bluuebunny/crossref_metadata_2025_split huggingface dataset:
P495 POLYVASCULAR ATHEROSCLEROTIC DISEASE AND CARDIOLOGICAL REHABILITATION: FUNCTIONAL IMPROVEMENT AND RISK RECLASSIFICATION
Authors: Pezzoli S , Maloberti A , Ghidini S , Colombo V , Daus F , De Censi L , Morelli M , Alloni M , Giannattasio C Prof 
Published: May 2023

Abstract

Introduction
polyvascular atherosclerotic involvement is one of the definitions of extreme CV risk. For this reason, the search for carotid or lower limb asyntomatic atherosclerotic pathology can be useful to guarantee more intensive treatments for these individuals, who have already had a heart attack. Purpose: the aim was to understand how much the polyvascular patients can improve in functional terms after Cardiological Rehabilitation, comparing them with monovasculars. Besides, the study purpose was to evaluate how many patients are reclassified with an active research of asyntomatic atherosclerotic pathology with carotid ultrasound and Ankle Brachial Index (ABI).

Methods
The study sample was composed by 87 patients who underwent a cardiological rehabilitation cycle at the Niguarda hospital in Milan from March 2021 to April 2022. Of these, personal, medical, clinical, laboratory and instrumental data were collected. Functional improvement was assested as the difference in meters walked on the 6–minutes walking test (6MWT) on the start day (6MWT–1) and on the end day of rehabilitation (6MWT–2). All patients performed an ABI (to evaluate asyntomatic PAD) and a carotid ultrasound (to evaluate asyntomatic cerebrovascular disease).

Results
pre–riclassification, polyvascolar patients (13) compared to monovascular (74), in addition to being on average older (70 years vs 59 years, p=0.01), males (100% vs 73%, p&lt;0.001) and having had more previous recurrent myocardial infarctions (46% vs 8%, p=0.002), are less performing in terms of 6MWT–1 (428m vs 514m, p=0.002) and 6MWT–2 (517m vs 597m, p=0.008). About absolute functional improvement from the beginning to the end of rehabilitation, there are no statistically significant differences (81m vs 82m, p=0.919). Following reclassification, 7 patients switched from monovascular (67) to polyvascular (20).

Conclusions
our data showed that polyvascular patients can improve as much as monovasculars after Cardiological Rehabilitation. Furthermore, following ABI and carotid ultrasound, 8% of patients were reclassified. Polyvascular patients may receive more targeted and intensive therapies if properly diagnosed.
P496 EXTREME CARDIOVASCULAR RISK IN CARDIOLOGICAL REHABILITATION: PREVALENCE AND IMPACT ON PATIENT’S FUNCTIONAL IMPROVEMENT
Authors: Maloberti A , Senini E , Fabbri S , Ciampi C , Regazzetti M , Monticelli M , Pirola R , Giannattasio C Prof 
Published: May 2023

Abstract

Background
Among patients at very high cardiovascular risk, some are more likely to experience recurrent cardiovascular events. In may 2022, an article was published in the European Heart Journal proposing different definitions of patients at extreme cardiovascular risk. However, the process of defining the patient at extreme cardiovascular risk is still ongoing and more data also on its prevalence are needed. Aims: To assess the prevalence of patients at extreme cardiovascular risk in cardiological rehabilitation, to evaluate the clinical features of these patients. Furthermore, we want to establish how the extreme cardiovascular risk condition correlates with the functional improvement obtained during cardiac rehabilitation.

Methods
The study included 938 patients suffering from atherosclerosis who attended the cardiological rehabilitation of Niguarda Hospital in Milan. Patients diagnosed with non–ischemic heart failure or congenital heart disease have been excluded. Patients classified as at extreme cardiovascular risk were compared with the remaining patients and a multivariate linear regression was performed with absolute functional improvement as the dependent variable.

Results
Among 938 patients, 26.9% belong to the category of extreme cardiovascular risk. Patients at extreme cardiovascular risk showed a higher average age (67.8 ± 10.4 vs 64.1 ± 11.1 years; p ≤ 0.001), a higher prevalence of significant comorbidities (peripheral arterial disease, cerebrovascular disease, chronic kidney disease, dyslipidemia, diabetes, hypertension) and a lower functional improvement during cardiac rehabilitation (102.9 ± 68.6 vs 138.1 ± 86.5 m; p ≤ 0.001). At multivariate analysis extreme cardiovascular risk remains a significant determinant of the absolute functional improvement at Six–Minute Walking Test obtained during cardiac rehabilitation with b = –0.137 and p = 0.035, together with female sex (b = –0.136; p = 0.035).

Conclusion
Extreme cardiovascular risk is a widespread condition among patients with chronic coronary syndrome and adversely affects the patient’s functional improvement during cardiac rehabilitation. The identification of patients at extreme cardiovascular risk is a goal to be pursued in order to intensify secondary prevention strategies.
Experimental evolution of metabolism under nutrient restriction: enhanced amino acid catabolism and a key role of branched-chain amino acids
Authors: Cavigliasso Fanny , Savary Loriane , Spangenberg Jorge E , Gallart-Ayala Hector , Ivanisevic Julijana , Kawecki Tadeusz J 
Published: May 2023

Abstract
Periodic food shortage is a common ecological stressor for animals, likely to drive physiological and metabolic adaptations to alleviate its consequences, particularly for juveniles that have no option but to continue to grow and develop despite undernutrition. Here we study changes in metabolism associated with adaptation to nutrient shortage, evolved by replicate Drosophila melanogaster populations maintained on a nutrient-poor larval diet for over 240 generations. In a factorial metabolomics experiment we showed that both phenotypic plasticity and genetically-based adaptation to the poor diet involved wide-ranging changes in metabolite abundance; however, the plastic response did not predict the evolutionary change. Compared to nonadapted larvae exposed to the poor diet for the first time, the adapted larvae showed lower levels of multiple free amino acids in their tissues—and yet they grew faster. By quantifying accumulation of the nitrogen stable isotope 15N we show that adaptation to the poor diet led to an increased use of amino acids for energy generation. This apparent “waste” of scarce amino acids likely results from the trade-off between acquisition of dietary amino acids and carbohydrates observed in these populations. The three branched-chain amino acids (leucine, isoleucine, and valine) showed a unique pattern of depletion in adapted larvae raised on the poor diet. A diet supplementation experiment demonstrated that these amino acids are limiting for growth on the poor diet, suggesting that their low levels resulted from their expeditious use for protein synthesis. These results demonstrate that selection driven by nutrient shortage not only promotes improved acquisition of limiting nutrients, but also has wide-ranging effects on how the nutrients are used. They also show that the abundance of free amino acids in the tissues does not, in general, reflect the nutritional condition and growth potential of an animal.
Variation in parasite infection between replicates of speciation in Lake Victoria cichlid fish
Authors: Gobbin Tiziana P , Vanhove Maarten P M , Veenstra Renée , Maan Martine E , Seehausen Ole 
Published: May 2023

AbstractBecause of potentially strong eco-evolutionary interactions with their hosts, parasites may initiate or enhance host diversification. The adaptive radiation of cichlid fish in Lake Victoria provides a good system to study the role of parasites at different stages of host speciation. We analyzed the macroparasite infection of four replicates of sympatric blue and red Pundamilia species pairs that vary in their age and extent of differentiation. Sympatric host species differed in parasite community composition and in the infection levels of some of these parasite taxa. Most infection differences were consistent between sampling years, indicating temporal consistency in parasite-mediated divergent selection between species. Infection differentiation increased linearly with genetic differentiation. However, significant infection differences between sympatric species were only found in the oldest, most strongly differentiated Pundamilia species pair. This is inconsistent with parasite-driven speciation. Next, we identified five distinct species of Cichlidogyrus, a genus of highly specific gill parasites that has radiated elsewhere in Africa. Infection profiles of species of Cichlidogyrus differed between sympatric cichlid species only in the oldest and most differentiated pair, again inconsistent with parasite-mediated speciation. To conclude, parasites may contribute to host differentiation after speciation, but do not initiate host speciation.
Experimental validation of membrane distillation unit coupled with direct contact membrane using solar energy
Authors: Zarzoum K , Alquraish M M , Zhani K , Bacha H Ben 
Published: May 2023

Abstract
This paper presents an experimental validation of membrane distillation unit using solar energy which is coupled with direct contact membrane, which is placed at Kairouan University, Tunisia (35 N, 10 E) and tested on several sunny days. This unit is located as part of a cooperation project research and development between German Institute for Solar Energy Systems and Tunisian Electromechanical Systems Laboratory named: Solar driven membrane distillation for resource efficient desalination in remote areas. A theoretical model investigation as well as experimental is carried out. A mathematical model based on heat and mass transfers of the membrane distillation unit has been presented in this paper. The obtained global model of the membrane distillation unit has been converted to a set of algebraic system of equations to render them ordinary. To compare the experimental and numerical data of the mathematical model of the membrane distillation unit an example of the validation process that has been presented to assess the credibility of the obtained numerical model of membrane distillation unit, a laptop simulation program based on the global model of the unit is simulated by C++ software to solve the model of solar irradiation and all temperature on the journal productivity of the membrane distillation unit. It was shown by this study that the global mathematical model of the unit is able to predict accurately the trends of the thermal characteristic of the membrane distillation unit.
Cypermethrin toxicity in the environment: analytical insight into detection methods and microbial degradation pathways
Authors: Kansal Ishita , Kapoor Arushi , Solanki Swati , Singh Rachana 
Published: May 2023

Abstract
The unrestricted utilization of xenobiotic compounds has sparked widespread concern by the world's growing population. A synthetic pyrethroid called cypermethrin (CP) is commonly utilized as an insecticide in horticulture, agriculture, and pest control. The high toxicity levels of accumulated CP have prompted environmental concerns; it damages soil fertility, and an ecosystem of essential bacteria, and causes allergic reactions and tremors in humans by affecting their nervous systems. The damage caused by CP to groundwater, food, and health makes it imperative that new effective and sustainable alternatives are investigated. Microbial degradation has been established as a reliable technique for mineralizing CP into less toxic chemicals. Among the many enzymes produced by bacteria, carboxylesterase enzymes are determined to be the most efficient in the CP breakdown process. High-performance liquid chromatography (HPLC) and gas chromatography-mass spectrometry (GC-MS) have been reported as the best methods for determining CP and its metabolized products, with detection limits as low as ppb from diverse environmental samples. The current study describes the ecotoxicological impact of CP and innovative analytical techniques for their detection. The newly isolated CP-degrading bacterial strains have been evaluated in order to develop an efficient bioremediation strategy. The proposed pathways and the associated critical enzymes in the bacterial mineralization of CP have also been highlighted. Additionally, the strategic action to control CP toxicity has been discussed.
Estimating model parameters from SP anomaly of sheet-shaped sources using differential search and particle swarm optimization algorithms
Authors: Özyalın Şenol , Sındırgı Petek 
Published: May 2023

Abstract
In this study, the efficiency of estimating the model parameters of sheet-shaped single and multiple sources of the self-potential (SP) anomaly using the differential search algorithm (DSA) is investigated. First, noise-free and noisy synthetic anomalies are calculated for a single sheet-shaped source, and its model parameters estimated by DSA. The DSA inversion is also done for a model consisting of three inclined sheets. To test the effectiveness of the method, the same processes are repeated with a more conventional algorithm, particle swarm optimization (PSO), and the solutions of both methods are compared. The results of synthetic anomaly analyses show that DSA can predict the parameters as accurately as PSO. Then, both algorithms are also applied to two field SP anomalies (Surda and Beldih) that have been evaluated by different algorithms in the literature. The source of the Surda anomaly is modelled as one sheet, whereas the source model of the Beldih anomaly is assumed to consist of three sheets. The five model parameters for each model are estimated using both algorithms and it is determined that they are in good agreement with the findings of the previous studies. The contribution of the regional background anomaly to the synthetic and field anomalies are also included and regional coefficients are estimated. Finally, we conclude that DSA can solve the source parameters without the need for the initial values required in conventional iterative inversion methods and is an efficient and promising algorithm for determining the parameters of SP sources.
Breaking Down Grit: Persistency and Flexibility in the Career Plans of Military Medical Students
Authors: Landoll Ryan R , Highland Krista , Bell Kameha , Artino Anthony R , Moores Col Lisa K , Soh Michael , Uijtdehaage Sebastian , Durning Steven J , Grunberg Neil E , Dong Ting 
Published: May 2023

ABSTRACT

Introduction
The field of medicine is experiencing a crisis as high levels of physician and trainee burnout threaten the pipeline of future physicians. Grit, or passion and perseverance for long-term goals, has been studied in high-performing and elite military units and found to be predictive of successful completion of training in adverse conditions. The Uniformed Services University of the Health Sciences (USU) graduates military medical leaders who make up a significant portion of the Military Health System physician workforce. Taken together, an improved understanding of the relationships between burnout, well-being, grit, and retention among USU graduates is critical to the success of the Military Health System.

Materials and Methods
The current study was approved by the Institutional Review Board at USU and explored these relations among 519 medical students across three graduating classes. These students participated in two surveys approximately one year apart from October 2018 until November 2019. Participants completed measures on grit, burnout, and likelihood of leaving the military. These data were then merged with demographic and academic data (e.g., Medical College Admission Test scores) from the USU Long Term Career Outcome Study. These variables were then analyzed simultaneously using structural equation modeling to examine the relationships among variables in a single model.

Results
Results reaffirmed the 2-factor model of grit as both passion and perseverance (or interest consistency). No significant relationships emerged between burnout and other study variables. Sustained and focused interest was predictive of less likelihood of staying in the military.

Conclusion
This study offers important insights into the relationship among well-being factors, grit, and long-term career planning in the military. The limitations of using a single-item measure of burnout and measuring behavioral intentions in a short time frame during undergraduate medical education highlight the importance of future longitudinal studies that can examine actual behaviors across a career lifespan. However, this study offers some key insights into potential impacts on the retention of military physicians. The findings suggest that military physicians who are most likely to stay in the military tend to embrace a more fluid and flexible medical specialty path. This is critical in expectation setting for the military to train and retain military physicians across a wide range of critical wartime specialties.
Evaluating a Competency-Based Blended Health Professions Education Program: A Programmatic Approach
Authors: Samuel Anita , King Beth , Cervero Ronald M , Durning Steven J , Melton John 
Published: May 2023

ABSTRACT

Introduction
Competency-based education (CBE) programs usually evaluate student learning outcomes at a course level. However, a more comprehensive evaluation of student achievement of competencies requires evaluation at a programmatic level across all courses. There is currently insufficient literature on accomplishing this type of evaluation. In this article, we present an evaluation strategy adopted by the competency-based master’s degree program at the Center for Health Professions Education at the Uniformed Services University of Health Sciences to assess student achievement of competencies. We hypothesized that (1) learners would grow in the competencies through their time in the program and (2) learners would exhibit a behavioristic change as a result of their participation in the program.

Materials and Methods
The degree program at the Center for Health Professions Education conducts an annual student self-assessment of competencies using a competency survey. The competency survey data from graduated master’s students were collected, providing data from three time points: initial (pre-program survey), middle, and final (end-of-program survey). Open-ended responses from these three surveys were also analyzed. A general linear model for repeated measures was conducted. Significant effects were followed by post hoc tests across time. We also conducted post hoc analysis across domains to better understand the comparative levels of the domains at each time point. The responses to the open-ended prompt were thematically analyzed.

Results
Analysis of the quantitative data revealed that (1) learners reported significant growth across time, (2) learners had different perceptions of their competencies in each of the domains, and (3) not all domains experienced similar changes over time. Analysis of the free responses highlighted the impact of coursework on competency attainment and the behavioristic change in learners.

Conclusions
This study presents a strategic evaluation tool for course-based CBE programs that follow a traditional credit hour model. Programmatic evaluation of CBE programs should enable the inclusion of the learner’s voice and provide evaluation data that go beyond individual course evaluations.
Operation Bushmaster’s Impact on Military Medical Student Deployment Readiness
Authors: Cole Rebekah , Shumaker Jonathan T , Melo Estefania , Matthews Kevin J , Schwartz James , Vojta Leslie , Rudinsky Sherri L 
Published: May 2023

ABSTRACT

Introduction
Operation Bushmaster is a high-fidelity simulation held for fourth-year medical students at the Uniformed Services University. No past research has examined this multi-day simulation’s ability to prepare military medical students for the complexities of their first deployment. This qualitative study, therefore, explored Operation Bushmaster’s impact on military medical student deployment readiness.

Methods
We interviewed 19 senior military medical personnel serving as faculty members at Operation Bushmaster during October 2022 in order to explore how Operation Bushmaster prepares students for their first deployment. These interviews were recorded and transcribed. Each research team member then coded the transcripts and came to a consensus on the themes and patterns that emerged from the data.

Results
The following themes described the ways in which Operation Bushmaster prepares military medical students for their first deployment: (1) primes them for the stress of the operational environment; (2) teaches them to navigate austere conditions; (3) facilitates their leadership development; and (4) provides them with a deeper understanding of the military’s medical mission.

Conclusion
Operation Bushmaster immerses students in a realistic, stressful operational environment, challenging them to develop an adaptive mindset and efficacious leadership skills that they will utilize during future deployments.
Optimizing Care for Military Women: The Value of the Dual-Certified Family and Women’s Health Nurse Practitioner
Authors: Johnson Heather L , Best Natasha I , Johnson Christopher A , Seibert Diane C 
Published: May 2023

ABSTRACT
The number of women in the military has more than tripled over the past 50 years, increasing from 5% in the 1970s to 17% in 2023, making them essential for global health engagement and military operations. Provider competence and confidence are barriers to the consistent availability of preventive, gynecologic, and reproductive services for women across service locations and duty platforms. The Defense Health Board recommends standardizing services and improving the availability and scope of services for women at every point of care. In direct conflict with these recommendations, however, is a congressional call for a drawdown of medical forces, which creates a need for operationally trained clinicians with a broad skill set including comprehensive care for women. Advanced practice registered nurses, such as family and women’s health nurse practitioners, are key assets to fill this gap on military medical health-care teams. At the request of the U.S. Air Force, the Graduate School of Nursing at the Uniformed Services University began offering a Women’s Health Nurse Practitioner (WHNP) program in 2014. The WHNP curriculum was layered onto the existing Family Nurse Practitioner program so that Family Nurse Practitioner students receive enhanced education in women’s health and WHNP students are prepared to meet the holistic, primary care needs of patients across the lifespan in addition to caring for women with obstetric and urogenital health concerns. This article highlights the value of dual-certified Family Nurse Practitioners and WHNPs in the military health-care system. These Uniformed Services University alumni are uniquely prepared to provide comprehensive primary and specialty care for female warfighters across the lifecycle from stable, well-resourced duty stations to austere, operational settings or deployment platforms.