bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Nurse Preparation and Partnership in Antibiotic Stewardship Programs
Authors: Carter Eileen J. , Manning Mary Lou , Pogorzelska-Maziarz Monika 
Published: November 2019

OBJECTIVE
Describe clinical nurse involvement in antibiotic stewardship programs (ASPs).

BACKGROUND
The extent to which clinical nurses are supported and integrated into ASPs is unknown.

METHODS
Electronic survey of infection preventionists (IPs) working in acute care hospitals.

RESULTS
A total of 207 IPs nationwide reported on clinical nurses' involvement in their hospital's ASP. Among respondents, 42% reported the presence of a designated nurse executive that championed nurses' involvement in ASPs; 33% reported that the hospital provides antibiotic stewardship education and training to clinical nurses, and only 14% believed that clinical nurses have adequate stewardship knowledge to participate in ASP activities.

CONCLUSIONS
Study findings indicate the need for nurse leaders to improve the preparation and integration of clinical nurses in ASPs. While clinical nurses routinely perform activities that contribute to optimal antibiotic use, the knowledge and competency of clinical nurses in these activities and their formal integration in ASPs are minimal.
Cognitive impairment severity in relation to signs of subclinical Wernicke's encephalopathy in HIV and alcoholism comorbidity
Authors: Le Berre Anne-Pascale , Fama Rosemary , Sassoon Stephanie A. , Zahr Natalie M. , Pfefferbaum Adolf , Sullivan Edith V. 
Published: November 2019

Objectives:
The comorbidity of HIV infection and alcoholism (ALC) is prevalent. Wernicke's encephalopathy, a neurological disorder resulting from thiamine depletion, has been generally associated with alcoholism but has also been reported in HIV infection. This study examined whether subclinical Wernicke's encephalopathy signs could contribute to the heterogeneity of cognitive and motor deficits observed in individuals with both disease conditions (HIV+ALC).

Design:
Sixty-one HIV+ALC individuals and 59 controls were assessed on attention and working memory, production, immediate and delayed episodic memory, visuospatial abilities, and upper limb motor function.

Methods:
Using Caine criteria (dietary deficiency, oculomotor abnormality, cerebellar dysfunction, and altered mental state), HIV+ALC individuals were classified by subclinical Wernicke's encephalopathy risk factors.

Results:
Signs of subclinical Wernicke's encephalopathy were present in 20% of the HIV+ALC participants. For attention/working memory, delayed memory, and upper limb motor function, HIV+ALC Caine 2+ (i.e. meeting two or three criteria) demonstrated the most severe deficits, scoring lower than HIV+ALC Caine 1 (i.e. meeting one criterion), HIV+ALC Caine 0 (i.e. meeting no criteria), and controls.

Conclusion:
The high prevalence of subclinical signs of Wernicke's encephalopathy and relevance to performance indicate that this condition should be considered in assessment of HIV-infected individuals, especially when alcoholism comorbidity is known or suspected. Above and beyond clinical factors, such as depression, alcoholism and HIV disease-related variables, AIDS, hepatitis C and drug history known to mediate neuropsychological performance, subclinical Wernicke's encephalopathy signs could partly explain the heterogeneity in patterns and severity of cognitive and motor impairments in HIV-infected individuals with alcoholism comorbidity.
Serum extracellular vesicles expressing bone activity markers associate with bone loss after HIV antiretroviral therapy
Authors: Marques de Menezes Erika G. , Ramallho Janaina , Bucovsky Mariana , Shane Elizabeth , Yin Michael T. , Norris Philip J. 
Published: November 2019

Objective:
We tested whether bone-related extracellular vesicle phenotypes changed after initiating antiretroviral therapy (ART) and determined whether changes in levels of extracellular vesicles correlated with changes in bone mineral density (BMD).

Design:
Extracellular vesicle phenotypes were measured in blinded serum samples from 15 adults with HIV at baseline, 1, 3, 6 and 12 months after ART initiation. Not all samples were available at each time point so we averaged early (TP1, 1–3 months) and late (TP2, 6–12 months) time points.

Methods:
Extracellular vesicles were stained for osteocalcin (OC), RANKL (CD254), RANK (CD265), M-CSF (macrophage colony stimulating factor), and CD34. Serum OC, procollagen type I N-terminal propeptide (P1NP), and C-terminal telopeptide of type 1 collagen (CTx) were also measured.

Results:
BMD significantly decreased from baseline to 12 months. Levels of OC+EVs, serum OC, serum P1NP, and CTx were significantly higher at early and late time points compared with baseline. Increases in EVs expressing OC, RANKL, RANK, and CD34 from baseline to TP1 were associated with decreases in total hip BMD from baseline to 12 months. Change in serum OC, P1NP, and CTx from baseline to TP1 or TP2 did not correlate with change in BMD.

Conclusion:
Early changes in extracellular vesicles expressing markers of bone activity were associated with total hip bone loss 12 months after ART initiation. These data suggest that serum extracellular vesicles may serve as novel biomarkers of bone remodeling. Future studies are required to determine if extracellular vesicles contribute to the effects of ART on changes in bone turnover markers and BMD.
Effects of Ketamine Anesthesia on Efficacy, Tolerability, Seizure Response, and Neurocognitive Outcomes in Electroconvulsive Therapy
Authors: Ainsworth Nicholas J. , Sepehry Amir A. , Vila-Rodriguez Fidel 
Published: November 2019

Abstract
Electroconvulsive therapy (ECT) remains the most effective treatment for major depressive disorder. Ketamine is an anesthetic gaining attention for its rapid antidepressant effect. Numerous randomized controlled trials have investigated the effect of ketamine anesthesia in ECT on various clinical outcomes. Previous systematic reviews have not found benefit for overall depression response, although some have found evidence of benefit early in the ECT course. Clear quantitative conclusions have not been established regarding other outcomes, particularly while only using data from high-quality studies. We aimed to examine all data from double-blind randomized controlled trials comparing ketamine to other anesthetics via meta-analysis, to make recommendations regarding ECT practice and future research. Data were extracted for depressive symptoms, seizure duration and electrical dose, neuropsychological performance, and adverse effects. Effect sizes were calculated using Hedge's g and odds ratios. Eighteen studies (n = 915) were included in the meta-analysis. Ketamine was not found to enhance improvement of depressive symptoms, either early in ECT course or at end of study. Ketamine had a large effect on increasing seizure duration both overall (Hedge's g = 0.71, P = 0.038) and in the subgroup receiving ketamine in combination with another anesthetic (Hedge's g = 0.78, P < 0.01), and on decreasing electrical dose (Hedge's g = 1.98, P = 0.039). There was no significant effect of ketamine on any individual neuropsychological domain. Ketamine was not associated with increased adverse effects, except for hypertension in patients receiving ketamine monotherapy. Significant heterogeneity was present for many outcomes, and sensitivity analyses suggested a relation to methodological variation in most cases. This study supports the finding that ketamine does not enhance ECT's antidepressant effect, including on early improvement, but provides substantial evidence for enhancing seizure duration and reducing electrical dose. No significant benefit was found on neurocognitive outcomes, but analysis was limited by small sample sizes and high heterogeneity. Ketamine is generally safe in ECT, particularly as a coanesthetic. Our findings provide meta-analytic support to the recommendations in ECT clinical guidelines for use of coadjuvant ketamine in ECT where seizures are suboptimal. Further studies targeting neurocognitive outcomes are encouraged.
A pilot biomonitoring study of cumulative phthalates exposure among Vietnamese American nail salon workers
Authors: Varshavsky Julia R. , Morello-Frosch Rachel , Harwani Suhash , Snider Martin , Petropoulou Syrago-Styliani E. , Park June-Soo , Petreas Myrto , Reynolds Peggy , Nguyen Tuan , Quach Thu 
Published: November 2019

AbstractBackgroundMany California nail salon workers are low-income Vietnamese women of reproductive age who use nail products daily that contain androgen-disrupting phthalates which may increase risk of male reproductive tract abnormalities during pregnancy. Yet, few studies have characterized phthalate exposures among this workforce.ObjectiveTo characterize individual metabolites and cumulative phthalates exposure among a potentially vulnerable occupational group of nail salon workers.Study DesignWe collected 17 post-shift urine samples from Vietnamese workers at six San Francisco Bay Area nail salons in 2011, which were analyzed for four primary phthalate metabolites: mono-n-butyl-, mono-isobutyl-, mono(2-ethylhexyl)-, and monoethyl phthalates (MnBP, MiBP, MEHP, and MEP, respectively) (μg/L). Phthalate metabolite concentrations and a potency-weighted sum of parent compound daily intake (Σandrogen-disruptor, μg/kg/day) were compared to 203 Asian Americans from the 2011– 12 National Health and Nutritional Examination Survey (NHANES) using Student’s t-test and Wilcoxin signed rank test.ResultsCreatinine-corrected MnBP, MiBP, MEHP (μg/g), and cumulative phthalates exposure (Σandrogen-disruptor, μg/kg/day) levels were 2.9 (p< 0.0001), 1.6 (p= 0.015), 2.6 (p< 0.0001), and 2.0 (p< 0.0001) times higher, respectively, in our nail salon worker population compared to NHANES Asian Americans. Levels exceeded the NHANES 95thor 75thpercentiles among some workers.ConclusionThis pilot study suggests that nail salon workers are disproportionately exposed to multiple phthalates, a finding that warrants further investigation to assess their potential health significance.
Distinct single cell gene expression in peripheral blood monocytes correlates with tumor necrosis factor inhibitor treatment response groups defined by type I interferon in rheumatoid arthritis
Authors: Muskardin Theresa L. Wampler , Fan Wei , Jin Zhongbo , Jensen Mark A. , Dorschner Jessica M. , Ghodke-Puranik Yogita , Dicke Betty , Vsetecka Danielle , Wright Kerry , Mason Thomas , Persellin Scott , Michet Clement J. , Davis John M. , Matteson Eric , Niewold Timothy B. 
Published: November 2019

AbstractPreviously, we demonstrated that type I IFN (IFNβ/α) activity can predict non-response to tumor necrosis factor inhibitors (TNFi) in rheumatoid arthritis (RA). In this study, we examine the biology of TNFi non-response in monocytes from RA patients. We compared single cell gene expression in purified classical (CL, n=342) and non-classical (NC, n=359) monocytes. RA patients were grouped according to their pre-TNFi IFNβ/α activity: those likely to have EULAR no response (non-response group, IFNβ/α 0 or >1.3, n=9) and those likely to have EULAR moderate or good response (response group, IFNβ/α > 0 and ≤1.3, n=6). Major differences in gene expression were apparent in principal component and unsupervised cluster analyses. CL monocytes from the non-response group were unlikely to expressJAK1andIFI27(p <0.0001 and p 0.0005, respectively). In NC monocytes from the same group, expression ofIFNAR1, IRF1, TNFA, TLR4(p ≤0.0001 for each) and others was enriched. Interestingly,JAK1expression was absent in CL and NC monocytes from 9 patients. This pattern strongly associated with the non-response IFNβ/α group, suggesting a major biological difference betweenJAK1expressors and non-expressors. The type I IFN activity that was previously found to predict TNFi response associated with changes in gene expression in monocytes that suggest differential IFN pathway activation in RA patients who are either likely to respond or to have no response to TNFi. This work could suggest mechanisms for TNFi non-response, and potential therapeutic strategies for those patients unlikely to respond to TNFi.
Re-evaluating the evidence for fecal microbiota transplantation “super-donors” in inflammatory bowel disease
Authors: Olesen Scott W. , Gerardin Ylaine 
Published: November 2019

SUMMARYBackgroundFecal microbiota transplantation (FMT) is a recommended treatment for recurrent Clostridioides difficile infection, and there is promise that FMT may be effective for conditions like inflammatory bowel disease (IBD). Previous FMT clinical trials have considered the possibility of a “donor effect”, that is, that FMT material from different donors has different clinical efficacies.Aim & MethodsHere we re-evaluate evidence for donor effects in published FMT clinical trials for IBD.ResultsIn 7 of 9 published studies, no statistically significant donor effect was detected when rigorously re-evaluating the original analyses. One study had statistically significant separation of microbiota composition of pools of donor stool when stratified by patient outcome. One study reported a significant effect but did not have underlying data available for re-evaluation. When quantifying the uncertainty on the magnitude of the donor effect, confidence intervals were large, including both zero donor effect and very substantial donor effects.ConclusionAlthough we found very little evidence for donor effects, the existing data also cannot rule out the possibility that donor effects are clinically important. Large clinical trials prospectively designed to detect donor effects are likely necessary to determine if donor effects are clinically relevant for IBD.
Semantic computational analysis of anticoagulation use in atrial fibrillation from real world data
Authors: Bean Daniel M. , Teo James , Wu Honghan , Oliveira Ricardo , Patel Raj , Bendayan Rebecca , Shah Ajay M. , Dobson Richard J. B. , Scott Paul A. 
Published: November 2019

AbstractAtrial fibrillation (AF) is the most common arrhythmia and significantly increases stroke risk. This risk is effectively managed by oral anticoagulation. Recent studies using national registry data indicate increased use of anticoagulation resulting from changes in guidelines and the availability of newer drugs.The aim of this study is to develop and validate an open source risk scoring pipeline for free-text electronic health record data using natural language processing.AF patients discharged from 1st January 2011 to 1st October 2017 were identified from discharge summaries (N=10,030, 64.6% male, average age 75.3 ± 12.3 years). A natural language processing pipeline was developed to identify risk factors in clinical text and calculate risk for ischaemic stroke (CHA2DS2-VASc) and bleeding (HAS-BLED). Scores were validated vs two independent experts for 40 patients.Automatic risk scores were in strong agreement with the two independent experts for CHA2DS2-VASc (average kappa 0.78 vs experts, compared to 0.85 between experts). Agreement was lower for HAS-BLED (average kappa 0.54 vs experts, compared to 0.74 between experts).In high-risk patients (CHA2DS2-VASc ≥2) OAC use has increased significantly over the last 7 years, driven by the availability of DOACs and the transitioning of patients from AP medication alone to OAC. Factors independently associated with OAC use included components of the CHA2DS2-VASc and HAS-BLED scores as well as discharging specialty and frailty. OAC use was highest in patients discharged under cardiology (69%).Electronic health record text can be used for automatic calculation of clinical risk scores at scale. Open source tools are available today for this task but require further validation. Analysis of routinely-collected EHR data can replicate findings from large-scale curated registries.
Evaluation of the Hospital Readmissions Reduction Program
Authors: Khera Rohan , Wang Yongfei , Bernheim Susannah M. , Lin Zhenqiu , Normand Sharon-Lise T. , Krumholz Harlan M. 
Published: November 2019

ABSTRACTBackgroundThere is conflicting evidence about whether the Hospital Readmission Reduction Program (HRRP) is associated with an increase in mortality.MethodsIn a cohort of Medicare beneficiaries hospitalized with heart failure (HF), we compared two published approaches to evaluating the association of HRRP and risk-adjusted 30-day mortality, including changes in average mortality across periods and changes in slope of monthly mortality rates across discrete periods. We also tested various methods with simulated data that was designed with an inflection in mortality.ResultsWe identified 4,313,523 hospitalizations for HF, 1,788,219 for AMI, and 3,758,111 for pneumonia. Monthly slope-change models identified an increase in mortality for HF and pneumonia in the pre-HRRP period (P<.001 for slope-change). The changes in average mortality across the four time periods model found an increase in mortality for HF and pneumonia in the HRRP anticipation period (post-announcement, pre-implementation) as well as following HRRP implementation. However, under those conditions, our simulations reveal that method errs in identifying the timing of a change. Varying the data sources and risk-adjustment strategies had no significant effect on the results.ConclusionA national policy incentivizing efforts to reduce readmission did not increase the risk of mortality.
Evaluation of the concentration and profile of serum proteins and immunoglobulins in Mexican patients with advanced gastric cancer
Authors: y Orea María Alicia Díaz , Díaz Hernández Héctor Adrián , Lopez Rogelio Gonzalez , Conde Eduardo Gómez , Cárdenas Perea Maria Elena , Montaño Mónica Heredia , de los Ángeles Tapia Roldán María José , Juarez Alvarado Emmanuel Marcelino 
Published: November 2019

AbstractIntroductionGastric cancer remains an important health problem. It’s molecular mechanisms and interactions with the immune system are still not well elucidated. Therefore, we aimed to evaluate the concentration and profile of serum proteins and immunoglobulins in Mexican patients with advanced gastric cancer.Materials and methodsWe performed a descriptive study. Adult patients from both sexes were included. The problem group was formed of patients with advanced gastric cancer and the control group was formed of healthy subjects. Demographic data, gastric cancer histological type and stage of tumor node metastasis (TNM) system were recorded. The profile and concentration of serum proteins and immunoglobulins was determined and analyzed in different subgroups classified by sex, histologic type and stage of TNM system. To compare the concentrations of serum proteins and immunoglobulins the ANOVA test was performed. A p <0.05 was considered statistically significant.ResultsWe included 88 patients with advanced gastric cancer and 74 healthy controls. There were no differences in demographic data among the groups, and the most common gastric cancer type was the diffuse (67.04%). Women with gastric cancer from any type presented higher levels of immunoglobulin G (IgG) compared with the control group (p <0.001) and men with gastric cancer of intestinal type in TNM stage III presented higher levels of IgG compared with it’s counterpart of diffuse type (p <0.001). Also, patients with intestinal type gastric cancer presented higher concentrations of alpha-1 globulins compared with patients with the diffuse type (p <0.05). Finally, patients with diffuse gastric cancer TNM stage IV presented the lowest albumin/globulin ratios.ConclusionThere is a greater concentration of serum IgG in some subgroups of patients with advanced gastric cancer, the concentration of alpha-1 globulins is different between the intestinal and diffuse types and the albumin/globulin ratio is lower in the diffuse type.
Prevalence of erectile dysfunction patients with diabetes mellitus and its association with body mass index and glycated hemoglobin in Africa: a systematic review and meta-analysis
Authors: Shiferaw Wondimeneh Shibabaw , Akalu Tadesse Yirga , Aynalem Yared Asmare 
Published: November 2019

AbstractBackgroundMortality and morbidity in patients with diabetes mellitus (DM) is attributed to both the micro-vascular and macro-vascular complications. Variation among primary studies was seen on the prevalence of erectile dysfunction in Africa. Therefore, this study was aimed to estimate the pooled prevalence of erectile dysfunction patients with diabetes mellitus and its association with body mass index and glycated hemoglobin in Africa.MethodsPubMed, Web of Science, Cochrane library, Scopus, Psyinfo, Africa online journal and Google Scholar were searched. A funnel plot and Egger’s regression test were used to see publication bias. I-squared statistic was used to check heterogeneity of studies. DerSimonian and Laird random-effects model was applied to estimate the pooled effect size. The subgroup and Meta regression analysis were conducted by country, sample size, and year of publication. Sensitivity analysis was deployed to see the effect of single study on the overall estimation. STATA version 14 statistical software was used for meta-analysis.ResultA total of 20 studies with 5,177 study participants were included to estimate the pooled prevalence. The pooled prevalence of erectile dysfunction patients with diabetes mellitus was 61.62% (95% CI: 48.35–74.9). BMI ≥ 30kg/m2(AOR = 1.26; 95% CI: 0.73 –2.16), and glycated hemoglobin ≥ 7% (AOR = 0.93; 95% CI: 0.5–5.9), were identified factors though not statistically significant associated with erectile dysfunction.ConclusionsThe prevalence of erectile dysfunction in Africa remains high. Therefore, situation based interventions and country context specific preventive strategies could be developed to reduce the magnitude of erectile dysfunction among patients with diabetes mellitus.
Privacy-preserving quality control of neuroimaging datasets in federated environment
Authors: Saha D. K. , Calhoun V. D. , Du Y. , Fu Z. , Panta S. R. , Kwon S. , Sarwate A. D. , Plis S. M. 
Published: November 2019

AbstractPrivacy concerns for rare disease data, institutional or IRB policies, access to local computational or storage resources or download capabilities are among the reasons that may preclude analyses that pool data to a single site. A growing number of multi-site projects and consortia were formed to function in the federated environment to conduct productive research under constraints of this kind. In this scenario, a quality control tool that visualizes decentralized data in its entirety via global aggregation of local computations is especially important, as it would allow the screening of samples that cannot be jointly evaluated otherwise. To solve this issue, we present two algorithms: decentralized data stochastic neighbor embedding, dSNE, and its differentially private counterpart, DP-dSNE. We leverage publicly available datasets to simultaneously map data samples located at different sites according to their similarities. Even though the data never leaves the individual sites, dSNE does not provide any formal privacy guarantees. To overcome that, we rely on differential privacy: a formal mathematical guarantee that protects individuals from being identified as contributors to a dataset. We implement DP-dSNE with AdaCliP, a method recently proposed to add less noise to the gradients per iteration. We introduce metrics for measuring the embedding quality and validate our algorithms on these metrics against their centralized counterpart on two toy datasets. Our validation on six multi-site neuroimaging datasets shows promising results for the quality control tasks of visualization and outlier detection, highlighting the potential of our private, decentralized visualization approach.