bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sleep duration regularity, but not sleep duration, is associated with microvascular function in college students
Authors: Hoopes Elissa K , Berube Felicia R , D’Agata Michele N , Patterson Freda , Farquhar William B , Edwards David G , Witman Melissa A H 
Published: September 2020

Abstract

Study Objectives
Vascular dysfunction is a hypothesized mechanism linking poor sleep habits to an increased incidence of cardiovascular diseases (CVDs). However, the vascular profile associated with free-living sleep duration and sleep regularity has not been well elucidated, particularly in young adults. Thus, this study aimed to evaluate the associations between mean sleep duration, regularity in sleep duration, and peripheral vascular function in young adult college students.

Methods
Fifty-one healthy undergraduate students (20 ± 1 years) completed 14 days of 24-hour wrist actigraphy and subsequent vascular assessments. Macrovascular function was measured using brachial artery flow-mediated dilation (FMD) while microvascular function was measured via passive leg movement (PLM).

Results
Mean sleep duration was unrelated to FMD and PLM. Conversely, more irregular sleep duration (14-day sleep duration standard deviation [SD]) was unfavorably associated with all three measures of PLM-induced hyperemia (peak leg blood flow [LBF], p = 0.01; change in LBF from baseline to peak, p &lt; 0.01; LBF area under the curve, p &lt; 0.01), and remained significant in regression models which adjusted for sex, body mass index, blood pressure, physical activity, alcohol and caffeine consumption, and sleep duration (all p &lt; 0.05). When using a median split to dichotomize “low” and “high” sleep duration SD groups, those demonstrating high variability in sleep duration exhibited ~45% lower PLM responses compared with those demonstrating low variability.

Conclusions
Irregular sleep duration is associated with poorer microvascular function as early as young adulthood. These findings support the growing body of evidence that irregular sleep patterns may be an independent and modifiable risk factor for CVD.
Forage quality and beef cow preference is affected by wrap type of conventional and reduced-lignin alfalfa round bales stored outdoors
Authors: Reiter Amanda S , DiCostanzo Alfredo , Webb Megan , Zeltwanger Josh , Sheaffer Craig C , Jaqueth Aubrey , Martinson Krishona L 
Published: September 2020

Abstract
Storing hay outdoors can result in detrimental changes in forage quality. Additionally, alfalfa (Medicago sativa L.) cultivar may influence dry matter intake (DMI) and hay waste when feeding livestock. The objectives were to determine the effects of conventional or reduced-lignin alfalfa round bales stored outdoors and wrapped with plastic twine, net wrap, or B-Wrap on forage quality, beef cow preference, and hay waste. Round bales made from reduced-lignin (n = 12) or conventional (n = 12) alfalfa cultivars were baled and stored outdoors for 16 mo. Within each cultivar, four bale replicates were bound with plastic twine, net wrap, or B-Wrap. After storage, bales were fed in a switchback design with period confounded with alfalfa cultivar to 18 lactating Angus cows (Bos Taurus L.). The pairs had ad libitum access to three round-bale feeders where bales of each wrap type were placed for eight 48 h periods. Position of round bale wrap type was rotated according to a Latin Square arrangement. Bales were weighed and waste surrounding each feeder was collected at 24 and 48 h to calculate DMI and hay waste. Statistical significance was set at P &lt; 0.05. Alfalfa cultivar did not impact any of the response variables (P &gt; 0.05). At feeding, round bales wrapped in net wrap had greater (P &lt; 0.015) moisture content (16.4%) compared with those wrapped with B-Wrap (12.8%). Neutral detergent fiber was lower (P = 0.03) in bales wrapped in B-Wrap (46%) compared with twine-tied bales (49%) while net wrapped bales were not different. Total digestible nutrients (P = 0.02), and relative feed value (P = 0.04) were lower in twine-tied bales compared with B-Wrap while net wrapped bales were not different. Twine (7.1 × 106 colony forming units [CFU]/g) and net wrap (4.7 × 106 CFU/g) bales had greater (P &lt; 0.0001) mold counts than B-Wrap bales (4.8 × 104 CFU/g), while concentrations of other forage components and yeast counts were not different among wrap types (P &gt; 0.05). Total DMI, and DMI during the first 24 h, were greater (P ≤ 0.032) for B-Wrap bales compared to twine-tied bales indicating preference for hay wrapped in B-Wrap; net wrapped bales were not different. Dry matter intake in the first 24 h was negatively associated with the mold count (r = −0.52; P = 0.02), and hay waste was not affected by wrap type (P &gt; 0.05). These results confirm that wrap type affected forage quality and mold counts, which in turn influenced beef cattle preference of round bales stored outdoors.
Non-prescription Fentanyl Positive Toxicology: Prevalence, Positive Predictive Value of Fentanyl Immunoassay Screening, and Description of Co-substance Use
Authors: Kerensky Todd , LaRochelle Marc , Fan Shu-Ling , Kosakowski Sarah , Wason Kristin , Walley Alexander Y. 
Published: September 2020

Objectives:
Opioid overdose deaths in Massachusetts linked to illicitly-manufactured fentanyl have increased dramatically. In response, an urban safety-net hospital added urine fentanyl testing with reflex confirmation testing to its standard urine toxicology panel. The goals of this study were to describe fentanyl toxicology test results, identify the positive predictive value of presumptive fentanyl immunoassay, and describe co-substance use among those with unexpected fentanyl positive results.

Methods:
We included urine toxicology tests from January through June 2016 analyzed at an urban safety-net hospital. We excluded tests from individuals prescribed or administered fentanyl within the preceding 72 hours. Positive fentanyl immunoassay tests underwent reflex chromatography confirmation testing. Samples that confirmed positive for acetyl fentanyl and/or fentanyl and/or norfentanyl were considered true positives.

Results:
Of 11,873 urine samples, 10.4% of samples screened fentanyl positive and 8.8% were confirmed fentanyl positive. The positive predictive value of a positive urine fentanyl screen was 85.7%. Of 4398 unique patients, 13.2% had at least 1 test confirmed positive for nonprescription fentanyl. Patients with a confirmed fentanyl positive drug test were more likely to have positive urine drug test for barbiturates, benzodiazepines, cocaine, methadone, and opiates, and less likely to have oxycodone or buprenorphine.

Conclusions:
At an urban safety-net hospital, nonprescription fentanyl use was common and was associated with greater use of other substances favoring routine fentanyl testing. Although the positive predictive value of the screening test was high, confirmation testing detected substantial numbers of false positives, especially in older patients. Therefore, fentanyl confirmation testing should be used when results will change treatment approach and patient education.
Prescription Tranquilizer/Sedative Misuse Motives Across the US Population
Authors: Schepis Ty S. , Wastila Linda , McCabe Sean Esteban 
Published: September 2020

Objectives:
Roughly 6.5 million US residents engaged in prescription tranquilizer/sedative (eg, benzodiazepines, Z-drugs) misuse in 2018, but tranquilizer/sedative misuse motives are understudied, with a need for nationally representative data and examinations of motives by age group. Our aims were to establish tranquilizer/sedative misuse motives and correlates of motives by age cohort, and whether motive-age cohort interactions existed by correlate.

Methods:
Data were from the 2015 to 2018 US National Survey on Drug Use and Health, with 223,520 total respondents (51.5% female); 6580 noted past-year prescription tranquilizer/sedative misuse motives (2.4% overall, 50.3% female). Correlates included substance use (eg, opioid misuse), mental (eg, suicidal ideation) and physical health variables (e.g., inpatient hospitalization). Design-based, weighted cross-tabulations and logistic regression analyses were used, including analyses of age cohort-motive interactions for each correlate.

Results:
Prescription tranquilizer/sedative misuse motives varied by age group, with the highest rates of self-treatment only motives (ie, sleep and/or relax) in those 65 and older (82.7%), and the highest rates of any recreational motives in adolescents (12–17 years; 67.5%). Any tranquilizer/sedative misuse was associated with elevated odds of substance use, mental health, and physical health correlates, but recreational misuse was associated with the highest odds. Age-based interactions suggested stronger relationships between tranquilizer/sedative misuse and mental health in adults 50 and older.

Conclusions:
Any tranquilizer/sedative misuse signals a need for substance use and mental health screening, with intervention needs most acute in those with any recreational motives. Older adult tranquilizer/sedative misuse may be more driven by undertreated insomnia and anxiety/psychopathology than in younger groups.
Maternal and Neonatal Outcomes in Hospital-Based Deliveries With Water Immersion
Authors: Sidebottom Abbey C. , Vacquier Marc , Simon Kathrine , Wunderlich Whitney , Fontaine Patricia , Dahlgren-Roemmich Dawn , Steinbring Shannon , Hyer Barbara , Saul Lisa 
Published: September 2020

OBJECTIVE:
To compare neonatal intensive care unit (NICU) or special care nursery admission for deliveries with water immersion compared with deliveries in the matched control group without water immersion. Secondary outcomes included adverse neonatal diagnoses, maternal infections, and perineal lacerations.

METHODS:
We conducted a retrospective study using electronic health record data (2014–2018) from two health systems (eight hospitals), with similar clinical eligibility, associated with low risks of intrapartum complications, and implementation policies for waterbirth. The water immersion group included women intending waterbirth. Water immersion was recorded prospectively during delivery. The comparison population were women who met the clinical eligibility criteria for waterbirth but did not experience water immersion during labor. Comparison cases were matched (1:1) using propensity scores. Outcomes were compared using Fischer's exact tests and logistic regression with stratification by stage of water immersion.

RESULTS:
Of the 583 women with water immersion, 34.1% (199) experienced first-stage water immersion only, 65.9% (384) experienced second-stage immersion, of whom 12.0% (70) exited during second stage, and 53.9% (314) completed delivery in the water. Neonatal intensive care unit or special care nursery admissions were lower for second-stage water immersion deliveries than deliveries in the control group (odds ratio [OR] 0.3, 95% CI 0.2–0.7). Lacerations were lower in the second-stage immersion group (OR 0.5, 95% CI 0.4–0.7). Neonatal intensive care unit or special care nursery admissions and lacerations were not different between the first-stage immersion group and their matched comparisons. Cord avulsions occurred for 0.8% of second-stage water immersion deliveries compared with none in the control groups. Five-minute Apgar score (less than 7), maternal infections, and other adverse outcomes were not significantly different between either the first- or second-stage water immersion groups and their control group.

CONCLUSION:
Hospital-based deliveries with second-stage water immersion had lower risk of NICU or special care nursery admission and perineal lacerations than matched deliveries in the control group without water immersion.
Improved Outcomes With an Enhanced Recovery Approach to Cesarean Delivery
Authors: Mullman Luciana , Hilden Patrick , Goral Jan , Gwacham Nnamdi , Tauro Caitlin , Spinola Kristen , Rosales Kim , Collier Sheila , Holmes Lynice , Maccione Janice , Pitera Richard , Miller Richard , Yodice Paul 
Published: September 2020

OBJECTIVE:
To examine the results of a quality-improvement study that implemented an enhanced recovery after surgery (ERAS) program for cesarean delivery.

METHODS:
A pre–post design was used to assess changes in opioid use, length of stay, and costs among all patients undergoing cesarean delivery before and after implementation of an evidence-based ERAS pathway for the preoperative, intraoperative, and postoperative management of patients beginning December 2018.

RESULTS:
A total of 3,679 cesarean deliveries (scheduled and emergent) were included from January 1, 2018, through August 31, 2019, of which 2,171 occurred before implementation on December 17, 2018, and 1,508 occurred postimplementation. Eighty-four percent of patients received opioids as inpatients after cesarean delivery during the preimplementation period, as compared with 24% in the postimplementation period (odds ratio [OR] 16.8, 95% CI 14.3–19.9). Among patients who required any opioids, the total morphine milligram equivalents also significantly decreased (median 56.5 vs 15.0, mean relative change 0.32, 95% CI 0.28–0.35). Compared with the preimplementation period, those in the postimplementation period had a shorter postcesarean length of stay (3.2 vs 2.7 days, mean relative change 0.82, 95% CI 0.80–0.83, median 3 days in both periods), lower median direct costs by $349 (mean relative change 0.93, 95% CI 0.91–0.95), and no change in the 30-day readmission rate (1.4% vs 1.7%, OR 0.83, 95% CI 0.49–1.41).

CONCLUSION:
An ERAS approach for the cesarean delivery population is associated with improved outcomes including decreases in opioid use, length of stay, and costs.
Development and Validation of a Highly Sensitive Liquid Chromatography-Tandem Mass Spectrometry Technique to Determine Levamisole in Plasma and Saliva
Authors: Veltkamp Floor , Pistorius Marcel C. M. , Bouts Antonia H. M. , Mathôt Ron A. A. ,   on behalf of the LEARNS consortium
Published: September 2020

Background:
Levamisole is used as a steroid-sparing drug for the treatment of frequently relapsing or steroid-dependent idiopathic nephrotic syndrome in children. As part of a large multicentre randomized controlled trial with levamisole, pharmacokinetic and pharmacodynamic parameters of levamisole in children with idiopathic nephrotic syndrome were investigated, as well as the feasibility of using saliva as an alternative and patient-friendly matrix for determining levamisole concentrations. In this study, the authors presented the development and validation of a highly sensitive method for determining levamisole in plasma and saliva using liquid chromatography-tandem mass spectrometry (LC-MS/MS).

Methods:
In 100 μL samples, proteins were precipitated with 750 μL acetonitrile/methanol 420:80 (v/v) with levamisole-D5 as an internal standard. Calibration standards were prepared over a range of 0.1 ng/mL–50 ng/mL. To determine ultrafiltration efficiency, the ultrafiltrate was obtained by centrifuging blank plasma samples over the filter. Both filtered and nonfiltered samples were analyzed.

Results:
For plasma, accuracy and within-run and between-run imprecision were between 95.0% and 100% and <14.5%, respectively, and for saliva, between 100.9% and 107.5%, and <13.3%. No significant matrix effects were observed. Samples were stable at benchtop for 24 hours and −80°C, for at least 14 months (stability experiments ongoing). The ultrafiltration efficiency of unbound concentrations in plasma was lower than 85% (58.9%) but stable, and, therefore, the observed concentration should be corrected.

Conclusions:
Based on observations, the developed measure can determine levamisole concentrations in participant saliva samples.
Feasibility of an Interdisciplinary Intervention to Promote Balance Confidence in Lower-Limb Prosthesis Users: A Case Study
Authors: Churchill Rachel , Schneider Kristin L. , Calamari John E. , Henderson Roberta , Hwang Sungsoon , Major Matthew J. , Duncan Chad , Stachowiak Aaron , Reddin Christopher , Rosenblatt Noah J. 
Published: September 2020

ABSTRACT

Introduction
Low confidence in ones' ability to maintain balance during daily activities is a prevalent issue for lower-limb prosthesis users (LLPUs) that negatively impacts psychosocial function but is not currently addressed in rehabilitation. The purpose of this case study was to demonstrate feasibility of an intervention that combines cognitive behavioral therapy techniques with physical therapy to increase balance confidence, reduce avoidance behaviors, and increase community participation in LLPU.

Materials and Methods
A 58-year-old man with a unilateral transtibial amputation completed eight 120-minute intervention session, which included physical therapy in the form of virtual reality active gaming targeting balance and gait adaptability, followed by psychoeducation, cognitive restructuring, and a brief exposure exercise. The intervention was intended to improve balance and gait while addressing beliefs regarding physical abilities and their impact on behavior. All exercises were individually tailored to address real-world, subject-specific distress-inducing situations, identified jointly by a licensed physical therapist and behavioral counselor that were present throughout all intervention sessions. The primary outcome, balance confidence, was quantified before, during, immediately after, and 1 month after completion of the intervention. Additional measures of physical function and community participation were also assessed.

Results
Objective balance measures (Berg Balance Scale) improved by 9 points from baseline to follow-up, and balance confidence improved from 48.5% at baseline to 91.9% at 1-month follow-up. Gains in gait self-efficacy and reductions in fear-avoidance behavior mirrored this change.

Conclusions
This case study demonstrates that a multicomponent intervention is feasible and may provide a positive and helpful experience for LLPU to meaningfully improve balance confidence and reduce avoidance behavior.
Point-of-Care Ultrasound to Confirm Umbilical Line Placement
Authors: Kochan Michael J. , Kim Jane S. , Hoffman Suma B. , Mola Sara J. , Kim Jae H. , Viscardi Rose M. 
Published: September 2020

Introduction
Neonatal intensive care unit (NICU) provider point-of-care ultrasound (POCUS) procedural competency for umbilical line placement confirmation has not been defined, and the necessary training to achieve competency has not been previously studied. This study's objective was to test the hypothesis that a simulation-enhanced curriculum will improve NICU providers' POCUS competency to confirm umbilical line placement.

Methods
Neonatal intensive care unit providers without prior ultrasound experience were randomized to a curriculum with or without simulation-based training. Competency for catheter detection, tip localization, and scan interpretation on patients was determined using learning curve-cumulative summation, a specific statistical tool designed to indicate when a predefined level of performance is reached. Differences in success rates were analyzed by χ2 test.

Results
Two thirds (22/33) of participants completed 10 scans. Three (simulation) and 1 (control) attained catheter detection competency (P = 0.28). The simulation group was more successful for catheter detection (81% vs. 69%, P = 0.04) and scan interpretation (61% vs. 48%, P = 0.04). Success did not differ by umbilical vessel location, provider role, or duration of NICU experience.

Conclusions
A simulation-enhanced POCUS curriculum improved catheter detection rate and scan interpretation, but there was no difference in procedural competency between groups on ultrasound scans performed on patients with umbilical catheters. We speculate that more than 10 scans may be needed for NICU providers to obtain POCUS competency.
Stool banking for fecal microbiota transplantation: methods and operations at a large stool bank
Authors: Chen Justin , Zaman Amanda , Ramakrishna Bharat ,   OpenBiome Team, Olesen Scott W. 
Published: September 2020

ABSTRACTObjectivesFecal microbiota transplantation (FMT) is a recommended therapy for recurrentClostridioides difficileinfection and is being investigated as a potential therapy for dozens of microbiome-mediated indications. Stool banks centralize FMT donor screening and FMT material preparation with the goal of improving the safety, quality, convenience, and accessibility of FMT material. Although there are published consensuses on donor screening guidelines, there are few reports about the implementation of those guidelines in functioning stool banks.MethodsTo help inform consensus standards with data gathered from real-world settings and, in turn, to improve patient care, here we describe the general methodology used in 2018 by OpenBiome, a large stool bank, and its outputs in that year.ResultsIn 2018, the stool bank received 7,536 stool donations from 210 donors, a daily average of 20.6 donations, and processed 4,271 of those donations into FMT preparations. The median time a screened and enrolled stool donor actively donated stool was 5.8 months. The median time between the manufacture of an FMT preparation and its shipment to a hospital or physician was 8.9 months. Half of the stool bank’s partner hospitals and physicians ordered an average of 0.75 or fewer FMT preparations per month.ConclusionsFurther knowledge sharing should help inform refinements of stool banking guidelines and best practices.
Run for your life – an integrated virtual tissue platform for incorporating exercise oncology into immunotherapy
Authors: Serrano Josua Aponte , Hagar Amit 
Published: September 2020

AbstractThe purpose of this paper is to introduce a novelin silicoplatform for simulating early stage solid tumor growth and anti-tumor immune response. We present the model, test the sensitivity and robustness of its parameters, and calibrate it with clinical data from exercise oncology experiments which offer a natural biological backdrop for modulation of anti-tumor immune response. We then perform two virtual experiments with the model that demonstrate its usefulness in guiding pre-clinical and clinical studies of immunotherapy. The first virtual experiment describes the intricate dynamics in the tumor microenvironment between the tumor and the infiltrating immune cells. Such dynamics is difficult to probe during a pre-clinical study as it requires significant redundancy in lab animals and is prohibitively time-consuming and labor-intensive. The result is a series of spatiotemporal snapshots of the tumor and its microenvironment that can serve as a platform to test mechanistic hypotheses on the role and dynamics of different immune cells in anti-tumor immune response. The second virtual experiment shows how dosage and/or frequency of immunotherapy drugs can be optimized based on the aerobic fitness of the patient, so that possible adverse side effects of the treatment can be minimized.