bluuebunny/crossref_metadata_2025_split huggingface dataset:
Learning burnout and its association with perceived stress, social support, and the Big Five personality traits in Chinese medical students during the COVID-19 pandemic: a cross-sectional study
Authors: Wang Simeng , Li Honghe , Chen Xin , Yan Nan , Wen Deliang 
Published: December 2022

Abstract
Background
Owing to the coronavirus disease 2019, medical learning burnout has attracted increasing attention in educational research. It has a serious negative impact on medical students and their service quality. This could impair the professional development of medical students; weaken their personal and professional quality; and lead to problems such as increased medical errors and reduced patient care quality and satisfaction. This study aimed to examine the effects of perceived stress, social support, and the Big Five personality traits on learning burnout among medical students.

Methods
In November 2021, a cross-sectional survey was conducted at three medical universities in China. A self-administered questionnaire was distributed to 616 third- year students. Learning burnout, perceived stress, social support, and the Big Five personality traits (neuroticism, extroversion, openness, agreeableness, and conscientiousness) were anonymously measured. A total of 583 students were included in the final sample. Hierarchical linear regression was performed to explore the effects of perceived stress, social support, and Big Five personality traits on medical students’ learning burnout.

Results
Perceived stress was positively associated with learning burnout (emotional exhaustion: ß = 0.577, p < 0.001; cynicism: ß = 0.543, p < 0.001; low professional efficacy: ß = 0.455, p < 0.001) whereas social support was negatively related with it (low professional efficacy: ß = -0.319, p < 0.001). Neuroticism had a positive effect on emotional burnout (ß = 0.152, p = 0.009). Extraversion (ß = -0.116, p = 0.006) and conscientiousness (ß = -0.363, p < 0.001) had a negative effect on low professional efficacy. Agreeableness negatively affected emotional exhaustion (ß = -0.181, p < 0.001) and cynicism (ß = -0.245, p < 0.001) and positively affected low professional efficacy (ß = 0.098, p = 0.008). The associated factors together accounted for an additional variance of learning burnout (emotional exhaustion: 39.0%; cynicism: 36.8%; low professional efficacy: 48.7%).

Conclusions
Social support is a positive resource for fighting medical students’ burnout. Perceived stress was the strongest indicator of learning burnout. In addition to reducing perceived stress, developing extraversion, agreeableness, and conscientiousness should be included in burnout prevention and treatment strategies, particularly for medical students.
Major complications and mortality after ventral hernia repair: an eleven-year Swedish nationwide cohort study
Authors: Lindmark Mikael , Löwenmark Thyra , Strigård Karin , Gunnarsson Ulf 
Published: December 2022

Abstract
Background and aims
Ventral hernia repair is one of the most common surgical procedures performed worldwide. Despite the large volume, consensus is lacking regarding indications for repair or choice of surgical method used for reconstruction. The aim of this study was to explore the risk for major complications and mortality in ventral hernia repair using data from a nationwide patient register.

Method
Patient data of individuals over 18 years of age who had a ventral hernia procedure between 2004 and 2014 were retrieved from the Patient Register kept by the Swedish National Board of Health and Welfare. After exclusion of patients with concomitant bowel surgery, 45 676 primary surgical admissions were included. Procedures were dichotomised into laparoscopic and open surgery, and stratified for primary and incisional hernias.

Results
A total of 45 676 admissions were analysed. The material comprised 36% (16 670) incisional hernias and 64% (29 006) primary hernias. Women had a higher risk for reoperation during index admission after primary hernia repair (OR 1.84 (1.29–2.62)). Forty-three patients died of complications within 30 days of index surgery. Patients aged 80 years and older had a 2.5 times higher risk for a complication leading to reoperation, and a 12-fold higher mortality risk than patients aged 70–79 years.

Conclusion
Age is the dominant mortality risk factor in ventral hernia repair. Laparoscopic surgery was associated with a lower risk for reoperation during index admission. Reoperation seems to be a valid outcome variable, while registration of complications is generally poor in this type of cohort.
Predictors of modern contraceptive use among reproductive age women in high fertility countries in sub-Saharan Africa: evidence from demographic and health surveys
Authors: Negash Wubshet Debebe , Eshetu Habitu Birhan , Asmamaw Desale Bihonegn 
Published: December 2022

Abstract
Background
The world’s population has increased faster than expected due to high fertility rates, with sub-Saharan Africa accounting for most of the increase. Modern contraceptive use is the best option to reduce the high fertility rate. There is limited information on the prevalence of modern contraception and its predictors in sub-Saharan Africa’s high-fertility countries. Therefore, this study aimed to assess the prevalence and predictors of modern contraception among reproductive-age women in high fertility countries in sub-Saharan Africa.

Methods
We used Demographic and Health Survey data sets from the top 10 high fertility countries in sub-Saharan Africa. Stata version 16.0 software was used to analyze the data, and all statistical analyses were completed after the data had been weighted. Multilevel binary logistic regression was performed to identify factors associated with modern contraceptive use. Adjusted odds ratio with a 95% confidence interval, and a p value < 0.05 was used to declare statistical significance.

Results
The prevalence of modern contraceptive use in all the countries considered in this study was 10.72% (95% CI 10.57, 10.87). In terms of the predictor variables, young aged women, those who had attended a primary or secondary level of formal education, women who received antenatal care follow up, women who reported distance to the health facility as not a big problem, and women from rich families were more likely to use modern contraceptives.

Conclusion
Only one in 10 women of reproductive age used modern contraceptive methods in high fertility countries in sub-Saharan Africa. To improve the use of modern contraceptives, governments and non-governmental organizations studied in the countries should intensify programs that focus on those women who are economically poor, those with no formal education, no media exposure, and those with no antenatal care follow up.
eOSCE stations live versus remote evaluation and scores variability
Authors: Bouzid Donia , Mullaert Jimmy , Ghazali Aiham , Ferré Valentine Marie , Mentré France , Lemogne Cédric , Ruszniewski Philippe , Faye Albert , Dinh Alexy Tran , Mirault Tristan ,   on behalf of Université Paris Cité Osce study group, Smadja Nathan Peiffer , Muller Léonore , Pierrotin Laure Falque , Thy Michael , Assadi Maksud , Yung Sonia , de Tymowski Christian , le Hingrat Quentin , Eyer Xavier , Wicky Paul Henri , Oualha Mehdi , Houdouin Véronique , Jabre Patricia , Vodovar Dominique , Dioguardi Burgio Marco , Zucman Noémie , Tsopra Rosy , Tazi Asmaa , Ressaire Quentin , Nguyen Yann , Girard Muriel , Frachon Adèle , Depret François , Pellat Anna , de Masson Adèle , Azais Henri , de Castro Nathalie , Jeantrelle Caroline , Javaud Nicolas , Malmartel Alexandre , de Margerie Constance Jacquin , Chousterman Benjamin , Fournel Ludovic , Holleville Mathilde , Blanche Stéphane 
Published: December 2022

Abstract
Background
Objective structured clinical examinations (OSCEs) are known to be a fair evaluation method. These recent years, the use of online OSCEs (eOSCEs) has spread. This study aimed to compare remote versus live evaluation and assess the factors associated with score variability during eOSCEs.

Methods
We conducted large-scale eOSCEs at the medical school of the Université de Paris Cité in June 2021 and recorded all the students’ performances, allowing a second evaluation. To assess the agreement in our context of multiple raters and students, we fitted a linear mixed model with student and rater as random effects and the score as an explained variable.

Results
One hundred seventy observations were analyzed for the first station after quality control. We retained 192 and 110 observations for the statistical analysis of the two other stations. The median score and interquartile range were 60 out of 100 (IQR 50–70), 60 out of 100 (IQR 54–70), and 53 out of 100 (IQR 45–62) for the three stations. The score variance proportions explained by the rater (ICC rater) were 23.0, 16.8, and 32.8%, respectively. Of the 31 raters, 18 (58%) were male. Scores did not differ significantly according to the gender of the rater (p = 0.96, 0.10, and 0.26, respectively). The two evaluations showed no systematic difference in scores (p = 0.92, 0.053, and 0.38, respectively).

Conclusion
Our study suggests that remote evaluation is as reliable as live evaluation for eOSCEs.
Digital technologies in routine palliative care delivery: an exploratory qualitative study with health care professionals in Germany
Authors: May Susann , Bruch Dunja , Gehlhaar Anne , Linderkamp Felizitas , Stahlhut Kerstin , Heinze Martin , Allsop Matthew , Muehlensiepen Felix 
Published: December 2022

Abstract
Objective
To explore health care professionals’ (HCPs) perspectives, experiences and preferences towards digital technology use in routine palliative care delivery.

Methods
HCPs (n = 19) purposively selected from a sample of settings that reflect routine palliative care delivery (i.e. specialized outpatient palliative care, inpatient palliative care, inpatient hospice care in both rural and urban areas of the German states of Brandenburg and Berlin) participated in an explorative, qualitative study using semi-structured interviews. Interview data were analyzed using structured qualitative content analysis.

Results
Digital technologies are widely used in routine palliative care and are well accepted by HCPs. Central functions of digital technologies as experienced in palliative care are coordination of work processes, patient-centered care, and communication. Especially in outpatient care, they facilitate overcoming spatial and temporal distances. HCPs attribute various benefits to digital technologies that contribute to better coordinated, faster, more responsive, and overall more effective palliative care. Simultaneously, participants preferred technology as an enhancement not replacement of care delivery. HCPs fear that digital technologies, if overused, will contribute to dehumanization and thus significantly reduce the quality of palliative care.

Conclusion
Digital technology is already an essential part of routine palliative care delivery. While generally perceived as useful by HCPs, digital technologies are considered as having limitations and carrying risks. Hence, their use and consequences must be carefully considered, as they should discreetly complement but not replace human interaction in palliative care delivery.
Using patient flow analysis with real-time patient tracking to optimize radiation oncology consultation visits
Authors: Mesko Shane , Weng Julius , Das Prajnan , Koong Albert C. , Herman Joseph M. , Elrod-Joplin Dorothy , Kerr Ashley , Aloia Thomas , Frenzel John , French Katy E. , Martinez Wendi , Recinos Iris , Alshaikh Abdulaziz , Daftary Utpala , Moreno Amy C. , Nguyen Quynh-Nhu 
Published: December 2022

Abstract
Purpose
Clinical efficiency is a key component of the value-based care model and a driver of patient satisfaction. The purpose of this study was to identify and address inefficiencies at a high-volume radiation oncology clinic.

Methods and materials
Patient flow analysis (PFA) was used to create process maps and optimize the workflow of consultation visits in a gastrointestinal radiation oncology clinic at a large academic cancer center. Metrics such as cycle times, waiting times, and rooming times were assessed by using a real-time patient status function in the electronic medical record for 556 consults and compared between before vs after implementation of the PFA recommendations.

Results
The initial PFA revealed four inefficiencies: (1) protracted rooming time, (2) inefficient communications, (3) duplicated tasks, and (4) ambiguous clinical roles. We analyzed 485 consult-visits before the PFA and 71 after the PFA. The PFA recommendations led to reductions in overall median cycle time by 21% (91 min vs 72 min, p < 0.001), in cumulative waiting times by 64% (45 min vs 16 min; p < 0.001), which included waiting room time (14 min vs 5 min; p < 0.001) and wait for physician (20 min vs. 6 min; p < 0.001). Slightly less than one-quarter (22%) of consult visits before the PFA lasted > 2 h vs. 0% after implementation of the recommendations (p < 0.001). Similarly, the proportion of visits requiring < 1 h was 16% before PFA vs 34% afterward (p < 0.001).

Conclusions
PFA can be used to identify clinical inefficiencies and optimize workflows in radiation oncology consultation clinics, and implementing their findings can significantly improve cycle times and waiting times. Potential downstream effects of these interventions include improved patient experience, decreased staff burnout, financial savings, and opportunities for expanding clinical capacity.
Egfr signaling promotes juvenile hormone biosynthesis in the German cockroach
Authors: Li Zhaoxin , Zhou Caisheng , Chen Yumei , Ma Wentao , Cheng Yunlong , Chen Jinxin , Bai Yu , Luo Wei , Li Na , Du Erxia , Li Sheng 
Published: December 2022

Abstract
Background
In insects, an interplay between the activities of distinct hormones, such as juvenile hormone (JH) and 20-hydroxyecdysone (20E), regulates the progression through numerous life history hallmarks. As a crucial endocrine factor, JH is mainly synthesized in the corpora allata (CA) to regulate multiple physiological and developmental processes, including molting, metamorphosis, and reproduction. During the last century, significant progress has been achieved in elucidating the JH signal transduction pathway, while less progress has been made in dissecting the regulatory mechanism of JH biosynthesis. Previous work has shown that receptor tyrosine kinase (RTK) signaling regulates hormone biosynthesis in both insects and mammals. Here, we performed a systematic RNA interference (RNAi) screening to identify RTKs involved in regulating JH biosynthesis in the CA of adult Blattella germanica females.

Results
We found that the epidermal growth factor receptor (Egfr) is required for promoting JH biosynthesis in the CA of adult females. The Egf ligands Vein and Spitz activate Egfr, followed by Ras/Raf/ERK signaling, and finally activation of the downstream transcription factor Pointed (Pnt). Importantly, Pnt induces the transcriptional expression of two key enzyme-encoding genes in the JH biosynthesis pathway: juvenile hormone acid methyltransferase (JHAMT) and methyl farnesoate epoxidase (CYP15A1). Dual-luciferase reporter assay shows that Pnt is able to activate a promoter region of Jhamt. In addition, electrophoretic mobility shift assay confirms that Pnt directly binds to the − 941~ − 886 nt region of the Jhamt promoter.

Conclusions
This study reveals the detailed molecular mechanism of Egfr signaling in promoting JH biosynthesis in the German cockroach, shedding light on the intricate regulation of JH biosynthesis during insect development.
Outcomes and risk factors with COVID-19 or influenza in hospitalized asthma patients
Authors: Dupont Axelle , Couffignal Camille , Arias Camila , Salah Kankoe , Phillips-Houlbraq Mathilde , Le Brun Mathilde , Taillé Camille 
Published: December 2022

AbstractBackgroundAt the time of the SARS-CoV-2 emergence, asthma patients were initially considered vulnerable because respiratory viruses, especially influenza, are associated with asthma exacerbations, increased risk of hospitalization and more severe disease course. We aimed to compare the asthma prevalence in patients hospitalized for COVID-19 or influenza and risk factors associated with poor prognosis with the diseases.MethodsThis retrospective cohort study used the Paris university hospitals clinical data warehouse to identify adults hospitalized for COVID-19 (January to June 2020) or influenza (November 2017 to March 2018 for the 2017–2018 influenza period and November 2018 to March 2019 for the 2018–2019 period). Asthma patients were identified with J45 and J46 ICD-10 codes. Poor outcomes were defined as admission in intensive care or death.ResultsAsthma prevalence was significantly higher among influenza than COVID-19 patients (n = 283/3 119, 9.1%, 95% CI [8.1–10.1] in 2017–2018 and n = 309/3 266, 9.5%, 95% CI [8.5–10.5] in 2018–2019 versus n = 402/9 009, 4.5%, 95% CI [4.0–4.9]). For asthma patients, 31% with COVID-19 were admitted to an intensive care unit versus 23% and 21% with influenza. Obesity was a risk factor for the 2017–2018 influenza period, smoking and heart failure for the 2018–2019 period. Among COVID-19 patients with asthma, smoking and obesity were risk factors for the severe form.ConclusionsIn this study, patients with an asthma ICD-10 code were less represented among COVID-19 patients than among influenza-infected ones. However, outcomes were poorer for COVID-19 than influenza patients, both with asthma. These data highlight the importance of protective shields and vaccination against influenza and COVID-19 in this population.
Gaseous nitric oxide tumor ablation induces an anti-tumor abscopal effect
Authors: Confino Hila , Dirbas Frederick M. , Goldshtein Matan , Yarkoni Shay , Kalaora Rinat , Hatan Meital , Puyesky Shani , Levi Yakir , Malka Lidor , Johnson Matt , Chaisson Selena , Monson Jedidiah M. , Avniel Amir , Lisi Steve , Greenberg David , Wolf Ido 
Published: December 2022

Abstract
Background
In-situ tumor ablation provides the immune system with the appropriate antigens to induce anti-tumor immunity. Here, we present an innovative technique for generating anti-tumor immunity by delivering exogenous ultra-high concentration (> 10,000 ppm) gaseous nitric oxide (UHCgNO) intratumorally.

Methods
The capability of UHCgNO to induce apoptosis was tested in vitro in mouse colon (CT26), breast (4T1) and Lewis lung carcinoma (LLC-1) cancer cell lines. In vivo, UHCgNO was studied by treating CT26 tumor-bearing mice in-situ and assessing the immune response using a Challenge assay.

Results
Exposing CT26, 4T1 and LLC-1 cell lines to UHCgNO for 10 s–2.5 min induced cellular apoptosis 24 h after exposure. Treating CT26 tumors in-situ with UHCgNO followed by surgical resection 14 days later resulted in a significant secondary anti-tumor effect in vivo. 100% of tumor-bearing mice treated with 50,000 ppm UHCgNO and 64% of mice treated with 20,000 ppm UHCgNO rejected a second tumor inoculation, compared to 0% in the naive control for 70 days. Additionally, more dendrocytes infiltrated the tumor 14 days post UHCgNO treatment versus the nitrogen control. Moreover, T-cell penetration into the primary tumor was observed in a dose-dependent manner. Systemic increases in T- and B-cells were seen in UHCgNO-treated mice compared to nitrogen control. Furthermore, polymorphonuclear-myeloid-derived suppressor cells were downregulated in the spleen in the UHCgNO-treated groups.

Conclusions
Taken together, our data demonstrate that UHCgNO followed by the surgical removal of the primary tumor 14 days later induces a strong and potent anti-tumor response.
circCYP24A1 facilitates esophageal squamous cell carcinoma progression through binding PKM2 to regulate NF-κB-induced CCL5 secretion
Authors: Gu Lina , Sang Yang , Nan Xixi , Zheng Yang , Liu Fei , Meng Lingjiao , Sang Meixiang , Shan Baoen 
Published: December 2022

Abstract
Background
Esophageal squamous cell carcinoma (ESCC) is a common gastrointestinal malignant tumor, while the molecular mechanisms have not been fully elucidated. Multiple circular RNAs have been reported to involve in the onset and progression of malignant tumors through various molecular mechanisms. However, the clinical significance and functional mechanism of most circRNAs involved in the progression of ESCC remains obscure.

Methods
RNA-Seq was used to explore potential circRNAs in participated in 5 pairs of ESCC and their corresponding normal esophageal tissues. The up-regulated circCYP24A1 was selected. Fluorescence in situ hybridization was cunducted to verificated the expression and intracellular localization of circCYP24A1 by using the tissue microarray. The Kaplan–Meier method and Cox proportional hazards model was used to examine the potential prognostic value of circCYP24A1 on overall survival of ESCC patients. The biological function were confirmed by gain- and loss-of-function approaches in vivo. mRNA expression profile microarray was proformed to investigate the downstream signaling pathways involved in circCYP24A1. RNA pull-down assay and mass spectrometry were performed to identify the proteins associated with circCYP24A1. Rescue experiments were carried out to identified hypothetical regulatory role of circCYP24A1 on ESCC progression in vivo and in virto.

Results
In this study, we identified circCYP24A1 in ESCC tissues by RNA sequencing, which is up-regulated in 114 cases of ESCC tissues and acts as a novel prognosis-related factor. Moreover, circCYP24A1 promoted the ability of proliferation, migration, invasion and clone formation in vitro, as well as tumor growth in vivo. Mechanistically, chemokine (C-Cmotif) ligand 5 (CCL5) is functional downstream mediator for circCYP24A1, which is screened by mRNA microarray. Moreover, circCYP24A1 physically interacts with M2 isoform of pyruvate kinase (PKM2). Rescue experiments showed that PKM2 knockdown partly reverses the promotional effects of circCYP24A1. It was revealed that circCYP24A1 increases secretion of CCL5 through the mechanism mainly by interacting with PKM2, an activator of NF-κB pathway, and thereby accelerate malignant progression of ESCC.

Conclusions
Up-regulated circCYP24A1 could activate NF-κB pathway by binding PKM2, which promotes the secretion of CCL5 and accelerate malignant progression of ESCC. Our fndings recommended a novel function for circCYP24A1 as a potential effective biomarker for judging prognosis and a therapeutic target in ESCC.