bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hemorrhagic abdominal pseudocyst following ventriculoperitoneal shunt: a case report
Authors: Wang Hong-Cai , Tong Yi-Lei , Li Shi-Wei , Chen Mao-Song , Wang Bo-Ding , Chen Hai 
Published: March 2021

Abstract
Background
Abdominal cerebrospinal fluid (CSF) pseudocyst is an uncommon but important complication of ventriculoperitoneal (VP) shunts. While individual articles have reported many cases of abdominal CSF pseudocyst following VP shunts, no case of a hemorrhagic abdominal pseudocyst after VP shunts has been reported so far.

Case presentation
This article reports a 68-year-old woman with a 4-month history of progressive abdominal pain and distention. She denied any additional symptoms. A VP shunt was performed 15 years earlier to treat idiopathic normal pressure hydrocephalus and no other abdominal surgery was performed. Physical examination revealed an elastic palpable mass in her right lower abdomen, which was dull to percussion. Abdominal computed tomography (CT) scan indicated a large cystic collection of homogenous iso-density fluid in the right lower abdominal region with clear margins. The distal segment of the peritoneal shunt catheter was located within the cystic mass. Abdominal CSF pseudocyst was highly suspected as a diagnosis. Laparoscopic cyst drainage with removal of the whole cystic mass was performed, 15-cm cyst which found with thick walls and organized chronic hematic content. No responsible vessel for the cyst hemorrhage was identified. No further shunt revision was placed. Histological examination showed that the cyst wall consisted of outer fibrous tissue and inner granulation tissue without epithelial lining, and the cystic content was chronic hematoma. The patient had an uneventful postoperative course and remained asymptomatic for 8-mo follow-up.

Conclusion
To the best of our knowledge, this is the first report of hemorrhagic onset in the abdominal pseudocyst following VP shunt. Such special condition can accelerate the appearance of clinical signs of the abdominal pseudocyst after VP shunts, and its mechanisms may be similar to the evolution of subdural effusion into chronic subdural hematoma (CSDH).
Oral health academics’ conceptualisation of health promotion and perceived barriers and opportunities in dental practice: a qualitative study
Authors: Bracksley-O’Grady Stacey , Anderson Karen , Masood Mohd 
Published: March 2021

Abstract
Background
Oral diseases place a significant burden on individual and population health. These diseases are largely preventable; health promotion initiatives have been shown to decrease the disease rates. However, there is limited implementation of health promotion in dentistry, this could be due to a number of factors; the ethos and philosophy of dentistry is focused on a curative, individualised approach to oral diseases, confusion around health promotion as a concept. Oral health academics are well placed to implement health promotion, training of these professionals needs to include prevention, as training influences dental practice. However, there is a little understanding about how oral health academics (dental professionals who educate dental and oral health students) view health promotion. The aim of this exploratory study is to understand how oral health academics conceptualise health promotion and perceive the barriers and possible opportunities for health promotion implementation in dental practice.

Methods
Nominal group technique (NGT), a highly structured face-to-face meeting, was conducted with 24 oral health academics to explore how they conceptualize health promotion and the barriers and opportunities for health promotion in practice. An additional 4 questions were emailed to oral health educators after the NGT meeting to gather additional data, 6 oral health academics were involved. The data was analyzed using thematic analysis.

Results
Three board themes were identified: “Knowledge, ideas and concepts of health promotion”, “Challenges to health promotion”, “Opportunities for health promotion practice”. The oral health academics in this study discussed health promotion in a holistic way, however, health education and behaviour change were mentioned more than other aspects of health promotion. The structure of dental practice specifically the curative approach that underpins dentistry and the lack of funding, and value placed on health promotion could act as a challenge to health promotion being implemented in practice. There has been a shift towards prevention in dentistry, however the participants acknowledge there needs to be a change in the curative culture of the profession. Collaboration with other health professionals and using a common risk factor approach were the identified opportunities for health promotion practice.

Conclusions
Oral health academics have a holistic understanding of health promotion, but still focus more on behavioural approaches which is common within dentistry. For a change to occur in health promotion practice a change in the structure, curative approach and funding model of dentistry is required. Collaboration with other health professionals is an opportunity to be capitalised on. Training of future dental professionals is the perfect place to start to implement the changes and opportunities for health promotion presented in this paper.
Medical educators’ beliefs about teaching, learning, and knowledge: development of a new framework
Authors: Ottenhoff- de Jonge Marleen W. , van der Hoeven Iris , Gesundheit Neil , van der Rijst Roeland M. , Kramer Anneke W. M. 
Published: March 2021

Abstract
Background
The educational beliefs of medical educators influence their teaching practices. Insight into these beliefs is important for medical schools to improve the quality of education they provide students and to guide faculty development.
Several studies in the field of higher education have explored the educational beliefs of educators, resulting in classifications that provide a structural basis for diverse beliefs. However, few classification studies have been conducted in the field of medical education. We propose a framework that describes faculty beliefs about teaching, learning, and knowledge which is specifically adapted to the medical education context. The proposed framework describes a matrix in which educational beliefs are organised two dimensionally into belief orientations and belief dimensions. The belief orientations range from teaching-centred to learning-centred; the belief dimensions represent qualitatively distinct aspects of beliefs, such as ‘desired learning outcomes’ and ‘students’ motivation’.

Methods
We conducted in-depth semi-structured interviews with 26 faculty members, all of whom were deeply involved in teaching, from two prominent medical schools. We used the original framework of Samuelowicz and Bain as a starting point for context-specific adaptation. The qualitative analysis consisted of relating relevant interview fragments to the Samuelowicz and Bain framework, while remaining open to potentially new beliefs identified during the interviews. A range of strategies were employed to ensure the quality of the results.

Results
We identified a new belief dimension and adapted or refined other dimensions to apply in the context of medical education. The belief orientations that have counterparts in the original Samuelowicz and Bain framework are described more precisely in the new framework. The new framework sharpens the boundary between teaching-centred and learning-centred belief orientations.

Conclusions
Our findings confirm the relevance of the structure of the original Samuelowicz and Bain beliefs framework. However, multiple adaptations and refinements were necessary to align the framework to the context of medical education. The refined belief dimensions and belief orientations enable a comprehensive description of the educational beliefs of medical educators. With these adaptations, the new framework provides a contemporary instrument to improve medical education and potentially assist in faculty development of medical educators.
Microbial production of ectoine and hydroxyectoine as high-value chemicals
Authors: Liu Mengshuang , Liu Hui , Shi Meng , Jiang Mingyue , Li Lingling , Zheng Yanning 
Published: March 2021

AbstractEctoine and hydroxyectoine as typical representatives of compatible solutes are not only essential for extremophiles to survive in extreme environments, but also widely used in cosmetic and medical industries. Ectoine was traditionally produced by Halomonas elongata through a “bacterial milking” process, of which the marked feature is using a high-salt medium to stimulate ectoine biosynthesis and then excreting ectoine into a low-salt medium by osmotic shock. The optimal hydroxyectoine production was achieved by optimizing the fermentation process of Halomonas salina. However, high-salinity broth exacerbates the corrosion to fermenters, and more importantly, brings a big challenge to the subsequent wastewater treatment. Therefore, increasing attention has been paid to reducing the salinity of the fermentation broth but without a sacrifice of ectoine/hydroxyectoine production. With the fast development of functional genomics and synthetic biology, quite a lot of progress on the bioproduction of ectoine/hydroxyectoine has been achieved in recent years. The importation and expression of an ectoine producing pathway in a non-halophilic chassis has so far achieved the highest titer of ectoine (~ 65 g/L), while rational flux-tuning of halophilic chassis represents a promising strategy for the next-generation of ectoine industrial production. However, efficient conversion of ectoine to hydroxyectoine, which could benefit from a clearer understanding of the ectoine hydroxylase, is still a challenge to date.
Prevalence, awareness, treatment, and control of dyslipidemia among diabetes mellitus patients and predictors of optimal dyslipidemia control: results from the Korea National Health and Nutrition Examination Survey
Authors: Kim Seung Jae , Kwon Oh. Deog , Kim Kyung-Soo 
Published: March 2021

AbstractBackgroundThis study aimed to investigate the prevalence, awareness, treatment, and control rates of dyslipidemia and identify the predictors of optimal control (low-density lipoprotein cholesterol < 100 mg/dL) among patients with diabetes mellitus (DM).MethodsA cross-sectional study was conducted using the representative Korea National Health and Nutrition Examination Survey (2014–2018). Overall, 4311 patients with DM, aged ≥19 years, and without cardiovascular diseases were selected, and the prevalence, awareness, treatment, and control rates of dyslipidemia were calculated. Univariate and multivariate logistic regression analyses were conducted to evaluate the factors influencing the optimal control of dyslipidemia.ResultsDyslipidemia was prevalent in 83.3% of patients with DM, but the awareness and treatment rates were 36.5 and 26.9%, respectively. The control rate among all patients with dyslipidemia was 18.8%, whereas it was 61.1% among those being treated. Prevalence and awareness rates were also significantly higher in women than in men. Dyslipidemia was most prevalent in those aged 19–39 years, but the rates of awareness, treatment, and control among all patients with dyslipidemia in this age group were significantly lower than those in other age groups. The predictors of optimal control were age ≥ 40 years [range 40–49 years: adjusted odds ratio (aOR) 3.73, 95% confidence interval (CI) 1.43–9.72; 50–59 years: aOR 6.25, 95% CI 2.50–15.65; 60–69 years: aOR 6.96, 95% CI 2.77–17.44; 70–79 years: aOR 9.21, 95% CI 3.58–23.74; and ≥ 80 years: aOR 4.43, 95% CI 1.60–12.27]; urban living (aOR 1.44, 95% CI 1.15–1.80); higher body mass index (aOR 1.27, 95% CI 1.13–1.42); lower glycated hemoglobin levels (aOR 0.71, 95% CI 0.67–0.76); hypertension (aOR 1.53, 95% CI 1.22–1.92); poorer self-rated health status (aOR 0.72, 95% CI 0.62–0.84); and receiving regular health check-ups (aOR 1.58, 95% CI 1.25–2.00).ConclusionsMost patients with DM were diagnosed with dyslipidemia, but many were unaware of or untreated for their condition. Therefore, their control rate was suboptimal. Thus, by understanding factors influencing optimal control of dyslipidemia, physicians should make more effort to encourage patients to undergo treatment and thus, adequately control their dyslipidemia.
Evaluating a capacity building program on women’s health for displaced community health workers in fragile settings in Lebanon
Authors: Naal Hady , Mendelsohn Rebecca , Brome Dayana , Noubani Aya , Nabulsi Dana , Muhieddine Dina , Saleh Shadi 
Published: March 2021

Abstract
Background
Displaced populations in fragile settings experience health disparities that are seldom attended to. Task-shifting, which involves training non-specialized community health workers (CHW) to deliver basic education and health services is a favorable strategy to address this problem, however very little data exist on this topic in the Middle East region. We conducted a long-term evaluation of the Women’s Health Certificate delivered to Syrian refugees and host community in informal tented settlements in Lebanon under the Mobile University for Health (MUH) program. The training was delivered through a mobile classroom approach that incorporated a blended learning modality.

Methods
We collected short-term data from the 42 trained CHW (knowledge assessments and satisfaction measures) during the delivery of the intervention between March and August 2019, and long-term data (semi-structured interviews with 8 CHW and focus group discussion with 9 randomly selected community members) one year later between July and August 2020. The evaluation approach was informed by the Kirkpatrick evaluation model, and the qualitative data were analyzed using qualitative content analysis.

Results
Data from the CHWs and community members were triangulated, and they showed that the training enhanced access to education due to its mobile nature and provided opportunities for CHWs to engage and interact with learning material that enhanced their knowledge and favorable behaviors regarding women’s health. In turn, CHWs were empowered to play an active role in their communities to transfer the knowledge they gained through educating community members and providing women’s health services and referrals. Community members benefited from the CHWs and called for the implementation of more similar training programs.

Conclusion
This is one of few studies reporting a long-term community-level evaluation of a task-shifting program on women’s health among displaced populations in Lebanon. Our findings support the need to increase funding for similar programs, and to focus on delivering programs for a variety of health challenges. It is also essential to enhance the reach and length of recruitment to wider communities, to design concise, interactive, and engaging sessions, and to provide tools to facilitate circulation of learning material, and resources for referrals to health services.
Combining the responses of habitat suitability and connectivity to climate change for an East Asian endemic frog
Authors: Luo Zhenhua , Wang Xiaoyi , Yang Shaofa , Cheng Xinlan , Liu Yang , Hu Junhua 
Published: March 2021

Abstract
Background
Understanding the impacts of past and contemporary climate change on biodiversity is critical for effective conservation. Amphibians have weak dispersal abilities, putting them at risk of habitat fragmentation and loss. Both climate change and anthropogenic disturbances exacerbate these risks, increasing the likelihood of additional amphibian extinctions in the near future. The giant spiny frog (Quasipaa spinosa), an endemic species to East Asia, has faced a dramatic population decline over the last few decades. Using the giant spiny frog as an indicator to explore how past and future climate changes affect landscape connectivity, we characterized the shifts in the suitable habitat and habitat connectivity of the frog.

Results
We found a clear northward shift and a reduction in the extent of suitable habitat during the Last Glacial Maximum for giant spiny frogs; since that time, there has been an expansion of the available habitat. Our modelling showed that “overwarm” climatic conditions would most likely cause a decrease in the available habitat and an increase in the magnitude of population fragmentation in the future. We found that the habitat connectivity of the studied frogs will decrease by 50–75% under future climate change. Our results strengthen the notion that the mountains in southern China and the Sino-Vietnamese transboundary regions can act as critical refugia and priority areas of conservation planning going forward.

Conclusions
Given that amphibians are highly sensitive to environmental changes, our findings highlight that the responses of habitat suitability and connectivity to climate change can be critical considerations in future conservation measures for species with weak dispersal abilities and should not be neglected, as they all too often are.
Respiratory and systemic impacts following MWCNT inhalation in B6C3F1/N mice
Authors: Migliaccio Christopher T. , Hamilton Raymond F. , Shaw Pamela K. , Rhoderick Joseph F. , Deb Sanghamitra , Bhargava Rohit , Harkema Jack R. , Holian Andrij 
Published: March 2021

Abstract
Background
A very pure multi-walled carbon nanotube (MWCNT) that was shown to have very low toxicity in vitro, was evaluated for lung and systemic effects and distribution following inhalation exposure.

Methods
B6C3F1/N mice were exposed to varying doses (0, 0.06, 0.2, and 0.6 mg/m3) of the (99.1% carbon) MWCNT by inhalation for 30 days (excluding weekends). Ten days following the last exposure, the lungs and spleen were harvested and processed for histology and immune cell population assessment. In addition, lung lavage cells and fluid were analyzed. Stimulated Raman scattering (SRS) was used to identify particles in the lungs, spleen, kidneys, liver, mediastinal and brachial lymph nodes, and olfactory bulb. Splenic tissue sections were stained with hematoxylin and eosin (H&E) for light microscopic histopathology assessment. Blood plasma was analyzed for cytokines and cathepsins. A section of the spleen was processed for RNA isolation and relative gene expression for 84 inflammation-related cytokines/chemokines.

Results
Following MWCNT exposure, particles were clearly evident in the lungs, spleens, lymph nodes and olfactory bulbs, (but not livers or kidneys) of exposed mice in a dose-dependent manner. Examination of the lavaged lung cells was unremarkable with no significant inflammation indicated at all particle doses. In contrast, histological examination of the spleen indicated the presence of apoptotic bodies within T cells regions of the white pulp area. Isolated splenic leukocytes had significant changes in various cells including an increased number of proinflammatory CD11b+Ly6C+ splenic cells. The gene expression studies confirmed this observation as several inflammation-related genes were upregulated particularly in the high dose exposure (0.6 mg/m3). Blood plasma evaluations showed a systemic down-regulation of inflammatory cytokines and a dose-dependent up-regulation of lysosomal cathepsins.

Conclusions
The findings in the lungs were consistent with our hypothesis that this MWCNT exposure would result in minimal lung inflammation and injury. However, the low toxicity of the MWCNT to lung macrophages may have contributed to enhanced migration of the MWCNT to the spleen through the lymph nodes, resulting in splenic toxicity and systemic changes in inflammatory mediators.
Psychological predictors of chronic pain in Al Kharj region, Saudi Arabia
Authors: Al-Zahrani Jamaan , Shubair Mamdouh M. , Al-Ghamdi Sameer , Aldossari Khaled K. , Alsalamah Majid , Al-Khateeb Badr F. , Saeed Abdulkarim , Alshahrani Saeed , AlSuwaidan Aseel Salem , Alrasheed Abdullah A. , El-Metwally Ashraf 
Published: March 2021

Abstract
Background
Psychological distress is one of the major determinants for the experience progression, and recovery of chronic pain. However, it is unclear whether physical pain in specific body sites could be predictive of psychological illness. In this study, we aim to investigate the link between chronic pain in specific anatomical sites and psychological distress represented in the General Health Questionnaire-12 (GHQ-12 items).

Methods
A population-based cross-sectional study was conducted in Al Kharj region of Saudi Arabia. We included 1003 participants. Data were collected using the GHQ-12, and a subjective report on eight anatomical pain sites. Data analysis used statistical software SPSS version 26.0 for Windows statistical package.

Results
Chronic musculoskeletal pain in the neck and head regions was significantly associated with higher psychological distress. Other sites (back, lower limb, chest, abdominal and upper limb pain) were not associated with psychological distress. In multiple regression analysis, chronic ‘general’ pain was significantly associated with higher psychological distress (unstandardized Beta regression coefficient = 2.568; P < 0.0001). The patients with younger age were more likely to develop negative psychological disorders (unstandardized Beta = − 3.137; P = 0.038). Females were more likely to have higher psychological distress than males (unstandardized Beta = 2.464, P = 0.003). Single (not-married) people have a higher risk of psychological distress than married people (unstandardized Beta = 2.518, P = 0.025). Also, job type/status whether being unemployed (not working) or ‘civilian’ (civil servant/worker) was positively and significantly associated with an increased probability of psychological distress (unstandardized Beta = 1.436, P = 0.019).

Conclusion
Chronic ‘general’ pain was significantly associated with negative psychological disorders. The government of Saudi Arabia needs to focus on patients with chronic ‘general’ pain, females, young and unmarried individuals as potentially ‘high-risk’ population subgroups for adverse psychological disorders, and subsequent long-term complications.
Resection of primary cardiac angiosarcoma infiltrating the right atrioventricular junction and tricuspid valve: a case report
Authors: Bakr Lubna , AlKhalaf Hussam , Takriti Ahmad 
Published: March 2021

AbstractBackgroundPrimary cardiac tumours are extremely rare. Most of them are benign. Sarcomas account for 95% of the malignant tumours. Prognosis of primary cardiac angiosarcoma remains poor. Complete surgical resection is oftentimes hampered when there is extensive tumour involvement into important cardiac apparatus. We report a case of cardiac angiosarcoma of the right atrium and ventricle, infiltrating the right atrioventricular junction and tricuspid valve.Case presentationInitially, a 22-year-old man presented with dyspnoea. One year later, he had recurrent pericardial effusion. Afterwards, echocardiography revealed a large mass in the right atrium, expanding from the roof of the right atrium to the tricuspid valve. The mass was causing compression on the tricuspid valve, and another mass was seen in the right ventricle. Complete resection of the tumour was impossible. The mass was resected with the biggest possible margins. The right atrium was reconstructed using heterologous pericardium. The patient’s postoperative course was uneventful. Postoperative echocardiography showed a small mass remaining in the right side of the heart. Histopathology and immunohistochemistry confirmed the diagnosis of angiosarcoma. The patient underwent adjuvant chemotherapy and radiotherapy later on. He survived for 1 year and 5 days after the surgery. After a diagnosis of lung and brain metastases, he ended up on mechanical ventilation for 48 h and died.ConclusionsSurgical resection combined with postoperative chemotherapy and radiotherapy is feasible even in patients with an advanced stage of cardiac angiosarcoma when it is impossible to perform complete surgical resection.