bluuebunny/crossref_metadata_2025_split huggingface dataset:
When it’s needed most: a blueprint for resident creative writing workshops during inpatient rotations
Authors: Edwards Lauren Michelle , Kim Yeuen , Stevenson Matthew , Johnson Tyler , Sharp Nora , Reisman Anna , Srinivasan Malathi 
Published: October 2021

Background
Narrative Medicine may mitigate physician burnout by increasing empathy and self-compassion, and by encouraging physicians to deeply connect with patient stories/experiences. However, Narrative Medicine has been difficult to implement on hectic inpatient teaching services that are often the most emotionally taxing for residents.

Objective
To evaluate programmatic and learner outcomes of a novel narrative medicine curriculum implementation during inpatient medicine rotations for medical residents. Programmatic outcomes included implementation lessons. Learner outcomes included preliminary understanding of impact on feelings of burnout. Additionally, we developed a generalizable narrative medicine framework for program implementation across institutions.

Methods
We developed and implemented a monthly 45-min Narrative Medicine workshop on Stanford’s busiest and emotionally-demanding inpatient rotation (medical oncology). Using the Physician Wellbeing Inventory (PWBI, range 1–7; 3–4 = high burnout risk; ≥4, high burnout), we anonymously assessed resident burnout during pre-implementation control year (2017–2018, weeks 1 and 4), and implementation year (2018–2019, weeks 1 and 4). We interviewed program directors and facilitators regarding curriculum implementation challenges/facilitators.

Results
Residents highly rated the narrative medicine curriculum, and the residency program renewed the course for 3 additional years. We identified success factors for programmatic success including time neutrality, control of session, learning climate, building trust, staff partnership, and facilitators training. During control year, resident burnout was initially high (n = 16; mean PBWI = 3.0, SD: 1.1) and increased by the final week (n = 15; PBWI = 3.4, SD: 1.6). During implementation year, resident burnout was initially similar (n = 13; PBWI = 3.1, SD: 1.9) but did not rise as much by rotation end (n = 24; PBWI = 3.3, SD: 1.6). Implementation was underpowered to detect small effect sizes. Based on our our experience and literature review, we propose an educational competency framework potentially helpful to facilitate inpatient narrative medicine workshops, as a blueprint for other institutions.

Conclusions
Inpatient Narrative Medicine is feasible to implement during a challenging inpatient rotation and may have important short-term effects in mitigating burnout rise, with more study needed. We share teaching tools and propose a competency framework which may be useful to support development of inpatient narrative medicine curricula across institutions.
A statistical quality assessment method for longitudinal observations in electronic health record data with an application to the VA million veteran program
Authors: Wang Hui , Belitskaya-Levy Ilana , Wu Fan , Lee Jennifer S. , Shih Mei-Chiung , Tsao Philip S. , Lu Ying ,   on behalf of VA Million Veteran Program
Published: October 2021

Abstract
Background
To describe an automated method for assessment of the plausibility of continuous variables collected in the electronic health record (EHR) data for real world evidence research use.

Methods
The most widely used approach in quality assessment (QA) for continuous variables is to detect the implausible numbers using prespecified thresholds. In augmentation to the thresholding method, we developed a score-based method that leverages the longitudinal characteristics of EHR data for detection of the observations inconsistent with the history of a patient. The method was applied to the height and weight data in the EHR from the Million Veteran Program Data from the Veteran’s Healthcare Administration (VHA). A validation study was also conducted.

Results
The receiver operating characteristic (ROC) metrics of the developed method outperforms the widely used thresholding method. It is also demonstrated that different quality assessment methods have a non-ignorable impact on the body mass index (BMI) classification calculated from height and weight data in the VHA’s database.

Conclusions
The score-based method enables automated and scaled detection of the problematic data points in health care big data while allowing the investigators to select the high-quality data based on their need. Leveraging the longitudinal characteristics in EHR will significantly improve the QA performance.
Evaluation of the stability of cucurbit[8]uril-based ternary host−guest complexation in physiological environment and the fabrication of a supramolecular theranostic nanomedicine
Authors: Wu Han , Chen Zuobing , Qi Shaolong , Bai Bing , Ye Jiajun , Wu Dan , Shen Jie , Kang Fei , Yu Guocan 
Published: October 2021

Abstract
Background
Supramolecular theranostics have exhibited promising potentials in disease diagnosis and therapy by taking advantages of the dynamic and reversible nature of non-covalent interactions. It is extremely important to figure out the stability of the driving forces in physiological environment for the preparation of theranostic systems.

Methods
The host−guest complexation between cucurbit[8]uril (CB[8]), 4,4′-bipyridinium, and napththyl guest was fully studied using various characterizations, including nuclear magnetic resonance spectroscopy, ultraviolet–visible (UV–vis) spectroscopy, isothermal titration calorimetry (ITC). The association constants of this ternary complex were determined using isothermal titration calorimetry. The stability of the non-covalent interactions and self-assemblies form from this molecular recognition was confirmed by UV–vis spectroscopy and dynamic light scattering (DLS). A supramolecular nanomedicine was constructed on the basis of this 1:1:1 ternary recognition, and its in vitro and in vivo anticancer efficacy were thoroughly evaluated. Positron emission tomography (PET) imaging was used to monitor the delivery and biodistribution of the supramolecular nanomedicine.

Results
Various experiments confirmed that the ternary complexation between 4,4′-bipyridinium, and napththyl derivative and CB[8] was stable in physiological environment, including phosphate buffered solution and cell culture medium. Supramolecular nanomedicine (SNM@DOX) encapsulating a neutral anticancer drug (doxrubincin, DOX) was prepared based on this molecular recognition that linked the hydrophobic poly(ε-caprolactone) chain and hydrophilic polyethylene glycol segment. The non-covalent interactions guaranteed the stability of SNM@DOX during blood circulation and promoted its tumor accumulation by taking advantage of the enhanced permeability and retention effect, thus greatly improving the anti-tumor efficacy as compared with the free drug.

Conclusion
Arising from the host-enhanced charge-transfer interactions, the CB[8]-based ternary recognition was stable enough in physiological environment, which was suitable for the fabrication of supramolecular nanotheranostics showing promising potentials in precise cancer diagnosis and therapy.

Graphic Abstract
Esthetic and functional reconstruction of large mandibular defects using free fibula flap and implant-retained prosthetics - a case series with long-term follow-up
Authors: Sass Tamás , Piffkó József , Braunitzer Gábor , Oberna Ferenc 
Published: October 2021

AbstractBackgroundThe reconstructive and rehabilitative management of large mandibular defects with basal continuity is challenging in many respects, especially in the vertical dimension. The free fibula flap is an under-utilised but efficient approach in this indication. The aim of this case series is to demonstrate its use and long-term success.Case presentationThree cases are presented, where the patient had a large bone defect (at least 5 cm in length and 1 cm in the vertical dimension), but the continuity of the mandible was maintained. Two cases were related to pathological fracture and one was a large defect due to oncological surgery. Vertical augmentation with free microvascularised fibula flap was carried out, followed by implant-retained prosthetic therapy. Clinical status has been followed up for 5 to 6 years, with special attention to the condition of the peri-implant tissues and any radiographically detectable alterations or complications. No complications occurred during the follow-up. Function and esthetics have remained unchanged throughout.ConclusionsFree microvascularised fibula flap reconstruction combined with implant-retained prosthetics allows a lasting functional and esthetic solution in the discussed indication.
Polymethyl methacrylate cure time in simulated in vivo total knee arthroplasty versus in vitro conditions
Authors: Funk Daniel A. , Nguyen Quang-Viet , Swank Michael 
Published: October 2021

Abstract
Background
The present means of confirming the cure of intra-operative polymethyl methacrylate (PMMA) cement are to wait for the remainder cement to harden. To our knowledge, there is no available technique to determine the precise moment of cure for in-vivo cement beneath the tibial tray. This study uses a novel means to determine cement curing time in two environments. One environment represents the operating theater, and the other environment attempts to model cement conditions under the tibial tray during surgery.

Materials and methods
We determined the temperature-versus-time plot of cement curing using the following two temperature sensors: one in a simulated implanted tibial tray and another in the remainder cement. We performed 55 tests using dental methyl methacrylate cement mixed in the same ratio as the orthopedic cement. To simulate in vivo conditions, a simulated stainless-steel tibial tray was implanted on a cancellous bone substitute (Sawbones, Vashon Island, WA, USA) using standard cement technique and subsequently placed in a 90°F (32.2 °C) circulating water bath. We positioned a temperature sensor in the cement mantel and positioned a second sensor in a portion of the remaining cement. The temperature from both sensors was measured simultaneously, beginning at 5 min after mixing and continuing for 20 min. The first derivative of the temperature provided the precise curing time for each condition. We analyzed the results of 55 repeated experiments with an independent samples t-test.

Results
With the described technique, we were able to accurately determine the moment of cure of the cement beneath the simulated tray. There was a mean difference between cure time of 5 min and 26 s (p value < 0.001) between the two conditions.

Conclusions
We validated that our technique was successful in determining the precise time to cure in two different environments.

Level of evidence
This was not a clinical trial and did not involve patients as such the level of evidence was Grade A: Consistent 1 and 2.
Antimicrobial stewardship measures in cardiac surgery and its impact on surgical site infections
Authors: Surat Güzin , Bernsen Dominik , Schimmer Christoph 
Published: October 2021

AbstractObjectiveThe goal of this study was to monitor the compliance and impact on a protocol change of surgical antimicrobial prophylaxis in cardiac surgery favouring cefazolin instead cefuroxime, initiated by the hospital’s antimicrobial stewardship team.MethodsThis quality improvement study was performed in a tertiary care hospital in collaboration with the department of cardiothoracic surgery and the hospitals antimicrobial stewardship team following a revision of the standard for surgical antimicrobial prophylaxis including 1029 patients who underwent cardiac surgery. 582 patients receiving cefuroxime and 447 patients receiving cefazolin respectively were compared without altering any other preventative perioperative measures including its postoperative duration of less than 24 h. Adherence and surgical site infections were compiled and analysed.ResultsA complete adherence was achieved. Overall surgical site infections occurred in 37 (3.6%) of the cases, 20 (3.4%) in cefuroxime patients and 17 (3.8%) in cefazolin patients (p value = 0.754). No statistically significant differences could be found in any of the primary endpoints, but there was a trend towards less deep sternal wound infections in the cefazolin group.ConclusionsThe study supports the role of antimicrobial stewardship in cardiac surgery and mirrors the success of a multidisciplinary team aiming to minimize adverse events by optimizing antibiotic use.
Recent advances in understanding the effects of lignin structural characteristics on enzymatic hydrolysis
Authors: Yuan Yufeng , Jiang Bo , Chen Hui , Wu Wenjuan , Wu Shufang , Jin Yongcan , Xiao Huining 
Published: October 2021

AbstractEnzymatic hydrolysis of lignocellulose for bioethanol production shows a great potential to remit the rapid consumption of fossil fuels, given the fact that lignocellulose feedstocks are abundant, cost-efficient, and renewable. Lignin results in low enzymatic saccharification by forming the steric hindrance, non-productive adsorption of cellulase onto lignin, and deactivating the cellulase. In general, the non-productive binding of cellulase on lignin is widely known as the major cause for inhibiting the enzymatic hydrolysis. Pretreatment is an effective way to remove lignin and improve the enzymatic digestibility of lignocellulose. Along with removing lignin, the pretreatment can modify the lignin structure, which significantly affects the non-productive adsorption of cellulase onto lignin. To relieve the inhibitory effect of lignin on enzymatic hydrolysis, enormous efforts have been made to elucidate the correlation of lignin structure with lignin–enzyme interactions but with different views. In addition, contrary to the traditional belief that lignin inhibits enzymatic hydrolysis, in recent years, the addition of water-soluble lignin such as lignosulfonate or low molecular-weight lignin exerts a positive effect on enzymatic hydrolysis, which gives a new insight into the lignin–enzyme interactions. For throwing light on their structure–interaction relationship during enzymatic hydrolysis, the effect of residual lignin in substrate and introduced lignin in hydrolysate on enzymatic hydrolysis are critically reviewed, aiming at realizing the targeted regulation of lignin structure for improving the saccharification of lignocellulose. The review is also focused on exploring the lignin–enzyme interactions to mitigate the negative impact of lignin and reducing the cost of enzymatic hydrolysis of lignocellulose.
Droplets generated from toilets during urination as a possible vehicle of carbapenem-resistant Klebsiella pneumoniae
Authors: Arena Fabio , Coda Anna Rita Daniela , Meschini Valentina , Verzicco Roberto , Liso Arcangelo 
Published: October 2021

Abstract
Background
In the health care setting, infection control actions are fundamental for containing the dissemination of multidrug-resistant bacteria (MDR). Carbapenemase-producing Enterobacterales (CPE), especially Klebsiella pneumoniae (CR-KP), can spread among patients, although the dynamics of transmission are not fully known. Since CR-KP is present in wastewater and microorganisms are not completely removed from the toilet bowl by flushing, the risk of transmission in settings where toilets are shared should be addressed. We investigated whether urinating generates droplets that can be a vehicle for bacteria and explored the use of an innovative foam to control and eliminate this phenomenon.

Methods
To study droplet formation during urination, we set up an experiment in which different geometrical configurations of toilets could be reproduced and customized. To demonstrate that droplets can mobilize bacteria from the toilet bowl, a standard ceramic toilet was contaminated with a KPC-producing Klebsiella pneumoniae ST101 isolate. Then, we reproduced urination and attached culture dishes to the bottom of the toilet lid for bacterial colony recovery with and without foam.

Results
Rebound droplets invariably formed, irrespective of the geometrical configuration of the toilet. In microbiological experiments, we demonstrated that bacteria are always mobilized from the toilet bowl (mean value: 0.11 ± 0.05 CFU/cm2) and showed that a specific foam layer can completely suppress mobilization.

Conclusions
Our study demonstrated that droplets generated from toilets during urination can be a hidden source of CR-KP transmission in settings where toilets are shared among colonized and noncolonized patients.
A Randomized Study of Lenvatinib 18 mg vs 24 mg in Patients With Radioiodine-Refractory Differentiated Thyroid Cancer
Authors: Brose Marcia S , Panaseykin Yury , Konda Bhavana , de la Fouchardiere Christelle , Hughes Brett G M , Gianoukakis Andrew G , Joo Park Young , Romanov Ilia , Krzyzanowska Monika K , Leboulleux Sophie , Binder Terri A , Dutcus Corina , Xie Ran , Taylor Matthew H 
Published: October 2021

Abstract

Background
Lenvatinib is a multikinase inhibitor approved to treat radioiodine-refractory differentiated thyroid cancer (RR-DTC) at a starting dose of 24 mg/day. This study explored, in a double-blinded fashion, whether a starting dose of 18 mg/day would provide comparable efficacy with reduced toxicity.

Methods
Patients with RR-DTC were randomized to lenvatinib 24 mg/day or 18 mg/day. The primary efficacy endpoint was objective response rate as of week 24 (ORRwk24); the odds ratio noninferiority margin was 0.4. The primary safety endpoint was frequency of grade ≥3 treatment-emergent adverse events (TEAEs) as of week 24. Tumors were assessed using RECIST v1.1. TEAEs were monitored and recorded.

Results
The ORRwk24 was 57.3% (95% CI 46.1, 68.5) in the lenvatinib 24-mg arm and 40.3% (95% CI 29.3, 51.2) in the lenvatinib 18-mg arm, with an odds ratio (18/24 mg) of 0.50 (95% CI 0.26, 0.96). As of week 24, the rates of TEAEs grade ≥3 were 61.3% in the lenvatinib 24-mg arm and 57.1% in the lenvatinib 18-mg arm, a difference of −4.2% (95% CI −19.8, 11.4).

Conclusion
A starting dose of lenvatinib 18 mg/day did not demonstrate noninferiority compared to a starting dose of 24 mg/day as assessed by ORRwk24 in patients with RR-DTC. The results represent a clinically meaningful difference in ORRwk24. The safety profile was comparable, with no clinically relevant difference between arms. These results support the continued use of the approved starting dose of lenvatinib 24 mg/day in patients with RR-DTC and adjusting the dose as necessary.
Plasma Steroid Profiling in Patients With Adrenal Incidentaloma
Authors: Berke Kristina , Constantinescu Georgiana , Masjkur Jimmy , Kimpel Otilia , Dischinger Ulrich , Peitzsch Mirko , Kwapiszewska Aleksandra , Dobrowolski Piotr , Nölting Svenja , Reincke Martin , Beuschlein Felix , Bornstein Stefan R , Prejbisz Aleksander , Lenders Jacques W M , Fassnacht Martin , Eisenhofer Graeme 
Published: October 2021

Abstract

Context
Most patients with adrenal incidentaloma have nonfunctional lesions that do not require treatment, while others have functional or malignant tumors that require intervention. The plasma steroid metabolome may be useful to assess therapeutic need.

Objective
This work aimed to establish the utility of plasma steroid profiling combined with metanephrines and adrenal tumor size for the differential diagnosis of patients with adrenal incidentaloma.

Methods
This retrospective cross-sectional study, which took place at 7 European tertiary-care centers, comprised 577 patients with adrenal incidentaloma, including 19, 77, 65, 104 and 312 respective patients with adrenocortical carcinoma (ACC), pheochromocytoma (PHEO), primary aldosteronism (PA), autonomous cortisol secretion (ACS), and nonfunctional adrenal incidentaloma (NFAI). Mesaures of diagnostic performance were assessed (with [95% CIs]) for discriminating different subgroups of patients with adrenal incidentaloma.

Results
Patients with ACC were characterized by elevated plasma concentrations of 11-deoxycortisol, 11-deoxycorticosterone, 17-hydroxyprogesterone, androstenedione, and dehydroepiandrosterone-sulfate, whereas patients with PA had elevations of aldosterone, 18-oxocortisol, and 18-hydroxycortisol. A selection of those 8 steroids, combined with 3 others (cortisol, corticosterone, and dehydroepiandrosterone) and plasma metanephrines, proved optimal for identifying patients with ACC, PA, and PHEO at respective sensitivities of 83.3% (66.1%-100%), 90.8% (83.7%-97.8%), and 94.8% (89.8%-99.8%); and specificities of 98.0% (96.9%-99.2%), 92.0% (89.6%-94.3%), and 98.6% (97.6%-99.6%). With the addition of tumor size, discrimination improved further, particularly for ACC (100% [100%-100%] sensitivity, 99.5% [98.9%-100%] specificity). In contrast, discrimination of ACS and NFAI remained suboptimal (70%-71% sensitivity, 89%-90% specificity).

Conclusion
Among patients with adrenal incidentaloma, the combination of plasma steroid metabolomics with routinely available plasma free metanephrines and data from imaging studies may facilitate the identification of almost all clinically relevant adrenal tumors.
North Korea as a Method: A Critical Review
Authors: Song Jay 
Published: October 2021

Abstract
North Korean studies is an established subfield within Korean studies. The current article reviews methodological trends in North Korean studies, mainly in social sciences, over the past two decades. It aims to demonstrate the evolution of data and methodologies employed by scholars in the field by focusing on three methods—statistical analyses, interviews, and theory testing—as well as to examine benefits and challenges associated with each methodology. The study finds that data and methodologies have become significantly diversified and sophisticated with increased accessibility to digitized North Korean materials, multidisciplinary eclectic methods, and computational analytical tools used by a new generation of scholars. At the core, it is the validity of data that can genuinely contribute to evidence-based scientific investigation. It also highlights that researchers’ epistemological barriers can seriously undermine the transparency in data and research design. Self-reflection, cross-examination, and rigorous peer review can further advance the quality of North Korean studies.
Subramania Bharati and the Rhetoric of Enthusiasm
Authors: Sunder Rajan Rajeswari 
Published: October 2021

AbstractThis article identifies the rhetoric and sentiment of enthusiasm as a certain specifically Tamil historical-aesthetic-political conjuncture that operates in both an affective register and as a structure of publicity. The “people,” who emerge as a subject of politics within the crucible of the swadeshi movement, are both “the masses” (a populist political subject) as well as the anticipated citizens of a future sovereign democracy. To distinguish the Tamil conjuncture from the histories of European populism, Part I outlines the political implications of public enthusiasm in the European Enlightenment. Kant, in his articulation of enthusiasm as a form of reason, is the critical figure here. Whereas in English poetry enthusiasm was domesticated and contained, Bharati’s writings and their impact exemplify its very different trajectory in colonial India. In Part II, Bharati’s poetry is analyzed under three heads: the enthusiasm it manifests, its language and rhetoric, and its focus on nationalism and social reform. Part III describes the communicative technologies and the formation of Bharati’s public and then the colonial conjuncture in which his work encountered censorship and prohibition. The conclusion underlines the significance of Bharati’s writings and the relevance of the political enthusiasm they generated—and still do.