bluuebunny/crossref_metadata_2025_split huggingface dataset:
Investigating perceptions and attitude toward telenursing among undergraduate nursing students for the future of nursing education: a cross-sectional study
Authors: Mun Minji , Choi Subin , Woo Kyungmi 
Published: April 2024

Abstract
Background
Telenursing is poised to emerge as a novel healthcare delivery system in the digital age. Hence, understanding nursing students' perspectives and readiness is pivotal for its effective implementation. This study investigated nursing students' perceptions regarding, and attitudes toward, telenursing and the factors that influenced their attitudes based on the technology acceptance model.

Methods
This study used a cross-sectional descriptive approach. The participants consisted of 188 nursing students (first to fourth year) enrolled in the College of Nursing in Korea. Differences in attitudes toward telenursing were analyzed using independent t-test and one-way analysis of variance. Pearson’s correlation coefficient was used to examine the correlations between the main variables. Factors that influenced attitudes toward telenursing were analyzed using multiple regression.

Results
Of the participants, 65.4% lacked substantial awareness of telenursing and 19.1% had prior telenursing experience. Although prospects on telenursing indicated that 90.4% had an optimistic view, face-to-face nursing was heavily preferred for both satisfactory and favored healthcare delivery. Many cited the Internet as their source of knowledge, and only 18.6% had received telenursing education. Attitude toward telenursing was significantly more positive among those with experience of telenursing, telenursing observation in clinical practice, and telenursing education exposure. The regression model was statistically significant (F = 67.445, p < .000). Factors, such as perceived usefulness, social influence, innovativeness, and self-efficacy, influenced attitudes toward telenursing.

Conclusions
Nursing students exhibited a lack of substantial awareness of telenursing; however, they simultaneously displayed a positive outlook. This lack of comprehensive understanding could stem from the absence of formal education in telenursing. Understanding and utilizing the potential of telenursing could be significantly aided by nursing students' education and knowledge. Thus, it is necessary to include telenursing education in the nursing curriculum. The skills and knowledge required for telenursing clinical practice can be developed through telenursing education. Such preparedness will affect nurses’ attitudes and intentions and the quality of telenursing offered to patients in the future.
Transformational nurse leadership attributes in German hospitals pursuing organization-wide change via Magnet® or Pathway® principles: results from a qualitative study
Authors: Kleine Joan , Köppen Julia , Gurisch Carolin , Maier Claudia B. 
Published: April 2024

Abstract
Background
Budget constraints, staff shortages and high workloads pose challenges for German hospitals. Magnet® and Pathway® are concepts for implementing organization-wide change and redesigning work environments. There is limited research on the key elements that characterize nurse leaders driving the implementation of Magnet®/Pathway® principles outside the U.S. We explored the key attributes of nurse leaders driving organization-wide change through Magnet®/Pathway® principles in German hospitals.

Methods
Using a qualitative study design, semi-structured interviews (n = 18) were conducted with nurse leaders, managers, and clinicians, in five German hospitals known as having started implementing Magnet® or Pathway® principles. The interviews were recorded and transcribed verbatim. Data were analyzed in Atlas.ti using content analysis. For the analysis, a category system was created using a deductive-inductive approach.

Results
Five leadership attributes and eleven sub-attributes were identified as main themes and sub-themes: Visionary leaders who possess and communicate a strong vision and serve as role models to inspire change. Strategic leaders who focus on strategic planning and securing top management support. Supportive leaders who empower, emphasizing employee motivation, individualized support, and team collaboration. Stamina highlights courage, assertiveness, and resilience in the face of challenges. Finally, agility which addresses a leader’s presence, accessibility, and rapid responsiveness, fostering adaptability.

Conclusions
The study demonstrates leadership attributes explicitly focusing on instigating and driving organization-wide change through Magnet®/Pathway® principles in five German hospitals. The findings suggest a need for comprehensive preparation and ongoing development of nurse leaders aimed at establishing and sustaining a positive hospital work environment.
Characterization of a pleiotropic regulator MtrA in Streptomyces avermitilis controlling avermectin production and morphological differentiation
Authors: Tian Jinpin , Li Yue , Zhang Chuanbo , Su Jianyu , Lu Wenyu 
Published: April 2024

Abstract
Background
The macrolide antibiotic avermectin, a natural product derived from Streptomyces avermitilis, finds extensive applications in agriculture, animal husbandry and medicine. The mtrA (sav_5063) gene functions as a transcriptional regulator belonging to the OmpR family. As a pleiotropic regulator, mtrA not only influences the growth, development, and morphological differentiation of strains but also modulates genes associated with primary metabolism. However, the regulatory role of MtrA in avermectin biosynthesis remains to be elucidated.

Results
In this study, we demonstrated that MtrA, a novel OmpR-family transcriptional regulator in S. avermitilis, exerts global regulator effects by negatively regulating avermectin biosynthesis and cell growth while positively controlling morphological differentiation. The deletion of the mtrA gene resulted in an increase in avermectin production, accompanied by a reduction in biomass and a delay in the formation of aerial hyphae and spores. The Electrophoretic Mobility Shift Assay (EMSA) revealed that MtrA exhibited binding affinity towards the upstream region of aveR, the intergenic region between aveA1 and aveA2 genes, as well as the upstream region of aveBVIII in vitro. These findings suggest that MtrA exerts a negative regulatory effect on avermectin biosynthesis by modulating the expression of avermectin biosynthesis cluster genes. Transcriptome sequencing and fluorescence quantitative PCR analysis showed that mtrA deletion increased the transcript levels of the cluster genes aveR, aveA1, aveA2, aveC, aveE, aveA4 and orf-1, which explains the observed increase in avermectin production in the knockout strain. Furthermore, our findings demonstrate that MtrA positively regulates the cell division and differentiation genes bldM and ssgC, while exerting a negative regulatory effect on bldD, thereby modulating the primary metabolic processes associated with cell division, differentiation and growth in S. avermitilis, consequently impacting avermectin biosynthesis.

Conclusions
In this study, we investigated the negative regulatory effect of the global regulator MtrA on avermectin biosynthesis and its effects on morphological differentiation and cell growth, and elucidated its transcriptional regulatory mechanism. Our findings indicate that MtrA plays crucial roles not only in the biosynthesis of avermectin but also in coordinating intricate physiological processes in S. avermitilis. These findings provide insights into the synthesis of avermectin and shed light on the primary and secondary metabolism of S. avermitilis mediated by OmpR-family regulators.
Anti-EGFR ScFv functionalized exosomes delivering LPCAT1 specific siRNAs for inhibition of lung cancer brain metastases
Authors: Jiang Jun , Lu Yuan , Chu Jie , Zhang Xiao , Xu Chao , Liu Shaojie , Wan Zhuo , Wang Jiawei , Zhang Lu , Liu Kui , Liu Zhenhua , Yang Angang , Ren Xinling , Zhang Rui 
Published: April 2024

AbstractBrain metastasis (BM) is one of the leading causes of cancer-related deaths in patients with advanced non-small cell lung cancer (NSCLC). However, limited treatments are available due to the presence of the blood-brain barrier (BBB). Upregulation of lysophosphatidylcholine acyltransferase 1 (LPCAT1) in NSCLC has been found to promote BM. Conversely, downregulating LPCAT1 significantly suppresses the proliferation and metastasis of lung cancer cells. In this study, we firstly confirmed significant upregulation of LPCAT1 in BM sites compared to primary lung cancer by analyzing scRNA dataset. We then designed a delivery system based on a single-chain variable fragment (scFv) targeting the epidermal growth factor receptor (EGFR) and exosomes derived from HEK293T cells to enhance cell-targeting capabilities and increase permeability. Next, we loaded LPCAT1 siRNA (siLPCAT1) into these engineered exosomes (exoscFv). This novel scFv-mounted exosome successfully crossed the BBB in an animal model and delivered siLPCAT1 to the BM site. Silencing LPCAT1 efficiently arrested tumor growth and inhibited malignant progression of BM in vivo without detectable toxicity. Overall, we provided a potential platform based on exosomes for RNA interference (RNAi) therapy in lung cancer BM.
Comprehensive HIV knowledge and associated factors among reproductive-age women: analysis of the Gambia Demographic and Health Survey 2019/2020
Authors: Tsegaw Menen , Mulat Bezawit , Shitu Kegnie , Barrow Amadou 
Published: April 2024

Abstract
Introduction
Globally, there are 37.7 million people living with human immunodeficiency virus (HIV). So far, there is no study done in Gambia which assessed comprehensive HIV knowledge and its associated factors. Therefore, this study aims to assess comprehensive HIV knowledge and its associated factors among reproductive-age women in Gambia.

Objective
To assess the prevalence of comprehensive HIV knowledge and its associated factors among reproductive-age women in Gambia.

Methods
The study used the Gambian Demographic and Health Survey, which was conducted from 21 November 2019 to 30 March 2020 in Gambia. The survey employed a stratified two-stage cluster sampling technique to recruit study participants. Logistic regression analysis was used to identify factors associated with HIV comprehensive knowledge. Statistical significance was declared at a P value of less than 0.05 with a 95% confidence interval (CI).

Results
The overall prevalence of comprehensive HIV knowledge was 27.1% (25.1–36.2%). Older age [adjusted odds ratio (AOR) of 1.20 (95% CI 1.16–1.26)], using contraceptive [AOR of 1.15 (95% CI 1.01–1.31)], higher education [AOR of 4.73 (95% CI 3.86–5.81)], rich wealth quintile [AOR of 1.61 (95% CI 1.37–1.87)], media exposure [AOR of 1.76 (95% CI 1.39–2.23)], ever tested for HIV [AOR of 1.55 (95% CI 1.42–1.74)], visited health facility within the last 12 months [AOR of 1.26 (95% CI 1.12–1.41)] and decision-making autonomy [AOR of 1.42 (95% CI 1.27–1.60)] were positively associated with comprehensive HIV knowledge. However, being married [AOR of 0.72 (95% CI 0.62–0.82)] was negatively associated with comprehensive HIV knowledge.

Conclusions
The prevalence of comprehensive HIV knowledge was low in Gambia. Educational interventions that focused mainly on awareness creation about HIV/AIDS should be designed especially for married women and lower socio-economic status. An effort has to be made to address those disparities at the national level.
The protein composition of exosomes released by prostate cancer cells is distinctly regulated by androgen receptor-antagonists and -agonist to stimulate growth of target cells
Authors: Atri Roozbahani Golnaz , Kokal-Ribaudo Miriam , Heidari Horestani Mehdi , Pungsrinont Thanakorn , Baniahmad Aria 
Published: April 2024

Abstract
Background
Prostate cancer (PCa) is a prevalent malignancy in men worldwide, ranking as the second leading cause of cancer-related death in Western countries. Various PCa hormone therapies, such as androgen receptor (AR)-antagonists or supraphysiological androgen level (SAL) reduce cancer cell proliferation. However, treated cells may influence the growth of neighboring cells through secreted exosomes in the tumor microenvironment (TME). Here, the change of protein content of exosomes secreted from PCa cells through treatment with different AR-antagonists or SAL has been analyzed.

Methods
Isolation of exosomes via ultracentrifugation of treated human PCa LNCaP cells with AR-agonist and various AR-antagonists; analysis of cellular senescence by detection of senescence associated beta galactosidase activity (SA β-Gal); Western blotting and immunofluorescence staining; Mass spectrometry (MS-spec) of exosomes and bioinformatic analyses to identify ligand-specific exosomal proteins. Growth assays to analyze influence of exosomes on non-treated cells.

Results
MS-spec analysis identified ligand-specific proteins in exosomes. One thousand seventy proteins were up- and 52 proteins downregulated by SAL whereas enzalutamide upregulated 151 proteins and downregulated 42 exosomal proteins. The bioinformatic prediction indicates an up-regulation of pro-proliferative pathways. AR ligands augment hub factors in exosomes that include AKT1, CALM1, PAK2 and CTNND1. Accordingly, functional assays confirmed that the isolated exosomes from AR-ligand treated cells promote growth of untreated PCa cells.

Conclusion
The data suggest that the cargo of exosomes is controlled by AR-agonist and -antagonists and distinct among the AR-antagonists. Further, exosomes promote growth that might influence the TME. This finding sheds light into the complex interplay between AR signaling and exosome-mediated communication between PCa cells.
Melanocytes in regenerative medicine applications and disease modeling
Authors: Coutant Kelly , Magne Brice , Ferland Karel , Fuentes-Rodriguez Aurélie , Chancy Olivier , Mitchell Andrew , Germain Lucie , Landreville Solange 
Published: April 2024

AbstractMelanocytes are dendritic cells localized in skin, eyes, hair follicles, ears, heart and central nervous system. They are characterized by the presence of melanosomes enriched in melanin which are responsible for skin, eye and hair pigmentation. They also have different functions in photoprotection, immunity and sound perception. Melanocyte dysfunction can cause pigmentary disorders, hearing and vision impairments or increased cancer susceptibility. This review focuses on the role of melanocytes in homeostasis and disease, before discussing their potential in regenerative medicine applications, such as for disease modeling, drug testing or therapy development using stem cell technologies, tissue engineering and extracellular vesicles.
Provider assessment of the temporomandibular joint in Juvenile idiopathic arthritis: a retrospective analysis from the CARRA database
Authors: Costello Anna , Twilt Marinka , Lerman Melissa A. ,   for the CARRA Registry Investigators
Published: April 2024

Abstract
Background
Temporomandibular joint (TMJ) involvement is an often underrecognized complication of juvenile idiopathic arthritis (JIA) that can cause decreased mandibular growth, altered facial morphology, and orofacial pain. It is estimated that the TMJ is affected in 30–45% of children with JIA. Standardized physical examination and imaging evaluations are important in accurately assessing active TMJ arthritis and sequalae. Little is known about the rate at which providers evaluate TMJ involvement in their clinical practice.

Methods
Data were obtained from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry. Data fields related to assessment for TMJ arthritis were added in 2019. Patients were included in the study if they had a diagnosis of JIA and had data recorded between January 2020 and August 2021. Standard descriptive statistics were used to describe demographic and clinical features.

Results
A total of 17,761 visits were reviewed for a total of 7473 patients with JIA. A total of 52.7% of patients had maximal mouth opening (MMO) recorded as finger breadths or total incisal distance (TID). Only 8% had TID measured. A total of 5.0% had MRI with contrast performed. A total of 939 patients had a diagnosis of TMJ arthritis. Of these, 28.5% had an MRI documented, 83% had an MMO documented, and 40% had TID measured. Few patient-level characteristics were statistically related to having MMO assessed. MRI was more likely to be obtained in older and in female patients. MMO was recorded at a given visit > 80% of the time at 17 sites, and it was recorded < 1% of the time at 8 sites. MRIs were infrequently performed at all sites, with 27 sites having no MRIs obtained and only 7 sites having an MRI obtained at > 10% of visits.

Conclusions
MMO is not consistently measured in patients with JIA, and it is rarely measured quantitatively. Similarly, TMJ MRIs are rarely obtained in patients with JIA. Site of care is more associated with TMJ assessments than patient-level characteristics. These data suggest that provider education is needed to improve the assessment of the TMJ in patients with JIA to enable earlier recognition and prevent long-term complications.
Synergistic efficacy of repetitive peripheral magnetic stimulation on central intermittent theta burst stimulation for upper limb function in patients with stroke: a double-blinded, randomized controlled trial
Authors: Chang Chi-Shou , Chen Chia-Ling , Chen Rou-Shayn , Chen Hsieh-Ching , Chen Chung-Yao , Chung Chia-Ying , Wu Katie Pei-Hsuan , Wu Ching-Yi , Lin Keh-chung 
Published: April 2024

Abstract
Background
Non-invasive techniques such as central intermittent theta burst stimulation (iTBS) and repetitive peripheral magnetic stimulation (rPMS) have shown promise in improving motor function for patients with stroke. However, the combined efficacy of rPMS and central iTBS has not been extensively studied. This randomized controlled trial aimed to investigate the synergistic effects of rPMS and central iTBS in patients with stroke.

Method
In this study, 28 stroke patients were randomly allocated to receive either 1200 pulses of real or sham rPMS on the radial nerve of the affected limb, followed by 1200 pulses of central iTBS on the ipsilesional hemisphere. The patients received the intervention for 10 sessions over two weeks. The primary outcome measures were the Fugl-Meyer Assessment-Upper Extremity (FMA-UE) and the Action Research Arm Test (ARAT). Secondary outcomes for activities and participation included the Functional Independence Measure-Selfcare (FIM-Selfcare) and the Stroke Impact Scale (SIS). The outcome measures were assessed before and after the intervention.

Results
Both groups showed significant improvement in FMA-UE and FIM-Selfcare after the intervention (p < 0.05). Only the rPMS + iTBS group had significant improvement in ARAT-Grasp and SIS-Strength and activity of daily living (p < 0.05). However, the change scores in all outcome measures did not differ between two groups.

Conclusions
Overall, the study’s findings suggest that rPMS may have a synergistic effect on central iTBS to improve grasp function and participation. In conclusion, these findings highlight the potential of rPMS as an adjuvant therapy for central iTBS in stroke rehabilitation. Further large-scale studies are needed to fully explore the synergistic effects of rPMS on central iTBS.

Trial registration
This trial was registered under ClinicalTrials.gov ID No.NCT04265365, retrospectively registered, on February 11, 2020.
Multilevel modeling analysis of bottle feeding and its determinants among children 0–23 months in East Africa: evidence from recent DHS data (2015–2022)
Authors: Terefe Bewuketu , Habtie Adane , Chekole Bogale 
Published: April 2024

Abstract
Background
Despite breastfeeding recommendations, the prevalence and length of breast milk feeding in developing nations is rapidly decreasing, with bottle feeding taking its place. This reduces the effectiveness of breastfeeding and is associated with diarrheal disease mortality and morbidity. The purpose of this study was to determine the prevalence, distribution, and determinants of bottle feeding among under-two-year-old children in the region.

Methods
The ten East African countries’ Demographic and Health Surveys (DHS) recent data from 2015 to 2022 was used. The data were weighted using sample weights for probability sampling and nonresponse. The study used 43,150 weighted children. A multi-level logistic regression model was used, and P - values of ≤ 0.2 and < 0.05 were used to declare candidate variables in the binary, and multivariable to declare significant variables, respectively.

Results
The prevalence of bottle feeding among children under-two-years-old in East Africa was 10.08% (95% CI 9.79, 10.36), ranging from 4.04% (95% CI 3.56, 4.53) in Tanzania to 33.40% (95% CI 32.72, 34.08) in Kenya. High antenatal care communities (AOR 1.22; 95% CI 1.11, 1.35), mothers aged 25–34 years (AOR 1.17; 95% CI 1.06, 1.28), high wealth index communities (AOR 1.12; 95% CI 1.02,1.25), women who had at least one types mass media exposure (AOR 1.64; 95% CI 1.53, 1.77), women from communities with high level mass media exposure (AOR 1.36; 95% CI 1.23, 1.52), given first birth after teenage years (AOR 1.17; 95% CI 1.09, 1.26), having more than one health visit in the year (AOR 1.37; 95% CI 1.27,1.47), multiple children (AOR 1.46; 95% CI 1.22, 1.75) were associated with higher rates of bottle feeding. Whereas a primary education (AOR 0.51; 95% CI 0.47, 0.54), having 3–5 living children (AOR 0.86; 95% CI 0.79, 0.95), a rural setting (AOR 0.53; 95% CI 0.49, 0.58), and a long distance from health facilities (AOR 0.84; 95% CI, 0.78, 0.91) were associated with lower rates of bottle feeding.

Conclusions
The overall prevalence of bottle feeding was moderate in East African countries. Improving the availability and accessibility of health facilities to mothers, utilizing maternal healthcare, and media exposure will contribute to a significant decrease in the inappropriate bottle feeding of children in East Africa.