bluuebunny/crossref_metadata_2025 huggingface dataset:
Orwell, Una Marson, and Mulk Raj Anand
Authors: Dinsman Melissa
Published: February 2025

This biographical and theoretical chapter focuses on two Orwell collaborators at the BBC: Una Marson and Mulk Raj Anand. Through a discussion of Orwell’s work and friendships with Marson and Anand, this chapter closely examines what Susheila Nasta has called their “substantial two-way intellectual interactions” and illustrates that these interactions were not only built in the radio station, but were also anticipated by similarly held political positions on empire and race. Divided into two parts, this chapter first discusses each author’s politics and how these led them to the BBC before turning to their collaborative work on Voice and their continued contact in their radio afterlives. A close analysis of these authors’ radio careers and BBC partnerships shows that the aesthetics and politics of Marson and Anand were not transformed by working with Orwell, but instead were enhanced by their shared literary and political commitments.
Orwell and Feminism
Authors: Bluemel Kristin
Published: February 2025

The story of Orwell’s relationship with feminism reveals ties that are as strong, persistent, and productive as any he forged with other political movements and ideologies. This chapter maps out several of the most important critical consequences of the vexed, contradictory, more than century-long relationship between Orwell and feminism for twenty-first-century feminist and non-feminist readers by asking: What has Orwell done for feminism? What has feminism done and what might it do for Orwell? It finds its answers in literary, biographical, and cultural criticism by Beatrix Campbell, Daphne Patai, Janet Montefiore, Alison Light, Nick Hubble, Ben Clarke, and D. J. Taylor, among others, as well as in the fiction and letters of Orwell’s contemporaries Virginia Woolf, Naomi Mitchison, Jacintha Buddicom, and Walter Greenwood.
Societal Constitutionalism
Authors: Golia Angelo , Teubner Gunther
Published: February 2025

This chapter outlines the close but conflicted relationship between societal constitutionalism and digital constitutionalism. The main argument is that societal constitutionalism provides a perspective which complements state-centred and global perspectives on digital constitutionalism, notably when it comes to the constitutionalizing potential of norms that do not come from the formal law-making institutions centred on national and international politics. The first section outlines the critique of societal constitutionalism to liberal, state-centred constitutional theory, pointing at long-standing blind spots and broadening the normative goals of (digital) constitutionalism. The second section analyses the constructive contributions of societal constitutionalism to digital constitutionalism, through three key concepts of polycontexturality, conflict, and generalization/respecification. The third section of the chapter points to the persisting differences between the societal perspectives and other perspectives on digital constitutionalism as well as to the connections with other strands of literature concerned with the interface between law and digital technologies, notably so-called law and political economy.
A novel model for identifying infections in patients with acute-on-chronic liver disease (AoCLD): A nationwide, multicenter, prospective cohort study
Authors: Zhou Hui , Li Hai , Deng Guohong , Wang Xianbo , Zheng Xin , Chen Jinjun , Meng Zhongji , Zheng Yubao , Gao Yanhang , Qian Zhiping , Liu Feng , Lu Xiaobo , Shi Yu , Shang Jia , Huang Yan , Chen Ruochan
Published: February 2025

Background and aims

To establish an early and quick model for diagnosing infections in patients with acute-on-chronic liver disease (AoCLD).

Approach

This study analyzed 3,949 patients from two multicenter prospective cohorts of the Chinese Acute-on-Chronic Liver Failure (CATCH-LIFE) study. The dataset was randomly divided into training and validation cohorts in a 7:3 ratio. In the training cohort, logistic regression and least absolute shrinkage and selection operator regression analyses were used to identify predictive risk factors for infection in patients with AoCLD, and a simple nomogram was established. Two different cutoff values were determined to stratify infection risk in AoCLD patients.

Results

The developed diagnostic model included six variables: cirrhosis, ascites, neutrophil count (N), and total bilirubin, C-reactive protein (CRP), and blood sodium levels. The area under the receiver operating characteristic curve for the training and validation cohorts were 0.818 and 0.809, respectively, significantly higher than using CRP, procalcitonin, or N alone. Additionally, in the training cohort, we set a low cutoff value of 0.2028, resulting in a sensitivity of 80.15%, specificity of 68.25%, and a negative predictive value of 92.7% for rule-out diagnosis. A high cutoff value of 0.4045 resulting in a specificity of 90.1%, sensitivity of 52.7%, and a positive predictive value of 64% for rule-in diagnosis. These cutoff values were validated in the validation cohort.

Conclusions

We established a nomogram model to assist clinicians in diagnosing infections in patients with AoCLD, effectively improving the accuracy and timeliness of diagnosis.
Combined Magnesium and Silicon Ions Siliconynergistically Promote Functional Regeneration of Skeletal Muscle by Regulating Satellite Cell Fate
Authors: Xia Hangbin , Yang Chen , Li Huili , Huang Lingwei , Zeng Zhen , Chi Runrun , Yang Ziwei , Wang Yuzen , Chang Jiang , Jiao Yiren , Li Wenzhong
Published: February 2025

Muscle satellite cells (MuSCs) play a vital role in skeletal muscle regeneration. However, in intractable muscle diseases such as volumetric muscle loss (VML), the quantity and function of MuSCs are significantly reduced, severely limiting the body's inherent muscle regeneration capability. In this study, we propose a novel strategy to modulate the fate of MuSCs using a combination of bioactive magnesium (Mg) and silicon (Si) ions, sustainably delivered through magnesium silicate (MgSiO3, MS) bioceramic-based scaffolds. In vitro, Mg and Si ions synergistically promote the proliferation and differentiation of MuSCs. Similarly, Mg and Si ions derived from MS/poly (L-lactic acid) (MS/PLLA) composite scaffold also increases the proliferation and differentiation ability of MuSCs. Furthermore, MS/PLLA composite scaffolds facilitate the activation of MuSCs, regeneration of muscle fiber, and neovascularization, while inhibiting fibrosis, thereby effectively restoring muscle function and promoting tibialis anterior muscle functional regeneration in a VML mouse model. Mechanistically, the combination of Mg and Si ions promotes the activation and proliferation of MuSCs by activating the Notch1-Hes1 pathway. Besides, the combination of Mg and Si ions also improves the differentiation of MuSCs by up-regulating Myod and Myog, and enhances fusion by up-regulating Mymk and Mymx expression. The outcomes of our research introduce a promising approach to the treatment of skeletal muscle injuries and related diseases.
Andromache Among the Ambassadors: Ambrose Philips’s The Distrest Mother (1712)
Authors: Stanyon Miranda
Published: February 2025

Now a relatively obscure figure, the Trojan woman Andromache had a lively afterlife in the long eighteenth century. A central text for her English reception in this period was Ambrose Philips’s The Distrest Mother (1712). An adaptation of Jean Racine’s breakthrough success, Andromaque (1667), Philips’s play became a staple of the stage and helped to confirm Andromache’s status as a paradigmatic wife, widow and mother within emerging cultures of sensibility and bourgeois constrictions on motherhood. Yet ‘domestic virtue concerns all the world’, as Richard Steele wrote of Andromache, and there is far more of the world at stake in Philips’s play than a tale of purely private femininity would suggest. By examining Philips’s interventions in Racine, his friendship networks and early career, especially in diplomacy, this essay situates The Distrest Mother at the intersection of home affairs and international relations. Shaped by party politics in the late years of Queen Anne’s reign, and by the contested end to the War of the Spanish Succession, Philips’s Andromache emerges as a mixed figure, involved at once in discourses of ideal domesticity, patriotism, international intervention, asylum seeking, cosmopolitanism, and the law of nations.
Impact of Relapse in BDNF Receptors Expression in Patients With a First Episode of Schizophrenia
Authors: Bioque Miquel , Llorca-Bofí Vicent , MacDowell Karina S , Amoretti Sílvia , Mezquida Gisela , Cuesta Manuel J , Diaz-Caneja Covadonga M , Ibáñez Ángela , Segarra Rafael , González-Pinto Ana , Roldán Alexandra , Sáiz Pilar A , Mané Anna , Lobo Antonio , Martínez-Pinteño Albert , Cano-Escalera Guillermo , Berrocoso Esther , Bernardo Miquel ,   2EPs Group
Published: February 2025

Background and Hypothesis

Relapsing after a first episode of schizophrenia (FES) is a main predictor of clinical and functional prognosis. Brain-derived neurotrophic factor (BDNF) plays a critical role in neuronal development and plasticity, and its signaling may be altered by successive relapses.

Design

We assessed the impact of first relapse in the expression of the 2 isoforms of the BDNF tropomyosin-related kinase B (TrkB) receptor (active full-length TrkB-F and inactive truncated TrkB-T) in peripheral blood mononuclear cells from 53 FES patients in clinical remission followed up for 3 years.

Results

The group of participants that relapsed (n = 24) during the follow-up presented a significant decrease in the expression of the active TrkB-F receptor compared to baseline (M = 100 ± 28.13 vs. M = 83.42 ± 33.84, t = 2.5, P = .02), with no changes in the inactive TrkB-T receptor expression nor in BDNF plasma levels. This decrease also led to a significant decline in the F/T ratio (M = 1.13 ± 0.38 vs. 0.94 ± 0.36, t = 2.17, P = .041). No significant differences were found in the receptors’ expression nor in plasma levels in the group of cases that remained in remission (n = 29). These results were not associated with baseline differences between the groups in terms of the BDNF signaling pathway biomarkers, clinical or treatment variables.

Conclusions

These findings highlight the biological impact that a relapse produces over the systemic BDNF-TrkB signaling pathway, potentially undermining crucial neuronal functions. Identifying the actors involved can help design specific interventions for relapse prevention and improve the functional prognosis of people in the early stages of schizophrenia.
Posterior Ligamentous Augmentation is Associated with Reduced Rates of Proximal Junctional Kyphosis and Failure in Adult Spinal Deformity Surgery
Authors: Texakalidis Pavlos , Matsoukas Stavros , Krushelnytskyy Mykhaylo , Swong Kevin , El Tecle Najib , Koski Tyler R , Dahdaleh Nader S
Published: February 2025

Study Design.

Systematic review and meta-analysis

Objective.

To evaluate the impact of posterior ligamentous augmentation (PLA) on proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) in adult spinal deformity (ASD) surgery.

Summary of background data.

Adult spinal deformity (ASD) surgery is frequently complicated by PJK and PJF, with reported rates ranging from 17% to 61.7%. Techniques such as PLA, which involves spinous process or sublaminar tethering at the upper instrumented vertebra (UIV) +1 or +2, have been investigated as potential methods to mitigate these complications.

Methods.

A systematic literature review and meta-analysis was performed according to the PRISMA guidelines. Most studies defined PJK as an increase of ≥10° or ≥20° in the sagittal Cobb angle from UIV to UIV+2 compared to preoperative measurements. PJF was defined as PJK necessitating revision surgery.

Results.

Eight comparative studies comprising 1,333 patients (PLA: 579; no PLA: 754) were included. The mean age ranged from 55 to 68.6 years across studies, with a mean follow-up period of 17.6 to 31.2 months. There were no significant differences between the PLA and no PLA groups in terms of age (MD 2.53; 95% CI -0.28 to 5.34, I²: 64.8%), BMI (MD 1.03; 95%CI -0.87 to 2.93, I²:69%), or sagittal vertical axis (SVA) preoperatively (MD 3.92; 95% CI -1.90 to 9.75, I²:73.1%) and postoperatively (MD -1.54; 95%CI -4.10 to 1.01, I²: 56.2%). However, the PLA group demonstrated significantly lower odds of developing PJK compared to the no PLA group (PLA: 25.8%; no PLA: 28.8%; OR: 0.54; 95%CI 0.34 to 0.85, I²: 37.4%). Furthermore, PLA was associated with significantly lower odds of PJF (PLA: 3.3%; no PLA: 12.3%; OR: 0.23; 95%CI 0.12 to 0.47, I²: 17.9%).

Conclusions.

PLA in ASD surgery is associated with reduced odds of developing PJK and PJF over a follow-up period of 17.6 to 31.2 months.
Implementation of the Minimum Clinically Important Difference for the Neck Disability Index is Often Problematic
Authors: Evaniew Nathan , Malholtra Armaan K , Charest-Morin Raphaële , Soroceanu Alex , Jacobs W Bradley , Cadotte David W , McIntosh Greg , Dea Nicolas
Published: February 2025

Study design.

Systematic Review

Objective.

To determine the incidence of inappropriate or uncertain implementation of the Minimally Important Clinical Difference (MCID) for the Neck Disability Index (NDI).

Summary of background data.

The NDI consists of 10 items that yield a total score out of 50, but some users double the scale to report total scores out of 100. The most used MCID for the NDI is 7.5 out of 50. Implementation of the MCID can be problematic if users are not attentive to the scale of the NDI.

Methods.

We performed a methodological review of studies that cited the MCID for the NDI. We defined appropriate implementation as congruent magnitude of the scales used for NDI data and the MCID. We evaluated study characteristics associated with appropriate implementation using multivariable logistic regression.

Results.

Among 163 included studies, twenty (12%) reported a 0-50 scale for the NDI, 66 (40%) reported a 0-100 scale, and the remaining 77 (47%) did not report which scale was used. Fifty-seven (35%) reported an MCID of 7.5, 37 (23%) reported an MCID of 15, and the remaining 69 (42%) did not report which value of the MCID used. Appropriate implementation of the MCID occurred in 39 studies (24%), while implementation was inappropriate in 16 (10%) and uncertain due to poor reporting in 108 (66%). Studies published more recently (OR 1.20 per year, 95% CI 1.02 to 1.40, P=0.03) and studies that were RCTs (OR 4.85, 95% CI 1.25 to 18.79, P=0.02) had greater odds of being associated with appropriate implementation.

Conclusions.

Inappropriate implementation of the MCID for the NDI is problematic and occurs often, and uncertain implementation due to poor reporting is also common. Evidence users should be cautious when interpreting studies that implement the NDI, and should consider whether the magnitude of the scales used for the NDI and the MCID are congruent.
Basilar Invagination Diagnosis, Classification, and Radiology
Authors: Yaman Onur , Zileli Mehmet , Avcı İdris , Chen Zan , Lee June Ho , Sá-Carneiro Geraldo , Costa Francesco , Ben Ali Said , Dantas Fernando , Oertel Joachim , Visocchi Massimiliano , Parthiban Jutty , Goel Atul , Botelho Ricardo , Alves Oscar L.
Published: February 2025

Study Design.

A systematic literature review and consensus using Delphi method.

Objective.

This review aimed to analyze recent literature on diagnosis, classification, and radiologic characteristics of Basilar Invagination (BI) to generate recommendations on these topics.

Summary of background.

Basilar invagination diagnosis, classifications, and radiologic characteristics evolved during the last decade; however, many debatable criteria disturb a common language fundamental to compare clinical research.

Material and Methods.

The WFNS Spine Committee organized two separate consensus meetings to discuss and create statements that were voted on to reach a consensus.

Results.

Basilar invagination mainly results from a CVJ developmental abnormality and is often associated with congenital anomalies. There is also an acquired type that occurs by bone softening, such as rheumatoid arthritis. It can be classified as Type I (atlantoaxial dislocation) and Type II (without atlantoaxial dislocation) basilar invagination. Clinical signs may either be due to brainstem compression or cervical spinal cord compression and instability. Although many radiological measurements are proposed, the most reliable ones are the McRae’s line, Chamberlain’s line, and Boogard angle.

Conclusions.

Diagnosis of basilar invagination should be made by midsagittal craniocervical X-Rays, CTs or MRI. There are two types of basilar invagination: Type I basilar invagination is associated with instability, and treatment can focus on stabilization. However, Type II basilar invagination may need decompressive surgeries.
Wearable Sensors for Pre- and Post-Operative Assessment of Cervical Myelopathy
Authors: Glassman Steven D , Gum Jeffrey L , Mathew Justin , Crawford Charles H , Djurasovic Mladen , Carreon Leah Yacat
Published: February 2025

Study design.

Prospective observational cohort.

Objectives.

To report on the role of a single wearable sensor in the evaluation of patients with Cervical Spondylotic Myelopathy (CSM).

Summary of Background Data.

Clinical evaluation of CSM is limited, as Hoffmann’s sign, Romberg testing and Tandem Gait are largely subjective and binary, making deterioration or improvement difficult to document accurately.

Methods.

Patients scheduled for surgical treatment of CSM underwent in-office and 24-hour continuous at-home data collection using a single wearable sensor. In-office testing consisted of Standing, Romberg testing, Tandem Gait and Timed Up & Go (TUG). Testing was repeated 6-months post-operatively.

Results.

Statistically significant improvements were seen following surgical treatment in the Romberg test eyes-open maximum antero-posterior sway (P=0.010), eyes-open total path traveled (P=0.048); in Tandem Gait speed (P=0.021), duration (P=0.002), antero-posterior sway (P=0.046) and initial peak acceleration (P=0.001). There was no statistically significant difference in TUG testing. At-home gait pattern revealed a trend toward decreased lateral sway post-operatively (P=0.062) and fewer sleep turns (P=0.078)

Conclusion.

Wearable sensor data effectively quantifies standard exam findings and identifies new metrics with the potential to assess more accurately pre-operative and post-operative function in patients with CSM. Previously unreported pre-operative to 6-month post-operative changes were seen in speed of gait and ground impact force during Tandem Gait. These metrics were more sensitive as compared to the normal antero-posterior and lateral sway assessment. 24-hour sensor data showed decreased number of turns during sleep post-operatively. This study suggests that wearable sensor data will be a viable source for quantifiable data with the potential to guide treatment for patients with CSM. This capability is based partly on better quantification of existing binary measures, but also on identification of unanticipated patterns within the data.
The Impact of Chronic Obstructive Pulmonary Disease on Immune Checkpoint Inhibitor Effectiveness in Non-small Cell Lung Cancer: A Population Health Study
Authors: Chan Sze Wah Samuel , Pond Gregory R. , Goffin John R.
Published: February 2025

Chronic obstructive pulmonary disease (COPD) and lung cancer are associated diseases. COPD confers a negative prognosis in NSCLC, but the clinical benefit of immune checkpoint inhibitors (ICI) in this population is unclear. A population-level analysis of patients in Ontario, Canada was performed through the ICES (formerly known as the Institute for Clinical Evaluative Sciences) administrative database. Patients with NSCLC and treated with PD-1/PD-L1 immune checkpoint inhibitors between Jan 2010 and Dec 2020 were included. Overall survival (OS) was estimated using the Kaplan-Meier method and compared using Cox proportional hazards regression. Hospitalizations and duration of treatment were compared secondarily using logistic and linear regression. A total of 4306 patients received ICI and 54% of patients had a diagnosis of COPD. Median (95% CI) OS was 9.2 (8.5–9.9) months for patients with COPD and 8.2 (7.3–8.8) for patients without COPD, which was not significantly different (adjusted hazard ratio (aHR) = 0.94, 95% CI, 0.87–1.01, P = 0.092). Similarly, the median time on treatment was not different (85 vs. 99 days, multivariable P = 0.10). However, the 90-day hospitalization rate was decreased in the COPD population (multivariable odds ratio 0.76, 95% CI 0.62–0.94, P = 0.011). Among patients with NSCLC receiving ICI, our data suggest that a diagnosis of COPD does not result in shortened treatment, poorer survival, or higher rates of hospitalization. COPD itself should not be considered a contraindication to ICI.
Breaking the ice: How awareness training affects the treatment of domestic violence patients by health care professionals
Authors: Beck Thomas , Förster Charlotte , König Stefanie , Pavlic Marion
Published: February 2025

Background

Domestic violence (DV) is a neglected topic in health care, resulting in delays in the identification of DV victims and suboptimal care.

Purpose

The attitudes of health care professionals (HCPs) toward stigmas associated with victims of DV can affect the care offered to the latter. The HCPs' attitude toward victims of DV is therefore an important but neglected topic in health care research. Therefore, the purpose of this study was to determine whether awareness training changes HCPs' attitudes toward victims of DV, especially with regard to their stigmatization.

Methodology

Problem-centered interviews were conducted with 12 health professionals (six women and six men, six with and six without previous awareness training) concerning their attitudes and approaches to DV and those affected by it.

Results

Our data analysis indicates a significant difference in HPC attitudes toward potential DV victims depending on whether or not HCPs have undergone awareness training.

Conclusion

Awareness training does not only improve theoretical knowledge about DV; it also changes staff attitudes toward DV victims, especially with regard to their stigmatization.

Practice Implications

Our study shows that awareness training changes the HCPs' attitudes toward victims of DV. This change in attitude might reduce pressure on both the HCP and the victim, which in turn might help the victim to accept the care offered. Therefore, awareness training can help to reduce barriers to helping victims of DV.
Chorioretinal Findings in Intraocular IgG4-Related Disease: A Case Report and Review of the Literature
Authors: Magazin Maja , Jones Skyler G. , Fazio Alexis , Thomas Dilip A. , Espinosa-Heidmann Diego
Published: February 2025

Purpose:

This manuscript reports intraocular IgG4-related disease (IgG4-RD) presenting as panuveitis with a large subretinal mass and contralateral orbital mass. It includes a literature review highlighting IgG4-RD's diagnostic challenges, emphasizing clinical, histopathologic, and multimodal-imaging findings.

Methods:

PubMed was searched for “all fields” with keywords "IgG4" AND "retina" AND "choroid" from 1974 to March 2024, revealing 16 cases of 23 eyes detailing IgG4-related chorioretinal manifestations.

Results:

The most common presenting symptom was painful vision loss (31%). Chorioretinal findings included: large subretinal or choroidal masses (35%), multifocal subretinal lesions (26%), and retinal detachment (22%). Associated ophthalmic findings included: scleritis or sclerouveitis (52%), vitritis (48%), orbital disease (13%), and papillitis (9%). IgG4+/IgG ratios in ocular tissue varied 20-54.5%. IgG4+ plasma cells per high power field ranged 50-133. Ophthalmic modalities used to aid in diagnosis included B-scan ultrasonography (US-B, 56%), optical coherence tomography (OCT, 31%), fluorescein angiography (FA, 25%), fundus-autofluorescence (FAF, 13%), and indocyanine-green angiography (ICGa, 13%). Masses on B-scan were heterogenous or homogenous with medium-to-high reflectivity. Magnetic resonance imaging (MRI) evaluation was hypointense on T2-weighted imaging (75%) and hyperintense on T1-weighted imaging (38%) with progressive contrast enhancement (50%). Management required a multidisciplinary approach with steroid and steroid-sparing agents.

Conclusion:

IgG4-RD has diverse and variable ocular presentations and diagnostic manifestations. Definitive diagnosis is made via biopsy. Further studies are necessary for non-invasive diagnosis.
Postoperative bile leaks did not affect the survival of hepatoblastoma but were associated with long-term complications: retrospective case-control study
Authors: Maniwa Junnosuke , Kawakubo Naonori , Tamaki Akihiko , Kondo Takuya , Takahashi Yoshiaki , Fukuta Atsuhisa , Yoshimaru Koichiro , Nagata Kouji , Miyata Junko , Matsuura Toshiharu , Tajiri Tatsuro
Published: February 2025

Purpose:

This study assessed the long-term impact of bile leak complications on the pediatric hepatoblastoma (HB) patients post-surgery. With HB predominantly affecting children under five, the increased survival rates necessitate a focus on the post-surgical complications, particularly concerning the effects of bile leaks.

Methods:

A retrospective analysis was conducted on patients treated for HB at our institution from 1980 to 2022. The diagnosis, operative procedure, complications, mortality, and prognosis were retrospectively analyzed to examine the incidence and long-term effects of surgical complications, especially bile leaks. The study involved detailed statistical analyses, including assessments of the Kaplan–Meier survival rates and comparisons of complication incidences using log-rank tests.

Results:

Of the 53 reviewed cases, 43 were analyzed. Bile leaks occurred in 20% of liver resection patients, markedly impacting their long-term QOL through severe complications like gastric obstructions, portal vein occlusion, and bile duct stricture. Nonetheless, the overall 5-year survival rate was high at 87.8%. The prognosis did not differ significantly between patients with and without short-term complications.

Conclusion:

In patients with HB, postoperative bile leaks occasionally lead to long-term complications. Even if the complications do not influence their prognosis, surgeons must be alert for the possibility of long-term complications after surgery for HB.
First Responder Perceptions on Occupational Health and Safety Following the 2010 Deepwater Horizon Oil Spill Cleanup Operations: A Qualitative Study
Authors: Testoff Addison C. , Louzado-Feliciano Paola , Moore Kevin J. , Caban-Martinez Alberto J.
Published: February 2025

Objective

Identify and describe factors that impacted first responder’s health and safety during the 2010 Deepwater Horizon oil spill cleanup.

Methods

Pre-discussion survey and six focus group sessions conducted in May 2017 among Louisiana first responders.

Results

Among the 50 first responders 98.0% were male, 98% Caucasian, 95.3% non-Hispanic, 70.0% married and group mean age, 40.6 years (SD = 9.8). Oil exposure was reported by 56.2% of first responders, with 59.3% reporting skin contact, 77.8% inhalation, 11.1% ingestion, and 36.7% visited a doctor after the oil spill event. Four focus group themes emerged: 1) Collaboration between fire personnel and incident command staff; 2) Ensuring access to personal protective equipment; 3) Establishing contamination control protocols; and 4) Providing training.

Conclusion

Louisiana first responders at the oil spill cleanup reported post-event health effects and factors to improve response activities.
Co-producing a health advocate intervention for pediatric liver transplant recipients using human-centered design
Authors: Cheung Telly , Squires James E. , Bautista Bethany , Milionis Cynthia , Prugh Jonathan , Hsu Evelyn , Ebel Noelle H. , Campbell Kathleen , Vittorio Jennifer , Bucuvalas John C. , Gottlieb Laura M. , Lyles Courtney R. , Lai Jennifer C. , Wadhwani Sharad I.
Published: February 2025

Pediatric healthcare delivery systems are increasingly employing navigators, community health workers, and social workers to improve child and household access to healthcare and social services, with the goal of decreasing healthcare inequities. However, navigation strategies are understudied in pediatric liver transplantation. We used human-centered design methods, eliciting the perspectives of caregivers and transplant team members, to design a navigator role for pediatric liver transplantation. We enrolled 10 caregivers reporting household social risks and 6 transplant practitioners from 7 U.S. transplant centers. We conducted 8 virtual focus groups between 9/12/2023–1/31/2024 to define gaps in care and ideate on how lay navigators could mitigate those challenges. We utilized design tools to elicit stakeholders’ values and preferences. We recorded the focus groups and qualitatively analyzed audio transcripts to thematically identify essential job functions. Most caregivers reported earning an annual household income <$59,000 (70.0%), living below the federal poverty line (55.6%), and experiencing financial strain (80.0%). Caregivers wanted navigators to help them (1) access community-based resources, (2) build longitudinal relationships with the healthcare team, (3) prepare them for appointments, (4) communicate with their child’s school, and (5) address cultural differences between families and transplant practitioners. The transplant team wanted navigators to help caregivers (1) address families’ socioeconomic resource needs, (2) coordinate appointment scheduling, and (3) facilitate cultural and language-concordant care. Using structured design methodology, we designed a prototype navigator role for pediatric liver transplant care teams. Future studies should test the effectiveness of this navigator role in improving post-transplant outcomes.
Cochlear Implantation in Vestibular Schwannoma Surgery: Diagnostic Accuracy Analysis of Intraoperative Monitoring with Intracochlear Electrode
Authors: Zanoletti Elisabetta , Concheri Stefano , Tealdo Giulia , Cazzador Diego , Di Pasquale Fiasca Valerio M. , Franchella Sebastiano , Impala’ Giuseppe , Brotto Davide
Published: February 2025

Objective

To investigate the role of intraoperative cochlear nerve (CN) electric monitoring with MED-EL intracochlear test electrode (ITE) in assessing the CN functional integrity.

Setting

Tertiary referral center.

Patients

Patients with intrameatal or 2 to 13 mm in the cerebello-pontine angle vestibular schwannoma (VS), not suitable for hearing preservation surgery but eligible for tumor resection via translabyrinthine approach and simultaneous cochlear implant (CI) rehabilitation.

Intervention

ITE was used to register electrically evoked auditory brainstem response (eABR) before and after VS resection. All patients with anatomical preservation of CN underwent CI, regardless of eABR results, which served as the index test and was compared with postoperative sound perception by CI stimuli (gold standard test).

Results

Twelve of seventeen cases allowed anatomical preservation of CN and were considered for the study. Seven of twelve cases demonstrated sound detection with CI, and six of twelve showed some degree of speech discrimination. eABR test with ITE achieved an accuracy of 66.7%, a sensitivity of 42.9%, and a specificity of 100%. Positive and negative predictive values were 100% and 55.6%, respectively.

Conclusion

When eABR can be evoked with ITE, the attempt of CI was likely to be successful, whereas in cases of eABR absence, other factors should be considered to reduce unsuccessful CI and not preclude rehabilitation in patients who would benefit from CI. Further studies and longer follow-up are needed to analyze the role of ITE in VS surgery with CI.
Time-in-therapeutic range falls as the target international normalized ratio range increases in patients on warfarin
Authors: Malik Imran , Priest Paul , Jennings Ian , Gomez Keith
Published: February 2025

The main objective was to assess whether the time-in-therapeutic range (TTR) in patients on warfarin is affected by the international normalized ratio (INR) range. We also evaluated whether the performance of the INR is negatively impacted as its absolute value increases.

First, we extracted key performance indicators of the INR from 22 surveys of the UK National External Quality Assurance Scheme (NEQAS). We then analysed TTR in 6584 warfarin monitoring episodes that were categorized by range and indication.

NEQAS surveys in which the sample INR was above 3.0 had more participants outwith consensus with higher coefficient of variation and standard error mean. The outwith consensus percentage was correlated with the mean reported INR value.

In warfarinised patients, we found that the TTR was lower at INR ranges above the standard 2.0 to 3.0.

We concluded that the performance of the INR assay decreases at higher values. Furthermore, increasing the INR range above the standard 2.0 to 3.0 in warfarinised patients has an adverse effect on TTR. This is important because the INR range may be increased to try and improve efficacy, whereas these data suggest that it may have the opposite effect.
An atypical presentation of catastrophic antiphospholipid syndrome with refractoriness to treatment
Authors: Zhang Shannon , Qiao Jesse
Published: February 2025

Catastrophic antiphospholipid syndrome (CAPS) is a rare and life-threatening manifestation of antiphospholipid syndrome (APS). Diagnosing CAPS can be particularly challenging, especially due to significant overlap in pathophysiology, signs, and symptoms with other complex hematologic conditions, including thrombotic microangiopathies (TMA) and immune-mediated thrombocytopenia (ITP). In many cases, definitive diagnosis is not clear, leading to delays in care and poor outcomes. Here, we present an elderly patient with previously diagnosed APS now presenting with suspected CAPS, admitted to our inpatient service with a complicated hospital course. The patient received daily plasma exchange, steroids, intravenous immunoglobulin, and therapeutic heparin for anticoagulation. Despite treatment, there was worsening of thrombocytopenia suggesting refractoriness to ongoing treatment. We outline our diagnostic approach, clinical evaluation, treatment strategies, and differential diagnoses pertinent to our atypical clinical presentation of CAPS.
Characteristics, risk factors, and disease course of musculoskeletal manifestations in patients with inflammatory bowel disease: a prospective longitudinal cohort study
Authors: Jansen Fenna M. , den Broeder Nathan , van Hal Tamara W. , Mahler Elien A.M. , van Dop Willemijn A. , Hoentjen Frank
Published: February 2025

Background

Musculoskeletal manifestations occur in half of the patients with inflammatory bowel disease (IBD) and contribute to a reduced quality of life (QoL) and increased work disability. We aimed to evaluate the natural disease course, characteristics, and risk factors of musculoskeletal manifestations in patients with IBD.

Methods

We performed a prospective longitudinal cohort study in patients with IBD with and without musculoskeletal manifestations with a 1-year follow-up. Primary outcome was the proportion of patients with resolution of musculoskeletal manifestations. Secondary outcomes included the proportion of patients with IBD that developed new musculoskeletal manifestations during follow-up; the correlation among IBD activity, baseline characteristics, and musculoskeletal disease course; and the difference in QoL between patients with and without musculoskeletal manifestations.

Results

In total, 243 patients with IBD were included (124 with and 119 without musculoskeletal manifestations). In the majority of patients (62.2%), musculoskeletal manifestations were of noninflammatory nature. Overall, peripheral and axial manifestations were persistent in 85.7 and 44.6% at 1 year, respectively. The QoL at baseline and at 1 year was lower in the group with musculoskeletal manifestations compared with patients without these manifestations. Female sex and age above 40 were associated with the presence of musculoskeletal manifestations.

Conclusion

Musculoskeletal manifestations in patients with IBD are mostly noninflammatory disorders, persist at 1 year of follow-up, and occur more frequently in patients of age above 40 and female sex. Overall, patients with musculoskeletal manifestations have lower QoL compared with patients without musculoskeletal manifestations.
Comparison of clinical characteristics and outcomes in patients with hepatocellular carcinoma based on serum alpha-fetoprotein status
Authors: Li Jing , Cheng Xi , Meng Yan , Wang Miaomiao
Published: February 2025

Background:

Alpha-fetoprotein (AFP) is the most commonly used and crucial tumor marker in clinical diagnosis and prognosis guidance for hepatocellular carcinoma (HCC). However, approximately 30% of HCC patients do not exhibit abnormal serum AFP levels at the time of diagnosis. This study aims to investigate the clinical characteristics and prognosis differences between AFP-negative and AFP-positive patients with HCC.

Methods

Clinical data on patients diagnosed between 2010 and 2015 from the Surveillance, Epidemiology, and End Results Program were collected and analyzed. All patients with HCC were reported as AFP-negative or AFP-positive based on AFP test results. Overall survival (OS) and cancer-specific survival (CSS) were compared between the AFP-negative and AFP-positive patients. Logistic regression analysis and multivariable Cox regression analysis were performed to identify the association of AFP with tumor size, lymph node metastasis, distant metastasis, and CSS.

Results

Of 7090 patients, 2074 (29.3%) and 5016 (70.7%) were AFP-negative and AFP-positive patients, respectively. The 5-year OS and CSS rates in AFP-negative patients were significantly better than AFP-positive patients (36.4 vs. 20.7% and 46.7 vs. 27.2%, both P < 0.001). Logistic regression analysis revealed that the AFP level was an independent risk factor of tumor size [odds ratio (OR), 1.821; 95% confidence interval (CI), 1.625–2.040; P < 0.001], N stage (OR, 1.922; 95% CI, 1.528–2.417; P
< 0.001) and M stage (OR, 2.435; 95% CI, 1.980–2.995; P < 0.001). On multivariable Cox-regression analyses, AFP-positive was associated with decreased CSS (hazard ratio, 1.452; 95% CI, 1.355–1.557; P < 0.001).

Conclusion

Abnormal serum AFP was significantly associated with worse prognosis, larger tumor size, more lymph node metastasis, and distant metastasis. Patients with AFP-positive may need more individualized treatment decision and further optimization of HCC management strategies.
Neutrophil gelatinase–associated lipocalin for predicting acute kidney injury in orthotopic liver transplantation: a systematic review and meta-analysis
Authors: Yan Fangran , Zhou Zenghua , Du Xueke , He Sheng , Pan Linghui
Published: February 2025

Acute kidney injury (AKI) is associated with poor prognosis. New biomarkers, like neutrophil gelatinase–associated lipocalin (NGAL), are helpful for early warning of AKI. This study aims to investigate the accuracy of NGAL in evaluating the perioperative AKI of liver transplantation. The four databases, PubMed, Web of Science, Embase, and Cochrane Library, were searched for relevant studies published from database inception to August 2023. Results were pooled using random-effects models, and heterogeneity was examined. A total of 16 case–control studies with 1271 patients were included. The results showed that both preoperative [standardized mean difference (SMD) = 0.53; 95% confidence interval (CI): 0.15, 0.91; P < 0.001] and postoperative NGAL levels (SMD = 0.63; 95% CI: 0.24, 1.03; P < 0.001) were higher in the AKI group compared with the non-AKI group. Subgroup analysis by continents showed higher preoperative NGAL levels in AKI patients in the European population (SMD = 1.63; 95% CI: 0.55, 0.27; P = 0.003), but no differences in Asian, African, North American, and South American. Subgroup analysis by continents revealed higher postoperative NGAL levels in the European (SMD = 1.63; 95% CI: 0.55, 0.27; P = 0.002) and Asian populations (SMD = 0.42; 95% CI: 0.04, 0.81; P = 0.039). Higher postoperative NGAL levels in plasma and urine were observed in AKI patients compared with non-AKI patients [plasma (SMD = 1.29; 95% CI: 0.21, 2.38; P = 0.011), urine (SMD = 0.88; 95% CI: 0.18, 1.59; P = 0.035)], while there was no difference in African, North American, South American, and serum NGAL. NGAL level may be an important biomarker for early detection of AKI in the perioperative period of liver transplantation.
The causes, and impact, of colonoscopic perforation for endoscopists: lessons from a qualitative interview study
Authors: Derbyshire Edmund , Brown Sally , Hungin Sir Pali , Dobson Christina , Rutter Matthew D.
Published: February 2025

Introduction

Safety and the avoidance of adverse events are crucial in patient care. A number of explanatory variables for the serious adverse event of colonoscopic perforation have been identified; however, the context in which perforation occurs has largely been overlooked, as too has the subsequent impact on the colonoscopist. This study examined the human and environmental factors associated with colonoscopic perforations, along with colonoscopists’ reactions to these, with a view to informing strategies for safer practice and clinician support.

Methods

This qualitative study explored the experiences of colonoscopists who reported a previous colonoscopic perforation. Semi-structured interviews were undertaken with 11 colonoscopists, recruited through professional networks. Interviews were recorded and transcribed and analysed using a framework approach.

Results

Human and environmental factors contributing to perforation included colonoscopist fatigue, time pressure and equipment failure. Four distinct stages were identified in colonoscopists’ reactions to perforation: ‘The Perforation Realisation’ comprising a range of strong and powerful emotions; ‘The Consequences’ involving feelings of personal responsibility, self-blame, fear of repercussion and vulnerability; ‘Acceptance and Refocus’ comprising a period of coming to terms with the perforation; and finally ‘Reflection and Learning’ where the colonoscopist reflected on the case and applied learning to their future practice.

Conclusion

This study examines colonoscopists’ personal experiences of perforations. It identifies the stages that colonoscopists experience after causing a perforation, and some of the broader contextual factors that can lead to these potentially preventable adverse events. The data suggest the need for greater emotional and pastoral support for endoscopists when such events occur.
Examining Women’s Self-Management Strategies for Recurrent Bacterial Vaginosis in New York City
Authors: Davis Alissa , Sun Yihang , Chitnis Julia , Brenner Rachel , Landers Sara , Pathela Preeti , Crawley Addie , Ashmore Mary
Published: February 2025

Introduction

Bacterial vaginosis (BV) is the most prevalent vaginal condition among women, yet limited data exist on how women manage recurring BV and their perceptions of BV triggers. This study aimed to explore women’s experiences with BV onset and recurrence, the various self-treatment strategies used, and adherence to medication regimens.

Methods

From March 2020-May 2022, we recruited females at birth ages ≥18 years, who had received a BV diagnosis within the past year at one of four New York City Department of Health and Mental Hygiene (NYC DOHMH) sexual health clinics (SHCs) to take part in semi-structured interviews.

Results

A total of 41 women participated, with over half (n = 23) from the SHC in the Bronx.

Most women identified as non-Hispanic or Hispanic Black (n = 32), and nearly a quarter as bisexual (n = 8). Women cited sexual (e.g., partner infidelity) and non-sexual (e.g., diet, perfumed soaps) triggers for BV recurrence. To reduce BV recurrence, women reported engaging in self-management strategies like dietary and hygiene changes, including some practices (e.g., increased douching) that are known to exacerbate BV. Some women reported low adherence to the seven-day metronidazole pill regimen, primarily due to side effects.

Discussion

Findings highlight self-management strategies women use to reduce BV recurrence and indicate further education about which strategies may be helpful or harmful is needed. Some patients may need additional BV medication adherence support for multi-day dosing of oral metronidazole or access to alternate treatment regimens.
Improving Time to First Feeding for Preterm Infants: A Quality Improvement Approach
Authors: May Molly F. , McKinney Melissa L. , Cestare Danielle , Hussey Alicia , Zevallos Alvaro Barboza , Garber Samuel , Posencheg Michael A. , Puopolo Karen M. , Mukhopadhyay Sagori
Published: February 2025

Introduction:

Early initiation of enteral feeding is reported to reduce sepsis and mortality in preterm infants. Less than half of stable infants born <35 weeks gestational age with birth weight <2,000 g are fed within 24 hours of birth at our center.

Methods:

The Specific, measureable, achievable, relevant, timely aim of this quality improvement project was to increase the initiation of enteral feeding within 24 hours of birth from 49% (baseline) to 75% among infants born <35 weeks gestational age with birth weight <2,000 g between November 2022 and December 2023. We identified the unavailability of a mother’s own milk as a major barrier to early feeding initiation. Project interventions included antenatal lactation consultation, patient-dedicated breast pumps, standardized feeding orders, and multidisciplinary education. The outcome measure was the time to first enteral feeding, and the balancing measures were the diagnosis of necrotizing enterocolitis (NEC) and the use of formula for first feeding.

Results:

The proportion of infants with feeding initiated within 24 hours of birth increased from 49% to 80% during the project period. The incidence of NEC was unchanged (1.9% before and during the project period). Both before and during the project, feedings were most frequently initiated with pasteurized donor human milk (49.7% versus 58.7%), followed by mother’s own milk (37.8% versus 35.6%) and formula (12.5% versus 5.8%).

Conclusions:

This quality improvement project increased the proportion of eligible infants fed within 24 hours of birth without a change in the incidence of NEC or an increase in formula use as first feeding.