bluuebunny/crossref_metadata_2025_split huggingface dataset:
Randomized Controlled Trial of Telementoring During Resource-Limited Patient Care Simulation Improves Caregiver Performance and Patient Survival
Authors: Pamplin Jeremy C. , Veazey Sena R. , Barczak Stacie , Fonda Stephanie J. , Serio-Melvin Maria L. , Ross Kevin S. , Colombo Christopher J. 
Published: May 2024

OBJECTIVES:
To determine the impact of telementoring on caregiver performance during a high-fidelity medical simulation model (HFMSM) of a critically ill patient in a resource-limited setting.

DESIGN:
A two-center, randomized, controlled study using a HFMSM of a patient with community-acquired pneumonia complicated by acute respiratory distress syndrome.

SETTING:
A notional clinic in a remote location staffed by a single clinician and nonmedical assistant.

PARTICIPANTS:
Clinicians with limited experience managing critically ill patients.

INTERVENTIONS:
Telemedicine (TM) support.

MEASUREMENTS:
The primary outcome was clinical performance as measured by accuracy, reliability, and efficiency of care. Secondary outcomes were patient survival, procedural quality, subjective assessment of the HFMSM, and perceived workload.

MAIN RESULTS:
TM participants (N = 11) performed better than non-TM (NTM, N = 12) in providing expected care (accuracy), delivering care more consistently (reliability), and without consistent differences in efficiency (timeliness of care). Accuracy: TM completed 91% and NTM 42% of expected tasks and procedures. Efficiency: groups did not differ in the mean (± sd) minutes it took to obtain an advanced airway successfully (TM 15.2 ± 10.5 vs. NTM 22.8 ± 8.4, p = 0.10) or decompress a tension pneumothorax with a needle (TM 0.7 ± 0.5 vs. NTM 0.6 ± 0.9, p = 0.65). TM was slower than NTM in completing thoracostomy (22.3 ± 10.2 vs. 12.3 ± 4.8, p = 0.03). Reliability: TM performed 13 of 17 (76%) tasks with more consistent timing than NTM. TM completed 68% and NTM 29% of procedural quality metrics. Eighty-two percent of the TM participants versus 17% of the NTM participants simulated patients survived (p = 0.003). The groups similarly perceived the HFMSM as realistic, managed their patients with personal ownership, and experienced comparable workload and stress.

CONCLUSIONS:
Remote expertise provided with TM to caregivers in resource-limited settings improves caregiver performance, quality of care, and potentially real patient survival. HFMSM can be used to study interventions in ways not possible with real patients.
Effect of Carbamazepine on Darunavir Trough Concentrations: When the Dose Can Make the Difference—A Case Study
Authors: Cattaneo Dario , Caloni Beatrice , Caronni Stefania , Calvagna Nunziata , Bonini Igor , Giacomelli Andrea , Gervasoni Cristina 
Published: May 2024

Background:
Carbamazepine (CBZ) is an antiseizure medication known to induce the expression of cytochrome P4503A metabolic enzymes. Here, we describe a man living with HIV who underwent several changes in the daily dose of CBZ, which resulted in different induction effects on darunavir trough concentrations.

Methods:
A 59-year-old man with HIV, successfully undergoing maintenance antiretroviral treatment with darunavir/cobicistat once daily (combined with raltegravir), was prescribed CBZ for recurrent trigeminal neuralgia. Over subsequent months, the patient underwent various changes in the doses (from 200 to 800 mg/d) and trough concentrations (from 3.6 to 18.0 mg/L) of CBZ, guided by clinical response to trigeminal neuralgia.

Results:
A highly significant inverse association was observed between darunavir trough concentration and both CBZ dose or trough concentration (coefficient of determination >0.75, P < 0.0001). Ultimately, the darunavir dose was increased to 600 mg twice daily with ritonavir and dolutegravir to ensure optimal antiretroviral coverage, anticipating potential further uptitration of CBZ doses.

Conclusions:
The impact of CBZ on boosted darunavir exposure seemed to be dose- and concentration-dependent. The management of such drug–drug interactions in daily practice was facilitated through therapeutic drug monitoring. This case underscores the importance of a multidisciplinary approach that incorporates both antiretroviral and nonantiretroviral comedications contributing to the optimal management of polypharmacy in individuals living with HIV.
Effects of Plasmapheresis on Serum Lithium Levels in an ICU Patient with Bipolar Disorder: A Case Study
Authors: Lien Thuy N. T. , Mohamed Sherin M. M. , van den Bogaard Bas , Touw Daan J. , Franssen Eric J. F. 
Published: May 2024

Abstract:
This is a case description of a patient with bipolar disorder undergoing lithium therapy who received plasmapheresis for neuromyelitis optica spectrum disorder. Plasmapheresis resulted in lower and subtherapeutic serum lithium levels. Using therapeutic drug monitoring, a dose escalation of 80% was necessary to maintain therapeutic serum lithium levels. This underscores the importance of individualized therapy through therapeutic drug monitoring.
Lessons From the Global SARS-CoV-2 Health Emergency for Potential Future Pandemics
Authors: Abrescia Nicola , D'Abbraccio Maurizio , De Marco Mario , Maddaloni Adelaide 
Published: May 2024

Abstract
The emergence of novel infectious agents with pandemic potential remains a critical global concern, as underscored by the COVID-19 pandemic. This study investigates the various factors contributing to the risk of new pandemics and proposes a framework for pandemic prevention and mitigation.
We review the characteristics of several infectious agents, including influenza viruses, coronaviruses, filoviruses, paramyxoviruses, Lassa fever virus, Crimean-Congo hemorrhagic fever virus, and the yellow fever virus. These agents are discussed in terms of their transmission modes, reservoirs, potential for human-to-human spread, and historical outbreaks. We emphasize the importance of monitoring and early detection of these agents, especially those with localized outbreaks and zoonotic potential.
Our analysis highlights the role of human activities in pandemic risk. Factors such as overuse of antibiotics, environmental changes (deforestation, wildlife habitat encroachment), climate change effects on disease vectors, and increasing global connectivity are examined as drivers of disease emergence.
Furthermore, we propose a foursome of critical actions for pandemic prevention and response: early detection and rapid containment; restricting the transmission by social distancing, masking, quarantine, and elimination of vector, which are crucial even before the vaccine is available; global vaccine and treatment distribution; and robust health policy implementation. We emphasize the importance of international collaboration, information sharing, and preparedness to effectively combat pandemics.
In conclusion, this commentary provides a comprehensive overview of infectious agents with pandemic potential and their associated risks. It calls for proactive measures to prevent and mitigate future pandemics, emphasizing the need for a global strategy that combines early detection, rapid response, and sustained public health infrastructure.
Impact of advanced image-guided systems on correction of corneal astigmatism during FLACS
Authors: Yalamanchili Siri P. , Cleary Sean M. , Sell Shawn S. , Feustel Paul J. , Schultze Robert L. 
Published: May 2024

Purpose:
To determine the effectiveness of the correction of corneal astigmatism using the Alcon Image Guidance (IG) system vs manual marking in the orientation of femtosecond laser–assisted cataract surgery (FLACS).

Setting:
Private practice, Albany, New York.

Design:
Retrospective review.

Methods:
Patients who underwent FLACS with IG and without IG were from January 2018 to June 2022 investigated. Variables including preoperative keratometry values, cylinder, spherical equivalent (SE), and visual acuity (VA) were collected, as well as the cyclorotation angle delta registered by IG, postoperative refractive cylinder, SE, and VA. The primary outcome was postoperative refractive cylinder in patients with IG compared with those without IG.

Results:
A total of 160 eyes were included, with 103 eyes that had IG and 57 eyes that did not have IG. Postoperative cylinder was similar in those with IG (0.31 ± 0.36 diopters [D]) compared with those without IG (0.31 ± 0.37 D) (P = .97). Average cyclorotation in the IG group was 2.82 ± 3.03 degrees. When cyclorotation was stratified into 3 groups (<2.8 degrees, 2.8 to 8.5 degrees, >8.5 degrees), no differences were found in postoperative refractive cylinder (P = .35).

Conclusions:
Patients who underwent FLACS with IG had similar postoperative cylinder outcomes compared with those without IG. This study suggests that the accommodation of cyclotorsion using an advanced IG system is similar to that obtained with manual marking techniques in patients having 2 D or less of astigmatism corrected.
Dosimetric Considerations for 177Lu-DOTATATE Therapy in a Patient With Chronic Renal Failure Under Hemodialysis
Authors: Chaib Sarah , Tylski Perrine , Lachachi Choaib , Keniza Tassadit , Levigoureux Elise 
Published: May 2024

Abstract
This case report explores the use of 177Lu-DOTATATE in a hemodialysis patient. For the first time, this study assesses the average dose received by the bone marrow, the primary organ at risk, using an original double estimation method through independently acquired imaging and biological samples counting data. Despite elevated doses, the absorbed doses to the bone marrow (0.662–0.740 Gy) were within safe limits. Radiation protection measurements for staff were also compliant. This work supports that effective early dialysis and systematic personalized dosimetry are crucial for hemodialysis patients undergoing 177Lu-PRRT due to their variability (residual excretion, treatment history, etc).
Increased PSMA-Targeted 18F-DCFPyL Uptake in Peripheral T-Cell Lymphoma
Authors: Milrod Charles J. , Brown Cory , Mega Anthony E. 
Published: May 2024

Abstract
Peripheral T-cell lymphomas are a heterogenous group of lymphomas with a high rate of extranodal disease. We present a case of increased 18F-DCFPyL uptake in peripheral T-cell lymphoma of subcutaneous tissue and bone. Familiarity with the increased 18F-DCFPyL uptake and extranodal presentation of peripheral T-cell lymphomas can avoid misinterpretation for metastatic disease.
PSMA-Avid Desmoid Tumor of the Abdominal Wall on 18F-Piflufolastat PET/CT
Authors: Bommekal Siddharth , Flynt Lesley , Tewari Sanjit Om , Surasi Devaki Shilpa Sudha 
Published: May 2024

Abstract
Prostate-specific membrane antigen (PSMA) PET/CT is widely used in the evaluation of suspected metastasis for initial definitive therapy and suspected recurrence of prostate cancer. We outline a case report of a 62-year-old man with history of prostate cancer treated with surgery, salvage radiation, and hormonal therapy presenting with rising PSA levels. There was incidental detection of a PSMA-avid subcutaneous abdominal wall mass on PSMA PET/CT study, which was consistent with desmoid fibromatosis on an ultrasound-guided biopsy.
Feeding Tube Clinic Effect on Nutrition
Authors: Choy Kevin , Abbitt Danielle , Moyer Amber , Moore John T. , Wikiel Krzysztof J. , Jones Teresa S. , Robinson Thomas N. , Jones Edward L. 
Published: May 2024

Background:Optimizing nutrition is essential for recovery after major surgery or severe illness. Feeding tubes (FT) can be placed in patients limited by oral enteral nutrition. Given the myriad of locations in which these procedures are performed (radiology, intensive care unit, and endoscopy suite), routine follow-up is challenging. The purpose of this study was to evaluate the impact of an FT clinic on nutrition. We hypothesized that enrollment in the FT clinic would result in improved nutritional outcomes.Methods:Retrospective review of Veteran Affairs Medical Center patients with FTs placed from January 2010 to January 2020. Demographics and body mass index (BMI) were recorded. Serum albumin recorded within 1 month of tube placement was compared to within 1 month of tube removal, death, or at the end of the study period. FT clinic participation required at least 2 visits. Indications for FT placement and duration were recorded. Patients were excluded when both BMI and albumin values were incomplete, and if FTs were placed for decompression.Results:Ninety-three patients underwent FT placement during the study period; 5 (5%) were excluded. The average age was 64.8±9.7 years, with the majority being male, 85 patients (97%). Eighteen (20%) patients were seen in the FT clinic (FTC) and 70 (80%) were managed outside of FTC (nFTC). There were no differences in age, gender, or indication for FT. Mean albumin increased 0.42±0.85 g/dL in the FTC group versus −0.07±0.72 g/dL in the nFTC group (P=0.037). The FTC group BMI increased, 0.38 kg/m2vs. −1.48 kg/m2in nFTC patients,P=0.041. The FTC patients maintained their tubes longer (36.5 vs. 7.0 mo,P=0.0014).Conclusions:Patients managed in a dedicated FT clinic experienced an improvement in their serum albumin values and increases in their BMI. In addition, they also maintained their FTs longer. To optimize nutrition and reduce weight loss, patients who require FTs should be enrolled in a dedicated FT clinic.
Prospective derivation and validation of a necrotizing soft tissue infections score: An EASTmulticenter trial
Authors: Kim Dennis Y. , lavasile Amanda , Kaji Amy H. , Nahmias Jeffry , Grigorian Areg , Mukherjee Kaushik , Penaloza Liz , Posluszny Joseph , Logan Charles D. , Michelin Erika , Serena Thomas , Sahr Sheryl , Bekdache Khaldoun , Stoddard Nathan , Choudhry Asad , Encalada Ronald Zerna , Saltzman Darin , Padilla Reynaldo , Truitt Michael , Grossman Verner Heather , Hunt Darren , Purvis Victoria , Ross Samuel Wade , Mallah Mike M. , Dultz Linda , Kuhlenschmidt Kali , Mentzer Caleb J. , Lonkar Adwait , Chang Grace , Lemon Brittney , de Virgilio Christian 
Published: May 2024

BACKGROUND
Although several risk indices have been developed to aid in the diagnosis of necrotizing soft tissue infections (NSTIs), these instruments suffer from varying levels of reproducibility and failure to incorporate key clinical variables in model development. The objective of this study was to derive and validate a clinical risk index score, NECROSIS, for identifying NSTIs in emergency general surgery (EGS) patients being evaluated for severe skin and soft tissue infections.

METHODS
We performed a prospective study across 16 sites in the United States of adult EGS patients with suspected NSTIs over a 30-month period. Variables analyzed included demographics, admission vitals and laboratories, physical examination, radiographic, and operative findings. The main outcome measure was the presence of NSTI diagnosed clinically at the time of surgery. Multivariate analysis was performed to identify independent predictors for the presence of NSTI using the Hosmer-Lemeshow test and the Akaike information criteria.

RESULTS
Of 362 patients, 297 (82%) were diagnosed with an NSTI. Overall mortality was 12.3%. Multivariate analysis identified three independent predictors for NSTI: systolic blood pressure of ≤120 mm Hg, violaceous skin, and white blood cell count of ≥15 × 103/μL. Multivariate modeling demonstrated Hosmer-Lemeshow goodness of fit (p = 0.9) with a c statistic for the prediction curve of 0.75. Test characteristics of the NECROSIS score were similar between the derivation and validation cohorts.

CONCLUSION
NECROSIS is a simple and potentially useful clinical index score for identifying at-risk EGS patients with NSTIs. Future validation studies are warranted.

LEVEL OF EVIDENCE
Diagnostic Tests or Criteria; Level III.
Predicting blood transfusion following traumatic injury using machine learning models: A systematic review and narrative synthesis
Authors: Oakley William , Tandle Sankalp , Perkins Zane , Marsden Max 
Published: May 2024

BACKGROUND
Hemorrhage is a leading cause of preventable death in trauma. Accurately predicting a patient's blood transfusion requirement is essential but can be difficult. Machine learning (ML) is a field of artificial intelligence that is emerging within medicine for accurate prediction modeling. This systematic review aimed to identify and evaluate all ML models that predict blood transfusion in trauma.

METHODS
This systematic review was registered on the International Prospective register of Systematic Reviews (CRD4202237110). MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were systematically searched. Publications reporting an ML model that predicted blood transfusion in injured adult patients were included. Data extraction and risk of bias assessment were performed using validated frameworks. Data were synthesized narratively because of significant heterogeneity.

RESULTS
Twenty-five ML models for blood transfusion prediction in trauma were identified. Models incorporated diverse predictors and varied ML methodologies. Predictive performance was variable, but eight models achieved excellent discrimination (area under the receiver operating characteristic curve, >0.9) and nine models achieved good discrimination (area under the receiver operating characteristic curve, >0.8) in internal validation. Only two models reported measures of calibration. Four models have been externally validated in prospective cohorts: the Bleeding Risk Index, Compensatory Reserve Index, the Marsden model, and the Mina model. All studies were considered at high risk of bias often because of retrospective data sets, small sample size, and lack of external validation.

DISCUSSION
This review identified 25 ML models developed to predict blood transfusion requirement after injury. Seventeen ML models demonstrated good to excellent performance in silico, but only four models were externally validated. To date, ML models demonstrate the potential for early and individualized blood transfusion prediction, but further research is critically required to narrow the gap between ML model development and clinical application.

LEVEL OF EVIDENCE
Systematic Review Without Meta-analysis; Level IV.
Energy partitioning in the cell cortex
Authors: Chen Sheng , Seara Daniel S. , Michaud Ani , Kim Songeun , Bement William M. , Murrell Michael P. 
Published: May 2024

AbstractLiving systems are driven far from thermodynamic equilibrium through the continuous consumption of ambient energy1. In the cell cortex, this energy is invested in the formation of diverse patterns in chemical and mechanical activities, whose unique spatial and temporal dynamics determine cell phenotypes and behaviors2-6. However, how cells partition internal energy between chemical and mechanical work is unknown7-9. Here we measured the entropy production rate (EPR) of both the chemical and mechanical subsystems of the cell cortex across a broad range of periodic patterns as the system is driven further from equilibrium via manipulation of the Rho GTPase pathway, which controls cortical actin filaments (F-actin) and myosin-II. We find that at lower levels of Rho GAP (GTPase activating protein) expression, which produce pulses or “choppy” Rho and F-actin waves, energy is comparably partitioned between the chemical and mechanical subsystems and is subject to the constraint of Onsager reciprocity. Within the range of reciprocity, the EPR is maximized in choppy waves that resemble the waves associated with cell division3,10. However, as the cortex is driven even further from equilibrium into elaborate labyrinthine or spiral traveling wave trains via increased GAP expression, reciprocity is broken, marking an increasingly differential partitioning of energy and an uncoupling of chemical and mechanical activities. We further demonstrate that energy partitioning and reciprocity are determined by the competition between the timescales of chemical reaction and mechanical relaxation. These results indicate that even within coupled cellular subsystems, both the relative proportions of energy partitioned to each subsystem and the ultimate phenotypic outcome vary dramatically as a function of the overall energy investment.
Validation of a guidelines-based digital tool to assess the need for germline cancer genetic testing
Authors: Russell Callan D. , Daley Ashley V. , Van Arnem Durand R. , Hila Andi V , Johnson Kiley J. , Davies Jill N. , Cytron Hanah S. , Ready Kaylene J. , Armstrong Cary M. , Sylvester Mark E. , Caleshu Colleen A. 
Published: May 2024

ABSTRACTPurposeEfficient and scalable solutions are needed to identify patients who qualify for germline cancer genetic testing. We evaluated the clinical validity of a brief, patient-administered hereditary cancer risk assessment digital tool programmed to assess if patients meet criteria for germline genetic testing, based on personal and family history, and in line with national guidelines.MethodsWe applied the tool to cases seen in a nationwide telehealth genetic counseling practice. Validity of the tool was evaluated by comparing the tool’s assessment to that of the genetic counselor who saw the patient. Patients’ histories were extracted from genetic counselor-collected pedigrees and input into the tool by the research team to model how a patient would complete the tool. We also validated the tool’s assessment of which specific aspects of the personal and family history met criteria for genetic testing.ResultsOf the 152 cases (80% ((121/152)) female, mean age 52.3), 56% (85/152) had a personal history of cancer and 66% (99/152) met genetic testing criteria. The tool and genetic counselor agreed in 96% (146/152) of cases. Most disagreements (4/6; 67%) occurred because the GC’s assessment relied on details the tool was not programmed to collect since patients typically don’t have access to the relevant information (pathology details, risk models). We also found complete agreement between the tool and research team on which specific aspects of the patient’s history met criteria for genetic testing.ConclusionWe observed a high level of agreement with genetic counselor assessments, affirming the tool’s clinical validity in identifying individuals for hereditary cancer predisposition testing and its potential for increasing access to hereditary cancer risk assessment.
Viral mimicry and memory deficits upon microglial deletion of ATRX
Authors: Shafiq S. , Ghahramani A. , Mansour K. , Pena-Ortiz M. , Sunstrum J.K. , Jiang Y. , Rowland M.E , Inoue W. , Bérubé N.G. 
Published: May 2024

AbstractThe importance of chromatin-mediated processes in neurodevelopmental and intellectual disability disorders is well recognised. However, how chromatin dysregulation in glial cells impacts cognitive abilities is less well understood. Here, we demonstrate that targeted loss of the ATRX chromatin remodeler in microglia alters chromatin accessibility profiles, leading to the de-repression of endogenous retroelements, triggering viral mimicry. Functionally, we find that ATRX microglial deficiency alters the electrophysiological properties of hippocampal neurons and causes deficits in object recognition and spatial memory. Overall, these findings demonstrate that ATRX is required in microglia to preserve chromatin structure and maintain microglial homeostasis. Disruption of these functions elicit neuroinflammation and cognitive deficits and potentially contribute to the pathology of human neurological disorders caused byATRXmutations.