bluuebunny/crossref_metadata_2025_split huggingface dataset:
Human Challenge Studies With Wild-Type Severe Acute Respiratory Sydrome Coronavirus 2 Violate Longstanding Codes of Human Subjects Research
Authors: Spinola Stanley M , Broderick Camilla , Zimet Gregory D , Ott Mary A 
Published: December 2020

Abstract
This manuscript explores the ethics of human inoculation experiments in young healthy adults with wild-type severe acute respiratory sydrome coronavirus 2 (SARS-CoV-2) as a tool to evaluate vaccine efficacy in the context of the Nuremberg Code, the Declaration of Helsinki, and the Belmont Report, and in the context of dose-response relationships with infectious agents. Despite societal pressure to develop a SARS-CoV-2 challenge model to evaluate vaccines, we argue that there are substantial risks that cannot be adequately defined because the dose of SARS-CoV-2 that causes severe disease in young adults is unknown. In the absence of curative therapy, even if a volunteer consents, longstanding ethical codes governing human subjects research preclude the conduct of such experiments.
Histological Evidence of Pulmonary Microthrombosis and Vasculitis in Life-Threatening Respiratory Virus Diseases
Authors: Dolby Heather W , Potey Philippe , Wilder-Smith Annika B , Clohisey Sara , Millar Jonathan E , Baillie J Kenneth , Dorward David A , Lucas Christopher D , Russell Clark D 
Published: December 2020

Abstract
Pulmonary microthrombosis and vasculitis occur in fatal coronavirus disease 2019. To determine whether these processes occur in other life-threatening respiratory virus infections, we identified autopsy studies of fatal influenza (n  =  455 patients), severe acute respiratory syndrome ([SARS] n  =  37), Middle East respiratory syndrome (n  =  2), adenovirus (n  =  34), and respiratory syncytial virus (n  =  30). Histological evidence of thrombosis was frequently present in adults with fatal influenza and SARS, with vasculitis also reported.
Aorto-cavitary fistula to the left ventricle with severe aortic regurgitation as a complication of prosthetic valve infective endocarditis: a novel report
Authors: Sanchez-Nadales Alejandro , Celis-Barreto Valentina , Khan Amir , Anampa-Guzman Andrea , Olanipekun Olalekan 
Published: December 2020

ABSTRACT
Infective endocarditis can present in different clinical forms and lead to a variety of complications depending on the affected valvular and perivalvular structures. We describe a case of a 74-year-old male who developed an aortic-cavitary fistulous tract as a complication of prosthetic aortic valve infective endocarditis. Transesophageal echocardiography (TEE) revealed an aorto-cavitary fistula (ACF) connecting the aortic root with the left ventricle, creating an intracardiac shunt, which resulted in severe aortic regurgitation physiology. The patient underwent surgery with successful exclusion of the ACF. ACF is an unusual complication of infective endocarditis that creates an abnormal communication between the aortic root and the heart chambers, establishing an intracardiac shunt. This case highlights that physicians should be aware of the possibility of rare cardiac complications in infective endocarditis. TEE is a valid diagnostic test for ACF.
Butane-induced acute global myocardial ischemia without coronary artery pathology
Authors: Grigorov Vladimir , Grigorov Mladen , Grigorov Evgeni , Nocheva Hristina 
Published: December 2020

ABSTRACT
The case report describes a case of acute myocardial ischemia precipitated by propane butane inhalation. The dependency of this substance around the world is still moderate but is increasing due to the easy availability of the substance and the facility with which the effects can be concealed. The toxicity of the substance is significant; affecting the heart, the brain and the liver. The most common outcome is sudden death. In this article, we describe a survivor after an episode of acute poisoning and his interesting cardiac pathology.
An unusual cause of recurrent pediatric vomiting (an extraluminal pyloric duplication cystic): A case report
Authors: Doya Leen Jamel , Hassan Naya Talal , Bijow Fareeda Wasfy , Mansour Hanin Ahmed , Ahmad Sawsan , Nooh Fedaa , Ibrahim Ali 
Published: December 2020

ABSTRACT
Vomiting is a common symptom of a multitude of diseases in children. It is usually part of benign illness and can occur at any age. Recurrent vomiting can be a symptom of life-threatening medical or surgical emergencies. It can be rarely caused by an extraluminal pyloric duplication cyst. Early recognition is essential for preventing delays in management and potential complications.
Here we report a case of an extraluminal pyloric duplication presenting as progressive gastric outlet obstruction cyst in a 14-month-old Syrian boy. The diagnosis was made through abdominal ultrasound, gastrointestinal endoscopy and abdominal computed tomography scan.
Association of autosomal dominant polycystic kidney disease, asymptomatic multiple giant coronary arteries aneurysms and abdominal aortic aneurysm: a case report
Authors: Hindawy Abdullah Rida , Daboul Baraa , Hanafi Ibrahem , Albitar Sami 
Published: December 2020

ABSTRACT
Autosomal dominant polycystic kidney disease (ADPKD) is a systemic disease characterized by the formation of multiple cysts in several organs. The formation of aneurysms accompanying this disease is being increasingly reported in the literature, and mutations in PKD-1 and PKD-2 are suspected in this etiology. Although the association between ADPKD and multiple coronary arteries aneurysms (CAA) was reported several times, we are presenting a case with the combination of ADPKD, multiple giant CAAs, abdominal aortic aneurysms and a suspected intracranial aneurysm, which has never been reported. The asymptomatic presentation of these multiple aneurysms might support the recommendations for further diagnostic investigations in these patients.
Neutrophil to lymphocyte ratio is a prognosis factor for post-operative pneumonia in aneurysmal subarachnoid hemorrhage patients
Authors: Chen Yue , Lian Bao-Qiang , Peng Lei , Ding Chen-Yu , Lin Yuan-Xiang , Yu Liang-Hong , Wang Deng-Liang , Kang De-Zhi 
Published: December 2020

Abstract

Background:
Although a variety of risk factors of pneumonia after clipping or coiling of the aneurysm (post-operative pneumonia [POP]) in patients with aneurysmal subarachnoid hemorrhage (aSAH) have been studied, the predictive model of POP after aSAH has still not been well established. Thus, the aim of this study was to assess the feasibility of using admission neutrophil to lymphocyte ratio (NLR) to predict the occurrence of POP in aSAH patients.

Methods:
We evaluated 711 aSAH patients who were enrolled in a prospective observational study and collected admission blood cell counts data. We analyzed available demographics and baseline variables for these patients and analyzed the correlation of these factors with POP using Cox regression. After screening out the prognosis-related factors, the predictive value of these factors for POP was further assessed.

Results:
POP occurred in 219 patients (30.4%) in this cohort. Patients with POP had significantly higher NLR than those without (14.11 ± 8.90 vs. 8.80 ± 5.82, P < 0.001). Multivariate analysis revealed that NLR remained a significant factor independently associated with POP following aSAH after adjusting for possible confounding factors, including the age, World Federation of Neurosurgical Societies (WFNS) grade, endovascular treatment, and ventilator use. And the predictive value of NLR was significantly increased after WFNS grade was combined with NLR (NLR vs. WFNS grade × NLR, P = 0.011).

Conclusions:
Regardless of good or poor WNFS grade, patients having NLR >10 had significantly worse POP survival rate than patients having NLR ≤10. NLR at admission might be helpful as a predictor of POP in aSAH patients.
Mobility Deterioration During Acute Pneumonia Illness Is Associated With Increased Hospital Length of Stay and Health Service Costs: An Observational Study
Authors: Lloyd Melanie , Callander Emily , Simons Koen , Karahalios Amalia , Maguire Graeme , Janus Edward , Karunajeewa Harin 
Published: December 2020

Purpose:
To assess the association of mobility deterioration during community-acquired pneumonia (CAP) illness on length of stay (LOS), readmissions, and institutional costs.

Methods:
This longitudinal observational study included 347 individuals hospitalized with CAP. All were offered routine early mobilization with a physiotherapist within 24 hours of admission and then daily during hospital stay. The exposure of interest was mobility status at time of clinical stability when compared with the premorbid level. Modelling adjusted for factors such as age, residential status, premorbid mobility level, comorbidities, and pneumonia severity.

Results:
One hundred forty-one (41%) individuals met the definition of mobility deterioration during the acute illness. The mean (95% confidence interval [CI]) time from achievement of clinical stability to hospital discharge for the groups with and without mobility deterioration was 5.7 (4.2–7.2) and 2.3 (1.4–3.2) days, respectively, with associated higher hospitalization costs (arithmetic mean ratio [95% CI] 1.61 [1.24–2.10]) in the mobility deterioration group. There was no evidence of an association between mobility deterioration and 90-day readmission (odds ratio [95% CI]: 1.34 [0.81–2.24]).

Conclusions:
Mobility deterioration during acute pneumonia illness has a significant impact on hospital LOS and resource use even in a hospital system that has an early mobility program. Further research is needed to investigate these associations and alternative interventions.

Trial registration:
ClinicalTrials.gov, Identifier: NCT02835040.
A Survey of Factors That May Cause Practice Inconsistencies and Impact Care in Pulmonary Rehabilitation
Authors: Pata Rachel W. , Giblin Jillian , Cassata Emily , Cortez Regina , Pascale Alicia , Hall Megan 
Published: December 2020

Purpose:
Research about methods implemented in pulmonary rehabilitation is needed. Inconsistencies in this multifaceted intervention may impact care.

Methods:
A survey was administered to outpatient pulmonary rehabilitation programs, addressing program characteristics, and perceived importance and frequency of rehabilitation components. Descriptive statistics and post-hoc correlations were analyzed.

Results:
Clinicians present during exercise included respiratory therapists (72.2%), exercise physiologists (50%), registered nurses (44.4%), physical therapists (11.1%), occupational therapists (5.6%), dieticians (5.6%), and physicians (5.6%). On a scale of 1 to 5 (never vs always), programs provided: exercises for all extremities (5), individualized exercise (4.89, SD = 0.46), resistance training (4.5, SD = 0.83), balance training (3.28, SD = 1.1), alternative exercise methods (1.94, SD = 1.55), home equipment education (3.44, SD = 1.12), social support avenues (3.83, SD = 1.26), and home safety assessments (1.56, SDs = 1.07). All programs offered warm-up, cool down, and breathing exercises; 44% offered inspiratory resistance training, 22% high-intensity aerobic, and 11% high-intensity interval training. Twenty-four varied resources were used for patient education. Smoking cessation and nutritional consults were inconsistently offered. Reported limiting factors included compliance (66.7%), transportation (55.6%), staffing (33.3%), and facility size (33.3%).

Conclusions:
Limited resources, varied personnel, and patient compliance may contribute to practice inconsistencies. Improved resources, transportation, and an inclusive team may improve care standardization.
WITH OR WITHOUT INTERNAL LIMITING MEMBRANE PEELING FOR IDIOPATHIC EPIRETINAL MEMBRANE
Authors: Sun Yi , Zhou Rouxi , Zhang Bowen 
Published: December 2020

Purpose:
To clarify whether internal limiting membrane (ILM) peeling provides better outcomes for patients with idiopathic epiretinal membrane.

Methods:
Randomized controlled trials comparing epiretinal membrane removal with and without ILM peeling were searched in Embase, PubMed, Web of Science, Cochrane Library, and CNKI before April 15, 2020. The pooled mean difference (MD) for best-corrected visual acuity, central macular thickness, and odds ratio for recurrence were calculated.

Results:
Eight randomized controlled trials involving 422 eyes were included. No significant difference in best-corrected visual acuity (final follow-up: MD, 0.03 logarithm of the minimum angle of resolution [1.5 Early Treatment Diabetic Retinopathy Study letters]; 95% confidence interval [CI], −0.04 to 0.09 [−4.5 to 2 Early Treatment Diabetic Retinopathy Study letters]; P = 0.40) or recurrence rate (odds ratio, 0.21; 95% CI, 0.04–1.05; P = 0.06) between the groups was observed. However, patients with ILM peeling presented thicker central macular thickness at 3 months (MD, 16.36; 95% CI, 1.26–31.46; P = 0.03), 6 months (MD, 22.64; 95% CI, 10.29–34.98; P = 0.0003) and the final follow-up (MD, 25.87; 95% CI, 13.96–37.79; P < 0.0001).

Conclusion:
The study showed that ILM peeling did not significantly improve the postoperative visual outcome or decrease recurrence, but result in thicker central macular thickness, indicating that it is inessential for idiopathic epiretinal membrane.
MICROCYSTIC MACULAR EDEMA AND CYSTOID MACULAR EDEMA BEFORE AND AFTER EPIRETINAL MEMBRANE SURGERY
Authors: Lee Dong Hyun , Park Sung Eun , Lee Christopher Seungkyu 
Published: December 2020

Purpose:
To investigate the types of intraretinal cysts that are associated with epiretinal membranes and to evaluate the effects of each type of intraretinal cyst on postoperative outcomes.

Methods:
Retrospective, cross-sectional study design. Patients who underwent preoperative fluorescent angiography and epiretinal membrane surgery from February 2014 to May 2019 were included. Intraretinal cysts were subdivided into cystoid macular edema with angiographic leakage and microcystic macular edema (MME) without angiographic leakage.

Results:
A total of 100 eyes from 100 patients were enrolled. Intraretinal cysts were present in 54 (54.0%) eyes before surgery, of which 27 (27.0%) eyes showed MME, 18 (18.0%) eyes showed cystoid macular edema, and 9 (9.0%) eyes showed cystoid macular edema and MME. After surgery, the number of eyes with cystoid macular edema decreased significantly (P < 0.001), whereas the number of eyes with MME did not (P = 0.302). Absence of preoperative MME, poorer initial visual acuity, increased central foveal thickness, and intact ellipsoidal zone were associated with favorable visual recovery (P = 0.035, 0.033, 0.018, and 0.035, respectively).

Conclusion:
Microcystic macular edema associated with epiretinal membranes was a poor prognostic factor for epiretinal membrane surgery. The persistent existence of MME after surgery affirms related chronic structural changes. Further studies should investigate whether earlier surgical intervention (possibly before the development of MME) benefits visual outcomes.
NATURAL COURSE OF VITREOMACULAR TRACTION IN EYES WITH DIABETIC RETINOPATHY AND FACTORS ASSOCIATED WITH SPONTANEOUS RELEASE
Authors: Garip Rüveyde , Çınar Ayça Küpeli , Çınar Abdulkadir Can , Gürlü Vuslat 
Published: December 2020

Purpose:
The aim of this study was to determine the natural course of vitreomacular traction (VMT) in patients with diabetic retinopathy and to evaluate the factors associated with VMT relief.

Methods:
Seventy-four eyes of 65 patients with VMT accompanying diabetic retinopathy were evaluated retrospectively. The presence of intravitreal injection and the presence of panretinal photocoagulation were obtained from the medical records of the patients. Spontaneous release of VMT, the horizontal length of vitreomacular traction, the presence of hyperreflective retinal spots, the presence of the epiretinal membrane, and the grade of VMT were evaluated from the spectral-domain optical coherence tomography images. Factors associated with the spontaneous release of VMT were evaluated by logistic regression analysis.

Results:
Spontaneous release was observed in 28 eyes (37.8%). The horizontal length of VMT was lower in the release of the VMT group compared with the persistent VMT group (P = 0.03). The persistent VMT group had a higher rate of hyperreflective retinal spots and epiretinal membrane compared with the release of the VMT group (respectively; P = 0.003 and P = 0.031). No statistically significant difference was observed between the release of VMT and persistent VMT groups in terms of intravitreal injection and panretinal photocoagulation treatment (respectively; P = 0.938 and P = 0.36). The absence of hyperreflective retinal spots was the most important prognostic factor for the spontaneous release of VMT (P = 0.029).

Conclusion:
Spontaneous release of VMT observed higher rates of patients without hyperreflective retinal spots, epiretinal membrane, and patients with lower horizontal length of VMT.
Reflections of COVID-19 on Dermatology Practice
Authors: Richardson Veronica L. , Garcia-Albea Victoria R. , Bort Nicole L. , Mayne Susan L. , Nolen Mary E. , Bobonich Margaret A. 
Published: December 2020

ABSTRACT
When the COVID-19 pandemic struck the United States in early 2020, few healthcare workers were prepared for what lay ahead. Dermatology nurses, medical assistants, and nurse practitioners experienced rapid changes in the way they conducted their daily practice. This article discusses many of those changes and explores the challenges these healthcare workers faced and continue to face. Almost every aspect of how dermatologic care was delivered prepandemic was affected. Some dermatology nurses, medical assistants, and nurse practitioners were redeployed to COVID-19 testing tents and inpatient hospital units or were asked to perform tasks to help support other healthcare workers. This article explores how clinical practice, dermatology staff, patient care, and education were affected. These changes forced dermatology healthcare workers to be brave, accept risks, and ultimately grow from these experiences.
Improving Inpatient Tobacco Treatment Measures: Outcomes Through Standardized Treatment, Care Coordination, and Electronic Health Record Optimization
Authors: Iannello Justin , Levitt Mary P. , Poetter Daniel , Bromberg David , James Leann , Cruz Melinda , Jean-Baptiste Marie , Henry Monique , Parissis Eleni I. , King Elizabeth D. , Antwi Catherine , Johnson Dawn , Skjerve Patti , Kothari Amit J. , Schweighardt Chris , Reynolds Ericka , Wood Kelley , Reiss Alexander 
Published: December 2020

ABSTRACT

Introduction:
The Centers for Disease Control and Prevention states that tobacco use is the largest and most preventable cause of disease and mortality in the United States. The Joint Commission implemented inpatient tobacco treatment measures (TTMs) in 2012 to encourage healthcare systems to create processes that help patients quit tobacco use through evidence-based care.

Methods:
A tobacco cessation care delivery system was implemented at James A. Haley Veterans' Hospital and Clinics, which included: standardized pathways within the Veterans Health Administration (VHA) electronic health record system to improve nicotine replacement therapy ordering; evidence-based tobacco cessation counseling; and improved care coordination for tobacco cessation treatment through the use of technological innovation.

Results:
Outcomes were obtained from the VHA quality metric reporting system known as Strategic Analytics for Improvement and Learning (SAIL). TOB-2 and TOB-3 (two Joint Commission inpatient TTMs) equivalent to tob20 and tob40 within SAIL improved by greater than 300% after implementation at James A. Haley Veterans' Hospital and Clinics.

Conclusion:
Implementation of a tobacco cessation care system at James A. Haley Veterans' Hospital and Clinics enhanced interdisciplinary coordination of tobacco cessation care and resulted in improvements of The Joint Commission inpatient TTMs by greater than threefold.
Processes for Trauma Care at Six Level I Trauma Centers During the COVID-19 Pandemic
Authors: Harwood Laura , Jarvis Stephanie , Salottolo Kristin , Redmond Diane , Berg Gina M. , Erickson Wendy , Spruell Dana , Deas Shenequa , Sharpe Paul , Atnip Amy , Cornutt David , Mains Charles , Bar-Or David 
Published: December 2020

ABSTRACT

Introduction:
As the COVID-19 pandemic spread, patient care guidelines were published and elective surgeries postponed. However, trauma admissions are not scheduled and cannot be postponed. There is a paucity of information available on continuing trauma care during the pandemic. The study purpose was to describe multicenter trauma care process changes made during the COVID-19 pandemic.

Methods:
This descriptive survey summarized the response to the COVID-19 pandemic at six Level I trauma centers. The survey was completed in 05/2020. Questions were asked about personal protective equipment, ventilators, intensive care unit (ICU) beds, and negative pressure rooms. Data were summarized as proportions.

Results:
The survey took an average of 5 days. Sixty-seven percent reused N-95 respirators; 50% sanitized them with 25% using ultraviolet light. One hospital (17%) had regional resources impacted. Thirty-three percent created ventilator allocation protocols. Most hospitals (83%) designated more beds to the ICU; 50% of hospitals designated an ICU for COVID-19 patients. COVID-19 patients were isolated in negative pressure rooms at all hospitals.

Conclusions:
In response to the COVID-19 pandemic, Level I trauma centers created processes to provide optimal trauma patient care and still protect providers. Other centers can use the processes described to continue care of trauma patients during the COVID-19 pandemic.
Examining the Implementation of Physical Activity and Healthy Eating Policies in a Large, Public Health Organization
Authors: McCardel Rachel E. , Loedding Emily H. , Padilla Heather M. 
Published: December 2020

Objective:
To examine the implementation of physical activity and healthy eating policies in eighteen locations of a large, public health organization.

Methods:
We used a mixed-methods design that included a survey of employees to describe location characteristics (ie, number of employees, race/ethnicity of employees), a survey of wellness ambassadors to determine which policies were implemented, and semi-structured, telephone interviews with wellness ambassadors to examine the barriers and facilitators to policy implementation.

Results:
Six locations implemented both policies, nine locations only implemented the physical activity policy, and two locations did not implement either policy. Structural characteristics and geographic spread impeded implementation, whereas leadership engagement and access to information about the policies facilitated implementation.

Conclusions:
Consistent and adequate policy implementation in each location of an organization is critical to providing equity in health promotion programs for employees.