bluuebunny/crossref_metadata_2025_split huggingface dataset:
Artificial Intelligence in Hand Surgery – How Generative AI is Transforming the Hand Surgery Landscape
Authors: TAN Ruth En Si , TEO Wendy Zi Wei , PUHAINDRAN Mark E. 
Published: March 2024

Artificial intelligence (AI) has witnessed significant advancements, reshaping various industries, including healthcare. The introduction of ChatGPT by OpenAI in November 2022 marked a pivotal moment, showcasing the potential of generative AI in revolutionising patient care, diagnosis and treatment. Generative AI, unlike traditional AI systems, possesses the ability to generate new content by understanding patterns within datasets. This article explores the evolution of AI in healthcare, tracing its roots to the term coined by John McCarthy in 1955 and the contributions of pioneers like John Von Neumann and Alan Turing. Currently, generative AI, particularly Large Language Models, holds promise across three broad categories in healthcare: patient care, education and research. In patient care, it offers solutions in clinical document management, diagnostic support and operative planning. Notable advancements include Microsoft’s collaboration with Epic for integrating AI into electronic medical records (EMRs), enhancing clinical data management and patient care. Furthermore, generative AI aids in surgical decision-making, as demonstrated in plastic, orthopaedic and hepatobiliary surgeries. However, challenges such as bias, hallucination and integration with EMR systems necessitate caution and ongoing evaluation. The article also presents insights from the implementation of NUHS Russell-GPT, a generative AI chatbot, in a hand surgery department, showcasing its utility in administrative tasks but highlighting challenges in surgical planning and EMR integration. The survey showed unanimous support for incorporating AI into clinical settings, with all respondents being open to its use. In conclusion, generative AI is poised to enhance patient care and ease physician workloads, starting with automating administrative tasks and evolving to inform diagnoses, tailored treatment plans, as well as aid in surgical planning. As healthcare systems navigate the complexities of integrating AI, the potential benefits for both physicians and patients remain significant, offering a glimpse into a future where AI transforms healthcare delivery. Level of Evidence: Level V (Diagnostic)
Derecognition Diplomacy: a Study of Morocco’s Foreign Policy on the Western Sahara
Authors: Hecht Caroline 
Published: March 2024

Summary
International recognition, and its revocation, derecognition, have important legal and practical implications. This article addresses the issue of derecognition as a foreign policy strategy answering the question: what are the strategies that origin states pursue to achieve the derecognition of contested states? Analysis of the foreign policy of Morocco towards the Western Sahara shows that origin states do indeed seek derecognition as a policy goal, primarily using economic and domestic political tools. International law and identity linkages appear to play a more rhetorical than influential role. Power politics is notably absent from recogniser state decision-making, but lack of great power interest may foster the sense of ambiguity under which derecognition thrives. This article provides a theory of derecognition foreign policy; a taxonomy of recogniser states into holdouts, reversers and cyclers; and a plausibility probe of the relationship between recogniser states and their associated foreign policy tools.
Unraveling goitered gazelle (Gazella subgutturosa) diversification: insights from phylogeography and species distribution modeling
Authors: Asadollahi Mojgan , Ahmadzadeh Faraham , Keyghobadi Nusha 
Published: March 2024

Abstract
The impact of climate fluctuations on the genetic diversity and distribution of species is of particular concern for large mammals that are already at risk of extinction. In this study, we investigated the genetic status of populations, the evolutionary relationships, and the current and future state of population dispersion of the goitered gazelle, Gazella subgutturosa, using 109 mtDNA sequences (cytb) and species distribution modeling. We assessed the impact of past (Last Glacial Maximum [lgm: 21 Kya] and Mid-Holocene [6 Kya]), current, and future (2070) climate on the phylogeography and spatial distribution of the species. Our results indicate evidence of divergence of two main clades (G. subgutturosa subgutturosa, and G. subgutturosa yarkandensis) (1.052 Mya) and a further split between two clades of G. s. subgutturosa (Middle Eastern and Central Iranian) in the middle Pleistocene. Historical species distribution models suggest the species’ range has not changed much across all periods examined, but there has been a decreasing trend from 21k to the current. Future climate projections (bcc-csm1 and ccsm4, rcp s 4.5 and 6 scenarios) predict a contraction of suitable habitat at the northern and southern edges of the species’ current distribution, shifting the range to the center of the study area. Biogeographic analyses suggest that vicariance and dispersal events have shaped the genetic structure of G. subgutturosa. Our findings suggest that the current genetic structure of the species is potentially related to Pleistocene climatic fluctuations and refuges (Alborz, Zagros, and Kope Dagh Mountains) during cold periods. The study highlights the importance of understanding the genetic status of populations and their evolutionary relationships to effectively prevent further declines of species at risk of extinction.
New Miocene fossil taxa illuminate the evolution and paleobiogeography of the Ponto-Caspian gammaroid amphipod radiation
Authors: Copilaş-Ciocianu Denis , Ionesi Viorel 
Published: March 2024

Abstract
The Ponto-Caspian radiation of gammaroid amphipods is one of the world’s most diverse lacustrine crustacean radiations as well as the only lacustrine amphipod radiation with a fossil record (dating back 9 Ma). However, the phyletic relationship between fossils and extant species was never formally investigated, hampering our evolutionary understanding of this diverse clade. Here, we present the first morphology-based phylogeny (114 characters) of Ponto-Caspian gammaroids that includes 99% of extant taxa, all previously known fossils, as well as newly discovered fossil specimens from the Late Miocene (10.5 Ma) of eastern Romania. Our phylogenetic and phenetic results strongly support the monophyly of all fossil taxa. However, despite its widespread Late Miocene distribution throughout the Paratethys Sea, this fossil clade left no modern descendants. Its exact phylogenetic position is ambiguous, although it is nested in the radiation’s crown group. Morphometric analyses further indicate that fossil species occupy a narrower and peripheral morphospace relative to extant taxa. Our results support the assignment of the newly discovered Romanian fossils to a new genus, Eogmelina gen. nov. with two new species Eogmelina moldavica gen. et sp. nov. and Eogmelina prisca gen. et sp. nov. Finally, our findings call for a fundamental systematic restructuring of Ponto-Caspian gammaroids at genus and family level.
The Cost of Poverty: The Relationship Between Insurance Status, Length of Stay, and Discharge Disposition in Trauma Patients
Authors: Bontrager Alexandria M. , Medvecz Andrew J. , Smith Candice , Smith Michael C. 
Published: March 2024

Introduction Insurance status (IS) is known to be associated with length of stay (LOS). The impact of IS on excess LOS (ELOS), days between medical readiness and discharge date, has not been explored. Methods We conducted a retrospective study of patients with pelvic fractures at a level I trauma center. Outcomes included ELOS (primary), discharge disposition (secondary), and ELOS-associated complications (secondary). Results 185 patients were included. Uninsured patients were the youngest and had the least baseline comorbidities (31.3 years (median), Charlson Comorbidity Index (CCI) .1) while publicly insured patients were the oldest and had the most baseline comorbidities (58.4 years (median), CCI 2.32). Excess LOS and associated complications did not differ among groups. After regression analysis, UIPs had longer LOS than PRPs (2.07 days, 95% CI .28-3.85). UIPs were recommended to go to inpatient rehabilitation 51.6% of the time but were discharged home 93.6% of the time; 81.0% of these changes were attributed to insufficient financial resources. Conclusions Excess LOS and complications associated with ELOS were not associated with IS. Although UIPs were younger and had fewer baseline comorbidities, they had longer LOS after regression analysis. While discharge recommendations differed based on insurance status, UIPs had limited access to rehabilitation due to financial disparities. Despite initial treatment team recommendations, UIPs had to be sent home as their lack of insurance precluded inpatient rehabilitation placement.
The effects of tranexamic acid in patients treated with extracorporeal membrane oxygenation after cardiac surgery
Authors: Chen Wei , Du Zhongtao , Wang Liangshan , Wang Mengjun , Wang Hong , Hou Xiaotong 
Published: March 2024

Background The lysine analog tranexamic acid (TXA) is used as a blood protective drug in cardiac surgery, but efficacy and safety outcomes in patients treated with extracorporeal membrane oxygenation (ECMO) after surgery remain poorly understood. Methods From January 1, 2017 to December 31, 2022, we retrospectively analyzed patients assisted by ECMO after cardiac surgery and divided them into TXA and control groups depending on whether TXA was used or not. The primary study outcome was red blood cell (RBC) transfusion during ECMO. Results In total, 321 patients treated with ECMO after cardiac surgery were assessed; 185 patients were eligible for inclusion into to the TXA-intervention group and 136 into to the control group. RBC transfusion during ECMO was 8.0 IU (4.0 IU–14.0 IU) in the TXA group versus 10.0 IU (6.0 IU–16.0 IU) in the control group ( p = .034). Median total chest drainage volume after surgery was 1460.0 mL (650.0–2910.0 mL) and 1680.0 mL (900.0–3340.0 mL) in TXA and control groups, respectively ( p = .021). Postoperative serum D-dimer levels were significantly lower in the TXA group when compared with the control group; 1.125 µg/mL (0.515–2.176 µg/mL) versus 3.000 µg/mL (1.269–5.862 µg/mL), p < .001. Serious adverse events, including vascular occlusive events, did not differ meaningfully between groups. Conclusions In patients treated with ECMO after cardiac surgery, TXA infusion modestly but significantly reduced RBC transfusions and chest tube output when compared with the control group.
A five-year review of chemoradiotherapy practice in anal cancer: Radiotherapy audit results from a cancer centre in Wales, UK
Authors: Tunio Mutahar A. , Davies Nicki , Caparros Elliot , Davies Janis , Foyle Stuart 
Published: March 2024

Aim: To review a five-year clinical practice of radical chemoradiotherapy (CRT) for anal cancers at a cancer centre in Wales. Methods: A retrospective audit examined the quality of radical CRT for anal cancers treated between November 2016 and November 2021 by investigating seven critical indicators set by Radiation Therapy Oncology Group and ACT II trials, (1) 95% completion of computed tomography simulation within 14 days of consent, (2) 100% CRT delivery within 28 days of computed tomography simulation, (3) 100% CRT delivery within 28 days of consent, (4) overall treatment time of RT 38 days with > 2 days breaks <5%, (5) 75% completion of concurrent chemotherapy, (6) <2% CRT related colostomies, and (7) <2% the 30-days mortality rate. Results: A total of 80 anal cancers received CRT over five years. Around 95.0% underwent computed tomography simulation within 14 days of consent. The observed slight deviation was related to the Covid pandemic in 2020. About 96.3% started CRT within 28 days of computed tomography simulation. The mean duration of CRT was 37.9 days. Radiotherapy (RT) interruptions > 2 days were about 5%, and 67.5% started CRT within 28 days of consent. About 92.5% and 76.2% completed mitomycin and capecitabine without breaks, respectively. The colostomy rate was 1.2%, and the 30-day mortality was 1.2%. Conclusion: Audit results matched with the standards in six domains. Overall treatment time of 37.9 days, colostomy rates of 1.2%, and the 30-day mortality rate of 1.2% were commendable. Overall time interval between consent and CRT delivery can be achieved by time-constrained measures.
UCL Throwing Injuries in Nonprofessional Baseball Players: A 14-Year Retrospective Study
Authors: Zaremski Jason L. , Pazik Marissa , Hunt Harold , Dodd William S. , Nguyen Binh K. , Farmer Kevin W. , Horodyski MaryBeth 
Published: March 2024

Background: This study evaluated treatment modality (surgical vs nonoperative) of medial ulnar collateral ligament (UCL) injuries in nonprofessional throwing baseball athletes by comparing type, severity, and location of UCL injury. Hypothesis: Baseball players with closed medial epicondyle physes and concomitant throwing-related UCL injury will be more likely to undergo surgical intervention than players with open medial epicondyle physes. Study Design: Retrospective. Level of Evidence: Level 5. Methods: A total of 119 baseball players with a mean age of 16.9 ± 2.5 years (range, 11-25 years) were included in the study. Datapoints included sex, age at time of injury, severity, and location of UCL injury, growth plate status, operative versus conservative management, and concomitant flexor forearm injury. Results: A total of 75 players were treated conservatively; 43 underwent UCL reconstruction (UCL-R), and 1 had an unknown treatment outcome. No significant difference was found for age related to treatment type, UCL-R (17.2 ± 2.2) versus conservative treatment (16.8 ± 2.6). Athletes with closed medial epicondylar growth plates were more likely to undergo UCL-R than athletes with open medial epicondylar growth plates ( P = 0.02). There were no significant differences between UCL injury location (42 distal, 37 proximal, 18 combined tear locations, 11 complete tears, and 11 intact UCLs with inflammation) by treatment type ( P = 0.09). There was a significant difference for UCL severity (11 complete tears, 96 partial tears) by treatment type ( P = 0.03). Conclusion: Nonprofessional athletes with closed medial epicondylar growth plates and throwing-related UCL injuries were more likely to be treated surgically. Baseball athletes with partial tears, if skeletally immature, require further long-term evaluation. Clinical Relevance: Continued knowledge gains in this area of throwing medicine will further improve our treatment algorithms in nonprofessional baseball players.
Cortical Laminar Necrosis After Severe Hydrocephalus: Case Report and Review of the Literature
Authors: Peyton Margo A. , Cho Sung-Min , Xia Yuanxuan , Piran Pirouz , Luciano Mark , Rivera-Lara Lucia 
Published: March 2024

Objectives We present a case of cortical laminar necrosis after severe hydrocephalus to highlight considerations for multimodal cerebral autoregulation monitoring to determine mean arterial pressure (MAP) thresholds during neurological emergencies, as well as postoperative head imaging for patients with ventriculoperitoneal shunts (VPS). Methods A 40-year-old woman with a history of Chiari II malformation and non-communicating hydrocephalus with VPS presented in septic shock from a sacral wound. One week after colostomy for fecal diversion, the patient became comatose and had progressive slowing to full suppression on electroencephalogram (EEG). Results CT imaging revealed hydrocephalus, most likely due to VPS distal obstruction from intraperitoneal surgery. Despite neurosurgical and neurocritical care management, MRI confirmed diffuse cortical hypoxic ischemic injury. Discussion The Neurocritical Care Society’s Emergency Neurological Life Support (ENLS) protocol for neurological emergencies focuses on managing increased intracranial pressure (ICP) but does not set MAP goals. As ICP may be very high during brain herniation, our case demonstrates that higher MAP may be required to maintain adequate circulation. To determine the optimal MAP target, bedside multimodality monitoring, including ICP monitors, transcranial doppler, and near infrared spectroscopy, can help establish individualized cerebral autoregulation guided thresholds. Outside of a neurological intensive care unit, EEG can monitor cerebral blood flow and indicate windows for intervention before exam or imaging changes. Additionally, our case demonstrates how a post-operative surveillance CT head should be considered for patients with VPS.
Feasibility and Impact Assessment of a Food Insecurity Protocol in a Large Urban Pediatric Primary Care Network
Authors: Kim Noah , Fischer Laura , Gross Sarah Haley , Weissman Mark , Essel Kofi 
Published: March 2024

Introduction/Objectives: In 2022, 1 in 6 households with children experienced food insecurity (FI) in the United States. The negative impact of FI on child health is well documented and pediatric clinicians are encouraged to actively screen and intervene in clinical settings. This study aims to evaluate the feasibility and impact of a FI management protocol implemented in 2017 at a pediatric primary care health network serving patients who are Medicaid-eligible in Washington, DC. Methods: In 2019, an 18-item electronic survey was sent to a convenience sample of 42 pediatric clinicians within the health network to understand their knowledge, attitudes, and behaviors surrounding implementation. Both quantitative and qualitative responses were collected and analyzed. We report frequencies of the Likert-type responses, including perceived compliance with protocol components and intervention efficacy. We evaluated the relationship between FI knowledge level and rates of clinician documentation compliance by chi square and Cramer’s V statistic for effect size. Open-ended responses were reviewed, and common themes were identified and used to provide context for quantitative results. Results and Conclusions: Out of 42 clinicians invited to complete the survey, 35 completed responses. All respondents reported universal screening for FI (100%) at routine examinations, 80% reported frequently electronically documenting FI in medical records, and 91% of clinicians reported frequently referring families who screened positive for FI to at least one FI resource, with 24% reporting that resources met families’ needs. Open-ended responses revealed increased awareness of FI prevalence and of patient experiences in households experiencing FI, increased satisfaction with clinical management of FI, but also concerns around having limited clinical time to do the protocol and the usefulness and accessibility of referred resources. In conclusion, implementing this pilot FI protocol was feasible, but clinicians perceived limited impact of the protocol on alleviating FI and desired more robust intervention options. Further improvements include shifting the burden of performing the protocol away from the clinician, such as by streamlining the protocol or identifying a resource staff member, and establishing more accessible and effective FI interventions such as “Food as Medicine” offerings in partnership with community organizations.
Cross-Cultural Adaptation and Validation of the Perception of the Doctor-Patient Relationship (PREMEPA) Questionnaire in Chronic Multi-Pathological Patients
Authors: Zarza-Arribas María , Menárguez Puche Juan Francisco , Morales López Rosario , Barber Valles Josep Xavier , Orozco Beltrán Domingo Luis 
Published: March 2024

Objective: To conduct a cross-cultural adaptation and validation in Primary Care of the PREMEPA doctor-patient relationship perception questionnaire. Design: Descriptive, cross-sectional study, using self-administered questionnaires. Qualitative validation: an adapted version of the original questionnaire, was adapted to our culture. The process consisted of the evaluation, cross-cultural adaptation and consensus of a group of experts. The questionnaire was piloted on a sample of 32 patients diagnosed with at least 2 chronic pathologies. Measures: Cognitive piloting, comprehensibility assessment, content validation and internal consistency analysis using Cronbach’s alpha coefficient. Quantitative validation: the internal consistency, construct validity and validity of the questionnaire were studied by means of a confirmatory factor analysis developed in a multicenter study, randomly selecting 202 patients with at least 2 chronic pathologies. Results: Content validity of the new Spanish version was confirmed to be adequate. Comprehensibility and internal consistency (Cronbach’s α coefficient = 0.78) were adequate. The confirmatory factor analysis showed good dimensionality, factor relationship and internal consistency, as well as acceptable construct validity. The final result was a 13-item questionnaire consisting of 2 dimensions, which explain 58.5% of the variance: participation in decision-making (accounting for 45.2% of the variance) and person-centered communication (encompassing courtesy, empathy, humanity, and trust). Conclusions: This adapted version of the PREMEPA questionnaire can be considered valid for use in the Spanish population with a history of chronic pathology. This version of PREMEPA provides a new instrument to understand and improve chronic patient care, which can improve the doctor-patient relationship, encouraging adherence to treatment and enhancing health outcomes.
A Radiologic Triangle Sign for Percutaneous Adductor Tendon Release (PATR): Cadaveric Study and Case Series
Authors: Del Vecchio Jorge Javier , Dealbera Eric Daniel , Chemes Lucas Nicolás , Slullitel Gastón , Calvi Juan Pablo , Dalmau-Pastor Miki 
Published: March 2024

Background: Combining osteotomies and soft tissue procedures is believed to reduce sesamoids in their anatomical position and maintain long-term correction when treating hallux valgus deformity. This study determines if a radiologic association exists between a radiolucent sign and a full percutaneous adductor tendon release (PATR), including a cadaveric study and a consecutive case series. Another aim was to determine the intra- and interobserver reliability of these observations. Methods: A prospective observational study was made between 2018 and 2019. First, a PATR was done on cadaveric specimens and, after the procedures, dissected to correlate what was seen fluoroscopically. The clinical group included 39 feet that presented mild-to-moderate HV deformity and were treated with percutaneous osteotomies associated with PATR. Results: Observers 1 and 2 saw a radioscopic radiolucent sign in 100% of cadavers and the patient population. They also observed a triangle-shaped image with an incidence of 75%, which we have named the “triangle sign.” Conclusion: The triangle sign may be helpful in the intraoperative confirmation of PATR and latero-plantar capsule release using this percutaneous technique. Level of Evidence: Level II, development of diagnostic criteria.