bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessment of performance and confidence level of simulation based clinical examination of respiratory system in undergraduate medical students of a medical college: a comparative cross-sectional study
Authors: Rajaure Yesha Shree , Thapa Bikalp , Budhathoki Lee , Rana Shavana R.L. , Neupane Rajendra , Karki Parag 
Published: December 2023

Introduction:
Students in the preclinical phase have adequate clinical exposure to normal physiological findings of clinical examinations performed in healthy peers but do not have exposure to pathological findings other than theoretical knowledge, which is challenging for students during the clinical phase of curricula in examining actual patients. Simulation based medical education (SBME) has recently emerged to address this gap. This study aimed to assess performance and confidence level of simulation based clinical examination of respiratory system in preclinical undergraduate medical students of a medical college.

Methods:
A comparative cross-sectional study was conducted in the Department of Human Physiology of Medical College. All second year medical students using purposive sampling were taken. Students were divided into three groups and subdivided into six subgroups and each subgroup carried out examination in either healthy subjects or both healthy subjects and manikin. Predesigned proforma was used for assessment of students and the clinical examination process was invigilated by certified physiologists.

Results:
Students who received both simulation and conventional tutoring methods were able to accurately identify all lung sounds better as compared to those with conventional tutoring with the percentage difference being maximum in identifying vesicular (29 vs 6), stridor (28 vs 6), and bronchial (25 vs 6) breath sounds and least in identifying coarse crackles (3 vs 2). Majority (39 out of 41) of the students receiving SBME of respiratory system were satisfied with the simulation based practice and 34 of those students were even confident on clinical examination.

Conclusion:
SBME increases performance status and confidence level in medical students. A practical curriculum can be planned to incorporate simulation based clinical examination in preclinical medical students in practical sessions.
Healthy Behaviors Among Non-Hispanic Black and Hispanic People Affected by Cancer During the Posttreatment Survivorship
Authors: Seven Memnun , Moraitis Ann Marie , Hammer Marilyn J. , Pearlman Jessica , Reid Allecia E. , Sturgeon Susan R. , Wenzel Jennifer 
Published: December 2023

Background
There are disparities in health behaviors across racial and ethnic groups. However, limited studies focus on cancer survivors’ experiences developing and maintaining healthy behaviors, particularly in non-Hispanic Black (NHB) and Hispanic people.

Objective
This study aimed to understand the experiences of NHB and Hispanic people affected by cancer in developing and maintaining positive health behaviors beyond a cancer diagnosis.

Methods
The data were collected in a mixed-method study through semistructured interviews with 29 NHB and Hispanic cancer survivors between June and October 2022. Conventional content analysis was used.

Results
The lived experiences of cancer survivors were narrated in 3 themes: impact of a cancer diagnosis on oneself, facilitators and barriers to health and health behaviors, and utilization of available sources for health. Facilitators and barriers to health and health behaviors were further explored as biological (eg, symptoms, comorbidities), behavioral (eg, help-seeking behavior, sleep pattern), physical/built (eg, available sources, neighborhood), and sociocultural environment (eg, income, transportation, knowledge, culture, upbringing, household and community composition, social and family network), and healthcare system–related factors (eg, insurance coverage, personal preferences, perceived discrimination, and stigma).

Conclusion
Non-Hispanic Black and Hispanic people, specifically those living in disadvantaged neighborhoods with limited sources or where they feel discriminated and stereotyped, those with limited income and transportation, and those with physical, social, or mental health problems, seemed to have challenges prioritizing health behaviors and maintaining healthy living.

Implications for Practice
Biological, behavioral, and psychosocial determinants of health behaviors should be addressed through multilevel collaborations among different levels of partners.
Association Between Estimated Geocoded Residential Maternal Exposure to Lithium in Drinking Water and Risk for Autism Spectrum Disorder in Offspring in Denmark
Authors: Liew Zeyan , Meng Qi , Yan Qi , Schullehner Jörg , Hansen Birgitte , Kristiansen Søren Munch , Voutchkova Denitza D. , Olsen Jørn , Ersbøll Annette Kjær , Ketzel Matthias , Raaschou-Nielsen Ole , Ritz Beate R. 
Published: December 2023

(Abstracted from JAMA Pediatr 2023;177(6):617–624)
Lithium is an element that is common in trace amounts, whereas larger quantities are often used as a mood-stabilizing medication for bipolar disorders. The mechanism of action of lithium in the brain is unknown, but there are many theories; one postulated mechanism of action of lithium overlaps with neurodevelopment and autism.
Second Victim Symptoms and Desired Support Strategies Among Italian Health Care Workers in Friuli-Venezia Giulia: Cross-Sectional Survey and Latent Profile Analysis
Authors: Scarpis Enrico , Beorchia Yvonne , Moretti Valentina , Favero Beatrice , Farneti Federico , Cocconi Roberto , Quattrin Rosanna , Castriotta Luigi 
Published: December 2023

Background and Objective
The second victim (SV) phenomenon concerns health care workers (HCWs) whose involvement in a medical error, as well as non-error patient safety events, has affected their well-being. Its prevalence ranges from 10% to 75% and can predispose HCWs to burnout, increasing the probability of committing errors. The primary aim of our study was to determine the prevalence of HCWs involved in an adverse patient safety event in Friuli Venezia Giulia Region (Italy). The secondary aims were to use latent profile analysis to identify profiles of SVs and factors influencing profile membership, and to evaluate the relationship between the severity of symptoms and desired support options.

Methods
A cross-sectional survey through the Italian version of the Second Victim Experience and Support Tool tool was conducted in 5 local health authorities. Descriptive statistics were conducted for all variables. Associations and correlations were assessed with statistical tests, as appropriate. Latent profile analysis was based on the scores of dimensions measuring SVs’ symptoms. Factors affecting profile membership were assessed through multinomial logistic regression.

Results
A total of 733 HCWs participated. Of them, 305 (41.6%) experienced at least 1 adverse event. Among dimensions measuring SVs’ symptoms, psychological distress had the highest percentage of agreement (30.2%). Three latent profiles were identified: mild (58.7%), moderate (24.3%), and severe (17.0%) symptoms. Severe symptoms profile was positively associated with the agreement for extraoccupational support and negatively associated with the agreement for organizational support. A respected colleague with whom to discuss the details of the incident (78.7%) and free counseling outside of work (71.2%) were the support options most desired by HCWs. The severity of symptoms was directly associated with the desire for support strategies.

Conclusions
The prevalence of HCWs involved in adverse events is consistent with the literature. Three latent profiles have been identified according to SV symptoms, and the higher the severity of symptoms, the greater the reliance on extraoccupational support.
Brief Report: Relationship Between Adiposity and Biomarkers of Aging and Frailty Among Adults Aging With HIV
Authors: Oliveira Vitor H. F. , Willig Amanda L. , Horvat Davey Christine , Buford Thomas W. , Menezes Prema , Cachay Edward , Crane Heidi M. , Burkholder Greer A. , Gripshover Barbara M. , Fleming Julia G. , Cleveland John D. , Webel Allison R. 
Published: December 2023

Background:
This study examined the relationships among adiposity, handgrip, physical function, inflammation (ie, senescence-associated secretory phenotype chemokines as biomarkers of aging and frailty), and sex hormones in aging people with HIV.

Methods:
This cross-sectional exploratory study included 150 people with HIV aged ≥40 years (67.3% of participants were male). Our measures included (1) body mass index and waist circumference as measures of adiposity; (2) handgrip as a measure of muscle strength; (3) short physical performance battery as a measure of physical function; (4) interleukin-6, tumor necrosis factor alpha receptor II, high sensitivity C-reactive protein, C-X-C motif chemokine 10, and C-X3-C motif chemokine ligand 1 also known as fractalkine as senescence-associated secretory phenotype chemokines; and (5) free testosterone, estradiol, sex hormone–binding globulin, and dehydroepiandrosterone as sex hormones. Quantile regression analyses were used to identify relationships among inflammatory markers and hormones with age, adiposity, handgrip, and physical function.

Results:
Overall, 74% (n = 111) of participants were classified as overweight or obese and 53.3% (n = 80) presented with abdominal obesity. After controlling for age and sex, body mass index was positively associated with estradiol (β = 0.043, P < 0.01), and waist circumference was positively associated with high sensitivity C-reactive protein (β = 2.151, P < 0.01). After controlling for sex, age was positively associated with C-X-C motif chemokine 10 (β = 0.024, P = 0.03) and tumor necrosis factor alpha receptor II (β = 2.205, P = 0.01). After controlling for age and sex, short physical performance battery was negatively associated with dehydroepiandrosterone (β = −0.004, P = 0.01); no statistically significant associations were observed for handgrip.

Conclusion:
Adiposity levels and aging were associated with inflammation (ie, C-X-C motif chemokine 10, tumor necrosis factor alpha receptor II, and high sensitivity C-reactive protein) among people with HIV aged 40 years and older.
Antimicrobial Prophylaxis with Ampicillin-sulbactam Compared with Cefazolin for Esophagectomy
Authors: Hirano Yuki , Konishi Takaaki , Kaneko Hidehiro , Itoh Hidetaka , Matsuda Satoru , Kawakubo Hirofumi , Uda Kazuaki , Matsui Hiroki , Fushimi Kiyohide , Daiko Hiroyuki , Itano Osamu , Yasunaga Hideo , Kitagawa Yuko 
Published: December 2023

Objective:
To assess the effect of antimicrobial prophylaxis with ampicillin-sulbactam (ABPC/SBT) compared with cefazolin (CEZ) on the short-term outcomes after esophagectomy.

Summary Background Data:
CEZ is widely used for antimicrobial prophylaxis in esophagectomy without procedure-specific evidence, whereas ABPC/SBT is preferred in some hospitals to target both aerobic and anaerobic oral bacteria.

Methods:
Data of patients who underwent esophagectomy for cancer between July 2010 and March 2019 were extracted from a nationwide Japanese inpatient database. Overlap propensity score weighting was conducted to compare the short-term outcomes [including surgical site infection (SSI), anastomotic leakage, and respiratory failure] between antimicrobial prophylaxis with CEZ and ABPC/SBT, after adjusting for potential confounders. Sensitivity analyses were also performed using propensity score matching and instrumental variable analyses.

Results:
Among 17,772 eligible patients, 16,077 (90.5%) and 1695 (9.5%) patients were administered CEZ and ABPC/SBT, respectively. SSI, anastomotic leakage, and respiratory failure occurred in 2971 (16.7%), 2604 (14.7%), and 2754 patients (15.5%), respectively. After overlap weighting, ABPC/SBT was significantly associated with a reduction in SSI [odds ratio 0.51 (95% confidence interval 0.43–0.60)], anastomotic leakage [0.51 (0.43–0.61)], and respiratory failure [0.66 (0.57–0.77)]. ABPC/SBT was also associated with reduced respiratory complications, postoperative length of stay, and total hospitalization costs. The proportion of Clostridioides difficile colitis and noninfectious complications did not differ between the groups. Propensity score matching and instrumental variable analyses demonstrated equivalent results.

Conclusions:
The administration of ABPC/SBT as antimicrobial prophylaxis for esophagectomy was associated with better short-term postoperative outcomes compared to CEZ.
Incidence of Acute Rejection Compared With Endomyocardial Biopsy Complications for Heart Transplant Patients in the Contemporary Era
Authors: Cusi Vincenzo , Vaida Florin , Wettersten Nicholas , Rodgers Nicholas , Tada Yuko , Gerding Bryn , Urey Marcus Anthony , Greenberg Barry , Adler Eric D. , Kim Paul J. 
Published: December 2023

Background.
The reference standard of detecting acute rejection (AR) in adult heart transplant (HTx) patients is an endomyocardial biopsy (EMB). The majority of EMBs are performed in asymptomatic patients. However, the incidence of treated AR compared with EMB complications has not been compared in the contemporary era (2010–current).

Methods.
The authors retrospectively analyzed 2769 EMBs obtained in 326 consecutive HTx patients between August 2019 and August 2022. Variables included surveillance versus for-cause indication, recipient and donor characteristics, EMB procedural data and pathological grades, treatment for AR, and clinical outcomes.

Results.
The overall EMB complications rate was 1.6%. EMBs performed within 1 mo after HTx compared with after 1 mo from HTx showed significantly increased complications (OR, 12.74, P < 0.001). The treated AR rate was 14.2% in the for-cause EMBs and 1.2% in the surveillance EMBs. We found the incidence of AR versus EMB complications was significantly lower in the surveillance compared with the for-cause EMB group (OR, 0.05, P < 0.001). We also found the incidence of EMB complications was higher than treated AR in surveillance EMBs.

Conclusions.
The yield of surveillance EMBs has declined in the contemporary era, with a higher incidence of EMB complications compared with detected AR. The risk of EMB complications was highest within 1 mo after HTx. Surveillance EMB protocols in the contemporary era may need to be reevaluated.
Analyzing morphological alternations of vessels in multiple Sclerosis using SLO images of the eyes
Authors: Soltanipour Asieh , Arian Roya , Aghababaei Ali , Kafieh Raheleh , Ashtari Fereshteh 
Published: December 2023

AbstractBackgroundOur purpose was to investigate the most relevant and discriminating clinical feature set of Scanning laser ophthalmoscopy (SLO) images, which could differentiate multiple sclerosis (MS) and healthy control (HC) patients.MethodsIn this work, SLO images were used for the first time to measure the most valuable manual and clinical features from some retinal structures, optic disc, cup and blood vessels, for MS and HC classifications. For this, first an age-matching algorithm along with a subject-wise k-fold cross-validation data splitting approach were applied for construction of training, validation and test dataset, minimizing the risk of model overestimation. Then, it was needed to segment the retinal structures from the SLO images, and due to the lack of ground truth for our SLO images, we took advantage of a previously proposed deep learning algorithm for anatomical segmentation using color fundus images. But owing to different imaging modalities of SLO images, we also used two stages of pre-processing and post-processing to obtain accurate results for the segmentation step. Following that, a set of manual and clinical features was measured from the segmented optic disc, cup and vessels to gain a better comprehension of the features playing an important role in classification of MS and HC images. Finally, three simple machine learning models were applied to evaluate the measured features and the most valuable and effective features were computed.ResultsThe measured feature set from the segmented optic disc, cup and blood vessels resulted in a mean accuracy (ACC) of 83%, sensitivity (SE) of 79%, specificity (SP) of 85%, and AUROC of 84%, when testing on validation data by using a XGBoost classifier model. Furthermore, horizontally disc location, fractal dimension and intensity variation of blood vessels were selected as the most important and effective features for MS and HC classification.ConclusionThe location of optic disc, fractal dimension and vessel intensity, the ratio between intensity of vessels to intensity of he whole SLO image, were selected as three most valuable features for MS and HC classification. Regarding the optic disc location, we found out the used SLO images had been captured with two different imaging techniques. So, this feature could not be trusted as the most important feature. Two other features were confirmed by one expert as clinically distinguishing features for MS and HC classification.
Expanding the phenotypic spectrum of TRAF7 syndrome: report of eleven new cases and literature review
Authors: Palma-Milla Carmen , Prat-Planas Aina , Soengas-Gonda Emma , Centeno-Pla Mónica , Sánchez-Pozo Jaime , Lazaro-Rodriguez Irene , Quesada-Espinosa Juan F. , Arteche-Lopez Ana , Olival Jonathan , Pacio-Miguez Marta , Palomares-Bralo María , Santos-Simarro Fernando , Cancho-Candela Ramón , Vázquez-López María , Seidel Veronica , Martinez-Monseny Antonio F , Casas-Alba Didac , Grinberg Daniel , Balcells Susanna , Serrano Mercedes , Rabionet Raquel , Martin Miguel A. , Urreizti Roser 
Published: December 2023

ABSTRACTTRAF7 syndrome, a multisystemic neurodevelopmental disorder caused by germline missense variants in theTRAF7gene, exhibits heterogeneous clinical presentations. We present a detailed description of eleven new TRAF7 syndrome cases, featuring eight distinct variants, including a novel one. Phenotypic analysis and a comprehensive review of the 58 previously reported cases outline consistent clinical presentations, emphasizing dysmorphic features, developmental delay, endocrine manifestations, and cardiac defects. In this enlarged collection, novelties include a wider range of cognitive dysfunction, with some individuals exhibiting normal development despite early psychomotor delay. Communication challenges, particularly in expressive language, are prevalent, necessitating alternative communication methods. Autistic traits, notably rigidity, are observed in the cohort. Also, worth highlighting are hearing loss, sleep disturbances, and endocrine anomalies, including growth deficiency. Cardiac defects, frequently severe, pose early-life complications. Facial features, including arched eyebrows, contribute to the distinct gestalt. A novel missense variant, p.(Arg653Leu), further underscores the complex relationship between germlineTRAF7variants and somatic changes linked to meningiomas. Our comprehensive analysis expands the phenotypic spectrum, emphasizing the need for oncological evaluations and proposing an evidence-based schedule for clinical management. This study contributes to a better understanding of TRAF7 syndrome, offering insights for improved diagnosis, intervention, and patient care.Key MessageTRAF7 syndrome, a complex neurodevelopmental disorder, exhibits variable cognitive outcomes, complex behavioral presentation and clinical complications emphasizing the need for tailored interventions and follow-up.
NHANES-GPT: Large Language Models (LLMs) and the Future of Biostatistics
Authors: Titus Alexander J. 
Published: December 2023

AbstractBackgroundLarge Language Models (LLMs) like ChatGPT have significant potential in biomedicine and health, particularly in biostatistics, where they can lower barriers to complex data analysis for novices and experts alike. However, concerns regarding data accuracy and model-generated hallucinations necessitate strategies for independent verification.ObjectiveThis study, using NHANES data as a representative case study, demonstrates how ChatGPT can assist clinicians, students, and trained biostatisticians in conducting analyses and illustrates a method to independently verify the information provided by ChatGPT, addressing concerns about data accuracy.MethodsThe study employed ChatGPT to guide the analysis of obesity and diabetes trends in the NHANES dataset from 2005-2006 to 2017-2018. The process included data preparation, logistic regression modeling, and iterative refinement of analyses with confounding variables. Verification of ChatGPT’s recommendations was conducted through direct statistical data analysis and cross-referencing with established statistical methodologies.ResultsChatGPT effectively guided the statistical analysis process, simplifying the interpretation of NHANES data. Initial models indicated increasing trends in obesity and diabetes prevalence in the U.S.. Adjusted models, controlling for confounders such as age, gender, and socioeconomic status, provided nuanced insights, confirming the general trends but also highlighting the influence of these factors.ConclusionsChatGPT can facilitate biostatistical analyses in healthcare research, making statistical methods more accessible. The study also underscores the importance of independent verification mechanisms to ensure the accuracy of LLM-assisted analyses. This approach can be pivotal in harnessing the potential of LLMs while maintaining rigorous standards of data accuracy and reliability in biomedical research.
Safe and reliable transport of prediction models to new healthcare settings without the need to collect new labeled data
Authors: Tuwani Rudraksh , Beam Andrew 
Published: December 2023

AbstractHow can practitioners and clinicians know if a prediction model trained at a different institution can be safely used on their patient population? There is a large body of evidence showing that small changes in the distribution of the covariates used by prediction models may cause them to fail when deployed to new settings. This specific kind of dataset shift, known as covariate shift, is a central challenge to implementing existing prediction models in new healthcare environments. One solution is to collect additional labels in the target population and then fine tune the prediction model to adapt it to the characteristics of the new healthcare setting, which is often referred to as localization. However, collecting new labels can be expensive and time-consuming. To address these issues, we recast the core problem of model transportation in terms of uncertainty quantification, which allows one to know when a model trained in one setting may be safely used in a new healthcare environment of interest. Using methods from conformal prediction, we show how to transport models safely between different settings in the presence of covariate shift, even when all one has access to are covariates from the new setting of interest (e.g. no new labels). Using this approach, the model returns a prediction set that quantifies its uncertainty and is guaranteed to contain the correct label with a user-specified probability (e.g. 90%), a property that is also known as coverage. We show that a weighted conformal inference procedure based on density ratio estimation between the source and target populations can produce prediction sets with the correct level of coverage on real-world data. This allows users to know if a model’s predictions can be trusted on their population without the need to collect new labeled data.