bluuebunny/crossref_metadata_2025_split huggingface dataset:
Purpose in Life
Authors: Yager Joel , Kay Jerald 
Published: April 2023

Abstract
Having a purpose in life is strongly associated with well-being and quality of life. Some individuals develop their sense of purpose early in life and can sustain lifelong ideals. In contrast, we identify four transdiagnostic syndromes where purpose in life is impaired: 1) deficiencies in generating purpose; 2) loss of purpose due to traumatic events such as catastrophic illnesses or bereavements; 3) conflicts due to crossed purposes; and 4) maladaptive purposes, such as life-limiting single-minded goals, dominating others, or exacting revenge. Several psychotherapies associated with positive and existential psychologies help patients construct, reconstruct, or retain a sense of purpose. However, given the strong links between a sense of purpose and beneficial health and mental health outcomes, the authors suggest that many patients in psychiatric treatment including psychotherapies will benefit from attention to these issues. This article reviews approaches for assessing and addressing purpose in life in psychiatric treatment, to enhance patients' healthy sense of purpose where this characteristic is impaired.
Quality of Life During the First Three Waves of the COVID-19 Pandemic and Two Earthquakes in Croatia
Authors: Kovačić Petrović Zrnka , Peraica Tina , Blažev Mirta , Tomašić Lea , Kozarić-Kovačić Dragica 
Published: April 2023

Abstract
In a cross-sectional study, we measured the impact of the first three COVID-19 pandemic waves and two earthquakes, occurring during the same period in Croatia, on the quality of life (QoL) of the general adult population. An online survey consisting of sociodemographic questions, questions related to COVID-19 and earthquake stressors, the World Health Organization Quality of Life (WHOQoL)-BREF scale, Impact of Event Scale, and Patient Health Questionnaire 4 was completed by 220 men and 898 women (mean age, 35.1 ± 12.3 years). In a series of regressions, we examined the association among five blocks of predictors and six dependent QoL variables, four domain scores, and two global scores. Both WHOQoL-BREF global and domain scores after the prolonged stress were significantly predicted by anxiety, depression, stress symptoms, and sociodemographic characteristics. COVID-19-related stressors predicted significantly physical and psychological health, social relationships, and environmental QoL, whereas earthquake-related stressors predicted health satisfaction, physical and psychological health, and environmental QoL.
Intravascular Large B-cell Lymphoma Presenting as Sudden Death
Authors: Jackson Nicole R. 
Published: April 2023

Abstract
Intravascular large B-cell lymphoma is a rare subset of non-Hodgkin lymphoma composed of mature B lymphoma cells confined to the intravascular space. This disease remains elusive because it lacks a discrete tumor mass, can affect any part of the body, and has vague symptoms paired with heterogeneous clinical findings resulting in delayed or missed accurate diagnosis, even at postmortem examination. This is a case of a woman who died within hours of presenting to the emergency department with a diagnosis of intravascular large B-cell lymphoma made through autopsy examination, adding to the knowledge of this rare disease and bringing it to the attention of practicing autopsy and forensic pathologists.
National Trends in Acellular Dermal Matrix Utilization in Immediate Breast Reconstruction
Authors: Graziano Francis D. , Plotsker Ethan L. , Rubenstein Robyn N. , Haglich Kathryn , Stern Carrie S. , Matros Evan , Nelson Jonas A. 
Published: April 2023

BACKGROUND:
Implant-based reconstruction is most common method of immediate breast reconstruction in the United States, with acellular dermal matrices(ADM) playing a significant role in implant support and coverage. This study evaluated recent national trends in ADM use in immediate breast reconstruction and assessed patient characteristics and 30-day complication rates.

METHODS:
We queried the American College of Surgeons(ACS) National Surgical Quality Improvement Program (NSQIP) database for all patients undergoing immediate breast reconstruction from 2015 to 2020. Primary outcomes were major surgical and medical complications, as well as ADM use per year. Subset analysis was performed to compare patients undergoing immediate breast reconstruction with ADM in 2015 versus 2020.

RESULTS:
In 39,800 immediate breast reconstructions, ADMs were used in 55.5%(n=22,087 cases). ADM usage increased annually from 2015–2020. Direct-to-implant (DTI) reconstruction was significantly associated with ADM use(p<0.001). Compared to the no ADM cohort, there was a significantly increased rate of return to the OR for any reason(p < 0.001). When comparing the 2015 and 2020 ADM cohorts, the 2020 ADM cohort had a significantly higher rate of superficial infections. Obesity, smoking history, and insulin-dependent diabetes were independent risk factors for superficial wounds in ADM patients.

CONCLUSIONS:
ADM use in immediate breast reconstruction increased significantly from 2015–2020, likely reflecting national trends in increasing DTI and prepectoral breast reconstruction. Obesity, smoking history, and insulin-dependent diabetes were independent risk factors for superficial wound infections in the ADM cohort. Patients with ADM had a slight increased incidence of return to the operating room.
Impact of one-piece fronto-orbital distraction osteogenesis on orbital morphology and the development of strabismus in patients with unilateral craniosynostosis
Authors: Park Hojin , Choi Jong Woo , Ra Young Shin 
Published: April 2023

Background:
Unicoronal craniosynostosis (UCS) is associated with orbital dysmorphologies that underlie ophthalmologic dysfunctions, such as strabismus. This study aimed to assess orbital dysmorphology in patients with UCS and how it changes after fronto-orbital distraction osteogenesis (FODO), and to analyze the features of new-onset strabismus.

Methods:
A retrospective analysis was conducted on 19 patients with UCS who underwent FODO between May 2008 and November 2020. Ophthalmologic records and computed tomography were reviewed. Seven parameters, including width, height, volume, and 4-direction orbital angles were evaluated in patients with UCS and compared with those of age-matched control subjects.

Results:
The superolateral angle (SLA) and vertical angle (VA) of the ipsilateral orbit and the superomedial angle (SMA) of the contralateral orbit were more obtuse than those of the controls. Following FODO, the ipsilateral SLA was decreased from 69.2±5.4 degrees to 59.1±4.2 degrees (p=0.001), and the contralateral SMA was decreased from 64.8±5.8 degrees to 60.2±6.0 degrees (p=0.003). Four of the 17 patients without strabismus in the preoperative period developed strabismus, and the horizontal type was the most common. Logistic regression analysis demonstrated a significant association between new-onset strabismus and superomedial angle difference between both orbits (p=0.041, odds ratio: 1.39).

Conclusions:
Orbital dysmorphology in the UCS is bilateral, and the orbital roofs are dysmorphic. The bilateral orbital roofs are lifted toward the fused coronal suture and can be improved after FODO. Horizontal strabismus, such as esotropia and exotropia, is common after FODO, and superomedial orbital roof asymmetry may play a role in its development.
Spatial Fidelity of Microvascular Perforating Vessels as Perceived by Augmented Reality Virtual Projections
Authors: Cholok David J , Fischer Marc J , Leuze Christoph W , Januszyk Michael , Daniel Bruce L , Momeni Arash 
Published: April 2023

Background:
Autologous breast reconstruction yields improved long-term aesthetic results but requires increased resources of practitioners and hospital systems. Innovations in radiographic imaging have been used increasingly to improve the efficiency and success of free-flap harvest. Augmented reality (AR) affords the opportunity to superimpose relevant imaging on a surgeon’s native field of view, potentially facilitating dissection of anatomically variable structures. To validate the spatial fidelity of AR projections of deep inferior epigastric perforator flap (DIEP) relevant anatomy, comparisons of 3D models and their virtual renderings were performed by four independent observers. Measured discrepancies between the real and holographic models were evaluated.

Methods:
3D-printed models of DIEP relevant anatomy were fabricated from CTA data from 19 de-identified patients. The corresponding CTA data was similarly formatted for the Microsoft Hololens to generate corresponding projections. Anatomic points were initially measured on 3D models, after which, the corresponding points were measured on the Hololens projections from two separate vantages. Statistical analyses, including Generalized Linear Modeling, were performed to characterize spatial fidelity regarding translation, rotation, and scale of holographic projections.

Results:
Amongst all participants, the median translational displacement at corresponding points was 9.0 mm, 12.1 mm, and 13.5 mm between the real 3D model and V1, 3D model and V2, and between V1 and V2, respectively.

Conclusion:
Corresponding points, including topography of perforating vessels for the purposes of breast reconstruction can be identified within millimeters, but there remain multiple independent contributors of error, most notably the participant and location at which the projection is perceived.
Classification of Health Information Technology Safety Events in a Pediatric Tertiary Care Hospital
Authors: Khan Amina , Karavite Dean J. , Muthu Naveen , Shelov Eric , Nawab Ursula , Desai Bimal , Luo Brooke 
Published: April 2023

Objective
State agencies have developed reporting systems of safety events that include events related to health information technology (HIT). These data come from hospital reporting systems where staff submit safety reports and nurses, in the role of safety managers, review, and code events. Safety managers may have varying degrees of experience with identifying events related to HIT. Our objective was to review events potentially involving HIT and compare those with what was reported to the state.

Methods
We performed a structured review of 1 year of safety events from an academic pediatric healthcare system. We reviewed the free-text description of each event and applied a classification scheme derived from the AHRQ Health IT Hazard Manager and compared the results with events reported to the state as involving HIT.

Results
Of 33,218 safety events for a 1-year period, 1247 included key words related to HIT and/or were indicated by safety managers as involving HIT. Of the 1247 events, the structured review identified 769 as involving HIT. In comparison, safety managers only identified 194 of the 769 events (25%) as involving HIT. Most events, 353 (46%), not identified by safety managers were documentation issues. Of the 1247 events, the structured review identified 478 as not involving HIT while safety managers identified and reported 81 of these 478 events (17%) as involving HIT.

Conclusions
The current process of reporting safety events lacks standardization in identifying health technology contributions to safety events, which may minimize the effectiveness of safety initiatives.
Stress Testing the Cardiac Catheterization Laboratory
Authors: Jafri Farrukh Nadeem , Santana Felipes Rachel C. , Bliagos Dimitrios , Torres Rafael E. , Bellido Simon , Arif Amber , Elwell Diana , Mirante Doreen , Ellsworth Kelly , Cardasis John , Anastasian George , Pinto Hazel , Kochar Ajar 
Published: April 2023

Introduction
Although uncommon, cardiac arrests in the cardiac catheterization laboratory (CCL) are often catastrophic and likely to increase with rising case complexity. In situ simulation (ISS) has been used to identify latent safety threats (LSTs) in inpatient units but has not yet been studied in the CCL.

Methods
Three Plan-Do-Study-Act (PDSA) cycles leveraging ISS were conducted focused on acute airway management. Data collected through debriefs focused on (1) airway management, (2) equipment availability, and (3) interdepartmental communication. The LSTs were subcategorized and plotted on the Survey Analysis for Evaluating Risk (SAFER)-Matrix. A SAFER score was calculated based on quantifying the likelihood of harm, scope, and the number of times a threat was identified during simulation. Time to definitive airway was collected as a secondary measure. Interventions were developed using cause and effect and driver diagrams between PDSA cycles.

Results
Eleven total simulations through 3 PDSA cycles were conducted between January and December 2021 (5 in PDSA 1, 4 in PDSA 2, and 2 in PDSA 3). One hundred one LSTs were identified with 14 total subcategories. The mean SAFER score decreased from 5.37 in PDSA 1, to 2.96 in PDSA 2, and to 1.00 in PDSA 3. Bivariate regression analysis showed a decrease in SAFER score of 2.19 for every PDSA cycle (P = 0.011). Ordinary least squares regression had a decrease of 1.65 in airway-related threats every PDSA cycle (P < 0.01) as well as an increase in intubation time of 35.0 seconds for every 1-unit increase in communication threat identified (P = 0.037).

Conclusions
This study successfully leveraged ISS and existing quality improvement initiatives in the CCL, resulting in a decrease in airway-related threats as measured through simulation.
Inflammatory Type Focal Cerebral Arteriopathy of the Posterior Circulation in Children: a comparative cohort study
Authors: Slavova Nedelina , Münger Robin , Sanchez-Albisua Iciar , Regényi Maria , Oesch Gabriela , Fluss Joël , Hackenberg Annette , Lebon Sébastien , Maier Oliver , Datta Alexandre , Bigi Sandra , Grunt Sebastian , Steinlin Maja 
Published: April 2023

AbstractBackgroundInflammatory type Focal Cerebral Arteriopathy (FCA-i) in the anterior circulation (AC) is well characterized and the FCA severity score (FCASS) reflects the severity of disease. We identified cases of FCA-i in the posterior circulation (PC) and adapted the FCASS to describe these cases.MethodsPatients from the Swiss NeuroPaediatric Stroke Registry (SNPSR) with ischemic stroke in the PC and AC due to FCA-i and available neuroimaging were gathered. Comparison of data regarding Pediatric National Institutes of Health Stroke Scale (pedNIHSS) score and Pediatric Stroke Outcome Measure (PSOM) and FCASS was performed. We estimated infarct size by the modified pediatric Alberta Stroke Program Early Computed Tomography Score (pedASPECTS) in children with AC stroke and the adapted Bernese posterior diffusion-weighted imaging (DWI) score in the PC.ResultsThirty-six children with a median age of 6.3 years ([IQR 2.8,8.6; range 0.9,15.6], 21 males, 58.3%) with FCA-i were identified. The total incidence rate was 0.151/100 000/year (95%CI 0.109–0.209). Seven had PC FCA-i and 5 had FCA-i in both circulations. Time to final FCASS was longer in the PC compared to AC, evolution of FCASS did not differ. Initial pedNIHSS was highest in children with FCA-i in the PC with a median of 8.0 (IQR 5.0-18.0), compared to 4.5 (IQR 2.0-8.0) in those with AC FCA-i and 6.0 (IQR 6.0-6.0) with involvement of both AC and PC. Different to the anterior cases PC infarct volume did not correlate with higher discharge, maximum or final FCASS scores (R 0.25, 0.35, 0.54).ConclusionThe PC is affected in up to one third of cases of FCA-i. These cases should be included in future investigations on FCA-i. Although it did not correlate with clinical outcome in our cohort, the modified FCASS may well serve as a marker for the evolution of the arteriopathy in posterior FCA-i.
An approach to assess the patient benefit of demand management strategies
Authors: Yago Martín 
Published: April 2023

ABSTRACTBackgroundMuch of the testing performed by clinical laboratories does not translate into benefit for patients. To reduce the number of these low-value tests, laboratories use different intervention strategies, trying to adapt the analytical demand to clinical needs. The effectiveness of these interventions is usually evaluated through indicators related to the activity or cost rather than the benefit they imply for patients.MethodsWe have derived expressions that relate the fraction of patients tested (Rt) and the abnormal result rate (Ra) obtained by the requesting physician with the net benefit that the use of the test represents for both tested and untested patients.ResultsThe behavior of physicians regarding the use of a test in each healthcare context and the effect of an intervention on this behavior can be characterized by these two parameters:RaandRt. An increase in the value ofRaimplies a greater net benefit for all patients attended. When the physician is selective in the use of the test, an increase in the value ofRtimplies a greater benefit for untested patients but represents a limit to the increase inRa.ConclusionsInterventions aimed at reducing the demand for tests should act primarily by increasing selectivity in the use of tests, increasing the benefit for the patients tested and compensating the harm that the reduction in testing entails for patients who are not.
Weather Shocks, Child Mortality, and Adaptation: Experimental Evidence from Uganda
Authors: Björkman Nyqvist Martina , von Carnap Tillmann , Guariso Andrea , Svensson Jakob 
Published: April 2023

AbstractBackgroundHuman-caused climate change is already increasing the intensity and frequency of extreme weather events, such as droughts. The health and economic consequences of these events are expected to be particularly severe for populations in low-income settings whose livelihoods rely on rain-fed agriculture. Within these populations, children are an especially vulnerable group, as undernutrition is linked to 45% of all child deaths across the globe. Despite progress, adaptation gaps exist. We still lack strong evidence on policies to effectively mitigate climate change’s most severe consequences for children. In this paper we ask whether adaptation investments in the form of improved community healthcare can build climate resilience in a low-income country setting.MethodsWe reanalyzed data from a clustered randomized controlled trial inducing spatial variation across 214 Ugandan villages in community-health program strengthening, and combined it with quasi-experimental data on locality-specific rainfall shocks. In the intervention clusters, financially incentivized community health workers (CHWs) were deployed over a three-year period to conduct home visits and provide integrated community case management and maternal, newborn, and child health treatment and preventive services. The trial followed 7,018 households with young children (3,790 in 115 intervention clusters and 3,228 in 99 control clusters) over three years. We estimated the effect of low rainfall in the growing season on infant mortality in the following (post-harvest and lean) period, conditional on CHW deployment, over six season-pairs in 2011-2013.FindingsThere were 134 infant deaths in the intervention clusters (38.6 deaths per 1000 infant-years) over the three-year trial period. 60 deaths (40.7 deaths per 1000 infant-years) occurred in periods following growing seasons with rainfall below the long-run detrended mean (rainfall deficit seasons), and 74 deaths (36.8 deaths per 1000 infant-years) occurred in periods following growing seasons rainfall above the long-run detrended mean (rainfall surplus seasons). There were 160 infant deaths in the comparison clusters (61.3 deaths per 1000 infant-years). 83 deaths (81.5 deaths per 1000 infant-years) occurred in periods following rainfall deficit seasons, and 77 deaths (46.3 deaths per 1000 infant-years) occurred in periods following rainfall surplus seasons. Adjusting only for the stratified random assignment of clusters, the mean difference corresponded to a 46% reduction in under-five mortality rate (p=.000; adjusted rate ratio 0.54, 95% CI 0.39-0.73) following rainfall deficit seasons. The risk of infant deaths in the comparison relative to the intervention group increased in the magnitude of the rainfall deficit.InterpretationAdaptation investments in a low-income context – here in the form of improved access to community health care – reduced the risk of infant mortality following adverse weather events.
Association Between Artificial Intelligence-Derived Tumor Volume and Oncologic Outcomes for Localized Prostate Cancer Treated with Radiation Therapy
Authors: Yang David D , Lee Leslie K , Tsui James MG , Leeman Jonathan E , Lee Katie N , McClure Heather M , Sudhyadhom Atchar , Guthier Christian V , Mouw Kent W , Martin Neil E , Orio Peter F , Nguyen Paul L , D’Amico Anthony V , King Martin T 
Published: April 2023

BackgroundAlthough clinical features of multi-parametric magnetic resonance imaging (mpMRI) have been associated with biochemical recurrence in localized prostate cancer, such features are subject to inter-observer variability.ObjectiveTo evaluate whether the volume of the dominant intraprostatic lesion (DIL), as provided by a deep learning segmentation algorithm, could provide prognostic information for patients treated with definitive radiation therapy (RT).Design, Setting, and ParticipantsRetrospective study of 438 patients with localized prostate cancer who underwent an endorectal coil, high B-value, 3-Tesla mpMRI and were treated with RT between 2010 and 2017.InterventionRT.Outcome Measurements and Statistical AnalysisBiochemical recurrence and metastasis risk, assessed with a cause-specific Cox regression and time-dependent receiver operating characteristic analysis.Results and LimitationsThe artificial intelligence (AI) model identified DILs with an area under the receiver operating characteristic curve (AUROC) of 0.827 at the patient level. For the 233 patients with available PI-RADS scores, with a median follow-up of 5.6 years, AI-defined DIL volume was significantly associated with biochemical failure (adjusted hazard ratio 1.54, 95% confidence interval 1.09-2.17, p=0.014) after adjustment for PI-RADS score. Among all 438 patients with a median follow-up of 6.9 years, the AUROC for predicting 7-year biochemical failure for AI volume (0.790) was similar to that for an expanded National Comprehensive Cancer Network (NCCN+) category (p=0.17). The AUROC for predicting 7-year metastasis for AI volume trended towards being higher compared to NCCN+ categories (0.854 vs 0.769, p=0.06).ConclusionsA deep learning algorithm could identify the DIL with good performance. AI-defined DIL volume may be able to provide prognostic information independent of the NCCN+ risk group or other radiologic factors for patients with localized prostate cancer treated with RT.