bluuebunny/crossref_metadata_2025_split huggingface dataset:
Costs of hospital trauma team simulation training: a prospective cohort study
Authors: Rosqvist Eerika , Ylönen Marika , Torkki Paulus , Repo Jussi P , Paloneva Juha 
Published: June 2021

ObjectivesThis study investigated the costs of 2-hour multiprofessional in situ hospital trauma team simulation training and its effects on teams’ non-technical skills using the T-NOTECHS instrument.BackgroundSimulation is a feasible and effective teaching and learning method. Calculating the costs of simulated trauma team training in medical emergency situations can yield valuable information for improving its overall cost-effectiveness.DesignA prospective cohort study.SettingTrauma resuscitation room in Central Finland Hospital, Finland.Participants475 medical professionals in 81 consecutive, simulated trauma teams.Primary and secondary outcome measuresTeam simulation training costs in 2017 and 2018 were analysed in the following two phases: (1) start-up costs and (2) costs of education. Primary outcome measures were training costs per participant and training costs per team. Secondary outcome measures were non-technical skills, which were measured on a 5–25-point scale using the T-NOTECHS instrument.ResultsThe annual mean total costs of trauma team simulation training were €58 000 for 40 training sessions and 238 professionals. Mean cost per participant was €203. Mean cost per team was €1220. The annual costs of simulation training markedly decreased when at least 70–80 teams participated in the training. Mean change in T-NOTECHS score after simulation training was +2.86 points (95% CI 1.97 to 3.75;+14.5%).ConclusionsThe greater the number of teams trained per year, the lower the costs per trauma team. In this study, we developed an activity-based costing method to calculate the costs of trauma team simulation training to help stakeholders make decisions about whether to initiate or increase existing trauma team simulation training or to obtain these services elsewhere.
Extent of awareness and attitudes on plagiarism among post-graduate resident doctors and junior medical faculty in India: a cross-sectional, multicentric study
Authors: Raj Jeffrey Pradeep , Venkatachalam Shreeraam , Amaravati Rajkumar S , Siby Noel , Oommen Aswathy Maria , Jose Jesin Elsa , George Melvin , Ramraj Balaji , Penumutsa Vijay Subbaraju , Bodda Deepthi Rani , Rajad R , Reshmi R , Inbaraj Leeberk Raja , Rajiv S , Bhandare Basavaraj , Aiyappan Rajalakshmy , Mathew Philip , Saleem Ahammed K , Shetty Robin , Bhuvaneswari G , Suresh Kumar T , Prasanna B Lakshmi , Manderwad Guru Prasad 
Published: June 2021

ObjectivesThough dissertation is mandatory for postgraduates (PG), it is unknown if adequate knowledge on plagiarism exists at that level. Thus, we intended to study the knowledge and attitude towards plagiarism among junior doctors in India.DesignCross-sectional studySettingPG medical residents and Junior faculty from various teaching institutions across south India.ParticipantsA total of N=786 doctors filled the questionnaires of which approximately 42.7% were from government medical colleges (GMCs) and the rest from private institutions.MethodsParticipants were given a pretested semistructured questionnaire which contained: (1) demographic details; (2) a quiz developed by Indiana University, USA to assess knowledge and (3) Attitudes towards Plagiarism Questionnaire (ATPQ).Outcome measuresThe Primary outcome measure was knowledge about plagiarism. The secondary outcome measure was ATPQ scores.ResultsA total of N=786 resident doctors and junior faculty from across 11 institutions participated in this study. Of this, 42.7% were from GMCs and 60.6% were women. The mean (SD) knowledge score was 4.43 (1.99) out of 10. The factors (adjusted OR; 95% CI; p value) that emerged as significant predictors of knowledge were number of years in profession (−0.181; −0.299 to –0.062; 0.003), no previous publication (0.298; 0.099 to 0.498; 0.003) and working in a GMC (0.400; 0.106 to 0.694; 0.008). The overall mean (SD) scores of the three attitude components were: Permissive attitudes—37.33 (5.33), critical attitudes —20.32 (4.82) and subjective norms—31.05 (4.58), all of which corresponded to the moderate category.ConclusionParticipants lacked adequate knowledge on how to avoid plagiarism suggesting a need for a revamp in medical education curriculum in India by incorporating research and publication ethics.
Adjuvant effects of vitamin A and vitamin D supplementation on treatment of children with attention-deficit/hyperactivity disorder: a study protocol for a randomised, double-blinded, placebo-controlled, multicentric trial in China
Authors: Zhou Ping , Wolraich Mark Lee , Cao Ai-hua , Jia Fei-Yong , Liu Bin , Zhu Lin , Liu Yongfang , Li Xiaoli , Li Chao , Peng Bin , Yang Ting , Chen Jie , Cheng Qian , Li Tingyu , Chen Li 
Published: June 2021

IntroductionApproximately 7.2% of children in the world suffer from attention-deficit/hyperactivity disorder (ADHD). Due to the availability of the osmotic-release oral-system methylphenidate, ADHD currently has a remission rate of up to 30.72%. Nevertheless, it has been reported that patients with ADHD tend to exhibit vitamin A and vitamin D deficiency, which may aggravate the symptoms of ADHD. This study aims to determine the effect of vitamin A and vitamin D supplementation as adjunctive therapy to methylphenidate on the symptoms of ADHD.Methods and analysisThis is a parallel, prospective, interventional multicentric study. Patients will be enrolled from the southern, central and northern parts of China. A target of 504 patients will be followed for 8 weeks. They will be allocated into three groups (vitamin AD, vitamin D and placebo) and administered the interventions accordingly. Data on changes in the symptoms of ADHD as well as changes in the serum concentrations of vitamin A and vitamin D will be recorded. Both responders and nonresponders based on the sociodemographic and clinical data will also be described to mitigate selection bias.Ethics and disseminationThis study is performed in accordance with the Declaration of Helsinki and was approved by the Institutional Review Board of Children’s Hospital of Chongqing Medical University, China (approval number: (2019) IRB (STUDY) number 262). The results of the trial will be reported in peer-reviewed scientific journals and academic conferences regardless of the outcomes.Trial registration numberNCT04284059.
National cross-sectional cohort study of the relationship between quality of mental healthcare and death by suicide
Authors: Shiner Brian , Gottlieb Daniel J , Levis Maxwell , Peltzman Talya , Riblet Natalie B , Cornelius Sarah L , Russ Carey J , Watts Bradley V 
Published: June 2021

BackgroundPatient safety-based interventions aimed at lethal means restriction are effective at reducing death by suicide in inpatient mental health settings but are more challenging in the outpatient arena. As an alternative approach, we examined the association between quality of mental healthcare and suicide in a national healthcare system.MethodsWe calculated regional suicide rates for Department of Veterans Affairs (VA) Healthcare users from 2013 to 2017. To control for underlying variation in suicide risk in each of our 115 mental health referral regions (MHRRs), we calculated standardised rate ratios (SRRs) for VA users compared with the general population. We calculated quality metrics for outpatient mental healthcare in each MHRR using individual metrics as well as an Overall Quality Index. We assessed the correlation between quality metrics and suicide rates.ResultsAmong the 115 VA MHRRs, the age-adjusted, sex-adjusted and race-adjusted annual suicide rates varied from 6.8 to 92.9 per 100 000 VA users, and the SRRs varied between 0.7 and 5.7. Mean regional-level adherence to each of our quality metrics ranged from a low of 7.7% for subspecialty care access to a high of 58.9% for care transitions. While there was substantial regional variation in quality, there was no correlation between an overall index of mental healthcare quality and SRR.ConclusionThere was no correlation between overall quality of outpatient mental healthcare and rates of suicide in a national healthcare system. Although it is possible that quality was not high enough anywhere to prevent suicide at the population level or that we were unable to adequately measure quality, this examination of core mental health services in a well-resourced system raises doubts that a quality-based approach alone can lower population-level suicide rates.
Prognostic significance of competition ratios in surgical specialty training selection
Authors: Mellor Katie , Robinson David B , Luton Oliver , James Osian P , Powell Arfon G M T , Hopkins Luke , Hemington-Gorse Sarah , Egan Richard J , Lewis Wyn G 
Published: June 2021

AbstractBackgroundA competition ratio (CR) indicates the ratio of total applications for a training post when compared with numbers of specialty posts available. This study aimed to evaluate CRs’ influence on National Training Number (NTN) selection in a single UK Statutory Education Body.MethodsConsecutive core surgical trainees numbering 154 (105 men, 49 women; median years since graduation: four) were studied over a 6-year period. Annual specialty specific CRs were obtained from Health Education England's website, and primary outcome measure was UK NTN appointment.ResultsOverall NTN appointment was 45.5%. Median CR was 2.36; range Oral & Maxillofacial Surgery 0.70 (2020) to Neurosurgery 22.0 (2020). Multivariable analysis revealed that NTN success was associated with: CR (OR 0.46, p=0.003), a single scientific publication (OR 6.25, p=0.001), cohort year (2019, OR 12.65, p=0.003) and Universal Annual Review of Competence Progression Outcome 1 (OR 45.24, p&lt;0.001). CRs predicted NTN appointment with a Youden index defined critical ratio of 4.42; 28.6% (n=8) versus 49.2% (n=62), p=0.018.ConclusionCRs displayed 30-fold variation, with CRs below 4.42 associated with twofold better NTN promotion, but strong clinical competence and academic reach again emerged as the principal drivers of career advancement.
Comparison of the Effect of Alpha and Hydrocortisone Ointments on Prevention of Acute Skin Complications Due to Radiotherapy in Breast Cancer Patients
Authors: Rezaei Mansour , Khoshay Ahmad , Amirifard Nasrin , Goli Ali , Abdi Alireza 
Published: June 2021

Background. Radiotherapy in breast cancer patients is associated with acute and delayed side effects. This study aimed to compare the effect of alpha and hydrocortisone 1% (H1%) ointments on prevention of acute skin complications due to radiotherapy in breast cancer patients. Methods. This clinical trial was conducted on 86 patients with breast cancer in the radiotherapy center of Imam Reza Hospital of Kermanshah, Iran. Using the records, the patients were selected and randomly divided into alpha and H1% groups after obtaining informed consent. The severity of dermatitis, complications, and patient complaints during treatment were evaluated weekly for up to 6 weeks by RTOG criteria. Data were analyzed using SPSS-16 software. Results. At the end of the third, fourth, fifth, and sixth weeks, 10 (11.7%), 25 (29.1%), 53 (61.6%), and 28 (32.6%) patients had skin complications, respectively. In weeks 5 and 6 in the H1 group, the incidence of complications was higher (

P

= 0.001). The frequency of pain and burning complaints at the end of the third, fourth, fifth, and sixth weeks was 15 (17.4%), 37 (43.0%), 52 (60.5%), and 1(1.2%), respectively. Pain and burning intensity in the fourth and fifth weeks in the H1 group was lower than alpha (

P

= 0010). Complaints of skin itching at the end of the third, fourth, and fifth weeks were 16 (18.6%), 25 (29.1%), and 28 (32.6), respectively. This complication was lower in the H1% group during these weeks (

P

< 0.05). Conclusion. Alpha ointment is more effective than H1% in relieving pain and burning, preventing complications except itching. It seems using an alpha ointment or combining it with H1% is an appropriate strategy to reduce the rate of injuries and skin complications of radiotherapy.
An AIB1 Isoform Alters Enhancer Access and Enables Progression of Early-Stage Triple-Negative Breast Cancer
Authors: Sharif Ghada M. , Campbell Moray J. , Nasir Apsra , Sengupta Surojeet , Graham Garrett T. , Kushner Max H. , Kietzman William B. , Schmidt Marcel O. , Pearson Gray W. , Loudig Olivier , Fineberg Susan , Wellstein Anton , Riegel Anna T. 
Published: June 2021

Abstract

AIB1Δ4 is an N-terminally truncated isoform of the oncogene amplified in breast cancer 1 (AIB1) with increased expression in high-grade human ductal carcinoma in situ (DCIS). However, the role of AIB1Δ4 in DCIS malignant progression has not been defined. Here we CRISPR-engineered RNA splice junctions to produce normal and early-stage DCIS breast epithelial cells that expressed only AIB1Δ4. These cells showed enhanced motility and invasion in 3D cell culture. In zebrafish, AIB1Δ4-expressing cells enabled invasion of parental cells when present in a mixed population. In mouse xenografts, a subpopulation of AIB1Δ4 cells mixed with parental cells enhanced tumor growth, recurrence, and lung metastasis. AIB1Δ4 chromatin immunoprecipitation sequencing revealed enhanced binding to regions including peroxisome proliferator-activated receptor (PPAR) and glucocorticoid receptor (GR) genomic recognition sites. H3K27ac and H3K4me1 genomic engagement patterns revealed selective activation of breast cancer-specific enhancer sites by AIB1Δ4. AIB1Δ4 cells displayed upregulated inflammatory response genes and downregulated PPAR signaling gene expression patterns. In the presence of AIB1Δ4 enabler cells, parental cells increased NF-κB and WNT signaling. Cellular cross-talk was inhibited by the PPARγ agonist efatutazone but was enhanced by treatment with the GR agonist dexamethasone. In conclusion, expression of the AIB1Δ4-selective cistrome in a small subpopulation of cells triggers an “enabler” phenotype hallmarked by an invasive transcriptional program and collective malignant progression in a heterogeneous tumor population.

Significance:
A minor subset of early-stage breast cancer cells expressing AIB1Δ4 enables bulk tumor cells to become invasive, suggesting that selective eradication of this population could impair breast cancer metastasis.
The effectiveness of a combination of Occupational Therapy and Social Skills Training in people with schizophrenia: A rater-blinded randomized controlled trial
Authors: Ercan Doğu Selma , Kayıhan Hülya , Kokurcan Ahmet , Örsel Sibel 
Published: June 2021

Introduction This study aimed to assess the impact of a holistic combination of Occupational Therapy and Social Skills Training on occupational performance, social participation, and clinical symptoms in people with schizophrenia. Method 60 people with schizophrenia were randomly assigned to two groups. One group received standardized Social Skills Training once a week for a total of 10 sessions, while the other group received a combination of Occupational Therapy and Social Skills Training once a week for a total of 16 sessions. Results A greater increase was determined in the scores of COPM total performance/satisfaction and the Community Integration Questionnaire in the Occupational Therapy and Social Skills Training group. Furthermore, these achievements were sustained in the Occupational Therapy and Social Skills Training group compared to the Social Skills Training group at the 6-month follow-up. Conclusion The clients received the combination of Occupational Therapy and Social Skills Training showed a better improvement compared to the Social Skills Training group in terms of occupational performance, social participation, and severity of clinical symptoms. The use of Occupational Therapy in a holistic approach in psychosocial rehabilitation of people with schizophrenia can increase their functionality and social participation. Further studies are needed to assess long-term effects of Occupational Therapy in schizophrenia.
“Why Don’t You Reach Out to Dad?”: Involving Fathers in Therapy
Authors: Thomas Alvin , Lee Jocelyn R. Smith , Muhammed Michael , Caldwell Cleopatra H. 
Published: June 2021

Purpose: The literature indicates that engaging fathers in family therapy improves children’s mental health outcomes; however, clinicians are generally ill prepared for this challenge. Method: This qualitative study applies multiple case-study design to focus group data addressing social worker’s training experiences and attitudes toward involving fathers in therapy. Results: From an analysis of qualitative data from 14 social workers in training, three themes are discussed: (1) clinician exposure to nonresident fathers and their perceptions of the role of fathers in families, (2) barriers experienced in engaging fathers in the therapeutic process, and (3) training to work with nonresident fathers. Discussion: The themes are discussed with sample responses from representative participants and training areas. The findings suggest areas of focus for clinician training and practice such as modeling in session strategies, providing supervision and consultation, adjusting institutional policy, and offering additional course work and seminars that encourage and scaffold father engagement.
Perceived Loneliness and Severe Sleep Disorders in Adult Women during the Covid-19 Quarantine: A Cross-Sectional Study in Colombia
Authors: Monterrosa-Castro Álvaro , Monterrosa-Blanco Angélica , González-Sequeda Andrea 
Published: June 2021

Background: Quarantine is a measure to control COVID-19 spread, resulting in an increased perception of loneliness. In turn, sleep disorders (SD) may be more frequently reported in uncertain circumstances. Objectives: To identify the association between loneliness and severe SD, in women quarantined due to the COVID-19 pandemic. Methods: A cross-sectional study carried out in women, between 40 and 79 years and living in Colombia. The women were invited through social network to complete 5 digital instruments: de Jong Gierveld Loneliness Scale, Menopause Rating Scale, Fear of COVID-19 Five-item Version, Coronavirus Anxiety Scale, and Francis Religion Scale. Bivariate analysis and adjusted logistic regression between loneliness and SD were performed. Results: 1133 women participated, half of them under 50 years old. 43.1% had emotional loneliness, 39.9% social loneliness and 43.3% general loneliness. SD were identified in 6 out of 10 women, those with mild SD presented an OR of 1.84, 1.85, and 1.64, for emotional, social and general loneliness, respectively. Loneliness was associated twice with moderate SD, and more than twice with severe SD. Very severe SD reached OR:5.81 for emotional loneliness, OR:4.38 social loneliness and OR:4.02 general loneliness. In the presence of religiosity, fear and anxiety due to COVID-19, statistical significance was retained for associations, except intense SD with general loneliness. Conclusions: SD were significantly associated with loneliness in our study population. It is important to assess sleep quality and perception of loneliness in middle-aged women, especially during periods of quarantine due to a pandemic to avoid health implications.
Transcriptomic landscape of circulating mononuclear phagocytes in Langerhans cell histiocytosis at the single-cell level
Authors: Shi Hui , He Han , Cui Lei , Kvedaraite Egle , Bian Zhilei , Huang Tao , Lee Christopher Z. W. , Li Zhigang , He Jian , Gong Yandong , Li Zongcheng , Zhou Jie , Zeng Yang , Li Xianlong , Ni Yanli , Bai Zhijie , Liu Chen , Li Na , Ma Honghao , Wang Dong , Lan Yu , Ginhoux Florent , Zhang Rui , Liu Bing 
Published: June 2021

AbstractLangerhans cell histiocytosis (LCH) is an inflammatory myeloid neoplasm caused by aberrant activation of the mitogen-activated protein kinase (MAPK) pathway. Circulating myeloid cells from patients often carry disease-associated mutations and can be differentiated into langerinhigh LCH-like cells in vitro, but their detailed immune-phenotypic and molecular profiles are lacking and could shed key insights into disease biology. Here we recruited 217 pediatric LCH patients and took blood and tissue samples for BRAFV600E analysis. Immune-phenotyping of the circulating Lin−HLA-DR+ immune population in 49 of these patients revealed that decreased frequency of plasmacytoid dendritic cells was significantly linked to disease severity. By single-cell RNA sequencing of samples from 14 patients, we identified key changes in expression of RAS-MAPK-extracellular signal-regulated kinase (ERK) signaling-related genes and transcription factors in distinct members of the mononuclear phagocyte system in the presence of BRAFV600E. Moreover, treatment of patients with the BRAF inhibitor dabrafenib resulted in MAPK cascade inhibition, inflammation prevention, and regulation of cellular metabolism within mononuclear phagocytes. Finally, we also observed elevated expression of RAS-MAPK-ERK signaling-related genes in a CD207+CD1a+ cell subcluster in skin. Taken together, our data extend the molecular understanding of LCH biology at single-cell resolution, which might contribute to improvement of clinical diagnostics and therapeutics, and aid in the development of personalized medicine approaches.
Transforming acidic coiled-coil protein-3: a novel marker for differential diagnosis and prognosis prediction in endocervical adenocarcinoma
Authors: Wen Yan-Lin , Yan Shu-Mei , Wei Wei , Yang Xia , Zhang Shi-Wen , Yun Jing-Ping , Liu Li-Li , Luo Rong-Zhen 
Published: June 2021

Abstract
Background
Endocervical adenocarcinoma (ECA) is further classified as human papillomavirus (HPV)-associated (HPVA) or non-HPVA (NHPVA), per the International Endocervical Adenocarcinoma Criteria and Classification (IECC). HPVA is a glandular tumor with stromal invasion and/or exophytic expansile-type invasion, associated with the typical molecular characteristics of high-risk HPV (HR-HPV) infection. Transforming acidic coiled-coil protein-3 (TACC3),an oncogene that is frequently abnormally expressed,represents a vital biomarker for multiple human malignancies. This study aimed to examine the role of TACC3 in the diagnosis and prognosis of ECA.

Methods
We analyzed 264 patients with ECA who underwent surgical resection, classifying their tumors into HPVA and NHPVA subtypes. The expression levels of TACC3, P16, MLH1, PMS2, MSH2, MSH6 and Ki-67 in tumors were evaluated by tissue microarray using immunohistochemistry (IHC). HPV subtypes were identified in formalin-fixed paraffin-embedded (FFPE) ECA tissues by the polymerase chain reaction (PCR).

Results
ECA samples showed increased TACC3 expression relative to adjacent non-carcinoma samples. TACC3 expression was higher in HPVA than in NHPA. In the HPVA subtype, high TACC3 expression was significantly correlated with P16-positive, Ki-67-high expression. Furthermore, TACC3 levels were significantly related to tumor histological type (P = 0.006), nerve invasion (P = 0.003), differentiation (P = 0.004), surgical margin (P = 0.012), parametrium invasion (P = 0.040), P16 expression (P < 0.001), and Ki-67 (P = 0.004). Additionally, Kaplan–Meier analysis showed that TACC3 upregulation was associated with poor overall survival (OS, P = 0.001), disease-free survival (DFS, P < 0.001), and recurrence survival (P < 0.001). Multivariate analysis indicated that elevated TACC3 expression served as a marker to independently predict ECA prognosis. ROC curve analyses indicated that TACC3, P16, and HPV subtypes showed similar utility for distinguishing HPVA from NHPVA, with areas under the ROC curves of 0.640, 0.649, and 0.675, respectively. The combination of TACC3 and HPV subtypes improved the diagnostic performance of ECA compared with TACC3, P16, and HPV subtypes alone.

Conclusions
Taken together, our findings identify that TACC3 is a promising complementary biomarker for diagnosis and prognosis for patients with ECA.