bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nudging During Pediatric Intensive Care Conferences With Family Members: Retrospective Analysis of Transcripts From a Single-Center, 2015–2019*
Authors: Olive Aliza M. , Finnsdottir Wagner Asdis , Mulhall Daniel T. , October Tessie W. , Hart Joanna L. , Sherman Ashley K. , Wallisch Jessica S. , Miller-Smith Laura 
Published: February 2024

OBJECTIVES:
Nudging, a behavioral economics concept, subtly influences decision-making without coercion or limiting choice. Despite its frequent use, the specific application of nudging techniques by clinicians in shared decision-making (SDM) is understudied. Our aim was to analyze clinicians’ use of nudging in a curated dataset of family care conferences in the PICU.

DESIGN:
Between 2019 and 2020, we retrospectively studied and coded 70 previously recorded care conference transcripts that involved physicians and families from 2015 to 2019. We focused on decision-making discussions examining instances of nudging, namely salience, framing, options, default, endowment, commission, omission, recommend, expert opinion, certainty, and social norms. Nudging instances were categorized by decision type, including tracheostomy, goals of care, or procedures.

SETTING:
Single-center quaternary pediatric facility with general and cardiac ICUs.

PATIENTS:
None.

INTERVENTIONS:
None.

MEASUREMENTS:
We assessed the pattern and frequency of nudges in each transcript.

MAIN RESULTS:
Sixty-three of the 70 transcripts contained SDM episodes. These episodes represented a total of 11 decision categories based on the subject matter of nudging instances, with 308 decision episodes across all transcripts (median [interquartile range] 5 [4–6] per conference). Tracheostomy was the most frequently discussed decision. A total of 1096 nudging instances were identified across the conferences, with 8 (6–10) nudge types per conference. The most frequent nudging strategy used was gain frame (203/1096 [18.5%]), followed by loss frame (150/1096 [13.7%]).

CONCLUSIONS:
Nudging is routinely employed by clinicians to guide decision-making, primarily through gain or loss framing. This retrospective analysis aids in understanding nudging in care conferences: it offers insight into potential risks and benefits of these techniques; it highlights ways in which their application has been used by caregivers; and it may be a resource for future trainee curriculum development.
Comparing the Quality of Domain-Specific Versus General Language Models for Artificial Intelligence-Generated Differential Diagnoses in PICU Patients*
Authors: Akhondi-Asl Alireza , Yang Youyang , Luchette Matthew , Burns Jeffrey P. , Mehta Nilesh M. , Geva Alon 
Published: February 2024

OBJECTIVES:
Generative language models (LMs) are being evaluated in a variety of tasks in healthcare, but pediatric critical care studies are scant. Our objective was to evaluate the utility of generative LMs in the pediatric critical care setting and to determine whether domain-adapted LMs can outperform much larger general-domain LMs in generating a differential diagnosis from the admission notes of PICU patients.

DESIGN:
Single-center retrospective cohort study.

SETTING:
Quaternary 40-bed PICU.

PATIENTS:
Notes from all patients admitted to the PICU between January 2012 and April 2023 were used for model development. One hundred thirty randomly selected admission notes were used for evaluation.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Five experts in critical care used a 5-point Likert scale to independently evaluate the overall quality of differential diagnoses: 1) written by the clinician in the original notes, 2) generated by two general LMs (BioGPT-Large and LLaMa-65B), and 3) generated by two fine-tuned models (fine-tuned BioGPT-Large and fine-tuned LLaMa-7B). Differences among differential diagnoses were compared using mixed methods regression models. We used 1,916,538 notes from 32,454 unique patients for model development and validation. The mean quality scores of the differential diagnoses generated by the clinicians and fine-tuned LLaMa-7B, the best-performing LM, were 3.43 and 2.88, respectively (absolute difference 0.54 units [95% CI, 0.37–0.72], p < 0.001). Fine-tuned LLaMa-7B performed better than LLaMa-65B (absolute difference 0.23 unit [95% CI, 0.06–0.41], p = 0.009) and BioGPT-Large (absolute difference 0.86 unit [95% CI, 0.69–1.0], p < 0.001). The differential diagnosis generated by clinicians and fine-tuned LLaMa-7B were ranked as the highest quality in 144 (55%) and 74 cases (29%), respectively.

CONCLUSIONS:
A smaller LM fine-tuned using notes of PICU patients outperformed much larger models trained on general-domain data. Currently, LMs remain inferior but may serve as an adjunct to human clinicians in real-world tasks using real-world data.
Benefits, Challenges, and Opportunities in Addressing Medicaid Beneficiaries' Non-Medical Risks to Health: A Qualitative Analysis
Authors: LaPoint Myklynn , Vu Maihan B. , Ricks Katharine , Flower Kori B. , Domino Marisa Elena , Dave Gaurav , Berkowitz Seth A. 
Published: February 2024

Context:
North Carolina's Healthy Opportunities Pilots (HOP) is a Medicaid 1115 Waiver program that seeks to address nonmedical risks to health for Medicaid beneficiaries through multisector collaboration. Among other stakeholders, HOP involves collaboration between human services organizations that deliver interventions, network leads, which establish and oversee the human services organizations within a region of the state.

Objective:
To understand how employees at human services organizations and network leads prepared to deliver HOP services.

Design:
Qualitative analysis of semistructured interviews. Interviews were conducted between April and June 2022. Interviews were recorded, transcribed verbatim, coded thematically, and analyzed using a conceptual model derived from the consolidated framework for implementation research.

Setting:
Organizations within North Carolina counties participating in HOP.

Participants:
Employees of human services and network lead organizations across all 3 HOP regions of North Carolina.

Results:
The researchers interviewed 37 participants. Overall, organizations experienced benefits from HOP participation, including capacity-building resources, flexibility in allocating resources, and creating community-wide enthusiasm for addressing nonmedical risks to health. There were also key challenges. These included the time needed to build capacity, adjustments to the work processes and regulations inherent to multisector collaboration, geographic variation in availability of services to offer, and the difficulty of addressing different needs. Finally, participants recognized substantial opportunities that HOP presented, including membership in a more extensive network, exposure to a learning community, and a more sustainable funding source.

Conclusions:
The perspectives of individuals preparing to deliver HOP services offer important lessons for those developing and implementing large-scale programs that can address nonmedical threats to health.
Charting the Advocacy Landscape: A Qualitative Content Analysis of Syllabi in Public Health Graduate Education
Authors: Schneider Glenn E. , DiOrio Alexandra , Asada Yuka , Hearne Shelley A. 
Published: February 2024

Context:
Addressing public health challenges necessitates policy approaches, but concerns persist about public health graduates' preparedness to advocate.

Objective:
This qualitative study sought to assess advocacy content and skills taught to Master of Public Health students enrolled in US accredited schools and programs of public health (SPPHs) by analyzing 98 course syllabi submitted to the Council on Education for Public Health (CEPH) between 2019 and 2021. Syllabi were submitted by SPPHs during their (re)accreditation process to demonstrate compliance with CEPH's advocacy competency requirement.

Design:
Qualitative content analysis study. Syllabi were analyzed using MAXQDA Qualitative Data Analysis Software using a 2-coder approach.

Setting:
SPPHs accredited by CEPH.

Participants:
Ninety-eight syllabi submitted to CEPH by 22 schools of public health and 54 programs of public health.

Main Outcome Measures:
Exemplary language from advocacy courses and assignments and aggregate frequency of syllabi advocacy content and skills.

Results:
Most advocacy courses (61%) were survey, health policy, or health care delivery courses, covering policy (66%), policy communication (46%), coalition-building (45%), lobbying (36%), community organizing (33%), and media advocacy (24%) skills. Only 7% prioritized advocacy skill instruction, and 10% addressed how to advocate in an equitable way.

Conclusions:
Defining public health advocacy and essential skills is crucial. Issuing competency guidelines, supporting advocacy faculty, offering standardized training, and expanding experiential learning are important first steps. More research is needed on how academic institutions are incorporating equity skill training into courses, whether separate from or combined with advocacy skills.
Superiority of a Silk Surgical Site Wound Closure Device over Synthetic Dressings
Authors: Rouhani Daniel S. , Singh Navin K. , Chao James J. , Almutairi Adah , Seradj Mehran H. , Badowski-Platz Rebecca , Toranto Jason D. , Mofid M. Mark 
Published: February 2024

Background:
Silk fibroin is an emerging biomaterial with enhanced properties of cellular regeneration, growth, and proliferation. The use of a silk fibroin wound dressing has the potential to decrease the incidence of wound-healing complications and to improve patient outcomes compared with synthetic dressing alternatives.

Methods:
A randomized, single-blind clinical trial was conducted on 50 patients who were dressed with a silk fibroin dressing on 1 side of their body and 3M Steri-Strips on the contralateral side after abdominoplasty, reduction mammaplasty, or brachioplasty procedures. Data were collected over 5 postoperative visits using photographs and an investigator-administered questionnaire to monitor erythema, skin irritation, skin discomfort, need for pharmaceutical intervention, wound dehiscence, and mechanical skin injury. A comprehensive 75-patient statistical analysis was conducted, combining the results with a previously published study comparing Dermabond Prineo with the silk dressing.

Results:
A total of 20.8% of patients (10 of 48) were assessed by surgeons as having skin erythema (7 to 10) on the Steri-Strip control side, with 0% (0 of 48) on the silk dressing side (P = 0.002). The frequency of breast triple-point separation in 43 cases was 30.2% (13 of 43) on the Steri-Strip side and 9.3% (4 of 43) on the silk side (P = 0.012). A total of 75% of patients (36 of 48) had partial or total detachment of Steri-Strips, 0% (0 of 48) had total detachment of the silk dressing, and 18.8% (9 of 48) had partial detachment of the silk dressing within the first 2 weeks (P < 0.001).

Conclusion:
A silk fibroin wound dressing significantly reduces the incidence of wound-healing complications throughout the postoperative period.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, II.

Clinical Relevance Statement:
The adoption of a silk fibroin wound dressing into clinical practice has the potential to improve patient outcomes, decrease medical adhesive–related skin injuries, and reduce the rate of wound-healing complications.
Examining incidence of diabetes in people with HIV: tracking the shift in traditional and HIV-related risk factors
Authors: Mohammad Pritom Gazi Sakir , Yang Xueying , Gao Haoyuan , Chen Shujie , Zhang Jiajia , Olatosi Bankole , Li Xiaoming 
Published: February 2024

Background and objective:The risk factors of diabetes mellitus (DM) in people with HIV (PWH) may be dynamic in a life course manner. This study aimed to describe incidence of DM and investigate the trajectory of changes in risk factor associated with DM incidence over around 15 years among a statewide cohort of PWH in South Carolina (SC).Design:This is a population-based cohort study.Methods:Data were retrieved from the integrated statewide electronic health records between 2006 and 2020 in SC. Separate subgroup analysis was conducted according to the patients’ different follow up duration (i.e., 5, 10, and 15 years) to observe the evolving risk factors of DM development, using multivariable logistic regressions.Results:The DM incidence among a total of 9115 PWH was 8.9 per 1000 person-years. In the overall model, being >60 years old, hypertension, and obesity were positively associated with DM while alcohol consumption, years of HIV diagnosis and high percentage days of viral suppression were negatively associated with the outcome. In the subgroup analyses, similar risk factors were observed. The odds of DM increased in a graded fashion with age. Hypertension was positively associated with DM in all groups and retention to care was negatively associated with the outcome in groups 1 and 3.Conclusion:This large-scale population-based study has revealed a relatively lower incidence of DM among PWH than some other US States. The evolving risk factors over time underline the need for maintaining retention to care to prevent the occurrence of DM.
Effect of Lower Extremity Nerve Decompression in Patients with Painful Diabetic Peripheral Neuropathy
Authors: Rozen Shai M. , Wolfe Gil I. , Vernino Steven , Raskin Philip , Hynan Linda S. , Wyne Kathleen , Fulmer Rita , Pandian Geetha , Sharma Shiv K. , Mohanty Ahneesh J. , Sanchez Cristina V. , Hembd Austin , Gorman April 
Published: February 2024

Objective:
Evaluate the effect of nerve decompression on pain in patients with lower extremity painful Diabetic Peripheral Neuropathy (DPN).

Summary Background Data:
Currently, no treatment provides lasting relief for patients with DPN. Benefits of nerve decompression remain inconclusive.

Methods:
This double-blinded, observation- and same-patient sham surgery-controlled randomized trial enrolled patients aged 18-80 years with lower extremity painful DPN who failed one-year of medical treatment. Patients were randomized to nerve decompression- or observation-group (2:1). Decompression-group patients were further randomized and blinded to nerve decompression in either right or left leg and sham surgery in the opposite leg. Pain (11-point Likert score) was compared between decompression and observation groups and between decompressed versus sham legs at 12 and 56 months.

Results:
Of 2987 screened patients, 78 were randomized. At 12 months, compared with controls (n=37), both right-decompression-group (n=22) and left-decompression-group (n=18) reported lower pain (mean difference for both, −4.46; [95% CI, −6.34 to −2.58 and −6.48 to −2.45 respectively]; P<0.0001). Decompressed and sham legs equally improved. At 56 months, compared with controls (n=14), pain was lower in both the right-decompression-group (n=20) (mean difference, −7.65; [95% CI, −9.87 to −5.44]; P<0.0001) and left-decompression-group (n=16) (mean difference, −7.26; [95% CI, −9.60 to −4.91]; P<0.0001). Mean pain score was lower in decompressed versus sham legs (mean difference, 1.57 [95% CI, 0.46 to 2.67]; P=0.0002).

Conclusion:
Although nerve decompression was associated with reduced pain, the benefit of surgical decompression needs further investigation since a placebo effect may be responsible for part or all of these effects.
Ambulatory seizure detection
Authors: Bernini Adriano , Dan Jonathan , Ryvlin Philippe 
Published: February 2024

Purpose of review
To review recent advances in the field of seizure detection in ambulatory patients with epilepsy.

Recent findings
Recent studies have shown that wrist or arm wearable sensors, using 3D-accelerometry, electrodermal activity or photoplethysmography, in isolation or in combination, can reliably detect focal-to-bilateral and generalized tonic-clonic seizures (GTCS), with a sensitivity over 90%, and false alarm rates varying from 0.1 to 1.2 per day. A headband EEG has also demonstrated a high sensitivity for detecting and help monitoring generalized absence seizures. In contrast, no appropriate solution is yet available to detect focal seizures, though some promising findings were reported using ECG-based heart rate variability biomarkers and subcutaneous EEG.

Summary
Several FDA and/or EU-certified solutions are available to detect GTCS and trigger an alarm with acceptable rates of false alarms. However, data are still missing regarding the impact of such intervention on patients’ safety. Noninvasive solutions to reliably detect focal seizures in ambulatory patients, based on either EEG or non-EEG biosignals, remain to be developed. To this end, a number of challenges need to be addressed, including the performance, but also the transparency and interpretability of machine learning algorithms.
Challenging fungal infections in cystic fibrosis: a case of mixed Aspergillus species infection and antifungal combination testing
Authors: Pontes Laís , Reichert-Lima Franqueline , Perini Leme Giordano Ana Luisa , Moretti Maria Luiza , Zaninelli Schreiber Angélica 
Published: February 2024

Aspergillus stands as the predominant fungal genus in the airways of cystic fibrosis (CF) patients, significantly contributing to their morbidity and mortality. Aspergillus fumigatus represents the primary causative species for infections, though the emergence of rare species within the Aspergillus section Fumigati has become noteworthy. Among these, Aspergillus lentulus is particularly significant due to its frequent misidentification and intrinsic resistance to azole antifungal agents. In the invasive aspergillosis and resistant infections, combination antifungal therapy has proven to be an effective approach. This report documents a case involving the death of a CF patient due to a pulmonary exacerbation linked to the colonization of multiple Aspergillus species, including A. lentulus, A. fumigatus, and A. terreus, and treated with Itraconazole (ITC) monotherapy. We delineated the procedures used to characterize the Aspergillus isolates in clinical settings and simulated in vitro the impact of the combination antifungal therapy on the isolates obtained from the patient. We evaluated three different combinations: Amphotericin B (AMB) + Voriconazole (VRC), AMB + Anidulafungin (AND), and VRC + AND. Notably, all strains isolated from the patient exhibited a significant decrease in their minimum inhibitory concentration (MIC) or minimum effective concentration (MEC) values when treated with all combinations. The VRC + AMB combination demonstrated the most synergistic effects. This case report emphasizes the importance of susceptibility testing and precise identification of Aspergillus species to enhance patient prognosis. It also underscores the potential benefits of combined antifungal treatment, which, in this case, could have led to a more favorable patient outcome.
Intermittent energy restriction inhibits tumor growth and enhances paclitaxel response in a transgenic mouse model of endometrial cancer
Authors: Zhao Ziyi , Wang Jiandong , Kong Weimin , Fang Ziwei , Coleman Michael , Milne Ginger , Burkett Wesley C. , Newton Meredith A. , Lee Douglas , Deng Beor , Shen Xiaochang , Suo Hongyan , Sun Wenchuan , Hursting Stephen , Zhou Chunxiao , Bae-Jump Victoria L 
Published: February 2024

AbstractObjectiveOverweight/obesity is the strongest risk factor for endometrial cancer (EC), and weight management can reduce that risk and improve survival. We aimed to establish the differential abilities of intermittent energy restriction (IER) and low-fat diet (LFD), alone and in combination with paclitaxel, to reverse the procancer effects of high-fat diet (HFD)-induced obesity in a mouse model of EC.MethodsLkb1fl/flp53fl/flmice were fed high-fat diet (HFD) or LFD to generate obese and lean phenotypes, respectively. Obese mice were maintained on HFD or switched to LFD (HFD-LFD) or IER (HFD-IER). Ten weeks after induction of endometrial tumor, mice in each group received paclitaxel or placebo for 4 weeks. Body and tumor weights; tumoral transcriptomic, metabolomic and oxylipin profiles; and serum metabolic hormones and chemocytokines were assessed.ResultsHFD-IER and HFD-LFD, relative to HFD, reduced body weight; reversed obesity-induced alterations in serum insulin, leptin and inflammatory factors; and decreased tumor incidence and mass, often to levels emulating those associated with continuous LFD. Concurrent paclitaxel, versus placebo, enhanced tumor suppression in each group, with greatest benefit in HFD-IER. The diets produced distinct tumoral gene expression and metabolic profiles, with HFD-IER associated with a more favorable (antitumor) metabolic and inflammatory environment.ConclusionInLkb1fl/flp53fl/flmice, IER is generally more effective than LFD in promoting weight loss, inhibiting obesity-related endometrial tumor growth (particularly in combination with paclitaxel), and reversing detrimental obesity-related metabolic effects. These findings lay the foundation for further investigations of IER as a EC prevention strategy in women with overweight/obesity.
Sterol-lipids enable large-scale, liquid-liquid phase separation in bilayer membranes of only 2 components
Authors: Wilson Kent J. , Nguyen Huy Q. , Gervay-Hague Jacquelyn , Keller Sarah L. 
Published: February 2024

AbstractDespite longstanding excitement and progress toward understanding liquid-liquid phase separation in natural and artificial membranes, fundamental questions have persisted about which molecules are required for this phenomenon. Except in extraordinary circumstances, the smallest number of components that has produced large-scale, liquid-liquid phase separation in bilayers has stubbornly remained at three: a sterol, a phospholipid with ordered chains, and a phospholipid with disordered chains. This requirement of three components is puzzling because only two components are required for liquid-liquid phase separation in lipid monolayers, which resemble half of a bilayer. Inspired by reports that sterols interact closely with lipids with ordered chains, we tested whether phase separation would occur in bilayers in which a sterol and lipid were replaced by a single, joined sterol-lipid. By evaluating a panel of sterol-lipids, some of which are found in bacteria, we discovered a minimal bilayer of only two components (PChemsPC and diPhyPC) that robustly demixes into micron-scale, liquid phases. It suggests a new role for sterol-lipids in nature, and it reveals a membrane in which tie-lines (and, therefore, the lipid composition of each phase) are straightforward to determine and will be consistent across multiple laboratories.Significance StatementA wide diversity of bilayer membranes, from those with hundreds of lipids (e.g., vacuoles of living yeast cells) to those with very few (e.g., artificial vesicles) phase separate into micron-scale liquid domains. The number of components required for liquid-liquid phase separation has been perplexing: only two should be necessary, but more are required except in extraordinary circumstances. What minimal set of molecular characteristics leads to liquid-liquid phase separation in bilayer membranes? This question inspired us to search for single, joined “sterol-lipid” molecules to replace both a sterol and a phospholipid in membranes undergoing liquid-liquid phase separation. By producing phase-separating membranes with only two components, we mitigate experimental challenges in determining tie-lines and in maintaining constant chemical potentials of lipids.