish as their primary language. All patients who were seen in the clinic during the 2020 calendar year were included. The primary study outcome is the number of Healthcare Effectiveness Data and Information Set measures in which patients, seen in a student-run free clinic, meet or exceed national comparisons.

Results
The healthcare outcomes of 238 patients, mean age 47.8 years and 54.6% female, were examined in 18 Healthcare Effectiveness Data and Information Set measures. The student-run free clinic met or exceeded national metrics in 16 out of 18 categories.

Conclusions
The student-run free clinic met or exceeded the national standard of care according to national metrics. Evidence-based priorities have been clarified for future improvement. Other student-run free clinics should similarly evaluate the quality of their services.
The effect of spaced learning on the learning outcome and retention of nurse anesthesia students: a randomized-controlled study
Authors: Khalafi Ali , Fallah Zahra , Sharif-Nia Hamid 
Published: March 2024

Abstract
Background
Poor learning and retention are common problems of students, which may be alleviated by optimization of widely used educational methods such as lectures. This study aimed to investigate the effect of spaced learning on the learning outcome and retention of nurse anesthesia students.

Methods
This was a randomized controlled study with a pre-and post-test design on 64 nurse anesthesia students who were divided into two groups of spaced lecture (n = 32) and conventional lecture (n = 32). The spaced lectures included three 30-minute training sessions with 10-minute intervals while the conventional sessions including 90 min of continuous training. Students’ knowledge was measured using one valid and reliable questionnaire developed by the research team. All students in both groups took a pre-test, and their level of knowledge acquisition was evaluated immediately after the training. Their level of knowledge retention was tested two and four weeks after the lecture.

Results
There was no significant difference between the two groups regarding demographic characteristics (p > 0.05). In the pre-test, the mean score of knowledge in the intervention group was lower than that in the control group, there was no significant difference (p = 0.177). But after the intervention, the mean scores of learning outcome and retention in the intervention group were significantly higher than those in the control group (p < 0.001, eta = 0.576). Also, the results showed that learning outcome and retention across the three academic semesters in the two groups are significantly different, and students with a higher academic semester obtained a significantly higher mean score of knowledge and retention (p < 0.001, eta = 0.604).

Conclusion
Spaced learning improves nurse anesthesia students’ knowledge and retention more than conventional method. Future studies focusing on spaced learning should specifically examine the impact of duration and number of intervals, as well as the time gap between training and measurement of learning retention.
Inductive process of moral distress development in viewpoints from surgical nurses: a mixed-method study
Authors: Hosseinpour Azam , Keshmiri Fatemeh 
Published: March 2024

Abstract
Background
Moral distress is a multifactorial and complex phenomenon influenced by various individual, cultural, and systemic factors. This study aimed to investigate the frequency and intensity of nurses’ moral distress, explore their experiences, and develop the conceptual model of risk factors of moral distress in surgical units and operating rooms.

Method
This is a sequential mixed-method study conducted at four teaching hospitals affiliated with the Qom University of Medical Sciences. In the first step, the moral distress of nurses in surgical units and operating rooms was investigated by a survey. The participants included nurses who worked in the operating room and surgical units. (n = 180). The data was collected by a Moral Distress Scale-Revised (MDS-R) questionnaire. In the second step, the experiences of nurses regarding risk factors of moral distress were explored using semi-structured interviews and analyzed using the conventional content analysis by Graneheim and Lundman’s approach.

Results
One hundred eighty nurses participated in this study. The mean total moral distress scores ranged from 12 to 221, with a mean (SD) of 116.8 (42.73). The causes of moral distress cited with the highest frequency and intensity related to the ‘role of healthcare providers’. The experiences of the participants in the theme ‘Inductive process of moral distress development’ were categorized into three categories: ‘Melting into the faulty system’, ‘Power and the system as distress promotors’, and ‘Perceived unpleasant consequences’.

Conclusion
The results indicated that the frequency of moral distress in operating rooms and surgical units was at a moderate level and the distress intensity of nurses was at a moderately high level. The results indicated that in the investigated system, the “inductive moral process of distress development” was continuously understood by the participants. This process was influenced by systemic and individual factors. Weak assertiveness, conservative compromise, and desensitization to unprofessionalism as individual factors were effective in causing distress. Risk factors at the systemic level led nurses to melt into the faulty system and created adverse outcomes at the individual level. The lack of systemic support and the stabilization of mobbing by powerful system members had a negative impact on the individual factors of distress development. Also, these factors directly cause negative consequences.
Assessment of preventive practices towards hepatitis B infection among nursing students in Bangladesh: role of knowledge, attitudes and sociodemographic factors
Authors: Tamanna Sumaiya Sultana , Paul Kallol Deb , Al Banna Md. Hasan , Zannat Zamia , Paul Anup Kumar , Sultana Sadia , Alshahrani Najim Z. , Talukder Sohan , Hassan Md. Nazmul 
Published: March 2024

Abstract
Background
Globally, hepatitis B infection (HBI) poses a substantial public health concern and healthcare workers, including nursing students, are at a higher risk of contracting this disease. Thus, the study aimed to assess how knowledge, attitudes, and sociodemographic factors are associated with HBI prevention among a sample of Bangladeshi nursing students.

Methods
A cross-sectional survey was performed among 737 nursing students from the nursing institutes of Khulna and Barishal divisions in Bangladesh from January to April 2023. The data were collected by providing questionnaires (structured questionnaire) in the classroom, following a stratified random sampling process. A model of multinomial logistic regression was used to evaluate the factors linked to HBI prevention practices.

Result
The mean (SD) scores were 11.42 (± 2.88) for knowledge, 4.33 (± 1.91) for attitude and 4.27 (± 2.056) for practice respectively. Participants’ low knowledge (adjusted odds ratio, aOR = 2.562, 95% CI: 1.29–5.07) and poor attitude (aOR = 5.730, 95% CI: 3.19–10.28) regarding HBI were significantly associated with higher likelihood of poor practice towards HBI prevention. Moreover, being 2nd year of nursing students (aOR = 2.147, 95% CI: 1.19–3.86), being aged 19–20 years (aOR = 3.038, 95% CI: 1.30–7.09), being married (aOR = 0.320, 95%CI: 0.13–0.82) and having a family history of HBI (aOR = 0.134, 95%CI: 0.05–0.36) were significantly associated with poor practices of HBI prevention among study participants.

Conclusion
The knowledge, attitude and practice scores of the nursing students on HBI prevention were suboptimal. We advocate for implementing regular HBI prevention education and policies, free or subsidized services, skill development, proper HBI prevention enforcement and strict professional ethics within nursing colleges. Such efforts should predominantly focus on second-year, aged 19–20 and unmarried nursing students.
Healthcare worker burnout: exploring the experiences of doctors working in a maternity unit in Namibia
Authors: Brückner Tanya Y. , Heemelaar S. , Endjala T. , van den Akker T. 
Published: March 2024

Abstract
Background
Globally, healthcare workers (HCWs) in maternity units are at high risk of developing burnout. Burnout can lead to multiple harmful impacts on HCWs, their patients, and the broader healthcare system. Little is known about the burden of burnout among sub-Saharan African HCWs. Although evidence suggests that maternity unit doctors in a hospital complex in Namibia are at risk of developing burnout, no studies have been conducted on doctors in this department yet.

Methods
Through participant observation and a mixed-methods needs assessment, this study aimed to explore the drivers, experiences, and impact of burnout symptoms among doctors in this department, and current support mechanisms in place. Survey data was collected from 18 participants and seven in-depth interviews were conducted. Burnout risk was assessed using the Burnout Assessment Tool.

Results
Seven out of 18 participants were at very high risk for burnout and three were at risk, showing a high prevalence of burnout risk. Burnout risk remained similar between levels of staff, while gender qualitatively impacted burnout-related experiences. Drivers of burnout were identified at personal, occupational, and systemic levels.

Conclusions
Over half of participants were at risk or at very high risk of burnout. Results highlighted a need for support and identified areas for intervention and further research. Such areas include blame culture, lack of trust between colleagues, and systemic drivers of burnout. This study contributes to the understanding of burnout among HCWs in sub-Saharan Africa.
CircHAS2 activates CCNE2 to promote cell proliferation and sensitizes the response of colorectal cancer to anlotinib
Authors: Li Haosheng , Feng Haoran , Zhang Tao , Wu Junwei , Shen Xiaonan , Xu Shuiyu , Xu Lianghui , Wang Shaodong , Zhang Yaqi , Jia Wenqing , Ji Xiaopin , Cheng Xi , Zhao Ren 
Published: March 2024

Abstract
Background
Tyrosine kinase inhibitors (TKIs) are crucial in the targeted treatment of advanced colorectal cancer (CRC). Anlotinib, a multi-target TKI, has previously been demonstrated to offer therapeutic benefits in previous studies. Circular RNAs (circRNAs) have been implicated in CRC progression and their unique structural stability serves as promising biomarkers. The detailed molecular mechanisms and specific biomarkers related to circRNAs in the era of targeted therapies, however, remain obscure.

Methods
The whole transcriptome RNA sequencing and function experiments were conducted to identify candidate anlotinib-regulated circRNAs, whose mechanism was confirmed by molecular biology experiments. CircHAS2 was profiled in a library of patient-derived CRC organoids (n = 22) and patient-derived CRC tumors in mice. Furthermore, a prospective phase II clinical study of 14 advanced CRC patients with anlotinib-based therapy was commenced to verify drug sensitivity (ClinicalTrials.gov identifier: NCT05262335).

Results
Anlotinib inhibits tumor growth in vitro and in vivo by downregulating circHAS2. CircHAS2 modulates CCNE2 activation by acting as a sponge for miR-1244, and binding to USP10 to facilitate p53 nuclear export as well as degradation. In parallel, circHAS2 serves as a potent biomarker predictive of anlotinib sensitivity, both in patient-derived organoids and xenograft models. Moreover, the efficacy of anlotinib inclusion into the treatment regimen yields meaningful clinical responses in patients with high levels of circHAS2. Our findings offer a promising targeted strategy for approximately 52.9% of advanced CRC patients who have high circHAS2 levels.

Conclusions
CircHAS2 promotes cell proliferation via the miR-1244/CCNE2 and USP10/p53/CCNE2 bidirectional axes. Patient-derived organoids and xenograft models are employed to validate the sensitivity to anlotinib. Furthermore, our preliminary Phase II clinical study, involving advanced CRC patients treated with anlotinib, confirmed circHAS2 as a potential sensitivity marker.
ECM stiffness affects cargo sorting into MSC-EVs to regulate their secretion and uptake behaviors
Authors: Liu Zhixiao , Liu Yingying , Li Yu , Xu Sha , Wang Yang , Zhu Yuruchen , Jiang Chu , Wang Kaizhe , Zhang Yinan , Wang Yue 
Published: March 2024

AbstractMesenchymal stem cell-derived extracellular vesicles (MSC-EVs) have garnered extensive attention as natural product-based nanomedicines and potential drug delivery vehicles. However, the specific mechanism for regulating MSC-EVs secretion and delivery remains unclear. Here, we demonstrate that extracellular matrix (ECM) stiffness regulates the secretion and delivery of EVs by affecting MSCs' cargo sorting mechanically. Using multi-omics analysis, we found that a decrease in ECM stiffness impeded the sorting of vesicular transport-related proteins and autophagy-related lipids into MSC-EVs, impairing their secretion and subsequent uptake by macrophages. Hence, MSC-EVs with different secretion and uptake behaviors can be produced by changing the stiffness of culture substrates. This study provides new insights into MSC-EV biology and establishes a connection between MSC-EV behaviors and ECM from a biophysical perspective, providing a basis for the rational design of biomedical materials.
Graphical Abstract
AURKB promotes bladder cancer progression by deregulating the p53 DNA damage response pathway via MAD2L2
Authors: Li Linzhi , Jiang Pengcheng , Hu Weimin , Zou Fan , Li Ming , Rao Ting , Ruan Yuan , Yu Weimin , Ning Jinzhuo , Cheng Fan 
Published: March 2024

Abstract
Background
Bladder cancer (BC) is the most common urinary tract malignancy. Aurora kinase B (AURKB), a component of the chromosomal passenger protein complex, affects chromosomal segregation during cell division. Mitotic arrest-deficient 2-like protein 2 (MAD2L2) interacts with various proteins and contributes to genomic integrity. Both AURKB and MAD2L2 are overexpressed in various human cancers and have synergistic oncogenic effects; therefore, they are regarded as emerging therapeutic targets for cancer. However, the relationship between these factors and the mechanisms underlying their oncogenic activity in BC remains largely unknown. The present study aimed to explore the interactions between AURKB and MAD2L2 and how they affect BC progression via the DNA damage response (DDR) pathway.

Methods
Bioinformatics was used to analyze the expression, prognostic value, and pro-tumoral function of AURKB in patients with BC. CCK-8 assay, colony-forming assay, flow cytometry, SA-β-gal staining, wound healing assay, and transwell chamber experiments were performed to test the viability, cell cycle progression, senescence, and migration and invasion abilities of BC cells in vitro. A nude mouse xenograft assay was performed to test the tumorigenesis ability of BC cells in vivo. The expression and interaction of proteins and the occurrence of the senescence-associated secretory phenotype were detected using western blot analysis, co-immunoprecipitation assay, and RT-qPCR.

Results
AURKB was highly expressed and associated with prognosis in patients with BC. AURKB expression was positively correlated with MAD2L2 expression. We confirmed that AURKB interacts with, and modulates the expression of, MAD2L2 in BC cells. AURKB knockdown suppressed the proliferation, migration, and invasion abilities of, and cell cycle progression in, BC cells, inducing senescence in these cells. The effects of AURKB knockdown were rescued by MAD2L2 overexpression in vitro and in vivo. The effects of MAD2L2 knockdown were similar to those of AURKB knockdown. Furthermore, p53 ablation rescued the MAD2L2 knockdown-induced suppression of BC cell proliferation and cell cycle arrest and senescence in BC cells.

Conclusions
AURKB activates MAD2L2 expression to downregulate the p53 DDR pathway, thereby promoting BC progression. Thus, AURKB may serve as a potential molecular marker and a novel anticancer therapeutic target for BC.