bluuebunny/crossref_metadata_2025 huggingface dataset:
Critical thinking and misinformation vulnerability: Experimental evidence from Colombia
Authors: List John A , Ramirez Lina M , Seither Julia , Unda Jaime , Vallejo Beatriz H
Published: October 2024

Misinformation represents a vital threat to the societal fabric of modern economies. While skills interventions to detect misinformation such as de-bunking and prebunking, media literacy, and manipulation resilience have begun to receive increased attention, evidence on de-biasing interventions and their link with misinformation vulnerability is scarce. We explore the demand for misinformation through the lens of augmenting critical thinking in an online framed field experiment during the 2022 Presidential election in Colombia. Data from roughly 2.000 individuals suggest that providing individuals with information about their own biases (obtained through a personality test) has no impact on skepticism towards news. But (additionally) showing participants a de-biasing video seems to enhance critical thinking, causing subjects to more carefully consider the truthfulness of potential misinformation.
From the inside out: Were the cuticular Pseudonocardia bacteria of fungus-farming ants originally domesticated as gut symbionts?
Authors: Innocent Tabitha M , Sapountzis Panagiotis , Zhukova Mariya , Poulsen Michael , Schiøtt Morten , Nash David R , Boomsma Jacobus J
Published: October 2024

The mutualistic interaction specificity between attine ants and antibiotic-producing Actinobacteria has been controversial because Pseudonocardia strains cannot always be isolated from worker cuticles across attine ant species, while other actinobacteria can apparently replace Pseudonocardia and also inhibit growth of Escovopsis mycopathogens. Here we report that across field samples of Panamanian species: (i) Cuticular Pseudonocardia were largely restricted to species in the crown of the attine phylogeny and their appearance likely coincided with the first attines colonizing Central/North America. (ii) The phylogenetically basal attines almost always had cuticular associations with other Actinobacteria than Pseudonocardia. (iii) The sub-cuticular glands nourishing cuticular bacteria appear to be homologous throughout the phylogeny, consistent with an ancient general attine-Actinobacteria association. (iv) The basal attine species investigated always had Pseudonocardia as gut symbionts while Pseudonocardia presence appeared mutually exclusive between cuticular and gut microbiomes. (v) Gut-associated Pseudonocardia were phylogenetically ancestral while cuticular symbionts formed a derived crown group within the Pseudonocardia phylogeny. We further show that laboratory colonies often secondarily acquire cuticular Actinobacteria that they do not associate with in the field, suggesting that many previous studies were uninformative for questions of co-adaptation in the wild. An exhaustive literature survey showed that published studies concur with our present results, provided that they analyzed field colonies and that Actinobacteria were specifically isolated from worker cuticles shortly after field collection. Our results offer several testable hypotheses for a better overall understanding of attine-Pseudonocardia interaction dynamics and putative coevolution throughout the Americas.
Positive beliefs about cross-partisan empathy can strengthen Americans’ support for democracy
Authors: Santos Luiza A , Voelkel Jan G , Willer Robb , Zaki Jamil
Published: October 2024

Undemocratic practices, such as voter suppression and election interference, threaten democracies worldwide. Across four studies (N = 4,350), we find that informational and motivational factors drive Americans’ support for such practices. Partisans drastically overestimate how much opponents support undemocratic practices, which decreases people's willingness to defend democracy themselves (S1–S2). One remedy for this dynamic is to inform people about the extent to which their rivals actually support democracy, but in polarized contexts, people are incurious about the true beliefs of outpartisans. To address this, we test a new method for improving democratic attitudes—changing beliefs about cross-party empathy. Empathizing across disagreements can improve connections and boost persuasion. When people learn about these valued consequences of empathic engagement, their curiosity about outpartisans increases (S3), and they choose to learn about opponents’ support for democracy, which reduces their own support for undemocratic practices and politicians (S4). Our findings suggest that fostering support for democracy requires not just informational strategies but also motivational ones. The power of our combined approach comes in that—instead of presenting people with information about outpartisans—it induces them to seek out that information themselves. Together, these results highlight how cross-party empathy beliefs can increase people's curiosity about those they disagree with and disrupt processes of political escalation.
Toward building deliberative digital media: From subversion to consensus
Authors: Pentland Alex , Tsai Lily
Published: October 2024

Evidence-based and human-centric design of digital media platforms could reduce many of the problems of misinformation, polarization, and misaligned incentives that plague both society and individual organizations. With these sorts of design changes, it may become possible to build deliberative digital media that are useful both for discussions of contentious issues and for achieving successful collective action. In this Perspective paper, we discuss several issues in which current-day social science indicates the origin of these problems and suggests methods for improvement. Finally, we analyze a popular deliberative democracy platform to illustrate how social science might enable design of next-generation digital media suitable for democratic deliberation, and in which generative artificial intelligence might be useful.
Wearable network for multilevel physical fatigue prediction in manufacturing workers
Authors: Mohapatra Payal , Aravind Vasudev , Bisram Marisa , Lee Young-Joong , Jeong Hyoyoung , Jinkins Katherine , Gardner Richard , Streamer Jill , Bowers Brent , Cavuoto Lora , Banks Anthony , Xu Shuai , Rogers John , Cao Jian , Zhu Qi , Guo Ping
Published: October 2024

Manufacturing workers face prolonged strenuous physical activities, impacting both financial aspects and their health due to work-related fatigue. Continuously monitoring physical fatigue and providing meaningful feedback is crucial to mitigating human and monetary losses in manufacturing workplaces. This study introduces a novel application of multimodal wearable sensors and machine learning techniques to quantify physical fatigue and tackle the challenges of real-time monitoring on the factory floor. Unlike past studies that view fatigue as a dichotomous variable, our central formulation revolves around the ability to predict multilevel fatigue, providing a more nuanced understanding of the subject’s physical state. Our multimodal sensing framework is designed for continuous monitoring of vital signs, including heart rate, heart rate variability, skin temperature, and more, as well as locomotive signs by employing inertial motion units strategically placed at six locations on the upper body. This comprehensive sensor placement allows us to capture detailed data from both the torso and arms, surpassing the capabilities of single-point data collection methods. We developed an innovative asymmetric loss function for our machine learning model, which enhances prediction accuracy for numerical fatigue levels and supports real-time inference. We collected data on 43 subjects following an authentic manufacturing protocol and logged their self-reported fatigue. Based on the analysis, we provide insights into our multilevel fatigue monitoring system and discuss results from an in-the-wild evaluation of actual operators on the factory floor. This study demonstrates our system’s practical applicability and contributes a valuable open-access database for future research.
Polarization in multidisciplinary perspective
Authors: Dimant Eugen , Kimbrough Erik O
Published: October 2024

This article provides an introduction to and overview of the articles in the PNAS Nexus Special Feature on Polarization and Trust.
Artificial intelligence in food and nutrition evidence: The challenges and opportunities
Authors: Bailey Regan L , MacFarlane Amanda J , Field Martha S , Tagkopoulos Ilias , Baranzini Sergio E , Edwards Kristen M , Rose Christopher J , Schork Nicholas J , Singhal Akshat , Wallace Byron C , Fisher Kelly P , Markakis Konstantinos , Stover Patrick J
Published: October 2024

Science-informed decisions are best guided by the objective synthesis of the totality of evidence around a particular question and assessing its trustworthiness through systematic processes. However, there are major barriers and challenges that limit science-informed food and nutrition policy, practice, and guidance. First, insufficient evidence, primarily due to acquisition cost of generating high-quality data, and the complexity of the diet-disease relationship. Furthermore, the sheer number of systematic reviews needed across the entire agriculture and food value chain, and the cost and time required to conduct them, can delay the translation of science to policy. Artificial intelligence offers the opportunity to (i) better understand the complex etiology of diet-related chronic diseases, (ii) bring more precision to our understanding of the variation among individuals in the diet-chronic disease relationship, (iii) provide new types of computed data related to the efficacy and effectiveness of nutrition/food interventions in health promotion, and (iv) automate the generation of systematic reviews that support timely decisions. These advances include the acquisition and synthesis of heterogeneous and multimodal datasets. This perspective summarizes a meeting convened at the National Academy of Sciences, Engineering, and Medicine. The purpose of the meeting was to examine the current state and future potential of artificial intelligence in generating new types of computed data as well as automating the generation of systematic reviews to support evidence-based food and nutrition policy, practice, and guidance.
Surface-active microrobots can propel through blood faster than inert microrobots
Authors: Wu Chenjun , Omori Toshihiro , Ishikawa Takuji
Published: October 2024

Microrobots that can move through a network of blood vessels have promising medical applications. Blood contains a high volume fraction of blood cells, so in order for a microrobot to move through the blood, it must propel itself by rearranging the surrounding blood cells. However, swimming form effective for propulsion in blood is unknown. This study shows numerically that a surface-active microrobot, such as a squirmer, is more efficient in moving through blood than an inert microrobot. This is because the surface velocity of the microrobot steers the blood cells laterally, allowing them to propel themselves into the hole they are digging. When the microrobot size is comparable to a red blood cell or when the microrobot operates under a low Capillary number, the puller microrobot swims faster than the pusher microrobot. The trend reverses under considerably smaller microrobot sizes or high Capillary number scenarios. Additionally, the swimming speed is strongly dependent on the hematocrit and magnetic torque used to control the microrobot orientation. A comparative analysis between the squirmer and Janus squirmer models underscores the extensive applicability of the squirmer model. The obtained results provide new insight into the design of microrobots propelled efficiently through blood, paving the way for innovative medical applications.
Wealth Taxation and Household Saving: Evidence from Assessment Discontinuities in Norway
Authors: Ring Marius A K
Published: October 2024

Neither theory nor existing empirical evidence support the notion that wealth taxation reduces saving. Theoretically, the effect is ambiguous due to opposing income and substitution effects. Empirically, the effect may be masked by misreporting responses. Using geographic discontinuities in the Norwegian annual net-wealth tax and third-party-reported data on savings, I find that wealth taxation causes households to save more. Each additional NOK of wealth tax increases annual net financial saving by 3.76, implying that households increase saving enough to offset both current and future wealth taxes. This positive effect on saving is primarily financed by increases in labour earnings. These responses are the combination of small negative effects of increasing the marginal tax rates and larger positive effects of increasing average rates. My findings imply that income effects may dominate substitution effects in household responses to rate-of-return shocks, which has implications for both optimal taxation and macroeconomic modelling.
Identifying and supporting vaccine champions in pediatric primary care: a qualitative interview study
Authors: Kong Wei Yi , Heisler-MacKinnon Jennifer , Oh Nul Loren , McKeithen Mary Catharine , Stalford Samantha R , Brennan Meghan B , Shea Christopher M , Liu Amy , Gottfredson O’Shea Nisha , Ozawa Sachiko , Brewer Noel T , Gilkey Melissa B
Published: October 2024

Implementation science research identifies clinical champions as instrumental in aligning healthcare professionals’ (HCPs) behavior with practice guidelines for delivering health services, including vaccinations. However, we know relatively little about identifying or supporting champions. To characterize who vaccine champions are, what they do, and how to support their work in pediatric primary care. In 2022, we interviewed a purposive sample of peer-nominated or self-identified vaccine champions (n=20) and HCPs who worked with vaccine champions (n=4). We thematically analyzed qualitative data. Vaccine champions’ defining characteristics were firsthand primary care experience, whether as providers or nursing staff, and a strong belief in vaccinations as uniquely effective tools for primary prevention. Participants noted these beliefs were “part of the DNA” of specialties like pediatrics and infectious disease, where they perceived champions as especially common. Being “insatiable in their quest for knowledge,” champions primarily conceptualized their role as understanding and sharing complex information and performance metric data related to vaccine administration. Champions’ role in leading other implementation strategies, such as communication training, was more peripheral. Champions reported that dedicated time and staff support helped them “go above and beyond” to improve vaccination rates. Our findings suggest that vaccine champions can be found among providers and nursing staff with deep clinical experience and commitment to primary prevention through vaccination, including through providing vaccine education to colleagues. Healthcare systems can allocate resources to support champions as educators, while exploring opportunities to extend their role in other implementation strategies to improve vaccination rates.
A Measurement of Aggregate Trade Restrictions and Their Economic Effects
Authors: Estefania-Flores Julia , Furceri Davide , Hannan Swarnali A , Ostry Jonathan D , Rose Andrew K
Published: October 2024

This study develops a new Measure of Aggregate Trade Restrictions (MATR) using data from the IMF's Annual Report on Exchange Arrangements and Exchange Restrictions. MATR is a measure of direct and indirect official government policy related to the international flow of goods and services. MATR is simple, plausible, quantitative, easily updated, based on relevant measures of trade policy and other international restrictions affecting trade (e.g., payment restrictions), and covers an unbalanced sample of up to 157 countries from 1949 to 2019. MATR is strongly correlated with, and—importantly—more comprehensive, in terms of country and time coverage, than existing measures of de jure openness; it is also granular. As such, MATR empowers empirical analysis to increase coverage in research related to trade restrictions and other trade-related openness policies. MATR is used in the study to show that direct and indirect restrictions to trade are associated with significant contractions in output.
Selectivity as discrimination: lessons from the case law on fiscal measures for identifying State aid
Authors: McMahon Christopher
Published: October 2024

Article 107(1) of the Treaty on the Functioning of the European Union was originally designed to regulate the grant of subsidies by Member States, but it has been applied increasingly in recent years to regulate tax measures. Attempts to apply the State aid rules in this way have been met with controversy as they have been applied in unpredictable ways that have introduced significant changes to the existing tests in the case law for identifying State aid. These changes include a broader interpretation of the concept of selectivity, one of the criteria used to identify aid, which has been reoriented around the discrimination standard, whereby a measure is selective if it differentiates between categories of undertakings without being capable of justification by some legitimate public policy objective. Most controversially, this has facilitated the enforcement of the State aid rules against a wider range of State interventions. This article argues that the discrimination standard represents the most plausible and effective way of understanding selectivity among the alternative tests which have been proposed in the case law and academic literature. However, it goes on to identify a significant deficiency in the discrimination standard in the manner in which it is currently applied by the Union courts. The test inevitably requires certain value judgments to be made, but these are not made explicit by the existing case law. This article then proceeds to give further reflections on options for the refinement of the framework for assessing selectivity based on the discrimination standard and the existing logic of the case law and the objectives of the State aid control regime, which indicates how principled and coherent boundaries to the notion of State aid might be assessed in an individual case.
Sestrin2 serves as a scaffold protein to maintain cardiac energy and metabolic homeostasis during pathological stress
Authors: Seale Blaise , Slotabec Lily , Nguyen Jennie D. , Wang Hao , Patterson Cory , Filho Fernanda , Rouhi Nadiyeh , Adenawoola Michael I. , Li Ji
Published: October 2024

Cardiovascular diseases (CVDs) are a leading cause of morbidity and mortality worldwide. Metabolic imbalances and pathological stress often contribute to increased mortality. Sestrin2 (Sesn2) is a stress‐inducible protein crucial in maintaining cardiac energy and metabolic homeostasis under pathological conditions. Sesn2 is upregulated in response to various stressors, including oxidative stress, hypoxia, and energy depletion, and mediates multiple cellular pathways to enhance antioxidant defenses, promote autophagy, and inhibit inflammation. This review explores the mechanisms through which Sesn2 regulates these pathways, focusing on the AMPK‐mTORC1, Sesn2‐Nrf2, and HIF1α‐Sesn2 pathways, among others. We can identify the potential therapeutic targets for treating CVDs and related metabolic disorders by comprehending these complex mechanisms. Sesn2's unique ability to respond thoroughly to metabolic challenges, oxidative stress, and inflammation makes it a promising prospect for enhancing cardiac health and resilience against pathological stress.
Video Review Can Measure Surgical Robotic Skill Development in a Resident Robotic Hernia Curriculum: A Retrospective Cohort Study
Authors: Hays Sarah B. , Al Abbas Amr I. , Kuchta Kristine , Rojas Aram , Ramirez Barriga Melissa , Mehdi Syed Abbas , Haggerty Stephen , Hedberg H. Mason , Linn John , Talamonti Mark , Hogg Melissa E.
Published: October 2024

Background:

Hernia repairs are one of the most common general surgery procedures and an essential part of training for general surgery residents. The widespread incorporation of robotic hernia repairs warrants the development of a procedure-specific robotic curriculum to assist novice surgeons in improving technical skills.

Objective:

To evaluate a robotic hernia simulation-based curriculum for general surgery residents using video review.

Methods:

Retrospective cohort study of PGY-3 general surgery residents from the University of Chicago from 2019 to 2021. The residents completed inguinal hernia repair (IHR) and ventral hernia repair (VHR) drills as part of a robotic simulation curriculum. The drills were recorded and graded according to the modified objective structured assessment of technical skills (OSATS) and time to completion. The drills were completed by 3 attending surgeons to establish gold-standard benchmarks.

Results:

In total, 20 residents started the curriculum, 19 completed all IHR drills and 17 completed all VHR drills. Attending surgeon total OSATS scores and time to completion were significantly better than the trainees on the first attempt (P < 0.05). When comparing 1st to 4th attempt, resident OSATS scores improved significantly for IHR (15.5 vs 23.3; P < 0.001) and VHR (16.8 vs 23.3; P < 0.001). Time also improved over 4 attempts (IHR: 28.5 vs 20.5 minutes; P < 0.001 and VHR: 29.6 vs 21.2 minutes; P < 0.001). Residents achieved attending-level OSATS scores by their fourth attempt for VHR, but not for IHR. Residents did not achieve attending-level times for either hernia drills.

Conclusions:

The robotic hernia curriculum improved resident performance on hernia repair drills and was well-received by the residents.
Thoracolumbar Sagittal Morphology and Segmental Inclination
Authors: Qiu Weipeng , Sun Zhuoran , Zhou Siyu , Chen Zimu , Han Gengyu , Zou Da , Zhao Yi , Chen Ze , Qi Qiang , Li Weishi
Published: October 2024

Study Design.

A cross-sectional cohort study.

Objective.

To present a normative value reference of spinal segmental inclination stratified by age and pelvic incidence (PI), and to clarify the impact of segmental inclination on spinal sagittal morphology.

Summary of Background Data.

Thoracolumbar segmental inclination has been shown to correlate with the clinical outcomes of adult spinal deformity surgery. However, there currently exists no normative value reference in a large sample of asymptomatic population.

Methods.

Asymptomatic adult volunteers were enrolled from the community. All volunteers underwent a standing full-spine anteroposterior and lateral radiograph. Lumbar tilt (LT) and thoracic tilt (TT) were measured to quantify the segmental inclination of the lumbar and thoracic spine. Regional curvature, global balance and thoracolumbar apex were analyzed across different age and PI groups. The correlation between sagittal parameters and age was analyzed using Pearson correlation tests.

Results.

A total of 618 volunteers were included with a mean age of 38.7 ± 17.1 years (range 18 to 82 y). As age increased, the LT and TT significantly increased (P<0.001). The LT was significantly correlated with PI (r=0.410, P<0.001), with the low PI group exhibiting a greater negative LT. The TT remained constant across different PI groups. Compared to the young and middle-age groups, the thoracic apex and lumbar apex were located more caudally in the elderly group (P<0.001). Subjects with a more caudal lumbar apex exhibited a greater negative LT, and those with a more caudal thoracic apex exhibited a greater positive TT.

Conclusion.

The thoracic spine naturally adapts to a relatively neutral position, yet it tends to tilt forward with aging. The physiological lumbar inclination is predominantly determined by the PI value with a slight backward tilt, and tends to counteract the anterior truncal inclination with advanced age. Physiological segmental inclination should be considered in spinal surgical planning.
Cinnamon potential in alleviating early postmenopause symptoms: a randomized clinical trial
Authors: Refaei Mansoureh , Karami Zahra , Kazemi Farideh , Moradkhani Shirin , Masoumi Seyedeh Zahra , Jenabi Ensieh , Jafari Mobina
Published: October 2024

Objective

Menopause is a substantial physical, mental, and emotional transition in a woman's life. Most women suffer symptoms during menopause, impacting their quality of life for a decade or more. This study aimed to determine the effect of cinnamon on the severity of postmenopause symptoms.

Methods

A randomized, triple-blind, parallel clinical trial was conducted on 60 postmenopausal women in the health centers of Hamadan, Iran. The study included women aged 45 to 60 years who were 1 to 3 years after their last menstrual period. The participants were assigned to two groups using a permuted block randomization method. The intervention group received a daily dose of one cinnamon capsule (1 g) for 2 months, whereas the control group received a placebo. The participants, researchers, and statistical analysts were all blinded. The study measured the severity of menopause symptoms using the Menopause Rating Scale before and 2 months later. Data were analyzed using Stata-13 software.

Results

Data from 59 individuals were analyzed. The analyses were adjusted for baseline Menopause Rating Scale scores. After the intervention, the severity of menopause symptoms was lower in the intervention group (13.95 ± 4.16) compared to the control group (16.64 ± 4.16) (P = 0.01), with an effect size of 0.65 (95% CI, 0.12-1.17). Additionally, the intervention group had lower scores for psychological symptoms compared to the control group (P = 0.006), with an effect size of 0.74 (95% CI, 0.21-1.27).

Conclusions

The consumption of cinnamon in postmenopausal women has been found to improve the severity of menopause symptoms, with a particular emphasis on the psychological domain.
Simultaneous Robot-assisted Lipoabdominoplasty and Cholecystectomy
Authors: Borisenko Anastasiya S. , Sharobaro Valentin I. , Vetshev Fedor P. , Avdeev Alexey E. , Bilyalov Ildar R. , Ahmed Alsheikh Yousif M.
Published: October 2024

In the current era of advanced technologies, robotic surgery is rapidly evolving. New articles are emerging on the use of robots in general surgery, urology, and oncology, with single cases in maxillofacial surgery. In this article, we describe the successful use of robotic techniques for simultaneously performing suturing repair of the diastasis of the rectus abdominis muscles, aesthetic correction of the anterior abdominal wall with lipoabdominoplasty, and cholecystectomy. That, according to our knowledge, has not ever been done before.
Prevalence and Association of Deep Vein Thrombosis on Clinical Outcomes Among COVID-19 Patients
Authors: Zhang Vicky , Collins Michael Dylan , Rubens Muni , Saxena Anshul , Ramamoorthy Venkataraghavan , Roy Mukesh , Appunni Sandeep , Doke Mayur , Khosla Atulya Aman , McGranaghan Peter , Chaparro Sandra , Jimenez Javier
Published: October 2024

Background

Studies have shown that COVID-19 could lead coagulation defects, resulting in increased morbidity and mortality. In this study, we sought to estimate the prevalence of deep vein thrombosis (DVT) among COVID-19 hospitalizations and its effects on hospital outcomes using a large administrative database.

Methods

We conducted a retrospective analysis of the 2020 California State Inpatient Database. All hospitalizations ≥18 years and primary diagnosis of COVID-19 were included and were stratified into those with and without DVT. The main outcomes of the study were in-hospital mortality, prolonged length of stay, vasopressor use, mechanical ventilation, and intensive care unit admission.

Results

We included a total of 94,114 primary COVID-19 hospitalizations for the analysis. Among them, 1575 (1.7%) had DVT. After adjusting for covariates, regression analysis showed that those with DVT had significantly greater odds for mortality (adjusted odds ratio [aOR], 2.34; 95% confidence interval [CI], 2.07–2.65), prolonged length of stay (aOR, 3.51; 95% CI, 3.16–3.91), vasopressor use (aOR, 4.23; 95% CI, 3.78–4.74), mechanical ventilation (aOR, 2.90; 95% CI, 2.38–3.53), and intensive care unit admission (aOR, 4.32; 95% CI, 3.85–4.84).

Conclusions

In our cohort, though only a few COVID-19 hospitalizations had DVT, the risk for adverse outcome was significantly higher. Therefore, healthcare providers should promptly monitor for DVT among COVID-19 patients and manage it promptly.
Collaboration to Remove Barriers to Pump Integration With the Electronic Health Record
Authors: Romp Celeste R. , Ross Lori , Baucom Sabrina , Dalmolin Breanna K. , Chang Catherine
Published: October 2024

Background:

The Institute for Safe Medication Practices and The Joint Commission recommend the implementation of bidirectional smart infusion pump interoperability with the electronic health record (EHR) to improve medication safety. However, there are barriers associated with implementation of this process.

Purpose:

The purpose of this process improvement project was to identify, evaluate, and implement improvements in pump integration with the EHR to decrease manual programming and increase the use of the smart pump functions (the dose error reduction system or infusion guardrails).

Methods:

A medication safety task force was formed, and end users were surveyed for barriers. The task force found and implemented solutions to improve the process.

Results:

Infusion pump integration rates for seven hospitals improved from 79.4% to 91.8% (p < .001), and the use of smart pump programming increased from 84.7% to 93.6%.

Conclusions:

Including all stakeholders in the project allowed barriers to be identified and solutions to be implemented. As more healthcare systems implement technology-related processes to improve patient safety, this work can guide medication safety teams on how to optimize technology use by removing barriers to the use of pump integration with the EHR.
Prevalence of Asymptomatic Changes in the Groin Region Among Adult Professional Soccer Players and Their Association With Limb Dominance
Authors: Bezuglov Eduard , Izmailov Sergey , Grinchenko Alesia , Emanov Anton , Shoshorina Maria , Malyakin Georgiy , Telyshev Danila , Lyubushkina Anastasia , Lazarev Artemii , Morgans Ryland
Published: October 2024

Objective:

To investigate the prevalence of asymptomatic radiologic groin region findings in adult professional soccer players using magnetic resonance imaging (MRI) and examine the influence of age and limb dominance on their occurrences.

Design:

Cross-sectional trial.

Setting:

Soccer club medical service, private practice.

Participants:

Forty-seven male professional soccer players.

Interventions:

Players underwent a groin presigning MRI scan with a magnetic field induction of 1.5 Tesla. Image analysis of their pubic bones was performed according to The Copenhagen Standardized MRI protocol to assess the pubic symphysis and adductor regions of players.

Main Outcome Measures:

The prevalence of various changes in the symphysis, pubic bone, and adjacent areas.

Results:

Fifty images of pubic bones and adjacent regions (53.2%) highlighted 1 to 4 changes, while another 44 images (46.8%) demonstrated 5 or more changes. The most frequent changes observed in the pubic bone were joint surface irregularities (100%), symphyseal sclerosis (93.6%), pubic bone swelling (56.3%), parasymphyseal high-intensity line (55.3%), fatty infiltration in bone marrow (38.3%), and adductor tendinopathy (34%). When comparing the prevalence of different changes in the dominant and nondominant limbs, no statistically significant differences were found.

Conclusions:

In adult professional soccer players with no prior groin pain complaints in recent history (12 months), asymptomatic changes are extremely common in the pubic joint and adjacent areas, including those that are very likely to be considered the main cause of pain when investigated in soccer players with groin pain. None of these changes were associated with limb dominance.
Can Trabecular Bone Score Enhance Fracture Risk Assessment in Long-Distance Runners With Bone Stress Injuries?
Authors: Madi Rashad , Khan Sarem , Rajapakse Chamith S. , Khan Amna N. , Temme Kate
Published: October 2024

Objective:

To evaluate the trabecular bone score (TBS) Z scores in long-distance runners with bone stress injuries (BSIs) in whom the bone mineral density (BMD) Z score is more than −1.0 (Aim 1) and whether the number of runners with abnormal TBS Z scores would be higher in those with BSI in trabecular-rich sites as compared with cortical-rich sites (Aim 2).

Design:

Retrospective cohort study.

Setting:

Institutional sports medicine center.

Patients:

We analyzed Z scores derived from the TBS and BMD in 44 long-distance runners aged 18 to 40 years who had sustained BSIs between 2017 and 2023 and undergone a dual-energy x-ray absorptiometry scan with reported TBS measurements within 1 year before or 2 years after their injuries.

Independent Variables:

Bone mineral density and TBS Z scores.

Main Outcome Measures:

Evaluation of BMD and TBS Z scores in long-distance runners with BSIs, further stratified according to cortical-rich and trabecular-rich BSIs.

Results:

Bone mineral density assessments revealed an average Z score of −0.96 ± 0.99. In this cohort of 44 runners, 55% (n = 24) of runners were reported to have BMD Z score more than −1.0. Within this subgroup, 54% (n = 13) displayed abnormal TBS. Stratifying BSIs by trabecular- (n = 23) and cortical-rich (n = 19) sites, we found no significant difference in sex, mean BMD, or the number of runners with abnormal TBS between the 2 groups.

Conclusions:

Trabecular bone score Z scores in sports medicine may provide complementary information to BMD in long-distance runners with BSI, particularly when the BMD Z scores are more than −1.0. However, further research is needed to validate the usefulness of TBS Z scores in this context.

Study Design:

Cohort study.

Level of Evidence:

Retrospective Case Series, IV.
What Psychological Factors Affect Return to Sports After Shoulder Stabilization Surgery? A Scoping Review
Authors: Velasquez Garcia Ausberto , Caballero Gabriel , Chaney Grace K. , Marinakis Katina , Orizola Alejandro
Published: October 2024

Objective:

Despite excellent functional outcomes after shoulder stabilization surgery, a substantial number of patients fail to return to sports (RTS) at the preinjury level. The psychological factors affecting RTS postsurgery have been underexplored. This scoping review aimed to identify and analyze potential psychological factors influencing the decision to RTS after shoulder stabilization surgery.

Data Sources:

We reviewed the EBSCOhost/SPORTDiscus, PubMed/Medline, Scopus, EMBASE, and Cochrane Library databases for studies on patients with anterior glenohumeral instability who underwent stabilization surgery. We included studies that reported on RTS and considered the psychological factors influencing the decision to return.

Main Results:

Our analysis comprised 21 articles involving 2073 patients. Psychological factors influencing RTS after surgery were categorized within the framework of transactional stress and coping model. Primary appraisal factors, such as fear of reinjury, kinesiophobia, and anxiety, emerged as significant influencers. In addition, we explored factors related to social support, self-determination, motivation, competing interests, and advanced age. Assessment tools were used to evaluate the psychological readiness for RTS.

Conclusions:

This scoping review identified fear of reinjury and kinesiophobia as important psychological barriers to returning to sports after shoulder stabilization surgery. The limited use of psychological assessment tools and lack of comparative studies have restricted robust conclusions.

Level of Evidence:

Level IV, Scoping review.
The Utility of Patency Capsule in Patients With Crohn’s Disease
Authors: Odah Tarek , Karime Christian , Hashash Jana G. , Kinnucan Jami A. , Picco Michael F. , Farraye Francis A.
Published: October 2024

Background:

Video capsule retention is a complication that can have serious consequences in patients with Crohn’s disease (CD). The patency capsule was developed to detect small bowel strictures. The usefulness of patency capsules in patients who do not have evidence of small bowel disease on imaging is uncertain.

Study:

This is a multicenter retrospective study of patients with suspected or confirmed CD who underwent a patency capsule study between January 2017 and February 2023. We excluded patients who were lost to follow-up or did not have computerized tomography or magnetic resonance imaging of the abdomen within 180 days before or after the patency capsule study.

Results:

A total of 105 patients met the inclusion criteria with 69% having a confirmed CD diagnosis. The majority of patients (95/105; 90.5%) passed their patency capsule. A total of 91 patients had their subsequent video capsule endoscopy (VCE), with 96.7% (88/91) successfully passing the capsule. Out of those who passed the VCE, 2 patients had patency capsule retention. Both had normal small bowel imaging. Meanwhile, the 3 patients who had VCE retention had evidence of small bowel disease in their imaging scans. The presence of abnormal small bowel wall thickening or stricture on imaging had a statistically significant association with VCE retention (P=0.02).

Conclusion:

Our study demonstrated a statistically significant association between small bowel disease on imaging and retention of both patency capsules and VCE. Small bowel imaging in patients with suspected or documented CD had a negative predictive value of 100% for VCE retention.
Treatment and Survival Disparities in Asian Americans With Hepatocellular Carcinoma
Authors: Hu Robert , Ying Xiaohan , Ng Nicole , Lieu Ricki , Jesudian Arun , Rosenblatt Russell , Silberstein Peter , Lucero Catherine
Published: October 2024

Background:

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer death in the United States and globally. The Asian American, Native Hawaiian, and Pacific Islander (AANHPI) population has often been studied as one homogenous cohort despite its heterogeneity. We aim to understand differences in treatment modality and mortality among AANHPI patients with early-stage HCC.

Methods:

The National Cancer Database was queried between 2004 and 2019. Patients with early-stage HCC eligible for liver transplantation (LT) were included. AANHPI patients were further disaggregated into subgroups, and non-Hispanic White (NHW) patients were included as reference. χ2 was used for categorical variables and the Student t test was used for continuous variables. Survival curves were generated using Kaplan-Meier estimates.

Results:

A total of 3039 (8.5%) AANHPI and 32,845 (91.5%) NHW were included. Among the AANHPI, 1368 (45.0%) were East Asian (EA), 1229 (40.4%) were Southeast Asian (SEA), 302 (9.9%) were South Asian (SA), and 140 (4.6%) were Native Hawaiian and other Pacific Islander (NHPI). Compared with NHW, AANHPI patients were less likely to undergo LT but had lower mortality. When disaggregated, SA patients were more likely to receive LT (HR: 2.70), and SEA (HR: 1.43) and NHPI (HR: 1.90) patients had higher mortality when compared with EA, all P<0.01.

Conclusions:

AANHPI with early-stage HCC had better survival as a cohort. However, when disaggregated, there were notable disparities among different subgroups. AANHPI represents an incredibly diverse group of individuals, and it is imperative for physicians, researchers, and policy makers to appreciate the true heterogeneity of this population.
EUS-guided Drainage of Pancreatic Fluid Collections Using Lumen Apposing Metal Stents With or Without Coaxial Plastic Stents
Authors: Kamal Faisal , Khan Muhammad Ali , Lee-Smith Wade , Sharma Sachit , Acharya Ashu , Farooq Umer , Gangwani Manesh Kumar , Saeed Aamir , Aziz Muhammad , Hayat Umar , Saleem Nasir , Kumar Anand , Schlachterman Alexander , Kowalski Thomas
Published: October 2024

Background and Aims:

Co-axial plastic double pigtail stents (DPSs) are commonly placed through lumen apposing metal stents (LAMS) in patients with pancreatic fluid collections (PFCs) to decrease the risk of adverse events. In this meta-analysis, we have compared the outcomes of LAMS plus co-axial DPS versus LAMS alone in patients with PFCs.

Methods:

We reviewed several databases to identify the studies that compared outcomes of LAMS with DPS to LAMS without DPS in the treatment of PFCs. Our outcomes of interest were overall adverse events, clinical success and individual adverse events such as stent (LAMS) migration, stent occlusion, bleeding, and infection. We calculated pooled risk ratios (RR) with 95% confidence intervals (CIs) for the analysis of outcomes. We used a random effects model to analyze the data. Heterogeneity was assessed using the I2 statistic.

Results:

We included 10 studies with 685 patients. Rate of overall adverse events was significantly lower in the LAMS+DPS group compared with LAMS alone, RR (95% CI) 0.58 (0.40, 0.87). There was no significant difference in the rate of clinical success between groups, RR (95% CI) 1.03 (0.94, 1.13). We found no significant difference in rate of stent occlusion between groups. Rate of infection was significantly lower in LAMS+DPS group, RR (95% CI) 0.46 (0.24, 0.85). There was no significant difference in rate of bleeding and stent (LAMS) migration between groups.

Conclusions:

Addition of co-axial DPS to LAMS decreases the risk of adverse events in patients with PFCs and should be considered in all patients with PFCs.
Defining and Validating Criteria to Identify Populations Who May Benefit From Home-Based Primary Care
Authors: Salinger Maggie R. , Ornstein Katherine A. , Kleijwegt Hannah , Brody Abraham A. , Leff Bruce , Mather Harriet , Reckrey Jennifer , Ritchie Christine S.
Published: October 2024

Background:

Home-based primary care (HBPC) is an important care delivery model for high-need older adults. Currently, target patient populations vary across HBPC programs, hindering expansion and large-scale evaluation.

Objectives:

Develop and validate criteria that identify appropriate HBPC target populations.

Research Design:

A modified Delphi process was used to achieve expert consensus on criteria for identifying HBPC target populations. All criteria were defined and validated using linked data from Medicare claims and the National Health and Aging Trends Study (NHATS) (cohort n=21,727). Construct validation involved assessing demographics and health outcomes/expenditures for selected criteria.

Subjects:

Delphi panelists (n=29) represented diverse professional perspectives. Criteria were validated on community-dwelling Medicare beneficiaries (age ≥70) enrolled in NHATS.

Measures:

Criteria were selected via Delphi questionnaires. For construct validation, sociodemographic characteristics of Medicare beneficiaries were self-reported in NHATS, and annual health care expenditures and mortality were obtained via linked Medicare claims.

Results:

Panelists proposed an algorithm of criteria for HBPC target populations that included indicators for serious illness, functional impairment, and social isolation. The algorithm’s Delphi-selected criteria applied to 16.8% of Medicare beneficiaries. These HBPC target populations had higher annual health care costs [Med (IQR): $10,851 (3316, 31,556) vs. $2830 (913, 9574)] and higher 12-month mortality [15% (95% CI: 14, 17) vs. 5% (95% CI: 4, 5)] compared with the total validation cohort.

Conclusions:

We developed and validated an algorithm to define target populations for HBPC, which suggests a need for increased HBPC availability. By enabling objective identification of unmet demands for HBPC access or resources, this algorithm can foster robust evaluation and equitable expansion of HBPC.
Atypical PC-BPPV – Cupulolithiasis and Short-Arm Canalithiasis: A Retrospective Observational Study
Authors: Helminski Janet O.
Published: October 2024

Background and Purpose:

Atypical posterior canal (pc) benign paroxysmal positional vertigo (BPPV) may be caused by cupulolithiasis (cu), short arm canalithiasis (ca), or jam. The purpose of this study was to describe the clinical presentation and differential diagnosis of pc-BPPV-cu and short arm canalithiasis.

Methods:

This retrospective observation study identified persons with atypical pc-BPPV based on history and findings from four positional tests. Patterns of nystagmus suggested canal involved and mechanism of BPPV. Interventions included canalith repositioning procedures (CRP).

Results:

Fifteen persons, 17 episodes of care, met inclusion criteria, 65% referred following unsuccessful CRPs. Symptoms included persistent, non-positional unsteadiness, “floating” sensation, with half experiencing nausea/vomiting. Downbeat nystagmus with/without torsion in Dix-Hallpike (DH) and Straight Head Hang (SHH) position and no nystagmus upon sitting up, occurred in 76% of persons attributed to pc-BPPV-cu. Upbeat nystagmus with/without torsion and vertigo/retropulsion upon sitting up, occurred in 24% attributed to pc-BPPV-ca short arm. During SHH, canal conversion from pc-BPPV-cu to long arm canalithiasis occurred in 31%. The Half-Hallpike position identified pc-BPPV-cu in 71%. The Inverted Release position identified pc-BPPV-cu adjacent short arm and pc-BPPV-ca short arm.

Discussion and Conclusion:

Persistent, peripheral nystagmus that is downbeat or downbeat/torsion away from involved ear in provoking positions and no nystagmus sitting up, may be attributed to pc-BPPV-cu, and nystagmus that is upbeat or upbeat/torsion towards involved ear upon sitting up may be attributed to pc-BPPV-ca short arm. Both are effectively treated with canal- and mechanism-specific CRPs.

Video Abstract available

for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: (http://links.lww.com/JNPT/A487).
Evaluation of a Large Language Model on the American Academy of Pediatrics' PREP Emergency Medicine Question Bank
Authors: Ramgopal Sriram , Varma Selina , Gorski Jillian K. , Kester Kristen M. , Shieh Andrew , Suresh Srinivasan
Published: October 2024

Background

Large language models (LLMs), including ChatGPT (Chat Generative Pretrained Transformer), a popular, publicly available LLM, represent an important innovation in the application of artificial intelligence. These systems generate relevant content by identifying patterns in large text datasets based on user input across various topics. We sought to evaluate the performance of ChatGPT in practice test questions designed to assess knowledge competency for pediatric emergency medicine (PEM).

Methods

We evaluated the performance of ChatGPT for PEM board certification using a popular question bank used for board certification in PEM published between 2022 and 2024. Clinicians assessed performance of ChatGPT by inputting prompts and recording the software's responses, asking each question over 3 separate iterations. We calculated correct answer percentages (defined as correct in at least 2/3 iterations) and assessed for agreement between the iterations using Fleiss' κ.

Results

We included 215 questions over the 3 study years. ChatGPT responded correctly to 161 of PREP EM questions over 3 years (74.5%; 95% confidence interval, 68.5%–80.5%), which was similar within each study year (75.0%, 71.8%, and 77.8% for study years 2022, 2023, and 2024, respectively). Among correct responses, most were answered correctly on all 3 iterations (137/161, 85.1%). Performance varied by topic, with the highest scores in research and medical specialties and lower in procedures and toxicology. Fleiss' κ across the 3 iterations was 0.71, indicating substantial agreement.

Conclusion

ChatGPT provided correct answers to PEM responses in three-quarters of cases, over the recommended minimum of 65% provided by the question publisher for passing. Responses by ChatGPT included detailed explanations, suggesting potential use for medical education. We identified limitations in specific topics and image interpretation. These results demonstrate opportunities for LLMs to enhance both the education and clinical practice of PEM.