bluuebunny/crossref_metadata_2025_split huggingface dataset:
Suicide in Nepal
Authors: Wenzel Thomas , Risal Ajay 
Published: September 2024

Abstract
Nepal is one of the poorest countries in the world, but with a rich culture and a multi-religious history. Suicide rates, especially in women, are high and might reflect discriminative practices against women in general. Over the last decades, many subgroups of the population, but also the population as a whole, have suffered a number of severe social and economic stressors that should be considered in this context. The complex multi-ethnic and multi-religious setting does not permit simplified conclusions as to the influence of these factors on suicide rates. Preventive strategies are part of the government’s agenda, and initiatives by universities and non-governmental organizations have started but suffer from limited resources and complex challenges in the country.
Suicide scripts of the Nacirema (aka American)
Authors: Sara Canetto Silvia 
Published: September 2024

Abstract
Taking as a model a satirical account of Nacirema (‘American’ spelt backwards) body beliefs and rituals, as observed by a fictional anthropologist, in a 1956 article by Miner, this chapter provides an analysis of Nacirema/American suicide patterns and beliefs from the point of view of an imaginary outsider. Specifically, Nacirema/American suicide patterns by sex, age, and ‘race’, and Nacirema/American beliefs about these patterns are narrated from the standpoint of the imaginary outsider, and in light of Nacirema/American dominant scripts of femininity and masculinity. This reversal of perspectives aims to facilitate recognition of how in ‘America’, as everywhere, suicide is a deeply cultural act. This chapter ends with a discussion of the necessity of a cultural perspective in suicide theory, research, and prevention, especially in relation to dominant ‘American’ suicide theory, research, and prevention, because of how rarely dominant ‘American’ suicide theory, research, and prevention are the focus of a cultural analysis.
Critical care
Authors: Nethercott Daniel , Shelley Maire 
Published: September 2024

Abstract
Communication skills are fundamental to critical care. Structured communication is essential in crisis situations. Similarly, handover requires focused communication.
Communicating with patients with tracheostomies can be a challenge. It helps to communicate regularly in short sessions using closed questions. Communication with patient’s families involves active listening, development of rapport, and empathy with avoidance of information overload and jargon. Ensure that the messages delivered are clear and consistent. Be aware that miscommunication is a common issue as patients and families tend to seize on any information without necessarily understanding context. At the end of life it is important to communicate sensitively with a focus on the patient’s and family’s needs rather than our own. Silence is a very effective tool to promote rapport and allow space for people to speak. Even withdrawal of active therapy can be framed in a positive way along with emphasis on non-abandonment and ongoing supportive care.
When bad things happen
Authors: Strange Khursandi Diana C. , Tan Suyin G.M. 
Published: September 2024

Abstract
Breaking bad news is never easy whether the incident is minor and predictable or a major unforeseen event. The ‘LAURS’ principles and ‘GREAT’ template support the development of communication skills in this context. The anaesthetist needs to listen attentively, recognize, and respect the diversity of possible emotional responses. They should be prepared to apologize without attributing blame and be able to provide not only factual information, but also emotional support including dealing with anger and acknowledging uncertainty. Disclosure interviews should be planned with avoidance of jargon and information delivered in small chunks. To avoid creating the impression of a ‘cover up’, communication needs to be open and factual with time allowed for the recipient to digest information and ask questions. Staff involved in an incident resulting in patient harm may also be affected by burn-out and mental health issues, especially if litigation occurs. They also need to receive support.
Media
Authors: Selak Tanya , Prineas Stavros 
Published: September 2024

Abstract
Medical professionals increasingly use online media in their interactions with patients, and form relationships with the community in the public health setting. When we meet patients in the anaesthetic bay, many have been influenced by information on the internet. Discussion of such information during consultation may be perceived by some doctors as a threat to their knowledge and experience, however social media use can lead to more equal and active communication as patients feel empowered by knowledge and preparation. Social media platforms can also be used for doctor–patient interactions, but they bring ethical considerations such as patient confidentiality, privacy, and the maintenance of appropriate patient–doctor boundaries. During electronic communication there is a diminution of non-verbal cues, which can lead to misinterpretations and misunderstandings. Given that social media is ubiquitous in our community we need to optimize communication to maximize impact and minimize misunderstandings.
Hypnotic techniques
Authors: Hansen Ernil , Faymonville Marie-Elisabeth , Bejenke Christel J. , Vanhaudenhuyse Audrey 
Published: September 2024

Abstract
Hypnosis acts as a vehicle through which advanced communication techniques can be utilized in a highly effective way with important benefits in anaesthesia, pain medicine, emergency, and intensive care. Information overwhelm in acute medical situations results in patients going into a natural trance where they become highly focused and extremely suggestible. Therefore, the subconscious with its regulation of involuntary psychological and physiological functions can respond therapeutically to suggestion even without a formal hypnotic induction. Basic principles of such hypnotic communication are a dissociation to an inner safe and comfortable place or situation, the reframing of disturbing noises, sensations, or conversations, non-verbal expressions of support and reassurance, specific suggestions against pain or bleeding, and addressing basic psychological needs to neutralize stressors. Of utmost importance is the development and maintenance of a trustful therapeutic alliance without whitewashing or concealment. Hypnosis is complementary and supportive to treatment rather than an alternative or replacement.
Upper airway obstruction
Authors: Swami Himanshu , Hawthorne Maurice 
Published: September 2024

Abstract
Common causes of sudden onset upper airway obstruction include allergy, trauma, infection, inhaled foreign body; slow onset obstruction is usually due to tumours. Speedy assessment of the severity and level of the obstruction is a key skill. Poiseulle’s equation indicates that small changes in diameter of the airway have dramatic effects on the flow of air through the upper airway. This as lead to the aphorism—‘if you are thinking about a tracheostomy you probably should be doing one right now.’ It is important to recognize prodromal symptoms in airway-threatening infections (e.g. pain and swallowing problems) before the airway is compromised and stridor starts. Valuable time can be bought in the acute situation with administration of oxygen, (or heliox), steroids while preparations are made to secure the airway. It should be remembered that since Hib vaccination, acute epiglottitis leading to death is now nearly always a disease of adults.
Military-Civilian Partnership to Improve Combat Casualty Care Readiness Among Non-physician Providers
Authors: Na Hyun Kyoung , Cacchione Pamela Z , Cannon Jeremy , Schwab C William , Yelon Jay A 
Published: September 2024

ABSTRACT

Background
Military-civilian partnerships (MCP) provide a bidirectional exchange of information and trauma best practices. In 2021, Penn Presbyterian Medical Center and the U.S. Navy signed a 3-year memorandum of understanding to embed active duty trauma providers into the Trauma Division to facilitate the training and sustainment of combat casualty care (CCC) skills. To date, there is little evidence to demonstrate the efficacy of military-civilian partnerships in maintaining combat casualty readiness in non-physician trauma providers.

Methods
We evaluated the impact of combat casualty readiness for non-physician providers by mapping clinical experiences in an urban Level I trauma center against the Defense Health Agency’s Joint Trauma Systems (JTS) Clinical Practice Guidelines (CPG). The JTS CPGs provide best practices for CCCand highlight the critical skills providers need to know before deploying to an austere environment. Patient acuity data and specific JTS CPG skills performed by a non-physician providers were collected in their respective specialties for each patient seen between January 2023 to January 2024. Analyses were performed using descriptive statistics via Redcap.

Results
A sample of 6 Navy personnel in different specialties: 1 Physician Assistant, 3 Registered Nurses (emergency medicine, perioperative, critical care), and 2 corpsmen (scrub tech and search & rescue/prehospital medic) completed 1299 records on patients treated. In all, 685 (52.7%) were trauma patients and 614 (47.3%) were non-trauma patients. Categories of injuries seen, listed from the most frequent to the least, were as follows: Other (764), Falls (250), Motor Vehicle Crashes (164), Gunshot Wound (126), Stab-related injuries (41). Category 1 skills, defined as “essential to know,” were performed in 921 (36.1%) of the patients treated. In Category 2, skills described as “important to know” were performed in 889 (34.8%) of the patients treated. Category 3 skills, identified as “less urgent” as they are rare among trauma patients, were performed in 486 (19.0%) of the patients treated, and 252 (9.8%) required none of the JTS CPG skills. These categories were further broken down based on the frequency of the skills performed. Analysis revealed strengths and identified opportunities to direct clinical experience for underperforming skills.

Conclusion
Military-civilian partnerships support CCC readiness. The data presented and the continuation of mapping personnel’s clinical experience to military CPGs can gauge readiness in non-physician trauma providers. Notably, several skills in each category were identified as opportunities to modify the clinical exposure of the military provider. These findings indicate that modifications in clinical assignments could enhance active duty combat casualty readiness in these critical skills.
A pilocytic astrocytoma with novel ATG16L1::NTRK2 fusion responsive to larotrectinib: a case report with genomic and functional analysis
Authors: Deland Lily , Keane Simon , Olsson Bontell Thomas , Sjöberg Bexelius Tomas , Gudinaviciene Inga , De La Cuesta Esther , De Luca Francesca , Nilsson Jonas A , Carén Helena , Mörse Helena , Abel Frida 
Published: September 2024

Abstract
The outcome of pilocytic astrocytoma (PA) depends heavily on the success of surgery. In cases where surgery alone is not curative, genetic analysis can be used to identify treatment targets for precision medicine. Here, we report a pediatric PA case that underwent incomplete surgical resection due to the tumor location. Clinical routine analyses demonstrated that the tumor did not carry any BRAF alteration. After postoperative surveillance, according to the low-grade glioma (LGG) protocol, recurrent tumor progressions resulted in multiple chemotherapy regimens. Screening formalin-fixed paraffin-embedded tumor material using an open-ended RNA sequencing panel revealed a novel in-frame autophagy related 16 like 1-neurotrophic receptor tyrosine kinase 2 (ATG16L1::NTRK2) fusion gene. The NTRK2 rearrangement was subsequently confirmed by fluorescent in situ hybridization on tumor tissue sections. Functional validation was performed by in vitro transient transfection of HEK293 cells and showed the ATG16L1::TRKB fusion protein to activate both the mitogen-activated protein kinase pathway and the phosphoinositide 3-kinase oncogenic pathways through increased phosphorylation of extracellular signal-regulated kinase, AKT, and S6. As a result of the identification of the NTRK fusion, the patient was enrolled in a phase I/II clinical trial of the highly selective TRK inhibitor larotrectinib. The patient responded well without significant side effects, and 8 months after the start of treatment, the contrast-enhancing tumor lesions were no longer detectable, consistent with a complete response as per Response Assessment in Neuro-Oncology (RANO) criteria. Presently, after 22 months of treatment, the patient’s complete remission is sustained. Our findings highlight the importance of screening for other oncogenic drivers in BRAF-negative LGGs since rare fusion genes may serve as targets for precision oncology therapy.
A Dedicated Graduate Certificate in Health Equity: A Novel Approach to Increase the Future Physician Capacity to Address Health Inequities
Authors: Wilkins Consuelo H. , Friedman Elisa C. , Posada-Castaneda Rocio , Marshall Brian I. , Miller Bonnie M. , Spalluto Lucy B. 
Published: September 2024

Abstract

Problem
Pervasive health inequities require new approaches to medical education to equip future physicians to address unjust disparities in health outcomes. Few curricula exist that focus on development of competencies and leadership skills in health equity, and little is known about the content that should be included.

Approach
Vanderbilt University Medical Center and Vanderbilt University School of Medicine developed and implemented the Graduate Certificate in Health Equity (CHE) to address this educational gap. The CHE proposal was approved in summer 2019, enrollment began in October 2019, and the first course was offered in February 2020. The CHE includes 11 objectives, and programming spans medical school years 2 to 4. Students must complete 2 foundational courses, 2 health equity–focused electives, and a health equity immersion experience.

Outcomes
Seventy-three students have enrolled since the CHE launched in academic year 2019 to 2020. In year 1, 14 third-year students enrolled in an inaugural condensed version and 16 second-year students enrolled in the full program. In subsequent years, 16 students (year 2), 15 students (year 3), and 12 students (year 4) enrolled. To date, 38 medical students have graduated. The CHE has engaged 16 community partners, including community health centers, immigrant and refugee services, rural health programs, and the LGBTQI+ community, as lecturers and hosts for immersion experiences.

Next Steps
Future work will include updating objectives and developing a rigorous evaluation scheme. The CHE team will follow up with graduates to determine how the CHE influenced their care for marginalized and minoritized patients, ability to identify and address systemic and structural barriers, and career development. The CHE is a potential model for other institutions to adapt and implement. Accruing a critical mass of institutions with health equity–focused programming for medical students is necessary to develop future leaders in health equity.
Positive end-expiratory pressure and emergence preoxygenation after bariatric surgery: effect on postoperative oxygenation
Authors: Östberg Erland , Larsson Alexander , Wagner Philippe , Eriksson Staffan , Edmark Lennart 
Published: September 2024

BACKGROUND
Positive end-expiratory pressure (PEEP) is important to increase lung volume and counteract airway closure during anaesthesia, especially in obese patients. However, maintaining PEEP during emergence preoxygenation might increase postoperative atelectasis by allowing susceptible lung areas to be filled with highly absorbable oxygen that gets entrapped when small airways collapse due to the sudden loss of PEEP at extubation.

OBJECTIVE
This study aimed to test the hypothesis that withdrawing PEEP just before emergence preoxygenation would better maintain postoperative oxygenation.

DESIGN
Prospective, randomised controlled trial.

SETTING
Single centre secondary hospital in Sweden between December 2019 and January 2023.

PATIENTS
A total of 60 patients, with body mass index between 35 and 50 kg m−2, undergoing laparoscopic bariatric surgery.

INTERVENTION
Intraoperative ventilation was the same for all patients with a fixed PEEP of 12 or 14 cmH2O depending on body mass index. No recruitment manoeuvres were used. After surgery, patients were allocated to maintained PEEP or zero PEEP during emergence preoxygenation.

MAIN OUTCOME MEASURES
The primary outcome was change in oxygenation from before awakening to 45 min postoperatively as measured by estimated venous admixture calculated from arterial blood gases.

RESULTS
Both groups had impaired oxygenation postoperatively; in the group with PEEP maintained during awakening, estimated venous admixture increased by mean 9.1%, and for the group with zero PEEP during awakening, estimated venous admixture increased by mean 10.6%, difference −1.5% (95% confidence interval −4.6 to 1.7%), P = 0.354. Throughout anaesthesia, both groups exhibited low driving pressures and superior oxygenation compared with the awake state.

CONCLUSIONS
Withdrawing PEEP before emergence preoxygenation, did not alter early postoperative oxygenation in obese patients undergoing laparoscopic bariatric surgery. Intraoperative oxygenation was excellent despite using fixed PEEP and no recruitment manoeuvres, but deteriorated after extubation, indicating a need for future studies aimed at improving the emergence procedure.

CLINICAL TRIAL NUMBER AND REGISTRY

www.clinicaltrials.gov, NCT 04150276.
Corneal Endothelial Cell Loss During Uneventful Cataract Surgery in Hispanics Versus Non-Hispanics
Authors: Heinz Montoya Rafael , Edmundo Vasquez Luis , Lee Christian , Hancock Saxon , Kheirkhah Ahmad 
Published: September 2024

Purpose:Limited information exists on the possible effects of ethnicity on corneal endothelial cell parameters and their changes during cataract surgery. Thus, we evaluated corneal endothelial cell density (ECD) and endothelial cell loss (ECL) during surgery for senile cataract in Hispanic and non-Hispanic White adults.Methods:This retrospective study included 312 eyes of 227 patients ≥50 years who underwent phacoemulsification with intraocular lens implantation for senile cataract. Preoperatively and 1 to 2 months after surgery, specular microscopy was performed to measure ECD, coefficient of variation (CV), and hexagonal cell percentage (HEX). Regression analysis was used to compare baseline values as well as surgery-related changes in corneal endothelial cell parameters between Hispanic and non-Hispanic patients considering demographics, biometric parameters, and intraoperative cumulative dissipated energy (CDE).Results:There were 109 Hispanics and 118 non-Hispanics. Anterior chamber depth (ACD) was significantly lower in Hispanics (3.12±0.36 mm) compared with non-Hispanics (3.25±0.37 mm,P=0.009). There were no significant differences in baseline ECD between Hispanics (2,547±365 cells/mm2) and non-Hispanics (2,483±380 cells/mm2,P=0.17). There were also no significant differences in ECL (16.8%±17.0% vs. 17.4%±18.1%,P=0.46), increase in CV (3.8%±20.7% vs. 1.5%±21.6%,P=0.51), and decrease in HEX (−2.7%±8.5% vs. −1.8%±7.0%,P=0.33) between these two groups. Regression analysis showed that ECL was associated with a shallower ACD (P=0.003), a higher CDE (P<0.001), but not with ethnicity (P=0.46).Conclusion:There are no significant differences in ECD and ECL between Hispanics and non-Hispanics undergoing cataract surgery. Although Hispanics have a shallower ACD, the ethnic difference seems to be clinically insignificant.
The Association Between Increasing Vasoactive Medication Dose and Adverse Events During Physical and Occupational Therapy Sessions
Authors: Johnson Rebecca P. , Beagle Caroline , Kaeser Christa , Mitchell Sara , Lambright Joseph , Overton Matthew , Taylor Savannah 
Published: September 2024

Introduction:
The purpose of this study was to examine the incidence of adverse events (AEs) during physical and occupational therapy sessions in which the doses of vasoactive medications were increased to allow for maintenance of blood pressure during mobility progression. A secondary purpose was to determine factors associated with AEs.

Review of Literature:
Recent research has found a low rate of AEs when mobilization is performed on high doses of vasoactive medications. There has been no published work regarding the feasibility or safety of increasing vasoactive medication dose to progress mobility, though this practice occurs frequently in some intensive care units.

Methods:
A retrospective medical record review of 44 patients participating in 100 physical and/or occupational therapy sessions was performed. Data regarding patient demographics, illness severity, medication and medication titration, comorbid conditions, mobility level, and AEs were collected. Descriptive statistics were calculated, and relationships between variables were explored.

Results:
Eight patients (18%) experienced nine AEs across nine physical therapy sessions (9%). AEs were not correlated with illness severity (r
pb = .024, P = .81), medication dose during the session (τb = .051, P = .55), amount of medication dose increase during the session (τb = −.027, P = .75), or mobility level (P = .755). There was a higher incidence of AEs in patients with chronic respiratory disease compared to those without (P = .011).

Discussion and Conclusion:
This was the first study to investigate the practice of titrating vasoactive medications to allow for increased mobility. While this sample had a higher rate of AEs than observed in previous studies involving early mobilization, all AEs were transient and without long-term consequence. Titration of vasoactive medications to allow for increased levels of mobility may be done without AEs in some patients, though further investigation is needed.
The primary cause of markedly elevated aminotransferases in hospitalized patients with cirrhosis in ischemic hepatitis
Authors: Allam Jad , Ibrahim Ahmed , Rockey Don C. 
Published: September 2024

BackgroundMarked elevation in aminotransferases (≥1000 IU/l) is typically associated with acute liver injury. Here, we hypothesized that the cause of elevation in aminotransferases ≥1000 in patients with cirrhosis is likely due to a limited number of disorders and may be associated with poor outcomes.AimWe aimed to investigate the most common etiologies of acute elevations in aminotransferases in patients with cirrhosis, and to examine their associated outcomes.MethodsFrom May 2012 to December 2022, all hospitalized patients with cirrhosis and an aspartate aminotransferase or alanine aminotransferase ≥ 1000 IU/l were identified through Medical University of South Carolina’s Clinical Data Warehouse. Complete clinical data were abstracted for each patient, and in-hospital mortality was examined.ResultsThe cohort was made up of 152 patients, who were 57 ± 12 years old, with 51 (34%) women. Underlying liver disease included mainly hepatitis C cirrhosis, alcohol-related cirrhosis, metabolic dysfunction-associated steatohepatitis cirrhosis, autoimmune cirrhosis, primary sclerosing cholangitis cirrhosis, and cryptogenic cirrhosis. The most common cause of marked elevation in aminotransferases in cirrhotic patients was ischemic hepatitis (71%), followed by chemoembolization (7%), autoimmune hepatitis (6%), drug-induced liver injury (3%), post-transjugular intrahepatic portosystemic shunt placement (3%), rhabdomyolysis (3%), and hepatitis C (2%). During hospitalization and over a 1-month follow-up period, the mortality rate in patients with ischemic hepatitis was 73% (79/108), while that for other causes of liver injury was 20% (9/44).ConclusionIschemic hepatitis is the leading cause of marked elevation of aminotransferases in patients with cirrhosis, with distinctive clinical characteristics than other etiologies, and significantly poorer outcomes.