bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effectiveness of Ketamine As a Rescue Drug for Patients Experiencing Benzodiazepine-Resistant Status Epilepticus in the Prehospital Setting
Authors: Scheppke Kenneth A. , Pepe Paul E. , Garay Sebastian A. , Coyle Charles W. , Antevy Peter M. , Perlmutter Michael C. , Scheppke Eric K. , Crowe Remle P. 
Published: December 2024

OBJECTIVES:
Accumulating basic science data, early clinical findings and various feasibility considerations have provided rationales for administering ketamine as a proposed rescue medication for midazolam-resistant status epilepticus (SE) in the logistically challenging prehospital environment. This report details the multiyear experience of paramedics managing midazolam-resistant SE following the introduction of a ketamine-rescue protocol.

DESIGN:
A 7-year, population-based, observational study was conducted to evaluate outcomes of patients treated with IV, intraosseous, intramuscular, or intranasal ketamine for SE despite sufficient midazolam dosings. Tracked outcomes included: 1) rapid/sustained termination of clinical seizures in adults while under paramedics’ care; 2) corresponding evaluations in children/adolescents; 3) any concerning observations regarding need for assisted ventilation, intubation, or other active interventions post-ketamine; and 4) any identifiable associations between outcomes and circumstances, demographics, or medical history.

SETTING:
Emergency response 9-1-1 system serving a large, diverse U.S. county (jurisdictional population, 961,000/1,769 sq miles).

PATIENTS:
Those receiving ketamine from paramedics for persistent seizures.

INTERVENTIONS:
Adults and adolescents: 100 mg ketamine IV/intraosseous/intramuscular/intranasal; children: 1 mg/kg intramuscular/intranasal.

MEASUREMENTS AND MAIN RESULTS:
Among 81 total cases, 57 involved adults (18–86 yr old) receiving the SE-midazolam + ketamine protocol. Ketamine rapidly terminated convulsions in 56 (98.2%) without recurrence during prehospital and hospital arrival phases. For approved reasons, paramedics administered ketamine directly (no midazolam) in eight adults and one child, terminating convulsions in every case. Among 15 childhood/adolescent cases treated per protocol, ketamine rapidly terminated SE activity in 11, but only mitigated it in four, including two retrospectively judged to involve nonseizure activity and two involving intranasal administration. Among all 81 ketamine-treated cases, there were no identifiable clinically significant complications attributable to ketamine, particularly the need for any additional active interventions.

CONCLUSIONS:
Ketamine appeared to be consistently effective in treating adults with ongoing out-of-hospital seizures that were resistant to sufficient dosings of midazolam. Similar results were observed in children/adolescents.
Shoshin Beriberi in a Child With Intestinal Failure: A Case Report
Authors: Böhrer Madeleine , Burgess Paige , Da Costa Sao Pedro Tais , Boctor Dana Liza , Boggs Samantha 
Published: December 2024

Background:
Acute illness states with increased metabolic demand can precipitate severe thiamine deficiency if physiologic needs exceed endogenous stores and supplementation. Patients with preexisting risk factors such as parenteral nutrition (PN) dependence, eating disorders, gastrointestinal disorders, or surgeries are especially vulnerable.

Case Summary:
A 9-year-old girl with short bowel syndrome receiving long-term PN, including standard thiamine supplementation, presented with refractory shock following aspiration. Profound hyperlactatemia, cardiac dysfunction, and vasoactive requirements persisted despite extracorporeal membrane oxygenation and resolved only after treatment with parenteral thiamine.

CONCLUSIONS:
Hemodynamic collapse due to thiamine deficiency (Shoshin beriberi) may occur during acute illness in children with nutritional risk factors and should be considered in refractory hyperlactatemia. Timely treatment with parenteral thiamine can support dramatic hemodynamic recovery. Treatment of suspected thiamine deficiency should not be delayed for laboratory confirmation as current thiamine reference ranges correlate poorly with clinical severity, and functional testing may not be readily available.
Zero-count Detector
Authors: Semkow Thomas M. 
Published: December 2024

Abstract
We developed a statistical theory of zero-count-detector (ZCD), which is defined as a zero-class Poisson under conditions outlined in this paper. ZCD is often encountered in the studies of rare events in physics, health physics, and many other fields where counting of events occurs. We found no acceptable solution to ZCD in classical statistics and affirmed the need for the Bayesian statistics. Several uniform and reference priors were studied, and we derived Bayesian posteriors, point estimates, and upper limits. It was shown that the maximum-entropy prior, containing the most information, resulted in the smallest bias and the lowest risk, making it the most admissible and acceptable among the priors studied. We also investigated application of zero-inflated Poisson and Negative-binomial distributions to ZCD. It was shown using Bayesian marginalization that, under limited information, these distributions reduce to the Poisson distribution.
INCREASED RISK OF CYSTOID MACULAR EDEMA AFTER CATARACT SURGERY IN EYES PREVIOUSLY VITRECTOMIZED FOR IDIOPATHIC EPIRETINAL MEMBRANE
Authors: Iuliano Lorenzo , Maestranzi Gisella , Corbelli Eleonora , Rasore Gabriele , Bandello Francesco , Codenotti Marco 
Published: December 2024

Purpose:
To assess the rate and risk factors of cystoid macular edema (CME) both after isolated vitrectomy and after subsequent phacoemulsification in eyes with primary noncomplicated rhegmatogenous retinal detachment (RRD) or idiopathic epiretinal membrane (ERM).

Methods:
Retrospective observation of institutional patients undergoing vitrectomy for RRD or vitrectomy with internal limiting membrane peeling for ERM from 2016 to 2021, further analyzing those who later underwent phacoemulsification. The CME rate was assessed within the first 6 months after both vitrectomy and cataract surgery.

Results:
The authors included 187 phakic eyes with ERM and 311 with RRD undergoing isolated vitrectomy. Postvitrectomy CME occurred in 12.8% of ERM cases compared with 1% in RRD cases (P < 0.0001). Stage-4 ERMs and intraoperative laser were found associated with CME. After uncomplicated phacoemulsification, the CME rate was higher in eyes vitrectomized for ERM (13.8%) compared with RRD (2%, P = 0.0055). Postvitrectomy CME was found to be associated with an increased risk of postcataract CME (odds ratio 13.588, P = 0.0187).

Conclusion:
In eyes undergoing phacoemulsification postvitrectomy, the risk of CME is higher when vitrectomy was performed for ERM compared with RRD. The ERM-related intraretinal changes, together with the required surgical stress, may play a role in making these eyes more susceptible to CME.
A Review of Contact Lens Regulations in the Asia Pacific Region
Authors: Lee Jie Rong Jerome , Yee Ting Hui , Levitz David , Lim Blanche Xiao Hong , Mehta Jodhbir Singh , Stapleton Fiona , Lim Chris Hong Long 
Published: December 2024

Abstract:
The increased usage of nonrefractive cosmetic contact lenses in Asia and a trend toward increased online purchasing of both refractive and cosmetic contact lenses poses unique challenges in the management of contact lens–related complications. However, regulations have lagged behind this increased uptake in the community. This paper reviews regulations surrounding the manufacturing, import, and distribution of contact lenses in the Asia Pacific region and compares them with international regulations from the European Union and United States. It found a need for more specific regulations and closer surveillance targeted at new trends in contact lens purchasing and usage. This paper also found a need for more effective enforcement of current regulations.
Interactions between antidiabetes medications and heart–brain axis
Authors: Ong Leong Tung , Sia Ching-Hui 
Published: December 2024

Purpose of review
The heart–brain axis (HBA) is the physiological interactions between the cardiovascular and nervous systems through autonomic nerves, hormones, and cytokines. Patients diagnosed with diabetes mellitus have an increased risk of the cardiovascular and neurological diseases. However, recent evidence demonstrated that different antidiabetic drugs may delay cognitive impairment and improve cardiovascular outcomes. This review examines the impact of antidiabetic drugs on the HBA in patients with diabetes.

Recent findings
Metformin improves the cardiovascular and cognitive outcomes through adenosine 5′-monophosphate-activated protein kinase activation. Sodium-glucose cotransporter-2 inhibitors reduce inflammation, oxidative stress by inhibiting the NLRP3 inflammasome thereby reducing the incidence of heart failure and formation of beta-amyloid and neurofibrillary tangles in the brain. Dipeptidyl peptidase-4 inhibitors exhibit neuroprotective effects in Alzheimer's disease by reducing amyloid-beta and tau pathology and inflammation but may exacerbate heart failure risk due to increased sympathetic activity and prolonged β-adrenergic stimulation. Glucagon-like peptide-1 receptor agonists exhibit neuroprotective effects in Alzheimer's and Parkinson's diseases by reducing neuroinflammation, but may increase sympathetic activity, potentially elevating heart rate and blood pressure, despite their cardioprotective benefits.

Summary
Antidiabetes medications have the potential to improve cardiovascular and cognitive outcomes; however, additional studies are required to substantiate these effects.
Atherogenic low-density lipoprotein and cardiovascular risk
Authors: Hernando-Redondo Javier , Niño Olga Castañer , Fitó Montse 
Published: December 2024

Purpose of review
Despite reductions in low-density lipoprotein (LDL) cholesterol (LDLc), residual cardiovascular risk remains due to factors beyond lipoprotein levels, such as LDL particle count, size, electronegativity and modifications. Technological advances allow detailed profiling of LDL particles, offering potential biomarkers for diagnosis, prognosis, and treatment of cardiovascular disease (CVD). The aim of this review is to provide an updated overview of the state of knowledge in the field of LDL atherosclerotic role, which is evolving rapidly due to technological advances in biomarker measurement and applications.

Recent findings
While small dense LDL has been linked to increased CVD risk, current approaches favor a comprehensive evaluation of all lipoprotein subtypes, as this is a more feasible and standardized method. The atherogenic potential of circulating oxidized LDL (oxLDL) may be the key factor in the onset and progression of atherosclerosis. Thus, elevated oxLDL levels are recognized as a marker of increased CVD risk in both general and high-risk populations, although further research is needed to clarify some conflicting findings. The oxidized LDL receptor 1 (LOX-1) has emerged as a promising target for immunotherapy and innovative drug delivery strategies to modulate atherosclerosis.

Summary
A panel of biomarkers related to LDL atherogenicity may help predict future ischemic events. An atheroprotective diet and increased physical activity could improve LDL oxidation. OxLDL has become a target for immunomodulatory antiatherosclerosis therapy and delivering LDL-based nanocarriers holds promise for both imaging and therapeutics.
Time to Resolution of Severe Anemia in Young Children With Iron Deficiency
Authors: Leister John , Norby Faye L. , Boucher Alexander A. 
Published: December 2024

Iron deficiency anemia in children remains a pervasive problem. Prolonged iron deficiency anemia (IDA) is linked to adverse neurodevelopmental outcomes, but the duration of severe IDA (hemoglobin <7 g/dL) in children is poorly studied, particularly for racial/ethnic minority groups. We reviewed the electronic medical records of 92 children (1 to 5 y old) with IDA within a major metropolitan health care system. Duration of anemia, hemoglobin at diagnosis and nadir, age, sex, race/ethnicity, and the use of intravenous interventions were analyzed by Kaplan-Meier curves, Cox regression, and logistic regression. The majority of the included children were Asian (72.8%). Anemia resolution was documented in 68% of cases, and 47% of cases received intravenous intervention. Iron repletion was only confirmed in 37% of cases (n=34), leaving many children with unclear resolution at risk for recurrence. Caucasian children had anemia resolution faster than Black or Asian children, and the latter groups were also less likely to reach hemoglobin normalization. Children with intravenous interventions were more likely to have documented resolution than those with only oral treatment. Those receiving intravenous interventions were more likely to be followed through anemia resolution, although treatment standardization was lacking, and confirmation of iron storage repletion was rarely checked. Future studies should emphasize the importance of ensuring iron storage replacement and potentially utilize time-to-anemia resolution data to determine optimal hemoglobin values for intravenous iron as a first-line intervention.
Telehealth in Gynecologic Oncology Clinical Trials
Authors: Andriani Leslie , Saikali Linda M. , Plenn Eion , Gleason Emily , Grabill Megan , Bilger Andrea , Koelper Nathanael C. , Smith Anna Jo B. , Rendle Katharine A. , Simpkins Fiona , Ko Emily M. 
Published: December 2024

OBJECTIVE:
To describe patient, research staff, and clinician perspectives regarding the effects of telehealth and remote clinical trial operations on safety, quality, and experience in gynecologic oncology clinical trials.

METHODS:
This qualitative study used semistructured interviews conducted from May to June 2022 with purposively sampled clinical trial participants, research staff, and clinicians involved in gynecologic oncology clinical trials with telehealth utilization. Participants described telehealth in clinical trial experiences, including benefits and barriers to receipt and provision of care, satisfaction, and quality. Transcripts were coded and analyzed with a modified content analysis approach based on research objectives and emergent themes. An adapted version of the validated Telehealth Usability Questionnaire was administered to all invited participants.

RESULTS:
Five patients, seven clinicians, and five research staff were interviewed. Patients and clinicians reported that telehealth, remote testing, and medication delivery positively affected quality of life by reducing financial burden, wait times, and transportation needs. Interviewees did not report telehealth-related changes in treatment-related adverse effects, referrals for urgent evaluation, or compromise of privacy but expressed concerns about the lack of physical examinations. Patients reported that telehealth increased scheduling burden without negative effects on care quality, counseling comprehension, relationships with trial teams, or satisfaction. Clinicians and research staff reported improved workflows regarding remote consent, sponsor interactions, and documentation but challenges with virtual patient education and off-site testing. Clinicians highlighted disparities for patients with limited technology access and reported institutional and insurance-based telehealth policies as barriers. Survey responses supported qualitative findings.

CONCLUSION:
Despite notable limitations, patients, research staff, and clinicians recommended continued utilization of telehealth and remote clinical trial operations in clinical trials. Future clinical trial designs should consider telehealth inclusion.
Understanding Strategies to Reduce the Impact of Non-urgent Visits to the Pediatric Emergency Department
Authors: Qureshi Erica , Nguyen Kelly , Burstein Brett , Moe Jessica , Miller Steven P. , Meckler Garth , Doan Quynh 
Published: December 2024

Context:
The pediatric emergency department (PED) is increasingly being used for non-urgent reasons. This impacts PED input and throughput, and contributes to overcrowding. To identify solutions, it is essential to identify and describe the approaches that have been trialed.

Objective:
We completed a scoping review to identify and then describe the design and outcomes of all initiatives undertaken to reduce the impact of non-urgent visits on the PED.

Data Sources:
We searched 4 databases (MEDLINE, EMBASE, EBM, and CINAHL) to identify research published from the database inception until March 31, 2024.

Study Selection:
Studies met our inclusion criteria if they focused on the pediatric ED, defined non-urgent visits, described an intervention (hypothesizing it would reduce the impact of non-urgent visits on the PED), and reported on the interventions impact.

Data Extraction:
The title and abstract of each study were independently screened for inclusion by 2 reviewers (E.Q., K.N.), and disagreements were resolved by deliberation until consensus was achieved. This process was then repeated for the full text of all articles.

Results:
In total, we screened 11,600 articles and 20 were included. Nine interventions focused on PED input, 10 on PED throughput, and 1 on both PED input and throughput. Definitions of non-urgent visits and outcomes measures used to assess the effectiveness of an intervention differed between studies. Three types of strategies employed to reduce the impact of non-urgent visits on the PED were identified, these include (1) engaging nonpediatric emergency medicine clinicians by including them into the PED or connecting non-urgent patients to community locations for care, (2) reorganizing PED operations in anticipation of non-urgent visits, and (3) providing education to prevent future non-urgent visits.

Conclusions:
Consistent definitions of non-urgent visits and standardized outcome measures may allow for more precise comparisons between studies. We identify 3 commonly employed strategies that may help reduce the impact of non-urgent visits on the PED.
Children and Restraints Study in Emergency Ambulance Transport-Cardiopulmonary Resuscitation (CARSEAT-CPR)
Authors: Cochran-Caggiano Nicholas , Tse Whitney , Swinburne Cecily , Lang Nicholas , Till Sara , Donovan Sean , Woodson Mary Clare C. , Dailey Michael W. 
Published: December 2024

Objectives
To compare the ability to perform basic life support (BLS) skills on children and infants in a moving ambulance whether or not they are properly secured to the stretcher.

Methods
Emergency Medicine Services provider ability to perform BLS skills was measured in moving ambulances on a closed course using an analog for child and infant cardiac arrest. Data were compared for child and infant manikins secured to the stretcher via different methods in simulated patient resuscitations performed by 24 participants.

Results
We found that there was no significant difference in mean rate (P = 0.104), depth (P = 0.21), or chest compression fraction (P = 0.92) between tests on restrained and unrestrained pediatric manikins. For infants, there was a 4-mm difference in compression depth (P = 0.0018). The clinical significance of this difference is not readily apparent. Infant tests did not show a difference in compression rate (P = 0.35) or compression fraction (P = 0.26). Across all tests, the rate and depth of compressions were adequate, but compression fraction was not adequate in the infant simulations. There were no differences in ventilations between restrained and unrestrained simulations (child P = 0.15; infant P = 0.13) but both were less than the American Heart Association recommendation.

Conclusions
In this simulation study, it was found that there was no significant difference noted in BLS adequacy between unrestrained pediatric patients and those restrained with commercial devices. Overall, the ability to perform appropriate BLS on children was equivocal and our simulations suggested BLS could not be adequately performed on infants regardless of restraint type/status.
The Effect of Graded Motor Imagery on Pain and Function in Individuals with Knee Osteoarthritis
Authors: Yıldız Kızkın Zeynep , Oğuz Semra , Ak Semih 
Published: December 2024

Abstract

Objective
To examine whether graded motor imagery (GMI) was as effective as transcutaneous electrical nerve stimulation (TENS) in improving pain and functionality in patients with knee osteoarthritis (PwKOA).

Design
Forty-six PwKOA were randomized (1:1) into the GMI and the TENS groups. Both groups participated in home-based and functional exercises. A visual analog scale (VAS), the pressure pain threshold, range of motion (ROM), muscle strength, the Timed Up and Go Test, and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were evaluated at baseline, after 8 weeks of treatment, and after a 6-week follow-up period.

Results
The within-group comparisons showed significant improvements in outcomes for both treatments. However, the difference between the groups was significant in favor of the GMI group in knee flexion ROM, knee extensor muscle strength, and WOMAC-pain and WOMAC-function parameters at the end of the treatment, and VAS-activity, knee flexor muscle strength, and WOMAC-stiffness values showed greater improvement in the GMI group compared with the TENS group at the end of the 6-week follow-up (for all, p < 0.05).

Conclusions
GMI seems to be a more effective adjuvant than TENS. If applied in PwKOA, pain and functional recovery improved, and results were maintained for up to 6 weeks.
Fostering Inclusivity in PM&R: A National Survey
Authors: Adeniyi Adedeji , Fuentes Shane , Farah Raysha , Lawani Sahadah , Sosa Oliver , Puckerine Mikaili , Stein Joel , von Rickenbach Kristian J 
Published: December 2024

Abstract
There is a persistent underrepresentation of women and multiple ethnic minority groups among medical school and residency applicants and trainees, particularly in Physical Medicine and Rehabilitation (PM&R). There is limited information on what causes these demographic disparities in PM&R and on strategies to increase interest in the field. To address this gap and improve early recruitment efforts, the authors conducted the first-ever national survey to gather information on pre-medical students’ perceived barriers to medical school admissions, career interests, perceptions of PM&R, and strategies to increase interest in PM&R. The survey received 1093 responses from 236 colleges with a diverse representation of participants, including 53.3% (n = 583) from historically underrepresented groups such as those Underrepresented in Medicine (URiM), and those from rural communities, and/or low socioeconomic backgrounds. Only 31.2% (n = 313) knew the existence of PM&R. However, 60.0% (n = 568) of respondents were interested in learning more about PM&R through shadowing a PM&R physician (82.2%, n = 780), attending workshops (75.9%, n = 720), and mentorship (58.9%, n = 559). The national survey revealed limited exposure to PM&R at the pre-medical level but a strong interest in dedicated mentorship and workshops, suggesting effective strategies to address underrepresentation.