bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sanctified Sexism: Effects of Purity Culture Tropes on White Christian Women’s Marital and Sexual Satisfaction and Experience of Sexual Pain
Authors: Sawatsky Joanna , Lindenbach Rebecca , Gregoire Sheila Wray , Gregoire Keith 
Published: November 2024

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

Abstract

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

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

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

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

Abstract

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

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

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

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

Study Design:
Systematic review.

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

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

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Conclusion:
Hypotony following vitrectomy may rarely predispose patients to the development of focal chorioretinal atrophy.
Paternal, Maternal, and Familial Factors as Predictors of Sturge–Weber Syndrome Neurological Outcome
Authors: McKenney Kieran D. , Zabel Andrew T. , Harris Jayda M. , Comi Anne M. 
Published: November 2024

Objectives:
To identify potential risk factors influencing Sturge–Weber Syndrome (SWS) and neurological outcomes in individuals with SWS and port-wine birthmarks from paternal, maternal, and familial factors.

Methods:
This study follows a retrospective cross-sectional design. Clinical visits took place at the Kennedy Krieger Institute, a tertiary care center. Participants were individuals with SWS or port-wine birthmarks.

Results:
Higher paternal age at conception was associated with a range of cognitive dysfunctions in offspring with SWS brain involvement. Indeed, paternal age was associated with low intelligence quotient (n = 25, P = .004), strokes or stroke-like episodes (n = 34, P = .030), gross and/or fine motor delay (n = 34, P = .036), delays in ability to perform activities of daily living (n = 30, P = .012), and delayed learning compared to peers (n = 31, P = .027). Furthermore, paternal age was correlated with worse cognitive outcomes, as measured by cognitive Neuroscore (r
s = 0.575, P < .001, n = 32). When maternal thyroid disease and hypertension were present during pregnancy, offspring were more likely to experience low intelligence quotient (n = 30, P = .041) and regression of any abilities (n = 37, P = .045), respectively. Logistic regression confirmed the association between paternal age and severe cognitive Neuroscore (β = .580, P = .033, odds ratio: 1.79, 95% confidence interval: 1.05–3.04), even when controlling for the effects of seizures and strokes or stroke-like episodes.

Conclusions:
Prenatal factors were associated with neurological symptoms in subjects with SWS. Older paternal age, in particular, may predict worse neurocognitive outcomes. Further research is needed in larger cohorts to determine the value of the identified prenatal factors as prognostic tools. Likewise, animal models may be used to determine the impact of prenatal factors on the severity of outcome.
Mammalian colonic contribution of amino acids to whole-body homeostasis
Authors: Kashyap Sindhu , Kurpad Anura V. 
Published: November 2024

Purpose of review
The colon is an effective bioreactor with auxotrophic microbiota that can serve by hydrolyzing dietary and endogenous protein, as well as by synthesizing essential amino acids through nitrogen salvage. Due to assumed negligible amino acid absorption, this colonic contribution was thought to be minimal, but this may not be true.

Recent findings
Several studies that examined the colonic environment in health and disease, show the presence of proteases in the colonic lumen, which are of both host and microbial origin, along with indirect evidence of amino acid transporters in the colonic epithelium. There are also amino acid biosynthetic pathways in the microflora, and the contribution of colonic amino acid to host amino acid nutrition has been shown in wild animals. Yet, current direct and quantitative evidence on amino acid absorption in human colon is minimal.

Summary
Although amino acid absorption in colon is not very well established, current studies show that substantial amounts of amino acid could possibly be contributed to the host by the colon. There is a need for assessing this contribution quantitatively using direct isotopic methods under different nutritional conditions, dietary intakes, and clinical conditions.
Single-center analysis of cardiac amyloidosis using 99mTc-HMDP imaging for diagnosis and evaluation after tafamidis treatment
Authors: Egi Ryuta , Matsusaka Yohji , Watanabe Kaho , Seto Akira , Matsunari Ichiro , Arai Takahide , Nakano Shintaro , Kuji Ichiei 
Published: November 2024

Objective
This study aimed to evaluate the diagnostic performance of 99mTc-hydroxymethylene diphosphonate (99mTc-HMDP) imaging for cardiac amyloidosis and to demonstrate changes in cardiac uptake of 99mTc-HMDP after tafamidis treatment.

Methods
Seventy-five patients with suspected cardiac amyloidosis who underwent 99mTc-HMDP imaging were included. We compared visual Perugini grades and semiquantitative heart-to-contralateral (H/CL) area ratios, myocardial maximum standardized uptake value (SUVmax), and peak of SUV (SUVpeak) between cardiac transthyretin amyloidosis (ATTR) and amyloid light-chain amyloidosis (AL). Comparison of interobserver reproducibility between H/CL ratios and myocardial SUVmax/SUVpeak was performed. H/CL ratio of 99mTc-HMDP and myocardial SUVmax/SUVpeak were compared before and after tafamidis administration for cardiac wild-type ATTR.

Results
Among 75 patients, 20 patients (26.7%) were visually positive based on Perugini grade. Fifteen and three patients were pathologically identified as cardiac ATTR and AL, respectively. ATTR group (n = 15) had significantly higher H/CL ratios of 99mTc-HMDP than AL group (n = 3) (P = 0.003). ATTR group (n = 15) had significantly higher myocardial SUVmax/SUVpeak of 99mTc-HMDP than AL group (n = 2) (P = 0.015). Myocardial SUVmax/SUVpeak had better interobserver reproducibility than H/CL ratios. After tafamidis treatment for cardiac wild-type ATTR, the decrease in myocardial SUVpeak was significant but not in H/CL ratios and myocardial SUVmax.

Conclusion
H/CL ratio and SUVmax/SUVpeak in 99mTc-HMDP imaging were useful for diagnosing cardiac ATTR. Myocardial SUVpeak may be useful for monitoring changes in cardiac uptake after tafamidis treatment for cardiac ATTR.