bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of clear aligners on the vertical position of the molar teeth and the vertical and sagittal relationships of the face: a preliminary retrospective before-after clinical trial
Authors: Moradinejad Mehrnaz , Harrell Ricky E. , Mousavi Sayed Mohammad , Alavi Minoo , Basseri Alireza Darvish , Feiz Arman , Daryanavard Hanie , Rakhshan Vahid 
Published: February 2024

Abstract
Introduction
Despite the popularity of clear aligners, their predictability has not been assessed adequately. Moreover, no study has investigated their effects on numerous dentomaxillary variables. Therefore, this study was conducted for the first time, assessing several new or controversial items. The aim of the study was to evaluate the effects of clear aligners on the vertical position of the molar teeth and the vertical and sagittal relationships of the face.

Methods
This preliminary retrospective before-after non-randomized clinical trial was performed on 168 observations of 84 patients (33.60±9.28 years, 54 females) treated with 0.75mm Invisalign appliances. Pretreatment and posttreatment values were measured for: mandibular plane angle, occlusal plane angle, Y-Axis, ANB, facial angle, lower anterior facial height, overbite, and the distances of the molars from the palate and mandibular plane were measured. The alterations in parameters caused by treatment (delta values) were calculated for each measurement. Effects of treatment and some parameters on delta values were analyzed statistically (α=0.05).

Results
Mean±SD of ΔMP-FH, ΔOP-FH, ΔY-Axis, ΔLAFH, ΔNPog-FH, ΔANB, ΔOverbite, ΔSNB, Δ6-PP, Δ7-PP, Δ6-MP, and Δ7-MP were respectively 0.11±1.61, 0.80±1.56, 0.15±1.18, 0.07±0.91, -0.22±1.25, 0.03±0.62, 0.04±1.15, -0.06±1.14, -0.36±0.94, -0.32±1.14, 0.19±0.96, 0.18±1.10. Only the alterations in OP-FH, 6-PP, and 7-PP were significant (P≤0.011). Age, sex, treatment duration, or pretreatment mandibular plane angle were not correlated with any delta values. However, the pretreatment occlusal plane angle was negatively correlated with ΔOP-FH and ΔY-Axis. Crowding was correlated negatively with ΔOP-FH and ΔY-Axis and positively with ΔNPog-FH. Overjet was negatively correlated with ΔANB and ΔOverbite (P≤0.035).

Conclusions
Invisalign intruded first/second maxillary molars and increased the occlusal plane angle. Age, sex, and treatment duration were not correlated with post-treatment anatomic alterations.
Towards a set of competencies in palliative care nursing in Spain: what’s getting in the way of consensus?
Authors: Guanter-Peris Lourdes , Alburquerque-Medina Eulàlia , Solà-Pola Montserrat , Pla Margarida 
Published: February 2024

Abstract
Background
Spain currently lacks a competency framework for palliative care nursing. Having such a framework would help to advance this field in academic, governmental, and health management contexts. In phase I of a mixed-methods sequential study, we collected quantitative data, proposing 98 competencies to a sample of palliative care nurses. They accepted 62 of them and rejected 36.

Methods
Phase II is a qualitative phase in which we used consensus techniques with two modified nominal groups to interpret the quantitative findings with the objective of understanding of why the 36 competencies had been rejected. Twenty nurses from different areas of palliative care (direct care, teaching, management, research) participated. We conducted a thematic analysis using NVivo12 to identify meaning units and group them into larger thematic categories.

Results
Participants attributed the lack of consensus on the 36 competencies to four main reasons: the rejection of standardised nursing language, the context in which nurses carry out palliative care and other factors that are external to the care itself, the degree of specificity of the proposed competency (too little or too great), and the complexity of nursing care related to the end of life and/or death.

Conclusions
Based on the results, we propose reparative actions, such as reformulating the competencies expressed in nursing terminology to describe them as specific behaviours and insisting on the participation of nurses in developing institutional policies and strategies so that competencies related to development, leadership and professional commitment can be implemented. It is essential ​​to promote greater consensus on the definition and levels of nursing intervention according to criteria of complexity and to advocate for adequate training, regulation, and accreditation of palliative care expert practice. Locally, understanding why the 36 competencies were rejected can help Spanish palliative care nurses reach a shared competency framework. More broadly, our consensus methodology and our findings regarding the causes for rejection may be useful to other countries that are in the process of formalising or reviewing their palliative care nursing model.
A qualitative study of social accountability translation: from mission to living it
Authors: Cleland Jennifer , Zachariah Anand , David Sarah , Pulimood Anna , Poobalan Amudha 
Published: February 2024

Abstract
Background
Medical schools are increasingly adopting socially accountable mission and curricula, the realisation of which are dependent on engaging individuals to embody the mission’s principles in their everyday activities as doctors. However, little is known about how graduates perceive the efforts taken by their medical school to sensitise them to social accountability values, and how they translate this into their working lives. Our aim was to explore and understand graduate perceptions of how their medical school influenced them to embody a social accountability mission in their working lives.

Methods
This was a qualitative interview study carried out with graduates/alumni [n = 51] of Christian Medical College, Vellore [CMCV], India, a school with a long-established and explicit social-accountability mission. Data coding and analysis were initially inductive and thematic using Braun and Clarke’s six step framework. MacIntyre’s virtue ethics theory framed secondary analysis, allowing us to consider the relationships between individual and contextual factors.

Results
Our participants perceived that CMCV invested heavily in selecting personal qualities aligned with the CMCV mission. They saw that these qualities were reinforced through various practices: [e.g., placements in resource limited and/or remote and rural settings]; community engagement and expectations [e.g., student self-governance]; role modelling [staff and more senior students]. Much emphasis was placed on sustaining these traditions and practices over time, creating a strong sense of identity and belonging among participants, traditions which were fostered further by the alumni network and continued engagement with CMCV post-graduation.

Conclusions
Ensuring social accountable medical education depends on alignment and interactions over time between context and structures, systems and human agents. Further studies are needed to extend understanding of how students from diverse contexts experience socially accountable medical education and translate their educational experience into their thinking and practice after graduation.
Performance of ChatGPT on Chinese national medical licensing examinations: a five-year examination evaluation study for physicians, pharmacists and nurses
Authors: Zong Hui , Li Jiakun , Wu Erman , Wu Rongrong , Lu Junyu , Shen Bairong 
Published: February 2024

Abstract
Background
Large language models like ChatGPT have revolutionized the field of natural language processing with their capability to comprehend and generate textual content, showing great potential to play a role in medical education. This study aimed to quantitatively evaluate and comprehensively analysis the performance of ChatGPT on three types of national medical examinations in China, including National Medical Licensing Examination (NMLE), National Pharmacist Licensing Examination (NPLE), and National Nurse Licensing Examination (NNLE).

Methods
We collected questions from Chinese NMLE, NPLE and NNLE from year 2017 to 2021. In NMLE and NPLE, each exam consists of 4 units, while in NNLE, each exam consists of 2 units. The questions with figures, tables or chemical structure were manually identified and excluded by clinician. We applied direct instruction strategy via multiple prompts to force ChatGPT to generate the clear answer with the capability to distinguish between single-choice and multiple-choice questions.

Results
ChatGPT failed to pass the accuracy threshold of 0.6 in any of the three types of examinations over the five years. Specifically, in the NMLE, the highest recorded accuracy was 0.5467, which was attained in both 2018 and 2021. In the NPLE, the highest accuracy was 0.5599 in 2017. In the NNLE, the most impressive result was shown in 2017, with an accuracy of 0.5897, which is also the highest accuracy in our entire evaluation. ChatGPT’s performance showed no significant difference in different units, but significant difference in different question types. ChatGPT performed well in a range of subject areas, including clinical epidemiology, human parasitology, and dermatology, as well as in various medical topics such as molecules, health management and prevention, diagnosis and screening.

Conclusions
These results indicate ChatGPT failed the NMLE, NPLE and NNLE in China, spanning from year 2017 to 2021. but show great potential of large language models in medical education. In the future high-quality medical data will be required to improve the performance.
Dimension reduction and outlier detection of 3-D shapes derived from multi-organ CT images
Authors: Selle Michael , Kircher Magdalena , Schwennen Cornelia , Visscher Christian , Jung Klaus 
Published: February 2024

AbstractBackgroundUnsupervised clustering and outlier detection are important in medical research to understand the distributional composition of a collective of patients. A number of clustering methods exist, also for high-dimensional data after dimension reduction. Clustering and outlier detection may, however, become less robust or contradictory if multiple high-dimensional data sets per patient exist. Such a scenario is given when the focus is on 3-D data of multiple organs per patient, and a high-dimensional feature matrix per organ is extracted.MethodsWe use principal component analysis (PCA), t-distributed stochastic neighbor embedding (t-SNE) and multiple co-inertia analysis (MCIA) combined with bagplots to study the distribution of multi-organ 3-D data taken by computed tomography scans. After point-set registration of multiple organs from two public data sets, multiple hundred shape features are extracted per organ. While PCA andt-SNE can only be applied to each organ individually, MCIA can project the data of all organs into the same low-dimensional space.ResultsMCIA is the only approach, here, with which data of all organs can be projected into the same low-dimensional space. We studied how frequently (i.e., by how many organs) a patient was classified to belong to the inner or outer 50% of the population, or as an outlier. Outliers could only be detected with MCIA and PCA. MCIA andt-SNE were more robust in judging the distributional location of a patient in contrast to PCA.ConclusionsMCIA is more appropriate and robust in judging the distributional location of a patient in the case of multiple high-dimensional data sets per patient. It is still recommendable to apply PCA ort-SNE in parallel to MCIA to study the location of individual organs.
Implementing a tobacco-free workplace program at a substance use treatment center: a case study
Authors: Rogova Anastasia , Leal Isabel Martinez , Britton Maggie , Chen Tzuan A. , Lowenstein Lisa M. , Kyburz Bryce , Casey Kathleen , Skeene Kim , Williams Teresa , Reitzel Lorraine R. 
Published: February 2024

Abstract
Background
People with substance use disorders smoke cigarettes at much higher rates than the general population in the United States and are disproportionately affected by tobacco-related diseases. Many substance use treatment centers do not provide evidence-based tobacco cessation treatment or maintain comprehensive tobacco-free workplace policies. The goal of the current work is to identify barriers and facilitators to a successful and sustainable implementation of a tobacco-free workplace program, which includes a comprehensive tobacco-free policy and evidence-based cessation treatment services, in a substance use treatment center.

Methods
This study is based on an ethnographic approach and uses a qualitative case study design. Data were collected via interviews with staff (n = 6) and clients (n = 16) at the substance use treatment center and site visits (n = 8). Data were analyzed using thematic analysis guided by the extended Normalization Process Theory designed to inform the implementation of innovations in healthcare practice.

Results
Staff at the substance use treatment center supported the implementation of the program and shared a good understanding of the purpose of the intervention and its potential benefits. However, the study identified significant challenges faced by the center during implementation, including widespread tobacco use among clients, contributing to attitudes among staff that tobacco cessation was a low-priority problem due to a perceived lack of interest in quitting and inability to quit among their clients. We identified several factors that contributed to changing this attitude, including provision of tobacco training to staff, active leadership support, low number of staff members who smoked, and access to material resources, including nicotine replacement products. The implementation and active enforcement of a comprehensive tobacco-free workplace program contributed to a gradual change in attitudes and improved the provision of evidence-based tobacco cessation care at the substance use treatment center.

Conclusions
Substance use treatment centers can integrate tobacco cessation practices in their daily operations, despite multiple challenges they face due to the complex behavioral health and socioeconomic needs of their clients. With proper support, substance use treatment centers can provide much needed tobacco cessation care to their clients who are disproportionately affected by tobacco-related health conditions and systemic health inequities.
Exploration of the potential association between GLP-1 receptor agonists and suicidal or self-injurious behaviors: a pharmacovigilance study based on the FDA Adverse Event Reporting System database
Authors: Zhou Jianxing , Zheng You , Xu Baohua , Long Songjun , Zhu Li-e , Liu Yunhui , Li Chengliang , Zhang Yifan , Liu Maobai , Wu Xuemei 
Published: February 2024

Abstract
Background
Establishing whether there is a potential relationship between glucagon-like peptide 1 receptor agonists (GLP-1RAs) and suicidal or self-injurious behaviors (SSIBs) is crucial for public safety. This study investigated the potential association between GLP-1RAs and SSIBs by exploring the FDA Adverse Event Reporting System (FAERS) database.

Methods
A disproportionality analysis was conducted using post-marketing data from the FAERS repository (2018 Q1 to 2022 Q4). SSIB cases associated with GLP-1RAs were identified and analyzed through disproportionality analysis using the information component. The parametric distribution with a goodness-of-fit test was employed to analyze the time-to-onset, and the Ω shrinkage was used to evaluate the potential effect of co-medication on the occurrence of SSIBs.

Results
In total, 204 cases of SSIBs associated with GLP-1RAs, including semaglutide, liraglutide, dulaglutide, exenatide, and albiglutide, were identified in the FAERS database. Time-of-onset analysis revealed no consistent mechanism for the latency of SSIBs in patients receiving GLP-1RAs. The disproportionality analysis did not indicate an association between GLP-1RAs and SSIBs. Co-medication analysis revealed 81 cases with antidepressants, antipsychotics, and benzodiazepines, which may be proxies of mental health comorbidities.

Conclusions
We found no signal of disproportionate reporting of an association between GLP-1RA use and SSIBs. Clinicians need to maintain heightened vigilance on patients premedicated with neuropsychotropic drugs. This contributes to the greater acceptance of GLP-1RAs in patients with type 2 diabetes mellitus or obesity.

Graphical Abstract
Serial cultures in invert emulsion and monophase systems for microbial community shaping and propagation
Authors: Dijamentiuk Alexis , Mangavel Cécile , Gapp Chloé , Elfassy Annelore , Revol-Junelles Anne-Marie , Borges Frédéric 
Published: February 2024

Abstract
Background
Microbial communities harbor important biotechnological potential in diverse domains, however, the engineering and propagation of such communities still face both knowledge and know-how gaps. More specifically, culturing tools are needed to propagate and shape microbial communities, to obtain desired properties, and to exploit them. Previous work suggested that micro-confinement and segregation of microorganisms using invert (water-in-oil, w/o) emulsion broth can shape communities during propagation, by alleviating biotic interactions and inducing physiological changes in cultured bacteria. The present work aimed at evaluating invert emulsion and simple broth monophasic cultures for the propagation and shaping of bacterial communities derived from raw milk in a serial propagation design.

Results
The monophasic setup resulted in stable community structures during serial propagation, whereas the invert emulsion system resulted in only transiently stable structures. In addition, different communities with different taxonomic compositions could be obtained from a single inoculum. Furthermore, the implementation of invert emulsion systems has allowed for the enrichment of less abundant microorganisms and consequently facilitated their isolation on culture agar plates.

Conclusions
The monophasic system enables communities to be propagated in a stable manner, whereas the invert emulsion system allowed for the isolation of less abundant microorganisms and the generation of diverse taxonomic compositions from a single inoculum.
Factors associated with safe and successful postoperative day 1 discharge after lung operations: a systematic review and meta-analysis
Authors: Martins Russell Seth , Fatimi Asad Saulat , Ansari Amna Irfan , Raheel Hamna , Poulikidis Kostantinos , Latif M. Jawad , Razi Syed Shahzad , Bhora Faiz Y. 
Published: February 2024

Abstract
Background
A shorter length of stay (LOS) is associated with fewer hospital-acquired adverse conditions and decreased utilization of hospital resources. While modern perioperative care protocols have enabled some ambitious surgical teams to achieve discharge as early as within postoperative day 1 (POD1), most other teams remain cautious about such an approach due to the perceived risk of missing postoperative complications and increased readmission rates. We aimed to identify factors that would help guide surgical teams aiming for safe and successful POD1 discharge after lung resection.

Methods
We searched the PubMed, Embase, Scopus, Web of Science and CENTRAL databases for articles comparing perioperative characteristics in patients discharged within POD1 (DWPOD1) and after POD1 (DAPOD1) following lung resection. Meta-analysis was performed using a random-effects model.

Results
We included eight retrospective cohort studies with a total of 216,887 patients, of which 22,250 (10.3%) patients were DWPOD1. Our meta-analysis showed that younger patients, those without cardiovascular and respiratory comorbidities, and those with better preoperative pulmonary function are more likely to qualify for DWPOD1. Certain operative factors, such as a minimally invasive approach, shorter operations, and sublobar resections, also favor DWPOD1. DWPOD1 appears to be safe, with comparable 30-day mortality and readmission rates, and significantly less postoperative morbidity than DAPOD1.

Conclusions
In select patients with a favorable preoperative profile, DWPOD1 after lung resection can be achieved successfully and without increased risk of adverse outcomes such as postoperative morbidity, mortality, or readmissions.
Inter-platform reproducibility of ultrasound-based fat fraction for evaluating hepatic steatosis in nonalcoholic fatty liver disease
Authors: Jeon Sun Kyung , Lee Jeong Min 
Published: February 2024

Abstract
Objectives
To evaluate the inter-platform reproducibility of ultrasound-based fat fraction examination in nonalcoholic fatty liver disease (NAFLD).

Methods
Patients suspected of having NAFLD were prospectively enrolled from January 2023. Ultrasound-based fat fraction examinations were performed using two different platforms (ultrasound-derived fat fraction [UDFF] and quantitative ultrasound-derived estimated fat fraction [USFF]) on the same day. The correlation between UDFF and USFF was assessed using Pearson correlation coefficient. Intraclass correlation coefficient (ICC), Bland–Altman analysis with 95% limits of agreement (LOAs), and the coefficient of variation (CV) were used to assess inter-platform reproducibility.

Results
A total of 41 patients (21 men and 20 women; mean age, 53.9 ± 12.6 years) were analyzed. Moderate correlation was observed between UDFF and USFF (Pearson’s r = 0.748; 95% confidence interval [CI]: 0.572–0.858). On Bland–Altman analysis, the mean difference between UDFF and USFF values was 1.3% with 95% LOAs ranging from -8.0 to 10.6%. The ICC between UDFF and USFF was 0.842 (95% CI: 0.703–0.916), with a CV of 29.9%.

Conclusion
Substantial inter-platform variability was observed among different ultrasound-based fat fraction examinations. Therefore, it is not appropriate to use ultrasound-based fat fraction values obtained from different vendors interchangeably.

Critical relevance statement
Considering the substantial inter-platform variability in ultrasound-based fat fraction assessments, caution is imperative when interpreting and comparing fat fraction values obtained from different ultrasound platforms in clinical practice.

Key points
• Inter-platform reproducibility of ultrasound-based fat fraction examinations is important for its clinical application.
• Significant variability across different ultrasound-based fat fraction examinations was observed.
• Using ultrasound-based fat fraction values from different vendors interchangeably is not advisable.

Graphical Abstract