bluuebunny/crossref_metadata_2025_split huggingface dataset:
Recent advances in precision medicine for individualized immunosuppression
Authors: Fu Shengyi , Zarrinpar Ali 
Published: June 2020

Purpose of review
The current tools to proactively guide and individualize immunosuppression in solid organ transplantation are limited. Despite continued improvements in posttransplant outcomes, the adverse effects of over-immunosuppression or under-immunosuppression are common. The present review is intended to highlight recent advances in individualized immunosuppression.

Recent findings
There has been a great focus on genomic information to predict drug dose requirements, specifically on single nucleotide polymorphisms of CYP3A5 and ABCB1. Furthermore, biomarker studies have developed ways to better predict clinical outcomes, such as graft rejection.

Summary
The integration of advanced computing tools, such as artificial neural networks and machine learning, with genome sequencing has led to intriguing findings on individual or group-specific dosing requirements. Rapid computing allows for processing of data and discovering otherwise undetected clinical patterns. Genetic polymorphisms of CYP3A5 and ABCB1 have yielded results to suggest varying dose requirements correlated with race and sex. Newly proposed biomarkers offer precise and noninvasive ways to monitor patient's status. Cell-free DNA quantitation is increasingly explored as an indicator of allograft injury and rejection, which can help avoid unneeded biopsies and more frequently monitor graft function.
Autoimmune Hepatitis in Children
Authors: Cuarterolo Miriam L. , Ciocca Mirta , López Susana , Araujo María , Álvarez Fernando 
Published: June 2020

ABSTRACTObjective:The aim of this study was to find the outcome and adverse effects of 2 initial treatments in children with autoimmune hepatitis, prednisone (PRED) plus azathioprine (AZA) versus cyclosporine (CsA).Study Design:Between December 2008 and February 2012, 50 consecutive patients were centrally randomized to 1 of 2 treatment arms. Group 1: PRED was indicated at a dose of 1 to 2 mg · kg−1 · day−1 (up to 60 mg/day) and AZA at a dose of 1 to 2 mg · kg−1 · day−1. Group 2: CsA was administered at a dose of 4 mg · kg−1 · day−1 orally divided into 2 doses. After remission, all patients were given a combination of PRED at 0.3 to 0.5 mg · kg−1 · day−1 and AZA at 1 to 2 mg · kg−1 · day−1. Children presenting liver failure were placed on a triple immunosuppressive regimen if this condition persisted after 1 week of treatment, after liver function normalization they were switched back to their initial scheme.Results:A total of 26 patients received PRED‐AZA and 24 CsA. Both treatments showed similar initial results in effectiveness and safety, although remission was achieved earlier with PRED‐AZA: 8.6 versus CsA: 13.6 weeks (P < 0.0081). All children recovered liver function in a mean time of 32 ± 26 days. Cushingoid syndrome was more frequently observed with PRED‐AZA (P < 0.001) and gingival hypertrophy with CsA (P < 0.001). A significant increase in body mass index was observed in all patients from initial treatment to remission, being greater with PRED‐AZA.Conclusions:Similar outcomes were obtained with PRED plus AZA or CsA treatments. Either therapeutic strategy could be used according to the particular characteristics of each patient. Triple immunosuppression was beneficial in patients with liver failure at onset.
Association of Clinical Nursing Work Environment with Quality and Safety in Maternity Care in the United States
Authors: Clark Rebecca R. S. , Lake Eileen T. 
Published: June 2020

Abstract

Purpose:
Maternal outcomes in the United States are the poorest of any high-income country. Efforts to improve the quality and safety of maternity care are frequently reported by individual hospitals, limiting generalizability. The purpose of this study is to describe maternity care quality and safety in hospitals in four states.

Study Design and Methods:
This cross-sectional study is a secondary analysis of the Panel Study of Effects of Changes in Nursing on Patient Outcomes data. Registered nurses reported on maternity unit quality, safety, and work environment. Descriptive statistics and clustered linear regressions were used. Results: The sample included 1,165 nurses reporting on 166 units in California, New Jersey, Pennsylvania, and Florida in 2015. One-third of nurses, on average, gave their units an overall safety grade of “excellent,” but this decreased to less than one-sixth of nurses in units with poor work environments. Overall, 65% of nurses reported that their mistakes were held against them. A good work environment, compared with poor, was significantly associated with fewer nurses grading safety as poor (β -35.6, 95% CI -42.9 – -28.3).

Clinical Implications:
Our research found that the nurses in the majority of hospitals with maternity units in four states representing a quarter of the nation's annual births felt their units do not provide excellent quality care and have a less than optimal safety climate.
Ending the HIV Epidemic: Contributions Resulting From Syphilis Partner Services
Authors: DiOrio Dawne , Collins Dayne , Hanley Shane 
Published: June 2020

Background
There is a high level of coinfection with human immunodeficiency virus (HIV) among persons diagnosed with syphilis in the United States. Public health workers at state and local health departments help inform exposed partners to sexually transmitted disease (STD)/HIV infections to facilitate early testing and treatment (partner services). The federal initiative, Ending the HIV Epidemic (EHE), identifies 4 key strategies: diagnose, treat, prevent, and respond. This study describes the contributions of syphilis partner services to the EHE strategies in a county prioritized by the EHE plan.

Methods
A retrospective record review of reported early syphilis cases (less than 1 year's duration) between 2016 and 2018 in the Indianapolis area was conducted to determine the extent of new HIV diagnoses, retention in HIV care, and other evidence-based HIV prevention interventions occurring after provision of syphilis partner services.

Results
A total of 752 partners to early syphilis were attempted to be notified of exposure. There were 1,457 case patients and partners that received STD/HIV prevention counseling; 400 partners received STD treatment, 352 partners learned their HIV status, and 22 received new HIV diagnoses, with 68% retained in medical care and 60% virally suppressed. Two thirds of partner services were completed within 21 days. New HIV positivity among partners to HIV-negative syphilis case patients was 3.5% and 14% among HIV-positive syphilis case patients.

Conclusions
Partner services for syphilis was an effective method of addressing the EHE strategies, resulting in persons at risk tested, STD treatment provided, behavioral prevention counseling provided, and new HIV cases identified, leading to retention in medical care and viral suppression.
Facilitators and Barriers to Expedited Partner Therapy: Results From a Survey of Family Physicians
Authors: Wong Jason , Zakher Bernadette , Consolacion Theodora , Leong Jeffrey , Choi Alexandra , Prescott Cheryl , Ng Brian , Pawa Jasmine , Campbell Audrey 
Published: June 2020

Background
Expedited partner therapy (EPT) can prevent transmission of sexually transmitted infections (STIs) and reinfection of the index patient. We surveyed family physicians (FPs) in British Columbia to understand their perceptions of barriers and facilitators to EPT use and explored how perceptions varied by demographic and practice characteristics.

Methods
Survey participants were recruited through the Divisions of Family Practice, which include greater than 90% of FPs in British Columbia. Common barriers and facilitators for EPT were identified using descriptive statistics. The association between each EPT barrier and facilitator and demographic and practice characteristics were tested using χ2 test.

Results
One hundred eighty-one FPs started the survey, of which 146 (80.7%) answered 10 questions or more and were analyzed. Overall, inaccurate information about sex partners (88 [60.3%] of 146) and medicolegal concerns (87 [59.6%] of 146) were the most common barriers reported. Family physicians in nonurban settings were more likely to identify insufficient time as a barrier compared with FPs in urban settings (P < 0.01). The most common facilitators were having a health care professional for follow-up after prescribing EPT (110 [75.3%] of 146), improved remuneration (93 [63.7%] of 146), clear clinical guidelines around EPT (87/146, 59.6%), and having a legal framework (92 [63.0%] of 146). Family physicians practicing for less than 9 years (the median) were more likely to identify the latter as facilitating EPT compared with FPs practicing for 9 years or longer (P < 0.05).

Conclusions
Ensuring patients have access to a health care professional for follow-up, improved remuneration, and development of clinical guidelines and a legal framework can support the implementation of EPT. Tools catered to different practice types and contexts may help increase EPT use.
Leveraging Crowdsourcing for Human Immunodeficiency Virus Testing Posters: A Visual Content Analysis and Cognitive Responses Among Chinese Men Who Have Sex With Men
Authors: Smith M. Kumi , Cao Bolin , Fu Rong , Zhao Yang , Liu Chuncheng , Lazard Allison J. , Tucker Joseph D. 
Published: June 2020

Introduction
Extensive marketing and advertising research has informed a deep understanding of the link between visual design and consumer behaviors, providing a useful framework for assessing associations between human immunodeficiency virus (HIV)-related health posters and viewer responses.

Methods
Crowdsourced posters included finalist submissions from a series of nationwide crowdsourcing contests. Centers for Disease Control (CDC) images were sampled from an online poster database maintained by the National Center for acquired immune deficiency syndrome (AIDS). Once coded according to a set of 27 visual features, posters were shown to an online sample of Chinese men who have sex with men—a group currently experiencing the highest HIV incidence in China—to assess their viewer response.

Results
The CDC posters were more likely to use positive facial expressions (65%; 95% confidence interval [CI], 40.9–83.7] vs 12.5%; 95% CI, 2.2–4%) and an educational messaging style (85%; 95% CI, 61.1–96% vs 31.3%; 95% CI, 12.1–58.5). Crowdsourced posters exhibited better craftsmanship than CDC posters (more design simplicity, image diversity, color choice, design quality, and moderate use of text) used more visual metaphors (56.3%; 95% CI, 30.6–79.2 vs 5%; [95% CI, 0.2–26.9%]). Several differences in visual complexity were identified but these lacked statistical significance.

Conclusion
Crowdsourced posters were of higher craftsmanship, possibly due to their ability to recruit skills of professional designers. The CDC posters' use of positive visual reinforcement (smiling faces) and educational messaging may be a legacy of their role in the early days of the epidemic in disseminating basic HIV/AIDS knowledge and dispelling misinformation. Crowdsourcing posters' used more metaphors, suggesting better ability to leverage in-group codes and language.
Population Size Estimate of Men Who Have Sex With Men, Female Sex Workers, and People Who Inject Drugs in Mozambique: A Multiple Methods Approach
Authors: Sathane Isabel , Boothe Makini A.S. , Horth Roberta , Baltazar Cynthia Semá , Chicuecue Noela , Seleme Jessica , Raymond Henry F. 
Published: June 2020

Background
Accurate estimates of key population size are necessary to design programs and policies to prevent and reduce new HIV infections and to monitor the dynamics of the epidemic. The first bio-behavioral surveillance surveys, with population size estimation activities, were conducted in Mozambique in 2010 to 2014.

Methods
We used multiple methods—sequential sampling, unique object, unique event, and service multipliers—to estimate the numbers of men who have sex with men (MSM), female sex workers (FSW), and people who inject drugs (PWID) living in major cities in Mozambique. Results were applied to population sizes to estimate the number of people living with HIV and those unaware of their status.

Results
Our results suggest that Maputo has 5182 MSM, which constitutes 1.0% of the adult male population (plausibility bounds, 0.5%–2.6%); Beira, 1796 (1.4%, 1.0%–2.2%); and Nampula, 874 (0.6%, 0.4%–1.6%). The number of FSW population is 1514 (0.6%; plausibility bounds, 0.4%–1.6% of adult female city population) in Maputo, 2616 (2.2%, 1.3%–6.0%) in Beira, and 2052 (1.4%, 0.8%–5.9%) in Nampula. The number of people who inject drugs is 2518 (0.4%; plausibility bounds, 0.3%–0.5% of adult male city population) in Maputo and 1982 (1.2%, 0.6%–1.9%) in Nampula. People living with HIV ranged from 25 to 497 MSM, 382 to 664 FSW, and 712 to 1340 PWID, whereas people living with HIV unaware of their HIV positive serostatus ranged from 24 to 486 MSM, 327 to 552 FSW, and 265 to 468 PWID.

Conclusions
Although estimates generally fell within the range of those from the literature, the triangulation of survey and programmatic data over time will increasingly refine population size estimates and support the optimal allocation of limited resources.
Lack of Sexually Transmitted Infection Treatment Accuracy When Relying on Syndromic Management in an Urgent Care Setting
Authors: Glasgow Kimberly E. 
Published: June 2020

Background
Chlamydia and gonorrhea are 2 of the most common sexually transmitted infections, and patients are increasingly seeking care for them in urgent care clinics. Providers often rely on syndromic management because of prolonged test turnaround times, which can result in inappropriate treatment.

Methods
This study retrospectively evaluated chlamydia and gonorrhea treatment accuracy of adults, men and women, 18 years and older in 4 urgent cares in Northeast Iowa, using standard nucleic acid amplification test in a 6-month time frame through medical records review. Seven hundred twenty-two visits were evaluated.

Results
The proportion of patients who were treated at the time of their visit was 25.8% (n = 186/722), resulting in 68.8% (n = 128/186) overtreatment and 8.2% (n = 44/536) undertreatment. Logistic regression analysis found that treatment prescribed without diagnostic test results and the patient-collected vaginal swabs were predictors of inappropriate treatment. Patients who were treated in the clinic were significantly less likely to be treated appropriately compared with patients who were treated later based on test results (odds ratio, 0.04; confidence interval, 0.02–0.06). Patients who self-collected vaginal swabs had significantly lower odds of being treated appropriately (odds ratio, 0.04; confidence interval, 0.09–0.80).

Conclusions
Syndromic management leads to inaccurate treatment of chlamydia and gonorrhea at the time of the initial patient visit. Changes in practice in urgent care are needed to improve treatment accuracy by promoting antibiotic stewardship and decreasing forward disease transmission.
Dual-Plane Gluteal Myocutaneous Flap for Reconstruction of Ischial Tuberosity Pressure Wounds
Authors: Sinnott Catherine J. , Stavrides Steven , Boutros Christina , Kuruvilla Annet , Glickman Laurence T. 
Published: June 2020

Purpose
Ischial tuberosity pressure wounds are the most common type of pressure wound and contribute to a large percentage of the total cost of surgical and nonsurgical management of pressure wounds. Gluteal myocutaneous and fascocutaneous flaps are well-documented methods of coverage for ischial pressure wounds. This study aimed to describe results using a novel dual-plane gluteal myocutaneous flap technique for reconstruction of ischial tuberosity pressure wounds.

Methods
A retrospective chart review was performed of all patients who underwent dual-plane gluteus maximus myocutaneous flap reconstruction for ischial tuberosity pressure wounds performed by a single surgeon from 2012 to 2018. Patient demographic, clinical, and operative characteristics were reviewed. Outcomes were assessed by analyzing complication rates including recurrence, need for revision surgery, dehiscence, necrosis, wound infection, seroma, and hematoma.

Results
Eight dual-plane gluteus maximus myocutaneous flaps were performed for reconstruction of ischial tuberosity pressure wounds in 7 male patients with a mean age of 49.1 ± 14.9 years (mean ± SD) and mean body mass index of 26.7 ± 6.4 kg/m2. All patients were nonambulatory secondary to spinal cord injury or congenital neurological disease. Two patients (28.6%) were diabetic, and 1 patient (14.3%) was an active smoker. The mean defect size after debridement of ischial pressure wounds was 60.7 ± 29.4 cm2. After a mean follow-up of 16.4 months, partial wound dehiscence occurred in 1 patient (14.3%) and was managed with local wound care only. Infection and recurrence occurred in another patient (14.3%) and required revision surgery.

Conclusions
The dual-plane gluteal myocutaneous flap is an effective method for reconstruction of ischial tuberosity pressure wounds. Partially elevating the cutaneous layer off the gluteus maximus muscle allows for greater mobility and rotation of the muscle flap into the ischial pressure wound defect and closure of the flap and donor site with the cutaneous layer.
Improving the Quality of Evaluation Data in Simulation-Based Healthcare Improvement Projects
Authors: Santomauro Chiara M. , Hill Andrew , McCurdie Tara , McGlashan Hannah L. 
Published: June 2020

Summary Statement
Simulation is increasingly being used in healthcare improvement projects. The aims of such projects can be extremely diverse. Accordingly, the outcomes or participant attributes that need to be measured can vary dramatically from project-to-project and may include a wide range of nontechnical skills, technical skills, and psychological constructs. Consequently, there is a growing need for simulation practitioners to be able to identify suitable measurement tools and incorporate them into their work. This article provides a practical introduction and guide to the key considerations for practitioners when selecting and using such tools. It also offers a substantial selection of example tools, both to illustrate the key considerations in relation to choosing a measure (including reliability and validity) and to serve as a convenient resource for those planning a study. By making well-informed choices, practitioners can improve the quality of the data they collect, and the likelihood that their projects will succeed.
Military civilian partnerships: International proposals for bridging the Walker Dip
Authors: Jensen Guy , van Egmond Teun , Örtenwall Per , Peralta Ruben , Aboutanos Michel B. , Galante Joseph 
Published: June 2020

ABSTRACT
The Walker Dip refers to the cycle of the improvement of care for the battle injured soldier over the course of a conflict, followed by the decline in the skills needed to provide this care during peacetime, and the requisite need to relearn those skills during the next conflict. As the operational tempo of the conflicts in Afghanistan and Iraq has declined, concerns have arisen regarding whether US military surgeons are prepared to meet the demands of future conflicts. This problem is not unique to the US military, and allied nations have taken creative steps to address the Walker Dip in their own surgical communities. A panel entitled “Military and Civilian Trauma System Integration: Where Have We Come; Where Are We Going and What Can We Learn from Our International Partners” at the 2018 American Association for the Surgery of Trauma meeting brought together a cadre of civilian and military surgeons with experience in this area. The efforts described involved the creation of a new trauma training program in Doha, Qatar, the military civilian partnership in the Netherlands, and the steps taken to address the deficit of penetrating trauma in Sweden. This article focuses on the lessons that can be learned from our allied partners to assure readiness for deployment among military surgeons.

LEVEL OF EVIDENCE
Economic and Value Based Evaluations, level V.
Tremor pathophysiology: lessons from neuroimaging
Authors: Madelein van der Stouwe A.M. , Nieuwhof Freek , Helmich Rick C. 
Published: June 2020

Purpose of review
We discuss the latest neuroimaging studies investigating the pathophysiology of Parkinson's tremor, essential tremor, dystonic tremor and Holmes tremor.

Recent findings
Parkinson's tremor is associated with increased activity in the cerebello-thalamo-cortical circuit, with interindividual differences depending on the clinical dopamine response of the tremor. Although dopamine-resistant Parkinson's tremor arises from a larger contribution of the (dopamine-insensitive) cerebellum, dopamine-responsive tremor may be explained by thalamic dopamine depletion. In essential tremor, deep brain stimulation normalizes cerebellar overactivity, which fits with the cerebellar oscillator hypothesis. On the other hand, disconnection of the dentate nucleus and abnormal white matter microstructural integrity support a decoupling of the cerebellum in essential tremor. In dystonic tremor, there is evidence for involvement of both cerebellum and basal ganglia, although this may depend on the clinical phenotype. Finally, in Holmes tremor, different causal lesions map to a common network consisting of the red nucleus, internal globus pallidus, thalamus, cerebellum and pontomedullary junction.

Summary
The pathophysiology of all investigated tremors involves the cerebello-thalamo-cortical pathway, and clinical and pathophysiological features overlap among tremor disorders. We draw the outlines of a hypothetical pathophysiological axis, which may be used besides clinical features and cause in future tremor classifications.