bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health risk assessment of toxic metals and DNA damage in somatic and germ cells by soil and groundwater of a major cement factory in Nigeria
Authors: Alabi Okunola A , Ayeni Funmilayo E , Afolabi Tomiwa A 
Published: October 2024

Abstract
The waste generated from cement manufacturing is an important source of heavy metal contamination of groundwater and soil. This study investigated the concentration of toxic metals in the soil of a major cement factory and nearby groundwater. Ecological and carcinogenic risks of the metals were calculated. Potential reproductive toxicity and genotoxic effects of the samples were assessed in the sex and somatic cells of male mice using sperm abnormalities and bone marrow micronucleus (MN) assays, respectively. Also, the serum ALP, ALT, AST, total testosterone (TT), luteinizing hormone (LH), and follicle-stimulating hormone (FSH); and liver SOD and CAT activities were measured in the treated mice. Cr, Cu, Ni, Zn, Mn, Cd, and Pb levels in the soil and groundwater exceeded the allowable maximum standard. Ingestion and dermal contact were the most probable routes of human exposure with children having about 3 times higher probability of exposure to the metals than adults. Ni, Pb, and Cr presented carcinogenic risks in children and adults. In the MN result, nuclear abnormalities in the studied mice especially micronucleated polychromatic erythrocytes increased significantly (P &lt; 0.05). Compared to the negative control, the ratio of PCE/NCE showed the cytotoxicity of the 2 samples. Data further showed a significant increase in the serum ALP, AST, and ALT while the liver CAT and SOD activities concomitantly decreased in the exposed mice. Sperm morphology results showed that the samples contained constituents capable of inducing reproductive toxicity in exposed organisms, with alterations to the concentrations of TT, LH, and FSH. Toxic metal constituents of the samples were believed to induce these reported reproductive toxicity and genotoxic effects. These results showed the environmental pollution caused by cement factories and the potential effects the pollutants might have on exposed eukaryotic organisms.
Defining VOC signatures of airway epithelial cells with PM2.5 exposure
Authors: Linderholm Angela L , Borras Eva , Aribindi Katyayini , Jones Leilani L , Rojas Dante E , Bein Keith , McCartney Mitchell M , Davis Cristina E , Harper Richart W , Kenyon Nicholas J 
Published: October 2024

Abstract
Volatile organic compounds (VOCs) produced by the lung in response to exposure to environmental pollutants can be utilized to study their impact on lung health and function. Previously, we developed a method to measure VOCs emitted from well-differentiated tracheobronchial epithelial cells in vitro. Using this method, we exposed well-differentiated proximal (PECs) and distal airway epithelial cells (DECs) to varying doses of traffic-related air pollutants (TRAP) and wildfire particulates to determine specific VOC signatures after exposure. We utilized PM2.5 TRAP collected from the Caldecott tunnel in Oakland, CA and the 2018 Camp Fire to model “real-life” exposures. The VOCs were collected and extracted from Twisters and analyzed using gas chromatography-mass spectrometry. Exposure to both types of particulate matter (PM) resulted in specific VOC responses grouped by individual subjects with little overlap. Interestingly the VOCs produced by the PECs and DECs were also differentiated from each other. Our studies suggest that PM exposure induces a specific compartmentalized cellular response that can be exploited for future studies. This response is cell-type specific and potentially related to a phenotype we have yet to uncover.
Clinician and Practice Characteristics Associated With Support of Office-Based Methadone: Findings From a National Survey
Authors: Sung Minhee L. , Black Anne C. , Blevins Derek , Henry Brandy F. , Cates-Wessel Kathryn , Dawes Michael A. , Hagle Holly , Joudrey Paul J. , Molfenter Todd , Levin Frances R. , Fiellin David A. , Edelman E. Jennifer 
Published: October 2024

Background
Alternative models for methadone delivery outside of federal and state-regulated opioid treatment programs may improve access. We determined factors associated with clinician support for continuing office-based methadone.

Methods
We used data from the electronic Opioid Use Disorder Provider COVID-19 Survey conducted among X-waivered clinicians who were providing outpatient, longitudinal treatment of opioid use disorder (OUD) from July 2020 to August 2020. The outcome variable was selecting “The opportunity for patients to receive office-based methadone” when asked “Which pandemic-related policy changes or new policy changes would you like to be continued or started after the pandemic?” Using sequential multivariable logistic regression modeling, we estimated the association between clinician and practice characteristics and support for office-based methadone.

Results
Of 1900 respondents, 728 met the inclusion criteria. Twenty-eight percent indicated support for office-based methadone. Clinician characteristics associated with support for office-based methadone were being Black or African American versus White (adjusted odds ratio [AOR] [95% confidence interval (CI)], 2.88 [1.19–6.98]), having provided medications for OUD (MOUD) for >15 years versus ≤15 years (AOR [95% CI], 1.66 [1.02–2.68]), treating 51 to 100 patients with MOUD monthly versus <25 patients (AOR [95% CI], 1.79 [1.04–3.09]), providing methadone (AOR [95% CI], 1.71 [1.03–2.85]) versus not providing MOUD previously, and working in an academic medical center versus other settings (AOR [95% CI], 1.88 [1.11–3.16]).

Conclusions
A minority of surveyed X-waivered clinicians supported office-based methadone. Efforts to expand access to methadone via office-based settings should address implementation barriers.
Can Offset Analgesia Magnitude Provide Additional Information About Endogenous Pain Modulation in People With Knee Osteoarthritis?
Authors: Johansson Elin , Puts Sofie , Rice David , Beckwée David , Leemans Lynn , Bilterys Thomas , Schiphof Dieuwke , Bautmans Ivan , Coppieters Iris , Nijs Jo 
Published: October 2024

Objectives:
To investigate the relationship between offset analgesia magnitude and the responsiveness to conditioned pain modulation (CPM), temporal summation of (second) pain (TSP), and clinical pain severity in people with knee osteoarthritis (KOA).

Methods:
Electrical stimuli were applied to 88 participants with KOA to measure offset analgesia at the volar forearm of the dominant hand, and CPM and TSP at the most symptomatic knee and ipsilateral volar wrist. Clinical pain severity was assessed using the pain subscale of the Knee injury and Osteoarthritis Outcome Score (KOOSPAIN). Linear mixed-effects models evaluated pain modulatory effects across all tests, and Spearman partial correlations assessed associations between offset analgesia, CPM, TSP, and KOOSPAIN while accounting for covariates of interest. Participants unable to validly finish all psychophysical tests were excluded from effect and correlation analyses but were evaluated for predictors of nonvalid completion using bivariate Stochastic Search Variable Selection.

Results:
Significant pain modulation was observed across all psychophysical tests (P<0.05), and no meaningful predictors of nonvalid test completion were found. Offset analgesia magnitude did not significantly correlate with CPM, TSP, or KOOSPAIN (P≥0.05), with a maximum partial correlation coefficient of ρ=0.21.

Discussion:
Offset analgesia was not associated with CPM, TSP, or KOOSPAIN in people with KOA. Despite the lack of case-control studies comparing offset analgesia between people with KOA and healthy controls, these findings suggest that offset analgesia may provide information about endogenous pain modulation beyond CPM and TSP, though its clinical translation remains uncertain.
The Prevalence of Intraoperative Neuromonitoring in Anterior Cervical Discectomy and Fusion
Authors: Rowe Dana G. , Barrett Connor , Owolo Edwin , Rivera Nicole , Johnson Eli , Abdelgadir Jihad , Crowell Kerri-Anne , Goodwin C. Rory , Erickson Melissa M. 
Published: October 2024

Study Design:
Retrospective cohort study.

Objective:
The purpose of this study was to (1) evaluate recent trends in the use of intraoperative neuromonitoring (IONM) for anterior cervical discectomy and fusion (ACDF) in the United States, (2) assess regional variations in the use of IONM, and (3) assess the association between IONM and clinical outcomes.

Summary of Background Data:
IONM is frequently used during anterior cervical procedures to mitigate the risk of neurological injury. Prior studies have demonstrated decreasing utilization of IONM in ACDFs. However, no recent studies have re-assessed these trends.

Methods:
Cases of cervical myelopathy and radiculopathy that underwent ACDF from 2011 to 2021 were identified through the PearlDiver Patient Record Database. Rates of IONM were compared based on patient age, gender, income, and region. Complications, 30-day readmissions, and reimbursement rates were also assessed.

Results:
We identified 285,939 patients undergoing isolated ACDF, with 45,943 (16.1%) of these cases using IONM. There was a significant increase in the use of IONM for ACDFs over the study period (R
2=0.87, P<0.001). Significant regional variability was observed in the utility of IONM (Northeast; 21.2%, Midwest; 16.3%, South; 14.7%, West; 14.2%; P<0.001). Younger age and higher patient income were associated with increased utility of IONM (P<0.001). IONM was associated with significantly higher costs but no reduction in rates of postoperative neurological complications (P<0.001 and 0.29, respectively).

Conclusion:
This study demonstrates a significant increase in IONM utilization during ACDFs over the past decade. Considerable differences exist in IONM use concerning patient demographics, income, and geographic region, with the highest utilization in the Northeast. Notably, despite the association of IONM with over a 20% increase in reimbursement rates, its implementation was not associated with a reduction in rates of neurological complications.
Comparison between ultrasound-guided intertransverse process and erector spinae plane blocks for breast cancer surgery
Authors: Qian Lulu , Zhang Hongye , Miao Yongsheng , Qu Zongyang , Zhang Yuelun , Hua Bin , Hua Zhen 
Published: October 2024

BACKGROUND
Clinical comparisons between intertransverse process block (ITPB) and erector spinae plane block (ESPB) are lacking.

OBJECTIVE
This study aimed to compare their blocking profile and clinical efficacy in breast cancer surgery.

DESIGN
Randomised, blinded, active-controlled superiority trial.

SETTING
A tertiary hospital in China from 20 February to 31 July 2023.

PATIENTS
Sixty-eight females undergoing unilateral breast cancer surgery.

INTERVENTION
Patients were randomised to receive either ITPB performed at T2–6 (5 ml of 0.5% ropivacaine per level) or ESPB at T4 (25 ml of 0.5% ropivacaine). General anaesthesia and postoperative analgesia were standardised.

MAIN OUTCOME MEASURES
The primary outcome was the number of blocked dermatomes at anterior T2–7, assessed 45 min after block completion, with a predefined superiority margin of 1.5 dermatomes. The important secondary outcome was the worst resting pain scores (11-point numerical rating scale) within 30 min in the recovery room, which was tested following a gatekeeping procedure. Other secondary outcomes included resting pain scores at various time points, use of rescue analgesics, opioid consumption, patient satisfaction, recovery quality score, and adverse effects within 24 h postoperatively.

RESULTS
The ITPB group showed a median [q1, q3] of 5 [4, 6] blocked dermatomes at anterior T2–7, whereas the ESPB group had 1 [0, 4], with a median difference of 4 (95% confidence interval (CI), 3 to 4); the lower 95% CI limit exceeded the predefined superiority margin of 1.5 (superiority P < 0.001). Worst resting pain scores within 30 min in the recovery room in the ITPB group were 1 [0, 2] vs. 3 [1, 4] in the ESPB group, with a median difference of −1 (95% CI, −2 to 0; P = 0.004). Patients in the ITPB group required fewer rescue analgesics within 30 min in the recovery room than did those in the ESPB group. No other clinically relevant results were observed in the secondary outcomes.

CONCLUSIONS
Although ITPB demonstrated more consistent anterior dermatomal spread and improved immediate postoperative analgesia compared to ESPB, no additional benefits were identified for breast cancer surgery. Future studies may investigate the potential of ITPB for surgical anaesthesia.

TRIAL REGISTRATION

www.chictr.org.cn (ChiCTR2300068454).
The Effect of Forgiveness Psychoeducation on Death Anxiety, Caregiver Burden, and Forgiveness Tendencies in Caregivers of Patients at the End of Life
Authors: Şahin Merve , Demirkıran Fatma 
Published: October 2024

Background
Providing caregivers with the skills and awareness of forgiveness is crucial to help them express their emotions, navigate the grieving process more smoothly, enhance their interaction with the patient, and make the time until the patient’s death more meaningful.

Objective
To examine the effect of forgiveness psychoeducation on death anxiety, caregiver burden, and forgiveness tendencies in caregivers of patients at the end of life.

Methods
A randomized controlled experimental method was used, including a pretest, posttest, 1-month follow-up, and 3-month follow-up. The research sample included 56 caregivers of patients (experimental group = 28, control group = 28) at the end of life. During the study, forgiveness psychoeducation was administered to the experimental group, whereas no intervention was carried out in the control group. Data were collected using the Personal Information Form, Thorson-Powell Death Anxiety Scale, Caregiver Burden Scale, and Heartland Forgiveness Scale.

Results
The average scores of death anxiety and caregiving burden in the posttest and follow-up measurements of caregivers in the experimental group were statistically significantly lower than those of caregivers in the control group (P < .05).

Conclusion
Forgiveness psychoeducation reduces death anxiety and caregiving burdens in caregivers of patients at the end of life. It is recommended to provide psychoeducation on forgiveness.

Implication for Practice
The psychoeducation conducted by Consultation Liaison Psychiatry Nurses aimed at increasing the internal process of forgiveness can positively influence the communication, emotions, and spiritual development of caregivers of patients at the end of life. Thus, improving the quality of care can be achieved through forgiveness.
Sleep and circadian rhythm disturbances as risk and progression factors for multiple chronic overlapping pain conditions: a protocol for a longitudinal study
Authors: Mun Chung Jung , Youngstedt Shawn D. , Petrov Megan E. , Pituch Keenan A. , Elliott Jeffrey A. , George Steven Z. , LoVecchio Frank , Mardian Aram S. , Elam Kit K. , Winsick Nina , Eckert Ryan , Sajith Surabhi , Alperin Kate , Lakhotia Ananya , Kohler Kaylee , Reid Matthew J. , Davis Mary C. , Fillingim Roger B. 
Published: October 2024

Abstract

Introduction:
Chronic overlapping pain conditions (COPCs), such as chronic low back pain (cLBP) and fibromyalgia, frequently cooccur and incur substantial healthcare costs. However, to date, much focus has been placed on individual anatomically based chronic pain conditions, whereas little is known about the mechanisms underlying progression to multiple (more than 1) COPCs. This study aims to address the gap by investigating the role of common and modifiable risk factors, specifically sleep and circadian rhythm disturbances, in the development of multiple COPCs.

Methods:
The study will enroll 300 participants with cLBP, including 200 with cLBP only and 100 with cLBP plus other COPCs (ie, fibromyalgia, temporomandibular disorders, irritable bowel syndrome, and chronic headaches) and follow them up for 12 months. Sleep and circadian rhythms will be assessed using wireless sleep electroencephalography, 24-hour evaluation of the rhythm of urinary 6-sulfatoxymelatonin, actigraphy, and sleep diaries. Pain amplification using quantitative sensory testing, psychological distress using validated self-report measures, and the number of pain sites using a pain body map will also be assessed.

Perspectives:
This research aims to (1) comprehensively characterize sleep/circadian disturbances in individuals with single and multiple COPCs using multimodal in-home assessments; (2) examine the associations between sleep/circadian disturbances, changes in pain amplification, and psychological distress; and (3) investigate the relationship among these factors and the progression in the number of pain sites, a proxy for multiple COPCs. The findings will provide insights into the mechanisms leading to multiple COPCs, potentially informing treatment and prevention strategies for these complex conditions.
Bipolar disorder in people with HIV
Authors: Vollmond Cecilie V. , Tetens Malte M. , Gerstoft Jan , Kronborg Gitte , Johansen Isik S. , Larsen Carsten S. , Porskrog Anders , Dalager-Pedersen Michael , Leth Steffen , Kessing Lars V. , Lebech Anne-Mette , Obel Niels , Omland Lars H. 
Published: October 2024

Objectives:
To assess whether bipolar disorders are associated with the risk of HIV infection and whether the risk of bipolar disorders is increased among people with HIV (PWH) and their siblings.

Design:
Nationwide, population-based, combined matched nested case-control and cohort study of PWH of Danish origin (1995–2021), a comparison cohort from the background population, matched on date of birth and sex, and sibling cohorts.

Methods:
Conditional logistic regression and Cox regression was used to calculate adjusted odds ratios (aORs) for HIV infection and hazard ratios among PWH for bipolar disorder and receipt of lithium.

Results:
We included 5322 PWH and 53 220 comparison cohort members. In the case–control study, bipolar disorder was associated with an increased risk of HIV infection [aOR: 1.9, 95% confidence interval (CI): 1.2–3.0], especially when injection drug use was the route of infection (aOR: 7.6, 95% CI: 2.0–28.9). In the cohort study, we observed an increased risk of bipolar disorders among PWH, especially in the first 2 years of observation (hazard ratio: 4.2, 95% CI: 2.4–7.4), whereas the risk of receipt of lithium was lower and the CI crossed 1. The 20-year risk of bipolar disorders for PWH was approximately 1%. Siblings of PWH also had an increased risk of bipolar disorder but not to the same degree as PWH and not of receipt of lithium.

Conclusion:
Bipolar disorders are associated with the risk of HIV infection, and PWH have increased risk of bipolar disorder and receipt of lithium beyond what familial factors could explain.
Democratizing Virtual Patient Case Creation: A Proof-of-concept Technical Framework for Clinicians
Authors: Tsaftaridis Nikolaos , Koulas Ioannis , Zafeiropoulos Stefanos , Saint-Joy Veauthyelau , Ilali Marwa , Ibrahim Michel , Brice Taina , Haynes Norrisa 
Published: October 2024

AbstractObjectiveVirtual patient cases are a scalable and engaging tool for training medical professionals. Strategies and frameworks for their implementation in teaching and training settings are few, technically complicated and/or expensive. We developed and evaluated open source and free virtual patient cases to test knowledge acquisition during an echocardiography training program for internal medicine trainees in Haiti. The objective of this paper is to describe the technical aspects of the GMENEcho virtual patient cases implementation and motivate similar work by resource-constrained teams.MethodsWe used an open source engine for text-based games (Twine) since it provides the necessary interaction mechanics and is usable out-of-the-box. The case code was written in SugarCube 2.30.0 notation and the tweego-generated .html file was hosted on Github Pages for continuous integration and deployment, making iterations by the clinical team seamless. Data from completed tests were reported back via email through a third party integration.ResultsThe technical work was completed in two weeks by a team member with a clinical background and minimal computer programming experience. The virtual patient cases were deployed for a pretest (November 2023) and a second time unaltered for a posttest (June 2024) after the interim hands-on and theoretical training had been completed. Qualitative feedback was positive or neutral. The overall score in the posttest was significantly higher with a large effect size (mean absolute improvement 15.26%, p < 0.001; Cohen’s d: 1.398), similarly to the diagnostic score (mean absolute difference 16.09%, p < 0.001; Cohen’s d: 1.402). Management performance missed statistical significance by a small margin. The System Usability Scale (SUS) score was 74.6 (“Excellent”).There was reduced inter-trainee variability across metrics in the posttest, including the SUS score.DiscussionThis proof-of-concept methodology can be applied to create clinical patient cases for use within a class or a clinical training setting, through a friendly graphical user interface. A more complex software stack can allow for remote or larger scale implementations with additional features.ConclusionThe rapid development time and positive qualitative and quantitative feedback highlight the potential of this approach for clinical education in resource-constrained settings. It can serve as a template for more streamlined adaptations of case-based learning in diverse healthcare settings.