bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effects of living and learning conditions on the health-related quality of life of children and adolescents during the COVID-19 lockdown in the French Grand Est region
Authors: Bourion-Bédès Stéphanie , Rousseau Hélène , Batt Martine , Tarquinio Pascale , Lebreuilly Romain , Sorsana Christine , Legrand Karine , Tarquinio Cyril , Baumann Cédric 
Published: March 2022

Abstract
Introduction
COVID-19 lockdown measures resulted in children and adolescents staying and learning at home. This study investigated health-related quality of life (HRQoL) and its associated factors among youth during the first lockdown.

Methods
A cross-sectional study was conducted among 8- to 18-year-olds from the French Grand Est region. Sociodemographic data and information on living and learning conditions were collected using an online survey. HRQoL was assessed using the KIDSCREEN-27. Multiple regression analysis was performed to explore factors related to low HRQoL in each dimension.

Results
In total, 471 children from 341 households were included. Difficulties isolating at home were associated with low HRQoL in the psychological well-being (OR = 2.2, 95% CI: 1.2–4.0) and parent relations and autonomy (OR = 2.1, 95% CI: 1.2–3.8) dimensions. Conflicts with dwelling occupants were related to increased ORs in the psychological well-being (OR = 2.9, 95% CI: 1.9–4.6), parent relations and autonomy (OR = 2.2, 95% CI: 1.4–3.4) and school environment (OR = 2.4, 95% CI: 1.5–3.7) dimensions. Living in an apartment (OR = 1.8, 95% CI: 1.1–3.1), never leaving home (OR = 2.6, 95% CI: 1.2–5.9), having indoor noise at home (OR = 2.3, 95% CI: 1.2–4.6), and having a parent with high anxiety (OR = 1.8, 95% CI: 1.1–3.1) were associated with low HRQoL in the social support and peers dimension. Children working less than 1 h/day on schoolwork had an increased OR of 3.5 (95% CI: 1.4–9.0) in the school environment dimension.

Conclusion
Living and learning conditions were associated with low HRQoL among children and adolescents during the COVID-19 lockdown. Prevention and intervention programs are needed to support youth by facilitating their interactions and improving their coping and to prepare for future waves.
Ethical challenges and moral distress among field epidemiologists
Authors: Cooke Emma , Lopez George , Hilmers Angela , Addiss David G. 
Published: March 2022

AbstractBackgroundAs ‘disease detectives’ and directors of public health programs, field epidemiologists play essential roles in protecting public health. Although ethical issues receive considerable attention in medical and research settings, less is known about ethical challenges faced by field epidemiologists in public health programs. Similarly, little is known about moral distress among field epidemiologists, i.e., situations in which they are constrained from acting on what they know to be morally right. Moral distress is strongly associated with empathy fatigue, burnout, reduced job retention, and disengagement. To better understand ethics training needs for field epidemiologists, in February 2019, members of TEPHIConnect, an online and mobile networking platform for Field Epidemiology Training Program (FETP) alumni, were invited to participate in an anonymous survey about ethical challenges and moral distress.ResultsAmong 126 respondents from 54 countries, leading causes of ethical dilemmas included inadequate informed consent (61%), inequitable allocation of resources (49%), and conflicts of interest (43%). These occur primarily in settings of disease outbreaks (60%); research (55%); and public health programs at the state, province, or national level (45%) or community level (43%). Work-related moral distress was reported by 91% of respondents, including 26% who experience it “frequently” or “almost always.” Field epidemiologists working in low- and low-middle income countries were more likely to report moral distress “frequently” or “almost always” than those in higher-income countries (33.0% vs 9.1%,P = 0.006). The most common perceived contributors to moral distress included excessive stress and work demands (30%) and inadequate support from leaders (25%).ConclusionsField epidemiologists face significant work-related ethical challenges, which are endemic to public health and political systems. A substantial proportion of field epidemiologists also experience some degree of moral distress, often in association with these challenges. These findings indicate an unmet need among field epidemiologists for support in navigating ethical challenges, as well as for resources to address the human and professional consequences of moral distress.
Effects of non-surgical decompression therapy in addition to routine physical therapy on pain, range of motion, endurance, functional disability and quality of life versus routine physical therapy alone in patients with lumbar radiculopathy; a randomized controlled trial
Authors: Amjad Fareeha , Mohseni-Bandpei Mohammad A. , Gilani Syed Amir , Ahmad Ashfaq , Hanif Asif 
Published: March 2022

Abstract
Background
Lumbar radiculopathy is an extensively common complaint reported by patients of low back pain (LBP), resulting in several impairments. A comparatively novel technique, non-surgical spinal decompression (NSD), is introduced, which uses a sensitive computerized feedback mechanism and decompresses the spinal nerve roots through segmental distraction. The objective of this study was to determine the effects of NSD therapy in addition to routine physical therapy on pain, lumbar range of motion (ROM), functional disability, back muscle endurance (BME), and quality of life (QOL) in patients with lumbar radiculopathy.

Methods
A total of sixty patients with lumbar radiculopathy were randomly allocated into two groups, an experimental (n = 30) and a control (n = 30) group, through a computer-generated random number table. Baseline values were recorded before providing any treatment by using a visual analogue scale (VAS), Urdu version of Oswestry disability index (ODI-U), modified-modified Schober’s test (MMST), prone isometric chest raise test, and Short Form 36-Item Survey (SF-36) for measuring the pain at rest, functional disability, lumbar ROM, BME, and QOL, respectively. All patients received twelve treatment sessions over 4 weeks, and then all outcome measures were again recorded.

Results
By using the ANCOVA test, a statistically significant (p < 0.05) between-group improvement was observed in VAS, ODI-U, BME, lumbar ROM, role physical (RP), and bodily pain (BP) domains of SF-36, which was in favour of NSD therapy group. The between-group difference was 1.07 ± 0.32 cm (p < .001) for VAS, 5.65 ± 1.48 points (p < .001) for ODI-U, 13.93 ± 5.85 s (p = 0.002) for BME, 2.62 ± 0.27 cm (p < .001) for lumbar flexion, 0.96 ± 0.28 (p < .001) for lumbar extension, 5.77 ± 2.39 (p = 0.019) for RP and 6.33 ± 2.52 (p = 0.016) for BP domain of SF-36. For these outcomes, a medium to large effect size (d = 0.61–2.47, 95% CI: 0.09–3.14) was observed.

Conclusion
It was concluded that a combination of non-surgical spinal decompression therapy with routine physical therapy is more effective, statistically and clinically, than routine physical therapy alone in terms of improving pain, lumbar range of motion, back muscle endurance, functional disability, and physical role domain of quality of life, in patients with lumbar radiculopathy, following 4 weeks of treatment.

Trial registration
WHO Iranian registry of clinical trials (IRCT20190717044238N1) Dated: 23.12.2019.
Efficacy of a pharmacist-managed diabetes clinic in high-risk diabetes patients, a randomized controlled trial - “Pharm-MD”
Authors: Halalau Alexandra , Sonmez Melda , Uddin Ahsan , Karabon Patrick , Scherzer Zachary , Keeney Scott 
Published: March 2022

Abstract
Background
Diabetes mellitus affects 13% of American adults. To address the complex care requirements necessary to avoid diabetes-related morbidity, the American Diabetes Association recommends utilization of multidisciplinary teams. Research shows pharmacists have a positive impact on multiple clinical diabetic outcomes.

Methods
Open-label randomized controlled trial with 1:1 assignment that took place in a single institution resident-run outpatient medicine clinic. Patients 18–75 years old with type 2 diabetes mellitus and most recent HbA1c ≥9% were randomized to standard of care (SOC) (continued with routine follow up with their primary provider) or to the SOC + pharmacist-managed diabetes clinic PMDC group (had an additional 6 visits with the pharmacist within 6 months from enrollment). Patients were followed for 12 months after enrollment. Data collected included HbA1c, lipid panel, statin use, blood pressure control, immunization status, and evidence of diabetic complications (retinopathy, nephropathy, neuropathy). Intention-to-treat and per-protocol analysis were performed.

Results
Forty-four patients were enrolled in the SOC + PMDC group and 42 patients in the SOC group. Average decrease in HbA1c for the intervention compared to the control group at 6 months was − 2.85% vs. -1.32%, (p = 0.0051). Additionally, the odds of achieving a goal HbA1c of ≤8% at 6 months was 3.15 (95% CI = 1.18, 8.42, p = 0.0222) in the intervention versus control group. There was no statistically significant difference in the remaining secondary outcomes measured.

Conclusions
Addition of pharmacist managed care for patients with type 2 diabetes mellitus is associated with significant improvements in HbA1c compared with standard of care alone. Missing data during follow up limited the power of secondary outcomes analyses.

Trial registration
ClinicalTrials.gov, ID:NCT03377127; first posted on 19/12/2017.
Antimicrobial activity, in vitro anticancer effect (MCF-7 breast cancer cell line), antiangiogenic and immunomodulatory potentials of Populus nigra L. buds extract
Authors: Kis Brigitta , Pavel Ioana Zinuca , Avram Stefana , Moaca Elena Alina , Herrero San Juan Martina , Schwiebs Anja , Radeke Heinfried H. , Muntean Delia , Diaconeasa Zorita , Minda Daliana , Oprean Camelia , Bojin Florina , Dehelean Cristina Adriana , Soica Codruta , Danciu Corina 
Published: March 2022

Abstract
Purpose
The aim of this study was to evaluate the antioxidant potential, antimicrobial activity, the in vitro anticancer effect (tested on MCF-7 breast cancer cell line), as well as the antiangiogenic and immunomodulatory potential of Populus nigra L. bud (Pg) extract collected from the western part of Romania.

Results
Populus nigra L. bud extract presents an important antioxidant activity, due to the rich phytochemical composition. Regarding the biological activity, results have shown that poplar bud extract presents a significant inhibitory activity against Gram-positive bacteria and a dose-dependent decrease of MCF-7 tumor cell viability with an IC50 of 66.26 μg/mL, while not affecting healthy cells. Phenomena of early apoptotic events at the maximum concentration tested (150 μg/mL) were detected by Annexin V-PI double staining. The extract induced G0/G1 phase cell cycle arrest. In addition, Pg extract showed antiangiogenic potential on the chorioallantoic membrane. Also, at the highest concentration (150 μg/mL), good tolerability and no signs of toxicity upon vascular plexus were observed. Moreover, in low concentrations, the Pg extract had immunomodulatory activity on primary human dendritic cells by upregulating IL-12 and IL-23 subunits.

Conclusion
The study concludes that poplar bud extract elicited antioxidant activity, antitumor properties on the breast cancer cell line, followed by an antiangiogenic effect and an immunomodulatory potential on human primary dendritic cells. The biological activity of Populus nigra L. buds extract may open new directions of research on the topic addressed.
Implementing a flipped classroom model in an evidence-based medicine curriculum for pre-clinical medical students: evaluating learning effectiveness through prospective propensity score-matched cohorts
Authors: Tsao Yen-Po , Yeh Wan-Yu , Hsu Teh-Fu , Chow Lok-Hi , Chen Wei-Chih , Yang Ying-Ying , Shulruf Boaz , Chen Chen-Huan , Cheng Hao-Min 
Published: March 2022

AbstractBackgroundIn a flipped classroom (FC) model, blended learning is used to increase student engagement and learning by having students finish their readings at home and work on problem-solving with tutors during class time. Evidence-based medicine (EBM) integrates clinical experience and patient values with the best evidence-based research to inform clinical decisions. To implement a FC and EBM, students require sufficient information acquisition and problem-solving skills. Therefore, a FC is regarded as an excellent teaching model for tutoring EBM skills. However, the effectiveness of a FC for teaching EBM competency has not been rigorously investigated in pre-clinical educational programs. In this study, we used an innovative FC model in a pre-clinical EBM teaching program.MethodsFC’s teaching was compared with a traditional teaching model by using an assessment framework of prospective propensity score matching, which reduced the potential difference in basic characteristics between the two groups of students on 1:1 ratio. For the outcome assessments of EBM competency, we used an analysis of covariance and multivariate linear regression analysis to investigate comparative effectiveness between the two teaching models. A total of 90 students were prospectively enrolled and assigned to the experimental or control group using 1:1 propensity matching.ResultsCompared with traditional teaching methods, the FC model was associated with better learning outcomes for the EBM competency categories of Ask, Acquire, Appraise, and Apply for both written and oral tests at the end of the course (allp-values< 0.001). In particular, the “appraise” skill for the written test (6.87 ± 2.20) vs. (1.47 ± 1.74),p < 0.001), and the “apply” skill for the oral test (7.34 ± 0.80 vs. 3.97 ± 1.24,p < 0.001) had the biggest difference between the two groups.ConclusionsAfter adjusting for a number of potential confunding factors, our study findings support the effectiveness of applying an FC teaching model to cultivate medical students’ EBM literacy.
Interrater reliability in the assessment of physiotherapy students
Authors: Gittinger Flora P. , Lemos Martin , Neumann Jan L. , Förster Jürgen , Dohmen Daniel , Berke Birgit , Olmeo Anke , Lucas Gisela , Jonas Stephan M. 
Published: March 2022

Abstract
Background
Reliable and objective assessment of psychomotor skills in physiotherapy students’ education is essential for direct feedback and skill improvement. The aim of this study is to determine the interrater reliability in the assessment process of physiotherapy students and to analyse the assessment behaviour of the examiners.

Methods
Physiotherapy teachers from two different schools assessed students from two different schools performing proprioceptive neuromuscular facilitation (PNF) patterns. An evaluation sheet with a 6-point rating scale and 20 evaluation criteria including an overall rating was used for assessment. The interrater reliability was determined calculating an intraclass-correlation coefficient (ICC) and Krippendorff’s alpha. The assessment behaviour of the examiners was further analysed calculating the location parameters and showing the item response distribution over item in form of a Likert plot.

Results
The ICC estimates were mostly below 0.4, indicating poor interrater reliability. This was confirmed by Krippendorff’s alpha. The examiners showed a certain central tendency and intergroup bias.

Discussion and conclusion
The interrater reliability in this assessment format was rather low. No difference between the two physiotherapy schools concerning the interrater reliability could be identified. Despite certain limitations of this study, there is a definite need for improvement of the assessment process in physiotherapy education to provide the students with reliable and objective feedback and ensure a certain level of professional competence in the students.

Trial registration
The study was approved by the ethics committee of the Medical Faculty RWTH Aachen University (EK 340/16).
Transformative learning through participation: experiences at a rural clinical training site in South Africa
Authors: Müller Jana , Reardon Cameron , Coetzee Francois , Bester Juanita , Dube Kopano , Hanekom Susan , du Plessis Elmarize , Couper Ian 
Published: March 2022

AbstractBackgroundDistributed training has been cited as an opportunity that offers transformative learning experiences in preparing a future workforce to address local needs. For this reason, rural and longitudinal placements are increasingly being adopted by medical schools across the world. Place, participation and person are considered integral in the process of transformation of medical students into responsive graduates on the distributed platform. This article aims to explore the experiences and perceptions of student learning on a rural training platform in South Africa while considering the interrelation between person, place and participation as a process of transformation to becoming a health care professional. The research forms part of a 5-year longitudinal case study, initiated in 2019 to explore a university-rural hospital collaboration on students, staff and the local health care system.MethodsData was collected using interviews and surveys from 63 purposively selected and consenting participants between January and November of 2019. All qualitative data were inductively analysed using an interpretivist approach to thematic analysis for the purposes of this article. All quantitative data was analysed descriptively using Microsoft Excel. Ethics and permission for this research was granted by the Stellenbosch University Human Research Ethics Committee, the Undergraduate Students Programme Committee and the Northern Cape Department of Health, South Africa.FindingsFour themes, namely: authenticity of context; participation in a community of practice and social activities; supervision and reflection; and distance support were extracted from the data. These findings contribute to the theory of transformative learning on the distributed platform by expanding on the interrelationship of person, place and participation, specifically as it relates to participation within various communities and practices. The value of active participation in reflection and supervision, distance academic support and social support systems are explored.ConclusionsThe three dimensions and interrelationship of person, place and participation in the process of transformative learning on the rural training platform can be further unpacked by exploring the types of participation that have facilitated student learning in this research context. Participation in interprofessional teams; supervision, reflection and distance support appear to be the most crucial elements during this transformative learning process.
The impact of 3D printed models on spatial orientation in echocardiography teaching
Authors: Salewski Christoph , Nemeth Attila , Sandoval Boburg Rodrigo , Berger Rafal , Hamdoun Hasan , Frenz Hannes , Spintzyk Sebastian , Hahn Julia Kelley , Schlensak Christian , Krüger Tobias 
Published: March 2022

Abstract
Purpose
During our transthoracic echocardiography (TTE) courses, medical students showed difficulty in spatial orientation. We implemented the use of 3D printed cardiac models of standard TTE views PLAX, PSAX, and A4C and assessed their efficacy in TTE-teaching.

Methods
One hundred fifty-three participants were split into two groups. A pre-test-retest of anatomy, 2D -, and 3D orientation was conducted. The intervention group (n = 77) was taught using 3D models; the control group (n = 76) without. Both were comparable with respect to baseline parameters. Besides test-scores, a Likert scale recorded experiences, difficulties, and evaluation of teaching instruments.

Results
From the 153 students evaluated, 123 improved, 20 did worse, and ten achieved the same result after the course. The median overall pre-test score was 29 of 41 points, and the retest score was 35 (p < 0.001). However, the intervention group taught with the 3D models, scored significantly better overall (p = 0.016), and in 2D-thinking (p = 0.002) and visual thinking (p = 0.006) subtests. A backward multivariate linear regression model revealed that the 3D models are a strong individual predictor of an excellent visual thinking score. In addition, our study showed that students with difficulty in visual thinking benefited considerably from the 3D models.

Conclusion
Students taught using the 3D models significantly improved when compared with conventional teaching. Students regarded the provided models as most helpful in their learning process. We advocate the implementation of 3D-printed heart models featuring the standard views for teaching echocardiography. These findings may be transferable to other evidence based medical and surgical teaching interventions.
Implementability of collecting patient-reported outcome data in stroke unit care – a qualitative study
Authors: Lebherz Lisa , Fraune Elisa , Thomalla Götz , Frese Marc , Appelbohm Hannes , Rimmele David Leander , Härter Martin , Kriston Levente 
Published: March 2022

Abstract
Background
Patient-reported outcome measures (PROMs) assess patient-relevant effects of medical treatments. We aimed to evaluate the implementation of the International Consortium for Health Outcomes Measurement Standard Set for Stroke (ICHOM-SSS) into routine inpatient care of a stroke unit.

Methods
The ICHOM-SSS was administered in a certified stroke unit during and after inpatient care. Semi-structured interviews with medical staff (n = 5) and patients or their proxies (n = 19) about their experience were audio-recorded and analysed using thematic analyses. Implementation outcomes were chosen in advance and adhered to current standards of implementation science.

Results
Patients perceived the ICHOM-SSS to be relevant and feasible. They reported limited understanding of why the assessment was introduced. The overall acceptance of using PROMs was high. While medical staff, too, perceived the assessment to be appropriate and relevant, their appraisal of feasibility, sustainability, and their acceptance of the implementation were low.

Conclusions
For a sustainable implementation of PROMs in clinical practice, IT resources need to be adapted, medical care needs to be reorganized, and additional clinical resources are required. Future research should investigate benefits of the ICHOM-SSS and a simpler, automated implementation in stroke care.

Trial registration
ClinicalTrials.gov Identifier: NCT03795948, retrospectively registered on 8 January 2019.