bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hirschsprung disease managed with one-stage transanal endorectal pullthrough in a low-resource setting without frozen section
Authors: Negash Samuel , Getachew Hanna , Tamirat Dagnachew , Mammo Tihitena Negussie 
Published: March 2022

Abstract
Background
Over the past few decades, surgery for Hirschsprung’s disease (HD) has evolved into a minimally invasive, single-stage procedure with excellent outcomes. Intraoperative frozen section biopsy is critical for this procedure to avoid the potential risk of leaving a retained aganglionic segment. However, this facility is not available in most low-income countries. Therefore, a two-stage procedure with an initial colostomy is still practiced in the developing world. We aimed to evaluate the outcome of single-stage transanal pullthrough performed in a facility without frozen section biopsy.

Methods
A retrospective review of all patients who underwent transanal pullthrough in two teaching hospitals over a 6-year period (2015–2020).

Results
Forty-seven children underwent transanal endorectal pullthrough (TERPT). Age at surgery ranged from 2 months to 6 years and mean weight was 8.7 kg. Barium enema did not show transition zone in 6 patients (12.8%) while others demonstrated short segment HD. Intraoperatively, the transition zone was visualized in 40 patients (85%). TERPT alone was performed in 35 (74.5%), TERPT with laparotomy to visualize transition zone in 9 (26.7%) and TERPT with transabdominal mobilization was required in 3 (6.4%). Definitive histopathologic examination revealed aganglionic segment pullthrough in 4 (8.5%) and transitional zone pullthrough in another 4 (8.5%). However, with long term follow up all eight children remained asymptomatic and no intervention was required.

Conclusions
Transanal pullthrough offers reduced number of surgeries and faster recovery. We have also observed a good functional outcome despite a discrepancy with pathology results. Overall, our data suggests it is a safe and viable option for the treatment of short segment HD in facilities where frozen section is not available.
Various painful oral adverse reactions following COVID-19 vaccination: a case series
Authors: Chun Youngwoo , Jang Jihee , Jo Jung Hwan , Park Ji Woon 
Published: March 2022

Abstract
Background
Adverse events are increasingly being reported with the growing COVID-19 vaccination rate. However, the current literature on orofacial adverse effects following COVID-19 vaccination are severely limited. With the continuation of the global vaccination campaign the incidence of oral adverse effects will inevitably increase.

Case presentation
Clinical characteristics and treatment results of nine patients who complained of pain and discomfort of the oral cavity following SARS-CoV-2 vaccination were analyzed. Swelling and pain of the posterior palatal area, pain on palatal area of the central incisor, pain on the mucosa of the lip and lower gingiva, right preauricular region and right posterior lower gingiva, the buccal mucosa, tongue, and the right lower second molar area were the reported symptoms. Ulceration and swelling of the oral mucosa were found in certain cases. The symptoms were generally mild and responded well to medication within a relatively short period of time.

Conclusion
Oral adverse reactions following COVID-19 vaccination were manageable with treatment. Clinicians should understand the true nature of orofacial adverse reactions following COVID-19 vaccines and guide patients in decision-making.
Student-led curricular approaches in medical education: the educational effects of a virtual fundamentals of COVID-19 course
Authors: Chiu Megan Z. , Gerena Rolando G. , Roll Rebekah L. , Baker Joseph M. , Gomez Maritza , Brown Cameron M. , Brenner Abigail M. , Huang Christina C. , Ko Paul Y. , Bauer Margaret E. , Trujillo Daniel J. 
Published: March 2022

Abstract
Background
As the field of education was adapting to virtual learning during the COVID-19 pandemic, a need quickly emerged for a course to prepare medical students for future clinical practice. This call to action was answered by creating an innovative Fundamentals of COVID-19 course at the Indiana University School of Medicine (IUSM). As a group of medical student leaders at IUSM, we developed this online course in order to support our fellow students and the community.

Methods
The study examined the educational effects of completing the Fundamentals of COVID-19 course. In order to examine these effects, the study asked enrolled students to complete both a pre- and post-course self-assessment survey. Students were asked an identical set of questions on each survey about their knowledge, skills, and abilities (KSA) regarding COVID-19. Composite scores were created for each KSA learning domain. Responses were provided using a five-point Likert scale ranging from 1 = strongly disagree to 5 = strongly agree.

Results
Out of the 724 students enrolled, 645 students completed both the pre- and post-course assessment surveys. Findings show that there were both meaningful and statistically significant differences in students’ responses to the pre- and post-course surveys. Results show 1.) a significant mean increase in the knowledge composite score of 1.01, 95% CI [0.95, 1.06], t(644) = 36.4, p < .001, d = 1.43; 2.) a significant mean increase in the skills composite score of .55, 95% CI [0.50, 0.60], t(644) = 20.70, p < .001, d = 0.81. and 3.) a significant mean increase of the abilities composite score of 1.02, 95% CI [.97, 1.07], t(644) = 36.56, p < .001, d = 1.44.

Conclusions
These findings demonstrate that the student-developed, online Fundamentals of COVID-19 course resulted in notable and statistically significant educational effects. The increase in students’ self-reported ratings, especially in the knowledge and abilities domains, indicate that meaningful learning occurred within the course. These findings have notable implications for medical student training during healthcare emergencies, such as a pandemic, as well as within modern clerkship environments. Overall, our findings provide evidence that student-led curricular design and virtual delivery of course content can be effective tools in undergraduate medical education.
Why do medical residents prefer paternalistic decision making? An interview study
Authors: Driever Ellen M. , Tolhuizen Ivo M. , Duvivier Robbert J. , Stiggelbout Anne M. , Brand Paul L. P. 
Published: March 2022

Abstract
Background
Although shared decision making is championed as the preferred model for patient care by patient organizations, researchers and medical professionals, its application in daily practice remains limited. We previously showed that residents more often prefer paternalistic decision making than their supervisors. Because both the views of residents on the decision-making process in medical consultations and the reasons for their ‘paternalism preference’ are unknown, this study explored residents’ views on the decision-making process in medical encounters and the factors affecting it.

Methods
We interviewed 12 residents from various specialties at a large Dutch teaching hospital in 2019–2020, exploring how they involved patients in decisions. All participating residents provided written informed consent. Data analysis occurred concurrently with data collection in an iterative process informing adaptations to the interview topic guide when deemed necessary. Constant comparative analysis was used to develop themes. We ceased data collection when information sufficiency was achieved.

Results
Participants described how active engagement of patients in discussing options and decision making was influenced by contextual factors (patient characteristics, logistical factors such as available time, and supervisors’ recommendations) and by limitations in their medical and shared decision-making knowledge. The residents’ decision-making behavior appeared strongly affected by their conviction that they are responsible for arriving at the correct diagnosis and providing the best evidence-based treatment. They described shared decision making as the process of patients consenting with physician-recommended treatment or patients choosing their preferred option when no best evidence-based option was available.

Conclusions
Residents’ decision making appears to be affected by contextual factors, their medical knowledge, their knowledge about SDM, and by their beliefs and convictions about their professional responsibilities as a doctor, ensuring that patients receive the best possible evidence-based treatment. They confuse SDM with acquiring informed consent with the physician’s treatment recommendations and with letting patients decide which treatment they prefer in case no evidence based guideline recommendation is available. Teaching SDM to residents should not only include skills training, but also target residents’ perceptions and convictions regarding their role in the decision-making process in consultations.
Talent cultivation in health technology assessment: an expert survey
Authors: Wu Yu-Shan , Chen Chiehfeng , Wang Lin-Chien , Jian Li-Shan , Ko Yu 
Published: March 2022

Abstract
Background
Health technology assessment (HTA) has become essential in many countries over the past few years, and the demand for HTA professionals has increased in academia, governments, and industries. This study aimed to examine which courses are most important and which training activities are most helpful for the development of HTA proficiency as perceived by HTA experts.

Methods
The survey questionnaire was developed by literature review and expert opinion. Convenience sampling was used to survey HTA experts from the industrial sector, academic/research units, and government/independent assessment organizations using an online survey tool, SurveyCake. We collected respondents’ demographic information and asked them to assess the importance of each course included in an HTA program on a 5-point Likert Scale (1 = least important; 5 = highly important). In addition, respondents were asked to assess the extent to which various activities are helpful for HTA proficiency development.

Results
A total of 158 domestic and overseas experts in HTA-related fields were invited to participate in the survey and 68 completed the questionnaire. Among the respondents, the majority were female (57.4%) and working in academia (44.1%). The mean ± standard deviation of respondents’ age and number of years spent in HTA-related fields were 43.2 ± 11.0 years and 11.3 ± 9.9 years, respectively. The course that was rated the most important was “Pharmacoeconomics/Cost-effectiveness analysis” with a score of 4.8 ± 0.4 points, followed by “Health economics” at 4.7 ± 0.7 points. Moreover, internships at HTA-related institutions were perceived to be the most helpful training activity for HTA proficiency development.

Conclusions
Our study findings provide a better understanding of the requirements for developing HTA proficiency and can serve as a reference for the modification of current HTA education and training programs.
Assessing the utility and efficacy of e-OSCE among undergraduate medical students during the COVID-19 pandemic
Authors: Shorbagi Sarra , Sulaiman Nabil , Hasswan Ahmad , Kaouas Mujtaba , Al-Dijani Mona M. , El-hussein Rania Adil , Daghistani Mada Talal , Nugud Shumoos , Guraya Salman Yousuf 
Published: March 2022

Abstract
Background
The outbreak of coronavirus disease 2019 (COVID-19) and its quick progression to a global pandemic has urged medical schools to shift from didactic to distance learning and assessment approaches. The quality of clinical training and assessment have been jeopardized due to the regulatory restrictions and potential hazards to human lives. The aim of this paper is to evaluate the utility and efficacy of an electronic Objective Structured Clinical Examination (e-OSCE), which attempted to transform the format of a face-to-face OSCE to an e-OSCE.

Methods
We conducted three end of clerkship e-OSCEs for final year medical students in Surgery, Medicine and Family Medicine using the teleconferencing application of Microsoft Teams (MST). The e-OSCE blueprint included the assessment of all clinical skills except physical examination and procedural skills. Examiners supervised e-OSCE from the college campus, while all students were remotely assessed through the MST channels. During the exam, the students stayed in their specified MST channel and examiners rotated across all students. The utility and efficacy of e-OSCE was evaluated using a self-administered questionnaire for students, examiners and e-OSCE team.

Results
The data analysis showed that 93.4% students and 84.3% examiners agreed with the quality and process of e-OSCE. Similarly, 83.6% students and 98% examiners agreed with the seamless organization of e-OSCE. As many as 45.9% students and 74.5% examiners agreed that e-OSCE was close to real life practice. Approximately one fifth of students and one third of examiners preferred e-OSCE over the face-to-face OSCE. The analysis of qualitative data generated the themes of e-OSCE structure and technology. While majority of participants were satisfied with e-OSCE, students were concerned about examiners’ training and e-OSCE contents. Examiners and e-OSCE team recognized the paper-less, tech-savy, fast and reliable format of e-OSCE.

Conclusion
During and beyond COVID- 19 era, e-OSCE is a strong substitute to standard OSCE for assessing clinical competence except for physical examination and procedural skills. The planning and implementation of e-OSCE reflects an ingenuity in the assessment of clinical competencies of medical students.
Patterns of antimicrobial, multidrug and methicillin resistance among Staphylococcus spp. isolated from canine specimens submitted to a diagnostic laboratory in Tennessee, USA: a descriptive study
Authors: Lord Jennifer , Millis Nick , Jones Rebekah Duckett , Johnson Brian , Kania Stephen A. , Odoi Agricola 
Published: March 2022

AbstractBackgroundMultidrug- and methicillin-resistant staphylococci are both veterinary and public health concerns due to their zoonotic potential. Therefore, the objective of this study was to investigate patterns of antimicrobial, multidrug, and methicillin resistance among fourStaphylococcusspp. commonly isolated from canine clinical specimens submitted to the Clinical Bacteriology Laboratory at the University of Tennessee College of Veterinary Medicine (UTCVM).MethodsResults of antimicrobial susceptibility testing andmecApolymerase chain reaction (PCR) for isolates of four commonStaphylococcusspp. isolates were obtained from the Bacteriology Laboratory at the UTCVM between 01/01/2006 and 12/31/2017. Cochran-Armitage trend test was used to assess temporal trends of antimicrobial resistance (AMR), multidrug resistance (MDR), and methicillin resistance. Kappa test of agreement was used to assess agreement between the results of PCR and disk diffusion tests.ResultsMost of the 7805 isolates wereS. pseudintermedius(6453 isolates), followed byS. coagulans(860),S. aureus(330), andS. schleiferi(162).AmongS. pseudintermediusisolates, 45.5% were MDR, and 30.8% were methicillin-resistant (MRSP). There was a significant temporal increase in MRSP (p = 0.017). Chloramphenicol resistance increased among both MRSP and methicillin-susceptible (MSSP) isolates (p <  0.0001). AmongS. aureusisolates, 40.9% were MDR, 37.4% were methicillin-resistant (MRSA), and the proportion of MRSA isolates increased significantly (p = 0.0480) over time. There was an increasing temporal trend in the proportion of MDR isolates among MSSP (p = 0.0022), but a decrease among MRSP (p <  0.0001) and MRSA (p = 0.0298).S. schleiferihad the highest percentage (56.9%) of methicillin-resistant isolates. Oxacillin disk diffusion was superior to cefoxitin for the detection ofmecA-mediated resistance and had almost perfect agreement withmecAPCR assay forS. pseudintermedius(95.4% agreement, kappa (κ) = 0.904;p <  0.0001),S. coagulans(95.6%, κ = 0.913;p <  0.0001) andS. schleiferi(97.7%, κ = 0.945;p <  0.0001). However, cefoxitin disk diffusion was superior to oxacillin disk diffusion and had almost perfect agreement with mecA PCR assay forS. aureus(95.3%, κ = 0.834;p <  0.0001).ConclusionsThe levels of resistance and increasing temporal trends are concerning. These findings have implications for treatment decisions and public health due to the zoonotic potential of staphylococci. Continued surveillance and use of antibiograms to guide clinical decisions will be critical.
A novel method for transforming Geobacillus kaustophilus with a chromosomal segment of Bacillus subtilis transferred via pLS20-dependent conjugation
Authors: Mori Kotaro , Fukui Kaho , Amatsu Ryotaro , Ishikawa Shu , Verrone Valeria , Wipat Anil , Meijer Wilfried J. J. , Yoshida Ken-ichi 
Published: March 2022

Abstract
Background
Geobacillus kaustophilus is a thermophilic Gram-positive bacterium. Methods for its transformation are still under development. Earlier studies have demonstrated that pLS20catΔoriT mobilized the resident mobile plasmids from Bacillus subtilis to G. kaustophilus and transferred long segments of chromosome from one cell to another between B. subtilis.

Results
In this study, we applied mobilization of the B. subtilis chromosome mediated by pLS20catΔoriT to transform G. kaustophilus. We constructed a gene cassette to be integrated into G. kaustophilus and designed it within the B. subtilis chromosome. The pLS20catΔoriT-mediated conjugation successfully transferred the gene cassette from the B. subtilis chromosome into the G. kaustophilus allowing for the desired genetic transformation.

Conclusions
This transformation approach described here will provide a new tool to facilitate the flexible genetic manipulation of G. kaustophilus.
Book review of Afghan Village Voices: Stories from a Tribal Community, edited by Richard Tapper and Nancy Lindisfarne-Tapper
Authors: Wilson Mary Beth 
Published: March 2022

Book detailsRichard Tapper and Nancy Lindisfarne-Tapper (eds).Afghan Village Voices: Stories from a Tribal CommunityLondon: I.B. Tauris & Company; 2020.500 pages, ISBN 978-0-7556-0085-4
Study on Roof Deterioration Characteristics of Immersed Tunnel Exposed to Fire by Multi-Phase Meso-Model
Authors: Wang Wei , Yao Xuendan , Gao Guiqiang , Zhang Yanfei 
Published: March 2022

AbstractDeterioration characteristics analysis of lining structure has received intense research interests for immersed tube tunnel fire, while a considerable part of the spotlight is on numerical simulation. However, most of existing works consider concrete lining as a macroscopic homogeneous material for simulation analysis, ignoring the difference of its internal components. This paper aims at studying the mesoscopic deterioration characteristics of immersed tube tunnel roof structure towards efficient safety design of immersed tube tunnel roof. In particular, we establish a mesoscopic model of immersed tube tunnel under thermo-mechanical coupling using ANSYS. Compared with the traditional homogeneous approaches, the proposed mesoscopic model can directly simulate the fire degradation process of immersed tube tunnel roof structure, which blazes marvelous trail for related engineering applications. Our extensive simulation results reveal the progressive failure process of micro-cracks initiation, development, expansion and coalescence in the roof of immersed tube tunnel.
Chronic corticosterone disrupts the circadian rhythm of CRH expression and m6A RNA methylation in the chicken hypothalamus
Authors: Yang Yang , Han Wanwan , Zhang Aijia , Zhao Mindie , Cong Wei , Jia Yimin , Wang Deyun , Zhao Ruqian 
Published: March 2022

Abstract
Background
Corticotropin-releasing hormone (CRH), the major secretagogue of the hypothalamic-pituitary-adrenal (HPA) axis, is intricately intertwined with the clock genes to regulate the circadian rhythm of various body functions. N6-methyladenosine (m6A) RNA methylation is involved in the regulation of circadian rhythm, yet it remains unknown whether CRH expression and m6A modification oscillate with the clock genes in chicken hypothalamus and how the circadian rhythms change under chronic stress.

Results
Chronic exposure to corticosterone (CORT) eliminated the diurnal patterns of plasma CORT and melatonin levels in the chicken. The circadian rhythms of clock genes in hippocampus, hypothalamus and pituitary are all disturbed to different extent in CORT-treated chickens. The most striking changes occur in hypothalamus in which the diurnal fluctuation of CRH mRNA is flattened, together with mRNA of other feeding-related neuropeptides. Interestingly, hypothalamic m6A level oscillates in an opposite pattern to CRH mRNA, with lowest m6A level after midnight (ZT18) corresponding to the peak of CRH mRNA before dawn (ZT22). CORT diminished the circadian rhythm of m6A methylation with significantly increased level at night. Further site-specific m6A analysis on 3’UTR of CRH mRNA indicates that higher m6A on 3’UTR of CRH mRNA coincides with lower CRH mRNA at night (ZT18 and ZT22).

Conclusions
Our results indicate that chronic stress disrupts the circadian rhythms of CRH expression in hypothalamus, leading to dysfunction of HPA axis in the chicken. RNA m6A modification is involved in the regulation of circadian rhythms in chicken hypothalamus under both basal and chronic stress conditions.

Graphical Abstract
Factors affecting the emotional reactions of patient relatives who receive news of death: a prospective observational study
Authors: Güven Bülent Barış , Maden Özgür , Satar Ayşe Dudu , Ersoy Ayşın 
Published: March 2022

Abstract
Background
Reporting the death of relatives to a family member is a very stressful task for physicians. Grief reactions differ from person to person.

Methods
Demographic data of 100 patients who died after staying in ICU for more than three days were recorded. For each patient, one of the family members filled a form which contained their own age, gender, education level, marital status, number of children, degree of relationship, psychiatric treatment status, living in the same house as the patient, and whether they had ever visited the ICU before. Grief reactions were evaluated in five different categories: normal grief response, initial shock reaction, denial, feeling guilty and anger.

Results
When the death was reported, 55.0% of the relatives accepted this situation as normal, 19.0% felt guilty and 14.0% showed an initial shock reaction. The results showed that for a one-unit increase in the patient's age, the probability of the denial reaction among relatives was reduced by 746 times and the probability of feeling guilty was reduced by 698 times.

Conclusion
The rate of denial and guilt in the grief reactions among patient relatives when given news of death in the intensive care unit increases with the decrease in patient age.