bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trends in Nicotine Strength in Electronic Cigarettes Sold in the United States by Flavor, Product Type, and Manufacturer, 2017–2022
Authors: Wang Xu , Ghimire Ramesh , Shrestha Sundar S , Borowiecki Mateusz , Emery Sherry , Trivers Katrina F 
Published: March 2023

Abstract

Introduction
Most e-cigarettes contain highly addictive nicotine. This study assessed trends in nicotine strength in e-cigarettes sold in the United States during January 2017–March 2022.

Aims and Methods
We obtained January 2017–March 2022 national retail e-cigarette sales data from NielsenIQ. We assessed monthly average nicotine strength overall, by e-cigarette product and flavor type, and manufacturer. A Joinpoint regression model assessed the magnitude and significance of changes in nicotine strength.

Results
During January 2017–March 2022, monthly average nicotine strength of e-cigarette products increased from 2.5% to 4.4%, an average of 0.8% per month (p &lt; .001). Monthly average nicotine strength of disposable e-cigarettes increased the most (average monthly percentage change [AMPC] = 1.26%, p &lt; .001) as compared to prefilled pods (AMPC = 0.6%, p &lt; .001) and e-liquids (AMPC = 0.5%, p = .218). Monthly average nicotine strength for all flavors of e-cigarette products increased except for mint-flavored products. Increases were greatest for beverage-flavored products (AMPC = 2.1%, p &lt; .001), followed by menthol-flavored products (AMPC = 1.2%, p &lt; .001). Among the top 10 e-cigarette manufacturers assessed, monthly average nicotine strength decreased for Juul Labs products from 5% to 4.7% (AMPC = −0.1%, p &lt; .001) but increased significantly for five manufacturers’ products and remained unchanged at 5%–6% for four manufacturers’ products.

Conclusions
Monthly average nicotine strength of e-cigarette products increased overall, for most product and flavor types, and for some manufacturers in the United States during the study period. Imposing maximum limits on nicotine strength of e-cigarettes together with other evidence-based tobacco control strategies can help reduce the use of e-cigarettes among youth and increase tobacco product cessation among adults.

Implications
From January 2017 to March 2022, the monthly average nicotine strength of disposable e-cigarettes increased substantially and exceeded prefilled pods since May 2020. E-cigarettes with menthol flavor and youth-appealing flavors, like fruit, also had sharp increases in monthly average nicotine strength. Among the top 10 e-cigarette manufacturers, monthly average nicotine strength increased or remained unchanged at a high nicotine level for all manufacturers’ products, except Juul Lab’s products. Comprehensive strategies including restricting sales of all flavored e-cigarettes, restricting youth tobacco product access, and imposing maximum limits on nicotine strength may help reduce youth e-cigarette use and increase tobacco cessation.
Increased HIV Transmissions With Reduced Insurance Coverage for HIV Preexposure Prophylaxis: Potential Consequences ofBraidwood Management v. Becerra
Authors: Paltiel A David , Ahmed Ali R , Jin Elena Y , McNamara Meredithe , Freedberg Kenneth A , Neilan Anne M , Gonsalves Gregg S 
Published: March 2023

AbstractA US federal court recently ruled against requiring health insurers to cover human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) under the Affordable Care Act. For every 10% decrease in PrEP coverage resulting from this ruling among US men who have sex with men, we estimate an additional 1140 HIV infections in the following year in that population.
Clinical Use of the Thematic Apperception Test and Other Non-Normed Idiographic Assessment Methods
Authors: Lewis Katie C. , Clemence A. Jill 
Published: March 2023

Abstract
Performance-based assessment methods provide important insight into psychological functioning in ways that differ from those afforded by more structured tasks. Data obtained through performance-based methods can reveal the underlying issues, concerns, and preoccupations that are salient in understanding a respondent’s personality functioning and provide important insight into how they integrate information, approach novel situations and dilemmas, and utilize internal resources to achieve desired outcomes or avoid undesirable ones. This chapter reviews several commonly used performance-based measures, including the Thematic Apperception Test (TAT), Early Memories Task, and human figure drawing tasks. The chapter explores how data yielded by these measures can assist clinicians in evaluating patterns of personality that unfold over time and across relational contexts and identifies how contextual factors might influence trait expression in ways that are otherwise difficult to determine in assessment contexts. The chapter reviews the history, administration process, and general scoring and interpretation procedures of these measures, focusing primarily on the TAT, and provides a discussion of the limitations of these measures and areas in need of further study and development.
Changes in sexual function over 12 months after native-tissue vaginal pelvic organ prolapse surgery with and without hysterectomy
Authors: Chang Olivia H , Yao Meng , Ferrando Cecile A , Paraiso Marie Fidela R , Propst Katie 
Published: March 2023

AbstractBackgroundThere is a need to determine how preoperative sexual activity, uterine preservation, and hysterectomy affect sexual function after pelvic organ prolapse surgery.Aim(1) To determine changes in sexual function in women, stratified by preoperative sexual activity status, after native-tissue pelvic organ prolapse surgery. (2) To examine the impact of hysterectomy and uterine preservation on sexual function. (3) To determine predictors for postoperative dyspareunia.MethodsThis was a planned secondary analysis of a prospective cohort study. Sexual function was evaluated preoperatively and 6 and 12 months postoperatively. Sexual function was compared between those who had a hysterectomy and those who had uterine-preserving prolapse surgery. A logistic regression analysis was performed to assess predictors for dyspareunia.OutcomesPelvic Organ Prolapse–Urinary Incontinence Sexual Function Questionnaire.ResultsAt 12 months, 59 patients underwent surgery and were followed up (hysterectomy [n = 28, 47.5%] vs no hysterectomy [n = 31, 52.5%]; sexually active [n = 26, 44.1%] vs non–sexually active [n = 33, 55.9%]). Of those who did not undergo a hysterectomy, 17 (54.8%) had a uterine-preserving procedure. At 12 months, sexually active patients had significant improvement in sexual function (mean ± SD, 0.37 ± 0.43; P = .005), while non–sexually active patients reported significant improvement in satisfaction of sex life (P = .04) and not feeling sexually inferior (P = .003) or angry (P = .03) because of prolapse. No variables were associated with dyspareunia on bivariate analysis.Clinical ImplicationsIt did not appear that either uterine preservation or hysterectomy had any impact on sexual function. There was a 10% increase in people who were sexually active after surgery.Strengths and LimitationsThe major strength of our study is the use of a condition-specific validated questionnaire intended for sexually active and non–sexually active women. We interpreted our results utilizing a validated minimal clinically important difference score to provide interpretation of our results with statistical and clinical significance. The limitation of our study is that it was a secondary analysis that was not powered for these specific outcomes.ConclusionAt 12 months, for patients who were sexually active preoperatively, there was a clinically meaningful improvement in sexual function after native-tissue pelvic organ prolapse surgery. Non–sexually active women reported improvement in satisfaction of sex life. There was no difference in the sexual function of patients undergoing uterine preservation or posthysterectomy colpopexy when compared with those with concurrent hysterectomy, though this sample size was small.
Grading the severity of anaphylaxis
Authors: Stafford Aisling , Turner Paul J. 
Published: March 2023

Purpose of review
Despite no global consensus on a definition of anaphylaxis, there is increasing recognition that just as allergic reactions lie on a spectrum of severity, the same is for anaphylaxis. A variety of severity scores exist in the literature. We review the approaches taken to develop these scores, and their relative advantages and disadvantages.

Recent findings
There have been four recent comparisons of published severity scores. All have highlighted the heterogeneity between scoring systems, and the lack of transferability from one approach to another. Notably, only one score has been developed using a data-driven approach, and none has undergone formal and comprehensive validation.

Summary
It is unclear whether a single severity score is achievable, or indeed desirable. If the aim is to guide management of acute reactions, then assignment of severity is not only unnecessary but might delay treatment and cause harm. Severity scores are needed in the research setting, but require an approach which can discriminate between reactions of similar but nonidentical severity (particularly, nonanaphylaxis reactions). Any approach should be fit for purpose, informed by patient and clinician experience, and ideally be data-driven to minimize subjective bias and facilitate objective validation.
Self-Reported Cycling Performance and Impact on Falls in Persons With Bilateral Vestibulopathy
Authors: Danneels Maya , van de Berg Raymond , Leyssens Laura , Van Hecke Ruth , Dhooge Ingeborg , Cambier Dirk , Van Rompaey Vincent , Maes Leen 
Published: March 2023

Objectives:
The aim of this study was to investigate cycling skills, cycling difficulties, fall concern, and fall history while cycling in persons with bilateral vestibulopathy.

Design:
Fifty-one persons with bilateral vestibulopathy and 51 healthy control subjects filled out a questionnaire about cycling abilities. This questionnaire consisted of four parts: (1) general information about audiovestibular function, vision, and physical activity; (2) general cycling abilities, history, and difficulties; (3) fall concern while cycling in various situations; and (4) fall history.

Results:
Out of the 51 patients, 61% found riding a bicycle difficult, 29% were not able to cycle anymore, and 10% reported not having any problems riding a bicycle. Their mean cycling time decreased from 3.15 hrs weekly before to 1.27 hrs weekly after disease onset (p = 0.002). The latter also differed significantly from the mean cycling time of 3.51 hrs weekly in control subjects (p < 0.001). The main complaints while cycling were not being able to look behind (88%), having difficulties with visually stabilizing the environment (65%), and not being able to ride in a straight line (61%). The fall concern was significantly higher in the patient group, with cycling in the dark and at dusk, and turning the head as their main concerns (p < 0.001). Falls and near-falls were respectively reported in 50% and 65% of the patient group. Only the latter differed significantly from the control group. However, the number of reported falls differed significantly between both groups.

Conclusions:
This study demonstrates cycling difficulties in persons with bilateral vestibulopathy, related to problems with postural control and gaze stabilization. Knowledge about specific complaints and triggers is important to prevent future falls. A combination of coping strategies and aids, with vestibular rehabilitation focused on gaze stabilization might be considered, as well as avoidance of cycling in specific cases.
External Validation and Comparison of a General Ward Deterioration Index Between Diversely Different Health Systems
Authors: Cummings Brandon C. , Blackmer Joseph M. , Motyka Jonathan R. , Farzaneh Negar , Cao Loc , Bisco Erin L. , Glassbrook James D. , Roebuck Michael D. , Gillies Christopher E. , Admon Andrew J. , Medlin Richard P. , Singh Karandeep , Sjoding Michael W. , Ward Kevin R. , Ansari Sardar 
Published: March 2023

OBJECTIVES:Implementing a predictive analytic model in a new clinical environment is fraught with challenges. Dataset shifts such as differences in clinical practice, new data acquisition devices, or changes in the electronic health record (EHR) implementation mean that the input data seen by a model can differ significantly from the data it was trained on. Validating models at multiple institutions is therefore critical. Here, using retrospective data, we demonstrate how Predicting Intensive Care Transfers and other UnfoReseen Events (PICTURE), a deterioration index developed at a single academic medical center, generalizes to a second institution with significantly different patient population.DESIGN:PICTURE is a deterioration index designed for the general ward, which uses structured EHR data such as laboratory values and vital signs.SETTING:The general wards of two large hospitals, one an academic medical center and the other a community hospital.SUBJECTS:The model has previously been trained and validated on a cohort of 165,018 general ward encounters from a large academic medical center. Here, we apply this model to 11,083 encounters from a separate community hospital.INTERVENTIONS:None.MEASUREMENTS AND MAIN RESULTS:The hospitals were found to have significant differences in missingness rates (> 5% difference in 9/52 features), deterioration rate (4.5% vs 2.5%), and racial makeup (20% non-White vs 49% non-White). Despite these differences, PICTURE’s performance was consistent (area under the receiver operating characteristic curve [AUROC], 0.870; 95% CI, 0.861–0.878), area under the precision-recall curve (AUPRC, 0.298; 95% CI, 0.275–0.320) at the first hospital; AUROC 0.875 (0.851–0.902), AUPRC 0.339 (0.281–0.398) at the second. AUPRC was standardized to a 2.5% event rate. PICTURE also outperformed both the Epic Deterioration Index and the National Early Warning Score at both institutions.CONCLUSIONS:Important differences were observed between the two institutions, including data availability and demographic makeup. PICTURE was able to identify general ward patients at risk of deterioration at both hospitals with consistent performance (AUROC and AUPRC) and compared favorably to existing metrics.
Ureteroscopy during pregnancy under local anesthesia and light sedation: Technique and video
Authors: Juliebø-Jones Patrick , Beisland Christian , Gjengstø Peder , Maheswaran Rachel , Ulvik Øyvind 
Published: March 2023

Abstract
Ureteroscopy during pregnancy has become increasingly recognized as a safe intervention. Performing it under local anesthesia and light sedation reduces the risks associated with general or regional anesthesia, such as difficult airway scenarios, hypothermia, and hypotension. In addition, this approach reduces the total amount of fetal exposure to medications and anesthetic agents. Performing ureteroscopy in this manner requires a number of adjustments and modifications to the standard technique. This article provides a summary in a step-by-step format, as well as an accompanying video demonstration.
New insights into decidualization: immunological and genetic factors
Authors: Cuadrado-Torroglosa Isabel , García-Velasco Juan Antonio , Alecsandru Diana 
Published: March 2023

Purpose of review
Nowadays, there are many efforts focused on improving embryo quality for assisted reproduction treatments. Nevertheless, there are important maternal aspects, such as decidualization, also essential for pregnancy, often forgotten. With this review, we intend to highlight the main events involved in this endometrial phenomenon, as well as the cells and molecules that have recently been related to it.

Recent findings
Decidualization entails a complete transformation of the endometrium, with recent research reaffirming progesterone as its main molecular trigger. Certain immune components and membrane molecules have also been found to play a role in it, notably the killer immunoglobulin-like receptors (KIR) of uterine natural killer (uNK) cells, as well as the human leukocyte antigen (HLA)-F.

Summary
Progesterone directs the cellular changes that take place during decidualization, as well as the recruitment and maturation of uNKs, along with the coordinated action of interleukin-15. Likewise, the role of KIR and HLA-F in this process and in the subsequent development of pregnancy is being highlighted in many studies, with effects on reproductive outcomes related to the different genotypes of these molecules.
Pap smear recommendations in older women, does the data support stopping?
Authors: Grabinski Emma , Dunsmoor-Su Rebecca 
Published: March 2023

Purpose of review
To review the recommendations for cervical cancer screening in older women and to determine the evidence upon which the current and emerging recommendations are based on. To evaluate the possible consequences of stopping cervical cancer screening in older women.

Recent findings
Recommendations are to space cervical cancer screening intervals for women aged 21–65 and stop in women older than 65. Cervical cancer incidence and mortality burden are significant in women over the age of 65. Human papillomavirus (HPV) vaccination rates are poor in older women. Advanced cervical cancer rates are increasing, including adenocarcinoma rates. Vulvar carcinoma rates are also increasing, and gynecological care and exams are less frequent when women are not getting routine pap testing.

Summary
The current review shows that there is limited evidence on which to base the recommendation to stop screening. There is confusion among patients and physicians, and other healthcare providers over who to screen and when, and this is exacerbating the already known difficulty accessing healthcare among racial and ethnic minorities, underinsured, and rural populations, but rates of cancer are also rising most rapidly in white women. Recommendations to space or stop screening are often based on the perceived psychological distress of women undergoing testing and the cost of population screening.
Peripartum cardiomyopathy: risk factors and predictors of outcome
Authors: Viljoen Charle , Hoevelmann Julian , Sliwa Karen 
Published: March 2023

Purpose of review
Peripartum cardiomyopathy (PPCM) contributes significantly to maternal morbidity and mortality worldwide. In this review, we describe the present-day epidemiology and current understanding of the pathogenesis of PPCM. We provide an updated approach to diagnosis and management of PPCM, and discuss risk factors and predictors of outcome.

Recent findings
The highest incidences of PPCM have been reported in African, Asian, and Caribbean populations. Contemporary literature supports a ‘two-hit’ hypothesis, whereby the ‘first hit’ implies a predisposition, and the ‘second hit’ refers to an imbalanced peripartal hormonal milieu that results in cardiomyopathy. Whereas a half of patients will have left ventricular (LV) recovery, a tenth do not survive. Clinical findings and special investigations (ECG, echocardiography, cardiac MRI, biomarkers) can be used for risk stratification. Frequent prescription of guideline-directed medical therapy is associated with improved outcomes.

Summary
Despite advances in elucidating the pathogenesis of PPCM, it remains unclear why only certain women develop the disease. Moreover, even with better diagnostic work-up and management, it remains unknown why some patients with PPCM have persistent LV dysfunction or die. Future research should be aimed at better understanding of the mechanisms of disease and finding new therapies that could improve survival and LV recovery.
Expectations of Patients and Their Families After the Treatment of Substance Use Disorder
Authors: Alenezi Atallah 
Published: March 2023

Abstract

Background
Substance use disorders are economically and socially devastating to families and societies. Expectations of the patients and their families during the posttreatment phase of substance use disorder need to be emphasized to maintain a patient's sobriety and prevent relapse.

Aim
The aim of this study was to examine the prediction power of personal and sociodemographic factors of patients and their families to treatment outcomes.

Methods
A descriptive, correlational, cross-sectional design was used. Data were collected from 80 patients treated for substance use disorders from a major psychiatric hospital and their family members regarding social, health, and psychological expectations. A three-step multiple hierarchical regression analysis was used to predict the power of personal and sociodemographic characteristics of patients' and their families' expectations to treatment outcomes.

Results
Heroin use, codeine use, family education, and family support were significant predictors of rehabilitation expectation (p < .05). Level of education and heroin use were predictors for lower levels of rehabilitation expectation, whereas family support and codeine use were indicators for higher scores of rehabilitation expectation.

Conclusion
Emphasis should be given to expectations of the patient and their family through appropriate psychoeducation and enhanced understanding and partnership.
Familial hypercholesterolemia: The nexus of endothelial dysfunction and lipoprotein metabolism in COVID-19
Authors: Vuorio Alpo , Raal Frederick , Kovanen Petri T. 
Published: March 2023

Purpose of review
Patients with heterozygous familial hypercholesterolemia (HeFH) are at increased risk for COVID-19 cardiovascular complications in the acute phase of the infection. Elevated levels of LDL-C and often lipoprotein(a) are present from birth and lead to endothelial dysfunction, which is aggravated by a direct viral attack of the endothelial cells and their exposure to the toxic levels of circulating proinflammatory and prothrombotic mediators during the hyperinflammatory reaction typical of COVID-19.

Recent findings
Evidence to date shows the benefit of lipid-lowering therapy in patients with COVID-19. In HeFH patients who are at much higher cardiovascular risk, the focus should, therefore, be on the effective lowering of LDL-C levels, the root cause of the greater cardiovascular vulnerability to COVID-19 infection in these patients. The ongoing use of statins and other lipid-lowering therapies should be encouraged during the ongoing COVID pandemic to mitigate the risk of cardiovascular complications from COVID-19, particularly in HeFH patients.

Summary
Epidemiologic registry data show that the incidence of myocardial infarction is increased in SARS-CoV-2-infected HeFH patients. There is a need to study whether the risk for acute cardiovascular events is increased in the long-term and if there are changes in lipid metabolism after SARS-CoV infection(s) in patients with HeFH.