bluuebunny/crossref_metadata_2025_split huggingface dataset:
Correlates of cannabis use in a sample of mental health treatment-seeking Canadian armed forces members and veterans
Authors: St. Cyr Kate , Nazarov Anthony , Le Tri , Nouri Maede , Saha Priyonto , Forchuk Callista A , Soares Vanessa , Wanklyn Sonya G. , Bird Brian M. , Davis Brent D. , King Lisa , Ketcheson Felicia , Richardson J. Don 
Published: November 2023

Abstract
Objective
Canadian Armed Forces (CAF) members and Veterans are more likely to experience mental health (MH) conditions, such as posttraumatic stress disorder (PTSD), than the general Canadian population. Previous research suggests that an increasing number of individuals are employing cannabis for MH symptom relief, despite a lack of robust evidence for its effectiveness in treating PTSD. This research aimed to: (1) describe the prevalence of current cannabis use among MH treatment-seeking CAF members and Veterans; and (2) estimate the association between current cannabis use and a number of sociodemographic, military, and MH-related characteristics.

Method
Using cross-sectional intake data from 415 CAF members and Veterans attending a specialized outpatient MH clinic in Ontario, Canada, between January 2018 and December 2020, we estimated the proportion of CAF members and Veterans who reported current cannabis use for either medical or recreational purposes. We used multivariable logistic regression to estimate adjusted odds ratios for a number of sociodemographic, military, and MH-related variables and current cannabis use.

Results
Almost half of the study participants (n = 187; 45.1%) reported current cannabis use. Respondents who reported current cannabis use for medical purposes had a higher median daily dose than those who reported current cannabis use for recreational purposes. The multivariable logistic regression identified younger age, lower income, potentially hazardous alcohol use, and increased bodily pain as statistically significant correlates of current cannabis use among our MH treatment-seeking sample. PTSD severity, depressive severity, sleep quality, and suicide ideation were not statistically associated with current cannabis use.

Conclusions
Almost half of our treatment-seeking sample reported current cannabis use for medical or recreational purposes, emphasizing the importance of screening MH treatment-seeking military members and Veterans for cannabis use prior to commencing treatment. Future research building upon this study could explore the potential impact of cannabis use on MH outcomes.
Correlation analysis between physical activity and depressive tendencies among occupational groups: an isotemporal substitution approach
Authors: Liu Yihua , Lin Haoxiang , Zhang Hao , Zhang Xiaoyue , Yin Shengli 
Published: November 2023

Abstract
Objectives
Sedentary behaviour (SB) and physical activity (PA) have been shown to be associated with depression. However, behaviours, such as PA, occupy a portion of an individual’s 24-h day. Thus, an increase in time for one behaviour takes away time from another. Previous evidence suggests that it would be more appropriate to shift the focus to the importance of reallocating time spent in sedentary behaviour to time spent in physical activity. The aim of this study was to analyse the mutual replacement effect of different health behaviours on depressive tendencies by isotemporal substitution modelling (ISM) under the objective condition of considering a limited 24-h day. Second, we aimed to further explore the potential association between excessive or insufficient sleep duration and depressive symptoms.

Methods
A total of 10656 employees from 79 companies in four provinces of China participated in this survey.
The Center for Epidemiological Studies Depression Scale (CES-D) was used to measure workers’ depressive tendencies. The duration of various types of physical activity was self-reported by workers based on the International Physical Activity Questionnaire (IPAQ). ISM was used to assess the associations of time spent in different activities on displacement of equivalent time spent on other activities with depression risk.

Results
A total of 10656 participants (89.5% of the sample) were included in the analysis.
The ISM found that a 30-min unit of SB replaced with walking (OR, 95% CI: 0.83, 0.77–0.88), sleep (≤ 8 h) (OR, 95% CI: 0.77, 0.74–0.79), moderate physical activity (MPA) (OR, 95% CI: 0.87, 0.81–0.93) and vigorous physical activity (VPA) (OR, 95% CI: 0.91, 0.84–0.99) was significantly and negatively associated with the risk of depressive tendencies. When sleep duration was less than 8 h, each additional half hour of sleep time was significantly associated with a lower risk of depressive tendencies, and this association was no longer significant after 8 h.

Conclusion
Prolonged SB is common in the current workplace in China. Replacing an average of 30 min per day of SB with VPA and MPA, even walking is associated with less depression among workers. In addition, insufficient daily sleep is also an important risk factor for workers' depressive tendencies. These findings provide valuable evidence to promote mental health among occupational groups and support the development of healthy workplaces.
Views on sharing mental health data for research purposes: qualitative analysis of interviews with people with mental illness
Authors: Watson Emily , Fletcher-Watson Sue , Kirkham Elizabeth Joy 
Published: November 2023

Abstract
Background
Improving the ways in which routinely-collected mental health data are shared could facilitate substantial advances in research and treatment. However, this process should only be undertaken in partnership with those who provide such data. Despite relatively widespread investigation of public perspectives on health data sharing more generally, there is a lack of research on the views of people with mental illness.

Methods
Twelve people with lived experience of mental illness took part in semi-structured interviews via online video software. Participants had experience of a broad range of mental health conditions including anxiety, depression, schizophrenia, eating disorders and addiction. Interview questions sought to establish how participants felt about the use of routinely-collected health data for research purposes, covering different types of health data, what health data should be used for, and any concerns around its use.

Results
Thematic analysis identified four overarching themes: benefits of sharing mental health data, concerns about sharing mental health data, safeguards, and data types. Participants were clear that health data sharing should facilitate improved scientific knowledge and better treatments for mental illness. There were concerns that data misuse could become another way in which individuals and society discriminate against people with mental illness, for example through insurance premiums or employment decisions. Despite this there was a generally positive attitude to sharing mental health data as long as appropriate safeguards were in place.

Conclusions
There was notable strength of feeling across participants that more should be done to reduce the suffering caused by mental illness, and that this could be partly facilitated by well-managed sharing of health data. The mental health research community could build on this generally positive attitude to mental health data sharing by following rigorous best practice tailored to the specific concerns of people with mental illness.
Reducing prescribing of antibiotics for acute respiratory infections using a frontline nurse-led EHR-Integrated clinical decision support tool: protocol for a stepped wedge randomized control trial
Authors: Stevens Elizabeth R. , Agbakoba Ruth , Mann Devin M. , Hess Rachel , Richardson Safiya I. , McGinn Thomas , Smith Paul D. , Halm Wendy , Mundt Marlon P. , Dauber-Decker Katherine L. , Jones Simon A. , Feldthouse Dawn M. , Kim Eun Ji , Feldstein David A. 
Published: November 2023

Abstract
Background
Overprescribing of antibiotics for acute respiratory infections (ARIs) remains a major issue in outpatient settings. Use of clinical prediction rules (CPRs) can reduce inappropriate antibiotic prescribing but they remain underutilized by physicians and advanced practice providers. A registered nurse (RN)-led model of an electronic health record-integrated CPR (iCPR) for low-acuity ARIs may be an effective alternative to address the barriers to a physician-driven model.

Methods
Following qualitative usability testing, we will conduct a stepped-wedge practice-level cluster randomized controlled trial (RCT) examining the effect of iCPR-guided RN care for low acuity patients with ARI. The primary hypothesis to be tested is: Implementation of RN-led iCPR tools will reduce antibiotic prescribing across diverse primary care settings. Specifically, this study aims to: (1) determine the impact of iCPRs on rapid strep test and chest x-ray ordering and antibiotic prescribing rates when used by RNs; (2) examine resource use patterns and cost-effectiveness of RN visits across diverse clinical settings; (3) determine the impact of iCPR-guided care on patient satisfaction; and (4) ascertain the effect of the intervention on RN and physician burnout.

Discussion
This study represents an innovative approach to using an iCPR model led by RNs and specifically designed to address inappropriate antibiotic prescribing. This study has the potential to provide guidance on the effectiveness of delegating care of low-acuity patients with ARIs to RNs to increase use of iCPRs and reduce antibiotic overprescribing for ARIs in outpatient settings.

Trial registration
ClinicalTrials.gov Identifier: NCT04255303, Registered February 5 2020, https://clinicaltrials.gov/ct2/show/NCT04255303.
Quitting one’s job or leaving one’s profession: unexplored consequences of workplace violence and discrimination against health professionals
Authors: Hämmig Oliver 
Published: November 2023

Abstract
Background
Although workplace violence and discrimination against healthcare workers are global and universal phenomena, and violence at work is recognized as a serious and growing problem, in Switzerland, hardly anything is known about the related consequences on job changes and career endings, which are two major staffing challenges present in the notoriously understaffed healthcare sector.

Method
Data collected from a written survey conducted among 1,840 hospital employees, of which 1,441 were health professionals, were used to evaluate and estimate the prevalence and impact of specific and cumulated forms of workplace violence and discrimination on the work climate and particularly on subsequent turnover intentions and career endings. Established multi- and single-item measures were used as predicting, intervening and outcome variables. Relative frequencies stratified for nurses, physicians and therapists were calculated to estimate and differentiate the size of the phenomena under study. Furthermore, crosstabulations, as well as multivariate regression analyses, were performed to explore the associations of interest.

Results
Every fifth to sixth nurse and every seventh to eighth physician reported having had intentions to change jobs or leave the profession within the past year. These intentions become much more prevalent across all health professions when one or even two or more different forms of violence and/or discrimination at work are experienced and reported. Accordingly, the relative risks for intending to quit one’s job or leave one’s profession increase significantly and steadily with a growing number (1, 2 +) of different experienced forms of violence and/or discrimination at work compared to the reference group of those who are nonaffected (aOR from 2.5 up to 5.4). This fairly strong association was only slightly reduced (aOR from 2.1 to 4.0) when work climate was additionally taken into account as a potential intervening variable. Although work climate only partly accounted for the association under study, a poor work climate was an additional strong predictor and independent risk factor for intentions to turnover (aOR = 6.4) or leave the profession (aOR = 4.2).

Conclusions
Experiences of workplace violence and discrimination and the resulting poor work climate both together and independent of each other seem to be important causes of job changes and career endings among healthcare workers in Switzerland.
Transitions in health care settings for frequent and infrequent users of emergency departments: a population-based retrospective cohort study
Authors: Rosychuk Rhonda J. , Chen Anqi A. , Ospina Maria B. , McRae Andrew D. , Hu X. Joan , McLane Patrick 
Published: November 2023

Abstract
Background
Efforts to reduce emergency department (ED) volumes often target frequent users. We examined transitions in care across ED, hospital, and community settings, and in-hospital death, for high system users (HSUs) compared to controls.

Methods
Population-based databases provided ED visits and hospitalizations in Alberta and Ontario, Canada. The retrospective cohort included the top 10% of all the ED users during 2015/2016 (termed HSUs) and a random sample of controls (4 per each HSU) from the bottom 90% per province. Rates of transitions among ED, hospitalization, community settings, and in-hospital mortality were adjusted for sociodemographic and ED variables in a multistate statistical model.

Results
There were 2,684,924 patients and 579,230 (21.6%) were HSUs. Patient characteristics associated with shorter community to ED transition times for HSUs included Alberta residence (ratio of hazard ratio [RHR] = 1.11, 95% confidence interval [CI] 1.11,1.12), living in areas in the lower income quintile (RHR = 1.06, 95%CI 1.06,1.06), and Ontario residents without a primary health care provider (RHR = 1.13, 95%CI 1.13,1.14). Once at the ED, characteristics associated with shorter ED to hospital transition times for HSUs included higher acuity (e.g., RHR = 1.70, 95% CI 1.61, 1.81 for emergent), and for many diagnoses including chest pain (RHR = 1.71, 95%CI 1.65,1.76) and gastrointestinal (RHR = 1.66, 95%CI 1.62,1.71). Once admitted to hospital, HSUs did not necessarily have longer stays except for conditions such as chest pain (RHR = 0.90, 95% CI 0.86, 0.95). HSUs had shorter times to death in the ED if they presented for cancer (RHR = 2.51), congestive heart failure (RHR = 1.93), myocardial infarction (RHR = 1.53), and stroke (RHR = 1.84), and shorter times to death in-hospital if they presented with cancer (RHR = 1.29).

Conclusions
Differences between HSUs and controls in predictors of transitions among care settings were identified. Co-morbidities and limitations in access to primary care are associated with more rapid transitions from community to ED and hospital among HSUs. Interventions targeting these challenges may better serve patients across health systems..

Trial registration
Not applicable.
Acts of negotiation: toward a grounded theory of nursing practice in chronic wound care in Austria
Authors: Drgac Deborah , Himmelsbach Raffael 
Published: November 2023

Abstract
Background
Demographic change and the rise of diabetes mellitus are leading to a projected increase in the prevalence of chronic wounds. People suffering from chronic wounds experience significant losses in their health-related quality of life. Health systems struggle to meet the needs of these persons, even in high-income countries. This paper explores wound nurses’ perspectives on their professional practice in Austria. They play a key role as they do much of the treatment work, contribute to advancing the field, and enable interprofessional coordination. Their perspectives enable insights into how a health system provides care for elderly and chronically ill people.

Methods
We used the Constructivist Grounded Theory framework to analyse transcripts of 14 semi-structured qualitative interviews with nurses who work in different treatment settings.

Results
We identified three themes. Firstly, the interviewees characterise working with patients as a balancing act between offering enough support to build a trustful relationship while protecting themselves against the overwhelming situation of caring for a chronically ill person. Secondly, the interviewees compensate for nonexistent care pathways by building informal networks with doctors, which requires delicate relationship work. Thirdly, the study participants must prove their competence in every new professional encounter. Their need for professional autonomy clashes with the traditional doctor-nurse hierarchy. Based on these insights, we propose a grounded theory that conceives of nursing practice in terms of ‘acts of negotiations’.

Conclusion
Our results demonstrate that wound nurses in Austria operate in an institutional environment whose outdated imagination of the nursing role is at odds with the care demands that arise from a growing number of elderly and chronically ill people. We detailed the ‘acts of negotiation’ nurses deploy to compensate for this situation. We identify areas for policy intervention to strengthen the autonomy of wound nurses, including access to statutory health insurance billing.
Neuromolecular responses in disrupted mutualistic cleaning interactions under future environmental conditions
Authors: Ramírez-Calero S. , Paula J. R. , Otjacques E. , Ravasi T. , Rosa R. , Schunter C. 
Published: November 2023

Abstract
Background
Mutualistic interactions, which constitute some of the most advantageous interactions among fish species, are highly vulnerable to environmental changes. A key mutualistic interaction is the cleaning service rendered by the cleaner wrasse, Labroides dimidiatus, which involves intricate processes of social behaviour to remove ectoparasites from client fish and can be altered in near-future environmental conditions. Here, we evaluated the neuromolecular mechanisms behind the behavioural disruption of cleaning interactions in response to future environments. We subjected cleaner wrasses and surgeonfish (Acanthurus leucosternon, serving as clients) to elevated temperature (warming, 32 °C), increased levels of CO2 (high CO2, 1000 ppm), and a combined condition of elevated CO2 and temperature (warming and high CO2, 32 °C, and 1000 ppm) for 28 days.

Results
Each of these conditions resulted in behavioural disruptions concerning the motivation to interact and the quality of interaction (high CO2 − 80.7%, warming − 92.6%, warming and high CO2 − 79.5%, p < 0.001). Using transcriptomics of the fore-, mid-, and hindbrain, we discovered that most transcriptional reprogramming in both species under warming conditions occurred primarily in the hind- and forebrain. The associated functions under warming were linked to stress, heat shock proteins, hypoxia, and behaviour. In contrast, elevated CO2 exposure affected a range of functions associated with GABA, behaviour, visual perception, thyroid hormones and circadian rhythm. Interestingly, in the combined warming and high CO2 condition, we did not observe any expression changes of behaviour. However, we did find signs of endoplasmic reticulum stress and apoptosis, suggesting not only an additive effect of the environmental conditions but also a trade-off between physiological performance and behaviour in the cleaner wrasse.

Conclusions
We show that impending environmental shifts can affect the behaviour and molecular processes that sustain mutualistic interactions between L. dimidiatus and its clients, which could have a cascading effect on their adaptation potential and possibly cause large-scale impacts on coral reef ecosystems.
Biomineralized tetramethylpyrazine-loaded PCL/gelatin nanofibrous membrane promotes vascularization and bone regeneration of rat cranium defects
Authors: Wu Xiaoyu , Ni Su , Dai Ting , Li Jingyan , Shao Fang , Liu Chun , Wang Jiafeng , Fan Shijie , Tan Yadong , Zhang Linxiang , Jiang Qiting , Zhao Hongbin 
Published: November 2023

AbstractConventional electrospinning produces nanofibers with smooth surfaces that limit biomineralization ability. To overcome this disadvantage, we fabricated a tetramethylpyrazine (TMP)-loaded matrix-mimicking biomineralization in PCL/Gelatin composite electrospun membranes with bubble-shaped nanofibrous structures. PCL/Gelatin membranes (PG), PCL/Gelatin membranes containing biomineralized hydroxyapatite (HA) (PGH), and PCL/Gelatin membranes containing biomineralized HA and loaded TMP (PGHT) were tested. In vitro results indicated that the bubble-shaped nanofibrous surface increased the surface roughness of the nanofibers and promoted mineralization. Furthermore, sustained-release TMP had an excellent drug release efficiency. Initially released vigorously, it reached stabilization at day 7, and the slow-release rate stabilized at 61.0 ± 1.8% at 28 days. All membranes revealed an intact cytoskeleton, cell viability, and superior adhesion and proliferation when stained with Ghost Pen Cyclic Peptide, CCK-8, cell adhesion, and EdU. In PGHT membranes, the osteogenic and vascularized gene expression of BMSCs and human vascular endothelial cells was significantly upregulated compared with that in other groups, indicating the PGHT membranes exhibited an effective vascularization role. Subsequently, the membranes were implanted in a rat cranium defect model for 4 and 8 weeks. Micro-CT and histological analysis results showed that the PGHT membranes had better bone regenerative patterns. Additionally, the levels of CD31 and VEGF significantly increased in the PGHT membrane compared with those in other membranes. Thus, PGHT membranes could accelerate the repair of cranium defects in vivo via HA and TMP synergistic effects.
Graphical Abstract
Intervening in hnRNPA2B1-mediated exosomal transfer of tumor-suppressive miR-184-3p for tumor microenvironment regulation and cancer therapy
Authors: Zhou Xueqing , Hong Yiling , Liu Yupeng , Wang Li , Liu Xuan , Li Yi , Yuan Hong , Hu Fuqiang 
Published: November 2023

Abstract
Background
Despite being a common malignant tumor, the molecular mechanism underlying the initiation and progression of triple-negative breast cancers (TNBCs) remain unclear. Tumor-associated macrophages (TAMs) are often polarized into a pro-tumor phenotype and are associated with a poor prognosis of TNBCs. Exosomes, important mediators of cell-cell communication, can be actively secreted by donor cells to reprogram recipient cells. The functions and molecular mechanisms of tumor cell-derived exosomes in TNBCs progression and TAMs reprogramming urgently need to be further explored.

Results
We demonstrated that tumor cell-derived exosomes enriched with miR-184-3p were taken up by macrophages to inhibit JNK signaling pathway by targeting EGR1, thereby inducing M2 polarization of macrophages and synergistically promoting tumor progression. Nanoparticles loaded with oncogene c-Myc inhibitor JQ1 could suppress the polarization process by reducing Rac1-related exosome uptake by macrophage. More importantly, it was found for the first time that tumor-suppressive miR-184-3p was actively sorted into exosomes by binding to RNA-binding protein heterogeneous nuclear ribonucleoprotein A2B1 (hnRNPA2B1), thus facilitating tumor cell proliferation and metastasis by relieving the inhibitory effect of miR-184-3p on Mastermind-like 1 (MAML1). Overexpressing miR-184-3p in tumor cells and simultaneously knocking down hnRNPA2B1 to block its secretion through exosomes could effectively inhibit tumor growth and metastasis.

Conclusions
Our study revealed that hnRNPA2B1-mediated exosomal transfer of tumor-suppressive miR-184-3p from breast cancer cells to macrophages was an important mediator of TNBCs progression, providing new insights into TNBCs pathogenesis and therapeutic strategies.

Graphical Abstract