bluuebunny/crossref_metadata_2025_split huggingface dataset:
Systematic review of specialist selection methods with implications for diversity in the medical workforce
Authors: Amos Andrew James , Lee Kyungmi , Sen Gupta Tarun , Malau-Aduli Bunmi S. 
Published: August 2021

Abstract
Purpose
There is growing concern that inequities in methods of selection into medical specialties reduce specialist cohort diversity, particularly where measures designed for another purpose are adapted for specialist selection, prioritising reliability over validity. This review examined how empirical measures affect the diversity of specialist selection. The goals were to summarise the groups for which evidence is available, evaluate evidence that measures prioritising reliability over validity contribute to under-representation, and identify novel measures or processes that address under-representation, in order to make recommendations on selection into medical specialties and research required to support diversity.

Method
In 2020–1, the authors implemented a comprehensive search strategy across 4 electronic databases (Medline, PsychINFO, Scopus, ERIC) covering years 2000–2020, supplemented with hand-search of key journals and reference lists from identified studies. Articles were screened using explicit inclusion and exclusion criteria designed to focus on empirical measures used in medical specialty selection decisions.

Results
Thirty-five articles were included from 1344 retrieved from databases and hand-searches. In order of prevalence these papers addressed the under-representation of women (21/35), international medical graduates (10/35), and race/ethnicity (9/35). Apart from well-powered studies of selection into general practice training in the UK, the literature was exploratory, retrospective, and relied upon convenience samples with limited follow-up. There was preliminary evidence that bias in the measures used for selection into training might contribute to under-representation of some groups.

Conclusions
The review did not find convincing evidence that measures prioritising reliability drive under-representation of some groups in medical specialties, although this may be due to limited power analyses. In addition, the review did not identify novel specialist selection methods likely to improve diversity. Nevertheless, significant and divergent efforts are being made to promote the evolution of selection processes that draw on all the diverse qualities required for specialist practice serving diverse populations. More rigorous prospective research across different national frameworks will be needed to clarify whether eliminating or reducing the weighting of reliable pre-selection academic results in selection decisions will increase or decrease diversity, and whether drawing on a broader range of assessments can achieve both reliable and socially desirable outcomes.
Evaluation of new endodontic tooth models in clinical education from the perspective of students and demonstrators
Authors: Yekta-Michael Sareh Said , Färber Christoph Maria , Heinzel Alexander 
Published: August 2021

Abstract
Background
The quality of root canal treatments performed by undergraduate students is often unsatisfactory questioning the current methods of teaching. Based on treatment errors made by students participating the endodontic courses at RWTH Aachen University (Germany), new radiopaque artificial root canal treatment models (DRSK RCT; incisor, premolar, molar) were designed and developed. The aim of the study was to evaluate these models by groups of students and demonstrators.

Methods
A total number of 60 students and seven demonstrators from a single institution (RWTH Aachen) participated in this study. They performed endodontic treatments on either initial versions of the DRSK RCT or modified versions. The initial versions were evaluated by students (n = 25) and demonstrators (n = 7). The obtained questionnaire was conducted as 7-point Likert-Scale covering the topics material properties, feeling while performing exercises and perception of its closeness to reality via 19 items (students) and 21 items (demonstrators). According to the evaluations several alterations were applied to the DRSK RCT, the whole study was repeated and evaluated by different students (n = 35) and the same demonstrators (n = 7). Additionally, the demonstrators blindly evaluated the quality of root canal treatments performed by the students (n = 35) on the modified DRSK RCT. Comparisons between the initial versions and the modified versions were calculated using Chi-squared tests.

Results
Students as well as demonstrators positively evaluated both variants of the DRSK RCT with especially high ratings in the overall evaluation. Students’ rating of the pulp anatomy significantly increased from 5.4 ± 1.1 (mean ± SD) to 5.9 ± 0.9 (mean ± SD; p < 0.05) for the modified model. Likewise, students felt that the ability to flare root canals improved after alterations have been applied. Ratings significantly increased from 4.8 ± 1.6 (mean ± SD) to 5.6 ± 1.0 (mean ± SD; p < 0.05).

Conclusion
The results indicate that the DRSK RCT is a promising candidate to be used as an alternative to extracted teeth or as an additional tool for improving dental education. However, some limitations of our analysis have to be considered.
Medical educators’ beliefs about learning goals, teaching, and assessment in the context of curriculum changes: a qualitative study conducted at an Iranian medical school
Authors: Karami Morteza , Hashemi Nooriyah , van Merrienboer Jeroen 
Published: August 2021

Abstract
Background
Achieving changing needs, advancing knowledge, and innovations in higher education require the constant changes of medical school curricula and successfully applying the new reforms requires some modifications in the medical educators’ core beliefs. The purpose of this study was to describe the medical educators’ beliefs about the alignment of the learning goals with teaching and assessment processes in the context of the curriculum changes.

Method
A qualitative method was used to study the medical educators’ beliefs through selecting the faculty participants via a purposeful sampling strategy. The study was conducted at a Medical School in Iran. For the individual interviews, we invited both the professors of the basic sciences and the clinical professors who had thought medical students for at least 5 years. Ten educators were interviewed.

Result
The results of the research showed that, in the professors’ viewpoints, the development of competencies in the students has been abandoned and this is due to the priority of treatment to education in the clinical courses and the limited learning experiences. Moreover, the gap between the content and the context and the attendance of the students in the hospitals instead of the clinics to pass their internship courses has reduced the provision of authentic learning experiences. These conditions have affected the quality of education negatively. The non-systematic assessment has also worsened the situation.

Conclusion
Despite the changes in the curriculum, the compartmentalization of the curriculum and the structure of the medical education have caused the professors’ beliefs to be in line with the past perspectives. Some modifications in the structure of the curriculum seem to be necessary.
The effect of a smartphone application on women’s performance and health beliefs about breast self-examination: a quasi-experimental study
Authors: Shakery Mitra , Mehrabi Manoosh , Khademian Zahra 
Published: August 2021

AbstractBackgroundBreast Self-Examination (BSE) is a simple and inexpensive method for early diagnosis of breast cancer. This study aimed to determine the effect of a smartphone application on women’s performance and health beliefs regarding BSE.MethodsIn this quasi-experimental study, 150 women referring to therapeutic clinics in Jahrom, Iran from December 2019 to May 2020 were randomly assigned to an intervention or a control group. The intervention group participants had access to a smartphone application including BSE reminder, training, alarm, and feedback to the therapist. The application also contained educational movies and self-assessment. The study data were collected using Champion’s Health Belief Model Scale and BSE information record form before and six months after the intervention. Then, the data were entered into the SPSS 21 software and were analyzed using descriptive statistics, paired t-test, independent t-test, Chi-square, ANCOVA, Mann–Whitney, and Wilcoxon tests.ResultsAfter the intervention, the largest number of BSEs was four times among 60% of the participants in the intervention group and once among 24% of the participants in the control group during four months (p = 0.001). After the intervention, the mean differences of the scores of perceived susceptibility (1.03 ± 2.65 vs. 0.01 ± 0.42, p = 0.001), BSE barriers (2.80 ± 5.32 vs.  0.04 ± 1.43, p = 0.001), self-efficacy (10.75 ± 7.63 vs. − 2.75 ± 2.44, p = 0.001), and health motivation (2.77 ± 3.70 vs. − 0.29 ± 0.63, p = 0.001) were significantly higher in the intervention group compared to the control group. However, no significant difference was observed between the two groups with regard to perceived severity and BSE benefits after the intervention.ConclusionsAccess to the smartphone application enhanced the participants’ performance and health beliefs regarding BSE in the areas of perceived susceptibility, self-efficacy, and health motivation. Therefore, we recommend using the same smartphone application to improve women’s performance and health beliefs regarding BSE.
Equity and access to maternal and child health services in Ghana a cross-sectional study
Authors: Anarwat Samuel George , Salifu Mubarik , Akuriba Margaret Atosina 
Published: August 2021

Abstract
Background
Inequities in the distribution of and access to maternal and child health care services is pervasive in Ghana. Understanding the drivers of inequity in maternal and child health (MCH) is important to achieving the universal health coverage component of the Sustainable Development Goals (SDGs) and poverty reduction in developing countries. However, there is increasing disparities in MCH services, especially in rural -urban, and income quintiles. The study aimed to examine the disparities in maternal and child health care services in Ghana for policy intervention.

Methods
Data for this study was extracted from the nationally representative Ghana Statistical Service (GSS) Multiple Indicator Cluster Survey (MICS) round 4, 2011. Respondents of this survey were women of reproductive age 15–49 years with a sample size of 10,627 households. The models were estimated using multivariate regression analysis together with concentration index (CI) and risk ratio (RR) to assess the distribution of MCH indicator groups across the household wealth index.

Results
The results show that women with secondary school level and above were more likely to receive family planning, prenatal care, and delivery by a skilled health professional than those without formal education. Mothers with low level of educational attainment were 87% more likely to have their first pregnancy before the age of 20 years, and 78% were more likely to have children with under-five mortality, and 45% more likely to have children who had diarrhoea. teenage pregnancy (CI = − 0.133, RR =0.679), prenatal care by skilled health worker (CI = − 0.124, RR =0.713) under five mortality, child underweight, reported diarrhoea, and suspected pneumonia, though not statistically significant, were more concentrated in the poorer than in the richer households, The RR between the top and bottom quintiles ranged from 0.77 for child underweight to 0.82 for child wasting.

Conclusion
Geographic location, income status and formal education are key drivers of maternal and child health inequities in Ghana. Government can partner the private sector to implement health policies to address inequalities in MCH services through primary health care, and resource allocation skewed towards rural areas and the lower wealth quintile to bridge the inequality gaps and improve MCH outcomes. The government and the private sectors should prioritize female education, as that can improve maternal and child health.
Restoring patient trust in healthcare: medical information impact case study in Poland
Authors: Lewandowski Roman , Goncharuk Anatoliy G. , Cirella Giuseppe T. 
Published: August 2021

Abstract
Background
This study empirically evaluates the influence of medical information on patient trust at the physician level, the medical profession, hospitals, and with the payer. Restoring patient trust in a medical setting in Poland appears to be significantly affected due to the COVID-19 pandemic. Patient trust improves results from medical treatment, raises perception of healthcare performance, and smoothens the overall functionality of healthcare systems.

Methods
In order to study trust volatility, patients took part in a three-stage experiment designed via: (1) measured level of trust, (2) randomly dividing participants into two groups—control (i.e., re-examination of level of trust) and experimental (i.e., being exposed to a piece of certain manipulative information), and (3) checking whether observational changes were permanent.

Results
Results indicate that in the experimental group the increase of trust was noticed in the payer (27.7%, p < 0.001), hospitals (10.9%, p = 0.011), and physicians (decrease of 9.2%, p = 0.036).

Conclusion
The study indicated that in Poland medical information is likely to influence patient trust in healthcare while interpersonal and social trust levels may be related to increases of trust in hospitals and in the payer versus decreases in physicians.
Starvation-induced cell fusion and heterokaryosis frequently escape imperfect allorecognition systems in an asexual fungal pathogen
Authors: Vangalis Vasileios , Likhotkin Ilya , Knop Michael , Typas Milton A. , Papaioannou Ioannis A. 
Published: August 2021

Abstract
Background
Asexual fungi include important pathogens of plants and other organisms, and their effective management requires understanding of their evolutionary dynamics. Genetic recombination is critical for adaptability and could be achieved via heterokaryosis — the co-existence of genetically different nuclei in a cell resulting from fusion of non-self spores or hyphae — and the parasexual cycle in the absence of sexual reproduction. Fusion between different strains and establishment of viable heterokaryons are believed to be rare due to non-self recognition systems. Here, we investigate the extent and mechanisms of cell fusion and heterokaryosis in the important asexual plant pathogen Verticillium dahliae.

Results
We used live-cell imaging and genetic complementation assays of tagged V. dahliae strains to analyze the extent of non-self vegetative fusion, heterokaryotic cell fate, and nuclear behavior. An efficient CRISPR/Cas9-mediated system was developed to investigate the involvement of autophagy in heterokaryosis. Under starvation, non-self fusion of germinating spores occurs frequently regardless of the previously assessed vegetative compatibility of the partners. Supposedly “incompatible” fusions often establish viable heterokaryotic cells and mosaic mycelia, where nuclei can engage in fusion or transfer of genetic material. The molecular machinery of autophagy has a protective function against the destruction of “incompatible” heterokaryons.

Conclusions
We demonstrate an imperfect function of somatic incompatibility systems in V. dahliae. These systems frequently tolerate the establishment of heterokaryons and potentially the initiation of the parasexual cycle even between strains that were previously regarded as “incompatible.”
The impact of malaria during pregnancy on low birth weight in East-Africa: a topical review
Authors: Bakken Line , Iversen Per Ole 
Published: August 2021

Abstract
Background
Globally, approximately 15% of all babies are born with low birth weight (< 2.5 kg) and ≥ 90% of them are born in low- and middle-income countries. Malaria infection in pregnancy remains a public health concern as it can affect both the mother and the newborn. Notably, it increases the risk of newborns with low birth weight. The World Health Organization (WHO) recommends intermittent preventive treatment with ≥ 3 doses of sulfadoxine-pyrimethamine (SP) during pregnancy in areas with moderate to high malaria transmission in Africa. The aim of this topical review is to give an overview of the impact of malaria infection during pregnancy on low birth weight, with focus on East Africa where malaria is endemic.

Methods
Eleven studies were selected according to a predefined set of criteria.

Results
Three studies showed a significant reduction in the prevalence of low birth weight with intermittent preventive treatment with SP, whereas four studies found no significant impact of such treatment on low birth weight. The number of SP doses and compliance to this treatment may in part explain these discrepancies. Pregnant women with frequent symptomatic malaria infection had significantly higher risk of placental malaria.

Conclusion
The WHO recommendation of ≥ 3 doses of intermittent preventive treatment with SP during pregnancy seem effective in preventing low birth weight, but treatment compliance is a challenge. Malaria prophylaxis is important during pregnancy, especially in endemic areas of malaria, such as East Africa.
Determinants of health-related quality of life in patients with celiac disease: a structural equation modeling
Authors: Nikniaz Zeinab , Asghari Jafarabadi Mohammad , Abbasalizad Farhangi Mahdieh , Shirmohammadi Masood , Nikniaz Leila 
Published: August 2021

Abstract
Background
We aimed to investigate the determinants of Health-related quality of life (HRQOL) in Iranian patients with celiac disease (CD) using the structural equation modeling (SEM).

Methods
In the present cross-sectional study, a total of 170 adult patients with CD were recruited. The information regarding adherence to diet, symptom severity, and HRQOL were collected using the celiac disease adherence test (CDAT), gastrointestinal symptom rating scale (GSRS), and SF-36 questionnaire respectively. Association between various studied variables and HRQOL was assessed using SEM. The standardized regression weights were used to assess total, direct and indirect effects. The model fit indices were used to assess the “goodness of fit” between the hypothesized models.

Results
The mean age of participants was 37.57 ± 9.59 years. The results of SEM indicated that the overall fit of our model was acceptable. Adherence to the diet, GSRS score, occupation, and education level was significantly related to PCS of SF-36; and adherence to the diet, GSRS score, and education level were significantly correlated with MCS of SF-36. The analysis of indirect associations indicated that only adherence to diet indirectly via GSRS score was significantly associated with PCS and MCS of SF-36.

Conclusion
In adult patients with celiac disease, HRQOL was associated with age, education, adherence to GFD, and GSRS score. Additionally, occupation and disease duration were associated with HRQOL only in women and men respectively.
Failure load of the femoral insertion site of the anterior cruciate ligament in a porcine model: comparison of different portions and knee flexion angles
Authors: Yamauchi Shohei , Ishibashi Kyohei , Sasaki Eiji , Sasaki Shizuka , Kimura Yuka , Ishibashi Yasuyuki 
Published: August 2021

Abstract
Background
This study compared the failure load of the femoral insertion site of the anterior cruciate ligament between different portions and knee flexion angles.

Methods
In total, 87 fresh-frozen, porcine knees were used in this study. Three knees were used for histological evaluation; the remaining 84 knees were randomly divided into 4 groups: anterior anteromedial bundle, posterior anteromedial bundle, anterior posterolateral bundle, and posterior posterolateral bundle groups (n=21 per group). The anterior cruciate ligament femoral insertion site was divided into these four areas and excised, leaving a 3-mm square attachment in the center of each bundle. Tibia-anterior cruciate ligament-femur complexes were placed in a material testing machine at 30°, 120°, and 150° of knee flexion (n=7), and the failure load for each portion was measured under anterior tibial loading (0.33 mm/s).

Results
Histological study showed that the anterior cruciate ligament femoral insertion site consisted of direct and indirect insertions. Comparison of the failure load between the knee flexion angles revealed that all the failure loads decreased with knee flexion; significant decreases were observed in the failure load between 30 and 150° knee flexion in the posterior anteromedial bundle and posterior posterolateral bundle groups. Comparison of the failure load according to different portions revealed a significant difference between the anteromedial and posterolateral bundle groups at 150° of knee flexion, but no significant difference among the groups at 30° of flexion.

Conclusions
Although the failure load of the posterior portion decreased significantly in the knee flexion position, it (mainly consisting of indirect insertion) plays a significant role against anterior tibial load in the knee extension position; this appears to be related to the characteristics of the insertion site. Reflecting the complex structure and function of the ACL, this study showed that the failure load of the femoral insertion site varies with differences in positions and knee flexion angles.
Water, sanitation, and hygiene as a priority intervention for stunting in under-five children in northwest Ethiopia: a community-based cross-sectional study
Authors: Ademas Ayechew , Adane Metadel , Keleb Awoke , Berihun Gete , Tesfaw Getu 
Published: August 2021

AbstractBackgroundStunting was a significant public health problem for under-five in developing countries including Ethiopia. Globally, it was estimated 21.9% or 149 million (81.7 million in Asia and 58.8 million in Africa) under-five children stunted in 2018. In East Africa, 24 million are stunted which is the highest-burden from African regions. Hence, this study aimed to assess the prevalence of stunting and its association with Water Sanitation and Hygiene (WASH) in northwestern Ethiopia.MethodA community-based cross-sectional study design was conducted among 630 participants from December to mid-January 2019. From five kebeles, two were selected by a simple random sampling technique for the study. To reach study participants a systematic sampling technique was used. Data were collected by using an observational checklist, pretested questionnaire, and anthropometric measurement. Anthropometric indicator, height-for-age was determined using the current World Health Organization (WHO) growth standards. Multivariable logistic regression analysis was computed to analyze the data. From the multivariable analysis the Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) andP-value < 0.05 were used to declare statistical significance.ResultThe prevalence of stunting among under-five children was 35.6% (95%CI; 31.9–39.5%). The result from this study showed that having illiterate father and mother, give birth before marriage (single), large family size, short maternal height, unimproved drinking water source, unimproved sanitation, poor hygienic practice, having diarrhea in the previous 2 weeks before the data collection, method of child feeding, age at which complementary feeding started, frequency of feeding, not deworming and mothers who had antenatal care visit of fewer than three times were statistically associated with stunting.ConclusionIn this study, stunting was an important public health problem among under-five children. It remains the same as the national average prevalence of Ethiopia. To alleviate this problem proper family planning utilization, good dietary intake, maternal and paternal education, and WASH interventions are critical.