bluuebunny/crossref_metadata_2025_split huggingface dataset:
Associations of Patient and Parent Characteristics With Parental Decision Regret in the PICU: A Secondary Analysis of the 2015–2017 Navigate Randomized Comparative Trial*
Authors: Ashworth Rachel C. , Malone Jay R. , Franklin Dana , Sorce Lauren R. , Clayman Marla L. , Frader Joel , White Douglas B. , Michelson Kelly N. 
Published: May 2024

OBJECTIVES:To identify self-reported meaningful decisions made by parents in the PICU and to determine patient and parent characteristics associated with the development of parental decision regret, a measurable, self-reported outcome associated with psychologic morbidity.DESIGN:Secondary analysis of the Navigate randomized comparative trial (NCT02333396).SETTING:Two tertiary, academic PICUs.PATIENTS:Spanish- or English-speaking parents of PICU patients aged less than 18 years who were expected to remain in the PICU for greater than 24 hours from time of enrollment or who had a risk of mortality greater than 4% based on Pediatric Index of Mortality 2 score.INTERVENTIONS:None.MEASUREMENTS AND MAIN RESULTS:Between April 2015 and March 2017, 233 parents of 209 patients completed a survey 3–5 weeks post-PICU discharge which included the Decision Regret Scale (DRS), a 5-item, 5-point Likert scale tool scored from 0 (no regret) to 100 (maximum regret). Two hundred nine patient/parent dyads were analyzed. The decisions parents reported as most important were categorized as: procedure, respiratory support, medical management, parent–staff interactions and communication, symptom management, fluid/electrolytes/nutrition, and no decision. Fifty-one percent of parents had some decision regret (DRS > 0) with 19% scoring in the moderate–severe range (DRS 26–100). The mean DRS score was 12.7 (sd18.1). Multivariable analysis showed that parental Hispanic ethnicity was associated with greater odds ratio (OR 3.12 [95% CI, 1.36–7.13];p= 0.007) of mild regret. Being parents of a patient with an increased PICU length of stay (LOS) or underlying respiratory disease was associated with greater odds of moderate–severe regret (OR 1.03 [95% CI, 1.009–1.049];p= 0.004 and OR 2.91 [95% CI, 1.22–6.94];p= 0.02, respectively).CONCLUSIONS:Decision regret was experienced by half of PICU parents in the 2015–2017 Navigate study. The characteristics associated with decision regret (parental ethnicity, PICU LOS, and respiratory disease) are easily identifiable. Further study is needed to understand what contributes to regret in this population and what interventions could provide support and minimize the development of regret.
Brief Report: Evaluating the Efficacy of Psychobehavioral Interventions for Cardiovascular Risk Among People Living With HIV: A Systematic Review and Meta-Synthesis of Randomized Controlled Trials
Authors: Foley Jacklyn D. , Bernier Lauren B. , Ngo Long , Batchelder Abigail W. , O'Cleirigh Conall , Lydston Melissa , Yeh Gloria 
Published: May 2024

Abstract:
People with HIV (PWH) are disproportionately affected by cardiovascular disease (CVD). Psychobehavioral therapies are capable of targeting the pathophysiology underlying HIV-CVD comorbidity. This study synthesized findings from randomized controlled trials of psychobehavioral therapies for reducing CVD risk among PWH following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria were as follows: (1) used a randomized controlled trial design, (2) evaluated a cognitive–behavioral or mindfulness-based therapy, (3) sampled adults (age ≥18 years) with HIV, (4) measured a behavioral (eg, diet) or biological (eg, immune functioning) CVD risk factor, and (5) published in an English-language peer-reviewed journal. Electronic searches were conducted in 6 databases (eg, MEDLINE) using controlled vocabulary and free-text synonyms for HIV, psychobehavioral therapy, and CVD risk. Data were independently extracted with consensus reached. Outcomes were immune activation, tobacco smoking, stress, inflammation, and physical activity from 33 studies. There were stronger effects for psychobehavioral interventions compared with controls on CD4 [Hedge g = 0.262, 95% confidence interval (CI) = 0.127 to 0.396] and tobacco-smoking abstinence (Hedge g = 0.537, 95% CI = 0.215 to 0.86). There were no differences or insufficient data for stress, inflammation, or physical activity. No eligible studies examined psychobehavioral interventions on blood pressure, lipids, or weight in PWH. There is increasing importance to further invest in broader CVD risk reduction effort for PWH that include psychobehavioral intervention strategies.
Amputated Digit Replantations
Authors: Fijany Arman J. , Chaker Sara C. , Egozi Hannah P. , Hung Ya-Ching , Hill Bradford J. , Bhandari Laxminarayan , Thayer Wesley P. , Lineaweaver William C. 
Published: May 2024

Introduction
A common consideration for replantation success is the ischemia time following injury and the preservation temperature. A classic principle within the hand surgery community describes 12 hours of warm ischemia and 24 hours of cold ischemia as the upper limits for digit replantation; however, these limits are largely anecdotal and based on older studies. We aimed to compare survival data from the large body of literature to aid surgeons and all those involved in the replantation process in hopes of optimizing success rates.

Methods
The PubMed database was queried on April 4th, 2023, for articles that included data on digit replantation survival in terms of temperature of preservation and ischemia time. All primary outcomes were analyzed with the Mantel-Haenszel method within a random effects model. Secondary outcomes were pooled and analyzed using the chi-square statistic. Statistical analysis and forest plot generation were completed with RevMan 5.4 software with odds ratios calculated within a 95% confidence interval.

Results
Our meta-analysis identified that digits preserved in cold ischemia for over 12 hours had significantly higher odds of replantation success than the amputated digits replanted with 0–12 hours of warm ischemia time (P ≤ 0.05). The odds of survival in the early (0–6 hours) replantation group were around 40% greater than the later (6–12 hours) replantation group (P ≤ 0.05). Secondary outcomes that were associated with higher survival rates included a clean-cut amputation, increased venous and arterial anastomosis, a repair that did not require a vein graft, and replants performed in nonsmokers (P ≤ 0.05).

Discussion
Overall, these findings suggest that when predicting digit replantation success, time is of the essence when the digit has yet to be preserved in a cold environment. This benefit, however, is almost completely diminished when the amputated digit is appropriately maintained in a cold environment soon after injury. In conclusion, our results suggest that there is potential for broadening the ischemia time limits for digit replant survival outlined in the literature, particularly for digits that have been stored correctly in cold ischemia.
Dehiscence and Fistula Formation Following Anterior Palatal Reconstruction With Vomer Flap
Authors: Menville Jesse E. , Spake Carole , Soliman Luke , Shinde Nidhi , Persad-Paisley Elijah M. , Baranwal Navya , Woo Albert S. 
Published: May 2024

Background and Purpose:
Anterior palatal reconstruction using vomer flaps has been described during primary cleft lip repair. In this procedure, the mucoperiosteal tissue of the vomer is elevated to reconstruct the nasal mucosa overlying the cleft of the hard palate. Here the authors, evaluate the efficacy of a technique in which a superiorly based vomer flap is sutured to the lateral nasal mucosa. The authors assess vomer flap dehiscence rates and compare the likelihood of fistula development in this cohort to patients who underwent palatoplasty without vomer flap reconstruction.

Methods:
A retrospective chart review was conducted of all palatoplasties performed by the senior author at an academic institution during a 7-year period. Medical records were reviewed for demographic variables, operative characteristics, and postoperative complications up to 1 year following surgery. Logistic regression analysis was conducted to assess the effects of vomer flap reconstruction on fistula formation, adjusting for age and sex.

Results:
Fifty-eight (N=58) patients met the inclusion criteria. Of these, 38 patients (control group) underwent cleft palate reconstruction without previous vomer flap placement. The remaining 20 patients underwent cleft lip repair with vomer flap reconstruction before palatoplasty (vomer flap group). When bilateral cases were counted independently, 25 total vomer flap reconstructions were performed. Seventeen of these 25 vomer flap reconstructions (68%) were completely dehisced by the time of cleft palate repair. In the vomer flap group, 3 of the 20 patients (15%) developed fistulas in the anterior hard palate following the subsequent palatoplasty procedure. In the control group, only 1 of the 38 patients (2.6%) developed a fistula in the anterior hard palate. There was no significant association between cohorts and the development of anterior hard palate fistulas [odds ratio=10.88, 95% confidence interval (0.99–297.77) P=0.07], although analysis was limited by low statistical power due to the small sample size.

Conclusions:
In our patient population, anterior palatal reconstruction using a superiorly based vomer flap technique was associated with complete dehiscence in 68% of cases. Fistula formation in the anterior hard palate was also proportionately higher following initial vomer flap reconstruction (15% versus 2.6%). These results prompted the senior author to adjust his surgical technique to 1 in which the vomer flap overlaps the oral mucosa. While follow-up from these adjusted vomer flap reconstruction cases remains ongoing, early evidence suggests a reduced requirement for surgical revision following implementation of the modified technique.
Predicting Mortality Prior to Interhospital Hospital for “Unseen” General Surgery Patients
Authors: Al-deen Said Sayf , Gentle Corey K. , Gross Abby , Nimylowycz Kelly , Hossain Mir Shanaz , Weathers Allison , Walsh R. Matthew , Steele Scott R. , Regueiro Miguel , Augustin Toms 
Published: May 2024

Objective:
Develop and validate a mortality risk calculator that could be utilized at the time of transfer, leveraging routinely collected variables that could be obtained by trained non-clinical transfer personnel.

Summary Background Data:
There are no objective tools to predict mortality at the time of inter-hospital transfer for Emergency General Surgery (EGS) patients that are “unseen” by the accepting system.

Methods:
Patients transferred to general or colorectal surgery services from January 2016 through August 2022 were retrospectively identified and randomly divided into training and validation cohorts (3:1 ratio). The primary outcome was admission-related mortality, defined as death during the index admission or within 30 days post-discharge. Multiple predictive models were developed and validated.

Results:
Among 4,664 transferred patients, 280 (6.0%) experienced mortality. Predictive models were generated utilizing 19 routinely collected variables; the penalized regression model was selected over other models due to excellent performance using only 12 variables. The model performance on the validating set resulted in an area under the receiver operating characteristic curve, sensitivity, specificity, and balanced accuracy of 0.851, 0.90, 0.67, and 0.79, respectively. After bias correction, Brier score was 0.04, indicating a strong association between the assigned risk and the observed frequency of mortality.

Conclusion:
A risk calculator using twelve variables has excellent predictive ability for mortality at the time of interhospital transfer among “unseen” EGS patients. Quantifying a patient’s mortality risk at the time of transfer could improve patient triage, bed and resource allocation, and standardize care.
A New Functional Threshold for Minimally Invasive Lobectomy
Authors: Vanstraelen Stijn , Tan Kay See , Dycoco Joe , Adusumilli Prasad S. , Bains Manjit S. , Bott Matthew J. , Downey Robert J. , Gray Katherine D. , Huang James , Isbell James M. , Molena Daniela , Park Bernard J. , Rusch Valerie W. , Sihag Smita , Jones David R. , Rocco Gaetano 
Published: May 2024

Objective:
To assess the performance of a lower predicted postoperative (ppo) forced expiratory volume in 1 second (FEV1) or diffusion capacity of the lung for carbon monoxide (DLCO) (ppoFEV1/ppoDLCO) threshold to predict cardiopulmonary complications after minimally invasive surgery (MIS) lobectomy.

Background:
Although MIS is associated with better postoperative outcomes than open surgery, MIS uses risk-assessment algorithms developed for open surgery. Moreover, several different definitions of cardiopulmonary complications are used for assessment.

Methods:
All patients who underwent MIS lobectomy for clinical stage I to II lung cancer from 2018 to 2022 at our institution were considered. The performance of a ppoFEV1/ppoDLCO threshold of <45% was compared against that of the current guideline threshold of <60%. Three different definitions of cardiopulmonary complications were compared: Society of Thoracic Surgeons (STS), European Society of Thoracic Surgeons (ESTS), and Berry and colleagues' study.

Results:
In 946 patients, the ppoFEV1/ppoDLCO threshold of <45% was associated with a higher proportion correctly classified [79% (95% CI, 76%–81%) vs 65% (95% CI, 62%–68%); P<0.001]. The complication with the biggest difference in incidence between ppoFEV1/ppoDLCO of 45% to 60% and >60% was prolonged air leak [33 (13%) vs 34 (6%); P<0.001]. The predicted probability curves for cardiopulmonary complications were higher for the STS definition than for the ESTS or Berry definitions across ppoFEV1 and ppoDLCO values.

Conclusions:
The ppoFEV1/ppoDLCO threshold of <45% more accurately classified patients for cardiopulmonary complications after MIS lobectomy, emphasizing the need for updated risk-assessment guidelines for MIS lobectomy to optimize additional cardiopulmonary function evaluation.
A narrative review of community-based dementia care in India: experiences, challenges, and policy initiatives
Authors: Thomas Trisha , Dasgupta Jayashree 
Published: May 2024

Purpose of review
India is facing a significant increase in the aging population who are at risk for dementia. This review evaluates recent literature on community-based care, focusing on caregiver experiences, challenges and policy initiatives.

Recent findings
Dementia care in India is traditionally provided by family members who take on the role of caregivers. Studies on caregiver experiences have reflected high caregiving burden and related impact on their mental health. During the pandemic, caregivers experienced several unprecedented challenges in providing care, emphasizing the need for more research on community-based dementia care across the country. Telehealth and online caregiver training were identified as viable alternatives to support community dementia care. However, it may not be a feasible mode of delivery suitable across the Indian context, underscoring the need for culturally relevant and acceptable interventions. India is currently undertaking concerted policy efforts for dementia care through multiple initiatives like the National Program for Healthcare of the Elderly, the Mental Healthcare Act, and initiatives like the Atal Vayo Abhyuday Yojna. These initiatives aim to address the healthcare requirements of the elderly; nevertheless, a comprehensive evaluation of their impact is yet to be discerned.

Summary
There is a need for comprehensive research, to inform evidence-based policy and improve dementia care systems in India. Addressing gaps in existing dementia care capacities and healthcare initiatives, along with tailoring interventions to India's diverse contexts are critical for effective community care for dementia
Opioid vaccine clinical testing: lessons learned
Authors: Luba Rachel , Comer Sandra D. 
Published: May 2024

Purpose of review
Opioid use disorder (OUD) presents a serious public health concern, with dramatic increases in opioid-overdose mortality in recent years and a small percentage of those with OUD accessing or remaining engaged with available treatments. Efforts are currently underway to identify vaccines targeting opioids, which could provide a novel and complimentary approach. The current review provides an overview of existing literature, practical considerations for designing and conducting clinical trials with vaccines for opioids, and future directions.

Recent findings
This review covers the following themes: clinical trial design and selection of endpoints, timepoint selection, practical considerations and lessons learned from the first (ongoing) trial of a vaccine targeting opioids, and future directions.

Summary
Efforts to develop and test vaccines targeting OUD are based on a foundation of preclinical work and close collaboration between preclinical and clinical researchers. Efforts to learn from shortcomings of prior clinical trials of vaccines for other substances are essential in designing and testing effective vaccines for OUD. Design and implementation of clinical trials for a vaccine for OUD requires careful balance of participant safety and strategies for retention and efforts to gather viable data to inform future work.
Automated Cytometric Gating with Human-Level Performance Using Bivariate Segmentation
Authors: Chen Jiong , Ionita Matei , Feng Yanbo , Lu Yinfeng , Orzechowski Patryk , Garai Sumita , Hassinger Kenneth , Bao Jingxuan , Wen Junhao , Duong-Tran Duy , Wagenaar Joost , McKeague Michelle L. , Painter Mark M. , Mathew Divij , Pattekar Ajinkya , Meyer Nuala J. , John Wherry E. , Greenplate Allison R. , Shen Li 
Published: May 2024

AbstractRecent advances in cytometry technology have enabled high-throughput data collection with multiple single-cell protein expression measurements. The significant biological and technical variance between samples in cytometry has long posed a formidable challenge during the gating process, especially for the initial gates which deal with unpredictable events, such as debris and technical artifacts. Even with the same experimental machine and protocol, the target population, as well as the cell population that needs to be excluded, may vary across different measurements. To address this challenge and mitigate the labor-intensive manual gating process, we propose a deep learning framework UNITO to rigorously identify the hierarchical cytometric subpopulations. The UNITO framework transformed a cell-level classification task into an image-based semantic segmentation problem. For reproducibility purposes, the framework was applied to three independent cohorts and successfully detected initial gates that were required to identify single cellular events as well as subsequent cell gates. We validated the UNITO framework by comparing its results with previous automated methods and the consensus of at least four experienced immunologists. UNITO outperformed existing automated methods and differed from human consensus by no more than each individual human. Most critically, UNITO framework functions as a fully automated pipeline after training and does not require human hints or prior knowledge. Unlike existing multi-channel classification or clustering pipelines, UNITO can reproduce a similar contour compared to manual gating for each intermediate gating to achieve better interpretability and provide post hoc visual inspection. Beyond acting as a pioneering framework that uses image segmentation to do auto-gating, UNITO gives a fast and interpretable way to assign the cell subtype membership, and the speed of UNITO will not be impacted by the number of cells from each sample. The pre-gating and gating inference takes approximately 2 minutes for each sample using our pre-defined 9 gates system, and it can also adapt to any sequential prediction with different configurations.
Improving polygenic prediction from summary data by learning patterns of effect sharing across multiple phenotypes
Authors: Kunkel Deborah , Sørensen Peter , Shankar Vijay , Morgante Fabio 
Published: May 2024

AbstractPolygenic prediction of complex trait phenotypes has become important in human genetics, especially in the context of precision medicine. Recently, Morganteet al. introducedmr.mash, a flexible and computationally efficient method that models multiple phenotypes jointly and leverages sharing of effects across such phenotypes to improve prediction accuracy. However, a drawback ofmr.mashis that it requires individual-level data, which are often not publicly available. In this work, we introducemr.mash-rss, an extension of themr.mashmodel that requires only summary statistics from Genome-Wide Association Studies (GWAS) and linkage disequilibrium (LD) estimates from a reference panel. By using summary data, we achieve the twin goal of increasing the applicability of themr.mashmodel to data sets that are not publicly available and making it scalable to biobank-size data. Through simulations, we show thatmr.mash-rssis competitive with, and often outperforms, current state-of-the-art methods for single- and multi-phenotype polygenic prediction in a variety of scenarios that differ in the pattern of effect sharing across phenotypes, the number of phenotypes, the number of causal variants, and the genomic heritability. We also present a real data analysis of 16 blood cell phenotypes in UK Biobank, showing thatmr.mash-rssachieves higher prediction accuracy than competing methods for the majority of traits, especially when the data has smaller sample size.Author summaryPolygenic prediction refers to the use of an individual’s genetic information (i.e., genotypes) to predict traits (i.e., phenotypes), which are often of medical relevance. It is known that some phenotypes are related and are affected by the same genotypes. When this is the case, it is possible to improve the accuracy of predictions by using methods that model multiple phenotypes jointly and account for shared effects.mr.mashis a recently developed multi-phenotype method that can learn which effects are shared and has been shown to improve prediction. However,mr.mashrequires large data sets of genetic and phenotypic information collected at the individual level. Such data are often unavailable due to privacy concerns, or are difficult to work with due to the computational resources needed to analyze data of this size. Our work extendsmr.mashto require only summary statistics from Genome-Wide Association Studies instead of individual-level data, which are usually publicly available. In addition, the computations using summary statistics do not depend on sample size, making the newly developedmr.mash-rssscalable to extremely large data sets. Using simulations and real data analysis, we show that our method is competitive with other methods for polygenic prediction.