bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patterns and Perceptions of Standard Order Set Use Among Physicians Working Within a Multihospital System: Mixed Methods Study
Authors: Naicker Sundresan , Tariq Amina , Donovan Raelene , Magon Honor , White Nicole , Simmons Joshua , McPhail Steven M 
Published: September 2024

Background
Electronic standard order sets automate the ordering of specific treatment, testing, and investigative protocols by physicians. These tools may help reduce unwarranted clinical variation and improve health care efficiency. Despite their routine implementation within electronic medical records (EMRs), little is understood about how they are used and what factors influence their adoption in practice.

Objective
This study aims to (1) describe the patterns of use of standard order sets implemented in a widely used EMR (PowerPlans and Cerner Millennium) within a multihospital digital health care system; (2) explore the experiences and perceptions of implementers and users regarding the factors contributing to the use of these standard order sets; and (3) map these findings to the Capability, Opportunity, and Motivation Behavior (COM-B) model of behavior change to assist those planning to develop, improve, implement, and iterate the use of standard order sets in hospital settings.

Methods
Quantitative data on standard order set usage were captured from 5 hospitals over 5-month intervals for 3 years (2019, 2020, and 2021). Qualitative data, comprising unstructured and semistructured interviews (n=15), were collected and analyzed using a reflexive thematic approach. Interview themes were then mapped to a theory-informed model of behavior change (COM-B) to identify determinants of standard order set usage in routine clinical practice. The COM-B model is an evidence-based, multicomponent framework that posits that human actions result from multiple contextual influences, which can be categorized across 3 dimensions: capability, opportunity, and motivation, all of which intersect.

Results
The total count of standard order set usage across the health system during the 2019 observation period was 267,253, increasing to 293,950 in 2020 and 335,066 in 2021. There was a notable shift toward using specialty order sets that received upgrades during the study period. Four emergent themes related to order set use were derived from clinician interviews: (1) Knowledge and Skills; (2) Perceptions; (3) Technical Dependencies; and (4) Unintended Consequences, all of which were mapped to the COM-B model. Findings indicate a user preference for customized order sets that respond to local context and user experience.

Conclusions
The study findings suggest that ongoing investment in the development and functionality of specialty order sets has the potential to enhance usage as these sets continue to be customized in response to local context and user experience. Sustained and continuous uptake of appropriate Computerized Provider Order Entry use may require implementation strategies that address the capability, opportunity, and motivational influencers of behavior.
Effect of Virtual Reality Technology on Attention and Motor Ability in Children With Attention-Deficit/Hyperactivity Disorder: Systematic Review and Meta-Analysis
Authors: Yu Chuanwen , Wang Cheng , Xie Qi , Wang Chaoxin 
Published: September 2024

Abstract

Background
Attention-deficit/hyperactivity disorder (ADHD) is one of the common neurodevelopmental disorders in children and virtual reality (VR) has been used in the diagnosis and treatment of ADHD.

Objective
This paper aims to systematically evaluate the effect of VR technology on the attention and motor ability of children with ADHD.

Methods
The intervention method of the experimental group was VR technology, while the control group adopted non-VR technology. The population was children with ADHD. The outcome indicators were attention and motor abilities. The experimental design was randomized controlled trial. Two researchers independently searched PubMed, Cochrane Library, Web of Science, and Embase for randomized controlled trials related to the effect of VR technology on ADHD children’s attention and motor ability. The retrieval date was from the establishment of each database to January 4, 2023. The PEDro scale was used to evaluate the quality of the included literature. Stata (version 17.0; StataCorp LLC) was used for effect size combination, forest map-making, subgroup analyses, sensitivity analyses, and publication bias. GRADEpro (McMaster University and Evidence Prime Inc) was used to evaluate the level of evidence quality.

Results
A total of 9 literature involving 370 children with ADHD were included. VR technology can improve ADHD children’s attention (Cohen d=−0.68, 95% CI −1.12 to −0.24; P<.001) and motor ability (Cohen d=0.48, 95% CI 0.16-0.80; P<.001). The intervention method and diagnosis type for VR technology had a moderating effect on the intervention’ impact on children’s attention (P<.05). The improvement in children’s attention by “immersive” VR technology was statistically significant (Cohen d=−1.05, 95% CI −1.76 to −0.34; P=.004). The improvement of children’s attention by “nonimmersive” VR technology was statistically significant (Cohen d=−0.28, 95% CI −0.55 to −0.01; P=.04). VR technology had beneficial effects on both children with an “informal diagnosis” (Cohen d=−1.47, 95% CI −2.35 to −0.59; P=.001) and those with a “formal diagnosis” (Cohen d=−0.44, 95% CI −0.85 to −0.03; P=.03).

Conclusions
VR technology can improve attention and motor ability in children with ADHD. Immersive VR technology has the best attention improvement effect for informally diagnosed children with ADHD.
A Digital Approach for Addressing Suicidal Ideation and Behaviors in Youth Mental Health Services: Observational Study
Authors: Chong Min K , Hickie Ian B , Ottavio Antonia , Rogers David , Dimitropoulos Gina , LaMonica Haley M , Borgnolo Luke J , McKenna Sarah , Scott Elizabeth M , Iorfino Frank 
Published: September 2024

Background
Long wait times for mental health treatments may cause delays in early detection and management of suicidal ideation and behaviors, which are crucial for effective mental health care and suicide prevention. The use of digital technology is a potential solution for prompt identification of youth with high suicidality.

Objective
The primary aim of this study was to evaluate the use of a digital suicidality notification system designed to detect and respond to suicidal needs in youth mental health services. Second, the study aimed to characterize young people at different levels of suicidal ideation and behaviors.

Methods
Young people aged between 16 and 25 years completed multidimensional assessments using a digital platform, collecting demographic, clinical, social, functional, and suicidality information. When the suicidality score exceeded a predetermined threshold, established based on clinical expertise and service policies, a rule-based algorithm configured within the platform immediately generated an alert for treating clinicians. Subsequent clinical actions and response times were analyzed.

Results
A total of 2021 individuals participated, of whom 266 (11%) triggered one or more high suicidal ideation and behaviors notification. Of the 292 notifications generated, 76% (222/292) were resolved, with a median response time of 1.9 (range 0-50.8) days. Clinical actions initiated to address suicidality included creating safety plans (60%, 134/222), conducting safety checks (18%, 39/222), psychological therapy (8%, 17/222), transfer to another service (3%, 8/222), and scheduling of new appointments (2%, 4/222). Young people with high levels of suicidality were more likely to present with more severe and comorbid symptoms, including low engagement in work or education, heterogenous psychopathology, substance misuse, and recurrent illness.

Conclusions
The digital suicidality notification system facilitated prompt clinical actions by alerting clinicians to high levels of suicidal ideation and behaviors detected among youth. Further, the multidimensional assessment revealed complex and comorbid symptoms exhibited in youth with high suicidality. By expediting and personalizing care for those displaying elevated suicidality, the digital notification system can play a pivotal role in preventing rapid symptom progression and its detrimental impacts on young people’s mental health.
Using Large Language Models to Abstract Complex Social Determinants of Health From Original and Deidentified Medical Notes: Development and Validation Study
Authors: Ralevski Alexandra , Taiyab Nadaa , Nossal Michael , Mico Lindsay , Piekos Samantha , Hadlock Jennifer 
Published: September 2024

Background
Social determinants of health (SDoH) such as housing insecurity are known to be intricately linked to patients’ health status. More efficient methods for abstracting structured data on SDoH can help accelerate the inclusion of exposome variables in biomedical research and support health care systems in identifying patients who could benefit from proactive outreach. Large language models (LLMs) developed from Generative Pre-trained Transformers (GPTs) have shown potential for performing complex abstraction tasks on unstructured clinical notes.

Objective
Here, we assess the performance of GPTs on identifying temporal aspects of housing insecurity and compare results between both original and deidentified notes.

Methods
We compared the ability of GPT-3.5 and GPT-4 to identify instances of both current and past housing instability, as well as general housing status, from 25,217 notes from 795 pregnant women. Results were compared with manual abstraction, a named entity recognition model, and regular expressions.

Results
Compared with GPT-3.5 and the named entity recognition model, GPT-4 had the highest performance and had a much higher recall (0.924) than human abstractors (0.702) in identifying patients experiencing current or past housing instability, although precision was lower (0.850) compared with human abstractors (0.971). GPT-4’s precision improved slightly (0.936 original, 0.939 deidentified) on deidentified versions of the same notes, while recall dropped (0.781 original, 0.704 deidentified).

Conclusions
This work demonstrates that while manual abstraction is likely to yield slightly more accurate results overall, LLMs can provide a scalable, cost-effective solution with the advantage of greater recall. This could support semiautomated abstraction, but given the potential risk for harm, human review would be essential before using results for any patient engagement or care decisions. Furthermore, recall was lower when notes were deidentified prior to LLM abstraction.
Lista de verificação ergonômica para as bibliotecas
Authors: Santos Ana Beatriz Gomes de Souza , Alves Rosiane Pereira , Santos Luanna Correia dos 
Published: September 2024

As atividades laborais, como a de bibliotecários, quando realizadas inadequadamente ou em locais inapropriados podem afetar a saúde e o bem-estar dos trabalhadores. Assim, ferramentas para avaliação da atividade e do local de trabalho podem ser úteis para identificar os aspectos que podem ser melhorados. Este artigo tem por objetivo propor uma lista de verificação ergonômica para as bibliotecas da Universidade Federal de Pernambuco (UFPE). Foi realizado um estudo descritivo quali-quantitativo, com a aplicação de um questionário on-line elaborado com a ferramenta Google Forms, aos servidores das bibliotecas da UFPE, no período de agosto a novembro de 2020. Participaram 28 servidores de 12 bibliotecas da universidade. Os resultados revelaram dificuldades na infraestrutura das bibliotecas e no uso de equipamentos defeituosos e ultrapassados, principalmente, além de desconfortos físicos decorrentes das atividades. A lista de verificação proposta foi baseada nesses resultados e na necessidade avaliação presencial das condições ergonômicas dos locais de trabalho das bibliotecas da UFPE. Espera-se que a aplicação dessa lista norteie e facilite a avaliação ergonômica nesses locais específicos.
Demand Uncertainty and Tax-Motivated Outbound Income Shifting
Authors: Deng Zero , Steele Logan B. , Teng Haimeng 
Published: September 2024

ABSTRACT
We examine how uncertainty affects U.S. multinational firms’ outbound income shifting. Based on the Joint Committee on Taxation (2010) Report, we contend that tax savings from income shifting are closely tied to sales and therefore expect that demand uncertainty is a relevant factor driving the association between uncertainty and income shifting. We find that both worldwide and regional demand uncertainties constrain outbound income shifting, and the impact of demand uncertainty is greater when the cost of modifying income-shifting structures is likely to be higher. We split common proxies for uncertainty into demand and profit margin components and find that only demand uncertainty is reliably negatively associated with outbound income shifting. Our study extends prior work linking uncertainty to investment in tax planning by linking the nature of an important set of tax minimization strategies—income shifting—to the relevant uncertainty construct and sheds light on the “undersheltering puzzle.”
Data Availability: Data used in this study are available from public sources identified in the paper.
JEL Classifications: D81; E22; H26; M40.
Diagnostic performance of ClinCheck, Dolphin Imaging, and 3D Slicer software for Bolton discrepancy analysis
Authors: Teixeira Santana Thalita , Copello Flávio , Marañón-Vásquez Guido Artemio , Issamu Nojima Lincoln , Franzotti Sant’Anna Eduardo 
Published: September 2024

ABSTRACT

Objectives
To evaluate the diagnostic performance of ClinCheck, Dolphin Imaging orthodontic software, and 3D Slicer for the analysis of Bolton discrepancy (BD).

Materials and Methods
Fifty-five pairs of early-stage digital models of patients treated with Invisalign were printed to measure the BD by manual method with a digital caliper (gold standard). The discrepancy values calculated by ClinCheck were obtained. In addition, the sample STL files were measured using Dolphin Imaging and 3D Slicer software to obtain BD values. To assess reliability, precision, and accuracy of the methods, intraclass correlation coefficients (ICCs), Dahlberg’s formula, paired t-tests, and the Bland-Altman method were used, respectively. Repeated-measures analysis of variance with Bonferroni post hoc test was used to assess the difference between groups.

Results
The three methods showed reliable measurements (ICC ≥ 0.7), with the values of anterior Bolton slightly higher than overall Bolton. Measurements for the anterior Bolton showed higher precision (Dahlberg’s formula 0.65, 0.70, and 0.55) than those for the overall Bolton. For anterior Bolton, only the measurements obtained by ClinCheck and Dolphin Imaging were accurate (P &gt; .05, no proportion bias), while for overall Bolton, all groups had a significant difference. The Bland-Altman plots demonstrated no consistency for anterior Bolton measurements when 3D Slicer was used and for the overall Bolton.

Conclusions
ClinCheck and Dolphin Imaging showed accuracy to quantify anterior BD. For the overall Bolton measurements, ClinCheck showed a statistical difference from the manual assessment but without relevant clinical significance.
Podocyte-Specific Expression of the Stress Response Protein REDD1 Is Necessary for Diabetes-Induced Podocytopenia
Authors: Sunilkumar Siddharth , Yerlikaya Esma I. , Toro Allyson L. , Chen Han , Zhou Yandong , Gill Donald L. , Kimball Scot R. , Dennis Michael D. 
Published: September 2024

Diabetic nephropathy (DN) is the leading cause of end-stage renal disease, and effective treatment modalities that fully address its molecular etiology are lacking. Prior studies support that the stress response protein REDD1 (regulated in development and DNA damage 1) contributes to the development of diabetes complications. This study investigated a potential role for REDD1 expression in podocytes in diabetes-induced podocyte loss and compromised glomerular filtration. Podocyte-specific REDD1 deletion protected against renal injury, as evidenced by reduced albuminuria, glomerular hypertrophy, and mesangial matrix deposition in streptozotocin (STZ)-induced diabetic mice. Podocyte-specific REDD1 expression was required for diabetes-induced reduction in slit diaphragm (SD) proteins podocin and nephrin. Notably, podocyte-specific REDD1 deletion protected against podocytopenia and preserved glomerular basement membrane and foot process architecture in diabetic mice. In the kidneys of diabetic mice and in human podocyte cultures exposed to hyperglycemic conditions, REDD1 was necessary for increased expression of the transient receptor potential canonical 6 (TRPC6) channel. More specifically, REDD1 promoted nuclear factor-κB–dependent transcription of TRPC6, intracellular calcium entry, and cytoskeletal remodeling under hyperglycemic conditions. Overall, the findings provide new insight into the role of podocyte-specific REDD1 expression in renal pathology and support the possibility that therapeutics targeting REDD1 in podocytes could be beneficial for DN.

Article Highlights
Diabetes-induced albuminuria and reduced glomerular slit diaphragm proteins were associated with increased kidney REDD1 protein abundance. Podocyte-specific deletion of REDD1 attenuated diabetes-induced slit diaphragm protein reduction and podocyte loss. REDD1 was required for nuclear factor-κB–dependent TRPC6 expression and increased cytoplasmic calcium levels in podocytes. Podocyte-specific expression of REDD1 was necessary for altered glomerular architecture and albuminuria in diabetic mice.
Clients prefer collaborative decision-making with veterinarians regardless of appointment type
Authors: Groves Catherine N. H. , Coe Jason B. , Sutherland Katja A. , Bauman Cathy , Grant Lauren E. 
Published: September 2024

Abstract

OBJECTIVE
To determine clients’ preferences for veterinarians’ communication during decision-making in relation to 3 clinical contexts: preventive care, general problem (eg, illness or injury), and urgent appointments.

METHODS
A cross-sectional online questionnaire was distributed by use of snowball sampling to veterinary clients owning a pet. Demographic information was collected, and participants were then randomly assigned to a scenario reflecting one of the following clinical contexts (appointment types): preventive, general problem, or urgent. Discrete choice exercises were used to solicit client preferences for 5 aspects of veterinarians’ communication approach to decision-making with clients in clinical contexts: amount of information, presentation of plan (options or a recommendation), communication of value, nature of client involvement, and communication of financial cost. Relative-preference scores were calculated using hierarchical bayesian modeling.

RESULTS
Responses for 1,614 participants were included in the final analysis. The majority were female, lived in Canada, and were financially stable. Across clinical decision-making contexts, participants preferred to collaborate with the veterinarian, be offered options with a clear recommendation, be informed of present and future costs, and have benefits of any action regarding their pet’s health explained to them. For the general-problem context, participants preferred veterinarians’ communication to focus solely on concerns; in contrast, in preventive care and urgent contexts, participants preferred that communication include both normal findings and concerns.

CONCLUSIONS
Irrespective of clinical decision-making context, participants preferred collaborative decision-making with a veterinarian.

CLINICAL RELEVANCE
Veterinary professionals should consider, when possible, communication that supports a collaborative approach to decision-making with clients.
Popliteal sinus venipuncture in anurans
Authors: Heniff Ashlyn C. , Minter Larry J. , Balko Julie A. , DeVoe Ryan S. 
Published: September 2024

Abstract

OBJECTIVE
To demonstrate an underutilized, reliable, and technically simple anuran venipuncture technique by use of the popliteal sinus.

ANIMALS
Medium to large (> 30 g) anuran species.

METHODS
The animal is manually restrained using an encircling grip around the pelvic girdle. With the ventrum facing the phlebotomist, the phlebotomist grasps the distal hind limb and gently extends it. If necessary, the medial stifle can be rinsed with sterile water or saline to remove gross debris. Using a caudomedial approach, a 25- to 27-G, 0.5-inch (1.27-cm) needle and attached syringe is advanced toward the stifle at an approximately 45° angle while maintaining negative pressure. If lymphatic fluid or a visibly lymphatic fluid–contaminated blood sample is obtained, the sample is discarded and the attempt is repeated with a new needle and syringe. Collection volume should not exceed 1% of body weight in systemically healthy animals. In compromised animals, a reduction in collection volume should be considered (eg, ≤ 0.5% of body weight). While the phlebotomist may have an ergonomic preference, either hind limb can be used for blood collection.

RESULTS
Popliteal sinus venipuncture in anurans can be safely and easily performed with only manual restraint.

CLINICAL RELEVANCE
Commonly utilized anuran blood collection techniques include venipuncture of the ventral abdominal vein and lingual venous plexus and cardiocentesis. These techniques can be technically difficult and may pose risks to the patient, particularly if attempted without chemical restraint. Popliteal sinus venipuncture is a reliable, technically simple alternative blood collection technique that can be safely performed in anurans with only manual restraint.
Multidisciplinary Design Optimization of Active Debris Removal Mission via Electric Propulsion
Authors: Hofheins Giuliana C. , Kann Elliot , Mayo-Smith Alexander , Haji Maha N. , Petro Elaine M. 
Published: September 2024

A design optimization framework for an active orbital debris removal mission to minimize the life cycle cost and mission time is presented. The general concept of operations consists of spacecraft capable of deorbiting 22 identical high-priority debris from sun-synchronous orbit via continuous low thrust from electrostatic thrusters. This modular subsystem framework is proposed and investigated with a fractional factorial design of experiments approach as preliminary analysis in order to inform effects of design variables as well as identify the scope of possible design and output space. The single-objective optimization minimizes the life cycle cost of the mission through a heuristic-based genetic algorithm, resulting in a 4.12-year, $354 million mission using 5.34 kW xenon Hall thrusters. Pareto fronts generated by a multiobjective weighted-sum genetic algorithm are presented to highlight the cost and time objective space for both a nominal and expensive xenon price per kilogram to show design space fluctuations with xenon price volatility. High-power 8 kW xenon Hall thrusters are proven to be in closest proximity to the utopia of the multiobjective design space with a cost of $687 million and mission time of 1 year. High-power krypton Hall thrusters prove to offer a comparable alternative to xenon systems.