bluuebunny/crossref_metadata_2025_split huggingface dataset:
Differences between Australian triathlon coaching practices and evidence-based training load management recommendations
Authors: Wells Leighton A. , Bruce Lyndell , Hoffmann Samantha M. , Kremer Peter , Dwyer Dan B 
Published: December 2024

Objectives The training load practices of triathlon coaches are poorly understood. The aim of this study was to explore and describe these practices to create an opportunity to compare their alignment with evidence-based practices. Design The study employs an online survey and descriptive statistical analysis to investigate load practices. Method: 63 Australian triathlon coaches with 12 or more months of experience were surveyed. They held tertiary qualifications (27.7%), were AusTriathlon accredited (25.3%) and coached mainly age-group athletes (94%). Coaches’ use of subjective and objective metrics for prescribing, measuring, and monitoring training load and communication frequency with athletes was examined. The survey investigated use of subjective metrics (e.g., s/RPE) and objective metrics (e.g., Time/Distance/Pace) for prescribing and monitoring load, frequency of monitoring sessions, and communication with athletes. Results Most coaches prescribe load using subjective metrics (78% of coaches) and objective metrics (76%). Load is measured/monitored by 81% of coaches using objective metrics, with subjective metrics less commonly used (62%). Less than half (43.5%) monitor every session/day, while most monitor load only weekly (51.6%) or monthly (4.8%). Communication about load occurs mostly every 4 weeks (38.7%). Conclusions Coaches’ load practices only partially align with evidence-based recommendations. The use of subjective measures to monitor load is not common, neither is the consideration of acute and chronic loads. Many coaches communicate infrequently with their athletes. The potential consequence is health risks to athletes that could be addressed before they are missed. Coaches can make better use of technology to help them manage load.
Misoprostol: From cervical softening to coronary stiffening
Authors: Teo Zhongyang , Lim Shu Hui , Ng Mingwei 
Published: December 2024

Introduction This case of misoprostol-induced coronary vasospasm demonstrates the rare but potentially serious cardiac-related adverse events which arose from the use of misoprostol in a young healthy adult with no past cardiac history of note. Case Presentation A 37-year-old female with a history of idiopathic vasculitis but no known cardiovascular risk factors was administered misoprostol vaginally for an elective outpatient hysteroscopy. She developed typical cardiac symptoms of severe chest pain and her initial electrocardiogram demonstrated changes mimicking an anterolateral ST-elevation myocardial infarction. Fortunately, her symptoms resolved shortly before her presentation to the Emergency Department, and her cardiac troponin levels were within normal limits. She underwent further workup during her inpatient stay in a Cardiology ward which revealed no evidence of coronary artery disease, and she was discharged with the rare diagnosis of misoprostol-induced coronary vasospasm. Discussion and Conclusion This case illustrates the importance of physician awareness to patients who present with cardiac symptoms following misoprostol administration. We recommend that misoprostol be administered with caution in patients with vasculitis or traditional cardiovascular risk factors and that these high-risk patients should be counselled for the potential of rare but serious cardiac-related adverse events arising from coronary vasospasm.
Benefits and drawbacks of videoconferencing in eldercare from care workers’ perspectives
Authors: Mustola Ville , Oinas Tomi , Leinonen Emilia , Taipale Sakari 
Published: December 2024

Objective The purpose of this study is to examine how care workers’ characteristics are related to the perceived benefits and drawbacks of using videoconferencing in the care of older people. The factors chosen for this study are: age, education, perceived information and communication technology (ICT) support, interest in technology, ICT skills and possible prior experience of using videoconferencing tools. Methods Our data source was the second wave (2021) of the University of Jyväskylä survey on elder care work ( N = 3607), collected from four large trade unions in Finland. We used a multinomial logistic regression to group respondents according to their experiences of technology use and a path analysis to estimate the effects of care workers’ characteristics and prior experiences on the perceived benefits of videoconferencing tools in eldercare work. Results We found that the personal characteristics of a care worker are associated with both the use of videoconferencing and its perceived benefits and drawbacks. In addition, we discovered that prior use of videoconferencing tools, especially in direct care work, affects the perceived benefits of them. Those who have used videoconferencing in direct care work perceive them as more beneficial for both their own work and for clients. Conclusions Based on these results, we suggest that healthcare and social welfare organizations pay attention to the characteristics of care workers, especially when estimating the necessary amount of ICT support. More ICT support should be targeted to those with a lower level of education and higher age.
A mixed methods crossover randomized controlled trial exploring the experiences, perceptions, and usability of artificial intelligence (ChatGPT) in health sciences education
Authors: Veras Mirella , Dyer Joseph-Omer , Shannon Holly , Bogie Bryce J M , Ronney Morgan , Sekhon Harmehr , Rutherford Derek , Silva Paulo Goberlânio Barros , Kairy Dahlia 
Published: December 2024

Background Generative artificial intelligence (AI) integrated programs such as Chat Generative Pre-trained Transformers (ChatGPT) are becoming more widespread in educational settings, with mounting ethical and reliability concerns regarding its usage. This paper explores the experiences, perceptions, and usability of ChatGPT in undergraduate health sciences students. Methods Twenty-seven students at Carleton University (Canada) were enrolled in a crossover randomized controlled trial study from a Health Sciences course during the Fall 2023 academic term. The intervention condition involved the use of ChatGPT-3.5, whereas the control condition involved using conventional web-based tools. Technology usability was compared between ChatGPT-3.5 and the traditional tools using questionnaires. Focus group discussions were conducted with seven students to further elaborate on student perceptions and experiences. Reflexive thematic analysis was employed to identify themes from the focus group data. Results Easiness of learnability for personal use and a perception of quick learnability towards ChatGPT-3.5 were significantly higher, compared to conventional online tools from the Systems Usability Scale. Qualitative results highlighted strong benefits of ChatGPT-3.5, such as being a tool for increased overall productivity and brainstorming. However, students identified challenges associated with reliability and accuracy, and concerns about academic integrity. Conclusions Despite the benefits and positive usability of ChatGPT-3.5 identified by students, an explicit need for the development of policies, procedures and regulations remains. An established framework of best practices for the usage of AI within health science education is necessary. This will ensure accountability of users and lead to a more effective integration of AI technologies into academic settings.
Exploring user engagement with real-time verbal feedback from an exoskeleton-based virtual exercise coach
Authors: Maharjan Raju , Mendu Sanjana , Mariani Milton , Abdullah Saeed , Hansen John Paulin 
Published: December 2024

Objective Engaging users during physical exercise is crucial for fostering long-term commitment, however, sustaining that engagement remains a significant challenge. This study explores the design of a voice-enabled exoskeleton-based virtual exercise coach (VEC) that provides real-time verbal feedback to enhance user engagement. The objectives of this study are twofold: (i) to compare user engagement with real-time verbal feedback from both VEC and human exercise coach (HEC) during physical exercise, and (ii) to understand users’ perceptions and gather their recommendations for improving future VEC technologies. Methods We developed an exoskeleton-based VEC that delivers real-time verbal feedback on users’ exercise performance. To evaluate its impact on user engagement, we conducted a lab-based mixed-methods study ([Formula: see text]) over a period of 6 weeks comparing users’ engagement with the VEC and HEC using User Engagement Scale (UES) questionnaire and conducted semi-structured interviews to understand users’ perceptions of the VEC. Results Participants in this study found the VEC more engaging than the HEC, in terms of focused attention ([Formula: see text]) and perceived usability ([Formula: see text]). Post-interaction interviews revealed that (i) users found the VEC to be engaging, intuitive, easy to use, and convenient; (ii) users perceived the VEC as a valuable training companion that could help reduce the emotional insecurities often associated with going to the gym; and (iii) users expressed a desire for the VEC to have a personality and embodiment that motivates and supports personalized interactions. Conclusion Based on our results, we discuss the challenges and implications for designing future voice-enabled VECs that support engaging physical exercises.
Heterogeneity of aerobic fitness changes with exercise training in progressive multiple sclerosis: Secondary, exploratory analysis of data from the CogEx trial
Authors: Motl Robert W , Sandroff Brian M , Hernandez Roberto S , Amato Maria Pia , Brichetto Giampaolo , Chataway Jeremy , Chiaravalloti Nancy D , Cutter Gary , Dalgas Ulrik , DeLuca John , Farrell Rachel , Feys Peter , Filippi Massimo , Freeman Jennifer , Inglese Matilde , Meza Cecilia , Rocca Maria A , Salter Amber , Feinstein Anthony ,   CogEx Research Team
Published: December 2024

Background There is heterogeneity of aerobic fitness (VO2peak) changes with a standardized exercise training stimulus in the general population (i.e. some participants demonstrate improvements, others no change, and some a reduction in VO2peak). Objectives This secondary, exploratory analysis of data examined the heterogeneity of VO2peak responses and possible correlates among persons with progressive multiple sclerosis (PMS) from the CogEx trial. Methods CogEx was a multi-site, multi-arm, randomized, double-blinded, and sham-controlled trial undertaken by 11 sites in six different countries. Participants were randomized into one of four conditions with different combinations of exercise training and cognitive rehabilitation including respective sham conditions. The analysis focuses primarily on VO2peak change for the pooled exercise training intervention conditions compared with the pooled sham exercise control conditions. Results Waterfall plots for change in VO2peak suggested greater heterogeneity with exercise training than sham, and the proportions of difference in VO2peak change (i.e. improvement/worsening) were significantly different between exercise training and sham conditions( p < 0.05). The multivariable analysis indicated that lower baseline VO2peak ( p < 0.001) was the only statistically significant correlate of increases in VO2peak with exercise training. Conclusion Our results highlight the heterogeneity of change in VO2peak with exercise training that is correlated with initial aerobic capacity in PMS, and such results may inform hypothesis testing in future clinical trials of exercise training.
Failure to rescue—rapid response systems: A making healthcare safer rapid review
Authors: Winters Bradford D , Rosen Michael , Sharma Ritu , Zhang Allen , Bass Eric B 
Published: December 2024

Background Rapid response systems (RRSs) were developed to respond to early warnings of unexpected deterioration, but their effectiveness may be limited by factors impacting RRS activation (afferent limb) or response (efferent limb). Despite decades of RRS implementation, patients still experience unrecognized deterioration with associated worse outcomes. Methods This rapid review used modified search strategies to focus on the most valuable studies performed in the United States. Citations were screened by one reviewer with artificial intelligence as a second reviewer at the title/abstract review stage. The full text of eligible articles was then reviewed by a single team member to confirm eligibility. One reviewer completed the data abstraction, and a second reviewer checked the first reviewer's abstraction. Results Three categories of interventions were identified: implementation of a new RRS, and modifications to the afferent limb and/or efferent limb of an existing RRS. RRSs may have a large impact in reducing in-hospital mortality and an even greater impact in reducing cardiorespiratory arrest on hospital general wards in adults but the effect is unclear in children. Their impact on unanticipated intensive care unit admission is unclear. Modifications to the afferent and/or efferent limb were associated with a reduction in mortality and the incidence of cardiorespiratory arrest for adults. Conclusions RRS may have a large beneficial effect on hospital mortality and in-hospital cardiorespiratory arrest, but the strength of the evidence is low due to methodological weaknesses of the studies. Innovations in afferent and efferent limb structures show promise for increased benefit.
Scaling up mental health service provision through multisectoral integration: A qualitative analysis of factors shaping delivery and uptake among South Sudanese refugees and healthcare workers in Uganda
Authors: Ndlovu Jacqueline N. , Ouizzane Soukaina , Leku Marx R. , Okware Kenneth K. , Sentongo Hafsa , Nyangwen Bathsheba , Upadhaya Nawaraj , Skovdal Morten , Augustinavicius Jura L. , Tol Wietse A. 
Published: December 2024

Background There is a growing need for mental health and psychosocial support (MHPSS) interventions that can feasibly be provided to larger groups of people, particularly in humanitarian settings. However, scaling up mental health interventions is notoriously difficult. There are therefore growing calls for integrating mental health outside traditional health structures, both to increase reach and to address social determinants of mental health. The objective of this study is to explore barriers and facilitators of Self-Help Plus (SH+), an MHPSS innovation implemented through multisectoral integration. We explore delivery and uptake at the scale of SH+ and aim to understand intervention adaptation needs when integrating SH+ within other health and non-health sectors in Uganda. Method We conducted a qualitative study using in-depth interviews in two phases: first for a needs and resource assessment, and second for a process evaluation. We conducted 50 in-depth interviews with BRAC Uganda and MoH partner staff, intervention facilitators, and target impact group members between July and December 2022. A thematic network analysis process was used to identify barriers and facilitators of SH+ delivery and uptake at scale in Uganda. Results We identified five major factors that should be considered when scaling through multisectoral integration, namely: (1) adaptivity, (2) funding mechanisms, (3) social capital, (4) participation, and (5) sustainability. Within these factors, there were varying degrees to which a factor was a facilitator or barrier, depending on participants’ perceptions of the intervention. Conclusions Our findings suggest that multisectoral integration of SH+ into sectors both inside and outside of health may be a viable means to scale SH+ and increase reach. However, funding, partnerships, co-creation, and adaptability need to be further explored to facilitate better and more sustainable integration.
The interplay between students’ home literacy environment, reading attitudes and comprehension: a serial mediation analysis using PIRLS 2021-data
Authors: Claes Renée , Laga Jana , Denies Katrijn , Bleukx Nele , Dockx Jonas , Van Keer Hilde , Aesaert Koen 
Published: December 2024

Abstract
Background
Providing a rich home literacy environment (HLE) is considered to contribute to the development of students’ reading comprehension. However, less research attention has been given to the underlying mechanisms that influence this relationship, including potential mediating characteristics. The present study aims to assess whether students’ reading enjoyment, reading motivation and reading frequency mediate different aspects of the active and passive HLE and reading comprehension of Grade 4 students in Flanders (Belgium).

Methods
This study uses the Flemish data of the Progress in International Reading Literacy Study (PIRLS) 2021. Participants were 5114 students from 141 schools and their parents. The hypotheses were tested using a serial mediation model implemented through structural equation modelling.

Results
We observed different associations between specific aspects of the HLE and fourth graders’ reading comprehension. Both an active reading climate and the amount of books at home were found to be positively associated with students’ reading comprehension. We found no contributions of parents’ reading enjoyment and their own reading frequency to their child’s reading comprehension. We found significant indirect effects of both the active reading climate and parents' reading enjoyment on students' reading comprehension, mediated through students' reading enjoyment, motivation and reading frequency. Additionally, we found evidence for an indirect pathway from the amount of books at home to students' reading comprehension, mediated by their reading frequency.

Conclusions
Our findings highlight the importance of conceptualizing HLE as a broad construct consisting of multiple components (e.g., activities, beliefs, availability of literacy-related resources at home), as these aspects are related to students’ reading comprehension development in different ways.
Phacovitrectomy vs. consecutive vitrectomy for idiopathic macular holes: short and long-term outcomes and OCT image quality assessment
Authors: Prabhu Vishma , Gandhi Priyanka , Kathare Rupal , Godani Kanika , Hande Prathiba , Yadav Naresh Kumar , Chhablani Jay , Venkatesh Ramesh 
Published: December 2024

Abstract
Purpose
To compare short- and long-term anatomical, functional, and refractive outcomes between combined phacovitrectomy (PVS) and consecutive vitrectomy (CVS) for idiopathic macular holes (MHs). Also, to evaluate the role of preoperative optical coherence tomography (OCT) image quality in guiding surgical selection.

Methods
This retrospective study analyzed 183 phakic MH eyes operated between 2012 and 23, with patients divided into PVS and CVS groups. Demographic and ocular data, MH features, visual acuity (VA), refraction changes and postoperative outcomes, and follow-up details were collected. Pre- and post-operative OCT scans were evaluated for MH characteristics, OCT image quality, and surgical outcomes at short-term (≤ 3 months) and long-term (≥ 5 years) intervals.

Results
The study included 144 eyes in PVS group and 39 in CVS group. Median follow-up duration was 16 months for PVS group and 72 months for CVS group (p < 0.001). Both groups showed significant VA improvements and comparable MH closure rates at short-term follow-up. However, CVS group had significantly better postoperative VA at short-term (p = 0.001) and long-term (p = 0.017) intervals. The preoperative OCT quality index did not significantly differ between groups and was ineffective in assessing cataract grade or guiding surgical decisions. Both groups experienced a myopic refractive shift, with a higher magnitude in the PVS group (p = 0.04). Postoperative complications were similar between the groups.

Conclusion
CVS achieves better long-term VA than PVS following MH repair, despite similar anatomical outcomes. Preoperative OCT quality index is not effective for guiding surgical decisions, and careful refractive planning is essential, especially for PVS patients, to address postoperative myopic shifts.

Clinical trial registration number
Not applicable.
The safety of valproic acid treatment in children with epilepsy: a retrospective real-world research
Authors: Chen Xiner , Zhang Yujie , Liu Xinan , Tan Ruoyu , Cao Dezhi , Chen Li , Hu Yan , Li Bing , Huang Tieshuan , Zhou Qiang , Wen Jialun , Liao Jianxiang 
Published: December 2024

Abstract
Background
Liver damage, coagulopathy, hyperammonemia, fracture, menstrual disorder and amenorrhea are the most concerned adverse drug reactions of valproic acid (VPA). This study was aimed to retrospectively investigate the incidence of adverse drug reactions of VPA in the real world and its association with the age of patients and duration of treatment in order to obtain the safety data of VPA in children with epilepsy.

Methods
A total of 1943 patients diagnosed as epilepsy by the Pediatric Neurology Department of Shenzhen Children’s Hospital between December 2013 and December 2023, were included in the study. They received VPA as an initial treatment, and had followed up examinations over a time span of at least two years focusing on the adverse drug reactions of VPA.

Results
There was no significant difference in the incidence of liver damage, coagulation test abnormalities, and nasal bleeding during VPA monotherapy (30–90 days, 90–180 days, and > 2 years). Adolescent female patients (first visit age ≥ 12 years) showed no significant difference in the incidence of adverse reactions and abnormal ultrasound of the reproductive system pre- versus post-treatment at the first visit, similar for those below 12 years. However, laboratory blood tests revealed significantly age-dependent changes in certain biochemical markers. Two patients stopped VPA treatment due to thrombocytopenia and ovarian cystic mass comorbid with endometrial hyperplasia, recovering after VPA withdrawal.

Conclusions
The initial monotherapy of VPA is generally safe in children with epilepsy of all age ranges. In the real world, VPA does not increase the risk of liver damage, coagulation disorder, elevated blood ammonia, fractures, or low serum sodium, but may significantly decrease the platelet count at 3, 6, 12, and 24 months of treatment. There is no evidence showing that VPA may increase the incidence of impairment of adolescent female reproductive system. Among children under 1 year old, it is recommended to monitor the levels of serum ammonia and aspartate aminotransferase carefully.

Trial registration
ChiCTR2300075115.