bluuebunny/crossref_metadata_2025_split huggingface dataset:
Kidney Blood Flow and Renin-Angiotensin-Aldosterone System Measurements Associated With Kidney and Cardiovascular Dysfunction in Pediatric Shock
Authors: Fisler Grace , Murphy Kristina , Mastroianni Fiore , Schneider James B. , Deutschman Clifford S. , Leisman Daniel E. , Taylor Matthew D. 
Published: August 2024

IMPORTANCE:
Pediatric acute kidney injury (AKI) is a prevalent and morbid complication of shock. Its pathogenesis and early identification remain elusive.

OBJECTIVES:
We aim to determine whether renal blood flow (RBF) measurements by point-of-care ultrasound (POCUS) and renin-angiotensin-aldosterone system (RAAS) hormones in pediatric shock associate with vasoactive requirements and AKI.

DESIGN, SETTING, AND PARTICIPANTS:
This is a single-center prospective, noninterventional observational cohort study in one tertiary PICU in North American from 2020 to 2022 that enrolled children younger than 18 years with shock without preexisting end-stage renal disease.

MAIN OUTCOMES AND MEASURES:
RBF was measured by POCUS on hospital days 1 and 3 and plasma RAAS hormone levels were measured on day 1. The primary outcome was the presence of AKI by Kidney Disease Improving Global Outcomes criteria at first ultrasound with key secondary outcomes of creatinine, blood urea nitrogen (BUN), Vasoactive-Inotrope Score (VIS), and norepinephrine equivalent dosing (NED) 48 hours after first ultrasound.

RESULTS:
Fifty patients were recruited (20 with AKI, mean age 10.5 yr, 48% female). POCUS RBF showed lower qualitative blood flow (power Doppler ultrasound [PDU] score) and higher regional vascular resistance (renal resistive index [RRI]) in children with AKI (p = 0.017 and p = 0.0007). Renin and aldosterone levels were higher in the AKI cohort (p = 0.003 and p = 0.007). Admission RRI and PDU associated with higher day 3 VIS and NED after adjusting for age, day 1 VIS, and RAAS hormones. Admission renin associated with higher day 3 creatinine and BUN after adjusting for age, day 1 VIS, and the ultrasound parameters.

CONCLUSIONS AND RELEVANCE:
In pediatric shock, kidney blood flow was abnormal and renin and aldosterone were elevated in those with AKI. Kidney blood flow abnormalities are independently associated with future cardiovascular dysfunction; renin elevations are independently associated with future kidney dysfunction. Kidney blood flow by POCUS may identify children who will have persistent as opposed to resolving AKI. RAAS perturbations may drive AKI in pediatric shock.
Simulating the impact of greenspace exposure on metabolic biomarkers in a diverse population living in San Diego, California: A g-computation application
Authors: Teyton Anaïs , Nukavarapu Nivedita , Letellier Noémie , Sears Dorothy D. , Yang Jiue-An , Jankowska Marta M. , Benmarhnia Tarik 
Published: August 2024

Introduction:
Growing evidence exists that greenspace exposure can reduce metabolic syndrome risk, a growing public health concern with well-documented inequities across population subgroups. We capitalize on the use of g-computation to simulate the influence of multiple possible interventions on residential greenspace on nine metabolic biomarkers and metabolic syndrome in adults (N = 555) from the 2014–2017 Community of Mine Study living in San Diego County, California.

Methods:
Normalized difference vegetation index (NDVI) exposure from 2017 was averaged across a 400-m buffer around the participants’ residential addresses. Participants’ fasting plasma glucose, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglyceride concentrations, systolic and diastolic blood pressure, hemoglobin A1c (%), waist circumference, and metabolic syndrome were assessed as outcomes of interest. Using parametric g-computation, we calculated risk differences for participants being exposed to each decile of the participant NDVI distribution compared to minimum NDVI. Differential health impacts from NDVI exposure by sex, ethnicity, income, and age were examined.

Results:
We found that a hypothetical increase in NDVI exposure led to a decrease in hemoglobin A1c (%), glucose, and high-density lipoprotein cholesterol concentrations, an increase in fasting total cholesterol, low-density lipoprotein cholesterol, and triglyceride concentrations, and minimal changes to systolic and diastolic blood pressure, waist circumference, and metabolic syndrome. The impact of NDVI changes was greater in women, Hispanic individuals, and those under 65 years old.

Conclusions:
G-computation helps to simulate the potential health benefits of differential NDVI exposure and identifies which subpopulations can benefit most from targeted interventions aimed at minimizing health disparities.
Influenced: Exploring the Effect of Social Media on Medical Students’ Perceptions of Plastic Surgery
Authors: Ford Aubree , Doherty Courtney , Vargo James D. 
Published: August 2024

Background:
Medical students rarely receive dedicated education in plastic surgery, exposing them to influence from the internet or television programming that is frequently skewed toward cosmetic procedures. Additionally, social media posts from board-certified plastic surgeons make up a small portion of available content. These biased representations may impact students’ perceptions, narrowing the scope of referrals and limiting career exploration.

Methods:
Medical students at two academic medical centers were surveyed. Blinded data were collected on exposure to plastic surgery, social media usage, observed content, and perceptions of the specialty. Students’ understanding of plastic surgery was evaluated using clinical scenarios.

Results:
The response rate was 24.3%. Social media and television were the primary contributors to understanding of plastic surgery in 51.6% of students, especially for those who had not completed a surgical clerkship (P < 0.026). Students most frequently viewed plastic surgery content posted by influencers (28.1%), followed by board-certified plastic surgeons (24.1%), patients (21.2%), and nonplastic surgeon physicians (19.7%). Posts relating to cosmetic procedures (44.3%) were viewed most frequently. Students who followed board-certified plastic surgeons performed better when answering clinical vignettes (64.8% versus 50.9%).

Conclusions:
Social media and television play a significant role in medical students’ perceptions of plastic surgery. Students are also more likely to see posts from influencers than board-certified plastic surgeons, furthering potential bias. Quality content from board-certified surgeons and professional societies may improve scope of practice creep and student interest.
The Hierarchy of Needs: A Problem-based Framework for Extremity Reconstruction
Authors: Kareh Aurora M. , Souza Jason M. 
Published: August 2024

Summary:
Plastic and reconstructive surgeons continually evolve their surgical strategies with the aim of achieving the optimal patient outcome. Numerous well-known frameworks intended to guide reconstructive planning have been introduced and are entrenched in plastic surgery education, but are limited in their scope due to their procedure-based construct. Here, we introduce the hierarchy of reconstructive needs: a problem-based reconstructive framework that shifts operative planning to the specific needs of the defect and goals for restoration of normality while allowing for further innovation and evolution beyond our existing surgical capabilities.
Association between longitudinal biomarkers and major adverse liver outcomes in patients with non-cirrhotic metabolic dysfunction–associated steatotic liver disease
Authors: Shang Ying , Akbari Camilla , Dodd Maja , Zhang Xiao , Wang Tongtong , Jemielita Thomas , Fernandes Gail , Engel Samuel S. , Nasr Patrik , Vessby Johan , Rorsman Fredrik , Kechagias Stergios , Stål Per , Ekstedt Mattias , Hagström Hannes 
Published: August 2024

Background and Aims:
Noninvasive biomarkers provide prognostic information for the development of major adverse liver outcomes (MALOs) in patients with metabolic dysfunction–associated steatotic liver disease (MASLD), but the predictive value of longitudinal biomarker measurements has not been evaluated. We assessed whether changes in biomarkers could predict incident MALO in MASLD.

Approach and Results:
We analyzed a cohort of 1260 patients (71.7% on biopsy) with non-cirrhotic MASLD between 1974 and 2019. Data at baseline and follow-up visits were obtained from medical charts. MALO was determined through medical charts and linkage to national registers until the end of 2020. A joint modeling approach was used to quantify the associations between the trajectory of biomarkers and the risk of MALO. MASLD was diagnosed at a median age of 52 years (IQR: 39–60), and 59% were male. During a median follow-up of 12.2 years, 111 (8.8%) patients developed MALO. The joint modeling showed that an elevated fibrosis-4 score (HR: 2.60, 95% CI: 1.89–3.50), aspartate aminotransferase (HR: 2.69, 95% CI: 2.57–3.05), and lower platelet count (HR: 0.93, 95% CI: 0.90–0.97) at any time point were associated with an increased risk of MALO, whereas the rate of change in these biomarkers had no association with this risk.

Conclusions:
In addition to baseline measurements of noninvasive biomarkers such as fibrosis-4 score, aspartate aminotransferase, and platelets taken at MASLD diagnosis, monitoring their values over time is important, as the latest value of these biomarkers is closely associated with the risk of future MALO. The rate of change may not be as important.
The TBI Model Systems Neighborhood Socioeconomic Disadvantage Index (TBIMS-NSDI): Development and Comparison to Individual Socioeconomic Characteristics
Authors: Kumar Raj G. , Delgado Andrew , Corrigan John D. , Eagye CB , Whiteneck Gale G. , Juengst Shannon B. , Callender Librada , Bogner Jennifer A. , Pinto Shanti M. , Rabinowitz Amanda R. , Perrin Paul B. , Venkatesan Umesh M. , Botticello Amanda L. , Lequerica Anthony H. , Taylor Shameeke , Zafonte Ross D. , Dams-O’Connor Kristen 
Published: August 2024

Objective:
To create a census-based composite neighborhood socioeconomic deprivation index (NSDI) from geocoded residential addresses and to quantify how NSDI aligns with individual-level socioeconomic factors among people with traumatic brain injury (TBI).

Setting:
Community

Participants:
People enrolled in the TBI Model Systems National Database (TBIMS NDB).

Design:
Secondary analysis of a longitudinal cohort study.

Main Measures:
The TBIMS-NSDI was calculated at the census tract level for the United States population based on a principal components analysis of eight census tract-level variables from the American Community Survey. Individual socioeconomic characteristics from the TBIMS NDB were personal household income, education (years), and unemployment status. Neighborhood:Individual NSDI residuals represent the difference between predicted neighborhood disadvantage based on individual socioeconomic characteristics versus observed neighborhood disadvantage based on the TBIMS-NSDI.

Results:
A single principal component was found to encompass the eight socioeconomic neighborhood-level variables. It was normally distributed across follow-up years 2, 5, and 10 post-injury in the TBIMS NDB. In all years, the TBIMS-NDSI was significantly associated with individual-level measures of household income and education but not unemployment status. Males, persons of Black and Hispanic background, Medicaid recipients, persons with TBI caused by violence, and those living in urban areas, as well as in the Northeast or Southern regions of the United States, were more likely to have greater neighborhood disadvantage than predicted based on their individual socioeconomic characteristics.

Conclusions:
The TBIMS-NSDI provides a neighborhood-level indicator of socioeconomic disadvantage, an important social determinant of outcomes from TBI. The Neighborhood:Individual NSDI residual adds another dimension to the TBIMS-NSDI by summarizing how a person’s socioeconomic status aligns with their neighborhood socioeconomics. Future studies should evaluate how both measures affect TBI recovery and life quality. Research studying neighborhood socioeconomic disadvantage may improve our understanding of how systemic adversity influences outcomes after TBI.
Nursing Recommendations for Symptom-Specific Self-care of Low Anterior Resection Syndrome
Authors: Solnica Amy , Liebergall-Wischnitzer Michal , Shussman Noam 
Published: August 2024

Background
Low anterior resection syndrome (LARS) is a result of removing part or most of the rectum as a treatment for rectal cancer that negatively impacts quality of life. There is a lack of standardized nursing symptom-specific self-care recommendations for patients suffering from LARS.

Objective
The aim of this study was to map the existing research regarding nursing guidelines and symptom-specific recommendations for LARS self-care.

Methods
A systematic scoping review using 4 comprehensive databases (ProQuest, EMBASE, PubMed, and Web of Science) was completed using the PRISMA Extension for Scoping Reviews guidelines. Applying specified search terms, relevant articles were extracted using criteria and entered into an Excel database.

Results
Three publications met the study inclusion criteria: 1 randomized controlled pilot study; 1 nonrandomized, retrospective pilot study; and 1 retrospective, comparative, cross-sectional study. No professional nursing guidelines were found, but 3 nurse-led management programs were reviewed. Publications provided self-care nursing recommendations for all LARS symptoms except for repeated painful stools/tenesmus, soiling, or discrimination disorders/flatulence. Combination of nursing self-care recommendations included dietary/lifestyle modifications, fiber supplements/bulking agents, antidiarrheal and laxative over-the-counter medications, and pelvic floor muscle exercises.

Conclusions
When mapping the literature, there appears to be nurse-led management programs and recommendations for self-care for patients with LARS for almost all symptoms. Yet, there are no standardized recommendations.

Implications for Practice
Professional nursing practice guidelines for all symptoms are lacking. Nursing recommendations for self-care of LARS exist and need to be expanded and standardized to include all symptoms. Further research regarding comprehensive nursing self-care recommendations and management is warranted.
Transcutaneous vagus nerve stimulation effects on chronic pain: systematic review and meta-analysis
Authors: Costa Valton , Gianlorenço Anna Carolyna , Andrade Maria Fernanda , Camargo Lucas , Menacho Maryela , Arias Avila Mariana , Pacheco-Barrios Kevin , Choi Hyuk , Song Jae-Jun , Fregni Felipe 
Published: August 2024

Abstract
Chronic pain is one of the major causes of disability with a tremendous impact on an individual's quality of life and on public health. Transcutaneous vagus nerve stimulation (tVNS) is a safe therapeutic for this condition. We aimed to evaluate its effects in adults with chronic pain. A comprehensive search was performed, including randomized controlled trials published until October 2023, which assessed the effects of noninvasive tVNS. Cohen's d effect size and 95% confidence intervals (CIs) were calculated, and random-effects meta-analyses were performed. Fifteen studies were included. The results revealed a mean effect size of 0.41 (95% CI 0.17-0.66) in favor of tVNS as compared with control, although a significant heterogeneity was observed (χ2 = 21.7, df = 10, P = 0.02, I
2 = 53.9%). However, when compared with nonactive controls, tVNS shows a larger effect size (0.79, 95% CI 0.25-1.33), although the number of studies was small (n = 3). When analyzed separately, auricular tVNS and cervical tVNS against control, it shows a significant small to moderate effect size, similar to that of the main analysis, respectively, 0.42 (95% CI 0.08-0.76, 8 studies) and 0.36 (95% CI 0.01-0.70, 3 studies). No differences were observed in the number of migraine days for the trials on migraine. This meta-analysis indicates that tVNS shows promise as an effective intervention for managing pain intensity in chronic pain conditions. We discuss the design of future trials to confirm these preliminary results, including sample size and parameters of stimulation.
Babesiosis in immunosuppressed hosts: pathogenesis, diagnosis and management
Authors: Heller Howard M. 
Published: August 2024

Purpose of review
This review provides the most recent evidence of the challenges that occur in the management of babesiosis in immunocompromised hosts.

Recent findings
The epidemiology of babesiosis is affected by climate change leading to increasing numbers of cases as well as increasing areas of endemicity. Immunosuppressed hosts, especially with asplenia or B-cell defects, are at high risk of having severe disease as well as persistent and relapsed infection. Resistance to the primary therapies azithromycin and atovaquone can develop leading to further challenges in treating persistent or relapsed disease in the immunocompromised host.

Summary
Babesiosis is likely to become a more frequent infectious complication in immunosuppressed hosts as the areas of endemicity expand. Reduced efficacy of standard therapies is likely to continue emerging so more effort needs to be placed on methods of assessing resistance in vitro and developing more reliable treatments for resistant infections.
The Impact of Low Workplace Support During Pregnancy on Surgeon Distress and Career Dissatisfaction
Authors: Lwin Thinzar M. , Castillo-Angeles Manuel , Cunningham Carrie E. , Atkinson Rachel B. , Kim Eugene , Easter Sarah Rae , Gosain Ankush , Hu Yue-Yung , Rangel Erika L 
Published: August 2024

Objective:
To describe the impact of lack of workplace support (LOWS) for obstetric health on surgeon distress and career satisfaction.

Background:
Although most pregnant surgeons desire clinical duty reductions to mitigate obstetric risk, few modify their schedules due to low workplace support.

Methods:
US surgeons with at least one live birth completed an electronic survey. LOWS during pregnancy was defined as (1) disagreeing that colleagues/leadership were supportive of obstetric-mandated bedrest; (2) feeling unable to reduce clinical duties despite health concerns due to risk of financial penalties, requirement to make up missed call shifts, being perceived as “weak”, burdening colleagues, or accommodations being denied by the workplace. Multivariate logistic regression determined the association between LOWS and burnout, low quality of life, plans to leave clinical practice or to reduce work hours, and likelihood of recommending a surgical career to one’s child.

Results:
Of 557 surgeons, the 360 (64.6%) who reported LOWS during pregnancy were more likely to report burnout (OR:2.57; 95%CI:1.60-4.13), low quality of life (OR:1.57; 95%CI:1.02-2.41), a desire to leave their practice (OR:2.74; 95%CI: 1.36-5.49), plans to reduce clinical hours in the next year (OR:4.25; 95%CI:1.82-9.90), and were less likely to recommend their career to their child (OR:0.44; 95%CI:0.28-0.70).

Conclusions:
LOWS for maternal-fetal health concerns is associated with burnout, low quality of life, and career dissatisfaction. The work environment is a modifiable factor requiring system-level interventions to limit clinical work during pregnancy and provide fair compensation for covering surgeons. Supporting surgeons during pregnancy is a short-term investment with long-term implications for improving longevity and diversity of the workforce.
Financial innovation and gender dynamics: a comparative study of male and female FinTech adoption in emerging economies
Authors: Kumar Jitender , Rani Vinki 
Published: August 2024

Purpose
This paper aims to identify the factors influencing the adoption of financial technology (FinTech) services among Indian residents. Moreover, it compares the awareness levels among both male and female users to offer a comprehensive insight into FinTech adoption.

Design/methodology/approach
The research comprises two cross-sectional surveys utilizing self-administered questionnaires: Study A involves 411 male participants and Study B involves 473 female users in FinTech adoption. This article used a “Statistical Package for Social Science (SPSS) followed by partial least squares-structural equation modeling (PLS-SEM)” for data analysis.

Findings
The exciting finding reveals that attitude and personal innovativeness have a significant impact, while technology anxiety shows a statistically insignificant impact on awareness in both studies. Surprisingly, the socio-demographic factor significantly impacts awareness (in Study A) and has an insignificant impact on awareness in Study B. Moreover, both studies reveal that awareness significantly impacts perceived usefulness and ease of use. Additionally, the outcomes confirm a positive relation between awareness, perceived usefulness, ease of use and FinTech adoption in both studies.

Practical implications
The present research will offer valuable insights to all FinTech service providers and stakeholders, aiding them in planning and designing relevant policies.

Originality/value
As far as the researchers are aware, this study stands as the initial survey into FinTech that specifically examines the impact of gender on technology adoption. The divergence in awareness and adoption rates between males and females and the authors’ insightful findings illuminate the context's uniqueness. Moreover, this article offers a robust model for using FinTech services from the perspective of a developing economy.
Entrepreneurial orientation and product innovation performance: developing the linkages through strategic human resource management and technology capability
Authors: Abdelwahed Nadia A. Abdelmegeed , Al Doghan Mohammed A. , Shah Naimatullah , Soomro Bahadur Ali 
Published: August 2024

Purpose
The optimization of product innovation performance (PIP) is paramount to achieving sustained profitability in the face of current organizational challenges. In this study, as researchers, the authors investigate within the context of Saudi Arabian manufacturing firms’ entrepreneurial orientation (EO) direct impact on PIP and its indirect influence mediated by strategic human resource management (SHRM) and technology capability (TC).

Design/methodology/approach
This co-relational study used cross-sectional data. The authors collected the data from the manufacturing firms’ top management team, chief executive officers and other staff members, including human resource (HR) managers and chief information officers. This study’s conclusions are based on 307 cases.

Findings
Using SmartPLS4, this study’s findings demonstrate that EO exerts a positive and significant impact on SHRM, PIP and TC. SHRM has a positive and significant effect on PIP. In addition, TC is a positive and significant predictor of SHRM but not PIP. Turning to the mediating impacts, SHRM plays a positive mediating role between TC and PIP and a negative role between EO and PIP. Finally, TC reinforces the negative connections between EO and PIP.

Practical implications
This study's insights offer valuable guidance to firms and policymakers. They underscore the importance of investing in TC to reinforce SHRM and drive innovation. Moreover, these findings emphasize the need for firms to adopt a dynamic approach that comprises continuous monitoring, adaptation and tailored HR strategies supported by performance metrics. This proactive stance ensures that innovation remains a consistent and impactful element of their long-term strategy.

Originality/value
This study stands out by addressing existing gaps through its innovative integration of EO, SHRM, TC and PIP within a unified framework. It does so within the specific context of Saudi Arabian manufacturing firms and provides a unique and contextually relevant perspective that contributes to the knowledge body of the area.