bluuebunny/crossref_metadata_2025_split huggingface dataset:
Key tips for teaching in the clinical setting
Authors: Burgess Annette , van Diggele Christie , Roberts Chris , Mellis Craig 
Published: December 2020

AbstractTeaching with real patients in the clinical setting lies at the heart of health professional education, providing an essential component to clinical training. This is true of all the health disciplines – particularly medicine, nursing, dentistry, physiotherapy, and dietetics. Clinical tutorials orientate students to the culture and social aspects of the healthcare environment, and shape their professional values as they prepare for practice. These patient-based tutorials introduce students to the clinical environment in a supervised and structured manner, providing opportunities to participate in communication skills, history taking, physical examination, clinical reasoning, diagnosis and management. It is only through participation that new practices are learnt, and progressively, new tasks are undertaken. The aim of this paper is to provide health professional students and early career health professionals involved in peer and near peer teaching, with an overview of approaches and key tips for teaching in the clinical setting. Although there are many competencies developed by students in the clinical setting, our tips for teaching focus on the domains of medical knowledge, interpersonal and communication skills, and professionalism.
Active learning of medical students in Taiwan: a realist evaluation
Authors: Huang Chien-Da , Tseng Hsu-Min , Jenq Chang-Chyi , Ou Liang-Shiou 
Published: December 2020

Abstract
Background
Active learning is defined as any instructional method that engages students in the learning process. Cultural differences in learning patterns can play an important role in engagement with active learning. We aimed to examine process models of active learning to understand what works, for whom and why.

Methods
Forty-eight sixth- and seventh-year medical students with experience of active learning methods were purposively selected to participate in ten group interviews. Interactions around active learning were analysed using a realist evaluation framework to unpack the ‘context-mechanism-outcome’ (CMO) configurations.

Results
Three core CMO configurations, including cultural, training and individual domains, were identified. In the cultural context of a strong hierarchical culture, the mechanisms of fear prompted students to be silent (outcome) and dare not give their opinions. In the training context of teacher-student familiarity alongside teachers’ guidance, the mechanisms of learning motivation, self-regulation and enthusiasm were triggered, prompting positive learning outcomes and competencies (outcome). In the individual context of learning how to learn actively at an early stage within the medical learning environment, the mechanisms of internalisation, professional identity and stress resulted in recognising active learning and advanced preparation (outcomes).

Conclusions
We identified three CMO configurations of Taiwanese medical students’ active learning. The connections among hierarchical culture, fear, teachers’ guidance, motivation, the medical environment and professional identity have been shown to affect the complex interactions of learning outcomes. Fear derived from a hierarchical culture is a concern as it is a significant and specific contextual factor, often sparking fear with negative outcomes.
Building health system resilience in the context of primary health care revitalization for attainment of UHC: proceedings from the Fifth Health Sector Directors’ Policy and Planning Meeting for the WHO African Region
Authors: Tumusiime Prosper , Karamagi Humphrey , Titi-Ofei Regina , Amri Michelle , Seydi Aminata Binetou Wahebine , Kipruto Hillary , Droti Benson , Zombre Sosthene , Yoti Zabulon , Zawaira Felicitas , Cabore Joseph 
Published: December 2020

Abstract
Background
The recent 2018 Declaration of Astana recognized primary health care (PHC) as a means to achieve universal health coverage (UHC) and the health-related Sustainable Development Goals (SDGs). Following this declaration, country progress on operationalization of the PHC agenda and attainment of UHC has been stalled by the new challenges posed by the COVID-19 pandemic. The pandemic has also disrupted the continuity of essential health service provision and tested the resilience of the region’s health systems.

Methods
In accordance with this, the WHO Regional Office for Africa convened the Fifth Health Sector Directors’ Planning and Policy Meeting across the 47 Member States of the Region. The two-day forum focused on building health system resilience to facilitate service continuity during health threats, PHC revitalization, and health systems strengthening towards UHC.

Results
The Regional Forum provided evidence on building resilient health systems in the WHO African Region and engaged participants in meaningful and critical discussion. It is from these discussions that four key themes emerged: (1) working multisectorally/intersectorally, (2) moving from fragmentation to integration, (3) ensuring implementation and knowledge exchange, and (4) rethinking resilience and embracing antifragility. These discussions and associated groupings by thematic areas lend themselves to recommendations for the WHO.

Conclusions
This paper details the proceedings and key findings on building resilient health systems, the four themes that emerged from participant deliberation, and the recommendations that have emerged from the meeting. Deliberations from the Regional Forum are critical, as they have the potential to directly inform policy and program design, given that the meeting convenes health sector technocrats, who are at the helm of policy design, action, and implementation.
Long noncoding RNA NEAT1 regulates radio-sensitivity via microRNA-27b-3p in gastric cancer
Authors: Jiang Ying , Jin Shan , Tan Shisheng , Xue Yingbo , Cao Xue 
Published: December 2020

Abstract
Background
Long noncoding RNA nuclear-enriched abundant transcript 1 (NEAT1) exhibits an oncogenic role in multiple cancers, including gastric cancer (GC). But, the functions of NEAT1 in modulating radio-sensitivity of GC and its potential molecular mechanisms have not been totally elucidated.

Methods
qRT-PCR was performed to detect the expressions of NEAT1 and microRNA-27b-3p (miR-27b-3p). Kaplan–Meier survival curves for NEAT1 expression in GC created using KM Plotter. Colony formation assay was used to determine the survival fraction. Cell apoptosis was evaluated by flow cytometry. Luciferase reporter assay was used to verify the relationship between miR-27b-3p and NEAT1.

Results
NEAT1 was highly expressed while miR-27b-3p was downregulated in GC tissues and cells. NEAT1 was negatively correlated with that of miR-27b-3p and associated with poor overall survival. Moreover, NEAT1 and miR-27b-3p varied inversely after radiation in GC tissues and cells. Loss of NEAT1 or upregulation of miR-27b-3p increased the effect of radiation on cell survival fraction inhibition and apoptosis promotion. In addition, NEAT1 negatively regulated the expression of miR-27b-3p in GC cells. Interestingly, the depletion of miR-27b-3p dramatically attenuated the NEAT1 knockdown-mediated function in AGS and MKN-45 cells treated with radiation in vitro. Similarly, downregulation of NEAT1 enhanced the radiation-mediated inhibition of tumor growth, which was mitigated by decrease of miR-27b-3p.

Conclusion
NEAT1 depletion enhanced radio-sensitivity of GC by negatively regulating miR-27b-3p in vitro and in vivo.
Targeting REV7 effectively reverses 5-FU and oxaliplatin resistance in colorectal cancer
Authors: Sun Xianjun , Hou Wenhou , Liu Xin , Chai Jie , Guo Hongliang , Yu Jinming 
Published: December 2020

AbstractBackgroundDespite an enormous research effort, patients diagnosed with advanced colorectal cancer (CRC) still have low prognosis after surgical resection and chemotherapy. The major obstacle for CRC treatment is chemoresistance to front line anti-cancer drugs, such as 5-fluorouracil (5-FU) and oxaliplatin. However, the mechanism of chemoresistance to these drugs remains unclear.MethodsCell viability to 5-FU and oxaliplatin was measured by the CellTiter-Glo® 2.0 Cell Viability Assay. The endogenous REV7 protein in CRC cells was detected by western blotting. The translesion synthesis (TLS) events were measured by plasmid-based TLS efficiency assay. Cell apoptosis was evaluated by caspase3/7 activity assay. The in vivo tumor progression was analyzed by HT29 xenograft mice model.ResultsIn this study, we found that expression of REV7, which is a key component of translesion synthesis (TLS) polymerase ζ (POL ζ), is significantly increased in both 5-FU and oxaliplatin resistant CRC cells. TLS efficiency analysis revealed that upregulated REV7 protein level results in enhanced TLS in response to 5-FU and oxaliplatin. Importantly, inhibition of REV7 by CRISPR/Cas9 knockout exhibited significant synergy with 5-FU and oxaliplatin in cell culture and murine xenograft model.ConclusionThese results suggest that combination of REV7 deficiency and 5-FU or oxaliplatin has strong inhibitory effects on CRC cells and identified REV7 as a promising target for chemoresistant CRC treatment.
Socioeconomic inequalities in the place of death in urban small areas of three Mediterranean cities
Authors: Nolasco Andreu , Fernández-Alcántara Manuel , Pereyra-Zamora Pamela , Cabañero-Martínez María José , Copete José M. , Oliva-Arocas Adriana , Cabrero-García Julio 
Published: December 2020

Abstract
Background
Dying at home is the most frequent preference of patients with advanced chronic conditions, their caregivers, and the general population. However, most deaths continue to occur in hospitals. The objective of this study was to analyse the socioeconomic inequalities in the place of death in urban areas of Mediterranean cities during the period 2010–2015, and to assess if such inequalities are related to palliative or non-palliative conditions.

Methods
This is a cross-sectional study of the population aged 15 years or over. The response variable was the place of death (home, hospital, residential care). The explanatory variables were: sex, age, marital status, country of birth, basic cause of death coded according to the International Classification of Diseases, 10th revision, and the deprivation level for each census tract based on a deprivation index calculated using 5 socioeconomic indicators. Multinomial logistic regression models were adjusted in order to analyse the association between the place of death and the explanatory variables.

Results
We analysed a total of 60,748 deaths, 58.5% occurred in hospitals, 32.4% at home, and 9.1% in residential care. Death in hospital was 80% more frequent than at home while death in a nursing home was more than 70% lower than at home. All the variables considered were significantly associated with the place of death, except country of birth, which was not significantly associated with death in residential care. In hospital, the deprivation level of the census tract presented a significant association (p < 0.05) so that the probability of death in hospital vs. home increased as the deprivation level increased. The deprivation level was also significantly associated with death in residential care, but there was no clear trend, showing a more complex association pattern. No significant interaction for deprivation level with cause of death (palliative, not palliative) was detected.

Conclusions
The probability of dying in hospital, as compared to dying at home, increases as the socioeconomic deprivation of the urban area of residence rises, both for palliative and non-palliative causes. Further qualitative research is required to explore the needs and preferences of low-income families who have a terminally-ill family member and, in particular, their attitudes towards home-based and hospital-based death.
Programmable N6-methyladenosine modification of CDCP1 mRNA by RCas9-methyltransferase like 3 conjugates promotes bladder cancer development
Authors: Ying Xiaoling , Jiang Xu , Zhang Haiqing , Liu Bixia , Huang Yapeng , Zhu Xiaowei , Qi Defeng , Yuan Gang , Luo Junhang , Ji Weidong 
Published: December 2020

AbstractAccumulating evidence has revealed significant roles for N6-methyladenosine (m 6 A) modification in the development of various cancers. We previously demonstrated an oncogenic role of m 6 A-modified CUB domain containing protein 1 (CDCP1) in bladder cancer (BC) progression. However, the biological functions and underlying molecular mechanisms of engineered programmable m 6 A modification of CDCP1 mRNA in BC remain obscure. Here, we established a targeted m 6 A RNA methylation system by fusing the catalytic domain of methyltransferase like 3 (METTL3CD) to RCas9 as the RNA-targeting module. The constructed RCas9- METTL3 retained methylation activity and mediated efficient site-specific m 6 A installation in the presence of a cognate single guide RNA and short protospacer adjacent motif-containing ssDNA molecule . Subsequently, targeting m 6 A installation onto the 3′ untranslated region of CDCP1 promoted CDCP1 mRNA translation and facilitated BC development in vitro and in vivo. Our findings demonstrate that the RCas9-METTL3 system mediates efficient sitespecific m 6 A installation on CDCP1 mRNA and promotes BC development. Thus, the RCas9-METTL3 system provides a new tool for studying m 6 A function and a potential strategy for BC epitranscriptome-modulating therapies.
More public health service providers are experiencing job burnout than clinical care providers in primary care facilities in China
Authors: Lu Shan , Zhang Liang , Klazinga Niek , Kringos Dionne 
Published: December 2020

Abstract
Background
Health workers are at high risk of job burnout. Primary care in China has recently expanded its scope of services to a broader range of public health services in addition to clinical care. This study aims to measure the prevalence of burnout and identify its associated factors among clinical care and public health service providers at primary care facilities.

Methods
A cross-sectional survey (2018) was conducted among 17,816 clinical care and public health service providers at 701 primary care facilities from six provinces. Burnout was measured by the Chinese version of the Maslach Burnout Inventory-General Scale, and multilevel linear regression analysis was conducted to identify burnout’s association with demographics, as well as occupational and organisational factors.

Results
Overall, half of the providers (50.09%) suffered from burnout. Both the presence of burnout and the proportion of severe burnout among public health service providers (58.06% and 5.25%) were higher than among clinical care providers (47.55% and 2.26%, respectively). Similar factors were associated with burnout between clinical care and public health service providers. Younger, male, lower-educated providers and providers with intermediate professional title, permanent contract or higher working hours were related to a higher level of burnout. Organisational environment, such as the presence of a performance-based salary system, affected job burnout.

Conclusions
Job burnout is prevalent among different types of primary care providers in China, indicating the need for actions that encompass the entirety of primary care. We recommend strengthening the synergy between clinical care and public health services and transforming the performance-based salary system into a more quality-based system that includes teamwork incentives.
Reactivity and increased proliferation of NG2 cells following central nervous system infection with Theiler’s murine encephalomyelitis virus
Authors: Bell Laura A. , Wallis Glenna J. , Wilcox Karen S. 
Published: December 2020

Abstract
Background
Neuron-glial antigen 2 (NG2) cells are a glial cell type tiled throughout the gray and white matter of the central nervous system (CNS). NG2 cells are known for their ability to differentiate into oligodendrocytes and are commonly referred to as oligodendrocyte precursor cells. However, recent investigations have begun to identify additional functions of NG2 cells in CNS health and pathology. NG2 cells form physical and functional connections with neurons and other glial cell types throughout the CNS, allowing them to monitor and respond to the neural environment. Growing evidence indicates that NG2 cells become reactive under pathological conditions, though their specific roles are only beginning to be elucidated. While reactive microglia and astrocytes are well-established contributors to neuroinflammation and the development of epilepsy following CNS infection, the dynamics of NG2 cells remain unclear. Therefore, we investigated NG2 cell reactivity in a viral-induced mouse model of temporal lobe epilepsy.

Methods
C57BL6/J mice were injected intracortically with Theiler’s murine encephalomyelitis virus (TMEV) or PBS. Mice were graded twice daily for seizures between 3 and 7 days post-injection (dpi). At 4 and 14 dpi, brains were fixed and stained for NG2, the microglia/macrophage marker IBA1, and the proliferation marker Ki-67. Confocal z stacks were acquired in both the hippocampus and the overlying cortex. Total field areas stained by each cell marker and total field area of colocalized pixels between NG2 and Ki67 were compared between groups.

Results
Both NG2 cells and microglia/macrophages displayed increased immunoreactivity and reactive morphologies in the hippocampus of TMEV-injected mice. While increased immunoreactivity for IBA1 was also present in the cortex, there was no significant change in NG2 immunoreactivity in the cortex following TMEV infection. Colocalization analysis for NG2 and Ki-67 revealed a significant increase in overlap between NG2 and Ki-67 in the hippocampus of TMEV-injected mice at both time points, but no significant differences in cortex.

Conclusions
NG2 cells acquire a reactive phenotype and proliferate in response to TMEV infection. These results suggest that NG2 cells alter their function in response to viral encephalopathy, making them potential targets to prevent the development of epilepsy following viral infection.
Fall inducing movable platform (FIMP) for overground trips and slips
Authors: Er Jie Kai , Donnelly Cyril John William , Wee Seng Kwee , Ang Wei Tech 
Published: December 2020

Abstract
Background
The study of falls and fall prevention/intervention devices requires the recording of true falls incidence. However, true falls are rare, random, and difficult to collect in real world settings. A system capable of producing falls in an ecologically valid manner will be very helpful in collecting the data necessary to advance our understanding of the neuro and musculoskeletal mechanisms underpinning real-world falls events.

Methods
A fall inducing movable platform (FIMP) was designed to arrest or accelerate a subject’s ankle to induce a trip or slip. The ankle was arrested posteriorly with an electromagnetic brake and accelerated anteriorly with a motor. A power spring was connected in series between the ankle and the brake/motor to allow freedom of movement (system transparency) when a fall is not being induced. A gait phase detection algorithm was also created to enable precise activation of the fall inducing mechanisms. Statistical Parametric Mapping (SPM1D) and one-way repeated measure ANOVA were used to evaluate the ability of the FIMP to induce a trip or slip.

Results
During FIMP induced trips, the brake activates at the terminal swing or mid swing gait phase to induce the lowering or skipping strategies, respectively. For the lowering strategy, the characteristic leg lowering and subsequent contralateral leg swing was seen in all subjects. Likewise, for the skipping strategy, all subjects skipped forward on the perturbed leg. Slip was induced by FIMP by using a motor to impart unwanted forward acceleration to the ankle with the help of friction-reducing ground sliding sheets. Joint stiffening was observed during the slips, and subjects universally adopted the surfing strategy after the initial slip.

Conclusion
The results indicate that FIMP can induce ecologically valid falls under controlled laboratory conditions. The use of SPM1D in conjunction with FIMP allows for the time varying statistical quantification of trip and slip reactive kinematics events. With future research, fall recovery anomalies in subjects can now also be systematically evaluated through the assessment of other neuromuscular variables such as joint forces, muscle activation and muscle forces.
A double-edged sword of using opioids and COVID-19: a toxicological view
Authors: Ataei Mahshid , Shirazi Farshad M. , Lamarine Roland J. , Nakhaee Samaneh , Mehrpour Omid 
Published: December 2020

AbstractToday, COVID-19 is spreading around the world. Information about its mechanism, prognostic factors, and management is minimal. COVID-19, as a human disease, has several identifying phases. Physicians of patients with COVID-19 may be interested in knowing whether opioid use disorder may affect their patients’ course or prognosis. This information may be crucial when considering the opioid epidemic in the US and other parts of the world. Opioid use at high doses and over several months duration can mitigate the immune system’s function, which may complicate the course of COVID-19 disease. Potential suppression of parts of the immune response may be important in prevention, clinical support, and therapeutic use of medications in various phases of the COVID-19. Specifically, opioid use disorders via an inhalation route may enhance the “late hyper-inflammatory phase” or result in end-organ damage. It is well established that opioids decrease ventilation as their effect on the medullary respiratory centers increases the risk of pneumonia. This increased risk has been associated with immune-suppressive opioids. The ultimate role of opioids in COVID-19 is not clear. This paper endorses the need for clinical studies to decipher the role and impact of chronic opioid use on viral diseases such as COVID-19.
Risk factors for adjacent segment degeneration after posterior lumbar fusion surgery in treatment for degenerative lumbar disorders: a meta-analysis
Authors: Wang Tao , Ding Wenyuan 
Published: December 2020

AbstractStudy designA meta-analysis.ObjectiveWe performed a meta-analysis to explore the incidence and risk factors of adjacent segment degeneration (ASD) after posterior lumbar fusion surgery.MethodsAn extensive search of the literature was performed in English database of PubMed, Embase, and Cochrane Library, and Chinese database of CNKI and WANFANG (up to May 2020). We collected factors including demographic data, surgical factor, and sagittal parameters. Data analysis was conducted with RevMan 5.3 and STATA 12.0.ResultsFinally, 19 studies were included in the final analysis. In our study, the rate of ASD after posterior lumbar fusion surgery was 18.6% (540 of 2896). Our data also showed that mean age, body mass index (BMI), the history of smoking and hypertension, preoperative adjacent disc degeneration, long-segment fusion, preoperative superior facet violation, high lumbosacral joint angle, pre- and post-operative L1-S1 sagittal vertical axis (SVA), post-operative lumbar lordosis (LL), and preoperative pelvic incidence (PI) were associated with the development of ASD. However, gender, history of diabetes, bone mineral density (BMD), preoperative Oswestry Disability Index (ODI) and Japanese Orthopedic Association (JOA), the type of fusion (PLIF vs TLIF), type of bone graft (auto- vs allograft), fusion to S1(vs non-fusion to S1), diagnose (lumbar disc herniation, lumbar spinal stenosis, lumbar spondylolisthesis), preoperative pelvic tilt (PT), LL and sacral slope (SS), post-operative SS, PT and PI were not associated with the development of ASD.ConclusionsIn our study, many factors were correlated with the risk of ASD after posterior lumbar fusion surgery. We hope this article can provide a reference for spinal surgeons in treatment for lumbar degenerative diseases.