bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Patient Safety Bundle and Team-Based Training on Obstetric Hypertensive Emergencies
Authors: Grogan Laura , Peterson Erika , Flatley Megan , Domeyer-Klenske Amy 
Published: August 2024

Objective Hypertensive disorders of pregnancy, defined as chronic (<20 weeks) or gestational (>20 weeks), are a leading cause of pregnancy-related mortality in the United States. Hypertensive disorders of pregnancy had increased prevalence from 13.3 to 15.9% among delivery hospitalizations between 2017 and 2019. The objective of this project was to increase the percentage of obstetric patients with hypertensive emergency who received evidence-based treatment within 60 minutes at a single academic center.
Study Design Data were collected before and after the implementation of a hypertension patient safety bundle. Each occurrence of hypertensive emergency was assessed to determine if evidence-based intervention occurred within 60 minutes, and if the intervention steps were successfully followed. Bundle implementation included creation of a standardized order set and interdisciplinary team-based simulations. Baseline data compared 250 preimplementation to 250 postimplementation interventions. The quality improvement interdisciplinary team reevaluated data monthly and incorporated process improvements through Plan-Do-Study-Act (PDSA) cycles to achieve a goal of 80% of patients receiving evidence-based treatment within 60 minutes.
Results A total of 1,025 hypertensive emergencies were identified in 543 patients. Prior to the protocol on average 64% of patients received evidence-based, timely treatment. After implementation of this bundle and several PDSA cycles, we sustained >80% of patients receiving target treatment for the final 6 months of data collection. The leading deviations were “no medication given” and “incorrect medication.” Improvements in order set accessibility and repeated team-based trainings led to improvement in these identified protocol deviations.
Conclusion Implementation of a patient safety bundle led to a sustained 6-month improvement in the percentage of patients receiving appropriate treatment of obstetric hypertensive emergency within 60 minutes of the first severe hypertension measurement. Processes that may have helped achieve this outcome included standardized order sets, team awareness of institutional data, and team-based simulations.
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Diabetes and Early Development: Epigenetics, Biological Stress, and Aging
Authors: Wang Guanglei , Shen Wei-Bin , Chen Anna Wu , Reece E. Albert , Yang Peixin 
Published: August 2024

Pregestational diabetes, either type 1 or type 2 diabetes, induces structural birth defects including neural tube defects and congenital heart defects in human fetuses. Rodent models of type 1 and type 2 diabetic embryopathy have been established and faithfully mimic human conditions. Hyperglycemia of maternal diabetes triggers oxidative stress in the developing neuroepithelium and the embryonic heart leading to the activation of proapoptotic kinases and excessive cell death. Oxidative stress also activates the unfolded protein response and endoplasmic reticulum stress. Hyperglycemia alters epigenetic landscapes by suppressing histone deacetylation, perturbing microRNA (miRNA) expression, and increasing DNA methylation. At cellular levels, besides the induction of cell apoptosis, hyperglycemia suppresses cell proliferation and induces premature senescence. Stress signaling elicited by maternal diabetes disrupts cellular organelle homeostasis leading to mitochondrial dysfunction, mitochondrial dynamic alteration, and autophagy impairment. Blocking oxidative stress, kinase activation, and cellular senescence ameliorates diabetic embryopathy. Deleting the mir200c gene or restoring mir322 expression abolishes maternal diabetes hyperglycemia-induced senescence and cellular stress, respectively. Both the autophagy activator trehalose and the senomorphic rapamycin can alleviate diabetic embryopathy. Thus, targeting cellular stress, miRNAs, senescence, or restoring autophagy or mitochondrial fusion is a promising approach to prevent poorly controlled maternal diabetes-induced structural birth defects. In this review, we summarize the causal events in diabetic embryopathy and propose preventions for this pathological condition.Key Points
Vascular Placental Pathology and Cardiac Structure in Stillborn Fetuses
Authors: Freedman Alexa A. , Cersonsky Tess E.K. , Pinar Halit , Goldenberg Robert L. , Silver Robert M. , Ernst Linda M. 
Published: August 2024

Objective Adverse pregnancy outcomes, including preterm birth and preeclampsia, are associated with worse cardiovascular outcomes for offspring. Examination of the placenta is important for understanding how the prenatal period shapes long-term cardiovascular health. We sought to investigate the association between placental vascular malperfusion and fetal cardiac structure.
Study Design Data obtained from the Stillbirth Collaborative Research Network included stillbirths with placental pathology and autopsy. Stillbirths were classified in two ways: based on the severity of placental maternal vascular malperfusion (MVM) and based on the cause of death (MVM, fetal vascular malperfusion [FVM], or acute infection/controls). Organ weight and heart measures were standardized by gestational age (GA) and compared across groups.
Results We included 329 stillbirths in the analysis by MVM severity and 76 in the analysis by cause of death (COD). While z-scores for most organ weights/heart measures were smaller when COD was attributed to MVM as compared with FVM or controls, heart weight and brain weight z-scores did not differ by COD (p > 0.05). In analyses accounting for body size, the difference between heart and body weight z-score was −0.05 (standard deviation [SD]: 0.53) among those with MVM as a COD and −0.20 (SD: 0.95) among those with severe MVM. Right and left ventricle thicknesses and tricuspid, pulmonary, mitral, and aortic valve circumferences were consistently as expected or larger than expected for GA and body weight. In the analysis investigating the severity of MVM, those with the most severe MVM had heart measures that were as expected or larger than expected for body weight while those with only mild to moderate MVM had heart measures that were generally small relative to body weight.
Conclusion When assessed as COD or based on severity, MVM was associated with heart measures that were as expected or larger than expected for GA and body weight, indicating possible heart sparing.
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The Implications of a “Flat” Oral Glucose Tolerance Test Curve in Pregnancy
Authors: Lopian Miriam , Segal Ella , Neiger Ran , Many Ariel , Kashani Ligumsky Lior 
Published: August 2024

Objective This study aimed to determine whether pregnant women who have “flat” oral glucose tolerance test (OGTT) curves in pregnancy are at increased risk of maternal or neonatal adverse outcomes.
Study Design We conducted a retrospective cohort study of the perinatal outcomes of pregnant women whose 100-g OGTT curve was “flat,” defined by a fasting serum glucose level below 95 mg/dL and the remaining values below 100 mg/dL. We compared their perinatal outcomes to women whose OGTT curve was “normal.” The primary outcomes compared were the prevalence of macrosomic and small for gestational age (SGA) neonates. Secondary outcomes included hypertensive disorders of pregnancy (HDP), prelabor anemia, thrombocytopenia, intrauterine fetal demise, placental abruption, indicated induction of labor, meconium-stained amniotic fluid, mode of delivery, postpartum hemorrhage, blood product transfusion, postpartum readmission, neonatal gender, gestational age at delivery, preterm birth, birth weight, low birth weight, umbilical artery pH < 7.1, Apgar score <7 at 5 minutes, neonatal intensive care unit admission, neonatal respiratory and infectious morbidity, and hypoglycemia. Composite adverse maternal and neonatal outcomes were also evaluated.
Results There were 1,060 patients in the study group and 10,591 patients in the control group. Patients with a flat OGTT were younger (28.3 vs. 29.8, p < 0.001) and less likely to be over 35 years old (14.1 vs. 23.4%, p < 0.001). They had a reduced risk of delivering a macrosomic neonate (11.4 vs. 15.1%, OR = 0.7 [0.58–0.89], p = 0.001) and having an unplanned cesarean delivery (7.5 vs. 10.2%, OR = 0.8 [0.58–0.96], p = 0.002). There was no difference in the rate of composite adverse maternal (14.0 vs. 15.4%, OR = 0.9 [0.7–1.0], p = 0.1) or neonatal outcome (5.3 vs. 4.5%, OR = 1.2 [0.9–1.5], p = 0.15). Neonates had a slightly lower mean birth weight (3,474 vs. 3,505 g, p = 0.04) but the rate of SGA was similar in the two groups (2.5 vs. 1.8%, OR = 1.3 [0.9–2.0], p = 0.08).
Conclusion Pregnant women whose OGTT curve is flat have a lower risk of delivering macrosomic neonates and undergoing unplanned cesarean delivery and are not at increased risk of adverse maternal or neonatal outcomes. More research is required to evaluate the relationship between different OGTT curves and the fetal growth rate.
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Social Determinants of Health and Diabetes in Pregnancy
Authors: Field Christine , Wang Xiao-Yu , Costantine Maged M. , Landon Mark B. , Grobman William A. , Venkatesh Kartik K. 
Published: August 2024

Social determinants of health (SDOH) are the conditions in which people are born, grow, work, live, and age. SDOH are systemic factors that may explain, perpetuate, and exacerbate disparities in health outcomes for different populations and can be measured at both an individual and neighborhood or community level (iSDOH, nSDOH). In pregnancy, increasing evidence shows that adverse iSDOH and/or nSDOH are associated with a greater likelihood that diabetes develops, and that when it develops, there is worse glycemic control and a greater frequency of adverse pregnancy outcomes. Future research should not only continue to examine the relationships between SDOH and adverse pregnancy outcomes with diabetes but should determine whether multi-level interventions that seek to mitigate adverse SDOH result in equitable maternal care and improved patient health outcomes for pregnant individuals living with diabetes.
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Cross-lingual Natural Language Processing on Limited Annotated Case/Radiology Reports in English and Japanese: Insights from the Real-MedNLP Workshop
Authors: Yada Shuntaro , Nakamura Yuta , Wakamiya Shoko , Aramaki Eiji 
Published: August 2024

Abstract
Background Textual datasets (corpora) are crucial for the application of natural language processing (NLP) models. However, corpus creation in the medical field is challenging, primarily because of privacy issues with raw clinical data such as health records. Thus, the existing clinical corpora are generally small and scarce. Medical NLP (MedNLP) methodologies perform well with limited data availability.
Objectives We present the outcomes of the Real-MedNLP workshop, which was conducted using limited and parallel medical corpora. Real-MedNLP exhibits three distinct characteristics: (1) limited annotated documents: the training data comprise only a small set (∼100) of case reports (CRs) and radiology reports (RRs) that have been annotated. (2) Bilingually parallel: the constructed corpora are parallel in Japanese and English. (3) Practical tasks: the workshop addresses fundamental tasks, such as named entity recognition (NER) and applied practical tasks.
Methods We propose three tasks: NER of ∼100 available documents (Task 1), NER based only on annotation guidelines for humans (Task 2), and clinical applications (Task 3) consisting of adverse drug effect (ADE) detection for CRs and identical case identification (CI) for RRs.
Results Nine teams participated in this study. The best systems achieved 0.65 and 0.89 F1-scores for CRs and RRs in Task 1, whereas the top scores in Task 2 decreased by 50 to 70%. In Task 3, ADE reports were detected by up to 0.64 F1-score, and CI scored up to 0.96 binary accuracy.
Conclusion Most systems adopt medical-domain–specific pretrained language models using data augmentation methods. Despite the challenge of limited corpus size in Tasks 1 and 2, recent approaches are promising because the partial match scores reached ∼0.8–0.9 F1-scores. Task 3 applications revealed that the different availabilities of external language resources affected the performance per language.
Disparities in Delirium across the Continuum of Care and Associations with Social Determinants of Health
Authors: Khanna Anu , Govil Malvika , Ayele Nohamin , Saadi Altaf 
Published: August 2024

AbstractDisparities exist in the identification, treatment, and management of delirium. These disparities can be most holistically and comprehensively understood by using a social–ecological model—which acknowledges multilevel impacts including individual, interpersonal, organizational, community, and policy-level factors—as well as a social determinant of health framework, that considers nonmedical factors that influence health outcomes. This narrative review leverages both frameworks to identify and discuss existing literature pertaining to the intersection of these social risk factors and delirium, focusing specifically on disparities due to racial and/or ethnic identity, language ability, and socioeconomic differences. We also look at disparities and the potential role of these social risk factors throughout the continuum of care, including prehospitalization, hospitalization, and posthospitalization factors. Understanding and analyzing the role of these inequities is critical to ensuring better health outcomes for patients at risk of and/or with delirium.
Overview of Unilateral and Bilateral Pediatric Facial Paralysis: Workup, Treatment, and Frontiers
Authors: Wiebe Jordan E. , Mulenga Chilando , Crabtree Jordan R. , Hussain Arif , Borschel Gregory H. 
Published: August 2024

AbstractPediatric facial nerve paralysis can present significant challenges based on its various etiologies, unique approach to treatment options, and overall outcomes. It can impact both the child and parent when regarding function, appearance, and psychosocial implications. The etiology of facial nerve palsy can include congenital, traumatic, iatrogenic, and idiopathic causes. In some, the paralysis is transient while others have permanent loss of function. A thorough evaluation and differential diagnosis are essential to guide treatment planning. The purpose of this paper is to review facial paralysis in children with a focus on surgical management.
The Effect of Self-Reported Race on Noninvasive Prenatal Screening Test Characteristics
Authors: Mitra Anjali N. , Dingel Aleksei , Kolarova Teodora , MacKinnon Hayley J. , Katz Ronit , Lockwood Christina M. , Shree Raj 
Published: August 2024

Objective Low fetal fraction (FF) on cell-free DNA (cfDNA)-based noninvasive prenatal screening (NIPS) is a common etiology for indeterminate results. As maternal Black race is implicated as a risk factor for low FF and more indeterminate results, we sought to evaluate this association.
Study Design This was a single-institution, retrospective cohort study of cfDNA-based NIPS performed between May 2017 and May 2022 with complete clinical data abstraction. We compared FF, indeterminate rates, and total cfDNA concentration among self-reported Black, White, and Other groups from NIPS results from 2017 to 2022 with full clinical data abstraction. Using linear regression and interaction testing, we evaluated associations between self-reported race, FF, indeterminate rate, and total cfDNA concentration.
Results In total, 1,591 participants met the inclusion criteria; 70.8% (n = 1,126) self-identified as White, 6.9% (n = 110) as Black, and 22.3% (n = 355) self-identified with another race. Mean FF was not different between the White, Black, or Other groups (11.8 vs. 11.2 vs. 11.7%, respectively, p = 0.52). This remained true after adjusting for body mass index (BMI), gestational age (GA) at draw, and fetal sex (all p > 0.17). Interaction testing for FF and total cfDNA by race with BMI, GA at draw, and fetal sex demonstrated no effect modification.
Conclusion In our population, maternal self-identified race, particularly Black race, does not affect FF. Biological plausibility for race-based differences on clinical tests requires ongoing thoughtful consideration.
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Impact of Inpatient Patient–Provider Language Concordance on Exclusive Breastfeeding Rates Postpartum
Authors: Abbate Alexandra M. , Saucedo Alexander M. , Ghartey Jeny , López Julia , Alvarez Miriam , Hall Emily , Avshman Elaine , Okafor Odera , Olshavsky Megan , Harper Lorie M. , Cahill Alison G. 
Published: August 2024

Objective Studies outside of obstetrics suggest that patient–provider language concordance may impact the efficacy of educational interventions and overall patient satisfaction. Many pregnant patients who present to the hospital for delivery with initial plans to exclusively breastfeed ultimately leave the hospital supplementing with formula. We aim to examine the impact of language concordance between patients and their primary bedside nurse during the delivery hospitalization period on the relationship between intended and actual feeding practices for term newborns of primiparous patients at a single institution.
Study Design This is a single-center, prospective cohort of primiparous patients with term, singleton gestations admitted for delivery between February 2022 and January 2023. Participants completed a predelivery survey on arrival and a postpartum survey before hospital discharge. The primary outcome was the association between nurse–patient language concordance and postpartum exclusive breastfeeding. Multiple logistic regression analysis was performed to assess the primary outcome, and p-values < 0.05 were considered significant.
Results Overall, 108 participants were surveyed, of which 84 (77.8%) noted language concordance with their primary nurse and 24 (22.2%) reported language discordance. The race/ethnicity, language spoken at home, reported plans to return to work, WIC (special supplemental nutrition program for women, infants, and children) enrollment, and prenatal feeding plan variables revealed significant differences in reported language concordance. Following adjustment for patient-reported prenatal feeding plan, patients who reported language concordance with their primary nurse were significantly more likely to exclusively breastfeed in the immediate postpartum period (adjusted odds ratio, 5.60; 95% confidence interval, 2.06–16.2).
Conclusion Patients who reported language concordance with their primary nurse were significantly more likely to breastfeed exclusively in the immediate postpartum period. These findings highlight that language concordance between patients and bedside health care providers may contribute to initiating and continuing exclusive breastfeeding during the peripartum period.
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Clinical Outcome of Patients with Epithelioid Glioblastoma Harboring BRAFV600E Mutation; A Single Institution Experience
Authors: Subramanian Preethi , Das Anindita , Chilukuri Srinivas , Rajendran Adhithyan , Patil Sushma , Mullapally Sujith Kumar , Krishna Uday , Kumar Roopesh , Jalali Rakesh 
Published: August 2024

Purpose Epithelioid glioblastoma (GBM) is a rare variant of GBM. The study aimed to look into clinicopathological details and outcomes of patients with epithelioid GBM harboring BRAFV600E mutation from a single institution.
Methods Ten cases of epithelioid GBM diagnosed over the past 5 years were reviewed. All patients underwent surgical resection followed by adjuvant treatment as per protocol after initial diagnosis. Of these, seven patients were planned to redo surgery, reradiation, BRAF with MEK inhibitors, and bevacizumab based on clinical condition, magnetic resonance imaging findings, and progression-free survival after their recurrence. Four recurrent patients had received dabrafenib and trametinib.
Results All tumor locations were supratentorial. The median follow-up was 2.3 years and the median time to recurrence was 19 months from the diagnosis (range 4–36 months). Four recurrent patients received BRAF + MEK inhibitors. One patient who started dabrafenib and trametinib experienced local progression after 33 months, followed by lung and bone metastasis. One patient died due to multiple subacute hemorrhages, who was a known case of congenital vascular malformations, and two patients remained disease-free after a year and 2 years.
Conclusion Epithelioid GBM is a very rare, but well-documented entity. Therefore, careful preoperative imaging and detailed evaluation of genetic studies including BRAF V600E mutation are necessary for accurate diagnosis and appropriate selection of treatment for epithelioid GBM. Dabrafenib plus trametinib showed clinically meaningful activity in patients with BRAF V600E mutation-positive recurrent high-grade glioma.
Therapeutic Plasma Exchange for a Critically Ill Late Preterm Infant with Multisystem Inflammatory Syndrome of Children: A Case Report and Review of the Literature
Authors: Saglik Adviye Cakil , Yilmaz Semerci Seda , Aygun Erhan , Gemici Hakan , Topal Neval , Buyukkale Gokhan 
Published: August 2024

AbstractMultisystem inflammatory syndrome of children (MIS-C) is a clinical picture that entered the medical nomenclature after the coronavirus disease 2019 pandemic. Although it primarily affects older children, there have been a limited number of cases reported during the neonatal period. Herein we present a patient, a late preterm infant, with severe MIS-C-related cerebral sinus venous thrombosis who was successfully treated with therapeutic plasma exchange. Practitioners can consider therapeutic plasma exchange as a safe and effective option for the treatment of critically ill MIS-C cases.
StreetTalk: exploring energy insecurity in New York City using a novel street intercept interview and social media dissemination method
Authors: Sprague Nadav L. , Fan Isabel B. , Dandeneau Michelle , Hernandez Perez Jorge Fabian , Birmingham Jordyn , De Los Santos Daritza , Riddick Milan I. , Meltzer Gabriella Y. , Siegel Eva L. , Hernández Diana 
Published: August 2024

AbstractThis study introduces StreetTalk, an original qualitative research methodology inspired by social media influencers, to investigate perceptions and experiences of energy insecurity among New York City (NYC) residents. Briefly, energy insecurity is defined as difficulty meeting household energy needs due to affordability, housing quality, outages and coping strategies. This present study employs dynamic short-form interviews with 34 participants from all five NYC boroughs of diverse economic, and racial/ethnic backgrounds. Thematic analysis of video-recorded interviews revealed six major energy insecurity-related categories: (1) conservation and trade-offs, (2) physical inefficiencies, (3) thermal agency, (4) response to the bill, (5) disappointment and distrust in energy-related authorities, and (6) desire for and barriers to clean energy adoption. These themes provide insight into NYC residents’ experiences with energy insecurity and are consistent with prior research. Beyond new scholarly insights, this study introduces StreetTalk, an innovative qualitative research methodology emphasizing rapid data collection and dissemination through social media platforms, including TikTok, Instagram, Facebook, and YouTube (@hotandcold_nyc). Taking advantage of modern technology and modes of communication, the research team was able to effectively break down barriers to academic research consumption as the videos achieved substantial engagement, with almost 200,000 views and impressions within the first year of launching this novel street-based data collection and social media dissemination campaign.