bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hearing loss and respiratory health symptoms among large-scale sawmill workers of the timber processing factories within the Gert Sibande District Municipality: a comparative cross-sectional study
Authors: Rathipe Moeletsi , Raphela Selepeng France 
Published: June 2023

Abstract
Background
Occupational exposure to wood dust may cause respiratory illnesses, while prolonged exposure to loud noise may cause noise-induced hearing loss.

Objective
The objective of the study was to assess the prevalence of hearing loss and respiratory symptoms among large-scale sawmill workers within the Gert Sibande Municipality in Mpumalanga Province, South Africa.

Methods
A comparative cross-sectional study consisting of 137 exposed and 20 unexposed randomly selected workers was undertaken from January to March 2021. The respondents completed a semi-structured questionnaire on hearing loss and respiratory health symptoms.

Data analyse
The data was analysed using Statistical Package for Social Sciences (SPSS) version 21 (Chicago II, USA). The statistical analysis of the difference between the two proportions was done using an independent student t-test. The level of significance was set at p < 0.05.

Results
There was a statistically significant difference between the exposed and unexposed workers on the prevalence of respiratory symptoms like phlegm (51.8 vs. 0.0%) and shortness of breath (chest pain) (48.2 vs. 50%). There was also a statistically significant difference between the exposed and unexposed workers on the signs and symptoms of hearing loss like tinnitus (ringing in the ears) (50 vs. 33.3%), ear infections (21.4 vs. 66.7%), ruptured ear drums (16.7 vs. 0.0%), and ear injuries (11.9 vs. 0.0%). The exposed workers reported always wearing personal protective equipment (PPE) (86.9%) compared to the unexposed workers (75%). The reason for not wearing PPE consistently by the exposed workers was due to not being available (48.5%), compared to the unexposed workers who reported other reasons (100%).

Conclusion
The prevalence of respiratory symptoms among the exposed workers was higher than that of the unexposed workers, except for chest pains (shortness of breath). The prevalence of symptoms of hearing loss among the exposed workers was higher than the unexposed workers, except for ear infections. The results suggest that measures should be implemented at the sawmill to help protect workers’ health.
Evaluating the performance of different Bayesian count models in modelling childhood vaccine uptake among children aged 12–23 months in Nigeria
Authors: Fagbamigbe A. F. , Lawal T. V. , Atoloye K. A. 
Published: June 2023

Abstract
Background
Choosing appropriate models for count health outcomes remains a challenge to public health researchers and the validity of the findings thereof. For count data, the mean–variance relationship and proportion of zeros is a major determinant of model choice. This study aims to compare and identify the best Bayesian count modelling technique for the number of childhood vaccine uptake in Nigeria.

Methods
We explored the performances of Poisson, negative binomial and their zero-inflated forms in the Bayesian framework using cross-sectional data pooled from the Nigeria Demographic and Health Survey conducted between 2003 and 2018. In multivariable analysis, these Bayesian models were used to identify factors associated with the number of vaccine uptake among children. Model selection was based on the -2 Log-Likelihood (-2 Log LL), Leave-One-Out Cross-Validation Information Criterion (LOOIC) and Watanabe-Akaike/Widely Applicable Information Criterion (WAIC).

Results
Exploratory analysis showed the presence of excess zeros and overdispersion with a mean of 4.36 and a variance of 12.86. Observably, there was a significant increase in vaccine uptake over time. Significant factors included the mother’s age, level of education, religion, occupation, desire for last-child, place of delivery, exposure to media, birth order of the child, wealth status, number of antenatal care visits, postnatal attendance, healthcare decision maker, community poverty, community illiteracy, community unemployment, rural proportion and number of health facilities per 100,000. The zero-inflated negative binomial model was best fit with -2Log LL of -27171.47, LOOIC of 54464.2, and WAIC of 54588.0.

Conclusion
The Bayesian zero-inflated negative binomial model was most appropriate to identify factors associated with the number of childhood vaccines received in Nigeria due to the presence of excess zeros and overdispersion. Improving vaccine uptake by addressing the associated risk factors should be promptly embraced.
Reparative dentin formation as a possible factor influencing the penetrability of dentin in human teeth with apical periodontitis: an ex vivo study
Authors: Ren Yueyue , Zhang Junsheng , Meng Tiantian , Li Wuli , Li Song 
Published: June 2023

AbstractBackgroundThere is still a lack of knowledge regarding the permeability and configuration of infected root dentin. The aim of this ex vivo study was to compare the dentin penetrability of healthy teeth and necrotic teeth with apical periodontitis by evaluating the penetration of sodium hypochlorite (NaOCl) and to analyze the histopathological features of root dentin.MethodsForty-eight molars were collected and divided into two groups. The clinical diagnosis for one group was pulp necrosis with apical periodontitis and the pulp and periapex were normal in the other group. Forty-eight straight roots were divided into two groups: infected and healthy. First, all root canals were stained with 2% methylene blue to visualize penetration after standard root canal instrumentation and irrigation. Transverse sections were obtained, and the dye penetration parameters were measured. The cross sections were processed to 20–30 μm and stained with hematoxylin and eosin for observation of the histopathological changes in the root dentin.ResultsThe maximum penetration depth, median penetration depth and penetration percentage of NaOCl solutions, in infected root canals were significantly lower than those in healthy root canals. The histopathological analysis showed that the frequency of reparative dentin formation in infected root canals was significantly greater than that in healthy root canals.ConclusionsThe dentin penetrability of teeth with necrotic teeth and apical periodontitis was more superficial during root canal irrigation than that of healthy teeth. The histopathological changes in infected radicular dentin, namely the formation of reparative dentin, might be associated with the lower permeability of dentin tubules in human teeth with apical periodontitis.
Evaluation of endometrioma size effect on ovarian reserve, embryo quality and pregnancy outcome after in vitro fertilization cycle; a cross-sectional study
Authors: Zareii Afsson , Askary Elham , Ghahramani Ameneh , Chamanara Kefayat , Abadi Alimohammad Keshtvarz Hesam , Afzalzadeh Azadeh 
Published: June 2023

Abstract
Introduction
Investigation of endometrioma size and its laterality on the quality of the embryo in patients with endometrioma compared to healthy subjects.

Materials and methods
In this retrospective and cross-sectional study, 70 patients with unilateral and bilateral endometrioma were recruited and compared with 70 age-matched infertile patients as the control group in terms of AMH before ovum pick-up, embryo quality as well as pregnancy outcome. Additionally, in the case group, we divided both unilateral (n = 32) and bilateral endometrioma patients (n = 38) into three groups based on the size of endometrioma. (1–3 cm, 3–6 cm, 6–10 cm)

Results
There was no difference in terms of age, BMI, parity, and age of menarche between the case and control groups. Moreover, no significant difference was observed in the baseline level of AMH between the case 2.96 ± 2.72 ng/dl (0.21–11.3) and control 2.73 ± 2.39 (0.21–12.8) groups. (P = 0.59) There was also no significant difference concerning AMH level between unilateral 3.58 ± 3.20 ng/dl (0.21–12.8) and bilateral endometrioma 2.45 ± 2.14 (0.21 − 0.20) groups. In terms of the quality and number of embryos, there was no significant difference between the case and control groups. (P = 0.30) Although the AMH level decreased with the increase in endometrioma size, this difference was not statistically significant. (P = 0.07) There was no significant difference in terms of the embryo quality between the groups based on the size of endometrioma. (P = 0.77) In addition, no significant difference was observed between the case and control groups in the terms of birth weight and pregnancy complications, such as premature delivery, cesarean section rate, neonatal respiratory distress, jaundice, as well as hospitalization rate. Head circumference of the newborns was higher in the endometrioma group while their Apgar score was lower in the case compared to the control group.

Conclusion
The presence of endometrioma by itself does not affect the main result of IVF procedures, including the number and quality of embryos and pregnancy outcome. Thus, IVF and embryo preservation and even pregnancy before surgery seem to be reasonable for endometriotic patients.
Perception of overseas experiences among medical students in Japan: a national online survey
Authors: Iwata Junna , Todoroki Ryota , Hashimoto Takehiro , Hyakutake Misa , Gomi Harumi , Nishizono Akira 
Published: June 2023

Abstract
Background
Data on the perceptions of medical students on international experience in non-English-speaking high-income countries (HICs) are very limited. This study aimed to assess the perceptions of medical students in Japan toward overseas experience while in school and post-graduation, as well as to characterize the support they require to pursue their profession in international settings.

Methods
A cross-sectional national survey was administered online between September 16, 2020, and October 8, 2020. Participants were recruited from 69 medical schools using snowball sampling through acquaintances and social media platforms. The survey results were analyzed by two researchers.

Results
A total of 548 students from 59 medical schools responded to the survey. Among them, 381 respondents (69%) expressed interest in working abroad, while only 40% seriously considered it. The majority of students responded that they would like to pursue clinical training abroad for a short term or while they were medical students (54%) or during a residency/fellowship (53%). The most popular regions among the respondents for future international experiences were North America and Europe. Finally, the most reported reasons for hesitation to work abroad were language barriers (70%), followed by lack of clarity regarding career options after working abroad (67%), difficulties obtaining medical licensure abroad (62%), and the lack of role models (42%).

Conclusions
Although nearly 70% of participants reported a high interest in working overseas, various barriers to working abroad were identified. Our findings identified key problem areas that could be targeted when promoting international experiences for medical students in Japan.
Training primary healthcare workers on a task-strengthening strategy for integrating hypertension management into HIV care in Nigeria: implementation strategies, knowledge uptake, and lessons learned
Authors: Oladele David Ayoola , Odusola Aina Olufemi , Odubela Oluwatosin , Nwaozuru Ucheoma , Calvin Colvin , Musa Zaidat , Idigbe Ifeoma , Nwakwo Chioma , Odejobi Yemi , Aifah Angela , Kanneh Nafesa , Mishra Shivani , Onakomaiya Deborah , Iwelunmor Juliet , Ogedegbe Olugbenga , Ezechi Oliver 
Published: June 2023

Abstract
Background
With improved access to anti-retroviral drugs, persons living with HIV/AIDS (PLWHA) are living longer but with attendant increased risks of non-communicable diseases (NCDs). The increasing burden of NCDs, especially hypertension, could reverse gains attributed to HIV care. Nurses and Community Health Officers (CHO) in Nigeria are cardinal in delivering primary health care. A task-strengthening strategy could enable them to manage hypertension in HIV care settings. This study aimed to assess their knowledge and practice of hypertension management among Healthcare workers (HCWs) and to explore the challenges involved in conducting onsite training during pandemics.

Methods
Nurses and CHOs in the employment of the Lagos State Primary Health Care Board (LSPHCB), Lagos State, Nigeria, were recruited. They were trained through hybrid (virtual and onsite) modules before study implementation and a series of refresher trainings. A pre-and post-training test survey was administered, followed by qualitative interviews to assess skills and knowledge uptake, the potential barriers and facilitators of task-sharing in hypertension management in HIV clinics, and the lessons learned.

Results
Sixty HCWs participated in the two-day training at baseline. There was a significant improvement in the trainees' knowledge of hypertension management and control. The average score during the pre-test and post-test was 59% and 67.6%, respectively. While about 75% of the participants had a good knowledge of hypertension, its cause, symptoms, and management, 20% had moderate knowledge, and 5% had poor knowledge at baseline. There was also an increase in the mean score between the pre-test and post-test of the refresher training using paired t-tests (P < 0.05). Role-playing and multimedia video use improved the participants' uptake of the training. The primary barrier and facilitator of task sharing strategy in hypertension management reported were poor delineation of duties among HCWs and the existing task shifting at the Primary Healthcare Centres (PHC) level, respectively.

Conclusions
The task strengthening strategy is relevant in managing hypertension in HIV clinics in Nigeria. The capacity development training for the nurses and CHOs involved in the Integration of Hypertension Management into HIV Care in Nigeria: A Task Strengthening Strategy (TASSH-Nigeria) study yielded the requisite improvement in knowledge uptake, which is a reassurance of the delivery of the project outcomes at the PHCs.
Implementation of neurological group-based telerehabilitation within existing healthcare during the COVID-19 pandemic: a mixed methods evaluation
Authors: Ackerley Suzanne , Wilson Neil , Boland Paul , Read Jessica , Connell Louise 
Published: June 2023

Abstract
Background
There is a need to evaluate if and how telerehabilitation approaches might co-exist within healthcare in the long-term. Our aim was to implement and evaluate a multidisciplinary group-based telerehabilitation approach for people engaging in neurological rehabilitation.

Methods
NeuroRehabilitation OnLine (NROL) was adapted and implemented within an existing healthcare system as a programme of repeating six-week blocks. A robust evaluation was undertaken simultaneously using a convergent parallel design underpinned by implementation frameworks. This included service data, and patient and staff interviews. Implementation success was conceptualised using the outcomes of appropriateness, acceptability and sustainability.

Results
Eight NROL blocks delivered 265 sessions with 1347 patient contacts, and NROL continues as part of standard practice. The approach was appropriate for varied demographics and had positive patient opinions and outcomes for many. Staff perceived NROL provided a compatible means to increase therapy and help meet targets, despite needing to mitigate some challenges when fitting the approach within the existing system. NROL was considered acceptable due to good attendance (68%), low drop-out (12%), and a good safety record (one non-injury fall). It was accepted as a new way of working across rehabilitation disciplines as an ‘extra layer of therapy’. NROL had perceived advantages in terms of patient and staff resource (e.g. saving time, energy and travel). NROL provided staffing efficiencies (ratio 0.6) compared to one-to-one delivery. Technology difficulties and reluctance were surmountable with dedicated technology assistance. Leadership commitment was considered key to enable the efforts needed for implementation and sustained use.

Conclusion
Pragmatic implementation of group-based telerehabilitation was possible as an adjunct to neurological rehabilitation within an existing healthcare system. The compelling advantages reported of having NROL as part of rehabilitation supports the continued use of this telerehabilitation approach. This project provides an exemplar of how evaluation can be run concurrently with implementation, applying a data driven rather than anecdotal approach to implementation.
The construction and operational models of internet hospitals in China: a hospital-based survey study
Authors: Chen Xuejiao , Wu Xinxia , Zhang Qihang , Jing Ran , Cheng Weibin , Tian Junzhang , Jin Changxiao 
Published: June 2023

Abstract
Background
China has empowered and continues to empower internet hospitals, which saw an increase in their development due to the pandemic, to fight against COVID-19. The construction and operational models of internet hospitals can be categorized as self-constructed and self-managed models, self-constructed and enterprise-run models, hospital and enterprise joint-owned models, and hosted by a third-party platform. Despite the growing importance of internet hospitals, there have been few systematic summaries of their construction and operational models. The primary purpose of the study was to understand the construction and operational models of internet hospitals in China.

Methods
Data was collected from 39 internet hospitals and 356 medical staff between September 2020 and April 2021, via internet hospital and hospital staff surveys. T-tests were used to compare the continuous variables, while Chi-square tests were employed to compare the proportions of categorical variables. The self-perception of the internet hospitals’ services was assessed using a 5-point Likert scale on 16 aspects and a root cause analysis was conducted to identify the root causes and influencing factors of current deficiencies experienced by internet hospitals.

Results
Among the 39 internet hospitals, 22 (56.4%) were self-constructed and self-managed. Compared to other models of Internet hospitals, self-constructed and self-managed hospitals had lower percentages of professionals providing online services (P = 0.006), numbers of doctors outside of the entity (P = 0.006), numbers of online nurses (P = 0.004), and the ratio of online nurses to offline doctors (P < 0.001). Of the 16 aspects evaluated with regards to the medical staff’s self-perception of the internet hospital services, the highest scores were given for fee transparency, fee rationality, travel cost capital, patience and responsibility, and consultation behaviors. The root causes included five aspects: human, channels, prices, services, and time.

Conclusions
While the self-constructed and self-managed model was found to be the most prevalent form of internet hospital in China, the different models of internet hospitals can have an impact on both the quantity and quality of online healthcare services. This study contributes to the existing literature on internet hospitals' construction and operational models, offering additional policy implications for telemedicine management.
A non-coding variant in the Kozak sequence of RARS2 strongly decreases protein levels and causes pontocerebellar hypoplasia
Authors: Nicolle Romain , Altin Nami , Siquier-Pernet Karine , Salignac Sherlina , Blanc Pierre , Munnich Arnold , Bole-Feysot Christine , Malan Valérie , Caron Barthélémy , Nitschké Patrick , Desguerre Isabelle , Boddaert Nathalie , Rio Marlène , Rausell Antonio , Cantagrel Vincent 
Published: June 2023

AbstractBi-allelic variants in the mitochondrial arginyl-transfer RNA synthetase (RARS2) gene have been involved in early-onset encephalopathies classified as pontocerebellar hypoplasia (PCH) type 6 and in epileptic encephalopathy. A variant (NM_020320.3:c.-2A > G) in the promoter and 5’UTR of the RARS2 gene has been previously identified in a family with PCH. Only a mild impact of this variant on the mRNA level has been detected. As RARS2 is non-dosage-sensitive, this observation is not conclusive in regard of the pathogenicity of the variant.We report and describe here a new patient with the same variant in the RARS2 gene, at the homozygous state. This patient presents with a clinical phenotype consistent with PCH6 although in the absence of lactic acidosis. In agreement with the previous study, we measured RARS2 mRNA levels in patient’s fibroblasts and detected a partially preserved gene expression compared to control. Importantly, this variant is located in the Kozak sequence that controls translation initiation. Therefore, we investigated the impact on protein translation using a bioinformatic approach and western blotting. We show here that this variant, additionally to its effect on the transcription, also disrupts the consensus Kozak sequence, and has a major impact on RARS2 protein translation. Through the identification of this additional case and the characterization of the molecular consequences, we clarified the involvement of this Kozak variant in PCH and on protein synthesis. This work also points to the current limitation in the pathogenicity prediction of variants located in the translation initiation region.
HOPX is a tumor-suppressive biomarker that corresponds to T cell infiltration in skin cutaneous melanoma
Authors: He Song , Ding Yu , Ji Zhonghao , Yuan Bao , Chen Jian , Ren Wenzhi 
Published: June 2023

Abstract
Background
Skin cutaneous melanoma (SKCM) is the most threatening type of skin cancer. Approximately 55,000 people lose their lives every year due to SKCM, illustrating that it seriously threatens human life and health. Homeodomain-only protein homeobox (HOPX) is the smallest member of the homeodomain family and is widely expressed in a variety of tissues. HOPX is involved in regulating the homeostasis of hematopoietic stem cells and is closely related to the development of tumors such as breast cancer, nasopharyngeal carcinoma, and head and neck squamous cell carcinoma. However, its function in SKCM is unclear, and further studies are needed.

Methods
We used the R language to construct ROC (Receiver-Operating Characteristic) curves, KM (Kaplan‒Meier) curves and nomograms based on databases such as the TCGA and GEO to analyze the diagnostic and prognostic value of HOPX in SKCM patients. Enrichment analysis, immune scoring, GSVA (Gene Set Variation Analysis), and single-cell sequencing were used to verify the association between HOPX expression and immune infiltration. In vitro experiments were performed using A375 cells for phenotypic validation. Transcriptome sequencing was performed to further analyze HOPX gene-related genes and their signaling pathways.

Results
Compared to normal cells, SKCM cells had low HOPX expression (p < 0.001). Patients with high HOPX expression had a better prognosis (p < 0.01), and the marker had good diagnostic efficacy (AUC = 0.744). GO/KEGG (Gene Ontology/ Kyoto Encyclopedia of Genes and Genomes) analysis, GSVA and single-cell sequencing analysis showed that HOPX expression is associated with immune processes and high enrichment of T cells and could serve as an immune checkpoint in SKCM. Furthermore, cellular assays verified that HOPX inhibits the proliferation, migration and invasion of A375 cells and promotes apoptosis and S-phase arrest. Interestingly, tumor drug sensitivity analysis revealed that HOPX also plays an important role in reducing clinical drug resistance.

Conclusion
These findings suggest that HOPX is a blocker of SKCM progression that inhibits the proliferation of SKCM cells and promotes apoptosis. Furthermore, it may be a new diagnostic and prognostic indicator and a novel target for immunotherapy in SKCM patients.