bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigating the impact of argumentation on high school students’ achievement in probability
Authors: Chitera Joshua , Gudyanga Remeredzayi , Dziva Daimond
Published: January 2025

This study aimed to investigate the impact of an argumentation instructional approach on high school students' understanding and performance in probability in Zimbabwe. A sample of 120 students was randomly assigned to experimental and control groups, with the experimental group receiving argumentation-based instruction while the control group followed traditional teaching methods. Both groups completed standardized pre-tests and post-tests, with results analysed using t-tests and ANCOVA. Findings indicated a significant improvement in the experimental group's performance. The study concluded that the argumentation approach positively influenced students' understanding and achievement in probability. However, limitations included the study's focus on a single school and a short intervention duration, suggesting future research should encompass multiple schools and longitudinal designs. The findings have implications for mathematics education policy and curriculum development in Zimbabwe and similar contexts.
Priority Health Professions Education Research in 21st Century
Authors: Mariya Jiandani  , Avinash Supe
Published: January 2025

Introduction: Health professions education is fast transforming due to the implementation of competency-based curriculum, the far-reaching effects of the COVID pandemic, and the wider use of newer methods and technology. Objective: To review the research priority in health professional education. Methods: An opinion from health professional educators and a review of articles pertaining to research priorities and future trends in health professional education was carried out in Pub Med and Google Scholar and priority areas were identified. Results: Emerging priority areas included 1) Context of Population Health Needs 2) Bridging the Gap: Health Equity and Social Determinants 3) Competency-driven curriculum needs 4) Capacity Building (Training Health Educators) 5) Integrating Cultural Competence and communication skills 6) Innovative methods and technological advances 7) Incorporation of Artificial Intelligence and Chat GPT. Conclusion: In the future educational research is likely to move to incorporate technology advances, capacity building to address various competencies and collaborative practice.
Flipped Classroom Approach: Making A Right Flip For Health Profession Education
Authors: Soumendra Sahoo
Published: January 2025

N/A
Triangles in Surgery and its Importance [Interesting Facts]
Authors: Murali Uthamalingam
Published: January 2025

The angles and triangles in surgery form a part of important association to the medical student and to the operating surgeon. They help in the identification as well as guiding us in the appropriate direction to the organ concern. Misidentification can lead to injuries. The objective is to present interesting facts about the triangles in surgery and their importance.
Unveiling Effective Learning Strategies: A Randomized Controlled Trial Comparing Audiovisual Mnemonics and Text Reading for Memory Retention in Medical Students
Authors: Dayasni Ratneswaren  , Khoo Jia Xian Ethan  , Narthana V. Vengadeshwaran  , Sasika Sumodh Dias  , Nan Nitra Than  , Mila Nu Nu Htay  , Soe Moe  , Htoo Htoo Kyaw Soe
Published: January 2025

Background: Learning with videos activates one’s sensory of sight and hearing, while learning with mnemonics helps one remember things more efficiently. Combining both audiovisual and mnemonic learning helps medical students to retain knowledge and gives better illustration and clarity towards learning compared to learning using text reading alone. This randomized control trial aimed to compare the learning with audiovisual mnemonic and text reading in enhancing memory retention and their satisfaction and engagement towards the study method. Methods: A total of 64 students were randomized, with 32 in the intervention group (audiovisual mnemonic) and 32 in the control group (text reading). Memory retention was assessed by employing multiple choice questions. Moreover, satisfaction and engagement towards the studying method was also assessed. Mann-Whitney U test and Fried man test were calculated. Results: It was observed that there is no significant difference of memory retention score between audiovisual mnemonic learning and text reading. However, it is worth noting that memory retention significantly improved over time within the audiovisual mnemonic group. Conclusion: Employing audiovisual mnemonic strategies seems to offer distinct advantages for medical students, as it improves their memory retention while also enhancing their satisfaction and engagement with the learning approach.
Influence of Gender on Clinical Examination Practices Among Undergraduate Medical Students
Authors: Deena Rasha Binti Abdul Rashid  , Chong Shi Yan  , Karesma Velan  , Migelarachchige Adeesha Randula Silva  , Htoo Htoo Kyaw Soe  , Soe Moe  , Murali Uthamalingam  , Mila Nu Nu Htay
Published: January 2025

Introduction: Clinical examinations are considered crucial clinical skills and are a significant component of a doctor's everyday duties. This study aimed to assess the association between gender and the frequency of clinical examinations, student’s perceived clinical examination competency and its associated factors among medical students.Methods: A cross-sectional study was conducted from July to August 2022 in a private medical university in Malaysia. The respondents were recruited by purposive sampling and the data was collected using Google form. The main outcomes were frequency of clinical examinations conducted, influence of gender in conducting clinical examination, confidence, and perceived clinical competency among clinical year undergraduate medical students.Results: A total of 130 respondents participated in the study. The findings revealed that a higher proportion of male respondents (68.5%) were sometimes refused by patients of the opposite sex to be present during clinical examination compared to females (28.9%). Besides that, 68.5% of males reported that their gender negatively affected their learning experience compared to female respondents (30.3%). Regarding the intimate examinations, male respondents were 2.74 times more likely to conduct ≥ 1-time male genitalia examination on patients than female respondents (95%CI: 1.16, 6.51). Practicing clinical examinations with actual patient was reported to be the most preferred methods by the respondents (87.7%). There was a significant association between the study year and respondents’ self-perception of their clinical competency skills (OR 2.69, 95%CI: 1.54, 3.83).Conclusion: Gender has an impact on clinical learning in medical students in a variety of ways, including clinical exposure, patients’ willingness, and consent. The extra effort is needed to make sure all students are learning the necessary skills and giving complete and acceptable patient care.
Communication Skills in Medical Training: Insights from Clinical Year Students - A Cross-Sectional study
Authors: Mohamad Izwan Shah Mohamad Ismail  , Maria Anne Mathews  , Precilia Pereira Narisan Pereira  , Sharmita Murugan  , Murali Uthamalingam  , Mila Nu Nu Htay  , Soe Moe  , Htoo Htoo Kyaw Soe
Published: January 2025

Introduction: Good communication skills are paramount among the essential abilities for physicians, a sentiment shared by medical students who recognize the significance of effective communication in becoming adept doctors. The cultivation of skills necessitates consistent and devoted learning, driven in part by one's disposition towards learning. Objectives: This cross-sectional study targeted clinical year medical students at Manipal University College Malaysia, aiming to scrutinize their attitudes towards learning communication skills and unearth barriers obstructing such skill development. Additionally, the study sought to evaluate the interplay between demographic factors, academic year, language proficiency, and the attitude towards learning communication skills. Methods: Data collection involved the distribution of online questionnaires via social media, garnering 105 responses, which were subsequently analysed using Epi Info software. Results: Results highlighted a prevailing positive attitude towards learning communication skills among a substantial number of participants, in contrast to those displaying a negative attitude. The study unveiled that age, ethnicity, academic year, and self-rated proficiency in English and Malay language, and communication skills did not exhibit significant correlations with negative attitude. However, gender, nationality, and academic year were notably associated with positive attitudes. Females, Malaysians, and final year medical students exhibited favourable attitudes, emphasizing their integral roles in fostering a constructive learning attitude. Conclusion: Understanding these dynamics can contribute to the refinement of communication skills training programs, fostering a holistic and effective medical education experience.
Transformative Medical Education: The Role of E-Pads in Revolutionizing Examinations Processes in Medical School
Authors: Sadikan Muhammad Zulfiqah
Published: January 2025

Electronic pads (E-pads) in medical education and examination revolutionize pattern schemes and enhance better learning methods. This review addresses E-pad implementation in medical school examinations, which mainly focuses on the usefulness of this technology, including its capacity to enable easy assessment, improve interactivity and engagement, make automatic exams that adapt to user personality and feedback, maintain data security, and to ensure accessibility and inclusivity during assessments. E-pads enlighten the assessment process by providing ease of digital test administration, and standardization of format and grading processes, hence delivering an efficient and consistent output. Interactivity features such as touchscreen interfaces combined with incorporating multimedia elements in the app arouse the engagement, understanding, and comprehension abilities of the learners. Learners' progress is met with adaptive testing algorithms that adjust the examination to their performance levels. In return, learners are supported by feedback mechanisms that create personalized learning paths. Next, E-pads can tackle issues with data security by encryption protocols and remote invigilating tools. Also, the usability of personalised accessibility features provides equality in access to college students with disabilities. Moving ahead, emerging technologies in E-pad will contribute to continuous improvement by integrating advanced features for autonomous item generation and adaptive testing. Through the extension of the potential of E-pad technology, medical educators can create more vibrant and inclusive examination conditions, and in addition, uplift the traditional way of education, so that the students can stand their ground towards modern healthcare practice.
Breaking Barriers, Building Bridges: A Review of Interprofessional Collaboration in Medical Education
Authors: Sadikan Muhammad Zulfiqah , Ariffin Indang Ariati
Published: January 2025

Interprofessional collaboration (IPC) in medical education is critical for equipping future healthcare providers to successfully address the complex problems of today’s healthcare system. Current review investigates the theoretical frameworks, advantages, barriers, innovations, assessment and future direction of IPC initiatives in medical education. Some of the theoretical frameworks, for example, the Interprofessional Education Collaborative (IPEC) Core Competencies and the Collaborative Care Model, serve as a foundation for understanding the principles and processes of IPC. IPC implies a boost in teamwork skills, development of communication skills, better understanding of roles and functions, enhancement of patient-centred care, and preparation for interdisciplinary practice. Nevertheless, some of the challenges, such as logistic constraints, faculty resistance, cultural barriers, lack of interdisciplinarity, and assessment problems hamper the implementation of some IPC initiatives. Future directions include Interprofessional Education (IPE) integration into curricula, health equity as a focus, technology-enhanced learning platforms embracement, interdisciplinary research, scholarship promotion, and fostering global collaboration and exchange. Through the establishment of such challenges and accepting future directions, medical schools will prepare learners to work well with teams and lead in healthcare. IPC in medical education is not just an educational strategy but a transforming force that has the potential to change healthcare systems, improve patient outcomes, and promote health equity as a whole.
Elevating Healthcare: The Integration of Modern Nutrition Science into Medical Education
Authors: Singar Saiful Anuar , Ahmad Hairi Haryati , Sadikan Muhammad Zulfiqah , Sadikan Siti Fairuz Nurr
Published: January 2025

Integrating modern nutrition science in medical school curriculums is crucial for medical students to be equipped with the required skills to adapt to the complexity of disease-nutrition knowledge. The primary challenges identified are the curriculum's factors, including the lack of faculty experts and the multitude of competing priorities. These challenges are proposed to be resolved through subject integration, interprofessional collaboration (IPC), innovative teaching methods, and constant faculty development. The integration of nutrition concepts means that nutrition can be embedded and reinforced in various courses throughout the program. At the same time, IPC enriches these initiatives with the diverse exposure of various disciplines. The implementation of innovative teaching methods leads to improvement in student engagement and the development of more skills, all of which are supported by faculty development, where they get more knowledge and skills to be able to teach nutrition concepts efficiently. Moreover, active student participation, engagement with the community for nutrition education are discussed. Future research and practice recommendations are multi-faceted, including feedback mechanisms, IPC, assessment methods, and faculty development. All the recommendations are aimed at significantly boosting the quality of the nutrition curriculum through an interdisciplinary approach, which will, ultimately, result in medical professionals capable of comprehensive patient care and general health and wellness promotion.
Optimising Medical Education: The Power and Potential of One Best Answer (OBA) Questions
Authors: Sadikan Muhammad Zulfiqah , Ahmad Hairi Haryati , Sahoo Soumendra
Published: January 2025

One best answer (OBA) questions are widely used in medical education as a formative and summative assessment tool to assess the knowledge, decision-making, and critical thinking of students. OBAs provide a medical scenario and several potential responses which students must choose the best response from the options. This review of OBAs aims to establish how the assessments work by noting their capacity to assess higher-order cognitive skills, which are helpful in clinical practice. Some of the important elements in the construction of good OBA questions are as follows: They should be clear, clinically relevant, have plausible distractors and should be able to assess higher cognitive skills. It is found that when students are encouraged to use OBAs, it allows for enhanced learning and knowledge retention. Also, the benefit of OBAs as a form of assessment is compared to other methods like essay questions and oral examination in terms of objectivity in scoring, simplicity of the assessment technique and flexibility of the assessment in covering a wide content area. Nevertheless, OBAs also have their shortcomings, for example, they may be ambiguous and, in general, it is not easy to come up with good plausible distractors. However, OBAs remain a useful form of assessment in medical education, if used in combination with other assessment procedures that would ensure the holistic evaluation of student competence.
Addressing Burnout in Medical Students and Residents: Strategies for Sustainable Well-being
Authors: Sadikan Muhammad Zulfiqah
Published: January 2025

The alarming rise in the level of burnout among medical students and residents harms their productivity and the well-being of patients. This perspective elaborates on the rates and contributing factors to burnout in medical education concerning available system factors like work overload, support, and emotional requirements. It suggests strategies to prevent burnout, such as promoting better work-life balance, enriching support measures, improving training models at institutions, introducing and standardizing resilience courses, and supporting changes in a positive environment. As evident, tackling burnout is crucial for promoting and sustaining a strong and caring health workforce.
Self-assessed affective and cognitive empathy and it’s predictors among medical students in a private institution in Malaysia
Authors: Selvasingam Suathe , Viknesvaran Sohan , Jai Prakash Dheeran , Siva Kumar Kirthanaa , Soe Moe  , Minoo Pothen  , Mila Nu Nu Htay
Published: January 2025

Background: Empathy is considered a vital social and interpersonal skill that allows people to communicate their needs, wants, and experiences with one another. It also acts as an emotional bridge to encourage prosocial behaviour. The study aimed to assess the level of affective empathy and cognitive empathy of medical students and the predictors that influence the varying degrees of each type of empathy among medical students in a private medical institution in Malaysia.Methods: The cross-sectional study was conducted in 2024. The respondents were recruited by convenience sampling method and data was collected with online questionnaires. The questionnaire included demographic variables and the Interpersonal Reactivity Index (IRI). Descriptive and inferential analyses were conducted by using SPSS (version 29) and P-value < 0.05 was considered statistically significant.Results: A total of 154 students participated in this study. The association between the level of affective, cognitive, total empathy and factors such as gender and previous exposure to empathy workshops/talks were statistically significant (P < 0.05). Age, ethnicity, nationality, year of study, family income, and number of siblings were deemed not significant in regard to the level of empathy.Conclusion: From this study, it is evident that women have higher levels of affective, cognitive, and total empathy compared to men. Moreover, those who have had previous exposure to empathy-related workshops/talks also cause an individual’s levels of empathy to be higher.
Comparing the knowledge and awareness of diabetes mellitus among pre-clinical and clinical medical students
Authors: Sadikan Muhammad Zulfiqah , Amirah Adam  , Sandesh Singh  , Wong Su Chi  , Mila Nu Nu Htay  , Mohd Yusof Hazwani
Published: January 2025

Introduction: Diabetes mellitus (DM) is a collection of metabolic illnesses characterised by hyperglycaemia caused by abnormalities in insulin production, insulin action, or both. It has become an epidemic, and in 2021 about 536.6 million people are living with DM. Aims: The objective of this study is to assess knowledge among preclinical and clinical year medical students in a private medical institution in Malaysia regarding DM. Methods: A cross-sectional survey of medical students was conducted on a designated questionnaire. Students were divided into two groups (pre-clinical and clinical groups) for analysis. Results: A total of 72 students participated, with 33.3% (24 students) from the preclinical group and 66.7% (48 students) from the clinical group. Over 87.5% of students correctly identified diabetes as a metabolic disorder, 90.6% knew the pancreas produces insulin, and 84.4% recognized the main insulin target+ organ. Common symptoms recognized included polyuria (79.2%), polydipsia (71.9%), polyphagia (61.5%), and delayed wound healing (75%), while pruritis vulvae was less frequently identified (11.5%). Both pre-clinical (100%) and clinical groups (95.8%) were aware of diabetes risk factors (p<0.001), and knew it is preventable (pre-clinical: 95.8%, clinical: 91.7%, p<0.001). Knowledge of diabetes screening was reported by 50% of pre-clinical and 43.8% of clinical students (p<0.001). Only 46.9% of students knew the World Health Organization (WHO) diagnostic criteria for diabetes (p<0.001), and 5% believed diabetes does not always require medication (p<0.001). Conclusion: The findings underscore the importance of continuous curriculum development and clinical immersion to optimize medical education outcomes related to diabetes care.
Assessing PBL in PBL spirit
Authors: Sahoo Soumendra , Sahoo Rashmirekha
Published: January 2025

It is important to design the assessment of problem-based learning (PBL) aligning to its learning process and outcomes defined. One is to assess the end of a learning process and report on a student’s learning, which is called summative assessment. The formative assessment is used through the collection of data along the course of a student’s learning journey, to appraise current performance and adjust the learning as well as instruction. Any assessment instrument applied for PBL should support the central concept of PBL, which is contextual learning, constructive learning, & collaborative learning. Hence the assessment in PBL should be both a process- & product-based approach.
Time management and its associated factors among medical students
Authors: Jahni Chatar Kaur  , Ng Wen Syuen  , Wong Kok Yi  , Amran Muhammad Adlan , Htoo Htoo Kyaw Soe  , Chong Sook Vui  , Htay Mila Nu Nu
Published: January 2025

Introduction: Time management is a set of principles, practices, and skills that enable individuals to complete tasks by working more efficiently rather than more complexly. This study aimed to identify time management patterns and associated factors among medical students in a private medical institution in Malaysia.Methods: This cross-sectional study was conducted in 2022 among medical students at a private medical institution in Malaysia. Respondents were recruited using convenience sampling, and data was collected via an online Google form. The questionnaire consisted of three sections: demographics, time management practices, and the influence of time management on respondents' behavior and performance. Data were analyzed using Epi Info version 7.2 software.Results: A total of 137 students participated in the study. The mean scores indicated that respondents had good to moderate abilities in time planning. Chinese students were reported to have higher time management scores compared to other ethnicities (p=0.024). Respondents living in rented housing or rooms had significantly higher time management scores than those living in hostels or with parents (p<0.001). Additionally, respondents without a habit of procrastination had significantly higher time management scores than their counterparts (p<0.001).Conclusion: In our study, students generally exhibited moderate to good time management skills, with particularly strong performance in the time attitude component. Individuals should be trained to cultivate good time management and reduce procrastination to develop more resilient and adaptive approaches in the future.
Interprofessional Education in Healthcare: Benefits, Challenges, and Impacts on Drug Management and Patient Care
Authors: Sadikan Muhammad Zulfiqah
Published: January 2025

Interprofessional education (IPE) is an integral component of healthcare training that encourages close working relationships among different healthcare professionals. Driven by its curriculum goal of integrating students from diverse fields like medicine, pharmacy, nursing and allied health to emphasize the development of key competencies for participation in teams and medication management, this approach brings students from all these fields together. IPE exposes students to common learning experiences which help students learn about their roles and responsibilities in patient care. Research indicates that collaborative learning environments not only serve to increase the knowledge that participants have of drug therapy but also aid in improving patient outcomes by decreasing medication errors as well as promoting patient-centric care. The IPE's impact on collaborative practice was discussed, with specific attention to the role played by medical education on medication management and patient outcomes.
Overview of Reliability and Validity of Assessments in Medical Education
Authors: Mila Nu Nu Htay  , M Ganesh Kamath  , Anand K M  , Sandheep Sugathan  , Eunice Ong Luyee  , Soumendra Sahoo
Published: January 2025

Reliability and validity of exam questions are crucial in the assessment of medical education. Validity refers to the meaning if the exam questions effectively measure as its purpose to measure, while reliability refers the consistency of a measurement or test. Various methods could be applied to measure the validity and reliability of examination questions. In this review, content validity, face validity, concurrent validity, construct validity, predictive validity are briefly mentioned for further application. Moreover, test-retest reliability, inter-rater reliability, alternate form reliability, split-half reliability are presented. Regular assessment on validity, reliability, and refinement of assessments based on feedback could reduce bias and improve quality of assessments in medical education.
Health Professionals and War in the Middle East
Authors: Wynia Matthew K.
Published: November 2023

In this Viewpoint, the author examines whether health care professionals have any responsibilities to speak out about the conflict in the Middle East.
Long-Term Clinical and Echocardiographic Outcomes Following the Ross Procedure
Authors: Notenboom Maximiliaan L. , Melina Giovanni , Veen Kevin M. , De Robertis Fabio , Coppola Giuditta , De Siena Paolo , Navarra Emiliano M. , Gaer Jullien , Ibrahim Michael E. K. , El-Hamamsy Ismail , Takkenberg Johanna J. M. , Yacoub Magdi H.
Published: November 2023

Importance

The Ross procedure as treatment for adults with aortic valve disease (AVD) has been the subject of renewed interest.

Objective

To evaluate the long-term clinical and echocardiographic outcomes following the Ross procedure for the treatment of adults with AVD.

Design, Setting, and Participants

This post hoc analysis of a randomized clinical trial included adult patients (age <69 years) who underwent a Ross procedure for the treatment of AVD, including those with active endocarditis, rheumatic AVD, decreased ejection fraction, and previous cardiac surgery. The trial, conducted from September 1, 1994, to May 31, 2001, compared homograft root replacement with the Ross procedure at a single center. Data after 2010 were collected retrospectively in November and December 2022.

Exposure

Ross procedure.

Main Outcomes and Measures

The primary end point was long-term survival among patients who underwent the Ross procedure compared with that in the age-, country of origin– and sex-matched general population. Secondary end points were freedom from any reintervention, autograft reintervention, or homograft reintervention and time-related valve function, autograft diameter, and functional status.

Results

This study included 108 adults (92 [85%] male) with a median age of 38 years (range, 19-66 years). Median duration of clinical follow-up was 24.1 years (IQR, 22.6-26.1 years; 2488 patient-years), with 98% follow-up completeness. Of these patients, 9 (8%) had active endocarditis and 45 (42%) underwent reoperations. The main hemodynamic lesion was stenosis in 30 (28%) and regurgitation in 49 (45%). There was 1 perioperative death (0.9%). Twenty-five year survival was 83.0% (95% CI, 75.5%-91.2%), representing a relative survival of 99.1% (95% CI, 91.8%-100%) compared with the general population (83.7%). At 25 years, freedom from any reintervention was 71.1% (95% CI, 61.6%-82.0%); from autograft reintervention, 80.3% (95% CI, 71.9%-89.6%); and from homograft reintervention, 86.3% (95% CI, 79.0%-94.3%). Thirty-day mortality after the first Ross-related reintervention was 0% and after all Ross-related reinterventions was 3.8% (n = 1); 10-year survival after reoperation was 96.2% (95% CI, 89.0%-100%).

Conclusions and Relevance

This study found that the Ross procedure provided excellent survival into the third decade postoperatively that was comparable to that in the general population. Long-term freedom from reintervention demonstrated that the Ross procedure may be a durable substitute into late adulthood, showing a delayed but progressive functional decline.

Trial Registration

isrctn.org Identifier: ISRCTN03530985
Mendelian Randomization as a Tool for Cardiovascular Research
Authors: Levin Michael G. , Burgess Stephen
Published: November 2023

Importance

Mendelian randomization (MR) is a statistical approach that has become increasingly popular in the field of cardiovascular disease research. It offers a way to infer potentially causal relationships between risk factors and outcomes using observational data, which is particularly important in cases where randomized clinical trials are not feasible or ethical. With the growing availability of large genetic data sets, MR has become a powerful and accessible tool for studying the risk factors for cardiovascular disease.

Observations

MR uses genetic variation associated with modifiable exposures or risk factors to mitigate biases that affect traditional observational study designs. The approach uses genetic variants that are randomly assigned at conception as proxies for exposure to a risk factor, mimicking a randomized clinical trial. By comparing the outcomes of individuals with different genetic variants, researchers may draw causal inferences about the effects of specific risk factors on cardiovascular disease, provided assumptions are met that address (1) the association between each genetic variant and risk factor and (2) the association of the genetic variants with confounders and (3) that the association between each genetic variant and the outcome only occurs through the risk factor. Like other observational designs, MR has limitations, which include weak instruments that are not strongly associated with the exposure of interest, linkage disequilibrium where genetic instruments influence the outcome via correlated rather than direct effects, overestimated genetic associations, and selection and survival biases. In addition, many genetic databases and MR studies primarily include populations genetically similar to European reference populations; improved diversity of participants in these databases and studies is critically needed.

Conclusions and Relevance

This review provides an overview of MR methodology, including assumptions, strengths, and limitations. Several important applications of MR in cardiovascular disease research are highlighted, including the identification of drug targets, evaluation of potential cardiovascular risk factors, as well as emerging methodology. Overall, while MR alone can never prove a causal relationship beyond reasonable doubt, MR offers a rigorous approach for investigating possible causal relationships in observational data and has the potential to transform our understanding of the etiology and treatment of cardiovascular disease.
Disseminated Monomorphic Pink Papules
Authors: Rusiñol Lluís , Mozos Ana , Yélamos Oriol
Published: November 2023

A woman in her 60s with previous breast carcinoma, currently in remission, presented with pruritic lesions on her chest, arms, and back. What is your diagnosis?
Acrodermatitis Enteropathica
Authors: Sivakumar Aravind , Vageshappa Rashmi K. , Kumari Rashmi
Published: November 2023

This case report describes a woman in her 20s with painful, red skin lesions present for 6 months that had gradually progressed from the groin to other sites.
“Choose Your Own Threat”—A Modern Paradigm for Academic Surgery
Authors: Han Jason J. , Soegaard Ballester Jacqueline M. , Cochran Amalia L.
Published: November 2023

This Viewpoint discusses a potential shift from academic surgery’s triple-threat paradigm (provide high-quality clinical care, perform primary research, and train residents and students) to defining success in ways that allow individual surgeons to focus on their own path based on intrinsic motivation and curiosity.
Effects of selective logging on genetic diversity and population structure of a keystone mistletoe
Authors: Fontúrbel Francisco E. , González‐Ancin Héctor , Rojas‐Hernández Noemí , Vega‐Retter Caren
Published: November 2023

The effects of habitat degradation remain not fully understood. A recent study reported low effects of habitat degradation on plant genetic diversity but indicates that reduction in habitat quality could impact it as well as gene flow indirectly via ecological interactions. Selective logging is a way of habitat degradation, but studies examining its effects on plant genetic diversity on non‐logged forest plant species are relatively scarce. Using 3470 single‐nucleotide polymorphisms, we assess the effects of different selective logging intensities on the genetic diversity of 66 individuals of a keystone mistletoe (Tristerix corymbosus). We also examined the possible relationship with its seed disperser (Dromiciops gliroides) abundance in three sites of the temperate rainforests of southern Chile, with different levels of selective logging intensity. Our results show that selective logging increases allelic richness and inbreeding in this mistletoe; inbreeding increased with selective logging intensity, and heterozygosity decreased with D. gliroides abundance. While wood extraction seems to positively affect T. corymbosus genetic diversity, its long‐term consequences—such as increased inbreeding—are yet to be assessed in future studies.
Impact of respiratory motion on 18F‐FDG PET radiomics stability: Clinical evaluation with a digital PET scanner
Authors: Chen Yu‐Hung , Kan Kuo‐Yi , Liu Shu‐Hsin , Lin Hsin‐Hon , Lue Kun‐Han
Published: November 2023

Purpose

18F‐FDG PET quantitative features are susceptible to respiratory motion. However, studies using clinical patient data to explore the impact of respiratory motion on 18F‐FDG PET radiomic features are limited. In this study, we investigated the impact of respiratory motion on radiomics stability with clinical 18F‐FDG PET images using a data‐driven gating (DDG) algorithm on the digital PET scanner.

Materials and Methods

A total of 101 patients who underwent oncological 18F‐FDG PET scans were retrospectively included. A DDG algorithm combined with a motion compensation technique was used to extract the PET images with respiratory motion correction. 18F‐FDG‐avid lesions from the thorax to the upper abdomen were analyzed on the non‐DDG and DDG PET images. The lesions were segmented with a 40% threshold of the maximum standardized uptake. A total of 725 radiomic features were computed from the segmented lesions, including first‐order, shape, texture, and wavelet features. The intraclass correlation coefficient (ICC) and coefficient of variation (COV) were calculated to evaluate feature stability. An ICC above 0.9 and a COV below 5% were considered high stability.

Results

In total, 168 lesions with and without respiratory motion correction were analyzed. Our results indicated that most 18F‐FDG PET radiomic features are sensitive to respiratory motion. Overall, only 27 out of 725 (3.72%) radiomic features were identified as highly stable, including one from the first‐order features (entropy), one from the shape features (sphericity), four from the gray‐level co‐occurrence matrix features (normalized and unnormalized inverse difference moment, joint entropy, and sum entropy), one from the gray‐level run‐length matrix features (run entropy), and 20 from the wavelet filter‐based features.

Conclusion

Respiratory motion has a significant impact on 18F‐FDG PET radiomics stability. The highly stable features identified in our study may serve as potential candidates for further applications, such as machine learning modeling.
Application of a pyramid pooling Unet model with integrated attention mechanism and Inception module in pancreatic tumor segmentation
Authors: Zhang Zhiwei , Tian Hui , Xu Zhenshun , Bian Yun , Wu Jie
Published: November 2023

Background

The segmentation and recognition of pancreatic tumors are crucial tasks in the diagnosis and treatment of pancreatic diseases. However, due to the relatively small proportion of the pancreas in the abdomen and significant shape and size variations, pancreatic tumor segmentation poses considerable challenges.

Purpose

To construct a network model that combines a pyramid pooling module with Inception architecture and SE attention mechanism (PIS‐Unet), and observe its effectiveness in pancreatic tumor images segmentation, thereby providing supportive recommendations for clinical practitioners.

Materials and methods

A total of 303 patients with histologically confirmed pancreatic cystic neoplasm (PCN), including serous cystic neoplasm (SCN) and mucinous cystic neoplasm (MCN), from Shanghai Changhai Hospital between March 2011 and November 2021 were included. A total of 1792 T2‐weighted imaging (T2WI) slices were used to build a CNN model. The model employed a pyramid pooling Inception module with a fused attention mechanism. The attention mechanism enhanced the network's focus on local features, while the Inception module and pyramid pooling allowed the network to extract features at different scales and improve the utilization efficiency of global information, thereby effectively enhancing network performance.

Results

Using three‐fold cross‐validation, the model constructed by us achieved a dice score of 85.49 ± 2.02 for SCN images segmentation, and a dice score of 87.90 ± 4.19 for MCN images segmentation.

Conclusion

This study demonstrates that using deep learning networks for the segmentation of PCNs yields favorable results. Applying this network as an aid to physicians in PCN diagnosis shows potential for clinical applications.
The role of the amygdala in ictal central apnea: insights from brain MRI morphometry
Authors: Micalizzi Elisa , Ballerini Alice , Giovannini Giada , Cioclu Maria Cristina , Scolastico Simona , Pugnaghi Matteo , Orlandi Niccolò , Malagoli Marcella , Genovese Maurilio , Todeschini Alessandra , Giunta Leandra , Villani Flavio , Meletti Stefano , Vaudano Anna Elisabetta
Published: November 2023

Objective

Ictal central apnea (ICA) is a frequent correlate of focal seizures, particularly in temporal lobe epilepsy (TLE), and regarded as a potential electroclinical biomarker of sudden unexpected death in epilepsy (SUDEP). Aims of this study are to investigate morphometric changes of subcortical structures in ICA patients and to find neuroimaging biomarkers of ICA in patients with focal epilepsy.

Methods

We prospectively recruited focal epilepsy patients with recorded seizures during a video‐EEG long‐term monitoring with cardiorespiratory polygraphic recordings from April 2020 to September 2022. Participants were accordingly subdivided into two groups: patients with focal seizures with ICA (ICA) and without (noICA). A pool of 30 controls matched by age and sex was collected. All the participants underwent MRI scans with volumetric high‐resolution T1‐weighted images. Post‐processing analyses included a whole‐brain VBM analysis and segmentation algorithms performed with FreeSurfer.

Results

Forty‐six patients were recruited (aged 15–60 years): 16 ICA and 30 noICA. The whole‐brain VBM analysis showed an increased gray matter volume of the amygdala ipsilateral to the epileptogenic zone (EZ) in the ICA group compared to the noICA patients. Amygdala sub‐segmentation analysis revealed an increased volume of the whole amygdala, ipsilateral to the EZ compared to controls [F(1, 76) = 5.383, pFDR = 0.042] and to noICA patients ([F(1, 76) = 5.383, pFDR = 0.038], specifically of the basolateral complex (respectively F(1, 76) = 6.160, pFDR = 0.037; F(1, 76) = 5.121, pFDR = 0.034).

Interpretation

Our findings, while confirming the key role of the amygdala in participating in ictal respiratory modifications, suggest that structural modifications of the amygdala and its subnuclei may be valuable morphological biomarkers of ICA.
Adaptive dynamic surface control of MIMO nonlinear systems: A hybrid event triggering mechanism
Authors: Huang Sai , Zong Guangdeng , Xu Ning , Wang Huanqing , Zhao Xudong
Published: November 2023

This paper addresses the event‐triggered stabilization control for multi‐input and multi‐output (MIMO) nonlinear systems. To handle the “explosion of complexity”, the dynamic surface control (DSC) technology is introduced to the proposed control scheme. In addition, the event‐driven idea is adopted to mitigate the data transmission pressure in sensor‐to‐controller and controller‐to‐actuator channels. Considering that the non‐derivable virtual controllers are commonly constructed in the event‐triggered control schemes aiming at saving dual‐channel resources, in this paper, a hybrid event‐triggering mechanism with multiple event detectors is developed to obtain differentiable virtual control signals, thereby providing a suitable application environment for the DSC technology. Meanwhile, an output‐based adaptive threshold is designed to obtain more communication benefits compared with the fixed threshold strategy. Finally, all signals in the closed‐loop system are ensured to be bounded under a standard Lyapunov stability analysis framework, and the effectiveness of the proposed control scheme is validated by a simulation example.
Ionic Conductivity Switchable and Shape Changeable Smart Skins with Azobenzene‐Based Ionic Reactive Mesogens
Authors: Oh Mintaek , Lim Seok‐In , Jang Junhwa , Wi Youngjae , Yu Dongmin , Hyeong Jaeseok , Kim Subin , Kim Woojin , Ha Minjeong , Jeong Kwang‐Un
Published: November 2023

To develop smart ionic skins capable of multi‐responsiveness and switchable ionic conductivity, a stimuli‐responsive and ionic conductive azobenzene‐based monomer is newly synthesized, uniaxially oriented, and polymerized for anisotropic liquid crystal elastomers (LCEs). Since the uniaxially oriented monodomain LCE with ionic asymmetric azobenzene monomers (i‐AAM) is prepared by thermal oligomerization, uniaxial stretching, and subsequent photopolymerization, the stimuli‐responsive i‐AAM LCE is thermally contracted by increasing the temperature above TNI as well as is bent along the aligned direction by irradiating it with UV light. In addition to the change of shape, the ionic conductivity of the LCE is reversible in response to heat and light stimuli. Polydomain i‐AAM LCE polymerized without the stretching process exhibits higher ionic conductivity than stretched monodomain LCE due to the initially formed stable ionic pathways. Ionic conductivity can also be switched simultaneously by polarity changes in response to the photoisomerization of i‐AAM, increased mobility from heat, and an elastic mechanoresponse from external stresses. These i‐AAM LCE‐based soft grippers exhibit stimuli‐responsive grasping and releasing actuation and detect ionic conductivity switches finely, suggesting potential as smart skins for advanced soft robots.
Single‐ and Multiscale Laser Patterning of 3D Printed Biomedical Titanium Alloy: Toward an Enhanced Adhesion and Early Differentiation of Human Bone Marrow Stromal Cells
Authors: Hariharan Avinash , Goldberg Phil , Schell Frederic , Hempel Ute , Striggow Friedrich , Hantusch Martin , Medina‐Sánchez Mariana , Lasagni Andrés F. , Gebert Annett
Published: November 2023

This study explores the enhancement of biocompatible titanium‐based implants through surface functionalization for improved bone healing. Specifically, a near‐beta type Ti‐13Nb‐13Zr alloy is 3D printed using laser powder bed fusion and subsequently textured using nanosecond (ns) and picosecond (ps) direct laser interference patterning (DLIP) to create single‐scale and multi‐scale surface textures. On these textures, the cell behavior, morphology, metabolic activity and osteogenic differentiation potential of human bone marrow stromal cells are assessed using fluorescence microscopy and MTS assays. Moreover, tissue non‐specific alkaline phosphatase activity served as an early osteoblast production marker. Compared to untextured specimens, both types of textures exhibited higher metabolic activity and cell proliferation. Single‐scale ns‐DLIP textures encouraged cell extensions anchored in groove regions, while ps‐DLIP textures with hierarchical structures promoted cell extensions attaching to nanostructures on sidewalls. The groove width and nanotopographies in groove areas facilitated cell spreading. Surface topography, roughness, and surface chemistry (surface energy, wettability) influenced cell adhesion, proliferation, and differentiation. A comprehensive evaluation of DLIP‐generated surface textures, including their topography and chemical states, complements the factors affecting in vitro cell behavior. Overall, this research demonstrates the potential of surface‐functionalized 3Dprinted titanium for a novel generation of biocompatible implants.
Biocompatible Rhamnolipid Self‐Assemblies with pH‐Responsive Antimicrobial Activity
Authors: Kadakia Parth , Valentin Jules D. P. , Hong Linda , Watts Samuel , Hameed Owais Abdul , Walch Michael , Salentinig Stefan
Published: November 2023

There is an urgent need for alternative antimicrobial materials due to the growing challenge of bacteria becoming resistant to conventional antibiotics. This study demonstrates the creation of a biocompatible pH‐switchable antimicrobial material by combining bacteria‐derived rhamnolipids (RL) and food‐grade glycerol monooleate (GMO). The integration of RL into dispersed GMO particles, with an inverse‐type liquid crystalline cubic structure in the core, leads to colloidally stable supramolecular materials. The composition and pH‐triggered structural transformations are studied with small‐angle X‐ray scattering, cryogenic transmission electron microscopy, and dynamic light scattering. The composition‐structure‐activity relationship is analyzed and optimized to target bacteria at acidic pH values of acute wounds. The new RL/GMO dispersions reduce Staphylococcus aureus (S. aureus) populations by 7‐log after 24 h of treatment with 64 µg mL−1 of RL and prevent biofilm formation at pH = 5.0, but have no activity at pH = 7.0. Additionally, the system is active against methicillin‐resistant S. aureus (MRSA) with minimum inhibitory concentration of 128 µg mL−1 at pH 5.0. No activity is found against several Gram‐negative bacteria at pH 5.0 and 7.0. The results provide a fundamental understanding of lipid self‐assembly and the design of lipid‐based biomaterials, which can further guide the development of alternative bio‐based solutions to combat bacteria.