bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cytotoxic activity of non-specific lipid transfer protein (nsLTP1) from Ajwain (Trachyspermum ammi) seeds
Authors: Alshammari Saud O. , Aldakhil Taibah , Alshammari Qamar A. , Salehi David , Ahmed Aftab 
Published: May 2022

Abstract
Background
Trachyspermum ammi, commonly known as Ajwain, is a member of the Apiaceae family. It is a therapeutic herbal spice with diverse pharmacological properties, used in traditional medicine for various ailments. However, all previous studies were conducted using small molecule extracts, leaving the protein’s bioactivity undiscovered.

Aim
The current study aimed to demonstrate the cytotoxic activity of Ajwain non-specific lipid transfer protein (nsLTP1) in normal breast (MCF10A), breast cancer (MCF-7), and pancreatic cancer (AsPC-1) cell lines. Also, to evaluate its structural stability in human serum as well as at high temperature conditions.

Methods
The cytotoxic activity of Ajwain nsLTP1 was evaluated in MCF-7 and AsPC-1 cell lines using MTT assay. Annexin V-FITC and PI staining were used to detect the early apoptotic and late apoptotic cells. The role of nsLTP1 in inducing apoptosis was further studied by quantifying Bcl-2, Bax, Caspase-3, Survivin, EGFR, and VEGF genes expression using RT-PCR. CD spectroscopy analyzed the nsLTP1 conformational changes after thermal treatment for structure stability determination. The RP-HPLC was used to analyze the nsLTP1 degradation rate in human serum at different time intervals incubated at 37 °C.

Results
Ajwain nsLTP1 showed a potent cytotoxic effect in MCF-7 and AsPC-1. The IC50 value obtained in MCF-7 was 8.21 μM, while for AsPC-1 4.17 μM. The effect of nsLTP1 on stimulating apoptosis revealed that the proportions of apoptotic cells in both cell lines were relatively increased depending on the concentration. The apoptotic cells percentage at 20 μM was in MCF-7 71% (***P < 0.001) and AsPC-1 88% (***P < 0.001). These results indicate that nsLTP1 might efficaciously induce apoptosis in multiple types of cancerous cells. Genes expression in MCF-7 and AsPC-1 showed significant upregulation in Bax and Caspase-3 and downregulation in Bcl-2, Survivin, EGFR, and VEGF protein. The CD analysis of nsLTP1 showed a significant thermostable property. In serum, nsLTP1 showed a slow degradation rate, indicating high stability with a half-life of ~ 8.4 h.

Conclusion
Our results revealed the potential anticancer activity of Ajwain nsLTP1 and its mechanism in inducing apoptosis. It further exhibited thermostable properties at high temperatures and in human serum, which suggested this protein as a promising anticancer agent.
The impact of small-group virtual patient simulator training on perceptions of individual learning process and curricular integration: a multicentre cohort study of nursing and medical students
Authors: Mestre André , Muster Marek , El Adib Ahmed Rhassane , Ösp Egilsdottir Hugrun , Byermoen Kirsten Røland , Padilha Miguel , Aguilar Thania , Tabagari Nino , Betts Lorraine , Sales Leila , Garcia Pedro , Ling Luo , Café Hugo , Binnie Alexandra , Marreiros Ana 
Published: May 2022

AbstractBackgroundThe COVID-19 pandemic has precipitated rapid changes in medical education to protect students and patients from the risk of infection. Virtual Patient Simulators (VPS) provide a simulated clinical environment in which students can interview and examine a patient, order tests and exams, prioritize interventions, and observe response to therapy, all with minimal risk to themselves and their patients. Like high-fidelity simulators (HFS), VPS are a tool to improve curricular integration. Unlike HFS, VPS require limited infrastructure investment and can be used in low-resource settings. Few studies have examined the impact of VPS training on clinical education. This international, multicenter cohort study was designed to assess the impact of small-group VPS training on individual learning process and curricular integration from the perspective of nursing and medical students.MethodsWe conducted a multi-centre, international cohort study of nursing and medical students. Baseline perceptions of individual learning process and curricular integration were assessed using a 27-item pre-session questionnaire. Students subsequently participated in small-group VPS training sessions lead by a clinical tutor and then completed a 32-item post-session questionnaire, including 25 paired items. Pre- and post-session responses were compared to determine the impact of the small-group VPS experience.ResultsParticipants included 617 nursing and medical students from 11 institutions in 8 countries. At baseline, nursing students reported greater curricular integration and more clinical and simulation experience than did medical students. After exposure to small-group VPS training, participants reported significant improvements in 5/6 items relating to individual learning process and 7/7 items relating to curricular integration. The impact of the VPS experience was similar amongst nursing and medical students.ConclusionsIn this multi-centre study, perceptions of individual learning process and curricular integration improved after exposure to small-group VPS training. Nursing and medical students showed similar impact. Small-group VPS training is an accessible, low-risk educational strategy that can improve student perceptions of individual learning process and curricular integration.
Decision-making approaches for children with life-limiting conditions: results from a qualitative phenomenological study
Authors: Vemuri Sidharth , Hynson Jenny , Williams Katrina , Gillam Lynn 
Published: May 2022

AbstractBackgroundFor children with life-limiting conditions who are unable to participate in decision-making, decisions are made for them by their parents and paediatricians. Shared decision-making is widely recommended in paediatric clinical care, with parents preferring a collaborative approach in the care of their child. Despite the increasing emphasis to adopt this approach, little is known about the roles and responsibilities taken by parents and paediatricians in this process. In this study, we describe how paediatricians approach decision-making for a child with a life-limiting condition who is unable to participate in decision-making for his/herself.MethodsThis qualitative phenomenological study involved 25 purposively sampled paediatricians. Verbatim transcripts from individual semi-structured interviews, conducted between mid-2019 and mid-2020, underwent thematic analysis. Interviews were based around a case vignette matched to the clinical experience of each paediatrician.ResultsTwo key themes were identified in the exploration of paediatricians' approach to decision-making for children with life-limiting conditions: (1) there is a spectrum of paediatricians’ roles and responsibilities in decision-making, and (2) the specific influences on paediatricians’ choice of approach for end-of-life decisions. In relation to (1), analysis showed four distinct approaches: (i) non-directed, (ii) joint, (iii) interpretative, and (iv) directed. In relation to (2), the common factors were: (i) harm to the child, (ii) possible psychological harm to parents, (iii) parental preferences in decision-making, and (iv) resource allocation.ConclusionsDespite self-reporting shared decision-making practices, what paediatricians often described were physician-led decision-making approaches. Adopting these approaches was predominantly justified by paediatricians’ considerations of harm to the child and parents. Further research is needed to elucidate the issues identified in this study, particularly the communication within and parental responses to physician-led approaches. We also need to further study how parental needs are identified in family-led decision-making approaches. These nuances and complexities are needed for future practice guidance and training around paediatric decision-making.Trial registration:Not applicable.
Predicting acute kidney injury following open partial nephrectomy treatment using SAT-pruned explainable machine learning model
Authors: Lazebnik Teddy , Bahouth Zaher , Bunimovich-Mendrazitsky Svetlana , Halachmi Sarel 
Published: May 2022

Abstract
Background
One of the most prevalent complications of Partial Nephrectomy (PN) is Acute Kidney Injury (AKI), which could have a negative impact on subsequent renal function and occurs in up to 24.3% of patients undergoing PN. The aim of this study was to predict the occurrence of AKI following PN using preoperative parameters by applying machine learning algorithms.

Methods
We included all adult patients (n = 723) who underwent open PN in our department since 1995 and on whom we have data on the pre-operative renal function. We developed a random forest (RF) model with Boolean satisfaction-based pruned decision trees for binary classification (AKI or non-AKI). Hyper-parameter grid search was performed to optimize the model's performance. Fivefold cross-validation was applied to evaluate the model. We implemented a RF model with greedy feature selection to binary classify AKI and non-AKI cases based on pre-operative data.

Results
The best model obtained a 0.69 precision and 0.69 recall in classifying the AKI and non-AKI groups on average (k = 5). In addition, the model's probability to correctly classify a new prediction is 0.75. The proposed model is available as an online calculator.

Conclusions
Our model predicts the occurrence of AKI following open PN with (75%) accuracy. We plan to externally validate this model and modify it to minimally-invasive PN.
Nurses’ knowledge and understanding of obstacles encountered them when administering resuscitation medications: a cross-sectional study from Palestine
Authors: Qedan Rawan I. , Daibes Marah A. , Al-Jabi Samah W. , Koni Amer A. , Zyoud Sa’ed H. 
Published: May 2022

AbstractBackgroundMedication errors (ME) are one of the most important reasons for patient morbidity and mortality, but insufficient drug knowledge among nurses is considered a major factor in drug administration errors. Furthermore, the complex and stressful systems surrounding resuscitation events increase nursing errors.AimsThis study aimed to assess the knowledge about resuscitation medications and understand the obstacles faced by nurses when giving resuscitation medications. Additionally, errors in the reporting of resuscitation medication administration and the reasons that prevented nurses from reporting errors were investigated.MethodsA cross-sectional study was conducted in the West Bank, Palestine. Convenient sampling was used to collect data, which was collected via a face-to-face interview questionnaire taken from a previous study. The questionnaire consisted of five parts: demographic data, knowledge of resuscitation medications (20 true/false questions), self-evaluation and causes behind not reporting ME, with suggestions to decrease ME.ResultsA total of 200 nurses participated in the study. Nurses were found to have insufficient knowledge about resuscitation medications (58.6%). A high knowledge score was associated with male nurses, those working in the general ward, the cardiac care unit (CCU), the intensive care unit (ICU) and the general ward. The main obstacles nurses faced when administering resuscitation medication were the chaotic environment in cardiopulmonary resuscitation (62%), the unavailability of pharmacists for a whole day (61%), and different medications that look alike in the packaging (61%). Most nurses (70.5%) hoped to gain additional training. In our study, we found no compatibility in the definition of ME between nurses and hospitals (43.5%).ConclusionsNurses had insufficient knowledge of resuscitation medications. One of the obstacles nurses faced was that pharmacists should appropriately arrange medications, and nurses wanted continuous learning and additional training about resuscitation medications to decrease ME.
Use of simulation to improve nursing students’ medication administration competence: a mixed-method study
Authors: Pol-Castañeda Sandra , Carrero-Planells Alba , Moreno-Mulet Cristina 
Published: May 2022

Abstract
Background
Medication administration errors are among the most important adverse events in healthcare systems. To minimise the risk of this occurring, nursing training programmes should emphasise the overriding priority of patient safety. In this respect, simulation can be a valuable resource in teaching procedures, for patient safety in general and safe medication administration in particular. In this study, we evaluate the use of a simulation-based activity for students to acquire skills in safe medication administration, and consider the students’ perceptions of this activity.

Methods
Second-year nursing students enrolled in the subject of pharmacology at a Spanish university during the academic year 2018–2019 were invited to participate in this mixed-method study. Their acquisition of professional competencies via a simulation exercise was evaluated according to the ‘six rights’. Before the simulation, each student completed a researcher-developed online questionnaire. The simulation was evaluated by the students’ tutor, using a checklist. A descriptive analysis was made of the data obtained from the questionnaire and during the simulation. At the end of the semester, the students' opinions were recorded in the questionnaire, in response to an open question. A content analysis was made of the responses to the open question.

Results
The simulation exercise was performed by 179 students, of whom 73 had previously completed the questionnaire. Analysis showed that, in comparison with the pre-simulation questionnaire results, compliance with the six rights improved in all dimensions except data documentation: right patient (from 64.4% to 83.3%); right medication (from 60.3% to 95.8%); right dose (from 60.3% to 100%); right route (from 54.8% to 95.8%); right time (from 24.7% to 70.8%); the right documentation result fell from 54.8% to 45.8%. The students expressed their satisfaction with the simulation method, affirming that it brought them closer to the reality of health care.

Conclusions
Simulation is a useful tool for the acquisition of skills in medication administration. The students were satisfied with the simulation capacity to bridge the gap between theory and practice. Moreover, simulation represents an added teaching resource in the nursing degree curriculum and is expected to enhance patient safety.
‘Leading from the front’ implementation increases the success of influenza vaccination drives among healthcare workers: a reanalysis of systematic review evidence using Intervention Component Analysis (ICA) and Qualitative Comparative Analysis (QCA)
Authors: Sutcliffe Katy , Kneale Dylan , Thomas James 
Published: May 2022

Abstract
Background
Seasonal influenza vaccination of healthcare workers (HCW) is widely recommended to protect staff and patients. A previous systematic review examined interventions to encourage uptake finding that hard mandates, such as loss of employment for non-vaccination, were more effective than soft mandates, such as signing a declination form, or other interventions such as incentives. Despite these overarching patterns the authors of the review concluded that ‘substantial heterogeneity’ remained requiring further analysis. This paper reanalyses the evidence using Intervention Component Analysis (ICA) and Qualitative Comparative Analysis (QCA) to examine whether the strategies used to implement interventions explain the residual heterogeneity.

Methods
We used ICA to extract implementation features and trialists’ reflections on what underpinned the success of the intervention they evaluated. The ICA findings then informed and structured two QCA analyses to systematically examine associations between implementation features and intervention outcomes. Analysis 1 examined hard mandate studies. Analysis 2 examined soft mandates and other interventions.

Results
In Analysis 1 ICA revealed the significance of ‘leading from the front’ rather than ‘top-down’ implementation of hard mandates. Four key features underpinned this: providing education prior to implementation; two-way engagement so HCW can voice concerns prior to implementation; previous use of other strategies so that institutions ‘don’t-go-in-cold’ with hard-mandates; and support from institutional leadership. QCA revealed that either of two configurations were associated with greater success of hard mandates. The first involves two-way engagement, leadership support and a ‘don’t-go-in-cold’ approach. The second involves leadership support, education and a ‘don’t-go-in-cold’ approach. Reapplying the ‘leading from the front’ theory in Analysis 2 revealed similar patterns.

Conclusions
Regardless of intervention type a ‘leading from the front’ approach to implementation will likely enhance intervention success. While the results pertain to flu vaccination among HCWs, the components identified here may be relevant to public health campaigns regarding COVID-19 vaccination.
Direct and indirect costs for hospitalized patients with dengue in Southern Sri Lanka
Authors: Weerasinghe N. P. , Bodinayake C. K. , Wijayaratne W. M. D. G. B. , Devasiri I. V. , Dahanayake N. J. , Kurukulasooriya M. R. P. , Premamali M. , Sheng T. , Nicholson B. P. , Ubeysekera H. A. , de Silva A. D. , Østbye T. , Woods C. W. , Tillekeratne L. G. , Nagahawatte A De S 
Published: May 2022

Abstract
Background
The Southern Province of Sri Lanka is endemic with dengue, with frequent outbreaks and occurrence of severe disease. However, the economic burden of dengue is poorly quantified. Therefore, we conducted a cost analysis to assess the direct and indirect costs associated with hospitalized patients with dengue to households and to the public healthcare system.

Methods
From June 2017–December 2018, we prospectively enrolled children and adults with acute dengue hospitalized at the largest, public tertiary-care (1800 bed) hospital in the Southern Province, Sri Lanka. We administered a structured questionnaire to obtain information regarding direct costs spent by households on medical visits, medications, laboratory testing, and travel for seeking care for the illness. Indirect costs lost by households were estimated by identifying the days of work lost by patients and caregivers and school days lost by children. Direct hospital costs were estimated using gross costing approach and adjusted by multiplying by annual inflation rates in Sri Lankan rupees and converted to US dollars.

Results
A total of 1064 patients with laboratory-confirmed dengue were enrolled. The mean age (SD) was 35.9 years (15.6) with male predominance (66.2%). The mean durations of hospitalization for adults and paediatric patients were 3.86 (SD = 1.51) and 4 (SD = 1.32) days, respectively. The per-capita direct cost borne by the healthcare system was 233.76 USD, and was approximately 14 times greater than the per-capita direct cost borne by households (16.29 USD, SD = 14.02). The per-capita average number of loss of working days was 21.51 (SD = 41.71), with mean per-capita loss of income due to loss of work being 303.99 USD (SD = 569.77), accounting for over 70% of average monthly income. On average, 10.88 days (SD = 10.97) of school days were missed due to the dengue episode. School misses were expected to reduce future annual income of affected children by 0.44%.

Conclusions
Dengue requiring hospitalization had a substantial economic burden on the public healthcare system in Sri Lanka and the affected households. These findings emphasize the importance of strengthening dengue control activities and improved use of hospital-based resources for care to reduce the economic impact of dengue in Sri Lanka.
Ten years of tracking mental health in refugee primary health care settings: an updated analysis of data from UNHCR’s Health Information System (2009–2018)
Authors: Fine Shoshanna L. , Kane Jeremy C. , Spiegel Paul B. , Tol Wietse A. , Ventevogel Peter 
Published: May 2022

AbstractBackgroundThis study examines mental, neurological, and substance use (MNS) service usage within refugee camp primary health care facilities in low- and middle-income countries (LMICs) by analyzing surveillance data from the United Nations High Commissioner for Refugees Health Information System (HIS). Such information is crucial for efforts to strengthen MNS services in primary health care settings for refugees in LMICs.MethodsData on 744,036 MNS visits were collected from 175 refugee camps across 24 countries between 2009 and 2018. The HIS documented primary health care visits for seven MNS categories: epilepsy/seizures, alcohol/substance use disorders, mental retardation/intellectual disability, psychotic disorders, severe emotional disorders, medically unexplained somatic complaints, and other psychological complaints. Combined data were stratified by 2-year period, country, sex, and age group. These data were then integrated with camp population data to generate MNS service utilization rates, calculated as MNS visits per 1000 persons per month.ResultsMNS service utilization rates remained broadly consistent throughout the 10-year period, with rates across all camps hovering around 2–3 visits per 1000 persons per month. The largest proportion of MNS visits were attributable to epilepsy/seizures (44.4%) and psychotic disorders (21.8%). There were wide variations in MNS service utilization rates and few consistent patterns over time at the country level. Across the 10 years, females had higher MNS service utilization rates than males, and rates were lower among children under five compared to those five and older.ConclusionsDespite increased efforts to integrate MNS services into refugee primary health care settings over the past 10 years, there does not appear to be an increase in overall service utilization rates for MNS disorders within these settings. Healthcare service utilization rates are particularly low for common mental disorders such as depression, anxiety, post-traumatic stress disorder, and substance use. This may be related to different health-seeking behaviors for these disorders and because psychological services are often offered outside of formal health settings and consequently do not report to the HIS. Sustained and equitable investment to improve identification and holistic management of MNS disorders in refugee settings should remain a priority.