bluuebunny/crossref_metadata_2025_split huggingface dataset:
An unusual case of acute cholecystitis complicated by haemobilia and Mirizzi-like obstruction: a case report and review of literature
Authors: Khawjah Ahmed , Khair Mugahid M. , Goubran R. 
Published: April 2024

Introduction:
Cystic artery pseudoaneurysm rupture presents a rare yet potentially fatal aetiology for upper gastrointestinal (GI) bleed. While uncommon, its incidence has been rising with increased hepatobiliary surgical interventions, predominantly attributed to iatrogenic injury and rarely secondary to acute cholecystitis. Clinical manifestations typically include epigastric pain, upper GI haemorrhage, and obstructive jaundice. Due to its rarity, it is often excluded from initial differential diagnoses.

Case report:
This is an unusual case of a 54-year-old male who presented with acute cholecystitis complicated by haemobilia and Mirizzi-like obstruction, in the setting of cystic artery pseudoaneurysm rupture. Initially, urgent transcatheter angiographic embolization of the cystic artery was performed to achieve hemodynamic stability. However, a triphasic computed tomography (CT) scan revealed the first attempt was unsuccessful, necessitating a second embolization. Subsequent imaging confirmed satisfactory embolization; however, a small area of liver necrosis was observed adjacent to the gallbladder. The patient was stable at discharge from the hospital and had an uncomplicated interval cholecystectomy.

Discussion:
This case highlights the complexity and challenges associated with diagnosing and managing cystic artery pseudoaneurysm rupture. Diagnosis often relies on arterial phase contrast-enhanced CT scan. While no guideline currently exist, management typically involves achieving hemodynamic stability through Transcatheter angiographic embolization, followed by interval cholecystectomy.

Conclusion:
Early recognition and intervention are crucial in managing cystic artery pseudoaneurysm rupture to prevent life-threatening haemorrhagic shock. Clinicians need to consider this rare condition in patients with upper GI bleeding and abnormal liver function tests.
Why Pursue a Doctorate? Findings From a Study of Doctorally Prepared RNs in an Integrated Healthcare System
Authors: Rosenfeld Peri , Glassman Kimberly S. 
Published: April 2024

OBJECTIVE
The aim of this study was to examine the motivations and perceptions of RNs with completed doctorates in an integrated healthcare system.

BACKGROUND
Historically, PhD preparation was the primary doctorate available for nurses, preparing them to conduct research and hold leadership positions. The recent growth of Doctor of Nursing Practice (DNP) programs that focus on either advanced clinical practice or executive competencies has significant implications for the future of nursing in practice settings.

METHODS
A 30-item survey was sent to all 93 RNs at a healthcare system who have completed doctorates.

RESULTS
A response rate of 71% found DNPs outnumber PhDs 3 to 1. PhDs are significantly more likely to perceive concrete benefits associated with their degrees, and DNPs are more likely to report that their degrees have not made a difference in their jobs.

CONCLUSIONS
Leaders in practice and education must collaborate to ensure that both DNPs and PhDs are engaged in positions that use their highest level of competence in any setting.
Organizational Climate for Inclusion Among Nurses
Authors: Traver Jodi , Yeaman Sarah , Arenas Cecily A. , Daugherty JoAnn , Davidson Judy E. 
Published: April 2024

OBJECTIVE
The aim of this study was to answer the research question: What factors predict sense of belonging among nurses?
The connection between inclusion (an element of diversity and equity) and a nurse's sense of belonging is poorly understood.

METHODS
In this mixed-methods research, regression analysis of Climate for Inclusion Scale subscales and Sense of Belonging score plus thematic content analysis of questions assessing sense of belonging were conducted. Nurses (n = 131) attending a research conference in June to July 2022 were invited to participate; 131 (72%) participated.

RESULTS
Climate for Inclusion Scale was positively associated with and predictive of sense of belonging (F
3,113 = 71.7, P < 0.001). Themes reflecting actions to enhance sense of belonging were as follows: authentic leadership, embracing social justice, team unification, feeling heard, being seen, professional development, developing a healthier work environment, and integration of differences.

CONCLUSIONS
Leaders can promote a sense of belonging among nurses by focusing on actions reflected in the themes.
A Comparison of Evidence-Based Practice Training With and Without Postimmersion Follow-up
Authors: Wayman Lisa M. , Walsh-Irwin Colleen , Sullivan Sheila Cox 
Published: April 2024

OBJECTIVE
The aim of this study was to determine best practice for evidence-based practice (EBP) education that leads to implementation.

BACKGROUND
Current methods of teaching EBP do not reliably translate to implementation.

METHODS
Participants in an EBP immersion were compared with participants in EBP immersion plus a follow-up EBP course.

RESULTS
The EBP immersion group implemented 18% of their initiatives. The EBP immersion plus the follow-up EBP course implemented 35% of their initiatives, and an additional 22% were in the process of implementation.

CONCLUSION
Evidence-based practice education may not be sufficient in promoting EBP implementation. Additional ongoing support may be needed to bring EBP initiatives through implementation.
Hemodynamic Reactivity to Mental Stress and Cognitive Function in Coronary Artery Disease
Authors: Moazzami Kasra , Kulshreshtha Ambar , Gold Matthew , Rahbar Alireza , Goldstein Felicia , Shah Amit J. , Bremner J. Douglas , Vaccarino Viola , Quyyumi Arshed A. 
Published: April 2024

ABSTRACT

Objective
People with coronary artery disease (CAD) are at higher risk of cognitive impairment than those without CAD. Psychological stress is a risk factor for both conditions, and assessing the hemodynamic reactivity to mental stress could explain the link between stress and cognitive function.

Methods
A total of 779 individuals with stable CAD from two prospective cohort studies were included. All individuals underwent acute mental stress testing, as well as conventional stress testing. Cognitive function was assessed both at baseline and at a 2-year follow-up. The rate-pressure product (RPP) was calculated as the mean systolic blood pressure times the mean heart rate at rest. RPP reactivity was defined as the maximum RPP during standardized mental stress test minus the RPP at rest.

Results
After multivariable adjustment, every standard deviation decrease in RPP reactivity with mental stress was associated with slower completion of Trail-A and Trail-B in both cohorts (13% and 11% in cohort 1, and 15% and 16% in cohort 2, respectively; p for all <.01). After a 2-year follow-up period, every standard deviation decrease in RPP reactivity with mental stress was associated with a 8% and 9% slower completion of Trail-A and Trail-B, respectively (p for all <.01). There was no significant association between RPP reactivity with conventional stress testing and any of the cognitive tests.

Conclusion
In the CAD population, a blunted hemodynamic response to mental stress is associated with slower visuomotor processing and worse executive function at baseline and with greater decline in these abilities over time.
Social Engagement in HIV Cure (Research) in the Netherlands: Understanding the Perceived Necessity and Concerns of People With HIV
Authors: Noorman Maaike A. J. , de Wit John B.F. , Marcos Tamika A. , Stutterheim Sarah E. , Jonas Kai J. , Den Daas Chantal 
Published: April 2024

Objective:
As the developments toward HIV cure are gaining prominence, engagement of people with HIV (PWH) becomes crucial. The aim of this study was to gain deeper insight into how PWH engage with HIV cure (research) by exploring their perspectives regarding awareness, importance, and meaning of HIV cure (research).

Methods:
Semistructured interviews were conducted with 30 purposively sampled PWH in the Netherlands. Interviews were transcribed verbatim, and thematic data analysis was undertaken.

Results:
The overall necessity for an HIV cure was high, but personal perceived necessity varied based on participants' lived experiences with HIV. Most participants saw less personal necessity due to their high quality of life, while those more affected by their HIV status expressed a stronger need for a cure. Participants held high expectations for an HIV cure, considering viral eradication as the only cure. Lack of awareness of potential HIV cure strategies and techniques shaped concerns. Antiretroviral treatment-free viral suppression was met with concerns and not considered a cure, but rather an improved form of treatment. Engagement with HIV cure manifested in various forms and levels, with only a few participants actively engaged or willing to participate in HIV cure clinical research. Most participants were interested but inactive and unsure about participating in HIV cure clinical research.

Conclusions:
PWH's social engagement in HIV cure (research) is shaped by their perceived necessity and concerns. Understanding these perceptions can increase social engagement.
HIV Pre-exposure Prophylaxis Use Among Men Experiencing Incarceration in the United States: A Prospective Cohort Study
Authors: Murphy Matthew , Rogers Brooke , Galipeau Drew , Toma Emily , Almonte Alexi , Napoleon Siena , Schmid Christopher H. , Ahluwalia Jasjit S. , Chan Philip 
Published: April 2024

Background:
Pre-exposure prophylaxis (PrEP) is an effective approach to preventing HIV acquisition and recommended for populations over-represented in carceral systems, given the overlap with populations disproportionately impacted by HIV. However, few studies have focused on PrEP initiation outcomes in a carceral setting to maximize public health impact.

Setting:
This study was conducted in a unified jail/prison system within the state of Rhode Island located in the United States.

Methods:
A prospective observational cohort of men initiating PrEP within a jail setting was enrolled in this trial. Men were referred by providers, staff, or after self-presenting for HIV preventive care, these individuals were offered enrollment in the study that involved evaluation for clinical PrEP eligibility, PrEP initiation while incarcerated, continuation upon community re-entry, and linkage to a community PrEP provider after release.

Results:
A total of 100 men in the jail facility (eg, “intake”) were enrolled in the cohort. Of the 100 men enrolled, 83% were determined to be PrEP eligible through standard clinical evaluation, 37% were prescribed PrEP, and 26% initiated PrEP while incarcerated. In total, 5% of enrolled individuals were linked successfully to PrEP care in the community.

Conclusion:
Our findings suggest preliminary feasibility and acceptability of initiating PrEP within a jail setting. There were significant challenges across the PrEP care continuum that can be used to inform future studies and practice.
International Collaborative Study Comparing Outcomes of Fenestrated Endovascular Aortic Repair in OCtogenarian vs Non-Octogenarian Patients
Authors: Prendes Carlota F. , Spath Paolo , Khashram Manar , Dias Nuno , Furlan Federico , Gouveia e Melo Ryan , Gallitto Enrico , Sonesson Björn , Mendes Pedro Luis , Gormley Sinead , Gargiulo Mauro , Wanhainen Anders , Tsilimparis Nikolaos , Mani Kevin 
Published: April 2024

Objective:
With an increasing life expectancy, more octogenarian patients are referred with complex aortic aneurysms (cAAA). The aim of this study was to evaluate short and mid-term outcomes following fenestrated aortic repair (FEVAR) in octogenarians.

Summary Background Data:
Few studies looking at octogenarian-specific outcomes with diverging results.

Methods:
Retrospective, multicentre cohort study including consecutive patients undergoing elective FEVAR for cAAAs or type IV thoracoabdominal aortic aneurysms between 2007-2022 in eight high-volume centres. Octogenarians vs. non-octogenarians were compared. The primary outcome was 30-day mortality. Secondary outcomes included 1, 2 and 5-year survival and reintervention rates.

Results:
A total of 729 patients (median age of 74.8 years [IQR 69.2 - 79.14]) were included, 169 (23%) of which were octogenarians, with 316 (43.3%) patients undergoing juxta/pararenal aneurysm repair. Although octogenarians presented less complex but larger (61 mm vs. 58 mm) aneurysms, the number of fenestrations was similar across groups. No differences in in-hospital mortality (4.1 vs. 3.0%), MAE (16.6% vs 12.2%) or reintervention rates (11.2 vs. 10%) were found. Multivariable logistic regression of in-hospital mortality identified BMI (OR 0.66, 95% CI 0.51-0.95, P=0.003), chronic heart failure (OR 7.70, 95% CI 1.36–36.15, P=0.003) and GFR<45 ml/min/1.73 m2 (OR 5.25, 95% CI 1.20–22.86, P=0.027) as independent predictors. Median follow-up was 41 months. The 1, 2 and 5-year survival rates were 91.3%, 81.8% and 49.5% in octogenarians vs 90.6%, 86.5% and 68.8% in non-octogenarian patients (Log-rank: =0.001). Freedom from aortic-related death and freedom from reintervention at five-years were similar across groups (log-rank=0.94 and .76, respectively). Age>80 was not an independent predictor of 30-day or long-term mortality on multivariable and Cox regression analysis.

Conclusions:
Elective FEVAR in octogenarians appears to be safe, with similar outcomes as in younger patients. Future studies looking at improved patient selection methods to ensure long-term survival benefits in both octogenarians and younger patients are warranted.
Factors That Influence the Pain Response of Patients Admitted to an Emergency Department for Acute Musculoskeletal Trauma
Authors: Leigheb Massimiliano , Montaño-Ocaña Juan , Sabbatini Maurizio 
Published: April 2024

Objective:
To monitor factors influencing pain intensity variations in patients admitted to an emergency department (ED).

Method:
A prospective observational study included 904 patients. Pain intensity was assessed at ED admission and discharge using a novel Visual Analog Scale interpretation. Patient data included trauma type, pain location, the injury environment, age, race, and the time elapse between assessments.

Results:
Distinct personal, temporal and contextual factors revealed characteristic pain improvement, and worsening patterns post-ED management.

Conclusions:
The ED's pivotal role in pain relief, influenced by various factors, underscores the importance of optimizing patient care.
Analysis of Motor Learning Principles Applied in Tasks or Motor Skills Trained by Stroke Patients
Authors: Sánchez-Silverio Víctor , Abuín-Porras Vanesa , Pedersini Paolo , Villafañe Jorge Hugo , Leigheb Massimiliano , Rodríguez-Costa Isabel 
Published: April 2024

Objective:
To analyze the principles applied to promote and evaluate motor learning in tasks or motor skills trained by stroke patients.

Methods:
Articles were included if they used motor learning principles in tasks or motor skills trained by stroke patients.

Results:
Twelve studies were included in this review. Quality was good for the included studies. Articles used motor learning principle based on practice (N = 12), repetitive training (N = 9), and feedback (N = 5).

Conclusions:
There are different motor learning principles to promote and evaluate motor learning in stroke patients. These findings could guide clinicians during training of tasks or motor skills.
Optimizing Telehealth Strategies for Rehabilitation
Authors: Bustamante-Vázquez Jorge Luis , Rodrigo-Morales Gaudencio Jonathan , De-Dios-Pérez Jhonatan Iván , Artiles-Sánchez Justo , Barragán-Caraballar Carlos , Alonso-Perez José Luís , Villafañe Jorge Hugo 
Published: April 2024

Background:
To investigate the experiences and perspectives of rural physical therapists in relation to various telehealth strategies in physical therapy.

Methods:
A qualitative field study was conducted in (n = 4344) remote regions of (n = 6) Mexico. Using telehealth technology, 16 physical therapists from 6 clinics expanded their reach and provided physical therapy care to patients located in nonmetropolitan sites. The outcomes measured were the sociodemographic characteristics, telemedicine modalities employed, and the types of treatments administered. These assessments were conducted pre-, post-intervention, and during the follow-up period.

Results:
This study included 4344 participants, averaging 44.5 ± 20.7 years old. Most visits (80.1%) were initial, while 19.9% were follow-ups, with an average of 12.4 ± 4.7 sessions. “Puebla sur” had the highest case frequency (29.3%), followed by “Tlalnepantla” (27.5%), “CAPU” (17.4%), “Tlalpan” (15.5%), and “Guadalajara” and “Guatemala” clinics with lower frequencies (8.8% and 1.5%, respectively).

Conclusions:
This study highlights the potential of telemedicine to surmount barriers such as limited access to health care facilities, physical impediments faced by patients in rural areas, and financial burdens on families. The findings contribute to the optimization of telehealth strategies, specifically tailored to the unique challenges of rehabilitation care in underserved rural communities.
Annular Ligament Instability
Authors: Abellán-Miralles César , Berlanga-de-Mingo Daniel , Samaniego-Alonso Raquel , Villafañe Jorge Hugo , Bascones-Rodríguez Karla 
Published: April 2024

Purpose:
Lateral elbow pain is frequently attributed to epicondylalgia; yet, less common pathologies with limited literature representation exist. This study aims to delineate the diagnostic significance of alterations in the biomechanics and morphology of the annular ligament as a distinctive factor in lateral elbow pain.

Methods:
A retrospective observational analysis was conducted on patients surgically treated for lateral elbow pain with arthroscopic assistance from January 2015 to December 2018. Initial preoperative diagnoses primarily indicated epicondylalgia.

Results:
The study encompassed 82 patients (48 men, 34 women; mean age: 44.6 ± 5.3 years), with 91.46% involved in demanding manual work. Notably, 17 patients underwent surgery due to recurrent symptoms. Arthroscopic assessments revealed diverse morphological and biomechanical variations in annular ligaments, designating 36 patients with an identified incompetent annular ligament.

Conclusions:
Our arthroscopic study on lateral epicondylalgia cases involved a comprehensive analysis of annular ligament anatomy and radiocapitellar joint biomechanics. The formulated anatomic classification, incorporating crucial variables such as radial head coverage and ligament tension, unveiled implications for joint instability. Recognition of simultaneous pathologies, notably annular ligament lesions, signifies a potential, yet unexplored, avenue for differential diagnosis in cases of lateral elbow pain.
Transposable elements in a cold-tolerant fly species,Drosophila montana: a link to adaptation to the harsh cold environments
Authors: Tahami Mohadeseh S. , Vargas-Chavez Carlos , Poikela Noora , Coronado-Zamora Marta , González Josefa , Kankare Maaria 
Published: April 2024

AbstractBackgroundSubstantial discoveries during the past century have revealed that transposable elements (TEs) can play a crucial role in genome evolution by affecting gene expression and inducing genetic rearrangements, among other molecular and structural effects. Yet, our knowledge on the role of TEs in adaptation to extreme climates is still at its infancy. The availability of long-read sequencing has opened up the possibility to identify and study potential functional effects of TEs with higher precision. In this work, we usedDrosophila montanaas a model for cold-adapted organisms to study the association between TEs and adaptation to harsh climates.ResultsUsing the PacBio long-read sequencing technique, wede novoidentified and manually curated TE sequences in fiveDrosophila montanagenomes from eco-geographical distinct populations. We identified 489 new TE consensus sequences which represented 92% of the total TE consensus inD. montana. Overall, 11-13% of theD. montanagenome is occupied by TEs, which as expected are non-randomly distributed across the genome. We identified five potentially active TE families, most of them from the retrotransposon class of TEs. Additionally, we found TEs present in the five analyzed genomes that were located nearby previously identified cold tolerant genes. Some of these TEs contain promoter elements and transcription binding sites. Finally, we detected TEs nearby fixed and polymorphic inversion breakpoints.ConclusionsOur research revealed a significant number of newly identified TE consensus sequences in the genome ofD. montana, suggesting that non-model species should be studied to get a comprehensive view of the TE repertoire in Drosophila species and beyond. Genome annotations with the newD. montanalibrary allowed us to identify TEs located nearby cold tolerant genes, and present at high population frequencies, that contain regulatory regions and are thus good candidates to play a role inD. montanacold stress response. Finally, our annotations also allow us to identify for the first time TEs present in the breakpoints of threeD. montanainversions.
Gfi1 controls the formation of exhausted effector-like CD8 T cells during chronic infection and cancer
Authors: Ojo Oluwagbemiga A , Shen Hongxing , Ingram Jennifer T , Bonner James A , Welner Robert S , Lacaud Georges , Zajac Allan J , Shi Lewis Z 
Published: April 2024

AbstractDuring chronic infections and tumor progression, CD8 T cells gradually lose their effector functions and become exhausted. These exhausted CD8 T cells are heterogeneous and comprised of different subsets, including self-renewing progenitors that give rise to Ly108−CX3CR1+effector-like cells. Generation of these effector-like cells is essential for the control of chronic infections and tumors, albeit limited. However, the precise cues and mechanisms directing the formation and maintenance of exhausted effector-like are incompletely understood. Using genetic mouse models challenged with LCMV Clone 13 or syngeneic tumors, we show that the expression of a transcriptional repressor, growth factor independent 1 (Gfi1) is dynamically regulated in exhausted CD8 T cells, which in turn regulates the formation of exhausted effector-like cells. Gfi1 deletion in T cells dysregulates the chromatin accessibility and transcriptomic programs associated with the differentiation of LCMV Clone 13-specific CD8 T cell exhaustion, preventing the formation of effector-like and terminally exhausted cells while maintaining progenitors and a newly identified Ly108+CX3CR1+state. These Ly108+CX3CR1+cells have a distinct chromatin profile and may represent an alternative target for therapeutic interventions to combat chronic infections and cancer. In sum, we show that Gfi1 is a critical regulator of the formation of exhausted effector-like cells.