bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient-, Clinician-, and Institution-level Variation in Inotrope Use for Cardiac Surgery: A Multicenter Observational Analysis
Authors: Mathis Michael R. , Janda Allison M. , Kheterpal Sachin , Schonberger Robert B. , Pagani Francis D. , Engoren Milo C. , Mentz Graciela B. , Shook Douglas C. , Muehlschlegel Jochen D. ,   Multicenter Perioperative Outcomes Group
Published: April 2023

Background
Conflicting evidence exists regarding the risks and benefits of inotropic therapies during cardiac surgery, and the extent of variation in clinical practice remains understudied. Therefore, the authors sought to quantify patient-, anesthesiologist-, and hospital-related contributions to variation in inotrope use.

Methods
In this observational study, nonemergent adult cardiac surgeries using cardiopulmonary bypass were reviewed across a multicenter cohort of academic and community hospitals from 2014 to 2019. Patients who were moribund, receiving mechanical circulatory support, or receiving preoperative or home inotropes were excluded. The primary outcome was an inotrope infusion (epinephrine, dobutamine, milrinone, dopamine) administered for greater than 60 consecutive min intraoperatively or ongoing upon transport from the operating room. Institution-, clinician-, and patient-level variance components were studied.

Results
Among 51,085 cases across 611 attending anesthesiologists and 29 hospitals, 27,033 (52.9%) cases received at least one intraoperative inotrope, including 21,796 (42.7%) epinephrine, 6,360 (12.4%) milrinone, 2,000 (3.9%) dobutamine, and 602 (1.2%) dopamine (non–mutually exclusive). Variation in inotrope use was 22.6% attributable to the institution, 6.8% attributable to the primary attending anesthesiologist, and 70.6% attributable to the patient. The adjusted median odds ratio for the same patient receiving inotropes was 1.73 between 2 randomly selected clinicians and 3.55 between 2 randomly selected institutions. Factors most strongly associated with increased likelihood of inotrope use were institutional medical school affiliation (adjusted odds ratio, 6.2; 95% CI, 1.39 to 27.8), heart failure (adjusted odds ratio, 2.60; 95% CI, 2.46 to 2.76), pulmonary circulation disorder (adjusted odds ratio, 1.72; 95% CI, 1.58 to 1.87), loop diuretic home medication (adjusted odds ratio, 1.55; 95% CI, 1.42 to 1.69), Black race (adjusted odds ratio, 1.49; 95% CI, 1.32 to 1.68), and digoxin home medication (adjusted odds ratio, 1.48; 95% CI, 1.18 to 1.86).

Conclusions
Variation in inotrope use during cardiac surgery is attributable to the institution and to the clinician, in addition to the patient. Variation across institutions and clinicians suggests a need for future quantitative and qualitative research to understand variation in inotrope use affecting outcomes and develop evidence-based, patient-centered inotrope therapies.

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True hermaphroditism: A nightmare for an adult
Authors: Vishwakarma Ranjit B. , Gite Venkat A. , Shaw Vivek , Sharma Shashank 
Published: April 2023

Abstract
The disorder of sex development is a rare disorder that usually occurs in early childhood. As adults, those with disorder of sexual development present with gynecomastia, primary amenorrhea, and primary infertility, which often causes great psychological impact. We report a unique case of a male adult hermaphrodite presenting with hematometra and hematosalpinx. Early management including psychiatry counseling, gender reassignment, and surgery is essential. Our patient underwent müllerian tissue removal with phallus reconstruction.
Rating the Rater: A Technique for Minimizing Leniency Bias in Residency Applications
Authors: Seaward James R. , Carter Lillian R. , Nagarkar Purushottam , Zhang Andrew Y. 
Published: April 2023

Background:
Each program in the highly competitive match for a surgical residency needs a way to review applicants effectively. Often this task is undertaken by individual faculty members, reviewing an applicant’s file and assigning a score. Despite being asked to rate on a standardized scale, our program found that ratings of the same applicants varied dramatically, with certain faculty consistently scoring higher or lower than others. This is termed leniency bias, or the Hawk-Dove effect, and can affect who is invited to interview depending on which faculty are assigned to review an applicant’s file.

Methods:
A technique to minimize leniency bias was developed and applied to this year’s 222 applicants for our plastic surgery residency. The effect of the technique was evaluated by comparing variance between ratings of the same applicants by different faculty before and after our technique.

Results:
The median variance of ratings of the same applicants reduced from 0.68 before correction to 0.18 after correction, demonstrating better agreement between raters of the applicants’ scores after our technique had been applied. This year, applying our technique affected whether or not 16 applicants (36% of interviewees) were invited for interview, including one applicant who matched to our program but who otherwise would not have been offered an interview.

Conclusions:
We present a simple but effective technique to minimize the leniency bias between raters of residency applicants. Our experience with this technique is presented together with instructions and Excel formulae for other programs to use.
Candida Colonization on the Surface of Contact Lenses in Long-Term Wearers and Boston Type 1 Keratoprosthesis Patients Presenting as White Mulberry-Shaped Deposits
Authors: Orive Bañuelos Ana , Santamaría Carro Alaitz , Feijóo Lera Raquel , Sacristán Egüén Cristina , Andollo Victoriano Noelia , Etxebarria Ecenarro Jaime 
Published: April 2023

Purpose:
To report Candida colonies on the surface of the contact lens in long-term contact lens wearers and patients with Boston type 1 keratoprosthesis (KPro I).

Methods:
A retrospective study was performed based on analyzing cultures from bandage contact lenses with small whitish mulberry-shaped deposits on their surface.

Results:
Eight samples (from seven patients) were positive for Candida. Seven of the eight were positive for Candida parapsilosis.

Conclusions:
The whitish deposits on contact lenses are often Candida colonies that colonize the surface but do not cause an active infection in the eye. C. parapsilosis is well-known for colonizing prosthetic devices. We underline the importance of including Candida species in the differential diagnosis of lens deposits, especially in susceptible patients such as keratoprosthesis carriers.
Public access defibrillation: challenges and new solutions
Authors: Folke Fredrik , Shahriari Persia , Hansen Carolina Malta , Gregers Mads Christian Tofte 
Published: April 2023

Purpose of review
The purpose of this article is to review the current status of public access defibrillation and the various utility modalities of early defibrillation.

Recent findings
Defibrillation with on-site automated external defibrillators (AEDs) has been the conventional approach for public access defibrillation. This strategy is highly effective in cardiac arrests occurring in close proximity to on-site AEDs; however, only a few cardiac arrests will be covered by this strategy. During the last decades, additional strategies for public access defibrillation have developed, including volunteer responder programmes and drone assisted AED-delivery. These programs have increased chances of early defibrillation within a greater radius, which remains an important factor for survival after out-of-hospital cardiac arrest.

Summary
Recent advances in the use of public access defibrillation show great potential for optimizing early defibrillation. With new technological solutions, AEDs can be transported to the cardiac arrest location reaching OHCAs in both public and private locations. Furthermore, new technological innovations could potentially identify and automatically alert the emergency medical services in nonwitnessed OHCA previously left untreated.
The SERENITY study: online Mindfulness-Based Cancer Recovery (e-MBCR) program for women living with breast and gynecological cancer—protocol for a pilot effectiveness-implementation randomized trial
Authors: Gaignard Marie-Estelle , Stanic Jelena , Bodmer Alexandre , Zaman Khalil , Sarivalasis Apostolos , Labidi-Galy Intidhar , Jermann Francoise , Di Marco Mariagrazia , Ljuslin Michael , Ryser Stephan , Ballabeni Pierluigi , Peters Solange , Dietrich Pierre-Yves , Eicher Manuela , Bondolfi Guido 
Published: April 2023

ABSTRACT

Background:
Mindfulness-Based Interventions (MBIs) have been shown to improve mental and physical health as well as biological processes of patients living with cancer. More research is needed to inform on the determinants that might facilitate or hinder their implementation in hospitals. The primary objective of this study was to explore the feasibility and implementation of an online Mindfulness-Based Cancer Recovery program (e-MBCR) for women with breast and gynecological cancer treated at two academic oncology centers in Switzerland. The secondary objective was to explore the psychological and biological effects of the program.

Methods:
The SERENITY study is a pilot hybrid effectiveness-implementation trial using a randomized waitlist-controlled design, including a mixed methods approach. The intervention groups receive treatment as usual and the e-MBCR program, whereas the control groups are on a wait-list to receive an online Mindfulness-Based Stress Reduction program at the end of the study. Four e-MBCR programs are delivered consecutively, with 12 patients in each group. Participants' attendance to the sessions is the primary outcome. Implementation outcomes of interest are feasibility, acceptability, appropriateness, fidelity, costs, and early sustainability. Implementation determinants will be described, and an exploratory analysis of psychological outcomes and cancer-related biomarkers will be performed at three time points (baseline, postintervention, and 3 months of follow-up).

Discussion:
The results of this study will inform a future large trial and adjustments needed for a real-world implementation of the program. The translational part of this study will contribute to the collective effort to better understand how MBIs affect important cancer-related biomarkers.
United States Health Policies on Gender-Affirming Care in 2022
Authors: Chin Madeline G. , LaGuardia Jonnby S. , Morgan Katarina B.J. , Ngo Halena , Moghadam Shahrzad , Huang Kelly X. , Bedar Meiwand , Cronin Brendan J. , Kwan Daniel , Lee Justine C. 
Published: April 2023

Background:
Within the United States, access to gender-affirming surgeries covered by health insurance has dramatically increased over the past decade. However, the perpetually changing landscape and inconsistencies of individual state health policies governing private and public insurance coverage present a lack of clarity for reconstructive surgeons and other physicians attempting to provide gender-affirming care. This work systematically reviewed the current U.S. health policies for both private insurance and Medicaid on a state-by-state basis.

Methods:
Individual state health policies in effect as of August 2022 on gender-affirming care were reviewed using the LexisNexis legal database, state legislature publications, and Medicaid manuals. Primary outcomes were categorization of policies as protective, restrictive, or unclear for each state. Secondary outcomes included analyses of demographics covered by current health policies and geographic differences.

Results:
Protective state-level health policies related to gender-affirming care were present in approximately half of the nation for both private insurance (49.0%) and Medicaid (52.9%). Explicitly restrictive policies were found in 5.9% and 17.6% of states for private insurance and Medicaid, respectively. Regionally, the Northeast and West had the highest rates of protective policies, while the Midwest and South had the highest rates of restrictive policies on gender-affirming care.

Conclusions:
State-level health policies on gender-affirming care vary significantly across the United States with regional associations. Clarity in the current and evolving state-specific health policies governing gender-affirming care is essential for surgeons and physicians caring for transgender and gender-diverse individuals.
Neurobrucellosis
Authors: Soares Cristiane N. , da Silva Marcus Tulius T. , Lima Marco Antonio 
Published: April 2023

Purpose of review
Brucellosis is one of the most common zoonosis worldwide, affecting 500 000 people, annually. Neurobrucellosis incidence is approximately 4%, and it is almost always heterogeneous. As there are no typical clinical features, its diagnosis is frequently misdiagnosing by other infections.

Recent findings
Neurobrucellosis picture includes meningitis, meningoencephalitis, encephalitis, cranial neuropathies, intracranial hypertension, sinus thrombosis, hemorrhages radiculitis, peripheral neuropathy, myelitis, and psychiatric manifestations. The diagnosis should be based on symptoms and signs suggestive of neurobrucellosis, not explained by other neurological disease, cerebrospinal fluid analysis, a positive Brucella serology or culture, and a response to specific antibiotics, with a significant improvement of cerebrospinal fluid parameters.

Summary
Neurobrucellosis can be insidious, and despite its global distribution, it is still unrecognized and frequently goes unreported. The understanding of the current epidemiology is necessary for eradication of the disease in humans, as well as the disease control in animals and prevention based on occupational hygiene and food hygiene.
Viral meningitis and encephalitis: an update
Authors: Gundamraj Vaishnavi , Hasbun Rodrigo 
Published: April 2023

Purpose of review
The most common infectious etiologies of meningitis and encephalitis are viruses. In this review, we will discuss current epidemiology, prevention, diagnosis, and treatment of the most common causes of viral meningitis and encephalitis worldwide.

Recent findings
Viral meningitis and encephalitis are increasingly diagnosed as molecular diagnostic techniques and serologies have become more readily available worldwide but recent progress in novel antiviral therapies remains limited. Emerging and re-emerging viruses that have caused endemic or worldwide outbreaks or epidemics are arboviruses (e.g., West Nile virus, Japanese encephalitis, Tick borne encephalitis, Dengue, Zika, Toscana), enteroviruses (e.g., Enterovirus 71, Enterovirus D68), Parechoviruses, respiratory viruses [e.g., severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza, metapneumoviruses, measles, mumps], and herpes viruses [e.g., herpes simplex virus (HSV) type 1 (HSV-1), HSV-2, human herpes (HV) 6, varicella zoster virus (VZV)]. Future efforts should concentrate in increasing availability for those viruses with effective vaccination [e.g., Japanese encephalitis, Tick borne encephalitis, varicella zoster viruses, SARS-CoV-2, influenza], prompt initiation of those with encephalitis with treatable viruses (e.g., HSV-1, VZV), increasing the diagnostic yield by using novel techniques such as metagenomic sequencing and avoiding unnecessary antibiotics in those with viral meningitis or encephalitis.

Summary
We review the current epidemiology, clinical presentation, diagnosis, and treatment of the common causative agents of viral meningitis and encephalitis worldwide.
Disease-Modifying Antirheumatic Drug Use and Its Effect on Long-term Opioid Use in Patients With Rheumatoid Arthritis
Authors: Sood Akhil , Kuo Yong-Fang , Westra Jordan , Raji Mukaila A. 
Published: April 2023

Background/Objectives
The prevalence of chronic pain is high in patients with rheumatoid arthritis (RA), increasing the risk for opioid use. The objective of this study was to assess disease-modifying antirheumatic drug (DMARD) use and its effect on long-term opioid use in patients with RA.

Methods
This cohort study included Medicare beneficiaries with diagnosis of RA who received at least 30-day consecutive prescription of opioids in 2017 (n = 23,608). The patients were grouped into non-DMARD and DMARD users, who were further subdivided into regimens set forth by the American College of Rheumatology. The outcome measured was long-term opioid use in 2018 defined as at least 90-day consecutive prescription of opioids. Dose and duration of opioid use were also assessed. A multivariable model identifying factors associated with non-DMARD use was also performed.

Results
Compared with non-DMARD users, the odds of long-term opioid use were significantly lower among DMARD users (odds ratio, 0.89; 95% confidence interval, 0.83–0.95). All regimens except non–tumor necrosis factor biologic + methotrexate were associated with lower odds of long-term opioid use relative to non-DMARD users. The mean total morphine milligram equivalent, morphine milligram equivalent per day, and total days of opioid use were lower among DMARD users compared with non-DMARD users. Older age, male sex, Black race, psychiatric and medical comorbidities, and not being seen by a rheumatologist were significantly associated with non-DMARD use.

Conclusion
Disease-modifying antirheumatic drug use was associated with lower odds of long-term opioid use among RA patients with baseline opioid prescription. Factors associated with non-DMARD use represent a window of opportunity for intervention to improve pain-related quality of life in patients living with RA.
Improving Model Transferability for Clinical Note Section Classification Models Using Continued Pretraining
Authors: Zhou Weipeng , Yetisgen Meliha , Afshar Majid , Gao Yanjun , Savova Guergana , Miller Timothy A. 
Published: April 2023

AbstractObjectiveThe classification of clinical note sections is a critical step before doing more fine-grained natural language processing tasks such as social determinants of health extraction and temporal information extraction. Often, clinical note section classification models that achieve high accuracy for one institution experience a large drop of accuracy when transferred to another institution. The objective of this study is to develop methods that classify clinical note sections under the SOAP (“Subjective”, “Object”, “Assessment” and “Plan”) framework with improved transferability.Materials and methodsWe trained the baseline models by fine-tuning BERT-based models, and enhanced their transferability with continued pretraining, including domain adaptive pretraining (DAPT) and task adaptive pretraining (TAPT). We added out-of-domain annotated samples during fine-tuning and observed model performance over a varying number of annotated sample size. Finally, we quantified the impact of continued pretraining in equivalence of the number of in-domain annotated samples added.ResultsWe found continued pretraining improved models only when combined with in-domain annotated samples, improving the F1 score from 0.756 to 0.808, averaged across three datasets. This improvement was equivalent to adding 50.2 in-domain annotated samples.DiscussionAlthough considered a straightforward task when performing in-domain, section classification is still a considerably difficult task when performing cross-domain, even using highly sophisticated neural network-based methods.ConclusionContinued pretraining improved model transferability for cross-domain clinical note section classification in the presence of a small amount of in-domain labeled samples.
The influence of highly effective modulator therapies on the sputum proteome in cystic fibrosis
Authors: Maher Rosemary E , Barry Peter J , Emmott Edward , Jones Andrew M , Lin Lijing , McNamara Paul S , Smith Jaclyn A , Lord Robert W 
Published: April 2023

ABSTRACTBackgroundThere have been dramatic clinical improvements in cystic fibrosis (CF) patients commenced on the cystic fibrosis conductance regulator (CFTR) modulator elexacaftor/tezacaftor/ivacaftor (ETI). Sputum proteomics is a powerful research technique capable of identifying important airway disease mechanisms. Using this technique, we evaluated how ETI changes the sputum proteome in people with CF.MethodsSputum samples from 21 CF subjects pre- and post-ETI, 6 CF controls ineligible for ETI, and 15 healthy controls were analysed by liquid chromatography mass spectrometry.ResultsPost-ETI, mean FEV1% increased by 13.7% (SD 7.9). Principal component and hierarchical clustering analysis revealed that the post-ETI proteome shifted to an intermediate state that was distinct from pre-ETI and healthy controls, even for those achieving normal lung function. Functional analysis showed incomplete resolution of neutrophilic inflammation. The CF control sputum proteome did not alter. At the protein-level many more proteins increased in abundance than decreased following ETI therapy (80 vs 30; adjusted p value <0.05), including many that have anti-inflammatory properties. Of those proteins that reduced in abundance many were pro-inflammatory neutrophil-derived proteins. Several important respiratory proteases were unchanged.ConclusionsSputum proteomics can provide insights into CF lung disease mechanisms and how they are modified by therapeutic intervention, in this case ETI. This study identifies imbalances in pro- and anti-inflammatory proteins in sputum that partially resolve with ETI even in those achieving normal spirometry values. This post-ETI intermediate state could contribute to ongoing airway damage and therefore its relevance to clinical outcomes needs to be established.
Estimating overdiagnosis in giant cell arteritis diagnostic pathways using genetic data: genetic association study
Authors: Chatzigeorgiou Charikleia , Barrett Jennifer H , Martin Javier ,   UK GCA Consortium, Morgan Ann W , Mackie Sarah L 
Published: April 2023

AbstractObjectivesPrompt diagnosis of giant cell arteritis (GCA) is important to avert visual loss. False-negative temporal artery biopsy (TAB) can occur. Without vascular imaging, GCA may be overdiagnosed in TAB-negative cases, but it is unclear how often this occurs. An unbiased test is a way to address an imperfect reference standard. We used the known Human Leukocyte Antigen (HLA) region genetic association of TAB-positive GCA to estimate the extent of overdiagnosis before widespread adoption of temporal artery ultrasound as a first-line test.MethodsPatients diagnosed with GCA between 1990-2014 consented to the UKGCA Consortium study. HLA region variants were jointly imputed from genome-wide genotypic data of cases and controls. Per-allele frequencies across all variants with p<1.0×10−5were compared with population control data to estimate overdiagnosis rates in cases without a positive TAB.ResultsGenetic data from 663 patients diagnosed with GCA were compared with data from 2619 population controls. TAB-negative GCA (n=147) and GCA without a TAB result (n=160) had variant frequencies intermediate between those of TAB-positive GCA and population controls. Making several strong assumptions, we estimated that around two-thirds of TAB-negative cases and around one-third of cases without TAB result may have been overdiagnosed. From these data, TAB sensitivity is estimated at around 88%.ConclusionsConservatively assuming 95% specificity, TAB has a negative likelihood ratio of around 0.12. Genotyping alone cannot diagnose GCA at the individual level. Group-level HLA variant genotyping might be used to compare the overall accuracy of different diagnostic pathways or different classification criteria sets.Key messagesUnder certain conditions and assumptions, overdiagnosis can be estimated using genetic data.The specificity of temporal artery biopsy was estimated as about 88%.Without vascular imaging, giant cell arteritis may often be overdiagnosed in biopsy-negative patients.