bluuebunny/crossref_metadata_2025_split huggingface dataset:
Competencies for Repetitive Transcranial Magnetic Stimulation in Postgraduate Medical Education: Expert Consensus Using a Modified Delphi Process
Authors: Lai Ka Sing Paris , Waxman Robyn , Blumberger Daniel M. , Giacobbe Peter , Hasey Gary , McMurray Lisa , Milev Roumen , Palaniyappan Lena , Ramasubbu Rajamannar , Rybak Yuri E. , Sacevich Tegan , Vila-Rodriguez Fidel , Burhan Amer M. 
Published: March 2023

Background Repetitive transcranial magnetic stimulation (rTMS) is recommended in Canadian guidelines as a first-line treatment for major depressive disorder. With the shift towards competency-based medical education, it remains unclear how to determine when a resident is considered competent in applying knowledge of rTMS to patient care. Given inconsistencies between postgraduate training programmes with regards to training requirements, defining competencies will improve the standard of care in rTMS delivery. Objective The goal of this study was to develop competencies for rTMS that can be implemented into a competency-based training curriculum in postgraduate training programmes. Methods A working group drafted competencies for postgraduate psychiatry trainees. Fourteen rTMS experts from across Canada were invited to participate in the modified Delphi process. Results Ten experts participated in all three rounds of the modified Delphi process. A total of 20 items reached a consensus. There was improvement in the Cronbach's alpha over the rounds of modified Delphi process (Cronbach's alpha increased from 0.554 to 0.824) suggesting improvement in internal consistency. The intraclass correlation coefficient (ICC) increased from 0.543 to 0.805 suggesting improved interrater agreement. Conclusions This modified Delphi process resulted in expert consensus on competencies to be acquired during postgraduate medical education programmes where a learner is training to become competent as a consultant and/or practitioner in rTMS treatment. This is a field that still requires development, and it is expected that as more evidence emerges the competencies will be further refined. These results will help the development of other curricula in interventional psychiatry.
Treatment with paraquat affects the expression of ferroptosis-related genes
Authors: Ge Xiaogang , Cai Qiqi , Zhang Sheng , Wu Xianlong , Ying Pan , Ke Jingjing , Yang Zhihui 
Published: March 2023

Objective We aimed to explore the mechanisms underlying paraquat (PQ)-induced damage using cell lines (NCTC1469, TC-1, TCMK-1) and bioinformatic analysis of the GSE153959 dataset. Assessment of changes in the expression of ferroptosis-related genes in cellular damage due to paraquat poisoning and the important value of these genes in the pathogenesis. Methods Data were retrieved from the Gene Expression Omnibus database. The differentially expressed genes (DEGs) related to ferroptosis were identified by Venn plots and analyzed for enrichment. Proteins encoded by these DEGs were studied for interactions. qRT-PCR and western blotting analyses of cultured cells were used to determine the expression of ferroptosis-related DEGs and their corresponding protein levels. Results We identified 25 DEGs primarily involved in epidermal growth factor receptor signaling, apoptotic signaling pathways, endoplasmic reticulum (ER) stress, and ferroptosis. From these, we uncovered eight ferroptosis-related DEGs, four of which were involved in ER response and regulators of ferroptosis— Chac1 (ChaC glutathione specific gamma-glutamylcyclotransferase 1), Atf3 (activating transcription factor 3), Tfrc (transferrin receptor), and Slc7a11 (solute carrier family 7 member 11). Significant changes in mRNA and protein levels of CHAC1, ATF3, TFRC, and SLC7A11 were confirmed in PQ-exposed cells. Conclusion ER stress and ferroptosis are critical for PQ-induced cell damage. CHAC1, ATF3, TFRC, and SLC7A11 are essential molecules implicated in PQ-induced ferroptosis that may serve as therapeutic targets for the amelioration of PQ poisoning.
Geographic Information Systems Utilization in Pediatric End-of-Life Research: A Scoping Review
Authors: Qualls Kerri A. , Svynarenko Radion , Cozad Melanie J. , Keim-Malpass Jessica , Huang Guoping , Lindley Lisa C. 
Published: March 2023

Currently, little is known about how geographic information systems (GIS) has been utilized to study end-of-life care in pediatric populations. The purpose of this review was to collect and examine the existing evidence on how GIS methods have been used in pediatric end-of-life research over the last 20 years. Scoping review method was used to summarize existing evidence and inform research methods and clinical practice was used. The Preferred Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA) was utilized. The search resulted in a final set of 17 articles. Most studies created maps for data visualization and used ArcGIS as the primary software for analysis. The scoping review revealed that GIS methodology has been limited to mapping, but that there is a significant opportunity to expand the use of this methodology for pediatric end-of-life care research.
Determinants Influencing Health-Promoting Behaviors in Individuals at High Risk of Stroke: A Cross-Sectional Study
Authors: Wei Xiao , Xu Mengfan , Yang Li , Gao Zihan , Kuang Jinke , Zhou Kexin 
Published: March 2023

Background Health-promoting behaviors and positive lifestyle changes are crucial for effective stroke prevention. However, individuals at high risk of stroke exhibit poor health behavior due to a deficiency of individual motivation. Moreover, there are only a few studies on health-promoting behaviors that have applied behavior change theories in individuals at high risk of stroke. Objective This study aimed to use the theory of the planned behavior (TPB) model to investigate determinants of health-promoting behaviors for stroke prevention and control. Method In this cross-sectional study, 263 participants were recruited from five community health centers in Qingdao. Confirmatory factor analysis was performed to assess the reliability and validity of the constructs, and structural equation modeling was used to analyze the proposed relationships between the TPB-related variables. Results The attitudes, subjective norms, and perceptions of behavioral control positively influenced behavioral intention. The behavioral intention had a positive effect on health-promoting behaviors. Attitudes, subjective norms, and perceived behavioral control were influenced primarily by the mediating variable behavioral intention to affect health-promoting behaviors. Stroke knowledge was an influential facilitator of behavioral attitudes, subjective norms, and perceived behavior control. Conclusion The TPB-based model is suitable for explaining health-promoting behaviors in individuals at risk of stroke and for guiding the development of effective health management programs. A comprehensive person-centered motivation behavior strategy that is based on health education and complemented by social support and health resource optimization is critical in promoting health behavior motivation and health promotion behaviors in stroke high-risk groups.
Characteristics of pediatric patients with multiple sclerosis and related disorders infected with SARS-CoV-2
Authors: Schreiner Teri , Wilson-Murphy Molly , Mendelt-Tillema Jan , Waltz Michael , Codden Rachel , Benson Leslie , Gorman Mark , Goyal Manu , Krupp Lauren , Lotze Tim , Mar Soe , Ness Jayne , Rensel Mary , Roalstad Shelly , Rodriguez Moses , Rose John , Shukla Nikita , Waubant Emmanuelle , Wheeler Yolanda , Casper T Charles , Chitnis Tanuja 
Published: March 2023

Background: Pediatric patients with multiple sclerosis (POMS) and related disorders, clinically isolated syndrome (CIS), myelin oligodendrocyte glycoprotein antibody disorder (MOGAD), and neuromyelitis optica spectrum disorder (NMOSD), are commonly treated with immunosuppressants. Understanding the impact of SARS-CoV-2 infection in patients may inform treatment decisions. Objective: Characterize SARS-CoV-2 infection prevalence and severity among a cohort of patients with POMS and related disorders, as well as the impact of disease-modifying therapies (DMTs). Methods: POMS and related disorders patients enrolled in a large, prospective registry were screened for COVID-19 during standard-of-care neurology visits. If confirmed positive of having infection, further analysis was undertaken. Results: Six hundred and sixty-nine patients were surveyed between March 2020 and August 2021. There were 73 confirmed COVID-19 infections. Eight of nine hospitalized patients (89%), and all patients admitted to the ICU were treated with B cell depleting therapy. The unadjusted odds ratio of hospitalization among those who tested positive of having had COVID-19 was 15.27 among those on B-cell-depleting therapy ( p = 0.016). Conclusions: B-cell-depleting treatment was associated with a higher risk of COVID-19, higher rates of hospitalization, and ICU admission, suggesting this therapy carries a higher risk of severe infection in POMS and related disorders.
Primary healthcare professionals’ role in monitoring infant growth: A scoping review
Authors: Rossiter Chris , Cheng Heilok , Denney-Wilson Elizabeth 
Published: March 2023

Excessive weight gain in infancy is an established risk for childhood obesity. Primary healthcare professionals have regular contact with infants and are well placed to monitor their growth. This review explores primary healthcare professionals’ practice in monitoring growth for infants from birth to 2 years, addressing assessment methods, practitioner confidence and interventions for unhealthy weight gain. Reviewers searched four databases for studies of primary healthcare professionals working in high-income countries that reported on practice monitoring infant growth. Thirty-six eligible studies documented health professionals’ practice with infants. While most clinicians regularly weighed and measured infants, some did not record measurements comprehensively. Growth monitoring occurred regularly during well-child visits but was less common during unscheduled visits. Some participants were less proficient at interpreting growth trajectories or lacked confidence in detecting excessive weight gain and in communicating concerns to parents. Few interventions addressed unhealthy growth among infants. Primary healthcare professionals require support to monitor growth trajectories effectively, to communicate appropriately with parents and to engage them in developing healthy behaviours early. Strategies are also required to monitor infants not regularly attending primary health care.
Lower levels of physical activity volume are beneficial, and it’s never too late to start: Results from the HUNT Study, Norway
Authors: Breidablik Hans Johan , Hufthammer Karl Ove , Rangul Vegar , Andersen Jon Roger , Meland Eivind , Hetlevik Øystein , Vie Tina Løkke 
Published: March 2023

Aims: We aimed to explore (a) how different patterns of physical activity (PA) over time (36 years) were associated with all-cause and cause-specific mortality, (b) if the association was similar for males and females and for different body mass levels and (c) how change in PA was associated with mortality for subjects who started out as physically inactive. Methods: The study is based on the prospective population-based cohort Trøndelag Health Study (HUNT) from 1984 to 2020, across four study waves. Data were linked to the Norwegian Cause of Death Registry. There were 123,005 participants, divided into three groups: persistently active, persistently inactive and mixed, with two cut-offs for PA: 60 and 150 minutes per week. The results are reported as cumulative incidence and hazard ratios (HRs). Results: At 60 minutes of PA per week, 8% of participants were persistently inactive, 15% were persistently active and 77% had a mixed pattern. At 150 minutes, the corresponding numbers were 32%, 2% and 65%. Compared to the persistently inactive group, for the 60-minute cut-off, the mixed group had an all-cause mortality HR of 0.83 (95% confidence interval (CI) 0.70–0.98), and the persistently active group had an HR of 0.51 (95% CI 0.40–0.65). For the 150-minute cut-off, the corresponding HRs were 0.84 (95% CI 0.75–0.94) and 0.48 (95% CI 0.26–0.88). The patterns were similar for males and females and across body mass index levels. Initially inactive participants had lower mortality if they ended up physically active, regardless of their activity level at an intermediate time point. Conclusions: At least 60 minutes of PA per week was associated with a marked reduction in mortality when this was a lasting habit over three decades. Given that six times as many people reach this less ambitious goal, it is vital to encourage all levels of PA in public health promotion. Any increase in PA during the lifespan is beneficial.
Comparison of the Efficacy and Safety of Ponatinib and Dasatinib in Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia With Central Nervous System Relapse: A Retrospective Study
Authors: Zhu Yuanxin , Zhu Ying , Miao Lei , Jia Tao , Mao Jianping , Xue Lianguo , Wang Ying 
Published: March 2023

Introduction Central nervous system leukemia (CNSL) is the most common extramedullary relapse site in patients with Philadelphia chromosome-positive (Ph-positive) acute lymphoblastic leukemia (ALL), with a poor prognosis and high relapse rate. Methods We characterized the clinical data of 21 Ph-positive B-ALL patients to analyze the efficacy and safety of ponatinib for patients with central nervous system relapsed Ph-positive ALL retrospectively. Results There were 11 males and 10 females in the cohort, and their median age was 45 (9-58) years old. The total CR (complete remission) rate was 90.5%. All 9 patients achieved CR in the ponatinib group, and 10 patients achieved CR in the dasatinib group (100% vs 83.3%, respectively; P = .486) and minimal residual disease-positive CR in the ponatinib group and dasatinib group (88.9% vs 58.3%, P = .178). The medium time after achieving CR was 5 and 8 weeks ( P = .047). The total median overall survival (OS) was 31.1 months, and the 3-year OS was 49.0%. The median relapse-free survival (RFS) was 31.0 months, and the 3-year RFS was 45.2%. Patients in the ponatinib group showed a significantly longer OS than those patients in the dasatinib group with (medium OS not reached vs 27.6 months, P = .045) or without (medium OS not reached vs 27.6 months, P = .039) T315I mutations. The median RFS between the ponatinib group and the dasatinib group with T315I was not reached and 16.2 months, P = .065. The median RFS between the ponatinib group and the dasatinib group without T315I was not reached and 16.2 months, P = .036. No treatment-related deaths were observed during the therapy. Conclusion (1) Ph-positive CNSL patients seemed to have a high rate of response and postinduction MRD negativity with ponatinib and dasatinib, but ponatinib seemed to show a shorter time to achieve remission than dasatinib. (2) Ponatinib maintenance treatment might show superior survival for Ph-positive CNSL patients with or without the T315I mutation. (3) Ponatinib and dasatinib seemed to be both safe for the clinical application of Ph-positive CNSL.
Unstable Middle Phalanx Base Fractures Treated With an Internal Joint Stabilizer: Preliminary Results
Authors: Klein David M. , Teytelbaum David E. , Patel Jay S. , Combs Taylor E. , Heifner John J. , Orbay Jorge L. 
Published: March 2023

Background: Unstable fractures of the base of the middle phalanx are notorious for causing chronic loss of proximal interphalangeal (PIP) joint function, and they remain a challenge for the hand surgeon. We report on a temporary intraoperatively constructed internal joint stabilizer for unstable PIP joint injuries. Methods: Across 2 institutions, a retrospective chart review was performed for cases with acute presentation of pilon fracture or fracture-dislocation of the base of the middle phalanx which were surgically treated with an internal joint stabilizer. Information collected included time from injury to surgical intervention, time from implantation to device removal, complications, and preoperative and postoperative range of motion. Results: Seven patients met the inclusion criteria with a mean age of 51 (range: 24-72) years and a mean follow-up of 29 (range: 11-72) months. After removal of the fixator, the mean arc of PIP joint motion was 8° to 88° (range: 0°-100°). There were no infections, no hardware loosening or failures, and no revision procedures. Conclusion: The current findings are comparable to the results for dynamic external fixators. An internal joint stabilizer for unstable injuries to the base of the middle phalanx provides satisfactory functional outcomes, allows early postoperative motion, and mitigates the routine complications which may arise with external fixation.
The suprascapular nerve block (SScNB) is easily administered using a landmark-based technique: A cadaveric study to assess nerve staining post-injection
Authors: Brennan C , Slevin Z , Savaridas T 
Published: March 2023

Aims The suprascapular nerve is an ideal target for nerve blockade to alleviate shoulder pain given its widespread innervation to the shoulder girdle. To widen availability of this treatment, we investigate whether an anatomical landmark technique can be adopted by novice injectors to provide efficacious blockade. Methods Five injectors were recruited with varying experience. 10 shoulders of Thiel embalmed cadavers were injected with blue dye. Written instructions and an illustration of the Dangoisse landmark technique were provided prior to injection. Cadavers were dissected and the presence or absence of dye staining reported by three observers and a consensus agreement reached. Results Dissection demonstrated diffuse staining in the suprascapular fossa. 90% of shoulders had adequate staining of the suprascapular nerve directly, or distal branches, which would provide adequate anaesthesia. Inter-observer agreement was good (k = 0.73) for staining at the supraspinous fossa and excellent (k = 0.87) for staining distally. The technique was performed by novice injectors with a good success rate. Conclusion This technique is reproducible by a range of clinicians to effectively provide anaesthesia of the SScN. Within a resource strained healthcare environment greater uptake of this technique is likely to be of benefit to a wider group of patients.
Family Physician Prescribing Practices and Perspectives on Shared Decision-Making Regarding the Use of Oral Anticoagulants for Stroke Prevention in Patients 75 Years or Older With Atrial Fibrillation
Authors: Ali Jahaan , Abbasi-Dezfouly Reza , Khera Sheny , Kivi Paul , Tian Peter George Jaminal 
Published: March 2023

Introduction: Atrial Fibrillation (AF) is common in older adults, yet guideline-recommended oral anti-coagulants (OACs) for stroke prevention are underused in this population. With a growing population of older adults at risk of AF seeking primary care, the objective of the study was to determine the management practices and perspectives of family physicians on the initiation of OACs for stroke prevention in AF patients 75 years or older, including their engagement of patients in shared decision-making. Methods: This was an online survey of family physicians affiliated with a Primary Care Network in Alberta, Canada. Results: Patient’s risk (of falls, bleeding, or stroke) was the most common factor (17/20, 85%) physicians considered when deciding to initiate OAC in older adult patients with AF. Physicians used the CHADS2VASC (13/14, 93%) and HASBLED (11/15, 73%) tools to determine stroke and bleeding risks, respectively. Majority (11/15, 73%) of the physicians agreed that they feel confident initiating OAC for AF patients ≥75, while 20% (3/15) were neutral. All physicians agreed that their patients participated in shared decision-making to initiate OAC for stroke prevention. Conclusion: Family physicians strongly consider patient risks and utilize risk-assessment tools when initiating OAC in older adults with AF. Despite all physicians reporting the use of shared decision-making and that their patients were educated on the indications for OAC, confidence in initiating treatment was variable. Further exploration into factors impacting physician confidence is needed.
Improved access to HCT with reduced racial disparities through integration with leukemia care and haploidentical donors
Authors: Bashey Asad , Zhang Xu , Morris Lawrence E. , Holland H. K. , Bachier-Rodriguez Lizamarie , Solomon Scott R. , Solh Melhem 
Published: March 2023

Abstract
Few patients with nonfavorable risk (NFR) acute leukemia and myeloid dysplasia syndrome (AL/MDS) undergo allogeneic transplantation (HCT). We assessed whether this could be improved by integrating HCT/leukemia care and the use of haploidentical donors. Of 256 consecutive patients aged &lt;75 years who received initial therapy at our center for NFR AL/MDS from 2016 to 2021, 147 (57%) underwent planned HCT (70% for patients aged &lt;60 years). In the logistic regression analysis, age (OR 1.50 per 10-year increment; P &lt; .001) and race (Black vs White [OR 2.05; P = .023]) were significant factors for failure to receive HCT. Reasons for no HCT included comorbidities (37%), poor KPS, lack of caregiver support, refractory malignancy (19% each), and patient refusal (17%). Lack of donor or insurance were rarely cited (3% each). In older patients (≥60 years), comorbidities (49 vs 15%; P &lt; .001) and KPS (25% vs 10%; P = .06) were more common, and lack of caregivers was less common (13% vs 30%; P = .031). In Black vs White patients, lack of caregivers (37% vs 11%; P = .002) was more frequent. The median time from initial treatment to HCT was 118 days and was similar for Black and White patients. Landmark analysis showed that HCT within 6 months of the initial treatment produced better survival. Multivariable analysis showed that HCT resulted in a significant survival benefit (HR 0.60; P = .020). With the above approach, most of the currently treated patients aged &lt;75 years can access planned HCT. Black patients remain at greater risk of not receiving HCT.