bluuebunny/crossref_metadata_2025_split huggingface dataset:
Editor's note
Authors: Marycz Adam 
Published: May 2022

Explainer Loose parts - Last month we explored James Tunnell's book, ‘Loose parts & beyond’, him and many others have written about them, but what do we mean by loose parts? It is nothing new, as England (2019) says, ‘look back at your own childhood’ ‘when children used sticks as swords’, this was loose parts play, even if we didn't label it as such. Other people refer to Simon Nicholson's theory of loose parts from the 1970's as being where it originated. However he may have created the term, not the concept. Daly and Beloglovsky (2015) says loose parts are materials that ‘children can carry, combine, redesign, line up, take apart and put… back together in almost endless ways.’ This means that any object matching the above description is a loose part, regardless of the material from which it is made.
‘Giving a piece of you’: the lecturer experience of aiding student wellbeing
Authors: Pavoni Katie , Phillips Louise 
Published: May 2022

Background: The mental health of ambulance clinicians is a national priority. For student paramedics, the risk and inherent vulnerability to poor mental wellbeing are significant. However, evidence exploring support in universities for paramedic students and the role of academic faculty in this within paramedic preregistration programmes is limited. Aims: To explore the experiences and perceptions of university lecturers towards supporting student paramedic wellbeing. Methods: A qualitative research design was adopted to explore the experiences of six paramedic senior lecturers from three urban universities. Data were collected via semi-structured interviews and thematically analysed using interpretative phenomenological analysis. Findings: Themes of ‘navigating the professional role,’ ‘the whole student’, ‘enabling cultural change’ and ‘supporting resilience and preparedness for practice’ were identified. Conclusions: University lecturers play a crucial role in student paramedic wellbeing and the unique role and identity of paramedic academics should be embraced. Paramedic programmes should consider a proactive approach to emotional health within the curriculum, alongside peer support, student-centred initiatives and tailored trauma support.
A randomized clinical trial demonstrating cell type specific effects of hyperlipidemia and hyperinsulinemia on pituitary function
Authors: McDonald Rosemary , Kuhn Katherine , Nguyen Thy B. , Tannous Andrew , Schauer Irene , Santoro Nanette , Bradford Andrew P. 
Published: May 2022

Introduction
Obesity is characterized by elevated lipids, insulin resistance and relative hypogonadotropic hypogonadism, reducing fertility and increasing risk of pregnancy complications and birth defects. We termed this phenotype ‘Reprometabolic Syndrome’ and showed that it can be recapitulated by acute infusions of lipid/insulin into healthy, normal weight, eumenorrheic women. Herein, we examined the broader impact of hyperlipidemia and euglycemic hyperinsulinemia on anterior pituitary trophic hormones and their targets.

Methods
Serum FSH, LH, TSH, growth hormone (GH), prolactin (PRL), thyroid hormones (free T4, total T3), cortisol, IGF-1, adiponectin, leptin and creatinine were measured in a secondary analysis of an interventional crossover study of 12 normal weight cycling women who underwent saline and heparin (control) infusion, or a euglycemic insulin infusion with heparin and Intralipid® (lipid/insulin), between days 2–5 in sequential menstrual cycles.

Results
In contrast to the decrease in gonadotropins, FSH and LH, infusion of lipid/insulin had no significant effects on other trophic hormones; TSH, PRL or GH. Thyroid hormones (fT4 and total T3), cortisol, IGF-1, adiponectin and creatinine also did not differ between saline or lipid/insulin infusion conditions. Leptin increased in response to lipid/insulin (p<0.02).

Conclusion
Acute hyperlipidemia and hyperinsulinemia exerted differential, cell type specific effects on the hypothalamic-pituitary-gonadal, adrenal and thyroid axes. Elucidation of mechanisms underlying the selective modulation of pituitary trophic hormones, in response to changes in diet and metabolism, may facilitate therapeutic intervention in obesity-related neuroendocrine and reproductive dysfunction.
Use of digital teaching resources and predictors of medical student performance during the pandemic: A prospective study
Authors: Seer Michelle , Kampsen Charlotte , Becker Tim , Hobert Sebastian , Anders Sven , Raupach Tobias 
Published: May 2022

Background
The coronavirus pandemic has led to increased use of digital teaching formats in medical education. A number of studies have assessed student satisfaction with these resources. However, there is a lack of studies investigating changes in student performance following the switch from contact to virtual teaching. Specifically, there are no studies linking student use of digital resources to learning outcome and examining predictors of failure.

Methods
Student performance before (winter term 2019/20: contact teaching) and during (summer term 2020: no contact teaching) the pandemic was compared prospectively in a cohort of 162 medical students enrolled in the clinical phase of a five-year undergraduate curriculum. Use of and performance in various digital resources (case-based teaching in a modified flipped classroom approach; formative key feature examinations of clinical reasoning; daily multiple choice quizzes) was recorded in summer 2020. Student scores in summative examinations were compared to examination scores in the previous term. Associations between student characteristics, resource use and summative examination results were used to identify predictors of performance.

Results
Not all students made complete use of the digital learning resources provided. Timely completion of tasks was associated with superior performance compared to delayed completion. Female students scored significantly fewer points in formative key feature examinations and digital quizzes. Overall, higher rankings within the student cohort (according to summative exams) in winter term 2019/20 as well as male gender predicted summative exam performance in summer 2020. Scores achieved in the first formative key feature examination predicted summative end-of-module exam scores.

Conclusions
The association between timely completion of tasks as well as early performance in a module and summative exams might help to identify students at risk and offering help early on. The unexpected gender difference requires further study to determine whether the shift to a digital-only curriculum disadvantages female students.
A Rare Case of Mitochondrial Neurogastrointestinal Encephalomyopathy
Authors: Manski Scott Adam , Adkins Christopher , Smith Colin , Blair Brian 
Published: May 2022

ABSTRACT
Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is a rare autosomal recessive disease due to mutations in the thymidine phosphorylase gene, leading to mitochondrial alterations and dysfunctions in oxidative phosphorylation. MNGIE is a multisystem disorder with gastrointestinal symptoms arising in large part from gut dysmotility and neurological manifestations including peripheral neuropathy. We discuss a patient with chronic vomiting, diarrhea, and weight loss with a prior unrevealing extensive workup who was hospitalized for severe protein-calorie malnutrition. The patient was found to have gastrointestinal dysmotility on a gastric emptying scan and persistently elevated lactate levels and was subsequently diagnosed with MNGIE after confirmatory testing.
Area Deprivation Index and Gut-Brain Axis in Cirrhosis
Authors: Bajaj Jasmohan S. , Fagan Andrew , McGeorge Sara , Sterling Richard K. , Rogal Shari , Sikaroodi Masoumeh , Gillevet Patrick M. 
Published: May 2022

INTRODUCTION:
Neighborhood deprivation has been associated with chronic diseases and with gut microbial alterations. Although cirrhosis is associated with gut microbiome changes and hepatic encephalopathy (HE), their association is unclear.

METHODS:
Demographics and cirrhosis details (model for end-stage liver disease [MELD], prior HE, and medications) were recorded from outpatients with cirrhosis. Area deprivation index (ADI), which ranks neighborhoods by socioeconomic disadvantage, was recorded as state decile and national percentile (high = worse for both) and dichotomized on the median. Patients underwent cognitive testing to diagnose minimal HE (MHE). Stool microbiota was analyzed using 16S ribosomal RNA for α/β-diversity. Multivariable analysis was used to evaluate the factors independently associated with MHE.

RESULTS:
A total of 321 people with cirrhosis (60 years, 78% men, 75% non-Hispanic White, 24% non-Hispanic African American, 4% Hispanic) were included. 45% had prior HE and 56% MHE. For ADI, the national percentile was 49.1 ± 21.8 while the state decile was 6.1 ± 2.3. ADI was not associated with race, ethnicity, MELD, or HE-related variables on regression. Regarding microbiota, α-diversity was lower in MHE and prior HE patients but similar across ADI rankings. Low vs high ADIs were associated with different β-diversity in univariable but not multivariable analyses. Multivariable analyses showed positive associations with MELD, prior HE, and lactate producers (Lactobacillus and Lacticaseibacillus) and negative associations with short-chain fatty acid producers (Blautia, Lachnoclostridium, and Anaerobutyricum) with MHE.

DISCUSSION:
Cirrhosis-related variables may be more influential in determining gut microbiome composition and cognitive impairment than ADI. Therefore, the focus should be on improving cirrhosis care, regardless of ADI, but studies evaluating other measures of social determinants are needed in cirrhosis.
Difficult-to-treat rheumatoid arthritis in the clinical practice of a rheumatological hospital. First look
Authors: Gordeev A. V. , Matyanova E. V. , Olyunin Yu. A. , Galushko E. A. , Zotkin E. G. 
Published: May 2022

Objective: to compare the course of the disease and therapy in rheumatoid arthritis (RA) patients who meet and do not meet the criteria for difficult- to-treat RA (D2T).Patients and methods. The study included RA patients who met the 2010 ACR/EULAR criteria and who were hospitalized in the V.A. Nasonova Research Institute of Rheumatology from March to October 2021. All patients underwent a conventional clinical and laboratory examination, radiography of the hands and distal feet, and the radiological stage of RA according to Steinbroker was assessed. To determine the inflammatory activity, the DAS28-ESR and DAS28-CRP indices were calculated.Results and discussion. The study included 303 patients with RA, 25 (8.4%) of them had D2T RA. The duration of RA in the D2T group was significantly longer than in other patients (15.9±11.8 and 11.9±9 years, respectively; p=0.04). X-ray changes in the joints in D2T were more pronounced. Patients with D2T had higher inflammatory activity at the time of hospitalization than patients who had continued prior therapy with biologic/targeted synthetic DMARDs. The dose of glucocorticoids (GC) in patients with D2T RA was higher compared to patients of other groups: on average 8.3±5.1 and 6.4±2.9 mg/day, respectively (p=0.02).Conclusion. The results of this study suggest that in Russia, as well as abroad, the treat-to-target principle has not yet become widespread, and the selection of adequate therapy takes too much time. At the same time, Russian rheumatologists primarily use GC to suppress inflammatory activity. The introduction of modern recommendations for the management of patients with RA into routine clinical practice, could possibly restrain the formation of D2T RA.
Systematic review and meta-analysis: risk factors for psoriatic arthritis. Part 2
Authors: Pereverzina N. O. , Kruglova L. S. , Korotaeva T. V. , Lila A. M. 
Published: May 2022

Psoriasis (PsO) is a chronic immune-mediated disease, in the pathogenesis of which various risk factors (RFs) and genetic predisposition play an important role. The complex interaction of genetic and trigger factors leads to the development of autoimmune and autoinflammatory reactions. Every fourth patient with skin PsO develops psoriatic arthritis (PsA), which, progressing and left untreated, can cause irreversible functional disorders, which necessitates early diagnosis of this disease.Objective: to identify endogenous risk factors for the development of PsA.Material and methods. We searched PubMed (MEDLINE), EMBASE, and Google Scholar databases for articles on endogenous risk factors for the development of PsA that were published over the past 10 years (until March 1, 2021). We searched for currently registered trials in the registers of clinical trials of US (ClinicalTrials.gov), of China (Chinese Clinical Trial Registry) and the WHO International Clinical Trial Registry Platform. The statistical analysis was prepared in accordance with the international guidelines for systematic reviews and meta-analysis (PRISMA) using the Statistic SPSS 26.0 program (USA). Meta-analysis was prepared using RevMan 5 software.Results and discussion. Part 2 of the systematic review included 56 articles on endogenous risk factors for the development of PsA. When preparing a meta-analysis, a statistically significant increase (1.68 times) in the risk of developing PsA in the presence of psoriatic lesions of the scalp was noted (95% confidence interval, CI 1.09–2.61). There was no statistically significant increase in the risk of developing PsA in the presence of inverse PsO. The mean PASI was significantly higher (mean difference 2.64; 95% CI 1.37–3.91) in patients with PsA compared with patients without this disease. Mean duration of illness was also longer (mean difference 2.64 years; 95% CI 1.34–4.50) in patients with PsA than in patients with PsO.Conclusion: PsO and PsA are multifactorial diseases. RFs not only affect their development, but also determine the characteristics of the clinical course, severity, and the presence of complications. Understanding the risk factors of the development of PsA is important for assessing the prognosis, timely diagnosis, and early initiation of therapy, which will prevent severe forms of the disease and disability in patients.
Undifferentiated connective tissue dysplasia and knee osteoarthritis: clinical manifestations and the state of carbohydrate metabolism
Authors: Popov A. A. , Izmozherova N. V. , Getmanova N. A. 
Published: May 2022

Objective: to evaluate the impact of undifferentiated connective tissue dysplasia (CTD) on the clinical manifestations of primary osteoarthritis (OA) in postmenopausal women.Patients and methods. The case-control study included 38 postmenopausal women with primary knee OA, radiological stage II. The main group included 19 patients who met the criteria for CTD, the control group included 19 patients without CTD.Results and discussion. Patients in the control group had significantly higher values of body mass index, hip circumference and more pronounced clinical manifestations of menopausal syndrome. Patients in the control group had all clinical components and laboratory criteria of the metabolic syndrome, they also had greater limitations of joint function compared to patients of the main group. In patients with CTD pathogenetic mechanisms of development and progression of OA differ from the metabolic phenotype of OA.Conclusion. The dysplastic phenotype of OA develops in the absence of metabolic syndrome and with less functional impairment than the metabolic phenotype. The metabolic phenotype of OA is associated with insulin resistance, more pronounced functional and psycho-emotional disturbances.
Therapeutic potential of a drug based on avocado and soy unsaponifiable compounds in the treatment of osteoarthritis: data from Russian and international studies (descriptive review)
Authors: Karateev A. E. , Lila A. M. 
Published: May 2022

Slow-acting symptomatic drugs (SYSADOA) occupy one of the leading positions in the complex treatment of osteoarthritis (OA). These drugs have a symptomatic and structure-modifying effect, while they are well tolerated and rarely cause serious adverse reactions (AEs). This review examines the evidence base for the use of one of the most popular SYSADOAs, avocado-soybean unsaponifiable compounds (ASACs, Piascledine 300).Objective: to provide the most complete analysis of clinical trials of ASACs in OA.Patients and methods. We performed a search in English-language (PubMed) and Russian-language (eLIBRARY.ru) electronic libraries for publications on clinical studies of the efficacy and safety of ASACs in OA. Among the English-language publications were selected: 3 randomized controlled trials (RCTs) of ASACs and their symptomatic effect (n=587), 2 RCTs of the structure-modifying effect of ASACs (n=562), 1 RCT comparing the effect of ASACs and chondroitin sulfate (n=364), and 1 observational study of ASACs in real practice (n=4185). Among the Russian- language publications, 1 observational study of ASACs in real practice (n=6448) and 5 papers containing data from open clinical trials of ASACs (n=356) were found.Results and discussion. According to the results of the presented studies, ASACs have proven efficacy in reducing the intensity of pain and dysfunction in knee OA. There are data confirming the structure-modifying effect of ASACs in OA of the hip joint (HJ). This drug is well tolerated: in RCTs, the incidence of AEs during ASACs and placebo usage was comparable. In observational studies (n=10 634), there were no serious AEs associated with the use of ASACs.Conclusion. There is a robust evidence base for the expediency of the active use of ASACs in knee OA. Given the similarity of the pathogenesis of OA of different localizations, the data of individual successful studies and a favorable safety profile, the use of ASACs can also be considered as a component of the complex treatment of OA of the hip joint, hand joints and spine.
Treatment of osteoporosis in clinical practice: first experience with the Russian generic drug of zoledronic acid
Authors: Toroptsova N. V. , Efremova A. O. , Korotkova T. A. , Dobrovolskaya O. V. , Demin N. V. , Feklistov A. Yu. , Samarkina E. Yu. , Cherkasova M. V. 
Published: May 2022

Objective: to evaluate the effect of the generic drug of zoledronic acid on bone mineral density (BMD) and markers of bone metabolism in patients with osteoporosis (OP), as well as possible long-term adverse reactions (AR) 12 months after drug administration.Patients and methods. The study included 30 postmenopausal women with OP (mean age 64±8 years) who signed an informed consent of participance in clinical observation. Patients received a single dose of generic zoledronic acid (5 mg) as a 15-minute infusion. All patients additionally took calcium and vitamin D. The dynamics of BMD and bone metabolism markers, as well as the safety and tolerability of the drug, were evaluated. Fractures that might have occurred during follow-up should have been reported as ARs.Results and discussion. During treatment with generic zoledronic acid, the increase in BMD in the lumbar region was 4.9% (p<0.0001), in the femoral neck –2.7% (p<0.01), and in the femur as a whole – 3.0% (p<0.0001). Positive dynamics (increase in BMD>2%) in the spine was detected in 26 (86.7%) patients, in the proximal femur – in 20 (66.7%) patients. There was a decrease in the intensity of pain in both the thoracic (by 62%; p=0.038) and lumbar (by 29%; p=0.022) spine. Three months after the administration of the drug, a decrease in the level of bone metabolism markers was revealed: CTX – by an average of 29.7%, and P1NP – by an average of 25.5%. ARs were post-dose reactions that occurred within the first 48 hours after drug infusion. Remote ARs, fractures of peripheral bones and vertebrae were not recorded.Conclusion. The use of the generic drug of zoledronic acid has demonstrated its positive effect on BMD and markers of bone metabolism, as well as safety.
Akumulasi logam Pb pada Air, Sedimen, dan Kerang Hijau (Perna viridis) di Perairan Tambak Lorok serta Analisis Batas Aman Konsumsi untuk Manusia
Authors: Kusuma Rizky Budhi , Supriyantini Endang , Munasik Munasik 
Published: May 2022

Tambak Lorok merupakan salah satu wilayah di Semarang yang dikelilingi oleh berbagai industri. Tambak Lorok juga menjadi kawasan pemukiman nelayan serta menjadi pusat penjualan hasil laut dengan adanya TPI Tambak Lorok. Limbah buangan industri dan rumah tangga di sekitar Tambak Lorok diduga menyebabkan terjadinya pencemaran logam berat timbal (Pb) di perairan yang tentunya dapat mempengaruhi organisme laut seperti kerang hijau (Perna viridis). Penelitian ini bertujuan untuk menganalisis kandungan logam berat Pb pada air, sedimen dan kerang hijau (Perna viridis) di Perairan Tambak Lorok, Semarang serta mengetahui hubungannya. Penelitian ini dilaksanakan pada bulan Januari – Maret 2021 dengan metode penelitian eksploratif kuantitatif. Analisis kandungan logam berat timbal (Pb) pada air, sedimen dan kerang hijau dilakukan di Laboratorium Teknik Lingkungan Universitas Diponegoro dengan metode AAS (Atomic Absorption Spectrophotometer). Hasil menunjukkan bahwa kandungan logam berat Pb Nilai determinasi (R2) kandungan logam berat timbal (Pb) dalam sedimen di Perairan Tambak Lorok yaitu R2 = 0,40 dan pada air yaitu R2 = 0,07. Hasil analisis korelasi menunjukkan tingkat keeratan hubungan yang kuat yaitu dengan nilai r = 0,63, sedangkan pada air terhadap kerang hijau (P. viridis) menunujukkan tingkat keeratan hubungan yang lemah dengan nilai r = 0,26. Tambak Lorok is one of the areas in Semarang which is surrounded by various industries. Tambak Lorok is also a residential area for fishermen and a center for selling marine products with the Tambak Lorok TPI. Industrial and household effluents around Tambak Lorok are suspected of causing heavy metal lead (Pb) pollution in the waters which of course can affect marine organisms such as green mussels (Perna viridis). This study aims to analyze the heavy metal content of Pb in water, sediment and green mussels (Perna viridis) in Tambak Lorok Waters, Semarang and to determine the relationship. This research was conducted in January – March 2021 with explorative quantitative research methods. Analysis of the heavy metal content of lead (Pb) in water, sediment and green mussels was carried out at the Environmental Engineering Laboratory of Diponegoro University using the AAS (Atomic Absorption Spectrophotometer) method. The results showed that the heavy metal content of Pb The determination value (R2) of the heavy metal content of lead (Pb) in the sediment in Tambak Lorok waters was R2 = 0.40 and in the water was R2 = 0.07. The results of the correlation analysis showed a strong level of a close relationship with a value of r = 0.63, while in water to green mussels (P. viridis) it showed a weak level of a close relationship with a value of r = 0.26.