bluuebunny/crossref_metadata_2025_split huggingface dataset:
Should Medical Insurance Review Serve the Patient’s Best Interests? Examples and Considerations Illustrated by Behavioral Health Cases
Authors: Harris Peter Q. , Abraham Melissa E. , Cohen Bruce M. 
Published: July 2023

Abstract
Physician medical directors working for health care insurance companies conduct utilization reviews, participate in quality-of-care reviews, and adjudicate appeals. As a result, they have access to substantial and important clinical information. The medical director may have both current and historical information that can assist the treatment team in providing care. Sharing this information with a patient’s current health care provider(s) is problematic due to concerns about patient privacy and the insurer’s goal of not assuming legal liability for patient care. While this paper considers legal issues, it predominantly addresses the ethical responsibilities of medical directors who have valuable information unavailable to or unrecognized by the treatment team. Although it is important to consider sharing general medical information, this paper emphasizes the sharing of behavioral health information, which can be highly sensitive but also pertinent to psychiatric and other medical treatment choices. We suggest that clinical information should flow from insurer to provider when the insurer has information that will benefit the patient or prove crucial to optimal care rather than just flow from provider to insurer for the purposes of claims payments. To support and secure that flow, the paper outlines procedures for determining the need to share information, the means of providing that information, ways to separate liability, and processes for protecting privacy.
Evaluation of the Use of Appetite Stimulants in Pediatric Patients with Cystic Fibrosis
Authors: Kennedy Kaitlin , Lee MinJae , Sathe Meghana , Ueng Ching-Sui , Sharma Preeti 
Published: July 2023

Objective:
Poor nutrition in patients with cystic fibrosis (CF) has been associated with lower lung function and increased morbidity and mortality. Conversely, better nutritional status has been associated with improved pulmonary function and fewer CF-associated complications. There is no consensus regarding appetite stimulant therapy in patients with CF (pwCF). The primary objective of this study was to determine if the use of appetite stimulants was associated with weight changes in pediatric pwCF in the ambulatory care setting.

Methods:
This was a retrospective study that evaluated 62 pediatric pwCF who received cyproheptadine or mirtazapine for appetite stimulation for at least 6 consecutive months. Weight z scores were collected for each patient at baseline, 3, 6, and 12 months of therapy, if available.

Results:
Increase in weight z score after 3 months of therapy was statistically significant based on both univariable and multivariable models when evaluating the entire cohort. The adjusted mean difference for change in weight z score was 0.33 (P < 0.001) from baseline to month 3. There was a statistically significant improvement in pulmonary function after 3 and 6 months of therapy.

Conclusions:
Appetite stimulant therapy was associated with improvement in weight z score in the first 3 months of treatment. Appetite stimulant therapy was associated with improvement in pulmonary function in the first 3 months of therapy, which supports the relationship between weight gain and improved pulmonary function in pwCF. These findings suggest that appetite stimulants contribute to weight gain in pediatric pwCF, particularly within the first 3 months of therapy.
Left Lobe First With Purely Laparoscopic Approach
Authors: Fujiki Masato , Pita Alejandro , Kusakabe Jiro , Sasaki Kazunari , You Taesuk , Tuul Munkhbold , Aucejo Federico N. , Quintini Cristiano , Eghtesad Bijan , Pinna Antonio , Miller Charles , Hashimoto Koji , Kwon Choon Hyuck David 
Published: July 2023

Objective:
Evaluate outcome of left-lobe graft (LLG) first combined with purely laparoscopic donor hemihepatectomy (PLDH) as a strategy to minimize donor risk.

Background:
An LLG first approach and a PLDH are 2 methods used to reduce surgical stress for donors in adult living donor liver transplantation (LDLT). But the risk associated with application LLG first combined with PLDH is not known.

Methods:
From 2012 to 2023, 186 adult LDLTs were performed with hemiliver grafts, procured by open surgery in 95 and PLDH in 91 cases. LLGs were considered first when graft-to-recipient weight ratio ≥0.6%. Following a 4-month adoption process, all donor hepatectomies, since December 2019, were performed laparoscopically.

Results:
There was one intraoperative conversion to open (1%). Mean operative times were similar in laparoscopic and open cases (366 vs 371 minutes). PLDH provided shorter hospital stays, lower blood loss, and lower peak aspartate aminotransferase. Peak bilirubin was lower in LLG donors compared with right-lobe graft donors (1.4 vs 2.4 mg/dL, P < 0.01), and PLDH further improved the bilirubin levels in LLG donors (1.2 vs 1.6 mg/dL, P < 0.01). PLDH also afforded a low rate of early complications (Clavien-Dindo grade ≥ II, 8% vs 22%, P = 0.007) and late complications, including incisional hernia (0% vs 13.7%, P < 0.001), compared with open cases. LLG was more likely to have a single duct than a right-lobe graft (89% vs 60%, P < 0.01). Importantly, with the aggressive use of LLG in 47% of adult LDLT, favorable graft survival was achieved without any differences between the type of graft and surgical approach.

Conclusions:
The LLG first with PLDH approach minimizes surgical stress for donors in adult LDLT without compromising recipient outcomes. This strategy can lighten the burden for living donors, which could help expand the donor pool.
Presenting Symptoms and Imaging Features of Posterior Cerebral Artery Stroke Causing Homonymous Hemianopia
Authors: Liu Elaine A. , Murali Sadhana , Rivera-de Choudens Roberto , Trobe Jonathan D. 
Published: July 2023

Background:
Posterior cerebral artery (PCA) stroke is a common cause of homonymous hemianopia and other neurologic deficits associated with more proximal ischemia in the vertebrobasilar circuit. Localization of the process can be challenging unless the symptom complex is well recognized, yet early diagnosis is critical to forestall dangerous driving and repeated stroke. We undertook this study to provide additional detail about the presenting symptoms and signs and their correlation with imaging abnormalities and stroke etiology.

Methods:
Retrospective study of medical records of patients presenting to a single tertiary care academic center between 2009 and 2020 with homonymous hemianopia from PCA stroke. We excerpted data on symptoms, visual and neurologic signs, incident medical procedures and diagnoses, and imaging features. We determined stroke etiology using the Causative Classification Stroke system.

Results:
In a cohort of 85 patients, 90% of strokes occurred without preceding symptoms. But in retrospect, 10% of strokes did have warning symptoms. In 20% of patients, strokes followed within 72 hours of a medical or surgical procedure or newly identified medical condition. In the subgroups of patients whose records contained a description of visual symptoms, 87% reported the visual sensation as negative, and 66% realized that it was located in a hemifield in both eyes. Concurrent nonvisual symptoms were present in 43% of patients, consisting commonly of numbness, tingling, and new headache. Infarction located outside the visual cortex affected primarily the temporal lobe, thalamus, and cerebellum, reflecting the widespread nature of ischemia. Nonvisual clinical manifestations and arterial cutoffs on imaging were associated with thalamic infarction, but the clinical features and location of the infarction did not correlate with the etiology of the stroke.

Conclusions:
In this cohort, clinical localization of the stroke was aided by the fact that many patients could lateralize their visual symptoms and had nonvisual symptoms suggestive of ischemia affecting the proximal vertebrobasilar circuit. Numbness and tingling were strongly linked to concurrent thalamic infarction. Clinical features and infarct location were not associated with the etiology of the stroke.
Demographics, Risk Factors, and Etiology of Posterior Cerebral Artery Stroke Causing Homonymous Hemianopia
Authors: Liu Elaine A. , Murali Sadhana , Rivera-de Choudens Roberto , Trobe Jonathan D. 
Published: July 2023

Background:
Posterior cerebral artery (PCA) strokes account for up to 10% of all ischemic strokes, often presenting with homonymous hemianopia. The proportion of these strokes attributed to various etiologies varies widely in previously published studies, owing largely to differing patient populations, definitions of stroke pathogenesis, and vascular territories involved. The Causative Classification System (CCS), an automated version of the Stop Stroke Study (SSS) Trial of Org 10,172 in Acute Stroke Treatment (TOAST) system, allows for a more rigorous assignment of stroke etiology.

Methods:
We excerpted clinical and imaging data on 85 patients who had PCA stroke with homonymous hemianopia examined at the University of Michigan. We compared the stroke risk factor profile of our PCA cohort with that of 135 patients with stroke in the distribution of the internal carotid artery (ICA) and middle cerebral artery (MCA) in an unpublished University of Michigan registry. We applied the CCS web-based calculator to our PCA cohort to determine stroke etiology.

Results:
In our PCA cohort, 80.0% had at least 2 conventional stroke risk factors and 30.6% had 4 risk factors, most commonly systemic hypertension. The risk factor profile of our PCA cohort resembled that of our ICA/MCA cohort except that the mean age of our PCA cohort was more than a decade younger and had a significantly lower frequency of atrial fibrillation (AF) than our ICA/MCA cohort. In nearly half of the patients with AF in our PCA cohort, AF was diagnosed after the stroke. Among stroke etiologies in our PCA cohort, 40.0% were of undetermined cause, 30.6% were from cardioaortic embolism, 17.6% were from other determined causes, and only 11.8% were from supra-aortic large artery atherosclerosis. Strokes after endovascular or surgical interventions were prominent among other determined causes.

Conclusions:
Most patients in our PCA cohort had multiple conventional stroke risk factors, a finding not previously documented. Mean age at stroke onset and AF frequency were lower than in our ICA/MCA cohort, in agreement with previous studies. As some other studies have found, nearly 1/3 of strokes were attributed to cardioaortic embolism. Within that group, AF was often a poststroke diagnosis, a finding not previously highlighted. Compared with earlier studies, a relatively high portion of strokes were of undetermined etiology and of other determined etiologies, including stroke after endovascular or surgical interventions. Supra-aortic large artery atherosclerosis was a relatively uncommon explanation for stroke.
How to address physical activity and exercise during treatment from eating disorders: a scoping review
Authors: Mathisen Therese Fostervold , Hay Phillipa , Bratland-Sanda Solfrid 
Published: July 2023

Purpose of review
This scoping review aimed to provide a recent update on how to address dysfunctional physical activity and exercise (DEx), and on effects and experiences from including supervised and adapted physical activity or exercise (PAE), during treatment of eating disorders.

Recent findings
A systematic search for peer-reviewed publications in the period 2021–2023 generated 10 original studies and 6 reviews, including one meta-analysis (reporting according to PRISMA and SWiM). Findings showed that DEx was effectively managed by use of psychoeducation and/or PAE. Inclusion of PAE as part of treatment showed low-to-moderate impact on health and positive or neutral effects on eating disorder psychopathology. There were no reports of adverse events. For individuals with anorexia nervosa, PAE improved physical fitness with no influence on body weight or body composition unless progressive resistance training was conducted. For individuals with bulimia nervosa, DEx was reduced simultaneously with increased functional exercise and successful implementation of physical activity recommendations during treatment. Experiences by individuals with eating disorders and clinicians, including accredited exercise physiologists, pointed to positive benefits by including PAE in treatment.

Summary
Lack of consensus about DEx and of recommendations for PAE in official treatment guidelines hinder adequate approaches to these issues in eating disorder treatment.
Bloodstream infections in cancer patients in central India: trend over five years
Authors: Choudhari Sonali , Gawande Ruchita , Watchmaker Jerestin , Bamnote Pooja , Mishra Pradeep , Dwivedi Pankaj 
Published: July 2023

Bloodstream infection (BSI) is a frequent complication in patients with cancer with high mortality. Significant changing trends are observed in the epidemiology of BSI over a period of time and varies from country to country. With this background we aimed to study the distribution and antibiogram of bacterial pathogens causing BSI in cancer patients in central India. This was a single centre retrospective observational study done in a tertiary care cancer hospital in India. All adult and paediatric patients of haematological and solid organ malignancies whose blood culture was sent were included. Blood cultures were processed with the BacT/ALERT 3D system (BioMerieux, France) and identification of bacteria to species level and antimicrobial susceptibility (AST) was performed using the Vitek 2 compact system (BioMerieux, France) according to the recommendations of the Clinical and Laboratory Standards Institute (CLSI). The demographic data and the microbiological data was retrieved from electronic medical records and microbiology laboratory records.Data was entered and tabulated using the Microsoft Excel software and statistical analysis was done using SPSS software. Culture positivity was higher in hemato-lymphoid malignancy as compared to solid organ malignancy. Gram-negative bacteria were more common etiologic agents of BSI in cancer patients. The rate of carbapenem resistant organisms was 24%. The MRSA rate was 60%. The poor sensitivity to primary empirical agent piperacillin–tazobactam and increasing prevalence of multidrug resistant organisms calls for stringent antimicrobial stewardship program.
Experimental procedures for flow cytometry of wild type mouse brain: A systematic review
Authors: Sharp Robert C. , Guenther Dylan T. , Farrer Matthew J. 
Published: July 2023

AbstractObjectiveTo systematically review the neuroimmunology literature to determine the average immune cell counts reported by flow cytometry in wild-type (WT) homogenized mouse brain.BackgroundMouse models of gene dysfunction are widely used to study age-associated neurodegenerative disorders, including Alzheimer’s disease and Parkinson’s disease. The importance of the neuroimmune system in these multifactorial disorders has become increasingly evident, and methods to quantify resident and infiltrating immune cells in brain, including flow cytometry, are necessary. However, there appears to be no consensus on the best approach to perform flow cytometry or quantify/report immune cell counts. The development of more standardized methods would accelerate neuroimmune discovery/validation by meta-analysis.MethodsExamination of the PROSPERO registry confirmed a systematic review of ‘neuroimmunology’ by ‘flow cytometry’ has yet to be reported. A protocol for a systematic review was subsequently based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) using Studies, Data, Methods and Outcomes (SDMO) criteria. Literature searches were conducted in Google Scholar and PubMed databases. From that search, 900 candidate studies were identified and 437 studies were assessed for eligibility based on formal exclusion criteria.ResultsOut of the 437 studies reviewed, 58 were eligible for inclusion and comparative analysis. Each study assessed immune cell subsets within homogenized mouse brain and used flow cytometry. Nonetheless, there was considerable variability in methods, data analysis, reporting and results. Descriptive statistics are presented on study designs and results, including medians with interquartile ranges (IQRs) and overall means with standard deviations (SD) for specific immune cell counts and their relative proportions, within and between studies. Results derived from 58 studies reported the most abundant immune cells within the brains were TMEM119+microglia, bulk CD4+T cells, and bulk CD8+T cells.ConclusionExperiments to conduct and report flow cytometry data, derived from WT homogenized mouse brains, would benefit from a more standardized approach. While within study comparisons are valid, variability in methods counts of immune cell populations are too broad for meta-analysis. Inclusion of a minimal protocol with more detailed methods, controls and standards could enable this nascent field to compare results across studies.
Threat expectation does not improve perceptual discrimination despite causing heightened priority processing in the frontoparietal network
Authors: Haddara Nadia , Rahnev Dobromir 
Published: July 2023

AbstractThreat cues have been widely shown to elicit increased sensory and attentional neural processing. However, whether this enhanced recruitment leads to measurable behavioral improvements in perception is still in question. Here we adjudicate between two opposing theories: that threat cues do or do not enhance perceptual sensitivity. We created threat stimuli by pairing one direction of motion in a random dot kinematogram with an aversive sound. While in the MRI scanner, 46 subjects (both men and women) completed a cued (threat/safe/neutral) perceptual decision-making task where they indicated the perceived motion direction of each moving dots stimulus. We found strong evidence that threat cues did not increase perceptual sensitivity compared to safe and neutral cues. This lack of improvement in perceptual decision-making ability occurred despite the threat cue resulting in widespread increases in frontoparietal BOLD activity, as well as increased connectivity between the right insula and the frontoparietal network. These results call into question the intuitive claim that expectation automatically enhances our perception of threat, and highlight the role of the frontoparietal network in prioritizing the processing of threat-related environmental cues.Significance StatementThreatening information receives enhanced priority processing in the brain. Evidence of increased neural activity to threat has fostered the current view that such selective processing leads to a boost in perception, suggesting that motivationally relevant top-down effects can directly change what we see. In the real world, danger is often preceded by an environmental cue that predicts its imminent approach. Here we used an aversive conditioning paradigm to test whether threat cues can change subjects’ ability to visually distinguish between threat and safe stimuli. Our results provide strong evidence for the lack of an effect of threat expectation on perceptual sensitivity, supporting the theory that perception is impenetrable by top-down cognitive influences despite robust neural attentional priority.
Investigating the ‘Bolsonaro effect’ on the spread of the Covid-19 pandemic: an empirical analysis of observational data in Brazil
Authors: Razafindrakoto Mireille , Roubaud François , Castilho Marta Reis , Pero Valéria , Saboia João 
Published: July 2023

AbstractBrazil counts among the countries the hardest hit by the Covid-19 pandemic. A great deal has been said about the negative role played by President Bolsonaro’s denialism, but relatively few studies have attempted to measure precisely what impact it actually had on the pandemic. Our paper conducts econometric estimates based on observational data at municipal level to quantitatively assess the ‘Bolsonaro effect’ over time from March 2020 to December 2022. To our knowledge, this paper presents the most comprehensive investigation of Bolsonaro’s influence in the spread of the pandemic from two angles: considering Covid-19 mortality and two key transmission mitigation channels (social distancing and vaccination); and exploring the full pandemic cycle (2020-2022) and its dynamics over time. Controlling for a rich set of relevant variables, our results find a strong and persistent ‘Bolsonaro effect’ on the death rate: municipalities that were more pro-Bolsonaro recorded significantly more fatalities. Furthermore, evidence suggests that the president’s attitude and decisions negatively influenced the population’s behaviour. Firstly, pro-Bolsonaro municipalities presented a lower level of compliance with social distancing measures. Secondly, vaccination was relatively less widespread in places more in favour of the former president. Finally, our analysis points to longer-lasting and damaging repercussions. Regression results are consistent with the hypothesis that the ‘Bolsonaro effect’impacted not only on Covid-19 vaccination, but has affected vaccination campaigns in general thereby jeopardizing the historical success of the National Immunization Program in Brazil.
Hebbian learning of stimulus-response associations using transcranial magnetic stimulation
Authors: Held Leslie , Cracco Emiel , Bardi Lara , Kiraga Maggie , Cristianelli Elio , Brass Marcel , Abrahamse Elger L. , Braem Senne 
Published: July 2023

AbstractClassical conditioning states that the systematic co-occurrence of a neutral stimulus with an unconditioned stimulus can cause the neutral stimulus to, over time, evoke the same response as the unconditioned stimulus. On a neural level, Hebbian learning suggests that this type of learning occurs through changes in synaptic plasticity when two neurons are simultaneously active, resulting in increased connectivity between them. Inspired by learning theories, we here investigated whether the mere co-activation of visual stimuli and stimulation of the primary motor cortex using transcranial magnetic stimulation (TMS) would result in stimulus-response associations that can impact future behaviour. During a learning phase, we repeatedly paired the presentation of a specific colour (but not other colours) with a TMS pulse over the motor cortex. Next, participants performed a two-alternative forced choice task where they had to categorize simple shapes and we studied whether the shapes’ task-irrelevant colour (and its potentially associated involuntary motor activity) affected the required motor response. Participants showed more errors on incongruent trials for stimuli that were previously paired with high intensity TMS pulses, but only when tested on the same day. Using a drift diffusion model for conflict tasks, we further demonstrate that this interference occurred early, and gradually increased as a function of associated TMS intensity. Taken together, our findings show that the human brain can learn stimulus-response associations using externally induced motor cortex stimulation.