bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgery of Schwannoma in the upper limb – sensitivity and specificity of preoperative magnetic resonance imaging and relation between tumour size and symptoms
Authors: Istefan Emanuel , Belstock Johannes , Dahlin Lars B. , Nyman Erika 
Published: September 2023

Abstract
Background
Benign peripheral nerve tumours consist of different types, most commonly Schwannomas. Preoperative Magnetic Resonance Imaging (MRI) is commonly performed before surgery and Pathoanatomical Diagnosis (PAD) confirms the diagnosis. Our aims were to study the utility of MRI and the relation between tumour size and symptoms.

Methods
Retrospectively, patients, surgically treated for benign nerve tumours between 2008 and 2019, were identified and preoperative MRI, with measurement of tumour size, PAD, symptoms, peroperative details, and symptomatic outcomes of surgery, were analysed.

Results
The sensitivity and specificity to correctly identify Schwannomas with preoperative MRI were 85% and 50%, respectively, based on 30 Schwannomas and nine neurofibromas that were identified. Tumour size did not affect the presence of preoperative symptoms, but patients with sensory dysfunction at last follow-up had larger Schwannomas (p < 0.05). Symptoms as a palpable tumour, paraesthesia and pain improved by surgical excision (p < 0.001, p < 0.001 and p < 0.012, respectively), but sensory and motor dysfunction were common postoperatively. No malignant peripheral nerve sheath tumours (MPNST) were found. Using a surgical microscope, instead of only loop magnification, lowered the risk of perioperative nerve injuries (p < 0.05), but did not further diminish postoperative symptoms.

Conclusions
Early and accurate diagnosis of Schwannomas is valuable for adequate presurgical preparation and prompt surgical intervention. Preoperative examination with MRI has a high sensitivity, but low specificity; although recent advancement in MRI technology indicates improvement in diagnostic precision. Surgical excision is preferably performed early in conjunction with symptomatic debut to improve outcome.
Spatio-temporal trends of the age-at-menarche percentiles among Portuguese women since 1920
Authors: Rodrigues Vitor , Martins Rui , de Sousa Bruno 
Published: September 2023

Abstract
Background
This work aims to study the spatio-temporal evolution of a woman’s age at menarche in the central region of Portugal. One of the concerns of the study is early or late menarches; thus, we consider percentile regression to build the respective curves as opposed to the more traditional mean regression approach.

Methods
We analysed the data from $$N=452\,348$$

N
=
452

348

women born in the period 1920–1973 who attended a free breast cancer screening program between 1990 and 2019. Distributional regression models inside the package GAMLSS in R were considered. These methods allowed us not only to model the location (mean) of the specific probability distribution of the age at menarche, but also allowed for the scale (variance) parameter of this distribution to depend on covariates. Additionally, a spatial random-effect was considered in order to capture the correlation at the regional level. The obtained clustered spatial effects were analysed to assess geographical differences among the percentiles of the age at menarche by year of birth.

Results
A decreasing trend in the age at menarche (about 1.5 years in 5 decades) and regional differences for all the considered percentiles were found. Women living in the north-central areas of the central region of Portugal tend to have menarche at older ages.

Conclusion
We obtained percentile estimates for the age at menarche by year of birth and region of residence and demonstrated that these two explanatory variables have an impact on the explanation about the decreasing trend in age at a woman’s first menstruation.
Evaluating the impact of continuing professional development courses on physician behavioral intention: a pre-post study with follow-up at six months
Authors: Bakwa Kanyinga Felly , Gogovor Amédé , Dofara Suélène Georgina , Gadio Souleymane , Tremblay Martin , Daniel Sam J. , Rivest Louis-Paul , Légaré France 
Published: September 2023

AbstractBackgroundContinuing professional development (CPD) for health professionals includes educational activities to maintain or improve skills. We evaluated the impact of a series of CPD courses by identifying factors influencing physicians’ intention to adopt targeted behaviors and assessing self-reported behavior adoption six months later.MethodsIn this pre-post study, eligible participants attended at least one in-person course at the Fédération des Médecins Spécialistes du Québec annual meeting in November 2019. Before and afterwards, participants completed CPD-REACTION, a validated questionnaire based on Godin’s integrated model for health professional behavior change that measures intention and psychosocial factors influencing intention. We used Wilcoxon signed-rank test to compare pre- and post-course intention scores and linear regression analyses to identify factors influencing intention. We also compared the post-course intention scores of participants reporting a behavior change six months later with the scores of those reporting no behavior change six months later. Qualitative data was collected only six months after courses and responses to open-ended questions were analyzed using the Theoretical Domains Framework.ResultsA total of 205/329 course attendees completed CPD-REACTION (response rate 62.3%). Among these participants, 158/329 (48%) completed the questionnaire before CPD courses, 129/329 (39.2%) only after courses and 47/329 (14.3%) at 6 months. Study population included 192 physicians of whom 78/192(40.6%) were female; 59/192(30.7%) were between 50 and 59 years old; and 72/192 (37.5%) were surgical specialist physicians. Mean intention scores before (n = 158) and after (n = 129) courses were 5.74(SD = 1.52) and 6.35(SD = 0.93) respectively. Differences in mean (DM) intention before and afterwards ranged from − 0.31(p = 0.17) to 2.25(p = 0.50). Multivariate analysis showed that beliefs about capabilities (β = 0.15, p = 0.001), moral norm (β = 0.75, p < 0.0001), and beliefs about consequences (β = 0.11, p = 0.04) influenced post-course intention. Post-course intention was correlated with behavior six months later (DM = 0.63; p = 0.02). Qualitative analysis showed that facilitators to behavior adoption after six months were most often related to the TDF domains of beliefs about capabilities. Most frequent barriers to adoption related to lack of resources.ConclusionsOverall, scores for intention to adopt targeted behaviors increased after the courses. CPD providers could increase participants’ intention by including interventions that emphasize beliefs about capabilities, moral norm and beliefs about consequences.
Tendencies towards emigration and their association with introversion and ethnocentrism among final-year medical students from Osijek, Croatia: a cross-sectional study
Authors: Milić Jakov , Vuksan-Ćusa Zrinka , Jakab Jelena , Ćurčić Maja , Puljak Livia , Vranješ Iva Milić , Miškulin Maja 
Published: September 2023

Abstract
Background
The migration of healthcare workers is attracting growing attention worldwide. Attitudes towards emigration develop over the years, and it is possible that, in addition to social factors, they are influenced by the characteristics of a person’s personality and the sense of belonging to the social environment. This study aimed to determine the tendencies of final-year medical students’ from Osijek, Croatia, towards emigration after graduation and after specialization, as well as their specialty preferences and to investigate whether introversion and ethnocentrism have an impact on attitudes toward leaving the country in search of employment elsewhere.

Methods
A cross-sectional study was conducted among final-year (6th year) medical students from Osijek, Croatia, in two consecutive academic years – 2014/2015 and 2015/2016. Students completed a questionnaire about sociodemographic characteristics, academic and scientific performance, preferences about their future medical career, the medical specialty of choice, emigration tendencies after graduation and specialization, ethnocentrism and introversion.

Results
There were 124 students who participated in the study (response rate: 96%). A quarter of participants agreed that they are likely or very likely to emigrate after graduation (25.0%) or after specialization (23.39%). Variables associated with the intention to emigrate were specialty preferences (students that prefer endocrinology and psychiatry had the highest emigration tendencies), academic year in which the participants were included (students included in 2014/2015 were more prone to emigrate after specialization, p = 0.060), prior involvement in scientific projects (students with experience in scientific projects expressed higher tendencies to emigrate after graduation, p = 0.023), and ethnocentrism (higher ethnocentrism was associated with a lower tendency towards emigration after specialization, Spearman’s rho = -0.191).

Conclusion
Our finding that a quarter of final-year medical students from the Faculty of Medicine Osijek were considering emigrating from Croatia in search of employment elsewhere after graduation or specialization is not as high as in previous Croatian studies or studies conducted in other European countries. Even though these data may be encouraging, considering the lack of physicians in Croatia, interventions are needed to prevent permanent emigration to protect the future functioning of the Croatian health system. Furthermore, our study did not find significant associations between levels of introversion and ethnocentrism and tendency to emigrate from Croatia. It seems that the phenomenon covering the emigration of students is more complex and influenced by many other factors which were not included in our study.
Physician assistant education program director attrition and consideration to leave
Authors: Sasek Cody A. , Kilstrom Jonathan L. , Opar Sebastian , Simons Zachary 
Published: September 2023

Abstract
Background
This study explores factors related to physician assistant (PA) education program directors’ (PD) consideration to leave their leadership role. This is important to better understand, with the need for additional PA education PDs as the number of PA programs grows in addition to current PA program leaders considering leaving their PD role.

Methods
Data from the 2019 Physician Assistant Education Association (PAEA) Faculty and Directors Survey were used to analyze factors related to consideration for leaving the PD position. Multiple logistic regression analyses were utilized to identify predictors of PD consideration for leaving their position. Multiple regression analyses were also used to explore factors related to burnout.

Results
The study found burnout was a modest predictor for consideration of leaving the PD position, while underrepresented minority status was not. Additional job stress, job satisfaction, and job experience variables were found to have a modest relationship with consideration of leaving, with odds ratios between 0.28 (lack of faculty respecting each other) and 5.29 (stress from lack of personal time) for those with statistically significant relationships.

Conclusions
PD consideration of leaving is a complex phenomenon with many variables and confounding factors likely at play, including, as demonstrated by this study, level of burnout. Study implications include a further understanding of how effective strategies might be designed and implemented to address the drivers of PA PD attrition. Further exploration of burnout as a possible mediating variable as well as more specific data collection directed at better understanding predictors of PD attrition would be valuable future research directions.
Study protocol for improving mental health during pregnancy: a randomized controlled low-intensity m-health intervention by midwives at primary care centers
Authors: Jimenez-Barragan Marta , del Pino Gutierrez Amparo , Garcia Jorge Curto , Monistrol-Ruano Olga , Coll-Navarro Engracia , Porta-Roda Oriol , Falguera-Puig Gemma 
Published: September 2023

Abstract
Background
Pregnancy-related anxiety and depression has received considerable attention worldwide. Mental health problems in pregnant women already since early weeks of gestation may have important consequences to the fetus. The necessity for more effective health care pathways, including some early interventions that reduce the overall burden of the childbearing situation appears a key factor for a successful birth and care of the baby. The few studies focalized in interventions, are focused on delivery and postpartum, without taking into account the whole maternity process. Current literature recommends the use of interventions based on new technologies for the treatment of mood disorders, already during the prenatal period. There have been scarce well-designed intervention studies that test technological low-intensity interventions by midwives to address pregnant women’s mental health, diminishing anxiety and depression during pregnancy.

Methods/design
Adult pregnant women (weeks 12–14 of gestation) will be recruited and screened from different primary care centers in Catalonia, Spain. Women who pass the initial mental screening will be randomly allocated to the relaxation virtual reality intervention or control group. The intervention aims to improve mental state of pregnant women during pregnancy, work through breathing, mindfulness and muscle relaxation techniques. Women in the control group will receive standard care offered by the public funded maternity services in Catalonia. The primary outcome measures will include the Edinburg Postnatal Depression (EPDS), State Trait Anxiety Inventory (STAI), Symptom Checklist-90 (SCL-90), and the Cambridge Worry Scale (CWS) instruments. Secondary outcome measures will include the Temperament and Character Inventory-Revised (TCI-R) and the Whooley and Generalized Anxiety Disorder-2 (GAD-2) questions. Routinary pregnancy monitoring measures will be also evaluated.

Discussion
This study aims to test the efficacy of a low-intensity, midwife-led e-health intervention based on new technologies to work on women’s anxiety and depression during pregnancy. We hypothesize that low-intensity mental health intervention during pregnancy, using an e-health (virtual reality) as a support tool, will be effective in reducing of anxiety, depressive symptoms, and improving satisfaction with pregnancy follow-up.

Trial registration
Clinical Trials ID NCT05756205.
Better caregiver mastery is associated with less anxiety in individuals with cognitive impairment
Authors: Hwang Yeji , McPhillips Miranda V. , Huang Liming , Perez G. Adriana , Hodgson Nancy A. 
Published: September 2023

AbstractBackgroundWhen caregivers have a high level of caregiver mastery, their care recipients with cognitive impairment have less behavioral health problems. However, the relationship between caregiver mastery and anxiety among care recipients over time is unknown. Therefore, this study was conducted to examine that better caregiver mastery is associated with less anxiety in individuals with cognitive impairment over time.MethodsA secondary data analysis was conducted using the Healthy Patterns Clinical Trial (NCT03682185) dataset and guided by Factors Associated with Behavioral and Psychological Symptoms of Dementia conceptual framework. This study included 154 dyads of individuals with cognitive impairment and their caregivers. Multiple linear regression analyses were performed on changes in anxiety. Model 1 included variables at the level of neurodegeneration (i.e., cognitive impairment and age). Model 2 added patient factors (i.e., sleep problems and depression) with the Model 1. Finally, Model 3 included caregiver factor (i.e., caregiver mastery) with the Model 2 to examine how changes in caregiver mastery influence changes in anxiety of care recipients.ResultsModel 3 was statistically significant; after controlling for variables at the level of neurodegeneration associated with cognitive impairment and patient factors, improvement of caregiver mastery over time (β =-0.230, p = 0.015) was related to decreased anxiety over time (R2 = 0.1099).ConclusionsCaregivers with high caregiver mastery may have better knowledge on how to care for their loved ones and how to manage their neuropsychiatric symptoms. Therefore, improving the level of caregiver mastery by providing psychoeducational programs and resources that family caregivers need will help reduce the frequency of anxiety in individuals with cognitive impairment.
Protein intrinsically disordered region prediction by combining neural architecture search and multi-objective genetic algorithm
Authors: Tang Yi-Jun , Yan Ke , Zhang Xingyi , Tian Ye , Liu Bin 
Published: September 2023

Abstract
Background
Intrinsically disordered regions (IDRs) are widely distributed in proteins and related to many important biological functions. Accurately identifying IDRs is of great significance for protein structure and function analysis. Because the long disordered regions (LDRs) and short disordered regions (SDRs) share different characteristics, the existing predictors fail to achieve better and more stable performance on datasets with different ratios between LDRs and SDRs. There are two main reasons. First, the existing predictors construct network structures based on their own experiences such as convolutional neural network (CNN) which is used to extract the feature of neighboring residues in protein, and long short-term memory (LSTM) is used to extract the long-distance dependencies feature of protein residues. But these networks cannot capture the hidden feature associated with the length-dependent between residues. Second, many algorithms based on deep learning have been proposed but the complementarity of the existing predictors is not fully explored and used.

Results
In this study, the neural architecture search (NAS) algorithm was employed to automatically construct the network structures so as to capture the hidden features in protein sequences. In order to stably predict both the LDRs and SDRs, the model constructed by NAS was combined with length-dependent models for capturing the unique features of SDRs or LDRs and general models for capturing the common features between LDRs and SDRs. A new predictor called IDP-Fusion was proposed.

Conclusions
Experimental results showed that IDP-Fusion can achieve more stable performance than the other existing predictors on independent test sets with different ratios between SDRs and LDRs.
Prenatal ambient air pollution exposure and child weight trajectories from the 3rd trimester of pregnancy to 2 years of age: a cohort study
Authors: Ji Nan , Johnson Mark , Eckel Sandrah P. , Gauderman William J. , Chavez Thomas A. , Berhane Kiros , Faham Dema , Lurmann Fred , Pavlovic Nathan R. , Grubbs Brendan H. , Lerner Deborah , Habre Rima , Farzan Shohreh F. , Bastain Theresa M. , Breton Carrie V. 
Published: September 2023

Abstract
Background
Prenatal air pollution exposure may increase risk for childhood obesity. However, few studies have evaluated in utero growth measures and infant weight trajectories. This study will evaluate the associations of prenatal exposure to ambient air pollutants with weight trajectories from the 3rd trimester through age 2 years.

Methods
We studied 490 pregnant women who were recruited from the Maternal and Development Risks from Environmental and Social Stressors (MADRES) cohort, which comprises a low-income, primarily Hispanic population in Los Angeles, California. Nitrogen dioxide (NO2), particulate matter < 10 µm (PM10), particulate matter < 2.5 µm (PM2.5), and ozone (O3) concentrations during pregnancy were estimated from regulatory air monitoring stations. Fetal weight was estimated from maternal ultrasound records. Infant/child weight measurements were extracted from medical records or measured during follow-up visits. Piecewise spline models were used to assess the effect of air pollutants on weight, overall growth, and growth during each period.

Results
The mean (SD) prenatal exposure concentrations for NO2, PM2.5, PM10, and O3 were 16.4 (2.9) ppb, 12.0 (1.1) μg/m3, 28.5 (4.7) μg/m3, and 26.2 (2.9) ppb, respectively. Comparing an increase in prenatal average air pollutants from the 10th to the 90th percentile, the growth rate from the 3rd trimester to age 3 months was significantly increased (1.55% [95%CI 1.20%, 1.99%] for PM2.5 and 1.64% [95%CI 1.27%, 2.13%] for NO2), the growth rate from age 6 months to age 2 years was significantly decreased (0.90% [95%CI 0.82%, 1.00%] for NO2), and the attained weight at age 2 years was significantly lower (− 7.50% [95% CI − 13.57%, − 1.02%] for PM10 and − 7.00% [95% CI − 11.86%, − 1.88%] for NO2).

Conclusions
Prenatal ambient air pollution was associated with variable changes in growth rate and attained weight from the 3rd trimester to age 2 years. These results suggest continued public health benefits of reducing ambient air pollution levels, particularly in marginalized populations.
Implication of diabetic status on platelet reactivity and clinical outcomes after drug-eluting stent implantation: results from the PTRG-DES consortium
Authors: Jeon Ki-Hyun , Jeong Young-Hoon , Chae In-Ho , Kim Byeong-Keuk , Joo Hyung Joon , Chang Kiyuk , Park Yongwhi , Song Young Bin , Ahn Sung Gyun , Lee Sang Yeub , Cho Jung Rae , Her Ae-Young , Kim Hyo-Soo , Kim Moo Hyun , Lim Do-Sun , Shin Eun-Seok , Suh Jung-Won ,   On Behalf of the PTRG-DES Consortium Investigators
Published: September 2023

Abstract
Background
Diabetes mellitus (DM) is associated with thrombogenicity, clinically manifested with atherothrombotic events after percutaneous cutaneous intervention (PCI). This study aimed to investigate association between DM status and platelet reactivity, and their prognostic implication in PCI-treated patients.

Methods
The Platelet function and genoType-Related long-term Prognosis-Platelet Function Test (PTRG-PFT) cohort was established to determine the linkage of platelet function test (PFT) with long-term prognosis during dual antiplatelet therapy including clopidogrel in patients treated with drug-eluting stent (DES). We assessed platelet reactivity using VerifyNow and ‘high platelet reactivity (HPR)’ was defined as ≥ 252 P2Y12 reaction unit (PRU). Major adverse cardiac and cerebrovascular event (MACCE) was a composite of all-cause death, myocardial infarction, stent thrombosis or stroke.

Results
Between July 2003 and Aug 2018, DES-treated patients with available PFT were enrolled (n = 11,714). Diabetic patients demonstrated significant higher levels of platelet reactivity (DM vs. non-DM: 225.7 ± 77.5 vs. 213.6 ± 79.1 PRU, P < 0.001) and greater prevalence of HPR compared to non-diabetic patients (38.1% vs. 32.0%, P < 0.001). PRU level and prevalence of HPR were significantly associated with insulin requirement and HbA1c level, as well as diabetic status. DM status and HPR phenotype had a similar prognostic implication, which showed the synergistic clinical impact on MACCE. Association between PRU level and MACCE occurrence seemed higher in diabetic vs. non-diabetic patients. In non-DM patients, HPR phenotype did not significantly increase the risk of MACCE (adjusted hazard ratio [HRadj]: 1.073; 95% confidence interval [CI]: 0.869–1.325; P = 0.511), whereas HPR was an independent determinant for MACCE occurrence among diabetic patients (HRadj: 1.507; 95% CI: 1.193–1.902; P < 0.001).

Conclusion
The levels of on-clopidogrel platelet reactivity are determined by diabetic status and the severity of DM. In addition, HPR phenotype significantly increases the risk of MACCE only in diabetic patients.

Clinical trial registration
URL: https://www.clinicaltrials.gov. Unique identifier: NCT04734028.