bluuebunny/crossref_metadata_2025_split huggingface dataset:
Are Chest Radiographs or Ultrasound More Accurate in Predicting a Pneumothorax or Need for a Thoracostomy Tube in Trauma Patients?
Authors: DeLoach Joseph P. , Reif Rebecca J. , Smedley Westin A. , Klutts Garrett N. , Bhavaraju Avi , Collins Terry H. , Kalkwarf Kyle J. 
Published: May 2023

Background Historically, chest radiographs (CXR) have been used to quickly diagnose pneumothorax (PTX) and hemothorax in trauma patients. Over the last 2 decades, chest ultrasound (CUS) as part of Extended Focused Assessment with Sonography in Trauma (eFAST) has also become accepted as a modality for the early diagnosis of PTX in trauma patients. Methods We queried our institution’s trauma databases for all trauma team activations from 2021 for patients with eFAST results. Demographics, injury variables, and the following were collected: initial eFAST CUS, CXR, computed tomography (CT) scan, and thoracostomy tube procedure notes. We then compared PTX detection rates on initial CXR and CUS to those on thoracic CT scans. Results 580 patients were included in the analysis after excluding patients without a chest CT scan within 2 hours of arrival. Extended Focused Assessment with Sonography in Trauma was 68.4% sensitive and 87.5% specific for detecting a moderate-to-large PTX on chest CT, while CXR was 23.5% sensitive and 86.3% specific. Extended Focused Assessment with Sonography in Trauma was 69.8% sensitive for predicting the need for tube thoracostomy, while CXR was 40.0% sensitive. Discussion At our institution, eFAST CUS was superior to CXR for diagnosing the presence of a PTX and predicting the need for a thoracostomy tube. However, neither test is accurate enough to diagnose a PTX nor predict if the patient will require a thoracostomy tube. Based on the specificity of both tests, a negative CXR or eFAST means there is a high probability that the patient does not have a PTX and will not need a chest tube.
Acute Outcomes of Cardiac Operations in Patients With Autoimmune Disorders: A National Analysis
Authors: Sakowitz Sara , Bakhtiyar Syed Shahyan , Kim Shineui , Ali Konmal , Verma Arjun , Chervu Nikhil , Sanaiha Yas , Benharash Peyman 
Published: May 2023

Background Accelerated atherosclerosis, inflammation, and valve pathology are known complications of autoimmune connective tissue diseases (AID). However, outcomes of coronary artery bypass graft surgery (CABG) or valve operations among these patients remain underexamined. Methods All adult hospitalizations for elective CABG or valve procedures were identified from the 2010-2019 Nationwide Readmissions Database. Autoimmune connective tissue disease was defined to include systemic lupus erythematosus (SLE), antiphospholipid syndrome (APLS), polymyalgia rheumatica (PMR), and other autoimmune AIDs. Entropy balancing was applied to generate balanced patient cohorts. Multivariable regression models were constructed to assess the independent associations between AID and outcomes of interest. Results Of ∼1 652 573 patients, 21 019 (1.3%) had AID (23.7% SLE, 17.2% APLS, 29.5% PMR, and 29.6% other). Autoimmune connective tissue disease patients were more frequently female (60.8 vs 33.1%, P < .001) and insured by Medicare (71.4 vs 62.2%, P < .001) and presented with a higher comorbidity index (5.2 ± 1.8 vs 4.1 ± 1.8, P < .001). Further, AID less frequently underwent isolated CABG (39.0 vs 52.3%) but more commonly isolated valve operations (41.9% vs 31.0%, P < .001), relative to non-AID. Following risk-adjustment, AID was not linked with increased odds of mortality or cardiac complications. However, AID was linked with a greater risk of thrombotic complications, blood transfusion, and non-elective readmission within 30 days, as well as a +$900 decrement in hospitalization costs. Discussion Autoimmune connective tissue disease patients demonstrated acceptable outcomes following CABG and valve procedures. However, novel prophylactic care pathways should be developed and instituted to address greater thrombotic and blood transfusion risk. Further investigation is needed to identify factors contributing to greater non-elective readmissions among these patients.
Effect of Maxillary Sinus Pneumatization on the Ease of Access to Prelacrimal Recess
Authors: Son Sang-Jun , Koo Hyung-Bon , Lee Jae-Hoon 
Published: May 2023

Objective: Prelacrimal recess approach can be used to access lesions of the anterior wall of the maxillary sinus (MS). Moreover, the longer the prelacrimal recess window distance (PLRWD), the easier it is to access the anterior wall. This study aimed to define the correlation between maxillary sinus pneumatization (MSP) and PLRWD, a previously defined anatomic factor predictive of the ease of prelacrimal recess approach (PLRA). Methods: In total, 506 sides of 253 participants were studied. In the axial image, the PLRWD, the distance between the anterior wall of the MS and the lacrimal duct, was measured through radioanatomical analysis and classified as type I (<3 mm), type II (3-7 mm), or type III (>7 mm). On the coronal image, the distance between the nasal floor and the lower end of the MS was measured. When MSP did not reach the nasal floor, it was classified as grade I, as grade II when MSP reached the nasal floor, and grade III when the MS was pneumatized below the nasal floor. Results: Type I included 115 sides (22.7%); type II, 277 sides (54.7%); and type III, 114 sides (22.5%). Grade I was observed in 58 sides (11.5%), grade II in 38 sides (7.5%), and grade III in 410 sides (81.0%). The mean PLRWD of grade I was 2.35 ± 2.41 mm, II was 3.37 ± 2.46 mm, and III was 5.55 ± 2.54 mm, showing a significant difference ( P < .001). Post hoc analysis showed significant differences in the mean PLRWD among grades I, II, and III. Two anatomical factors, the MSP and PLRWD, were positively correlated ( r = .507, P < .001). Conclusions: This study demonstrates a correlation between the feasibility of MSP and PLRA. Both MSP and PLRWD are essential diagnostic parameters for preoperative planning and better surgical outcomes.
“Children don’t think about these things”: Qualitative research on the relationship views and experiences of former unaccompanied refugee children
Authors: Anagnostaki Lida , Zaharia Alexandra 
Published: May 2023

Αlthough unaccompanied refugee minors have sadly been and still are a part of the movements observed worldwide of hundreds of thousands of migrants fleeing persecution, violence and war, there seems to be limited research on their relationships from their viewpoint. The present study explored the relationship experiences of former unaccompanied refugee children (now older adults). During the Greek civil war (1944–1949) thousands of children between the ages of three to 14 were taken from their villages in Greece and settled as unaccompanied refugees in institutions in countries of the former Eastern Bloc. The research sought to gain a rich understanding of their views and experiences regarding personal relationships. Nine older adults (8 men and 1 woman), who were separated from their families when they were younger than 10 years of age, were interviewed. Their narratives were analyzed using interpretative phenomenological analysis (IPA). The themes that emerged from the analysis demonstrated that attachment ties to their parents were severely affected by separation raising questions as regards the existence of attachment representations, the importance of relationships seemed generally undermined, while the role of peers was accentuated. The participants’ resilience and coping mechanisms are also discussed.
Genetic polymorphisms of pri-let-7f, gene–environment and gene–gene interactions, and associations with ischemic stroke risk in Liaoning Province
Authors: Qiu Luying , Wang Yuye , Liu Fang , Deng Shumin , He Zhiyi , Zheng Wenxu , Wang Yanzhe 
Published: May 2023

Objective The incidence of stroke has been rising annually and investigations into traditional risk factors have led to increased attention on genetic factors. In this study, we focused on the pri-let-7f gene, and investigated the association between pri-let-7f gene polymorphisms and ischemic stroke (IS). Methods This case–control study included 1803 patients and 1456 healthy controls of Han ethnicity living in Liaoning Province. We carried out genotyping analysis of two loci, pri-let-7f-1 rs10739971 and pri-let-7f-2 rs17276588, and performed statistical analysis controlling for confounding factors by logistic regression. Results The A alleles and AA genotypes of both loci were significantly associated with an increased risk of IS. Variant genotypes of rs17276588 may also increase the risk of IS in females with alcohol intake. Gene–gene interaction analysis showed combined effects of mutations in both these single nucleotide polymorphisms (SNPs). Conclusions This study demonstrated an association between pri-let-7f SNPs and IS, providing potential latent biomarkers for the risk of IS. However, more detailed studies are needed to clarify these results.
The Australian Early Psychosis Collaborative Consortium (AEPCC): Improving Clinical Care in Early Psychosis
Authors: Thompson Andrew , Fitzsimons Joanna , Killackey Eoin , Ahern Susannah , Amminger Paul , Alvarez-Jimenez Mario , Berk Michael , Cotton Sue , McNeil John , McGorry Patrick , Nelson Barnaby , O'Donoghue Brian , Ratheesh Aswin , Rickwood Debra , Yung Alison , Wood Stephen 
Published: May 2023

Objectives The field of early psychosis has undergone considerable expansion over the last few decades and has a strong evidence base of effectiveness. Like all areas of healthcare, however, early psychosis services need to more consistently deliver higher quality care to achieve better outcomes for patients and families. A national clinical research infrastructure is urgently required to enable the sector to deliver the highest quality care and expand and translate evidence more quickly and efficiently. This paper describes the establishment of the Australian Early Psychosis Collaborative Consortium (AEPCC) that aims to achieve this. Conclusion AEPCC is the first of its kind in Australia (and internationally). It will deliver the required clinical research infrastructure through the implementation of a clinical quality registry, clinical trials and translation network, and lived experience network. AEPCC will provide a critical resource to better understand the state of early psychosis care, and trial new interventions on a scale that has not previously been possible in Australia.
Expression of p16 Tumor Suppressor Protein in Malignant Ovarian Germ Cell Tumors; Immunohistochemical Study
Authors: Hosny Ghada , Ahmed Omar A , Ahmed Rania Makboul , Fadel Sabah Ahmed 
Published: May 2023

Background Malignant ovarian germ cell tumors represent small percentage of malignant ovarian neoplasms but they affect significantly young age group. Aim of the study To investigate the immunohistochemical expression of p16 tumor suppressor protein in malignant ovarian germ cell tumors. Materials and Methods Twenty-two malignant ovarian germ cell tumors (five dysgerminoma, eight immature teratoma, and nine yolk sac tumors), twenty mature cystic teratoma tumors and twenty normal ovarian tissue were immunohistochemically stained with p16 monoclonal antibody. Ki67 immunohistochemical staining was done for malignant ovarian germ cell tumors to assess proliferation. Results We found that p16 tumor suppressor protein is overexpressed in all malignant ovarian germ cell tumors in both nuclear and cytoplasmic locations compared to control and to mature cystic teratoma ( p-value <0.001). Cytoplasmic p16 expression was significantly correlated to Ki67 proliferation index in malignant ovarian germ cell tumors ( p-value = 0.033, r = 0.445). Conclusion Overexpression of p16 in malignant ovarian germ cell tumors denotes that dysfunction of the cyclin dependent kinase pathway is involved in tumorigenesis of malignant ovarian germ cell tumors.
Toxic hepatitis in metastatic breast cancer patient using ribociclib and denosumab
Authors: Bayram Doğan , Aktürk Esen Selin , Uçar Gökhan , Köş Fahriye Tuğba 
Published: May 2023

Introduction Hepatotoxicity is observed due to cyclin-dependent kinase (CDK4/6) inhibitors used to treat hormone receptor-positive metastatic breast cancer. However, it should not be ignored that denosumab may be hepatotoxic, although it is rare. Case Report A 73-year-old female patient with breast cancer with axillary lymph node, adrenal gland and bone metastases was started on ribociclib letrozole and denosumab treatment. Ribociclib treatment was discontinued due to grade 4 hepatotoxicity during treatment, but liver function tests did not decrease. After discontinuation of denosumab treatment, alanine aminotransferase and aspartate aminotransferase values regressed to baseline values. Management and Outcome Despite the discontinuation of ribociclib treatment, other causes of liver toxicity were investigated due to persistence of hepatic transaminases and elevation. Autoimmune hepatitis markers were negative. Hepatobiliary USG did not reveal any pathological findings except hepatosteatosis. Liver biopsy was performed to determine the etiology. Pathology result was compatible with acute hepatocellular damage (in favor of toxic hepatitis). A decrease in liver values was detected after discontinuation of denosumab treatment. Discussion Although cases with improvement in liver enzymes have been reported after discontinuation of ribociclib, no improvement in hepatotoxicity was observed in our case. Since the liver biopsy was toxic hepatitis, it was thought that other drugs used by the patient might cause this toxicity, and a significant decrease was observed in liver values after discontinuation of denosumab. Denosumab-induced liver toxicity is very rare, and there are only a limited number of cases in the literature.
Alterations of Spatial Memory and Gut Microbiota Composition in Alzheimer’s Disease Triple-Transgenic Mice at 3, 6, and 9 Months of Age
Authors: Wei Zhang , Li Daidi , Shi Jingshan 
Published: May 2023

Alzheimer’s disease (AD) is a progressive neurological disease. Gut microbial dysbiosis is associated with AD. This study involves the comparative assessment of spatial learning, β-amyloid peptide accumulation, and fecal microbiota alterations in 3×Tg-AD mice from 3 age groups: AD asymptomatic stage (3 m), presymptomatic stage (6 m), and the symptomatic stage of AD (9 m). We demonstrate that spatial memory deficits, brain Aβ accumulation, and weight gain in 3×Tg-AD mice gradually appear after 6 months of age. However, the total gut bacterial counts underwent changes from 3 to 6 months of age and were further altered at 9 months of age. Importantly, changes in gut bacteria abundance of Desulfobacterota and Actinobacteriota phyla in 6-month-old mice preceded apparent spatial memory deficits. In summary, Changes in the gut microbial community are one of the mechanisms of early AD pathology.
A case study of behaviour: Differences between a head coach and player-coach
Authors: Vickery Will , Bhardwaj Dhanur , Feros Simon , Bruce Lyndell , Nichol Adam 
Published: May 2023

Background Coach behaviour has received extensive attention in our literature base. This is particularly the case in recent times where systematic observations have highlighted common behaviours exhibited by coaches across various contexts. The current literature, however, lacks significant focus on the behaviours and practices of player-coaches. This is surprising given that these individuals may represent a significant proportion of the non-professional sporting industry. Purpose The purpose of this case study was to investigate the differences in behaviours used by a player-coach and head coach within the sport of cricket and provide a position statement as to how and why further research in this area could be conducted. Method One head coach (age  =  26 y; Level 1 Cricket Australia coaching accreditation) and one player-coach (age  =  30 y; Level 2 Cricket Australia coaching accreditation) were filmed during their typical practice sessions at various points of the cricket season. The behaviours of each coach were coded using a modified, cricket-specific version of the Coach Analysis and Intervention System. 1 Findings Across 12 practice sessions (head coach n  =  4, number of minutes recorded  =  1004; player-coach n  =  8, number of minutes recorded  =  567), observation (on task) and questioning (convergent) were the two most frequent behaviours, irrespective of the coach's role. The player-coach tended to use more instruction when compared to the head-coach, in addition to asking fewer (divergent) questions. Significantly more of the session was spent observing (on task) by the head coach than the player-coach. Specific to this study, the player-coach spent significantly more time involved in training as a player than the head coach. Based on the current findings, it appears that the role of the player-coach is likely to shape practice and behaviour. Indeed, we deploy social theory to provide tentative explanations for these key differences. Conclusion Overall, this paper is among the first to explore the role and practices of the player-coach. Given that player-coaches likely make up a significant proportion of the non-professional sporting industry, much greater research and attention is needed on this area moving forward. In particular, we feel that multiple or mixed-method studies that engage with social theory would be well positioned to develop generative insights into a) intentions behind the deployment of player-coach behaviour, b) actual behaviours engaged, and c) athlete (and others’) perceptions of such practice. Doing so would provide significant opportunities to develop bespoke education for this highly specialised – yet under examined – role.
From Stressful to Mindful: Reactions to a Proposed Emergency Department Design for Enhancing Mindfulness and Stress Reduction Among Healthcare Clinical Staff
Authors: Valipoor Shabboo , Bosch Sheila J. , Chiu Leong Yin Tanya 
Published: May 2023

Objectives: This study explored design solutions that can help clinicians manage work-related stress, pursue mindful work, and practice relaxation and coping strategies. Background: Clinicians are experiencing burnout at increasingly higher rates, leading to compromised patient care. While self-care and stress management strategies are shown to be effective in healthcare settings, little is known about how the design of healthcare settings can facilitate these strategies. Methods: Using findings of a preceding study by the authors, a virtual walk-through video of a design proposal for a free-standing emergency department was built. Feedback data were collected from clinicians in 10 in-depth interviews, and emerging themes were identified using qualitative content analysis. Results: Our findings suggest that work environments that reflect intentional efforts to meet clinicians’ needs for stress management can enhance their feeling of being valued and sense of professional worth. Clinicians are more likely to step away from work if there are multiple spaces for bio breaks and rest breaks. Primary break rooms are preferred to be close to patient care areas, but respite/escape spaces are preferred to be distant and private from patient care areas. Participants endorsed the provision of at least one staff bathroom large enough for extra seating and one outdoor respite space. Multiple workspaces should allow the completion of various tasks with adjustable levels of privacy. Conclusions: We suggest special attention to non-institutional aesthetics, providing choice and control, increasing flexibility, promoting privacy for focused work, maximizing access to daylight and outdoors, and providing opportunities for grief support.
Hereditary Neuropathy With Liability to Pressure Palsy Detected During the Use of Recreational Drugs
Authors: Castellucci Giovanni , Figueroa Michelle , Sivaswamy Lalitha 
Published: May 2023

Background: Nitrous oxide (N2O) has been an increasingly popular recreational drug over the past few years. Abuse is associated with severe neurological complications and even fatal outcomes. Purpose: Here we present a case of chronic nitric oxide abuse in a teenager presenting with rapidly progressive mixed sensory and motor polyneuropathy. Results: The initial diagnostic workup excluded electrolyte derangement, heavy metal intoxication, autoimmune neuropathy, myopathy, hematological disorders, and thyroid disease. On further questioning, patient reported 8-months of inhalation of nitrous oxide, commonly known as “whippets”. Subsequent tests revealed low Vitamin B12 and elevated homocysteine level. Eventual genetic test demonstrated a heterozygous deletion in the gene that encodes the peripheral myelin protein 22 (PMP22), consistent with a diagnosis of Hereditary Neuropathy with Liability to Pressure Palsies (HNPP). Conclusion: The association of neurologic and genetic findings with the timeline of nitrous oxide inhalation suggests a multifactorial etiology of her symptoms, with the N2O acting as a trigger to the axonal degeneration and demyelination detected on electrodiagnostic studies.
Sex differences in associations between creatinine and cystatin C-based kidney function measures with stroke and major bleeding
Authors: Lees Jennifer Susan , De La Mata Nicole L , Sullivan Michael K , Wyld Melanie L , Rosales Brenda M , Cutting Rachel , Hedley James Alan , Rutherford Elaine , Mark Patrick Barry , Webster Angela C 
Published: May 2023

Purpose: We sought to explore whether adding kidney function biomarkers based on creatinine (eGFRCr), cystatin C (eGFRCys) or a combination of the two (eGFRCr-Cys) could improve risk stratification for stroke and major bleeding, and whether there were sex differences in any additive value of kidney function biomarkers. Method: We included participants from the UK Biobank who had not had a previous ischaemic or haemorrhagic stroke or major bleeding episode, and who had kidney function measures available at baseline. Cause-specific Cox proportional hazards models tested associations between eGFRCr, eGFRCys and eGFRCr-Cys (mL/min/1.73 m2) with ischaemic and haemorrhagic stroke, major bleeding (gastrointestinal or intracranial, including haemorrhagic stroke) and all-cause mortality. Findings: Among 452,879 eligible participants, 246,244 (54.4%) were women. Over 11.5 (IQR 10.8–12.2) years, there were 3706 ischaemic strokes, 795 haemorrhagic strokes, 26,025 major bleeding events and 28,851 deaths. eGFRCys was more strongly associated with ischaemic stroke than eGFRCr: an effect that was more pronounced in women (men – HR: 1.16, 95% CI: 1.12–1.19; female to male comparison – HR: 1.11, 95% CI: 1.05–1.16, per 10 mL/min/1.73 m2 decline in eGFRCys). This interaction effect was also demonstrated for eGFRCr-Cys, but not eGFRCr. eGFRCys and eGFRCr-Cys were more strongly associated with major bleeding and all-cause mortality than eGFRCr in both men and women. Event numbers were small for haemorrhagic stroke. Discussion: To a greater degree than is seen in men, eGFRCr underestimates risk of ischaemic stroke and major bleeding in women compared to eGFRCys. The difference between measures is likely explained by non-GFR biology of creatinine and cystatin C. Conclusion: Enhanced measurement of cystatin C may improve risk stratification for ischaemic stroke and major bleeding and clinical treatment decisions in a general population setting, particularly for women.