bluuebunny/crossref_metadata_2025_split huggingface dataset:
The impact of an online intervention on the medical, dental and health sciences students about interprofessional education; a quasi-experimental study
Authors: Guraya Salman Y. , David Leena R. , Hashir Shermin , Mousa Noha A. , Al Bayatti Saad Wahbi , Hasswan Ahmed , Kaouas Mujtaba 
Published: August 2021

AbstractBackgroundInterprofessional education (IPE) encompasses integration, communication, mutual trust and shared decision-making with a common goal of improved patient care and safety. Despite its crucial role, IPE has not gained its anticipated popularity. This study aims to determine the impact of an online educational intervention about IPE on medical, dental and health sciences students in the University of Sharjah (UoS).MethodsThis quasi-experimental research was conducted in three phases; a pre-intervention phase where the Readiness for Interprofessional Learning Scale (RIPLS) inventory was administered online to the medical, dental and health sciences students of UoS; an intervention phase where an online workshop was organized via Microsoft Teams®; and a post-intervention phase where RIPLS was used to gather the students’ attitudes towards IPE. The independentttest was used to compare the responses between genders and junior and senior students. A paired samplettest was used to determine the impact of the intervention on the students’ understandings and attitudes about IPE.ResultsOut of 800 invited students, 530 students responded to the pre-intervention RIPLS survey. A comparison of the pre-post intervention for the RIPLS subscales of teamwork and collaboration, professional identification, and professional roles showed a significant improvement of students’ attitudes withp-values 0.03, 0.00 and 0.00, respectively. All workshop moderators scored a median of 4 or 5 to the essential elements of IPE during intervention except for a median of 3 for group dynamics.ConclusionThe present data, derived from the application of a brief online educational intervention, underpins the readiness and positive attitudes of undergraduate medical students towards IPE. The positive impact of online intervention necessitates the development of a structured and unified IPE curriculum to enhance the receptiveness and application of IPE in the medical field.
Modeling and prediction of pressure injury in hospitalized patients using artificial intelligence
Authors: Anderson Christine , Bekele Zerihun , Qiu Yongkai , Tschannen Dana , Dinov Ivo D. 
Published: August 2021

AbstractBackgroundHospital-acquired pressure injuries (PIs) induce significant patient suffering, inflate healthcare costs, and increase clinical co-morbidities. PIs are mostly due to bed-immobility, sensory impairment, bed positioning, and length of hospital stay. In this study, we use electronic health records and administrative data to examine the contributing factors to PI development using artificial intelligence (AI).MethodsWe used advanced data science techniques to first preprocess the data and then train machine learning classifiers to predict the probability of developing PIs. The AI training was based on large, incongruent, incomplete, heterogeneous, and time-varying data of hospitalized patients. Both model-based statistical methods and model-free AI strategies were used to forecast PI outcomes and determine the salient features that are highly predictive of the outcomes.ResultsOur findings reveal that PI prediction by model-free techniques outperform model-based forecasts. The performance of all AI methods is improved by rebalancing the training data and by including the Braden in the model learning phase. Compared to neural networks and linear modeling, with and without rebalancing or using Braden scores, Random forest consistently generated the optimal PI forecasts.ConclusionsAI techniques show promise to automatically identify patients at risk for hospital acquired PIs in different surgical services. Our PI prediction model provide a first generation of AI guidance to prescreen patients at risk for developing PIs.Clinical impactThis study provides a foundation for designing, implementing, and assessing novel interventions addressing specific healthcare needs. Specifically, this approach allows examining the impact of various dynamic, personalized, and clinical-environment effects on PI prevention for hospital patients receiving care from various surgical services.
Implementation of a patient-collected audio recording audit & feedback quality improvement program to prevent contextual error: stakeholder perspective
Authors: Ball Sherry L. , Weiner Saul J. , Schwartz Alan , Altman Lisa , Binns-Calvey Amy , Chan Carolyn , Falck-Ytter Corinna , Frenchman Meghana , Gee Bryan , Jackson Jeffrey L. , Jordan Neil , Kass Benjamin , Kelly Brendan , Safdar Nasia , Scholcoff Cecilia , Sharma Gunjan , Subramaniam Soumya , Weaver Frances , Wopat Maria 
Published: August 2021

Abstract
Background
Using patient audio recordings of medical visits to provide clinicians with feedback on their attention to patient life context in care planning can improve health care delivery and outcomes, and reduce costs. However, such an initiative can raise concerns across stakeholders about surveillance, intrusiveness and merit. This study examined the perspectives of patients, physicians and other clinical staff, and facility leaders over 3 years at six sites during the implementation of a patient-collected audio quality improvement program designed to improve patient-centered care in a non-threatening manner and with minimal effort required of patients and clinicians.

Methods
Patients were invited during the first and third year to complete exit surveys when they returned their audio recorders following visits, and clinicians to complete surveys annually. Clinicians were invited to participate in focus groups in the first and third years. Facility leaders were interviewed individually during the last 6 months of the study.

Results
There were a total of 12 focus groups with 89 participants, and 30 leadership interviews. Two hundred fourteen clinicians and 800 patients completed surveys. In a qualitative analysis of focus group data employing NVivo, clinicians initially expressed concerns that the program could be disruptive and/or burdensome, but these diminished with program exposure and were substantially replaced by an appreciation for the value of low stakes constructive feedback. They were also significantly more confident in the value of the intervention in the final year (p = .008), more likely to agree that leadership supports continuous improvement of patient care and gives feedback on outcomes (p = .02), and at a time that is convenient (p = .04). Patients who volunteered sometimes expressed concerns they were “spying” on their doctors, but most saw it as an opportunity to improve care. Leaders were supportive of the program but not yet prepared to commit to funding it exclusively with facility resources.

Conclusions
A patient-collected audio program can be implemented when it is perceived as safe, not disruptive or burdensome, and as contributing to better health care.
The association between mechanical ventilator compatible bed occupancy and mortality risk in intensive care patients with COVID-19: a national retrospective cohort study
Authors: Wilde Harrison , Mellan Thomas , Hawryluk Iwona , Dennis John M. , Denaxas Spiros , Pagel Christina , Duncan Andrew , Bhatt Samir , Flaxman Seth , Mateen Bilal A. , Vollmer Sebastian J. 
Published: August 2021

Abstract
Background
The literature paints a complex picture of the association between mortality risk and ICU strain.
In this study, we sought to determine if there is an association between mortality risk in intensive care units (ICU) and occupancy of beds compatible with mechanical ventilation, as a proxy for strain.

Methods
A national retrospective observational cohort study of 89 English hospital trusts (i.e. groups of hospitals functioning as single operational units). Seven thousand one hundred thirty-three adults admitted to an ICU in England between 2 April and 1 December, 2020 (inclusive), with presumed or confirmed COVID-19, for whom data was submitted to the national surveillance programme and met study inclusion criteria. A Bayesian hierarchical approach was used to model the association between hospital trust level (mechanical ventilation compatible), bed occupancy, and in-hospital all-cause mortality. Results were adjusted for unit characteristics (pre-pandemic size), individual patient-level demographic characteristics (age, sex, ethnicity, deprivation index, time-to-ICU admission), and recorded chronic comorbidities (obesity, diabetes, respiratory disease, liver disease, heart disease, hypertension, immunosuppression, neurological disease, renal disease).

Results
One hundred thirty-five thousand six hundred patient days were observed, with a mortality rate of 19.4 per 1000 patient days. Adjusting for patient-level factors, mortality was higher for admissions during periods of high occupancy (> 85% occupancy versus the baseline of 45 to 85%) [OR 1.23 (95% posterior credible interval (PCI): 1.08 to 1.39)]. In contrast, mortality was decreased for admissions during periods of low occupancy (< 45% relative to the baseline) [OR 0.83 (95% PCI 0.75 to 0.94)].

Conclusion
Increasing occupancy of beds compatible with mechanical ventilation, a proxy for operational strain, is associated with a higher mortality risk for individuals admitted to ICU. Further research is required to establish if this is a causal relationship or whether it reflects strain on other operational factors such as staff. If causal, the result highlights the importance of strategies to keep ICU occupancy low to mitigate the impact of this type of resource saturation.
Brucella melitensis UGPase inhibits the activation of NF-κB by modulating the ubiquitination of NEMO
Authors: Zhou Yucheng , Bu Zhaoyang , Qian Jing , Cheng Yuening , Qiao Lianjiang , Yang Sen , Cheng Shipeng , Wang Xinglong , Ren Linzhu , Yang Yanling 
Published: August 2021

Abstract
Background
UTP-glucose-1-phosphoryl transferase (UGPase) catalyzes the synthesis of UDP-glucose, which is essential for generating the glycogen needed for the synthesis of bacterial lipopolysaccharide (LPS) and capsular polysaccharide, which play important roles in bacterial virulence. However, the molecular function of UGPase in Brucella is still unknown.

Results
In this study, the ubiquitination modification of host immune-related protein in cells infected with UGPase-deleted or wild-type Brucella was analyzed using ubiquitination proteomics technology. The ubiquitination modification level and type of NF-κB Essential Modulator (NEMO or Ikbkg), a molecule necessary for NF-κB signal activation, was evaluated using Coimmunoprecipitation, Western blot, and dual-Luciferase Assay. We found 80 ubiquitin proteins were upregulated and 203 ubiquitin proteins were downregulated in cells infected with B. melitensis 16 M compared with those of B. melitensis UGPase-deleted strain (16 M-UGPase−). Moreover, the ubiquitin-modified proteins were mostly enriched in the categories of regulation of kinase/NF-κB signaling and response to a bacterium, suggesting Brucella UGPase inhibits ubiquitin modification of related proteins in the host NF-κB signaling pathway. Further analysis showed that the ubiquitination levels of NEMO K63 (K63-Ub) and Met1 (Met1-Ub) were significantly increased in the 16 M-UGPase−-infected cells compared with that of the 16 M-infected cells, further confirming that the ubiquitination levels of NF-κB signaling-related proteins were regulated by the bacterial UGPase. Besides, the expression level of IκBα was decreased, but the level of p-P65 was significantly increased in the 16 M-UGPase−-infected cells compared with that of the 16 M- and mock-infected cells, demonstrating that B. melitensis UGPase can significantly inhibit the degradation of IκBα and the phosphorylation of p65, and thus suppressing the NF-κB pathway.

Conclusions
The results of this study showed that Brucella melitensis UGPase inhibits the activation of NF-κB by modulating the ubiquitination of NEMO, which will provide a new scientific basis for the study of immune mechanisms induced by Brucella.
Prevalence and correlates of non-fatal overdose among people who use drugs: findings from rapid assessments in Massachusetts, 2017–2019
Authors: Shrestha Shikhar , Stopka Thomas J. , Hughto Jaclyn M. W. , Case Patricia , Palacios Wilson R. , Reilly Brittni , Green Traci C. 
Published: August 2021

Abstract
Background
People who experience non-fatal overdose (NFOD) are at high risk of subsequent overdose. With unprecedented increases in fentanyl in the US drug supply, many Massachusetts (MA) communities have seen a surge in opioid-related overdoses. The objective of this study was to determine factors associated with lifetime and past year NFOD in at-risk MA communities.

Methods
We conducted multiple rapid assessments among people who use drugs (PWUD) in eight MA communities using non-probability sampling (purposive, chain referral, respondent-driven) methods. We collected sociodemographic, substance use, overdose history, substance use treatment, and harm reduction services utilization data. We examined the prevalence of NFOD (lifetime and past year) and identified factors associated with NFOD through multivariable logistic regression analyses in a subset of 469 study participants between 2017 and 2019.

Results
The prevalence of lifetime and last year non-fatal opioid overdose was 62.5% and 36.9%, respectively. Many of the study participants reported heroin (64%) and fentanyl (45%) use during the 30 days preceding the survey. Nonprescription buprenorphine and fentanyl use were independently associated with higher odds of lifetime NFOD, while marijuana use was associated with lower odds of lifetime NFOD (p < 0.05). Injection as the route of administration, benzodiazepine, nonprescription buprenorphine, heroin, and fentanyl use were independently associated with higher odds, while methadone use was associated with lower odds of past year NFOD (p < 0.05).

Conclusion
We documented a high prevalence of past year and lifetime NFOD among PWUD in MA. Our findings provide indicators that can help inform interventions to prevent overdoses among PWUD, including overdose prevention, medication treatment, and naloxone distribution.
Circ-RNF111 aggravates the malignancy of gastric cancer through miR-876-3p-dependent regulation of KLF12
Authors: Wu Guoxian , Zhang Aimin , Yang Yinglin , Wu Dongping 
Published: August 2021

Abstract
Background
The aberrant expression of circular RNAs (circRNAs) plays vital roles in the advancement of human cancers, including gastric cancer (GC). In this study, the functions of circRNA ring finger protein 111 (circ-RNF111) in GC were investigated.

Methods
Quantitative real-time polymerase chain reaction (qRT-PCR) assay was performed for the levels of circ-RNF111, microRNA-876-3p (miR-876-3p) and krueppel-like factor 12 (KLF12) mRNA. RNase R assay was conducted for the feature of circ-RNF111. Cell Counting Kit-8 (CCK-8) assay, colony formation assay, wound-healing assay, and transwell assay were applied for cell viability, colony formation, migration, and invasion, respectively. Flow cytometry analysis was used to analyze cell apoptosis and cell cycle process. The glycolysis level was examined using specific commercial kits. Western blot assay was carried out to measure the protein levels of hexokinase 2 (HK-2) and KLF12. Dual-luciferase reporter assay and RNA immunoprecipitation (RIP) assay were employed to verify the combination between miR-876-3p and circ-RNF111 or KLF12. Murine xenograft model was constructed for the role of circ-RNF111 in vivo. Immunohistochemistry (IHC) was used for KLF12 level.

Results
Circ-RNF111 was higher expressed in GC tissues and cells than normal tissues and cells. Silencing of circ-RNF111 restrained cell viability, colony formation, migration, invasion, cell cycle process and glycolysis and induced apoptosis in GC cells in vitro. Circ-RNF111 positively regulated KLF12 expression via absorbing miR-876-3p. MiR-876-3p downregulation reversed the impacts of circ-RNF111 silencing on GC cell malignant phenotypes. MiR-876-3p overexpression repressed GC cell growth, metastasis and glycolysis, inhibited apoptosis and arrested cell cycle, while KLF12 elevation weakened the effects. Besides, circ-RNF111 knockdown inhibited tumor growth in vivo.

Conclusion
Circ-RNF111 knockdown relieved the development of GC by regulating miR-876-3p/KLF12 axis.
Monomorphic epitheliotropic intestinal T-cell lymphomas: a case report
Authors: Zhong Haibin , Zheng Yang , Zhang Feiran 
Published: August 2021

Abstract
Background
Monomorphic epitheliotropic intestinal T-cell lymphomas (MEITL) is a rare and aggressive subtype of lymphoma. The most common site of origin is small intestine. Patients are often presented with diagnosis of intestinal perforation with abdominal pain as the main consulting symptoms. Because of the deficiency of specific diagnostic measures and effective management, diagnosis is often confirmed in advanced stage with poor prognosis.

Case presentation
Here, we introduce a patient who has suffered from abdominal pain and diarrhea, and eventually been diagnosed as Monomorphic epitheliotropic intestinal T-cell lymphomas.

Conclusion
MEITL is rare in clinical practice with deficiency of early diagnostic measures and poor prognosis. Therefore, any patient with ambiguous gastrointestinal symptoms or perforation of the digestive tract where the primary lesion is difficult to identify should be alert to the possibility of this disease.
Provider REport of Sustainment Scale (PRESS): development and validation of a brief measure of inner context sustainment
Authors: Moullin Joanna C. , Sklar Marisa , Ehrhart Mark G. , Green Amy , Aarons Gregory A. 
Published: August 2021

Abstract
Background
Implementation scientists and practitioners often rely on frontline providers for reporting on implementation outcomes. Furthermore, measures of sustainment are few, and available sustainment measures are mainly setting or evidenced-based practice (EBP) specific, require organizational and system-level knowledge to complete, and often lack psychometric rigor. The aim of this study was to develop a brief, pragmatic, and generalizable measure for completion by frontline service providers of the implementation outcome, sustainment.

Methods
We utilized a Rasch measurement theory approach to scale the development and testing of psychometric parameters. Sustainment items were developed to be relevant for direct service providers to complete. In order to promote generalizability, data were collected and items were tested across four diverse psychosocial evidence-based practices (motivational interviewing [MI], SafeCare®, classroom pivotal response training [CPRT], and an individualized mental health intervention for children with autism spectrum disorder [AIM-HI]) and in four service settings (substance use disorder treatment, child welfare, education, and specialty mental health). Associations between the sustainment measure and sustainment leadership, sustainment climate, and attitudes towards the adoption and use of each of the EBPs were assessed to confirm construct validity.

Results
Three items for the Provider REport of Sustainment Scale (PRESS) were assessed for measuring the core component of sustainment: continued use of the EBP. Internal consistency reliability was high. The scale indicated fit to the Rasch measurement model with no response dependency, ordered thresholds, no differential item functioning, and supported unidimensionality. Additionally, construct validity evidence was provided based on the correlations with related variables.

Conclusion
The PRESS measure is a brief, three-item measure of sustainment that is both pragmatic and useable across different EBPs, provider types, and settings. The PRESS captures frontline staffs’ report of their clinic, team, or agency’s continued use of an EBP. Future testing of the PRESS for concurrent and predictive validity is recommended.
Influence of target dose heterogeneity on dose sparing of normal tissue in peripheral lung tumor stereotactic body radiation therapy
Authors: Wei Zhigong , Peng Xingchen , Wang Yan , Yang Lianlian , He Ling , Liu Zheran , Wang Jingjing , Mu Xiaoli , Li Ruidan , Xiao Jianghong 
Published: August 2021

Abstract
Objective
To evaluate the influence of target dose heterogeneity on normal tissue dose sparing for peripheral lung tumor stereotactic body radiation therapy (SBRT).

Methods
Based on the volumetric-modulated arc therapy (VMAT) technique, three SBRT plans with homogeneous, moderate heterogeneous, and heterogeneous (HO, MHE, and HE) target doses were compared in 30 peripheral lung tumor patients. The prescription dose was 48 Gy in 4 fractions. Ten rings outside the PTV were created to limit normal tissue dosage and evaluate dose falloff.

Results
When MHE and HE plans were compared to HO plans, the conformity index of the PTV was increased by approximately 0.08. The median mean lung dose (MLD), V5, V10, V20 of whole lung, D2%, D1cc, D2cc of the rib, V30 of the rib, D2% and the maximum dose (Dmax) of the skin, and D2% and Dmax of most mediastinal organs at risk (OARs) and spinal cord were reduced by up to 4.51 Gy or 2.8%. Analogously, the median Dmax, D2% and mean dose of rings were reduced by 0.71 to 8.46 Gy; and the median R50% and D2cm were reduced by 2.1 to 2.3 and 7.4% to 8.0%, respectively. Between MHE and HE plans there was little to no difference in OARs dose and dose falloff beyond the target. Furthermore, the dose sparing of rib V30 and the mean dose of rings were negatively correlated with the rib and rings distance from tumor, respectively.

Conclusions
For peripheral lung tumor SBRT, target conformity, normal tissue dose, and dose falloff around the target could be improved by loosening or abandoning homogeneity. While there was negligible further dose benefit for the maximum target dose above 125% of the prescription, dose sparing of normal tissue derived from a heterogeneous target decreased as the distance from the tumor increased.