bluuebunny/crossref_metadata_2025_split huggingface dataset:
An online Delphi study to investigate the completeness of the CanMEDS Roles and the relevance, formulation, and measurability of their key competencies within eight healthcare disciplines in Flanders
Authors: Janssens Oona , Embo Mieke , Valcke Martin , Haerens Leen 
Published: April 2022

AbstractBackgroundSeveral competency frameworks are being developed to support competency-based education (CBE). In medical education, extensive literature exists about validated competency frameworks for example, the CanMEDS competency framework. In contrast, comparable literature is limited in nursing, midwifery, and allied health disciplines. Therefore, this study aims to investigate (1) the completeness of the CanMEDS Roles, and (2) the relevance, formulation, and measurability of the CanMEDS key competencies in nursing, midwifery, and allied health disciplines. If the competency framework is validated in different educational programs, opportunities to support CBE and interprofessional education/collaboration can be created.MethodsA three-round online Delphi study was conducted with respectively 42, 37, and 35 experts rating the Roles (n = 7) and key competencies (n= 27). These experts came from non-university healthcare disciplines in Flanders (Belgium): audiology, dental hygiene, midwifery, nursing, occupational therapy, podiatry, and speech therapy. Experts answered with yes/no (Roles) or on a Likert-type scale (key competencies). Agreement percentages were analyzed quantitatively whereby consensus was attained when 70% or more of the experts scored positively. In round one, experts could also add remarks which were qualitatively analyzed using inductive content analysis.ResultsAfter round one, there was consensus about the completeness of all the Roles, the relevance of 25, the formulation of 24, and the measurability of eight key competencies. Afterwards, key competencies were clarified or modified based on experts’ remarks by adding context-specific information and acknowledging the developmental aspect of key competencies. After round two, no additional key competencies were validated for the relevance criterion, two additional key competencies were validated for the formulation criterion, and 16 additional key competencies were validated for the measurability criterion. After adding enabling competencies in round three, consensus was reached about the measurability of one additional key competency resulting in the validation of the complete CanMEDS competency framework except for the measurability of two key competencies.ConclusionsThe CanMEDS competency framework can be seen as a grounding for competency-based healthcare education. Future research could build on the findings and focus on validating the enabling competencies in nursing, midwifery, and allied health disciplines possibly improving the measurability of key competencies.
Fighting the waves; Covid-19 family life interference in a neurodevelopmental disorder-caregiver population
Authors: Nylén-Eriksen Mats , Lara-Cabrera Mariela Loreto , Grov Ellen Karine , Skarsvaag Hanne , Lie Irene , Dahl-Michelsen Tone , Sæterstrand Torill Margaret , Mandahl Arthur , Hafstad Hege , Lersveen Mona Breding , Bjørnnes Ann Kristin 
Published: April 2022

AbstractIntroductionThe current COVID-19 pandemic interferes with family lives across the world, particularly families of children with neurodevelopmental disorders (NDDs) are at a greater risk for being negatively impacted by the pandemic. Together with representatives from this caregiver population the aim was to explore the interference associated with normal family life caused by the COVID-19 pandemic.MethodThis is a descriptive study using a cross-sectional design. Following a strategic network sampling strategy, a user-developed national survey was completed by a larger sample (N = 1,186) of parents and informal caregivers of children with NDDs. The survey utilized a combination of both closed and open-ended questions, and a logistic regression analysis was carried out to assess the association between family characteristics, characteristics of the child, and COVID-19 related family life interference. Before carrying out the regression an inductive content analysis of the open-ended question on `How has the isolation affected the family´ was carried out to construct the outcome variable.ResultsThe initial analysis indicated that the COVID-19 pandemic induced a shift in everyday family life and a lack of guidance and support related to managing the challenges they were facing. Caregivers who reported that COVID-19 had significantly interfered with their family life, were more likely to report having anxious children, and to have experienced an increased number of conflicts at home. The logistic regression showed that both anxious children and increased conflicts considerably increased the risk for reporting family life interference compared to those that reported no increased conflicts or anxious children.DiscussionConsidering how the COVID-19 related increased conflicts at home and anxious children threaten the family life of the NDD caregiver population, as an external source of family stress, which might lead to negative impact on their mental and physical well-being, the need for further research in collaboration with user representatives is apparent. Our study suggests that more information should be provided to healthcare providers, social professionals, peers, people with NDDs, and caregivers of people with NDDs about the potential threats that a stressful life event such as the current pandemic can pose to their mental and physical health and their family life.
Scaling up community-based health insurance in Ethiopia: a qualitative study of the benefits and challenges
Authors: Mulat Addis Kassahun , Mao Wenhui , Bharali Ipchita , Balkew Rahel Belete , Yamey Gavin 
Published: April 2022

Abstract
Background
Ethiopia has achieved impressive improvements in health outcomes and economic growth in the last decade but its total health spending is among the lowest in Africa. Ethiopia launched a Community-Based Health Insurance (CBHI) scheme in 2011 with a vision of reaching 80% of districts and 80% of its population by 2020. This study aimed to identify early achievements in scaling up CBHI and the challenges of such scale-up.

Methods
We interviewed 18 stakeholders working on health financing and health insurance in Ethiopia, using a semi-structured interview guide. All interviews were conducted in English and transcribed for analysis. We performed direct content analysis of the interview transcripts to identify key informants’ views on the achievements of, and challenges in, the scale-up of CBHI.

Results
Implementation of CBHI in Ethiopia took advantage of two key “policy windows”—global efforts towards universal health coverage and domestic resource mobilization to prepare countries for their transition away from donor assistance for health. CBHI received strong political support and early pilots helped to inform the process of scaling up the scheme. CBHI has helped to mobilize community engagement and resources, improve access to and use of health services, provide financial protection, and empower women.

Conclusion
Gradually increasing risk pooling would improve the financial sustainability of CBHI. Improving health service quality and the availability of medicines should be the priority to increase and sustain population coverage. Engaging different stakeholders, including healthcare providers, lower level policy makers, and the private sector, would mobilize more resources for the development of CBHI. Training for operational staff and a strong health information system would improve the implementation of CBHI and provide evidence to inform better decision-making.
ANGPTL3 impacts proteinuria and hyperlipidemia in primary nephrotic syndrome
Authors: Zhong Fu , Liu Shurao , Li Yue , Li Guanyu , Liu Ming , Wang Jingzhi , Cui Weijing , Suo Yanhong , Gao Xia 
Published: April 2022

Abstract
Background
It is unclear why primary nephrotic syndrome (PNS) patients often have dyslipidemia. Recent studies have shown that angiopoietin-like protein 3 (ANGPTL3) is an important regulator of lipid metabolism. In this study, we explored how ANGPTL3 impacts dyslipidemia during PNS development.

Methods
We measured the serum levels of ANGPTL3 in PNS patients (n=196). Furthermore, the degree of proteinuria and lipid metabolism were examined in angptl3-overexpressing transgenic (angptl3-tg) mice at different ages. Moreover, in this study, we used the clustered regularly interspaced short palindromic repeats-associated protein 9 (CRISPR/Cas9) system to create angptl3-knockout (angptl3-/-) mice to investigate lipopolysaccharide (LPS)-induced nephrosis.

Results
Compared with that in the healthy group, the serum level of ANGPTL3 in the PNS group was significantly increased (32 (26.35-39.66) ng/ml vs. 70.44 (63.95-76.51) ng/ml, Z =-4.81, P < 0.001). There were significant correlations between the serum level of ANGPTL3 and the levels of cholesterol (r=0.34, P < 0.001), triglycerides (r= 0.25, P = 0.001) and low-density lipoprotein (r= 0.50, P < 0.001) in PNS patients. With increasing age, angptl3-tg mice exhibited increasingly severe hypertriglyceridemia and proteinuria. The pathological features of angptl3-tg mice included rich lipid droplet deposition in hepatocytes and diffuse podocyte effacement. Compared to wild-type mice, angptl3-/- mice showed significantly lower degrees of lipid dysfunction and proteinuria after stimulation with LPS. The effects of ANGPTL3 on nephrotic dyslipidemia were confirmed in cultured hepatocytes subjected to angptl3 knockdown or overexpression. Finally, significant alterations in lipoprotein lipase (LPL) levels were observed in liver tissues from Angptl3-/- and wild-type mice stimulated with LPS.

Conclusions
ANGPTL3 could be involved in the development of dyslipidemia, as well as proteinuria, during PNS pathogenesis. Inhibition of LPL expression may the mechanism by which ANGPTL3 induces hyperlipidemia in PNS.
miR-589-3p promoted osteogenic differentiation of periodontal ligament stem cells through targeting ATF1
Authors: Shi Fangchuan , He Rui , Zhu Jiahao , Lu Ting , Zhong Liangjun 
Published: April 2022

Abstract
Background
An increasing number of studies have shown that dysregulated miR-589-3p is associated with multiple diseases. However, the role of miR-589-3p in osteogenic differentiation of periodontal ligament stem cells (PDLSCs) remains unknown. This study aimed to explore the biological function and potential molecular mechanism of miR-589-3p in osteogenic differentiation of PDLSCs.

Methods
GSE159508 was downloaded from Gene Expression Omibus (GEO, http://www.ncbi.nlm.nih.gov/geo/). Differentially expressed miRNAs between osteogenic induction PDLSCs versus non-induction PDLSCs were obtained by R software. miR-589-3p mimic and miR-589-3p inhibitor and corresponding negative control were obtained and to identify the role of miR-589-3p in osteogenic differentiation of PDLSCs. ALP staining and ARS were used to evaluate ALP activity and mineralization, respectively. The targeted binding relationship between miR-589-3p and ATF1 was predicted and verified by target prediction analysis and dual-luciferase assay. Furthermore, the functional mechanism based on miR-589-3p and ATF1 in osteogenic differentiation of PDLSCs was further investigated through rescue experiments.

Results
According to the cut-off criteria with log 2 FC > 1.0 and P < 0.05, 514 differentially expressed miRNAs were identified between osteogenic induction and non-induction PDLSCs, including 309 upregulated miRNAs and 205 downregulated miRNAs. Compared with control PDLSCs, miR-589-3p expression level was notably increased in PDLSCs that underwent osteogenic induction. The overexpression of miR-589-3p promoted the cell viability of PDLSCs, while the low expression of miR-589-3p had the opposite effect. The dual luciferase reporter assay verified that ATF1 was proved to be a direct target of miR-589-3p in PDLSCs. And overexpressed miR-589-3p reduced the expression of ATF1. Overexpression of miR-589-3p enhanced the osteogenic capacity of PDLSCs, as demonstrated by increases in ALP activity, matrix mineralization, and RUNX2, OCN and OSX expression. In addition, the rescue experiments confirmed that overexpressed ATF1 restored the effects of overexpressed miR-589-3p on cell proliferation and osteogenic differentiation of PDLSCs.

Conclusion
miR-589-3p could down-regulate the expression of ATF1, thereby promote the proliferation and osteogenic differentiation of PDLSCs. This finding may provide a new therapeutic target for molecular therapy of periodontitis.
Determining the accuracy of preoperative total hip replacement 2D templating using the mediCAD® software
Authors: Mirghaderi Seyed Peyman , Sharifpour Sadula , Moharrami Alireza , Ahmadi Negar , Makuku Rangarirai , Salimi Maryam , Mortazavi Seyed Mohammad Javad 
Published: April 2022

Abstract
Background
Templating is a preoperative planning procedure that improves the efficiency of the surgical process and reduces postoperative complications of total hip arthroplasty (THA) by improving the precision of prediction of prosthetic implant size. This study aimed to evaluate the accuracy of the preoperative cup and stem size digital 2D templating of THA with mediCAD® software and find the factors that influence the accuracy, such as indication for surgery, patients’ demographics, implant brand, and the assessors’ grade of education.

Methods
We retrospectively retrieved 420 patient template images of all patients who underwent THA between March 2018 and March 2021. Templating of all included images was processed using mediCAD® software a day before surgery by a newcomer physician to hip arthroplasty course (PGY-2 orthopedic resident or hip surgery fellow). Preoperative templating cup and stem sizes were compared with the actual inserted implant sizes.

Result
After excluding ineligible patients, this study included 391 patients, 193 (49.4%) males and 198 (50.6%) females with a mean age of 43.3 ± 14.9. The average cup sizes predicted before and after surgery were 52.12 ± 14.28 and 52.21 ± 15.05 respectively, and the mean delta cup size (before and after surgery) was 2.79 ± 2.94. The delta stem size before and after surgery has a mean value of 1.53 ± 1.49. The acetabular cup components, measured within ± 0, ± 1, and ± 2 sizes, were 28.9%, 63.9%, 83.1% accurate, respectively. The femoral stem design component measured within ± 0, ± 1, and ± 2 sizes were 27.2%, 61.0%, 78.6% accurate, respectively. Wagner Cone® stem brand, DDH patients, and females showed significantly higher accuracy of stem size templating. Revision THA has the lowest accuracy in terms of cup size templating. The compression of accuracy rate between resident and fellow revealed no significant differences. Also, no significant difference was detected between the accuracy of templating performed in the first months with the second months of the arthroplasty course period.

Conclusion
Our study showed that under mentioned condition, templating using mediCAD® has acceptable accuracy in predicting the sizes of femoral and acetabular components in THA patients. Digital software like mediCAD® remains favorable because of the short learning curve, user-friendly features, and low-cost maintenance, leading to level-up patient care and THA efficacy. Further studies are necessary for clarifying the role of the assessor’s experience and expertise in THA preoperative templating.

Level of evidence
Level III (retrospective observational study).
Influence of the geometric and material properties of lumbar endplate on lumbar interbody fusion failure: a systematic review
Authors: Yu Yihang , Robinson Dale L. , Ackland David C. , Yang Yi , Lee Peter Vee Sin 
Published: April 2022

Abstract
Background
Lumbar interbody fusion (LIF) is an established surgical intervention for patients with leg and back pain secondary to disc herniation or degeneration. Interbody fusion involves removal of the herniated or degenerated disc and insertion of interbody devices with bone grafts into the remaining cavity. Extensive research has been conducted on operative complications such as a failure of fusion or non-union of the vertebral bodies. Multiple factors including surgical, implant, and patient factors influencing the rate of complications have been identified. Patient factors include age, sex, osteoporosis, and patient anatomy. Complications can also be influenced by the interbody cage design. The geometry of the bony endplates as well as their corresponding material properties guides the design of interbody cages, which vary considerably across patients with spinal disorders. However, studies on the effects of such variations on the rate of complications are limited. Therefore, this study aimed to perform a systematic review of lumbar endplate geometry and material property factors in LIF failure.

Methods
Search keywords included ‘factor/cause for spinal fusion failure/cage subsidence/cage migration/non-union’, ‘lumbar’, and ‘interbody’ in electronic databases PubMed and Scopus with no limits on year of publication.

Results
In total, 1341 articles were reviewed, and 29 articles were deemed suitable for inclusion. Adverse events after LIF, such as cage subsidence, cage migration, and non-union, resulted in fusion failure; hence, risk factors for adverse events after LIF, notably those associated with lumbar endplate geometry and material properties, were also associated with fusion failure. Those risk factors were associated with shape, concavity, bone mineral density and stiffness of endplate, segmental disc angle, and intervertebral disc height.

Conclusions
This review demonstrated that decreased contact areas between the cage and endplate, thin and weak bony endplate as well as spinal diseases such as spondylolisthesis and osteoporosis are important causes of adverse events after LIF. These findings will facilitate the selection and design of LIF cages, including customised implants based on patient endplate properties.
Acute shortening and re-lengthening versus antibiotic calcium sulfate-loaded bone transport for the management of large segmental tibial defects after trauma
Authors: Huang Qiang , Xu YiBo , Lu Yao , Ren Cheng , Liu Lu , Li Ming , Wang Qian , Li Zhong , Xue HanZhong , Zhang Kun , Ma Teng 
Published: April 2022

Abstract
Background
The purpose of this paper was to compare the clinical effects of acute shortening and re-lengthening (ASR) technique with antibiotic calcium sulfate-loaded bone transport (ACSBT) technique for the management of large segmental tibial defects after trauma.

Methods
In this retrospective study, 68 patients with large segmental tibial defects were included and completely followed. The bone loss was 3–10 cm. ASR group included 32 patients, while ACSBT group contained 36. There was no significant difference in demographic information between the two groups. The external fixation time (EFT) and external fixation index (EFI) were compared. Bone defect healing and limb functions were evaluated according to the Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria. Complications were compared by Paley classification.

Results
The mean EFT was 9.2 ± 1.8 months in ASR group and 10.1 ± 2.0 months in ACSBT group, respectively. The mean EFI was 1.5 ± 0.2 month/cm and 1.4 ± 0.3 month/cm. According to the ASAMI criteria, in ASR group bone defect healing was excellent in 22 cases, good in 7 cases and fair in 3 cases. In ACSBT group, it was excellent in 23 cases, good in 11 cases and fair in 2 cases. In ASR group, the limb function was excellent in 15 cases, good in 7 cases and fair in 10 cases, while it was excellent in 14 cases, good in 9 cases and fair in 13 cases with ACSBT group. There was no significant difference in EFI, bone defect healing and limb functions between the two groups (p > 0.05). The mean number of complications per patient in ACSBT group was significantly lower than that in ASR group (p < 0.05).

Conclusion
Both techniques can be successfully used for the management of large segmental tibial defects after trauma. There was no significant difference in EFI, limb functions and bone defect healing between the two groups. Compared with ASR group, the complication incidence in ACSBT group was lower, especially the infection-related complications. Therefore, for patients with large segmental bone defects caused by infection or osteomyelitis, ACSBT technique could be the first choice.
Tapered wedge stems decrease early postoperative subsidence following cementless total hip arthroplasty in Dorr type C femurs compared to fit-and-fill stems
Authors: Ikemura Satoshi , Motomura Goro , Hamai Satoshi , Fujii Masanori , Kawahara Shinya , Sato Taishi , Hara Daisuke , Shiomoto Kyohei , Nakashima Yasuharu 
Published: April 2022

Abstract
Background
To compare the degree of stem subsidence between two different femoral component designs and to determine the risk factors associated with stem subsidence after cementless total hip arthroplasty (THA) in Dorr type C femurs.

Methods
We retrospectively reviewed 104 consecutive hips in 100 patients with Dorr type C proximal femoral morphology who underwent primary cementless THA using a fit-and-fill stem or a tapered wedge femoral stem at our institution between January 2012 and June 2021. A fit-and-fill stem was used in 55 hips and a tapered wedge stem was used in 49 hips. Radiologically, the distance between the apex of the major trochanter and the stem shoulder were measured at three different time points (immediately [0W], one week [1W], and six weeks [6W] after surgery) and the degrees of stem subsidence were assessed by comparing the distance between 0 and 1W, 1W and 6W, and 0W and 6W, respectively.

Results
The mean degree of stem subsidence (0W vs. 1W) was 0.24 mm (standard deviation [SD] 0.36) in the fit-and-fill stem group, and 0.23 mm (SD 0.41) in the tapered wedge stem group. There was no significant difference between the two groups (P = 0.4862). However, the mean degrees of subsidence were significantly higher in the fit-and-fill stem group (1W vs. 6W, 0.38 mm [SD 0.68]; 0W vs. 6W, 0.65 mm [SD 0.87]) than in the tapered wedge stem group (1W vs. 6W, 0.16 mm [SD 0.32]; 0W vs. 6W, 0.24 mm [SD 0.38]) (P < 0.05 for both). In addition, the rates of > 3 mm subsidence (in which instability can be observed) were 18.2% (10 of 55 hips) and 2.0% (1 of 49 hips), respectively. There was also a significant difference between the two stems (P = 0.0091). Multivariate analysis demonstrated that fit-and-fill stem was a risk factor for > 3 mm subsidence after THA in Dorr type C femurs (P = 0.0050).

Conclusion
Our findings suggest that the tapered wedge stem is more suitable for Dorr type C femurs than the fit-and-fill stem to avoid early postoperative subsidence in cementless THA.