bluuebunny/crossref_metadata_2025 huggingface dataset:
The constitutional impact of rule-of-law spending conditionality
Authors: Torres Pérez Aida
Published: November 2024

The negotiation of an unprecedented recovery package to address the consequences of the COVID-19 pandemic provided momentum for a new instrument to condition the disbursement of EU funds to compliance with the rule-of-law principles. Regulation 2020/2092 (“the Conditionality Regulation”) was aimed at protecting the financial interests of the European Union and the sound management of EU funds against breaches of the rule of law. The aim of this article is to assess the validity, effectiveness, and broader impact of rule-of-law conditionality upon the EU constitutional architecture. The effectiveness in practice of the Conditionality Regulation is evaluated, together with the role of other conditionality mechanisms that have been used to promote rule-of-law standards, mainly the Recovery and Resilience Facility, which is the centerpiece of the NextGenerationEU package, and the Common Provisions Regulation, which includes a horizontal enabling condition that makes EU funds contingent upon the effective implementation and application of the EU Charter of Fundamental Rights. The suitability of rule-of-law conditionality as a form of governance with the current EU constitutional architecture is critically examined. Conditioning funding to promote values raises concerns from a constitutional perspective that include the risk of competence creep, repercussions for citizenship, and, finally, the undermining of trust and solidarity in interactions among member states. The Conditionality Regulation represents a relevant addition to the toolbox of instruments devised to address rule-of-law backsliding in the European Union, yet the expansion of rule-of-law conditionality could also be consequential for the ethos of the European Union.
Setting priorities for police operations by using a multicriteria decision approach with partial information
Authors: da Cunha Carla Patrícia Cintra Barros , de Miranda Mota Caroline Maria , Frej Eduarda Asfora , Roselli Lucia Reis Peixoto , de Almeida Adiel Teixeira
Published: November 2024

Accepted by: Konstantinos Nikolopoulos

The paper presents a real-world decision-making problem in the context of the Brazilian Federal Police (BFP), which consists of establishing priorities for police operations. This study deals with allocating resources to trigger police operations that, while demanding more resources and specialized techniques, also promote the effectiveness of police actions more conspicuously and directly. Driven by the value-focused thinking methodology, the objectives and values of the Federal Police were structured and represented by criteria, which let police operations be evaluated and prioritized. The Flexible and Interactive Tradeoff method was applied to rank the operations, with an innovative methodological perspective, which integrates two different paradigms for preference modelling: elicitation by decomposition and holistic evaluations. A mathematical modelling approach is presented to deal with the combination of both types of information obtained by the decision-maker (DM), in order to search for dominance relations between alternatives. This study shows how incorporating holistic judgements in the process can be useful for tightening the decision process since the inequalities obtained with holistic judgements have a high impact on the space of weights compatible with the DM’s preferences. A clear conceptual framework is presented for the analysis, showing how the application of such a combined approach to prioritizing special police operations adds a step to the decision-making processes and policies of the BFP, thereby broadening the managerial implications of tackling public security issues by seeking to solve them using management mathematics.
Outcomes of Enterococcus faecalis infective endocarditis according to MIC of amoxicillin: a multicentric study
Authors: Do Rego Hermann , Kherabi Yousra , Corvec Stephane , Plouzeau-Jayle Chloé , Bouchiat Coralie , Macheda Gabriel , Meyer Sylvain , Cattoir Vincent , Piau Caroline , Guillard Thomas , Zahar Jean-Ralph , Farfour Eric , Lecomte Raphaël , Amara Marlène , Isnard Christophe , Le Monnier Alban , Pilmis Benoit
Published: November 2024

Background

The incidence of Enterococcus faecalis infective endocarditis is increasing over time. Data on the impact of minimum inhibitory concentration (MIC) of amoxicillin on treatment outcomes are scarce. The objective of this study was to describe the epidemiology of E. faecalis infective endocarditis and to evaluate whether the MIC of amoxicillin might influence mortality.

Materials

We retrospectively included all consecutive patients diagnosed with definite E. faecalis infective endocarditis between 2013 and 2020 in 11 French hospitals. We extracted data from the local diagnosis-related group (DRG) database and matched these data with microbiological results. Amoxicillin MIC was determined by Etest strip. The primary endpoints were endocarditis-related mortality and risk factors for endocarditis-related mortality including amoxicillin MIC.

Results

A total of 403 patients with definite E. faecalis infective endocarditis were included. Patients were predominantly male (76.4%) with a median age of 74 years (67–82). Embolic complications occurred in 170 (42.1%) patients. Cardiac surgery was performed in 158 (61.5%) patients. The endocarditis-related mortality rate was 28.3% and the median delay between mortality and onset of hospitalization was 24 (9; 41) days. E. faecalis MIC of amoxicillin was available for 246 (61%) patients. The median MIC was 0.5 mg/L (0.4–0.7). Amoxicillin MIC was not found to be associated with in-hospital mortality. None of the variables included in the multivariate model were identified as a risk factor for mortality and there was no correlation between mortality and the duration of treatment for 4 weeks versus 6 weeks.

Conclusions

Higher amoxicillin MIC was not a risk factor leading to endocarditis-related mortality in definite E. faecalis infective endocarditis. However, further studies are needed to assess the effect of amoxicillin MIC on relapse.
Family-based whole-exome sequencing implicates a variant in lysyl oxidase like 4 in atypical femur fractures
Authors: Zhou Wei , van de Laarschot Denise M , van Rooij Jeroen G J , Koedam Marijke , Nguyen Hanh H , Uitterlinden André G , Ebeling Peter R , Thakker Rajesh V , Geusens Piet , van der Eerden Bram C J , Verkerk Annemieke J M H , Zillikens M Carola
Published: November 2024

Atypical femur fractures (AFFs) are rare adverse events associated with bisphosphonate use, having unclear pathophysiology. AFFs also cluster in families and have occurred in patients with monogenetic bone diseases sometimes without bisphosphonate use, suggesting an underlying genetic susceptibility. Our aim was to identify a genetic cause for AFF in a Caucasian family with 7 members affected by osteoporosis, including 3 siblings with bisphosphonate-associated AFFs. Using whole-exome sequencing, we identified a rare pathogenic variant c.G1063A (p.Gly355Ser) in lysyl oxidase like 4 (LOXL4) among 64 heterozygous rare, protein-altering variants shared by the 3 siblings with AFFs. The same variant was also found in a fourth sibling with a low-trauma femur fracture above the knee, not fulfilling all the ASBMR criteria of AFF and in 1 of 73 unrelated European AFF patients. LOXL4 is involved in collagen cross-linking and may be relevant for microcrack formation and bone repair mechanisms. Preliminary functional analysis showed that skin fibroblast-derived osteoblasts from the unrelated patient with the LOXL4 variant expressed less collagen type I and elastin, while osteogenic differentiation and mineralization were enhanced compared with 2 controls. In conclusion, this LOXL4 variant may underlie AFF susceptibility possibly due to abnormal collagen metabolism, leading to increased formation of microdamage or compromised healing of microcracks in the femur.
Romosozumab following denosumab improves lumbar spine bone mineral density and trabecular bone score greater than denosumab continuation in postmenopausal women
Authors: Hong Namki , Shin Sungjae , Kim Hyunjae , Cho Sung Joon , Park Jin Ah , Rhee Yumie
Published: November 2024

Romosozumab following anti-resorptive can be an effective sequential treatment strategy to improve bone strength. However, whether the transition to romosozumab after denosumab is associated with greater improvement in bone mineral density (BMD) and trabecular bone score (TBS) compared with denosumab continuation remains unclear. In this propensity score-matched cohort study, we analyzed data from postmenopausal women who initiated denosumab between 2017 and 2020. Individuals who were transited to 12 mo of romosozumab after denosumab were 1:1 matched to those who continued an additional 12 mo of denosumab (n = 86 for each group; denosumab-romosozumab [DR] and denosumab-denosumab [DD]). Mean BMD gain by denosumab treatment in matched DR and DD groups from denosumab initiation to transition (median 4 times [range 2-8]) was +4.8% and +2.0% in the lumbar spine (LS) and total hip, respectively. DR group showed greater LS BMD gain compared with the DD group (+6.8 vs +3.3% point, p<.001) for 12 mo post-transition independent of the duration of prior denosumab treatment, yielding greater overall LS BMD gain in DR compared with DD (+11.6% vs +8.0%, p<.001). DD group showed continued improvement of hip BMD, whereas hip BMD was maintained but not improved in the DR group. DR group was associated with greater TBS improvement than the DD group (2.9% vs 1.0%, p = .042). One month after the transition to romosozumab from denosumab, P1NP immediately increased above the level of denosumab initiation with relatively suppressed CTx, creating a transient anabolic window. For 12 mo follow-up, 1 incident morphometric vertebral fracture and 1 patella fracture were observed in DD, whereas 1 ankle fracture was observed in the DR group. Romosozumab following denosumab improved LS BMD and TBS greater than denosumab continuation in postmenopausal women.
Translated knowledge: the production of marginalization of the Roma during the COVID-19 pandemic
Authors: Schneeweis Adina
Published: November 2024

This research evaluates news during the first year of the coronavirus disease 2019 pandemic in order to examine how European publics made sense of the Roma, the largest and most marginalized ethnic community on the continent. Based on the analysis of news in English, French, Italian, and Romanian, the study finds that much of the coverage across national and cultural boundaries translated marginalization, already exacerbated by the health crisis, through familiar lenses of blame and backwardness. Whereas anti-ethnic discrimination was primarily recognized in news reliant on official, governmental sources, news in French and Italian chiefly circulated representations of otherness. Romanian news revealed both systemic racism and community solutions, also filtered through a discriminatory lens. Translating justice- or equity-oriented content—directly or ideologically—appeared incomplete, infrequent, and often filtered through bias. The tool of local and regional translation emerged as central to the circulation of ideas across the continent.
Vaping and Smoking Cue Reactivity in Young Adult Nonsmoking Electronic Cigarette Users: A Functional Neuroimaging Study
Authors: Liu Jiaying , Shi Zhenhao , Fabbricatore Jessica L , McMains Joshua T , Worsdale Allison , Jones Erin C , Wang Yidi , Sweet Lawrence H
Published: November 2024

Introduction

The rapid growth in the use of electronic cigarettes (e-cigarettes) among nonsmoking young adults is concerning, as it raises the potential for chronic vaping and nicotine addiction. A key characteristic of drug addiction is the elevated neural response to conditioned drug-related cues (i.e., cue reactivity). Generalized reactivity to both vaping and smoking cues may signify an increased risk for smoking initiation in nonsmoking vapers. In this study, we used functional magnetic resonance imaging (fMRI) to evaluate brain responses to vaping and smoking cues in young adult nonsmoking vapers.

Methods

Sixty-six young adult nonsmoking vapers underwent functional MRI while viewing visual cues pertaining to vaping, smoking, and nicotine-unrelated unconditioned reward (i.e., food). A priori region-of-interest analysis combined with exploratory whole-brain analysis was performed to characterize neural reactivity to vaping and smoking cues in comparison to food cues.

Results

The medial prefrontal cortex and the posterior cingulate cortex, regions that play a key role in drug cue reactivity, showed significantly increased neural response to vaping cues compared to food cues. The posterior cingulate cortex additionally showed increased neural responses to smoking cues compared to food cues.

Conclusions

Despite not currently smoking combustible cigarettes, young adult vapers exhibited heightened neural susceptibility to both vaping and smoking cues within brain systems associated with cue reactivity. The findings shed light on the mechanisms underlying nicotine addiction and smoking initiation risk in this critical population and may contribute to the development of science-based interventions and regulatory measures in the future.

Implications

The escalating vaping prevalence among US nonsmoking young adults is alarming, due to its potential ramifications for nicotine addiction development. Nicotine addiction is characterized by elevated neural response to conditioned nicotine-related cues. Using functional neuroimaging, we showed that young adult nonsmoking vapers exhibited heightened neural susceptibility to both vaping and smoking cues within brain systems previously associated with cue reactivity. Such cross-reactivity to both types of nicotine cues may serve as the mechanism underlying nicotine addiction and smoking initiation risk in this population. Our findings may contribute to the development of science-based interventions and regulatory measures addressing the vaping epidemic.
Evaluation of the Activity of Triazoles Against Non-fumigatus Aspergillus and Cryptic Aspergillus Species Causing Invasive Infections Tested in the SENTRY Program
Authors: Pfaller Michael A , Carvalhaes Cecilia G , Rhomberg Paul R , Klauer Abigail , Castanheira Mariana
Published: November 2024

The activity of isavuconazole and other triazoles against non-fumigatus (non-AFM) Aspergillus causing invasive aspergillosis was evaluated. A total of 390 non-AFM isolates were collected (1/patient) in 2017–2021 from 41 hospitals. Isolates were identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry and/or internal spacer region/β-tubulin sequencing and tested by Clinical and Laboratory Standards Institute (CLSI) broth microdilution. CLSI epidemiological cutoff values were applied, where available. Isavuconazole showed activity against Aspergillus sections Flavi (n = 122; minimum inhibitory concentration [MIC]50/90, 0.5/1 mg/L), Terrei (n = 57; MIC50/90, 0.5/0.5 mg/L), Nidulantes (n = 34; MIC50/90, 0.12/0.25 mg/L), Versicolores (n = 7; MIC50, 1 mg/L), and Circumdati (n = 2; MIC range, 0.12–2 mg/L). Similar activity was displayed by other triazoles against those Aspergillus sections. Most of the isolates from Aspergillus sections Fumigati (n = 9), Nigri (n = 146), and Usti (n = 12) exhibited elevated MIC values to isavuconazole (MIC50/90, 2/–, 2/4, and 2/8 mg/L), voriconazole (MIC50/90, 2/–, 1/2, and 4/8 mg/L), itraconazole (MIC50/90, 2/–, 2/4, and 8/>8 mg/L), and posaconazole (MIC50/90, 0.5/–, 0.5/1, and >8/>8 mg/L), respectively. Isavuconazole was active (MIC values, ≤1 mg/L) against Aspergillus parasiticus, Aspergillus tamarii, Aspergillus nomius, Aspergillus nidulans, Aspergillus unguis, Aspergillus terreus, Aspergillus alabamensis, and Aspergillus hortai, while isavuconazole MIC values between 2 and 8 mg/L were observed against cryptic isolates from Aspergillus section Fumigati. Isavuconazole inhibited 96.1% of Aspergillus niger and 80.0% of Aspergillus tubingensis at ≤4 mg/L, the CLSI wild-type cutoff value for A niger. Voriconazole, itraconazole, and posaconazole showed similar activity to isavuconazole against most cryptic species. Isavuconazole exhibited potent in vitro activity against non-AFM; however, the activity of triazoles varies among and within cryptic species.
Continued influence of false accusations in forming impressions of political candidates
Authors: Cohen Michael S , Halewicz Victoria , Yildirim Ece , Kable Joseph W
Published: November 2024

Previous work has shown that false information affects decision-making even after being corrected, a phenomenon known as “continued influence effects” (CIEs). Using mock social media posts about fictional political candidates, we observe robust within-participant CIEs: candidates targeted by corrected accusations are rated more poorly than candidates not targeted by allegations. These effects occur both immediately and after as much as a 2-day delay. We further demonstrate that vulnerability to CIEs in a political context varies systematically between individuals. We found that certain groups are more susceptible to CIEs on immediate candidate ratings (i) those who rely more on intuitive feelings, (ii) those with lower digital literacy knowledge, and (iii) younger individuals. These individuals’ judgments appear to be relatively more influenced by the refuted accusations and/or less influenced by the factual refutations. Interestingly, political orientation did not affect CIEs, despite its influence on explicitly identifying misinformation. Moreover, people recalled accusation stimuli better than refutations at a delay, suggesting that emotions may drive the prioritized processing of accusations. Our results indicate that analytic thinking could be protective when people judge political candidates targeted by refuted false information.
Open science in agricultural economics
Authors: Finger Robert , Henningsen Arne , Höhler Julia , Huber Robert , Rommel Jens , Grebitus Carola
Published: November 2024

We provide a ‘big picture’ of what Open Science is and what benefits, limitations, and risks it entails for agricultural economists. We show that Open Science comprises various aspects, such as the accessibility of science, transparency of scientific processes, open and findable, accessible, interoperable, and reusable (FAIR) research data and code, and openness in teaching and education. We identify potential benefits of Open Science for individual researchers and the public, as well as adoption barriers. We highlight that public benefits of a widespread uptake of Open Science practices still remain unexplored. We share best practice examples for key aspects of agricultural economic research, i.e. primary data collection and analysis, optimization and simulation models, use of replication packages, and an Open Science Community. Assessing the author guidelines of twelve agricultural economics journals for their Open Science practices, we find that data citation and transparency are considered important in many journals already, whereas replication, pre-registration, or results-blind reviews are encouraged but rarely enforced. It also becomes evident that the journals differ in terms of how strictly they enforce their open science guidelines. We close by providing recommendations for researchers, journal editors, policymakers, universities, research institutes, and funding agencies to better align public benefits with private incentives.
Employer Credit Checks: Poverty Traps Versus Matching Efficiency
Authors: Corbae Dean , Glover Andrew
Published: November 2024

We develop a framework to understand pre-employment credit screening as a signal from credit markets that alleviates adverse selection in labour markets. In our theory, people differ in both their propensity to default on debt and the profits they create for firms that employ them; in our calibrated economy, highly productive workers have a low default probability. This leads firms to create more jobs for those with good credit, which creates a poverty trap: an unemployed worker with poor credit has a low job finding rate, but cannot improve her credit without a job. This manifests as an endogenous loss in present-discounted wages that is typically taken as exogenous in quantitative models of consumer default. Banning employer credit checks eliminates the poverty trap, but pools job seekers and reduces matching efficiency: average unemployment duration rises by 2 days for high productivity workers and falls by 13 days for low-productivity workers.
Through an Hourglass Darkly? Navigating the Risk Landscape of the Reasonably Foreseeable Future
Authors: Aitchison Sharelle Anne
Published: November 2024

As refugee law has developed over time, broad authoritative principles have been espoused as interpretive aids to the refugee definition. The maxim that a well-founded fear of being persecuted entails a forward-looking appraisal of risk is one example. In some jurisdictions, such as Australia, the temporal yardstick of the reasonably foreseeable future has been introduced to guide decision-makers over the complex terrain of risk assessment. However, a close study of the case law reveals formulaic use, inconsistency and conflation of the standard with risk and its indicia—and if the standard is intended as a real risk heuristic this is far from clear or warranted. This study critically examines the reasonably foreseeable future notion in case law in Australia, including its origins as an imported, limiting standard of due diligence from other areas of international law. It signals refugee law’s vulnerability to the standard and cautions against applying the gloss of foreseeability and reasonableness as an unnecessary and obscure overlay to interpretation. It recommends instead the unadulterated real chance standard paired with narrative conventions on time, as strategies adopted in other areas of law to sensibly navigate the fraught notion of foreseeability. It proposes that the ordering of the definitional elements of well-founded fear, downstream of being persecuted, is critical to the analysis and, in simple terms, slow and deliberate thinking is required to pinpoint the temporal underpinnings of harm in relation to risk.
The Effects of Cognitive Remediation on Negative Symptoms in Schizophrenia-Spectrum Illness: A Meta-analytic Investigation of Efficacy
Authors: Melville Grace , Preisig Clara , Zheng Michael , Kurtz Matthew M
Published: November 2024

Background and Hypothesis

The number of clinical efficacy trials of Cognitive Remediation (CR), a behavioral intervention consisting of cognitive task practice and/or strategy training to improve cognitive skills in schizophrenia, has increased substantially over the past 25 years. While recent reviews have highlighted the effects of CR on cognition and function, CR effects on negative symptoms remain understudied. Given the overlap between negative symptoms and cognition, CR effects might be expected.

Study Design

Electronic databases were evaluated up to September 2023 using a broad range of search terms. Sixty-nine unique, controlled trials that used negative symptoms as an outcome were meta-analyzed. Data were independently extracted with excellent (>98%) reliability. Random effects models assessed the effects of CR on summary and expressive vs. experiential negative symptoms. Moderator analyses evaluated a broad array of treatment and participant factors.

Study Results

The meta-analysis (5319 participants) revealed that CR produced a small effect size improvement on summary negative symptoms (Hedge’s g = 0.179). Sample differences in age, duration of illness, symptoms, and antipsychotic dosage did not serve as a barrier to treatment benefit. CR also produced small-to-moderate improvements in alogia (Hedge’s g = 0.312) but not experiential negative symptoms. Programs of CR that utilized bridging activities that relate training of cognitive skills to activities of daily living produced greater improvement in negative symptoms (g = 0.281 vs 0.055). Longer CR programs also produce larger effects on negative symptoms.

Conclusions

CR produces small, consistent reductions in negative symptoms in people with schizophrenia. Variations in CR effects may be linked to different treatment ingredients.
The times, are they changing? Examining platform companies' chameleonic labour process as a response to the Spanish Ley Rider
Authors: Vieira Tiago , Mendonça Pedro
Published: November 2024

This article investigates the effects of the Spanish initiative to deploy a universal presumption of employment relationship for all platform couriers (Ley Rider). Drawing from 36 semi-structured interviews and several non-participant observations in Spain, this article shows that the impact of this initiative has been positive but limited. The eradication of bogus self-employment is a positive development, as it allows workers to access safety nets such as social security and employment rights while preserving valued aspects of their employment model like flexible scheduling. However, this progress is undermined by the platforms' efforts to circumvent regulations through what we term a ‘chameleonic labour process’. Such chameleonic behaviour on the part of the platforms includes: outsourcing labour operations to other companies; maintaining the independent contractor model; and, condoning undocumented work. Despite some progress, workers continue to face insecurity and low wages across all platforms, albeit in varying degrees and in different forms.
Can fertility decline help explain gender pay convergence?
Authors: Killewald Alexandra , Cricco Nino José
Published: November 2024

Prior scholarship demonstrates that motherhood wage penalties and fatherhood wage premiums contribute to the gender pay gap. These analyses typically take a cross-sectional perspective, asking to what extent gender inequalities in the association between parenthood and wages can explain gender pay inequality for a given cohort or at a given moment in time. By contrast, explorations of gender pay convergence over time have tended to start at the firm’s door, testing the explanatory power of changes in men’s and women’s human capital and job characteristics and neglecting the contributions of fertility change. We bring these two strands of research together, asking to what extent declines 1980–2018 in US employees’ number of children can explain gender pay convergence over the same period. Using a descriptive decomposition and data from the Panel Study of Income Dynamics, we show that, in gross terms, fertility decline can explain almost one-quarter of gender pay convergence from 1980 to 2018. Even net of a host of controls for human capital and job characteristics, fertility decline explains 8 percent of the attenuation of the US gender pay gap 1980–2018—about half as much as changes in education and about a quarter as much as changes in full-time work experience and job tenure combined. Finally, we show that employees’ fertility decline was fastest in the 1980s and subsequently slowed; this, in conjunction with persistent gender differences in parenthood–wage associations, helps explain stalled progress toward gender pay parity.
Sanctified Sexism: Effects of Purity Culture Tropes on White Christian Women’s Marital and Sexual Satisfaction and Experience of Sexual Pain
Authors: Sawatsky Joanna , Lindenbach Rebecca , Gregoire Sheila Wray , Gregoire Keith
Published: November 2024

Since the 1970s, research consistently links conservative religiosity with higher rates of primary sexual pain disorders in women. The effects on women’s marital and sexual satisfaction and experience of severe primary sexual pain due to belief in sexually restrictive and sexually coercive gender ideological tropes common in evangelical resources are described in a large snowball sample of white American Christian women (Sexual Satisfaction and Function Survey, N=5489). We found that belief in purity culture tropes was associated with higher rates of sexual pain disorders. Current belief in sexually restrictive tropes was associated with lower marital and sexual satisfaction as was past belief in sexually coercive tropes. Current internalization of two tropes was associated with higher marital satisfaction, likely explained by decreased marital satisfaction among those who deconstructed compared with those who still believe. Never believing tropes were protective for women’s marital and sexual satisfaction while belief deconstruction showed mixed effects.
Implementing Core Entrustable Professional Activities in Undergraduate Medical Education: A Psychometric Study
Authors: Violato Claudio , Englander Robert , Dale Esther , Gauer Jaqueline L.
Published: November 2024

Purpose

This study examines the feasibility and psychometric results of an assessment of entrustable professional activities (EPAs) as a core component of the clinical program of assessment in undergraduate medical education, assesses the learning curves for each EPA, explores the time to entrustment, and investigates the dependability of the EPA data based on generalizability theory (G theory) analysis.

Method

Third-year medical students from the University of Minnesota Medical School in 7 required clerkships from May 2022 through April 2023 were assessed. Students were required to obtain at least 4 EPA assessments per week on average from clinical faculty, residents supervising the students, or assessment and coaching experts. Student ratings were depicted as curves describing their performance over time; regression models were used to fit the curves.

Results

The complete class of 240 (138 women [58.0%] and 102 men [42.0%]) third-year medical students at the University of Minnesota Medical School (mean [SD] age at matriculation, 24.2 [2.7] years) participated. There were 32,614 EPA-based assessments (mean [SD], 136 [29.6] assessments per student). Reliability analysis using G theory found that an overall score dependability of 0.75 (range, 0-1) was achieved with 4 assessors on 4 occasions. The desired level of entrustment by academic year end was met by all 240 students (100%) for EPAs 1, 6, and 7, 237 (98.8%), 236 (98.3%), and 218 (90.8%) students for EPAs 2, 5, and 9, respectively, 197 students (82.1%) for EPA 3, 178 students (74.2%) for EPA 4, and 145 students (60.4%) for EPA 12. The most rapid growth was for EPA 2 (β0 = .286), followed by EPA 1 (β0 = .240), EPA 4 (β0 = .236), and EPA 10 (β0 = .230).

Conclusions

The study findings suggest that EPA ratings provide reliable and dependable data to make entrustment decisions about students’ performance.
The Use of Virtual Patients to Provide Feedback on Clinical Reasoning: A Systematic Review
Authors: Jay Robert , Sandars John , Patel Rakesh , Leonardi-Bee Jo , Ackbarally Yasmin , Bandyopadhyay Soham , Faraj Dabean , O’Hanlon Mary , Brown Jeremy , Wilson Emma
Published: November 2024

Purpose

Virtual patients (VPs) are increasingly used in health care professions education to support clinical reasoning (CR) development. However, the extent to which feedback is given across CR components is unknown, and guidance is lacking on how VPs can optimize CR development. This systematic review sought to identify how VPs provide feedback on CR.

Method

Seven databases (MEDLINE, EMBASE, CINAHL, ERIC, PsycINFO, Scopus, and ProQuest Dissertations) were searched in March 2023 using terms (e.g., medical education, virtual patient, case-based learning, computer simulation) adapted from a previous systematic review. All studies describing VP use for developing CR in medical professionals and provided feedback on at least 1 CR component were retrieved. Screening, data extraction, and quality assessment were performed. Narrative synthesis was performed to describe the approaches used to measure and provide feedback on CR.

Results

A total of 6,526 results were identified from searches, of which 72 met the criteria, but only 35 full-text articles were analyzed because the reporting of interventions in abstracts (n = 37) was insufficient. The most common CR components developed by VPs were leading diagnosis (23 [65.7%]), management or treatment plan (23 [65.7%]), and information gathering (21 [60%]). The CR components were explored by various approaches, from predefined questions to free text and concept maps.

Conclusions

Studies describing VP use for giving CR feedback have mainly focused on easy-to-assess CR components, whereas few studies have described VPs designed for assessing CR components, such as problem representation, hypothesis generation, and diagnostic justification. Despite feedback being essential for learning, few VPs provided information on the learner’s use of self-regulated learning processes. Educators designing or selecting VPs for CR use must consider the needs of learner groups and how different CR components can be explored and should make the instructional design of VPs explicit in published work.
Intraoperative Methadone in Spine Surgery ERAS Protocols
Authors: Rajkovic Christian , Vazquez Sima , Thomas Zach , Spirollari Eris , Nolan Bridget , Marshall Cameron , Sekhri Nitin , Siddiqui Ammar , Kinon Merritt D. , Wainwright John V.
Published: November 2024

Study Design:

Systematic review.

Objective:

To systematically review the use of intraoperative methadone in spine surgery and examine its effects on postoperative opioid use, pain, length of stay, and operative time.

Summary of Background Data:

Spine surgery patients commonly have a history of chronic pain and opioid use, and as a result, they are at an increased risk of severe postoperative pain. While pure mu opioids remain the standard for acute surgical pain management, they are associated with significant short-term and long-term adverse events. Methadone presents an alternative to pure mu opioids which may improve postoperative management of pain following intraoperative use.

Methods:

A systematic review of MEDLINE, Embase, and Web of Science databases was conducted to review existing literature detailing operating time, postoperative pain, opioid usage, and hospital length of stay (LOS) following intraoperative methadone administration in spine surgery.

Results:

Following screening of 994 articles and application of inclusion criteria, 8 articles were included, 4 of which were retrospective. Conventional spine surgery intraoperative analgesic strategies used as comparators for intraoperative methadone included hydromorphone, ketamine, and sufentanil. Considering patient outcomes, included studies observed that patients treated with intraoperative methadone had statistically similar or significantly reduced pain scores, opioid usage, and LOS compared with comparator analgesics. However, one study observed that intraoperative methadone used in a multimodal analgesia regimen strategy with ketamine resulted in a shortened LOS compared with the use of intraoperative methadone alone. Differences in operating time between cases that used intraoperative methadone and cases that used comparator analgesics were not statistically significant among included studies.

Conclusion:

Methadone may present an alternative option for both intraoperative and postoperative analgesia in spine surgery recovery protocols and may reduce postoperative pain, opioid use, and LOS while maintaining consistent operating time and reduced side effects of pure mu opioids.

Level of Evidence:

Level II.
Acute kidney injury in different time windows: a retrospective study of hospitalized elderly patients
Authors: Li Qinglin , Li Guanggang , Li Dawei , Chen Yan , Zhou Feihu
Published: November 2024

Background

To compare the differences between the Kidney Disease Improving Global Outcomes (KDIGO) criteria of the 48-hour window (early acute kidney injury [AKI], 3–5 day window [middle AKI], and 6–7 day window [late AKI]) in the diagnosis of AKI, as well as the relationship between the diagnosis time windows and 90-day mortality.

Methods

We conducted a retrospective cohort study. All elderly patients admitted to the Geriatric Department of the Chinese PLA General Hospital between 2007 and 2018 were evaluated for AKI during their hospital stay. Patients with AKI were divided into early, middle, and late AKI groups according to the time of diagnosis. Statistical analyses were performed using SPSS 21.0 statistical software. Continuous parametric variables are expressed as the means ± standard deviations (SDs), and continuous nonparametric variables are presented as the medians with interquartile ranges (25th and 75th percentiles). Categorical variables are presented as numbers (n) or percentages (%). Group comparisons were conducted using one-way analysis of variance or the Kruskal-Wallis H test for continuous variables and Pearson’s chi-square or Fisher’s exact test for categorical variables. Logistic regression analyses and a forward stepwise selection method were used to identify risk factors associated with AKI diagnosis time windows and 90-day mortality.

Results

During the follow-up period, 1847 patients were enrolled. Overall, 22.4% of the patients (413/1847) developed early AKI, 7.3% (134/1847) developed middle AKI, and 10.7% (197/1847) developed late AKI. Risk factors for early AKI included age, hypoalbuminemia, low prealbumin level, and the need for mechanical ventilation; middle AKI was significantly associated with age, low prealbumin, low hemoglobin, and the need for mechanical ventilation, whereas late AKI was closely associated with age, low baseline estimated glomerular filtration rate, low prealbumin, and low hemoglobin. In the multivariable-adjusted analysis, AKI time windows (early AKI, odds ratio [OR]: 6.069; P < 0.001; middle AKI, OR: 5.000; P < 0.001) and late AKI (OR: 2.847; P < 0.001) were more strongly associated with higher 90-day mortality than non-AKI.

Conclusion

Clinical differences and risk factors for AKI in elderly patients depend on the definition used. A better understanding of how AKI develops during different diagnostic windows may lead to improved outcomes.
Infections in the immunocompromised: lessons from a fatal case report of tricuspid endocarditis in multiple sclerosis
Authors: Cacciapuoti Fulvio , Gottilla Rossella , Costabile Fausta , Maniscalco Giorgia , Dell’Aversano Orabona Giuseppina , Cacciapuoti Federico
Published: November 2024

Background

Multiple sclerosis (MS), a chronic neurological disorder, is characterized by damage to the central nervous system, autoimmune processes, and deterioration of the myelin sheath, which lead to a variety of physical, cognitive, and emotional symptoms. Currently, a cure for MS does not exist, and treatments aim only to manage symptoms and enhance quality of life. Betaferon (interferon beta-1b), a disease-modifying therapy, is used to minimize the frequency of relapses and the progression of disability by altering immune responses. However, this therapeutic strategy also increases the risk of infectious diseases, such as tricuspid endocarditis, which is a severe infection of the heart valve that is often associated with chronic intravenous drug use and carries potential life-threatening consequences.

Case presentation

We present a case of a 48-year-old male who was undergoing Betaferon therapy for MS. He was admitted to the emergency room owing to fever, shortness of breath, and altered mental state. Physical examination revealed clinical signs of endocarditis, and laboratory results indicated severe thrombocytopenia, anemia, and elevated inflammatory markers. Imaging confirmed lung abnormalities and vegetations on the tricuspid valve. Blood cultures identified methicillin-sensitive Staphylococcus aureus. Intravenous antibiotics were initiated, and surgical intervention was planned. Despite initial antibiotic therapy improving his clinical and laboratory conditions, the patient experienced multiple pulmonary embolic events that led to death after 16 days of hospitalization.

Conclusion

This case underscores the challenges of identifying and managing endocarditis in immunocompromised patients and highlights the complexities of treating infections in individuals with chronic diseases.
ECCENTRIC MACULAR HOLES AS A POSTOPERATIVE COMPLICATION OF MACULAR SURGERY IN BLACK AFRICANS
Authors: El-Khoury Sylvain , Abdelmassih Youssef , Uwemeye Livin , Tuyisabe Theophile , Mikhail Michael
Published: November 2024

Purpose:

The objective of this study is to report on the incidence and the characteristics of eccentric macular holes as a complication of macular surgery with internal limiting membrane peeling in a black African population.

Methods:

This is a retrospective consecutive case series. Files of 125 patients who received macular surgery were reviewed, and 14 eyes of 14 patients were included in this study. Intervention consisted of pars plana vitrectomy with internal limiting membrane peeling for a full-thickness macular hole or epiretinal membrane. The main outcome measures were the development of eccentric macular holes, their characteristics (location, number), and best-corrected visual acuity.

Results:

Eccentric macular holes developed in 14 eyes of 14 patients with a mean age of 64.5 ± 9.4 years and a female predominance of 64%. The incidence of eccentric macular holes was 11.2%. Eccentric macular holes developed on average 4.4 ± 1.2 weeks after surgery. In 9 eyes (65%) location was temporal, in 3 eyes (21%) superotemporal, and in 2 eyes (14%) inferotemporal. Multiple holes were observed in 12 eyes (86%), and 5 eyes (35%) had confluent holes. Nine eyes (64%) had only full-thickness holes, 4 eyes (29%) had both full-thickness and lamellar holes, and 1 eye (7%) had only lamellar holes. Best-corrected visual acuity improved from 1.1 ± 0.33 logMAR to 0.89 ± 0.26 logMAR (P = 0.017).

Conclusion:

Eccentric macular hole formation showed a very high incidence in our setting and represents a main complication for macular surgery. In all cases, eccentric macular holes were formed in the temporal macula, and in most cases, they were multiple and full-thickness.
Symmetric Bilateral Macular Atrophy in Mucolipidosis type 3: A Rare Manifestation.
Authors: Dourado Fernanda Galante , de Queiroz Omote Daniel , Correia de Pinho Paula Dandara , Gianotti Pimentel Sérgio Luis
Published: November 2024

Purpose:

Describe a case of symmetric bilateral macular atrophy as an ophthalmological manifestation of Mucolipidosis type 3.

Methods:

Multimodal retinal imaging evaluation was performed, with color fundus photograph, fundus autofluorescence, fluorescein angiography and optical coherence tomography. Genetic testing confirmed the systemic diagnosis.

Results:

Genetic testing confirmed the diagnosis of Mucolipidosis type 3 and macular bilateral atrophy was considered a rare manifestation of the systemic disease.

Discussion:

Ophthalmological manifestations in mucolipidosis are rare, with corneal opacities being most reported. Our patient presented bilateral macular atrophy, which had not been previously described in association with the disease, and is important to consider different diagnosis.

Conclusion:

It is important to consider different diagnosis, such as retinal dystrophies and conditions causing macular atrophy, and this case highlights the importance of considering rare ophthalmological manifestations in syndromic diseases.
Macular Outer Retinal Atrophy Following Vitrectomy and Hypotony: Two Cases
Authors: Li Chloe Y , Flynn Erin E. , Chang Stanley
Published: November 2024

Purpose:

To characterize two cases of focal outer retinal atrophy and hypotony after vitrectomy.

Methods:

Retrospective chart review of two patients’ records between 2019 and 2023.

Results:

Patient 1 underwent vitrectomy, epiretinal membrane peel, and cataract extraction for visually significant macular pucker. She developed hypotony without a wound leak and was noted to have a focal parafoveal area of ellipsoid zone disruption by 1 week post-operatively, which evolved into outer retinal and chorioretinal atrophy within 6 weeks after surgery. This area of atrophy remained stable in size, but the patient later reported a paracentral scotoma. Patient 2 had multiple previous surgeries for retinal detachment with proliferative vitreoretinopathy. Seven years later, the IOL dislocated and was exchanged with scleral fixation of a new IOL. On post-operative day 1, he had hypotony with macular folds secondary to a leaking sclerotomy wound. The sclerotomies were sutured on post-operative day 3, and his intraocular pressure normalized. However, he developed a central, focal area of chorioretinal atrophy within 1 week of the initial surgery. The size of this area of atrophy remained stable over years but resulted in reduced central vision.

Conclusion:

Hypotony following vitrectomy may rarely predispose patients to the development of focal chorioretinal atrophy.
Defining a Therapeutic Target for Ganciclovir Therapy in Immunocompromised Children With Cytomegalovirus Infection: A Brief Report
Authors: Gao Maggie , Weerdenburg Heather , Yang Wenyu , Zhu Xiao , Gwee Amanda
Published: November 2024

Ganciclovir and valganciclovir are first-line treatments for cytomegalovirus in immunocompromised children; however, the optimal therapeutic target remains unclear. This review identified 6 studies that showed clearance of cytomegalovirus viremia occurs with a median area under the concentration–time curve (AUC24) between 23 and 70 μg·h/mL, with no clear correlation with efficacy or toxicity.
Infectious Morbidity and All-cause Mortality of Infants HIV-exposed Uninfected Compared to Infants HIV-unexposed Uninfected in Botswana
Authors: Dubois Melanie M. , Jao Jennifer , Sun Shan , Legbedze Justine , Schenkel Sara , Mmasa Nicholas , Kgole Samuel W. , Masasa Gosego , Happel Anna-Ursula , Iwase Saori C. , Haghighat Roxanna , Moyo Sikhulile , Sharma Tanvi S. , Edlefsen Paul T. , Shao Danica , Jaspan Heather , Powis Kathleen M.
Published: November 2024

Some studies have reported increased infectious morbidity and all-cause mortality risk among infants HIV-exposed uninfected compared with infants HIV-unexposed uninfected. In a retrospective analysis of infants enrolled in the Botswana-based Tshilo Dikotla study, we found no difference in the prevalence of infectious hospitalizations or deaths from any cause in the first year of life by perinatal HIV exposure.
Iridodialysis repair using a modified sewing machine technique
Authors: Precia Jayjumhar , Giller Elizabeth Aileen , Dualan Ivo John
Published: November 2024

A large iridodialysis can present with both visual and cosmetic disturbances, and therefore, surgical intervention is indicated. We describe a modified sewing machine technique in repairing large iridodialysis without the indication of an extensive scleral groove. Another modification made was a scleral flap. The scleral flap provides better control on the position of the knot and its whisker, allowing full coverage and eliminating the risk of whisker exposure and eventual conjunctival erosion. This technique for iridodialysis repair provides better cosmetic results, especially for extensive iridodialysis. It is also more economical and involves simple, safe, and efficient surgical maneuvers in repairing iridodialysis.