bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of Surgical Resident Competency Ratings With Patient Outcomes
Authors: Kendrick Daniel E. , Thelen Angela E. , Chen Xilin , Gupta Tanvi , Yamazaki Kenji , Krumm Andrew E. , Bandeh-Ahmadi Hoda , Clark Michael , Luckoscki John , Fan Zhaohui , Wnuk Greg M. , Ryan Andrew M. , Mukherjee Bhramar , Hamstra Stanley J. , Dimick Justin B. , Holmboe Eric S. , George Brian C. 
Published: February 2023

Purpose
Accurate assessment of clinical performance is essential to ensure graduating residents are competent for unsupervised practice. The Accreditation Council for Graduate Medical Education milestones framework is the most widely used competency-based framework in the United States. However, the relationship between residents’ milestones competency ratings and their subsequent early career clinical outcomes has not been established. It is important to examine the association between milestones competency ratings of U.S. general surgical residents and those surgeons’ patient outcomes in early career practice.

Method
A retrospective, cross-sectional study was conducted using a sample of national Medicare claims for 23 common, high-risk inpatient general surgical procedures performed between July 1, 2015, and November 30, 2018 (n = 12,400 cases) by nonfellowship-trained U.S. general surgeons. Milestone ratings collected during those surgeons’ last year of residency (n = 701 residents) were compared with their risk-adjusted rates of mortality, any complication, or severe complication within 30 days of index operation during their first 2 years of practice.

Results
There were no associations between mean milestone competency ratings of graduating general surgery residents and their subsequent early career patient outcomes, including any complication (23% proficient vs 22% not yet proficient; relative risk [RR], 0.97, [95% CI, 0.88–1.08]); severe complication (9% vs 9%, respectively; RR, 1.01, [95% CI, 0.86–1.19]); and mortality (5% vs 5%; RR, 1.07, [95% CI, 0.88–1.30]). Secondary analyses yielded no associations between patient outcomes and milestone ratings specific to technical performance, or between patient outcomes and composites of operative performance, professionalism, or leadership milestones ratings (P ranged .32–.97).

Conclusions
Milestone ratings of graduating general surgery residents were not associated with the patient outcomes of those surgeons when they performed common, higher-risk procedures in a Medicare population. Efforts to improve how milestones ratings are generated might strengthen their association with early career outcomes.
GABAergic Signaling during Spinal Cord Stimulation Reduces Cardiac Arrhythmias in a Porcine Model
Authors: Howard-Quijano Kimberly , Kuwabara Yuki , Yamaguchi Tomoki , Roman Kenny , Salavatian Siamak , Taylor Bradley , Mahajan Aman 
Published: February 2023

Background
Neuraxial modulation, including spinal cord stimulation, reduces cardiac sympathoexcitation and ventricular arrhythmogenesis. There is an incomplete understanding of the molecular mechanisms through which spinal cord stimulation modulates cardiospinal neural pathways. The authors hypothesize that spinal cord stimulation reduces myocardial ischemia–reperfusion—induced sympathetic excitation and ventricular arrhythmias through γ-aminobutyric acid (GABA)–mediated pathways in the thoracic spinal cord.

Methods
Yorkshire pigs were randomized to control (n = 11), ischemia–reperfusion (n = 16), ischemia–reperfusion plus spinal cord stimulation (n = 17), ischemia–reperfusion plus spinal cord stimulation plus γ-aminobutyric acid type A (GABAA) or γ-aminobutyric acid type B (GABAB) receptor antagonist (GABAA, n = 8; GABAB, n = 8), and ischemia–reperfusion plus GABA transaminase inhibitor (GABAculine, n = 8). A four-pole spinal cord stimulation lead was placed epidurally (T1 to T4). GABA modulating pharmacologic agents were administered intrathecally. Spinal cord stimulation at 50 Hz was applied 30 min before ischemia. A 56-electrode epicardial mesh was used for high-resolution electrophysiologic recordings, including activation recovery intervals and ventricular arrhythmia scores. Immunohistochemistry and Western blots were performed to measure GABA receptor expression in the thoracic spinal cord.

Results
Cardiac ischemia led to myocardial sympathoexcitation with reduction in activation recovery interval (mean ± SD, –42 ± 11%), which was attenuated by spinal cord stimulation (–21 ± 17%, P = 0.001). GABAA and GABAB receptor antagonists abolished spinal cord stimulation attenuation of sympathoexcitation (GABAA, –9.7 ± 9.7%, P = 0.043 vs. ischemia–reperfusion plus spinal cord stimulation; GABAB, –13 ± 14%, P = 0.012 vs. ischemia–reperfusion plus spinal cord stimulation), while GABAculine alone caused a therapeutic effect similar to spinal cord stimulation (–4.1 ± 3.7%, P = 0.038 vs. ischemia–reperfusion). The ventricular arrhythmia score supported these findings. Spinal cord stimulation during ischemia–reperfusion increased GABAA receptor expression with no change in GABAB receptor expression.

Conclusions
Thoracic spinal cord stimulation reduces ischemia–reperfusion—induced sympathoexcitation and ventricular arrhythmias through activation of GABA signaling pathways. These data support the hypothesis that spinal cord stimulation–induced release of GABA activates inhibitory interneurons to decrease primary afferent signaling from superficial dorsal horn to sympathetic output neurons in the intermediolateral nucleus.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Host factors predisposing to kidney disease in people with HIV
Authors: Hung Rachel K.Y. , Winkler Cheryl A. , Post Frank A. 
Published: February 2023

Purpose of review
To highlight advances in understanding of host factors, in particular host genetics, in the development of chronic kidney disease (CKD) in people with HIV.

Recent findings
In Black populations, the G1 and G2 variants of the apolipoprotein L1 (APOL1) gene predispose to HIV-associated nephropathy (HIVAN). The risk of HIVAN is mostly confined to individuals with two APOL1 variants (kidney-risk genotypes). APOL1 kidney-risk genotypes are present in approximately 80% of patients with HIVAN and account for nearly half the burden of end-stage CKD in people of African ancestry with HIV. Progress has been made in elucidating the mechanisms of kidney injury in APOL1 nephropathy, and several targeted molecular therapies are being investigated in clinical trials. Genome- and epigenome-wide association studies are identifying additional genes and pathways that may be involved in the pathogenesis of CKD in people with HIV.

Summary
Genetic variants of APOL1 are strongly associated with severe CKD and contribute to the high rates of CKD in Black populations with HIV. Most individuals with APOL1 kidney-risk genotypes, however, do not develop kidney disease and further studies are required to understand the role of additional genetic and environmental factors that may affect CKD risk in this population.
Novel co-axial, disposable, low-cost 3D printed videolaryngoscopes for patients with COVID-19: a manikin study
Authors: Gorman Laura , Dickson Andrew N. , Monaghan Myles , Vaughan Frank , Murphy Brian , Dowling Denis P. , McCaul Conan , Jones James F.X. 
Published: February 2023

BACKGROUND
COVID-19 continues to present challenges to both patient management and the protection of the airway management team involved, in particular in resource-constrained low-income countries. Among the most concerning complications in affected patients is rapid hypoxemic respiratory failure requiring tracheal intubation and mechanical ventilation. Videolaryngoscopy without peri-intubation oxygenation is the recommended approach in COVID-19 patients. However, the absence of peri-intubation oxygenation during intubation attempts can lead to hypoxia, and result in life-threatening complications in already critically ill patients.

OBJECTIVE
To develop low-cost disposable 3D printed videolaryngoscope designs with integrated channels for oxygen, suction, WIFI-enabled camera and tracheal tube channels, as well as a flexible transparent barrier anchor to offer optional additional protection to the user and airway management team.

DESIGN
A manikin study.

SETTING AND PARTICIPANTS
Three experienced consultant anaesthetists in the Mater Misericordiae University Hospital, Dublin, Ireland.

MAIN OUTCOME MEASURES
To generate novel co-axial videolaryngoscopes that meet International Standards, ISO7376 : 2020 standards for anaesthetic and respiratory equipment (laryngoscopes for tracheal intubation), and to demonstrate successful tracheal intubation of a manikin trainer in a range of configurations (‘easy’ to ‘difficult’) in accordance with the Cormack-Lehane grading of laryngeal view.

RESULTS
Final design prototypes met the minimum criteria for strength and rigidity according to ISO7376 : 2020, including blade tip displacement under load (65 N and 150 N). Preliminary validation has demonstrated successful tracheal intubation of a manikin trainer in all configurations including ‘difficult’ (Cormack-Lehane Grade 3 view).

CONCLUSIONS
This low-cost, rapid in-house manufacture could offer a mitigation of supply chain disruptions that can arise during global pandemics. Furthermore, it could offer a low-cost solution in low-income countries where there is an infection risk caused by re-using most current videolaryngoscopes requiring sterilisation before re-use, as well as limitations in the availability of personal protective equipment.
Haemodynamic monitoring and management in patients having noncardiac surgery
Authors: Flick Moritz , Joosten Alexandre , Scheeren Thomas W.L. , Duranteau Jacques , Saugel Bernd 
Published: February 2023

BACKGROUND
Haemodynamic monitoring and management is a mainstay of peri-operative anaesthetic care.

OBJECTIVE
To determine how anaesthesiologists measure and manage blood pressure and cardiac output, and how they guide fluid administration and assess fluid responsiveness in patients having noncardiac surgery.

DESIGN
Web-based survey.

SETTING
Survey among members of the European Society of Anaesthesiology and Intensive Care (ESAIC) in October and November 2021.

PARTICIPANTS
ESAIC members responding to the survey.

MAIN OUTCOME MEASURES
Respondents’ answers to 30 questions on haemodynamic monitoring and management, and fluid therapy.

RESULTS
A total of 615 fully completed surveys were analysed. Arterial catheters are usually not placed before induction of general anaesthesia (378/615; 61%) even when invasive blood pressure monitoring is planned. Mean arterial pressure (532/615; 87%) with lower intervention thresholds of 65 mmHg (183/531; 34%) or 20% below pre-operative baseline (166/531; 31%) is primarily used to guide blood pressure management. Cardiac output is most frequently measured using pulse wave analysis (548/597; 92%). However, only one-third of respondents (almost) always use cardiac output to guide haemodynamic management in high-risk patients (225/582; 39%). Dynamic cardiac preload variables are more frequently used to guide haemodynamic management than cardiac output [pulse pressure variation (almost) always: 318/589; 54%]. Standardised treatment protocols are rarely used for haemodynamic management (139/614; 23%). For fluid therapy, crystalloids are primarily used as maintenance fluids, to treat hypovolaemia, and for fluid challenges. The use of 0.9% saline and hydroxyethyl starch has declined over the last decade. The preferred methods to assess fluid responsiveness are dynamic preload variables and fluid challenges, most commonly with 250 ml of fluid (319/613; 52%).

CONCLUSION
This survey provides important information how anaesthesiologists currently measure and manage blood pressure and cardiac output, and how they guide fluid administration in patients having noncardiac surgery.
Accounting for the Potential of Overdispersion in Estimation of the Time-varying Reproduction Number
Authors: Ho Faith , Parag Kris V. , Adam Dillon C. , Lau Eric H. Y. , Cowling Benjamin J. , Tsang Tim K. 
Published: February 2023

Background:
The time-varying reproduction number, R

t
, is commonly used to monitor the transmissibility of an infectious disease during an epidemic, but standard methods for estimating R

t
seldom account for the impact of overdispersion on transmission.

Methods:
We developed a negative binomial framework to estimate R

t
and a time-varying dispersion parameter (k

t
). We applied the framework to COVID-19 incidence data in Hong Kong in 2020 and 2021. We conducted a simulation study to compare the performance of our model with the conventional Poisson-based approach.

Results:
Our framework estimated an R

t
peaking around 4 (95% credible interval = 3.13, 4.30), similar to that from the Poisson approach but with a better model fit. Our approach further estimated k

t
<0.5 at the start of both waves, indicating appreciable heterogeneity in transmission. We also found that k

t
decreased sharply to around 0.4 when a large cluster of infections occurred.

Conclusions:
Our proposed approach can contribute to the estimation of R

t
and monitoring of the time-varying dispersion parameters to quantify the role of superspreading.
Approaches for Assessing Effects of Exposures on Human Fertility
Authors: Shi Min , Weinberg Clarice R. 
Published: February 2023

Background:
Fecundability (conception rate per menstrual cycle) varies among non-contracepting couples. Time-to-pregnancy studies can identify exposures contributing to that variability, using three designs: incident cohort, prevalent cohort, and retrospective. Typically, researchers then apply semi-parametric, generalized linear time-to-pregnancy models to data, with either a log or a logit “link,” to estimate either a fecundability ratio (FR) or a fecundability odds ratio (FOR). The ongoing-attempt study design can also be informative.

Methods:
We consider a different generalized linear model, based on an inverse link. It models the heterogeneity as beta distributed and enables estimation of both the FR and FOR, defined based on population mean fecundabilities, without requiring constancy across attempt time. Under an ongoing-attempt design, the parameter associated with a dichotomous exposure has no clear meaning with a log or a logit link, but under the proposed approach estimates the ratio of the two average times to pregnancy. Basing simulations on conception rates from a large study, we compare the three analytic approaches for confidence interval coverage and power. We also assess the performance of a commonly used method for verifying the constancy of FOR or FR across time.

Results:
The inverse-link approach had slightly less power than the others, but its estimates maintained nominal confidence interval coverage under nonconstancy. A popular method for testing constancy across time for the FR and FOR had poor power.

Conclusions:
The inverse-link analysis offers a useful alternative to the usual methods, with estimation performance that generalizes to the ongoing-attempt design and does not require hard-to-verify constancy assumptions.
Short-term Air Pollution Levels and Blood Pressure in Older Women
Authors: Wen Tong , Liao Duanping , Wellenius Gregory A. , Whitsel Eric A. , Margolis Helene G. , Tinker Lesley F. , Stewart James D. , Kong Lan , Yanosky Jeff D. 
Published: February 2023

Background:
Evidence of associations between daily variation in air pollution and blood pressure (BP) is varied and few prior longitudinal studies adjusted for calendar time.

Methods:
We studied 143,658 postmenopausal women 50 to 79 years of age from the Women’s Health Initiative (1993–2005). We estimated daily atmospheric particulate matter (PM) (in three size fractions: PM2.5, PM2.5-10, and PM10) and nitrogen dioxide (NO2) concentrations at participants’ residential addresses using validated lognormal kriging models. We used linear mixed-effects models to estimate the association between air pollution concentrations and repeated measures of systolic and diastolic BP (SBP, DBP) adjusting for confounders and calendar time.

Results:
Short-term PM2.5 and NO2 were each positively associated with DBP {0.10 mmHg [95% confidence interval (CI): 0.04, 0.15]; 0.13 mmHg (95% CI: 0.09, 0.18), respectively} for interquartile range changes in lag 3-5 day PM2.5 and NO2. Short-term NO2 was negatively associated with SBP [−0.21 mmHg (95%CI: −0.30, −0.13)]. In two-pollutant models, the NO2–DBP association was slightly stronger, but for PM2.5 was attenuated to null, compared with single-pollutant models. Associations between short-term NO2 and DBP were more pronounced among those with higher body mass index, lower neighborhood socioeconomic position, and diabetes. When long-term (annual) and lag 3-5 day PM2.5 were in the same model, associations with long-term PM2.5 were stronger than for lag 3-5 day.

Conclusions:
We observed that short-term PM2.5 and NO2 levels were associated with increased DBP, although two-pollutant model results suggest NO2 was more likely responsible for observed associations. Long-term PM2.5 effects were larger than short-term.
Smoking Inequality Trends by Disability and Income in Australia, 2001 to 2020
Authors: Disney George , Petrie Dennis , Yang Yi , Aitken Zoe , Gurrin Lyle , Kavanagh Anne 
Published: February 2023

Background:
While policies to reduce smoking in many countries have been successful, disadvantaged groups (such as low-income groups) have only seen minor gains. People with disability are one such disadvantaged group and are more likely to smoke. However, evidence is limited on trends and inequalities in smoking for disabled people and on whether those also on low incomes are more likely to smoke.

Methods:
We use annual data from 2001 to 2020 of the Household Income and Labour Dynamics in Australia survey. We use a Bayesian model to estimate smoking prevalence trends and inequalities for people with disability (2020, n = 1,370) and without disability (2020, n = 6,229) across the whole population and within income tertiles. To avoid reverse causation (smoking causing disability), we focus on younger people (15–44 years).

Results:
Absolute reductions (per 100 people, [95% credible intervals]) in smoking were similar for people with (−13 [−16, −11]) and without disability (−15 [−16, −14]), with stable absolute but increasing relative inequalities. In the low-income group, absolute reductions in smoking prevalence for people with disability (−10 [−14, −6]) were smaller than in people without disability (−14 [−15, −12]), resulting in moderate evidence for increasing absolute inequalities (4 [0, 8]) and strong evidence for increasing relative inequalities. In high-income groups, disability-related absolute inequalities narrowed (−6 [−10, −3]), and relative inequalities were stable.

Conclusions:
Disabled people in Australia, especially those on low incomes, show signs of being left behind in efforts to reduce smoking.
Nationwide Bibliometric Analysis of Integrated Plastic Surgery Program Directors
Authors: Seu Michelle Y. , Esmaeeli Shooka , Wiegmann Aaron L. , Akin Jennifer , Jaraczewski Taylor , Dadrass Farnaz , Xu Thomas Q. , Dorafshar Amir H. , Shenaq Deana 
Published: February 2023

Background:
Studies have linked bibliometric indices with the academic level of plastic surgeons, but this relationship has not been explored with residency program directors (PDs). As teachers of the next generation, PDs’ academic performance is an important component of residency program success. We sought to identify distinguishing characteristics of integrated plastic surgery programs, focusing on their PD bibliometric indices.

Methods:
We identified plastic surgery programs based on 2021 Doximity reputation and research output rankings, respectively, and then divided them into four quartiles (Q1–Q4). PD academic history and bibliometric indices (h-index, the number of publications, and citations) were collected through Doximity profiles and program websites: PubMed, Scopus, Google Scholar, American Society of Plastic Surgeons, and Accreditation Council for Graduate Medical Education.

Results:
Eighty-four programs were identified. There was a significant positive relationship between h-index, the number of publications, and type of research with reputation ranking (P < 0.05). After adjusting for years of experience post-training, h-index (OR = 1.24; P < 0.001) and the number of publications (OR = 1.05, P < 0.001) were significantly associated with reputation ranking. There was a statistically significant relationship between PD research fellowship completion and research output ranking (P < 0.01). After adjusting for years of experience post-training, h-index (OR = 1.05; P = 0.047) and the number of publications (OR = 1.01; P = 0.04) were significantly associated with research output ranking.

Conclusion:
Higher ranked programs tend to have PDs who have a strong record of scholarly activity, as evidenced by certain bibliometric indices.
SCI-QOL and WOUND-Q Have the Best Patient-reported Outcome Measure Design: A Systematic Literature Review of PROMs Used in Chronic Wounds
Authors: van Alphen Tert C. , ter Brugge Floor , van Haren Emiel L.W.G. , Hoogbergen Maarten M. , Rakhorst Hinne 
Published: February 2023

Background:
Chronic wounds are a significant burden on healthcare systems due to high costs of care (2%–4% total healthcare cost) and a considerable burden on patient’s quality of life. Patient-reported outcome measures (PROMs) are questionnaires developed to enable patient self-assessments of their outcomes. A gap in knowledge exists because previous reviews on wound-specific PROMs did not evaluate the quality of the development. The main question is which PROM has the best quality development properties and should be used in clinical care and research.

Methods:
PubMed, Embase, and CINAHL were searched from their inception through December 2021. Studies that included patients aged 18 years or older, with chronic wounds, and who reported using a condition-specific PROM for wounds were extracted. We excluded generic PROMs, comments, guidelines, and editorial letters. The COSMIN-guidelines were used to evaluate the quality of the PROMs.

Results:
Of the 16,356 articles, a total of 251 articles describing 33 condition-specific PROMs for wounds were used. In total, 17 of 33 (52%) PROMs were developed for specific wound types, and nine of 33 (27%) PROMs were developed for any type of wound. Two of 33 (6%) PROMs were not rated because no development article was available. Only the SCI-QOL (Spinal Cord Injury-QOL) and the WOUND-Q rated “very good” in PROM design.

Conclusions:
Thirty-three condition-specific PROMs were found. Only the SCI-QOL and the WOUND-Q rated very good in PROM design. The WOUND-Q is the only condition-specific PROM, which can be used in all types of chronic wounds in any anatomic location.
Lacrimal Plasty with Dacryocystorhinostomy-Anastomosis Using Microsurgery
Authors: Yanagisawa Daisuke , Yuzuriha Shunsuke 
Published: February 2023

Background:
Dacryocystorhinostomy (DCR) is the standard treatment for nasolacrimal duct obstruction, but it has the disadvantage of creating a raw surface, which may lead to reocclusion due to the development of postoperative granulation tissue. In this study, we developed and evaluated an ideal new surgical method, dacryocystorhinostomy-anastomosis (DCR-A), involving end-to-side anastomosis under microscopic visualization that does not result in raw surfaces.

Methods:
In DCR, the lateral aspect of the dacryocyst and the nasal mucosa are incised, and the mucosal valves are sutured together. In DCR-A, the occluded section of the dacryocyst or nasolacrimal duct was trimmed and anastomosed by circumferential suturing through a hole in the nasal mucosa. The success rate and the requirement for postoperative therapy were compared between 21 sides of DCR patients and 11 sides of nasal DCR-A patients.

Results:
DCR-A was significantly better than conventional DCR. No additional postoperative therapy was required for DCR-A.

Conclusion:
DCR-A improves symptoms of nasolacrimal duct obstruction to a greater extent than conventional DCR and does not require additional postoperative treatment.