bluuebunny/crossref_metadata_2025_split huggingface dataset:
Virtual Reality Technology and Remote Digital Application for Tele-Simulation and Global Medical Education: An Innovative Hybrid System for Clinical Training
Authors: Almousa Omamah , Zhang Ruby , Dimma Meghan , Yao Jieming , Allen Arden , Chen Leo , Heidari Parastou , Qayumi Karim 
Published: May 2021

Objective. Although simulation-based medical education is fundamental for acquisition and maintenance of knowledge and skills; simulators are often located in urban centers and they are not easily accessible due to cost, time, and geographic constraints. Our objective is to develop a proof-of-concept innovative prototype using virtual reality (VR) technology for clinical tele simulation training to facilitate access and global academic collaborations. Methodology. Our project is a VR-based system using Oculus Quest as a standalone, portable, and wireless head-mounted device, along with a digital platform to deliver immersive clinical simulation sessions. Instructor’s control panel (ICP) application is designed to create VR-clinical scenarios remotely, live-stream sessions, communicate with learners and control VR-clinical training in real-time. Results. The Virtual Clinical Simulation (VCS) system offers realistic clinical training in virtual space that mimics hospital environments. Those VR clinical scenarios are customizable to suit the need, with high-fidelity lifelike characters designed to deliver interactive and immersive learning experience. The real-time connection and live-stream between ICP and VR-training system enables interactive academic learning and facilitates access to tele simulation training. Conclusions. VCS system provides innovative solutions to major challenges associated with conventional simulation training such as access, cost, personnel, and curriculum. VCS facilitates the delivery of academic and interactive clinical training that is similar to real-life settings. Tele-clinical simulation systems like VCS facilitate necessary academic-community partnerships, as well as global education network between resource-rich and low-income countries.
Deep anterior lamellar keratoplasty for corneal penetrating wounds
Authors: Sarnicola Enrica , Sarnicola Caterina , Cheung Albert Y , Sarnicola Vincenzo 
Published: May 2021

Purpose: To report our surgical experience of deep anterior lamellar keratoplasty (DALK) performed in eyes with scarring resulting from a corneal penetrating wound without tissue loss. Methods: Case series of three eyes of three patients that underwent DALK for poor vision due to a scar resulting from a previous corneal penetrating wound. Surgery was performed at least 1 year after the initial injury. Manual dissection technique was used in all cases. Preoperative and postoperative best correct visual acuity (BCVA), postoperative residual bed thickness, and postoperative endothelial cell count (ECC) were evaluated. Results: Preoperative BCVA ranged from 1.3 to 1.0 LogMAR. Two eyes were pseudophakic and one eye had a traumatic cataract. Manual DALK was successfully accomplished in all three cases. The mean residual recipient bed thickness was 103 µm (range 68–130 µm). The mean endothelial cell loss at the 6th month of follow-up was 6% (range 3%–11%) with a further 1% decrease at 4 years. One of the patients underwent cataract surgery and limbal relaxing incisions 1 year after DALK having a total endothelial cell loss of 4.8% at 2 years of follow-up. BCVA at 2 years of follow-up was 0.1 LogMAR (range 0.22–0.0 LogMAR). No episode of rejection was recorded, and all grafts remained clear at last follow-up (5 years, range 4–6 years). Conclusions: Manual DALK should be considered in cases of corneal scars in optical zone resulting from penetrating wound.
Variation in use of Caesarean section in Norway: An application of spatio-temporal Gaussian random fields
Authors: Mannseth Janne , Berentsen Geir D. , Skaug Hans J. , Lie Rolv T. , Moster Dag 
Published: May 2021

Aims: Caesarean section (CS) is a medical intervention performed in Norway when a surgical delivery is considered more beneficial than a vaginal. Because deliveries with higher risk are centralized to larger hospitals, use of CS varies considerably between hospitals. We describe how the use of CS varies geographically by municipality. Since indications for CS should have little variation across the relatively homogenous population of Norway, we expect fair use of CS to be evenly distributed across the municipalities. Methods: Data from the Medical Birth Registry of Norway were used in our analyses (810,914 total deliveries, 133,746 CSs, 440 municipalities). We propose a spatial correlation model that takes the location into account to describe the variation in use of CS across the municipalities. The R packages R-INLA and TMB are used to estimate the yearly municipal CS rate and the spatial correlation between the municipalities. We also apply stratified models for different categories of delivering women (Robson groups). Estimated rates are displayed in maps and model parameters are shown in tables. Results: The CS rate varies substantially between the different municipalities. As expected, there was strong correlation between neighbouring municipalities. Similar results were found for different Robson groups. Conclusions: The substantial difference in CS use across municipalities in Norway is not likely to be due to specific medical reasons, but rather to hospitals’ different policies towards the use of CS. The policy to be either more or less restrictive to CS was not specific to any category of deliveries.
Are self-reported and self-monitored adherence good proxies for reaching relevant plasma concentrations?: Experiences from a study of anti-depressants in healthy volunteers
Authors: Larsen Klaus Groes , Areberg Johan , Åström Daniel Oudin 
Published: May 2021

Background The use of electronic-based devices to measure and to improve adherence of subjects in clinical trials is increasing. AiCure has developed a mobile technology that is claimed to provide visual confirmation of drug ingestion. While there is evidence suggesting that including such self-monitoring device in a study increases adherence, the quality of the data produced by the device may be questionable. Can the mobile technology reliably distinguish whether a subject takes the study drug or not? Methods Adherence was calculated based on exposure, self-reporting and self-monitoring for subjects randomized to an anti-depressant. Levels of adherence and agreement between the three approaches were investigated based on calculation of proportions, two-way tables and receiver operating curves. Results A total of 214 subjects had measured concentrations of study drug at all three time points (end of weeks 3, 4 and 5), along with adherence data to define proportion of days adherent based on self-reporting and the self-monitoring instrument developed by AiCure. Self-reported adherence proportions were higher than self-monitored adherence proportions, although both were high (>90%). Neither self-reported and self-monitored adherence agreed with exposure-based adherence. Conclusion Both self-reported and self-monitored adherence overestimated adherence. Neither the self-reported nor the self-monitored adherence measure reflected subjects’ actual adherence. This prompts for cautiousness when interpreting either of them, and it underlines the need for thorough validation of electronic devices and software that claims to measure adherence. The AiCure instrument may not be able to reliably determine whether the subjects swallow the study medication.
Disparities in Dental Service Use among Adult Populations in the United States
Authors: Wu Y.Y. , Zhang W. , Wu B. 
Published: May 2021

Objectives: This article aims to examine the disparities in dental service utilization among 3 age groups: younger adults (20–49 y), middle-aged adults (50–64 y), and older adults (65+ y), among Whites, Hispanics, Blacks, Asians, American Indians or Alaska Natives (AIAN), and Native Hawaiian or other Pacific Islanders (NHOPI). Methods: Weighted logistic regression models were conducted to analyze 9 waves of cross-sectional survey data (2002–2018) from the Behavioral Risk Factor Surveillance System. We estimated age group- and race/ethnic–specific prevalences of dental service utilization adjusting sociodemographics and self-rated health for each wave and compared with crude analysis. Next, we performed linear regression analysis of the trend of adjusted prevalences over time and the average level by race/ethnicity and age groups. Results: Racial/ethnic disparities increased with age, even though the adjusted prevalences of dental service utilization were less apparent than the crude analysis. The all-wave average prevalence was 71%. Black older adults had the lowest level of dental service utilization (65%) as compared with the 2 highest groups: White older adults (79%) and Asian older adults (76%). The general younger adult populations had low prevalences, with the lowest among Asian younger adults (65%). AIAN and NHOPI individuals from all age groups tended to have average or below average prevalences. In addition, a decreasing trend of dental service utilization was observed among White individuals of all age groups (0.2%–0.3% lower per year, P < 0.01) and AIAN younger adults (0.5% lower per year, P < 0.01). Conclusion: Health policy, federal funding, and community-based programs should address the needs of dental service utilization for racial/ethnic minorities including Blacks, AIANs, and NHOPIs. Knowledge Transfer Statement: Our study offers insights into our understanding of disparities in dental service utilization among minority racial/ethnic groups. As health policy, federal funding, and community-based programs seek to improve oral health, there is a need to address access to and utilization of dental service for Blacks, American Indians or Alaska Natives, and Native Hawaiian or other Pacific Islanders.
Lessons to learn from tumor-educated platelets
Authors: Roweth Harvey G. , Battinelli Elisabeth M. 
Published: May 2021

Abstract
Platelets have long been known to play important roles beyond hemostasis and thrombosis. Now recognized as a bona fide mediator of malignant disease, platelets influence various aspects of cancer progression, most notably tumor cell metastasis. Interestingly, platelets isolated from cancer patients often display distinct RNA and protein profiles, with no clear alterations in hemostatic activity. This phenotypically distinct population, termed tumor-educated platelets, now receive significant attention for their potential use as a readily available liquid biopsy for early cancer detection. Although the mechanisms underpinning platelet education are still being defined, direct uptake and storage of tumor-derived factors, signal-dependent changes in platelet RNA processing, and differential platelet production by tumor-educated megakaryocytes are the most prominent scenarios. This article aims to cover the various modalities of platelet education by tumors, in addition to assessing their diagnostic potential.
The development and psychometric validation of a low-cost anthropomorphic 3D-printout simulator for training basic skills applicable to office-based hysteroscopy
Authors: Panazzolo Ana Rita Peixoto , Grando Leisa Beatriz , Volpato Lia Karina , de Oliveira Filho Getúlio R. 
Published: May 2021

Abstract
Background
Hysteroscopy training requires the development of specific psychomotor skills. Few validated low-cost models exist in hysteroscopy. The main objective of this study is to determine face, content, and construct validity of a simulator designed for training basic hysteroscopy skills applied to office-based hysteroscopy.

Methods
Twenty-five hysteroscopy experts and 30 gynecology residents participated in this prospective observational study. The simulator consisted of three color-textured, silicone-coated anthropomorphic 3-dimensional (3-D) printout uterine models inside a box. Each uterine model in the simulator was designed to develop one of the following basic hysteroscopic skills: hysteroscopic navigation, direct biopsy, and foreign body removal. Participants performed five video-recorded simulation attempts on each model. Procedure-specific checklists were used to rate performance.

Results
Median scores (25th–75th percentiles; p-value) 4 (3–4; p < 0.001) and surgical experience associated to the simulated procedures 4 (3–4; p < 0.001) indicated positive perceptions as to the realism of the internal cavity of the simulator. Median scores of 4 (3–4; p < 0.001) were assigned to the realism and utility of the tasks performed in the simulator for enhancing novice training in hysteroscopy. Expert performance scores were significantly higher and task completion times were significantly lower than those of novices in the navigation exercise (F(1,53) = 56.66; p < 0.001), the directed biopsy exercise (F(1,53) = 22.45; p < 0.001), and the foreign body removal exercise (F(1,53) = 58.51; p < 0.001). Novices’ performance improved on all three exercises: navigation exercise (F(1,53) = 182.44; p < 0.001), directed endometrial biopsy (F(1,53) = 110.53; p < 0.001), and foreign body removal (F(1,53) = 58.62; p < 0.001). Experts’ task completion times were significantly lower when compared to that of novices in the five attempts (p < 0,001) of the exercises: navigation (F(1,48) = 25.46; p < 0.001), directed biopsy (F(1,46) = 31.20; p < 0.001), and foreign body removal (F(1,50) = 69.8; p < 0.001). Novices’ task completion times diminished significantly throughout the sequence of exercises.

Conclusions
The low-cost simulator designed for the acquisition of basic skills in hysteroscopy demonstrated face, content, and construct validity.
Identification of homozygous haplotypes carrying putative recessive lethal mutations that compromise fertility traits in French Lacaune dairy sheep
Authors: Ben Braiek Maxime , Fabre Stéphane , Hozé Chris , Astruc Jean-Michel , Moreno-Romieux Carole 
Published: May 2021

Abstract
Background
Homozygous recessive deleterious mutations can cause embryo/fetal or neonatal lethality, or genetic defects that affect female fertility and animal welfare. In livestock populations under selection, the frequency of such lethal mutations may increase due to inbreeding, genetic drift, and/or the positive pleiotropic effects of heterozygous carriers on selected traits.

Results
By scanning the genome of 19,102 Lacaune sheep using 50 k single nucleotide polymorphism (SNP) phased genotypes and pedigree data, we identified 11 Lacaune deficient homozygous haplotypes (LDHH1 to LDHH11) showing a highly significant deficit of homozygous animals ranging from 79 to 100%. These haplotypes located on chromosomes 3, 4, 13, 17 and 18, spanned regions from 1.2 to 3.0 Mb long with a frequency of heterozygous carriers between 3.7 and 12.1%. When we compared at-risk matings (between carrier rams and daughters of carrier rams) and safe matings, seven of the 11 haplotypes were associated with a significant alteration of two fertility traits, a reduced success of artificial insemination (LDHH1, 2, 8 and 9), and/or an increased stillbirth rate (LDHH3, 6, 8, 9, and 10). The 11 haplotypes were also tested for a putative selective advantage of heterozygous carrier rams based on their daughter yield deviation for six dairy traits (milk, fat and protein yields, fat and protein contents and lactation somatic cell score). LDHH1, 3, 4, 5, 7, 9 and 11 were associated with positive effects on at least one selected dairy trait, in particular milk yield. For each haplotype, the most probable candidate genes were identified based on their roles in lethality of mouse knock-out models and in mammalian genetic disorders.

Conclusions
Based on a reverse genetic strategy, we identified at least 11 haplotypes with homozygous deficiency segregating in French Lacaune dairy sheep. This strategy represents a first tool to limit at-risk matings in the Lacaune dairy selection scheme. We assume that most of the identified LDHH are in strong linkage disequilibrium with a recessive lethal mutation that affects embryonic or juvenile survival in sheep but is yet to be identified.
SEM and TEM for identification of capsular fibrosis and cellular behavior around breast implants – a descriptive analysis
Authors: Kuehlmann Britta , Zucal Isabel , Bonham Clark Andrew , Joubert Lydia-Marie , Prantl Lukas 
Published: May 2021

Abstract
Background
Capsular fibrosis (CF) is the most common long-term complication in implant-based breast augmentation. It is well accepted that the foreign body response (FBR) instigates the development of fibrotic disease. Our study aims to compare murine and human samples of CF and describe the cellular and extracellular matrix (ECM) composition using scanning and transmission electron microscopy (SEM and TEM).

Results
Miniature microtextured silicone breast implants were implanted in mice and subsequently harvested at days 15, 30, and 90 post-operation. Isolated human capsules with the most aggravated form of CF (Baker IV) were harvested post-operation. Both were analyzed with SEM and TEM to assess cellular infiltration and ECM structure.
An architectural shift of collagen fiber arrangement from unidirectional to multidirectional was observed at day 90 when compared to days 15 and 30. Fibrosis was observed with an increase of histiocytic infiltration. Moreover, bacterial accumulation was seen around silicone fragments. These findings were common in both murine and human capsules.

Conclusions
This murine model accurately recapitulates CF found in humans and can be utilized for future research on cellular invasion in capsular fibrosis. This descriptive study helps to gain a better understanding of cellular mechanisms involved in the FBR. Increases of ECM and cellularity were observed over time with SEM and TEM analysis.
Strategies for detecting and identifying biological signals amidst the variation commonly found in RNA sequencing data
Authors: Wilfinger William W. , Miller Robert , Eghbalnia Hamid R. , Mackey Karol , Chomczynski Piotr 
Published: May 2021

Abstract
Background
RNA sequencing analysis focus on the detection of differential gene expression changes that meet a two-fold minimum change between groups. The variability present in RNA sequencing data may obscure the detection of valuable information when specific genes within certain samples display large expression variability. This paper develops methods that apply variance and dispersion estimates to intra-group data to identify genes with expression values that diverge from the group envelope. STRING database analysis of the identified genes characterize gene affiliations involved in physiological regulatory networks that contribute to biological variability. Individuals with divergent gene groupings within network pathways can thereby be identified and judiciously evaluated prior to standard differential analysis.

Results
A three-step process is presented for evaluating biological variability within a group in RNA sequencing data in which gene counts were: (1) scaled to minimize heteroscedasticity; (2) rank-ordered to detect potentially divergent “trendlines” for every gene in the data set; and (3) tested with the STRING database to identify statistically significant pathway associations among the genes displaying marked trendline variability and dispersion. This approach was used to identify the “trendline” profile of every gene in three test data sets. Control data from an in-house data set and two archived samples revealed that 65–70% of the sequenced genes displayed trendlines with minimal variation and dispersion across the sample group after rank-ordering the samples; this is referred to as a linear trendline. Smaller subsets of genes within the three data sets displayed markedly skewed trendlines, wide dispersion and variability. STRING database analysis of these genes identified interferon-mediated response networks in 11–20% of the individuals sampled at the time of blood collection. For example, in the three control data sets, 14 to 26 genes in the defense response to virus pathway were identified in 7 individuals at false discovery rates ≤1.92 E-15.

Conclusions
This analysis provides a rationale for identifying and characterizing notable gene expression variability within a study group. The identification of highly variable genes and their network associations within specific individuals empowers more judicious inspection of the sample group prior to differential gene expression analysis.
Genome-wide identification and analysis of class III peroxidases in Betula pendula
Authors: Cai Kewei , Liu Huixin , Chen Song , Liu Yi , Zhao Xiyang , Chen Su 
Published: May 2021

Abstract
Background
Class III peroxidases (POD) proteins are widely present in the plant kingdom that are involved in a broad range of physiological processes including stress responses and lignin polymerization throughout the plant life cycle. At present, POD genes have been studied in Arabidopsis, rice, poplar, maize and Chinese pear, but there are no reports on the identification and function of POD gene family in Betula pendula.

Results
We identified 90 nonredundant POD genes in Betula pendula. (designated BpPODs). According to phylogenetic relationships, these POD genes were classified into 12 groups. The BpPODs are distributed in different numbers on the 14 chromosomes, and some BpPODs were located sequentially in tandem on chromosomes. In addition, we analyzed the conserved domains of BpPOD proteins and found that they contain highly conserved motifs. We also investigated their expression patterns in different tissues, the results showed that some BpPODs might play an important role in xylem, leaf, root and flower. Furthermore, under low temperature conditions, some BpPODs showed different expression patterns at different times.

Conclusions
The research on the structure and function of the POD genes in Betula pendula plays a very important role in understanding the growth and development process and the molecular mechanism of stress resistance. These results lay the theoretical foundation for the genetic improvement of Betula pendula.