bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Empathy Training: An Explorative Qualitative Study in Search of the Barriers and Facilitators of Implementation
Authors: Barak Luca Claudia , Kuijpers Giliam , Hoeijmakers Lotte , Scheele Fedde 
Published: March 2022

Abstract
Background: Amid concerns about the decline of empathy during clinical training of medical clerks, evidence that empathy improves patient outcomes suggests some potential for teaching empathy in ways that will affect the knowledge, attitude and behaviour of medical clerks. This potential alone cannot, however, guarantee the success of educational innovations to introduce empathy to the medical curriculum. This research aims to investigate an implementation failure of a specific clinical initiative to enhance the empathy skills of clerks, namely the training of clerks to act as ‘MedGezels’ or ‘medical coaches’.Method: We conducted an explorative qualitative study on the basis of interview data collected and analyzed in a manner inspired by grounded theory and viewed through the lens of the readiness for change theory. We conducted semi-structured interviews with the most important stakeholders in the particular case study. Thematic analysis was done based on open and axial coding using ATLAS.ti 9, a qualitative data analyzing software program, which facilitated the emergence of common themes of interest for the study.Results: A total of 13 relevant stakeholders participated as interviewees in our study. The data was collected over a period of 3 months, from April to June 2021. Our analysis generated 6 main themes which can provide insights into why the implementation of the MedGezel educational innovation failed so far. The themes that emerged were: the case for change: why change?; practical necessity; leadership; management and resources; staff culture and the alignment with the corporate strategy. Discussion: The implementation failure is partially explainable as resulting from the personal attitudes and choices of participants who struggled to reconcile a vision that they liked but whose side effects they feared. While participants mentioned management and leadership issues several times, the importance of these was downplayed given that such organizational issues could be easily resolved in practice. What was more important and fatal to the initiative was its lack of alignment with staff culture, despite its alignment with corporate strategy. Conclusion: This investigation into the reasons behind the implementation failure of the MedGezel program produced 6 explanatory themes of which staff culture was most convincing.
How much does effective health facility inspection cost? An analysis of the economic costs of Kenya’s Joint Health Inspection innovations
Authors: Chege Timothy , Wafula Francis , Tama Eric , Khayoni Irene , Ogira Dosila , Gitau Njeri , Goodman Catherine 
Published: March 2022

Abstract
Background: In most low- and middle-income countries, health facility regulation is fragmented, ineffective and under-resourced. The Kenyan Government piloted an innovative regulatory regime involving Joint Health Inspections (JHI) which synthesized requirements across multiple regulatory agencies; increased inspection frequency; digitized inspection tools; and introduced public display of regulatory results. The pilot significantly improved regulatory compliance. Information on costs is essential to consider affordability and value for money. Methods: We calculated the economic costs of three phases: JHI checklist development, start-up activities, and first year of implementation, from the providers’ perspective in three pilot counties. Data collection involved extraction from expenditure records and key informant interviews. The annualized cost of JHI were calculated by adding annualized development and start-up costs to annual implementation costs. National level scale-up costs were also modelled and compared to those of current standard inspections.Results: The total economic cost of the JHI pilot was USD 1,125,600 (2017 USD), with the development phase accounting for 19%, start-up 43% and the first year of implementation 38%. The annualized economic cost was USD 519,287, equivalent to USD 206 per health facility visit and USD 311 per inspection completed. Scale up to the national level, while replacing international advisors with local staff, was estimated to cost approximately USD 4,823,728, equivalent to USD 103 per health facility visit and USD 155 per inspection completed. This compares to an estimated USD 86,997 per year (USD 113 per inspection completed) spent on a limited number of inspections prior to JHI. Conclusion: This is the first study we are aware of costing health facility inspections in sub-Saharan Africa. It has informed debates on appropriate inspection design and potential efficiency gains. It will also serve as an important benchmark for future studies, and a key input into cost-effectiveness analyses.
Understanding Interaction of Engineered Nanomaterials and Dissolved Organic Matters in River Sediments
Authors: Zhang Chen , Tan Xuejun , Yang Xue 
Published: March 2022

Abstract
Engineered nanomaterials (ENMs) would be settled and accumulated in sediments beneath the surface water. Investigation on the interactions between ENMs and dissolved organic matters (DOM) in sediments could assist researchers in better understanding the environmental behaviors of ENMs. This study adopted heating methods to extract DOM from the sediments in a river of Shanghai, China, and titanium dioxide nanoparticles were used as model ENMs. Three-dimensional fluorescence spectra revealed that humic-like substances possessed a better binding ability with ENMs than protein-like substances and fatty acids. Nano-TiO2 could destroy the α-helix structure of proteins. The rapidly diminishing intensity of α-helix bands suggested that secondary structure of protein was distorted, and the nano-TiO2 binding site was amino residues in main peptide chain. X-ray photoelectron spectra further not only demonstrated that protein-like, humic-like substances and fatty acids could adsorb on the surface of nano-TiO2, but also confirmed that phosphonate could combine with nano-TiO2 via P-Ti covalent bond. This study supported comprehensively scientific data and assisted in understanding the environmental behaviors of ENMs, in order to direct the pollution control of river sediments.
Remifentanil Is Associated With Increased Length-Of-Stay After Abdominal Surgery: A Single-Center Retrospective Propensity-Matched Cohort Study
Authors: Chan Steffi Kang Ting , Chong Margaret Yanfong , Ke Yu He , Abdullah Hairil Rizal 
Published: March 2022

Abstract
Perioperative remifentanil infusions have been postulated to help with recovery after surgery due to their rapid offset and predictable metabolism. However, evidence on patients undergoing abdominal surgery suggests an association between intraoperative remifentanil and longer length of stay in the post-anesthetic care unit, increased postoperative pain and analgesic requirement.We retrospectively evaluated 3648 adult patients who underwent major abdominal surgeries from 2013 to 2020 in a tertiary single center. Propensity score matching was conducted to balance 12 specific covariates between the treatment and control groups prior to further statistical analysis. We found that intraoperative remifentanil infusion was associated with an increased average hospital length of stay (10.62 in treatment group vs 10.13 in control group, 95% CI 0.048 - 0.088, P<0.001) and increased length of stay in the high dependency ward (1.89 days in treatment group vs 1.52 days in control group, 95% CI 0.126 - 0.223 P <0.001), but a shorter stay in the intensive care unit (4.03 hours in treatment group vs 7.01 hours in control group, 95% CI -0.509 - 0.452, P <0.001). Consistent with current evidence, there was no significant difference between the treatment and control groups for death in 3 months and 2 years post-surgery.In conclusion, our study suggests that remifentanil may not promote postoperative recovery as expected. Its role in enhancing recovery is debatable and further studies are needed to determine the cost effectiveness of remifentanil use in abdominal surgery.
Health Professionals' Readiness And Its Associated Factors To Implement Telemedicine System At Private Hospitals In Amhara Region, Ethiopia 2021
Authors: Wubante Sisay Maru , Nigatu Araya Mesfin , Jemere Adamu Takele 
Published: March 2022

Abstract
Introduction: in resource-limited settings incorporating the Telemedicine system into the healthcare system enhances exchanging valid health information for practicing evidence-based medicine for the diagnosis, treatment, and prevention of diseases. The successful implementation of a telemedicine system in health care inquires a study of numerous technical, organizational, infrastructure, and human elements.Objective: This study aimed to assess health professionals' readiness and its associated factors to implement a Telemedicine system at private hospitals in Amhara Region, Ethiopia 2021.Method: An institution-based cross-sectional study was conducted among 423 health professionals from March 3 to April 7 2021 at private hospitals in Amhara Region. A self-administered questionnaire was employed to collect the data. The data were analyzed by SPSS version 20 software. Descriptive statistics,bi-variable and multi-variable logistic regression analyses were performed. An adjusted odds ratio (AOR) with 95% CI was used to determine the s association between the independent and the outcome variable. Result: About Two-third (268;65.4%) of health professionals were ready to Telemedicine system.Knowledge (AOR=2.5;95% CI: [1.4, 4.6]), Attitude (AOR=3.2;95% CI: [(1.6,6.2]), computer literacy (AOR=2.2; 95% CI: [1.3, 3.9]), computer training (AOR=2.1;95% CI: [1.1, 4.1]), Computer skill (AOR=1.9;95% CI:[1.1, 3.4]),computer access at office (AOR = 2.1;95% CI: [1.1,3.7],Internet access at office (AOR=2.8;95%CI: [1.6,5.1]),Own personal computer(AOR=3.0;95% CI: [1.5,5.9])and work experience(AOR=3.1;95%CI: [1.4,6.7]) were significantly associated withTelemedicine readiness .Conclusion and Recommendation: In general the overall readiness of health professionals for the Telemedicine system is moderate. Inclusive packages of capacity building are fundamental to increasing the level of, knowledge, attitude, and training among health professionals.
Low Back Pain in Adolescent Elite Rowers and its Association to Skeletal Muscle Changes Detected by Quantitative Magnetic Resonance Imaging
Authors: Marth Adrian Alexander , Auer Timo Alexander , Bertalan Gergely , Gebert Pimrapat , Geisel Dominik , Hamm Bernd , Keller Sarah 
Published: March 2022

Abstract
Objectives:To assess demographic data, training characteristics and low back pain (LBP) in male adolescent elite rowers, visualize structural changes in the lumbar skeletal muscle with quantitative magnetic resonance imaging (qMRI) and correlate findings to reported long- and short-term pain intensity. Methods:In this single-center case series, twenty male elite rowers completed a questionnaire for retrieval of anthropometric data, training characteristics and a standardized back pain questionnaire. Participants then underwent MR imaging, which included the acquisition of T1- and T2-mapping sequences and Dixon-based sequences for the Erector spinae (ES) and Multifidus (MF) muscle. Reported short- and long-term pain intensity was correlated to relaxation times and training characteristics. Results:Short-term pain intensity was associated with shorter T1 relaxation (p = 0.025 and p 0.022 for ES and MF, respectively) and longer T2 relaxation times (p < 0.001 for ES and MF, respectively), while long-term pain intensity was associated to longer T2 relaxation times (p < 0.001 and p = 0.004 for ES and MF, respectively). Conclusion:Competitive adolescent rowers are at risk about developing LBP. qMRI parameters provide insight in structural changes in the lumbar skeletal muscle which are linked to reported short- and long-term pain intensity, indicating that muscular strains can account for LBP.
Enhancing the function of PLGA-collagen scaffold by incorporating TGF-β1 loaded PLGA-PEG-PLGA nanoparticles for cartilage tissue engineering using human dental pulp stem cells
Authors: Ghandforoushan Parisa , Hanaee Jalal , Aghazadeh Zahra , Samiei Mohammad , Navali Amir Mohammad , Khatibi Ali , Davaran Soodabeh 
Published: March 2022

Abstract
Researchers have scrutinized cartilage tissue regeneration to handle the deficiency of cartilage restoration capacity. This investigation proposed to compose an innovative nanocomposite biomaterial that enhances growth factor delivery to the injured cartilage site. Here, we describe the design and development of the biocompatible PLGA-collagen / PLGA-PEG-PLGA nanocomposite scaffold containing TGF-β1. PLGA-PEG-PLGA nanoparticles were employed as a delivery system embedding TGF-β1 as an articular cartilage repair therapeutic agent. This study evaluates various physicochemical aspects of fabricated scaffolds by 1HNMR, FT-IR, SEM, BET, and DLS methods. The physicochemical features of the developed scaffolds, including porosity, density, degradation, swelling ratio, mechanical properties, morphologies, BET, ELIZA, and cytotoxicity were assessed. SEM images displayed suitable cell adhesion and distribution of hDPSCs throughout the scaffolds. The cell viability was investigated with the MTT test. In real-time PCR testing, the expression of Sox-9, collagen type II, and aggrecan genes was monitored. According to the results, h-DPSCs exhibited high adhesion, proliferation, and differentiation on PLGA-collagen/PLGA-PEG-PLGA-TGF-β1 hydrogels compared to the control groups. RT-PCR assay data displayed that TGF-β1 loaded PLGA-PEG-PLGA nanoparticles puts forward chondroblast differentiation in hDPSCs through the expression of chondrogenic genes. Due to its potential for the growth and differentiation of hDPSCc, PLGA-collagen/PLGA-PEG-PLGA-TGF-β1 hydrogel is likely to be a suitable biomaterial for cartilage regeneration.
Osteogenically Induced Human Umbilical Cord Mesenchymal Stem Cell-derived Small Extracellular Vesicles Carrying Distinct microRNA Signature Improve Osteoinductivity of Tissue-engineered Bone
Authors: Zhou Yang , Rong Qiong , Li Shuyi , Liu Shangbin , Wu Wanqiu , Forouzanfar Tim , Wu Gang , Wang Jinheng , Zhou Miao 
Published: March 2022

Abstract
The authors have requested that this preprint be removed from Research Square.
Efficacy of elastodontic devices vs clear aligners in lower dental arch crowding reduction assessed by computer-aid evaluation
Authors: Ortu Eleonora , Pietropaoli Davide , Cova Samuele , Giannoni Mario , Monaco Annalisa 
Published: March 2022

Abstract
Backgroundthis pilot study aim to verify the efficacy of two orthodontic appliances in the treatment of the lower arch crowding in the growing patients.Methodtwenty patients aged 7–15 years were enrolled in the study, and separated into test and control groups. The test group included 10 patients (5 males, 5 females; mean age, 10.4 ± 1.57 years), who were treated with an elastodontic device. The control group included 10 patients (5 males, 5 females; mean age 10.8 ± 1.53 years), who were treated with clear aligners. Dental lower crowding were evaluated at two timepoints with intraorla scans: T0 (before starting therapy) and T1 (after 1 year).Resultsthere was not statistically significant difference between the two groups at T0 and T1 (p < 0.005).Conclusionelastodontic devices and clear aligners can help succesfully the orthodontist in the treatment of the lower crowding. This appliances are comfortably to wear, simply to clean everyday and reduce the number of dentist appointments. Finally, but not in order of importance, these devices have allowed to dentists to continue the orthodontic treatments during the lockdown during the covid 19 pandemic.
Bone Regeneration and Repair: The Negative Influence of Positive Charge
Authors: He Ling , Yao Yingling , Wang Nan , Nan Guoxin 
Published: March 2022

Abstract
Background: Fracture nonunion is a common and challenging complication. Studies have reported that direct current stimulation can promote fracture healing, but there are reports that there are differences in cell density near positive and negative electrodes during direct current stimulation. The purpose of this study is to explore the effect of direct current positive and negative electrodes on the proliferation of osteoblasts and the effect on fracture healing in vivo. Methods: In vitro, MC3T3-E1 cells were stimulated by positive and negative charge to observe cell proliferation and apoptosis. In vivo, after the model of double toes fracture in New Zealand white rabbits was built, positive and negative charge were respectively connected to Kirschner Wires of fractures. DR examination was performed on Day 1, Day 15 and Day 30 to observe the fracture healing. All rabbits were killed after the last examination, the bone tissue samples were analyzed histologically. Results: In vitro, compared to the proliferation rate of cells near negative charge, after 48 hours, the rate near the positive charge decreased significantly(p<0.05), and the apoptosis increased(p<0.05). In vivo, fracture sites connected to the positive charge were not healed and histomorphology analysis showed that the trabecular bone and mineralized bone decreased significantly. Conclusions: Positive charge inhibit the cell proliferation of osteoblasts; the fracture site with positive charge is not favor of fracture healing. The positive charge near the fracture site may be a reason for fracture nonunion.
Assessing the Cost Reduction Potential of CCUS Cluster Projects in China: A Case Study
Authors: Liu Muxin , Zhang Yueze , Liang Xi 
Published: March 2022

Abstract
Carbon capture, utilisation, and storage (CCUS) have garnered extensive attention as a target of carbon neutrality in China. The development trend of international CCUS projects indicates that the cluster construction of CCUS projects is the main direction of future development. The cost reduction potential of CCUS cluster projects has become a significant issue for CCUS stakeholders. The Pearl River Mouth Basin, adjacent to Guangdong province, is a suitable region for CCUS cluster project construction. To assess the cost reduction potential of CCUS cluster projects, we selected three coal-fired power plants in the coastal area of Guangdong as research targets. We initially assessed the costs of building individual CCUS projects for each plant and subsequently designed a CCUS cluster project for these plants. By comparing individual costs and CCUS cluster project costs, we assessed the cost reduction potential of CCUS cluster projects. The results show that CCUS cluster projects can significantly reduce costs by sharing pipelines and storage facilities. Furthermore, we conducted a simulation for the scenario of a larger designed capture capacity for each plant. We found that as the capture scale increases, the cost reduction potential is higher in the future, considering large-scale CCUS cluster projects.
Unbalance Between Working Memory Task-Activation and Task-Deactivation Networks in Epilepsy: Simultaneous EEG-fMRI Study
Authors: Qin Yun , Jiang Sisi , Yang Lili , Yao Dezhong , Luo Cheng 
Published: March 2022

Abstract
Working memory (WM) is one cognitive function, involving emergent properties of theta oscillation and large-scale network interactions. The synchronization of WM task-related networks in brain enhanced working memory performance. However, how these networks regulated WM processing was not well known, and the alteration of the interaction among these networks may play an important role in the patients with cognitive dysfunction. In this study, we used simultaneous EEG-fMRI to examine the features of theta oscillation and the functional interactions among activation/deactivation networks during n-back WM task in patients with idiopathic generalized epilepsy (IGE). The results showed that there was more enhancement of frontal theta power along with WM load increasing in IGE, and the theta power was positively correlated with the accuracy of the WM tasks. Moreover, fMRI activations/deactivations correlated with n-back tasks were estimated, and we found that IGE group had increased and widespread activations in high-load WM task, including frontoparietal activation network, and the task-related deactivation areas, such as the default mode network, primary visual and auditory networks. In addition, the result of network connectivity demonstrated decreased counteraction between activation network and deactivation network, and the counteraction was correlated with the higher theta power in IGE. These results indicated the important role of the interactions between activation and deactivation networks during WM process, and the unbalance among them may imply the pathophysiological mechanism of cognitive dysfunction in generalized epilepsy.
A Novel Method to Detect the Early Warning Signal of Covid-19 Transmission
Authors: Li Mingzhang , Ma Shuo , Liu Zhengrong 
Published: March 2022

Abstract
Background: Infectious illness outbreaks, particularly the corona-virus 19 pandemics in recent years, have wreaked havoc on human society, and the growing number of infected patients has put a strain on medical facilities. It’s necessary to forecast early warning signals of potential outbreaks of Covid-19, which would facilitate the health ministry to take some suitable control measures timely to prevent or slow the spread of Covid-19. However, since the intricacy of Covid-19 transmission, which connects biological and social systems, it is a difficult task to predict outbreaks of Covid-19 epidemics timely.Results: In this work, we developed a new model-free approach, called, the landscape network entropy based on Auto-Reservoir Neural Network (ARNN-LNE), for quantitative analysis of Covid-19 propagation, by mining dynamic information from regional networks and short-term high-dimensional time-series data. Through this approach, we successfully identified the early warning signals in six nations or areas based on historical data of Covid-19 infections.Conclusion: Based on the newly published data on new Covid-19 disease, the ARNN-LNE method can give early warning signals for the outbreak of Covid-19. It’s worth noting that ARNN-LNE only relies on small samples data, Thus, it has great application potential for monitoring outbreaks of infectious diseases.
Citric Acid Coated Iron Oxide Nanoparticles as Contrast Agent for Magnetic Resonance Imaging
Authors: Alzoubi F. Y. , Jabaly H. N. Al , Noqta O. A. Abu , Al-Khateeb H. M. , Alqadi M. K. , Bououdina Mohamed 
Published: March 2022

Abstract
Iron oxide nanoparticles (IONPs) were synthesized at varying pH (8 to 12) then subsequently coated with citric acid by co-precipitation as potential magnetic resonance imaging (MRI) contrast agents. The X-ray diffraction patterns confirmed that the structure of the as-synthesized powders is pure nanocrystalline magnetite Fe3O4 phase. FTIR analysis of citric acid-coated IONPs indicated the presence of peaks at 1357.70 and 1533.97 cm− 1, thus confirming the binding of citric acid on the surface of magnetite nanoparticles. Zeta potential measurements indicated that the citric acid-coated IONPs presents much-improved stability compared to bare IONPs; the Zeta potential absolute value is almost three times higher. Finally, citric acid-coated IONPs as a contrast agent for MRI clearly demonstrates their excellent ability to shorten T2 and T1 relaxation times by more than 94.7% and 67.9%, respectively. These results reveal that the citric acid-coated IONPs are excellent candidates for potential biomedical application primarily as MRI contrast agents.