bluuebunny/crossref_metadata_2025_split huggingface dataset:
Are Pediatric Trauma Transfers Justified?
Authors: Jones Vinci S. , Wirtenson Catherine , Penta Keri 
Published: December 2023

Introduction
Definitions of pediatric overtriage and unnecessary transfers for injured children have been instituted from a viewpoint of referral centers and have doubtful value for effecting interventions at referring centers. This study provides a unique insight into the factors prompting transfers at a peripheral institution.

Methods
The trauma registry of a level 2 pediatric trauma center was accessed, and pediatric transfers out to 2 level 1 pediatric trauma centers were identified over a period of 4 years. The outcomes of these patients at the accepting institutions were charted for descriptive analysis.

Results
The study identified 46 patients transferred out with a transfer rate of 6.6% when compared with total admissions. The mean Injury Severity Score (ISS) was 6.5, and the mean length of stay (LOS) at the receiving institution was 2.8 days. The reason for transfer from a specialty standpoint revealed 21 neurosurgical, 12 burn, 6 orthopedic, 4 faciomaxillary, and 2 ophthalmology patients. Overall transfer rate was 6.6%. Pediatric overtriage when defined as LOS < 24 hours at the receiving institution was 46.7%. Fifty percent of pediatric overtriage was prompted by need for a pediatric neurosurgery consult with medicolegal concern being cited as reason for transfer. Secondary overtriage when defined as LOS < 24 hours, no pediatric intensive care admission, no surgical intervention, and ISS < 9 was found in 13 patients (30.9%). The proportion of patients with Medicaid insurance was not different for the admissions (43.5%) when compared with the transfers (42.7%).

Conclusions
Existing definitions of overtriage have limited value in effecting interventions to reduce unnecessary transfers. Identifying specific factors at referring institutions including providing local availability of pediatric surgical specialists will potentially help mitigate injury-related pediatric overtriage.
Diagnostic Accuracy of the World Health Organization Pediatric Emergency Triage, Assessment and Treatment Tool Plus Among Patients Seeking Care in Nairobi, Kenya
Authors: Chen Josephine , Aluisio Adam R. , Tang Oliver Y. , Nwakibu Uzoma A. , Hunold Katherine M. , Wangara Ali Akida , Kiruja Jason , Maingi Alice , Mutiso Vincent , Thompson Peyton , Wachira Benjamin , Dunlop Stephen J. , Martin Ian B.K. , Myers Justin G. 
Published: December 2023

Introduction
The World Health Organization developed Emergency Triage Assessment and Treatment Plus (ETAT+) guidelines to facilitate pediatric care in resource-limited settings. ETAT+ triages patients as nonurgent, priority, or emergency cases, but there is limited research on the performance of ETAT+ regarding patient-oriented outcomes. This study assessed the diagnostic accuracy of ETAT+ in predicting the need for hospital admission in a pediatric emergency unit at Kenyatta National Hospital in Nairobi, Kenya.

Methods
This was a secondary analysis of a cross-sectional study of pediatric emergency unit patients enrolled over a 4-week period using fixed random sampling. Diagnostic accuracy of ETAT+ was evaluated using receiver operating curves (ROCs) and respective 95% confidence intervals (CIs) with associated sensitivity and specificity (reference category: nonurgent). The ROC analysis was performed for the overall population and stratified by age group.

Results
A total of 323 patients were studied. The most common reasons for presentation were upper respiratory tract disease (32.8%), gastrointestinal disease (15.5%), and lower respiratory tract disease (12.4%). Two hundred twelve participants were triaged as nonurgent (65.6%), 60 as priority (18.6%), and 51 as emergency (15.8%). In the overall study population, the area under the ROC curve was 0.97 (95% CI, 0.95–0.99). The ETAT+ sensitivity was 93.8% (95% CI, 87.0%–99.0%), and the specificity was 82.0% (95% CI, 77.0%–87.0%) for admission of priority group patients. The sensitivity and specificity for the emergency patients were 66.0% (95% CI, 55.0%–77.0%) and 98.0% (95% CI, 97.0%–100.0%), respectively.

Conclusions
ETAT+ demonstrated diagnostic accuracy for predicting patient need for hospital admission. This finding supports the utility of ETAT+ to inform emergency care practice. Further research on ETAT+ performance in larger populations and additional patient-oriented outcomes would enhance its generalizability and application in resource-limited settings.
68Ga-DOTATATE PET to Characterize Lesions in the Neuroaxis
Authors: Hartmann Katherine , Gillman Jennifer A. , Lazor Jillian W. , Ware Jeffrey B. , Weeks Joanna K. , Nasrallah Ilya M. , Farwell Michael D. , Pantel Austin R. 
Published: December 2023

Aim
The differentiation of paragangliomas, schwannomas, meningiomas, and other neuroaxis tumors in the head and neck remains difficult when conventional MRI is inconclusive. This study assesses the utility of 68Ga-DOTATATE PET/CT as an adjunct to hone the diagnosis.

Patients and Methods
This retrospective study considered 70 neuroaxis lesions in 52 patients with 68Ga-DOTATATE PET/CT examinations; 22 lesions (31%) had pathologic confirmation. Lesions were grouped based on pathological diagnosis and best radiologic diagnosis when pathology was not available. Wilcoxon rank sum tests were used to test for differences in SUVmax among paragangliomas, schwannomas, and meningiomas. Receiver operator characteristic curves were constructed.

Results
Paragangliomas had a significantly greater 68Ga-DOTATATE uptake (median SUVmax, 62; interquartile range [IQR], 89) than nonparagangliomas. Schwannomas had near-zero 68Ga-DOTATATE uptake (median SUVmax, 2; IQR, 1). Intermediate 68Ga-DOTATATE uptake was seen for meningiomas (median SUVmax, 19; IQR, 6) and other neuroaxis lesions (median SUVmax, 7; IQR, 9). Receiver operator characteristic analysis demonstrated an area under the curve of 0.87 for paragangliomas versus all other lesions and 0.97 for schwannomas versus all other lesions.

Conclusions
Marked 68Ga-DOTATATE uptake (>50 SUVmax) favors a diagnosis of paraganglioma, although paragangliomas exhibit a wide variability of uptake. Low to moderate level 68Ga-DOTATATE uptake is nonspecific and may represent diverse pathophysiology including paraganglioma, meningioma, and other neuroaxis tumors but essentially excludes schwannomas, which exhibited virtually no uptake.
Intraoperative Radioguided Localization of an Occult Neuroendocrine Tumor of the Ileum
Authors: Manca Gianpiero , Nonne Giovanna , Volterrani Duccio 
Published: December 2023

Abstract
We report the intraoperative radioguided localization of an occult well-differentiated neuroendocrine tumor of the ileum in a patient with a known neuroendocrine lymphonodal metastasis in the mesentery. Preoperative imaging included CT, PET/CT with 68Ga-DOTATOC, and SPECT/CT with 99mTc-HYNICTOC. These scans revealed morphological and functional properties of the primary tumor localized in the ileum. The day after IV 99mTc-HYNICTOC injection, the patient underwent surgery, and the target lesion was intraoperatively detected by a collimated handheld γ-probe. Postoperative pathology examination confirmed the target lesion to be a neuroendocrine tumor of the ileum.
FDG PET/CT in Solitary Isolated Renal Metastasis From Squamous Cell Lung Cancer
Authors: Zhang Jun , Dong Aisheng , Wang Yang 
Published: December 2023

Abstract
We describe FDG PET/CT findings in a patient with a solitary isolated renal metastasis from squamous cell lung cancer. The renal metastasis appeared as a small focus of activity at the renal cortex on FDG PET/CT at initial staging of the lung tumor, misinterpreted as cortical tracer retention, and was significantly enlarged on the second FDG PET/CT performed 4 months after the first PET/CT. This case demonstrates the usefulness of FDG PET/CT in identifying unexpected extrathoracic metastasis from lung cancer. Focal FDG uptake in the renal cortical region in a cancer patient should be evaluated carefully to avoid misdiagnosis.
Electroconvulsive Therapy Versus Repetitive Transcranial Magnetic Stimulation in Patients With a Depressive Episode
Authors: Strandberg Pontus , Nordenskjöld Axel , Bodén Robert , Ekman Carl Johan , Lundberg Johan , Popiolek Katarzyna 
Published: December 2023

Objectives
Electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS) are both effective in treating depression. Although rTMS induces fewer adverse effects, its effectiveness relative to ECT is not well established. The aim of this study was to investigate the treatment outcomes of ECT and rTMS in patients who have received both interventions.

Methods
This was a register-based observational crossover study in patients with depression who had undergone ECT and rTMS in Sweden between 2012 and 2021. Primary outcome was reduction in the Montgomery-Åsberg Depression Rating Scale—Self-report (MADRS-S) score. Secondary outcome was response defined as a 50% or greater decrease in the MADRS-S score. Subgroup analyses were performed to identify factors that predicted differential responses between rTMS and ECT. Continuous and categorical variables were analyzed using paired-samples t tests and McNemar tests, respectively.

Results
In total, 138 patients across 19 hospitals were included. The MADRS-S score after ECT and rTMS was reduced by 15.0 and 5.6 (P = 0.0001) points, respectively. Response rates to ECT and rTMS were 38% and 15% (P = 0.0001), respectively. Electroconvulsive therapy was superior across all subgroups classified according to age and severity of depression.

Conclusions
Our results suggest that ECT is more effective than rTMS in treating depression among patients who have received both interventions. Age and baseline depression severity did not predict who would similarly benefit from rTMS and ECT.
Rare isotope-containing diamond colour centres for fundamental symmetry tests
Authors: Morris Ian M. , Klink Kai , Singh Jaideep T. , Mendoza-Cortes Jose L. , Nicley Shannon S. , Becker Jonas N. 
Published: December 2023

Detecting a non-zero electric dipole moment in a particle would unambiguously signify physics beyond the Standard Model. A potential pathway towards this is the detection of a nuclear Schiff moment, the magnitude of which is enhanced by the presence of nuclear octupole deformation. However, due to the low production rate of isotopes featuring such ‘pear-shaped’ nuclei, capturing, detecting and manipulating them efficiently is a crucial prerequisite. Incorporating them into synthetic diamond optical crystals can produce defects with defined, molecule-like structures and isolated electronic states within the diamond band gap, increasing capture efficiency, enabling repeated probing of even a single atom and producing narrow optical linewidths. In this study, we used density functional theory to investigate the formation, structure and electronic properties of crystal defects in diamond containing

229

Pa

, a rare isotope that is predicted to have an exceptionally strong nuclear octupole deformation. In addition, we identified and studied stable lanthanide-containing defects with similar electronic structures as non-radioactive proxies to aid in experimental methods. Our findings hold promise for the existence of such defects and can contribute to the development of a quantum information processing-inspired toolbox of techniques for studying rare isotopes.

This article is part of the Theo Murphy meeting issue ‘Diamond for quantum applications’.
Development and validation of a digital twin for the analog scoliometer
Authors: Suresh Sinduja , Stubbs Annabelle , Amiri Amir , Izatt Maree T , Labrom Robert D , Askin Geoffrey N , Little J Paige 
Published: December 2023

ABSTRACTScoliosis is a complex 3D spine deformity characterised by an abnormal lateral curvature of the spine and associated rotation of the spine and ribcage. The rotational aspect of scoliosis is most commonly quantified in the Adam’s forward flexed position using an analog scoliometer. The scoliometer has a known user error of 5-8°, which is largely dependent on examiner experience, location of curve, patient positioning and BMI. The device is also limited by the 30° scale and parallax errors. Additionally, the scoliometer loses accuracy when the patient’s torso cannot be positioned parallel to the ground . This study describes the development of the first digital twin for the analog scoliometer to enable fast, gravity-independent reliable and accurate digital measurements of the Angle of Torso Rotation (ATR) from patient-specific 3D virtual models.A robust semi-automated algorithm of generative design which measures ATR from surface topography was developed. With an operating time of just a few seconds, it provides quick and reliable ATR measurements from simple parametric user inputs. 150 calibrated 3D virtual models of AIS patients treated at the Queensland Children’s Hospital Spine Clinic (QCHSC) obtained from our existing database of 3D surface scans (3DSS) and healthy non-scoliotic controls recruited for this study were used to validate the digital scoliometer tool.The tool showed excellent reliability in both intra-user (0.99) and inter-user (0.98) conditions. The digital values had a high positive correlation (0.897) and agreement (92.7%) with the analog ATR measurements made clinically. The tool also showed high sensitivity (95.83%) and specificity (76.76%). The development and validation of this virtual digital tool is significant for telehealth implementation in paediatric spine deformity management and is expected to enhance the remote health management of scoliosis.
Negative feedback control of hunger circuits by the taste of food
Authors: Aitken Tara J. , Ly Truong , Shehata Sarah , Sivakumar Nilla , La Santa Medina Naymalis , Gray Lindsay A. , Dundar Naz , Barnes Chris , Knight Zachary A. 
Published: December 2023

SummaryThe rewarding taste of food is critical for motivating animals to eat, but whether taste has a parallel function in promoting meal termination is not well understood. Here we show that hunger-promoting AgRP neurons are rapidly inhibited during each bout of ingestion by a signal linked to the taste of food. Blocking these transient dips in activity via closed-loop optogenetic stimulation increases food intake by selectively delaying the onset of satiety. We show that upstream leptin receptor-expressing neurons in the dorsomedial hypothalamus (DMHLepR) are tuned to respond to sweet or fatty tastes and exhibit time-locked activation during feeding that is the mirror image of downstream AgRP cells. These findings reveal an unexpected role for taste in the negative feedback control of ingestion. They also reveal a mechanism by which AgRP neurons, which are the primary cells that drive hunger, are able to influence the moment-by-moment dynamics of food consumption.
Endothelial samplingin situenables genetic characterization of vein of Galen Malformation
Authors: Hale Andrew T. , Liu Shanrun , Huang Fengyuan , Song Yuwei , Crowley Michael R. , Crossman David K. , Caudill Caroline , Smith Anastasia A. , Chapman Lindsey , Feldman Michael J. , Saccomano Benjamin W. , Rocque Brandon G. , Rozzelle Curtis J. , Blount Jeffrey P. , Johnston James M. , Chong Zechen , Jones Jesse G. 
Published: December 2023

AbstractBackground and ObjectivesVein of Galen malformation (VOGM), the result of arteriovenous shunting between choroidal and/or subependymal arteries and the embryologic prosencephalic vein, is among the most severe cerebrovascular disorders of childhood. While endovascular treatment options have improved outcomes, morbidity and mortality remain high. We hypothesized thatin situanalysis of the VOGM lesion using endoluminal tissue sampling (ETS) is feasible and may identify somatic mutations and transcriptional aberrations. A mechanistic understanding of VOGM genetics, pathogenesis, and maintenance will guide future therapeutic efforts.MethodsWe utilized a Mendelian, trio-based study design, collecting germline DNA (cheek swab) from patients and their families for whole exome sequencing (WES).In situVOGM ‘endothelial’ cells (EC), defined as CD31+ and CD45-, were obtained from coils via ETS during routine endovascular treatment. Autologous peripheral femoral ECs were also collected from the access sheath. Single-cell RNA sequencing (scRNA-seq) of both VOGM and femoral ECs was performed to demonstrate feasibility to define the transcriptional architecture. Comparison was also made to a published normative cerebrovascular transcriptome atlas. A subset of VOGM ECs was reserved for future DNA sequencing to assess for somatic and second-hit mutations.ResultsOur cohort contains 6 patients who underwent 10 ETS procedures from arterial and/or venous access during routine VOGM treatment (aged 12 days to ∼6 years). No periprocedural complications attributable to ETS occurred. Six unique coil types were used. ETS captured 98 ± 88 (mean ± SD; range 17-256) experimental ‘endothelial’ cells (CD31+ and CD45-). There was no discernable correlation between cell yield and coil type or route of access. Single cell RNA sequencing demonstrated hierarchical clustering and unique cell populations within the VOGM EC compartment compared to autologous femoral controls when annotated using a publicly available cerebrovascular cell atlas.ConclusionWe report the first successful utilization of ETS for VOGM. ETS appears safe and may supplement investigations aimed at development of a molecular-genetic taxonomic classification scheme for VOGM. Moreover, results may eventually inform the selection of personalized pharmacologic or genetic therapies for VOGM and cerebrovascular disorders more broadly.
Balanced Permeability Index: a multi-parameter index for improved in-vitro permeability
Authors: Weiss Dahlia R. , Baylon Javier L. , Evans Ethan D. , Paiva Anthony , Everlof Gerry , Cutrone Jingfang , Broccatelli Fabio 
Published: December 2023

ABSTRACTThe optimization of passive permeability is a key objective for orally available small molecule drug candidates. For drugs targeting the central nervous system (CNS), minimizing P-gp mediated efflux is an additional important target for optimization. The physicochemical properties most strongly associated with high passive permeability and lower P-gp efflux are size, polarity and lipophilicity. In this study, a new metric called the Balanced Permeability Index (BPI) was developed that combines these three properties. The BPI was found to be more effective than any single property in classifying molecules based on their permeability and efflux across a diverse range of chemicals and assays. The BPI can also be used to guide optimization in non-traditional small molecule modalities, such as protein degraders, which often lie outside of traditional small molecule space. BPI is easy to understand, allowing researchers to make decisions about which properties to prioritize during the drug development process.
Dynamic changes in somatosensory and cerebellar activity mediate temporal recalibration of self-touch
Authors: Kilteni Konstantina , Ehrsson H. Henrik 
Published: December 2023

AbstractAn organism’s ability to accurately anticipate the sensations caused by its own actions is crucial for a wide range of behavioral, perceptual, and cognitive functions. Notably, the sensorimotor expectations produced when touching one’s own body attenuate such sensations, making them feel weaker and less ticklish and rendering them easily distinguishable from potentially harmful touches of external origin. How the brain learns and keeps these action-related sensory expectations updated is unclear. We employed psychophysics and functional magnetic resonance imaging to pinpoint the behavioral and neural substrates of dynamic recalibration of expected temporal delays in self-touch. Psychophysical results revealed that self-touches were less attenuated after systematic exposure to delayed self-generated touches, while responses in the contralateral somatosensory cortex that normally distinguish between delayed and nondelayed self-generated touches became indistinguishable. During the exposure, the ipsilateral anterior cerebellum showed increased activity, supporting its proposed role in recalibrating sensorimotor predictions. Moreover, responses in the cingulate areas gradually increased, suggesting that as delay adaptation progresses, the nondelayed self-touches trigger activity related to cognitive conflict. Together, our results show that sensorimotor predictions in the simplest act of touching one’s own body are upheld by a sophisticated and flexible neural mechanism that maintains them accurate in time.
Circadian Vesicle Capture and Phase-Delayed Activity Maximize Synaptic Neuropeptide Release by Clock Neurons
Authors: Klose Markus K. , Kim Junghun , Gregg Sydney N. , Schmidt Brigitte F. , Xia Xiju , Li Yulong , Levitan Edwin S. 
Published: December 2023

AbstractDrosophilasLNv clock neurons release the neuropeptide PDF to control circadian rhythms. Strikingly, PDF content in sLNv terminals is rhythmic with late night synaptic accumulation occurring in preparation for exocytosis from dense-core vesicles (DCVs) hours later at midmorning. The timing of this rhythm has been puzzling because (a) DCV exocytosis occurs hours after elevations in resting membrane potential (RMP) and Ca2+levels in the soma, which have traditionally been considered surrogates for activity and peptidergic transmission, and (b) the mechanism for the daily surge in synaptic neuropeptide content is unknown. Here, a sensor for sNPF, a neuropeptide co-packaged into DCVs along with PDF, reveals native synaptic neuropeptide release requires Ca2+influx and occurs at midmorning under control of the circadian clock. Furthermore, Ca2+imaging demonstrates that presynaptic activity and neuropeptide release both peak at the same time of day, showing that activity and release rhythms at the presynapse are remarkably uncoupled from somatic Ca2+and RMP rhythms in these neurons. Finally, anterograde axonal transport of DCVs is constant throughout the day and retention of circulating DCVs rhythmically boosts presynaptic neuropeptide content. This late-night vesicle capture requires the circadian clock. Thus, the robust daily rhythms of synaptic neuropeptide release that controls circadian behavior is produced by clock-induced late-night vesicle capture and midmorning activity.Significance statementActivity-dependent neuropeptide release from clock neuron distal terminals regulates behavioral biorhythms. Neuropeptide levels in fly sLNv clock neuron terminals cycle each day: they increase late at night and decrease hours later apparently due to dense-core vesicle exocytosis that is curiously delayed relative to daily somatic depolarization and Ca2+elevation. Imaging shows that the boost in presynaptic neuropeptide content is mediated by circadian capture of release competent vesicles. Then at midmorning, long after presumptive somatic surrogates change, Ca2+influx evokes native synaptic neuropeptide release. These results demonstrate a remarkable uncoupling of the daily rhythms in peptidergic synaptic transmission and somatic indices. Furthermore, the rhythmic burst of neuropeptide release controlling circadian behavior is produced by clock-controlled vesicle capture and phase-delayed activity.