bluuebunny/crossref_metadata_2025_split huggingface dataset:
A framework for residents’ pursuit of excellence based upon non-cognitive and cognitive attributes
Authors: Saxena Anurag , Desanghere Loni 
Published: January 2023

AbstractPurposeExcellence, although variably conceptualized, is commonly used in medicine and the resident excellence literature is limited. Both cognitive attributes (CAs) and non-cognitive attributes (NCAs) are essential for academic and clinical performance; however, the latter are difficult to evaluate. Undergirded by an inclusive and non-competitive approach and utilizing CAs and NCAs, we propose a criterion-referenced behavioral framework of resident excellence.MethodsPerceptions of multiple stakeholders (educational administrators, faculty, and residents), gathered by survey (n = 218), document analysis (n = 52), and focus group (n = 23), were analyzed. Inductive thematic analysis was followed by deductive interpretation and categorization using sensitizing concepts for excellence, NCAs, and CAs. Chi-squared tests were used to determine stakeholder perception differences.ResultsAll stakeholders had similar perceptions (P &gt; .05) and 13 behavioral attributes in 6 themes undergirded by insight and conscientiousness were identified. The NCAs included: interpersonal skills (works with others, available, humble), professional (compassionate, trustworthy), commitment to profession (visible, volunteers), commitment to learn (proactively seeks feedback, creates learning opportunities), and work–life balance/integration (calm demeanor, inspirational). The CA (medical knowledge and intellect) included: applies knowledge to gain expertise and improves program’s caliber.ConclusionResident excellence is posited as a pursuit. The attributes are non-competitive, inclusionary, potentially achievable by all, and do not negatively affect freedom of choice. However, contextual and cultural differences are likely and these need validation across societal equity segments. There are implications for learners (adaptive reflection and learning goal orientation), faculty (reduced bias and whole-person feedback), and system leaders (enhancing culture and learning environments) to foster excellence.
Emergency department claims among Medicare beneficiaries with HIV, STDs, viral hepatitis or tuberculosis before and during the COVID-19 pandemic
Authors: Chang Man-Huei , Moonesinghe Ramal , Truman Benedict I 
Published: January 2023

Abstract

Background
Changes in emergency department (ED) usage among US Medicare beneficiaries (MB) with fee-for-service claims for HIV, viral hepatitis, sexually transmitted diseases (STDs) or tuberculosis (TB) (HHST) services have not been assessed since the COVID-19 pandemic.

Methods
During 2006–20, we assessed the annual number of MB with each HHST per 1000 persons with ED claims for all conditions, and changes in demographic and geographic distribution of ED claimants for each HHST condition.

Results
Of all persons who attended an ED for any condition, 10.5 million (27.5%) were MB with ≥1 ED claim in 2006; that number (percentage) increased to 11.0 million (26.7%) in 2019 and decreased to 9.2 million (22.7%) in 2020; &lt; 5 MB per 1000 ED population had HHST ED claims in 2020. The percentage increase in ED claims was higher for MB with STDs than for those with other HHST conditions, including a 10% decrease for MB with TB in 2020.

Conclusions
Trends in ED usage for HHST conditions were associated with changes in demographic and geographic distribution among MB during 2006–20. Updated ED reimbursement policies and primary care practices among MB might improve prevention, diagnosis and treatment of HHST conditions in the future.
The role of small GTPases in bisphenol AF-induced multinucleation in comparison with dibutyl phthalate in the male germ cells
Authors: Hu Chelin , Hsiao Zoey Hsuan , Yin Lei , Yu Xiaozhong 
Published: January 2023

AbstractThe goal of this study is to examine bisphenol AF (BPAF)-induced multinucleation (MNC) in comparison with dibutyl phthalate (DBP), known to induce MNC in mouse gonocytes in vivo. We performed image-based single-cell high content analysis (HCA) in the mouse spermatogonia C18-4 cells treated with various concentrations of BPAF and DBP. BPAF as low as 5 µM was cytotoxic and resulted in 40% cell death of the C18-4 cells after 72 h. HCA revealed that 5 µM of BPAF significantly increased the number of MNC by an average of 3.6-fold. DBP did not induce MNC in the doses we tested. Cytokinesis is tightly regulated by various small GTPase-signaling pathways. We, therefore, tested 5 selective GTPase inhibitors and found that Y27632, a ROCK inhibitor, reduced the BPAF-induced MNC by nearly 30%. Inhibition of Cdc42 by ML141 conversely increased the number of BPAF-induced MNC. We performed a hierarchical cluster analysis of the HCA data and demonstrated that the cytoskeletal disruption by BPAF was reversely modified by Y27632. We found that mRNA expression of genes regulating Rho and Rac GTPase activities, p190RhoGap and MgcRacGap, was altered in BPAF-treated C18-4 cells in a time-dependent manner. Multinucleated gonocytes are often indicators of disease pathologies. Our results provided the first evidence of mechanisms of the dual toxicity by BPAF to male germ cells, which induces chromosome endoreplication without the coordinated cytokinetic cellular components. The unique genotoxic mechanism of forming multinucleated germ cells suggests a novel mode of action in the male repro-toxicity concern over the increasingly ubiquitous presence of BPA analogs.
Next-generation PFAS 6:2 fluorotelomer sulfonate reduces plaque formation in exposed white-footed mice
Authors: Bohannon Meredith E , Narizzano Allison M , Guigni Blas A , East Andrew G , Quinn Michael J 
Published: January 2023

Abstract6:2 fluorotelomer sulfonate (6:2 FTS) has been used as a replacement for legacy per- and polyfluoroalkyl substances (PFAS). We assessed reproductive and developmental effects in a human-wildlife hybrid animal model based on the association of adverse effects linked to legacy PFAS with these sensitive life stages. In this study, white-footed mice were exposed orally to 0, 0.2, 1, 5, or 25 mg/kg-day 6:2 FTS for 112 days (4 weeks premating exposure plus at least 4 weeks mating exposure). Pregnancy and fertility indices were calculated, and litter production, total litter size, live litter size, stillbirths, litter loss, average pup weight, and pinna unfolding were assessed. Sex steroid and thyroid hormone serum levels were assessed. Body weight, histopathology, and immune function were also assessed in this study. Reproductive endpoints were not significantly altered in response to 6:2 FTS. Spleen weight increased in male mice dosed with 6:2 FTS. Immune function determined via a plaque-forming cell (PFC) assay was decreased in both male and female mice in the 2 highest doses. A low benchmark dose was calculated based on PFCs as the critical effect and was found to be 2.63 and 2.26 mg/kg-day 6:2 FTS in male and female mice, respectively. This study characterizes 6:2 FTS as being potentially immunotoxic with little evidence of effect on reproduction and development; furthermore, it models acceptable levels of exposure. These 2 pieces of information together will aid regulators in setting environmental exposure limits for this PFAS currently thought to be less toxic than other PFAS.
A new recommendation for febrile urinary tract infection in children aged 2–24 months: Tepecik UTI Guideline-2
Authors: Koyun Cezayir Begüm , Yavascan Önder , Alaygut Demet , Demir Belde Kasap , Mutlubas Fatma , Arslansoyu Camlar Secil , Alparslan Caner , Soyaltin Eren , Ozgur Su 
Published: January 2023

Abstract

Aim
Urinary tract infections (UTIs) represent a common febrile illness in infancy. The study compared two UTI guidelines in terms of number of imaging studies, presence of parenchymal damage and radiation exposure in patients with the first febrile UTI between 2 and 24 months of age.

Method
The results of Tepecik UTI Guideline-1 used until 2012 (Group 1, n = 105) were retrospectively compared with Tepecik UTI Guideline-2 (Group 2) used after 2013. In Group 1, urinary tract ultrasonography (US), dimercaptosuccinic acid (DMSA) and voiding cystourethrography (VCUG) were made in all patients. In Group 2, if the US result was abnormal, patients were evaluated with VCUG and DMSA. If the US was normal, only DMSA was performed. If the DMSA was abnormal, the VCUG was undergone (n: 43, 40.9%).

Results
The abnormal VCUG detection rate was 69.2% in Group 1 and 30.8% in Group 2 (p = 0.09). Sensitivity and specificity of US in the diagnosis of vesicoureteral reflux (VUR) was 15.9% and 96.7% in Group 1 and 61.5% and 70.5% in Group 2, respectively. Abnormal DMSA findings were observed among 33.3% (Groups 1) and 66.7% (Groups 2) subjects, respectively (p &gt; 0.05). The median radiation exposure (500 mrem) of patients in Group 1 was statistically significantly higher than those in Group 2 (200 mrem) (p &lt; 0.001).

Conclusion
The VCUG should not be the first examination to be considered in such patients. We think that Tepecik UTI Guideline-2 reduces unnecessary invasive procedure and radiation exposure and not missed VUR in the management of children with UTI at 2–24 months. Needs prospective follow-up studies before considering this recommendation.
The right antibiotic for the right neonate? A prospective observational cohort study at a district hospital in Pemba, Tanzania
Authors: Larsen Lærke Vinge , Lassen Mathilde Languille , Lund Stine , Nygaard Ulrikka , Bech Christine Manich , Mzee Said , Ali Said Mouhammed , Poulsen Anja 
Published: January 2023

Abstract

Background
The highest neonatal mortality is in Sub-Saharan Africa, where neonatal sepsis accounts for approximately 50%. At Pemba Island, Tanzania, we examined the use of prophylactic antibiotics in neonates and related it to WHO guidelines and compared clinical signs of infection with the use of antibiotic treatment; furthermore, we aimed to investigate all use of antibiotic treatment in the neonatal period.

Method
This prospective observational cohort study was performed from 1 January 2022 to 15 April 2022 at a district hospital on Pemba Island, Tanzania. Women admitted in early established or active labour, and their neonates, were eligible for inclusion. We used questionnaires for mother and health worker and examined the neonates 2 h after birth. Follow-up was made at discharge or at 18 h of life, and days 7 and 28.

Results
We included 209 women and their 214 neonates. The neonatal mortality was 5 of 214 (23 per 1000 live births). According to WHO guidelines 29 (13.6%) had ≥ 1 risk factor for infection. Of these, three (10.3%) received prophylactic antibiotic treatment; only one (3.4%) received the correct antibiotic drug recommended in guidelines. Thirty-nine (18.2%) neonates had ≥ 1 clinical indicator of infection and 19 (48.7%) of these received antibiotic treatment. A total of 30 (14.0%) neonates received antibiotics during the study period. Twenty-three (76.7%) were treated with peroral antibiotics.

Conclusion
Adherence to WHO guidelines for prophylactic antibiotic treatment to prevent neonatal infection was low. Further, only half of neonates with clinical signs of infection received antibiotics.
Systemic C‐peptide supplementation ameliorates retinal neurodegeneration by inhibiting VEGF‐induced pathological events in diabetes
Authors: Lee Ah‐Jun , Moon Chan‐Hee , Lee Yeon‐Ju , Jeon Hye‐Yoon , Park Won Sun , Ha Kwon‐Soo 
Published: January 2023

AbstractDiabetic retinopathy (DR) is caused by retinal vascular dysfunction and neurodegeneration. Intraocular delivery of C‐peptide has been shown to be beneficial against hyperglycemia‐induced microvascular leakage in the retina of diabetes; however, the effect of C‐peptide on diabetes‐induced retinal neurodegeneration remains unknown. Moreover, extraocular C‐peptide replacement therapy against DR to avoid various adverse effects caused by intravitreal injections has not been studied. Here, we demonstrate that systemic C‐peptide supplementation using osmotic pumps or biopolymer‐conjugated C‐peptide hydrogels ameliorates neurodegeneration by inhibiting vascular endothelial growth factor‐induced pathological events, but not hyperglycemia‐induced vascular endothelial growth factor expression, in the retinas of diabetic mice. C‐peptide inhibited hyperglycemia‐induced activation of macroglial and microglial cells, downregulation of glutamate aspartate transporter 1 expression, neuronal apoptosis, and histopathological changes by a mechanism involving reactive oxygen species generation in the retinas of diabetic mice, but transglutaminase 2, which is involved in retinal vascular leakage, is not associated with these pathological events. Overall, our findings suggest that systemic C‐peptide supplementation alleviates hyperglycemia‐induced retinal neurodegeneration by inhibiting a pathological mechanism, involving reactive oxygen species, but not transglutaminase 2, in diabetes.
Use of Nasal Swab Activity to Estimate Intake in Internal Dosimetry
Authors: Miller Guthrie , Dumit Sara , Poudel Deepesh , Klumpp John 
Published: January 2023

Abstract
In addition to a review of theoretical analyses, this work presents an empirical study of nasal swab data from the Los Alamos National Laboratory (LANL) database correlated with intake obtained from plutonium internal dosimetry calculations. As a result of this work, several “intake-versus-nasal-swab” models were derived. We advocate quantitative use of nasal swab measurements in dose assessment calculations and discuss ways that this can be done. The best description of the LANL plutonium internal dose database is arguably intake = A + Bx, where A = 2.7 Bq, B = 3.8, and x = summed nasal swab activity. The geometric standard deviation was found to be 8.2. This relationship, obtained using plutonium data, should apply also for other radionuclides.
Development of a structured musculoskeletal and rheumatic disease continuing education program for nurse practitioners
Authors: Kellahan Sara , Burnitt Lisa , Eisen Seth , Curtis Mary P. , Parks Deborah 
Published: January 2023

ABSTRACT
The workforce shortage of musculoskeletal and rheumatic disease (MSK-RMD) trained providers has led to the need for additional education for nurse practitioners (NPs) in MSK-RMD. An educational certificate was developed and implemented collaboratively between an academic medical center and a college of nursing. The NP-focused MSK-RMD education program enhanced the assessment and treatment of a variety of common RSK-RMD conditions. Interviews and online surveys were conducted with participants to evaluate the program experience. Participant interviews and survey findings demonstrate overall NP satisfaction with the program. Expanding the program to create an accessible virtual continuing education course may improve accessibility of MSK-RMD education for NPs in primary care and multidisciplinary environments.
Patient-Related Factors Do Not Predict Use of Computer-Based Auditory Training by New Adult Cochlear Implant Recipients
Authors: Dornhoffer James R. , Kinkhabwala Corin M. , Chidarala Shreya , Ma Cheng , Schvartz-Leyzac Kara C. , Meyer Ted A. , Sterba Katherine R. , Dubno Judy R. , McRackan Theodore R. 
Published: January 2023

Objective
The use of computer-based auditory training (CBAT) after cochlear implantation is associated with improved speech recognition and real-world functional abilities. However, patient-related factors associated with CBAT use remain unknown. This study seeks to identify such factors and recognize those at risk for not implementing CBAT.

Study Design
Prospective natural experiment.

Setting
Tertiary academic center.

Patients
A total of 117 new adult cochlear implant (CI) recipients with bilateral moderate-to-profound hearing loss.

Interventions/Main Outcome Measures
Patient demographic and lifestyle information, preimplantation aided speech recognition scores, Cochlear Implant Quality of Life (CIQOL) domain and global scores, CIQOL-Expectations scores, and CBAT use in the first 3 months after activation. Patient-related variables included age, sex, race, duration of hearing loss before implantation, hours of CI use per day, hearing-aid use before implantation, living arrangements/marital status, annual household income, employment, technology use, and education.

Results
Overall, 33 new CI users (28.2%) used CBAT in the first 3 months after activation. On bivariate analysis of the pre-CI CIQOL scores, CIQOL-Expectations score, aided speech recognition scores, and demographic/lifestyle factors examined, regular use of smartphone, tablet, or computer technology was significantly associated with an increased likelihood of CBAT use (odds ratio, 9.354 [1.198-73.020]), whereas higher CIQOL-Expectations emotional domain scores were associated with a lower likelihood of CBAT use (d = −0.69 [−1.34 to −0.05]). However, using multivariable analysis to control for potential confounding factors revealed no significant associations between CBAT use in the first 3 months after cochlear implantation and any examined factor.

Conclusions
No associations between patient demographic, lifestyle, or pre-CI speech recognition and patient-reported outcome measures and CBAT use were identified. Therefore, discussions with all patients after implantation on the availability of CBAT and its potential benefits are warranted. In addition, given the limited overall use of CBAT and its association with improved CI outcomes, future studies are needed to investigate facilitators and barriers to CBAT use.
Pipeline for Automated Processing of Clinical Cone-Beam Computed Tomography for Patient-Specific Temporal Bone Simulation: Validation and Clinical Feasibility
Authors: Andersen Steven Arild Wuyts , Hittle Brad , Keith Jason P. , Powell Kimerly A. , Wiet Gregory J. 
Published: January 2023

Objective
Patient-specific simulation allows the surgeon to plan and rehearse the surgical approach ahead of time. Preoperative clinical imaging for this purpose requires time-consuming manual processing and segmentation of landmarks such as the facial nerve. We aimed to evaluate an automated pipeline with minimal manual interaction for processing clinical cone-beam computed tomography (CBCT) temporal bone imaging for patient-specific virtual reality (VR) simulation.

Study Design
Prospective image processing of retrospective imaging series.

Setting
Academic hospital.

Methods
Eleven CBCTs were selected based on quality and used for validation of the processing pipeline. A larger naturalistic sample of 36 CBCTs were obtained to explore parameters for successful processing and feasibility for patient-specific VR simulation.
Visual inspection and quantitative metrics were used to validate the accuracy of automated segmentation compared with manual segmentation. Range of acceptable rotational offsets and translation point selection variability were determined. Finally, feasibility in relation to image acquisition quality, processing time, and suitability for VR simulation was evaluated.

Results
The performance of automated segmentation was acceptable compared with manual segmentation as reflected in the quantitative metrics. Total time for processing for new data sets was on average 8.3 minutes per data set; of this, it was less than 30 seconds for manual steps. Two of the 36 data sets failed because of extreme rotational offset, but overall the registration routine was robust to rotation and manual selection of a translational reference point. Another seven data sets had successful automated segmentation but insufficient suitability for VR simulation.

Conclusion
Automated processing of CBCT imaging has potential for preoperative VR simulation but requires further refinement.
Labyrinthine Fluid Signal Intensity on T2-Weighted MR Imaging in Patients With Vestibular Schwannomas Undergoing Proton Radiotherapy: A Longitudinal Assessment
Authors: Koetsier Kimberley S. , Mehan William A. , Buch Karen , Welling D. Bradley , van Benthem Peter Paul G. , Hensen Erik F. , Shih Helen A. 
Published: January 2023

Objective
In vestibular schwannoma patients, a loss of signal intensity (SI) on T2-weighted magnetic resonance imaging (MRI) has been reported within the ipsilateral labyrinth. The purpose of this study was to quantitatively evaluate the occurrence and course of this intensity loss in relation to proton radiotherapy and its possible association with hearing loss.

Study Design
Retrospective chart review.

Setting
Tertiary referral center.

Patients
Patients who received proton therapy for a vestibular schwannoma and underwent at least two high-resolution T2-weighted cisternographic sequence (constructive interference in steady state/fast imaging employing steady-state acquisition/DRIVE) MRIs and audiometry assessments.

Main Outcome Measures
Relative T2 SIs from the vestibules and basal/apical cochlear turns of the labyrinth, bilaterally.

Results
Ninety-five MRI scans from 34 patients were included. The apical turn of the ipsilateral cochlea showed a lower mean cochlear SI than on the contralateral side (±3.5 versus 5.0). The mean relative cochlear SI did not significantly change after proton radiotherapy. The ipsilateral vestibule showed a higher SI than the cochlea. The relative mean cochlear SI was not directly correlated to (the degree of) hearing loss before or after proton radiotherapy, nor did it predict future hearing loss.

Conclusion
The relative mean cochlear SI on cisternographic T2-MRI in vestibular schwannoma patients is diminished on the treated side, when compared with the ipsilateral vestibule and the contralateral cochlea/vestibule. The SI of the ipsilateral cochlea does not further decrease after proton radiotherapy and seems to be related to the tumor rather than the therapy. The diminished cochlear SI does not correlate with subsequent loss of hearing.
Predictive Ability of First-Side Cochlear Implant Performance in Adult Sequential Bilateral Cochlear Implantation
Authors: Quimby Alexandra E. , Wen Christopher Z. , Bigelow Douglas C. , Ruckenstein Michael J. , Brant Jason A. 
Published: January 2023

Objective
Predictors of second-side cochlear implant performance have not been well studied. We sought to assess whether speech recognition scores from first-side cochlear implant (CI1) could predict second-side cochlear implant (CI2) scores in sequential bilaterally implanted adults.

Study Design
Retrospective review using a prospectively collected database.

Setting
Academic tertiary care hospital.

Patients
Fifty-seven adults with postimplantation speech recognition testing performed at least 12 months after CI2.

Intervention
Sequential bilateral CI.

Main Outcome Measures
CI2 performance at ≥12 months as measured using consonant–nucleus–consonant (CNC) words and AzBio sentences in quiet and +10 dB signal-to-noise ratio (S/N).

Results
CI1 performance scores at ≥12 months were independently associated with CI2 performance scores at ≥12 months for CNC words (β = 0.371 [0.136–0.606], p = 0.003), AzBio sentences in quiet (β = 0.614 [0.429–0.80], p < 0.0001), and AzBio +10 dB S/N (β = 0.712 [0.459–0.964], p < 0.0001). CI1 scores on AzBio in quiet at 0 to 6 months were also independently associated with CI2 AzBio in quiet scores at ≥12 months (β = 0.389 [0.004–0.774], p = 0.048). Hearing loss etiology and duration, age at implantation, interval between CI1 and CI2, duration of hearing aid use, and preimplantation speech recognition testing scores were not consistently associated with CI2 scores at ≥12 months.

Conclusions
CI1 performance is an independent predictor of second-side performance as measured ≥12 months postimplantation. This may be a clinically useful metric when considering adult sequential bilateral implantation.