bluuebunny/crossref_metadata_2025_split huggingface dataset:
Global Well-Posedness and Refined Regularity Criterion for the Uni-Directional Euler-Alignment System
Authors: Li Yatao , Miao Qianyun , Tan Changhui , Xue Liutang 
Published: October 2024

Abstract
We investigate global solutions to the Euler-alignment system in $d$ dimensions with unidirectional flows and strongly singular communication protocols $\phi (x) = |x|^{-(d+\alpha )}$ for $\alpha \in (0,2)$. Our paper establishes global regularity results in both the subcritical regime $1&lt;\alpha &lt;2$ and the critical regime $\alpha =1$. Notably, when $\alpha =1$, the system exhibits a critical scaling similar to the critical quasi-geostrophic equation. To achieve global well-posedness, we employ a novel method based on propagating the modulus of continuity. Our approach introduces the concept of simultaneously propagating multiple moduli of continuity, which allows us to effectively handle the system of two equations with critical scaling. Additionally, we improve the regularity criteria for solutions to this system in the supercritical regime $0&lt;\alpha &lt;1$.
The Impact of Individual Cognitive Stimulation Therapy on Caregivers of Burn Patients
Authors: Zhang Cuina , Qin Beibei , Zhang Guihua , Feng Jianke , Wei Wei , Li Haitao , Xing Liang 
Published: October 2024

Abstract
This study aimed to investigate the effects of Individual Cognitive Stimulation Therapy (ICST) on the cognition, quality of life, and family relationships of caregivers of burn patients. A total of 98 caregivers of burn patients were randomly divided into a control group and a study group. The control group received routine interventions, while the study group underwent ICST, focusing on psychological diagnosis, comprehension, communication, and reeducation phases. Burn awareness levels, quality of life, social support utilization, and psychological resilience were assessed before and after the intervention. Before intervention, there were no significant differences in burn awareness levels, quality of life, social support utilization, or psychological resilience between the 2 groups. After the intervention, caregivers in the study group exhibited significantly higher scores in burn awareness levels, quality of life dimensions, social support utilization, and psychological resilience compared to the control group (P &lt; .05). Individual cognitive stimulation therapy can improve the burn awareness level, quality of life, and social support utilization of caregivers of burn patients, highlighting its significant clinical implications in enhancing caregiver well-being and patient care.
Effects of Social Determinants of Health and Social Support on Surgical Outcomes Among Patients Undergoing Hysterectomy
Authors: Hare Adam M. , Tappy Erryn , Schaffer Joseph I. , Kossl Kelsey , Gaigbe-Togbe Bertille , Kapadia Anjani , Dieter Alexis A. , Hamner Jennifer , Laporte Amanda K. , Mou Tsung , Mueller Margaret G. , Doo Josephine , Park Amy J. , Chapman Graham C. , Northington Gina , Shockley Marie , Iglesia Cheryl B. , Heit Michael 
Published: October 2024

OBJECTIVE:
To describe composite 30-day postoperative complication rates among patients undergoing hysterectomy during the coronavirus disease 2019 (COVID-19) pandemic and to determine baseline and postoperative mental health symptoms, levels of social support, and socioeconomic status and their association with hysterectomy outcomes.

METHODS:
This multicenter prospective cohort study at eight centers across the United States enrolled patients who underwent minimally invasive hysterectomy for benign indications during the COVID-19 pandemic. Patients completed preoperative and postoperative surveys assessing mental health (PHQ-9 [Patient Health Questionnaire]), social support (MOS-SS [Medical Outcomes Study Social Support Survey]), and socioeconomic status (Hollingshead Index [Hollingshead Four Factor Index of Socioeconomic Status]). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection rates and 30-day composite complication rates were measured and categorized by Clavien-Dindo Grade. Bivariate associations of survey data on complications were assessed. Logistic regression analyses were used to identify independent predictors of 30-day complications and complication severity.

RESULTS:
Postoperative complications within 30 days occurred in 67 of 273 (24.5%) patients. Most (88.1%) complications were mild, but eight (11.9%) experienced severe complications. Only three patients (1.1%) tested positive for SARS-CoV-2 infection. There were no differences in complication rates when comparing race and ethnicity, age, or socioeconomic status. Survey responses that indicated more depression and worse support from preoperative to postoperative were seen in patients with severe complications (P=.008 and P=.09, respectively). Multivariate analysis demonstrated that an increase in support scores was protective against severe complications (P=.02). Worsening depression scores were associated with more severe complications (P=.03).

CONCLUSION:
This study showed a high rate of complications (24.5%) among patients who underwent hysterectomy during the COVID-19 pandemic. Lower social support and worse mental health status are associated with worse postoperative outcomes after hysterectomy.
Development of a Practical Prediction Model for Adverse Neonatal Outcomes at the Start of the Second Stage of Labor
Authors: Clapp Mark A. , Li Siguo , James Kaitlyn E. , Reiff Emily S. , Little Sarah E. , McCoy Thomas H. , Perlis Roy H. , Kaimal Anjali J. 
Published: October 2024

OBJECTIVE:
To develop a prediction model for adverse neonatal outcomes using electronic fetal monitoring (EFM) interpretation data and other relevant clinical information known at the start of the second stage of labor.

METHODS:
This was a retrospective cohort study of individuals who labored and delivered at two academic medical centers between July 2016 and June 2020. Individuals were included if they had a singleton gestation at term (more than 37 weeks of gestation), a vertex-presenting, nonanomalous fetus, and planned vaginal delivery and reached the start of the second stage of labor. The primary outcome was a composite of severe adverse neonatal outcomes. We developed and compared three modeling approaches to predict the primary outcome using factors related to EFM data (as interpreted and entered in structured data fields in the electronic health record by the bedside nurse), maternal comorbidities, and labor characteristics: traditional logistic regression, LASSO (least absolute shrinkage and selection operator), and extreme gradient boosting. Model discrimination and calibration were compared. Predicted probabilities were stratified into risk groups to facilitate clinical interpretation, and positive predictive values for adverse neonatal outcomes were calculated for each.

RESULTS:
A total of 22,454 patients were included: 14,820 in the training set and 7,634 in the test set. The composite adverse neonatal outcome occurred in 3.2% of deliveries. Of the three modeling methods compared, the logistic regression model had the highest discrimination (0.690, 95% CI, 0.656–0.724) and was well calibrated. When stratified into risk groups (no increased risk, higher risk, and highest risk), the rates of the composite adverse neonatal outcome were 2.6% (95% CI, 2.3–3.1%), 6.7% (95% CI, 4.6–9.6%), and 10.3% (95% CI, 7.6–13.8%), respectively. Factors with the strongest associations with the composite adverse neonatal outcome included the presence of meconium (adjusted odds ratio [aOR] 2.10, 95% CI, 1.68–2.62), fetal tachycardia within the 2 hours preceding the start of the second stage (aOR 1.94, 95% CI, 1.03–3.65), and number of prior deliveries (aOR 0.77, 95% CI, 0.60–0.99).
Opportunities and Solutions: Unintentional Weight Loss
Authors: Guterman Rebecca , Chu Andy S. , Hirsch Rebecca , Singer Judy , Johnston Sarah , Fung Katy 
Published: October 2024

ABSTRACT
In this narrative review, the authors provide a concise overview of current information on the identification and management of unintentional weight loss (UWL) in clinical care settings. Unintended weight loss can occur widely and is often multifactorial. Clinicians should use screening tools to identify those experiencing UWL. Management includes nutrition assessments and diagnosing malnutrition when present. Nutrition counseling by a registered dietitian nutritionist should address the causes and manifestations of UWL. Individualized dietary plans with supplementation and/or nutrition support and medications for appetite stimulation may be considered. The presence of UWL at the end of life should be addressed in line with the patient’s care plan. Managing UWL is part of the multidisciplinary care teams’ responsibilities.
High-Quality Dietary Protein: The Key to Healthy Granulation Tissue
Authors: Chu Andy S. , Delmore Barbara , Chiu Ernest S. 
Published: October 2024

ABSTRACT
Wound healing is a complex process, particularly for full-thickness, chronic wounds. The processes of wound healing phases require support in order for wound healing to progress and be successful. Chronic wounds present a particular conundrum because they represent a dysfunction or interruption generally occurring between the inflammatory and proliferative phases. This progress remains delayed until the dysfunction is addressed. Older patients and those who are critically ill are generally most at risk of developing a chronic wound. A nonhealing wound is associated with increased healthcare costs and poor patient outcomes. Thus, it is imperative to promote the wound healing processes, reduce healthcare costs, and foster good patient outcomes.
Providers should address clinical issues when stalling is noted and there is a lack of progression through the phases of wound healing. One important issue to address is nutrition, because of its role in the formation of granulation tissue. Unfortunately, the importance of nutrition and its impact on successful wound healing are often overlooked. The literature is replete with nutrition measures that support wound healing, including the importance of protein; however, these are often not specific to the importance of protein in the formation of granulation tissue during the proliferative stage. In this article, the authors discuss the role of protein in creating healthy granulation tissue in the adult patient with a full-thickness wound.

GENERAL PURPOSE
To review the role of nutrition and high-quality dietary protein intake in creating healthy granulation tissue and optimize wound healing in patients with chronic wounds.

TARGET AUDIENCE
This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and registered nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES
After participating in this educational activity, the participant will:1. Summarize the structure and composition of proteins. 2. Specify the role of proteins in generating healthy granulation tissue and wound healing. 3. Explain the physiologic pathways involved in the wound healing process. 4. Describe evidence-based interventions to support nutrition in wound healing.
Hearing Screening in Older Adults in Primary Care Clinics: How the Effects of Setting and Provider Encouragement Differ by Patient Sex and Race
Authors: West Jessica S. , Dubno Judy R. , Francis Howard W. , Smith Sherri L. 
Published: October 2024

Objectives:
Few studies have examined how patient sex or race influence hearing healthcare, which was our study purpose.

Design:
We performed a secondary analysis using data from a pragmatic clinical trial that examined the effect of provider encouragement (yes/no) or setting (at-home/clinic) for older adults to follow through with routine hearing screening in primary care and the hearing healthcare pathway. Three protocols were compared: at-home screening without provider encouragement, at-home screening with provider encouragement, and in-clinic screening with provider encouragement.

Results:
Poisson regression (n = 627) showed few differences by patient sex but showed that Black patients in the at-home protocols were less likely to schedule or complete a formal diagnostic evaluation after a failed screening compared with Black patients in the clinic setting and White patients in all groups. Black patients, regardless of provider encouragement, were less likely to schedule or complete a diagnostic evaluation compared with White patients.

Conclusions:
Results suggest that in-clinic screenings may increase the use of hearing healthcare for Black patients.
A Biomechanical Analysis of Instrumentation Constructs During Vertebral Column Resection: Stability When You Need It!
Authors: Shaw K. Aaron , Niese Brad , Sucato Daniel J. 
Published: October 2024

Study Design:
Biomechanical Testing

Objective:
Investigate the optimal construct for stabilization of the spine during vertebral column resection (VCR).

Summary of Background Data:
VCR is a powerful technique for achieving correction in severe cases of spinal deformity. However, this also creates an unstable spine which requires stable fixation to prevent iatrogenic neurologic injury. It is common practice to place a temporary unilateral rod configuration to achieve this stability during surgery but no study to date has investigated the optimal construct configuration.

Methods:
A unilateral VCR model representing an acute 50° kyphotic deformity with a standardized 30 mm resection was created. Three conditions underwent testing: 1) Rod material and diameter, 2) rod configuration, and 3) number of fixation points. Six unique samples were tested in each group in both flexion-extension. Prior to testing a 10N preload and underwent cyclical testing in flexion/extension. System stiffness was calculated and compared across groups.

Results:
Assessment of rod size and composition using a single screw construct (2 total screws) demonstrated that for Titanium (Ti) rods, increasing rod size significantly increased the construct stiffness (P=0.001). Although Cobalt-chromium (Co-Cr) rods where significantly stiffer than the corresponding sized Ti rods, there was no significant difference between rod diameters for Co-Cr (P=0.98). However, when tested using a dual screw (4 total screws) construct, these constructs were significantly stiffer than the corresponding single screw constructs (P<0.0001). Of the various rod configurations, the dual rod demonstrated the greatest stiffness (34.8±2.1 N/mm; P<0.0001).

Conclusion:
Surgical construct stiffness during a VCR is multifactorial. Larger rod diameter, increased number of fixation points, stiffer rod material, and increased number of rods across the resection site increase the construct stiffness. With minimal points of fixation using Co-Cr rods, increasing rod diameter does not impart greater construct stiffness unless additional fixation points are included.
Association Between Clonal Hematopoiesis of Indeterminate Potential and Cardiovascular Outcomes in Patients With Acute Coronary Syndrome Who Have Quit Smoking: Study Design of a Prospective Cohort Study
Authors: Li Jing , Qi Zizhao , Xu Ying , Cao Yinan , Li Yi , Han Yaling 
Published: October 2024

Abstract
Despite quitting smoking, patients with acute coronary syndrome (ACS) still have an increased risk of cardiovascular events. Clonal hematopoiesis of indeterminate potential (CHIP), which may be induced by smoking, has been identified to be associated with the development of coronary artery disease. However, it is unclear whether CHIP has a detrimental effect on the poor prognosis of ACS patients even after smoking cessation. This single-center, prospective cohort study will recruit 1,029 ACS patients undergoing complete percutaneous coronary intervention. The enrolled patients will be categorized into 3 groups based on their smoking status at admission: current smoker, non-smoker, and previous smoker. Previous smokers are defined as patients who have quit smoking for at least 1 year before experiencing the index ACS event. Whole-exome sequencing will be performed to identify the occurrence of CHIP in each patient. The primary endpoint is major adverse cardiovascular and cerebrovascular events, defined as a composite of cardiac death, non-fatal myocardial infarction, ischemia-driven revascularization, hospitalization for heart failure, and ischemic stroke. The association between CHIP and the primary endpoint will be determined by using Cox proportional hazard regression. This study aims to investigate the association among smoking cessation, CHIP, and the prognosis of ACS patients to provide new insights into the impact of CHIP on ACS patients, particularly among those who have quit smoking. The results will be published following the STROBE in a peer-reviewed scientific journal (Trial registration number: NCT04987268).
Selective Clonal Regression After Interferon Therapy in Metastatic Melanoma
Authors: Fernandez-Flores Angel 
Published: October 2024

Abstract:
Regression (total or partial) is a common phenomenon in melanoma. From a pathogenic perspective, it is highly complex and only partially understood, involving aspects of both the tumor and the individual. One of the determining factors is the clonal selection of the tumor, wherein some clones within the tumor survive while others perish. This clonal selection can sometimes occur as a selective mechanism after the initiation of a therapeutic intervention. In many of these cases, the effect is detrimental, because the surviving clone is resistant to the applied therapy. However, occasionally, the therapy can successfully select the less harmful clone. We present an example of the latter, where therapy with interferon induced regression of the metastatic-capable melanocytic population, with only the primary tumor melanocytic population persisting. To confirm this, we demonstrated BRAF mutational similarity between the 2 populations, and an additional NRAS mutation in the metastatic population, which was absent in the primary tumor.
Perianal Pulse Granuloma Induced by Plant-Derived Baby Wipes
Authors: Wang Robin H. , Lullo Jenna J. , Dahiya Madhu , Eilers David B. 
Published: October 2024

Abstract:
Pulse granulomas are unusual foreign body reactions to exogenous plant material, featuring the presence of hyaline ring structures and granulomatous inflammation. Pulse granulomas have been reported to occur in the oral cavity, gastrointestinal tract, and respiratory tract. Cutaneous pulse granulomas are exceedingly rare. All reported cases have been closely associated with underlying pathology such as chronic inflammatory conditions, trauma, or surgical procedures which likely facilitated implantation of exogenous plant material. We report a novel case of a cutaneous pulse granuloma presenting in the perianal region of an otherwise healthy man. The authors propose that the source of the exogenous plant material is plant-derived baby wipes, which the patient had been using daily to the perianal region.
Strengthening the Multiple-Choice Assessment: Improving Item-Writing Skills of Physician Assistant Educators
Authors: Buterbaugh Abigail 
Published: October 2024

Abstract
Physician assistant (PA) educators are tasked with the challenging privilege of ensuring future PAs are knowledgeable and competent to practice medicine. Most enter academia without formal education in providing education. They learn as they go—a treacherous and steep learning curve. This study provides PA educators literature and skills to bolster the strength and validity of multiple-choice examination items to measure learner progress and identify knowledge gaps. Skills can be improved at the level of the individual educator and program or institution. Approaching item writing and item revision in a stepwise, evidence-based manner can improve the quality of the items, strengthening multiple-choice examinations. This process can yield improved assessments of students' medical knowledge and competence. This study aims to provide the PA educator with techniques to improve their item-writing skills.
Effect of NGN-Style Case Studies on Nursing Students’ Anxiety and Self-Confidence With Clinical Decision-Making
Authors: Ross Jennifer G. , Caputo Thomas , Scheve Ann 
Published: October 2024

Background:
The Next Generation National Council Licensing Examination (NCLEX) uses the Clinical Judgment Measurement Model in unfolding case studies to assess graduate nurses’ clinical judgment.

Purpose:
This study explored the impact of Next Generation NCLEX (NGN)-style case studies on baccalaureate nursing students’ self-confidence and anxiety with clinical decision-making.

Methods:
Seventy-six second-year baccalaureate nursing students participated in this 1-group convergent mixed-methods study. Students completed 7 NGN-style case studies during a Nursing Essentials course. Data were collected at the beginning and end of the semester.

Results:
Anxiety with clinical decision-making significantly decreased, and self-confidence with clinical decision-making significantly increased from pretest to posttest. Five qualitative themes derived from open-ended responses: realistic application of theory to practice, critical thinking, feedback, collaboration, and NCLEX preparation.

Conclusions:
This study provides preliminary evidence that formative NGN-style case studies are well received by students and result in positive outcomes. Further research is needed to more fully understand the effects of NGN-style case studies.
Development of a Virtual Pediatric Holistic Comfort Care Clinic
Authors: Braswell April A. , Denning Brittany , O’Brien Coleen E. , Harris Avianne 
Published: October 2024

Background:
Guided by the tenets of Kolcaba’s holistic comfort theory, we developed, implemented, and evaluated a simulated online pediatric advanced practice health center. The Pediatric Comfy Care Clinic (PCCC) was created to enhance person-centered diagnostic reasoning and holistic advanced management skills for family nurse practitioner students.

Methods:
Our interprofessional team used a standardized approach to online design and development while integrating essential holistic comfort theory concepts for student engagement and assessment of learning. We explored outcomes of pre- and postclinic quizzes and student reflection data using mixed methods.

Results:
Significant differences (P < .001) were noted in all postpractice quizzes in each affiliated PCCC module with variable student outcomes on graded clinic encounters. Important student perspectives on teaching and learning in the virtual clinic were noted.

Conclusion:
A comfort theory-driven, simulated, and digitally enhanced virtual clinic is feasible and valuable with important implications for holistic advanced practice.