bluuebunny/crossref_metadata_2025_split huggingface dataset:
Circulating Immune Complexes and Glucose-6-Phosphate Dehydrogenase Deficiency Predict Recurrent Blackwater Fever in Ugandan Children With Severe Malaria
Authors: Namazzi Ruth , Mellencamp Kagan A , Opoka Robert O , Datta Dibyadyuti , Lima-Cooper Giselle , Liepmann Claire , Sherman Julian , Rodriguez Ana , Kazinga Caroline , Ware Russell E , Goings Michael G , Lacerda Marcus , Abreu Marco , Schwantes-An Tae-Hwi , John Chandy C , Conroy Andrea L 
Published: August 2024

Abstract

Background
Recently, there has been an unexplained increase in the incidence of blackwater fever (BWF) in Eastern Uganda. In this study, we evaluated the association between immune complexes, glucose-6-phosphate dehydrogenase (G6PD) deficiency, and the occurrence and recurrence of BWF in children with severe malaria (SM).

Methods
Between 2014 and 2017, children aged 6 months to &lt;4 years hospitalized with SM and community children (CC) were recruited at 2 hospitals in Central and Eastern Uganda. We measured serum circulating immune complexes (cIC) and their relationship to SM complications and postdischarge outcomes, and evaluated effect mediation through G6PD deficiency.

Results
In total, 557 children with SM and 101 CC were enrolled. The mean age was 2.1 years. Children with SM had higher cIC levels than CC (P &lt; .001). After controlling for age, sex, and site, cIC were associated with severe anemia, jaundice, and BWF: adjusted odds ratio (aOR), 7.33 (95% confidence interval [CI], 3.45–15.58), P &lt; .0001; aOR, 4.31 (95% CI, 1.68–11.08), P = .002; and aOR, 5.21 (95% CI, 2.06–13.18), P &lt; .0001, respectively. cIC predicted readmissions for SM, severe anemia, and BWF: adjusted incidence rate ratios (aIRR), 2.11 (95% CI, 1.33–3.34), P = .001; aIRR, 8.62 (95% CI, 2.80–26.59), P &lt; .0001; and aIRR, 7.66 (95% CI, 2.62–22.45), P &lt; .0001, respectively. The relationship was most evident in boys where the frequency of the G6PD African allele (A−) was 16.8%. G6PD deficiency was associated with increases in cIC in boys (P = .01) and mediation analysis suggested G6PD deficiency contributes to recurrent severe anemia and BWF via increased cIC.

Conclusions
Immune complexes are associated with hemolytic complications and predict recurrences in SM survivors.
The contribution of porins to enterobacterial drug resistance
Authors: Davin-Regli Anne , Pagès Jean-Marie , Vergalli Julia 
Published: August 2024

Abstract
In Enterobacteriaceae, susceptibility to cephalosporins and carbapenems is often associated with membrane and enzymatic barrier resistance. For about 20 years, a large number of Klebsiella pneumoniae, Escherichia coli and Enterobacter cloacae presenting ß-lactam resistance have been isolated from medical clinics. In addition, some of the resistant isolates exhibited alterations in the outer membrane porin OmpC-OmpF orthologues, resulting in the complete absence of gene expression, replacement by another porin or mutations affecting channel properties. Interestingly, for mutations reported in OmpC-OmpF orthologues, major changes in pore function were found to be present in the gene encoding for OmpC. The alterations were located in the constriction region of the porin and the resulting amino acid substitutions were found to induce severe restriction of the lumen diameter and/or alteration of the electrostatic field that governs the diffusion of charged molecules. This functional adaptation through porins maintains the entry of solutes necessary for bacterial growth but critically controls the influx of harmful molecules such as β-lactams at a reduced cost. The data recently published show the importance of understanding the underlying parameters affecting the uptake of antibiotics by infectious bacteria. Furthermore, the development of reliable methods to measure the concentration of antibiotics within bacterial cells is key to combat impermeability-resistance mechanisms.
In vitro evaluation of ganaplacide/lumefantrine combination against Plasmodium falciparum in a context of artemisinin resistance
Authors: Manaranche Jeanne , Laurent Marion , Tressieres Roxane , Nguyen Michel , Salim Maryam , Ouji Manel , Reyser Thibaud , Egwu Chinedu O , Robert Anne , Augereau Jean-Michel , Benoit-Vical Françoise , Paloque Lucie 
Published: August 2024

Abstract

Background
Ganaplacide, also known as KAF156, is among the new antimalarial drug candidates that have successfully reached Phase III clinical trials, and is proposed in combination with lumefantrine. This combination could replace the current front-line artemisinin-based combination therapies (ACTs) in case of Plasmodium falciparum resistance to both artemisinins and partner drugs. Indeed, the African continent, where the malaria burden is the highest, is currently experiencing worrying multiple emergences and spread of artemisinin resistance, which urges for the exploration of the antiparasitic properties of KAF156 in this context.

Objectives and methods
The objectives of this work were firstly to evaluate the risk of cross-resistance between artemisinins and KAF156 alone, and in combination with lumefantrine, using a panel of artemisinin-resistant strains carrying different pfk13 mutations and markers of other antiplasmodial drug resistances; secondly to explore in vitro the relevance of combining KAF156 and lumefantrine with artemisinins, based on the model of triple ACTs.

Results
Our results highlighted that KAF156 activity was not impaired by mutations in pfk13, pfcrt, pfmdr1, pfmdr2, pfdhps and pfdhfr genes or by pfmdr1 amplification. Moreover, we demonstrated that KAF156 alone and in combination with lumefantrine was active against artemisinin-resistant parasites, including when they are quiescent.

Conclusions
All these in vitro results evidence that multi-drug resistant parasites currently in circulation in the field might not affect KAF156 efficacy, and are encouraging signs for KAF156 use in a triple ACT to preserve the use of artemisinins for as long as possible.
Assessment of intermediate-term mortality following pancreatectomy for cancer
Authors: Janczewski Lauren M , Visenio Michael R , Joung Rachel Hae-Soo , Yang Anthony D , Odell David D , Danielson Elizabeth C , Posner Mitchell C , Skolarus Ted A , Bentrem David J , Bilimoria Karl Y , Merkow Ryan P 
Published: August 2024

Abstract

Background
Pancreatic cancer remains highly lethal, and resection represents the only chance for cure. Although patients are counseled regarding short-term (0-3 months) mortality, little is known about mortality 3-6 months (intermediate-term) following surgery. We assessed predictors of intermediate-term mortality, evaluated hospital-level variation, and developed a nomogram to predict intermediate-term mortality risk.

Methods
Patients undergoing pancreatic cancer resection were identified from the National Cancer Database (2010-2020). Multivariable logistic regression identified predictors of intermediate-term mortality and assessed differences between short-term and intermediate-term mortality. Multinomial regression grouped by intermediate-term mortality quartiles evaluated hospital-level variation. A neural network model was constructed to predict intermediate-term mortality risk. All statistical tests were 2-sided.

Results
Of 45 297 patients, 3974 (8.9%) died within 6 months of surgery of which 2216 (5.1%) were intermediate-term. Intermediate-term mortality was associated with increasing T category, positive nodes, lack of systemic therapy, and positive margins (all P &lt; .05) compared with survival beyond 6 months. Compared with short-term mortality, intermediate-term mortality was associated with treatment at high-volume hospitals, positive nodes, neoadjuvant systemic therapy, adjuvant radiotherapy, and positive margins (all P &lt; .05). Median intermediate-term mortality rate per hospital was 4.5% (interquartile range [IQR] = 2.6-6.5). Highest quartile hospitals had decreased odds of treatment with neoadjuvant systemic therapy, neoadjuvant radiotherapy, and adjuvant radiotherapy (all P &lt; .05). The neural network nomogram was highly accurate (accuracy = 0.9499; area under the receiver operating characteristics curve = 0.7531) in predicting individualized intermediate-term mortality risk.

Conclusion
Nearly 10% of patients undergoing pancreatectomy for cancer died within 6 months, of which one-half occurred in the intermediate term. These data have real-world implications to improve shared decision making when discussing curative-intent pancreatectomy.
Sustainable treatment success of an Os naviculare syndrome using conservative measures, infiltration therapy, and shock waves
Authors: Andresen Julian Ramin , Radmer Sebastian , Puchner Stephan E 
Published: August 2024

Abstract
Medial plantar foot pain can have various causes, and the painful Os tibiale externum should be considered in the differential diagnosis. A reliable diagnosis can be made through physical examination and multimodal imaging. We report on a 53-year-old man with severe, load-dependent pain consistent with an accessory navicular syndrome, caused by a pes planovalgus, which consecutively induced focal inflammation and tenosynovitis of the tibialis posterior tendon. Multifactorial conservative measures, including infiltration therapy, provided only moderate symptom relief. A final shockwave therapy ultimately led to a sustainable symptom relief.
Peanut phytobezoar: an unusual cause for small bowel obstruction
Authors: Sealey Andrew J , Lau Ngee-Soon 
Published: August 2024

Abstract
Bezoars are indigestible masses of material forming within the gastrointestinal system. Phytobezoars are the most common subtype consisting of plant matter such as fibre, skins, and seeds. Rarely they present causing small bowel obstruction (SBO) and may be difficult to distinguish from faecalization on imaging. Here we present the case of a man in his 70s who rapidly consumed an expiring bag of peanuts and subsequently developed a SBO due to formation of a peanut phytobezoar. After failing conservative management, he required emergency surgery with intentional enterotomy to milk out the bezoar. This case highlights the importance of maintaining a broad differential and thorough history taking in patients presenting with SBO.
Methodology and Definitions
Authors: Romano Cesare PR , Boggio Andrea 
Published: August 2024

Abstract
This chapter first describes the methodology followed and the sources used to prepare a historical account of the emergence and codification of the right to science, to map the right to science in contemporary legal instruments—mostly international but also national constitutions—and to determine the normative content of the right to science. Then, key terms at the core of the relationship between science and human rights are defined. These include “freedoms,” “rights,” “entitlements,” “science,” “scientific knowledge,” “scientific progress and advancement,” and “benefits.” The chapter also provides a disambiguation of science and culture, science and technology, science and pseudoscience, and science and the sciences.
The Right to Responsible Scientific Progress (Scientific Responsibility)
Authors: Romano Cesare PR , Boggio Andrea 
Published: August 2024

Abstract
Arguing that scientific responsibility is part of the normative content of the right to science, this chapter describes the normative basis and content of the second cluster of rights within the right to science: the right to responsible science. This right imposes two duties on scientists: to respect scientific integrity and to responsible anticipation. The chapter discusses how respect for scientific integrity requires scientists to adhere to the norms of research integrity and scientific citizenry and how the duty to responsible anticipation includes the duty to respect research participants and to anticipate the benefits and harms of scientific progress and its applications. The steps that scientists must implement to discharge both duties are also discussed. The chapter then looks at the role of states in ensuring adherence to scientific responsibility standards and proposes indicators for monitoring adherence.
The Right to Benefit from Scientific Progress
Authors: Romano Cesare PR , Boggio Andrea 
Published: August 2024

Abstract
This chapter presents the normative basis and content of the fourth cluster of rights within the right to science: to benefit from scientific progress. This right contains five rights: to access scientific knowledge; to anticipation and monitoring of impacts; to the development of beneficial applications; to the diffusion of and access to applications; and to policies aligned with scientific evidence. Framing scientific science as a global public good, the argument identifies the human rights standards that require that scientific knowledge and applications be made widely accessible to the public. It also critically assesses the precautionary principle as a regulatory tool to protect society from the harmful impacts of science and proposes the principle of prudence as better fitting human rights standards. The duty of policymakers to adhere to these standards and to adopt policies aligned with scientific evidence are also discussed. The chapter closes by proposing indicators to monitor compliance with these standards.
The Future of the Right to Science
Authors: Romano Cesare PR , Boggio Andrea 
Published: August 2024

Abstract
This chapter reflects on the status of the human right to science and looks into its future. Arguing that the right has been mostly overlooked in its potential to govern science, technology, and innovation, the chapter proposes ways in which policymakers, scholars, and practitioners can engage with the right to ensure the realization of its full potential. Further work needs to be done to translate right-to-science principles into standards of conduct to guide science, technology, and innovation policy. Additionally, policymakers, scholars, and practitioners must strengthen the monitoring of States’ adherence to the right-to-science standards and ensure opportunities for claims based on the right to science to be adjudicated in court. To this end, constitutional, statutory, and regulatory frameworks must be adapted to better incorporate right-to-science principles. This chapter proposes the negotiation and adoption of a global treaty in support of science. Such a treaty could help entrenching and deepening the normative content of the right to science. A sketch of the content of the proposed treaty is provided. The chapter also identifies future initiatives at the level of regional systems. It concludes by reiterating the value of framing science as a global public good and by inviting the international community to adopt the right to science as the leading framework to govern science, technology, and innovation, internationally and domestically.
Designing a Culture of Ethical Practice in Healthcare
Authors: Fitzgerald Heather , Rushton Cynda Hylton 
Published: August 2024

Abstract
Healthcare is reeling from escalating complexity, competing interests, and patients challenged by increasingly diverse and severe health conditions. Clinicians, including nurses, feel external pressures and inner conflicts about their ability to practice in ways that reflect their professional values. Clinicians and the people they serve are reporting disengagement and despair in an ever-chaotic culture that reflects societal disempowering norms and systems. A new paradigm is needed that leverages core ethical values, shifts patterns that undermine integrity, produces impactful, sustainable results, and offers a vision of hope for the future. This chapter applies a model of full-spectrum change to create a culture of ethical practice in healthcare. Key shifts that are necessary to begin the process of individual and organizational transformation are highlighted, including perspectives, recognition of patterns that are no longer working, and using design principles to produce strategic results. Promising practices to enable these shifts and exemplars from healthcare settings engaged in this work are highlighted.
Effectiveness of Sucrose Analgesia in Newborns Undergoing Painful Medical Procedures
Authors: Osborn David 
Published: August 2024

Abstract
Pain management guidelines promoted the widespread use of sucrose. However, there were concerns that few painful procedures had been evaluated and that sucrose may raise blood glucose levels in newborns of diabetic mothers. Taddio et al. randomized 240 healthy newborns of nondiabetic and diabetic mothers undergoing intramuscular injection, venipuncture, or heel-lance to oral sucrose 24% or water placebo. Overall mean pain scores were lower among newborns who received sucrose than among those who received placebo (mean difference –1.3; 95% confidence interval –2.0 to –0.6). There was no difference in the incidence of adverse effects or mean blood glucose levels.
Reduction of Maternal–Infant Transmission of Human Immunodeficiency Virus Type 1 With Zidovudine Treatment
Authors: van Kaam Anton H. , Onland Wes 
Published: August 2024

Abstract
Maternal–infant transmission is the primary means by which young children become infected with human immunodeficiency virus type 1 (HIV). Animal studies demonstrate that zidovudine may prevent or alter maternal–infant transmission of HIV. This study randomized 477 pregnant, HIV-infected women (CD4+ T-lymphocyte count &gt;200) between 14 and 34 weeks’ gestation to an antepartum, intrapartum, and neonatal treatment regimen with zidovudine or placebo. HIV infection status was known for 363 births and showed a 67.5% (95% confidence interval 40.7 to 82.1, p = 0.00006) relative risk reduction in HIV transmission in favor of the zidovudine group. Minimal short-term toxic effects were observed.
A Randomized Controlled Trial of Magnesium Sulfate for the Prevention of Cerebral Palsy
Authors: Foglia Elizabeth 
Published: August 2024

Abstract
Cerebral palsy (CP) is a leading cause of chronic childhood disability, with risk increasing with lower gestational ages. Early evidence suggested magnesium sulfate may be neuroprotective for infants born preterm. This randomized trial enrolled 2,241 women at risk of imminent preterm delivery between 24 and 31 weeks’ gestation. Patients were randomized to intravenous magnesium sulfate versus placebo therapy. There was no difference in the primary outcome of infant death or moderate or severe cerebral palsy at 2 years corrected age. However surviving infants born to mothers randomized to magnesium sulfate were significantly less likely to be diagnosed with moderate or severe cerebral palsy.
Understanding Implicit Bias and Responding to Microaggressions
Authors: Estime Stephen R. , Williams Brian H. 
Published: August 2024

Abstract
Implicit biases are unconscious associations about groups of people that can manifest as actions expressing prejudice, which can unwittingly perpetuate discrimination and are known as microaggressions. An understanding of implicit bias and microaggressions is an important skills for functioning as an effective leader in healthcare. Given the role of physicians as leaders who navigate difficult social and clinical interactions, these principles are especially pertinent. An understanding of one’s personal biases allows for improved communication in high-stakes interactions, may lead to better health outcomes and patient–provider interactions, and is a core component of professionalism. Addressing implicit bias at the individual level demands the acknowledgment that everyone harbors biases, that feedback is an important mechanism to uncover bias, and that adjusting one’s actions will allow for better future interactions in an increasingly complex world. At the institutional level, systems that address implicit bias can be achieved by a commitment from leadership to address bias at all levels to empower workers who may otherwise not be engaged and to offer pertinent and timely training to improve institutional diversity.
Cultural Sensitivity in the Healthcare Workplace
Authors: Mulaikal Teresa A. , Hastie Maya Jalbout 
Published: August 2024

Abstract
Culture can be defined as the intricate set of beliefs, values, and practices that impact personal choices. Physician–patient relationships, which are key determinants in achieving health equity, are impacted by the multicultural social context in which healthcare providers practice. Accordingly, physicians’ cultural sensitivity and competence can be developed to improve patient experiences and outcomes. Cultural competence relies in part on developing the skills for empathetic and respectful communications. In addition, organizational and structural factors perpetuate healthcare disparities. In this chapter, communications with patients and their families are explored in the context of end-of-life discussions and goals-of-care settings. Cultural sensitivity should be introduced during medical education and residency training and should be considered an important aspect of professional development.
Do Not Resuscitate and Physician Orders for Life-Sustaining Treatment
Authors: Berkman Emily , Clark Jonna D. , Lewis-Newby Mithya 
Published: August 2024

Abstract
Respecting patient autonomy is a requirement of ethical medical practice. When patients lack decision-making capacity, treatment decisions should be made based on previously documented patient preferences or through surrogate decision-makers. In an emergency, if a patient’s wishes are unknown and a surrogate decision-maker is unavailable, the default position is to provide all medically appropriate therapies. Adult patients have the right to forgo life-sustaining therapies. Ideally, conversations eliciting patient goals, educating regarding prognosis, and discussing potential benefits, burdens and alternatives take place within a trusting patient–clinician relationship over time, and decisions to forgo specific treatments should be documented by adult patients and their healthcare providers. Advance directives are legal documents that describe treatment preferences and/or identify a durable power of attorney for healthcare. They allow competent adults to make decisions for themselves for future care should they lose capacity. In contrast, physician orders for life-sustaining therapies forms are intended for patients who are frail or terminally ill. They apply to current care and describe preferences that apply across all medical environments. Regardless of format, written legal documentation that describes patient wishes best allows clinicians to honor individual preferences. In cases of discordance regarding treatment preferences, state specific mediation processes should be followed. Ethics committee consultation can be helpful or necessary.
Medical Aid in Dying
Authors: Sweet Ashley L. , Blanke Charles D. 
Published: August 2024

Abstract
This chapter on medical aid in dying (MAID) examines a growing end-of-life option, which has been legalized in 11 US jurisdictions. It defines MAID and distinguishes this practice from euthanasia. It reviews the eligibility criteria for accessing MAID in the United States and appraises these criteria in the specific case of a patient with the progressive neurodegenerative condition amyotrophic lateral sclerosis (ALS). It also summarizes key ethical arguments for and against MAID, and it assists readers, regardless of their own personal views on the ethical permissibility of this end-of-life option, in evaluating and responding to patient requests for MAID.