bluuebunny/crossref_metadata_2025_split huggingface dataset:
Scaffolding methods for systems of equations encountered in introductory physics courses
Authors: Robert Baker Mark 
Published: November 2024

Abstract
In the first semester calculus-based introductory physics course, the majority of problems that require mathematical methods use methods associated to solving systems of equations rather than methods of calculus. However, this is rarely explicitly stated, which is misleading to incoming students and gives them an unnecessary layer of fear with the “calculus” branding. Without explicit focus on the primary mathematical requirement, students can get the impression that there are hundreds of distinct problems presented in standard textbooks, which in fact rely primarily on just two types of systems of equations: linear and linear-quadratic systems. To address this, we developed a general system of equations method for introductory physics that places additional emphasis on setting up a system of equations, determining its type, performing a test to assess possible solutions and interpreting the problem geometrically. This method uses mathematics and concepts standard to high school curriculum and provides scaffolding to students as there are several ways in which they can demonstrate understanding of the problem before attempting to solve for an unknown. The scaffolding of this approach, combined with limiting the apparent scope of possible problems students can face and increased general understanding of the possible solutions, is sufficient to offset the additional steps that are expected of students in the problem solving process. We give common introductory physics problems as examples of the implementation of our methodology for both linear and linear-quadratic systems. Discussion of the various benefits and variations of this approach is also presented.
Beyond the Label: Extended Indications for Cervical Disc Arthroplasty
Authors: Bay Annika , Zhao Eric R. , Kwas Cole T. , Simon Chad Z. , Asada Tomoyuki , Qureshi Sheeraz A. 
Published: November 2024

Abstract
The purpose of this review is to provide an updated overview of non-FDA-approved applications of cervical disc arthroplasty, including the comparison with anterior cervical discectomy and fusion, serving as a reference for education and clinical decision-making.
Promoting Race and Ethnic Diversity in a Hospital-Based Randomized Clinical Trial to Address Untreated Alcohol Use Disorder: Initial Lessons Learned
Authors: Edelman E. Jennifer , Frankforter Tami , Rojas-Perez Oscar F. , Ablondi Karen , Castro Carla , Corvino Joanne , Garcia Isabel , Gordon Derrick M. , Jaramillo Yudilyn , Johnson Natrina L. , Jordan Ayana , Nich Charla , Paris Manuel , Pagano David , Weimer Melissa B. , Williams Emily C. , Kiluk Brian D. 
Published: November 2024

Objective
This study aimed to describe initial experiences and lessons learned conducting a trial focused on recruiting racially and ethnically diverse hospitalized patients with untreated alcohol use disorder (AUD).

Methods
The parent trial is comparing the effectiveness of strategies including Brief Negotiation Interview (BNI), facilitated initiation of medications for AUD, and computer-based training for cognitive behavioral therapy (CBT4CBT) on AUD treatment engagement post-hospitalization. Guided by the Framework for Reporting Adaptations and Modifications—Enhanced, we catalogued protocol changes and evaluated outcomes using study and electronic medical record data during the first 18 months of recruitment.

Results

Recipients: (1) Selected entry criterion to intentionally include individuals most likely impacted by structural racism, (2) developed multipronged recruitment approaches, and (3) selected bilingual, multicultural, and ethnically diverse research staff. Intervention: (1) Added scripts in the BNI to consider how cultural factors influence and how racism may impact, alcohol use, and AUD treatment engagement, (2) offered tablets as a compensation alternative with support for CBT4CBT initiation (as relevant), and (3) anticipate and troubleshoot internet access challenges. Setting: (1) Identified community-based AUD treatment options with Spanish-speaking services and (2) identified resources to address social determinants of health. Study: (1) Audited data to monitor whether diverse enrollment is occurring. Among n = 132 randomized as of March 1, 2024, 25% endorsed Black, 24% endorsed Latine, 58% endorsed White, 1% endorsed Indigenous, and 15% endorsed race not listed or declined to disclose. We observed no difference by race or ethnicity in recruitment or retention experiences.

Conclusions
Multilevel practices within a hospital-based AUD-focused trial can promote recruitment and retention of a racially and ethnically diverse sample.
Recent advances in immunometabolism in rheumatic diseases
Authors: Hisada Ryo , Kono Michihito 
Published: November 2024

Purpose of review
Aberrant autoreactive innate and adaptive immune responses cause systemic autoimmune diseases. Autoimmunity has been linked to abnormal metabolic states, and immunometabolism has emerged as a critical field in understanding the pathogenesis of rheumatic diseases. We aimed to explore the latest research on metabolic reprogramming in various immune cell types, including T cells, B cells, neutrophils, dendritic cells, monocytes, and macrophages, in the context of rheumatic diseases.

Recent findings
Each immune cell utilizes preferred metabolic pathways, and the cell activation dramatically modifies metabolic status. The inhibition of these pathways alters cell survival, differentiation, proliferation, and cytokine production – all of which contribute to rheumatic disease progression.

Summary
Targeting metabolic pathways or introducing anti-inflammatory metabolites, such as itaconate, could be novel therapeutic strategies for rheumatic diseases. Further research should focus on strategies for translating basic research findings to bedside applications.
Influence of Preoperative Disability on Outcomes Following Primary Surgical Treatment of Cervical Disc Herniation
Authors: Khosla Ishan , Anwar Fatima N. , Roca Andrea M. , Loya Alexandra C. , Medakkar Srinath S. , Kaul Aayush , Wolf Jacob C. , Federico Vincent P. , Sayari Arash J. , Lopez Gregory D. , Singh Kern 
Published: November 2024

Study Design:
Retrospective review.

Objective:
To evaluate how preoperative disability influences patient-reported outcomes (PROs) following primary surgical intervention for cervical herniated disc.

Summary of Background Data:
The effect of baseline disability has been evaluated for various spinal surgeries, but not specifically for primary cervical herniated disc.

Methods:
A prospectively maintained single surgeon database was retrospectively reviewed to identify patients who underwent primary cervical spine surgery for herniated nucleus pulposus. Demographics, perioperative data, and baseline/postoperative PROs were collected including Neck Disability Index (NDI), Visual Analog Scale-Arm/Neck (VAS-A/N), 12-Item Short Form Mental/Physical Component Scores (SF-12 MCS/PCS), Patient-Reported Outcome Measure Information System-Physical Function (PROMIS-PF), and 9-Item Patient-Health Questionnaire (PHQ-9). Baseline NDI <50/≥50 defined 2 cohorts. ΔPROs were determined at 6-week postoperatively/final follow-up (average 11.8±7.7 postoperative months). Overall rates of minimal clinically important difference (MCID) achievement were determined for each PRO. Perioperative characteristics/demographics/baseline PROs were compared with χ2 tests (categorical variables)/the Student t test (continuous variables). Intercohort postoperative PROs/ΔPROs/MCID attainment rates were compared with multivariate linear regression (continuous variables)/multivariate logistic regression (categorical variables) accounting for differences in insurance type.

Results:
Of 190 patients, there were 69 in the NDI ≥50 group. Patients with NDI ≥50 were more likely to have workers’ compensation, or Medicare/Medicaid insurance (P<0.001) and report worse baseline PROs (P≤0.001, all). After controlling for insurance type, NDI ≥50 patients continued to report worse PROs at 6 weeks/final follow-up (P≤0.037, all), except PROMIS-PF at 6 weeks postoperatively. NDI ≥50 patients reported greater NDI improvements at 6 weeks (P=0.007) and final follow-up (P<0.001). NDI ≥50 patients experienced higher overall MCID achievement rates for PHQ-9/NDI (P≤0.015, both).

Conclusions:
NDI ≥50 patients reported worse baseline mental/physical health and neck/arm pain and continued to report inferior postoperative outcomes including disability. Despite inferior absolute outcomes, NDI ≥50 patients reported greater improvements/achievement of clinically significant differences in disability through final follow-up. Further, these patients were more likely to experience clinically significant improvements in depressive burden.
Septic Shock Requiring Three Vasopressors: Patient Demographics and Outcomes
Authors: Kwak Gloria H. , Madushani Rajapaksha W. M. A. , Adhikari Lasith , Yan April Y. , Rosenthal Eric S. , Sebbane Kahina , Yanes Zahia , Restrepo David , Wong Adrian , Celi Leo A. , Kistler Emmett A. 
Published: November 2024

OBJECTIVES:
Septic shock is a common condition necessitating timely management including hemodynamic support with vasopressors. Despite the high prevalence and mortality, there is limited data characterizing patients who require three or more vasopressors. We sought to define the demographics, outcomes, and prognostic determinants associated with septic shock requiring three or more vasopressors.

DESIGN:
This is a multicenter retrospective cohort of two ICU databases, Medical Information Mart for Intensive Care IV (MIMIC-IV) and electronic ICU-Clinical Research Database, which include over 400,000 patients admitted to 342 ICUs.

PATIENTS:
Inclusion criteria entailed patients who were: 1) age 18 years old and older, 2) admitted to any ICU, 3) administered at least three vasopressors for at least 2 hours at any time during their ICU stay, and 4) identified to have sepsis based on the Sepsis-3 criteria.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
A total of 3447 patients met inclusion criteria. The median age was 67 years, 60.5% were male, and 96.6% had full code orders at the time of the third vasopressor initiation. Septic shock requiring three or more vasopressors was associated with 57.6% in-hospital mortality. Code status changes occurred in 23.9% of patients following initiation of a third vasopressor. Elevated lactate upon ICU admission (odds ratio [95% CI], 2.79 [2.73–2.85]), increased duration of time between ICU admission and third vasopressor initiation (1.78 [1.69–1.87]), increased serum creatinine (1.61 [1.59–1.62]), and age above 60 years (1.47 [1.41–1.54]) were independently associated with an increased risk of mortality based on analysis of the MIMIC-IV database. Non-White race and Richmond Agitation-Sedation Scale scores were not associated with mortality.

CONCLUSIONS:
Septic shock requiring three vasopressors is associated with exceptionally high mortality. Knowledge of patients at highest risk of mortality in this population may inform management and expectations conveyed in shared decision-making.
Continuous peri-operative glucose monitoring in noncardiac surgery
Authors: Putzu Alessandro , Grange Elliot , Schorer Raoul , Schiffer Eduardo , Gariani Karim 
Published: November 2024

BACKGROUND
Glucose management is an important component of peri-operative care. The usefulness of continuous glucose monitoring (CGM) in noncardiac surgery is uncertain.

OBJECTIVE
To systematically assess the glycaemic profile and clinical outcome of patients equipped with a CGM device during the peri-operative period in noncardiac surgery.

DESIGN
Systematic review.

DATA SOURCES
Electronic databases were systematically searched up to July 2024.

ELIGIBILITY CRITERIA
Any studies performed in the peri-operative setting using a CGM device were included. Closed-loop systems also administering insulin were excluded. Analyses were stratified according to diabetes mellitus status and covered intra-operative and postoperative data. Outcomes included glycaemic profile (normal range 3.9 to 10.0 mmol l−1), complications, adverse events, and device dysfunction.

RESULTS
Twenty-six studies (1016 patients) were included. Twenty-four studies were not randomised, and six used a control arm for comparison. In bariatric surgery, diabetes mellitus patients had a mean ± SD glucose of 5.6 ± 0.5 mmol l−1, with 15.4 ± 8.6% time below range, 75.3 ± 5.5% in range and 9.6 ± 6.7% above range. During major surgery, diabetes mellitus patients showed a mean glucose of 9.6 ± 1.1 mmol l−1, with 9.5 ± 9.1% of time below range, 56.3 ± 13.5% in range and 30.6 ± 13.9% above range. In comparison, nondiabetes mellitus patients had a mean glucose of 6.4 ± 0.6 mmol l−1, with 6.7 ± 8.4% time below range, 84.6 ± 15.5% in range and 11.2 ± 4.9% above range. Peri-operative complications were reported in only one comparative study and were similar in CGM and control groups. Device-related adverse events were rare and underreported. In 9.21% of cases, the devices experienced dysfunctions such as accidental removal and issues with sensors or readers.

CONCLUSION
Due to the limited number of controlled studies, the impact of CGM on postoperative glycaemic control and complications compared with point-of-care testing remains unknown. Variability in postoperative glycaemic profiles and a device dysfunction rate of 1 in 10 suggest CGM should be investigated in a targeted surgical group.
A novel cricoid pressure sensor device enhances the efficacy of oesophageal occlusion during Sellick's manoeuvre
Authors: Mishra Abhilasha , Ashok Vighnesh , Puri Goverdhan D. , Kumar Neelesh , Mathew Preethy J. 
Published: November 2024

BACKGROUND
The inability to measure the force applied during cricoid pressure is an important limitation in clinical practice. We developed a novel device to measure this force and provide real-time feedback to the operator.

OBJECTIVES
To test the hypothesis of superior oesophageal occlusion during cricoid pressure when guided by the novel device as compared with conventional practice.

DESIGN
A prospective randomised controlled trial.

SETTING
Tertiary University Hospital, May to December 2021.

PATIENTS
Sixty-five ASA I/II adult patients of either sex scheduled for elective surgery under general anaesthesia requiring tracheal intubation. Patients with comorbidities involving the neck, those at risk of pulmonary aspiration, anticipated difficult airway and BMI at least 35 kg  m−2 were excluded.

INTERVENTION
Operators applied cricoid pressure with their fingers in both groups. Participants were randomised into ‘feedback group’ where the operator adjusted this force based on the force measured by the novel device, and ‘control group’ where the force measured by the device was shielded from the operator.

MAIN OUTCOME MEASURES
The primary outcome was the rate of occlusion of oesophageal opening assessed by whether a 12 CH orogastric tube could be inserted into the oesophageal entrance during videolaryngoscopy. Secondary outcomes included the magnitudes of force measured during cricoid pressure, oesophageal diameter measured ultrasonographically during cricoid pressure and intubation parameters.

RESULTS
Sixty-four patients completed the study. The oesophageal opening was occluded in significantly more patients in the feedback group compared with the control group (94 vs. 6%; P = 0.001). The mean ± SD force (N) applied was significantly better and consistent at all time points in the feedback group compared to the control group (22.65 ± 7.81 vs. 14.57 ± 11.13, P < 0.001). The median [IQR] anteroposterior diameter of the oesophagus during cricoid pressure was less in the feedback group compared to the control group (0.49 [0.36 to 0.56] vs. 0.57 [0.48 to 0.65], P = 0.006).

CONCLUSIONS
The use of the novel sensor device achieved a significantly high rate of oesophageal occlusion during application of cricoid pressure.

TRIAL REGISTRATION
Clinical Trial Registry of India (CTRI/2021/05/033484).
The Burden of Plastic Surgery in Rural Kenya: The Kapsowar Hospital Experience
Authors: Rhodes Isaiah J. , Arbuiso Sophia , Zhang Ashley , Alston Chase C. , Medina Samuel J. , Liao Matthew , Nthumba Joseph , Chesang Patricia , Hayden Giles , Rhodes William R. , Otterburn David M. 
Published: November 2024

Purpose:
Both governmental and nongovernmental training programs are expanding efforts to train the next generation of plastic surgeons who will work in low- and middle-income countries (LMICs). Sufficient training is dependent on acquiring the appropriate skillset for these contexts. Few studies have characterized the spectrum of practice of plastic surgeons in LMICs and their relative disparity.

Methods:
We performed a retrospective review on all patients who received plastic surgery at a single institution in rural western Kenya from 2021 to 2023. Data such as diagnoses, procedures, and home village/town of residence were collected. Patient home location was geomapped using an open-access distance matrix application programming interface to estimate travel time based on terrain and road quality, assuming patient access to a private vehicle and ideal traveling conditions. Descriptive statistics were performed.

Results:
A total of 296 patients received surgery. Common procedures included treatment of cleft lip/palate (CLP), burn reconstruction, and reconstruction for benign tumors of the head and neck. The average distance to treatment was 159.2 minutes. Increased travel time was not associated with time to CLP repair (P > 0.05). Increased travel time was associated with delayed treatment for burns (P = 0.005), maxillofacial trauma (P = 0.032), and hand trauma (P = 0.016).

Conclusions:
Training programs for plastic surgeons in LMICs should ensure competency in CLP, flaps, burn reconstruction, and head and neck reconstruction. Our novel use of an application programming interface indicates that international partnerships have been more successful in decreasing treatment delays for CLP patients, but not other reconstructive procedure patients. Expanded commitment from international partners to address these reconstructive burdens in LMICs is warranted.
Role of the Pectoralis Major Muscle Flap in the Multidisciplinary Treatment of Esophageal Cancer
Authors: Barter Lauren , Forner David , French Daniel G. , Ednie Alexander , Darling Gail E. , Rigby Matthew H. 
Published: November 2024

Background:
Management of esophageal cancer is complex. Esophagectomy is associated with risk of significant complications. In this case series, we share the experience of our multidisciplinary team of thoracic surgeons and otolaryngologists in managing complications arising in the surgical treatment of esophageal cancer with the assistance of regional tissue transfer in the form of the pectoralis major flap.

Methods:
We present a case series highlighting 3 patients who underwent esophagectomy who experienced significant anastomotic or conduit complications which were managed with a pectoralis muscle flap.

Results:
Complications included tracheoesophageal fistula, refractory stenosis, and gastric conduit necrosis. Using a pectoralis major muscle flap with both myocutaneous and myofascial transfers was key to successful management. In the first patient, esophageal stent erosion after posterior tracheal wall dissection resulted in a tracheoesophageal fistula reconstructed through interposition of a myofascial flap. In the second patient, a tubed myocutaneous flap was interposed between the remnant gastric conduit and cervical esophagus to manage a posttreatment stenosis following resection of the stenosed segment. Finally, a myofascial flap was utilized to bolster a colonic interposition flap after initial necrosis of a gastric conduit that necessitated the creation of a temporary pharyngocutaneous fistula and subsequent colon interposition.

Conclusions:
Multidisciplinary care and collaboration are integral components for optimization of patient outcomes. In this case series, otolaryngology and thoracic surgery utilized multiple tools within their armamentarium to manage complications associated with the surgical management of esophageal cancer.
Simultaneous Use of the Anterior Interosseous Nerve as Both a Target and Donor Nerve in Radial to Median Nerve Transfers
Authors: Kobraei Edward M. 
Published: November 2024

Summary:
Nerve transfers play a crucial role in the management of nerve injuries. I present a case where a young weightlifter had a devastating high median nerve injury resulting in absent thumb flexor pollicis longus function and absent flexor digitorum superficialis (FDS) and flexor digitorum profundus function of the index finger. An extensor carpi radialis brevis branch of the radial nerve was transferred to the anterior interosseous nerve (AIN), and the distal AIN was then mobilized and reflected from distal to proximal to supply a second nerve transfer to an FDS-index branch of the median nerve. In this configuration, the AIN served as both the target motor nerve for the first transfer and the donor nerve for the second transfer. The use of the AIN in this manner had the effect of minimizing donor morbidity (only 1 functioning donor nerve sacrificed) while also delivering an additional donor nerve to a target in an anatomically distinct area, avoiding sacrifice of additional donors or use of nerve grafts. The patient had full recovery of flexor pollicis longus function and flexor digitorum profundus index function at 10 months, as well as full recovery of FDS function of the index finger at 1.5 years postoperatively.
Cleft Lip and Palate Correction: The Utah Protocol
Authors: Battistini Andrea , Marquez Jessica Lee , Scaife Jack , Collar Lucia , Kim Erinn , Johns Dana , Yamashiro Duane , Gociman Barbu 
Published: November 2024

Background:
Cleft repair remains a contentious issue in craniofacial surgery, especially regarding the optimal timing and techniques. This study aims to present our institutions’ current protocol for cleft lip and palate repair, including alveolar bone grafting (ABG).

Methods:
A total of 17 patients (20 clefts) treated with the latest protocol from 2016 to 2023 were evaluated. Demographic and clinical data were obtained from electronic charts. The protocol includes lip repair at 3 months, soft palate repair at 1 year, and hard palate closure with concurrent ABG at 2 years.

Results:
Mean graft height and thickness scores were 2.3 and 2.2, respectively. Three clefts showed scores marginally below the threshold for thickness, potentially requiring regrafting. Malocclusion was minimal with no significant crossbites or velopharyngeal insufficiency.

Conclusions:
Our modified protocol, emphasizing early hard palate closure with ABG, yields satisfactory outcomes in terms of graft height and thickness. Although long-term follow-up is warranted, our approach seems safe and efficient, potentially improving outcomes compared with traditional methods.