bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gut microbiota and its impact on critical illness
Authors: Battaglini Denise , Torres Antoni 
Published: January 2025

Purpose of review
This narrative review discusses the mechanisms connecting gut dysbiosis to adverse clinical outcomes in critically ill patients and explores potential therapeutic strategies.

Recent findings
In recent years, the study of microbiota in ICUs has gained attention because of its potential effects on patient outcomes. Critically ill patients often face severe conditions, which can compromise their immune systems and lead to opportunistic infections from bacteria typically harmless to healthy individuals. The relationship between aggressive medical treatments and microbiota composition remains unclear. Dysbiosis, characterized by reduced microbial diversity and the loss of beneficial bacteria, can lead to prolonged immunosuppression and increased pathogenic risks, contributing to infections and organ failure. Recent advancements in multiomics technologies have enhanced the understanding of host–microbe interactions and their implications in critical care.

Summary
The microbiota plays an important role in shaping outcomes for critically ill patients. According to evidence, alterations in the gut and lung microbiota are associated with disease severity, mortality, and overall patient recovery. Evolving research opens possibilities for personalized medicine by tailoring treatments based on individual microbiota profiles, though clinical applications are still developing.
Evaluating New Graduate Nurse Readiness for Practice
Authors: Catarelli Bryce , Thompson Lara , Zhang Xiaoxi , Weaver Michael 
Published: January 2025

Background:
New graduate nurses (NGNs) often feel unprepared to enter the nursing workforce. Nurse educators can collaborate with clinical partners to identify gaps in practice readiness to meet the current needs of novice nurses and improve their preparation for practice.

Purpose:
To evaluate perceived practice readiness among NGNs on hire and to identify areas for potential improvement in the nursing curriculum.

Methods:
A retrospective cross-sectional study was conducted on NGN readiness using Casey-Fink Graduate Nurse Experience Surveys. Data from 273 NGNs hired between 2021 and 2023 within 1 large nonprofit academic hospital were analyzed.

Results:
Over 75% of NGNs reported feeling comfortable/confident with communication, delegation, and organizing/prioritizing patient care needs. The primary challenges highlighted included lack of confidence and providing end-of-life care. NGNs often feel uncomfortable independently managing codes, ventilators, and chest tubes.

Conclusion:
Nurse educators should prioritize clinical experiences to increase confidence and reinforce training for providing end-of-life care and complex hands-on skills.
Superolateral Pedicle Breast Reduction for Patients with Medially Positioned Nipple-Areolar Complexes
Authors: Lava Christian X. , Li Karen R. , Episalla Nicole C. , Snee Isabel A. , Bell Alice C. , Fan Kenneth L. , Jabbour Samer F. 
Published: January 2025

Background:
The superolateral pedicle (SLP) is commonly used in our practice in breast reductions (BR) where the nipple-areolar complex (NAC) is too medial, restricting pedicle movement and positioning. This study demonstrates the safety and efficacy of the SLP.

Methods:
A retrospective review of BR patients from September 2022 to January 2024 was conducted. Demographic data, comorbidities, operative details, and complications were collected.

Results:
A total of 164 breasts (84 patients) underwent BR: 135 (80.5%) used the SMP technique and 29 (17.7%) used the SLP technique. Median weight of breast tissue resected in SMP and SLP cohorts were 841.0 (range = 178-9,953) and 706.0 (range = 186-1,250) g, respectively (p=0.126). In the SLP group, 4 (13.8%) breasts experienced at least one complication, including seroma requiring aspiration (n=3, 10.3%) and abscess formation requiring antibiotics (n=2, 6.9%). In the SMP group, 18 (13.3%) breasts experienced at least one complication, including hematoma (n=7, 5.2%), abscess formation (n=4, 3.0%), seroma (n=3, 2.2%), dehiscence (n=2, 1.5%), partial nipple necrosis (n=1, 0.7%), and fat necrosis (n=1, 0.7%). There were 5 (3.0%) cases of reoperation, all in the SMP group. In a propensity score matching analysis, complication rates were comparable between SLP (n=30 breasts) and SMP (n=23 breasts) groups (average treatment effect on the treated (ATT)=0.067; p=0.713).

Conclusion:
The SLP technique for BR is safe and efficacious, showing complication rates comparable to the SMP technique, with no significant differences in resection weight. These findings support its viability as an alternative to traditional pedicle techniques in BRs.
Identifying Variables Associated with Long-Term Quality of Life After Severe Lower Limb Trauma Using the LIMB-Q
Authors: Schuckink Kool Floor H.N. , Mureau Marc A.M. , van Bijnen Sybe , Stirler Vincent M.A. , Mundy Lily R. , de Jong Tim 
Published: January 2025

Background:
Severe lower limb trauma is associated with substantial impact on health-related quality of life. In some cases, severity of the trauma necessitates a decision between reconstruction and amputation. Therefore, the aim of this study was to identify variables associated with long-term quality of life using the LIMB-Q, and to compare outcomes between patients undergoing amputation versus those receiving reconstructive surgery.

Methods:
This retrospective, cross-sectional study, conducted at two Dutch healthcare institutions, involved patients with severe lower limb trauma who completed the LIMB-Q between February 2020 and October 2022.

Results:
This study consisted of 87 patients divided in two groups: an amputation group (n=32) and a reconstruction group (n=55). The most common injury types were 3B/C crush injuries according to the Gustilo-Anderson classification. Clinical variables significantly associated with different LIMB-Q subdomain scores included age at trauma on Function (p = 0.045), fracture related infection (FRI) on Function (p = 0.009) and chronic pain on Function, Symptoms and Work (p = 0.009, p = 0.009, and p = 0.027, respectively). No significant long-term differences were found comparing the amputation to the reconstruction group.

Conclusions:
Age at trauma, FRI, and chronic pain were variables, significantly associated with LIMB-Q subdomain scores in a group of 87 severe lower limb trauma patients. Long-term amputation and reconstruction groups report similar LIMB-Q scores, underscoring the importance of personalized treatment choices.
The Mark Cuban Cost Plus Drug Company Effect on Urogynecologic Drugs
Authors: Xu Raymond , Escott Megan , El Haraki Amr Sherif 
Published: January 2025

Importance
The Mark Cuban Cost Plus Drug Company (ie, Cost Plus Drugs) is a service that makes generic drugs affordable. Cortese et al recently published the top 9 most commonly used oral medications in treatment of urologic conditions and showed that Cost Plus Drugs would have provided an estimated $1.29 billion reduction in 2020 costs if they replaced the Medicare prices.

Objectives
We sought to investigate the savings for all drugs commonly used in urogynecology.

Study Design
We reviewed the generic drugs provided by Cost Plus Drugs and selected those commonly used for the treatment of urogynecologic conditions (N = 16). For each of the 16 drugs we identified the Cost Plus Drugs prices for the 30- and 90-count quantities. We then also calculated the 2021 Medicare spending for the 16 drugs. The potential savings were calculated as the difference between Cost Plus Drugs and Medicare 30- and 90-count prices, multiplied by the volume-adjusted number of units dispensed to Medicare beneficiaries in 2021.

Results
The total estimated savings when using Cost Plus Drugs compared to Medicare was $462,375,491.53 and $618,833,850.34 for 30- and 90-count pricing, respectively. The price of a 42.5-gram tube of vaginal estrogen cream was $22.48 on Cost Plus Drugs, compared to $293.66 through Medicare Part D.

Conclusions
Cost Plus Drugs is a novel program that has tremendous implications on costs savings in the context of prescription drugs and is particularly true for drugs used in the treatment of urogynecologic conditions, specifically vaginal estrogen.
Early achievement of hemostasis defined by transfusion velocity: A possible mechanism for whole blood survival benefit
Authors: Chipman Amanda M. , Luther James F. , Guyette Francis X. , Cotton Bryan A. , Cannon Jeremy W. , Schreiber Martin A. , Moore Ernest E. , Namias Nicholas , Minei Joseph P. , Yazer Mark H. , Vincent Laura , Cotton Abigail L. , Agarwal Vikas , Brown Joshua B. , Leeper Christine M. , Neal Matthew D. , Forsythe Raquel M. , Wisniewski Stephen R. , Sperry Jason L. ,   the SWAT Study Group
Published: January 2025

INTRODUCTION
Whole blood resuscitation is associated with survival benefits in observational cohort studies. The mechanisms responsible for outcome benefits have not been adequately determined. We sought to characterize the achievement of hemostasis across patients receiving early whole blood versus component resuscitation. We hypothesized that achieving hemostasis would be associated with outcome benefits and patients receiving whole blood would be more likely to achieve hemostasis.

METHODS
We performed a post hoc retrospective secondary analysis of data from a recent prospective observational cohort study comparing early whole blood and component resuscitation in patients at risk of hemorrhagic shock. Achievement of hemostasis was defined by receiving a single unit of blood or less, including whole blood or red cells, in any 60-minute period, over the first 4 hours from the time of arrival. Time-to-event analysis with log-rank comparison and regression modeling were used to determine the independent benefits of achieving hemostasis and whether achieving hemostasis was associated with whole blood resuscitation.

RESULTS
For the current analysis, 1,047 patients met the inclusion criteria for the study. When we compared patients who achieved hemostasis versus those who did not, achievement of hemostasis had significantly more hemostatic coagulation parameters, had lower transfusion requirements, and was independently associated with 4-hour, 24-hour and 28-day survival. Whole blood patients were significantly more likely to achieve hemostasis (88.9% vs. 81.1%, p < 0.001). Whole blood patients achieved hemostasis earlier (log-rank χ2 = 8.2, p < 0.01) and were independently associated with over twofold greater odds of achieving hemostasis (odds ratio, 2.4; 95% confidence interval, 1.6–3.7; p < 0.001).

CONCLUSION
Achievement of hemostasis is associated with significant outcome benefits. Early whole blood resuscitation is associated with a greater independent odds of achieving hemostasis and at an earlier time point. Reaching a nadir transfusion rate early following injury represents a possible mechanism of whole blood resuscitation and its attributable outcome benefits.

LEVEL OF EVIDENCE
Therapeutic/Care Management; Level III.
Caught in the Crossfire: A Single Institution’s 10-Year Experience with Pediatric Firearm Injury
Authors: Cochran Elizabeth D , Machchhar Arti , Qiao Jingbo , Chung Dai H 
Published: January 2025

Introduction:
Pediatric firearm-related injuries are now the leading cause of death among children in the United States. We sought to characterize the experience of a large free-standing children’s hospital treating children with firearm injuries.

Methods:
We reviewed all 2012-2022 gunshot wound encounters using the institutional trauma database of an urban Level 1 pediatric trauma center in Texas. Patient demographics, incident characteristics, and clinical outcomes were analyzed. Statistical analysis was performed using ANOVA and chi-square tests to evaluate the influence of socioeconomic factors. Injuries from recreational firearms like BB and pellet guns were excluded from this analysis.

Results:
Two hundred eleven pediatric patients were treated for gunshot wounds during the study period. There was an upward trend in the number of injuries per year, ranging from 6 in 2012 to 39 in 2021. The average patient age was 10.2 years. Violent injuries accounted for 51.7%, while accidental injuries led to 44.1%, and self-inflicted injuries made up 4.3%. Based on the Child Opportunity Index. 63.0% of patients lived in neighborhoods in the lowest opportunity quartile, while only 2.8% of patients lived in neighborhoods in the highest opportunity quartile. 22.7% of patients sustained injuries characterized as “major trauma,” as indicated by an Injury Severity Score of >15, and 8.5% of patients died.

Conclusions:
Firearms pose a substantial risk to children in the United States. There has been an increasing trend in pediatric firearm injuries over the last decade. The majority of children treated for firearm injury at our institution sustained injuries in the setting of gun violence. Injury prevention efforts should be aimed at decreasing intentional pediatric firearm injuries.
Simple vs Complex Aortic Arch Repair in Acute Type A Aortic Dissection
Authors: Pendarvis Jordyn , Sharaf Omar M , Bilgili Ahmet , Jiang Zhihua , Jeng Jaden A , Demos Daniel S , Spratt John R , Hess Phillip , Beaver Thomas M , Upchurch Gilbert R , Martin Tomas D , Jeng Eric I 
Published: January 2025

Background:
The purpose of this study is to evaluate the clinical outcomes of patients undergoing a simpler (hemiarch) vs complex (zone 2 arch) aortic repair for acute type A aortic dissection (TAAD).

Methods:
Adults (≥18 years) who underwent hemiarch or zone 2 arch repair for acute, hyperacute, or acute on chronic TAAD at a single institution between January 2018 and April 2024 were reviewed. Disabling stroke was defined as modified Rankin scale ≥4. Statistical analysis included univariate comparisons, Kaplan-Meier analysis, and multivariable modeling.

Results:
Two hundred eighty-three acute TAAD patients underwent hemiarch (44.5%, n=126) and/or zone 2 arch (55.5%, n=157) repair. Hemiarch patients were older (63.3±14.1 vs 56.3±12.2 years, P<0.001), but had lower rates of preoperative cerebrovascular disease (11.1%[n=14] vs 21.7%[n=34], P=0.03), chronic kidney disease (16.7%[n=21] vs 33.1%[n=52], P=0.003), and previous sternotomy (13.5%[n=17] vs 35.0%[n=55], P<0.001). Cardiopulmonary bypass and cross clamp times were shorter in hemiarch patients (214±78.5 vs 261±62.3 minutes, P<0.001; 135±54.4 vs 182±60.0 minutes, P<0.001, respectively). Postoperatively, there was no difference in the rate of disabling stroke (4.5%[n=13], P=0.12), tracheostomy (14.8%[n=43], P=0.15), pneumonia (17.2%[n=50], P=0.24), or renal failure requiring permanent dialysis (6.2%[n=18], P=0.47). In multivariable analysis, older age (HR 1.05, 95% CI=1.02-1.08) was a risk factor for longitudinal mortality, while complex aortic arch repair did not confer increased risk (HR 0.68, 95% CI=0.35-1.31).

Conclusions:
Complex aortic arch reconstruction provides a framework for down-stream endovascular procedures for the remaining aorta and can be performed in acute TAAD without increased risk of morbidity or mortality compared with a simpler repair.
Paludibacillus litoralis gen. nov., sp. nov.: a novel species of a novel genus in the family Paracoccaceae, isolated from the sediment of a tidal flat located in Zhoushan, China
Authors: He Dong-yan , Gao Jia-wei , Wang Yu-ruo , Cao Ke , Cao Yun-fei , Li Yang , Wang Lu-yao , Wang Xing-cheng , Xu Lin , Sun Cong 
Published: January 2025

A Gram-stain-negative, aerobic and rod-shaped bacterium, designated as HZG-20T, was isolated from a tidal flat in Zhoushan, Zhejiang Province, China. The 16S rRNA sequence similarities between strain HZG-20T and Pikeienuella piscinae RR4-56T, Coraliihabitans acroporae NNCM2T, Parvibaculum indicum P31T and Zhengella mangrovi X9-2-2T were 98.9, 91.7, 91.0 and 91.0%, respectively. Colonies of strain HZG-20T were 1.4 mm in diameter, milky white, round, smooth and convex after cultivating on marine agar at 30 °C for 48 h. Cells were catalase and oxidase-negative. Growth occurred at 15–37 ℃ (optimum, 28 ℃), pH 5.0–9.0 (optimum, pH 6.0–8.0) and with 0–8% (w/v) NaCl (optimum, 1–3%). It contained Menaquinone-8 (H2) as the sole respiratory quinone, and C16:0 (11.8–13.6%), C18:1
ω9c (6.8–13.3%) and C15:0 anteiso (10.9–27.7%) as the major cellular fatty acids. The main polar lipids were diphosphatidylglycerol, phosphatidylethanolamine, one unidentified phospholipid, one unidentified aminolipid, one unidentified phosphoglycolipid, two unidentified glycolipids (GL1–GL2) and three unidentified lipids (L1–L3). The genome of strain HZG-20T was 3 835 886 bp in length, comprised 3746 protein-coding genes, with DNA G+C content of 67.1 mol%. The phylogenetic and phylogenomic trees indicated that strain HZG-20T formed an independent and stable clade with P. piscinae RR4-56T. However, the average nucleotide identity, digit DNA–DNA hybridization and average amino acid identity values between strain HZG-20T and P. piscinae RR4-56T, C. acroporae NNCM2T, P. indicum P31T and Z. mangrovi X9-2-2T were 81.6, 71.1, 68.7 and 69.5%; 23.0, 18.5, 17.9 and 17.5%; and 78.2, 56.8, 56.5 and 61.9%, respectively, together with distinct chemotaxonomic features, indicating strain HZG-20T should not be assigned to known genera. As a result, a novel species of a novel genus within the family Paracoccaceae, designated as Paludibacillus litoralis gen. nov., sp. nov., was proposed. The type strain is HZG-20T (MCCC 1K08468T=KCTC 82692T).
Children’s outdoor play at early learning and child care centres: examining the impact of environmental play features on children's play behaviour
Authors: Ramsden Rachel , Pike Ian , Thorne Sally , Brussoni Mariana 
Published: January 2025

Early learning and child care centres are critical settings to support children’s regular, repeated and quality time spent in outdoor play. Gibson’s theory of affordances highlights the importance of the human-environment relationship, emphasizing how children use environmental information to inform their behaviour. This study aims to understand the association between children’s outdoor play behaviour and common environmental play features in early learning and child care outdoor play spaces, through the behaviour patterns of children. Children’s play behaviour was collected via observational behaviour mapping at eight early learning and child care centres in the Greater Vancouver region between September 2021 and November 2022, as part of the PROmoting Early Childhood Outside study. A multivariate logistic regression model examined the association between outdoor play behaviour and environmental play features, via odds ratio and 95% confidence intervals. The results indicate environmental play features, including gardening areas, playhouses, climbing structures and tricycle paths supported increased opportunities for children’s outdoor play. Gardening areas, playhouses, sandboxes, outdoor stages and fixed water features provided opportunities for exploratory play, while climbing structures and trike paths provided opportunities for physical play. Opportunities for diverse forms of play were less realized in dedicated open play areas, with the availability of loose parts and moveable equipment primarily influencing these spaces. The results of this study have important implications for future early learning and child care outdoor space design. Further research should consider children’s dynamic movement and transition between outdoor affordances, and the influence of loose parts on the use of environmental play features.
Realfreq: Real-time base modification analysis for nanopore sequencing
Authors: Samarasinghe Suneth , Deveson Ira , Gamaarachchi Hasindu 
Published: January 2025

AbstractMotivationNanopore sequencers allow sequencing data to be accessed in real-time. This allows live analysis to be performed, while the sequencing is running, reducing the turnaround time of the results. We introducerealfreq, a framework for obtaining real-time base modification frequencies while a nanopore sequencer is in operation.ResultsRealfreqcalculates and allows access to the real-time base modification frequency results while the sequencer is running. We demonstrate that the data analysis rate withrealfreqon a laptop computer can keep up with the output data rate of a nanopore MinION sequencer, while a desktop computer can keep up with a single PromethION 2 solo flowcell.Availability and ImplementationRealfreq is a free and open-source application implemented in C programming language and shell scripts. The source code and the documentation forrealfreqcan be found athttps://github.com/imsuneth/realfreq.
Motor evoked potentials as a side effect biomarker for deep brain stimulation programming
Authors: Testini Paola , Wang Austin , Cole Eric , Miocinovic Svjetlana 
Published: January 2025

AbstractObjectivesTo determine if motor evoked potentials (mEP) – stimulation-induced muscle activation measured using electromyography – can serve as a biomarker of corticobulbar (CBT) and corticospinal (CST) tract activation for deep brain stimulation (DBS) programming.MethodsIn 12 patients with Parkinson’s disease and subthalamic or pallidal DBS, contact mapping determined clinical motor side effect thresholds. For equivalent stimulation parameters, EMG was recorded from cranial and arm muscles to determine the presence, peak amplitudes and latencies of mEP. Clinical and mEP thresholds were compared and accuracy metrics calculated to assess similarity between mEP and reported side effects.ResultsThe mEP amplitudes increased with stimulation intensity. Latencies were shorter for cranial muscles, which were more likely to generate an mEP. Clinical and mEP thresholds were significantly correlated (R2= 0.31; p=0.0006), although most mEP thresholds were lower than clinical side effect thresholds. The mEP accuracy in predicting side effects was 0.72, with a sensitivity of 0.68 and a specificity of 0.73.ConclusionsEMG-recorded mEP correlated well with clinical side effects, and mEP often indicated subclinical CBT and CST activations.SignificanceThis study characterizes motor potentials evoked by DBS and demonstrates their utility as an objective biomarker for motor side effect threshold detection during DBS programming.Highlights-Deep brain stimulation can activate corticospinal/bulbar tract and evoke motor potentials in muscles measurable by surface EMG-Motor evoked potential thresholds correlate significantly with clinical side effect thresholds but occur at lower stimulation intensities-Motor evoked potentials may be a useful side effect biomarker for deep brain stimulation programming