bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hierarchical structure in the activities of daily living and trajectories of disability prior to death in elderly Chinese individuals
Authors: Han Yaofeng , Xue Jihui , Pei Wei , Fang Ya 
Published: October 2021

Abstract
Background
The global burden of disability continues to increase. Understanding the hierarchical structure of activities of daily living (ADL) and the trajectories of disability of elderly individuals is pivotal to developing early interventions.

Purpose
To determine the hierarchical structure of the ability of Chinese elderly individuals to perform ADL and further describe the trajectories of disability prior to death.

Methods
Longitudinal item response theory model (LIRT) was constructed for 28,345 elderly participants in the Chinese Longitudinal Healthy Longevity Survey, in which ADL were measured using the Katz scale from 1998 to 2018, until the participants’ death. Two difficulty parameters (κ−partial and κ−total) were used in the LIRT defining the thresholds for hierarchical structure in ADL (κ−partial: no limitation to partial limitation, κ−total: partial limitation to totally limited). Disability values estimated from the LIRT were fitted to a mixed-effects model to examine the manner in which the trajectories of disability varied with different subject characteristics.

Results
The findings confirmed the earliest loss in the capability to perform ADL (bathing(κ-partial = − 1.396), toileting(κ-partial = − 0.904)) at the level of partial limitation, with an overlap of partial and totally limited (total bathing, partial dressing, partial transferring, total dressing, partial feeding, partial continence), and finally a total loss of capability for toileting, feeding, transferring, and continence (κ-total = 3.647). Disability trajectories varied with sex (β = 0.041, SE = 0.001), place of residence (β = 0.010, SE = 0.001), and marital status (β = 0.144, SE = 0.001). Females, individuals living in urban areas, and those who lived without a spouse had a poorer disability status.

Conclusion
The loss in the ability to perform ADL has a hierarchical structure. Subject characteristics affect trajectories of disability in the elderly Chinese population.
Conversion from mycophenolate mofetil to mizoribine in the early stages of BK polyomavirus infection could improve kidney allograft prognosis: a single-center study from China
Authors: Li Ping , Cheng Dongrui , Wen Jiqiu , Ni Xuefeng , Xie Kenan , Li Xue , Chen Jinsong 
Published: October 2021

AbstractBackgroundSome studies have suggested mizoribine (MZR) could inhibit the replication of BK polyomavirus (BKPyV). The purpose of this study was to explore whether conversion from mycophenolate mofetil (MMF) to MZR in the early stages of BKPyV infection can improve kidney allograft prognosis.MethodsTwenty-one kidney transplant recipients with BKPyV viruria/viremia and ten with BK polyomavirus-associated allograft nephropathy (BKPyVAN) received MZR conversion therapy were retrospectively identified. The clearance rate of urine and blood BKPyV DNA, change of serum creatinine (SCr), uric acid (UA), hemoglobin (HB), white blood cell (WBC), lymphocyte ratio, platelet (PLT), routine urinalysis, panel reactive antibody (PRA), and gastrointestinal disorders during follow-up of the 2 groups were evaluated and compared.ResultsAfter MZR conversion therapy, the clearance rate of urine and blood viral load in BKPyV viruria/viremia group were 85.7 and 100 %, while that in BKPyVAN were 40 and 87.5 %, respectively. Stable SCr were observed in all cases of BKPyV viruria/viremia group, while that of BKPyVAN was only 40 % (P < 0.001) and one even progressed to end-stage renal disease. The results of routine urinalysis in the two groups showed no significant changes before and after MZR conversion therapy. However, in BKPyV viruria/viremia group, four cases developed acute rejection and one had positive PRA-II but no donor specific antibody, requiring conversion back to MMF. Hyperuricemia was the common adverse effect of MZR.ConclusionsConversion from MMF to MZR could help clear BKPyV infection. As compared to BKPyVAN, patients who underwent initiation of MZR conversion therapy in the early stages of BKPyV infection maintained stable allograft function. Prospective studies with larger sample size are needed to ascertain this preliminary finding.
Perceptions and knowledge of telemedicine in Ecuadorian practicing physicians: an instrument adaptation, validation and translation from English to Spanish
Authors: Alvarado-Villa Geovanny , KuonYeng-Escalante Christian , Sagñay-Pinilla Nicolás , Vera Paz Carlos , Cherrez-Ojeda Ivan 
Published: October 2021

Abstract
Background
During the COVID-19 pandemic, multiple countries have taken measures, such as isolation and quarantine, to prevent person-to-person spread of disease. These actions forced many physicians to adopt new techniques, such as telemedicine, to continue patient care, which has proven to be useful in continued care for those with non-COVID-19 pathologies. Various factors, such as security, confidentiality, cost-effectiveness, comfort, and the risk of malpractice, influence the perception of telemedicine among medical practitioners. The aim of this study was to adapt an existing instrument and validate it into a new Spanish version. The instrument is about the perceptions and knowledge of telemedicine in healthcare professionals.

Methods
The original questionnaire surveyed 6 domains with 40 questions, and each question was measured with a five-point Likert scale ranging from very high [5] to very low [1]. The survey was translated to Spanish using machine translation. The translation was reviewed independently, and then, a consensus was achieved regarding minor changes in the syntax of the survey to facilitate understanding. After expert feedback and questionnaire review, the research team members proposed reducing the instrument to 13 items in 4 domains due to the similarity of some questions. The sample was divided into 2randomly selected groups. Eligibility criteria included physicians providing private or public services with active medical/clinical practice.

Results
In total, 382 surveys were collected and separated into two random samples, S1 and S2 (198 and 184, respectively). In exploratory factor analysis (EFA), the 13 items were grouped into four theoretical domains, and item 7 presented cross loading between factors and was removed. Confirmatory factor analysis was performed to assess the scale reliability and interscale associations; three models were tested. Global Cronbach’s alpha for internal consistency was 0.76 for the EFA. The goodness of fit measures root mean square error of approximation and comparative fit index were 0.009 and 0.999, respectively, for the best model.

Conclusions
The translated instrument was clear, with adequate internal consistency, readability, and appropriate for application in the physician setting. This validated questionnaire made it possible to evaluate physicians’ knowledge of telemedicine to increase its use, especially during the COVID-19 pandemic.
Comparison of machine learning algorithms applied to symptoms to determine infectious causes of death in children: national survey of 18,000 verbal autopsies in the Million Death Study in India
Authors: Idicula-Thomas Susan , Gawde Ulka , Jha Prabhat 
Published: October 2021

Abstract
Background
Machine learning (ML) algorithms have been successfully employed for prediction of outcomes in clinical research. In this study, we have explored the application of ML-based algorithms to predict cause of death (CoD) from verbal autopsy records available through the Million Death Study (MDS).

Methods
From MDS, 18826 unique childhood deaths at ages 1–59 months during the time period 2004–13 were selected for generating the prediction models of which over 70% of deaths were caused by six infectious diseases (pneumonia, diarrhoeal diseases, malaria, fever of unknown origin, meningitis/encephalitis, and measles). Six popular ML-based algorithms such as support vector machine, gradient boosting modeling, C5.0, artificial neural network, k-nearest neighbor, classification and regression tree were used for building the CoD prediction models.

Results
SVM algorithm was the best performer with a prediction accuracy of over 0.8. The highest accuracy was found for diarrhoeal diseases (accuracy = 0.97) and the lowest was for meningitis/encephalitis (accuracy = 0.80). The top signs/symptoms for classification of these CoDs were also extracted for each of the diseases. A combination of signs/symptoms presented by the deceased individual can effectively lead to the CoD diagnosis.

Conclusions
Overall, this study affirms that verbal autopsy tools are efficient in CoD diagnosis and that automated classification parameters captured through ML could be added to verbal autopsies to improve classification of causes of death.
The role of Sociodemographic factors on goal achievement in a community-based diabetes prevention program behavioral lifestyle intervention
Authors: Devaraj Susan M. , Napoleone Jenna M. , Miller Rachel G. , Rockette-Wagner Bonny , Arena Vincent C. , Mitchell-Miland Chantele , Saad Mohammed Bu , Kriska Andrea M. 
Published: October 2021

Abstract
Background
The Diabetes Prevention Program (DPP) behavioral lifestyle intervention was effective among a diverse sample of adults with prediabetes. Demonstrated effectiveness in translated versions of the DPP lifestyle intervention (such as Group Lifestyle Balance, DPP-GLB) led to widescale usage with national program oversight and reimbursement. However, little is known about the success of these DPP-translation programs across subgroups of sociodemographic factors. This current effort investigated potential disparities in DPP-translation program primary goal achievement (physical activity and weight) by key sociodemographic factors.

Methods
Data were combined from two 12-month community-based DPP-GLB trials among overweight/obese individuals with prediabetes and/or metabolic syndrome. We evaluated change in weight (kilograms and percent) and activity (MET-hrs/week) and goal achievement (yes/no; ≥5% weight loss and 150 min per week activity) after 6 and 12 months of intervention within and across subgroups of race/ethnicity (non-Hispanic white, non-Hispanic black), employment status, education, income, and gender.

Results
Among 240 participants (85%) with complete data, most sociodemographic subgroups demonstrated significant weight loss. However, non-Hispanic white lost more weight at both 6 and 12 months compared to non-Hispanic black participants [median weight loss (IQR), 6 months: 5.7% (2.7–9.0) vs. 1.5% (1.2–7.5) p = .01 and 12 months: 4.8% (1.1–9.6) vs. 1.1% (− 2.0–3.7) p = .01, respectively]. In addition, a larger percentage of non-Hispanic white demonstrated a 5% weight loss at 6 and 12 months. Employment was significantly related to 12-month weight loss, with retired participants being the most successful. Men, participants with graduate degrees, and those with higher income were most likely to meet the activity goal at baseline and 12 months. Differences in physical activity goal achievement across gender, education, and income groups were significant at baseline, attenuated after 6 months, then re-emerged at 12 months.

Conclusions
The DPP-GLB was effective in promoting weight loss and helped to alleviate disparities in physical activity levels after 6 months. Despite overall program success, differences in weight loss achievement by race/ethnicity were found and disparities in activity re-emerged after 12 months of intervention. These results support the need for intervention modification providing more tailored approaches to marginalized groups to maximize the achievement and maintenance of DPP-GLB behavioral goals.

Trial registration
NCT01050205, NCT02467881.
Weekly team-based learning scores and participation are better predictors of successful course performance than case-based learning performance: role of assessment incentive structure
Authors: Carrasco Gonzalo A. , Behling Kathryn C. , Lopez Osvaldo 
Published: October 2021

Abstract
Background
Incentives for preparation and participation in case-based (CBL) and team-based learning (TBL) differ by virtue of differences in assessment, allowing us to evaluate the role these incentives play in preparation and participation in these activities as well as overall course performance.

Methods
Weekly TBL and CBL participation and performance as well as performance on the course final examination were recorded. Student participation was quantified and correlated with: (1) CBL preparation, participation, teamwork and completion of learning objectives scores, and (2) TBL individual readiness assurance test (iRAT) scores.

Results
Student final examination scores (n = 95) were more strongly correlated with TBL than CBL performance. No significant correlation was found between iRAT and CBL scores. Student participation was measured in 3 CBL groups (8 students/group) and 4 TBL teams (6 students/team). TBL participation was more strongly correlated with final examination scores than CBL participation. TBL participation was also correlated with iRAT scores. CBL scores for preparation, participation, teamwork and completion of learning objectives did not significantly correlate with iRAT scores or TBL participation.

Conclusion
These results suggest that the assessment incentives and methods used in TBL result in student performance that better predicts performance on summative examinations.
Faculty perceptions of factors that indicate successful educational outcomes of medical students’ research projects: a focus group study
Authors: Möller Riitta , Wallberg Annika , Shoshan Maria 
Published: October 2021

Abstract
Background
A growing number of medical schools have individual scholarly projects as a component of their curricula. The fact that all students, and not only those with research interests, have to carry out a project puts high demands on the projects and their supervision. Evidence is lacking for how to produce scholarly projects with satisfactory outcomes. This study aimed to explore the observations of faculty teachers regarding factors that predict the educational outcomes of medical students’ scholarly projects.

Methods
Two focus group interviews were held with seven of the 16 faculty coordinators who were external reviewers of students’ research projects. The audio-recorded interview transcripts were analyzed using qualitative content analysis. We employed a constant comparative approach to create categories firmly grounded in the participants’ experiences. A successful project was defined as coordinators’ perception that the stated learning outcomes were achieved, in terms of students’ ability to demonstrate a scientific attitude.

Results
Five categories emerged from the data: Supervision, Project setup, Student characteristics, Curriculum structure, and Institutional guidance. The supervisors’ experience and availability to students were mentioned as key factors for successful outcomes. Further, a clear aim and adaptation to the time frame were stated to be project-related factors that were also supervisors’ responsibilities. Important student-related factors were skills related to scientific writing, taking ownership of and managing the projects, and making use of feedback. Finally, the course requirements, support, and control accomplished by faculty coordinators played important roles.

Conclusions
Contributing factors to achievement of the learning outcomes were supervisors’ commitment and experience, and the projects being suitable for the time frame and having a clearly stated research question. Furthermore, the students’ prowess at scientific writing, adequate handling of feedback, and ability to assume ownership of the project contributed to the final outcome, as did adherence to curricular instructions.
Process evaluation for the Care Homes Independent Pharmacist Prescriber Study (CHIPPS)
Authors: Birt Linda , Dalgarno Lindsay , Wright David J , Alharthi Mohammed , Inch Jackie , Spargo Maureen , Blacklock Jeanette , Poland Fiona , Holland Richard C , Alldred David P. , Hughes Carmel M. , Bond Christine M. ,   on behalf of the CHIPPS study team, Blyth Annie , Watts Laura , Daffu-O’Reilly Amrit 
Published: October 2021

Abstract
Background
Medicines management in care homes requires significant improvement. CHIPPS was a cluster randomised controlled trial to determine the effectiveness of integrating pharmacist independent prescribers into care homes to assume central responsibility for medicines management. This paper reports the parallel mixed-methods process evaluation.

Method
Intervention arm consisted of 25 triads: Care homes (staff and up to 24 residents), General Practitioner (GP) and Pharmacist Independent Prescriber (PIP). Data sources were pharmaceutical care plans (PCPs), pharmacist activity logs, online questionnaires and semi-structured interviews. Quantitative data were analysed descriptively. Qualitative data were analysed thematically. Results were mapped to the process evaluation objectives following the Medical Research Council framework.

Results
PCPs and activity logs were available from 22 PIPs. Questionnaires were returned by 16 PIPs, eight GPs, and two care home managers. Interviews were completed with 14 PIPs, eight GPs, nine care home managers, six care home staff, and one resident. All stakeholders reported some benefits from PIPs having responsibility for medicine management and identified no safety concerns. PIPs reported an increase in their knowledge and identified the value of having time to engage with care home staff and residents during reviews. The research paperwork was identified as least useful by many PIPs. PIPs conducted medication reviews on residents, recording 566 clinical interventions, many involving deprescribing; 93.8% of changes were sustained at 6 months. For 284 (50.2%) residents a medicine was stopped, and for a quarter of residents, changes involved a medicine linked to increased falls risk. Qualitative data indicated participants noted increased medication safety and improved resident quality of life. Contextual barriers to implementation were apparent in the few triads where PIP was not known previously to the GP and care home before the trial. In three triads, PIPs did not deliver the intervention.

Conclusions
The intervention was generally implemented as intended, and well-received by most stakeholders. Whilst there was widespread deprescribing, contextual factors effected opportunity for PIP engagement in care homes. Implementation was most effective when communication pathways between PIP and GP had been previously well-established.

Trial registration
The definitive RCT was registered with the ISRCTN registry (registration number ISRCTN 17847169).
Characterization of receptor tyrosine kinase activation and biological activity of toceranib phosphate in canine urothelial carcinoma cell lines
Authors: Korec Daniela I. , Louke Darian S. , Breitbach Justin T. , Geisler Jennifer A. , Husbands Brian D. , Fenger Joelle M. 
Published: October 2021

Abstract
Background
Urothelial carcinoma (UC) accounts for > 90% of canine tumors occurring in the urinary bladder. Toceranib phosphate (TOC) is a multi-target receptor tyrosine kinase (RTK) inhibitor that exhibits activity against members of the split kinase family of RTKs. The purpose of this study was to evaluate primary UC tumors and UC cell lines for the expression and activation of VEGFR2, PDGFRα, PDGFRβ, and KIT to assess whether dysregulation of these RTKs may contribute to the observed biological activity of TOC.

Results
Transcript for VEGFR2, PDGFRα, PDGFRβ, and KIT was detected in all UC tissue samples and UC cell lines. The Proteome Profiler™ Human Phospho-RTK Array Kit (R & D Systems) provided a platform to assess phosphorylation of 42 different RTKs in primary UC tumors and UC cell lines. Evidence of PDGFRα and PDGFRβ phosphorylation was present in only 11% or 33% of UC tumors, respectively, and 25% of UC cell lines. Treatment of UC cell lines with TOC had no significant impact on cell proliferation, including UC cell lines with evidence of PDGFRβ phosphorylation.

Conclusions
Phosphorylation of several key RTKs targeted by TOC is present in a small subset of primary UC tumors and UC cell lines, suggesting that these RTKs do not exist in a state of continuous activation. These data suggest that activation of RTKs targeted by TOC is present in a small subset of UC tumors and UC cell lines and that treatment with TOC at physiologically relevant concentrations has no direct anti-proliferative effect on UC cells.
Factors affecting improvement of neurologic status evaluated by Quantitative Myasthenia Gravis Score for patients with thymomatous myasthenia gravis after extended thymectomy
Authors: Haoshuai Zhu , Jianyong Zou , Lei Yang , Bo Zeng , Xiao Jiefei , Zhang Xin , Chen Zhenguang , Chunhua Su 
Published: October 2021

Abstract
Background
The length of time for clinical improvement of patients with thymomatous myasthenia gravis (MG) after extended thymectomy is not clear. The purpose of this study was to determine the length of time after thymectomy in patients with thymomatous MG to achieve a 3-point reduction of Quantitative Myasthenia Gravis Score (QMGS), and identify variables associated with a failure to achieve the reduction.

Methods
The records of patients with thymomatous MG who underwent extended thymectomy from January 2005 to December 2018 were retrospectively reviewed. The primary end point was a reduction of 3 points of QMGs and the secondary end point was another reduction of 3 points of QMGs.

Results
A total of 481 patients were included in the analysis, the mean age of the patients was 41.63 ± 8.55 years, and approximately 60% were male. The median time to achieve a 3 point decrease in QMGS was 6 months, and the median time to achieve another 3 point decrease was 30 months. Multivariable analysis indicated that age ≥ 42 years and Masaoka-Koga stage > I were associated with a lower probability of achieving a 3 point decrease in QMGS (HR = 0.55 and 0.65, respectively). Likewise, multivariable analysis indicated that age ≥ 42 years and Masaoka-Koga stage > I were associated with a lower probability of achieving a second 3 point decrease in QMGS (HR = 0.53 and 0.53, respectively).

Conclusions
In patients with thymomatous MG who receive thymectomy, age ≥ 42 years and Masaoka-Koga stage > I are associated with a worse prognosis and failure to achieve a 3 point decrease in QMGS.