bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rapid rituximab administration: Safety of 60-minute infusions in malignant and benign haematological disease
Authors: Whiting Rebecca , Misko Jeanie , McGuire Matthew , Fox Emma 
Published: June 2024

Introduction Rituximab is a chimeric monoclonal antibody used to treat a range of malignant and benign haematological conditions. To minimise the risk of infusion-related toxicity, initial infusions are administered slowly over 4–6 h. In the absence of significant reactions, subsequent doses are often administered over an off-label rate of 90 min. In response to emergent data, our site adopted the use of rapid 60-min infusions for third and subsequent doses. This study aimed to review the safety and ongoing feasibility of 60-min rituximab infusions following institutional practice change. Methods Pharmacy dispensing records were used to identify all rituximab infusions dispensed under the direction of a haematologist between 1 January 2023 and 30 June 2023. Electronic medical records were reviewed retrospectively to characterise the incidence of infusion reactions. Results Eight-two patients received a total of 262 rituximab infusions, including 54 patients who received a total of 113 rapid 60-min infusions. No infusion-related reactions were observed with 60-min administration. Five patients who experienced grade 1–2 infusion reactions with their first or second dose of rituximab safely received 60-min infusions for third and subsequent doses without additional premedication. Indications for treatment included non-Hodgkin's lymphoma (76.99%), non-malignant disease states (17.70%), chronic lymphocytic leukaemia (3.54%) and post-transplant lymphoproliferative disorder (1.77%). Conclusion In the absence of severe reactions to initial and second doses, administration of rituximab over 60 min is well tolerated in patients with malignant and benign haematological disease.
The Case for Heterogeneity in Metacognitive Appraisals of Biased Beliefs
Authors: Cusimano Corey 
Published: June 2024

Academic Abstract Prominent theories of belief and metacognition make different predictions about how people evaluate their biased beliefs. These predictions reflect different assumptions about (a) people’s conscious belief regulation goals and (b) the mechanisms and constraints underlying belief change. I argue that people exhibit heterogeneity in how they evaluate their biased beliefs. Sometimes people are blind to their biases, sometimes people acknowledge and condone them, and sometimes people resent them. The observation that people adopt a variety of “metacognitive positions” toward their beliefs provides insight into people’s belief regulation goals as well as insight into way that belief formation is free and constrained. The way that people relate to their beliefs illuminates why they hold those beliefs. Identifying how someone thinks about their belief is useful for changing their mind. Public Abstract The same belief can be alternatively thought of as rational, careful, unfortunate, or an act of faith. These beliefs about one’s beliefs are called “metacognitive positions.” I review evidence that people hold at least four different metacognitive positions. For each position, I discuss what kinds of cognitive processes generated belief and what role people’s values and preferences played in belief formation. We can learn a lot about someone’s belief based on how they relate to that belief. Learning how someone relates to their belief is useful for identifying the best ways to try to change their mind.
Is admission neutrophil-to-lymphocyte ratio an outcome predictor in critically ill multiple trauma patients? A retrospective single-centre cross-sectional study
Authors: Jabbari Latife , Azizkhani Leila , Rouzbin Fereshte , salarpour elaheh , Hayati Saeed 
Published: June 2024

Background Trauma is a global health concern with a high mortality rate. Research suggests a potential link between neutrophil-to-lymphocyte ratio (NLR) and mortality. This study aims to assess the prognostic value of NLR in intensive care unit (ICU)-admitted individuals with multiple trauma. Methods This study reviewed medical records of multiple trauma patients admitted to the ICU of Shahid Mohammadi Hospital in Bandar Abbas, Iran, from 2020 to 2021. Variables assessed included age, sex, blood pressure, Glasgow Coma Scale, Injury Severity Score, NLR, trauma details, surgical procedures, hospital and ICU length of stay, duration of mechanical ventilation, and mortality. Results In the study, 160 multiple trauma patients were analyzed, with an average age of 34.13 ± 14.74 years. Among them, 130 (81.3%) were male and 75 (46.9%) died. The mean NLR did not show a significant difference between survivors and non-survivors ( p = 0.853). The predictive ability of NLR for mortality, as measured by the area under the receiver operating characteristic curve, was 0.530 (95% confidence interval [CI] 0.440; 0.620, p = 0.517). Patients who died had higher rates of ICU admission, mechanical ventilation requirement, longer mechanical ventilation duration, and longer hospital and ICU stays (all p < 0.001). Multivariable logistic regression analysis found that a non-sinus rhythm in the admission ECG was associated with approximately eight times higher odds of mortality compared to a sinus rhythm (adjusted odds ratio = 7.961, 95% CI 1.724; 36.759, p = 0.008). No significant association was found between NLR and mortality in univariable binary logistic regression, even after adjusting for various factors (adjusted OR = 0.967, 95% CI 0.989; 1.042, p = 0.375). Conclusions Our findings indicate that admission NLR did not demonstrate efficacy as a prognostic indicator of mortality among patients with multiple trauma admitted to the ICU.
Noise-Induced Hearing Loss: Should Surgeons Be Wearing Ear Protection During Primary Total Joint Arthroplasty?
Authors: Kwan Stephanie A. , Ong Alvin C. , Lutz Rex W. , Lau Vincent W. , Santoro Adam J. , Deirmengian Gregory K. 
Published: June 2024

Background: The risk of noise-induced hearing loss (NIHL) to orthopedic surgeons due to occupational exposures is unknown. A level of 85 decibels (dB) over an 8-hour time-weighted average (TWA) is considered hazardous. Question/Purpose: We sought to identify whether manual and/or robotic arthroplasty procedures increase surgeons’ risk of developing NIHL. Methods: At our institution, we prospectively collected intraoperative recordings with a microphone attached to the surgeon during manual total knee arthroplasty (TKA), manual total hip arthroplasty (THA), and robotic-assisted total knee arthroplasty (RTKA). Recordings taken in the operating room without operating room staff present served as baseline controls. The 172 recordings consisted of 46 baseline, 42 THA, 40 TKA, and 44 RTKA recordings. Decibel levels were reported as “maximum dB level” (the highest sound pressure level using an A-weighted dB scale), “LAeq” (the equivalent continuous sound level), “LCpeak” (the peak sound pressure level using a C-weighted dB scale), and “TWA” (the average dB level projected over an 8-hour period). The percentage of allowable daily noise dose was reported as “dose” and the measured dose projected over 8 hours as “projected dose.” Results: The recordings of surgeries had average maximum dB levels ranging from 106.0 to 108.0 dB, all significantly greater than controls. Robotic-assisted total knee arthroplasties had the highest average dose (18.7%) and average projected dose (252.0%). Conclusions: Our review of recordings at a single institution found that noise levels of RTKAs surpassed projected doses of 100%. Orthopedic surgeons performing more than 2 RTKAs per day may be at increased risk of NIHL. Further research is needed to assess the effectiveness of measures such as ear protection to minimize surgeons’ exposure.
“If I chose to listen to people, I possibly wouldn’t be using family planning”: Impact of external influences on women’s contraceptive autonomy in rural Northwest Tanzania
Authors: Lambert Valencia J , Samson Anna , Nzali Aneth , Mukasa Lydia , Kachembeho Neema , Bowers Sheridan , Kalluvya Samuel E , Mwakisole Agrey H , Downs Jennifer A 
Published: June 2024

Background: There is an increasing emphasis on promoting women’s autonomy in reproductive decision-making, particularly given global efforts to increase contraceptive access and uptake. Scales to quantify autonomy have inconsistently included the effect of external influences and focused primarily on influences of partners. Objectives: This study aimed to gain greater depth in understanding how influences including and beyond a woman’s partner affect her contraceptive decision-making, as well as how external influences can overlap and further complicate contraceptive decision-making. Design: A phenomenological, qualitative study in which in-depth interviews were conducted in three phases from May 2021 to February 2022 with women living in northwest Tanzania who had varying histories of contraceptive use or non-use. Methods: One-on-one, in-depth interviews were conducted in Swahili, the national language of Tanzania, by trained female interviewers. Interviews were digitally recorded, transcribed, translated into English, and independently coded by three investigators. Analysis was conducted using NVivo. The codes developed from the transcripts were grouped into overarching themes with supporting illustrative quotes. Results: A total of 72 women were interviewed. Partners were the most influential in women’s family planning decision-making, followed by friends, relatives, community religious leaders, and healthcare providers. Out of the 52 women with a partner who had ever used family planning, 76.9% had discussed their desire to use family planning with their partner and nearly all reported strong pressures to use or not to use family planning from partners, family, and friends. Rarely, participants stated that they were devoid of any influence. Conclusion: In rural Tanzania, women’s decision-making about family planning was highly impacted by external influences, including not only partners but also family, friends, and community. Indicators of women’s reproductive autonomy and measurements of interventions to promote contraceptive use should incorporate measures of these external influences.
Comparative effectiveness and safety of ozanimod versus other oral DMTs in relapsing-remitting multiple sclerosis: a synthesis of matching-adjusted indirect comparisons
Authors: Paul Damemarie , Swallow Elyse , Patterson-Lomba Oscar , Branchcomb Tychell , N’Dri Laetitia , Gomez-Lievano Andres , Liu Jingyi , Dua Akanksha , McGinley Marisa 
Published: June 2024

Background: Several oral disease-modifying therapies (DMTs) have been approved by the Food and Drug Administration for the treatment of relapsing-remitting multiple sclerosis (RRMS). In the absence of head-to-head randomized data, matching-adjusted indirect comparisons (MAICs) can evaluate the comparative effectiveness and safety of ozanimod versus other oral DMTs in RRMS. Objectives: To synthesize results from the published MAICs of ozanimod and other oral DMTs for 2-year outcomes in RRMS. Methods: Published MAICs involving ozanimod for the treatment of RRMS were identified. Extracted data elements included efficacy [annualized relapse rate (ARR), confirmed disability progression (CDP), and brain volume loss] and safety [adverse events (AEs), serious AEs (SAEs), AEs leading to discontinuation, and infection] outcomes. Results: The four MAIC studies identified compared ozanimod with fingolimod, teriflunomide, dimethyl fumarate (DMF), and ponesimod. All comparisons were adjusted for differences in age, sex, relapses within the previous year, Expanded Disability Status Scale score, and percentage of patients with prior DMTs. Outcomes at 2 years were analyzed based on comparisons that lacked a common comparator arm. Ozanimod was associated with significantly lower ARR versus teriflunomide [ARR ratio (95% CI) 0.73 (0.62, 0.84) and DMF 0.80 (0.67, 0.97)], with no significant difference versus fingolimod or ponesimod. The proportions of patients treated with ozanimod or fingolimod had similar 3- and 6-month CDP. Compared with teriflunomide and DMF, ozanimod was associated with a significantly lower risk of 3-month CDP; 6-month CDP was comparable. Ozanimod was associated with significantly lower rates of any AE and AEs leading to discontinuation compared with the other oral DMTs evaluated. Ozanimod also had significantly lower rates of SAEs versus teriflunomide and DMF and lower rates of reported infection outcomes versus fingolimod and ponesimod. Conclusion: Compared with the other oral DMTs evaluated in MAICs, ozanimod was associated with a favorable safety profile and improved or comparable efficacy outcomes.
A survey assessing knowledge and attitude about blood donation among blood donors in Jordan
Authors: Omaish Rahaf S. , Al-Fayyadh Zahraa A. , Al-Habashneh Shifar M. , Al-Mashhdi Safa Y. , Khasawneh Salah Y. , Naber Isam A. , Bourghli Sana L. , Al-Adily Tariq N. , Al-Fararjeh Firas M. , Sughayer Maher A. 
Published: June 2024

Background:Recruitment of low risk blood donors can be challenging. Efforts should be made to increase the level of awareness and positive attitude towards blood donation. An essential step to achieve this is obtaining comprehensive data about the current situation of awareness, knowledge and attitudes of the population towards blood donation.Methods/materials:The present study was conducted at two blood donation centres in Amman, Jordan, during 2021. A total of 536 whole blood donors were included. Data regarding their demographic characteristics, blood donation history as well as their knowledge and attitudes regarding blood donation were collected by a questionnaire.Results:Four hundred ninety participants (91.4%) were males, whereas only 46 participants (8.6%) were females. Ninety seven subjects (18.1%) were first time donors, whereas 431 subjects (81.9%) had previous donations. The participants’ median score in the knowledge section was 19.0 points (range 5–25 points). Based on a cut-off of 15 out of 28: 84% of the participants were knowledgeable. Similarly 97% of the participants had a positive attitude based on a cut-off of 17 out of 32 points. Multivariate analysis revealed that high knowledge score was significantly associated with study major and employment status, whereas a positive attitude was significantly associated with a higher income. More than half of first time donors stated lack of awareness as being the reason for not donating blood before.Conclusion:Measures to improve awareness, knowledge and attitudes towards blood donation should be implemented in order to meet the increasing demand for blood and blood components. Targeted campaigns, correction of some misconceptions and using different motivations are suggested.
Post-Operative Hyperextension Bracing Has the Potential to Reduce Proximal Junctional Kyphosis: A Propensity Matched Analysis of Braced versus Non-braced Cohorts
Authors: Shahi Pratyush , Merrill Robert K. , Pajak Anthony , Samuel Justin T. , Akosman Izzet , Clohisy John C. , Du Jerry , Zhang Bo , Elysee Jonathan , Kim David N. , Jordan Yusef , Knopp Rachel L. , Lovecchio Francis C. , Kim Han Jo 
Published: June 2024

Study Design Retrospective cohort. Objective Determine effects of bracing on proximal junctional kyphosis (PJK) after adult deformity correction. Methods Patients were identified from a single-surgeon dataset of posterior-only fusions for ASD (pelvis to UIV of T9-12) with a minimum of 1-year follow up. Starting in 2021, all lower thoracic fusions were braced using a hyperextension brace. Patients wore the brace at all times (unless in bed) for the first 6 weeks after surgery. A 1:1 propensity-match was performed based on age, number of levels, 3 column osteotomies, and magnitude of correction to identify a comparative non-braced cohort. Results 141 patients (113 non-brace, 28 brace) were evaluated. After matching, 56 patients were identified to form similar cohorts. Non-matched and matched groups had no statistically significant differences in demographics, comorbid conditions, surgical characteristics (except shorter operative time and lower EBL in the braced group), and preoperative radiographic parameters. For the overall cohort, the change in proximal junctional angle at 1-year was higher in the non-braced group (7.6° vs 8.1°, P = .047), and non-braced patients had a higher incidence of PJK at 1-year in both the overall cohort (36% vs 14%, P = .045) and matched cohort (43% vs 14%, P = .038). There was no difference in proximal junctional failure between groups. Conclusion This pilot study shows that our protocol for extension bracing may reduce rates of PJK. These findings can form the basis for future multi-center trials examining the effect of extension bracing on junctional complications.
Assessment of Nurses Fear Working in COVID-19 Pandemic Hospitals
Authors: Liel Farid Abu 
Published: June 2024

Introduction Nurses play pivotal roles in various facets of managing the COVID-19 epidemic, encompassing tasks such as identifying potential cases with infections, managing suspected patients, conducting patient assessments, and providing critical care to individuals afflicted with COVID-19. Objective The objective of this study was to assess the level of COVID-19 fear among nurses who care for infected or suspected COVID-19 patients in pandemic hospitals. Methods A cross-sectional study was conducted on 260 nurses employed at COVID-19 hospitals in Palestine. The Fear of COVID-19 Scale (FCV-19S) was employed to measure participants’ fear levels. The scale's potential values range from 7 to 35, with higher scores indicating a greater fear of COVID-19. Independent t-tests and ANOVA tests were utilized to evaluate differences between the variables. Results The analysis revealed that the mean total fear score of the nurses was 25.22 ± 5.07 (ranging from 7 to 35), indicating a high level of fear. Married nurses exhibited a fear mean score of 27.0 ± 4.9 ( p < 0.05). Similarly, nurses with children scored a mean fear level of 29.0 ± 4.6 ( p < 0.05). Additionally, nurses engaged in rotating shift work reported a fear mean score of 27.9 ± 4.4 ( p < 0.05). Furthermore, nurses who received COVID-19 training exhibited a fear mean score of 24.6 ± 4.8 ( p < 0.05). Likewise, nurses who experienced patient loss due to COVID-19 reported a fear mean score of 23.2 ± 4.5 ( p < 0.05). Conclusion The study confirmed that nurses in Palestine exhibit a significant level of fear concerning COVID-19. Marital status, having children, working schedule, experiencing the loss of a patient due to COVID-19, and receiving training related to COVID-19 were identified as factors associated with the fear of COVID-19 among nurses.
Enhancing Anatomy Education Throu€gh Flipped Classroom and Adaptive Learning A Pilot Project on Liver Anatomy
Authors: Vertemati Maurizio , Zuccotti Gian Vincenzo , Porrini Marisa 
Published: June 2024

OBJECTIVES Anatomy education plays a critical role in medical practice, and the level of anatomical knowledge among students and physicians significantly impacts patient care. This article presents a pilot project aimed at exploring the effectiveness of the Area9's Rhapsode platform, an intelligent tutoring system that uses artificial intelligence (AI) to personalize learning and collect data on mastery acquisition. METHODS The study focused on liver anatomy (microscopic and macroscopic anatomy, embryology, clinical anatomy) and employed a flipped classroom approach, incorporating adaptive learning modules and an interactive in-class session. A total of 123 first-year medicine students (55 M/68F) participated to the study. Content and resources of the module were adaptable to various digital devices. Statistics were compiled based, on the one hand, on the measurement of mastery for every single learning objective provided automatically by the platform via the student interactions with the system probes (questions); on the other hand, metacognition data were worked out by crossing mastery data with the self-awareness declared in every question and learning resource by each learner. RESULTS AND CONCLUSIONS At the outset of the study, students displayed a 18.11% level of conscious incompetence and a 19.43% level of unconscious incompetence. Additionally, 50.86% of students demonstrated conscious competence. By the conclusion of the learning module, the level of conscious incompetence had decreased to 1.87%, and 98.73% of students exhibited conscious mastery of the materials. The results demonstrated improved learning quality, positive repurposing of study time, enhanced metacognitive awareness among students, with most students demonstrating conscious mastery of the materials and a clear understanding of their level of competence. This approach, by providing valuable insights into the potential of AI-based adaptive learning systems in anatomy education, could address the challenges posed by limited teaching hours, shortage of anatomist, and the need for individualized instruction.
Acute astrocytic reaction is associated with 3-month functional outcome after stroke treated with endovascular therapy
Authors: Boutelier Ada , Ollivier Véronique , Mazighi Mikael , Kyheng Maeva , Labreuche Julien , Brikci-Nigassa Nahida , Solo Nomenjanahary Mialitiana , Delvoye Francois , Maier Benjamin , Paquet Claire , Ho-Tin-Noe Benoit , Desilles Jean-Philippe 
Published: June 2024

Introduction: More than 50% of large vessel occlusion (LVO) acute ischemic stroke (AIS) patients treated with endovascular therapy (EVT) remain severely disabled at 3 months. We hypothesized that acute astrocytic inflammatory response may play a pivotal role in post-AIS brain changes associated with poor functional outcome. We proposed to evaluate the level of YKL-40, a glycoprotein mainly released by reactive astrocytes. Patients and methods: A monocentric prospective cohort study was conducted on consecutive LVO AIS patients treated with EVT. Three blood samples (before, within 1 and 24-hour post-EVT) were collected to measure plasma YKL-40 concentrations. Functional outcome was assessed according to the modified Rankin Scale (mRS) score at 3 months. Results: Between 2016 and 2020, 120 patients were included. The plasma concentration of YKL-40 before EVT was statistically and independently associated with 3-month worse functional outcome (adjusted cOR, 1.59; 95% CI [1.05–2.44], p = 0.027) but not the two following samples 1-hour and 24-hour post-EVT. Accordingly, we found that excellent functional outcome was associated with a lower level of YKL-40 before and within 1 h after EVT ( p = 0.005 and p = 0.003, respectively) but not when measured 24 h after EVT ( p = 0.2). Discussion and conclusion: This study suggests that the astrocytic reaction to acute brain hypoxia, especially before recanalization, is associated with worse functional outcome. Such early biomarker of the astrocytic response in AIS may optimize individualized care in the future. Clinical Trial Registration-URL: http://www.clinicaltrials.gov . Unique identifier: NCT02900833.