bluuebunny/crossref_metadata_2025_split huggingface dataset:
Enhancing medical students` confidence and performance in integrated structured clinical examinations (ISCE) through a novel near-peer, mixed model approach during the COVID-19 pandemic
Authors: Baskaran Ravanth , Mukhopadhyay Srinjay , Ganesananthan Sashiananthan , Gamage Movin Peramuna , Dalavaye Nishaanth , Ng Vincent , Bennett Richard , Srinivasan Sripradha , Sureshkumarnair Parvathy , Spencer Robert , Bhatt Harsh , Manivannan Susruta , Zaben Malik 
Published: February 2023

Abstract
Background
Near-peer medical education serves as an important method of delivering education to junior students by senior students. Due to the reduced clinical exposure because of the COVID-19 pandemic, we developed a mentorship scheme to help medical students with their Integrated Structured Clinical Examinations (ISCEs) by providing a combination of near-peer mentorship together with lecture-based teaching on a weekly basis for a 12-week period. Students attended a specialty-focused lecture every Tuesday followed by a small group teaching session organised by their tutor.

Methods
A longitudinal evaluative interventional study was undertaken by the international student led medical education organisation, OSCEazy. The teaching programme was organised and conducted by third year medical students to a recruited cohort of second year medical students. Students’ perceptions of ISCEs (confidence, anxiety, and overall performance) were evaluated using 5-point Likert scales while their knowledge of the specialty was assessed using 10 single best answer questions which were distributed via Google® forms at the start and end of each week. In addition, we assessed tutor perceptions of their teaching and learning experience.

Results
Seventy-two tutees were enrolled in the programme (mean age: 24.4, female: 77.8%). 88.9% of the participants had not attended any online ISCE teaching prior to this. They preferred in-person ISCE teaching as compared to virtual sessions [median 4.5 (IQR 4–5) vs 3 (IQR 3–4), p <  0.0001), respectively]. There was a significant overall increase in knowledge when comparing pre-session and post-session performance [mean 53.7% vs 70.7%, p <  0.0001)]. There was a significant increase in student confidence [Confidence: median 3 (IQR:3–4) vs 4 (IQR 3–4), p <  0.0001] while no change was seen in the anxiety and perception of their overall performance in an ISCE. [Anxiety: median 3 (IQR 2–4) vs 3 (IQR 3–4), p = 0.37, Performance: median 3 (IQR 3–4) vs median 3 (IQR 3–4), p <  0.0001]. The tutors reported an increase in their confidence in teaching ISCEs online [median 3 (IQR 2–3.25) vs median 4 (IQR 4–5), p <  0.0001)].

Conclusion
Online near-peer teaching increases the confidence of both tutees and tutors involved while enhancing the tutees’ knowledge of the specialty. Thus, medical schools should incorporate near-peer teaching in their curriculum to enhance the student learning experience.
The factors affecting implementing shared decision-making in clinical trials: a cross-sectional survey of clinical research coordinators’ perceptions in Japan
Authors: Fujita Miho , Yonekura Yuki , Nakayama Kazuhiro 
Published: February 2023

Abstract
Background
The shared decision-making model has been proposed as the ideal treatment decision-making process in medical encounters. However, the decision to participate in clinical trials rarely involves shared decision-making. In this study, we investigated the perceptions of Japanese clinical research coordinators who routinely support the informed consent process.

Methods
This study aimed to (1) identify clinical research coordinators’ perceptions of the current status of shared decision-making implementation and its influencing factors, and (2) obtain suggestions to enhance the shared decision-making process in clinical trials. A cross-sectional survey was conducted using a web questionnaire based on the Theory of Planned behaviour. Invitations were sent to 1087 Japanese medical institutions, and responses from the participants were captured via the web. The shared decision-making process in clinical trials was defined according to the Shared Decision-Making Questionnaire for Doctors. The effect of the attitudes toward shared decision-making, clinical research coordinators’ subjective norms towards its implementation, perceived barriers to autonomous decision-making, and the number of difficult steps in the shared decision-making process on the shared decision-making current status as the shared decision-making intention was assessed by multiple regression analysis.

Results
In total, 373 clinical research coordinators responded to the questionnaire. Many believed that they were already implementing shared decision-making. Attitudes toward shared decision-making (t = 3.400, p < .001), clinical research coordinators’ subjective norms towards its implementation (t = 2.239, p = .026), perceived barriers to autonomous decision-making (t = 3.957, p < .001), and the number of difficult steps in the shared decision-making process (t = 3.317, p = .001) were found to significantly influence current status (Adjusted R2 = .123). However, results on perceived barriers to autonomous decision-making and the number of difficult steps in the shared decision-making process indicate a lack of knowledge of shared decision-making and decision-support skills among clinical research coordinators.

Conclusions
Clinical research coordinators might positively perceive shared decision-making based on normative beliefs without sufficient knowledge of it. Therefore, providing appropriate training on shared decision-making to clinical research coordinators and increasing awareness among stakeholders could enable its improvement.

Trial registration

Not applicable.
Patient dissatisfaction associated with physician-patient linguistic discordance in California clinics: an analytical cross-sectional study
Authors: Fernández-Ortega Miguel A. , Juárez-Flores Arturo , Olaiz-Fernández Gustavo A. , Muñiz-Salinas Daniel A. ,   AB1045 Law Analysis Group, Rojas-Russell Mario E. , Ponce-Rosas Efrén R. , Vicuña-de-Anda Félix J. , Aguirre-Gamero Arturo , Manzanilla-Romero Armando , León-Rodríguez Juan C. , Gómez-Peña Elena , Cuevas Maximiliano , Pawar Gagan , Fernández Rosa V. , Soto Graciela , Espejo-Iriarte Yamili , Rodríguez-Mendoza Omar 
Published: February 2023

Abstract
Background
Patient satisfaction is considered as a product of two psychological processes, a cognitive one, including expectations and perceptions, and an emotional one resulting from the congruence between expectation and subjective perception of the user. The objective was to identify the factors associated with the level of perceived satisfaction in patients treated in 36 nonprofit health clinics that offer comprehensive health care services in four counties in the state of California, United States.

Methods
Cross-sectional analytical study in 14 clinics in four California counties. It consisted of the application of a 30-item questionnaire to determine the degree of patient satisfaction with the clinic. The factorial composition of the quality of care and clinic quality components was analyzed and two factors with an Eigen value greater than 1 were obtained.

Results
A total of 846 responses were registered. Factor analysis identified two underlying dimensions: Physician Attitude and Empathy. It was found that the discordance in language between the physician and the patient generates a difference in the perception of satisfaction. Patients who prefer to speak English have better satisfaction than those who speak Spanish. Spanish speakers who do not have interpreter have lower satisfaction than those who do (p < 0,01).

Conclusions
The most important sociodemographic cofactor was language. Satisfaction decreased in Spanish-speaking patients who were not proficient in the use of English since they expressed fewer comments and doubts.
Socioeconomic disparity in the association between fine particulate matter exposure and papillary thyroid cancer
Authors: Crepeau Philip , Zhang Zhenyu , Udyavar Rhea , Morris-Wiseman Lilah , Biswal Shyam , Ramanathan Murugappan , Mathur Aarti 
Published: February 2023

Abstract
Background
Limited data exists suggesting that cumulative exposure to air pollution in the form of fine particulate matter (aerodynamic diameter ≤ 2.5 μm [PM2.5]) may be associated with papillary thyroid carcinoma (PTC), although this relationship has not been widely established. This study aims to evaluate the association between PM2.5 and PTC and determine the subgroups of patients who are at the highest risk of PTC diagnosis.

Methods
Under IRB approval, we conducted a case-control study of adult patients (age ≥ 18) newly diagnosed with PTC between 1/2013–12/2016 across a single health care system were identified using electronic medical records. These patients were compared to a control group of patients without any evidence of thyroid disease. Cumulative PM2.5 exposure was calculated for each patient using a deep learning neural networks model, which incorporated meteorological and satellite-based measurements at the patients’ residential zip code. Adjusted multivariate logistic regression was used to quantify the association between cumulative PM2.5 exposure and PTC diagnosis. We tested whether this association differed by gender, race, BMI, smoking history, current alcohol use, and median household income.

Results
A cohort of 1990 patients with PTC and a control group of 6919 patients without thyroid disease were identified. Compared to the control group, patients with PTC were more likely to be older (51.2 vs. 48.8 years), female (75.5% vs 46.8%), White (75.2% vs. 61.6%), and never smokers (71.1% vs. 58.4%) (p < 0.001). After adjusting for age, sex, race, BMI, current alcohol use, median household income, current smoking status, hypertension, diabetes, COPD, and asthma, 3-year cumulative PM2.5 exposure was associated with a 1.41-fold increased odds of PTC diagnosis (95%CI: 1.23–1.62). This association varied by median household income (p-interaction =0.03). Compared to those with a median annual household income <$50,000, patients with a median annual household income between $50,000 and < $100,000 had a 43% increased risk of PTC diagnosis (aOR = 1.43, 95%CI: 1.19–1.72), and patients with median household income ≥$100,000 had a 77% increased risk of PTC diagnosis (aOR = 1.77, 95%CI: 1.37–2.29).

Conclusions
Cumulative exposure to PM2.5 over 3 years was significantly associated with the diagnosis of PTC. This association was most pronounced in those with a high median household income, suggesting a difference in access to care among socioeconomic groups.
Determining the precise extent of sentinel basins during laparoscopic gastrectomy for early gastric cancer
Authors: Oh Sung Eun , An Ji Yeong , Min Jae-Seok , Jeong Sang-Ho , Ryu Keun Won 
Published: February 2023

Abstract
Purpose
By analyzing sentinel basin dissection (SBD) data from the SEntinel Node ORIented Tailored Approach (SENORITA) trial, we sought to determine the precise extent of the sentinel basin (SB) without a tracer.

Materials and methods
This study investigated SB length in patients (n = 25) who underwent laparoscopic SBD for early gastric cancer (EGC) in the SENORITA trial. SB length along the greater curvature (GC) and lesser curvature (LC) was measured intraoperatively before performing SBD.

Results
In all 25 cases, along the LC of the stomach, the lengths of the SB were 3.7 cm [2.0–5.0] (median [min–max]) proximally and 3.0 cm [2.3–5.5] distally; along the GC side, the lengths of the SB were 6.8 cm [3.5–11.0] proximally and 7.0 cm [3.8–9.5] distally from the tumors. The SB length at the GC or LC side was not significantly different between subgroups categorized by tumor depth, size, and longitudinal location. When tumors were located at the anterior wall of the stomach, the length of the proximal SB (10.0 cm [9.0–11.0]) at the GC side was the longest. In cases with several sentinel lymph nodes (SLNs), the lengths of the SB at the GC side were significantly longer than those with fewer SLNs. However, the lengths of the SB were similar on the LC side regardless of the number of SLNs.

Conclusions
This pilot study had some limitations of a small number of enrolled patients, the lack of research on the specific station of SLNs, and the inaccurate indication for sentinel node navigation surgery (SNNS) without tracer. Nevertheless, the present study which reported the extents of SBs might be the first step towards simplifying procedures in laparoscopic SNNS for stomach preservation in EGC.
Estrogen downregulates CD73/adenosine axis hyperactivity via adaptive modulation PI3K/Akt signaling to prevent myocarditis and arrhythmias during chronic catecholamines stress
Authors: Ndzie Noah Marie Louise , Adzika Gabriel Komla , Mprah Richard , Adekunle Adebayo Oluwafemi , Koda Stephane , Adu-Amankwaah Joseph , Xu Yaxin , Kanwore Kouminin , Wowui Prosperl Ivette , Sun Hong 
Published: February 2023

Abstract
Background
During myocardial damage, the sex hormone estrogen and CD73, the main enzyme that converts AMP into adenosine, are cardioprotective molecules. However, it is unclear how these two molecules work together to provide cardioprotection. The current study aimed to elucidate the interaction between estrogen and CD73 under chronic stress.

Methods
Ovariectomy and SHAM operations were done on FVB wild-type (WT) female mice. Two weeks after the operation, the mice were treated with daily isoproterenol (10 mg/kg/day) injections for 14 days. The effect of E2 on relevant cardiac injury biomarkers (BNP, ANP), myocardial morphology (cardiomyocyte surface area), electrocardiography, CD73 protein expression and activity, and macrophage (CD86 + and CD206 +) infiltrations were assessed. In vitro, H9C2 cells were treated with 1 nM of estrogen and 10 mM APCP (CD73 inhibitor α, β-methylene adenosine-5'-diphosphate), 10 µM isoproterenol and 20 µm LY294002 (PI3K inhibitor) for 24 h and western blot was done to elucidate the mechanism behind the effect of estrogen on the CD73/adenosine axis.

Results
Estrogen deficiency during chronic catecholamine stress caused myocardial injury, thereby triggering the hyperactivity of the CD73/adenosine axis, which aggravated myocarditis, adverse remodeling, and arrhythmias. However, estrogen normalizes CD73/Adenosine axis via the upregulation of PI3K/Akt pathways to prevent adverse outcomes during stress. In vivo results showed that the inhibition of PI3K significantly decreased PI3K/Akt pathways while upregulating the CD73/adenosine axis and apoptosis.

Conclusion
Estrogen’s pleiotropy cardioprotection mechanism during stress includes its normalization of the CD73/Adenosine axis via the PI3K/Akt pathway.
Whole transcriptome analysis to explore the impaired immunological features in critically ill elderly patients with sepsis
Authors: Chen I-Chieh , Chen Hsin-Hua , Jiang Yu-Han , Hsiao Tzu-Hung , Ko Tai-Ming , Chao Wen-Cheng 
Published: February 2023

AbstractBackgroundSepsis is a frequent complication in critically ill patients, is highly heterogeneous and is associated with high morbidity and mortality rates, especially in the elderly population. Utilizing RNA sequencing (RNA-Seq) to analyze biological pathways is widely used in clinical and molecular genetic studies, but studies in elderly patients with sepsis are still lacking. Hence, we investigated the mortality-relevant biological features and transcriptomic features in elderly patients who were admitted to the intensive care unit (ICU) for sepsis.MethodsWe enrolled 37 elderly patients with sepsis from the ICU at Taichung Veterans General Hospital. On day-1 and day-8, clinical and laboratory data, as well as blood samples, were collected for RNA-Seq analysis. We identified the dynamic transcriptome and enriched pathways of differentially expressed genes between day-8 and day-1 through DVID enrichment analysis and Gene Set Enrichment Analysis. Then, the diversity of the T cell repertoire was analyzed with MiXCR.ResultsOverall, 37 patients had sepsis, and responders and non-responders were grouped through principal component analysis. Significantly higher SOFA scores at day-7, longer ventilator days, ICU lengths of stay and hospital mortality were found in the non-responder group, than in the responder group. On day-8 in elderly ICU patients with sepsis, genes related to innate immunity and inflammation, such asZDHCC19,ALOX15, FCER1A,HDC, PRSS33,and PCSK9, were upregulated. The differentially expressed genes (DEGs) were enriched in the regulation of transcription, adaptive immune response, immunoglobulin production, negative regulation of transcription, and immune response. Moreover, there was a higher diversity of T-cell receptors on day-8 in the responder group, than on day-1, indicating that they had better regulated recovery from sepsis compared with the non-response patients.ConclusionSepsis mortality and incidence were both high in elderly individuals. We identified mortality-relevant biological features and transcriptomic features with functional pathway and MiXCR analyses based on RNA-Seq data; and found that the responder group had upregulated innate immunity and increased T cell diversity; compared with the non-responder group. RNA-Seq may be able to offer additional complementary information for the accurate and early prediction of treatment outcome.
Predicting patient-reported outcome of activities of daily living in stroke rehabilitation: a machine learning study
Authors: Chen Yu-Wen , Lin Keh-chung , Li Yi-chun , Lin Chia-Jung 
Published: February 2023

Abstract
Background
Machine Learning is increasingly used to predict rehabilitation outcomes in stroke in the context of precision rehabilitation and patient-centered care. However, predictors for patient-centered outcome measures for activities and participation in stroke rehabilitation requires further investigation.

Methods
This study retrospectively analyzed data collected for our previous studies from 124 participants. Machine Learning models were built to predict postintervention improvement of patient-reported outcome measures of daily activities (i.e, the Motor Activity Log and the Nottingham Extended Activities of Daily Living) and participation (i.e, the Activities of Daily Living domain of the Stroke Impact Scale). Three groups of 18 potential predictors were included: patient demographics, stroke characteristics, and baseline assessment scores that encompass all three domains under the framework of International Classification of Functioning, Disability and Health. For each target variable, classification models were built with four algorithms, logistic regression, k-nearest neighbors, support vector machine, and random forest, and with all 18 potential predictors and the most important predictors identified by feature selection.

Results
Predictors for the four target variables partially overlapped. For all target variables, their own baseline scores were among the most important predictors. Upper-limb motor function and selected demographic and stroke characteristics were also among the important predictors across the target variables. For the four target variables, prediction accuracies of the best-performing models with 18 features ranged between 0.72 and 0.96. Those of the best-performing models with fewer features ranged between 0.72 and 0.84.

Conclusions
Our findings support the feasibility of using Machine Learning for the prediction of stroke rehabilitation outcomes. The study was the first to use Machine Learning to identify important predictors for postintervention improvement on four patient-reported outcome measures of activities and participation in chronic stroke. The study contributes to precision rehabilitation and patient-centered care, and the findings may provide insights into the identification of patients that are likely to benefit from stroke rehabilitation.
Snake River alfalfa virus, a persistent virus infecting alfalfa (Medicago sativa L.) in Washington State, USA
Authors: Postnikova Olga A. , Irish Brian M. , Eisenback Jonathan , Nemchinov Lev G. 
Published: February 2023

AbstractHere we report an occurrence of Snake River alfalfa virus (SRAV) in Washington state, USA. SRAV was recently identified in alfalfa (Medicago sativa L.) plants and western flower thrips in south-central Idaho and proposed to be a first flavi-like virus identified in a plant host. We argue that the SRAV, based on its prevalence in alfalfa plants, readily detectable dsRNA, genome structure, presence in alfalfa seeds, and seed-mediated transmission is a persistent new virus distantly resembling members of the family Endornaviridae.
Machine learning-based model for predicting the esophagogastric variceal bleeding risk in liver cirrhosis patients
Authors: Hou Yixin , Yu Hao , Zhang Qun , Yang Yuying , Liu Xiaoli , Wang Xianbo , Jiang Yuyong 
Published: February 2023

AbstractBackgroundLiver cirrhosis patients are at risk for esophagogastric variceal bleeding (EGVB). Herein, we aimed to estimate the EGVB risk in patients with liver cirrhosis using an artificial neural network (ANN).MethodsWe included 999 liver cirrhosis patients hospitalized at the Beijing Ditan Hospital, Capital Medical University in the training cohort and 101 patients from Shuguang Hospital in the validation cohort. The factors independently affecting EGVB occurrence were determined via univariate analysis and used to develop an ANN model.ResultsThe 1-year cumulative EGVB incidence rates were 11.9 and 11.9% in the training and validation groups, respectively. A total of 12 independent risk factors, including gender, drinking and smoking history, decompensation, ascites, location and size of varices, alanine aminotransferase (ALT), γ-glutamyl transferase (GGT), hematocrit (HCT) and neutrophil-lymphocyte ratio (NLR) levels as well as red blood cell (RBC) count were evaluated and used to establish the ANN model, which estimated the 1-year EGVB risk.The ANN model had an area under the curve (AUC) of 0.959, which was significantly higher than the AUC for the North Italian Endoscopic Club (NIEC) (0.669) and revised North Italian Endoscopic Club (Rev-NIEC) indices (0.725) (allP <  0.001). Decision curve analyses revealed improved net benefits of the ANN compared to the NIEC and Rev-NIEC indices.ConclusionsThe ANN model accurately predicted the 1-year risk for EGVB in liver cirrhosis patients and might be used as a basis for risk-based EGVB surveillance strategies.