bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical nurses’ moral courage and related factors: an empowerment perspective
Authors: Hu Kaili , Liu Juan , Zhu Lisi , Zhou Yanrong 
Published: November 2022

Abstract
Background
Moral courage as part of the moral competence of nurses has received increasing attention. Determination of the factors affecting moral courage is important in improving the quality of care. The purpose of this study was to investigate moral courage and related factors among frontline nurses from an empowerment perspective.

Methods
A cross-sectional study was conducted using data collection instruments comprising four main parts: the self-designed form of demographic characteristics, Conditions for Work Effectiveness II (CWEQ-II), Spreitzer’s Psychological Empowerment Scale (PES) and Nurses’ Moral Courage Scale (NMCS). Data were collected from 226 nurses in a tertiary hospital between February and March 2022 in Wuhan, the capital city of Hubei Province in central China. Descriptive statistics and multiple linear regression were used to analyze the data.

Results
The means of the total scores for the CWEQ-II, PES and the NMCS were 3.52 (SD = 0.69), 3.85 (SD = 0.53) and 3.90 (SD = 0.67), respectively. All the dimensions and the total scores of the CWEQ-II and PES were significantly correlated with the NMCS (p < 0.001). According to the multivariate stepwise regression analysis, CWEQ-II and PES were determined to be factors affecting NMCS. These variables explained 35.9% of the total variance in the moral courage scores of nurses.

Conclusion
The level of moral courage among nurses is above average. Structural empowerment and psychological empowerment were the key factors affecting the promotion of moral courage. Hospital and organizational administrations should be conscious of the role of attach structural empowerment and psychological empowerment in the nursing workplace in increasing moral courage.
Tracking, naming, specifying, and comparing implementation strategies for person-centred care in a real-world setting: a case study with seven embedded units
Authors: Fridberg Helena , Wallin Lars , Tistad Malin 
Published: November 2022

Abstract
Background
The implementation of person-centred care (PCC) is advocated worldwide. Stakeholders in charge of implementing PCC as a broad-scale change across the health care sector face two intertwined and complex challenges. First, making sense of PCC as an intervention with complex innovation characteristics and second, staging implementation of PCC by choosing appropriate implementation strategies. We aimed to explore one of these challenges by tracking, naming, specifying, and comparing which strategies and how strategies were enacted to support the implementation of more PCC in a real-world setting represented by one health care region in Sweden.

Methods
A case study with seven embedded units at two organisational levels within a health care region was conducted from 2016 to 2019. Data were collected from three sources: activity logs, interviews, and written documents. Strategies were identified from all sources and triangulated deductively by name, definition, and cluster in line with the taxonomy Expert Recommendations for Implementing Change (ERIC) and specified according to recommendations by Proctor and colleagues as actor, action, action target, temporality, dose, outcome, and justification.

Results
Four hundred thirteen activities were reported in logs, representing 43 discrete strategies identified in ERIC (n = 38), elsewhere (n = 1), or as emerging strategies (n = 4). The highest reported frequencies of discrete strategies were identified as belonging to two clusters: Train and educate stakeholders (40%) and Develop stakeholder interrelationships (38%). We identified a limited number of strategies belonging to the cluster Use evaluative and iterative strategies (4.6%) and an even smaller number of strategies targeting information to patients about the change initiative (0.8%). Most of the total dose of 11,076 person-hours in the 7 units was spent on strategies targeting health care professionals who provide PCC (81.5%) while the dose of strategies targeting support functions was 18.5%.

Conclusions
Our findings show both challenges and merits when strategies for implementation of PCC are conducted in a real-world setting. The results can be used to support and guide both scientists and practitioners in future implementation initiatives.
Bio-nanocomplexes with autonomous O2 generation efficiently inhibit triple negative breast cancer through enhanced chemo-PDT
Authors: Zeng Zhihong , Wang Zhou , Chen Simin , Xiao Chang , Liu Minzhuo , Zhang Jie , Fan Jialong , Zhao Yanzhong , Liu Bin 
Published: November 2022

AbstractAs one kind of aggressive cancer, triple-negative breast cancer (TNBC) has become one of the major causes of women mortality worldwide. Recently, combinational chemo-PDT therapy based on nanomaterials has been adopted for the treatment of malignant tumor. However, the efficacy of PDT was partly compromised under tumor hypoxia environment due to the lack of sustainable O2 supply. In this study, CeO2-loaded nanoparticles (CeNPs) with peroxidase activity were synthesized to autonomously generate O2 by decomposing H2O2 within tumor region and reprogramming the hypoxia microenvironment as well. Meanwhile, the compound cinobufagin (CS-1) was loaded for inhibiting TNBC growth and metastasis. Moreover, the hybrid membrane camouflage was adopted to improve the biocompatibility and targeting ability of nanocomplexes. In vitro assay demonstrated that decomposition of H2O2 by CeO2 achieved sustainable O2 supply, which accordingly improved the efficacy of PDT. In turn, the generated O2 improved the cytotoxicity and anti-tumor migration effect of CS-1 by downregulating HIF-1α and MMP-9 levels. In vivo assay demonstrated that the combination of CS-1 and PDT significantly inhibited the growth and distance metastasis of tumor in MDA-MB-231 bearing mice. Thus, this chemo-PDT strategy achieved satisfactory therapeutic effects by smartly utilizing the enzyme activity of nanodrugs and special micro-environment of tumor.
Evaluation of CSF albumin quotient in neuronal surface antibody-associated autoimmune encephalitis
Authors: Lai Qi-Lun , Cai Meng-Ting , Zheng Yang , Fang Gao-Li , Du Bing-Qing , Shen Chun-Hong , Wang Jia-Jia , Weng Qin-Jie , Zhang Yin-Xi 
Published: November 2022

Abstract
Background and Objectives
Disruption of brain barriers is considered to be involved in the pathogenesis of neuronal surface antibody-associated autoimmune encephalitis (NSAE), but few studies have focused on their relationship. We aimed to explore the association between the integrity of brain barriers and clinical and paraclinical characteristics in patients with NSAE.

Methods
This retrospective study consecutively recruited patients with NSAE. The cerebrospinal fluid (CSF) / serum albumin quotient (Qalb) was used to evaluate the function of brain barriers. The data on demographic information, clinical manifestations, magnetic resonance imaging (MRI), CSF findings and prognosis were collected and analyzed.

Results
Of the 93 patients included, 33 (35.5%) patients were assigned to the elevated Qalb group and 60 (64.5%) patients to the normal Qalb group. Males and prodromal symptoms were more common in elevated Qalb group (both P < 0.05). The CSF white blood cell, protein, immunoglobulin G and albumin were significantly higher in elevated Qalb group (all P < 0.05). Patients with elevated Qalb were more likely to have brain lesions on MRI (60.6% versus 33.3%, P = 0.011). The modified Rankin Scale (mRS) scores at discharge and at last follow-up were significantly higher in patients with elevated Qalb than those with normal Qalb (both P < 0.05). After univariate and multivariate analyses, Qalb elevation (adjusted odds ratio = 3.96, 95% confidence interval = 1.15–13.59, P = 0.029) was demonstrated as the only independent risk factor for a poor prognosis.

Discussion
Males, prodromal symptoms, brain lesions on MRI, CSF pleocytosis, and elevated CSF protein were more common in NSAE patients with increased Qalb. Qalb elevation was an independent prognostic indicator for a poor prognosis in NSAE.
Outpatient management of acute uncomplicated appendicitis after laparoscopic appendectomy: a randomized controlled trial
Authors: Elvira López Jordi , Sales Mallafré Ricard , Padilla Zegarra Erlinda , Carrillo Luna Luis , Ferreres Serafini Joan , Tully Roisin , Memba Ikuga Robert , Jorba Martin Rosa 
Published: November 2022

Abstract
Objective
To confirm the safety and efficacy of outpatient management of laparoscopic appendectomy, with an enhanced recovery after surgery (ERAS) protocol, in adult patients with uncomplicated acute appendicitis.

Summary background data
Outpatient laparoscopic appendectomy is feasible and secure in selected patients in observational studies. The benefits include reduced length of stay (LOS) and postoperative complications. This is the first randomized controlled trial of outpatient management following ERAS protocol.

Methods
Patients admitted from the emergency department with acute appendicitis were randomized into one of two groups: standard care within the hospital (HG) or the outpatient group (OG). An ERAS protocol was followed for both groups. Patients in the HG were admitted to the surgical ward. Patients in the OG were referred to the day-surgery unit. The primary endpoint was the length of stay.

Results
Ninety-seven patients were included: 49 in the OG and 48 in the HG. LOS was significantly shorter in the OG (mean 8.82 h) than in the HG (mean 43.53 h), p < 0.001. There was no difference in readmission rates (p = 0.320); we observed only one readmission in the OG. No further emergency consultations or complications were observed. The cost saving was $516.52/patient as a result of the intervention.

Conclusion
Outpatient management of appendectomy is safe and feasible procedure in selected patients. This approach could become the standard of care for patients with uncomplicated appendicitis, showing fewer complications, lower LOS and cost.
Trial registration: Registration: www.clinicaltrials.gov (NCT05401188) Clinical Trial ID: NCT05401188
The exact solutions of Fokas-Lenells equation based on Jacobi elliptic function expansion method
Authors: Zhao Yan-Nan , Wang Na 
Published: November 2022

AbstractThe Fokas-Lenells (FL) equation, which is rich in physical property in soliton theory as well as optical fiber, is a generalization of the higher-order Schrödinger equation. We construct the periodic solutions of the FL equation based on the Jacobi elliptic function expansion method in this context. Moreover, the characteristics of the obtained solutions are visualized graphically by selecting appropriate parameters.
Perceived environmental barriers and facilitators of refugee children’s physical activity in/around refugee accommodation: a qualitative case study in Berlin
Authors: Chen Siqi , Knöll Martin 
Published: November 2022

Abstract
Background
Previous research have identified built environmental attributes associated with refugee children’s physical activity (PA); however, there is a lack of research focusing on refugee children’s environmental perceptions at the individual level. We examined the perceived environmental barriers and facilitators of refugee children’s PA.

Methods
Perceptions of PA environments by refugee children (n = 15, 6 to 13 years old) and their parents (n = 10) were captured by questionnaires and drawing workshops from one refugee accommodation in Berlin. Besides, photovoice was conducted with three children to obtain an in-depth understanding of their experiences of existing environments for PA. Research was applied between June and July 2019. All research material was transcribed and analysed using thematic analysis.

Results
Refugee children and their parents identified micro-environments as the centre of children’s daily PA, they usually played indoors but most parents perceived there was no spaces. In meso environments, children and parents thought there were insufficient spaces and were worried about neighbourhood safety. Furthermore, parents concerned more about ‘space accessibility’ for their children’s playing purposes instead of ‘space quality (e.g., equipment)’ . Children also indicated the importance of informal spaces for their PA.

Conclusions
Refugee children perceive a lack of space and safety when attempting to play in the existing micro and meso environments. Related practitioners should focus on providing more play spaces in micro environments and safe access to existing neighbourhood playfields. These efforts can augment much-needed research on strategies to better integrate refuge facilities to their urban context and essential in minimising current health and spatial inequality issues these vulnerable groups face across Germany and worldwide.
Lactobacillus reuteri tryptophan metabolism promotes host susceptibility to CNS autoimmunity
Authors: Montgomery Theresa L. , Eckstrom Korin , Lile Katarina H. , Caldwell Sydney , Heney Eamonn R. , Lahue Karolyn G. , D’Alessandro Angelo , Wargo Matthew J. , Krementsov Dimitry N. 
Published: November 2022

Abstract
Background
Dysregulation of gut microbiota-associated tryptophan metabolism has been observed in patients with multiple sclerosis. However, defining direct mechanistic links between this apparent metabolic rewiring and individual constituents of the gut microbiota remains challenging. We and others have previously shown that colonization with the gut commensal and putative probiotic species, Lactobacillus reuteri, unexpectedly enhances host susceptibility to experimental autoimmune encephalomyelitis (EAE), a murine model of multiple sclerosis. To identify underlying mechanisms, we characterized the genome of commensal L. reuteri isolates, coupled with in vitro and in vivo metabolomic profiling, modulation of dietary substrates, and gut microbiota manipulation.

Results
The enzymes necessary to metabolize dietary tryptophan into immunomodulatory indole derivatives were enriched in the L. reuteri genomes, including araT, fldH, and amiE. Moreover, metabolite profiling of L. reuteri monocultures and serum of L. reuteri-colonized mice revealed a depletion of kynurenines and production of a wide array of known and novel tryptophan-derived aryl hydrocarbon receptor (AhR) agonists and antagonists, including indole acetate, indole-3-glyoxylic acid, tryptamine, p-cresol, and diverse imidazole derivatives. Functionally, dietary tryptophan was required for L. reuteri-dependent EAE exacerbation, while depletion of dietary tryptophan suppressed disease activity and inflammatory T cell responses in the CNS. Mechanistically, L. reuteri tryptophan-derived metabolites activated the AhR and enhanced T cell production of IL-17.

Conclusions
Our data suggests that tryptophan metabolism by gut commensals, such as the putative probiotic species L. reuteri, can unexpectedly enhance autoimmunity, inducing broad shifts in the metabolome and immunological repertoire.
Remarkably reproducible psychological (memory) phenomena in the classroom: some evidence for generality from small-N research
Authors: Imam Abdulrazaq A. 
Published: November 2022

Abstract
Background
Mainstream psychology is experiencing a crisis of confidence. Many of the methodological solutions offered in response have focused largely on statistical alternatives to null hypothesis statistical testing, ignoring nonstatistical remedies that are readily available within psychology; namely, use of small-N designs. In fact, many classic memory studies that have passed the test of replicability used them. That methodological legacy warranted a retrospective look at nonexperimental data to explore the generality of the reported effects.

Method
Various classroom demonstrations were conducted over multiple semesters in introductory psychology courses with typical, mostly freshman students from a predominantly white private Catholic university in the US Midwest based on classic memory experiments on immediate memory span, chunking, and depth of processing.

Results
Students tended to remember 7 ± 2 digits, remembered more digits of π following an attached meaningful story, and remembered more words after elaborative rehearsal than after maintenance rehearsal. These results amount to replications under uncontrolled classroom environments of the classic experiments originally conducted largely outside of null hypothesis statistical testing frameworks.

Conclusions
In light of the ongoing replication crisis in psychology, the results are remarkable and noteworthy, validating these historically important psychological findings. They are testament to the reliability of reproducible effects as the hallmark of empirical findings in science and suggest an alternative approach to commonly proffered solutions to the replication crisis.
The substantiveness of socioeconomic school compositional effects in Australia: measurement error and the relationship with academic composition
Authors: Sciffer Michael G. , Perry Laura B. , McConney Andrew 
Published: November 2022

AbstractThis study examines the effect of school socioeconomic composition on student achievement growth in Australian schooling, and its relationship with academic composition utilising the National Assessment Program—Literacy and Numeracy (NAPLAN) dataset. Previous research has found that school composition predicts a range of schooling outcomes. A critique of school compositional research has been that measurement error may have biased findings of compositional effects. Prior studies have found that socioeconomic compositional effect sizes are small when models include academic composition. The relationship between socioeconomic and academic compositions has yet to be fully determined. Multi-level regressions and structural equation models were compared to estimate the degree of bias in socioeconomic compositional effects due to measurement error. Multi-level path models were used to test if academic composition mediated the relationship between socioeconomic composition and achievement growth. The results showed that measurement error did not bias compositional effects in the dataset, and academic composition mediates the relationship between socioeconomic composition and achievement growth. We argue that school value-add research should include academic composition to account for contextual effects. The socioeconomic compositional effect is of practical significance to policy makers and educational researchers due to its relative size compared to average student achievement growth. Potential reforms include ensuring public subsidies to private schools in Australia do not increase school segregation and the amelioration of the effects of residential segregation through school funding reforms.
Outcomes of malignancy in adults with congenital heart disease: a single center experience
Authors: Venkatesh Prashanth , Yan Kimberly L. , Bravo-Jaimes Katia , Yang Eric H. , Lluri Gentian 
Published: November 2022

Abstract
Background
Malignancy is known to be a major cause of death in adult congenital heart disease (ACHD). However, data regarding cardiovascular and cancer-related outcomes in ACHD are lacking.

Methods
We conducted a retrospective single-center cohort study comprising patients with ACHD and malignancy. The primary outcome was all-cause mortality. Key secondary outcomes included major adverse cardiovascular and cerebrovascular events (MACCE), cardiotoxicity events and consequent cancer therapy modifications.

Results
Sixty-eight patients with ACHD and a history of cancer were included in the study. 82% of patients had moderate or great ACHD anatomic complexity. Over a median follow-up of 5 years after cancer diagnosis, 16 (24%) patients died, with 69% of deaths being due to cancer. Univariate predictors of mortality were baseline arrhythmia (OR 3.82, 95% CI 1.15-12.67, p = 0.028), baseline diuretic therapy (OR 3.54, 95% CI 1.04-12.04, p = 0.044) and advanced cancer stage at diagnosis (OR 2.37, 95% CI 1.32-4.25, p = 0.004). MACCE occurred in 40 (59%) patients and was independently predicted by baseline diuretic requirement (OR 9.91, 95% CI 1.12-87.85, p = 0.039). A 14% incidence of cardiotoxicity was seen; 3 patients needed modification and 1 patient needed temporary interruption of cancer therapy for 2 weeks.

Conclusions
Considerable mortality occurred in this cohort of patients with ACHD and cancer; most deaths were cancer-related. A high rate of MACCE was observed, yet rates of obligatory modification of cancer therapy due to cardiotoxicity were low.
Εφαρμογές προσχολικής ηλικίας για συσκευές με οθόνες αφής
Authors: Σκουρλής Στυλιανός 
Published: November 2022

Στην παρούσα μελέτη γίνεται αναφορά σε εφαρμογές προσχολικής ηλικίας σε συσκευές με οθόνες αφής και παρουσιάζονται βραχυχρόνια και μακροχρόνια αποτελέσματα. Βασίζεται κατά κύριο λόγο στο λειτουργικό android το οποίο έχει γνωρίσει ιδιαίτερη ανάπτυξη τα τελευταία χρόνια αλλά επίσης διότι το κόστος παραγωγής εφαρμογών αλλά και απόκτησης συσκευής που να το υποστηρίζει, παραμένει σε εξαιρετικά χαμηλά επίπεδα. Λόγω της λειτουργικότητας και της αμεσότητας του λειτουργικού δημιουργήθηκαν εφαρμογές οι οποίες απευθύνονται σε παιδιά προσχολικής ηλικίας και κάνουν χρήση τις ιδιότητες των οθονών αφής και όχι μόνο. Παρουσιάζονται τα αποτελέσματα της έρευνας που πραγματοποιήθηκε σε ειδικούς και παιδιά καθώς και οι βελτιώσεις που έγιναν στις εφαρμογές. Επίσης γίνεται λόγος για τις ιδιότητες που θα έπρεπε να έχουν οι εφαρμογές που προορίζονται για παιδιά και εκμεταλλεύονται τις ιδιότητες των οθονών αφής.
Ο ρόλος των μέσων στην ευαισθητοποίηση των πολιτών για την κλιματική αλλαγή
Authors: Σακκά Ηλιάνα 
Published: November 2022

Η κλιματική αλλαγή αποτελεί ένα από τα κρισιμότερα ζητήματα της εποχής μας. Ο ρόλος των ΜΜΕ κρίνεται πιο αναγκαίος από όσο ποτέ προκειμένου να επικοινωνήσει την κλιματική κρίση και να επηρεάζει τη δημόσια ανησυχία. Τα ΜΜΕ διαθέτουν την ιδιαίτερη ικανότητα να ενθαρρύνουν κοινωνικές αλλαγές με βάση το γεγονός ότι μπορούν να παρουσιάσουν σε μεγάλα τμήματα του πληθυσμού εναλλακτικούς και νέους τρόπους κοινωνικής δράσης. Η παρούσα εργασία αναλύει το περιεχόμενο (ανάλυση περιεχομένου) της τηλεοπτικής εκπομπής «Κλίμα». Ειδικότερα, διερευνήθηκε κατά πόσο ασχολήθηκε και ανέλυσε ζητήματα γύρω από την κλιματική αλλαγή και αν τελικά μπορεί να αποτελέσει δίαυλο της περιβαλλοντικής εκπαίδευσης και ευαισθητοποίησης, κινητήριες δυνάμεις για τη δημιουργία δράσεων. Από την επεξεργασία των δεδομένων η εκπομπή προσπαθεί να προσεγγίσει τα θέματα από όλες τις κλίμακες του χρόνου και του χώρου εφαρμόζοντας τους βασικούς άξονες της περιβαλλοντικής εκπαίδευσης. Ωστόσο, το μέγεθος και οι επιπτώσεις της κλιματικής αλλαγής απαιτούν την ύπαρξη περισσότερων περιβαλλοντικών εκπομπών με πολυμεσικό περιεχόμενο, καθώς μόνο τότε τα μέσα μπορούν να μετατρέπουν σε παιδαγωγικό εργαλείο προσφέροντας σωστή κατανόηση της περιπλοκότητας της κλιματικής αλλαγής.
Χαιρετισμός
Authors: Σοφός Αλιβίζος (Λοΐζος) , ΣΙΑΚΑΣ Σπύρος 
Published: November 2022

Χαιρετισμός από τους εκδότες
Το περιοδικό Afimec ως τόπος συλλογής και διάχυσης της επιστημονικής γνώσης, εδράζει σε δύο πυλώνες/κομβικά στοιχεία, τη δυνατότητα έκφρασης σε συγγενή επιστημονικά πεδία και τη δυνατότητα διεπιστημονικών συνεργασιών στον τομέα της επικοινωνίας.
Σε αυτό το πλαίσιο, χαιρετίζουμε την προσπάθεια του Νίκου Αντωνόπουλου ως guest editor，ο οποίος επιμελήθηκε και εξέδωσε έντεκα άρθρα που παρουσιάστηκαν στο πρώτο ετήσιο ελληνόφωνο επιστημονικό συνέδριο εργαστηρίων επικοινωνίας cclabs. Κεντρικός άξονας όλων των άρθρων αποτελεί η επικοινωνία σε όλες τις εκφάνσεις της (οπτική, ακουστική, κειμενική), πράγμα που εντάσσει την προσπάθεια αυτή στη πολιτική και φιλοσοφία του διεθνούς επιστημονικού περιοδικού ανοικτής πρόσβασης Afimec.