bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of social determinants of health on hepatocellular carcinoma surveillance, treatment, and health care costs
Authors: Singal Amit G. , Kilgore Karl M. , Shvets Elizabet , Parikh Neehar D. , Mehta Neil , Burak Ozbay A. , Teigland Christie , Hafez Omar , Schroeder Amy , Yang Audrey , Schinkel Jill 
Published: October 2024

Background:The impact of clinical factors and social determinants of health on treatment patterns and health care costs among patients with HCC is unknown.Methods:Using 100% Medicare Fee-For-Service claims and a commercial multipayor claims database, we identified patients diagnosed with HCC from January 1, 2017, to December 31, 2020. Surveillance receipt was defined 12 months prior to HCC diagnosis, whereas treatment and health care costs were assessed post-HCC diagnosis. Multinomial logistic regression was used to assess the association between demographics, social determinants of health, and surveillance or HCC treatment. Multivariable generalized linear regression was used to identify factors associated with total health care costs.Results:Of the 32,239 patients with HCC (mean age 68 y, 67% male, 73% White), 70% received surveillance and only half (51%) received any treatment. Curative treatment receipt was higher among those with prior surveillance (24% with CT/MRI and 18% with ultrasound vs. 9% with no surveillance). Curative treatment was independently associated with HCC surveillance and inversely associated with Black race, lower education level, and diagnosis in the year 2020 (COVID-19 year). Higher health care costs were independently associated with Black race, low English proficiency, living alone, and diagnosis in 2018–2020, and inversely associated with CT/MRI-based surveillance.Conclusions:Race and social determinants of health were independently associated with curative treatment receipt and health care costs. Increasing access to high-quality HCC surveillance may improve treatment receipt and reduce health disparities among patients with HCC.
Longitudinal outcomes of iStent inject with cataract surgery compared with cataract surgery alone: real-world data from the Fight Glaucoma Blindness registry
Authors: Clement Colin I. , Nguyen Vuong , Howes Frank , Danks Jenny , Lee Vincent , Wechsler David , Gregory-Roberts Emily , Gillies Mark , Lawlor Mitchell 
Published: October 2024

Purpose:
To compare combined phacoemulsification and iStent inject with phacoemulsification alone.

Setting:
Fight Glaucoma Blindness (FGB) registry, Sydney, Australia.

Design:
Prospective observational registry study.

Methods:
Eyes that had combined phacoemulsification with iStent inject (iStent group), n = 1257 were compared with eyes that had phacoemulsification only (cataract alone, n = 163). The primary outcome was percentage of eyes achieving >20% intraocular pressure (IOP) reduction from baseline 12 months postoperatively. Secondary outcomes included mean IOP and medication reduction, adverse events, and secondary procedures.

Results:
At 12 months, the percentage of eyes achieving >20% reduction of IOP was significantly higher in the iStent group compared with the cataract-alone group (40.9% vs 30.1% P < .001). Adverse events occurred at a low rate in both groups, and secondary IOP-lowering procedures were significantly less frequent in the iStent group compared with cataract alone.

Conclusions:
Real-world outcomes from the FGB registry at 12 months show that phacoemulsification combined with iStent inject has a higher efficacy and reduced need for secondary IOP-lowering surgery compared with phacoemulsification alone.
Viewing Medical Education Through the Lens of Second Language Acquisition
Authors: Loder Rayne 
Published: October 2024

Abstract
The domains of second language learning and medical learning, although different in many ways, share several commonalities. In both, there is an element of declarative learning, such as memorizing terms and rules and understanding schema. However, both domains also classically include immersive learning in authentic environments with experts (fluent speakers in language, experienced clinicians in medicine) as a means to achieve mastery. Physician assistant (PA) educators may benefit from considering these commonalities and how they may apply to their own educational practices. Several hypotheses from Stephen Krashen's monitor model of second language acquisition (acquisition-learning distinction, the monitor hypothesis, affective filter) are presented with parallels to PA education. As the study of a second language is a common experience within the United States, explicit discussion of the similarities between language and medical learning may be a tool that PA educators can use particularly to help learners as they transition from didactic to clinical learning.
Image reconstruction parameters and the standardized uptake value ratios in brain amyloid PET
Authors: Takeshi Nii , Shota Hosokawa , Tomoya Kotani , Yasunori Nakamura , Ryotaro Kondo , Yasuyuki Takahashi 
Published: October 2024

Objectives
The present study investigated various image reconstruction protocols for amyloid PET using phantom test criteria published by the Japanese Society of Nuclear Medicine (JSNM) and compared them with the composite standardized uptake value ratio (cSUVR) in clinical imaging.

Methods
Hoffman 3D phantoms and cylindrical phantoms were collected for 30 min according to the JSNM guidelines. Images were created under various reconstruction protocols by three physical evaluation items in the guidelines and were assessed: gray matter/white matter contrast (%contrast), uniformity (SDuROImean), and image noise [coefficient of variation (CV)]. We compared the cSUVR of images reconstructed under 15 protocols using 18F-flutemetamol and 18F-florbetapir in 15 cases each and the guidelines for physical evaluation of reconstruction parameters.

Results
No significant differences were observed in cSUVR between reconstruction protocols that satisfied the guidelines’ criteria for %contrast and CV and those that did not; however, the visual impression of images differed. SDuROImean, which evaluated uniformity, met the criteria in all data.

Conclusion
Reconstruction protocols should be selected appropriately using guidelines and other information, as cSUVR remains largely the same even if the visual impression of the images differs between different reconstruction protocols. When the relationship between %contrast and CV is expressed in terms of several reconstruction protocols, the graph shows a curved shape, and the optimal protocols for both %contrast and CV are near its center. Since cSUVR is similar to optimal parameters, even under parameters outside this range, multiple parameters need to be considered when selecting image reconstruction protocols for amyloid PET.
Institution-Wide Moral Distress Among Nurses
Authors: Booth Adam T. , Dobson Bridget F. , Christian Becky J. , Clark Paul R. , Sha Shuying 
Published: October 2024

BACKGROUND
Moral distress is the inability to do the right thing due to imposed constraints.

OBJECTIVE
Explore the presence of moral distress among nurses.

METHODS
A quantitative, exploratory, cross-sectional study at a level 1 trauma center using the Measure of Moral Distress for Healthcare Professionals (MMD-HP).

RESULTS
Ninety-seven nurses completed the MMD-HP. The top 3 items contributing to moral distress included inadequate staffing, inadequate resources, and lack of administrative support. Nurses who considered leaving had more moral distress. Moral distress explained 28.5% of the variance associated with nurses' “intent to leave” and “primary unit” (P < 0.001). Moral distress for nurses 40 to 49 years of age was higher compared with nurses 50 years or older.

CONCLUSIONS
Moral distress involved deficiencies in staffing, resources, and administrative support. Research should explore interventions to mitigate moral distress among nurses by promoting safe staffing levels, the provision of adequate resources, and increased administrative support.
Evaluating associations between social risks and health care utilization in patients with chronic low back pain
Authors: Pak Sang S. , Jiang Yuxi , Lituiev Dmytro S. , De Marchis Emilia H. , Peterson Thomas A. 
Published: October 2024

Abstract

Introduction:
Care and outcomes for patients with chronic low back pain (cLBP) are influenced by the social risk factors that they experience. Social risk factors such as food insecurity and housing instability have detrimental effects on patient health and wellness, healthcare outcomes, and health disparities.

Objectives:
This retrospective cross-sectional study examined how social risk factors identified in unstructured and structured electronic health record (EHR) data for 1,295 patients with cLBP were associated with health care utilization. We also studied the impact of social risk factors, controlling for back pain–related disability on health care utilization.

Methods:
Included patients who received outpatient spine and/or physical therapy services at an urban academic medical center between 2018 and 2020. Five identified social risks were financial insecurity, housing instability, food insecurity, transportation barriers, and social isolation. Outcomes included 4 categories of health care utilization: emergency department (ED) visits/hospitalizations, imaging, outpatient specialty visits related to spine care, and physical therapy (PT) visits. Poisson regression models tested associations between the presence of identified social risks and each outcome measure.

Results:
Identified social risks in 12.8% of the study population (N = 166/1,295). In multivariate models, social isolation was positively associated with imaging, specialty visits, and PT visits; housing instability was positively associated with ED visits/hospitalizations and imaging; food insecurity was positively associated with ED visits/hospitalizations and specialty visits but negatively associated with PT visits; and financial strain was positively associated with PT visits but negatively associated with ED visits/hospitalization.

Conclusion:
These associations were seen above and beyond other factors used as markers of socioeconomic marginalization, including neighborhood-level social determinants of health, race/ethnicity, and insurance type. Identifying and intervening on social risk factors that patients with cLBP experience may improve outcomes and be cost-saving.
The impact of a customized aesthetic prosthetic leg cover on social interaction cues and attitudes in the general UK population: Two experimental studies
Authors: Phelps Ceri , Hutchings Paul Barry , Stokes Tim , Cooke Zoe , Williams Mark , Jenkins Sean 
Published: October 2024

Objectives:
To explore the impact of an aesthetic prosthetic leg cover on attitudes toward individuals with lower-limb amputation and associated social interaction cues among the general UK population.

Study Design:
Two novel experimental methodologies.

Methods:
In study 1, participants (n = 188) viewed 1 of 3 images of an individual: (1) wearing a traditional stem prosthetic, (2) wearing an aesthetic leg cover, or (3) as a nonamputee. They then completed an attitude scale and rated the personality of the individual using the 10-item Big Five Inventory. Study 2 (n = 31) used eye tracking and facial expression software to explore gaze and facial arousal when viewing 1 of 9 manipulated videos of the same individual talking about 3 different scenarios.

Results:
In study 1, the aesthetic leg cover led to significantly higher ratings of agreeableness than stem and nonamputee images and significantly higher ratings of extraversion than the nonamputee image. Attitudes toward an individual with a prosthesis did not significantly differ depending on which image they viewed and were generally positive. In study 2, all participants focused mainly on the individual's face regardless of scenario topic or leg condition, although participants focused more around the leg cover in more active contexts.

Conclusions:
Customized aesthetic leg covers may help individuals living with amputation to be perceived more positively in social situations. These experimental methodologies could be extended to explore the differential impact of context, functionality, and activity of specific types of customized aesthetic prosthetics and could help inform shared decision-making processes in clinical settings.
Effective Pediatric Blood Management in Craniosynostosis Surgery: A Long-Term Update
Authors: Moore Reece , Pfershy Hanna , Pletcher Jocelyn , Boville Brian , Girotto John A. , Carlson Anna R. 
Published: October 2024

Background:
Blood transfusion is common in cranial vault surgery, and protocolized efforts to minimize transfusion have been reported in recent years. This study assesses the long term, prospective outcomes of a pediatric blood management protocol for the cranial vault reconstruction (CVR) population.

Materials and Methods:
Data from a retrospective control cohort and a prospective cohort employing a protocol for preoperative hematologic optimization of patients undergoing CVR from January 2015 to October 2023 was reviewed. Preoperative hemoglobin (Hgb) determined the preoperative protocol. Intraoperative tranexamic acid (TXA) and/or aminocaproic acid, cell-saver technology, and postoperative iron or erythropoietin alfa supplementation were also used in the protocol. For statistical analysis, P<0.05 was deemed significant.

Results:
The cohort consisted of 194 successive patients (20 control and 174 treatment). Age, sex, and weight were not significantly different between groups. Mean postoperative Hgb was significantly higher in the control group (P<0.01). No difference was observed in Hgb at discharge between control and treatment groups. Mean estimated blood loss, volume of intraoperative packed red blood cells, rate of packed red blood cell transfusion, and mean total transfusion volume during hospitalization were significantly higher in the control group compared with the treatment group (P<0.01). Mean length of stay did not differ between groups.

Conclusion:
Efforts to optimize blood management in the CVR population are critical. This prospective study represents a robust and reproducible protocol for pediatric blood management with significant reductions in transfusion requirements.
Evaluating the Learning Curve and Patient Outcomes in Endoscopically Assisted Craniosynostosis Surgery: A 20-Year Analysis
Authors: Chargi Najiba , Kregel Mark , Xi Tong , Dormaar Titiaan , Borstlap Wilfred , van Lindert Erik , Delye Hans , Nienhuijs Marloes 
Published: October 2024

Objectives:
To analyze the learning curve associated with endoscopic-assisted craniosynostosis surgery (EACS) at a single institution over a period of 2 decades.

Material and methods:
Patients who underwent EACS between 2004 and 2023 were included in this retrospective study. The impact of surgical experience was assessed by analyzing the duration of surgery and anesthesia, blood loss, need for blood transfusion, postoperative complications, and length of hospital stay, in relation to the number of surgeries performed.

Results:
On the basis of 310 patients, the overall complication rate was low, with only 23 patients (7.4%) experiencing postoperative complications and 33 patients (10.6%) requiring a blood transfusion. The median length of hospital stay was 3 days (range 1–7 days). The results showed a statistically significant learning curve associated with EACS, with each additional surgery reducing the odds of postoperative complications by 0.7% (P<0.001) and the odds of blood transfusion by 0.8% (P<0.001). In addition, there were significant reductions in the duration of anesthesia, duration of surgery, and length of hospital stay over time (P<0.001).

Conclusion:
EACS is a safe and effective technique for treating craniosynostosis with low complication rates and a significant learning curve over time. Surgeons can expect to achieve better outcomes with greater surgical experience.
Use of Financial Hardship as a Metric for Assessing Financial Toxicity in Surgical Trauma Patients
Authors: Ehsan Anam N. , Saha Shivangi , Hathi Preet , Vengadassalapathy Srinivasan , Sana Hamaiyal , Ganesh Praveen , Huang Chuan-Chin , Chauhan Shashank , Singhal Maneesh , Weissman Joel S. , Atun Rifat , Sabapathy Shanmuganathan Raja , Ranganathan Kavitha 
Published: October 2024

Background:
Financial toxicity is the detrimental impact of health care costs that must be mitigated to achieve universal health coverage. Catastrophic health expenditure (CHE) is widely used to measure financial toxicity but does not capture patient perspectives of unaffordable health care costs. Financial hardship (FH), a patient-reported outcome measure, is currently underutilized but may be an important adjunct metric. The authors compare CHE to FH as metrics evaluating financial toxicity.

Methods:
A prospective, multicenter cohort study was conducted across 3 public and private tertiary-care hospitals in India. Adult surgical trauma inpatients in plastic and orthopedic surgery departments were assessed. The development of CHE, health expenditures >10% of annual income, and FH, the patient-reported impact of financial toxicity in the form of asset liquidation, debt acquisition, and job loss, were compared by the health system and using logistic regression models.

Results:
Among 744 surgical trauma patients, low income, longer hospital stays, and increased injury severity were significantly associated with the likelihood of incurring CHE and FH (P<0.05). Only FH was significantly associated with lack of insurance (OR: 0.22; 95% CI: 1.14–2.71). Public hospitals had higher rates of FH than CHE (55% versus 23%). Private hospitals had more CHE than FH (53% versus 32%).

Conclusions:
FH is an important metric of financial toxicity that provides important adjunct information to CHE for at-risk populations. FH is particularly informative for public institutions with low direct medical costs. Nuanced utilization of CHE and FH provides a more comprehensive, patient-oriented approach to evaluating unaffordable health care costs that can help shape financial risk protection policy.
Polyphenol-rich fraction of Bergenia ligulata (Wall.) Engl. sensitizes colon and breast cancer metastasis in vivo: Evidence of cell-type specific mechanism
Authors: De Samhita , Ghosh Suvranil , Roy Somesh , Jana Kuladip , Mandal Subhas C , Pal Mahadeb 
Published: October 2024

AbstractBackgroundColon and breast cancer are one of the leading causes of mortality worldwide. Limited efficacies of present treatments highlighted an urgent need for improvement. Bergenia ligulata is known for its anticancer properties in Indian traditional and folk medicine though the molecular basis of its effects, particularly its anti-metastatic properties, is not well understood. Anti-prostate cancer activity of a LCMS defined polyphenol-rich fraction fromBergenia ligulata(PFBL) rhizome extract has already been published showing promising results in preclinical models.PurposeThe present study aims to explore anti-cancer activity and anti-metastatic potentials of PFBL against colon and breast cancers in both in vitro and preclinical settings.Study design and methodsPFBL alone or in synergy with standard chemotherapeutic drugs was tasted in CT26 and 4T1 subcutaneous solid tumors in BALB/c mice. The effect of PFBL was analyzed in terms of changes in tumor mass and different molecular marker levels. Anti-metastatic potential of PFBL was evaluated in CT26 and 4T1 lung metastasis model in mice focusing on the number of lung nodules and lung size.ResultsOur results evidenced that PFBL efficiently regressed both CT26 and 4T1-induced solid tumors alone and in combination with 5FU/doxorubicin without affecting the health of normal host. Notably, PFBL suppressed lung metastasis of 4T1 and CT26 cells in mice with great efficacy. Analysis of tumor and cell extracts suggested that colon cancer cells died by autophagy, while breast cancer cells majorly died by caspase-dependent apoptosis. PFBL actions involved AMPK-dependent inhibition of mTORC1 and subsequent increase in LC3II, PARP1, CDK4 and Cyclin D1 levels in both HCT116 and MCF7 cells; an elevation of intracellular ROS level was the major cause of death in both the cancer types. PFBL treatment also reversed the EMT marker expressions in in vivo and in vitro.ConclusionPFBL regressed colon and breast cancer metastasis through distinct mechanisms with little effect on healthy mice. The present study underscored PFBL as a novel anti-tumor and anti-metastasis candidate warranting further testing in clinical settings.
Limitations of the radiotheranostic concept in neuroendocrine tumors due to lineage-dependent somatostatin receptor expression on hematopoietic stem and progenitor cells
Authors: Nguyen Nghia , Min Yu , Rivière Jennifer , van der Garde Mark , Ghosh Sukhen , Bartos Laura M. , Brendel Matthias , Bassermann Florian , Azhdarinia Ali , Weber Wolfgang A. , Götze Katharina S. , Kossatz Susanne 
Published: October 2024

AbstractRadiopharmaceutical therapy (RPT) has become an effective treatment option for neuroendocrine tumors (NETs) and castration-resistant prostate cancer and is in clinical development for a growing number of indications. One of the major advantages of theranostic RPT is that the distribution of radiopharmaceuticals in the human body can be imaged, and radiation doses to the patient’s organs can be calculated. However, accurate dosimetry may be fundamentally limited by microscopic heterogeneity of radiopharmaceutical distribution. We developed fluorescent analogs of somatostatin-receptor-subtype 2 (SSTR2) targeting Lutetium-177 labelled radiopharmaceuticals that are clinically used in patients with neuroendocrine tumors (NETs) and studied their uptake by hematopoietic stem and progenitor cells (HSPC). Hematopoietic stem cells (HSCs) and multipotent progenitor cells (MPPs) showed high and specific SSTR2-ligand uptake, which was at similar levels as neuroendocrine tumor cells. Furthermore, they displayed a several-fold higher uptake of SSTR2-antagonists than of SSTR2-agonists. HSPC treatment with a177Lu-labelled antagonist and agonist showed a stronger reduction of HSC proliferation by the antagonist. Due to the scarcity of HSCs and MPPs, their contribution to total bone marrow uptake of SSTR2-ligands is not detectable in imaging-based dosimetry studies. This likely explains why SSTR2-antagonists caused pancytopenia in clinical trials despite safe dosimetry estimates. In conclusion, target expression heterogeneity can lead to underestimation of radiopharmaceutical toxicity and should be considered when designing clinical trials for new radiopharmaceuticals. The implications of our findings go beyond somatostatin receptor-targeted radiopharmaceuticals and suggest more generally that first-in-human studies should not only be guided by radiation dosimetry from imaging studies but should also include careful escalation of the administered therapeutic activity. The MMC technology is modular and can be applied to other peptide or protein-based radiopharmaceuticals to study cellular distribution and potential bone marrow uptake prior to clinical testing.