bluuebunny/crossref_metadata_2025_split huggingface dataset:
Physical Symptom Cluster Subgroups in Chronic Kidney Disease
Authors: Lockwood Mark B. , Lash James P. , Pauls Heather , Chung Seon Yoon , Samra Manpreet , Ryan Catherine , Park Chang , DeVon Holli , Bronas Ulf G. 
Published: November 2019

Background
Symptom burden associated with chronic kidney disease can be debilitating, with a negative effect on patient health-related quality of life. Latent class clustering analysis is an innovative tool for classifying patient symptom experience.

Objectives
The aim of the study was to identify subgroups of patients at greatest risk for high symptom burden, which may facilitate development of patient-centered symptom management interventions.

Methods
In this cross-sectional analysis, baseline data were analyzed from 3,921 adults enrolled in the Chronic Renal Insufficiency Cohort Study from 2003 to 2008. Latent class cluster modeling using 11 items on the Kidney Disease Quality of Life symptom profile was employed to identify patient subgroups based on similar observed physical symptom response patterns. Multinomial logistic regression models were estimated with demographic variables, lifestyle and clinical variables, and self-reported measures (Kidney Disease Quality of Life physical and mental component summaries and the Beck Depression Inventory).

Results
Three symptom-based subgroups were identified, differing in severity (low symptom, moderate symptom, and high symptom). After adjusting for other variables in multinomial logistic regression, membership in the high-symptom subgroup was less likely for non-Hispanic Blacks and men. Other factors associated with membership in the high-symptom subgroup included lower estimated glomerular filtration rate, history of cardiac/cardiovascular disease, higher Beck Depression Inventory scores, and lower Kidney Disease Quality of Life physical and mental component summaries.

Discussion
Three symptom subgroups of patients were identified among patients with mild-to-moderate chronic kidney disease. Several demographic and clinical variables predicted membership in subgroups. Further research is needed to determine if symptom subgroups are stable over time and can be used to predict healthcare utilization and clinical outcomes.
Patient Ethnicity and Pediatric Visits to the Emergency Department for Fever
Authors: Shapiro Daniel J. , Fine Andrew M. 
Published: November 2019

Objectives
Previous research has identified ethnic differences in parents' beliefs about fever, but whether patient ethnicity is associated with health care use for fever is uncertain. Our objectives were to describe the national rate of pediatric visits to the emergency department (ED) for fever and to determine whether there is variation in this rate by patient ethnicity.

Methods
Using the National Hospital Ambulatory Medical Care Survey between 2012 and 2015, we estimated the proportion of ED visits with a complaint of fever by patients 0 to 18 years old and compared this proportion across patient ethnicity. We performed multivariable logistic regression controlling for sociodemographic characteristics and visit acuity to determine whether patient ethnicity was independently associated with visits for fever.

Results
Fever was the reason for 19% [95% confidence interval (CI), 18%–20%] of pediatric visits to the ED, and the proportion of visits for fever was highest among Hispanic patients (25%; 95% CI, 23%–27%) and lowest among non-Hispanic white patients (15%; 95% CI, 14%–17%). In multivariable analysis, the adjusted odds of visits for fever were greater for Hispanic patients (odds ratio, 1.56; 95% CI, 1.38–1.83) and non-Hispanic non-black patients of other races (1.34; 95% CI, 1.02–1.77) compared with non-Hispanic white patients.

Conclusions
There is significant ethnic variation in the use of emergency medical services for fever in the United States, and these disparities are not fully explained by differences in the acuity of illness or differences in socioeconomic status. Interventions to empower parents to manage nonurgent pediatric fever should incorporate ethnocultural differences in parents' understanding of fever.
Global status of Toxoplasma gondii infection and associated risk factors in people living with HIV
Authors: Safarpour Hanie , Cevik Muge , Zarean Mehdi , Barac Aleksandra , Hatam-Nahavandi Kareem , Rahimi Mohammad T. , Bannazadeh Baghi Hossein , Koshki Tohid J. , Pagheh Abdol S. , Shahrivar Firooz , Ebrahimi Mina , Ahmadpour Ehsan 
Published: November 2019

Objective:

Toxoplasma infection remains as the most common cause of focal brain lesions among people living with HIV (PLHIV) despite the decline in opportunistic infections with the introduction of antiretroviral treatment. This study was conducted to provide a summary of evidence about the seroprevalence of Toxoplasma gondii and prevalence of active T. gondii infection and associated risk factors among PLHIV.

Design:
Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Scopus, PubMed, Science Direct and EMBASE were searched from 1997 to July 2018. All peer-reviewed original research articles describing T. gondii infection among PLHIV with different diagnostic methods were included.

Methods:
Incoherence and heterogeneity between studies were quantified by I
2 index and Cochran's Q test. Publication and population bias were assessed with funnel plots and Egger's regression asymmetry test. All statistical analyses were performed using StatsDirect.

Results:
In total, 111 studies from 37 countries assessing 66 139 blood samples were included in this study. The pooled prevalence of T. gondii infection among PLHIV was 3.24% by IgM and 26.22% by molecular methods using the random-effects model. Pooled seroprevalence of T. gondii by IgG was 44.22%. There was a relationship between Toxoplasma prevalence and sex, raw meat consumption, contact with cat and knowledge about toxoplasmosis.

Conclusion:
High Toxoplasma seroprevalence among PLHIV observed in this study emphasizes the need for implementing screening and prophylaxis tailored to the local context. Owing to the serious and significant clinical manifestations of the parasite in case of reactivation, early identification of seropositivity for initiating prophylaxis among those with a CD4+ cell count of less than 200 cells/ml is recommended.
Upregulation of IL-32 Isoforms in Virologically Suppressed HIV-Infected Individuals: Potential Role in Persistent Inflammation and Transcription From Stable HIV-1 Reservoirs
Authors: Zaidan Sarah M. , Leyre Louise , Bunet Rémi , Larouche-Anctil Etienne , Turcotte Isabelle , Sylla Mohamed , Chamberland Annie , Chartrand-Lefebvre Carl , Ancuta Petronela , Routy Jean-Pierre , Baril Jean-Guy , Trottier Benoit , MacPherson Paul , Trottier Sylvie , Harris Marianne , Walmsley Sharon , Conway Brian , Wong Alexander , Thomas Réjean , Kaplan Robert C. , Landay Alan L. , Durand Madeleine , Chomont Nicolas , Tremblay Cécile L. , El-Far Mohamed ,   for the Canadian HIV and Aging Cohort Study
Published: November 2019

Background:
Human IL-32 is a polyfunctional cytokine that was initially reported to inhibit HIV-1 infection. However, recent data suggest that IL-32 may enhance HIV-1 replication by activating the HIV-1 primary targets, CD4+ T-cells. Indeed, IL-32 is expressed in multiple isoforms, some of which are proinflammatory, whereas others are anti-inflammatory.

Setting and Methods:
Here, we aimed to determine the relative expression of IL-32 isoforms and to test their inflammatory nature and potential to induce HIV-1 production in latently infected cells from virologically suppressed HIV-infected individuals. IL-32 and other cytokines were quantified from plasma and supernatant of CD4+ T-cells by ELISA. Transcripts of IL-32 isoforms were quantified by qRT-PCR in peripheral blood mononuclear cells. The impact of recombinant human IL-32 isoforms on HIV-1 transcription was assessed in CD4+ T-cells from HIV-1+cART+ individuals by qRT-PCR.

Results:
All IL-32 isoforms were significantly upregulated in HIV-1+cART+ compared to HIVneg individuals with IL-32β representing the dominantly expressed isoform, mainly in T-cells and NK-cells. At the functional level, although IL-32γ induced typical proinflammatory cytokines (IL-6 and IFN-γ) in TCR-activated CD4+ T-cells, IL-32α showed an anti-inflammatory profile by inducing IL-10 but not IL-6 or IFN-γ. However, IL-32β showed a dual phenotype by inducing both pro- and anti-inflammatory cytokines. Interestingly, consistent with its highly pro-inflammatory nature, IL-32γ, but not IL-32α or IL-32β, induced HIV-1 production in latently infected CD4+ T-cells isolated from combined antiretroviral therapy–treated individuals.

Conclusions:
Our data report on the differential expression of IL-32 isoforms and highlight the potential role of IL-32, particularly the γ isoform, in fueling persistent inflammation and transcription of viral reservoir in HIV-1 infection.
Renal Metastasis From Neuroblastoma Shown on MIBG Imaging
Authors: Wen Zhe , Zhuang Hongming 
Published: November 2019

Abstract
A 6-year-old girl with high-risk neuroblastoma underwent a 123I-MIBG scan to monitor the disease status. In addition to the known lesion in the right retroperitoneal region, there were additional foci of increased activity in the right upper quadrate of the abdomen, which were not typical bowel activity. SPECT/CT images located the activity in the cortex of the lower pole of the right kidney, which was partially calcified. Subsequent biopsy confirmed neuroblastoma metastasis to the right kidney, which is extremely rare.
Isolated Immunoglobulin G4–Related Disease of Nasal Septum and Maxilla
Authors: Rodriguez Fonseca Omar Dario , Suarez Juan Pablo , Dominguez Maria Luz , Fernandez Llana Belen , Vigil Carmen , Martin Noelia , Gonzalez Francisco Manuel 
Published: November 2019

Abstract
Immunoglobulin G4–related disease (IgG4-RD) is a systemic inflammatory condition that can manifest in atypical locations. We present the case of a middle-aged woman presenting with isolated IgG4-RD of left maxilla and nasal septum, confirmed with 18F-FDG PET/CT. She achieved complete metabolic response with multiple pharmacologic treatment, but 1 year later, she experienced local relapse, and FDG PET/CT found new additional lesions in humeral vasculature and lungs. This case illustrates the usefulness of FDG PET/CT for initial evaluation and monitoring of IgG4-RD with unusual nasomaxillary involvement.
Duty Hour Reform and the Outcomes of Patients Treated by New Surgeons
Authors: Kelz Rachel R. , Niknam Bijan A. , Sellers Morgan M. , Sharpe James E. , Rosenbaum Paul R. , Hill Alexander S. , Zhou Hong , Hochman Lauren L. , Bilimoria Karl Y. , Itani Kamal , Romano Patrick S. , Silber Jeffrey H. 
Published: November 2019

Objective:
The aim of the study was to address the controversy surrounding the effects of duty hour reform on new surgeon performance, we analyzed patients treated by new surgeons following the transition to independent practice.

Summary Background Data:
In 2003, duty hour reform affected all US surgical training programs. Its impact on the performance of new surgeons remains unstudied.

Methods:
We studied 30-day mortality among 1,483,074 Medicare beneficiaries undergoing general and orthopedic operations between 1999 and 2003 (“traditional“ era) and 2009 and 2013 (“modern” era). The operations were performed by 2762 new surgeons trained before the reform, 2119 new surgeons trained following reform and 15,041 experienced surgeons. We used a difference-in-differences analysis comparing outcomes in matched patients treated by new versus experienced surgeons within each era, controlling for the hospital, operation, and patient risk factors.

Results:
Traditional era odds of 30-day mortality among matched patients treated by new versus experienced surgeons were significantly elevated [odds ratio (OR) 1.13; 95% confidence interval (CI) (1.05, 1.22), P < 0.001). The modern era elevated odds of mortality were not significant [OR 1.06; 95% CI (0.97–1.16), P = 0.239]. Relative performance of new and experienced surgeons with respect to 30-day mortality did not appear to change from the traditional era to the modern era [OR 0.93; 95% CI (0.83–1.05), P = 0.233]. There were statistically significant adverse changes over time in relative performance to experienced surgeons in prolonged length of stay [OR 1.08; 95% CI (1.02–1.15), P = 0.015], anesthesia time [9 min; 95% CI (8–10), P < 0.001], and costs [255USD; 95% CI (2–508), P = 0.049].

Conclusions:
Duty hour reform showed no significant effect on 30-day mortality achieved by new surgeons compared to their more experienced colleagues. Patients of new surgeons, however, trained after duty hour reform displayed some increases in the resources needed for their care.
Inner Deliberations of Surgeons Treating Critically-ill Emergency General Surgery Patients
Authors: Kulkarni Shreyus S. , Briggs Alexandra , Sacks Olivia A. , Rosengart Matthew R. , White Douglas B. , Barnato Amber E. , Peitzman Andrew B. , Mohan Deepika 
Published: November 2019

Background:
30% of elderly patients who require emergency general surgery (EGS) die in the year after the operation. Preoperative discussions can determine whether patients receive preference-sensitive care. Theoretically, surgeons frame their conversations after systematically assessing the risks and benefits of management options based on the clinical characteristics of each case. However, little is known about how surgeons actually deliberate about those options.

Objective:
To identify variables that influence surgeons’ assessment of management options for critically-ill EGS patients.

Methods:
We conducted semi-structured interviews with 40 general surgeons in western Pennsylvania who worked in a variety of hospital settings. Interviews explored perioperative decision-making by asking surgeons to think aloud about selected memorable cases and a standardized case vignette of a frail patient with acute mesenteric ischemia. We used constant comparative methods to analyze interview transcripts and inductively developed a framework for the decision-making process.

Results:
Surgeons averaged 13 years (standard deviation (SD) 10.4) of experience; 40% specialized in trauma/acute care surgery. Important themes regarding the main topic of “perioperative decision-making” included many considerations beyond the clinical characteristics of cases. Surgeons described the importance of variables ranging from the availability of institutional resources to professional norms. Surgeons often remarked on their desire to achieve individual flow, team efficiency, and concordant expectations of treatment and prognosis with patients.

Conclusions:
This is the first study to explore how surgeons decide among management options for critically-ill EGS patients. Surgeons’ decision-making reflected a broad array of clinical, personal, and institutional variables. Effective interventions to ensure preference-sensitive care for EGS patients must address all of these variables.
Mathematical Analysis of EEG Concordance in Preterm Twin Infants
Authors: Lloyd Rhodri O. , O'Toole John M. , Livingstone Vicki , Filan Peter M. , Boylan Geraldine B. 
Published: November 2019

Purpose:
Preterm twins are at higher risk of neurodisability than preterm singletons, with monochorionic–diamniotic (MCDA) twins at higher risk than dichorionic–diamniotic (DCDA) twins. The impact of genetic influences on EEG concordance in preterm twins <32 weeks of gestational age is not established. This study aims to investigate EEG concordance in preterm MCDA and dichorionic–diamniotic twins during maturation.

Methods:
Infants <32 weeks of gestational age had multichannel EEG recordings for up to 72 postnatal hours, with repeat recordings at 32 and 35 weeks of postmenstrual age. Twin pairs had synchronous recordings. Mathematical EEG features were generated to represent EEG power, discontinuity, and symmetry. Intraclass correlations, while controlling for gestational age, estimated similarities within twins.

Results:
EEGs from 10 twin pairs, 4 MCDA and 6 dichorionic–diamniotic pairs, and 10 age-matched singleton pairs were analyzed from a total of 36 preterm infants. For MCDA twins, 17 of 22 mathematical EEG features had significant (>0.6; P < 0.05) intraclass correlations at one or more time points, compared with 2 of 22 features for DCDA twins and 0 of 22 for singleton pairs. For MCDA twins, all 10 features of discontinuity and all four features of symmetry were significant at one or more time-points. Three features of the MCDA twins (spectral power at 3–8 Hz, EEG skewness at 3–15 Hz, and kurtosis at 3–15 Hz) had significant intraclass correlations over all three time points.

Conclusions:
Preterm twin EEG similarities are subtle but clearly evident through mathematical analysis. MCDA twins showed stronger EEG concordance across different postmenstrual ages, thus confirming a strong genetic influence on preterm EEG activity at this early development stage.
Motivational Strategies for Stroke Rehabilitation: A Descriptive Cross-sectional Study
Authors: Oyake Kazuaki , Suzuki Makoto , Otaka Yokei , Tanaka Satoshi 
Published: November 2019

AbstractBackground and PurposeThe addition of motivational strategies to a rehabilitation program is thought to enhance patient adherence and improve outcomes. However, little is known about how rehabilitation professionals motivate stroke patients during rehabilitation. The primary objective of this study was to provide a comprehensive and quantitative list of motivational strategies for stroke rehabilitation. In addition, we aimed to examine (1) whether professionals with more clinical experience used a higher number of motivational strategies, (2) the purpose for using each strategy, and (3) the information considered when choosing strategies.MethodsThis descriptive, cross-sectional study was conducted using a web survey with a random sample of 407 rehabilitation professionals including physicians, nurses, physical therapists, occupational therapists, and speech-language-hearing therapists.ResultsWe received data for 362 participants. Fifteen strategies were found to be used by more than 75% of the respondents reported using to motivate their patients. Almost all of the respondents reported that they actively listen to and praise their patients to increase patient adherence to rehabilitation programs. Respondents with more clinical experience tended to use a higher number of motivational strategies (rho = 0.208, p < 0.001). For 11 of the 15 strategies selected by more than 75% of respondents, the highest percentage of respondents reported that they used the strategies to make rehabilitation worthwhile for their patients. The majority of respondents reported that they decide which motivational strategy to use by considering comprehensive information regarding the patient health condition, environmental factors, and personal factors.ConclusionsThe comprehensive list of motivational strategies obtained may be useful for increasing patient adherence to rehabilitation, especially for professionals with less clinical experience. Furthermore, our findings regarding the purpose for using each strategy and the information used to choose strategies might help rehabilitation professionals to utilize the motivational strategy list.
Genomic Epidemiology of Methicillin-Resistant Staphylococcus aureus in Two Cohorts of High-Risk Military Trainees
Authors: Lee Robyn S. , Millar Eugene V. , Callendrello Alanna , English Caroline E. , Elassal Emad M. , Ellis Michael W. , Bennett Jason W. , Hanage William P. 
Published: November 2019

AbstractBackgroundMRSA skin and soft tissue infection (SSTI) is a significant cause of morbidity in military trainees. To guide interventions, it is critical we understand the epidemiology of MRSA in this population.MethodsTwo cohorts (‘companies’) of US Army Infantry trainees (N=343) at Fort Benning, GA, USA, were followed during their training cycles (Jun.-Dec. 2015). Trainees had nares, oropharynx, perianal and inguinal areas swabbed for MRSA colonization at five ∼2-4 week intervals, and monitored for SSTI throughout training. Epidemiological data were collected. Isolates were sequenced using Illumina HiSeq and NovaSeq. Single-nucleotide polymorphisms and clusters were identified. Multi-locus sequence type (MLST) and antimicrobial resistance genes were predicted from de novo assemblies.Results87 trainees were positive at least once for MRSA (12 had SSTI, 2 without any colonization). Excluding those positive at baseline, 43.7% were colonized within the first month of training. 244/254 samples were successfully sequenced (including all SSTI). ST8 (n=135, 100% of SSTI), ST5 (n=81) and ST87 (n=21) were the most represented. Three main Clusters were identified, largely corresponding to these STs. Sub-analyses within Clusters showed multiple importations of MRSA, with transmission subsequently predominantly within, rather than between, platoons in each company. Over 50% of trainees were colonized only at other anatomical sites; restricting analyses to nares missed substantial transmission.ConclusionsSerial importations of MRSA into this high-risk setting likely contribute to the ongoing burden of MRSA colonization and infection among military trainees. Sampling multiple anatomical sites is critical for comprehensive characterization of MRSA transmissionSummaryUS Infantry trainees were followed through training for MRSA skin and soft tissue infection, swabbing for colonization at 2-4 week intervals. Sequencing suggests serial importations of diverse strains on base, followed by transmission mostly within platoons, involving multiple anatomical sites.
Protein thermal stability does not correlate with cellular half-life: Global observations and a case study of tripeptidyl-peptidase 1
Authors: Collier Aaron M. , Nemtsova Yuliya , Kuber Narendra , Banach-Petrosky Whitney , Modak Anurag , Sleat David E. , Nanda Vikas , Lobel Peter 
Published: November 2019

AbstractLate-infantile neuronal ceroid lipofuscinosis (LINCL) is a neurodegenerative lysosomal storage disorder caused by mutations in the gene encoding the protease tripeptidyl-peptidase 1 (TPP1). Progression of LINCL can be slowed or halted by enzyme replacement therapy, where recombinant human TPP1 is administered to patients. In this study, we utilized protein engineering techniques to increase the stability of recombinant TPP1 with the rationale that this may lengthen its lysosomal half-life, potentially increasing the potency of the therapeutic protein. Utilizing multiple structure-based methods that have been shown to increase the stability of other proteins, we have generated and evaluated over 70 TPP1 variants. The most effective mutation, R465G, increased the melting temperature of TPP1 from 55.6°C to 64.4°C and increased its enzymatic half-life at 60°C from 5.4 min to 21.9 min. However, the intracellular half-life of R465G and all other variants tested in cultured LINCL-patient derived lymphoblasts was similar to that of WT TPP1. These results provide structure/function insights into TPP1 and indicate that improvingin vitrothermal stability alone is insufficient to generate TPP1 variants with improved physiological stability. This conclusion is supported by a proteome-wide analysis that indicates that lysosomal proteins have higher melting temperatures but also higher turnover rates than proteins of other organelles. These results have implications for similar efforts where protein engineering approaches, which are frequently evaluatedin vitro, may be considered for improving the physiological properties of proteins, particularly those that function in the lysosomal environment.