bluuebunny/crossref_metadata_2025_split huggingface dataset:
Metastatic insulinoma—outcomes in the current era
Authors: Masharani Umesh , Lindsay Sheila , Moon Farhana , Paciorek Alan , Bergsland Emily 
Published: October 2024

Abstract

Background
Multimodal interventions in neuroendocrine tumors appear to have a beneficial impact on survival. Metastatic insulinoma is associated with hypoglycemia and, historically, a shortened life expectancy.

Methods
The authors retrospectively analyzed the clinical outcomes of patients with metastatic insulinomas treated at a tertiary care center between 2006 and 2023.

Results
Clinical data on 14 patients with metastatic insulinoma (metastases to the liver, skeleton, and lung) were reviewed in this descriptive study. The patients underwent various treatments including surgery; liver directed therapies (embolization, selective internal radiotherapy), somatostatin analogs; targeted agents (everolimus); systemic chemotherapy (capecitabine/temozolomide; carboplatin/etoposide); external beam radiation; and peptide receptor radiotherapy. Seven subjects died during follow-up. The time of the 7 deaths ranged from 2.5 to 10.4 years (median time to death was 8.2 years). This compares to previous reports of median survival of about 2 years. Seven subjects are alive 1.2-12.3 years after diagnosis. Hypoglycemia was well-controlled and did not cause the deaths.

Conclusions
Multimodal interventions in metastatic insulinoma can be effective in managing hypoglycemia. The patients on multimodal treatments also lived a long time when considering previous published reports of median survival of just 2 years. Our findings challenge previous assumptions regarding clinical outcomes in this patient population.
Asymmetric fluctuation of overlapping dinucleosome studied by cryoelectron microscopy and small-angle X-ray scattering
Authors: Shimizu Masahiro , Tanaka Hiroki , Nishimura Masahiro , Sato Nobuhiro , Nozawa Kayo , Ehara Haruhiko , Sekine Shun-ichi , Morishima Ken , Inoue Rintaro , Takizawa Yoshimasa , Kurumizaka Hitoshi , Sugiyama Masaaki 
Published: October 2024

Abstract
Nucleosome remodelers modify the local structure of chromatin to release the region from nucleosome-mediated transcriptional suppression. Overlapping dinucleosomes (OLDNs) are nucleoprotein complexes formed around transcription start sites as a result of remodeling, and they consist of two nucleosome moieties: a histone octamer wrapped by DNA (octasome) and a histone hexamer wrapped by DNA (hexasome). While OLDN formation alters chromatin accessibility to proteins, the structural mechanism behind this process is poorly understood. Thus, this study investigated the characteristics of structural fluctuations in OLDNs. First, multiple structures of the OLDN were visualized through cryoelectron microscopy (cryoEM), providing an overview of the tilting motion of the hexasome relative to the octasome at the near-atomistic resolution. Second, small-angle X-ray scattering (SAXS) revealed the presence of OLDN conformations with a larger radius of gyration than cryoEM structures. A more complete description of OLDN fluctuation was proposed by SAXS-based ensemble modeling, which included possible transient structures. The ensemble model supported the tilting motion of the OLDN outlined by the cryoEM models, further suggesting the presence of more diverse conformations. The amplitude of the relative tilting motion of the hexasome was larger, and the nanoscale fluctuation in distance between the octasome and hexasome was also proposed. The cryoEM models were found to be mapped in the energetically stable region of the conformational distribution of the ensemble. Exhaustive complex modeling using all conformations that appeared in the structural ensemble suggested that conformational and motional asymmetries of the OLDN result in asymmetries in the accessibility of OLDN-binding proteins.
Measurement of γ-Rays Generated by Neutron Interaction with 16O at 30 MeV and 250 MeV
Authors: Tano T , Horai T , Ashida Y , Hino Y , Iacob F , Maurel A , Mori M , Collazuol G , Konaka A , Koshio Y , Nakaya T , Shima T , Wendell R 
Published: October 2024

Abstract
Deep understanding of $\gamma$-ray production from the fast neutron reaction in water is crucial for various physics studies at large-scale water Cherenkov detectors. We performed test experiments using quasi-mono energetic neutron beams ($E_n = 30$ and 250 MeV) at Osaka University’s Research Center for Nuclear Physics to measure $\gamma$-rays originating from the neutron–oxygen reaction with a high-purity germanium detector. Multiple $\gamma$-ray peaks which are expected to be from excited nuclei after the neutron–oxygen reaction were successfully observed. We measured the neutron beam flux using an organic liquid scintillator for the cross section measurement. With a spectral fitting analysis based on the tailored $\gamma$-ray signal and background templates, we measured cross sections for each observed $\gamma$-ray component. The results will be useful to validate neutron models employed in ongoing and future water Cherenkov experiments.
Reserves Were Not So Ample After All
Authors: Copeland Adam , Duffie Darrell , Yang Yilin (David) 
Published: October 2024

Abstract
We show that the likelihood of a liquidity crunch in wholesale U.S. dollar funding markets depends on levels of reserve balances at the financial institutions that are the most active intermediaries of these markets. Heightened risk of an imminent liquidity crunch is signaled by significant delays in intraday payments to these large financial institutions over the prior two weeks. Our study contributes to the broader dialogue surrounding the Federal Reserve’s ongoing quantitative tightening.
The Shadow Cost of Collateral
Authors: Pan Guangqian , Pan Zheyao , Xiao Kairong 
Published: October 2024

Abstract
We quantify the cost of pledging collateral for small businesses by exploiting a regulatory quirk of the SBA disaster lending program in which firms are exempt from posting collateral if their loan size is below a threshold. Firms bunch their loans below the threshold, and the resultant distortion in the loan size distribution reveals the magnitude of the collateral cost. The collateral cost is substantial and varies across collateral types, business sectors, and collateral laws in ways consistent with flexibility-based theories. Our findings have implications for firms’ borrowing constraints and disaster lending program designs.
Chewing Gum to Treat Postoperative Nausea and Vomiting in Female Patients: A Multicenter Randomized Trial
Authors: Darvall Jai N. , De Silva Anurika P. , von Ungern-Sternberg Britta , Story David A. , Davidson Andrew J. , Allen Megan L. , Tran-Duy An , Schultz-Ferguson Cindy , Ha Vi , Braat Sabine , Leslie Kate ,   on behalf of the CHEWY Trial Group and the ANZCA Clinical Trials Network
Published: October 2024

Background:
Postoperative nausea and vomiting is common after general anesthesia, with consequences for patient outcomes, satisfaction with care, and healthcare costs. The aim was to compare a new treatment, chewing gum, with a widely used intravenous agent, ondansetron, to treat postoperative nausea and vomiting in female patients in the postanesthesia care unit.

Methods:
This study was a multicenter, randomized, controlled noninferiority trial in 17 hospitals in Australia and New Zealand. Female patients aged 12 yr or older undergoing volatile anesthetic–based general anesthesia for laparoscopic or breast surgery were enrolled. Protocolized antiemetic prophylaxis was administered. Patients who developed postoperative nausea and vomiting in the postanesthesia care unit were randomized to either 15 min of chewing gum or 4 mg intravenous ondansetron. The primary outcome was cessation of nausea, retching, or vomiting with no recurrence nor rescue medication for 2 h after administration of the randomized intervention (i.e., complete response).

Results:
Of 865 enrolled patients, 218 were randomized. In a per-protocol analysis, 50 of 105 (47.6%) ondansetron-treated patients compared with 31 of 103 (30.1%) chewing gum–treated patients achieved the primary outcome (absolute risk difference [95% CI], −17.3 [−30.4 to −4.3]%), not reaching the prespecified noninferiority limit. The time to complete response was longer for patients randomized to chewing gum (hazard ratio [95% CI], 0.53 [0.34 to 0.83]), and they were more likely to receive antiemetics in the 24 h after surgery (absolute risk difference [95% CI], 14.1 [1.6 to 26.5]%).

Conclusions:
Chewing gum cannot be recommended as an alternative to ondansetron for treatment of postoperative nausea and vomiting in female patients administered antiemetic prophylaxis.
Radiographic Measurements of Pes Planovalgus Do Not Predict Clinical Outcomes in Tarsal Coalition Excision
Authors: Rushin Claire , Mo Michelle , Miller Patricia E. , Spencer Samantha , Mahan Susan T. 
Published: October 2024

Objective:
Many patients who undergo tarsal coalition excision have persistent postoperative pain. Most studies have utilized cat scan (CT) scan parameters of pes planovalgus and heel valgus but have found this to be an inconsistent predictor of outcomes. Plain radiographic parameters have been less utilized in trying to predict outcomes after coalition excision. Radiographic talonavicular coverage angle correlates with pain in patients with flexible pes planovalgus (PPV) but has not been studied in tarsal coalition population. Furthermore, foot alignment is not understood to change after simple coalition excision. The purpose of this study was to compare plain radiographic parameters, including talonavicular coverage angle, with pain after tarsal coalition excision, as well as compare preoperative and postoperative weight-bearing radiographs.

Methods:
Seventy-seven feet that underwent excision of the tarsal coalition had clinical outcomes and radiographic data collected >1 year postoperatively. Measures of PPV on preoperative and postoperative weight-bearing radiographs and CT scans were evaluated.

Results:
Patients were an average of 13 years old at excision. Of the total, 65% had calcaneonavicular (CN) coalitions, whereas the remainder had talocalcaneal coalitions. All patients had significant postoperative improvement in clinical outcomes but 34% (13/38) had continued pain at the most recent follow-up, more so in talocalcaneal than CN coalitions (55% vs 26%, P < 0.001). The subset with CN coalitions had more severe preoperative PPV but greater postoperative PPV improvement. Except for a weak correlation between radiographic weight-bearing (anterior-posterior) talus-first metatarsal angle and pain with activity (r = -0.54), there were no other correlations between preoperative radiographic parameters and clinical outcomes. Heel valgus on CT did not correlate with radiographic measurements of PPV or pain.

Conclusions:
We did not find a correlation of radiographic PPV with persistent pain after tarsal coalition excision. We did find improvement in radiographic PPV in CN coalitions after treatment with simple excision. Heel valgus on CT was not a useful metric for evaluating PPV in the setting of a tarsal coalition.

Level of Evidence:
Level III—prognostic study.
Robot-assisted kidney transplantation: initial experience from a tertiary hospital in China
Authors: Zhang Mingxiao , Ding Zhenshan , Zhao Ying , He Yuhui , Deng Yisen , Zhang Tianyu , Shen Congrong , Cao Chuanzhen , Wang Jianfeng 
Published: October 2024

Abstract

Background
Robot-assisted kidney transplantation (RAKT) has currently become an effective alternative to open kidney transplantation (OKT), which has long been considered the gold standard for kidney transplant surgery. This study aimed to summarize our initial experience with RAKT and explore its safety and feasibility.

Materials and methods
Ten cases of RAKT, including 8 cases of deceased-donor kidney transplantation and 2 cases of living-donor kidney transplantation, were performed at our center from March 2023 to November 2023. Perioperative clinical data and follow-up results of patients were collected and statistically analyzed.

Results
All RAKT surgeries were performed successfully with no complications. The average operative time was 297.90 ± 65.59 minutes, and the median estimated blood loss was 100 mL. The average serum creatinine level decreased from 918.14 ± 166.63 μmol/L preoperatively to 109.89 ± 29.89 μmol/L at discharge. The postoperative outcomes of RAKT from both deceased and living donors were satisfactory during the follow-up period.

Conclusions
RAKT is an effective alternative to OKT and is suitable for both deceased- and living-donor kidney transplantations. The postoperative outcomes were satisfactory, and the postoperative complications were acceptable. RAKT appears to be a safe and feasible procedure for transplantation teams skilled in OKT and robot-assisted surgery.
Updating probability of pathogenicity for RYR1 and CACNA1S exon variants in individuals without malignant hyperthermia after exposure to triggering anesthetics
Authors: Roberts David A. , Bastarache Lisa , He Jing , Lewis Adam , Aka Ida T. , Shotwell Matthew S. , Reddy Srijaya K. , Hogan Kirk J. , Biesecker Leslie G. , Kertai Miklos D. 
Published: October 2024

Objectives
We aimed to classify genetic variants in RYR1 and CACNA1S associated with malignant hyperthermia using biobank genotyping data in patients exposed to triggering anesthetics without malignant hyperthermia phenotype.

Methods
We identified individuals who underwent surgery and were exposed to triggering anesthetics without malignant hyperthermia phenotype and who had RYR1 or CACNA1S genotyping data available in our biobank. We classified all variants in the cohort using a Bayesian framework of the American College of Medical Genetics and Genomics and the Association of Molecular Pathologists guidelines for variant classification and updated the posterior probabilities from this model with the new information from our biobank cohort.

Results
We identified 253 patients with 95 RYR1 variants and 12 CACNA1S variants. After applying a Bayesian framework, we classified 17 variants as benign (B), 31 as likely benign (LB), 57 as uncertain (VUS), and 2 as likely pathogenic (LP). When we incorporated evidence about unique exposures to malignant hyperthermia triggering anesthetic agents, 48 of 107 (45%) variants were downgraded (9 to B, 37 to LB, and 2 to VUS). Notably, 41 (72%) of 57 VUSs were downgraded to B or LB. When repeat anesthetics in the same individual were counted as one exposure, 42 of 107 (39%) of variants were downgraded (5 to B, 35 to LB, and 2 to VUS). Specifically, 37 (65%) of 57 VUSs were downgraded to LB.

Conclusion
Deidentified biorepositories linked with anesthetic data offer a new method of integrating clinical evidence into the assessment of variant probability of pathogenicity.
Development of Domains of Competence and Competencies for Physical Therapist Education
Authors: Ambler Steven B. , Burlis Tamara L. , Clark B. Ruth , Holtzman Gregory W. , McGee Patricia Navarro , Frost Jody S. , Randolph Jessica L. , Norton Barbara J. , Holleran Carey L. 
Published: October 2024

Background and Purpose.
Competency-based education (CBE) has been gaining widespread acceptance as a viable method for transforming education within health professions. The purpose of this report is to describe the process we used to develop a set of domains of competence and associated competencies for physical therapists. The catalyst for this effort was our desire to implement CBE as part of the major renewal of our Doctor of Physical Therapy curriculum.

Method/Model Description and Evaluation.
We developed a draft set of domains and competencies for physical therapists by considering the future of physical therapy and relevant CBE literature. Next, we used a multistep survey-and-revise process to develop consensus on the appropriateness and clarity of each domain and competency. Surveys were repeated until an 85% threshold level of agreement was achieved for each domain and competency. Between rounds of the surveys, the Competency and Entrustment Writing Team reviewed feedback and edited items accordingly.

Outcomes.
The writing and feedback processes resulted in consensus on a total of 57 competencies, organized into 8 domains of competence.

Discussion and Conclusion.
The development of defined outcomes for physical therapist education (PTE) through domains and competencies provides a framework for a broader effort to re-envision PTE. Careful attention to ensuring that the framework uses shared language across professions has the potential to enhance health care and the health of society.
Safety and Efficacy of Rigid Bronchoscopy-guided Percutaneous Dilational Tracheostomy
Authors: Murn Michael , Burbano Alma V. , Lara Juan C. , Swenson Kai , Beattie Jason , Parikh Mihir , Majid Adnan 
Published: October 2024

Background:
Percutaneous dilational tracheostomy (PDT) is commonly performed by a broad spectrum of practitioners. Aside from relative contraindications such as morbid obesity, coagulopathy, and complex airway anatomy, it is preferred over surgical tracheostomy in the critically ill. Rigid bronchoscopy-guided (RBG) PDT provides a secure airway, allows for unobstructed ventilation, protects the posterior membrane from puncture, and increases suction capacity.

Methods:
This is a retrospective case series of patients who underwent RBG-PDT from 2008 to 2023 at Beth Israel Deaconess Medical Center. Electronic medical records were reviewed for preprocedural demographic data, procedural events, and postprocedural outcomes.

Results:
A total of 104 patients underwent RBG-PDT over a 15-year period. Median patient age was 61.95 (95% CI: 59.00-64.90), median BMI was 30.25 kg/m2 (IQR, 23.6 to 37.2) with 41.9% (32.5% to 51.3%) of patients included having a BMI over 30 kg/m2. PDT placement occurred in a mean of 13.7 days after intubation, with 70% due to prolonged mechanical ventilation resulting from ongoing respiratory failure. In all, 51.0% of patients had at least one increased bleeding risk factor, with an increased aPTT >36 seconds being the most common (36.5%). In all, 26.9% of patients underwent tracheostomy with ongoing therapeutic anticoagulation with heparin. In total, 60.6% of patients received concomitant percutaneous endoscopic gastrostomy (PEG) tube placement. No cases of pneumothorax or loss of the airway at the time of exchange of the endotracheal tube for rigid tracheoscopy were reported.

Conclusion:
RBG-PDT is a safe and effective procedure extending the patient population appropriate for PDT when performed by an experienced Interventional Pulmonology team.
Mediating Effects of Resilience on the Relationship Between Stress and Professional Commitment Among Nursing Students
Authors: Lin Pao-Chen , Chang Ya-Wen , Chang Yu-Hsuan 
Published: October 2024

Background:
Research on the relationship between stress, professional commitment, and resilience among nursing students is lacking.

Purpose:
To examine the mediating effect of resilience on the relationship between stress and professional commitment among nursing students during their fundamental nursing practicum.

Methods:
A cross-sectional design was used. Nursing students who were aged 17 to 20 years and had completed fundamental nursing practicum within 1 week were recruited. The survey covered stress, resilience, and professional commitment. The mediation analysis was conducted using the PROCESS macro with a bootstrap approach.

Results:
This study recruited 485 nursing students. Stress was significantly negatively correlated with resilience and professional commitment, whereas resilience was significantly positively correlated with professional commitment. Furthermore, resilience partially mediated the relationship between stress and professional commitment.

Conclusions:
Appropriate interventions should be implemented to help nursing students reduce stress and improve their resilience, which can thus enhance their professional commitment to the nursing profession.
The Incidence and Severity of Pediatric Injuries Sustained by Electric Bikes and Powered Scooters
Authors: Moati Seraj , Tavor Oren , Capua Tali , Sukhotnik Igor , Glatstein Miguel , Rimon Ayelet , Cohen Neta 
Published: October 2024

Objectives
This study aimed to describe the incidence and severity of electrical bicycle (E-bike)– and power scooter (P-scooter)–related injuries and their secular trends among pediatric patients presenting to a pediatric emergency department (ED).

Methods
This retrospective cohort study of patients aged <18 years who sustained E-bike and P-scooter injuries was performed between 2018 and 2023. We explored trends of severe trauma cases, ED visits, hospitalizations, and surgical interventions. Severity of trauma was rated by either an injury severity score (ISS) of >15 or the patient's need for acute care as defined by intensive care unit (ICU) admission, direct disposition to the operating room, acute interventions performed in the trauma room, and in-hospital death.

Results
Of the 1466 pediatric patients who presented to our pediatric ED following P-scooter and E-bike injuries, 216 (14.7%) were hospitalized, with a median age of 14.0 years (interquartile range, 10.5–16.0 years) and male predominance (69.0%). The number of ED visits increased 3.5-fold by study closure, with a parallel increase in hospitalizations, surgical interventions, and severe trauma cases. The relative percentages of severe trauma cases were not significantly different over time. Among hospitalized patients, 3 patients (1.4%) died and 9 (4.1%) required rehabilitation care.

Conclusions
The incidence and severity of E-bike and P-scooter injuries and fatalities continue to increase within the pediatric population. Current personal and road safety regulations are providing inadequate in preventing these injuries, highlighting an urgent need for revision and stricter enforcement.
Incidence of high blood pressure among Kenyan adults with HIV
Authors: Suvada Kara , Kocher Erica , Diwan Nazha , Nagy Andrew , Nderitu Mary , Kibaara Charles , Ngomoa Richard , Cagle Tony J. , Kariuki Jacob , Wall Kristin M. , Brunissen Ludivine , Ramireddy Shashank , Johnson Leslie C.M. , Chung Michael H. , Ali Mohammed K. 
Published: October 2024

Objective:
People with HIV (PWH) face a heightened risk of cardiovascular diseases, partly because of increased high blood pressure risk. This study assessed high blood pressure burden (i.e. incidence and prevalence) among PWH in Kenya over time.

Design:
Longitudinal, open cohort study.

Methods:
We estimated the incidence and prevalence of high blood pressure in a large sample of Kenyans with HIV from the Coptic Hope Center using electronic medical records from 2004 to 2023. We defined incident high blood pressure as first visit after baseline at which each patient had a SBP at least 140 mmHg and/or a DBP at least 90 mmHg.

Results:
Our sample included 38 709 PWH seeking care at Coptic Hope Center clinics in Kenya (2004–2023). Nearly 40% of patients had high blood pressure at first visit. Among the 60% of patients initially normotensive, almost 40% developed high blood pressure within 20 years. The yearly prevalence of high blood pressure ranged from 8 to 58%. Average SBP was higher among patients who had their first visit from 2019 to 2023 compared with those visiting in the early 2000s and 2010s.

Conclusion:
Our findings reveal a high and rising burden of high blood pressure among PWH in a large, faith-based health system in Kenya. This underscores the need for stronger integration of care for individuals with concurrent HIV, high blood pressure, and other noncommunicable diseases (NCDs). Current systems are insufficient for achieving blood pressure control among PWH. Further research and funding for efforts to address HIV and NCD care in Kenya are warranted.