bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementation of an antimicrobial stewardship program in the Australian private hospital system: qualitative study of attitudes to antimicrobial resistance and antimicrobial stewardship
Authors: Ayton Darshini , Watson Eliza , Betts Juliana M. , Doyle Joseph , Teh Benjamin , Valoppi Glenn , Cotta Menino , Robertson Megan , Peel Trisha 
Published: December 2022

Abstract
Background
Antimicrobial Stewardship (AMS) is a key method to tackle antimicrobial resistance (AMR). In Australia, private hospitals have a higher rate of inappropriate prescribing and non-compliance with antimicrobial guidelines, yet this phenomenon is poorly described. Private hospitals make up 49% of hospitals in Australia, making it vital to understand AMS in this setting.

Methods
This study aimed to explore capabilities, opportunities and motivations for AMR and AMS with stakeholders at an Australian private hospital, and identify barriers and enablers 5 years post-implementation of an AMS program comparing with pre-implementation findings. A mixed-methods study was performed, involving three focus groups with stakeholders. All doctors, nurses and pharmacists at the hospital were invited to complete a survey on their experiences with and awareness of AMR, AMS and antimicrobial prescribing.

Results
Thirteen staff took part in the focus groups, 100 staff responded to the survey. Staff understood the importance of the AMS program, but active engagement was low. Staff felt more thorough feedback and monitoring could improve prescribing behaviour, but acknowledged difficulty in private hospitals in changing habits of staff who valued autonomy in making prescribing decisions. Half of respondents felt the current AMS restrictions should continue. Executive engagement may be needed to drive system changes across a complex network.

Conclusion
AMS awareness increased post-implementation, but staff remained sceptical of its benefits. Engagement and education of medical consultants regarding local benefits of AMS must improve. Enhanced understanding of feedback provision, methods for engagement, and advocacy from leadership will ensure success and longevity for the program.
Descriptive phenomenology study of the reasons for the low uptake of free health service package among type II diabetic patients
Authors: Amini-Rarani Mostafa , Karimi Saeed , Gharacheh Laleh 
Published: December 2022

Abstract
Background
Although several diabetes management and control programs are introduced in Iran, rate of using such cares in patients with Type II Diabetic in Ahvaz is low and they show no tendency for receiving free diabetes service package. The aim of this study was to identify reasons behind low uptake of free health service package among T2DM patients in Ahvaz, Iran.

Methods
This descriptive phenomenology study based on semi-structured guided interviews of patients with Type II Diabetic in Ahvaz, was carried out in the year 2021. Through purposeful sampling, 495 patients with diabetics who not received health services package more than 6 months were interviewed until the data saturation. The gathered data were analyzed through conventional content analysis.

Results
Reasons were categorized into three themes which include 13 subthemes and 57 codes. Themes included individual, accessibility, and structural factors. Besides, subthemes were lack of awareness, poor health literacy, adverse patients experience, difficulties to use services, verbal miscommunication cultural barriers, low trust, geographic barriers, time barriers, financial difficulties, lack of human resources, poor service delivery, and organizational factors were as barriers to participation.

Conclusion
Regarding individual level, there is a need for further training of diabetic patients. Besides, for accessibility and structural factors Iranian healthcare system needs a comprehensive integrated care for the management of diabetes, this underlines the collaboration for improving patients' uptake of free health service package.
Self-reported attitudes, skills and use of evidence-based practice among Swiss chiropractors: a national survey
Authors: Albisser Arlette , Schweinhardt Petra , Bussières André , Baechler Mirjam 
Published: December 2022

Abstract
Study Objectives
The high burden of disease associated with musculoskeletal disorders severely impacts patients’ well-being. As primary care providers, Swiss chiropractors ought to contribute towards identifying and using effective treatment strategies. An established approach is the full integration of evidence-based practice (EBP). This study aimed to investigate the attitudes, skills and use of EBP among Swiss chiropractors, as well as investigating potential facilitators and barriers for its adoption.

Methods and material
All 329 members of the Swiss Association of Chiropractic (ChiroSuisse) were invited in March 2021 to participate in this cross-sectional survey. Data were acquired anonymously online, using the Evidence-Based practice Attitude and utilization SurvEy (EBASE). The survey encompassed 55 questions measuring attitudes (n = 8, response range 1–5; total score range of 8–40), skills (n = 13, response range 1–5; total score range of range of 13–65) and use of EBP (n = 6, response range 0–4; total score range of 0–24).

Results
228 (69.3%) chiropractors returned complete EBASE questionnaires. This sample was representative of all ChiroSuisse members with respect to gender, age groups and proportion of chiropractic residents. Respondents generally held positive attitudes towards EBP, as indicated by the high mean (31.2) and median (31) attitude sub-score (range 11–40). Self-reported skills had a mean sub-score of 40.2 and median of 40 (range 13–65). Knowledge about EBP-based clinical practice had been primarily obtained in chiropractic under- or postgraduate education (33.8% and 26.3%, respectively). Use of EBP achieved a lower sub-score, with mean and median values of 7.4 and 6, respectively (range 0–24). The most commonly identified barriers preventing EBP uptake were lack of time (67.9%) and lack of clinical evidence in chiropractic/manual therapy-related health fields (45.1%).

Conclusion
Swiss chiropractors held favourable attitudes and reported moderate to moderate-high skill levels in EBP. Nevertheless, similar to chiropractors in other countries, the self-reported use of EBP was relatively low, with lack of time and lack of clinical evidence being the most named barriers.
Mesenchymal stem cell-derived exosomes as a new therapeutic strategy in the brain tumors
Authors: Ghasempour Elham , Hesami Shilan , Movahed Elaheh , keshel Saeed Heidari , Doroudian Mohammad 
Published: December 2022

AbstractBrain tumors are one of the most mortal cancers, leading to many deaths among kids and adults. Surgery, chemotherapy, and radiotherapy are available options for brain tumor treatment. However, these methods are not able to eradicate cancer cells. The blood–brain barrier (BBB) is one of the most important barriers to treat brain tumors that prevents adequate drug delivery to brain tissue. The connection between different brain parts is heterogeneous and causes many challenges in treatment. Mesenchymal stem cells (MSCs) migrate to brain tumor cells and have anti-tumor effects by delivering cytotoxic compounds. They contain very high regenerative properties, as well as support the immune system. MSCs-based therapy involves cell replacement and releases various vesicles, including exosomes. Exosomes receive more attention due to their excellent stability, less immunogenicity and toxicity compare to cells. Exosomes derived from MSCs can develop a powerful therapeutic strategy for different diseases and be a hopeful candidate for cell-based and cell-free regenerative medicine. These nanoparticles contain nucleic acid, proteins, lipids, microRNAs, and other biologically active substances. Many studies show that each microRNA can prevent angiogenesis, migration, and metastasis in glioblastoma. These exosomes can—act as a suitable nanoparticle carrier for therapeutic applications of brain tumors by passing through the BBB. In this review, we discuss potential applications of MSC and their produced exosomes in the treatment of brain tumors.
Preimplantation genetic testing for aneuploidy: challenges in clinical practice
Authors: Yang Hui , DeWan Andrew Thomas , Desai Mayur M. , Vermund Sten H. 
Published: December 2022

AbstractPreimplantation genetic testing for aneuploidy (PGT-A) has been used widely during in vitro fertilization procedures in assisted reproductive centers throughout the world. Despite its wide use, concerns arise from the use of PGT-A technology in clinical decision-making. We address knowledge gaps in PGT-A, summarizing major challenges and current professional guidelines. First, PGT-A is a screening test and not a diagnostic test. Second, mosaicism is much higher in the blastocyst stage from PGT-A than had been recognized previously and a mosaic embryo may not accurately represent the genetic disease risk for future fetal disorders. Third, PGT-A was not validated clinically before use in patients; the best use of this technology for selected age-groups remains uncertain. Given these gaps, we believe that current professional policies relying on industry-self-regulation are insufficient. In the USA, the Food and Drug Administration may be the most appropriate agency to provide more definitive guidelines and regulations that are needed for better practice.
Molecular characterization and toxicity evaluation of indigenous Bacillus thuringiensis isolates against key lepidopteran insect pests
Authors: Gothandaraman Rajadurai , Venkatasamy Balasubramani , Thangavel Tamilnayagan , Eswaran Kokiladevi , Subbarayalu Mohankumar 
Published: December 2022

Abstract
Background
The indiscriminate use of synthetic insecticides is not affordable and poses collateral damage to humans, non-target organisms, and environmental health. Bacillus thuringiensis (Bt) is a cosmopolitan, antagonistic soil bacterium employed as an alternative to chemical insecticides in pest management. In this study, genetic diversity and insecticidal activity of 50 indigenous Bt isolates were investigated in order to find the effective Bt isolates with a broad spectrum of insecticidal activity against lepidopteran insects.

Results
Most of the Bt isolates investigated appeared as creamy white in colour and fried egg or mucoid-type colonies having a flat or raised elevation with entire or undulated margins. Out of 50 isolates investigated, crystal shapes varied from cuboidal (40.00%), spherical (36.00%), bipyramidal (30.00%), rectangular (10.00%), and minute crystal attached to the spores (28.00%). SDS-PAGE analysis revealed that the molecular weight of the crystal proteins of Bt isolates ranged from ~ 30 to ~ 200 kDa in size. Among the Bt isolates screened, ~ 135 kDa size representing Cry1 protein was observed in 12 isolates (24.00%) and 65 kDa representing Cry2 was observed in 14 isolates (28.00%). PCR analysis was performed for cry1, cry2, cry3, cry4, cry9, vip1, vip2, and vip3 genes, which revealed the presence of cry1 gene alone in 5 isolates, and cry2 alone in 7 isolates, whereas 7 isolates were positive for cry1, cry2, and vip3 genes together. None of the Bt isolates showed the presence of cry3, cry4, cry9, vip1, and vip2 genes. Toxicity of Bt isolates was tested against four species of lepidopteran larvae, viz. Plutella xylostella Linnaeus, Helicoverpa armigera Hubner, Spodoptera litura Fabricius, and S. frugiperda Smith. Among them, 6 isolates (T29, T30, T31, T357, T381, and T388) produced 100% larval mortality against all four species of insects.

Conclusion
The present study showed the diversity of Bt isolates and confirmed the significance of relentless exploration of Bt isolates for novel genes. Further investigations need to be carried out to disclose the hidden potential of these toxic isolates.
Predictive value of cerebral collaterals on CT angiography on the outcome of patients with acute anterior ischemic stroke receiving thrombolysis treatment
Authors: Darwish Esam Saad , Othman Mostafa H. , Youssef Ahmed Hamdy , Tawfik Ahmed Mamdouh , Tohamy Amal M. 
Published: December 2022

Abstract
Background
Functional outcomes of patient with acute ischemic stroke are influenced by the status of the cerebral collaterals. The study aims at evaluating the influence of cerebral collaterals on clinical and radiological outcome in patients with acute anterior ischemic stroke (AAIS) treated with IV recombinant tissue plasminogen activator (IV-rtPA).

Results
Independent predictors of good functional outcomes were in the form of low NIHSS (odds ratio = 1.23, 95%CI = 1.01–2.34, p = 0.01), ASPECT ≥ 8 (odds ratio = 4.56, 95%CI = 3.40–7.89, p < 0.001), and good collateral status by Miteff grading system (odds ratio = 1.23, 95%CI = 2.22–6.79, p < 0.001).

Conclusion
Good collateral status is associated with milder stroke volume and good functional outcome. Also, low NIHSS, ASPECT score ≥ 8 and good collateral status by Miteff grading system were reliable independent predictors of favorable outcome in IV-rtPA treated patients with AAIS.
A prospective cross-sectional study assessing teaching of interventional radiology across 20 Australian medical schools, endorsed by the Australian Medical Students Association
Authors: Clements Warren , Zia Adil , Srinivas Abhishekh , Davis Jasmine , Goh Gerard S. 
Published: December 2022

Abstract
Background
Existing literature from around the world has shown that teaching of Interventional Radiology (IR) to medical students remains suboptimal. Despite calls for improvement at a “grass-roots” level, most IRs find that junior doctors have limited or no knowledge of IR, and thus reduced awareness of potential IR treatments for their patients or contemplating IR as a future career. The aim of this study was to survey current medical students to assess perception of whether a wider variety of medical schools are integrating IR into their curriculum, from universities all across Australia.
This was a prospective cross-sectional study of members of the Australian Medical Students Association (AMSA) from across Australia. Students were given a 14-question survey of current university teaching and students’ knowledge of the discipline of IR. The primary outcome was perception of current teaching and knowledge of IR. Secondary outcomes include awareness of technical, clinical, and other duties of IRs.

Results
Surveys were sent in a newsletter and posted on the AMSA Facebook page to their members. 82 responses were received via students from 20 out of 23 Australian medical schools. 61% of students described poor or no knowledge of IR. Teaching of IR was significantly worse than diagnostic radiology (p < 0.001), only 12% suggested that current IR teaching was adequate, and 99% suggested that IR teaching could be improved. Only 11% of students would consider a career in IR.

Conclusions
Medical student perception of exposure to IR is poor compared to diagnostic radiology. Better awareness may lead to improved referral patterns for patients and more career interest in IR.
Exploring a rhizobium to fix nitrogen in non-leguminous plants by using a tumor-formation root pathogen
Authors: Zhao Ying , Gao Lixia , Gao Zhixiao , Tian Binnian , Chen Tao , Xie Jiatao , Cheng Jiasen , Fu Yanping , Li Youguo , Xiao Shunyuan , Bisseling Ton , Jiang Daohong 
Published: December 2022

AbstractOver 110 million tons of nitrogen fertilizer every year is used for crop production. Scientists have dreamed of enabling rhizobial nitrogen fixation in non-leguminous crops to mitigate the increasing demand for nitrogen fertilizer. However, despite decades of research, rhizobial nitrogen fixation in non-host plants has not been demonstrated. Here, we reported that an N-fixing rhizobium and a clubroot pathogen Plasmodiophora brassicae exhibited a synergistic effect on fixing nitrogen in cruciferous plants. Rhizobia were found to invade P. brassicae-infected rapeseed (Brassica napus) roots in the field. The colonization of rhizobium on rapeseed roots was confirmed by co-inoculating Mesorhizobium huakuii with P. brassicae under controlled laboratory conditions. M. huakuii infection could alleviate clubroot symptoms and promote the growth of diseased rapeseeds. M. huakuii could fix nitrogen in P. brassicae-infected plants based on the results of 15N isotope dilution tests. The expression of homologs of legume genes required for symbiosis and early-nodulin genes was significantly upregulated in Arabidopsis during early infection by P. brassicae. More importantly, M. huakuii could even fix nitrogen in P. brassicae-resistant rapeseed cultivar and promote plant growth when co-inoculated with P. brassicae. Our findings provide a new avenue to understand the interaction of rhizobia with non-host plants, stimulate the exploration of fixing nitrogen in non-leguminous plants by nitrogen-fixing rhizobia, and develop a strategy for both disease control and nitrogen fixation on non-host crops.
A case study of a novel summer bridge program to prepare transfer students for research in biological sciences
Authors: Zuckerman Austin L. , Juavinett Ashley L. , Macagno Eduardo R. , Bloodgood Brenda L. , Gaasterland Terry , Artis David , Lo Stanley M. 
Published: December 2022

AbstractUndergraduate research experiences enculturate students into the research community by providing support networks to explore advanced professional opportunities. However, transfer students are at a considerable disadvantage for pursuing these opportunities due to the time constraints imposed by institutional structures. Here, we report a case study of a novel summer bridge program to prepare incoming transfer students for research experiences in biological sciences. During the summer, participants committed to full-time program activities, including hands-on training with laboratory techniques through research projects and designing and executing an independent project. Pre- and post-program surveys were administered, and participants reported substantial gains in research self-efficacy and knowledge of scientific career pathways. Participants also reported strong learning and social support in the program. After the program, 30 out of 32 participants secured positions in faculty laboratories, with most continuing on to positions in industry, graduate programs, or medical and health professions. In a post-program interview, participants reported many benefits from the program, such as mentorship from faculty, developing transferable skills and research interests, and an easier transition from community college to university. While descriptive, this summer bridge program could inform future design-based research and implementations in different institutional contexts.
Inspecting the corrosion state of underground reinforced concrete structures
Authors: Pfändler Patrick , Bircher Lukas , Angst Ueli 
Published: December 2022

AbstractUnnoticed corrosion in underground reinforced concrete structural members – such as foundations, retaining walls, or piles – may severely threaten the integrity of structures. However, condition assessment of the ground-buried structural parts is challenging, because the areas of interest are hardly accessible for visual inspection or non-destructive testing. An example of particular practical relevance is reinforcement corrosion at the back-side of the lower end of cantilever retaining walls, near the construction joint between stem and heel of the base slab. The collapse of a cantilever retaining wall in Austria was a tragic reminder of the dangers of unnoticed corrosion. The drawback of current inspection methods is that they are laborious and costly, but still, only a tiny fraction of the structure can be inspected. Considering that the degree of corrosion can vary significantly along a structure, such local information includes a risk that corrosion elsewhere remains undetected.A novel inspection system is proposed here, combining the well-proven half-cell potential measurement technique with steered horizontal underground drilling technologies. With this approach, a tailor-made probe is brought in proximity to the concrete surface in the soil and electrochemical measurements are performed to characterize the corrosion condition. The main advantage is that virtually the entire length of the structure can be inspected, thus overcoming the limitations of highly local inspection. Moreover, the proposed technique includes a method to constantly monitor the functionality of the potential measuring probe, based on electrical resistance measurements. The feasibility of the approach was confirmed in laboratory experiments on a mortar block in soil. These findings were confirmed in a field experiment. The results suggest that local corroding zones of practice-relevant size can be detected for a distance between the reference electrode and the steel surface of at least 25 cm. On the basis of this work, underground corrosion inspection of cantilever retaining walls is considered feasible, and the development of similar technologies as the one proposed here may in the future considerably enhance condition assessment of structures buried in the ground.
Xanthine oxidase inhibitory potentials of flavonoid aglycones of Tribulus terrestris: in vivo, in silico and in vitro studies
Authors: Ajala Olusegun Samson , Ayeleso Ayotomiwa Olubusayo , Owolabi Mbang , Akinleye Moshood Olusola , Ukpo Grace 
Published: December 2022

Abstract
Background
Despite the ongoing safety-driven spate of flavonoid xanthine oxidase (XOD) inhibition investigations, there is a lack of flavonoid-based uricostatic antihyperuricemic agents in clinical medicine. The poor pharmacokinetic profiles of glycosides (the natural form of existence of most flavonoids) relative to their aglycones could be largely responsible for this paradox. This investigation was aimed at providing both functional and molecular bases for the possible discovery of XOD inhibitory (or uricostatic) anti-hyperuricemic flavonoid aglycones from the leaves of a flavonoid-rich medicinal plant, Tribulus terrestris. To this end, the flavonoid aglycone fraction of T. terrestris leaf extract (FATT) was evaluated in vivo for antihyperuricemic activity in ethanol-induced hyperuricemic mice, monitoring serum and liver uric acid levels. Molecular docking and molecular dynamics simulation studies were carried out on the three major flavonoid aglycones of T. terrestris (isorhamnetin, quercetin and kaempferol) against an inhibitor conformation XOD model. The three flavonoids were also subjected to in vitro XOD activity assay, comparing their IC50 to that of allopurinol, a standard uricostatic antihyperuricemic drug.

Results
FATT significantly lowered serum uric acid (p < 0.0001) and liver uric acid (p < 0.05) levels of the experimental animals, implying anti-hyperuricemic activity with uricostatic action mechanism allusions. Molecular docking studies revealed high binding affinity values (− 7.8, − 8.1, − 8.2 kcal/mol) for the aglycones (isorhamnetin, quercetin and kaempferol, respectively). Radius of gyration and RMSD analyses of the molecular dynamics simulation trajectories of the three aglycone–XOD complexes revealed substantial stability, the highest stability being demonstrated by the kaempferol–XOD complex. In vitro XOD activity assay showed kaempferol (IC50: 8.2 ± 0.9 μg/ml), quercetin (IC50: 20.4 ± 1.3 μg/ml) and isorhamnetin (IC50: 22.2 ± 2.1 μg/ml) to be more potent than allopurinol (IC50: 30.1 ± 3.0 μg/ml).

Conclusion
This work provides a scientific basis for the use of T. terrestris in the treatment of hyperuricemia-related (e.g. kidney stone and gout) disorders. It also provides the molecular basis for a focussed screening of the flavonoid aglycones chemical space for the possible discovery of flavonoid-based uricostatic anti-hyperuricemic drugs or drug templates.