bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development and Validation of a Deep Learning Model for Prediction of Adult Physiological Deterioration
Authors: Shashikumar Supreeth P. , Le Joshua Pei , Yung Nathan , Ford James , Singh Karandeep , Malhotra Atul , Nemati Shamim , Wardi Gabriel 
Published: September 2024

BACKGROUND:
Prediction-based strategies for physiologic deterioration offer the potential for earlier clinical interventions that improve patient outcomes. Current strategies are limited because they operate on inconsistent definitions of deterioration, attempt to dichotomize a dynamic and progressive phenomenon, and offer poor performance.

OBJECTIVE:
Can a deep learning deterioration prediction model (Deep Learning Enhanced Triage and Emergency Response for Inpatient Optimization [DETERIO]) based on a consensus definition of deterioration (the Adult Inpatient Decompensation Event [AIDE] criteria) and that approaches deterioration as a state “value-estimation” problem outperform a commercially available deterioration score?

DERIVATION COHORT:
The derivation cohort contained retrospective patient data collected from both inpatient services (inpatient) and emergency departments (EDs) of two hospitals within the University of California San Diego Health System. There were 330,729 total patients; 71,735 were inpatient and 258,994 were ED. Of these data, 20% were randomly sampled as a retrospective “testing set.”

VALIDATION COHORT:
The validation cohort contained temporal patient data. There were 65,898 total patients; 13,750 were inpatient and 52,148 were ED.

PREDICTION MODEL:
DETERIO was developed and validated on these data, using the AIDE criteria to generate a composite score. DETERIO’s architecture builds upon previous work. DETERIO’s prediction performance up to 12 hours before T0 was compared against Epic Deterioration Index (EDI).

RESULTS:
In the retrospective testing set, DETERIO’s area under the receiver operating characteristic curve (AUC) was 0.797 and 0.874 for inpatient and ED subsets, respectively. In the temporal validation cohort, the corresponding AUC were 0.775 and 0.856, respectively. DETERIO outperformed EDI in the inpatient validation cohort (AUC, 0.775 vs. 0.721; p < 0.01) while maintaining superior sensitivity and a comparable rate of false alarms (sensitivity, 45.50% vs. 30.00%; positive predictive value, 20.50% vs. 16.11%).

CONCLUSIONS:
DETERIO demonstrates promise in the viability of a state value-estimation approach for predicting adult physiologic deterioration. It may outperform EDI while offering additional clinical utility in triage and clinician interaction with prediction confidence and explanations. Additional studies are needed to assess generalizability and real-world clinical impact.
Predictors of ICU Surrogates’ States of Concurrent Prolonged Grief, Posttraumatic Stress, and Depression Symptoms*
Authors: Wen Fur-Hsing , Prigerson Holly G. , Chuang Li-Pang , Chou Wen-Chi , Huang Chung-Chi , Hu Tsung-Hui , Tang Siew Tzuh 
Published: September 2024

OBJECTIVES:
Scarce research explores factors of concurrent psychologic distress (prolonged grief disorder [PGD], posttraumatic stress disorder [PTSD], and depression). This study models surrogates’ longitudinal, heterogenous grief-related reactions and multidimensional risk factors drawing from the integrative framework of predictors for bereavement outcomes (intrapersonal, interpersonal, bereavement-related, and death-circumstance factors), emphasizing clinical modifiability.

DESIGN:
Prospective cohort study.

SETTING:
Medical ICUs of two Taiwanese medical centers.

SUBJECTS:
Two hundred eighty-eight family surrogates.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Factors associated with four previously identified PGD-PTSD-depressive-symptom states (resilient, subthreshold depression-dominant, PGD-dominant, and PGD-PTSD-depression concurrent) were examined by multinomial logistic regression modeling (resilient state as reference). Intrapersonal: Prior use of mood medications correlated with the subthreshold depression-dominant state. Financial hardship and emergency department visits correlated with the PGD-PTSD-depression concurrent state. Higher anxiety symptoms correlated with the three more profound psychologic-distress states (adjusted odds ratio [95% CI] = 1.781 [1.562–2.031] to 2.768 [2.288–3.347]). Interpersonal: Better perceived social support was associated with the subthreshold depression-dominant state. Bereavement-related: Spousal loss correlated with the PGD-dominant state. Death circumstances: Provision of palliative care (8.750 [1.603–47.768]) was associated with the PGD-PTSD-depression concurrent state. Surrogate-perceived quality of patient dying and death as poor-to-uncertain (4.063 [1.531–10.784]) correlated with the subthreshold depression-dominant state, poor-to-uncertain (12.833 [1.231–133.775]), and worst (12.820 [1.806–91.013]) correlated with the PGD-PTSD-depression concurrent state. Modifiable social-worker involvement (0.004 [0.001–0.097]) and a do-not-resuscitate order issued before death (0.177 [0.032–0.978]) were negatively associated with the PGD-PTSD-depression concurrent and the subthreshold depression-dominant state, respectively. Apparent unmodifiable buffering factors included surrogates’ higher educational attainment, married status, and longer time since loss.

CONCLUSIONS:
Surrogates’ concurrent bereavement distress was positively associated with clinically modifiable factors: poor quality dying and death, higher surrogate anxiety, and palliative care—commonly provided late in the terminal-illness trajectory worldwide. Social-worker involvement and a do-not-resuscitate order appeared to mitigate risk.
Comparative performance of pharmacogenetics-based warfarin dosing algorithms in Chinese population: use of a pharmacokinetic/pharmacodynamic model to explore dosing regimen through clinical trial simulation
Authors: Shi Keli , Deng Jiexin 
Published: September 2024

Objective
Warfarin has a narrow therapeutic window and large variability in dosing that are affected by clinical and genetic factors. To help guide the dosing of warfarin, the Clinical Pharmacogenetics Implementation Consortium has recommended the use of pharmacogenetic algorithms, such as the ones developed by the International Warfarin Pharmacogenetics Consortium (IWPC) and by Gage et al. when genotype information is available.

Methods
In this study, simulations were performed in Chinese cohorts to explore how dosing differences between Western (by IWPC and Gage et al.) and Chinese algorithms (by Miao et al.) would mean in terms of anticoagulation effect in clinical trials. We first tried to replicate a published clinical trial comparing genotype-guided dosing to routine clinical dosing in Chinese patients. We then made simulations where Chinese cohorts received daily doses recommended by Gage, IWPC, and Miao algorithms.

Results
We found that in simulation conditions where dosing specifications were strictly followed, genotype-guided dosing by IWPC and Lenzini formulae was more likely to overshoot the upper limit of the therapeutic window by day 15, and thus may have a lower % time in therapeutic range (%TTR) than that of clinical dosing group. Also, in comparing Gage, IWPC, and Miao algorithms, we found that the Miao dosing cohort has the highest %TTR and the lowest risk of over-anticoagulation by day 28.

Conclusion
In summary, our results confirmed that algorithms developed based on data from local patients may be more suitable for achieving therapeutic international normalized ratio window in Chinese population.
Long-term exposure to antihypertensive drugs and the risk of cancer occurrence: evidence from a large population-based study
Authors: Franchi Matteo , Torrigiani Ginevra , Kjeldsen Sverre Erik , Mancia Giuseppe , Corrao Giovanni 
Published: September 2024

Objective:
Available data on the association between antihypertensive drugs and cancer are characterized by a few years follow-up. Our aim has been to evaluate the association between long-term exposure to antihypertensive drugs and the risk of cancer occurrence.

Methods:
Using the healthcare utilization databases of the Lombardy region (Italy), individuals aged 40–85 years who had no previous history of cancer and were newly dispensed with at least one antihypertensive drug from the major drug classes between 2009 and 2011 were followed from the first drug dispensation to December 31, 2020. Data were analyzed according to the first drug used and the intention to treat principle, but also via an “as treated” approach, that is, by considering changes of and exposure to drugs during follow-up. The association between the duration of exposure to each drug class and the risk of cancer occurrence was evaluated using the adjusted Cox regression models.

Results:
The study cohort included 338 910 new drug users (median age, 59 years; 49.5% males). During a median follow-up of 10.2 years, 36 556 cancers occurred. There was no consistent significant association between the risk of cancer occurrence and angiotensin-converting-enzyme inhibitors, angiotensin-receptor blockers, or thiazides. A progressive, weak increase in cancer occurrence was associated with progressive exposure to calcium channel blockers and, limited to long-term exposure, to beta-blockers. A modest progressive increase in risk was observed also for thiazide-like and loop diuretics in the as treated, although not in the intention to treat approach.

Conclusions:
Long-term evaluation of exposure to antihypertensive drugs did not show consistent associations between thiazides, angiotensin-receptor blockers, or angiotensin-converting-enzyme inhibitors and the risk of cancer occurrence. A weak association was observed between cancer and the duration of exposure to calcium channel blockers and beta-blockers.
Ocular manifestations of West Nile virus
Authors: Dossett James P. , Clavell Christine I. , Ghorayeb Ghassan 
Published: September 2024

Purpose of review
Over the past two decades, the ophthalmic manifestations of West Nile virus have been more clearly established in the literature. This review aims to summarize its diagnosis and pathogenesis, with a focus on its clinical appearance, characteristic imaging features, and management.

Recent findings
Ocular manifestations of West Nile virus present early in the disease course and are more common in cases with severe neurological involvement. The use of optical coherence tomography (OCT), optical coherence tomography angiography (OCT-A), fundus autofluorescence (FAF), fluorescein angiogram (FA), and indocyanine green angiography (ICGA) can aid in its diagnosis and management.

Summary
West Nile virus infection may present with ocular findings that include anterior uveitis, vitritis, retinitis, chorioretinitis, and optic neuropathy; visual prognosis can range from excellent to poor depending on severity of involvement and the presence of secondary complications, such as occlusive vasculitis and macular ischemia. Diagnosis may be aided by multimodal imaging assessment. The ophthalmologist should have a high clinical suspicion for ocular involvement in cases of severe systemic disease.
Ethical considerations for large language models in ophthalmology
Authors: Kalaw Fritz Gerald P. , Baxter Sally L. 
Published: September 2024

Purpose of review
This review aims to summarize and discuss the ethical considerations regarding large language model (LLM) use in the field of ophthalmology.

Recent findings
This review of 47 articles on LLM applications in ophthalmology highlights their diverse potential uses, including education, research, clinical decision support, and surgical assistance (as an aid in operative notes). We also review ethical considerations such as the inability of LLMs to interpret data accurately, the risk of promoting controversial or harmful recommendations, and breaches of data privacy. These concerns imply the need for cautious integration of artificial intelligence in healthcare, emphasizing human oversight, transparency, and accountability to mitigate risks and uphold ethical standards.

Summary
The integration of LLMs in ophthalmology offers potential advantages such as aiding in clinical decision support and facilitating medical education through their ability to process queries and analyze ophthalmic imaging and clinical cases. However, their utilization also raises ethical concerns regarding data privacy, potential misinformation, and biases inherent in the datasets used. Awareness of these concerns should be addressed in order to optimize its utility in the healthcare setting. More importantly, promoting responsible and careful use by consumers should be practiced.
Novel artificial intelligence for diabetic retinopathy and diabetic macular edema: what is new in 2024?
Authors: Vujosevic Stela , Limoli Celeste , Nucci Paolo 
Published: September 2024

Purpose of review
Given the increasing global burden of diabetic retinopathy and the rapid advancements in artificial intelligence, this review aims to summarize the current state of artificial intelligence technology in diabetic retinopathy detection and management, assessing its potential to improve care and visual outcomes in real-world settings.

Recent findings
Most recent studies focused on the integration of artificial intelligence in the field of diabetic retinopathy screening, focusing on real-world efficacy and clinical implementation of such artificial intelligence models. Additionally, artificial intelligence holds the potential to predict diabetic retinopathy progression, enhance personalized treatment strategies, and identify systemic disease biomarkers from ocular images through ‘oculomics’, moving towards a more precise, efficient, and accessible care. The emergence of foundation model architectures and generative artificial intelligence, which more clearly reflect the clinical care process, may enable rapid advances in diabetic retinopathy care, research and medical education.

Summary
This review explores the emerging technology of artificial intelligence to assess the potential to improve patient outcomes and optimize personalized management in healthcare delivery and medical research. While artificial intelligence is expected to play an increasingly important role in diabetic retinopathy care, ongoing research and clinical trials are essential to address implementation issues and focus on long-term patient outcomes for successful real-world adoption of artificial intelligence in diabetic retinopathy.
Artificial intelligence in myopia in children: current trends and future directions
Authors: Ng Yin Ling Clarissa , Zhu Xiangjia , Ang Marcus 
Published: September 2024

Purpose of review
Myopia is one of the major causes of visual impairment globally, with myopia and its complications thus placing a heavy healthcare and economic burden. With most cases of myopia developing during childhood, interventions to slow myopia progression are most effective when implemented early. To address this public health challenge, artificial intelligence has emerged as a potential solution in childhood myopia management.

Recent findings
The bulk of artificial intelligence research in childhood myopia was previously focused on traditional machine learning models for the identification of children at high risk for myopia progression. Recently, there has been a surge of literature with larger datasets, more computational power, and more complex computation models, leveraging artificial intelligence for novel approaches including large-scale myopia screening using big data, multimodal data, and advancing imaging technology for myopia progression, and deep learning models for precision treatment.

Summary
Artificial intelligence holds significant promise in transforming the field of childhood myopia management. Novel artificial intelligence modalities including automated machine learning, large language models, and federated learning could play an important role in the future by delivering precision medicine, improving health literacy, and allowing the preservation of data privacy. However, along with these advancements in technology come practical challenges including regulation and clinical integration.
Microbiome contributions to pain: a review of the preclinical literature
Authors: Pratt McKenna L. , Plumb Ashley N. , Manjrekar Aditi , Cardona Lucia M. , Chan Cheri K. , John Juanna M. , Sadler Katelyn E. 
Published: September 2024

Abstract
Over the past 2 decades, the microbiome has received increasing attention for the role that it plays in health and disease. Historically, the gut microbiome was of particular interest to pain scientists studying nociplastic visceral pain conditions given the anatomical juxtaposition of these microorganisms and the neuroimmune networks that drive pain in such diseases. More recently, microbiomes both inside and across the surface of the body have been recognized for driving sensory symptoms in a broader set of diseases. Microbiomes have never been a more popular topic in pain research, but to date, there has not been a systematic review of the preclinical microbiome pain literature. In this article, we identified all animal studies in which both the microbiome was manipulated and pain behaviors were measured. Our analysis included 303 unique experiments across 97 articles. Microbiome manipulation methods and behavioral outcomes were recorded for each experiment so that field-wide trends could be quantified and reported. This review specifically details the animal species, injury models, behavior measures, and microbiome manipulations used in preclinical pain research. From this analysis, we were also able to conclude how manipulations of the microbiome alter pain thresholds in naïve animals and persistent pain intensity and duration in cutaneous and visceral pain models. This review summarizes by identifying existing gaps in the literature and providing recommendations for how to best plan, implement, and interpret data collected in preclinical microbiome pain experiments.
Association of Novel Ventricular Assist Device Self-report Measures With Overall Health-Related Quality of Life
Authors: Grady Kathleen L. , Burns James L. , Allen Larry A. , Stehlik Josef , Teuteberg Jeffrey , McIlvennan Colleen K. , Kirklin James K. , Beiser David G. , Lindenfeld JoAnn , Denfeld Quin E. , Lee Christopher S. , Kiernan Michael , Cella David , Klein Liviu , Walsh Mary Norine , Ruo Bernice , Adler Eric , Rich Jonathan , Pham Duc Thinh , Yancy Clyde , Murks Catherine , Bedjeti Katy , Hahn Elizabeth A. 
Published: September 2024

Background
Few study authors examined factors influencing health-related quality of life (HRQOL) early after left ventricular assist device (LVAD) implantation.

Objective
The purpose of this study was to determine whether 5 novel self-report measures and other variables were significantly associated with overall HRQOL at 3 months after LVAD surgery.

Methods
Patients were recruited between October 26, 2016, and February 29, 2020, from 12 US sites. Data were collected before LVAD implantation and at 3 months post LVAD implantation. Overall HRQOL measures included the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) overall summary score (OSS) and EuroQol 5-dimension- 3L visual analog scale. Potential factors associated with overall HRQOL included 5 novel self-report measures (Satisfaction with Treatment, Being Bothered by VAD Self-care and Limitations, VAD Team Communication, Self-efficacy regarding VAD Self-care, and Stigma), and demographic and clinical characteristics. Statistics included regression analyses.

Results
Of enrollees, 242 completed self-report measures at baseline, and 142 completed measures 3 months postoperatively. Patients were 55 ± 13 years old, with 21% female, 24% non-White, 39% high school or lower educated, and 47% destination therapy. Using the KCCQ-12 OSS, higher Satisfaction with Treatment was associated with a higher KCCQ-12 OSS; Being Bothered by VAD Self-care and Limitations, high school or lower education, chest incision pain, cardiac dysrhythmias within 3 postoperative months, and peripheral edema were associated with a worse KCCQ-12 OSS (R
2 = 0.524). Factors associated with a worse 3-month EuroQol 5-dimension-3L visual analog scale were female sex, adverse events within 3 months post implantation (cardiac dysrhythmias, bleeding, and venous thrombosis), and chest incision pain (R
2 = 0.229). No factors were associated with a higher EuroQol 5-dimension-3L visual analog scale score at 3 months.

Conclusions
Two novel measures, demographics, postimplantation adverse events, and symptoms were associated with post-LVAD KCCQ-12 OSS early after surgery.
Ultrasound-Guided Percutaneous Ultrasonic Tenotomy for Refractory Patellar Tendinopathy in High-Level Athletes: A Case Series
Authors: Omodani Toru , Saito Masayoshi , Ikuta Futoshi 
Published: September 2024

Objective:
To elucidate the clinical outcomes and return-to-sport status of high-level athletes with refractory patellar tendinopathy treated with ultrasound-guided percutaneous ultrasonic tenotomy (PUT).

Design:
Case series study.

Setting:
Single orthopaedic clinic.

Patients:
Five cases involving 8 knees from athletes (average age: 22 years, range: 17-30 years) who presented with refractory patellar tendinopathy and underwent PUT between 2022 and 2024. Conservative treatments had previously been attempted without sufficient pain relief or return to sports.

Interventions:
All patients underwent ultrasound-guided PUT using the TX-2 device from Tenex Health. Jogging was resumed 1 month after surgery, and a return to competitive sports was permitted as early as 3 months postsurgery.

Main Outcome Measures:
Preoperative and postoperative Victorian Institute of Sport Assessment (VISA) scores and Numerical Rating Scale (NRS) scores for pain. Time to return to full training and competitive sports, and presence of postoperative infection signs.

Results:
The VISA score significantly improved from a preoperative average of 43.1 to a postoperative average of 77.1 (P = 0.0004). The NRS significantly decreased from a preoperative average of 6.4 to a postoperative average of 2.8 (P = 0.0005). Four cases involving 6 knees fully returned to sports, with an average return time of 3 months and 19 days (range: 3 months to 4 months and 13 days). One case involving 2 knees did not show sufficient pain improvement and the patient could not return to sports. No signs of infection were observed in any case.

Conclusions:
PUT for refractory patellar tendinopathy in high-level athletes generally results in favorable treatment outcomes and successful return to sports. This study provides novel insights into the effectiveness of PUT for patellar tendinopathy in athletes, highlighting the need for future studies with larger sample sizes to validate these findings and explore factors associated with poor outcomes.