bluuebunny/crossref_metadata_2025_split huggingface dataset:
Affirmative Palliative Care for Transgender and Gender Nonconforming Individuals
Authors: Lippe Megan Pfitzinger , Eyer Joshua C. , Roberts Kailey E. , Ritter Emma R. , DiMauro Pierce K. , McKinney Robert E. , Williamson Cassandra L. , Rosa William E. 
Published: March 2023

ABSTRACT:
Nurses have a professional and ethical responsibility to provide inclusive, affirmative palliative care to transgender and gender nonconforming (TGNC) individuals experiencing life-limiting illness or injury. In accordance with standards for professional nursing and health organizations, nurses must continue to take tangible steps to achieve a level of care that is affirming, holistic, nonprejudicial, and collaborative. Providing quality care for TGNC individuals requires informed, competent integration of palliative nursing care, gender-affirmative care, and trans-person-centered health care within nursing practice. An interdisciplinary national team of experts collaborated to identify ways nurses could better uphold their professional responsibilities to TGNC individuals with serious illness. The purposes of this article are to: 1) describe elements of TGNC-inclusive palliative nursing care; and 2) present eight concrete recommendations to achieve affirmative clinical practice for TGNC patients living with life-limiting illness and their family of origin and/or family of choice. These recommendations address professional development, communication, medication reconciliation, mental health, dignity and meaning, social support and caregivers, spiritual beliefs and religion, and bereavement care.
Multimodal Prediction of Favorable Outcome After Cardiac Arrest: A Cohort Study*
Authors: Vanat Aurélien , Lee Jong Woo , Elkhider Hisham , Novy Jan , Ben-Hamouda Nawfel , Oddo Mauro , Rossetti Andrea O. 
Published: March 2023

OBJECTIVES:
Prognostic guidelines after cardiac arrest (CA) focus on unfavorable outcome prediction; favorable outcome prognostication received less attention. Our aim was to identify favorable outcome predictors and combine them into a multimodal model.

DESIGN:
Retrospective analysis of prospectively collected data (January 2016 to June 2021).

SETTING:
Two academic hospitals (Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Brigham and Women’s Hospital, Boston, MA).

PATIENTS:
Four hundred ninety-nine consecutive comatose adults admitted after CA.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
CA variables (initial rhythm, time to return of spontaneous circulation), clinical examination (Full Outline of UnResponsiveness [FOUR] score at 72 hr, early myoclonus), electroencephalography (EEG) (reactivity, continuity, epileptiform features, and prespecified highly malignant patterns), somatosensory-evoked potentials, quantified pupillometry, and serum neuron-specific enolase (NSE) were retrieved. Neurologic outcome was assessed at 3 months using Cerebral Performance Category (CPC); 1 and 2 were considered as favorable outcome. Predictive performance of each variable toward favorable outcomes were calculated, and most discriminant items were combined to obtain a multimodal prognostic score, using multivariable ordinal logistic regression, receiving operator characteristic curves, and cross-validation. Our analysis identified a prognostic score including six modalities (1 point each): 1) early (12–36 hr) EEG not highly malignant, 2) early EEG background reactivity, 3) late (36–72 hr) EEG background reactivity and 4) continuity, 5) peak serum NSE within 48 hours less than or equal to 41 µg/L, and 6) FOUR score greater than or equal to 5 at 72 hours. At greater than or equal to 4 out of 6 points, sensitivity for CPC 1–2 was 97.5% (95% CI, 92.9–99.5%) and accuracy was 77.5% (95% CI, 72.7–81.8%); area under the curve was 0.88 (95% CI, 0.85–0.91). The score showed similar performances in the validation cohort.

CONCLUSIONS:
This study describes and externally validates a multimodal score, including clinical, EEG and biological items available within 72 hours, showing a high performance in identifying early comatose CA survivors who will reach functional independence at 3 months.
Development and External Validation of the International Early Warning Score for Improved Age- and Sex-Adjusted In-Hospital Mortality Prediction in the Emergency Department
Authors: Candel Bart Gerard Jan , Nissen Søren Kabell , Nickel Christian H. , Raven Wouter , Thijssen Wendy , Gaakeer Menno I. , Lassen Annmarie Touborg , Brabrand Mikkel , Steyerberg Ewout W. , de Jonge Evert , de Groot Bas 
Published: March 2023

Objectives:
Early Warning Scores (EWSs) have a great potential to assist clinical decision-making in the emergency department (ED). However, many EWS contain methodological weaknesses in development and validation and have poor predictive performance in older patients. The aim of this study was to develop and externally validate an International Early Warning Score (IEWS) based on a recalibrated National Early warning Score (NEWS) model including age and sex and evaluate its performance independently at arrival to the ED in three age categories (18–65, 66–80, > 80 yr).

Design:
International multicenter cohort study.

Setting:
Data was used from three Dutch EDs. External validation was performed in two EDs in Denmark.

Patients:
All consecutive ED patients greater than or equal to 18 years in the Netherlands Emergency department Evaluation Database (NEED) with at least two registered vital signs were included, resulting in 95,553 patients. For external validation, 14,809 patients were included from a Danish Multicenter Cohort (DMC).

Measurements and Main Results:
Model performance to predict in-hospital mortality was evaluated by discrimination, calibration curves and summary statistics, reclassification, and clinical usefulness by decision curve analysis. In-hospital mortality rate was 2.4% (n = 2,314) in the NEED and 2.5% (n = 365) in the DMC. Overall, the IEWS performed significantly better than NEWS with an area under the receiving operating characteristic of 0.89 (95% CIs, 0.89–0.90) versus 0.82 (0.82–0.83) in the NEED and 0.87 (0.85–0.88) versus 0.82 (0.80–0.84) at external validation. Calibration for NEWS predictions underestimated risk in older patients and overestimated risk in the youngest, while calibration improved for IEWS with a substantial reclassification of patients from low to high risk and a standardized net benefit of 5–15% in the relevant risk range for all age categories.

Conclusions:
The IEWS substantially improves in-hospital mortality prediction for all ED patients greater than or equal to18 years.
Iterative Development of the Caregiver Wellness After Traumatic Brain Injury Program (CG-Well)
Authors: Kreitzer Natalie , Adeoye Opeolu , Wade Shari L. , Kurowki Brad G. , Thomas Stephanie , Gillespie Lauren , Bakas Tamilyn 
Published: March 2023

Objectives:
(1) To iteratively design a web/phone-based intervention to support caregivers of adults acutely following traumatic brain injury (TBI), Caregiver Wellness (CG-Well), and (2) to obtain qualitative and quantitative feedback on CG-Well from experts and caregivers to refine the intervention.

Setting:
A level I trauma and tertiary medical center.

Participants:
Convenience sample of a total of 19 caregivers and 25 experts.

Design:
Multistep prospective study with iterative changes to CG-Well: (1) developed intervention content based on qualitative feedback from a prior study and literature review; (2) obtained qualitative feedback from 10 experts; (3) refined content using a modified Delphi approach involving 4 caregivers and 6 experts followed by qualitative interviews with 9 caregivers; (4) designed CG-Well website and videos; and (5) obtained feedback on program acceptability, appropriateness, and feasibility from 6 caregivers and 9 experts.

Interventions:
CG-Well included content on TBI, self-care and support, and skill-building strategies delivered through a website and telephone calls.

Main Outcome Measure(s):
Qualitative data were analyzed using content analysis. Caregivers and experts completed Likert-type scales to rate module relevance, clarity, accuracy, utility and website acceptability, appropriateness, and feasibility (1 = strongly disagree to 5 = strongly agree). Means and standard deviations (SD) characterized ratings.

Results:
Qualitative findings were instrumental in designing and refining CG-Well. Ratings were positive for modules (means and SD for relevant [4.9, 0.33], clear [4.6, 0.53], accurate [4.9, 0.33], and useful [5, 0]) and the website (means and SD for acceptable [4.8, 0.36], appropriate [4.8, 0.35], and feasible [4.8, 0.36]).

Conclusions:
The iterative design process for CG-Well resulted in a highly acceptable program. An early-stage randomized controlled trial is underway to estimate treatment effects for a future well-powered clinical trial.
An Absence of Persistent Postural Stability Deficits Following a Sport Concussion in Collegiate Athletes
Authors: Troiano Mia , Thompson Xavier , Boukhechba Mehdi , Hertel Jay , Resch Jacob E. 
Published: March 2023

Objective:
The purpose of our study was to determine whether persistent postural stability deficits exist in athletes following sport concussion (SC) in comparison with preinjury (baseline) values using Sample Entropy (SampEn).

Setting:
Sports medicine clinic.

Patients or Other Participants:
Participants consisted of 71 collegiate athletes (44 male, 27 female) with an average age of 19.9 ± 0.96 years who had a history of 1 concussion that occurred during their time as a collegiate athlete.

Design:
In our prospective, cohort design participants completed the Sensory Organization Test (SOT) at baseline, upon reporting symptom-free following a diagnosed SC, and upon establishing a new baseline prior to the start of the subsequent sport season.

Main Outcome Measures:
The SOT's condition scores were calculated and analyzed in alignment with the manufacturer's instructions. SampEn was calculated in the anterior-posterior (AP) and medial-lateral (ML) directions from the center-of-pressure oscillations over the 20-second time series for each SOT condition. The SOT and SampEn outcome scores for each condition were analyzed with repeated-measures analyses of variance.

Results:
Significant main effects were observed for the SOT's conditions 3 (F
1.6, 114.8 = 7.83, P = .001, η
2 = 0.10 [0.02-0.20]), 5 (F
1.8, 126.8 = 11.53, P < .001, η
2 = 0.14 [0.04-0.25]), and 6 (F
1.9, 134.5 = 25.11, P < .001, η
2 = 0.26 [0.14-0.37]), with significant improvements across time. Significant main effects were also observed for SampEn in the AP direction for conditions 3 (F
2, 140 = 7.59, P = .001, η
2 = 0.10 [0.02-0.19]) and 6 (F
2, 140 = 6.22, P = .003, η
2 = 0.08 [0.011-0.170]), with significant improvements across time.

Conclusions:
Following a diagnosed SC, our results suggest that collegiate athletes returned if not exceeded baseline values at the symptom-free and new baseline assessments. The application of linear and nonlinear measures of postural stability following a SC yielded similar outcomes in conjunction with a baseline assessment. Our findings support the clinical utility of the baseline SC assessment when evaluating persisting balance deficits when using linear or nonlinear measures.
Stress and Sleep in Relation to Severity of Building Related Symptoms
Authors: Claeson Anna-Sara , Edvardsson Berit , Liljelind Ingrid 
Published: March 2023

ObjectiveThis study investigates different aspects of stress and sleep in medically examined individuals with varying severity of building-related symptoms (BRS).MethodsThree questionnaires were used to assess acute and long-term stress and sleep (Perceived Stress Scale; Shirom Melamed Burnout Questionnaire, and Karolinska Sleep Questionnaire).ResultsIndividuals with BRS, regardless of severity, did not differ in level of perceived stress (indicator of short-term stress). The indicators of long-term stress differed between the groups where an increased severity was associated with higher levels of burnout and sleep problems.ConclusionsThe study suggests an association between symptom severity and measures of long-term stress and sleep quality. This has implications for the treatment of persons affected by BRS, because not only the environment needs to be treated, but also the concurrent signs of distress, such as burnout or sleep problems.
The utility of delta troponin in diagnosing significant coronary artery disease in patients with symptomatic atrial fibrillation.
Authors: Oxenford Cassie , Fryar James , Pelecanos Anita , O’Rourke Peter , Tan Christopher , Alghamry Alaa 
Published: March 2023

Background
Troponin I (cTnI) elevation is common in patients with atrial fibrillation (AF) but does not reliably indicate underlying coronary ischemia. We investigated whether dynamic changes in cTnI value (delta troponin) are useful in revealing significant coronary artery disease (sCAD) in patients presenting with symptomatic AF.

Methods
We conducted a retrospective case-control study analyzing serial cTnI values in 231 patients presenting with symptomatic AF who had an objective assessment for underlying CAD within 6 months of the index admission. Diagnostic performance of an elevated cTnI (>0.04 μg/L) only, and elevated cTnI coupled with Youden Index derived cutoffs for absolute and relative changes in troponin, for distinguishing patients with sCAD, was evaluated.

Results
A total of 107 patients had an elevated cTnI on serial measurements. In this group, the area under the receiver operating characteristic curve was 0.69 [95% confidence interval (CI), 0.56–0.81] for relative delta troponin and 0.71 (95% CI, 0.59–0.83) for absolute delta troponin. The optimal diagnostic cutoff for relative delta troponin was > −0.42, and > −0.055 μg/L for absolute delta troponin. The specificity of elevated troponin to diagnose sCAD increased from 56 to 77% when relative delta troponin was added, and to 88% with absolute delta troponin. Although the sensitivity of cTnI elevation (57.1%) decreased to 50% for relative and 35.7% for absolute delta troponin, the negative predictive values were high and similar at 86%.

Conclusion
When added to the troponin peak, delta troponin is a promising test for the diagnosis of significant coronary artery disease in patients presenting with symptomatic AF with elevated cTnI. This result requires prospective validation in a larger cohort of patients.
All-Cause 30-Day Readmission and Mortality
Authors: Hamadi Hanadi Y. , Boamah Sheila , Apatu Emma , Tafili Aurora , Spaulding Aaron 
Published: March 2023

OBJECTIVE
The aim of this study was to determine whether Magnet® and non-Magnet hospitals differ in the occurrence of 30-day readmission and mortality rates among the Medicare population when considering community health factors.

BACKGROUND
Magnet hospitals have shown favorable outcomes regarding 30-day readmission and mortality; however, previous research has not evaluated whether the hospital community influences the likelihood of the patient being readmitted to a hospital or how Magnet facilities may mitigate potential mortality risks.

METHOD
This study used a cross-sectional study design of 1791 hospitals using a propensity score matching technique to compare Magnet and non-Magnet hospitals with similar hospital and community characteristics.

RESULTS
Results reveal no differences in readmission scores between Magnet and non-Magnet hospitals. When considering mortality scores, Magnet hospitals had better performance for pneumonia, congestive heart failure, and chronic obstructive pulmonary disease compared with non-Magnet hospitals.

CONCLUSIONS
Our results suggest that there may be universal efforts to improve overall readmission rates taken by hospitals to minimize potential penalties and maximize patient outcomes.
Value of Handheld Optical Illuminated Magnifiers for Sustained Silent Reading by Visually Impaired Adults
Authors: Kaminski John E. , Yoshinaga Patrick D. , Chun Melissa W. , Yu Megan , Shepherd John D. , Chan Tiffany L. , Deemer Ashley , Bittner Ava K. ,   the BeST-AID Study Team
Published: March 2023

SIGNIFICANCE
Vision rehabilitation providers tend to recommend handheld, illuminated optical magnifiers for short-duration spot reading tasks, but this study indicates that they are also a viable option to improve sustained, continuous text reading (e.g., books or magazines), especially for visually impaired adults who read slowly with only spectacle-based near correction.

PURPOSE
The utility of handheld optical magnifiers for sustained silent reading tasks involving normal-sized continuous text could be a valuable indication that is not recognized by vision rehabilitation providers and patients.

METHODS
Handheld, illuminated optical magnifiers were dispensed to 29 visually impaired adults who completed the sustained silent reading test by phone at baseline without the new magnifier and 1 month after using the magnifier. Reading speed in words per minute (wpm) was calculated from the time to read each page and then averaged across up to 10 pages or determined for the fastest read page (maximum).

RESULTS
From baseline without the magnifier to 1 month with the magnifier, there was a significant improvement in mean reading speed by 14 wpm (95% confidence interval [CI], 2.6 to 24; P = .02) and for maximum reading speed by 18 wpm (95% CI, 5.4 to 30; P = .005) on average across participants. Participants who had slower baseline reading speeds without the magnifier demonstrated significantly greater improvements in mean and maximum reading speeds on average with the magnifier (95% CI, 8 to 32 [P = .003]; 95% CI, 4 to 36 [P = .02]). A significantly greater number of pages were read with the new magnifier than without it (Wilcoxon z = −2.5; P = .01). A significantly greater number of pages were read with the magnifier by participants who read fewer pages at baseline (95% CI, 0.57 to 5.6; P = .02) or had greater improvements in mean reading speed (95% CI, 0.57 to 5.6; P = .007).

CONCLUSIONS
Many visually impaired adults read more quickly and/or read a greater number of pages after using a new magnifier for a month than compared to without it. The largest gains occurred among those with more difficulty at baseline, indicating the potential to improve reading rates with magnifiers for those with greater deficits.
Case Report: When Two Is Worse Than One—Stereo Imbalance in a Case of Wavefront-guided Scleral Lenses
Authors: Nguyen Lan Chi , Lew Wei Hau , Kauffman Matthew J. , Marsack Jason D. , Applegate Raymond A. , Coates Daniel R. 
Published: March 2023

SIGNIFICANCE
Wavefront-guided scleral lenses (WGSLs) reduce visually debilitating residual higher-order aberrations. Although reduced higher-order aberrations lead to improvement in monocular high-contrast visual acuity (VA), the success of the lenses in everyday life depends on additional factors such as retinal contrast, binocular balance, and stereoacuity.

PURPOSE
This report describes a case where WGSLs provided improved monocular vision compared with scleral lenses (SLs) but reduced binocularity and stereoacuity.

CASE REPORT
A 48-year-old woman with moderate keratoconus right eye (OD) and severe left eye (OS) was fitted with SLs and WGSLs. Visual acuity with best SLs was 20/20−2 OD and 20/25−2 OS. Residual higher-order root-mean-square (HORMS) wavefront error (6 mm pupil) was 0.56 μm OD and 1.38 μm OS. Visual acuity with WGSLs was 20/16−2 OD and 20/25+2 OS, and residual HORMS was 0.41 μm OD and 0.98 μm OS. Monocularly, WGSLs were reported to provide better VA. However, binocularly, the patient reported an “imbalanced feeling” and preferred the SLs over WGSLs. Binocular VA at distance was 20/25 with SLs and 20/25−2 with WGSL. To investigate, the Worth Four-Dot test was performed, and the outcomes reported fusion with SLs but suppression OS at distance with WGSLs. Stereoacuity was 160 arc seconds at near and 120 arc seconds at distance with SLs and 400 arc seconds at near and >1200 arc seconds at distance with WGSLs. Dichoptic contrast balancing showed a balance point of 0.48 with SLs and 0.17 with WGSLs, indicating a strong preference toward OD. Simulation of the patient's retinal image revealed a greater difference in image contrast between the two eyes with WGSLs.

CONCLUSIONS
Wavefront-guided scleral lenses reduced HORMS and improved VA compared with SLs. However, in this case, it inadvertently caused binocular imbalance. As WGSLs become more widely available, future work should include methods to optimize binocular balance to maximize overall patient satisfaction.
Fecal Microbiota Transplantation as a Cancer Therapeutic
Authors: Stoff Ronen , Wolf Yochai , Boursi Ben 
Published: March 2023

Abstract
For decades, cancer research and treatment focused on the cellular level, viewing cancer as a genetic disease of cell transformation. In the era of chemotherapy and radiotherapy, studies from the second half of the 19th century suggesting an association between the microbiota and cancer were almost neglected. The main focus of the field was limited to identification of specific viruses and bacteria that may serve as direct carcinogens leading to the recognition of 7 viruses (i.e., human papillomavirus, hepatitis B virus, and Kaposi sarcoma–associated herpesvirus) and 1 bacterium (Helicobacter pylori) as human carcinogens by the International Agency for Research on Cancer (https://monographs.iarc.who.int/agents-classified-by-the-iarc/). Shortly after the publication of the first draft of the human genome project in February 2001, the Nobel laureate microbiologist Joshua Lederberg raised the question: “Is human identity all in the genes?” It took more than a decade later and the development of multiomic techniques to confirm that his answer “each one of us is a small ecological community” was correct (Lederberg J. Keynote Address: Beyond the Genome. Brooklyn Law Rev 67). This ecological notion became relevant to cancer prevention, prediction, and treatment following the immunotherapy revolution and the understanding of the metabolic and immunologic roles of the microbiota in health and disease. Recently, the microbiota was recognized as an emerging hallmark of cancer following a large body of research showing its role in tumorigenesis, treatment efficacy and toxicity, and initial data regarding the role of microbial modulation in cancer therapy (Cancer Discov 2022;12(1):31–46). In the current review, we will focus on the role of fecal microbiota transplantation, the first microbial modulation technique that is used mainly in low-complexity conditions such as recurrent Clostridium difficile infections (Aliment Pharmacol Ther 2017;46(5):479–493), as a possible cancer therapeutic. However, to better understand the suggested roles of fecal microbiota transplantation in medical oncology, we first need to understand cancer as an ecological niche and the role of the microbiota in tumorigenesis and cancer treatment, specifically immunotherapy.