bluuebunny/crossref_metadata_2025_split huggingface dataset:
Practice Variation in Urine Collection Among Emergency Department Providers in Pre–toilet-trained Children With Suspected Urinary Tract Infection
Authors: Wilson Lucy M. , Klassen Terry P. , Crombie Tighe , Gangwani Apoorva , Wai Lai Veronica Ka , Gripp Karen , Doyle Elisabete , Beer Darcy , Hogue Kaitlin , Florescu Oana , Knisley Lisa , Aregbesola Alex 
Published: February 2025

Background:
Urinary tract infections are a common cause of acute illness among children presenting to the emergency department (ED). Many techniques exist to collect urine specimens in pre–toilet-trained children. There is wide practice variation regarding the most appropriate collection method. This variation also appears to exist across national health organizations and societies. To date, little is known about the extent of practice variation in urine collection methods or the influence of patient and health care provider characteristics on the choice of collection method.

Materials and Methods:
A cross-sectional survey was designed and comprised of 3 sections: pediatric emergency medicine physician demographics, pediatric ED demographics, and case scenarios designed to assess the context surrounding urine collection method choice. The survey was disseminated to pediatric emergency medicine physicians across Canada from February 2023 to April 2023. A descriptive analysis of the characteristics of pediatric emergency medicine physicians and the EDs in which they worked was performed. Multivariate logistic regression models were used to examine pediatric emergency medicine physicians and ED factors that influence urine collection methods.

Results:
Of 235 surveys, 96 were returned (41% participation rate). Most respondents were aged 40 to 49 (n=31, 35.6%), female (60.5%), completed residency in Ontario (18.4%) and Quebec (17.2%), and worked at the Children’s Hospital of Eastern Ontario (16%). There was variation in urine collection methods among pediatric emergency medicine physicians with a preference for transurethral catheterization and bladder stimulation versus other methods. Factors such as the length of wait time of patients to be seen in the ED (odds ratio=3.03, 95% CI=1.14-8.09) and year postmedical school (odds ratio=1.67, 95% CI=1.07-2.60) were associated with increased choice of urinary catheterization when selecting a urine collection method.

Conclusions:
The data suggests there is practice variation in urine collection methods among Canadian pediatric emergency medicine physicians. This practice variation is influenced by both individual providers and the demographics of EDs.
Clinical Features and Management Strategies in Children With Mycoplasma Pneumoniae
Authors: Garcia Tamara , Florin Todd A. , Leonard Jan , Shah Samir S. , Ruddy Richard M. , Wallihan Rebecca , Desai Ankita P. , Alter Sherman , El-Assal Osama , Marzec Sarah , Keaton Meghan , Yun Ki Wook , Leber Amy L. , Mejias Asuncion , Cohen Daniel M. , Ramilo Octavio , Ambroggio Lilliam ,   On Behalf of the Children’s Hospitals Initiative for Research in Pneumonia (CHIRP)
Published: February 2025

Objective:

Mycoplasma pneumoniae (Mp) is the most detected bacterial pathogen in children with community-acquired pneumonia (CAP). Our primary objective was to compare the clinical presentation, clinical management, and outcomes of children with and without Mp CAP across 6 children’s hospitals.

Methods:
Eligible children were 2 months old or above and diagnosed with CAP in a prospective multicenter cohort study between October 1, 2015 and June 31, 2018. Children were excluded if they had complex chronic conditions. Children were tested for Mp via polymerase chain reaction assays. Clinical outcomes included hospitalization, and among hospitalized children length of stay, pediatric intensive care unit (PICU) admission, and rehospitalization within 8 weeks of discharge. Negative binomial and logistic regression were performed to determine the association of Mp with clinical outcomes.

Results:
Of the 415 children included, 38 (7.4%) had Mp detected. Children with Mp were older [median interquartile range age 8.8 (3.1, 13.0) vs. 4.6 (interquartile range: 2, 8.2) y], more likely to receive azithromycin (68.4% vs. 22.2%) and more likely to receive antibiotics in the prior 2 weeks (63.2% vs. 35.7%) versus those with non-Mp CAP. Children with Mp CAP were 33% less likely to stay in the hospital for an additional day (95% CI: 0.48-0.94).

Conclusion:
Children with Mp CAP are more likely to have a longer duration of symptoms, but there are no statistical differences in symptom prevalence, laboratory values, or radiographic findings. There was no statistical difference in clinical outcomes for children with Mp CAP suggesting that clinical presentation and outcomes are similar between Mp and non-Mp CAP. Polymerase chain reaction testing for Mp CAP may be the only way to discriminate between non-Mp and Mp CAP.
Therapeutic Scoliosis-Specific Exercises for a Child With Spinal Muscular Atrophy: A Case Report
Authors: Kanner Cara H. , Rodriguez-Torres Rafael , Wallach Rebekah , Bakarania Prachi , Montes Jacqueline 
Published: February 2025

Purpose:
The purpose of this study is to report on therapeutic scoliosis-specific exercises (PSSE) for a child with spinal muscular atrophy (SMA) who had spinal fusion.

Methods:
PSSE were recommended after scoliosis was diagnosed and exercises focused on posture and improving strength preoperatively and restoring function postoperatively.

Results:
Gross motor function remained stable before spinal fusion, briefly decreased after the procedure, and then stabilized post-surgery. Distance walked on the 6-minute walk test decreased post-surgery but improved after the addition of PSSE to the Standard of Care.

Conclusions:
Including PSSE as an adjunct to traditional interventions may be beneficial for children with SMA. Evidence supports incorporating PSSE to improve posture preoperatively in idiopathic scoliosis. Its use postoperatively and in children with SMA is not well studied. Controlled studies are needed to understand the impact of pre- and post-op PSSE in children with SMA.
Deep Learning–Based Signal Amplification of T1-Weighted Single-Dose Images Improves Metastasis Detection in Brain MRI
Authors: Haase Robert , Pinetz Thomas , Kobler Erich , Bendella Zeynep , Zülow Stefan , Schievelkamp Arndt-Hendrik , Schmeel Frederic Carsten , Panahabadi Sarah , Stylianou Anna Magdalena , Paech Daniel , Foltyn-Dumitru Martha , Wagner Verena , Schlamp Kai , Heussel Gudula , Holtkamp Mathias , Heussel Claus Peter , Vahlensieck Martin , Luetkens Julian A. , Schlemmer Heinz-Peter , Haubold Johannes , Radbruch Alexander , Effland Alexander , Deuschl Cornelius , Deike Katerina 
Published: February 2025

Objectives
Double-dose contrast-enhanced brain imaging improves tumor delineation and detection of occult metastases but is limited by concerns about gadolinium-based contrast agents' effects on patients and the environment. The purpose of this study was to test the benefit of a deep learning–based contrast signal amplification in true single-dose T1-weighted (T-SD) images creating artificial double-dose (A-DD) images for metastasis detection in brain magnetic resonance imaging.

Materials and Methods
In this prospective, multicenter study, a deep learning–based method originally trained on noncontrast, low-dose, and T-SD brain images was applied to T-SD images of 30 participants (mean age ± SD, 58.5 ± 11.8 years; 23 women) acquired externally between November 2022 and June 2023. Four readers with different levels of experience independently reviewed T-SD and A-DD images for metastases with 4 weeks between readings. A reference reader reviewed additionally acquired true double-dose images to determine any metastases present. Performances were compared using Mid-p McNemar tests for sensitivity and Wilcoxon signed rank tests for false-positive findings.

Results
All readers found more metastases using A-DD images. The 2 experienced neuroradiologists achieved the same level of sensitivity using T-SD images (62 of 91 metastases, 68.1%). While the increase in sensitivity using A-DD images was only descriptive for 1 of them (A-DD: 65 of 91 metastases, +3.3%, P = 0.424), the second neuroradiologist benefited significantly with a sensitivity increase of 12.1% (73 of 91 metastases, P = 0.008). The 2 less experienced readers (1 resident and 1 fellow) both found significantly more metastases on A-DD images (resident, T-SD: 61.5%, A-DD: 68.1%, P = 0.039; fellow, T-SD: 58.2%, A-DD: 70.3%, P = 0.008). They were therefore able to use A-DD images to increase their sensitivity to the neuroradiologists' initial level on regular T-SD images. False-positive findings did not differ significantly between sequences. However, readers showed descriptively more false-positive findings on A-DD images. The benefit in sensitivity particularly applied to metastases ≤5 mm (5.7%–17.3% increase in sensitivity).

Conclusions
A-DD images can improve the detectability of brain metastases without a significant loss of precision and could therefore represent a potentially valuable addition to regular single-dose brain imaging.
Prognostic Role of Enhancing Mural Nodules in Intraductal Papillary Mucinous Neoplasms with High-Risk Stigmata
Authors: Kumano Ryohei , Ohno Eizaburo , Ishikawa Takuya , Yamao Kentaro , Mizutani Yasuyuki , Iida Tadashi , Uetsuki Kota , Yamamura Takeshi , Furukawa Kazuhiro , Nakamura Masanao , Honda Takashi , Kawashima Hiroki 
Published: February 2025

Objective:
To evaluate the prognostic impact of invasive nodules (IN) detected by contrast-enhanced endoscopic ultrasound (CE-EUS) in intraductal papillary mucinous neoplasms (IPMNs) with high-risk stigmata (HRS) and their role in guiding surgery.

Summary of Background Data:
IPMNs with HRS are surgical candidates, but their long-term outcomes and the need for surgery in all patients remain unclear.

Methods:
This single-center retrospective study included 257 patients with IPMN and HRS, comparing CE-EUS and CT for detecting IN. It evaluated overall survival (OS) and disease-specific survival (DSS) between surgical and observation groups and identified factors influencing OS through multivariate analysis.

Results:
Median follow-up was 53.4 months. Of 257 patients, 226 (87.9%) underwent surgery and 31 (12.1%) were observed. Non-IN patients showed significantly better 5-year OS and DSS than IN patients in both groups (surgery, OS 87.9% vs. 53.2% and DSS 96.9% vs. 64.3%; observation, OS 84.7% vs. 23.3% and DSS 100% vs. 32.8%). Non-IN group that underwent surgery had better 10-year DSS than those in the observed group (96.9% vs. 66.7%). However, with an age-adjusted Charlson comorbidity index (ACCI) ≥5, there was no significant difference in 5-year OS between the groups (77.1% vs. 79.3%, P=0.7036). CE-EUS showed higher sensitivity than CT detecting IN (P=0.042). Independent predictors of poor OS included ACCI ≥5, nonsurgery, mural nodule ≥10 mm, and IN.

Conclusions:
CE-EUS effectively detected IN, significantly impacting the prognosis of IPMN with HRS. Its superior sensitivity to CT and ability to predict OS/DSS highlight its importance in guiding clinical management.
Outcomes of Retroperitoneal vs Transperitoneal Approach for Open Abdominal Aortic Aneurysm Repair Stratified by Aortic Cross-Clamping Site
Authors: Hamouda Mohammed , Abdelkarim Ahmed , Kricfalusi Mikayla , Brooke Benjamin S , Malas Mahmoud B 
Published: February 2025

Background:
The approach for open infrarenal Abdominal Aortic Aneurysm (AAA) repair is mainly surgeon driven based on experience and prior training. While the midline Transperitoneal (TP) remain the most common, the Retroperitoneal (RP) approach is usually utilized in more complex cases where suprarenal cross-clamping is necessary. As prior literature is conflicting on optimal outcomes between the two approaches, we aimed to compare RP vs TP outcomes stratified by aortic clamp level.

Study Design:
The Vascular Quality Initiative database was queried for all patients who underwent open AAA repair from January 2012 to February 2024. Patients were stratified according to aortic cross-clamp site: infrarenal, interrenal, suprarenal, and supraceliac. We used multivariate logistic regression to analyze outcomes of RP vs TP within each clamp site while adjusting for baseline and clinically relevant variables.

Results:
A total of 8,842 patients were included. Compared to TP, RP approach was associated with higher odds of postoperative dialysis [aOR=1.74,(95%CI 1.07-2.83),p=0.025) with infrarenal cross-clamping. However, at higher clamping sites RP was associated with lower odds of bowel ischemia [aOR=0.40,(95%CI 0.20-0.80),p=0.009] with interrenal clamping; lower odds of dialysis [aOR=0.66,(95%CI 0.44-0.99),p=0.048], bowel ischemia [aOR=0.52,(95%CI 0.32-0.85),p=0.009) and 30-day mortality [aOR=0.48,(95%CI 0.30-0.79),p=0.004) with suprarenal clamping; and lower in-hospital [aOR=0.35,(95%CI 0.16-0.80),p=0.013) and 30-day mortality [aOR=0.41,(95%CI 0.17-0.98),p=0.046] with supraceliac clamping.

Conclusion:
In this large multi-institutional study, we identified that differential outcomes of RP vs TP approaches for open AAA are modified by aortic cross-clamping level. RP is associated with lower postoperative complications and better survival compared to TP in cases requiring more proximal cross-clamping sites. However, TP approach is associated with lower risk of renal complications in cases restricted to infrarenal clamping.
Change targets, messaging, and content delivery for a community-engaged social media campaign addressing HIV-related stigma in Peru: a qualitative study
Authors: Nunez Alyson , Curtis Marguerite , Wong Milagros , Kosyluk Kristin A. , Galea Jerome T. , Franke Molly F. , Errea Renato A. 
Published: February 2025

ABSTRACTMitigating HIV-related stigma is critical to improving HIV outcomes and reaching global HIV targets. We conducted formative community-engaged research to identify key characteristics of a social media campaign to address HIV-related stigma among youth in Lima, Peru. Focus groups and in-depth interviews with young people living with HIV (men who have sex with men, transgender women, sex workers, persons with perinatally-acquired HIV, cisgender women, and Venezuelan migrants), HIV advocates, and healthcare providers were carried out from November 2022 to July 2023. Audio recordings were transcribed verbatim and analysed for emergent themes using framework analysis. Two change targets were identified for campaign messaging: 1) changing how HIV and people living with HIV (PLWH) are perceived, and 2) changing attitudes and actions towards PLWH. Messages aligning with the first change target included education to raise awareness that HIV does not discriminate; HIV is a chronic, treatable condition; and “undetectable equals untransmittable” (U=U). Messages aligning with the second target included normalizing open conversations about HIV, encouraging support versus pity for PLWH, fostering unity among HIV-affected communities, and promoting inclusion of PLWH. Participants provided recommendations to achieve these messaging objectives, including how, to whom and by whom messages are delivered.
Acute obstructive uropathy in male C57Bl/6 mice after general anesthesia with fentanyl, midazolam and medetomidine
Authors: Wallace Damian J. , Holmgren Carl , Czubayko U. , Klesing Jeanine , Machado Daniela Martin , Kerr Jason N. D. 
Published: February 2025

AbstractThe selective alpha-2 adrenoreceptor agonist medetomidine is commonly used as a component of combination solutions for general anesthesia in rodents and small animals. However, it has also been reported to increase the risk of obstructive uropathy in male mice. Here we report that in a recent cohort of mice undergoing two sequential surgical procedures using the anesthetic combination of fentanyl, midazolam and medetomidine (FMM) for general anesthesia, 60% of the male mice developed severe obstructive uropathy within 48 hours of the second surgery. We also report one case of an older male mouse developing severe obstructive uropathy after a single general anesthesia with FMM. In a subsequent pilot study involving five male mice undergoing similar surgical procedures, also with two sequential surgeries, but using xylazine as the alpha-2 adrenoreceptor agonist in the narcotic combination, none of the animals developed obstructive uropathy in the post-operative period or thereafter. We suggest that replacement of medetomidine with xylazine should be considered for general anesthesia in male mice undergoing multiple successive anesthesia events or in for procedures in older males.
Adaptation of protein stability to thermally heterogeneous environments
Authors: Priklopil Tadeas , Bomblies Kirsten , Widmer Alex 
Published: February 2025

AbstractProper protein folding is essential for biological function, and its disruption can lead to disease, reduced fitness, or death. The ability of a protein to maintain its folded conformation is thus critical for life, making it a key target of adaptive evolution. However, protein stability is sensitive to environmental factors, particularly temperature, which can threaten phenotypic integrity and organismal survival under thermal changes. Despite its importance, the influence of complex thermal environments – characterized here by mean temperature, thermal fluctuations, and environmental heterogeneity – on the evolution of protein stability remains poorly understood. To address this, we developed a mathematical framework that combines two well-established models: a population genetic model describing species distributed across habitats with distinct thermal environments, and a thermodynamic model of protein stability incorporating temperature-dependent enthalpy and entropy contributions. We focus on two-state proteins that alternate between folded and unfolded states and assume that allelic fitness is maximized in proteins that achieve an optimal balance between flexibility and rigidity. Using this framework, we performed an invasion analysis of mutations (sensuadaptive dynamics framework) affecting three thermodynamic parameters that fully determine protein stability profiles. Where possible, we derived analytical expressions for evolutionarily optimal thermodynamic parameters and complemented these with numerical solutions. Our results show that mean temperature and thermal fluctuations have orthogonal effects on thermodynamic parameters, underscoring the need to consider both when studying protein stability adaptation. We further examined thermally heterogeneous environments, where subpopulations connected by migration experience different mean temperatures, identifying conditions that favor either local (specialist) or global (generalist) adaptation. Our results may explain why one thermodynamic parameter shows little association with thermal adaptation and suggest that local adaptation is more likely for proteins with stability profiles limited to narrow temperature ranges. Additionally, our analysis reveals whether a locally adapted protein originated in a colder or warmer habitat. Finally, we identified trade-offs in thermodynamic parameters that influence local or global adaptation. This study offers key predictions about protein evolution in complex thermal environments and lays the groundwork for developing practical tools to understand how temperature shapes adaptation and biodiversity.
Robust constrained weighted least squares for in vivo human cardiac diffusion kurtosis imaging
Authors: Coveney Sam , Afzali Maryam , Mueller Lars , Teh Irvin , Szczepankiewicz Filip , Jones Derek K. , Schneider Jurgen E 
Published: February 2025

AbstractSummaryRobust estimation with convexity constraints significantly improves signal fitting for in vivo human cardiac diffusion kurtosis imaging.PurposeCardiac diffusion tensor imaging (cDTI) is an emerging technique to investigate the microstructure of heart tissue. At sufficiently high b-values, additional information on microstructure can be observed, but the data require a representation beyond DTI such as diffusion kurtosis imaging (DKI). cDTI is highly prone to image corruption, which researchers usually attempt to handle with shot-rejection. However, this can be handled more generally with robust estimation techniques. Recent work has also demonstrated the need to perform constrained fitting for DKI, as fitted parameters can otherwise violate necessary constraints on the signal behaviour, causing significant errors in estimated measures.MethodsWe developed robust constrained weighted least squares (RCWLS) by combining robust estimation with convexity constraints specifically for DKI. Using in vivo cardiac DKI data from 11 healthy volunteers collected with a Connectom scanner, we tested various combinations of fitting techniques, with/without robustness and with/without constraints.ResultsRCWLS was the only tested technique that convincingly showed radial kurtosis to be larger than axial kurtosis for all subjects, something that is expected in myocardium due to increased restrictions to diffusion in the plane perpendicular to the primary myocyte direction. RCWLS also showed the best correction of corrupted regions in diffusion parameter maps for individual subjects.ConclusionFitting techniques utilizing both robust estimation and constraints are essential to facilitate applicability of in vivo cardiac DKI.
Modelling the Impact of Dominant Transport Pathways on Antarctic Krill Fishing Activity in the Southern Ocean
Authors: Kelly Cian , Ellingsen Ingrid , Daae Ragnhild , Alver Morten Omholt 
Published: February 2025

AbstractAntarctic krill (Euphasia superba) are a key component in the Southern Ocean ecosystem, especially in the Atlantic sector, where the majority of the population is concentrated. The Norwegian commercial krill fishery exclusively targets three subareas in the Antarctic: the western Antarctic Peninsula, and the northern shelves of both the South Orkney Islands and South Georgia. Given it’s reliance on oceanic transport from other regions and the potential impact of rising sea temperatures on the northern habitat, the South Georgian krill population is particularly sensitive to altering environmental conditions. The relative distance from the peninsular regions to South Georgia means that choosing to trawl in this region implies a higher risk, which is why it is exclusively targeted in winter when extensive sea-ice makes peninsular regions unsafe and inaccessible to commercial fishery operations. In this article, we show that relative to operations at South Orkney and the Antarctic Pensinsula, average catches at South Georgia have been lower with higher variability over the past 15 years. Using a Lagrangian modelling approach, we illustrate that variability in advection from source regions in the Antarctic Peninsula are correlated with proceeding catch values at South Georgia. This was not the case for source release sites at the South Orkney Islands. The dominant transport pathways for krill were strongly determined by position of regional fronts and the source sites of recruits to South Georgia were related to the position of fronts at both the Antarctic Peninsula and South Orkney Islands. This study highlights the importance of advective patterns on the variability in krill fishing activity and supports the hypothesis that South Georgia is a sink region for krill in the Southern Ocean while the western Antarctic Peninsula is a central source site.