bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Light Intensity on the Relative Afferent Pupillary Defect in Unilateral Neuro-ophthalmic Pathology
Authors: Negi Rahul , Raviselvan Munispriyan , Yarravarapu Divyank , Chillakala Koteswararao , Durai C. V. Reena , Baskar Juhi , Jain Ashish , Bisht Karan , Bhate Manjushree , Bharadwaj Shrikant R. 
Published: August 2023

ABSTRACT

SIGNIFICANCE
Objective pupillometry with standardized light intensities allows a comprehensive assessment of the relative afferent pupillary defect in patients with unilateral neuro-ophthalmic pathology.

PURPOSE
This study aimed to determine the impact of varying light intensities on the grade of relative afferent pupillary defect in unilateral neuro-ophthalmic pathology vis-à-vis healthy controls.

METHODS
Monocular pupillary light reflexes of 20 controls (14 to 50 years) and 31 cases (12 to 72 years) with clinically diagnosed relative afferent pupillary defect were measured thrice using 1-second-long light pulses, followed by 3 seconds of darkness, at eight light intensities (6.4 to 1200 lux) using objective pupillometry. The relative afferent pupillary defect was quantified as the ratio of the percentage change in the direct light reflexes of the left and right eyes. Its change with light intensity was described using standard exponential fits.

RESULTS
The median (25th to 75th interquartile range) defect score of 54.8% cases decreased from baseline values of 1.58 (1.25 to 1.87) for right eye pathology and 0.45 (0.39 to 0.55) for left eye pathology to saturation values of 1.18 (1.05 to 1.31) and 0.98 (0.95 to 1.06), respectively, at light intensities between 56.9 and 300.5 lux. Like controls (1.01 [1.00 to 1.06]), the defect scores of the remaining 45.2% cases were constant with light intensity at 1.23 (1.18 to 1.46) and 0.87 (0.86 to 0.89) for right and left eye pathologies, respectively.

CONCLUSIONS
Relative afferent pupillary defects may decrease with test light intensity in a significant proportion of patients with unilateral neuro-ophthalmic pathology. This highlights the importance of objective pupillometry with standardization light intensities for clinical assessment of afferent pupillary defects.
The Accuracy of Classification Systems in Nonsyndromic Sagittal Craniosynostosis
Authors: Skadorwa Tymon , Skadorwa Joanna , Wierzbieniec Olga 
Published: August 2023

Numerous classification systems of nonsyndromic sagittal craniosynostosis (NSC) are applied but none has gained a wide acceptance, since each classification is focused on distinct aspects. The aim of the study was to assess the accuracy of 4 classifications of NSC discussed in the literature by defining the associations among the classifications, individual features (sex, age, cranial index), and objective morphologic criteria (frontal bossing, retrocoronal constriction, sagittal ridge, and occipital bulleting). The study was conducted on anonymized thin-cut CT scans of 133 children with NSC 1 to 12 months old (mean age 5.42 mo). The type of cranial dysmorphology was assessed using 4 classification systems, focusing on skull shape, pattern of sagittal suture closure (Heuzé classification), deformation of skull vault (Sakamoto classification), and a single-dominant feature (David classification). Each patient was also independently investigated for the presence of morphologic criteria. A multivariate analysis was performed to explore the relations among the classifications and assess their accuracy. In the analyzed cohort sphenocephaly (38.3%), CFF type by Heuzé (30.8%), type I by Sakamoto (72.9%), and a central type by David (42.9%) were dominant findings. Regarding the morphologic criteria, frontal bossing was observed the most frequently (91.7%). The age of patients and cranial index differed significantly among the shapes of skull and David classifications (P<0.001). The shape-based system showed the strongest correlation with other classifications and with measurable variables. Other classifications have much in common and some overlap, but none of them constitutes a standalone system to define all aspects of cranial dysmorphology in NSC.
Using Virtual Patients to Support Empathy Training in Health Care Education
Authors: Gilbert Alan , Carnell Stephanie , Lok Benjamin , Miles Anna 
Published: August 2023

Introduction
Empathy is essential for effective patient care. Yet, research shows suboptimal empathy in patient-practitioner interactions. Intelligent virtual patient simulations may offer an effective educational tool for empathy training. This observational study explored the quality of speech pathology of students' empathy responses in virtual patient simulations.

Methods
Using the 7-point Empathic Communication Coding System (ECCS), we examined 72 students' empathic communication during a 12-week virtual patient interview series as part of their standard curriculum across 4 cohorts (a total of 388 empathic responses). The ECCS data were tallied and graphically displayed. We compared year groups (cohorts from 2015 to 2018), changes over semester, and differences between virtual patients.

Results
Median ECCS scores were 4 of a maximum of 6 (interquartile range, 3) across all interviews. Most students (89%) scored between a level 2 (implicit recognition) and level 5 (confirmation) with only a few responses scoring at the lowest 2 levels of empathy (0: denial, 0.5%; 1: automatic recognition, 2%) or the highest level of empathy (6: shared feeling or experience, 9%). Students consistently acknowledged patients' feelings and often offered an action, solution, or reassurance. However, shared feelings or experiences were infrequent.

Conclusions
Although virtual patient simulations do not replace experiential learning such as simulation, standardized patients, and clinical practicum, they offer a safe environment to practice skills. This article provides support for designing larger controlled clinical trials and provides insights for educators on how to design virtual patient empathic opportunities of varying complexity for students.
Vitamins in neuropathy: pathophysiological and therapeutic roles
Authors: Chen Peng , Song Xue-Jun 
Published: August 2023

Purpose of review
Vitamin deficiency is a risk factor in the development of peripheral neuropathy, which leads to complex and severe diseases. This review provides an update overview of the literature on the roles of vitamins in peripheral neuropathy, highlighting their pathophysiological and therapeutic roles.

Recent findings
The importance and clinical manifestations and implications of the vitamins and vitamin deficiencies are further demonstrated in peripheral neuropathy and the associated diseases. Vitamin deficiency is common in various severe and complex diseases such as diabetes, chemotherapy, acute nutritional axonal neuropathy, dermatitis, complex regional pain syndrome, postherpetic neuralgia, carpal tunnel syndrome, and so forth and some rare clinical case reports. There is evidence that deficiencies of almost all vitamins are associated with diabetic neuropathy. Vitamin supplementation may serve as an effective therapeutic strategy.

Summary
The vitamins play critical roles in maintaining physiological functions, and vitamin deficiencies cause peripheral neuropathy with various severe and complex diseases. The therapeutic benefits of vitamins and further understanding of the mechanisms for vitamin treatment effects should be emphasized and highlighted. More clinical trials are needed to establish optimal treatment strategies for vitamins in the various neuropathies. A large range of people/patients screening for vitamin deficiencies may be considered in order to provide early diagnosis and timely medical assistance.
Reducing Retained Foreign Objects in the Operating Room: A Quality Improvement Initiative
Authors: Keane Olivia A , Chambers Cindi , Brady Colin M , Rehberg Jeff , Iyer Srikant , Santore Matthew T 
Published: August 2023

Background:
While the incidence of pediatric retained foreign objects (RFOs) during surgery is diminutive (1/32,000), RFOs are often the most common sentinel events reported. In 2021, our institution noted an increase in RFOs evidenced by a substantial decrease in days between events. We aimed to minimize the incidence of RFO which was measured as an increase days between events at our institution by implementation of a Quality Improvement (QI) initiative.

Study Design:
This effort was conducted across four surgical centers within a tertiary children’s healthcare system in December 2021. Patients undergoing surgery within this healthcare system across all surgical specialties were included. The QI initiative was developed by a multidisciplinary team and included six steps focusing on quiet time, minimizing interruptions, and closed loop communication during final surgical count. Seven Plan-Do-Study-Act (PDSA) cycles were used to test, refine, and implement the protocol. Adherence to the final surgical count protocol was monitored throughout the study period.

Results:
In 2021, prior to protocol implementation, average time between RFO events was 29 days. After implementation of our quality initiative, the final surgical count protocol, we improved to 451 days between RFO events by February 2023, exceeding the upper control limit (235 days). Following implementation, the number of RFO events dropped from 7 in 2021 to 0 in 2022. Adherence to the final surgical count protocol implementation was 96.4% by the end of cycle 7.

Conclusions:
Retained foreign objects (RFOs) during pediatric surgical procedures can be successfully reduced using quality improvement methodology focusing on standardizing the procedure of the final surgical count.
A Convection-Free Apparatus for Low Force and High Efficiency Centrifugation
Authors: Yang Teng-Chieh 
Published: August 2023

ABSTRACTCentrifugation is a common technique for material separation. Most biological materials are separated under a relatively strong centrifugal force. Despite several reports highlighted the impact from centrifugal force on the separated materials, low force centrifugation typically results in low efficiency of separation and may not be achievable from the traditional centrifugation apparatus. Here, we present a novel apparatus for separating materials under low centrifugal force with high efficiency. Compare to the traditional apparatus, the design of this apparatus minimizes the convection during centrifugation. Using homogeneous polystyrene particles, we confirmed that the centrifugation process is essentially convection-free. Separation of human blood cells indicated that, under a fixed centrifugal force, less than half of the centrifugation time is required compared to the traditional apparatus. The isolated human peripheral blood mononuclear cells have higher viability and can afford multiple centrifugations without impacting cell viability. Additionally, this new apparatus has a higher resolution to separate materials by size and is sensitive to detect size heterogeneity. This apparatus provides a new opportunity for efficient centrifugation under low centrifugal force and for a systematic evaluation of the impact from centrifugal force on the quality of separated materials.
“When a man drinks alcohol it’s cool but when a woman drinks she is a hoe”: A Qualitative Exploration of Alcohol, Gender, Stigma, and Sexual Assault in Moshi, Tanzania
Authors: Pauley Alena , Metcalf Madeline , Buono Mia , Rent Sharla , Mikindo Mariana , Sawe Yvonne , Kilasara Joseph ,   APRN MNS-FNP, Boshe Judith , Staton Catherine A. , Mmbaga Blandina T. 
Published: August 2023

AbstractBackgroundAlcohol’s ever-increasing global use poses a distinct threat to human well-being, with intake and associated burdens rising especially quickly in low- and middle-income countries like Tanzania. Prior research has shown alcohol use and related consequences differ by gender in Moshi, Tanzania, with important implications for both clinical care and future alcohol-reduction interventions. This study builds upon this knowledge by providing a deeper understanding of how gender differences affect alcohol-related stigma and sexual assault among Emergency Department (ED) and Reproductive Health Center (RHC) patients at Kilimanjaro Christian Medical Center (KCMC) in Moshi.MethodsIn-depth interviews (IDIs) were conducted among ED and RHC KCMC patients (n = 19) selected for participation via purposive sampling. A mix of inductive and deductive coding schemes was used to identify themes and subthemes. All data were analyzed through a grounded theory approach.ResultsGender roles that linked men with financial responsibilities and women with child caretaking led to different expectations on alcohol intake, with alcohol use normalized for men but vilified for women. Women who drank, for example, were deemed poor mothers and undesirable spouses. Patients likewise emphasized that both alcohol-related stigma and sexual violence disproportionately impacted women, the latter fueled through alcohol use, with serious and lasting acts of discrimination and isolation from community members seen among women alcohol users but not for men.ConclusionWomen alcohol users in Moshi are subject to severe social consequences, facing disproportionate stigma and sexual violence as compared to men. Alcohol-related treatment for women should be mindful of the disproportionate burdens present in this context and incorporate strategies to address and/or mitigate these harms in subsequent care and interventions.
Protocol for a scoping review of literature on digital sexual, reproductive, and gender health care for LGBTQI+ youth
Authors: McLeod Julie , Flowers Paul , Gibbs Jo , Estcourt Claudia S. , MacDonald Jennifer 
Published: August 2023

AbstractIntroductionLesbian, gay, bisexual, trans, queer, questioning, and other sexual and gender minority (LGBTQI+) youth are diverse populations who experience poor sexual health outcomes (e.g., high rates of sexually transmitted infections (STIs) and human immunodeficiency virus (HIV), unplanned pregnancy, and sexual violence) and multiple barriers to sexual and reproductive health care (SRHC) and gender health care (GHC). In high-income, developed countries, barriers include confidentiality concerns; stigma and discrimination; and health care providers’ lack of specific training. Digital SRHC and GHC have the potential to overcome key barriers for LGBTQI+ youth by offering anonymous and independent access to care. However, the literature on digital SRHC and GHC for LGBTQI+ youth is fragmented, often focussing on one sub-population at a time, despite shared barriers. The extent and nature of recent literature regarding digital SRHC and GHC for LGBTQI+ youth is unclear, as is acceptability of, and barriers/facilitators to, LGBTQI+ youth engaging with digital SRHC and GHC.ObjectiveTo identify, describe, and evaluate the methodological quality of, the existing literature on digital SRHC and GHC for LGBTQI+ youth in high-income, developed countries, synthesise study findings, and make recommendations for future research.Inclusion criteriaResearch studies from 2018 onward in published and grey literature on any aspect of digital (e.g., websites, mobile applications) SRHC and GHC (e.g., online information, support and advice, and clinical care for STIs and HIV, fertility, sexual violence, sexual wellbeing, and gender expression and transition) for LGBTQI+ youth (aged 10-35 years) in high-income, developed countries.MethodThis study will follow the Joanna-Briggs Institute (JBI) methodology for scoping reviews. The databases to be searched include APA PsycInfo (ProQuest); APA PsycArticles (ProQuest); CINAHL Complete (EBSCO); MEDLINE (EBSCO); ERIC (EBSCO); British Education Index (EBSCO); Education Database (ProQuest); Computer Science Database (ProQuest); and Web of Science. Grey literature will be identified using Google Scholar. Studies will be screened against and selected for inclusion in line with the eligibility criteria. Key data from included studies will be extracted to a structured spreadsheet, adapted from the JBI extraction tool, then synthesised qualitatively using the JBI meta-aggregative approach for a systematic narrative account, accompanied by tables as appropriate.
Impact of treatment of varicose veins with polidocanol foam compared to conventional surgery on quality of life
Authors: Sakugawa Lissa Severo , Portela Felipe Soares Oliveira , Louzada Andressa Cristina Sposato , Portugal Maria Fernanda Cassino , Teivelis Marcelo Passos , Mendes Cynthia de Almeida , Fioranelli Alexandre , Wolosker Nelson 
Published: August 2023

ABSTRACTBackground and objectiveLower limb varicose veins are very prevalent and there are several treatment options available, including conventional surgery and polidocanol foam sclerotherapy. Few studies analyze therapeutic modalities based on PROMs (patient-reported outcome measures). The aim of this study was to evaluate the impact of treatment with polidocanol foam sclerotherapy compared to conventional surgery in a large sample, based on an analysis of PROMs.MethodsThis was a prospective, observational, and qualitative study of 205 patients who underwent varicose vein treatment with polidocanol foam sclerotherapy (57 patients - 90 legs) or conventional surgery (148 patients - 236 legs). Patients were assessed preoperatively and 30 days after the procedure using venous disease severity scores (VCSS) and specific venous disease quality of life questionnaires (VEINES-QoL/Sym).ResultsBoth treatments promoted a significant improvement in VCSS and VEINES 30 days after the procedure (p < 0.05). However, surgery promoted a greater improvement in VCSS (on average 4.02 points difference, p < 0.001), VEINES-QoL (8 points difference, p < 0.001) and VEINES-Sym (on average 11.66 points better, p < 0.001) compared to sclerotherapy. Post-operative pain and aesthetic concern about the legs were the domains of the questionnaires that had the greatest impact on this difference between the two types of treatment, generating worse results with sclerotherapy.ConclusionPolidocanol foam sclerotherapy and conventional surgery have a positive impact on quality of life after 30 days, but there is a more significant improvement in patients undergoing conventional surgery.
Early Hyperoxaemia and 2-year Outcomes in Infants with Hypoxic-ischemic Encephalopathy- a Secondary Analysis of the Infant Cooling Evaluation (ICE) trial
Authors: Badurdeen Shiraz , Cheong Jeanie L Y , Donath Susan , Graham Hamish , Hooper Stuart B , Polglase Graeme R , Jacobs Sue , Davis Peter G 
Published: August 2023

AbstractObjective(s)To determine the causal relationship between exposure to early hyperoxaemia and death/disability in infants with hypoxic-ischemic encephalopathy (HIE).Study designWe analyzed data from the Infant Cooling Evaluation (ICE) trial that enrolled newborns ≥35 weeks’ gestation with moderate-severe HIE, randomly allocated to hypothermia or normothermia. The primary outcome was death or major sensorineural disability at 2 years. We included infants with arterial pO2measured within 2 h of birth. Using a directed acyclic graph, we established that markers of severity of perinatal hypoxia-ischemia and pCO2were a minimally sufficient set of variables for adjustment in a regression model to estimate the causal relationship between arterial pO2and death/disability.ResultsAmong 221 infants, 116 (56%) had arterial pO2and primary outcome data. The unadjusted analysis revealed a U-shaped relationship between arterial pO2and death/disability. Among hyperoxaemic infants (pO2100–500 mmHg) the risk of death/disability was 40/58 (0.69), while the risk in normoxaemic infants (pO240 – 99mmHg) was 20/48 (0.42). In the adjusted model, hyperoxaemia increased the risk of death/disability (adjusted risk ratio 1.61, 95% CI 1.07 – 2.00, p= 0.03) in relation to normoxaemia.ConclusionsEarly hyperoxaemia increased the risk of death/disability among infants who had an early arterial pO2in the ICE trial. Limitations include the possibility of residual confounding and other causal biases. Further work is warranted to confirm this relationship in the era of routine therapeutic hypothermia.
Patient Phenotyping for Atopic Dermatitis with Transformers and Machine Learning
Authors: Wang Andrew , Fulton Rachel , Hwang Sy , Margolis David J. , Mowery Danielle L. 
Published: August 2023

AbstractBackgroundAtopic dermatitis (AD) is a chronic skin condition that millions of people around the world live with each day. Performing research studies into identifying the causes and treatment for this disease has great potential to provide benefit for these individuals. However, AD clinical trial recruitment is a non-trivial task due to variance in diagnostic precision and phenotypic definitions leveraged by different clinicians as well as time spent finding, recruiting, and enrolling patients by clinicians to become study subjects. Thus, there is a need for automatic and effective patient phenotyping for cohort recruitment.ObjectiveOur study aims to present an approach for identifying patients whose electronic health records suggest that they may have AD.MethodsWe created a vectorized representation of each patient and trained various supervised machine learning methods to classify when a patient has AD. Each patient is represented by a vector of either probabilities or binary values where each value indicates whether they meet a different criteria for AD diagnosis. Results: The most accurate AD classifier performed with a class-balanced accuracy of 0.8036, a precision of 0.8400, and a recall of 0.7500 when using XGBoost (Extreme Gradient Boosting).ConclusionsCreating an automated approach for identifying patient cohorts has the potential to accelerate, standardize, and automate the process of patient recruitment for AD studies; therefore, reducing clinician burden and informing knowledge discovery of better treatment options for AD.
Clinical, Echocardiographic, and Longitudinal Characteristics Associated with Heart Failure with Improved Ejection Fraction
Authors: Romero Erick , Baltodano Alexander Francois , Rocha Paulo , Sellers-Porter Camryn , Patel Dev Jaydeep , Soroya Saad , Bidwell Julie , Ebong Imo , Gibson Michael , Liem David A. , Jimenez Shirin , Bang Heejung , Sirish Padmini , Chiamvimonvat Nipavan , Lopez Javier E. , Cadeiras Martin 
Published: August 2023

AbstractBackgroundHeart failure (HF) with improved ejection fraction (HFimpEF) has better outcomes than HF with reduced ejection fraction (HFrEF). However, factors contributing to HFimpEF remain unclear. This study aimed to evaluate clinical and longitudinal characteristics associated with subsequent HFimpEF.MethodsThis was a single-center retrospective HFrEF cohort study. Data were collected from 2014 to 2022. Patients with HFrEF were identified using ICD codes, echocardiographic data, and natriuretic peptide levels. The main endpoints were HFimpEF (defined as ejection fraction >40% at ≥3 months with ≥10% increase) and mortality. Cox proportional hazards and mixed effects models were used for analyses.ResultsThe study included 1307 HFrEF patients with a median follow-up of 16.3 months (IQR 8.0-30.6). The median age was 65 years; 68% were male while 57% were white. On follow-up, 39% (n=506) developed HFimpEF, while 61% (n=801) had persistent HFrEF. A multivariate Cox regression model identified sex, race comorbidities, echocardiographic, and natriuretic peptide as significant covariates of HFimpEF (p<0.05). The HFimpEF group had better survival compared to the persistent HFrEF group (p<0.001). Echocardiographic and laboratory trajectories differed between groups.ConclusionIn this HFrEF cohort, 39% transitioned to HFimpEF and approximately 50% met the definition within the first 12 months. In a HFimpEF model, sex, comorbidities, echocardiographic parameters, and natriuretic peptide were associated with subsequent HFimpEF. The model has the potential to identify patients at risk of subsequent persistent or improved HFrEF, thus informing the design and implementation of targeted quality-of-care improvement interventions.