bluuebunny/crossref_metadata_2025_split huggingface dataset:
Premature termination, satisfaction with care, and shared decision-making during home treatment compared to inpatient treatment: A quasi-experimental trial
Authors: Weinmann Stefan , Nikolaidis Konstantinos , Längle Gerhard , von Peter Sebastian , Brieger Peter , Timm Jürgen , Fischer Lasse , Raschmann Svenja , Holzke Martin , Schwarz Julian , Klocke Luisa , Rout Sandeep , Hirschmeier Constanze , Herwig Uwe , Richter Janina , Kilian Reinhold , Baumgardt Johanna , Hamann Johannes , Bechdolf Andreas 
Published: September 2023

Abstract

Background
Inpatient equivalent home treatment (IEHT), implemented in Germany since 2018, is a specific form of home treatment. Between 2021 and 2022, IEHT was compared to inpatient psychiatric treatment in a 12-months follow-up quasi-experimental study with two propensity score matched cohorts in 10 psychiatric centers in Germany. This article reports results on the treatment during the acute episode and focuses on involvement in decision-making, patient satisfaction, and drop-out rates.

Methods
A total of 200 service users receiving IEHT were compared with 200 matched statistical “twins” in standard inpatient treatment. Premature termination of treatment as well as reasons for this was assessed using routine data and a questionnaire. In addition, we measured patient satisfaction with care with a specific scale. For the evaluation of patient involvement in treatment decisions, we used the 9-item Shared Decision Making Questionnaire (SDM-Q-9).

Results
Patients were comparable in both groups with regard to sociodemographic and clinical characteristics. Mean length-of-stay was 37 days for IEHT and 28 days for inpatient treatment. In both groups, a similar proportion of participants stopped treatment prematurely. At the end of the acute episode, patient involvement in decision-making (SDM-Q-9) as well as treatment satisfaction scores were significantly higher for IEHT patients compared to inpatients.

Conclusions
Compared to inpatient care, IEHT treatment for acute psychiatric episodes was associated with higher treatment satisfaction and more involvement in clinical decisions.
Pediatric Features of Genetic Predisposition to Polycystic Ovary Syndrome
Authors: Zhu Jia , Eliasen Anders U , Aris Izzuddin M , Stinson Sara E , Holm Jens-Christian , Hansen Torben , Hivert Marie-France , Bønnelykke Klaus , Salem Rany M , Hirschhorn Joel N , Chan Yee-Ming 
Published: September 2023

Abstract

Context
Polycystic ovary syndrome (PCOS) has historically been conceptualized as a disorder of the reproductive system in women. However, offspring of women with PCOS begin to show metabolic features of PCOS in childhood, suggestive of childhood manifestations.

Objective
To identify childhood manifestations of genetic risk for PCOS.

Methods
We calculated a PCOS polygenic risk score (PRS) for 12 350 girls and boys in 4 pediatric cohorts—ALSPAC (UK), COPSAC (Denmark), Project Viva (USA), and The HOLBÆK Study (Denmark). We tested for association of the PRS with PCOS-related phenotypes throughout childhood and with age at pubarche and age at peak height velocity and meta-analyzed effects across cohorts using fixed-effect models.

Results
Higher PRS for PCOS was associated with higher body mass index in midchildhood (0.05 kg/m2 increase per 1 SD of PRS, 95% CI 0.03, 0.07, P = 3 × 10−5) and higher risk of obesity in early childhood (OR 1.34, 95% CI 1.13, 1.59, P = .0009); both persisted through late adolescence (P all ≤.03). Higher PCOS PRS was associated with earlier age at pubarche (0.85-month decrease per 1 SD of PRS, 95% CI −1.44, −0.26, P = .005) and younger age at peak height velocity (0.64-month decrease per 1 SD of PRS, 95% CI −0.94, −0.33, P = 4 × 10−5).

Conclusion
Genetic risk factors for PCOS are associated with alterations in metabolic, growth, and developmental traits in childhood. Thus, PCOS may not simply be a condition that affects women of reproductive age but, rather, a possible manifestation of an underlying condition that affects both sexes starting in early life.
Approach to the Patient: Hormonal Therapy in Transgender Adults With Complex Medical Histories
Authors: Iwamoto Sean J , Rothman Micol S , T’Sjoen Guy , Defreyne Justine 
Published: September 2023

Abstract
While endocrinologists continue to initiate gender-affirming hormone therapy (GAHT) in healthy transgender and gender diverse (TGD) patients, they may also encounter more TGD patients in their clinics with complex medical histories that influence the patient-provider shared decision-making process for initiating or continuing GAHT. The purpose of this Approach to the Patient article is to describe management considerations in 2 adults with thromboembolic disease and 2 adults with low bone mineral density in the setting of feminizing and masculinizing GAHT.
State-Level Abortion Policy Hostility and Unplanned Births in the Pre-Dobbs Era
Authors: Eddelbuettel Julia C. P. , Sassler Sharon 
Published: September 2023

Abstract
An increasingly hostile policy climate has reshaped abortion access in the United States. Recent literature has studied the effects of restrictive abortion policies on reproductive health outcomes. This study is the first to investigate the association between state-level abortion policy hostility and the pregnancy intentions of women with a pregnancy resulting in live birth. Data are from the Pregnancy Risk Assessment Monitoring System survey, merged with a state-level legislative database from 2012–2018 and other state-level controls. Cross-sectional results reveal that a one-unit increase in abortion policy hostility is associated with a relative risk (odds) of having a live birth resulting from an unintended versus intended pregnancy that is 1.02 times as high (RRR = 1.02, 95% confidence interval = 1.01, 1.03). This result corresponds to a 13% increase in the predicted probability of having a live birth resulting from an unintended pregnancy between a zero-hostility and a maximum-hostility state. Models stratified by demographic and socioeconomic characteristics reveal that the association between abortion policy hostility and live birth resulting from an unintended pregnancy is particularly robust among women in younger, less educated, Medicaid, uninsured, and rural populations.
The Natural History of Hemorrhage in Brain Arteriovenous Malformations—Poisson Regression Analysis of 1066 Patients in a Single Institution
Authors: Yang Wuyang , Feghali James , Sattari Shahab Aldin , Hung Alice L. , Chen Yuxi , Huang Judy 
Published: September 2023

BACKGROUND AND OBJECTIVES:
Natural history of hemorrhage in brain arteriovenous malformations (bAVM) is reported at 2%–4% per year. Published studies using survival analysis fail to account for recurrent hemorrhagic events. In this study, we present a large, single institution series to elucidate the natural history of bAVM using multivariable Poisson regression.

METHODS:
This is a retrospective cohort study. All patients with bAVM seen at our institution from 1990 to 2021 were included. Hemorrhages after detection of bAVM during the untreated interval were recorded. Natural history of hemorrhage was calculated by dividing number of hemorrhages by untreated interval. The frequency of hemorrhages followed a Poisson distribution. Multivariable Poisson regression with an offset variable of untreated interval in patient-years was constructed. Model selection was through a stepwise Akaike information criterion method. Stratified hemorrhagic rate was presented using different combinations of significant factors.

RESULTS:
A total of 1066 patients with nonhereditary hemorrhagic telangiectasia harboring a single bAVM were included. Ninety (8.44%) patients had 101 hemorrhages during an untreated interval of 3596.3344 patient-years, translating to an overall hemorrhagic rate of 2.81% per year. Significant factors increasing hemorrhage risk included ruptured presentation (P < .001), increasing age (P < .001), female sex (P = .043), and deep location (P = .040). Adult male patients with ruptured presentation and deep bAVMs sustained the highest annual risk at 10.81%, whereas no hemorrhages occurred in unruptured pediatric male patients or ruptured pediatric (younger than 18 years) male patients with superficial bAVMs.

CONCLUSION:
Hemorrhage after bAVM detection occurs in 8.41% of all patients, and the rate averages 2.81% per year. However, this risk varies from 0.00% to 10.81% per year depending on various risk factor combinations. Efforts should be made to stratify bAVM hemorrhage rate by risk factors for more precise estimation of bleeding risk if left untreated.
Taste papilla cell differentiation requires the regulation of secretory protein production by ALK3-BMP signaling in the tongue mesenchyme
Authors: Ishan Mohamed , Wang Zhonghou , Zhao Peng , Yao Yao , Stice Steven L. , Wells Lance , Mishina Yuji , Liu Hong-Xiang 
Published: September 2023

ABSTRACT
Taste papillae are specialized organs, each of which comprises an epithelial wall hosting taste buds and a core of mesenchymal tissue. In the present study, we report that during early taste papilla development in mouse embryos, bone morphogenetic protein (BMP) signaling mediated by type 1 receptor ALK3 in the tongue mesenchyme is required for epithelial Wnt/β-catenin activity and taste papilla differentiation. Mesenchyme-specific knockout (cKO) of Alk3 using Wnt1-Cre and Sox10-Cre resulted in an absence of taste papillae at E12.0. Biochemical and cell differentiation analyses demonstrated that mesenchymal ALK3-BMP signaling governed the production of previously unappreciated secretory proteins, i.e. it suppressed those that inhibit and facilitated those that promote taste papilla differentiation. Bulk RNA-sequencing analysis revealed many more differentially expressed genes (DEGs) in the tongue epithelium than in the mesenchyme in Alk3 cKO versus control. Moreover, we detected downregulated epithelial Wnt/β-catenin signaling and found that taste papilla development in the Alk3 cKO was rescued by the GSK3β inhibitor LiCl, but not by Wnt3a. Our findings demonstrate for the first time the requirement of tongue mesenchyme in taste papilla cell differentiation.
The metabolic associated fatty liver disease responses of lifestyle changes using diet and exercise
Authors: Altaf Benash , Mohamed Mahaneem , Jawed Shireen , Wan Ghazali Wan Syaheedah 
Published: September 2023

Objective: This review is aimed to study MAFLD responses of lifestyle modifications using Diet and Exercise.
Methods: The sources for this MAFLD review following PRISMA protocol were PubMed, Google scholar, Scopus and Science Direct. Quality of evidence was assessed by consistent results with previous studies. Assessment of quality was done by Joanna Briggs Institute criteria. Quality of evidence was assessed by GRADE approach tool.
Results: This review included 12 studies, from which five were qualitative and seven quantitative. The later showed poor dietary habits and sedentary lifestyle exhibiting MAFLD which eventually affect their quality of life. Further studies suggested that by introducing healthy lifestyle in MAFLD group using diet and exercise caused reduction in BMI, obesity levels, improved glycemic control and reversal of liver fat content with improved liver enzymes.
Conclusion: Subjects with MAFLD experienced poor quality of life. Altering lifestyle by diet and exercise can improve their physical wellbeing.
doi: https://doi.org/10.12669/pjms.39.6.7990
How to cite this: Altaf B, Mohamed M, Jawed S, Ghazali WSW. The metabolic associated fatty liver disease responses of lifestyle changes using diet and exercise. Pak J Med Sci. 2023;39(6):---------. doi: https://doi.org/10.12669/pjms.39.6.7990
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Development and validation of Digi-MEE Instrument measuring online learning environments in medical education
Authors: Naeem Noor-i-Kiran , Hadie Siti Nurma Hanim , Ismail Irwan Mahazir , Yusoff Muhamad Saiful Bahri 
Published: September 2023

Objectives: To develop and validate Digital Medical Education Environment (Digi-MEE) Instrument for measuring online learning environment in medical education.
Methods: This series of studies involved 696 participants from May 2022 to December 2022. Following scoping review, invited modified e-Delphi experts developed consensus on the components and related items for measuring online learning environments. A panel of content experts and a group of medical students carried out content and response-process validation to determine Content Validity Index (CVI) and Face Validity Index (FVI) respectively. This was followed by exploratory and confirmatory factor analysis and reliability analysis to determine Digi-MEE’s factorial structure and internal consistency using SPSS version 26.0 and AMOS 26.0.
Results: Delphi experts agreed upon nine components with 73 items of initial Digi-MEE version. CVI of Digi-MEE 2.0 was more than 0.90. with FVI of Digi-MEE 3.0 of 0.87. Exploratory factor analysis yielded 46 items with 57.18% variance. Confirmatory factor analysis led to the final Digi-MEE version containing 28 items within nine components with acceptable levels of goodness of fit indices. Overall Cronbach alpha of the final Digi-MEE was more than 0.90, and for the nine components ranged between 0.62 and 0.76.
Conclusion: Digi-MEE is a promising valid and reliable instrument to evaluate online education environment in medical education. Content, response-process, factorial structure, and internal consistency evidence support the validity of Digi-MEE. Medical schools can use Digi-MEE as an evaluation tool for the continuous quality improvement of online learning environments.
doi: https://doi.org/10.12669/pjms.39.6.8430
How to cite this: Naeem NK, Hadie SNH, Ismail IM, Yusoff MSB. Development and validation of Digi-MEE Instrument measuring online learning environments in medical education. Pak J Med Sci. 2023;39(6):---------. doi: https://doi.org/10.12669/pjms.39.6.8430
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Lumefantrine pressure selects nonsynonymous mutation in cysteine desulfurase IscS gene in the rodent malaria parasite Plasmodium berghei ANKA
Authors: Gachie Beatrice , Chepngetich Jean , Muriithi Brenda , Thiong’o Kelvin , Gathirwa Jeremiah , Kimani Francis , Mwitari Peter , Magoma Gabriel , Kiboi Daniel 
Published: September 2023

Background: Lumefantrine (LM), piperaquine (PQ), and amodiaquine (AQ) are the essential long-acting partner drugs in the artemisinin-based combination therapies (ACTs) treatment regimens globally. The recent report on the emergence of artemisinin-resistant parasites portends an imminent failure of the partner drug in clearing the high residual parasite densities. Understanding the resistance mechanisms to partner drugs remains critical for tracking resistant parasites. Cysteine desulfurase IscS (nfs1), one of the proteins involved in the iron-sulfur (FeS) biogenesis pathway, has been implicated in mediating malaria parasite drug resistance. Methods: Using the rodent malaria parasites Plasmodium berghei ANKA in mice, we assessed whether the nfs1 gene is associated with LM, PQ, and AQ resistance. We first verified the stability of the LM, PQ, and AQ-resistant parasites in the standard 4-Day Suppressive Test. By means of PCR and sequencing analysis, we probed for single nucleotide polymorphisms (SNPs) in the nfs1 gene. Using qPCR, we then measured the expression of the nfs1 gene in resistant parasites relative to the drug-sensitive parent parasites. Results: Our analyses of nfs1 reveal a non-synonymous Gln142Arg mutation in the LM and PQ-resistant parasites. This mutation was not detected in the AQ-resistant parasites. The mRNA quantification of the nfs1 gene reveals differential expression in both LM and PQ-resistant parasites. Conversely, nfs1 expression remained unchanged in the AQ-resistant parasites. Conclusion: Our data suggest that LM and PQ selection pressure induces nonsynonymous mutation and differential expression of the nfs1 gene in Plasmodium berghei. Collectively, these findings provide a premise for investigating LM and PQ resistance mechanisms in both P. berghei and P. falciparum.
Physical activity of pregnant women - benefits for pregnancy
Authors: Kępka Przemysław , Ben Rhaiem Rami , Kuziemkowska Daria , Kuźma Jan , Łącka-Majcher Anna , Łokczewska-Bojar Aleksandra , Tarsa Grzegorz , Skotalczyk Magdalena , Sawińska Zuzanna , Sudelska Katarzyna 
Published: September 2023

Introduction: Physical activity in pregnant women, as in the rest of the population, helps to maintain good health and prevent diseases. It has a positive effect on the body of the future mother, but is also a source of measurable benefits for the developing fetus. There are many methods of active spending time for pregnant women that are not only safe but also recommended to ensure the proper course of pregnancy.
Aim of the study: The aim of our study is to present current recommendations regarding activity among pregnant women and the benefits for the mother and fetus resulting from regular and moderate physical activity.
Material and methods: We reviewed scientific publications using the Google Scholar database, using keywords such as “physical activity during pregnancy” or “physical activity among pregnant women”.
Conclusions: Physical activity in pregnant women is not only safe but also recommended. According to the recommendations, pregnant women should exercise regularly in a way that is not too strenuous and does not pose a risk of injury. Regular, moderate activity during pregnancy brings a number of benefits for the pregnant woman and the fetus.
Understanding implementation of a complex intervention in a stroke rehabilitation research trial: A qualitative evaluation using Normalisation Process Theory
Authors: Johnson Louise , Mardo Julia , Demain Sara 
Published: September 2023

Background
The Implicit Learning in Stroke study was a pilot cluster randomised controlled trial, investigating the use of different motor learning strategies in acute stroke rehabilitation. Participating Stroke Units (n = 8) were from the South East/West regions of the UK, with the experimental intervention (implicit learning) being delivered by clinical teams. It required therapists to change how they gave instructions and feedback to patients during rehabilitation. This paper reports the processes underpinning implementation of the implicit learning intervention. The evaluation aimed to i) understand how therapists made sense of, engaged with and interpreted the effects of the intervention; ii) compare this to the experience reported by patients; iii) extrapolate learning of broader relevance to the design and conduct of research involving complex interventions in stroke rehabilitation.

Methods
Qualitative evaluation, with data collected through focus groups with clinical staff (n = 20) and semi structured interviews with people with stroke (n = 19). Mixed inductive and theory driven analysis, underpinned by Normalisation Process Theory.

Results
How therapists made sense of and experienced the intervention impacted how it was implemented. The intervention was delivered by individual therapists, and was influenced by their individual values, beliefs and concerns. However, how teams worked together to build a shared (team) understanding, also played a key role. Teams with a more “flexible” interpretation, reported the view that the intervention could have benefits in a wide range of scenarios. Those with a more fixed, “rule based” interpretation, found it harder to implement, and perceived the benefits to be more limited. Therapists’ concerns that the intervention may impair therapeutic relationships and patient learning were not reflected in how patients experienced it.

Conclusions
Changing practice, whether in a research study or in the “real world”, is complex. Understanding the process of implementation is crucial to effective research delivery. Implementation frameworks facilitate understanding, and subsequently the systematic and iterative development of strategies for this to be addressed. How teams (rather than individuals) work together is central to how complex interventions are understood and implemented. It is possible that new complex interventions work best in contexts where there are ‘flexible’ cultures. Researchers should consider, and potentially measure this, before they can effectively implement and evaluate an intervention.

Trial registration
Clinical Trials - NCT03792126.
SMOOTH protocol: A pilot randomised prospective intra-patient single-blinded observational study for examining the mechanistic basis of ablative fractional carbon dioxide laser therapy in treating hypertrophic scarring
Authors: Chen Yung-Yi , Patel Krupali M. , Imran Rizwana , Hassouna Tarek , Amirize Ezekwe , Abdulsalam Abdulrazak , Bishop Jonathan , Slade Anita , Ventura Maximina , Yarrow Jeremy , Lord Janet M. , Wilson Yvonne , Moiemen Naiem S. 
Published: September 2023

Background
Burn injuries are the fourth most common type of trauma and are associated with substantial morbidity and mortality. The impact of burn injury is clinically significant as burn injuries often give rise to exuberant scarring. Hypertrophic scarring (HTS) is a particular concern as up to 70% of burns patients develop HTS. Laser therapy is used for treating HTS and has shown positive clinical outcomes, although the mechanisms remain unclear limiting approaches to improve its effectiveness. Emerging evidence has shown that fibroblasts and senescent cells are important modifiers of scarring. This study aims to investigate the cellular kinetics in HTS after laser therapy, with a focus on the association of scar reduction with the presence of senescent cells.

Methods
We will conduct a multicentre, intra-patient, single-blinded, randomised controlled longitudinal pilot study with parallel assignments to achieve this objective. 60 participants will be recruited to receive 3 interventional ablative fractional CO2 laser treatments over a 12-month period. Each participant will have two scars randomly allocated to receive either laser treatment or standard care. Biopsies will be obtained from laser-treated, scarred-no treatment and non-scarred tissues for immune-histological staining to investigate the longitudinal kinetics of p16INK4A+-senescent cells and fibroblast subpopulations (CD90+/Thy1+ and αSMA+). Combined subjective scar assessments including Modified Vancouver Scar Scale, Patient and Observer Scar Assessment Scale and Brisbane Burn Scar Impact Profile; and objective assessment tools including 3D-Vectra-H1 photography, DermaScan® Cortex, Cutometer® and ColoriMeter®DSMIII will be used to evaluate clinical outcomes. These will then be used to investigate the association between senescent cells and scar reduction after laser therapy. This study will also collect blood samples to explore the systemic biomarkers associated with the response to laser therapy.

Discussion
This study will provide an improved understanding of mechanisms potentially mediating scar reduction with laser treatment, which will enable better designs of laser treatment regimens for those living with HTS.

Trial registration
ClinicalTrials.gov: NCT04736251.