bluuebunny/crossref_metadata_2025_split huggingface dataset:
Differences in the Assessed Performance of Medical Interns in a Comparison of Competency-based and Subject-based Curricula: a Qualitative Study
Authors: Prihatiningsih Titi Savitri , Utomo Prattama Santoso , Nurrokhmanti Hikmawati , Claramita Mora , Scherpbier Albert 
Published: April 2021

Abstract
Background: An internship is a transitional training period a medical school graduate undertakes prior to attaining full registration as a medical doctor. Numerous studies have shone a light on the unpreparedness of medical school graduates for the realities of medical practice. Implementation of a competency-based curriculum (CBC) is thought to produce better prepared medical graduates because this curriculum is more structured and integrated; moreover, learning outcomes, the learning process, and assessment are better aligned in the cognitive, affective, and psychomotor domains. During 2006–2011, Indonesia conducted a nation-wide reform shifting to a CBC from a subject-based curriculum (SBC) and launched an internship program in 2013. This study aimed to compare the performances of medical interns training under these two different curricula. Methods: This study was conducted in Yogyakarta Province, involving six supervisors and six interns from six different types of district hospitals. Qualitative, semi-structured interview methods, and thematic analysis were applied. Results: In total, 1,296 initial codings were identified and grouped under the following topics: overall experience (327), effective communication (97), scientific foundation (47), clinical skills (48), information management (23), management of health problems (194), self-insight and professional development (351), and professionalism (209). Eighteen themes emerged, namely understanding the internship, authority, practice context, interprofessional communication, patient communication, cultural awareness in communication, gap and fulfillment in clinical skills, knowledge gap and enhanced knowledge, assumption of a General Practitioner role, progression to profiency, information literacy, internal motivation, learning opportunities, constructive feedback, transition, and working culture. There were irregular patterns of performance from both of the CBC and SBC interns. Interestingly, compared with the SBC group, the CBC group revealed less confidence and assertiveness in handling patients. This group also lacked communication skills when interacting with nurses and patients alike. Moreover, the SBC group demonstrated the ability to learn and adapt quickly to the working environment. Neither group paid much attention to information literacy. Conclusion: We cannot conclude that a CBC would yield better prepared medical graduates. The results of this study showed irregular patterns in eight areas. Hospital contexts and variation in the characters of interns might have contributed to this irregularity. More exposure to the working context and greater contributions from the healthcare system are recommended in the medical curriculum, whether it be a CBC or a SBC. WC:338
Two Novel Esterases from Deep-Sea Sediment Reveal Key Residues for Thermostability
Authors: Ding Yi , Yang Xiao-chen , Huo Ying-yi , Jian Shu-ling , Xu Xue-we , Cui Heng-lin , Wu Yue-hong 
Published: April 2021

Abstract
Thermostability is one of the major concerns in the industrial application of enzymes. In this study, two novel family IV esterases, Est2 and Est4, were identified from a deep-sea sediment metagenomic library. The two enzymes had high amino acid sequence identity (96%) with only twelve different residues. Characteristic analysis indicated that both enzymes shared most of the enzymatic properties, including optimum p-nitrophenyl substrates (p-nitrophenyl butyrate and hexanoate), temperature (40°C) and pH (7.0–8.0). Interestingly, Est2 showed higher thermostability at 50°C than Est4. Mutagenesis analysis of Est2 identified two out of twelve differential amino acids, Asp18 and Lys289, that were crucial for the thermostability of the enzymes. Asp18 determined both the thermostability and catalytic activity of Est2. Structural analysis showed that Asp18 was located at the cap domain of Est2 and might be involved in the mobility of the cap domain. Lys289, located at the surface of Est2, determined the discrepancy in the surface potential between the two enzymes. Our results provide inspiration for research on the thermostability of esterases and improve the application potential of deep sea-derived esterases in industrial production.
Research on functional boards and plastic films based on animal skin and hydroxyapatite
Authors: Zhang Jiaxing , Chen Zhijun , Long Zhongzhen , Shan Zhihua 
Published: April 2021

Abstract
Nano-Hydroxyapatite precursors with calcium and phosphorus salts (Ca/P = 1.67) were introduced into a three-dimensional collagen network matrix (3DCM) based on goat skin pretreated with glutaraldehyde for in situ growth, and a functional HAG-3DCM board was obtained. After plasticity compression, a transparent protein plastic film was formed. Response surface methodology based on plasticity pressure conditions was used, and the strength, hardness and water resistance of the HAG-3DCM plastic film was significantly improved. This study demonstrates a new approach for the preparation of animal skin materials with new application value.
Neonatal Nursing Led Research Activity in the UK: A Survey of Current Practice
Authors: Gallagher Katie , Petty Julia , Cooper Joanne , Marlow Neil 
Published: April 2021

Abstract
Background: Neonatal nurses are ideally placed in practice to undertake research enhancing the care of families. More information is required, however, around neonatal nursing led research to advance leadership in this area. The aim of this study was to determine neonatal nursing led research activity within the UK. Methods: The study used a web-based survey design and neonatal nurses were eligible if they were working at or towards Masters or Doctoral level qualification in the UK. The survey was distributed to members of the Neonatal Nurses Association, UK Schools of Nursing and shared on social media pages of authors and professional organisations. Results were analysed using descriptive and frequency statistics and content analysis. Results: Of the 56 respondents, 14% (n=8) had a Doctoral level qualification and 43% (n=24) of participants held a Masters qualification. Lack of time and funding knowledge was the largest barrier to research. Only 30% (n=3) of participants had a research mentor and only 18% (n=3) were from a neonatal nursing background. Conclusions: There are limited numbers of neonatal nurses undertaking or leading nursing research in the UK. Further support is required to enhance clinical academic career trajectories to ensure research is a viable pathway for future generations of neonatal nurses.
Direct cost of management and clinical profile of severe malaria in Paediatric Hospital of Mbujimayi; Congo DR
Authors: Mbalabu Oshwa Badibengi , Tshibangu Evariste Kabamba , Disashi Guyslain Tumba , Mantshumba Jean Caurent Bikete , Bobanga Thierry Lengu 
Published: April 2021

Abstract
Background: Leading cause of morbidity and mortality of the Congolese child, malaria especially severe is so much a source of economic losses, both direct (related to curative treatment or prevention) and indirect (due to absenteeism or the decrease of productivity), non-negligible for Mbujimayi’s population whose majority lives below the poverty line.Methods: This prospective study related to the direct cost of in-hospital hold in charge of severe malaria among children of 6 to 59 months, as well as the factors influencing it, was undertaken from July 01, 2012 to June 30, 2013 in the Provincial Hospital Dipumba. Consultation, laboratory tests, medication and hospitalization were the components of the direct cost. EPI Info and SPSS software were used to analyse data. Results: Severe malaria accounted for 70.9% of admissions (534 of 753). The subject was generally male (55.1%), under 3 years of age (28.6±17.5 months), having received no correct anti-malarial treatment before admission (81.5%), brought urgently in serious condition (95.5%), subjected to a low rate of laboratory tests (4.8±1.6) and treated mainly with quinine infusion (93.25%). Recovery amounted to 79.2% against 7.3% of deaths most often early. The majority of affected households (81.5%) were very poor as earning less than $ 30/month. The mean direct cost of the hold in charge of a severe malaria episode rose to US $ 38.6±11.2 (range US $ 8.5-79.94) of which 74% were bound to medication, 11% to consultation, 8% to hospitalization and 7% to laboratory tests. Age, quality of treatment before admission, severity at admission, severe anaemia and disease outcome were the factors influencing this direct cost.Conclusion: Malaria is a costly disease in relation to the standard of living of our population and severe malaria is the main reason for hospitalization among children aged 6 to 59 months. It is necessary to reinforce management capabilities of cases correctly and early so much at home that in hospital and to streamline medical prescriptions in order to reduce costs led by malaria.
Micro- and Macrocirculatory Effects of Landiolol: A Double-Blind, Randomized Study Following Cardiac Surgery
Authors: Ferraris Arnaud , Jacquet-Lagrèze Matthias , Cazenave Laure , Fornier William , Jalalzai Wajma , Rousseau-Saine Nicolas , Allaouchiche Bernard , Junot Stephane , Pozzi Matteo , Fellahi Jean-Luc 
Published: April 2021

Abstract
Background: Postoperative atrial fibrillation (POAF) increases morbidity and mortality after cardiac surgery. Landiolol, a selective ultra-short-acting betablocker has been recently suggested to prevent POAF in the cardiac surgical setting with a good safety profile. Micro- and detailed macrocirculatory effects of landiolol remain however largely unknown in that setting.Methods: We conducted a prospective, randomized, double-blind study versus placebo in patients undergoing conventional cardiac surgery. Incremental doses of intravenous landiolol from 0.5 to 10 μg-1.kg-1.min-1 or placebo were administrated postoperatively. Microcirculatory variables were assessed by both peripheral near-infrared spectroscopy (NIRS) in combination with a vascular occlusion test and sublingual videomicroscopy. Macrocirculatory variables were obtained from transpulmonary thermodilution and transthoracic echocardiography. Results: Fifty-nine adult patients were allocated to the landiolol group (n=30) or the placebo group (n=29) from January to November 2019. Heart rate significantly decreased in the landiolol group (P<0.01) whereas mean arterial pressure (P=0.05) and stroke volume (P=0.63) were not significantly modified throughout the study. No modification was found in left and right systolic and diastolic ventricular functions except a significant increase in E/A ratio in the landiolol group (P=0.02). No difference was evidenced between groups in microcirculatory parameters at any landiolol dose. POAF occurred in 9 (32%) vs. 5 (17%) patients in placebo and landiolol groups, respectively (P=0.28). Conclusions: Postoperative incremental doses of landiolol up to 10 μg-1.kg-1.min-1 are efficacious to control heart rate without significant alterations in both micro- and macrocirculation following conventional cardiac surgery.
WITHDRAWN: Intrathecal methotrexate combination with systemic chemotherapy in glioblastoma patients with leptomeningeal metastases
Authors: kang xun , Chen Feng , Kang Zhuang , Wang Ce , Yang Shoubo , Wang Yali , Qian Zenghui , Li Yan , Li Shan , Chen Jianxin , Lin Hao , Fang Aizhong , Lin Yi , Jiang Bo , Li Parker , Peng Yichen , Wang Xiaomin , Li Wenbin 
Published: April 2021

Abstract
Purpose
Glioblastoma (GBM) is the most common and aggressive primary malignant brain tumor with a bad outcome. Leptomeningeal disease (LMD) is a severe complication of GBM, with a worse outcome and have no effective treatment. A combination chemotherapy was conducted to evaluated the effective of GBM patients with LMD.
Methods
A retrospective analysis was conducted of GBM patients diagnosed with LMD between January 2012 and December 2019 in our institution. All these patients accepted at least one cycle of combination therapy combination intrathecal methotrexate(MTX) with systemic chemotherapy. Clinical and pathological data were analyzed to explore the effective treatment and the outcome of GBM patients with LMD.
Results
Twenty-six patients were enrolled in this study. The median time from GBM diagnosis to LMD development was 9.3 months (range 2–59 months). The median overall survival of LMD patients from diagnosis after accepted systemic chemotherapy combination with intrathecal methotrexate was 10.5 months (range 2–59 months). In the Cox univariate analysis, gross resection of tumor (p = 0.022), KPS༞60 (p = 0.002) and Ommaya reservoir implantation (p༜0.001) were correlated with survival. Multivariate analysis showed that KPS༞60 (p = 0.037) and Ommaya reservoir implantation (p = 0.014) were positive factors correlated with survival. The common toxicities of combination therapy were myelotoxicity and gastrointestinal reactions. According to Common Terminology Criteria of Adverse Events 4.03, most of the toxicities were less than grade 3.
Conclusion
Intrathecal methotrexate combined with systemic chemotherapy is an effective treatment for GBM patients with LMD and has mild treatment-related side effects.
Serial Changes in Cardiac Sympathetic Nervous Function After Transcatheter Aortic Valve Replacement: A Prospective Observational Study Using 123I-meta-iodobenzylguanidine Imaging
Authors: Kadoya Yoshito , Zen Kan , Tamaki Nagara , Nakamura Shunsuke , Fujimoto Tomoki , Yashige Masaki , Takamatsu Kazuaki , Ito Nobuyasu , Yamano Michiyo , Yamano Tetsuhiro , Nakamura Takeshi , Kawajiri Hidetake , Numata Satoshi , Yaku Hitoshi , Matoba Satoaki 
Published: April 2021

Abstract

Purpose:Transcatheter aortic valve replacement (TAVR) can rapidly improve cardiac sympathetic nervous function (CSNF) within 2 weeks in patients with aortic stenosis (AS). However, it remains unclear whether such short-term improvements will be sustained thereafter. The present study aimed to investigate the mid-term (i.e., 6–12 months) effects of TAVR on CSNF in patients with severe AS using 123I-meta-iodobenzylguanidine (MIBG) imaging.Methods:Patients with severe AS who were scheduled to undergo TAVR between October 2017 and June 2019 were enrolled in this single-centre, prospective, observational study. MIBG imaging was performed at baseline, within 2 weeks after TAVR, and at 6–12 months post-TAVR to evaluate the heart–mediastinum ratio (H/M) and washout rate (WR). Differences between each MIBG parameter at three time points were analysed, and factors involved in the long-term improvement in the late H/M were investigated. Results:Of 183 consecutive patients, 75 (19 men; median age: 86 years) were evaluated. The late H/M significantly improved within 2 weeks after TAVR (P=0.041) and further improved over 6–12 months after TAVR (P=0.041). The WR rapidly improved immediately after TAVR (P=0.003) but remained unchanged at 6–12 months (P=0.827). Multivariate analysis revealed that the baseline mean aortic valve pressure gradient (mPG) was an independent predictor of mid-term improvement in the late H/M (>0.1) (adjusted odds ratio: 0.035; 95% confidence interval: 0.004–0.070; P=0.037). Patients with a high baseline mPG (≥58 mmHg) exhibited a significantly greater increase in the late H/M than those with a low baseline mPG (<42 mmHg) (0.24 vs. 0.01; P=0.029).Conclusions:CSNF, as denoted by the late H/M, demonstrated sustained improvement from within 2 weeks after TAVR until 6–12 months later. Such improvement was related to baseline hemodynamic AS severity.
The understanding of control in patients with advanced cancer. An interpretative phenomenological study
Authors: Rodríguez-Prat Andrea , Pergolizzi Denise , Crespo Iris , Balaguer Albert , Porta-Sales Josep , Monforte-Royo Cristina 
Published: April 2021

Abstract
Background

In the context of life-threatening illness, loss of control is argued as a source of suffering and loss of perceived dignity, whereas having control over the dying process has been seen as a way of maintaining personal independence. Little is known about meaning of control since the patients’ perspective. Thus, the aim of this study was to explore the meaning of control from the perspective of patients with advanced cancer.
Methods

We conducted semi-structured qualitative interviews using an interpretive phenomenological analysis approach. Eight patients with advanced cancer from an oncology unit and a palliative care unit from Barcelona (Spain) were interviewed.
Results

Two themes emerged: 1) factors that influence the perception of control, with subthemes: uncertainty about future suffering, personality traits underlying a need for control; patient-medical interactions; and 2) perceiving control over an uncontrollable illness, explained by perceived control over subjective wellbeing and relinquishing control through coping strategies.
Conclusions

This study allowed us to understand what control means to advanced cancer patients. The data allowed us to identify strategies that promote a sense of control in these patients. The illness, according to the participants, was experienced as series of losses. However, attention was often focused on areas where they continued to have control. Future research should address how both family members and healthcare professionals can help to empower patients.
Title page Title Perspectives on COVID-19 testing policies and practices: a qualitative study with scientific advisors and NHS health care workers in England
Authors: Martindale Anne-Marie , Pilbeam Caitlin , Mableson Hayley , Tonkin-Crine Sarah , Atkinson Paul , Borek Aleksandra , Lant Suzie , Gobat Nina , Solomon Tom , Sheard Sally 
Published: April 2021

Abstract
Background As COVID-19 death rates have risen and health-care systems have experienced increased demand, national testing strategies have come under scrutiny. Utilising qualitative interview data from a larger COVID-19 study, this paper provides insights into influences on and the enactment of national COVID-19 testing strategies for health care workers (HCWs) in English NHS settings during wave one of the COVID-19 pandemic (March-August 2020). We aim to inform COVID-19 learning and future pandemic diagnostic preparedness.Methods A remote qualitative, semi-structured longitudinal interview method was employed with a purposive snowball sample of senior scientific advisors to the UK Government on COVID-19, and HCWs employed in NHS primary and secondary health care settings in England. 24 interviews from 13 participants were selected from the larger project dataset. Framework analysis was informed by the non-adoption, abandonment, scale-up, spread, and sustainability of patient-facing health and care technologies implementation framework (NASSS) and by normalisation process theory (NPT).Results Our account highlights tensions between the communication and implementation of national testing developments; scientific advisor and HCW perceptions about infectiousness; and uncertainties about the responsibility for testing and its implications at the local level.Conclusions Consideration must be given to the implications of mass NHS staff testing, including the accuracy of information communicated to HCWs; how HCWs interpret, manage, and act on testing guidance; and the influence these have on health care organisations and services.
Benchmarking laboratory processes to characterise low-biomass respiratory microbiota
Authors: Hasrat Raiza , Kool Jolanda , Piters Wouter A.A. de Steenhuijsen , Chu Mei Ling J.N. , Kuiling Sjoerd , Groot James , Logchem Elske van , Fuentes Susana , Franz Eelco , Bogaert Debby , Bosch Thijs 
Published: April 2021

Abstract
The low biomass of respiratory samples makes it difficult to accurately characterise the microbial community composition. PCR conditions and contaminating microbial DNA can alter the biological profile. The objective of this study was to benchmark the currently available protocols to accurately analyse the microbial community of low biomass samples. To study the effect of PCR conditions on the microbial community composition, we amplified the 16S rRNA gene of respiratory samples using various DNA input and different number of PCR cycles. Libraries were purified by gel electrophoresis or AMPure XP and sequenced by V2 and V3 MiSeq reagent kits by Illumina sequencing. The positive control was diluted in different solvents. PCR conditions had no significant influence on the microbial community composition of low biomass samples. Purification methods and MiSeq reagent kits had only a modest impact on microbiota profiles, while profiles of positive controls were significantly influenced by type of dilution solvent. Microbiota profiles of low biomass samples can be accurately distinguished from DNA blanks. Microbiota profiling of low biomass samples is stable under several PCR conditions, purification methods and MiSeq reagent kits. We recommend to use amplification with 30 PCR cycles. The amplicon pools can best be purified by two consecutive AMPure XP steps and sequenced by V3 MiSeq reagent kit. The benchmarked standardized workflow presented here ensures comparability of results within and between low biomass microbiome studies.
A seq2seq model to forecast the COVID-19 cases, deaths and reproductive R numbers in US counties
Authors: Zhang-James Yanli , Hess Jonathan , Salkin Asif , Wang Dongliang , Chen Samuel , Winkelstein Peter , Morley Christopher P , Faraone Stephen V 
Published: April 2021

Abstract
The global pandemic of coronavirus disease 2019 (COVID-19) has killed almost two million people worldwide and over 400 thousand in the United States (US). As the pandemic evolves, informed policy-making and strategic resource allocation relies on accurate forecasts. To predict the spread of the virus within US counties, we curated an array of county-level demographic and COVID-19-relevant health risk factors. In combination with the county-level case and death numbers curated by John Hopkins university, we developed a forecasting model using deep learning (DL). We implemented an autoencoder-based Seq2Seq model with gated recurrent units (GRUs) in the deep recurrent layers. We trained the model to predict future incident cases, deaths and the reproductive number, R. For most counties, it makes accurate predictions of new incident cases, deaths and R values, up to 30 days in the future. Our framework can also be used to predict other targets that are useful indices for policymaking, for example hospitalization or the occupancy of intensive care units. Our DL framework is publicly available on GitHub and can be adapted for other indices of the COVID-19 spread. We hope that our forecasts and model can help local governments in the continued fight against COVID-19.