bluuebunny/crossref_metadata_2025_split huggingface dataset:
Estimating the Cost of Point-of-Care Early Infant Diagnosis in a Program Setting: A Case Study Using Abbott m-PIMA and Cepheid GeneXpert IV in Zimbabwe
Authors: Mukherjee Sushant , Cohn Jennifer , Ciaranello Andrea L. , Sacks Emma , Adetunji Oluwarantimi , Chadambuka Addmore , Mafaune Haurovi , Makayi McMillan , McCann Nicole , Turunga Esther 
Published: June 2020

Background:
Point-of-care early infant diagnosis (POC EID) increases access to HIV test results and shortens time to result-return and antiretroviral therapy initiation, as compared to central laboratory-based EID. However, to scale-up POC EID, governments need more information about programmatic costs.

Methods:
We evaluated POC EID costs from a health systems perspective. Our primary analysis assessed the Abbott m-PIMA and 2 versions of the Cepheid GeneXpert IV platforms—with a solar battery or gel battery—used in Zimbabwe, with instrument purchase. We also included the following 2 scenarios with zero upfront equipment purchase: (1) m-PIMA using a reagent rental model, with an all-inclusive price when the buyer commits to an average testing volume, and (2) GeneXpert IV, reflecting contexts where GeneXpert is already in place for tuberculosis diagnosis or HIV viral load monitoring. We collected data from project expenditures, observations of health workers, and from government salary scales. We calculated cost per EID test based on number of EID tests performed on each machine per day.

Results:
The cost per successfully completed test was $44.55 for m-PIMA with platform purchase and $25.89 for m-PIMA reagent rental. Costs for GeneXpert IV with platform purchase were $25.70 using a solar battery, $25.29 using a gel battery, and $23.85 under a scenario assuming no equipment costs. In our primary analyses, materials costs comprised 73%–74% total costs, equipment 14%–20%, labor 5%–8%, training 1%, facility upgrades 1%, and monitoring 1%.

Conclusions:
As countries consider scaling up POC EID, these data are important for budgeting and planning.
Quiet FLAIR at 7T MRI
Authors: Rösch Julie , Mennecke Angelika , Knott Michael , Doerfler Arnd , Grodzki David M. 
Published: June 2020

Objective
The aim of this study was to investigate acoustic noise reduction and image quality of cranial magnetic resonance imaging (MRI) at 7T MRI with and without sequence-based acoustic noise reduction.

Materials and Methods
Fifteen patients and 5 healthy volunteers underwent 7T MRI scanning. A fluid-attenuated inversion recovery (FLAIR) sequence was acquired with and without sequence-based acoustic noise reduction. The acoustic noise generated by each sequence was measured. Quantitative and qualitative assessments regarding signal-to-noise ratio, contrast-to-noise ratio, lesion conspicuity, level of artifacts, and overall image quality were performed. Furthermore, detection rates of white matter lesions were evaluated by 2 observers for both sequences.

Results
Acoustic noise was significantly reduced from initially 92.7 dB(A) to 78.9 dB(A), corresponding to an 80% reduction in sound pressure. The visual assessment revealed no significant difference in the level of artifacts. Although rated very high by both readers, lesion conspicuity and image quality averaged better for the regular FLAIR sequence. Signal-to-noise ratio and contrast-to-noise ratio slightly decreased when applying the sequence-based acoustic noise reduction. No significant difference was found between the detection rates of white matter lesions for both observers.

Conclusions
Reducing sound pressure by 80% in FLAIR imaging at 7T ultra-high-field MRI is feasible while maintaining high diagnostic image quality.
Microsurgical Replantation of Completely Avulsed Scalp Segment Recovered From Under Snow
Authors: Akyurek Mustafa , Lujan-Hernandez Jorge 
Published: June 2020

Abstract
Complete scalp avulsion is a devastating injury resulting in permanent disfigurement. Replantation is the procedure of choice whenever possible. This report describes a successful case of microsurgical reattachment of complete scalp avulsion of temporoparietal segment in a 72-year-old female patient after her hair was tangled in the hoof crack of a horse when the animal slipped on ice and fell on a cold New England night. The amputated segment could be recovered from under snow only after 4 hours following the incident. The procedure involved microvascular anastomoses of superficial temporal artery and vein. The recovery was uneventful, with complete survival of the replant, including the severely crushed segment. There was no need for any transfusion. Long term follow up revealed excellent aesthetic outcome with complete hair growth. This report presents a case experience of successful scalp replantation even after the amputated part was exposed to freezing conditions for 4 hours.
Outcomes and Health Care Utilization After Early Hospital Dismissal in Kidney Transplantation
Authors: Calderon Esteban , Chang Yu-Hui , Chang James M. , Velazco Cristine S. , Giorgakis Emmanouil , Srinivasan Ananth , Moss Adyr A. , Khamash Hasan , Heilman Raymond , Reddy Kunam S. , Mathur Amit K. 
Published: June 2020

Objective:
To understand whether reduced lengths of stay after kidney transplantation were associated with excess health care utilization in the first 90 days or long-term graft and patient survival outcomes.

Background:
Reducing length of stay after kidney transplant has an unknown effect on post-transplant health care utilization. We studied this association in a cohort of 1001 consecutive kidney transplants.

Methods:
We retrospectively reviewed 2011–2015 data from a prospectively-maintained kidney transplant database from a single center.

Results:
A total of 1001 patients underwent kidney transplant, and were dismissed from the hospital in 3 groups: Early [≤2 days] (19.8%), Normal [3–7 days] (79.4%) and Late [>7 days] (3.8%). 34.8% of patients had living donor transplants (Early 51%, Normal 31.4%, Late 18.4%, P < 0.001). Early patients had lower delayed graft function rates (Early 19.2%, Normal 32%, Late73.7%, P = 0.001). By the hospital dismissal group, there were no differences in readmissions or emergency room visits at 30 or 90 days. Glomerular filtration rate at 12 months and rates of biopsy-proven acute rejection were also similar between groups. The timing of hospital dismissal was not associated with the risk-adjusted likelihood of readmission. Early and Normal patients had similar graft and patient survival. Late dismissal patients, who had higher rates of cardiovascular complications, had significantly higher late mortality versus Normal dismissal patients in unadjusted and risk-adjusted models.

Conclusion:
Dismissing patients from the hospital 2 days after kidney transplant is safe, feasible, and improves value. It is not associated with excess health care utilization or worse short or long-term transplant outcomes.
Radiologic predictors of in-hospital mortality after traumatic craniocervical dissociation
Authors: Schellenberg Morgan , Anderson Geoffrey A. , Owattanapanich Natthida , Cheng Vincent , Lam Lydia , Demetriades Demetrios , Inaba Kenji , Myers Lee 
Published: June 2020

BACKGROUND
Traumatic craniocervical dissociation (CCD) is the forcible dislocation of the skull from the vertebral column. Because most CCD patients die on scene, prognostication for those who arrive alive to hospital is challenging. The study objective was to determine if greater dissociation, based on radiologic measurements of CCD, is predictive of in-hospital mortality among patients surviving to the emergency department.

METHODS
All trauma patients arriving to our Level 1 trauma center (January 2008 to April 2019) with CCD were retrospectively identified and included. Transfers and patients without computed tomography head/cervical spine were excluded. Study patients were dichotomized into groups based on in-hospital mortality. Radiologic measurements of degree of CCD were performed based on the index computed tomography scan by an attending radiologist with Emergency Radiology fellowship training. Measurements were compared between patients who died in-hospital versus those who survived.

RESULTS
After exclusions, 36 patients remained: 12 (33%) died and 24 (67%) survived. Median age was 55 years (30–67 years) versus 44 (20–61 years) (p = 0.199). Patients who died had higher Injury Severity Score (39 [31–71] vs. 27 [14–34], p = 0.019) and Abbreviated Injury Scale head/neck score (5 [5–5] vs. 4 [3–4], p = 0.001) than survivors. The only radiologic measurement that differed between groups was greater soft tissue edema at mid C1 among patients who died (12.37 [7.60–14.95] vs. 7.86 [5.25–11.61], p = 0.013). Receiver operating characteristic curve analysis of soft tissue edema at mid C1 and mortality revealed 10.86 mm or greater of soft tissue width predicted mortality with sensitivity and specificity of 0.75. All other radiologic parameters, including the basion-dens interval, were comparable between groups (p > 0.05).

CONCLUSION
Among patients who arrive alive to hospital after traumatic CCD, greater radiologic dissociation is not associated with increased mortality. However, increased soft tissue edema at the level of mid C1, particularly 10.86 mm or greater, is associated with in-hospital death. These findings improve our understanding of this highly lethal injury and impart the ability to better prognosticate for patients arriving alive to hospital with CCD.

LEVEL OF EVIDENCE
Prognostic and Epidemiological, Level III.
Early treatment with exosomes following traumatic brain injury and hemorrhagic shock in a swine model promotes transcriptional changes associated with neuroprotection
Authors: Williams Aaron M. , Higgins Gerald A. , Bhatti Umar F. , Biesterveld Ben E. , Dekker Simone E. , Kathawate Ranganath G. , Tian Yuzi , Wu Zhenyu , Kemp Michael T. , Wakam Glenn K. , Liu Baoling , Li Yongqing , Buller Benjamin , Alam Hasan B. 
Published: June 2020

BACKGROUND
We have shown that administration of mesenchymal stem cell–derived exosomes (single dose given within 1 hour) in models of traumatic brain injury (TBI) and hemorrhagic shock is neuroprotective. The precise mechanisms responsible for the neuroprotection are not fully understood. This study was designed to investigate the transcriptomic changes in the brain that are associated with this treatment strategy.

METHODS
Yorkshire swine (40–45 kg) were subjected to a severe TBI (12-mm cortical impact) and hemorrhagic shock (40% estimated total blood volume). One hour into shock, animals were randomized (n = 5/cohort) to receive either lactated Ringer's (LR; 5 mL) or exosomes suspended in LR (LR + EXO; 1 × 1013 exosome particles in 5 mL LR). Animals then underwent additional shock (1 hour) followed by normal saline resuscitation. After 6 hours of observation, brain swelling (% increase compared with the uninjured side) and lesion size (mm3) were assessed. Periinjured brain tissue was processed for RNA sequencing, analyzed with high through-put RNA sequencing data analysis, and results compared between control and experimental groups.

RESULTS
Exosome treatment significantly increased (p < 0.005) gene expression associated with neurogenesis, neuronal development, synaptogenesis, and neuroplasticity. It also significantly reduced (p < 0.005) genes associated with stroke, neuroinflammation, neuroepithelial cell proliferation, and nonneuronal cell proliferation contributing to reactive gliosis. Exosome treatment also significantly increased (p < 0.005) the genes that are associated with stability of blood-brain barrier.

CONCLUSIONS
Administration of a single dose of exosomes induces transcriptomic changes suggestive of neuroprotection. Their use as a treatment for TBI is promising and requires further investigation for human translation.
Dynamic effects of calcium on in vivo and ex vivo platelet behavior after trauma
Authors: Matthay Zachary A. , Fields Alexander T. , Nunez-Garcia Brenda , Patel Maya H. , Cohen Mitchell J. , Callcut Rachael A. , Kornblith Lucy Z. 
Published: June 2020

BACKGROUND
Mobilization of intra and extracellular calcium is required for platelet activation, aggregation, and degranulation. However, the importance of alterations in the calcium-platelet axis after injury is unknown. We hypothesized that in injured patients, in vivo initial calcium concentrations (pretransfusion) predict ex vivo platelet activation and aggregation, viscoelastic clot strength, and transfusion of blood products. We additionally hypothesized that increasing calcium concentrations ex vivo increases the expression of platelet activation surface receptors and platelet aggregation responses to agonist stimulation in healthy donor blood.

METHODS
Blood samples were collected from 538 trauma patients on arrival to the emergency department. Standard assays (including calcium), platelet aggregometry (PA) and thromboelastometry (ROTEM) were performed. In PA, platelet activation (prestimulation impedance [Ω]) and aggregation responses to agonist stimulation (area under the aggregation curve [AUC]) with adenosine diphosphate (ADP), thrombin receptor-activating peptide, arachidonic acid (AA), and collagen (COL) were measured. Multivariable regression tested the associations of calcium with PA, ROTEM, and transfusions. To further examine the calcium-platelet axis, calcium was titrated in healthy blood. Platelet aggregometry and ROTEM were performed, and expression of platelet glycoprotein IIb/IIIa and P-selectin was measured by flow cytometry.

RESULTS
The patients were moderately injured with normal calcium and platelet counts. Higher calcium on arrival (pretransfusion) was independently associated with increased platelet activation (prestimulation, Ω; p < 0.001), aggregation (ADP-stimulated, AUC; p = 0.002; thrombin receptor-activating peptide–stimulated, AUC; p = 0.038), and clot strength (ROTEM max clot firmness; p < 0.001), and inversely associated with 24-hour transfusions of blood, plasma, and platelets (all p < 0.005). Up-titrating calcium in healthy blood increased platelet activation (prestimulation, Ω; p < 0.001), aggregation (ADP, AA, COL-stimulated AUCs; p < 0.050), and expression of P-selectin (p = 0.003).

CONCLUSION
Initial calcium concentrations (pretransfusion) are independently associated with platelet activation, aggregation, clot-strength, and transfusions after injury. These changes may be mediated by calcium driven expression of surface receptors necessary for platelet activation and aggregation. However, the therapeutic benefit of early, empiric calcium repletion in trauma patients remains undefined.

LEVEL OF EVIDENCE
Prognostic, level V.
A clinical pharmacist-led integrated approach for evaluation of medication errors among medical intensive care unit patients
Authors: Aghili Mina , Neelathahalli Kasturirangan Meera 
Published: June 2020

ABSTRACT

Aim:
Medication errors jeopardize the safety of critically ill patients. Using only one method for the detection of medication errors may not reflect an existing picture of patient safety accurately. Therefore, we designed a clinical pharmacist-led integrated approach to evaluate incidence rate, type, and severity of medication errors and preventable adverse drug events (ADEs) and to assess the impact of the implementation of interventions recommended by the clinical pharmacist.

Methods:
A prospective study was conducted from November 2017 to January 2019 in the medical ICU. The clinical pharmacist performed a combination of medication error detection methods, which included medication chart review, patient monitoring until discharge/death, and attending medical rounds. Detected medication errors were intervened with prescribers. Based on the prescribers’ decision on delivered interventions, patients were divided into two groups: A (clinical pharmacist's interventions were implemented), and B (clinical pharmacist's interventions were not implemented). We compared patients’ outcomes obtained from study groups to evaluate the impact of the implementation of interventions performed by the clinical pharmacist.

Results:
A total of 271 medication errors (122.62 per 1000 patient hospital-days) were detected among the study patients (n = 228). Drug–drug interactions (70, 25.8%), guideline nonconformity (51, 18.8%), and inadequate drug monitoring (29, 11%) were the most common types of detected medication errors. Eighty-six percentage of the clinical pharmacist's interventions were implemented by prescribers. Approximately half of medication errors were intercepted before reaching to patients who received the clinical pharmacist's interventions (group A). Overall, medication errors induced 33 preventable ADEs (14.93 per 1000 patient hospital-days), of which the number of preventable ADEs was significantly greater in group B (P < 0.0001). Significantly in group B, detected medication errors initiated chains of consecutive errors when the clinical pharmacist's interventions were not accepted. Also, this group had significantly increased length of stay (P < 0.0001), number of deaths (P = 0.0312), and more than a three-fold greater number of patients intratransferring to higher levels of care (P = 0.0235; odds ratio, 3.41; 95% confidence interval, 1.08–10.8).

Conclusion:
The clinical pharmacist-led integrated approach revealed that medication errors commonly occurred among critically ill patients, and the clinical pharmacist's interventions intercepted the majority of these medication errors. The number of preventable ADEs was significantly fewer in a group of patients who received these interventions. However, medication errors formed chains of errors that adversely affected patients’ investigated outcomes in the study group with no implementation of the clinical pharmacist interventions.
Coronavirus testing indicates transmission risk increases along wildlife supply chains for human consumption in Viet Nam, 2013-2014
Authors: Huong Nguyen Quynh , Thanh Nga Nguyen Thi , Van Long Nguyen , Luu Bach Duc , Latinne Alice , Pruvot Mathieu , Phuong Nguyen Thanh , Vinh Quang Le Tin , Van Hung Vo , Lan Nguyen Thi , Hoa Nguyen Thi , Minh Phan Quang , Diep Nguyen Thi , Tung Nguyen , Ky Van Dang , Roberton Scott I. , Thuy Hoang Bich , Van Long Nguyen , Gilbert Martin , Wicker Leanne , Mazet Jonna A. K. , Johnson Christine Kreuder , Goldstein Tracey , Tremeau-Bravard Alex , Ontiveros Victoria , Joly Damien O. , Walzer Chris , Fine Amanda E. , Olson Sarah H. 
Published: June 2020

AbstractOutbreaks of emerging coronaviruses in the past two decades and the current pandemic of a novel coronavirus (SARS-CoV-2) that emerged in China highlight the importance of this viral family as a zoonotic public health threat. To gain a better understanding of coronavirus presence and diversity in wildlife at wildlife-human interfaces in three southern provinces in Viet Nam 2013-2014, we used consensus Polymerase Chain Reactions to detect coronavirus sequences. In comparison to previous studies, we observed high proportions of positive samples among field rats (34.0%, 239/702) destined for human consumption and insectivorous bats in guano farms (74.8%, 234/313) adjacent to human dwellings. Most notably among field rats, the odds of coronavirus RNA detection significantly increased along the supply chain from field rats sold by traders (reference group; 20.7% positivity, 39/188) by a factor of 2.2 for field rats sold in large markets (32.0%, 116/363) and 10.0 for field rats sold and served in restaurants (55.6%, 84/151). Coronaviruses were detected in the majority of wildlife farms (60.7%, 17/28) and in the Malayan porcupines (6.0%, 20/331) and bamboo rats (6.3%, 6/96) that are farmed. We identified six known coronaviruses in bats and rodents, clustered in threeCoronaviridaegenera, including theAlpha-,Beta-, andGammacoronaviruses. Our analysis also suggested either mixing of animal excreta in the environment or interspecies transmission of coronaviruses, as both bat and avian coronaviruses were detected in rodent feces in the trade. The mixing of multiple coronaviruses, and their apparent amplification along the wildlife supply chain into restaurants, suggests maximal risk for end consumers and likely underpins the mechanisms of zoonotic spillover to people.
Localization of hyphal growth associated with mycotoxin production during the malting of Fusarium head blight infected grains
Authors: Jin Zhao , Solanki Shyam , Ameen Gazala , Gross Thomas , Poudel Roshan Sharma , Borowicz Pawel , Brueggeman Robert S. , Schwarz Paul 
Published: June 2020

ABSTRACTFusarium head blight (FHB) and the occurrence of mycotoxins is the largest food safety threat to malting and brewing grains. Objectives of the current study were to localize the growth ofFusariumwithin FHB infected kernels and to associate it with the production of DON that occurred during malting. FHB infected barley, wheat, rye, and triticale grains that exhibited large increases inFusarium Tri5DNA and trichothecene mycotoxins following malting, were screened for hyphal localization. The growth of hyphae, both on the surface of kernels and within tissues of grain and malt was, imagined by scanning electron microscopy and confocal laser scanning microscopy assisted with WGA-Alexa Fluor 488 pre-staining, respectively. In barley, hyphae were primarily present on or within husk, vascular bundle, and pericarp cavities. Following malting, large amounts of hyphal growth were observed in not only these regions, but also in the aleurone layer, endosperm, and embryo. Extensive fungal growth was also observed following malting of wheat, rye, and triticale. Interestingly, these grains already had an extensive internal presence of hyphae in unmalted grain, occurring in the pericarp, testa, vascular bundle, nucellar projection, aleurone layer, endosperm, pericarp and endosperm cavities, and embryo. Shotgun sequencing followed by metagenomics analysis verified thatFusariumspp. accounted for above 90% of the fungal hyphae growing in the interior of grains during malting, which coincided with the significant production of mycotoxins.