bluuebunny/crossref_metadata_2025_split huggingface dataset:
Motor Impairment and Disuse Are Independent Predictors of Vascular Outcomes Poststroke
Authors: Miller Tiev , Ouyang Huixi , Tsang Charlotte S L , Calderón-Juárez Martín , Ying Michael T C , Pang Marco Y C 
Published: February 2025

Abstract

Importance
Cardiorespiratory fitness is reduced after stroke due to inactivity which may cause structural and functional changes to blood vessels in the extremities. Identifying clinical factors contributing to vascular function may be important for tailoring rehabilitation programs that reduce secondary disease risk and adverse events.

Objective
The study objective was to compare measures of arterial and intramuscular blood flow between the paretic and nonparetic upper limbs of individuals with stroke and healthy comparators. Associations between these parameters and stroke-related impairment were also examined.

Design
This was a cross-sectional study.

Setting
The setting was a university laboratory.

Participants
Participants were individuals with stroke (n = 64; mean age = 60.8 [SD = 7.7] years) and matched controls (n = 64; mean age = 59.4 [SD = 7.8] years).

Main Outcomes/Measures
Brachial artery blood flow volume (Vflow) and arterial diameter (AD) were measured using Doppler ultrasound. Intramuscular blood perfusion of the biceps brachii was estimated using the vascularity index (VI). Motor recovery and perceived use of paretic upper limbs were assessed with the Fugl-Meyer Assessment (FMA) and Motor Activity Log (MAL), respectively.

Results
Side × group interactions were observed for AD (F = 22.6) and VI (F = 4.00). Post hoc analyses showed lower AD and VI for paretic sides (stroke group), greater Vflow for dominant sides (comparators), and greater percent side-to-side differences (%SSDs) in AD and VI for the stroke group than for comparators. %SSDs in Vflow, AD, and VI demonstrated weak correlations with impairment (MAL, FMA) (ρ = 0.253 to 0.347). MAL was an independent predictor of %SSD in Vflow (β = −0.286), and FMA was an independent predictor of %SSDs in AD (β = −0.307) and VI (β = 0.371).

Conclusions/Relevance
Relative to the nonparetic and bilateral limbs of comparators, arterial size and intramuscular blood flow in the paretic upper limbs of individuals with stroke were significantly reduced. Motor impairment and disuse emerged as independent predictors of all vascular outcomes and may be potential intervention targets for reducing cardiovascular disease risk after stroke.
Towards Enhancing Drug Development Methodology to Treat Cognitive Impairment Associated With Schizophrenia and Other Neuropsychiatric Conditions: Insights From 2 Decades of Clinical Trials
Authors: Horan William P , Kalali Amir , Brannan Stephen K , Drevets Wayne , Leoni Matthew , Mahableshwarkar Atul , Martin William J , Rao Srinivas , Reuteman-Fowler Corey , Sauder Colin , Savitz Adam , Singh Jaskaran , Tiller Jane , Walker Gary , Wendland Jens R , Harvey Philip D 
Published: February 2025

Abstract
Cognitive impairment is a core feature and leading cause of functional disability in schizophrenia and other neuropsychiatric disorders. The Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) initiative in the early 2000s marked a pivotal moment for drug development, establishing consensus on methodology for treatment studies, including assessment strategies and trial designs, for cognitive impairment associated with schizophrenia (CIAS). Despite extensive industry-sponsored and academic drug development efforts over the last 2 decades using these strategies no pharmacological treatments have been approved for CIAS. Drawing on pharmaceutical industry experience and scientific developments since the MATRICS initiative, we review lessons learned about the practical and operational complexities of conducting large-scale CIAS clinical trials. Based on this collective experience, we identify elements of the MATRICS guidelines that may warrant reconsideration and suggest some new approaches to streamline the drug development pathway, without weakening standards for evidence. Our goal is to initiate an open exchange among all stakeholders about possible enhancements to drug development methodology that optimize our ability to develop new treatments for cognitive impairment in schizophrenia and other neuropsychiatric disorders.
Does It Matter Who You Ask For Time Use Data?
Authors: Sharma Deepti , Swaminathan Hema , Lahoti Rahul 
Published: February 2025

Abstract
Time-use statistics are recall intensive and sensitive to measurement error. This study uses a nationally representative time-use survey from India to investigate how self and proxy reporting impacts the reported time spent on various activities by men and women. Proxy informants tend to report higher time use for both men and women on employment activities (14 to 26 percent) and lower time use on production for self-consumption, unpaid domestic work, and care work (5 to 33 percent) as compared to self-reports. On average, women proxies differ more from self-reports when reporting about both men and women in their households as compared to men proxies. Investigating the mechanisms we find that the self–proxy differences are systematic and not attributable solely to random measurement error. Information asymmetry between the self and proxy respondents plays a key role—spouses and self–proxy respondents with similar characteristics have smaller reporting differences than non-spouses and other respondents. Gendered perception of what activities are classified as work influences the differences in reporting, which highlights asymmetric measurement error.
Variation in Corticosteroid Prescribing Practices for Patients With Septic Shock
Authors: Soni Kanupriya , Minturn John S. , Davis Billie S. , Bukowski Leigh A. , Kahn Jeremy M. , Barbash Ian J. 
Published: February 2025

OBJECTIVES:
Understanding sources of variation in acute care delivery may inform targeted strategies to promote evidence-uptake. We sought to characterize physician-level and ICU-level variation in corticosteroid prescribing for patients with septic shock.

DESIGN:
We performed a retrospective cohort study using the electronic health record of a multihospital health system. We identified ICU patients with septic shock admitted between 2018 and 2020. Using medication administration data, we determined which patients received corticosteroids within 2 days of vasopressor initiation. We linked each patient to their attending physician of record using digital signatures from clinical documentation. We then fit a hierarchical mixed-effects logistic regression model to identify factors associated with corticosteroid use and quantify variation in corticosteroid administration across physicians and ICUs.

SETTING:
Twenty-six ICUs across nine hospitals in the United States.

PATIENTS:
ICU patients with septic shock.

MEASUREMENTS AND MAIN RESULTS:
Of 5322 patients with vasopressor dependent septic shock, 1294 (24.3%) were treated with corticosteroids within 2 days of vasopressor initiation. We linked these patients to 174 unique attending physicians across 26 ICUs. At the ICU-level, median corticosteroid use was 21.8% (interquartile range [IQR], 18.5–25.7%). At the physician-level, median corticosteroid use was 22.0% (IQR, 11.9–32.7%). In the mixed-effects regression controlling for patient and physician characteristics, 16.5% of the variation in corticosteroid administration was attributable to the ICUs and 10.1% was attributable to the physicians.

CONCLUSIONS:
Both ICUs and physicians contribute to observed variation in the use of corticosteroids for vasopressor dependent septic shock. These findings underscore the need for multilevel interventions to standardize evidence-based practices in critical care.
Society of Critical Care Medicine Guidelines on Adult Critical Care Ultrasonography: Focused Update 2024
Authors: Díaz-Gómez José L. , Sharif Sameer , Ablordeppey Enyo , Lanspa Michael J. , Basmaji John , Carver Thomas , Taylor Jayne Chirdo , Gargani Luna , Goffi Alberto , Hynes Allyson M. , Hernandez Antonio , Kasal Jan , Koratala Abhilash , Kort Smadar , Lindbloom Peter , Liu Rachel , Livezey Pete , Lobo Viveta , Malone Susan , Mayo Paul , Mitchell Carol , Niu Ng , Panebianco Nova , Parekh Madhavi , Price Susana , Sarwal Aarti , Teran Felipe , Via Gabriele , Vieillard-Baron Antoine , Weekes Anthony , Wiley Brandon , Lewis Kimberley , Nikravan Sara 
Published: February 2025

RATIONALE:
Critical care ultrasonography (CCUS) is rapidly evolving with new evidence being published since the prior 2016 guideline.

OBJECTIVES:
To identify and assess the best evidence regarding the clinical outcomes associated with five CCUS applications in adult patients since the publication of the previous guidelines.

PANEL DESIGN:
An interprofessional, multidisciplinary, and diverse expert panel of 36 individuals including two patient/family representatives was assembled via an intentional approach. Conflict-of-interest policies were strictly followed in all phases of the guidelines, including task force selection and voting.

METHODS:
Focused research questions based on Population, Intervention, Control, and Outcomes (PICO) for adult CCUS application were developed. Panelists applied the guidelines revision process described in the Standard Operating Procedures Manual to analyze supporting literature and to develop evidence-based recommendations as a focused update. The evidence was statistically summarized and assessed for quality using the Grading of Recommendations, Assessment, Development, and Evaluation approach. The evidence-to-decision framework was used to formulate recommendations as strong or conditional.

RESULTS:
The Adult CCUS Focused Update Guidelines panel aimed to understand the current impact of CCUS on patient important outcomes as they related to five PICO questions in critically ill adults. A rigorous systematic review of evidence to date informed the panel’s recommendations. In adult patients with septic shock, acute dyspnea/respiratory failure, or cardiogenic shock, we suggest using CCUS to guide management. Given evidence supporting an improvement in mortality, we suggest the use of CCUS for targeted volume management as opposed to usual care without CCUS. Last, there was insufficient data to determine if CCUS should be used over standard care without CCUS in the management of patients with cardiac arrest.

CONCLUSIONS:
The guidelines panel achieved strong agreement regarding the recommendations for CCUS to improve patient outcomes. These recommendations are intended for consideration along with the patient’s existing clinical status.
Environmental Sustainability in ICUs: A Report From the Society of Critical Care Medicine Sustainability Task Force
Authors: Domico Michele , Meyer Matthew J. , Blackburn Laura , Toomey Shari A. , Gooch Megan E. , Nadkarni Vinay M. , Huckleberry Yvonne , Draper Andy , Palmieri Tina L. , Nazer Lama H. , Nader Amjad , Valcin E. Kate , Evans Susan , Al-Hakim Tamara , Murthy Srinivas 
Published: February 2025

Objectives:
The charge of the newly formed Society of Critical Care Medicine Sustainability Task Force is to describe actionable items supporting environmental stewardship for ICUs, to discuss barriers associated with sustainability initiatives and outline opportunities for future impact.

Data Sources:
Ovid Medline, EBSCOhost CINAHL, Elsevier Embase, and Scopus databases were searched through to March 2024 for studies reporting on environmental sustainability and critical care.

Study Selection:
Systematic reviews, narrative reviews, quality improvement projects, randomized clinical trials, and observational studies were prioritized for review. Bibliographies from retrieved articles were scanned for articles that may have been missed.

Data Extraction:
Data regarding environmental sustainability initiatives that aimed to quantify, manage, or mitigate pollution and/or carbon emissions with a focus on ICUs, barriers to change, and opportunities for development were qualitatively assessed.

Data Synthesis:
ICUs are resource-intensive and as such, methods to attenuate carbon emissions and waste can play a substantial role in mitigating the sizable burden of healthcare-related pollution and greenhouse gas emissions. Several initiatives and strategies exist for clinicians and providers to engage in environmental stewardship, with specific attention to avoiding low-value care while maintaining or improving patient safety and high-quality care. Increased focus on sustainability can be met with resistance to change, including institutional, financial, and behavioral barriers. Collaboration and innovative thinking create valuable opportunities for clinicians, patients, families, and policymakers to advocate for patient and planetary health.

Conclusions:
Within the healthcare system, ICUs are well positioned to lead sustainability action, policy, and practice. Critical care teams have the capability and the moral responsibility to mitigate the negative impact of critical care medicine upon our environment and become change agents promoting sustainable healthcare for the benefit of human health.
Effects of visual impairment and its restoration on electroencephalogram during walking in aged females
Authors: Ao Mingxin , Huang Hongshi , Li Xuemin , Ao Yingfang 
Published: February 2025

Abstract

Background:
Visual input significantly influences cerebral activity related to locomotor navigation, although the underlying mechanism remains unclear. This study aimed to analyze the effects of chronic visual impairment and its rehabilitation on sensorimotor integration during level walking in patients with age-related cataract.

Methods:
This prospective case series enrolled 14 female patients (68.4 ± 4.7 years) with age-related cataract, scheduled for consecutive cataract surgeries at the Department of Ophthalmology in Peking University Third Hospital from June 2019 to June 2020. Electroencephalogram (EEG) signals during level walking were recorded using a portable EEG system before and 4 weeks after visual restoration. Walking speed was assessed using the Footscan system. Spectral power of the theta and alpha bands was analyzed with repeated-measures analysis of variance, with Assignment (rest and walking), Phase (preoperative and postoperative), and Electrode sites (F3, Fz, F4, O1, and O2) as within-subject factors.

Results:
Compared to the visual impairment state, theta band power significantly decreased after visual restoration (13.16 ± 1.58 μV2
vs. 23.65 ± 3.48 μV2, P = 0.018). Theta activity was notably reduced during walking (17.24 ± 2.43 μV2
vs. 37.86 ± 6.62 μV2, P = 0.017), while theta power at rest was not statistically significant difference between the two phases (9.44 ± 1.24 μV2
vs. 9.08 ± 1.74 μV2, P = 0.864). Changes in walking speed were correlated with alterations in theta power at O1 (r = −0.574, P = 0.032) and O2 (r = −0.648, P = 0.012) during rest. Alpha band power remained stable during walking and was unaffected by visual status.

Conclusions:
Chronic visual impairment from age-related cataract triggers enhanced cerebral activation of sensorimotor integration to compensate for visual decline during locomotion. This cerebral over-activation is effectively alleviated by visual restoration.
Treatment of Mild-to-moderate Progressive Hemifacial Atrophy by Acellular Dermal Matrix Combined With Preoperative Digital Evaluation
Authors: Cheng Xinhao , Dong Haijiang , Yan Chengxiang , Li Zhibin , Xie Baihui , Li Yu , Liu Huilong , Zhang Yijun , Wang Ximei 
Published: February 2025

Background:
Progressive hemifacial atrophy (PHA) is a rare condition marked by the gradual degeneration of skin, soft tissues, muscles, and, in advanced stages, bone. The primary approach for managing PHA involves surgical interventions to reconstruct and restore the facial contour. The current treatments each present several limitations. Therefore, there is a critical need for innovative therapeutic methodologies for PHA soft-tissue reconstruction.

Methods:
Eight patients diagnosed with Guerrerosantos II and III PHA were included in the study. Preoperative 3-dimensional facial scans were digitally analyzed, and corresponding 3-dimensional-printed models were generated to assess soft-tissue deficiencies. Based on this evaluation, acellular dermal matrix (ADM) was tailored to a stepped, multilayered composite dermis of a specific shape and size. It was then anatomically anchored at precise locations and supplemented with volume filler and ligament-mimicking repairs.

Results:
The location, volume, and thickness of the ADM postoperatively were highly compatible with preoperative evaluations, significantly improving the facial contour and morphological and volumetric differences. All patients achieved good healing without other complications and reported improved postoperative scores on the FACE-Q craniofacial modules (P < 0.05).

Conclusions:
Structural repair of PHA using ADM, guided by preoperative digital assessments, provides a safe, effective, and relatively stable outcome. This approach is innovative for achieving precise facial reconstruction.
Impact of Single Long Stents Versus Overlapping Stents on Clinical Outcomes in Primary PCI
Authors: Machado Guilherme Pinheiro , Negreira-Caamaño Martin , Márquez Daniel Tébar , Moura Schmidt Marcia , Pagnoncelli Alan , Neves de Araujo Gustavo , Cadaval Goncalves Sandro , Wainstein Marco , Schaan de Quadros Alexandre , Jurado-Román Alfonso , Wainstein Rodrigo 
Published: February 2025

Background:
Patients with long coronary lesions undergoing primary percutaneous coronary intervention (pPCI) have higher rates of adverse clinical events. Both stent length and stent overlap are associated with worse outcomes; however, data comparing very long stent (VLS) to overlapping stents (OSs) are limited, particularly during pPCI. This study aimed to compare the impact of a single VLS versus ≥2 OSs on clinical outcomes in a multicenter registry of patients undergoing pPCI.

Methods:
This study included patients with ST-segment elevation myocardial infarction (STEMI) who underwent pPCI using a single VLS (≥38 mm) or ≥2 OS (total stent length, ≥38 mm) in the culprit lesion. After propensity score matching based on tortuosity, calcification, Killip class, culprit lesion length ≥40 mm, and culprit vessel, the final cohort for analysis was selected. The primary endpoint was a combination of mortality and target lesion failure (reinfarction, stent thrombosis, or new revascularization) at 2 years.

Results:
Among 647 consecutive STEMI patients who underwent pPCI between March 2016 and September 2022, 353 received VLS and 294 received OSs. After propensity score matching, 264 patients remained (132 in each group). The occurrence of the primary outcome (VLS: 12.9 vs. OS: 15.9%; P = 0.86), all-cause mortality (VLS: 7.6 vs. OS: 9.8%; P = 0.51), and target lesion failure (VLS: 8.3 vs. OS: 6.8, P = 0.64) were similar between the 2 groups.

Conclusions:
In this cohort of real-world patients with STEMI undergoing pPCI, we found no significant difference in outcomes between VLS and OSs. Both strategies are reasonable treatment options for STEMI patients.
Bivalirudin Versus Heparin in Patients Undergoing Percutaneous Coronary Intervention in Acute Coronary Syndromes
Authors: Krittanawong Chayakrit , Ahuja Tania , Wang Zhen , Qadeer Yusuf Kamran , Moras Errol , Virk Hafeez Ul Hassan , Alam Mahboob , Jneid Hani , Sharma Samin 
Published: February 2025

Introduction:
Data on outcomes between unfractionated heparin and bivalirudin anticoagulation during percutaneous coronary intervention (PCI) in acute coronary syndromes remain inconclusive. We aimed to systematically analyze PCI outcomes by comparing unfractionated heparin and bivalirudin.

Methods:
We systematically searched Ovid MEDLINE, Ovid Embase, Ovid Cochrane Database of Systematic Reviews, Scopus, and Web of Science from database inception in 1966 through January 2024 for studies evaluating PCI outcomes comparing unfractionated heparin and bivalirudin. Two investigators independently reviewed the data. Conflicts were resolved through consensus. Random-effects meta-analyses were used.

Results:
A total of 10 prospective trials were identified that enrolled 42,253 individuals who presented with an acute coronary syndrome. Our analysis found that heparin when compared to bivalirudin was associated with an increased risk of trial-based definition of major bleeding [relative risk (RR): 1.68, 95% confidence interval (CI): 1.29–2.20], nonaccess site complications (RR: 4.6, 95% CI: 1.75–12.09), thrombolysis in myocardial infarction major bleeding (RR: 1.70, 95% CI: 1.20–2.41), major bleeding risks (RR: 1.87, 95% CI: 1.49–2.36), cardiovascular disease death (RR: 1.26, 95% CI: 1.02–1.57), and thrombocytopenia (RR: 1.67, 95% CI: 1.07–2.62). There were no statistically significant differences between heparin and bivalirudin for all-cause mortality, major adverse cardiovascular event, stroke, reinfarction, target vessel revascularization, and acute or stent thrombosis.

Conclusions:
The present meta-analysis demonstrates bivalirudin reduces major bleeding when used for anticoagulation during PCI in patients with acute coronary syndromes and is not associated with an increased risk of stent thrombosis or major adverse cardiovascular event.
Self-Collected Vaginal Specimens for HPV Testing: Recommendations From the Enduring Consensus Cervical Cancer Screening and Management Guidelines Committee
Authors: Wentzensen Nicolas , Massad L. Stewart , Clarke Megan A. , Garcia Francisco , Smith Robert , Murphy Jeanne , Guido Richard , Reyes Ana , Phillips Sarah , Berman Nancy , Quinlan Jeffrey , Lind Eileen , Perkins Rebecca B. ,   Enduring Consensus Cervical Cancer Screening and Management Guidelines Committee
Published: February 2025

Objective
The Enduring Consensus Cervical Cancer Screening and Management Guidelines Committee developed recommendations for the use of self-collected vaginal specimens for human papillomavirus (HPV) testing in health care settings.

Methods
A comprehensive literature search was performed, external systematic reviews were evaluated, and HPV genotype agreement between self-collected vaginal and clinician-collected cervical specimens was summarized. Recommendations considered available data, public comments, and expert consensus. Recommendations were ratified through a vote by the Consensus Stakeholder Group.

Results
Clinician-collected cervical specimens are preferred and self-collected vaginal specimens are acceptable for primary HPV screening of asymptomatic average-risk individuals. Repeat testing in 3 years is recommended following HPV-negative screens using self-collected vaginal specimens. Colposcopy with collection of cytology and biopsies is recommended following positive tests for HPV types 16 and 18. Clinician-collected cytology or dual stain for triage testing is recommended following positive tests for HPV 45, 33/58, 31, 52, 35/39/68, or 51 or for pooled HPV other types but negative for HPV 16 or 18. Repeat HPV testing in 1 year is recommended following a positive test for HPV types 56/59/66 and no other carcinogenic types. Minimal data exist on use of self-collected vaginal specimens for surveillance following abnormal screening test results, colposcopy or treatment, and therefore, clinician-collected cervical specimens are preferred.

Conclusions
Human papillomavirus testing of self-collected vaginal specimens expands cervical cancer screening options and has potential to increase access for currently underscreened individuals. Laboratory and clinical workflows will need to be modified to ensure adequate specimen processing and follow-up.