bluuebunny/crossref_metadata_2025_split huggingface dataset:
Data-driven approach to identifying potential laboratory overuse in general internal medicine (GIM) inpatients
Authors: Weinerman Adina S , Guo Yishan , Saha Sudipta , Yip Paul M , Lapointe-Shaw Lauren , Fralick Michael , Kwan Janice L , MacMillan Thomas E , Liu Jessica , Rawal Shail , Sheehan Kathleen A , Simons Janet , Tang Terence , Bhatia Sacha , Razak Fahad , Verma Amol A 
Published: July 2023

BackgroundReducing laboratory test overuse is important for high quality, patient-centred care. Identifying priorities to reduce low value testing remains a challenge.ObjectiveTo develop a simple, data-driven approach to identify potential sources of laboratory overuse by combining the total cost, proportion of abnormal results and physician-level variation in use of laboratory tests.Design, setting and participantsA multicentre, retrospective study at three academic hospitals in Toronto, Canada. All general internal medicine (GIM) hospitalisations between 1 April 2010 and 31 October 2017.ResultsThere were 106 813 GIM hospitalisations during the study period, with median hospital length-of-stay of 4.6 days (IQR: 2.33–9.19). There were 21 tests which had a cumulative cost >US$15 400 at all three sites. The costliest test was plasma electrolytes (US$4 907 775), the test with the lowest proportion of abnormal results was red cell folate (0.2%) and the test with the greatest physician-level variation in use was antiphospholipid antibodies (coefficient of variation 3.08). The five tests with the highest cumulative rank based on greatest cost, lowest proportion of abnormal results and highest physician-level variation were: (1) lactate, (2) antiphospholipid antibodies, (3) magnesium, (4) troponin and (5) partial thromboplastin time. In addition, this method identified unique tests that may be a potential source of laboratory overuse at each hospital.ConclusionsA simple multidimensional, data-driven approach combining cost, proportion of abnormal results and physician-level variation can inform interventions to reduce laboratory test overuse. Reducing low value laboratory testing is important to promote high value, patient-centred care.
Multiagency approaches to preventing sudden unexpected death in infancy (SUDI): a review and analysis of UK policies
Authors: Ball Helen L , Keegan Alice-Amber , Whitehouse Daniel R , Cooper Louise S , Lovell-Kennedy Sophie R , Murray Laura M , Newbury-Birch Dorothy , Cleghorn Nicola J , Healy Amanda 
Published: July 2023

BackgroundRecent reviews of sudden unexpected deaths in infancy (SUDI) in England recommend a multiagency working (MAW) approach to prevention but lack clear guidance around how this might be implemented.AimsIn England, local authorities commission and oversee public health services. This review examines how local authority policies address implementation of MAW for SUDI prevention to understand local variations and identify strengths and weaknesses.MethodsUsing a comprehensive list of all metropolitan, county, unitary councils and London boroughs in England, we systematically searched local authority websites for relevant published documents and submitted freedom of information (FOI) requests where policies or guidance for SUDI prevention had not been sourced online. We extracted data from documents using a standardised form to summarise policy contents which were then collated, described and appraised.FindingsWe searched the websites of 152 council and London boroughs, identifying 36 relevant policies and guidelines for staff. We submitted 116 FOI requests which yielded 64 responses including six valid documents: 45% (52/116) of local authorities did not respond. Seventeen councils shared the same guidance under safeguarding partnerships; removal of duplicates resulted in 26 unique documents. Only 15% (4/26) of the documents included a detailed plan for how MAW approaches were to be implemented despite 73% (19/26) of the documents mentioning the importance of engaging the MAW in raising awareness of safe sleep for babies with vulnerable families. Five areas of variation were identified across policies: (1) scope, (2) responsibilities, (3) training, (4) implementation and (5) evaluation.ConclusionsThere are discrepancies between local authorities in England in whether and how MAW for SUDI prevention is carried out. Strengths and weaknesses of approaches are identified to inform future development of MAW for SUDI prevention.
Frostbite: a treatment guideline for prehospital treatment in a military environment
Authors: Turner B L , van Dongen T T.C.F , Berendsen R R , de Jong F J.M , Endert E L , van Hulst R A , Hoencamp R 
Published: July 2023

Frostbite remains a severe medical condition that causes long-lasting sequelae and can threaten military operations. Information on prehospital treatment of frostbite is scarce and existing guidelines are aimed at the general population.This paper provides a guideline on prehospital emergency care of frostbite in the (Netherlands) Armed Forces. The insights gained from studies reporting on frostbite treatment in the prehospital setting were combined with the expert opinions of the authors and applied to the military context. The resulting guideline consists of two stages: (prolonged) field care and care at a Medical Treatment Facility. The cornerstones are rewarming in warm water and evacuation to a medical facility. Additional aspects of prehospital treatment are rehydration, proper analgesia, non-steroidal anti-inflammatory drugs and wound care.We suggest further collaboration among North Atlantic Treaty Organization partners and other affiliated nations, focusing on the full spectrum of military injury management including state-of-the-art aftercare, long-lasting sequelae and return to duty after frostbite.
Neglected Mendelian causes of stroke in adult Chinese patients who had an ischaemic stroke or transient ischaemic attack
Authors: Li Wei , Li Hao , Lu Chaoxia , Zhao Jialu , Xu Huichun , Xu Zhe , Mitchell Braxton , Jiang Yong , Gu Hong-Qiu , Xu Qin , Wang Anxin , Meng Xia , Lin Jinxi , Jing Jing , Li Zixiao , Zhu Wanlin , Liang Zhigang , Wang Mengxing , Wang Yongjun 
Published: July 2023

Background and purpose
Multiple factors play important roles in the occurrence and prognosis of stroke. However, the roles of monogenic variants in all-cause ischaemic stroke have not been systematically investigated. We aim to identify underdiagnosed monogenic stroke in an adult ischaemic stroke/transient ischaemic attack (TIA) cohort (the Third China National Stroke Registry, CNSR-III).

Methods
Targeted next-generation sequencing for 181 genes associated with stroke was conducted on DNA samples from 10 428 patients recruited through CNSR-III. The genetic and clinical data from electronic health records (EHRs) were reviewed for completion of the diagnostic process. We assessed the percentages of individuals with pathogenic or likely pathogenic (P/LP) variants, and the diagnostic yield of pathogenic variants in known monogenic disease genes with associated phenotypes.

Results

In total, 1953 individuals harboured at least one P/LP variant out of 10 428 patients. Then, 792 (7.6%) individuals (comprising 759 individuals harbouring one P/LP variant in one gene, 29 individuals harbouring two or more P/LP variants in different genes and 4 individuals with two P/LP variants in
ABCC6
) were predicted to be at risk for one or more monogenic diseases based on the inheritance pattern. Finally, 230 of 792 individuals manifested a clinical phenotype in the EHR data to support the diagnosis of stroke with a monogenic cause. The most diagnosed Mendelian cause of stroke in the cohort was cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. There were no relationships between age or family history and the incidence of first symptomatic monogenic stroke in patients.

Conclusion
The rate of monogenic cause of stroke was 2.2% after reviewing the clinical phenotype. Possible reasons that Mendelian causes of stroke may be missed in adult patients who had an ischaemic stroke/TIA include a late onset of stroke symptoms, combination with common vascular risks and the absence of a prominent family history.
Developing scoring functions based on soil texture to assess agricultural soil health in Quebec, Canada
Authors: Gauthier Mélanie , Hogue Richard , D'Astous-Pagé Joël , Champagne Michel , Halde Caroline 
Published: July 2023

Adoption of soil health indicators to assess physical, biological, and chemical properties involves adapting their interpretation for a specific region using scoring functions. Accordingly, we used data provided from 1166 soil samples distributed between fine-, medium-, and coarse-textured soils, collected in agricultural areas across the province of Quebec, Canada, and analyzed for 15 soil health indicators. Scoring functions were calculated according to the means and standard deviations obtained for each soil health indicator by textural group. Three scoring types were used: “more-is-better”, “less-is-better”, and “optimum-is-best”. The results showed that 12 indicators were significantly influenced by soil texture and need separate scoring functions, except for wet aggregate stability, penetration resistance of the surface hardness (0–15 cm), and pH. This led to the development of one to three scoring functions for each soil health indicator. Correlation analysis between soil health indicators was also investigated to better understand relationships between soil physical, biological, and chemical properties. We observed that soil biological indicators were moderately to strongly correlated with each other ( r = 0.59–0.74) and with soil physical indicators ( r = 0.60–0.76). Overall, the results of this study led to the development of new scoring functions based on soil texture to interpret soil health indicators objectively and accurately for the benefit of Quebec farmers and agricultural stakeholders. The findings of this study demonstrated the need to adapt scoring functions to better account for the impact of regional factors on agricultural soils for the interpretation of soil health indicators.
Natural Killer Cell Activation by Ubiquitin-specific Protease 6 Mediates Tumor Suppression in Ewing Sarcoma
Authors: Jain Kanika , Henrich Ian C. , Quick Laura , Young Robert , Mondal Shreya , Oliveira Andre M. , Blobel Gerd A. , Chou Margaret M. 
Published: July 2023

Ewing sarcoma is a rare and deadly pediatric bone cancer for which survival rates and treatment options have stagnated for decades. Ewing sarcoma has not benefited from immunotherapy due to poor understanding of how its immune landscape is regulated. We recently reported that ubiquitin-specific protease 6 (USP6) functions as a tumor suppressor in Ewing sarcoma, and identified it as the first cell-intrinsic factor to modulate the Ewing sarcoma immune tumor microenvironment (TME). USP6 induces intratumoral infiltration and activation of multiple innate immune lineages in xenografted nude mice. Here we report that natural killer (NK) cells are essential for its tumor-inhibitory functions, as NK cell depletion reverses USP6-mediated suppression of Ewing sarcoma xenograft growth. USP6 expression in Ewing sarcoma cells directly stimulates NK cell activation and degranulation in vitro, and functions by increasing surface levels of multiple NK cell-activating ligands. USP6 also induces surface upregulation of the receptor for the apoptosis-inducing ligand tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), providing an additional route for enhanced sensitivity to NK cell killing. Furthermore, USP6-expressing Ewing sarcoma and NK cells participate in a paracrine immunostimulatory feedforward loop, wherein IFNγ secreted by activated NK cells feeds back on USP6/Ewing sarcoma cells to induce synergistic expression of chemokines CXCL9 and CXCL10. Remarkably, expression of USP6 in subcutaneous Ewing sarcoma xenografts induces systemic activation and maturation of NK cells, and induces an abscopal response in which growth of distal tumors is inhibited, coincident with increased infiltration and activation of NK cells. This work reveals how USP6 reprograms the Ewing sarcoma TME to enhance antitumor immunity, and may be exploited for future therapeutic benefit.

Significance:
This study provides novel insights into the immunomodulatory functions of USP6, the only cancer cell–intrinsic factor demonstrated to regulate the immune TME in Ewing sarcoma. We demonstrate that USP6-mediated suppression of Ewing sarcoma tumorigenesis is dependent on NK cells. USP6 directly activates NK cell cytolytic function, inducing both intratumoral and systemic activation of NK cells in an Ewing sarcoma xenograft model.
Interaction of Filamin C With Actin Is Essential for Cardiac Development and Function
Authors: Zhou Xiaohai , Fang Xi , Ithychanda Sujay Subbayya , Wu Tongbin , Gu Yusu , Chen Chao , Wang Li , Bogomolovas Julius , Qin Jun , Chen Ju 
Published: July 2023

BACKGROUND:
FLNC (filamin C), a member of the filamin family predominantly expressed in striated muscles, plays a crucial role in bridging the cytoskeleton and ECM (extracellular matrix) in cardiomyocytes, thereby maintaining heart integrity and function. Although genetic variants within the N-terminal ABD (actin-binding domain) of FLNC have been identified in patients with cardiomyopathy, the precise contribution of the actin-binding capability to FLNC’s function in mammalian hearts remains poorly understood.

METHODS:
We conducted in silico analysis of the 3-dimensional structure of mouse FLNC to identify key amino acid residues within the ABD that are essential for FLNC’s actin-binding capacity. Subsequently, we performed coimmunoprecipitation and immunofluorescent assays to validate the in silico findings and assess the impact of these mutations on the interactions with other binding partners and the subcellular localization of FLNC. Additionally, we generated and analyzed knock-in mouse models in which the FLNC-actin interaction was completely disrupted by these mutations.

RESULTS:
Our findings revealed that F93A/L98E mutations completely disrupted FLNC-actin interaction while preserving FLNC’s ability to interact with other binding partners ITGB1 (β1 integrin) and γ-SAG (γ-sarcoglycan), as well as maintaining FLNC subcellular localization. Loss of FLNC-actin interaction in embryonic cardiomyocytes resulted in embryonic lethality and cardiac developmental defects, including ventricular wall malformation and reduced cardiomyocyte proliferation. Moreover, disruption of FLNC-actin interaction in adult cardiomyocytes led to severe dilated cardiomyopathy, enhanced lethality and dysregulation of key cytoskeleton components.

CONCLUSIONS:
Our data strongly support the crucial role of FLNC as a bridge between actin filaments and ECM through its interactions with actin, ITGB1, γ-SAG, and other associated proteins in cardiomyocytes. Disruption of FLN-actin interaction may result in detachment of actin filaments from the extracellular matrix, ultimately impairing normal cardiac development and function. These findings also provide insights into mechanisms underlying cardiomyopathy associated with genetic variants in FLNC ABD and other regions.
Comparison of Out‐of‐Hospital Cardiac Arrest Outcomes Between Asian and White Individuals in the United States
Authors: Gupta Kashvi , Raj Rohan , Asaki S. Yukiko , Kennedy Kevin , Chan Paul S. 
Published: July 2023

Background
Disparities in bystander cardiopulmonary resuscitation (CPR) and survival have been reported for Black and Hispanic individuals with out‐of‐hospital cardiac arrest (OHCA). Whether Asian individuals have lower rates of bystander CPR and survival for OHCA, as compared with White individuals, remains unknown.

Methods and Results

Within the US‐based CARES (Cardiac Arrest Registry to Enhance Survival), we identified 278 989 OHCAs in Asian and White individuals during 2013 to 2021. Using hierarchical Poisson logistic regression with emergency medical service agency modeled as a random effect and patient and OHCA characteristics as fixed effects, we compared rates of bystander CPR, survival to discharge, and favorable neurological survival between Asian and White individuals with OHCA. Overall, 14 835 (5.3%) OHCAs occurred in Asian individuals. Compared with White individuals with OHCA, Asian individuals were older (67.0±17.6 versus 62.8±16.9 years) and were less likely to have drug overdose as the cause of OHCA (1.3% versus 6.6%) and a shockable arrest rhythm (19.2% versus 22.4%). Layperson bystander CPR rates were similar between Asian and White individuals (42.6% versus 42.1%; adjusted relative risk for Asian individuals, 0.99 [95% CI, 0.97–1.02];
P
=0.69). However, rates of survival to discharge were lower in Asian individuals with OHCA (8.2% versus 10.3%; adjusted relative risk 0.92 [0.86–0.98]
P
=0.006). Similarly, the rate of favorable neurological survival was lower for Asian individuals (6.5% versus 8.7%; adjusted relative risk, 0.85 [0.79–0.91];
P
<0.001).

Conclusions
Despite similar rates of bystander CPR, Asian individuals with OHCA have lower survival rates than White individuals with OHCA. The reasons for the lower survival rate deserve further study to determine whether there are disparities in resuscitation care between Asian and White individuals with OHCA.
Moist Baroclinic Instability of Mid–High-Latitude Intraseasonal Oscillations
Authors: Cui Jing , Li Tim , Wang Lijuan 
Published: July 2023

Abstract
The origin of mid–high-latitude intraseasonal oscillations (ISOs) was investigated through both observational and theoretical studies. It was found that maximum intraseasonal variability centers appear near 60°N, which is at odds with maximum synoptic variability centers that are located along the upper-tropospheric jet stream (∼45°N). The ISO along 60°N is characterized by a typical zonal wavelength of 7700 km and a westward phase speed of −3 m s−1. A marked feature of the mid–high-latitude ISO is a tight coupling among moisture and precipitation and circulation. Motivated by this observational discovery, a moist baroclinic theoretical model was constructed. The analysis of this model indicates that under a realistic background mean state, the model generates the most unstable mode along the reference latitude (60°N), which has a preferred zonal wavelength of 7000 km, a westward phase speed of about −3 m s−1, a westward tilted vertical structure, and a zonal structure of perturbation moisture/precipitation being located to the east of the low-level trough, all of which resemble the observed. The cause of the instability arises primarily from the moisture–precipitation–circulation feedback under a moderate background vertical shear.
Processes Controlling the Seasonally Varying Emergence of Forced Arctic Longwave Radiation Changes
Authors: Shaw Jonah K. , Kay Jennifer E. 
Published: July 2023

Abstract
Most observed patterns of recent Arctic surface warming and sea ice loss lie outside of unforced internal climate variability. In contrast, human influence on related changes in outgoing longwave radiation has not been assessed. Outgoing longwave radiation captures the flow of thermal energy from the surface through the atmosphere to space, making it an essential indicator of Arctic change. Furthermore, satellites have measured pan-Arctic radiation for two decades while surface temperature observations remain spatially and temporally sparse. Here, two climate model initial-condition large ensembles and satellite observations are used to investigate when and why twenty-first-century Arctic outgoing longwave radiation changes emerge from unforced internal climate variability. Observationally, outgoing longwave radiation changes from 2001 to 2021 are within the range of unforced internal variability for all months except October. The model-predicted timing of Arctic longwave radiation emergence varies throughout the year. Specifically, fall emergence occurs a decade earlier than spring emergence. These large emergence timing differences result from seasonally dependent sea ice loss and surface warming. The atmosphere and clouds then widen these seasonal differences by delaying emergence more in the spring and winter than in the fall. Finally, comparison of the two ensembles shows that more sea ice and a more transparent atmosphere during the melt season led to an earlier emergence of forced longwave radiation changes. Overall, these findings demonstrate that attributing changes in Arctic outgoing longwave radiation to human influence requires understanding the seasonality of both forced change and internal climate variability.
Adverse Events Associated With Disparity Between Patients’ BMI and Operating Table Size—A Need for Improved Surgical Innovations
Authors: Watts Emelia , Patel Diti , Hoops Heather , Elkbuli Adel 
Published: July 2023

Background The lack of proper equipment to accommodate patients with high BMI can jeopardize the safety of the patients and medical staff. In this review, we aim to discuss the availability of obesity accommodations in the operating room, along with its impact, implications, and future recommendations. Methods Four databases were searched for articles pertaining to surgical table dimensions and the implications for safety, with a special focus on patients with larger BMIs. Articles were separated into 4 categories: Existing OR Table Options, Safety Implications for Patients, Reported Adverse Events Associated with Operating Table Inadequacy, and Safety Implications for Medical Staff. Results A total of 18 articles and documents were included in this review. Most of the literature that discusses surgical tables with higher weight capacity is specific only to weight loss surgeries. Operating table dimensions have changed little in the past 100 years and standard operating tables have weight limits of 500 pounds. Several case reports underline the hazards of inadequately sized surgical tables. Conclusions This review demonstrates that a lack of proper equipment, such as surgical tables with adequate width and weight limits, can be a major contributor to the endangerment of bariatric surgical patients and the medical professionals who care for them. Further research and surgical innovation may be required to develop superior operating tables to address the unique concerns of this patient populations.
Representations of Mental Illness in a Ga Community in Southern Ghana
Authors: Dzokoto Vivian Afi , Tutu Annabella Osei , Kpobi Lily , Banks Kira Hudson , Ryder Andrew G. 
Published: July 2023

This study explored lay concepts about and attributions of mental illness in a Ga community in southern Ghana. The study’s sample consisted of 11 Ga men and 12 Ga women, ranging in age from 30-81. Participants completed one-on-one interviews. Participants ascribed to polyphasic attributions of mental illness including biomedical and spiritual explanations. Attributions informed understandings of help-seeking behavior. Stigma was recognized as an important factor in the lived experience of people with mental illness. The recognition of individual distress as a marker of mental illness seemed less prominent than social indicators. Our interviewees’ narratives highlighted the importance of the social context in identifying and making meaning of mental illness in the community of study.