bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nested Randomized Controlled Trials in Large Databases: An Opportunity for Inflammatory Bowel Disease?
Authors: Temido Maria Jose , Honap Sailish , Danese Silvio , Jairath Vipul , Magro Fernando , Portela Francisco , Peyrin-Biroulet Laurent 
Published: August 2024

Abstract

Introduction
Although randomized controlled trials (RCTs) are the gold standard for investigating the efficacy and safety of interventions, they present major operational challenges due to their complexity, time-consuming nature, and costs. To address some of these difficulties, RCTs nested in cohorts (RCTsNC) have been developed. The aim was to review the opportunities and challenges of RCTsNC in inflammatory bowel disease (IBD).

Methods
A literature search was conducted using MEDLINE, Embase, Cochrane and Clinicaltrials.gov from inception until March 2024 to identify studies focusing on this topic.

Results
RCTsNC is an emerging trial design, which has been successfully utilized across several medical disciplines but not IBD. It enables the use of longer-term longitudinal data for safety and efficacy assessment, and enhanced recruitment and follow up processes. Observational data for IBD, derived from research (cohort and case-control studies) and non-research sources (electronic health records and registries), provides access to comprehensive records for a large number of IBD patients, which could present an opportunity to enhance the performance of RCTsNC. Leveraging pre-existing cohorts and their organizational structures improves patient acceptance and is more economical compared to traditional randomized trials. It may permit researchers to address knowledge gaps in IBD (specific sub-populations, or the effect of environmental exposures on disease course). Limitations of RCTsNC include the risk of selection bias and constraints related to comparisons with placebo.

Conclusion
RCTsNC offers a promising opportunity for IBD research and provides an alternative study design given the challenges of conventional trial designs in the current IBD RCT landscape.
Genetic characterization of candidate ecdysteroid kinases in Drosophila melanogaster
Authors: Scanlan Jack L , Robin Charles 
Published: August 2024

Abstract
Ecdysteroids are major hormones in insects and control molting, growth, reproduction, physiology, and behavior. The biosynthesis of ecdysteroids such as 20-hydroxyecdysone (20E) from dietary sterols is well characterized, but ecdysteroid catabolism is poorly understood. Ecdysteroid kinases (EcKs) mediate the reversible phosphorylation of ecdysteroids, which has been implicated in ecdysteroid recycling during embryogenesis and reproduction in various insects. However, to date, only 2 EcK-encoding genes have been identified, in the silkworm Bombyx mori and the mosquito Anopheles gambiae. Previously, we identified 2 ecdysteroid kinase-like (EcKL) genes—Wallflower (Wall) and Pinkman (pkm)—in the model fruit fly Drosophila melanogaster that are orthologs of the ecdysteroid 22-kinase gene BmEc22K. Here, using gene knockdown, knockout, and misexpression, we explore Wall and pkm's possible functions and genetically test the hypothesis that they encode EcKs. Wall and pkm null mutants are viable and fertile, suggesting that they are not essential for development or reproduction, whereas phenotypes arising from RNAi and somatic CRISPR appear to derive from off-target effects or other artifacts. However, misexpression of Wall results in dramatic phenotypes, including developmental arrest, and defects in trachea, cuticle, and pigmentation. Wall misexpression fails to phenocopy irreversible ecdysteroid catabolism through misexpression of Cyp18a1, suggesting that Wall does not directly inactivate 20E. Additionally, Wall misexpression phenotypes are not attenuated in Cyp18a1 mutants, strongly suggesting that Wall is not an ecdysteroid 26-kinase. We hypothesize that the substrate of Wall in this misexpression experiment and possibly generally is an unknown, atypical ecdysteroid that plays essential roles in Drosophila development, and may highlight aspects of insect endocrinology that are as-yet uncharacterized. We also provide preliminary evidence that CG5644 encodes an ecdysteroid 22-kinase conserved across Diptera.
A Jurisdictional Vertigo: Compulsory Arbitration, Sports and the European Court of Human Rights
Authors: Shahlaei Faraz 
Published: August 2024

Abstract
This article discusses jurisdictional issues when cases related to arbitral awards of the Court of Arbitration for Sport end up before the European Court of Human Rights (ECtHR). By focusing on the ECtHR’s Third Chamber judgment in the Semenya case, it discusses how the unique governance structure of sports governing bodies, as the benchmark for such disputes, has distorted the traditional jurisdictional paradigms of the ECtHR, posing challenges for the Court in addressing potential human rights violations in the realm of sports. This article argues that human rights claims arising from sports activities form a new class of human rights litigation stemming from the activities of private actors with a strong public character. Such dynamics grant the ECtHR a central role as the ultimate arbiter in protecting human rights within the realm of sports and require it to subject the sports proceedings to a comprehensive review both on procedural and substantive grounds, even with relation to athletes residing outside the territory of Council of Europe member States.
Gallstone in the gastric remnant after bariatric surgery
Authors: da Cunha Sofia Teixeira , Vergos Georgios , Pfefferkorn Urs 
Published: August 2024

Abstract
In the last decades, bariatric surgery has been widely performed to treat obesity and its co-morbidities, with the laparoscopic Roux-en-Y gastric bypass (LRYGB) being the second most commonly performed procedure. Abdominal pain after LRYGB is a common symptom. This report concerns a case of a rare cause of chronic abdominal pain after LRYGB and cholecystectomy in a 48-year-old woman due to a cholesterol stone within the gastric remnant that was removed via open gastrectomy. This is the first documented case of cholesterol stone formation in the gastric remnant and underscores the importance of vigilance for atypical complications in patients undergoing bariatric procedures.
Type I choledochal cyst. Total laparoscopic resection and Roux-en-Y reconstruction to two separated ducts
Authors: Reyes Natalia , Sotomayor Camila , Inzunza Martín , Briceño Eduardo , Viñuela Eduardo , Martínez Jorge , Jarufe Nicolás 
Published: August 2024

Abstract
A choledochal cyst is a rare condition that requires surgical treatment to prevent complications, such as obstructive jaundice, cyst rupture, cholangitis, and the risk of malignancy. Complete cyst excision is considered the best option, as it reduces the risk of inflammation and the development of cholangiocarcinoma. Therefore, cholecystectomy and complete cyst resection followed by reconstruction with a Roux-en-Y hepaticojejunostomy is the treatment of choice. We present a case (with video) that shows the complete resection of a type I choledochal cyst with Roux-en-Y reconstruction of two separate ducts since the right posterior duct reached the cyst independently. The laparoscopic approach offers all the advantages of mini-invasive surgery and better visualization of the structures; however, biliary reconstruction to fine ducts implies a surgical challenge that requires high training in mini-invasive surgery.
Nursing Ethics as an Independent Subfield of Healthcare Ethics
Authors: Vogelstein Eric 
Published: August 2024

Abstract
This chapter explores the question of whether there is a unique field of nursing ethics that is important to separate from the ethics of the other healthcare professions, and if so, what the nature and ground of such a field would be. It is argued that norms intrinsic to the practice of nursing probably do not ground a unique set of ethical norms for the profession, while contingent yet institutionally embedded factors related to power structures, as well as the prevalence and type of interactions nurses typically have with patients (compared with other healthcare professionals), do generate unique ethical problems and obligations for nurses. Thus, it is those aspects of modern nursing practice that form the basis for a robust and important field of nursing ethics.
The Relevance of Feminist Ethics for Moral Communities in Healthcare Work
Authors: Liaschenko Joan , Peter Elizabeth 
Published: August 2024

Abstract
This chapter examines the concept of moral community, arguing that the characteristics of a moral community can be well articulated using the theoretical representation of morality in feminist ethics. The authors reflect on the history of the concept in nursing and medicine that draws attention to the importance of relationships in delivering care in increasingly complex environments that function best when people are accountable to each other in fulfilling their responsibilities. Next, they examine empirical studies that demonstrate the role of moral communities in preventing and diminishing the moral concerns of nurses by fostering positive identities, repairing damaged identities, and supporting moral agency. Particular attention to the feminist concept of situated knowing is explored to add understanding to how the perspectives of people are variously respected in a moral community. Ultimately, moral communicative work and institutional and structural support are essential in building and sustaining moral communities.
Moral Expertise and Epistemic Peerhood
Authors: Watson Jamie Carlin 
Published: August 2024

Abstract
Nurses face increasing pressure to contribute to complex moral decisions. This contribution requires robust competence in ethical judgment. And while this need for ethical competence is explicit, how one acquires that competence is often vague, and nursing education does not always prepare nurses to cultivate skill in moral decision-making. In this chapter, the author introduces concepts from expertise studies and contemporary debates over moral expertise to discuss how nurses might enhance these skills, whether they are new graduates or seasoned veterans. And while leaving it an open question whether anyone can acquire robust moral expertise, the author summarizes recent empirical work that suggests not only that nurses can enhance their moral judgment, but also highlights concrete strategies for improving ethics education in nursing, both formal curricular instruction and continuing professional development, from the bedside to roles in institutional leadership.
Revisiting Moral Agency
Authors: Bartlett Jennifer L. , Taylor Carol 
Published: August 2024

Abstract
Moral agency requires moral character, the formation of values and identification of motivation, moral sensibility and responsiveness, ethical reasoning and discernment, moral accountability, and the gumption to enact change through transformative moral leadership. The development of moral agency in nursing parallels professional development in other healthcare professions. Nurses must possess moral agency as individuals caring for patients, families, and communities, but they cannot ignore the agency required of nurses in system, institution, sociopolitical, and global environments. This chapter considers moral agency in several situations designed to highlight the role of the nurse as an essential part of the healthcare system. Moral agency remains embedded in the fabric of nursing—the authors of this chapter seek to articulate its application.
The Ethical Rationale for Comprehensive Neonatal Intensive Care Unit Follow-Up
Authors: Carter Angel C. , Carter Brian S. 
Published: August 2024

Abstract
In this chapter, the authors (a neonatology physician and ethicist and a neonatal nurse practitioner, who both work in the Neonatal Intensive Care Unit [NICU] Follow-Up Clinic) look at how best to conduct follow-up care for high-risk NICU graduates from Level III and IV NICUs. The common goals for neonatal follow-up include clinical assessments of feeding and physical growth; attainment of developmental milestones; monitoring neurocognitive, neuromotor, and special sensory functioning (vision, hearing, speech, and language) throughout the infant-toddler period and enlisting necessary special services such as physical, occupational, and/or speech therapies to optimize the baby’s outcome. Such service provision brings with it the need to attend to ethical issues such as: addressing care coordination improvement; dealing with community-based pediatric-specific resource capacity; addressing the social determinants of health; and using follow-up data to inform perinatal-neonatal counseling and the development of NICU best practices.
How Confucian Values Shape the Moral Boundaries of Family Caregiving
Authors: Chan Helen Yue-lai , Kim Richard , Leung Doris Yin-ping , Cheng Ho-yu , Chong Connie Yuen-yu , Chien Wai-tong 
Published: August 2024

Abstract
The moral values within the modern healthcare system are primarily shaped by a number of Western moral frameworks, such as consequentialism and Kantianism, that aspire for universal applicability, cutting across culture and time. However, human morality, like human beings, is significantly shaped by the norms, roles, and responsibilities that are constitutive of one’s particular culture and society. In East Asia, where Confucian values have been deeply institutionalized in the culture, filial piety (xiao) remains the core value prescribing how children should demonstrate reciprocal care to their parents and older relatives. Other values and virtues, including guilt, shame (chi), benevolence (ren), and ritual propriety (li), also constitute the ethics of family caregiving and impact a range of important issues such as truth-telling and end-of-life care. Given that concepts such as individuality and autonomy are not prioritized in East Asian cultures, substantial power is given to the family of individuals regarding many critical healthcare decisions. How exactly, if at all, these Confucian values can be applied to the contemporary healthcare setting is not clear, and the divergent ways that people understand these values from both a traditional and contemporary point of view raise further challenges. This chapter examines how the historical and contemporary interpretations of Confucian values shape family caregiving and discusses a number of ethical issues that emerge when these values are applied to contemporary healthcare situations.
Constructing Avenues for Agency
Authors: Guidry-Grimes Laura K. 
Published: August 2024

Abstract
The aim of this chapter is to elucidate how persons with disabilities can be rendered vulnerable in various clinical contexts, which has implications for how nurses should identify and address different types of barriers for patients in their care. The chapter begins by surveying the conceptual territory surrounding the term “disability,” since how this term is conceptualized will make a difference for framing the nature of vulnerabilities as they arise. Next, the chapter examines how institutional environments (such as hospitals and nursing homes) can limit opportunities for agency, and this discussion will include the challenges faced by persons with physical, intellectual, and psychiatric disabilities. This chapter emphasizes how nurses, nurse assistants, and healthcare facilities should proactively mitigate vulnerabilities for disabled people and enable different forms of agency.
Teaching With Pictures
Authors: Wilkenfeld Daniel A. , Johnson Christa M. 
Published: August 2024

Abstract
Nursing ethics educators (and educators more generally) frequently find value in presenting and discussing with students tragic historical events in clinical practice or medical research. In this chapter, the authors argue that the use of images of victims in these cases is ethically problematic. Specifically, they argue that it is not acceptable in a classroom setting to use identifiable photographs of people in a heightened vulnerable state without at least their implied consent, even for otherwise laudable goals. While there is undoubtedly consequentialist value in utilizing such tools, the authors ultimately argue that doing so violates deontological constraints (e.g., with regard to autonomy and respect for persons). If one grants (as is largely assumed) that ends do not typically justify means, this provides grounds for revising current practice.
Effects of Indomethacin in Premature Infants With Patent Ductus Arteriosus
Authors: Mitra Souvik 
Published: August 2024

Abstract
Indomethacin is a nonselective cyclooxygenase inhibitor indicated for treatment of patent ductus arteriosus (PDA) in preterm infants. This multicenter randomized controlled trial (RCT) explored the efficacy of 2 strategies of indomethacin therapy in preterm infants with a symptomatic PDA, as part of initial therapy or following a trial of conservative medical management. Infants who received indomethacin as an initial therapy had a significantly higher primary PDA closure rate compared with conservative management alone (79% vs 35%; p &lt;0.001). When indomethacin was used as a backup therapy for infants who failed to respond to conservative medical management, 27% ultimately underwent PDA ligation (as compared with 21% of infants originally treated with indomethacin). There were no statistically significant differences noted for mortality, BPD, IVH, or NEC between any of the groups.
Pressure-Regulated Volume Control Ventilation vs Synchronized Intermittent Mandatory Ventilation for Very Low Birth Weight Infants
Authors: Jensen Erik A. 
Published: August 2024

Abstract
At the time of this trial, the risks and benefits of synchronized volume-control versus pressure-guarantee mechanical ventilation in preterm infants were uncertain. D’Angio et al. randomized 212 ventilated infants with birth weights of 500 to 1249 g to receive synchronized pressure-regulated volume control (PRVC) ventilation or pressure-limited synchronized intermittent mandatory ventilation (SIMV) beginning within 6 hours after birth. No differences were observed between PRVC and SIMV in the primary outcome of proportion of infants alive and extubated at 14 days (36.5% versus 40.7%), the length of mechanical ventilation in survivors (median 33 versus 24 days), or survival without bronchopulmonary dysplasia (63.5% versus 57.1%).
Palivizumab, a Humanized Respiratory Syncytial Virus Monoclonal Antibody, Reduces Hospitalization From Respiratory Syncytial Virus Infection in High-Risk Infants
Authors: King Brian Christopher 
Published: August 2024

Abstract
Respiratory syncytial virus (RSV) is a leading cause of respiratory illness in high-risk infants. The IMpact-RSV trial investigated whether prophylactic monthly injections of a monoclonal antibody targeting RSV, palivizumab, would safely reduce hospitalizations due to RSV. One thousand five hundred and two formerly preterm infants were randomized in a 2:1 ratio to palivizumab or a placebo in a double-blind approach during a single RSV season. Monthly palivizumab injections resulted in a 55% reduction in RSV-related hospitalizations (4.8% versus 10.6%; 95% confidence interval [CI] 0.38 to 0.72, p &lt;0.001). There were also significant reductions in hospital days (36.4 versus 62.6; p &lt;0.001) and days with supplemental oxygen (30.3 versus 50.6; p &lt;0.001) for the palivizumab group, without significant adverse events.
Multicenter Trial of Cryotherapy for Retinopathy of Prematurity
Authors: Hagadorn James I. 
Published: August 2024

Abstract
Although use of cryotherapy for severe retinopathy of prematurity (ROP) was gaining acceptance in some countries, controlled trials defining its safety and efficacy were lacking. The CRYO-ROP trial randomized individual eyes of babies with severe ROP to cryotherapy or observation and followed structural and visual outcomes. Cryotherapy entailed transscleral cryotherapy of the avascular retina. At interim analysis, structural outcome was better at 3 months following treatment in eyes undergoing cryotherapy, as compared with untreated eyes (21.8% versus 43%; χ2 20.5, p &lt;0.0001), prompting early halt of randomization. The most common complications during the procedure were hemorrhage (retinal, preretinal, or vitreous; 19.1%), conjunctival or subconjunctival hematoma (10.2%), and bradycardia or other arrhythmia (8.9%).
Newborn-Care Training and Perinatal Mortality in Developing Countries
Authors: Ehret Danielle E. Y. 
Published: August 2024

Abstract
Most neonatal deaths and stillbirths occur in low-resourced settings. This study assessed the effectiveness of 2 newborn-care training programs implemented in phases. First, instructors trained birth attendants from rural communities in 6 low- and middle-income countries in the World Health Organization Essential Newborn Care (ENC) course (before-and-after design; n = 57,643). Next, investigators conducted a cluster-randomized, controlled trial of a modified version of the American Academy of Pediatrics Neonatal Resuscitation Program (NRP) compared with no further training (n = 62,366). Following ENC training, there was no significant reduction in the primary outcome of early neonatal mortality (RR 0.99, 95% CI 0.81 to 1.22). Regarding secondary outcomes, perinatal mortality was unchanged (RR 0.85, 95% CI 0.70 to 1.02); although there was a significant reduction in stillbirth rate (RR 0.69, 95% CI 0.54 to 0.88, p &lt;0.01). Following NRP training, there was no reduction in early neonatal mortality, stillbirth, or perinatal mortality.
Stress and Burnout in Healthcare
Authors: Heinz Eric R. , Nguyen Hieu T. 
Published: August 2024

Abstract
Burnout is classically considered a multifaceted syndrome that can affect any individual in the workplace setting. It can occur in any workplace environment, but, in the past several years, its prevalence in the healthcare industry has gained more attention. Burnout has been defined as consisting of emotional exhaustion, depersonalization, and low personal accomplishment. Up to 40% of physicians have reported burnout. Risk factors that contribute to physician burnout include female gender, young age, long working hours, low job satisfaction, and presence of a work–home conflict. Physical activity, mindfulness, and institutional wellness programs that include cognitive behavioral therapy and stress management may reduce the prevalence of burnout in healthcare workers.
Diversity and Equity in the Workplace
Authors: Clarke Callisia N. 
Published: August 2024

Abstract
Creating and maintaining a diverse physician workforce is vital to eliminating healthcare disparities and improve health equity for all. Despite formal efforts to increase the pipeline of physicians coming from backgrounds underrepresented in medicine, adequate representation for these groups continues to lag. Disparities in recruitment, retention, promotion, and leadership advancement contribute to discriminatory policies and practices that hinder professional growth and personal job satisfaction, leading to high rates of attrition. Attempts to improve diversity in the physician workforce must start with an inclusive environment where effective recruitment practices and retention efforts align with departmental and institutional goals. Leaders must commit to creating an atmosphere of equity, inclusivity, tolerance, and empowerment and apply significant financial and structural support to achieve and maintain this. Specific areas to address include reducing barriers to leadership and promotion for minority groups, minimizing the objective effects of implicit bias, preventing social and academic isolation, and following fair and transparent guidelines for promotion and compensation.