bluuebunny/crossref_metadata_2025_split huggingface dataset:
Teaching clinical handover with ISBAR
Authors: Burgess Annette , van Diggele Christie , Roberts Chris , Mellis Craig 
Published: December 2020

AbstractClinical handover is one of the most critical steps in a patient’s journey and is a core skill that needs to be taught to health professional students and junior clinicians. Performed well, clinical handover should ensure that lapses in continuity of patient care, errors and harm are reduced in the hospital or community setting. Handover, however, is often poorly performed, with critical detail being omitted and irrelevant detail included. Evidence suggests that the use of a structured, standardised framework for handover, such as ISBAR, improves patient outcomes. The ISBAR (Introduction, Situation, Background, Assessment, Recommendation) framework, endorsed by the World Health Organisation, provides a standardised approach to communication which can be used in any situation. In the complex clinical environment of healthcare today, ISBAR is suited to a wide range of clinical contexts, and works best when all parties are trained in using the same framework. It is essential that healthcare leaders and professionals from across the health disciplines work together to ensure good clinical handover practices are developed and maintained. Organisations, including universities and hospitals, need to invest in the education and training of health professional students and health professionals to ensure good quality handover practice. Using ISBAR as a framework, the purpose of this paper is to highlight key elements of effective clinical handover, and to explore teaching techniques that aim to ensure the framework is embedded in practice effectively.
Interprofessional education: tips for design and implementation
Authors: van Diggele Christie , Roberts Chris , Burgess Annette , Mellis Craig 
Published: December 2020

AbstractInterprofessional education (IPE) is a critical approach for preparing students to enter the health workforce, where teamwork and collaboration are important competencies. IPE has been promoted by a number of international health organisations, as part of a redesign of healthcare systems to promote interprofessional teamwork, to enhance the quality of patient care, and improve health outcomes. In response, universities are beginning to create and sustain authentic and inclusive IPE activities, with which students can engage. A growing number of health professionals are expected to support and facilitate interprofessional student groups. Designing interprofessional learning activities, and facilitating interprofessional groups of students requires an additional layer of skills compared with uniprofessional student groups. This article outlines the key points for planning and practicing interprofessional facilitation within the classroom and clinical setting.
Team-based learning: design, facilitation and participation
Authors: Burgess Annette , van Diggele Christie , Roberts Chris , Mellis Craig 
Published: December 2020

AbstractTeam-based learning (TBL) provides an active, structured form of small group learning, that can be applied to large classes. Student accountability is achieved through the specific steps of TBL, including pre-class preparation, readiness assurance testing, problem-solving activities, and immediate feedback. Globally, a growing number of healthcare faculties have adopted TBL in a variety of combinations, across diverse settings and content areas. This paper provides a succinct overview of TBL and guidance for teachers towards successful design and implementation of TBL within health professional education. It also offers guidance for students participating in TBL. The paper is informed by both educational theory, and the extensive, seven year experience of the first and last authors in designing, implementing, facilitating and evaluating TBL at a large medical school.
Impact of a web-based module on trainees’ ability to interpret neonatal cranial ultrasound
Authors: Ben Fadel Nadya , McAleer Sean 
Published: December 2020

Abstract
Background
Accurate interpretations of neonatal cranial ultrasound (CUS) studies are essential skills for physicians in neonatal intensive care units (NICUs) in order to properly diagnose and manage brain injury. However, these skills are not formally taught to pediatric and neonatal-perinatal medicine (NPM) trainees in Canada. Therefore, our study describes the design, implementation, and evaluation of a new web-based learning (WBL) module that focuses on teaching these skills.

Methods
Trainees’ needs assessment survey, sent to all NPM and pediatrics trainees (n = 62), concluded that most of them feel uncomfortable with their ability to interpret CUS, highlighting the need for a new educational intervention. The needs assessment informed the development of the WBL module, which we evaluated using questionnaires and pre-and post-testing methods to measure participants’ satisfaction, knowledge gain, skills development, and behaviour changes. Only trainees rotating through the NICU over 6 months (n = 23) were invited to participate in all the evaluation steps. We used the ADDIE instructional design model as a framework for this project.

Results
Respondents were very satisfied with the module, and their baseline knowledge increased significantly after studying and engaging with the module. The post-test score was 76% (p < 0.001) compared to the pre-test mean score of 42%. Tests for CUS interpretation skills assessment showed that 49% of pre-test answers were incorrect compared to 8% in the post-test (p < 0.001). Seventy-eight percent of trainees (n = 18) responded to a survey conducted a year after implementation, and 78% of the respondents (n = 14) reported that they still used these skills and shared this knowledge with junior trainees.

Conclusion
A WBL module for teaching neonatal CUS interpretation considerably improved trainees’ knowledge and enhanced their skills in interpreting neonatal CUS.
Biomechanical analysis of canine medial patellar luxation with femoral varus deformity using a computer model
Authors: Lee Jiyun , Sim Heedong , Jeong Jaemin , Kim Sun-Young , Yang Seokjo , Jeong SeongMok , Lee HaeBeom 
Published: December 2020

Abstract
Background
Femoral varus deformities complicating the realignment of the quadriceps muscles are frequently associated with medial patellar luxation (MPL) in dogs. Therefore, distal femoral osteotomy (DFO) is recommended in dogs affected with severe MPL and a distal femoral varus deformity. The presence of an anatomic lateral distal femoral angle (aLDFA) of ≥ 102° has been anecdotally recommended as an indication for performing corrective DFO in large-breed dogs. However, the effect of a femoral varus deformity on MPL has not been scientifically evaluated. We aimed to evaluate the influence of a femoral varus deformity on MPL using a finite element method based computer model.
Three-dimensionally reconstructed computed tomographic images of a normal femur from a Beagle dog were deformed using meshing software to create distal varus deformities. A total of thirteen aLDFAs, including 95°, 98° and 100°–110°, were simulated. The patellar positions and reaction force between the patella and trochlear grooves were calculated for all finite element models under constant rectus femoris muscle activation.

Results
The patella was displaced medially from the trochlear groove at an aLDFA of ≥103°. With an aLDFA of 103° to 110°, the reaction force was equal to zero and then decreased to negative values during the simulation, while other models with aLDFAs of 95°, 98°, and 100°-102° had positive reaction force values. The patella began to luxate at 24.90 seconds (sec) with an aLDFA of 103°, 19.80 sec with an aLDFA of 104°, 21.40 sec with an aLDFA of 105°, 20.10 sec with an aLDFA of 106°, 18.60 sec with an aLDFA of 107°, 15.30 sec with an aLDFA of 108°, 16.60 sec with an aLDFA of 109°, and 11.90 sec with an aLDFA of 110°.

Conclusion
Severe distal femoral varus with an aLDFA of ≥103° caused MPL when other anatomical factors were controlled. Thissimplified computer model provides complementary information to anecdotal cutoffs for DFO, hence it should be applied to clinical patients with caution.
Averting expenditure on malaria: effects on labour productivity of maize farmers in Bunkpurugu-Nakpanduri District of Ghana
Authors: Mabe Franklin Nantui , Dafurika Thomas 
Published: December 2020

Abstract
Background
Malaria has been one of the commonest diseases during farming season, which affects farmers’ health resulting in a reduction in the number of days spent on the farm. As a result, farmers are regularly trying to avert malaria infection through preventive measures. Motivated by this argument, this study sought to determine the effects of malaria averting expenditure on labour productivity of maize farmers in Bunkpurugu-Nakpanduri District in the Northern Region of Ghana.

Methods
A cross-sectional primary data was collected from 194 maize farmers. Both descriptive and quantitative data analysis approaches were employed. Conditional mixed process was used to estimate the effects of malaria prevention expenditure on maize farmers’ labour productivity.

Results
The study revealed that maize farmers incurred an average expenditure of GHc284.6 to prevent malaria annually. The result shows that factors that affect maize farmers’ malaria prevention expenditure include off-farm income, household size, presence of bushes around houses, presence of pregnant women and number of household members in school. Meanwhile, quantity of fertilizer, seed, weedicides, farming experience, age, ownership of motorbike and averting expenditure are significant determinants of maize labour productivity. The study revealed that farmers who spend more money to avert malaria attack are more labour productive.

Conclusions
Therefore, this study recommends that Ministry of Health and Ministry of Food and Agriculture should collaborate and integrate health extension service on malaria in agricultural extension to educate farmers on the need to avert malaria. Farmers should be educated on malaria preventive strategies, such as clearing of bushes around houses, draining of stagnant water, sleeping in treated mosquito nets among others. Lastly, aside distribution of free mosquito nets to pregnant women, they should be subsidized and made available to all farmers for malaria prevention.
The effects of everyday-life exposure to polycyclic aromatic hydrocarbons on biological age indicators
Authors: Pavanello Sofia , Campisi Manuela , Mastrangelo Giuseppe , Hoxha Mirjam , Bollati Valentina 
Published: December 2020

AbstractBackgroundFurther knowledge on modifiable aging risk factors is required to mitigate the increasing burden of age-related diseases in a rapidly growing global demographic of elderly individuals. We explored the effect of everyday exposure to polycyclic aromatic hydrocarbons (PAHs), which are fundamental constituents of air pollution, on cellular biological aging. This was determined via the analysis of leukocyte telomere length (LTL), mitochondrial DNA copy number (LmtDNAcn), and by the formation of anti-benzo[a]pyrene diolepoxide (B[a]PDE–DNA) adducts.MethodsThe study population consisted of 585 individuals living in North-East Italy. PAH exposure (diet, indoor activities, outdoor activities, traffic, and residential exposure) and smoking behavior were assessed by questionnaire and anti-B[a]PDE–DNA by high-performance-liquid-chromatography. LTL, LmtDNAcn and genetic polymorphisms [glutathione S-transferase M1 and T1 (GSTM1; GSTT1)] were measured by polymerase chain reaction. Structural equation modelling analysis evaluated these complex relationships.ResultsAnti-B[a]PDE–DNA enhanced with PAH exposure (p = 0.005) and active smoking (p = 0.0001), whereas decreased with detoxifying GSTM1 (p = 0.021) and in females (p = 0.0001). Subsequently, LTL and LmtDNAcn reduced with anti-B[a]PDE–DNA (p = 0.028 andp = 0.018), particularly in males (p = 0.006 andp = 0.0001). Only LTL shortened with age (p = 0.001) while elongated with active smoking (p = 0.0001). Besides this, the most significant determinants of PAH exposure that raised anti-B[a]PDE–DNA were indoor and diet (p = 0.0001), the least was outdoor (p = 0.003).ConclusionNew findings stemming from our study suggest that certain preventable everyday life exposures to PAHs reduce LTL and LmtDNAcn. In particular, the clear association with indoor activities, diet, and gender opens new perspectives for tailored preventive measures in age-related diseases.CapsuleEveryday life exposure to polycyclic aromatic hydrocarbons reduces leukocyte telomere length and mitochondrial DNA copy number through anti-B[a]PDE-DNA adduct formation.
Is left-sided involvement of hepatocellular carcinoma an important preoperative predictive factor of poor outcome?
Authors: Sakuraoka Yuhki , Kubota Keiichi , Tanaka Genki , Shimizu Takayuki , Tago Kazuma , Park Kyung Hwa , Matsumoto Takatsugu , Shiraki Takayuki , Mori Shozo , Iso Yukihiro , Aoki Taku 
Published: December 2020

Abstract
Background
The tumor location is the most simple clinical factor and important in liver surgery to make surgical procedure. However, no previous study has investigated the prognostic differences and clinical features of hepatocellular carcinoma showing specific laterality. This study is the first report to focus on the laterality and aimed to lead to more simple and useful predictive factor rather than recent complicated predictive models.

Methods
Patients who underwent liver resection for the first time for single tumors located within each lobe between 2000 and 2018 were enrolled. We divided them into two groups based on tumor location: a right-sided group and a left-sided group. Univariable and multivariable analyses were performed to assess survival differences in relation to several other factors.

Results
There were 595 eligible patients; the 5-year survival rates and disease-free survival rates were 49.5% and 19.1% in the left-sided group and 55.6% and 24.5% in the right-sided group, respectively (p = 0.026). Statistical analyses revealed that the following preoperative prognostic factors were independently significant (p < 0.05) in the left-sided group: indocyanine green retention rate at 15 min, alpha fetoprotein, protein induced by vitamin K absence or antagonists-II level, and larger tumor size.

Conclusion
The left-sided group had a poorer prognosis than the right-sided group. A left-sided tumor location is a significant preoperative factor predictive of poor outcome in patients with hepatocellular carcinoma.
Workforce experience of the implementation of an advanced clinical practice framework in England: a mixed methods evaluation
Authors: Lawler Jessica , Maclaine Katrina , Leary Alison 
Published: December 2020

Abstract
Background
This study aims to understand how the implementation of the advanced clinical practice framework in England (2017) was experienced by the workforce to check assumptions for a national workforce modelling project. The advanced clinical practice framework was introduced in England in 2017 by Health Education England to clarify the role of advanced practice in the National Health Service.

Methods
As part of a large-scale workforce modelling project, a self-completed questionnaire was distributed via the Association of Advanced Practice Educators UK aimed at those studying to be an Advanced Clinical Practitioner or who are practicing at this level in order to check assumptions. Semi-structured phone interviews were carried out with this same group. Questionnaires were summarised using descriptive statistics in Excel for categorical responses and interviews and survey free-text were analysed using thematic analysis in NVivo 10.

Results
The questionnaire received over 500 respondents (ten times that expected) and 15 interviews were carried out. Advanced clinical practice was considered by many respondents the only viable clinical career progression. Respondents felt that employers were not clear about what practicing at this level involved or its future direction. 54% (287) thought that ‘ACP’ was the right job title for them. 19% (98) of respondents wanted their origin registered profession to be included in their title. Balancing advanced clinical practice education concurrently with a full-time role was challenging, participants underestimated the workload and expectations of employer’s training. There is an apparent dichotomy that has developed from the implementation of the 2017 framework: that of advanced clinical practice as an advanced level of practice within a profession, and that of Advanced Clinical Practitioner as a new generic role in the medical model.

Conclusions
Efforts to establish further clarity and structure around advanced clinical practice are needed for both the individuals practising at this level and their employers. A robust evaluation of the introduction of this role should take place.
Plasma exosome-derived microRNAs expression profiling and bioinformatics analysis under cross-talk between increased low-density lipoprotein cholesterol level and ATP-sensitive potassium channels variant rs1799858
Authors: Liu Cheng , Lai Yanxian , Ying Songsong , Zhan Junfang , Shen Yan 
Published: December 2020

AbstractBackgroundExosome-derived microRNAs (exo-miRs) as messengers play important roles, in the cross-talk between genetic [ATP-sensitive potassium channels (KATP) genetic variant rs1799858] and environmental [elevated serum low-density lipoprotein cholesterol (LDL-C) level] factors, but the plasma exo-miRs expression profile and its role in biological processes from genotype to phenotype remain unclear.MethodsA total of 14 subjects with increased LDL-C serum levels (≥ 1.8 mmol/L) were enrolled in the study. TheKATPrs1799858 was genotyped by the Sequenom MassARRAY system. The plasma exo-miRs expression profile was identified by next-generation sequencing.Results64 exo-miRs were significantly differentially expressed (DE), among which 44 exo-miRs were up-regulated and 20 exo-miRs were down-regulated in those subjects carrying T-allele (TT + CT) of rs1799858 compared to those carrying CC genotype. The top 20 up-regulated DE-exo-miRs were miR-378 family, miR-320 family, miR-208 family, miR-483-5p, miR-22-3p, miR-490-3p, miR-6515-5p, miR-31-5p, miR-210-3p, miR-17-3p, miR-6807-5p, miR-497-5p, miR-33a-5p, miR-3611 and miR-126-5p. The top 20 down-regulated DE-exo-miRs were let-7 family, miR-221/222 family, miR-619-5p, miR-6780a-5p, miR-641, miR-200a-5p, miR-581, miR-605-3p, miR-548ar-3p, miR-135a-3p, miR-451b, miR-509-3-5p, miR-4664-3p and miR-224-5p. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were subsequently implemented to identify the top 10 DE-exo-miRs related specific target genes and signaling pathways. Only 5 DE-exo-miRs were validated by qRT-PCR as follows: miR-31-5p, miR-378d, miR-619-5p, miR-320a-3p and let-7a-5p (allP < 0.05).ConclusionThese results firstly indicated the plasma exo-miRs expression profile bridging the link between genotype (KATPrs1799858) and phenotype (higher LDL-C serum level), these 5 DE-exo-miRs may be potential target intermediates for molecular intervention points.
Clinical and molecular characteristics of 69 Chinese patients with ornithine transcarbamylase deficiency
Authors: Lu Deyun , Han Feng , Qiu Wenjuan , Zhang Huiwen , Ye Jun , Liang Lili , Wang Yu , Ji Wenjun , Zhan Xia , Gu Xuefan , Han Lianshu 
Published: December 2020

Abstract
Background
This study aimed to describe the clinical and biochemical features of Chinese patients with ornithine transcarbamylase deficiency (OTCD), and to investigate the mutation spectrum of OTC gene and their potential correlation with phenotype.

Methods
Sixty-nine patients with OTCD were enrolled between 2004 and 2019. Clinical and laboratory data were reviewed retrospectively from medical records.

Results
Fifteen cases (13 males, 2 females) presented with early onset; 53 cases (21 males, 32 females) had late onset, and one female was asymptomatic. The median onset age was 1.5 years (range 1 day–56 years). Urine orotic acid levels were increased in all patients tested, while only 47.6% of patients showed decreased serum levels of citrulline. The peak plasma ammonia levels were higher in early-onset patients than in late-onset patients (P < 0.01). Fifty-four different mutations of OTC gene were identified and 18 of them were novel. R277W (10.6%) was the most common mutation, followed by G195R (4.6%) and A209V (3.0%). By June 2019, 41 patients had survived, 24 were deceased, and 4 were lost to follow-up. Among the survivors, 13 patients had received liver transplantation at a median age of 3 years, with a one-year survival rate of 100%. The mortality of OTCD is extremely high among patients with early onset (80.0% versus 24.5% in patients with late onset).

Conclusions
The evaluation of serum citrulline level is of limited value in diagnosis of OTCD, while urine orotic acid detection and genetic testing are more helpful.
Association between Fur Animal Necrotizing Pyoderma in breeding farm mink (Neovison vison) and reduced fertility
Authors: Honoré Oliver Legarth , Sebbelov Ida , Wallin Agnethe , Petersen Annemette , Clausen Tove , Larsen Peter Foged , Hammer Anne Sofie 
Published: December 2020

AbstractBackgroundThe disease Fur Animal Necrotizing Pyoderma (FNP) has since 2000 been reported in many fur producing countries including Canada, Finland and Denmark. Development of FNP is characterised by rapidly forming treatment-resistant wounds on paws and in the head region. Economic losses related to FNP have been associated with mortality and decreased fur quality as well as increased veterinary costs. Also it has been suggested that FNP may be associated with reduced production results for breeding mink. The aim of this study was to evaluate if there is an association between FNP lesions in breeding animals and reduced production results based on a retrospective cohort study.Results1465 breeding animals (244 males and 1221 females) were followed during the breeding season 2019 on five Danish mink farms. Two farms were removed from the analysis since no occurrence of FNP appeared in the observation group. After exclusion, 846 breeding animals (148 males and 698 females) remained in the analysis and were divided into two groups: exposed (EXP) or non-exposed (N-EXP) depending on the disease history of the males during mating. Females exposed to FNP positive males during breeding in average produce 14% fewer kits (P = 0.032) and these females were also more than double as likely to produce small litters (N ≥ 3) than N-EXP females. Female’s from the EXP group were introduced more times to males than females in the N-EXP group (P = 0.0001, 2.5 more times in average). Females in the EXP group did not have a statistically higher risk of becoming barren (P = 0.138) though the relative risk of becoming barren was 77% higher after encountering a FNP male.ConclusionsThis study shows that FNP has more economic losses for the farms than direct loss of animals. Females in contact with males with FNP lesion during breeding have a higher risk of becoming barren, and produce significantly fewer kits compared to females whom haven’t been in contact with a FNP positive male.