bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effectiveness of Blended Learning versus Lectures alone on ECG Analysis and Interpretation by Medical Students
Authors: Viljoen Charle Andre , Millar Rob Scott , Manning Kathryn , Burch Vanessa Celeste 
Published: June 2020

Abstract
Background Most medical students lack confidence and are unable to accurately interpret ECGs. Better methods of ECG instruction are therefore being sought. Current literature indicates that the use of e-learning for ECG analysis and interpretation skills (ECG competence) is not superior to lecture-based teaching. We aimed to assess whether blended learning (lectures supplemented with the use of a web application) resulted in better acquisition and retention of ECG competence in medical students, than with conventional teaching (lectures alone). Methods Two cohorts of fourth-year medical students were studied prospectively. The conventional teaching cohort (n=67) attended four hours of interactive lectures, covering the basic principles of Electrocardiography, waveform abnormalities and arrhythmias. In addition to attending the same lectures, the blended learning cohort (n=64) used a web application that facilitated deliberate practice of ECG analysis and interpretation, with structured feedback. All participants completed three tests: pre-intervention (assessing baseline ECG competence at start of clinical clerkship), immediately post-intervention (assessing acquisition of ECG competence at end of six-week clinical clerkship) and delayed post-intervention (assessing retention of ECG competence six months after clinical clerkship, without any further ECG training). Diagnostic accuracy and uncertainty were assessed in each test. Results The pre-intervention test scores were similar for blended learning and conventional teaching cohorts (mean 31.02±13.19% versus 31.23±11.52% respectively, p=0.917). While all students demonstrated meaningful improvement in ECG competence after teaching, blended learning was associated with significantly better scores, compared to conventional teaching, in immediate (75.27±16.22% vs 50.27±17.1%, p<0.001; Cohen’s d =1.58), and delayed post-intervention tests (57.70±18.54% vs 37.63±16.35%, p<0.001; Cohen’s d =1.25). Although diagnostic uncertainty decreased after ECG training in both cohorts, blended learning was associated with better confidence in ECG analysis and interpretation. Conclusion Blended learning was superior in teaching ECG analysis and interpretation skills to medical students and achieved better levels of ECG competence and confidence than conventional lectures. Although medical students undergo a significant attrition of ECG competence without ongoing training, blended learning also resulted in better retention of ECG competence than conventional teaching. Web applications enabling deliberate practice with structured feedback may therefore be a useful adjunct to lectures for teaching Electrocardiography.
Differences and Similarities of High-resolution Computed Tomography Features Between Pneumocystis Pneumonia and Cytomegalovirus Pneumonia in Aids Patients
Authors: Du Chunjing , Liu Jingyuan , Chen Hui , Yan Shuo , Pu Lin , Xiong Haofeng , Xiang Pan , Li Chuansheng , Zhang Ming , Chen Budong , Li Ang 
Published: June 2020

Abstract
Background: Accurate differentiating diagnosis of pneumocystis pneumonia and cytomegalovirus pneumonia is crucial for choosing therapies in AIDS patients. Hence, the purposes of this study was to compare the CT features of pneumocystis pneumonia and cytomegalovirus pneumonia in AIDS patients and to spot the valuable findings which might contribute to an accurate diagnosis between two cohorts.MethodsA total of 112 AIDS patients, 78 withpneumocystis pneumoniaand 34 werecytomegalovirus pneumonia,were included in this study.Two experienced chest radiologists retrospectively reviewed CT images for 17 features including ground-glass opacity, consolidation, nodules, and halo sign. Significance was calculated by the chi-square(χ2)test.ResultsThe presence of consolidation (61.77% in cytomegalovirus pneumonia,35.9% in pneumocystis pneumonia, p=0.011), halo signs (32.35% in cytomegalovirus pneumonia, 11.54% in pneumocystis pneumonia, p＜0.001), and nodules (47.06% in cytomegalovirus pneumonia,8.97% in pneumocystis pneumonia, p＜0.001), especially small nodules (32.5% in cytomegalovirus pneumonia, 6.41% in pneumocystis pneumonia, p＜0.001) without perilymphatic distribution,was significantly more frequent in patients with cytomegalovirus pneumonia than in those with pneumocystis pneumonia. Large nodules were not found in any of patients with cytomegalovirus pneumonia. The presence of ground-glass opacity (100% in pneumocystis pneumonia and cytomegalovirus pneumonia), reticulation(57.69% in pneumocystis pneumonia, 52.94% in cytomegalovirus pneumonia, p=0.782) andbronchial wall thickening (34.62% in pneumocystis pneumonia, 47.06% in cytomegalovirus pneumonia, p=0.213) were common in both groups.ConclusionsAnalysis of consolidation, nodules, and halo signs may contribute to prioritize differential diagnosis of pneumocystis pneumonia or cytomegalovirus pneumonia. However, some CT features considered typicalin oneor other diseases appear with similar frequency in both cohorts of AIDS patients.
Spatial Variations in Seismicity Characteristics in and Around the Source Region of the 2019 Yamagata-Oki Earthquake, Japan
Authors: Ueda Taku , Kato Aitaro , Ogata Yoshihiko , Yamaya Lina 
Published: June 2020

Abstract
The 2019 {\text{M}}_{\text{j}} 6.7 Yamagata-Oki Earthquake occurred adjacent to the northeastern edge of the source region of the 1964 {\text{M}}_{\text{j}} 7.5 Niigata Earthquake, offshore of Yamagata Prefecture, Japan. Few aftershocks occurred in the source region of the Yamagata-Oki earthquake immediately following the Niigata earthquake, and the recent seismicity rate in this region is extremely low compared with that of the surrounding region. This spatial variation in seismicity may allow us to elucidate plausible physical processes that shape the spatiotemporal evolution of these shallow-crustal environments. Here, we investigate the spatial variations in seismicity characteristics by applying the HIerarchical Space–Time Epidemic Type Aftershock Sequence (HIST-ETAS) model to an earthquake catalog compiled by the Japan Meteorological Agency for events in and around the Yamagata-Oki earthquake rupture region. We compare spatial variations in the background seismicity rate and aftershock productivity estimated from the HIST-ETAS model with the geophysical features in the study region. The background seismicity rate is high along the eastern margin of the Sea of Japan and correlates well with a previously identified zone that possesses a high geodetic shear strain rate. The two major earthquakes occurred in and around an active shear zone, suggesting that the background seismicity rate may serve as a key parameter for evaluating seismic hazard across the Japanese Archipelago. Furthermore, the source region of the Yamagata-Oki earthquake has a higher aftershock productivity, lower b-value, and lower seismic-wave velocity than that of the Niigata earthquake. We interpret this low-velocity zone to be a well-developed damaged rock that resulted in both a reduction in the b-value and an increase in aftershock productivity based on previous laboratory experiments and numerical results; this damage makes the rock more ductile at the macroscopic scale. The higher ductility in the source region of the Yamagata-Oki earthquake may have worked as a soft barrier against the propagation of dynamic rupture that occurred during the Niigata earthquake.
Phylogenetic systematics of Butyrivibrio and Pseudobutyrivibrio genomes illustrate possession of open genomes rich in orthologous accessory genes with an abundance of carbohydrate-active enzyme isoforms
Authors: Huws Sharon , Skvortsov Timofey , Santos Fernanda Godoys , Courtney Stephen , Ting Karen Siu , Creevey Chris 
Published: June 2020

Abstract
BackgroundButyrivibrio and Pseudobutyrivibrio dominate in anaerobic gastrointestinal microbiomes, particularly the rumen, where they play a key role in harvesting energy from the diet. Within these genera, 5 rumen species have been classified (B. fibrisolvens, B. hungatei, B. proteoclasticus, P. ruminis and P. xylanivorans); nonetheless, the phylogeny and evolution of these genera is still unclear. Given the recent increase in available genomes, a re-investigation of the phylogenetic systematics and evolution of Butyrivibrio and Pseudobutyrivibrio is timely.ResultsWe show, using both a 16S rDNA and 40 gene marker phylogenetic tree, that 6 species, namely 1. P. ruminis, 2. P. xylanivorans, 3. B. fibrisolvens, 4. Butyrivibrio sp., 5. B. hungatei, and 6. B. proteclasticus likely exist. Pangenome analysis at 100% core definition showed a high abundance of accessory genes (91.50 to 99.34%) compared with core genes (0.66 to 8.50%), illustrating possession of very open genomes. Across the 71 genomes, 870 COGs (clusters of orthologous genes) were shared by all taxa, suggesting evolution through speciation from a common ancestor. Further analysis of Carbohydrate-Active Enzymes (CAZymes) genes show that most are within the accessory genome and orthologous in descent with numerous within-family CAZyme isoforms apparent, CAZyme family tree lineages show that these isoforms largely group according to the 6 species, suggesting extensive horizontal gene transfer within these families.ConclusionsWe show the extensive genomic variation found within Butyrivibrio, and to a lesser extent, Pseudobutyrivibrio. and demonstrate the existence of a new Butyrivibrio species. The Butyrivibrio and Pseudobutyrivibrio genomes are very open with very low % core genomes and high % accessory genomes., and possess a number of GH isoforms that we hypothesise facilitate metabolic plasticity and resilience under dietary perturbations. This study utilizes all currently available genomes and consequently provides a major advancement in our understanding of these important anaerobic bacteria.
Acute Exacerbation of Chronic Subjective Tinnitus: a Cross-sectional Study
Authors: Fang Bixing , Liang Yinfei , Gu Jing , Li Zhenzhi , Cen Jintian , Yuan Lianxiong , Zheng Ke , Chen Dan , Li Zhicheng , Zeng Xiangli 
Published: June 2020

Abstract
Background: To analyze data from the tinnitus study that addresses the factors contributing to the acute exacerbation of chronic subjective tinnitus, and providing a comprehensive landscape of multiple factors action patterns on acute exacerbation of tinnitus.Methods: It reports data from patients with chronic subjective tinnitus, enabling a direct comparison of results between the stable stage of chronic tinnitus and the acute exacerbation of chronic tinnitus samples. Participants had completed comprehensive audiometric testing and numerous questionnaires.Results: Results are presented from n=602 participants across the two sites, including 204 patients in the stable stage of tinnitus and 398 patients in acute exacerbation of tinnitus. The data reveal that: ①Acute exacerbation of chronic tinnitus is affected by many factors, among them, aggravated hearing loss, fatigue, stress, disturbed sleep, negative emotion, upper respiratory tract infection, noise exposure, and abruptly changed barometric pressure may aggravate the tinnitus; ②Smoking, drink, and course of tinnitus are not risked factors for acute exacerbation of chronic tinnitus; ③Comparison of the importance of the four factors induce acute exacerbation of chronic tinnitus, fatigue and stress are the most important, then, in turn, negative emotions and sleep disorders.Conclusions: ①There were many incentives for acute exacerbation of chronic tinnitus and multiple causes coexist under normal conditions. ②The prevention and prognosis management of acute exacerbation of chronic tinnitus should be approached from multiple dimensions, which includes biological, social support, patient psychology.Trial registration: Not applicable
Baseline Factors Identified For Prediction of Good Responders in Patients With End-Stage Diffuse Coronary Artery Disease Undergoing Intracoronary CD34+ Cell Therapy
Authors: Sung Pei-Hsun , Chiang Hsin-Ju , Li Yi-Chen , Chiang John Y , Chu Chi-Hsiang , Shao Pei-Lin , Lee Fan-Yen , Lee Mel S. , Yip Hon-Kan 
Published: June 2020

Abstract
Background: Treating patients with end-stage diffuse coronary artery disease (EnD-CAD) unsuitable for coronary intervention remains a clinical challenge. They usually express refractory angina and have high risk for mortality. Although growing data have indicated cell therapy is an alternative solution to medical or invasive therapy, there are still lacking useful markers to predict whether heart function will improve in the EnD-CAD patients who underwent circulatory-derived CD34+ cell therapy. By utilizing the baseline variables and results from our previous phase I/II clinical trials, the aim of this study tried to elucidate the variables predictive of the “good response” to CD34+ cell therapy.Methods: This retrospective study included 38 patients in the phase I clinical trial (2011-2014), and 30 patients in the phase II clinical trial (2013-2017). These patients were categorized into “good responders” and “non-responders” according to their 1-year improvement of LVEF ≥7.0% or <7.0% after intracoronary CD34+ cell therapy. Univariate and multivariate logistic regression model was performed to identify potential independent predictors of good responder to cell therapy, followed by Hosmer–Lemeshow (H-L) test for goodness of fit and prediction power.Results: Among baseline data, multivariate analysis demonstrated that history of former smoker was independently predictive of good responders (p=0.006). On the other hand, male gender, the baseline Canadian Cardiovascular Society angina score ≥3 and grades of LV diastolic dysfunction ≥2 were significantly negative predictors of good responders (all p<0.01). After administration of subcutaneous granulocyte-colony stimulating factor (G-CSF), a higher post-G-CSF neutrophil count in addition to the above four baseline variables played crucial roles in early prediction of good response to CD34+ cell therapy for EnD-CAD (all p<0.03). The H-L test displayed a good prediction power with sensitivity 83.3%, specificity 85.3% and accuracy 84.4%. Conclusions: Using the results of our phase I/II clinical trials, previous smoking habit, female sex, lower grades of angina score and diastolic dysfunction were identified to be independently predictive of “good response” to CD34+ cell therapy in the patients with EnD-CAD.Trial registration: This is a retrospective analysis based on the phase I (ISRCTN72853206) and II (ISRCTN26002902) clinical trials
Comparisons of acromiohumeral distance measurements between two- and three-dimensional imaging and between the supine and standing positions
Authors: Yoshida Yuki , Matsumura Noboru , Yamada Yoshitake , Yamada Minoru , Yokoyama Yoichi , Matsumoto Morio , Nakamura Masaya , Nagura Takeo , Jinzaki Masahiro 
Published: June 2020

Abstract
Background
Narrowing of the acromiohumeral distance (AHD) implies a rotator cuff tear. However, AHD measurements on two-dimensional (2D) imaging or with the patient in the supine position might differ from that while standing during daily activity. This study aimed to accurately measure the distance between the acromion and the humeral head on three-dimensional (3D) imaging acquired in the standing position and to compare this with AHD measurements made on images acquired in the supine position and on 2D images.
Methods
Computed tomography (CT) images of 166 shoulders from 83 healthy volunteers (31 male and 52 female; mean age 40.1 ± 5.8 years; age range, 30–49 years) were prospectively acquired in the supine and standing positions using conventional and upright CT scanners, respectively. AHD was calculated as the minimum distance between the acromion and the humeral head on the 3D surface models. Two-dimensional AHD was measured on anteroposterior digitally reconstructed radiographs images. The AHD values were compared between the supine and standing positions and between the 2D and 3D measurements.
Results
The mean values of 2D AHD were 8.8 ± 1.3 mm (range, 5.9–15.4 mm) in the standing position and 8.1 ± 1.2 mm (range, 5.3–14.3 mm) in the supine position. The mean values of 3D AHD were 7.3 ± 1.4 mm (range, 4.7–14.0 mm) in the standing position and 6.6 ± 1.2 mm (range, 4.4–13.7 mm) in the supine position. The values of 3D AHD were significantly lower than those of 2D AHDs in both the standing and supine positions (P < 0.001). The values of 2D and 3D AHDs were significantly lower in the supine position than in the standing position (P < 0.001).
Conclusions
The present results indicated that assessments in the supine position can underestimate the value of the AHD compared with those made in the standing position and that assessments using 2D analysis can overestimate the value. It is necessary to understand that the anatomical distance of the subacromial space changes with images and gravity.
Contribution of Root Respiration to Total Soil Respiration During the Non-growth Seasonin Mine Reclaimed Soil With Different Covering Soil Thicknesses
Authors: Chen Min , Chen Xiaoyang , Hu Zhiyong , Fan Tingyu , Zhang Shiwen , Liu Ying 
Published: June 2020

Abstract
An accurate assessment of root respiration in mine reclaimed soil is important for effectively evaluating mining area ecosystem. This study investigated dynamic changes in root respiration and contribution of root respiration to total soil respiration (Rr/Rt ratio) during the non-growth season in mine reclaimed soil with different covering soil thicknesses. According to covering soil thicknesses, the study area was divided into four sites: 10-25 cm (site A), 25-45 cm (site B), 45-55 cm (site C) and 55-65 cm (site D). From November 2017 to April 2018 (except February in 2018), the soil respiration, root respiration, temperature at 5 cm, water content and root biomass were measured. The results showed thatsoiltemperature and root respiration exhibited similar diurnal and monthly variations. The root respiration was strongly influenced by soil temperature during the non-growing season, which showed an exponential and positive relationship with soil temperature (P<0.001). The root respiration varied withthe covering soil thickness and was the greatest with the covering soil thickness at 25–45 cm.The Rr/Rt ratio also exhibited monthly variations. During the non-growth season, the mean value of the Rr/Rt ratio were 51.15% in mine reclaimed soil. The study indicated that root respiration was the primary source of soil respiration and important to estimate the potential of emission of soilCO2 at regional scale inmine reclaimed soil.
Different Impacts of the zero-markup drug policy on county general and traditional Chinese medicine hospitals: Evidence from Shandong province, China
Authors: Jiang Xiaofeng , He Ping , Zhu Dawei , Shi Xuefeng , Meng Qingyue 
Published: June 2020

Abstract
BackgroundAs a key part of the new round of health reform, the zero-markup drug policy (ZMDP) removed the profit margins of drug sales at public health care facilities, and had some effects to the operation of these institutions. This study aims to assess whether the ZMDP has different impacts between county general and traditional Chinese medicine (TCM) hospitals.MethodsWe obtained longitudinal data from all county general and TCM hospitals of Shandong province in 2007-2017. We used difference-in-difference (DID) method to identify the overall and dynamic effects of the ZMDP.ResultsOn average, after the implementation of the ZMDP, the share of revenue from medicine sales reduced by 16.47% and 10.42%, the revenue from medicine sales reduced by 24.04% and 11.58%, in county general and TCM hospitals, respectively. The gross revenue reduced by 5.07% in county general hospitals. The number of annual outpatient visits reduced by 11.22% in county TCM hospitals. Government subsidies increased by 199.22% and 89.3% in county general and TCM hospitals, respectively. The ZMDP reform was not significantly associated with the revenue and expenditure surplus, the number of annual outpatient visits and the number of annual inpatient visits in county general hospitals, the gross revenue, the revenue and expenditure surplus and the number of annual inpatient visits in county TCM hospitals. In terms of dynamic effects, the share of revenue from medicine sales, revenue from medicine sales, and gross revenue decreased by 20.20%, 32.58% and 6.08% respectively, and up to 28.53%, 63.89% and 17.94% after adoption, while government subsidies increased by around 170% to 200% in county general hospitals. The number of annual outpatient visits decreased by 9.70% and up to 18.84% in county TCM hospitals.ConclusionThe ZMDP achieved its some initial goals of removing the profits from western medicines in county hospitals’ revenue without disrupting the normal operation, and had different impacts between county general and TCM hospitals. Meanwhile, some unintended consequences were also recognized through the analysis, such as the decline of the utilization of the TCM.
Unmet need for health services among refugees and asylum seekers in Thailand, relative to the Thai population: an analytic cross sectional study, 2019
Authors: Suphanchaimat Rapeepong , Sinam Pigunkaew , Phaiyarom Mathudara , Pudpong Nareerut , Julchoo Sataporn , Kunpeuk Watinee , Thammawijaya Panithee 
Published: June 2020

Abstract
BackgroundAlthough the Thai government has introduced policies to promote health of migrants, it is still the case that urban refugees and asylum seekers (URAS) seem to be neglected. This study aimed to explore the degree of healthcare access through the perspective of unmet need in URASs, relative to the Thai population.MethodsA cross-sectional survey, using a self-reporting questionnaire adapted from the Thai Health and Welfare Survey (HWS), was performed in late 2019, with 181 URASs attending the survey. The samples were randomly selected from the roster of the Bangkok Refugee Center. The data of the URAS survey were combined with data of the Thai population (n=2,941) from the HWS. Unmet need for health services was defined as the status of when a respondent needed healthcare in the past twelve months but failed to receive it. Bivariate analysis was conducted to explore the demographic and unmet need difference between URASs and Thais. Multivariable logistic regression and mixed-effects (ME) model were performed to determine factors associated with unmet need.ResultsOverall, URASs were of lower age, less educated and living in more economically deprived households, compared with Thais. About 98% of URASs were uninsured by any of the existing health insurance schemes. The prevalence of unmet need among URASs was significantly higher than Thais in both outpatient (OP) and inpatient (IP) services (54.1% versus 2.1% and 28.0% versus 2.1%, respectively). Being uninsured demonstrated the greatest degree of association with unmet need, especially for OP care. The association between insurance status and unmet need was more pronounced in ME model, relative to multivariable logistic regression. URASs migrating from Arab nations suffered from unmet need to a greater extent, compared with those originating from non-Arab nations.ConclusionThe prevalence of unmet need in URASs was drastically high, relative to the prevalence in Thais. Factors suggesting a positive relationship with unmet need included advanced age, lower education achievement, and, most evidently, being unsinured. Policy makers should consider a policy option to enrol URASs in the nationwide public insurance scheme to create health security for the entire Thai society.