bluuebunny/crossref_metadata_2025_split huggingface dataset:
Understanding academic rank among PAs practicing in academic medical centers
Authors: Louwagie Victoria , Halasy Michael 
Published: September 2023

ABSTRACT

Objective:
To evaluate the attitudes and prevalence of academic/clinical rank among practicing physician associates/assistants (PAs) in different specialties and geographic locations.

Methods:
We surveyed PAs in clinical practice with a bias toward hospital/academic-based clinicians. The survey was a modified instrument to evaluate perceptions, attitudes, barriers, and prevalence of academic rank.

Results:
Overall, 65% of respondents indicated academic/clinical rank opportunities were of interest, but 60.8% noted that they were not eligible to hold rank in their institutions. Nearly 55% indicated a desire to hold rank, but 81.9% of respondents did not hold rank. The survey response rate was 22.9%. A lack of departmental emphasis was a common barrier to rank.

Conclusions:
Clinically practicing PAs clearly have a desire or interest in academic/clinical rank, but barriers persist. Further development of opportunities to hold academic/clinical rank with mentorship may improve PA careers and propel professional advancement and parity.
Carbon monoxide poisoning
Authors: Overfelt Conner 
Published: September 2023

ABSTRACT
Diagnosis of carbon monoxide (CO) poisoning is challenging, as it is generally based on a history of present illness leading to clinical suspicion. CO is a tasteless, odorless, and colorless gas that has become known as the “silent killer.” CO poisoning affects approximately 50,000 people in the United States each year and presents with wide range of nonspecific symptoms. Patients often do not know that they are being exposed to CO gas; it is therefore important to ask pertinent questions when taking a patient's history. Treatment consists of oxygen therapy. If a diagnosis is not made and treatment is not administered promptly, complications may occur.
APRNs' perception of telehealth use
Authors: Adelman Deborah S. , Fant Catherine , Koklys Julia C. 
Published: September 2023

Abstract

Background:
The COVID-19 pandemic resulted in a significant increase in the use of telehealth. Although advanced practice registered nurses (APRNs) play an essential role in improving healthcare accessibility, including the provision of telehealth, for many individuals, few studies examining provider perceptions of telehealth have included APRN participants.

Methods:
This article describes a quantitative, descriptive study involving a survey administered electronically to a convenience sample of APRNs from one state.

Results:
Seventy-five APRN participants completed the survey, with NPs comprising nearly 90% of the sample. On average, surveyed APRNs had been conducting telehealth visits for 2.57 years. Most participants were able to develop or maintain rapport with new or established patients using telehealth and felt that their patients were satisfied by these visits. More than one-third of participants reported that new patients seen via telehealth received somewhat worse care than patients seen face to face, and one-quarter reported that established patients seen via telehealth received somewhat worse care.

Conclusion:
Although some concerns exist, overall, APRNs' perceptions of the use of telehealth were positive, with most wishing to continue providing care via telehealth in the future. This study adds to the literature on providers' perceptions of telehealth by describing the APRN viewpoint.
Assessing the Safety and Efficacy of Tranexamic Acid Usage in Osteogenesis Imperfecta Patients
Authors: Eaton Vincent , Braaten Marco , Schissel Makayla , Wallace Maegen 
Published: September 2023

Background:
Osteogenesis Imperfecta (OI) usually causes an increased fracture burden and bone deformity, with subsequent operations common. In addition to skeletal manifestations, there is a potential increase in bleeding susceptibility due to the increased frequency of orthopedic procedures, warranting investigation into methods to mitigate this risk. This study aims to evaluate the safety and efficacy of tranexamic acid (TXA) usage to reduce intraoperative blood loss in children with OI. We want to assess the potential benefits, risks, and complications involved with TXA use in this patient population.

Methods:
TXA-receiving patients (cases) were matched 1:1 with non-TXA-receiving controls on the following criteria: age within 2 years, bone category, and OI Type. Descriptive statistics were used to summarize the data. Fisher Exact Test was performed to compare transfusion status between groups. A Wilcoxon Rank Sum test was performed to assess differences between the groups in days of stay, length of surgery, and estimated blood loss (EBL). All analyses were conducted using SAS version 9.4. P<0.05 was considered statistically significant.

Results:
Our TXA-receiving population of 30 patients consisted of 11 females and 19 males. One patient was OI type I, 13 were OI type III, 14 were OI type IV, and 2 were categorized as Other (not Type I through Type IV). We found a significant difference in transfusion status (P=0.02), with zero TXA patients requiring a transfusion compared with 20% of the control cases. There is also a significant difference in median EBL (P=0.0004) between groups, with TXA patients having decreased intraoperative EBL (20 vs. 62.5 mL). There was also a difference in median days of postoperative stay between TXA-receiving and non–TXA-receiving patients (P=0.001; 2.6 vs. 4 d).

Conclusions:
Our study concluded that TXA use in OI patients is associated with lower perioperative transfusions and intraoperative blood loss rates. These results support the standard usage of TXA in these patients to reduce intraoperative blood loss.

Level of Evidence:
Level III
Genetic insights into thymic carcinomas and thymic neuroendocrine neoplasms denote prognosis signatures and pathways
Authors: Wang Shuyuan , Gu Zhitao , Zhu Lei , Han Yuchen , Yu Hong , Fang Wentao , Han Baohui 
Published: September 2023

Abstract

Background:
Thymic carcinomas (TCs) and thymic neuroendocrine neoplasms (TNENs) are two aggressive subtypes of thymic malignancy. Traditional therapy for advanced TCs and TNENs has limited outcome. New genomic profiling of TCs and TNENs might provide insights that contribute to the development of new treatment approaches.

Methods:
We used gene panel sequencing technologies to investigate the genetic aberrations of 32 TC patients and 15 TNEN patients who underwent surgery at Shanghai Chest Hospital between 2015 and 2017. Patient samples were sequenced using a 324-gene platform with licensed technologies. In this study, we focused on clinically relevant genomic alterations (CRGAs), which are previously proven to be pathogenic alterations, to identify the pathology-specific mutational patterns, prognostic signatures of TCs and TNENs.

Results:
The mutational profiles between TCs and TNENs were diverse. The genetic alterations that ranked highest in TCs were in CDKN2A, TP53, ASXL1, CDKN2B, PIK3C2G, PTCH1, and ROS1, while those in TNENs were in MEN1, MLL2, APC, RB1, and TSC2. Prognostic analysis showed that mutations of ROS1, CDKN2A, CDKN2B, BRAF, and BAP1 were significantly associated with worse outcomes in TC patients, and that mutation of ERBB2 indicated shortened disease-free survival (DFS) and overall survival (OS) in TNEN patients. Further investigation found that the prognosis-related genes were focused on signal pathways of cell cycle control, chromatin remodeling/DNA methylation, phosphoinositide 3-kinases (PI3K)/protein kinase B (AKT)/mammalian target of rapamycin (mTOR), and receptor tyrosine kinase (RTK)/RAS/mitogen-activated protein kinase (MAPK) signaling.

Conclusion:
We profiled the mutational features of 47 Chinese patients with thymic malignancy of diverse pathologic phenotypes to uncover the integrated genomic landscape of these rare tumors, and identified the pathology-specific mutational patterns, prognostic signatures, and potential therapeutic targets for TCs and TNENs.
First-Pass Success of Intubations Using Video Versus Direct Laryngoscopy in Children With Limited Neck Mobility
Authors: Khanam Dilruba , Schoenfeld Elizabeth , Ginsberg-Peltz Julien , Lutfy-Clayton Lucienne , Schoenfeld David A. , Spirko Blake , Brown Calvin A. , Nishisaki Akira ,   for the National Emergency Airway Registry (NEAR) and National Emergency Airway Registry for Children (NEAR4KIDS) and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI)
Published: September 2023

Objective
It is not clear whether video laryngoscopy (VL) is associated with a higher first-pass success rate in pediatric patients with limited neck mobility when compared with direct laryngoscopy (DL). We sought to determine the association between the laryngoscopy method and first-pass success.

Methods
In this retrospective cohort study, we examined intubation data extracted from 2 prospectively collected, multicenter, airway management safety databases (National Emergency Airway Registry and the National Emergency Airway Registry for children), obtained during the years 2013–2018 in the emergency department. Intubations were included if patients were aged younger than 18 and had limited neck mobility. We compared first-pass success rates for ED intubations that were performed using VL versus DL. We built a structural causal model to account for potential confounders such as age, disease category (medical or trauma condition), other difficult airway characteristics, use of sedatives/paralytics, and laryngoscopist training level. We also analyzed adverse events as a secondary outcome.

Results
Of 34,239 intubations (19,071 in the National Emergency Airway Registry and 15,168 in the National Emergency Airway Registry for children), a total of 341 intubations (1.0%) met inclusion criteria; 168 were performed via VL and 173 were performed via DL. The median age of patients was 124 months (interquartile range, 48–204). There was no difference in first-pass success between VL and DL (79.8% vs 75.7%, P = 0.44). Video laryngoscopy was not associated with higher first-pass success (odds ratio, 1.11; 95% confidence interval 0.84–1.47, with DL as a comparator) when a structural causal model was used to account for confounders. There was no difference in the adverse events between VL and DL groups (13.7% vs 8.7%, P = 0.19).

Conclusion
In children with limited neck mobility receiving tracheal intubation in the ED, neither VL nor DL was associated with a higher first-pass success rate.
Post Living Donor Liver Transplantation Small-for-size Syndrome: Definitions, Timelines, Biochemical, and Clinical Factors for Diagnosis: Guidelines From the ILTS-iLDLT-LTSI Consensus Conference
Authors: Kow Alfred Wei Chieh , Liu Jiang , Patel Madhukar S. , De Martin Eleonora , Reddy Mettu Srinivas , Soejima Yuji , Syn Nicholas , Watt Kymberly , Xia Qiang , Saraf Neeraj , Kamel Refaat , Nasralla David , McKenna Greg , Srinvasan Parthi , Elsabbagh Ahmed M. , Pamecha Vinayendra , Palaniappan Kumar , Mas Valeria , Tokat Yaman , Asthana Sonal , Cherukuru Ramkiran , Egawa Hiroto , Lerut Jan , Broering Dieter , Berenguer Marina , Cattral Mark , Clavien Pierre-Alain , Chen Chao-Long , Shah Samir , Zhu Zhi-Jun , Emond Jean , Ascher Nancy , Rammohan Ashwin , Bhangui Prashant , Rela Mohamed , Kim Dong-sik , Ikegami Toru ,   On behalf of the ILTS-iLDLT-LTSI SFSS Working Group
Published: September 2023

Background.
When a partial liver graft is unable to meet the demands of the recipient, a clinical phenomenon, small-for-size syndrome (SFSS), may ensue. Clear definition, diagnosis, and management are needed to optimize transplant outcomes.

Methods.
A Consensus Scientific committee (106 members from 21 countries) performed an extensive literature review on specific aspects of SFSS, recommendations underwent blinded review by an independent panel, and discussion/voting on the recommendations occurred at the Consensus Conference.

Results.
The ideal graft-to-recipient weight ratio of ≥0.8% (or graft volume standard liver volume ratio of ≥40%) is recommended. It is also recommended to measure portal pressure or portal blood flow during living donor liver transplantation and maintain a postreperfusion portal pressure of <15 mm Hg and/or portal blood flow of <250 mL/min/100 g graft weight to optimize outcomes. The typical time point to diagnose SFSS is the postoperative day 7 to facilitate treatment and intervention. An objective 3-grade stratification of severity for protocolized management of SFSS is proposed.

Conclusions.
The proposed grading system based on clinical and biochemical factors will help clinicians in the early identification of patients at risk of developing SFSS and institute timely therapeutic measures. The validity of this newly created grading system should be evaluated in future prospective studies.
Cavernous Sinus MRI Findings in Inflammatory and Ischemic Oculomotor Cranial Nerve Palsies
Authors: Yunqing Wu , Shilei Cui , Yong Li , Qing Li , Xiaohong Shi , Jiawei Wang 
Published: September 2023

Background:
The significance of asymmetric enhancement on cavernous sinus MRIs in the differential diagnosis of ischemic and inflammatory oculomotor cranial nerve (OCN) palsies remains controversial. This study explored the cavernous sinus MRI findings for cavernous sinus idiopathic inflammation (inflammation group), microvascular ischemic OCN palsy (ischemic group), and ocular myasthenia gravis (OMG group) patients.

Methods:
A total of 66, 117, and 60 patients were included in the inflammation, ischemic, and OMG groups, respectively. Cavernous sinus MRIs were retrospectively analyzed.

Results:
The abnormality rates of cavernous sinus MRIs for OMG and ischemic groups were 41.7% (25/60) and 61.5% (72/117), respectively. Inconsistency rates between clinical topical diagnosis and imaging findings for inflammation and ischemic groups were 3.0% (2/66) and 13.7% (16/117), respectively (P = 0.020). In the inflammation group, cavernous sinus thickness, thickening enhancement, and enhancing adjacent lesions were noted in 90.9% (60/66), 71.2% (47/66), and 25.8% (17/66) of the patients, whereas in the ischemic group, they were noted in 51.3% (60/117), 38.5% (45/117), and 0.9% (3/117) of the patients, respectively (P < 0.001). Among ischemic CN III palsy patients, 55.5% (15/27) and 16.7% (2/12) of the cases had CN III enlargement and enhancement in the diabetic and nondiabetic groups, respectively (P = 0.037).

Conclusions:
Cavernous sinus MRI abnormalities can be explained by specific pathologic mechanisms of the primary disease based on the complex neuroanatomy. However, suspicious inflammatory changes cannot exclude the possibility of ischemia and over reliance on these findings should be avoided.
Primary Subacute Osteomyelitis of the Talus in a Child by an Unusual Organism: A Case Report and Literature Review
Authors: Shah Sohaib , Donnachie Douglas , Niazi Noman , Conyers Russell , Dartnell Jo , Katchburian Marcos , Ayodele Oluwarantimi 
Published: September 2023

Case

We would like to present the case of a 6-year-old girl who presented with progressive ankle pain and eventual inability to weight bear. She was shown to have primary acute osteomyelitis of the talus caused by Pasteurella canis, a commensal organism usually found in the oropharynx of dogs, despite the absence of any history of a dog bite or other zoonotic risk factors.

We describe the symptoms, signs, radiographic appearances and outcome of the surgical and medical management, along with a review of the literature. This case report aims to increase awareness of this rare pathology and help guide other clinicians in accurately diagnosing and managing the condition.
Ancient genomic linkage couples metabolism with erythroid development
Authors: Preston Alexandra E. , Frost Joe N. , Badat Mohsin , Teh Megan , Armitage Andrew E. , Norfo Ruggiero , Wideman Sarah K. , Hanifi Muhammad , White Natasha , Roy Noémi , Ghesquiere Bart , Babbs Christian , Kassouf Mira , Davies James , Hughes Jim R. , Beagrie Rob , Higgs Douglas R. , Drakesmith Hal 
Published: September 2023

AbstractGeneration of mature cells from progenitors requires tight coupling of differentiation and metabolism. During erythropoiesis, erythroblasts are required to massively upregulate globin synthesis then clear extraneous material and enucleate to produce erythrocytes1–3.Nprl3has remained in synteny with the α-globin genes for >500 million years4, and harbours the majority of the α-globin enhancers5. Nprl3 is a highly conserved inhibitor of mTORC1, which controls cellular metabolism. However, whether Nprl3 itself serves an erythroid role is unknown. Here, we show that Nprl3 is a key regulator of erythroid metabolism. Using Nprl3-deficient fetal liver and adult competitive bone marrow - fetal liver chimeras, we show that NprI3 is required for sufficient erythropoiesis. Loss of Nprl3 elevates mTORC1 signalling, suppresses autophagy and disrupts erythroblast glycolysis and redox control. Human CD34+ progenitors lacking NPRL3 produce fewer enucleated cells and demonstrate dysregulated mTORC1 signalling in response to nutrient availability and erythropoietin. Finally, we show that the α-globin enhancers upregulateNprI3expression, and that this activity is necessary for optimal erythropoiesis. Therefore, the anciently conserved linkage ofNprI3, α-globin and their associated enhancers has enabled coupling of metabolic and developmental control in erythroid cells. This may enable erythropoiesis to adapt to fluctuating nutritional and environmental conditions.
Environmental Factors Associated with Incidence and Distribution ofV. parahaemolyticusandV. vulnificusin Chesapeake Bay, Maryland, USA: A three-year case study
Authors: Gangwar Mayank , Usmani Moiz , Jamal Yusuf , Brumfield Kyle D. , Huq Anwar , Unnikrishnan Avinash , Colwell Rita R. , Jutla Antarpreet S. 
Published: September 2023

AbstractMembers of the genusVibrioare ecologically significant bacteria native to aquatic ecosystems globally, and a few can cause diseases in humans. Vibrio-related illnesses have increased in recent years, primarily attributed to changing environmental conditions. Therefore, understanding the role of environmental factors in the occurrence and growth of pathogenic strains is crucial for public health. Water, oyster, and sediment samples were collected between 2009 and 2012 from Chester River and Tangier Sound sites in Chesapeake Bay, Maryland, USA, to investigate the relationship between water temperature, salinity, and chlorophyll with the incidence and distribution ofVibrio parahaemolyticus(VP) andVibrio vulnificus(VV). Odds ratio analysis was used to determine association between the likelihood of VP and VV presence and these environmental variables. Results suggested that water temperature threshold of 20°C or higher was associated with an increased risk, favoring the incidence ofVibrio spp. A significant difference in salinity was observed between the two sampling sites, with distinct ranges showing high odds ratio forVibrioincidence, especially in water and sediment, emphasizing the impact of salinity on VP and VV incidence and distribution. Notably, salinity between 9-20 PPT consistently favored theVibrioincidence across all samples. Relationship between chlorophyll concentrations and VP and VV incidence varied depending on sample type. However, chlorophyll range of 0-10 µg/L was identified as critical in oyster samples for both vibrios. Analysis of odds ratios for water samples demonstrated consistent outcomes across all environmental parameters, indicating water samples offer a more reliable indicator ofVibrio spp.incidence.ImportanceUnderstanding the role of environmental parameters in the occurrence ofVibriospecies posing significant public health risks and economic burdens such asVibrio parahaemolyticusandVibrio vulnificusare of paramount importance. These aquatic bacteria are responsible for various human diseases, including gastroenteritis and wound infections, which can be severe and sometimes fatal. Recent observations suggest that certain environmental conditions may favor the growth ofVibrio, leading to more severe disease outcomes. By investigating the environmental factors that influence the occurrence ofVibrio parahaemolyticusandVibrio vulnificus, the need to gain insights into the favorable ranges of environmental variables is apparent. The significance of this research is in identifying the favorable ranges of environmental and ecological factors, which holds the potential to provide an aid in the intervention and mitigation strategies through the development of predictive models, ultimately enhancing our ability to manage and control diseases caused by these pathogens.
“Tranq-Dope” Overdose and Mortality: Lethality Induced by Fentanyl and Xylazine
Authors: Smith Mark A. , Biancorosso Samantha L. , Camp Jacob D. , Hailu Salome H. , Johansen Alexandra N. , Morris Mackenzie H. , Carlson Hannah N. 
Published: September 2023

AbstractThe recreational use of fentanyl in combination with xylazine (i.e., “tranq-dope”) represents a rapidly emerging public health threat characterized by significant toxicity and mortality. This study quantified the interactions between these drugs on lethality and examined the effectiveness of potential rescue medications to prevent a lethal overdose. Male and female mice were administered acute doses of fentanyl, xylazine, or their combination via intraperitoneal injection, and lethality was determined 30, 60, 90, 120, and 1440 min (24 hr) after administration. Both fentanyl and xylazine produced dose-dependent increases in lethality when administered alone. A nonlethal dose of fentanyl (56 mg/kg) produced an approximately 5-fold decrease in the estimated LD50for xylazine (i.e., the dose estimated to produce lethality in 50% of the population). Notably, a nonlethal dose of xylazine (100 mg/kg) produced an approximately 100-fold decrease in the estimated LD50for fentanyl. The opioid receptor antagonist, naloxone (3 mg/kg), but not the alpha-2 adrenergic receptor antagonist, yohimbine (3 mg/kg), significantly decreased the lethality of a fentanyl-xylazine combination. Lethality was rapid, with death occurring within 10 min after a high dose combination and generally within 30 min at lower dose combinations. Males were more sensitive to the lethal effects of fentanyl-xylazine combinations under some conditions, suggesting biologically relevant sex differences in sensitivity to fentanyl-xylazine lethality. These data provide the first quantification of the lethal effects of “tranq-dope” and suggest that rapid administration of naloxone may be effective at preventing death following overdose.