bluuebunny/crossref_metadata_2025_split huggingface dataset:
Enhancing Patient Transport Systems in the U.S. Department of Defense’s National Disaster Medical System (NDMS) Pilot Program
Authors: Adeniji Adeteju , Anderson Clemia , Klemann Michael , Kimball Michelle , Lee Clark , Sison Allyson , Freeman Jeffrey 
Published: October 2024

Abstract

Objective
Congress directed the Secretary of Defense (DoD) to conduct a Pilot program to increase the National Disaster Medical System’s (NDMS) surge capacity, capabilities, and interoperability to support patient movement during a large-scale overseas contingency operation.

Methods
The Pilot conducted a mixed methods exploratory study, the Military-Civilian NDMS Interoperability Study (MCNIS), identifying 55 areas of solutions for NDMS innovation that align with interagency stakeholder interests. Priorities were determined via facilitated discussions, refined and validated by all five Pilot sites.

Results
As the DoD provides essential support for the patient movement component within NDMS, the results highlighted areas for improvement between receiving patients at an airfield and moving them to NDMS definitive care partners during a large medical surge event. This includes patient tracking capabilities, transportation processes and patient placement.

Conclusions
In collaboration with the Departments of Health & Human Services, Homeland Security, Transportation, and Veterans Health Administration, the Pilot is addressing these areas for improvement, by executing site-specific projects that will be validated and identified for export across the system. Leaders across the Pilot site healthcare networks are working to enhance patient movement and tracking. Ultimately, the Pilot will deliver dozens of proven solutions to enhance the NDMS’s patient movement capabilities.
Military-Civilian Integration as a Tool to Bolster Mass Casualty Incident Response Globally
Authors: Aryankalayil Joseph B , Madha Emad , Arnaouti Matthew , Worlton Tamara , Joseph Michelle 
Published: October 2024

Abstract

Objectives
In a model of military-civilian trauma system integration, coordination of mass casualty incident response by military and civilian entities could be more effective through reduced duplication of services and improved resource utilization. The following study seeks to examine and address the challenges faced in establishing integrated trauma systems.

Methods
Through a survey this study comprehensively gathered data on trauma system capabilities and the current degree of military-civilian integration of 73 individual countries. Through a scoring method based on participant responses, countries were classified into three distinct integration types, ranging from minimal (Type I) to robust (Type III). This method allowed analysis of the association of numerous trauma system factors with increased integration status.

Results
A higher integration status is associated with coordinated use of military and civilian resources for aero-medical evacuation (Chi Square p<0.05). With regards to resource utilization, countries with higher integration status exhibited more rapid availability of blood products (Chi Square p<0.05), a critical factor contributing to improved mortality among traumatically injured patients.

Conclusion
By identifying key areas where integration can be strengthened, and by understanding the underlying factors shaping these frameworks, this research seeks to build more collaborative and resource-efficient responses to mass casualty incidents globally.
A Comparative Study of Terrorist Attacks Targeting Healthcare in North America vs Europe
Authors: Wertz Raphael , Stryckman Benoit , Besenyő János , Jasani Gregory 
Published: October 2024

Abstract

Objective
This study sought to compare terrorist attacks targeting healthcare in two different geographical areas that are economically and culturally similar: North America and Europe.

Methods
The Global Terrorism Database is a database that documents 214,666 worldwide terrorist events from 1970 to 2021. It was searched to identify terrorist attacks against healthcare using keywords. We manually excluded incidents that did not specifically relate to attacks on healthcare. This resulted in 311 and 150 entries in North America and Europe respectively.

Results
The most common method of attack in Europe was bombing (42%) compared to attacks on infrastructure (66%) in North America. The primary target in North America was abortion related (84%). In Europe, the primary target was businesses (37%). In Europe, 18.7% of attacks were assassinations or attempts vs 3% in North America. The total number of fatalities in Europe is 51 vs 3 in North America.

Conclusion
Even though there were significantly more attacks in North America, there were far fewer total fatalities compared to Europe. Attacks in North America appear to be ideological, targeting infrastructure to send a message. Whereas, in Europe, the targets and methods used are more targeted towards the individual and their property.
Implementation of an Electronic Health Record System for Use Inhumanitarian Emergencies, Disaster Response, and Conflict Zones
Authors: Draugelis Sarah D , Brown Erik C , Smith Sean G , Sutherland Philip , Yendewa George A , Mohareb Amir M , Donahue Donald A 
Published: October 2024

Abstract

Objective
Despite the global expansion of electronic medical record (EMR) systems and their increased integration with artificial intelligence (AI), their utilization in disaster settings remains limited, and few studies have evaluated their implementation. We aimed to evaluate Fast Electronic Medical Record (fEMR), a novel, mobile EMR designed for resource-limited settings, based on user feedback.

Methods
We examined usage data through October 2022 to categorize the nature of its use for disaster response and determine the number of patients served. We conducted interviews with stakeholders and gathered input from clinicians who had experience using fEMR.

Results
Over eight years, fEMR was employed 60 times in 11 countries across four continents by 14 organizations (universities, non-profits, and disaster response teams). This involved 37,500+ patient encounters in diverse settings including migrant camps at the US-Mexico and Poland-Ukraine borders, mobile health clinics in Kenya and Guatemala, and post-earthquake relief in Haiti. User feedback highlighted adaptability, but suggested hardware and workflow improvements.

Conclusion
EMR systems have the potential to enhance healthcare delivery in humanitarian responses, offer valuable data for planning and preparedness, and support measurement of effectiveness. As a simple, versatile EMR system, fEMR has been deployed to numerous disaster response and low-income settings.
Factors Associated with Behavioral Health Outcomes in Veterinarians Involved in Disaster Responses
Authors: Wisnieski Lauren , Vroegindewey Gary , Jenkins Jennifer L 
Published: October 2024

Abstract

Objective
The objective of this study was to determine what factors are associated with behavioral health in veterinary disaster responders.

Methods
An online cross-sectional survey was distributed via snowball sampling. Results were analyzed using chi-square analyses.

Results
Responses from 237 veterinarians were analyzed. Being involved in more than 1 disaster event was associated with higher anxiety and/or depression (43.4% vs 28.6%, respectively), difficulty with relationships (28.1% vs 14.3%, respectively), and a greater prevalence of sleep problems (44.6% vs 28.0%, respectively) compared to only being involved in 1 event. Veterinarians that were deployed longer than 2 months had the highest prevalence of anxiety and/or depression (43.9%) and sleep problems (50.0%). Veterinarians that received behavioral health training before deployment had lower rates of anxiety and/or depression (27.8% vs 42.9%, respectively) compared to those who did not receive training. Respondents involved with depopulation had the highest rates of anxiety and/or depression (66.7%) and sleep problems (58.1%).

Conclusions
Factors associated with behavioral health outcomes included the number and length of deployments, receiving behavioral health training, and being involved in depopulation. To reduce the risk of behavioral health outcomes, interventions such as time-off and behavioral health support are needed.
Clinical information extraction for lower-resource languages and domains with few-shot learning using pretrained language models and prompting
Authors: Richter-Pechanski Phillip , Wiesenbach Philipp , Schwab Dominic Mathias , Kiriakou Christina , Geis Nicolas , Dieterich Christoph , Frank Anette 
Published: October 2024

Abstract
A vast amount of clinical data are still stored in unstructured text. Automatic extraction of medical information from these data poses several challenges: high costs of clinical expertise, restricted computational resources, strict privacy regulations, and limited interpretability of model predictions. Recent domain adaptation and prompting methods using lightweight masked language models showed promising results with minimal training data and allow for application of well-established interpretability methods. We are first to present a systematic evaluation of advanced domain-adaptation and prompting methods in a lower-resource medical domain task, performing multi-class section classification on German doctor’s letters. We evaluate a variety of models, model sizes (further-pre)training and task settings, and conduct extensive class-wise evaluations supported by Shapley values to validate the quality of small-scale training data and to ensure interpretability of model predictions. We show that in few-shot learning scenarios, a lightweight, domain-adapted pretrained language model, prompted with just 20 shots per section class, outperforms a traditional classification model, by increasing accuracy from

$48.6\%$

to

$79.1\%$

. By using Shapley values for model selection and training data optimization, we could further increase accuracy up to

$84.3\%$

. Our analyses reveal that pretraining of masked language models on general-language data is important to support successful domain-transfer to medical language, so that further-pretraining of general-language models on domain-specific documents can outperform models pretrained on domain-specific data only. Our evaluations show that applying prompting based on general-language pretrained masked language models combined with further-pretraining on medical-domain data achieves significant improvements in accuracy beyond traditional models with minimal training data. Further performance improvements and interpretability of results can be achieved, using interpretability methods such as Shapley values. Our findings highlight the feasibility of deploying powerful machine learning methods in clinical settings and can serve as a process-oriented guideline for lower-resource languages and domains such as clinical information extraction projects.
Who are the people of Cyprus? The national identity building process in Cyprus from the late 19th to the early 20th century
Authors: Çetiner Nur 
Published: October 2024

Abstract
This article offers a nuanced examination of the complex identity dynamics among the Christian and Muslim communities in Cyprus during the late 19th and early 20th century, particularly in the aftermath of British administration replacing Ottoman rule in 1878. The article draws attention to the profound impact of this historical transition on the identity formation processes of both communities. Despite the shared wartime experience of the First World War, the Christian and Muslim communities in Cyprus failed to construct a cohesive identity rooted in their common geographical space. Drawing on Zygmunt Bauman’s concept of ambivalence, the article explores the complex process by which Cypriot communities sought to align their identity with larger nations, namely Greece and Turkey, rather than grounding it in their local context. The article contends that the genesis of their ambivalence can be traced back to 1878 when British administration replaced Ottoman rule on the island.
Efficacy of esketamine for perinatal depression: a systematic review and meta-analysis
Authors: Wong Sabrina , Le Gia Han , Kwan Angela T.H. , Teopiz Kayla M. , Rhee Taeho Greg , Ho Roger , Rosenblat Joshua D. , Mansur Rodrigo , McIntyre Roger S. 
Published: October 2024

AbstractObjectivePostpartum depression (PPD), now referred to as perinatal depression, is a prevalent and debilitating mood disorder that reduces health-related quality of life (HRQoL) and psychosocial functioning. Esketamine, which is efficacious in adults with treatment-resistant depression and individuals with depression and suicidality, is also analgesic in pain management during childbirth labour. Herein, we investigate the efficacy of prophylactic esketamine in reducing the incidence of PPD.MethodsWe performed a systematic review (i.e., PubMed, Scopus, and Ovid databases; inception to January 22, 2024) of randomized controlled trials that investigated the use of esketamine for PPD. We delimited our search to studies that prespecified the prevention of PPD with esketamine as the primary outcome. A meta-analysis was performed on PPD incidence rates using a random effects model.ResultsOur analysis consisted of seven studies that met our eligibility criteria. We found that esketamine was significantly associated with a decreased incidence of PPD diagnosis within one week of childbirth (OR = 0.30, 95% CI = [0.15, 0.60], p = 0.0047). We also observed that esketamine was significantly associated with a decreased incidence of PPD diagnosis between 4 to 6 weeks post-delivery (OR = 0.33, 95% CI = [0.18, 0.59], p = 0.0034).ConclusionOur results indicate that esketamine may have preventive antidepressant effects during the postpartum period. The aforementioned points have both mechanistic and clinically meaningful implications for the treatment of PPD.
Healing grief: Insights from relatives of cancer patients with prolonged grief. The FamiLife multicenter qualitative study
Authors: Flahault Cécile , Fasse Léonor , Veber Laetitia , Sonrier Marie , Leborgne Marie Annick , Michel Dominique , Marché Véronique , Vanbésien Anne , Evin Adrien , Pujol Nicolas , Copel Laure , Kaczmarek Willeme , Kirsch Sylvie , Verlaine Catherine , Verliac Virginie , Delarivière Emmanuel , Fosset-Diaz Virginie , Guastellas Virginie , Michonneau-Gandon Véronique , Perruchio Ségolène , Ranchou Gaelle , de Francqueville Laurence Birkui , Poupardin Cécile , Touzet Licia , Mathias Carmen , Mhalla Alaa , Bouquet Guillaume , Richard Bruno , Gracia Dominique , Bienfait Florent , Ruckly Stéphane , Timsit Jean François , Garrouste-Orgeas Maité 
Published: October 2024

Abstract

Background
Prolonged grief is a chronic and debilitating condition that affects millions of persons worldwide. The aim of this study was to use a qualitative approach to better understand how relatives with prolonged grief disorder perceive what does or not help them and whether they were able to make recommendations.

Methods
Participants were all relatives of deceased patients admitted to 26 palliative care units involved in the FamiLife study; relatives were included if diagnosed with prolonged grief symptoms (i.e., Inventory Complicated Grief (ICG) questionnaire with a cut-off >25), and volunteered to participate. Semi-directed telephone interviews were conducted by psychologists between 6 and 12 months after the patient’s death. The interviews were open-ended, without a pre-established grid, then transcribed and analyzed using a thematic approach.

Results
Overall, 199/608 (32.7%) relatives were diagnosed with prolonged grief symptoms, i.e., with an ICG score >25, and 39/199 (20%) agreed to be interviewed. The analysis yielded 4 themes: (1) the experience of mourning: intense sadness and guilt (reported by 35/39 participants, 90%); (2) aggravating factors (38/39, 97%): feeling unprepared for death and loneliness, presence of interpersonal barriers to adjustment, external elements hindering the mourning progress; (3) facilitating factors (39/39, 100%): having inner strength or forcing oneself to get better, availability of social and emotional support; and (4) the suggestions grieving relatives had to alleviate the grief burden (36/39, 92%). The analysis enabled to identify 5 suggestions for relieving the grief burden: improving communication, developing education about death and grief, maintaining contact, offering psychological support, and choosing the right time for the palliative care team to contact the relatives.

Conclusions
This study revealed how bereaved relatives experienced the help provided by the healthcare teams, their representations, and what could be improved. These findings could be used to design intervention studies.
Leverage points for increased grain legume consumption: a Swedish case study
Authors: Scheuermann Mary , Wood Amanda , Gordon Line J. , Röös Elin , Schultz Lisen 
Published: October 2024

Abstract
Food production and consumption need to substantially change to meet global environmental and public health goals. Increasing grain legume consumption in most countries is key to providing nourishing food for all while contributing to cropping system sustainability with relatively low environmental impact. But what actions have the potential to increase such consumption? The wide knowledge of how to cultivate grain legumes among Swedish farmers, low current consumption in most of the population, and prior shifts in dietary patterns make Sweden an interesting context for studying the potential increase of grain legumes in diets. We identify system-level actions in peer-reviewed and grey literature with the potential to increase grain legume consumption and apply the leverage points framework to evaluate the transformative potential of these actions for the food system in Sweden. Our findings show that most actions suggested in the literature so far focus on increased production, while fewer suggestions integrate production and consumption. Few actions address the deeper leverage points with most transformative potential compared with those with less transformative potential. We qualitatively analyze the actions and develop a chain of leverage illustrating how several actions together could be combined to support change at the deepest leverage point, creating social norms for the consumption of healthy foods. The chain includes developing new tools, facilities and products; changing standards; building feedback loops; changing the food environment; building new information flows between actors; and reforming the value chain. To implement the actions identified in this analysis, a range of value chain actors and supportive policies at the national and European Union levels will be needed.
Optimizing Palmer amaranth (Amaranthus palmeri) genetic testing of seeds using real-time (quantitative) PCR
Authors: Bratsch Sara , Thiede Denise , Viner Diandra , Sarangi Debalin , Merriman Michael , Blair Shane , Cortilet Anthony 
Published: October 2024

AbstractThe Amaranthus genus contains numerous agronomic weedy species that are widely distributed across the United States. The seeds of many Amaranthus species are morphologically indistinguishable. The Minnesota Department of Agriculture declared Palmer amaranth (Amaranthus palmeri S. Watson) a prohibited noxious weed seed in 2016. Any Amaranthus spp. seeds that are identified as contaminants during routine seed testing require genetic testing to determine whether A. palmeri is present. This research aimed to validate and optimize the molecular detection of A. palmeri in seed. We refined the DNA extraction from pools of Amaranthus spp. seeds ranging in size from 1 to 100 seeds to improve sample testing throughput. Real-time polymerase chain reaction (qPCR) using primers developed by Murphy and colleagues correctly identified the presence of A. palmeri genetics in 84 samples containing 0, 1, 2, 25, or 50 A. palmeri seeds in samples containing up to 100 seeds. The method specificity was examined using 17 Amaranthus species and 4 hybrids of unknown genetics. The Murphy regular qPCR cycle amplified Watson’s amaranth (Amaranthus watsonii Standl.), spleen amaranth (Amaranthus dubius Mart. ex Thell.), and spiny amaranth (Amaranthus spinosus L.), which would result in false-positive calls; however, the fast cycle only identified A. watsonii as a potential false positive. Examination of the Murphy primer binding site revealed an identical sequence for A. palmeri and A. watsonii. Additional markers were evaluated and optimized for use in qPCR to eliminate the risk of a false positive. The additional markers did eliminate the amplification of A. dubius and A. spinosus but did not eliminate the amplification for A. watsonii. Currently, A. watsonii is not known to be distributed outside of its limited native range and is not expected to be encountered in samples.
Optimal infused CD34+ cell dose in multiple myeloma patients undergoing upfront autologous hematopoietic stem cell transplantation
Authors: Pasvolsky Oren , Marcoux Curtis , Milton Denái R. , Pal Babar , Tanner Mark R. , Bashir Qaiser , Srour Samer , Lee Jaehyun , Saini Neeraj , Lin Paul , Ramdial Jeremy , Nieto Yago , Tang Guilin , Aljawai Yosra , Kebriaei Partow , Becnel Melody R. , Lee Hans C. , Patel Krina K. , Thomas Sheeba K. , Orlowski Robert Z. , Shpall Elizabeth J. , Champlin Richard E. , Qazilbash Muzaffar H. 
Published: October 2024

AbstractAutologous transplantation remains the standard of care for eligible multiple myeloma (MM) patients, yet optimal CD34+ cell dose remains unclear. We conducted a retrospective study on MM patients undergoing upfront transplant between 2005 and 2021 and divided them into low (≤2.5 × 106 cells/kg) and high (>2.5 × 106 cells/kg) CD34+ dose groups. We included 2479 patients, 95 in the low CD34+ group and 2384 in the high CD34+ group. Patients in the low CD34+ group were older (63.2 vs 61.1 years, p = 0.013), more often had R-ISS III (19% vs 9%, p = 0.014), received plerixafor (60% vs 35%, p < 0.001) and transplanted after 2009 (88% vs 80%, p = 0.047). Time to neutrophil and platelet recovery was longer in the low CD34+ group. Median PFS and OS were lower in the low CD34+ group (31.6 vs. 43.6 months, p = 0.011 and 76.4 vs. 108.2 months, p < 0.001, respectively). Evaluation of incrementally higher CD34+ dose did not show significant improvement in survival at thresholds >2.5 × 106 cells/kg. Multivariable analysis affirmed that CD34+ >2.5 × 106 cells/kg was associated with better PFS (HR 0.71, p = 0.008) and OS (0.59, p < 0.001). After propensity score matching, a CD34+ dose >2.5 × 106 cells/kg remained a predictor of better OS (0.42, p < 0.001). In conclusion, CD34+ dose >2.5 × 106 cells/kg was associated with improved survival, without any additional benefit at incrementally higher doses.
A multiplex single-cell RNA-Seq pharmacotranscriptomics pipeline for drug discovery
Authors: Dini Alice , Barker Harlan , Piki Emilia , Sharma Subodh , Raivola Juuli , Murumägi Astrid , Ungureanu Daniela 
Published: October 2024

Abstract
The gene-regulatory dynamics governing drug responses in cancer are yet to be fully understood. Here, we report a pipeline capable of producing high-throughput pharmacotranscriptomic profiling through live-cell barcoding using antibody–oligonucleotide conjugates. This pipeline combines drug screening with 96-plex single-cell RNA sequencing. We show the potential of this approach by exploring the heterogeneous transcriptional landscape of primary high-grade serous ovarian cancer (HGSOC) cells after treatment with 45 drugs, with 13 distinct classes of mechanisms of action. A subset of phosphatidylinositol 3-OH kinase (PI3K), protein kinase B (AKT) and mammalian target of rapamycin (mTOR) inhibitors induced the activation of receptor tyrosine kinases, such as the epithelial growth factor receptor (EGFR), and this was mediated by the upregulation of caveolin 1 (CAV1). This drug resistance feedback loop could be mitigated by the synergistic action of agents targeting PI3K–AKT–mTOR and EGFR for HGSOC with CAV1 and EGFR expression. Using this workflow could enable the personalized testing of patient-derived tumor samples at single-cell resolution.