bluuebunny/crossref_metadata_2025 huggingface dataset:
An Omitted Variable Bias Framework for Sensitivity Analysis of Instrumental Variables
Authors: Cinelli Carlos , Hazlett Chad
Published: January 2025

We develop an omitted variable bias framework for sensitivity analysis of instrumental variable estimates that naturally handles multiple side-effects (violations of the exclusion restriction assumption) and confounders (violations of the ignorability of the instrument assumption) of the instrument, exploits expert knowledge to bound sensitivity parameters, and can be easily implemented with standard software. Specifically, we introduce sensitivity statistics for routine reporting, such as (extreme) robustness values for instrumental variables, describing the minimum strength that omitted variables need to have to change the conclusions of a study. Next we provide visual displays that fully characterize the sensitivity of point estimates and confidence intervals to violations of the standard instrumental variable assumptions. Finally, we offer formal bounds on the worst possible bias under the assumption that the maximum explanatory power of omitted variables is no stronger than a multiple of the explanatory power of observed variables. Conveniently, many pivotal conclusions regarding the sensitivity of the instrumental variable estimate (e.g. tests against the null hypothesis of zero causal effect) can be reached simply through separate sensitivity analyses of the effect of the instrument on the treatment (the first stage) and the effect of the instrument on the outcome (the reduced form). We apply our methods in a running example that uses proximity to college as an instrumental variable to estimate the returns to schooling.
Prevalence, incidence and mortality of inflammatory bowel disease in the Netherlands: development and external validation of machine learning models
Authors: van Linschoten Reinier C A , van Leeuwen Nikki , van Klaveren David , Pierik Prof Marieke J , Creemers Rob , Hendrix Evelien M B , Hazelzet Prof Jan A , van der Woude Prof C Janneke , West Rachel L , van Noord Desirée
Published: January 2025

Background and aims

Large registries are promising tools to study the epidemiology of IBD. We aimed to develop and validate machine learning models to identify IBD cases in administrative data, aiming to determine the prevalence, incidence, and mortality of IBD in the Netherlands.

Methods

We developed machine learning models for administrative data to identify IBD cases and classify them on subtype and incidence year. Models were developed in a population-based cohort and externally validated in a hospital cohort. Models were evaluated on Brier score, area under the receiver operating characteristic curve (AUC), calibration, and accuracy. The best models were used to determine the epidemiology of IBD in the Netherlands between 2013 and 2020.

Results

For identifying IBD cases the random forest model was best (AUC: 0.97, 95% CI [0.96; 0.97]). The gradient boosted trees model for subtype was best (accuracy: 0.95, 95% CI [0.94; 0.95]) as was the random forest model for incidence year (0.88, 95% CI [0.86; 0.89]). The prevalence of IBD in the Netherlands was 577.6 (95% CI [566.7; 586.2]) per 100,000 on December 31, 2020, with varying prevalence across the Netherlands. Incidence of IBD was 20.1 (95% CI [18.0; 22.3]) per 100,000 in 2020 and stable over time. Mortality rates of IBD patients rose over time and were 11.6 (95% CI [10.5; 11.8]) per 1,000 in 2020 as compared to 9.5 in the general population.

Conclusion

IBD cases can be accurately identified using administrative data. The prevalence of IBD in the Netherlands is increasing slower than expected, suggesting a trend towards the epidemiological stage of Prevalence Equilibrium.
New ways to use imaging data in cardiovascular research: survey of opinions on federated learning and synthetic data
Authors: Williams Michelle C , MacArthur Jacqueline , Forsyth Ross , Petersen Steffen E
Published: January 2025

Introduction

Federated learning and the creation of synthetic data are emerging tools which may enhance the use of imaging data in cardiovascular research. This study sought to understand the perspectives of cardiovascular imaging researchers on the potential benefits and challenges associated with these technologies.

Methods

The British Heart Foundation Data Science Centre conducted a series of online surveys and a virtual workshop to gather insights from stakeholders involved in cardiovascular imaging research about federated learning and synthetic data generation.

Results

The federated learning survey included 67 respondents: 18% (n=12) were currently using federated learning, 4% (n=3) had previously used it, 31% (n=21) were planning to use it, and 46% (n=31) were neither using nor planning to use it. Highlighted benefits included data privacy and enhanced collaboration, while challenges included data heterogeneity and technical complexity. The synthetic data survey had 22 respondents: 50% (n=11) were currently using synthetic imaging data, 36% (n=8) expressed interest in using it, and 14% (n=3) thought it should not be used. Among the respondents, 50% had created synthetic imaging data and 45% had used it in cardiovascular research. Advantages cited included privacy preservation, increased dataset size and diversity, improved data access, and reduced administrative burden. Concerns included potential biases, trust issues, privacy concerns, and the fact that the images were not real and may have limited diversity or quality.

Conclusion

Federated learning and synthetic data offer opportunities for advancing cardiovascular imaging research by addressing data privacy concerns and expanding data availability. However, challenges must be addressed to realise their full potential.
On the Distribution of the Error Terms in the Divisor and Circle Problems
Authors: Lamzouri Youness
Published: January 2025

We study the distribution functions of several classical error terms in analytic number theory, focusing on the remainder term in the Dirichlet divisor problem $\Delta (x)$. We first bound the discrepancy between the distribution function of $\Delta (x)$ and that of a corresponding probabilistic random model, improving results of Heath-Brown and Lau. We then determine the shape of its large deviations in a certain uniform range, which we believe to be the limit of our method, given our current knowledge about the linear relations among the $\sqrt{n}$ for square-free positive integers $n$. Finally, we obtain similar results for the error terms in the Gauss circle problem and in the second moment of the Riemann zeta function on the critical line.
Evolutionary changes in the ovipositor shape of xyelid sawflies (Hymenoptera: Xyelidae) revealed by early fossils
Authors: Oyama Nozomu , Maeda Haruyoshi , Rasnitsyn Alexandr P , Shinoda Kenji , Takahashi Humio , Béthoux Olivier
Published: January 2025

Considering taxonomic diversity, extant xyelid sawflies represent a very small subset of the past diversity of the group. A complementary approach to investigate evolutionary changes in this family is to consider ovipositor morphology, an ecologically important organ. New, well-preserved specimens from the Upper Triassic Ominé locality (Momonoki Formation, Mine Group; Carnian; Japan) and belonging to the †Madygellinae, one of the earliest Xyelidae subfamilies, are newly described and assigned to four new species, belonging to three genera (one being new). Two of the specimens expose body parts and wings, providing important information regarding ovipositor morphology. To further appreciate the evolution of this organ, we surveyed both fossil and extant Xyelidae. Extant forms display both extremes of the range of ovipositor types, namely the high aspect ratio “dagger-like” and “needle-like” types (in Xyelinae) and the low aspect ratio “short and wide” type (in Macroxyelinae). All known Triassic representatives display high aspect ratio ovipositor types. In contrast, Middle Jurassic to Lower Cretaceous sawflies show the highest diversity of ovipositor types for the family. Afterwards, the observed range declined and concentrated on the two, very distinct types known nowadays. Decline in ovipositor disparity was not contemporaneous in Xyelinae and Macroxyelinae: specialization occurred during the Jurassic-Cretaceous transition for the Xyelinae, while Macroxyelinae displayed their peak of diversity during the Lower Cretaceous, with a postponed decline. Ovipositor shape transition was probably accompanied with a larval diet change in Macroxyelinae. Ovipositor disparity therefore further contributes depicting extant Xyelidae as a subset on a once more diverse group.
Hardcore music ontologies
Authors: Mahoney Tim
Published: January 2025

Hardcore increases the speed, intensity, and contradictions of punk rock. Considering prevailing theories of rock music ontologies in the light of hardcore art practices provides reasons to rethink what we thought. Hardcore shows how recording-centered ontologies, underemphasizing what goes into playback, miss the materiality of some recording artworks. Hardcore art practices also show how performance-centered ontologies force us to divorce the played music from its full, embodied performanced artwork. In both cases, I highlight hardcore art practices and how they conceive of artworks in a more multi-faceted fashion than either predominant view can fully capture.
Defective HIV-1 DNA pol sequences are not associated with HIV-1 DNA levels and drive most APOBEC-context drug resistance mutations
Authors: Alidjinou Enagnon Kazali , Coulon Pauline , Tetart Macha , Guigon Aurélie , Diarra Ava , Aissi Emmanuelle , Bazus Hélène , Derdour Vincent , Meybeck Agnès , Viget Nathalie , Hober Didier , Bocket Laurence , Robineau Olivier
Published: January 2025

Introduction

The specificity of HIV-1 DNA genotypic resistance tests (GRTs) is hampered by the detection of the APOBEC-context drug resistance mutations (AC DRMs), usually harboured by replication-incompetent proviruses. We sought factors associated with defective sequences in the HIV-1 pol region. In addition, AC DRMs and their link with defective sequences were investigated.

Methods

We included ART-treated patients with viral suppression or plasma viral load (VL) lower than 200 copies/mL, who underwent HIV-1 DNA genotyping, with successful sequencing of protease (PR), reverse transcriptase (RT) and integrase (IN) regions. Sequencing was performed using either the Sanger method or the Sentosa® NGS approach with a 20% cut-off. All hypermutated sequences and/or those containing at least one stop codon were considered defective.

Results

A total of 613 HIV-1 DNA GRTs were analysed. Defective sequences were identified for 186 samples (30.3%) including 65 PR sequences, 92 RT sequences and 65 IN sequences. No association, including HIV-1 DNA levels, was found with the detection of defective pol sequences. A total of 226 AC DRMs were recorded in all sequences. Most of these mutations (78%) were harboured by defective sequences. AC DRMs did not emerge in the plasma viral population, and likely do not impact the virological response to ART.

Conclusions

Defectives pol sequences were not associated with HIV-1 DNA levels and harboured most of the AC DRMs. Such mutations likely have no clinical impact, and should not be reported in routine practice. Consensus guidelines for reporting HIV-1 DNA GRTs are needed, especially for the assessment and management of AC DRMs.
Assessing the Effects of Immune Checkpoint Inhibitors on Bone Utilizing Machine Learning-assisted Opportunistic Quantitative Computed Tomography
Authors: Matheson Bryn E , Jaremko Jacob L , Dowhanik Alexandra , Gill Jasmine , Gallant Cassandra , Walker John , Armani Nathan , Leslie William D , Kolinsky Michael , Boyd Steven K , Ye Carrie
Published: January 2025

Immune checkpoint inhibitors (ICI) are widely used in cancer treatment, yet their impact on bone health remains unclear. This study aimed to perform a retrospective cohort study utilizing routine computed tomography (CT) scans from patients with melanoma to perform opportunistic quantitative CT (QCT) analysis to investigate the effects of ICI treatment on skeletal health, including volumetric bone mineral density (vBMD) measurements and osteoarthritis (OA) parameters. A previously established machine-learning assisted opportunistic QCT pipeline was used to estimate lumbar spine vBMD from baseline and 12-month follow-up CT scans in patients with melanoma treated with ICI therapy and those not treated with ICI therapy. Facet joint OA, osteophyte formation and endplate sclerosis was also graded. Independent and paired t tests were used to determine any differences in vBMD and OA parameters between ICI users and non-ICI users. Multivariable linear regression models were used to control for confounding variables. Non-ICI users had a significant decrease in vBMD of -6.96 mg/cm3 from baseline to follow-up, whereas the ICI users had no significant change. There was a significant difference in change in vBMD from baseline to follow-up between the two groups, with the non-ICI users experiencing a 11.22 mg/cm3 larger decrease in vBMD. After adjusting for baseline age, sex, baseline vBMD and change in OA parameters, this difference remained significant at -13.04 mg/cm3. Among the ICI users, those who had a decline in vBMD had a lower baseline vBMD compared to those who increased vBMD. Neither group showed a significant change in OA parameters over the follow-up period, nor a difference in change between ICI and non-ICI users, even after adjusting for sex, age and baseline OA parameters. While the effects of ICI treatment on vBMD may vary based on baseline bone health, ICIs do not significantly impact OA parameters in the short term.
Adverse events, success, and tolerability of biliary endoscopic retrograde cholangiopancreatography with conscious sedation vs anaesthesia: a multi-centre prospective study
Authors: Smith Zachary L , Kayal Ahmed , Ruan Yibing , Lethebe Brendan Cord , Siersema Peter D , Padrón Alejandra Tepox , Alshammari Yousef , Samnani Sunil , Koury Hannah F , Chau Millie , Howarth Megan , Cartwright Shane , Brenner Darren R , Tavakkoli Anna , Keswani Rajesh N , Elmunzer Badih Joseph , Wani Sachin , Forbes Nauzer ,   CReATE Working Group, Chen Yen-I , Barkun Alan N , Singh Andrew , Hookey Lawrence , Arya Naveen , Calo Natalia Causada , Grover Samir C , Lei Yang , Li Suqing , Mohamed Rachid , Turbide Christian , Bishay Kirles , Gonzalez-Moreno Emmanuel , Meng Zhao Wu , Heitman Steven J
Published: January 2025

Background and Aims

Endoscopic retrograde cholangiopancreatography (ERCP) is performed using anaesthesia or conscious sedation, though the effectiveness, adverse events (AEs), and tolerability of each approach remain unclear. Thus, we compared these approaches prospectively.

Methods

We performed a multi-centre prospective cohort study including patients with native papillae undergoing ERCP for biliary indications between 2018 and 2023. The primary outcome was sedation-related AEs, defined as sustained hypoxaemia or hypotension, unplanned mask ventilation or intubation, vasopressor or reversal agent use, cardiorespiratory arrest, or death. Secondary outcomes included other AEs, technical success measures, and patient-reported tolerability using a validated scale. Multivariable logistic regression was performed in addition to propensity score-matched analyses.

Results

At 8 centres, a total of 3174 first-time biliary ERCPs were performed, 433 (13.6%) employing anaesthesia. Nine sedation-related AEs occurred with conscious sedation (0.3%), while 2 (0.5%) occurred with anaesthesia (odds ratio, OR, 0.35, 0.07-2.37). Only 25 (0.9%) conscious sedation-supported ERCPs were aborted due to the inability to appropriately sedate patients. There were no significant differences in other AE rates, cannulation success, time, or attempts, use of pre-cut or needle-knife access methods, or inadvertent pancreatic duct cannulation. Odds of significant patient-reported intra-procedural awareness and discomfort were both higher with conscious sedation (ORs 16.19, 4.81-54.53, and 21.25, 4.44-101.61, respectively). Propensity score-matched analyses yielded no differences in any outcome compared with primary analyses.

Conclusions

Routine biliary ERCP is equally safe and effective with conscious sedation (vs anaesthesia). Given regional resource limitations, conscious sedation is justified as a primary option for routine biliary ERCP.
Translating Fairtrade. Contact zones and discursive power in the global production network of certified Darjeeling tea
Authors: Wenner Miriam , Heidler Andri
Published: January 2025

The mechanisms through which voluntary sustainability standards (VSS) become effective as means of private governance and how they influence power relations in global production networks (GPNs) of certified goods are not well understood. Focussing on the last mile of VSS’ travel, we scrutinize the discursive dimension of power as it operates through the translation of Fairtrade in a local contact zone, namely Fairtrade trainings with workers at Indian tea plantations. Drawing on insights from postcolonial translation studies and actor-network-theory we show that the ways in which VSS are translated by cultural brokers are critical to processes of (dis)empowerment of workers. By showing how translation informs discursive power, our research offers a novel framework to unpack the power structures associated with private regulation as set within the context of multi-polar governance structures and the postcolonial legacies of places.
Laparoscopic surgery for giant retroperitoneal lymphangioma: a case report
Authors: Zhu Shengchang , Pan Jinggang
Published: January 2025

This case report describes a 66-year-old male diagnosed with a giant retroperitoneal lymphangioma, presenting with an abdominal mass confirmed via magnetic resonance imaging (MRI). Laparoscopic surgery was successfully performed to excise the mass, with histopathological examination confirming the diagnosis. The patient’s postoperative recovery was uneventful, with no signs of recurrence or metastasis observed at the three-month follow-up. This case underscores the feasibility and advantages of utilizing laparoscopic techniques in the management of large retroperitoneal lymphangiomas.
Perforator plus supraclavicular flap for reconstruction following resection of extensive recurrent basal cell carcinoma of face: a case report
Authors: Thapa Anup , Luitel Prajjwol , Paudel Sujan , Shrestha Asim , Sharma Ankit
Published: January 2025

Basal cell carcinomas are common facial malignancies with minimally invasive treatment approaches effective in the majority of cases. Recurrent aggressive lesions pose significant challenges and need wide local excision with major reconstruction. Geriatric patient with multiple comorbidities needs customized reconstructions to minimize morbidity. We present a case of longstanding invasive confluent basal cell carcinoma involving right cheek, ear lobule, and retroauricular area. The perforator plus variant of supraclavicular flap was successfully used for closure of the large defect.
Courting controversy? The constitutional implications of the Court of Justice of the European Union’s involvement in the resolution of disputes after Brexit
Authors: O’Connor Niall , Karatzia Anastasia , Konstadinides Theodore
Published: January 2025

The article sheds light on the under-discussed, but nonetheless constitutionally significant issue of the changing landscape for dispute resolution between the United Kingdom (UK) and the European Union (EU) post-Brexit. This pertains, in particular, to the Court of Justice of the European Union’s (CJEU) likely involvement in the resolution of disputes between the two parties across the arrangements governing both the UK’s withdrawal from and future relationship with the EU. The authors explore the dispute resolution mechanisms under the Withdrawal Agreement and the Trade and Cooperation Agreement (TCA), as well as the Court’s ‘legacy role’ in relation to (former) EU law concepts beyond the confines of the two Agreements. This article thereby evaluates the constitutional importance of the future role of the CJEU as a dispute settlement forum in these contexts, including the relationship between sources of ‘norms’ and the extent to which the UK will remain subject to its jurisdiction, or at least its influence, in the long term, whether directly or indirectly. It is argued that the CJEU’s influence, as well as the authority of EU law in the UK more generally, is now mediated through domestic law concepts, such as the recently devised concept of ‘assimilated EU law’, which replaces ‘retained EU law’, and which have the capacity to obfuscate the constitutional origins and thereby the constitutional legacy of EU-derived concepts. The article further contends that the ostensibly restricted involvement of the CJEU in the UK–EU relationship after Brexit must be appraised through the prism of the Withdrawal Agreement and TCAs’ provisions, which possess uniform legal force in both jurisdictions. The Agreements indicate a more expansive and enduring constitutional role for the CJEU and EU law concepts broadly speaking, than the one the then UK Government has publicly conceived. Consequently, a notable dissonance emerges between the political objective of ‘taking back control’ and the reality created by the legal framework governing the UK’s cooperation with the EU including the mechanism for resolving future disputes. Despite Brexit, the CJEU will continue to shape the constitutional contours of the relationship between domestic and Union law as well as between domestic sources of law, for many years to come.
Origins and Distribution of Panicum Mosaic Virus and Sugarcane Mosaic Virus on Stenotaphrum secundatum in Australia
Authors: Tran Nga T. , Teo Ai Chin , McTaggart Alistair R. , Campbell Paul R. , Persley Denis M. , Thomas John E. , Geering Andrew D. W.
Published: January 2025

Stenotaphrum secundatum is a premium turf grass in warm temperate and subtropical regions of the world and is the most important turf species in Australia based on the value of its production. A new disease called buffalo grass yellows (BGY) has become a problem on turf farms in Australia. We surveyed turf farms in New South Wales (NSW), Queensland (Qld) and Western Australia to determine whether panicum mosaic virus (PMV) and sugarcane mosaic virus (SCMV) were associated with BGY. PMV was only found on three farms, two located in the Hawkesbury Valley near Sydney, and a third at Echuca, about 800 km to the southwest of the former location. SCMV was more prevalent, present in all major cultivars and states surveyed. We analyzed phylogenetic relationships for SCMV and found that isolates infecting S. secundatum in Australia belonged to three clades. The first included Australian isolates typical of the population of viruses circulating in Digitaria didactyla. The second included a single NSW isolate from S. secundatum ‘SS100’ that grouped with otherwise American isolates of SCMV recorded in S. secundatum and Saccharum officinale from Florida, and Zea mays from Ohio. Finally, an isolate of SCMV from S. secundatum originating from a turf farm in southeast Qld grouped with viruses mostly infecting maize; this record is potentially the first maize-adapted strain of SCMV in Australia. Our study sheds light on the aetiology of the BGY disease syndrome and invasion history of PMV and SCMV in Australia.
The Benefits of Hearing Aids for Adults: A Systematic Umbrella Review
Authors: Tang Diana , Tran Yvonne , Bennett Rebecca J. , Lo Charles , Lee Jien Nien , Turner Jessica , Gopinath Bamini
Published: January 2025

Objectives:

This umbrella review aims to summarize the major benefits of hearing aid usage in adults by synthesizing findings from published review articles.

Design:

A comprehensive search of databases, including MEDLINE, EMBASE, PsycINFO, and Google Scholar, was conducted. The search was limited to English-language review articles published between 1990 and 2023, focusing on hearing aid outcomes in at least 5 adults (aged ≥18 years). Two researchers independently screened titles, abstracts, and full-text articles, and conducted a quality assessment using the Joanna Briggs Checklist for Systematic Reviews and Research Syntheses. A third researcher was involved in discussions with the 2 researchers to resolve conflicts during the screening and quality assessment stages.

Results:

Eleven articles were included in this review. There were three systematic reviews with meta-analysis and eight systematic reviews without meta-analysis. The quality assessment indicated that articles scored between 6 and 11 out of a total of 11 criteria. Three articles met all quality criteria. Study participants tended to be middle-aged (≥40 years) or older adults (≥65 years). Participant gender was less clear as this was not consistently reported but appeared to favor men. This umbrella review found that speech perception, communication function, hearing handicap, and self-assessed hearing aid benefit were consistently positively associated with hearing aid use in the analysis of included studies. Hearing handicap was the most frequently reported outcome with evidence from four different studies supporting its mitigation with hearing aid use. There was insufficient evidence in terms of benefit on balance, cognitive function, depression, tinnitus, loneliness, and social isolation. There was conflicting evidence on the impact of hearing aid use on quality of life. Among eligible studies, there were no reports of negative impacts of hearing aid use.

Conclusions:

There are a number of potential benefits associated with hearing aid use. However, this review found that there was a clear lack of high-quality evidence and limited use of robust study design to support the benefits of hearing aids on other outcomes such as quality of life and cognition. Inconsistent use and interpretation of various outcome measures makes it difficult to produce homogenous data which is needed to make more conclusive statements about the benefits of hearing aids.
Acceptance of Virtual Reality Training for Chemotherapy Administration Among Nursing Students
Authors: Chang Chia-Lun , Tsai Shu-Chun , Lu Chi-Yu , Chan Chia-Jung , Huang Tsai-Wei , Gautama Made Satya Nugraha
Published: January 2025

Virtual reality technology offers an extended and repeatable environment for delivering digital learning and training. This study investigated the acceptance of a smartphone virtual reality training program among nursing students for chemotherapy administration using a modified Technology Acceptance Model. The teaching materials for the chemotherapy administration process were designed using smartphone virtual reality to provide prelicensure students with an opportunity to learn procedural steps in a controlled, risk-free environment. A total of 56 nursing students, both undergraduate and postbaccalaureate, participated in the virtual reality training and completed questionnaires assessing their perceptions of usefulness, ease of use, and intention to use the technology. Three factors of the modified Technology Acceptance Model had positive correlations with the overall complexity of chemotherapy (skill complexity): perceived usefulness (r = 0.27, P = .04), perceived ease of use (r = 0.27, P = .04), and intention to use (r = 0.38, P = .004). No significant correlation was observed between attitude toward use and skill complexity. In subsequent path analysis, the model explained 63.4% of the variance in the intention to use virtual reality. Positive correlations were found for five hypotheses: perceived usefulness (γ = 0.586) and age (γ = 0.244) with attitude toward use, perceived ease of use with perceived usefulness (γ = 0.749), and perceived usefulness (γ = 0.595) and skill complexity (γ = 0.176) with intention to use. Nursing students showed a high willingness to learn and practice through virtual reality, particularly when techniques and skills were inherently difficult or dangerous. This suggests that virtual reality can be an effective teaching medium for complex and high-risk procedures in nursing education.
Multiplex Polymerase Chain Reaction Versus Standard Bacterial Culture in Critically Ill Children With Suspected Pneumonia
Authors: Osborne Christina M. , Ambroggio Lilliam , Langelier Charles , Silviera Lori , Wagner Brandie D. , Yehya Nadir , Levy Robert , Carpenter Todd C. , Simões Eric A. F. , Maddux Aline B. , Leroue Matthew K. , Tsitsiklas Alexandra , Mick Eran , Williamson Kayla , Mourani Peter M. , Dominguez Samuel R.
Published: January 2025

Background:

Bacterial lower respiratory tract infection, particularly ventilator-associated pneumonia (VAP), is a significant cause of morbidity and mortality in children who require mechanical ventilation (MV). Microbiologic diagnosis has relied on bacterial culture, but reverse transcriptase polymerase chain reaction (RT-PCR) with bacterial targets is now available for clinical use. We compared the diagnostic performance of tracheal aspirate (TA) multiplex RT-PCR to culture in children requiring MV with suspected lower respiratory tract infection.

Methods:

This is a secondary analysis of a prospective cohort of children (30 days to 18 years) at a single center requiring MV via an endotracheal tube for >72 hours in whom daily research TAs were collected. TAs were collected within 24 hours of clinically obtained cultures and analyzed by RT-PCR using the Biofire FilmArray Pneumonia Panel and compared with clinical culture results.

Results:

We compared the results of culture to RT-PCR for 56 samples at intubation and 74 samples from patients with suspected VAP. RT-PCR demonstrated increased detection of on-panel bacteria compared with culture (intubation 73.2% vs. 55.3% P = 0.048, suspected VAP 68.9% vs. 58.1%, P = 0.17) and had an overall sensitivity of 93.9%, specificity of 43.2% and negative predictive value of 92.1% for detection of pathogenic organisms. Overall, 33.8% of samples were positive by both methods, and 29.2% were negative by both methods. Two samples were positive by both methods but detected different on-panel organisms between culture and RT-PCR.

Conclusions:

RT-PCR demonstrates high sensitivity and negative predictive value for the detection of on-panel pathogens in respiratory samples from critically ill children requiring MV. RT-PCR use may alter antibiotic prescriptions in this population.
Three cases of hemoglobin M disease in a family lineage: Case report and literature review
Authors: Shen Yuhong , Wang Yue , Xue Lu , Li Chunhuai , He Lili , Wu Shuangshuang
Published: January 2025

Rationale:

This study presents a case of hemoglobin M disease (HMD), a rare inherited disorder characterized by persistent cyanosis and hypoxemia, observed across 3 generations within a single family. The diagnosis of HMD poses significant challenges, particularly in asymptomatic individuals, due to its rarity and the subtlety of its symptoms. Notably, there is a scarcity of reports on methemoglobinemia in pediatric populations, which further complicates early detection and intervention. The primary objectives of this study are to enhance awareness of HMD, to advocate for accurate diagnosis and timely treatment, and to underscore the necessity of considering this condition in patients with a familial history of cyanosis.

Patient concerns:

A 6-year-old boy presented to our hospital with fatigue and cyanosis in his lips and mouth. Both the child’s mother and grandfather had a history of similar symptoms since their childhood.

Diagnoses:

Diagnosis of hemoglobin M disease.

Interventions:

The patient was treated with vitamin C.

Outcomes:

Genetic testing revealed that the patient and her mother carried the c.190C > T mutation, leading to the p.H63Y amino acid change linked to the methemoglobin (MetHb) mutation. Despite undergoing vitamin C therapy, the patient’s symptoms of cyanosis and fatigue persisted.

Lessons:

Hemoglobin M disease can be readily diagnosed with a delay. Methemoglobinemia should be considered in patients with a family history of cyanosis but no cardiopulmonary disease. Hospital blood gas analysis should include a protocol for detecting methemoglobin, and genetic testing can help confirm the diagnosis.
Recent advances in osteoarthritis research: A review of treatment strategies, mechanistic insights, and acupuncture
Authors: Lou Zhengchi , Bu Fan
Published: January 2025

Osteoarthritis (OA) is a chronic joint condition affecting millions worldwide, characterized by the gradual degeneration of joint cartilage, leading to pain, stiffness, and functional impairment. Although the pathogenesis of OA is not fully understood, the roles of inflammation, metabolic dysregulation, and biomechanical stress are increasingly recognized. Current treatments, including pharmacotherapy, physical therapy, and surgical interventions, aim to alleviate symptoms and improve quality of life, yet they face limitations and challenges. In recent years, researchers have explored a variety of new treatment strategies, such as molecular targeted therapy, biologic treatments, regenerative medicine, and lifestyle modifications, aiming to directly address the root causes and complex mechanisms of OA. This review aims to summarize the latest research advancements to provide fresh perspectives for clinical treatment and lay the foundation for future research and development of treatment strategies for OA.
Investigating the relationship between social media use and the attitudes towards nutrition and body image shame among Iranian female students: A cross-sectional study
Authors: Keyvanpour Sogol , Namazi Masoumeh , Hosseini Fatemeh , Ebrahimi Narges
Published: January 2025

Social media are Internet-based services that allow participation in online communities and exchanges. Considering the high and increasing statistics of the use of social media all over the world and its impact on people’s lives, the present study aimed to determine the relationship between social media and nutritional attitudes and body image shame among Iranian female students. This cross-sectional study was performed on 201 female student of Tehran University of Medical Sciences in Tehran, Iran from May to December 2023. Data collection was done using a paper form. Data collection tools included a questionnaire on demographic information, Jahanbani social media use questionnaire, nutrition attitude questionnaire (EAT-26), and Body Image Shame Questionnaire (BISS). SPSS software version 28 was used for the descriptive analysis of the data, to examine the relationships between the studied variables, and to measure and evaluate the accuracy of the AMOS model. Based on the reported results, the indicator of social media usage had a significant and positive direct effect on the attitude towards nutrition of students (P < .05). Additionally, social media usage had a significant and positive direct effect on the indicator of body image shame of students (P < .05). Furthermore, students’ attitude towards nutrition had a significant and positive effect on the indicator of body image shame of students (P < .001). The findings underscore the need for interventions that address the negative effects of social media on young women’s perceptions of their bodies and their relationship with food. By promoting media literacy, body positivity, and healthy nutritional attitudes, it is possible to mitigate the harmful effects of social media and support the well-being of young women.
Implementation of an Advance Directives Completion Protocol for Hospitalized Patients With Serious Illness
Authors: Onyeike Ifeoma , Smith Amy , Cormack Carrie
Published: January 2025

Despite mandates requiring hospitals to offer advance directives to all patients, many adults do not have advance directives in place at the end of life. This quality improvement project aimed to implement an evidence-based, standardized protocol to increase advance directive completion rates for hospitalized patients with serious illnesses. A preimplementation and postimplementation design was used to evaluate the impact of an educational intervention and advance directive completion protocol. The project was conducted at a midsized urban community hospital in the Northeastern United States. Charts were reviewed for 250 patients with serious, chronic illnesses admitted under family medicine. Over the 11-month project period, advance directive completion rates increased from 21% (17/82) preintervention to 43% (73/168) postintervention, a statistically significant improvement of 22% (P = .001). Protocol compliance rates increased from 0% to 50% (8/16) for nurses and from 17% to 31% (9/52 to 21/68) for resident providers. The results support the use of a standardized advance directive completion protocol, combined with educational sessions, to improve advance directive completion rates for seriously ill patients and safeguard their autonomy at the end of life.
Development and Validation of the Scale of Hypoglycemia Self-Care Behavior in Type 2 Diabetes
Authors: Huang Mei-Chuan , Yang Ya-Ping , Hsiao Hua-Tsen , Lee Mei-Yueh
Published: January 2025

Background

Inappropriate dietary, exercise, and medication self-care behaviors among persons with diabetes can easily trigger hypoglycemia. Clinically, it is necessary to quickly identify high-risk groups for hypoglycemic events to provide targeted hypoglycemia education. However, there is currently a lack of precise tools to assess self-care behaviors related to hypoglycemia.

Objectives

To develop and validate a hypoglycemia self-care behavior scale for evaluating the behaviors of persons with diabetes in handling and preventing hypoglycemic events.

Methods

A cross-sectional study with purposive sampling was conducted to recruit 300 persons with type 2 diabetes who had experienced hypoglycemic events from a medical center and a primary care clinic in southern Taiwan. Data were collected using a structured questionnaire from December 2021 to September 2023.

Results

The original hypoglycemia self-care behavior scale, comprising 26 items, was reduced to 17 items, measuring six factors after exploratory factor analysis. Subsequently, the scale was further refined to 10 items covering four factors through structural equation modeling. The validity and reliability were assessed during this process, and the developed scale was subsequently verified for both. Factor loadings ranged from .50–.97, explaining 76% of the total variance. The four factors included “hypoglycemia recognition and carbohydrate supplementation,” “prevention of hypoglycemia during exercise,” “carbohydrate assessment,” and “seeking medical assistance.” The hypoglycemia self-care behavior scale—developed and validated through structural equation modeling—demonstrates satisfactory model fit, convergent validity, and discriminant validity. Internal consistency was within the range of .73–.94, indicating strong reliability.

Discussion

The hypoglycemia self-care behavior scale not only functions as a tool for the rapid assessment of self-care behaviors during hypoglycemic events by clinical health care professionals but can also serve as reference for hypoglycemia-related health education.
Pressure injury prevention
Authors: Giuffrida Patricia , Thomas Anna L. , David Heather H. , Davila Shannon , Morgan Loretta D.
Published: January 2025

ECRI and the Institute for Safe Medication Practices (ISMP) Patient Safety Organization (PSO) convened an interdisciplinary pressure-injury-prevention safety collaborative to strengthen pressure injury assessment, prevention, and treatment planning. Several teams met over 5 months in 2023 to share knowledge and performance improvement tools. This article discusses the safety collaborative, which provided a learning-system platform for participating teams to develop and share improvement plans under the protection of the PSO and to strengthen their pressure-injury-related action plans.
Cutting out hair discrimination in nursing
Authors: Johns Nakita , Anderson Kahlia
Published: January 2025

There is a gap in knowledge about proper hair care for patients of African, Afro-Caribbean, or any African mixed ancestry with natural or textured hair in healthcare settings. Such knowledge gap could contribute to hair discrimination. This article explores the biological and cultural aspects of hair as well as specific hair care strategies, products, and tools, to educate nurses on providing appropriate care for this population.
Surgical Scheduling Errors During Manual Data Transfer
Authors: Davis Timothy , Ong Tony , Nguyen Terry , Dang Adrienne , Chaganti Anil , Jones Stephanie , Lim Jungjae , Bajaj Akash , Naidu Ramana , Paicius Richard , Khurana Sanjay
Published: January 2025

Background and Objectives:

Retrospective studies examining errors within a surgical scheduling setting do not fully represent the effects of human error involved in transcribing critical patient health information (PHI). These errors can negatively impact patient care and reduce workplace efficiency due to insurance claim denials and potential sentinel events. Previous reports underscore the burden physicians face with prior authorizations which may lead to serious adverse events or the abandonment of treatment due to these delays. This study simulates the process of PHI transfer during surgical scheduling to examine the error rate of experienced schedulers when manually transferring PHI from surgical forms into electronic health records (EHR).

Methods:

Participants (n = 50) manually input PHI from four surgical scheduling forms into a simulated EHR form. Eight critical data points were identified and defined as data that delay claim approvals and payments. Subjects were randomly assigned to either a control (18 minutes) or experimental (10 minutes) group. Transcription errors were flagged to measure the percentage of incorrectly inputted data fields. Two-tailed t-tests were used to determine statistical significance (P < .05).

Results:

100% of subjects in both cohorts had at least one or more errors in every form. The 10-minute cohort had a higher average “critical errors” rate than the 18-minute cohort (P = .03). Of the 200 forms completed, 171 forms contained 1 or more “critical errors,” resulting in a potential 85.5% delay or denial in authorization or payments. The highest incidence of critical errors across all fields occurred with ICD-10 codes, CPT codes, authorization number, procedure, and insurance ID number. As critical errors fields of authorization number and insurance ID often lead to automatic denials, not only are they more susceptible to transcription error due to alphanumeric values but more indicative of delays in treatment.

Conclusions:

These findings reveal a clear “pain point” in the routine scheduling process that leads to authorization and payment denials. With various touch points of manual data transfer in surgical scheduling, data degradation due to human error may compound at each step. Health care institutions should consider adopting digital solutions and investing in training programs to optimize clinical practice efficiency and reduce the possibility of inaccurate manual PHI transfer. Future case studies on denied payments will help further elucidate the economic impact on practices, as well as inform strategic decisions by those who directly handle health care management.
Detectability of Al18F-NOTA-HER2-BCH PET for Nodal Metastases in Patients With HER2-Positive Breast Cancer
Authors: Guo Xiaoyi , Liu Jiayue , Lin Shiyu , Gui Xinyu , Ding Jin , Liu Teli , Zhou Nina , Li Suping , Zhu Hua , Yang Zhi
Published: January 2025

Purpose

The aim of this study was to compare Al18F-NOTA-HER2-BCH and 18F-FDG for detecting nodal metastases in patients with HER2-positive breast cancer on PET/CT.

Patients and Methods

In this retrospective study, 62 participants with HER2-positive breast cancer underwent both Al18F-NOTA-HER2-BCH and 18F-FDG PET/CT. Participants were pathologically confirmed as HER2-positive (IHC 3+ or IHC 2+ with gene amplification on FISH). Three independent readers visually assessed uptake of tracers on imaging. Furthermore, the diagnostic accuracy of nodal metastases was assessed using c-statistics. The lesion uptakes were quantified by SUVmax and target-to-background ratio (TBR) and compared using the general linear mixed model.

Results

The findings showed nodal metastases in 33 (53%) participants, including 45% only with regional nodal metastasis and 55% with nonregional nodal metastasis. On per-patient level, the sensitivity and specificity of Al18F-NOTA-HER2-BCH and 18F-FDG based on the majority reads were 0.97, 0.97, and 0.85, 0.77, respectively. Five participants were visualized only on Al18F-NOTA-HER2-BCH. Seven participants with high uptake only on 18F-FDG PET/CT were confirmed to be inflammatory uptake by pathological results and later imaging follow-up. On per-lesion level, Al18F-NOTA-HER2-BCH PET/CT detected more axillary (98.8% vs 70.2%), extra-axillary (100% vs 61.7%), and nonregional (99.1% vs 67.0%) lymph nodal metastases than 18F-FDG PET/CT. Additionally, Al18F-NOTA-HER2-BCH PET/CT detected more nodal metastases small than 10 mm than 18F-FDG PET/CT (198 vs 125, 99.5% vs 62.8%). The median SUVmax and TBR of regional or nonregional nodal metastases at Al18F-NOTA-HER2-BCH were all higher than those on 18F-FDG (range of median SUVmax, 8.0–11.4 vs 2.3–5.6; P range, <0.001–0.007; range of median TBR, 7.3–16.3 vs 2.9–5.3; P range, <0.001). No adverse reactions related to imaging agents were observed in all participants.

Conclusions

Al18F-NOTA-HER2-BCH PET/CT detected more regional and nonregional lymph nodal metastases in patients with HER2-positive breast cancer than on 18F-FDG PET/CT, especially for lesions small than 10 mm.
Case Report
Authors: Proto Sara , Carrara Lorenzo , Zanoni Lucia , Attard Luciano , Nanni Cristina
Published: January 2025

We present the case of a 60-year-old man admitted to the hospital presenting with high FUO (fever of unknown origin), strong headache, face erythematous-desquamative cutaneous lesions, long history of abdominal pain, and diffuse myalgia. He was also previously treated with immunosuppressants and currently managed with corticosteroids for a seronegative rheumatic disease. Given the immunocompromised state, an infective etiology was suspected. The patient was referred, as part of standard clinical practice, to perform an 18F-FDG PET/CT to identify potential causes of FUO.
Rare Neoplastic Meningitis in Cerebellar Medulloblastoma Detected by PET/CT
Authors: Acar Tayyar Merve Nur , Tamam Müge Öner , Atakır Kadir , Köprülü İbrahim , Vergili Ayşe
Published: January 2025

Neoplastic meningitis, also known as leptomeningeal metastases, is a rare clinical entity seen in less than 1%–2% of primary nervous system tumors. Diagnosis of leptomeningeal metastases is difficult and is achieved by cytologic evidence of malignant cells in cerebrospinal fluid, or demonstration of radiologic abnormality. 18F-FDG PET/CT can detect leptomeningeal metastases before anatomical changes. In this case, a 42-year-old man with cerebellar medulloblastoma underwent surgery and radiotherapy and had FDG uptake in 3 separate locations after 3 months. The findings indicated leptomeningeal metastases, confirmed by MRI. This highlights the role of 18F-FDG PET/CT in detecting leptomeningeal disease postmedulloblastoma treatment.
Small Bowel Leiomyoma Mimics Neuroendocrine Tumor on 68Ga-DOTATATE PET/CT
Authors: Ponna Nikhil Prasanna , Luong Tu Vinh , Navalkissoor Shaunak
Published: January 2025

A 57-year-old man with a 3-month history of lower abdominal pain and rectal bleeding with black stools underwent urgent abdominal CT, which revealed an ovoid hyperdense lesion in the ileum in the right iliac fossa. The prime differential was a midgut neuroendocrine tumor. Thus, the patient was referred for a 68Ga-DOTATATE PET/CT scan, which demonstrated intense activity in this lesion with no evidence of somatostatin receptor expression elsewhere. Surgical small bowel resection later revealed a small bowel leiomyoma, which was confirmed on immunohistochemistry analysis. This case demonstrates that leiomyomas can express somatostatin receptors and can be a false-positive on 68Ga-DOTATATE PET/CT scan.