bluuebunny/crossref_metadata_2025_split huggingface dataset:
Establishing a pharmacy revenue integrity team: A blueprint for increasing pharmacy’s role in health-system revenue cycle
Authors: Rodgers John Killian L , Francart Suzanne J , Amerine Lindsey B 
Published: April 2023

Abstract

Purpose
An increasing focus on driving margin has pushed health-system pharmacy departments to find new ways of generating new or protecting existing revenue. At UNC Health, a dedicated pharmacy revenue integrity (PRI) team has been operating since 2017. This team has been able to significantly reduce revenue loss from denials, increase billing compliance, and improve revenue capture. This article provides a framework for establishing a PRI program and reports results generated from it.

Summary
The activities of a PRI program can be grouped into 3 main pillars: minimizing revenue loss, optimizing revenue capture, and ensuring billing compliance. Minimizing revenue loss is accomplished primarily through management of pharmacy charge denials and can be an ideal first step in establishing a PRI program due to the tangible value generated. Optimizing revenue capture involves a combination of clinical expertise and understanding of billing operations to ensure medications are being billed and reimbursed appropriately. Finally, ensuring billing compliance, including ownership of the pharmacy charge description master and maintenance of electronic health record medication lists, is vital in preventing charge and reimbursement errors.

Conclusion
Successfully bringing traditional revenue cycle functions into the department of pharmacy can be a daunting task but provides significant opportunities to create value for a health system. Key factors to the success of a PRI program include robust data access, hiring individuals with financial and pharmacy expertise into PRI positions, strong relationships with the existing revenue cycle teams, and a progressive model that allows for incremental expansion of services.
Glycemic patterns and impact of early hyperglycaemia in patients with cardiogenic shock on mechanical circulatory support
Authors: Nair Raunak Mohan , Chawla Sanchit , Mentias Amgad , Saleem Talha , Vural Adil , Ko Taeyong , Rampersad Penelope , Cremer Paul , Menon Venu 
Published: April 2023

Abstract

Aims
Hyperglycaemia has been an established predictor of poor outcomes in critically ill patients. The aim of this study is to assess the pattern of early glycemic control in patients with cardiogenic shock (CS) on temporary mechanical circulatory support (MCS) and its impact on short-term outcomes.

Methods and results
All adult patients admitted to the Cleveland clinic cardiac intensive care unit (CICU) between 2015 and 2019 with CS necessitating MCS with intra-aortic balloon pump (IABP), Impella or venous arterial- extra corporeal membrane oxygenation (VA- ECMO) exclusively for CS were retrospectively analyzed. Blood glucose values were collected for the first 72 h from the time of MCS insertion. Patients were categorized into three groups [group 1 = mean blood glucose (MBG) &lt; 140, group 2 = MBG between 140 and 180, and group 3 = MBG &gt;180]. The primary outcome was 30-day all-cause mortality. A total of 393 patients with CS on temporary MCS [median age (Q1, Q3), 63 (54, 70), 42% females], were admitted to our CICU during the study period. Of these, 144 patients (37%) were on IABP, 121 patients (31%) were on Impella, and 128 (32%) were on VA-ECMO. Upon stratifying the patients into groups depending on MBG during the initial time period after MCS placement, 174 patients (44%) had MBG less than 140 mg/dL, 126 patients (32%) had MBG between 140 and 180 mg/dL whereas 93 (24%) patients had MBG &gt; 180 mg/dL. Overall, patients on IABP had the best glycemic control during the early period whereas those on ECMO had the highest MBG during the initial timeframe. A comparison of 30-day mortality revealed that patients with MBG &gt;180 mg/dL had worse outcomes compared to the other two groups (P = 0.005). Multivariable logistic regression revealed that hyperglycaemia was an independent predictor of poor outcomes in CS patients on MCS when undifferentiated by device type (aOR 2.27, 95% CI 1.19–4.42, P = 0.01). However, upon adjusting for the type of MCS device, this effect was no longer present.

Conclusion
A significant proportion of patients with CS on MCS manifest early hyperglycaemia regardless of diabetic status. The presence of early hyperglycaemia in these patients acted predominantly as a surrogate of the underlying shock severity and was associated with worse short-term outcomes. Future studies should assess whether strategies to optimize glycemic control in this high-risk cohort can independently improve clinical outcomes.
A humanized yeast model reveals dominant-negative properties of neuropathy-associated alanyl-tRNA synthetase mutations
Authors: Meyer-Schuman Rebecca , Marte Sheila , Smith Tyler J , Feely Shawna M E , Kennerson Marina , Nicholson Garth , Shy Mike E , Koutmou Kristin S , Antonellis Anthony 
Published: April 2023

Abstract
Aminoacyl-tRNA synthetases (ARSs) are essential enzymes that ligate tRNA molecules to cognate amino acids. Heterozygosity for missense variants or small in-frame deletions in six ARS genes causes dominant axonal peripheral neuropathy. These pathogenic variants reduce enzyme activity without significantly decreasing protein levels and reside in genes encoding homo-dimeric enzymes. These observations raise the possibility that neuropathy-associated ARS variants exert a dominant-negative effect, reducing overall ARS activity below a threshold required for peripheral nerve function. To test such variants for dominant-negative properties, we developed a humanized yeast assay to co-express pathogenic human alanyl-tRNA synthetase (AARS1) mutations with wild-type human AARS1. We show that multiple loss-of-function AARS1 mutations impair yeast growth through an interaction with wild-type AARS1, but that reducing this interaction rescues yeast growth. This suggests that neuropathy-associated AARS1 variants exert a dominant-negative effect, which supports a common, loss-of-function mechanism for ARS-mediated dominant peripheral neuropathy.
Children’s Religious Identity in Alternative Care and Adoption: The Need to Recentre the Child’s Best Interest in International Human Rights Adjudication
Authors: Do Vale Alves Ayla 
Published: April 2023

ABSTRACT
This article argues that international human rights (quasi-)adjudicatory institutions should do better in considering the best interests of the child and freedom of religion in cases involving human rights aspects of alternative care and adoption. The European Court of Human Rights, particularly, has been using obscure and contradictory standards, which ultimately do not privilege the child’s best interests in matters affecting them directly. Recent Grand Chamber jurisprudence instead puts parents’ interests above the child’s. A child-centred approach where children are not objectified, but treated as autonomous, rights-bearing, legal persons, with independent interests that may override those of other stakeholders is needed. This article explores general international and European rules governing children’s religious rights in alternative care and adoption to expose the Court’s pitfalls in centring children in decision-making involving religion particularly. It generally promotes adoption of a child-centred approach in international human rights courts, and particularly highlights existing hurdles in such approach where the decision-making involves conflicting interests concerning religion.
Using machine learning to alleviate the allometric effect in otolith shape-based species discrimination: the role of a triplet loss function
Authors: Chen Yuwen , Zhu Guoping 
Published: April 2023

Abstract
Species identification by fish otoliths is an effective and appropriate approach. However, the allometric growth of otoliths can cause discrimination confusion, particularly in juvenile otolith classification. In the Southern Ocean, Chionodraco rastrospinosus,Krefftichthys anderssoni,Electrona carlsbergi, andPleuragramma antarcticum are frequently caught together in krill fishery as bycatch species. Furthermore, the otolith shape of these four species is relatively similar in juvenile fish, making the identification of fish species difficult. In this study, we tried and evaluated many commonly used machine learning techniques to solve this problem. Eventually, by introducing a triplet loss function (function used to reduce intraspecific variation and increase inter-specific variation), the discrimination confusion caused by the allometric growth of otoliths was reduced. The classification results show that the neural network model with the triplet loss function achieves the best classification accuracy of 96%. The proposed method can help improve otolith classification performance, especially under the context of limited sampling effort, which is of great importance for trophic ecology and the study of fish life history.
Does the low-carbon construction of cities in China reduce carbon emission intensity?
Authors: He Chengkang , Shu Cheng , Zou Jinlang , Li Yunliang 
Published: April 2023

Abstract
Currently, realizing the coordinated green development of the economy and environment has become the focus of all walks of life. To achieve this goal, it is important for cities to promote carbon reduction. China has implemented a low-carbon city pilot (LCP) policy since 2010 to achieve green transformative development. In this context, this study aims to assess whether the LCP policy achieves carbon peaking and carbon neutrality goals. Using 2007–2019 prefecture-level panel data from China and a time-varying difference-in-difference model, we conduct a quasi-natural experiment. The empirical results show that the carbon emission intensity (CEI) is greatly reduced in cities that implemented the LCP policy. Compared with the control group, the average value of CEI of cities in the experimental group is approximately three percentage points lower, and the robustness test results prove the reliability of the baseline estimates. In addition, we examine the time lag effect and find that in the experimental group, the CEI of cities is significantly lower in the fourth year and has a tendency to gradually increase. Meanwhile, the heterogeneity analysis in this research groups the samples according to economic development, population agglomeration and resource endowment. We find that in cities with better economic development, higher population agglomeration and relatively underdeveloped resource endowment, there is a greater reduction in CEI. Finally, we conduct a mechanism test and find that in the experimental group, the CEI of cities is severely reduced due to industrial structure optimization, environmental enforcement strengthening and technological innovation capabilities enhancement.
Dirichlet Sub-Laplacians on Homogeneous Carnot Groups: Spectral Properties, Asymptotics, and Heat Content
Authors: Carfagnini Marco , Gordina Maria 
Published: April 2023

Abstract
We consider sub-Laplacians in open bounded sets in a homogeneous Carnot group and study their spectral properties. We prove that these operators have a pure point spectrum and prove the existence of the spectral gap. In addition, we give applications to the small ball problem for a hypoelliptic Brownian motion and the large time behavior of the heat content in a regular domain.
The association between prescription drug monitoring programs and controlled substance prescribing: a cross-sectional study using data from 2019 National Electronic Health Records Survey
Authors: Mehta Shivani , Brown William , Ferguson Erin , Najera James , Pantell Matthew S 
Published: April 2023

AbstractObjectiveThe use of controlled medications such as opioids, stimulants, anabolic steroids, depressants, and hallucinogens has led to an increase in addiction, overdose, and death. Given the high attributes of abuse and dependency, prescription drug monitoring programs (PDMPs) were introduced in the United States as a state-level intervention.Materials and methodsUsing cross-sectional data from the 2019 National Electronic Health Records Survey, we assessed the association between PDMP usage and reduced or eliminated controlled substance prescribing as well as the association between PDMP usage and changing a controlled substance prescription to a nonopioid pharmacologic therapy or nonpharmacologic therapy. We applied survey weights to produce physician-level estimates from the survey sample.ResultsAdjusting for physician age, sex, type of medical degree, specialty, and ease of PDMP, we found that physicians who reported “often” PDMP usage had 2.34 times the odds of reducing or eliminating controlled substance prescriptions compared to physicians who reported never using the PDMP (95% confidence interval [CI] 1.12–4.90). Adjusting for physician age, sex, type of doctor, and specialty, we found that physicians who reported “often” use of the PDMP had 3.65 times the odd of changing controlled substance prescriptions to a nonopioid pharmacologic therapy or nonpharmacologic therapy (95% CI: 1.61–8.26).DiscussionThese results support the continued use, investment, and expansion of PDMPs as an effective intervention for reducing controlled substance prescription and changing to nonopioid/pharmacologic therapy.ConclusionOverall, frequent usage of PDMPs was significantly associated with reducing, eliminating, or changing controlled substance prescription patterns.
Wallerian degeneration in the brain after organophosphorus poisoning: a case report
Authors: Gajurel Bikram P. , Giri Subarna , Poudel Navin , Kharel Sanjeev , Karn Ragesh , Rajbhandari Reema , Ojha Rajeev , Gautam Niraj , Shrestha Aashish 
Published: April 2023

Introduction and Importance:
The type, quantity, and potency of the organophosphorus compound (OPC) taken determine the symptoms of OPC poisoning as well as their severity. The exact etiology for organophosphorus (OP) poisoning delay neuropathy regulating Wallerian degeneration is still unknown.

Case Presentation:
We report here a rare case of a 25-year-old lady with Wallerian degeneration in the brain found in an MRI in a patient after OPC ingestion. MRI of the brain, in our case, shows Wallerian degeneration of the corona radiata, internal capsule, and midbrain.

Clinical Discussion:
Some OPCs can lead to OP-induced delayed neuropathy, a form of delayed neurotoxicity in humans (OPIDN). The distal axonopathy’s (in OPIDN) morphological pattern resembles Wallerian degeneration, which happens in vitro following nerve damage. Although delayed Wallerian degeneration from organophosphate poisoning often affects the peripheral nervous system, it can also affect the central nervous system. Rehabilitation therapy combined with appropriate nursing care has been demonstrated to improve the disease.

Conclusion:
Central nervous system involvement after OP poisoning is rare, and MRI of the brain and spinal cord can document evidence of Wallerian degeneration after OP poisoning.
Thymoma: a fatal case report of recurring pneumonia from Tanzania
Authors: Sadiq Abid M. , Mukamuri Ruvimbo R. , Kamabu Eugenie M. , Kimondo Faustini C. , Sadiq Adnan M. , Nkya Gilbert Z. 
Published: April 2023

Introduction and importance:
Thymomas present either concurrently with myasthenia gravis, with local pressure symptoms, or asymptomatically as a mediastinal mass. Due to its variable presentation, the incidence is low, as not all cases would be identified. Thymomas can present with a rare entity of combined T-cell and B-cell immunodeficiency in adults. Thymectomy is the most important prognostic factor, including preventing autoimmune manifestations of thymoma, but immunodeficiency may persist after thymectomy.

Case presentation:
The authors report a case of thymoma with evidence of immunodeficiency, manifesting as recurrent pneumonia and respiratory distress in an HIV-seronegative 62-year-old man with a suspected diagnosis 3 years before admission. During his bouts of pneumonia, blood cultures revealed methicillin-resistant Staphylococcus aureus, which was initially treated with vancomycin and then with clindamycin. Although hypogammaglobulinemia was not established in our low-resource setting, there was a reduced CD4-cell count with an abnormal CD4/CD8 ratio. The patient responded well to the first course of antibiotics. However, the second attempt was unsuccessful, which led to his demise.

Conclusion:
Clinicians should be aware that thymoma can cause immunodeficiency. Clinical suspicion should be raised in patients who present with recurrent infections, particularly in thymoma cases with adult-onset immunodeficiency.
Endometriosis of the umbilicus in a 36-year-old woman: a case report and literature review
Authors: Yahaya James J. , Morgan Emmanuel D. , Abraham Zephania S. 
Published: April 2023

Introduction and importance:
Extrapelvic endometriosis is quite rare, with a reported prevalence ranging between 0.5 and 1%, and the condition is more likely to pose diagnostic challenges. This condition is more likely to pose clinical diagnostic challenges as it may mimic metastasis such as Sister Mary Joseph’s nodule.

Case presentation:
Herein is reported the case of a 36-year-old woman who presented with a hard nodular dark-bluish umbilicus mass that had a tendency to increase in size and was accompanied by severe pain during menstruation for ∼2 years is reported. Laparotomy revealed a normal uterus without involvement of any other pelvic organ by the endometrial tissue except the umbilicus part. Histological evaluation revealed endometriosis of the umbilicus.

Clinical discussion:
By far, primary endometriosis of the umbilicus is extremely rare, and most of the time, extrapelvic endometriosis involving the umbilicus would be secondary to surgical procedures involving the abdominal cavity as it was for the presented patient. Although endometriosis is rare, it should always be considered among women of reproductive age presenting with cyclic pains.

Conclusions:
Meticulous investigation of patients suspected to have umbilical endometriosis helps to confirm the diagnosis and hence expedites proper management of the patients; this also prevents chances of malignant transformation of the condition despite such possibilities being extremely rare.
An unprecedented occurrence of incidental tonsillar ectopic primary Papillary Thyroid Carcinoma in an adult female: A case report
Authors: Abdul Khalek Gheed , Al Laham Omar , Abazid Eias , Asaad Wisam , Almaydaani Mohamad , Ahmad Mohamad 
Published: April 2023

Introduction and Importance:
Any defect in the early phases of the normal complex embryogenic pathway might lead to anatomical anomalies that lead to the formation of ectopic thyroid gland tissue. Overall, ectopic thyroid tissue incidence is one in 300 000, and the rate of malignant transformation among those is merely 1%. However, documented cases of malignant transformation of ectopic thyroid tissue in the tonsils have not yet been – to the best of the knowledge – documented in published literature.

Case Presentation:
We illustrate the case of a 58-year-old female who was referred to the clinic after she underwent a tonsillectomy due to chronic discomfort and gradual difficulty in swallowing. Documentation of an ectopic primary Papillary Thyroid Carcinoma in one of the patient’s excised tonsils was achieved after thorough histopathological and immunohistochemical analyses took place. Radiological evaluation excluded any metastatic involvement and paved the path toward surgical intervention, which was comprised of a total thyroidectomy.

Clinical Discussion:
Surgical resection of the patient’s thyroid gland was achieved, and the subsequent histopathological analysis of the specimens revealed nodular hyperplasia with degenerative changes but without evidence of malignant transformation in her thyroid gland.

Conclusion:
Ectopic primary Papillary Thyroid Carcinoma is an immensely rare occurrence, regardless of population parameters. Its incidence could originate in various anatomical locations, but to the best of the knowledge, its incidence in the tonsils has not been previously documented in published literature. Adequate levels of clinical awareness in this situation could timely alleviate patient complaints and aid in performing optimal life-saving interventions.
A rare case of intramuscular hemangioma of splenius capitis: a case report
Authors: Maharjan Suman , Hona Anil , Karki Sabin 
Published: April 2023

Introduction and Importance:
Intramuscular hemangiomas are benign lesion that rarely occurs within the skeletal muscle of the head and neck regions. These lesions present with nonspecific symptoms resulting in only a few instances of accurate preoperative diagnosis.

Case Presentation:
A 20-year-old male presented with swelling over the nape of the neck on the right side. On clinical examination, the solitary swelling was 4×4 cm on measurement, soft on consistency with regular margin, fluctuant, with no skin changes over the swelling, nontender, no restriction in range of motion of the neck, and no pulsation felt.

Clinical Findings and Investigations:
Ultrasonography and contrast-enhanced MRI revealed intramuscular hemangioma involving the right splenius capitis muscle with no extension to adjacent muscles and minimal extension to the subcutaneous tissue.

Interventions and Outcome:
Excision of the lesion along with splenius capitis was performed with stable postoperative hemodynamics.

Conclusion:
Since intramuscular hemangiomas pose a challenge in preoperative diagnosis, it requires the sensible use of imaging modalities. Although several treatment modalities have surfaced, intramuscular hemangiomas require definitive operative management to reduce their recurrence.
Management of appendicitis: appendicectomy, antibiotic therapy, or both?
Authors: Weledji Elroy P. , Zisuh Anutebeh V. , Ngounou Eleanore 
Published: April 2023

Introduction:
Appendicitis is a global disease with an incidence of 7–12% in the population of the USA and Europe but is low and rising in the developing world. It is the most common acute general surgical emergency, but as no investigation is accurate, the diagnosis has to rely on clinical symptoms and signs and, thus, frequently misdiagnosed. The aim of the study was to debate the arguments for managing appendicitis (operative, nonoperative, or both).

Patients and methods:
Electronic searches of the MEDLINE (PubMed) database, Cochrane Library, and Science Citation Index were performed to identify original published studies on appendicitis and the pre-COVID-19 (coronavirus disease 2019) and post-COVID-19 management. Relevant articles were searched from relevant chapters in specialized texts, and all have been included.

Discussion:
There are indications for operative (surgery), nonoperative (antibiotics), or both in the management of acute appendicitis. Although laparoscopic appendicectomy is becoming the gold standard of treatment, knowledge of the pros and cons of this approach versus the open approach is important. The controversy in the management of the appendix mass/abscess between an expedient appendicectomy or a combination of conservative management (antibiotics) and interval appendicectomy remains.

Conclusion:
Laparoscopic appendicectomy is becoming the gold standard for the treatment of appendicitis. However, the advantages of the innovations in minimally invasive and endoscopic surgery are unlikely to render formal open appendicectomy obsolete. Nonoperative management with antibiotics may suffice in selected cases with uncomplicated appendicitis. It is imperative that patients are counseled appropriately if primary antibiotic treatment is to be routinely offered as first-line therapy.