bluuebunny/crossref_metadata_2025_split huggingface dataset:
Toward Detection of Nocturnal Hypoglycemia in People With Diabetes Using Consumer-Grade Smartwatches and a Machine Learning Approach
Authors: Mendez Camilo , Kaykayoglu Ceren Asli , Bähler Thiemo , Künzler Juri , Lizoain Aritz , Rothenbühler Martina , Schmidt Markus H. , Laimer Markus , Witthauer Lilian 
Published: February 2025

Background: Nocturnal hypoglycemia poses significant risks to individuals with insulin-treated diabetes, impacting health and quality of life. Although continuous glucose monitoring (CGM) systems reduce these risks, their poor accuracy at low glucose levels, high cost, and availability limit their use. This study examined physiological biomarkers associated with nocturnal hypoglycemia and evaluated the use of machine learning (ML) to detect hypoglycemia during nighttime sleep using data from consumer-grade smartwatches. Methods: This study analyzed 351 nights of 36 adults with insulin-treated diabetes. Participants wore two smartwatches alongside CGM systems. Linear mixed-effects models compared sleep and vital signs between nights with and without hypoglycemia during early and late sleep. A ML model was trained to detect hypoglycemia solely using smartwatch data. Results: Sixty-six nights with spontaneous hypoglycemia were recorded. Hypoglycemic nights showed increased wake periods, heart rate, stress levels, and activity during early sleep, with weaker effects during late sleep. In nights when hypoglycemia occurred during early sleep, the ML model performed comparable or better than prior studies with an area under the receiver operator curve of 0.78 for level 1 and 0.83 for level 2 hypoglycemia, with sensitivity of 0.78 and 0.89, specificity of 0.64 for both, negative predictive value of 0.94 and 0.99, and positive predictive value of 0.25 and 0.13 for level 1 and level 2 hypoglycemia, respectively. Conclusions: Consumer-grade smartwatches demonstrate promise for detecting nocturnal hypoglycemia, particularly during early sleep. Refining models to reduce false alarms could enhance their clinical utility as low-cost, accessible tools to complement CGM.
Enhancing Professionalism Online (Netiquette) in Medical Schools: A Systematic Scoping Review
Authors: Ng Donovan Kai Wei , Liang Jonathan Zhen , Wong Ruth Si Man , Raveendran Vijayprasanth , Phua Gillian Li Gek , Fong Warren , Lim Crystal , Zhou Jamie Xuelian , Krishna Lalit Kumar Radha 
Published: February 2025

Background The relaxing of COVID-19 pandemic restrictions has not seen the return to previous in-person teaching formats. As blended training continues to be used, there is emphasis on the need to better appreciate the expectations, etiquette, and professional code of conduct (“netiquette”) surrounding online learning, especially in light of evidence that poor online professionalism compromises learning and clinical practice. Objectives This review seeks to map regnant netiquette guidelines in medical schools that will inform and provide preliminary recommendations for a clinically relevant framework. Design This study is a systematic scoping review (SSR). Methods Krishna's Systematic Evidence-Based Approach (SEBA)'s Constructivist ontological and Relativist epistemological lens was used to guide this SSR. The SEBA process involves 6 stages, including the Systematic Approach, Split Approach, Jigsaw Perspective, Funneling, Analysis of evidence-based and non-data-driven literature, and Synthesis of the SSR in SEBA. Results In total, 7941 abstracts were reviewed, 198 full text articles were evaluated, and 83 articles were included. The analysis of the results revealed 4 key domains: (1) current guidelines, (2) manifestations, (3) contributing factors, and (4) implications. This SSR in SEBA highlights variability and gaps in current guidelines and reveals the impact of sociocultural factors on breaches in netiquette. Unsurprisingly, contextual and clinical considerations shape the contributory factors impacting lapses in netiquette and their implications. Conclusions Based on the data accrued, this article proposes basic guidelines on netiquette and measures to support their effective employment. This includes curricular adaptations, methods of teaching and enhancing engagement with the students and faculty training. Drawing on prevailing studies, it also recommends methods of assessing netiquette, online professionalism, and the learning environment. Suggestions are also made for future areas of study.
Schwartz Rounds in Higher Education Settings: A Systematic Review of the Research with Recommendations
Authors: Zile Amy , Owen Joel , Gorick Hugh , Orford Amy , Panagiotaki Georgia 
Published: February 2025

BACKGROUND Higher education institutions (HEIs) have recently integrated Schwartz Rounds (Rounds) as innovative ways of supporting health professional students’ reflective practice, interprofessional learning and compassionate care. Emerging evidence suggests that Rounds benefit students’ shared sense of belonging and insight into emotional aspects of training and care, providing safe places to share experiences and reflect. Our review examines the current literature regarding health students’ evaluation of Rounds in HEIs, exploring experiences and perceived benefits of participating. We consider methodological issues with the existing literature and propose ways of addressing these in future research. METHODS Systematic searches were conducted on EBSCO, PsycINFO, PubMed and ASSIA to identify available literature relating to Schwartz Rounds in higher education. Eight studies – six with a mixed method design and two qualitative – were included in the review. Study quality and risk of bias were assessed. Evaluation survey data and themes generated from qualitative responses were considered together and a narrative synthesis was constructed. RESULTS Despite challenges with differing measurements and scale usage, five themes were identified reflecting the experience and perceived benefits for students attending Rounds. Students highlighted the value of peer connection and communication; normalisation of emotions; collaborative reflection and self-awareness; and the relevance of Rounds in their daily work and patient care. Students also commented on barriers to participation including Rounds’ multidisciplinary nature, their group size, and the presence of staff. The majority of students rated Rounds as excellent or exceptional and agreed they should be integrated into the curriculum. CONCLUSIONS Our findings on Schwartz Rounds in higher education suggest they support student reflective practice and confidence in providing compassionate, high-quality patient care. However, the quality of research in this area is mixed, reflecting the relatively recent integration of Rounds in Higher education, and the challenges of implementing and evaluating new interventions in educational settings.
The impact of teacher feedback on medical students’ self-regulated learning: a serial mediation model of teacher-student interaction and sense of school belonging
Authors: Tian Jing , Hui Zhidan , Lei Hongde 
Published: February 2025

Abstract

Background
Self-regulated learning is crucial for medical students because of the rigorous and dynamic nature of medical education. Previous studies have demonstrated the positive influence of teacher feedback on students’ self-regulated learning, particularly in basic education contexts. However, research exploring the mechanisms through which teacher feedback affects self-regulated learning among medical students in higher education contexts remains limited. This study aims to investigate the impact of teacher feedback on medical students’ self-regulated learning, with a focus on the mediation roles of teacher-student interaction and sense of school belonging.

Methods
Data were collected from a comprehensive survey of undergraduates at H University, a prestigious research-oriented institution in China. The sample included 6,546 medical students spanning five academic years (2014, 2016, 2018, 2021, and 2023). The Student Survey of Learning and Development questionnaire was utilized to collect data, and teacher feedback, teacher-student interaction, sense of school belonging, and self-regulated learning were chosen as variables in this study. Structural equation modeling was employed to analyze the relationships among these variables, with mediation and serial mediation effects assessed via the bootstrap method.

Results
Teacher feedback significantly predicted medical students’ self-regulated learning (β = 0.136, p < 0.001). Teacher-student interaction (β = 0.377, p < 0.001) and sense of school belonging (β = 0.325, p < 0.001) were found to mediate the relationship between teacher feedback and self-regulated learning. The mediation effects, with effect sizes of 0.116 for teacher-student interaction and 0.045 for sense of school belonging, accounted for 37.91% and 14.71% of the total effect, respectively. Additionally, there was a serial mediation model between teacher feedback and self-regulated learning that had a value of 0.009, accounting for 2.94% of the total effect.

Conclusion
This study provides empirical evidence supporting the role of teacher feedback in promoting medical students’ self-regulated learning, with teacher-student interaction and sense of school belonging serving as important mediating factors. These findings have implications for designing effective educational interventions to cultivate self-regulated learners capable of adapting to the rapidly evolving landscape of medical knowledge and practice.
Strategies for improving maternal care for ethnic minority women with obstetric anal sphincter injuries in the UK
Authors: Olakotan Olufisayo , Sudhakar Vedhapriya , Lim Jennifer Nw , Bhavsar Mina , Siddiqui Farah , Ayaz Rabina , Henry Gillian O’Brady , Pillay Thillagavathie 
Published: February 2025

Abstract

Background
Women from minority ethnic groups in the UK have the highest prevalence of obstetric anal sphincter injuries (OASI), including third- and fourth-degree perineal tears sustained during childbirth. Incorporating the voices of mothers at higher risk of OASI is crucial in developing strategies to improve care and well-being.

Aim
To identify strategies perceived as important by women with lived experience of OASI in Leicester, UK, to improve their care and well-being.

Methodology
Women at high risk of and with lived experience of OASI in Leicester, UK, were invited, through our local maternity and neonatal voices partnership, to participate in a virtual focus group discussion (FGDs). Two FGDs were conducted to accommodate participants' availability. The first session included seven women, while the second session included three women. All participants were from underrepresented groups with lived experiences of OASI within the past one to ten years. A discussion guide was used to explore participants’ perceptions and experiences of OASI care, as well as their views on culturally and linguistically sensitive maternal care strategies. The discussion was recorded and transcribed. The data were analysed using the six-step thematic analysis approach by Braun and Clarke.

Results
The participants identified strategies to provide culturally appropriate care for obstetric anal sphincter injuries, including linguistically accessible prenatal resources, comprehensive midwifery training, updated prenatal education, standardized postpartum care, the inclusion of fathers in prenatal education, empathetic care, building trust, and community engagement and education.

Conclusion
This study highlights disparities in maternal healthcare outcomes for women from diverse ethnic backgrounds who experience OASI. Addressing these inequalities requires incorporating the voices of those directly affected to inform culturally sensitive policies and practices in maternal care.
Is non-conveyance solo-ambulances a useful mean to meet the increasing demand for emergency medical services in Denmark?
Authors: Møller Frederikke Amalie , Persson Mads Lillethorup , Engholm Elisabeth Larsen , Jensen Penille Horsbøl Kirkegaard , Vaeggemose Ulla , Gehrt Tine Bennedsen 
Published: February 2025

Abstract

Background
The growing demand for acute medical assistance creates an increasing pressure on emergency medical services (EMS) and emergency departments. This calls for initiatives to prevent avoidable admissions. A novel non-conveyance solo-ambulance was introduced in the Central Denmark Region; the Prehospital Visitation Unit (PVU). We investigated patient characteristics and prehospital management by the PVU, while exploring employee perspectives on the implementation process and how they perceived their expanded role and responsibilities working with the PVU.

Methods
This mixed-methods study had a convergent parallel design. Patient data was collected on all patients assessed by the PVU between April 1st 2022 and April 1st 2023. Furthermore, 19 semi-structured interviews with paramedics, EMS dispatchers and technical dispatchers partaking in the operation of the PVU were conducted. Interviews were analyzed using thematic analysis with an inductive approach, drawing on principles from grounded theory.

Results
Throughout the study period, the PVU served 1510 patients (median age: 60, IQR: 33–77). Among these, 83.6% were assigned an urgency level B, indicating acute, but not life-threatening, situations. Patients presented with a broad range of complaints, including a high number of patients with non-specific complaints. Paramedics completed treatment on-scene for 29.1% of all patients, spending a median time of 49 min (IQR: 33–64) on-scene. In the interviews, four themes were identified: (1) The implementation strategy had gaps, but was supported by ongoing adjustments, (2) Facilitating a patient-centered approach for the benefit of the patient and the system, (3) Community partnership and internal collaboration enabled paramedics as healthcare facilitators, and (4) Flexible workflows were needed to maintain professional agency.

Conclusions
The PVU seems to offer a valuable alternative within the EMS, particularly for patients with non-specific complaints and conditions manageable at a lower level of care. Strong collaboration allowed paramedics to take on a facilitating role, creating appropriate pathways and providing patient-centered care. However, for successful implementation, ongoing adjustments were required, particularly in maintaining the professional autonomy of the healthcare professionals. As prehospital EMS increasingly respond to non-acute medical needs, initiatives like the PVU can play an important role in meeting growing demands.
Pharmacogenomic of LH and its receptor: are we ready for clinical practice?
Authors: Conforti Alessandro , Di Girolamo Raffaella , Guida Maurizio , Alviggi Carlo , Casarini Livio 
Published: February 2025

Abstract
Luteinizing hormone (LH) is fundamental to support development and reproduction. It acts through a receptor expressed in the gonads, modulating mitogenic, anti-apoptotic, and steroidogenic signals. LH is also marketed as a drug for controlled ovarian stimulation (COS), where it is administered to women to support the action of follicle-stimulating hormone and can lead to specific responses, depending on the individual genetic background. These concepts underline the relevance of a pharmacogenetic approach to COS, in the attempt to optimize clinical outcomes and avoid adverse events. However, knowledge is currently limited by the paucity of clinical studies. This review aims to provide a comprehensive overview of LH and its receptor activity, starting from the description of their molecular pathways from in vitro studies. Data on LH action from in vivo studies were described, as well as the impact of LH and LH/choriogonadotropin (hCG) receptor genetic variants on folliculogenesis and its association with infertility or polycystic ovarian syndrome. Finally, evidence from clinical studies evaluating genetic polymorphisms in the context of assisted reproductive technology treatments and its implications for a pharmacogenomic approach were discussed.
Surfing follicular waves in ovarian stimulation: is there a role for LH in DuoStim protocols? A narrative review and SWOT analysis
Authors: Vaiarelli Alberto , Cimadomo Danilo , Cerrillo Maria , Ubaldi Filippo Maria , García Velasco Juan Antonio 
Published: February 2025

Abstract
IVF treatments should be personalized to collect an appropriate number of oocytes, taking into account the woman’s age and ovarian reserve, in order to maximize the efficacy and efficiency of the IVF process. From a scientific perspective, the ‘continuous recruitment theory’ suggests that several follicular waves are continuously recruited to grow and regress throughout one ovarian cycle. Clinically, this approach has paved the way for the theorization of a double stimulation protocol back-to-back in the same ovarian cycle (DuoStim) to rescue anovulatory waves. This protocol has been successfully adopted by several independent groups in the last decade to improve the number of oocytes in a short timeframe. Although the published data are promising for treating patients of advanced maternal age with reduced ovarian reserve and poor oocyte/embryo competence, the protocols adopted vary across studies. In this challenging population, choosing the appropriate protocol in the DuoStim context is critical to maximize the ovarian response and exploit the potential of individual follicular waves. In this regard, the administration of luteinizing hormone (LH) could be relevant to promote steroidogenesis and folliculogenesis, increase androgen production, improve pre-antral and antral follicle recruitment, and enhance the expression of follicle-stimulating hormone receptors in the granulosa cells. This review presents a step-by-step outline of all DuoStim protocols and proposes a SWOT (strengths, weaknesses, opportunities, threats) analysis of LH administration in the context of DuoStim.
How does overweight affect bone mineral density and oral health in adult hypophosphatasia?– A single center experience
Authors: Dudde Florian , Fildebrandt Dominik , Petz Karin , Smeets Ralf , Gosau Martin , Amling Michael , Beikler Thomas , Barvencik Florian 
Published: February 2025

Abstract

Aim
The aim of this study was to investigate the influence of overweight (BMI ≥ 25 (kg/m²)) on the oral health status in patients with adult hypophosphatasia (HPP).

Materials and methods
Throughout a retrospective assessment both oral health status and bone metabolism including dual x-ray absorptiometry (DXA) for bone mineral density (BMD) measures were analyzed. The oral health status was assessed by the decayed/missing/filled teeth index (DMFT), clinical attachment level (CAL), probing pocket depth (PPD), and the periodontal screening index (PSI). The study population was divided into two groups based on the overweight classification by BMI (Overweight = BMI ≥ 25 kg/m²; n = 17) vs. non-overweight ( BMI < 25 kg/m²; n = 31).

Results
48 HPP patients were included in this study. Overweight HPP patients showed a significantly reduced oral health status regarding filled teeth, DMFT, PSI, PPD and periodontitis severity index compared to non-overweight HPP patients. Furthermore, overweight HPP patients revealed significantly higher DXA findings regarding BMD, T- and Z-scores.

Conclusion
In the present study overweight (BMI ≥ 25 (kg/m²)) is associated with a poorer oral health status and higher BMD in adult HPP.

Clinical relevance
Since overweight is associated with a poorer oral health status in the general population and promotes the development of periodontal disease, the findings of the present study indicate that overweight also affects oral health in adult HPP.
“It’s a reasonable gamble”—rural residents’ experience participating in cancer clinical trials at a single rural trial unit
Authors: McPhee Narelle J. , Hughes Diane , Ristevski Eli 
Published: February 2025

Abstract

Background
We conducted a qualitative study to examine what factors influence rural-residing people with cancer to participate in cancer clinical trials (CCT) and what factors influence their retention in CCT.

Methods
Purposive sampling was used to recruit participants from a regional cancer centre in Victoria, Australia, to participate in a semi-structured interview. Eligible participants were ≥ 18 years of age at the time of cancer diagnosis, newly consented to a clinical trial (< 1 year) or have been a trial participant for ≥ 1 year, lived in a non-metropolitan area classified within the Monash Modified (MM) Model 2–7 and able to provide informed consent. Thematic analysis was used to analyse the interview data.

Results
Seventeen participants were interviewed; 10 identified as female and seven as male. Participant’s ages ranged from 52 to 77 years, with a median age of 62 years. Eight participants had been on a CCT for ≤ 1 and 10 for ≥ 1 year. Factors that influenced their decision to participate in a CCT included trust and confidence in clinical trial staff, exposure to and trust in the experiences of cancer peers, altruism, low-risk trials and local access to trials. The factors influencing their decision to remain in a CCT included balancing the benefits and burdens of the trial, having no doubts about participating despite knowing the risks and seeing the personal benefits of participating in a CCT.

Conclusion
Our study shows that trust-based relationships, peer support, and altruism encourage rural residents to participate in CCT. To improve access to CCT for rural residents, a multi-faceted approach involving clinicians, health services, trial sponsors and policymakers is needed. These approaches must promote and facilitate the inclusion of diverse populations, prioritise CCT participation, and inform patients of CCT opportunities. We must recognise the knowledge and expertise of rural patients and caregivers and ensure they are involved as co-designers of future CCTs.