bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mind the implementation gap: a systems analysis of the NHS Long Term Workforce Plan to increase the number of doctors trained in the UK raises many questions
Authors: Geary Una , McKee Martin , Petty-Saphon Katie 
Published: February 2024

Abstract

Background
The National Health Service (NHS) in England is facing a workforce crisis. A new Long Term Workforce Plan (LTWP) seeks to address this, setting out ambitious proposals to expand and reform domestic medical education and training in England. However, there are concerns about their feasibility.

Sources of data
In September 2023, over 60 individuals representing medical education and training in the UK participated in an exercise run by UK Medical Schools Council by using systems theory to identify risks.

Areas of agreement
The UK does need more ‘home grown’ doctors, but the LTWP has important gaps, including lack of attention to postgraduate training, absence of reference to the need for more educators and capital investment and risk of inadequate clinical placement capacity, particularly in primary care settings.

Areas of controversy
There are unresolved differences in the understanding of a proposed medical apprenticeship model and no scheme has, as yet, been approved by the General Medical Council. Participants were unable to determine who the beneficiaries of this scheme will be (apart from the apprentices themselves).

Growing points
While the LTWP represents a welcome, although overdue, commitment to address the NHS workforce crisis, we identified significant gaps that must be resolved.

Areas timely for developing research
First, the development of the LTWP provides a case study that adds to literature on policymaking in the UK. Second, while we only examined the expansion of medical training, the method could be applied to other parts of the LTWP. Third, a prospective evaluation of its implementation is necessary.
Predicting brain age using partition modeling strategy and atlas-based attentional enhancement in the Chinese population
Authors: Wu Yingtong , Chen Yingqian , Yang Yang , Lin Chuxuan , Su Shu , Zhao Jing , Wu Songxiong , Wu Guangyao , Liu Heng , Liu Xia , Yang Zhiyun , Zhang Jian , Huang Bingsheng 
Published: February 2024

Abstract
As a biomarker of human brain health during development, brain age is estimated based on subtle differences in brain structure from those under typical developmental. Magnetic resonance imaging (MRI) is a routine diagnostic method in neuroimaging. Brain age prediction based on MRI has been widely studied. However, few studies based on Chinese population have been reported. This study aimed to construct a brain age predictive model for the Chinese population across its lifespan. We developed a partition prediction method based on transfer learning and atlas attention enhancement. The participants were separated into four age groups, and a deep learning model was trained for each group to identify the brain regions most critical for brain age prediction. The Atlas attention-enhancement method was also used to help the models focus only on critical brain regions. The proposed method was validated using 354 participants from domestic datasets. For prediction performance in the testing sets, the mean absolute error was 2.218 ± 1.801 years, and the Pearson correlation coefficient (r) was 0.969, exceeding previous results for wide-range brain age prediction. In conclusion, the proposed method could provide brain age estimation to assist in assessing the status of brain health.
The weak genetic structure of Melolontha melolontha (L.) and Melolontha hippocastani (Fabr.), two important forest pests, indicates their large population sizes and effective gene flow
Authors: Niemczyk Marzena , Tereba Anna , Skrzecz Iwona , Kajtoch Łukasz 
Published: February 2024

Abstract
Cockchafers Melolontha spp. are polyphagous root pests and outbreak species of considerable economic importance to forestry in Europe. Knowledge of genetic diversity within and between cockchafer populations is largely unexplored but could lead to more effective monitoring and management strategies of these pests. In this study, we fill several gaps in the knowledge of the genetic population structure of Melolontha melolontha and Melolontha hippocastani. Using microsatellite loci and over 200 individuals per species, we examined the genetic structure of Melolontha spp. populations collected from three primary outbreak areas in central and southeastern Poland. We demonstrated that our focal species share some common genetic patterns, such as considerable genetic diversity within subpopulations (within sampling sites) with minor effects of past bottlenecks possibly masked by current population sizes. The estimates of effective population sizes, although subject to wide credibility intervals, indicated a large number of individuals contributing to further generations of the population. The migration rates exceed the threshold of one per generation required for gene flow and maintenance of population equilibrium, indicating limited impact from forest management practices on either cockchafer species. While genetic differentiation was observed in M. melolontha populations, supported by various indices (fixation index, principal coordinate analysis, assignment tests), the M. hippocastani populations were genetically similar. This disparity may hint at the potential historical divergence between these species. In this aspect, more detailed phylogeographic and population genetic studies covering a large area of the Palaearctic distributions of both species are required. Our findings constitute one of the initial efforts aimed at delineating the genetic diversity, differentiation, population structure, gene flow, and migration patterns within Melolontha spp. This exploration is especially significant for M. hippocastani, given its completely unexplored genetic population structure.
Determining the effective diffusivity coefficient and activation energy in thin-layer drying of Haj Kazemi peach slices and modeling drying kinetics using ANFIS
Authors: Barforoosh Majid Yazdani , Borghaee Ali Mohammad , Rafiee Shahin , Minaei Saeid , Beheshti Babak 
Published: February 2024

Abstract
This study investigated the moisture changes in Haj Kazemi peach slices during drying in a thin-layer dryer at five temperature levels (40, 50, 60, 70, and 80°C), three levels of inlet air velocity (1, 1.5, and 2 m/s), and three slice thicknesses (2, 4, and 6 mm). The relative moisture content during drying was calculated, and an adaptive neuro fuzzy inference system (ANFIS) was used to predict the drying process of peach slices. The results indicated that slice thickness had a greater impact on drying time than air velocity. Moreover, an almost direct relationship was observed between changes in slice thickness and drying time. The effective moisture diffusivity coefficient in peach slices increased with an increase in slice thickness, temperature, and air velocity and ranged from 9.57 × 10^-10 to 4.33 × 10^-9 m^2/s under different experimental conditions. The calculated activation energy for drying peach slices under experimental conditions ranged from 16.74 to 20.48 kJ/mol. The designed model for simulating the drying conditions was based on an adaptive neuro fuzzy inference system (ANFIS) with input and output membership functions of triangular and linear shapes and a hybrid learning algorithm. The model could simulate the drying process with a correlation coefficient of 0.979.
Innovative cinque rib-roughened stimulators on performance improvement in triangular channel solar air heater
Authors: Stalin P Michael Joseph , Lokanadham R , Naveen Gaddam , Singh Bharat , Tayyab Shaik Abdul , Panchal Hitesh , Kumar Abhinav , Siddiqui Md Irfanul Haque , Natrayan L , Shah Mohd Asif 
Published: February 2024

Abstract
Present study investigates application of cinque-faced rib roughening to improve the efficiency of solar air heaters (SAHs). Research focuses on a novel design, the cinque-faced rib-roughened triangular channel SAH (CFRTCSAH), which incorporates five-faced wire ribs on the absorber plate’s underside. By breaking down the laminar sublayer and enhancing flow separation and reattachment, - ribs significantly enhance heat transfer. It establishes a comprehensive theoretical model to analyze the thermal and hydraulic performance of the CFRTCSAH. The study considers the influence of parameters such as relative roughness pitch (P/e) and relative roughness height (e/Dh) on thermal efficiency and heat removal factor. The results demonstrate that the CFRTCSAH achieves remarkable thermal efficiency, reaching up to 80.7% under optimal roughness parameters (P/e = 12, e/Dh = 0.05). It is found that an increase in mass flow rates positively impacts thermal efficiency but should not exceed 0.09 kg/s for maximum effective efficiency. Additionally, it has observed that the CFRTCSAH performs most effectively when the relative roughness pitch ratio (P/e) is set to 12. A higher relative roughness height (e/Dh) promotes convective heat transfer, enhancing thermal performance, especially at lower mass flow rates. Conclusion presents a novel approach to improving the thermal performance of SAHs by introducing cinque-faced rib roughening. The CFRTCSAH design exhibits significant potential for achieving high thermal efficiency and can contribute to more efficient solar energy utilization in various applications. These findings offer valuable insights for the development of SAHs, promoting sustainable and energy-efficient technologies.
The impact of nuance DAX ambient listening AI documentation: a cohort study
Authors: Haberle Tyler , Cleveland Courtney , Snow Greg L , Barber Chris , Stookey Nikki , Thornock Cari , Younger Laurie , Mullahkhel Buzzy , Ize-Ludlow Diego 
Published: February 2024

Abstract

Objective
To assess the impact of the use of an ambient listening/digital scribing solution (Nuance Dragon Ambient eXperience (DAX)) on caregiver engagement, time spent on Electronic Health Record (EHR) including time after hours, productivity, attributed panel size for value-based care providers, documentation timeliness, and Current Procedural Terminology (CPT) submissions.

Materials and Methods
We performed a peer-matched controlled cohort study from March to September 2022 to evaluate the impact of DAX in outpatient clinics in an integrated healthcare system. Primary outcome measurements included provider engagement survey results, reported patient safety events related to DAX use, patients’ Likelihood to Recommend score, number of patients opting out of ambient listening, change in work relative values units, attributed value-based primary care panel size, documentation completion and CPT code submission deficiency rates, and note turnaround time.

Results
A total of 99 providers representing 12 specialties enrolled in the study; 76 matched control group providers were included for analysis. Median utilization of DAX was 47% among active participants. We found positive trends in provider engagement, while non-participants saw worsening engagement and no practical change in productivity. There was a statistically significant worsening of after-hours EHR. There was no quantifiable effect on patient safety.

Discussion
Nuance DAX use showed positive trends in provider engagement at no risk to patient safety, experience, or clinical documentation. There were no significant benefits to patient experience, documentation, or measures of provider productivity.

Conclusion
Our results highlight the potential of ambient dictation as a tool for improving the provider experience. Head-to-head comparisons of EHR documentation efficiency training are needed.
Pharmacological evidence that the inhibitory effects of prostaglandin E2 are mediated by the EP2 and EP4 receptors in human neutrophils
Authors: Lavoie Jean-Philippe C , Simard Mélissa , Kalkan Hilal , Rakotoarivelo Volatiana , Huot Sandrine , Di Marzo Vincenzo , Côté Andréanne , Pouliot Marc , Flamand Nicolas 
Published: February 2024

Abstract
Prostaglandin E2 (PGE2) is a recognized inhibitor of granulocyte functions. However, most of the data supporting this was obtained when available pharmacological tools mainly targeted the EP2 receptor. Herein, we revisited the inhibitory effect of PGE2 on reactive oxygen species production, leukotriene biosynthesis, and migration in human neutrophils. Our data confirm the inhibitory effect of PGE2 on these functions and unravel that the effect of PGE2 on human neutrophils is obtained by the combined action of EP2 and EP4 agonism. Accordingly, we also demonstrate that the inhibitory effect of PGE2 is fully prevented only by the combination of EP2 and EP4 receptor antagonists, underscoring the importance of targeting both receptors in the effect of PGE2. Conversely, we also show that the inhibition of ROS production by human eosinophils only involves the EP4 receptor, despite the fact that they also express the EP2 receptor.
Chlamydial Proctitis Mimicking Inflammatory Bowel Disease in a Young Active Duty Sailor With Undiagnosed Human Immunodeficiency Virus Infection: A Case Report
Authors: Oliver Logan , Pak Kevin , Maier Adam , Sadowski Brett 
Published: February 2024

ABSTRACT
Proctitis is an inflammation of the lining of the rectum that can be either acute or chronic in presentation. Symptoms include rectal bleeding, constipation, rectal discharge, rectal pain, and tenesmus. It is commonly associated with inflammatory bowel diseases (IBDs) such as ulcerative colitis and Crohn’s disease. However, it is important to consider the infectious causes of proctitis such as the sexually transmitted infections (STIs), especially Chlamydia trachomatis and Neisseria gonorrhoeae, as these can mimic the symptoms and pathology of IBD. We present the case of a young male sailor with subacute rectal bleeding who was hospitalized with initial concern for an index presentation of IBD. Endoscopic evaluation revealed proctitis although findings were atypical for inflammation related to IBD. Acquisition of additional history revealed that he had both receptive and insertive anal intercourse with both male and female partners. A full STI screening, including HIV was performed. Results were positive for both rectal C. trachomatis and HIV antigen and antibody serology, which were confirmed as HIV-1 on confirmatory testing. He was treated with doxycycline for his chlamydial proctitis with symptom resolution and was also initiated on antiretroviral therapy for his HIV infection. This case highlights the importance of obtaining a sexual history and considering STIs as a cause of proctitis, as this will ensure proper screenings and prompt subsequent treatment and potentially avoid unnecessary endoscopic and medical evaluation, which could potentially worsen the underlying process.
GPR97 deficiency suppresses Wnt/β‐catenin signaling in hypertensive nephropathy
Authors: Gao Ping , Zhu Jinghan , Xiangyun Guo , Li Jing , Wu Jichao 
Published: February 2024

AbstractAccumulating evidence shows that renal fibrosis plays a key role in the development of hypertensive nephropathy (HTN). Therefore, a better understanding of the underlying mechanism of renal fibrosis regulation in HTN would be critical for designing rational strategies for therapeutic interventions. In this study, we revealed that GPR97, a novel identified adhesion G coupled receptor, plays an important role in the regulation of Wnt/β‐catenin signaling, which is the crucial driver of renal fibrosis in HTN. First, we identified that the expression of GPR97 correlated with the β‐catenin expression in renal biopsy from patients with HTN. Moreover, we found that GPR97 deficiency inhibited Wnt/β‐catenin signaling in mice with HTN, as evidenced by the reduction of β‐catenin expression and downstream target proteins, including MMP7 and Fibronectin. Mechanistically, we found that GPR97 could directly bind with Wnt1 in cultured tubular cells and TGF‐β1 treatment enhanced the binding ability of GPR97 and Wnt1. In addition, the gene silencing of GPR97 could decrease the Wnt1‐induced fibrotic phenotype of tubular cells and inflammatory responses, suggesting that the binding of GPR97 and Wnt1 promoted Wnt/β‐catenin signaling. Collectively, our studies reveal that GPR97 is a regulator of Wnt/β‐catenin signaling in HTN, and targeting GPR97 may be a novel therapeutic strategy for HTN treatment.
A Suprapatellar approach, when compared to an Infrapatellar approach, yields less Anterior Knee Pain and better patellofemoral joint Function, for intramedullary nailing of diaphyseal tibial fractures. Results of a Randomised Controlled Trial.
Authors: van de Pol Gerrit J , Axelrod Daniel E , Conyard Christopher , Tetsworth Kevin D 
Published: February 2024

OBJECTIVES:
To assess if a suprapatellar (SP) approach, when compared to an infrapatellar (IP) approach, yielded less patient reported anterior knee pain and higher patellofemoral joint function at 6 weeks and 12 months post operatively, when treating tibial fractures with intramedullary nailing

METHODS:

Design:
Prospective, parallel group randomized control trial

Setting:
Tertiary level one trauma care centre, Brisbane, Australia

Patients Selection Criteria:
Skeletally mature patients with an acute diaphyseal tibial fracture (AO/OTA 41A2/3, 42 A1- 43A3) amenable to an IMN were included. Exclusion criteria were peri-prosthetic fractures, nonunions, and presence of a contralateral injury that would restrict weightbearing.

Outcome Measures and Comparisons:
Anterior knee pain, through the visual analogue scale (VAS) and patellofemoral function using the Kujala scale at 6-weeks and 12-months were compared between those treated with a SP and IP approach.

Results:
95 tibia fractures were included in the randomized trial, with complete follow-up data for 44 and 46 tibia fractures in the SP and IP groups, respectively. The SP cohort exhibited better patella-femoral knee function at both 6 weeks post operatively (Kajula 53.0 for SP vs 43.2 for IP, p<0.01)) and 12 months (Kujala 92.0 for SP vs 81.3 for IP (p<0.01)), and a reduction in anterior knee pain at 12-months post-operatively (VAS 0.7 SP vs 2.9 IP, p<0.01).

Conclusions:
This randomized trial demonstrated clinically meaningful differences in patellofemoral function, for a suprapatellar versus infrapatellar approach, with a greater than 10 point discrepancy in Kujala score at both 6 weeks and 12 months. Additionally, there was a clinically important difference in VAS knee pain scores for patients at 12 months, but not at 6 weeks, post operatively. These results contribute to the growing body of evidence demonstrating the functional and clinical benefits of the suprapatellar approach.
Impact of Skin Pigmentation on Cerebral Regional Saturation of Oxygen Using Near-Infrared Spectroscopy: A Systematic Review
Authors: Patel Nikunj A. , Bhattal Harvir S. , Griesdale Donald E. , Hoiland Ryan L. , Sekhon Mypinder S. 
Published: February 2024

OBJECTIVES:
Near-infrared spectroscopy (NIRS) is used in critical care settings to measure regional cerebral tissue oxygenation (rSo
2). However, the accuracy of such measurements has been questioned in darker-skinned individuals due to the confounding effects of light absorption by melanin. In this systematic review, we aim to synthesize the available evidence on the effect of skin pigmentation on rSo
2 readings.

DATA SOURCES:
We systematically searched MEDLINE, Cochrane Database of Systematic Reviews, Embase, and Google Scholar from inception to July 1, 2023.

STUDY SELECTION:
In compliance with our PROSPERO registration (CRD42022347548), we selected articles comparing rSo
2 measurements in adults either between racial groups or at different levels of skin pigmentation. Two independent reviewers conducted full-text reviews of all potentially relevant articles.

DATA EXTRACTION:
We extracted data on self-reported race or level of skin pigmentation and mean rSo
2 values.

DATA SYNTHESIS:
Of the 11,495 unique records screened, two studies (n = 7,549) met our inclusion criteria for systematic review. Sun et al (2015) yielded significantly lower rSo
2 values for African Americans compared with Caucasians, whereas Stannard et al (2021) found little difference between self-reported racial groups. This discrepancy is likely because Stannard et al (2021) used a NIRS platform which specifically purports to control for the effects of melanin. Several other studies that did not meet our inclusion criteria corroborated the notion that skin pigmentation results in lower rSo
2 readings.

CONCLUSIONS:
Skin pigmentation likely results in attenuated rSo
2 readings. However, the magnitude of this effect may depend on the specific NIRS platform used.
Results of a Pilot Virtual Microsurgery Course for Plastic Surgeons in LMICs
Authors: Davis Greta L. , Abebe Metasebia W. , Vyas Raj M. , Rohde Christine H. , Coriddi Michelle R. , Pusic Andrea L. , Gosman Amanda A. 
Published: February 2024

Background:
The Plastic Surgery Foundation’s Surgeons in Humanitarian Alliance for Reconstruction, Research and Education (SHARE) program seeks to expand surgical capacity worldwide through mentorship and training for local plastic surgeons. This study aims to define the need for microsurgery training among SHARE global fellows and describe results of a pilot course.

Methods:
Ten participants of the SHARE Virtual Microsurgical Skills Course were asked to complete an anonymous survey. Pre- and post-course response rates were 100% and 50.0%, respectively.

Results:
There was a high incidence of microsurgical problems encountered in the clinical setting. Resource availability was varied, with high access to loupes (100%), yet limited access to microsurgery instruments (50%), medications (40%), operating microscope (20%), skilled nursing (0%) and appropriate peri-operative care settings (0%). Participants identified vessel preparation, instrument selection, and suture handling as priority learning objectives for a microsurgery skills course. Post-course satisfaction with learning objectives was high (60% “very good,” 40% “excellent”). Participants reported high levels of improvement in suture handling (Likert 4.60±0.55), end-to-end anastomosis (4.40±0.55), instrument selection (4.20±0.45), vessel preparation (4.20±0.45), and economy of motion (4.20±0.45).

Conclusions:
This study demonstrates a high frequency of reconstructive problems encountered by global fellows yet low access to appropriate resources to perform microsurgical procedures. Initial results from a pilot virtual microsurgery course demonstrate very high satisfaction and high self-rated improvement in key microsurgical skills. The virtual course is an effective and accessible format for training surgeons in basic microsurgery skills and can be augmented by providing longitudinal opportunities for remote feedback.