bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of orally administered dexmedetomidine to induce emesis in cats
Authors: Maxwell Kathleen M , Odunayo Adesola , Wissel Charlotte 
Published: May 2024

Case series summary This case series describes the use of orally administered dexmedetomidine at a dose of 20 µg/kg to induce emesis in six cats. Emesis was successfully induced in 5/6 cats, with each of the cats vomiting once. The reasons for inducing vomiting included known or suspected ingestion of lilies, onions, acetaminophen (paracetamol) or acetylsalicylic acid. Four of the five cats in which emesis induction was successful did not develop any clinical signs of toxicity associated with the toxin ingested; the fifth cat developed clinicopathological changes consistent with acetaminophen toxicity. All six cats exhibited moderate to profound sedation, as expected, but no other adverse effects were documented. Relevance and novel information Induction of emesis in cats is notoriously difficult. This case series describes a novel route of administration of dexmedetomidine, a commonly available medication, with a high success rate observed for inducing emesis in this group of cats.
Information-seeking behaviour in patients exploring orthognathic surgery: A qualitative study
Authors: Wade Nicola , Paul Ninu , Nagar Nathan , Rolland Sarah , Germain Sarah 
Published: May 2024

Objective: To explore how orthognathic patients seek information during decision-making. Design: Qualitative, cross-sectional study. Setting: A hospital in Cumbria, UK. Participants: Prospective orthognathic patients. Methods: Participants were purposively recruited from joint orthognathic clinics after the original consultation. Semi-structured interviews were conducted via remote video call with nine participants aged 18–30 years. Data collection and reflexive thematic analysis occurred in parallel until thematic saturation was achieved. Results: The central finding of this research was that patients were making informed decisions about orthognathic surgery. Four themes were identified to support this central finding including the following: (1) selective engagement with orthognathic information sources; (2) the central role of patient-specific information from professionals and peers; (3) Internet use to supplement standard information resources; and (4) concerns over information found online. The preferred source of information was verbal from the clinical team as it was trusted and person-specific. Past patients were identified as valued sources of information and establishing contact through digital social media networks was found to be a convenient alternative to face-to-face. Online information found was valued but concerns included information overload, problems establishing applicability and concerns over its credibility. Conclusion: Orthognathic patients were making informed decisions about their treatment. This study highlights the central role of the patient–clinician interaction in decision-making, especially in providing patient-specific information. Insight into the nuances of information-seeking behaviours will better inform clinical care. Since patients frequently access online information that is decision-relevant, encouraging patients to discuss online searches will support the shared decision-making process and alleviate any concerns with information found. During consultation, explaining the purpose of an information aid rather than expecting patients to read them separately, may further enhance its usefulness in decision-making. This study identified an unmet need for visual aids, such as real-time images of postoperative recovery. These findings can inform the design of future information resources.
Improvement in Nutritional Knowledge Confidence and Food-Agency: Outcomes of the First French-Speaking Culinary Medicine Courses Among Medical Students
Authors: Dodin Sylvie , Bégin Catherine , Lucas Michel 
Published: May 2024

Background Medical students often lack sufficient nutrition education, leading to confidence gaps and an inability to address this healthcare aspect. Culinary Medicine (CM) courses offer an innovative solution. Methods We tested the first French-speaking CM courses among 2 groups of second-third year medical students, compared to a control group (CG). The objectives were to assess if an optional CM course could enhance their confidence in both nutritional knowledge and providing nutritional advice, and improve their food agency (CAFPAS: Cooking and Food Provisioning Action Scale). The analysis examines changes in scores by comparing post-session to pre-session questionnaire measurements. Results Of the 22 CM students and 6 in CG, predominantly aged 20-25 years, Caucasian, and female, the majority (CG = 100%, CM = 86.4%) reported <5 hours of nutrition education. Almost all expressed dissatisfaction with nutrition education provided in medicine, both quantitatively and qualitatively. CM students reported significantly increased confidence in their knowledge and ability to advise about nutrition during the sessions. We also observed improvements in their CAFPAS scores, which measure food agency, while the control group exhibited no change in confidence or CAFPAS scores. Conclusion The findings highlight CM as practical strategy for integrating nutrition education into medical curricula, offering insights for enhancing future physicians’ knowledge.
How to make EU enlargement work? A grass-roots approach to strategic preparations
Authors: Lavrelashvili Teona 
Published: May 2024

Enlargement is back on the EU agenda. Leaders have broken long-established foreign policy taboos by green-lighting accession talks with Ukraine and the Republic of Moldova, and by awarding EU candidate country status to Georgia. This bold step has elevated the expectations of the existing candidate countries, instilling renewed optimism in the Western Balkans Six. At the same time, the EU has recognised the need to carry out its own reforms to be prepared to integrate potentially 10 new member states. However, given the complexities of EU institutional reform, coupled with the uncertain political context, expectations of EU enlargement may lead to disillusionment. This article argues that the EU should not tie its progress on institutional reform too closely to its enlargement policy and that it needs to take a grass-roots approach to enlargement. It should focus on strengthening horizontal cooperation, enhancing efficiency and increasing public involvement in the EU enlargement process.
Changing the narrative: The future we want to see. Insights from older generations
Authors: Gheno Ilenia 
Published: May 2024

Demographic change, a prominent trend in our societies, impacts the labour market, pensions, and the health and care sectors, among others. Concurrently, ageing brings opportunities, as older people actively contribute to society through work, caregiving and knowledge sharing. When looking at demographic change, it is important to consider its intersections with other global trends, such as inequality, climate change and technological advancements, and how this interconnectedness impacts people's daily lives across their lifespan. This article delves into recent European policy approaches and research on demographic change, pinpointing shortcomings and suggesting initiatives to reshape perceptions of ageing and revise the current narrative of old age. Drawing on insights from AGE Platform Europe, the European advocacy organisation of and for older people, this article highlights the collective advocacy efforts at the European and international levels. These efforts aim to truly embody the European motto ‘United in Diversity’ and to foster fairer and more resilient societies.
Carotid artery calcium score: Definition, classification, application, and limits
Authors: Saba Luca , Benson John C , Scicolone Roberta , Paraskevas Kosmas I , Gupta Ajay , Cau Riccardo , Suri Jasjit S , Schindler Andreas , Balestrieri Antonella , Nardi Valentina , Song Jae W , Wintermark Max , Lanzino Giuseppe 
Published: May 2024

Introduction In the current paper, the “carotid artery calcium score” method is presented with the target to offer a metric method to quantify the amount of calcification in the carotid artery. Model and Definition The Volume of Interest (VOI) should be extracted and those voxels, with a Hounsfield Unit (HU) value ≥130, should be considered. The total weight value is determined by calculating the sum of the HU attenuation values of all voxels with values ≥130 HU. This value should be multiplied by the conversion factor (“or voxel size”) and divided by a weighting factor, the attenuation threshold to consider a voxel as calcified (and therefore 130 HU): this equation determines the Carotid Artery Calcium Score (CACS). Results In order to provide the demonstration of the potential feasibility of the model, the CACS was calculated in 131 subjects (94 males; mean age 72.7 years) for 235 carotid arteries (in 27 subjects, unilateral plaque was present) considered. The CACS value ranged from 0.67 to 11716. A statistically significant correlation was found (rho value = 0.663, p value = .0001) between the CACS in the right and left carotid plaques. Moreover, a statistically significant correlation between the age and the total CACS was present (rho value = 0.244, p value = .005), whereas no statistically significant difference was found in the distribution of CACS by gender ( p = .148). The CACS was also tested at baseline and after contrast and no statistically significant difference was found. Conclusion In conclusion, this method is of easy application, and it weights at the same time the volume and the degree of calcification in a unique parameter. This method needs to be tested to verify its potential utility, similar to the coronary artery calcium score, for the risk stratification of the occurrence of cerebrovascular events of the anterior circulation. Further studies using this new diagnostic tool to determine the prognostic value of carotid calcium quantification are needed.
Selection of criteria for a telemedicine framework for designing, implementing, monitoring and evaluating telemedicine interventions: Validation using a modified Delphi process
Authors: Katz Che , Robles Noemí , Novillo-Ortiz David , Saigí-Rubió Francesc 
Published: May 2024

Objectives The call to scale up telemedicine services globally as part of the digital health transformation lacks an agreed-upon set of constructs to guide the implementation process. A lack of guidance hinders the development, consolidation, sustainability and optimisation of telemedicine services. The study aims to reach consensus among telemedicine experts on a set of implementation constructs to be developed into an evidence-based support tool. Methods A modified Delphi study was conducted to evaluate a set of evidence-informed telemedicine implementation constructs comprising cores, domains and items. The study evaluated the constructs consisting of five cores: Assessment of the Current Situation, Development of a Telemedicine Strategy, Development of Organisational Changes, Development of a Telemedicine Service, and Monitoring, Evaluation and Optimisation of Telemedicine Implementation; seven domains: Individual Readiness, Organisational Readiness, Clinical, Economic, Technological and Infrastructure, Regulation, and Monitoring, Evaluation and Optimisation; divided into 53 items. Global telemedicine specialists ( n = 247) were invited to participate and evaluate 58 questions. Consensus was set at ≥70%. Results Forty-five experts completed the survey. Consensus was reached on 78% of the constructs evaluated. Regarding the core constructs, Monitoring, Evaluation and Optimisation of Telemedicine Implementation was determined to be the most important one, and Development of a Telemedicine Strategy the least. As for the domains, the Clinical one had the highest level of consensus, and the Economic one had the lowest. Conclusions This research advances the field of telemedicine, providing expert consensus on a set of implementation constructs. The findings also highlight considerable divergence in expert opinion on the constructs of reimbursement and incentive mechanisms, resistance to change, and telemedicine champions. The lack of agreement on these constructs warrants attention and may partly explain the barriers that telemedicine services continue to face in the implementation process.
Risk of Cephalic Vein Injury During the Creation of an Anterior Portal in Shoulder Arthroscopy
Authors: Inoue Jumpei , Tawada Kaneaki , Yamada Kunio , Takenaga Tetsuya , Tsuchiya Atsushi , Takeuchi Satoshi , Isobe Yuki , Hanaki Shunta , Murakami Hideki , Yoshida Masahito 
Published: May 2024

Background: There is a risk of cephalic vein injury during shoulder arthroscopy. However, limited data regarding its anatomic course are available. Purpose: To analyze the positional relationship and factors affecting the distance between the coracoid tip and cephalic veins. Study design: Case series; Level of evidence, 4. Methods: A total of 80 contrast‐enhanced computed tomography images from 80 patients (mean age, 49.6 ± 20.3 years; 61 men) were retrospectively analyzed. The distance between the center of the coracoid tip and the vertical line through the cephalic vein was measured in the axial (D1) and sagittal (D2) planes. The distance between 1 cm lateral to the center of the coracoid tip and the vertical line through the cephalic vein was measured in the sagittal plane (D3). Each distance was compared according to patient sex and laterality. Associations between each distance and the patient's age, height, weight, and body mass index were investigated. Results: The mean D1 was 18.4 ± 7.3 mm in 59 patients. The mean D2 was 23.4 ± 11.6 mm, and it was within 10 mm in 10 patients (12.5%). The mean D3 was 33.7 ± 12.2 mm. There was no significant difference in D1, D2, and D3 according to patient sex or laterality. A positive correlation was observed only between D3 and patient height ( r = 0.320; P = .034). Conclusion: The cephalic vein was found to travel a mean of 23.4 mm distal and 33.7 mm distal to 1 cm lateral to the coracoid tip. Therefore, Care should be taken to avoid cephalic vein injury when creating an anterior inferior portal or 5-o’clock portal around these areas.
Practical Tips for Undergraduate Medical Education Advisors in Residency Application Signaling
Authors: Spatz Christin , Olaf Mark , Ellison Halle 
Published: May 2024

Objectives The residency application process has become increasingly complex for medical students and advisors to navigate. Program signaling was piloted to improve applicants’ abilities to obtain interview offers at programs they were strongly interested in. The initial positive results led to expansion of signaling to additional specialties over the next two application cycles. Despite the benefits of program signaling, the variation in signaling practices among specialties has presented challenges for both advisors and students when determining how to best allocate signals. The aim of this study is to identify students’ perceptions of the signaling process, how this may impact outcomes, and to guide future educational programming. Methods This is an exploratory original survey study of students in a US allopathic medical school applying in ERAS for the 2023 residency cycle. The survey was developed to determine students’ understanding of how programs would use signals in the application process and assess strategies students used to allocate signals. We compared program signals to student interview offers and match outcomes using descriptive statistics. Results 57 of 96 eligible students completed the survey. 51% signaled a range of programs based on their perceived competitiveness for the program while 40% signaled programs of interest regardless of perceived competitiveness. 53% of students thought sending a signal would increase their chance of an interview, while 42% were unsure how the signal would be used by residency programs. Students received interviews at 49% of the programs signaled, which increased to 56.5% when specialties offering more than 7 signals were excluded. 35% of students matched at a signaled program. Conclusions Students’ perceptions and strategies related to the signaling process are varied and may impact interview offers. Advisors should monitor and review internal institutional trends to help inform future educational programming to optimize signal allocation for their students.
Exploring social media influences on vaccine decision-making in parents: a netnography
Authors: Smith Susan E. , Sivertsen Nina , Lines Lauren , De Bellis Anita 
Published: May 2024

Background: Immunization is one of the most significant health initiatives of recent times. Despite this, vaccine hesitancy is increasing and was listed as one of the top 10 threats to global health by the World Health Organization in 2019. A major factor associated with vaccine hesitancy is thought to be the viral spread of misinformation by a small but active anti-vaccination movement. Objectives: The purpose of this study was to explore the influences of social media on vaccine decision-making in parents. Design: This study is part of a larger body of research that explored vaccine decision-making in parents. Other methods included were an online survey and semi-structured interviews. This study investigated the influence of cyberculture on parents in an online environment. Method: This study employed netnography, a form of qualitative inquiry with its roots in ethnography as methodology and a purpose-designed Facebook page as the means of exploring a purpose-designed online community with a particular focus on the culture, belief systems and influences present. Both manual and computer-assisted thematic analyses were used to analyse the data obtained. Results: Three key themes were identified in this study. These included vaccine safety concerns, the emotional debate and COVID-19-specific issues. The results indicated the presence of strong anti-vaccination sentiment combined with an ‘infodemic’ of conspiracy theories, misinformation and vitriol with the potential to negatively impact parents seeking immunization information. Conclusion: Given the popularity and accessibility of social media and the ready access to misinformation present online, it is evident that parental vaccine decision-making may be impacted adversely. Therefore, it is important that healthcare professionals are aware of this and provide adequate and timely education prior to parents seeking information on social media.
Association of Opioid and Concurrent Benzodiazepine, Skeletal Muscle Relaxant, and Gabapentinoid Usage on Healthcare Expenditure and Resource Utilization: A Serial Cross-Sectional Study, 2009 to 2019
Authors: Sepassi Aryana , Li Meng , Suh Kangho , Stottlemyer Britney , Bounthavong Mark 
Published: May 2024

Background: Healthcare providers may be utilizing central nervous system (CNS) depressants to reduce opioid use due to recent changes in public policy. Combination use of these agents with opioids increases the risk of respiratory depression and death. Healthcare expenditures by individuals using these drug combinations have not been previously quantified. We sought to characterize healthcare costs and expenditures associated with a population reporting concurrent CNS depressants and opioid use compared with nonopioid analgesics in the United States from 2009 to 2019. Methods: A serial cross-sectional design was used to compare the healthcare expenditures of adult Medical Expenditure Panel Survey respondents who were prescribed nonopioid analgesics, opioids only, opioids/benzodiazepines (BZD), opioids/BZD/skeletal muscle relaxants (SMR), or opioids/gabapentin (gaba) using pooled data from 2009 to 2019. Expenditure (cost and resource utilization) categories included inpatient, outpatient, office-based, and prescription medicine. Average marginal effects were used to compare survey-weighted annual costs and resource utilizations across the groups as compared to nonopioid analgesic respondents, adjusted for covariates. Results: A weighted total of 34 241 838 individuals were identified. Most were opioid-only respondents (46.5%), followed by nonopioid analgesic (43.4%), opioid/BZD (5.3%), opioid-gaba (3.5%), and opioid/BZD/SMR respondents (1.3%). In comparison to the study groups with nonopioid analgesics, opioid-gaba users had the highest significant incremental cost difference among the different pairings (+$11 684, P < .001). Opioid-gaba, opioid/BZD, and opioid/BZD/SMR respondents had significantly higher inpatient, emergency department, and prescription drug costs and use compared to nonopioid analgesic respondents. Opioid-only respondents had higher outpatient and office-based costs and visits compared to nonopioid analgesic respondents. Conclusions: As healthcare providers seek to utilize fewer opioids for pain management, attention must be paid to ensuring safe and effective use of concurrent CNS depressants to mitigate high healthcare costs and burden.
Stress Exposure and PTSD in a Cross-Sectional Residential Substance Use Treatment Sample
Authors: Schacht Rebecca L. , Meyer Laurel E. , Wenzel Kevin R. , Mette Meghan E. , Berg Samantha K. , Lewis Christa R. , Carrano Jennifer L. , Fishman Marc 
Published: May 2024

Background: Aim 1 of this cross-sectional, observational study with people in residential treatment for substance use disorders (SUDs) was to document stress exposure. Aim 2 was to assess potential sociodemographic and health differences based on probable posttraumatic stress disorder (PTSD) status. Aim 3 was to assess relative contributions of Diagnostic and Statistical Manual (DSM)-congruent versus DSM-incongruent stressors (Criterion A vs non-Criterion A) to mental and physical health. We hypothesized that both types of stressors would significantly contribute to impairment across indicators and that DSM-congruent stressor exposure would be more strongly associated with impairment than DSM-incongruent exposure. Methods: We assessed exposure to DSM-congruent traumatic stressors and DSM-incongruent life stressors, PTSD and depressive symptoms, emotion regulation difficulties, substance use recovery capital, and physical/mental health-related quality of life among 136 people in residential SUD treatment who were 64% men, 36% women; 49% white, 41% Black, 11% multiracial/another race; 18% lesbian, gay, or bisexual (LGB+); mean age = 39.82 (standard deviation = 12.24) years. Results: Participants reported experiencing a mean of 9.76 (SD = 6.11) DSM-congruent events. Those with probable PTSD were younger and more likely to be LGB+ than those without probable PTSD ( P < .05). Experiencing higher numbers of DSM-congruent events was associated with more severe PTSD and depressive symptoms, emotion regulation difficulties, and lower physical health-related quality of life ( P < .05). DSM-incongruent stressor exposure was not independently associated with any indicators. Recovery capital was not associated with either type of stress exposure. Conclusions: Stressful event exposure among people in residential SUD treatment is very high. Those who are younger or LGB+ in residential SUD treatment may be at greater risk of developing PTSD. DSM-congruent stressors are more consistently associated with mental health indicators than are DSM-incongruent stressors. Prioritizing treatment targets and identifying implementable treatment strategies can be challenging with this complex population.