bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medullary Thyroid Cancer: Updates and Challenges
Authors: Gild Matti L , Clifton-Bligh Roderick J , Wirth Lori J , Robinson Bruce G 
Published: May 2023

Abstract
A personalized approach to the management of medullary thyroid cancer (MTC) presents several challenges; however, in the past decade significant progress has been made in both diagnostic and treatment modalities. Germline rearranged in transfection (RET) testing in multiple endocrine neoplasia 2 and 3, and somatic RET testing in sporadic MTC have revolutionized the treatment options available to patients. Positron emission tomography imaging with novel radioligands has improved characterization of disease and a new international grading system can predict prognosis. Systemic therapy for persistent and metastatic disease has evolved significantly with targeted kinase therapy especially for those harboring germline or somatic RET variants. Selpercatinib and pralsetinib are highly selective RET kinase inhibitors that have shown improved progression-free survival with better tolerability than outcomes seen in earlier multikinase inhibitor studies. Here we discuss changes in paradigms for MTC patients: from determining RET alteration status upfront to novel techniques for the evaluation of this heterogenous disease. Successes and challenges with kinase inhibitor use will illustrate how managing this rare malignancy continues to evolve.
Pro-Con Debate: Interdisciplinary Perspectives on Industry-Sponsored Research
Authors: Sessler Daniel I. , Alman Benjamin , Treggiari Miriam M. , Mont Michael A. 
Published: May 2023

Pro: Nearly all new devices and drugs come from industry that provides two-thirds of the funding for medical research, and a much higher fraction of clinical research. Realistically, without corporate-funded studies, perioperative research would stagnate with little innovation and few new products. Opinions are ubiquitous and normal, but do not constitute epidemiologic bias. Competent clinical research includes many protections against selection and measurement bias, and the publication process provides at least moderate protection against misinterpretation of results. Trial registries largely prevent selective data presentation. Sponsored trials are particularly protected against inappropriate corporate influence because they are usually codesigned with the US Food and Drug Administration, and analyses are based on formal predefined statistical plans, as well as being conducted with rigorous external monitoring. Novel products, which are essential for advances in clinical care, largely come from industry, and industry appropriately funds much of the required research. We should celebrate industry’s contribution to improvements in clinical care.
Con: While industry funding contributes to research and discovery, examples of industry-funded research demonstrate bias. In the setting of financial pressures and potential conflict of interest, bias can influence the type of study design, hypotheses being tested, rigor and transparency in data analysis, interpretation, as well as reporting of the results. Unlike public granting agencies, industry does not necessarily provide funding based on unbiased peer review following an open call for proposals. The focus on success can influence the choice of a comparator, which might not be ideal among the possible alternatives, the language used in the publication, and even the ability to publish. Unpublished negative trials can result in selected information being withheld from the scientific community and the public. Appropriate safeguards are needed to ensure that research addresses the most important and relevant questions, that results are available even when they do not support the use of a product produced by the funding company, that populations studied reflect the relevant patients, that the most rigorous approaches are applied, that studies have the appropriate power to address the question posed, and that conclusions are presented in an unbiased manner.
Sociodemographic Disparities in Postoperative Nausea and Vomiting
Authors: Lee Donaldson C. , Vetter Thomas R. , Dobyns Jeffrey B. , Crump Sandra J. , Benz David L. , Short Roland T. , Parks Dale A. , Beasley T. Mark , Liwo Amandiy N. 
Published: May 2023

BACKGROUND:
Postoperative nausea and vomiting (PONV) prophylaxis is consistently considered a key indicator of anesthesia care quality. PONV may disproportionately impact disadvantaged patients. The primary objectives of this study were to examine the associations between sociodemographic factors and the incidence of PONV and clinician adherence to a PONV prophylaxis protocol.

METHODS:
We conducted a retrospective analysis of all patients eligible for an institution-specific PONV prophylaxis protocol (2015–2017). Sociodemographic and PONV risk data were collected. Primary outcomes were PONV incidence and clinician adherence to PONV prophylaxis protocol. We used descriptive statistics to compare sociodemographics, procedural characteristics, and protocol adherence for patients with and without PONV. Multivariable logistic regression analysis followed by Tukey-Kramer correction for multiple comparisons was used to test for associations between patient sociodemographics, procedural characteristics, PONV risk, and (1) PONV incidence and (2) adherence to PONV prophylaxis protocol.

RESULTS:
Within the 8384 patient sample, Black patients had a 17% lower risk of PONV than White patients (adjusted odds ratio [aOR], 0.83; 95% confidence interval [CI], 0.73–0.95; P = .006). When there was adherence to the PONV prophylaxis protocol, Black patients were less likely to experience PONV compared to White patients (aOR, 0.81; 95% CI, 0.70–0.93; P = .003). When there was adherence to the protocol, patients with Medicaid were less likely to experience PONV compared to privately insured patients (aOR, 0.72; 95% CI, 0.64–1.04; P = .017). When the protocol was followed for high-risk patients, Hispanic patients were more likely to experience PONV than White patients (aOR, 2.96; 95% CI, 1.18–7.42; adjusted P = .022). Compared to White patients, protocol adherence was lower for Black patients with moderate (aOR, 0.76; 95% CI, 0.64–0.91; P = .003) and high risk (aOR, 0.57; 95% CI, 0.42–0.78; P = .0004).

CONCLUSIONS:
Racial and sociodemographic disparities exist in the incidence of PONV and clinician adherence to a PONV prophylaxis protocol. Awareness of such disparities in PONV prophylaxis could improve the quality of perioperative care.
Evaluation of a Protocol for the Management of Maintenance and Reversal of Rocuronium Block Using Neostigmine or Sugammadex
Authors: Thilen Stephan R. , Liang Tinny , Kruse Timothy N. , Cain Kevin C. , Treggiari Miriam M. , Bhananker Sanjay M. 
Published: May 2023

BACKGROUND:
Postoperative residual neuromuscular blockade (PRNB) is defined as an adductor pollicis train-of-four ratio (TOFR) <0.9. It is a common postoperative complication when nondepolarizing muscle relaxants are either not reversed or reversed with neostigmine. PRNB has been reported in 25% to 58% of patients who receive intermediate-acting nondepolarizing muscle relaxants, and it is associated with increased morbidity and decreased patient satisfaction. We conducted a prospective descriptive cohort study during the implementation of a practice guideline that included the selective use of sugammadex or neostigmine. The primary study aim of this pragmatic study was to estimate the incidence of PRNB at arrival to the postanesthesia care unit (PACU) when the practice guideline is followed.

METHODS:
We enrolled patients undergoing orthopedic or abdominal surgery requiring neuromuscular blockade. Rocuronium administration was guided by surgical requirements and based on ideal body weight, with dose reductions for women and/or age >55 years. Only qualitative monitoring was available to the anesthesia providers, and selection of sugammadex or neostigmine was guided by tactile assessments of the response to train-of-four (TOF) stimulation by a peripheral nerve stimulator. Neostigmine was administered if no fade was detected in the TOF response at the thumb. Deeper blocks were reversed with sugammadex. The prespecified primary and secondary end points were the incidence of PRNB at arrival to the PACU, defined as a normalized TOFR (nTOFR) < 0.9, and severe PRNB, defined as nTOFR <0.7 on arrival to the PACU. Anesthesia providers were blinded to all quantitative measurements made by research staff.

RESULTS:
Analysis included 163 patients, and 145 underwent orthopedic and 18 abdominal surgeries. Of the 163 patients, 92 (56%) were reversed with neostigmine and 71 (44%) with sugammadex. The overall incidence of PRNB at PACU arrival was 5 of 163 or 3% (95% confidence interval [CI], 1–7). The incidence of severe PRNB in PACU was 1% (95% CI, 0–4). Three of the 5 subjects with PRNB had TOFR <0.4 at time of reversal but were given neostigmine since anesthesia providers detected no fade by qualitative assessment.

CONCLUSIONS:
The use of a protocol that specifies rocuronium dosing and selective use of sugammadex versus neostigmine based on qualitative assessment of TOF count and fade allowed us to achieve an incidence of PRNB of 3% (95% CI, 1–7) at PACU arrival. Quantitative monitoring may be needed to further reduce this incidence.
Anesthesia in the Korean War
Authors: Zhao Elizabeth , Barr Justin 
Published: May 2023

Relying on original, primary source documentation from the National Archives, we describe the practice of anesthesia in mobile army surgical hospital (MASH) units and the 171st Evacuation Hospital during the latter part of the Korean War in 1953. Values were scaled and reported as percentages.
These Essential Technical Medical Data Sheets reveal a surprising proportion (12.9%) of men received spinal anesthetics, despite official recommendations to the contrary. Still, the majority (69.2%) of the wounded underwent general anesthesia, most commonly through a mixture of thiopental and nitrous oxide. Despite data from World War II demonstrating the advantages of endotracheal intubation in these patients, few patients (20.6%) were intubated. Six percent benefited from the new curare-based drugs. This is the first English-language article that describes the practice of anesthesia during the Korean War. Utilizing primary source documentation, we found that general anesthesia was the most common type utilized. Newer techniques were not as commonly adopted, despite official recommendations and data from the time. The care provided closely resembled that delivered in the Second World War but inspired a series of technological and pedagogical reforms through the 1950s to improve military anesthesia for the next conflict.
Air sacs are a key adaptive trait of the insect respiratory system
Authors: Harrison Jon F. , McKenzie Evan K. G. , Talal Stav , Socha John J. , Westneat Mark W. , Matthews Philip G. D. 
Published: May 2023

ABSTRACT
Air sacs are a well-known aspect of insect tracheal systems, but have received little research attention. In this Commentary, we suggest that the study of the distribution and function of air sacs in tracheate arthropods can provide insights of broad significance. We provide preliminary phylogenetic evidence that the developmental pathways for creation of air sacs are broadly conserved throughout the arthropods, and that possession of air sacs is strongly associated with a few traits, including the capacity for powerful flight, large body or appendage size and buoyancy control. We also discuss how tracheal compression can serve as an additional mechanism for achieving advection in tracheal systems. Together, these patterns suggest that the possession of air sacs has both benefits and costs that remain poorly understood. New technologies for visualization and functional analysis of tracheal systems provide exciting approaches for investigations that will be of broad significance for understanding invertebrate evolution.
Instruments used to assess gender-affirming healthcare access: a scoping review protocol
Authors: Kearns Seán , Hardie Philip , O'Shea Donal , Neff Karl 
Published: May 2023

Background: Internationally, the demand for gender-affirming care has increased exponentially in recent years. The clinical presentation of those seeking care has changed with an increase in transmasculine and non-binary identities and a decrease in the average age of those seeking care. Healthcare navigation remains complicated for this population and warrants further investigation in light of ongoing changes in the field. This paper presents a protocol for a scoping review to map and synthesise the academic and grey literature on instruments used to assess healthcare navigation and access for transgender and non-binary individuals seeking gender-affirming care. Methods: This review will search databases (PsychINFO, CINAHL, Medline, and Embase.) and grey literature sources. In line with the methodological framework for scoping reviews, the following six stages will be undertaken: (1) identifying the research question, (2) identifying relevant studies, (3) study selection, (4) charting the data, (5) collating, summarising and reporting results and (6) consultation. The PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation will be utilised and reported. The research team will undertake the study as outlined in this protocol and an expert panel of young transgender and non-binary youth will oversee the project through patient and public involvement. Conclusions: This scoping review has the potential to inform policy, practice, and future research through enhanced understanding of the complex interplay of factors that impact healthcare navigation for transgender and non-binary people seeking gender-affirming care. The results from this study will inform further research into healthcare navigation considerations generally and will inform a research project entitled “Navigating access to gender care in Ireland—a mixed-method study on the experiences of transgender and non-binary youth”.
KAJIAN UPAYA PENGHEMATAN AIR BERSIH DI KANTOR DINAS PERHUBUNGAN KABUPATEN PASURUAN
Authors: Purnomo Alfan 
Published: May 2023

Pertumbuhan jumlah penduduk, industri dan perkantoran yang pesat saat ini mengakibatkan kebutuhan dan pemakaian air terus meningkat setiap tahunnya. Salah satu upaya pemerintah untuk mengurangi konsumsi air di lingkungan gedung dan perkantoran pemerintahan, dengan mengeluarkan Instruksi Presiden (Inpres) Nomor 13 Tahun 2011. Kantor Dinas Perhubungan Kabupaten Pasuruan belum mempunyai program penghematan air bersih. Tujuan dari penelitian ini adalah untuk melakukan identifikasi pemakaian air bersih dan upaya-upaya yang harus dilakukan terkait penghematan air bersih di Kantor Dinas Perhubungan (Dishub) Kabupaten Pasuruan.
Studi ini dilakukan melalui studi lapangan dengan cara wawancara dan observasi langsung. Kemudian direncanakan strategi upaya penghematan air secara manajemen dan secara teknologi. Upaya penghematan air ini juga memperhitungkan dampak positif yang dirasakan, yaitu efisiensi secara finansial.
Dari studi ini didapatkan efisiensi penghematan tahap 1 (2021 – 2022) dengan melakukan rekomendasi program secara manajeman, melakukan perbaikan pipa dan keran yang bocor untuk air PDAM sebesar 20,6% dan air sumur sebesar 20,69%.Tahap 2 (2023 – 2024) dengan melakukan pergantian toilet jongkok menjadi tolet duduk untuk air PDAM sebesar 34% dan air sumur sebesar 20% Tahap 3 (2025 – 2029) dengan melakukan pemasangan meter air dan pemanfaatan air hujan, untuk air PDAM sebesar 4% dan tahap 4 (2030 – 2032) dengan melakukan daur ulang air limbah domestik untuk air PDAM sebesar 34%. Efisiensi secara finansial per bulan rencana penghematan air yang di dapatkan sebesar Rp. 678.298 untuk tahap 1, Rp. 246.291 untuk tahap 2, Rp. 43.149 untuk tahap 3, dan Rp. 371.901 untuk tahap 4.
Older adults and stroke survivors are steadier when gazing down
Authors: Koren Yogev , Handelzalts Shirley , Parmet Yisrael , Bar-Haim Simona 
Published: May 2023

Background
Advanced age and brain damage have been reported to increase the propensity to gaze down while walking, a behavior that is thought to enhance stability through anticipatory stepping control. Recently, downward gazing (DWG) has been shown to enhance postural steadiness in healthy adults, suggesting that it can also support stability through a feedback control mechanism. These results have been speculated to be the consequence of the altered visual flow when gazing down. The main objective of this cross-sectional, exploratory study was to investigate whether DWG also enhances postural control in older adults and stroke survivors, and whether such effect is altered with aging and brain damage.

Methods
Posturography of older adults and stroke survivors, performing a total of 500 trials, was tested under varying gaze conditions and compared with a cohort of healthy young adults (375 trials). To test the involvement of the visual system we performed spectral analysis and compared the changes in the relative power between gaze conditions.

Results
Reduction in postural sway was observed when participants gazed down 1 and 3 meters ahead whereas DWG towards the toes decreased steadiness. These effects were unmodulated by age but were modulated by stroke. The relative power in the spectral band associated with visual feedback was significantly reduced when visual input was unavailable (eyes-closed condition) but was unaffected by the different DWG conditions.

Conclusions
Like young adults, older adults and stroke survivors better control their postural sway when gazing down a few steps ahead, but extreme DWG can impair this ability, especially in people with stroke.
Examining subjective understandings of autistic burnout using Q methodology: A study protocol
Authors: Mantzalas Jane , Richdale Amanda L. , Dissanayake Cheryl 
Published: May 2023

Background
Early research indicates that autistic burnout is a chronic, debilitating condition experienced by many autistic people across the lifespan that can have severe consequences for their mental health, wellbeing, and quality of life. To date, studies have focused on the lived experiences of autistic adults, and findings suggest that a lack of support, understanding, and acceptance by others can contribute to the risk of autistic burnout. The study outlined in this protocol will investigate how autistic people with and without experience of autistic burnout, their families, friends, healthcare professionals and non-autistic people understand the construct of autistic burnout to identify commonalities and gaps in knowledge.

Study and design
Q methodology will be used to investigate participants’ subjective understandings of autistic burnout. Q methodology is a mixed-methods design that is well-suited to exploratory research and can elucidate a holistic and comprehensive representation of multiple perspectives about a topic. Participants will complete a card sorting activity to rank how strongly they agree or disagree with a set of statements about autistic burnout and participate in a semi-structured interview to discuss their responses. A first-order factor analysis will be conducted for each participant group, followed by second-order factor analysis to compare the groups’ viewpoints. The interview data will provide additional insights into the factors.

Conclusion
Q methodology has not previously been used to examine autistic and non-autistic people’s perspectives about autistic burnout. Projected study outcomes include enhanced understanding of the characteristics, risks, and protective factors of autistic burnout. The findings will have practical implications for improving detection of autistic burnout and identifying strategies to support autistic adults with prevention and recovery. The results may also inform the development of a screening protocol and identify potential avenues for future research.
Trends in health service use among persons with Parkinson’s disease by rurality: A population-based repeated cross-sectional study
Authors: Maclagan Laura C. , Marras Connie , Sewell Isabella J. , Wu C. Fangyun , Butt Debra A. , Tu Karen , Bronskill Susan E. 
Published: May 2023

Background
The global burden of Parkinson’s disease (PD) has more than doubled over the past three decades, and this trend is expected to continue. Despite generally poorer access to health care services in rural areas, little previous work has examined health system use in persons with PD by rurality. We examined trends in the prevalence of PD and health service use among persons with PD by rurality in Ontario, Canada.

Methods
We conducted a repeated, cross-sectional analysis of persons with prevalent PD aged 40+ years on April 1st of each year from 2000 to 2018 using health administrative databases and calculated the age-sex standardized prevalence of PD. Prevalence of PD was also stratified by rurality and sex. Negative binomial models were used to calculate rate ratios with 95% confidence intervals comparing rates of health service use in rural compared to urban residents in 2018.

Results
The age-sex standardized prevalence of PD in Ontario increased by 0.34% per year (p<0.0001) and was 459 per 100,000 in 2018 (n = 33,479), with a lower prevalence in rural compared to urban residents (401 vs. 467 per 100,000). Rates of hospitalizations and family physician visits declined over time in both men and women with PD in rural and urban areas, while rates of emergency department, neurologist, and other specialist visits increased. Adjusted rates of hospitalizations were similar between rural and urban residents (RR = 1.04, 95% CI [0.96, 1.12]), while rates of emergency department visits were higher among rural residents (RR = 1.35, 95% CI [1.27, 1.42]). Rural residents had lower rates of family physician (adjusted RR = 0.82, (95% CI [0.79, 0.84]) and neurologist visits (RR = 0.74, 95% CI [0.72, 0.77]).

Interpretation
Lower rates of outpatient health service use among persons residing in rural regions, contrasting with higher rates of emergency department visits suggest inequities in access. Efforts to improve access to primary and specialist care for persons with PD in rural regions are needed.