bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changes in Behavior with Increasing Pregnancy Attempt Time
Authors: Wise Lauren A. , Wesselink Amelia K. , Hatch Elizabeth E. , Weuve Jennifer , Murray Eleanor J. , Wang Tanran R. , Mikkelsen Ellen M. , Sørensen Henrik Toft , Rothman Kenneth J. 
Published: June 2020

Background:
The extent to which couples change their behaviors with increasing pregnancy attempt time is not well documented.

Methods:
We examined change in selected behaviors over pregnancy attempt time in a North American preconception cohort study. Eligible females were ages 21–45 years and not using fertility treatment. Participants completed baseline and bimonthly follow-up questionnaires for up to 12 months or until pregnancy.

Results:
Among 3,339 females attempting pregnancy for 0–1 cycles at enrollment, 250 contributed 12 months of follow-up without conceiving. Comparing behaviors at 12 months versus baseline, weighted for loss-to-follow-up, we observed small-to-moderate reductions in mean caffeine intake (−19.5 mg/day, CI = −32.7, −6.37), alcohol intake (−0.85 drinks/week, CI = −1.28, −0.43), marijuana use (−3.89 percentage points, CI = −7.33, 0.46), and vigorous exercise (−0.68 hours/week, CI = −1.05, −0.31), and a large increase in activities to improve conception chances (e.g., ovulation testing) (21.7 percentage points, CI = 14.8, 28.6). There was little change in mean cigarette smoking (−0.27 percentage points, CI = −1.58, 1.04), perceived stress scale score (−0.04 units, CI = −0.77, 0.69), or other factors (e.g., sugar-sweetened soda intake, moderate exercise, intercourse frequency, and multivitamin use), but some heterogeneity within subgroups (e.g., 31% increased and 32% decreased their perceived stress scores by ≥2 units; 14% reduced their smoking but none increased their smoking by ≥5 cigarettes/day).

Conclusions:
Although many behaviors changed with increasing pregnancy attempt time, mean changes tended to be modest for most variables. The largest differences were observed for the use of caffeine, alcohol, and marijuana, and methods to improve conception chances.
Updates in uterine artery embolization for leiomyomas
Authors: Kim Annie , Arabkhazaeli Moona , Ulrich Amanda , Lerner Veronica , Shin Ja Hyun 
Published: June 2020

Purpose of review
Uterine leiomyomas are a common condition estimated to affect 70–80% of reproductive-aged women. An evolving body of evidence continues to guide our understanding of various surgical and interventional treatment options, such as uterine artery embolization (UAE). This article provides an updated review of novel findings regarding UAE.

Recent findings
Despite an abundance of observational studies and several small randomized controlled trials, large scale long-term comparative efficacy studies are lacking. Although short-term outcomes continue to be favorable, recent trials show reoperation rate of up to 35% in 10 years and may raise some concerns regarding ovarian reserve, fertility and pregnancy outcomes.

Summary
UAE remains a safe and effective alternative to surgery in the management of leiomyomas. A deeper investigation into understanding this treatment's optimal use in various patient populations is needed.
Association Between Structure-function Characteristics and Visual Field Outcomes in Glaucoma Subjects With Intraocular Pressure Reduction After Trabeculectomy
Authors: Kadziauskienė Aistė , Chua Jacqueline , Baskaran Mani , Yow Ai Ping , Tan Bingyao , Sng Chelvin , Ašoklis Rimvydas , Lesinskas Eugenijus , Crowston Jonathan , Schmetterer Leopold , Wong Damon Wing Kee 
Published: June 2020

Precis:
Improvements in post-trabeculectomy visual field (VF) outcomes were found to be significantly associated with preoperative nerve fiber layer thickness parameters extracted from the sectorized structure-function relationship, baseline VF, and severity of glaucoma.

Objective:
To determine whether the preoperative structure-function relationship helps to predict visual outcomes at 1-year post-trabeculectomy.

Patients and Methods:
In total, 91 eyes from 87 participants who successfully underwent trabeculectomy were included in our study. All eyes received optical coherence tomography imaging and VF assessment using 30-2 standard automated perimetry preoperatively at baseline and postoperatively 1 year after trabeculectomy. The linear mixed-model analysis was used to assess the association of structure and function at baseline, and multivariate analysis to investigate factors associated with postoperative VF outcomes.

Results:
Results from multivariate and univariate analysis for VF 1 year after trabeculectomy showed that a positive preoperative retinal nerve fiber layer thickness deviation from the structure-function model was found to be significantly associated with improved postoperative VF outcomes [β=0.06 dB/μm; 95% confidence interval (CI), 0.03-0.09]. Other significant factors included baseline VF MD (β=−0.18; 95% CI, −0.23 to −0.13) and the presence of severe glaucoma (β=−1.69; 95% CI, −2.80 to −0.57). Intraocular pressure was positively associated with improved VF outcomes only in univariate analysis (β=0.06; 95% CI, 0.01-0.11).

Conclusions and Relevance:
Characteristics derived from the baseline structure-function relationship were found to be strongly associated with postoperative VF outcomes. These findings suggest that the structure-function relationship could potentially have a role in predicting VF progression after trabeculectomy.
Difficult Balance Between Multidrug-Resistant Cytomegalovirus Infection and Graft-Versus-Host Disease in an Allogeneic Hematopoietic Stem Cell Transplant Recipient
Authors: Rhee Yoona , Santos Carlos A.Q. , Lurain Nell , Marinovic Debra A. , Prockop Susan E. , Varma Ankur , Papanicolaou Genovefa , Ustun Celalettin , Nathan Sunita 
Published: June 2020

Abstract
We present a case of multidrug-resistant cytomegalovirus (CMV) infection in an allogeneic hematopoietic stem cell transplant recipient with graft-versus-host disease. We demonstrate evolving viral mutations with documented resistance to first-line CMV DNA polymerase inhibitors and letermovir. Leflunomide and compassionate use investigational third-party CMV-specific cytotoxic T-cell lymphocyte infusions led to reductions in CMV viremia; however, the patient succumbed to respiratory failure. This article highlights the difficult balance between immunosuppression for graft-versus-host disease therapy and refractory CMV treatment, with a review of CMV antiviral therapy.
Practical applications of nutritional scores
Authors: Mendes Rosa , Bento Luís 
Published: June 2020

Purpose of review
Any intensive therapy requires individual adaptation, despite the standardization of the concepts that support them. Among these therapies, nutritional care has repeatedly been shown to influence clinical outcome. In order to evaluate the risk of malnutrition among critically ill patients and to identify those patients who may benefit from medical nutrition therapy is imperative to have a validated screening tool to optimize nutritional care.
The scope of this review is to analyze the recent literature on the management of nutritional scores for patients admitted to the ICU.

Recent findings
Critically ill patient staying for more than 24–48 h in the ICU, if unable to eat, should be considered at risk for malnutrition. Several nutritional tools have been proposed but not all are validated to screening those patients. The limitations of existing screening tools are described.

Summary
Nutritional scores should be routinely performed at ICU admission according to recommended guidelines. An approach to incorporate these tools into everyday clinical practice is suggested.
Incidence of metachronous gastric cancer after endoscopic submucosal dissection associated with eradication status of Helicobacter pylori
Authors: Ikeda Ryosuke , Hirasawa Kingo , Sato Chiko , Sawada Atsushi , Nishio Masafumi , Fukuchi Takehide , Kobayashi Ryosuke , Makazu Makomo , Kaneko Hiroaki , Maeda Shin 
Published: June 2020

Objective:
This study compared the clinicopathological features and treatment outcomes of patients with primary early gastric cancers (EGCs) who had undergone Helicobacter pylori eradication and endoscopic submucosal dissection (ESD) with those of patients who were H. pylori-positive and had undergone ESD. Additionally, we investigated the incidence of metachronous cancer in these patients.

Methods:
We retrospectively analyzed 1849 EGCs in 1407 patients who underwent ESD whom 201 primary EGCs were detected after H. pylori eradication (eradication group) and 1648 primary EGCs were detected in patients infected with H. pylori (infection group). We evaluated the clinicopathological features and treatment outcomes of the first ESD. We next divided 938 patients whose follow-up periods were >1 year into three groups, an eradication group (n = 61), an infection group (n = 562), and an eradication after ESD group (n = 315). The groups’ cumulative metachronous occurrence rates were determined.

Results:
The eradication group’s median tumor size was significantly smaller, and the tumors were significantly more likely to be flat/depressed than those in the infection group. The groups did not differ regarding the treatment outcomes. The cumulative incidence of metachronous cancer was significantly higher in the eradication group than in the eradication after ESD group (P = 0.0454) and in the infection group than in the eradication after ESD group (P = 0.0233).

Conclusion:
The treatment outcomes for EGC in the eradication group were favorable. The higher incidence of metachronous cancer in the eradication group suggests that careful endoscopic follow-up examinations are required.
Germline mutations: many roles in leukemogenesis
Authors: Chen Kevin Z. , Kazi Rafi , Porter Christopher C. , Qu Cheng-Kui 
Published: June 2020

Purpose of review
The purpose of this review is to summarize the current understanding of germline mutations as they contribute to leukemia development and progression. We also discuss how these new insights may help improve clinical management of germline mutations associated with leukemia.

Recent findings
Germline mutations may represent important initial mutations in the development of leukemia where interaction with somatic mutations provide further hits in leukemic progression. In addition, germline mutations may also contribute to leukemogenesis by impacting bone marrow stem-cell microenvironment and immune cell development and function.

Summary
Leukemia is characterized by the clonal expansion of malignant cells secondary to somatic or germline mutations in a variety of genes. Understanding somatic mutations that drive leukemogenesis has drastically improved our knowledge of leukemia biology and led to novel therapeutic strategies. Advances have also been made in identifying germline mutations that may affect leukemic development and progression. This review will discuss the biological and clinical relationship of germline mutations with clonal hematopoiesis, bone marrow microenvironment, and immunity in the progression of leukemia.
Small interfering RNA to proprotein convertase subtilisin/kexin type 9: transforming LDL-cholesterol-lowering strategies
Authors: Brandts Julia , Ray Kausik K. 
Published: June 2020

Purpose of review
Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibition is a new strategy to reduce LDL cholesterol (LDL-C), that is currently pursued by mAbs. A promising novel approach to target PCSK9 is using small interfering RNAs to inhibit hepatic PCSK9 synthesis. The first small interfering RNA developed for this purpose is inclisiran. Here, we review its clinical trial data and potential impact on patient management.

Recent findings
Inclisiran achieves sustained, additional 50% LDL-C reduction in patients receiving background statin therapy. Resulting LDL-C changes can be maintained by an infrequent dosing regimen with twice per year injections, that appear safe and well tolerated. Thus far, inclisiran has been studied in patients with established cardiovascular disease, high-risk primary prevention and in patients with familial hypercholesterolemia.

Summary
High and very high-risk individuals may benefit from the additional LDL-C-lowering effect of inclisiran when added to current lipid-lowering therapies. Furthermore, the simple dosing regimen may improve the convenience for users and facilitate patient adherence to therapy. The safety and convenience of inclisiran may offer new opportunities for population health.
Public Health Representation on Active Transportation Bodies Across US Municipalities
Authors: Omura John D. , Kochtitzky Christopher S. , Galuska Deborah A. , Fulton Janet E. , Shah Sagar , Carlson Susan A. 
Published: June 2020

Context:
Municipal bodies such as planning or zoning commissions and active transportation advisory committees can influence decisions made by local governments that support physical activity through active transportation. Public health professionals are encouraged to participate in and inform these processes. However, the extent of such collaboration among US municipalities is currently unknown.

Objective:
To estimate the prevalence of active transportation bodies among US municipalities and the proportion with a designated public health representative.

Design:
A cross-sectional survey administered from May through September 2014.

Setting:
Nationally representative sample of US municipalities with populations of 1000 or more people.

Participants:
Respondents were the city or town manager, planner, or person with similar responsibilities (N = 2018).

Main Outcome Measures:
The prevalence of planning or zoning commissions and active transportation advisory committees among municipalities and whether there was a designated public health representative on them.

Results:
Approximately 90.9% of US municipalities have a planning or zoning commission, whereas only 6.5% of these commissions have a designated public health representative. In contrast, while 16.5% of US municipalities have an active transportation advisory committee, 22.4% of them have a designated public health representative. These active transportation bodies are less common among municipalities that are smaller, rural, located in the South, and where population educational attainment is lower. Overall, few US municipalities have a planning or zoning commission (5.9%) or an active transportation advisory committee (3.7%) that also has a designated public health representative.

Conclusions:
Approximately 9 in 10 US municipalities have a planning or zoning commission, whereas only 1 in 6 has an active transportation advisory committee. Public health representation on active transportation bodies across US municipalities is low. Increasing the adoption of active transportation advisory committees and ensuring a designated public health representative on active transportation bodies may help promote the development of activity-friendly communities across the United States.
Local Health Departments' Capacity for Workplace Health Promotion Programs to Prevent Chronic Disease: Comparison of Rural, Micropolitan, and Urban Contexts
Authors: Brown Meagan C. , Kava Christine , Bekemeier Betty , Ornelas India J. , Harris Jeffrey R. , Chan Kwun C. G. , Robertson Meg , Hannon Peggy A. 
Published: June 2020

Objective:
To examine local health department (LHD) contexts, capacity for, and interest in partnering with employers on workplace health promotion programs (WHPPs) for chronic disease prevention.

Design:
Qualitative interviews with LHD directors.

Setting:
LHDs from 21 counties in 10 states.

Participants:
Twenty-one LHD directors.

Main Outcome Measures(s):
Experiences and perceptions of existing partnerships, decision making, funding, data needs, and organizational capacity for WHPP partnerships with employers.

Results:
We identified 3 themes: (1) LHDs see the value of partnering with employers but lack the capacity to do so effectively; (2) while LHDs base priorities on community need, funding ultimately drives decision making; and (3) rural, micropolitan, and urban LHDs differ in their readiness and capacity to work with employers.

Conclusions:
Understanding LHDs' partnership capacity and context is essential to the successful implementation of WHPP partnerships with employers. Expanding these partnerships may require additional financial investments, particularly among rural LHDs.
Ethnic and Racial Diversity in Academic Physical Medicine and Rehabilitation Compared with All Other Medical Specialties
Authors: Sanchez Ashley N. , Martinez Claudia I. , Stampas Argyrios , Pedroza Claudia , Escalon Miguel X. , Silver Julie K. , Frontera Joel , Verduzco-Gutierrez Monica 
Published: June 2020

Abstract
The primary aim of this study was to compare ethnic/racial diversity in academic physical medicine and rehabilitation (PM&R) with all other medical specialties in academia. The secondary aim was to characterize the ethnic/racial diversity of current PM&R program directors. Self-reported ethnicity/race information was collected from the Association of American Medical Colleges and Accreditation Council for Graduate Medical Education. Ethnicity/race was defined as white, Asian, African American, Hispanic, and other. Odds ratios (ORs) and Fisher’s exact tests were used to compare ethnic/racial differences at each career level between each specialty. In 2017, in PM&R, compared with whites, there was decreased odds of African Americans by 89% (OR, 0.11), 90% for Hispanics (OR, 0.10), 62% for Asians (OR, 0.38), and 73% for other (OR, 0.27) (all P < 0.001). This disparity increased in full professors: 99% (OR, 0.01), 96% (OR, 0.04), 87% (OR, 0.13), and 90% (OR, 0.10), respectively (all P < 0.001). In 2019, most PM&R program directors identified as white (51%) compared with Hispanic (4%) and African American (2%). Overall, ethnic/racial underrepresented minorities in medicine decreased with increasing academic rank. Therefore, more robust initiatives must be implemented to improve the exposure, recruitment, and retention of ethnic/racial underrepresented minorities at all levels of PM&R academia.
Contralateral Depressor Labii Inferioris Chemodenervation for Congenital Unilateral Lower Lip Palsy
Authors: Çam Osman Halit , Özücer Berke 
Published: June 2020

Introduction:
Congenital unilateral lower lip palsy – also known as asymmetric crying facies – is isolated asymmetry of the lower lip unilaterally. It is characterized by isolated lower lip asymmetry during smiling and speech. Although etiology is unknown, depressor labii inferioris (DLI) weakness is hold responsible.

Aim:
Purpose of this study was to evaluate the effectiveness of contralateral depressor labii inferioris botulinum toxin injection on patients’ concern levels and patient satisfaction. Ten units of botulinum toxin A injection was carried out to the healthy contralateral side.

Methodology:
Eleven patients were treated. Patients’ pretreatment and posttreatment concern regarding asymmetry during speech and smiling was evaluated with a questionnaire. Patients’ perception of treatment satisfaction was also evaluated with a questionnaire.

Results:
Mean score related to concern about asymmetric appearance during smiling decreased from 1.6 ± 0.8 to 0.5 ± 0.5. Mean score related to concern about asymmetric appearance during speech decreased from 1.6 ± 0.5 to 0.4 ± 0.5. Eleven out of 11 patients reported improvement with speech whereas 10 out of 11 patients reported improvement with smiling. No weakness about oral competence was reported.

Conclusion:
Most congenital unilateral lower lip palsy patients are concerned regarding their asymmetric appearance while smiling or speaking. Chemodenervation of the contralateral DLI muscle reduces concern levels and has high patient satisfaction. Chemodenervation of the contralateral healthy DLI muscle is a valid, practical treatment option.
Participation in a System-Thinking Simulation Experience Changes Adverse Event Reporting
Authors: Sanko Jill S. , Mckay Mary 
Published: June 2020

IntroductionSystem failures are contributing factors in the thousands of adverse events occurring in US healthcare institutions yearly. This study explored the premise that exposure to a simulation experience designed to improve system thinking (ST) would impact adverse event reporting patterns.MethodsAn intervention-control study was used to explore impacts of participation in a simulation designed to improve ST on adverse event reporting. Each summer Bachelor in Nursing Science students along with medical students participate in a week-long simulation-based interprofessional patient safety course. During the 2017 course, Friday Night in the ER, a table-top simulation designed to develop ST was included. As part of the school nursing's simulation program, students are asked to report adverse events observed or committed during simulation encounters into a simulated adverse event reporting system outside the simulation-based interprofessional patient safety course. Adverse event reporting system data were used to examine patterns of adverse event reporting in control and intervention groups studied.ResultsFindings demonstrated differences in proportions of reported adverse events. The proportion of reported adverse events by students with the second and terminal semesters of course work combined and the 2016 and 2018 control groups combined demonstrated statistically significant differences,P< 0.001. Additional analysis revealed that the intervention group reported more medication-related events, whereas the control group reported more failure to rescue and airway-related events.ConclusionsExposure to a simulation designed to develop ST seems to impact adverse event reporting. These findings support the idea that ST may change safety monitoring behaviors.
Role and Outcome of Laparoscopic/Minimally Invasive Surgery for Variety of Colorectal Emergencies
Authors: Ahmed Salman E. , Jha Anshu , Norman Sarah , Jha Madan , Garg Dharmendra 
Published: June 2020

Background:
Recently, the laparoscopic or minimally invasive approach has become common practice for planned colorectal malignancies. Its use in the emergency setting is limited by various factors, including resource availability and surgical expertise. However, more recent evidence suggests a laparoscopic approach to colorectal emergencies, which is comparable with laparoscopic routine work, and often promising. In this study, authors have investigated the outcome of the laparoscopic approach in both benign and malignant colorectal emergencies.

Method:
Retrospective analysis of prospectively collected data (theater records, histology database, and discharge records) over the course of 9 years. The standard surgical approach included conventional laparoscopic and single-port technique (single-incision laparoscopic surgery). The outcome variables included in the final analysis were: success of the minimally invasive approach, conversion rate, postoperative complications, return to theater, and mortality.

Results:
A total of 202 (males, 110 and females, 92) emergency patients with a median age of 59 years underwent surgery between December 2009 and 2019. The mean operating time was 169 minutes and median American Society of Anesthesiology grade III. Single-incision laparoscopic surgery was used in 19 patients (9.4%). The conversion to open surgery was 12.3% (n=25). The majority of them had primary anastomosis (n= 132, 65.3%).
The complications from most to least frequent were:Postoperative ileus (35%).Postoperative respiratory complications (7.4%).Intra-abdominal collection (9%); half of which were anastomotic leak (4.5%).Major wound infection (3.9%).Return to theater for laparotomy (2.9%).

Conclusion:
The favorable results obtained in this study underline the theme that with the availability of resources and expertise, it is possible to offer minimal invasive approach to emergency colonic pathology.