bluuebunny/crossref_metadata_2025_split huggingface dataset:
You Get What You Reward: A Qualitative Study Exploring Medical Student Engagement in 2 Different Assessment Systems
Authors: Jauregui Joshua , McClintock Adelaide H. , Schrepel Caitlin , Fainstad Tyra , Bierer S. Beth , Heeneman Sylvia 
Published: September 2024

Abstract

Purpose
Educational impact is dependent on student engagement. Assessment design can provide a scaffold for student engagement to determine the focus of student efforts. Little is known about how medical students engage with assessment. Therefore, we asked the following research question: How do medical students engage with the process of assessment and their assessment data in 2 clinical assessment systems?

Method
This multi-institutional, cross-sectional constructivist grounded theory study of fourth-year undergraduate medical students at the University of Washington and Cleveland Clinic Lerner College of Medicine assessed 2 different assessment systems: traditional tiered grading, in which clerkship grades were summative, and programmatic assessment, in which students received low-stake, narrative feedback across clerkships with progress based on aggregated performance data in student portfolios. All fourth-year students were invited to participate in one-on-one semistructured interviews guided by student engagement theory between September 2022 and January 2023. Verbatim transcripts underwent iterative, qualitative analysis.

Results
Twenty-two medical students were interviewed, 13 from a traditional grading assessment system and 9 from a programmatic assessment system. Three major ways in which assessment systems affected how students engaged with their assessments were categorized into the affective, cognitive, and behavioral domains of engagement: as a sociocultural statement of value, as the cognitive load associated with the assessment system and practices themselves, and as the locus of power and control in learning and authentic practice.

Conclusions
Medical students’ beliefs about assessment goals, cognitive burden of assessment, and relationships with others significantly affected their engagement with their assessments. In assessment systems that reward grading and an archetypal way of being, students report engaging by prioritizing image over learning. In programmatic assessment systems, students describe more fully and authentically engaging in their assessment for and as learning. Systems of assessment communicate what is rewarded, and you get what you reward.
Championing Civility in the Clinical Learning Environment: Evaluation of a Novel Training Program
Authors: Shofer Sharon L. , Gagliardi Jane P. , Bryant Stephanie , Khedagi Apurva M. , Mohottige Dinushika , Gregory Ada , Zaas Aimee K. , Truong Tracy , Staples Betty B. 
Published: September 2024

Abstract

Problem
Incivility in the health care workplace is increasing and negatively impacts everyone in the environment, including health care team members and the patients and families they serve. This study examined the efficacy and impact of Civility Champions (CCs), a novel training program for a multidisciplinary cohort of faculty and graduate medical education (GME) trainees based in principles of trauma-informed care, nonviolent communication, and restorative practices.

Approach
Participants were 39 faculty and GME trainees representing 6 departments in a major academic medical center. The concurrent, mixed-methods study employed the Kirkpatrick New World Model as a framework for the creation of the evaluation tools as well as to analyze and report the results of the study. Quantitative and qualitative data analysis examined participants’ reactions, perceived learning, workplace use of the skills following training, and initial indicators of whether the program is on track to meet its goals.

Outcomes
Participants found CCs training to be valuable (84.6% agree or strongly agree that training was relevant and would recommend it to others). Post-training, CCs felt an increased sense of confidence and commitment using the skills and knowledge learned as indicated by a positive average change score (P < .05) on all measures. At the 6-month survey, 70% of CCs had employed the skills. Results on the implementation of the CCs program found that key success factors include improving program visibility, providing opportunities for skill refreshment, and fostering a supportive community.

Next Steps
This study expanded a novel training program to multidisciplinary departments and provided early evaluation of the efficacy of the training in the health care workplace. CCs training showed significant measurable benefit using both quantitative and qualitative measures. Future iterations will include training interdisciplinary cohorts and will attempt to assess the program’s impact on institutional culture.
Full Endoscopic Bilateral Discectomy at L5/S1 Level
Authors: Liu Xinchun 
Published: September 2024

Study Design:
Technical report.

Objective:
This report aimed to describe a 3-step unilateral uniportal interlaminar circum-dural approach for entire spinal canal inspection and bilateral discectomy at L5/S1 level.

Summary of Background Data:
Treatment of lumbar disc herniation with bilateral symptoms at L5/S1 level is complicated in full endoscopic surgeries. Unilateral interlaminar approaches have been used for bilateral discectomy at L5/S1 level through a uniportal ventral dural approach or a biportal dorsal dural approach. Despite the reporting of successful clinical outcomes, inspection and manipulation of the entire spinal canal via a unilateral approach remain challenging.

Methods:
The 3-step inspection of the entire spinal canal includes the ipsilateral side, the midline, and the contralateral side. Two typical cases are provided to further demonstrate the technique. In case 1, bilateral symptoms were caused by bilateral multifocal herniations. In case 2, bilateral symptoms were caused by a huge midline herniation.

Results:
The surgical purposes were achieved as intended in both of the 2 cases. The herniations were successfully removed and the pain was relieved immediately after surgery.

Conclusions:
As indicated by the preliminary application, the present technique, integrating the advantages of both the ventral and the dorsal dural approaches, is probably an ideal choice for bilateral discectomy at L5/S1 level.
Active and Secondhand Smoke Exposure and Cervical Cancer: Analysis of the NHANES 2007–2016
Authors: Capps Natalie Pate , Rhoads Sarah Jane , Barone Claudia Protzman , Wright Patricia , Selig James P. , Rojo Martha 
Published: September 2024

Background:
Cervical cancer is the third most prevalent cancer among women worldwide. Despite efforts to reduce cervical cancer through human papillomavirus vaccination, a significant problem remains. Active smoking is a cofactor for cervical cancer, but the data are mixed regarding the role of secondhand smoke exposure (SHSE) in cervical cancer pathogenesis.

Objective:
To examine the relationship between cervical cancer and smoke exposure (active and SHSE).

Methods:
A retrospective analysis was employed on data from the National Health and Nutrition Examination Survey 2007–2016. This nationally representative dataset yielded a total sample of 13 396 women ≥20 years old. Cervical cancer history and smoke exposure (self-reported and biochemically measured) were used in a logistic regression model.

Results:
Women who lived with more household smokers and those who were active smokers had significantly higher odds of cervical cancer, controlling for covariates.

Conclusion:
In addition to active smoking status, assessment of smokers in the household may be a clinically important assessment tool in women at risk for cervical cancer. Further analysis is needed to clarify the role of SHSE in cervical cancer pathogenesis.

Implications for Practice:
Health care providers must assess an individual’s smoking status and provide smoking cessation education about the risk of cervical cancer from smoking, especially to household smokers and women exposed to secondhand smoke.

Foundational:
This study provides an understanding imperative to the health and wellness of patients. Smoke exposure remains pervasive worldwide and understanding the relationship between smoke exposure and cervical cancer is important.
Decision-making in Nasal Dorsum Reconstruction in Revision Rhinoplasty
Authors: Anco Norman , Caballero Gonzalo C. , Valverde Karen , Nuñez José 
Published: September 2024

Background:
The approach to revision rhinoplasty is a challenge that plastic surgeons often face. The objective of this communication is to describe a surgical algorithm for patients undergoing revision rhinoplasty based on the stability of the nasal dorsum.

Methods:
The study included 18 patients, six men and 12 women, aged 19–54 years, who had previously undergone rhinoplasty and who visited our clinic to request a new procedure due to unsatisfactory results in those procedures. A surgical algorithm developed by the main author (N.A.) was followed for revision rhinoplasty, and then a validated rhinoplasty outcome evaluation questionnaire was applied 1 year after surgery to assess aesthetic outcomes.

Results:
The questionnaire was applied to all participants, showing a significant increase in patient satisfaction. Before surgery, a minimum value of six and a maximum of 21 (mean of 12) were found. After revision rhinoplasty following the proposed surgical algorithm, a minimum value of 21 and a maximum of 30 (mean of 29) were found, and this difference was statistically significant (P < 0.001).

Conclusions:
The surgical algorithm used for nasal dorsum reconstruction in patients undergoing revision rhinoplasty improved patient satisfaction and could be a feasible procedure to approach patients who have previously undergone rhinoplasty.
Sex Differences in Changes in Cardiorespiratory Fitness and Additional Health Outcomes Following Exercise Training in Adults With Atrial Fibrillation
Authors: Vidal-Almela Sol , Marçal Isabela R. , Wong Jennie , Terada Tasuku , Nguyen Bao-Oanh , Joensen Albert M. , Mills Mark T. , Bittman Jesse , Prud’Homme Denis , Reed Jennifer L. 
Published: September 2024

Purpose:
Improving cardiorespiratory fitness (CRF) through exercise training is associated with lower morbidity and mortality in patients with atrial fibrillation (AF). Smaller CRF improvements have been suggested in females than males with cardiovascular disease following exercise training. This systematic review compared changes in CRF (primary) and additional physical and mental health outcomes following exercise training between females and males with AF.

Review Methods:
Five bibliographic databases were searched to identify prospective studies implementing exercise training in patients with AF. The mean difference (MD) in the change following exercise training was compared between sexes using random-effects meta-analyses.

Summary:
Sex-specific data were obtained from 19 of 63 eligible studies, with 886 participants enrolled in exercise training (n = 259 [29%] females; female: 68 ± 7 years, male: 66 ± 8 years). Exercise training was 6 weeks to 1 year in duration and mostly combined moderate- to vigorous-intensity aerobic and resistance training, 2 to 6 d/wk. Changes in CRF did not differ between sexes (MD = 0.15: 95% CI, −1.08 to 1.38 mL O2/kg/min; P = .81; I
2 = 27%). Severity of AF (MD = 1.00: 95% CI, 0.13-1.87 points; I
2 = 0%), general health perceptions (MD = −3.71: 95% CI, −6.88 to −0.55 points; I
2 = 22%), and systolic blood pressure (MD = 3.11: 95% CI, 0.14-6.09 mmHg; I
2 = 42%) improved less in females than in males. Females may benefit from more targeted exercise training programs given their smaller improvement in several health outcomes than males. However, our findings are largely hypothesis-generating, considering the limited sample size and underrepresentation of females (29% females in our review vs 47% females with AF globally).
Transition in Quality Of Life Among Older Patients With Bladder Cancer and Its Association With Treatment: A Clustering Approach
Authors: Golzy Mojgan , Beheshti Mohammad , Henslee Brandon , Rosen Geoffrey , Murray Katie S. 
Published: September 2024

Purpose:
To classify older patients with bladder cancer (BC) based on quality-of-life (QoL) measures and explore the clusters transitions over a 2-year period and patient characteristics, BC stages, and treatment. Patients with BC report a significant decline in functional status and QoL. The association of this transition and patient characteristics and treatment over time is not known. We aim to explore this association.

Methods:
Data were obtained from patients with BC in the SEER-MHOS database (1998-2021).
Unsupervised cluster analysis was employed to identify homogeneous clusters of patients with similar functionality based on age, physical and mental component score, and ability to perform activities of daily living. Univariate and multivariable analyses were performed to assess the association of patient characteristics and treatment on cluster transitions over a 2-year interval.

Results:
The final cohort consisted of 2934 (age 65 or older) older patients with BC. We identified 3 distinct clusters: 67.9% in Cluster 1; 25.4% in Cluster 2; and 6.7% in Cluster 3. After 2 years, 11.7% patients showed improvement and 14% experienced a decline. Cancer/treatment characteristics were not associated with cluster transition. Younger age and being married were identified as factors associated with improvement. Older age, non–homeownership, and last-year fall were associated with transition to less healthy cluster.

Conclusions:
Over a 2-year interval after BC diagnosis, a quarter of patients will have substantial changes in QoL. No significant association was observed between cluster transition and BC characteristics. Age as well as marital, fall, and homeowner status do impact this transition.
Endogenous retroviruses activate MARCO-mediated inflammatory response to block retroviral infection
Authors: Hu Xuming , Guo Wang , Wu Huixian , Liu Jinlu , Chen Xujing , Han Xiao , Zhang Yu , Zhang Yang , Cao Zhengfeng , Bao Qiang , Chai Wenxian , Chen Shihao , Zhao Wenming , Chen Guohong , Cui Hengmi , Xu Qi 
Published: September 2024

AbstractEndogenous retroviruses (ERVs) are remnants of ancient retroviral infections and can profoundly affect the host antiviral innate immune response, although the mechanisms by which these changes occur are largely unknown. Here we report that chicken-specific ERVs exert genetic resistance to exogenous retrovirus infection. Mechanistically, chicken-specific ERVs activated the scavenger receptor MARCO (macrophage receptor with collagenous structure)-mediated TLR3-IL-1β inflammatory response in macrophages. Under the presence of MARCO, macrophages response to viral infection through inducing TLR3-IL-1β inflammatory response. Conversely, lack of MARCO increased the viral replication levels and attenuated the antiviral inflammatory response. MARCO-mediated ligand delivery enhances TLR3-IL-1β antiviral response, and IL-1β expression is responsible for viral inhibition. Restoring MARCO or IL-1β expression overcomes viral infection in macrophages. Our study provides new insights into the molecular mechanisms underlying the host defense against exogenous retroviruses infection and may have important implications for the development of novel therapeutic strategies against retroviruses infection.
The small MAF transcription factor MAFG co-opts MITF to promote melanoma progression
Authors: Vera Olga , Martinez Michael , Soto-Vargas Zulaida , Wang Kaizhen , Xu Xiaonan , Ruiz-Buceta Sara , Mecozzi Nicol , Chadourne Manon , Posorske Benjamin , Angarita Ariana , Bok Ilah , Liu Qian , Murikipudi Harini , Kim Yumi , Messina Jane L. , Tsai Kenneth Y. , Major Michael B. , Lau Eric K. , Yu Xiaoqing , Ibanez-de-Caceres Inmaculada , Karreth Florian A. 
Published: September 2024

ABSTRACTTranscription factor deregulation potently drives melanoma progression by dynamically and reversibly controlling gene expression programs. We previously identified the small MAF family transcription factor MAFG as a putative driver of melanoma progression, prompting an in-depth evaluation of its role in melanoma. MAFG expression increases with human melanoma stages and ectopic MAFG expression enhances the malignant behavior of human melanoma cells in vitro, xenograft models, and genetic mouse models of spontaneous melanoma. Moreover, MAFG induces a melanoma phenotype switch from a melanocytic state to a more dedifferentiated state. Mechanistically, MAFG interacts with the lineage transcription factor MITF which is required for the pro-tumorigenic effects of MAFG. MAFG and MITF co-occupy numerous genomic sites and MAFG overexpression influences the expression of genes harboring binding sites for the MAFG∼MITF complex. These results establish MAFG as a potent driver of melanomagenesis through dimerization with MITF and uncover an unappreciated mechanism of MITF regulation.Significance statementMITF is critically involved in melanoma progression and phenotype switching. We discovered that MAFG interacts with MITF to influence expression of MITF target genes and facilitate a shift toward a dedifferentiated melanoma cell state. This study demonstrates that MAFG promotes melanomagenesis by influencing MITF activity, an unappreciated mechanism of MITF regulation.
Serial Two-Photon Tomography Imaging of the whole marmoset brain for neuroanatomical analyses
Authors: Watakabe Akiya , Tani Toshiki , Abe Hiroshi , Skibbe Henrik , Ichinohe Noritaka , Yamamori Tetsuo 
Published: September 2024

ABSTRACTSerial Two photon tomography (STPT) imaging is a technique to image a mass of tissue in its three-dimensional shape by combining two-photon imaging with automatic stage control and microtome slicing. We successfully implemented this technique for tracing the axonal projections in the marmoset brain. Here we describe the detailed experimental procedures that realized reliable volumetric imaging of the whole marmoset brain. We also introduce auxiliary histological techniques including visualization of myelin structure by simple light reflection, and immunological detection of non-fluorescent anterograde and retrograde tracers, which further enhance the utility of STPT data.
Beyond the (log)book: Comparing accelerometer non-wear detection techniques in toddlers
Authors: Letts Elyse , da Silva Sarah M , Cristofaro Natascja Di , King-Dowling Sara , Obeid Joyce 
Published: September 2024

AbstractBackgroundAccelerometers are increasingly used to measure physical activity and sedentary time in toddlers. Data cleaning or wear time validation can impact outcomes of interest, particularly in young children who spend less time awake. However, no study has systematically compared wear time validation strategies in toddlers. As such, the objective of this study is to compare different fully-automated methods of distinguishing wear and non-wear time (counts and raw data algorithms) to the semi-automated (counts with logbooks) criterion method in toddlers.MethodsWe recruited 109 toddlers (age 12-35 mos) as part of the iPLAY study to wear an ActiGraph w-GT3X-BT accelerometer on the right hip for ∼7 consecutive days (removed for sleep and water activities). Parents completed a logbook to indicate monitor removal and nap times. We tested 15 nonwear detection methods grouped into 4 main categories: semi-automated logbook, consecutive 0 counts, modified consecutive 0 counts (Troiano and Choi), and raw data methods (van Hees and Ahmadi). Using logbooks as the criterion standard (all wear and wake-time only wear), we calculated the accuracy and F1 scores and compared overall wear time with a two one-sided test of equivalence.ResultsParticipant daily wear time ranged from 556 to 684 minutes/day depending on method. Accuracy and F1 score ranged from 86 to 95%. Five methods were considered equivalent to the AllWear nonwear criterion (true wear time including sleep-time wear), with only one equivalent to the AwakeWear criterion. Mean absolute differences were lower for the AllWear criterion but ranged 49 to 192 minutes/dayConclusionsThe 5min0count, 10min_0count, 30min_0count, Troiano60s, and Ahmadi methods provide high accuracy and equivalency when compared to semi-automated cleaning using logbooks. This paper provides insights and quantitative results that can help researchers decide which method may be most appropriate given their population of interest, sample size, and study protocol.
Development and initial evaluation of a conversational agent for Alzheimer’s disease
Authors: Castano-Villegas Natalia , Llano Isabella , Villa Maria Camila , Martinez Julian , Zea Jose , Urrea Tatiana , Bañol Alejandra Maria , Bohorquez Carlos , Martinez Nelson 
Published: September 2024

ABSTRACTBackgroundConversational Agents have attracted attention for personal and professional use. Their specialisation in the medical field is being explored. Conversational Agents (CA) have accomplished passing-level performance in medical school examinations and shown empathy when responding to patient questions. Alzheimer’s disease is characterized by the progression of cognitive and somatic decline. As the leading cause of dementia in the elderly, it is the subject of continuous investigations, which result in a constant stream of new information. Physicians are expected to keep up with the latest clinical guidelines; however, they aren’t always able to do so due to the large amount of information and their busy schedules.ObjectiveWe designed a conversational agent intended for general physicians as a tool for their everyday practice to offer validated responses to clinical queries associated with Alzheimer’s Disease based on the best available evidence.MethodologyThe conversational agent uses GPT-4o and has been instructed to respond based on 17 updated national and international clinical practice guidelines about Dementia and Alzheimer’s Disease. To approach the CA’s performance and accuracy, it was tested using three validated knowledge scales. In terms of evaluating the content of each of the assistant’s answers, a human evaluation was conducted in which 7 people evaluated the clinical understanding, retrieval, clinical reasoning, completeness, and usefulness of the CA’s output.ResultsThe agent obtained near-perfect performance in all three scales. It achieved a sensitivity of 100% for all three scales and a specificity of 75% in the less specific model. However, when modifying the input given to the assistant (prompting), specificity reached 100%, with a Cohen’s kappa of 1 in all tests. The human evaluation determined that the CA’s output showed comprehension of the clinical question and completeness in its answers. However, reference retrieval and perceived helpfulness of the CA reply was not optimal.ConclusionsThis study demonstrates the potential of the agent and of specialised LLMs in the medical field as a tool for up-to-date clinical information, particularly when medical knowledge is becoming increasingly vast and ever-changing. Validations with health care experts and actual clinical use of the assistant by its target audience is an ongoing part of this project that will allow for more robust and applicable results, including evaluating potential harm.