bluuebunny/crossref_metadata_2025 huggingface dataset:
Towards a patient-centred approach in therapeutic patient education. A qualitative study exploring health care professionals’ practices and related representations
Authors: Roussel Sandrine , Frenay Mariane
Published: April 2022

Objectives

This study aimed to explore the practice-representation links among Health Care Professionals (HCP)s practising Therapeutic Patient Education (TPE). Understanding these links might actually help to address the challenges of TPE implementation, particularly the patient-centred dimension.

Methods

A qualitative study using individual interviews was conducted with HCPs practising in French-speaking Belgium or in France. Data analysis was carried out in two steps: to draw up a typology of educational practices (including variations) and, in line with the Social Representation Theory, to identify possible related social representations.

Results

The typology, based on HCP-Patient power distribution, was built from 26 interviews. Four types and nine subtypes were identified. Besides the power distribution, practice (sub)types were also specific regarding communication modes, consideration for patients’ representations, motivational approach, personalization, complexity of methods and learning contents, and practice reflexivity. Practices were seldom constant. Three variations were highlighted: within a subtype, between different subtypes, and between education and technical care. Both practice subtypes and variations were related to specific decisive representations.

Discussion

Representations related to practices and those related to practices variations offer new perspectives for TPE implementation. There is no panacea for achieving more patient-centred approaches; tailored strategies based on practice subtypes are needed.
Crossmodal associations between visual textures and temperature concepts
Authors: Barbosa Escobar Francisco , Velasco Carlos , Byrne Derek Victor , Wang Qian Janice
Published: April 2022

Visual textures are critical in how individuals form sensory expectations about objects, which include somatosensory properties such as temperature. This study aimed to uncover crossmodal associations between visual textures and temperature concepts. In Experiment 1 ( N = 193), we evaluated crossmodal associations between 43 visual texture categories and different temperature concepts (via temperature words such as cold and hot) using an explicit forced-choice test. The results revealed associations between striped, cracked, matted, and waffled visual textures and high temperatures and between crystalline and flecked visual textures and low temperatures. In Experiment 2 ( N = 247), we conducted six implicit association tests (IATs) pairing the two visual textures most strongly associated with low ( crystalline and flecked) and high ( striped and cracked) temperatures with the words cold and hot as per the results of Experiment 1. When pairing the crystalline and striped visual textures, the results revealed that crystalline was matched to the word cold, and striped was matched to the word hot. However, some associations found in the explicit test were not found in the IATs. In Experiment 3 ( N = 124), we investigated how mappings between visual textures and concrete entities may influence crossmodal associations with temperature and these visual textures. Altogether, we found a range of association strengths and automaticity levels. Importantly, we found evidence of relative effects. Furthermore, some of these crossmodal associations are partly influenced by indirect mappings to concrete entities.
Toll road sector in Brazil: Regulation by contract and recent innovations
Authors: Camacho Fernando , Cruz Carlos Oliveira
Published: April 2022

The existing stock of road infrastructure in Brazil is still suboptimal and presents a bottleneck for economic growth. Concessions are being used to leverage the development and delivery of road infrastructure, although the first concessions have experienced some difficulties. Based on past lessons, Brazil has revised the regulatory framework and concessions models, by acting at three main critical success factors: creating a clear and transparent regulatory framework, improving procurement rules to ensure a more effective search for the “right” partner (and filtering opportunistic investors), and, finally, establishing a more effective risk-sharing strategy, providing the right incentives to mitigate delays and contractual breach, while increasing the bankability and overall project’s quality. This paper provides an overview of these changes and provides valuable lessons for academics and practitioners involved in concession design and management, particularly, in the road sector.
Glycemic Outcomes During Real-World Hybrid Closed-Loop System Use by Individuals With Type 1 Diabetes in the United States
Authors: Arunachalum Siddharth , Velado Kevin , Vigersky Robert A. , Cordero Toni L.
Published: April 2022

Background:

Glycemic outcomes during real-world hybrid closed-loop (HCL) system use by individuals with type 1 diabetes, in the United States, were retrospectively analyzed.

Methods:

Hybrid closed-loop system data voluntarily uploaded to Carelink™ personal software from March 2017 to November 2020 by individuals (aged ≥7 years) using the MiniMed™ 670G system and having ≥10 days of continuous glucose monitoring data after initiating Auto Mode were assessed. Glycemic outcomes including the mean glucose management indicator (GMI), sensor glucose (SG), percentage of time spent in (TIR), below (TBR), and above (TAR) target range (70-180 mg/dL) were analyzed. Outcomes were also analyzed in a subgroup of users per baseline GMI of <7% versus >8%.

Results:

The overall cohort (N = 123 355 users, with a mean of 87.9% of time in Auto Mode) had a GMI of 7.0% ± 0.4%, TIR of 70.4% ± 11.2%, TBR <70 mg/dL of 2.2% ± 2.1% and TAR>180 mg/dL of 27.5% ± 11.6%, post-Auto Mode initiation. Compared with pre-Auto Mode initiation, users (N = 52 941, 88.6% of time in Auto Mode) had a GMI that decreased from 7.3% ± 0.6% to 7.1% ± 0.5% ( P < .001), TIR that increased from 61.5% ± 15.1% to 68.1% ± 11.9% ( P < .001), TAR>180 mg/dL that decreased from 36.3% ± 15.7% to 29.8% ± 12.2% ( P < .001) and TBR<70 mg/dL that decreased from 2.11 ± 2.4 to 2.07% ± 2.25% ( P = .002). While all metrics statistically improved for the baseline GMI >8.0% group, the baseline GMI <7.0% group had unchanged TIR (77.4% ± 7.4% to 77.5% ± 8.0%, P = .456) and TAR>180 mg/dL that increased (19.2 ± 6.7 to 19.6 ± 7.9%, p < 0.001).

Conclusion:

Real-world HCL system use in the U.S. demonstrated overall glycemic control that trended similarly with the system pivotal trial outcomes and previous real-world system use analyses.
Is eNAMPT/visfatin a potential serum marker of papillary thyroid cancer?
Authors: Sawicka-Gutaj Nadia , Ziółkowska Paulina , Derwich Aleksandra , Gut Paweł , Czarnywojtek Agata , Kloska Michał , Ruchała Marek
Published: April 2022

Purpose:

The role of nicotinamide phosphoribosyltransferase (NAMPT)/visfatin in a more aggressive course of many malignancies has been proven. Previous studies have noticed the importance of visfatin in thyroid neoplastic tissue, but the diagnostic and prognostic value of its serum concentration has not been investigated so far. Our study aimed to consider whether extracellular NAMPT (eNAMPT) could be a potential serum marker in recurrent papillary thyroid cancer (PTC).

Methods:

It was a prospective observational study with consecutive enrolment. We recruited 100 patients with PTC after thyroidectomy with postoperative 131I ablation and 100 healthy controls. Also, 50 randomly selected patients underwent laboratory assessment (including eNAMPT serum concentration by ELISA Assay Kit, TSH, free thyroid hormones, TSH-stimulated thyroglobulin Tg, antibodies – TgAbs, TPOAb) and body composition analysis twice: at admission and 6 months after being on suppressive levothyroxine doses. TSH-stimulated Tg of 1 ng/ml was defined as the cutoff value for predicting disease status as complete remission ( n = 55) and recurrent or persistent structural disease ( n = 45).

Results:

The visfatin serum concentrations in patients diagnosed with PTC and in healthy subjects were not statistically significantly different ( p = 0.9425). The eNAMPT levels were also similar in disease-free patients and the ones with tumour relapse. Besides, ROC curve analysis did not detect eNAMPT as a biomarker of PTC.

Conclusion:

We have not found visfatin as a potential serum marker of papillary thyroid cancer. Also, eNAMPT has no prognostic value in assessing the risk of disease recurrence or metastasis in PTC management.
First presentation of pyoderma gangrenosum in a patient with partial immunoglobulin A deficiency
Authors: Demirel S , Shetty M , Patel M , Mahmood K
Published: April 2022

Summary

We describe the case of a 58-year-old female with an intensely painful and rapidly enlarging necrotic cutaneous ulcer to the right shin on a background of partial immunoglobulin A deficiency (IgAD). She was seen by various healthcare professionals and managed with upscaling antibiotics for cellulitis requiring an inpatient hospital stay. The dermatology team made a clinical diagnosis of ulcerative Pyoderma Gangrenosum (PG) on assessing the patient 13 days post-onset of symptoms. The patient responded dramatically to steroids and oral tetracycline. This case highlights the unusually described association between PG and IgAD as well as the diagnostic challenge seen in patients presenting with PG.
A comparison of low-dose teicoplanin-loaded spacer application vs. high-dose vancomycin-and-gentamicin-loaded spacer application in the treatment of periprosthetic knee infection
Authors: Cimen Osman , Oner Ali , Koksal Alper , Dırvar Ferdi , Mert Muhammed , Şahin Mümine Nursu , Kargın Deniz
Published: April 2022

Background/purpose

In the current study, our aim was to compare the efficacy and biocompatibility of teicoplanin-loaded and vancomycin-and-gentamicin-loaded articulating spacers used in two-stage revision arthroplasty for eradication of periprosthetic knee joint infection.

Methods

In the current retrospective cohort study, there were 24 patients who were given 2 g or less antibiotics per 40 g of cement in the low-dose teicoplanin group, and 20 patients who were given a total of 3.6 g or more antibiotics per 40 g of cement in the high-dose vancomycin and gentamicin group. Two groups were compared statistically.

Results

There was no statistically significant difference in the treatment failure between the two groups (p = 0.488). No statistically significant differences were found in spacer fracture rates between the two groups (p = 0.802).

Conclusion

The current study has demonstrated that low-dose teicoplanin protocol is as effective and safe as high-dose vancomycin and gentamycin protocol.
The Pharmacogenetics of Opiates and Its Impact on Delirium in Mechanically Ventilated Adults: A Pilot Study
Authors: Austin C. Adrian , Szeto Andy , Gupta Apoorva , Wiltshire Timothy , Crona Daniel J. , Kistler Christine
Published: April 2022

Background: Pharmacogenetics may explain a substantial proportion of the variation seen in the efficacy and risk profile of analgesosedative drugs and the incidence of delirium in critically ill adults. Objectives: Conduct a feasibility study to demonstrate the reliability of collecting and analyzing pharmacogenetic information from critically ill patients and to assess the impact of pharmacogenetics on intensive care unit (ICU) outcomes. Methods: We prospectively enrolled subjects from the Medical ICU at the University of North Carolina (UNC). DNA was obtained via a buccal swab and evaluated using the DNA2Rx assay. We collected data on demographics, daily cumulative psychoactive medication exposure, and severity of illness. We performed daily delirium assessments via the CAM-ICU. We analyzed associations between select single nucleotide polymorphisms (SNPs) and delirium. Results: From June, 2018 through January, 2019, we screened 244 patients and enrolled 50. The median age was 62.0 years old (range: 28-82 years old), and 27 (54%) of the subjects were female. In all, 49 (98%) samples were both high quality and sufficient quantity. In secondary analyses, we found that 80% (12/15) of patients with two 2 copies of a G allele at rs4680 on COMT experienced delirium, whereas 44% (4/9) of patients with 2 copies of an A allele at this location had delirium. In all, 44% (4/9) of patients with 2 T allele copies at rs7439366 on UGT2B7 experienced delirium compared to 73% (11/15) of patients with 2 C allele copies at this location. Conclusions: We can feasibly collect genetic information from critically ill adults. We were able to efficiently collect high quality DNA of sufficient quantity to conduct pharmacogenetic analysis in this critically ill population. Although the sample size of our current study is too small to conduct robust inferential analyses, it suggests potential SNP targets for a future larger study.
COVID-19 and tuberculosis: the double whammy of respiratory pathogens
Authors: Shariq Mohd , Sheikh Javaid A. , Quadir Neha , Sharma Neha , Hasnain Seyed E. , Ehtesham Nasreen Z.
Published: April 2022

Prior to coronavirus disease 2019 (COVID-19), tuberculosis (TB) was the worst killer among infectious diseases. The union of these two obnoxious respiratory diseases can be devastating, with severe public health implications. The COVID-19 pandemic has affected all TB-elimination programmes due to the severe burden on healthcare systems and the diversion of funds and attention towards controlling the pandemic. The emerging data show that the COVID-19 pandemic caused a marked decrease in case notifications and bacille Calmette–Guérin immunisations, ultimately promoting disease transmission and increasing the susceptible population. The similarity between the clinical characteristics of TB and COVID-19 adds to the public health complications, with evidence of immune dysregulation in both cases leading to severe consequences. Clinical evidence suggests that severe acute respiratory syndrome coronavirus 2 infection predisposes patients to TB infection or may lead to reactivation of latent disease. Similarly, underlying TB disease can worsen COVID-19. Treatment options are limited in COVID-19; therefore, using immunosuppressive and immunomodulatory regimens that can modulate the concomitant bacterial infection and interaction with anti-TB drugs requires caution. Thus, considering the synergistic impact of these two respiratory diseases, it is crucial to manage both diseases to combat the syndemic of TB and COVID-19.
A rare case of residual root myiasis caused by Clogmia albipunctata larvae (Diptera: Psychodidae)
Authors: Chen Juan , Liu Jinrui , Liu Yun , Liu Yingjie
Published: April 2022

Background

Dental injury caused by caries and trauma is the main cause of residual roots. Food trapped in the residual roots is difficult to clean. If the residual roots are not treated and cared for in time, flies can take advantage as soon as hygiene slips. Here, we present a rare case of human residual root myiasis caused by Clogmia albipunctata larvae, never previously reported.

Case presentation

A 26-year-old lady found two active, living larvae in her mouth while brushing her teeth. She did not present with fever, pain and any uncomfortable oral feeling. The intraoral examination revealed the right second mandibular molar was severely damaged as a result of caries, leaving a residual tooth root. The mucosa above it was mildly erythematous and edematous. No larvae and no inflamed gums were observed in her mouth. When normal saline was used to flush the area of the residual root with a syringe, four larvae appeared from the residual root. The larvae were observed by naked eye and under a light microscope. They were identified as the mature stage larvae of Clogmia albipunctata. Because the patient was in lactation, medication was not recommended. Treatment included the removal of all visible larvae followed by flushing the residual root with normal saline three times a day. The patient was followed-up weekly for one month. No more larvae were found and the erythematous and edematous mucosa healed completely.

Conclusions

The existence of a residual root can result in residual root myiasis. Myiasis caused by Clogmia albipunctata larvae or other fly larvae should be considered in cases of residual root infection.
Explaining variance in breastfeeding intentions and behaviors among a cohort of Midwest mothers using a theory of planned behavior-based structural model
Authors: Esquerra-Zwiers Anita , Goris Emilie Dykstra , Franzen Aaron
Published: April 2022

Background

The Theory of Planned Behavior (TPB) has guided the investigation of breastfeeding since the 1980’s, incorporating the major constructs of attitudes, subjective norms/normative beliefs, perceived behavioral control, and intentions.The purpose of this research study was to define a TPB-based structural latent variable model so as to explain variance in breastfeeding intentions and behaviors among a cohort of Midwest breastfeeding mothers.

Methods

The longitudinal descriptive study utilized questionnaire data collected from a convenience sample of 100 women with low-risk pregnancies with the intention to breastfeed at three separate time points (> 30 weeks antepartum, 10 and 60 days postpartum). Data were coded and analyzed using IBM SPSS, SAS and thelavaanpackage in R.

Results

Participants were predominantly White (94%,n = 94), married (95%,n = 95), college-educated (96%,n = 96), and had previous breastfeeding experience (75%,n = 75). The majority gave birth vaginally (79%,n = 75). Varimax analysis revealed a plurality of factors within each domain. Attempts to fit a structural model, including both hierarchical and bi-factor latent variables, failed, revealing a lack of statistical significance and poor fit statistics.

Conclusion(s)

These findings illustrate the importance of using methods that fit the phenomena explained. Contributors to poor model fit may include outdated tools lacking cultural relevance, a change in social norms, or a failure to capture the possible influence of social media and formula marketing on breastfeeding behaviors. The null finding is a significant finding, indicating the need to revisit and refine the operationalization and conceptual underpinnings of the TPB through qualitative methods such as exploring the lived experiences of breastfeeding women in the Midwest region.
Change in timing of induction protocol in nulliparous women to optimise timing of birth: results from a single centre study
Authors: Slade Laura , Digance Georgina , Bradley Angela , Woodman Richard , Grivell Rosalie
Published: April 2022

Background

Induction of labour (IOL) is a common obstetric intervention. When planning IOL, especially in women at risk for complications at delivery, the aim should be for delivery to occur when senior staff are available to optimise safe care.

Methods

A change in timing of IOL protocol at our institution was introduced in November 2018 aiming to increase births occurring “in-hours” defined as 08:00 to 20:00 h. This retrospective cohort study compares the odds of “in-hours” birth before and after the intervention and the association on birth outcomes. The study compared outcomes during the new IOL pathway period to a historical birth cohort from January to December 2017. Inclusion criteria were nulliparous women undergoing planned IOL at term with a cephalic singleton pregnancy. Logistic regression was used to compare odds of in-hours birth for the 2 periods with adjustment for maternal age at delivery, gestation, more than 2 cervical ripening agents required, undergoing IOL for post-dates pregnancy, mode of birth, whether or not IOL proceeded according to planned protocol and missing values using multiple imputation.

Results

The rate of deliveries occurring in-hours were higher following the intervention; n = 118/285 (45.6%) pre-intervention versus n = 251/470 (53.4%) post-intervention; adjusted OR = 1.47, 95% CI = 1.07–2.01, p = 0.02). The percentage of caesarean sections (CS) occurring in-hours was significantly lower in the pre-intervention group n = 71/153 (28.3%) compared with the post intervention group = 35/132(46.4%) (p < 0.001)). The rate of CS was higher in the pre intervention n = 132/285(46.3%) compared with the post intervention group n = 153/470 (32.4%)).

Conclusions

The change in induction procedures was associated with a significantly higher rate of births occurring in-hours and a lower rate of overall of CS. This policy change led to a better pattern of timing of birth for nulliparous women undergoing IOL.
Novel pathological predictive factors for extranodal extension in oral squamous cell carcinoma: a retrospective cohort study based on tumor budding, desmoplastic reaction, tumor-infiltrating lymphocytes, and depth of invasion
Authors: Noda Yuri , Ishida Mitsuaki , Ueno Yasuhiro , Fujisawa Takuo , Iwai Hiroshi , Tsuta Koji
Published: April 2022

Background

Extranodal extension (ENE) is a poor prognostic factor for oral squamous cell carcinoma (OSCC). Identifying ENE by clinical and/or radiological examination is difficult, thereby leading to unnecessary neck dissections. Currently, no definitive predictors are available for ENE. Thus, we aimed to determine the histological predictors of ENE by routine histopathological examination using biopsy and surgically resected specimens.

Methods

This retrospective study included 186 surgically resected OSCC and 83 matched biopsy specimens. Clinical features associated with the tumor microenvironment, including desmoplastic reaction (DR), tumor budding (TB), and tumor-infiltrating lymphocytes (TILs), were evaluated using hematoxylin and eosin-stained primary OSCC and neck dissection specimens. These histological features were divided into two groups: DR-immature (DR-I) and DR-mature (DR-M); TB-high (TB-H) and TB-low (TB-L); and TILs-low (TILs-L) and TILs-high (TILs-H). Clinical depth of invasion (cDOI) and pathological DOI (pDOI) were adapted for biopsies and resections, respectively; DOI was evaluated as DOI > 10 mm and DOI ≤ 10 mm. The clinicopathological relationships between these histopathological features and ENE and the independent risk factors for ENE were analyzed. The histological predictors of ENE were evaluated.

Results

The histological status of DR, TILs, and TB present in biopsy and resection specimens showed high accuracy with that of ENE. DR-I, TILs-L, and TB-H were significantly associated with lymph node metastasis, cDOI, and pDOI. Bivariate and multivariate analyses revealed that TB-H and pDOI > 10 mm in resections were independent factors for the presence of ENE (ENE +). The combination of TB-H/pDOI > 10 mm in resection specimens showed high specificity (91%) and accuracy (83%) regarding ENE + . Although there proved to be no independent factors in biopsies, DR-I and TILs-L were significantly associated with ENE + (p < 0.001). The combination of DR-I/TILs-L/cDOI > 10 mm in biopsies exhibited high sensitivity and specificity with ENE + (70% and 77%, respectively,p < 0.001). These histological predictors could detect even minor ENE (< 2 mm).

Conclusions

The tumor microenvironment status in primary OSCC was significantly associated with that of ENE, and TB-H was an independent risk factor for ENE. The histological status of DR-I/TILs-L/cDOI > 10 mm in biopsy specimens and TB-H/pDOI > 10 mm in resection specimens is a useful predictor of ENE.
HOX and PBX gene dysregulation as a therapeutic target in glioblastoma multiforme
Authors: Arunachalam Einthavy , Rogers William , Simpson Guy R. , Möller-Levet Carla , Bolton Gemma , Ismael Mohammed , Smith Christopher , Keegen Karl , Bagwan Izhar , Brend Tim , Short Susan C. , Hong Bangxing , Otani Yoshihiro , Kaur Balveen , Annels Nicola , Morgan Richard , Pandha Hardev
Published: April 2022

Background

Glioblastoma multiforme (GBM) is the most common high-grade malignant brain tumour in adults and arises from the glial cells in the brain. The prognosis of treated GBM remains very poor with 5-year survival rates of 5%, a figure which has not improved over the last few decades. Currently, there is a modest 14-month overall median survival in patients undergoing maximum safe resection plus adjuvant chemoradiotherapy.HOXgene dysregulation is now a widely recognised feature of many malignancies.

Methods

In this study we have focused onHOXgene dysregulation in GBM as a potential therapeutic target in a disease with high unmet need.

Results

We show significant dysregulation of these developmentally crucial genes and specifically thatHOXgenes A9, A10, C4 and D9 are strong candidates for biomarkers and treatment targets for GBM and GBM cancer stem cells. We evaluated a next generation therapeutic peptide, HTL-001, capable of targetingHOXgene over-expression in GBM by disrupting the interaction between HOX proteins and their co-factor, PBX. HTL-001 induced both caspase-dependent and –independent apoptosis in GBM cell lines.

Conclusion

In vivo biodistribution studies confirmed that the peptide was able to cross the blood brain barrier. Systemic delivery of HTL-001 resulted in improved control of subcutaneous murine and human xenograft tumours and improved survival in a murine orthotopic model.
Promoting exercise behavior and cardiorespiratory fitness among college students based on the motivation theory
Authors: Li Bo , Han Shanshan , Meng Shuqiao , Lee Jaewoo , Cheng Jie , Liu Yang
Published: April 2022

Background

In recent years, there has been an increase in the incidence of health problems among college students in China, the lack of adequate physical exercise is the major reason. This study aimed to investigate methods to promote exercise behavior and cardiovascular fitness among college students based on the motivation theory.

Methods

Cardiovascular fitness levels of 641 college students (20.72 ± 1.41 years old) were measured. Exercise motivation was assessed using the physical exercise motivation scale and physical exercise rating scale. Correlation analysis, regression analysis, and structural equation models were used to assess exercise motivation, exercise behavior, and cardiovascular fitness. Energy relationships were determined to develop a path model that promotes exercise behavior and aerobic fitness among college students.

Results

The exercise motivation of college students was directly related to cardiovascular fitness (effect value: 0.577) or indirectly related through the mediating effect of exercise behavior (effect value: 0.215). The influence of health motivation on exercise behavior (β = 0.132,p = 0.001) and cardiovascular fitness (β = 0.251,p < 0.001) was greater than that of other factors of motivation.

Conclusions

The physical exercise behavior of college students partially mediates the relationship between exercise motivation and cardiovascular fitness. Therefore, the educational concept of “Health First” should be promoted in college sports. Internal motivation of exercise can be transformed into external motivation to improve students’ exercise behavior and cardiovascular fitness through enhancing their cardiopulmonary capacity.
Medical students’ self-evaluation of character, and method of character education
Authors: Hur Yera , Yeo Sanghee , Lee Keumho
Published: April 2022

Background

As medical doctors must have a strong sense of ethics, character education is particularly important for them compared with other professions. This follow-up study aimed to establish the foundation for developing a character education program in medical schools by (1) conducting a survey among medical students on the self-assessment of one’s character based on eight qualities (service and sacrifice, empathy and communication, care and respect, honesty and humility, responsibility and calling, collaboration and magnanimity, creativity and positivity, patience and leadership), the perceived importance of character, and satisfaction with character education at medical school, and (2) analyzing the usefulness of learning methods for acquiring character elements. It also aimed at verifying the (3) gender differences in self-evaluation of character elements, and (4) academic-year differences in the survey items.

Methods

Medical students’ perceptions were identified through a questionnaire survey among 856 medical students from five South Korean medical schools. The questionnaire comprised items on the achievement level of the character element, importance of character in the medical curriculum, satisfaction with character education in medical schools, and the learning method’s degree of helpfulness. Descriptive statistics, t-test, and one-way ANOVA were used to compare responses.

Results

The importance of eight-character qualities had high average scores, whereas the average scores for satisfaction with character education and achievement level were comparatively low. For the question on each learning method’s helpfulness in gaining the eight-character qualities, the score of team-based learning activities was the highest, followed by club activities, relationships with peers, role modeling of professors, and course study. Regarding satisfaction with character education, male students gave higher scores than female students, manifesting a statistically significant difference. Regarding the importance of the character element in medical education, statistically significant differences existed based on academic year.

Conclusion

Medical students’ perceptions of character education varied according to gender and academic year. They regarded character education highly but were unsatisfied with the current character education at medical schools. Thus, diverse character education curricula must be developed and implemented along with extra-curricular character programs. An effective approach to implementing character education can be discovered by verifying the differences in students’ perceptions based on the character education courses in medical schools.
Efficacy of a blended learning programme in enhancing the communication skill competence and self-efficacy of nursing students in conducting clinical handovers: a randomised controlled trial
Authors: Chung Jessie Yuk Seng , Li William Ho Cheung , Cheung Ankie Tan , Ho Laurie Long Kwan , Chung Joyce Oi Kwan
Published: April 2022

Background

A clinical handover is an essential nursing practice that ensures patient safety. However, most newly graduated nurses struggle to conduct clinical handovers as they lack sufficient communication skill competence and self-efficacy in this practice. This study aimed to examine the efficacy of a blended learning programme on the communication skill competence and self-efficacy of final-year nursing students in conducting clinical handovers.

Methods

A randomised controlled design was used. A convenience sample of 96 final-year baccalaureate nursing students at a local university. Data were collected in 2020. Participants were randomly assigned to either an experimental group (n = 50) that received a blended learning programme with face-to-face training and an online module on handover practice, or a waitlist control group (n = 46) that received only face-to-face handover training during the study period and an online module immediately after the completion of data collection. The primary outcome was the communication skill competence and the secondary outcome was the self-efficacy of the participants in conducting clinical handovers. An analysis of covariance was used to examine the between-subjects effects on self-efficacy and communication skill competence in conducting clinical handovers after controlling for the significantly correlated variables. A paired sample t-test was used to determine the within-subjects effects on self-efficacy.

Results

The participants in the experimental group had significantly higher communication skill competence (p < 0.001) than those in the waitlist control group. Although both groups showed a significant improvement in self-efficacy, the mean scores of the experimental group were higher than those of the waitlist control group (p < 0.001).

Conclusions

This study demonstrated the efficacy of a blended learning approach in improving the communication skill competence and self-efficacy of final-year nursing students in conducting clinical handovers. Nurse educators should incorporate a blended learning approach into the nursing curriculum to optimise the content of training programmes for teaching nursing students in conducting clinical handovers.

Trial registration

The study protocol was registered in the Registration ClinicalTrials.gov (NCT05150067; retrospective registration; date of registration 08/12/2021).
The impact of medical insurance reimbursement on postoperative inflammation reaction in distinct cardiac surgery from a single center
Authors: Jiang Qin , Yu Tao , Huang Keli , Huang Xiaobo , Zhang Qingfeng , Hu Shengshou
Published: April 2022

Background

Evidences shows that socioeconomic status is reversely associated with the risk of morbidity and mortality for people with cardiovascular disease via pro-inflammation mechanism, but the population profile is not deeply defined on. We aimed to investigate the impact of medical insurance coverage on postoperative systemic inflammatory reaction in two kinds of disease populations undergoing distinct cardiac procedures.

Methods

A total of 515 patients receiving open mitral valve procedure with high-total expense from May 2013 through May 2021 in Sichuan Provincial People’s Hospital were retrospectively collected and stratified according to medical insurance reimbursement: low coverage with high out-pocket (< 30%), medium coverage (≤ 60%, but ≥ 30%), and high coverage (> 60%). Another 118 cases undergoing atrium septum defect (ASD) or patent foramen ovale (PFO) occlusion and taking on consistent low-total expense and low-coverage (< 30%) were also classified according to their insured conditions. The postoperative systemic inflammatory response indexes were high sensitivity C-reactive protein (hs-CRP) and the neutrophil–lymphocyte ratio (NLR).

Results

Low insurance reimbursement population undergoing open mitral valve procedure had a higher level of hs-CRP and NLR but not troponin I protein or lactate within 48 h postoperatively, and higher thoracic drainage, longer ventilation use and stay in intensive care unit. No significant difference in inflammatory indexes existed among diverse medical insurance coverage in population undergoing ASD/PFO occlusion.

Conclusions

Higher inflammatory reaction and weaker clinical recovery was associated with lower insurance coverage population undergoing open mitral valve procedure but not ASD/PFO interventional occlusion procedure.
Clinically relevant CHK1 inhibitors abrogate wild-type and Y537S mutant ERα expression and proliferation in luminal primary and metastatic breast cancer cells
Authors: Pescatori Sara , Leone Stefano , Cipolletti Manuela , Bartoloni Stefania , di Masi Alessandra , Acconcia Filippo
Published: April 2022

Background

Challenges exist in the clinical treatment of luminal estrogen receptor α (ERα)-positive breast cancers (BCs) both to prevent resistance to endocrine therapy (ET) and to treat ET-resistant metastatic BCs (MBC). Therefore, we evaluated if kinases could be new targets for the treatment of luminal primary and MBCs.

Methods

 ~ 170 kinase inhibitors were applied to MCF-7 cells either with adaptative or genetic resistance to ET drugs and both ERα levels and cell proliferation were measured. Robust-Z-score calculation identified AZD7762 (CHK1/CHK2 inhibitor) as a positive hit. Subsequently, Kaplan–Meier analyses of CHK1 and CHK2 impact on ERα-positive BC patients relapse-free-survival (RFS), bioinformatic evaluations of CHK1 and CHK2 expression and activation status as a function of ERα activation status as well as drug sensitivity studies in ERα-positive BC cell lines, validation of the impact of the ATR:CHK1 and ATM:CHK2 pathways on the control of ERα stability and BC cell proliferation via inhibitor- and siRNA-based approaches, identification of the molecular mechanism required for inhibitor-dependent ERα degradation in BC and the impact of CHK1 and CHK2 inhibition on the 17β-estradiol (E2):ERα signaling, synergy proliferation studies between ET-drugs and clinically relevant CHK1 inhibitors in different luminal BC cell lines, were performed.

Results

A reduced CHK1 expression correlates with a longer RFS in women with ERα-positive BCs. Interestingly, women carrying luminal A BC display an extended RFS when expressing low CHK1 levels. Accordingly, CHK1 and ERα activations are correlated in ERα-positive BC cell lines, and the ATR:CHK1 pathway controls ERα stability and cell proliferation in luminal A BC cells. Mechanistically, the generation of DNA replication stress rather than DNA damage induced by ATR:CHK1 pathway inhibition is a prerequisite for ERα degradation. Furthermore, CHK1 inhibition interferes with E2:ERα signaling to cell proliferation, and drugs approved for clinical treatment of primary and MBC (4OH-tamoxifen and the CDK4/CDK6 inhibitors abemaciclib and palbociclib) exert synergic effects with the CHK1 inhibitors in clinical trials for the treatment of solid tumors (AZD7762, MK8776, prexasertib) in preventing the proliferation of cells modeling primary and MBC.

Conclusions

CHK1 could be considered as an appealing novel pharmacological target for the treatment of luminal primary and MBCs.
Impact of COVID-19 lockdown restrictions on cardiac rehabilitation participation and behaviours in the United Kingdom
Authors: Kirwan Richard , Perez de Heredia Fatima , McCullough Deaglan , Butler Tom , Davies Ian G.
Published: April 2022

Background

COVID-19 lockdown measures led to the suspension of centre-based cardiac rehabilitation (CR). We aimed to describe the impact of lockdown on CR behaviours and perceptions of efficacy in a sample of CR participants.

Methods

An online survey was conducted amongst CR participants from May to October 2020, COVID-19-related lockdown restrictions. Anthropometric data, participant-determined levels of motivation and self-perceived efficacy, CR practices etc., pre- and post-lockdown, were collected.

Results

The probability of practicing CR in public gyms and hospitals decreased 15-fold (47.2% pre-, 5.6% post-lockdown; OR[95% CI] 0.065[0.013; 0.318], p < 0.001), and 34-fold (47.2% pre, 2.8% post; OR[95% CI] 0.029[0.004; 0.223], p < 0.001), respectively. Amongst participants, 79.5% indicated that their CR goals had changed and were 78% less likely to engage in CR for socialization after lockdown (47.2% pre, 16.7% post; OR[95% CI] 0.220[0.087; 0.555]; p = 0.002). The probability of receiving in-person supervision decreased by 90% (94.4% pre, 16.7% post; OR[95% CI] 0.011[0.002; 0.056]), while participants were almost 7 times more likely to use online supervision (11.1% pre, 44.4% post; OR[95% CI] 6.824[2.450; 19.002]) (both p < 0.001). Fifty percent indicated that their enjoyment of CR was lower than before lockdown and 27.8% reported they would be less likely to continue with CR in the newer format.

Conclusions

Lockdown was associated with considerable changes in how CR was practiced, motivation levels and willingness to continue with CR. Further research is warranted to develop and improve strategies to implement in times when individuals cannot attend CR in person and not only during pandemics.
The effect of animal versus plant protein on muscle mass, muscle strength, physical performance and sarcopenia in adults: protocol for a systematic review
Authors: Reid-McCann Rachel J. , Brennan Sarah F. , McKinley Michelle C. , McEvoy Claire T.
Published: April 2022

Background

The evidence base for the role of dietary protein in maintaining good muscle health in older age is strong; however, the importance of protein source remains unclear. Plant proteins are generally of lower quality, with a less favourable amino acid profile and reduced bioavailability; therefore, it is possible that their therapeutic effects may be less than that of higher quality animal proteins. This review aims to evaluate the effectiveness of plant and animal protein interventions on muscle health outcomes.

Methods

A robust search strategy was developed to include terms relating to dietary protein with a focus on protein source, for example dairy, meat and soy. These were linked to terms related to muscle health outcomes, for example mass, strength, performance and sarcopenia. Five databases will be searched: MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, Embase and Web of Science. Studies included will be randomised controlled trials with an adult population (≥ 18) living in the community or residential homes for older adults, and only English language articles will be included. Two independent reviewers will assess eligibility of individual studies. The internal validity of included studies will be assessed using Cochrane Risk of Bias 2.0 tool. Results will be synthesised in narrative format. Where applicable, standardised mean differences (SMD) (95% confidence interval [CI]) will be combined using a random-effects meta-analysis, and tests of homogeneity of variance will be calculated.

Discussion

Dietary guidelines recommend a change towards a plant-based diet that is more sustainable for health and for the environment; however, reduction of animal-based foods may impact protein quality in the diet. High-quality protein is important for maintenance of muscle health in older age; therefore, there is a need to understand whether replacement of animal protein with plant protein will make a significant difference in terms of muscle health outcomes. Findings from this review will be informative for sustainable nutritional guidelines, particularly for older adults and for those following vegan or vegetarian diets.

Systematic review registration

PROSPERO CRD420201886582
Extremal properties of the beta-normal distribution
Authors: Jiang Yingying , Li Baokun
Published: April 2022

Asymptotic behaviors of the extremes of the beta-normal distribution are derived. The higher-order asymptotic expansions of the probability density and cumulative distribution functions for the maximum are given under an optimal normalizing constants. In particular, the associated rates of convergence are explicitly calculated.
A case of successful slide tracheoplasty for long-segment congenital tracheal stenosis in a neonate with a congenital diaphragmatic hernia and Fallot’s tetralogy
Authors: Todo Marie , Okuyama Hiroomi , Saka Ryuta , Tazuke Yuko , Ueno Takayoshi , Sawa Yoshiki
Published: April 2022

Background

Congenital tracheal stenosis (CTS) is a rare and life-threatening airway disorder, which is often associated with cardiac malformations. Among them, neonatal symptomatic CTS with cardiac malformations has an extremely poor prognosis. In contrast to cardiac malformation, congenital diaphragmatic hernia (CDH) has rarely been associated with CTS. We report a neonatal case in which slide tracheoplasty and intracardiac repair were performed simultaneously for CTS and Fallot’s tetralogy (TOF).

Case presentation

An infant with left CDH and Fallot's tetralogy (TOF) was born by cesarean section at 38 weeks of gestation. At the time of resuscitation, a 2.5 mm (ID) endotracheal tube could only be inserted just below the vocal cords. After repairing the CDH at 3 days of age, planned extubation was performed at 7 days of age. However, the patient required re-intubation due to life-threatening episodes after 2 days of the extubation. Enhanced CT revealed a long segment CTS from the upper trachea to the right bronchus (length of stenosis: 40 mm, minimum inner diameter: 2 mm). At 24 days of age, veno-arterial extracorporeal membrane oxygenation (ECMO) was introduced due to severe respiratory failure. At 28 days of age, slide tracheoplasty and palliative right ventricular outflow tract reconstruction (RVOTR) was performed with cardiopulmonary bypass (CPB). After tracheoplasty, a 3.5 mm tracheal (ID) tube could be placed in the reconstructed trachea in a patient with CTS. ECMO was completed 7 days after the operation. On the 17th day after the operation, he was extubated successfully. He was discharged 5 months after birth with home oxygenation therapy.

Conclusions

We reported the successful simultaneous correction of slide tracheoplasty and palliative RVOTR for a neonate with CDH. ECMO was used for respiratory management before and after surgery.
Calcifying fibrous tumor of the ileum resected by single-port laparoscopic surgery: a case report
Authors: Takabatake Kazuya , Arita Tomohiro , Kuriu Yoshiaki , Shimizu Hiroki , Kiuchi Jun , Takaki Wataru , Konishi Hirotaka , Yamamoto Yusuke , Morimura Ryo , Shiozaki Atsushi , Ikoma Hisashi , Kubota Takeshi , Fujiwara Hitoshi , Okamoto Kazuma , Sonobe Yuta , Tanaka Noriyuki , Konishi Eiichi , Otsuji Eigo
Published: April 2022

Background

Calcifying fibrous tumors (CFTs) are rare benign tumors. Because CFTs sometimes relapse, radical resection with adequate margins is necessary. We report a case of ileal CFT resected using single-port laparoscopic surgery.

Case presentation

A 33-year-old man presented with chief complaints of abdominal pain and vomiting. Computed tomography demonstrated a 45-mm-sized pelvic mass with partial calcification in the ileum. The patient was diagnosed with an ileal tumor, and partial resection of the ileum was performed using the single-port laparoscopic technique. Pathologic findings revealed hypocellular spindle cells with dense hyalinized collagen, interspersed calcification, and infiltration of lymphoplasmacytic cells. Immunohistochemical analysis showed that the factor XIIIa was positive and other tumor-specific markers were negative. Based on these findings, the tumor was finally diagnosed as a CFT.

Conclusions

Although CFT is benign, multifocal and recurrent CFTs have been reported. Therefore, careful intraperitoneal observation and curative resection are necessary. Single-port laparoscopic surgery is acceptable, both in terms of curability and minimal invasiveness.
Traditional medicinal plants used by hypertensive patients in Belize: a qualitative evaluation of beliefs and practices
Authors: Mphuthi David D. , Husaini Danladi Chiroma
Published: April 2022

Background

Belize is rich in rainforest and vast medicinal plants that have the potential for drug discoveries. Few studies have examined the use of medicinal plants in the management of chronic diseases in Belize. The present study appraised indigenous Belizeans' opinions, beliefs, and practices of medicinal plants used for hypertension management. Twenty-four hypertensive patients were interviewed using a semi-structured interview guide from January to May 2019. Interview results were transcribed using Microsoft Excel and loaded into qualitative data analysis (QDA) Miner Lite version 2.0.6 online software for coding. The integrated themes and sub-themes generated were presented in narrative passages and used to summarize study findings on medicinal plants used in the management of hypertension in Belize.

Results

Fifteen medicinal plants belonging to 15 plant families were reported by the participants as medicinal plants used to manage hypertension. The plants include Annona muricata, Artocarpus altilis, Cecropia peltata, Ananas comosus, Cymbopogon andropogoneae, Uncaria tomentosa, Allium sativum, Bixa orellana, Moringa oleifera, Momordica charantia, and Cassia grandis. Leaves were the most commonly used plant part; decoction was the most common method of preparation, while ½ to 1 glass was the daily recommended dose. Mild side effects were reported, while antioxidant activity was the perceived efficacy.

Conclusion

Hypertensive patients in Belize opined that medicinal plants and herbs were efficacious in lowering blood pressure, as evidenced by home monitoring and regular checkups at the hospital. They also reported minimal side effects in the use of the medicinal plants. There is a need for a comprehensive evaluation of Belize’s medicinal plants to unravel their potential for drug discovery.