bluuebunny/crossref_metadata_2025_split huggingface dataset:
The first report of Champsosaurus lindoei (Choristodera: Champsosauridae) from the Campanian of the United States: anatomical, phylogenetic, and palaeoecological significance
Authors: Dudgeon Thomas W , Mallon Jordan C , Evans David C 
Published: August 2023

Abstract
Although the neochoristodere Champsosaurus is well documented in Campanian deposits of western North America, species-diagnostic remains from these strata are restricted to the Dinosaur Park Formation of Alberta, Canada. Here, we describe an exceptionally well-preserved specimen of Champsosaurus lindoei from the Two Medicine Formation of Montana, USA—one of the few occurrences of the genus within the formation, and the first confirmed occurrence of C. lindoei outside of Dinosaur Provincial Park and its vicinity. This specimen preserves previously unknown aspects of this species, including the pes, tail, and integument, allowing for the first detailed postcranial description in this taxon. The integumentary impressions preserved on the ventral surface are the largest described thus far for Champsosaurus, supporting previous suggestions that Champsosaurus scales increase in size ventrally. We also conducted the first species-level phylogeny for Champsosaurus, where we recovered a pectinate tree topology with Palaeocene species as the sister taxa to older Maastrichtian and Campanian species, and provide further evidence for at least three lineages of Champsosaurus surviving the Cretaceous-Palaeogene (K-Pg) extinction. Finally, the recovery of the specimen from the semi-arid upland deposits of the Two Medicine Formation suggests that Champsosaurus may have been better able to withstand drier environments than previously thought.
Current Perspectives on Pressure Injuries in Persons with Dark Skin Tones from the National Pressure Injury Advisory Panel
Authors: Black Joyce , Cox Jill , Capasso Virginia , Bliss Donna Z. , Delmore Barbara , Iyer Vignesh , Massaro Jacqueline , Munro Cassendra , Pittman Joyce , Ayello Elizabeth A. 
Published: August 2023

ABSTRACT

Background
Pressure injury (PI) development is multifactorial. In patients with dark skin tones, identifying impending PIs by visual skin assessment can be especially challenging. The need for improved skin assessment techniques, especially for persons with dark skin tones, continues to increase. Similarly, greater awareness of the need for inclusivity with regard to representation of diverse skin colors/tones in education materials is apparent.

Objective
To provide current perspectives from the literature surrounding skin assessment and PI development in patients with dark skin tones.

Methods
The following elements will be discussed through the lens of skin tone: (1) historical perspectives of PI staging from the National Pressure Injury Advisory Panel, (2) epidemiology of PI, (3) anatomy and physiology of the skin, (3) skin tone assessment and measurement, (4) augmented visual assessment modalities, (5) PI prevention, (6) PI healing, (7) social determinants of health, and (8) gaps in clinician education.

Conclusions
This article highlights the gap in our clinical knowledge regarding PIs in patients with dark skin tones. Racial disparities with regard to PI development and healing are especially clear among patients with dark skin tones. Skin tone color assessment must be standardized and quantifiable in clinical education, practice, and research. This work is urgently needed, and support from private and governmental agencies is essential.
Enterovirus Central Nervous System Infection in Infancy, the Value of Routine Testing
Authors: Giva Sheiniz , Barry Rachel , Drew Richard J. , Geoghegan Sarah 
Published: August 2023

Background:
Human nonpolio enterovirus (EV) is a major cause of infection in neonates and infants; however, the clinical presentation and cerebrospinal fluid findings vary significantly. Infection caused by EV in patients under 1 year of age can present with a broad clinical spectrum, from fever to severe systemic and/or neurological disease.

Methods:
Retrospective cohort analysis of infants with EV central nervous system (CNS) infection presenting to a tertiary center between January 2017 and December 2022. We recorded patient demographics, parent-reported symptoms at presentation, and blood and cerebrospinal fluid (CSF) testing at presentation.

Results:
Seventy-eight patients were included in the final study. Forty-one percent of infants with an EV CNS infection had a normal CSF white blood cell count. Clinical presentation was similar in infants with and without CSF pleocytosis. Median C-reactive protein was higher in cases of EV CNS infection without pleocytosis.

Conclusion:
EV CNS infection commonly presents without CSF pleocytosis. Testing for EV should be considered in febrile infants with no source regardless of CSF parameters.
Who Hurt You at Work? Results From a Nationwide Survey of Association Between Absenteeism and Workplace Violence, Stratified by Perpetrator
Authors: Lee Na-Rae , Lee Kyung-Jae , Lee June-Hee 
Published: August 2023

Objective
This study aimed to determine the association between workplace violence and sickness absenteeism.

Methods
We analyzed the data from the fifth and sixth waves of the Korean Working Conditions Surveys. Individuals younger than 18 years and self-employed or unpaid family workers were excluded. Descriptive statistics, χ2 tests, and multiple logistic regression analysis were conducted.

Results
After adjusting for sociodemographic, occupational, and job-related characteristics, we found that the workers who had experienced workplace violence had higher rates of sickness absenteeism, especially when the perpetrator of violence was a coworker.

Conclusions
Daily contact with the perpetrator at the workplace can cause distress and recollection of painful memories; thus, the aftermath of being harassed inside the workplace can be even more devastating than the event itself. A sensitive approach to recognizing the perpetrators of violence is needed.
Sonomyography for Control of Upper-Limb Prostheses: Current State and Future Directions
Authors: Engdahl Susannah M. , Acuña Samuel A. , Kaliki Rahul R. , Sikdar Siddhartha 
Published: August 2023

ABSTRACT

Problem Statement
Despite the recent advancements in technology, many individuals with upper-limb loss struggle to achieve stable control over multiple degrees of freedom in a prosthesis. There is an ongoing need to develop noninvasive prosthesis control modalities that could improve functional patient outcomes.

Proposed Solution
Ultrasound-based sensing of muscle deformation, known as sonomyography, is an emerging sensing modality for upper-limb prosthesis control with the potential to significantly improve functionality. Sonomyography enables spatiotemporal characterization of both superficial and deep muscle activity, making it possible to distinguish the contributions of individual muscles during functional movements and derive a large set of independent prosthesis control signals. Using sonomyography to control a prosthesis has shown great promise in the research literature but has not yet been fully adapted for clinical use. This article describes the implementation of sonomyography for upper-limb prosthesis control, ongoing technological development, considerations for deploying this technology in clinical settings, and recommendations for future study.

Clinical Relevance
Sonomyography may soon become a clinically viable modality for upper-limb prosthesis control that could offer prosthetists an additional solution when selecting optimal treatment plans for their patients.
Triage Value of Cervical Exfoliated Cell DNA Ploidy Analysis in Cervical High-Risk Human Papillomavirus–Positive Women
Authors: Chu Boliang , Dong Jie , Chen Yingying , Ru Xiaofang , Zhang Wenwen , Chen Yun , Zhang Xiaoxing , Cheng Xiaodong 
Published: August 2023

Objective
This study aimed to investigate the triage value obtained in DNA ploidy analysis of cervical exfoliated cells in women with high-risk human papillomavirus (HR-HPV)-positive status in the primary screening of cervical cancer.

Methods
The authors selected 3,000 HR-HPV–positive women for cervical exfoliated cell sampling and conducted DNA ploidy analysis, liquid-based cytology (LBC), colposcopy, and cervical biopsy. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of high-grade squamous intraepithelial lesion (HSIL)-positive detection between DNA ploidy analysis and LBC were compared according to histopathology diagnosis as the golden criteria, and the efficacy of predicting HSIL-positive immediate risk was evaluated.

Results
A total of 2,892 HR-HPV–positive women were enrolled in the investigation. For HSIL+ women, the DNA ploidy group showed a significantly higher sensitivity (CIN2+: 79.21% vs 65.35%, p = .022; CIN3+: 81.48% vs 70.37%, p = .013), lower specificity (CIN2+: 85.00% vs 96.59%, p < .001; CIN3+: 84.14% vs 93.41%, p < .001), and lower PPV (CIN2+: 16.23% vs 29.33%, p = .001; CIN3+: 8.92% vs 16.89%, p = .002) compared with the LBC group, whereas the NPV showed no significant difference. Compared with LBC alone in diagnosing HSIL, DNA ploidy combined with LBC showed higher specificity (CIN2+: 99.21% vs 96.59%, p = .003; CIN3+: 96.48% vs 93.41%, p < .001) and higher PPV (CIN2+: 41.35% vs 29.33%, p = .022; CIN3+: 24.81% vs 16.89%, p = .028), whereas no significant difference was observed in the sensitivity (CIN2+: 54.46% vs 65.35%, p = .063; CIN3+: 61.11% vs 70.37%, p = .221) and NPV (p > .05). Among the HR-HPV–positive women positive for DNA ploidy, the imminent risk of CIN2+ and CIN3+ were 15.62% and 8.92%, respectively, above the threshold for the colposcopy positive rate. Among the positive cases both for DNA ploidy and the LBC result of negative for intraepithelial lesion or malignancy, the immediate risk of CIN3+ was 3.31%, below the threshold for colposcopy positive rate. Besides, for women with LBC result of ASC-US and above, the immediate risk of CIN3+ was greater than 4%.

Conclusions
The DNA ploidy analysis can be used as an effective triage method for HR-HPV–positive women during the primary screening of cervical cancer, although it can provide higher specificity when combined with LBC and reduce the referral rate for colposcopy.
Content Validity of a High-Fidelity Surgical Middle Ear Simulator: A Randomized Prospective International Multicenter Trial
Authors: Youner Emily R. , Chillakuru Yeshwant R. , Xu Helen , Dedmon Matthew , Labadie Robert , Djalilian Hamid , Mahboubi Hossein , Westerberg Brian , Vaisbuch Yona , Blevins Nikolas , Chen Joseph , Lin Vincent , Joyce Morgan G. , Moncada Paola X. , Dabiri Sasan , Gurgel Richard K. , Kouhi Ali , Monfared Ashkan S. 
Published: August 2023

Objective
After demonstration of face validity of a surgical middle ear simulator (SMS) previously, we assessed the content validity of the simulator with otolaryngology residents.

Study Design
Multicenter randomized prospective international study.

Setting
Four academic institutions.

Methods
Novice participants were randomized into control, low-fidelity (LF), and high-fidelity (HF) groups. Control and LF produced 2 recordings from 2 attempts, and HF produced 4 recordings from 10 attempts, with trials 1, 4, 7, and 10 used for scoring. Three blinded experts graded videos of the simulated stapedectomy operation using an objective skills assessment test format consisting of global and stapedotomy-specific scales.

Results
A total of 152 recordings from 61 participants were included. Baseline characteristics did not differ significantly between groups. Depending on the step of the operation, inter-rater reliability ranged from 24 to 90%. For LF and HF, years of training was significantly associated with improved scores in certain objective skills assessment test subparts. HF outperformed the control group on stapes and global scores (p < 0.05). The HF group demonstrated improvement in global score over trials, but plateaued after four trials. Scores varied greatly for participants from different institutions in certain operative steps, such as transecting incudostapedial joints, likely due to differences in instrumentation and time elapsed since manufacture.

Conclusion
Practice with SMS led to better performance in both global and stapes-specific scores. Further studies are needed to examine construct validity and to create otology-appropriate grading systems. Variables like instrumentation and decline in flexibility of the simulator after 12 months greatly affect performance on the simulator.
Application of Field Sterility to Safely Reduce Cost and Waste in Cleft Surgery
Authors: Taub Peter J. , Oleru Olachi , Mandelbaum Max G. , Seyidova Nargiz 
Published: August 2023

Background:
Healthcare spending in the United States remains a major concern, requiring reforms to control spending and curtail costs. Medical supply is one of the largest expenses for hospitals and strategies should be utilized to reduce nonbeneficial service delivery, which increases cost without concomitant increase in value. Introduction of field sterility is one of the potential strategies that has been applied in several surgical disciplines to improve cost-efficiency by reducing overuse of resources and decreasing enormous medical waste. Of course, this must be applied without a diminution in safety.

Methods:
The PubMed, Medline, and Cochrane databases from 1980 to 2022 were used to review literature. Key words included “cleft surgery and field sterility,” “sterile gloves and oral surgery,” “oral surgery and field sterility,” “sterile techniques and cleft palate surgery,” “sterile versus nonsterile gloves,” “sterile and non-sterile gloves and minor surgery,” “skin laceration repair and sterile techniques,” “sterile gloves and wound suture,” “surgical site infection and field sterility,” “operating room versus clinical setting,” “operating rooms economics and hand surgery,” and “main operating room versus ambulatory.”

Results:
The literature search yielded 827 articles. Following evaluation of titles, abstracts, and manuscript contents, 23 articles were ultimately included, of which 10 discussed field sterility and cost-efficiency for cutaneous procedures, 9 hand surgery, and 4 oral surgery. There was no study evaluating field sterility application in cleft surgery. In the reviewed studies, no statistical significance was observed in surgical site infection (SSI) with substantial cost savings and medical waste reduction when hand procedures were performed in ambulatory settings with field sterility compared to the main operating room (OR). Furthermore, no difference was observed for SSI in wound closure, excision of skin lesions, or Mohs micrographic surgery when nonsterile gloves were used.

Conclusion:
The incidence of infection following most cleft-related procedures remains low. As such, the application of field sterility may be ideal for this setting. The cost and waste associated with standard operating protocols are not warranted for many cleft procedures.
Diagnostic accuracy of CEUS in identifying Solid Pancreatic Lesions:- A meta analysis
Authors: Desai Dev , Patel Shimolee , Shah Hetvi , Shah Abhijay , Verma Anushka , Malafi Maria Eleni 
Published: August 2023

AbstractBackgroundSolid pancreatic lesions are crucial to identify because of their high incidence rate and their poor survival rate. Surgical biopsy, ultrasonography, computed tomography, MRI, and PET-CT are examples of diagnostic tools. Although common, endoscopic ultrasonography guided biopsy carries a risk of needle track seeding. A more effective and affordable method for determining the differential diagnosis of solid pancreatic lesions is contrast-enhanced ultrasonography (CEUS). CEUS is a less nephrotoxic method that uses a contrast chemical to distinguish between teratomas, benign tumors, and neuroendocrine tumors. The goal of this meta-analysis is to evaluate how well CEUS can identify solid pancreatic lesions for use in clinical diagnostic procedures.MethodologyMedical literature comprehensively searched and reviewed without restrictions to particular study designs, or publication dates using PubMed, Cochrane Library and Google Scholar databases for all relevant literature. The extraction of necessary data proceeded after specific inclusion and exclusion criteria were applied. Meta Analysis included 27 RCTs and 3061 patients, and analyzed using the QualSyst yool. The risk of bias was evaluated by using QUADAS-2 analysis.The statistical software packages MetaDiSc 1.4, RevMan (Review Manager, version 5.3), SPSS (Statistical Package for the Social Sciences, version 20) and Excel in Stata 14 were used to perform the statistical analyses.ResultAccording to the findings of four studies, CEUS demonstrates high sensitivity, with values equal to or above 95%, and one study indicates specificity above 95%. True Positive (TP) and True Negative (TN) values are reported as 2080 and 621, respectively, while False Positive (FP) and False Negative (FN) values are noted as 124 and 236. With a 95% confidence interval, CEUS sensitivity is calculated as 0.90 (range: 0.89 to 0.91) and specificity as 0.83 (range: 0.80 to 0.86). The positive predictive value (PPV) of CEUS is estimated at approximately 94.3%. These results highlight CEUS as a promising tool for diagnosing pancreatic lesions.ConclusionThe study concluded that CEUS (Contrast-Enhanced Ultrasound) is an important diagnostic test for pancreatic lesions. This is due to their high sensitivity and specificity, along with other aspects like enhanced visualization, real-time imaging, and safety benefits. Additionally, CEUS is cost-effective, making it a practical choice in healthcare settings with budget constraints.Thus, CEUS remains a valuable asset for healthcare professionals in their efforts to accurately diagnose pancreatic lesions.
A Mixed-Effects Model to Predict COVID-19 Hospitalizations Using Wastewater Surveillance
Authors: Daza–Torres Maria L. , Montesinos-López J. Cricelio , Bischel Heather N. , Naughton Colleen C. , Desai Angel N. , Wolfe Marlene K. , Boehm Alexandria B. , Nuño Miriam 
Published: August 2023

AbstractDuring the COVID-19 pandemic, many countries and regions investigated the potential use of wastewater-based disease surveillance as an early warning system. Initially, methods were created to detect the presence of SARS-CoV-2 RNA in wastewater. Investigators have since conducted extensive studies to examine the link between viral concentration in wastewater and COVID-19 cases in areas served by sewage treatment plants over time. However, only a few reports have attempted to create predictive models for hospitalizations at county-level based on SARS-CoV-2 RNA concentrations in wastewater. This study implemented a linear mixed-effects model that observes the association between levels of virus in wastewater and county-level hospitalizations. The model was then utilized to predict short-term county-level hospitalization trends in 21 counties in California based on data from March 21, 2022, to May 21, 2023. The modeling framework proposed here permits repeated measurements as well as fixed and random effects. The model that assumed wastewater data as an input variable, instead of cases or test positivity rate, showed strong performance and successfully captured trends in hospitalizations. Additionally, the model allows for the prediction of SARS-CoV-2 hospitalizations two weeks ahead. Forecasts of COVID-19 hospitalizations could provide crucial information for hospitals to better allocate resources and prepare for potential surges in patient numbers.
AI-BASED MRI MONITORING IN MULTIPLE SCLEROSIS: REAL-WORLD CLINICAL VALIDATION
Authors: Barnett Michael , Wang Dongang , Beadnall Heidi , Bischof Antje , Brunacci David , Butzkueven Helmut , Brown J William L , Cabezas Mariano , Das Tilak , Dugal Tej , Guilfoyle Daniel , Klistorner Alexander , Krieger Stephen , Kyle Kain , Ly Linda , Masters Lynette , Shieh Andy , Tang Zihao , van der Walt Anneke , Ward Kayla , Wiendl Heinz , Zhan Geng , Zivadinov Robert , Barnett Yael , Wang Chenyu 
Published: August 2023

ABSTRACTModern management of MS targets No Evidence of Disease Activity (NEDA): no clinical relapses, no magnetic resonance imaging (MRI) disease activity and no disability worsening. While MRI is the principal tool available to neurologists for monitoring clinically silent MS disease activity and, where appropriate, escalating treatment, standard radiology reports are qualitative and may be insensitive to the development of new or enlarging lesions. Existing quantitative neuroimaging tools lack adequate clinical validation. In 397 multi-center MRI scan pairs acquired in routine practice, we demonstrate superior case-level sensitivity of a clinically integrated AI-based tool over standard radiology reports (93.3% vs 58.3%), relative to a consensus ground truth, with minimal loss of specificity. We also demonstrate equivalence of the AI-tool with a core clinical trial imaging lab for lesion activity and quantitative brain volumetric measures, including percentage brain volume loss (PBVC), an accepted biomarker of neurodegeneration in MS (mean PBVC -0.32% vs -0.36% respectively), whereas even severe atrophy (>0.8% loss) was not appreciated in radiology reports. Finally, the AI-tool additionally embeds a clinically meaningful, experiential comparator that returns a relevant MS patient centile for lesion burden, revealing, in our cohort, inconsistencies in qualitative descriptors used in radiology reports. AI-based image quantitation enhances the accuracy of, and value-adds to, qualitative radiology reporting. Scaled deployment of these tools will open a path to precision management for patients with MS.
Representation of the hierarchical and functional structure of an ambulatory network of medical consultations through social network analysis, with an emphasis on the role of medical specialties
Authors: Biscione Fernando Martín , da Silva Juliano Domingues 
Published: August 2023

AbstractBackgroundAmbulatory Health Care Networks (Amb-HCN) emerge when doctors establish circuits of patient referral and counter-referral in their offices, explicitly or spontaneously. We aimed to characterize the structural and functional topology of an Amb-HCN of a private health insurance provider (PHIP) using objective metrics from graph theory.MethodsA Social Network Analysis was conducted with administrative claim data of a Brazilian PHIP. Included were beneficiaries of a healthcare plan not restricting the location or physician caring for the patient. A directional and weighted network was constructed, where doctors were vertices and patient referrals between doctors were edges. Vertex-level measures were calculated and grouped into three theoretical constructs: patient follow-up; relationship with authorities; and centrality profiles. To characterize physicians into these profiles, cluster analysis was conducted using the non-hierarchical K-means technique.FindingsBetween 04/01/2021 and 05/15/2022, 666,263 individuals performed 3,863,222 office visits with 4,554 physicians. Non-primary-care medical specialties (e.g., cardiology, endocrinology etc.) were associated with central profile in the graph, while surgical specialties predominated in the periphery, along with pediatrics. Only pediatrics was associated with strong and prevalent patient follow-up. Weak and shared patient follow-up was present for many doctors from internal medicine and family medicine. All profiles exhibited pairwise relationships with each other, and with clinical characteristics and outcomes of the patients they treated. For example, physicians identified as authorities were frequently central and treated patients with more comorbidities. Eleven medical communities were identified with clear territorial and medical specialty segregation.ConclusionsViewing the Amb-HCN as a social network provided emerging insights into the most influential actors and specialties, potential gaps in care, and the most prevalent diseases in our patient portfolio. Identifying self-constituted Amb-HCN can form a rational basis for developing more formal networks or monitoring patient care performance without assigning responsibility to single physicians.