bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effectiveness of an interprofessional assessment and management approach for people with chronic low back disorders delivered via virtual care: A randomized controlled trial pilot intervention
Authors: Lovo Stacey , Imeah Biaka , Sari Nazmi , O’Connell Megan E , Milosavljevic Steve , Angarita-Fonseca Adriana , Bath Brenna 
Published: June 2024

Objective Virtual care for chronic conditions has seen uptake due to COVID-19. Evaluation of virtual models is important to ensure evidence-based practice. There is a paucity of research in the use of virtual care for management of chronic back disorders. The objective of this study was to evaluate effectiveness of a team-based virtual care model for back disorder assessment where a physical therapist uses virtual care to join a nurse practitioner and patient in a rural Saskatchewan, Canada community. Methods Sixty-four rural adults with chronic back disorders were randomly allocated to receive either: (1) team-based virtual care ( n = 24); (2) care from an urban physical therapist travelling to community ( n = 20); or (3) care from a rural nurse practitioner ( n = 20). The team-based care group involved a nurse practitioner located with a rural patient, and a physical therapist joining using virtual care. The physical therapist alone and the nurse practitioner alone groups received in-person assessments. Groups with a physical therapist involved had follow-up treatments by in-person physical therapy. Outcomes over six months included pain, disability, back beliefs, satisfaction, quality-adjusted health status and management-related costs. Results There were no significant differences for pain, disability, back beliefs and satisfaction between groups. The average cost per patient for implementing in-person physical therapist assessment ($135) was higher compared with the team over virtual care ($118) and NP care ($59). Conclusion Primary outcomes were not different by group. Physical therapist alone was more costly than other groups. Future research should include more participants, longer follow-up time and refined cost parameters. Trial Registration ClinicalTrials.gov NCT02225535; https://clinicaltrials.gov/ct2/show/NCT02225535 (Archived by WebCite at http://www.webcitation.org/6lqLTCNF7 ).
Tracing the Origin and Creating the Future to Find the Lost Dimension of Nature in Modern Education: The Second Follow-up Study of Life-Practice Educology
Authors: Ye (叶澜) Lan 
Published: June 2024

Purpose This paper focuses on the relationship between nature and education, which is crucial to educology and educational reform yet has not received much attention in educology or educational reform efforts or research in China. Design/Approach/Methods Through retrospection and analysis of the history, this study attempts to sort out the emergence of views of nature in China and changes in them over time as a preliminary to reconceptualizing the relationship between contemporary education and nature from a theoretical perspective and advancing the research on relevant themes in practice. Findings This paper is divided into three parts. Part 1 elaborates on the evolution of classical views of nature in ancient China, from the beginning of Chinese civilization. Part 2 examines how classical views of nature were changed or even lost in social upheavals. Part 3 explores the intricate process of “stepping out from the shadow” and “shaping the future” and discusses its characteristics. Originality/Value This work attempts to recover and reconstruct the long-lost dimension of nature in education and educology. Only if we retrieve the lost dimension of nature in society, educational systems and schools can we achieve a holistic change in Chinese education from modern to contemporary.
Total Elbow Arthroplasty Versus Open Reduction and Internal Fixation for Distal Humerus Fractures: A Propensity Score Matched Analysis of 30-Day Postoperative Complications
Authors: Sandoval Luke A. , Reiter Charles R. , Wyatt Phillip B. , Satalich James R. , Ernst Brady S. , O’Neill Conor N. , Vanderbeck Jennifer L. 
Published: June 2024

Introduction Open reduction and internal fixation (ORIF) is an established surgical procedure for distal humeral fractures; however, total elbow arthroplasty (TEA) has become an increasingly popular alternative for elderly patients with these injuries. Using a large sample of recent patient data, this study compares the rates of short-term complications between ORIF and TEA and evaluates complication risk factors. Methods Patients who underwent primary TEA or ORIF from 2012 to 2021 were identified by Current Procedural Terminology codes in the American College of Surgeons National Surgical Quality Improvement Program database. Propensity score matching controlled for demographic and comorbid differences. The rates of 30-day postoperative complications were compared. Results A total of 1539 patients were identified, with 1365 (88.7%) and 174 (11.3%) undergoing ORIF and TEA, respectively. Patients undergoing TEA were older on average (ORIF: 56.2 ± 19.8 years, TEA: 74.3 ± 11.0 years, P < .001). 348 patients were included in the matched analysis, with 174 patients in each group. TEA was associated with an increased risk for postoperative transfusion (OR = 6.808, 95% CI = 1.355 – 34.199, P = .020). There were no significant differences in any adverse event (AAE) between procedures ( P = .259). A multivariate analysis indicated age was the only independent risk factor for the development of AAE across both groups (OR = 1.068, 95% CI = 1.011 – 1.128, P = .018). Conclusion The risk of short-term complications within 30-days of ORIF or TEA procedures are similar when patient characteristics are controlled. TEA, however, was found to increase the risk of postoperative transfusions. Risks associated with increasing patient age should be considered prior to either procedure. These findings suggest that long-term functional outcomes can be prioritized in the management of distal humerus fractures.
A Worksite Intervention Program for Obese Sedentary Women Using Wearable Technology
Authors: Cebrick-Grossman Joan A. , Fetherman Debra L. 
Published: June 2024

Background: The sedentary aspects of work have been associated with increased health risks. The purpose of this study was to compare the effects of high intensity interval training (HIIT) and increased steps on anthropometric, body mass, and body composition changes over a 12-week period. Methods: 12 sedentary, obese, body mass index (BMI) = 32.98 ± 3.21 kg/m2, adult (46.10 ± 9.56 years), females volunteered for the study and were randomly assigned into one of the two groups, the HIIT group and the STEP group. During the 12-week study, all participants’ movements were monitored during their workday, via an accelerometer, a Movband™, 5 days/week. Findings: The HIIT group ( n = 5) engaged in structured exercise (~15.0 ± 3.5 minutes), defined as total body moves which consisted of eight different routines: upper and lower extremity, two cardio segments, two total body, yoga, and abdominal exercises. The STEP group ( n = 7) averaged ~7,000 steps/day throughout 12 weeks. Pre- and post-program measurements included: five anthropometric measurements (biceps, waist, abdomen, hips, and thigh), along with body mass and body composition measures: relative (%) body fat via dual x-ray absorptiometry (DEXA) scan, fat mass, fat-free mass, and lean mass. Conclusions: Statistical significance was determined among participants for biceps, hips, and thigh measurements along with body mass and body composition changes for improved health. Application to Practice: This work is suggestive that a physical activity intervention integrated into the workplace via work processes and/or structured exercise is supportive in reducing anthropometric and body composition measurements, while changing body mass, to increase health and reduce obesity-related chronic disease risks in sedentary women.
MRI Features That Contribute to Decision-Making for Treatment of Capitellar OCD Lesions: An Expert Consensus Using the Delphi Method
Authors: Kostyun Regina O. , Nguyen Jie C. , Chhabra Bobby , Todd R. Lawrence J. , Polousky John D. , Saper Michael , Uquillas Carlos , Nissen Carl W. ,   Members of the ROCKET Group, Kostyun Regina O. , Albright Jay , Bae Donald , Bohn Deb , Chan Charles , Crepeau Allison , Edmonds Eric , Fabricant Peter , Ganley Theodore , Little Kevin , Lee Pace James , Pacicca Donna , Pennock Andrew , Saluan Paul , Shea Kevin , Wall Eric , Wilson Philip , Nissen Carl W. 
Published: June 2024

Background: Most healthcare providers utilize magnetic resonance imaging (MRI) to assist in diagnosing and treating osteochondritis dissecans (OCD) of the capitellum. However, consensus on imaging features that portend clinically relevant information in the care of these lesions has not been determined. Purpose: To conduct a survey on the MRI features of a capitellar OCD that are salient for clinical decision-making using a classic Delphi protocol. Study Design: A consensus statement. Methods: Invitations to participate were sent to 33 healthcare providers identified as capitellar OCD experts. A classic 3-round survey method was used to gather agreement and consensus on the level of importance for clinical decision-making on 33 MRI features. A concise list of features that guide decision-making on the stability of an OCD lesion and the ability of an OCD lesion to heal with nonoperative care was also identified. Agreement and consensus were determined a priori as ≥66%. Results: Of the 33 identified experts, 20 agreed to participate, and 17 (52%) completed all 3 rounds. Of the 33 MRI features evaluated, 17 reached agreement as important for clinical decision-making by the experts. Consensus was reached for a concise list of MRI features that were significant to decision-making (94%), suggestive of a stable lesion (100%), had the potential to heal with nonoperative treatment (94%), were suggestive of an unstable lesion (100%), and had low potential to heal with nonoperative treatment (88%). Conclusion: This 3-round Delphi process produced consensus on clinically relevant MRI features that contribute to clinical decision-making for capitellar OCD. The results of this study will be used as the basis for an interrater reliability assessment of the identified salient features, creating the foundation for developing a reliable MRI assessment tool rooted in clinical experiences. The development of a standardized assessment of capitellar OCD is intended to improve clinical practice and patient outcomes.
Unpacking HPV Stigma: Assessing Healthcare Workers’ Knowledge and Stigma Towards HPV While Exploring the Connection Between the Two
Authors: Ziaee Arash , Ziaee Masood , Asghari Arghavan , Elhamirad Samira , Azarkar Ghodsiyeh 
Published: June 2024

Objectives Human Papillomavirus (HPV) is a leading cause of cervical cancer, yet existing social stigmas and unequal access to healthcare compromise its preventability through screening and vaccination. Understanding healthcare professionals’ knowledge and perceptions of HPV is pivotal in enhancing the quality and effectiveness of preventive healthcare strategies. This article aims to explore and understand the relationship between healthcare workers’ knowledge and stigma towards HPV. Design and Methods A questionnaire of 27 stigma and 24 knowledge questions was provided for healthcare personnel. Demographic questions were also included. Stigma levels were determined based on a total median score. Fully adjusted multinomial logistic regression models were used to find the correlation between knowledge regarding HPV and the stigma level. Results Five hundred fifty-two healthcare workers answered the questionnaire. The findings showed that while most participants had adequate to moderate knowledge about the prevention and complications of HPV, they lacked knowledge about symptoms and treatment. Stigma towards HPV disease was evident in some participants, with attitudes varying depending on demographic factors and knowledge level. The model indicated that age, gender, and specific knowledge questions were significantly associated with stigma levels. Interestingly, the presence of knowledge in some areas increased the stigma level. Conclusions In conclusion, the study sheds light on the stigmatization and knowledge gaps regarding HPV disease among healthcare personnel and, intriguingly, that increased knowledge does not necessarily correlate with decreased stigma. The findings highlight the need for targeted education and training programs to improve healthcare providers’ knowledge in these specific areas.
A randomised phase II study of extended pleurectomy/decortication preceded or followed by chemotherapy in patients with early-stage pleural mesothelioma: EORTC 1205
Authors: Raskin Jo , Surmont Veerle , Maat Alexander P.W.M. , Yahia Maha , Burgers Sjaak A. , Pretzenbacher Yassin , De Ryck Frederic , Cornelissen Robin , Klomp Houke M. , Oliveira Ana , Aerts Joachim , Baas Paul , Marreaud Sandrine , Van Meerbeeck Jan P. , Van Schil Paul E.Y. 
Published: June 2024

BackgroundThe role of surgery in pleural mesothelioma remains controversial. It may be appropriate in highly selected patients as part of a multimodality treatment including chemotherapy. Recent years have seen a shift from extrapleural pleuropneumonectomy toward extended pleurectomy/decortication. The most optimal sequence of surgery and chemotherapy remains unknown.MethodsEORTC-1205-LCG was a multicentric, noncomparative phase 2 trial, 1:1 randomising between immediate (arm A) and deferred surgery (arm B), followed or preceded by chemotherapy. Eligible patients (Eastern Cooperative Oncology Group 0–1) had treatment-naïve, borderline resectable T1–3 N0–1 M0 mesothelioma of any histology. Primary outcome was rate of success at 20 weeks, a composite end-point including 1) successfully completing both treatments within 20 weeks; 2) being alive with no signs of progressive disease; and 3) no residual grade 3–4 toxicity. Secondary end-points were toxicity, overall survival, progression-free survival and process indicators of surgical quality.Findings69 patients were included in this trial. 56 (81%) patients completed three cycles of chemotherapy and 58 (84%) patients underwent surgery. Of the 64 patients in the primary analysis, 21 out of 30 patients in arm A (70.0%; 80% CI 56.8–81.0%) and 17 out of 34 patients (50.0%; 80% CI 37.8–62.2%) in arm B reached the statistical end-point for rate of success. Median progression-free survival and overall survival were 10.8 (95% CI 8.5–17.2) months and 27.1 (95% CI 22.6–64.3) months in arm A, and 8.0 (95% CI 7.2–21.9) months and 33.8 (95% CI 23.8–44.6) months in arm B. Macroscopic complete resection was obtained in 82.8% of patients. 30- and 90-day mortality were both 1.7%. No new safety signals were found, but treatment-related morbidity was high.InterpretationEORTC 1205 did not succeed in selecting a preferred sequence of pre- or post-operative chemotherapy. Either procedure is feasible with a low mortality, albeit consistent morbidity. A shared informed decision between surgeon and patient remains essential.
Multivariate investigation of Moringa oleifera morpho-physiological and biochemical traits under various water regimes
Authors: Hajaji Afef N. , Heikal Yasmin M. , Hamouda Ragaa A. E. F. , Abassi Mejda , Ammari Youssef 
Published: June 2024

Abstract
Background
The climatic changes crossing the world menace the green life through limitation of water availability. The goal of this study was to determine whether Moringa oleifera Lam. trees cultivated under Tunisian arid climate, retain their tolerance ability to tolerate accentuated environmental stress factors such as drought and salinity. For this reason, the seeds of M. oleifera tree planted in Bouhedma Park (Tunisian arid area), were collected, germinated, and grown in the research area at the National Institute of Research in Rural Engineering, Waters and Forests (INRGREF) of Tunis (Tunisia). The three years aged trees were exposed to four water-holding capacities (25, 50, 75, and 100%) for 60 days to realise this work.

Results
Growth change was traduced by the reduction of several biometric parameters and fluorescence (Fv/Fm) under severe water restriction (25 and 50%). Whereas roots presented miraculous development in length face to the decrease of water availability (25 and 50%) in their rhizospheres. The sensitivity to drought-induced membrane damage (Malondialdehyde (MDA) content) and reactive oxygen species (ROS) liberation (hydrogen peroxide (H2O2) content) was highly correlated with ROS antiradical scavenging (ferric reducing antioxidant power (FRAP) and (2, 2’-diphenyl-1-picrylhydrazyle (DPPH)), phenolic components and osmolytes accumulation. The drought stress tolerance of M. oleifera trees was associated with a dramatic stimulation of superoxide dismutase (SOD), catalase (CAT), glutathione reductase (GR), ascorbate peroxidase (APX), and glutathione peroxidase (GPX) activities.

Conclusion
Based on the several strategies adopted, integrated M. oleifera can grow under drought stress as accentuated adverse environmental condition imposed by climate change.
Programmed death-ligand 1 expression in carcinoma of unknown primary
Authors: Kim Hye Min , Koo Ja Seung 
Published: June 2024

AbstractWe examined the expression of programmed death-ligand 1 (PD-L1) in carcinoma of unknown primary (CUP) and its potential implications. Tissue microarrays were constructed for 72 CUP cases (histologic subtypes: 22 adenocarcinoma, 15 poorly differentiated carcinoma, 19 squamous cell carcinoma, and 14 undifferentiated carcinoma; clinical subtype: favorable type 17 [23.6%], unfavorable type 55 [76.4%]), with immunohistochemical staining performed for PD-L1 (22C3, SP142, SP263, and 28 − 8), CK7, and CK20 to determine the association between staining results and clinicopathological parameters. In CUP, the PD-L1 positivity rate was 5.6–48.6% (tumor cells [TC] or tumor proportion score [TPS]: 5.6–36.1%, immune cell score [IC]: 8.3–48.6%, combined positive score [CPS]: 16.7%) using different cutoff values for 22C3 (TPS ≥ 1%, CPS ≥ 10), SP142 (TC ≥ 50%, IC ≥ 10%), SP263, and 28 − 8 (TC and IC ≥ 1%). PD-L1 SP142 TC and PD-L1 SP263 IC showed the lowest (5.6%) and highest (48.6%) positivity rates, respectively. The PD-L1 positivity rate did not significantly differ based on the histologic subtype, clinical subtype, or CK7/CK20 across clones. Considering TC κ ≥ 1%, TC κ ≥ 50%, IC κ ≥ 1%, and IC κ ≥ 10%, the PD-L1 positivity rate was TC = 4.2–36.1% and IC = 9.7–48.6%; the overall agreement between antibodies ranged from 69.4 to 93.1%, showing fair or better agreement (κ ≥ 0.21). In CUP, PD-L1 positivity varied depending on antibodies and scoring systems, with no difference observed according to histologic or clinical subtypes.
New evidence: Metformin unsuitable as routine adjuvant for breast cancer: a drug-target mendelian randomization analysis
Authors: Xu Jing-Xuan , Zhu Qi-Long , Bi Yu-Miao , Peng Yu-Chong 
Published: June 2024

Abstract
Purpose
The potential efficacy of metformin in breast cancer (BC) has been hotly discussed but never conclusive. This genetics-based study aimed to evaluate the relationships between metformin targets and BC risk.

Methods
Metformin targets from DrugBank and genome-wide association study (GWAS) data from IEU OpenGWAS and FinnGen were used to investigate the breast cancer (BC)-metformin causal link with various Mendelian Randomization (MR) methods (e.g., inverse-variance-weighting). The genetic association between type 2 diabetes (T2D) and the drug target of metformin was also analyzed as a positive control. Sensitivity and pleiotropic tests ensured reliability.

Results
The primary targets of metformin are PRKAB1, ETFDH and GPD1L. We found a causal association between PRKAB1 and T2D (odds ratio [OR] 0.959, P = 0.002), but no causal relationship was observed between metformin targets and overall BC risk (PRKAB1: OR 0.990, P = 0.530; ETFDH: OR 0.986, P = 0.592; GPD1L: OR 1.002, P = 0.806). A noteworthy causal relationship was observed between ETFDH and estrogen receptor (ER)-positive BC (OR 0.867, P = 0.018), and between GPD1L and human epidermal growth factor receptor 2 (HER2)-negative BC (OR 0.966, P = 0.040). Other group analyses did not yield positive results.

Conclusion
The star target of metformin, PRKAB1, does not exhibit a substantial causal association with the risk of BC. Conversely, metformin, acting as an inhibitor of ETFDH and GPD1L, may potentially elevate the likelihood of developing ER-positive BC and HER2-negative BC. Consequently, it is not advisable to employ metformin as a standard supplementary therapy for BC patients without T2D.
Challenges and opportunities for competency-based health professional education in Bangladesh: an interview, observation and mapping study
Authors: Byrne-Davis Lucie , Carr Natalie , Roy Tapash , Chowdhury Salim , Omer Usmaan , Nawaz Saher , Advani Dolce , Byrne Olivia , Hart Jo 
Published: June 2024

Abstract
Background
Bangladesh has a shortfall of health professionals. The World Health Organization states that improving education will increase recruitment and retention of health workers. Traditional learning approaches, in medical education particularly, focus on didactic teaching, teaching of subjects and knowledge testing. These approaches have been superseded in some programmes, with a greater focus on active learning, integrated teaching and learning of knowledge, application, skills and attitudes or values and associated testing of competencies as educational outcomes. In addition, some regions do not have continuous professional development or clinical placements for health worker students, contributing to difficulties in retention of health workers. This study aims to explore the experiences of health professional education in Bangladesh, focusing on what is through observation of health professional education sessions and experiences of educators.

Methods
This mixed method study included 22 observations of teaching sessions in clinical and educational settings, detailed analysis of 8 national curricula documents mapped to Global Competency and Outcomes Framework for Universal Health Coverage and 15 interviews of professionals responsible for health education. An observational checklist was created based on previous literature which assessed training of within dimensions of basic clinical skills; diagnosis and management; professionalism; professional development; and effective communication. Interviews explored current practices within health education in Bangladesh, as well as barriers and facilitators to incorporating different approaches to learning.

Results
Observations revealed a variety of approaches and frameworks followed across institutions. Only one observation included all sub-competencies of the checklist. National curricula documents varied in their coverage of the Global Competency and Outcomes Framework domains. Three key themes were generated from a thematic analysis of interview transcripts: (1) education across the career span; (2) challenges for health professional education; (3) contextual factors and health professional education. Opportunities for progression and development post qualification are limited and certain professions are favoured over others.

Conclusion
Traditional approaches seem to predominate but there is some enthusiasm for a more clinical focus to education and for more competency based approaches to teaching, learning and assessment.