bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mobile health clinics in a rural setting: a cost analysis and time motion study of La Clínica in Oregon, United States
Authors: Higgins Abigail , Tilghman Middy , Lin Tracy Kuo 
Published: January 2025

Abstract

Background
Mobile Health Clinics (MHCs) are an alternate form of healthcare delivery that may ameliorate current rural–urban health disparities in chronic diseases and have downstream impacts on the health system by reducing costs. Evaluations of providers’ time allocation on MHCs are scarce, hindering knowledge transfer related to MHC implementation strategies.

Methods
Retrospective economic cost was assessed using business ledgers and expert assessments in 2023 US Dollar (USD) from 2022 to 2023. Time motion observational study assessed nurse practitioner (NP) and community health worker (CHW) time allocation and compared them between patients residing in isolated rural areas (hereafter isolated rural patients) and patients experiencing houselessness (PEH) sub-populations. Procedure codes were assessed retrospectively for each patient encounter (n = 1,981) over one year (April 2022 to April 2023). We used statistical significance tests (chi-square and Fisher’s Exact) to evaluate difference across sub-populations.

Results
Intervention start-up and operational costs totaled 275,000USD and 308,000USD, respectively, with the largest allocations to the modified recreational vehicle (RV) unit and labor. NP attributed 32% of time on direct care (mean = 153.00 min (SD = 37.80 min)), 38% on indirect care (186.0 (53.40)), and 21% on MHC tasks (104.00 (23.94)). CHW spent 47% of time on MHC tasks (182.00 (29.46)), 22% on medical care tasks (85.01 (SD 81.97)), and 22% on social needs tasks (87.70 (86.71 min)). NP time allocation did not differ significantly between isolated rural patients and PEH (p > 0.01), but CHW time did (p < 0.01). Of all procedures, 31.3% were vaccinations (N = 438), 27.0% were Covid-19 related (N = 377), 12.8% were outside referrals (N = 179), and 11.8% were point of care testing. Healthcare utilization varied between patient sub-populations, with Isolated Rural patient use dominated by Covid-19 and Influenza vaccines whereas PEH use was dominated by point of care testing (p < 0.01).

Conclusion
Patient sub-populations require varying provider time in different tasks and variable economic resources for interventions. As local policy makers balance resources and community health needs, a complete understanding of the resources required to operate an MHC and use of provider time is essential for informed decision making and successful implementation in underserved communities.
Knowledge, attitudes, and beliefs regarding acute coronary syndrome in patients with type 2 diabetes: a cross-sectional study
Authors: Amerzadeh Mohammad , Bahrami Mahdie , Senmar Mojtaba , Hosseinkhani Zahra , Shafiei Kisomi Zahra 
Published: January 2025

Abstract

Introduction
Cardiovascular diseases are one of the leading causes of mortality and disability among individuals with diabetes. Cardiac mortality in these patients is often associated with the prevalence of silent ischemia. Increasing awareness and changing patient behaviors and attitudes can reduce disease-related mortality. Therefore, this study aimed to determine the knowledge, attitudes, and beliefs regarding acute coronary syndrome in patients with type 2 diabetes mellitus (T2DM).

Methods
This cross-sectional study was conducted on 303 diabetic patients attending the Velayat and Bou Ali hospitals in Qazvin, Iran, in 2024. Inclusion criteria included a willingness to participate in the study, mental health status (based on existing records), and no history of myocardial infarction (MI). Data collection tools comprised a demographic questionnaire and the ACS Response questionnaire. Data analysis was performed using descriptive and analytical statistics, with a significance level of <0.05 for all tests.

Results
The mean (standard deviation) scores for knowledge, attitudes, and performance of patients with T2DM were 67.46 (6.3), 62.11 (28.2), and 97.22 (5.4), respectively. In the knowledge section, the highest percentage of correct responses was related to awareness of facilities in the hospital to reduce heart attack-related damages (62.3%) and familiarity with the symptoms of arm or hand numbness (43.41%). Patients had a low attitude towards heart disease, with approximately 36.4% being somewhat or completely confident in their ability to assist others with a heart attack. Regarding performance, 45.7% of individuals believed that they should promptly go to the hospital during a heart attack. Additionally, 44.2% preferred others to transport them to the hospital during a heart attack instead of using an ambulance.

Conclusion
Our findings indicate that patients with T2DM lack sufficient knowledge, attitudes, and beliefs regarding the symptoms of acute coronary syndrome (ACS). Although ACS manifests through various symptoms, patients in this study primarily identified chest pain, arm pain, and shortness of breath as indicators of ACS. At the same time, over half of the participants were unaware of other symptoms. Therefore, it is essential to educate individuals about the full range of potential ACS symptoms.
The perception of fairness in the division of labor around first childbirth in Germany
Authors: Hornung Maria , Comolli Chiara Ludovica 
Published: January 2025

Abstract
The transition to parenthood is a pivotal life course event that impacts well-being, relationship quality and the distribution of housework and paid work. In Germany, during the transition to first-time parenthood, women often reduce their involvement in paid work and take on a larger share of housework, leading to a more gendered division of labor. This shift could influence perceptions of fairness in the division of labor inducing both men and women to perceive the division as being more fair to themselves or more fair to their partner. Using data from the German Panel Analysis of Intimate Relationships and Family Dynamics (pairfam) and fixed effects models, we examine how women’s and men’s perception of fairness of the division of labor varies around first childbirth conceptualizing different phases spanning from 5 years before until 5 years after the first childbirth. Relative to baseline, mothers (-to-be) reported a fairer division of labor (less under-benefitting) from around conception to right after childbirth. Yet, already from 6 months after childbirth mothers’ perception of fairness becomes less fair to them again and the perception of under-benefitting continues as the child ages. For fathers-to-be, perceptions of fairness did not vary substantially around childbirth. We further found that neither the change in the division of housework, nor in the division of paid work, explained changes in fairness perceptions during the transition to parenthood.
Broadband negative refraction based on a pair of anti-parity-time structures
Authors: Fei Zhonghan , Gong Menyang , Shi Fan , Liu Xiaozhou 
Published: January 2025

Abstract
An anti-parity-time (A-PT) symmetric system, of which the refractive index satisfies

, can present intriguing scattering properties like continuous coherent perfect absorption (CPA) spectrum and laser spectrum, which are symmetric to each other in the parameter space. In this work, an acoustic parity-time (PT) symmetric system consisting of two A-PT symmetric structures is introduced to realize a broadband negative refraction. When the two A-PT symmetric structures are at their CPA mode and laser mode, respectively, the PT symmetric system can display its unidirectional negative refraction property. As the two A-PT structures we design here have a broadband CPA and laser modes, the PT symmetric negative refraction system will be broadband. Besides, the exceptional point (EP) of the proposed PT symmetric system corresponds to the CPA point and laser point of its two components, and it is unidirectionally transparent on broadband as well.
Decreasing miR-433-3p Activity in the Osteoblast Lineage Blunts Glucocorticoid-mediated Bone Loss
Authors: Thakore Prachi , Karki Sangita , Hrdlicka Henry C , Garcia-Munoz John , Pereira Renata C , Delany Anne M 
Published: January 2025

Abstract
Glucocorticoid excess causes bone loss due to decreased bone formation and increased bone resorption; miR-433-3p is a microRNA (miRNA) that negatively regulates bone formation in male mice by targeting Runx2 as well as RNAs involved in Wnt, protein kinase A, and endogenous glucocorticoid signaling. To examine the impact of miR-433-3p on glucocorticoid-mediated bone loss, transgenic mice expressing a miR-433-3p tough decoy inhibitor in the osteoblast lineage were administered prednisolone via slow-release pellets. Bone loss was greater in control mice treated with prednisolone compared with miR-433-3p tough decoy mice due to higher osteoclast activity in the controls. In whole femurs, Rankl was significantly higher in prednisolone-treated controls compared with miR-433-3p tough decoy mice. Surprisingly, negative regulators of Wnt signaling Sost and Dkk1 were higher in miR-433-3p tough decoy mice and were unaffected by prednisolone. Luciferase- 3′-untranslated region reporter assays demonstrated that Sost is a novel miR-433-3p target, whereas Dkk1 is a previously validated miR-433-3p target. miR-433-3p levels are lower in matrix-synthesizing osteoblasts than in more osteocytic cells; thus the impact of miR-433-3p on the osteoblast lineage may be dependent on cell context: it is a negative regulator in matrix-depositing osteoblasts by targeting RNAs important for differentiation and function but a positive regulator in osteocytes, due to its ability to target prominently expressed negative regulators of Wnt signaling, Sost and Dkk1. The mechanisms by which miR-433-3p indirectly regulates glucocorticoid-mediated osteoclastogenesis remain unknown. However, we speculate that this regulation may be mediated by miR-433-3p activity in osteocytes, which play an important role in controlling osteoclastogenesis.
A New Leydig Cell–Exclusive Cre Line Allows Lineage Tracing of Fetal and Adult Leydig Cell Populations in the Mouse
Authors: Robert Nicholas M , Ferrier-Tarin Shirley , Tremblay Jacques J 
Published: January 2025

Abstract
Leydig cells produce hormones that are required for male development, fertility, and health. Two Leydig cell populations produce these hormones but at different times during development: fetal Leydig cells, which are active during fetal life, and adult Leydig cells, which are functional postnatally. Historically, our ability to understand the origin and function of Leydig cells has been made difficult by the lack of genetic models to exclusively target these cells. Taking advantage of the Leydig cell–exclusive expression pattern of the Insl3 gene, we used a CRISPR/Cas9 gene-editing strategy to knock-in iCre recombinase into the mouse Insl3 locus. To demonstrate the Leydig cell–exclusive nature of our iCre line, lineage-tracing experiments were performed by crossing Insl3iCre mice with a Rosa26LoxSTOPLox-TdTomato reporter. iCre activity was restricted to male offspring. TdTomato fluorescence was detected both in fetal and adult Leydig cells and colocalized with CYP17A1, a classic Leydig cell marker. Prior to birth, fluorescence was observed in fetal Leydig cells beginning at embryonic day 13.0. Fluorescence was also detected in adult Leydig cells starting at postnatal day 5 and continuing to the mature testis. Fluorescence was not detected in any other fetal or adult tissue examined, except for the unexpected finding that the adrenal cortex contains some Insl3-expressing Leydig-like cells. Our Leydig cell–exclusive iCre line therefore constitutes an invaluable new tool to study not only the origin of Leydig cells but also to target genes that have been long-proposed to be important for the development and functioning of these critical endocrine cells.
FLCN Variants in Parathyroid Carcinoma and Atypical Parathyroid Tumors
Authors: Burke Callie Shea , Bellizzi Justin , Costa-Guda Jessica , Arnold Andrew 
Published: January 2025

Abstract
Parathyroid carcinoma (PC) and atypical parathyroid tumors (APT) are incompletely understood and pose challenges in definitive diagnosis. FLCN sequence variants have recently been linked to PC and APT. Inactivating mutations in the ubiquitously expressed FLCN tumor suppressor gene, encoding folliculin, cause Birt-Hogg-Dubé syndrome (BHD), a rare tumor predisposition syndrome. Germline inactivating FLCN variants, accompanied by somatic allelic loss, were reported in 2 unrelated patents with PC, both with clinical features, but no diagnosis, of BHD. Somatic frameshift variants of likely pathogenicity were reported in 1 patient with PC and 1 with APT. On the other hand, neither PC nor APT has been reported in sizeable BHD series. To better understand the frequency of FLCN variants in PC and APT, we analyzed a series of 10 patients with sporadic PC and 14 with APT by direct Sanger DNA sequencing. We identified no inactivating FLCN mutations in any of the PC or APT samples examined. A germline missense variant (p.Gly325Val), predicted as benign/tolerated, was seen in 1 PC and a synonymous variant in 1 APT. The absence of pathogenic mutations detected in our series of PC and APT further suggests that FLCN variants are rare in these tumors. Nevertheless, the potential roles of FLCN in the pathogenesis of PC and APT merits further consideration and study.
The impact of health risk communication on self-perceived health and worry of targeted groups: Lessons from the Swedish COVID-19 response
Authors: Rickardsson Jonna , Mellander Charlotta 
Published: January 2025

Background
The Swedish COVID-19 strategy aimed to protect vulnerable groups through targeted measures, categorizing individuals aged 70 and above as high-risk. This study examines the impact of such group-based risk assessments on subjective health and virus-related concerns among older adults.

Methods
We analyzed survey data from the SOM Institute for 68- to 71-year-olds in 2019 (N = 684) and 2020 (N = 726). Using ordered logit regression, we compared perceived health and virus-related concerns between individuals just below (68–69 years) and just above (70–71 years) the high-risk age threshold, controlling for demographic factors.

Results
In 2020, 70-year-olds reported significantly lower perceived health compared to their 69-year-old peers, a difference not observed in 2019. Furthermore, 70-year-olds exhibited significantly higher virus-related concerns than their slightly younger counterparts. These patterns persisted when expanding the analysis to include individuals aged 68 and 71.

Conclusion
Our findings suggest that the Swedish COVID-19 strategy, while aimed at protecting individuals aged 70 and over, may have inadvertently increased perceived vulnerability and health concerns within this group. Conversely, those just below the high-risk age threshold reported better health and lower virus-related concerns, highlighting potential unintended psychological consequences of age-based risk communication.
Strategies to reduce hyperglycemia-related anxiety in elite athletes with type 1 diabetes: A qualitative analysis
Authors: Katz Alexandra , Shulkin Aidan , Fortier Marc-André , Yardley Jane E , Kichler Jessica , Housni Asmaa , Talbo Meryem K. , Rabasa-Lhoret Rémi , Brazeau Anne-Sophie 
Published: January 2025

Objective
Managing blood glucose levels is challenging for elite athletes with type 1 diabetes (T1D) as competition can cause unpredictable fluctuations. While fear of hypoglycemia during physical activity is well documented, research on hyperglycemia-related anxiety (HRA) is limited. HRA refers to the heightened fear that hyperglycemia-related symptoms will impair functioning. This study investigates current strategies employed to mitigate HRA during competition and the development of alternative approaches.

Research design and methods
Elite athletes with TID, aged >14 who self-reported HRA during competition were recruited. Elite athletes were defined as individuals exercising >10 hours per week whose athletic performance has achieved the highest competition level. 60 to 90-minute virtual semi-structured interviews were analyzed using an Interpretative Phenomenological Analysis.

Results
Ten elite athletes with T1D (average age 25 ± 3 years; T1D duration 12 ± 8 years; number of competitions per year 27 ± 19; training time per week 12 ± 6 hours) reported the strategies they currently use to mitigate HRA. These strategies include managing insulin and nutrition intake, embracing social support networks, using technology, practicing relaxation techniques, establishing routines, performing pre-competition aerobic exercise, and maintaining adequate sleep hygiene. Several additional approaches that could be implemented were identified including establishing targeted support networks, developing peer-reviewed resources on HRA, ensuring support teams have sufficient tools, and improving existing technology.

Conclusions
Elite athletes with T1D use physiological and psychological strategies to mitigate HRA during competition. This finding highlights the need for increased support and education for these athletes, and advancements in technology. A multidisciplinary approach involving healthcare professionals, athletic staff, and peer mentors could help integrate personalized anxiety management and diabetes care strategies into training regimens, enhancing both mental resilience and performance outcomes for athletes with T1D.
Safety and effectiveness of an herbal decoction (modified Saengmaeksan) in hypertensive patients: Protocol for a real-world prospective observational study
Authors: Cho Nahyun , Moon Hobin , Shin Kyung-Min , Kang Byoung-Kab , Leem Jungtae , Yang Changsop 
Published: January 2025

Objective
Hypertension, a common chronic disease, often leads to serious complications. While conventional management relies on antihypertensive drugs, which can cause side effects and adherence issues, alternative treatments like herbal medicine are gaining attention. This study examines the efficacy and safety of modified Saengmaeksan, an East Asian herbal remedy, in treating hypertension.

Methods
This single-arm, prospective, observational study will be conducted at Kyunghee Bichedam Korean Medicine Clinic from October 23, 2023 to August 30, 2024, enrolling 30 hypertensive patients. Over 12 weeks, participants will undergo 4 visits, receiving modified Saengmaeksan twice daily for 8 weeks, with a subsequent 4-week follow-up. Primary outcome is the change in systolic blood pressure from the baseline to week 8. Secondary outcomes include diastolic blood pressure changes, radial artery tonometry, and quality of life evaluations. Safety assessments will include monitoring hematologic parameters and adverse events. Data will be analyzed using an ANCOVA model for adjusting confounders.

Discussion
Modified Saengmaeksan has shown potential for lowering blood pressure in clinical settings, supported by animal and cell studies. However, human studies are scarce. This research will employ radial artery tonometry to analyze blood pressure comprehensively, exploring Saengmaeksan’s hemodynamic effects. The study’s goal is to support the approval of modified Saengmaeksan as a hypertension treatment by the South Korean Food and Drug Administration and to promote the industrialization of traditional herbal medicine in managing hypertension. The findings will provide essential data for future clinical research, aiding in feasibility assessments and sample size determinations for randomized controlled trials.
Home intravenous diuretic administration for heart failure management: A scoping review
Authors: Krauter Morgan B. , McGilton Katherine S. , Patel Stuti S. , Harkness Karen , Colella Tracey J. F. 
Published: January 2025

Background
Heart failure (HF) significantly impacts healthcare systems due to high rates of hospital bed utilization and readmission rates. Chronic HF often leads to frequent hospitalizations due to recurrent exacerbations and a decline in patient health status. Intravenous (IV) diuretic administration is essential for treating worsening HF. Emerging strategies include home-based IV diuretic therapy administration; however, limited practical implementation guidance is available. This scoping review aims to summarize the literature on home IV diuretic administration for HF patients, focusing on the interventions’ characteristics, and facilitators and barriers to its implementation.

Methods
This review followed the scoping review framework proposed by Arksey and O’Malley and PRIMSA-ScR. A comprehensive search was conducted across six databases (CINAHL, the Cochrane Library, EMBASE, MEDLINE, PsychINFO and Scopus) and grey literature to identify English studies from inception to April 13, 2024. Two independent reviewers screened articles and resources for inclusion and data was extracted using a form created by the authors in Covidence.

Results
The search yielded 2,049 results, with nine studies meeting the inclusion criteria. Studies varied in design, including feasibility, pilot, observational, and pre/post-intervention evaluations. The majority were conducted in European countries, with sample sizes ranging from 12 to 96 patients receiving home IV diuretics for HF. Key implementation challenges include appropriate patient selection, IV cannulation competency of healthcare providers, and multi-disciplinary and multi-agency collaboration.

Conclusions
Evidence on home IV diuretic administration practices for HF management remains limited. However, this scoping review suggests that commonalities across studies could form the basis for developing standard protocols in outpatient settings. Despite the lack of formal evidence-based guidelines, the findings also suggest that tailored, community-specific approaches and safe infusion guidance documents could enhance the efficacy and scalability of home IV diuretic therapy. Future research should focus on refining these strategies and exploring diuretic escalation methods beyond traditional acute care administration to optimize patient outcomes.
Letras móveis na alfabetização
Authors: Miranda Mariana , Montuani Daniela 
Published: January 2025

Este artigo apresenta parte dos resultados de uma pesquisa de mestrado que buscou refletir sobre o uso de letras móveis em turmas de alfabetização, a partir da análise do discurso das professoras e da observação das práticas com esse recurso em turmas de 1º ano do Ensino Fundamental. Neste artigo serão apresentadas análises referentes ao conteúdo das entrevistas realizadas com professoras da rede pública de ensino de Belo Horizonte. A análise das falas das docentes revelaram: (i) as motivações para o uso de letras móveis em sala de aula de aula; (ii) reflexões sobre as diferenças na escrita com letras móveis e escrita no papel; (iii) uma variedade de possibilidades de uso de letras móveis em sala de aula, elencando aspectos referentes à materialidade, à frequência de uso e à variedade das propostas didáticas com esse recurso; e ainda, (iv) os desafios no uso de letras móveis em sala de aula, que perpassam questões que envolvem o acesso ao material, as tensões na gestão da atividade em sala de aula e dificuldades de realização de um planejamento significativo que equilibre as funções lúdicas e didáticas no uso desse recurso.