bluuebunny/crossref_metadata_2025_split huggingface dataset:
Validation of the InBody BP170 oscillometric home blood pressure monitor in general population according to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization Universal Standard
Authors: Kollias Anastasios , Anagnostopoulos Ioannis , Gravvani Areti , Stambolliu Emelina , Bountzona Ioanna , Menti Ariadni , Stergiou George S. 
Published: October 2019

Objective
To evaluate the accuracy of the InBody BP170 oscillometric upper-arm home blood pressure (BP) monitor in general population according to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ESH/ISO) Universal Standard (ISO 81060-2:2018).

Methods
Subjects were recruited to fulfill the age, gender, BP and cuff distribution criteria of the AAMI/ESH/ISO Universal Standard in general population using the same arm sequential BP measurement method. Two cuffs of the test device were used for arm circumference 22–32 (medium) and 32–42 cm (large).

Results
One-hundred five subjects were recruited and 88 were analyzed. For validation Criterion 1, the mean ± SD of the differences between the test device and reference BP readings was 0.9 ± 6.9/0.5 ± 5.5 mmHg (systolic/diastolic). For Criterion 2, the SD of the averaged BP differences between the test device and reference BP per subject was 5.77/4.80 mmHg (systolic/diastolic).

Conclusion
The InBody BP170 oscillometric home BP monitor fulfilled all the requirements of the AAMI/ESH/ISO Universal Standard (ISO 81060-2:2018) in general population and can be recommended for clinical use.
How comorbidities impact Early Warning Score as a predictor of 7-day mortality
Authors: Langsted Sandra Nima Damsholt , Dynesen Jens Jacob , Liesanth Janet Yde , Jessen Marie Kristine , Mackenhauer Julie , Ahrensberg Jette , Kirkegaard Hans 
Published: October 2019

Background:
Early Warning Score systems are used to monitor patients at risk of deterioration. How comorbidities impact Early Warning Score’s ability to predict short-term mortality in the emergency department is not fully elucidated. The aim of the study was to investigate how comorbidities impact Early Warning Score as predictor of 7-day mortality.

Methods:
This is an observational cohort study of adult emergency department patients attending one of the five emergency departments in Central Region Denmark from 1 March 2015 to 31 May 2015. Charlson Comorbidity Index was used as a measure of comorbidities. Logistic regression was used to calculate the odds ratio for 7-day mortality. Patients were compared in three groups: Charlson Comorbidity Index: 0, 1–2, 3+.

Results:
A total of 30 060 adult patients attended one of the five emergency departments. Nineteen thousand one hundred twenty-three patients were included. Charlson Comorbidity Index 3+ patients presenting with Early Warning Score 0, 1–2 or 3–4 had significantly higher odds ratio of 7-day mortality compared to Charlson Comorbidity Index 0 patients with equal Early Warning Score. For patients with Early Warning Score 5+, Charlson Comorbidity Index -status had no significant impact on 7-day mortality after adjusting for age.

Conclusion:
In patients presenting with lower acuity (Early Warning Score 0–4) Charlson Comorbidity Index has a significant impact on 7-day mortality regardless of Early Warning Score. Including Charlson Comorbidity Index status in Early Warning Score or adjusting for Charlson Comorbidity Index -status could increase the predictive value of Early Warning Score in predicting 7-day mortality.
Effect of oxygen therapy on the risk of mechanical ventilation in emergency acute pulmonary edema patients
Authors: Chu Michael Yat Sun , Guo Wenjia , Lim Kwee Kwang , Lim Beng Leong 
Published: October 2019

Objective:
We investigated the effects of hyperoxemia on morbidity and mortality in acute cardiogenic pulmonary edema (ACPE).

Methods:
We conducted a retrospective cohort study of patients in our emergency department (ED) with ACPE who received arterial blood gases. Patients were classified based on the first PaO2 as hypoxemic (<75 mmHg), normoxemic (75–100 mmHg) and hyperoxemic (>100 mmHg). The primary outcome was the rates of mechanical ventilation (MV). We also reported adjusted odds ratios (AOR) and their 95% confidence intervals (CI) of the primary outcome after adjusting for predictors of MV determined a priori. Secondary outcomes were median hospital length of stay (LOS) and in-hospital mortality.

Results:
We recruited 335 patients; 34.0% had hyperoxemia. The rates of normoxemia and hypoxemia were 27.5% and 38.5%, respectively. The rates of MV were: hypoxemic 60/129 (46.5%) vs. normoxemic 41/92 (44.6%) vs. hyperoxemic 50/114 (43.9%); P = 0.62. The AORs for MV for the hyperoxemic and hypoxemic groups (reference: normoxemic group) were 0.98 (95% CI: 0.53–1.79) and 1.38 (95% CI: 0.77–2.48), respectively. Intubation rates for the groups were: hypoxemic 15/129 (11.6%) vs. normoxemic 6/92 (6.5%) vs. hyperoxemic 12/114 (10.6%); P = 0.43. The secondary outcomes were comparable among the groups. In-hospital mortality rates were: hypoxemic 6/129 (4.7%) vs. 6/92 (6.5%) vs. 10/114 (8.8%); P = 0.42.

Conclusion:
Our exploratory study did not report effects on mechanical ventilation, median hospital LOS and in-hospital mortality from hyperoxemia compared to hypoxemic and normoxemic ED patients with ACPE. Further studies are warranted to prove or disprove our findings.
99mTc DTPA vs. 51Cr EDTA for glomerular filtration rate measurement: is there a systematic difference?
Authors: McMeekin Helena , Barnfield Mark , Wickham Fred , Burniston Maria 
Published: October 2019

Aim
The study aimed to investigate whether a systematic difference exists between 51Cr EDTA and 99mTc DTPA for measurement of glomerular filtration rate (GFR).

Methods
The distribution of GFR results from candidates attending the Royal Free Hospital for assessment of suitability for kidney donation was compared before and after the change from 51Cr EDTA to 99mTc DTPA using three-sample slope-intercept GFR calculation with samples at 2, 3, and 4 hours. A second cohort of oncology patients attending Leeds Teaching Hospitals NHS Trust underwent simultaneous GFR measurement with both tracers by full characterisation of the plasma clearance curve with nine samples between 5 minutes and 8 hours post-injection. Three-sample slope-intercept GFR was also calculated for comparison with cohort 1.

Results
From the first cohort, a statistically significant (P = 0.008) systematic difference of 5.8% (95% confidence interval: 1.5%–10.1%) was found in the three-sample slope-intercept GFR, with 99mTc DTPA giving the higher result. From the second cohort, a statistically significant (P = 0.00001) systematic difference of 2.9% (95% confidence interval: 1.8%–3.9%) was found in three-sample slope-intercept GFR, with 99mTc DTPA giving the higher result. There was no statistically significant difference between the tracers when GFR was calculated by full characterisation of the plasma clearance curve.

Conclusion
There is a small systematic difference between GFR measured with 99mTc DTPA and 51Cr EDTA using abbreviated techniques, which is removed when GFR is calculated by full characterisation of the plasma clearance curve. The difference is not clinically significant in the context of intra-patient variability of GFR measurement.
Dysphagia lusoria: problem or incidentaloma?
Authors: Epperson Madison V. , Howell Rebecca 
Published: October 2019

Purpose of review
To address the incidental versus pathogenic nature of dysphagia lusoria and to provide a review of the cause, clinical presentation, diagnosis, and treatment of this condition with respect to recent literature.

Recent findings
Case reports comprise the majority of recent literature concerning dysphagia lusoria. Many patients with an aberrant right subclavian artery (ARSA) have additional coexisting vascular anomalies. While most individuals present around age 50, some present as children and neonates. Of note, this population may present with dysphagia as opposed to respiratory findings alone, as previously described. In the diagnostic workup, most patients receive a battery of radiologic tests, which may not be necessary. Significantly, dietary modifications and medical management alone may resolve symptoms. Nonetheless, a wide range of operative techniques are available for the treatment of dysphagia lusoria.

Summary
Clinicians should have a higher suspicion for dysphagia lusoria in patients with known vascular, heart, or chromosomal anomalies. Diagnosis should begin with a barium esophagram followed by a computed tomography angiogram or magnetic resonance angiogram. Avoid unnecessary studies. In many cases, an ARSA may be an incidental finding with comorbid gastroesophageal reflux disease or another medical condition responsible for the symptoms. Medical versus surgical management should be considered on a case-by-case basis.
Liver Transplantation for Propionic Acidemia
Authors: Alexopoulos Sophoclis P. , Matsuoka Lea , Hafberg Einar , Morgan Thomas , Thurm Cary , Hall Matt , Godown Justin 
Published: October 2019

ABSTRACTObjectives:Propionic acidemia (PA) is a rare inborn error of metabolism resulting from deficiency in the enzyme necessary for catabolism of branched‐chain amino acids, some odd chain fatty acids and cholesterol. Despite optimal medical management, PA often leads to acute and progressive neurological injury. Reports on liver transplantation (LT) as a cellular therapy are limited and varied. The objective of this study was to examine the largest collection of patients who underwent LT for PA.Methods:Examining the Scientific Registry of Transplant Recipients and the Pediatric Health Information System administrative billing databases, we performed a multicenter, retrospective analysis of LT over a 16‐year period. During this period, 4849 pediatric LT were performed out of which 23 were done for PA at 10 different centers.Results:The majority of recipients were 5 years of age or younger and had status 1b exception points at the time of transplant. The 1‐, 3‐, and 5‐year graft survival for PA LT recipients was 84.6% and the 1‐, 3, and 5‐year patient survival was 89.5%. There was no significant difference in graft or patient survival between PA and non‐PA LT recipients. Despite historical data to the contrary, we did not find an increased incidence of hepatic arterial thrombosis in patients undergoing LT for PA. Patients in the PA LT group, however, had a significantly higher postoperative rate of readmission compared with the non‐PA LT group (90.5% vs 72.8%, P = 0.021).Conclusion:LT for children with PA is a viable treatment option with acceptable outcomes.
Improving Perinatal Care Through Theory Application
Authors: Côté-Arsenault Denise , Hubbard Lori Johnson 
Published: October 2019

Abstract
Theories from various perspectives can increase nurses' understanding of maternal behaviors throughout the developmental process of pregnancy and postpartum. The purpose of this article is to present relevant theories that maternity nurses will likely find useful, and to demonstrate their applicability through an unfolding exemplar case. Nurses can provide improved and more sensitive care when guided by psychosocial theories such as Rubin's tasks of pregnancy, prenatal attachment, pregnancy as a liminal phase, and the grief work in postpartum as proposed by Mercer. Use of relevant theories can promote holistic nursing care, increase critical thinking, and improve nursing responsiveness to unique family situations such as pregnancy after loss and premature birth.
Knowledge of HIV Status Is Associated With a Decrease in the Severity of Depressive Symptoms Among Female Sex Workers in Uganda and Zambia
Authors: Ortblad Katrina F. , Musoke Daniel Kibuuka , Chanda Michael M. , Ngabirano Thomson , Velloza Jennifer , Haberer Jessica E. , McConnell Margaret , Oldenburg Catherine E. , Bärnighausen Till 
Published: October 2019

Background:
Knowledge of HIV-positive status may result in depressive symptoms, which may be a concern to scaling novel HIV testing interventions that move testing outside the health system and away from counselor support.

Setting:
Uganda and Zambia.

Methods:
We used longitudinal data from 2 female sex worker (FSW) cohorts in Uganda (n = 960) and Zambia (n = 965). Over 4 months, participants had ample opportunity to HIV testing using standard-of-care services or self-tests. At baseline and 4 months, we measured participants' perceived knowledge of HIV status, severity of depressive symptoms (continuous PHQ-9 scale, 0–27 points), and prevalence of likely depression (PHQ-9 scores ≥10). We estimated associations using individual fixed-effects estimation.

Results:
Compared with unknown HIV status, knowledge of HIV-negative status was significantly associated with a decrease in depressive symptoms of 1.06 points in Uganda (95% CI −1.79 to −0.34) and 1.68 points in Zambia (95% CI −2.70 to −0.62). Knowledge of HIV-positive status was significantly associated with a decrease in depressive symptoms of 1.01 points in Uganda (95% CI −1.82 to −0.20) and 1.98 points in Zambia (95% CI −3.09 to −0.88). The prevalence of likely depression was not associated with knowledge of HIV status in Uganda but was associated with a 14.1% decrease with knowledge of HIV-negative status (95% CI −22.1% to −6.0%) and a 14.3% decrease with knowledge of HIV-positive status (95% CI −23.9% to −4.5%) in Zambia.

Conclusions:
Knowledge of HIV status, be it positive or negative, was significantly associated with a decrease in depressive symptoms in 2 FSW populations. The expansion of HIV testing programs may have mental health benefits for FSWs.
Cloverleaf Sign in Pelvic Magnetic Resonance Imaging for Deep Infiltrating Endometriosis
Authors: Härmä Kirsi , Binda Aleksandra , Ith Michael , Poellinger Alexander , Siegenthaler Franziska , Heverhagen Johannes , Imboden Sara , Mueller Michael 
Published: October 2019

Objectives
The aim of this study was to evaluate the significance of a new imaging sign, the “cloverleaf sign,” in diagnosing deep infiltrating endometriosis (DIE) with magnetic resonance imaging (MRI) in concordance to intraoperative findings.

Materials and Methods
This retrospective study included 103 patients operated during the January 2016 to June 2018 period with preoperative 1.5 T and 3 T MRI, with or without vaginal and rectal gel filling. Magnetic resonance imaging scans were read blinded to intraoperative findings by a specialized gynecologic radiologist and a junior radiologist, and then compared with intraoperative findings by looking at the operation report, postoperative diagnosis, and intraoperative images and videos by an experienced gynecologist surgeon specialized in endometriosis surgery. All endometriosis lesions were confirmed by pathology. The “cloverleaf sign” was defined as a cloverleaf-like figure in imaging morphology; the “leaves” formed by at least 3 different organs come together in the center of the figure formed by constrictive adhesions including T2-weighted (T2W) hypointense DIE. Operation times, intraoperative blood loss, and the frequency of DIE and bowel resections were analyzed in cloverleaf and noncloverleaf groups. The 2-sample Wilcoxon rank-sum (Mann-Whitney U) test and multivariate analysis of variance were used to calculate the significance of an overall impact of cloverleaf sign on operation time, blood loss, and the amount of the bowel resection rate. P < 0.05 was considered statistically significant.

Results
The prevalence of DIE in the study population was 79.6%. A total of 11.5% of the patients had no endometriosis, 32.6% had rASRM I and II, and 55.9% had rASRM III and IV. Forty-six patients (45%) had received rectal and vaginal gel opacification before scanning, 57 (55%) did not. A cloverleaf sign on MRI was detected in 34 patients (15 in gel filling and 19 in nonfilling group). The interreader agreement was almost perfect 0.91 (κ). The median operation time in the cloverleaf group was 248 minutes (interquartile range [IQR], 165–330) compared with 145 minutes in the noncloverleaf group (IQR, 90–210), that is, significantly higher (P < 0.001). Intraoperative blood loss was also significantly higher in the conglomerate group (125 vs 50 mL; IQR, 100–300 vs 50–100; P < 0.001). Of the bowel resections in our study population, 41% (14/34) were performed on patients with a cloverleaf sign in the MRI, compared with 13% (9/69) in patients without the cloverleaf sign.

Conclusions
The “cloverleaf” MRI sign was associated with significantly longer operation time, increased intraoperative blood loss, and higher rates of bowel resection in DIE patients.
Low-Radiation-Dose Stress Myocardial Perfusion Measurement Using First-Pass Analysis Dynamic Computed Tomography
Authors: Hubbard Logan , Malkasian Shant , Zhao Yixiao , Abbona Pablo , Kwon Jungnam , Molloi Sabee 
Published: October 2019

Objectives
The aim of this study was to assess the feasibility of a prospective first-pass analysis (FPA) dynamic computed tomography (CT) perfusion technique for accurate low-radiation-dose global stress perfusion measurement.

Materials and Methods
The prospective FPA technique was evaluated in 10 swine (42 ± 12 kg) by direct comparison to a previously validated retrospective FPA technique. Of the 10 swine, 3 had intermediate stenoses with fractional flow reserve severities of 0.70 to 0.90. In each swine, contrast and saline were injected peripherally followed by dynamic volume scanning with a 320-slice CT scanner. Specifically, for the reference standard retrospective FPA technique, volume scans were acquired continuously at 100 kVp and 200 mA over 15 to 20 seconds, followed by systematic selection of only 2 volume scans for global perfusion measurement. For the prospective FPA technique, only 2 volume scans were acquired at 100 kVp and 50 mA for global perfusion measurement. All prospective global stress perfusion measurements were then compared with the corresponding reference standard retrospective global stress perfusion measurements through regression analysis. The CTDIvol
32 and size-specific dose estimate of the prospective FPA technique were also determined.

Results
All prospective global stress perfusion measurements (PPRO) at 50 mA were in good agreement with the reference standard retrospective global stress perfusion measurements (PREF) at 200 mA (PPRO = 1.07 PREF −0.09, r = 0.94; root-mean-square error = 0.30 mL/min per gram). The CTDIvol
32 and size-specific dose estimate of the prospective FPA technique were 2.3 and 3.7 mGy, respectively.

Conclusions
Accurate low-radiation-dose global stress perfusion measurement is feasible using a prospective FPA dynamic CT perfusion technique.
Sex Disparity in Academic Rank and Industry Payments to Plastic Surgeons
Authors: Ngaage Ledibabari M. , Harris Chelsea , Rosen Carly , Ge Shealinna , Kim Cecelia , Rada Erin M. , Manahan Michele , Silverman Ronald P. , Slezak Sheri , Rasko Yvonne M. 
Published: October 2019

Introduction
Despite increasing representation in surgery, women continue to lag behind men in important metrics. Little is known on how industry funding may also contribute to this ongoing disparity. This article seeks to quantify industry payments to academic plastic surgeons (APSs) by sex and examine the relationship between funding and academic achievement.

Methods
We conducted a cross-sectional analysis of industry payments disbursed to APSs in 2017. Faculty were identified using departmental listings of Accreditation Council for Graduate Medical Education plastic surgery residency programs. Payments were identified via the Center for Medicare and Medicaid Services open payment database. Academic achievement was assessed using rank (eg, assistant professor), leadership designation (eg, division head), and Scopus H-index and then controlled for time in practice.

Results
Of the 805 APSs, the majority were male (82% male vs 18% female, P < 0.0001). Significant sex differences emerged in average yearly industry contributions (men, US $3202, vs women, US $707; P < 0.0001). Across all academic ranks, men received significantly higher payments than women (P < 0.0500). Men constituted 93% of full professors and were almost twice as likely to hold additional leadership positions compared with women (odds ratio, 1.82; P = 0.0143). After adjustment for time in practice, there was no difference in H-indices between male and female APSs, although payment disparity persisted (P < 0.0001).

Conclusions
Substantial sex-based disparities exist among APSs' academic rank and leadership attainment, which is not attributed to differences in academic qualifications or experience. To better elucidate the sources of this disparity, future studies should assess sexed differences in payment types. Furthermore, we urge for increased transparency in the selection process for industry payments.
Happiness in Plastic Surgery
Authors: Sterling David A. , Grow Jacob N. , Vargo James D. , Nazir Niaman , Butterworth James A. 
Published: October 2019

Background
Despite a heightened appreciation for wellness in medicine, there exists little information specific to plastic surgery. The purpose of this research was to assess happiness within the field of plastic surgery.

Methods
A cross-sectional study was conducted in July of 2017 by distributing an American Society of Plastic Surgeons sponsored survey to a random cohort of current practicing American Society of Plastic Surgeons members, residents and fellows. In addition, the same survey was sent to medical students applying to integrated plastic surgery residency. Total happiness scores (Subjective Happiness Scale) were averaged and compared between and within surveyed groups.

Results
A total of 595 individuals completed surveys, including 287 practicing surgeons, 116 residents, 12 fellows, and 180 medical students. Differences in happiness scores between the groups were statistically significant (P < 0.01). For practicing physicians, happiness scores were significantly greater for those more than 20 years out from training (P < 0.01). Furthermore, a significantly positive correlation was found between practice expectations coming out of residency and happiness scores (Pearson correlation coefficient, 0.2; P < 0.01).

Conclusions
Despite the prevalence of burnout and mental health disorders associated with a career in medicine, plastic surgeons and trainees report high levels of happiness. Practicing plastic surgeons report increased happiness further out from training and when meeting practice expectations coming out of training. Otherwise, there were no significant differences in happiness between groups. Regarding sex, it is encouraging to report no significant sex discrepancies with happiness in a field where women still face significant adversity.