bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early rectal cancer: The diagnostic performance of MRI supplemented with a rectal micro-enema and a modified staging system to identify tumors eligible for local excision
Authors: Viktil Ellen , Hanekamp Bettina Andrea , Nesbakken Arild , Løberg Else Marit , Sjo Ole Helmer , Negård Anne , Dormagen Johann Baptist , Schulz Anselm 
Published: April 2024

Background In staging early rectal cancers (ERC), submucosal tumor depth is one of the most important features determining the possibility of local excision (LE). The micro-enema (Bisacodyl) induces submucosal edema and may hypothetically improve the visualization of tumor depth. Purpose To test the diagnostic performance of MRI to identify ERC suitable for LE when adding a pre-procedural micro-enema and concurrent use of a modified classification system. Material and Methods In this prospective study, we consecutively included 73 patients with newly diagnosed rectal tumors. Two experienced radiologists independently interpreted the MRI examinations, and diagnostic performance was calculated for local tumors eligible for LE (Tis-T1sm2, n = 43) and non-local tumors too advanced for LE (T1sm3-T3b, n = 30). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were registered for each reader. Inter- and intra-reader agreements were assessed by kappa statistics. Lymph node status was derived from the clinical MRI reports. Results Reader1/reader2 achieved sensitivities of 93%/86%, specificities of 90%/83%, PPV of 93%/88%, and NPV of 90%/81%, respectively, for identifying tumors eligible for LE. Rates of overstaging of local tumors were 7% and 14% for the two readers, and kappa values for the inter- and intra-reader agreement were 0.69 and 0.80, respectively. For tumors ≤T2, all metastatic lymph nodes were smaller than 3 mm on histopathology. Conclusion MRI after a rectal micro-enema and concurrent use of a modified staging system achieved good diagnostic performance to identify tumors suitable for LE. The rate of overstaging of local tumors was comparable to results reported in previous endorectal ultrasound (ERUS) studies.
Pregnancy exercise effectiveness on anxiety level among pregnant women
Authors: Susanti  , Hassan Hafizah Che , Aljaberi Musheer Abdulwahid 
Published: April 2024

Background:Changes in one’s mental state are possible during pregnancy because it is a phase. Anxiety is one of these mental changes that is common during pregnancy and has a tendency to have a detrimental impact on both the mother and the fetus. This study aims to examine the effectiveness of pregnancy exercise on pregnancy anxiety levels.Design and methods:The method used in this study was quasi-experimental with a purposive sampling technique. The Hamilton Anxiety Rating Scale (HARS) is the instrument that is employed in this study, and it will be given to the sample group of 15 pregnant women without complications to determine their levels of anxiety. This research was conducted at one of the Health Centers in Batam City, Indonesia. The sample is instructed to perform pregnancy exercise for a total of 4 weeks, with each week’s instruction consisting of pregnancy exercise being performed twice for a total of 1 h.Result:The findings of the data analysis performed with the t-test, which assessed the differences in sample anxiety levels before and after taking out pregnant exercise, showed a value of p = 0.000. This indicates that the value of p is less than 0.05, which is the threshold at which the significance level of the test is considered to be significant.Conclusions:Therefore, childbirth of complementary care in the form of exercise during pregnancy can have the impact of lowering levels of anxiety.
Updating Eindhoven: Clarifying the features of a patient safety near miss
Authors: Woodier Nick , Burnett Charlotte , Sampson Paul , Moppett Iain 
Published: April 2024

Background There are benefits to healthcare from reporting and learning from near misses in patient care. However, there have been longstanding issues with identifying near misses, with variation in definitions. Learning is being lost, unlike in other industries that have harnessed their learning potential. The features of a healthcare near miss have never been described nor modelled. This study aimed to identify those features to support near-miss identification, reporting and learning. Methods This study took a mixed-methods approach with participants from healthcare and four high-reliability industries – aviation, maritime, nuclear and rail. Qualitative exploration helped identify the features of a near miss, while quantitative supported assessment of agreement on features between participants through the use of a scenario. Results Participants from 17 healthcare and 35 industry organisations took part. Quantitative findings demonstrated variation in agreement of the features of a near miss using Fleiss Kappa. Qualitative findings identified the following themes in relation to the features of a near miss – context dependent, involve control, are complex and represent vulnerabilities. In particular, several industries have lists of specific situations that constitute near misses that support reporting and focus. Conclusion Without clear agreement of the features of a healthcare near miss, definitions will continue to vary. This study has, for the first time, provided exploration and clarification of the features of a near miss with the offer of a healthcare model for future validation. Without addressing the fundamentals, such as agreeing what a near miss is, healthcare cannot hope to learn from them.
Arthroscopic Remplissage Using a Double-Pulley Technique
Authors: Ashy Cody , Pottanat Paul , Slone Harris , Pullen W. Michael 
Published: April 2024

Background: Anterior shoulder instability is associated with Hill-Sachs lesions (HSLs) in 40% to 90% of cases. When addressing anterior shoulder instability, unaddressed engaging or “off-track” HSL have a recurrence rate of 75%. Remplissage is a known technique to address recurrent instability in the setting of an engaging HSL. In this video, we demonstrate that a double-anchor-pulley technique may be used to address recurrent instability in the setting of engaging HSL. Indications: Patients with recurrent anterior shoulder instability with off-track HSL in patients with glenoid bone loss <20% are candidates for arthroscopic Remplissage. Technique Description: Patients are placed in the lateral decubitus position. Examination under anesthesia is performed to assess for degree of instability and engagement of HSL. Posterior, anterosuperior, and anteroinferior portals are established. Routine diagnostic arthroscopy is performed with identification of the HSL. While viewing from an anterosuperior portal and working through the posterior portal, the HSL bed is prepared with curettage and a bur. A 5.5-mm accessory Cannula is used through an accessory posterior portal. Two knotless all-suture self-tensioning anchors are placed in the anterior and inferior aspect of the defect, passed through the cannula, and tagged for later identification. Bankart stabilization is performed. The knotless anchors are linked to each other to perform a knotless repair with a broad area of compression. Results: Results are excellent with only a 5.6% failure rate, significant patient improvement, low complication rate, and 95.5% return to play. Discussion: We demonstrate the technical aspects of an all-arthroscopic Remplissage technique using all-suture knotless anchors to provide a simple and reproducible method of performing a Remplissage. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
Primary large B-cell lymphomas of immune-privileged sites
Authors: Roschewski Mark , Phelan James D. , Jaffe Elaine S. 
Published: April 2024

Abstract
Diffuse large B-cell lymphoma (DLBCL) encompasses a diverse spectrum of aggressive B-cell lymphomas with remarkable genetic heterogeneity and myriad clinical presentations. Multiplatform genomic analyses of DLBCL have identified oncogenic drivers within genetic subtypes that allow for pathologic subclassification of tumors into discrete entities with shared immunophenotypic, genetic, and clinical features. Robust classification of lymphoid tumors establishes a foundation for precision medicine and enables the identification of novel therapeutic vulnerabilities within biologically homogeneous entities. Most cases of DLBCL involving the central nervous system (CNS), vitreous, and testis exhibit immunophenotypic features suggesting an activated B-cell (ABC) origin. Shared molecular features include frequent comutations of MYD88 (L265P) and CD79B and frequent genetic alterations promoting immune evasion, which are hallmarks of the MCD/C5/MYD88 genetic subtype of DLBCL. Clinically, these lymphomas primarily arise within anatomic sanctuary sites and have a predilection for remaining confined to extranodal sites and strong CNS tropism. Given the shared clinical and molecular features, the umbrella term primary large B-cell lymphoma of immune-privileged sites (IP-LBCL) was proposed. Other extranodal DLBCL involving the breast, adrenal glands, and skin are often ABC DLBCL but are more heterogeneous in their genomic profile and involve anatomic sites that are not considered immune privileged. In this review, we describe the overlapping clinical, pathologic, and molecular features of IP-LBCL and highlight important considerations for diagnosis, staging, and treatment. We also discuss potential therapeutic vulnerabilities of IP-LBCL including sensitivity to inhibitors of Bruton tyrosine kinase, immunomodulatory agents, and immunotherapy.
Cost-effectiveness of prophylaxis with recombinant vs plasma-derived VWF in severe von Willebrand disease in the United States
Authors: Waldron Christina , Ito Satoko , Wang Daniel , Allen Cecily , Viswanathan Giri , Bona Robert D. , Cuker Adam , Goshua George 
Published: April 2024

Abstract
We evaluated the cost-effectiveness of prophylaxis with recombinant von Willebrand factor (rVWF) vs with plasma-derived von Willebrand factor (pdVWF) for patients with severe Von Willebrand disease. We found that rVWF is a cost-saving factor replacement compared with pdVWF across all willingness-to-pay thresholds in the United States.
Deletion of mouse lysyl oxidase in megakaryocytes affects bone properties in a sex-dependent manner
Authors: Karagianni Aikaterini , Karkempetzaki Anastasia Iris , Brooks Daniel , Matsuura Shinobu , Dambal Vrinda , Trackman Philip C. , Ravid Katya 
Published: April 2024

Abstract
Lysyl oxidase (LOX) is a facilitator of extracellular matrix cross-linking. Using newly developed megakaryocyte-specific LOX knockout mice, we show that LOX expressed in these scarce bone marrow cells affects bone volume and collagen architecture in a sex-dependent manner.
QTL mapping for the flag leaf-related traits using RILs derived from Trititrigia germplasm line SN304 and wheat cultivar Yannong15 in multiple environments
Authors: Zhang Xia , Xing Piyi , Lin Caicai , Wang Honggang , Bao Yinguang , Li Xingfeng 
Published: April 2024

Abstract
Background
Developing and enriching genetic resources plays important role in the crop improvement. The flag leaf affects plant architecture and contributes to the grain yield of wheat (Triticum aestivum L.). The genetic improvement of flag leaf traits faces problems such as a limited genetic basis. Among the various genetic resources of wheat, Thinopyrum intermedium has been utilized as a valuable resource in genetic improvement due to its disease resistance, large spikes, large leaves, and multiple flowers. In this study, a recombinant inbred line (RIL) population was derived from common wheat Yannong15 and wheat-Th. intermedium introgression line SN304 was used to identify the quantitative trait loci (QTL) for flag leaf-related traits.

Results
QTL mapping was performed for flag leaf length (FLL), flag leaf width (FLW) and flag leaf area (FLA). A total of 77 QTLs were detected, and among these, 51 QTLs with positive alleles were contributed by SN304. Fourteen major QTLs for flag leaf traits were detected on chromosomes 2B, 3B, 4B, and 2D. Additionally, 28 QTLs and 8 QTLs for flag leaf-related traits were detected in low-phosphorus and drought environments, respectively. Based on major QTLs of positive alleles from SN304, we identified a pair of double-ended anchor primers mapped on chromosome 2B and amplified a specific band of Th. intermedium in SN304. Moreover, there was a major colocated QTL on chromosome 2B, called QFll/Flw/Fla-2B, which was delimited to a physical interval of approximately 2.9 Mb and contained 20 candidate genes. Through gene sequence and expression analysis, four candidate genes associated with flag leaf formation and growth in the QTL interval were identified.

Conclusion
These results promote the fine mapping of QFll/Flw/Fla-2B, which have pleiotropic effects, and will facilitate the identification of candidate genes for flag leaf-related traits. Additionally, this work provides a theoretical basis for the application of Th. intermedium in wheat breeding.
Continuous palliative sedation until death: a qualitative study of palliative care clinicians’ experiences
Authors: Guité-Verret Alexandra , Boivin Jessica , Hanna Andrew M. R. , Downar James , Bush Shirley H. , Marcoux Isabelle , Guay Diane , Tapp Diane , Lapenskie Julie , Gagnon Bruno 
Published: April 2024

Abstract
Background
The practice of continuous palliative sedation until death is the subject of much medical and ethical debate, which is reflected in the inconsistency that persists in the literature regarding the definition and indications of palliative sedation.

Aim
This study aims to gain a better understanding of palliative care clinicians’ experiences with continuous palliative sedation.

Design
We conducted a qualitative study based on focus group discussions.

Setting/participants
We conducted six focus groups with a total of 28 palliative care clinicians (i.e., 15 nurses, 12 physicians, and 1 end-of-life doula) from diverse care settings across Canada, where assisted dying has recently been legalized.

Results
An interpretative phenomenological analysis was used to consolidate the data into six key themes: responding to suffering; grappling with uncertainty; adapting care to ensure ongoing quality; grounding clinical practice in ethics; combining medical expertise, relational tact, and reflexivity; and offering an alternative to assisted death.

Conclusions
Interaction with the patient’s family, uncertainty about the patient’s prognosis, the concurrent practice of assisted dying, and the treatment of existential suffering influence the quality of sedation and indicate a lack of clear palliative care guidelines. Nevertheless, clinicians exhibit a reflective and adaptive capacity that can facilitate good practice.
Integrating training in evidence-based medicine and shared decision-making: a qualitative study of junior doctors and consultants
Authors: Simons Mary , Fisher Georgia , Spanos Samantha , Zurynski Yvonne , Davidson Andrew , Stoodley Marcus , Rapport Frances , Ellis Louise A. 
Published: April 2024

Abstract
Background
In the past, evidence-based medicine (EBM) and shared decision-making (SDM) have been taught separately in health sciences and medical education. However, recognition is increasing of the importance of EBM training that includes SDM, whereby practitioners incorporate all steps of EBM, including person-centered decision-making using SDM. However, there are few empirical investigations into the benefits of training that integrates EBM and SDM (EBM-SDM) for junior doctors, and their influencing factors. This study aimed to explore how integrated EBM-SDM training can influence junior doctors’ attitudes to and practice of EBM and SDM; to identify the barriers and facilitators associated with junior doctors’ EBM-SDM learning and practice; and to examine how supervising consultants’ attitudes and authority impact on junior doctors’ opportunities for EBM-SDM learning and practice.

Methods
We developed and ran a series of EBM-SDM courses for junior doctors within a private healthcare setting with protected time for educational activities. Using an emergent qualitative design, we first conducted pre- and post-course semi-structured interviews with 12 junior doctors and thematically analysed the influence of an EBM-SDM course on their attitudes and practice of both EBM and SDM, and the barriers and facilitators to the integrated learning and practice of EBM and SDM. Based on the responses of junior doctors, we then conducted interviews with ten of their supervising consultants and used a second thematic analysis to understand the influence of consultants on junior doctors’ EBM-SDM learning and practice.

Results
Junior doctors appreciated EBM-SDM training that involved patient participation. After the training course, they intended to improve their skills in person-centered decision-making including SDM. However, junior doctors identified medical hierarchy, time factors, and lack of prior training as barriers to the learning and practice of EBM-SDM, whilst the private healthcare setting with protected learning time and supportive consultants were considered facilitators. Consultants had mixed attitudes towards EBM and SDM and varied perceptions of the role of junior doctors in either practice, both of which influenced the practice of junior doctors.

Conclusions
These findings suggested that future medical education and research should include training that integrates EBM and SDM that acknowledges the complex environment in which this training must be put into practice, and considers strategies to overcome barriers to the implementation of EBM-SDM learning in practice.
Individuals’ attitudes toward digital mental health apps and implications for adoption in Portugal: web-based survey
Authors: Nogueira-Leite Diogo , Marques-Cruz Manuel , Cruz-Correia Ricardo 
Published: April 2024

Abstract
Background
The literature is consensual regarding the academic community exhibiting higher levels of mental disorder prevalence than the general population. The potential of digital mental health apps for improving access to resources to cope with these issues is ample. However, studies have yet to be performed in Portugal on individuals’ attitudes and perceptions toward digital mental health applications or their preferences and decision drivers on obtaining mental health care, self-assessment, or treatment.

Objective
This study aims to understand the determinants of digital mental health applications use in the Portuguese academic community of Porto, along with potential adoption barriers and enablers.

Methods
A cross-sectional, web-based survey was delivered via dynamic email to the University of Porto’s academic community. Data collection occurred between September 20 and October 20, 2022. We used structural equation modeling to build three models, replicating a peer-reviewed and published study and producing a newly full mediation model shaped by the collected data. We tested the relationships between use of digital mental health apps and perceived stress, perceived need to seek help for mental health, perceived stigma, past use of mental health services, privacy concerns, and social influence.

Results
Of the 539 participants, 169 (31.4%) reported having used digital mental health apps. Perceived stress and a latent variable, comprising perceptions of mental health problems and coping strategies, were positively associated with mental health app use, while privacy concerns regarding one’s information being accessible to others were negatively associated. Perceived stigma, need to seek help, and close relationships did not have a statistically significant direct effect.

Conclusions
These findings can inform product and policy development of new, better-targeted digital mental health app interventions, with implications for researchers and academia, industry, and policymakers. Our study concludes that, to maximize adherence to these apps, they should have low to no financial charges, demonstrate evidence of their helpfulness and focus on the timely delivery of care. We also conclude that to foster digital mental health app use, there is a need to improve mental health literacy, namely regarding self-awareness of one’s conditions, acceptable stress levels, and overall behavior towards mental health.

Trial registration
RR2-10.2196/41040.
Implementation of an audit and feedback module targeting low-value clinical practices in a provincial trauma quality assurance program: a cost-effectiveness study
Authors: Conombo Blanchard , Guertin Jason R. , Hoch Jeffrey S. , Grimshaw Jeremy , Bérubé Mélanie , Malo Christian , Berthelot Simon , Lauzier François , Stelfox Henry T. , Turgeon Alexis F. , Archambault Patrick , Belcaid Amina , Moore Lynne 
Published: April 2024

Abstract
Background
Audit and Feedback (A&F) interventions based on quality indicators have been shown to lead to significant improvements in compliance with evidence-based care including de-adoption of low-value practices (LVPs). Our primary aim was to evaluate the cost-effectiveness of adding a hypothetical A&F module targeting LVPs for trauma admissions to an existing quality assurance intervention targeting high-value care and risk-adjusted outcomes. A secondary aim was to assess how certain A&F characteristics might influence its cost-effectiveness.

Methods
We conducted a cost-effectiveness analysis using a probabilistic static decision analytic model in the Québec trauma care continuum. We considered the Québec Ministry of Health perspective. Our economic evaluation compared a hypothetical scenario in which the A&F module targeting LVPs is implemented in a Canadian provincial trauma quality assurance program to a status quo scenario in which the A&F module is not implemented. In scenarios analyses we assessed the impact of A&F characteristics on its cost-effectiveness. Results are presented in terms of incremental costs per LVP avoided.

Results
Results suggest that the implementation of A&F module (Cost = $1,480,850; Number of LVPs = 6,005) is associated with higher costs and higher effectiveness compared to status quo (Cost = $1,124,661; Number of LVPs = 8,228). The A&F module would cost $160 per LVP avoided compared to status quo. The A&F module becomes more cost-effective with the addition of facilitation visits; more frequent evaluation; and when only high-volume trauma centers are considered.

Conclusion
A&F module targeting LVPs is associated with higher costs and higher effectiveness than status quo and has the potential to be cost-effective if the decision-makers’ willingness-to-pay is at least $160 per LVP avoided. This likely represents an underestimate of true ICER due to underestimated costs or missed opportunity costs. Results suggest that virtual facilitation visits, frequent evaluation, and implementing the module in high-volume centers can improve cost-effectiveness.