bluuebunny/crossref_metadata_2025_split huggingface dataset:
Labor Analgesia Initiation With Dural Puncture Epidural Versus Conventional Epidural Techniques: A Randomized Biased-Coin Sequential Allocation Trial to Determine the Effective Dose for 90% of Patients of Bupivacaine
Authors: Maeda A. , Villela-Franyutti D. , Lumbreras-Marquez M.I. , Murthy A. , Fields K.G. , Justice S. , Tsen L.C. 
Published: February 2024

(Anesth Analg. 2023. doi: 10.1213/ANE.0000000000006691)
Neuraxial labor analgesia includes the conventional epidural (EPL) technique as well as the combined spinal epidural and dural puncture epidural (DPE) techniques. Some advantages to the DPE technique have been discovered through research in comparison to the EPL technique. A study was conducted using a biased-coin up-down allocation method to determine the effective dose of bupivacaine needed to achieve initial analgesia in 90% of women in labor (ED90) using the DPE and EPL techniques. It was hypothesized that a lower bupivacaine dose would be needed with the DPE versus the EPL.
Public Health’s Role in a Post-Dobbs World—The New York City Abortion Access Hub
Authors: Stein T.B. , Vasan A. 
Published: February 2024

(N Engl J Med. 388;21. doi: 10.1056/NEJMp2301278)
The US court case Dobbs v. Jackson Women’s Health Organization removed the constitutional right to abortion. Currently, 13 states ban abortion with few exceptions, while other states have enacted certain restrictions around abortion. This, coupled with new legislation frequently being introduced that further restricts access to abortions, has made it very difficult for people searching for abortion information or services.
The Compatibility of Oxytocin and Tranexamic Acid Injection Products When Mixed for Coadministration by Infusion for the Treatment of Postpartum Hemorrhage: An In Vitro Investigation
Authors: Lambert P. , Tomazzini A. , Wright P. , McEvoy C. , Gallos I.D. , Ammerdorffer A. , Chinery L. , Coomarasamy A. , Gulmezoglu A.M. 
Published: February 2024

(BJOG. 2023;130:741–749)
Postpartum hemorrhage (PPH) is defined as the loss of more than 1000 mL of blood after childbirth. Signs and symptoms are present after birth, and they can be prevented. The World Health Organization has defined treatment for PPH. World Health Organization has created a bundle of recommendations based on evidence consisting of uterotonic medications, tranexamic acid (TXA), intravenous fluids, and uterine massage. This treatment bundle is known as E-MOTIVE intervention and is to be administered in cases of PPH.
Immediate Hypersensitivity to Chlorhexidine: Experience From an Allergy Center in China
Authors: Xiao H. , Zhang H. , Jia Q. , Xu F. , Meng J. 
Published: February 2024

(Anesthesiology. 2023; 138:364–371)
Chlorhexidine is a commonly used topical antibacterial agent for Gram-positive and Gram-negative bacteria and can be found in a great variety of antibacterial products. As use has increased, instances of allergic reactions to the compound have been reported, including contact dermatitis and anaphylaxis. As chlorhexidine is a component ingredient in many products used perioperatively, allergic reactions occurring in this setting can often be attributed to other factors rather than chlorhexidine as the true source. This study was designed to summarize the experience of an allergy center in China with chlorhexidine reactions.
Point of Care Maternal Ultrasound in Obstetrics
Authors: Easter S.R. , Hameed A.B. , Shamshirsaz A. , Fox K. , Zelop C.M. 
Published: February 2024

(Am J Obstet Gynecol. 2023;228(5):509–520)
Point-of-care ultrasound (POCUS) is generally defined as the medical application of ultrasound directly at a patient’s bedside to assess acute or critical medical conditions. It is routinely used in emergencies, operating rooms, and intensive care units because of its many advantages. POCUS has a lack of radiation, is easily accessible and affordable, and allows obstetricians and other providers to take an ultrasound without having to transport their patients. While POCUS is usually limited to fetal and uterine imaging, it can be adjusted to assess maternal health by helping to diagnose, accelerate the commencement of targeted therapy, and evaluate response to treatment. In turn, earlier diagnoses and treatment can help improve complications in pregnant patients and hopefully reduce causes of preventable death.
Preeclampsia at Term Can Be Classified Into Two Clusters With Different Clinical Characteristics and Outcomes Based on Angiogenic Biomarkers in Maternal Blood
Authors: Chaiworapongsa T. , Romero R. , Gotsch F. , Suksai M. , Gallo D.M. , Jung E. , Krieger A. , Chaemsaithong P. , Erez O. , Tarca A.L. 
Published: February 2024

(Am J Obstet Gynecol. 2023;228:569.e1–569.e24)
Pre-eclampsia, a complex and multisystemic disorder affecting a significant percentage of pregnancies worldwide, is a leading cause of preterm birth and maternal mortality. This condition is not uniform and can be classified into different subtypes based on gestational age and underlying pathophysiological mechanisms. Understanding these subtypes is crucial for predicting maternal and fetal outcomes and developing targeted therapeutic strategies.
A Randomized Trial Assessing the Impact of Educational Podcasts on Personal Control and Satisfaction During Childbirth
Authors: Cai F. , McCabe M. , Srinivas S.K. 
Published: February 2024

(Am J Obstet Gynecol. 2023;228:592.e1–592.e10)
Educational childbirth resources (including technology) can benefit pregnant women in several different ways. This includes lowering anxiety and fear around childbirth, decreasing perceptions of pain, and improving a sense of overall control throughout the birthing process. This study aimed to assess how educational podcasts can influence a pregnant woman’s labor experience, specifically through patient satisfaction and a sense of control during childbirth.
Virtual Reality is Beneficial in Decreasing Pain in Laboring Women: A Preliminary Study
Authors: Massov L. , Robinson B. , Rodriguez-Ramirez E. , Maude R. 
Published: February 2024

(Aust N Z J Obstet Gynaecol.2023; 63: 193–197)Labor pain is a highly variable experience, with a wide range of both pharmacological and nonpharmacologic methods available to help relieve pain during labor. Virtual reality (VR) distraction therapy is one of many nonpharmacologic modalities shown to assist patients in managing their acute pain in clinical settings. This has been tested in patients undergoing chemotherapy, physical therapy, treatment for dental work, and burn wounds, among other procedures. Those who use VR technology wear a headset to experience a 3D multisensory virtual world. Four published quantitative studies to date have used VR to determine the influence of VR on laboring women’s pain scores. This preliminary study is an open-label, randomized, controlled cross-over trial to examine how effective VR is in decreasing pain in laboring women.
Is 1 Day of Focused Training in Echocardiographic Assessment Using Subxiphoid-Only (EASy) Examination Enough? A Tertiary Hospital Response to the COVID-19 Crisis and the Use of the EASy Examination to Support Unit-Wide Image Acquisition
Authors: Bughrara Nibras F. , Neilson Maegan R. , Jones Stephanie , Workman Lorna , Chopra Amit , Pustavoitau Aliaksei 
Published: February 2024

OBJECTIVES:
We assessed the efficacy of 1-day training in echocardiography assessment using subxiphoid-only (EASy) followed by supervised image interpretation and decision-making during patient rounds as a novel approach to scaling up the use of point-of-care ultrasound (POCUS) in critically ill patients.

DESIGN:
Retrospective analysis of medical records and EASy examination images.

SETTING:
Tertiary care academic hospital.

PATIENTS:
A total of 14 adults (> 18 yr old) with COVID-19-associated respiratory failure under the care of Albany Medical Center’s surge response team from April 6–17, 2020 who received at least one EASy examination.

INTERVENTIONS:
Residents (previously novice sonographers) were trained in EASy examination using 1 day of didactic and hands-on training, followed by independent image acquisition and supervised image interpretation, identification of hemodynamic patterns, and clinical decision-making facilitated by an echocardiography-certified physician during daily rounds.

MEASUREMENTS AND MAIN RESULTS:
We recorded the quality of resident-obtained EASy images, scanning time, and frequency with which the supervising physician had to repeat the examination or obtain additional images. A total of 63 EASy examinations were performed; average scanning time was 4.3 minutes. Resident-obtained images were sufficient for clinical decision-making on 55 occasions (87%), in the remaining 8 (13%) the supervising physician obtained further images.

CONCLUSIONS:
EASy examination is an efficient, valuable tool under conditions of scarce resources. The educational model of 1-day training followed by supervised image interpretation and decision-making allows rapid expansion of the pool of sonographers and implementation of bedside echocardiography into routine ICU patient management.
An advanced machine learning method for simultaneous breast cancer risk prediction and risk ranking in Chinese population: A prospective cohort and modeling study
Authors: Liu Liyuan , He Yong , Kao Chunyu , Fan Yeye , Yang Fu , Wang Fei , Yu Lixiang , Zhou Fei , Xiang Yujuan , Huang Shuya , Zheng Chao , Cai Han , Bao Heling , Fang Liwen , Wang Linhong , Chen Zengjing , Yu Zhigang 
Published: February 2024

Abstract

Background:
Breast cancer (BC) risk-stratification tools for Asian women that are highly accurate and can provide improved interpretation ability are lacking. We aimed to develop risk-stratification models to predict long- and short-term BC risk among Chinese women and to simultaneously rank potential non-experimental risk factors.

Methods:
The Breast Cancer Cohort Study in Chinese Women, a large ongoing prospective dynamic cohort study, includes 122,058 women aged 25–70 years old from the eastern part of China. We developed multiple machine-learning risk prediction models using parametric models (penalized logistic regression, bootstrap, and ensemble learning), which were the short-term ensemble penalized logistic regression (EPLR) risk prediction model and the ensemble penalized long-term (EPLT) risk prediction model to estimate BC risk. The models were assessed based on calibration and discrimination, and following this assessment, they were externally validated in new study participants from 2017 to 2020.

Results:
The AUC values of the short-term EPLR risk prediction model were 0.800 for the internal validation and 0.751 for the external validation set. For the long-term EPLT risk prediction model, the area under the receiver operating characteristic curve was 0.692 and 0.760 in internal and external validations, respectively. The net reclassification improvement index of the EPLT relative to the Gail and the Han Chinese Breast Cancer Prediction Model (HCBCP) models for external validation was 0.193 and 0.233, respectively, indicating that the EPLT model has higher classification accuracy.

Conclusions:
We developed the EPLR and EPLT models to screen populations with a high risk of developing BC. These can serve as useful tools to aid in risk-stratified screening and BC prevention.
Adherence to a reproductive health intervention for young adults with sickle cell
Authors: Eades-Brown Nyema T. , Oguntoye Anne O. , Aldossary Dalal , Ezenwa Miriam O. , Duckworth Laurie , Dede Duane , Johnson-Mallard Versie , Yao Yingwei , Gallo Agatha , Wilkie Diana J. 
Published: February 2024

ABSTRACT

Background:
The CHOICES intervention is tailored specifically for young adults with sickle cell disease (SCD) or sickle cell trait (SCT). The face-to-face (F2F) delivery format is feasible with efficacy for improving knowledge about reproductive health for those with SCD or SCT.

Purpose:
The purpose of the study was to compare the participant adherence to a remote online CHOICES intervention study (N = 107) and a F2F CHOICES intervention study (N = 234).

Methodology:
In both studies, participants with SCD or SCT were randomized into experimental or usual care control groups. Descriptive statistics were collected for all participants by group in both studies. Adherence was measured by retention at each data collection time point. Independent t-tests were conducted to compare mean participant adherence of the F2F and online studies postbaseline (6, 12, 18, and 24 months).

Results:
There was a significant difference in mean adherence postbaseline between the studies (p = .005). The results suggest that more research is necessary for proper online participant retention.

Conclusion:
Advance practice nurses that are well informed on CHOICES can transmit the availability of this evidence-based intervention to this special population. Special referral for the CHOICES intervention, which is tailored specifically for young adults with SCD or SCT, may increase adherence to the intervention if it comes from trusted health care providers.

Implications:
Nurse practitioners are educators in primary and acute care settings. Encounters with reproductive age populations with SCD or SCT can occur in both settings.
Optimizing surveillance of low-risk metabolic dysfunction associated steatotic liver disease using transient elastography
Authors: Gopalakrishna Harish , Nair Gayatri B. , Salman Roghani Roham , Ravendhran Natarajan , Rotman Yaron 
Published: February 2024

Background
Most people with metabolic dysfunction-associated steatotic liver disease (MASLD) lack significant fibrosis and are considered low-risk. Surveillance strategy for low-risk MASLD remains uncertain.

Aim
Identify which low-risk subjects can avoid follow-up vibration-controlled transient elastography (VCTE) within 1 year.

Methods
Retrospective analysis of two independent low-risk MASLD cohorts (baseline liver stiffness [LS] < 8kPa) with routine 6–12 months follow-up VCTE. The primary outcome was LS ≥ 8kPa on follow-up, requiring referral and further work-up according to current guidance. Predictors of the primary outcome on univariate and multivariate logistic regression were incorporated into a decision algorithm, and validated in an independent cohort.

Results
Of 206 subjects in the derivation cohort, 96 were low-risk. After a median of 10 months, 24 (25%) low-risk subjects had LS ≥ 8kPa. Baseline LS (P < 0.01) and ALT change from baseline (P = 0.02) (multivariate AUROC = 0.84 [0.74–0.94]) predicted the primary outcome, and were incorporated to a two-step decision algorithm. Low-risk subjects with baseline LS < 5.5 kPa can avoid repeating VCTE in a year, while those with LS > 6.8 kPa require one. For intermediate baseline LS (5.5–6.8kPa), repeat VCTE is only indicated when ALT increase > 6 U/L. The algorithm had 92% negative predictive value, 78% specificity, and 78% accuracy in the derivation cohort. In the validation cohort (n = 64), it had 91% NPV, 72% specificity, and 71% accuracy.

Conclusion
In low-risk MASLD, a simple algorithm combining baseline LS and ALT change can be used to safely avoid a repeat VCTE in a year.
Vaccination May Be Economically and Epidemiologically Advantageous Over Frequent Screening for Gonorrhea Prevention
Authors: Williams Austin M. , Gromov Dmitry , Spicknall Ian H. , Romero-Severson Ethan O. 
Published: February 2024

BackgroundGonorrhea's rapid development of antimicrobial resistance underscores the importance of new prevention modalities. Recent evidence suggests that a serogroup B meningococcal vaccine may be partially effective against gonococcal infection. However, the viability of vaccination and the role it should play in gonorrhea prevention are an open question.MethodsWe modeled the transmission of gonorrhea over a 10-year period in a heterosexual population to find optimal patterns of year-over-year investment of a fixed budget in vaccination and screening programs. Each year, resources could be allocated to vaccinating people or enrolling them in a quarterly screening program. Stratifying by mode (vaccination vs. screening), sex (male vs. female), and enrollment venue (background screening vs. symptomatic visit), we consider 8 different ways of controlling gonorrhea. We then found the year-over-year pattern of investment among those 8 controls that most reduced the incidence of gonorrhea under different assumptions. A compartmental transmission model was parameterized from existing literature in the US context.ResultsVaccinating men with recent symptomatic infection, which selected for higher sexual activity, was optimal for population-level gonorrhea control. Given a prevention budget of $3 per capita, 9.5% of infections could be averted ($299 per infection averted), decreasing gonorrhea sequelae and associated antimicrobial use by similar percentages. These results were consistent across sensitivity analyses that increased the budget, prioritized incidence or prevalence reductions in women, or lowered screening costs. Under a scenario where only screening was implemented, just 5.5% of infections were averted.ConclusionsA currently available vaccine, although only modestly effective, may be superior to frequent testing for population-level gonorrhea control.
Diagnosis and Management of Esophageal Fistulas After Lung Transplantation: A Case Series
Authors: Vanstraelen Stijn , Vos Robin , Dausy Marie , Van Slambrouck Jan , Vanluyten Cedric , De Leyn Paul , Coosemans Willy , Decaluwé Herbert , Van Veer Hans , Depypere Lieven , Bisschops Raf , Demedts Ingrid , Casaer Michael P. , Debaveye Yves , De Vlieger Greet , Godinas Laurent , Verleden Geert , Van Raemdonck Dirk , Nafteux Philippe , Ceulemans Laurens J. 
Published: February 2024

Background.
Lung transplantations are highly complex procedures, often conducted in frail patients. Through the addition of immunosuppressants, healing can be compromised, primarily leading to the development of bronchopleural fistulas. Although esophageal fistulas (EFs) after lung transplantation remain rare, they are associated with significant morbidity. We aimed to investigate the clinical presentation, diagnostic approaches, and treatment strategies of EF after lung transplantation.

Methods.
All patients who developed EF after lung transplantation at the University Hospitals Leuven between January 2019 and March 2022 were retrospectively reviewed and the clinical presentations, diagnostic approaches, and treatment strategies were summarized.

Results.
Among 212 lung transplantation patients, 5 patients (2.4%) developed EF. Three patients were male and median age was 39 y (range, 34–63). Intraoperative circulatory support was required in 3 patients, with 2 needing continued support postoperatively. Bipolar energy devices were consistently used for mediastinal hemostasis. All EFs were right-sided. Median time to diagnosis was 28 d (range, 12–48) and 80% of EFs presented as recurrent respiratory infections or empyema. Diagnosis was made through computed tomography (n = 3) or esophagogastroscopy (n = 2). Surgical repair with muscle flap covering achieved an 80% success rate. All patients achieved complete resolution, with only 1 patient experiencing a fatal outcome during a complicated EF-related recovery.

Conclusion.
Although EF after lung transplantation remains rare, vigilance is crucial, particularly in cases of right-sided intrathoracic infection. Moreover, caution must be exercised when applying thermal energy in the mediastinal area to prevent EF development and mitigate the risk of major morbidity. Timely diagnosis and surgical intervention can yield favorable outcomes.
Towards human-centred standards for legal help AI
Authors: Hagan Margaret 
Published: February 2024

As more groups consider how AI may be used in the legal sector, this paper envisions how companies and policymakers can prioritize the perspective of community members as they design AI and policies around it. It presents findings of structured interviews and design sessions with community members, in which they were asked about whether, how, and why they would use AI tools powered by large language models to respond to legal problems like receiving an eviction notice. The respondents reviewed options for simple versus complex interfaces for AI tools, and expressed how they would want to engage with an AI tool to resolve a legal problem. These empirical findings provide directions that can counterbalance legal domain experts' proposals about the public interest around AI, as expressed by attorneys, court officials, advocates and regulators. By hearing directly from community members about how they want to use AI for civil justice tasks, what risks concern them, and the value they would find in different kinds of AI tools, this research can ensure that people's points of view are understood and prioritized, rather than only domain experts' assertions about people's needs and preferences around legal help AI.
This article is part of the theme issue ‘A complexity science approach to law and governance'.
GPT-4 passes the bar exam
Authors: Katz Daniel Martin , Bommarito Michael James , Gao Shang , Arredondo Pablo 
Published: February 2024

In this paper, we experimentally evaluate the zero-shot performance of GPT-4 against prior generations of GPT on the entire uniform bar examination (UBE), including not only the multiple-choice multistate bar examination (MBE), but also the open-ended multistate essay exam (MEE) and multistate performance test (MPT) components. On the MBE, GPT-4 significantly outperforms both human test-takers and prior models, demonstrating a 26% increase over ChatGPT and beating humans in five of seven subject areas. On the MEE and MPT, which have not previously been evaluated by scholars, GPT-4 scores an average of 4.2/6.0 when compared with much lower scores for ChatGPT. Graded across the UBE components, in the manner in which a human test-taker would be, GPT-4 scores approximately 297 points, significantly in excess of the passing threshold for all UBE jurisdictions. These findings document not just the rapid and remarkable advance of large language model performance generally, but also the potential for such models to support the delivery of legal services in society.
This article is part of the theme issue ‘A complexity science approach to law and governance’.
Entrepreneurial practices towards entrepreneurial intentions from Chinese vocational college students: a mediation-moderation model
Authors: Qin Chengbin 
Published: February 2024

Purpose
The entrepreneurial ecosystem within Chinese vocational colleges offers a unique platform to investigate the interplay between entrepreneurial passion, education and intention. This study aims to assess the effect of entrepreneurial education on alertness, passion and mindset, in turn, on entrepreneurial orientation and intentions. In addition, the study examines the mediating role of the entrepreneurial mindset between entrepreneurial passion and education; and to identify the moderating effect of entrepreneurial self-efficacy between entrepreneurial orientation and intentions.

Design/methodology/approach
Using a cross-sectional methodology based on self-reported data from students across various Chinese vocational colleges, the study used a quantitative method to derive its findings.

Findings
The results highlighted a strong positive effect of entrepreneurial education on passion, mindset and alertness. The study also found that an increased emphasis on entrepreneurial education fostered a proactive entrepreneurial orientation, a significant predictor of entrepreneurial intentions. The entrepreneurial mindset played a pivotal mediating role, enhancing the direct effects observed. Moreover, students with higher entrepreneurial self-efficacy exhibited a more substantial inclination towards entrepreneurial intentions, further buttressed by their orientation.

Originality/value
This study underscores the critical role of fostering passion, education and self-efficacy in cultivating entrepreneurial intentions among students in Chinese vocational colleges, offering valuable theoretical and managerial implications for educators and policymakers alike.