bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of Game-Based Learning on Students’ Achievement in Science: A Meta-Analysis
Authors: Lei Hao , Chiu Ming Ming , Wang Danyi , Wang Chenxin , Xie Tongwei 
Published: February 2022

This meta-analysis examines the effects of game-based learning (GBL), compared with traditional instructional methods, on the science achievement of students, ranging from primary school to university. Results from the 41 primary studies of 6256 participants showed heterogeneity among effect sizes. The random effects model results showed a positive effect (g = .705, 95% CI = [.603, .807], p < .001), suggesting that students learned substantially more via GBL than traditional instruction. Additionally, moderation analysis found that the link between GBL and science achievement was stronger (a) among students in Eastern countries than Western countries; (b) among primary school students than undergraduates, junior or senior secondary school students; (c) on quizzes, final exams, and course grades than assignment scores; (d) for interventions between 4 hours and 1 week, smaller for those less than 4 hours, and smallest for those over 1 week; and (e) slightly in later publication years.
The incorporation of β-tricalcium phosphate nanoparticles within silk fibroin composite scaffolds for enhanced bone regeneration: An in vitro and in vivo study
Authors: Jing Tienan , yi liu  , Xu Li , Chen Cen , Liu Fan 
Published: February 2022

To investigate the osteogenesis of β-tricalcium phosphate nanoparticles-incorporated silk fibroin (SF/β-TCP) composite scaffolds, SF-based scaffolds with different β-TCP proportion (2/1, 1/1, and 1/2) were fabricated by freeze-drying technology in the present study. Structural and physicochemical properties of SF-based scaffolds were evaluated by using scanning electron microscope, X-ray diffraction, Fourier transformed infrared spectroscopy (ATR-FTIR) and transmission electron microscope. Biocompatibility and osteogenesis of SF/β-TCP scaffolds were investigated by using bone marrow mesenchymal stem cells (BMSCs). Eight New Zealand rabbits were selected, while four 8-mm-diameter calvarial defects were created in each rabbit to place SF/β-TCP scaffolds. The harvested specimens at 4 and 12 weeks were used to evaluate the bone forming ability by micro-CT and histological examination. The results suggested incorporation of β-TCP displayed flake-like pore morphology with proper pore sizes. With the increasing proportion of β-TCP, composite scaffolds exhibited higher compressive strength, lower swelling ratio and degradation rate, as well as enhanced biomineralization capacity. Alkaline phosphatase activity and collagen type I expression levels of BMSCs were significantly increased in the presence of β-TCP nanoparticles. All composite scaffolds with different β-TCP proportion had good bone formation ability at 12 weeks. Among them, SF/β-TCP (1/2) scaffold exhibited the favorable osteogenesis capability which had great potential for applications in bone regeneration.
Experiences of critical care nurses during the early months of the COVID-19 pandemic
Authors: Moore Dorothy James , Dawkins Denise , Hampton Michelle DeCoux , McNiesh Susan 
Published: February 2022

Background: Critical care nurses have risked their lives and in some cases their families through hazardous duty during the COVID-19 pandemic and have faced multiple ethical challenges. Research/aim: The purpose of our study was to examine how critical care nurses coped with the sustained multi-faceted pressures of the critical care environment during the unchartered waters of the COVID-19 pandemic. It was anticipated that our study might reveal numerous ethical challenges and decision points. Research design: A qualitative descriptive study, utilizing an interpretivist paradigm. Participants and research setting: Critical care nurses, working in either intensive care units or emergency departments (N = 11) who were primarily from Northern California hospitals. Individual in-depth ZOOM® session interviews, guided by semi-structured questions, were used to collect data. Interviews lasted between 18 and 59 min, with an average length of 33 min. Session interviews were transcribed and analyzed. Ethical considerations: This study was approved by the researchers’ university Institutional Review Board. Findings: Five main themes emerged: Fear of the Unknown, Adapting to Practice Changes and Challenges, Patient Advocacy and Moral Distress, Isolation and the Depersonalization of Care, and Professionalism and a Call to Duty. Discussion and conclusion: Fear of becoming ill or bringing COVID-19 home to their families was a constant source of anxiety for nurses. There were numerous changes in policy and challenges to standard practice protocols, including most notably shortages in personal protective equipment, which nurses navigated resourcefully. Most nurses interviewed were motivated by a sense of professional duty. The nurses experienced some moral distress in their inability to advocate as they might like for their patients, especially at end of life. Infection control requirements for isolation.
Suicide-related crisis presentations to a rural emergency department: A retrospective cohort study
Authors: MacDermott Sean , Sutton Keith , Motorniak David , Bredhauer Jacqueline , Wright Fiona , Whyte Merryl , van Vuuren Julia , Spelten Evelien 
Published: February 2022

Objective The study sought to investigate the profile and characteristics of suicide-related crisis presentations and factors associated with repeat presentations to a rural hospital Emergency Department (ED). Method This retrospective cohort study examined suicide-related crisis presentation data from a rural ED for the years 2008–2018 inclusive. Descriptive statistical analyses included demographic characteristics and trends over time. Factors associated with increased likelihood to re-present to the ED for suicide-related crisis were identified using Odds Ratio analyses. Results First Nations People, adolescents and young adults were at increased risk of presentation. Suicidal crisis presentations had increased well beyond that which might be accorded to the catchment’s population increase and almost a third of presentations involved individuals re-presenting in suicide-related crisis. Repeat presentation was positively associated with younger age, less acute triage category, discharge to the community and leaving the ED before/during treatment. Conclusions This study illustrates the importance of flagging, follow-up and support of rural repeat presenters to reduce further suicidal behaviours and presentation. Findings support the need for culturally safe and appropriate interventions and follow-up services. It is recommended to extend approach this to non-ED settings.
Anthropometry Based Growth and Body Composition in Infants with Complex Congenital Heart Disease
Authors: Irving Sharon Y. , Ravishankar Chitra , Miller Mary , Chittams Jesse , Stallings Virginia , Medoff-Cooper Barbara 
Published: February 2022

Background: Infants with congenital heart disease (CHD) often have poor growth and altered body composition (fat and muscle accretion). Aim: Describe growth patterns in infants with CHD using interval weight, length, head circumference (HC), triceps (TSF), subscapular skinfolds (SSSF), and mid-upper arm circumference (MUAC) measurements. Subjects and Methods: A total of 120 infants enrolled: 48% healthy and 58% with CHD (45% single ventricle [SV]; 55% two ventricle [2V] physiology). Weight, length, HC, TSF, SSSF, and MUAC measured at 3-, 6-, 9-, and 12-months of age. Results: CHD infants had lower weight, length, and HC z-scores at 3-, 6-, and 9-months. At 9-months, infants with SV physiology had larger TSF and SSSF z-scores over 2V and healthy infants. Overall MUAC z-scores were smaller at 3- and 6-months in infants with CHD. Conclusison: Infants with CHD have a complex pattern of growth. Longitudinal growth and body composition measurements provide information to better understand this pattern.
The Impact of Race and Ethnicity on Surgical Risk and Outcomes Following Palatoplasty: An Analysis of the NSQIP Pediatric Database
Authors: Halsey Jordan N. , Asti Lindsey , Kirschner Richard E. 
Published: February 2022

Objective To determine how race and ethnicity affect palatoplasty 30-day outcomes. Design Retrospective review. Patients/setting The 2012 to 2019 National Surgical Quality Improvement Program (NSQIP) Pediatric database was used to identify patients ≤ 2 years who underwent primary palatoplasty. We compared demographics, comorbidities, and 30-day outcomes among different racial and ethnic groups. Logistic regression was used to determine independent risk factors for adverse events. Main outcome measures Increased risk for adverse events and postoperative surgical outcomes, including complications, readmission, and prolonged length of stay. Results A total of 8537 patients were identified in the database. African-American patients had the highest proportion of premature infants and infants with a BMI < 15% at the time of repair. Asian patients underwent palatoplasty at a later age compared to other races (12.7 months vs 11.7-12.1 months). Postoperatively, the odds of a complication were significantly higher in Asian patients (aOR = 1.73, 95% CI: 1.17-2.57) and other/unknown patients (aOR = 1.40, 95% CI: 1.05-1.86), but not among African American (aOR = 1.02, 95% CI: 0.70-1.47) or Hispanic (aOR = 0.93, 95% CI: 0.69–1.26) patients. Other/unknown patients were more likely to require postoperative ventilation (aOR = 2.34, 95% CI: 1.38-3.95). The odds of readmission were highest in Asian and other/unknown patients. African American, Hispanic, and other/unknown patients were more likely than Caucasian patients to be hospitalized > 2 days postoperatively. Conclusion This study highlights ethnic differences in presentation and 30-day outcomes following palatoplasty. Further evaluation of disparities in cleft care should be performed to improve healthcare access and surgical outcomes.
Abemaciclib: The First FDA-Approved CDK4/6 Inhibitor for the Adjuvant Treatment of HR+ HER2− Early Breast Cancer
Authors: Raheem Farah , Ofori Henry , Simpson Lacey , Shah Vishal 
Published: February 2022

Objective: To review the new indication of cyclin-dependent kinase (CDK4/6) inhibitor abemaciclib for the adjuvant treatment of hormone receptor positive (HR+), human epidermal growth factor receptor 2 negative (HER2−), axillary lymph node (LN) positive early breast cancer (EBC) at high risk of recurrence and a Ki-67 ≥20%. Data Sources: A literature search was performed through PubMed, ClinicalTrials.gov, and Food and Drug Administration (FDA) website (February 1, 2018, to December 23, 2021) to identify relevant information. Study Selection and Data Extraction: Human and animal studies related to pharmacology, pharmacokinetics, efficacy, and safety of abemaciclib were identified. Data Synthesis: Addition of abemaciclib to standard of care endocrine therapy (ET) for patients with high-risk clinicopathologic features and Ki-67 ≥20% demonstrated 30% reduction in the risk of developing invasive disease and distant recurrence. At 15.5 months, abemaciclib + ET demonstrated a significant improvement in invasive disease-free survival (IDFS) vs ET alone (hazard ratio [HR], 0.75; 95% confidence interval [CI], 0.60-0.93, P = 0.01). At 27 months, IDFS benefit was maintained (HR, 0.70; 95% CI, 0.59-0.82, P < 0.0001). Diarrhea occurred in more than 80% of patients in the abemaciclib arm. Relevance to Patient Care and Clinical Practice: This review describes the clinical applicability of adjuvant abemaciclib for patients with HR+, HER2− EBC at high risk for recurrence. Conclusion: Adjuvant abemaciclib significantly reduces the risk for early development of invasive disease and distant recurrence in patients with HR+, HER2− node positive EBC. Longer follow-up is needed to determine the impact of adjuvant abemaciclib on late disease recurrence and survival outcomes.
Intermittent Versus Continuous Infusion Dosing of Intravenous Proton Pump Inhibitors for Upper Gastrointestinal Bleeding
Authors: Leung Thomas , Kedzior Sonya , Moore Kerry , Bierman Jesse , Coralic Zlatan 
Published: February 2022

Background: Proton pump inhibitor (PPI) continuous infusions or intermittent boluses are used for the treatment of upper gastrointestinal bleeding (UGIB). Intermittent boluses are easier to give and are of lower cost without affecting clinical outcomes. Objective: To compare the rate of rebleeding between intermittent bolus and continuous infusion PPI therapy. Methods: We performed a retrospective, multicenter review of patients with UGIB receiving either continuous or intermittent PPI therapy. During the study period, due to drug and supply shortages, each institution implemented policies preferring intermittent PPI bolus therapy. We performed bivariate and multivariable comparisons of the 2 treatment strategies, with the primary outcome of interest being incidence of rebleeding. Additional variables of interest included intensive care unit (ICU) and hospital lengths of stay, discharge disposition, and in-hospital mortality. Results: Compared with intermittent bolus dosing (n = 209), patients receiving continuous infusion PPI (n = 237) were associated with a higher rate of rebleeding (33.8% vs 23.0%; P = 0.012); however, no difference was detected in multivariable analysis: adjusted odds ratio, 1.50 (95% confidence interval, 0.91-2.50). There was no difference in median hospital or ICU length of stay, discharge disposition, or in-hospital mortality. Correlatively, patients receiving continuous infusion therapy were more likely to have liver disease (29.1% vs 20.1%; P = 0.028), alcohol use disorder (28.3% vs 16.3.%; P = 0.003), history of lower gastrointestinal bleeding (6.4% vs 1.9%; P = 0.021), variceal bleeding (6.3 vs 2.4%, P = 0.045), and be admitted to the ICU (65.0% vs 32.5%, P = 0.00). Conclusions: Introduction of intermittent PPI bolus UGIB treatment via change in hospital policy was not associated with higher rates of rebleeding. However, continuous PPI therapy may have been perceived as more effective as it was used more commonly in high-risk patients.
Ibuprofen-Associated Hypokalemia and Metabolic Acidosis: Systematic Literature Review
Authors: Man Anca M. , Piffer Arianna , Simonetti Giacomo D. , Scoglio Martin , Faré Pietro B. , Lava Sebastiano A. G. , Bianchetti Mario G. , Milani Gregorio P. 
Published: February 2022

Objective: Ibuprofen is a widely used nonsteroidal anti-inflammatory drug, which has been occasionally associated with hypokalemia and metabolic acidosis. The objective of this report is to analyze the literature on this issue and to address the underlying pathophysiology. Data Sources: Excerpta Medica, the National Library of Medicine, and Web of Science were searched from inception to July 16, 2021. Study Selection and Data Extraction: Papers reporting individually documented humans on ibuprofen with hypokalemia, acidosis, or both were retained. Data were extracted using a checklist. Data synthesis: For the final analysis, we evaluated 41 reports describing 50 cases (26 males and 24 females; 36 adults and 14 children) with often profound hypokalemia, acidosis, or both after ingestion of ibuprofen. Twenty-six cases were acute and 24 long term. Hypokalemia and acidosis occurred not only after ingestion of very high doses but also after ingestion of moderately high or even normal doses of ibuprofen. Laboratory values consistent with an excessive urinary potassium excretion or an altered urinary acidification were often disclosed in most cases. Discontinuation of ibuprofen resulted in a resolution of hypokalemia and acidosis within days in 47 cases. The course was lethal in 3 cases. Relevance to Patient Care and Clinical Practice: This review highlights potentially fatal side effects of ibuprofen and can help doctors who are confronted with such a situation. Conclusions: These data highlight the potential of ibuprofen to occasionally induce hypokalemia and acidosis of renal origin. Discontinuation of ibuprofen results in a resolution within days.
Imaging Findings and First Metatarsal Rotation in Hallux Valgus
Authors: Najefi Ali-Asgar , Katmeh Rateb , Zaveri Amit Kamal , Alsafi Mohammad Khalid , Garrick Frances , Malhotra Karan , Patel Shelain , Cullen Nicholas , Welck Matthew 
Published: February 2022

Background: Failure to identify and correct malrotation of the first metatarsal may lead to recurrent hallux valgus deformity. We aimed to identify the proportion of hallux valgus patients with increased first metatarsal pronation using weightbearing computed tomography (WBCT) and to identify the relationship with conventional radiographic measurements. Methods: WBCT scans were analyzed for 102 feet with a hallux valgus angle (HVA) and intermetatarsal angle (IMA) greater than or equal to 16 and 9 degrees, respectively. Metatarsal pronation angle (MPA), alpha angle, sesamoid rotation angle (SRA), and sesamoid position were measured on standardized coronal WBCT slices. Pronation was recorded as positive. Hindfoot alignment angle (HAA) was assessed using dedicated software. Pearson correlation and multiple regression analyses were used to assess differences between groups. Results: Mean HVA was 29.8±9.4 degrees and mean IMA was 14.1±3.7 degrees. Mean MPA was 11.9±5.8 (range 0-26) degrees and mean alpha angle was 11.9±6.8 (range −3 to 29) degrees. In a previous study, we demonstrated the upper limit of normal MPA as 16 degrees and alpha angle as 18 degrees. Based on these criteria, we identified abnormal metatarsal pronation in 32 feet (31.4%). We found a strong positive correlation between SRA and HVA/IMA ( R = 0.67/0.60, respectively, P < .001). IMA and HAA weakly correlated with MPA and alpha angle (IMA: R = 0.26/0.27, respectively, P < .01; HAA: R = 0.26/0.27, respectively, P < .01). Regression analyses suggested that increasing IMA was the most significant radiographic predictor of increased pronation. In this cohort, there was no correlation between HVA or sesamoid position and MPA / alpha angle (HVA: P = .36/.12, respectively, sesamoid position, P = .86/.77, respectively). Conclusion: In this cohort of 102 feet that met plain radiographic criteria for hallux valgus deformity, first metatarsal pronation was found abnormal in 31.4% of patients. We found a weak association between the IMA and hindfoot valgus, but not the HVA.
Offloading Plantar Pressures in Healthy Adults: Stirrup Cast vs Total Contact Cast
Authors: Al Khalifa Ahmed , Al Khalifa Muneera , Khan Ryan M. , Awoke Adam , Cherry Ahmed , Halai Mansur , Daniels Timothy R. 
Published: February 2022

Background: Diabetic foot ulcers are associated with significant morbidity and mortality while posing a challenge for healthcare professionals. Offloading is considered the mainstay of treatment. Total contact casting (TCC) is widely used but does not effectively offload the hindfoot. Some studies suggest that a metal stirrup is effective at offloading midfoot and hindfoot ulcers. The primary purpose of this study is to compare the offloading mechanism of TCC to a stirrup cast. Methods: A pilot observational study assessing 12 healthy volunteers who underwent casting with a TCC or stirrup cast. A sensor (Pedar; Novel GmbH) that measures maximum force, peak pressure, and contact time and area of each foot region, was placed inside the cast to assess the offloading mechanisms of the 2 interventions. Results: We measured a reduction in all plantar foot loading parameters from the TCC to the stirrup cast. The highest reductions of 85% to 96% (±5%-13%) were noted in maximum force and peak pressure under the forefoot ( P < .0001) and found reductions in maximum force, the contact area of all regions of the foot, peak pressure and contact time of the forefoot and midfoot, and contact area of the hindfoot ( P < .05). Conclusion: In this experimental trial of healthy adults, the stirrup cast was more effective than the TCC by offloading the foot mostly in the forefoot and midfoot.
Discrimination between Pancreatic Cancer, Pancreatitis and Healthy Controls Using Urinary Polyamine Panel
Authors: Nissinen Samuli I. , Venäläinen Markus , Kumpulainen Pekka , Roine Antti , Häkkinen Merja R. , Vepsäläinen Jouko , Oksala Niku , Rantanen Tuomo 
Published: February 2022

Backround Polyamines play an important role in cellular proliferation, and the change in polyamine metabolism is reported in various cancers. We searched for urinary polyamine signature for distinguishing between pancreatic cancer, premalignant lesions of the pancreas (PLP), acute and chronic pancreatitis, and controls. Methods Patients and controls were prospectively recruited in three Finnish hospitals between October 2013 and June 2016. The patients provided a urine sample at the time of the diagnosis. The panel of 14 polyamines was obtained in a single run with mass spectrometry. The polyamine concentrations were analysed with quadratic discriminant analysis and cross-validated with leave-one-out cross-validation. Results Sixty-eight patients with pancreatic cancer, 36 with acute pancreatitis, 18 with chronic pancreatitis and 7 with PLP were recruited, as were 53 controls. The combination of 4 polyamines – acetylputrescine, diacetylspermidine, N8-acetylspermidine and diacetylputrescine – distinguished pancreatic cancer and PLP from controls (sensitivity = 94%, specificity = 68% and AUC = 0.88). The combination of diacetylspermidine, N8-acetylspermidine and diacetylspermine distinguished acute pancreatitis from controls (sensitivity = 94%, specificity = 92%, AUC = 0.98). The combination of acetylputrescine, diacetylspermidine and diacetylputrescine distinguished chronic pancreatitis from controls (sensitivity = 98%, specificity = 71%, AUC = 0.93). Conclusions Optimally selected urinary polyamine panels discriminate between pancreatic cancer and controls, as well as between acute and chronic pancreatitis and controls.
Aspirin use in patients with diagnosed diabetes in the United States and China: Nationally representative analysis
Authors: Wang Xin , Hao Guang , Chen Zuo , Zhang Linfeng , Kang Yuting , Yang Ying , Zheng Congyi , Zhou Haoqi , Chen Lu , Wang Zengwu , Gao Runlin 
Published: February 2022

Background The epidemiological data on the use of aspirin in diabetic patients is very limited. The main purpose of this study is to examine the current status of aspirin use in the United States (US) and China in large representative populations. Methods Data came from the National Health and Nutrition Examination Survey (NHANES) and China Hypertension Survey (CHS), two nationally representative cross-sectional studies. Results The percentage of aspirin use was 73.8% in US diabetic patients with ASCVD, and the percentage of aspirin use in diabetic patients with high ASCVD risk was marginally higher in men ( p = .052), 54.5% in men and 37.1% in women. The percentages of aspirin use in diabetic patients with intermediate and low ASCVD risk were 55.1% and 35.0%, respectively. In China, the percentage of aspirin use in diabetic patients with ASCVD was 53.5%, and were 14.3%, 9.7%, and 3.2% among diabetic patients with high, intermediate, and low ASCVD risk, respectively. Conclusions In summary, the percentage of aspirin use in primary prevention in US diabetic patients in men was higher than in women, and this percentage for primary and secondary prevention in US patients was higher than that in Chinese patients.