bluuebunny/crossref_metadata_2025_split huggingface dataset:
Scan of the postgraduate educational environment domains questionnaire: a reliable and valid tool for the evaluation of educational environment in postgraduate medical education
Authors: Seyedhassan Sadrian , Mahsa Moosavi , Jeyran Ostovarfar , Mitra Amini , Rezvan Ghaderpanah , Sedigheh Mokhtarpour 
Published: October 2024

Abstract
Background
The educational environment plays a critical role in shaping learners’ perceptions and experiences in medical education. Evaluating and enhancing the quality of this environment is essential for the continuous improvement of medical training programs. The Scan of the Postgraduate Educational Environment Domains (SPEED) is a concise instrument that assesses three domains of the educational environment. This study aimed to translate the SPEED questionnaire into Persian and evaluate its validity and reliability in the context of postgraduate.

Methods
A cross-sectional study was conducted with 200 first and second-year medical residents. The Persian translation of the SPEED questionnaire was assessed for content validity, and confirmatory factor analysis was performed to evaluate its structural validity. Cronbach’s alpha coefficient was calculated to assess internal consistency reliability.

Results
The Persian-translated SPEED questionnaire demonstrated satisfactory content validity, with all items exceeding the minimum acceptable values for content validity ratio and index. Confirmatory factor analysis indicated an acceptable fit for the 3-dimensional structure of the SPEED instrument. Internal consistency reliability analysis showed high reliability for the content, atmosphere, and organization domains.

Conclusion
The Persian-translated version of the SPEED questionnaire is a valid and reliable tool for assessing the domains of the educational environment in postgraduate medical education.
Risk of suicide in patients with atrial fibrillation receiving different oral anticoagulants: a nationwide analysis using target trial emulation framework
Authors: Li Brian Meng-Hsun , Yang Avery Shuei-He , Cheng Michael Chun-Yuan , Huang Huei-Kai , Lai Edward Chia-Cheng 
Published: October 2024

Abstract
Background
The suicide risk in patients with atrial fibrillation receiving novel oral anticoagulants or warfarin has not been evaluated in real-world practice. Moreover, reducing vitamin K levels may increase the suicide risk, underscoring the importance of selecting appropriate oral anticoagulants to prevent unintended outcomes. Therefore, we aimed to evaluate the association between different types of oral anticoagulants and the risk of attempted and completed suicide among patients with atrial fibrillation.

Methods
This nationwide study retrieved data from Taiwan's National Health Insurance Research Database from 2012 to 2020. This study included patients with atrial fibrillation aged 20 years and older who newly received oral anticoagulant treatment, and who had no contraindications for NOACs and no history of suicide-related events. The main outcomes were suicide-related outcomes, including attempted suicide and completed suicide. This study employed the target trial emulation framework to improve the causal inference for the observed association.

Results
A total of 103,768 (71.74%) patients taking NOACs and 40,877 (28.26%) patients taking warfarin were included in this study. Compared to those receiving warfarin, patients receiving NOACs were associated with a lower risk of suicide-related outcomes (HR, 0.82; 95% CIs, 0.69–0.96).

Conclusions
The findings of this cohort study suggested that patients receiving NOACs were associated with a lower risk of suicidal attempts but similar risk of complete suicide, compared to those receiving warfarin. Considering the risk of suicide, NOACs could be the preferred anticoagulants for patients with atrial fibrillation.
Infant feeding knowledge among women living with HIV and their interaction with healthcare providers in a high-income setting: a longitudinal mixed methods study
Authors: Moseholm Ellen , Aho Inka , Mellgren Åsa , Johansen Isik S , Katzenstein Terese L , Pedersen Gitte , Storgaard Merete , Weis Nina 
Published: October 2024

AbstractBackgroundRecent changes in the infant feeding guidelines for women living with HIV from high-income countries recommend a more supportive approach focusing on shared decision-making. Limited information is available on the infant feeding knowledge of women living with HIV and how healthcare providers engage with them in this context. This multicenter, longitudinal, mixed methods study aims to get a comprehensive and nuanced understanding of infant feeding knowledge among women living with HIV of Nordic and non-Nordic origin living in Nordic countries, and their interaction with healthcare providers regarding infant feeding planning.MethodsPregnant women living with HIV in Denmark, Finland, and Sweden were recruited in 2019–2020. The Positive Attitudes Concerning Infant Feeding (PACIFY) questionnaire was completed in the 3rd trimester (T1), three (T2), and six (T3) months postpartum. Women who completed the quantitative survey were also invited to participate in qualitative semi-structured interviews at T1 and T3. Results from the survey and interviews were brought together through merging to assess for concordance, complementarity, expansion, or discordance between the datasets and to draw meta-inferences.ResultsIn total, 44 women living with HIV completed the survey, of whom 31 also participated in the interviews. The merged analyses identified two overarching domains: Knowledge about breastfeeding in the U = U era and Communications with healthcare providers. The women expressed confusion about breastfeeding in the context of undetectable equals untransmittable (U = U). Women of Nordic origin were more unsure about whether breastfeeding was possible in the context of U = U than women of non-Nordic origin. Increased postpartum monitoring with monthly testing of the mother was not seen as a barrier to breastfeeding, but concerns were found regarding infant testing and infant ART exposure. Infant feeding discussions with healthcare providers were welcome but could also question whether breastfeeding was feasible, and many participants highlighted a need for more information.ConclusionsHealthcare providers caring for women living with HIV must have up-to-date knowledge of HIV transmission risks during breastfeeding and engage in shared decision-making to optimally support infant feeding choices.
Integrated serum pharmacochemistry, 16S rDNA sequencing, and metabolomics to reveal the material basis and mechanism of Shouhui Tongbian capsule against diphenoxylate-induced slow transit constipation in rats
Authors: Yang Jiaying , Xiao He , Yao Jingchun , Zhang Pin , Yi Bojiao , Fang Zhengyu , Guo Na , Guan Yongxia , Zhang Guimin 
Published: October 2024

Abstract
Background
Slow transit constipation (STC) is highly prevalent and has rising incidence. Shouhui Tongbian capsule (SHTB) is a traditional Chinese Medicine formula with extensive and highly efficacious usage in STC treatment, however, its mechanism of action, especially the regulation of microbiome and lipid metabolites, remains unclear.

Methods
After quality control of SHTB using LC‒MS to obtain its material basis, we tried to elucidate the cohesive modulatory network of SHTB against STC using hyphenated methods from microbiomics, lipidomics, mass spectrometry imaging (MSI) and molecular methods.

Results
SHTB could repair intestinal barrier damage, reduce systemic inflammation and increase intestinal motility in a diphenoxylate-induced STC rat model. Based on 16S rDNA sequencing results, SHTB rehabilitated the abnormal changes in Alloprevotella, Coprococcus, Marvinbryantia, etc., which were associated with STC symptoms. Meanwhile, microbial functional prediction showed that lipid metabolism was improved with SHTB administration. The differential lipids, including fatty acids, lysophosphatidylcholine, phosphatidylcholine, sphingomyelin triglyceride and ceramide, that are closely related to STC disease and SHTB efficacy. Furthermore, SHTB significantly reversed the abnormal expression of these key target enzymes in colon samples, including CTP-phosphocholine cytidylyltransferase, CTP-phosphoethanolamine cytidylyltransferase, phosphatidic acid phosphatase, acid sphingomyelinase etc.

Conclusions
Combined analysis demonstrated that SHTB reducing lipid accumulation and recovery of intestinal microbial homeostasis was the critical mechanism by which SHTB treats STC.
Pain in recessive dystrophic epidermolysis bullosa (RDEB): findings of the Prospective Epidermolysis Bullosa Longitudinal Evaluation Study (PEBLES)
Authors: Jeffs Eunice , Pillay Elizabeth I. , Ledwaba-Chapman Lesedi , Bisquera Alessandra , Robertson Susan J. , McGrath John A. , Wang Yanzhong , Martinez Anna E. , Mellerio Jemima E. 
Published: October 2024

Abstract
Background
Pain is common in the genetic skin fragility disorder epidermolysis bullosa (EB), from skin and mucosal injury and inflammation as well as extra-mucocutaneous sites. Individuals living with EB have identified pain as a priority for better treatments.

Objectives
The Prospective EB Longitudinal Evaluation Study (PEBLES) is a prospective register study exploring the natural history of RDEB across all ages from birth to death. Here, we investigated the characteristics and treatment of pain in different RDEB subtypes.

Methods
Information was collected from individuals with different RDEB subtypes over an 8-year period. Data included visual analogue scale (VAS) ratings of background and procedural pain, its location, intensity and impact on sleep, as well as pain medication. Disease severity scores and quality of life measures were correlated to pain scores.

Results
Sixty-one participants (13 children, 48 adults) completed a total of 361 reviews. Pain was common, experienced by 93% of participants at index review, with 80% suffering both background and procedural pain. Across all RDEB patients, the median VAS for background pain was 40 (out of 100) [interquartile range 20,60] and for those having regular dressing changes, median procedural pain was 52 [40,80]. Severe (RDEB-S) and pruriginosa (RDEB-Pru) groups had the greatest increase in procedural compared to background pain of 20 and 22 VAS points, respectively. Correlations between disease severity and quality of life impairment were observed across most groups, particularly RDEB-S. Over half of those studied experienced pain frequently or constantly, and in one third pain disturbed sleep at least 4 nights per week. Skin was the commonest source of pain in all subtypes except inversa RDEB where the mouth was the main site. Despite frequent and severe pain, one third of participants used no medication for pain and, in those that did, pain levels remained high suggesting ineffectiveness of current pain management approaches and a significant unmet need in RDEB.

Conclusion
The frequency, severity, and impact of pain in all RDEB patients is significant, particularly in RDEB-S and RDEB-Pru. Our findings highlight that current RDEB pain management is poorly effective and that further research is needed to address this symptom.
Isolated and multiple causes of equine dystocia
Authors: Ellerbrock Markus , Krohn Judith , Büttner Kathrin , Wehrend Axel 
Published: October 2024

Abstract
Background
Dystocia is rare in horses, but is life-threatening for mares and foals. Therefore, veterinary research depends on up-to-date data to optimise equine dystocia management. In addition, knowledge of the prognosis of equine dystocia is necessary to advise animal owners. This retrospective study of equine dystocia aimed to enrich existing datasets with up-to-date information. For the first time, the focus was on the causes of dystocia that occurred alone or in combination. Over a period of 10 years, 72 cases of dystocia were analysed using a standardised, predetermined diagnosis code.

Results
Of the 72 cases of dystocia, an isolated cause of dystocia was identified in 37 cases (51.4%) and 35 mares showed a combination of two or more causes (48.6%). Foetal causes were significantly more frequent origin of dystocia (66/69) than maternal causes (3/66) (P < 0.0001). Incorrect posture of the foetal forelimbs and head was the most common combination at 25.7%. The most common isolated cause of dystocia was incorrect posture of the foetal forelimbs (18.9%). A foetotomy was performed in 68% of cases. A caesarean section or an extraction was performed in 13.9% of the cases. Three mares died before any obstetric care was provided. Nine mares (12.5%) were not discharged alive. 73 foals were delivered of which 55 were already dead before veterinary treatment began. In relation to the total number of births in which the foetus was alive at the start of obstetric care, the foetal mortality rate was 61.1% and 88.9% by the time the mare was discharged.

Conclusions
It has been demonstrated for the first time that multiple causes of dystocia in horses are almost as common as isolated causes of dystocia. Neonatal mortality remains high, indicating that the timely detection and treatment of dystocia has the highest priority.
Prediction of allograft function in pre-transplant kidneys using sound touch elastography (STE): an ex vivo study
Authors: Pan Fu-shun , Yang Dao-peng , Zhao Guo-dong , Huang Shu-qi , Wang Yan , Xu Ming , Qiu Jiang , Zheng Yan-ling , Xie Xiao-yan , Huang Gang 
Published: October 2024

Abstract
Background
The purpose of the study was to evaluate renal quality and predict posttransplant graft function using ex vivo sound touch elastography (STE).

Methods
In this prospective study, 106 donor kidneys underwent ex vivo STE examination and biopsy from March 2022 to August 2023. The mean stiffness of the superficial cortex (STEsc), deep cortex (STEdc), and medulla (STEme) was obtained and synthesized into one index (STE) through the factor analysis method. Additionally, 100 recipients were followed up for 6 months. A random forest algorithm was employed to explore significant predictive factors associated with the Remuzzi score and allograft function. The performance of parameters was evaluated by using the area under the receiver operating characteristic curve (AUC).

Results
STE had AUC values of 0.803 for diagnosing low Remuzzi and 0.943 for diagnosing high Remuzzi. Meanwhile, STE had an AUC of 0.723 for diagnosing moderate to severe ATI. Random forest algorithm identified STE and Remuzzi score as significant predictors for 6-month renal function. The AUC for STE in predicting postoperative allograft function was 0.717, which was comparable with that of the Remuzzi score (AUC = 0.756). Nevertheless, the specificity of STE was significantly higher than that of Remuzzi (0.913 vs 0.652, p < 0.001). Given these promising results, donor kidneys can be transplanted directly without the need for biopsy when STE ≤ 11.741.

Conclusions
The assessment of kidney quality using ex vivo STE demonstrated significant predictive value for the Remuzzi score and allograft function, which could help avoid unnecessary biopsy.

Critical relevance statement
Pre-transplant kidney quality measured with ex vivo STE can be used to assess donor kidney quality and avoid unnecessary biopsy.

Key Points

STE has significant value for diagnosing low Remuzzi and high Remuzzi scores.

STE achieved good performance in predicting posttransplant allograft function.

Assessment of kidney quality using ex vivo STE could avoid unnecessary biopsies.

Graphical Abstract
A convolutional neural network to optimize multi-mission satellite altimeter fusion for improving the marine gravity field
Authors: Li Qianqian , Zhai Zhenhe , Bao Lifeng , Wang Yong , Wu Lin , Mao Guocheng , Sun Heping 
Published: October 2024

AbstractSatellite altimetry is the main tool for constructing global or regional marine gravity fields. To improve the accuracy and spatial resolution, it is necessary to fuse multi-mission altimeters. How to determine the weights of multi-mission altimeters is a crucial issue, making the conventional calculation process very complex. In addition, traditional satellite inversion methods are often independent of shipborne gravity, which is used only as validation data, thus not take full advantages of high accuracy and resolution of shipborne gravity. In this study, we introduce a convolutional neural network (CNN) to merge the vertical deflections (DOVs) obtained from multi-altimeter missions to construct a marine gravity model in the South China Sea. High-accuracy shipborne gravity and a dataset comprising DOVs and geo-locations are employed as input data for neural network training. For the validation of CNN method, the gravity model is also computed by conventional Inverse Vening Meinesz (IVM) method. Independent shipborne gravity measurements and SIO V32.1, DTU17 models are used as validation data. The evaluation results show that the CNN-derived model achieves a higher level of accuracy, yielding a standard deviation (STD) of 3.21 mGal, with an improvement of 36.56% compared to IVM-derived model. More than 92% of the differences between the CNN-derived model and shipborne gravity are less than 5 mGal. In addition, spectral analysis results further show that the CNN-derived model has stronger energy at short wavelengths (less than 25 km) compared to other models. These findings reveal that CNN method is feasible for marine gravity recovery and the CNN-derived model can achieve higher accuracy. The CNN method can improve the accuracy and spectral characteristics of the constructed gravity model by taking advantage of the high accuracy and high resolution of shipborne gravity.
Graphical Abstract
Multimodal apparent diffusion MRI model in noninvasive evaluation of breast cancer and Ki-67 expression
Authors: Chang Huan , Chen Jinming , Wang Dawei , Li Hongxia , Ming Lei , Li Yuting , Yu Dan , Yang Yu Xin , Kong Peng , Jia Wenjing , Yan Qingqing , Liu Xinhui , Zeng Qingshi 
Published: October 2024

Abstract
Background
To assess the capability of multimodal apparent diffusion (MAD) weighted magnetic resonance imaging (MRI) to distinguish between malignant and benign breast lesions, and to predict Ki-67 expression level in breast cancer.

Methods
This retrospective study was conducted with 93 patients who had postoperative pathology-confirmed breast cancer or benign breast lesions. MAD images were acquired using a 3.0 T MRI scanner with 16 b values. The MAD parameters, as flow (fF, DF), unimpeded (fluid) (fUI), hindered (fH, DH, and αH), and restricted (fR, DR), were calculated. The differences of the parameters were compared by Mann–Whitney U test between the benign/malignant lesions and high/low Ki-67 expression level. The diagnostic performance was assessed by the area under the receiver operating characteristic curve (AUC).

Results
The fR in the malignant lesions was significantly higher than in the benign lesions (P = 0.001), whereas the fUI and DH were found to be significantly lower (P = 0.007 and P < 0.001, respectively). Compared with individual parameter in differentiating malignant from benign breast lesions, the combination parameters of MAD (fR, DH, and fUI) provided the highest AUC (0.851). Of the 73 malignant lesions, 42 (57.5%) were assessed as Ki-67 low expression and 31 (42.5%) were Ki-67 high expression. The Ki-67 high status showed lower DH, higher DF and higher αH (P < 0.05). The combination parameters of DH, DF, and αH provided the highest AUC (0.691) for evaluating Ki-67 expression level.

Conclusions
MAD weighted MRI is a useful method for the breast lesions diagnostics and the preoperative prediction of Ki-67 expression level.
Dimensional models of personality and a multidimensional framework for treating personality pathology
Authors: Natoli Adam P. , Murdock Jacy G. , Merguie Jules L. , Hopwood Christopher J. 
Published: October 2024

SUMMARY
The categorisation of personality pathology into discrete disorders has been an enduring standard. However, dimensional models of personality are becoming increasingly prominent, in part owing to their superior validity and clinical utility. We contend that dimensional models also offer a unique advantage in treating mental illness. Namely, psychotherapy approaches and the components of dimensional models of personality can both be arranged hierarchically, from general to specific factors, and aligning these hierarchies provides a sensible framework for planning and implementing treatment. This article begins with a brief review of dimensional models of personality and their supporting literature. We then outline a multidimensional framework for treatment and present an illustrative fictitious clinical case before ending with recommendations for future directions in the field.
Clinical characteristics and suicidal ideation as predictors of suicide: prospective study of 1000 referrals to general adult psychiatry
Authors: Hayward David , Johnston Blair , MacIntyre Donald J. , Steele Douglas 
Published: October 2024

Aims and method
Questions often follow the suicide of someone who presented to general adult psychiatry (GAP) when expressing suicidal thoughts: ‘Why were they not admitted, or managed differently, when they said they were suicidal?’ Answering these questions requires knowledge of the prevalence of suicidal ideation in patients presenting to GAP. Therefore, we determined the general clinical characteristics, including suicidal ideation, of a large sample of patients presenting to a GAP emergency assessment service or referred as non-emergencies to a GAP service.

Results
Suicidal ideation was very common, being present in 76.4% of emergency presentations and 33.4% of non-emergency referrals. It was very weakly associated with suicide, varied between different diagnostic categories, and previous assessment by GAP did not appear to affect it. The suicide rate during the contingent episode of care was estimated as 66 per 100 000 episodes.

Clinical implications
This, and other evidence, shows that suicide cannot be predicted with an accuracy that is useful for clinical decision-making. This is not widely appreciated but has serious consequences for patients and healthcare resources.
Functional neurological disorder in pregnancy, labour and the postpartum period: systematic review
Authors: Cabreira Verónica , McLoughlin Caoimhe , Shivji Natasha , Lodge Alexandra , Rhijn Sanne Van , Keynejad Roxanne C. , Coebergh Jan , Carson Alan , Stone Jon , Lehn Alex , Hoeritzauer Ingrid 
Published: October 2024

Aims and method
Functional neurological disorder (FND) most often presents in women of childbearing age, but little is known about its course and outcomes during pregnancy, labour and postpartum (the perinatal period). We searched MEDLINE, PsycInfo and Embase combining search terms for FND and the perinatal period. We extracted data on patient demographics, subtype of FND, timing of symptom onset, comorbidities, medications, type of delivery, investigations, treatment, pregnancy outcomes and FND symptoms at follow-up.

Results
We included 36 studies (34 case reports and 2 case series) describing 43 patients. Six subtypes of FND were identified: functional (dissociative) seizures, motor weakness, movement disorder, dissociative amnesia, speech disorders and visual symptoms. New onset of perinatal FND was more common in the third trimester and onwards. Some women with functional seizures were exposed to unnecessary anti-seizure prescriptions and intensive care admissions.

Clinical implications
Prospective studies are urgently needed to explore how FND interacts with women's health in the perinatal period.