bluuebunny/crossref_metadata_2025_split huggingface dataset:
Digital learning in medical education: comparing experiences of Malaysian and Japanese students
Authors: Jun Xin L. , Ahmad Hathim A. A. , Jing Yi N. , Reiko A. , Noor Akmal Shareela I. 
Published: August 2021

Abstract
Background
Medical education has undergone a transformation from conventional to digital learning, enabling learning without any time and place restrictions. Nevertheless, the actual trends of usage and its impact on learning motivation among medical students between developed and developing nations are yet to be investigated. Hence, this study compares the effect of digital learning on learning motivation among Malaysian and Japanese medical students in Universiti Kebangsaan Malaysia (UKM) and Shiga University of Medical Science (SUMS) respectively.

Methods
A modified Students Motivation towards Science Learning (SMTSL) was used to assess the digital learning usage and learning motivation among 150 UKM and 147 SUMS medical students throughout Year 1 to 5.

Results
The frequency of digital learning usage and learning motivation among UKM medical students was significantly higher as compared to SUMS (p < 0.001). Electronic books (e-books) were the most preferred source of digital learning among UKM medical students as compared to SUMS medical students who used research articles, e-books, online courses and videos at similar frequencies. UKM medical students in the clinical phase exhibited a significantly higher learning motivation as compared to preclinical students (p < 0.05) but not among SUMS medical students.

Conclusion
A suitable learning environment should be developed to encourage digital learning usage among different levels of medical students to enhance its complementary role in medical education and augment the level of motivation among medical students in continuous lifelong learning.
Hospital nurses’ knowledge regarding older patients: a multicenter study
Authors: Derks Christel T. A. J. , Hutten - van den Elsen Marjo M. G. M. , Hakvoort Lysette J. , van Mersbergen Mariëlle P. J. ,   RENurse Consortium, Schuurmans Marieke J. , Dikken Jeroen 
Published: August 2021

Abstract
Background
Nursing care in hospitals increasingly involves older adults. A nursing workforce able to care for the ageing population is therefore critical for ensuring quality older adult care. Gaining insight in the knowledge and attitudes of nurses regarding older patients in the Netherlands is needed to develop and increase the impact of education- and quality improvement programs which can positively influence nurses’ knowledge and attitudes regarding older patients.

Methods
A cross-sectional multicenter study was performed. Data was collected in ten tertiary medical teaching hospitals well spread across the Netherlands (89 wards, 2902 nurses). Knowledge levels were measured using the Knowledge about Older Patient-Quiz (KOP-Q), consisting of 30 true-false questions. Knowledge levels of registered nurses are compared with knowledge levels known from literature of first year nursing students; last year nursing students; nurses; and nurse specialist. Potential associated factors considered were: age; sex; education; experience; opinions and preferences. Opinion and preferences regarding working with older patients were measured by three questions: 1) which patient group nurses preferred to work with; 2) how nurses feel about the increase of older patients in the hospital; and 3) whether nurses find it difficult to care for older patients.

Results
From all wards, a representative sample of 1743 registered hospital nurses working on all 89 wards participated. On all wards, a large range in knowledge levels is observed between nurses, with 37% of nurses presenting knowledge levels comparable with nursing student and 31% of nurses presenting knowledge levels comparable with nurse specialists. Knowledge is related to age (p < .001), work experiences (p < .001), preparatory secondary education (p < .001) and nurses education level (p = .012). A minority (12.5%) prefers working with older patients and most nurses do not find it difficult.

Conclusions
This study shows that there is a large diversity in knowledge levels of Dutch hospital nurses in every hospital, on every ward. A majority of nurses demonstrate negative opinions and preferences. This implies that older patients admitted can receive different levels of quality of care on the same day as nurses with different knowledge levels provide care during the various shifts. Findings demonstrate an urgent need for education programs with themes regarding essential care for older patients in the Netherlands.
Treating patients with opioid overdose at a primary care emergency outpatient clinic: a cost-minimization analysis
Authors: Vibeto Jon Hjellum , Vallersnes Odd Martin , Dobloug Andrea , Brekke Mette , Jacobsen Dag , Ekeberg Øivind , Wangen Knut Reidar 
Published: August 2021

Abstract
Background
Treating patients with acute poisoning by substances of abuse in a primary care emergency clinic has previously been shown to be a safe strategy. We conducted an economic evaluation of this strategy compared to hospital treatment, which is the usual strategy.

Methods
Assuming equal health outcomes, we conducted a cost-minimization analysis. We constructed a representative opioid overdose patient based on a cohort of 359 patients treated for opioid overdose at the Oslo Accident and Emergency Outpatient Clinic (OAEOC) from 1.10.2011 to 30.9.2012. Using a health care system perspective, we estimated the expected resources used on the representative patient in primary care based on data from the observed OAEOC cohort and on information from key informants at the OAEOC. A likely course of treatment of the same patient in a hospital setting was established from information from key informants on provider procedures at Drammen Hospital, as were estimates of hospital use of resources. We calculated expected costs for both settings. Given that the treatments usually last for less than one day, we used undiscounted cost values.

Results
The estimated per patient cost in primary care was 121 EUR (2018 EUR 1.00 = NOK 9.5962), comprising 97 EUR on personnel costs and 24 EUR on treatment costs. In the hospital setting, the corresponding cost was 612 EUR, comprising 186 EUR on personnel costs, 183 EUR on treatment costs, and 243 EUR associated with intensive care unit admission. The point estimate of the cost difference per patient was 491 EUR, with a low-difference scenario estimated at 264 EUR and a high-difference scenario at 771 EUR.

Conclusions
Compared to hospital treatment, treating patients with opioid overdose in a primary care setting costs substantially less. Our findings are probably generalizable to poisoning with other substances of abuse. Implementing elements of the OAEOC procedure in primary care emergency clinics and in hospital emergency departments could improve the use of health care resources.
Association between Veterans Aging Cohort Study (VACS) index and neurocognitive function among people living with HIV–a cross sectional study in coastal South India
Authors: Ganapathy Archana , Achappa Basavaprabhu , Kulkarni Vaman , Madi Deepak , Holla Ramesh , Bhaskaran Unnikrishnan , Rathi Priya , Mahalingam Soundarya , Dsouza Nikhil Victor 
Published: August 2021

Abstract
Background
HIV is an infectious disease affecting 36.7 million people worldwide. In recent times, Antiretroviral Therapy (ART) has become accessible to the majority of People Living with HIV (PLHIV) and this has transformed the course of infection to one that is chronic, characterized by fewer diseases pathognomonic of AIDS. In view of this, there is a pressing need for better markers, apart from the routine HIV indicators, to detect comorbidities such as Neurocognitive Impairment (NCI). The aim of this study was to find out the association between Veterans Aging Cohort Study (VACS) index and Neurocognitive function in HIV positive patients.

Methods
In our study, we included 97 HIV positive patients and their Neurocognitive function was assessed using a combination of Montreal Cognitive Assessment and Grooved Pegboard Test, while VACS index was calculated using the most recent laboratory values. Binomial Logistics Regression analyses, adjusting for potential confounding variables, was performed to determine the association between VACS score and Neurocognitive Impairment.

Results
We found that a higher VACS Index was associated with global and domain-wise Neurocognitive impairment (p < 0.01), specifically in the domains of attention (p < 0.01) and fine motor skills (p = 0.01). Our study also showed that among all the VACS components, older age (p = 0.02) and lower hemoglobin (p < 0.01) values were associated with global NCI. After plotting an ROC curve, a VACS cut-off score of 11.00 was identified as it had good sensitivity (87.0%) and specificity (71.4%) in identifying Global NCI.

Conclusion
Our findings extend prior research on the use of VACS Index to predict global and domain-wise NCI in HIV-positive patients. However, further research with more comprehensive neurocognitive testing is required in our setting before VACS Index can be used as a tool to screen for neurocognitive dysfunction among PLHIV.
Noise constrains the evolution of call frequency contours in flowing water frogs: a comparative analysis in two clades
Authors: Zhao Longhui , Santos Juan C. , Wang Jichao , Ran Jianghong , Tang Yezhong , Cui Jianguo 
Published: August 2021

Abstract
Background
The acoustic adaptation hypothesis (AAH) states that signals should evolve towards an optimal transmission of the intended information from senders to intended receivers given the environmental constraints of the medium that they traverse. To date, most AAH studies have focused on the effect of stratified vegetation on signal propagation. These studies, based on the AAH, predict that acoustic signals should experience less attenuation and degradation where habitats are less acoustically complex. Here, we explored this effect by including an environmental noise dimension to test some AAH predictions in two clades of widespread amphibians (Bufonidae and Ranidae) that actively use acoustic signals for communication. By using data from 106 species in these clades, we focused on the characterization of the differences in dominant frequency (DF) and frequency contour (i.e., frequency modulation [FM] and harmonic performances) of mating calls and compared them between species that inhabit flowing-water or still-water environments.

Results
After including temperature, body size, habitat type and phylogenetic relationships, we found that DF differences among species were explained mostly by body size and habitat structure. We also showed that species living in lentic habitats tend to have advertisement calls characterized by well-defined FM and harmonics. Likewise, our results suggest that flowing-water habitats can constrain the evolutionary trajectories of the frequency-contour traits of advertisement calls in these anurans.

Conclusions
Our results may support AAH predictions in frogs that vocalize in noisy habitats because flowing-water environments often produce persistent ambient noise. For instance, these anurans tend to generate vocalizations with less well-defined FM and harmonic traits. These findings may help us understand how noise in the environment can influence natural selection as it shapes acoustic signals in affected species.
Validation of the Indonesian version of the foot and ankle score in patients with chronic lateral ankle instability
Authors: Adhitya I Putu Gde Surya , Yu Wen‐Yu , Saraswati Putu Ayu Sita , Winaya I Made Niko , Lin Mau‐Roung 
Published: August 2021

AbstractBackgroundThis study aimed to examine the psychometric performance of the Foot and Ankle Outcome Score (FAOS) used in Indonesian patients with chronic lateral ankle instability (CLAI).MethodsThe FAOS was translated into Indonesian through standardized procedures. Among 224 patients with unilateral CLAI recruited from 14 physical therapy clinics during a 1‐year period, reliabilities, construct validities, and responsiveness levels of the FAOS were examined. Active and passive range of motion of ankle dorsiflexion or plantiflexion, figure‐of‐eight, numeric pain rating scale (NPRS), and Short Form (SF)‐36 were used to test the construct validities.ResultsThe five subscales indicated adequate internal consistency (Cronbach's alpha, 0.74 ~ 0.96) and interrater test‐retest reliabilities (interclass correlation coefficients, 0.80 ~ 0.94). Subscales of the FAOS moderately converged with those selected measures with similar constructs ( values, 0.32 ~ 0.53), with the exception of the correlation of pain with the NPRS (, ‐0.06). Results of the principal component analysis showed that the five‐factor structure of the FAOS was appropriate for the Indonesian data, although six items (four in the pain and two in the other symptoms (OSs) subscales) did not perfectly fit their original subscales. Guyatt's responsiveness index for the FAOS's subscales changed in the SF‐36's physical function over a 1‐month period and ranged 0.37 to 1.27.ConclusionsThe Indonesian version of the FAOS demonstrated acceptable reliabilities and responsiveness, and fair construct validities among CLAI patients, although certain items in the pain and OSs subscales may need to be further explored and improved.
A quantitative analysis of extension and distribution of lung injury in COVID-19: a prospective study based on chest computed tomography
Authors: Pellegrini Mariangela , Larina Aleksandra , Mourtos Evangelos , Frithiof Robert , Lipcsey Miklos , Hultström Michael , Segelsjö Monica , Hansen Tomas , Perchiazzi Gaetano 
Published: August 2021

AbstractBackgroundTypical features differentiate COVID-19-associated lung injury from acute respiratory distress syndrome. The clinical role of chest computed tomography (CT) in describing the progression of COVID-19-associated lung injury remains to be clarified. We investigated in COVID-19 patients the regional distribution of lung injury and the influence of clinical and laboratory features on its progression.MethodsThis was a prospective study. For each CT, twenty images, evenly spaced along the cranio-caudal axis, were selected. For regional analysis, each CT image was divided into three concentric subpleural regions of interest and four quadrants. Hyper-, normally, hypo- and non-inflated lung compartments were defined. Nonparametric tests were used for hypothesis testing (α = 0.05). Spearman correlation test was used to detect correlations between lung compartments and clinical features.ResultsTwenty-three out of 111 recruited patients were eligible for further analysis. Five hundred-sixty CT images were analyzed. Lung injury, composed by hypo- and non-inflated areas, was significantly more represented in subpleural than in core lung regions. A secondary, centripetal spread of lung injury was associated with exposure to mechanical ventilation (p < 0.04), longer spontaneous breathing (more than 14 days,p < 0.05) and non-protective tidal volume (p < 0.04). Positive fluid balance (p < 0.01), high plasma D-dimers (p < 0.01) and ferritin (p < 0.04) were associated with increased lung injury.ConclusionsIn a cohort of COVID-19 patients with severe respiratory failure, a predominant subpleural distribution of lung injury is observed. Prolonged spontaneous breathing and high tidal volumes, both causes of patient self-induced lung injury, are associated to an extensive involvement of more central regions. Positive fluid balance, inflammation and thrombosis are associated with lung injury.Trial registrationStudy registered a priori the 20th of March, 2020. Clinical Trials ID NCT04316884.
Musculoskeletal practices for the preparticipation physical examination
Authors: Corrente Connor , Silvis Matthew , Murphy Joseph , Gallo Robert , Onks Cayce 
Published: August 2021

Abstract
Background
Little is known about the musculoskeletal (MSK) exam providers use during the Preparticipation Physical Examination (PPE). The primary aims of this study were to determine current practice with regards to the MSK screening exam, if goals are being met, and if there may be opportunities for improvement.

Methods
This cross-sectional survey-based study utilized a REDCap instrument that was distributed to members of the American Academy of Family Physicians (AAFP) and the American Medical Society for Sports Medicine (AMSSM). Questions focused on participant demographics and MSK exam practices for the PPE. Descriptive statistics were used.

Results
The study had a total of 616 participants with a response rate of 9 %. The majority of respondents (82 %) were familiar with the 4th Edition PPE Monograph and 80 % either moderately or strongly agreed that they use this as a guideline for their MSK screening exam. The 90 s MSK screening test was implemented by 52 % of the participants. The majority of participants use an orthopedic exam as part of their PPE (82 %). Ninety-two percent of participants felt satisfied that their MSK exam would screen for current injury, while only 42 % were satisfied that it effectively screened for future injury. 86 % of participants agree that the MSK exam should be performed, while 26 % said that they don’t perform a physical exam at all.

Discussion
There is a lack of understanding of the PPE Monograph as there is wide variability in MSK screening techniques providers use despite the majority of participants being familiar with the guidelines described in the monograph. Additionally, providers don’t believe that the MSK exam screens for future injury.

Conclusions
The goals of the MSK portion of the 4th Edition PPE monograph are not adequately being met and there is a need for further research to validate screening exams for the prevention of MSK injury.
A new stability result for a thermoelastic Bresse system with viscoelastic damping
Authors: Mukiawa Soh Edwin , Enyi Cyril Dennis , Apalara Tijani Abdulaziz 
Published: August 2021

AbstractWe investigate a thermoelastic Bresse system with viscoelastic damping acting on the shear force and heat conduction acting on the bending moment. We show that with weaker conditions on the relaxation function and physical parameters, the solution energy has general and optimal decay rates. Some examples are given to illustrate the findings.
Abortion care in a pandemic: an analysis of the number and social profile of people requesting and receiving abortion care during the first COVID-19 lockdown (March 16 to June 14, 2020) in Flanders, Belgium
Authors: De Kort Leen , Wood Jonas , Wouters Edwin , Van de Velde Sarah 
Published: August 2021

AbstractBackgroundThe COVID-19 pandemic and the national COVID-19 measures might have increased potential barriers to abortion care and created new ones, especially for vulnerable groups. This study documents the impact of the pandemic and the lockdown measures on the profile of people going through the abortion process.MethodsUsing anonymized patient records from a Belgian abortion centre, we first compared the number of abortion requests and procedures during the first COVID-19 lockdown with the same months in the five preceding years. Next, we analysed the social profile of people requesting an abortion in those two time periods and looked at the number of long-acting reversible contraceptive devices (LARC) placed after curettage.ResultsThe abortion centre saw a drop in the number of abortion requests during the lockdown. This difference was more pronounced for people in paid employment and people using (modern) contraception. People were also more likely to request an abortion earlier in their pregnancy. The drop in abortion procedures and LARC’s placed after curettage was proportionate to the drop in abortion requests and did not differ according to clients’ characteristics.ConclusionQuestions arose concerning the potential selectivity with which COVID-19 influenced the need for abortion care and accessibility to services. Although there was a general drop in abortion requests and procedures during the first COVID-19 lockdown in the studied abortion centre, our results suggest that the profile of people requesting and receiving an abortion did only slightly change during the lockdown, and did not affect vulnerable groups visibly harder.
The limits of clinical findings in similar phenotypes, from Carpenter to ATRX syndrome using a whole exome sequencing approach: a case review
Authors: Sáenz Samantha S. , Arias Benjamin , Hosomichi Kazuyoshi , Romero Vanessa I. 
Published: August 2021

Abstract
Background
The diagnostic process for uncommon disorders with similar manifestations is complicated and requires newer technology, like gene sequencing for a correct diagnosis.

Main body
We described two brothers clinically diagnosed with Carpenter syndrome, which is a condition characterized by the premature fusion of certain skull bones (craniosynostosis), abnormalities of the fingers and toes, and other developmental problems, for which they underwent craniotomies. However, whole exome sequencing analysis concluded a novel pathological variation in the ATRX chromatin remodeler gene and protein remodeling demonstrated structural variations that decreased the function, giving a completely different diagnosis to these patients.

Conclusion
Our study focuses on the importance of using newer technologies, such as whole exome sequencing analysis, in patients with ambiguous phenotypes.
Metabolic and transcriptomic profiles of glioblastoma invasion revealed by comparisons between patients and corresponding orthotopic xenografts in mice
Authors: Cudalbu Cristina , Bady Pierre , Lai Marta , Xin Lijing , Gusyatiner Olga , Hamou Marie-France , Lepore Mario , Brouland Jean-Philippe , Daniel Roy T. , Hottinger Andreas F. , Hegi Monika E. 
Published: August 2021

AbstractThe invasive behavior of glioblastoma, the most aggressive primary brain tumor, is considered highly relevant for tumor recurrence. However, the invasion zone is difficult to visualize by Magnetic Resonance Imaging (MRI) and is protected by the blood brain barrier, posing a particular challenge for treatment. We report biological features of invasive growth accompanying tumor progression and invasion based on associated metabolic and transcriptomic changes observed in patient derived orthotopic xenografts (PDOX) in the mouse and the corresponding patients’ tumors. The evolution of metabolic changes, followed in vivo longitudinally by 1H Magnetic Resonance Spectroscopy (1H MRS) at ultra-high field, reflected growth and the invasive properties of the human glioblastoma transplanted into the brains of mice (PDOX). Comparison of MRS derived metabolite signatures, reflecting temporal changes of tumor development and invasion in PDOX, revealed high similarity to spatial metabolite signatures of combined multi-voxel MRS analyses sampled across different areas of the patients’ tumors. Pathway analyses of the transcriptome associated with the metabolite profiles of the PDOX, identified molecular signatures of invasion, comprising extracellular matrix degradation and reorganization, growth factor binding, and vascular remodeling. Specific analysis of expression signatures from the invaded mouse brain, revealed extent of invasion dependent induction of immune response, recapitulating respective signatures observed in glioblastoma. Integrating metabolic profiles and gene expression of highly invasive PDOX provided insights into progression and invasion associated mechanisms of extracellular matrix remodeling that is essential for cell–cell communication and regulation of cellular processes. Structural changes and biochemical properties of the extracellular matrix are of importance for the biological behavior of tumors and may be druggable. Ultra-high field MRS reveals to be suitable for in vivo monitoring of progression in the non-enhancing infiltration zone of glioblastoma.