bluuebunny/crossref_metadata_2025_split huggingface dataset:
Telehealth in the Military Health System: Impact, Obstacles, and Opportunities
Authors: Madsen Cathaleen , Poropatich Ronald , Koehlmoos Tracey Pérez 
Published: March 2023

ABSTRACT

Background
The U.S. Military Health System (MHS) pioneered the use of telehealth in deployed environments in the early 1990s. However, its use in non-deployed environments historically lagged behind that of the Veterans Health Administration (VHA) and comparable large civilian health systems, due to administrative, policy, and other obstacles that slowed or blocked its expansion in the MHS. A report was prepared in December 2016, which summarized past and then-present telehealth initiatives in the MHS; described the obstacles, opportunities, and policy environment; and provided three possible courses of action for expansion of telehealth in deployed and non-deployed settings.

Methods
Gray literature, peer-reviewed literature, presentations, and direct input were aggregated under the guidance of subject matter experts.

Results
Past and then-current efforts demonstrated significant telehealth capability in use and in development for the MHS, mainly in deployed or operational settings. Policy from 2011 to 2017 demonstrated an environment favorable for MHS expansion, while the review of comparable civilian and veterans’ healthcare systems showed significant benefits including increased access and lower cost from use of telehealth in non-deployed settings. The 2017 National Defense Authorization Act charged the Secretary of Defense with promoting telehealth usage for the Department of Defense, including provisions for removing obstacles and reporting progress within 3 years. The MHS has the ability to reduce burdensome interstate licensing and privileging requirements, but still requires an increased level of cybersecurity, compared to civilian systems.

Discussion
The benefits of telehealth fit with the MHS Quadruple Aim of improving cost, quality, access, and readiness. Readiness is particularly served by the use of “physician extenders,” which allows nurses, physician assistants, medics, and corpsmen to provide hands-on care under remote oversight and to practice at the top of their licenses. Based on this review, three courses of action were recommended: to focus largely on developing telehealth in deployed environments; to maintain focus in deployed environments and increase telehealth development in non-deployed environments to keep pace with the VHA and private sector; or to use lessons learned from military and civilian telehealth initiatives to leapfrog the private sector.

Conclusion
This review serves as a snapshot in time of the steps leading to telehealth expansion before 2017, which helped to set the stage for later use of telehealth in behavioral health initiatives and as a response to coronavirus disease 2019. The lessons learned are ongoing and further research is expected to inform additional development of telehealth capability for the MHS.
Graduate Medical Education in the Military Health System: Strategic Analysis and Options
Authors: Degutis Linda C , Kellermann Arthur L , Jackson Kevin , Middleton Allen , Harris Racine S 
Published: March 2023

ABSTRACT

Introduction
At the request of then-Assistant Secretary of Defense for Health Affairs, Dr. Jonathan Woodson, Defense Health Horizons (DHH) examined options for shaping Graduate Medical Education (GME) in the Military Health System (MHS) in order to achieve the goals of a medically ready force and a ready medical force.

Materials and Methods
The DHH interviewed service GME directors, key designated institutional officials, and subject-matter experts on GME in the military and civilian health care systems.

Results
This report proposes numerous short- and long-term courses of action in three areas:
1. Balancing the allocation of GME resources to suit the needs of active duty and garrisoned troops. We recommend developing a clear, tri-service mission and vision for GME in the MHS and expanding collaborations with outside institutions in order to prepare an optimal mix of physicians and ensure that trainees meet requirements for clinical experience.
2. Improving the recruitment and tracking of GME students, as well as the management of accessions. We recommend several measures to improve the quality of incoming students, to track the performance of students and medical schools, and to foster a tri-service approach to accessions.
3. Aligning MHS with the tenets of the Clinical Learning Environment Review to advance a culture of safety and to help the MHS become a high reliability organization (HRO). We recommend several actions to strengthen patient care and residency training and to develop a systematic approach to MHS management and leadership.

Conclusion
Graduate Medical Education (GME) is vital to produce the future physician workforce and medical leadership of the MHS. It also provides the MHS with clinically skilled manpower. Graduate Medical Education (GME) research sows the seeds for future discoveries to improve combat casualty care and other priority objectives of the MHS. Although readiness is the MHS’s top mission, GME is also vital to meeting the other three components of the quadruple aim (better health, better care, and lower costs). Properly managed and adequately resourced GME can accelerate the transformation of the MHS into an HRO. Based on our analysis, DHH believes that there are numerous opportunities for MHS leadership to strengthen GME so it is more integrated, jointly coordinated, efficient, and productive. All physicians emerging from military GME should understand and embrace team-based practice, patient safety, and a systems-oriented focus. This will ensure that those we prepare to be the military physicians of the future are prepared to meet the needs of the line, to protect the health and safety of deployed warfighters, and to provide expert and compassionate care to garrisoned service members, families, and military retirees.
Chemical models of adenine precursors cyanamide and carbodiimide in the interstellar medium
Authors: Zhang Xia , Quan Donghui , Li Runxia , Esimbek Jarken , Chen Long-Fei , Zhao Guoming , Zhou Yan 
Published: March 2023

ABSTRACT
Cyanamide (NH2CN) and its isomer, carbodiimide (HNCNH), may form adenine in the interstellar medium (ISM) via a series of reactions. Therefore, they are considered key prebiotic molecules in the study of the origin of life. We used the three-phase NAUTILUS chemical code, which includes the gas, the dust surface, and the icy mantle, to investigate the formation and destruction of cyanamide and carbodiimide. We added over 200 new chemical reactions of the two isomers and related species and established a relatively complete network. We applied cold core, hot corino/core, and shock models to simulate the different physical environments, and found that the two isomers are mainly produced by the free radical reactions on grain surfaces. Our simulated results suggest that cyanamide and carbodiimide molecules come from surface chemistry at early evolutionary stages. Then they are released back to the gas phase, either by thermal process (in hot cores, hot corinos) or by shock-induced desorption (in shock regions). We speculate that it is an inefficient route to form a tautomer of adenine by starting from molecules cyanoacetylene (C3NH), cyanamide, and carbodiimide in ISM.
A solar metallicity galaxy at z &gt; 7? Possible detection of the [N ii] 122 μm and [O iii] 52 μm lines
Authors: Killi Meghana , Watson Darach , Fujimoto Seiji , Akins Hollis , Knudsen Kirsten , Richard Johan , Harikane Yuichi , Rigopoulou Dimitra , Rizzo Francesca , Ginolfi Michele , Popping Gergö , Kokorev Vasily 
Published: March 2023

ABSTRACT
We present the first detection of the [N ii] 122 $\mu$m and [O iii] 52 $\mu$m lines for a reionization-epoch galaxy. Based on these lines and previous [C ii] 158 $\mu$m and [O iii] 88 $\mu$m measurements, using two different radiative transfer models of the interstellar medium, we estimate an upper limit on electron density of ≲500 cm−3 and an approximate gas-phase metallicity of Z/Z⊙ ∼ 1.1 ± 0.2 for A1689-zD1, a gravitationally lensed dusty galaxy at z = 7.133. Other measurements or indicators of metallicity so far in galaxy interstellar media at z ≳ 6 are typically an order of magnitude lower than this. The unusually high metallicity makes A1689-zD1 inconsistent with the fundamental metallicity relation, although there is likely significant dust obscuration of the stellar mass, which may partly resolve the inconsistency. Given a solar metallicity, the dust-to-metals ratio is a factor of several lower than expected, hinting that galaxies beyond z ∼ 7 may have lower dust formation efficiency. Finally, the inferred nitrogen enrichment compared to oxygen, on which the metallicity measurement depends, indicates that star formation in the system is older than about 250 Myr, pushing the beginnings of this galaxy to z &gt; 10.
The influence of physiological and lifestyle factors on essential mineral element isotopic compositions in the human body: implications for the design of isotope metallomics research
Authors: Sullivan Kaj V , Moore Rebekah E T , Vanhaecke Frank 
Published: March 2023

Abstract
In the last 20 years, the application of high-precision isotopic analysis of essential mineral elements (Mg, K, Ca, Fe, Cu, and Zn) to biomedicine (sometimes referred to as isotope metallomics) has revealed that their stable isotopic compositions are altered by the metal dysregulation that is fundamental to the pathogenesis of many cancers and other diseases. Despite many published works showing the diagnostic and prognostic potential of this approach, a number of factors that may influence the stable isotopic composition of these essential mineral elements in healthy individuals remain unstudied. In this perspective article, we summarize the available evidence from trophic level studies, animal models, and ancient and modern humans, relating to physiological and lifestyle factors that appear likely (there is evidence indicating their influence) or unlikely (there is evidence indicating their lack of influence) to require controlling for when investigating variations in essential mineral element isotopic compositions in human subjects. We also discuss factors that require additional data to properly assess. There is evidence that sex, menopausal status, age, diet, vitamin and metal supplementation, genetic variation, and obesity influence the isotopic composition of at least one essential mineral element in the human body. The task of investigating potential influences on essential mineral element isotopic compositions in the human body is sizeable, but presents an exciting research opportunity, with each incremental advance helping to improve the quality of research output in the context of isotope metallomics.
Bisulfite probing reveals DNA structural intricacies
Authors: Bagshaw Andrew T M , Gemmell Neil J 
Published: March 2023

Abstract
In recent decades, study of DNA structure has largely been focused on the interrelationships between nucleotides at the level of nearest neighbours. A little-utilized approach to probing structure on a larger scale is non-denaturing bisulfite modification of genomic DNA in conjunction with high-throughput sequencing. This technique revealed a marked gradient in reactivity increasing towards the 5′ end of poly-dC:dG mononucleotide repeats as short as two base pairs, suggesting that access of the anion may be greater at these points due to positive-roll bending not predicted by existing models. Consistent with this, the 5′ ends of these repeats are strikingly enriched at positions relative to the nucleosome dyad that bend towards the major groove, while their 3′ ends tend to sit outside these areas. Mutation rates are also higher at the 5′ ends of poly-dC:dG when CpG dinucleotides are excluded. These findings shed light on the mechanisms underlying bending/flexibility of the DNA double helix as well as the sequences that facilitate DNA packaging.
The MksG nuclease is the executing part of the bacterial plasmid defense system MksBEFG
Authors: Weiß Manuela , Giacomelli Giacomo , Assaya Mathilde Ben , Grundt Finja , Haouz Ahmed , Peng Feng , Petrella Stéphanie , Wehenkel Anne Marie , Bramkamp Marc 
Published: March 2023

Abstract
Cells are continuously facing the risk of taking up foreign DNA that can compromise genomic integrity. Therefore, bacteria are in a constant arms race with mobile genetic elements such as phages, transposons and plasmids. They have developed several active strategies against invading DNA molecules that can be seen as a bacterial ‘innate immune system’. Here, we investigated the molecular arrangement of the Corynebacterium glutamicum MksBEFG complex, which is homologous to the MukBEF condensin system. We show here that MksG is a nuclease that degrades plasmid DNA. The crystal structure of MksG revealed a dimeric assembly through its C-terminal domain that is homologous to the TOPRIM domain of the topoisomerase II family of enzymes and contains the corresponding ion binding site essential for DNA cleavage in topoisomerases. The MksBEF subunits exhibit an ATPase cycle in vitro and we reason that this reaction cycle, in combination with the nuclease activity provided by MksG, allows for processive degradation of invading plasmids. Super-resolution localization microscopy revealed that the Mks system is spatially regulated via the polar scaffold protein DivIVA. Introduction of plasmids results in an increase in DNA bound MksG, indicating an activation of the system in vivo.
LncRNA HOTAIRM1 functions in DNA double-strand break repair via its association with DNA repair and mRNA surveillance factors
Authors: Chuang Tzu-Wei , Su Chun-Hao , Wu Pei-Yu , Chang Yao-Ming , Tarn Woan-Yuh 
Published: March 2023

Abstract
The eukaryotic exon junction complex component Y14 participates in double-strand break (DSB) repair via its RNA-dependent interaction with the non-homologous end-joining (NHEJ) complex. Using immunoprecipitation-RNA-seq, we identified a set of Y14-associated long non-coding RNAs (lncRNAs). The lncRNA HOTAIRM1 serves as a strong candidate that mediates the interaction between Y14 and the NHEJ complex. HOTAIRM1 localized to near ultraviolet laser-induced DNA damage sites. Depletion of HOTAIRM1 delayed the recruitment of DNA damage response and repair factors to DNA lesions and compromised the efficiency of NHEJ-mediated DSB repair. Identification of the HOTAIRM1 interactome revealed a large set of RNA processing factors including mRNA surveillance factors. The surveillance factors Upf1 and SMG6 localized to DNA damage sites in a HOTAIRM1-dependent manner. Depletion of Upf1 or SMG6 increased the level of DSB-induced non-coding transcripts at damaged sites, indicating a pivotal role for Upf1/SMG6-mediated RNA degradation in DNA repair. We conclude that HOTAIRM1 serves as an assembly scaffold for both DNA repair and mRNA surveillance factors that act in concert to repair DSBs.
Prophylactic and early outpatient treatment of COVID-19 in patients with kidney disease: considerations from the Immunonephrology Working Group of the European Renal Association (ERA-IWG)
Authors: Hilhorst Marc , Bemelman Frederike J , Bruchfeld Annette , Fernandez-Juarez Gema M , Floege Jürgen , Frangou Eleni , Goumenos Dimitrios , van Kooten Cees , Kronbichler Andreas , Stevens Kate I , Turkmen Kultigin , Wiersinga W Joost , Anders Hans-Joachim 
Published: March 2023

ABSTRACT
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic led to rapid vaccine development and large global vaccination schemes. However, patients with immune-mediated kidney disease, chronic kidney diseases and kidney transplant recipients show high non-response rates to vaccination despite more than three vaccinations and, consequently, reduced viral clearance capacity when infected while receiving certain immunosuppressants, carrying an elevated risk for coronavirus disease 2019 (COVID-19)-related morbidity and mortality. SARS-CoV-2 evolution has been characterized by the emergence of novel variants and spike mutations contributing to waning efficacy of neutralizing antibodies. To this end, the therapeutic field expands from vaccination towards a combined approach of immunization, pre-exposure prophylaxis and early post-exposure treatment using direct-acting antivirals and neutralizing monoclonal antibodies to treat early in the disease course and avoid hospitalization. This expert opinion paper from the Immunonephrology Working Group of the European Renal Association (ERA-IWG) summarizes available prophylactic and/or early treatment options (i.e. neutralizing monoclonal antibodies and direct-acting antivirals) of SARS-CoV-2-infected patients with immune-mediated kidney disease, chronic kidney disease and kidney transplant recipients.
VILLIN2 regulates cotton defense againstVerticillium dahliaeby modulating actin cytoskeleton remodeling
Authors: Li Wen-Bo , Song Shuang-Wei , Zhong Meng-Meng , Liu Lan-Gong , Su Lei , Han Li-Bo , Xia Gui-Xian , Sun Yong-Duo , Wang Hai-Yun 
Published: March 2023

AbstractThe active structural change of actin cytoskeleton is a general host response upon pathogen attack. This study characterized the function of the cotton (Gossypium hirsutum) actin-binding protein VILLIN2 (GhVLN2) in host defense against the soilborne fungus Verticillium dahliae. Biochemical analysis demonstrated that GhVLN2 possessed actin-binding, -bundling, and -severing activities. A low concentration of GhVLN2 could shift its activity from actin bundling to actin severing in the presence of Ca2+. Knockdown of GhVLN2 expression by virus-induced gene silencing reduced the extent of actin filament bundling and interfered with the growth of cotton plants, resulting in the formation of twisted organs and brittle stems with a decreased cellulose content of the cell wall. Upon V. dahliae infection, the expression of GhVLN2 was downregulated in root cells, and silencing of GhVLN2 enhanced the disease tolerance of cotton plants. The actin bundles were less abundant in root cells of GhVLN2-silenced plants than in control plants. However, upon infection by V. dahliae, the number of actin filaments and bundles in the cells of GhVLN2-silenced plants was raised to a comparable level as those in control plants, with the dynamic remodeling of the actin cytoskeleton appearing several hours in advance. GhVLN2-silenced plants exhibited a higher incidence of actin filament cleavage in the presence of Ca2+, suggesting that pathogen-responsive downregulation of GhVLN2 could activate its actin-severing activity. These data indicate that the regulated expression and functional shift of GhVLN2 contribute to modulating the dynamic remodeling of the actin cytoskeleton in host immune responses against V. dahliae.
A comparison of the assessments used in campus-based years at the College of Medicine, Imam Abdulrahman Bin Faisal University, Saudi Arabia
Authors: Latif Rabia , Alsunni Ahmed A 
Published: March 2023

Abstract

Study Purpose
Multiple assessment tools are used to assess future doctors’ knowledge, clinical skills, and professional attitudes. In the present research, the difficulty level and discriminating ability of different types of written and performance-based assessments designed to measure the knowledge and competency of medical students were compared.

Methods
The assessment data of 2nd & 3rd-year medical students (the academic year 2020-2021) in the College of Medicine at Imam Abdulrahman Bin Faisal University (IAU) were retrospectively reviewed. Based on end-of-the-year overall grades, students were divided into high and low scorers. Both groups were compared by independent sample t-test for their mean scores achieved in each type of assessment. Difficulty level and discriminating ability of the assessments were also explored. MS Excel and Statistical Package for Social Sciences (SPSS version 27) were used for analysis. Area under the curve was calculated through ROC analysis. A p-value &lt;0.05 was believed significant.

Results
In each type of written assessment, the high scorer group achieved significantly higher scores compared to the low scorers. Among performance-based assignments (except the PBLs), scores did not differ significantly between high and low scorers. The difficulty level of performance-based assessments was “easy” whereas it was “moderate” for written assessments (except the OSCE). The discriminating ability of performance-based assessments was “poor” whereas it was “moderate/excellent” for written assessments (except the OSCE).

Conclusion
Our study results indicate that written assessments have excellent discriminatory ability. However, performance-based assessments are not as difficult and discriminatory as written assessments. The PBLs are relatively discriminatory among all performance-based assessments.
Key messages What is already known on this topic At Imam Abdulrahman Bin Faisal University, written and performance-based assessments both are graded on criterion-referenced scales. The student’s grades at the end of the year are an aggregate of his/her scores in written and performance-based assessments. What this study adds Our study results show that performance-based assessments are not as difficult and discriminatory in differentiating between high and low scorers as written assessments. How this study might affect research, practice or policy Performance-based assessments should be made a hurdle exam (pass or fail) for the students to move to the next level, or students must pass each assessment component (written and performance-based) separately.
Health Care Professionals’ Decision Making Related to Mobility and Safety for People in the Hospital: A Scoping Review
Authors: Bainbridge Liz , Fary Robyn E , Briffa Kathy , Hill Keith D , Burton Elissa 
Published: March 2023

Abstract

Objective
Mobility dysfunction can have an impact on safety, and this fact is particularly relevant to hospital settings. There are no clear standards for how health care professionals should approach the aim to encourage mobility without compromising safety. The objective of this scoping review was to identify factors that shape health care professionals’ decision making for people in hospitals, in situations in which mobility and safety are taken into consideration.

Methods
For this scoping review, 4 databases (Medline, CINAHL, PubMed, and Scopus) were searched. Terms previously agreed upon were used to identify peer-reviewed articles related to decision making by health care professionals in hospital settings (acute and rehabilitation), in which safety and mobility were factors for consideration. An initial screening of titles and abstracts was conducted by a single reviewer. Two reviewers independently screened the full texts of the remaining articles. The key findings of the articles were synthesized to determine common themes.

Results
After 10,717 articles were screened, 28 met the inclusion criteria. Ten themes influencing decision making were identified: Clinical factors assessed; health care professional experience; limited use of standardized tests; impact of institutional governance; risk/benefit trade-off; capacity for decision making; role of the multidisciplinary team; families and others; communication; and fear of negative outcomes.

Conclusion
A wide range of factors influence health care professionals’ decision making. The decisions can be complex, and individual priorities may vary in the balancing of safety with promotion of independence. Health care professionals rely on experience, clinical judgment, and shared decision making.

Impact
This review brings attention to many factors that contribute to decision making when mobility and safety are the factors. Health care professionals should include patients’ values and monitor the impact of their personal preferences on this process.