bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of Color Vision Deficiency in an Adult Population in South Korea
Authors: Kim Hyojin , Ng Jason S. 
Published: November 2019

SIGNIFICANCELarge differences in failure rates for color vision screening have been reported among different regional groups. However, color vision deficiency prevalence in Korea has only been investigated within a small area of the country.PURPOSEThis study examines the prevalence of failing a color vision screening and its sex-related differences using a sample that is representative of the whole Korean population.METHODSThis population-based cross-sectional study evaluated 2686 subjects (age, 19 to 49 years) who participated in the sixth Korea National Health and Nutrition Examination Survey (2013). Color vision deficiency was assessed using the Hardy-Rand-Rittler (HRR) test by an ophthalmologist. According to standard criteria for the HRR, it classified each subject as color normal, protan, deutan, tritan, or unclassified color vision loss. All participants had comprehensive medical evaluations and ocular history taken.RESULTSThe weighted overall prevalence of color vision deficiency in the Korean population was 3.9% (95% confidence interval, 3.0 to 5.4%). The prevalence of color vision deficiency was higher in male participants (6.5%) than in female participants (1.1%). Among all participants, deutan deficiency (2.5%) had a higher prevalence than did protan deficiency (0.4%). For male participants who failed the HRR screening, deutan-type deficiency was detected most often (64.2%), whereas an unclassified color vision deficiency type was the most common (52.9%) among female participants who failed the HRR screening. As expected, male participants were more likely to fail the HRR screening compared with female participants (prevalence ratio, 6.08; 95% confidence interval, 3.61 to 10.26).CONCLUSIONSThis large population-based study of color vision deficiency among Koreans gives the most accurate estimate of failing a color vision screening test to date and provides useful information for planning adaptive strategies.
Significance of Morphine Concentration in Bile, Liver, and Blood
Authors: Mercurio Isabella , Ceraso Gianluigi , Melai Paola , Gili Alessio , Troiano Gianmarco , Agostinelli Fausto , Lancia Massimo , Bacci Mauro 
Published: November 2019

AbstractForensic pathologists are requested to select matrices alternative to blood in cases of toxicological interest in which blood is not available for different reasons. We evaluated morphine concentrations in blood, bile, and liver samples in 52 cases of heroin overdoses, relating them to each other, to understand the information that could be derived from their analysis. Gas chromatography/mass spectrometry analysis was performed for all the samples positive on screening for opiates. Shapiro-Wilk test, nonparametric Mann-Whitney test, linear regression analysis, and Bland-Altman test were used for analysis. Linear regression demonstrated that there was not a statistically significant association in morphine concentrations between blood and bile and blood and liver. Mean liver/blood ratio was 2.76, varying from 0.131 to 13.379, and bile/blood ratio was 28.79, varying from 0.28 to 559.16. According to these results, bile analysis is a “screening test”; biliary or hepatic concentration of morphine cannot provide information on hematic concentration at the time of death, having no forensic value taken individually.
Causes of Sudden Unexpected Death in Schizophrenia Patients
Authors: Sun Daming , Li Liliang , Zhang Xiang , Blanchard Thomas G. , Fowler David R. , Li Ling 
Published: November 2019

Background
Schizophrenia is a detrimental psychiatric disorder, with an increased mortality from natural and nonnatural causes.

Methods
This study was a retrospective review of autopsy cases of all the individuals with history of schizophrenia investigated by the Office of the Chief Medical Examiner, State of Maryland, for a 5-year period from 2008 to 2012.

Result
A total of 391 schizophrenia patients were autopsied at the Office of the Chief Medical Examiner because they died suddenly and unexpectedly. Their age ranged from 15 to 100 years with the mean age of 49.5 years. Of the 391 deaths, 191 (48.8%) were white, 185 (47.3%) were African American, and 15 (3.9%) were either Hispanic or Asian. The male and female ratio was 1.5:1. The majority of deaths (64.2%) were caused by natural diseases, 12.0% deaths were accidents, 11.5% deaths were suicides, and 9.7% deaths were homicides. The manner of death remained undetermined in 38 cases (9.7%). Of the 251 natural deaths, 198 cases (78.9%) were owing to cardiovascular diseases. Cause of death was listed as cardiac arrhythmia in 11 cases. This diagnosis of cardiac arrhythmia was made by exclusion based on death scene investigation, review of medical history, complete autopsy, and toxicological tests. Drug intoxication was the second most common cause of death.

Conclusions
The study shows high fatality caused by cardiovascular diseases and drug intoxication among schizophrenia patients, which calls attention of the medical community to closely monitor the high risk factors of sudden death among schizophrenia patients.
Forensic Spermatozoa Detection
Authors: Suttipasit Papanu 
Published: November 2019

AbstractSemen is crucial evidence for some sex crimes, with its sole confirmation being sperm detection. The success of sperm detection is dependent on all levels of preanalytic and analytic procedures. Specimen collection must be performed by well-trained and competent forensic physicians as well as forensic nurses, with preservation done properly before laboratory transfer. Laboratory procedures should consider archival sperm identification, by visualization, with adequate amounts separated from other cells to obtain male DNA profiles. Differential extraction is robust and accepted as the forensic standard but is time consuming and may result in male DNA loss. Thus, alternative methods and microdevices have been developed. Challenges in sperm isolation from vaginal or buccal epithelium mixes and discrimination in multiperpetrator cases have been overcome by single-cell profiling; however, problems inherent in identical twin discrimination and azoospermia have yet to be solved. Epigenetics and future molecular biomarkers may hold the key; therefore, all laboratory processes must consider DNA and RNA protection. Long-term specimen preservation should be done when possible in light of future confirmatory tests.
Prescribing Patterns of Oral Opioid Analgesic for Acute Pain at a Tertiary Care Children's Hospital Emergency Departments and Urgent Cares
Authors: Wang George Sam , Reese Jennifer , Bakel Leigh Anne , Leonard Jan , Bielsky Alan , Reid Ashley , Bos Tod , Nickels Sarah , Bajaj Lalit 
Published: November 2019

Objectives
Despite Centers for Disease Control and Prevention guidelines on adult opioid prescribing, there is a paucity of evidence and no guidelines to inform opioid prescribing in pediatrics. To develop guidelines on pediatric prescribing, it is imperative to evaluate current practice on opioid use. The objectives were to describe prescribing patterns of opioids for acute pain at a children's hospital and to compare clinical characteristics of patients who received less or greater than 3 days.

Methods
A retrospective review of oral opioid analgesics prescribed for acute pain at a tertiary care children's hospital emergency department and urgent care from January 1, 2017, to December 31, 2017. Patients younger than 22 years who received an opioid prescription upon discharge were included. Patients with hematology/oncology or chronic pain diagnosis were excluded.

Results
Opioids were prescribed for a median of 2.2 days (interquartile range, 1.4–3.0 days). Most opioids were prescribed for ≤3 days (1326; 79.3%), and there were 44 (2.6%) prescriptions for >7 days. Twenty-two opioid formulations were prescribed. Single-ingredient oxycodone was the most commonly prescribed (877; 52.5%); there were 724 (43.3%) acetaminophen combination products. Common diagnoses were orthopedic (973; 58.2%), surgery/burn/trauma (195; 11.7%), and ear/nose/throat (143; 8.6%). Patients who received >3 days of opioids were younger (P < 0.001), and there was no differences in sex, ethnicity, insurance, or provider qualifications.

Conclusions
Overall, prescribing patterns for the duration of opioid analgesics were ≤3 days, with a median of 2 days. There was a large range of days prescribed, with variations in prescribing characteristics among patients and providers.
Attitudes Toward Electronic Sexual Health Assessments Among Adolescents in the Emergency Department
Authors: Langerman Steven D. , Badolato Gia M. , Goyal Monika K. 
Published: November 2019

Objectives
Adolescents account for nearly half of all newly diagnosed sexually transmitted infection (STI) cases in the United States and frequently access health care via emergency departments (EDs). However, there are many barriers to ED-based STI screening. Electronic sexual health assessments may overcome some of these ED-specific barriers. Thus, the objective of this study was to assess adolescent attitudes toward electronic sexual health assessments to guide STI screening in the ED.

Methods
This was a secondary analysis of data from 2 cross-sectional studies evaluating acceptability of electronic sexual health assessments in the pediatric ED. Study participants completed an electronic questionnaire that elicited sexual behavior information and attitudes toward electronic sexual health assessments. We interrogated the electronic health record to determine if sexual histories were documented, and if so, we assessed patient preference for mode of assessment. We performed multivariable logistic regression to identify demographic factors associated with acceptance of electronic sexual health assessments.

Results
Of the 1159 adolescents surveyed, 935 (80.7%; 95% confidence interval, 78.3–82.9) found electronic assessments an acceptable method by which to provide sexual health information. The majority (n = 874 [75.4%]; 72.8–77.9) reported a preference for electronic assessments over other modes of assessment. Acceptance of electronic assessments was associated with STI-related chief complaint (adjusted odds ratio, 1.7; 1.0–2.7) and private insurance (adjusted odds ratio, 1.8; 1.2–2.7).

Conclusions
Electronic sexual health assessments are acceptable to adolescents and are an efficient alternative to face-to-face sexual health assessments. Future studies should focus on how best to integrate electronic assessments into the ED workflow.
Liaison Public Health Nurse Project: Innovative Public Health Approach to Combat Infectious Disease in Hospitals
Authors: Sakamoto Sharon , Terashita Dawn , Balter Sharon 
Published: November 2019

Context:
Infectious disease threats, high incidence/prevalence of health care–associated infections, and multidrug-resistant organisms challenge hospitals to improve infection prevention/control strategies and infectious disease preparedness/response efforts.

Program:
The Los Angeles County (LAC) Department of Public Health (DPH), Hospital Outreach Unit (HOU) addressed this need with the liaison public health nurse (LPHN) project, which is designed to strengthen capacity and bridge the care continuum with hospitals to prevent/control infectious disease.

Implementation:
The project utilizes 5 LPHNs who interface with LAC hospitals to improve reporting of infectious disease/hospital outbreaks, strengthen the surveillance infrastructure, and enhance communication/collaboration. The LPHNs communicate regularly and meet one-on-one with hospital infection preventionists with focused discussion, consultation, and assessment of infectious disease, participate in joint infection control meetings/conferences/calls, outreach on joint public health projects, and educate/train hospital staff.

Evaluation:
Within the first 7 years of implementation (2003) of the unit, reporting of hospital outbreaks increased 27%; hospitals reporting infectious disease via a county reporting system increased 95% during the same period. Currently, 64% of hospitals are reporting via the electronic laboratory reporting system (automated transmission to public health of reportable laboratory findings). In addition, the number of hospital infection control committee meetings LPHNs were invited to increased 96% during the first 7 years. The LPHNs/HOU participate(d) in 9 joint infection prevention/control projects with hospitals.

Discussion:
The threat of emerging infectious disease, health care–associated infections, and multidrug-resistant organisms is an ongoing challenge. Preventing infectious disease requires innovative approaches to effect and empower hospitals to respond. The LAC DPH LPHN project has proved to be an invaluable resource and key component to enable effective communication/collaboration to improve infection prevention and control strategies/preparedness efforts and protect the public's health from infectious disease.
Factors Associated With Latent Tuberculosis Infection Treatment Failure Among Patients With Commercial Health Insurance—United States, 2005-2016
Authors: Iqbal Shareen A. , Isenhour Cheryl J. , Mazurek Gerald , Langer Adam J. , Chang Man-Huei , Truman Benedict I. 
Published: November 2019

Context:
Approximately 80% of US tuberculosis (TB) cases verified during 2015-2016 were attributed to untreated latent TB infection (LTBI). Identifying factors associated with LTBI treatment failure might improve treatment effectiveness.

Objective:
To identify patients with indicators of isoniazid (INH) LTBI treatment initiation, completion, and failure.

Methods:
We searched inpatient and outpatient claims for International Classification of Diseases (Ninth and Tenth Revisions), National Drug, and Current Procedural Terminology codes. We defined treatment completion as 180 days or more of INH therapy during a 9-month period. We defined LTBI treatment failure as an active TB disease diagnosis more than 1 year after starting LTBI treatment among completers and used exact logistic regression to model possible differences between groups. Among treatment completers, we matched 1 patient who failed treatment with 2 control subjects and fit regression models with covariates documented on medical claims paid 6 months or less before INH treatment initiation.

Participants:
Commercially insured US patients in a large commercial database with insurance claims paid during 2005-2016.

Main Outcome Measures:
(1) Trends in treatment completion; (2) odds ratios (ORs) for factors associated with treatment completion and treatment failure.

Results:
Of 21 510 persons who began LTBI therapy during 2005-2016, 10 725 (49.9%) completed therapy. Treatment noncompletion is associated with those younger than 45 years, living in the Northeast or South Census regions, and women. Among persons who completed treatment, 30 (0.3%) progressed to TB disease. Diagnoses of rheumatoid arthritis during the 6 months before treatment initiation and being aged 65 years or older (reference: ages 0-24 years) were significantly associated with INH LTBI treatment failure (adjusted exact OR = 5.1; 95% CI, 1.2-28.2; and adjusted exact OR = 5.1; 95% CI, 1.2-25.3, respectively).

Conclusion:
Approximately 50% of persons completed INH LTBI therapy, and of those, treatment failure was associated with rheumatoid arthritis and persons 65 years or older among a cohort of US LTBI patients with commercial health insurance.
Factors Facilitating or Hindering Use of Evidence-Based Diabetes Interventions Among Local Health Departments
Authors: Poehler Allison R. , Parks Renee G. , Tabak Rachel G. , Baker Elizabeth A. , Brownson Ross C. 
Published: November 2019

Objective:
The objective of this study was to assess facilitators, barriers, and capacities to use of evidence-based programs and policies (EBPPs) in local health departments (LHDs).

Design:
A qualitative study design was used to elicit a contextual understanding of factors. One-hour interviews were conducted among directors and diabetes/chronic disease practitioners from LHDs. A consensus coding approach was used to identify themes.

Setting and Participants:
Twenty-four participants from 14 Missouri LHDs completed interviews.

Results:
Themes were identified as facilitators, barriers, or capacities that enhance EBPP use. Facilitators included awareness of EBPPs, leadership and supervisor support of EBPP use, and facilitators to increase capacity to implement EBPPs. Skills development, targeted messaging, and understanding of evidence-based decision-making (EBDM) terminology were needed. Barriers to EBPPs use were described at the individual, organizational, and interorganizational levels and included community buy-in, limited resources, relevance to partners, and time scarcity. Capacities included the ways LHDs learn about EBPPs, methods that influence the use of EBPPs, and resources needed to sustain EBPPs. Top ways to learn about EBPPs were in-person interactions. Staff meetings, meetings with decision makers, and relevant evidence influenced decision making. Resources needed were funding, organizational capacity, and partnerships. Directors' and practitioners' views differed on type of agency culture that promoted EBPP use, preferences for learning about EBPPs, ways to influence decisions, needs, and barriers to EBPPs.

Conclusions:
These findings can inform future strategies to support uptake of EBPPs in diabetes and chronic disease control in LHDs. LHDs have a good understanding of EBPPs, but subtle differences in perception of EBPPs and needs exist between directors and practitioners. Investment in capacity building and fostering an organizational culture supportive of EBDM were key implications for practice. By investing in employee skill development, LHDs may increase agency capacity. Researchers should use preferred channels and targeted messaging to disseminate findings.
Changes in Muscle Activation and Ground Reaction Force of the Lower Limbs According to Foot Placement During Sit-to-Stand Training in Stroke Patients
Authors: Noh Hyeon-Je , Kim Chang-Yong , Kim Hyeong-Dong , Kim Suhng-Wook 
Published: November 2019

Objective
The aims of the study were to investigate the kinetic effects of sit-to-stand training in various foot positions on the coronal plane in patients with strokes and to suggest appropriate exercises.

Design
Thirty-six poststroke subjects participated in this study. The subjects performed three sit-to-stand trials in the following foot positions: (a) symmetric foot positioning (symmetric), (b) affected foot placed to the side (asymmetric 1), and (c) and less affected foot placed to the side (asymmetric 2). They were asked to perform sit-to-stand training at a spontaneous velocity and remain standing for 5 secs, whereas the vertical ground reaction force was measured using force platforms. The activation of lower limb muscles was evaluated using surface electromyography, and the peak and mean vertical ground reaction force and weight-bearing symmetry ratio were evaluated using force platforms.

Results
Our results showed significant increases in the muscle activation, peak and mean vertical ground reaction force, and weight-bearing symmetry ratio of the lower limbs using the asymmetric 2 strategy (P < 0.05).

Conclusions
Our results suggest that sit-to-stand training with the less affected foot placed to the side by the width of the subject’s foot may be the most beneficial in the rehabilitation of patients with hemiparetic stroke.
The Role of Subsymptom Threshold Aerobic Exercise for Persistent Concussion Symptoms in Patients With Postconcussion Syndrome
Authors: McIntyre McKyla , Kempenaar Ainsley , Amiri Mohammadreza , Alavinia Seyed Mohammad , Kumbhare Dinesh 
Published: November 2019

AbstractIn recent years, there has been a shift away from rest until total symptom resolution after concussion, due to the potential adverse consequences of inactivity. Aerobic exercise has been increasingly investigated for the treatment of postconcussion syndrome, whereby symptoms persist beyond 4 wks. The aim of this review was to systematically review the literature on subsymptom threshold aerobic exercise as a treatment for postconcussion syndrome. We conducted systematic literature searches in databases: MEDLINE (Ovid), CINAHL, PubMed, and Embase. After thorough review, 12 articles met the eligibility criteria and were included in the systematic review. The quality of selected studies was low to moderate. Subsymptom threshold aerobic exercise was associated with improvement in symptoms in patients with postconcussion syndrome for all included studies. The most commonly used protocols incorporated 20 mins of exercise at 80% of the heart rate that provoked symptoms, 5–6 days per week, with no adverse events documented. However, there was considerable variation in exercise protocols, and many studies incorporated subsymptom threshold aerobic exercise as part of a broader rehabilitation plan. Evidence supports subsymptom threshold aerobic exercise as a promising treatment for postconcussion syndrome. Further studies are required to delineate the optimal intensity, duration, and frequency of exercise for postconcussion syndrome in a variety of populations.
Effects of Elastic Resistance Exercise After Total Knee Replacement on Muscle Mass and Physical Function in Elderly Women With Osteoarthritis
Authors: Liao Chun-De , Tsauo Jau-Yih , Chiu Yen-Shuo , Ku Jan-Wen , Huang Shih-Wei , Liou Tsan-Hon 
Published: November 2019

Objective
Knee osteoarthritis and age are associated with high sarcopenia risk, especially in patients who have received total knee replacement. The aim of this study was to identify the effects of elastic resistance exercise training after total knee replacement on muscle mass and physical outcomes in older women with knee osteoarthritis.

Design
Sixty older women who received unilateral primary total knee replacement surgery were randomized to an experimental group, which received 12 wks of postoperative elastic resistance exercise training, or a control group, which received standard care. The outcome measures included physical function performance (ie, Timed Up & Go, gait speed, forward reach, single-leg stance, timed chair rise), appendicular lean mass, and the Western Ontario and McMaster Universities Osteoarthritis Index. The assessment time points were 2 wks before surgery (T0), 1 mo after surgery (T1, before resistance exercise training), and 4 mos after surgery (T2, upon completion of resistance exercise training).

Results
After 12 wks of postoperative elastic resistance exercise training, the experimental group exhibited a significantly greater change in appendicular lean mass (mean difference = 0.81 kg, P = 0.004) than the control group. Elastic resistance exercise training also exerted significant effects on Timed Up & Go and gait speed with mean differences of 0.28 m/sec (P < 0.001) and −2.66 secs (P < 0.001), respectively.

Conclusions
A 12-wk elastic resistance exercise training program after total knee replacement exerted benefits on muscle mass, mobility, and Western Ontario and McMaster Universities Osteoarthritis Index functional outcomes in older women with knee osteoarthritis.