bluuebunny/crossref_metadata_2025_split huggingface dataset:
Disaster day: a simulation-based competition for educating emergency medicine residents and medical students on disaster medicine
Authors: Gue Shayne , Cohen Stephanie , Tassone Maria , Walker Ayanna , Little Andy , Morales-Cruz Martin , McGillicuddy Casey , Lebowitz David , Pell Robert , Vera Ariel , Nazario Steven , Mejias Darielys , Bobbett Andrew , Dixon Drake , Quinones Anines , Ganti Latha 
Published: September 2023

Abstract
Background
Disaster medicine is a growing field within the specialty of emergency medicine, but educational training typically focuses on hospital drills or other educational strategies, such as didactics, simulation, or tabletop exercises. With the success of gamification in other medical education applications, we sought to investigate if a novel gamified curricular innovation would lead to improved test performance and confidence in the ability to manage a real mass casualty incident (MCI).

Methods
This was a prospective observational study of medical students and emergency medicine residents who participated in a 4-h simulation-based competition consisting of 4 unique stations. Each station had learning objectives associated with the content taught. Learners completed a pre-event survey, followed by participation in the competitive gamification event, and subsequently completed a post-event survey. Differences between pre- and post-event responses were matched and analyzed using paired and unpaired t tests for medical knowledge assessments, the Mann–Whitney U test for perceptions of confidence in the ability to manage an MCI event, and descriptive statistics provided on perceptions of the effectiveness of this educational strategy.

Results
We analyzed data from 49 learners with matched (and unmatched) pre- and post-event survey responses. There was a statistically significant increase in medical knowledge assessment scores in both unmatched group means and available matched data (47 to 69%, p < 0.01, and 50 to 69%, p < 0.05). Self-reported confidence in the ability to handle an MCI scenario also significantly increased (p < 0.01). Finally, 100% of respondents indicated they “agreed” or “strongly agreed” that the event was an effective education tool for disaster preparedness and training.

Conclusions
In this study, we found that learners perceived a novel gamification event as an effective educational tool, which led to improved learner knowledge and self-reported confidence in the ability to manage a real MCI.
Acute effects of empagliflozin on open-loop baroreflex function and urinary glucose excretion in rats with chronic myocardial infarction
Authors: Kawada Toru , Li Meihua , Nishiura Akitsugu , Yoshida Yuki , Yokota Shohei , Matsushita Hiroki , Fukumitsu Masafumi , Uemura Kazunori , Alexander Joe , Saku Keita 
Published: September 2023

AbstractSodium–glucose cotransporter 2 (SGLT2) inhibitors have exerted cardioprotective effects in clinical trials, but underlying mechanisms are not fully understood. As mitigating sympathetic overactivity is of major clinical concern in the mechanisms of heart failure treatments, we examined the effects of modulation of glucose handling on baroreflex-mediated sympathetic nerve activity and arterial pressure regulations in rats with chronic myocardial infarction (n = 9). Repeated 11-min step input sequences were used for an open-loop analysis of the carotid sinus baroreflex. An SGLT2 inhibitor, empagliflozin, was intravenously administered (10 mg/kg) after the second sequence. Neither the baroreflex neural nor peripheral arc significantly changed during the last observation period (seventh and eighth sequences) compared with the baseline period although urinary glucose excretion increased from near 0 (0.0089 ± 0.0011 mg min−1 kg−1) to 1.91 ± 0.25 mg min−1 kg−1. Hence, empagliflozin does not acutely modulate the baroreflex regulations of sympathetic nerve activity and arterial pressure in this rat model of chronic myocardial infarction.
A systematic comparison of human mitochondrial genome assembly tools
Authors: Mahar Nirmal Singh , Satyam Rohit , Sundar Durai , Gupta Ishaan 
Published: September 2023

Abstract
Background
Mitochondria are the cell organelles that produce most of the chemical energy required to power the cell's biochemical reactions. Despite being a part of a eukaryotic host cell, the mitochondria contain a separate genome whose origin is linked with the endosymbiosis of a prokaryotic cell by the host cell and encode independent genomic information throughout their genomes. Mitochondrial genomes accommodate essential genes and are regularly utilized in biotechnology and phylogenetics. Various assemblers capable of generating complete mitochondrial genomes are being continuously developed. These tools often use whole-genome sequencing data as an input containing reads from the mitochondrial genome. Till now, no published work has explored the systematic comparison of all the available tools for assembling human mitochondrial genomes using short-read sequencing data. This evaluation is required to identify the best tool that can be well-optimized for small-scale projects or even national-level research.

Results
In this study, we have tested the mitochondrial genome assemblers for both simulated datasets and whole genome sequencing (WGS) datasets of humans. For the highest computational setting of 16 computational threads with the simulated dataset having 1000X read depth, MitoFlex took the least execution time of 69 s, and IOGA took the longest execution time of 1278 s. NOVOPlasty utilized the least computational memory of approximately 0.098 GB for the same setting, whereas IOGA utilized the highest computational memory of 11.858 GB. In the case of WGS datasets for humans, GetOrganelle and MitoFlex performed the best in capturing the SNPs information with a mean F1-score of 0.919 at the sequencing depth of 10X. MToolBox and NOVOPlasty performed consistently across all sequencing depths with a mean F1 score of 0.897 and 0.890, respectively.

Conclusions
Based on the overall performance metrics and consistency in assembly quality for all sequencing data, MToolBox performed the best. However, NOVOPlasty was the second fastest tool in execution time despite being single-threaded, and it utilized the least computational resources among all the assemblers when tested on simulated datasets. Therefore, NOVOPlasty may be more practical when there is a significant sample size and a lack of computational resources. Besides, as long-read sequencing gains popularity, mitochondrial genome assemblers must be developed to use long-read sequencing data.
HCV knowledge and attitudes among HIV-negative MSM and MSM living with HIV in China: results from a cross-sectional online survey
Authors: Xu Wenqian , Zhao Peizhen , Li Haiyi , Wang Cheng 
Published: September 2023

Abstract
Background
Men who have sex with men (MSM) are at high risk of hepatitis C virus (HCV) infection, especially for those living with human immunodeficiency virus (HIV). Learning about knowledge of and attitudes towards HCV is essential to inform health promotion interventions development. This is one of very limited studies to examine the level of knowledge and attitudes towards HCV and their determinants among HIV-negative MSM and MSM living with HIV in China.

Methods
A cross-sectional survey was conducted across seven provinces in China from December 2021 to January 2022. All the MSM living with HIV were recruited offline, whereas the recruitment ratio for HIV-negative MSM was half online and half offline. Data on socio-demographic characteristics, sexual behaviors, knowledge about HCV, and attitude towards HCV from participants were collected through the online survey. Univariate and multivariable logistic regressions were used to determine the associated factors.

Results
Only 39.3% (33/84) of HIV-negative men and 44.0% (37/84) of men living with HIV had a good level knowledge about HCV. Nearly one-third (32.1%, 27/84) of HIV-negative men and 41.7% (35/84) of men living with HIV reported a positive attitude towards HCV. For HIV-negative men, positive attitude towards HCV was associated with the multiple sexual partners (aOR: 5.8, 95%CI:1.9–18.1) and the use of recreational substances (aOR: 3.1, 95%CI: 1.0-9.4). For men living with HIV, knowledge about HCV was associated with disclosing sexual orientation to healthcare providers, family or friends (aOR: 7.0, 1.9–26.0), the multiple sexual partners (aOR: 0.2, 0.1-1.0), the use of recreational substances (aOR: 3.7, 95%CI: 1.1–13.1) and the HBV testing history (aOR: 7.3, 95%CI: 1.6–32.7); positive attitude towards HCV was associated with the use of recreational substances (aOR: 3.1, 95%CI: 1.1-9.0).

Conclusions
The majority of Chinese MSM showed an inadequate knowledge of and negative attitude towards HCV irrespective of HIV infection status. More tailored education campaigns and multicomponent interventions are required to be targeted on MSM, and more researches are also needed to inform how best to address the negative attitudes of this population towards HCV.
Coexistence of open-angle glaucoma and sarcoidosis-associated optic neuropathy
Authors: Jung Eun Hye , Kim Woonghee , Yoon Ra Gyoung , Kim Ko Eun 
Published: September 2023

Abstract
Background
In cases with advanced glaucomatous disc changes, further changes associated with other optic neuropathies cannot be easily identified. We present a case of preexisting open-angle glaucoma and concurrent involvement of sarcoidosis-associated optic neuropathy.

Case presentation
A 53-year-old man presented with gradual visual loss in his left eye, which began 1 year ago and accelerated 3 months ago. The best-corrected visual acuity in the right eye was 20/20 and counting fingers in the left. Intraocular pressures (IOP) were 12 mmHg in the right eye and 34 mmHg in the left. We diagnosed him with advanced open-angle glaucoma in the left eye based on the advanced glaucomatous cupping of the left optic disc. The IOP in the left eye dropped to 10 mmHg and was well controlled with antiglaucomatous medication; however, his left optic disc developed pallor 3 months after the treatment. The patient was revealed to be diagnosed with sarcoidosis a month ago and had been treated with systemic corticosteroids thereafter by a pulmonologist. Orbital magnetic resonance imaging revealed sarcoidosis-associated optic neuropathy in the left eye. Subsequently, optic neuropathy occurred in his right eye.

Conclusions
In eyes with advanced glaucomatous disc change, detecting the coexistence of other optic neuropathies can be difficult. This report highlights the importance of careful ophthalmic examinations and investigation for etiologies of other optic neuropathies if non-glaucomatous changes are suspected even in eyes with advanced glaucoma.
Color stability of two different resin matrix ceramics: randomized clinical trial
Authors: Mahrous Aliaa Ibrahim , Salama Aya A. , Shabaan Alshaimaa Ahmed , Abdou Ahmed , Radwan Mohamed Mostafa 
Published: September 2023

Abstract
Background
One of the most common causes of aesthetic failure and restoration replacement is the tooth restorations color mismatch specifically after aging.

Methods
One hundred and two participants with endodontically treated first molar were selected clinically. The patients were randomly splited into two groups and restored either with Cerasmart hybrid ceramic or Vita Enamic polymer infiltrated ceramic network (PICN) crowns and cemented using dual cure adhesive cement. The color difference (ΔE) values after cementation at 0 (Baseline), 6, and 12 months of use were obtained by quantification of L*, a*, and b* values with a digital spectrophotometer. Mann–Whitney test used to compare between tested groups at each time point and between (α = 0.05).

Results
At 6 months follow-up intervals, Vita Enamic group showed the highest significant ∆L* (p = 0.035) and ∆a* (p < 0.001) compared to Cerasmart group. ∆b* and ∆E showed no significant difference between both groups (p > 0.05). Furthermore, all color parameters of both groups showed statistically significant difference at 12 months follow-up intervals. After 12 months, Vita Enamic restorations presented higher color change compared to Cerasmart restorations with a (p-value of 0.0120). When comparing the total color difference ∆Et through-out the follow-up intervals of Vita Enamic & Cerasmart groups, there were insignificant difference (p = 0.263).

Conclusion
Both hybrid materials demonstrated comparable color stability after 1 year of clinical service within clinical acceptance range. However, Cerasmart demonstrated a better colour stability after 1 year.

Trial registration
ClinicalTrials.gov (ID: NCT05501808) 15/8/ 2022- ‘retrospectively registered’.
Is there an association between out-of-pocket hospital costs, quality and care outcomes? A systematic review of contemporary evidence
Authors: Walsan Ramya , Mitchell Rebecca J. , Braithwaite Jeffrey , Westbrook Johanna , Hibbert Peter , Mumford Virginia , Harrison Reema 
Published: September 2023

Abstract
Background
Out of pocket (OOP) costs vary substantially by health condition, procedure, provider, and service location. Evidence of whether this variation is associated with indicators of healthcare quality and/or health outcomes is lacking.

Methods
The current review aimed to explore whether higher OOP costs translate into better healthcare quality and outcomes for patients in inpatient settings. The review also aimed to identify the population and contextual-level determinants of inpatient out-of-pocket costs. A systematic electronic search of five databases: Scopus, Medline, Psych Info, CINAHL and Embase was conducted between January 2000 to October 2022. Study procedures and reporting complied with PRISMA guidelines. The protocol is available at PROSPERO (CRD42022320763).

Findings
A total of nine studies were included in the final review. A variety of quality and health outcomes were examined in the included studies across a range of patient groups and specialities. The scant evidence available and substantial heterogeneity created challenges in establishing the nature of association between OOP costs and healthcare quality and outcomes. Nonetheless, the most consistent finding was no significant association between OOP cost and inpatient quality of care and outcomes.

Interpretation
The review findings overall suggest no beneficial effect of higher OOP costs on inpatient quality of care and health outcomes. Further work is needed to elucidate the determinants of OOP hospital costs.

Funding
This study was funded by Medibank Better Health Foundation.
Wild ungulates as sentinels of flaviviruses and tick-borne zoonotic pathogen circulation: an Italian perspective
Authors: Grassi Laura , Drigo Michele , Zelená Hana , Pasotto Daniela , Cassini Rudi , Mondin Alessandra , Franzo Giovanni , Tucciarone Claudia Maria , Ossola Martina , Vidorin Elena , Menandro Maria Luisa 
Published: September 2023

Abstract
Background
Vector-borne zoonotic diseases are a concerning issue in Europe. Lyme disease and tick-borne encephalitis virus (TBEV) have been reported in several countries with a large impact on public health; other emerging pathogens, such as Rickettsiales, and mosquito-borne flaviviruses have been increasingly reported. All these pathogens are linked to wild ungulates playing roles as tick feeders, spreaders, and sentinels for pathogen circulation. This study evaluated the prevalence of TBEV, Borrelia burgdorferi sensu lato, Rickettsia spp., Ehrlichia spp., and Coxiella spp. by biomolecular screening of blood samples and ticks collected from wild ungulates. Ungulates were also screened by ELISA and virus neutralization tests for flaviviral antibody detection.

Results
A total of 274 blood samples were collected from several wild ungulate species, as well as 406 Ixodes ricinus, which were feeding on them. Blood samples tested positive for B. burgdorferi s.l. (1.1%; 0-2.3%) and Rickettsia spp. (1.1%; 0-2.3%) and showed an overall flaviviral seroprevalence of 30.6% (22.1–39.2%): 26.1% (17.9–34.3%) for TBEV, 3.6% (0.1–7.1%) for Usutu virus and 0.9% (0-2.7%) for West Nile virus. Ticks were pooled when possible and yielded 331 tick samples that tested positive for B. burgdorferi s.l. (8.8%; 5.8–11.8%), Rickettsia spp. (26.6%; 21.8–31.2%) and Neoehrlichia mikurensis (1.2%; 0-2.4%). TBEV and Coxiella spp. were not detected in either blood or tick samples.

Conclusions
This research highlighted a high prevalence of several tick-borne zoonotic pathogens and high seroprevalence for flaviviruses in both hilly and alpine areas. For the first time, an alpine chamois tested positive for anti-TBEV antibodies. Ungulate species are of particular interest due to their sentinel role in flavivirus circulation and their indirect role in tick-borne diseases and maintenance as Ixodes feeders and spreaders.
Serum branch-chained amino acids are increased in type 2 diabetes and associated with atherosclerotic cardiovascular disease
Authors: Moreno-Vedia Juan , Llop Dídac , Rodríguez-Calvo Ricardo , Plana Núria , Amigó Núria , Rosales Roser , Esteban Yaiza , Girona Josefa , Masana Lluís , Ibarretxe Daiana 
Published: September 2023

Abstract
Background and aim
Circulating biomarkers of metabolic and cardiovascular diseases can help in the early detection and prevention of those diseases. Using proton nuclear magnetic resonance (1H-NMR), we aimed to study the plasma levels of low-molecular-weight metabolites (LMWMs) in a cohort of 307 patients with metabolic diseases to assess their relationships with type-2 diabetes (T2D) and incident atherosclerotic cardiovascular disease (ASCVD).

Methods
We conducted a cross-sectional and prospective study. We included 307 patients attending the Lipid Unit of our University Hospital for the treatment of the following metabolic disturbances and associated disorders: T2D (73.9%), obesity (58.7%), and hypertension (55.1%). 1H-NMR was used to study the plasma levels of 13 LMWMs. LMWM serum concentrations were evaluated in patients with and without T2D. and the correlations with several parameters and their associations with T2D were analyzed. The association between LMWM levels at baseline and the development of ASCVD in patients with T2D after 10 years of follow-up was also evaluated.

Results
Among the LMWMs measured, the branched-chain amino acids (BCAAs) valine, leucine and isoleucine showed a positive association with several clinical and lipid-related biochemical parameters and inflammatory markers (p < 0.05). Likewise, these three BCAAS were associated with diabetes even after adjusting for covariates (p < 0.05). During the follow-up period of 10 years, 29 of the 185 patients with diabetes at baseline (15.68%) developed ASCVD. After adjusting for clinical covariates, baseline levels of valine and alanine were associated with the development of ASCVD (p < 0.05).

Conclusion
Overall, our results indicated that plasma levels of LMWMs measured by 1H-NMR could be potential biomarkers associated with T2D. Moreover, alanine and valine can help in the early detection of the cardiovascular risk associated with this metabolic disease.
Perceptions and drivers of healthcare provider and drug dispenser practices for the treatment of malaria in pregnancy in the context of multiple first-line therapies in western Kenya: a qualitative study
Authors: Osoro Caroline B. , Dellicour Stephanie , Ochodo Eleanor , Young Taryn , ter Kuile Feiko O. , Gutman Julie R. , Hill Jenny 
Published: September 2023

Abstract
Background
Emergence of Plasmodium falciparum resistance to artemether-lumefantrine in Africa prompted the pilot introduction of multiple first-line therapies (MFT) against malaria in Kenya, potentially exposing women-of-childbearing-age (WOCBAs) to anti-malarials with unknown safety profiles in the first trimester. This qualitative study explored knowledge and perceptions among healthcare providers providing malaria treatment to WOCBAs and pregnant women.

Methods
In-depth interviews were conducted with purposively selected public and private health facility (HF) and drug outlet (DO) providers within and outside the pilot-MFT area. County health managers were interviewed about their knowledge of the national treatment guidelines. Transcripts were coded by content analysis using the World Health Organization health system building blocks (leadership/governance, financing, health workforce, health information systems, access to medicines, and service delivery).

Results
Thirty providers (HF:21, DO:9) and three health managers were interviewed. Eighteen providers were from HFs in the pilot-MFT area; the remaining three and all nine DOs were outside the pilot-MFT area. The analysis revealed that providers had not been trained in malaria case management in the previous twelve months. DO providers were unfamiliar with national treatment guidelines in pregnancy and reported having no pregnancy tests. Health managers were unable to supervise DOs due to resource limitations. Providers from HFs and DOs noted poor sensitivity of malaria rapid diagnostic tests (RDTs) and hesitancy among patients who associated malaria-RDTs with HIV testing. Almost all providers reported anti-malarial stock-outs, with quinine most affected. Patient preference was a major factor in prescribing anti-malarials. Providers in HFs and DOs reported preferentially using artemether-lumefantrine in the first trimester due to the side effects and unavailability of quinine.

Conclusion
Knowledge of malaria case management in drug outlets and health facilities remains poor. Improved regulation of DO providers is warranted. Optimizing treatment of malaria in pregnancy requires training, availability of malaria commodities, and pregnancy tests.