bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adverse Events of Surgical Drain Placement: An Analysis of the NSQIP Database
Authors: Talwar Abhinav , Bansal Ashir , Knight Gabriel , Caicedo Juan-Carlos , Riaz Ahsun , Salem Riad 
Published: July 2023

Background Surgical site drainage is important to prevent hematoma, seroma, and abscess formation. However, the placement of drain placement also predispose patients to several postoperative complications. The aim of this study is to clarify the risk-benefit profile of surgical drain placement. Methods The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Procedure-Targeted Databases were used to identify patients who underwent hepatectomy, pancreatectomy, nephrectomy, cystectomy, and prostatectomy. Patients who underwent each procedure were divided into 2 groups based on intraoperative drain placement. Propensity score-matched cohorts of these 2 groups were compared in terms of postoperative adverse events, readmission, reoperation, and length of stay. Results Hepatectomy patients with drains experienced organ space infections ( P < .001), sepsis ( P < .001), and readmission ( P = .021) more often than patients without drains. Patients who underwent pancreatectomy and had drains placed experienced wound dehiscence less frequently than those without drains ( P = .04). For hepatectomy, pancreatectomy, nephrectomy, and prostatectomy populations, patients with drains had longer lengths of stay ( P < .05). Matched populations across all procedures did not differ in terms of reoperation rate. Discussion Prophylactic surgical drain placement may be associated with increased infectious complications and prolonged length of stay. Further studies are needed to elucidate the complete adverse event profile of surgical drains. Nonetheless, outcomes may be improved with better patient selection or advancements in drain technology.
Association Between All-Cause Mortality and High-Sensitivity Cardiac Troponin Concentrations in Patients With Chest Pain
Authors: Annie Frank H. , Kepfinger Joshua , Ahmed Fatima , Pervez Muhammad Ijaz , Elashery Ahmad 
Published: July 2023

We assessed the association between troponin levels and all-cause mortality in individuals with chest pain who presented to the Charleston Area Medical Center Emergency Department (CAMC). We identified adult patients with chest pain as defined in the International Classification of Diseases 10 (R07) family group from the CAMC data warehouse between June 6, 2020, and June 6, 2021. These cases required a visit to the emergency room. We created 3 different cohorts to assess the endpoints of all-cause mortality at 30 days and 6 months. Patients were divided into the following 3 categories: negative troponin level, defined as high sensitivity troponin I (HSTNI) assay ≤15 pg/mL for women and ≤20 pg/mL for men; weakly positive, 21–88 pg/mL for men and 16–88 pg/mL for women; and strongly positive, >88 pg/mL for men and women. A propensity score matching analysis was also conducted using the negative group as a control; the weakly and strongly positive groups were compared to the control across differing cardiology covariates. This study introduces novel cutoffs for high-sensitivity troponin I (Beckman Coulter assay, Beckman Coulter, Inc., Chaska Campus, 1000 Lake Hazeltine Drive, Chaska, Minnesota 55318).
Earnings Management and Investor Protection During a Banking Crisis: The Role of the “Spare Tire” Effect
Authors: Imperatore Claudia , Trombetta Marco 
Published: July 2023

This article analyzes the association between earnings management and investor protection during banking crises. Using a sample of firms from 16 European countries for the period 2006–2018, we show that, as banking conditions worsen, firms are more likely to manage earnings upward in countries with a stronger institutional environment, where alternative sources of financing are better available and more accessible. Moreover, we show that this strategy is successful because these firms are able to raise relatively more equity financing. JEL Classification M41, G14
Stabilizing deep Q-learning with Q-graph-based bounds
Authors: Hoppe Sabrina , Giftthaler Markus , Krug Robert , Toussaint Marc 
Published: July 2023

State-of-the art deep reinforcement learning has enabled autonomous agents to learn complex strategies from scratch on many problems including continuous control tasks. Deep Q-networks (DQN) and deep deterministic policy gradients (DDPGs) are two such algorithms which are both based on Q-learning. They therefore all share function approximation, off-policy behavior, and bootstrapping—the constituents of the so-called deadly triad that is known for its convergence issues. We suggest to take a graph perspective on the data an agent has collected and show that the structure of this data graph is linked to the degree of divergence that can be expected. We further demonstrate that a subset of states and actions from the data graph can be selected such that the resulting finite graph can be interpreted as a simplified Markov decision process (MDP) for which the Q-values can be computed analytically. These Q-values are lower bounds for the Q-values in the original problem, and enforcing these bounds in temporal difference learning can help to prevent soft divergence. We show further effects on a simulated continuous control task, including improved sample efficiency, increased robustness toward hyperparameters as well as a better ability to cope with limited replay memory. Finally, we demonstrate the benefits of our method on a large robotic benchmark with an industrial assembly task and approximately 60 h of real-world interaction.
Food Insecurity and Psychological Distress Amongst Parenting Women in Treatment for Opioid Use: Identifying Barriers to Nutritional Equity and Implications for Future Intervention Research
Authors: Gannon Meghan , McLaughlin Kimberly , Short Vanessa , Wu Alice , Inguito Kai , Hand Dennis J. , Abatemarco Diane J. 
Published: July 2023

Purpose To describe the prevalence of food insecurity among pregnant and parenting women with opioid use disorder (OUD), its association with psychosocial health, and their experience with the Special Supplemental Nutrition Program for Women Infant Child (WIC) program. Design This cross-sectional study collected survey data through REDCAP. Setting The study was conducted at a single, urban, opioid treatment program. Subjects A total of 91 female participants (≥18 years of age and receiving OUD treatment services) were approached about the study and all consented. Measures Measures included: US Household Short Form Food Security Survey, Patient Health Questionnaire 4(PHQ4), Perceived Stress Scale (PSS), and a demographics and food behavior survey. Analysis Descriptive analyses (frequency, means) described data and Chi-Square, Fischer’s exact, t-tests were used to compare data between food security groups. Results Participants were on average 34 years old, Caucasian (68%), and non-Hispanic (87%). Most reported low (32%) to very low (33%) food security. Pearson correlation analyses indicate a strong positive linear relationship between Food Security Score and PHQ4 Total ( P = .0002), PHQ4 Depression ( P = .0003), PHQ4 Anxiety ( P = .0009), and PSS Total ( P < .0001). Only 38% felt the foods available in WIC supported their breastfeeding. Limitations include a single site and recall bias. Conclusions Significant nutritional inequity in families affected by maternal substance use exists, with potential for adverse maternal and child development related implications.
Analysis of risk factors and development of a nomogram prediction model for lupus nephritis in systemic lupus erythematosus patients
Authors: Tang Zhen , Wang Jia-Min , Qin Jia-Min , Wen Li-Ming 
Published: July 2023

Background This study aimed to explore risk factors for lupus nephritis (LN) in systemic lupus erythematosus (SLE) patients and establish a Nomogram prediction model based on LASSO-logistic regression. Methods The clinical and laboratory data of SLE patients in Meishan People’s Hospital from July 2012 to December 2021 were analyzed retrospectively. All SLE patients were divided into two groups with or without LN. Risk factors were screened based on LASSO-logistic regression analysis, and a Nomogram prediction model was established. The receiver operating characteristic curve, calibration curves, and decision curve analysis were adopted to evaluate the performance of the Nomogram model. Results A total of 555 SLE patients were enrolled, including 303 SLE patients with LN and 252 SLE patients without LN. LASSO regression and multivariate logistic regression analyses showed that ESR, mucosal ulcer, proteinuria, and hematuria were independent risk factors for LN in SLE patients. The four clinical features were incorporated into the Nomogram prediction model. Results showed that calibration curve was basically close to the diagonal dotted line with slope 1 (ideal prediction case), which proved that the prediction ability of the model was acceptable. In addition, the decision curve analysis showed that the Nomogram prediction model could bring net clinical benefits to patients when the threshold probability was 0.12–0.54. Conclusion Four clinical indicators of ESR, mucosal ulcer, proteinuria, and hematuria were independent risk factors for LN in SLE patients. The predictive power of the Nomogram model based on LASSO-logistic regression was acceptable and could be used to guide clinical work.
Overlap syndrome of anti-aquaporin-4 positive neuromyelitis optica spectrum disorder and systemic lupus erythematosus: A systematic review of individual patient data
Authors: Kopp Chirag Rajkumar , Prasad Chandra Bhushan , Naidu Shankar , Sharma Vishal , Misra Durga Prasanna , Agarwal Vikas , Sharma Aman 
Published: July 2023

Background Neurological involvement can occur in systemic lupus erythematosus (SLE) due to co-existing neuromyelitis optica spectrum disorder (NMOSD). The symptoms can mimic those of neuropsychiatric manifestations of SLE. Pathogenic anti-aquaporin-4 (AQP4) antibodies, commonly found in NMOSD, are responsible for the neuroinflammatory response and secondary demyelinating lesions. These anti-AQP4 antibodies can be the drivers of neuroinflammatory process in SLE patients, which is distinct from the immunopathogenesis seen in traditional neuropsychiatric SLE. The clinical course is often a relapsing one and is managed differently. In this review, we describe and outline the clinical course and outcomes of AQP4+ NMOSD/SLE overlap cases. Methods To investigate the co-existence of SLE with AQP4+NMOSD, we conducted a systematic review of individual patient data from case reports and case series reported in major databases. The study extracted clinic-demographic features, imaging and laboratory profiles, treatment approaches, and outcomes of these patients. Inclusion criteria for the review required patients to have positivity for AQP4 or NMO in the blood and/or cerebrospinal fluid (CSF) and exhibit at least one manifestation of both NMOSD and SLE. Results In this overlap between SLE and AQP4+NMOSD, a high female preponderance was observed, with 42 out of 46 patients (91.3%) being female. Nearly half of the NMOSD cases (47.8%) had onset after lupus, with a median of 5 years between the two diagnoses. Hematological manifestations were seen in the majority of patients (63%), as well as longitudinally extensive transverse myelitis (87%), and brainstem involvement on imaging (29.6%). Cerebrospinal fluid analysis showed a dominantly lymphocytic pleocytosis, with oligoclonal bands being reported scarcely. Although cyclophosphamide was the most common steroid sparing agent used for maintenance, robust evidence for both efficacy and safety in AQP4+NMOSD is available for mycophenolate mofetil, azathioprine, and rituximab. The majority of reported cases showed a relapsing course, while one patient had a monophasic course. Conclusion AQP4+NMOSD in SLE patients is a relapsing and neurologically disabling disorder that can mimic neuropsychiatric manifestations, frequently occurs after the onset of lupus or may predate, responds to immunosuppressants, and necessitates indefinite treatment.
Occupational Stress Among Middle-Aged Professionals in India
Authors: Kazmi Syed Sajid Husain , Shukla Jyotsana , Tripathi Rakesh Kumar , Zaidi S.Z.H. 
Published: July 2023

Background Professional world nowadays is very competitive, and surviving the cutthroat competition while sustaining work-related stress and pressure is an important task for employees. Professionals are required to meet daily and monthly objectives and may encounter work-related stressors. Purpose The study aims to explore occupational stress among middle-aged professionals in the age range of 45–60 years from the marketing, banking, and teaching sectors. Methods A total sample of 180 consented middle-aged professionals in the age range of 45–60 years from the banking, teaching, and marketing sectors were included in the study using a purposive and snowball sampling technique. Professionals having serious medical or psychiatric conditions and undergoing treatment for the same were excluded. The Occupational Stress Index was administered to assess different types of occupational stressors. The statistical analysis was done using the Statistical Package for Social Sciences version 20 software. A descriptive analysis and a one-way analysis of variance (ANOVA) were used to get meaningful results. Results Results revealed that 40% of the middle-aged professionals reported experiencing minimal levels of occupational stress, followed by 32.2% experiencing moderate levels and 27.8% experiencing high levels of occupational stress. Additionally, it was found that a significantly higher percentage (91.6%) of banking professionals reported low levels of occupational stress compared to their counterparts. Eighty percent of marketing professionals reported experiencing high levels of occupational stress, whereas a majority (73.3%) of teaching professionals reported moderate levels of occupational stress. Conclusion Occupational stress with different severity levels is found to be common among middle-aged professionals, which is a risk factor to develop mental health problems and affects well-being. Large-scale primary and secondary interventions are required to manage stress and facilitate professional growth and development in India.
Family Experiences with Diagnosis of Craniosynostosis: Thematic Analysis of Online Discussion Boards
Authors: Varagur Kaamya , Murphy John , Skolnick Gary B. , Naidoo Sybill D. , McEvoy Sean D. , Strahle Jennifer M. , Patel Kamlesh B 
Published: July 2023

Objective Apply thematic analysis of online discussion boards to characterize families’ experiences and concerns regarding craniosynostosis diagnoses to aid physicians in tailoring care to families. Design Grounded theory-based qualitative analysis. Setting Discussion boards related to craniosynostosis identified via Google and Yahoo. Patients/Participants Posts about craniosynostosis between 2017–2022. Interventions Thematic analysis was performed using three rounds of coding. Post features including author type and use of technical language were examined. Main Outcome Measure Overarching themes emerging from analysis of posts, with forums analyzed until sufficient thematic repetition was observed. Results 366 posts from 4 websites by 290 unique users were included. Parents of patients with craniosynostosis wrote 59% of posts while patients wrote 4%. Five selective codes were identified: 1) Building Community, 2) Diagnosis/Evaluation, 3) Treatment, 4) Outcomes, and 5) Emotional Concerns. Building Community was the most assigned code (85% of posts). 71% of parents’ posts expressing emotional concerns expressed negative emotions, commonly regarding anxiety about diagnosis (71%), frustration about doctors’ responses (21%), or negative reactions to online search results (17%). 88% of patients’ posts expressed positive emotions, discussing positive long-term outcomes. Concerns that may guide physicians included anxiety about delayed diagnosis, difficulty distinguishing postpartum head shape changes from craniosynostosis, and difficulty finding a care team. Conclusions Online discussion boards allow families of patients with craniosynostosis to share experiences and find community. Improving communication between surgeons, pediatricians, and families about timing of evaluation and revising online information about this condition may ameliorate some anxiety associated with this diagnosis.
Acute Deltoid Injury in Ankle Fractures: A Biomechanical Analysis of Different Repair Constructs
Authors: Wagner Emilio , Wagner Pablo , Escudero Mario I. , Pacheco Florencia , Salinas David , Godoy-Santos Alexandre Leme , Palma Felipe , Guzmán-Venegas Rodrigo , Berral–De la Rosa Francisco Jose 
Published: July 2023

Background: The importance of the deltoid ligament in the congruency and coupling of the tibiotalar joint is well known. The current trend is to repair it in cases of acute injuries in the context of ankle fractures; however, there is limited information on how it should be reconstructed. The objective of this study was to compare different deltoid ligament repair types in an ankle fracture cadaveric model. Methods: Sixteen cadaveric foot-ankle-distal tibia specimens were used. All samples were prepared as a supination external rotation ankle fracture model. Axial load and cyclic axial rotations were applied on every specimen using a specifically designed frame. This test was performed without deltoid injury, with deltoid injury, and after repair. The reconstruction was performed in 4 different ways (anterior, posterior, middle, and combined). Medial clear space (MCS) was measured for each condition on simulated weightbearing (WB) and gravity stress (GS) radiographs. Reflective markers were used in tibia and talus, registering the kinematics through a motion analysis system to record the tibiotalar uncoupling. Results: After deltoid damage, in all cases the MCS increased significantly on GS radiographs, but there was no increase in the MCS on WB radiographs. After repair, in all cases, the MCS was normalized. Kinematically, after deltoid damage, the tibiotalar uncoupling increased significantly. All isolated repairs achieved a similar tibiotalar uncoupling value as its baseline condition. The combined repair resulted in a significant decrease in tibiotalar uncoupling. Conclusion: Our results show that deltoid repair recovers the tibiotalar coupling mechanism in an ankle fracture model. Isolated deltoid repairs recovered baseline MCS and tibiotalar uncoupling values. Combined repairs may lead to overconstraint, which could lead to postoperative stiffness. Clinical studies are needed to prove these results and show clinically improved outcomes. Clinical Relevance: This study helps in finding the optimum deltoid repair to use in an acute trauma setting.
Surveillance After a Previous Cutaneous Melanoma Diagnosis: A Scoping Review of Melanoma Follow-Up Guidelines
Authors: Johnston Leah , Starkey Samantha , Mukovozov Ilya , Robertson Lynne , Petrella Teresa , Alhusayen Raed 
Published: July 2023

Introduction Cutaneous melanoma accounts for more than 70% of all skin cancer deaths. Follow-up surveillance is an integral part of melanoma patient care, to facilitate early detection of recurrences and subsequent primary melanomas. The purpose of this scoping review is to provide an overview of recently published melanoma surveillance guidelines from regional and national melanoma working groups. Methods A systematic search for relevant studies in MEDLINE and Embase was conducted in September 2022 and was limited to publications from 2010 or later. Results A total of 1047 articles were retrieved, and after abstract and full text review, 26 articles from 19 different organizations met inclusion criteria. Life-long annual skin surveillance with a physician was recommended by 53% (9/17) of guidelines. Routine laboratory investigations were recommended by 7/19 guidelines. Regional lymph node ultrasound was recommended by 9/16 guidelines, most often in stage IB or higher, and was optional in 7/16 for patients who met specific criteria. Surveillance with PET-CT or CT and MRI was recommended by 15 and 11 guidelines, respectively, most commonly in stage IIC or higher, with a variable frequency and total duration. Five out of 9 guidelines indicated a preference for skin surveillance to be completed with a dermatologist. Conclusion Guidelines were highly variable for many aspects of melanoma surveillance, which may be partly attributed to regional differences in healthcare workforce distribution and availability of imaging technologies. Further high-level studies are recommended to provide more evidence on the most effective clinical and imaging follow-up surveillance protocols.
Blended versus face-to-face cognitive behavioural therapy for severe fatigue in patients with multiple sclerosis: A non-inferiority RCT
Authors: de Gier Marieke , Beckerman Heleen , Twisk Jos , Knoop Hans , de Groot Vincent 
Published: July 2023

Background: Cognitive behavioural therapy (CBT) reduces multiple sclerosis (MS)-related fatigue. Implementation of face-to-face CBT is hindered by limited treatment capacity and traveling distances to treatment locations. Objective: Evaluate whether blended CBT (online treatment modules supported with guidance by a therapist) is non-inferior to face-to-face CBT in reducing fatigue severity in severely fatigued patients with MS. Method: A non-inferiority multicentre randomized clinical trial, in which 166 patients with MS were allocated to either face-to-face or blended CBT. Primary outcome was fatigue severity assessed with the Checklist Individual Strength fatigue subscale directly post-treatment (week 20). Mixed model analysis was used by a statistician blinded for allocation to determine between-group differences post-treatment. The upper limit of the 95% confidence interval (CI) was compared to a pre-specified non-inferiority margin of 5.32. Results: Blended CBT ( N = 82) was non-inferior to face-to-face CBT ( N = 84) (B = 1.70, 95% CI: −1.51 to 4.90). Blended CBT significantly reduced therapist time ( B = −187.1 minutes, 95% CI: 141.0–233.3). Post hoc analysis showed more improvement ( B = −5.35, 95% CI: −9.22 to −1.48) when patients received their preferred treatment. No harm related to treatment was reported. Discussion: Blended CBT is an efficient alternative to face-to-face CBT. Offering the preferred CBT format may optimize treatment outcome.
Robotic Microsurgery in Plastic and Reconstructive Surgery: A Literature Review
Authors: Ghandourah Hussain S. H. , Schols Rutger M. , Wolfs Joost A. G. N. , Altaweel Fahed , van Mulken Tom J. M. 
Published: July 2023

Background Surgical robots have innovated the microsurgical field by providing advantages that improve surgical performance. These robots have been adopted by certain specialties more than others. This study discusses the potential advantages of robotics in plastic and reconstructive surgery. Method This study is a literature review of articles investigating “robotic microsurgery in plastic and reconstructive surgery” using the PubMed database and the Cochrane Library. Result A total of nineteen relevant articles were found and 5 articles performed a direct comparison between the robotic and manual approaches. Longer operating times were reported in the robotic groups featuring higher learning curves. Reported advantages to robotic use included higher accuracy, precision and flexibility, elimination of tremor and improvement of ergonomic factors. Conclusion While the results provide an outlook into the outcome of robotic platforms in this field, current research is limited and further studies are required to provide a fundamental analysis.