bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effect of training medical students in the community area in the midst of the Covid-19 pandemic in China: a community-based study
Authors: Li Ying , Pan YiYang , Ding XiWen , Aierken Ayizuhere , Jiang Wei 
Published: July 2023

Abstract
Background
Community practice training is an important part of education in medicine, public health, social medicine, and other disciplines. The objective of this study is to explore the effect and importance of the community practice of Master of Public Health graduates on community residents’ health during the Coronavirus Disease 2019 pandemic.

Methods
This study used a pretest-posttest design. A total of 152 participants with age ≥ 60 years were selected using a multistage sampling method from Hangzhou in China. Baseline and endline data were collected using structured questionnaires by face-to-face interviews. All psychological and behavioral measurements were performed using standardized instruments and showed good reliability and validity. A total of 147 participants were included in the analysis. The chi-square and rank sum tests were used to compare the difference between baseline and endline for categorical variables. Binary logistic regression analysis was used to evaluate the association between community practice training and changes in psychology and behavior.

Results
The result of chi-square test revealed a statistically significant difference in participants’ eating habits from baseline to endline. Participants reported that the self-perceived health status was different between endline and baseline by the rank sum test. The results of logistic regression analysis showed that community practice training was significantly associated with increased self-efficacy scores, cognitive function and eating habits, with odd ratios of 1.08, 0.90 and 1.93, respectively.

Conclusions
Community practice training was associated with changes in health behavior and psychology of community residents. Our results suggested enhanced community practice training for students under the Master of Public Health program.
Comparison of the end-of-life decisions of patients with hospital-acquired pneumonia after the enforcement of the life-sustaining treatment decision act in Korea
Authors: Baek Ae-Rin , Hong Sang-Bum , Bae Soohyun , Park Hye Kyeong , Kim Changhwan , Lee Hyun-Kyung , Cho Woo Hyun , Kim Jin Hyoung , Chang Youjin , Lee Heung Bum , Gil Hyun-Il , Shin Beomsu , Yoo Kwang Ha , Moon Jae Young , Oh Jee Youn , Min Kyung Hoon , Jeon Kyeongman , Baek Moon Seong ,   and the Korean HAP/VAP Study Group
Published: July 2023

Abstract
Background
Although the Life-Sustaining Treatment (LST) Decision Act was enforced in 2018 in Korea, data on whether it is well established in actual clinical settings are limited. Hospital-acquired pneumonia (HAP) is a common nosocomial infection with high mortality. However, there are limited data on the end-of-life (EOL) decision of patients with HAP. Therefore, we aimed to examine clinical characteristics and outcomes according to the EOL decision for patients with HAP.

Methods
This multicenter study enrolled patients with HAP at 16 referral hospitals retrospectively from January to December 2019. EOL decisions included do-not-resuscitate (DNR), withholding of LST, and withdrawal of LST. Descriptive and Kaplan–Meier curve analyses for survival were performed.

Results
Of 1,131 patients with HAP, 283 deceased patients with EOL decisions (105 cases of DNR, 108 cases of withholding of LST, and 70 cases of withdrawal of LST) were analyzed. The median age was 74 (IQR 63–81) years. The prevalence of solid malignant tumors was high (32.4% vs. 46.3% vs. 54.3%, P = 0.011), and the ICU admission rate was lower (42.9% vs. 35.2% vs. 24.3%, P = 0.042) in the withdrawal group. The prevalence of multidrug-resistant pathogens, impaired consciousness, and cough was significantly lower in the withdrawal group. Kaplan–Meier curve analysis revealed that 30-day and 60-day survival rates were higher in the withdrawal group than in the DNR and withholding groups (log-rank P = 0.021 and 0.018). The survival of the withdrawal group was markedly decreased after 40 days; thus, the withdrawal decision was made around this time. Among patients aged below 80 years, the rates of EOL decisions were not different (P = 0.430); however, mong patients aged over 80 years, the rate of withdrawal was significantly lower than that of DNR and withholding (P = 0.001).

Conclusions
After the LST Decision Act was enforced in Korea, a DNR order was still common in EOL decisions. Baseline characteristics and outcomes were similar between the DNR and withholding groups; however, differences were observed in the withdrawal group. Withdrawal decisions seemed to be made at the late stage of dying. Therefore, advance care planning for patients with HAP is needed.
Efficacy of interactive manual dexterity training after stroke: a pilot single-blinded randomized controlled trial
Authors: Térémetz Maxime , Hamdoun Sonia , Colle Florence , Gerardin Eloïse , Desvilles Claire , Carment Loïc , Charron Sylvain , Cuenca Macarena , Calvet David , Baron Jean-Claude , Turc Guillaume , Maier Marc A. , Rosso Charlotte , Mas Jean-Louis , Lindberg Påvel G. 
Published: July 2023

Abstract
Objective
To compare the efficacy of Dextrain Manipulandum™ training of dexterity components such as force control and independent finger movements, to dose-matched conventional therapy (CT) post-stroke.

Methods
A prospective, single-blind, pilot randomized clinical trial was conducted. Chronic-phase post-stroke patients with mild-to-moderate dexterity impairment (Box and Block Test (BBT) > 1) received 12 sessions of Dextrain or CT. Blinded measures were obtained before and after training and at 3-months follow-up. Primary outcome was BBT-change (after–before training). Secondary outcomes included changes in motor impairments, activity limitations and dexterity components. Corticospinal excitability and short intracortical inhibition (SICI) were measured using transcranial magnetic stimulation.

Results
BBT-change after training did not differ between the Dextrain (N = 21) vs CT group (N = 21) (median [IQR] = 5[2–7] vs 4[2–7], respectively; P = 0.36). Gains in BBT were maintained at the 3-month post-training follow-up, with a non-significant trend for enhanced BBT-change in the Dextrain group (median [IQR] = 3[− 1–7.0], P = 0.06). Several secondary outcomes showed significantly larger changes in the Dextrain group: finger tracking precision (mean ± SD = 0.3 ± 0.3N vs − 0.1 ± 0.33N; P < 0.0018), independent finger movements (34.7 ± 25.1 ms vs 7.7 ± 18.5 ms, P = 0.02) and maximal finger tapping speed (8.4 ± 7.1 vs 4.5 ± 4.9, P = 0.045). At follow-up, Dextrain group showed significantly greater improvement in Motor Activity Log (median/IQR = 0.7/0.2–0.8 vs 0.2/0.1–0.6, P = 0.05). Across both groups SICI increased in patients with greater BBT-change (Rho = 0.80, P = 0.006). Comparing Dextrain subgroups with maximal grip force higher/lower than median (61.2%), BBT-change was significantly larger in patients with low vs high grip force (7.5 ± 5.6 vs 2.9 ± 2.8; respectively, P = 0.015).

Conclusions
Although immediate improvements in gross dexterity post-stroke did not significantly differ between Dextrain training and CT, our findings suggest that Dextrain enhances recovery of several dexterity components and reported hand-use, particularly when motor impairment is moderate (low initial grip force). Findings need to be confirmed in a larger trial.
Trial registration ClinicalTrials.gov NCT03934073 (retrospectively registered)
Cytomegalovirus drug resistance mutations in transplant recipients with suspected resistance
Authors: Recio Vanessa , González Irene , Tarragó David 
Published: July 2023

AbstractResistant CMV infections are challenging complications after SOT and HSCT. Prompt recognition of ARMs is imperative for appropriate therapy. 108 plasma samples from 96 CMV + transplant recipients with suspected resistance were analysed in CNM in a retrospective nationwide study from January 2018 to July 2022 for resistance genotyping. ARMs in UL97 and UL54 were found in 26.87% (18/67) and 10.60% (7/66) of patients, respectively. Patients’ ARM distribution in UL97 was as follows: L595S n = 3; L595S/M460I n = 1; L595S/N510S n = 1; L595W n = 1; C603W n = 4; A594V n = 3; A594E n = 1; C607Y n = 1; L397R/T409M/H411L/M460I n = 1; L397I n = 1; H520Q n = 1; four patients showed ARMs in UL54 as well (F412C n = 1; T503I n = 2; P522S n = 1), whereas three patients exhibited ARMs in UL54 only (L501I/T503I/L516R/A834P n = 1; A987G n = 2). L516R in UL54 and L397R/I and H411L in UL97 have been found for the first time in a clinical sample. L595S/W was the most prevalent ARM found to lend resistance to GCV. In UL54 all ARMs lent resistance to GCV and CDV. In addition, A834P, found in one patient, also lent resistance to FOS. CMV load did not differ significantly in patients with or without ARMs, and no differences were found either between patients with ARMs in UL97 or in UL97 and UL54. Despite extensive use of classical antivirals for the treatment of CMV infection after HSCT and SOT, ARMs occurred mainly in viral UL97 kinase, which suggests that CDV and mostly FOS continue to be useful alternatives to nucleoside analogues after genotypic detection of ARMs.
Aged mesenchymal stem cells and inflammation: from pathology to potential therapeutic strategies
Authors: Yang Xue , Wang Ying , Rovella Valentina , Candi Eleonora , Jia Wei , Bernassola Francesca , Bove Pierluigi , Piacentini Mauro , Scimeca Manuel , Sica Giuseppe , Tisone Giuseppe , Mauriello Alessandro , Wei Lixin , Melino Gerry , Shi Yufang 
Published: July 2023

AbstractNatural ageing of organisms and corresponding age-related diseases result mainly from stem cell ageing and “inflammaging”. Mesenchymal stem cells (MSCs) exhibit very high immune-regulating capacity and are promising candidates for immune-related disease treatment. However, the effect of MSC application is not satisfactory for some patients, especially in elderly individuals. With ageing, MSCs undergo many changes, including altered cell population reduction and differentiation ability, reduced migratory and homing capacity and, most important, defective immunosuppression. It is necessary to explore the relationship between the “inflammaging” and aged MSCs to prevent age-related diseases and increase the therapeutic effects of MSCs. In this review, we discuss changes in naturally ageing MSCs mainly from an inflammation perspective and propose some ideas for rejuvenating aged MSCs in future treatments.
Why do older adults decline participation in research? Results from two deprescribing clinical trials
Authors: Strayer Thomas E. , Hollingsworth Emily K. , Shah Avantika S. , Vasilevskis Eduard E. , Simmons Sandra F. , Mixon Amanda S. 
Published: July 2023

Abstract
Background
Heterogenous older adult populations are underrepresented in clinical trials, and their participation is necessary for interventions that directly target them. The purpose of this study was to evaluate reasons why hospitalized older adults declined participation in two deprescribing clinical trials.

Methods
We report enrollment data from two deprescribing trials, Shed-MEDS (non-Veterans) and VA DROP (Veterans). For both trials, inclusion criteria required participants to be hospitalized, age 50 or older, English-speaking, and taking five or more home medications. Eligible patients were approached for enrollment while hospitalized. When an eligible patient or surrogate declined participation, the reason(s) were recorded and subsequently analyzed inductively to develop themes, and a chi-square test was used for comparison (of themes between Veterans and non-Veterans).

Results
Across both trials, 1226 patients (545 non-Veterans and 681 Veterans) declined enrollment and provided reasons, which were condensed into three themes: (1) feeling overwhelmed by their current health status, (2) lack of interest or mistrust of research, and (3) hesitancy to participate in a deprescribing study. A greater proportion of Veterans expressed a lack of interest or mistrust in research (42% vs 26%, chi-square value = 36.72, p < .001), whereas a greater proportion of non-Veterans expressed feeling overwhelmed by their current health status (54% vs 35%, chi-square value = 42.8 p < 0.001). Across both trials, similar proportion of patients expressed hesitancy to participate in a deprescribing study, with no significant difference between Veterans and non-Veterans (23% and 21%).

Conclusions
Understanding the reasons older adults decline participation can inform future strategies to engage this multimorbid population.
Failure of diltiazem to prevent 1:1 conduction of atrial flutter: a case report
Authors: Tiver K. D. , Martin D. K. , Quah J. , Lahiri A. , Ganesan A. N. 
Published: July 2023

Abstract
Background
Atrial flutter with 1:1 conduction to the ventricles is a dangerous cardiac arrhythmia. Contemporary guidelines recommend atrioventricular nodal blocking agents should be co-administered with class 1C anti-arrhythmics, as prophylaxis against 1:1 flutter. No guidance is provided on the type or strength of atrioventricular nodal blockade required, and in practice, these agents are frequently prescribed at low dose, or even omitted, due to their side effect profile.

Case presentation
A 62 year old Caucasian man with a history of paroxysmal atrial fibrillation treated with flecainide, presented with atrial flutter with 1:1 conduction to the ventricles and was cardioverted. Diltiazem was added to prevent this complication and he again presented with atrial flutter with 1:1 conduction to the ventricles, despite prophylaxis with coadministration of diltiazem.

Conclusions
This case report demonstrates failure of diltiazem to prevent 1:1 flutter in a patient chronically treated with flecainide for paroxysmal atrial fibrillation.
Bladder carcinosarcoma treated by cystectomy and adjuvant chemotherapy with good outcomes: a case report
Authors: Kouhen Fadila , Dahbi Zineb , Afif Mohammed , Chihabeddine Meriem , Errafiy Nadia , Oqbani Kenza , Omor Youssef , Elhossini Amal 
Published: July 2023

Abstract
Background
Primary carcinosarcoma of the bladder is a rare and highly aggressive tumor, representing less than 1% of all bladder neoplasms. There is no specific treatment guideline has for carcinosarcoma of the bladder, and majority of published patients was treated exclusively by surgery.

Case presentation
We report a case of 65-year-old Moroccan man, presented with macroscopic hematuria, pollakiuria and painful urination. Histological analysis showed a biphasic epithelial and mesenchymal proliferation, with invasion of lamina propria and muscularis, compatible with diagnosis of bladder carcinosarcoma. The patient was treated with cystectomy and adjuvant chemotherapy based on gemcitabin-cisplatin, 18 months after treatment, patient still free of recurrence.

Conclusion
Carcinosarcoma of the urinary bladder is a rare and aggressive tumor regardless treatment. A multidisciplinary management based on radical cystectomy and combined adjuvant treatments can improve prognosis. In this work, we suggest to propose adjuvant chemotherapy whenever possible.
Effects of a Low-Carbohydrate-High-Protein Pre-Exercise Meal in Type 1 Diabetes—a Randomized Crossover Trial
Authors: Kristensen Kasper B , Ranjan Ajenthen G , McCarthy Olivia M , Holst Jens J , Bracken Richard M , Nørgaard Kirsten , Schmidt Signe 
Published: July 2023

Abstract

Context
Current guidelines for exercise-related glucose management focus on reducing bolus and/or basal insulin doses and considering carbohydrate intake. Yet far less attention has been paid to the potential role of other macronutrients alongside carbohydrates on glucose dynamics around exercise.

Objective
To investigate the effects of a low-carbohydrate-high-protein (LCHP) compared with a high-carbohydrate-low-protein (HCLP) pre-exercise meal on the metabolic, hormonal, and physiological responses to exercise in adults with insulin pump–treated type 1 diabetes.

Methods
Fourteen adults (11 women, 3 men) with insulin pump–treated type 1 diabetes (median [range] HbA1c of 50 [43-59] mmol/mol (6.7% [6.1%-7.5%]), age of 49 [25-65] years, and body mass index of 24.0 [19.3-27.1] kg/m2) completed an unblinded, 2-arm, randomized, crossover study. Participants ingested isocaloric meals that were either LCHP (carbohydrate 21%, protein 52%, fat 27%) or HCLP (carbohydrate 52%, protein 21%, fat 27%) 90 minutes prior to undertaking 45 minutes of cycling at moderate intensity. Meal insulin bolus was dosed according to meal carbohydrate content but reduced by 25%. Basal insulin rates were reduced by 35% from meal ingestion to end of exercise.

Results
Around exercise the coefficient of variability was lower during LCHP (LCHP: 14.5 ± 5.3 vs HCLP: 24.9 ± 7.7%, P = .001). Over exercise, LCHP was associated with a lesser drop (LCHP: Δ−1.49 ± 1.89 vs HCLP: Δ−3.78 ± 1.95 mmol/L, P = .001). Mean insulin concentration was 30% lower during exercise for LCHP compared with HCLP (LCHP: 25.5 ± 11.0 vs HCLP: 36.5 ± 15.9 mU/L, P &lt; .001).

Conclusion
Ingesting a LCHP pre-exercise meal lowered plasma glucose variability around exercise and diminished the drop in plasma glucose over exercise.
ZnUMBA – a live imaging method to detect local barrier breaches
Authors: Higashi Tomohito , Stephenson Rachel E. , Schwayer Cornelia , Huljev Karla , Higashi Atsuko Y. , Heisenberg Carl-Philipp , Chiba Hideki , Miller Ann L. 
Published: July 2023

ABSTRACT
Epithelial barrier function is commonly analyzed using transepithelial electrical resistance, which measures ion flux across a monolayer, or by adding traceable macromolecules and monitoring their passage across the monolayer. Although these methods measure changes in global barrier function, they lack the sensitivity needed to detect local or transient barrier breaches, and they do not reveal the location of barrier leaks. Therefore, we previously developed a method that we named the zinc-based ultrasensitive microscopic barrier assay (ZnUMBA), which overcomes these limitations, allowing for detection of local tight junction leaks with high spatiotemporal resolution. Here, we present expanded applications for ZnUMBA. ZnUMBA can be used in Xenopus embryos to measure the dynamics of barrier restoration and actin accumulation following laser injury. ZnUMBA can also be effectively utilized in developing zebrafish embryos as well as cultured monolayers of Madin–Darby canine kidney (MDCK) II epithelial cells. ZnUMBA is a powerful and flexible method that, with minimal optimization, can be applied to multiple systems to measure dynamic changes in barrier function with spatiotemporal precision.
Risk-Adapted Intraoperative Radiation Therapy (IORT) for Breast Cancer: A Novel Analysis
Authors: Silverstein Melvin J. , Kim Brian , Lin Kevin , Lloyd Shane , Snyder Lincoln , Khan Sadia , Kramme Katherine , Chen Peter 
Published: July 2023

Abstract
Background
Randomized trials have shown that risk-adapted intraoperative radiation therapy (IORT) after breast-conserving surgery for low-risk breast cancer patients is a safe alternative to whole-breast radiation therapy (WBRT). The risk-adapted strategy allows additional WBRT for predefined high-risk pathologic characteristics discovered on final histopathology. The greater the percentage of patients receiving WBRT, the lower the recurrence rate. The risk-adapted strategy, although important and necessary, can make IORT appear better than it actually is.

Methods
Risk-adapted IORT was used to treat 1600 breast cancers. They were analyzed by the intention-to-treat method and per protocol to better understand the contribution of IORT with and without additional whole-breast treatment. Any ipsilateral breast tumor event was considered a local recurrence.

Results
During a median follow-up period of 63 months, local recurrence differed significantly between the patients who received local treatment and those who received whole-breast treatment. For 1393 patients the treatment was local treatment alone. These patients experienced 79 local recurrences and a 5-year local recurrence probability of 5.95 %. For 207 patients with high-risk final histopathology, additional whole-breast treatment was administered. They experienced two local recurrences and a 5-year local recurrence probability of 0.5 % (p = 0.0009).

Conclusions
Whole-breast treatment works well at reducing local recurrence, and it is a totally acceptable and necessary addition to IORT as part of a risk-adapted program. However, the more whole-breast treatment that is given, the more it dilutes the original plan of simplifying local treatment and the less we understand exactly what IORT contributes to local control as a stand-alone treatment.
Organizing Data Analytics
Authors: Alonso Ricardo , Câmara Odilon 
Published: July 2023

We develop a theory of credible skepticism in organizations to explain the main tradeoffs in organizing data generation, analysis, and reporting. In our designer-agent-principal game, the designer selects the information privately observed by the agent who can misreport it at a cost, whereas the principal can audit the report. We study three organizational levers: tampering prevention, tampering detection, and the allocation of the experimental-design task. We show that motivating informative experimentation while discouraging misreporting are often conflicting organizational goals. To incentivize experimentation, the principal foregoes a flawless tampering detection/prevention system and separates the tasks of experimental design and analysis. This paper was accepted by Alfonso Gambardella, business strategy. Supplemental Material: The online appendix is available at https://doi.org/10.1287/mnsc.2023.00207 .
Realization of an optical nanostructure 4×1  multiplexer based on metal-insulator-metal plasmonic waveguides
Authors: Abdulwahid Saif H. , Wadday Ahmed Ghanim , Ali Faris Mohammed , Hamza Bashar J. , Al-Shamani Ali Najah 
Published: July 2023

The optical multiplexer was created at a nanoscale plasmonic structure
utilizing the finite element method (FEM) with COMSOL version 5.5
software to enable maximum light confinement, high-speed optical
systems, and a tiny structure. The metal-insulator-metal technology at
a nanoscale dimension is used for creating the 4×1 multiplexer. In this design, the
transmission threshold (Tthreshold) is selected to be 100% for
separating between logic “1” and logic “0” at a 1310 nm
operating wavelength. The modulation depth (MD), contrast ratio (CR),
and insertion loss (IL) characteristics were explained to evaluate the
performance of the multiplexer. The CR has 3.48 dB, the MD
offers an ideal performance with 95.28 %, and the IL has
3.31 dB.
Magneto-optical engineering by plasmonic and dielectric metasurfaces in a CoFeB perforated microstructure
Authors: Shnan N. S. , Roostaei N. , Hamidi S. M. 
Published: July 2023

We have investigated theoretically and experimentally the effect of plasmonic and all-dielectric metasurfaces on the magneto-optical response of the 2D periodic structure. For this purpose, we fabricate polydimethylsiloxane-based 2D microstructures. So, we coated them with a gold layer and a TiO2 dielectric layer as plasmonic and dielectric metasurfaces, respectively, CoFeB as the prominent magneto-optical thin films. We record the spectral magneto-optical longitudinal Kerr effect under 40 mT, and the spectrometer’s response in all visible regions. Our results show that the electric and magnetic dipole moments enhance the magneto-optical response by factors of one and two in two closer channels in 650 and 660 nm in an all-dielectric structure, respectively. The plasmonic hot spot-based magneto-optical enhancement is also confirmed in two other media with an enhancement factor of two.