bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development and Validation of Subsyndromal Delirium Prediction Model in Patients With Advanced Malignant Tumor
Authors: Wang Pan , Xiao Weisheng 
Published: November 2023

Background
Subsyndromal delirium (SSD) is a clinical manifestation between delirium and nondelirium. There is no established guideline for diagnosing SSD, with a few different tools used for diagnosis.

Objectives
To construct and verify the risk prediction model for subdelirium syndrome in patients with advanced malignant tumors and explore its application value in risk prediction.

Methods
A total of 455 patients admitted to the Oncology Department in a tertiary grade A hospital in Hengyang City were recruited from December 2020 to May 2021. They were selected as the modeling group. The model was constructed by logistic regression. A total of 195 patients with advanced malignant tumors from June 2021 to July 2021 were selected to validate the developed model.

Results
The predictors incorporated into the model were opioids (odds ratio [OR], 1.818), sleep disorders (OR, 1.783), daily living ability score (OR, 0.969), and pain (OR, 1.810). In the modeling group, the Hosmer-Lemeshow goodness-of-fit test was P = .113, the area under the receiver operating characteristic curve was 0.884, the sensitivity was 0.820, and the specificity was 0.893. In the validation group, the Hosmer-Lemeshow goodness-of-fit test P = .108, the area under the receiver operating characteristic curve was 0.843, the Yuden index was 0.670, the sensitivity was 0.804, and the specificity was 0.866.

Conclusions
This model has excellent precision in the risk prediction of subdelirium in patients with advanced malignant tumors.

Implications for Practice
The model we developed has a guiding significance for specialized tumor nurses to care for patients with advanced malignant tumors and improve their quality of life.
Syphilis Screening Among Young Black Men Who Have Sex with Women in New Orleans, LA
Authors: Ratnayake Aneeka , Gomes Gérard , Kissinger Patricia J. 
Published: November 2023

Abstract

Background
Current US syphilis screening focuses on men who have sex with men (MSM), due to the increased risk of infection in their sexual networks, and on pregnant people, due to complications associated with congenital syphilis. However, screening for men who have sex with women (MSW) who are at increased risk of syphilis is also recommended. Factors associated with syphilis testing and positivity were assessed among young, Black MSW.

Methods
Data from the Check It study—a seek, test, and treat study for chlamydia in New Orleans, LA among Black MSW aged 15-26—were used. Survey data was used to elicit self-reported syphilis testing, self-reported testing results, and socio-demographic and behavioral factors associated with these two outcomes.

Results
Per CDC, all men in the study were recommended for syphilis screening due to their age, race, and geographic location. Of the 1458 men included, 272 (18.7%) reported ever having been syphilis tested, 267 men reported their results, and 23 (8.6%) reported testing positive. In logistic regression, older age (OR: 1.21 per year older, p < 0.001), prior Ct, GC, and/or HIV testing (OR: 50.32, p < 0.001), and younger age at sexual debut (0.90 per year older, p = 0.005), were significantly associated with prior syphilis testing. Additionally, testing positive for Ct and/or GC during the study was significantly associated with a history of syphilis positivity (OR: 3.08, p = 0.031).

Conclusions
Though syphilis testing was associated with factors that might increase risk of acquisition, only 19% of individuals meeting CDC testing recommendations had ever been screened.
Report of 5146 Cases of Coronavirus Disease 2019-Related Mortality From Cook County, Illinois Causes of Death, Demographics, and Comorbidities
Authors: Lesnikova Iana , Obukhau Aliaksandr , Lashmanova Natalia , Braun Ankica , Venkatraman Sindhuja Murali Kilapandal , Vega Matthew , Wolf Maxim Y. , Arunkumar Ponni 
Published: November 2023

Abstract
A cross-sectional study used 5216 laboratory-confirmed coronavirus disease 2019 (severe acute respiratory syndrome coronavirus 2)–related mortality cases in Cook County of Illinois. The data set included each case's demographic data, manner of death, and comorbidities. The age ranged from 0 to 108 years, with a median of 73.5 years. There were few mortality cases in the age group younger than 30 years, and the incidence of fatal infection increased with age. We demonstrated an increased incidence of mortality in males compared with females (P < 0.01). The urban population had a higher incidence of fatal infection than the suburban population (P < 0.01). We found a significant increase (P < 0.01) in the incidence of fatal coronavirus disease 2019 (severe acute respiratory syndrome coronavirus 2) infection in African American males compared with background frequencies. Latino population demonstrated younger ages at death compared with the non-Latino population. Obesity and hypertension significantly predict fatal outcomes in the younger age group. In comparison, dementia and hypertensive and arteriosclerotic cardiovascular disease are significant predictive factors in the older age group. In a large data set, we demonstrated that the demographical distribution of the population and comorbidities is associated with the risk of fatal complications and death.
Diversity in Cancer Care
Authors: Akimoto Kai , Taparra Kekoa , Brown Thelma , Patel Manali I. 
Published: November 2023

Abstract
Access to and participation in cancer clinical trials determine whether such data are applicable, feasible, and generalizable among populations. The lack of inclusion of low-income and marginalized populations limits generalizability of the critical data guiding novel therapeutics and interventions used globally. Such lack of cancer clinical trial equity is troubling, considering that the populations frequently excluded from these trials are those with disproportionately higher cancer morbidity and mortality rates. There is an urgency to increase representation of marginalized populations to ensure that effective treatments are developed and equitably applied. Efforts to ameliorate these clinical trial inclusion disparities are met with a slew of multifactorial and multilevel challenges. We aim to review these challenges at the patient, clinician, system, and policy levels. We also highlight and propose solutions to inform future efforts to achieve cancer health equity.
Social Drivers of Cancer Risk and Outcomes Among African American Men
Authors: Halbert Chanita Hughes 
Published: November 2023

AbstractSocial risk factors play an important role in minority health and cancer health disparities. Exposure to stress and stress responses are important social factors that are now included in conceptual models of cancer health disparities. This report summarizes results from studies that examined stress exposure and responses among African Americans. Data from studies that were conducted as part of a transdisciplinary and translational research center are also presented to provide additional insight about the nature of racial differences in specific stressors among African American and White prostate cancer patients.
Primary Prevention of Cancer
Authors: Gorin Sherri Sheinfeld , Hirko Kelly 
Published: November 2023

Abstract
Cancer continues to be the second most common cause of death in the United States. Racially and ethnically minoritized populations continue to experience disparities in cancer prevention compared with majority populations. Multilevel interventions—from policy, communities, health care institutions, clinical teams, families, and individuals—may be uniquely suited to reducing health disparities through behavioral risk factor modification in these populations. The aim of this article is to provide a brief overview of the evidence for primary prevention among racially and ethnically minoritized subpopulations in the United States. We focus on the epidemiology of tobacco use, obesity, diet and physical activity, alcohol use, sun exposure, and smoking, as well as increasing uptake of the Human Papillomavirus Vaccine (HPV), as mutable behavioral risk factors. We describe interventions at the policy level, including raising excise taxes on tobacco products; within communities and with community partners, for safe greenways and parks, and local healthful food; health care institutions, with reminder systems for HPV vaccinations; among clinicians, by screening for alcohol use and providing tailored weight reduction approaches; families, with HPV education; and among individuals, routinely using sun protection. A multilevel approach to primary prevention of cancer can modify many of the risk factors in racially and ethnically minoritized populations for whom cancer is already a burden.
Prostate Cancer, Race, and Health Disparity
Authors: Roach Mack , Coleman Pamela W. , Kittles Rick 
Published: November 2023

Abstract
Prostate cancer (PCa) in African American men is one of the most common cancers with a great disparity in outcomes. The higher incidence and tendency to present with more advanced disease have prompted investigators to postulate that this is a problem of innate biology. However, unequal access to health care and poorer quality of care raise questions about the relative importance of genetics versus social/health injustice. Although race is inconsistent with global human genetic diversity, we need to understand the sociocultural reality that race and racism impact biology. Genetic studies reveal enrichment of PCa risk alleles in populations of West African descent and population-level differences in tumor immunology. Structural racism may explain some of the differences previously reported in PCa clinical outcomes; fortunately, there is high-level evidence that when care is comparable, outcomes are comparable.
Satisfaction survey toward an innovative orthosis for children with cerebral palsy with pes planovalgus
Authors: Viallard Lisa , Cordillet Sébastien , Dohin Julie , Gaultier Odile , Maignan Laurane , Rauscent Hélène , Bonan Isabelle 
Published: November 2023

Background:
Pes planovalgus (PPV) is common in children with cerebral palsy and can cause pain and gait alterations over time. Initial treatment of flexible PPV includes orthotics, despite a lack of consensus on the type of orthosis. We developed an innovative ankle-foot orthosis (RAFO). RAFO is a one-piece orthosis designed to correct both the valgus and the flat of the foot. Its conception situated above the malleolar enables a moderate anti equinus effect. Its precise description and fabrication’s process is detailed.

Objective(s):
We wanted to assess user's satisfaction after several months of use and looked for clinical criteria of satisfaction.

Study Design:
Retrospective.

Methods:
We conducted a satisfaction study through a telephonic QUEST (Quebec User Evaluation of Satisfaction with Assistive Technology) survey analysing the device and the process in children and parents. 24 parents were contacted, whose child was wearing RAFO on a daily basis for at least 4 months. 20 parents answered the questionnaire. The results were then related to clinical data to research satisfaction’ criteria.

Results:
Mean QUEST satisfaction was 4.25/5 (4.18/5 for device and 4.38/5 for process). Advantages reported concerned weight and dimensions (95%), although 20% reported the necessity to change to a shoe size above, ease of use (90%) and level of comfort (80%). Parent’s satisfaction regarding perceived effectiveness was 80%. Children with equinus due to triceps surae spasticity were more susceptible to develop pain with our orthosis.

Conclusions:
Parents were overall very satisfied with the orthosis. Its technical characteristics allowing both to be a corrector of flat foot and valgus and at the same time to be comfortable and discreet makes it innovative. The presence of spastic equinus is a limit for its utilization.
A Review of Radiation-Induced Vascular Injury and Clinical Impact
Authors: Kameni Lionel E. , Januszyk Michael , Berry Charlotte E. , Downer Mauricio A. , Parker Jennifer B. , Morgan Annah G. , Valencia Caleb , Griffin Michelle , Li Dayan J. , Liang Norah E. , Momeni Arash , Longaker Michael T. , Wan Derrick C. 
Published: November 2023

Abstract
The number of cancer survivors continues to increase because of advances in therapeutic modalities. Along with surgery and chemotherapy, radiotherapy is a commonly used treatment modality in roughly half of all cancer patients. It is particularly helpful in the oncologic treatment of patients with breast, head and neck, and prostate malignancies. Unfortunately, among patients receiving radiation therapy, long-term sequalae are often unavoidable, and there is accumulating clinical evidence suggesting significant radiation-related damage to the vascular endothelium. Ionizing radiation has been known to cause obliterative fibrosis and increased wall thickness in irradiated blood vessels. Clinically, these vascular changes induced by ionizing radiation can pose unique surgical challenges when operating in radiated fields. Here, we review the relevant literature on radiation-induced vascular damage focusing on mechanisms and signaling pathways involved and highlight microsurgical anastomotic outcomes after radiotherapy. In addition, we briefly comment on potential therapeutic strategies, which may have the ability to mitigate radiation injury to the vascular endothelium.
Ultrasound-Guided Transversus Abdominis Plane Blocks Versus Local Infiltration Anesthesia on Postanesthesia Care Unit Pain Control in Patients Undergoing Abdominoplasty
Authors: Heffern Jadyn N. , Puyana Salomon , Hajebian Hooman H. , Kresofsky Kevin , Chaffin Abigail E. , Lindsey John T. 
Published: November 2023

Goals/Purpose
The goal of this study was to compare ultrasound-guided transversus abdominis plane (TAP) blocks to local infiltration anesthesia with or without blind rectus sheath blocks in patients who underwent abdominoplasty at an outpatient surgery center.

Methods/Technique
A retrospective review was conducted of patients who underwent outpatient abdominoplasty performed by the senior surgeon (J.T.L.). Group 1 received local infiltration anesthesia with or without blind rectus sheath blocks between April 2009 and December 2013. Group 2 received surgeon-led, intraoperative, ultrasound-guided, 4-quadrant TAP blocks between January 2014 and December 2021. Outcomes measured were opioid utilization (morphine milligram equivalents), pain level at discharge, and time spent in postanesthesia care unit (PACU).

Results
Sixty patients in each of the 2 study groups met the study criteria for a total of 120 patients. The study groups were similar except for a lower average age in group 1. Patients who received TAP blocks (group 2) had significantly lower morphine milligram equivalent requirements in the PACU (3.07 vs 8.93, P = 0.0001) and required a shorter stay in PACU (95.4 vs 117.18 minutes, P = 0.0001). There were no significant differences in pain level at discharge.

Conclusions
Surgeon-led, intraoperative, ultrasound-guided, 4-quadrant TAP blocks statistically significantly reduced opioid utilization in PACU by 65.6% and average patient time in the PACU by 18.5% (21.8 minutes).
Prostacyclin in trauma patients with hemorrhagic shock: A randomized clinical trial
Authors: Johansson Pär I. , Fenger Eriksen Christian , Bovbjerg Pernille E. , Gaarder Christine , Pall Marlene , Henriksen Hanne Hee , Pedersen Kristine H. , Vigstedt Martin , Lange Theis , Næss Pål Aksel , Strømgaard Andersen Mikkel , Kirkegaard Hans , Stensballe Jakob 
Published: November 2023

BACKGROUND
A main cause of trauma morbidity and mortality is multiple-organ failure, and endotheliopathy has been implicated. Pilot studies indicate that low-dose prostacyclin improves endothelial functionality in critically ill patients, suggesting that this intervention may improve trauma patient outcome.

METHODS
We conducted a multicenter, randomized, blinded, clinical investigator-initiated trial in 229 trauma patients with hemorrhagic shock who were randomized 1:1 to 72 hours infusion of the prostacyclin analog iloprost (1 ng/kg/min) or placebo. The primary outcome was the number of intensive care unit (ICU)–free days alive within 28 days of admission. Secondary outcomes included 28-day all-cause mortality and hospital length of stay.

RESULTS
The mean number of ICU-free days alive within 28 days was 15.64 days in the iloprost group versus 13.99 days in the placebo group (adjusted mean difference, −1.63 days [95% confidence interval (CI), −4.64 to 1.38 days]; p = 0.28). The 28-day mortality was 18.8% in the iloprost group versus 19.6% in the placebo group (odds ratio, 1.01 [95% CI, 0.51–2.0]; p = 0.97). The mean hospital length of stay was 19.96 days in the iloprost group versus 27.32 days in the placebo group (adjusted mean difference, 7.84 days [95% CI, 1.66–14.02 days], p = 0.01).

CONCLUSION
Iloprost did not result in a statistically significant increase in the number of ICU-free days alive within 28 days of admission, whereas it was safe and a statistically significant reduction in hospital length of stay was observed. Further research on prostacyclin in shocked trauma patients is warranted.

LEVEL OF EVIDENCE
Therapeutic/Care Management; Level II.
TiME OUT: Time-specific machine-learning evaluation to optimize ultramassive transfusion
Authors: Meyer Courtney H. , Nguyen Jonathan , ElHabr Andrew , Venkatayogi Nethra , Steed Tyler , Gichoya Judy , Sciarretta Jason D. , Sikora James , Dente Christopher , Lyons John , Coopersmith Craig M. , Nguyen Crystal , Smith Randi N. 
Published: November 2023

BACKGROUND
Ultramassive transfusion (UMT) is a resource-demanding intervention for trauma patients in hemorrhagic shock, and associated mortality rates remains high. Current research has been unable to identify a transfusion ceiling or point where UMT transitions from lifesaving to futility. Furthermore, little consideration has been given to how time-specific patient data points impact decisions with ongoing high-volume resuscitation. Therefore, this study sought to use time-specific machine learning modeling to predict mortality and identify parameters associated with survivability in trauma patients undergoing UMT.

METHODS
A retrospective review was conducted at a Level I trauma (2018–2021) and included trauma patients meeting criteria for UMT, defined as ≥20 red blood cell products within 24 hours of admission. Cross-sectional data were obtained from the blood bank and trauma registries, and time-specific data were obtained from the electronic medical record. Time-specific decision-tree models predicating mortality were generated and evaluated using area under the curve.

RESULTS
In the 180 patients included, mortality rate was 40.5% at 48 hours and 52.2% overall. The deceased received significantly more blood products with a median of 71.5 total units compared with 55.5 in the survivors (p < 0.001) and significantly greater rates of packed red blood cells and fresh frozen plasma at each time interval. Time-specific decision-tree models predicted mortality with an accuracy as high as 81%. In the early time intervals, hemodynamic stability, undergoing an emergency department thoracotomy, and injury severity were most predictive of survival, while, in the later intervals, markers of adequate resuscitation such as arterial pH and lactate level became more prominent.

CONCLUSION
This study supports that the decision of “when to stop” in UMT resuscitation is not based exclusively on the number of units transfused but rather the complex integration of patient and time-specific data. Machine learning is an effective tool to investigate this concept, and further research is needed to refine and validate these time-specific decision-tree models.

LEVEL OF EVIDENCE
Prognostic and Epidemiological; Level IV.
The interaction between geriatric and neighborhood vulnerability: Delineating prehospital risk among older adult emergency general surgery patients
Authors: Zogg Cheryl K. , Falvey Jason R. , Kodadek Lisa M. , Staudenmayer Kristan L. , Davis Kimberly A. 
Published: November 2023

BACKGROUND
When presenting for emergency general surgery (EGS) care, older adults frequently experience increased risk of adverse outcomes owing to factors related to age (“geriatric vulnerability”) and the social determinants of health unique to the places in which they live (“neighborhood vulnerability”). Little is known about how such factors collectively influence adverse outcomes. We sought to explore how the interaction between geriatric and neighborhood vulnerability influences EGS outcomes among older adults.

METHODS
Older adults, 65 years or older, hospitalized with an AAST-defined EGS condition were identified in the 2016 to 2019, 2021 Florida State Inpatient Database. Latent variable models combined the influence of patient age, multimorbidity, and Hospital Frailty Risk Score into a single metric of “geriatric vulnerability.” Variations in geriatric vulnerability were then compared across differences in “neighborhood vulnerability” as measured by variations in Area Deprivation Index, Social Vulnerability Index, and their corresponding subthemes (e.g., access to transportation).

RESULTS
A total of 448,968 older adults were included. For patients living in the least vulnerable neighborhoods, increasing geriatric vulnerability resulted in up to six times greater risk of death (30-day risk-adjusted hazards ratio [HR], 6.32; 95% confidence interval [CI], 4.49–8.89). The effect was more than doubled among patients living in the most vulnerable neighborhoods, where increasing geriatric vulnerability resulted in up to 15 times greater risk of death (30-day risk-adjusted HR, 15.12; 95% CI, 12.57–18.19). When restricted to racial/ethnic minority patients, the multiplicative effect was four-times as high, resulting in corresponding 30-day HRs for mortality of 11.53 (95% CI, 4.51–29.44) versus 40.67 (95% CI, 22.73–72.78). Similar patterns were seen for death within 365 days.

CONCLUSION
Both geriatric and neighborhood vulnerability have been shown to affect prehospital risk among older patients. The results of this study build on that work, presenting the first in-depth look at the powerful multiplicative interaction between these two factors. The results show that where a patient resides can fundamentally alter expected outcomes for EGS care such that otherwise less vulnerable patients become functionally equivalent to those who are, at baseline, more aged, more frail, and more sick.

LEVEL OF EVIDENCE
Prognostic and Epidemiological; Level III.