bluuebunny/crossref_metadata_2025_split huggingface dataset:
Psychometric Properties of Vestibular and Ocular Measures Used for Concussion Assessments: A Scoping Review
Authors: Barnes Keely , Sveistrup Heidi , Karimijashni Motahareh , Bayley Mark , Marshall Shawn 
Published: September 2024

Background:
Concussions most commonly affect the vestibular and ocular systems. Clinical measures used in the assessment of vestibular and ocular deficits should contain strong psychometric properties so that clinicians can accurately detect abnormality to guide treatment interventions.

Objectives:
The aim of this scoping review was: (1) to identify the measures used to evaluate the vestibular and ocular domains postconcussion and (2) to document the psychometric properties of the measures.

Methods:
Two databases (Medline (Ovid) and Embase) were searched from inception to May 2023. An updated search was completed in January 2024 using the same databases and search terms. Studies were screened and data were extracted independently by 2 reviewers. Measures were categorized into vestibular, ocular, or both (vestibular and ocular) domains, and relevant psychometric properties were documented.

Results:
Fifty-two studies were included in this review. 28 studies explored the use of vestibular measures, 12 explored ocular measures, and 12 explored both vestibular and ocular measures or explored the use of vestibulo-ocular reflex measures. Most studies explored the properties associated with balance measures, particularly the balance error scoring system. Diagnostic accuracy (sensitivity and specificity metrics) of the associated measures was the most frequently documented characteristic in the literature.

Conclusion:
Identification of clinical measures used to evaluate vestibular and ocular deficits postconcussion is needed to understand the evidence supporting their use in practice. Documenting the psychometric properties will allow clinicians and researchers to understand the status of the current literature and support for the use of certain measures in practice in terms of their ability to appropriately detect deficits in people with concussion when deficits are truly present.
Limbal Subconjunctival Abscess: A Rare Complication of Acanthamoeba Keratitis
Authors: Sibley Daniel , de Benito Llopis Laura 
Published: September 2024

Purpose:

Acanthamoeba keratitis (AK) is a rare infection affecting the cornea. Immune-mediated sclerokeratitis is a well-documented late complication often requiring systemic immunosuppression. We present an alternative clinical presentation of subconjunctival abscesses caused by direct invasion of the Acanthamoeba and a proposed management strategy.

Methods:
This study was a single case report performed at a tertiary care center in the United Kingdom.

Results:
A 42-year-old contact lens wearer with a history of swimming in contact lenses presented with 2 days of pain, redness, and photophobia. There was clinical suspicion for AK that was later confirmed on confocal microscopy and cultures. Four months into treatment with polyhexamethylene biguanide 0.06% monotherapy, they experienced a relapse of symptoms and developed multiple subconjunctival limbal abscesses with associated scleritis. These were drained in the office, and topical treatment changed to chlorhexidine 0.2%. The aspirate was culture-positive Acanthamoeba. Despite initially improving, the abscess reoccurred within a month. Repeat drainage was performed, and topical and oral voriconazole was added to the treatment regime. The abscess resolved leaving an area of scleromalacia.

Conclusions:
Despite immune-mediated sclerokeratitis being a more common complication of AK, infectious scleritis can also occur. Correct identification of the cause of scleritis is required to prevent mistreatment of infectious scleritis with systemic immunosuppression. The abscess resolved with repeated drainage and the use of topical and systemic voriconazole.
Efficacy of Rituximab in Autoimmune-Mediated IgG4 Pancreaticobiliary Disease
Authors: Loganathan Priyadarshini , Siby Ninette , Mohan Babu P. , Gajendran Mahesh , Chandan Saurabh , Echavarria Juan , Saligram Shreyas , Adler Douglas G. 
Published: September 2024

Background and Aims:IgG4 pancreaticobilliary disease (IgG4-PBD) typically shows a rapid improvement with glucocorticoid treatment, yet most patients experience a recurrence. Rituximab (RTX) has emerged as a hopeful approach to prevent relapses in IgG4-PBD. Nevertheless, there is a lack of data on the efficacy and safety of RTX in IgG4-PBD. In this study, we aim to perform a systematic review and meta-analysis to study the pooled efficacy of RTX in this patient population.Methods:Multiple databases, including MEDLINE, SCOPUS, and Embase, were searched (in March 2024) using specific terms for studies evaluating the efficacy and safety of RTX in IgG4 pancreatic biliary disease. Outcomes of interest were relapse, remission, partial remission rates, and adverse events. Standard meta-analysis methods were used using the random-effects model.I2% heterogeneity was used to assess the heterogeneity.Results:Twelve studies were included in the study (257 patients). The pooled rate of complete remission was 68% (54% to 80%),I2=53%, respectively. The pooled relapse rate was 23% (13% to 36%),I2=64%. The pooled rate of total adverse events was 21% (12% to 35%),I2=52%. The pooled partial remission rate is 16% (7% to 32%),I2=25%. The pooled rate of complete and partial remission was 81% (66% to 90%),I2=75%. The pooled infusion reaction and infection were 12% (7% to 18%),I2=0% and 14% (8% to 22%),I2=16%, respectively.Conclusion:RTX therapy appears effective in inducing and maintaining remission of pancreaticobiliary disease with a low rate of side effects. RTX presents as a promising treatment option for patients grappling with recurrent or unresponsive IgG4-related ailments. In addition, RTX emerges as an attractive alternative for individuals intolerant to steroids or experiencing IgG4-related disease relapses. Future studies comparing RTX with other immunomodulators will offer deeper insights into relapse factors and elucidate the appropriateness of utilizing this maintenance treatment following the initial flare.
Racial and Ethnic Disparities in Emergency Department Use Among Older Adults With Asthma and Primary Care Nurse Practitioner Work Environments
Authors: Poghosyan Lusine , Liu Jianfang , Turi Eleanor , Flandrick Kathleen , Robinson Marcia R. , George Maureen , Martsolf Grant R. , Carthon J. Margo Brooks , O’Reilly-Jacob Monica 
Published: September 2024

Background
Older adults from specific racial and ethnic minoritized groups experience disproportionately higher asthma prevalence, morbidity, and mortality. They also often use emergency departments (EDs) to manage their asthma. High-quality primary care can improve asthma control and prevent ED use. Nurse practitioners (NPs) provide an increasing proportion of primary care to minoritized patients, yet often, they work in poor work environments that strain NP care.

Objectives
We examined whether racial and ethnic health disparities in ED visits among older adults with asthma are moderated by the NP work environment in primary care practices.

Methods
In 2018–2019, we used a cross-sectional design to collect survey data on NP work environments from 1,244 NPs in six geographically diverse states (i.e., Arizona, California, New Jersey, Pennsylvania, Texas, and Washington). We merged the survey data with 2018 Medicare claims data from 46,658 patients with asthma to assess the associations of all-cause and ambulatory care-sensitive conditions, ED visits with NPs’ work environment, and race and ethnicity using logistic regression.

Results
More than one third of patients with asthma visited the ED in 1 year, and a quarter of them had an ambulatory care-sensitive condition ED visit. Black and Hispanic patients were more likely than White patients to have all-cause and ambulatory care-sensitive condition ED visits. NP work environment moderated the association of race with all-cause and ambulatory care-sensitive condition ED visits among patients with asthma. Greater standardized NP work environment scores were associated with lower odds of all-cause and ambulatory care-sensitive condition ED visits between Black and White patients.

Discussion
Disparities in ED visits between Black and White patients with asthma decrease when these patients receive care in care clinics with more favorable NP work environments. Preventing unnecessary ED visits among older adults with asthma is a likely benefit of favorable NP work environments. As the NP workforce grows, creating favorable work environments for NPs in primary care is vital for narrowing the health disparity gap.
Experiences and Health Outcomes of Emerging Adults with Type 1 Diabetes: A Mixed Methods Study
Authors: Al Bayrakdar Amani , Puzantian Houry , Noureddine Samar , Abu-Saad Huijer Huda , Nasrallah Mona , Joiner Kevin L. , Martyn-Nemeth Pamela , Tfayli Hala 
Published: September 2024

Abstract

Background
Emerging adults with type 1 diabetes are at risk of poorer diabetes-related health outcomes than other age groups. Several factors affecting the health and experiences of the emerging adults are culture and healthcare specific.

Objectives
The aim of this study was to explore the experience of emerging adults living with type 1 diabetes in Lebanon, describe their diabetes self-care and diabetes-related health outcomes (HbA1c and diabetes distress), and identify the predictors of these outcomes.

Methods
A convergent mixed methods design was used with 90 participants aged 18-29 years. Sociodemographic, clinical data, and measures of diabetes distress, social support, and self-care were collected. Fifteen emerging adults participated in individual semi-structured interviews. Multiple linear regression was used to determine predictors of diabetes outcomes. Thematic analysis was used to analyze qualitative data. Data integration was used to present the mixed methods findings.

Results
The study sample had a mean HbA1c of 7.7% (SD = 1.36) and 81.1 % reported moderate to severe diabetes distress levels. The participants had good levels of diabetes self-care and high levels of social support. HbA1c was predicted by insulin treatment type, age at diagnosis, and diabetes self-care; while diabetes distress was predicted by diabetes knowledge, blood glucose monitoring approach, and diabetes self-care. “Living with type 1 diabetes during emerging adulthood: the complex balance of a chemical reaction” was the overarching theme of the qualitative data, with three underlying themes: “Breaking of bonds: changes and taking ownership of their diabetes”, “The reactants: factors affecting the diabetes experience”, and “Aiming for equilibrium”. The integrated mixed methods results revealed one divergence between the qualitative and quantitative findings related to the complexity of the effect of received social support.

Discussion
The suboptimal health of the emerging adults despite good self-care highlights the importance of addressing cultural and healthcare specific factors such as diabetes knowledge and public awareness, social support, and availability of technology to improve diabetes health. Findings of this study can guide future research, practice, and policy development.
Increased risk of hospitalization among children who were HIV-exposed and uninfected compared to population controls
Authors: Brochon Jeanne , Ducruet Thierry , Taillefer Suzanne , Lamarre Valérie , Renaud Christian , Metras Marie-Elaine , Karatzios Christos , Puyat Joseph H. , Singer Joel , Valois Silvie , Soudeyns Hugo , Boucoiran Isabelle , Kakkar Fatima 
Published: September 2024

Objectives:
While studies have demonstrated increased morbidity and mortality risk in infancy among children who are HIV-exposed and uninfected (CHEU), longitudinal data are limited. The objective of this study was to assess long-term risk of hospitalization among CHEU compared to children who are HIV-unexposed and uninfected (CHUU), and determine risk factors for hospitalization among CHEU.

Design:
A longitudinal cohort study (1988–2015) linking the Centre maternel et infantile sur le SIDA cohort (Montreal, Quebec) to administrative data from the Régie de l’assurance maladie du Québec (RAMQ), a universal health insurance provider in the province of Quebec.

Methods:
CHEU from the CMIS cohort were matched 1 : 3 by age, sex, and postal code with CHUU controls from the RAMQ database. Incidence and causes of hospitalization between CHEU and CHUU were compared using Poisson regression.

Results:
Seven hundred twenty-six CHEU were matched to 2178 CHUU. Risk of first hospitalization was significantly higher among CHEU at 1 year (incidence rate ratio [IRR] 2.22 [1.86–2.66]), 5 years (IRR 1.62 [1.39–1.90]), and over the lifespan (IRR 1.55 [1.33–1.81]). Among CHEU, significant risk factors for hospitalization on univariate regression analysis included birth year before 2005, prematurity, small for gestational age (SGA), detectable maternal viral load (dVL) at delivery, and maternal hepatitis C co-infection. In the adjusted analysis, small for gestational age and dVL remained significant risk factors.

Conclusion:
CHEU had a higher rate of hospitalization than CHUU controls across their lifespan. Significant risk factors included SGA and detectable maternal dVL, suggesting a need for enhanced pediatric care for these children.
Optimizing Lower Extremity Local Flap Reconstruction in Peripheral Vascular Disease
Authors: Li Karen R. , Rohrich Rachel N. , Lava Christian X. , Akbari Cameron M. , Attinger Christopher E. 
Published: September 2024

Background
Local flaps remain a valuable reconstructive tool as a means for limb salvage for patients with advanced arterial disease. Our single-center, retrospective cohort study aims to compare the outcomes of different patterns of blood flow affected by vascular disease to pedicles in local flap reconstruction of the foot and ankle.

Methods
A retrospective review of 92 patients and 103 flaps was performed. On angiograms, pattern of blood flow to the flap pedicle was determined to be direct inline flow (DF) or indirect flow (IF). Patterns of IF were either by arterial-arterial connections (AC) or unnamed randomized collaterals (RC). Primary outcomes were immediate flap success and limb salvage. Comparative analyses were performed using the χ2 and Fisher tests for categorical variables.

Results
Among all flaps, 73.8% (n = 76/103) had DF and 26.2% (n = 27/103) had IF. Both groups experienced similar rates of immediate flap success (DF = 97.3% vs IF = 92.6%, P = 0.281) and limb salvage (DF = 75.% vs IF = 66.7%, P = 0.403). However, the rate of contralateral amputation was significantly higher in the IF group (26.9% vs 5.3%, P = 0.006). When comparing the 3 distinct patterns of blood flow (DF vs AC vs RC), pedicled flaps were more commonly supplied by DF and AC, while random pattern flaps were more commonly supplied by RC (P = 0.042).

Conclusions
Alternative routes of revascularization can maintain local flap viability and achieve similar rates of limb salvage but risks contralateral amputation. We found that pedicled and local muscle flaps require inline blood flow or blood supply by ACs. Meanwhile, random pattern flap can be supported by random collaterals.
A quality assessment tool for focused abdominal sonography for trauma examinations using artificial intelligence
Authors: Cull John , Morrow Dustin , Manasco Caleb , Vaughan Ashley , Eicken John , Smith Hudson 
Published: September 2024

BACKGROUND
Current tools to review focused abdominal sonography for trauma (FAST) images for quality have poorly defined grading criteria or are developed to grade the skills of the sonographer and not the examination. The purpose of this study is to establish a grading system with substantial agreement among coders, thereby enabling the development of an automated assessment tool for FAST examinations using artificial intelligence (AI).

METHODS
Five coders labeled a set of FAST clips. Each coder was responsible for a different subset of clips (10% of the clips were labeled in triplicate to evaluate intercoder reliability). The clips were labeled with a quality score from 1 (lowest quality) to 5 (highest quality). Clips of 3 or greater were considered passing. An AI training model was developed to score the quality of the FAST examination. The clips were split into a training set, a validation set, and a test set. The predicted scores were rounded to the nearest quality level to distinguish passing from failing clips.

RESULTS
A total of 1,514 qualified clips (1,399 passing and 115 failing clips) were evaluated in the final data set. This final data set had a 94% agreement between pairs of coders on the pass/fail prediction, and the set had a Krippendorff α of 66%. The decision threshold can be tuned to achieve the desired tradeoff between precision and sensitivity. Without using the AI model, a reviewer would, on average, examine roughly 25 clips for every 1 failing clip identified. In contrast, using our model with a decision threshold of 0.015, a reviewer would examine roughly five clips for every one failing clip — a fivefold reduction in clips reviewed while still correctly identifying 85% of passing clips.

CONCLUSION
Integration of AI holds significant promise in improving the accurate evaluation of FAST images while simultaneously alleviating the workload burden on expert physicians.

LEVEL OF EVIDENCE
Diagnostic Test/Criteria; Level II.
Does early transfusion of cold-stored whole blood reduce the need for component therapy in civilian trauma patients? A systematic review
Authors: Risha Mohamad , Alotaibi Abdullah , Smith Shane , Priestap Fran , Iansavitchene Alla , Laverty Colin , Hilsden Rich , Beckett Andrew , Spurrell David , Vogt Kelly , Ball Ian 
Published: September 2024

BACKGROUND
Civilian acute trauma care has advanced in recent decades; however, traumatic injury remains the leading cause of death in individuals aged 15 to 29 years in the United States and worldwide. Uncontrolled hemorrhage is the leading preventable cause of death in trauma patients, with up to half of these deaths occurring before reaching a medical facility. The timely application of hemorrhage control measures is critical to enhance the survivability of trauma patients and is one of the major challenges faced by medical providers in austere environments. The purpose of this review is to explore if early resuscitation with cold-stored whole blood therapy reduces the need for component therapy in the first 24 hours postinjury in the civilian population.

METHODS
Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we performed a systematic literature search in Medline, EMBASE, and Transfusion Evidence Library for studies reporting data on 24-hour blood product usage in trauma patients in hemorrhagic shock receiving initial therapy with whole blood. Two reviewers independently performed the selection of eligible studies.

RESULTS
Of a total of 2,150 identified studies, 11 studies (n = 4,792) met the inclusion criteria. There was heterogeneity in the study design, interventions, and outcomes. Seven studies reported a statistically significant decrease in 24-hour transfusion requirements in the whole blood intervention group in comparison with the control component therapy group. Three studies reported no significant difference between the two groups. One of the studies reported an increase in 24-hour transfusion requirements in the whole blood group.

CONCLUSION
Overall, there appears to be a decrease in component therapy use following initial resuscitation with whole blood in trauma patients with hemorrhagic shock. However, further research is needed to address this important practical question (PROSPERO registration no. CRD42023422173).

LEVEL OF EVIDENCE
Systematic Review; Level IV.
Current Status of Health Care Bioethics Committees in Chile: Suggestions for Improvement in Public Health Management
Authors: Barra Novoa Rodrigo 
Published: September 2024

ABSTRACTThis study examines the current functioning of Health Care Bioethics Committees (HBCs) in Chile, with the objective of providing recommendations for improving public health care management. Through a comprehensive literature review and a case analysis of the ‘Hospital Clínico de la Universidad de Chile’, the structure, functions and challenges of the CEA are explored. The research reveals the importance of the multidisciplinary composition of the committees, the need for continuing education in bioethics, and the relevance of the consultative role in ethical decision making. The results suggest that the effectiveness of CABs does not necessarily depend on the number of members or the length of their terms of office, but on the quality of their training and experience. It is concluded that for adequate health care management, it is essential to strengthen the role of the CEA in the ethical education of health care personnel and in the development of institutional regulations, as well as to improve their visibility and accessibility within the Chilean health care system.
Caspase-Activated DNase localizes to cancer causing translocation breakpoints during cell differentiation
Authors: Alsowaida Dalal , Larsen Brian D. , Hachmer Sarah , Azimi Mehri , Arezza Eric , Brunette Steve , Tur Steven , Palii Carmen G. , Albraidy Bassam , Sorensen Claus S. , Brand Marjorie , Dilworth F. Jeffrey , Megeney Lynn A. 
Published: September 2024

AbstractCaspase activated DNase (CAD) induced DNA breaks promote cell differentiation and therapy-induced cancer cell resistance. CAD targeting activity is assumed to be unique to each condition, as differentiation and cancer genesis are divergent cell fates. Here, we made the surprising discovery that a subset of CAD-bound targets in differentiating muscle cells are the same genes involved in the genesis of cancer-causing translocations. In muscle cells, a prominent CAD-bound gene pair isPax7andFoxo1a, the mismatched reciprocal loci that give rise to alveolar rhabdomyosarcoma. We show that CAD-targeted breaks in thePax7gene are physiologic to reducePax7expression, a prerequisite for muscle cell differentiation. A cohort of these CAD gene targets are also conserved in early differentiating T cells and include genes that spur leukemia/lymphoma translocations. Our results suggest the CAD targeting of translocation prone oncogenic genes is non-pathologic biology and aligns with initiation of cell fate transitions.