bluuebunny/crossref_metadata_2025_split huggingface dataset:
You Cannot Function in “Overwhelm”: Helping Primary Care Navigate the Slow End of the Pandemic
Authors: Sullivan Erin E. , Etz Rebecca S. , Gonzalez Martha M. , Deubel Jordyn , Reves Sarah R. , Stange Kurt C. , Hughes Lauren S. , Linzer Mark 
Published: May 2024

SUMMARY

Goal:
This study was developed to explicate underlying organizational factors contributing to the deterioration of primary care clinicians’ mental health during the COVID-19 pandemic.

Methods:
Using data from the Larry A. Green Center for the Advancement of Primary Health Care for the Public Good’s national survey of primary care clinicians from March 2020 to March 2022, a multidisciplinary team analyzed more than 11,150 open-ended comments. Phase 1 of the analysis happened in real-time as surveys were returned, using deductive and inductive coding. Phase 2 used grounded theory to identify emergent themes. Qualitative findings were triangulated with the survey’s quantitative data.

Principal Findings:
The clinicians shifted from feelings of anxiety and uncertainty at the start of the pandemic to isolation, lack of fulfillment, moral injury, and plans to leave the profession. The frequency with which they spoke of depression, burnout, and moral injury was striking. The contributors to this distress included crushing workloads, worsening staff shortages, and insufficient reimbursement. Consequences, both felt and anticipated, included fatigue and demoralization from the inability to manage escalating workloads. Survey findings identified responses that could alleviate the mental health crisis, namely: (1) measuring and customizing workloads based on work capacity; (2) quantifying resources needed to return to sufficient staffing levels; (3) promoting state and federal support for sustainable practice infrastructures with less administrative burden; and (4) creating patient visits of different lengths to rebuild relationships and trust and facilitate more accurate diagnoses.

Practical Applications:
Attention to clinicians’ mental health should be rapidly directed to on-demand, confidential mental health support so they can receive the care they need and not worry about any stigma or loss of license for accepting that help. Interventions that address work–life balance, workload, and resources can improve care, support retention of the critically important primary care workforce, and attract more trainees to primary care careers.
Supportive Care Needs of Patients With Temporary Ostomy in Enhanced Recovery After Surgery: A Mixed-Methods Study
Authors: HU Jieman , ZHANG Xiuling , SUN Jianan , HU Haiyan , TANG Chulei , BA Lei , XU Qin 
Published: May 2024

ABSTRACT

Background
Enhanced recovery after surgery (ERAS), a global surgical quality improvement initiative, reduces the length of stay in the hospital. Temporary stoma care for rectal cancer is complex, and patients require prolonged care services to adjust to the stoma. The shorter stay durations in the new model challenge the conventional care pathways and create new patient needs.

Purpose
This study was designed to explore the supportive care needs of patients under the new surgical model to provide a reference for the design of ERAS nursing care plans.

Methods
A convergent parallel mixed-methods design was used in this study. Patients with temporary stomas for rectal cancer were recruited using a convenience sampling method in gastrointestinal surgery wards and wound & stoma clinics in two public tertiary care hospitals in China. Standardized questionnaires were administered to 140 patients to collect quantitative data, and semistructured interviews were conducted individually with 13 patients to collect qualitative data. The questionnaire data were analyzed using descriptive statistics, and the interview data were analyzed using thematic analysis.

Results
“Health system and information needs” and “care and support needs” were identified in both the qualitative and quantitative analyses as the most significant unmet needs of the participants. In addition, the qualitative analysis identified receiving focused stoma care instructions and easily understandable information as essential to fulfilling health system and information needs. Care and support needs included access to continued postdischarge services and attention from medical professionals.

Conclusion/Implications for Practice
The participants in this study experienced a variety of unmet supportive care needs under the ERAS protocol, with gaps particularly notable in two categories: “health system and information needs” and “care and support needs.” Increased perioperative care and shorter hospital stays under the ERAS protocol reduce opportunities for patients to receive targeted instruction and shift much of the ostomy education and care workload out of the hospital, requiring greater attention from clinical nurses to ensure quality of care.
Five Evidence-Based Strategies to Foster a Culture of Well-Being in Physician Assistant Education
Authors: Hoffmann Chelsey 
Published: May 2024

Introduction
The objective of this study was to discuss evidence-based strategies to promote a culture of well-being with physician assistant (PA) education.

Methods
Published literature on medical student, resident, and PA student well-being was reviewed with findings subsequently categorized according to well-being strategy.

Results
Five themes were found from existing well-being research within medical student and PA student education: faculty role modeling and support, dedicated curricular time, pass/fail grading schema and de-emphasizing grades, peer support and learning communities, and evaluation importance.

Discussion
Physician assistant educators may be able to foster a culture of well-being for their students by making even small adjustments to the existing educational curriculum.
The Impact of Piezoelectric Device in Cholesteatoma Endoscopic Surgery: Retrospective Evaluation of Safety and Functional Results
Authors: Marchioni Daniele , Ronzani Guglielmo , Gazzini Sandra , Fulco Gianfranco , Rubini Alessia 
Published: May 2024

Objective
Atticotomy represents an essential surgical step within the management of attical cholesteatoma during endoscopic ear surgery. The aim of the present study was to evaluate the safety and functional results of an endoscopic atticotomy performed with piezosurgery, in terms of audiological outcomes and tissue's healing.

Methods
This is an observational retrospective study on patients with attical cholesteatoma who underwent endoscopic ear surgery with piezoelectric atticotomy and subsequent scutum reconstruction either with tragal cartilage or temporalis muscle fascia. Scutumplasty's status was evaluated via scheduled outpatient controls through an endoscopic check and classified as stable or unstable at least 10 months after surgery. A pre- and postoperative audiometric examination was performed in each patient.

Results
Eighty-four patients were enrolled. In 50 out of 84 patients (59.52%), an exclusive endoscopic procedure was performed, whereas in 34 patients (40.48%) a combined microscopic/endoscopicapproach was adopted. In 72 cases (85.71%), scutum's reconstruction appeared to be normally positioned, whereas 12 patients developed a retraction pocket, which was self-cleaning in 8 of them and non–self-cleaning in the remaining 4. In 17 patients, a slight sensorineural hearing loss (between 5 and 15 dBHL) was observed, and in 2 patients, the loss was greater than 15 dBHL. Overall, no significative differences between pre- and postoperative pure-tone average bone thresholds resulted (p = 0.4983), though a mild significant hearing deterioration was detected by the specific analysis at 4000 Hz (p = 0.0291).

Conclusion
Piezosurgery represents an extremely useful tool in performing atticotomy during endoscopic tympanoplasties. Our data seem to support the safety of its usage in this specific step, as it did not lead to any significant sensorineural damage on overall pure-tone average. Moreover, satisfactory tissue healing in regard to scutum reconstruction was observed.
Stapedotomy Versus Cochlear Implantation for Far Advanced Otosclerosis: Insights From a Patient With Matched Preoperative and Postoperative Function
Authors: Khandalavala Karl R. , Dornhoffer Jim R. , Lane John I. , Carlson Matthew L. 
Published: May 2024

Objective
To examine patient preference after stapedotomy versus cochlear implantation in a unique case of a patient with symmetrical profound mixed hearing loss and similar postoperative speech perception improvement.

Patients
An adult patient with bilateral symmetrical far advanced otosclerosis, with profound mixed hearing loss.

Intervention
Stapedotomy in the left ear, cochlear implantation in the right ear.

Main Outcome Measure
Performance on behavioral audiometry, and subjective report of hearing and intervention preference.

Results
A patient successfully underwent left stapedotomy and subsequent cochlear implantation on the right side, per patient preference. Preoperative audiometric characteristics were similar between ears (pure-tone average [PTA] [R: 114; L: 113 dB]; word recognition score [WRS]: 22%). Postprocedural audiometry demonstrated significant improvement after stapedotomy (PTA: 59 dB, WRS: 75%) and from cochlear implant (PTA: 20 dB, WRS: 60%). The patient subjectively reported a preference for the cochlear implant ear despite having substantial gains from stapedotomy. A nuanced discussion highlighting potentially overlooked benefits of cochlear implants in far advanced otosclerosis is conducted.

Conclusion
In comparison with stapedotomy and hearing aids, cochlear implantation generally permits greater access to sound among patients with far advanced otosclerosis. Though the cochlear implant literature mainly focuses on speech perception outcomes, an underappreciated benefit of cochlear implantation is the high likelihood of achieving “normal” sound levels across the audiogram.
Long-Term Outcomes of a Percutaneous Wide-Diameter Bone-Anchored Hearing Implant: A Clinical Evaluation of More than 800 Implants
Authors: Teunissen Emma M. , Caspers Coosje J.I. , Vijverberg Maarten A. , Pennings Ronald J.E. , Mylanus Emmanuel A.M. , Hol Myrthe K.S. 
Published: May 2024

Objective
This study evaluates the clinical outcomes of 807 percutaneous wide-diameter bone-anchored hearing implants (BAHIs) in 701 patients. In addition, it compares patient groups and examines bone conduction device (BCD) usage.

Study design
Retrospective cohort study. Mean follow-up period of 3.8 years.

Setting
Tertiary referral center.

Patients
All patients implanted with a percutaneous wide-diameter BAHI until December 2020 were included. Patients were divided into age groups, “loading-time” groups, and, if applicable, specific subgroups thought to be at risk for complications postsurgery, e.g., intellectual disability and comorbidities.

Main outcome measures
Soft tissue reaction, implant survival, revision surgery, and BCD usage.

Results
In 9.1% of the 5,188 observations of 807 implants, an adverse soft tissue reaction was reported according to the Holgers’ scale. Significantly more (adverse) soft tissue reactions were observed in children and intellectually disabled (ID) patients (p < 0.05). Comorbidity subgroups showed no significant differences in soft tissue reactions. Implant loss percentage, including explantations, was 6.2%. Implant survival was significantly worse in patients with ID (14.1%; p = 0.021). Pediatric age, early loading, or comorbidities did not significantly influence implant survival. At least 592 implants (73.4%) were used for bone conduction hearing, of which 65.4% were used daily.

Conclusion
Both children and ID patients are more prone to (adverse) soft tissue reactions, ID patients only have a higher risk of implant loss. The rate of implant loss in children seemed to be reduced compared to previous studies and thus more comparable to adults since using wide-diameter implants.
Revisiting resistant hypertension in kidney disease
Authors: Bansal Shweta 
Published: May 2024

Purpose of review
As compared to controlled or uncontrolled hypertension, resistant hypertension in patients with chronic kidney disease (CKD) poses a significantly increased healthcare burden due to greater target end-organ damage including cardiovascular disease and CKD progression. Patients with CKD have two to three times higher risk of developing resistant hypertension. True resistant hypertension needs to be distinguished from apparent treatment resistant hypertension (aTRH); however, it is usually not possible in epidemiological studies. Moreover, impact of contemporary guidelines changes in the target blood pressure (BP) goal to less than 130/80 mmHg remains to be determined.

Recent findings
Up to half of patients with CKD meet aTRH criteria using 2017 ACC/AHA target BP less than 130/80 mmHg. Excess sodium retention in extracellular and tissue compartment remains the cornerstone cause of resistance to the treatment in CKD. Maximizing and optimizing the diuretic regimen in addition to dietary sodium restriction plays a critical role in these patients. Management requires a trustworthy provider-patient relationship facilitating identification and intervention for the barriers restricting the uptake of lifestyle modifications and medications. Recently, renal denervation has been approved and many other novel agents are on the horizon for treatment of true resistant hypertension associated with CKD.

Summary
This review discusses the latest in the pathophysiology, definition, identification and treatment strategies of resistant hypertension in individuals with CKD. Further investigations are required to identify the prevalence, future implication and treatment outcome data for true resistant hypertension associated with CKD.
Machine perfusion in liver transplantation: recent advances and coming challenges
Authors: Wehrle Chase J. , Jiao Chunbao , Sun Keyue , Zhang Mingyi , Fairchild Robert L. , Miller Charles , Hashimoto Koji , Schlegel Andrea 
Published: May 2024

Purpose of review
Machine perfusion has been adopted into clinical practice in Europe since the mid-2010s and, more recently, in the United States (US) following approval of normothermic machine perfusion (NMP). We aim to review recent advances, provide discussion of potential future directions, and summarize challenges currently facing the field.

Recent findings
Both NMP and hypothermic-oxygenated perfusion (HOPE) improve overall outcomes after liver transplantation versus traditional static cold storage (SCS) and offer improved logistical flexibility. HOPE offers additional protection to the biliary system stemming from its’ protection of mitochondria and lessening of ischemia-reperfusion injury. Normothermic regional perfusion (NRP) is touted to offer similar protective effects on the biliary system, though this has not been studied prospectively.
The most critical question remaining is the optimal use cases for each of the three techniques (NMP, HOPE, and NRP), particularly as HOPE and NRP become more available in the US. There are additional questions regarding the most effective criteria for viability assessment and the true economic impact of these techniques. Finally, with each technique purported to allow well tolerated use of riskier grafts, there is an urgent need to define terminology for graft risk, as baseline population differences make comparison of current data challenging.

Summary
Machine perfusion is now widely available in all western countries and has become an essential tool in liver transplantation. Identification of the ideal technique for each graft, optimization of viability assessment, cost-effectiveness analyses, and proper definition of graft risk are the next steps to maximizing the utility of these powerful tools.
High-Frequency Heart Rate Variability Is Prospectively Associated With Sleep Complaints in a Healthy Working Cohort
Authors: Cribbet Matthew R. , Thayer Julian F. , Jarczok Marc N. , Fischer Joachim E. 
Published: May 2024

Objective
Vagus nerve functioning, as indexed by high-frequency heart rate variability (HF-HRV), has been implicated in a wide range of mental and physical health conditions, including sleep complaints. This study aimed to test associations between HF-HRV measured during sleep (sleep HF-HRV) and subjective sleep complaints 4 years later.

Methods
One hundred forty-three healthy employees (91% male; MAge = 47.8 years [time 2], SD = 8.3 years) of an industrial company in Southern Germany completed the Jenkins Sleep Problems Scale, participated in a voluntary health assessment, and were given a 24-hour ambulatory heart rate recording device in 2007. Employees returned for a health assessment and completed the Jenkins Sleep Problems Scale 4 years later.

Results
Hierarchical regression analyses showed that lower sleep HF-HRV measured in 2007 was associated with higher self-reported sleep complaints 4 years later after controlling for covariates (r
ab,c = −0.096, b = −0.108, 95% CI, −0.298 to 0.081, ΔR
2 = 0.009, p = .050).

Conclusions
These data are the first to show that lower sleep HF-HRV predicted worse sleep 4 years later, highlighting the importance of vagus nerve functioning in adaptability and health.
Making a Statement
Authors: LaValley Myles N. , Eble Danielle J. , Kuzon William M. , Peters Blair R. , Skokan Alexander J. , Ettinger Russell E. , Morrison Shane D. 
Published: May 2024

Objective:
Despite politically charged media coverage and legislation surrounding gender-affirming care (GAC), many organizations have released position statements to provide scientifically backed clinical practice standards, combat misinformation, and inform medicolegal policies. The purpose of this study is to objectively assess the availability and the content of the official position statements of relevant medical professional organizations regarding GAC.

Summary Background Data:
A list of US medical professional organizations with likely involvement in GAC based on medical or surgical specialties was compiled.

Methods:
For included organizations, we evaluated the availability, content, and publication year of positions on GAC through October 2023. When available, formal positions were categorized as supportive or unsupportive.

Results:
A total of 314 professional medical organizations were screened for our study based on specialty, relevance to GAC, and issuance of patient guidelines or position statements. Inclusion criteria were met by 55 organizations. Most organizations (35, 63.6%) had formal position statements on GAC. Support for GAC was described in 97.1% (n=34). Further, 94.2% (n=33) of available statements explicitly addressed GAC in individuals less than 18 years old and were largely supportive (96.9%, n=32).

Conclusions:
This cross-sectional analysis demonstrates that a majority of multidisciplinary professional medical organizations with relevance to GAC have issued formal position statements on the topic. Available positions were overwhelmingly supportive of individualized access to gender-affirming therapies in adult and adolescent populations. However, silence from some organizations continues to represent a modifiable disparity in the provision of GAC.
Examining the Frequency of Second Endoscopy and Its Effect on Patient Outcomes With Upper Gastrointestinal Bleeding in Southeast of Iran
Authors: Alijani Fatemeh , Khoshnazar Seyedeh Mahdieh , Eslami Omid 
Published: May 2024

Background:This study investigated the frequency and impact of repeat endoscopy in patients with acute upper gastrointestinal bleeding (AUGIB) in a referral hospital in Southeast Iran.Materials and Methods:A cross-sectional descriptive-analytical study was conducted on the records of 190 patients who underwent endoscopy for AUGIB in 2019. The study compared the demographic and clinical characteristics, outcomes, and treatments of patients who had a second endoscopy (n=64) with those who did not (n=126). The data were analyzed with SPSS software, and aPvalue less than 0.05 was considered significant.Results:The results showed that repeat endoscopy was not significantly associated with age, gender, initial symptoms, bleeding site, first endoscopy time, or disease outcome. However, repeat endoscopy was significantly associated with higher bleeding severity, different wound types, different bleeding causes, longer hospital stay, and different treatments in the first endoscopy. The main reasons for repeat endoscopy were poor visibility and recurrent bleeding. The majority of repeat endoscopies were performed within 2 days of the first one. Most patients who had a second endoscopy did not receive any treatment, and those who did received combined thermal and epinephrine injections.Conclusions:The study concluded that routine second endoscopy is not necessary for all patients with AUGIB, but it may be beneficial for some cases. Further research is needed to clarify the indications and timing of repeat endoscopy in AUGIB.
Guide assignment in single-cell CRISPR screens using crispat
Authors: Braunger Jana M. , Velten Britta 
Published: May 2024

MotivationPooled single cell CRISPR screens have emerged as a powerful tool in functional genomics to probe the effect of genetic interventions at scale. A crucial step in the analysis of the resulting data is the assignment of cells to gRNAs corresponding to a specific genetic intervention. However, this step is challenging due to a lack of systematic benchmarks and accessible software to apply and compare different guide assignment strategies. To address this, we here propose crispat (CRISPR guide assignment tool), a Python package to facilitate the choice of a suitable guide assignment strategy for single cell CRISPR screens.ResultsWe demonstrate the package on four single cell CRISPR interference screens at low multiplicity of infection from two studies, where crispat identifies strong differences in the number of assigned cells, downregulation of the target genes and number of discoveries across different guide assignment strategies, highlighting the need for a suitable guide assignment strategy to obtain optimal power in single cell CRISPR screens.Availability and Implementationcrispat is implemented in python and the source code, installation instructions and tutorials can be found athttps://github.com/velten-group/crispat. Code to reproduce all findings in this paper is available athttps://github.com/velten-group/crispat_analysis.ContactBritta Velten,britta.velten@cos.uni-heidelberg.deSupplementary InformationSupplementary Information can be found in the Supplementary Information file.
Morphotype-specific calcium signaling in human microglia
Authors: Nevelchuk Sofia , Brawek Bianca , Schwarz Niklas , Valiente-Gabioud Ariel , Wuttke Thomas V. , Kovalchuk Yury , Koch Henner , Höllig Anke , Steiner Frederik , Figarella Katherine , Griesbeck Oliver , Garaschuk Olga 
Published: May 2024

AbstractKey functions of Ca2+signaling in rodent microglia include monitoring the brain state or the surrounding neuronal activity and sensing the danger or damage in their vicinity. Microglial Ca2+dyshomeostasis is a disease hallmark in many mouse models of neurological disorders but the Ca2+signal properties of human microglia remain unknown. Using a newly developed toolbox, we analyzedin situCa2+signaling of decades-old human cortical microglia. The data revealed marked compartmentalization of Ca2+signals, with signal properties differing across the compartments and resident morphotypes. The basal Ca2+levels were low in ramified and high in ameboid microglia. The fraction of cells with ongoing Ca2+signaling, the fraction and the amplitude of process Ca2+signals and the duration of somatic Ca2+signals decreased when moving from ramified via hypertrophic to ameboid microglia. In contrast, the size of active compartments, the fraction and amplitude of somatic Ca2+signals and the duration of process Ca2+signals increased along this pathway.