bluuebunny/crossref_metadata_2025_split huggingface dataset:
Considerations for the Effective Integration of Virtual Simulation in the Undergraduate Nursing Curriculum
Authors: Roye Jennifer , Anderson Mindi , Diaz Desiree A. , Rogers Meagan 
Published: October 2020

Abstract
Nursing education employs a cadre of strategies to address faculty shortages, increased student admissions, and the decreased availability of clinical sites. Virtual simulation provides an innovative way to provide a robust learning experience that can be used in conjunction with or in lieu of some portion of clinical experiences. The authors highlight how virtual simulation can be used and outline considerations for educators considering virtual simulation integration.
Experiences of Nursing Professionals Working With Women Diagnosed With Opioid Use Disorder and Their Newborns
Authors: Reese Sarah E. , Riquino Michael R. , Molloy Jen , Nguyen Van , Smid Marcela C. , Tenort Bernice , Gezinski Lindsay B. 
Published: October 2020

Background:
As the rate of opioid use in pregnancy escalates, there are a growing number of women diagnosed with opioid use disorder (OUD) and their newborns being cared for in inpatient settings.

Purpose:
In this study, we sought to better understand the experiences of nurses and nursing assistants working with women diagnosed with OUD and their newborns. By identifying the needs of nurses and nursing assistants, the findings from this study may contribute to reductions in stigma and improved patient care.

Methods:
Nurses and nursing assistants were recruited from a postpartum unit at a large urban hospital in Utah. Participants (n = 30) attended up to 4 semistructured focus groups. We utilized Braun and Clarke's 6-phase approach to thematic analysis to analyze transcribed interviews.

Findings/Results:
Themes identified during the data analysis process included negative feelings and reactions toward patients; preferential concern for the newborn over maternal well-being; and identification of organizational and training needs to overcome these challenges.

Implications for Practice:
These findings identify strategies for addressing challenges faced by nurses and nursing assistants in caring for women diagnosed with OUD and their newborns.

Implications for Research:
Future research should examine the effectiveness of approaches to reduce behaviors influenced by stigma among nurses and nursing assistants working with women diagnosed with OUD and their newborns, as well as employee and patient satisfaction, and long-term health outcomes.
Immunoglobulin and Complement Immunohistochemistry on Paraffin Sections in Autoimmune Bullous Diseases: A Systematic Review and Meta-analysis
Authors: Kasperkiewicz Michael , Lai Olivia , Kim Gene , DeClerck Brittney , Woodley David T. , Zillikens Detlef , Recke Andreas 
Published: October 2020

Abstract:
Immunohistochemistry (IHC) on formalin-fixed, paraffin-embedded tissue has been proposed as a potential tool in the diagnosis of autoimmune bullous diseases (AIBDs) in lieu of standard direct immunofluorescence (DIF) microscopy. To comprehensively determine the diagnostic accuracy of immunoglobulin and complement IHC for diagnosis of AIBDs, we conducted a systematic review and multivariate Bayesian model-based meta-analysis of the literature. Quality and heterogeneity assessment of studies was performed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) checklist and the I2 index, respectively. Electronic searches using PubMed from April 1964 to July 2020 identified 14 articles meeting predetermined inclusion and exclusion criteria. Median sensitivities with 95% credible intervals in pemphigus and pemphigoid were 0.24 (0.01–0.89) and 0.22 (0.02–0.77) with immunoglobulin G (IgG), 0.77 (0.39–0.95) and 0.25 (0.02–0.85) with IgG4, 0.11 (0.02–0.32) and 0.86 (0.56–0.98) with C3d, and 0.84 (0.56–0.97) and 0.75 (0.37–0.94) with C4d, respectively. Specificities were 1.00 (0.00–1.00) with IgG, 0.98 (0.89–1.00) with IgG4, 0.99 (0.97–1.00) with C3d, and 0.99 (0.97–1.00) with C4d. The risk of bias and heterogeneity among studies was a serious problem, decreasing the level of evidence. Our work suggests that, in selected cases, paraffin-based IHC may be a helpful procedure to screen for AIBDs, especially when specialized laboratories and/or biopsy specimens for DIF do not exist. Nevertheless, more studies with a refined quality design are needed to explore the true usefulness of this diagnostic method in AIBDs.
Study of Tattoo Colorants in Skin by Conventional and Polarized Light Microscopy
Authors: Fernandez-Flores Angel , Cassarino David 
Published: October 2020

Abstract:
Tattoos are a common practice in the 21st century. Although most modern pigments are organic and made of vegetable or plastic compounds, they still sometimes elicit an adverse reaction in the skin. Identifying the tattoo pigment in such biopsies is not always an easy task. To study how tattoo inks appear in the skin, we injected 14 different colors of commercial tattoo ink into normal skin obtained from a mastectomy specimen. One unstained section was obtained from each case, as well as one section stained with hematoxylin-eosin from each case. All sections were observed under the microscope. Stained and unstained sections were also examined under polarized light. We did not observe any modification of the ink color with the staining process with hematoxylin-eosin. However, some pigments appeared differently in stained and unstained sections than in the vial. Pink was the most difficult color to identify from the eosinophilic tissue. None of the colors showed any birefringent particles. However, in some unstained slides under polarized light, the color of the pigment appeared more similar to the one in the vial than in the stained slide.
ENDOPHTHALMITIS PRESENTING AS RETINAL VASCULITIS LESS THAN 24 HOURS AFTER AFLIBERCEPT INJECTION: A CASE REPORT
Authors: Weinstein Jessica E. , Greven Margaret A. 
Published: October 2020

Purpose:
We describe a case of endophthalmitis caused by Streptococcus salivarius presenting as a retinal vasculitis less than 24 hours after intravitreal injection.

Methods:
A case report.

Results:
The patient progressed from a hemorrhagic retinal vasculitis to severe endophthalmitis with no view to the posterior segment within 24 hours. The visual acuity progressed from 20 of 20 preinjection to light perception within less than 48 after injection. Vitreous tap and injection was performed within 24 hours of intravitreal aflibercept injection, followed by pars plana vitrectomy the next day. The final visual acuity was hand motions.

Conclusion:

Streptococcus salivarius is a virulent organism that may cause an endophthalmitis early after intravitreal injection with an unusual presentation of hemorrhagic retinal vasculitis. A high index of suspicion for infectious endophthalmitis should be maintained for all patients presenting with ocular inflammation and worsening vision in the days after intravitreal injections.
The Role of Donor Rim Fungal Cultures
Authors: Terry Mark A. 
Published: October 2020

Abstract:
Culturing all donor rims for fungus makes no sense. Only 1% of all cultures will be positive, and of those positive cultures, only 6% will also have a clinical infection. Prophylactically treating all positive cultures means 94% of patients will be treated unnecessarily. Fungal cultures do not reliably direct specific medication choice, and fungal infections of the interface in endothelial keratoplasty and deep anterior lamellar keratoplasty are nearly impervious to medical therapy. Suspected fungal infections of the deep stromal interface should be treated expeditiously with penetrating keratoplasty before peripheral spread or endophthalmitis occur.
Outcomes of Penetrating and Lamellar Corneal Patch Grafts
Authors: Sharma Supriya , Rathi Anubha , Murthy Somasheila I. , Trivedi Mihika , Patel Chaitali , Mohamed Ashik , Chaurasia Sunita 
Published: October 2020

Purpose:
To report the indications, long-term structural and functional outcomes, and prognostic factors for the success of penetrating and lamellar corneal patch grafts.

Methods:
This is a retrospective analysis of 49 patients who underwent the corneal patch graft procedure over 8 years. The baseline, preoperative, and postoperative characteristics along with their outcomes were evaluated.

Results:
Forty-nine eyes (49 patients) with a mean follow-up of 20.3 ± 3.27 months (range 6–48) were included. Thirty-one patients underwent full-thickness grafts for corneal perforation, and 18 underwent lamellar grafts for severe thinning. The most common indication was corneal thinning and/or perforation secondary to microbial keratitis (17 eyes, 34.7%). Anatomic success was achieved in 31 eyes (63.2%), in which no further surgical intervention was required for tectonicity. Functional success was achieved in 22 of 37 eyes (59.5%), where along with anatomic success, significant visual gain was also obtained. Absolute graft failure was noted in 12 eyes (24.5%), which developed recurrence of primary pathology requiring reintervention within the first 6 months. Good prognostic factor for success included sterile corneal perforations. The presence of microbial keratitis was noted to be a guarded prognostic factor for success.

Conclusions:
Corneal patch graft can serve as a good therapeutic modality for corneal ulceration or thinning, not amenable to treatment with tissue adhesive application. Both anatomical success and functional success of 60% was achieved in our series. Those performed for immune-mediated conditions fared the best. Subsequent optical procedures may be performed for further visual rehabilitation at a later stage.
Clinical Evaluation of Electrolysis for Reis-Bücklers Corneal Dystrophies and In Vivo Histological Analysis Using Anterior Segment Optical Coherence Tomography
Authors: Nishino Tsubasa , Kobayashi Akira , Mori Natsuko , Yokogawa Hideaki , Sugiyama Kazuhisa 
Published: October 2020

Purpose:
To report the effectiveness and clinical outcomes of corneal electrolysis for Reis-Bücklers corneal dystrophies (RBCDs) and provide in vivo histological analysis using anterior segment optical coherence tomography (AS-OCT).

Methods:
A total of 7 patients with RBCD (2 male patients, 5 female patients; mean age, 50.0 years) from 3 pedigrees were enrolled in this prospective study. All patients underwent corneal electrolysis for decreased visual acuity or blurred vision. Changes in visual acuity, refraction, and corneal thickness were evaluated 1 month after electrolysis and statistically analyzed. Changes observed in AS-OCT images before and after electrolysis were qualitatively and quantitatively assessed.

Results:
A total of 22 electrolysis procedures were performed on 7 patients during the median follow-up period of 10.7 years. Mean visual acuity significantly improved postoperatively, from 0.59 to 0.31 logarithm of the minimum angle of resolution (P = 0.013). Changes in refraction (from −2.42 to −2.12 D) and corneal thickness (from 570.8 to 577.6 μm) were not significant (P = 0.77 and P = 0.80, respectively). In all cases, assessment of AS-OCT images showed that the band lesion in Bowman's layer became less reflective after electrolysis. The mean thickness of the band lesion decreased from 101.5 to 88.3 μm (P = 0.002).

Conclusions:
Corneal electrolysis is an excellent treatment option for corneal opacities caused by RBCD. Corneal electrolysis improves visual acuity without changing corneal thickness or refraction. Therefore, repeat corneal electrolysis over the years might be a preferred long-term treatment strategy for RBCD. Moreover, AS-OCT is suitable for evaluating the effectiveness of this treatment and might be useful during postoperative follow-up.
Nasopharyngeal Microbiota Analysis in Healthy and Otitis-prone Children
Authors: Folino Francesco , Fattizzo Miriam , Ruggiero Luca , Oriano Martina , Aliberti Stefano , Blasi Francesco , Gaffuri Michele , Marchisio Paola , Torretta Sara 
Published: October 2020

Background:
Recurrent acute otitis media (RAOM) is common in children, and it may result in spontaneous tympanic membrane perforation (STMP), management of which is often challenging. In the upper respiratory tract (URT), resident microorganisms play a pivotal role in otitis media pathogenesis and prevention, as they are able to inhibit the colonization process and otopathogens growth. In particular, Dolosigranulum spp. and Corynebacterium spp. have been associated with respiratory health in several studies. This study aims at comparing both nasopharyngeal microbiota of children with RAOM versus matched controls and nasopharyngeal microbiota of children with a history of RAOM with STMP.

Method:
Nasopharyngeal swabs were collected from 132 children, median age 3.51 (2.13–4.72), including 36 healthy children, 50 with RAOM without STMP, and 46 with RAOM with STMP. Bacterial DNA was subsequently extracted and 16S rRNA gene V3-V4 regions were polymerase chain reaction amplified and sequenced using Illumina MiSeq technology.

Results:
A higher relative abundance of Dolosigranulum and Corynebacterium genera was detected in the nasopharynx of healthy children (16.5% and 9.3%, respectively) in comparison with RAOM without STMP (8.9% and 4.3%, respectively) and RAOM with STMP (5.2% and 2.8%, respectively). A decreasing pattern in relative abundance of these 2 pivotal genera through disease severity was detected. In all groups, the most abundant genera were Moraxella, Streptococcus and Haemophilus, followed by Dolosigranulum and Corynebacterium.

Conclusions:
Our study provides a characterization of the URT microbiota in otitis-prone children with and without history of recurrent STMP, suggesting that the role of Dolosigranulum and Corynebacterium in regulating the healthy URT microbiota should be further studied.
Antibiotic Prescriptions for Children With Community-acquired Pneumonia: Findings From Italy
Authors: Costenaro Paola , Cantarutti Anna , Barbieri Elisa , Scamarcia Antonio , Oletto Andrea , Sacerdoti Paolo , Lundin Rebecca , Cantarutti Luigi , Giaquinto Carlo , Donà Daniele 
Published: October 2020

Introduction and Objective:
Community-acquired pneumonia (CAP) is one of the most common reasons of prescribing antibiotics for children, often with overuse of broad-spectrum antibiotics. The aim of this study is to describe the antibiotic prescriptions for Italian children with CAP, at the primary care level.

Study Design:
Retrospective cohort study conducted among children 3 months–14 years of age with CAP, enrolled in Pedianet (http://www.pedianet.it) from January 1, 2009 to December 31, 2018. Antibiotic treatment was defined as narrow-spectrum (NS-ABT) if amoxicillin and broad-spectrum (BS-ABT) if amoxicillin/clavulanic acid, cephalosporins or any combination. Crude and adjusted logistic regressions for the odds of receiving NS-ABT were conducted (all episodes of CAP and per patient). A P value <0.05 was considered statistically significant.

Results:
Among 9691 CAP, 7260 episodes from 6409 children followed by 147 pediatricians were analyzed. The 16.7% of CAP [1216/7260, 95% confidence interval (CI): 15.9%–17.6%] received an NS-ABT while 53.3% (3863/7260, 95% CI: 52%–54.4%) received BS-ABTs and 30% (2181/7260, 95% CI: 28.9%–31.1%) macrolides. Within 10 years, a slight but increasing trend of NS-ABT prescription was observed (P < 0.001). Factors independently associated with reduced odds of receiving an NS-ABT compared with BS-ABT including macrolides were being older than 5 years [odds ratio (OR) 0.45, 95% CI: 0.39–0.52], living in Central/Southern Italy (OR 0.13, 95% CI: 0.10–0.16) and being exposed to ABT 3 months before (OR 0.61, 95% CI: 0.53–0.70). These findings were confirmed comparing NS-ABT versus BS-ABT excluding macrolides (n = 5079) and when the analysis was limited to index CAP.

Conclusion:
Our findings report a very limited prescription of narrow-spectrum antibiotics for Italian children with CAP.
Job Stress and Subclinical Cardiovascular Disease
Authors: Lorentz Luciana Bivanco de Lima , Santos Itamar de Souza , Bittencourt Márcio Sommer , Griep Rosane Harter , Lotufo Paulo Andrade , Bivanco-Lima Danielle , Benseñor Isabela J.M. 
Published: October 2020

Objective:
We aimed to evaluate the relationship between job stress and subclinical cardiovascular disease at ELSA-Brasil.

Methods:
We considered job stress domains (demand, skill discretion, decision authority, and social support) as independent variables and coronary artery calcium (CAC more than 0) and carotid intima-media thickness (CIMT more than P75% as a continuous variable) as dependent ones. Odds ratio (OR) and 95% confidence interval (95% CI) were presented crude, with further adjustments for sociodemographic, cardiovascular risk factors, and lifestyle variables. Linear regression models were built for CIMT using the same covariates.

Results:
Although significant associations were observed in the crude models, after multivariate adjustment CAC and CIMT were not significantly associated with demand, skill discretion, decision authority, and social support.

Conclusions:
Our results did not support an association between job stress and subclinical cardiovascular disease measured by CAC or CIMT.
Longitudinal Evaluation of Lung Function in Gulf War I Veterans Exposed to Depleted Uranium
Authors: Glick Danielle R. , Brown Clayton H. , Li Lan , Weiler-Lisowski Bethany , Gaitens Joanna M. , McDiarmid Melissa , Hines Stella E. 
Published: October 2020

Objective:
Gulf War I (GWI) Veterans exposed to depleted uranium (DU) have undergone biennial surveillance to assess for DU-related health effects. No DU-specific respiratory effects have been observed cross-sectionally, but longitudinal lung function decline has not been assessed.

Methods:
A dynamic cohort of 71 Veterans underwent spirometry testing between 1999 and 2019. Longitudinal rates of decline of spirometry values were compared among Veterans with high versus low uranium levels using a linear mixed model.

Results:
There was no significant difference in rate of decline of spirometry values between Veterans with high versus low uranium levels. The overall rate of decline was similar to that of the general population.

Conclusions:
In 20 years of follow-up, there does not appear to be an accelerated rate of decline of lung function among veterans exposed to depleted uranium.
Sleep Problems and Melatonin Prescription After Concussion Among Youth Athletes
Authors: Howell David R. , Potter Morgan N. , Provance Aaron J. , Wilson Pamela E. , Kirkwood Michael W. , Wilson Julie C. 
Published: October 2020

Objectives:
To examine the effect of sleep disturbances on concussion symptom recovery and to examine the effect of melatonin prescription on symptom improvement among concussed adolescents with sleep problems.

Design:
Longitudinal test–retest.

Setting:
Sports medicine clinic.

Participants:
Patients aged 8 to 18 years, diagnosed with a concussion, evaluated within 14 days after injury, and evaluated again 15 to 35 days after injury.

Independent Variables:
We grouped patients based on whether they reported sleep disturbances within 14 days of injury.

Main Outcome Measures:
Outcome measures included symptom severity, headache severity, melatonin prescription, and the change in symptom severity between visits.

Results:
Two hundred twenty-five patients were included: 36% who reported sleep problems (44% female; age = 14.4 ± 2.0 years; evaluated 7.3 ± 3.8 and 23.2 ± 5.4 days after injury) and 64% who did not (32% female; age = 14.6 ± 2.3 years; evaluated 7.2 ± 3.4 and 23.0 ± 5.3 days after injury). Those with sleep problems reported higher symptom severity than those without across the 2 visits (22.1 ± 14.3 vs 14.6 ± 12.5; P < 0.001). There was no significant difference in the change in symptom severity between visits among those who received [median = 9-point improvement; interquartile range (IQR) = 1-14] and did not (median = 9, IQR = 2-18) receive a melatonin prescription (P = 0.80).

Conclusions:
Sleep problems among pediatric patients within 2 weeks of concussion are associated with more severe symptoms. Melatonin prescription was not associated with faster symptom recovery.
Embracing Change in the Pursuit of Excellence: Transitioning to the Clinical Internship Evaluation Tool for Student Clinical Performance Assessment
Authors: North Sara , Sharp Amanda 
Published: October 2020

Background and Purpose.
The assessment of physical therapist student competence in the clinical learning environment is valuable and necessary. However, educators and clinicians are becoming increasingly disenchanted with their chosen assessment tools and delivery platforms. The profession recently called for a pursuit of excellence that includes an analysis of performance evaluation practices and consideration of assessment tools. In line with this call, the purpose of this report was to disseminate one academic institution's exploration, implementation, and early outcomes of the transition from the Clinical Performance Instrument (CPI) to the Clinical Internship Evaluation Tool (CIET) for full-time student clinical performance assessment.

Case Description.
After identification of key stakeholders, the authors completed an initial exploration and comparison of CPI versus CIET, executed a pilot trial of CIET use, and implemented a transition from CPI to CIET for all full-time clinical experiences.

Outcomes.
This report presents the outcomes of the initial exploration and comparison of assessment tools, the CIET pilot, the academic processes in transitioning to the CIET, and the post-implementation evaluation results, each with consideration of unique stakeholder perspectives.

Discussion and Conclusion.
The transition from CPI to CIET for full-time student clinical performance assessment was successful in meeting the needs of key stakeholders. This report presents the first known addition to the literature regarding CIET implementation since the original institution's publications. Ongoing use and evaluation of the CIET and other alternative tools for student performance assessment, both within and across institutions, is necessary to address the profession's pursuit of excellence and to better meet the demand for contemporary educational practices in the clinical learning environment.
Rabbit as an Animal Model for Ocular Surface Disease, Tear Osmolarity, Electrolyte, and Tear Ferning Profiles
Authors: Lantyer-Araujo Nayone Lima , Lacerda Ariane de Jesus , Mendonça Marcos Antônio , da Silva Ana Paula de Souza Martins , Dórea Neto Francisco de Assis , Portela Ricardo Dias , Oriá Arianne Pontes 
Published: October 2020

SIGNIFICANCE
The tear film promotes ocular surface health and protection through its various constituents' functions. The application of methods for ocular surface examination is essential in the research of diseases that affect the tear film. Rabbits have been used as a model to study some human ocular diseases and to test ophthalmic products.

PURPOSE
The aim of the present study was to determine the biochemical profile, osmolarity, and tear ferning patterns of rabbit tears.

METHODS
Ten rabbits (Oryctolagus cuniculus) were evaluated for tear osmolarity, tear ferning types and grades (using Rolando and Masmali scales), and biochemical analysis of total protein, urea, and electrolytes (chloride, phosphorus, iron, sodium, potassium, and calcium).

RESULTS
Median ± semi-interquartile range for tear osmolarity was 283.5 ± 7.5 mOsm/L. Tear ferning test grades were type 1.0 ± 0.5 on the Rolando scale and 1.0 ± 0.5 on the Masmali scale. Type I and grade 1 were the most commonly observed ferning classifications (60 and 50%, respectively) for the rabbits' tears. Results for electrolytes and other biochemical compounds were as follows: total protein 4.40 g/dL, urea 130.60 mg/dL, chloride 196.51 mEq/L, phosphate 7.35 mg/dL, iron 95.76 μg/dL, sodium 202.04 mmol/L, potassium 12.74 mmol/L, and calcium 11.53 mg/dL.

CONCLUSIONS
The results of the various tests described herein may serve as a basis for research using rabbits as an ophthalmic disease model and in the development of diagnostic and therapeutic agents used for ocular health.