bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving the Resident Educational Experience in a Level IV Neonatal/Infant Intensive Care Unit
Authors: Handley Sara C. , Pouppirt Nicole , Zucker Eric , Coughlin Katherine A. , Ades Anne 
Published: October 2020

Introduction:
The neonatal/infant intensive care unit (N/IICU) at the Children’s Hospital of Philadelphia is a 98-bed, level IV unit through which second-year pediatric residents rotate monthly. We developed a quality improvement project to improve the resident educational experience using goal setting. Primary objectives were to increase resident educational goal identification to 65% and goal achievement to 85% by June 2017. Secondary objectives were to (1) increase in-person feedback from fellows and/or attendings to 90% by June 2017 and (2) sustain improvements through June 2018.

Methods:
The quality improvement team developed a driver diagram and administered a baseline survey to 48 residents who had rotated through the N/IICU in the 18 months before the project. Plan-Do-Study-Act cycles targeted project awareness and trialing of 3 different methods to elicit goals and track feedback, from July 2016 through June 2018.

Results:
The baseline survey response rate was 52% (n = 25). Among 60 rotating residents, the median resident-reported rate of goal achievement increased from 37.5% to 50%, and residents receiving in-person feedback increased from 25% to 50%. Of the 63% (n = 38) of residents who participated in data collection, goal identification and achievement increased from 38% to 100% between academic year 2016 and academic year 2017, and in-person feedback increased from 24% to 82%.

Conclusions:
Instituting a goal-setting framework for residents during their N/IICU rotation increased goal achievement and in-person feedback. Consistent resident participation in postrotation data collection made measuring project outcomes challenging. These data support goal-oriented learning as an approach to enhance learner engagement and improve goal achievement.
Long-term Effects of an Evidence-based Guideline for Emergency Management of Pediatric Syncope
Authors: Shanahan Kristen H. , Monuteaux Michael C. , Brunson Dalton , Guse Sabrina E. , Alexander Mark E. , Porter John J. , Neuman Mark I. , Fine Andrew M. 
Published: October 2020

Introduction:
Variability exists in the management of childhood syncope as clinicians balance resource utilization with the need to identify serious diseases. Limited evidence exists regarding the long-term impact of evidence-based guidelines (EBGs) on clinical practices. This study’s objective was to measure long-term changes in the management of syncope after implementing a syncope EBG in a single pediatric emergency department following the redistribution of resources to facilitate compliance over time.

Methods:
We included healthy patients aged 8–22 years, presenting to the pediatric emergency department with syncope between 2009 and 2017. Interrupted time series analysis compared testing rates and length of stay among the pre-EBG, short-term follow-up, and long-term follow-up periods.

Results:
The study included 1,294 subjects. From the pre-EBG period to the long-term follow-up period, recommended electrocardiogram and urine pregnancy test rose significantly [level change odds ratio (95% confidence interval) 5.56 (1.73–17.91) and 3.15 (1.07–9.32), respectively]. Testing and management not recommended by the EBG decreased significantly, including complete blood count, electrolytes, point-of-care glucose, chest radiograph, and intravenous fluids [level change odds ratio (95% confidence interval) 0.19 (0.09–0.40), 0.15 (0.07–0.32), 0.38 (0.18–0.81), 0.17 (0.06–0.49), and 0.18 (0.08–0.39), respectively]. Length of stay declined significantly. No delayed diagnoses occurred.

Conclusions:
Sustained improvements in syncope management persisted during long-term follow-up of the EBG despite minimal resources. The EBG was associated with increased focused evaluation and decreased low yield testing. EBGs may be useful tools to influence sustained clinical practices to promote safe, cost-effective, and high-quality care.
Mathematical Model Impact Analysis of a Real-Life Pre-exposure Prophylaxis and Treatment-As-Prevention Study Among Female Sex Workers in Cotonou, Benin
Authors: Geidelberg Lily , Mitchell Kate M. , Alary Michel , Mboup Aminata , Béhanzin Luc , Guédou Fernand , Geraldo Nassirou , Goma-Matsétsé Ella , Giguère Katia , Aza-Gnandji Marlène , Kessou Léon , Diallo Mamadou , Kêkê René K. , Bachabi Moussa , Dramane Kania , Lafrance Christian , Affolabi Dissou , Diabaté Souleymane , Gagnon Marie-Pierre , Zannou Djimon M. , Gangbo Flore , Silhol Romain , Cianci Fiona , Vickerman Peter , Boily Marie-Claude 
Published: October 2020

Background:
Daily pre-exposure prophylaxis (PrEP) and treatment-as-prevention (TasP) reduce HIV acquisition and transmission risk, respectively. A demonstration study (2015–2017) assessed TasP and PrEP feasibility among female sex workers (FSW) in Cotonou, Benin.

Setting:
Cotonou, Benin.

Methods:
We developed a compartmental HIV transmission model featuring PrEP and antiretroviral therapy (ART) among the high-risk (FSW and clients) and low-risk populations, calibrated to historical epidemiological and demonstration study data, reflecting observed lower PrEP uptake, adherence and retention compared with TasP. We estimated the population-level impact of the 2-year study and several 20-year intervention scenarios, varying coverage and adherence independently and together. We report the percentage [median, 2.5th–97.5th percentile uncertainty interval (95% UI)] of HIV infections prevented comparing the intervention and counterfactual (2017 coverages: 0% PrEP and 49% ART) scenarios.

Results:
The 2-year study (2017 coverages: 9% PrEP and 83% ART) prevented an estimated 8% (95% UI 6–12) and 6% (3–10) infections among FSW over 2 and 20 years, respectively, compared with 7% (3–11) and 5% (2–9) overall. The PrEP and TasP arms prevented 0.4% (0.2–0.8) and 4.6% (2.2–8.7) infections overall over 20 years, respectively. Twenty-year PrEP and TasP scale-ups (2035 coverages: 47% PrEP and 88% ART) prevented 21% (17–26) and 17% (10–27) infections among FSW, respectively, and 5% (3–10) and 17% (10–27) overall. Compared with TasP scale-up alone, PrEP and TasP combined scale-up prevented 1.9× and 1.2× more infections among FSW and overall, respectively.

Conclusions:
The demonstration study impact was modest, and mostly from TasP. Increasing PrEP adherence and coverage improves impact substantially among FSW, but little overall. We recommend TasP in prevention packages.
Computed tomography-derived body composition analysis in patients with advanced cancer: clinical utility and future research
Authors: Abbass Tanvir , Dolan Ross D. , McMillan Donald C. 
Published: October 2020

Purpose of review
With weight loss increasingly occurring against a background of obesity across a variety of advanced cancers, there has been increasing interest in computed tomography (CT)-derived body composition analysis. Various imaging software packages and thresholds are commonly in use in CT-derived body composition analysis. This review discusses the current research in field of body composition with emphasis on the information required for such measurements to be taken into routine clinical practice.

Recent findings
CT is widely used for tumour staging in patients with cancer. Over the last decade, this imaging modality has been exploited to make measurements of body composition. Using a common landmark (L3) several different thresholds have been developed to stratify adipose and muscle tissue areas according to age, sex and BMI and their relationship with survival. A significant relationship between CT-derived body composition and clinical outcomes has been shown in different tumour types and geographical locations. However, there is considerable variation with methods, thresholds and muscle groups used for analysis. Therefore, there would appear to be a need to develop reliable methodology and population-specific reference ranges to guide clinical interpretation and enable routine clinical use.

Summary
There has been an explosion of clinical research interest in CT-derived body composition analysis. Such body composition analysis provides important host phenotype information which has prognostic value. For CT-derived body composition to be fit for use in routine clinical practice, there is need for universally accepted terminology, software, muscle group selection, prognostic thresholds to standardize such body composition analysis.
Barriers to Care Affecting Presentation to Urogynecologists in a Community Setting
Authors: Smith Fiona K. , Agu Ijeoma , Murarka Shivani , Siddiqui Gazala , Orejuela Francisco J. , Muir Tristi W. , Antosh Danielle D. 
Published: October 2020

Objective
To evaluate barriers to care for patients presenting to urogynecologists and determine how these barriers differ in private and public/county health care settings.

Methods
Standardized anonymous questionnaires were distributed from May 2018 to July 2018 to new patients presenting to a urogynecologist at three institutions: two private health care clinics (sites A and B) and one public/county hospital clinic (site C). Patients identified symptom duration, symptom severity, and factors inhibiting presentation to care from a list of barriers. Patients then identified the primary barrier to care.

Results
One hundred nine questionnaires were distributed, and 88 were submitted, resulting in an 81% response rate (31 from site A, 30 from site B, 27 from site C). In analysis of the private versus public setting, there was no statistical difference between age (58 years vs 57 years, P = 0.69), body mass index (28 vs 30, P = 0.301), symptom duration (24 months vs 16 months, P = 0.28), or severity respectively. When asked to identify the primary barrier to presentation, patients in the private setting stated they did not know to see a specialist (26.2%, P = 0.002), while patients in the public setting could not obtain a closer appointment time (22.2% vs 13.1%, P = 0.35. Additionally, patients in the public setting were more likely to cite lack of health care coverage as a barrier to care (18.5% vs 1.6%, P = 0.01).

Conclusion
This study highlights barriers that can contribute to the disparity of care seen in our patient population. Efforts should be made to acknowledge and mitigate hindrances impacting access to care.
Polycarbonate Urethane Mesh: A New Material for Pelvic Reconstruction
Authors: Bickhaus Jennifer A. , Fraser Matthew O. , Weidner Alison C. , Jayes Friederike L. , Amundsen Cindy L. , Gall Ken , Miller Andrew T. , Marini Frank C. , Robboy Stanley J. , Siddiqui Nazema Y. 
Published: October 2020

Objective
Polycarbonate urethane (PCU) is a new biomaterial, and its mechanical properties can be tailored to match that of vaginal tissue. We aimed to determine whether vaginal host immune and extracellular matrix responses differ after PCU versus lightweight polypropylene (PP) mesh implantation.

Methods
Hysterectomy and ovariectomy were performed on 24 Sprague-Dawley rats. Animals were divided into 3 groups: (1) PCU vaginal mesh, (2) PP vaginal mesh, and (3) sham controls. Vagina-mesh complexes or vaginas (controls) were excised 90 days after surgery. We quantified responses by comparing: (1) histomorphologic scoring of hematoxylin and eosin– and Masson trichrome–stained slides, (2) macrophage subsets (immunolabeling), (3) pro-inflammatory and anti-inflammatory cytokines (Luminex panel), (4) matrix metalloproteinase (MMP)-2 and -9 using an enzyme-linked immunosorbent assay, and (5) type I/III collagen using picrosirius red staining.

Results
There was no difference in histomorphologic score between PCU and PP (P = 0.211). Although the histomorphologic response was low surrounding all mesh fibers, groups with PCU and PP mesh had a higher histomorphologic score than the control group (P < 0.005 and P < 0.002, respectively). There were no differences between groups in terms of macrophage subsets, pro-inflammatory cytokines, anti-inflammatory cytokines, MMP-2 and MMP-9, or collagen ratio.

Conclusions
Polycarbonate urethane, an elastomer with material properties similar to those of vaginal tissue, elicits minimal host inflammatory responses in a rat model. Because its implantation does not elicit more inflammation than currently used lightweight PP, using PCU for prolapse mesh warrants further investigation with larger animal models.
The Association of Preoperative Medication Administration and Preoperative and Intraoperative Factors With Postoperative Urinary Retention After Urogynecologic Surgery
Authors: Schmidt Payton , Kobernik Emily K. , Fairchild Pamela S. , Anderson Alec , Lanham Michael , Berger Mitchell B. 
Published: October 2020

Objectives
The aim of this study was to determine if preoperative medication administration is associated with postoperative urinary retention (PUR) after urogynecologic procedures and identify preoperative and intraoperative factors that are predictive of PUR.

Methods
A retrospective review of patients who underwent prolapse and/or incontinence surgery was performed. The primary outcome was PUR, defined as postoperative retrograde void trial with postvoid residuals of greater than 100 mL. Bivariate analysis was performed to compare demographics and preoperative and intraoperative characteristics of women with and without PUR, and multivariable logistic regression modeling was used to identify independent predictors of PUR.

Results
Of women in this cohort, 44.8% (364/813) had PUR. There were no significant differences in preoperative medication administration in women with and without PUR. Age older than 60 years (adjusted odds ratio [aOR], 1.48; 95% confidence interval [CI], 1.09–2.02), combined prolapse and incontinence surgery (aOR, 1.84; 95% CI, 1.29–2.62), vaginal hysterectomy (aOR, 1.66; 95% CI, 1.66–2.38), and procedure time (aOR, 1.01; 95% CI, 1.00–1.01) were associated with increased odds of PUR, whereas laparoscopic sacrocolpopexy was associated with lower odds (aOR, 0.22; 95% CI, 0.10–0.46).

Discussion
Although preoperative medication administration was not associated with PUR, other clinically important variables were age older than 60 years, vaginal hysterectomy, incontinence and prolapse surgery, or longer procedure time. Sacrocolpopexy reduced the odds of PUR by approximately 80%. These factors may be useful in preoperative and postoperative counseling regarding PUR after urogynecologic surgery.
Correlation Between Hypertrophic Cervical Elongation and Pelvic Organ Prolapse
Authors: Yang Zhiqi , Xia Zhijun , Cheng Yue 
Published: October 2020

Objectives
The association between hypertrophic cervical elongation and pelvic organ prolapse (POP) has been observed, but causation has not been determined. This study assessed the relationship of POP with hypertrophic cervical elongation according to menopausal status and the pelvic compartment involved in prolapse.

Methods
This retrospective single-center case-control study was conducted at Shengjing Hospital of China Medical University between January 2017 and May 2019. Transverse and anteroposterior diameter of the cervix and cervical length were obtained by manual intravaginal measurement for 508 patients with POP and 510 patients without POP. Data were analyzed based on POP compartment and menopausal status.

Results
In the premenopausal group, there was a statistically significant difference in the proportion of patients with hypertrophic cervical elongation in the non-POP and POP groups (P < 0.05); However, among postmenopausal patients, there was no statistical significance between these groups (P > 0.05). Patients with apical compartment POP had a higher proportion of occurrence of hypertrophic cervical elongation than those with nonapical compartment POP (P < 0.05).

Conclusions
Hypertrophic cervical elongation in premenopausal patients is significantly associated with POP; in particular, there is a significant correlation between apical compartment POP and hypertrophic cervical elongation.
Ocular Motor and Vestibular Characteristics of Antiglutamic Acid Decarboxylase–Associated Neurologic Disorders
Authors: Wang Yujie , Tourkevich Roksolyana , Bosley Justin , Gold Daniel R. , Newsome Scott D. 
Published: October 2020

Background:
Antiglutamic acid decarboxylase (GAD)-associated neurologic disorders are rare, with varied presentations, including stiff-person syndrome (SPS) and cerebellar ataxia (CA). Vestibular and ocular motor (VOM) dysfunction can be the main presentation in a subset of patients.

Methods:
Retrospective review of the Johns Hopkins Hospital medical records from 1997 to 2018 identified a total of 22 patients with a diagnosis of anti-GAD–associated SPS or CA who had detailed VOM assessments. Eight had prominent VOM dysfunction at the initial symptom onset and were referred to neurology from ophthalmology or otolaryngology (“early dominant”). Fourteen patients had VOM dysfunction that was not their dominant presentation and were referred later in their disease course from neurology to neuro-ophthalmology (“nondominant”). We reviewed clinical history, immunological profiles, and VOM findings, including available video-oculography.

Results:
In the 8 patients with early dominant VOM dysfunction, the average age of symptom onset was 53 years, and 5 were men. The most common symptom was dizziness, followed by diplopia. Seven had features of CA, and 4 had additional features of SPS. None had a structural lesion on brain MRI accounting for their symptoms. The most common VOM abnormalities were downbeating and gaze-evoked nystagmus and saccadic pursuit. All received immune therapy and most received symptomatic therapy. Most experienced improvement in clinical outcome measures (modified Rankin scale and/or timed 25-foot walk test) or VOM function. By contrast, in the 14 patients in whom VOM dysfunction was nondominant, most had an SPS phenotype and were women. VOM abnormalities, when present, were more subtle, although mostly still consistent with cerebellar and/or brainstem dysfunction.

Conclusions:
Individuals with anti-GAD–associated neurologic disorders may present with prominent VOM abnormalities at the initial symptom onset that localize to the cerebellum and/or brainstem. In our cohort, immune and symptomatic therapies improved clinical outcomes and symptomatology.
Common and rare variants in HFE are not associated with Parkinson’s disease in Europeans
Authors: Saini Prabhjyot , Bandres-Ciga Sara , Alcantud Jose Luis , Ruz Clara , Gan-Or Ziv ,   for the International Parkinson’s disease Genomics Consortium
Published: October 2020

AbstractA recent study suggested that the p.H63D variant in HFE, a gene involved in iron homeostasis, may modify α-synuclein pathology, the pathological hallmark of Parkinson’s disease (PD). If indeed this gene and specific variant are involved in PD, we expect to find differential distribution of HFE variants when comparing PD patients and controls. We analyzed genome-wide association study (GWAS) data from 14,671 PD patients and 17,667 controls and full sequencing data from additional 1,647 PD patients and 1,050 controls, using logistic regression models, and burden and Kernel tests. The HFE p.H63D variant was not associated with PD, nor did all the other common variants in the HFE locus. We did not find association of rare HFE variants with PD as well in all types of burden and Kernel tests. Our results do not support a role for HFE in PD.
Severity of COVID-19 at elevated exposure to perfluorinated alkylates
Authors: Grandjean P , Timmermann C.A.G. , Kruse M. , Nielsen F. , Vinholt P. Just , Boding L. , Heilmann C. , Mølbak K. 
Published: October 2020

AbstractBackgroundThe course of coronavirus disease 2019 (COVID-19) seems to be aggravated by air pollution, and some industrial chemicals, such as the perfluorinated alkylate substances (PFASs), are immunotoxic and may contribute as well.MethodsFrom Danish biobanks, we obtained plasma samples from 323 subjects aged 30-70 years with known SARS-CoV-2 infection. The PFAS concentrations measured at the background exposures included five PFASs known to be immunotoxic. Register data was obtained to classify disease status, other health information, and demographic variables. We used ordinal and ordered logistic regression analyses to determine associations between PFAS concentrations and disease outcome.ResultsPlasma-PFAS concentrations were higher in males, in subjects with Western European background, and tended to increase with age, but were not associated with the presence of chronic disease. Of the study population, 108 (33%) had not been hospitalized, and of those hospitalized, 53 (16%) had been in intensive care or were deceased. Among the five PFASs considered, perfluorobutanoic acid (PFBA) showed an odds ratio (OR) of 2.19 (95% confidence interval, CI, 1.39-3.46) for increasing severities of the disease, although the OR decreased to 1.77 (95% CI, 1.09, 2.87) after adjustment for age, sex, sampling site and interval between blood sampling and diagnosis.ConclusionsMeasures of individual exposures to immunotoxic PFASs included PFBA that accumulates in the lungs. Elevated plasma-PFBA concentrations were associated with an increased risk of more severe course of CIVID-19. Given the low background exposure levels in this study, the role of PFAS exposure in COVID-19 needs to be ascertained in populations with elevated exposures.
Drinking and smoking polygenic risk is associated with neurodevelopmental outcomes of children and young adults independently of psychopathology and substance use
Authors: De Angelis Flavio , Wendt Frank R. , Pathak Gita A. , Tylee Daniel S. , Goswami Aranyak , Gelernter Joel , Polimanti Renato 
Published: October 2020

AbstractBackgroundAlcohol drinking and tobacco smoking are hazardous behaviors associated with a wide range of adverse health outcomes, including many mental and physical disorders.MethodsTo investigate the pleiotropic mechanisms linking these traits to cognitive and behavioral development, we explored the association of polygenic risk scores (PRS) related to drinks per week (DPW), age of smoking initiation (ASI), smoking initiation (SI), cigarettes per day (CPD), and smoking cessation (SC) with 433 neurodevelopmental features in 4,498 children and young adults of European ancestry from the Philadelphia neurodevelopmental cohort (PNC). This sample was not enriched for specific psychiatric traits, but 21% of the PNC participants endorsed substance use.ResultsAfter applying a false discovery rate multiple testing correction accounting for the number of PRS and traits tested, we identified 36 associations related to psychotic symptoms, emotion and age recognition social competencies, verbal reasoning, anxiety-related traits, parents’ education, and substance use. These associations were independent of the genetic correlations among the alcohol-drinking and tobacco-smoking traits and those with cognitive performance, educational attainment, risk-taking behaviors, and psychopathology. The removal of participants endorsing substance use did not affect the associations of each PRS with neurodevelopmental traits identified as significant in the discovery analyses. Gene-ontology enrichment analyses identified several neurobiological processes underlying mechanisms of the PRS associations we report. These were mainly related to brain connectivity.ConclusionsWe provide novel insights into the genetic overlap of smoking and drinking behaviors with neurodevelopment in children and young adults, highlighting their independence from psychopathology and other substance use.