bluuebunny/crossref_metadata_2025_split huggingface dataset:
A concept of “cultural competence” among public health nurses in Japan
Authors: Hoshi Momoko , Nakano Kumiko , Iwamoto Megumu , Omori Junko 
Published: March 2024

AbstractObjectivesTo clarify the conceptual structure of “cultural competence (CC)” among Japanese public health nurses (PHNs), to enhance culturally appropriate support.MethodsA modified grounded theory approach (M‐GTA) was used. A total of 11 municipal PHNs participated in this study. Data were collected through semistructured interviews. Interviews were audiotaped and transcribed. A comparative analysis was performed using M‐GTA.ResultFive categories were identified. Japanese PHNs supported foreign residents while (1) maintaining a sincere attitude with curiosity and humility toward others regarding CC; (2) deepening their realization of issues arising from awareness of one's own and other cultures; (3) developing their knowledge about clients’ cultures and the surrounding environments; and (4) mastering the skills of building a relationship with clients while creating supportive systems surrounding them. As they gained more experience in supporting foreign residents, as indicated in the above categories, their cultural competence grew, allowing them to (5) gain experience while encountering individuals without holding stereotypes and prejudice.ConclusionsThe concepts of CC that emerged are based on cultural humility and are cultivated through supportive activities. The concepts identified in this study can serve as educational guidelines for health nurses and other care providers in Japan.
Innovation in practice: A deviant case analysis of a locally developed assessment tool used in a psychiatric and addiction clinic in Sweden
Authors: Härd Sofia 
Published: March 2024

AbstractThis article analyses the use of a locally developed assessment tool designed to generate aggregated data to evaluate the work of a psychiatric and addiction clinic. The use of tools, methods and interventions in the Swedish social services is usually based on recommendations in national guidelines established by the National Board of Health and Welfare (NBHW). Thus, a locally produced and systematically used assessment tool provides an interesting deviant case for discussing knowledge production and use from the perspective of evidence‐based practice. The assessment tool was characterised by the specific psychiatric and addiction clinic context, where local needs and prerequisites were prioritised over the recommendations found in NBHW guidelines. The empirics comprise interviews with 12 professionals who used the tool, where experience of using the tool was analysed using a thematic analysis. The findings can be summarised in three main conclusions. First, tinkering of tools and methods is not necessarily associated with limited practice applicability or relevance. Second, professionals are more likely to appreciate a tool if that tool is designed with a treatment and conversation rationality in mind. Third, rather than perceived as more valid than other types of knowledge, NBHW‐recommended tools are associated with a certain shape or style – but a shape or style that is permeated by legitimacy.
What is the environmental impact of a blood transfusion? A life cycle assessment of transfusion services across England
Authors: Hibbs Stephen P. , Thomas Stephen , Agarwal Nikhil , Andrews Charlotte , Eskander Sylvia , Abdalla Aaliyah Sharif , Staves Julie , Eckelman Matthew J. , Murphy Michael F. 
Published: March 2024

AbstractBackgroundHealthcare activities significantly contribute to greenhouse gas (GHG) emissions. Blood transfusions require complex, interlinked processes to collect, manufacture, and supply. Their contribution to healthcare emissions and avenues for mitigation is unknown.Study Design and MethodsWe performed a life cycle assessment (LCA) for red blood cell (RBC) transfusions across England where 1.36 million units are transfused annually. We defined the process flow with seven categories: donation, transportation, manufacturing, testing, stockholding, hospital transfusion, and disposal. We used direct measurements, manufacturer data, bioengineering databases, and surveys to assess electrical power usage, embodied carbon in disposable materials and reagents, and direct emissions through transportation, refrigerant leakage, and disposal.ResultsThe central estimate of carbon footprint per unit of RBC transfused was 7.56 kg CO2 equivalent (CO2eq). The largest contribution was from transportation (2.8 kg CO2eq, 36% of total). The second largest was from hospital transfusion processes (1.9 kg CO2eq, 26%), driven mostly by refrigeration. The third largest was donation (1.3 kg CO2eq, 17%) due to the plastic blood packs. Total emissions from RBC transfusion are ~10.3 million kg CO2eq/year.DiscussionThis is the first study to estimate GHG emissions attributable to RBC transfusion, quantifying the contributions of each stage of the process. Primary areas for mitigation may include electric vehicles for the blood service fleet, improving the energy efficiency of refrigeration, using renewable sources of electricity, changing the plastic of blood packs, and using methods of disposal other than incineration.
Genomic analysis of inter-hospital transmission of vancomycin-resistant
Enterococcus faecium
sequence type 80 isolated during an outbreak in Hiroshima, Japan
Authors: Segawa Takaya , Masuda Kanako , Hisatsune Junzo , Ishida-Kuroki Kasumi , Sugawara Yo , Kuwabara Masao , Nishikawa Hideki , Hiratsuka Takahiro , Aota Tatsuaki , Tao Yasuo , Iwahashi Yoshimi , Ueda Kuniko , Mae Kaori , Masumoto Ken , Kitagawa Hiroki , Komatsuzawa Hitoshi , Ohge Hiroki , Sugai Motoyuki 
Published: March 2024

ABSTRACT

Outbreaks caused by vancomycin-resistant enterococci that transcend jurisdictional boundaries are occurring worldwide. This study focused on a vancomycin-resistant enterococcus outbreak that occurred between 2018 and 2021 across two cities in Hiroshima, Japan. The study involved genetic and phylogenetic analyses using whole-genome sequencing of 103 isolates of vancomycin-resistant enterococci to identify the source and transmission routes of the outbreak. Phylogenetic analysis was performed using core genome multilocus sequence typing and core single-nucleotide polymorphisms; infection routes between hospitals were inferred using BadTrIP. The outbreak was caused by
Enterococcus faecium
sequence type (ST) 80 carrying the
vanA
plasmid, which was derived from strain A10290 isolated in India. Of the 103 isolates, 93 were
E. faecium
ST80 transmitted across hospitals. The circular
vanA
plasmid of the Hiroshima isolates was similar to the
vanA
plasmid of strain A10290 and transferred from
E. faecium
ST80 to other STs of
E. faecium
and other
Enterococcus
species by conjugation. The inferred transmission routes across hospitals suggest the existence of a central hospital serving as a hub, propagating vancomycin-resistant enterococci to multiple hospitals. Our study highlights the importance of early intervention at the key central hospital to prevent the spread of the infection to small medical facilities, such as nursing homes, with limited medical resources and a high number of vulnerable individuals.
Deep metagenomic characterization of the gut virome in pregnant women with preeclampsia
Authors: Lv Li-Juan , Wen Ji-Ying , Zhang Yue , Guo Ruo-Chun , Li Hui , Yi Zhou-Ting , He Tian-Wen , Chen Min-Chai , Chen Yang , Wu Xiao-Yan , Li Sheng-hui , Kang Jian , Hou Ya-Ping , Yan Qiu-long , Yin Ai-Hua 
Published: March 2024

ABSTRACT

Preeclampsia (PE), a pregnancy-specific syndrome, has been associated with the gut bacteriome. Here, to investigate the impact of the gut virome on the development of PE, we identified over 8,000 nonredundant viruses from the fecal metagenomes of 40 early-onset PE and 37 healthy pregnant women and profiled their abundances. Comparison and correlation analysis showed that PE-enriched viruses frequently connected to
Blautia
species enriched in PE. By contrast, bacteria linked to PE-depleted viruses were often the Bacteroidaceae members such as
Bacteroides
spp.,
Phocaeicola
spp.,
Parabacteroides
spp., and
Alistipes shahii
. In terms of viral function, PE-depleted viruses had auxiliary metabolic genes that participated in the metabolism of simple and complex polysaccharides, sulfur metabolism, lipopolysaccharide biosynthesis, and peptidoglycan biosynthesis, while PE-enriched viruses had a gene encoding cyclic pyranopterin monophosphate synthase, which seemed to be special, that participates in the biosynthesis of the molybdenum cofactor. Furthermore, the classification model based on gut viral signatures was developed to discriminate PE patients from healthy controls and showed an area under the receiver operating characteristic curve of 0.922 that was better than that of the bacterium-based model. This study opens up new avenues for further research, providing valuable insights into the PE gut virome and offering potential directions for future mechanistic and therapeutic investigations, with the ultimate goal of improving the diagnosis and management of PE.

IMPORTANCE

The importance of this study lies in its exploration of the previously overlooked but potentially critical role of the gut virome in preeclampsia (PE). While the association between PE and the gut bacteriome has been recognized, this research takes a pioneering step into understanding how the gut virome, represented by over 8,000 nonredundant viruses, contributes to this condition. The findings reveal intriguing connections between PE-enriched viruses and specific gut bacteria, such as the prevalence of
Blautia
species in individuals with PE, contrasting with bacteria linked to PE-depleted viruses, including members of the Bacteroidaceae family. These viral interactions and associations provide a deeper understanding of the complex dynamics at play in PE.
Polymorphic transformations of titanium oxides contribute to economic uranium mineralization in sandstone
Authors: Yin Shuo , Yan Zhaobin , Fu Jiali , Zhang Wen , Liu Hong , Xia Fei , Wang Qingfei 
Published: March 2024

Abstract
Sandstone-hosted uranium (U) deposits provide a significant U resource for nuclear energy worldwide. Driven by redox reactions, tetravalent uranium-bearing minerals are commonly associated with reductants (e.g., pyrite and organic matter). However, numerous observations have revealed that tetravalent uranium-bearing minerals can spatially coexist with chemically stabilized titanium oxides in sandstone-hosted U deposits, requiring a complementary mechanism to interpret these findings. We present a new model based on in situ texture, trace-element content, and titanium isotopic ratio, as well as polymorph type and related transformation for titanium oxides from the Yaojia Formation of the southwestern Songliao Basin in northeast China. Specifically, in our model, abundant nanopores were generated during the spontaneous transformation of anatase to rutile, producing a porous material for hexavalent U adsorption. Facilitated by a U-rich source rock, adsorbed U in porous titanium oxide from the lower Yaojia Formation was up to several thousand parts per million. In order to minimize surface energy, a subsequent decrease in surface area by merging small pores is inevitable. When the evolved surface area was small enough, hexavalent U would be desorbed and subsequently transformed to tetravalent U by local reductants, forming uraninite nanoparticles on the surface of U-rich rutile with relatively large pores. Our newly proposed mechanism not only contributes to a better understanding of economic U mineralization in sandstone, but also suggests that U occurred as uranium oxide instead of brannerite in sandstone-hosted U deposits, providing a nano-mineralogical perspective required for industrial processing.
ICGA-GPT: report generation and question answering for indocyanine green angiography images
Authors: Chen Xiaolan , Zhang Weiyi , Zhao Ziwei , Xu Pusheng , Zheng Yingfeng , Shi Danli , He Mingguang 
Published: March 2024

BackgroundIndocyanine green angiography (ICGA) is vital for diagnosing chorioretinal diseases, but its interpretation and patient communication require extensive expertise and time-consuming efforts. We aim to develop a bilingual ICGA report generation and question-answering (QA) system.MethodsOur dataset comprised 213 129 ICGA images from 2919 participants. The system comprised two stages: image–text alignment for report generation by a multimodal transformer architecture, and large language model (LLM)-based QA with ICGA text reports and human-input questions. Performance was assessed using both qualitative metrics (including Bilingual Evaluation Understudy (BLEU), Consensus-based Image Description Evaluation (CIDEr), Recall-Oriented Understudy for Gisting Evaluation-Longest Common Subsequence (ROUGE-L), Semantic Propositional Image Caption Evaluation (SPICE), accuracy, sensitivity, specificity, precision and F1 score) and subjective evaluation by three experienced ophthalmologists using 5-point scales (5 refers to high quality).ResultsWe produced 8757 ICGA reports covering 39 disease-related conditions after bilingual translation (66.7% English, 33.3% Chinese). The ICGA-GPT model’s report generation performance was evaluated with BLEU scores (1–4) of 0.48, 0.44, 0.40 and 0.37; CIDEr of 0.82; ROUGE of 0.41 and SPICE of 0.18. For disease-based metrics, the average specificity, accuracy, precision, sensitivity and F1 score were 0.98, 0.94, 0.70, 0.68 and 0.64, respectively. Assessing the quality of 50 images (100 reports), three ophthalmologists achieved substantial agreement (kappa=0.723 for completeness, kappa=0.738 for accuracy), yielding scores from 3.20 to 3.55. In an interactive QA scenario involving 100 generated answers, the ophthalmologists provided scores of 4.24, 4.22 and 4.10, displaying good consistency (kappa=0.779).ConclusionThis pioneering study introduces the ICGA-GPT model for report generation and interactive QA for the first time, underscoring the potential of LLMs in assisting with automated ICGA image interpretation.
Epidemiology of musculoskeletal injury in professional and amateur golfers: a systematic review and meta-analysis
Authors: Williamson Thomas R , Kay Robert S , Robinson Patrick G , Murray Andrew D , Clement Nicholas D 
Published: March 2024

ObjectiveTo determine the prevalence and incidence of musculoskeletal injury in amateur and professional golfers, and to identify common injury sites and factors associated with increased injury frequency.DesignSystematic epidemiological review and meta-analysis.Data sourcesPubMed (Medline), Embase, the Cochrane Library and SPORTDiscus were searched in September 2023.Eligibility criteriaStudies published in the English language reporting the incidence or prevalence of musculoskeletal injuries in golfers at all anatomical sites.Results20 studies (9221 golfers, 71.9% male, 28.1% female) were included, with mean age 46.8 years. Lifetime injury prevalence was significantly greater in professional golfers (73.5% (95% CI: 47.3% to 93.0%)) than amateur golfers (56.6% (95% CI: 47.4% to 65.5%); relative risk (RR)=1.50, p<0.001). Professional golfers had a significantly greater lifetime prevalence of hand and wrist (RR=3.33, p<0.001) and lower back injury (RR=3.05, p<0.001). Soft tissue injuries were most common, and diagnoses were typically non-specific. Injury frequency was not associated with age or sex. Two studies reported a greater injury risk in amateur golfers playing more than three and four rounds per week.ConclusionOver half of golfers are at risk of sustaining a musculoskeletal injury during their lifetime. Risks and patterns of injury differ between professional and amateur golfers, with professionals significantly more likely to develop lower back, and hand and wrist injuries. A recent international consensus statement on the reporting of injury and illness in golf should aid consistency in future research assessing the epidemiology of specific diagnoses, informing golf injury prevention and management strategies.PROSPERO registration numberCRD42023408738.
Assessing patient risk, benefit and outcomes in drug development: an observational study of regorafenib clinical trials
Authors: Dennis Brody , Bratten Chance , Hughes Griffin K , Peña Andriana M , McIntire Ryan , Ladd Chase , Gardner Brooke , Nowlin William , Livingston Reagan , Tuia Jordan , Haslam Alyson , Prasad Vinay , Vassar Matt 
Published: March 2024

ObjectiveOur objective of this study was to analyse all oncological clinical trials using regorafenib to create a complete risk/benefit profile for the drug.BackgroundCreating a novel chemotherapy is costly both in time and capital spent for drug manufacturers. To regenerate what they’ve spent, drug manufacturers may attempt to repurpose their medications for new indications via clinical trials. To fully understand the risk/benefits in comparison to a drug’s efficacy, a pooled analysis must be completed.MethodsWe screened PubMed, Embase, Cochrane (CENTRAL) and ClinicalTrials.gov for trials of regorafenib used to treat solid cancers. Next, we extracted median progression-free survival and overall survival in months, adverse event rates and objective response rate (ORR). Studies were deemed positive, negative or indeterminate based on their pre-specified endpoints and tolerability.Results56 clinical trials were included in our final sample, with 4960 total participants across 13 indications. Most studies (44 of 56; 78.75%) were non-blinded, and a majority were non-randomised (41 of 56; 73.21%). Trials for colorectal cancer started out as positive but became more negative over time. Cumulative risk to patients increased over time while ORR stayed consistently low.ConclusionsOur findings suggest that since regorafenib’s original Food and Drug Administration (FDA) approval, the risk profile for its original indication increased. The amount of non-randomised, single-arm trials in our sample size was concerning, indicating that higher quality research must be conducted. Our results propose that regorafenib’s efficacy and safety may be more impactful in cancers other than its FDA approvals.
Operational priorities for engaging with India’s private healthcare sector for the control of tuberculosis: a modelling study
Authors: Ricks Saskia , Singh Ananya , Sodhi Ridhima , Pal Arnab , Arinaminpathy Nimalan 
Published: March 2024

ObjectivesTo estimate the potential impact of expanding services offered by the Joint Effort for Elimination of Tuberculosis (JEET), the largest private sector engagement initiative for tuberculosis (TB) in India.DesignWe developed a mathematical model of TB transmission dynamics, coupled with a cost model.SettingAhmedabad and New Delhi, two cities with contrasting levels of JEET coverage.ParticipantsEstimated patients with TB in Ahmedabad and New Delhi.InterventionsWe investigated the epidemiological impact of expanding three different public–private support agency (PPSA) services: provider recruitment, uptake of cartridge-based nucleic acid amplification tests and uptake of adherence support mechanisms (specifically government supplied fixed-dose combination drugs), all compared with a continuation of current TB services.ResultsOur results suggest that in Delhi, increasing the use of adherence support mechanisms among private providers should be prioritised, having the lowest incremental cost-per-case-averted between 2020 and 2035 of US$170 000 (US$110 000–US$310 000). Likewise in Ahmedabad, increasing provider recruitment should be prioritised, having the lowest incremental cost-per-case averted of US$18 000 (US$12 000–US$29 000).ConclusionResults illustrate how intervention priorities may vary in different settings across India, depending on local conditions, and the existing degree of uptake of PPSA services. Modelling can be a useful tool for identifying these priorities for any given setting.
Development and applications of the Anaesthetists’ Non-Technical Skills behavioural marker system: a systematic review
Authors: Kang Jiamin , Hu Jiale , Yan Chunji , Xing Xueyan , Tu Shumin , Zhou Fang 
Published: March 2024

ObjectivesTo comprehensively synthesise evidence regarding the validity and reliability of the Anaesthetists’ Non-Technical Skills (ANTS) behavioural marker system and its application as a tool for the training and assessment of non-technical skills to improve patient safety.DesignSystematic review.Data sourcesWe employed a citation search strategy. The Scopus and Web of Science databases were searched for articles published from 2002 to May 2022.Eligibility criteriaEnglish-language publications that applied the ANTS system in a meaningful way, including its use to guide data collection, analysis and reporting.Data extraction and synthesisStudy screening, data extraction and quality assessment were performed by two independent reviewers. We appraised the quality of included studies using the Joanna Briggs Institute Critical Appraisal Checklists. A framework analysis approach was used to summarise and synthesise the included articles.Results54 studies were identified. The ANTS system was applied across a wide variety of study objectives, settings and units of analysis. The methods used in these studies varied and included quantitative (n=42), mixed (n=8) and qualitative (n=4) approaches. Most studies (n=47) used the ANTS system to guide data collection. The most commonly reported reliability statistic was inter-rater reliability (n=35). Validity evidence was reported in 51 (94%) studies. The qualitative application outcomes of the ANTS system provided a reference for the analysis and generation of new theories across disciplines.ConclusionOur results suggest that the ANTS system has been used in a wide range of studies. It is an effective tool for assessing non-technical skills. Investigating the methods by which the ANTS system can be evaluated and implemented for training within clinical environments is anticipated to significantly enhance ongoing enhancements in staff performance and patient safety.PROSPERO registration numberCRD42022297773.