bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing medical students’ perceived stress levels by comparing a chatbot-based approach to the Perceived Stress Questionnaire (PSQ20) in a mixed-methods study
Authors: Moldt Julia-Astrid , Festl-Wietek Teresa , Mamlouk Amir Madany , Herrmann-Werner Anne 
Published: November 2022

ObjectiveDigital transformation in higher education has presented medical students with new challenges, which has increased the difficulty of organising their own studies. The main objective of this study is to evaluate the effectiveness of a chatbot in assessing the stress levels of medical students in everyday conversations and to identify the main condition for accepting a chatbot as a conversational partner based on validated stress instruments, such as the Perceived Stress Questionnaire (PSQ20).MethodsIn this mixed-methods research design, medical-student stress level was assessed using a quantitative (digital- and paper-based versions of PSQ20) and qualitative (chatbot conversation) study design. PSQ20 items were also shortened to investigate whether medical students’ stress levels can be measured in everyday conversations. Therefore, items were integrated into the chat between medical students and a chatbot named Melinda.ResultsPSQ20 revealed increased stress levels in 43.4% of medical students who participated ( N  =  136). The integrated PSQ20 items in the conversations with Melinda obtained similar subjective stress degree results in the statistical analysis of both PSQ20 versions. Qualitative analysis revealed that certain functional and technical requirements have a significant impact on the expected use and success of the chatbot.ConclusionThe results suggest that chatbots are promising as personal digital assistants for medical students; they can detect students’ stress factors during the conversation. Increasing the chatbot's technical and social capabilities could have a positive impact on user acceptance.
Impact of Obesity on Severity of Ankle Fracture
Authors: Wong Liam H. , Atwater Lara C. , Wyland Alden E. 
Published: November 2022

Category: Trauma; Ankle Introduction/Purpose: Ankle fractures are one of the most common types of foot and ankle trauma requiring surgery. Prior studies have investigated the association between obesity and ankle fracture on a general level, but not all studies have broken down the data by ankle fracture pattern subtypes. The aim of this study was to investigate the association between obesity and severity of ankle fractures, as classified by single malleolar (isolated fibular, posterior malleolar or medial malleolar), bimalleolar, trimalleolar and pilon subtypes. Methods: We retrospectively investigated the patient charts of 1,326 treated ankle fractures from 2011 to 2021 at a level 1 trauma center as identified by CPT codes. Collected data included age, diagnosis, BMI (obese > 30 kg/ m2), and vitamin D. For this study, we excluded patients who did not have a fracture of a malleoli or a pilon fracture (n=129). Severity of fracture was determined by number of malleoli fractured with the addition of pilon fracture as the most severe. Inferential statistics were performed using ANOVA and chi-squared tests. Results: Of 1,197 patients with an operatively managed ankle fracture (median age 28.7 years), 516 (43.2%) were obese. There were 434 (36.3%) unimalleolar fractures, 396 (33.1%) bimalleolar fractures, 294 (24.6%) trimalleolar fractures, and 73 (6.1%) pilon fractures. Obesity represented 39.4% (n=171) of unimalleolar fractures, 42.7% (n=169) of bimalleolar fractures, 50.0% (n=147) of trimalleolar fractures, and 39.7% (n=29) of pilon fractures (P<0.037). There were 273 (62.9%) lateral malleolar fractures, 127 (29.3%) medial malleolar fractures, and 34 (7.8%) posterior malleolar fractures. Obesity represented 45.4% (n=124) of lateral malleolar fractures, 29.1% (n=37) of medial malleolar fractures, and 29.4% (n=10) of posterior malleolar fractures (P<0.004). Obese patients had a higher probability of a trimalleolar fracture compared to a unimalleolar (OR 1.54; 95% CI, 1.14-2.07; P=0.005) as well as having a lateral malleolar fracture compared to a medial malleolar (OR 2.02; 95% CI, 1.29-3.18; P=0.002). Conclusion: This review of all operatively treated ankle fractures at a level 1, academic trauma center suggests that obesity is associated with increasing severity of ankle fracture patterns, with the exception of pilon fractures. Obese patients have a higher probability of having a trimalleolar fracture than a unimalleolar fracture. Obese patients are also more likely to have a lateral malleolar fracture compared to a medial malleolar fracture. Patients and clinicians should be aware of this higher risk of trimalleolar fractures as these fractures are commonly associated with worse outcomes and a higher probability of developing osteoarthritis.
Impact of Pain in Other Body Regions on the Foot-Specific Quality of Life in Patients with Hallux Valgus
Authors: Yamaguchi Satoshi , Kimura Seiji , Mikami Yukio 
Published: November 2022

Category: Bunion Introduction/Purpose: The purpose of this study was to clarify the prevalence of pain outside the foot, and to determine the associations of pain outside the foot with foot-specific quality of life (QOL) in patients with hallux valgus. Methods: Patients scheduled to undergo surgery for idiopathic hallux valgus (rheumatoid forefoot deformity not included) were recruited. Patients less than 20 years old, and those with a history of foot and ankle surgery were excluded. Patients answered whether they experienced disabling pain in 13 body regions other than the foot. Foot-specific QOL was assessed using the Self- Administered Foot Evaluation questionnaire (SAFE-Q). Foot pain was quantified using the visual analogue scale (VAS). Patient characteristics, including age, sex, comorbidity, anxiety, and depression, were also surveyed. The association between pain elsewhere and the SAFE-Q and pain VAS scores were assessed using univariate and multivariate analyses. Results: Of 102 patients, 55 (54%) experienced pain other than the foot. All SAFE-Q subscale scores were lower, and pain VAS was higher in patients with pain elsewhere than in patients without. In the multivariate analysis, an increase in the number of pain regions was independently associated with a decrease in SAFE-Q scores and an increase in pain VAS. Conclusion: More than half of the patients with hallux valgus experienced pain elsewhere. The presence of pain elsewhere was associated with poorer foot-specific QOL and severer foot pain. Assessment of pain elsewhere is necessary to evaluate foot- specific QOL in HV patients.
Calcaneal Malunions Management and Types of Surgical Correction
Authors: Zeynalov Vadim , Arapova Irina 
Published: November 2022

Category: Hindfoot; Ankle Introduction/Purpose: Number of fractures of the calcaneus amounts to 1-5.7% of all fractures of skeleton bones according to various authors. Moreover, these figures correspond to 50% of all fractures of feet bones. Consequences of calcaneus malunion leads to early disability, arthrosis, pain syndrome, disorder of the entire low extremity axis of motion alongside cosmetic defects and shoe wearing discomfort. Purpose of the study: classification of calcaneal malunions based on a geometrically normal position and dimensions of hindfoot in order to develop optimal type of treatment for multicomponent calcaneal deformity. Methods: Twelve patients with post traumatic deformed hindfoot after malunited calcaneal fractures and as a result varus and valgus deformity, subtalar arthritis, pain syndrome, shoe wear discomfort at different stages after trauma (from 1 to 10 years) were examined, underwent surgical alignment of calcaneus and were followed up for 24 months. All cases were assessed clinically using the American Orthopaedic Foot & Ankle Society (AOFAS) and visual analog scale (VAS); radiologically by measuring hindfoot varus/valgus, talus tilt, Meary's angle, and hight of calcaneal. Results: It was found a significant improvement in AOFAS (55.2 preoperatively to 78.8 after 24 months) and VAS (65 preoperatively to 30.1). Moreover, our study revealed a significant improvement in the radiographic measurements including hindfoot varus/valgus, the talar inclination, Meary's angle, and hight of calcaneus. Conclusion: The elimination of angular hindfoot varus or valgus deformation, exostectomy of the lateral wall and subtalar fusion, as well as the use of a tricortical autograft for distarction arthrodesis at III-V type Zwipp and Rammelt classification, resulted in reduced pain, improved function, cosmetic results and shoe wearing.
How I use risk factors for success or failure of CD19 CAR T cells to guide management of children and AYA with B-cell ALL
Authors: Myers Regina M. , Shah Nirali N. , Pulsipher Michael A. 
Published: November 2022

Abstract
By overcoming chemotherapeutic resistance, chimeric antigen receptor (CAR) T cells facilitate deep, complete remissions and offer the potential for long-term cure in a substantial fraction of patients with chemotherapy refractory disease. However, that success is tempered with 10% to 30% of patients not achieving remission and over half of patients treated eventually experiencing relapse. With over a decade of experience using CAR T cells in children, adolescents, and young adults (AYA) to treat relapsed/refractory B-cell acute lymphoblastic leukemia (B-ALL) and 5 years since the first US Food and Drug Administration approval, data defining the nuances of patient-specific risk factors are emerging. With the commercial availability of 2 unique CD19 CAR T-cell constructs for B-ALL, in this article, we review the current literature, outline our approach to patients, and discuss how individual factors inform strategies to optimize outcomes in children and AYA receiving CD19 CAR T cells. We include data from both prospective and recent large retrospective studies that offer insight into understanding when the risks of CAR T-cell therapy failure are high and offer perspectives suggesting when consolidative hematopoietic cell transplantation or experimental CAR T-cell and/or alternative immunotherapy should be considered. We also propose areas where prospective trials addressing the optimal use of CAR T-cell therapy are needed.
Electroacupuncture improves cognitive impairment in diabetic cognitive dysfunction rats by regulating the mitochondrial autophagy pathway
Authors: Ge Xia , Wang Ling , Cui Qianqian , Yan Hongli , Wang Zhongbao , Ye Shandong , Zhang Qingping , Fei Aihua 
Published: November 2022

Abstract
Background
Diabetes-associated cognitive dysfunction has become a major public health concern. However, the mechanisms driving this disease are elusive. Herein, we explored how electroacupuncture improves learning and memory function in diabetic rats.

Methods
The diabetic model was established by intraperitoneal injection of streptozotocin (STZ) in adult Sprague–Dawley rats. Rats were fed on high-fat and high-sugar diets. Learning and memory functions were assessed using behavioral tests. The hematoxylin and eosin (H&E) staining, Western blotting, real-time PCR, ELISA, immunohistochemistry, and transmission electronic microscopy (TEM) was performed to test related indicators.

Results
High-fat and high-sugar diets impaired learning and memory function in rats, while electroacupuncture treatment reversed these changes. The model group presented highly prolonged escape latency compared to the control group, indicating impaired learning and memory functions. The TEM examination showed that electroacupuncture enhanced Aβ clearance and mitochondrial autophagy in hippocampal neuronal cells by increasing DISC1 expression.

Conclusions
Electroacupuncture improves learning and memory function in diabetic rats by increasing DISC1 expression to promote mitophagy. This enhanced Aβ clearance, alleviating cytotoxicity in hippocampal neuronal cells.
Optimisation of the core subset for the APY approximation of genomic relationships
Authors: Pocrnic Ivan , Lindgren Finn , Tolhurst Daniel , Herring William O. , Gorjanc Gregor 
Published: November 2022

Abstract
Background
By entering the era of mega-scale genomics, we are facing many computational issues with standard genomic evaluation models due to their dense data structure and cubic computational complexity. Several scalable approaches have been proposed to address this challenge, such as the Algorithm for Proven and Young (APY). In APY, genotyped animals are partitioned into core and non-core subsets, which induces a sparser inverse of the genomic relationship matrix. This partitioning is often done at random. While APY is a good approximation of the full model, random partitioning can make results unstable, possibly affecting accuracy or even reranking animals. Here we present a stable optimisation of the core subset by choosing animals with the most informative genotype data.

Methods
We derived a novel algorithm for optimising the core subset based on a conditional genomic relationship matrix or a conditional single nucleotide polymorphism (SNP) genotype matrix. We compared the accuracy of genomic predictions with different core subsets for simulated and real pig data sets. The core subsets were constructed (1) at random, (2) based on the diagonal of the genomic relationship matrix, (3) at random with weights from (2), or (4) based on the novel conditional algorithm. To understand the different core subset constructions, we visualise the population structure of the genotyped animals with linear Principal Component Analysis and non-linear Uniform Manifold Approximation and Projection.

Results
All core subset constructions performed equally well when the number of core animals captured most of the variation in the genomic relationships, both in simulated and real data sets. When the number of core animals was not sufficiently large, there was substantial variability in the results with the random construction but no variability with the conditional construction. Visualisation of the population structure and chosen core animals showed that the conditional construction spreads core animals across the whole domain of genotyped animals in a repeatable manner.

Conclusions
Our results confirm that the size of the core subset in APY is critical. Furthermore, the results show that the core subset can be optimised with the conditional algorithm that achieves an optimal and repeatable spread of core animals across the domain of genotyped animals.
Factors influencing conveyance of older adults with minor head injury by paramedics to the emergency department: a multiple methods study
Authors: Nicholson Helen , Voss Sarah , Black Sarah , Taylor Hazel , Williams David , Benger Jonathan 
Published: November 2022

Abstract
Background
Head injury (HI) in older adults due to low-energy falls result in a substantial number of emergency department (ED) attendances. However, mortality associated with minor HI is very low. Reducing conveyance to hospital is important for older adults and is a priority for the National Health Service (NHS). Therefore, paramedics are required to make accurate decisions regarding conveyance to the ED. This study used routine data and semi-structured interviews to explore the factors that influence paramedic decision-making when considering whether to convey an adult aged 65 years and over with a minor HI to the ED.

Methods
Semi-structured telephone interviews were completed with ten UK paramedics from a single EMS (ambulance) provider organisation. Interviews explored the factors influencing the paramedics’ conveyance decision-making in adults aged 65 years and over with a minor HI. Data were initially analysed inductively to develop a thematic framework. A retrospective analysis of ambulance service data was also completed to determine the scope and scale of the issue in Southwest England. An in-depth audit of 100 conveyed patient records was used to determine the proportion of patients conveyed to the ED who met National Institute for Health and Care Excellence (NICE) and Joint Royal Colleges Ambulance Liaison Committee (JRCALC) guidelines.

Results
In 2019 South Western Ambulance Service NHS Foundation Trust (SWASFT) attended 15,650 emergency calls to patients aged 65 and over with minor HI, with 70.5% conveyed to ED. 81% of conveyed patients met NICE and JRCALC guideline criteria for conveyance, with the remainder conveyed due to wound care or other medical concerns. The framework developed from the interviews comprised four themes: resources; patient factors; consequences; paramedic factors. Important factors included: the patient’s social situation; guidelines; clinical support availability; the history and presentation of the patient; risk.

Conclusion
This study examined paramedic conveyance decisions for older people with minor HI. It identified multiple influencing factors, highlighting the complex nature of these decisions, and may serve as a basis for developing an intervention to safely decrease ED conveyance in this patient group.
Using information from network meta-analyses to optimize the power and sample allocation of a subsequent trial with a new treatment
Authors: Hu Dapeng , Wang Chong , Ye Fangshu , O’Connor Annette M. 
Published: November 2022

Abstract
Background
A critical step in trial design is determining the sample size and sample allocation to ensure the proposed study has sufficient power to test the hypothesis of interest: superiority, equivalence, or non-inferiority. When data are available from prior trials and leveraged with the new trial to answer the scientific questions, the value of society’s investment in prior research is increased. When prior information is available, the trial design including the sample size and allocation should be adapted accordingly, yet the current approach to trial design does not utilize such information. Ensuring we maximize the value of prior research is essential as there are always constraints on resources, either physical or financial, and designing a trial with adequate power can be a challenge.

Methods
We propose an approach to increasing the power of a new trial by incorporating evidence from a network meta-analysis into the new trial design and analysis. We illustrate the methodology through an example network meta-analysis, where the goal is to identify the optimal allocation ratio for the new three-arm trial, which involves the reference treatment, the new treatment, and the negative control. The primary goal of the new trial is to show that the new treatment is non-inferior to the reference treatment. It may also be of interest to know if the new treatment is superior to the negative control. We propose an optimal treatment allocation strategy which is derived from minimizing the standard error of the log odds ratio estimate of the comparison of interest. We conducted a simulation study to assess the proposed methods to design a new trial while borrowing information from the existing network meta-analysis and compare it to even allocation methods.

Results
Using mathematical derivation and simulations, we document that our proposed approach can borrow information from a network meta-analysis to modify the treatment allocation ratio and increase the power of the new trial given a fixed total sample size or to reduce the total sample size needed to reach a desired power.

Conclusions
When prior evidence about the hypotheses of interest is available, the traditional equal allocation strategy is not the most powerful approach anymore. Our proposed methodology can improve the power of trial design, reduce the cost of trials, and maximize the utility of prior investments in research.
Appropriateness of antibiotic treatment of acute respiratory tract infections in Tunisian primary care and emergency departments: a multicenter cross-sectional study
Authors: Bel Haj Ali Khaoula , Sekma Adel , Messous Selma , Trabelsi Imen , Ben Youssef Jalel , Maghraoui Hamida , Razgallah Rabie , walha Adel , Grissa Mohamed Habib , Beltaief Kaouthar , Mezgar Zied , Coubantini Ahmed , Bouida Wahid , Msolli Mohamed Amine , Boukef Riadh , Boubaker Hamdi , Nouira Semir 
Published: November 2022

Abstract
Background
Little is known about the pattern and appropriateness of antibiotic prescriptions in patients with acute respiratory tract infections (ARTIs).

Objective
Describe the antibiotics used to treat ARTIs in Tunisian primary care offices and emergency departments (EDs), and assess the appropriateness of their use.

Methods
It was a prospective multicenter cross-sectional observational clinical study conducted at 63 primary care offices and 6 EDS during a period of 8 months. Appropriateness of antibiotic prescription was evaluated by trained physicians using the medication appropriateness index (MAI). The MAI ratings generated a weighted score of 0 to 18 with higher scores indicating low appropriateness. The study was conducted in accordance with the Declaration of Helsinki and national and institutional standards. The study was approved by the Ethics committee of Monastir Medical Faculty.

Results
From the 12,880 patients screened we included 9886 patients. The mean age was 47.4, and 55.4% were men. The most frequent diagnosis of ARTI was were acute bronchitis (45.3%), COPD exacerbation (16.3%), tonsillitis (14.6%), rhinopharyngitis (12.2%) and sinusitis (11.5%). The most prescribed classes of antibiotics were penicillins (58.3%), fluoroquinolones (17.6%), and macrolides (16.9%). Antibiotic therapy was inappropriate in 75.5% of patients of whom 65.2% had bronchitis. 65% of patients had one or more antibiotic prescribing inappropriateness criteria as assessed by the MAI. The most frequently rated criteria were with expensiveness (75.8%) and indication (40%). Amoxicillin-clavulanic acid and levofloxacin were the most inappropriately prescribed antibiotics. History of cardiac ischemia ([OR] 3.66; 95% [CI] 2.17–10.26; p < 0.001), asthma ([OR] 3.29, 95% [CI] 1.77–6.13; p < 0.001), diabetes ([OR] 2.09, 95% [CI] 1.54–2.97; p = 0.003), history of COPD ([OR] 1.75, 95% [CI] 1.43–2.15; p < 0.001) and age > 65 years (Odds Ratio [OR] 1.35, 95% confidence interval [CI] 1.16–1.58; p < 0.001) were associated with a higher likelihood of inappropriate prescribing.

Conclusion
Our findings indicate a high inappropriate use of antibiotics in ARTIs treated in in primary care and EDs. This was mostly related to antibiotic prescription in acute bronchitis and overuse of expensive broad spectrum antibiotics. Future interventions to improve antibiotic prescribing in primary care and EDs is needed.

Trial registration
the trial is registered at Clinicaltrials.gov registry (NCT04482231).