bluuebunny/crossref_metadata_2025_split huggingface dataset:
Delayed-Onset White-Dot Syndrome in the Setting of Traumatic Choroidal Rupture
Authors: Husain Alina , Winebrake James P. , Goldberg Naomi R. , Mahrous M. Abdallah , Kovacs Kyle D. 
Published: January 2025

Purpose: To describe a patient with a traumatic choroidal rupture and a submacular hemorrhage, the course of which was complicated by delayed-onset posterior uveitis resembling a white-dot syndrome. Methods: A single case was evaluated. Results: A 34-year-old man presented after being struck in the left eye with a tennis ball. The visual acuity (VA) was 20/30 with otherwise normal ophthalmic vitals. An examination showed traumatic iritis and choroidal rupture with a submacular hemorrhage without subfoveal involvement. Despite treatment of anterior segment inflammation and a worsening hemorrhage with topical agents and intravitreal aflibercept, the VA decreased to 20/600. A repeat examination with optical coherence tomography showed new optic disc edema, placoid outer retinal lesions adjacent to the choroidal rupture, and corresponding ellipsoid zone atrophy. A broad workup was unremarkable, and the patient completed a long taper of high-dose oral prednisone without recurrence. Conclusions: Traumatic exposure of the immunologically privileged subretinal space to high-flow choroidal circulation likely triggered a pathway involving self-autoantigenicity and a uveitic response.
Feasibility of using Continuous Positive Airway Pressureviathe ‘LeVe CPAP System’ among Children with Acute Hypoxaemic Respiratory Failure at Mengo Hospital Kampala Uganda: A Mixed Methods study
Authors: Namulema Edith , Davis Birch William , Nakiriba Mayega Rhoda , Namugga Barbara , Musasizi Racheal , Tumwesigye Ambrose , Littlejohns Anna , Please Helen , Sharma Vishal , Cunningham Alice , Waters Ian , Brettle David , Parmar Jiten D , Miller Roy , Beacon Tim , Murdoch Stuart , Culmer Peter , Kapur Nikil , Winton Mark , Lawton Tom 
Published: January 2025

Continuous positive airway pressure (CPAP) is a well-established treatment modality for children in moderate and severe respiratory failure in well-resourced settings. However, the availability of CPAP is generally poor in many resource-limited settings, in large part because existing CPAP devices are not designed for cost and resource efficiency, which precludes their use. The LeVe CPAP System has been co-developed by an international multidisciplinary team specifically for use in low resource settings. In this paper we report the first study evaluating the efficacy of using the LeVe CPAP System as an intervention for children with Acute Hypoxaemic Respiratory Failure at Mengo Hospital in Kampala, Uganda.A total of 42 paediatric patients were recruited onto the study, all of whom were failing to maintain oxygen saturation above 88% at room conditions. Key clinical measures including oxygen saturation, heart rate, respiratory rate, and dyspnoea were recorded every hour for the length of admission on the paediatric ward. At completion, 39 patients had recovered and were successfully discharged while 3/42 (7%) died in the early phases of treatment. Surviving patients showed improvements in all clinical measures, particularly in the first 12 h of treatment, and no adverse effects were reported after continued use. Additionally, we interviewed five parents whose children were undergoing treatment to gain a qualitative assessment of perceptions to the LeVe CPAP system.Outcomes of the study demonstrate the capability of the LeVe CPAP system to treat paediatric patients in respiratory failure and support the system's wider adoption in low resource settings.
Factors contributing to anxiety in adolescents surviving thalassemia major in Indonesia
Authors: Mediani Henny Suzana , Fuadah Novitasari Tsamrotul 
Published: January 2025

Abstract

Background
Thalassemia major is a significant public health concern, passed from parents to children, which can be mitigated through screening programs. Inconsistencies in blood transfusions and iron chelation therapy result in physical changes that can cause psychological problems, with anxiety being the most prominent. This study aimed to examine the factors influencing anxiety levels among adolescent thalassemia major survivors.

Methods
The research utilized a quantitative approach with a correlational analytic design and cross-sectional method. It included a population of 122 adolescent survivors, all of whom were included using a total sampling technique. Data analysis involved univariate analysis by frequency distribution, bivariate analysis using the chi-square test, and multivariate analysis with logistic regression.

Results
The findings of the study showed that adolescent thalassemia survivors experienced varying levels of anxiety: mild anxiety in 70.5%, moderate anxiety in 9.8%, and severe anxiety in 19.7%. Significant associations were observed between anxiety levels and factors such as body image (p < 0.001), self-esteem, and coping strategies, while social support did not show a significant relationship. Body image was identified as the most impactful factor, with poor body image raising the risk of severe anxiety by 11.6 times.

Conclusions
Anxiety is common among adolescent thalassemia survivors, with body image, self-esteem, and coping skills being key factors. Poor body image notably increases the risk of severe anxiety, emphasizing the need for psychological support focused on body image, self-esteem, and coping strategies to improve mental health in this group.
Strategies and resources used by public health units to encourage COVID-19 vaccination among priority groups: a behavioural science-informed review of three urban centres in Canada
Authors: Langmuir Tori , Wilson Mackenzie , McCleary Nicola , Patey Andrea M. , Mekki Karim , Ghazal Hanan , Estey Noad Elizabeth , Buchan Judy , Dubey Vinita , Galley Jana , Gibson Emily , Fontaine Guillaume , Smith Maureen , Alghamyan Amjad , Thompson Kimberly , Crawshaw Jacob , Grimshaw Jeremy M. , Arnason Trevor , Brehaut Jamie , Michie Susan , Brouwers Melissa , Presseau Justin 
Published: January 2025

Abstract

Background
Ensuring widespread COVID-19 vaccine uptake is a public health priority in Canada and globally, particularly within communities that exhibit lower uptake rates and are at a higher risk of infection. Public health units (PHUs) have leveraged many resources to promote the uptake of recommended COVID-19 vaccine doses. Understanding barriers and facilitators to vaccine uptake, and which strategies/resources have been used to address them to date, may help identify areas where further support could be provided. We sought to identify the strategies/resources used by PHUs to promote the uptake of the first and third doses of the COVID-19 vaccine among priority groups in their jurisdictions. We examined the alignment of these existing strategies/resources with behavioral science principles, to inform potential complementary strategies/resources.

Methods
We reviewed the online and in-person strategies/resources used by three PHUs in Ontario, Canada to promote COVID-19 vaccine uptake among priority groups (Black and Eastern European populations, and/or neighbourhoods with low vaccine uptake or socioeconomic status). Strategies/resources were identified from PHU websites, social media, and PHU liaison. We used the Behaviour Change Techniques (BCT) Taxonomy – which describes 93 different ways of supporting behaviour change – to categorise the types of strategies/resources used, and the Theoretical Domains Framework – which synthesises 14 factors that can be barriers or facilitators to decisions and actions – to categorise the barriers and facilitators addressed by strategies/resources.

Results
PHUs operationalised 21 out of 93 BCTs, ranging from 15 to 20 BCTs per PHU. The most frequently operationalised BCTs were found in strategies/resources that provided information about COVID-19 infection and vaccines, increased access to COVID-19 vaccination, and integrated social supports such as community ambassadors and engagement sessions with healthcare professionals. Identified BCTs aligned most frequently with addressing barriers and facilitators related to Knowledge, Environmental context and resources, and Beliefs about consequences domains.

Conclusion
PHUs have used several BCTs to address different barriers and facilitators to COVID-19 vaccine uptake for priority groups. Opportunities should be pursued to broaden the scope of BCTs used (e.g., operationalizing the pros and cons BCT) and barriers/facilitators addressed in strategies/resources for ongoing and future COVID-19 vaccine uptake efforts among general and prioritised populations.
Exploring the hidden synergy between system thinking and patient safety competencies among critical care nurses: a cross-sectional study
Authors: Atalla Amal Diab Ghanem , Bahr Rwan Ragab Rabea , El-Sayed Ahmed Abdelwahab Ibrahim 
Published: January 2025

Abstract

Background
Patient safety remains a global priority, with nurses playing a crucial role in minimizing errors and improving patient outcomes. System thinking, which involves understanding how various components of a healthcare system interact, is increasingly recognized as essential for enhancing patient safety competencies.

Aim
This study investigates the impact of systems thinking on patient safety competencies among nurses in critical care units, exploring the relationship between systems thinking and various subdomains of patient safety competencies.

Methods
A cross-sectional study was conducted at all critical care units of Alexandria Main University Hospital, Egypt. Data were collected from a convenience sample of 289 nurses using the system thinking scale and the patient safety competency self-evaluation questionnaire. Correlation and regression analyses were performed to examine the relationship between systems thinking and patient safety competencies, controlling for demographic factors such as age, qualifications, and years of experience.

Results
Nurses demonstrated moderate to high levels of systems thinking (mean = 82.36 ± 12.14) and patient safety competencies (mean = 162.74 ± 23.56). Strong positive correlations were found between systems thinking and patient safety competencies (r = 0.605, p < 0.05), particularly in areas such as error reporting, communication, and infection prevention. Regression analysis revealed that systems thinking significantly predicted patient safety competencies, increasing the explained variance from 58.8 to 67.7%.

Conclusion
The findings highlight the critical role of systems thinking in enhancing nurses’ patient safety competencies. Nurses with higher systems thinking skills are better equipped to prevent errors and improve communication, ultimately enhancing patient care quality.

Implications
Nursing schools should integrate system thinking into nursing curricula to prepare future nurses for complex healthcare environments. Healthcare organizations should incorporate system thinking into professional development programs to enhance the competencies of practicing nurses. Nurse managers can foster a culture of safety by promoting interdisciplinary collaboration and reflective practice. Broader adoption of system thinking can improve patient outcomes, especially in resource-constrained environments.

Clinical trial number
Not applicable.
Evidence to practice – lessons learnt in developing an implementation strategy for an online digital health intervention (Eczema Care Online)
Authors: Howells Laura , Thomas Kim S. , Santer Miriam , Muller Ingrid , Greenwell Kate , Roberts Amanda , Williams Hywel C. , Harvey Jane , Lax Stephanie J. , Rogers Natasha K. , Sach Tracey H. , Lawton Sandra , Steele Mary , Sivyer Katy , Hooper Julie , Ahmed Amina , Wilczynska Sylvia , Langan Sinead , Leighton Paul 
Published: January 2025

Abstract

Background
Eczema Care Online (www.EczemaCareOnline.org.uk/) is an online self-management toolkit which includes tailored content for young people (13–25 years) and for parents of children that have eczema (0–12 years). Testing in two randomised controlled trials has shown that it is easy to use, cost effective and offers a sustained improvement in eczema symptoms.
Implementing Eczema Care Online outside of a funded research study and ensuring that it reaches those that will most benefit from is now a key challenge. This paper describes the lessons learnt from developing and delivering an implementation strategy.

Methods
Data from systematic reviews, stakeholder consultation meetings, interviews with trial participants, intervention usage data during the trial, and existing eczema information websites informed our implementation plan. Using Normalisation Process Theory, an implementation plan combined these findings with practical, context-specific actions to encourage wider adoption of the intervention.

Results
Data was successfully mapped to the four constructs of Normalisation Process Theory, and factors and processes that encourage implementation identified. These include: promoting how Eczema Care Online is different to other sources of information; aligning to and embedding in existing eczema resources (from charities and healthcare providers); simplifying aspects to aid ease of use; and, highlighting evidence that shows that Eczema Care Online works.
Key lessons in developing an implementation strategy include 1) start implementation work early 2) maintain flexibility to explore multiple routes to implementation 3) use secondary data sources 4) balance theory with practicalities 5) consider longer-term maintenance beyond the life of the research project.

Conclusion
Implementation planning is a key stage of the research process that is often not adequately resourced. Implementation planning ensures effective interventions developed and evaluated in research studies are utilised in everyday practice.
Experimental hypothermia by cold air: a randomized, double-blind, placebo-controlled crossover trial
Authors: Helland Ane M. , Mydske Sigurd , Assmus Jörg , Brattebø Guttorm , Wiggen Øystein , Kvidaland Haakon K. , Thomassen Øyvind 
Published: January 2025

Abstract

Background
Accidental hypothermia is associated with high morbidity and mortality. Research on treatment strategies for accidental hypothermia is complicated by the low incidence and heterogeneous patient population. We have developed a new method for clinical trials of experimental hypothermia, to enable further studies of active rewarming. If cold ambient air is effective as a cooling method, this would mimic the most frequent clinical setting of hypothermic patients and provide a feasible cooling method for field studies. We aimed to induce mild hypothermia in healthy volunteers by exposure to cold ambient air, and tested the hypothesis that drug-induced suppression of endogenous thermoregulation would be required.

Methods
In a randomized, double-blind, crossover design, 15 healthy volunteers wearing wet clothes were put in a windy climate chamber set to 5 °C. Each participant completed the experimental procedure twice, once receiving active drugs (meperidine and buspirone) and once receiving placebo. The experiments were separated by a one-week wash-out period. Primary outcome was core temperature at termination, defined as 3 h of exposure or 35 °C. The between-groups difference was assessed using analysis of covariance (ANCOVA) with left censoring (Tobit model) and individual random intercept. Secondary outcomes were trajectory of core temperature and reduction of shivering.

Results
At termination, the active drug vs placebo group differed in temperature by 1.4 °C. With adjustment for the removal of participants reaching 35 °C, the estimated mean difference was 1.7 °C (1.4–2.0, p < 0.001). Shivering was effectively reduced, but not completely inhibited by the drug regimen, and core temperature declined at a rate of − 0.82 °C per hour.

Conclusion
The novel protocol utilizing cold air as a cooling method and drug-induced suppression of endogenous thermoregulation, is effective and enables future research projects. We have provided suggestions for minor alterations.

Trial registration:

EudraCT ID 2023–506020-81–00.
Midgut immune profiling and functional characterization of Aedes aegypti ABC transporter gene(s) using systemic and local bacterial challenges
Authors: Kumar Vikas , Garg Shilpi , Sisodia Diksha , Gupta Lalita , Kumar Sanjeev , Saxena Vishal 
Published: January 2025

Abstract

Background
The mosquito midgut is crucial for digestion and immune interactions. It produces several immune factors that protect the organ from invading pathogens and can limit their propagation. Studies on mosquito midgut transcriptome following pathogen exposure have revealed the presence of non-canonical immune genes, such as ABC transporters, whose function in insect immunity remains unexplored. Therefore, this study focuses on identifying and characterising the immune role of ABC transporters in the midgut of Aedes aegypti, a primary arboviral vector.

Methods
To identify the midgut-expressed ABC transporters, the mosquitoes were challenged with a mixture of gram-negative (Escherichia coli) and gram-positive (Micrococcus luteus) bacteria, and the expression of all ABC transporters was analysed with PCR using gene-specific primers. Furthermore, the transcriptional alterations of midgut ABC transporters were explored at different time points upon a thoracic nano-injection (systemic challenge) or infectious blood meal (local challenge) of the bacterial mixture through quantitative real-time PCR (qPCR), and one gene was selected for RNAi-mediated gene silencing and its role assessment in midgut immune responses.

Results
The expression of all 48 microbial-induced midgut-expressing Ae. aegypti ABC transporter genes upon systemic or local bacterial challenges was analyzed. Based on the transcriptomic data and potential immune expression similar to the well-known immune gene defensin, AaeABCG3 was selected for RNAi-mediated gene silencing and characterization. The AaeABCG3 gene silencing exhibited a significant reduction of midgut bacterial load through the induction of nitric oxide synthase (NOS) in sugar-fed and systemic bacterial-challenged mosquitoes. In contrast, midgut bacterial load was significantly regulated by induction of defensin A and cecropin G in the late hours of local bacterial challenges in AaeABCG3-silenced mosquitoes.

Conclusions
The silencing of AaeABCG3 modulated the mosquito midgut immune response and disturbed the midgut microbiota homeostasis. The systemic immune responses of AaeABCG3-silenced mosquitoes were influenced by the JAK-STAT pathway with no induction of Toll and IMD immune pathways. Interestingly, Toll and IMD immune pathways actively participated in the late hours of local bacterial challenges, suggesting that the route of infection influences these immune responses; however, the molecular mechanism behind these phenomena still needs to be explored. Overall, this work provides significant insight into the importance of ABC transporters in mosquito immunity.

Graphical Abstract
Destabilization of mutualistic interactions shapes the early heat stress response of the coral holobiont
Authors: Marangon Emma , Rädecker Nils , Li Joan Y. Q. , Terzin Marko , Buerger Patrick , Webster Nicole S. , Bourne David G. , Laffy Patrick W. 
Published: January 2025

Abstract

Background
The stability of the symbiotic relationship between coral and their dinoflagellate algae (Symbiodiniaceae) is disrupted by ocean warming. Although the coral thermal response depends on the complex interactions between host, Symbiodiniaceae and prokaryotes, the mechanisms underlying the initial destabilization of these symbioses are poorly understood.

Results
In a 2-month manipulative experiment, we exposed the coral Porites lutea to gradually increasing temperatures corresponding to 0–8 degree heating weeks (DHW) and assessed the response of the coral holobiont using coral and Symbiodiniaceae transcriptomics, microbial 16S rRNA gene sequencing and physiological measurements. From early stages of heat stress (< 1 DHW), the increase in metabolic turnover shifted the holobiont to a net heterotrophic state in which algal-derived nutrients were insufficient to meet host energy demands, resulting in reduced holobiont performance at 1 DHW. We postulate the altered nutrient cycling also affected the coral-associated microbial community, with the relative abundance of Endozoicomonas bacteria declining under increasing heat stress. Integration of holobiont stress responses correlated this decline to an increase in expression of a host ADP-ribosylation factor, suggesting that Symbiodiniaceae and Endozoicomonas may underlie similar endosymbiotic regulatory processes.

Conclusions
The thermotolerance of coral holobionts therefore is influenced by the nutritional status of its members and their interactions, and this identified metabolic interdependency highlights the importance of applying an integrative approach to guide coral reef conservation efforts.
Telehealth group intervention for adolescents and young adults with cancer: a feasibility pilot study protocol
Authors: Chan Sherilynn F. , Patten Joanna , Lau Nancy 
Published: January 2025

Abstract

Background
Providing opportunities for social interaction and access to psychosocial interventions are 2 of the 15 Standards for Psychosocial Care for Children with Cancer and Their Families. Peer relationships are especially important among adolescents and young adults (AYAs), and cancer disrupts this aspect of social development. Many AYAs with cancer report a desire to engage in peer support groups; however, this remains a critical unmet need. Telehealth is a cost-effective and increasingly common modality for delivering health care that reduces access barriers and may be an especially good fit for AYAs with cancer. Little work has evaluated the feasibility and acceptability of peer support groups for AYAs with cancer. The purpose of this study is to evaluate the feasibility and acceptability of a telehealth peer support group intervention for AYAs with cancer.

Methods
Telehealth group interventions are offered twice yearly as standard of care at Seattle Children’s Hospital to AYAs on or off treatment for cancer or a brain tumor. Group members are assigned to a High School Group (grades 9–12) or an AYA Group (spring of grade 12 or older). Aim 1 is to determine the feasibility and acceptability of the intervention for all patients who participate in groups in their clinical care. Feasibility will be assessed based on a priori metrics (enrollment, attendance, attrition) for all group members. Group and telehealth acceptability will be assessed by a 16-item internally developed measure that was adapted from the Client Satisfaction Questionnaire. Aim 2 is to conduct patient stakeholder semi-structured interviews post-intervention with 20 AYAs to gather feedback and inform intervention refinement. Participants who opt-in for study procedures will also complete exploratory measures of social connectedness/isolation, depression, and benefit finding, pre- and post-intervention (Aim 3).

Discussion
Findings from this pilot study will inform intervention refinement, intervention implementation, and sample sizes for future powered trials. This study will provide preliminary empirical evidence to support the development of effective group interventions for AYAs with cancer that increase opportunities for social interaction and access to peer support, with the potential to contribute to improved psychosocial care of AYAs with cancer.