bluuebunny/crossref_metadata_2025_split huggingface dataset:
Accessing peripartum care in an internal medicine clinic: Barriers, interventions, and racial disparities
Authors: Malani Kanika , Arbaugh Sarah , Bilodeau Courtney 
Published: May 2024

Objective This study evaluates obstacles peripartum patients with additional medical needs face and services that would be helpful in obtaining this care. Study Design A survey was administered to 226 patients at a clinic specializing in internal medicine care for peripartum patients. Data was analyzed through descriptive statistics and linear regression. Results The three most reported barriers that interfered with attending medical appointments included the inability to leave work (41%), being too busy (33%), and lack of childcare (29%). Hispanic and Black patients reported more barriers to care as compared to White patients. The three most reported interventions that would be helpful in attending appointments were more virtual appointment options (38%), increased insurance coverage (31%), and provision of childcare (30%). Interventions were widely rated as helpful regardless of barriers faced and race reported. Conclusions Targeted interventions are needed to enhance access to peripartum care, especially for patients from marginalized racial and ethnic populations.
Atropine sulfate as a continuous intravenous infusion for the treatment of organophosphate toxicity in a cat
Authors: Baker Edward , Southern Carl , Martinez Jennifer 
Published: May 2024

Case summary A 1-year-old male neutered domestic shorthair cat presented on an emergency basis with clinical signs suspected to be secondary to organophosphate (OP) toxicity. The control of clinical abnormalities (bradycardia, obtundation, tachypnea, anorexia) was achieved using high-dose continuous rate intravenous infusion (CRI) of atropine sulfate (maximum rate 0.1 mg/kg/h). After 5 days of hospitalization, the patient made a full clinical recovery without the development of atropine toxicity, intermediate syndrome or delayed polyneuropathy at 4 weeks after discharge. Relevance and novel information Treatment of OP toxicity in cats is sparsely reported in veterinary literature. Current standards of treatment and published protocols recommend the use of atropine sulfate as intermittent boluses for the treatment of muscarinic signs of toxicity; however, there is a paucity of information regarding the safety and efficacy of atropine sulfate as a CRI for severe toxicosis as described in humans. This report includes the first published case using such a treatment protocol in a cat.
UK homecare providers’ views about, and experiences of, digitalisation: A national survey
Authors: Healey Jan , Davey Vanessa , Liddle Jennifer , O’Rourke Gareth , Hanratty Barbara , Beresford Bryony 
Published: May 2024

Objective Using digital systems to support the management and delivery of social care is a priority for UK governments. This study explored progress towards, and experiences of, digitalisation in the homecare sector and providers’ views on contributing client data to a national policy/research dataset. Methods Over 150 UK homecare providers completed an on-line survey (October–December 2022). The survey was hosted on Qualtrics and comprised fixed- and free-text response questions. The recruited sample aligned with the profile of UK homecare providers in terms of use of digital systems, organisation type and size. Results Almost all respondents (95.5%) were using digital systems, in part or exclusively, to support care delivery. However, many (42.7%) reported a desire to further digitalise or a dissatisfaction with existing systems. Findings highlight the time and work involved in choosing a a software system, with the decision regarded as relatively high risk. Over 50 different software systems were being used across the sample. Most respondents (72.5%) supported the creation of a national dataset on homecare users. However, support and recompense are likely to needed to secure buy-in from what is a predominantly private sector context. Conclusions Findings suggest a complex and changing situation, with numerous different digital systems being used and the sector at different stages of digitalisation. The high-pressure, low margin context of UK homecare appeared to be exerting an influence on progress towards digitalisation. Evaluations of government strategies to stimulate and support digitalisation in this diverse and predominantly private sector context will be valuable.
Experiences of Residents and Fellows at Mayo Clinic After the Rapid Implementation of Telemedicine During the COVID-19 Pandemic
Authors: Clapp Adrianna D.M. , Punj Mantavya , Farford Bryan , TerKonda Sarvam P. , Presutti R. John , Hattery Wendy M. , Leak Michelle A. , Austin Matthew K. , Keith Joshua J. 
Published: May 2024

OBJECTIVE The COVID-19 pandemic led to many changes across medical organizations and graduate medical education programs nationwide including the rapid implementation of telemedicine as a modality for delivering health care. The purpose of this study was to investigate the telemedicine experiences of residents and fellows with their self-reported level of preparedness, impact on their education including precepting, skill development, and patient-physician relationships, and perceptions of telehealth platforms and curricula in the future. METHODS A total of 365 Mayo Clinic residents and fellows across three sites (Florida, Arizona, and Minnesota) were identified as trainees who conducted at least one telemedicine encounter from January 1, 2020 to June 30, 2020 and were sent an electronic survey by e-mail. RESULTS There was a total of 103 completed surveys across various specialties with 58.3% female respondents, 63.1% residents, 35.0% fellows and 77.7% of respondents who attended medical school in the United States. Most trainees reported having very little to no exposure to telemedicine in their medical careers before the pandemic. The majority were satisfied with their first telemedicine encounter and found precepting comparable to in-person visits. The trainees in this study had a favorable view with 98.1% believing telemedicine will play a more prevalent role in the future and most agreed this should be included in medical school and residency training. CONCLUSION Our survey found that after the implementation of telemedicine during the COVID-19 pandemic, the experiences of trainees at a multi-site academic center were overall positive. More research is needed on the perceptions of skill development (physical exam and history taking) during a telemedicine encounter and outlining an optimal telemedicine curriculum that can improve confidence in trainees.
Artificial intelligence to predict individualized outcome of acute ischemic stroke patients: The SIBILLA project
Authors: Caliandro Pietro , Lenkowicz Jacopo , Reale Giuseppe , Scaringi Simone , Zauli Aurelia , Uccheddu Christian , Fabiole-Nicoletto Simone , Patarnello Stefano , Damiani Andrea , Tagliaferri Luca , Valente Iacopo , Moci Marco , Monforte Mauro , Valentini Vincenzo , Calabresi Paolo 
Published: May 2024

Introduction: Formulating reliable prognosis for ischemic stroke patients remains a challenging task. We aimed to develop an artificial intelligence model able to formulate in the first 24 h after stroke an individualized prognosis in terms of NIHSS. Patients and methods: Seven hundred ninety four acute ischemic stroke patients were divided into a training (597) and testing (197) cohort. Clinical and instrumental data were collected in the first 24 h. We evaluated the performance of four machine-learning models (Random Forest, K-Nearest Neighbors, Support Vector Machine, XGBoost) in predicting NIHSS at discharge both in terms of variation between discharge and admission (regressor approach) and in terms of severity class namely NIHSS 0–5, 6–10, 11–20, >20 (classifier approach). We used Shapley Additive exPlanations values to weight features impact on predictions. Results: XGBoost emerged as the best performing model. The classifier and regressor approaches perform similarly in terms of accuracy (80% vs 75%) and f1-score (79% vs 77%) respectively. However, the regressor has higher precision (85% vs 68%) in predicting prognosis of very severe stroke patients (NIHSS > 20). NIHSS at admission and 24 hours, GCS at 24 hours, heart rate, acute ischemic lesion on CT-scan and TICI score were the most impacting features on the prediction. Discussion: Our approach, which employs an artificial intelligence based-tool, inherently able to continuously learn and improve its performance, could improve care pathway and support stroke physicians in the communication with patients and caregivers. Conclusion: XGBoost reliably predicts individualized outcome in terms of NIHSS at discharge in the first 24 hours after stroke.
Multimorbidity and acute infectious diseases in urban and semi-urban settings in Peru: A mixed-methods study
Authors: Anza-Ramirez Cecilia , Najarro Lizzete , Bernabé-Ortiz Antonio , Diez-Canseco Francisco , Fottrell Edward , Abubakar Ibrahim , Hernández-Vásquez Akram , Carrillo-Larco Rodrigo M. , Hurst John R. , Miranda Juan Jaime 
Published: May 2024

Background The co-occurrence of chronic diseases and acute infectious events exacerbates disability and diminishes quality of life, yet research in Low- and Middle-Income countries is scarce. We aimed to investigate the relationship between infectious events and multimorbidity in resource-constrained settings. Methods We conducted a sequential mixed-method study in Lima and Tumbes, Peru, with participants having multimorbidity from the CRONICAS Cohort Study. They completed a questionnaire on the occurrence, treatment, and health-seeking behaviour related to acute infectious events. Qualitative interviews explored the perceptions and links between multimorbidity and acute infectious events for a subgroup of participants. Findings Among individuals with multimorbidity, low awareness of chronic conditions and poor medication adherence. The cumulative incidence for respiratory and gastrointestinal infections, the most reported acute conditions, was 2.0 [95%CI: 1.8–2.2] and 1.6 [1.2–1.9] events per person per year, respectively. Individuals with cancer (6.4 [1.6–11.2] events per person per year) or gastrointestinal reflux (7.2 [4.4–10.1] events per person per year) reported higher cumulative incidence of infectious events than others, such as those with cardiovascular and metabolic conditions (5.2 [4.6–5.8] events per person per year). Those with three or more chronic conditions had a slightly higher cumulative incidence compared with individuals with two conditions (5.7 [4.4–7.0] vs 5.0 [4.4–5.6] events per person per year). Around 40% of individuals with multimorbidity sought healthcare assistance, while others chose drugstores or didn't seek help. Our qualitative analysis showed diverse perceptions among participants regarding the connections between chronic and acute conditions. Those who recognized a connection emphasized the challenges in managing these interactions. Interpretation Our study advances understanding of multimorbidity challenges in resource-limited settings, highlighting the impact of acute infections on patients' existing multimorbidity burden.
To mask or not to mask: The role of concealment behavior, stigma experience, and community connectedness in autistic people's mental health
Authors: Khudiakova Valeria , Le Forestier Joel M. , Chasteen Alison L. 
Published: May 2024

Psychological theory and results from previous empirical studies paradoxically suggest that concealing and revealing one's autism can each result in reduced mental well-being. On one hand, autistic people who reveal their autistic identity experience considerable anti-autism stigma, which can lead to worse mental health outcomes compared to autistic people who conceal their autistic identity. On the other hand, autistic people who conceal their autistic identity are not afforded the benefits of autistic community connectedness, potentially undermining mental health outcomes compared to autistic people who reveal their autistic identity. The present study explores the relationships between autism concealment behaviors, autistic community connectedness, stigma experience, and mental well-being in autistic people. In an analytic sample of 409 autistic people, we found that concealing one's autistic identity was related to worse depressive symptoms, and that this relationship was related to experiencing greater stigma, and not to differences in community connectedness. These findings reinforce the need for combatting stigma against autistic people. Lay Abstract Many autistic people try to hide their autistic traits or appear more in line with typical social norms through changing their behavior, even when it is uncomfortable, which is known as camouflaging. Previous studies have shown that autistic people often attribute mental health difficulties, such as anxiety and depression, to concealing their autism through camouflaging. In part, this might be because concealing one's autism is related the loss of a sense of community with other autistic people, which is a protective factor for autistic people's mental health. However, allowing one's autistic identity to be public by forgoing camouflaging can make autistic people more likely to face judgement, stigmatization, and unfair treatment due to society's negative view of autism, which can also lead to poor mental health. Autistic people may thus be in a double bind between engaging in camouflaging but possibly experiencing related mental health difficulties and camouflaging less but encountering more stigmatization. In this study, we explored what contributes to this seemingly contradictory relationship between autism concealment and depressive symptoms. We collected data from 409 autistic people in an online survey. The results showed that participants who concealed their autism more were more likely to show depressive symptoms. This increase in depression symptoms was explained by experiencing stigma rather than feeling connected to the autistic community. These findings suggest negative effects of camouflaging and stigma on autistic people's mental health and support the call for increased autism acceptance.
Unmet healthcare needs in Southeastern Europe: a systematic review
Authors: Maslyankov Ivan 
Published: May 2024

Objectives: This study sought to systematically review the existing literature on self-reported unmet healthcare needs in Southeastern Europe. Methods: A systematic literature review of quantitative evidence in English and Bulgarian was performed in July 2023 using the following databases: Medline, Embase and EconLit. Publications were only included if they used self-reported unmet healthcare needs as an indicator of access to healthcare, concerned people living in Albania, Bosnia and Herzegovina, Bulgaria, Greece, Kosovo, Montenegro, Serbia, North Macedonia or Romania and if they were published after 2003. Quality assessment of the included publications was performed using the Appraisal tool for Cross-Sectional Studies (AXIS) tool. Results: Twenty-three publications of varying quality were included in the review. Significantly more evidence was available for Greece, Bulgaria and Romania than for the rest of the region. Data collected through Pan-European surveys were commonly used, but almost half of the studies were only descriptive. Generally, the prevalence of unmet healthcare needs has decreased over the years. Unmet healthcare needs were higher among people of lower socioeconomic and educational status, ethnic minorities and migrants and high cost was consistently identified as the primary barrier to accessing healthcare. Conclusion: Unmet healthcare needs are more prevalent among already disadvantaged societal groups. A trend of a declining prevalence of unmet needs has been observed, but it is more notable in the more socioeconomically developed countries. Improving financial protection should be a priority for the healthcare systems.
Static Ultrasonographic Assessment for Central Venous Catheterization Reduces Catheter Dysfunction in the Emergency Department
Authors: Çebişli Ali , Dişel Nezihat Rana , Taşkın Ömer , Açıkalın Akpınar Ayça , Sebe Ahmet 
Published: May 2024

Objective: This study aimed to investigate the effect of a static ultrasonographic (US) examination of the central venous structures before central venous catheterization (CVC) and the success of the procedure. Materials and Methods: In this prospective study, patients who underwent CVC, in an emergency department (ED), were divided into two groups: patients who underwent CVC using the anatomical landmark technique (n = 34) and patients who underwent CVC using a static US examination (n = 33). The procedure times, success rates, and number of catheters used were compared. Results: A total of 67 patients who underwent CVC were included in the study. Compared with the anatomical landmark technique, the static US examination had a higher procedural success rate ( P = .001), fewer total interventions ( P = .001), and fewer postprocedural catheter dysfunctions ( P = .048). While there was no difference in the duration of the CVC between groups ( P = .222), the total time spent was longer using a static US examination ( P = .022). Conclusion: The static US examination was a practical, easy-to-apply method that could be used for CVC placement in an ED. This study demonstrated sonography had a high success rate in CVC procedures and contributed to a reduction in the number of interventions and catheters used.
Acalabrutinib plus venetoclax and rituximab in treatment-naive mantle cell lymphoma: 2-year safety and efficacy analysis
Authors: Wang Michael , Robak Tadeusz , Maddocks Kami J. , Phillips Tycel , Smith Stephen D. , Gallinson David , Calvo Roser , Wun Chuan-Chuan , Munugalavadla Veerendra , Jurczak Wojciech 
Published: May 2024

Abstract
This phase 1b study evaluated safety and efficacy of acalabrutinib, venetoclax, and rituximab (AVR) in treatment-naive mantle cell lymphoma (TN MCL). Patients received acalabrutinib from cycle 1 until progressive disease (PD) or undue toxicity, rituximab for 6 cycles with maintenance every other cycle through cycle 24 or until PD, and venetoclax, beginning at cycle 2, for 24 cycles. Twenty-one patients were enrolled; 95.2% completed induction (6 AVR cycles) and 47.6% continued acalabrutinib maintenance. Thirteen (61.9%) patients had grade 3-4 adverse events (AEs), most commonly neutropenia (33.3%). Seven (33.3%) patients had COVID-19 infection (6 [28.6%] serious AEs and 5 [23.8%] deaths, all among unvaccinated patients). There was no grade ≥3 atrial fibrillation, ventricular tachyarrhythmias, major hemorrhages, or tumor lysis syndrome. Overall response rate (ORR) was 100% (95% CI, 83.9-100.0) with 71.4% complete response. With median follow-up of 27.8 months, median progression-free survival (PFS) and overall survival (OS) were not reached. PFS rates at 1 and 2 years were 90.5% (95% CI, 67.0-97.5) and 63.2% (95% CI, 34.7-82.0), respectively; both were 95% after censoring COVID-19 deaths. OS rates at 1 and 2 years were 95.2% (95% CI, 70.7-99.3) and 75.2% (95% CI, 50.3-88.9), respectively; both were 100% after censoring COVID-19 deaths. Overall, 87.5% of patients with available minimal residual disease (MRD) data achieved MRD negativity (10–6; next-generation sequencing) during treatment. AVR represents a chemotherapy-free regimen for TN MCL and resulted in high ORR and high rates of MRD negativity. The trial was registered at www.ClinicalTrials.gov as #NCT02717624.
Early serum biomarkers to characterise different phenotypes of primary graft dysfunction after lung transplantation: a systematic scoping review
Authors: Scaravilli Vittorio , Turconi Gloria , Colombo Sebastiano Maria , Guzzardella Amedeo , Bosone Marco , Zanella Alberto , Bos Lieuwe , Grasselli Giacomo 
Published: May 2024

BackgroundLung transplantation (LUTX) is often complicated by primary graft dysfunction (PGD). Plasma biomarkers hold potential for PGD phenotyping and targeted therapy. This scoping review aims to collect the available literature in search of serum biomarkers for PGD phenotyping.MethodsFollowing JBI and PRISMA guidelines, we conducted a systematic review searching MEDLINE, Web of Science, EMBASE and The Cochrane Library for papers reporting the association between serum biomarkers measured within 72 h of reperfusion and PGD, following International Society for Heart and Lung Transplantation (ISHLT) guidelines. We extracted study details, patient demographics, PGD definition and timing, biomarker concentration, and their performance in identifying PGD cases.ResultsAmong the 1050 papers screened, 25 prospective observational studies were included, with only nine conducted in the last decade. These papers included 1793 unique adult patients (1195 double LUTX, median study size 100 (IQR 44–119)). Most (n=21) compared PGD grade 3 to less severe PGD, but only four adhered to 2016 PGD definitions. Enzyme-linked immunosorbent assays and the multiplex bead array technique were utilised in 23 and two papers, respectively. In total, 26 candidate biomarkers were identified, comprising 13 inflammatory, three endothelial activation, three epithelial injury, three cellular damage and two coagulation dysregulation markers. Only five biomarkers (sRAGE, ICAM-1, PAI-1, SP-D, FSTL-1) underwent area under the receiver operating characteristic curve analysis, yielding a median value of 0.58 (0.51–0.78) in 406 patients (276 double LUTX).ConclusionsSeveral biomarkers exhibit promise for future studies aimed at PGD phenotyping after LUTX. To uncover the significant existing knowledge gaps, further international prospective studies incorporating updated diagnostic criteria, modern platforms and advanced statistical approaches are essential.
Rescue of impaired blood-brain barrier in tuberous sclerosis complex patient derived neurovascular unit
Authors: Brown Jacquelyn A. , Faley Shannon L. , Judge Monika , Ward Patricia , Ihrie Rebecca A. , Carson Robert , Armstrong Laura , Sahin Mustafa , Wikswo John P. , Ess Kevin C. , Neely M. Diana 
Published: May 2024

Abstract
Background
Tuberous sclerosis complex (TSC) is a multi-system genetic disease that causes benign tumors in the brain and other vital organs. The most debilitating symptoms result from involvement of the central nervous system and lead to a multitude of severe symptoms including seizures, intellectual disability, autism, and behavioral problems. TSC is caused by heterozygous mutations of either the TSC1 or TSC2 gene and dysregulation of mTOR kinase with its multifaceted downstream signaling alterations is central to disease pathogenesis. Although the neurological sequelae of the disease are well established, little is known about how these mutations might affect cellular components and the function of the blood–brain barrier (BBB).

Methods
We generated TSC disease-specific cell models of the BBB by leveraging human induced pluripotent stem cell and microfluidic cell culture technologies.

Results
Using microphysiological systems, we demonstrate that a BBB generated from TSC2 heterozygous mutant cells shows increased permeability. This can be rescued by wild type astrocytes or by treatment with rapamycin, an mTOR kinase inhibitor.

Conclusion
Our results demonstrate the utility of microphysiological systems to study human neurological disorders and advance our knowledge of cell lineages contributing to TSC pathogenesis and informs future therapeutics.