bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exploring Medical Student Experiences With Direct Observation During the Pediatric Clerkship
Authors: Alex Capri P. , Fromme H. Barrett , Greenberg Larrie , Ryan Michael S. , Gustafson Sarah , Neeley Maya K. , Nunez Shaughn , Rideout Molly E. , VanNostrand Jessica , Orlov Nicola M. 
Published: May 2024

Abstract

Purpose
Direct observation (DO) enables assessment of vital competencies, such as clinical skills. Despite national requirement that medical students experience DOs during each clerkship, the frequency, length, quality, and context of these DOs are not well established. This study examines the quality, quantity, and characteristics of DOs obtained during pediatrics clerkships across multiple institutions.

Method
This multimethod study was performed at 6 U.S.-based institutions from March to October 2022. In the qualitative phase, focus groups and/or semistructured interviews were conducted with third-year medical students at the conclusion of pediatrics clerkships. In the quantitative phase, the authors administered an internally developed instrument after focus group discussions or interviews. Qualitative data were analyzed using thematic analysis, and quantitative data were analyzed using anonymous survey responses.

Results
Seventy-three medical students participated in 20 focus groups, and 71 (97.3%) completed the survey. The authors identified 7 themes that were organized into key principles: before, during, and after DO. Most students reported their DOs were conducted primarily by residents (62 [87.3%]) rather than attendings (6 [8.4%]) in inpatient settings. Participants reported daily attending observation of clinical reasoning (38 [53.5%]), communication (39 [54.9%]), and presentation skills (58 [81.7%]). One-third reported they were never observed taking a history by an inpatient attending (23 [32.4%]), and one-quarter reported they were never observed performing a physical exam (18 [25.4%]).

Conclusions
This study revealed that students are not being assessed for performing vital clinical skills in the inpatient setting by attendings as frequently as previously believed. When observers set expectations, create a safe learning environment, and follow up with actionable feedback, medical students perceive the experience as valuable; however, the DO experience is currently suboptimal. Therefore, a high-quality, competency-based clinical education for medical students is necessary to directly drive future patient care by way of a competent physician workforce.
Academic Medicine and Rural Health System Partnerships: Enhancing Education While Advancing Physician Workforce Priorities
Authors: Hawes Emily M. , Rodefeld Lori , Weinstein Debra F. 
Published: May 2024

Abstract
A worsening shortage of rural physicians paralleling increasing health disparities demands attention. Past and ongoing efforts to address this shortage have had positive effects and can inform new strategies to achieve even greater impact. Interventions have included the development of regional medical school campuses and rural-focused tracks to recruit medical students from rural areas, expansion of rural-based graduate medical education (GME) programs and tracks, and use of institutional and individual financial incentives for rural-based training and/or practice. National policy has also taken aim at this challenge with provisions aimed at expanding rural GME in the Medicare, Medicaid, and State Children’s Health Insurance Program Balanced Budget Refinement Act of 1999 and the Consolidated Appropriations Act of 2021. Additionally, several states have funded growth in GME, and supportive pathways for Medicare reimbursement and for Veterans Administration funding have been implemented. The authors recommend a new strategy for bolstering the rural physician workforce, focused on using academic-rural partnerships to incorporate rural rotations as a routine part of GME. They explain how the current health care landscape supports this approach and outline additional steps toward implementation. Centralized data collection and analysis are noted as essential to guide future efforts.
Remote Topography-Guided Transepithelial Photorefractive Combined Phototherapeutic Keratectomy Telesurgery
Authors: Alessio Giovanni , Puzo Pasquale , Di Pardo Camilla , Sborgia Alessandra , D'Oria Francesco 
Published: May 2024

Purpose.
The purpose of this study was to report the first remote telesurgery in a case of epithelial basement membrane disease with recurrent corneal erosions.

Methods.
Topography-guided transepithelial photorefractive combined phototherapeutic keratectomy (PRK-PTK) is a surgical option that treats corneal irregularities and prevents the recurrences of erosions while treating the refractive error.

Results.
We performed for the first time a remote transepithelial topography-guided combined PRK-PTK using the iRes®2 excimer laser platform (iVIS Technologies, Taranto, Italy), with the surgeon sitting in his own room and controlling the excimer laser in remote with 5G connection through the Remote Control Station and the patient in the operating room. At one-month post-operative, visual acuity was 20/20 and the patient's symptoms subsided.

Conclusions.
Our surgery opens the era of telesurgery in the corneal panorama.
Improving First Case Operating Room Efficiency
Authors: Afford Rebecca , Chan Megan , Garelnabi Rana , Ali Akbari Fariba Haji , Wiseman Sam M. 
Published: May 2024

ABSTRACT

Introduction:
Improving transition to the operating room (OR) can enhance healthcare efficiency. Our aim was to determine whether adopting a communication board (CB) for first case surgical patients reduced delays to OR.

Methods:
A retrospective observational study was conducted from April to October 2021. We calculated differences in surgical daycare (SDC) departure time before and after implementation of the CB, differences in departure whether the CB was used or not, delay in variability between surgical specialties, and overall adoption of the CB.

Results:
After CB adoption, 13% of first cases left SDC by predefined target times. The mean delay in transfer was 18:51 minutes. When the CB was used, cases were on average 10:43 late, compared with 26:00 when it was not used. Otolaryngology had the shortest delays while plastic surgery had the longest. Reasons for delays included staffing delays, holds, and pending laboratory results.

Conclusions:
Introducing a CB significantly reduced delays in transferring first case surgical patients from SDC to the OR.
Herpes simplex (HSV-1) encephalitis in an infant: a case report study
Authors: Hosseini Parmis Sadat , Golfiroozi Saeed , Hosseini Parnian Sadat , Ghelichi-Ghojogh Mousa , Delavari Sahar , Hosseini Seyed Ahmad 
Published: May 2024

Introduction and importance:
The herpes simplex virus (HSV) is the most common cause of acute sporadic encephalitis, a severe and often fatal disease in humans. It is associated with high mortality and morbidity rates in untreated patients.

Case presentation:
An 11-month-old child was admitted to the hospital presenting with acute fever and seizures characterized by staring episodes and spastic movements affecting the left side of the body. Diagnostic workup revealed abnormal T2 flair hyperintense foci in bi-temporoparietal lobes and right thalamus, and bilateral otomastoiditis were detected. A positive result for HSV-1 was obtained through HSV type 1/2 polymerase chain reaction (PCR) testing, leading to a diagnosis of herpes encephalitis.

Clinical discussion:
While acyclovir has proven to be an effective therapeutic option, mortality and neurological sequelae continue to be reported in a notable fraction of patients. HSV encephalitis is mainly caused by two strains of the herpes simplex virus: HSV-1, more frequently observed in children and adults, and HSV-2, commonly seen in neonates and those with compromised immune systems. MRI scans often reveal that the brain lesions are localized to certain areas, although temporal involvement may not always be evident. The symptoms of herpetic encephalitis can greatly vary, making early diagnosis and treatment vital for improving patient outcomes.

Conclusion:
This case report highlights the clinical presentation, diagnostic challenges, and treatment strategies for HSV-1 encephalitis and underscores the importance of early recognition and prompt initiation of antiviral therapy in suspected cases of HSV-1 encephalitis.
Automated Calculator for the Pediatric Sequential Organ Failure Assessment Score: Development and External Validation in a Single-Center 7-Year Cohort, 2015–2021
Authors: Akhondi-Asl Alireza , Luchette Matthew , Mehta Nilesh M. , Geva Alon 
Published: May 2024

OBJECTIVES:The pediatric Sequential Organ Failure Assessment (pSOFA) score summarizes severity of organ dysfunction and can be used to predict in-hospital mortality. Manual calculation of the pSOFA score is time-consuming and prone to human error. An automated method that is open-source, flexible, and scalable for calculating the pSOFA score directly from electronic health record data is desirable.DESIGN:Single-center, retrospective cohort study.SETTING:Quaternary 40-bed PICU.PATIENTS:All patients admitted to the PICU between 2015 and 2021 with ICU stay of at least 24 hours.INTERVENTIONS:None.MEASUREMENTS AND MAIN RESULTS:We used 77 records to evaluate the automated score. The automated algorithm had an overall accuracy of 97%. The algorithm calculated the respiratory component of two cases incorrectly. An expert human annotator had an initial accuracy of 75% at the patient level and 95% at the component level. An untrained human annotator with general clinical research experience had an overall accuracy of 16% and component-wise accuracy of 67%. Weighted kappa for agreement between the automated method and the expert annotator’s initial score was 0.92 (95% CI, 0.88–0.95), and between the untrained human annotator and the automated score was 0.50 (95% CI, 0.36–0.61). Data from 9146 patients (in-hospital mortality 3.6%) were included to validate externally the discriminability of the automated pSOFA score. The admission-day pSOFA score had an area under the receiver operating characteristic curve of 0.79 (95% CI, 0.77–0.82).CONCLUSIONS:The developed automated algorithm calculates pSOFA score with high accuracy and is more accurate than a trained expert rater and nontrained data abstracter. pSOFA’s performance for predicting in-hospital mortality was lower in our cohort than it was for the originally derived score.
Respiratory Displacement of the Right Adrenal Vein: Comparison of Inspiratory and Expiratory Computed Tomography With Catheter Venography
Authors: Hara Junko , Ishii Shiro , Tanabe Hayato , Yamakuni Ryo , Suenaga Hiroki , Kono Teruyuki , Kuroiwa Daichi , Sekino Hirofumi , Shimabukuro Michio , Ito Hiroshi 
Published: May 2024

Objective
The aim of the study is to reveal the respiratory displacement of the right adrenal vein (RAV) to predict the exact location of the RAV during adrenal venous sampling (AVS).

Methods
Computed tomography (CT) scans obtained 45 seconds (breath-hold at inhalation) and 70 seconds (breath-hold at exhalation) after contrast material injection were compared to venograms of the RAV of patients with primary aldosteronism who underwent AVS between January 2016 and December 2020. The craniocaudal distance between the center of the Th11/12 disc and the RAV orifice was measured; the craniocaudal location of the RAV orifice was also specified relative to vertebral bodies and intervertebral discs on inspiratory phase CT (In-CT), expiratory phase CT (Ex-CT), and catheter venography. The transverse and vertical angles of the RAV and the position of the RAV orifice on the inferior vena cava (IVC) circumference were measured on In-CT and Ex-CT.

Results
In total, 51 patients (30 males, 21 females; mean age, 54.9 ± 11.1 years) were included. Craniocaudal distances between the center of the Th11/12 disc and RAV orifice were significantly different among the following 3 acquisitions: catheter venography versus In-CT (15.2 ± 8.4 mm); venography versus Ex-CT (5.6 ± 4.1 mm); and In-CT versus Ex-CT (19.6 ± 8.0 mm) (all, P < 0.001). The craniocaudal location of the RAV orifice on venography was significantly closer to that on Ex-CT than on In-CT (P < 0.001); measurements using venograms compared with In-CT and Ex-CT scans were within 1 level difference in 18 (35.3%) and 47 (92.2%) patients, respectively (P < 0.001). The vertical angle of the RAV was significantly more likely to be smaller on In-CT than on Ex-CT (P < 0.001).

Conclusions
RAV locations and angles change with respiratory motion. It is crucial to consider the respiratory phase of CT because it can enable a more accurate prediction of the location of the RAV during AVS.
Cortical Lesions as an Early Hallmark of Multiple Sclerosis: Visualization by 7 T MRI
Authors: Durozard Pierre , Maarouf Adil , Zaaraoui Wafaa , Stellmann Jan-Patrick , Boutière Clémence , Rico Audrey , Demortière Sarah , Guye Maxime , Le Troter Arnaud , Dary Hugo , Ranjeva Jean-Philippe , Audoin Bertrand , Pelletier Jean 
Published: May 2024

Objectives
Compelling evidence indicates a significant involvement of cortical lesions in the progressive phase of multiple sclerosis (MS), significantly contributing to late-stage disability. Despite the promise of ultra-high-field magnetic resonance imaging (MRI) in detecting cortical lesions, current evidence falls short in providing insights into the existence of such lesions during the early stages of MS or their underlying cause. This study delineated, at the early stage of MS, (1) the prevalence and spatial distribution of cortical lesions identified by 7 T MRI, (2) their relationship with white matter lesions, and (3) their clinical implications.

Materials and Methods
Twenty individuals with early-stage relapsing-remitting MS (disease duration <1 year) underwent a 7 T MRI session involving T1-weighted MP2RAGE, T2*-weighted multiGRE, and T2-weighted FLAIR sequences for cortical and white matter segmentation. Disability assessments included the Expanded Disability Status Scale, the Multiple Sclerosis Functional Composite, and an extensive evaluation of cognitive function.

Results
Cortical lesions were detected in 15 of 20 patients (75%). MP2RAGE revealed a total of 190 intracortical lesions (median, 4 lesions/case [range, 0–44]) and 216 leukocortical lesions (median, 2 lesions/case [range, 0–75]). Although the number of white matter lesions correlated with the total number of leukocortical lesions (r = 0.91, P < 0.001), no correlation was observed between the number of white matter or leukocortical lesions and the number of intracortical lesions. Furthermore, the number of leukocortical lesions but not intracortical or white-matter lesions was significantly correlated with cognitive impairment (r = 0.63, P = 0.04, corrected for multiple comparisons).

Conclusions
This study highlights the notable prevalence of cortical lesions at the early stage of MS identified by 7 T MRI. There may be a potential divergence in the underlying pathophysiological mechanisms driving distinct lesion types, notably between intracortical lesions and white matter/leukocortical lesions. Moreover, during the early disease phase, leukocortical lesions more effectively accounted for cognitive deficits.
Contemporary diagnosis and management of mild TBI (concussions): What you need to know
Authors: Panzera Joseph C. , Podolak Olivia E. , Master Christina L. 
Published: May 2024

ABSTRACT
Concussion is a common injury in children and adolescents and is a form of mild traumatic brain injury that surgeons will see in their acute care practice. With a rapidly changing evidence base for diagnosis and management, we will focus on the importance of timely identification and diagnosis, as well as the early initiation of active management of pediatric concussion immediately after injury through recovery. This approach involves the application of targeted therapies for specific deficits identified after concussion, addressing the individual pattern of symptoms experienced by patients following concussion. We will review what is known about the underlying pathophysiology that drives the clinical manifestations of concussion, the targeted clinical assessments that can both aid in the diagnosis of concussion, as well as drive the active rehabilitation of deficits seen after concussion. The standardized approach to the return to activities will also be described, including return to learning and sports.
A deep phenotyping study in mouse and iPSC models to understand the role of oligodendroglia in optic neuropathy in Wolfram syndrome
Authors: Ahuja K. , Vandenabeele M. , Nami F. , Lefevere E. , Van hoecke J. , Bergmans S. , Claes M. , Vervliet T. , Neyrincki K. , Burg T. , De Herdt D. , Bhaskar P. , Zhu Y. , Looser Z. J. , Loncke J. , Gsell W. , Plaas M. , Agostinis P. , Swinnen J.V. , Van Den Bosch L. , Bultynck G. , Saab A. S. , Wolfs E. , Chai Y.C. , Himmelreich U. , Verfaillie C. , Moons L. , De Groef L. 
Published: May 2024

AbstractWolfram syndrome (WS) is a rare childhood disease characterized by diabetes mellitus, diabetes insipidus, blindness, deafness, neurodegeneration and eventually early death, due to autosomal recessive mutations in theWFS1(andWFS2) gene. While it is categorized as a neurodegenerative disease, it is increasingly becoming clear that other cell types besides neurons may be affected and contribute to the pathogenesis. MRI studies in patients and phenotyping studies in WS rodent models indicate white matter/myelin loss, implicating a role for oligodendroglia in WS-associated neurodegeneration. In this study, we sought to determine if oligodendroglia are affected in WS and whether their dysfunction may be the primary cause of the observed optic neuropathy and brain neurodegeneration. We demonstrate that 7.5-month-oldWfs1Δexon8mice display signs of abnormal myelination and a reduced number of oligodendrocyte precursor cells (OPCs) as well as abnormal axonal conduction in the optic nerve. An MRI study of the brain furthermore revealed grey and white matter loss in the cerebellum, brainstem, and superior colliculus, as is seen in WS patients. To further dissect the role of oligodendroglia in WS, we performed a transcriptomics study of WS patient iPSC-derived OPCs and pre-myelinating oligodendrocytes. Transcriptional changes compared to isogenic control cells were found for genes with a role in ER function. However, a deep phenotyping study of these WS patient iPSC-derived oligodendroglia unveiled normal differentiation, mitochondria-associated endoplasmic reticulum (ER) membrane interactions and mitochondrial function, and no overt signs of ER stress. Overall, the current study indicates that oligodendroglia functions are largely preserved in the WS mouse and patient iPSC-derived models used in this study. These findings do not support a major defect in oligodendroglia function as the primary cause of WS, and warrant further investigation of neurons and neuron-oligodendroglia interactions as a target for future neuroprotective or -restorative treatments for WS.
Heterogeneous Cardiac- and Neural Crest-Derived Aortic Smooth Muscle Cells have Similar Transcriptional Changes after TGFβ Signaling Disruption
Authors: Ren Pengwei , Jiang Bo , Hassab Abdulrahman , Li Guangxin , Li Wei , Assi Roland , Tellides George 
Published: May 2024

AbstractSmooth muscle cells (SMCs) of cardiac and neural crest origin contribute to the developing proximal aorta and are linked to disease propensity in adults. We analyzed single-cell transcriptomes of SMCs from mature thoracic aortas in mice to determine basal states and changes after disrupting transforming growth factor-β (TGFβ) signaling necessary for aortic homeostasis. A minority of Myh11 lineage-marked SMCs differentially expressed genes suggestive of embryological origin. Additional analyses in Nkx2-5 and Wnt1 lineage-marked SMCs derived from cardiac and neural crest progenitors, respectively, showed both lineages contributed to a major common cluster and each lineage to a minor distinct cluster. Common cluster SMCs extended from root to arch, cardiac subset cluster SMCs from root to mid-ascending, while neural crest subset cluster SMCs were restricted to the arch. The neural crest subset cluster had greater expression of a subgroup of TGFβ-dependent genes suggesting specific responsiveness or skewed extracellular matrix synthesis. Nonetheless, deletion of TGFβ receptors in SMCs resulted in similar transcriptional changes among all clusters, primarily decreased extracellular matrix molecules and modulators of TGFβ signaling. Many embryological markers of murine aortic SMCs were not confirmed in adult human aortas. We conclude: (i) there are multiple subtypes of cardiac- and neural crest-derived SMCs with shared or distinctive transcriptional profiles, (ii) neural crest subset SMCs with increased expression of certain TGFβ-inducible genes are not spatially linked to the aortic root predisposed to aneurysms from aberrant TGFβ signaling, and (iii) loss of TGFβ responses after receptor deletion is uniform among SMCs of different embryological origins.
Paraventricular Thalamus Neuronal Ensembles Encode Early-life Adversity and Mediate the Consequent Sex-dependent Disruptions of Adult Reward Behaviors
Authors: Kooiker Cassandra L. , Birnie Matthew T. , Floriou-Servou Amalia , Ding Qinxin , Thiagarajan Neeraj , Hardy Mason , Baram Tallie Z. 
Published: May 2024

AbstractEarly-life adversity increases risk for mental illnesses including depression and substance use disorders, disorders characterized by dysregulated reward behaviors. However, the mechanisms by which transient ELA enduringly impacts reward circuitries are not well understood. In mice, ELA leads to anhedonia-like behaviors in males and augmented motivation for palatable food and sex-reward cues in females. Here, the use of genetic tagging demonstrated robust, preferential, and sex-specific activation of the paraventricular nucleus of the thalamus (PVT) during ELA and a potentiated reactivation of these PVT neurons during a reward task in adult ELA mice. Chemogenetic manipulation of specific ensembles of PVT neurons engaged during ELA identified a role for the posterior PVT in ELA-induced aberrantly augmented reward behaviors in females. In contrast, anterior PVT neurons activated during ELA were required for the anhedonia-like behaviors in males. Thus, the PVT encodes adverse experiences early-in life, prior to the emergence of the hippocampal memory system, and contributes critically to the lasting, sex-modulated impacts of ELA on reward behaviors.