bluuebunny/crossref_metadata_2025_split huggingface dataset:
“All Students Matter”: The Place of Race in Discourse on Student Debt in a Federal Higher Education Policymaking Process
Authors: Felix Eric R. , Gándara Denisa , Jones Sosanya 
Published: April 2024

Background: Nearly two decades have passed since the last successful reauthorization of the Higher Education Act. Since then, student loan debt and the accumulation patterns based on race have become a pressing issue to address in U.S. society. Purpose: Student debt is one of the key issues on the federal higher education policy agenda. The purpose of this paper is to examine how race is addressed in a congressional hearing held to discuss the reauthorization of the Higher Education Act. Specifically, we examined one congressional policy markup hearing to understand how members frame student debt and the racialized dynamics embedded within. Research Design: We combined critical race theory and racial frames to discursively analyze 14 hours of congressional hearings on the reauthorization of the Higher Education Act. Through critical discourse analysis, we interrogated the racialized discourse among policymakers as they proposed solutions and alternatives to address the issue of student debt during the policy markup process. Conclusions/Recommendations: Our findings highlight four types of discourse within a policy markup hearing: “All Students” Matter, Paternalistic, Race-Evasive, and Explicit Racial Discourse. We offer recommendations for policymakers and researchers to contend with ahistoricism and race-evasiveness prevalent in policy markup hearings and ways for future policy proposals to be more explicit in naming the groups facing disproportionate negative impact, the mechanisms that produce such inequities, and interventions that can address them.
A palliative care goals model for people with dementia and their family: Consensus achieved in an international Delphi study
Authors: Nishimura Mayumi , Harrison Dening Karen , Sampson Elizabeth L , Vidal Edison Iglesias de Oliveira , Nakanishi Miharu , Davies Nathan , Abreu Wilson , Kaasalainen Sharon , Eisenmann Yvonne , Dempsey Laura , Moore Kirsten J , Bolt Sascha R , Meijers Judith MM , Dekker Natashe Lemos , Miyashita Mitsunori , Nakayama Takeo , van der Steen Jenny T 
Published: April 2024

Background: Advance care planning in dementia includes supporting the person and their family to consider important goals of care. International research reports the importance of psycho-social-spiritual aspects towards end of life. Aim: To develop a multidimensional international palliative care goals model in dementia for use in practice. Design: International Delphi study integrating consensus and evidence from a meta-qualitative study. The Delphi panel rated statements about the model on a 5-point agreement scale. The criteria for consensus were pre-specified. Setting/participants: Seventeen researchers from eight countries developed an initial model, and 169 candidate panellists were invited to the international online Delphi study. Results: Panellists (107; response 63.3%) resided in 33 countries. The model comprised four main care goals: (1) Comfort ensured; (2) Control over function maintained; (3) Identity protected and personhood respected and (4) Coping with grief and loss−person and caregiver supported. The model reflects how needs and care goals change over time with the progression of dementia, concluding with bereavement support. The first version of the model achieved a consensus after which it was slightly refined based on feedback. We did not achieve a consensus on adding a goal of life prolongation, and on use of the model by people with dementia and family themselves. Conclusion: A new palliative care goals model for people with dementia and their families includes relationship aspects for use by professionals and achieved a consensus among a panel with diverse cultural background. The position of life prolongation in relation to palliative care goals needs further research.
The gender gap in stone-related surgery: A comprehensive analysis from an Israeli perspective
Authors: Golomb Dor , Cooper Amir , Raz Orit 
Published: April 2024

Objective: To investigate the gender gap in the context of stone-related surgery within an Israeli population. Methods: We conducted a retrospective cohort study using administrative databases from Clalit Health Services to identify adults aged 18 and above who had their initial surgical treatment for upper tract urolithiasis. We employed descriptive statistics to outline the baseline patient characteristics, and the Cochran–Armitage test for trend was utilized to analyze surgical trends. Results: Between 2003 and 2020, a total of 36,624 adult patients underwent surgical treatment for upper tract urinary stones. The mean age of patients was 55.01 years (standard deviation (SD) 16.6) for ureteroscopy (URS), 55.05 years (SD 15.1) for percutaneous nephrolithotripsy (PCNL), and 51.07 years (SD 15.1) for shockwave lithotripsy (SWL). When considering the distribution of procedures by gender, males accounted for 69.5% of URS cases, 58.3% of PCNL cases, and 70.6% of SWL cases, whereas females represented 30.5%, 41.7%, and 29.4% of URS, PCNL, and SWL cases, respectively. Across all surgical modalities, the male-to-female ratio exhibited fluctuations without a consistent trend, with both increases and decreases observed. In URS, the ratio saw a modest increase from 1.967 in 2003 to 2.173 in 2020. For PCNL, the ratio initially increased from 2.361 in 2003 to 2.549 in 2014, followed by subsequent fluctuations, but an overarching trend was not apparent. In contrast, for SWL, the ratio decreased from 2.15 in 2003 to 1.32 in 2020, with varying changes in between. Conclusion: This study highlights the dynamic nature of gender gap in stone-related surgery outcomes. While the male-to-female ratio exhibited fluctuations over a 17-year period, no consistent trend emerged. The absence of a clear trend underscores the complex and multifaceted factors influencing the gender gap in urolithiasis.
Influence of moisture and salinity on property degradation of nano-engineered epoxy polymers for offshore applications
Authors: Sindu B. S. , Sasmal Saptarshi 
Published: April 2024

This study has attempted to investigate the influence of major environmental degradation factors for offshore and coastal structures, such as moisture and salinity, on epoxy-based bonded composite systems and to identify the means of degradation of the same. Exhaustive experimental investigations have been carried out with different salinity levels (0%, 2.5% and 5%) and exposure periods (45 days to longer time periods (>1 year)) to determine the influence of the same on the mechanical property degradation of epoxy polymers. The effect of degraded properties on the performance degradation of bonded epoxy composite systems in terms of damage pattern and load-carrying capacity has been investigated using numerical simulations with non-linear material models and traction-separation interface behaviour. Further, it is also attempted to fundamentally engineer the epoxy polymers using nanosilica to improve their mechanical properties and environmental resistance. Finally, diffusion tests have been performed on the plain and nanoengineered epoxy polymers to understand the change in diffusion mechanisms due to nanoengineering, and a correlation has been established between the diffusion behaviour and the mechanical property degradation. The findings of this study will lead towards the development of stronger and more durable epoxy-bonded composite systems for marine applications.
Serum long non-coding Ribonucleic Acid H19 serves as a biomarker for systemic lupus erythematosus and participates in the disease progression
Authors: Yang Hongyu , Wang Shuping , Wang Fei , Bai Xuemei , Ren Juan 
Published: April 2024

Aim This study aimed to investigate the expression of H19 and its possible molecular mechanism in systemic lupus erythematosus (SLE). Methods The expression of H19 and miR-19b in serum and peripheral blood mononuclear cells (PBMCs) were detected by reverse transcription quantitative polymerase chain reaction (RT-qPCR). Receiver operator characteristic (ROC) curve was constructed to evaluate the diagnostic value of serum H19 in SLE. Pearson correlation coefficient was used to analyze the correlation between serum levels of H19 and miR-19b. Flow cytometry and Cell counting kit-8 (CCK-8) assay were performed to detect cell apoptosis and viability. The levels of pro-inflammatory and anti-inflammatory factors were measured by enzyme-linked immunosorbent assay (ELISA). Luciferase reporter gene assay was conducted to verify the interaction between H19 and miR-19b. Results The expression of H19 and miR-19b in SLE group were up-regulated and down-regulated, respectively. Serum H19 has certain clinical diagnostic value in SLE. In in vitro studies, overexpression of H19 can significantly inhibit the viability of PBMCs and promote apoptosis and inflammatory response of PBMCs by interacting with miR-19b. Conclusions The expression of H19 is upregulated in patients with SLE and plays a role in cell function and inflammation by targeting miR-19b in PBMCs, which may be one of the pathological mechanisms of SLE.
Investigating Factors Associated with Drug Adherence Among Individuals with Hyperuricemia: A Cross-sectional Study
Authors: Andala Sri , Sofyan Hizir , Hasballah Kartini , Marthoenis  
Published: April 2024

Introduction: The prevalence of hyperuricemia is on the rise in specific populations, and there are difficulties in maintaining medication adherence. This study aims to investigate the factors linked to drug adherence in individuals with hyperuricemia. Methods: This was a cross-sectional study, which was conducted in 2023 by recruiting respondents with hyperuricemia. The demographic data collected included age, gender, occupation, body height and weight, education, marital status and ethnicity. Furthermore, drug adherence was determined based on the response to the Morisky Medication Adherence Scale-8. Acceptance and knowledge were measured using questionnaires given to the participants. Multivariate logistic regression analysis was then used to obtain the determinants of drug adherence. Results: Among 524 respondents who participated in the study, 60.3% and 30.15% had moderate and high adherence to serum uric acid-lowering drugs, respectively. The results showed that older age had a strong association with lower adherence ( p < .01), while high disease acceptance significantly predicted higher levels ( p < .01). Knowledge about gout symptoms ( p = .003; OR: 0.28 [95% CI: 0.12-0.65]), causal factors ( p < .001; OR: 2.63 [95% CI: 1.48-4.65]) and uric acid-lowering alternatives ( p < .001; OR: 8.17 [95% CI: 4.11-16.25]) also had a positive correlation with higher levels. Conclusion: Knowledge and acceptance had a significant correlation with drug adherence among individuals with hyperuricemia in Aceh Province, Indonesia.
The Experience of Cervical Cancer Patients Undergoing Hysterectomy: A Qualitative Study
Authors: Liu Xiao-Qin , Wang Lan , Gu Xuan , Shan Xiao , Xie Juan , Gao Wen-Ying , Gu Yu-Hui , Zhang Yan , Gu Dong-Mei 
Published: April 2024

Introduction: Due to different social and cultural backgrounds, cervical cancer patients’ experience of the treatment process and quality of life after treatment will be different. This study sought to gain in-depth understanding of the experiences of Chinese cervical cancer patients as regards their quality of life and physical symptoms. Methodology: Semi-structured interviews were used to collect data. We recruited 15 women with cervical cancer in eastern China for in-depth interviews. All data were entered into the NVivo 12 software program for analysis. Results: Four themes emerged from the data: (a) uncertainty; (b) physical suffering; (c) psychological pressure; and (d) challenges of marriage and family. Discussion: Cervical cancer patients showed concerns about the disease itself and the physical discomfort it causes, as well as changes in social relations. Health professionals need to talk about these issues and develop strategies to address them accordingly.
Clinico-Epidemiological Profile, Trends, and Health-Related Outcomes of Snakebite Victims: A One-Year Prospective Study from Eastern India
Authors: Stephen Shine , Mohanty Chitta Ranjan , Radhakrishnan Rakesh Vadakkethil , Issac Alwin , Jacob Jaison , Krishnan Nadiya , VR Vijay , Guru Satyabrata , Muhammed Shaji Ijas , Aggarwal Achala 
Published: April 2024

Introduction Snakebite envenomation is a significant life-threatening public health problem in Southeast Asia (SEA). In this region, India reported the largest number of snakebite deaths from 2000 to 2019 (1.2 million), with an average of 58,000 deaths yearly. Methods This prospective observational study was carried out among snakebite victims at the emergency department (ED) of a tertiary care public sector hospital in eastern India. Results A total of 145 cases of venomous snakebite were investigated. More than half ( n = 81, 56%) of the snakebite victims were between 17 to 45 years. Most of the snakebite victims were male (68%) and were farmers (53%) by occupation. The majority of snakebites occurred during the daytime (76%) and while outdoors (67%). Most victims sustained a bite on the lower extremity (71%). The peak incidence of snakebites occurred from June to September (69%). Three-quarters of all patients were unaware of the required first aid measures following a snakebite. Among the 145 venomous snakebites, 48 were presumptively identified as the Indian cobra, 32 by the Indian krait, 56 by the Russel's viper, and 9 by saw-scaled viper. The mean duration from the snakebite to the onset of systemic effects in the Indian cobra was 52 ± 14.28 min, 66 ± 18.35 min in the Indian krait, 42 ± 13.47 min in Russel's viper, and 48 ± 16.38 min in saw-scaled viper. Respiratory failure was the commonly observed complication following an elapid envenomation. The mortality rate was 2.1% among the patients treated with antivenom. Conclusions Snakebite is considered an occupational hazard in India, commonly affecting the young population in their productive period. The peak incidence was during monsoon season, and the majority had neurotoxic envenomation following an elapid bite (55%) that contributed to the increased mortality and morbidity among young adults. Of the 145 patients, the majority (84%) recovered fully with treatment; 16% of the victims developed morbidity viz cellulitis, respiratory failure, acute renal failure, compartment syndrome, local tissue necrosis, intracerebral hemorrhage, and disseminated intravascular coagulation. Appropriate first aid measures and timely medical intervention can significantly improve the treatment outcome following snakebites.
The HUC progression score: A new method for determining KERATOCONUS progression
Authors: Eguileor Beatriz de Luis , Zorrozúa Borja Santos , Ecenarro Jaime Etxebarria 
Published: April 2024

Purpose To establish new criteria for the progression of keratoconus, taking into account a Pentacam HR (high resolution) tomographeŕs repeatability limit. Methods This is a retrospective observational study, including 224 eyes in 154 patients diagnosed with keratoconus and patients treated with crosslinking, with a follow-up of at least one year, in which the new progression score of the Cruces University Hospital for keratoconus progression was analyzed. This score takes into account: maximum keratometry, thinnest corneal thickness, maximum posterior elevation, vertical coma and RMS of high order aberrations, all based on the tomographer repeatability limit. The effectiveness or not of crosslinking was determined. Results The Receiver Operating Characteristics (ROC) curves obtained in our validation met the criteria by being far from the reference diagonal. Moreover, young patients are more likely to have keratoconus that progresses, and the percentage of patients that showed progression was 14.3% of the eyes studied, with the most advanced keratoconus showing the least progression. Taking into account the new progression score of the Cruces Hospital, we would have indicated crosslinking in 2 eyes only and we observed that none progressed one year after treatment. Conclusions The the new progression score of the Cruces University Hospital is a method based on the real repeatability limit for keratoconic eyes. Moreover, it is easy to interpret and can be implemented with Pentacam software. It provides a numerical value that evaluates both the anterior and posterior surfaces of the cornea and corneal aberrations in the evolution of keratoconus.
The Role of Artificial Intelligence in Medical Education: A Systematic Review
Authors: Tozsin Atinc , Ucmak Harun , Soyturk Selim , Aydin Abdullatif , Gozen Ali Serdar , Fahim Maha Al , Güven Selcuk , Ahmed Kamran 
Published: April 2024

Background To examine the artificial intelligence (AI) tools currently being studied in modern medical education, and critically evaluate the level of validation and the quality of evidence presented in each individual study. Methods This review (PROSPERO ID: CRD42023410752) was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. A database search was conducted using PubMed, Embase, and Cochrane Library. Articles written in the English language between 2000 and March 2023 were reviewed retrospectively using the MeSH Terms “AI” and “medical education” A total of 4642 potentially relevant studies were found. Results After a thorough screening process, 36 studies were included in the final analysis. These studies consisted of 26 quantitative studies and 10 studies investigated the development and validation of AI tools. When examining the results of studies in which Support vector machines (SVMs) were employed, it has demonstrated high accuracy in assessing students’ experiences, diagnosing acute abdominal pain, classifying skilled and novice participants, and evaluating surgical training levels. Particularly in the comparison of surgical skill levels, it has achieved an accuracy rate of over 92%. Conclusion AI tools demonstrated effectiveness in improving practical skills, diagnosing diseases, and evaluating student performance. However, further research with rigorous validation is required to identify the most effective AI tools for medical education.
Impact of Intermittent Intraoperative Neuromonitoring (IONM) on the Learning Curve for Total Thyroidectomy by Residents in General Surgery
Authors: Fassari Alessia , Micalizzi Alessandra , Lelli Giulio , Gurrado Angela , Polistena Andrea , Iossa Angelo , De Angelis Francesco , Martini Lorenzo , Tamagnini Giovanni Traumuller , Testini Mario , Cavallaro Giuseppe 
Published: April 2024

Introduction Recurrent laryngeal nerve (RNL) identification constitutes the standard in thyroidectomy. Intraoperative nerve monitoring (IONM) has been introduced as a complementary tool for RLN functionality evaluation. The aim of this study is to establish how routine use of IONM can affect the learning curve (LC) in thyroidectomy. Methods Patients undergoing total thyroidectomy performed by surgery residents in their learning curve course in 2 academic hospitals, were divided into 2 groups: Group A, including 150 thyroidectomies performed without IONM by 3 different residents, and Group B, including 150 procedures with routine use of intermittent IONM, by other 3 different residents. LC was measured by comparing operative time (OT), its stabilization during the development of the LC, perioperative complication rate. Results As previously demonstrated, the LC was achieved after 30 procedures, in both groups, with no differences due to the use of IONM. Similarly, there were no significant differences among the 2 groups, and between subgroups independently matched, for both OT and complications, even when comparing RLN palsy. Direct nerve visualization and IONM assessment rates were comparable in all groups, and no bilateral RLN palsy (transient or permanent) were reported. No case of interrupted procedure to unilateral lobectomy, due to evidence of RLN injury, was reported. Conclusions The study demonstrates that the use of IONM thyroid surgery, despite requiring a specific training with experienced surgeons, does not particularly affect the learning curve of residents approaching this kind of surgery, and for this reason its routine use should be encouraged even for trainees.
Concomitant use of pre-emptive analgesia with local and general anesthesia in rat uterine pain surgical model
Authors: Mumtaz Saima , Baseer Najma , Habib Syed Hamid 
Published: April 2024

Preemptive analgesia is used for postoperative pain management, providing pain relief with few adverse effects. In this study, the effect of a preemptive regime on rat behavior and c-fos expression in the spinal cord of the uterine surgical pain model was evaluated. It was a lab-based experimental study in which 60 female Sprague-Dawley rats; eight to 10 weeks old, weighing 150–300 gm were used. The rats were divided into two main groups: (i) superficial pain group (SG) (with skin incision only), (ii) deep pain group (with skin and uterine incisions). Each group was further divided into three subgroups based on the type of preemptive analgesia administered i.e., “tramadol, buprenorphine, and saline subgroups.” Pain behavior was evaluated using the “Rat Grimace Scale” (RGS) at 2, 4, 6, 9 and 24 h post-surgery. Additionally, c-fos immunohistochemistry was performed on sections from spinal dorsal horn (T12-L2), and its expression was evaluated using optical density and mean cell count 2 hours postoperatively. Significant reduction in the RGS was noted in both the superficial and deep pain groups within the tramadol and buprenorphine subgroups when compared to the saline subgroup ( p ≤ .05). There was a significant decrease in c-fos expression both in terms of number of c-fos positive cells and the optical density across the superficial laminae and lamina X of the spinal dorsal horn in both SD and DG ( p ≤ .05). In contrast, the saline group exhibited c-fos expression primarily in laminae I-II and III-IV for both superficial and deep pain groups and lamina X in the deep pain group only ( p ≤ .05). Hence, a preemptive regimen results in significant suppression of both superficial and deep components of pain transmission. These findings provide compelling evidence of the analgesic efficacy of preemptive treatment in alleviating pain response associated with uterine surgery.