bluuebunny/crossref_metadata_2025_split huggingface dataset:
Stress and Burnout in Postgraduate Physiotherapy Students: A Mixed Methods Observational Cohort Study
Authors: Brooke Tess , Brown Makaela , Orr Robin , Gough Suzanne 
Published: August 2020

Abstract
Background and Purpose: The impact of stress and burnout in students is an emerging topic. When students perceive that they are unable to cope with stressors, there is increased potential for burnout. To maximise students’ higher educational institution (HEI) outcomes, students must be able to effectively cope with stressful demands. Research suggests physiotherapy students, in particular, suffer from a high risk of stress and burnout, however limited research exists on postgraduate, pre-registration, physiotherapy students. The purpose of this study was to determine perceived stress, burnout and associated coping strategies across three time points in the first year of a post-graduate, pre-registration physiotherapy program. Subjects: All first year Doctor of Physiotherapy (DPHTY) students at Bond University 2019 were invited to participate. Methods: A mixed methods observational cohort design was implemented in one Australian HEI to determine stress, burnout and coping strategies across 3 time points. The 51-item self-administered questionnaire consisted of demographics, the Coping Self Efficacy (CSE) Scale and Maslach Burnout Inventory – General Survey for Students (MBI-GS (S)), and open-ended questions.Results: A response rate of 62% (n=38) was achieved. There were no differences in stress and burnout scores between sexes, nor differences in stress and burnout over time. Highest median CSE scores were seen at T1, with highest median MBI-GS (S) cynicism (CYN) scores at T2, exhaustion (EX) at T1 and T2, and professional efficacy (PE) at T1 and T2. The greatest mean CSE changes were seen from T1-T2 and T1-T3, and PE greatest changes from T2-T3 and T1-T3. No strong correlation was found between stress and burnout. Curriculum coursework was a frequently reported stressor, along with clinical placement and transition periods. Coping strategies utilized by students were both positive and maladaptive. Positive strategies included sporting activities, baking, listening to music, and social connections, whereas maladaptive strategies included alcohol consumption, excessive eating and gaming. Conclusion: Student consistently identified periods of stress and burnout, with curriculum coursework in particular being a trigger. Findings acknowledge the need for further investigation on sources of perceived stress, burnout and coping mechanisms to optimise student welfare and enhance HEI outcomes.
Severity-associated markers and assessment model for predicting the severity of COVID-19: a retrospective study in Hangzhou, China
Authors: Qi Jianjiang , He Di , Yang Dagan , Wang Mengyan , Ma Wenjun , Cui Huaizhong , Ye Fei , Wang Fei , Xu Jinjian , Li Zhijian , Liu Chuntao , Wu Jing , Qi Kexin , Wu Rui , Huang Jinsong , Liu Shourong , Zhu Yimin 
Published: August 2020

Abstract
Background: The severity of COVID-19 associates with the clinical decision making and the prognosis of COVID-19 patients, therefore, early identification of patients who are likely to develop severe or critical COVID-19 is critical in clinical practice. The aim of this study was to screen severity-associated markers and construct an assessment model for predicting the severity of COVID-19.Methods: 172 confirmed COVID-19 patients were enrolled from two designated hospitals in Hangzhou, China. Ordinal logistic regression was used to screen severity-associated markers. Least Absolute Shrinkage and Selection Operator (LASSO) regression was performed for further feature selection. Assessment models were constructed using logistic regression, ridge regression, support vector machine and random forest. The area under the receiver operator characteristic curve (AUROC) was used to evaluate the performance of different models.Results: Age, comorbidity, fever, and 18 biochemical markers (C-reactive protein, lactate dehydrogenase, D-dimer, albumin, etc) were associated with the severity of COVID-19 (all P values <0.05). By LASSO regression, eight markers were included for the assessment model construction. The ridge regression model had the best performance with AUROCs of 0.930 (95% CI, 0.914-0.943) and 0.827 (95% CI, 0.716-0.921) in the internal and external validations, respectively. A risk score, established based on the ridge regression model, had good discrimination in all patients with an AUROC of 0.897 (95% CI 0.845-0.940), and a well-fitted calibration curve. Using the optimal cutoff value of 71, the sensitivity and specificity were 87.1% and 78.1%, respectively. A web-based assessment system was developed based on the risk score. Conclusions: A panel of clinical markers were associated with the severity of COVID-19. An assessment model with eight markers would help clinicians to detect the patients who are likely to develop severe or critical COVID-19 at admission.
Development and launch of the first Obstetrics and Gynaecology Master of Medicine residency training programme in Botswana
Authors: Luckett Rebecca , Nassali Mercy , Melese Tadele , Moreri-Ntshabele Badani , Moloi Thabo , Hofmeyr Justus , Chobanga Kudrra , Masunge Japhter , Makhema Joe , Pollard Maisie , Ricciotti Hope , Ramogola-Masire Doreeen , Bazzett-Matabele Lisa 
Published: August 2020

Abstract
Background: Sub-Saharan Africa (SSA) faces a severe shortage of Obstetrician Gynaecologists (OBGYNs). While the Lancet Commission for Global Surgery recommends 20 OBGYNs per 100,000 population, Botswana has only 40 OBGYNs for a population of 2.3 million. We describe the development of the first OBGYN Master of Medicine (MMed) training programme in Botswana to address this human resource shortage.Methods: We developed a 4-year OBGYN MMed programme at the University of Botswana (UB) using the Kern's approach. We benchmarked curriculum content, learning outcomes, competencies, assessment strategies and research requirements with regional and international programmes. We engaged relevant local stakeholders and developed international collaborations to support in-country subspecialty training.Results: The OBGYN MMed curriculum was completed and approved by all relevant UB bodies within ten months during which time additional staff were recruited and programme financing was assured. The programme was advertised immediately; 26 candidates applied for four positions, and all selected candidates accepted. The programme was launched in January 2020 with government salary support of all residents. The clinical rotations and curricular development have been rolled out successfully. The first round of continuous assessment of residents was performed and internal programme evaluation was conducted. The national accreditation process was initiated.Conclusion: Training OBGYNs in-country has many benefits to health systems in SSA. Curricula can be adjusted to local resource context yet achieve international standards through thoughtful design and purposeful collaborations.
Radotinib Enhances Cytarabine (Ara-C)-Induced Acute Myeloid Leukemia Cell Death
Authors: Heo Sook-Kyoung , Noh Eui-Kyu , Yu Ho-Min , Kim Do Kyoung , Seo Hye Jin , Lee Yoo Jin , Cheon Jaekyung , Koh SuJin , Min Young Joo , Choi Yunsuk , Jo Jae-Cheol 
Published: August 2020

Abstract
Background: Acute myeloid leukemia (AML) is a heterogeneous disease that frequently relapses after standard chemotherapy. Therefore, there is a need for the development of novel chemotherapeutic agents that could treat AML effectively. Radotinib, an oral BCR-ABL tyrosine kinase inhibitor, was developed as a drug for the treatment of chronic myeloid leukemia. Previously, we reported that radotinib exerts increased cytotoxic effects towards AML cells. However, little is known about the effects of combining radotinib with Ara-C, a conventional chemotherapeutic agent for AML, with respect to cell death and cell cycle distribution in AML cells. Methods: Synergistic anti-cancer effects of radotinib and Ara-C in AML cells including HL60, HEL92.1.7, THP-1 and bone marrow cells from AML patients have been examined. Diverse cell biological assays such as cell viability assay, Annexin V-positive cells, caspase-3 activity, cell cycle distribution, and related signaling pathway have been performed. We also confirmed synergistic effects of radotinib and Ara-C on the xenograft model in vivo. Results: The combination of radotinib and Ara-C was found to induce AML cell apoptosis, which involved the mitochondrial pathway. In brief, combined radotinib and Ara-C significantly induced Annexin V-positive cells, cytosolic cytochrome C, and the pro-apoptotic protein Bax in AML cells including HL60, HEL92.1.7, and THP-1. In addition, mitochondrial membrane potential and Bcl-xl protein were markedly decreased by radotinib and Ara-C. Moreover, this combination induced caspase-3 activity. Cleaved caspase-3, 7, and 9 levels were also increased by combined radotinib and Ara-C. Additionally, radotinib and Ara-C co-treatment induced G0/G1 arrest via the induction of CDKIs such as p21 and p27 and the inhibition of CDK2 and cyclin E. Thus, radotinib/Ara-C induces mitochondrial-dependent apoptosis and G0/G1 arrest via the regulation of the CDKI–CDK–cyclin cascade in AML cells. In addition, our results showed that combined treatment with radotinib and Ara-C inhibits AML cell growth, including tumor volumes and weights in vivo. Also, the combination of radotinib and Ara-C can sensitize cells to chemotherapeutic agents such as daunorubicin or idarubicin in AML cells. Conclusions: Therefore, our results can be concluded that radotinib in combination with Ara-C possesses a strong anti-AML activity.
Epidermal Growth Factor Receptor-Mutant Non-Small Cell Lung Cancer and Choroidal Metastases: Long-Term Outcome and Response to Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors
Authors: Bouchez Clémentine , Pluvy Johan , Soussi Ghassen , Nguenang Marina , Brosseau Solenn , Tourne Morgan , Collin Mégane , Théou-Anton Nathalie , Guyard Alice , Ammar Jamila , Khalil Antoine , Zalcman Gérard , Gounant Valérie 
Published: August 2020

Abstract
Background: Although previously reported, little is known about choroidal metastasis in Epidermal Growth Factor Receptor (EGFR)-mutant Non-small cell lung cancer (NSCLC). Methods: In this single-center retrospective cohort including 83 consecutive metastatic EGFR-mutant NSCLC patients, from Sept. 2015 to Oct. 2018, six exhibited symptomatic choroidal metastases. All brain MRI scans performed in the EGFR-mutant patients were reviewed, with one case of asymptomatic choroidal metastasis identified. Kaplan-Meier analysis and log-rank test were conducted to assess median overall survival (OS) from diagnosis for the two groups, with or without choroidal metastases.Results: Prevalence of choroidal metastases in EGFR-mutated NSCLCs was 8.4% (7/83). Five were women, and four current or former smokers. Molecular analysis showed three tumors with exon 19 deletion, three with L858R mutation, and one with complex exon 21 mutation. The choroidal metastases were symptomatic in six/seven patients. Visual disturbances decreased in all but one symptomatic cases upon EGFR TKI, and the choroidal response was maintained over time. Median follow-up was 42.2 mo (95%CI [37.2 - 47.1]). Median OS in the choroidal metastasis group was 23.4 mo (95%CI [0.1 - 51.4]) versus 27.9 mo (95%CI [16.9 - 38.9]) in the non-choroidal metastasis group (p=0.32). In the choroidal metastasis group, 2-year and 5-year OS were 47.6% and 0%, respectively, versus 55.8% and 26.3% in the non-choroidal metastasis subset.Conclusions: Choroidal metastases in NSCLC EGFR-mutant patients are rare but should be systematically suspected in case of visual disturbance. TKIs are efficient for treating visual symptoms. Whether choroidal metastases confer a worse prognosis remains unclear owing to the third-generation EGFR TKI osimertinib first-line registration.
Risk Of Dengue Transmission In Urban Areas Of Malang, Indonesia
Authors: Rakhmani Alidha Nur , Zuhriyah Lilik 
Published: August 2020

Abstract
Background. Larvae monitoring through community participation is one of dengue prevention programs to control mosquito larvae. Entomology index could be an indicator of the existence of mosquito larvae in an area. This study aimed to determine the entomology index in the urban areas in Malang city and key container which could be the breeding ground of mosquito.Methods. This study was a surveillance study conducted in five subdistricts in Malang city from November 2017 to April 2018. A semi-structured questionnaire delivered using interviews to 400 respondents was used to explore the practice of Dengue prevention behavior. Observations were performed to examine the mosquito larva existence among the houses of health volunteers.Results. Density figure in Malang was indicated as moderate density that had range 2-5 . Blimbing subdistrict had the highest House Index (HI) value, which was 30.3% with Container Index (CI) value of 10.6% and Breteau Index (BI) value of 36,3 %. The most common positive Controllable Containers were bathroom tub/container (8.5%) and the water reservoir of a refrigerator (3%).Conclusion. Urban area in Malang has a moderate risk of transmitting dengue fever whose highest risk area was Blimbing subdistrict. There is need health promotion more or strict policy to the community also health volunteers to observe bathroom containers and water reservoir of refrigerator.
Assessing How Health Information Needs of Individuals With Colorectal Cancer Are Met Across the Care Continuum: an International Cross-Sectional Survey
Authors: Dau Hallie , Safari Abdollah , Din Khalid Saad El , McTaggart-Cowan Helen , Loree Jonathan M. , Gill Sharlene , De Vera Mary A. 
Published: August 2020

Abstract
Background: Studies evaluating health information needs in colorectal cancer (CRC) lack specificity in terms of study samples involving patients. We assessed how health information needs of individuals with CRC are met across the care continuum.Methods: We administered an international, online based survey. Participants were eligible for the study if they: 1) were 18 years of age or older; 2) received a diagnosis of CRC; and 3) were able to complete the online health survey in English, French, Spanish, or Mandarin. We grouped participants according to treatment status. The survey comprised sections: 1) demographic and cancer characteristics; 2) health information needs; and 3) health status and quality of life. We used multivariable regression models to identify factors associated with having health information needs met and evaluated impacts on health-related outcomes.Results: We analyzed survey responses from 1,041 participants including 258 who were currently undergoing treatment and 783 who had completed treatment. Findings suggest that information needs regarding CRC treatments were largely met. However, we found unmet information needs regarding psychosocial impacts of CRC. This includes work/employment, mental health, sexual activity, and nutrition and diet. We did not identify significant predictors of having met health information needs, however, among participants undergoing treatment, those with colon cancer were more likely to have met health information needs regarding their treatments as compared to those with rectal cancer (0.125; 95% CI, 0.00 to 0.25; p-value = 0.051). Conclusions: Our study provides a comprehensive assessment of health information needs among individuals with CRC across the care continuum.
Sorafenib as a Second-Line Treatment in Metastatic Renal Cell Carcinoma in Mexico: A Prospective Cohort Study
Authors: Martin-Aguilar Ana Elena , Núñez-López Haidé Nayeli , Ramirez-Sandoval Juan C. 
Published: August 2020

Abstract
Background: Sequential inhibition of the vascular endothelial growth factor (VEGF) pathway with sorafenib could be useful for patients with metastatic renal cell carcinoma (RCC). Our aim was to determine the activity and tolerability of sorafenib as a second-line therapy in advanced RCC initially treated with a different VEGF-tyrosine kinase inhibitor (TKI).Methods: A prospective observational cohort in Mexico (2012–2019). We included 148 subjects with metastatic RCC and who had progression despite treatment with sunitinib (n = 144) or pazopanib (n = 4). The primary end-point was time to disease progression as evaluated every 12–16 weeks.Results: The mean age of the cohort was 58 years (interquartile range [IQR] 48-68), 104 (70%) were men, and 51 (35%) had a favorable prognosis according to the IMDC (International Metastatic RCC Database Consortium) prognostic model. The median progression-free survival (PFS) and overall-survival after the introduction of sorafenib treatment was 8.5 months (95% confidence interval [CI]: 6.8–10.2) and 40.1 months (95% CI: 35.2–45.0) respectively. The median overall survival from RCC diagnosis to death was 71 months (95% CI: 63.9–79.4). On multivariate analyses, age >65 years was associated with a longer PFS (HR 0.57; 95% CI: 0.35-0.93; p = 0.025). The median PFS in subjects aged >65 years was longer compared to subjects ≤65 years (14.0 [95% CI: 9.2–17.9] vs. 7.2 months [95% CI: 5.5–8.9]; p = 0.018). Adverse events grade ≥3 associated with sorafenib occurred in 42 (28%) patients.Conclusion: Sequential inhibition of VEGF with sorafenib as a second-line treatment may benefit patients with metastatic RCC, especially in subjects >65 years old.
Fabrication of Polylactic Acid/Paclitaxel Nano Fibers by Electrospinning for Cancer Therapeutics
Authors: Yu C. H. , Chan Vincent , Li Chuan , Hsieh J. H. , Lin P. H. , Tsai Ya-Hui , Chen Yun 
Published: August 2020

Abstract
Background: Polylactic acid (PLA) is a thermoplastic and biodegradable polyester, largely derived from renewable resources such as corn starch, cassava starch and sugarcane. However, PLA is only soluble in a narrow range of solvents such as tetrahydrofuran, dioxane, chlorinated solvents and heated benzene. The limited choices of solvent for PLA dissolution have imposed singificant challenges in the development of specifically engineered PLA nanofibers with electrospinning techniques.Methods: Generally, the electrospun polymeric materials have been rendered with unique properties such as high porosity and complex geometry while maintaining its biodegradability and biocompatibility for emerging biomedical applications. In this study, a new drug delivery system composed of PLA nanofibers with encapsulated paclitaxel was developed by the electrospinning of the respective nanofibers on top of a spin-coated thin film with the same chemical compositions. Our unique approach is meant for promoting strong bonding between PLA-based nanofibers and their respective films in order to improve the prolonged release properties and composite film stability within a fluctuative phyiochemical environment during cell culture.Results: PLA/paclitaxel nanofiber supported on respective polymeric films were probed by scanning electronic microscope, Fourier transform infrared spectrometer and water contact measurement for determining their surface morphologies, fibers’ diameters, molecular vibrational modes, and wettability, respectively. Moreover, PLA/paclitaxel nanofibers supported on respective spin-coated films at different loadings of paclitaxel were evaluated for their abilities in killing human colorectal carcinoma cells (HCT-116). More importantly, MTT assays showed that regardless of the concentrations of paclitaxel, the growth of HCT-116 was effectively inhibited by the prolonged release of paclitaxel from PLA/paclitaxel nanofibers.Conclusions: An effective prolonged delivery system based on PLA nanofiber has demonstrated exciting potentials for emerging applications in cancer therapeutics.
Medical Practice Differences Among Internal Medicine Fellows During in-hospital Emergency Department 24-hour Shifts
Authors: Repusic Marina , Zeljkovic Matea Kolacevic , Babacanli Alen , Olujic Vida , Radovanic Sandra , Sikic Aljosa , Radeljic Vjekoslav , Bulj Nikola , Pavlovic Nikola , Dula Kristijan , Manola Sime , zeljkovic ivan 
Published: August 2020

Abstract
Background There are limited data which show how Emergency Department (ED)-specific knowledge and skills are acquired throughout the internal medicine fellowship, especially during 24-hour shifts. The aim of the study was to assess the differences in medical practice between fellows among different fellowship-years in ED settings. Methods We conducted a cross-sectional, retrospective study at a large university hospital using data on every ED examination done during 2016. All data were taken from the hospital information system. We compared 1st-year fellows with all older fellows, as well as 5th-year fellows with all younger fellows. Results In 2016, 55 fellows had ≥ 15 24-hour shifts with 3 attending fellows during one shift. A total of 19’916 patients were examined by attending fellows in the ED. When compared to 2nd-year fellows, 1st-year fellows examined more patients brought to ED by out-of-hospital emergency medical team and had significantly higher share of examined patients per 24-hour shift with lower length of stay. When compared to 5th-year fellows, 1st-year fellows examined older patients, but had lower share of examined patients during one 24-hour shift and participated in fewer CPR cases. When compared to younger fellows, 5th-year fellows participated in more CPR cases and had higher proportion of patients admitted to hospital. Conclusion To our knowledge, this is the first report on the ED medical practice differences among fellows of different fellowship-year. When compared to other fellows, 1st-year fellows participated less in CPR cases, but were faster in providing medical care in ED. 5th-year fellows had the highest proportion of patients admitted to hospital and more CPR cases.
CD247 Functions as a Prognostic Biomarker for Cutaneous Malignant Melanoma Based on the Analysis of Tumor-immune Microenvironment
Authors: ma yi , Chen Shu-Shu , Feng Yan-Yan , Ma Ru-Yi , Wang Huan-Liang 
Published: August 2020

Abstract
Background: Cutaneous malignant melanoma (CMM) is among the most lethal cancers. The tumour microenvironment (TME) is closely linked with tumorigenesis, metastasis, and prognosis.Methods: We employed the ESTIMATE algorithm to calculate immune and stromal scores of malignant melanoma tissues from the Cancer Genome Atlas dataset, respectively, and determine core prognosis gene signature examined by COX proportional hazards model. Functional enrichment annotation, the Kyoto Encyclopedia of Genes and Genomes pathways, the Protein-Protein Interaction network, Weighted Gene Co-expression Network Analysis and overall survival analysis were used to formulate potential function of these genes that involved in immune-linked biological processes. CIBERSORT algorithm was used to estimate the abundances of immune cell types in CMM samples. Finally, the OncoLnc platform, the Gene Expression Profiling Interactive Analysis resources, and the Human Protein Atlas database were applied to validate our results. Results：908 differential expressed genes and ten hub genes were screened, and GO annotation indicated that immune response and inflammatory response were firmly involved in CMM tumorigenesis and progression. CD247, identified as the most significant prognostic biomarker, highly expressed in tumor samples and possessed a better prognosis than low expressed samples. The correlation analysis of immune cells infiltration unveiled that CD8+ T cell and Macrophages were intense significant to CMM patients' prognosis. Survival analysis suggested that ten hub genes and infiltrated immune cells are linked to the prognosis of CMM. ConnectiveMap analysis strongly indicated that L-securinine may be a promising candidate medicine for CMM patients.Conclusions: we deeply analyzed the immune-linked genes with the tumour microenvironment, and labeled CD247 as the most intriguing prognostic biomarker for CMM, which may bring better clinical outcomes for CMM patients.