bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early life manganese exposure and reported attention-related behaviors in Italian adolescents
Authors: Schildroth Samantha , Bauer Julia Anglen , Friedman Alexa , Austin Christine , Coull Brent A. , Placidi Donatella , White Roberta F. , Smith Donald , Wright Robert O. , Lucchini Roberto G. , Arora Manish , Horton Megan , Claus Henn Birgit 
Published: May 2024

Background:
Manganese (Mn) is an essential nutrient and neurotoxicant, and the neurodevelopmental effects of Mn may depend on exposure timing. Less research has quantitatively compared the impact of Mn exposure on neurodevelopment across exposure periods.

Methods:
We used data from 125 Italian adolescents (10–14 years) from the Public Health Impact of Metals Exposure Study to estimate prospective associations of Mn in three early life exposure periods with adolescent attention-related behaviors. Mn was quantified in deciduous teeth using laser ablation-inductively coupled plasma-mass spectrometry to represent prenatal (2nd trimester-birth), postnatal (birth ~1.5 years), and childhood (~1.5–6 years) exposure. Attention-related behavior was evaluated using the Conners Behavior Rating Scales in adolescence. We used multivariable linear regression models to quantify associations between Mn in each exposure period, and multiple informant models to compare associations across exposure periods.

Results:
Median tooth Mn levels (normalized to calcium) were 0.4 area under the curve (AUC) 55Mn:43Ca × 104, 0.1 AUC 55Mn:43Ca × 104, and 0.0006 55Mn:43Ca for the prenatal, postnatal, and childhood periods. A doubling in prenatal tooth Mn levels was associated with 5.3% (95% confidence intervals [CI] = −10.3%, 0.0%) lower (i.e., better) teacher-reported inattention scores, whereas a doubling in postnatal tooth Mn levels was associated with 4.5% (95% CI = −9.3%, 0.6%) and 4.6% (95% CI = −9.5%, 0.6%) lower parent-reported inattention and attention deficit/hyperactivity disorder index scores, respectively. Childhood Mn was not beneficially associated with reported attention-related behaviors.

Conclusion:
Protective associations in the prenatal and postnatal periods suggest Mn is beneficial for attention-related behavior, but not in the childhood period.
Implant Texture and Capsular Contracture: A Review of Cellular and Molecular Pathways
Authors: Wells Hannah J. , Yang Jenny C.C. , Edelstein-Keshet Leah , Isaac Kathryn V. 
Published: May 2024

Background:
Capsular contracture (CC) is a leading cause of morbidity in implant-based breast surgery. Implant surface texture has been implicated in CC development, yet its etiopathogenesis remains unclear. We conducted a systematic review to determine the influence of implant surface texture on cellular and molecular mechanisms involved in the etiopathogenesis of CC.

Methods:
A systematic review of the MEDLINE, Embase, Web of Science, and Scopus databases was completed to examine the influence of implant texture on cellular and molecular pathways leading to CC. Excluded articles were reviews and those examining solely the clinical presentation of CC.

Results:
Development of CC includes prolonged inflammation, increased myofibroblast density, parallel arrangement of collagen fibers, and biofilm formation. When compared with textured implants, smooth implants are associated with reduction in parallel collagen, capsule thickness, and sheer frictional force. Microtextured implants trigger a reduced macrophage response and decreased fibroblast activation as compared with smooth and macrotextured surfaces. Bacterial counts on microtextured and smooth surfaces are significantly lower than that of macrotextured surfaces. Both micro- and macrotextured implants have increased matrix metalloproteinases and activation of tumor necrosis factor α pathway, with increased activation of the transforming growth factor β1 pathway relative to smooth implants.

Conclusions:
Implant surface texture alters the cellular and molecular mechanisms in the chronic inflammatory process leading to CC. Given the complex biological system of cellular and molecular events in CC, a mathematical model integrating these influences may be optimal to deduce the etiopathogenesis.
Pilot Process Evaluation of the Supporting Older Adults at Risk Model: A RE-AIM Approach
Authors: Trotta Rebecca L. , Shoemaker Anne E. , Greysen S. Ryan , Boltz Marie 
Published: May 2024

ABSTRACT
Despite evidence supporting transitional care models, hospitals report challenges implementing and sustaining them. The Discharge to Assess (D2A) Model is an innovative solution to this problem but required translation from a national health system context to an U.S.-based context. We translated the central tenets of the D2A model to establish the Supporting Older Adults at Risk (SOAR) Model, which unfolds in three phases: Prepare, Transition, and Support. The purpose of this project was to conduct a process evaluation of the SOAR Model in practice using the RE-AIM Framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance). Forty patients completed all SOAR Model components for a Reach of 21%. Patients averaged 80 years of age, 53% were female, and 64% Black/AA. SOAR significantly improved discharge before noon, time to first home visit, and use of the in-house pharmacy. SOAR also improved length of hospital stay, emergency department visits, and readmissions. Twenty-one of the 26 Implementation measures unfolded with 75% or greater fidelity. Sixteen of the 24 Adoption measures unfolded with 75% or greater fidelity. COVID-19 limited Maintenance. Given the model unfolds across settings over time, requiring adoption from interprofessional team members, patients, and families, future work should focus on improving reach and adoption.
A Survey for Charting Intake, Output, and Body Weight in the Electronic Medical Record
Authors: Tao Jianling , May Sara , Li Mingyi , Monahan Marianne , Phanumas Donna , Seelig Charles 
Published: May 2024

ABSTRACT

Background:
The accuracy of documentation of body weight and fluid balance in hospitalized patients is frequently questioned.

Methods:
We conducted a survey to understand provider perceptions of the accuracy of intake, output, and weight charting in the electronic medical record. We sent a six-item questionnaire to nurses and physicians who provide inpatient service in a community-based teaching hospital of the Northeastern United States. We compared the response difference between nurses and physicians by Fisher exact test.

Results:
One hundred eight nurses and 39 physicians participated in the survey. Both nurses and physicians responded that the accuracy of documentation is crucial. However, only 25.7% of participating physicians and 38.3% of participating nurses considered that documentation in the electronic medical record is reliable. Both physicians and nurses assumed that the nurses are too busy to collect and document the data, and the variability of non-patient weight and variations in body weight measurement under different conditions account for inaccuracies in the documented body weight.

Conclusions:
Assessing the accuracy of documenting intake, output, and body weight in the electronic medical record is warranted. Providers believe that educating patients about fluid balance and volume assessment help to improve the accuracy in charting intake, output, and body weight in the electronic medical record.
Molecular characteristics of early-onset compared with late-onset colorectal cancer: a case controlled study
Authors: Tang Junwei , Peng Wen , Tian Chuanxing , Zhang Yue , Ji Dongjian , Wang Lu , Jin Kangpeng , Wang Fufeng , Shao Yang , Wang Xiaowei , Sun Yueming 
Published: May 2024

Background:
Early-onset colorectal cancer (EOCRC) is associated with a poorer prognosis relative to late-onset colorectal cancer (LOCRC), and its incidence has witnessed a gradual escalation in recent years. This necessitates a comprehensive examination of the underlying pathogenesis and the identification of therapeutic targets specific to EOCRC patients. The present study aimed to delineate the distinct molecular landscape of EOCRC by juxtaposing it with that of LOCRC.

Methods:
A total of 11 344 colorectal cancer patients, diagnosed between 2003 and 2022, were enrolled in this study, comprising 578 EOCRC cases and 10 766 LOCRC cases. Next-generation sequencing technology was employed to assess the tumor-related mutation and tumor mutation burden (TMB) in these patients. PD-L1 expression was quantified using immunohistochemistry. Microsatellite instability (MSI) was determined via capillary electrophoresis (2B3D NCI Panel).

Results:
Upon comparing LOCRC with EOCRC patients, the latter group demonstrated a tendency towards advanced TNM stage, lower tumor differentiation, and less favorable histological types. Among LOCRC patients, those with MSI-H status were found to have an earlier TNM stage compared to those with MSI-L/MSS status. Significantly, the incidence of MSI-H was notably higher in EOCRC (10.2%) compared to LOCRC (2.2%). Mutations in the 7-gene panel (ARID1A, FANCI, CASP8, DGFRA, DPYD, TSHR, and PRKCI) were more prevalent in LOCRC. Within the EOCRC cohort, patients with the MSI-H subtype displayed an earlier TNM stage but concurrently exhibited poorer tissue differentiation and a higher frequency of mucinous adenocarcinoma. Among EOCRC patients, FBXW7, FAT1, ATM, ARID1A, and KMT2B mutations were significantly enriched in the MSI-H subgroup. A comparative analysis of MSI-H patients revealed heightened mutation frequencies of FGFBR2, PBRM1, RNF43, LRP1B, FBXW7, ATM, and ARID1A in the EOCRC group. Furthermore, EOCRC patients demonstrated a higher overall TMB, particularly in the MSI-H subtype. PD-L1 expression was elevated in EOCRC and positively associated with MSI status.

Conclusions:
This study revealed a significantly higher MSI-H distribution rate in EOCRC, and EOCRC exhibits a distinct mutational signature coupled with higher PD-L1 expression. These findings hold promise in guiding personalized therapeutic strategies for improved disease management in EOCRC patients.
Effects of COVID-19 Status on Hip Fracture Surgical Outcomes: An ACS NSQIP Study
Authors: Shim Esther H. , Ghodasara Satyam K. , Roskam Justin S. , Gaccione Amanda G. , DiFazio Louis T. , Lombardo Gary , Nemeth Zoltan H. 
Published: May 2024

BACKGROUND:
Studies have indicated that patients infected with the SARS-CoV-2 virus fare worse clinically after a traumatic injury, especially those who are older and have other comorbidities.

OBJECTIVE:
This study aims to understand the effects of Corona Virus Disease 19 (COVID-19) diagnosis on patients undergoing surgery for hip fractures.

METHODS:
This is a retrospective review of the 2021 American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) Targeted Hip Fracture database for patients who underwent surgery. Two cohorts were formed based on patients’ preoperative COVID-19 status, as tested within 14 days prior to the operation. Several clinical factors were compared.

RESULTS:
The COVID-positive cohort consisted of 184 patients, all of whom had a laboratory-confirmed or clinically suspected SARS-CoV-2 infection, while the COVID-negative cohort consisted of 12,211 patients with no infection. A lower proportion of COVID-positive patients had an emergent operation compared to the COVID-negative cohort (58.70% vs. 73.09%, p < .001). Preoperatively, the COVID-positive cohort showed higher rates of coagulopathy/bleeding disorders (22.83% vs. 14.12%), congestive heart failure (16.30% vs. 9.84%), diabetes mellitus (28.26% vs. 19.24%), and dementia (42.39% vs. 28.07%), with p ≤ .005 for all. Postoperatively, a higher proportion of COVID-positive patients died (9.78% vs. 5.40%) or had pneumonia (8.70% vs. 3.65%), hospital readmission within 30 days (10.87% vs. 6.76%), and pressure sores (8.15% vs. 4.55%), with p ≤ .033 for all.

CONCLUSION:
The diagnosis of COVID-19 in hip fracture patients was associated with higher rates of postoperative complications, including mortality, when compared to COVID-negative patients, indicating the severity of the viral infection.
Impact of Bedside Laparotomy Simulation and Microlearning on Trauma Nurse Role Clarity, Knowledge, and Confidence
Authors: Messing Jonathan A. , Russell-Babin Kathleen , Baker Deborah , D’Aoust Rita 
Published: May 2024

BACKGROUND:
The care of patients undergoing low-volume, high-risk emergency procedures such as bedside laparotomy (BSL) remains a challenge for surgical trauma critical care nurses.

OBJECTIVES:
This study evaluates simulation and microlearning on trauma nurse role ambiguity, knowledge, and confidence in caring for patients during emergency BSL.

METHODS:
The study is a single-center, prospective pretest–posttest design conducted from September to November 2022 at a Level I trauma center in the Mid-Atlantic United States using simulation and microlearning to evaluate role clarity, knowledge, and confidence among surgical trauma intensive care unit (STICU) nurses. Participants, nurses from a voluntary convenience sample within a STICU, attended a simulation and received three weekly microlearning modules. Instruments measuring role ambiguity, knowledge, and confidence were administered before the simulation, after, and again at 30 days.

RESULTS:
From the pretest to the initial posttest, the median (interquartile range [IQR]) Role Ambiguity scores increased by 1.0 (1.13) (p < .001), and at the 30-day posttest, improved by 1.33 (1.5) (p < .001). The median (IQR) knowledge scores at initial posttest improved by 4.0 (2.0) (p < .001) and at the 30-day posttest improved by 3.0 (1.75) (p< .001). The median (IQR) confidence scores at initial posttest increased by 0.08 (0.33) (p = .009) and at the 30-day posttest improved by 0.33 (0.54) (p = .01).

CONCLUSIONS:
We found that simulation and microlearning improved trauma nurse role clarity, knowledge, and confidence in caring for patients undergoing emergency BSL.
Elements of an Advanced Trauma Education Program for Emergency Nurses: A Modified Delphi Approach
Authors: Wolf Lisa , Delao Altair , Kolbuk Monica Escalante , Simon Claire 
Published: May 2024

BACKGROUND:
Basic trauma education for emergency department (ED) staff is available, but there are currently no advanced trauma nursing practice standards for ED nurses.

OBJECTIVE:
The purpose of this study was to identify consensus-based elements of an advanced trauma nursing program for ED nurses.

METHODS:
We used a modified Delphi process with three rounds of online survey data collection to ensure a large group of geographically diverse experts. Data were collected from February 2023 to May 2023. The sample for Round 1 was recruited from members of the Emergency Nurses Association reporting job titles, including trauma coordinator, trauma nursing core course instructor, and vice president of trauma services (n = 829). Participants in subsequent rounds were drawn from respondents to the initial invitation to participate (n = 131). Members of an emergency nursing research council with clinical and research expertise reviewed the results and provided expert input.

RESULTS:
An initial sample of 131 experts identified 17 elements that were assigned a median score equivalent to “agree/strongly agree” (i.e., median 4/5 or 5/5) in Round 2 (n = 69). These elements were presented in Round 3 (n = 43) to determine a rank order. Critical thinking/clinical judgment was the overall priority, followed by assessment/reassessment and early recognition of trauma.

CONCLUSIONS:
Emergency department trauma care experts identified priority content for advanced trauma education. Heterogeneity in the final ranking of components for this advanced trauma course, specifically differences by facility, regional, or demographic characteristics, suggests that training and education may not conform to a one-size-fits-all model.
Nurse-Initiated Protocol to Improve Timely Antibiotic Administration in Pediatric Open Fractures
Authors: Scallon Kylie , Lee Jessica , Spencer Meghan , Schissel Makayla , Timmons Zebulon , Hanna Angela , Sneller Hannah 
Published: May 2024

BACKGROUND:
Early administration of antibiotics in the presence of open fractures is critical in reducing infections and later complications. Current guidelines recommend administering antibiotics within 60 min of patient arrival to the emergency department, yet trauma centers often struggle to meet this metric.

OBJECTIVES:
This study aims to evaluate the impact of a nurse-initiated evidence-based treatment protocol on the timeliness of antibiotic administration in pediatric patients with open fractures.

METHODS:
A retrospective pre–post study of patients who met the National Trauma Data Standard registry inclusion criteria for open fractures of long bones, amputations, or lawn mower injuries was performed at a Midwestern United States Level II pediatric trauma center. The time of patient arrival and time of antibiotic administration from preimplementation (2015–2020) to postimplementation (2021–2022) of the protocol were compared. Patients transferred in who received antibiotics at an outside facility were excluded.

RESULTS:
A total of N = 73 participants met the study inclusion criteria, of which n = 41 were in the preimplementation group and n = 32 were in the postimplementation group. Patients receiving antibiotics within 60 min of arrival increased from n = 24/41 (58.5%) preimplementation to n = 26/32 (84.4%) postimplementation (p< .05).

CONCLUSIONS:
Our study demonstrates that initiating evidence-based treatment orders from triage helped decrease the time from arrival to time of antibiotic administration in patients with open fractures. We sustained improvement for 24 months after the implementation of our intervention.
A Bibliometric study of the top 100 most-cited papers in high tibial osteotomy
Authors: Ye Ling-Chen , Zhang Jing-Yu , Jiang Ying-Ying , Xu Ren-Jie 
Published: May 2024

Background:
High tibial osteotomy (HTO) is a well-established surgical procedure employed to treat medial compartment knee osteoarthritis by modifying the mechanical axis of the lower limb, thereby reducing the load on the affected joint. It has gained increased attention in recent years, resulting in numerous research advancements in this field.

Methods:
The top 100 most-cited papers on HTO, published between 1970 and 2023, were identified by searching the Web of Science Core Collection database. Data, including the title, author, keywords, journal, publication year, country, and institution, were extracted. Subsequently, a bibliometric analysis was performed.

Results:
The 100 papers collectively garnered a total of 15 833 citations, with a median of 122 and an average of 158.33 citations per article. Since the onset of the 21st century, there has been a significant increase in the number of publications and citations. Lobenhoffer authored the most published papers. The majority of papers originated from the USA. Hannover Medical School produced the most papers. Analysis of keywords in the articles revealed several research hotspots, including open-wedge osteotomy, biomechanical study, tibial slope, patellar height, Puddu plate, TomoFix plate, stability, complications, and accuracy.

Conclusion:
This study offers bibliometric insights into HTO, underscoring that the USA is a prominent leader in this field. HTO has garnered increasing attention since the onset of the 21st century and is expected to remain a significant research area in the future. Concurrently, the authors advise focusing on potential research hotspots, such as the navigation system, to augment the accuracy of the correction.
A rare case of aortitis presenting as chest pain: a case report and literature review
Authors: Ahmed Hasaan , Ismayl Mahmoud , Palicherla Anirudh , Mathew Kalathil Ruth Ann , Vaza Shivani , Kabach Amjad , Goldsweig Andrew M. , Aboeata Ahmed 
Published: May 2024

Introduction and importance:
Chest pain is a frequent reason patients seek medical attention. The broad spectrum of potential etiologies makes determining the underlying cause of chest pain complex. Among cardiovascular etiologies, aortitis is a rare but life-threatening possibility that should be considered in the differential diagnosis.

Case presentation:
A 53-year-old female with a history of smoking presented with progressively worsening chest and epigastric pain over several weeks. She had seen multiple physicians previously for the same symptoms with unremarkable work-ups. Physical examination was notable for severe tenderness upon palpation of her lower abdomen. The electrocardiogram and troponins were unremarkable. Computed tomography of the abdomen revealed aneurysmal dilatation of the abdominal aorta, soft tissue thickening, and surrounding inflammatory stranding, consistent with aortitis. Infectious and autoimmune work-ups were unremarkable. Intravenous steroids were initiated, and her symptoms improved significantly. Her aortitis was attributed to inflammation secondary to chronic smoking.

Clinical discussion:
Aortitis is a rare condition with varied clinical presentations. Etiologies of aortitis include infection and non-infectious inflammation. Diagnosis of aortitis requires a thorough clinical assessment and prompt imaging of the aorta, with computed tomography being the preferred imaging modality.

Conclusion:
Evaluation for cardiovascular chest pain must extend beyond an electrocardiogram and troponin level. Imaging should be considered in patients with atypical symptoms. Aortitis is a rare but important diagnosis requiring immediate treatment.
The results of femoral lengthening using domestic unilateral external fixation and then plating: the first case series in Vietnam
Authors: Van Nguyen Luong , Nguyen Gioi Nang 
Published: May 2024

Introduction and importance:
This study aimed to assess the results of femoral lengthening using an external fixator and then plating.

Case presentation:
This prospective case series study enrolled 11 patients who underwent femoral lengthening and then plating (LATP) between January 2019 and April 2023. The average age of patients was 14.45 ± 7.54 years. One patient with a femur was lengthened and plated, and one tibia was lengthened over a nail simultaneously. The average femoral lengthening was 8.41 ± 1.35 cm.

Clinical discussion:
The femoral healing result was excellent in seven femurs and good in four femurs; the functional outcome was excellent in five patients and good in six patients. Pin-track infection occurred in all patients. A limited range of motion of knee flexion occurred in eight patients. Femoral varus and procurvatum deviation occurred during distraction in four and two patients. Femoral LATP was considered an attractive alternative to intramedullary lengthening nails in a low-income country.

Conclusion:
Our research suggests that femoral LATP was an effective method. However, the most common complications were pin-site infection and extensive knee contracture. Further research should be done with a larger sample size and longer follow-up time.

Level of evidence:
Level IV—prospective observational case series study.
Hypervascular gastrointestinal stromal tumor: a rare case report
Authors: Khana Firas , Katerji Abdulrahman , Sawas Taher , Zambakjian Jack , Kafa Dima , Abdullah Abdulmonem , Moussa Maen , Lbabidi Nour , Al-Najjar Zakaria , Ghazal Ahmad 
Published: May 2024

Introduction and importance:
To document a case of an ileal gastrointestinal stromal tumor that caused a massive lower gastrointestinal hemorrhage.

Case presentation:
A 55-year-old man presented with multiple episodes of melena and decreased hemoglobin levels. Computed tomography angiography (CTA) revealed a hypervascularized ileal mass.

Clinical discussion:
The mass was surgically excised, and the patient’s hemoglobin levels stabilized. Histopathological findings confirmed it to be a low-grade gastrointestinal stromal tumor (G1 GIST).

Conclusion:
GISTs are infrequent clinical entities that should be kept in mind when managing patients with gastrointestinal hemorrhage of unknown origin. Using proper imaging modalities is essential for the accurate diagnosis of such tumors, with CTA proving to be particularly effective in identifying hypervascularized tumors.