bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multi-professional perspectives to reduce moral distress: A qualitative investigation
Authors: Fantus Sophia , Cole Rebecca , Usset Timothy J , Hawkins Lataya E 
Published: February 2024

Background Encounters of moral distress have long-term consequences on healthcare workers’ physical and mental health, leading to job dissatisfaction, reduced patient care, and high levels of burnout, exhaustion, and intentions to quit. Yet, research on approaches to ameliorate moral distress across the health workforce is limited. Research Objective The aim of our study was to qualitatively explore multi-professional perspectives of healthcare social workers, chaplains, and patient liaisons on ways to reduce moral distress and heighten well-being at a southern U.S. academic medical center. Participants & Research Context Purposive sampling and chain-referral methods assisted with recruitment through hospital listservs, staff meetings, and newsletters. Interested participants contacted the principal investigator and all interviews were conducted in-person. Consent was attained prior to interviews. All interviews were recorded and transcribed verbatim. Research Design Directed content analysis was used to deductively organize codes and to develop themes in conjunction with the National Academy of Medicine’s National Plan for Health Workforce Well-Being. Rigor was attained through peer-debriefing, data triangulation methods, and frequent research team meetings. Ethical Considerations Ethics approval was obtained from the university and medical center institutional review boards. Findings Themes demonstrate that rather than offering interventions in the aftermath of moral distress, multilevel daily practices ought to be considered that pre-emptively identify and reduce morally distressing encounters through (1) the care team, (2) management and leadership, and (3) the health care industry. Strategies include interdisciplinary decision-making, trusting managerial relationships, and organizational policies and practices that explicitly invest in mental health promotion and diverse leadership opportunities. Conclusion Moral distress interventions ought to target short-term stress reactions while also addressing the long-term impacts of moral residue. Health systems must financially commit to an ethical workplace culture that explicitly values mental health and well-being.
Charting an Economic Sustainability Path: Quantile Regression Analysis of Green Finance and Financial Development in Newly Industrialized Economies
Authors: Mehmood Saqib , Kaewsaeng-on Rudsada 
Published: February 2024

Sustainability, once a fringe concept, has become a central theme in global discourse, commanding the attention of governments, industries, and individuals alike. Newly industrialized countries (NICs) stand as exemplars of economies in transition, teetering on the precipice of prosperity and vulnerability. The present study aimed to chart economic sustainability through green finance and financial development in NICs. The study uses Panel Quantile Regression (PQR) and robustness analysis using annual data from 1998 to 2022. Overall, the study results indicate heterogeneity in the impacts of green finance, financial development, and foreign direct investment on the economic sustainability of NICs. The findings from the PQR unveiled that green finance contributes to economic sustainability in lower and middle quantiles (15th, 25th and 50th quantiles) while showing negative but insignificant effects in higher quantiles (75th and 95th quantiles). Financial development is proxied through three distinct variables; however, the heterogeneity in the results of all the quantiles can be witnessed. In addition, the positive and significant impacts of FDI were validated approximately across all quartiles (15–75th), but positive and insignificant effects are endorsed in the 95th quantile. Compared heterogeneous panel estimators support analogous results; however, the amplitude of their parameters varied substantially. Finally, quantile slope equality and symmetric quantiles test as robustness analysis confirmed the authenticity of the results. Therefore, this study’s empirical findings can assist policymakers in comprehending how green finance, financial development, and FDI can achieve economic sustainability and address sustainability issues. JEL Classification F43, F65, O11, Q20
High-velocity impact performance of sandwich panels with additively manufactured hierarchical honeycomb cores: An experimental and numerical study
Authors: Ul Haq Ahsan , Narala Suresh Kumar Reddy 
Published: February 2024

The honeycomb sandwich panel presents a highly promising solution for enhancing ballistic behavior owing to its excellent strength-to-weight ratio and impact resistance. This study focuses on investigating the shock mitigation properties of honeycomb sandwich panels through experimentation and numerical simulation of high-velocity impact tests. Single-scale and double-scale hierarchical honeycomb cores are manufactured using selective laser melting with AlSi10Mg powder, combined with a pair of stainless steel (SS 316) sheets. High-velocity impact experiments were conducted within a velocity ranging from 100 to 270 m/s to examine the effects of different cores and projectile nose shapes on the dynamic response of the panels. Numerical simulations using ABAQUS/Explicit software were performed and validated against the experimental results. The sandwich panel with a double-scale hierarchical honeycomb core exhibited 7.8% and 6.1% more energy absorption compared to the single-scale hierarchical honeycomb core against conical and hemispherical nose projectiles, respectively. Additionally, the ballistic limit for the hemispherical projectile was found to be 8.9% higher than the conical-nose projectile under the same impact velocity and panel thickness. Moreover, an increase in panel thickness from 12 mm to 25 mm prompted a significant improvement of approximately 39% in specific energy absorption and a 44% increase in ballistic limit velocity. These findings highlight the considerable potential of single-scale and double-scale hierarchical honeycomb sandwich panels for the development of threat-resistant structures in critical dynamic loading applications.
Do Naturalistic Developmental Behavioral Interventions improve family quality of life? A systematic review and meta-analysis
Authors: Duncan Amanda Leigh , Keene Hannah , Shepley Collin 
Published: February 2024

Naturalistic Developmental Behavioral Interventions have been described as culturally responsive and family-friendly interventions, with research demonstrating improvements in children’s development when receiving these services. Given the child-directed nature of Naturalistic Developmental Behavioral Interventions and the intervention’s congruence with families’ daily routines, many studies have examined the impact of Naturalistic Developmental Behavioral Interventions on family and family member quality of life. Therefore, we conducted a systematic review and meta-analysis to explore the relationship between Naturalistic Developmental Behavioral Interventions and family quality of life. Results suggest that the receipt of Naturalistic Developmental Behavioral Intervention services neither improved nor worsened family and family member quality of life. For those involved in the provision of Naturalistic Developmental Behavioral Intervention services, there is an immediate need to convey to families that children’s improvements will likely not translate into improvements in family quality of life (osf.io/3ua5f). Lay abstract Naturalistic Developmental Behavioral Interventions have been described as culturally responsive and family-friendly interventions, with research demonstrating improvements in children’s development following the receipt of these interventions. Given the child-directed nature of Naturalistic Developmental Behavioral Interventions and the intervention’s integration within families’ daily routines, many studies have examined the impact of Naturalistic Developmental Behavioral Interventions on family and family member quality of life. We conducted a systematic review and meta-analysis to explore the relationship between Naturalistic Developmental Behavioral Interventions and family quality of life. Results suggest that the provision of a Naturalistic Developmental Behavioral Intervention neither improved nor worsened family or family member quality of life. For those involved in delivering Naturalistic Developmental Behavioral Intervention services, there is an immediate need to convey to families that children’s improvements will likely not translate into improvements in family quality of life.
Understanding Newcomer Challenges and Opportunities to Accessing Nature and Greenspace in Riverdale, Hamilton, Ontario: A Neighborhood-Centered Photovoice Study
Authors: Kandasamy Sujane , Kwan Matthew Y. , Memon Parsa K. , Desai Dipika , de Souza Russell J. , Montague Patty , Sherifali Diana , Wahi Gita , Anand Sonia 
Published: February 2024

Background Access to and engagement with greenspace is related to improved health benefits. We sought to collaborate with community members as partners in research and co-creators in knowledge to better understand which components within a newcomer-dense community help or hinder individual and community efforts to access greenspace and nature-based activities. Methods We used photovoice methodology to engage with local residents in focus groups, photowalks, and photo-elicitation interviews. Themes were developed using direct content analysis. Results A total of 39 participants (ages 11–70 years; median years in Canada of 3.25 years) were engaged in this program of research. From the analysis, we developed four themes: (a) peace and beauty; (b) memories of home; (c) safety and cleanliness; and (d) welcoming strengthened and new opportunities. Participants associated nature with peace, citing it as “under-rated” but “vital” to the neighborhood. Via photographs and stories, participants also shared a multitude of safety concerns that prevent their access to green/outdoor spaces for healthy active living programs or activities (e.g., woodchip-covered playgrounds, ample amounts of garbage littering the park and school grounds, lack of timely ice removal on sidewalks, limited safe biking paths, and unsafe motor vehicle practices at the crosswalks surrounding local parks). Conclusion To translate the key ideas and themes into an informed discussion with policy and decision-makers, we held an in-person exhibition and guided tour where community members, the lead photovoice researcher, and SCORE! principal investigator shared information about each theme in the form of a pseudo-narrative peppered with prepared discussion questions.
Associations of Circadian Rest-Activity Rhythms With Affect and Cognition in Community-Dwelling Stroke Survivors: An Ambulatory Assessment Study
Authors: Lau Stephen C. L. , Connor Lisa Tabor , Skidmore Elizabeth R. 
Published: February 2024

Background Rest-activity rhythm (RAR) is a modifiable behavioral factor associated with affect and cognition. Identifying RAR characteristics associated with affect and cognition among stroke survivors provides insight into preventing poststroke affective and cognitive impairment. Objective To examine the associations of RAR characteristics with affect and cognition among community-dwelling stroke survivors. Methods Forty participants with mild stroke (mean age = 52.8; 42.5% female; 55% White) reported their affect and cognitive complaints using ecological momentary assessment and wore an accelerometer for 7 consecutive days and completed the National Institutes of Health Toolbox Cognition Battery. RAR characteristics were extracted using parametric and non-parametric approaches. Multivariable linear regressions were used to identify RAR characteristics associated with affect and cognition. Results Later onset of rest ( B = 0.45; P = .008) and activity ( B = 0.36; P = .041) were positively associated with depressed affect. These associations were reversed for cheerful effect (rest onset: B = −0.42; P = .017; activity onset: B = −0.39; P = .033). Cheerful affect was also positively associated with relative amplitude (ie, distinctions in activity levels between rest and activity; B = .39; P = .030). Intra-daily variability (ie, RAR fragmentation; B = 0.35; P = .042) and later onset of activity ( B = .36; P = .048) were positively associated with cognitive complaints. Less erratic RAR was positively associated with fluid cognition ( B = 0.29; P = .036); RAR fragmentation was positively associated with crystallized cognition ( B = 0.39; P = .015). Conclusions We identified RAR correlates of affect and cognition among stroke survivors, highlighting the value of managing RAR and sleep in stroke rehabilitation. Future studies should test whether advancing the onset of rest and activity, promoting a regular active lifestyle, and improving rest and sleep in the nighttime protect stroke survivors from affective and cognitive impairment.
Current Practices for Rehabilitation After Meniscus Repair: A Survey of Members of the American Orthopaedic Society for Sports Medicine
Authors: Cong Ting , Reddy Rajiv P. , Hall Arielle J. , Ernazarov Akhmad , Gladstone James 
Published: February 2024

Background: There is no consensus among sports medicine surgeons in North America on postoperative rehabilitation strategy after meniscus repair. Various meniscal tear types may necessitate a unique range of motion (ROM) and weightbearing rehabilitation protocol. Purpose: To assess the current landscape of how sports medicine practitioners in the American Orthopedic Society for Sports Medicine (AOSSM) rehabilitate patients after the repair of varying meniscal tears. Study Design: Cross-sectional study. Methods: A survey was distributed to 2973 AOSSM members by email. Participants reviewed arthroscopic images and brief patient history from 6 deidentified cases of meniscus repair—in cases 1 to 3, the tears retained hoop integrity (more stable repair), and in cases 4 to 6, the tear patterns represented a loss of hoop integrity. Cases were shuffled before the presentation. For each case, providers were asked at what postoperative time point they would permit (1) partial weightbearing (PWB), (2) full weightbearing (FWB), (3) full ROM, and (4) ROM allowed immediately after surgery. Results: In total, 451 surveys were completed (15.2% response). The times to PWB and FWB in cases 1 to 3 (median, 0 and 4 weeks, respectively) were significantly lower than those in cases 4 to 6 (median, 4 and 6 weeks, respectively) ( P < .001). In tears with retained hoop integrity, the median time to PWB was immediately after surgery, whereas in tears without hoop integrity, the median time to PWB was at 4 weeks postoperatively. Similarly, the median time to FWB in each tear with retained hoop integrity was 4 weeks after surgery, while it was 6 weeks in each tear without hoop integrity. However, regardless of tear type, most providers (67.1%) allowed 0° to 90° of ROM immediately after surgery and allowed full ROM at 6 weeks. Most providers (83.3%) braced the knee after repair regardless of hoop integrity and utilized synovial rasping/trephination with notch microfracture—a much lower proportion of providers utilized biologic augmentation (9%). Conclusion: Sports medicine practitioners in the AOSSM rehabilitated meniscal tears differently based on hoop integrity, with loss of hoop stresses triggering a more conservative approach. A majority braced and utilized in situ adjuncts for biological healing, while a minority added extrinsic biologics.
Transcriptomic analysis reveals the molecular basis of photoperiod-regulated sex differentiation in tropical pumpkins (Cucurbita moschata Duch.)
Authors: Xue Shudan , Huang Hexun , Xu Yingchao , Liu Ling , Meng Qitao , Zhu Jitong , Zhou Meijiang , Du Hu , Yao Chunpeng , Jin Qingmin , Nie Chengrong , Zhong Yujuan 
Published: February 2024

Abstract
Background
Photoperiod, or the length of the day, has a significant impact on the flowering and sex differentiation of photoperiod-sensitive crops. The “miben” pumpkin (the main type of Cucurbita moschata Duch.) is well-known for its high yield and strong disease resistance. However, its cultivation has been limited due to its sensitivity to photoperiod. This sensitivity imposes challenges on its widespread cultivation and may result in suboptimal yields in regions with specific daylength conditions. As a consequence, efforts are being made to explore potential strategies or breeding techniques to enhance its adaptability to a broader range of photoperiods, thus unlocking its full cultivation potential and further promoting its valuable traits in agriculture.

Results
This study aimed to identify photoperiod-insensitive germplasm exhibiting no difference in sex differentiation under different day-length conditions. The investigation involved a phenotypic analysis of photoperiod-sensitive (PPS) and photoperiod-insensitive (PPIS) pumpkin materials exposed to different day lengths, including long days (LDs) and short days (SDs). The results revealed that female flower differentiation was significantly inhibited in PPS_LD, while no differences were observed in the other three groups (PPS_SD, PPIS_LD, and PPIS_SD). Transcriptome analysis was carried out for these four groups to explore the main-effect genes of sex differentiation responsive to photoperiod. The main-effect gene subclusters were identified based on the principal component and hierarchical cluster analyses. Further, functional annotations and enrichment analysis revealed significant upregulation of photoreceptors (CmCRY1, F-box/kelch-repeat protein), circadian rhythm-related genes (CmGI, CmPRR9, etc.), and CONSTANS (CO) in PPS_LD. Conversely, a significant downregulation was observed in most Nuclear Factor Y (NF-Y) transcription factors. Regarding the gibberellic acid (GA) signal transduction pathway, positive regulators of GA signaling (CmSCL3, CmSCL13, and so forth) displayed higher expression levels, while the negative regulators of GA signaling, CmGAI, exhibited lower expression levels in PPS_LD. Notably, this effect was not observed in the synthetic pathway genes. Furthermore, genes associated with ethylene synthesis and signal transduction (CmACO3, CmACO1, CmERF118, CmERF118-like1,2, CmWIN1-like, and CmRAP2-7-like) showed significant downregulation.

Conclusions
This study offered a crucial theoretical and genetic basis for understanding how photoperiod influences the mechanism of female flower differentiation in pumpkins.
Colorectal cancer pre-diagnostic symptoms are associated with anatomic cancer site
Authors: Briggs Nicole L. , Ton Mimi , Malen Rachel C. , Reedy Adriana M. , Cohen Stacey A. , Phipps Amanda I. , Burnett-Hartman Andrea N. , Newcomb Polly A. 
Published: February 2024

Abstract
Background
Signs and red flag symptoms in colorectal cancer (CRC) patients who are below the recommended screening age are often overlooked, leading to delayed diagnosis and worse prognosis. This study investigates how patient pre-diagnostic symptoms are associated with anatomic site of their cancer and whether the association varies by age at CRC diagnosis.

Methods
We ascertained CRC patients’ experienced symptoms and screening through medical abstractions from an ongoing population-based study of CRC patients identified through a SEER cancer registry (N = 626). We used logistic regression to estimate odds ratios and 95% confidence intervals for the association between symptoms and CRC anatomic site. Additional analyses were stratified by age at diagnosis. Early-onset was defined as less than 50 years of age at CRC diagnosis.

Results
Participants who experienced blood in stool were more likely (odds ratio (95% confidence interval)) to have rectal (vs. colon) cancer (4.37 (3.02, 6.33)), as were patients who experienced changes to stool (1.78 (1.21, 2.60)). Patients diagnosed with colon cancer were more likely to present with abdominal pain (0.30 (0.19, 0.47)), anemia (0.40 (0.21, 0.75)), other symptoms (0.33 (0.19, 0.55)) and no symptoms (0.68 (0.44, 1.04)). When stratifying by age at diagnosis, we found that the association between blood in stool and rectal tumor location was particularly pronounced for patients with early-onset CRC (6.48 (2.73, 15.41)).

Conclusions
Common pre-diagnostic red flag symptoms are associated with CRC anatomic site. These findings can inform best practices for gastroenterologist triage of care and early evaluation of CRC and are of key importance given the rise of early-onset (pre-screening age) CRC.

Trial registration
Not applicable to this study and analysis.
Perioperative point-of-care-testing of plasmacholinesterases identifies older patients at risk for postoperative delirium: an observational prospective cohort study
Authors: Gruendel Matthias S. , Brenneisen Wibke , Wollborn Jakob , Haaker Gerrit , Meersch Melanie , Gurlit Simone , Goebel Ulrich 
Published: February 2024

Abstract
Background
Postoperative delirium (POD) is a severe perioperative complication that may increase mortality and length-of-stay in older patients. Moreover, POD is a major economic burden to any healthcare system. An altered expression of Acetylcholine- and Butyrylcholinesterases (AChE, BuChE) due to an unbalanced neuroinflammatory response to trauma or an operative stimulus has been reported to play an essential role in the development of POD. We investigated if perioperative measurement of cholinesterases (ChEs) can help identifying patients at risk for the occurrence of POD in both, scheduled and emergency surgery patients.

Methods
This monocentric prospective observational cohort study was performed in a tertiary hospital (departments of orthopaedic surgery and traumatology). One hundred and fifty-one patients aged above 75 years were enrolled for scheduled (n = 76) or trauma-related surgery (n = 75). Exclusion criteria were diagnosed dementia and anticholinergic medication. Plasma samples taken pre- and postoperatively were analysed regarding AChE and BuChE activity. Furthermore, perioperative assessment using different cognitive tests was performed. The type of anaesthesia (general vs. spinal anaesthesia) was analysed. Primary outcome was the incidence of POD assessed by the approved Confusion Assessment Method (CAM) in combination with the expression of AChE and BuChE.

Results
Of 151 patients included, 38 (25.2%) suffered from POD; 11 (14%) in scheduled and 27 (36%) in emergency patients. AChE levels showed no difference throughout groups or time course.
Trauma patients had lower BuChE levels prior to surgery than scheduled patients (p < 0.001). Decline in BuChE levels correlated positively with the incidence of POD (1669 vs. 1175 U/l; p < 0.001). Emergency patients with BuChE levels below 1556 U/L were at highest risk for POD. There were no differences regarding length of stay between groups or incidence of POD. The type of anaesthesia had no influence regarding the incidence of POD. Only Charlson Comorbidity Index and Mini Nutrition Assessment demonstrated reliable strength in respect of POD.

Conclusions
Perioperative measurement of BuChE activity can be used as a tool to identify patients at risk of POD. As a point-of-care test, quick results may alter the patients’ course prior to the development of POD.

Trial registration
https://drks.de/search/de/trial/DRKS00017178.