bluuebunny/crossref_metadata_2025_split huggingface dataset:
Facilitating patient portal engagement: a channel expansion and behavior change wheel perspective
Authors: Cao Weidan , Cao Xiaohui 
Published: February 2024

IntroductionGiven the low patient portal adoption rates, the contradictory findings on the relationship between patient-provider communication and patient portal use, and the unclear mechanism of why doctor-patient communication might facilitate portal use as indicated in some existing studies, patient portal engagement warrants further examination.MethodsGuided by the behavior change wheel framework and the channel expansion theory, this study examined the facilitators of patient portal engagement and tested the relationship between the facilitators (e.g., social opportunity and psychological capability) through analyzing the HINTS national survey data (N = 1251).ResultsWe found that patient portal access (a physical opportunity) and physician advocacy (a social opportunity) were two significant predictors of portal engagement while educational attainment was not. We did not find any direct correlation between patient-centered communication (PCC) and patient portal engagement, but instead, found a significant indirect relationship between the two.DiscussionTo the best of our knowledge, this is the first study to employ the behavior change wheel and channel expansion theory to explain patient portal engagement. Theoretically, our study extended the behavior change theory by further explaining the relationship between the key components (e.g., capability, opportunity) of behavior change. Practical strategies to increase patient portal engagement were proposed.
Heart rhythm in vitro: measuring stem cell-derived pacemaker cells on microelectrode arrays
Authors: Kussauer Sophie , Dilk Patrick , Elleisy Moustafa , Michaelis Claudia , Lichtwark Sarina , Rimmbach Christian , David Robert , Jung Julia 
Published: February 2024

BackgroundCardiac arrhythmias have markedly increased in recent decades, highlighting the urgent need for appropriate test systems to evaluate the efficacy and safety of new pharmaceuticals and the potential side effects of established drugs.MethodsThe Microelectrode Array (MEA) system may be a suitable option, as it provides both real-time and non-invasive monitoring of cellular networks of spontaneously active cells. However, there is currently no commercially available cell source to apply this technology in the context of the cardiac conduction system (CCS). In response to this problem, our group has previously developed a protocol for the generation of pure functional cardiac pacemaker cells from mouse embryonic stem cells (ESCs). In addition, we compared the hanging drop method, which was previously utilized, with spherical plate-derived embryoid bodies (EBs) and the pacemaker cells that are differentiated from these.ResultsWe described the application of these pacemaker cells on the MEA platform, which required a number of crucial optimization steps in terms of coating, dissociation, and cell density. As a result, we were able to generate a monolayer of pure pacemaker cells on an MEA surface that is viable and electromechanically active for weeks. Furthermore, we introduced spherical plates as a convenient and scalable method to be applied for the production of induced sinoatrial bodies.ConclusionWe provide a tool to transfer modeling and analysis of cardiac rhythm diseases to the cell culture dish. Our system allows answering CCS-related queries within a cellular network, both under baseline conditions and post-drug exposure in a reliable and affordable manner. Ultimately, our approach may provide valuable guidance not only for cardiac pacemaker cells but also for the generation of an MEA test platform using other sensitive non-proliferating cell types.
Prognostic value of right ventricular free wall strain in patients with sepsis
Authors: Chen Hongmin , Huang Lei , Xing Boyuan , Gao Yang , Zhang Jie , Zhang Bingyi 
Published: February 2024

BackgroundRight ventricular systolic dysfunction (RVSD) in patients with sepsis is an area of growing interest, but its prognostic significance remains unclear and additional tools are needed to improve our understanding. Right ventricular free wall strain (RV-FWS) is a relatively new parameter to assess RV function. This study aimed to investigate the potential correlation between impaired RV-FWS and prognostic outcomes in patients with sepsis.MethodsWe prospectively assessed right ventricular function in patients with sepsis within the initial 24 h of their hospital admission. RV-FWS, right ventricular global strain (RV-GS), fractional area change (FAC), and tricuspid annular plane systolic excursion (TAPSE) were examined. RVSD was defined as impaired RV-FWS. Moreover, the association between RVSD and 30-day mortality rate was assessed.ResultsThis study included 89 patients. Among them, 27 (30.3%) succumbed to their illness within 30 days. The nonsurviving patients demonstrated significantly lower absolute RV-FWS (−19.7% ± 2.4% vs. −21.1% ± 2.1%, P = 0.008) and RV-GS (−17.7% ± 1.2% vs. −18.4% ± 1.4%, P = 0.032) values than the surviving patients. However, TAPSE and FAC values were not significantly different between the two groups. The optimal cutoff values for RV-FWS, RV-GS, FAC, and TAPSE were −19.0%, −17.9%, 36.5%, and 1.55 cm, respectively. Kaplan–Meier survival curves revealed that patients with impaired RV-FWS and RV-GS demonstrated lower 30-day survival rates, and the predictive performance of RV-FWS (hazard ratio [HR]: 3.97, 95% confidence interval [CI]: 1.85–8.51, P &lt; 0.001) was slightly higher than FAC and TAPSE. However, multivariable Cox regression analysis revealed no association between impaired RV-FWS and mortality outcomes (HR: 1.85, 95% CI: 0.56–6.14, P = 0.316).ConclusionsImpaired RV-FWS is not associated with short-term mortality outcomes, and RV strain imaging is of limited value in assessing the prognosis of sepsis.
[99mTc]Tc-HYNIC-ALUG SPECT/CT in the initial staging of 227 consecutive patients with newly diagnosed prostate cancer: a 5-year monocentric retrospective study
Authors: Li Bo , Ding Xintao , Duan Lili , Shi Jingqi , Tang Minmin , Zhang Jie , Zhao Zun , Wu Xinyu , Gao Yongju 
Published: February 2024

PurposeThe purpose of this study was to assess the effectiveness of [99mTc]Tc-HYNIC-ALUG SPECT/CT in the initial staging of patients with newly diagnosed PCa.MethodsA retrospective analysis was conducted on 227 consecutive patients who underwent [99mTc]Tc-HYNIC-ALUG SPECT/CT imaging for the primary staging of newly diagnosed PCa. The presence and location of PSMA-positive lesions were determined, and the maximum standardized uptake values (SUVmax) of the primary prostate tumor were also measured. The metastatic findings and SUVmax were stratified according to International Society of Urological Pathology (ISUP) grade, prostate-specific antigen (PSA) levels, and D’Amico classification. Furthermore, the [99mTc]Tc-HYNIC-ALUG SPECT/CT findings were compared to the histopathological findings in patients who had undergone radical prostatectomy with pelvic lymph node dissection (PLND).ResultsOf the 227 patients, 92.1% (209/227) had positive [99mTc]Tc-HYNIC-ALUG SPECT/CT findings. Advanced disease was detected in 38.8% (88/227) of the patients and was positively correlated with increasing ISUP grade and PSA levels. Lymph node metastases (both pelvic and extrapelvic), bone metastases, and visceral metastases were detected in 30.0% (68/227), 25.6% (58/227), and 3.1% (7/227) of the patients, respectively. For the 129 patients who underwent radical prostatectomy with PLND, the sensitivity of [99mTc]Tc-HYNIC-ALUG SPECT/CT in the evaluation of PCa was 90.7% (117/129). The sensitivity, specificity, accuracy, and positive and negative predictive values for detecting pelvic lymph node metastases on [99mTc]Tc-HYNIC-ALUG SPECT/CT were 23.5% (12/51), 93.6% (73/78), 65.9% (85/129), 70.6% (12/17), and 65.2% (73/112), respectively. Among the 209 patients with PSMA-avid primary prostate disease, the SUVmax of the primary prostate tumor was significantly associated with ISUP grade (p&lt;0.0001), PSA levels (p&lt;0.0001), D’Amico classification (p&lt;0.0001), and advanced disease (p&lt;0.0001). Receiver operating characteristic (ROC) analysis revealed that a PSA level &gt;19.8 ng/ml and SUVmax of the primary prostate tumor &gt;7.4 had a sensitivity of 71.6% and 71.6% and specificity of 76.9% and 82.6%, respectively, for detecting metastatic disease.Conclusions[99mTc]Tc-HYNIC-ALUG SPECT/CT emerges as a valuable imaging tool for the initial staging of newly diagnosed PCa. The presence of advanced disease and the SUVmax of the primary prostate tumor were positively correlated with ISUP grade and PSA levels.
Machine learning-based prediction of vitamin D deficiency: NHANES 2001-2018
Authors: Guo Jiale , He Qionghan , Li Yehai 
Published: February 2024

BackgroundVitamin D deficiency is strongly associated with the development of several diseases. In the current context of a global pandemic of vitamin D deficiency, it is critical to identify people at high risk of vitamin D deficiency. There are no prediction tools for predicting the risk of vitamin D deficiency in the general community population, and this study aims to use machine learning to predict the risk of vitamin D deficiency using data that can be obtained through simple interviews in the community.MethodsThe National Health and Nutrition Examination Survey 2001-2018 dataset is used for the analysis which is randomly divided into training and validation sets in the ratio of 70:30. GBM, LR, NNet, RF, SVM, XGBoost methods are used to construct the models and their performance is evaluated. The best performed model was interpreted using the SHAP value and further development of the online web calculator.ResultsThere were 62,919 participants enrolled in the study, and all participants included in the study were 2 years old and above, of which 20,204 (32.1%) participants had vitamin D deficiency. The models constructed by each method were evaluated using AUC as the primary evaluation statistic and ACC, PPV, NPV, SEN, SPE, F1 score, MCC, Kappa, and Brier score as secondary evaluation statistics. Finally, the XGBoost-based model has the best and near-perfect performance. The summary plot of SHAP values shows that the top three important features for this model are race, age, and BMI. An online web calculator based on this model can easily and quickly predict the risk of vitamin D deficiency.ConclusionIn this study, the XGBoost-based prediction tool performs flawlessly and is highly accurate in predicting the risk of vitamin D deficiency in community populations.
Analysis of dose–TSH response effect of levothyroxine soft-gel formulation
Authors: Trimboli Pierpaolo , Piticchio Tommaso , Dadda Zeno , Stramazzo Ilaria , Gamarra Elena , Ruinelli Lorenzo , Virili Camilla 
Published: February 2024

BackgroundHypothyroidism is treated with daily levothyroxine (LT4). In recent years, soft gel caps of LT4 (LT4-C) have been commercialized, and their performance has been optimized. Since guidelines recommend dose LT4 according to the tablet preparation efficacy, the present study was undertaken to obtain data about the daily requirement, normalized per body weight, of LT4-C.MethodsPatients undergoing LT4-C after total thyroidectomy and radioiodine treatment for differentiated thyroid carcinoma were selected. There was no specific indication of suppression of TSH (i.e., &lt;0.5 or &lt;0.1 mIU/L). Patients were required to maintain a stable LT4 dose during the study period. Patients with interfering factors were excluded from this study.ResultsThirty patients were enrolled (18 females and 12 males; median age, 50 years; median body weight, 71 kg; median LT4-C dose, 1.71 µg/kg/day). The analysis of patient age did not reveal any differences. The LT4-C dose correlated with free-T4 p = 0.03), but not with TSH (p = 0.42) and free-T3 (p = 0.13). TSH was &lt;1.0 mIU/L in 90% of the cases. The LT4-C dose–TSH response effect was analysed by probit regression model: the probability to achieve TSH &lt;1.0 mIU/l was 99% with a dose of 1.84 (95%CI 1.57–2.12) µg/kg/day, 75% with a dose of 1.38 µg/kg/day (95%CI 1.17–1.59), and 50% with a dose of 1.20 (95%CI 0.96–1.43). At ROC curve analysis, the most accurate cut-off of LT4-C dose to achieve TSH &lt;1.0 mIU/l was 1.53 ug/kg/day with 70% sensitivity and 100% specificity.ConclusionsAthyreotic patients can be initially treated with an LT4-C dose lower than previously stated. Therefore, further prospective studies are warranted.
High mortality risk among women with acromegaly still persists
Authors: Găloiu Simona , Toma Iustin-Daniel , Tănasie Denisa Isabella , Bărbulescu Andreea , Baciu Ionela , Niculescu Dan Alexandru , Trifănescu Raluca Alexandra , Căpăţînă Cristina , Radian Şerban , Poiană Cătălina 
Published: February 2024

IntroductionThe mortality ratio in patients with acromegaly has improved over the last few decades. We aimed to determine the mortality rate and correlated factors in patients with acromegaly before and after the introduction of national protocols for treatment. In addition, we determined whether there are sex-related differences in mortality of patients with acromegaly.MethodsThis observational retrospective study included 399 consecutive patients with acromegaly between January 2001–December 2022. Paraclinical data included random growth hormone (GH) and insulin-like growth factor-I (IGF1) levels, maximal pituitary tumor diameter at diagnosis, first visit, and last evaluation. Standardized mortality ratio (SMR) was calculated by dividing the observed and expected mortality rates. Cox regression analysis revealed the independent factors associated with mortality.ResultsAt the last visit, 31.07% (124) of patients were cured, 22.05% (88) had controlled acromegaly with medication, and 45.31% (181) had not controlled acromegaly. During follow-up (13.03 ± 5.65 years, 5216.62 person-years), 89 patients died (0.017%), resulting in an SMR of 1.18 [95% CI 0.95–1.45]. The independent factors associated with mortality were the last IGF1 level/last random GH level, absence of surgery, gonadotropin deficiency, and age. Patients with normal IGF1 after treatment showed an SMR of 0.71, whereas patients with IGF1 ratio &gt; 1 showed SMR=1.51. Patients diagnosed between 1975–2007 and 2008–2022 had SMR = 1.25 [95% CI 0.97–1.58] and SMR = 1.09 [95% CI 0.68–1.65], respectively. In females with acromegaly, SMR was 1.63 [95% CI 1.24–2.11]; 1.76 [95% CI 1.30–2.34] in women diagnosed before 2008 and 1.33 [95% CI 0.69–2.33] in those diagnosed after 2008. Males with acromegaly had a mortality ratio similar to males from the general population (SMR = 0.99, [95% CI 0.66–1.41]).ConclusionPatients diagnosed with acromegaly in the last 15 years had lower mortality rates than those diagnosed before 2008, due to the availability of new medications, primarily somatostatin receptor analogs and to a higher proportion of patients undergoing surgery. Females still have a high mortality ratio owing to older age at diagnosis and higher risk of metabolic complications. Therefore, efforts should be made for early diagnosis of acromegaly in women.
A consensus statement on perinatal mental health during the COVID-19 pandemic and recommendations for post-pandemic recovery and re-build
Authors: Jackson Leanne , Greenfield Mari , Payne Elana , Burgess Karen , Oza Munira , Storey Claire , Davies Siân M. , De Backer Kaat , Kent-Nye Flora E. , Pilav Sabrina , Worrall Semra , Bridle Laura , Khazaezadeh Nina , Rajasingam Daghni , Carson Lauren E. , De Pascalis Leonardo , Fallon Victoria , Hartley Julie M. , Montgomery Elsa , Newburn Mary , Wilson Claire A. , Harrold Joanne A. , Howard Louise M. , Sandall Jane , Magee Laura A. , Sheen Kayleigh S. , Silverio Sergio A. 
Published: February 2024

IntroductionThe COVID-19 pandemic posed a significant lifecourse rupture, not least to those who had specific physical vulnerabilities to the virus, but also to those who were suffering with mental ill health. Women and birthing people who were pregnant, experienced a perinatal bereavement, or were in the first post-partum year (i.e., perinatal) were exposed to a number of risk factors for mental ill health, including alterations to the way in which their perinatal care was delivered.MethodsA consensus statement was derived from a cross-disciplinary collaboration of experts, whereby evidence from collaborative work on perinatal mental health during the COVID-19 pandemic was synthesised, and priorities were established as recommendations for research, healthcare practice, and policy.ResultsThe synthesis of research focused on the effect of the COVID-19 pandemic on perinatal health outcomes and care practices led to three immediate recommendations: what to retain, what to reinstate, and what to remove from perinatal mental healthcare provision. Longer-term recommendations for action were also made, categorised as follows: Equity and Relational Healthcare; Parity of Esteem in Mental and Physical Healthcare with an Emphasis on Specialist Perinatal Services; and Horizon Scanning for Perinatal Mental Health Research, Policy, &amp; Practice.DiscussionThe evidence base on the effect of the pandemic on perinatal mental health is growing. This consensus statement synthesises said evidence and makes recommendations for a post-pandemic recovery and re-build of perinatal mental health services and care provision.
Case report: Complex evaluation of coagulation, fibrinolysis and inflammatory cytokines in a SARS-CoV-2 infected pregnant woman with fetal loss
Authors: Tóth Eszter Lilla , Orbán-Kálmándi Rita , Bagoly Zsuzsa , Lóczi Linda , Deli Tamás , Török Olga , Molnár Sarolta , Baráth Sándor , Singh Parvind , Hevessy Zsuzsanna , Katona Éva , Fagyas Miklós , Szabó Attila Ádám , Molnár Szabolcs , Krasznai Zoárd Tibor 
Published: February 2024

BackgroundSARS-CoV-2 infection during pregnancy increases the risk of severe obstetrical complications. Detailed evaluation of COVID-19-associated coagulopathy in a pregnancy with stillbirth hasn’t been described so far. Besides knowledge gaps in the pathomechanism leading to stillbirth in COVID-19 pregnancies, currently, no prognostic biomarker is available to identify pregnant patients who are at imminent risk of COVID-19-associated maternal and fetal complications, requiring immediate medical attention.CaseHere we report the case of a 28-year-old SARS-CoV-2 infected pregnant patient, admitted to our hospital at 28 weeks of gestation with intrauterine fetal loss. The presence of SARS-CoV-2 placentitis was confirmed by immunohistological evaluation of the placenta. She had only mild upper respiratory symptoms and her vital signs were within reference throughout labor and postpartum. The stillborn infant was delivered per vias naturales. Fibrinogen concentrate was administered before and after labor due to markedly decreased fibrinogen levels (1.49 g/l) at admission and excessive bleeding during and after delivery. Although coagulation screening tests were not alarming at admission, the balance of hemostasis was strikingly distorted in the patient. As compared to healthy age- and gestational age-matched pregnant controls, increased D-dimer, low FVIII activity, low FXIII level, marked hypocoagulability as demonstrated by the thrombin generation assay, together with shortened clot lysis and decreased levels of fibrinolytic proteins were observed. These alterations most likely have contributed to the increased bleeding observed during labor and in the early postpartum period. Interestingly, at the same time, only moderately altered inflammatory cytokine levels were found at admission. Serum ACE2 activity did not differ in the patient from that of age- and gestational age-matched healthy controls, suggesting that despite previous speculations in the literature, ACE2 may not be used as a potential biomarker for the prediction of COVID-19 placentitis and threatening fetal loss in SARS-CoV-2-infected pregnancies.ConclusionsAlthough based on this case report no prognostic biomarker could be identified for use in pregnant patients with imminent risk of fetal loss associated with COVID-19 placentitis, the above-described hemostasis alterations warrant awareness of postpartum hemorrhagic complications and could be helpful to identify patients requiring intensified medical attention.
Effect of deposition temperature on the tribo-mechanical properties of nitrogen doped DLC thin film
Authors: Shanmugasundar G. , Vanitha M. , Logesh K. , Cepova Lenka , Elangovan Muniyandy 
Published: February 2024

The tribomechanical characteristics of diamond-like carbon (DLC) coatings are notably superior to other hard coatings, making them highly desirable for industrial applications. This study focuses on the synthesis of nitrogen-doped DLC (N-DLC) films through chemical vapor deposition (CVD) methods, with an emphasis on varying the deposition temperature. Comprehensive characterization techniques such as atomic force microscopy (AFM), scanning electron microscopy (SEM), and nanoindentation were employed to investigate the morphological and mechanical attributes of these coatings. The thickness of the films, measured using a Dektak profilometer, demonstrated an increase from 1.9 to 2.8 µm as the deposition temperature rose. Nanoindentation testing revealed that the film deposited at 900°C exhibited the highest hardness (H) and modulus of elasticity (E), measuring 21.95 and 208.3 GPa, respectively. Conversely, the film deposited at 1,000°C showed the lowest values, with H and E at 14.23a and 141.9 GPa, respectively. The H/E ratio of the coatings initially rose from 0.096 to 0.106 as the deposition temperature increased from 800°C to 900°C. However, for deposition temperatures exceeding 900°C the H/E ratio began to decline.
Transforming professional identity of medical teachers in Pakistan by a certificate program in health professions education: a thematic analysis of reflective essays
Authors: Kiran Faiza , Ayub Rukhsana , Rauf Ayesha , Zahoor Asiya 
Published: February 2024

IntroductionA teacher’s professional identity development is a dynamic and continuous process that requires rigorous, longitudinal, faculty development initiatives which are designed to work on individual professional growth. Impact of such programs must be evaluated by qualitative means to identify the process of change; The purpose of our study was to investigate whether and how our thoughtfully designed 6-month certificate program has transformed the professional identity of medical teachers.MethodsThe study was conducted in National University of Medical Sciences, Pakistan using thematic analysis, wherein a weekly task of guided reflective writing, on Moodle, was given. Data was analyzed in six phases to achieve credibility and transferability.ResultsBy analyzing 202 reflective writings, seven subthemes were identified which manifest transformation in certain aspects of identity of participants and grouped under three major themes. The seven subthemes represent transformative journey of participants and include recognizing millennial learners’ dilemma, identifying learning gaps and overcoming barriers, discovering a newer version of self, alternative frame of thinking, transforming traditional classroom, conducive learning environment and Community of Practice. Three major themes identified were Awareness, Modeling and Socialization which represent three processes bringing transformation in participants.ConclusionOur faculty development program has transformed certain aspects of professional identities of medical teachers by incorporating informal teaching strategies of experiential learning, professional socialization, reflections, and role modeling. Participants’ beliefs and practices on teaching were challenged by giving a disorienting dilemma of millennial learners and learning theories. They underwent critical discourse with professional peers and mentors in community of practice, reflected on their traditional teaching practices, acquired new insight, underwent self-discovery, and introduced digitalization and interactive learning strategies within their classrooms.