bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rapid Manufacturing, Regulatory Approval, and Utilization of Patient-specific 3D-Printed Titanium Implants for Complex Multistage Spinal Surgeries
Authors: Yahanda Alexander T. , Barot Karma , Ruiz-Cardozo Miguel A. , Pet Mitchell A. , English Ian , Ohman J. Westley , Sanchez Luis A. , Hunt Steven R. , Brogan David M. , O’Keefe Regis J. , Albers Brian , Miller Evan , Goodwin Matthew L. , Molina Camilo A. 
Published: February 2025

Study design Technical note and case series. Objectives 3D-printed implants (3DPI) for spinal surgery are a relatively recent development. We report on our experience with the rapid creation and regulatory approval of patient-specific 3DPI for use in complex spinal reconstruction, including a novel expedited turnaround time for implant creation. Methods Four patients underwent placement of 3DPI to replace osseous anatomy during complex spinal reconstructions. These implants were created and used to replace patient-specific anatomy created by either en bloc tumor resection or by severe neurogenic spinal arthropathy. The surgical planning, implant creation, and postoperative outcomes are outlined. Results All patients underwent successful implantation of 3DPI, which was confirmed on postoperative imaging at most recent follow-up. The time to plan, create, obtain regulatory approval, and use the first 3DPI was 28 days. Subsequent 3DPI could be planned, approved, and used in surgery in as little as 4-5 days, which is faster than previously-published reports. Thus, a 3DPI could be generated based on osseous defects created during stage 1 of a multistage surgical plan and implanted during a subsequent stage in an especially expedited manner. Conclusions 3DPI may be used to effectively replace patient-specific anatomy during complex spinal reconstructions, including for osseous defects that are generated after the initial surgical procedure. These 3DPI may be created, approved, and used in surgery over much faster timelines than have been previously reported. Additional cases utilizing these custom 3DPI will further elucidate their utility during complex reconstructions.
Learning by Doing, and Doing it Right – Building a Multi-Dimensional Social Determinants of Health Curriculum in a Rural Internal Medicine Residency
Authors: Zhang Sophia , Zhu Yibei , Parrilla Lara , Du Kaili 
Published: February 2025

OBJECTIVES While there has been increasing awareness of the importance of social determinants of health (SDOH) learning for internal medicine residents and physicians, only a few residency programs have incorporated training into their curricula. For those who did, the curricula were often didactic and lacked action-driven components or community partnership. Therefore, we built an experiential SDOH curriculum with an action-driven element and emphasis on community partnerships in a newly established residency program in rural New York. METHODS Over 24 months, 22 internal medicine residents were engaged in SDOH lectures, workshops, and action-driven learning through implementing screening tools in residency clinics and working with community partners. After the curriculum, residents’ competency in addressing SDOH needs was assessed through Likert-scale questionnaires. Focused interviews were conducted among participating residents and faculty to obtain qualitative feedback on the curriculum. RESULTS Participating resident physicians demonstrated competency in recognizing and addressing SDOH needs after curriculum completion (mean competency score = 4.04). A significant increase in residents’ self-rated confidence in addressing SDOH was observed after training ( P = .002). Residents reported enhanced relationships with patients, effective utilization of community resources, and readiness to apply SDOH knowledge and skills to their future practice. Residents and faculty also discussed the SDOH challenges unique to rural primary care through their experiences. CONCLUSION This curriculum provides insights into an educational framework that improves residents’ SDOH awareness, integrates SDOH into resident physicians’ daily practice, and facilitates community collaboration. While challenges unique to rural primary care exist, this curriculum demonstrated the feasibility of longitudinal, action-driven, and community-centered SDOH education in rural areas that may inform future programs’ curricular design.
A clinical case of acute scrotal syndrome on the background of primary scrotal lipoma and literature review
Authors: Lim Raymond Zhun Ming , Soo Tze Hui , Sharin Mohamad Fairuz Mohamad , Ilias Aizat Sabri , Tharek Anas , Abdullah Maizaton Atmadini , Ahmad Adibah 
Published: February 2025

Abstract

Background
Primary scrotal lipomas are exceptionally uncommon entities within the scrotal sac frequently occur in younger males under 40. It usually painless and found incidentally during imaging. They are generally categorized based on their site of origin.

Case presentation
A 36-year-old man presented with an acute onset of severe left scrotal pain at midnight. Clinical examination revealed two scrotal masses in the left hemiscrotum associated with excruciating tenderness on palpation and loss of cremasteric reflex. Ultrasonography showed a well-defined, oval-shaped, isoechoic lesion underlying the median raphe of scrotum alongside bilateral normal testes. Given the intensity of unexplained pain despite high dose of analgesia, urgent scrotal exploration was done. Intra-operatively, a yellowish, firm mass was identified at the upper pole of the left main testis which was excised. Histopathological examination revealed a primary scrotal lipoma with no necrotic area seen.

Conclusions
Ultrasound is typically the first-line imaging technique to exclude more sinister pathology. The atypical presentation of excruciating pain mimicking testicular torsion in our case complicates the diagnostic process. Scrotal lipoma can be and should be excised as the standard treatment albeit found incidentally.
The TANGO-DM randomized controlled trial study protocol: treatment outcomes for gestational diabetes diagnosed according to WHO 2013 or WHO 1999 thresholds
Authors: Rademaker Doortje , de Wit Leon , van der Wel Anne , van den Akker Eline , Braams-Lisman Babette , Dullemond Remke , Evers Inge , Galjaard Sander , Hermsen Brenda , van Hoorn Marion , Huisjes Anjoke , Kaandorp Joepe , Lub Annemiek , Lunshof Simone , van der Made Flip , Nijman Remco , van Laar Judith , Vollebregt Karlijn , Velzel Joost , Vlemmix Floortje , Westerhuis Michelle , Wijnberger Lia , Wouters Maurice , Zwart Joost , Bosmans Judith , Bossuyt Patrick , Duijnhoven Ruben , Lopriore Enrico , de Miranda Esteriek , Verhoeven Corine , Mol Ben Willem , Franx Arie , DeVries J. Hans , van Rijn Bas , Painter Rebecca 
Published: February 2025

Abstract

Introduction
Gestational diabetes mellitus (GDM), or hyperglycemia first diagnosed in pregnancy, affects 7–10% of all pregnancies worldwide. Perinatal risk rises with increasing glycemia at oral glucose tolerance test (OGTT). The new (2013) WHO criteria recommend a lower fasting, and a higher post-load threshold for GDM diagnosis in comparison to the old (1999) WHO criteria. To date, however, outcomes of GDM treatment for those affected by the altered diagnostic criteria, has not been well investigated. We hypothesized that intensive GDM treatment according to the new (2013) GDM criteria would result in a reduction in infants with birth weight > 90th centile (large for gestational age, LGA), in comparison to treatment according to the old criteria (1999).

Methods
The TANGO-DM trial is an open label, multicenter randomized controlled trial. Participants are pregnant with a gestational age between 16 + 0 and 32 + 0 weeks, who underwent a 1-step venous 2- or 3-point 75-gram oral OGTT, were eligible if they had glucose concentrations discordant between the old (1999) and the new (2013) criteria. After informed consent, women are randomized to either intensive GDM treatment, consisting of dietary advice and glucose monitoring and, if euglycemia is not reached, antihyperglycemic agents, or normal obstetric care without GDM treatment. The primary outcome is large-for-gestational-age infants (birth weight > 90th percentile). Secondary outcome measures include maternal complications, obstetric complications, neonatal complications, obstetric interventions, quality of life, and healthcare and societal costs. Outcomes will be analyzed according to the intention-to-treat principle. The study is powered to detect a reduction in LGA from 16% in the untreated to 10% in the treated group, which requires 1032 participants (516 per arm; alpha-error 5% for 80% power).

Discussion
The TANGO-DM trial will provide high-level evidence to support or refute the use of the new 2013 WHO diagnostic criteria in terms of their ability to lower the number of large for gestational age infants and/or improve maternal and perinatal outcomes and/or costs in women with gestational diabetes.

Trial registration
Central Committee on Research Involving Human Subjects (CCMO) (NL63013.018.18). Registered on 22 September 2018.
Better floors, better health: a theory of change for an improved household flooring intervention in rural communities in Kwale and Bungoma counties, Kenya
Authors: Kepha Stella , Legge Hugo , Halliday Katherine E. , Ochwal Victoria , Elson Lynne , Mwongeli Jacinta , Oswald William E. , Kakoi Beatrice , Wambua James , Mwandawiro Charles , Fillinger Ulrike , Pullan Rachel , Njomo Doris 
Published: February 2025

Abstract

Background
Household flooring is increasingly being investigated as a determinant of health, however the pathways through which flooring may impact health and wellbeing are not yet well understood. The SABABU study is a cluster-randomised controlled trial evaluating the impact of an improved flooring intervention on soil-transmitted helminthiasis, tungiasis, and enteric infections in Bungoma and Kwale counties, Kenya. This paper presents the findings from a theory of change development process that was undertaken as part of the formative research phase of the SABABU project.

Methods
A co-creation workshop (n = 1), stakeholder meetings (n = 2), and community meetings (n = 2) were held with a range of participants including community members (n = 36), village-level leaders (n = 28), and local government stakeholders (n = 14) to draft and refine the theory of change framework. These meetings were informed by a previous formative research phase conducted in study communities – comprised of household observations, in-depth interviews, and focus group discussions with community members – to investigate daily routines, use of space within homes, and attitudes towards home improvement.

Results
The theory of change framework demonstrates how the improved household flooring intervention aims to reduce prevalence of soil-transmitted helminthiasis, enteric infections and tungiasis and improve psychological wellbeing among children and caregivers. Reductions in infections are predicated on limited contact between improved floors and animals, regular floor cleaning, and household members conducting their daily routines on the new floors. Gains in psychological wellbeing are tied to increased feelings of pride, self-efficacy, and social progress, as well as improved quality of life through reduced morbidity from enteric and parasitic infections.

Conclusion
This study presents a theory of change framework mapping the pathways through which an improved flooring intervention may impact health and wellbeing. The results can be of use to researchers or programmes that are in the design or evaluation phase of a household flooring project in Kenya or other settings where access to improved floors is limited.
Priority indicators for evaluating the impact of field epidemiology training programs – results of a global modified Delphi study
Authors: Flint James A. , Housen Tambri , Kirk Martyn D. , Durrheim David N. 
Published: February 2025

Abstract

Background
Field Epidemiology Training Programs (FETPs) aim to develop a skilled public health workforce through applied competency-based learning. With 98 programs globally and over 20,000 graduates, these programs play a crucial role in disease preparedness and response activities around the world. Despite their importance, there have been few published evaluations. This paper presents the results of a consensus-building process to develop a preferred array of indicators for evaluating the outputs, outcomes, and impacts of FETPs.

Methods
We conducted a modified Delphi study to reach consensus on preferred evaluation indicators for FETPs. An initial list of evaluation indicators were identified from literature reviews and consultations with impact evaluation experts and FETP professionals. A modified Delphi process was subsequently employed, involving two rounds of surveys and a final expert review meeting, to reach consensus on indicators. The Delphi panel included 23 experts representing diverse global regions and FETP roles.

Results
Consensus was reached to include 134 evaluation indicators in the final impact evaluation framework. These indicators were grouped as output, outcome, and impact indicators.

Conclusions
This study presents the first FETP impact evaluation framework with a comprehensive list of evaluation indicators for FETPs. This list of indicators is intended as a resource to promote and enhance the evaluation of FETPs and thus improve these important training programs which aim to strengthen national, regional and global health security.
How do medical students make sense of internal and external feedback to enhance their Dutch communication skills?
Authors: Yu Hao , Li Zhien , Köhler S. Eleonore , van Merriënboer Jeroen J. G. , Asoodar Maryam 
Published: February 2025

Abstract

Background
Feedback is crucial in medical education for developing communication skills and fostering comprehensive learning. Despite its importance, medical students often face challenges in effectively leveraging feedback. This study investigates how students perceive and make sense of internal and external feedback in a 2nd language (L2) medical Dutch course.

Methods
Sixteen third-year international medical students (mean age = 23) participated in a medical Dutch course that included six structured sessions. Each session encompassed a briefing, simulated patient consultations (SPCs), and a debriefing. The curriculum integrated internal feedback from self-reflections and external feedback from peers, teachers, and simulated patients. Data were gathered through a students’ feedback perception survey and semi-structured interviews and analyzed via inductive thematic analysis.

Results
Survey data indicated a trend where the preference, satisfaction, and trust in external feedback were higher than those for internal feedback. However, both types of feedback were regarded as equally effective in facilitating learning progress. Through thematic analysis, we identified five crucial themes that show how students perceive and make sense of various forms of feedback: proactive engagement with feedback, critically analyzing and utilizing the exchange in dialogues and discussions, self-reflection and progress tracking, value from diverse perspectives, and moment-specific and actionable feedback.

Conclusions
This study emphasizes the vital roles of internal and external feedback in enhancing medical Dutch communication skills among medical students. Internal feedback encourages self-reflection and growth, essential for complex medical communications, while external feedback provides clear, specific and supportive guidance and experience from teachers, simulated patients and peers. These feedback mechanisms together improve students’ skills in medical Dutch communication, leading to better doctor-patient interactions. Future research should focus on adapting these feedback strategies across diverse educational settings to further support the development of medical L2 communication skills in global medical contexts.
Patient coordination during the COVID-19 pandemic in the Amsterdam region: effects on capacity utilization and patient flow
Authors: Berkeveld E. , Rhebergen M. D. F. , Bloemers F. W. , Zandbergen H. R. , van Merode G. G. 
Published: February 2025

Abstract

Background
To manage COVID-19 surge demand, Dutch regional and national task forces were installed to coordinate a proportionate patient distribution. This study examined the effect of centralized COVID-19 patient coordination on hospital capacity utilization during the pandemic.

Methods
A retrospective observational double cohort study compared intra- and interregional patient coordination by the regional task force ROAZ Noord-Holland Flevoland. Coordination was compared to a simulated scenario without coordination based on a queueing model during two time periods from January 1, 2021, until May 1, 2021 and from August 1, 2021, until December 1, 2021. Daily data on patient ICU and clinical COVID-19 patient transfers, number of admissions, and capacity were assessed. The primary outcome was hospital capacity utilization.

Results
Overall, 1,213 patients were transferred both within the eleven regional hospitals and outside the region during cohort I and 528 patients during cohort II. During the first cohort, eight hospitals (ICU patients) and two hospitals (clinical patients) showed a utilization factor exceeding 100% without coordination which reduced to below 100% with coordination. During the second cohort, utilization factors exceeding 100% varied between the scenarios with and without coordination. In both cohorts, the majority of hospitals that showed a utilization factor below 100% in the scenario without coordination, showed an increased utilization factor in the scenario with coordination.

Conclusion
This retrospective double cohort analysis based on regional coordination of COVID-19 patients and a simulated scenario of absent regional coordination, identified that load-balancing of COVID-19 care demand generally resulted in an improved distribution of utilization among hospitals. In a crisis, we suggest a swift upscale from local, regional to national centralized coordination activity to enable inter and intra-regional patient coordination at an early stage. Future research is recommended to explore the applicability of coordination for other patient categories to benefit from regional centralization during a crises.
Location-independent leadership: managers’ experiences leading prehospital emergency care in Sweden – a qualitative study
Authors: Lindlöf Henrik , Savage Carl , Härenstam Karin Pukk , Vicente Veronica 
Published: February 2025

Abstract

Introduction
Research into management and leadership in healthcare has revealed that the organizational context influences quality improvement, which is why research is needed to better understand the particulars of leadership in the relatively unexplored field of prehospital emergency care. This includes aspects of managerial work related to managers' experiences and their understanding of their roles and existing operational routines. Therefore, this study aims to explore managers' experiences with management and leadership in the context of prehospital emergency care in Sweden.

Methods
A qualitative interview study design was conducted with 15 unit managers in prehospital emergency care from four of Sweden’s 21 regions. The transcripts from the in-depth interviews were subjected to inductive content analysis and reported according to the Consolidated Criteria for Reporting Qualitative Research.

Results
Three generic categories related to the managerial role were identified: challenges, openness and trust, and experience-based leadership. The challenges managers faced were a. lack of physical proximity; b. staff needs for knowledge and competency development; c. staff level of responsibility related to operating procedures and guidelines; and d. work culture. Trust was developed through open and personalized communication, trusting relationships, authenticity, and empathic ability. Experience-based leadership was cultivated over time through practice, reflection, guidance from peers, theoretical leadership training, and the adaptation of organizational structures.

Conclusions
We found the managerial role to be location independent, characterized by openness and trust, and cultivated through experience. In an environment characterized by academic training and work at distances, leaders manage individuals and remote teams while respecting individuals’ independence. They supported staff competence development and their desire to take responsibility through open and trusting relationships established through creating opportunities for competency development and a “learning-by-doing” epistemology built upon reflective practice.
Comparison of the chondrogenic potential of eBMSCs and eUCMSCs in response to selected peptides and compounds
Authors: Ajeeb Boushra , Kiyotake Emi A. , Keefe Peggy A. , Phillips Jennifer Nikki , Hatzel Jennifer N. , Goodrich Laurie R. , Detamore Michael S. 
Published: February 2025

Abstract

Background
Cartilage injuries pose significant challenges in horses and often lead to post-traumatic osteoarthritis (PTOA). Despite the advances in surgical and regenerative techniques, the result in most cases is the formation of a fibrocartilage repair tissue. Cell-based cartilage therapies are mainly focused on equine bone marrow-derived mesenchymal stem cells (eBMSCs) as they are easily accessible, and multipotent. Nonetheless, alternative allogeneic sources, for example equine umbilical cord matrix mesenchymal stromal cells (eUCMSCs), hold promise given their non-invasive and readily accessible nature. Considerable research has been dedicated to exploring chondroinductive factors (e.g., peptides and small compounds), aiming to replace growth factors for inducing chondrogenesis. However, these factors have not yet translated to the equine community. Therefore, in the current study, we selected from the literature two promising peptides, CM10 and CK2.1, and two promising compounds, kartogenin and SM04690, and assessed their chondroinductive potential with both eBMSCs and eUCMSCs. In addition, the chondroinductive potential of eBMSCs was evaluated in monolayer and spheroid culture in both hypoxia and normoxia in response to dexamethasone and/or transforming growth factor beta 3 (TGF-β3).

Results
Following 21 days of culture, none of the evaluated chondrogenic factors resulted in a higher gene expression of chondrogenic markers compared to the positive or negative controls with eBMSCs or eUCMSCs. Interestingly, spheroid culture in hypoxia with dexamethasone treatment (without TGF-β or any compound or peptide) was sufficient to induce the chondrogenic differentiation of eBMSCs.

Conclusion
Based on cell response to the positive control, in the conditions employed in the current study, eBMSCs may be preferred over eUCMSCs for chondrogenesis. The current study supports the use of spheroid culture, and the use of dexamethasone over TGF-β or any of the compounds or peptides tested here from the prior literature to drive chondrogenesis with eBMSCs.