bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intravenous iron staining: real-world incidence, preventability, and mitigation tools from a long-term quality improvement project
Authors: Canning Martin L , Hillen Jodie B , Kashiwagi Maya , Alizadeh Negin , Freeman Christopher R 
Published: September 2024

Abstract

Background
Iron deficiency is the leading cause of anaemia worldwide and is increasingly treated with intravenous (IV) iron therapy. Staining from IV iron therapy is a rare but significant and preventable adverse event. To mitigate patient harm, a health-service-wide quality improvement project was implemented. This study aimed to determine the real-world impact of a quality improvement project on IV iron staining incidents and preventability.

Methods
A retrospective chart audit was undertaken for all IV iron staining episodes reported in a directorate-wide clinical incident reporting database (RiskMan) between 2016 and 2022. Incidence rates of IV iron staining, preventability, and stain severity were compared pre- and post-implementation of a standardized IV iron procedure.

Results
Over 7 years, 103 IV iron stains were identified, resulting in a staining rate of 0.31 stains per 100 infusions (pre 0.27% and post 0.34%, P = .25). Implementation of the standardized IV iron procedure resulted in improvements in pharmacist review of the medication order (61.8% versus 89.7%, P &lt; .01), use of the statewide IV iron infusion consent form (27.3% versus 76.9%, P &lt; .01), and appropriate cannula site (14.3% versus 52.5%, P &lt; .01). Smaller stain sizes were associated with cessation of the infusion at identification of extravasation (312 cm2 versus 35 cm2) (P = .04). Preventability was assigned to 86% of stains.

Conclusion
The incidence rate of IV iron staining in a real-world clinical setting is 0.31%. There was increased compliance with several best practice principles and 86% of stains were preventable. Early identification and intervention of potential staining incidents results in smaller iron stains for patients. Quality improvement tools developed for this project can contribute to patient outcomes internationally.
Microbiological quality of vegan alternatives to dairy and meat products in England during 2022–3
Authors: Willis Caroline , Startin Catherine , Jorgensen Frieda , Sadler-Reeves Lorraine , Aird Heather , Lai Sandra , Amar Corinne 
Published: September 2024

Abstract

Aims
Plant-based alternatives to meat and dairy products have become increasingly popular in the UK. Despite a public perception that they have a relatively low microbiological risk, outbreaks of illness have been linked with these foods. This study aimed to assess the microbiological safety and quality of vegan alternatives to dairy and meat products available in England.

Methods and results
Samples were collected between September 2022 and March 2023 from retail, production, and catering premises, and tested for a range of bacterial pathogens and hygiene indicators using standard procedures. A total of 937 samples were tested, of which 92% were of a satisfactory microbiological quality, 3% were borderline, and 5% were unsatisfactory. Those interpreted as unsatisfactory were due to elevated counts of Enterobacteriaceae and Escherichia coli (indicators of poor hygiene) rather than pathogenic microorganisms. Listeria monocytogenes was present in five samples of tofu, all from the same producer (all at counts of &lt;100 CFU g–1), while other Listeria species were detected at counts of &lt;20 CFU g–1 in two burgers and two ‘vegan chicken’ products. The majority of samples did not have pH and water activity values that would significantly contribute to preventing microbial growth: 62.4% had pH &gt; 5.0 and 82.4% had Aw &gt; 0.94.

Conclusions
The majority of vegan products examined were of a satisfactory quality, but results demonstrate that microbiological control must be maintained using appropriate processing and storage temperatures, and application of a safe length of shelf life.
COVID-19 extracellular vesicles display heterogeneity based on viral and host RNA expression: implications for host immune response
Authors: Juárez Esmeralda , Vázquez-Pérez Joel A , Carreto-Binaghi Laura E , Martínez-Sanabria Claudia A , Salgado-Cantú Manuel G , Sarabia Carmen , Herrera María Teresa , Guzmán-Beltrán Silvia , Gutiérrez-González Luis H , González Yolanda 
Published: September 2024

Abstract
Viral RNA and miRNAs released by immune cells contribute to inflammation in COVID-19 patients. Here, we investigated the role of SARS-CoV2 RNA and host miRNAs carried within extracellular vesicles (EVs) in modulating inflammation. EVs were classified as positive or negative depending on their viral RNA cargo. To assess the function of viral RNA, EVs, and lipopolysaccharide (LPS) were used to stimulate whole blood samples from healthy subjects, and the secretion of 27 serum analytes was measured. EVs alone did not induce cytokines, chemokines, or growth factors. However, under LPS stimulation, (SARS-CoV2+) EVs increased IL-12 and decreased IL-13 secretion, while (SARS-CoV2−) EVs increased MIP-1α and IL-1β secretion. Host miR-19a-3p, -192-5p, -let-7c-5p, and -92b-3a were differentially expressed in association with viral RNA. EVs from COVID-19 patients exhibited differences in viral RNA and miRNA expression profiles that modulate LPS responses. This knowledge sheds light on the immunopathology of COVID-19.
A candidate coherent radio flash following a neutron star merger
Authors: Rowlinson A , de Ruiter I , Starling R L C , Rajwade K M , Hennessy A , Wijers R A M J , Anderson G E , Mevius M , Ruhe D , Gourdji K , van der Horst A J , ter Veen S , Wiersema K 
Published: September 2024

ABSTRACT
In this paper, we present rapid follow-up observations of the short GRB 201006A, consistent with being a compact binary merger, using the LOw Frequency ARray (LOFAR). We have detected a candidate 5.6$\sigma$, short, coherent radio flash at 144 MHz at 76.6 min post-GRB with a 3$\sigma$ duration of 38 s. This radio flash is 27 arcsec offset from the GRB location, which has a probability of being co-located with the GRB of $\sim$0.05 per cent (3.8$\sigma$) when accounting for measurement uncertainties. Despite the offset, we show that the probability of finding an unrelated transient within 40 arcsec of the GRB location is $\lt 10^{-6}$ and conclude that this is a candidate radio counterpart to GRB 201006A. We performed image plane dedispersion and the radio flash is tentatively (2.4$\sigma$) shown to be highly dispersed, allowing a distance estimate, corresponding to a redshift of $0.58\pm 0.06$. The corresponding luminosity of the event at this distance is $6.7^{+6.6}_{-4.4} \times 10^{32}$ erg s$^{-1}$ Hz$^{-1}$. If associated with GRB 201006A, this emission would indicate prolonged activity from the central engine that is consistent with being a newborn, supramassive, likely highly magnetized, millisecond spin neutron star (a magnetar).
The expected kinematic matter dipole is robust against source evolution
Authors: von Hausegger Sebastian 
Published: September 2024

ABSTRACT
Recent measurements using catalogues of quasars and radio galaxies have shown that the dipole anisotropy in the large-scale distribution of matter is about twice as large as is expected in the standard lambda cold dark matter ($\Lambda$CDM) model, indeed in any cosmology based on the Friedman–Lemaître–Robertson–Walker (FLRW) metric. This expectation is based on the kinematic interpretation of the dipole anisotropy of the cosmic microwave background, i.e. as arising due to our local peculiar velocity. The effect of aberration and Doppler boosting on the projected number counts on the sky of cosmologically distant objects in a flux-limited catalogue can then be calculated and confronted with observations. This fundamental consistency test of FLRW models proposed by Ellis & Baldwin in 1984 was revisited recently arguing that redshift evolution of the sources can significantly affect the expected matter dipole. In this note, we demonstrate that the Ellis & Baldwin test is in fact robust to such effects, hence the $\gt 5\sigma$ dipole anomaly uncovered recently remains an outstanding challenge to the $\Lambda$CDM model.
Intelligent Borders: Exploring the Suitability of Artificial Intelligence Systems in Refugee Status Determination Under International Law
Authors: Amoroso Mario Pasquale 
Published: September 2024

Abstract
This article assesses the potential use of Artificial Intelligence (AI) in Refugee Status Determination, exploring how AI systems, including biometrics, predictive analytics, and emotion recognition, could support or replace human decision-making in determining refugee status. While AI could speed up and improve the objectivity of Refugee Status Determination procedures, the article raises concerns about its limitations in assessing the subjective fear of persecution, a critical element of refugee claims. The inability of AI systems to fully account for emotional and personal nuances leads to the possibility of discriminatory practices, particularly when AI is used without human oversight. The study highlights how AI could exacerbate power imbalances between asylum-seekers and States, transforming these technologies into tools for anti-immigration policies. It therefore calls for caution in the use of AI in Refugee Status Determination procedures and stresses that human interaction remains essential for the fair assessment of refugee claims. This article concludes that while AI can assist in certain aspects of the Refugee Status Determination procedures, its full implementation without careful legal and human rights considerations poses significant risks.
Evaluation of a New Diabetes Mellitus Index Based on Measurements Using the Scheimpflug Analyzer Corvis ST
Authors: Ramm Lisa , Herber Robert , Patzner Maria Magdalena , Pillunat Lutz E. 
Published: September 2024

Purpose:
Chronic hyperglycemia causes changes in corneal biomechanics that can be measured with the Scheimpflug Analyzer Corvis ST. The diagnostic reliability of the new diabetes mellitus (DM) index developed based on this should be evaluated.

Methods:
In a prospective cross-sectional study, the index was initially developed using data from 81 patients with DM and 75 healthy subjects based on logistic regression analysis. The reliability of the DM index was subsequently assessed using data from another 61 patients and 37 healthy individuals. In addition, the dependence of the DM index on indicators of disease severity was analyzed.

Results:
The index initially achieved a sensitivity of 79% and specificity of 80% with a cutoff value of 0.58. The evaluation showed a sensitivity of 67% and specificity of 76% with an optimized cutoff of 0.51 (area under the curve = 0.737, P < 0.001). The DM index correlated weakly with the severity of diabetic retinopathy (r = 0.209, P = 0.014). It was increased in the presence of diabetic maculopathy (P = 0.037) and in type 1 DM compared with patients with type 2 disease (P = 0.039).

Conclusions:
In this first evaluation, the new DM index achieved sufficiently good sensitivity and specificity and was weakly associated with disease-specific factors. With further improvements, it could complement the diagnostic options in DM with a simple, rapid, and noninvasive assessment method.
Foundation models in ophthalmology: opportunities and challenges
Authors: Sevgi Mertcan , Ruffell Eden , Antaki Fares , Chia Mark A. , Keane Pearse A. 
Published: September 2024

Purpose of review
Last year marked the development of the first foundation model in ophthalmology, RETFound, setting the stage for generalizable medical artificial intelligence (GMAI) that can adapt to novel tasks. Additionally, rapid advancements in large language model (LLM) technology, including models such as GPT-4 and Gemini, have been tailored for medical specialization and evaluated on clinical scenarios with promising results. This review explores the opportunities and challenges for further advancements in these technologies.

Recent findings
RETFound outperforms traditional deep learning models in specific tasks, even when only fine-tuned on small datasets. Additionally, LMMs like Med-Gemini and Medprompt GPT-4 perform better than out-of-the-box models for ophthalmology tasks. However, there is still a significant deficiency in ophthalmology-specific multimodal models. This gap is primarily due to the substantial computational resources required to train these models and the limitations of high-quality ophthalmology datasets.

Summary
Overall, foundation models in ophthalmology present promising opportunities but face challenges, particularly the need for high-quality, standardized datasets for training and specialization. Although development has primarily focused on large language and vision models, the greatest opportunities lie in advancing large multimodal models, which can more closely mimic the capabilities of clinicians.
Is Orbital Lobe of the Lacrimal Gland Dispensable? Tear Volume, Ocular Surface, and MRI Volumetric Analysis
Authors: Singh Swati , Ali Mohammad Javed 
Published: September 2024

Purpose:
To investigate the effects of lacrimal gland reduction surgeries on the tear volume and ocular surface.

Methods:
This is a cohort study of patients post 2 lacrimal gland reduction surgeries: partial orbital lobe dacryoadenectomy for refractory epiphora (4 patients, mean age: 31 ± 13.6 years, 3 males) and complete orbital lobe dacryoadenectomy for lacrimal gland pleomorphic adenoma (15 patients, mean age: 41 ± 12 years, 7 females). Changes in Schirmer I, ocular surface staining, symptomatology, and lacrimal gland volumetrics (MRI) were assessed before and after the surgical procedure.

Results:
The median Schirmer value reduction following partial orbital lobe dacryoadenectomy was 5 mm at a mean follow-up of 18 ± 4.9 months. None of them developed dry eye disease or positive ocular staining. The gland volume was reduced by 45.9% to 53.5% in 3 patients and 13.3% in 1 patient. The epiphora improved moderately in 93% of patients. Of 15 patients with lacrimal gland pleomorphic adenoma excision, the median reduction in Schirmer I was 4 mm at a mean follow-up of 12.8 months.

Conclusion:
Partial or complete removal of the orbital lobe of the lacrimal gland does not induce dry eye disease in otherwise healthy individuals. However, gland volume does not recover following partial reduction, and it seems unlikely that the lacrimal gland regenerates following partial removal.
DRESS syndrome and tuberculosis: Implementation of a desensitization and re-desensitization protocol to recover antituberculosis drugs in a case series at a specialized TB Unit in Lima, Peru
Authors: Morán-Mariños Cristian , Llanos-Tejada Felix , Salas-Lopez Juan , Villanueva-Villegas Renzo , Chavez-Huamani Antonella , Vidal-Ruiz María , Rodriguez-Calienes Aaron , Casanova-Mendoza Renato 
Published: September 2024

Rationale:Antituberculosis drugs (ATDs) could cause severe and rare reactions, such as Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome. Recovering ATDs might guarantee a higher cure rate for tuberculosis patients. Our aim was to evaluate the results of desensitization and re-desensitization to recover ATDs in a case series of patients with DRESS syndrome.Patient concerns and diagnoses:A retrospective case series study was conducted on patients with DRESS syndrome due to therapy with ATDs from 2021 to 2023. Desensitization and re-desensitization protocols, designed with an algorithm proposed by the Tuberculosis Specialized Unit of the Dos de Mayo National Hospital in Lima, Peru, were implemented.Interventions and outcomes:A total of 18 patients underwent desensitization or re-desensitization protocols, achieving an overall success rate of 72.2%. The average time for the development of DRESS syndrome due to ATDs was 19 days. Rifampicin (84.2%), isoniazid (68.4%), and pyrazinamide (26.3%) were identified as the main drugs responsible for this adverse reaction. All patients presented with fever and skin rash, with an average eosinophil percentage of 16.7% (interquartile range: 4.5–28.8). Organ involvement (liver, kidney, and heart) was observed in 8 patients, but only 2 patients experienced severe complications due to DRESS syndrome. A significant association was found between the number of ATDs used and eosinophil levels (P=.03).Lessons:The study introduced a desensitization and re-desensitization algorithm for the treatment of DRESS syndrome, notable for its safety, adaptability, and high success rate. This advancement provided healthcare professionals with safer and more effective therapeutic approaches for managing this complex condition.
Administration of the Postpartum Glucose Tolerance Test During the Delivery Hospitalization Compared With 4–12 Weeks Postpartum
Authors: Ciomperlik Hailie , Harper Megan , Hossain Md Faruk , Turrentine Mark A. 
Published: September 2024

OBJECTIVE:
To estimate the rate of noncompletion of testing for type 2 diabetes in individuals with gestational diabetes mellitus (GDM) with a fasting 75-g, 2-hour oral glucose tolerance test in the immediate postpartum period before hospital discharge compared with 4–12 weeks postpartum by performing a systematic review and meta-analysis.

DATA SOURCES:
We explored EMBASE, MEDLINE, Web of Science, CINAHL, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials for studies comparing the rate of type 2 diabetes screening in individuals with GDM in the immediate postpartum period before hospital discharge with 4–12 weeks postpartum.

METHODS OF STUDY SELECTION:
Two reviewers separately identified studies, obtained data, and gauged study quality. The rate of type 2 diabetes screening was compared, and odds ratios (ORs) with 95% CIs were estimated.

TABULATION, INTEGRATION, AND RESULTS:
Five prospective and two retrospective cohort studies were identified with 2,254 individuals with GDM at 13 hospitals. Studies evaluated individuals with GDM who delivered and underwent screening for type 2 diabetes in the immediate postpartum period from May 1994 through October 2021. Four studies were from the United States, and one was from Korea, Brazil, and Iran. In these studies, testing was offered in both periods: A pooled proportion of 6.6% (95% CI, 0.23–20.5%) did not complete immediate postpartum testing before hospital discharge, and 53.0% (95% CI, 37.1–68.6%) did not complete testing at 4–12 weeks postpartum. The overall rate of noncompletion of screening in the immediate postpartum period was lower compared with individuals who had screening in the 4–12 week follow-up (pooled OR 0.21, 95% CI, 0.05–0.79, I
2=93%).

CONCLUSION:
Improved compliance with screening for type 2 diabetes in individuals diagnosed with GDM can be achieved after delivery before hospital discharge compared with screening at 4–12 weeks postpartum.

SYSTEMATIC REVIEW REGISTRATION:
PROSPERO, CRD42024530659.
PM&R Connections: A pilot study evaluating the adoptability and impact of a serious educational game on trainees at a Physical Medicine and Rehabilitation program
Authors: Stone Shane N. , Kirshblum Steven 
Published: September 2024

Abstract
To enhance engagement and educational outcomes, game-based learning has been introduced into undergraduate and graduate medical education programs. Using a free website, “PM&R Connections”, a serious game, was created to provide trainees with an alternative method of reviewing content to identify knowledge gaps to direct studying. The game was used by 19/33 trainees and 92.3% of users required <10 minutes to complete a puzzle. 76.9% of users found the tool helpful, 69.2% recommended the game, and 92.3% desired more puzzles to be developed. Confusion on how to play and intimidation were the most reported barriers to play, and only 46% of users changed their study habits. The positive feedback and desire for more puzzles to be developed provide a foundation to further develop the game.
Optimizing Intraflap Anastomosis of Conjoined Bilateral DIEP Flap for Breast Reconstruction: Planning, Execution and Outcomes in 201 patients
Authors: Kim Ju Hee , Lee Kyeong-Tae , Mun Goo-Hyun 
Published: September 2024

BACKGROUND
Conjoined bilateral deep inferior epigastric perforator (DIEP) flap with intraflap anastomosis is an efficient approach for breast reconstruction, enabling the use of almost the entire abdominal tissue. Variations in bilateral DIEA anatomy may make it challenging to apply this technique consistently. This study aimed to derive optimal strategies for achieving reliable conjoined bilateral DIEP flap with intraflap anastomosis universally.

METHODS:
For all consecutive patients undergoing conjoined bilateral DIEP flap-based breast reconstruction from 2009 to 2023, preoperative planning and intraoperative execution for the pedicle configurations were reviewed. Their postoperative outcomes were evaluated.

RESULTS:
In total 201 patients were included, with no cases requiring conversion to extraflap anastomosis. In preoperative planning, candidates for recipient vessels for intraflap anastomosis were typically selected based on DIEA branching patterns, identified through computed tomographic angiography; Type I (single trunk) prioritizing the superior continuation, type II (two main trunks) considering a side branch, and type III (three main trunks) favoring the first bifurcating branch. Comparing candidates from bilateral DIEA, the primary pedicle was determined, providing larger recipient vessels. Most cases followed the planned approach smoothly, however 28 required intraoperative changes, mostly aimed at securing larger recipients by changing the primary pedicle or harvesting more caudally located perforators to obtain larger superior continuations. Four perfusion-related complications developed, which were resolved successfully without flap failure.

CONCLUSIONS:
Our results suggest an efficient strategy for securing a reliable recipient vessel, tailored to patient anatomy, in conjoined bilateral DIEP flap breast reconstruction with intraflap anastomosis, leading to achieving optimal outcomes.
Effect of Preoperative Autologous Blood Storage in Major Hepatectomy for Perihilar Malignancy
Authors: Onoe Shunsuke , Yokoyama Yukihiro , Igami Tsuyoshi , Yamaguchi Junpei , Mizuno Takashi , Sunagawa Masaki , Watanabe Nobuyuki , Kawakatsu Shoji , Ando Masahiko , Nagino Masato , Ebata Tomoki 
Published: September 2024

Objective:
To reappraise whether preoperative autologous blood donation reduces post-hepatectomy liver failure (PHLF) in major hepatectomy for perihilar malignancy.

Summary Background Data:
Autologous blood storage and transfusion are carried out to reduce the use of allogeneic blood transfusion during hepatectomy and prevent postoperative complications. However, the clinical benefit in major hepatectomy has been controversial.

Methods:
This randomized clinical trial included patients who underwent major hepatectomy with extrahepatic bile duct resection for perihilar malignancy. Eligible patients were randomly assigned (1:1) to undergo surgery with or without the use of autologous blood transfusion. The primary outcome was the incidence of clinically relevant PHLF (grade B/C according to the International Study Group of Liver Surgery definition).

Results:
Between February 6, 2019, and May 12, 2023, 138 consecutive patients were enrolled in the study (blood storage group n=68, non-storage group n=70). Twenty-five patients who did not undergo resection were excluded; the remaining 113 patients were investigated as the full analysis set (blood storage group n=60, non-storage group n=53). Surgical procedures, operative time, and blood loss were not significantly different between the two groups. The incidence of PHLF was comparable (blood storage group n=10 [17%], non-storage group n=10 [19%]; P=0.760). There were also no between-group differences in other postoperative outcomes, including the incidence of Clavien-Dindo Grade Ⅲ or higher (72% vs. 72%, P=0.997) and median duration of hospital stay (25 vs. 29 d, P=0.277).

Conclusions:
Autologous blood storage did not contribute to reducing the incidence of PHLF in patients undergoing major hepatectomy.