bluuebunny/crossref_metadata_2025_split huggingface dataset:
Failure to demonstrate effects of interruptions on diagnostic reasoning: three experiments
Authors: Alajaji Mai , Saleh Nada , AlKhulaif Ali Hassan , Mamede Silvia , Rotgans Jerome I. , Sukkarieh Hatouf , AlHarbi Nouf , Magzoub Mohi Eldin , Schmidt Henk G. 
Published: March 2022

AbstractBackgroundDiagnostic error is a major source of patient suffering. Researchshows that physicians experience frequent interruptions while being engaged with patients and indicate that diagnostic accuracy may be impaired as a result. Since most studies in the field are observational, there is as yet no evidence suggesting a direct causal link between being interrupted and diagnostic error. Theexperiments reported in this article were intended to assess this hypothesis.MethodsThree experiments were conducted to test the hypothesis that interruptions hurt diagnostic reasoning and increase time on task. In the first experiment (N = 42), internal medicine residents, while diagnosing vignettes of actual clinical cases were interrupted halfway with a task unrelated to medicine, solving word-spotting puzzles and anagrams. In the second experiment (N = 78), the interruptions were medically relevant ones. In the third experiment (N = 30), we put additional time pressure on the participants. In all these experiments, a control group diagnosed the cases without interruption. Dependent variables were diagnostic accuracy and amount of time spent on the vignettes.ResultsIn none of the experiments interruptions were demonstrated to influence diagnostic accuracy. In Experiment 1: Mean of interrupted group was 0.88 (SD = 0.37) versus non- interrupted group 0.91 (SD = 0.32). In Experiment 2: Mean of interrupted group was 0.95 (SD = 0.32) versus non-interrupted group 0.94 (SD = 0.38). In Experiment 3: Mean of interrupted group was 0.42 (SD = 0.12) versus non-interrupted group 0.37 (SD = 0.08). Although interrupted residents in all experiments needed more time to complete the diagnostic task, only in Experiment 2, this effect was statistically significant.ConclusionsThese three experiments, taken together, failed to demonstrate negative effects of interruptions on diagnostic reasoning. Perhaps physicians who are interrupted may still have sufficient cognitive resources available to recover from it most of the time.
Relationship between spiritual health, resilience, and happiness among a group of dental students: a cross-sectional study with structural equation modeling method
Authors: Hatami Saeed , Shekarchizadeh Hajar 
Published: March 2022

AbstractBackgroundGiven the importance of spiritual health, resilience and happiness to encounter challenges facing dental students, we aimed to examine these variables, their relationship and the mediating role of resilience between spiritual health and happiness among a group of Iranian dental students in Islamic Azad University of Isfahan.MethodsIn this cross-sectional study, utilizing a stratified sampling method, 150 volunteer dental students in different academic years filled in the Persian version of Spiritual Well-Being scale, the Persian version of Connor-Davidson Resilience Scale, and Isfahan-Fordyce Happiness Inventory. Independent t-test, Kruskal–Wallis test, and Pearson correlation coefficient served for statistical analysis. In addition, we conducted a Structural Equation Modeling analysis.ResultsThe mean age of the students was 23.43 ± 3.11, and 56% were women. The mean score of spiritual health, resilience, and happiness was 89.27 ± 16.69, 90.19 ± 15.03, and 295.17 ± 65.82, respectively. Spiritual health of a great majority of dental students was upper medium or high (87.3%), most of them had high level of resilience (69.3%), and 55.3% reported medium level of happiness. Spiritual health was directly associated with both happiness and resilience (p <  0.001). Resilience acted as an intermediary variable between spiritual health and happiness (p <  0.001).ConclusionsSpiritual health was associated with increased happiness, and this relationship was mediated by resilience. Thus, it is recommended to address the issue of spiritual health to those students with lower scores in order to increase their resilience and their level of happiness.
Audit of documentation accompanying referred maternity cases to a referral hospital in northern Ghana: a mixed-methods study
Authors: Ameyaw Edward Kwabena , Amoah Roberta Mensima , Njue Carolyne , Tran Nguyen Toan , Dawson Angela 
Published: March 2022

Abstract
Background
Effective referral of maternity cases, which cannot be managed at the primary healthcare level, with detailed referral forms is important for reducing possible delays in the provision of higher-level healthcare. This is the first study to audit documentation or referral forms that accompany referred maternity cases to a referral hospital in the northern region of Ghana.

Materials and methods
This study employed an explanatory sequential mixed-method design, starting with a quantitative review of referral forms that accompanied all patients referred to four units (antenatal, antenatal emergency, labour and neonatal intensive care) of a referral hospital in northern Ghana. In-depth interviews were held with the heads of the four units afterwards. Descriptive statistics were computed for the quantitative data. The qualitative data was subjected to content analysis. Integration of the data occurred at the data interpretation/discussion level.

Results
A total of 217 referral forms were analysed. Nearly half of the cases were referred from the Tamale Metropolis (46.5%) and 83.9% were referred for advanced care, whilst 8.3% were referred due to a lack of medical logistics and equipment such as oxygen and skilled personnel (6%). Completion rates of the referral forms were as follows: < 50% completion (n = 81; 37.3%), 50–75% completion (n = 112; 51.6%) above 75% completion (n = 24; 11.1%). Some of the handwriting were not legible and were quite difficult to read. The key informants stated that incomplete forms sometimes delay treatment. The head of the antenatal care unit at the referral hospital suggested professional development sessions as a strategy for supporting clinicians to fill the forms as expected.

Conclusion
The Ghana Health Service should conduct regular audits, develop job aides and provide incentives for health professionals who accurately complete referral forms. Completing forms and digitizing health records can help ensure further efficiencies in the health information system and sustain good maternity referral documentation practices.
Nasal carriage of Methicillin-Resistant Staphylococcus aureus among sympatric free-ranging domestic pigs and wild Chlorocebus pygerythrus in a rural African setting
Authors: Kalule John Bosco , Nakintu Valeria Zalwango , SSendawula Simon Peter 
Published: March 2022

Abstract
Background
Methicillin Resistant Staphylococcus aureus (MRSA) nasal carriage in domestic pigs and vervet monkeys is a risk factor for subsequent severe infections in domestic pigs and for dissemination to the human population. This study assessed nasal carriage of MRSA in domestic pigs and sympatric vervet monkeys in a rural African village during an outbreak of a virus hemorrhagic fever suspected to be contracted from wild primates.
This study was conducted during the 2012 Ebola outbreak to determine nasal carriage of MRSA in free-ranging domestic pigs and sympatric freely roaming vervet monkeys using conventional methods. Staphylococcus aureus (S. aureus) isolated from the anterior nares were tested for susceptibility to commonly used antibiotics and conventional PCR was used to confirm methicillin resistance. The MRSA strains were then genotyped using SCCmec typing.

Results
Overall, there was a high level of resistance to tetracycline [90% (63/70) in pigs and 67% (10/15) in vervet monkeys], trimethoprim/sulphamethoxazole [90% (63/70) in pigs and 67% (10/15) in vervet monkeys], and penicillin [83% (58/70) in pigs and 67% (10/15) in vervet monkeys]. Most of the MRSA strains (91.6%, 11/12) were of the SCCmec type I [1B] genotype.

Conclusion
The nasal carriage of drug resistant S. aureus in freely roaming domestic and wild animals presents a risk for widespread environmental spread of antimicrobial resistance thus presenting a risk for treatment failure in domestic animals, wild animals, and humans.
Remnant lipoprotein cholesterol is associated with incident new onset diabetes after transplantation (NODAT) in renal transplant recipients: results of the TransplantLines Biobank and cohort Studies
Authors: Szili-Torok Tamas , Sokooti Sara , Osté Maryse C. J. , Gomes-Neto Antonio W. , Dullaart Robin P. F. , Bakker Stephan J. L. , Tietge Uwe J. F. 
Published: March 2022

Abstract
Background
New onset diabetes after transplantation (NODAT) is a frequent and serious complication of renal transplantation resulting in worse graft and patient outcomes. The pathophysiology of NODAT is incompletely understood, and no prospective biomarkers have been established to predict NODAT risk in renal transplant recipients (RTR). The present work aimed to determine whether remnant lipoprotein (RLP) cholesterol could serve as such a biomarker that would also provide a novel target for therapeutic intervention.

Methods
This longitudinal cohort study included 480 RTR free of diabetes at baseline. 53 patients (11%) were diagnosed with NODAT during a median [interquartile range, IQR] follow-up of 5.2 [4.1–5.8] years. RLP cholesterol was calculated by subtracting HDL and LDL cholesterol from total cholesterol values (all directly measured).

Results
Baseline remnant cholesterol values were significantly higher in RTR who subsequently developed NODAT (0.9 [0.5–1.2] mmol/L vs. 0.6 [0.4–0.9] mmol/L, p = 0.001). Kaplan-Meier analysis showed that higher RLP cholesterol values were associated with an increased risk of incident NODAT (log rank test, p < 0.001). Cox regression demonstrated a significant longitudinal association between baseline RLP cholesterol levels and NODAT (HR, 2.27 [1.64–3.14] per 1 SD increase, p < 0.001) that remained after adjusting for plasma glucose and HbA1c (p = 0.002), HDL and LDL cholesterol (p = 0.008) and use of immunosuppressive medication (p < 0.001), among others. Adding baseline remnant cholesterol to the Framingham Diabetes Risk Score significantly improved NODAT prediction (change in C-statistic, p = 0.01).

Conclusions
This study demonstrates that baseline RLP cholesterol levels strongly associate with incident NODAT independent of several other recognized risk factors.
Operation of a triage committee for advanced life support during the COVID-19 pandemic
Authors: Herreros Benjamín , Ruiz de Luna Rafael , de la Calle Natalia , Gayoso Diego , Martínez Paula , Olaciregui Dague Karmele , Palacios Gregorio 
Published: March 2022

Abstract
Background
During the first weeks of March 2020 in Spain, the cases of severe respiratory failure progressively increased, generating an imbalance between the clinical needs for advanced life support (ALS) measures and the effective availability of ALS resources. To address this problem, the creation of triage committees (TC) was proposed, whose main function is to select the best candidates to receive ALS. The main objective of our study is to describe the clinical characteristics of the patients evaluated by the TC of the Alcorcón Foundation University Hospital (AFUH) during the first wave of SARS CoV-2. Other objectives are to determine if there are differences between the patients considered candidates / not candidates for ALS and to analyze the functioning of the TC.

Methods
Retrospective observational study of all patients assessed by the AFUH TC.

Results
There were 19 meetings, in which 181 patients were evaluated, 65.4% male and with a mean age of 70.1 years. 31% had some degree of functional dependence, the Barthel median was 100 and Charlson 4. 58.5% were not considered a candidate for ALS at that time. The patients considered candidates to receive ALS were younger (72 vs 66; p < 0.001), had less comorbidity (Charlson 4 vs 3; p < 0.001) and had a better previous functional situation. A median of 5 physicians participated in each meeting and, after being assessed by the TC, 13.6% received ALS: 29.3% of those considered candidates for ALS and 2% of the non-candidates.

Conclusions
The patients evaluated by the TC had a mean age of 70 years, high comorbidity and almost a third had some degree of functional dependence. More than half were not considered candidates for ALS at that time, these patients being older, with more comorbidity and a worse previous functional situation. TC decisions, based on objective clinical criteria, were almost always respected. Public institutions must get involved in triage procedures, which should and in our opinion must include the creation of TC in health centers. The implementation of Anticipated Decision programs (ADP) would help enable patients affected by triage decisions to participate in them.
Development and psychometric properties of COVID-19 related Healthcare Student stress scale (CHSSS)
Authors: Baghcheghi Nayereh , Mesri Mehdi , Karimi Mahmood , Bigdeli Shoaleh , Koohestani Hamid Reza 
Published: March 2022

Abstract
Background
There is no valid and reliable tool to measure COVID-19 healthcare stress felt by healthcare students. A scale was developed to assess COVID-19 stress in healthcare students and its psychometrics was examined.

Methods
This is a two phases mixed-method study including a qualitative stage consisting of student interview and literature review to develop content of the tool. In the quantitative stage, the psychometrics of the scale was examined in 2020–2021.

Results
The COVID-19 related healthcare student stress scale (CHSSS) featured five factors including fear of catching coronavirus, social constraints, changes in education, non-compliance of health protocols and worrying news and overload information, which totally explained 51.75% of the total variance.

Conclusion
Validity and reliability of CHSSS with 17 items were supported to measure COVID-19 stress in healthcare students as a self-assessment tool. Researchers can utilize this tool to assess COVID-19 stress in healthcare students and introduce policies and intervention especially designed for healthcare students.
Brain death: a clinical overview
Authors: Spears William , Mian Asim , Greer David 
Published: March 2022

AbstractBrain death, also commonly referred to as death by neurologic criteria, has been considered a legal definition of death for decades. Its determination involves many considerations and subtleties. In this review, we discuss the philosophy and history of brain death, its clinical determination, and special considerations. We discuss performance of the main clinical components of the brain death exam: assessment of coma, cranial nerves, motor testing, and apnea testing. We also discuss common ancillary tests, including advantages and pitfalls. Special discussion is given to extracorporeal membrane oxygenation, target temperature management, and determination of brain death in pediatric populations. Lastly, we discuss existing controversies and future directions in the field.
Successful separation of male pygopagus with anal canal and urethral reconstruction: a case report
Authors: Toyama Chiyoshi , Nomura Motonari , Tazuke Yuko , Yokota Chisato , Kagawa Naoki , Kishima Haruhiko , Yoshimura Akihiro , Ujike Takeshi , Nagahara Akira , Nonomura Norio , Kubo Tateki , Matsui Futoshi , Matsumoto Fumi , Okuyama Hiroomi 
Published: March 2022

Abstract
Background
Pygopagus is a type of conjoined twin binding at the buttocks. Some cases of pygopagus involve the fusion of the gastrointestinal tract, urinary tract, and spinal cord. Few cases of male pygopagus have been reported; however, the prognosis after separation is unclear. Herein, we report a case of male pygopagus in which successful separation was performed with the reconstruction of the anal canal.

Case presentation
Twins with male pygopagus were born at 35 weeks by cesarean section. They shared a common anus, penis, and scrotum with four testes. The infants had normal defecation and urination after birth. The separation surgery was scheduled when they were 5 months. Two distinct anesthesia teams and four surgical teams (neurosurgery, pediatric urology, plastic surgery, and pediatric surgery) were involved in the multidisciplinary approach. After separating the spinal cord, we found that the anal canal and sphincter muscle complex were fused near the anal aperture, and we separated them. The fused penis and testis were separated and reconstructed using the same incisional line as the other separation, and the reconstructions of the anal canals with the sphincter muscle complex were completed. Both patients had an uneventful postoperative course. At 2 years of age, they could walk and defecate independently. In addition, they voided spontaneously without urinary incontinence at the time of 3 years and 11 months.

Conclusions
Separation of the spinal cord with anal canal and urethral reconstruction is important for male pygopagus patients as it allows them to preserve their independent function.
Ecology of sand flies (Diptera: Psychodidae, Phlebotominae) in Jajarm County, an area with high risk of cutaneous leishmaniasis, in North Khorasan, Iran
Authors: Jalali Hasan , Nikookar Seyed Hassan , Hosseini-Vasoukolaei Nasibeh , Jahanifard Elham , Enayati Ahmad Ali , Motevalli-Haghi Farzad , Yazdani-Charati Jamshid 
Published: March 2022

AbstractThe present study was conducted to investigate the ecological aspects of sand flies in southwestern North Khorasan, in which cutaneous leishmaniasis caused byLeishmania majorhas been reported with the highest annual incidence in Iran. Sampling was carried out in four localities including: Khorasha (natural), Ghamiteh (natural), Jorbat (semi urban) and Brick kilns (urban), twice a month using 105 sticky paper traps from indoors and outdoors dwellings during May-December 2017. Specimens were removed from sticky papers, washed in acetone, preserved in 80% ethanol, mounted on microscopic slides by Puri’s medium, and identified using valid morphological keys. Simpson (D), richness (S), Menhinick (DMg), Margalef (DMn), Shannon-Weiner (H′), evenness (J’) were calculated for species diversity. The synanthropic index was determined for the first time in the area. Totally 517 specimens were collected, 47% in outdoors and 30.4% in human indoor dwellings and 22.6% in animal. Eight species of sand flies including 5 species of the genusPhlebotomusand 3 species of the genusSergentomyiawere identified.Phlebotomus papatasiandSergentomyia sintoniwere the most common and Eudominant species, active in all months, collected in the maximum number and percentage in September and August, respectively, and showed the highest abundance in outdoors. The synanthropic index ranged from 6.25 to 38.9 in the study area. The Shannon-Wiener index was estimated to be up to 1.4 and 1.37 in Khorasha and November, respectively, which showed the highest diversity due to maximal richness and evenness compared to other areas. High abundance ofPh. papatasi, as the main vector of cutaneous leishmaniasis, can enhance the potential risk of emerging CL in new areas, the data can be equally important when vector control measures are considered.
Optimal cut points of N-terminal of the prohormone brain natriuretic peptide (NT-proBNP) in patients with COVID-19
Authors: Chehrazi Mohammad , Yavarpour Hanieh , Jalali Farzad , Saravi Mehrdad , Jafaripour Iraj , Hedayati Mohammad Taghi , Amin Kamyar , Pourkia Roghayeh , Abroutan Saied , Javanian Mostafa , Ebrahimpour Soheil , Ziaie Naghmeh 
Published: March 2022

Abstract
Background
COVID19 patients may suffer from multiple cardiovascular complications. Recently, N-terminal of the prohormone brain natriuretic peptide (NT-proBNP) was a potentially independent risk factor for COVID-19 in-hospital death. The present study aimed to find new optimal cut points for NT-proBNP across censored survival failure time outcomes in hospitalized COVID-19 patients.

Results
This cohort study was conducted on 272 patients with COVID-19 whose initial records were recorded from March 2020 to July 2020. Demographic characteristics, clinical examinations, and laboratory measurements were collected at the beginning of the admission registered in the patient record system located in the hospital. We used the maximally selected rank statistics to determine the optimal cut points for NT-proBNP (the most significant split based on the standardized log-rank test). Survival time was defined as the days from hospital admission to discharge day. In this cohort study, two optimal cut points for NT-proBNP were 331 (pg/mL) and 11,126 (pg/mL) based on a survival model. The adjusted HR of NT-proBNP for in-hospital death was 3.41 (95% CI: 1.22–9.51, P = 0.02) for medium against low category, and 3.84 (95% CI: 1.30–11.57, P = 0.01) for high in comparison with low group.

Conclusions
We reported a dramatically increased concentration of NT-proBNP among COVID-19 patients without heart failure in both severe and non-severe cases. Moreover, our study showed that a high level of NT-proBNP was highly associated with the prolonged survival time of patients with COVID-19. NT-proBNP is a strong prognostic indicator of in-hospital death in the second week of admission.
Tailoring enhanced production and identification of isoflavones in the callus cultures of Pueraria thomsonii Benth and its model verification using response surface methodology (RSM): a combined in vitro and statistical optimization
Authors: Li Yu , Saravana Kumar Pachaiyappan , Liu Yu , Qiu Jiao , Ran Yalan , Yuan Mingyuan , Fang Xinyue , Tan Xuhui , Zhao Renjun , zhu Ji , He Meijun 
Published: March 2022

Abstract
Background
Scientifically, isoflavones from Pueraria thomsonii Benth possess diverse pharmacological activities and have been used to treat various diseases. In vitro propagation of callus has contributed to the reliability for large-scale production of target compounds. However, the factors affecting the biosynthesis of major isoflavones daidzin, puerarin and daidzein in the callus culture of P. thomsonii are still not known. Therefore, we aimed to enhance the in vitro production of daidzin, puerarin and daidzein by optimizing three independent factors such as temperature, NAA and 6-BA concentrations.

Results
Our findings showed that the optimal concentrations for in vitro biomass production and efficient synthesis of puerarin, daidzin and daidzein were found to be 0.158%, 0.463% and 0.057%, respectively. In addition, the HPLC fingerprint with chemo-metrics analysis was constructed by linear regression of the puerarin, daidzin and daidzein which was found to be in the range of 1.0–36.0, 5.0–72.0 and 1.0–15.0 mg/mL and the LODs and LOQs were found to be 0.15, 0.52, 0.35 and 0.28, 1.50, 0.50 mg/mL for puerarin, daidzin and daidzein, respectively. Surprisingly, our results were also in agreement with the concentration obtained from the model verification for optimal and efficient production of puerarin, daidzin and daidzein which was found to be 0.162%, 0.458% and 0.049%, respectively.

Conclusions
In summary, our present investigation provides new insights that could facilitate the enhanced production of valuable isoflavones in P. thomsonii using plant cell cultures treated with appropriate elicitor combinations and temperature. As far as the authors are concerned, this is the first report on production of daidzin, puerarin and daidzein at higher yield at laboratory level for a wide range of applications in future food, medicinal and pharmaceutical companies.