bluuebunny/crossref_metadata_2025_split huggingface dataset:
Developing attributes and attribute-levels for subacromial pain syndrome: A systematic review and qualitative study
Authors: Tróndarson Tróndur Frídi , Storgaard Filip Sandberg , Larsen Mikkel Bjerre , Rathleff Michael Skovdal , Clausen Mikkel Bek , Lyng Kristian Damgaard 
Published: June 2024

Abstract

Background
Subacromial pain syndrome (SAPS), the most common cause of shoulder pain, can be treated through different treatments with similar effects. Therefore, in terms of deciding on the right treatment fit, patient preferences need to be understood. We aimed to identify treatment characteristics that delineate interventions (attributes) and corresponding sets of specific categorical range (attribute-levels) for SAPS.

Methods
This multiple method study systematically reviewed both qualitative and quantitative studies on patient preferences for treatment of SAPS, which informed semi-structured interviews with 9 clinicians and 14 patients. The qualitative data from the interviews was analyzed using the framework analysis formulated by Ritchie and Spencer. Attributes and attribute levels of the systematic review and interviews were summarized and categorized.

Results
The search resulted in 2607 studies, 16 of which met the eligibility criteria. The review identified 120 potential attributes, which were synthesized into 25 potential attributes. Fourteen new potential attributes were identified through the interviews, equaling a total of 39 attributes across 11 categories. Levels for 37 attributes were identified through systematic review and interviews, we were unable to identify levels for 2 attributes.

Conclusions
This study identified attributes and attribute levels for the treatment of SAPS. There was a discrepancy in the frequency of the represented attributes between the literature and interviews. This study may improve the understanding of patient preferences for the treatment of SAPS and help individualize care. Our study informs a future discrete choice experiment and supports shared decision-making in clinical practice.
Dose, dose, dose, but where is the patient dose?
Authors: Rehani Madan M , Xu Xie George 
Published: June 2024

Abstract
The article reviews the historical developments in radiation dose metrices in medical imaging. It identifies the good, the bad, and the ugly aspects of current-day metrices. The actions on shifting focus from International Commission on Radiological Protection (ICRP) Reference-Man–based population-average phantoms to patient-specific computational phantoms have been proposed and discussed. Technological developments in recent years involving AI-based automatic organ segmentation and ‘near real-time’ Monte Carlo dose calculations suggest the feasibility and advantage of obtaining patient-specific organ doses. It appears that the time for ICRP and other international organizations to embrace ‘patient-specific’ dose quantity representing risk may have finally come. While the existing dose metrices meet specific demands, emphasis needs to be also placed on making radiation units understandable to the medical community.
Evaluation of uncertainty in personal dose measured using CaSO4:Dy-based TLD badge at different workplaces
Authors: Pradhan Suresh M , Pathan Munir S , Chakrabarty Shatabdi , Selvam T Palani , Sapra Balvinder K 
Published: June 2024

Abstract
The metrological quality of a measurement is characterised by evaluating the uncertainty in the measurement. In this paper, uncertainty in personal dose measured using individual monitoring CaSO4:Dy-based thermoluminescence dosimeter badge is evaluated by application of the guide to the expression of uncertainty in measurement method. The present dose reporting quantity, whole body dose (WBD) and the proposed quantity, personal dose equivalent, Hp(10) has been used as measurands. The influence of various input quantities on the measurement were analyzed through tests that conform to the requirements of the International Electrotechnical Commission IEC 62387. The study found that the expanded uncertainties for WBD and Hp(10) measurements were 63.4% and 41.4%, respectively, corresponding to a 95% coverage probability for workplace fields covering a wide photon energy range (33–1250 keV). However, the uncertainty estimates were quite lower for the type of workplaces that are identified using the dose evaluation algorithm. The input quantities, namely, the response to a mixture of photon beam qualities and photon energy and angular dependence contribute the most to the total uncertainty.
CarcSeq detection of lorcaserin-induced clonal expansion ofPik3caH1047R mutants in rat mammary tissue
Authors: Faske Jennifer B , Myers Meagan B , Bryant Matthew , He Xiaobo , McLellen Florence , Bourcier Todd , Parsons Barbara L 
Published: June 2024

AbstractLorcaserin is a 5-hydroxytryptamine 2C (serotonin) receptor agonist and a nongenotoxic rat carcinogen, which induced mammary tumors in male and female rats in a 2-yr bioassay. Female Sprague Dawley rats were treated by gavage daily with 0, 30, or 100 mg/kg lorcaserin, replicating bioassay dosing but for shorter duration, 12 or 24 wk. To characterize exposure and eliminate possible confounding by a potentially genotoxic degradation product, lorcaserin and N-nitroso-lorcaserin were quantified in dosing solutions, terminal plasma, mammary, and liver samples using ultra-high-performance liquid chromatography-electrospray tandem mass spectrometry. N-nitroso-lorcaserin was not detected, supporting lorcaserin classification as nongenotoxic carcinogen. Mammary DNA samples (n = 6/dose/timepoint) were used to synthesize PCR products from gene segments encompassing hotspot cancer driver mutations, namely regions of Apc, Braf, Egfr, Hras, Kras, Nfe2l2, Pik3ca, Setbp1, Stk11, and Tp53. Mutant fractions (MFs) in the amplicons were quantified by CarcSeq, an error-corrected next-generation sequencing approach. Considering all recovered mutants, no significant differences between lorcaserin dose groups were observed. However, significant dose-responsive increases in Pik3ca H1047R mutation were observed at both timepoints (ANOVA, P &lt; 0.05), with greater numbers of mutants and mutants with greater MFs observed at 24 wk as compared with 12 wk. These observations suggest lorcaserin promotes outgrowth of spontaneously occurring Pik3ca H1047R mutant clones leading to mammary carcinogenesis. Importantly, this work reports approaches to analyze clonal expansion and demonstrates CarcSeq detection of the carcinogenic impact (selective Pik3ca H0147R mutant expansion) of a nongenotoxic carcinogen using a treatment duration as short as 3 months.
In situ measurements of dissolved gases in xylem sap as tracers in plant physiology
Authors: Marion Capucine , Gharun Mana , Brennwald Matthias S , Kipfer Rolf 
Published: June 2024

Abstract
Trees transport gases from the ground into the atmosphere through the process of transpiration. Tracing gases transported through this mechanism continuously and under field conditions remains an experimental challenge. Here we measured gases dissolved in the tree sap in situ and in real time, aiming to simultaneously analyse the transport of several gases (He, Ar, Kr, N2, O2 and CO2) from the soil, through the trees, into the atmosphere. We constructed and inserted custom-made semi-permeable membrane probes in the xylem of a fir tree and measured gas abundances at different heights using a portable gas equilibrium membrane-inlet mass spectrometer (‘miniRUEDI’). With this method, we were able to continuously measure the abundances of He, Ar, Kr, N2, O2 and CO2 in sap over several weeks. We observed diurnal variations of CO2 and O2 concentrations that reflected tree physiological activities. As a proof of the concept that trees do uptake dissolved gases in soil water, we irrigated the tree with He-enriched water in a tracer experiment and were able to determine upward sap flow velocity. Measurements of inert gases together with reactive species, such as CO2 and O2, allowed separation of the physical transport and exchange of gases derived from the soil or atmosphere from biological reactions. We discuss the opportunities that our technique provides for continuous in situ measurements of gases in the tree sap.
Transcriptome and metabolome reveal the effects of ABA promotion and inhibition on flavonoid and amino acid metabolism in tea plant
Authors: Gao Chenxi , Wang Zhihui , Wu Weiwei , Zhou Zhe , Deng Xuming , Chen Zhidan , Sun Weijiang 
Published: June 2024

Abstract
Flavonoids (especially anthocyanins and catechins) and amino acids represent a high abundance of health-promoting metabolites. Although we observed abscisic acid accumulation in purple leaves and low levels in albino tea leaves, the specific mechanism behind its impact on flavor compounds remains unclear. In this study, we treated tea leaves with exogenous abscisic acid and abscisic acid biosynthesis inhibitors (Flu), measured physiological indicators and conducted comprehensive transcriptomic and metabolomic analyses to elucidate the potential mechanisms underlying color change. Our results demonstrate that abscisic acid treatment induces purple coloration, while Flu treatment causes discoloration in tea leaves. Metabolomic analysis revealed higher levels of four anthocyanins and six catechins in the group treated with abscisic acid in comparison with the control group. Additionally, there was a notable increase in 15 amino acids in the Flu-treated group. Notably, the levels of flavonoids and amino acids showed an inverse relationship between the two treatments. Transcriptomic comparison between the treatments and the control group revealed upregulation of differentially expressed genes encoding dihydroflavonol reductase and uridine diphosphate-glycose flavonoid glycosyltransferase in the abscisic acid-treated group, leading to the accumulation of identified anthocyanins and catechins. In contrast, differentially expressed genes encoding nitrate reductase and nitrate transporter exhibited elevated expression in the group treated with Flu, consequently facilitating the accumulation of amino acids, specifically L-theanine and L-glutamine. Furthermore, our co-expression network analysis suggests that MYB and bHLH transcription factors may play crucial roles in regulating the expression of differentially expressed genes involved in the biosynthesis of flavonoids and amino acids. This study provides insights for targeted genetic engineering to enhance the nutritional and market value of tea, together with the potential application of purple and albino tea leaves as functional beverages. It also offers guidance for future breeding programs and production.
The Impact of the Preoperative Mental Health Component Summary (MCS) Score on Short-Term Outcomes After Lumbar Fusion
Authors: Ezeonu Teeto , Narayanan Rajkishen , Heard Jeremy C. , Lee Yunsoo A. , Mazmudar Aditya , Zucker Jeffrey , Shaer Alexander , Dulitzki Yoni , Resnick Dylan , Canseco Jose A. , Kurd Mark F. , Kaye Ian D. , Hilibrand Alan S. , Vaccaro Alexander R. , Kepler Christopher , Schroeder Gregory D. 
Published: June 2024

Study Design.
Retrospective cohort study.

Objective.
The purpose of this study is to characterize the relationship between preoperative MCS and surgical outcomes after lumbar spine surgery including inpatient complications, length of stay, readmissions, and reoperations.

Summary of Background Data.
As the prevalence of mental health disorders in the United States increases, it is important to identify risks associated with poor mental health status in the surgical spine patient. The mental health component summary (MCS) of the Short Form-12 has been used extensively as an indication of a patient’s mental health status and psychological well-being.

Patients and Methods.
Adult patients older than or equal to 18 years who underwent primary one to three level lumbar fusion surgery at our academic medical institution from 2017 to 2021 were retrospectively identified. Preoperative MCS score was used to analyze outcomes in patients based on a cutoff (<45.6). A score >45.6 indicated better preoperative mental health and a score ≤45.6 indicated worse preoperative mental health.

Results.
Patients with lower preoperative MCS scores had longer hospital stays (3.86±2.16 vs. 3.55±1.42 d, P=0.010) and were more likely to have inpatient renal complications (3.09% vs. 7.19%, P=0.006). Patients with lower preoperative MCS scores also had lower activity measure for post-acute care (AM-PAC) scores (17.1±2.85 vs. 17.6±2.49, P=0.030). Ninety-day surgical readmissions, medical readmissions, and reoperations were not significantly different between groups (P>0.05).

Conclusion.
Our study suggests that patients with lower preoperative mental health scores (MCS ≤45.6) were independently more likely to experience more renal complications and longer length of stay after primary lumbar fusion. In addition, higher MCS scores may correlate with better postoperative mobility and daily activity scores. Nevertheless, long-term outcomes are not significantly different between patients of better or worse preoperative mental health.

Level of Evidence.
Level IV.
Liposomal Bupivacaine Analgesia in Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Retrospective Cohort Study
Authors: Knackstedt Rebecca W. , Lin Jennifer H. , Kakoty Swapnabir 
Published: June 2024

Background:
Liposomal bupivacaine (LB) can be used for postsurgical analgesia after breast reconstruction. We examined real-world clinical and economic benefits of LB versus bupivacaine after deep inferior epigastric perforator (DIEP) flap breast reconstruction.

Methods:
This retrospective cohort study used the IQVIA claims databases to identify patients undergoing primary DIEP flap breast reconstruction in 2016–2019. Patients receiving LB and those receiving bupivacaine were compared to assess opioid utilization in morphine milligram equivalents (MMEs) and healthcare resource utilization during perioperative (2 weeks before surgery to 2 weeks after discharge) and 6-month postdischarge periods. A generalized linear mixed-effects model and inverse probability of treatment weighting method were performed.

Results:
Weighted baseline characteristics were similar between cohorts (LB, n = 669; bupivacaine, n = 348). The LB cohort received significantly fewer mean MMEs versus the bupivacaine cohort during the perioperative (395 versus 512 MMEs; rate ratio [RR], 0.771 [95% confidence interval (CI), 0.677–0.879]; P = 0.0001), 72 hours after surgery (63 versus 140 MMEs; RR, 0.449 [95% CI, 0.347–0.581]; P < 0.0001), and inpatient (154 versus 303 MMEs; RR, 0.508 [95% CI, 0.411–0.629]; P < 0.0001) periods; postdischarge filled opioid prescriptions were comparable. The LB cohort was less likely to have all-cause inpatient readmission (odds ratio, 0.670 [95% CI, 0.452–0.993]; P = 0.046) and outpatient clinic/office visits (odds ratio, 0.885 [95% CI, 0.785–0.999]; P = 0.048) 3 months after discharge than the bupivacaine cohort; other all-cause healthcare resource utilization outcomes were not different.

Conclusions:
LB was associated with fewer perioperative MMEs and all-cause 3-month inpatient readmissions and outpatient clinic/office visits than bupivacaine in patients undergoing DIEP flap breast reconstruction.
An unsupervised learning model based on CT radiomics features accurately predicts axillary lymph node metastasis in breast cancer patients: diagnostic study
Authors: Qu Limeng , Mei Xilong , Yi Zixi , Zou Qiongyan , Zhou Qin , Zhang Danhua , Zhou Meirong , Pei Lei , Long Qian , Meng Jiahao , Zhang Huashan , Chen Qitong , Yi Wenjun 
Published: June 2024

Background:
The accuracy of traditional clinical methods for assessing the metastatic status of axillary lymph nodes (ALNs) is unsatisfactory. In this study, the authors propose the use of radiomic technology and three-dimensional (3D) visualization technology to develop an unsupervised learning model for predicting axillary lymph node metastasis in patients with breast cancer (BC), aiming to provide a new method for clinical axillary lymph node assessment in patients with this disease.

Methods:
In this study, we retrospectively analyzed the data of 350 patients with invasive BC who underwent lung-enhanced computed tomography (CT) and axillary lymph node dissection surgery at the Department of Breast Surgery of the Second Xiangya Hospital of Central South University. The authors used 3D visualization technology to create a 3D atlas of ALNs and identified the region of interest for the lymph nodes. Radiomic features were subsequently extracted and selected, and a prediction model for ALNs was constructed using the K-means unsupervised algorithm. To validate the model, the authors prospectively collected data from 128 BC patients who were clinically evaluated as negative at our center.

Results:
Using 3D visualization technology, we extracted and selected a total of 36 CT radiomics features. The unsupervised learning model categorized 1737 unlabeled lymph nodes into two groups, and the analysis of the radiomic features between these groups indicated potential differences in lymph node status. Further validation with 1397 labeled lymph nodes demonstrated that the model had good predictive ability for axillary lymph node status, with an area under the curve of 0.847 (0.825–0.869). Additionally, the model’s excellent predictive performance was confirmed in the 128 axillary clinical assessment negative cohort (cN0) and the 350 clinical assessment positive (cN+) cohort, for which the correct classification rates were 86.72 and 87.43%, respectively, which were significantly greater than those of clinical assessment methods.

Conclusions:
The authors created an unsupervised learning model that accurately predicts the status of ALNs. This approach offers a novel solution for the precise assessment of ALNs in patients with BC.
Sepsis phenotypes, subphenotypes, and endotypes: are they ready for bedside care?
Authors: Scherger Sias J. , Kalil Andre C. 
Published: June 2024

Purpose of review
Sepsis remains a leading global cause of morbidity and mortality, and despite decades of research, no effective therapies have emerged. The lack of progress in sepsis outcomes is related in part to the significant heterogeneity of sepsis populations. This review seeks to highlight recent literature regarding sepsis phenotypes and the potential for further research and therapeutic intervention.

Recent findings
Numerous recent studies have elucidated various phenotypes, subphenotypes, and endotypes in sepsis. Clinical parameters including vital sign trajectories and microbial factors, biomarker investigation, and genomic, transcriptomic, proteomic, and metabolomic studies have illustrated numerous differences in sepsis populations with implications for prediction, diagnosis, treatment, and prognosis of sepsis.

Summary
Sepsis therapies including care bundles, fluid resuscitation, and source control procedures may be better guided by validated phenotypes than universal application. Novel biomarkers may improve upon the sensitivity and specificity of existing markers and identify complications and sequelae of sepsis. Multiomics have demonstrated significant differences in sepsis populations, most notably expanding our understanding of immunosuppressed sepsis phenotypes. Despite progress, these findings may be limited by modest reproducibility and logistical barriers to clinical implementation. Further studies may translate recent findings into bedside care.
Do Patients With NASH-related Cirrhosis Have Better Overall Survival Compared With Other Etiologies of Cirrhosis? A Population-based Study
Authors: Singh Ritu R. , Gopakumar Harishankar , Dhillon Sonu 
Published: June 2024

Goals and Background:
Nonalcoholic steatohepatitis (NASH) is a leading cause of cirrhosis. We aim to explore the clinical outcomes of NASH cirrhosis compared with other etiologies of cirrhosis.

Methods:
We utilized an EHR-based database (TriNetX) to study the outcomes of NASH cirrhosis. Patients diagnosed with NAFLD or NASH and cirrhosis between January 2016 and December 2019 were identified utilizing appropriate ICD-10-CM codes. The primary outcome was 3-year overall survival. Secondary outcomes were decompensated cirrhosis, hepatocellular carcinoma, and liver transplantation. The Control group was patients with other etiologies of cirrhosis than NASH. Study and control groups were matched for demographic characters and comorbidities using propensity score matching.

Results:
We identified 45,063 patients with NASH cirrhosis. The NASH cirrhosis cohort comprised older (61 vs. 59 y) White (78% vs. 64%) women (58% vs. 38%) with more comorbidities (diabetes mellitus, obesity, ischemic heart disease, history of cancer, chronic kidney disease). After propensity score matching, patients with NASH cirrhosis had a better 3-year survival (78% vs. 74%, HR 0.79, 95% CI 0.77-0.82) compared with patients with non-NASH cirrhosis. Hepatocellular carcinoma was diagnosed less commonly in patients with NASH cirrhosis (6.7% vs. 10.6%, P<0.001), and liver transplantation was performed more often for NASH cirrhosis compared with non-NASH cirrhosis [Risk ratio 1.13 (1.08–1.18)].

Conclusions:
Patients with NASH cirrhosis probably have better 3-year overall survival than other etiologies of cirrhosis. This is an interesting finding, as patients with NASH are older and have more comorbidities. Improved survival can be partly explained by a higher probability of liver transplantation and improvements in cardiovascular outcomes.
Alternative Models of Nurse Staffing May Be Dangerous in High-Stakes Hospital Care
Authors: Lasater Karen B. , Muir K. Jane , Sloane Douglas M. , McHugh Matthew D. , Aiken Linda H. 
Published: June 2024

Background:Hospitals are resurrecting the outdated “team nursing” model of staffing that substitutes lower-wage staff for registered nurses (RNs).Objectives:To evaluate whether reducing the proportion of RNs to total nursing staff in hospitals is in the best interest of patients, hospitals, and payers.Research Design:Cross-sectional, retrospective.Subjects:In all, 6,559,704 Medicare patients in 2676 general acute-care US hospitals in 2019.Measures:Patient outcomes: in-hospital and 30-day mortality, 30-day readmission, length of stay, and patient satisfaction. Avoidable Medicare costs associated with readmissions and cost savings to hospitals associated with shorter stays are projected.Results:A 10 percentage-point reduction in RNs was associated with 7% higher odds of in-hospital death, 1% higher odds of readmission, 2% increase in expected days, and lower patient satisfaction. We estimate a 10 percentage-point reduction in RNs would result in 10,947 avoidable deaths annually and 5207 avoidable readmissions, which translates into roughly $68.5 million in additional Medicare costs. Hospitals would forgo nearly $3 billion in cost savings annually because of patients requiring longer stays.Conclusions:Reducing the proportion of RNs in hospitals, even when total nursing personnel hours are kept the same, is likely to result in significant avoidable patient deaths, readmissions, longer lengths of stay, and decreased patient satisfaction, in addition to excess Medicare costs and forgone cost savings to hospitals. Estimates represent only a 10 percentage-point dilution in skill mix; however, the team nursing model includes much larger reductions of 40–50 percentage-points—the human and economic consequences of which could be substantial.