bluuebunny/crossref_metadata_2025_split huggingface dataset:
Teaching Ethics and Professionalism: A National Survey of Ophthalmology Residency Program Directors
Authors: Kretz Alyssa M. , deSante-Bertkau Jennifer E. , Boland Michael V. , Guo Xinxing , Collins Megan E. 
Published: June 2021

Abstract
Background While ethics and professionalism are important components of graduate medical education, there is limited data about how ethics and professionalism curricula are taught or assessed in ophthalmology residency programs.
Objective This study aimed to determine how U.S. ophthalmology residency programs teach and assess ethics and professionalism and explore trainee preparedness in these areas.
Methods Directors from accredited U.S. ophthalmology residency programs completed an online survey about components of programs' ethics and professionalism teaching curricula, strategies for assessing competence, and trainee preparedness in these areas.
Results Directors from 55 of 116 programs (46%) responded. The most common ethics and professionalism topics taught were informed consent (38/49, 78%) and risk management and litigation (38/49, 78%), respectively; most programs assessed trainee competence via 360-degree global evaluation (36/48, 75%). While most (46/48, 95%) respondents reported that their trainees were well or very well prepared at the time of graduation, 15 of 48 (31%) had prohibited a trainee from graduating or required remediation prior to graduation due to unethical or unprofessional conduct. Nearly every program (37/48, 98%) thought that it was very important to dedicate curricular time to teaching ethics and professionalism. Overall, 16 of 48 respondents (33%) felt that the time spent teaching these topics was too little.
Conclusion Ophthalmology residency program directors recognized the importance of an ethics and professionalism curriculum. However, there was marked variation in teaching and assessment methods. Additional work is necessary to identify optimal strategies for teaching and assessing competence in these areas. In addition, a substantial number of trainees were prohibited from graduating or required remediation due to ethics and professionalism issues, suggesting an impact of unethical and unprofessional behavior on resident attrition.
Association between UGT1A1*28 Gene Polymorphism and Severe Neutropenia due to Colorectal Cancer Treatment with Irinotecan: Evidence Based on Meta-Analysis
Authors: Santos Tayná Aparecida de Oliveira , Leão-Cordeiro Jacqueline Andréia Bernardes , Cunha Daiane de Oliveira , Vilanova-Costa Cesar Augusto Sam Tiago , Passos Xisto Sena , Silva Antonio Márcio Teodoro Cordeiro 
Published: June 2021

AbstractObjective The present study aimed to evaluate the relationship between UGT1A1*28 gene polymorphism and the prevalence of neutropenia in patients with colorectal cancer treated with irinotecan.Method Thirteen studies were included. These papers were selected from the Virtual Health Library, Scientific Electronic Library Online, International Health Sciences Literature and PubMed, and their data were collected and evaluated using the BioEstat 5.3 software (BioEstat, Belém, PA, Brazil).Results Three genotypes were analyzed, namely 6/6 (wild type), 6/7, and 7/7. In total, 2,146 patients were included in the present study; of these, 55.6% (n = 1,193) had 6/6 genotype, 37.3% (n = 801) were heterozygous (6/7), and 7.1% (n = 152) had the 7/7 genotype. A total of 1,672 (77.9%) patients displayed mild neutropenia, whereas 474 (22.1%) had severe neutropenia. When contrasting the 6/7 and 7/7 genotypes with the 6/6 genotype using statistical tests for meta-analysis, patients with the 7 allele, either in homozygosis or heterozygosis, presented higher risk of developing severe neutropenia than patients with the 6/6 genotype (odds ratio = 1.559; 95% confidence interval = 1.163–2.090; p = 0.003).Conclusion The analysis of the UGT1A1*28 gene polymorphism can aid the choice of treatment for patients with colorectal cancer in personalized medicine, increasing the chances of therapeutic success.
The Impact of Surgery-Related Muscle Injury on Prevalence and Characteristics of Acute Postcraniotomy Headache – A Prospective Consecutive Case Series
Authors: Huckhagel Torge , Westphal Manfred , Klinger Regine 
Published: June 2021

Abstract
Background The latest third edition of the International Classification of Headache Disorders delineates diagnostic criteria for acute headache attributed to craniotomy (AHAC), but data on possible predisposing factors are sparse. This prospective observational study aims to evaluate the impact of surgery-related muscle incision on the prevalence, severity, and characteristics of AHAC.
Patients and Methods Sixty-four consecutive adults (mean age: 54.2 ± 15.2 years; 26 males and 38 females) undergoing cranial neurosurgery for various reasons without preoperative headache were included. After regaining consciousness, all patients reported their average daily headache on a numeric pain rating scale (NRS; range: 0–10), headache characteristics, as well as analgesic consumption from day 1 to 3 after surgery. Three distinct patient cohorts were built with respect to the surgical approach (craniotomy ± muscle incision; burr hole surgery) and group comparisons were performed. Additionally, patients with AHAC ≥ 3 NRS were reevaluated at 7.2 ± 2.3 months following treatment by means of standardized questionnaires to determine the prevalence of persistent headache attributed to craniotomy as well as headache-related disability and quality of life.
Results Thirty of 64 (46.9%) patients developed moderate to severe AHAC (NRS ≥ 3) after cranial neurosurgery. There were no significant group differences with regard to age, gender, or general health condition (American Society of Anesthesiologists Physical Status Classification). Craniotomy patients with muscle incision suffered from significantly higher early postoperative mean NRS scores compared with their counterparts without procedure-related muscle injury (3.4 ± 2.3 vs. 2.3 ± 1.9) as well as patients undergoing burr hole surgery (1.2 ± 1.4; p = 0.02). Moreover, the consumption of nonopioid analgesics was almost doubled following muscle-transecting surgery as compared with muscle-preserving procedures (p = 0.03). Young patient age (odds ratio/95% confidence interval for each additional year: 0.93/0.88–0.97) and surgery-related muscle injury (5.23/1.62–19.41) were identified as major risk factors for the development of AHAC ≥ 3 NRS. There was a nonsignificant trend toward higher pain chronification rate as well as headache-related disability after craniotomy with muscle injury.
Conclusion Surgery-related muscle damage may be an important predisposing factor for AHAC. Therefore, if a transmuscular approach is unavoidable, the neurosurgeon should be aware of the need for adequately adjusted intra- and postoperative analgesia in these cases.
Examining the Relationship between Altmetric Score and Traditional Bibliometrics in the Ophthalmology Literature for 2013 and 2016 Cohorts
Authors: Wiley Zachary C. , Boyd Carter J. , Ananthasekar Shivani , Bhat Nita , Harish Bindiganavile Shruthi , Lee Andrew G. 
Published: June 2021

Abstract
Background In this study, we reviewed a select sample of ophthalmology literature to determine if there was a correlation between Altimetric and traditional citation-based and impact factor metrics. We hypothesized that Altmetric score would more closely correlate with impact factor and citations in 2016.
Methods Journal Citation Reports for the year 2013 was used to find the 15 highest impact factor ophthalmology journals in 2013. Then Elsevier's Scopus was used to identify the 10 most cited articles from each journal for the years 2013 and 2016. Metrics for all identified articles were collected using the Altmetric Bookmarklet, and date of Twitter account creation was noted for journals with such an account. Altmetric scores, impact factor, and citation counts were tabulated for each article. Pearson's correlation coefficient (r) determined correlation of independent variables (number of citations or impact factor) with dependent variable (Altmetric score). For our Twitter analysis, account age was the independent variable and calculated correlation coefficients (r) were the dependent variable. Proportion of variance was determined with a coefficient of determination (R
2).
Results This study included 300 articles, evenly split between 2013 and 2016. Within the 2013 cohort, three journals had significant positive correlations between citation count and Altmetric score. For the 2016 cohort, both Altmetric score and citation count (r = 0.583, p < 0.001) and Altmetric score and impact factor (r = 0.183, p = 0.025) revealed significant positive correlations. In 2016, two journals were found to have significant correlations between Altmetric score and citation number. Neither year revealed a significant correlation between the age of a journal's Twitter profile and the relationship between Altmetric score and citation count. In each year, Twitter accounted for the highest number of mentions.
Conclusion The findings suggest that correlation between Altmetric score and traditional quality metric scores may be increasing. Altmetric score was correlated with impact factor and number of citations in 2016 but not 2013. At this time, Altmetrics are best used as an adjunct that is complementary but not an alternative to traditional bibliometrics for assessing academic productivity and impact.
Quantifying the Impact of Infusion Alerts and Alarms on Nursing Workflows: A Retrospective Analysis
Authors: Yu Denny , Obuseh Marian , DeLaurentis Poching 
Published: June 2021

Abstract
Background Smart infusion pumps affect workflows as they add alerts and alarms in an information-rich clinical environment where alarm fatigue is already a major concern. An analytic approach is needed to quantify the impact of these alerts and alarms on nursing workflows and patient safety.
Objectives To analyze a detailed infusion dataset from a smart infusion pump system and identify contributing factors for infusion programming alerts, operational alarms, and alarm resolution times.
Methods We analyzed detailed infusion pump data across four hospitals in a health system for up to 1 year. The prevalence of alerts and alarms was grouped by infusion type and a selected list of 32 high-alert medications (HAMs). Logistic regression was used to explore the relationship between a set of risk factors and the occurrence of alerts and alarms. We used nonparametric tests to explore the relationship between alarm resolution times and a subset of predictor variables.
Results The study dataset included 745,641 unique infusions with a total of 3,231,300 infusion events. Overall, 28.7% of all unique infusions had at least one operational alarm, and 2.1% of all unique infusions had at least one programming alert. Alarms averaged two per infusion, whereas at least one alert happened in every 48 unique infusions. Eight percent of alarms took over 4 minutes to resolve. Intravenous fluid infusions had the highest rate of error-state occurrence. HAMs had 1.64 more odds for alerts than the rest of the infusions. On average, HAMs had a higher alert rate than maintenance fluids.
Conclusion Infusion pump alerts and alarms impact clinical care, as alerts and alarms by design interrupt clinical workflow. Our study showcases how hospital system leadership teams can leverage infusion pump informatics to prioritize quality improvement and patient safety initiatives pertaining to infusion practices.
Endovascular Management of Hepatic Encephalopathy
Authors: Le Hieu , Thukral Siddhant , Devane A. Michael , Saddekni Souheil , Varma Rakesh K. 
Published: June 2021

AbstractTransjugular intrahepatic portosystemic shunt (TIPS) and spontaneous portosystemic shunts (SPSS) may lead to new or worsening hepatic encephalopathy (HE), especially in patients with chronic liver disease. Patients with medically refractory HE (rHE) may benefit from endovascular interventions. In this review, we briefly describe the post-TIPS and SPSS vascular anatomy, pathophysiology, classification, factors associated with HE, and the medical management of HE. In addition, we will discuss current endovascular techniques for HE management, their advantages, disadvantages, and review of the current literature.
Splenic Artery Embolisation for the Emergency Treatment of Sinistral Portal Hypertension: A Systematic Review
Authors: Grout-Smith Harriet , Dumenci Ozbil , Tait N. Paul , Alsafi Ali 
Published: June 2021

Abstract
Objectives Sinistral portal hypertension (SPH) is caused by increased pressure on the left portal system secondary to splenic vein stenosis or occlusion and may lead to gastric varices. The definitive management of SPH is splenectomy, but this is associated with significant mortality and morbidity in the acute setting. In this systematic review, we investigated the efficacy and safety of splenic artery embolisation (SAE) in managing refractory variceal bleeding in patients with SPH.
Methods A comprehensive literature search was conducted using MEDLINE and Embase databases. A qualitative analysis was chosen due to heterogeneity of the studies.
Results Our search yielded 339 articles, 278 of which were unique. After initial screening, 16 articles relevant to our search remained for full text review. Of these, 7 were included in the systematic review. All 7 papers were observational, 6 were retrospective. Between them they described 29 SAE procedures to control variceal bleeding. The technical success rate was 100% and there were no cases of rebleeding during follow up. The most common complication was post-embolisation syndrome. Four major complications occurred, two resulting in death. These deaths were the only 30-day mortalities recorded and were in patients with extensive comorbidities.
Conclusions Although there is a distinct lack of randomized controlled studies comparing SAE to other treatment modalities, it appears to be safe and effective in treating hemorrhage secondary to SPH.
The Cosmos Collaborative: A Vendor-Facilitated Electronic Health Record Data Aggregation Platform
Authors: Tarabichi Yasir , Frees Adam , Honeywell Steven , Huang Courtney , Naidech Andrew M. , Moore Jason H. , Kaelber David C. 
Published: June 2021

AbstractObjective Learning healthcare systems use routinely collected data to generate new evidence that informs future practice. While implementing an electronic health record (EHR) system can facilitate this goal for individual institutions, meaningfully aggregating data from multiple institutions can be more empowering. Cosmos is a cross-institution, single EHR vendor-facilitated data aggregation tool. This work aims to describe the initiative and illustrate its potential utility through several use cases.Methods Cosmos is designed to scale rapidly by leveraging preexisting agreements, clinical health information exchange networks, and data standards. Data are stored centrally as a limited dataset, but the customer facing query tool limits results to prevent patient reidentification.Results In 2 years, Cosmos grew to contain EHR data of more than 60 million patients. We present practical examples illustrating how Cosmos could further efforts in chronic disease surveillance (asthma and obesity), syndromic surveillance (seasonal influenza and the 2019 novel coronavirus), immunization adherence and adverse event reporting (human papilloma virus and measles, mumps, rubella, and varicella vaccination), and health services research (antibiotic usage for upper respiratory infection).Discussion A low barrier of entry for Cosmos allows for the rapid accumulation of multi-institutional and mostly de-duplicated EHR data to power research and quality improvement queries characteristic of learning healthcare systems. Limitations are being vendor-specific, an “all or none” contribution model, and the lack of control over queries run on an institution's healthcare data.Conclusion Cosmos provides a model for within-vendor data standardization and aggregation and a steppingstone for broader intervendor interoperability.
The Effect of Prenatal and Postnatal Treatment with Intravenous Immunoglobulin on Severity of Neonatal Hemochromatosis: The Tale of Two Brothers (Case Report)
Authors: Mugarab-Samedi Veronica , Ryan Michelle D. , Awad Essa Hamdan Al , Elsharkawy Adel 
Published: June 2021

Abstract
Background Neonatal hemochromatosis (NH) is a rare condition that was the main reason for liver transplantation in infants. With the realization that NH results from the fetal complement-mediated liver injury, intravenous immunoglobulins (IVIG) were successfully introduced for the treatment.
Case Presentation We present two cases of NH from the same family to illustrate the role of antenatal treatment with IVIG in alleviation and possible prevention of this serious morbidity.
Conclusion A prenatal treatment and early postnatal administration of IVIG are effective ways to manage NH that help to reduce the severity of the symptoms, prevent liver failure, and avoid the need for liver transplantation.
Which Strategies Improve Physicians' Experience with Health Information Technology?
Authors: Haskell Jacqueline , Mandeville Brittany , Cooper Emily , Gardner Rebekah 
Published: June 2021

Abstract
Objectives While electronic health records (EHRs) have improved billing efficiency and note legibility, they may also disrupt clinical workflows, affect patient interactions, and contribute to physician burnout. This study aimed to identify effective strategies, as reported by physicians, to mitigate these EHR shortcomings.
Methods The Rhode Island Department of Health administers a health information technology (HIT) survey biennially to all physicians in active practice statewide. The 2019 survey asked physicians about strategies implemented personally or by their practice to improve their experience working with HIT. Physicians who identified at least one strategy were then asked if each implemented strategy was “actually useful.”
Results The 2019 survey was administered to 4,266 physicians, with a response rate of 43%. Both office- and hospital-based physicians most commonly reported that their practices had implemented voice-recognition dictation software (48 and 68%, respectively). Office- and hospital-based physicians identified self-care as the most commonly implemented personal change (48 and 47%, respectively). However, 26% of office-based and 15% of hospital-based physicians reported reducing clinical hours or working part-time to improve their experience working with HIT. The strategies identified as “actually useful” varied by practice setting and were not always the most widely implemented approaches.
Conclusion Most physicians reported that both they personally and their practices had implemented strategies to improve their experience with HIT. Physicians found some of these strategies more helpful than others, and the strategies identified as most useful differed between office- and hospital-based physicians. From a workforce and access perspective, prioritizing strategies that physicians find “actually useful” is critical, as many physicians in both settings reported reducing clinical hours to improve their experience.
The COVID-19 wicked problem in public health ethics: conflicting evidence, or incommensurable values?
Authors: Angeli Federica , Camporesi Silvia , Dal Fabbro Giorgia 
Published: June 2021

AbstractWhile the world was facing a rapidly progressing COVID-19 second wave, a policy paradox emerged. On the one side, much more was known by Autumn 2020 about the mechanisms underpinning the spread and lethality of Sars-CoV-2. On the other side, how such knowledge should be translated by policymakers into containment measures appeared to be much more controversial and debated than during the first wave in Spring. Value-laden, conflicting views in the scientific community emerged about both problem definition and subsequent solutions surrounding the epidemiological emergency, which underlined that the COVID-19 global crisis had evolved towards a full-fledged policy “wicked problem”. With the aim to make sense of the seemingly paradoxical scientific disagreement around COVID-19 public health policies, we offer an ethical analysis of the scientific views encapsulated in the Great Barrington Declaration and of the John Snow Memorandum, two scientific petitions that appeared in October 2020. We show that how evidence is interpreted and translated into polar opposite advice with respect to COVID-19 containment policies depends on a different ethical compass that leads to different prioritization decisions of ethical values and societal goals. We then highlight the need for asituatedapproach to public health policy, which recognizes that policies are necessarily value-laden, and need to be sensitive to context-specific and historic socio-cultural and socio-economic nuances.
High-quality, temperature-dependent terahertz spectroscopy of single crystalline L-alanine: Experiment and density-functional theory
Authors: Sanders T. J. , Allen J. L. , Horvat J. , Lewis R. A. 
Published: June 2021

For the first time, the terahertz transmittance spectra of l-alanine have been measured using a single crystal. Measurements were obtained over a large temperature range (12–300 K) and revealed 18 absorptions between 20 and 250 cm−1. These modes were sharp and symmetric, a feature of single crystals and low temperatures. The spectra were directly compared to those of a powdered pellet sample. Raman spectroscopy and x-ray diffraction were used to confirm the sample’s structure and purity. With increasing temperature, all modes exhibit spectral redshift, well described by a Bose–Einstein model, indicating the phonon origin of the absorptions. The exceptions are the 91 and 128 cm−1 modes. The former blueshifts. The latter initially blueshifts but transitions to redshifting. Both behaviors are anomalous. Density-functional theory modeling helped assign all the observed modes.
Human variation in gingival inflammation
Authors: Bamashmous Shatha , Kotsakis Georgios A. , Kerns Kristopher A. , Leroux Brian G. , Zenobia Camille , Chen Dandan , Trivedi Harsh M. , McLean Jeffrey S. , Darveau Richard P. 
Published: June 2021

SignificanceExperimental gingivitis studies where dental hygiene is withheld from select teeth, allowing natural bacterial accumulation, provide a unique opportunity to study the reversible transition from health to inflammatory disease in humans. Longitudinal analysis of both the microbial and host changes during human experimental gingivitis revealed a previously unknown variation in the human host response and microbial succession sequence during inflammation. The significance of our findings can be summarized in two major points. First, the study comprehensively characterizes three different clinical responses—designated high, low, and slow—discerning unique host and microbial features that define each group. Second, we have unveiled previously unrecognized host protective mechanisms to prevent inflammatory bone resorption during reversible gingival inflammation.
Scalable live-attenuated SARS-CoV-2 vaccine candidate demonstrates preclinical safety and efficacy
Authors: Wang Ying , Yang Chen , Song Yutong , Coleman J. Robert , Stawowczyk Marcin , Tafrova Juliana , Tasker Sybil , Boltz David , Baker Robert , Garcia Liliana , Seale Olivia , Kushnir Anna , Wimmer Eckard , Mueller Steffen 
Published: June 2021

Significance
This work demonstrates the feasibility of rationally designing and synthesizing vaccine candidates for testing in response to an emerging disease in real world conditions. Furthermore, using a live attenuated codon-pair–deoptimized virus approach ensures that all components of the host immune system will be engaged, and potential effects from the vector sequences from hybrid live viruses are avoided. Evidence from other codon-deoptimized viruses suggests that COVI-VAC will be resistant to reversion and loss of potency due to antigenic drift. The ease of large-scale virus growth under permissive conditions coupled with the potential for single-dose intranasal administration make COVI-VAC an appealing candidate for clinical testing for possible use in mass immunization programs.