bluuebunny/crossref_metadata_2025_split huggingface dataset:
Characterization and Comparison of Primary Care Appointment Utilization Patterns Among Military Health System Beneficiaries
Authors: Self Amanda , Khan Munziba , Banaag Amanda , Koehlmoos Tracey 
Published: August 2020

Abstract

Introduction
The role of primary care in the United States is vitally important to improving health outcomes, minimizing waste, and controlling cost. The Military Health System is tasked with both caring for its beneficiaries and ensuring the medical readiness of active duty service members, who often have needs unique to those in the civilian population. Balancing the number of individuals assigned to a primary care clinician with the clinician’s capacity to meet their medical needs and anticipated appointment demand is a fundamental cornerstone of effective primary care clinic management in any setting.

Materials and methods
Using the Military Health System Data Repository, this cross-sectional study utilized descriptive statistics and Poisson regression to describe crude and adjusted primary care appointment utilization trends among Military Health System beneficiaries during fiscal year 2016.

Results
The primary care appointment utilization rate of the study population was 3.3 visits per person-year. The youngest and oldest age groups, women, active duty, and those enrolled to Army clinics had the highest utilization rates within each of the respective covariates. Active duty women had the highest utilization of any group in the data set, with a crude rate of 4.7 visits per person-year.

Conclusions
Primary care utilization trends are different among different demographic subgroups within the Military Health System (MHS). Unmet demand, patient acuity, clinician continuity, robustness of team support, and other important factors that influence appointment utilization were not incorporated in this study. Superficially, these data suggest that the MHS enrollment target of 1,100–1,300 patients per full-time primary care clinician is roughly appropriate, though this should be interpreted with caution given the limitations.
ACK1–AR and AR–HOXB13 signaling axes: epigenetic regulation of lethal prostate cancers
Authors: Kim Eric H , Cao Dengfeng , Mahajan Nupam P , Andriole Gerald L , Mahajan Kiran 
Published: August 2020

AbstractThe androgen receptor (AR) is a critical transcription factor in prostate cancer (PC) pathogenesis. Its activity in malignant cells is dependent on interactions with a diverse set of co-regulators. These interactions fluctuate depending on androgen availability. For example, the androgen depletion increases the dependence of castration-resistant PCs (CRPCs) on the ACK1 and HOXB13 cell survival pathways. Activated ACK1, an oncogenic tyrosine kinase, phosphorylates cytosolic and nuclear proteins, thereby avoiding the inhibitory growth consequences of androgen depletion. Notably, ACK1-mediated phosphorylation of histone H4, which leads to epigenetic upregulation of AR expression, has emerged as a critical mechanism of CRPC resistance to anti-androgens. This resistance can be targeted using the ACK1-selective small-molecule kinase inhibitor (R)-9b. CRPCs also deploy the bromodomain and extra-terminal domain protein BRD4 to epigenetically increase HOXB13 gene expression, which in turn activates the MYC target genes AURKA/AURKB. HOXB13 also facilitates ligand-independent recruitment of the AR splice variant AR-V7 to chromatin, compensating for the loss of the chromatin remodeling protein, CHD1, and restricting expression of the mitosis control gene HSPB8. These studies highlight the crosstalk between AR–ACK1 and AR–HOXB13 pathways as key mediators of CRPC recurrence.
Frequency of false-positive FISH 1p/19q codeletion in adult diffuse astrocytic gliomas
Authors: Ball Matthew K , Kollmeyer Thomas M , Praska Corinne E , McKenna Michelle L , Giannini Caterina , Raghunathan Aditya , Jentoft Mark E , Lachance Daniel H , Kipp Benjamin R , Jenkins Robert B , Ida Cristiane M 
Published: August 2020

AbstractBackgroundOligodendroglioma is genetically defined by concomitant IDH (IDH1/IDH2) mutation and whole-arm 1p/19q codeletion. Codeletion of 1p/19q traditionally evaluated by fluorescence in situ hybridization (FISH) cannot distinguish partial from whole-arm 1p/19q codeletion. Partial 1p/19q codeletion called positive by FISH is diagnostically a “false-positive” result. Chromosomal microarray (CMA) discriminates partial from whole-arm 1p/19q codeletion. Herein, we aimed to estimate the frequency of partial 1p/19q codeletion that would lead to a false-positive FISH result.MethodsFISH 1p/19q codeletion test probe coordinates were mapped onto Oncoscan CMA data to determine the rate of partial 1p/19q codeletion predicted to be positive by FISH. Diffuse astrocytic gliomas with available CMA data (2015–2018) were evaluated and classified based on IDH1-R132H/ATRX/p53 immunohistochemistry, IDH/TERT promoter targeted sequencing, and/or CMA according to classification updates. Predicted false-positive cases were verified by FISH whenever possible.ResultsThe overall estimated false-positive FISH 1p/19q codeletion rate was 3.6% (8/223). Predicted false positives were verified by FISH in 6 (of 8) cases. False-positive rates did not differ significantly (P = .49) between IDH-mutant (4.6%; 4/86) and IDH-wildtype (2.9%; 4/137) tumors. IDH-wildtype false positives were all WHO grade IV, whereas IDH-mutant false positives spanned WHO grades II-IV. Testing for 1p/19q codeletion would not have been indicated for most false positives based on current classification recommendations.ConclusionSelective 1p/19q codeletion testing and cautious interpretation for conflicting FISH and histopathological findings are recommended to avoid potential misdiagnosis.
Utility of Repeat Nasopharyngeal SARS-CoV-2 RT-PCR Testing and Refinement of Diagnostic Stewardship Strategies at a Tertiary Care Academic Center in a Low-Prevalence Area of the United States
Authors: Lepak Alexander J , Chen Derrick J , Buys Ashley , Stevens Linda , Safdar Nasia 
Published: August 2020

AbstractBackgroundMultiple factors have led to an extremely high volume of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcription polymerase chain reaction (RT-PCR) testing. Concerns exist about sensitivity and false-negative SARS-CoV-2 RT-PCR testing results. We describe a retrospective observational study examining the utility of repeat nasopharyngeal (NP) SARS-CoV-2 RT-PCR testing at an academic center in a low-prevalence setting.MethodsAll patients within our health system with &gt;1 NP SARS-CoV-2 RT-PCR test result were included. SARS-CoV-2 RT-PCR testing was performed according to 1 of 4 validated assays. Key clinical and demographic data were collected, including whether the patient was inpatient or outpatient at time of the test and whether the test was performed as part of a person under investigation (PUI) for possible coronavirus disease 2019 or for asymptomatic screening.ResultsA total of 660 patients had &gt;1 NP SARS-CoV-2 PCR test performed. The initial test was negative in 638. There were only 6 negative-to-positive conversions (0.9%). All 6 were outpatients undergoing a PUI workup 5–17 days after an initial negative result. In &gt;260 inpatients with repeat testing, we found no instances of negative-to-positive conversion including those undergoing PUI or asymptomatic evaluation.ConclusionsIn a low-prevalence area, repeat inpatient testing after an initial negative result, using a highly analytically sensitive SARS-CoV-2 RT-PCR, failed to demonstrate negative-to-positive conversion. The clinical sensitivity of NP RT-PCR testing may be higher than previously believed. These results have helped shape diagnostic stewardship guidelines, in particular guidance to decrease repeated testing in the inpatient setting to optimize test utilization and preserve resources.
Lessons Learned From the First 10 Consecutive Cases of Intravenous Bacteriophage Therapy to Treat Multidrug-Resistant Bacterial Infections at a Single Center in the United States
Authors: Aslam Saima , Lampley Elizabeth , Wooten Darcy , Karris Maile , Benson Constance , Strathdee Steffanie , Schooley Robert T 
Published: August 2020

Abstract

Background
Due to increasing multidrug-resistant (MDR) infections, there is an interest in assessing the use of bacteriophage therapy (BT) as an antibiotic alternative. After the first successful case of intravenous BT to treat a systemic MDR infection at our institution in 2017, the Center for Innovative Phage Applications and Therapeutics (IPATH) was created at the University of California, San Diego, in June 2018.

Methods
We reviewed IPATH consult requests from June 1, 2018, to April 30, 2020, and reviewed the regulatory process of initiating BT on a compassionate basis in the United States. We also reviewed outcomes of the first 10 cases at our center treated with intravenous BT (from April 1, 2017, onwards).

Results
Among 785 BT requests to IPATH, BT was administered to 17 of 119 patients in whom it was recommended. One-third of requests were for Pseudomonas aeruginosa, Staphylococcus aureus, and Mycobacterium abscessus. Intravenous BT was safe with a successful outcome in 7/10 antibiotic-recalcitrant infections at our center (6 were before IPATH). BT may be safely self-administered by outpatients, used for infection suppression/prophylaxis, and combined successfully with antibiotics despite antibiotic resistance, and phage resistance may be overcome with new phage(s). Failure occurred in 2 cases despite in vitro phage susceptibility.

Conclusions
We demonstrate the safety and feasibility of intravenous BT for a variety of infections and discuss practical considerations that will be critical for informing future clinical trials.
Upper Extremity Muscle Strength in Children With Unilateral Spastic Cerebral Palsy: A Bilateral Problem?
Authors: Dekkers Koen J F M , Rameckers Eugene A A , Smeets Rob J E M , Gordon Andrew M , Speth Lucianne A W M , Ferre Claudio L , Janssen-Potten Yvonne J M 
Published: August 2020

AbstractObjectiveThe objective was to investigate whether muscle strength in the nonaffected and affected upper extremities (UEs) in children (7–12 years) with unilateral spastic cerebral palsy (USCP) differs from that in children with typical development (TD).MethodsA cross-sectional study design was used. Isometric arm strength (wrist flexion, wrist extension with flexed and extended fingers, elbow flexion/extension) was assessed in 72 children (mean age = 9.3 [SD = 1.9] years) with USCP, and isometric grip/pinch strength was assessed in 86 children (mean age = 9.3 [SD = 1.8] years) with USCP. Arm/grip/pinch strength was assessed in 120 children (mean age = 9.5 [SD = 1.7] years) with TD. Arm strength was measured with a hand-held dynamometer, and grip/pinch strength was measured with a calibrated, modified (digitized) grip dynamometer and a pinch meter. The nonaffected UE of children with USCP was compared with the preferred UE of children with TD because both sides represent the preferred UE. The affected UE was compared with the nonpreferred UE of children with TD, as both sides represent the nonpreferred UE.ResultsIn all measurements except for grip strength of the preferred UE, children with USCP were weaker than children with TD.ConclusionsIn children with USCP, muscle strength weakness exists in both UEs.ImpactWhen unimanual or bimanual ability limitations are present in children with unilateral cerebral palsy, investigation of the muscle strength of the nonaffected UE should be part of the assessment.
Can Personal Parties Facilitate Women’s Political Seniority? A Study of Internal Rules of Conduct
Authors: Smrek Michal 
Published: August 2020

AbstractLeader-driven personal parties often campaign on a ticket promising elite renewal and novel ways of doing politics. One way of looking apart from the sitting political establishment is to recruit women into visible party positions. This study examines whether personal parties can improve women’s access to reelection by institutionalizing performance-based rules of internal promotion, which are necessitated by the lack of organic party cohesion. A site-intensive study of the Slovak Freedom and Solidarity party identifies a number of gendered structural constraints that impede the party’s female incumbents from excelling in those tasks that are deemed important by the party.
Cellular and molecular mechanisms of xenobiotics-induced premature senescence
Authors: Liang Yuehui , Liang Ningjuan , Yin Lirong , Xiao Fang 
Published: August 2020

Abstract
Premature senescence, which share common features with replicative senescence such as morphology, senescence-associated galactosidase (SA-β-gal) activity, cell cycle regulation, and gene expression, can be triggered by the exposure of various xenobiotics including environmental pollutant, peroxides, and anticancer drugs. The exact mechanisms underlying the senescence onset and stabilization are still obscure. In this review, we summarized the possible cellular and molecular mechanisms of xenobiotics-induced premature senescence, including induction of reactive oxygen species (ROS), tumor suppressors, and DNA damage; disequilibrium of calcium homeostasis; activation of transforming growth factor-β (TGF-β); and blockage of aryl hydrocarbon receptor (AHR) pathway. The deeper understanding of the molecular mechanisms underlying xenobiotics-induced senescence may shed light on new therapeutic strategies for age-related pathologies and extend healthy lifespan.
Limited vertical CO2 transport in stems of mature boreal Pinus sylvestris trees
Authors: Tarvainen Lasse , Wallin Göran , Linder Sune , Näsholm Torgny , Oren Ram , Ottosson Löfvenius Mikaell , Räntfors Mats , Tor-Ngern Pantana , Marshall John D 
Published: August 2020

Abstract
Several studies have suggested that CO2 transport in the transpiration stream can considerably bias estimates of root and stem respiration in ring-porous and diffuse-porous tree species. Whether this also happens in species with tracheid xylem anatomy and lower sap flow rates, such as conifers, is currently unclear. We infused 13C-labelled solution into the xylem near the base of two 90-year-old Pinus sylvestris L. trees. A custom-built gas exchange system and an online isotopic analyser were used to sample the CO2 efflux and its isotopic composition continuously from four positions along the bole and one upper canopy shoot in each tree. Phloem and needle tissue 13C enrichment was also evaluated at these positions. Most of the 13C label was lost by diffusion within a few metres of the infusion point indicating rapid CO2 loss during vertical xylem transport. No 13C enrichment was detected in the upper bole needle tissues. Furthermore, mass balance calculations showed that c. 97% of the locally respired CO2 diffused radially to the atmosphere. Our results support the notion that xylem CO2 transport is of limited magnitude in conifers. This implies that the concerns that stem transport of CO2 derived from root respiration biases chamber-based estimates of forest carbon cycling may be unwarranted for mature conifer stands.
A cross-sectional survey to assess the risk factors associated with stigmatizing attitudes towards patients with podoconiosis among rural youth in southern Ethiopia
Authors: Engdawork Kibur , Davey Gail , Ayode Desta , McBride Colleen M , Tadele Getnet 
Published: August 2020

Abstract

Background
Many health conditions are associated with stigma due to beliefs about their causes and the physical changes experienced by patients. Among such conditions are several neglected tropical diseases (NTDs). Podoconiosis, classified as an NTD, is a form of lymphoedema caused by the co-influence of genetic and environmental factors. It is a major public health problem in Ethiopia and is associated with intense stigma. Despite this, little is known about the factors contributing to stigmatizing attitudes against patients with the disease.

Methods
A cross-sectional survey was conducted in southern Ethiopia to analyse the attitudes of rural youth and associated risk factors for stigmatizing attitudes towards patients with podoconiosis, with the aim of informing stigma reduction strategies.

Results
The survey included 336 randomly selected youth. Of the 177 (52.7%) youth who held more stigmatizing attitudes toward patients with podoconiosis, 105 (59.3%) were females and 171 (96.6%) did not have affected friends. Accurate knowledge about gene–environment influences and rejection of infectious causes of podoconiosis were associated with less stigmatizing attitudes.

Conclusions
Improving understanding of the gene–environment interaction and dispelling beliefs about infectious causes may reduce negative attitudes about podoconiosis. Affected youth may play an important role as agents of change to spread non-stigmatizing messages.
An Organizational Socialization Perspective on Young Adults’ Ideas About Retirement: Examining Sources of Retirement Information, Meanings of Retirement, and Source-Meaning Associations
Authors: Gettings Patricia E , Anderson Lindsey B 
Published: August 2020

Abstract
This study drew from literature on organizational socialization, namely an early phase called vocational anticipatory socialization (VAS), to examine the sources of information from which young adults learn about retirement, the meanings they ascribe to retirement, and associations between sources of retirement information and meanings. In study 1, quantitative content analysis was used to code 671 responses from young adults. In study 2, semi-structured interviews with 16 young adults were conducted and abductively analyzed. Results revealed 16 sources of information about retirement with grandparents and parents emerging as primary sources, and 13 meanings of retirement (e.g., freedom from work, financial issues, how time is spent, life phase, physical decline) that can be combined to construct negative or positive framings. In addition, chi-square analyses indicated significant associations between some source-meaning combinations in study 1, whereas study 2 revealed the nature of explicit and implicit advice from family members. Theoretical and practical implications are discussed.
Original Research: Nurses' Knowledge and Comfort with Assessing Inpatients' Firearm Access and Providing Education on Safe Gun Storage
Authors: Sheppard Kimberly Smith , Hall Kathryn , Carney Julia , Griffith Catherine , Rudolph Meaghan , Zelinsky Megan , Gettings Elise 
Published: August 2020

ABSTRACT

Purpose:
This study sought to evaluate nurses' knowledge and comfort with assessing inpatients' access to firearms and providing education on firearm safety and storage. Facilitators and barriers to such assessment, as well as best methods for educating nurses and patients on firearm safety and storage, were also explored.

Methods:
Nurses from a general medical unit and a psychiatric unit at a large urban hospital were invited to complete a 22-question online survey. Descriptive statistics were computed to analyze survey responses for each unit.

Results:
Forty-two nurses—21 from each unit—participated. More than 50% of nurses on each unit were unfamiliar with state law on safe gun storage, and none had prior training in educating others on firearm safety and storage. Compared with nurses on the psychiatric unit, those on the general medical unit were less comfortable asking patients about firearm access and safe gun storage. Several facilitators and barriers to assessment emerged. Facilitators identified by similar numbers of nurses on each unit included receiving relevant education and having educational information available for patients. Nurses on both units also endorsed having a safety protocol and a documentation policy in place. Barriers identified by similar numbers of nurses on each unit included lack of adequate knowledge about firearm safety and lack of patient educational materials. More medical unit than psychiatric unit nurses also named lack of time and not knowing what to do with collected information. More than 80% of nurses on each unit reported that they would feel comfortable providing patients with information on safe firearm storage if it were available; a pamphlet was endorsed most often as the best method. A one-hour class involving the security department and other disciplines was the top endorsed nurse learning strategy.

Conclusions:
Findings from this study highlighted several factors, including nursing specialty, that may influence inpatient assessment of firearm access and safe gun storage. These results can help inform hospital policies and nursing education initiatives aimed at improving safe gun storage practices among patients and the general public.
Quantitative Assessment of Eosinophils in Dermatomyositis Skin Biopsies With Correlation of Eosinophils to Pruritus and Other Clinical Features
Authors: Khanna Urmi , Vaughan Heidi , North Jeffrey , Haemel Anna 
Published: August 2020

Abstract:
The objective of this retrospective study was to analyze dermatomyositis skin biopsies for the presence of eosinophils and correlate this finding with other histopathologic and clinical characteristics. Cases of dermatomyositis evaluated in a single dermatologist's adult autoimmunity practice over a 2.5-year period were identified via ICD-10 diagnosis code. Dermatopathology archives were then searched for any corresponding biopsies consistent with dermatomyositis, and those identified were assessed for eosinophils, adnexal involvement, epidermal atrophy, dermal mucin, and basement membrane thickening. Histopathologic findings were correlated with key clinical features, including itch. A total of 39 biopsies from 17 patients were included. Eosinophils were noted in 44% of biopsies (n = 17) from 12 patients. Dermal mucin deposition and adnexal interface dermatitis were noted in 72% (n = 28) and 44% (n = 17) of biopsy specimens, respectively. Of 12 patients with eosinophils present in at least 1 biopsy specimen, 11 (92%) patients had a clinical history of pruritus of their skin lesions (P = 0.052). Limitations of this study include retrospective design and small number of patients.
The Emperor's New Clothes: A Critique of the Current WHO Classification of Malignant Melanoma
Authors: Weyers Wolfgang 
Published: August 2020

Abstract:
The World Health Organization’s classification of skin tumors of 2018 presents melanoma as a loose assembly of independent biologic entities, each of which is characterized by a distinctive constellation of clinical, histopathologic, and molecular findings that evolve through different pathways of lesional progression from a benign to an intermediate and, ultimately, malignant tumor. The alleged pathways, however, are based on vague correlations and fail to take into account the common occurrence of lesions that cannot be assigned to either of them. Moreover, there is no such thing as a lesional progression. The evolvement of neoplasms is always a clonal and, therefore, initially focal event. In the majority of melanomas, there is no evidence of a juxtaposition of a benign, intermediate, and malignant portion. Occasionally, a melanoma may develop within the confines of a melanocytic nevus, but a nevus cannot transform into melanoma. The concept of lesional progression merely serves to handle problems of differential diagnosis because it obscures and, in fact, denies the difference between benign and malignant neoplasms. In the current classification of the World Health Organization, every lesion is said to bear some risk of malignant progression, intermediate categories are recognized for all alleged pathways, and no distinction is made between “high-grade dysplasia” and melanoma in situ. Differentiation between benign and malignant neoplasms of melanocytes may be difficult, but the concept of lesional progression does not address those problems; it merely offers evasions under the disguise of diagnoses.