bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Association Between High and Unnecessary Antibiotic Prescribing: A Cohort Study Using Family Physician Electronic Medical Records
Authors: Kitano Taito , Langford Bradley J , Brown Kevin A , Pang Andrea , Chen Branson , Garber Gary , Daneman Nick , Tu Karen , Leung Valerie , Candido Elisa , Wu Julie Hui-Chih , Hwee Jeremiah , Silverman Michael , Schwartz Kevin L 
Published: August 2020

Abstract

Background
Approximately 25% of outpatient antibiotic prescriptions are unnecessary among family physicians in Canada. Minimizing unnecessary antibiotics is key for community antibiotic stewardship. However, unnecessary antibiotic prescribing is much harder to measure than total antibiotic prescribing. We investigated the association between total and unnecessary antibiotic use by family physicians and evaluated inter-physician variability in unnecessary antibiotic prescribing.

Methods
This was a cohort study based on electronic medical records of family physicians in Ontario, Canada, between April 2011 and March 2016. We used predefined expected antibiotic prescribing rates for 23 common primary care conditions to calculate unnecessary antibiotic prescribing rates. We used multilevel Poisson regression models to evaluate the association between total antibiotic volume (number of antibiotic prescriptions per patient visit), adjusted for multiple practice- and physician-level covariates, and unnecessary antibiotic prescribing.

Results
There were 499 570 physician–patient encounters resulting in 152 853 antibiotic prescriptions from 341 physicians. Substantial inter-physician variability was observed. In the fully adjusted model, we observed a significant association between total antibiotic volume and unnecessary prescribing rate (adjusted rate ratio 2.11 per 10% increase in total use; 95% CI 2.05–2.17), and none of the practice- and physician-level variables were associated with unnecessary prescribing rate.

Conclusions
We demonstrated substantial inter-physician variability in unnecessary antibiotic prescribing in this cohort of family physicians. Total antibiotic use was strongly correlated with unnecessary antibiotic prescribing. Total antibiotic volume is a reasonable surrogate for unnecessary antibiotic use. These results can inform community antimicrobial stewardship efforts.
Pretreatment and Acquired Antiretroviral Drug Resistance Among Persons Living With HIV in Four African Countries
Authors: Crowell Trevor A , Danboise Brook , Parikh Ajay , Esber Allahna , Dear Nicole , Coakley Peter , Kasembeli Alex , Maswai Jonah , Khamadi Samoel , Bahemana Emmanuel , Iroezindu Michael , Kiweewa Francis , Owuoth John , Freeman Joanna , Jagodzinski Linda L , Malia Jennifer A , Eller Leigh Ann , Tovanabutra Sodsai , Peel Sheila A , Ake Julie A , Polyak Christina S ,   AFRICOS Study Group
Published: August 2020

AbstractBackgroundEmerging HIV drug resistance (HIVDR) could jeopardize the success of standardized HIV management protocols in resource-limited settings. We characterized HIVDR among antiretroviral therapy (ART)-naive and experienced participants in the African Cohort Study (AFRICOS).MethodsFrom January 2013 to April 2019, adults with HIV-1 RNA &gt;1000 copies/mL underwent ART history review and HIVDR testing upon enrollment at 12 clinics in Uganda, Kenya, Tanzania, and Nigeria. We calculated resistance scores for specific drugs and tallied major mutations to non-nucleoside reverse transcriptase inhibitors (NNRTIs), nucleoside reverse transcriptase inhibitors (NRTIs), and protease inhibitors (PIs) using Stanford HIVDB 8.8 and SmartGene IDNS software. For ART-naive participants, World Health Organization surveillance drug resistance mutations (SDRMs) were noted.ResultsHIVDR testing was performed on 972 participants with median age 35.7 (interquartile range [IQR] 29.7–42.7) years and median CD4 295 (IQR 148–478) cells/mm3. Among 801 ART-naive participants, the prevalence of SDRMs was 11.0%, NNRTI mutations 8.2%, NRTI mutations 4.7%, and PI mutations 0.4%. Among 171 viremic ART-experienced participants, NNRTI mutation prevalence was 83.6%, NRTI 67.8%, and PI 1.8%. There were 90 ART-experienced participants with resistance to both efavirenz and lamivudine, 33 (36.7%) of whom were still prescribed these drugs. There were 10 with resistance to both tenofovir and lamivudine, 8 (80.0%) of whom were prescribed these drugs.ConclusionsParticipants on failing ART regimens had a high burden of HIVDR that potentially limited the efficacy of standardized first- and second-line regimens. Management strategies that emphasize adherence counseling while delaying ART switch may promote drug resistance and should be reconsidered.
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), a newly emerged pathogen: an overview
Authors: Rathore Jitendra Singh , Ghosh Chaitali 
Published: August 2020

ABSTRACT
Coronavirus disease 2019 (COVID-19) is a viral pneumonia, responsible for the recent pandemic, and originated from Wuhan, China, in December 2019. The causative agent of the outbreak was identified as coronavirus and designated as severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2). Few years back, the severe acute respiratory syndrome coronavirus (SARS- CoV) and the Middle East respiratory syndrome coronavirus (MERS-CoV) were reported to be highly pathogenic and caused severe infections in humans. In the current situation SARS-CoV-2 has become the third highly pathogenic coronavirus that is responsible for the present outbreak in human population. At the time of this review, there were more than 14 007 791 confirmed COVID-19 patients which associated with over 597 105 deaths in more then 216 countries across the globe (as reported by World Health Organization). In this review we have discussed about SARS-CoV, MERS-CoV and SARC-CoV-2, their reservoirs, role of spike proteins and immunogenicity. We have also covered the diagnosis, therapeutics and vaccine status of SARS-CoV-2.
Development of a porcine model of emergency resternotomy at a low-volume cardiac surgery centre
Authors: Guenther Timothy M , Chen Sarah A , Gustafson Joshua D , Wozniak Curtis J , Kiaii Bob 
Published: August 2020

Abstract
Emergency resternotomy in the intensive care unit (ICU) is a rarely performed, yet potentially life-saving intervention. Success relies on recognition of a deteriorating clinical condition, timely deployment of equipment/personnel and rapid execution. Given how infrequently it is performed, we sought to develop a large animal model of resternotomy to prepare ICU nurses and technicians at our low-volume cardiac surgery military centre. A porcine model of resternotomy was developed at the end of an already-scheduled trauma lab. Participants worked their way through a pre-planned simulation scenario, culminating in the need for resternotomy. Pre-simulation surveys assessing knowledge and comfort level with aspects of resternotomy were compared to post-simulation surveys. Participants improved their knowledge of resternotomy by 20.4% (P &lt; 0.0001; 14.7% for nurses and 26.9% for technicians). Improvements were seen in all aspects assessed relating to subjective comfort/preparedness of resternotomy. The model was an effective and realistic method to augment training of ICU staff about resternotomy. Costs associated with this model can be reduced when used in conjunction with large animal labs. This model should be used together with mannequin-based methods of resternotomy training to provide a realistic training environment and assessment of skills at capable institutions.
Fraïssé–Hintikka theorem in institutions
Authors: Găină Daniel , Kowalski Tomasz 
Published: August 2020

Abstract
We generalize the characterization of elementary equivalence by Ehrenfeucht–Fraïssé games to arbitrary institutions whose sentences are finitary. These include many-sorted first-order logic, higher-order logic with types, as well as a number of other logics arising in connection to specification languages. The gain for the classical case is that the characterization is proved directly for all signatures, including infinite ones.
Global 3D hydrodynamic modeling of absorption in Lyα and He 10830 A lines at transits of GJ3470b
Authors: Shaikhislamov I F , Khodachenko M L , Lammer H , Berezutsky A G , Miroshnichenko I B , Rumenskikh M S 
Published: August 2020

Abstract
Warm Neptune GJ3470b has been recently observed in 23S-23P transition of metastable helium, yielding absorption of about 1 per cent in Doppler velocity range of [-40; 10] km/s. Along with previous detection of absorption in Lyα with depth of 20–40 per cent in the blue and red wings of the line, it offers a complex target for simulation and testing of the current models. Obtained results suggest that absorption in both these lines comes from interaction of expanding upper planetary atmosphere with stellar plasma wind, allowing to constrain the stellar plasma parameters and the helium abundance in planet atmosphere.
They Don’t See a Lot of People My Color: A Mixed Methods Study of Racial/Ethnic Stereotype Threat Among Medical Students on Core Clerkships
Authors: Bullock Justin L. , Lockspeiser Tai , del Pino-Jones Amira , Richards Regina , Teherani Arianne , Hauer Karen E. 
Published: August 2020

Purpose
Stereotype threat is an important psychological phenomenon in which fear of fulfilling negative stereotypes about one’s group impairs performance. The effects of stereotype threat in medical education are poorly characterized. This study examined the prevalence of racial/ethnic stereotype threat amongst fourth-year medical students and explored its impact on students’ clinical experience.

Method
This was an explanatory sequential mixed methods study at 2 institutions in 2019. First, the authors administered the quantitative Stereotype Vulnerability Scale (SVS) to fourth-year medical students. The authors then conducted semistructured interviews among a purposive sample of students with high SVS scores, using a qualitative phenomenographic approach to analyze experiences of stereotype threat. The research team considered reflexivity through group discussion and journaling.

Results
Overall, 52% (184/353) of students responded to the survey. Collectively, 28% of students had high vulnerability to stereotype threat: 82% of Black, 45% of Asian, 43% of Latinx, and 4% of White students. Eighteen students participated in interviews. Stereotype threat was a dynamic, 3-stage process triggered when students experienced the workplace through the colored lens of race/ethnicity by standing out, reliving past experiences, and witnessing microaggressions. Next, students engaged in internal dialogue to navigate racially charged events and workplace power dynamics. These efforts depleted cognitive resources and interfered with learning. Finally, students responded and coped to withstand threats. Immediate and deferred interventions from allies reduced stereotype threat.

Conclusions
Stereotype threat is common, particularly among non-White students, and interferes with learning. Increased minority representation and developing evidence-based strategies for allyship around microaggressions could mitigate effects of stereotype threat.
Expanding the Traditional History and Physical Examination to Address Chronic Diseases and Social Needs: A Multisite Randomized Control Trial of 4 Medical Schools
Authors: Kirley Kate , Hayer Rupinder , Khan Tamkeen , Johnson Eric , Sanchez Erin Stephany , Kosowicz Lynn , Terry Valerie , Henderson David , Krebsbach Cory , Park Yoon Soo , Dekhtyar Michael , Williams Brent C. 
Published: August 2020

Purpose
This study gathers validity evidence of an expanded History and Physical examination (H&P 360) to address chronic diseases through incorporation of biopsychosocial elements that are lacking in traditional H&P assessments via a multisite randomized controlled trial among medical students.

Method
Third- and fourth-year medical students (n = 159) at 4 schools participated in an Objective Structured Clinical Examination designed with 2 cases for chronic disease. Students were randomized into the treatment group, which involved brief written instructions on how to use the H&P 360 followed by a standardized patient (SP) interaction, or the control group, which used the traditional H&P in an SP interaction without additional instructions. Validity evidence was gathered for content (alignment with an empirically derived expanded history list), response process (feedback from raters and learners on the process), internal structure (reliability and item-level psychometrics), relations to other variables (comparison between treatment and control groups), and consequences (survey results from learners on experience).

Results
H&P 360 items were blueprinted by faculty experts. SP observation checklist grading was consistent, and postassessment debrief confirmed favorable educational experience among learners. The reliability of the H&P 360 was .76. Overall mean scores on the H&P 360 content (mean = 15.96, standard deviation [SD] = 3.66) were significantly higher compared with the traditional H&P (mean = 10.99, SD = 2.69, Cohen’s d = 1.17, P < .001).

Conclusions
Medical students using the H&P 360 collected significantly more biopsychosocial information compared with students using the traditional H&P, providing empirical support for teaching and assessing biopsychosocial information. The assessment demonstrated strong validity evidence supporting the use of the H&P 360 assessment in medical schools.
Patients, Pride, and Prejudice: Exploring Black Ontarian Physicians’ Experiences of Racism and Discrimination
Authors: Mpalirwa Joseph , Lofters Aisha , Nnorom Onye , Hanson Mark D. 
Published: August 2020

Purpose
Black physicians’ and trainees’ experiences of racism are not well documented in Canada, reflecting a knowledge gap needing correction to combat racism in Canadian health care. The authors undertook a descriptive study of Black physicians and trainees in the Canadian province of Ontario. The goal of this study was to report upon racism experienced by participant Ontarian physicians to challenge the purported rarity of racism in Canadian health care.

Method
An anonymous online survey of physicians and trainees who self-identify as Black (African/Afro-Canadian/African American/Afro-Caribbean) was administered in March and April 2018 through the Black Physicians’ Association of Ontario (BPAO) listserv. The survey was modeled on qualitative interview guides from American studies. Snowball sampling was employed whereby BPAO members forwarded the survey to eligible colleagues (non-BPAO members) to maximize responses. Survey data were analyzed and key themes described.

Results
Survey participants totalled 46, with a maximal response rate of 38%. Participants reported positive experiences of collegiality with Black colleagues and strong bonds with Black patients. Negative discrimination experiences included differential treatment and racism from peers, superiors, and patients. Participants reported race as a major factor in their selection of practice location, more so than selection of career. Participants also expressed a lack of mentorship, and there was a strong call for increased mentorship from mentors with similar ethno-racial backgrounds.

Conclusions
This study challenges the notion that racism within Canadian health care is rare. Future systematic collection of information regarding Black physicians’ and trainees’ experiences of racism will be key in appreciating the prevalence and nature of these experiences.
A New Approach for Lateral Sinus Floor Elevation
Authors: Covani Ugo , Giammarinaro Enrica , Marconcini Simone 
Published: August 2020

Abstract
The lateral sinus lift procedure has been extensively investigated and described as a reliable surgical solution aimed at facilitating implant placement and rehabilitation when the posterior upper maxilla is atrophic. The standard technique consists in a lateral antrostomy, the careful raising of the sinus membrane, and following apposition of a bone substitute between the membrane and the sinus floor. The present technical note illustrates a new conservative technique enabling lateral sinus lift without the use of bone substitutes and with predictable outcomes.
Early Recognition of Raised Intracranial Pressure in Craniosynostosis Using Optical Coherence Tomography
Authors: Rufai Sohaib R. , Jeelani Noor ul Owase , McLean Rebecca J. 
Published: August 2020

Objective:
Craniosynostosis can be associated with raised intracranial pressure (ICP), which can pose deleterious effects on the brain and vision if untreated. Estimating ICP in children is challenging, whilst gold standard direct intracranial measurement of ICP is invasive and carries risk. This systematic review aims to evaluate the role of optical coherence tomography (OCT), a noninvasive imaging technique, for detecting raised ICP in children with craniosynostosis.

Methods:
The authors conducted a systematic review of the literature published from inception until 19 August, 2019 in the Cochrane Central Register of Controlled Trials, PubMed, MEDLINE, and EMBASE. Eligible studies evaluated the role of OCT in detecting raised ICP in children aged 0 to 16 years with craniosynostosis. Main outcome measures were sensitivity and specificity of OCT parameters for raised ICP. Quality assessment was performed using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-sectional Studies.

Results:
Out of 318 records identified, data meeting the inclusion criteria were obtained from 3 studies. The quality of 2 studies was poor whilst 1 was fair. Optical coherence tomography demonstrated higher sensitivity and specificity for detecting raised ICP compared to fundus examination, clinical history, radiological testing, and visual field testing.

Conclusions:
This systematic review demonstrated a lack of quality evidence for OCT as a screening tool for children with craniosynostosis. Further research is required to clarify the strength of OCT in this role and to determine which OCT parameters are most appropriate.
Finite Element Analysis of 2- and 3-Point Internal Fixation Methods for the Treatment of Zygomaticomaxillary Complex Fracture
Authors: Li Yan , Wu Pengsen , Liu Shuyi , Tang Meiting , Yu Shen , Kikkawa Don O. , Lu Wei 
Published: August 2020

Abstract
Open reduction followed by internal fixation (ORIF) has been regarded as the most effective technique for surgical repair of zygomaticomaxillary complex (ZMC) fractures. However, the ideal internal fixation method to achieve stable reduction remains controversial. This research aims to assess and compare the stability of the 2- and 3-point screw-plate fixation methods using finite element method (FEM). Based on computed tomography (CT), the finite element models of 2-point (ZFS + IOR) and 3-point (ZFS + IOR + ZMB) fixation for isolated displaced ZMC fracture were reconstructed. The force of 120 N was applied to the models to simulate the masseter muscle strength. The maximum stress and displacement of the 2 models were measured to compare the stability. Two geometrically accurate and finite element models were reconstructed successfully. In both the 2- and 3-point fixation models, the maximum stress was significantly lower than the mechanical properties of pure titanium and titanium alloys and the maximum displacement was ≤0.1 mm. The results of this study suggested that both 2- and 3-point fixation of isolated displaced ZMC fractures provide good stability. The FEM innovatively applied in this study can not only show the biomechanical properties of the orbital skeleton and masseter muscle but also assess the stability of the two fixation methods and provide a theoretical reference. This study verifies the effectiveness of 2-point fixation and combined with the clinical benefits of reduced incisions, shorter operative time and lower cost, make this an attractive method.
Pharyngoplasty for Speech Disorders Following Brain Injury
Authors: Johnston Emma , Martin Serena , McLarnon Michael , Hill Chris 
Published: August 2020

Introduction:
Dysarthria is one of the commonest neurological speech disorders resulting from brain injury. However, hypernasality commonly co-exists in this subgroup of patients and is commonly overlooked. The authors aim to investigate the merit of surgery in improving hypernasality and speech intelligibility in patients with a mixed pattern of dysarthria and hypernasality secondary to brain injury.

Materials and Methods:
Data was collected from the regional plastic surgery unit over a 10-year period. All patients who underwent a pharyngoplasty for speech improvement following total brain injury from either a traumatic injury or a cerebrovascular accident were included. Patients were followed up post-operatively to assess; improvement in speech rehabilitation, complications and the need for surgical revision.

Results:
Six patients had a pharyngoplasty for speech improvement. Either a Hynes or Jackson pharyngoplasty was performed, with one patient requiring a hemi-pharyngoplasty. Post-operatively, 1 patient experienced self-limiting sleep apnea which resolved within 1 month. One patient developed obstructive symptoms and required revision. Overall, 83% of patients had clear improvement in speech intelligibility and articulation.

Conclusions:
The authors have shown that surgical intervention, in the form of a pharyngoplasty, is an effective method of improving speech intelligibility and articulation, by improving hypernasality and restoring communication in this cohort of patients. The aim of this paper is to highlight this option to colleagues and to heighten the awareness that many patients with a total brain injury have a mixed pattern of speech disturbance and not solely the dysarthria that is attributed to this condition.
Congenital Deficiency of Alar Cartilage
Authors: Günebakan Çağlar , Kuzu Selçuk 
Published: August 2020

Abstract
Alar cartilage anatomically determines the size, position, and shape of the nose type. It is also effective in the respiratory function of the nose. The structure of alar cartilage differs from person to person. Congenital anomalies of the nose due to absence of alar cartilage are extremely rare. Usually, trauma and infections are blamed for etiology. The absence of nasal alar cartilage causes both aesthetically nasal deformities and respiratory dysfunction problems. In the literature, congenital alar cartilage defect has been reported as cases with a substantial partial defect. In this study, it is aimed to present a case with unilateral, isolated, complete alar cartilage absence detected in a patient who underwent septorhinoplasty, and with the treatment approach applied in light of current literature knowledge.