bluuebunny/crossref_metadata_2025_split huggingface dataset:
Education modalities for serious illness communication training: A scoping review on the impact on clinician behavior and patient outcomes
Authors: Lavecchia Melissa , Myers Jeff , Bainbridge Daryl , Incardona Nadia , Levine Oren , Steinberg Leah , Schep Daniel , Vautour Joanna , Kumar Shilpa Jyothi , Seow Hsien 
Published: July 2023

Background: Several clinician training interventions have been developed in the past decade to address serious illness communication. While numerous studies report on clinician attitudes and confidence, little is reported on individual education modalities and their impact on actual behavior change and patient outcomes. Aim: To examine what is known about the education modalities used in serious illness communication training and their impact on clinician behaviors and patient outcomes. Design: A scoping review using the Joanna Briggs Methods Manual for Scoping Reviews was conducted to examine studies measuring clinician behaviors or patient outcomes. Data sources: Ovid MEDLINE and EMBASE databases were searched for English-language studies published between January 2011 and March 2023. Results: The search identified 1317 articles: 76 met inclusion criteria describing 64 unique interventions. Common education modalities used were: single workshop ( n = 29), multiple workshops ( n = 11), single workshop with coaching ( n = 7), and multiple workshops with coaching ( n = 5); though they were inconsistently structured. Studies reporting improved clinician skills tended to be in simulation settings with neither clinical practice nor patient outcomes explored. While some studies reported behavior changes or improved patient outcomes, they did not necessarily confirm improvements in clinician skills. As multiple modalities were commonly used and often embedded within quality improvement initiatives, the impact of individual modalities could not be determined. Conclusion: This scoping review of serious illness communication interventions found heterogeneity among education modalities used and limited evidence supporting their effectiveness in impacting patient-centered outcomes and long-term clinician skill acquisition. Well-defined educational modalities and consistent measures of behavior change and standard patient-centered outcomes are needed.
Analysis of Pulpal Stress in Varied Orthodontic Tooth Movements at Different Bone Levels: A Finite Element Analysis
Authors: Kathia Rakshita , Singla Anshul , Singh Vishal , Puri Amrita 
Published: July 2023

Aim To analyze the pulpal stress in varied orthodontic tooth movements at ideal force levels and different bone levels, and compare any differences in pulpal stress values between anterior and posterior teeth. Materials and Methods Four Finite Element Method models of incisor and molar teeth were simulated with normal bone height and 50% bone height. Each of these models was loaded with five different types of orthodontic tooth movements—Tipping, Translation, Intrusion, Extrusion, and Rotation. The ideal force levels simulated for each type of tooth movement were: Intrusion-20 g, Extrusion-60 g, Tipping-60 g, Translation-120 g, Rotation-60 g. The pulpal stress was evaluated at three levels—pulp chamber, pulp canal, and below root apex, so that we get three values of pulpal stress for anterior and posterior teeth, for each type of tooth movement and its corresponding force level. Results The results showed that in both incisor and molar models with normal bone height as well as 50% bone height, rotation gave the highest pulpal stress while translation gave the least. In both incisor and molar models with normal bone height as well as 50% bone height, pulpal stress was found out to be highest in the root apex region of the tooth. The stress values for incisor and molar models with 50% bone height were found to be almost double that of the models with normal bone height. The pulpal stress for incisor teeth was found to be greater than the molar teeth for all types of tooth movement. Conclusion The present findings indicate that the stress manifested below the root apex is highest. Rotational movements induce the highest stress and translational forces develop the lowest stress related to the physiologic capillary blood pressure. Furthermore, in situations with reduced periodontium, lower forces are needed to reach the maximum tolerable stress compared with teeth with intact periodontium.
Typologies and Features of Play in Mobile Games for Mental Wellbeing
Authors: Reay Emma , Ma Minhua , Krzywinska Tanya , Pavarini Gabriela , Hugh-Jones Siobhan , Mankee-Williams Anna , Belinskiy Anton , Bhui Kamaldeep 
Published: July 2023

Background The smartphone market is saturated with apps and games purporting to promote mental wellness. There has been a significant number of studies assessing the impact of these digital interventions. Motivation The majority of review papers solely focussed on the impact of strict rules and award systems of the apps. There is comparatively little attention paid to other game techniques designed to encourage creativity, a lusory attitude, and playful experiences. Results This gap is addressed in this paper in a consideration and analysis of a purposive selection of six mobile games marketed for wellbeing, our focus is on both external and internal motivations that these games offer. Our specific interest is how these games balance rule-based play with creativity. We find that ludic play is a highly-structured, rule-bound, goal-oriented play, in contrast to paedic play which a freeform, imaginative, and expressive. We argue that while ludic play is purposed towards the promotion of habit formation and generates feelings of accomplishment, it nonetheless relies heavily on extrinsic motivation to incentivise engagement. By contrast, paidic play, specifically role-playing, improvisation, and the imaginative co-creation of fictional game worlds, can be used effectively in these games to facilitate self-regulation, self-distancing, and therefore provides intrinsically-motivated engagement. In the context of games for mental wellbeing, ludic play challenges players to complete therapeutic exercises, while paidic play offers a welcoming refuge from real world pressures and the opportunity to try on alternate selves. Conclusion Our intention is not to value paidic play over ludic play, but to consider how these two play modalities can complement and counterbalance each other to generate more effective engagement.
Clinical Implications of Microscopic Colitis Isolated to Polyps
Authors: Miller Caroline , Whitney-Miller Christa , Ettel Mark G. 
Published: July 2023

Microscopic colitis is generally identified on random colon biopsies performed for chronic diarrhea, but rarely incidental polyps have histologic features of microscopic colitis. We compared patients with polypoid microscopic colitis to control patients with conventional polyps to determine the implications of polypoid microscopic colitis. Medical records were searched for patients without prior or concurrent microscopic colitis who were found to have polypoid microscopic colitis. For each patient with polypoid microscopic colitis, one patient with conventional polyps was selected as a control. We reviewed the histologic features of each polypoid microscopic colitis specimen, and evaluated endoscopic and clinical findings for polypoid microscopic colitis patients and controls. Twenty-six patients with polypoid microscopic colitis were identified with histologic features of collagenous colitis in 8 patients (31%) and lymphocytic colitis in 18 patients (69%). Polypoid microscopic colitis was unifocal in 14 patients (54%) and multifocal in 12 patients (46%). Patients with polypoid microscopic colitis were older than control patients (median age = 60 years vs 66 years, P = .04). On follow-up 7 patients with polypoid microscopic colitis (33%) developed chronic diarrhea compared to 3 (12%) controls ( P = .16). Of patients with follow-up biopsies, 1 patient with polypoid microscopic colitis (13%) and no control patients developed microscopic colitis ( P = 1). Polypoid microscopic colitis may be identified in asymptomatic patients and most patients do not develop chronic diarrhea, but some patients with polypoid microscopic colitis develop diarrhea (33% vs 12% in controls) or conventional microscopic colitis on follow-up. Thus pathologists should distinguish polypoid microscopic colitis from conventional microscopic colitis but may inform clinicians of the uncertain association with chronic diarrhea to guide decisions regarding follow-up.
Acute angle-closure related with choroidal metastasis from lung adenocarcinoma: A case report and literature review
Authors: Kuo Chen-Jung , Hung Chih-Heng , Tu Pei-Ning , Chen Yi-Chun 
Published: July 2023

Purpose Acute angle-closure is a rare manifestation of choroidal metastasis. We reported a case of choroidal metastasis from lung adenocarcinoma presenting with unilateral acute angle-closure attacks relieved with radiotherapy after failed conventional medical and laser treatments. This represented the first detailed report of treatments of secondary acute angle-closure attacks in patients with choroidal metastasis Case description A 69-year-old female without ocular history was diagnosed with metastatic lung adenocarcinoma. One month later, she complained of blurred vision and pain in the right eye that lasted 2 days. IOP was 58 mmHg and best-corrected visual acuity (BCVA) was counting finger in the right eye. Slit-lamp examination revealed corneal edema with ciliary congestion, extremely shallow anterior chamber both centrally and peripherally, mid-dilated pupil and moderate cataract in the right eye. While the left eye was normal. B-scan ultrasound and orbital computed tomography showed an appositional choroidal detachment with an underlying choroidal thickening suggesting choroidal metastasis in the right eye. There was limited effect of medical and laser therapy. IOP was 9 mmHg in the right eye after two months of palliative external beam radiotherapy in the right orbit. BCVA was hand motion in the right eye. Slit lamp examination revealed clear cornea, deep anterior chamber in the right eye. Regression of choroidal detachment and choroidal metastasis in the right eye were observed in B-scan ultrasound. Conclusion This case demonstrated that patient with secondary acute angle-closure attacks from large bullous choroidal detachment related to choroidal metastasis could only be successfully treated with radiotherapy as both medical and laser therapy might not be capable of breaking angle-closure attacks.
Changes in the uninjected contralateral eye after intravitreal brolucizumab for exudative age-related macular degeneration
Authors: Mora Paolo , Bellucci Carlo , Radice Lorenzo M. , Manzotti Francesca , Gandolfi Stefano 
Published: July 2023

Purpose Herein we describe the change in the amount of macular oedema in one eye after contralateral intravitreal brolucizumab injections in a patient with neovascular age-related macular degeneration (nAMD). Case Report A patient with bilateral nAMD underwent intravitreal bevacizumab injections in both eyes with little improvement in the best-corrected visual acuity (BCVA) and central macular exudation. The treatment was switched to aflibercept, but there was incomplete drying of the macula in both eyes. After uneventful cataract extraction, the central macular thickness (CMT) increased markedly in the operated left eye (LE), which was unresponsive to subtenon triamcinolone and further intravitreal aflibercept. Cataract surgery was also performed in the right eye (RE) combined with an intravitreal sustained-release dexamethasone implant. Nevertheless, the CMT increased. Intravitreal brolucizumab injections were performed in the RE with almost complete disappearance of the oedema in the treated eye. Concurrently, the contralateral uninjected eye showed a remarkable decrease in CMT. Five months after the first brolucizumab injection, the macular exudation increased again in both eyes. A second brolucizumab injection was performed in the RE only, and was followed by a prompt reduction in CMT in both the injected RE and uninjected LE. Conclusions Although contralateral retinal changes have been described for many other vascular endothelial growth factor inhibitors, there is little evidence for brolucizumab. We describe a repeated dose- and time-related effect on the uninjected eye in a case of nAMD.
Racial disparities in lower extremity orthopaedic injuries presenting to U.S. emergency departments from 2010 to 2020
Authors: Gupta Arjun , Singh Priya , Badin Daniel , Mo Kevin C , Greenberg Marc , Musharbash Farah N , Hughes Alice J , Ficke James R , Aiyer Amiethab A 
Published: July 2023

Introduction Racial and ethnic disparities remain a major problem in orthopedic surgery, driving inequitable resource distribution, disparate clinical outcomes, and increased healthcare costs. The objective of this study was to investigate potential racial/ethnic disparities in the incidence and injury patterns of orthopedic lower extremity trauma (LET) in the United States over the past 10 years, as well as differences in final disposition outcomes. Materials and Methods The National Electronic Injury Surveillance System database was queried for all orthopedic LET presenting to U.S. emergency departments from 2010 to 2020. Incidence rate ratios (IRR) were used to compare incidence rates between racial/ethnic groups. Multivariate logistic regression was performed to compare disposition outcomes. Results Black/African Americans (Black/AAs) consistently experienced the highest incidence of LET over the 10-year period analyzed (709.108 per 100,000 person-years), followed by Whites (547.159 per 100,000 person-years). Furthermore, Black/AAs had the highest incidence of polytrauma (114.19 per 100,000 person-years), over 1.7x greater than Whites (IRR: 1.73 [95% confidence interval (CI): 1.72–1.75]). Black/AAs had over 2-fold higher odds of death after LET compared to Whites (adjusted odds ratio [aOR] 2.15 [95% CI: 1.78–2.59]). By 2019 to 2020, the incidence of deaths among Black/AAs reached more than triple that of Whites (IRR: 3.50 [95% CI: 2.74–4.46]). Black/AAs were also the most likely to be discharged against medical advice (AMA) (aOR: 1.94 [95% CI: 1.92–1.96]), and the least likely to be admitted as inpatients (aOR: 0.683 [95% CI: 0.679–0.688]). Conclusions Despite Black/AAs experiencing a disproportionately higher incidence of LET and over 2-fold greater odds of death compared to Whites, they were also the most likely to be discharged AMA and least likely to be admitted as inpatients. Understanding the effects of conscious/unconscious biases and the importance of effective communication and patient education may help physicians ensure that injuries in this patient population are not prematurely discharged, potentially improving clinical outcomes, and reducing mortality. Level of Evidence III.
Indocyanin Green Fluorescence Evaluation of Colonic Perfusion During Elective Open Abdominal Aortic Aneurysm Repair
Authors: Tam Adam , Abdel-Rahim Ahmed , Dix Francis , Barwell Jamie , Mittapalli Devender 
Published: July 2023

Objectives Colonic ischaemia is a rare but devastating complication of open aortic aneurysm repair and is associated with high morbidity and a mortality of up to 50%. The aim of this study was to determine the safety and effectiveness of using indocyanin green florescence (ICG) to interrogate colonic perfusion intra-operatively. Design Prospective observational study. Methods All elective open abdominal aneurysm repairs over a 6 month period underwent colonic perfusion interrogation with ICG according to a pre-defined protocol. Patient demographics and imaging findings were recorded prior to surgery. ICG was given just prior to laparotomy closure. Time to florescence was measured from the start of IV administration to surgeon defined maximal florescence of the sigmoid colon. Results Ten patients fulfilled the inclusion criteria. All patients were male with an average age of 69.7 years. Inferior mesenteric artery reimplantation was performed in 5 patients. Median colonic fluorescence time was 58 s. No complications related to ICG were identified. A single patient had clinical concern of colonic ischaemia and delayed perfusion (>3 min) on ICG; colorectal opinion advised not for immediate resection. At relook laparotomy, ischaemic colon at the area of demarcation was noted and a Hartmann’s procedure was performed. No other patients had delayed perfusion and no further episodes of colonic ischaemia were noted. IMA reimplantation did not show statistical difference in colonic ICG time ( P = .81, 95% CI -1.98 to 2.45). There was no statistical difference between operating times between the cohort and all repairs performed 6 months before the data collection ( P = .59, 95% CI -.73 to 1.24). Conclusion In this pilot study ICG appears to be a safe and useful adjunct in objective assessment of colonic perfusion during open AAA repair. Further research is required to fully determine its role in this cohort of patients.
Pre-operative exercise therapy to increase blood vessel diameter in patients undergoing radiocephalic arteriovenous fistula creation
Authors: Ong Chee Wui , Lo Zhiwen Joseph , Liang Shanying , Hong Qiantai , Zhang Li , Lingam Pravin , Chong Lester , Chandrasekar Sadhana , Tan Glenn Wei Leong , Yong Enming 
Published: July 2023

Background Post-operative upper extremity exercise is recommended to patients with arteriovenous fistulas. It is postulated that increased blood flow to vessels improves maturation and patency rates. Recent studies favour pre-operative exercise therapy to improve the outcomes of arteriovenous fistula creation. Objectives To investigate if pre-operative exercise therapy increases vessel diameter and maturation in patients undergoing distal arteriovenous fistula creation. Methods 34 patients planned for radiocephalic arteriovenous fistula creation were recruited at a tertiary university hospital Vascular Surgery Unit. Patients underwent a 6-week period of self-directed daily upper extremity exercises before surgery. Patients were reviewed up to 6 months post-surgery. The primary outcome investigated was change in venous and arterial diameters following exercise intervention. The secondary outcome investigated was the primary failure rate of the newly created arteriovenous fistulas. Results After exercise therapy, mean hand grip strength increased from 20.3 ± 6.62 kg to 21.9 ± 7.16 kg ( p=.01). There was a statistically significant increase in basilic vein diameter amongst those who demonstrated strict compliance to at least 42 days of pre-operative exercise therapy by 0.51 mm from 3.23 ± 1.09 mm to 3.74 ± 1.31 mm ( p=.03). Primary failure rate of newly created radiocephalic arteriovenous fistulas was 25% (7 of 28), comparable to our previous series of 436 distal arteriovenous fistulas created which had a failure rate of 26%. Conclusions There was a trend of increase in vein diameters after pre-operative exercise therapy. Although not statistically significant, patients with successful arteriovenous fistula creation had longer mean completion of exercise days.
γ-2 and GSG1L bind with comparable affinities to the tetrameric GluA1 core
Authors: Yu Chenlu , Runge Hendrik F. P. , Mukhopadhyay Antara , Zolles Gerd , Ulbrich Maximilian H. 
Published: July 2023

Abstract
Background
The AMPA-type ionotropic glutamate receptor mediates fast excitatory neurotransmission in the brain. A variety of auxiliary subunits regulate its gating properties, assembly, and trafficking, but it is unknown if the binding of these auxiliary subunits to the receptor core is dynamically regulated. Here we investigate the interplay of the two auxiliary subunits γ-2 and GSG1L when binding to the AMPA receptor composed of four GluA1 subunits.

Methods
We use a three-color single-molecule imaging approach in living cells, which allows the direct observation of the receptors and both auxiliary subunits. Colocalization of different colors can be interpreted as interaction of the respective receptor subunits.

Results
Depending on the relative expression levels of γ-2 and GSG1L, the occupancy of binding sites shifts from one auxiliary subunit to the other, supporting the idea that they compete for binding to the receptor. Based on a model where each of the four binding sites at the receptor core can be either occupied by γ-2 or GSG1L, our experiments yield apparent dissociation constants for γ-2 and GSG1L in the range of 2.0–2.5/µm2.

Conclusions
The result that both binding affinities are in the same range is a prerequisite for dynamic changes of receptor composition under native conditions.
Supervised topological data analysis for MALDI mass spectrometry imaging applications
Authors: Klaila Gideon , Vutov Vladimir , Stefanou Anastasios 
Published: July 2023

AbstractBackgroundMatrix-assisted laser desorption/ionization mass spectrometry imaging (MALDI MSI) displays significant potential for applications in cancer research, especially in tumor typing and subtyping. Lung cancer is the primary cause of tumor-related deaths, where the most lethal entities are adenocarcinoma (ADC) and squamous cell carcinoma (SqCC). Distinguishing between these two common subtypes is crucial for therapy decisions and successful patient management.ResultsWe propose a new algebraic topological framework, which obtains intrinsic information from MALDI data and transforms it to reflect topological persistence. Our framework offers two main advantages. Firstly, topological persistence aids in distinguishing the signal from noise. Secondly, it compresses the MALDI data, saving storage space and optimizes computational time for subsequent classification tasks. We present an algorithm that efficiently implements our topological framework, relying on a single tuning parameter. Afterwards, logistic regression and random forest classifiers are employed on the extracted persistence features, thereby accomplishing an automated tumor (sub-)typing process. To demonstrate the competitiveness of our proposed framework, we conduct experiments on a real-world MALDI dataset using cross-validation. Furthermore, we showcase the effectiveness of the single denoising parameter by evaluating its performance on synthetic MALDI images with varying levels of noise.ConclusionOur empirical experiments demonstrate that the proposed algebraic topological framework successfully captures and leverages the intrinsic spectral information from MALDI data, leading to competitive results in classifying lung cancer subtypes. Moreover, the framework’s ability to be fine-tuned for denoising highlights its versatility and potential for enhancing data analysis in MALDI applications.