bluuebunny/crossref_metadata_2025_split huggingface dataset:
Kahoot! como herramienta de gamificación del aprendizaje: una experiencia con estudiantes de Medicina
Authors: Cordero-Cordero Gabriela , Guevara-Vizcaíno Claudio , Erazo-Álvarez Cristian 
Published: September 2022

El objetivo del presente estudio fue analizar la percepción de los estudiantes de Medicina con respecto al uso del Kahoot como herramienta de gamificación del aprendizaje, se realizó un estudio cuantitativo, no experimental de corte transversal, que incluyó una muestra representativa de 97 estudiantes del primer ciclo de la carrera de Medicina de la Universidad Católica de Cuenca [UCACUE]-Sede Azogues. Para cumplir este cometido se aplicó una encuesta estructurada ajustada de acuerdo a la realidad local. El instrumento fue estructurado en cinco categorías: (1) compromiso, (2) concentración, (3) motivación y competencia, (4) aprendizaje, (5) diversión y disfrute. Con la finalidad de garantizar la consistencia interna del instrumento se sometió a juicio de expertos y a validación por medio del coeficiente Alfa de Cronbach obteniendo un 0,758 de fiabilidad. Entre los principales resultados, se pudo evidenciar que los estudiantes perciben Kahoot como una herramienta que los mantiene motivados, comprometidos, y que, acompañado del elemento competitivo, estimula su participación individual y colaborativa. Finalmente se concluye que se debería hacer extensivo a otras asignaturas el uso de este tipo de herramientas de gamificación para instaurar un mejor ambiente en el aula y fortalecer el rendimiento académico.
Kreativitas Guru Min 02 Kota Madiun Dalam Penggunaan Media Pembelajaran Daring Pada Pelajaran Tematik IPS
Authors: Eky Hastuti Dian Nur Antika 
Published: September 2022

Abstrak. Penelitian ini bertujuan untuk mengetahui kreativitas guru dalam menerapkan media pembelajaran daring di MIN 02 Kota Madiun Tahun pelajaran 2020/2021. Penelitian ini menggunakan pendekatan kualitatif dengan jenis penelitian studi kasus. Subjek penelitian ini yaitu guru kelas 3 yang berjumlah 2 dan kepala sekolah MIN 02 Kota Madiun. Teknik pengumpulan datanya menggunakan wawancara dan cek dokumen. Dalam penelitian ini menggunakan triangulasi sumber dan teknik. Hasil penelitian menunjukkan adanya kreativitas guru dalam penggunaan media pembelajaran daring. Hal ini dibuktikan dengan hasil wawancara dan dokumentasi yang menunjukkan bahwa guru di MIN 02 Kota Madiun sudah kreatif dalam penggunaan media pembelajaran daring dimana Guru di MIN 02 Kota Madiun melaksanakan kreativitas dalam penggunaan media pembelajaran daring dengan menggunakan media berupa E-Learning, google meet, zoom meeting, media cetak, dan rekaman suara.Kata Kunci: Kreativitas, Media, Pembelajaran Daring
Systemically engineering Bacillus amyloliquefaciens for increasing its antifungal activity and green antifungal lipopeptides production
Authors: Wang Susheng , Wang Rui , Zhao Xiuyun , Ma Gaoqiang , Liu Na , Zheng Yuqing , Tan Jun , Qi Gaofu 
Published: September 2022

The biosynthesis of antifungal lipopeptides iturin and fengycin has attracted broad interest; however, there is a bottleneck in its low yield in wild strains. Because the key metabolic mechanisms in the lipopeptides synthesis pathway remain unclear, genetic engineering approaches are all ending up with a single or a few gene modifications. The aim of this study is to develop a systematic engineering approach to improve the antifungal activity and biosynthesis of iturin and fengycin in Bacillus amyloliquefaciens. First, blocking the carbon overflow metabolic pathway to increase precursor supply of the branched-chain amino acids by knockout of bdh, disrupting sporulation to extend the stage for producing antifungal lipopeptides by deletion of kinA, blocking of siderophore synthesis to enhance the availability of amino acids and fatty acids by deletion of dhbF, and increasing Spo0A∼P by deletion of rapA, could improve the antifungal activity by 24%, 10%, 13% and 18%, respectively. Second, the double knockout strain ΔbdhΔkinA, triple knockout strain ΔbdhΔkinAΔdhbF and quadruple knockout strain ΔkinAΔbdhΔdhbFΔrapA could improve the antifungal activity by 38%, 44% and 53%, respectively. Finally, overexpression of sfp in ΔkinAΔbdhΔdhbFΔrapA further increased the antifungal activity by 65%. After purifying iturin and fengycin as standards for quantitative analysis of lipopeptides, we found the iturin titer was 17.0 mg/L in the final engineered strain, which was 3.2-fold of the original strain. After fermentation optimization, the titer of iturin and fengycin reached 31.1 mg/L and 175.3 mg/L in flask, and 123.5 mg/L and 1200.8 mg/L in bioreactor. Compared to the original strain, the iturin and fengycin titer in bioreactor increased by 22.8-fold and 15.9-fold in the final engineered strain, respectively. This study may pave the way for the commercial production of green antifungal lipopeptides, and is also favorable for understanding the regulatory and biosynthetic mechanism of iturin and fengycin.
Outcomes after right ventricular outflow tract reconstruction with valve substitutes: A systematic review and meta-analysis
Authors: Wang Xu , Bakhuis Wouter , Veen Kevin M. , Bogers Ad J. J. C. , Etnel Jonathan R. G. , van Der Ven Carlijn C. E. M. , Roos-Hesselink Jolien W. , Andrinopoulou Eleni-Rosalina , Takkenberg Johanna J. M. 
Published: September 2022

IntroductionThis study aims to provide an overview of outcomes after right ventricular outflow tract (RVOT) reconstruction using different valve substitutes in different age groups for different indications.MethodsThe literature was systematically searched for articles published between January 2000 and June 2021 reporting on clinical and/or echocardiographic outcomes after RVOT reconstruction with valve substitutes. A random-effects meta-analysis was conducted for outcomes, and time-related outcomes were visualized by pooled Kaplan–Meier curves. Subgroup analyses were performed according to etiology, implanted valve substitute and patient age.ResultsTwo hundred and seventeen articles were included, comprising 37,078 patients (age: 22.86 ± 11.29 years; 31.6% female) and 240,581 patient-years of follow-up. Aortic valve disease (Ross procedure, 46.6%) and Tetralogy of Fallot (TOF, 27.0%) were the two main underlying etiologies. Homograft and xenograft accounted for 83.7 and 32.6% of the overall valve substitutes, respectively. The early mortality, late mortality, reintervention and endocarditis rates were 3.36% (2.91–3.88), 0.72%/y (95% CI: 0.62–0.82), 2.62%/y (95% CI: 2.28–3.00), and 0.38%/y (95%CI: 0.31–0.47) for all patients. The early mortality for TOF and truncus arteriosus (TA) were 1.95% (1.31–2.90) and 10.67% (7.79–14.61). Pooled late mortality and reintervention rate were 0.59%/y (0.39–0.89), 1.41%/y (0.87–2.27), and 1.20%/y (0.74–1.94), 10.15%/y (7.42–13.90) for TOF and TA, respectively. Endocarditis rate was 0.21%/y (95% CI: 0.16–0.27) for a homograft substitute and 0.80%/y (95%CI: 0.60–1.09) for a xenograft substitute. Reintervention rate for infants, children and adults was 8.80%/y (95% CI: 6.49–11.95), 4.75%/y (95% CI: 3.67–6.14), and 0.72%/y (95% CI: 0.36–1.42), respectively.ConclusionThis study shows RVOT reconstruction with valve substitutes can be performed with acceptable mortality and morbidity rates for most patients. Reinterventions after RVOT reconstruction with valve substitutes are inevitable for most patients in their life-time, emphasizing the necessity of life-long follow-up and multidisciplinary care. Follow-up protocols should be tailored to individual patients because patients with different etiologies, ages, and implanted valve substitutes have different rates of mortality and morbidity.Systematic review registration[www.crd.york.ac.uk/prospero], identifier [CRD42021271622].
Higher serum phosphorus and calcium levels provide prognostic value in patients with acute myocardial infarction
Authors: Cao Wei , Li Yilan , Wen Yao , Fang Shaohong , Zhao Bing , Zhang Xiaoyuan , Zhang Yanxiu , Lang Xueyan , Yu Bo , Zhang Yao 
Published: September 2022

BackgroundAlthough traditional cardiovascular risk factors are closely related to the poor prognosis of acute myocardial infarction (AMI) patients, there are few studies on the relationship of serum phosphorus and calcium with prognosis in AMI patients. The relationship of serum phosphorus and calcium with prognostic biomarkers in AMI remains unclear.Methods and resultsA total of 3,891 AMI patients were enrolled from a prospective cohort study. We investigated the association of serum phosphorus and calcium with prognostic biomarkers. The risk of in-hospital heart failure (HF), post-discharge HF, all-cause mortality and cardiac mortality was estimated across quartiles of serum phosphorus and calcium levels. Serum phosphorus and calcium levels were associated with biomarkers of prognosis. Overall, 969 patients developed in-hospital HF during hospitalization, 549 patients developed post-discharge HF during a median follow-up of 12 months, and 252 patients died, with 170 cardiac deaths since admission. In the fully adjusted model, compared with patients in quartile 2 (Q2), patients with serum phosphorus levels in Q4 were at greater risk of post-discharge HF [sub-distributional hazard ratios (SHR) 1.55; 95% confidence interval (CI), 1.21–1.99], in-hospital HF [odds ratio (OR) 1.84; 95% CI, 1.47–2.31], all-cause mortality (HR 1.59; 95% CI, 1.08–2.32), and cardiac mortality (SHR 1.68; 95% CI, 1.03–2.75). Compared with patients in Q2, patients with corrected calcium levels in Q4 had a higher risk of in-hospital HF (OR 1.62; 95% CI, 1.29–2.04), all-cause mortality (HR 1.99; 95% CI, 1.37–2.88), and cardiac mortality (SHR 1.87; 95% CI, 1.19–2.96; all p-trend &lt; 0.05).ConclusionSerum phosphorus and calcium levels were associated with AMI prognostic biomarkers in AMI. Higher serum phosphorus was independently related to the increased risk of in-hospital HF, postdischarge HF, all-cause mortality and cardiac mortality, and higher serum calcium was independently related to the increased risk of in-hospital HF, all-cause mortality and cardiac mortality after AMI.
Scaling up a decentralized offline patient ID generation and matching algorithm to accelerate universal health coverage: Insights from a literature review and health facility survey in Nigeria
Authors: Chukwu Emeka , Ekong Iniobong , Garg Lalit 
Published: September 2022

BackgroundQuality of health service delivery data remains sub-optimal in many Low and middle-income countries (LMICs) despite over a decade of progress in digitization and Health Management Information Systems (HMIS) improvements. Identifying everyone residing in a country utilizing universal civil registration and/or national unique identification number systems especially for vulnerable patients seeking care within the care continuum is an essential part of pursuing universal health coverage (UHC). Many different strategies or candidate digital technologies exist for uniquely identifying and tracking patients within a health system, and the different strategies also have their advantages and trade-offs. The recent approval of Decentralized identifier (DID) core specification by World Wide Web Consortium (W3C) heralds the search for consensus on standard interoperable DID methods.ObjectiveThis paper aims to: (1) assess how candidate Patient Identification Systems fit the digital Patient ID desirable attributes framework in literature; and (2) use insights from Nigeria to propose the scale-up of an offline, interoperable decentralized Patient ID generation and a matching model for addressing network reliability challenges of centralized electronic registries in LMICs.MethodsWe combined: (i) systematic review of the literature to identify the characteristics of leading candidates for Patient ID systems, with (ii) review of policies and (iii) quantitative survey of 14 general hospitals in Nigeria's Federal Capital Territory to understand the model(s) of patient ID strategies currently implemented by public hospitals.ResultsEvidence from the literature review and quantitative survey showed that no current Patient ID strategy in Nigeria simultaneously meets the six attributes of uniqueness, unchanging, uncontroversial, inexpensive, ubiquitous, and uncomplicated required for ensuring the reliability of unique patient identification systems and of the HMIS more generally.ConclusionsThe findings are used to propose a model of algorithms for universal-offline Patient ID generation and matching models that is cost effective and can be easily scaled-up throughout Nigeria. The prototype has promise for generating and validating a universally unique Patient ID given a set of patient characteristics without a central rigid authority. The model can also help to fast-track the implementation of a Master Patient Index (MPI) and interoperability of existing digital health platforms in LMICs.
Application of potential vorticity tendency diagnosis method to high-resolution simulation of tropical cyclones
Authors: Xie Tong , Wu Liguang , Yu Jinhua 
Published: September 2022

As the grid spacing in the numerical simulation decreases to ∼1 km, the potential vorticity (PV) structure of the simulated tropical cyclone (TC) is an annular tower of high PV with low PV in the eye and the resulting reversal of the radial PV gradient in the inner core is subject to dynamic instability, leading to complicated small-scale features in the PV field. While the PV tendency (PVT) method has been successfully used to diagnose TC motion in numerical simulations with relatively coarse resolution (∼10 km), it has been found that the PVT diagnosis method fails in the TC simulation with grid spacing of ∼1 km. This study reveals that the failure of the PVT diagnosis method in the high-resolution simulation with grid spacing of ∼1 km arises from the induced small-scale features in the PV field. The high localized PV features do not affect TC motion, but make it difficult to calculate the gradient of azimuthal mean PV when the time interval of the model output is ∼1 h. It is suggested that the PVT method can be applied to high-resolution simulations by increasing the time interval of the model output and/or smoothing the model output to reduce the influence of small-scale PV features.
Height outcomes in Korean children with idiopathic short stature receiving growth hormone treatment
Authors: Chae Hyun Wook , Hwang Il-Tae , Lee Ji-Eun , So Cheol Hwan , Rhie Young-Jun , Lim Jung Sub , Kwon Eun Byul , Yi Kyung Hee , Kim Eun Young , Jo Chae-Ku , Shim Kye Shik , Gil Ha-Yeong , Seong Min-Jeong , Nam Chung Mo , Moon Ji-Su , Hwang Jin Soon 
Published: September 2022

ObjectivesGrowth hormone (GH) therapy’s capacity to increase height velocity and height at the end of the study in children with idiopathic short stature (ISS) is controversial. We aimed to investigate the height standard deviation score (SDS) and height velocity of patients with ISS in Korea who received GH treatment.MethodsWe retrospectively reviewed and performed linear mixed model and survival analyses on data from 12 tertiary hospitals in Korea, including subjects diagnosed with ISS from January 2009 to September 2019, treated with GH therapy for more than 6 months, and who were at a pre-pubertal state at the time of diagnosis.ResultsWe included 578 children (330 boys and 248 girls). The mean daily dose of GH in this study was 0.051 mg/kg, which was lower than the approved dose in Korea of 0.062 - 0.067 mg/kg. Height SDS was higher in patients who started treatment before the age of 6 years. The probability of reaching the target SDS (-1 SDS) from the beginning of treatment to 2–3 years after its start was higher in children starting treatment before the age of 6 years. The hazard ratio to reach the target SDS (-1 SDS) when using automatic pen or electronic devices was 1.727 times higher than that when using the needle and syringe device.ConclusionISS patients should start GH treatment at an early age, and even lower-than-recommended drug doses may be effective. The selection of automatic pen or electronic device can have a positive effect on reaching the target height SDS.
A case analysis of turbulence characteristics and ozone perturbations over eastern China
Authors: Qin Zilin , He Yang , Zhao Xiaoran , Feng Yutao , Yi Xin 
Published: September 2022

Our knowledge of the vertical variabilities in turbulence and ozone perturbation in the free atmosphere is severely limited because of the scarcity of high-resolution observation data. Based on the Thorpe method, a new set of sounding data in Shanghai, China, was used herein to analyze the distributions of turbulence and ozone perturbation. The region in which turbulence activity is relatively frequent spans from 5-15 km in the middle and upper troposphere. Due to the combined action of large wind shear and thermal convection, the low-troposphere stratification conditions are conducive to the generation of large-scale turbulence. Turbulence has a certain effect on atmospheric ozone concentration exchanges; in most regions located near turbulence, ozone partial pressure perturbations occur. In the troposphere, the ozone profile is most influenced by atmospheric static instability, while in the stratosphere, both wind shear and thermal convection play important roles in the emergence of ozone perturbations.
Biologics for psoriasis patients under 18 years of age: Real-world evidence from the Chinese psoriasis real world evidence research group
Authors: Zheng Yu-Xin , Ye Li-Ran , Yan Bing-Xi , Chen Si-Qi , Cai Sui-Qing , Man Xiao-Yong 
Published: September 2022

BackgroundTreatment for pediatric psoriasis is challenging because of the lack of real-world evidence, especially for biological therapies.ObjectivesThis study evaluated the efficacy and safety of biologics in children with psoriasis based on real-world evidence.MethodsPediatric psoriasis patients aged &lt;18 years who were treated with biologics in our hospital (2020–2022) were prospectively analyzed. Patients treated with adalimumab, secukinumab, or ixekizumab were followed up for at least 16 weeks, and 22 of 38 patients completed the 52-week observation period. Dermatologist raters were blinded to ensure the reliability of the PASI, BSA, and PGA score assessments. PASI 75 or PGA 0/1 at week 12 represented an efficient indicator.ResultsThirty-eight patients (20 males and 18 females; median age, 12.6 ± 4.1 years) were enrolled, and none were lost to follow-up. All participants were diagnosed with psoriasis, including plaque psoriasis (n = 36), nail psoriasis (n = 1), and pustular psoriasis (n = 1). Within 12 weeks, all patients achieved scores above PASI 75 and PGA 0/1. The average time to reach PASI 75 was 4.3 ± 2.0, 3.2 ± 1.8, and 2.4 ± 0.4 weeks in patients using adalimumab, secukinumab, and ixekizumab, respectively, and, 27.2% (3/11), 86.4% (19/22), and 75.0% (3/4) of these patients achieved PASI 100 at week 12, respectively. Moreover, 18 of 20 patients with plaque psoriasis maintained ≥PASI 75 after 52 weeks. The most commonly reported adverse effect was upper respiratory tract infection, and no severe adverse effects were reported.ConclusionsOur real-world data demonstrated the safety and effectiveness of adalimumab, secukinumab, and ixekizumab in children with psoriasis.
Effect of scalp nerve block with ropivacaine on postoperative pain in pediatric patients undergoing craniotomy: A randomized controlled trial
Authors: Ning Li , Jiang Lai , Zhang Qingqing , Luo Mengqiang , Xu Daojie , Peng Yuanzhi 
Published: September 2022

BackgroundScalp nerve block (SNB) is widely used for postoperative pain control, intraoperative hemodynamic control, and opioid-sparing in adult craniotomies. However, there are few studies of SNB in pediatric patients undergoing craniotomy. In the present study, we aimed to investigate the effect of SNB on postoperative pain, intraoperative hemodynamic stability, and narcotic consumption in pediatric craniotomy under general anesthesia.MethodsThis trial is a single-center, prospective, randomized, and double-blind study. A total of 50 children aged between 2 and 12 years who are undergoing elective brain tumor surgery will be randomly allocated in a 1:1 ratio to receive either 0.2% ropivacaine for SNB (group SNB, intervention group, n = 25) or the same volume of saline (group Ctrl, control group, n = 25). The primary outcome was to assess the score of postoperative pain intensity at time 1, 4, 8, 12, 24, and 48 h postoperatively using the FLACC score method. Secondary outcomes were to record intraoperative hemodynamic variables (MAP and HR) during skull-pin fixation, skin incision and end of skin closure, intraoperative total consumption of remifentanil and propofol, postoperative opioid consumption, and the incidence of postoperative nausea and vomiting.ResultsFifty patients were analyzed (n = 25 in SNB group; n = 25 in control group). Compared to the control group, postoperative pain intensity was significantly relieved in the SNB group up to 8 h post-operatively. In addition, SNB provided good intraoperative hemodynamic stability, reduced intraoperative overall propofol and remifentanil consumption rate, and postoperative fentanyl consumption compared to the control group. However, the incidence of postoperative nausea and vomiting was not different between SNB and the control group.ConclusionsIn pediatric craniotomies, SNB with 0.2% ropivacaine provides adequate postoperative pain control and good intraoperative hemodynamic stability during noxious events compared to the control group.Clinical trial registrationChinese Clinical Trial Registry [No: ChiCTR2100050594], Prospective registration.
The effects of age and sex on the incidence of multiple step saccades and corrective saccades
Authors: Ma Wenbo , Zhang Mingsha 
Published: September 2022

ObjectiveAlthough multiple step saccades (MSS) is occasionally observed in healthy subjects, it is more pronounced in patients with aging-related neurodegenerative diseases, particularly Parkinson’s disease (PD). Thus, MSS has been treated as a complementary biomarker for diagnosing PD. Despite the aforementioned knowledge, several questions remain unexplored: (1) How does aging affect MSS? (2) Is there a sex difference in MSS? (3) Are there differences in MSS between vertical and horizontal saccades? (4) Are MSS and corrective saccade (CS) the same behavior? (5) How do age and sex affect CS? The objectives of the present study are to address these questions.MethodFour hundred eighty healthy participants were recruited to perform a visually guided reactive saccade task. Participants were divided into six groups according to their ages. Each group consisted of 40 male and 40 female participants. Eye movements were recorded with infrared eye trackers.ResultsThe incidence of MSS increased as a function of age, whereas the incidence of CS first increased with age 20–49 and then decreased with age 50–79. The incidences of both MSS and CS did not show sex differences. The incidence of MSS in vertical saccades was significantly higher than that in horizontal saccades, and their difference increased with increasing age, whereas the incidence of CS showed a reversed pattern.ConclusionAge and saccadic direction affect the occurrences of MSS and CS differently, indicating that MSS and CS are different saccadic behaviors. In addition, measuring saccades could reliably reflect the function of human’s brain which is affected by aging.