bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diversity, Equity, and Inclusion Lessons From Developing Stroke Education Programs for West Michigan Asian Communities
Authors: Antonio Aileen A. , Anderson Taylor , Ngo Vincent , Park Sojung , Woolner Susan , Farooq Muhammad , Santos Ronel , Gorelick Philip 
Published: February 2024

BACKGROUND:
Asians in the United States, facing health care disparities, have increased stroke risk. Multiple subgroups, with distinct cultures and languages, add complexity to caring for Asian American (AsA) communities. We developed a tailored stroke education program for underserved West Michigan AsA communities. Methodology, lessons learned, and diversity, equity, and inclusion insights are described.

METHODS:
Neurology residents and faculty, in collaboration with trained community-specific navigators, developed culturally resonant stroke education that was tailored to meet the needs of specific self-identified West Michigan AsA communities. Educational and debriefing sessions were delivered over 6 months, following the Plan-Do-Study-Act model, to elucidate diversity, equity, and inclusion insights and improve materials and delivery methods.

RESULTS:
Eighty-six non-English-speaking participants from 5 self-identified AsA communities (Burmese, Buddhist Vietnamese, Catholic Vietnamese, Chinese, and Nepali) attended educational stroke sessions. The average age of attendees was 57.6±13.2 years; most were females (70%). Diversity, equity, and inclusion insights included identification of Asian cultural beliefs about acute stroke treatment (eg, bloodletting), investigator insights (eg, need for kitchen-table programs), systemic barriers (eg, language), and mitigation strategies.

CONCLUSIONS:
Institutions should consider the integration of equity-focused, trainee-influenced quality improvement projects, such as this culturally resonant stroke educational program for AsA, to enhance stroke care in these vulnerable communities.
Effect of Remote Ischemic Conditioning in Ischemic Stroke Subtypes: A Post Hoc Subgroup Analysis From the RESIST Trial
Authors: Blauenfeldt Rolf Ankerlund , Mortensen Janne Kaergaard , Hjort Niels , Valentin Jan Brink , Homburg Anne-Mette , Modrau Boris , Sandal Birgitte Forsom , Gude Martin Faurholdt , Berhndtz Anne Brink , Johnsen Søren Paaske , Hess David C. , Simonsen Claus Ziegler , Andersen Grethe 
Published: February 2024

BACKGROUND:
Remote ischemic conditioning (RIC) is a simple and noninvasive procedure that has proved to be safe and feasible in numerous smaller clinical trials. Mixed results have been found in recent large randomized controlled trials. This is a post hoc subgroup analysis of the RESIST trial (Remote Ischemic Conditioning in Patients With Acute Stroke), investigating the effect of RIC in different acute ischemic stroke etiologies, and whether an effect was modified by treatment adherence.

METHODS:
Eligible patients were adults (aged ≥18 years), independent in activities of daily living, who had prehospital stroke symptoms with a duration of less than 4 hours. They were randomized to RIC or sham. The RIC treatment protocol consisted of 5 cycles with 5 minutes of cuff inflation alternating with 5 minutes with a deflated cuff. Acceptable treatment adherence was defined as when at least 80% of planned RIC cycles were received. The analysis was performed using the entire range (shift analysis) of the modified Rankin Scale (ordinal logistic regression).

RESULTS:

A total of 698 had acute ischemic stroke, 253 (36%) were women, and the median (interquartile range) age was 73 (63–80) years. Median (interquartile range) overall adherence to RIC/sham was 91% (68%–100%). In patients with a stroke due to cerebral small vessel disease, who were adherent to treatment, RIC was associated with improved functional outcome, and the odds ratio for a shift to a lower score on the modified Rankin Scale was 2.54 (1.03–6.25);
P
=0.042. The association remained significant after adjusting for potential confounders. No significant associations were found with other stroke etiologies, and the overall test for interaction was not statistically significant (χ
2
, 4.33,
P
=0.23).

CONCLUSIONS:
In patients with acute ischemic stroke due to cerebral small vessel disease, who maintained good treatment adherence, RIC was associated with improved functional outcomes at 90 days. These results should only serve as a hypothesis-generating for future trials.

REGISTRATION:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT03481777.
Implementation of a Thrombectomy Stroke Center Triage Program in New York City Emergency Medical Services
Authors: Brandler Ethan S. , Lancet Elizabeth A. , Murphy Sheree , Lai Pamela H. , Carrano Vincent , Prezant David J. , Redlener Michael , Ben‐Eli David 
Published: February 2024

Background
Due to the increased morbidity and mortality associated with acute cerebral ischemia caused by large vessel occlusions, the New York City (NYC) 9‐1‐1 Emergency Medical Services system implemented the NYC Stroke Triage Protocol with the intention of improving access to endovascular therapy for patients with suspected severe stroke.

Methods
Successful collaboration between multiple stakeholders enabled the NYC region to develop and implement a new stroke system of care for patients treated by Emergency Medical Services. Descriptive statistics including medians (interquartile range) and proportions were used as appropriate. Continuous data were compared using Mann–Whitney tests for medians and categorical data were compared by using Pearson chi‐square test.

Results
Between April 1, 2019 and March 31, 2022, 1337 (83.5%) patients directly transported under the NYC Stroke Triage Protocol by the NYC 9‐1‐1 Emergency Medical Services system to a Thrombectomy Stroke Center had a stroke diagnosis. Patients transported to a more distant Thrombectomy Stroke Center traveled an average of 5.7 minutes longer compared with those who were delivered to the closest Primary Stroke Center but the overall time between first patient contact and first pass at a Thrombectomy Stroke Center was an estimated 98.2 minutes shorter. Approximately 24% of directly transported patients with a stroke diagnosis underwent a thrombectomy.

Conclusions
The NYC Stroke Triage Protocol increased access to advanced interventional stroke care for eligible patients by decreasing time to treatment through prehospital identification of patients with severe stroke and directly transporting them to a stroke center capable of providing endovascular therapy.
Ko Wai Au – Ko Wai Au: Expressions of Wai
Authors: Denton Andrew , Gibbons Andrew , White Jayne , Williams Ngaroma M. , Martin Kaitlyn 
Published: February 2024

Abstract
As part of the international “Wash from the Start” omep (World Organization for Early Childhood Education) project, researchers shared time with children in three early childhood centre communities in the South Island of Aotearoa New Zealand – Te Wai Pounamu. The research explored young children’s engagement with local conditions of water through fieldwork annotations and photographic visual methods. The video article presented here is a photo essay that spans the researcher teams’ experiences in their encounters with the children and teachers they had the privilege to spend time with over a sunny week in Autumn 2022.
Fumed nanosilica as filler for semi-rigid palm oil-based polyurethane foam: Mechanical, material, thermal, and fire response
Authors: Dzulkifli Mohd Haziq , Majid Rohah A , Ghazali Siti Khairunisah , Yahya Mohd Yazid 
Published: February 2024

Incorporating nano-sized fillers into bio-based polyurethane (PU) foams typically enhances their properties. In present investigation, palm oil-based PU foams are fabricated with varied loadings (0 to 5 wt%) of fumed nanosilica. The foams are then characterized for their fire-retardancy, thermal stability, foam morphology, and also mechanical properties. Marginal improvement in Limiting Oxygen Index (LOI) values, as well as failure to be rated under UL-94 Vertical Combustion Test indicate limited potential of fumed silica in improving flammability of organic polymeric foams; suggesting exorbitant amount is required for any distinguishable effect to manifest. Interestingly; results from Thermogravimetry Analysis (TGA) shows marked improvements in terms of char residue with more than seven-fold increase at 5 wt% filler loading, possibly owed to the inert filler nature of fumed nanosilica forming a char barrier and acting as fuel diluent. Filled PU foams displayed an increased open-cell content, likely because the filler functioned as a cell opener. Removing the influence of density, the normalized compressive properties showed notable improvement up until a certain loading, which could be credited to the increased stiffness imparted by the filler itself. The results portray the potential of fumed nanosilica as filler for bio-based PU foams, offering enhanced thermal stability and limited fire retardancy.
Co-designing a culturally-sensitive theory-driven advance care planning game with Chinese older adults and healthcare providers
Authors: Liu Li , Wang Yao , Ho Tad Chun-Kwan , Li Miranda Man-Yee , Cheung Eddie Wai-Sum , Chow Rita Suk-Kuen , Gu Can , Chan Helen Yue-Lai 
Published: February 2024

Background: Advance care planning can be challenging because discussing end-of-life care often has negative connotations. Gamification is a novel approach to encourage advance care planning conversations in Western culture. Aim: To co-design a game with multiple stakeholders to promote advance care planning in Chinese communities. Design: A two-phase design guided by the Medical Research Council framework for developing complex interventions was adopted between May 2019 and August 2020. In phase I, a game prototype was developed based on literature review, expert consultation and end-user consultation. In Phase II, the game prototype was tested among end-users and refined according to their feedback and expertise of a multi-disciplinary team through an iterative process. Setting/participants: Experts in the field of aged care, palliative care, life education and game development and Chinese community-dwelling adults aged 60 years or older. Results: A board game called ‘ The Five Tastes Found in a Grocery Store’ was developed. The game design was shaped by Bandura’s Self-efficacy theory and feedback from experts and end-users. The participants generally found the gaming experience enjoyable and appreciated the opportunity to discuss end-of-life care openly. Conclusions: This study is the first to develop an evidence-informed, theory-based, culturally sensitive game for promoting advance care planning in the Chinese community using a co-design approach.
The contribution of the nursing profession to the establishment of social justice: A grounded theory study
Authors: Hosseinzadegan Fariba , Habibzadeh Hosein , Jasemi Madineh 
Published: February 2024

Background Social inequities in the healthcare system threaten global health. Efforts to establish equity in healthcare is a key goal of healthcare systems worldwide. Social justice is a basic value of the nursing profession that always merits attention. Objective This study aimed to identify and explain the processes of the nursing profession’s participation in establishing social justice in healthcare system. Research design and methods This qualitative study was conducted using the grounded theory method. Participants and research context Data were collected through in-depth, semi-structured, individual interviews with 26 participants, 23 of whom were members of the nursing profession. Sampling started purposefully and, then, continued with theoretical sampling. Field notes were also taken for data collection. Data analysis was performed using Corbin and Strauss’ 2015 method. Ethical considerations The research was approved by the Ethics Committee of Urmia University of Medical Sciences in Iran. Findings The “Professional Dynamics in the Path of Justice” was the study’s core category. This theory is the result of nine main categories: “inefficient professional authority,” “social justice, a neglected component in education,” “clinical concerns, barriers to nurses’ presence in society,” “individual input reserves to facilitate social justice,” “inadequate maturity of the profession in the path of equity in health,” “promoting justice in clinical practice,” “a tendency to community-oriented profession,” “use of personal approaches for justice promotion,” and “emerging justice-expanding nursing.” These categories cover the underlying factors, strategies, and outcomes of the nursing profession’s participation in establishing social justice process in healthcare. Conclusion The theory of professional dynamics in the path of justice can be used as a practical guide to describe the role of nurses in establishing social justice. Further studies with a quantitative approach to applying this theory are recommended.
Assessing Breast Cancer Screening and Outcomes Among First Nations Women in Alberta
Authors: Letendre Angeline , Shewchuk Brittany , Healy Bonnie A. , Chiang Bonnie , Bill Lea , Newsome James , Rahul Chinmoy Roy , Yang Huiming , Kopciuk Karen A. 
Published: February 2024

Background Breast cancer (BC) incidence rates for First Nations (FN) women in Canada have been steadily increasing and are often diagnosed at a later stage. Despite efforts to expand the reach of BC screening programs for FN populations in Alberta (AB), gaps in screening and outcomes exist. Methods Existing population-based administrative databases including the AB BC Screening Program, the AB Cancer Registry, and an AB-specific FN registry data were linked to evaluate BC screening participation, detection, and timeliness of outcomes in this retrospective study. Tests of proportions and trends compared the findings between FN and non-FN women, aged 50–74 years, beginning in 2008. Incorporation of FN principles of ownership, control, access, and possession (OCAP®) managed respectful sharing and utilization of FN data and findings. Results The average age-standardized participation (2013-8) and retention rates (2015-6) for FN women compared to non-FN women in AB were 23.8% ( P < .0001) and 10.3% ( P = .059) lower per year, respectively. FN women were diagnosed with an invasive cancer more often in Stage II ( P-value = .02). Following 90% completion of diagnostic assessments, it took 2–4 weeks longer for FN women to receive their first diagnosis as well as definitive diagnoses than non-FN women. Conclusion Collectively, these findings suggest that access to and provision of screening services for FN women may not be equitable and may contribute to higher BC incidence and mortality rates. Collaborations between FN groups and screening programs are needed to eliminate these inequities to prevent more cancers in FN women.
Seven-Year clinical outcomes after implantation of Eyecryl posterior chamber phakic intraocular lenses for high myopia
Authors: Kırgız Ahmet , Yalçınkaya Çakır Gülay , Çakır İhsan , Yıldırım Yusuf , Ağca Alper 
Published: February 2024

Purpose To evaluate the long-term clinical outcomes, safety and efficacy of Eyecryl posterior-chamber phakic intraocular lens implantation (pIOL) implantation in patients with high myopia. Methods Patients with myopia between −6.00 and −20.00 dioptres and with endothelial cell density (ECD) was ≥2300 cells/mm2 were included. Preoperative and postoperative first, fourth, and seventh years of refraction, uncorrected/corrected distance visual acuity (UDVA/CDVA), ECD, central vault were detected. Results Thirty-six eyes were analyzed. The mean UDVA and CDVA in postoperative seventh years were 0.25 ± 0.31 and 0.13 ± 0.24 logMAR, respectively. The safety and efficacy indices were 1.55 ± 0.54 and 1.24 ± 0.53, respectively. The mean cumulative ECD loss was 6.96% ( p < 0.001). The central vault at the 1st and the 7th year were 0.52 ± 0.14 and 0.49 ± 0.14 mm, respectively ( p = 0.25). Conclusions These findings supported the long-term stability, efficacy, safety of the Eyecryl pIOL for high myopia. Eyecryl posterior chamber pIOL is one of the effective refractive options in correcting high myopia.
“No man is an island”: How Chinese netizens use deliberate metaphors to provide “depression sufferers” with social support
Authors: Jing Youping , Jiang Guiying 
Published: February 2024

Objective Online social support provides a way to positively influence depression sufferers. In the present study, we aim to analyze how social support in Chinese online depression communities is communicated through the lens of deliberate metaphor theory (DMT) to deepen the understanding of the under-researched complicated, emotionally laden, and culture-related concepts of this experience. Methods We collected data (n = 3546 comments) from the Warm Supporting section of the Depression Super Topic, a major Chinese online depression community on Weibo. The data were analyzed using a metaphorical analysis with the Metaphor Identification Procedure Vrije Universiteit and a thematic analysis. Results Our findings identify two themes: deliberate metaphors (DMs) of depression and DMs of social environment for depression sufferers. The former conceptualizes future expectations without depression (as rosy images; victorious battles; the beaten black dog); disorder (as subtle objects; subjective initiative events); depression sufferers (as valuable objects; important roles); and present life with depression (as optional events; spiritual practices; fragile objects). The latter conceptualizes social connection (as solid objects; nonessentials); individuals in the social environment (as energetic objects; vicious roles); and prejudice (as colored objects). Conclusions The findings suggest that DMs as important online social support resources, helping to express empathy and normalize depression with more common-sense, and non-judgmental concepts. Additionally, in DMs, Chinese netizens navigate the intricate intersection of medical and moral perspectives on depression and its recovery, leveraging both aspects to offer comprehensive social support. “Confucian-based” elements are embedded in culture-related social support expressions in DMs. In practice, our findings contribute to tailored and appropriate health interventions for depression.
Enhancing Maternal Caregiving Capabilities Model to Prevent Childhood Stunting: A UNICEF-Inspired Model
Authors: Has Eka Mishbahatul Marah , Krisnana Ilya , Efendi Ferry 
Published: February 2024

Introduction The proportion of stunted children in Indonesia is slowly decreasing. In most families, a mother is responsible for child care. The quality of maternal caregiving capability influences the mother’s ability to adopt appropriate childcare practices, which is essential to prevent childhood stunting. Objectives This study aimed to develop a model to enhance maternal caregiving capabilities in preventing childhood stunting based on the UNICEF model of care. Methods The study used an analytical observational design involving a pair of mothers and their youngest 6–23-month-old children registered at Posyandu (Community-based Integrated Health Care Center). Six hundred respondents were taken using a cluster sampling technique across seven healthcare centers in Surabaya City, East Java, Indonesia. The independent variables were child, mother, father, and household factors, then maternal caregiving capabilities. The dependent variable was the nutritional behavior to prevent childhood stunting. Data were collected using questionnaires and then analyzed using the Structural Equation Model-Partial Least Squares (SEM-PLS) test. Results The study found that maternal caregiving capabilities are influenced by child (T-stat 2.605), mother (T-stat 3,800), and household factors (T-stat 10,338). Maternal caregiving capabilities affect stunting preventive behavior in children aged 6–23 months (T-stat 2.493). Household factors were the strongest factor affecting maternal caregiving capabilities. Conclusion Enhancing maternal caregiving capabilities model can be developed using its constituents, especially perceived physical health, psychological well-being, and decision-making. Household factors, including economic level and food security, were also important. High maternal caregiving capabilities were expected to enable mothers to improve their behavior to prevent childhood stunting (6–23 months).
Study within a trial 119: The effectiveness of a thank you card to improve trial follow up; a randomised study within a trial
Authors: Arundel Catherine , Welch Charlie , Tharmanathan Puvanendran , Dias Joseph 
Published: February 2024

Background With attrition common in randomised trials, strategies are needed to minimise this. Many retention strategies include ‘thanks’ elements however there is currently no evidence of the effectiveness of a ‘thank you’ intervention separate to other trial activity or information. This Study Within A Trial (SWAT) sought to assess if a thank you card increases completion of the host trial primary outcome. Methods A two arm SWAT, using a 1:1 (intervention:control) allocation ratio, embedded within the DISC trial. The primary outcome was the difference in retention rate at 1 year post-treatment. Secondary outcomes were outcome data completeness, cost, and retention at 2 years post-treatment. Analyses were conducted using logistic regression adjusting for SWAT and host trial allocation. Results A total of 358 participants were randomised and included in the SWAT analyses. Completion of the 1-year outcome visit was 89.7% ( n = 157) in the intervention group and 90.2% (165) in the control group (adjusted odds ratio (OR) 0.95, 95% CI 0.48 to 1.90, p = .89). There was no evidence of a difference in completeness of key outcome data (adjusted OR 1.84, 95% CI 0.71 to 4.73, p = .20) or retention at 2 years post treatment (adjusted OR 1.13, 95% CI 0.59 to 2.17, p = .72). Conclusion It remains unclear if thank you cards increased the rate of primary outcome follow-up completion within the DISC trial. However, as the first evaluation of a distinct ‘thank you’ intervention for improving retention rates, further replications are required to determine effectiveness, ideally in populations other than older, male, Caucasians.