bluuebunny/crossref_metadata_2025_split huggingface dataset:
Facilitators, barriers, and changes in POCUS use: longitudinal follow-up after participation in a national point-of-care ultrasound training course in Japan
Authors: Yamada Toru , Soni Nilam J. , Minami Taro , Kitano Yuka , Yoshino Shumpei , Mabuchi Suguru , Hashimoto Masayoshi 
Published: July 2024

Abstract
Background
POCUS training courses are effective at improving knowledge and skills, but few studies have followed learners longitudinally post-course to understand facilitators, barriers, and changes in POCUS use in clinical practice. We conducted a prospective observational study of physicians who attended 11 standardized POCUS training courses between 2017 and 2019 in Japan. Physicians who attended a standardized POCUS course were surveyed about their current frequency of POCUS use of the heart, lung, abdomen, and lower extremity veins, and perceived barriers and facilitators to POCUS use in clinical practice.

Results
Data were analyzed from 112 completed surveys (response rate = 20%). A majority of responding physicians were faculty (77%) in internal medicine (69%) affiliated with community hospitals (55%). The mean delay between course attendance and survey response was 50.3 months. A significant increase in POCUS use from < 1 to ≥ 1 time per week was seen for all organ systems after 50 months post-course (p < 0.01). Approximately half of course participants reported an increase in the frequency of cardiac (61%), lung (53%), vascular (44%), and abdominal (50%) ultrasound use. General facilitators of POCUS use were easy access to ultrasound machines (63%), having a colleague with whom to learn POCUS (47%), and adequate departmental support (46%). General barriers included lack of opportunities for POCUS training (47%), poor access to ultrasound machines (38%), and limited time for POCUS training (33%). In the group with increased POCUS usage, specific facilitators reported were enhanced POCUS knowledge, improved image acquisition skills, and greater self-confidence in performing POCUS. Conversely, the group without increased POCUS usage reported lack of supervising physicians, low confidence, and insufficient training opportunities as specific barriers.

Conclusions
Approximately half of physicians reported an increase in cardiac, lung, vascular, and abdominal POCUS use > 4 years after attending a POCUS training course. In addition to improving access to ultrasound machines and training opportunities, a supportive local clinical environment, including colleagues to share experiences in learning POCUS and local experts to supervise scanning, is important to foster ongoing POCUS practice and implementation into clinical practice.
Diffuse pulmonary arteriovenous malformation presenting with secondary polycythemia and headaches: a case report
Authors: Ahmed Salaar , Ansari Amna Irfan , Khan Abdullah Saeed , Khan Javaid Ahmed 
Published: July 2024

Abstract
Background
Pulmonary arteriovenous malformations are a relatively uncommon medical condition, affecting roughly 1 in every 2500 individuals. Of those suffering from pulmonary arteriovenous malformations, 80% have an underlying genetic condition: hereditary hemorrhagic telangiectasia.

Case presentation
We present the case of a 20-year-old Pakistani male with a history of persistent slower-onset frontal headaches that increased in severity within the course of the day. His hemoglobin was 18 g/dl, indicating polycythemia, for which he had undergone seven venesections in a month previously. His physical examination was unremarkable. His computed tomography scan depicted multiple dilated tortuous vessels with branching linear opacities in the right lower lobe of the lungs. The multiple feeding arteries were supplied by the right main pulmonary artery, and the large draining veins led to the right inferior pulmonary vein. This was identified as a diffuse pulmonary arteriovenous malformation. He was recommended for a right pulmonary artery angiogram. It showed multiple tortuous vessels with a nidus and large draining veins—features of a diffuse arteriovenous malformation in the right lower lobe of the lung consistent with the computed tomography scan. Embolization of two of these vessels feeding the arteriovenous malformation was conducted, using Amplatzer Vascular plug 2, whereas multiple pushable coils (five coils) were used for embolizing the third feeding vessel. This achieved 70–80% successful embolization of right pulmonary AVM; however, some residual flow was still seen in the arteriovenous malformation given the complexity of the lesion. Immediately after, his oxygen saturation improved from 78% to 96%.

Conclusion
Diffuse pulmonary arteriovenous malformations, as seen in this patient, are rare, accounting for less than 5% of total pulmonary arteriovenous malformations diagnosed. The patient presented with a complaint of progressive frontal headaches, which can be attributed to low oxygen saturation or the presence of a cerebral arteriovenous malformation. There was no history of hereditary hemorrhagic telangiectasia in the patient’s family. Furthermore, although most patients with hereditary hemorrhagic telangiectasia and hence pulmonary arteriovenous malformation have complaints of iron-deficiency anemia, our patient in contrast was suffering from polycythemia. This can be explained as a compensatory mechanism in hypoxemic conditions. Moreover, the patient had no complaint of hemoptysis or epistaxis, giving a varied presentation in comparison with a typical pulmonary arteriovenous malformation.
Preclinical evaluation of [18F]SYN1 and [18F]SYN2, novel radiotracers for PET myocardial perfusion imaging
Authors: Krajewski Seweryn , Steczek Lukasz , Gotowicz Karina , Karczmarczyk Urszula , Towpik Joanna , Witkowska-Patena Ewa , Łyczko Krzysztof , Mazur Maciej , Kozanecki Przemysław , Włostowska Joanna , Knuuti Juhani , Dziuk Mirosław , Garnuszek Piotr , Kozanecki Cezary 
Published: July 2024

Abstract
Background
Positron emission tomography (PET) is now an established diagnostic method for myocardial perfusion imaging (MPI) in coronary artery disease, which is the main cause of death globally. The available tracers show several limitations, therefore, the 18F-labelled tracer is in high demand nowadays. The preclinical studies on normal Wistar rats aimed to characterise two potential, novel radiotracers, [18F]SYN1 and [18F]SYN2, to evaluate which is a better candidate for PET MPI cardiotracer.

Results
The dynamic microPET images showed rapid myocardial uptake for both tracers. However, the uptake was higher and also stable for [18F]SYN2, with an average standardized uptake value of 3.8. The biodistribution studies confirmed that [18F]SYN2 uptake in the cardiac muscle was high and stable (3.02%ID/g at 15 min and 2.79%ID/g at 6 h) compared to [18F]SYN1 (1.84%ID/g at 15 min and 0.32%ID/g at 6 h). The critical organs determined in dosimetry studies were the small intestine and the kidneys. The estimated effective dose for humans was 0.00714 mSv/MBq for [18F]SYN1 and 0.0109 mSv/MBq for [18F]SYN2. The tested dose level of 2 mg/kg was considered to be the No Observed Adverse Effect Level (NOAEL) for both candidates. The better results were achieved for [18F]SYN2, therefore, further preclinical studies were conducted only for this tracer. Radioligand binding assays showed significant responses in 3 from 68 assays: muscarinic acetylcholine M1 and M2 receptors and potassium channel hERG. The compound was mostly metabolised via an oxidative N-dealkylation, while the fluor substituent was not separated from the molecule.

Conclusion
[18F]SYN2 showed a favourable pharmacodynamic and pharmacokinetic profile, which enabled a clear visualization of the heart in microPET. The compound was well-tolerated in studies in normal rats with moderate radiation exposure. The results encourage further exploration of [18F]SYN2 in clinical studies.
Theorizing the socio-cultural dynamics of consumer decision-making for participation in community-supported agriculture
Authors: Takagi Sota , Numazawa Yusuke , Katsube Kentaro , Omukai Wataru , Saijo Miki , Ohashi Takumi 
Published: July 2024

AbstractIn the context of the urgent need to establish sustainable food systems, community-supported agriculture (CSA), in which consumers share risks with producers, has gained increasing attention. Understanding the factors that influence consumer participation in CSA is crucial, yet the complete picture and interrelations of these factors remain unclear in existing studies. This research adopts a scoping review and the KJ method to elucidate the factors influencing consumer participation in CSA and to theorize consumer participation. In particular, we focus on the dynamics of individual decision-making for participation, under the premise that individuals are embedded in socio-cultural environments. We examine the decision-making process based on the seesaw of expected gains and losses from participation, along with the reflexivity to the individual and the process of updating decision-making post-participation. Our study highlights how individual decision-making for participation is influenced by relationships with others within the embedded socio-cultural environment, as well as by attachment and connection to the community. It also shows that discrepancies between expectations and experiences post-participation, and the transformation of the social capital, promote the updating of decision-making processes. In addition, among the factors identified in this study for participation in CSA, the decision to participate was heavily influenced by expectations of “variety of ingredients,” suggesting that other factors such as “food education and learning opportunities,” “contribution to environmental and social issues,” and “connections with people and nature” had little impact. Although there are limitations, the insights gained from this study offer profound implications for stakeholders and provide valuable insights for more sustainable and efficient CSA practices.
Implementation factors of tuberculosis control program in primary healthcare settings in China: a mixed-methods using the Consolidated Framework for Implementation Research framework
Authors: Zhou Jiani , Yuan Quan , Huang Qingning , Wang Qingya , Huang Hexiang , Chen Wei , Wang Geng , Liu Shili , Zhang Ting , Zhao Xi , Li Ying 
Published: July 2024

Abstract
Background
Tuberculosis (TB) is a major cause of death worldwide, and Chinese TB burden ranked the second globally. Chinese primary healthcare (PHC) sectors implement the TB Control Program (TCP) to improve active case finding, referral, treatment adherence, and health education. This study aimed to identify barriers and enablers of TCP implementation in high TB burden regions of West China.

Methods
We conducted a representative study using mixed-methods in 28 counties or districts in Chongqing Municipality and Guizhou Province of West China from October 2021 to May 2022. Questionnaire surveys and semi-structured in-depth interviews were conducted with 2720 TB healthcare workers (HCWs) and 20 interviewees in PHC sectors. Descriptive statistical analysis was used to investigate TB HCWs’ characteristics, and path analysis model was utilized to analyze the impact of associated factors on TCP implementation. Thematic framework analysis was developed with the guide of the adapted Consolidated Framework for Implementation Research (CFIR) on factors of TCP implementation.

Results
This study found that 84.6% and 94.1% of community and village HCWs had low professional titles. Based on the results of multiple regression analysis and correlation analysis, lower TB core knowledge scores (-0.09) were identified as barriers for TCP implementation in community PHC sectors, and low working satisfaction (-0.17) and low working willingness (-0.10) are barriers for TPC implementation in village PHC sectors. The results of in-depth interviews reported barriers in all domains and enablers in four domains of CFIR. There were identified 19 CFIR constructs associated with TCP implementation, including 22 barriers such as HCWs’ heavy workload, and 12 enablers such as HCWs’ passion towards TCP planning.

Conclusions
With the guide of the CFIR framework, complex factors (barriers and enablers) of TCP implementation in PHC sectors of West China were explored, which provided important evidences to promote TB program in high TB burden regions. Further implementation studies to translate those factors into implementation strategies are urgent needed.

Graphical Abstract
A study on chromium thin film with positive photoresist as a masking layer towards the wet bulk micromachining of Borofloat glass
Authors: Sahu Vishal , Dewangan Priyanka , Vardhan Robbi Vivek , Rinfela Vanlal , Menon P. Krishna , Pal Prem 
Published: July 2024

AbstractBulk micromachining is commonly used to fabricate microstructures such as deep cavities, through-holes, and microchannels in glass wafers, which have diverse applications in the areas of science and technology. The methods for glass bulk micromachining include mechanical, dry, and wet etching; among them, wet etching is widely used due to its multifaceted advantages. Masking layer plays an eminent role in wet etching. In the current study, Cr thin film combined with positive photoresist (AZ1512HS) is investigated as the masking layer to develop deep cavities in Borofloat glass wafers via wet etching route. Initially, DC magnetron sputtered Cr thin film is deposited at room temperature, 200 °C, and 400 °C, respectively, on three different glass wafers, followed by spin coating of photoresist on it. Photolithography process is used for patterning, and then selective etching of Cr is performed. Thereafter, wet etching of glass wafers is executed in 10% hydrofluoric acid (HF) solution. This work shows that the sustainability of the masking layer is highly dependent on the deposition temperature of Cr thin film, and the sustainability increases with the increase in the deposition temperature. The high temperature (400 °C) deposited Cr thin film along with photoresist exhibits superior sustainability as a masking layer, and it relatively provides a longer etch time of 380 min, excellent etch depth of  ~  245 µm with negligible surface defects and well-defined structures on glass wafer when etched in 10% HF solution.
Clear aligner therapy practices among orthodontists practicing in Canada
Authors: Miranda e Paulo Djessyca , Moreira-Santos Letícia Fernanda , Tavares Maisa Costa , Weir Tony , Meade Maurice J. , Flores-Mir Carlos 
Published: July 2024

Abstract
Background
The acceptability and preference for clear aligner therapy (CAT) has been increasing among orthodontists, but there is still a lack of consensus regarding CAT best practices. Consequently, this study aimed to investigate CAT practices among orthodontists practicing in Canada.

Methods
The survey was conducted among orthodontists practicing in Canada using a modified previously published survey. Sixty orthodontists participated (6.1% response rate). It consisted of 11 sections with open and closed questions related to demographic information and particularities about using or not using CAT. The survey responses were exported from REDCap to a Microsoft Excel (Microsoft, Redmond, Wash) spreadsheet, then statistically analyzed using SPSS software (SPSS for Windows, version 21.0; IBM Inc., Armonk, NY, USA). The comments were categorized under themes and subthemes. Data were organized in descriptive statistics, expressing frequencies and percentages.

Results
Almost 30% of the orthodontist’s annual caseload was treated with CAT, most frequently prescribed to adult patients. Case complexity and patient cooperation were the factors that most influenced the decision to prescribe CAT. Almost half of orthodontists reported sometimes combining CAT with adjunctive fixed appliances.

Conclusions
Most orthodontists prescribe CAT, and its use is based on the malocclusion’s complexity. Orthodontists who do not prescribe CAT believe that fixed appliance therapy has superior treatment outcomes.
Designing chatbots in language classrooms: an empirical investigation from user learning experience
Authors: Wiboolyasarin Watcharapol , Wiboolyasarin Kanokpan , Tiranant Phornrat , Boonyakitanont Poomipat , Jinowat Nattawut 
Published: July 2024

AbstractAmidst the technological evolution shaping the landscape of education, this research critically examines the imperative factors influencing the design of language-teaching chatbots in Thai language classrooms. Employing a comprehensive two-pronged methodology, our study delves into the intricacies of chatbot design by engaging with a diverse participant pool of pre-service teachers, in-service teachers, and educators. The study included the chatbot design opinion survey, a validated scale assessing attitudes toward chatbot design, and semi-structured interviews with teachers, educators, and experts to offer qualitative insights. Our findings reveal five key factors influencing chatbot design: learner autonomy and self-directed learning, content and interaction design for language skill development, implementation and usage considerations, alternative learning approaches and flexibility, and content presentation and format. Concurrently, thematic analysis of interviews results in five overarching themes: enhancing interactive language learning, motivational learning experience, inclusive language learning journey, blended learning companion, and communicative proficiency coaching. These findings inform the development of effective chatbots for Thai language classrooms within the evolving landscape of technology-driven education. These findings inform the development of effective chatbots for language classrooms within the evolving landscape of technology-driven education.
Ventriculo-arterial (VA) coupling and fQRS as new selection criteria for primary prevention ICD placement
Authors: Engstrom Nathan , Letson Hayley L. , Ng Kevin , Dobson Geoffrey P. 
Published: July 2024

AbstractFor decades, left ventricular ejection fraction (LVEF < 35%) has been a mainstay for identifying heart failure (HF) patients most likely to benefit from an implantable cardioverter defibrillator (ICD). However, LVEF is a poor predictor of sudden cardiac death (SCD) and ignores 50% of HF patients with mildly reduced and preserved LVEF. The current international guidelines for primary prophylaxis ICD therapy are inadequate. Instead of LVEF, which is not a good measure of LV contractility or hemodynamic characterization, we hypothesize ventriculo-arterial (VA) coupling combined with fragmented QRS (fQRS) will improve risk stratification and patient suitability for an ICD. Quantifying cardiac and aortic mechanics, and predicting active arrhythmogenic substrate, from varying fQRS morphologies, may help to stratify ischemic and non-ischemic patients with different functional capacities and predisposition for lethal arrhythmias. We propose HF patients with a low physiological reserve may not benefit from ICD therapy, whereas those patients with higher reserves and extensive arrhythmogenic substrate may benefit. Our hypothesis combining VA coupling with fQRS changes has the potential to widen HF patient participation (low and high LVEF) and advance personalized medicine for HF patients at high risk of SCD.
Smart decision support system for keratoconus severity staging using corneal curvature and thinnest pachymetry indices
Authors: Muhsin Zahra J. , Qahwaji Rami , AlShawabkeh Mo’ath , AlRyalat Saif Aldeen , Al Bdour Muawyah , Al-Taee Majid 
Published: July 2024

Abstract
Background
This study proposes a decision support system created in collaboration with machine learning experts and ophthalmologists for detecting keratoconus (KC) severity. The system employs an ensemble machine model and minimal corneal measurements.

Methods
A clinical dataset is initially obtained from Pentacam corneal tomography imaging devices, which undergoes pre-processing and addresses imbalanced sampling through the application of an oversampling technique for minority classes. Subsequently, a combination of statistical methods, visual analysis, and expert input is employed to identify Pentacam indices most correlated with severity class labels. These selected features are then utilized to develop and validate three distinct machine learning models. The model exhibiting the most effective classification performance is integrated into a real-world web-based application and deployed on a web application server. This deployment facilitates evaluation of the proposed system, incorporating new data and considering relevant human factors related to the user experience.

Results
The performance of the developed system is experimentally evaluated, and the results revealed an overall accuracy of 98.62%, precision of 98.70%, recall of 98.62%, F1-score of 98.66%, and F2-score of 98.64%. The application's deployment also demonstrated precise and smooth end-to-end functionality.

Conclusion
The developed decision support system establishes a robust basis for subsequent assessment by ophthalmologists before potential deployment as a screening tool for keratoconus severity detection in a clinical setting.
Crisis in the gut: navigating gastrointestinal challenges in Gulf War Illness with bioengineering
Authors: Collier Claudia A. , Salikhova Aelita , Sabir Sufiyan , Foncerrada Steven , Raghavan Shreya A. 
Published: July 2024

AbstractGulf War Illness (GWI) is characterized by a wide range of symptoms that manifests largely as gastrointestinal symptoms. Among these gastrointestinal symptoms, motility disorders are highly prevalent, presenting as chronic constipation, stomach pain, indigestion, diarrhea, and other conditions that severely impact the quality of life of GWI veterans. However, despite a high prevalence of gastrointestinal impairments among these veterans, most research attention has focused on neurological disturbances. This perspective provides a comprehensive overview of current in vivo research advancements elucidating the underlying mechanisms contributing to gastrointestinal disorders in GWI. Generally, these in vivo and in vitro models propose that neuroinflammation alters gut motility and drives the gastrointestinal symptoms reported in GWI. Additionally, this perspective highlights the potential and challenges of in vitro bioengineering models, which could be a crucial contributor to understanding and treating the pathology of gastrointestinal related-GWI.