bluuebunny/crossref_metadata_2025_split huggingface dataset:
Platonic character education
Authors: Mintz Avi I 
Published: September 2023

Abstract
In A Platonic Theory of Moral Education, Mark Jonas and Yoshiaki Nakazawa have argued that Plato outlines a theory of virtue education. Alkis Kotsonis has similarly argued that Plato articulated a theory of intellectual character education. I think that Jonas, Nakazawa, and Kotsonis have opened a productive line of enquiry on this matter, and I expand on their work in this paper by identifying connections between Plato’s work and the contemporary discourse on character education, which features four domains of virtues: moral, intellectual, civic, and performance virtues. Plato’s treatment of virtue, I argue, not only can be mapped onto the contemporary treatment of character education but it also further demonstrates that cultivating virtue—the project of character education—was a paramount concern for Plato.
Progranulin deficiency exacerbates cardiac remodeling after myocardial infarction
Authors: Sasaki Takahiro , Kuse Yoshiki , Nakamura Shinsuke , Shimazawa Masamitsu , Hara Hideaki 
Published: September 2023

AbstractMyocardial infarction (MI) is a lethal disease that causes irreversible cardiomyocyte death and subsequent cardiovascular remodeling. We have previously shown that the administration of recombinant progranulin (PGRN) protects against myocardial ischemia and reperfusion injury. However, the post‐MI role of PGRN remains unclear. In the present study, we investigated the effects of PGRN deficiency on cardiac remodeling after MI. Wild‐type and PGRN‐knockout mice were subjected to MI by ligation of the left coronary artery for histological, electrophysiological, and protein expression analysis. Cardiac macrophage subpopulations were analyzed by flow cytometry. Bone marrow‐derived macrophages (BMDMs) were acquired and treated with LPS + IFN‐γ and IL‐4 to evaluate mRNA levels and phagocytic ability. PGRN expression was gradually increased in the whole heart at 1, 3, and 7 days after MI. Macrophages abundantly expressed PGRN at the border areas at 3 days post‐MI. PGRN‐knockout mice showed higher mortality, increased LV fibrosis, and severe arrhythmia following MI. PGRN deficiency increased the levels of CD206 and MerTK expression and macrophage infiltration in the infarcted myocardium, which was attributed to a larger subpopulation of cardiac CCR2+ Ly6Clow CD11b+ macrophages. PGRN‐deficient BMDMs exhibited higher TGF‐β, IL‐4R, and lower IL‐1β, IL‐10 and increased acute phagocytosis following stimulation of LPS and IFN‐γ. PGRN deficiency reduced survival and increased cardiac fibrosis following MI with the induction of abnormal subpopulation of cardiac macrophages early after MI, thereby providing insight into the relationship between properly initiating cardiac repair and macrophage polarization after MI.
Outcomes of Emergency Department Patients With Opioid Use Disorder Utilizing a Virtual Addiction Bridge Clinic: A Case Series
Authors: Wills Brandon K. , Ringwood Katy J. , Davis Theresa T. , Provost Rosellen , Bachireddy Chethan , Wang Jennifer , Keyser-Marcus Lori , Moeller F. Gerard 
Published: September 2023

Objectives
Within the last decade, there has been a dramatic increase in the rate of emergency department (ED) visits and death from opioid overdose. Those who present to the ED are at high risk for subsequent morbidity and mortality. Despite effective treatment, many patients do not get rapidly connected to outpatient care. The aim of this investigation was to describe outpatient treatment engagement after ED discharge among patients with opioid use disorder (OUD) enrolled in a virtual Addiction Bridge Clinic (ABC).

Methods
This was a retrospective case series describing an ED-initiated referral for rapid telehealth follow-up among patients with OUD. The primary outcome was addiction treatment engagement among those who completed the initial virtual ABC visit (engaged in ABC) vs. those who did not complete an ABC visit (Not engaged in ABC) at 1 week, 1 month, and 3 and 6 months timepoint intervals after the initial ED presentation.

Results
Of the N = 201 patients referred to the ABC between March and December 2021, a majority were Black (71%) and male (77%). Of the 201 referrals, 85 (42%) completed an initial ABC telehealth visit. Subsequent treatment engagement was 26% at 1 week, 26% at 1 month, 22% at 3 months, and 18% at 6 months after the index ED visit.

Conclusions
A telehealth-enabled virtual addiction bridge clinic is one potential approach to reduce barriers to rapid treatment access. Strategies are needed to improve subsequent addiction treatment engagement after a virtual addiction bridge clinic visit.
Fracture Patterns and Mortality in Osteopetrosis: A 7-year Retrospective Analysis from Türkiye’s National Registry
Authors: Bingöl Olgun , Yaşar Niyazi Erdem , Özdemir Güzelali , Bekmez Şenol , Söylemez Mehmet Salih , Dumlupinar Ebru , Ayvali Mustafa Okan , Ata Naim , Ülgü M. Mahir , Birinci Şuayip , Bingöl İzzet 
Published: September 2023

Background:
The aim of this study is to determine the demographic data, fracture treatment methods, and medical treatments of patients diagnosed with osteopetrosis in the national registry.

Methods:
Patients with International Classification of Diseases (ICD)-10 code Q78.2 for osteopetrosis between January 1, 2016 and April 11, 2023 were retrospectively reviewed. Data on sex, age at time of diagnosis, fracture history, mortality, and use of medications were evaluated for all patients. In addition, open reduction and internal fixation, closed reduction and internal fixation, closed reduction and casting, and conservative treatment methods were noted. The number of patients requiring deformity surgery was determined. The incidence and prevalence of osteopetrosis were also calculated in this cross-sectional study.

Results:
A total of 476 patients diagnosed with osteopetrosis were identified. The mean age at time of diagnosis of these patients was 5.79 ± 5.43 years. A total of 101 patients died. As the age at diagnosis decreased, the mortality rate of the patients increased with statistical significance (P<0.001). A total of 192 fractures were seen in 121 osteopetrosis patients in this study. Femur fractures were most common among these patients with osteopetrosis. A history of fracture was statistically significantly less common in patients using a combination of vitamin D + calcium compared with patients not using such medication (P<0.001). In this 7-year cross-sectional study, the incidence was found to be 1 in 416,000 and the prevalence was 0.00199% in the population under 18 years of age.

Conclusion:
Younger age at diagnosis is associated with higher mortality in patients with osteopetrosis. In addition, the combination of vitamin D and calcium were associated with lower fracture incidence.

Level of Evidence:
Prognostic Level II.
The Pressure Is on: Dorsal Versus Volar Univalves for Long-arm Casts
Authors: Udall Dallyn , Zimmerman Remy , Bastrom Tracey , Schlechter John 
Published: September 2023

Background:
Fiberglass casts are routinely used to treat fractures of the upper extremity. When posttraumatic edema is anticipated, the cast is often valved to hopefully prevent potential complications, especially compartment syndrome. Due to volar forearm compartments being most involved with upper extremity compartment syndrome, volar skin surface pressures (SSP) are paramount. Despite past literature showing that a univalved cast will retain a 3-point mold better than a bivalved cast, there is a paucity of information analyzing the effects of univalving on the volar SSP. We hypothesized that a volar univalve technique would have a greater decrease in the volar skin surface pressures compared to a dorsal univalve in long-arm casts.

Methods:
A 100-mL saline bag attached to an arterial line pressure transducer was placed between a long-arm cast and the skin along the volar forearm of a single adult volunteer. Fourteen casts were applied by a single certified orthopaedic technologist with 30 years of experience and assigned randomly to receive either a volar or dorsal univalve. We calculated the change in volar forearm SSP on each cast in 4 stages: isolated univalve, with a 3-mm cast spacer, with a 6-mm spacer, and with bivalve. Statistical analysis of the data was performed using a Mann-Whitney U test.

Results:
When comparing volar versus dorsal univalve, volar SSP significantly dropped by a mean of 32.00 versus 20.43 mm Hg (P value=0.001) in stage I, 45.14 versus 38.00 mm Hg in stage II (P value=0.026), and 56.53 versus 49 mm Hg in stage III (P value=0.001). There was no significant difference between the 2 groups after a bivalve was performed at stage IV (P value=0.318).

Conclusion:
Our findings support that a volar univalve with a 6-mm spacer will provide the greatest reduction of skin surface pressure while theoretically maintaining the cast’s structural integrity and biomechanical properties when compared to a bivalved cast.

Level of Evidence:
Level II, prospective comparative study.
Tracheoesophageal Fistula Closure in a Pediatric Patient Using a Supraclavicular Artery Island Flap
Authors: Seebauer Caroline T. , Völkl Melanie , Kunkel Jürgen , Künzel Julian , Kühnel Thomas , Hofmann Hans-Stefan , Bohr Christopher 
Published: September 2023

Summary:
Acquired tracheoesophageal fistulas can lead to large defects with fatal complications. Surgical management is challenging but necessary to prevent respiratory infections and poor weight gain. Therefore, a reliable and pliable flap like the pedicled supraclavicular artery island flap with its wide arc of rotation and robust vascularization is needed for reconstruction. We highlight the surgical technique and postoperative measures in managing a tracheoesophageal fistula due to button battery ingestion in a 9-month-old boy with the supraclavicular artery island flap. In summary, the supraclavicular artery island flap is a safe and successful tool for closure of large acquired tracheoesophageal fistulas in pediatric patients.
Carotid intima–media thickness and incident hypertension: the Brazilian Longitudinal Study of Adult Health
Authors: Dutra Robertson T. , Bensenor Isabela M. , Goulart Alessandra C. , Pereira Alexandre C. , Lotufo Paulo A. , Santos Itamar S. 
Published: September 2023

Background:High blood pressure (BP) increases carotid intima–media thickness (CIMT). On the other hand, it is not clear whether the vascular abnormalities reflected in high CIMT may predict incident hypertension. The present study aims to investigate the association between CIMT and incident hypertension after 4 years of follow-up in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a multiethnic sample of middle-aged adults from six Brazilian cities.Methods:We analyzed data from 6682 ELSA-Brasil participants (aged 35–74) without hypertension and with complete CIMT data at baseline. After 4 years of follow-up, we describe hypertension incidence, stratifying the sample according to age, sex, and race-specific CIMT quartiles. We also built crude and adjusted Poisson regression models to analyze the association between mean and maximal CIMT values and incident hypertension.Results:We found incident hypertension in 987 (14.8%) participants. According to mean CIMT quartile groups, hypertension incidence varied from 10.2% (first quartile group) to 22.4% (fourth quartile group;Pfor trend <0.001). In fully adjusted models, 0.1 mm increments in mean CIMT values were associated with a 16% [relative risk (RR):1.16; 95% confidence interval (95% CI) 1.10–1.21;P < 0.001] higher risk of incident hypertension, respectively. Results were similar when maximal CIMT values were considered instead of mean CIMT values.Conclusion:CIMT values at baseline strongly predicted incident hypertension after 4 years of follow-up in this large multiethnic cohort. This highlights the relationship between CIMT and BP and may provide important insights into the significance of this ultrasound measurement.
Anxiety and depression in patients with uveitis: a comprehensive review of observational studies
Authors: Choo Charlene H. , Gonzales John , Shantha Jessica G. 
Published: September 2023

Purpose of the review
The purpose of this review is to provide a comprehensive summary of observational studies evaluating anxiety and depression in patients with uveitis.

Recent findings
A higher prevalence of depression was reported in patients with uveitis compared to healthy controls in most observational studies. Symptoms of anxiety were often, but not always, significantly worse in patients with uveitis compared to controls. Most studies found that patients with uveitis had reduced vision-related quality of life that was associated with anxiety and depression symptoms.

Summary
Patients with uveitis have a higher risk of experiencing symptoms of depression and could benefit from screening and treatment. Preliminary screening for vision-related quality of life could also help determine if the patient requires assistance in mental health or other aspects of daily living.
Neuro-ophthalmic manifestations of autoimmune disorders: diagnostic pearls & pitfalls
Authors: Poonja Sabrina , Costello Fiona 
Published: September 2023

Purpose of review
The purpose of this review is to highlight a clinical-anatomical approach to localizing neuro-ophthalmic manifestations of associated autoimmune disorders.

Recent findings
Our understanding of autoimmune conditions has changed considerably over recent years, particularly with the emergence of novel autoantibodies. Cardinal neuro-ophthalmic signs and symptoms of antibody-mediated autoimmune disorders have been well characterized; knowledge thereof may be the first step towards an accurate diagnosis.

Summary
A thorough history, further refined by a comprehensive examination are cornerstones to disease localization in clinical medicine. Taken together, these essential steps both guide investigations and facilitate early recognition of autoimmune disorders. From a neuro-ophthalmic perspective, it is important to understand heralding signs and symptoms of autoimmune syndromes, avoid cognitive errors, and remain mindful of common diagnostic pitfalls to optimize care.

Video abstract

http://links.lww.com/COOP/A61
Preoperative planning of compact zone trajectory is necessary in treating osteoporotic vertebral compression fracture with endplate involvement: A prospective randomized controlled study
Authors: Hung Pei-I , Chou Po-Hsin , Yao Yu-Cheng , Chen Kuan-Jung , Lin Hsi-Hsien , Wang Shih-Tien , Chang Ming-Chau , Liu Chien-Lin 
Published: September 2023

Background:
This prospective randomized controlled study compares the clinical and radiological outcomes between reduction methods with or without compact trabecular bone during percutaneous kyphoplasty in osteoporotic vertebral fractures.

Methods:
The cohort of 100 patients who underwent percutaneous kyphoplasty was randomly divided into group A (guide pin and balloon introduced directly into fracture site) and group B (guide pin and balloon inserted away fracture site). The surgery duration, clinical and radiological outcomes postoperatively and at follow-up, and complications of cement leakage and adjacent fracture were recorded. Patients were followed up for an average of 20.18 months. The clinical outcomes were assessed using the Oswestry Disability Index and visual analog scale.

Results:
The two groups had similar patient demographics, surgery times, and volume of cement injected. The method using elevation of the collapsed endplate indirectly had no significant influence on radiological outcomes but significantly decreased the occurrence of intradiscal cement leakage and improved 1- and 12-month postoperative functional outcomes.

Conclusion:
Elevating and reinforcing the collapsed endplate rather than just filling the defect during percutaneous kyphoplasty is safe and effective. This technique decreased pain and improved function with lower rates of further collapse of the osteoporotic vertebrae compared to defect-filling alone.
“I had become fed up”: A qualitative study of Black nurse practitioners' experiences fighting against health inequity, racism, and burnout
Authors: Brooks Carthon J. Margo , Aponte Ravenne , Mason Aleigha , Nikpour Jacqueline 
Published: September 2023

ABSTRACT

Background:
Increasing diversity in the nurse practitioner (NP) workforce is key to improving outcomes among patients who experience health inequities. However, few studies to date have examined the specific mechanisms by which NPs from diverse backgrounds address inequities in care delivery.

Purpose:
To explore Black NPs' efforts in addressing inequities, and the facilitators and barriers they face in doing so.

Methodology:
We conducted focus groups and interviews of Black NPs (N = 16) in the greater Philadelphia area in early 2022, just following the height of the COVID-19 pandemic and the social unrest of the early 2020s. Data were analyzed using thematic analysis.

Results:
Emergent themes included: Strategies Utilized to Address Health Inequities; Burnout & the Minority Tax; Risks & Rewards of Taking a Stance; and Uneven Promises of Organizational Engagement. Nurse practitioners prioritized patient-centered, culturally congruent care, taking additional time to explore community resources and learn about patients' lives to facilitate care planning. Participants advocated to administrators for resources to address inequities while simultaneously navigating organizational dynamics, microaggressions, and racism. Finally, NPs identified organizational-level barriers, leading to emotional exhaustion and several participants' intent to leave their roles.

Conclusions:
Black NPs use a myriad of strategies to improve equity, yet frequently face substantial barriers and emotional exhaustion in doing so with little change to the inequities in care.

Implications:
The NP workforce has a critical role to play in reducing health inequities. The strategies outlined by Black NPs in this study offer a roadmap for all clinicians and health care organizations to prioritize equity in care delivery.
Understanding Sexual and Gender Minority Populations and Organ-Based Screening Recommendations for Human Papillomavirus–Related Cancers
Authors: Jodry Dominique , Obedin-Maliver Juno , Flowers Lisa , Jay Naomi , Floyd Serina , Teoh Deanna , Conageski Christine , Downs Levi , Khan Michelle J. 
Published: September 2023

Objectives
Sexual gender minority (SGM) populations are at risk for human papillomavirus (HPV)–related cancers of the anogenital tract and oropharynx and often face barriers to health care. The goals of this document are to clarify language to provide inclusive care for SGM populations and to provide recommendations for screening and prevention of HPV-related cancers in SGM populations.

Materials and Methods
An expert committee convened by the American Society for Colposcopy and Cervical Pathology performed a narrative review of the literature through February 2023. A comprehensive MEDLINE database search was performed for relevant studies. The literature review was divided into categories by organ/topic and by SGM population. Given the variability in available data for several of the categories, recommendations were made based on national guidelines where appropriate or expert opinion where there were less data to support risk-based guidelines.

Results
Definitions and terminology relevant to SGM populations are presented. The authors advocate the adoption of sexual orientation gender identity data collection and an organ-based screening approach, which is possible with knowledge of patient anatomy, sexual behaviors, and clinical history. This includes screening for cervical cancer per national recommendations, as well as screening for anal, vulvar, vaginal, penile, and oral cancers based on risk factors and shared clinical decision making. The authors recommend consideration of HPV vaccination in all SGM individuals up to age 45 years old who are at risk.

Conclusions
An organ-based screening approach is part of a global strategy to create an inclusive care environment and mitigate barriers to screening and prevention of HPV-mediated cancers in SGM populations.
Future Directions for Research on Anal Precancerous Lesion Treatment
Authors: Albuquerque Andreia 
Published: September 2023

Abstract
The benefit of treating anal precancerous lesions to reduce anal cancer progression was recently shown in people living with HIV. This will certainly impact the future development of recommendations on anal cancer prevention by including anal precancerous lesions screening and treatment for people living with HIV. However, by bringing this topic to the spotlight, it has also uncovered data that are still missing in this field and that need to be addressed by research.
This article will discuss the many unanswered questions about treatment of anal precancerous lesions and future directions for research.
“Check Your Vulva”—A Patient Education and Virtual Vulva Care Pilot Project
Authors: Selk Amanda , Elangainesan Praniya , Tannenbaum Evan , Wong Karen 
Published: September 2023

Objective
The aim of the study is to identify whether vulvar self-examination learned from a web site could lead to a self-identification of vulvar lesions and the feasibility of virtual vulvar care with patient submitted photos.

Materials and Methods
The study used a prospective cohort design in a tertiary academic hospital over a 1-year period. Eligible participants who self-identified a vulvar lesion/skin changes were invited to send vulvar photos through a secure patient portal and schedule a phone consult to discuss diagnosis/management. Clinical data, photo interpretability, and patient satisfaction measures were collected. Self-referral patients versus vulva clinic waitlist patients were analyzed separately.

Results
Few people were interested in submitting vulvar photos online. Twenty-eight participants directly contacted the study, 8 consented, and 6 sent in vulvar photos. Forty four of 476 on the waitlist consented but only 24 of 44 sent in photos (5% of waitlist patients). The median time for a virtual assessment was 7 days for study participants while it was 18 months for the in-person usual care pathway. Most patient submitted photos were assessable. However, 60% participants needed help from another person to take the photos. More than 90% of patients required an in-person visit for their vulvar condition/concerns. While most patients were happy with the virtual process, 58% rated their satisfaction with the ease of taking photos of the genital region as “fair” or “poor.”

Conclusions
Virtual care with photos/phone calls might be feasible, although most patients are unlikely to participate. Because of patient discomfort, unease with taking photos, and patient privacy concerns, vulvar care should continue to be in-person for most new consults.