bluuebunny/crossref_metadata_2025_split huggingface dataset:
We Need to Talk: Advancing Open Inquiry
Authors: Cassel Christine K. , Maurana Cheryl A. 
Published: February 2024

Abstract
In this article, the authors explore the current state of divisiveness in U.S. society and its impact on medical schools. Higher education institutions are increasingly faced with challenges in supporting freedom of speech while respecting marginalized groups who may feel attacked by certain kinds of speech. “Cancel culture” has resulted in misunderstandings, job loss, and a growing fear of expressing ideas that may offend someone. These dynamics are particularly relevant in medicine, where issues of racial justice, reproductive health, gender identity, and end-of-life care, occurring in the context of personal and religious differences, affect patient care.
Despite these challenges, there must be ways to talk and listen respectfully to each other and bridge sociopolitical divides. Open inquiry and discussion are essential to medical education and patient care. There needs to be a common language and a setting where open engagement is encouraged and supported. This requires expertise and practice. The authors describe several models that offer constructive approaches toward this goal. Organizations including Braver Angels, Constructive Dialogue Institute, Essential Partners, and Greater Good Science Center are working to advance open inquiry and discussion, as are psychology leaders whose methods encourage empathy and learning from one another before engaging in a charged, polarized discussion topic. These and others are using methods that can benefit medical education in supporting diversity of ideas and deliberative discussions to equip students with skills to overcome divisiveness in their training and clinical practice.
Promoting civil discourse is critical to society’s well-being, and respectful engagement and open inquiry are essential to medical education and patient care. Despite the challenges posed by current societal divides, there are ways to talk with each other respectfully and constructively. The authors assert that this requires ongoing effort and practice, which are crucial for the health care enterprise to flourish.
Impression of Primary Care Follow-Up After a PICU Admission: A Pilot Survey of Primary Care Pediatricians
Authors: Harris-Kober Sarah , Motzel Alyssa , Grant Scott , Berman Brian , Yagiela Lauren 
Published: February 2024

OBJECTIVES:
The majority of PICU general follow-up occurs with primary care providers. Our objective was to investigate primary care pediatricians’: 1) comfort with and barriers to caring for children after a PICU admission, 2) knowledge of and screening for post-intensive care syndrome in pediatrics (PICS-P), and 3) resource needs.

DESIGN:
Pilot cross-sectional survey study.

SETTING:
Metropolitan Detroit, Michigan from September 2022 to March 2023.

SUBJECTS:
Primary care pediatricians.

MEASUREMENT AND MAIN RESULTS:
The survey included 15 questions on provider demographics, comfort with and barriers to caring for children after a PICU admission, knowledge of and screening practices for PICS-P, and resource needs. The median values for continuous data and frequencies for categorical data were calculated. The survey response rate was 17% (26/152). The median age was 38.5 years (interquartile range 34–52 yr) and 19 of 26 (73%) were female. In case studies, 26 of 26 (100%) were “very comfortable” resuming care for a patient with a straightforward bronchiolitis PICU admission while 8 of 26 participants (31%) were “somewhat uncomfortable” and 1 of 26 (4%) was “not at all comfortable” with caring for a patient after a complex acute respiratory distress syndrome PICU admission. Seven of 26 participants (27%) were familiar with the term “post-intensive care syndrome in pediatrics.” Over 50% screened for four of five PICS-P domains. Key barriers were care coordination with specialists, discomfort or difficulties with managing new home equipment, and inadequate or missing documentation.

CONCLUSIONS:
In this pilot study, approximately one-third of primary care pediatricians had knowledge of PICS-P. Participants experienced numerous care barriers. Our findings suggest future research could engage improved study methods and designs, and focus on interventions to support primary care-provided PICU follow-up.
Persistent Critical Illness and Long-Term Outcomes in Patients With COVID-19: A Multicenter Retrospective Cohort Study
Authors: Ling Ryan Ruiyang , Bonavia William , Ponnapa Reddy Mallikarjuna , Pilcher David , Subramaniam Ashwin 
Published: February 2024

OBJECTIVES:
A nontrivial number of patients in ICUs experience persistent critical illness (PerCI), a phenomenon in which features of the ICU course more consistently predict mortality than the initial indication for admission. We aimed to describe PerCI among patients with critical illness caused by COVID-19, and these patients’ short- and long-term outcomes.

DESIGN:
Multicenter retrospective cohort study.

SETTING:
Australian and New Zealand Intensive Care Society Adult Patient Database of 114 Australian ICUs between January 1, 2020, and March 31, 2022.

PATIENTS:
Patients 16 years old or older with COVID-19, and a documented ICU length of stay.

EXPOSURE:
The presence of PerCI, defined as an ICU length of stay greater than or equal to 10 days.

MEASUREMENTS:
We compared the survival time up to 2 years from ICU admission using time-varying robust-variance estimated Cox proportional hazards models. We further investigated the impact of PerCI in subgroups of patients, stratifying based on whether they survived their initial hospitalization.

MAIN RESULTS:
We included 4961 patients in the final analysis, and 882 patients (17.8%) had PerCI. ICU mortality was 23.4% in patients with PerCI and 6.5% in those without PerCI. Patients with PerCI had lower 2-year (70.9% [95% CI, 67.9–73.9%] vs. 86.1% [95% CI, 85.0–87.1%]; p < 0.001) survival rates compared with patients without PerCI. Patients with PerCI had higher mortality (adjusted hazards ratio: 1.734; 95% CI, 1.388–2.168); this was consistent across several sensitivity analyses. When analyzed as a nonlinear predictor, the hazards of mortality were inconsistent up until 10 days, before plateauing.

CONCLUSIONS:
In this multicenter retrospective observational study patients with PerCI tended to have poorer short-term and long-term outcomes. However, the hazards of mortality plateaued beyond the first 10 days of ICU stay. Further studies should investigate predictors of developing PerCI, to better prognosticate long-term outcomes.
Retinal artery to vein ratio is associated with cerebral microbleeds in individuals with type 1 diabetes
Authors: Tarkkonen Aleksi , Fickweiler Ward , Eriksson Marika , Sun Jennifer K. , Thorn Lena M. , Summanen Paula , Groop Per-Henrik , Putaala Jukka , Martola Juha , Gordin Daniel ,   the FinnDiane Study Group
Published: February 2024

Objectives:
A third of asymptomatic individuals with type 1 diabetes (T1D) show signs of cerebrovascular disease in brain MRI. These signs associate with advanced stages of diabetic retinal disease, but not in mild or moderate retinopathy. We aimed to evaluate a wider spectrum of retinal changes by exploring the relationship between quantitative measures of retinal vessel parameters (RVP) and cerebrovascular changes in T1D.

Methods:
We included 146 neurologically asymptomatic individuals with T1D [51% women, median age 40 (33.0–45.1) years] and 24 healthy, sex-matched and age-matched controls. All individuals underwent a clinical and biochemical work-up and brain MRI, which was evaluated for cerebral microbleeds (CMBs), white matter hyperintensities, and lacunar infarcts. RVPs, including central retinal arteriole (CRAE) and central retinal vein (CRVE) equivalents and the ratio of the two variables (arteriovenous ratio, AVR) were assessed quantitatively by a computer-assisted method (IVAN software, version 3.2.6) from fundus images.

Results:
Among T1D participants, those with CMBs had a lower arteriovenous ratio (AVR) compared with those without CMBs (P = 0.023). AVR was inversely associated with the amount of CMBs (r = −0.063, P = 0.035). CMB prevalence was higher in those with AVR below the median (31%) compared with above the median (16%, P < 0.001), and this difference was significant also after individuals with only no-to-mild retinopathy were included (28 vs. 16%, P = 0.005). A correlation between blood pressure and CRAE (r = −0.19, P = 0.025) appeared among those with T1D.

Conclusion:
Regardless of the severity of diabetic retinopathy, AVR is associated with the existence of CMBs in T1D.
The Short-term Effects of Artificial Tears on the Tear Film Assessed by a Novel High-Resolution Tear Film Imager: A Pilot Study
Authors: Antman Gal , Tessone Isaac , Rios Hernan A. , Verticchio Alice , Sidoti Paul A. , King-Smith P. Ewen , Suchowski Haim , Beitner Daniel , Eckert George , Siesky Brent , Rosen Richard B. , Chen Masako 
Published: February 2024

Purpose:
The purpose of this study was to investigate the effects of artificial tears (AT) on the sublayers of the tear film assessed by a novel tear film imaging (TFI) device.

Methods:
The mucoaqueous layer thickness (MALT) and lipid layer thickness (LLT) of 198 images from 11 healthy participants, 9 of whom had meibomian gland disease, were prospectively measured before and after exposure to 3 different AT preparations (Refresh Plus; Retaine [RTA]; Systane Complete PF [SYS]), using a novel nanometer resolution TFI device (AdOM, Israel). Participants were assessed at baseline and at 1, 5, 10, 30, and 60 minutes after instilling 1 drop of AT during 3 sessions on separate days. Repeated-measures analysis of variances were used for comparisons with P < 0.05 considered significant.

Results:
For all ATs, the mean MALT was greatest 1 minute after drop instillation, with an increase of 67%, 55%, and 11% above the baseline for SYS, Refresh Plus, and RTA, respectively. The SYS formulation demonstrated the highest percentage increases in mean MALT and LLT at most postdrop time points. The MALT differences were significantly higher in the SYS than in the RTA (P = 0.014). After 60 minutes, no AT group demonstrated statistically significant changes in MALT or LLT compared with baseline.

Conclusions:
We report, for the first time, the effects of AT on MALT and LLT using a high-resolution TFI. A substantial acute mean MALT increase occurs 1 minute after AT instillation with all agents tested, but there were clear differences in response and durability, suggesting the benefits of choosing specific AT according to the needs of each patient.
APOL1 nephropathy – a population genetics success story
Authors: Tabachnikov Orly , Skorecki Karl , Kruzel-Davila Etty 
Published: February 2024

Purpose of review
More than a decade ago, apolipoprotein L1 (APOL1) risk alleles designated G1 and G2, were discovered to be causally associated with markedly increased risk for progressive kidney disease in individuals of recent African ancestry. Gratifying progress has been made during the intervening years, extending to the development and clinical testing of genomically precise small molecule therapy accompanied by emergence of RNA medicine platforms and clinical testing within just over a decade.

Recent findings
Given the plethora of excellent prior review articles, we will focus on new findings regarding unresolved questions relating mechanism of cell injury with mode of inheritance, regulation and modulation of APOL1 activity, modifiers and triggers for APOL1 kidney risk penetrance, the pleiotropic spectrum of APOL1 related disease beyond the kidney – all within the context of relevance to therapeutic advances.

Summary
Notwithstanding remaining controversies and uncertainties, promising genomically precise therapies targeted at APOL1 mRNA using antisense oligonucleotides (ASO), inhibitors of APOL1 expression, and small molecules that specifically bind and inhibit APOL1 cation flux are emerging, many already at the clinical trial stage. These therapies hold great promise for mitigating APOL1 kidney injury and possibly other systemic phenotypes as well. A challenge will be to develop guidelines for appropriate use in susceptible individuals who will derive the greatest benefit.
Prediction of Admission to Intensive Care Unit and 1-Year Mortality After Acute Pancreatitis With Walled-Off Pancreatic Necrosis
Authors: Ebrahim Mohamed , Werge Mikkel Parsberg , Novovic Srdan , Amin Nadia Emad Lotfi , Karstensen John Gásdal , Jørgensen Henrik Løvendahl 
Published: February 2024

Background and aims
Pancreatic walled-off necrosis (WON) carries significant mortality and morbidity risks, often necessitating intensive care unit (ICU) admission. This retrospective study aimed to evaluate whether routine biochemical parameters at the time of the index endoscopic procedure could predict ICU admission and 1-year mortality following endoscopic treatment of WON.

Materials and Methods
We retrospectively identified 201 consecutive patients who underwent endoscopic drainage for WON between January 1, 2010, and December 31, 2020. Associations between routine biochemical blood tests and outcomes were assessed using logistic regression models.

Results
Within 1 year of the index endoscopy, 31 patients (15.4%) died, and 40 (19.9%) were admitted to the ICU due to sepsis. Preoperative electrolyte disturbances were more prevalent among ICU-admitted patients and nonsurvivors. Hyperkalemia, hypoalbuminemia, and elevated urea were significant predictors of 1-year mortality, while hypernatremia, elevated serum creatinine, and hypoalbuminemia predicted ICU admission. Predictive models exhibited good discriminative ability, with an AUC of 0.84 (95% CI,0,75–0.93) for 1-year mortality and 0.86 (95%CI, 0.79–0.92) for ICU admission.

Conclusions
Preoperative imbalances in routine blood tests effectively predict adverse outcomes in endoscopically treated WON patients.
Evaluating Social Determinants of Health Related to Cancer Survivorship and Quality of Care
Authors: Somayaji Darryl , Mohedat Heba , Li Chin-Shang 
Published: February 2024

Background
Social determinants of health posit that negative outcomes are influenced by individuals living in underserved and underresourced neighborhoods.

Objective
This study examines a cancer diagnosis, race/ethnicity, age, geographic location (residence), education, and social economic status factors at disease onset and treatment.

Methods
A multivariable PO regression analysis was run for quality of care at testing or diagnosis, and quality of care at treatment and the quality of received care compared with another person.

Results
Participants are representative of the Southern Community Cohort Study (SCCS) of adults diagnosed with breast (n = 263), prostate (n = 195), lung (n = 46), colorectal (n = 105), or other cancers (n = 526). This study includes cancer survivors who completed the SCCS Baseline and Cancer Navigation Surveys in urban (73.13%) and rural (26.87%) areas. White participants reported a higher quality of received care for testing or diagnosis and care for treatment compared with Black participants. Participants with high school or equivalent education (odds ratio, 1.662; 95% confidence interval, 1.172-2.356; P = .0044) or some college or junior college education (odds ratio, 1.970; 95% confidence interval, 1.348-2.879; P = .0005) were more likely to report a better level of quality of received care for treatment.

Conclusions
The SCCS represents individuals who are historically underrepresented in cancer research. The results of this study will have broad implications across diverse communities to reduce disparities and inform models of care.

Implications for Practice
Nurses are positioned to evaluate the quality of population health and design and lead interventions that will benefit underserved and underresourced communities.
Impact of Exergames on the Rehabilitation of Cancer Patients Undergoing Major Abdominal Surgery
Authors: Alves Isabel , Moreira Ana Paula , Sousa Teresa , Teles Paulo , Magalhães Bruno Miguel , Goncalves Filipe , Fernandes Carla Sílvia 
Published: February 2024

Background
Exergames can be an appealing strategy that is integrated into post–abdominal surgery rehabilitation.

Objective
The aim of this study was to assess the effectiveness of exergame rehabilitation in improving independence in activities of daily living (ADLs) and patient balance after abdominal cancer surgery.

Methods
A randomized control-group study was carried out in an oncological hospital in Portugal. Seventy postoperative patients were included, and data collection took place between January 2023 and May 2023. The patients were randomly assigned to either an exergame rehabilitation program (n = 35) or a traditional rehabilitation program (n = 35). The assessed outcomes were the Barthel and Berg scales, and data collection occurred at 3 different time points: admission, 48 hours postoperatively, and on the seventh day after surgery.

Results
At the third assessment, a statistically significant difference was observed between the 2 groups for both indicators, ADLs and balance.

Conclusions
There was an improvement in ADLs and balance in the exergames group. By the seventh day after surgery, the intervention group showed improvement in balance and ADLs compared with the control group.

Implications for Practice
The use of exergames can be a solution to the challenges of traditional rehabilitation methods after abdominal surgery for cancer for postoperative patients. This is the first study carried out in this specific population.
Aging with robots: a brief review on eldercare automation
Authors: Zhang Yuhan , Luo Longxiang , Wang Xiuli 
Published: February 2024

Abstract
Robotic solutions designed to cater to the needs of the elderly, commonly known as eldercare robots or nursing robots, hold the promise of delivering intelligent elderly care, alleviating societal caregiving pressures, and reducing financial burdens on nations. Scholars across various disciplines have delved into the realm of eldercare robotics from different perspectives. Four types of robots at the design level are currently used in the elderly care industry: anthropomorphic, zoomorphic, cartoon, and mechanical-functional. They can play such roles as assistants, companions, and even surrogate pets, providing support for the elderly’s daily routines, cognitive enhancement, and emotional well-being. Acceptance of eldercare robots hinges on three key factors: technical attributes, user-specific characteristics, and the surrounding social environment. The utilization of eldercare robots has the potential to positively impact various aspects of the elderly population, such as their physiological health, cognitive abilities, psychological well-being, and social interactions. However, it can also lead to social isolation, reduced autonomy, increased sense of objectification, blurred responsibility attribution, and tendencies towards deceptive and childish behavior. Additionally, eldercare robots also influence healthcare professionals in terms of workload, working conditions, job satisfaction and sense of purpose, both positively and negatively. This paper examines these research findings within the context of theories in communication, technology ethics, and medical ethics, shedding light on the multifaceted landscape of eldercare robotics.
The impact of digitalized community-based square-stepping exercise program (DC-SSEP) on cognitive and balance functions among older adults living in senior facilities: A pilot study
Authors: Lee Kyoung Eun , Boham Mikaela , Zhao Meng , Ro YoungHee , Cong Xiaomei , Huang Yuxia 
Published: February 2024

Abstract

Objectives:
Older adults exhibit high desire for Active and Healthy Aging (AHA) without physical or mental dysfunction, particularly those living independently in senior facilities. Preserving or improving cognitive function and minimizing fall risks are essential for older adults to live a happy and active lifestyle. The purpose of this pilot study was to examine the feasibility, safety, and preliminary effectiveness of the innovative Digitalized Community-based Square-Stepping Exercise Program (DC-SSEP) in improving cognitive and physical function among older adults residing in senior facilities.

Methods:
Guided by the Health Promotion Model and Social Cognitive Theory, this pilot study used a quasi-experiment design with one intervention group. A total of 17 older adults recruited from a senior facility in Southern Texas participated in 40 sessions of DC-SSEP over 20 weeks. Cognitive function was measured using the latest version (8.1) of MoCA and the balance function focusing on balance and functional mobility was measured using Berg’s Balance Scale and Time to Up and Go.

Results:
Most participants were non-Hispanic White women. The DC-SSEP was a feasible and safe exercise program for older adults; and the results showed the preliminary effectiveness of the DC-SSEP in improving cognitive and balance function (P<0.01) among older adults, especially among older adults living in senior facilities.

Conclusion:
This pilot study is distinctive as it is among the first to evaluate the multi-layered impacts of DC-SSEP using IoT technology and integrated operating software in the U.S. Despite the small sample size and homogeneity of participants, this pilot study suggests multiple valuable directions for future research using DC-SSEP.
Application of the Left Lateral Decubitus Position in Laparoscopic Right Posterior Lobectomy
Authors: Huang Dong-Fang , Xu Jian-Bo , Du Ye-Mu , Wang Ye-Bo , Zhou Ding-Hua 
Published: February 2024

Objective:
To investigate the value of the left lateral decubitus position in laparoscopic right posterior lobe tumor resection.

Patients and Methods:
The clinical data of patients who underwent laparoscopic right posterior lobectomy from January 2020 to March 2023 were retrospectively collected and divided into group A (left lateral decubitus position group, n=30) and group B (conventional position group, n=35) according to different body positions. Intraoperative and postoperative data were collected and compared between the 2 groups.

Results:
The operation time (210.43±57.56 vs. 281.97±65.89, t=5.887, P<0.05), hilar occlusion time (23.97±14.25 vs. 35.79±12.62, t=4.791, P<0.05), intraoperative blood loss (162.14±72.61 vs. 239.65±113.56, t=5.713, P<0.05), postoperative feeding time (1.13±0.36 vs. 1.57±0.67, t=3.681, P<0.05), postoperative visual analog scale score (5.16±0.89 vs. 7.42±1.31, t=3.721, P<0.05), postoperative abdominal drainage tube indwelling time (4.58±1.34 vs. 5.42±1.52, t=4.553, P<0.05), incidence rate of complications (43.33% vs. 82.86%, χ2=11.075, P<0.05) in group A were lower than those in group B (P<0.05). Symptoms/side effects (32.42±3.42 vs. 27.44±3.31, t=4.331, P<0.05), and there were significant differences in social function (33.55±2.56 vs. 29.31±3.32, t=4.863, P<0.05).

Conclusion:
For right posterior lobe tumors of the liver, the left lateral decubitus position has many advantages in laparoscopic right posterior lobectomy, such as a wide field of view, simple steps, a short operation time, less bleeding, and a high postoperative quality of life. It is an effective treatment for right posterior lobe tumors of the liver and is worthy of being widely popularized.