bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intra- and inter-subtype HIV diversity between 1994 and 2018 in southern Uganda: a longitudinal population-based study
Authors: Kim Seungwon , Kigozi Godfrey , Martin Michael A , Galiwango Ronald M , Quinn Thomas C , Redd Andrew D , Ssekubugu Robert , Bonsall David , Ssemwanga Deogratius , Rambaut Andrew , Herbeck Joshua T , Reynolds Steven J , Foley Brian , Abeler-Dörner Lucie , Fraser Christophe , Ratmann Oliver , Kagaayi Joseph , Laeyendecker Oliver , Grabowski Mary K 
Published: August 2024

Abstract
There is limited data on human immunodeficiency virus (HIV) evolutionary trends in African populations. We evaluated changes in HIV viral diversity and genetic divergence in southern Uganda over a 24-year period spanning the introduction and scale-up of HIV prevention and treatment programs using HIV sequence and survey data from the Rakai Community Cohort Study, an open longitudinal population-based HIV surveillance cohort. Gag (p24) and env (gp41) HIV data were generated from people living with HIV (PLHIV) in 31 inland semi-urban trading and agrarian communities (1994–2018) and four hyperendemic Lake Victoria fishing communities (2011–2018) under continuous surveillance. HIV subtype was assigned using the Recombination Identification Program with phylogenetic confirmation. Inter-subtype diversity was evaluated using the Shannon diversity index, and intra-subtype diversity with the nucleotide diversity and pairwise TN93 genetic distance. Genetic divergence was measured using root-to-tip distance and pairwise TN93 genetic distance analyses. Demographic history of HIV was inferred using a coalescent-based Bayesian Skygrid model. Evolutionary dynamics were assessed among demographic and behavioral population subgroups, including by migration status. 9931 HIV sequences were available from 4999 PLHIV, including 3060 and 1939 persons residing in inland and fishing communities, respectively. In inland communities, subtype A1 viruses proportionately increased from 14.3% in 1995 to 25.9% in 2017 (P &lt; .001), while those of subtype D declined from 73.2% in 1995 to 28.2% in 2017 (P &lt; .001). The proportion of viruses classified as recombinants significantly increased by nearly four-fold from 12.2% in 1995 to 44.8% in 2017. Inter-subtype HIV diversity has generally increased. While intra-subtype p24 genetic diversity and divergence leveled off after 2014, intra-subtype gp41 diversity, effective population size, and divergence increased through 2017. Intra- and inter-subtype viral diversity increased across all demographic and behavioral population subgroups, including among individuals with no recent migration history or extra-community sexual partners. This study provides insights into population-level HIV evolutionary dynamics following the scale-up of HIV prevention and treatment programs. Continued molecular surveillance may provide a better understanding of the dynamics driving population HIV evolution and yield important insights for epidemic control and vaccine development.
Microfluidics—A novel technique for high‐quality sperm selection for greater ART outcomes
Authors: Bhat Ghulam Rasool , Lone Farooz Ahmad , Dalal Jasmer 
Published: August 2024

AbstractMicrofluidics represent a quality sperm selection technique. Human couples fail to conceive and this is so in a significant population of animals worldwide. Defects in male counterpart lead to failure of conception so are outcomes of assisted reproduction affected by quality of sperm. Microfluidics, deals with minute volumes (μL) of liquids run in small‐scale microchannel networks in the form of laminar flow streamlines. Microfluidic sperm selection designs have been developed in chip formats, mimicking in vivo situations. Here sperms are selected and analyzed based on motility and sperm behavioral properties. Compared to conventional sperm selection methods, this selection method enables to produce high‐quality motile sperm cells possessing non‐damaged or least damaged DNA, achieve greater success of insemination in bovines, and achieve enhanced pregnancy rates and live births in assisted reproduction—in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). Besides, the concentration of sperm available to oocyte can be controlled by regulating the flow rate in microfluidic chips. The challenges in this technology are commercialization of chips, development of fully functional species‐specific microfluidic tools, limited number of studies available in literature, and need of thorough understanding in reproductive physiology of domestic animals. In conclusion, incorporation of microfluidic system in assisted reproduction for sperm selection may promise a great success in IVF and ICSI outcomes. Future prospectives are to make this technology more superior and need to modify chip designs which is cost effective and species specific and ready for commercialization. Comprehensive studies in animal species are needed to be carried out for wider application of microfluidic sperm selection in in vitro procedures.
Effect of Leishmania infantum infection on B cell lymphopoiesis and memory in the bone marrow and spleen
Authors: Dirkx Laura , Loyens Marlotte , Van Acker Sara I. , Bulté Dimitri , Claes Mathieu , Radwanska Magdalena , Magez Stefan , Caljon Guy 
Published: August 2024

AbstractVisceral leishmaniasis (VL) is characterized by an uncontrolled infection of internal organs such as the spleen, liver and bone marrow (BM) and can be lethal when left untreated. No effective vaccination is currently available for humans. The importance of B cells in infection and VL protective immunity has been controversial, with both detrimental and protective effects described. VL infection was found in this study to increase not only all analyzed B cell subsets in the spleen but also the B cell progenitors in the BM. The enhanced B lymphopoiesis aligns with the clinical manifestation of polyclonal hypergammaglobulinemia and the occurrence of autoantibodies. In line with earlier reports, flow cytometric and microscopic examination identified parasite attachment to B cells of the BM and spleen without internalization, and transformation of promastigotes into amastigote morphotypes. The interaction appears independent of IgM expression and is associated with an increased detection of activated lysosomes. Furthermore, the extracellularly attached amastigotes could be efficiently transferred to infect macrophages. The observed interaction underscores the potentially crucial role of B cells during VL infection. Additionally, using immunization against a fluorescent heterologous antigen, it was shown that the infection does not impair immune memory, which is reassuring for vaccination campaigns in VL endemic areas.
Incidence and Risk Factors for Severe Postpartum Hemorrhage in Women With Anterior Low-Lying or Previa Placenta and Prior Cesarean: Prospective Population-Based Study
Authors: Pinton A , Deneux-Tharaux C , Seco A , Sentilhes L , Kayem G ,   on behalf of the PACCRETA Study Group
Published: August 2024

(BJOG. 2023;130(13):1653–1661. doi: 10.1111/1471-0528.17554)
The presence of an abnormally located placenta (either anterior low lying or previa) along with a history of prior cesarean section is associated with placenta accreta spectrum (PAS). Diagnostic tests for PAS are recommended for patients with this combination of risk factors to provide care at specialized, high resource institutions and limit maternal morbidity and mortality. Recommendations for referral to specialized centers in the setting of prior cesarean delivery and either anterior low lying or placenta previa vary due to lack of evidence in this group of patients. This population-based cohort study seeks to understand whether the incidence and risk factors for severe PPH can be found in women with an abnormally located placenta as well as a prior cesarean section in the absence of a prenatal PAS diagnosis.
Risk of Recurrent Severe Maternal Morbidity: A Population-Based Study
Authors: Ukah UV , Platt RW , Auger N , Lisonkova S , Ray JG , Malhamé I , Ayoub A , El-Chaâr D , Dayan N 
Published: August 2024

(Am J Obstet Gynecol. 2023;229(5):545.e1–545.e11. doi: 10.1016/j.ajog.2023.06.010)
The occurrence of severe maternal morbidity (SMM), a composite indicator of maternal wellness and care in pregnancy or up to 42 days following delivery, is increasing. SMM precedes over half of maternal deaths, is associated with extended hospital stays, and linked to long-term cardiovascular health concerns. Public health agencies prioritize monitoring SMM to drive better clinical care and outcomes. Understanding SMM recurrence is crucial for informed decision-making and complex care planning during subsequent pregnancies. Recent epidemiologic studies, several limited to privately insured populations, have found a 3 to 8 folds increased relative risk of SMM recurrence. However, diverse populations and individual SMM criteria have not been studied. This study aimed to understand SMM recurrence risk in a second pregnancy in patients with a history of SMM as a primary composite outcome and by disease-specific conditions secondarily, adjusting for known factors like age, health conditions, substance use, and socioeconomic status.
Cannabis Exposure and Adverse Pregnancy Outcomes Related to Placental Function
Authors: Metz TD , Allshouse AA , McMillin GA , Greene T , Chung JH , Grobman WA , Haas DM , Mercer BM , Parry S , Reddy UM , Saade GR , Simhan HN , Silver RM 
Published: August 2024

(JAMA. 2023;330(22):2191–2199. doi: 10.1001/jama.2023.21146)
Cannabis use has steadily increased over the last decade and is now viewed by many pregnant individuals as relatively safe in many forms. Previously published research in pregnancy is limited by inaccurate assessment of exposure to cannabis, relying heavily on self-reported use, and significant confounding that influences pregnancy outcomes including tobacco use, anxiety, and depression. Researchers agree that the prevalence of cannabis use is chronically underestimated, due to the stigma associated with any drug use in pregnancy as well as potential legal consequences in states with mandatory reporting. Exposure to cannabis has been linked to placental dysfunction and poor fetal growth. This study was executed to evaluate an association between cannabis use and adverse pregnancy outcomes that are related to placental function, as well as to understand the strength of the association based on exposure timing and intensity.
Intrapartum Continuous Subcutaneous Insulin Infusion Versus Intravenous Insulin Infusion Among Pregnant Individuals With type 1 Diabetes Mellitus: A Randomized Controlled Trial
Authors: Wilkie GL , Delpapa E , Leftwich HK 
Published: August 2024

(Am J Obstet Gynecol. 2023;229(6):680.e1–680.e8. doi: 10.1016/j.ajog.2023.07.003)
Type 1 diabetes mellitus (T1DM) requires life-long insulin management and is a component of pregestational diabetes, affecting 1% to 2% of all pregnancies. Maternal exposure to placental hormones heightens insulin resistance and the potential for poor glycemic control. Hypoglycemia, diabetes-related complications, diabetic ketoacidosis, congenital anomalies, stillbirth, macrosomia, cesarean delivery, polyhydramnios, and hypertensive disorders or pregnancy are known complications of T1DM, especially in the setting of poor glycemic management. Neonatal exposure to high maternal blood sugar during pregnancy can lead to severe complications like neonatal hypoglycemia, respiratory distress syndrome, polycythemia, and jaundice and maternal glucose control in labor is important for neonatal hypoglycemia reduction. Optimal intrapartum glycemic control methods vary among providers, ranging from continuous subcutaneous insulin infusion (CSII) to intravenous (IV) insulin infusion, with limited data on neonatal outcomes. This study sought to understand the effect of intrapartum CSII in comparison to IV insulin infusion on first neonatal blood glucose level in pregnant patients with T1DM utilizing CSII at baseline.
United States Rural Residence Is Associated With Increased Acute Maternal End-organ Injury or Mortality After Birth: A Retrospective Multistate Analysis, 2007-2018
Authors: Chaturvedi R , Lui B , Tangel VE , Abramovitz SE , Pryor KO , Lim KG , White RS 
Published: August 2024

(Int J Obstet Anesth. 2023;56:103916. doi:10.1016/j.ijoa.2023.103916)
The maternal mortality rate in the USA rose from 7.2 to 23.8 deaths per 100,000 live births between 1987 and 2020. This increase, along with a 200% rise in severe maternal morbidity (SMM), may be partly due to increased comorbidity among expectant mothers. However, social determinants of health also play a role, including location, race/ethnicity, and age. Analysis of national data shows that women in highly urban or rural areas face higher risks of combined SMM and mortality compared with those in smaller cities. Anesthetic choice further influences outcomes, with neuraxial analgesia linked to lower SMM rates during vaginal births. Access to such anesthesia may vary based on social determinants like rural-urban disparities. This study aims to explore differences in maternal outcomes based on residency, anesthesia type, and mode of delivery, hypothesizing that rural residents face more significant risks and disparities in anesthesia access.
Oxytocin at Elective Cesarean Delivery: A Dose-finding Study in Pregnant People With Twin Pregnancy
Authors: Peska E , Balki M , Pfeifer W , Maxwell C , Ye XY , Downey K , Carvalho JCA 
Published: August 2024

(Anesth Analg. 2024;138(4):814–820. doi:10.1213/ANE.0000000000006309)
Multiple pregnancies pose a well-known danger for postpartum hemorrhage (PPH). Compared with single pregnancies, individuals expecting multiples face heightened risks like uterine atony, severe PPH, blood transfusion, hysterectomy, prolonged hospital stays, and mortality, regardless of income level. Uterine atony, a significant cause of PPH, is more common in multiple pregnancies. Prophylactic oxytocin postdelivery is crucial in PPH prevention, though it can have adverse effects and should be given at the minimum effective dose. Studies suggest varying oxytocin requirements based on clinical scenarios like body mass index and cesarean delivery (CD) for labor complications in multiple pregnancies, prompting the need for tailored dosages for PPH prevention.
Cultivating Common Ground: The Intersection of Mental Health and Faith
Authors: Verduin Marcia L. , Tower Keith 
Published: August 2024

Abstract
During and following the COVID-19 pandemic, the world experienced a significant increase in the prevalence of mental health problems along with a concomitant increase in mental health service utilization rates. Even though the stigma associated with mental health problems has been decreasing and service utilization rates have increased, these have not been seen in all segments of the population; for instance, some religious beliefs have been associated with less frequent and lower rates of mental health service use. In this commentary, the authors, an academic psychiatrist and a community-based pastor, describe how their informal academic-community collaboration led to a series of speaking opportunities to help an international group of clergy members develop a better understanding of mental health and how mental health problems may intersect with faith. They reflect on lessons learned from these opportunities and their professions, discuss opportunities for academic faculty to apply these lessons in their daily practices, and encourage academic faculty to consider a “common ground” approach in their own community outreach efforts. The authors underscore the importance of building connections with people who might have beliefs, views, or understandings of medical concepts that differ from academic medicine’s and of teaching trainees how to build these connections. They challenge individual clinicians and academic faculty to identify spheres of influence that they have in their own lives through which they can create a positive impact for medicine and public health by finding shared experiences and common ground, clarifying misunderstandings, educating where needed, and serving as role models to encourage trainees to do the same.
Barriers Facing Undocumented Medical Students Without DACA
Authors: Fabi Rachel , Suleiman Halima , Kuczewski Mark 
Published: August 2024

Abstract
Despite predictions that the United States will experience a growing physician shortage in the coming decades, there remains a population of would-be clinicians who are barred from becoming licensed physicians because of their immigration status. Undocumented medical students who do not have Deferred Action for Childhood Arrivals (DACA) status have to overcome many barriers to gain admittance to medical school, but because they lack work authorization in the United States, they are unable to enter residency training. In this article, the authors highlight the implications of this dilemma for academic medicine. After detailing the experiences of an undocumented medical student, they examine the historical and policy background of this barrier to licensure and board certification. The authors consider the most immediate option available to academic medical institutions: to create a viable training program that is an alternative to residency. Such an alternative training program would need to be equivalent in quality to an accredited residency program and enable its trainees to become board-certified but not be a form of employment. Finally, the authors conclude with a call for academic medicine to engage in advocacy in support of legislative solutions for undocumented young people.
Is Next-day Discharge Safe After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis?
Authors: Kirk Andrew M. , Barré Alyssa M. , Prusick Vincent W. , Conley Caitlin , Muchow Ryan D. 
Published: August 2024

Objective:
While the implementation of enhanced recovery after surgery protocols and improvements in pain control have decreased the length of stay (LOS) after scoliosis surgery, adolescents are typically hospitalized for several days after posterior spinal instrumented fusion (PSF). The purpose of this study was to determine whether next-day discharge after PSF for adolescent idiopathic scoliosis (AIS) had an equivalent safety profile compared with longer LOS. The secondary purpose was to examine perioperative factors associated with next-day discharge.

Methods:
We performed a retrospective study of all patients who underwent PSF for AIS at a single institution from 2017 to 2022. We compared patients based on postoperative LOS with an early discharge group consisting of those who were discharged on the first postoperative day 1 (POD1; n = 40) and a standard discharge group consisting of those who were discharged after POD1 (n = 71). We documented preoperative variables, including patient demographics and curve characteristics, intraoperative variables, including levels fused, implant density, operative time, and blood loss, and postoperative variables, including emergency department (ED) visits within 30 days and hospital readmissions within 90 days.

Results:
One hundred eleven patients were included with a mean curve magnitude of 67 degrees. Forty patients (36%) were discharged on POD1. There were one (3%) ED visit and 2 (5%) readmissions in the early discharge group and 3 (4%) ED visits and 2 (3%) readmissions in the standard discharge group (P = 0.64 and 0.55, respectively). Patients in whom intravenous methadone was used intraoperatively were more likely to discharge POD1 (P = 0.02). There were no other significant differences in perioperative variables between the two groups including: BMI, distance from home to hospital, magnitude of main curve, curve flexibility, number of levels fused, estimated blood loss, implant density, operative time, or postoperative pain scores.

Conclusions:
Next-day discharge after PSF for AIS has an equivalent safety profile compared with longer LOS. Over one-third of patients were discharged on POD1, and there was no statistically significant difference in ED visits or hospital readmissions between the groups. Patients in whom intravenous methadone was used intraoperatively were more likely to discharge POD1.

Clinical Relevance:
In a retrospective study of posterior spinal fusions for AIS, we found no increase in ED visits or hospital readmissions for those discharged the next day.

Level of Evidence:
Level III.
Do ChatGPT and Gemini Provide Appropriate Recommendations for Pediatric Orthopaedic Conditions?
Authors: Pirkle Sean , Yang JaeWon , Blumberg Todd J. 
Published: August 2024

Background:
Artificial intelligence (AI), and in particular large language models (LLMs) such as Chat Generative Pre-Trained Transformer (ChatGPT) and Gemini have provided additional resources for patients to research the management of healthcare conditions, for their own edification and the advocacy in the care of their children. The accuracy of these models, however, and the sources from which they draw conclusions, have been largely unstudied in pediatric orthopaedics. This research aimed to assess the reliability of machine learning tools in providing appropriate recommendations for the care of common pediatric orthopaedic conditions.

Methods:
ChatGPT and Gemini were queried using plain language generated from the American Academy of Orthopaedic Surgeons (AAOS) Clinical Practice Guidelines (CPGs) listed on the Pediatric Orthopedic Society of North America (POSNA) web page. Two independent reviewers assessed the accuracy of the responses, and chi-square analyses were used to compare the 2 LLMs. Inter-rater reliability was calculated via Cohen’s Kappa coefficient. If research studies were cited, attempts were made to assess their legitimacy by searching the PubMed and Google Scholar databases.

Results:
ChatGPT and Gemini performed similarly, agreeing with the AAOS CPGs at a rate of 67% and 69%. No significant differences were observed in the performance between the 2 LLMs. ChatGPT did not reference specific studies in any response, whereas Gemini referenced a total of 16 research papers in 6 of 24 responses. 12 of the 16 studies referenced contained errors and either were unable to be identified (7) or contained discrepancies (5) regarding publication year, journal, or proper accreditation of authorship.

Conclusion:
The LLMs investigated were frequently aligned with the AAOS CPGs; however, the rate of neutral statements or disagreement with consensus recommendations was substantial and frequently contained errors with citations of sources. These findings suggest there remains room for growth and transparency in the development of the models which power AI, and they may not yet represent the best source of up-to-date healthcare information for patients or providers.