bluuebunny/crossref_metadata_2025_split huggingface dataset:
Electronic documentation burden among outpatient rehabilitation therapists: a qualitative descriptive study and quality improvement initiative
Authors: Schwartz-Dillard Jessica , Ng Travis , Villegas Joann , Johnson Derrick , Murray-Weir Mary 
Published: July 2024

Abstract

Objectives
Outpatient rehabilitation (rehab) physical, occupational, and speech therapists use electronic health records (EHR), yet their documentation experiences, including any documentation burden, are not well researched. Therapists are a growing portion of the U.S. healthcare workforce, whose need is critical to the health of an aging population. We aimed to describe outpatient rehab therapists’ documentation experiences and identify strategies for mitigating any documentation burden.

Materials and Methods
We used qualitative descriptive methodology to conduct 4 focus groups with outpatient rehab therapists at Hospital for Special Surgery, a multi-site orthopedic institution. Transcripts were inductively coded to identify themes and actionable strategies for improving the therapists’ documentation experiences. Therapists provided feedback and prioritization of proposed strategies.

Results
A total of 13 therapists were interviewed. Five themes and 10 subthemes characterize the therapists’ documentation experience by a feeling that documentation inhibits clinical care and work/life balance, a perceived lack of support and efficiencies, the desire to document to communicate clinical care, and a design vision for improving the EHR. Top prioritized strategies for improvement included use of timesaving templates, expanding dictation, decluttering the EHR interface, and support for free texting over discrete data capture.

Discussion
Outpatient rehab therapists experience documentation burden similar to that documented of physicians and nurses. Manual data entry imposes burden on therapists’ time and clinical care.

Conclusion
A multi-faceted approach is needed for improving therapists’ experiences including EHR redesign, technology supporting dictation and narrative to discrete data capture, and support from leadership and regulators.
Opportunistic Infections, Mortality Risk, and Prevention Strategies in Patients With Vacuoles, E1 Enzyme, X-Linked, Autoinflammatory, Somatic (VEXAS) Syndrome
Authors: Czech Mary , Cuellar-Rodriguez Jennifer , Patel Bhavisha A , Groarke Emma M , Cowen Edward W , Turturice Benjamin , Beck David B , Wilson Lorena , Goodspeed Wendy , Darden Ivana , Young Neal S , Hickstein Dennis , Ombrello Amanda , Hoffman Patrycjia , Arikan Evsen Apaydin , Sinaii Ninet , Hathaway Londa , Castelo-Soccio Leslie , Fike Alice , Kastner Daniel B , Grayson Peter C , Ferrada Marcela A 
Published: July 2024

Abstract

Background
VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome is a genetic disorder characterized by bone marrow failure and systemic inflammation, putting patients at risk for infections. This study comprehensively examines the prevalence of opportunistic infections in patients with VEXAS, evaluating their impact on clinical outcomes and potential preventive measures.

Methods
Patients with confirmed VEXAS were included. Survival analysis and logistic regression were used to identify associations between opportunistic infections and mortality. Infection rates (IRs) for Pneumocystis jirovecii pneumonia (PJP) and alphaherpesviruses were calculated over a prospective 8-month observation period in relationship to prophylaxis.

Results
Of 94 patients with VEXAS, 6% developed PJP; 15% had alphaherpesvirus reactivation, with varicella zoster virus (VZV) being the most common herpesvirus; and 10% contracted a nontuberculous mycobacterial (NTM) infection. Risk of death was significantly increased per month following a diagnosis of PJP (hazard ratio [HR], 72.41 [95% confidence interval {CI}, 13.67–533.70]) or NTM (HR, 29.09 [95% CI, 9.51–88.79]). Increased odds for death were also observed in patients with a history of herpes simplex virus (HSV) reactivation (odds ratio [OR], 12.10 [95% CI, 1.29–114.80]) but not in patients with VZV (OR, 0.89 [95% CI, .30–2.59]). Prophylaxis for PJP (IR, 0.001 vs 0 per person-day, P &lt; .01) and VZV (IR, 0.006 vs 0 per person-day, P = .04) markedly decreased infection rates with a number needed to treat of 4 and 7, respectively.

Conclusions
Opportunistic infections are common in patients with VEXAS. Patients who develop PJP, HSV, or NTM are at increased risk for death. Prophylaxis against PJP and VZV is highly effective.
GMP-compliant iPS cell lines show widespread plasticity in a new set of differentiation workflows for cell replacement and cancer immunotherapy
Authors: Terheyden-Keighley Daniel , Hühne Melanie , Berger Thomas , Hiller Björn , Martins Soraia , Gamerschlag Anna , Sabour Davood , Meffert Andrea , Kislat Andreas , Slotta Carsten , Hafezi Francois , Lichte Jens , Sudheer Smita , Tessmer Karen , Psathaki Katherina , Ader Marius , Kogler Gesine , Greber Boris 
Published: July 2024

Abstract
Cell therapeutic applications based on induced pluripotent stem cells (iPSCs) appear highly promising and challenging at the same time. Good manufacturing practice (GMP) regulations impose necessary yet demanding requirements for quality and consistency when manufacturing iPSCs and their differentiated progeny. Given the scarcity of accessible GMP iPSC lines, we have established a corresponding production workflow to generate the first set of compliant cell banks. Hence, these lines met a comprehensive set of release specifications and, for instance, displayed a low overall mutation load reflecting their neonatal origin, cord blood. Based on these iPSC lines, we have furthermore developed a set of GMP-compatible workflows enabling improved gene targeting at strongly enhanced efficiencies and directed differentiation into critical cell types: A new protocol for the generation of retinal pigment epithelium (RPE) features a high degree of simplicity and efficiency. Mesenchymal stromal cells (MSCs) derived from iPSCs displayed outstanding expansion capacity. A fully optimized cardiomyocyte differentiation protocol was characterized by a particularly high batch-to-batch consistency at purities above 95%. Finally, we introduce a universal immune cell induction platform that converts iPSCs into multipotent precursor cells. These hematopoietic precursors could selectively be stimulated to become macrophages, T cells, or natural killer (NK) cells. A switch in culture conditions upon NK-cell differentiation induced a several thousand-fold expansion, which opens up perspectives for upscaling this key cell type in a feeder cell-independent approach. Taken together, these cell lines and improved manipulation platforms will have broad utility in cell therapy as well as in basic research.
Genetically Similar Xanthomonas arboricola pv. pruni Strains and Associated Phages Display Phenotypic and Genotypic Variation Across 35 Years
Authors: D'Amico-Willman Katherine M. , Joglekar Prasanna , Ritchie David F. , Smith Amber M. , Heiberger Helena , Huerta Alejandra I. 
Published: July 2024

Bacteriophages (phages), viruses that infect bacteria, have key ecological and evolutionary functions in the phytobiome. Despite the importance of phages as primary drivers for bacterial evolution, phage-bacteria interactions across spatiotemporal scales in natural, agricultural settings are underexplored. With increased interest in phage-based therapies to manage bacterial pathogens, an enhanced understanding of phage genetic and functional diversity at the population level and how this, in turn, impacts bacterial evolution and virulence, is necessary. This study presents data on the genetic similarity among Xanthomonas arboricola pv. pruni (Xap) strains isolated from different geographic locations that display different lytic phenotypes when challenged with a panel of six phage isolates collected in the same region over four decades. The minor yet significant genetic variation among this small population of Xap strains is structured by both geographic location and response to phage infection. Phage genomes are also highly similar, with conserved and diverse genomic loci that correspond to isolation year. The six phages characterized here cluster into the Kantovirinae subfamily and possibly form a new genus. Only future studies will elucidate the role of Xap and Xapφ phage genes identified here in the virulence and lysis of Xap and how these, in turn, impact bacterial spot disease outcomes. The research and tripartite pathosystem presented here provide a unique opportunity to investigate the coevolution of phage-phytobacterial pathogen-plant host in depth in an agricultural setting with the potential to monitor the rate at which phage populations contribute to bacterial genetic diversity across geographic and temporal scales. [Formula: see text] Copyright © 2025 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Cardiac diastolic dysfunction by cigarette smoking is associated with mitochondrial integrity in the heart
Authors: Slotabec Lily , Wang Hao , Seale Blaise , Wen Changhong , Filho Fernanda , Li Ji 
Published: July 2024

AbstractCigarette smoking behaviors are harmful and cause one out of ten deaths due to cardiovascular disease. As population sizes grow and number of cigarette smokers increases, it is vital that we understand the mechanisms leading to heart failure in cigarette smokers. We have reported that metabolic regulation of a histone deacetylase, SIRT1, modulates cardiovascular and mitochondrial function under stress. Given this conclusion, we hypothesized that chronic cigarette smoking led to cardiovascular dysfunction via a reduction SIRT1. Mice were randomly organized into smoking or nonsmoking groups, and the smoking group received cigarette smoke exposure for 16 weeks. Following 16‐week exposure, diastolic function of the heart was impaired in the smoking group as compared to sham, indicated by a significant increase in E/e’. The electrical function of the heart was also impaired in the smoking group compared to the sham group, indicated by increased PR interval and decreased QTc interval. This diastolic dysfunction was not accompanied by increased fibrosis in mouse hearts, although samples from human chronic smokers indicated increased fibrosis compared to their nonsmoker counterparts. As well as diastolic dysfunction, mitochondria from the 16‐week smoking group showed significantly impaired function, evidenced by significant decreases in all parameters measured by the mitochondrial stress test. We further found biochemical evidence of a significantly decreased level of SIRT1 in left ventricles of both mouse and human smoking groups compared to nonsmoking counterparts. Data from this study indicate that decreased SIRT1 levels by cigarette smoking are associated with diastolic dysfunction caused by compromised mitochondrial integrity.
Beneficial Effect of Calcium Treatment for Hyperkalemia Is Not Due to “Membrane Stabilization”*
Authors: Piktel Joseph S. , Wan Xiaoping , Kouk Shalen , Laurita Kenneth R. , Wilson Lance D. 
Published: July 2024

OBJECTIVES:
Hyperkalemia is a common life-threatening condition causing severe electrophysiologic derangements and arrhythmias. The beneficial effects of calcium (Ca2+) treatment for hyperkalemia have been attributed to “membrane stabilization,” by restoration of resting membrane potential (RMP). However, the underlying mechanisms remain poorly understood. Our objective was to investigate the mechanisms underlying adverse electrophysiologic effects of hyperkalemia and the therapeutic effects of Ca2+ treatment.

DESIGN:
Controlled experimental trial.

SETTING:
Laboratory investigation.

SUBJECTS:
Canine myocytes and tissue preparations.

INTERVENTIONS AND MEASUREMENTS:
Optical action potentials and volume averaged electrocardiograms were recorded from the transmural wall of ventricular wedge preparations (n = 7) at baseline (4 mM potassium), hyperkalemia (8–12 mM), and hyperkalemia + Ca2+ (3.6 mM). Isolated myocytes were studied during hyperkalemia (8 mM) and after Ca2+ treatment (6 mM) to determine cellular RMP.

MAIN RESULTS:
Hyperkalemia markedly slowed conduction velocity (CV, by 67% ± 7%; p < 0.001) and homogeneously shortened action potential duration (APD, by 20% ± 10%; p < 0.002). In all preparations, this resulted in QRS widening and the “sine wave” pattern observed in severe hyperkalemia. Ca2+ treatment restored CV (increase by 44% ± 18%; p < 0.02), resulting in narrowing of the QRS and normalization of the electrocardiogram, but did not restore APD. RMP was significantly elevated by hyperkalemia; however, it was not restored with Ca2+ treatment suggesting a mechanism unrelated to “membrane stabilization.” In addition, the effect of Ca2+ was attenuated during L-type Ca2+ channel blockade, suggesting a mechanism related to Ca2+-dependent (rather than normally sodium-dependent) conduction.

CONCLUSIONS:
These data suggest that Ca2+ treatment for hyperkalemia restores conduction through Ca2+-dependent propagation, rather than restoration of membrane potential or “membrane stabilization.” Our findings provide a mechanistic rationale for Ca2+ treatment when hyperkalemia produces abnormalities of conduction (i.e., QRS prolongation).
Risk Factors for Upper Extremity Impairment after Mastectomy: A Single Institution Retrospective Review
Authors: Carr Hannah M. , Patel Ronak A. , Beederman Maureen R. , Maassen Nicholas H. , Hanson Summer E. 
Published: July 2024

Background:
Patients with breast cancer treated with mastectomy are more likely to develop upper extremity dysfunction compared with those treated with breast-conserving therapy. This study aimed to identify cancer and treatment characteristics that may be risk factors for development of upper extremity dysfunction in patients treated with mastectomy.

Methods:
The authors performed a retrospective chart review of patients at the University of Chicago who were treated with a unilateral or bilateral mastectomy from 2010 to 2020 and developed upper extremity dysfunction based on International Classification of Disease-10 codes. Patients were analyzed by side of body (left or right). Patient demographics and treatment characteristics were extracted from the electronic medical record.

Results:
In total, 259 patients met criteria and were included in our study. A total of 396 upper extremities were recorded as experiencing dysfunction and were analyzed. Mean age was 60 years (range = 28–96), and mean body mass index was 28.4 (SD = 7.5). An estimated 54% of patients underwent breast reconstruction. After multivariable analysis, chronic upper extremity pain was found to be associated with ipsilateral radiotherapy (P < 0.001) and ipsilateral in situ cancer (0.041). Limited range of motion was found to be associated with ipsilateral invasive cancer (P = 0.01), any ipsilateral mastectomy surgery (P < 0.001), and ipsilateral radiotherapy (P = 0.03). Musculoskeletal dysfunction was found to be associated with no ipsilateral modified radical mastectomy (P = 0.033). No oncological or treatment characteristics were found to be associated with decreased strength or adhesive capsulitis. Furthermore, breast reconstruction (implant or autologous tissue based) was not associated with upper extremity dysfunction.

Conclusion:
Breast cancer characteristics and treatment modalities may predispose patients treated with mastectomy to developing types of upper extremity dysfunction.
Frequency and Outcome of Emergency Penetrating Keratoplasty in Infectious Keratitis in Sweden During the 21st Century
Authors: Viberg Andreas , Byström Berit 
Published: July 2024

Purpose:
To study the frequency over time and outcome of penetrating keratoplasty (PK), “keratoplasty à chaud,” in patients with infectious keratitis with 2-year follow-up data.

Methods:
This register-based study included keratitis cases that had undergone PK in Sweden between 2001 and 2020 and reported to the Swedish Corneal Transplant Register.

Results:
During the study period, 69 eyes were subjected to acute PK due to progressive infectious keratitis. The number increased from 2 annual procedures in the first half of the study period to 5 in the second half (P = 0.01). Preoperative corneal perforation was present in 43.5% (n = 30) of the eyes. Two years after surgery, follow-up data were completed in the register for 53 eyes; of these, 62.3% (n = 33) were considered to have functioning grafts, and 20.8% (n = 11) had experienced a rejection episode. The visual acuity improved from hand motion to counting fingers (P = 0.002), and the proportion of eyes with a visual acuity of ≤1.0 logMAR increased from 5.7% (n = 3) before the surgery to 45.3% (n = 24) at the 2-year follow-up (P < 0.001).

Conclusions:
The number of active infectious keratitis cases undergoing keratoplasty à chaud increased in Sweden during the 21st century. Most of the cases were successful regarding the structural integrity of the bulb, that is, “had a saved eye” and even a functioning graft 2 years after corneal transplantation. The visual gain was distinct, albeit modest. In cases with severe infectious keratitis, and even a concomitant perforation in the cornea due to the infection, corneal transplantation should continue to be an option.
Management of vitreous floaters: a review
Authors: Aleman Alexis Ivan , Kiryakoza Lauren , Sridhar Jayanth , Sengillo Jesse 
Published: July 2024

Purpose of review
Vitreous floaters, characterized by the perception of spots or shadows in the visual field, commonly result from posterior vitreous detachment and can cause chronic symptoms in affected patients. The diagnosis of posterior vitreous detachment is typically determined clinically and can sometimes be confirmed with optical coherence topography (OCT) [1▪▪]. The objective of this review is to review management options for symptomatic vitreous floaters.

Recent findings
Symptoms of vitreous floaters may be mild or may significantly affect patient quality of life. Observation is the most common management strategy. Procedural management options include pars plana vitrectomy (PPV) and neodymium-doped yttrium aluminium garnet (Nd:YAG) vitreolysis. PPV is considered the most definitive management option for vitreous floaters. PPV, however, carries inherent risks, notably infection, cataract formation, and retinal detachment [2]. Nd:YAG laser vitreolysis is a less invasive alternative with studies demonstrating varied success [1▪▪,3,4].

Summary
This review provides insights into the current state of knowledge regarding the management of vitreous floaters and can guide clinical decision-making.
Immune recovery uveitis: an ocular manifestation in HIV/AIDS receiving treatment
Authors: Dionson Martin M. 
Published: July 2024

Purpose of review
This article intends to briefly discuss AIDS, summarize the current literature on immune recovery uveitis, describe its ocular manifestations and complications, and tackle its complex management.

Recent findings
The clinical picture of immune recovery uveitis is still evolving. Up to today, there are still no definite criteria for immune recovery uveitis, and although closely associated with cytomegalovirus retinitis and HIV/AIDS, there are several cases of similar intraocular response in non-HIV patients. The exact pathology for this paradoxical inflammatory reaction remains unclear; however, there is an interest in identifying biomarkers to determine underlying mechanisms and identify patients at risk. The management of this disease also remains a challenge and no standardized treatment approach exists currently.

Summary
Immune recovery uveitis is an important cause of visual morbidity particularly in HIV/AIDS patients receiving highly active antiretroviral. It is a paradoxical reaction that is frequently associated with a prior cytomegalovirus retinitis infection. Although it can be a transient and self-limiting process, there is a complex decision on the timing of antiviral treatment and the initiation of antiretroviral treatment to prevent immune recovery uveitis. Furthermore, a substantial challenge arises in balancing
treatment decisions for complications in refractory cases.
Prevalence, pain trajectories, and presurgical predictors for chronic postsurgical pain in a pediatric sample in Spain with a 24-month follow-up
Authors: Ceniza-Bordallo Guillermo , Gómez Fraile Andrés , Martín-Casas Patricia , Rabbitts Jennifer A. , Li Rui , Palermo Tonya M. , López-de-Uralde-Villanueva Ibai 
Published: July 2024

Abstract
Pediatric chronic pain, particularly chronic postsurgical pain (CPSP), poses a significant public health challenge, impacting 20% of pediatric populations. While several presurgical predictors have been identified, there is a scarcity of data on long-term outcomes, especially beyond 1 to 2 years postsurgery. Previous research primarily focuses on North American children, creating gaps in understanding CPSP outcomes in diverse health systems, such as in Spain. This study, registered as NCT04735211, investigates CPSP in 159 children and adolescents (mean age = 12.4 years, 37.1% girls, retention rate = 65%) undergoing various surgeries in Spain. The objectives include examining CPSP prevalence (Numerical Rating Scale ≥ 4) at 3, 6, 12, and 24 months, exploring postsurgical pain trajectories through group-based trajectory modeling, and identifying potential presurgical predictors for CPSP (pain intensity, pain catastrophizing, pain anxiety, fear of pain, kinesiophobia, health-related quality of life, pain interference, and physical activity), using multiple logistic regressions. Results show a CPSP prevalence of 41% at 3 months, decreasing to 14% at 24 months. Presurgical factors including pain intensity (adjusted odds ratio [aOR] = 1.25, 95% confidence interval [CI] = 1.02-1.53), pain catastrophizing (aOR = 1.06, 95% CI = 1.00-1.13), and pain anxiety (aOR = 1.06, 95% CI = 1.02-1.11) were associated with CPSP at 3 months. Group-based trajectory modeling revealed 3 postsurgical pain trajectories: Low Pain with Rapid Recovery Group (30.2%), Moderate Pain with Recovery Group (53.5%), and High Pain with Slow Recovery Group (16.3%), with group differences in presurgical predictors, excluding physical activity. This study contributes valuable insights into CPSP, emphasizing the need for long-term follow-up. The findings could inform the implementation of preventive programs for CPSP into diverse health systems.
Construction of a Risk Prediction Model for the Occurrence of Acute Skin Failure in Critically Ill Patients: A Prospective Study
Authors: ZHU Li-Hong , SHEN Yan-Fei , REN Qi , LIN Juan 
Published: July 2024

ABSTRACT

Background
The risk factors for acute skin failure (ASF), a serious complication of the skin, are not fully understood.

Purpose
This study was designed to explore the risk factors for ASF in critically ill patients and construct a clinical prediction model.

Methods
Intensive care unit patients were prospectively observed and assigned into two groups: with and without ASF. A logistic regression model was constructed, and its predictive power and clinical utility were evaluated.

Results
Of the 204 eligible patients enrolled as participants, 58 (28.43%) developed ASF. Sepsis, vasoactive drugs, and age were shown to be risk factors for ASF, whereas peripheral perfusion index ratio and albumin level were shown to be protective factors. The area under the receiver operating characteristic curve was 0.83. The maximum Youden index of the model was 0.39 (specificity: 0.87, sensitivity: 0.77). The Hosmer–Lemeshow test (p = .20) and calibration curve showed good fitness and predictive utility with respect to the model.

Conclusions
The developed model effectively predicts ASF risk, allowing for the early identification of high-risk patients. Identifying risk factors such as sepsis, vasoactive drugs, and age and considering protective factors such as peripheral perfusion index and albumin levels may help optimize care plans. Clinical staff should pay special attention to these factors and their impact on skin health in critically ill patients.