bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors influencing the complex problem-solving skills in reflective learning: results from partial least square structural equation modeling and fuzzy set qualitative comparative analysis
Authors: Wang Ying , Xu Ze-Ling , Lou Jia-Yao , Chen Ke-Da 
Published: May 2023

AbstractBackgroundThe Organization for Economic Cooperation and Development emphasizes the importance of complex problem-solving (CPS) skills in the 21st century. CPS skills have been linked to academic performance, career development, and job competency training. Reflective learning, which includes journal writing, peer reflection, selfreflection, and group discussion, has been explored to improve critical thinking and problem-solving abilities. The development of various thinking modes and abilities, such as algorithmic thinking, creativity, and empathic concern, all affect problem-solving skills. However, there is a lack of an overall theory to relate variables to each other, which means that different theories need to be integrated to focus on how CPS skills can be effectively trained and improved.MethodsData from 136 medical students were analyzed using partial least square structural equation modeling (PLSSEM) and fuzzy set qualitative comparative analysis (fsQCA). A hypothesized model examining the associations between the CPS skills and influence factors was constructed.ResultsThe evaluation of the structural model showed that some variables had significant influences on CPS skills, while others did not. After deleting the insignificant pathways, a structural model was built, which showed that mediating effects of empathic concern and critical thinking were observed, while personal distress only had a direct effect on CPS skills. The results of necessity showed that only cooperativity and creativity are necessary conditions for critical thinking. The fsQCA analysis provided clues for each different pathway to the result, with all consistency values being higher than 0.8, and most coverage values being between 0.240 and 0.839. The fsQCA confirmed the validity of the model and provided configurations that enhanced the CPS skills.ConclusionsThis study provides evidence that reflective learning based on multi-dimensional empathy theory and 21 stcentury skills theory can improve CPS skills in medical students. These results have practical implications for learning and suggest that educators should consider incorporating reflective learning strategies that focus on empathy and 21 stcentury skills to enhance CPS skills in their curricula.
What do patients think about the Hungarian health care system and medical students’ learning outcomes? A cross-sectional study on the patients’ perspective in Hungary
Authors: Varga Zsuzsanna , Pótó Zsuzsanna , Csathó Árpád , Füzesi Zsuzsanna 
Published: May 2023

Abstract
Background
The doctor-patient relationship has changed a lot in the 21st century and the varying expectations of the patients play an important role in future professional medical care. The knowledge of patients’ needs is crucial in determining the learning outcomes in medical education. The objective of this study was to examine the expectations of the patients regarding professional and soft skills (e.g. communicational skills, empathy) of doctors and to get a deeper view.

Methods
Face-to face data collection through self-reported questionnaire in accredited health care institutions (GPs, hospitals, outpatient care) in Hungary was carried out in 2019. Descriptive statistics, independent sample t-tests, k-means cluster and gap matrices were performed to analyze the data.

Results
In total 1115 patients (male-female: 50–50%, age groups: between 18 and 30: 20%, between 31 and 60: 40% above 60: 40%) participated in the survey. They rated sixteen learning outcomes along with two dimensions: importance and satisfaction. Except for one learning outcome, patients rated the outcomes more important than they were satisfied with them (negative gap). Positive gap was registered only in the case of respecting individual specialty during patient care.

Conclusions
The results suggest the importance of learning outcomes in relation to the rate of satisfaction from the patients’ perspectives. In addition, the results support that patients’ need are not met in medical care. Patients’ ratings also make an emphasis on the fact that besides professional knowledge other learning outcomes are also important in health care which should have been emphasized as a basis in medical education.
Socioeconomic inequities in specialized health services use following COVID-19 in individuals from Southern Brazil
Authors: Vieira Yohana Pereira , Rocha Juliana Quadros Santos , Dutra Rinelly Pazinato , Nunes Lorrany da Silva , Duro Suele Manjourany Silva , Saes Mirelle de Oliveira 
Published: May 2023

AbstractBackgroundEvidence on inequalities in the health services use is important for public policy formulation, even more so in a pandemic context. The aim of this study was to evaluate socioeconomic inequities in the specialized health use services according to health insurance and income, following COVID-19 in individuals residing in Southern Brazil.MethodsThis was a cross-sectional telephone survey with individuals aged 18 years or older diagnosed with symptomatic COVID-19 using the RT-PCR test between December 2020 and March 2021. Questions were asked about attendance at a health care facility following COVID-19, the facilities used, health insurance and income. Inequalities were assessed by the following measures: Slope Index of Inequality (SII) and Concentration Index (CIX). Adjusted analyses were performed using Poisson regression with robust variance adjustment using the Stata 16.1 statistical package.Results2,919 people (76.4% of those eligible) were interviewed. Of these, 24.7% (95%CI 23.2; 36.3) used at least one specialized health service and 20.3% (95%CI 18.9; 21.8) had at least one consultation with specialist doctors after diagnosis of COVID-19. Individuals with health insurance were more likely to use specialized services. The probability of using specialized services was up to three times higher among the richest compared to the poorest.ConclusionsThere are socioeconomic inequalities in the specialized services use by individuals following COVID-19 in the far south of Brazil. It is necessary to reduce the difficulty in accessing and using specialized services and to extrapolate the logic that purchasing power transposes health needs. The strengthening of the public health system is essential to guarantee the population’s right to health.
Comparing reproductive intentions before and during the COVID-19 pandemic: a cross-sectional study
Authors: Rezaei Fatemeh , Amiri-Farahani Leila , Haghani Shima , Pezaro Sally , Behmanesh Fereshteh 
Published: May 2023

Abstract
Background and Aim
Reproductive behaviors and intentions are affected by several factors, including the COVID-19 pandemic crisis. This study was conducted with the aim of comparing the intention to reproduce and its causes in Iran during the period prior to and during the COVID-19 pandemic.

Methods
This descriptive-comparative study included 425 cisgender women from 6 urban health centers and 10 rural centers in Babol city, Mazandaran province, Iran. Urban and rural health centers were selected using a multi-stage approach with proportional allocation. A questionnaire was used to collect data in relation to individual characteristics and reproductive intentions.

Results
Most participants aged between 20 and 29 years had a diploma level of education, were housewives and lived in the city. The intention to reproduce decreased from 11.4% before the pandemic to 5.4% during the pandemic (p = 0.006). The most common reason for wanting to have children prior to the pandemic was not having children (54.2%). During the pandemic, a desire to reach the ideal number of children was the most common reason to want to have children (59.1%), though no statistically significant difference was observed between the two periods (p = 0.303). The most common reason for not wanting to have children in both periods was having enough children already (45.2% before and 40.9% during the pandemic). The reasons for not wanting to have children had a statistically significant difference between the two periods (p < 0.001). Reproductive intentions had a statistically significant relationship with the variables of age (p < 0.001), the education level of both participants (p < 0.001) and spouses (p = 0.006), occupation (p = 0.004), and socio-economic status (p < 0.001).

Conclusion
Despite restrictions and lockdowns, the COVID-19 pandemic had a negative impact on people’s desire to reproduce in this context. Economic problems caused by the sanctions which increased during the COVID-19 crisis may be one of the reasons for a reduction in people’s intentions to become parents. Future research could usefully investigate whether this decrease in the desire to reproduce will lead to significant changes in population level and future birth rates.
Clinical characteristics of COVID-19 associated vasculopathic diseases
Authors: Greistorfer Thiemo , Jud Philipp 
Published: May 2023

AbstractCoronavirus disease 19 (COVID-19) has shown to be an infectious disease affecting not only of the respiratory system, but also cardiovascular system leading to different COVID-19-associated vasculopathies. Venous and arterial thromboembolic events have been frequently described among hospitalized patients with COVID-19 and inflammatory vasculopathic changes have also been observed. Several of the reported COVID-19 associated vasculopathies exhibit differences on epidemiology, clinical characteristics and outcome compared to non-COVID-19 types. This review focuses on the epidemiology, clinical, diagnostic and therapeutic characteristics as well as outcome data of COVID-19 associated thromboembolic events and inflammatory vasculopathies, elaborating similarities and differences with non-COVID-19 cohorts.
System identification: a feasible, reliable and valid way to quantify upper limb motor impairments
Authors: van de Ruit Mark , van der Velden Levinia L. , Onneweer Bram , Benner Joyce L. , Haarman Claudia J. W. , Ribbers Gerard M. , Selles Ruud W. 
Published: May 2023

Abstract
Background
Upper limb impairments in a hemiparetic arm are clinically quantified by well-established clinical scales, known to suffer poor validity, reliability, and sensitivity. Alternatively, robotics can assess motor impairments by characterizing joint dynamics through system identification. In this study, we establish the merits of quantifying abnormal synergy, spasticity, and changes in joint viscoelasticity using system identification, evaluating (1) feasibility and quality of parametric estimates, (2) test–retest reliability, (3) differences between healthy controls and patients with upper limb impairments, and (4) construct validity.

Methods
Forty-five healthy controls, twenty-nine stroke patients, and twenty cerebral palsy patients participated. Participants were seated with the affected arm immobilized in the Shoulder-Elbow-Perturbator (SEP). The SEP is a one-degree-of-freedom perturbator that enables applying torque perturbations to the elbow while providing varying amounts of weight support to the human arm. Participants performed either a ‘do not intervene’ or a resist task. Elbow joint admittance was quantified and used to extract elbow viscosity and stiffness. Fifty-four of the participants performed two sessions to establish the test–retest reliability of the parameters. Construct validity was assessed by correlating system identification parameters to parameters extracted using a SEP protocol that objectifies current clinical scales (Re-Arm protocol).

Results
Feasibility was confirmed by all participants successfully completing the study protocol within ~ 25 min without reporting pain or burden. The parametric estimates were good with a variance-accounted-for of ~ 80%. A fair to excellent test–retest reliability was found ($$ICC = 0.46-0.98$$

I
C
C
=
0.46
-
0.98

) for patients, except for elbow stiffness with full weight support ($$ICC = 0.35$$

I
C
C
=
0.35

). Compared to healthy controls, patients had a higher elbow viscosity and stiffness during the ‘do not intervene’ task and lower viscosity and stiffness during the resist task. Construct validity was confirmed by a significant (all $$p<0.03$$

p
<
0.03

) but weak to moderate ($$r = 0.36-0.50$$

r
=
0.36
-
0.50

) correlation with parameters from the Re-Arm protocol.

Conclusions
This work demonstrates that system identification is feasible and reliable for quantifying upper limb motor impairments. Validity was confirmed by differences between patients and controls and correlations with other measurements, but further work is required to optimize the experimental protocol and establish clinical value.
Intra-hippocampal cis-P tau microinjection induces long-term changes in behavior and synaptic plasticity in mice
Authors: Fatemeh Bakhtiarzadeh , Koorosh Shahpasand , Amir Shojaei , Yaghoub Fathollahi , Javad Mirnajafi-Zadeh 
Published: May 2023

Abstract
Background
Alzheimer's disease is accompanied by an abnormal high accumulation of cis-P tau. However, the long-term changes in behavior following tau accumulation remains under debate. The present study investigated the long-term effects of tauopathy on learning and memory, synaptic plasticity, and hippocampal cell numbers.

Results
Cis-P tau was microinjected into the dorsal hippocampus to generate Alzheimer’s like-disease model in C57BL/6 mice. Cis-P tau injected animals showed a significant impairment in learning and memory in Y-maze and Barnes maze tests. In another group of animals, the generation of long-term potentiation (LTP) was evaluated in hippocampal slices 7 months after cis-P tau injection. LTP induction was disrupted only in the dorsal but not ventral hippocampal slices. The basal synaptic transmission was also reduced in dorsal hippocampal slices. In addition, hippocampal sampling was done, and the number of cells was assessed by Nissl staining. Obtained results indicated that the number of survived cells was significantly reduced in the dorsal and ventral hippocampus of cis P-tau injected animals compared to the animals in control group. However, the decrement of cell number was higher in the dorsal compared to the ventral hippocampus.

Conclusions
In conclusion, intra-hippocampal cis-P tau injection produced learning and memory impairment at 7 months after its injection. This impairment might result from LTP disruption and a significant decrease in the number of neurons in the dorsal hippocampus.

Graphical Abstract
Complication, fusion, and revision rate in the lumbar cortical bone trajectory and pedicle screw fixation techniques: a systematic review and meta-analysis
Authors: Wang Yixi , Kahaer Alafate , Maimaiti Abulikemu , Guo Hailong , Rexiti Paerhati 
Published: May 2023

Abstract
Background
To obtain the complication rate, fusion rate, and revision rate of the lumbar cortical bone trajectory technique and pedicle screw fixation technique in lumbar interbody fusion surgery by single-arm meta-analysis and lay a basis for orthopedic surgeons to select the fixation techniques and perioperative management.

Methods
PubMed, Ovid Medline, Web of Science, CNKI, and Wanfang databases were searched comprehensively. Data extraction, content analysis, and quality assessment of the literature were performed by two independent reviewers according to the Cochrane Collaboration guidelines using R and STATA software for single-arm meta-analysis.

Results
The total complication rate of the lumbar cortical bone trajectory technique was 6%, including a hardware complication rate of 2%, ASD (adjacent segment degeneration) rate of 1%, wound infection rate of 1%, dural damage rate of 1%, hematoma rate tending to 0%, fusion rate of 94%, and revision rate of 1%. Lumbar pedicle screw fixation techniques had a total complication rate of 9%, with a hardware complication rate of 2%, ASD rate of 3%, wound infection rate of 2%, dural damage rate of 1%, hematoma rate tending to 0%, fusion rate of 94%, and revision rate of 5%. This study was registered with PROSPERO, CRD42022354550.

Conclusion
Lumbar cortical bone trajectory was associated with a lower total complication rate, ASD rate, wound infection rate, and revision rate than pedicle screw fixation. The cortical bone trajectory technique reduces the incidence of intraoperative and postoperative complications and can be an alternative in lumbar interbody fusion surgery.
The effects of cold compress and transcutaneous electrical nerve stimulation on the pain associated with chest tube removal among patients with coronary bypass grafting
Authors: Hatefi Fatemeh , Kazemi Majid , Manglian Parvin , Shahi Moridi Dadullah , Heydari Shahin , Hasani Hadi 
Published: May 2023

Abstract
Background and aim
Chest tube removal (CTR) can cause severe acute pain which is usually described by patients as a painful experience. This study compared the effects of cold compress, transcutaneous electrical nerve stimulation (TENS), and combined cold compress-TENS on CTR-associated pain among patients with coronary artery bypass grafting (CABG).

Methods
This randomized controlled trial was conducted in 2018–2019 using a double-blind four-group design. Participants were 120 patients with CABG selected from Shafa hospital, Kerman, Iran, and randomly allocated to a cold compress, a TENS, a combined cold compress-TENS, and a placebo group (compress with room temperature) and TENS with an off TENS device. Each participant received the intervention for 15 min immediately before CTR. CTR-associated pain was assessed before, during, immediately after, and 15 min after CTR. Data were analyzed using the SPSS program (v. 22.0) at a significance level of less than 0.05.

Results
The data of 29 participants in the placebo group, 26 in the TENS group, 30 in the cold compress group, and 26 in the combined cold compress-TENS group was gathered. Baseline demographic and clinical characteristics and pain intensity scores of participants had no statistically significant differences among all four groups (P > 0.05). The mean score of pain intensity in all groups was at its highest level during CTR and gradually decreased afterwards, but this pain intensity reduction in the compress-TENS group was significantly greater than other groups (P < 0.001).

Conclusion
Combined cold compress-TENS is more effective than separate cold compress and TENS in reducing CTR-associated pain among patients with CABG. Therefore, non-pharmacological methods such as combined cold compress-TENS are recommended for managing CTR-associated pain.
Role of breath-hold lung PET in stage IA pulmonary adenocarcinoma
Authors: Cheng Zhaoping , Chen Li , Wang Ximing , Wang Ying , Zhao Minjie , Zan Keyu , Liu Wen , Cui Xiao , Chai Leiying , Ge Min , Li Kun , Duan Yanhua 
Published: May 2023

Abstract
Background
Respiratory motion during PET acquisition may result in image blurring and resolution loss, reduced measurement of radiotracer uptake, and consequently, inaccurate lesion quantification and description. With the introduction of the total-body PET system, short-time PET acquisition is feasible due to its high sensitivity and spatial resolution. The purpose of this study was to evaluate the additional value of 20-s breath-hold (BH) lung PET in patients with stage IA pulmonary adenocarcinoma.

Methods
Forty-seven patients with confirmed stage IA pulmonary adenocarcinoma were enrolled in this retrospective study. All patients underwent a 300-s FB whole-body PET, followed by a BH lung PET. The SUVmax, TBR of the lesions and the percentage difference in nodule SUVmax (%ΔSUVmax) and TBR (%ΔTBR) between the two acquisitions was also calculated. The lesions were further divided by distance from pleura for subgroup analysis. The lesion detectability on PET images was the percentage of FDG-positive lesions.

Results
Among 47 patients, the BH lung PET images identified all lung nodules, and there was a significant difference in overall nodule SUVmax and TBR between BH PET and FB PET (both p < 0.01). The %ΔSUVmax and %ΔTBR were significantly higher in nodules adjacent to pleura (≤ 10 mm in distance) than those away from pleura (both p < 0.05). The lesion detectability of BH lung PET was significantly higher than that of FB PET (p < 0.01).

Conclusion
BH PET acquisition is a practical way to minimize motion artifacts in PET which has the potential to improve lesion detection for stage IA pulmonary adenocarcinoma.

Critical relevance statement
BH PET acquisition is a practical way to minimize motion artifacts in PET which has the potential to improve lesion detection for stage IA pulmonary adenocarcinoma.

Graphical Abstract
Cell therapy in end-stage liver disease: replace and remodel
Authors: Hu Xin-Hao , Chen Lan , Wu Hao , Tang Yang-Bo , Zheng Qiu-Min , Wei Xu-Yong , Wei Qiang , Huang Qi , Chen Jian , Xu Xiao 
Published: May 2023

AbstractLiver disease is prevalent worldwide. When it reaches the end stage, mortality rises to 50% or more. Although liver transplantation has emerged as the most efficient treatment for end-stage liver disease, its application has been limited by the scarcity of donor livers. The lack of acceptable donor organs implies that patients are at high risk while waiting for suitable livers. In this scenario, cell therapy has emerged as a promising treatment approach. Most of the time, transplanted cells can replace host hepatocytes and remodel the hepatic microenvironment. For instance, hepatocytes derived from donor livers or stem cells colonize and proliferate in the liver, can replace host hepatocytes, and restore liver function. Other cellular therapy candidates, such as macrophages and mesenchymal stem cells, can remodel the hepatic microenvironment, thereby repairing the damaged liver. In recent years, cell therapy has transitioned from animal research to early human studies. In this review, we will discuss cell therapy in end-stage liver disease treatment, especially focusing on various cell types utilized for cell transplantation, and elucidate the processes involved. Furthermore, we will also summarize the practical obstacles of cell therapy and offer potential solutions.
Ionospheric disturbances over South America related to Tonga volcanic eruption
Authors: Takahashi H. , Figueiredo C. A. O. B. , Barros D. , Wrasse C. M. , Giongo G. A. , Honda R. H. , Vital L. F. R. , Resende L. C. A. , Nyassor P. K. , Ayorinde T. T. , Carmo C. S. , Padua M. B. , Otsuka Y. 
Published: May 2023

AbstractOn January 15, 2022, we observed various unusual atmospheric wave events over South America: Atmospheric pressure waves (Lamb mode) around 12:30 to 17:30 UT, tsunamis along the Chilean coast at around 17:00 to 19:00 UT, and ionospheric disturbances between 11:30 and 20:00 UT. We understand that these events were generated by the Tonga volcanic eruption that occurred at (20.55°S, 175.39°W) in South Pacific Ocean at 04:15 UT. Several traveling ionospheric disturbances (TIDs), the horizontal wavelengths of 330 to 1174 km and the phase speed of 275–544 m/s were observed before and after the Lamb wave passed over the continent and the arrival of the tsunami on the Chile coast. The observed TID characteristics suggest us that these waves might be generated by the two atmospheric events, Lamb wave and gravity waves induced by the tsunamis. This is the first time to report the signature of ionospheric disturbances over the South American continent generated by the huge volcanic eruption.
Graphical Abstract