bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of Anticoagulation in Pregnant Women With Mechanical Heart Valves
Authors: Daughety Molly M. , Zilberman-Rudenko Jevgenia , Shatzel Joseph J. , McCarty Owen J. T. , Raghunathan Vikram , DeLoughery Thomas G. 
Published: June 2020

Importance
Mechanical heart valves (MHVs) pose significant thrombogenic risks to pregnant women and their fetuses, yet the choice of anticoagulation in this clinical setting remains unclear. Various therapeutic strategies carry distinct risk profiles that must be considered when making the decision about optimal anticoagulation.

Objective
We sought to review existing data and offer recommendations for the anticoagulation of pregnant women with MHVs, as well as management of anticoagulation in the peripartum period.

Evidence Acquisition
We performed a literature review of studies examining outcomes in pregnant women receiving systemic anticoagulation for mechanical valves, and also reviewed data on the safety profiles of various anticoagulant strategies in the setting of pregnancy.

Results
Warfarin has been shown to increase rates of embryopathy and fetal demise, although it has traditionally been the favored anticoagulant in this setting. Low-molecular-weight heparin, when dosed appropriately with close therapeutic monitoring, has been shown to be safe for both mother and fetus.

Conclusions and Relevance
We favor the use of low-molecular-weight heparin with appropriate dosing and monitoring for the anticoagulation of pregnant women with MHVs. Data suggest that this approach minimizes the thrombotic risk associated with the valve while also providing safe and effective anticoagulation that can be easily managed in the peripartum period.

Target Audience
Obstetricians and gynecologists, family physicians.

Learning Objectives
After completing this activity, the learner should be better able to: describe the clinical considerations in choosing an anticoagulation strategy for a pregnant patient with an MHV; evaluate the existing data about the safety profile of various anticoagulation strategies and the potential benefits and risks of each approach to the mother and fetus; and discuss one recommended approach to management of mechanical valves in the pregnant patient and assess the clinical nuances associated with each individual patient's decision.
Learning to See Racism: Perspective Transformation Among Stakeholders in a Regional Health and Equity Initiative
Authors: Walsh Colleen C. , Willen Sarah S. , Williamson Abigail Fisher 
Published: June 2020

Context:
Achieving a meaningful reduction in health inequities will require not only policy and programmatic changes but also an increased understanding of structural racism and its deleterious impact on health and well-being. One way to enhance understanding is to actively promote “perspective transformation” (PT) around race among health equity stakeholders. Experiences of PT are defined as moments or events that bring about a deepened understanding of racism and that may result in new ways of thinking and acting.

Objective:
To identify catalysts and effects of PT among health equity stakeholders.

Design:
Semistructured, in-person interviews were conducted with stakeholders (n = 50) as part of a 2-phase, mixed-methods study (n = 170). Interviews were audio-recorded, transcribed, and coded using a mixed-methods software platform.

Setting:
Health Improvement Partnership-Cuyahoga (HIP-Cuyahoga), a regional health and equity initiative in Greater Cleveland, Ohio.

Participants:
A purposive sample of participants in HIP-Cuyahoga spanning 5 groups: metro-wide decision makers, public health professionals, clinicians, community leaders, and community members.

Results:
More than two-thirds of interviewees reported at least one discrete experience that catalyzed PT, as defined earlier. Three catalysts were especially common: witnessing, learning, and personally experiencing racism. A fourth, less common catalyst involved getting uncomfortable during discussions of race and racism. Experiences of PT resulted in common effects including acquiring new terms, concepts, and frameworks; carrying the conversation forward; finding fellow travelers; and feeling energized and motivated to confront structural racism and its consequences. People of color tended to experience PT, and its catalysts and effects, differently than White interviewees.

Conclusions:
Many health equity stakeholders have experienced PT around racism and its impact. Experiencing PT is associated with new skills, capacities, and motivations to confront racism and its impact on health and well-being. Understanding how different groups experience PT can help advance efforts to promote health equity.
Associations Between State Public Health Agency Structure and Pace and Extent of Implementation of Social Distancing Control Measures
Authors: Strickland Colten J. , Karaye Ibraheem M. , Horney Jennifer A. 
Published: June 2020

Objective:
To assess associations between state public health agency governance and timing and extent of implementation of social distancing control measures during COVID-19 response.

Design:
State public health agencies were stratified by governance, and data on timing and extent of social distancing were collected from the Institute for Health Metrics and Evaluation. Multinomial logistic regression and time-to-event analyses were conducted to quantify impacts of governance structure on timing and extent of social distancing.

Setting:
State health departments in the United States.

Results:
States operating under centralized public health governance structures enacted social distancing 4 days after decentralized states and had a 73% reduced likelihood of enacting a social distancing policy (hazard ratio = 0.27; 95% CI, 0.08 to 0.86).

Conclusion:
State health department governance structure may have implications on timing and extent of social distancing control measures implemented during a public health emergency.
Postpartum Mental Health Care for Mothers of Multiples: A Qualitative Study of New Mothers’ Treatment Preferences
Authors: WENZE SUSAN J. , MIERS QUINN A. , BATTLE CYNTHIA L. 
Published: June 2020

Objectives:
Despite the expanding literature on empirically supported strategies for treating perinatal mental health concerns in new mothers, no published reports have examined tailored support interventions for parents of twins or higher-order multiples. The goal of this study was to improve our understanding of the unique postpartum experiences of new mothers of multiples, gauge interest in both traditional and e-health approaches to mental health care, and discuss aspects of mental health treatment viewed to be most helpful.

Methods:
Twenty-eight women who had given birth to their first set of multiples within the past year were recruited online. Participants completed self-report measures of depression, anxiety, and sleep disruption and took part in telephone focus groups.

Results:
On average, participants had elevated depression and anxiety symptoms and notably disrupted sleep. Although some positive elements of the postpartum period were noted, most participants described this time as stressful, overwhelming, and exhausting. They identified experiences that were unexpected or unique to parenting multiples and indicated numerous desired aspects of mental health treatment. Interest in internet-delivered care was especially high.

Conclusions:
This study lays the groundwork for the development of a targeted psychosocial intervention to address mental health concerns among new mothers of multiples, particularly those who are already engaged and seeking support and community online. This report also suggests myriad ways in which providers can best address the needs of this population (eg, utilize providers with expertise in multiples, deliver care in the home, use e-health approaches, and normalize unique stressors and negative moods).
Technological Advances of Magnetic Resonance Imaging in Today's Health Care Environment
Authors: Attenberger Ulrike I. , Biber Stephan , Wichtmann Barbara D. 
Published: June 2020

Abstract
Today's health care environment is shifting rapidly, driven by demographic change and high economic pressures on the system. Furthermore, modern precision medicine requires highly accurate and specific disease diagnostics in a short amount of time. Future imaging technology must adapt to these challenges.
Demographic change necessitates scanner technologies tailored to the needs of an aging and increasingly multimorbid patient population. Accordingly, examination times have to be short enough that diagnostic images can be generated even for patients who can only lie in the scanner for a short time because of pain or with low breath-hold capacity.
For economic reasons, the rate of nondiagnostic scans due to artifacts should be reduced as far as possible. As imaging plays an increasingly pivotal role in clinical-therapeutic decision making, magnetic resonance (MR) imaging facilities are confronted with an ever-growing number of patients, emphasizing the need for faster acquisitions while maintaining image quality.
Lastly, modern precision medicine requires high and standardized image quality as well as quantifiable data in order to develop image-based biomarkers on which subsequent treatment management can rely.
In recent decades, a variety of approaches have addressed the challenges of high throughput, demographic change, and precision medicine in MR imaging. These include field strength, gradient, coil and sequence development, as well as an increasing consideration of artificial intelligence. This article reviews state-of-the art MR technology and discusses future implementation from the perspective of what we know today.
Dermoid Cyst in the Postauricular Area
Authors: Jeong Junhui , Choi Yoon Jung , Lee Kyuin , Choi Hyun Seung 
Published: June 2020

Abstract
Dermoid cyst is a rare benign tumor and about 7% of occurrences are found in the head and neck region. Its location is almost always in the midline of the body such as the orbit, oral cavity, and nose, but it is rarer in and around the auricle. The authors present a 31-year-old woman with dermoid cyst in the postauricular area which is a rare site for this lesion. In surgery under local anesthesia, the mass was limited to the subcutaneous area and excised completely. Surgical excision should be considered for cosmetic reasons and the mass should be excised completely to prevent recurrence and infection. Histopathologic confirmation is important and mandatory after excision to confirm the pathologic diagnosis and rule out the possibility of malignancy.
Optimizing Perioperative Red Blood Cell Utilization and Wastage in Pediatric Craniofacial Surgery
Authors: Reddy Srijaya K. , Volpi-Abadie Jacqueline , Gordish-Dressman Heather , Chao Jerry W. , Luban Naomi L.C. , Deutsch Nina 
Published: June 2020

Abstract
Utilization, wastage, and adverse consequences of assigning one full red blood cell (RBC) unit were investigated for children undergoing craniosynostosis surgery. The authors hypothesized that significant RBC wastage in the perioperative period exists for pediatric craniofacial surgery. The authors sought to determine what factors could guide patient-specific blood product preparation by evaluating utilization and wastage of RBCs in pediatric patients undergoing surgical correction of craniosynostosis. Eighty-five children with craniosynostosis undergoing surgical correction at our institution between July 2013 and June 2015 were identified. Fifty-three patients received RBC transfusion in the perioperative period, while 32 patients were not transfused. Primary outcome measures were intraoperative, postoperative, and total percent of RBC wastage. Secondary analysis compared the impact of patient weight and procedure type on perioperative RBC wastage. Of the 53 patients who received perioperative RBC transfusion, 35 patients received a volume of blood less than the full volume of the RBC unit while 18 patients received the full volume of blood. There was no significant relationship between perioperative RBC wastage, the type of craniofacial procedure performed, or the duration of surgical time. Children who received a perioperative transfusion and had RBC wastage weighed significantly less than those who received a full volume. These findings suggest that for craniofacial surgical patients weighing less than 10 kg, a protocol that splits cross-matched RBC units can decrease perioperative RBC wastage and blood donor exposure. A future prospective study will determine the success of this intervention as well as the potential to decrease exposure to multiple blood donors.
Laparoscopic Transabdominal Preperitoneal (TAPP) Inguinal Hernia Repair Using Fibrin Glue for Fixation of the Mesh and Peritoneum Closure
Authors: Ielpo Benedetto , Ferri  , Silva Jesus , Quijano Yolanda , Vicente Emilio , Diago Maria V. , Caruso Riccardo 
Published: June 2020

Purpose:
The aim of this case series is to describe our ongoing experience of laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair using Tisseel fibrin glue for the fixation of the mesh and peritoneum closure.

Materials and Methods:
From October 2018, patients who underwent laparoscopic TAPP for unilateral inguinal hernia repair using Tisseel fibrin glue to secure the mesh and the peritoneum, with a minimum of 1 year of follow-up, have been included. Patient demographics, main operative findings, and main postoperative outcomes were analyzed prospectively using a visual analgesic scale (VAS) and a modified short-form 36 (SF-36) questionnaire.

Results:
A total of 26 patients have been included and none have been lost during the follow-up. The mean operative time was 92.1 minutes and there was no conversion. The median hospital stay was 1.03 day (range, 1 to 2). The mean follow-up duration was 19.3 months (range, 12 to 26 mo) and none had a recurrence. The postoperative VAS score at 1, 7, 30 days, and 6 months from surgery was 3.18, 1.52, 0, and 0, respectively. The mean SF-36 score at 1, 6, and 12 months from surgery was 90.09, 94.8, and 05.1, respectively.

Conclusions:
The use of fibrin glue for TAPP inguinal hernia repair is a safe and feasible technique with favorable results. Larger comparative randomized studies are needed to confirm these early results.
CIGB-258 immunomodulatory peptide: a novel promising treatment for critical and severe COVID-19 patients
Authors: Venegas-Rodriguez R , Santana-Sanchez R , Peña-Ruiz R , Bequet-Romero M , Hernandez-Cedeño M , Santiesteban-Licea B , Garcia A , Aroche PR , Oliva-Perez D , Ortega-Gonzalez LM , Baldomero J E , Cruz LR , Guillén G , Martinez-Donato G , Dominguez-Horta MC ,   for the CIGB-258 Study Group
Published: June 2020

AbstractThis study characterizes the first clinical application of CIGB-258 in COVID-19 patients. CIGB-258 is an immunoregulatory peptide, derived from the cellular heat shock protein 60 (HSP60). Sixteen patients with COVID-19 in serious (31%) or critical (69%) conditions were included in this study. All critically ill patients recovered from the respiratory distress condition. Two of these patients had a fatal outcome due to nosocomial infections.The five seriously ill patients considerably improved. C-reactive protein (CRP) and interleukin-6 (IL-6) levels significantly decreased during treatment. CIGB-258 seems to be an effective and safe treatment option in COVID-19 patients under cytokine storm.TRIAL REGISTRATION: RPCEC00000313
G6PD variant distribution in sub-Saharan Africa and potential risks of using chloroquine/hydroxychloroquine based treatments for COVID-19
Authors: Rocha Jorge da , Othman Houcemeddine , Tiemessen Caroline T. , Botha Gerrit , Ramsay Michèle , Masimirembwa Collen , Adebamowo Clement , Choudhury Ananyo , Brandenburg Jean-Tristan , Matshaba Mogomotsi , Simo Gustave , Gamo Francisco-Javier , Hazelhurst Scott ,   as members of the H3Africa Consortium
Published: June 2020

AbstractChloroquine/hydroxychloroquine have been proposed as potential treatments for COVID-19. These drugs have warning labels for use in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Analysis of whole-genome sequence data of 458 individuals from sub-Saharan Africa showed significant G6PD variation across the continent. We identified nine variants, of which four are potentially deleterious to G6PD function, and one (rs1050828) that is known to cause G6PD deficiency. We supplemented data for the rs1050828 variant with genotype array data from over 11,000 Africans. Although this variant is common in Africans overall, large allele frequency differences exist between sub-populations. African sub-populations in the same country can show significant differences in allele frequency (e.g. 16.0% in Tsonga vs 0.8% in Xhosa, both in South Africa, p = 2.4 × 10−3). The high prevalence of variants in the G6PD gene found in this analysis suggests that it may be a significant interaction factor in clinical trials of chloroquine and hydrochloroquine for treatment of COVID-19 in Africans.
Clinical features of COVID-19 patients in Abdul Wahab Sjahranie Hospital, Samarinda, Indonesia
Authors: Paramita Swandari , Isnuwardana Ronny , Marwan Marwan , Alfian Donny Irfandi , Masjhoer David Hariadi 
Published: June 2020

AbstractIntroductionCoronavirus Disease (COVID-19) is caused by SARS-CoV-2 infection. Indonesia officially established the first COVID-19 confirmation case in early March 2020. East Kalimantan has been determined as a candidate for the new capital of Indonesia since 2019. This makes Abdul Wahab Sjahranie Hospital Samarinda as the largest hospital there has been designated as the main referral hospital for COVID-19 patients in East Kalimantan. We report the epidemiological, clinical, laboratory, and radiological characteristics of these patients.MethodsAll patients with laboratory-confirmed COVID-19 by RT-PCR were admitted to Abdul Wahab Sjahranie Hospital in Samarinda. We retrospectively collected and analyzed data on patients with standardized data collection from medical records.ResultsBy May 8, 2020, 18 admitted hospital patients had been identified as having laboratory-confirmed COVID-19. Most of the infected patients were men (16 [88.9%] patients); less than half had underlying diseases (7 [38.9%] patients). Common symptoms at the onset of illness were cough (16 [88.9%] patients), sore throat (8 [44.4%] patients), and fever (8 [44.4%] patients). Laboratory findings of some patients on admission showed anemia. Levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were increased in 10 (55.6%) of 18 patients. On admission, abnormalities in chest x-ray images were detected in 6 (33.3%) patients who had pneumonia. The mean duration from the first hospital admission to discharge was 33.1 ± 9.2 days.DiscussionThe majority of COVID-19 patients are male. COVID-19 comorbidities were found in several patients. The main clinical symptoms of COVID-19 in this study were cough, sore throat, and fever. The abnormal laboratory finding in COVID-19 patients is anemia, an increase in AST and ALT levels, and chest x-ray images of pneumonia. All patients are in mild condition. The average length of hospital admission patients to discharge is more than 30 days.ConclusionAlthough all patients are in mild condition, the inability of a local laboratory to check for positive confirmation of COVID-19 makes the admission period of the patient in the hospital very long. The availability of RT-PCR tests at Abdul Wahab Sjahranie Hospital Samarinda will greatly assist the further management of COVID-19 patients.
COVID-19 containment in the Caribbean: the experience of Small Island Developing States
Authors: Murphy MM , Jeyaseelan SM , Howitt C , Greaves N , Harewood H , Quimby KR , Sobers N , Landis RC , Rocke KD , Hambleton IR 
Published: June 2020

ABSTRACTBackgroundSmall island developing states (SIDS) have limited absolute resources for responding to national disasters, including health emergencies. Since the first confirmed case of COVID-19 in the Caribbean on 1st March 2020, non-pharmaceutical interventions (NPIs) have been widely used to control the resulting COVID-19 outbreak. We document the variety of government measures introduced across the Caribbean and explore their impact on aspects of outbreak control.MethodsDrawing on publically available information, we present confirmed cases and confirmed deaths to describe the extent of the Caribbean outbreak. We document the range of outbreak containment measures implemented by national Governments, focussing on measures to control movement and gatherings. We explore the temporal association of containment measures with the start of the outbreak in each country, and with aggregated information on human movement, using smartphone positioning data. We include a set of comparator countries to provide an international context.ResultsAs of 25th May, the Caribbean reported 18,755 confirmed cases and 631 deaths. There have been broad similarities but also variation in the number, the type, the intensity, and particularly the timing of the NPIs introduced across the Caribbean. On average, Caribbean governments began controlling movement into countries 27 days before their first confirmed case and 23 days before comparator countries. Controls on movement within country were introduced 9 days after the first case and 36 days before comparators. Controls on gatherings were implemented 1 day before the first confirmed case and 30 days before comparators. Confirmed case growth rates and numbers of deaths have remained low across much the Caribbean. Stringent Caribbean curfews and stay-at-home orders coincided with large reductions in community mobility, regularly above 60%, and higher than most international comparator countries.ConclusionStringent controls to limit movement, and specifically the early timing of those controls has had an important impact on containing the spread of COVID-19 across much of the Caribbean. Very early controls to limit movement into countries may well be particularly effective for small island developing states. With much of the region economically reliant on international tourism, and with steps to open borders now being considered, it is critical that the region draws on a solid evidence-base to balance the competing demands of economics and public health.