bluuebunny/crossref_metadata_2025_split huggingface dataset:
Heterologous expression of genes from a cyanobacterial endosymbiont highlights substrate exchanges with its diatom host
Authors: Nieves-Morión Mercedes , Camargo Sergio , Bardi Sepehr , Ruiz María Teresa , Flores Enrique , Foster Rachel A 
Published: June 2023

Abstract
A few genera of diatoms are widespread and thrive in low-nutrient waters of the open ocean due to their close association with N2-fixing, filamentous heterocyst-forming cyanobacteria. In one of these symbioses, the symbiont, Richelia euintracellularis, has penetrated the cell envelope of the host, Hemiaulus hauckii, and lives inside the host cytoplasm. How the partners interact, including how the symbiont sustains high rates of N2 fixation, is unstudied. Since R. euintracellularis has evaded isolation, heterologous expression of genes in model laboratory organisms was performed to identify the function of proteins from the endosymbiont. Gene complementation of a cyanobacterial invertase mutant and expression of the protein in Escherichia coli showed that R. euintracellularis HH01 possesses a neutral invertase that splits sucrose producing glucose and fructose. Several solute-binding proteins (SBPs) of ABC transporters encoded in the genome of R. euintracellularis HH01 were expressed in E. coli, and their substrates were characterized. The selected SBPs directly linked the host as the source of several substrates, e.g. sugars (sucrose and galactose), amino acids (glutamate and phenylalanine), and a polyamine (spermidine), to support the cyanobacterial symbiont. Finally, transcripts of genes encoding the invertase and SBPs were consistently detected in wild populations of H. hauckii collected from multiple stations and depths in the western tropical North Atlantic. Our results support the idea that the diatom host provides the endosymbiotic cyanobacterium with organic carbon to fuel N2 fixation. This knowledge is key to understanding the physiology of the globally significant H. hauckii–R. euintracellularis symbiosis.
PRISM—Pain Recovery and Integrative Systems Model: A Process-Based Cognitive-Behavioral Approach for Physical Therapy
Authors: Tatta Joe , Pignataro Rose M , Bezner Janet R , George Steven Z , Rothschild Carey E 
Published: June 2023

Abstract

The Academy of Orthopedic Physical Therapy Pain Education Manual supports the advancement of modern pain content, and the National Institutes of Health Federal Pain Research Strategy has called for new models for pain management. This Perspective proposes the Pain Recovery and Integrative Systems Model (PRISM) as a new model that addresses the multidimensional nature of pain. PRISM is a salutogenic, integrative, process-based cognitive-behavioral model designed for physical therapist education and practice. PRISM aligns with national and international initiatives to better understand and manage pain, thereby mitigating the global opioid crisis. PRISM aims to address the multidimensional nature of pain while building resilience, nurturing growth, and facilitating pain recovery.

Impact
PRISM is a salutogenic, integrative, process-based cognitive-behavioral model to guide physical therapists in managing the multidimensional nature of pain.
Dosimetric impact of bladder volume on organs at risk during external beam radiotherapy of cervical cancer
Authors: Mohamadian Niloofar , Nasseri Shahrokh , Hosseini Sare , Molaie Fatemeh , Zarifi Shiva , Eskandari Azam , Momennezhad Mehdi 
Published: June 2023

Abstract
This study aimed to investigate the effect of bladder volume on the dosimetry of pelvic organs at risk (OARs) in patients treated with external beam radiation therapy. Twenty patients with locally advanced cervical cancer were selected. Two computed tomography-simulation scans were obtained, one with an empty bladder followed by one with a full bladder. The acquired images were transferred to the treatment planning system. Target and OARs were contoured in both images, and treatment plans were performed for each computed tomography image. The delivered doses to target and OARs were determined using dose–volume histograms. The mean dose of the bowel bag in the empty and full bladder were 35.06 ± 4.13 (Gy) and 31.59 ± 3.86 (Gy), respectively. Furthermore, the V45 of the bowel bag in the empty bladder was 364.27 ± 154.39 (cc) and in the full bladder, it was 240.84 ± 129.66 (cc). The mean dose of the rectum in the empty and full bladder were 49.50 ± 1.95 (Gy) and 49.18 ± 1.03 (Gy), respectively. The rectal V50 (%) was 52.82 ± 21.84 (%) in the empty bladder and 45.49 ± 29.55 (%) in the full bladder. The mean dose and V45 of the bowel bag, also V50 of the rectum, had significantly decreased in the full bladder status (p-value &lt; 0.05). The results showed that the bladder volume significantly affected the delivered dose to the bowel bag and rectum. The average bowel bag V45 and rectum V50 in the full bladder were significantly decreased. Bladder distention is an effective method to improve the dosimetric parameters of pelvic OARs.
Effect of grain inclusion rates in diets provided to early-weaned calves and steroidal implants utilization on growth performance and carcass characteristics of beef steers
Authors: Pittaluga Alejandro M , Kieffer Justin , Relling Alejandro E 
Published: June 2023

Abstract
One hundred and twenty-one Angus × SimAngus-crossbred steers (body weight (BW) = 159 ± 22 kg) were used to evaluate the effects of different grain inclusion (GI) rates in diets provided to early-weaned calves and steroidal implants (SI) utilization on growth performance and carcass characteristics, particularly intramuscular fat deposition, of beef steers. The experiment was conducted as a randomized complete block design with a 2 × 2 factorial arrangement of treatments, consisting of two GI rates (35% vs. 58%, dry matter (DM) basis), each one associated or not to steroidal implant utilization (no implants vs. 80 mg trenbolone acetate (TA) + 16 mg estradiol followed by 120 mg TA + 24 mg of estradiol). After being early-weaned (124 ± 14 d of age), steers were offered an average of 4.5 kg/d (DM basis) of a concentrate-based diet with a greater or lesser GI rate for 60 d. After being fed a concentrate-based diet with different GI rates for 60 d, steers were fed a common backgrounding diet for 56 d and subsequently fed a common high-grain diet until harvested at a constant final BW (620 kg). Steers were not implanted until the beginning of the backgrounding phase and then re-implanted when initiating the finishing phase. Data were analyzed using PROC MIXED in SAS. There were no GI × SI interactions (P ≥ 0.62) for any of the growth performance parameters throughout the experimental period. Implanted steers tended to have a greater average daily gain (P = 0.10) during the finishing phase than nonimplanted steers. For the 12th rib fat thickness and yield grade (YG), a GI × SI interaction (P = 0.03) and a tendency for a GI × SI interaction (P = 0.10) was detected, respectively. Nonimplanted steers fed diets with greater GI rates presented the greatest 12th rib fat thickness and tended to have the greatest YG among treatments. No other interactions (P ≥ 0.33) were observed for the hot carcass weight, Longissimus muscle (LM) area, quality grade, marbling score, and kidney-pelvic-heart fat content. Steers fed diets with lesser GI rates tended to have a greater LM area than steers fed diets with greater GI rates (P = 0.10). Results from this experiment indicate that varying GI rates in diets provided to early-weaned calves and subsequent implantation with steroidal hormones did not affect marbling deposition.
Moving Beyond the Dichotomous Assessment of Professionalism in the Internal Medicine Clerkship: Results of a National Survey of Clerkship Directors
Authors: Montgomery Mary W. , Petersen Elizabeth M. , Weinstein Amy R. , Curren Camilla , Hufmeyer Kathryn , Kisielewski Michael , Krupat Edward , Osman Nora Y. 
Published: June 2023

Abstract

Purpose
This study examines how internal medicine clerkship faculty and leadership conceptualize professionalism and professional behaviors and attitudes, identifies whether and how faculty use metrics to assess professionalism and factor it into clerkship grades, and describes barriers that prevent faculty from feeling prepared to support the development of professional behaviors in students.

Method
The Clerkship Directors in Internal Medicine opened a call for thematic survey section proposals to its physician-faculty members, blind-reviewed all submissions, and selected 4 based on internal medicine clinical clerkship training experience relevance. The survey launched on October 5 and closed on December 7, 2021. Data were analyzed using descriptive statistics.

Results
Of 137 core clerkship directors (CDs) at Liaison Committee on Medical Education–accredited medical schools, 103 (75.2%) responded to the survey. Of 102 respondents (1 nonrespondent), 84 (82.4%) identified professional behavior lapses in involvement and 60 (58.8%) identified introspection lapses. Of 103 respondents, 97 (94.2%) reported that their clerkships ask clinical faculty and residents to formally evaluate professionalism, and 64 (62.1%) reported that they factor professionalism assessments into final clerkship grades. CDs reported multiple barriers to addressing professionalism directly with students, including logistical barriers, professionalism assessment subjectivity concerns, and the possible adverse effect of an unprofessional label for students.

Conclusions
Professionalism assessment and remediation in medical education currently center on a deficit model that seeks to identify and remediate professionalism lapses, rather than a developmental model that seeks to nurture growth. This dichotomous characterization of behaviors as professional or unprofessional limits assessment and can adversely affect the learning environment. The authors propose a shift to a developmental model that considers professionalism as a continuous process parallel to the acquisition of clinical skills and medical knowledge.
Scholarly Curriculum at a Psychiatry Residency Program in Canada: 10-Year Outcomes
Authors: Iskhakova S. , Vasudev K. 
Published: June 2023

Problem
For research in medicine to address needed interventions and produce outcomes relevant to patient care, it is important for physicians to gain hands-on experience in scientific methods during their training. However, the results of recent studies in the United States and Canada indicate low interest in research among residents.

Approach
In 2011, involvement in a scholarly activity was made mandatory for all residents joining the Western University psychiatry residency program (WUPRP). A faculty member was appointed as a research coordinator who collaborated with research-intensive faculty members and prepared a list of potential projects suitable for resident involvement; organized monthly research meetings to support residents in initiating scholarly activities, monitor their progress, and address challenges; and developed competency-based research objectives, guidelines, and assessment tool.

Outcomes
Data on all residents enrolled at WUPRP from 2011 to 2017 (the latter graduated in 2022 with completed scholarly requirements) were analyzed with respect to residents’ participation in a scholarly project. A total of 54 residents were enrolled during this period. Fifty-two (96%) residents were involved in a scholarly project; of these 52, 38 (73%) completed their project. Of these 38, 32 (84%) had academic achievements, which include poster and oral presentations at a conference, publications, and prizes and awards. Of the 52 residents involved in a scholarly project, 14 (27%) residents could not complete their projects, though they still met scholarly activity requirements and 1 (2%) enrolled in the Western University Clinician Investigator Program with the goal of pursuing research as a career.

Next Steps
There is a lack of data on how many WUPRP graduates from 2011 to 2017 are currently pursuing careers in research. The authors plan to perform longer and closer follow-up of residents to evaluate whether a scholarly curriculum makes an impact on residents’ career choices.
The Evaluation and Treatment of an Infant Exposed to Nongenital HSV-2
Authors: Staggs Jenna 
Published: June 2023

Background:
Pregnant persons with a primary genital herpes simplex virus (HSV) infection can transfer HSV to the fetus or infant through the placenta or birth canal, which can cause significant infant morbidity or mortality. Primary nongenital infections with HSV-1 or HSV-2 in pregnant persons and the risk of infant infection are not well documented, leaving the clinician to make non-evidence-based decisions on evaluation and treatment in such presentations.

Clinical Findings:
A term newborn was delivered vaginally by a pregnant person with a nongenital HSV-2 infection. The pregnant person's rash first appeared around 32 weeks' gestation, started on their lower back, and terminated on the outer left hip. The rash improved but was still present at time of delivery, and this rash was their first known HSV outbreak.

Primary Diagnosis:
Prenatal exposure to HSV-2.

Interventions:
Diagnostics included the pregnant person's rash surface culture, immunoglobulin G and immunoglobulin M for HSV-1 and -2; infant surface, cerebral spinal fluid (CSF), and serum HSV-1 and HSV-2 polymerase chain reactions (PCRs), infant CSF studies, blood culture, liver function tests, and treatment with intravenous acyclovir.

Outcomes:
This infant remained clinically well during hospitalization and was discharged home at 5 days of life when CSF, surface, and serum PCRs resulted negative.

Practice Recommendations:
Risk for infant HSV infection versus parent/infant separation and exposure to invasive procedures and medications should be considered when pregnant persons present with primary versus recurrent nongenital HSV infections. Research is needed for the evaluation and treatment of infants born to pregnant persons with primary nongenital HSV infections in pregnancy.
Readability of Patient-Reported Outcomes in Spine Surgery and Implications for Health Literacy
Authors: Issa Tariq Z. , Lee Yunsoo , Mazmudar Aditya S. , Lambrechts Mark J. , Sellig Mason , Hilibrand Alan S. , Vaccaro Alexander R. , Schroeder Gregory D. , Kepler Christopher K. 
Published: June 2023

Study Design:Observational study.Objective:To evaluate the readability of commonly utilized patient-reported outcome measures (PROMs) in spine surgery.Summary of Background Data:Although studies have evaluated patient education materials, discharge instructions, and informed consent forms in spine surgery, there is a dearth of literature on the readability of PROMs despite widespread health illiteracy. Without knowledge of PROM readability, it is unclear whether these measures are able to be understood by the average spine patient.Materials and Methods:We analyzed all commonly utilized nonvisual PROMs within the spinal literature and uploaded PROMs into an online readability calculator. The Flesch Reading Ease Score (FRES) and Simple Measure of Gobbledygook (SMOG) Index were collected. A FRES>79 or SMOG<7 was considered readable by the general population per American Medical Association and Centers for Disease Control guidelines. A stricter threshold recommended in health care (SMOG <6 or FRES>89) was then used to further review readability.Results:Seventy-seven PROMs were included. Based on FRES, the mean readability of all PROMs was 69.2 ± 17.2 (range, 10–96.4), indicating an average eighth to ninth-grade reading level. The mean readability score categorized by the SMOG Index was 8.12 ± 2.65 (range, 3.1–25.6), representing an eighth-grade reading level. Compared with the reading level of the general population, 49 (63.6%) PROMs are written above the United States literacy level, according to FRES. Using stricter definitions of readability, 8 PROMs were considered readable, including PROM Information System pain behavior (FRES: 96.4 and SMOG: 5.2), PROM Information System sleep disturbance (SMOG: 5.6), Neck Pain and Disability Scale (SMOG: 4.3), and Zung Depression Scale (SMOG: 3.1).Conclusions:Most PROMs utilized in spine surgery require an average reading competency far above the average patient’s comprehension. This may have a meaningful impact on understanding PROM instruments and may affect the accuracy of complete surveys and the rates of incompletion.
What Factors Are Associated With Stem Breakage in Distal Femoral Endoprosthetic Replacements Undertaken for Primary Bone Tumors?
Authors: Carlisle Emma , Steadman Peter , Lowe Martin , Rowell Philip , Sommerville Scott 
Published: June 2023

Abstract

Background
The advantages of distal femoral replacement prostheses for reconstructions after tumors are well known; one such implant, the Global Modular Replacement System (GMRS), has been widely used since 2003. Although implant breakage has been reported, the frequency of this event has varied across different studies.

Questions/purposes
(1) What percentage of patients who underwent distal femur resection and replacement using the GMRS for primary bone tumors at one center experienced stem breakage? (2) At what timepoints did these breakages occur, and what factors were common among the stems that broke?

Methods
We performed a retrospective study of all patients who underwent distal femur resection and replacement using the GMRS for a diagnosis of primary bone sarcoma by the Queensland Bone and Soft-tissue Tumor service from 2003 to 2020 who had a minimum of 2 years of follow-up. Standard follow-up for primary bone sarcoma involves radiographic imaging of the femur at 6 weeks and 3 months postoperatively and yearly thereafter. From a chart review, we identified patients with femoral stem breakage. Patient and implant details were recorded and analyzed. A total of 116 patients had undergone a distal femoral replacement with the GMRS prosthesis for primary bone sarcoma; however, 6.9% (eight of 116 patients) died before completing the 2-year follow-up period and were excluded. Of the remaining 108 patients, 15% (16 patients) had died at the time of this review; however, given that they completed the 2-year follow‐up period and did not experience stem breakage, they were included. Furthermore, 15% (16 patients) were considered lost to follow-up and excluded because they have not been seen in the past 5 years but were not known to have died or experienced stem breakage. This left 92 patients for analysis.

Results
Stem breakages were identified in 5.4% (five of 92) of patients. All stem breakages occurred in stem diameters 11 mm or less with a porous body construct; the percentage of patients with breakage in this group was 16% (five of 31). All patients with stem fracture demonstrated minimal ongrowth to the porous coated body. The median time to stem fracture was 10 years (range 2 to 12 years); however, two of the five stems broke within 3 years.

Conclusion
We recommend the use of a larger-diameter GMRS cemented stem (> 11 mm), and either the line-to-line cementing method or an uncemented stem from an alternative company should be considered in order to achieve this larger stem in smaller canals. If a stem less than 12 mm in diameter must be used or there is evidence of minimal ongrowth, then close follow-up and prompt investigation of new symptoms should occur.

Level of Evidence
Level IV, therapeutic study.
Evaluation of Processed Nerve Allograft in Peripheral Nerve Surgery: A Systematic Review and Critical Appraisal
Authors: Frostadottir Drifa , Chemnitz Anette , Johansson OT Linn J. , Holst Jan , Dahlin Lars B. 
Published: June 2023

Background:
Peripheral nerve injuries cause substantial problems when not treated properly. A specific problem is reconstruction of nerve defects, which can be treated in different ways. This study aimed to systematically review whether processed nerve allograft (PNA) is justified in reconstruction of a nerve defect in patients after posttraumatic or iatrogenic peripheral nerve injury and to compare PNA with other established methods.

Methods:
A systematic review with a focused question, PICO (patient, intervention, comparison, outcome) and constraints, was performed. A structured literature search, including several databases, was done to evaluate the existing evidence for outcomes and postoperative complications related to PNA. The certainty of evidence was classified according to Grading of Recommendations, Assessment, Development and Evaluations.

Results:
No conclusions, concerning differences in outcome of nerve reconstruction using PNA compared with the use of nerve autograft or conduits, could be drawn. The level of certainty for all evaluated outcomes was very low (⊕◯◯◯). Most published studies lack a control group to patients treated with PNA; being only descriptive, making it difficult to compare PNA with established methods without substantial risk of bias. For studies including a control group, the scientific evidence was of very low certainty, due to a low number of included patients, and large, undefined loss of patients during follow-up, rendering a high risk of bias. Finally, the authors often had financial disclosures.

Conclusion:
Properly conducted randomized controlled trial studies on the use of PNA in reconstruction of peripheral nerve injuries are needed to establish recommendations in clinical practice.
Day to Day and Environmental Risk Factors for Psychological Distress Among Healthcare Workers
Authors: Atkins Kaitlyn , Cooney Erin E. , Park Soim , Closser Svea , Surkan Pamela J. , Marker Hannah C. , Schneider-Firestone Sarah , Kalb Luther G. , Thrul Johannes , Veenema Tener Goodwin 
Published: June 2023

Objective
Despite a growing literature on mental health among clinical staff during COVID-19, factors shaping distress for nonclinical staff are understudied and may be driven by inequalities at work. We aimed to discuss the role of workplace factors in shaping psychological distress for a diverse group of clinical, nonclinical, and other health and hospital workers (HHWs).

Methods
This convergent parallel mixed-methods study with HHWs in a US hospital system included an online survey (n = 1127) and interviews (n = 73) collected from August 2020 to January 2021. We thematically analyzed interviews; findings informed log binomial regression estimating risk factors for severe psychological distress (Patient Health Questionnaire - 4 item version [PHQ-4] scores of 9 or greater).

Results
Qualitatively, day-to-day stressors fostered fear and anxiety, and concerns about work environments manifest as betrayal and frustration with leadership. Distress was associated with burnout, financial concerns, and feeling betrayed or unsupported by the institution and leadership. Staff in service versus clinical roles had higher risk for severe distress (adjusted prevalence ratio = 2.04, 95% confidence interval = 1.13–2.66); HHWs receiving workplace mental health support had lower risk (adjusted prevalence ratio = 0.52, 95% confidence interval = 0.29–0.92.

Conclusions
Our mixed-methods study underscores how the pandemic brought inequalities to the surface to increase distress for vulnerable HHWs. Workplace mental health activities can support HHWs now and during future crises.