bluuebunny/crossref_metadata_2025_split huggingface dataset:
Imaging the Retinal Vascular Mural Cells In Vivo: Elucidating the Timeline of Their Loss in Diabetic Retinopathy
Authors: Huang Bonnie B. , Fukuyama Hisashi , Burns Stephen A. , Fawzi Amani A. 
Published: December 2023

BACKGROUND:
Vascular mural cells (VMCs) are integral components of the retinal vasculature with critical homeostatic functions such as maintaining the inner blood-retinal barrier and vascular tone, as well as supporting the endothelial cells. Histopathologic donor eye studies have shown widespread loss of pericytes and smooth muscle cells, the 2 main VMC types, suggesting these cells are critical to the pathogenesis of diabetic retinopathy (DR). There remain, however, critical gaps in our knowledge regarding the timeline of VMC demise in human DR.

METHODS:
In this study, we address this gap using adaptive optics scanning laser ophthalmoscopy to quantify retinal VMC density in eyes with no retinal disease (healthy), subjects with diabetes without diabetic retinopathy, and those with clinical DR and diabetic macular edema. We also used optical coherence tomography angiography to quantify capillary density of the superficial and deep capillary plexuses in these eyes.

RESULTS:

Our results indicate significant VMC loss in retinal arterioles before the appearance of classic clinical signs of DR (diabetes without diabetic retinopathy versus healthy, 5.0±2.0 versus 6.5±2.0 smooth muscle cells per 100 µm;
P
<0.05), while a significant reduction in capillary VMC density (5.1±2.3 in diabetic macular edema versus 14.9±6.0 pericytes per 100 µm in diabetes without diabetic retinopathy;
P
=0.01) and capillary density (superficial capillary plexus vessel density, 37.6±3.8 in diabetic macular edema versus 45.5±2.4 in diabetes without diabetic retinopathy;
P
<0.0001) is associated with more advanced stages of clinical DR, particularly diabetic macular edema.

CONCLUSIONS:
Our results offer a new framework for understanding the pathophysiologic course of VMC compromise in DR, which may facilitate the development and monitoring of therapeutic strategies aimed at VMC preservation and potentially the prevention of clinical DR and its associated morbidity. Imaging retinal VMCs provides an unparalleled opportunity to visualize these cells in vivo and may have wider implications in a range of diseases where these cells are disrupted.
Effects of Contact Force on Lesion Size During Pulsed Field Catheter Ablation: Histochemical Characterization of Ventricular Lesion Boundaries
Authors: Nakagawa Hiroshi , Castellvi Quim , Neal Robert , Girouard Steven , Laughner Jacob , Ikeda Atsushi , Sugawara Masafumi , An Yoshimori , Hussein Ayman A. , Nakhla Shady , Taigen Tyler , Srounbek Jakub , Kanj Mohamed , Santangeli Pasquale , Saliba Walid I. , Ivorra Antoni , Wazni Oussama M. 
Published: December 2023

Background:
Effects of contact force (CF) on lesion formation during pulsed field ablation (PFA) have not been well validated. The purpose of this study was to determine the relationship between average CF and lesion size during PFA using a swine-beating heart model.

Methods:
A 7F catheter with a 3.5-mm ablation electrode and CF sensor (TactiCath SE, Abbott) was connected to a PFA system (CENTAURI, Galvanize Therapeutics). In 5 closed-chest swine, biphasic PFA current was delivered between the ablation electrode and a skin patch at 40 separate sites in right ventricle (28 Amp) and 55 separate sites in left ventricle (35 Amp) with 4 different levels of CF: (1) low (CF range of 4–13 g; median, 9.5 g); (2) moderate (15–30 g; median, 21.5 g); (3) high (34–55 g; median, 40 g); and (4) no electrode contact, 2 mm away from the endocardium. Swine were sacrificed at 2 hours after ablation, and lesion size was measured using triphenyl tetrazolium chloride staining. In 1 additional swine, COX (cytochrome c oxidase) staining was performed to examine mitochondrial activity to delineate reversible and irreversible lesion boundaries. Histological examination was performed with hematoxylin and eosin and Masson trichrome staining.

Results:
Ablation lesions were well demarcated with triphenyl tetrazolium chloride staining, showing (1) a dark central zone (contraction band necrosis and hemorrhage); (2) a pale zone (no mitochondrial activity and nuclear pyknosis, indicating apoptosis zone); and a hyperstained zone by triphenyl tetrazolium chloride and COX staining (unaffected normal myocardium with preserved mitochondrial activity, consistent with reversible zone). At constant PFA current intensity, lesion depth increased significantly with increasing CF. There were no detectable lesions resulting from ablation without electrode contact.

Conclusions:
Acute PFA ventricular lesions show irreversible and reversible lesion boundaries by triphenyl tetrazolium chloride staining. Electrode-tissue contact is required for effective lesion formation during PFA. At the same PFA dose, lesion depth increases significantly with increasing CF.
Calculating Relative Lung Perfusion Using Fluoroscopic Sequences and Image Analysis: The Fluoroscopic Flow Calculator
Authors: Barak-Corren Yuval , Herz Christian , Lasso Andras , Dori Yoav , Tang Jessica , Smith Christopher L. , Callahan Ryan , Rome Jonathan J. , Gillespie Matthew J. , Jolley Matthew A. , O’Byrne Michael L. 
Published: December 2023

BACKGROUND:
Maldistribution of pulmonary blood flow in patients with congenital heart disease impacts exertional performance and pulmonary artery growth. Currently, measurement of relative pulmonary perfusion can only be performed outside the catheterization laboratory. We sought to develop a tool for measuring relative lung perfusion using readily available fluoroscopy sequences.

METHODS:
A retrospective cohort study was conducted on patients with conotruncal anomalies who underwent lung perfusion scans and subsequent cardiac catheterizations between 2011 and 2022. Inclusion criteria were nonselective angiogram of pulmonary vasculature, oblique angulation ≤20°, and an adequate view of both lung fields. A method was developed and implemented in 3D Slicer’s SlicerHeart extension to calculate the amount of contrast that entered each lung field from the start of contrast injection and until the onset of levophase. The predicted perfusion distribution was compared with the measured distribution of pulmonary blood flow and evaluated for correlation, accuracy, and bias.

RESULTS:

In total, 32% (79/249) of screened studies met the inclusion criteria. A strong correlation between the predicted flow split and the measured flow split was found (
R
2
=0.83;
P
<0.001). The median absolute error was 6%, and 72% of predictions were within 10% of the true value. Bias was not systematically worse at either extreme of the flow distribution. The prediction was found to be more accurate for either smaller and younger patients (age 0–2 years), for right ventricle injections, or when less cranial angulations were used (≤20°). In these cases (n=40), the prediction achieved
R
2
=0.87, median absolute error of 5.5%, and 78% of predictions were within 10% of the true flow.

CONCLUSIONS:
The current study demonstrates the feasibility of a novel method for measuring relative lung perfusion using conventional angiograms. Real-time measurement of lung perfusion at the catheterization laboratory has the potential to reduce unnecessary testing, associated costs, and radiation exposure. Further optimization and validation is warranted.
Saudi Foreign Policy Over Three Centuries: A Study of Constants
Authors: al-Khathlan Saleh M. 
Published: December 2023

Abstract
This paper aims to study Saudi foreign policy since the beginning of Saudi contact with the outside world during the 18th century, to determine the degree of continuity and change therein and to see if there was a pattern or patterns that distinguished it, despite the changes in the internal and external contexts, the different personalities involved, the growth of capabilities, as well as the difference in challenges. To accomplish this, the goals and determinants of Saudi foreign policy are presented as well as the most significant writings on the subject in order to assess the conclusions reached. Emphasis is placed on reading the features of Saudi foreign policy during the period following the unification of the Kingdom, since it is the longest time span and the most diverse and mature period.
Lateral compression behavior of expanded polypropylene foam-filled carbon fiber reinforced polymer and aluminum/carbon fiber reinforced polymer composite tubes: An experimental study
Authors: Yalçın Muhammet Muaz , İskender Özsoy Mehmet 
Published: December 2023

This study investigates the energy-absorbing capability of the circular cross-section carbon fiber reinforced polymer (CFRP) and Aluminum/CFRP (Al/CFRP) composite tubular structures under quasi-static lateral compression. The CFRP composite tubes were manufactured with the 6, 8, and 10 layers to observe the thickness effect. A specially designed and manufactured polymer mold was used to manufacture identical CFRP composite tubes. Expanded polypropylene (EPP) foam with densities of 30 kg/m3, 60 kg/m3, and 75 kg/m3 was chosen as a filler material to enhance the energy absorption and efficiency because of its superior properties of high strength-to-weight ratio. The experiments revealed that the carbon fiber layer number directly affected CFRP and Al/CFRP composite tubes' force and the absorbed energy values. The increase in the maximum and average force values is more evident than in the Al/CFRP tubes due to using aluminum tubes constraining the effect of the carbon woven part. Additionally, EPP foam filling significantly contributes to the tubes' absorbed energy. The absorbed energy increased proportional to the foam density, and the 10-layer Al/CFRP tube filled with 75 kg/m3 sample absorbed the highest energy value as 257 J. However, considering the crashworthiness parameters (i.e., specific energy absorption, crush force efficiency, and work effectiveness), the best sample combination did not absorb the highest energy. Although the 6-layer CFRP composite tube absorbed the lowest energy, it has higher specific energy absorption and work effectiveness. According to the crashworthiness parameters, the best efficiency was obtained in the 10-layer composite tubes filled with 75 kg/m3.
Evaluating Workforce Mental Health and Well-Being: A Review of Assessments
Authors: Imboden Mary T. , Wolfe Emily , Evers Kerry , Ferrão Arline , Mochari-Greenberger Heidi , Johnson Sara , Kirsten Wolf , Seaverson Erin L. D. 
Published: December 2023

The disruption, trauma, and stressors brought by COVID-19 have increased recognition and normalization of workforce mental health needs. Objective Given the importance of mental health and well-being assessments to employers' efforts to optimize employee health and well-being, this paper reviews mental health assessments that have utility in the workplace. Data Source A review of publicly available mental health and well-being assessments was conducted with a primary focus on burnout, general mental health and well-being, loneliness, psychological safety, resilience, and stress. Inclusion Criteria Assessments had to be validated for adult populations; available in English as a stand-alone tool; have utility in an employer setting; and not have a primary purpose of diagnosing a mental health condition. Data Extraction All assessments were reviewed by a minimum of two expert reviewers to document number of questions, subscales, fee structure, international use, translations available, scoring/reporting, respondent (ie, employee or organization), and the target of the assessment (ie, mental health domain and organizational or individual level assessments. Data Synthesis & Results Sixty-six assessments across the six focus areas met inclusion criteria, enabling employers to select assessments that meet their self-identified measurement needs. Conclusion This review provides employers with resources that can help them understand their workforce’s mental health and well-being status across multiple domains, which can serve as a needs assessment, facilitate strategic planning of mental health and well-being initiatives, and optimize evaluation efforts.
Psychiatry trainee experience of working in a child and adolescent eating disorder program
Authors: McDonnell Collin J. , Hopkins Liza , Cheah Danny 
Published: December 2023

Objectives Eating disorders are serious psychiatric conditions that affect people of all ages. Many psychiatry trainees' first and only experience with eating disorders during training is their Child and Adolescent Psychiatry (CAP) rotation. This study aimed to explore the learning experience of psychiatry trainees working within an Eating Disorder Program (EDP) during their CAP rotation. Methods Fifteen trainees who participated in the EDP were recruited to complete an online survey and focus groups; a thematic analysis design was used to identify themes emerging from their responses. Results Themes emerged from the trainee learning experience of working in the EDP around what they found they learnt, what aided that process, what was difficult, and recommendations for future improvement. Conclusions This study provided insight into the trainee experience in an EDP as one example of how trainees can learn about eating disorders and one way that could inform future workforce and training initiatives.
Associations between the spread of COVID-19 and end-of-life circumstances in the non-infected population of Sweden
Authors: Sennfält Stefan , Hedman Christel , Fürst Carl Johan 
Published: December 2023

Aims: Since its outbreak in 2020, the COVID-19 pandemic has directly caused the premature death of millions. However, indirect consequences, such as social restrictions, have affected a far greater number. We explored the association between the spread of COVID-19 and end-of-life circumstances in the infected and non-infected population in Sweden. Methods: In this descriptive, population-based, observational study, we primarily used data from the Swedish National Registry of Palliative Care, which covers about 60% of all deaths in Sweden. We explored the association between the spread of COVID-19 and place of death, people present at death and end-of-life symptoms using regression analyses. Results: The study included 190,291 individuals who died in any region of Sweden from 1 January 2019 to 30 June 2022, of which 10,646 were COVID-19 cases. Correlated to the temporal and geographical spread of COVID-19, there was a greater proportion of individuals dying without the presence of their next-of-kin, and consequently more people dying alone, both in those with and without COVID-19. There was a similar pattern of a greater proportion of deaths taking place in nursing homes and in the individual’s own home. However, we did not find substantial associations to reported symptoms, such as anxiety or confusion. Conclusions: This study shows the profound effects of the COVID-19 pandemic on end-of-life circumstances in both the infected and non-infected population in Sweden. As we prepare for future pandemics, there is a need to develop strategies to minimise the impact on non-infected individuals.
Evaluation of the departmental inter-rater reliability when scoring thyroid nodules according to the British Thyroid Association Ultrasound-classification model: Is there significant disagreement?
Authors: Rtam Nabil 
Published: December 2023

Introduction: The British Thyroid Association Ultrasound-classification is a risk stratification model which grades thyroid nodules in U2–5 based on their sonographic appearance. Existence of variability between the ultrasound operators when U-scoring is reported in the literature with some evidence found in the author’s department. The aim of this study was to investigate whether there is significant disagreement in the department and identify potential reasons for variability. Methods: Eight operators, radiologists and sonographers, were recruited to grade 33 TNs and answer a tick box questionnaire using the British Thyroid Association lexicon. The inter-operator variability for the U-categories, indication for fine-needle aspiration biopsy and ultrasound features was assessed using Fleiss’ kappa and Gwet-AC1. The operators’ accuracy was measured against the most experienced operator in the department using Cohen’s kappa and percentage agreement. Results: Fair agreement (Fleiss’ K = 0.21) was obtained between the participants when U-scoring (U2–5). Fair-to-moderate agreement was noted between sonographers ( K = 0.40). Significant variability was demonstrated between radiologists ( p > 0.05). Indication for fine-needle aspiration biopsy reached fair to almost substantial agreement (radiologists’ AC1 = 0.34, sonographers’ AC1 = 0.58, overall AC1 = 0.41). No significant variability measured for echogenicity ( K = 0.29), composition ( K = 0.33), shape ( K = 0.58), margin ( K = 0.45), halo ( K = 0.34) and vascularity ( K = 0.44). Accuracy reached fair agreement (mean Cohen’s K = 0.29) and moderate agreement (mean AC1 = 0.53) for the U-categories and fine-needle aspiration biopsy, respectively. Radiologists demonstrated lower accuracy. Conclusion: No significant inter-rater variability in U-scoring or recommending fine-needle aspiration biopsy was demonstrated between all the operators in the department. Radiologists showed significant variability in U-scoring and lower accuracy. Reliability and accuracy could be improved by addressing those problematic categories and features identified with this study.
Sonographic anatomy and technique to image the plantar digital nerves and aid identification of a Morton’s neuroma
Authors: Fenech Michelle 
Published: December 2023

Introduction: The anatomy of the forefoot is complex, and the sonographic assessment to image the plantar digital nerves and exclude, diagnose or discriminate between a Morton’s neuroma and intermetatarsal bursitis can be challenging. Topic description and discussion: A good appreciation of the sonographic anatomy, technique, normal and abnormal appearances is required to undertake a sonographic assessment of the forefoot and its interspaces, particularly the plantar digital nerves. This is unpacked in this paper with associated pictorial aids. Muscles, tendons, and ligaments of the interspaces and the nearby metatarsophalangeal joints and their associated soft-tissue structures are helpful sonographic landmarks to guide imaging and assessment of the common and proper plantar digital nerves and the intermetatarsal bursa. These need to be appreciated from both dorsal and plantar sonographic approaches, in both short- and long-axis imaging planes. Conclusion: Improved understanding of the anatomy and sonographic appearances of the interspace structures can enhance the sonographic assessment of the forefoot and improve diagnosis of a Morton’s neuroma and/or intermetatarsal bursitis when present to guide patient management.
Association between vertebral artery dominance and basilar artery curvature in migraineurs: an anatomical magnetic resonance imaging study
Authors: Otu Ebru , Şen Selva , Örmeci Tuğrul , Yüzbaşıoğlu Neslihan 
Published: December 2023

Background and Purposes Numerous studies demonstrate a link between cerebrovascular alterations and migraine pathogenesis. We investigated the association between migraine and vertebral artery dominance (VAD), basilar artery (BA) curvature, and elongation. Materials and Methods This cross-sectional MRI study included 74 migraine patients and 74 control subjects aged between 18 and 55 years. Diameters of the intracranial part of the vertebral artery (VA) and BA, height of the BA bifurcation, and total lateral displacement of the BA were measured. In addition, we investigated the directional relationship between VAD and BA curvature. Results There were no statistically significant differences between the groups regarding VA and BA diameters and total lateral displacement of the BA. The height of the BA bifurcation was found to be significantly higher in migraine patients compared to controls ( p = 0.002). The left-side VAD was more frequent in migraine patients compared to control subjects (60.8% (45/74) vs 41.9% (31/74), p = 0.001). In migraine patients, particularly those with aura (MwA) patients, with left-side VAD, the rate of BA displacement to the right side is significantly higher than those with right-side VAD or non-VAD ( p = 0.022). Also, we found that total lateral displacement of the BA is correlated with VA asymmetry in patients with MwA (r = 0.538, p = 0.007). Conclusion VAD and its opposite-directional relationship with the lateral displacement of the BA may be associated with migraine pathophysiology. Together with aging, this association may contribute to changes in the vertebrobasilar system (VBS) geometry which may result in increased risk for posterior circulation infarction (PCI) in migraineurs.
Assessment of stress in caregivers of acutely hospitalized elderly and its relation to hospital outcomes
Authors: Mohamed Enas R. , Abou-Hashim Rania M. , Shaltoot Heba 
Published: December 2023

Abstract
Background
It is important to understand and identify the physical and emotional strain among caregivers of the elderly as caregivers may have much more strain and burden than non-caregivers, which subsequently may affect their well-being and the clinical outcome of the elderly they are caring for.

Methods
To assess caregiver stress and its effect on hospital outcomes at the geriatric department in Ain Shams University Hospitals, a cross-sectional study was done that included adults, aged ≥ 60 years, hospitalized for treatment of acute medical conditions and their accompanied caregivers where the patients were subjected to complete comprehensive geriatric assessment while cares givers’ stress was assessed using Caregiver Self-Assessment Questionnaire.

Results
Many elderly were found to need caregivers and the need increased with age as well as multiple comorbidities especially dementia, delirium, and urinary incontinence. Stress prevalence among caregivers is high (85%) and it increases with the age of the patients and the patient having several comorbidities such as cancer, neurological diseases, and sleep problems. Stress was also associated with high mortality of patients.

Conclusion
As there is an increase in the elderly population with a subsequent increase in the need for caregivers who suffer from caregiver stress, more studies are needed in the future to highlight this problem and find ways to relieve caregivers’ stress.
Pox and Proximities
Authors: Farhan Sara 
Published: December 2023

AbstractThis article conceptualizes Iraq's medical diplomatic missions as inter-Asian linkages that rested on solidarity movements, professional networks, and the commitments of medical experts. It traces the machinations of Iraq's medical diplomacy, specifically the agendas and processes of advancing health care as humanitarian aid at a time when social unrest and outbreaks of infectious diseases led to mass inoculation and biosurveillance programs supported by regional and international medical missions. The emergence of semi-trained inoculators coupled with efforts to expand medical education faculties prompted the increase of medical labor production for both domestic and diplomatic purposes. Iraq's Cold War medical diplomacy was prismatic, multilateral and multidirectional. The dispensation and reception of biological protection, scientific technologies, and medical labor transformed Iraq into a site of biomedical knowledge production.
Erratum on “Demonstrations and Price Competition in New Product Release”
Authors: Chen Zhiqiang , Xu Shengshuo , Zhou Fangkezi , Li Yongjun 
Published: December 2023

This paper was accepted by Dmitri Kuksov, marketing. Supplemental Material: The online appendix is available at https://doi.org/10.1287/mnsc.2023.03030 .