bluuebunny/crossref_metadata_2025_split huggingface dataset:
The development of cultural competences in nursing students and their significance in shaping the future work environment: a pilot study
Authors: Ličen Sabina , Prosen Mirko 
Published: November 2023

AbstractBackgroundWorking in a culturally diverse environment entails a moral and professional responsibility to provide culturally competent care. This has been recognised as an important measure to reduce health inequalities, improve the quality of care and increase patient satisfaction. The aim of this study was to assess the level of cultural competence in nursing students a decade after the introduction of transcultural nursing content into the nursing curriculum in Slovenia.MethodsA descriptive cross-sectional design with 180 s-year nursing students as a convenience sample was used. Cultural competence was assessed using the Cultural Competence Assessment Tool (CCATool) via an online survey. IBM SPSS facilitated statistical analysis, using descriptive statistics and inferential methods, including the chi-square test. Non-parametric tests (Mann Whitney U, Kruskal-Wallis H and Wilcoxon signed-rank) were used for non-normally distributed data (Shapiro-Wilk test, p < 0.05). The significance was set at p ≤ 0.05.ResultsThe results indicate that students demonstrate a high level of cultural competence, although there is room for improvement in terms of cultural sensitivity, as determined by coding the CCATool. The results also show a remarkable contrast between their self-assessed scores and the objective scores obtained from CCATool coding of the statements in each subscale (p < 0.005). In addition, significant differences (p = 0.002) are found in subscale “Cultural Knowledge” particularly between students who have lived abroad for more than 6 months and those who have not. The latter group has a higher score in the CCATool, indicating greater cultural knowledge.ConclusionsThe study suggests that the presence of transcultural elements in the Slovenian nursing curriculum is associated with higher self-reported levels of cultural competence among nursing students, although the present research design does not allow for causal interpretations. This competence is of immense importance in preparing students for their future professional environment. However, it is crucial to further refine the nursing curriculum, especially through greater integration of transcultural content in all health disciplines. In addition, the introduction of innovative teaching and learning approaches can better prepare students to deal with the diverse cultural experiences they will encounter in their nursing careers.
Effects of chromosomal translocation characteristics on fertilization and blastocyst development — a retrospective cohort study
Authors: Wu Shanshan , Zhang Jianrui , Guan Yichun , Ren Bingnan , Zhang Yuchao , Liu Xinmi , Wang Kexin , Zhang Mingmei , Li Zhen 
Published: November 2023

Abstract
Objective
To determine the effect of different translocation characteristics on fertilization rate and blastocyst development in chromosomal translocation patients.

Methods
This retrospective cohort study was conducted at the Third Affiliated Hospital of Zhengzhou University From January 2017 to December 2022.All couples were diagnosed as reciprocal translocation or Robertsonian translocation by karyotype of peripheral blood lymphocytes test. After adjusting for confounding factors, the effect of chromosomal rearrangement characteristics, such as carrier sex, translocation type, chromosome length and break sites, on fertilization rate and embryo development were analysed separately using multiple linear regression.

Results
In cases of Robertsonian translocation (RobT), the carrier sex plays an independent role in fertilization rate, and the male carriers was lower than that of female carriers (76.16% vs.86.26%, P = 0.009). In reciprocal translocation (RecT), the carrier sex, chromosome types and break sites had no influence on fertilization rate, blastocyst formation rate (P > 0.05). However, patients with human longer chromosomal (chromosomes 1–5) translocation have a lower available blastocyst formation rate (Group AB vs. Group CD: 41.49%vs.46.01%, P = 0.027). For male carriers, the translocation types was an independent factor affecting the fertilization rate, and the RobT was the negative one (B = − 0.075, P = 0 0.009). In female carriers, we did not observe this difference (P = 0.227).

Conclusions
In patients with chromosomal translocation, the fertilization rate may be influenced by carrier sex and translocation type, chromosomes 1–5 translocation may adversely affect the formation of available blastocysts. Break sites have no role in fertilization and blastocyst development.
The TFPI2–PPARγ axis induces M2 polarization and inhibits fibroblast activation to promote recovery from post-myocardial infarction in diabetic mice
Authors: Guo Mengqi , Xia Zongyi , Hong Yefeng , Ji Hongwei , Li Fuhai , Liu Wenheng , Li Shaohua , Xin Hui , Tan Kai , Lian Zhexun 
Published: November 2023

Abstract
Background
Diabetes mellitus is one of the causes of poor ventricular remodelling and poor cardiac recovery after myocardial infarction (MI). We previously reported that tissue factor pathway inhibitor-2 (TFPI2) was downregulated in response to hyperglycaemia and that it played a pivotal role in extracellular matrix (ECM) degradation and cell migration. Nonetheless, the function and mechanism of TFPI2 in post-MI remodelling under diabetic conditions remain unclear. Therefore, in the present study, we investigated the role of TFPI2 in post-MI effects in a diabetic mouse model.

Results
TFPI2 expression was markedly decreased in the infarcted myocardium of diabetic MI mice compared with that in non-diabetic mice. TFPI2 knockdown in the MI mouse model promoted fibroblast activation and migration as well as matrix metalloproteinase (MMP) expression, leading to disproportionate fibrosis remodelling and poor cardiac recovery. TFPI2 silencing promoted pro-inflammatory M1 macrophage polarization, which is consistent with the results of TFPI2 downregulation and M1 polarization under diabetic conditions. In contrast, TFPI2 overexpression in diabetic MI mice protected against adverse cardiac remodelling and functional deterioration. TFPI2 overexpression also inhibited MMP2 and MMP9 expression and attenuated fibroblast activation and migration, as well as excessive collagen production, in the infarcted myocardium of diabetic mice. TFPI2 promoted an earlier phenotype transition of pro-inflammatory M1 macrophages to reparative M2 macrophages via activation of peroxisome proliferator-activated receptor gamma.

Conclusions
This study highlights TFPI2 as a promising therapeutic target for early resolution of post-MI inflammation and disproportionate ECM remodelling under diabetic conditions.
Barriers and facilitators of implementing electronic monitors to improve adherence and health outcomes in tuberculosis patients: protocol for a systematic review based on the Consolidated Framework for Implementation Research
Authors: Li Wenhui , Su Min , Zhang Weile , Fan Xiaojing , Li Renzhong , Gao Yulong , Wei Xiaolin 
Published: November 2023

Abstract
Background
Tuberculosis (TB) has been regarded as ‘a relentless scourge’, increasing morbidity and mortality and burdening vulnerable populations. Poor adherence to TB treatment and ineffective traditional interventions hinders TB control. A novel TB approach called ‘electronic monitors’, equipping medication boxes with daily audio or visual reminders for electronically monitoring medication intake, seems promising in improving adherence and health outcomes and overcoming the weaknesses of traditional interventions. However, no review has systematically examined and synthesized the influencing factors of implementing electronic monitors. Implementation research offers the means to analyse the influencing factors of the implementation and its process, fitting well with the aim of this review. Therefore, the widely recognized Consolidated Framework for Implementation Research (CFIR), which offers a common taxonomy for evaluating intervention implementation, will be adopted to systematically identify barriers and facilitators of the electronic monitors for improving adherence and health outcomes in patients with TB.

Methods and analysis
The systematic review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Literature research will be conducted in five electronic databases (Ovid MEDLINE, CINAHL, EMBASE, Cochrane Library and Web of Science) to identify the barriers and facilitators of implementing electronic monitors in patients with TB. The CFIR will be used as a guide for categorizing and synthesizing the barriers and facilitators. Study screening, data extraction, quality appraisal and data analysis will be conducted by two independent reviewers. The use of additional reviewers will solve any disagreements between the two reviewers.

Discussion
Given the increased prominence of TB epidemiology and the adherence problem of electronic monitors, there is a solid rationale for synthesizing the existing studies via the CFIR. The findings and conclusion of this review will lay bare the achievements and effectiveness of implementing electronic monitors, as well as the attendant gaps and limitations. Further strategies for facilitating the implementation of electronic monitors will also be explored. This review will be of essential significance for research and practice, supporting future academic research initiatives centred on patients with TB and aiding electronic monitor design in lowering the morbidity and mortality associated with TB disease.
Trial registration number: PROSPERO: CRD42023395747.
Factors associated with an increased risk of osteochondral injuries after patellar dislocations: a systematic review
Authors: Yi Zhi , Zhang Xiaohui , Wu Meng , Jiang Jin , Xia Yayi 
Published: November 2023

Abstract
Purpose
The purpose of the study was to summarize the available evidence and identify risk factors for osteochondral injuries (OCIs) after patellar dislocations.

Methods
A systematic literature review was conducted in PubMed, Embase, Web of Science, Cochrane Library, and China national knowledge infrastructure from inception to December 22, 2022, according to the preferred reporting items for systematic reviews and meta-analyses guidelines. Studies regarding risk factors for OCIs after patellar dislocations were included. Literature search, data extraction, and quality assessment were performed independently by two authors.

Results
A total of 16 studies with 1945 patients were included. The risk factors for OCIs after patellar dislocation were categorized into four main categories, including demographic characteristics, patellar depth and position, femoral trochlear morphology, and other risk factors in this study. Five and three studies supported the idea that male sex and skeletal maturation may be risk factors, respectively. Normal femoral trochlea (two studies) and complete medial patellofemoral ligament (MPFL) injuries (two studies) may be associated with the development of OCIs. Three studies show that ligamentous laxity or joint hypermobility may prevent OCIs. Patellar depth and position (eight studies) may not be associated with the development of OCIs.

Conclusions
Based on the available evidence, an increased risk of OCIs following patellar dislocation may be associated with male sex and skeletal maturation. Furthermore, normal femoral trochlea and complete MPFL injuries may increase the risk of OCIs, while factors such as ligamentous laxity or joint hypermobility may reduce the risk.

Level of Evidence

Level IV, systematic review of Level II and IV studies.
Subphenotypes in patients with acute respiratory distress syndrome treated with high-flow oxygen
Authors: Blot Pierre-Louis , Chousterman Benjamin G. , Santafè Manel , Cartailler Jérôme , Pacheco Andrés , Magret Mònica , Masclans Joan R. , Artigas Antoni , Roca Oriol , García-de-Acilu Marina 
Published: November 2023

Abstract
Background
Acute respiratory distress syndrome (ARDS) subphenotypes differ in outcomes and treatment responses. Subphenotypes in high-flow nasal oxygen (HFNO)-treated ARDS patients have not been investigated.

Objectives
To identify biological subphenotypes in HFNO-treated ARDS patients.

Methods
Secondary analysis of a prospective multicenter observational study including ARDS patients supported with HFNO. Plasma inflammation markers (interleukin [IL]-6, IL-8, and IL-33 and soluble suppression of tumorigenicity-2 [sST2]) and lung epithelial (receptor for advanced glycation end products [RAGE] and surfactant protein D [SP-D]) and endothelial (angiopoietin-2 [Ang-2]) injury were measured. These biomarkers and bicarbonate were used in K-means cluster analysis to identify subphenotypes. Logistic regression was performed on biomarker combinations to predict clustering. We chose the model with the best AUROC and the lowest number of variables. This model was used to describe the HAIS (High-flow ARDS Inflammatory Subphenotype) score.

Results
Among 41 HFNO patients, two subphenotypes were identified. Hyperinflammatory subphenotype (n = 17) showed higher biomarker levels than hypoinflammatory (n = 24). Despite similar baseline characteristics, the hyperinflammatory subphenotype had higher 60-day mortality (47 vs 8.3% p = 0.014) and longer ICU length of stay (22.0 days [18.0–30.0] vs 39.5 [25.5–60.0], p = 0.034). The HAIS score, based on IL-8 and sST2, accurately distinguished subphenotypes (AUROC 0.96 [95%CI: 0.90–1.00]). A HAIS score ≥ 7.45 was predictor of hyperinflammatory subphenotype.

Conclusion
ARDS patients treated with HFNO exhibit two biological subphenotypes that have similar clinical characteristics, but hyperinflammatory patients have worse outcomes. The HAIS score may identify patients with hyperinflammatory subphenotype and might be used for enrichment strategies in future clinical trials.
Liver organoid culture methods
Authors: Hu Yiqing , Hu Xiaoyi , Luo Jia , Huang Jiacheng , Sun Yaohan , Li Haoyu , Qiao Yinbiao , Wu Hao , Li Jianhui , Zhou Lin , Zheng Shusen 
Published: November 2023

AbstractOrganoids, three-dimensional structures cultured in vitro, can recapitulate the microenvironment, complex architecture, and cellular functions of in vivo organs or tissues. In recent decades, liver organoids have been developed rapidly, and their applications in biomedicine, such as drug screening, disease modeling, and regenerative medicine, have been widely recognized. However, the lack of repeatability and consistency, including the lack of standardized culture conditions, has been a major obstacle to the development and clinical application of liver organoids. It is time-consuming for researchers to identify an appropriate medium component scheme, and the usage of some ingredients remains controversial. In this review, we summarized and compared different methods for liver organoid cultivation that have been published in recent years, focusing on controversial medium components and discussing their advantages and drawbacks. We aimed to provide an effective reference for the development and standardization of liver organoid cultivation.
Impact on Survival of Early Versus Late Initiation of Adjuvant Chemotherapy After Pancreatic Adenocarcinoma Surgery: A Target Trial Emulation
Authors: Kirkegård Jakob , Ladekarl Morten , Lund Andrea , Mortensen Frank 
Published: November 2023

Abstract
Background
We examined the impact of early (0–4 weeks after discharge) versus late (> 4–8 weeks after discharge) initiation of adjuvant chemotherapy on pancreatic adenocarcinoma survival.

Methods
We used Danish population-based healthcare registries to emulate a hypothetical target trial using the clone-censor-weight approach. All eligible patients were cloned with one clone assigned to ‘early initiation’ and one clone assigned to ‘late initiation’. Clones were censored when the assigned treatment was no longer compatible with the actual treatment. Informative censoring was addressed using inverse probability of censoring weighting.

Results
We included 1491 patients in a hypothetical target trial, of whom 32.3% initiated chemotherapy within 0–4 weeks and 38.3% between > 4 and 8 weeks after discharge for pancreatic adenocarcinoma surgery; 206 (13.8%) initiated chemotherapy after > 8 weeks, and 232 (15.6%) did not initiate chemotherapy. Median overall survival was 30.4 and 29.9 months in late and early initiators, respectively. The absolute differences in OS, comparing late with early initiators, were 3.2% (95% confidence interval [CI] − 1.5%, 7.9%), − 0.7% (95% CI − 7.2%, 5.8%), and 3.2% (95% CI − 2.8%, 9.3%) at 1, 3, and 5 years, respectively. Late initiators had a higher increase in albumin levels as well as higher pretreatment albumin values.

Conclusions
Postponement of adjuvant chemotherapy up to 8 weeks after discharge from pancreatic adenocarcinoma surgery is safe and may allow more patients to receive adjuvant therapy due to better recovery.
Blue light photobiomodulation for reactivation of healing in wounds not responding to standard therapy
Authors: Ricci Elia , Pittarello Monica 
Published: November 2023

Objective: Blue light (410–430nm) has been suggested to be effective in the healing process of hard-to-heal wounds. The aim of this study was to test this hypothesis. Method: This single-centre observational study assessed the efficacy of photobiomodulation with blue light (120 seconds at a distance of 4cm from the wound bed once a week for four weeks) in activating healing in patients with hard-to-heal skin lesions (mean duration 23.9 months) of the lower limb that had not responded to four weeks of standard treatment. Results: A total of 59 patients were assessed. Wounds were divided into groups according to aetiology: hard-to-heal venous wound (30.5%); hard-to-heal arterial and mixed wounds (16.9%); hard-to-heal inflammatory wound (22.0%); other hard-to-heal wounds (13.6%); and acute wound (16.9%). The mean reduction in wound area at the end of the four-week treatment period with blue light compared with baseline was 51.38% (p<0.001) across all wounds. Among subgroups, the best performance was obtained for hard-to-heal venous wounds, achieving a 63.36% (p<0.001) mean reduction in wound size, and acute wounds, achieving a mean reduction of 82.76% (p<0.001). The greatest mean change in wound bed score was seen at the end of the four-week treatment period with blue light, with an increase in the mean score from 8.6 at baseline to 12.8 at week four (77.2%; p<0.001). There was a clear decrease in pain during blue light treatment, achieving a reduction in the average numeric rating scale (NRS) from 4.3 at baseline to 1.8 at week 4 (53.23%; p <0.001). At week 4, the highest proportion of complete healing was seen in acute (100.0%) and venous wounds (83.3%). Conclusion: Based on these results, photobiomodulation with blue light appears to reactivate the healing process in acute and hard-to-heal wounds that do not respond to standard treatment. Photobiomodulation with blue light treatment is easy to perform and safe, with no reported adverse events or side-effects.
Dark Kitchen e Marketplaces no Forno: Caminhos e Desafios Para o Crescimento da Palatos
Authors: Baesso Lucas , Romani-Dias Marcello 
Published: November 2023

Este caso de ensino relata a trajetória da Palatos, fruto do sonho empreendedor de Flávio. A trajetória de sucesso e expansão da firma é hoje referência regional no ramo da panificação: suas três unidades recebem milhares de clientes diariamente. Mas, diante do futuro da Palatos se impõem dilemas que envolvem sua operação de delivery. A possibilidade de expansão desta operação via investimento em uma dark kitchen é uma realidade, e Flávio deve ponderar entre aumentar sua capacidade instalada, com consequente extensão do seu raio de atuação, e a necessidade de altos investimentos. Outro dilema existente está relacionado ao posicionamento estratégico da Palatos quanto aos canais de aquisição de pedidos: a firma deve priorizar de marketplaces, apostando no ganho de eficiência e controle, em detrimento da maior proximidade ao cliente conferida pelo atendimento online humanizado? As informações foram obtidas a partir de documentos privados, entrevistas e dados secundários de mercado. O caso contribui ao fomentar reflexões sobre tópicos atuais e relevantes ao setor de alimentação fora do lar, aplicáveis a outros setores e tipos organizacionais. Objetiva discutir as oportunidades e desafios enfrentados pelo negócio para seu ganho de competitividade com base em conceitos e ferramentas de estratégia empresarial, como o modelo VRIO e a matriz GUT.
Mode coupling in FM-EDFAs caused by fiber bending: theory and experiments
Authors: Wang Qiquan , Wu Baojian , Jiang Xinrui , Wen Feng , Qiu Kun 
Published: November 2023

Refractive index perturbation caused by erbium-doped fiber (EDF) bending is inevitable in the fabrication of erbium-doped fiber amplifiers (EDFAs). The resulting mode coupling might bring about the deviation of theoretical results from experimental data. We present a theoretical model of FM-EDFAs with mode coupling due to fiber bending and carry out a proof-of-concept experiment by a 3.2-m-long EDF stretcher. Our experiments show that the fluctuation of modal gain due to fiber bending is about 1.5 dB for LP01 and LP11e modes, and about 2.5 dB for LP11o mode, and the theoretical model is more useful for the FM-EDFA design in the presence of fiber bending.
Serum wisteria floribunda agglutinin-positive human Mac-2 binding protein is unsuitable as a diagnostic marker of occult hepatocellular carcinoma in end-stage liver cirrhosis
Authors: Nagakawa Kantoku , Hidaka Masaaki , Hara Takanobu , Matsushima Hajime , Imamura Hajime , Tanaka Takayuki , Adachi Tomohiko , Soyama Akihiko , Kanetaka Kengo , Eguchi Susumu 
Published: November 2023

Background and purpose
Serum glycosylated Wisteria floribunda agglutinin-positive Mac-2 binding protein (WFA+-M2BP) is a marker of liver fibrosis and hepatocellular carcinoma (HCC). In this study, we aimed to evaluate the diagnostic ability of WFA+-M2BP for occult HCC, which current diagnostic imaging tests fail to detect.

Methods
Patients who underwent hepatectomy for liver transplantation (LT) and whose whole liver could be sliced and subjected to histological examination between 2010 and 2018 were eligible for this study (n = 89). WFA+-M2BP levels were measured in samples collected before the LT. Comparison of the postoperative histological test results with the preoperative imaging data grouped the patients into histologically no group (N), histologically detected group (D), histologically increased group (I), and histologically decreased or same group (DS), and the results were compared with the WFA+-M2BP values. In addition, comparisons were made between each data with and without HCC, including occult HCC, and total tumor diameter.

Results
Irrespective of underlying hepatic disease conditions, there were 6 patients in the N group, 10 in the D group, 41 in the I group, and 32 in the DS group. The median of the serum WFA+-M2BP level for each group was as follows: N group, 8.05 (1.25–11.9); D group, 11.025 (1.01–18.21); I group, 9.67 (0.29–17.83); and DS group, 9.56 (0.28–19.44) confidence of interval. We found no significant differences between the pairings. Comparison of underlying hepatic diseases revealed that liver cirrhosis due to hepatitis B and C and non-B and -C liver cirrhosis had no significant differences. AFP levels, on the other hand, had significant relationships in comparison between the presence or absence of histological HCC, in correlation between total tumor diameter, and in the ROC analysis for the diagnosis of HCC including occult HCC.

Conclusion
Serum WFA+-M2BP cannot help diagnose occult HCC that is already undetected using imaging tests in decompensated liver cirrhosis patients requiring LT.