bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Neuraxial Preservative-Free Morphine in Vaginal Delivery on Opiate Consumption and Recovery: A Randomized Control Trial
Authors: Katz Daniel , Hyers Benjamin , Siddiqui Saher , Ouyang Yuxia , Hamburger Joshua , Knibbs Nakiyah , Beilin Yaakov 
Published: July 2024

BACKGROUND:
Neuraxial opioids are commonly used after cesarean delivery (CD). However, they are not commonly used after vaginal delivery (VD) though some studies have suggested they may be beneficial from a pain perspective. However, they did not evaluate other potential benefits including patient satisfaction, impact on postpartum depression and breastfeeding (BF) success, or side effects such as pruritus.

METHODS:
Parturients who delivered vaginally with epidural analgesia were randomized to receive either 2 mg of preservative-free morphine (4 mL) or saline (4 mL) via the epidural catheter within 1 hour of VD. Routine analgesics were unchanged and included q 6-hour dosing of acetaminophen 975 mg orally and ketorolac 30 mg intravenous (IV). Hydromorphone 2 mg or oxycodone 10 mg were offered for breakthrough pain. Our primary outcome was opiate consumption in the first 24 hours after drug administration. Secondary outcomes included pain scores at 24 hours and 1 week postpartum as well as opiate consumption up to 1 week postpartum. Additional end points such as obstetric quality of recovery score (OBS-QOR10) breast feeding success, and an Edinburgh Postnatal Depression Score (EPDS) were also obtained.

RESULTS:
Data were analyzed for 157 parturients, 80 in the morphine group and 77 in the saline group. No difference was observed in the EDPS score predelivery or intention to BF. We found a statistically significant difference in the use of opioids in the first 24 hours, 3.8% (95% confidence interval [CI], 0.9%–11.3%) vs 14.3% (7.7%–24.5%) in the morphine and saline groups, respectively; and in total opioid dose, median (interquartile range, IQR [range]) of morphine milligram equivalent vs 0 (0–0 [0–47.5]) vs 0 (0–0 [0–72]), P = .023, in the morphine and saline groups, respectively. Verbal pain scores (0–10) at 24 hours were lower in the morphine group (median (IQR [range): 2.0 (1–4 [0–10]) vs 3.0 (1.5–5.0 [0–10]), P = .043. There was a greater incidence of pruritus in the morphine group versus saline group, 37.5% (95% CI, 27.1%–49.1%) vs 18.2% (95% CI, 10.6%–29.0%), P = .008. We did not find any differences in the OBS-QOR10, BF success, or EPDS at 6 weeks PP (P < .05).

CONCLUSIONS:
A single epidural dose of 2 mg preservative-free morphine after VD was effective at decreasing pain and opioid use at 24 hours after VD but came at the cost of increased pruritus. We did not detect any differences in BF, recovery scores, or PPD. Future studies should focus on elucidating the role of neuraxial preservative-free morphine after VD.
End-Tidal Control Versus Manual Control of Inhalational Anesthesia Delivery: A Randomized Controlled Noninferiority Trial
Authors: McCabe Melissa D. , Dear Guy de L. , Klopman Matthew A. , Garg Kritika , Seering Melinda S. 
Published: July 2024

BACKGROUND:
Precise anesthesia delivery helps ensure amnesia, analgesia, and immobility. Conventionally, the end-tidal anesthetic concentration is maintained through manual adjustment of the fresh gas flow and anesthetic vaporizer output. Some anesthesia delivery systems can deliver and maintain clinician-selected end-tidal anesthetic agent (EtAA) concentration using a modified closed-loop system. We evaluated the performance of an End-tidal Control (EtC) system on the Aisys CS2 anesthesia machine (GE HealthCare). We hypothesized EtC anesthetic delivery would be noninferior to manually controlled anesthetic delivery.

METHODS:
The Multi-site Anesthesia randomized controlled STudy of End-tidal control compared to conventional Results (MASTER) Trial evaluated anesthetic delivery in 210 adult patients receiving inhaled anesthesia. Patients were randomized to either EtC or manual control (MC) anesthetic delivery. The primary objective was to determine whether, compared to conventional anesthesia practice, EtC achieves and maintains clinician-specified EtAA and end-tidal oxygen (Eto
2) concentrations within defined noninferiority limits. Noninferiority was concluded if the lower limit of the 95% confidence interval (CI) of the difference between the percent duration within the acceptable range (5% of steady state or a margin of ~10% of each agent’s minimum alveolar concentration) for EtC and MC was ≥ −5% for both EtAA and Eto
2. Secondary objectives included performance measures: response time: time required to attain 90% of the first desired EtAA, overshoot: amount the controller (or vaporizer delivery) exceeded the desired EtAA, and accuracy: average deviation from the desired EtAA.

RESULTS:
EtC achieved and sustained targeted EtAA and Eto
2 concentrations within the noninferiority threshold. The EtAA was within 5% of the desired value 98% ± 2.05% of the time with EtC compared to 45.7% ± 31.7% of the time with MC (difference 52.3% [95% CI, 45.9%–58.6%], P < .0001). For Eto
2, EtC was within the noninferiority limit 86.3% ± 22.8% of the time compared with MC at 41% ± 33.3% (P < .0001, difference 45.3% [95% CI, 36.1%–54.5%]). The median response time for achieving 90% of the initial EtAA desired value was 75 seconds with EtC and 158 seconds with MC (P = .0013). EtC exhibited a median overshoot of 6.64% of the selected EtAA concentration, whereas MC often failed to reach the clinician’s desired value. The difference in median percent deviation from desired EtAA value was 15.7% ([95% CI, 13.5%–19.0%], P < 0001).

CONCLUSIONS:
EtC achieves and maintains the EtAA and Eto
2 concentration in a manner that is noninferior to manually controlled anesthesia delivery.
Transcending Transcendental Homelessness: Exile and the Idea of the Primitive in Brazil
Authors: Cardoso Rafael 
Published: July 2024

AbstractThis article examines the relationship between exile and artistic primitivism, focusing on the experiences of European artists who sought refuge in twentieth-century Brazil. It begins by looking at broad issues of acculturation to Brazilian society, through a cursory examination of the biographies of artists Carybé, Hansen-Bahia, and Pierre Verger, all of whom engaged directly with Afro-Brazilian culture in Bahia. It then proceeds to a detailed discussion of the concept of transcendental homelessness, drawn from Lukács’s The Theory of the Novel, as an overarching category encompassing both exile and primitivism. It concludes with a case study of painter Dimitri Ismailovitch, born in Kyiv and active in Rio de Janeiro, whose work straddles the borderline between cultural appropriation and transculturation. The role of emulation, conversion, and the carnivalesque as strategies affording cultural conviviality is analyzed. How does the condition of exile overlap with racial difference, and can it play a role in overriding it? The intersection of the exilic imagination with diasporic imaginaries deserves further scrutiny.
A qualitative study of Samoan cancer patients’ experiences
Authors: Every Alice , Cuesta-Briand Beatriz , Hansell Dyxon , Burich Shelley , Tofilua Fuamatala , Crawford Gregory B , Collier Aileen 
Published: July 2024

To investigate the palliative care experiences of Samoan patients with cancer and the impact these experiences have on their quality of life. Methods: This qualitative interview study was part of a larger study that interviewed19 participants recruited among patients with cancer registered with Samoa Cancer Society, or patients recently discharged from the main tertiary hospital in Samoa. Interview transcripts were reviewed, and the research team identified the key palliative-care-related themes. Results: Analysis led to the generation of the following key themes: living with pain; resource constraints; support from family and faith; and interactions with healthcare professionals. Most participants were experiencing unresolved pain as a result of poor health knowledge, lack of access to medications and practical issues, such as financial limitations and lack of transport. Participants also reported a lack of resources, including financial constraints, as a significant barrier to effective healthcare. Sources of support for patients with cancer were most commonly strong family relationships and religious faith. Although it was difficult for the participants to access care from healthcare professionals, they found that honest communication about their condition was comforting. However, they were frustrated if they felt communication was unsatisfactory. Conclusion: This study provides much needed evidence on the issues that affect the quality of life patients with cancer receiving palliative care and their families in Samoa. It also highlights the intersectionality of these issues and how this compounds the patient experience. Practical recommendations for improving palliative care lie in a few key areas, including a need for improved access to opioids and support for family caregivers. However, from a systemic perspective, the way forward should lie in harnessing the strengths of Samoan culture, including the strong sense of family and the role of religion, to provide support and care for palliative patients.
Concurrent occurrence of adenocarcinoma and urothelial carcinoma of the prostate gland: A case report
Authors: Hsu Jhe Yuan , Lin Yi Sheng , Huang Li Hua , Tsao Tang Yi , Hsu Chao Yu , Ou Yen Chuan , Tung Min Che 
Published: July 2024

BACKGROUND
Adenocarcinoma is the most common subtype of prostate cancer. Prostatic urothelial carcinoma (UC) typically originates from the prostatic urethra. The concurrent occurrence of adenocarcinoma and UC of the prostate gland is uncommon.
CASE SUMMARY
We present the case of an 82-year-old male patient with simultaneous adenocarcinoma and UC of the prostate gland. The patient underwent a transrectal ultrasound-guided biopsy, and the pathology test revealed UC. Subsequently, transurethral laser prostatectomy was performed, and the pathology test indicated adenocarcinoma of the prostate with a Gleason score of 3 + 4 and high-grade UC. Therefore, the patient was treated with androgen deprivation therapy, systemic chemotherapy, and immunotherapy. Magnetic resonance imaging performed during follow-up revealed a prostate tumor classified as cT2cN1M0, stage IVA. Therefore, the patient underwent robotic-assisted radical prostatectomy and bilateral pelvic lymph node dissection. The final pathology test of the prostate gland revealed acinar-type adenocarcinoma, Gleason pattern 4 + 3, pT2N0M0, and high-grade UC. The patient regularly presented to the clinic for postoperative follow-up evaluations. He did not experience any urinary discomfort.
CONCLUSION
According to our literature review, this is the first reported case of coexisting adenocarcinoma and UC of the prostate gland.
Late-stage diagnosis: The driving force behind high breast cancer mortality in Ethiopia: A systematic review and meta-analysis
Authors: Geremew Habtamu , Golla Eyasu Bamlaku , Simegn Mulat Belay , Abate Alegntaw , Ali Mohammed Ahmed , Kumbi Hawi , Wondie Smegnew Gichew , Mengstie Misganaw Asmamaw , Tilahun Werkneh Melkie 
Published: July 2024

Introduction
Breast cancer continues to be the most common malignancy and the leading cause of cancer-related deaths in Ethiopia. The poor prognosis and high mortality rate of breast cancer patients in the country are largely caused by late-stage diagnosis. Hence, understanding the epidemiology of late-stage diagnosis is essential to address this important problem. However, previous reports in Ethiopia indicated inconsistent findings. Therefore, this literature review was conducted to generate dependable evidence by summarizing the prevalence and determinants of late-stage diagnosis among breast cancer patients in Ethiopia.

Methods
Pertinent articles were retrieved by systematically searching on major electronic databases and gray literature. Data were extracted into an Excel spreadsheet and analyzed using the STATA 17 statistical software. The pooled estimates were summarized using the random effect meta-analysis model. Heterogeneity and small study effect were evaluated using the I2 statistics and Egger’s regression test in conjunction with the funnel plot, respectively. Meta-regression, sub-group analysis, and sensitivity analysis were also employed. Protocol registration number: CRD42024496237.

Results
The pooled prevalence of late-stage diagnosis after combining reports of 24 studies with 8,677 participants was 65.85 (95% CI: 58.38, 73.32). Residence (adjusted OR: 1.92; 95% CI: 1.45, 2.53), patient delay at their first presentation (adjusted OR: 2.65; 95% CI: 1.56, 4.49), traditional medicine use (adjusted OR: 2.54; 95% CI: 1.89, 3.41), and breast self-examination practice (adjusted OR: 0.28; 95% CI: 0.09, 0.88) were significant determinants of late-stage diagnosis.

Conclusion
Two-thirds of breast cancer patients in Ethiopia were diagnosed at an advanced stage. Residence, delay in the first presentation, traditional medicine use, and breast self-examination practice were significantly associated with late-stage diagnosis. Public education about breast cancer and its early detection techniques is crucial to reduce mortality and improve the survival of patients. Besides, improving access to cancer screening services is useful to tackle the disease at its curable stages.
Cost-effectiveness of applying high-sensitivity troponin I to a score for cardiovascular risk prediction in asymptomatic population
Authors: Jülicher Paul , Makarova Nataliya , Ojeda Francisco , Giusepi Isabella , Peters Annette , Thorand Barbara , Cesana Giancarlo , Jørgensen Torben , Linneberg Allan , Salomaa Veikko , Iacoviello Licia , Costanzo Simona , Söderberg Stefan , Kee Frank , Giampaoli Simona , Palmieri Luigi , Donfrancesco Chiara , Zeller Tanja , Kuulasmaa Kari , Tuovinen Tarja , Lamrock Felicity , Conrads-Frank Annette , Brambilla Paolo , Blankenberg Stefan , Siebert Uwe 
Published: July 2024

Introduction
Risk stratification scores such as the European Systematic COronary Risk Evaluation (SCORE) are used to guide individuals on cardiovascular disease (CVD) prevention. Adding high-sensitivity troponin I (hsTnI) to such risk scores has the potential to improve accuracy of CVD prediction. We investigated how applying hsTnI in addition to SCORE may impact management, outcome, and cost-effectiveness.

Methods
Characteristics of 72,190 apparently healthy individuals from the Biomarker for Cardiovascular Risk Assessment in Europe (BiomarCaRE) project were included into a discrete-event simulation comparing two strategies for assessing CVD risk. The standard strategy reflecting current practice employed SCORE (SCORE); the alternative strategy involved adding hsTnI information for further stratifying SCORE risk categories (S-SCORE). Individuals were followed over ten years from baseline examination to CVD event, death or end of follow-up. The model tracked the occurrence of events and calculated direct costs of screening, prevention, and treatment from a European health system perspective. Cost-effectiveness was expressed as incremental cost-effectiveness ratio (ICER) in € per quality-adjusted life year (QALYs) gained during 10 years of follow-up. Outputs were validated against observed rates, and results were tested in deterministic and probabilistic sensitivity analyses.

Results
S-SCORE yielded a change in management for 10.0% of individuals, and a reduction in CVD events (4.85% vs. 5.38%, p<0.001) and mortality (6.80% vs. 7.04%, p<0.001). S-SCORE led to 23 (95%CI: 20–26) additional event-free years and 7 (95%CI: 5–9) additional QALYs per 1,000 subjects screened, and resulted in a relative risk reduction for CVD of 9.9% (95%CI: 7.3–13.5%) with a number needed to screen to prevent one event of 183 (95%CI: 172 to 203). S-SCORE increased costs per subject by 187€ (95%CI: 177 € to 196 €), leading to an ICER of 27,440€/QALY gained. Sensitivity analysis was performed with eligibility for treatment being the most sensitive.

Conclusion
Adding a person’s hsTnI value to SCORE can impact clinical decision making and eventually improves QALYs and is cost-effective compared to CVD prevention strategies using SCORE alone. Stratifying SCORE risk classes for hsTnI would likely offer cost-effective alternatives, particularly when targeting higher risk groups.
Posthuman Gaming: Avatars, Gamers, and Entangled Subjectivities, Poppy Wilde (2024)
Authors: Alberto Maria K. 
Published: July 2024

Review of: Posthuman Gaming: Avatars, Gamers, and Entangled Subjectivities, Poppy Wilde (2024)
Abingdon: Routledge, 232 pp.,
ISBN 978-1-03205-503-9, e-book, USD 52.95
Mapping access to medical service provision at micro-scale: Dynamics in supply and demand in Germany
Authors: Reiter Denis , Hecht Robert , Jehling Mathias 
Published: July 2024

This paper demonstrates an approach to the problem of micro-scale analysis of medical service provision in Germany. Research focuses include estimating population dynamics, mapping access to medical facilities and identifying spatial patterns in medical service provision. We applied the Enhanced Two Step Floating Catchment Area method to quantify changes in access to primary care physicians over a period of eleven years. Our study reveals that overall access is modestly rising, but significant spatial disparities exist between different regions of Germany. We describe both supply and demand issues behind the observed changes in access. As a key result, we identify four types of regions with differing access-population dynamics. Our main conclusion on the topic of medical service provision is that spatial planning is facing a multi-dimensional problem rather than a one-dimensional one, and that access to services depends on a combination of factors. Concerning differences between rural and urban regions, we find that that there is no general positive or negative trend for either.
Methylxanthine and polyphenol distribution in guarana cultivars
Authors: Santos Géssica Aline Nogueira dos , Schimpl Flávia Camila , Ribeiro Milena Dantas , Scherer Filho Celso , Valente Mágno Sávio Ferreira , Silva José Ferreira da 
Published: July 2024

Guarana is a plant a native to the Amazon, and its seeds are used as soft drinks and other energy drink ingredients. The phytochemical aspects of guarana have been extensively explored for its use in herbal and cosmetic compositions due to the presence of metabolites, such as methylxanthines and polyphenols. This work aims to fill a gap in the information about the presence and accumulation of methylxanthines and polyphenols in leaves and fruits of guarana cultivars. Thus, information will be generated to contribute for future studies on guarana genetic improvement and plant physiology. Methylxanthines (caffeine [Cf], theobromine [Tb], and theophylline [Tf]) and phenolic compounds (catechin [Ct] and epicatechin [EC]) were quantified by HPLC in the leaves and fruits (pericarp and seed) of eighteen guarana cultivars. Tf was not detected in any tissue. Caffeine is present almost exclusively in seeds (4.21 ± 0.69 g.100g dry weight-1), while theobromine is predominant in leaves. Although catechin and epicatechin are present in both tissues, their contents are higher in seeds, with mean values of 1.36 and 0.76 g.100g dry weight-1, respectively. In guarana cultivars under study, BRS-Satere and BRS-608 stood out due to the high caffeine and phenolic contents in seeds. On the other hand, in BRS-Luzeia cultivar, the highest catechin and epicatechin contents were observed in leaves. The results provide new perspectives for the commercial exploitation of other guarana tissues, which could favor the industry, since the main source of these compounds are guarana seeds.
Cost-benefit considerations of the biased diagnostician
Authors: Sonnenberg Amnon 
Published: July 2024

Abstract

Objectives
In the cognitive process of establishing a diagnosis, the performance of a diagnostician can be characterized in terms of sensitivity and specificity. The aims of the present study are to analyze in quantitative terms how cognitive bias affects the performance of a diagnostician, and how a diagnostician’s biased decision making is further influenced by personal cost-benefit considerations.

Methods
The test matrices of two sequential diagnostic tests are manipulated according to the rules of linear algebra, using multiplication of the second with the first test matrix to calculate their joint test characteristics. The decision tree and receiver operating characteristic (ROC) of a biased and unbiased diagnostician are used to calculate which combination of test characteristics maximizes the expected utility value.

Results
Biased diagnosticians cannot establish a diagnosis beyond their own limited or distorted level of understanding. An unbiased and a biased diagnostician alike adjust their choice of test characteristics according to their different cost-benefit estimation of the various test outcomes. From the perspective of an unbiased diagnostician, the choices made by a biased diagnostician appear to invert reality. However, the same appearance of inverted reality is perceived by the biased diagnostician, judging the choices made by the unbiased diagnostician.

Conclusions
As a general principle, human testers cannot test beyond their own level of understanding. They only see what they know. As they base their judgment on preconceived notions about the utilities associated with different test outcomes, human testers also tend to only know what they want to know.
Climate Change Policy Development: A Multiple Streams Analysis of the Inflation Reduction Act of 2022
Authors: McGlynn Morgan , Sparks Aaron C. 
Published: July 2024

Abstract
Climate change has been on the national agenda since the late 1970s, yet until recently, little progress had been made at the federal level because of the dominance of the fossil fuel industry within the policy subsystem. In this article, we use multiple streams approach with process tracing methods to examine why significant climate policy was able to pass in 2022, despite growing polarization, when previous attempts had all failed. We examine two key case studies, the failure of Waxman-Markey in 2010 and the success of the Inflation Reduction Act in 2022. In 2010 some climate organizations were hesitant about cap and trade as a policy mechanism to address climate change and failed to stimulate advocacy in their grassroots. Since then, climate groups rallied around an alternative policy approach, which involves investing in clean technology inspired by the Green New Deal. Activists built significant power within the Democratic Party, evident in climate policy remaining prominent on the policy agenda at the beginning of Biden’s presidency. Moreover, media outlets have improved their coverage of extreme weather events by tying them to climate change. In short, the political dynamics changed with growing grassroots climate advocacy, motivating citizens to elect Democratic leaders capable of passing climate legislation and keeping climate high on the policy agenda.