bluuebunny/crossref_metadata_2025_split huggingface dataset:
Application and practice of a step-by-step method combined with case-based learning in Chinese otoendoscopy education
Authors: Wei Fanqin , Sun Qiyang , Qin Zili , Zhuang Huiwen , Jiang Guangli , Wu Xuan 
Published: February 2021

Abstract
Background
Standardized training allows more physicians to master otoendoscopic surgery. However, the lecture-based learning (LBL) applied in otoendoscopy teaching may not be conducive to training students in clinical thinking and surgical ability. It is necessary to explore innovative methods for otoendoscopy teaching. This study aimed to determine the effect of a step-by-step (SBS) method combined with case-based learning (CBL) in otoendoscopy teaching.

Methods
Fifty-nine physicians who participated in otoendoscopy training were selected as the study subjects and randomly divided into two groups (A and B). Group A underwent training with the SBS & CBL method, while Group B underwent training with the LBL & CBL method. The effects of these two methods for otoendoscopy training were compared by evaluation of professional skills and questionnaires before and after the training.

Results
Proficiency in otoendoscopic anatomy and grades for both professional knowledge and otoendoscopic skills were significantly higher in Group A than in Group B(P < 0.05). In terms of learning interest, surgical ability, acting capacity during surgery, reducing surgical complications, and satisfaction with learning experience, all responses from Group A were better than those from Group B(P < 0.05).

Conclusions
The SBS & CBL method may help to improve ability in otoendoscopic surgery and clinical thinking and appears suitable for endoscopy teaching.
The anatomy of electronic patient record ethics: a framework to guide design, development, implementation, and use
Authors: Jacquemard Tim , Doherty Colin P. , Fitzsimons Mary B. 
Published: February 2021

AbstractBackgroundThis manuscript presents a framework to guide the identification and assessment of ethical opportunities and challenges associated with electronic patient records (EPR). The framework is intended to support designers, software engineers, health service managers, and end-users to realise a responsible, robust and reliable EPR-enabled healthcare system that delivers safe, quality assured, value conscious care.MethodsDevelopment of the EPR applied ethics framework was preceded by a scoping review which mapped the literature related to the ethics of EPR technology. The underlying assumption behind the framework presented in this manuscript is that ethical values can inform all stages of the EPR-lifecycle from design, through development, implementation, and practical application.ResultsThe framework is divided into two parts: context and core functions. The first part ‘context’ entails clarifying: the purpose(s) within which the EPR exists or will exist; the interested parties and their relationships; and the regulatory, codes of professional conduct and organisational policy frame of reference. Understanding the context is required before addressing the second part of the framework which focuses on EPR ‘core functions’ of data collection, data access, and digitally-enabled healthcare.ConclusionsThe primary objective of the EPR Applied Ethics Framework is to help identify and create value and benefits rather than to merely prevent risks. It should therefore be used to steer an EPR project to success rather than be seen as a set of inhibitory rules. The framework is adaptable to a wide range of EPR categories and can cater for new and evolving EPR-enabled healthcare priorities. It is therefore an iterative tool that should be revisited as new EPR-related state-of-affairs, capabilities or activities emerge.
Enhancing the ethical conduct of a longitudinal cluster-randomized trial of psychosocial stimulation intervention for children with complicated severe acute malnutrition through Rapid Ethical Assessment: a qualitative study
Authors: Tessema Tesfalem T. , Alamdo Andamlak G. , Mekonnen Eyoel B. , Debele Fanna A. , Bamud Juhar A. , Abessa Teklu G. , Lema Tefera Belachew 
Published: February 2021

Abstract
Background
Informed consent is a universally accepted precondition for scientific researches involving human participants. However, various factors influence the process of obtaining authentic informed consent, and researchers particularly working in resource-poor countries often face considerable difficulties in implementing the universally recommended procedures for obtaining informed consent. We have conducted this Rapid Ethical Assessment (REA) to accommodate the local cultural norms and to understand the relevant ethical issues in the Silti community before the conduct of a cluster-randomized controlled trial.

Methods
This REA was conducted in two purposively selected Woredas/Districts and Worabe Town administration of Silti Zone. Data were collected using in-depth interviews and focus group discussions. Purposive and convenient sampling techniques were used to select respondents. Five in-depth interviews and 15 Focus Group Discussions were conducted in the Amharic language. The collected data was transcribed, translated, and analyzed using a thematic approach.

Result
Most of the community members never heard about research and therapeutic misconception was common. In the area, the permission of people working in the formal and informal community administration is essential before approaching individuals. The male head of the household should also be involved in the decision before individual household members participate in research. Furthermore, sensitizing the community using public and religious gatherings was suggested before individual recruitment. In the consent process, delivering selected information particularly the purpose and benefits of the research was emphasized and the tendency of preferring verbal consent was documented despite the willingness of the individuals to sign on the consent form. Local health workers were identified as appropriate personnel to communicate information and the procedures of the research were found to be acceptable. However, the value of small incentives was suggested to motivate potential participants. Finally, involving all concerned stakeholders and respecting the cultural norm of the community was emphasized.

Conclusion
Through REA, we understand the research awareness of the community, their expectation, and the cultural norms relevant to the ethical conduct of research. It enabled us to devise culturally sensitive and scientifically sound strategies to secure authentic informed consent. The process of conducting REA was found to be feasible, quick, and efficient.
Prediction of adverse drug reactions based on knowledge graph embedding
Authors: Zhang Fei , Sun Bo , Diao Xiaolin , Zhao Wei , Shu Ting 
Published: February 2021

Abstract
Background
Adverse drug reactions (ADRs) are an important concern in the medication process and can pose a substantial economic burden for patients and hospitals. Because of the limitations of clinical trials, it is difficult to identify all possible ADRs of a drug before it is marketed. We developed a new model based on data mining technology to predict potential ADRs based on available drug data.

Method
Based on the Word2Vec model in Nature Language Processing, we propose a new knowledge graph embedding method that embeds drugs and ADRs into their respective vectors and builds a logistic regression classification model to predict whether a given drug will have ADRs.

Result
First, a new knowledge graph embedding method was proposed, and comparison with similar studies showed that our model not only had high prediction accuracy but also was simpler in model structure. In our experiments, the AUC of the classification model reached a maximum of 0.87, and the mean AUC was 0.863.

Conclusion
In this paper, we introduce a new method to embed knowledge graph to vectorize drugs and ADRs, then use a logistic regression classification model to predict whether there is a causal relationship between them. The experiment showed that the use of knowledge graph embedding can effectively encode drugs and ADRs. And the proposed ADRs prediction system is also very effective.
EMS utilization predictors in a Mobile Integrated Health (MIH) program
Authors: Pinet-Peralta Luis M. , Glos Lukas J. , Sanna Evan , Frankel Brian , Lindqvist Ernest 
Published: February 2021

Abstract
Background
The provision of unnecessary Emergency Medical Services care remains a challenge throughout the US and contributes to Emergency Department overcrowding, delayed services and lower quality of care. New EMS models of care have shown promise in improving access to health services for patients who do not need urgent care. The goals of this study were (1) to identify factors associated with EMS utilization (911) and (2) their effects on total EMS calls and transports in an MIH program.

Methods
The study sample included 110 MIH patients referred to the program or considered high-users of EMS services between November 2016 and September 2018. The study employed descriptive statistics and Poisson regressions to estimate the effects of covariates on total EMS calls and transports.

Results
The typical enrollee is a 60-year-old single Black male living with two other individuals. He has a PCP, takes 12 medications and is compliant with his treatment. The likelihood of calling and/or being transported by EMS was higher for males, patients at high risk for falls, patients with asthma/COPD, psychiatric or behavioral illnesses, and longer travel times to a PCP. Each prescribed medication increased the risk for EMS calls or transports by 4%. The program achieved clear reductions in 911 calls and transports and savings of more than 140,000 USD in the first month.

Conclusions
This study shows that age, marital status, high fall risk scores, the number of medications, psychiatric/behavioral illness, asthma/COPD, CHF, CVA/stroke and medication compliance may be good predictors of EMS use in an MIH setting. MIH programs can help control utilization of EMS care and reduce both EMS calls and transports.
Evolutionary dynamics and structural consequences of de novo beneficial mutations and mutant lineages arising in a constant environment
Authors: Kinnersley Margie , Schwartz Katja , Yang Dong-Dong , Sherlock Gavin , Rosenzweig Frank 
Published: February 2021

Abstract
Background
Microbial evolution experiments can be used to study the tempo and dynamics of evolutionary change in asexual populations, founded from single clones and growing into large populations with multiple clonal lineages. High-throughput sequencing can be used to catalog de novo mutations as potential targets of selection, determine in which lineages they arise, and track the fates of those lineages. Here, we describe a long-term experimental evolution study to identify targets of selection and to determine when, where, and how often those targets are hit.

Results
We experimentally evolved replicate Escherichia coli populations that originated from a mutator/nonsense suppressor ancestor under glucose limitation for between 300 and 500 generations. Whole-genome, whole-population sequencing enabled us to catalog 3346 de novo mutations that reached > 1% frequency. We sequenced the genomes of 96 clones from each population when allelic diversity was greatest in order to establish whether mutations were in the same or different lineages and to depict lineage dynamics. Operon-specific mutations that enhance glucose uptake were the first to rise to high frequency, followed by global regulatory mutations. Mutations related to energy conservation, membrane biogenesis, and mitigating the impact of nonsense mutations, both ancestral and derived, arose later. New alleles were confined to relatively few loci, with many instances of identical mutations arising independently in multiple lineages, among and within replicate populations. However, most never exceeded 10% in frequency and were at a lower frequency at the end of the experiment than at their maxima, indicating clonal interference. Many alleles mapped to key structures within the proteins that they mutated, providing insight into their functional consequences.

Conclusions
Overall, we find that when mutational input is increased by an ancestral defect in DNA repair, the spectrum of high-frequency beneficial mutations in a simple, constant resource-limited environment is narrow, resulting in extreme parallelism where many adaptive mutations arise but few ever go to fixation.
Pattern and trend of five major musculoskeletal disorders in China from 1990 to 2017: findings from the Global Burden of Disease Study 2017
Authors: Wu Dongze , Wong Priscilla , Guo Cui , Tam Lai-Shan , Gu Jieruo 
Published: February 2021

Abstract
Background
With increasing life expectancy in China, no large population-based studies have been done on the trend for musculoskeletal disorders in China. We have investigated the pattern and trend of five major musculoskeletal disorders in China from the Global Burden of Disease Study 2017 and its association with sociodemographic index (SDI).

Methods
The main outcome measures were incidence, prevalence, and disability-adjusted life years (DALYs) for rheumatoid arthritis, osteoarthritis, low back pain, neck pain, and gout. Average annual percent change (AAPC) and annual percent change (APC) between 1990 and 2017 were analyzed with Joinpoint regression.

Results
The age-standardized rate of incidence, prevalence, and DALYs for the five major musculoskeletal disorders increased with age. For SDI, the age-standardized rate of DALYs was zigzagged increasing for rheumatoid arthritis and curvilinear increasing for gout, curvilinear decreasing for low back pain, and reaching to the highest point for osteoarthritis and neck pain with an SDI value of 0.61. The AAPC in age-standardized rate of DALYs indicated an increasing trend for rheumatoid arthritis (0.20, 95% CI 0.07, 0.34), osteoarthritis (0.26, 95% CI 0.20, 0.31), neck pain (0.09, 95% CI 0.07, 0.12), and gout (0.25, 95% CI 0.23, 0.27), but a decreasing trend for low back pain (− 0.96, 95% CI − 0.98, − 0.93). The AAPC of risk factors indicated a decreasing trend in smoking (− 0.14, 95% CI − 0.24, − 0.04) for rheumatoid arthritis, smoking (− 0.22, 95% CI − 0.24, − 0.19) and occupational ergonomic factors (− 1.25, 95% CI − 1.29, − 1.21) for low back pain, and impaired kidney function (− 0.95, 95% CI − 1.00, − 0.90) for gout, but an increasing trend in high body-mass index for osteoarthritis (3.10, 95% CI 3.03, 3.17), low back pain (3.07, 95% CI 2.99, 3.14), and gout (3.12, 95% CI 3.04, 3.20). Comparing the burden of five musculoskeletal diseases in China with the 19 countries of G20, China ranked first to second in the number of DALYs, and 12th to 16th in age-standardized rate of DALYs.

Conclusion
There are remarkably complex temporal patterns in disease burden and risk factors for five major musculoskeletal disorders across past three decades. Population-wide initiatives targeting high body-mass index may mitigate the burden of musculoskeletal disorders.
Chemotherapeutic and targeted agents can modulate the tumor microenvironment and increase the efficacy of immune checkpoint blockades
Authors: Li Jun-Yan , Chen Yu-Pei , Li Ying-Qin , Liu Na , Ma Jun 
Published: February 2021

AbstractThe development of immune checkpoint blockade (ICB)-based immunotherapy has dramatically changed methods of cancer treatment. This approach triggers a durable treatment response and prolongs patients' survival; however, not all patients can benefit. Accumulating evidence demonstrated that the efficacy of ICB is dependent on a robust antitumor immune response that is usually damaged in most tumors. Conventional chemotherapy and targeted therapy promote the antitumor immune response by increasing the immunogenicity of tumor cells, improving CD8+ T cell infiltration, or inhibiting immunosuppressive cells in the tumor microenvironment. Such immunomodulation provides a convincing rationale for the combination therapy of chemotherapeutics and ICBs, and both preclinical and clinical investigations have shown encouraging results. However, the optimal drug combinations, doses, timing, and sequence of administration, all of which affect the immunomodulatory effect of chemotherapeutics, as well as the benefit of combination therapy, are not yet determined. Future studies should focus on these issues and help to develop the optimal combination regimen for each cancer.
Responsiveness of PROMIS and Patient Health Questionnaire (PHQ) Depression Scales in three clinical trials
Authors: Kroenke Kurt , Stump Timothy E. , Chen Chen X. , Kean Jacob , Damush Teresa M. , Bair Matthew J. , Krebs Erin E. , Monahan Patrick O. 
Published: February 2021

AbstractBackgroundThe PROMIS depression scales are reliable and valid measures that have extensive normative data in general population samples. However, less is known about how responsive they are to detect change in clinical settings and how their responsiveness compares to legacy measures. The purpose of this study was to assess and compare the responsiveness of the PROMIS and Patient Health Questionnaire (PHQ) depression scales in three separate samples.MethodsWe used data from three clinical trials (two in patients with chronic pain and one in stroke survivors) totaling 651 participants. At both baseline and follow-up, participants completed four PROMIS depression fixed-length scales as well as legacy measures: Patient Health Questionnaire 9-item and 2-item scales (PHQ-9 and PHQ-2) and the SF-36 Mental Health scale. We measured global ratings of depression change, both prospectively and retrospectively, as anchors to classify patients as improved, unchanged, or worsened. Responsiveness was assessed with standardized response means, statistical tests comparing change groups, and area-under-curve analysis.ResultsThe PROMIS depression and legacy scales had generally comparable responsiveness. Moreover, the four PROMIS depression scales of varying lengths were similarly responsive. In general, measures performed better in detecting depression improvement than depression worsening. For all measures, responsiveness varied based on the study sample and on whether depression improved or worsened.ConclusionsBoth PROMIS and PHQ depression scales are brief public domain measures that are responsive (i.e., sensitive to change) and thus appropriate as outcome measures in research as well as for monitoring treatment in clinical practice.Trial registrationClinicalTrials.gov ID: NCT01236521, NCT01583985, NCT01507688
Association of health checkups with health-related quality of life among public servants: a nationwide survey in Taiwan
Authors: Shih Dann-Pyng , Kuo Hsien-Wen , Liang Wen-Miin , Lin Ping-Yi , Tseng Pochang , Wang Jong-Yi 
Published: February 2021

Abstract
Background
Preventive health checkups have gained in importance over the last decade. The association of health checkups and the number of diseases with health-related quality of life (HRQoL), including physical and mental health, remains unclear. We sought to investigate the aforementioned association among Taiwanese public servants.

Methods
A cross-sectional survey was conducted using randomized and multistage stratified cluster sampling based on proportional probabilistic sampling. The questionnaires addressed demographics, job characteristics, health behaviors, health status, 3 types of health checkups during the preceding 3 years (government-paid health checkup [GPHC], self-paid health checkup [SPHC], and no health checkup [NOHC]), and physical component summary (PCS) and mental component summary (MCS) scores of the Short-Form Health Survey. In total 11,454 middle-aged public servants were analyzed. A multivariate general linear model (GLM) was used to estimate PCS and MCS scores by using least square means.

Results
Health checkup types were associated with a significant difference in PCS scores among the public servants. Scores of PCS and MCS were both significantly higher in the GPHC group than in the NOHC group for those with no chronic diseases (51.20 vs. 50.66 [P = 0.008] and 46.23 vs. 45.58 [P = 0.02], respectively). Compared with the NOHC group, both scores of GPHC and SPHC groups were significantly associated with higher PCS scores for public servants with ≥ 2 chronic diseases (46.93 vs. 45.13 [P = 0.002] and 46.52 vs. 45.13 [P = 0.009], respectively).

Conclusion
In Taiwan, public servants undergoing GPHCs are more likely to report higher PCS scores than are those undergoing SPHCs. It is crucial that encourage periodically using the health checkup to improve health status and HRQoL.
Understanding patient outcomes to develop a multimorbidity adapted patient-reported outcomes measure: a qualitative description of patient and provider perspectives
Authors: Sasseville Maxime , Chouinard Maud-Christine , Fortin Martin 
Published: February 2021

Abstract
Background
Multimorbidity is a complex health situation that requires interventions tailored to patient needs; the outcomes of such interventions are difficult to evaluate. The purpose of this study was to describe the outcomes of patient-centred interventions for people with multimorbidity from the patients’ and healthcare providers’ perspectives.

Methods
This study followed a qualitative descriptive design. Nine patients with multimorbidity and 18 healthcare professionals (nurses, general practitioners, nutritionists, and physical and respiratory therapists), participating in a multimorbidity-adapted intervention in primary care were recruited. Data were collected using semi-structured interviews with 12 open-ended questions. Triangulation of disciplines among interviewers, research team debriefing, data saturation assessment and iterative data collection and analysis ensured a rigorous research process.

Results
Outcome constructs described by participants covered a wide range of themes and were grouped into seven outcome domains: Health Management, Physical Health, Functional Status, Psychosocial Health, Health-related Behaviours, General Health and Health Services. The description of constructs by stakeholders provides valuable insight on how outcomes are experienced and worded by patients.

Conclusion
Participants described a wide range of outcome constructs, which were relevant to and observable by patients and were in line with the clinical reality. The description provides a portrait of multimorbidity-adapted intervention outcomes that are significant for the selection and development of clinical research outcome measures.