bluuebunny/crossref_metadata_2025_split huggingface dataset:
Self-regulated learning of anatomy during the COVID-19 lockdown period in a low-income setting
Authors: Chapupu Tapiwa , Gatsi Anesuishe B , Chibhabha Fidelis , Zilundu Prince L. M. 
Published: May 2024

AbstractIn March 2020, universities in Zimbabwe temporarily closed and switched to remote learning to contain the spread of SARS Cov2 infections. The sudden change to distance learning gave autonomy to students to direct their own learning. To understand how the students at the University of Zimbabwe and Midlands State University adapted to emergency remote learning, focus group discussions and a self-administered questionnaire survey based on the self-regulated learning inventory were conducted to capture cognitive, motivational, and emotional aspects of anatomy learning during the COVID-19 pandemic. Thematic analysis was used to identify patterns among these students’ lived experiences. Two coders analyzed the data independently and discussed the codes to reach a consensus. The results showed that students at the two medical schools cognitively and meta-cognitively planned, executed and evaluated self-regulated strategies in different ways that suited their environments during the COVID-19 lockdown. Several factors, such as demographic location, home setting/situation, socioeconomic background and expertise in using online platforms, affected the students’ self-directed learning. Students generally adapted well to the constraints brought about by the lockdown on their anatomy learning in order to learn effectively. This study was able to highlight important self-regulated learning strategies that were implemented during COVID-19 by anatomy learners, especially those in low-income settings, and these strategies equip teachers and learners alike in preparation for similar future situations that may result in forced remote learning of anatomy.
Co-designing Entrustable Professional Activities in General Practitioner’s training: a participatory research study
Authors: Andreou Vasiliki , Peters Sanne , Eggermont Jan , Schoenmakers Birgitte 
Published: May 2024

Abstract
Background
In medical education, Entrustable Professional Activities (EPAs) have been gaining momentum for the last decade. Such novel educational interventions necessitate accommodating competing needs, those of curriculum designers, and those of users in practice, in order to be successfully implemented.

Methods
We employed a participatory research design, engaging diverse stakeholders in designing an EPA framework. This iterative approach allowed for continuous refinement, shaping a comprehensive blueprint comprising 60 EPAs. Our approach involved two iterative cycles. In the first cycle, we utilized a modified-Delphi methodology with clinical competence committee (CCC) members, asking them whether each EPA should be included. In the second cycle, we used semi-structured interviews with General Practitioner (GP) trainers and trainees to explore their perceptions about the framework and refine it accordingly.

Results
During the first cycle, 14 CCC members agreed that all the 60 EPAs should be included in the framework. Regarding the formulation of each EPAs, 20 comments were given and 16 adaptations were made to enhance clarity. In the second cycle, the semi-structured interviews with trainers and trainees echoed the same findings, emphasizing the need of the EPA framework for improving workplace-based assessment, and its relevance to real-world clinical scenarios. However, trainees and trainers expressed concerns regarding implementation challenges, such as the large number of EPAs to be assessed, and perception of EPAs as potentially high-stakes.

Conclusion
Accommodating competing stakeholders’ needs during the design process can significantly enhance the EPA implementation. Recognizing users as experts in their own experiences empowers them, enabling a priori identification of implementation barriers and potential pitfalls. By embracing a collaborative approach, wherein diverse stakeholders contribute their unique viewpoints, we can only create effective educational interventions to complex assessment challenges.
Improvement in nurse staffing ratios according to policy changes: a prospective cohort study
Authors: Kim Yunmi , Lee Kyounga , Jung Minho 
Published: May 2024

Abstract
Background
Since 1999, reimbursements for nursing services for inpatients have been paid differentially according to the nurse staffing ratios in Korea. However, differentiated nursing fees are insufficient for nurse staffing; thus, steps have been taken to improve the policy. This study aimed to identify the impact of a policy that changed the method of calculating nurse staffing ratios from the nurse-to-bed ratio to the nurse-to-patient ratio on improving the nurse staffing ratio in medical institutions.

Methods
Data were collected from 1,339 medical institutions that continuously provided medical services from 2017 to of 2021, and a prospective cohort was used for analysis. A generalized estimating equation for longitudinal ordered logistic regression was used to identify the impact of this policy change on the nurse staffing ratios in medical institutions.

Results
During the cohort study, 59.8% of the first-applied group of medical institutions and 65.6% of the second-applied group of medical institutions improved their nurse staffing ratios. However, only 22.6% of the medical institutions to which the revised calculation method was not applied improved their nurse staffing ratios. A statistically significant difference was found in the improved nurse staffing ratio depending on whether and when the revised calculation method was applied (χ2 = 89.830, p < .001). The analysis of nurse staffing ratios of medical institutions from 2017 to 2021 showed that the likelihood of improving the nurse staffing ratio increased gradually after the revised calculation method was adopted. Also,the likelihood of the nurse staffing ratio improving in the first-applied group was 1.41 times higher (odds ratio = 1.41, 95% confidence interval = 1.04–1.92) than in the non-applied group. The odds ratio for the improvement of nurse staffing ratio in the second-applied group was 2.35 (95% confidence interval = 1.76–3.14).

Conclusions
Financial incentives inherent in the new policy can be regarded as the driving force behind improvements in nurse staffing ratios. The revised calculation method should be extended to all medical institutions nationwide, and the law should be revised to secure the minimum number of nurses.
Naringin attenuates Actinobacillus pleuropneumoniae-induced acute lung injury via MAPK/NF-κB and Keap1/Nrf2/HO-1 pathway
Authors: Huang Qi-Lin , Huang Li-Na , Zhao Guan-Yu , Liu Chen , Pan Xiang-Yi , Li Zhao-Rong , Jing Xiao-Han , Qiu Zheng-Ying , Xin Rui-Hua 
Published: May 2024

AbstractActinobacillus pleuropneumoniae (APP) causes porcine pleuropneumonia (PCP), which is clinically characterized by acute hemorrhagic, necrotizing pneumonia, and chronic fibrinous pneumonia. Although many measures have been taken to prevent the disease, prevention and control of the disease are becoming increasingly difficult due to the abundance of APP sera, weak vaccine cross-protection, and increasing antibiotic resistance in APP. Therefore, there is an urgent need to develop novel drugs against APP infection to prevent the spread of APP. Naringin (NAR) has been reported to have an excellent therapeutic effect on pulmonary diseases, but its therapeutic effect on lung injury caused by APP is not apparent. Our research has shown that NAR was able to alleviate APP-induced weight loss and quantity of food taken and reduce the number of WBCs and NEs in peripheral blood in mice; pathological tissue sections showed that NAR was able to prevent and control APP-induced pathological lung injury effectively; based on the establishment of an in vivo/in vitro model of APP inflammation, it was found that NAR was able to play an anti-inflammatory role through inhibiting the MAPK/NF-κB signaling pathway and exerting anti-inflammatory effects; additionally, NAR activating the Nrf2 signalling pathway, increasing the secretion of antioxidant enzymes Nqo1, CAT, and SOD1, inhibiting the secretion of oxidative damage factors NOS2 and COX2, and enhancing the antioxidant stress ability, thus playing an antioxidant role. In summary, NAR can relieve severe lung injury caused by APP by reducing excessive inflammatory response and improving antioxidant capacity.
Ultrasonography screening of hepatic cystic echinococcosis in sheep flocks used for evaluating control progress in a remote mountain area of Hejing County, Xinjiang
Authors: Qi Xinwei , Song Tao , Li Zhao , Jiang Tao , Zhang Zhuangzhi , Wu Chuanchuan , Guo Gang , Dong Jian , Dawuti Wubulitalifu , Dou Jingrui , Li Jun , Wen Hao , Zhang Wenbao 
Published: May 2024

Abstract
Background
Although ultrasonography (US) has been widely used in the diagnosis of human diseases to monitor the progress of cystic echinococcosis (CE) control, the screening method for hepatic CE in sheep flocks requires adjustment. In this study, we used a US scanner to screen sheep flocks and evaluated the efficacy of dosing dogs once a year with praziquantel for 7 years from 2014 to 2021.

Methods
All sheep in the three flocks were screened using an ultrasound scanner in 2014 and compared with the prevalence of infection in 2021 in Bayinbuluke, Xinjiang, China. Sheep age was determined using incisor teeth. Cyst activity and calcification were determined using US images. The dogs were dewormed with praziquantel once a year to control echinococcosis in the community.

Results
Three flocks had 968 sheep in 2014, with 13.22%, 22.62%, 18.7%, 27.27%, 11.88%, and 6.3% of sheep aged 1, 2, 3, 4, 5, and ≥ 6 years old, respectively. US scanning revealed that the overall CE prevalence was 38.43% (372/968), with active cysts and calcified cysts present in 9.40% (91/968) and 29.02% (281/968) of the sheep, respectively. For the young sheep aged 1 and 2 years, the prevalence of active and calcified cysts was: 1.56% and 0.91%, and 10.94% and 18.72%, respectively. Approximately 15.15% and 16.52% of the 4- and 5-year-old sheep, respectively, harbored active cysts. There was no significant difference in the infection rates of sheep between 2014 and 2021 (P > 0.05).

Conclusions
US is a practical tool for the field screening of CE in sheep flocks. One-third of the sheep population in the flocks was 1–2 years old, and these sheep played a very limited role in CE transmission, as most of the cysts were calcified. Old sheep, especially culled aged sheep, play a key role in the transmission of CE. Dosing dogs once a year did not affect echinococcosis control.
Nitrogen starvation causes lipid remodeling in Rhodotorula toruloides
Authors: Mishra Shekhar , Deewan Anshu , Zhao Huimin , Rao Christopher V. 
Published: May 2024

AbstractBackgroundThe oleaginous yeastRhodotorula toruloidesis a promising chassis organism for the biomanufacturing of value-added bioproducts. It can accumulate lipids at a high fraction of biomass. However, metabolic engineering efforts in this organism have progressed at a slower pace than those in more extensively studied yeasts. Few studies have investigated the lipid accumulation phenotype exhibited byR. toruloidesunder nitrogen limitation conditions. Consequently, there have been only a few studies exploiting the lipid metabolism for higher product titers.ResultsWe performed a multi-omic investigation of the lipid accumulation phenotype under nitrogen limitation. Specifically, we performed comparative transcriptomic and lipidomic analysis of the oleaginous yeast under nitrogen-sufficient and nitrogen deficient conditions. Clustering analysis of transcriptomic data was used to identify the growth phase where nitrogen-deficient cultures diverged from the baseline conditions. Independently, lipidomic data was used to identify that lipid fractions shifted from mostly phospholipids to mostly storage lipids under the nitrogen-deficient phenotype. Through an integrative lens of transcriptomic and lipidomic analysis, we discovered thatR. toruloidesundergoes lipid remodeling during nitrogen limitation, wherein the pool of phospholipids gets remodeled to mostly storage lipids. We identify specific mRNAs and pathways that are strongly correlated with an increase in lipid levels, thus identifying putative targets for engineering greater lipid accumulation inR. toruloides. One surprising pathway identified was related to inositol phosphate metabolism, suggesting further inquiry into its role in lipid accumulation.ConclusionsIntegrative analysis identified the specific biosynthetic pathways that are differentially regulated during lipid remodeling. This insight into the mechanisms of lipid accumulation can lead to the success of future metabolic engineering strategies for overproduction of oleochemicals.
sEMG-based automatic characterization of swallowed materials
Authors: Hassan Eman A. , Khalifa Yassin , Morsy Ahmed A. 
Published: May 2024

AbstractMonitoring of ingestive activities is critically important for managing the health and wellness of individuals with various health conditions, including the elderly, diabetics, and individuals seeking better weight control. Monitoring swallowing events can be an ideal surrogate for developing streamlined methods for effective monitoring and quantification of eating or drinking events. Swallowing is an essential process for maintaining life. This seemingly simple process is the result of coordinated actions of several muscles and nerves in a complex fashion. In this study, we introduce automated methods for the detection and quantification of various eating and drinking activities. Wireless surface electromyography (sEMG) was used to detect chewing and swallowing from sEMG signals obtained from the sternocleidomastoid muscle, in addition to signals obtained from a wrist-mounted IMU sensor. A total of 4675 swallows were collected from 55 participants in the study. Multiple methods were employed to estimate bolus volumes in the case of fluid intake, including regression and classification models. Among the tested models, neural networks-based regression achieved an R2 of 0.88 and a root mean squared error of 0.2 (minimum bolus volume was 10 ml). Convolutional neural networks-based classification (when considering each bolus volume as a separate class) achieved an accuracy of over 99% using random cross-validation and around 66% using cross-subject validation. Multiple classification methods were also used for solid bolus type detection, including SVM and decision trees (DT), which achieved an accuracy above 99% with random validation and above 94% in cross-subject validation. Finally, regression models with both random and cross-subject validation were used for estimating the solid bolus volume with an R2 value that approached 1 and root mean squared error values as low as 0.00037 (minimum solid bolus weight was 3 gm). These reported results lay the foundation for a cost-effective and non-invasive method for monitoring swallowing activities which can be extremely beneficial in managing various chronic health conditions, such as diabetes and obesity.
Effects of gender-affirming hormone therapy on body fat: a retrospective case‒control study in Chinese transwomen
Authors: Pei Qin , Song Yuwei , Huang Zhongwei , Yu Hongkun , Xu Hao , Ye Xunda , Gao Lvfen , Gong Jian , Tian Xiaoying 
Published: May 2024

Abstract
Background
There is insufficient research on how gender-affirming hormone therapy (GAHT) affects body fat modifications in transwomen from China. It is unclear whether hormone therapy affects the prevalence of obesity and blood lipid levels within this population. The current research aimed to assess how GAHT and treatment duration had an impact on the change in and redistribution of body fat in Chinese transwomen.

Methods
This study included 40 transwomen who had not received GAHT and 59 who had. Body fat, blood lipid, and blood glucose levels were measured. GAHT is mainly a pharmacologic (estrogen and anti-androgen) treatment. The study also stratified participants based on the duration of GAHT to assess its impact on body fat distribution. The duration of GAHT was within one year, one to two years, two to three years, or more than three years.

Results
After receiving GAHT, total body fat increased by 19.65%, and the percentage of body fat increased by 17.63%. The arm, corrected leg, and leg regions showed significant increases in fat content (+ 24.02%, + 50.69%, and + 41.47%, respectively) and percentage (+ 25.19%, + 34.90%, and + 30.39%, respectively). The total visceral fat content decreased (-37.49%). Based on the diagnostic standards for a body mass index ≥ 28 or total body fat percentage ≥ 25% or 30%, the chance of developing obesity did not change significantly. Blood glucose levels significantly increased (+ 12.31%). Total cholesterol levels (-10.45%) decreased significantly. Fat changes in those who received GAHT for one to two years were significantly different from those who did not receive GAHT.

Conclusion
After receiving GAHT, total body fat and regional fat increased in Chinese transwomen, and the body fat distribution changed from masculine to feminine, especially during the first two years. However, neither the increase in total body fat percentage nor the decrease in visceral fat content didn’t bring about significant changes in the incidence of obesity, nor did triglycerides or low-density lipoprotein-cholesterol.
Association between metabolic syndrome and kidney cancer risk: a prospective cohort study
Authors: Wang Lin , Du Han , Sheng Chao , Dai Hongji , Chen Kexin 
Published: May 2024

Abstract
Background
Kidney cancer has become known as a metabolic disease. However, there is limited evidence linking metabolic syndrome (MetS) with kidney cancer risk. This study aimed to investigate the association between MetS and its components and the risk of kidney cancer.

Methods
UK Biobank data was used in this study. MetS was defined as having three or more metabolic abnormalities, while pre-MetS was defined as the presence of one or two metabolic abnormalities. Hazard ratios (HRs) and 95% confidence intervals (CIs) for kidney cancer risk by MetS category were calculated using multivariable Cox proportional hazards models. Subgroup analyses were conducted for age, sex, BMI, smoking status and drinking status. The joint effects of MetS and genetic factors on kidney cancer risk were also analyzed.

Results
This study included 355,678 participants without cancer at recruitment. During a median follow-up of 11 years, 1203 participants developed kidney cancer. Compared to the metabolically healthy group, participants with pre-MetS (HR= 1.36, 95% CI: 1.06-1.74) or MetS (HR= 1. 70, 95% CI: 1.30-2.23) had a significantly greater risk of kidney cancer. This risk increased with the increasing number of MetS components (P for trend < 0.001). The combination of hypertension, dyslipidemia and central obesity contributed to the highest risk of kidney cancer (HR= 3.03, 95% CI: 1.91-4.80). Compared with participants with non-MetS and low genetic risk, those with MetS and high genetic risk had the highest risk of kidney cancer (HR= 1. 74, 95% CI: 1.41-2.14).

Conclusions
Both pre-MetS and MetS status were positively associated with kidney cancer risk. The risk associated with kidney cancer varied by combinations of MetS components. These findings may offer novel perspectives on the aetiology of kidney cancer and assist in designing primary prevention strategies.
A qualitative exploration of health care workers’ approaches to relational harm reduction in HIV primary care settings
Authors: Kay Emma Sophia , Creasy Stephanie L. , Townsend Jessica , Hawk Mary 
Published: May 2024

Abstract
Background
Structural harm reduction is an approach to care for people who use drugs (PWUD) that incorporates services and resources (e.g., naloxone, sterile syringes). As conceptualized in our previous research, harm reduction is also “relational,” encompassing a patient-provider relationship that is non-judgmental and respectful of patients’ autonomy. Little is known about health care workers’ (HCW) knowledge or attitudes towards harm reduction beyond structural strategies, whose availability and legality vary across geographical settings. To operationalize how relational harm reduction is both characterized and employed in HIV care settings, where nearly half of patients have a diagnosed substance use disorder, we qualitatively explored HCWs’ knowledge of and use of harm reduction via individual in-depth interviews.

Methods
Our study sample included three HIV clinics, one in Birmingham, Alabama (AL) and two in Pittsburgh, Pennsylvania (PA). We conducted individual interviews with n = 23 health care workers via Zoom, using a semi-structured interview guide to probe for questions around health care workers’ attitudes towards and experiences with providing care to PWH who use drugs and their knowledge of and attitudes towards relational and structural harm reduction. Data was analyzed in Dedoose using thematic analysis.

Results
Qualitative analyses revealed two primary themes, Continuum of Relational Harm Reduction in Practice and Limited Harm Reduction Training. Nearly all HCWs (n = 19, 83%) described a patient interaction or expressed a sentiment that corresponded with the principles of relational harm reduction. Yet, over half of participants (n = 14, 61%) used language to describe PWH who use drugs that was stigmatizing or described an interaction that was antithetical to the principles of relational harm reduction. Five HCWs, all from Birmingham, were unaware of the term ‘harm reduction.’ Few HCWs had any harm reduction training, with most learning about harm reduction from webinars/conferences or on the job.

Conclusion
Our findings suggest that relational harm reduction in HIV care settings is practiced along a continuum, and that a range of behaviors exist even within individual HCWs (e.g., used stigmatizing terms such as “addict” but also described patient interactions that reflected patients’ autonomy). Given that harm reduction is typically described as a structural approach, a broader definition of harm reduction that is not dependent on policy-dependent resources is needed.