bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quality measures in primary care skin cancer management: a qualitative study of the views of key informants
Authors: Spanos Samantha , Singh Nehal , Laginha Bela I , Arnolda Gaston , Smith Andrea L , Wilkinson David , Cust Anne E , Braithwaite Jeffrey , Rapport Frances 
Published: July 2024

ObjectivesThis study explored potential quality measures to improve skin cancer management in primary care settings, and the barriers and facilitators associated with their implementation.DesignSemistructured interviews and qualitative proforma surveys were conducted with skin cancer experts from a range of healthcare settings. Framework analysis was employed to identify key groups of quality measures within the domains of the Donabedian model of healthcare quality (structure, process, outcome). Interview and survey data were triangulated to identify common groups of quality measures, barriers and facilitators.ParticipantsWe purposively recruited skin cancer experts from Australia and internationally with knowledge and experience in skin cancer management. The final sample consisted of 15 participants who had clinical or academic backgrounds.ResultsParticipants unequivocally expressed the need for quality measures to guide skin cancer care. Ten groups of quality measures were identified: three groups related to the structural elements of care (eg, diagnostic tools), four related to the processes of care (eg, diagnostic process) and three related to outcomes of care (eg, treatment outcomes). Implementation barriers included clinician resistance, system inadequacies and external factors (eg, patient risk). Facilitators included incentives, education, agreed and feasible indicators and support and guidance.ConclusionsTo service a growing population of skin cancer patients in Australia, the role of primary care needs to be more clearly specified, and its care providers supported and more engaged in quality improvement processes. Structure, process and outcome quality measures, derived from detailed guidance for primary care settings, can be used to track practitioner performance and facilitate ongoing improvement.
Challenges to young children’s swimming lesson participation in New South Wales, Australia
Authors: Mead Edwina , Peden Amy E , Angell Blake , Macniven Rona 
Published: July 2024

BackgroundChild swimming lessons are a key intervention for drowning prevention; however, participation has been severely affected by COVID-19 restrictions and cost-of-living challenges. To encourage re-engagement, the New South Wales government began providing A$100 swimming lesson vouchers. Parent/carers of eligible preschool-aged children were asked to complete a survey during voucher creation. This study aimed to examine pre-existing challenges to lesson participation among families who had not participated in the preceding 12 months.MethodsCross-sectional data from parent/carer surveys completed between December 2021 and June 2022 were analysed. Binary logistic models analysed associations between sociodemographic factors and answered affirmatively to one or more challenges to participation from a predefined list.ResultsOf 221 218 vouchers created, 79 553 parent/carers (36%) indicated that their child had not participated in swimming lessons in the last 12 months and responded to the question about participation challenges. Parent/carers of children with disabilities or residing in low socioeconomic areas had higher odds of indicating cost was a challenge while regional/remote families had over five times higher odds of indicating swim school availability difficulties. Families speaking a non-English language at home had over 2.5 times higher odds of thinking that their child was too young for swimming lessons, higher odds of thinking swimming lessons were not important and higher odds of indicating that COVID-19 had challenged participation.ConclusionThese findings highlight how different population groups experience challenges to participation in swimming lessons. Alleviating costs and increasing lesson availability is important.
Collaterals at angiography guide clinical outcomes after endovascular stroke therapy in HERMES
Authors: Liebeskind David S , Luff Marie K , Bracard Serge , Guillemin Francis , Jahan Reza , Jovin Tudor G , Majoie Charles B L M , Mitchell Peter J , van der Lugt Aad , Menon Bijoy K , San Roman Luis , Campbell Bruce , Muir Keith W , Hill Michael D , Dippel Diederik W J , Saver Jeffrey L , Demchuk Andrew M , Davalos Antoni , White Phil , Brown Scott B , Goyal Mayank 
Published: July 2024

BackgroundRobust collateral circulation has been linked with better reperfusion and clinical outcomes. It remains unclear how individual assessments of collateral circulation may be translated into clinical practice.MethodsThe pooled Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials (HERMES) angiography dataset was analyzed by a centralized, independent imaging core blinded to other clinical data. Conventional angiography was acquired immediately prior to endovascular therapy. Collaterals were graded with the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN) system and associated with baseline patient characteristics, reperfusion, and day 90 modified Rankin Score (mRS). Both 90-day all-cause mortality and day 90 mRS were modeled via multivariable logistic regression.ResultsAngiography was available in 376/605 (62%) patients. Baseline ASPECTS (Alberta Stroke Program Early CT Score) (p=0.043), history of diabetes mellitus (p=0.048), site of occlusion (p<0.001), and degree of subsequent Thrombolysis in Cerebral Infarction (TICI) reperfusion (p<0.001) were associated with collateral grades. ASITN collateral grade was strongly associated with ordinal mRS from baseline to 90 days in an unadjusted analysis (p<0.001). Multivariable regression demonstrated that collateral status is a strong determinant of mRS outcome in the presence of other predictors (OR=1.37 per grade, 95% CI [1.05 to 1.74], p=0.018). By comparing ORs, 1 unit of ASITN was determined to be approximately equivalent to 4.5 points of NIHSS, 11 years of age, 1.5 points of ASPECTS, or 100 min less delay from onset to puncture, in terms of impact on mRS.ConclusionsIndividual collateral physiology may contribute significantly to reperfusion success and clinical outcomes after acute ischemic stroke. Building a consensus for the role of angiographic collateral assessment in the allocation of adjuvant reperfusion therapies may help galvanize a precision medicine approach in stroke.
Femoral versus radial access for middle meningeal artery embolization for chronic subdural hematomas: multicenter propensity score matched study
Authors: Salem Mohamed M , Sioutas Georgios S , Gajjar Avi , Khalife Jane , Kuybu Okkes , Carroll Kate T , Hoang Alex Nguyen , Baig Ammad A , Salih Mira , Baker Cordell , Cortez Gustavo M , Abecassis Zack , Ruiz Rodriguez Juan Francisco , Davies Jason M , Cawley C Michael , Riina Howard , Spiotta Alejandro M , Khalessi Alexander , Howard Brian M , Hanel Ricardo A , Tanweer Omar , Tonetti Daniel , Siddiqui Adnan H , Lang Michael , Levy Elad I , Ogilvy Christopher S , Srinivasan Visish M , Kan Peter , Gross Bradley A , Jankowitz Brian , Levitt Michael R , Thomas Ajith J , Grandhi Ramesh , Burkhardt Jan Karl 
Published: July 2024

BackgroundWith transradial access (TRA) being more progressively used in neuroendovascular procedures, we compared TRA with transfemoral access (TFA) in middle meningeal artery embolization (MMAE) for chronic subdural hematoma (cSDH).MethodsConsecutive patients undergoing MMAE for cSDH at 14 North American centers (2018–23) were included. TRA and TFA groups were compared using propensity score matching (PSM) controlling for: age, sex, concurrent surgery, previous surgery, hematoma thickness and side, midline shift, and pretreatment antithrombotics. The primary outcome was access site and overall complications, and procedure duration; secondary endpoints were surgical rescue, radiographic improvement, and technical success and length of stay.Results872 patients (median age 73 years, 72.9% men) underwent 1070 MMAE procedures (54% TFA vs 46% TRA). Access site hematoma occurred in three TFA cases (0.5%; none required operative intervention) versus 0% in TRA (P=0.23), and radial-to-femoral conversion occurred in 1% of TRA cases. TRA was more used in right sided cSDH (58.4% vs 44.8%; P<0.001). Particle embolics were significantly higher in TFA while Onyx was higher in TRA (P<0.001). Following PSM, 150 matched pairs were generated. Particles were more utilized in the TFA group (53% vs 29.7%) and Onyx was more utilized in the TRA group (56.1% vs 31.5%) (P=0.001). Procedural duration was longer in the TRA group (median 68.5 min (IQR 43.1–95) vs 59 (42–84); P=0.038), and radiographic success was higher in the TFA group (87.3% vs 77.4%; P=0.036). No differences were noted in surgical rescue (8.4% vs 10.1%, P=0.35) or technical failures (2.4% vs 2%; P=0.67) between TFA and TRA. Sensitivity analysis in the standalone MMAE retained all associations but differences in procedural duration.ConclusionsIn this study, TRA offered comparable outcomes to TFA in MMAE for cSDH in terms of access related and overall complications, technical feasibility, and functional outcomes. Procedural duration was slightly longer in the TRA group, and radiographic success was higher in the TFA group, with no differences in surgical rescue rates.
Thrombectomy patients with minor stroke: factors of early neurological deterioration
Authors: Heitkamp Christian , Winkelmeier Laurens , Flottmann Fabian , Schell Maximilian , Kniep Helge , Broocks Gabriel , Thaler Christian , Steffen Paul , Thomalla Goetz , Fiehler Jens , Faizy Tobias D 
Published: July 2024

BackgroundA sizeable proportion of stroke patients with large vessel occlusion present with minor neurological deficits. Whether mechanical thrombectomy (MT) is beneficial in these patients is controversial. We aimed to investigate factors of early neurological deterioration (END) in thrombectomy patients with minor stroke and hypothesized that END is linked to unfavorable functional outcomes.MethodsMulticenter cohort study screening all patients prospectively enrolled in the German Stroke Registry–Endovascular Treatment (n=13 082) between 2015 and 2021. Patients who underwent MT for anterior circulation vessel occlusion with baseline National Institutes of Health Stroke Scale (NIHSS) score of <6 were included. END was defined as an increase in NIHSS score of ≥4 within the first 24 hours after MT. Multivariable regression analyses were performed to investigate factors associated with END and its association with unfavorable functional outcomes 90 days after treatment (modified Rankin Scale (mRS) score ≥2).ResultsAmong 817 patients included, 24% exhibited END and 48% had unfavorable functional outcomes. Prestroke mRS (adjusted odds ratio (aOR) [95% CI] 1.42 [1.13 to 1.78]), baseline NIHSS (aOR [95% CI] 0.83 [0.73 to 0.94]), time from admission to groin puncture (aOR [95% CI] 1.04 [1.02 to 1.07]), general anesthesia (aOR [95% CI] 1.68 [1.08 to 2.63]), number of passes (aOR [95% CI] 1.15 [1.03 to 1.29]), adverse events during treatment (aOR [95% CI] 1.89 [1.19 to 3.01]), successful recanalization (aOR [95% CI] 0.29 [0.17 to 0.50]), and intracranial hemorrhage on follow-up imaging (aOR [95% CI] 3.40 [1.90 to 6.07]) were independently associated with END. END was independently linked to unfavorable functional outcomes (aOR [95% CI] 7.51 [4.57 to 12.34]).ConclusionsAlmost a quarter of thrombectomy patients with minor stroke developed END. These patients had twice the odds of experiencing unfavorable functional outcomes.
Disruption, transformation and silos: medical humanities and the management gurus
Authors: Miller Gavin 
Published: July 2024

AbstractTo disrupt, to transform and to break through silos are common sense aims for the medical humanities and other interdisciplinary endeavours. These keywords arise because of the influence upon the academy of management and business gurus, reputed experts who arose in response to the economic crises of the 1980s. Despite the noted analytic deficiencies in the concept of disruption, and its association with product innovation, the term has been extended to academic research, where it connotes radical novelty in research practice, typically accompanied by profound organisational and managerial change. ‘Disruption’ has become wedded to the word ‘transformation’ as national funders seek to support more radically innovative research that will maintain Western economic hegemony. A distorted version of Kuhn’s model of scientific revolutions underpins the discourse of transformation, which fits humanities research to a template in which revolutionary, transformative shifts can be instrumentally favoured by funders, at the expense of inferior ‘incremental’ progress. Disruptive and transformative research are, according to funders, more readily produced in organisations that have broken through silos between disciplines. The silo metaphor misleadingly models academic disciplines as if they were essentially unitary entities, akin to the functionally specialised units of a business organisation. The discourse of silos arises from the guru doctrine of the learning organisation. This theory supposes that the organisation—including the university—is literally a living organism, and thereby susceptible to corporate sickness, mortality, infection and disability. Medical humanity researchers should be aware of, and reject, this vitalist metaphysic in which the optimal organisation is a culturally homogeneous supra-personal organism whose immense capacities are harnessed by visionary leaders. Moreover, a new vocabulary should be developed for research evaluation, superseding the supposed hierarchical opposition between transformative and incremental research.
Orthopedic Frailty Score and adverse outcomes in patients with surgically managed isolated traumatic spinal injury
Authors: Mohammad Ismail Ahmad , Hildebrand Frank , Forssten Maximilian Peter , Ribeiro Marcelo A F , Chang Parker , Cao Yang , Sarani Babak , Mohseni Shahin 
Published: July 2024

BackgroundWith an aging global population, the prevalence of frailty in patients with traumatic spinal injury (TSI) is steadily increasing. The aim of the current study is to evaluate the utility of the Orthopedic Frailty Score (OFS) in assessing the risk of adverse outcomes in patients with isolated TSI requiring surgery, with the hypothesis that frailer patients suffer from a disproportionately increased risk of these outcomes.MethodsThe Trauma Quality Improvement Program database was queried for all adult patients (18 years or older) who suffered an isolated TSI due to blunt force trauma, between 2013 and 2019, and underwent spine surgery. Patients were categorized as non-frail (OFS 0), pre-frail (OFS 1), or frail (OFS ≥2). The association between the OFS and in-hospital mortality, complications, and failure to rescue (FTR) was determined using Poisson regression models, adjusted for potential confounding.ResultsA total of 43 768 patients were included in the current investigation. After adjusting for confounding, frailty was associated with a more than doubling in the risk of in-hospital mortality (adjusted incidence rate ratio (IRR) (95% CI): 2.53 (2.04 to 3.12), p<0.001), a 25% higher overall risk of complications (adjusted IRR (95% CI): 1.25 (1.02 to 1.54), p=0.032), a doubling in the risk of FTR (adjusted IRR (95% CI): 2.00 (1.39 to 2.90), p<0.001), and a 10% increase in the risk of intensive care unit admission (adjusted IRR (95% CI): 1.10 (1.04 to 1.15), p=0.004), compared with non-frail patients.ConclusionThe findings indicate that the OFS could be an effective method for identifying frail patients with TSIs who are at a disproportionate risk of adverse events.Level of evidenceLevel III.
Acoustic telemetry and network analysis reveal seasonal spatial overlap between gadid species in a subarctic coastal marine protected area
Authors: King Benjamin G.C. , Morris Corey J. , Green John M. , Gregory Robert S. , Snelgrove Paul V.R. , Cote David , Pennell Curtis J. 
Published: July 2024

The Gilbert Bay marine protected area (MPA) was established in Labrador, Canada to protect a resident population of Atlantic cod ( Gadus morhua) and associated habitat. However, fisheries removals outside MPA boundaries have contributed to population decline and increases in potentially competing species may hinder recovery. Using acoustic telemetry and network analyses, we compared movements of Gilbert Bay cod ( n = 23), conspecifics from offshore environments (offshore Atlantic cod, n = 19), and Greenland cod ( Gadus ogac, n = 14) within and outside MPA boundaries from August 2014 to June 2017. Similar summer space use resulted in species overlap at seaward MPA boundaries and outside the MPA. In winter, Gilbert Bay cod and Greenland cod distributions overlapped within some MPA areas, and offshore Atlantic cod were absent. Some Gilbert Bay cod remained within the MPA year-round. Summer vulnerability to fisheries harvest outside MPA boundaries and winter overlap with competing Greenland cod within the MPA, may collectively challenge Gilbert Bay cod population recovery. Our study demonstrates the utility of acoustic telemetry and network analyses in evaluating animal movements for MPA management.
X-ray emission spectrum for axion–photon conversion in magnetospheres of strongly magnetized neutron stars
Authors: Yadav Shubham , Mishra M. , Sarkar Tapomoy Guha 
Published: July 2024

AbstractDetecting axionic dark matter (DM) could be possible in an X-ray spectrum from strongly magnetized neutron stars (NSs). We examine the possibility of axion–photon conversion in the magnetospheres of strongly magnetized NSs. In the current work, we investigate how the modified Tolman–Oppenheimer–Volkoff (TOV) system of equations (in the presence of a magnetic field) affects the energy spectrum of axions and axions-converted-photon flux. We have considered the distance-dependent magnetic field in the modified TOV system of equations. We employ three different equations of states (EoSs), namely APR, FPS, and SLY, to solve these equations. We obtain the axions emission rate by including the Cooper-pair-breaking formation process and Bremsstrahlung process in the core of NSs using the NSCool code. We primarily focus on Magnificient seven (M7) star RXJ 1856.5-3754. We further investigate the impact of the magnetic field on the actual observables, such as axion energy spectrum and axion-converted-photon flux at an axion mass in meV range by assuming mass $$M_{NS} \sim 1.4M_{\odot }.$$

M

NS

∼
1.4

M
⊙

.

We compare our calculated axion-converted-photon flux from all available archival data sets from PN+MOS+Chandra. We also study the variation of the energy spectrum at a fixed energy with varying central magnetic fields. Our predicted axion-converted-photon flux values as a function of axion energy closely follow the experimentally archival data, which allows us to put bounds on the axion mass for the three EoS.
The E3 Ubiquitin Ligase FBXO38 Maintains the Antitumor Function of Natural Killer Cells by Sustaining IL15R Signaling
Authors: Shi Yongjing , Zheng Xiaodong , Peng Hui , Xu Chenqi , Sun Rui , Tian Zhigang , Sun Haoyu , Wang Xianwei 
Published: July 2024

Abstract
Natural killer (NK) cells are the main innate antitumor effector cells but their function is often constrained in the tumor microenvironment. It has been reported that the E3 ligase FBXO38 accelerates PD-1 degradation in tumor-infiltrating T cells to unleash their cytotoxic function. In this study, we found that the transcriptional levels of FBXO38 in intratumoral NK cells of patients with cancer and tumor-bearing mice were significantly lower than in peritumoral NK cells. Conditional knockout of FBXO38 in NK cells accelerated tumor growth and increased tumor metastasis. FBXO38 deficiency resulted in impaired proliferation and survival of tumor-infiltrating NK (TINK) cells. Mechanistically, FBXO38 deficiency enhanced TGF-β signaling, including elevating expression of Smad2 and Smad3, which suppressed expression of the transcription factor Eomes and further reduced expression of surface IL15Rβ and IL15Rγc on NK cells. Consequently, FBXO38 deficiency led to TINK cell hyporesponsiveness to IL15. Consistent with these observations, FBXO38 mRNA expression was positively correlated with the proliferation of TINK cells in multiple human tumors. To study the therapeutic potential of FBXO38, mice bearing human tumors were treated with FBXO38 overexpressed human primary NK cells and showed a significant reduction in tumor size and prolonged survival. In conclusion, our results suggest that FBXO38 sustains NK-cell expansion and survival to promote antitumor immunity and have potential therapeutic implications as they suggest FBXO38 could be harnessed to enhance NK cell–based cancer immunotherapy.
Macrophage Migration Inhibitory Factor Promotes Thromboinflammation and Predicts Fast Progression of Aortic Stenosis
Authors: Mueller Karin Anne Lydia , Langnau Carolin , Harm Tobias , Sigle Manuel , Mott Kristina , Droppa Michal , Borst Oliver , Rohlfing Anne-Katrin , Gekeler Sarah , Günter Manina , Goebel Nora , Franke Ulrich F.W. , Radwan Medhat , Schlensak Christian , Janning Henrik , Scheuermann Sophia , Seitz Christian M. , Rath Dominik , Kreisselmeier Klaus-Peter , Castor Tatsiana , Mueller Iris Irmgard , Schulze Harald , Autenrieth Stella E. , Gawaz Meinrad Paul 
Published: July 2024

BACKGROUND:
Aortic stenosis (AS) is driven by progressive inflammatory and fibrocalcific processes regulated by circulating inflammatory and valve resident endothelial and interstitial cells. The impact of platelets, platelet-derived mediators, and platelet-monocyte interactions on the acceleration of local valvular inflammation and mineralization is presently unknown.

METHODS:
We prospectively enrolled 475 consecutive patients with severe symptomatic AS undergoing aortic valve replacement. Clinical workup included repetitive echocardiography, analysis of platelets, monocytes, chemokine profiling, aortic valve tissue samples for immunohistochemistry, and gene expression analysis.

RESULTS:

The patients were classified as fast-progressive AS by the median ∆Vmax of 0.45 m/s per year determined by echocardiography. Immunohistological aortic valve analysis revealed enhanced cellularity in fast-progressive AS (slow- versus fast-progressive AS; median [interquartile range], 247 [142.3–504] versus 717.5 [360.5–1234];
P
<0.001) with less calcification (calcification area, mm
2
: 33.74 [27.82–41.86] versus 20.54 [13.52–33.41];
P
<0.001). MIF (macrophage migration inhibitory factor)-associated gene expression was significantly enhanced in fast-progressive AS accompanied by significantly elevated MIF plasma levels (mean±SEM; 6877±379.1 versus 9959±749.1;
P
<0.001), increased platelet activation, and decreased intracellular MIF expression indicating enhanced MIF release upon platelet activation (CD62P, %: median [interquartile range], 16.8 [11.58–23.8] versus 20.55 [12.48–32.28],
P
=0.005; MIF, %: 4.85 [1.48–9.75] versus 2.3 [0.78–5.9],
P
<0.001). Regression analysis confirmed that MIF-associated biomarkers are strongly associated with an accelerated course of AS.

CONCLUSIONS:
Our findings suggest a key role for platelet-derived MIF and its interplay with circulating and valve resident monocytes/macrophages in local and systemic thromboinflammation during accelerated AS. MIF-based biomarkers predict an accelerated course of AS and represent a novel pharmacological target to attenuate progression of AS.