bluuebunny/crossref_metadata_2025_split huggingface dataset:
Teaching psychiatry to medical students in the time of COVID-19: experiences from UK medical schools
Authors: Leung Ho Tim Timothy , Ajaz Ali , Bruce Helen , Korszun Ania 
Published: July 2021

Aims and methodEducation leads for undergraduate psychiatry in UK medical schools completed questionnaires on adaptations made to undergraduate psychiatry education, their impact and what lessons could be learnt for the future.ResultsRespondents from 24 medical schools across the UK reported a major shift to online teaching delivery, with reduced workplace learning and increased use of teleconferencing, online tasks and self-directed learning. Changes were implemented with some faculty training provided, but little additional funding or resources from medical schools or National Health Service trusts. A variety of challenges and opportunities were reported.Clinical implicationsDespite the extraordinary efforts of education leads to maintain undergraduate psychiatry education, the pandemic may affect the development of students’ professional competencies and recruitment into psychiatry. Individual clinicians, trusts and medical and foundation schools have much to offer, and need to work with students to replace what has been lost during the pandemic.
International Multicenter Validation Study of the SAGIT® Instrument in Acromegaly
Authors: Giustina Andrea , Bronstein Marcello D , Chanson Philippe , Petersenn Stephan , Casanueva Felipe F , Sert Caroline , Houchard Aude , Melmed Shlomo 
Published: July 2021

Abstract

Context
The SAGIT® instrument (SAGIT) has been developed to enable accurate characterization of acromegaly disease activity.

Objective
We evaluated the ability of SAGIT to discriminate acromegaly disease control status.

Methods
This multicenter, noninterventional, prospective and retrospective, longitudinal study, conducted at academic and private clinical practice sites, included patients aged ≥ 18 years with a diagnosis of controlled (n = 109) or non-controlled (n = 105) acromegaly, assessed by clinical global evaluation of disease control (CGE-DC) questionnaire, investigator therapeutic decision, and international guidelines. Control status was not determined at baseline for 13 patients. Since 9 patients were enrolled retrospectively, all presented analyses are based on the prospective population (N = 227). Patients were assessed over a 2-year follow-up period. Classification and regression tree (CART) analyses were performed to investigate how SAGIT components at baseline (signs/symptoms [S], associated comorbidities [A], growth hormone levels [G], insulin-like growth factor 1 levels [I], tumor features [T]) discriminate between controlled and non-controlled acromegaly.

Results
Baseline mean subscores S, G, I, and T were significantly lower in patients with CGE-DC controlled vs CGE-DC non-controlled acromegaly. SAGIT components I and G for CGE-DC and S, A, G, I, and T for the clinician’s therapeutic decision were retained by CART analyses. For international guidelines, only SAGIT component I was retained. The risk for undergoing ≥ 1 treatment change during the study was 3.44 times greater for CGE-DC non-controlled acromegaly relative to CGE-DC controlled acromegaly.

Conclusion
The SAGIT instrument is a valid and sensitive tool to comprehensively and accurately assess acromegaly severity.
Systems-Level Opportunities in the Management of Primary Hyperparathyroidism: an Informatics-Based Assessment
Authors: Dawood Nardeen B , Tseng Chi-Hong , Nguyen Dalena T , Yan Kimberly L , Livhits Masha J , Leung Angela M , Yeh Michael W 
Published: July 2021

AbstractContextPrimary hyperparathyroidism (PHPT), a leading cause of hypercalcemia and secondary osteoporosis, is underdiagnosed.ObjectiveThis work aims to establish a foundation for an electronic medical record–based intervention that would prompt serum parathyroid hormone (PTH) assessment in patients with persistent hypercalcemia and identify care gaps in their management.MethodsA retrospective cohort study was conducted in a tertiary academic health system of outpatients with persistent hypercalcemia, who were categorized as having classic or normohormonal PHPT. Main outcome measures included the frequencies of serum PTH measurement in patients with persistent hypercalcemia, and their subsequent workup with bone mineral density (BMD) assessment, and ultimately, medical therapy or parathyroidectomy.ResultsAmong 3151 patients with persistent hypercalcemia, 1526 (48%) had PTH measured, of whom 1377 (90%) were confirmed to have classic (49%) or normohormonal (41%) PHPT. PTH was measured in 65% of hypercalcemic patients with osteopenia or osteoporosis (P &lt; .001). At median 2-year follow-up, bone density was assessed in 275 (20%) patients with either variant of PHPT (P = .003). Of women aged 50 years or older with classic PHPT, 95 (19%) underwent BMD assessment. Of patients with classic or normohormonal PHPT, 919 patients (67%) met consensus criteria for surgical intervention, though only 143 (15%) underwent parathyroidectomy.ConclusionWithin a large academic health system, more than half of patients with confirmed hypercalcemia were not assessed for PHPT, including many patients with preexisting bone disease. Care gaps in BMD assessment and medical or surgical therapy represent missed opportunities to avoid skeletal and other complications of PHPT.
Geographic, Gender, and Seasonal Variation of Diabetes: A Nationwide Study With 1.4 Million Participants
Authors: Zhang Yuanfeng , Tong Mingkun , Wang Bo , Shi Zumin , Wang Ping , Li Liming , Ning Yi , Lu Tao 
Published: July 2021

Abstract

Context
China has experienced a rapid increase in the prevalence of diabetes.

Objective
We assessed the prevalence of diabetes among Chinese adults who attended preventive physical examinations and analyzed geographical and gender difference in seasonal variation of fasting blood glucose (FBG).

Methods
The study used data from 1 390 088 participants attending preventive health examination at 430 health screening centers in 220 cities. Diagnosis of diabetes and prediabetes were based on FBG and glycated hemoglobin A1c and self-reported physician’s diagnosis. We calculated age- and sex-standardized prevalence of diabetes according to the sixth Chinese population census data in 2010. Geographical distribution of diabetes and prediabetes were represented on a country map. FBG levels were analyzed to detect seasonal variation adjusted for age and gender by geographic location.

Results
The standardized prevalence of diabetes was 8.70% (95% CI, 8.22%-9.19%), 10.7% in men and 6.61% in women. Among those with diabetes, 43.7% (95% CI, 40.9%-46.5%) were aware of their conditions and 38.5% (95% CI, 36.0%-41.1%) were treated. Only 49.3% (95% CI, 47.0%-51.6%) of treated patients achieved glycemic control. The mean level of FBG was higher in winter than summer and in the northern than the southern region.

Conclusion
The prevalence of diabetes was high while the percentages of awareness, treatment, and glycemic control were low among adults. Effective measures are needed to prevent and manage diabetes in China. Geographic and seasonal variation of diabetes should be considered for its prevention and control.
Weight Loss Prior to Pregnancy and Early Gestational Glycemia: Prepare, a Randomized Clinical Trial
Authors: LeBlanc Erin S , Smith Ning X , Vesco Kimberly K , Hillier Teresa A , Stevens Victor J 
Published: July 2021

Abstract

Context
Women with elevated body mass index are encouraged to lose weight before pregnancy, but no trials have tested the effects of prepregnancy weight loss on risk of developing gestational diabetes.

Objective
This work aims to determine whether prepregnancy weight loss improved the early metabolic environment as measured by early gestational diabetes diagnosis.

Methods
This was a secondary analysis of a pragmatic randomized clinical trial conducted between May 2015 and October 2019 in an integrated health system that encouraged first-trimester gestational diabetes screening for high-risk women, including those with obesity. Women aged 18 to 40 years with a body mass index (BMI) greater than or equal to 27 who were planning pregnancy were randomly assigned to a behavioral weight loss intervention or usual care. Clinical care decisions and data collection were blind to condition assignment. We compared rates of diagnosis with gestational diabetes in early pregnancy between the groups using logistic regression.

Results
Of 326 participants, 168 (89 in the intervention and 79 in usual care) had singleton pregnancies during the study period. At baseline, mean age was 31.3 ± 3.5 years and BMI was 34.8 ± 5.8. Fifty-nine (66%) intervention participants and 57 (72%) usual care participants underwent early screening. Among those, intervention participants were 73% less likely to be diagnosed with gestational diabetes than usual care participants (adjusted odds ratio [aOR], 0.27; 95% CI, 0.09-0.80). There was no difference in diagnosis of gestational diabetes in later pregnancy (aOR, 1.08; 95% CI, 0.41-2.81).

Conclusion
Participation in a prepregnancy weight loss intervention led to lower rates of gestational diabetes diagnosis in early pregnancy. This suggests positive effects of prepregnancy weight loss on the early metabolic environment, a critical factor in offspring metabolic risk.
Ticket to Brussels. One-way or Return? Profiles and typology of Greek MEPs, 1981-2019
Authors: Kakepaki Manina , Karayiannis Yiannis 
Published: July 2021

Στο άρθρο αναλύονται κοινωνικό-δημογραφικά χαρακτηριστικά των Ελλήνων/Ελληνίδων ευρωβουλευτών που εξελέγησαν στο Ευρωπαϊκό Κοινοβούλιο στις εννέα εκλογικές αναμετρήσεις από το 1981 έως το 2019. Εξετάζεται εάν μετά το 2014, όταν άλλαξε η μέθοδος επιλογής των υποψηφίων με την εισαγωγή του σταυρού προτίμησης, τα δημογραφικά χαρακτηριστικά των εκλεγμένων και το κοινωνικό και πολιτικό τους κεφαλαίο διαφέρουν σε σχέση με αυτά των ευρωβουλευτών/τριών που είχαν εκλεγεί τα προηγούμενα χρόνια. Εξετάζεται, επίσης, η σχέση ανάμεσα στο Εθνικό και το Ευρωπαϊκό Κοινοβούλιο και, ειδικότερα, α) σε ποιο βαθμό το Ευρωπαϊκό Κοινοβούλιο λειτουργεί ως σημείο εκκίνησης για την πολιτική σταδιοδρομία των ευρωβουλευτών/τριών στην εθνική πολιτική σκηνή, β) εάν χρησιμεύει ως πεδίο για την εμφάνιση "υπερεθνικών ελίτ" με διακριτά χαρακτηριστικά από εκείνα των εγχώριων ελίτ ή γ) εάν είναι μια μορφή πολιτικής αποστρατείας για τις εθνικές ελίτ. Με βάση τα διαθέσιμα δεδομένα, προτείνεται μια τυπολογία της καριέρας προς το/στο Ευρωκοινοβούλιο και αναλύονται τα ιδιαίτερα χαρακτηριστικά κάθε επιμέρους τύπου.
An Application of the Information Entropy to Nuclei
Authors: Massen S. E. 
Published: July 2021

Shannon's information entropies in position- and momentum-space and their sum $S$ are calculated for various $s$-$p$ and $s$-$d$ shell nuclei using a correlated one-body density matrix depending on the harmonic oscillator size $b_0$ and the short range correlation parameter $y$ which originates from a Jastrow correlation function. It is found that the information entropy sum for a nucleus depends only on the correlation parameter $y$ through the simple relation $S= s_{0A} + s_{1A} y^{-\lambda_{sA}}$, where $s_{0A}$, $s_{1A}$ and $\lambda_{sA}$ depend on the mass number $A$. Finally, we propose a method to determine the correlation parameter from the above property of $S$ as well as the linear dependence of $S$ on the logarithm of the number of nucleons.
Virtual or face to face classes: Ecuadorian university students’ perceptions during the pandemic
Authors: Sevy-Biloon Julia 
Published: July 2021

Due to the pandemic, classes have moved online for 2020-2021, and a return to face-to-face classes in the National University of Education (UNAE) in Ecuador is unknown. Students studying in the undergraduate program to be English language teachers are slowly adapting to this new form of E-learning, and some have found that they prefer online classes, while many are waiting for the day they return to classes. The objective of this study is to look at the pros and cons given by 69 students discussing why taking classes virtually or face to face is a better option for EFL and being an ELT professional in these turbulent times. Some prefer online learning for various reasons such as safety, comfort, economic reasons, and having more time in general. While some find E-learning difficult and want to return to synchronous classes because they feel there is little interaction between classmates and teachers, cannot practice English authentically, cannot get clarification from the teacher, have a hard time concentrating online, and there are constant internet connection issues. In conclusion, this information has great importance for teachers today who are struggling to teach in this new medium and teach to the needs of their students to aid in their planning and will contribute to future teachers who will teach online.
Multimodal neuroimaging markers of variation in cognitive ability in older HIV+ men
Authors: Fernandez Cruz Ana Lucia , Chen Chien-Ming , Sanford Ryan , Collins D. Louis , Brouillette Marie-Josée , Mayo Nancy E. , Fellows Lesley K. 
Published: July 2021

ObjectiveThis study used converging methods to examine the neural substrates of cognitive ability in middle-aged and older men with well-controlled HIV infection.MethodsSeventy-six HIV+ men on antiretroviral treatment completed an auditory oddball task and an inhibitory control (Simon) task while time-locked high-density EEG was acquired; 66 had usable EEG data from one or both tasks; structural MRI was available for 43. We investigated relationships between task-evoked EEG responses, cognitive ability and immunocompromise. We also explored the structural correlates of these EEG markers in the sub-sample with complete EEG and MRI data (N = 27).ResultsEEG activity was associated with cognitive ability at later (P300) but not earlier stages of both tasks. Only the oddball task P300 was reliably associated with HIV severity (nadir CD4). Source localization confirmed that the tasks engaged partially distinct circuits. Thalamus volume correlated with oddball task P300 amplitude, while globus pallidus volume was related to the P300 in both tasks.InterpretationThis is the first study to use task-evoked EEG to identify neural correlates of individual differences in cognition in men living with well-controlled HIV infection, and to explore the structural basis of the EEG markers. We found that EEG responses evoked by the oddball task are more reliably related to cognitive performance than those evoked by the Simon task. We also provide preliminary evidence for a subcortical contribution to the effects of HIV infection severity on P300 amplitudes. These results suggest brain mechanisms and candidate biomarkers for individual differences in cognition in HIV.
COVID-19 severity and mortality in multiple sclerosis are not associated with immunotherapy: Insights from a nation-wide Austrian registry
Authors: Bsteh Gabriel , Assar Hamid , Hegen Harald , Heschl Bettina , Leutmezer Fritz , Di Pauli Franziska , Gradl Christiane , Traxler Gerhard , Zulehner Gudrun , Rommer Paulus , Wipfler Peter , Guger Michael , Enzinger Christian , Berger Thomas ,   for the AUT-MuSC investigators
Published: July 2021

Background
The COVID-19 pandemic challenges neurologists in counselling patients with multiple sclerosis (pwMS) regarding their risk by SARS-CoV-2 and in guiding disease-modifying treatment (DMT).

Objective
To characterize the prevalence and outcome of COVID-19 in pwMS specifically associated with different DMT in a nationwide population-based study.

Methods
We included patients aged ≥18 years with a confirmed diagnosis of MS and a diagnosis of COVID-19 established between January 1, 2020 and December 31, 2020. We classified COVID-19 course as either mild, severe or fatal. Impact of DMT and specifically immunosuppressants (alemtuzumab, cladribine, fingolimod, ocrelizumab or rituximab) on COVID-19 outcome was determined by multivariable models, adjusted for a-priori-risk.

Results
Of 126 MS patients with COVID-19 (mean age 43.2 years [SD 13.4], 71% female), 86.5% had a mild course, 9.5% a severe course and 3.2% died from COVID-19. A-priori-risk significantly predicted COVID-19 severity (R2 0.814; p<0.001) and mortality (R2 0.664; p<0.001). Adjusting for this a-priori-risk, neither exposure to any DMT nor exposure to specific immunosuppressive DMT were significantly associated with COVID-19 severity (odds ratio [OR] 1.6; p = 0.667 and OR 1.9; p = 0.426) or mortality (OR 0.5; p = 0.711 and 2.1; 0.233) when compared to no DMT.

Conclusions
In a population-based MS cohort, COVID-19 outcome was not associated with exposure to DMT and immunosuppressive DMT when accounting for other already known risk factors. This provides reassuring evidence that COVID-19 risk can be individually anticipated in MS and–except for a very small proportion of high-risk patients–treatment decisions should be primarily focused on treating MS rather than the pandemic.
An evaluation of factors that may influence clinicians’ decisions not to enroll eligible patients into randomized trials in critical care
Authors: Ramanan Mahesh , Billot Laurent , Rajbhandari Dorrilyn , Myburgh John , Venkatesh Balasubramanian 
Published: July 2021

Objectives
To determine the association between intensive care unit (ICU) characteristics and clinicians’ decision to decline eligible patients for randomization into a multicentered pragmatic comparative-effectiveness controlled trial.

Methods
Screening logs from the Adjunctive Glucocorticoid Therapy in Septic Shock Trial (ADRENAL) and site-level data from the College of Intensive Care Medicine and Australia New Zealand Intensive Care Society were examined. The effects of ICU characteristics such as tertiary academic status, research coordinator availability, number of admissions, and ICU affiliations on clinicians declining to randomize eligible patients were calculated using mixed effects logistic regression modelling.

Results
There were 21,818 patients screened for inclusion in the ADRENAL trial at 69 sites across five countries, out of which 5,501 were eligible, 3,800 were randomized and 659 eligible patients were declined for randomization by the treating clinician. The proportion of eligible patients declined by clinicians at individual ICUs ranged from 0 to41%. In the multivariable model, none of the ICU characteristics were significantly associated with higher clinician decline rate.

Conclusions
Neither tertiary academic status, nor other site-level variables were significantly associated with increased rate of clinicians declining eligible patients.
Hematological abnormalities and comorbidities are associated with COVID-19 severity among hospitalized patients: Experience from Bangladesh
Authors: Rahman Md. Ashrafur , Shanjana Yeasna , Tushar Md. Ismail , Mahmud Tarif , Rahman Ghazi Muhammad Sayedur , Milan Zahid Hossain , Sultana Tamanna , Chowdhury Ali Mohammed Lutful Hoq , Bhuiyan Mohiuddin Ahmed , Islam Md. Rabiul , Reza Hasan Mahmud 
Published: July 2021

BackgroundThe hematological abnormalities are assumed to be involved in the disease progression of COVID-19. However, the actual associations between specific blood parameters and COVID-19 are not well understood. Here we aimed to assess the correlations between hematological parameters and the severity of COVID-19.MethodsWe included COVID-19 patients who were admitted to Evercare Hospital Ltd, Dhaka, Bangladesh, between November 10, 2020, to April 12, 2021, with a confirmed case of RT-PCR test. We recorded demographic information, clinical data, and routine hematological examination results of all COVID-19 patients. We performed statistical analyses and interpretation of data to compare severe COVID-19 patients (SCP) and non-severe COVID-19 patients (NSCP).ResultsThe age and BMI of the admitted COVID-19 patients were 48.79±8.53 years and 25.82±3.75 kg/m2. This study included a total of 306 hospitalized COVID-19 patients. Among them, NSCP and SCP were 198 and 108, respectively. And we recorded 12 deaths from SCP. We observed the alterations of several hematological parameters between SCP and NSCP. Among them, we noticed the increased levels of C-reactive protein (CRP), d-dimer, and ferritin showed good indicative value to evaluate the severity of COVID-19. Also, there were positive correlations among these parameters. Moreover, we found correlations between the outcomes of COVID-19 patients with patient’s demographics and comorbid diseases.ConclusionBased on our results, CRP, d-dimer, and ferritin levels at admission to hospitals represent simple assessment factors for COVID-19 severity and the treatment decisions at the hospital setup. These blood parameters could serve as indicators for the prognosis and severity of COVID-19. Therefore, our study findings might help to develop a treatment protocol for COVID-19 patients at the hospital setup.
Prehabilitation-Driven Changes in Frailty Metrics Predict Mortality in Patients With Advanced Liver Disease
Authors: Lin Fei-Pi , Visina Jacqueline M. , Bloomer Pamela M. , Dunn Michael A. , Josbeno Deborah A. , Zhang Xingyu , Clemente-Sanchez Ana , Tevar Amit D. , Hughes Christopher B. , Jakicic John M. , Duarte-Rojo Andrés 
Published: July 2021

INTRODUCTION:
Frailty is a predictor of morbidity and mortality in cirrhosis. Although evidence for prehabilitation is promising, the data for liver transplant (LT) candidates are limited. The primary aim of this study was to evaluate the effect of a novel prehabilitation strategy on changes in frailty metrics and survival in LT candidates. The secondary aim was to determine liver-related and extrahepatic conditions associated with frailty.

METHODS:
In this ambispective cohort study, all patients underwent frailty assessment using the liver frailty index (LFI), 6-minute walk test, and gait speed test performed by a dedicated physical therapist. Home-based exercise prescription was individualized to each patient's baseline physical fitness.

RESULTS:
We included 517 patients (59% men, median age 61 years, and a model for end-stage liver disease score of 12) evaluated during 936 PT visits. Frailty metrics were affected by age, sex, and liver-related parameters, but not by model for end-stage liver disease. Patients with nonalcoholic fatty liver disease and alcohol-related cirrhosis had worse frailty metrics by all tools. We demonstrated the feasibility of prehabilitation in improving both LFI and 6-minute walk test, particularly in adherent patients. A median LFI improvement of 0.3 in frail patients was associated with improved survival in univariate analysis. Compliance with physical therapist visits (hazards ratio = 0.35 [0.18–0.67] for 2 visits and hazards ratio = 0.54 [0.31–0.94] for ≥3 visits) was independently associated with increased survival.

DISCUSSION:
Prehabilitation improves frailty metrics in LT candidates and is associated with a survival advantage. Our findings provide a framework for the standardized prehabilitation program in LT candidates while prioritizing compliance, adherence, and on-training LFI goal accomplishment.
No Associations Between Regular Use of Proton Pump Inhibitors and Risk of All-Cause and Cause-Specific Mortality: A Population-Based Cohort of 0.44 Million Participants
Authors: He Qiangsheng , Xia Bin , Meng Wenbo , Fan Die , Kuo Zi-Chong , Huang Junjie , Qin Xiwen , Zou Huachun , He Yulong , Zhang Changhua , Fang Shuo , Pan Yihang , Yang Man , Yuan Jinqiu 
Published: July 2021

INTRODUCTION:
The association between proton pump inhibitors' (PPIs) use and mortality remains unclear.

METHODS:
This was a prospective analysis of 440,840 UK residents and 13,154 deaths. We evaluated the associations with multivariate Cox regression.

RESULTS:
After adjusting for confounders, such as over health status and longstanding diseases, the regular use of PPIs was not associated with an increased risk of all-cause mortality and mortality due to neoplasms, circulatory system diseases, respiratory system diseases, digestive system diseases, external causes, and other causes.

DISCUSSION:
Regular use of PPIs was not associated with an increased risk of all-cause and cause-specific mortality.