bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing the Impact of a Training Initiative for Nasopharyngeal and Oropharyngeal Swabbing for COVID‐19 Testing
Authors: Abud Brittany T. , Hajnas Natalia M. , Redleaf Miriam , Kerolus Julia L. , Lee Victoria 
Published: August 2020

ObjectiveThe accuracy and reliability of COVID‐19 testing are critical to limit transmission. After observing variability in testing techniques, we otolaryngologists at a tertiary medical center initiated and evaluated the impact of nasopharyngeal and oropharyngeal swabbing training, including video instruction, to standardize sampling techniques and ensure high‐quality specimens.MethodsParticipants in the training were employees (N = 40). Training consisted of an instructional video on how to perform nasopharyngeal and oropharyngeal swabs and a live demonstration. Participants completed pre‐ and posttraining surveys assessing their knowledge and confidence in performing nasopharyngeal and oropharyngeal swabs. They then performed swabbing on partners, which was graded per a standardized checklist.ResultsMean scores for knowledge‐based questions and confidence in swabbing were significantly higher after the training session (both P <. 001). All participants scored ≥6 of 8 on the posttraining checklist. Ninety‐five percent rated the video as very or extremely useful.DiscussionSpecialized instruction for nasopharyngeal swabbing improved participants’ knowledge—specifically, the appropriate head position and minimum swab time in nasopharynx—and their confidence. After the training, their swabbing execution scores were high.Implications for PracticeVideo‐assisted hands‐on instruction for nasopharyngeal swab sampling can be used to standardize teaching. When prompt and accurate testing is paramount, this instruction can optimize procedural technique and should be used early and often. In addition, there may be a professional responsibility of otolaryngologists to participate in such initiatives.
Prognostic Significance of I-Month Postdischarge BNP in Identifying Patients at High Risk of Mortality and Readmission After Decompensated Heart Failure
Authors: Kumar Vinod , Goel Pravin K. , Khanna Roopali , Kapoor Aditya , Mahajan Kunal 
Published: August 2020

Objective: The B-type natriuretic peptide (BNP) levels could predict future cardiovascular events in congestive heart failure patients. Most studies have correlated basal BNP levels to long-term outcomes. Limited data exist on the prognostic significance of 1-month postdischarge BNP levels after acute heart failure. Methods: Consecutive patients admitted for worsening heart failure were enrolled. BNP was measured at admission, predischarge and at 1-month following discharge. Patients were followed for 1 year for end points of death and rehospitalization. Results: A total of 150 patients (mean age 60.8 + 13.8 years) were included in the heart failure study. 81 (54%) patients had acute heart failure secondary to acute coronary syndrome, while the rest (46%) had acute decompensation of chronic heart failure irrespective of etiology. Mean ejection fraction was 28.6 + 8.9%. 14 patients expired during hospitalization. BNP at admission was an important predictor of in hospital mortality ( P value = .003). Following discharge, 7 events (3 deaths and 4 rehospitalizations) occurred over next 1 month. 1-month outcome was predicted by baseline BNP ( P value = .01) as well as discharge BNP value ( P value = .001). A total of 55 events (26 rehospitalization and 29 deaths) occurred at follow-up of 1 year. Age > 50years, ejection fraction at baseline and all time sequential BNP levels (at admission, discharge, as well as 1 month) were univariate predictors of death and rehospitalization at 1 year. The BNP at 1 month had best discriminative power and remained the lone significant predictor in the multivariate analysis ( P = < .001). Conclusions: 1-month postdischarge BNP level is a useful prognostic factor that predicts mortality and rehospitalization at 1-year follow-up, in patients admitted with heart failure, and helps in identifying patients who need more intensive drug treatment and closer follow-up.
Building access to care in adult sickle cell disease: defining models of care, essential components, and economic aspects
Authors: Kanter Julie , Smith Wally R. , Desai Payal C. , Treadwell Marsha , Andemariam Biree , Little Jane , Nugent Diane , Claster Susan , Manwani Deepa G. , Baker Judith , Strouse John J. , Osunkwo Ifeyinwa , Stewart Rosalyn W. , King Allison , Shook Lisa M. , Roberts John D. , Lanzkron Sophie 
Published: August 2020

AbstractSickle cell disease (SCD) is the most common inherited blood disorder in the United States. It is a medically and socially complex, multisystem illness that affects individuals throughout the lifespan. Given improvements in care, most children with SCD survive into adulthood. However, access to adult sickle cell care is poor in many parts of the United States, resulting in increased acute care utilization, disjointed care delivery, and early mortality for patients. A dearth of nonmalignant hematology providers, the lack of a national SCD registry, and the absence of a centralized infrastructure to facilitate comparative quality assessment compounds these issues. As part of a workshop designed to train health care professionals in the skills necessary to establish clinical centers focused on the management of adults living with SCD, we defined an SCD center, elucidated required elements of a comprehensive adult SCD center, and discussed different models of care. There are also important economic impacts of these centers at an institutional and health system level. As more clinicians are trained in providing adult-focused SCD care, center designation will enhance the ability to undertake quality improvement and compare outcomes between SCD centers. Activities will include an assessment of the clinical effectiveness of expanded access to care, the implementation of SCD guidelines, and the efficacy of newly approved targeted medications. Details of this effort are provided.
Medical marijuana certification for patients with sickle cell disease: a report of a single center experience
Authors: Curtis Susanna A. , Lew Dana , Spodick Jonathan , Hendrickson Jeanne E. , Minniti Caterina P. , Roberts John D. 
Published: August 2020

Abstract
More than one-third of adults with sickle cell disease (SCD) report using cannabis-based products. Many states list SCD or pain as qualifying conditions for medical marijuana, but there are few data to guide practitioners whether or whom should be certified. We postulated that certifying SCD patients may lead to a reduction in opioid use and/or health care utilization. Furthermore, we sought to identify clinical characteristics of patients who would request this intervention. Retrospective data obtained over the study period included rates of health care and opioid utilization for 6 months before certification and after certification. Patients who were certified but failed to obtain medical marijuana were compared with those who obtained it. Patients who were certified were invited to participate in a survey regarding their reasons for and thoughts on certification. Patients who were certified for medical marijuana were compared with 25 random patients who did not request certification. Fifty adults with SCD were certified for medical marijuana and 29 obtained it. Patients who obtained medical marijuana experienced a decrease in admission rates compared with those who did not and increased use of edible cannabis products. Neither group had changes in opioid use. Patients who were certified for medical marijuana had higher rates of baseline opioid use and illicit cannabis use compared with those who did not request certification. Most patients with SCD who requested medical marijuana were already using cannabis illicitly. Obtaining medical marijuana decreased inpatient hospitalizations.
SQMtools: automated processing and visual analysis of ’omics data with R and anvi’o
Authors: Puente-Sánchez Fernando , García-García Natalia , Tamames Javier 
Published: August 2020

AbstractBackgroundThe dramatic decrease in sequencing costs over the last decade has boosted the adoption of high-throughput sequencing applications as a standard tool for the analysis of environmental microbial communities. Nowadays even small research groups can easily obtain raw sequencing data. After that, however, non-specialists are faced with the double challenge of choosing among an ever-increasing array of analysis methodologies, and navigating the vast amounts of results returned by these approaches.ResultsHere we present a workflow that relies on the SqueezeMeta software for the automated processing of raw reads into annotated contigs and reconstructed genomes (bins). A set of custom scripts seamlessly integrates the output into the anvi’o analysis platform, allowing filtering and visual exploration of the results. Furthermore, we provide a software package with utility functions to expose the SqueezeMeta results to the R analysis environment.ConclusionsAltogether, our workflow allows non-expert users to go from raw sequencing reads to custom plots with only a few powerful, flexible and well-documented commands.
Genetic diversity of aflatoxin-producing Aspergillus flavus isolated from selected groundnut growing agro-ecological zones of Uganda
Authors: Acur Amos , Arias Renée S. , Odongo Steven , Tuhaise Samuel , Ssekandi Joseph , Adriko John , Muhanguzi Dennis , Buah Stephen , Kiggundu Andrew 
Published: August 2020

AbstractBackgroundGroundnut pre- and post-harvest contamination is commonly caused by fungi from the GenusAspergillus.Aspergillus flavusis the most important of these fungi. It belongs to sectionFlavi; a group consisting of aflatoxigenic (A. flavus,A. parasiticusandA. nomius) and non-aflatoxigenic (A. oryzae,A. sojaeandA. tamarii) fungi. Aflatoxins are food-borne toxic secondary metabolites ofAspergillusspecies associated with severe hepatic carcinoma and children stuntedness. Despite the well-known public health significance of aflatoxicosis, there is a paucity of information about the prevalence, genetic diversity and population structure ofA. flavusin different groundnut growing agro-ecological zones of Uganda. This cross-sectional study was therefore conducted to fill this knowledge gap.ResultsThe overall pre- and post-harvest groundnut contamination rates withA. flavuswere 30.0 and 39.2% respectively. Pre- and post-harvest groundnut contamination rates withA. flavusacross AEZs were; 2.5 and 50.0%; (West Nile), 55.0 and 35.0% (Lake Kyoga Basin) and 32.5 and 32.5% (Lake Victoria Basin) respectively. There was no significant difference (χ2 = 2,p = 0.157) in overall pre- and post-harvest groundnut contamination rates withA. flavusand similarly no significant difference (χ2 = 6,p = 0.199) was observed in the pre- and post-harvest contamination of groundnut withA. flavusacross the three AEZs. The LKB had the highest incidence of aflatoxin-producingAspergillusisolates while WN had no singleAspergillusisolate with aflatoxin-producing potential.Aspergillusisolates from the pre-harvest groundnut samples had insignificantly higher incidence of aflatoxin production (χ2 = 2.667,p = 0.264) than those from the post-harvest groundnut samples. Overall,A. flavusisolates exhibited moderate level (92%,p = 0.02) of genetic diversity across the three AEZs and low level (8%,p = 0.05) of genetic diversity within the individual AEZs. There was a weak positive correlation (r = 0.1241,p = 0.045) between genetic distance and geographic distance amongA. flavuspopulations in the LKB, suggesting that genetic differentiation in the LKB population might be associated to geographic distance. A very weak positive correlation existed between genetic variation and geographic location in the entire study area (r = 0.01,p = 0.471), LVB farming system (r = 0.0141,p = 0.412) and WN farming system (r = 0.02,p = 0.478). Hierarchical clustering using the unweighted pair group method with arithmetic means (UPGMA) revealed two main clusters of genetically similarA. flavusisolates.ConclusionsThese findings provide evidence that genetic differentiation inA. flavuspopulations is independent of geographic distance. This information can be valuable in the development of a suitable biocontrol management strategy of aflatoxin-producingA. flavus.
The cumulative duration of bispectral index less than 40 concurrent with hypotension is associated with 90-day postoperative mortality: a retrospective study
Authors: Yoon Soohyuk , Yoo Seokha , Hur Min , Park Sun-Kyung , Lee Hyung-Chul , Jung Chul-Woo , Bahk Jae-Hyon , Kim Jin-Tae 
Published: August 2020

Abstract
Background
The relationship between intraoperative low bispectral index (BIS) values and poor clinical outcomes has been controversial. Intraoperative hypotension is associated with postoperative complication. The purpose of this study was to investigate the influence of intraoperative low BIS values and hypotension on postoperative mortality in patients undergoing major abdominal surgery.

Methods
This retrospective study analyzed 1862 cases of general anesthesia. We collected the cumulative time of BIS values below 20 and 40 as well as electroencephalographic suppression and documented the incidences in which these states were maintained for at least 5 min. Durations of intraoperative mean arterial pressures (MAP) less than 50 mmHg were also recorded. Multivariable logistic regression was used to evaluate the association between suspected risk factors and postoperative mortality.

Results
Ninety-day mortality and 180-day mortality were 1.5 and 3.2% respectively. The cumulative time in minutes for BIS values falling below 40 coupled with MAP falling below 50 mmHg was associated with 90-day mortality (odds ratio, 1.26; 95% confidence interval, 1.04–1.53; P = .019). We found no association between BIS related values and 180-day mortality.

Conclusions
The cumulative duration of BIS values less than 40 concurrent with MAP less than 50 mmHg was associated with 90-day postoperative mortality, not 180-day postoperative mortality.
Identifying Phenogroups in patients with subclinical diastolic dysfunction using unsupervised statistical learning
Authors: Kaptein Yvonne E. , Karagodin Ilya , Zuo Hongquan , Lu Yu , Zhang Jun , Kaptein John S. , Strande Jennifer L. 
Published: August 2020

Abstract
Background
Subclinical diastolic dysfunction is a precursor for developing heart failure with preserved ejection fraction (HFpEF); yet not all patients progress to HFpEF. Our objective was to evaluate clinical and echocardiographic variables to identify patients who develop HFpEF.

Methods
Clinical, laboratory, and echocardiographic data were retrospectively collected for 81 patients without HF and 81 matched patients with HFpEF at the time of first documentation of subclinical diastolic dysfunction. Density-based clustering or hierarchical clustering to group patients was based on 65 total variables including 19 categorical and 46 numerical variables. Logistic regression analysis was conducted on the entire study population as well as each individual cluster to identify independent predictors of HFpEF.

Results
Unsupervised clustering identified 3 subgroups which differed in gender composition, severity of cardiac hypertrophy and aortic stenosis, NT-proBNP, percentage of patients who progressed to HFpEF, and timing of disease progression from diastolic dysfunction to HFpEF to death. Clusters that had higher percentages of women had progressively milder cardiac hypertrophy, less severe aortic stenosis, lower NT-proBNP, were diagnosed at an older age with HFpEF, and survived to an older age. Independent predictors of HFpEF for the entire cohort included diabetes, chronic kidney disease, atrial fibrillation, and diuretic use, with additional predictive variables found for each cluster.

Conclusions
Cluster analysis can identify phenotypically distinct subgroups of patients with diastolic dysfunction. Clusters differ in HFpEF and mortality outcome. In addition, the variables that correlate with and predict HFpEF outcome differ among clusters.
Discontinuation of aspirin before non-cardiac surgery causing ventricular mural thrombus for a patient with left ventricular aneurysm: a case report
Authors: Huang Linger , Wang Kaili , Zhu Shaojun , Wang Kuirong , Zhou Yanfeng 
Published: August 2020

Abstract
Background
Left ventricular mural thrombus (LVMT) is a life-threatening complication in patients with left ventricular dysfunction.

Case presentation
A 67-year-old man had a history of penetrating myocardial infarction and left ventricular aneurysm (LVA). The patient was scheduled for a non-cardiac surgery and stopped aspirin for 10 days to reduce the risk of bleeding. Fresh LVMT was revealed via the transesophageal echocardiography (TEE) after the preoperative discontinuation of aspirin.

Conclusions
Perioperative repeated evaluation for the thrombosis by echocardiography is essential in cases of patients with cardiovascular disease undergoing non-cardiac surgery. In high risk patient, during temporary interruption of antiplatelets, bridging with perioperative low-molecular-weight heparin is advisable.
Early L-T4 intervention improves fetal heart development in pregnant rats with subclinical hypothyroidism rats by activating BMP4/Smad4 signaling pathway
Authors: Xue D. , Sun J. L. , Yang J. 
Published: August 2020

Abstract
Background
It is unclear whether the offspring of subclinical hypothyroidism (SCH) pregnant rats still have abnormal cardiac development, and whether early intervention with L-T4 can improve the abnormality of these offspring. Therefore, the aim of this study was to investigate the effect of early L-T4 intervention on the heart development of offspring of SCH pregnant rats and its possible molecular mechanism.

Methods
Eighty female Wistar rats were randomly divided into Sham group (placebo control), SCH group, LT4-E10 group (L-T4 treatment started on the 10th day of gestation), and LT4-E13 group (L-T4 treatment started on the 13th day of gestation). Each group was further divided into E16 (16th day of gestation), E18 (18th day of gestation), P5 (5th day postnatal day), and P10 (10th day postnatal day) subgroups. The levels of serum TT4 and TSH, the ratio of heart weight to body weight of offspring rats, the expression of metabolic enzymes, and the histopathology of cardiomyocytes were determined. To elucidate the effects of L-T4 on cardiac development of offspring of SCH pregnant rats, the expression levels of GATA4, Nkx2–5 and proteins involved in BMP4/Smad4 signaling pathway were detected by immunohistochemistry, real time quantitative polymerase chain reaction and Western blotting to elucidate the molecular mechanism of L-T4 regulating the heart development of the offspring of SCH pregnant rats.

Results
Compared with Sham group, serum TSH was significantly increased in SCH pregnant rats. Moreover, early L-T4 intervention significantly reduced the levels of serum TSH. Compared with the offspring in the SCH group, early L-T4 intervention significantly increased the heart weight, heart weight to body weight ratio, the activities of succinate dehydrogenase (SDH), Na+/K+-ATPase and Ca2+-ATPase, but reduced myocardial cell shrinkage and nuclear staining, hyperemia/congestion and vacuolar degeneration. In addition, early L-T4 intervention not only significantly increased the mRNA and protein expression of Gata4 and Nkx2–5, but also increased the protein expression involved in BMP4/Smad4 signal pathway in myocardium of the offspring of SCH pregnant rats.

Conclusions
Early L-T4 intervention can regulate the cardiac development of the offspring of SCH pregnant rats by activating BMP4/Smad4 signaling pathway and increasing the expression of Gata4 and Nkx2–5 proteins.
The effect of problem-based learning after coronary heart disease – a randomised study in primary health care (COR-PRIM)
Authors: Köhler Anita Kärner , Jaarsma Tiny , Tingström Pia , Nilsson Staffan 
Published: August 2020

AbstractBackgroundCardiac rehabilitation is effective after coronary heart disease (CHD). However, risk factors remain, and patients report fear for recurrence during recovery. Problem-based learning is a pedagogical method, where patients work self-directed in small groups with problem solving of real-life situations to manage CHD risk factors and self-care. We aimed to demonstrate the better effectiveness of problem-based learning over home-sent patient information for evaluating long-term effects of patient empowerment and self-care in patients with CHD. Hypothesis tested: One year of problem-based learning improves patients’ empowerment- and self-efficacy, to change self-care compared to 1 year of standardised home-sent patient information after CHD.MethodsPatients (N = 157) from rural and urban areas in Sweden between 2011 and 2015 (78% male; age.68 ± 8.5 years) with CHD verified by percutaneous coronary intervention (PCI) (70.1%) or coronary artery by-pass surgery (CABG) and CABG+PCI or myocardial infarction (29.9%) were randomly assigned to problem-based learning (experimental group;n = 79) or home-sent patient information (controls;n = 78). The problem-based learning intervention consisted of patient education in primary care by nurses tutoring groups of 6–9 patients on 13 occasions over 1 year. Controls received home-sent patient information on 11 occasions during the study year.ResultsAt one-year follow-up, the primary outcome, patient empowerment, did not significantly differ between the experimental group and controls. We found no significant differences between the groups regarding the secondary outcomes e.g. self-efficacy, although we found significant differences for body mass index (BMI) [− 0.17 (SD 1.5) vs. 0.50 (SD 1.6),P = 0.033], body weight [− 0.83 (SD) 4.45 vs. 1.14 kg (SD 4.85),P = 0.026] and HDL cholesterol [0.1 (SD 0.7) vs. 0.0 mmol/L (SD 0.3),P = 0.038] favouring the experimental group compared to controls.ConclusionsThe problem-based learning- and the home-sent patient information interventions had similar results regarding patient empowerment, self-efficacy, and well-being. However, problem-based learning exhibited significant effects on weight loss, BMI, and HDL cholesterol levels, indicating that this intervention positively affected risk factors compared to the home-sent patient information.Trial registrationNCT01462799 (February 2020).