bluuebunny/crossref_metadata_2025_split huggingface dataset:
Moral Distress and Associated Factors Among Nurses Working in Central Ethiopia: a cross-sectional study
Authors: Getahun Mihiret Shawel , Gurara Abenet Menene , Bekele Nardos Tilahun , Kumbi Mahlet Mesfin , Zeleke Mahlet Daniel , Leta Milko Desu , Kebede Yabets Tesfaye , Fikreyesus Mihiret , Negussie Yohannes Mekuria 
Published: October 2023

Abstract
Background
Moral distress is recognized as a problem affecting nurse professionals globally. Unaddressed moral distress harm nurses' physical and mental health, the quality of patient care, and the performance of healthcare organizations. However, evidence on the magnitude and risk factors of moral distress is limited in Ethiopia in general and in the study area in particular. Thus, thus study aimed to assess the magnitude of moral distress and associated factors among nurses working in Adama Comprehensive Specialized Hospital Medical College, central Ethiopia, 2023.
Methods
A facility-based cross-sectional study was conducted from January 1 to 30, 2023, on 219 nurses. A simple random sampling technique was employed to select the study participants. A self-administered structured questionnaire was used for data collection and Moral Distress Scale-Revised (MDS-R) was used to assess moral distress. Data were checked, coded, and entered into Epi info version 7, and then exported to the Statistical Package for Social Science version 26 for analysis. Bivariable and multivariable logistic regression analyses were carried out to identify factors associated with moral distress. The odds ratio with its 95% confidence interval was used as a measure of association and statistical significance was declared at a p-value < 0.05.
Result
A total of 212 nurses were included in the analysis making the response rate 96.8%. The magnitude of moral distress was 86.8% (95% CI: 82.1%, 91.0%). Perceived powerlessness (AOR = 6.08; 95% CI: 1.69, 11.8), lack of confidence (AOR = 7.08; 95% CI: 2.05–14.41), inadequate staffing (AOR = 12.46; 95% CI:3.28,15.1), and perceived weak organizational support (AOR = 11.59; 95% CI: 2.8,17.33) were significantly associated with moral distress.
Conclusion
The magnitude of moral distress was high among nurses in the study setting. Perceived powerlessness, lack of confidence, inadequate staffing, and perceived weak organizational support were independent determinants of moral distress. Thus, creating adequate number of staff, and establishing acceptable organizational policies are ways to reduce moral distress.
Rationally Micropatterned Antifogging Hydrogels Counteracting Extreme Condensation
Authors: Poulikakos Dimos , Park Hyunchul , Lam Cheuk Wing Edmond , Haechler Iwan , Schutzius Thomas 
Published: October 2023

Abstract
Loss of transparency due to water vapor condensation, is a widespread problem across diverse applications such as windows, eyewear, displays, vehicles, and kitchenware. Conventional antifogging strategies relying on hydrophilic, or hydrophobic coatings, based on chemistry and/or nano-topography, can counteract up to mild water deposition, but lose functionality at excessive condensation environments. Here, we present a passive approach, rationally micropatterning an inherently hydrophilic hydrogel to maintain high transparency under supersaturation. Guided by optics and wetting theory, and employing a diffusion model to calculate related timescales of water film formation, we engineer a wicking structure on poly(ethylene glycol) diacrylate hydrogel, facilitating long-term sustainable filmwise condensation. Employing quantitative optical clarity measurements and visualization, we show that our approach clearly outperforms state of the art antifogging alternatives, retaining high optical clarity even in boiling environments. Facile fabrication and superior performance establish our microstructured hydrogel as an excellent choice for sustaining transparency under extreme condensation.
Generalist, specialist, or expert in palliative care? A cross-sectional open survey on healthcare professionals’ self-description.
Authors: Zuilekom Ingrid van , Metselaar Suzanne , Godrie Fleur , Onwuteaka-Philipsen Bregje , Os-Medendorp Harmieke Van 
Published: October 2023

Abstract
Background
In the Netherlands, palliative care is provided by generalist healthcare professionals (HCPs) if possible, and by palliative care specialists if necessary. However, it still needs to be clarified what specialist expertise entails, what specialized care consists of, and which training or work experience is needed to become a palliative care specialist. In addition to generalists and specialists, ‘experts’ in palliative care are recognized within the nursing and medical professions, but it is unclear how these three roles relate. This study aims to explore how HCPs working in palliative care describe themselves in terms of generalist, specialist, and expert and how this self-description is related to their work experience and education.
Methods
A cross-sectional open online survey with both pre-structured and open-ended questions among HCPs who provide palliative care. Analyses were done using descriptive statistics and thematic coding of open-ended questions.
Results
854 HCPs filled out the survey; 74% received additional training, and 79% had more than five years of working experience in palliative care. Based on working experience, 17% describe themselves as a generalist, 34% as a specialist, and 44% as an expert. Almost three out of four HCPs attributed their level of expertise on both their education and their working experience. Self-described specialists and experts had more working experience in palliative care, often had additional training, attended to more patients with palliative care needs, and were more often physicians. 76% consider it important to have both
specialists and experts in palliative care.
However, there were divergent perspectives on the distinction between specialist and expert. HCPs wish more clarity about what defines a specialist or an expert, how to become a specialist or expert, and when you need a specialist or an expert.
Conclusions
Although the grounds on which HCPs describe themselves as generalist, specialist, or experts differ, HCPs who describe themselves as specialists or experts mostly do so based on both their post-graduate education and their work experience. HCPs find it important to have specialists and experts in palliative care in addition to generalists and indicate more clarity about (the requirements for) these three roles is needed.
Neuromyelitis optica spectrum disorder complicated with pure red cell aplasia: A case report
Authors: Jiang Wanqing , Wang Jue , Feng Yu , Liu Qian , Liu Mingjun , Sun Huiying , Zhang Kun , Ji Qingyu , Jia Peifei , Liu Xuewen 
Published: October 2023

Abstract
Background: Pure red cell aplasia (PRCA) in a patient with neuromyelitis optica spectrum disorder (NMOSD) has not been reported before. This study presents a patient with NMOSD who developed PRCA.
Case presentation: A 54-year-old female was admitted to the Second Affiliated Hospital of Baotou Medical College in January 2023 for dysuria and progressive numbness and weakness of both lower limbs. Physical examination showed she had difficulty standing and walking in a straight line. Both lower limbs showed positive Babinski and Chaddock signs. MRI showed abnormal signals in the spinal cord. Aquaporin-4-IgG (AQP-4-IgG) was positive (1:320), and NMOSD was confirmed. Intravenous immunoglobulin and methylprednisolone were given, and the symptoms improved. She was readmitted for fatigue, palpitations, and shortness of breath in May 2023. Bone marrow aspiration and biopsy showed elevated erythroid precursors and erythroid hypoplasia, while megakaryocytes and myeloid precursors were normal. Chest CT examination showed no mediastinal lymph node enlargement and thymoma. PRCA secondary to NMOSD was diagnosed. Recombinant human erythropoietin was given, and her condition was improved after 1.5 months, as indicated by blood cell count and imaging.
Conclusions: As PRCA may be secondary to NMOSD, a comprehensive evaluation of immune function and bone marrow biopsy may be necessary if abnormal blood cells are found while managing NMOSD.
New interlayer excitons in 2D bilayers revealed under strong electric field
Authors: Bolotin Kirill , Kovalchuk Sviatoslav , Greben Kyrylo , Kumar Abhijeet , Pessel Simon , Soyka Jan , Cao Qing , Watanabe Kenji , Taniguchi Takashi , Christiansen Dominik , Selig Malte , Knorr Andreas , Siegfried Eigler 
Published: October 2023

Abstract
Excitons in bilayer transition metal dichalcogenides (2L-TMDs) are Coulomb-bound electron/hole pairs that can be viewed as broadly tunable analogs of atomic or molecular systems. Here, we study the properties of 2L-TMD excitons under a strong electric field. To overcome the field limit reached in previous experiments, we developed a new organic/inorganic molecular gating technique. This approach allows us to achieve an electric field strengh of about 0.35 V nm-1, more than a factor of two higher than achieved previously in purely solid-state gated devices. Under this field, inter- and intralayer excitons are brought into an energetic resonance, allowing us to discover new emergent properties of the resulting states. We detect a previously unseen interlayer exciton that only becomes visible at high electric field through hybridization with intralayer A exciton. Moreover, the system experiences an ultra-strong Stark splitting of > 380 meV with exciton energies tunable over a large range of the optical spectrum, holding potential for optoelectronics. Our work paves the way for using strong electric fields to study new physical
regimes and control exciton hybridization in 2D semiconductors.
Understanding the risks of co-exposures in a changing world: A case study of dual monitoring of the biotoxin domoic acid and Vibrio spp. in Pacific oyster
Authors: Lie Alle A.Y. , Zimmer-Faust Amity G. , Diner Rachel E. , Kunselman Emily , Daniel Zachary , Artsdalen Kathryn , Garcia Mariana C. Salas , Gilbert Jack A. , Shultz Dana , Chokry Jeff , Langlois Kylie , Smith Jayme 
Published: October 2023

Abstract
Assessing the co-occurrence of health risk factors in coastal ecosystems is challenging due to limited co-located environmental monitoring data. Understanding co-occurrence is particularly important for risk factors that may be associated with or occur in similar environmental conditions, such as harmful algal bloom toxins and bacterial pathogens within the genus Vibrio. This study examined the co-occurrence of Vibrio spp. and domoic acid (DA) by analyzing existing California Department of Public Health monitoring data of V. parahaemolyticus and DA, and conducting seasonal monitoring for these risk factors across two Southern California embayments. Existing public health monitoring efforts in the state were robust for individual risk factors, however it was difficult to evaluate the co-occurrence of these risk factors in oysters collected around the same date (5-day window) between 2015 and 2020. Co-monitoring of two Southern California embayments revealed that DA and Vibrio spp. (V. vulnificus or V. parahaemolyticus) co-occurred in 34% of sampled oysters in most seasons. Interestingly, both the overall detection frequency and co-occurrence of these risk factors was considerably less frequent in water samples. These findings expand our understanding of the simultaneous presence of DA and Vibrio spp. in bivalves and demonstrate the feasibility of co-monitoring different risk factors from the same sample. Individual programs monitoring for different risk factors from the same sample matrix may consider combining efforts to reduce cost and streamline the process and better understand prevalence of co-occurring health risk factors.
Design by simulation of a hybrid electric microgrid for the Cuarto Congreso community, Sancti Spíritus, Cuba
Authors: Hernández Lic. Eliecer Sotolongo , Ponce-Valdes Yudelkys , Garciga Julio Pedraza 
Published: October 2023

Abstract
Currently, renewable energies are part of the strategies adopted to promote the change towards a new, more efficient and diversified energy system. The world is moving through the change of systems electrical isolated what they use sources from generation based in hydrocarbons by hybrid generation electrification schemes that use renewable energy sources. In this article, the electrical microgrid systems without connection to the National Electroenergetic System, also known as isolated microgrids, are treated. Firstly, the target community is characterized both electrically and geographically. The case study of the technical-economic feasibility of the implementation of a microgrid in the Cuarto Congreso community, located in an isolated area belonging to the municipality of Fomento located in Sancti Spíritus, is developed. In this study, different variants of electricity supply for the community were designed by simulation using the HOMER software, taking into account the existing conditions in it. Finally, the results obtained are electrically validated.
Hypertensive disorders of pregnancy and adverse outcomes of twins
Authors: Feng Zhoushan , Jia Chunhong , Tong Xiao-mei , He Zheng , Yang Chunxia , Shen Wei , Ding Yueqin , Liu Jin , Meng Qiong , Zhang Aiqin , Jiang Hong , Yan Wenkang , Qiu Jianwu , Wei Xian , Zhang Yayu , Lin Xiaobo , Liu Lijun , Jin Ya , Wei Youfen , Zhang Weixing , Yang Xiufang , Wang Yitong , Cai Yangfan , Wu Fan , Cui Qiliang 
Published: October 2023

Abstract
Background
Hypertensive disorders of pregnancy (HDP) can significantly impact infant outcomes. However, research on the effects of HDP on twin pregnancies is limited and has not been well understood.
Methods
Data were collected from 22 medical centers across 12 provinces in China, spanning from January 2018 to December 2020. The primary variable of interest was HDP, and perinatal outcomes and neonatal complications were meticulously examined. Statistical analyses employed multivariable logistic regression, propensity score matching, and overlap weighting (OW).
Results
Out of a total of 6,307 twin pregnancies, 1,013 cases (16.1%) were diagnosed with HDP. HDP increased the likelihood of preterm birth (2.68 [2.27–3.15] OW). Specifically, HDP elevated the rates of early and late preterm births (1.29 [1.00-1.67] OW and 2.31 [2.00-2.68] OW, respectively), while reducing the likelihood of extremely preterm births (0.32 [0.12–0.77] OW). Additionally, HDP was associated with increased rates of low birth weight and small for gestational age (OW-OR [95%CI] of 1.54 [1.34–1.78] and 1.18 [1.00-1.42], respectively). Furthermore, it significantly heightened the likelihood of birth weight discordance (> 15%, > 20%, and > 25%). Among twin complications, HDP was linked to elevated rates of oxygen requirement (1.29 [1.07–1.56] OW), 1-minute Apgar scores < 7 (1.29 [1.07–1.56] OW), and NICU admissions (1.58 [1.32–1.90] OW). Stratified and sensitivity analyses reaffirmed the robustness of these findings.
Conclusions
HDP increases adverse outcomes in twins, both in terms of perinatal and complication risks. Therefore, careful monitoring and management are imperative for mothers diagnosed with HDP carrying twins to mitigate these adverse outcomes.
Trial registration:
NA
Senescent and disease-associated microglia are modifiable features of aged brain white matter
Authors: Schafer Marissa , Carver Chase , Gomez Paul , Rodriguez Sonia , Kachergus Jennifer , Liu Yi , Shi Ji , Tran Tommy , Wang Liguo , Melov Simon , Thompson E. 
Published: October 2023

Abstract
Brain white matter tracts undergo structural and functional changes linked to late-life cognitive decline, but the cellular and molecular contributions to their selective vulnerability are not well defined. In naturally aged mice, we demonstrate that senescent and disease-associated microglia (DAM) phenotypes converge in hippocampus-adjacent white matter. Through gold-standard gene expression and immunolabeling combined with high-dimensional spatial mapping, we identified microglial cell fates in aged white matter characterized by aberrant morphology, microenvironment reorganization, and expression of senescence and DAM markers, including galectin 3 (GAL3/Lgals3), B-cell lymphoma 2 (Bcl2), and cyclin dependent kinase inhibitors, including Cdkn2a/p16ink4a. Pharmacogenetic or pharmacological targeting of p16ink4a or BCL2 reduced white matter GAL3+ DAM abundance and rejuvenated microglial fimbria organization. Our results demonstrate dynamic changes in microglial identity in aged white matter that can be reverted by senotherapeutic intervention to promote homeostatic maintenance in the aged brain.
Knowledge, attitude, and practice toward chemotherapy-related neutropenia and febrile neutropenia among breast cancer patients Running title: KAP of chemotherapy neutropenia in breast cancer
Authors: Chen Yilin , Zhou Huanhao , Jiang Junzhen 
Published: October 2023

Abstract
Aims
This study aimed to investigate the knowledge, attitude, and practice (KAP) toward chemotherapy-related neutropenia and febrile neutropenia (FN) among breast cancer patients.
Materials and methods
A multi-center cross-sectional study enrolled breast cancer chemotherapy patients at four hospitals between April and June 2023. A self-administered questionnaire was developed to assess KAP scores. The structural equation model (SEM) was used to analyze the interactions between patients' knowledge and attitude and demographic characteristics.
Results
A total of 246 patients completed the questionnaire. The mean knowledge score was 12.46 ± 6.21 (possible range: 0–26) and the mean attitude score was 30.00 ± 2.58 (possible range: 7–35). Less than half of the patients knew whether their chemotherapy protocol was a high-risk protocol for FN (45.95%). However, the majority of patients were aware of the need for the prophylactic administration of leukocyte-raising agents (79.67%). Multivariate logistic regression analysis showed that junior college and above (OR = 4.69, 95% CI = 2.23–9.89, P < 0.001) was associated with adequate knowledge. Living in urban areas (OR = 0.58, 95% CI = 0.34–0.97, P = 0.037) was associated with positive attitude. The SEM showed that experience with chemotherapy-related neutropenia or FN had a direct effect on knowledge (β = 1.77, p = 0.029).
Conclusion
This study found inadequate knowledge, positive attitude and suboptimal practice toward chemotherapy-related neutropenia and FN among breast cancer chemotherapy patients. Tailored and effective education programs need to be designed and implemented to improve relevant KAP in this patient population.
Betaine addition to dietary can alleviate intestinal injury to growing meat rabbits in summer heat through the AAT/mTOR pathway
Authors: Li Zimei , Pu Junning , Chen Xiang , Chen Yanbin , Peng Xiaoyan , Cai Jingyi , Jia Gang , Zhao Hua , Tian Gang 
Published: October 2023

Abstract
Background
The aim of this experiment was to investigate the effect of different levels of betaine (Bet) inclusion in the diet on the intestinal health of growing meat rabbits under summer heat. A total of 100 weaned Qixing meat rabbits aged 35 days with similar body weight (748.61 ± 38.59 g) were randomly divided into five treatment groups: control group (basal diet), and Bet groups (basal diet + 0.75, 1.0, 1.5 or 2.0 g/kg Bet). The average daily temperature in the rabbitry during the experiment was 30.48°C and the relative humidity was 69.44%.
Results
Dietary addition of Bet had no significant effect on growth performance and health status of growing meat rabbits (P > 0.05), but it increased ileal secretory immunoglobulin A (sIgA) content compared to the control under summer heat (P < 0.05). Addition of 0.75 g/kg Bet up-regulated jejunal IL-4, down-regulated ileal TNF-α expression (P < 0.05). The addition of 1.0 g/kg Bet increased the villi height (VH) in the jejunum (P < 0.05). Serum glucose levels were reduced in rabbits, and up-regulated jejunal and ileal SLC6A20 expression fed with 1.5 g/kg Bet (P < 0.05). When added at 2.0 g/kg, Bet reduced serum HSP70 content, jejunal VH was increased, and up-regulated duodenal SLC7A6, SLC38A2, mTOR and 4EBP-2 expression (P < 0.05). Correlation analysis revealed that intestinal mTOR expression was significantly and positively correlated with SLC7A6, SLC38A2, SLC36A1 and IL-4 expression (P < 0.05).
Conclusions
Dietary addition of Bet can up-regulate the expression of anti-inflammatory factors through the AAT/mTOR pathway, improve the intestinal immune function, alleviate intestinal damage in growing meat rabbits caused by summer heat, and improve intestinal health, with the best results achieved when the amount of Bet was 2.0 g/kg.
Surgical intervention after lenvatinib treatment in patients with advanced hepatocellular carcinoma
Authors: Okuno Masayuki , Hatano Etsuro , Tada Masaharu , Nishimura Takashi , Okamoto Tomohiro , Sueoka Hideaki , Iida Kenjiro , Nakamura Ikuo , Iijima Hiroko , Hirono Seiko 
Published: October 2023

Abstract
Background Survival efficacy and prognostic factors in patients with advanced hepatocellular carcinoma (HCC) who underwent surgical intervention after lenvatinib treatment is not well-understood.Methods Patients with advanced HCC who had lenvatinib treatment were retrospectively analyzed.Results Of 70 patients who were treated with lenvatinib, 14 patients underwent surgical intervention after lenvatinib treatment for 4–28 weeks. PFS was significantly longer in patients with surgical intervention than in patients with non-surgical treatment (median, 8.6 vs. 5.1 months, p = 0.019). Non-significant longer OS was also observed in patients with surgical intervention compared to patients with non-surgical treatment (median, unreached vs. 21.0 months, p = 0.206). In patients who underwent surgical intervention, 2 patients had a PR, and 12 had SD according to RECIST ver. 1.1 criteria. The serum AFP level was significantly lower after lenvatinib treatment than before lenvatinib treatment (median, 19.2 vs. 196.5 ng/mL, p = 0.0081). Eleven patients underwent curative surgery with a 14% major postoperative complication (Clavien‒Dindo ≥ IIIa) rate. Patients who exhibited decreases in AFP levels or were within the normal range of AFP levels during lenvatinib treatment had significantly longer PFS (median, 8.6 vs. 3.0 months, p = 0.0009) and OS (median, unreached vs. 12.4 months, p = 0.012) than patients who had AFP levels beyond the normal range that did not decrease during lenvatinib treatment.Conclusions Surgical intervention after lenvatinib treatment for advanced HCC was associated with longer PFS. Patients exhibiting decreases in AFP levels or were within the normal limit of AFP levels may be good candidates for surgical intervention after lenvatinib treatment for advanced HCC.