bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transition to substance use disorders: impulsivity for reward and learning from reward
Authors: Poulton Antoinette , Hester Robert 
Published: December 2019

AbstractSubstance dependence constitutes a profound societal burden. Although large numbers of individuals use licit or illicit substances, few transition to dependence. The specific factors influencing this transition are not well understood. Substance-dependent individuals tend to be swayed by the immediate rewards of drug taking, but are often insensitive to delayed negative consequences of their behavior. Dependence is consequently associated with impulsivity for reward and atypical learning from feedback. Behavioral impulsivity is indexed using tasks measuring spontaneous decision-making and capacity to control impulses. While evidence indicates drug taking exacerbates behavioral impulsivity for reward, animal and human studies of drug naïve populations demonstrate it might precede any drug-related problems. Research suggests dependent individuals are also more likely to learn from rewarding (relative to punishing) feedback. This may partly explain why substance-dependent individuals fail to modify their behavior in response to negative outcomes. This enhanced learning from reward may constitute a further pre-existing risk factor for substance dependence. Although impulsivity for reward and preferential learning from rewarding feedback are both underpinned by a compromised dopaminergic system, few studies have examined the relationship between these two mechanisms. The interplay of these processes may help enrich understanding of why some individuals transition to substance dependence.
Perioperative blood pressure in the elderly
Authors: Kozarek Katherine , Sanders Robert D. , Head Diane 
Published: December 2019

Purpose of review
Hemodynamic instability is common in the perioperative period because of obligate physiologic changes that occur with surgery. Despite the frequency of such hemodynamic changes and the potential harm associated with them, particularly in the elderly, guidelines to optimize perioperative blood pressure are lacking. The present review examines recent evidence for perioperative blood pressure management in the elderly.

Recent findings
Hypotension has been associated with poor outcomes, particularly renal injury, myocardial injury, and increased mortality, in the perioperative period. Hypertension, tachycardia, frequency of blood pressure monitoring, and management of chronic antihypertensive medications may also affect patient outcomes. Elderly patients may be especially prone to adverse events associated with perioperative hemodynamic instability.

Summary
Precise and intentional management of hemodynamic parameters, medication regimens, and blood pressure monitoring may reduce adverse events in elderly patients undergoing surgery. Further investigation is required to identify the exact hemodynamic parameters that mitigate risk.
Single-cell and spatial transcriptomics approaches of the bone marrow microenvironment
Authors: Al-Sabah Jude , Baccin Chiara , Haas Simon 
Published: December 2019

Purpose of review
The bone marrow is home to hematopoietic stem cells responsible for lifelong blood production, alongside mesenchymal stem cells required for skeletal regeneration. In the bone marrow, a unique combination of signals derived from a multitude of cell types results in the establishment of so-called niches that regulate stem-cell maintenance and differentiation. Recently, single-cell and spatially resolved transcriptomics technologies have been utilized to characterize the murine bone marrow microenvironment during homeostasis, stress and upon cancer-induced remodeling. In this review, we summarize the major findings of these studies.

Recent findings
Single-cell technologies applied to bone marrow provided the first systematic and label-free identification of bone marrow cell types, enabled their molecular and spatial characterization, and clarified the cellular sources of key prohematopoietic factors. Large transcriptional heterogeneity and novel subpopulations were observed in compartments previously thought to be homogenous. For example, Lepr+ Cxcl12-abundant reticular cells were shown to constitute the major source of prohematopoietic factors, but consist of subpopulations differing in their adipogenic versus osteogenic priming, morphology and localization. These subpopulations were suggested to act as professional cytokine secreting cells, thereby establishing distinct bone marrow niches.

Summary
Single-cell and spatially resolved transcriptomics approaches have clarified the molecular identity and localization of bone marrow-resident cell types, paving the road for a deeper exploration of bone marrow niches in the mouse and humans.
Demographics of Men and Minorities in Cosmetic Clinical Trials of Botulinum Toxin and Hyaluronic Acid Fillers
Authors: Roman Jorge , Zampella John G. 
Published: December 2019

BACKGROUND
The demographics of men and minorities in clinical studies of nonsurgical cosmetic procedures have not been well described. There is a growing interest in nonsurgical cosmetic procedures. The patients studied in clinical trials may not be reflective of the real-world demographic of patients seeking nonsurgical cosmetic procedures.

OBJECTIVE
To examine the demographics of men and minorities in clinical studies of nonsurgical cosmetic procedures.

METHODS
A systematic review of clinical trials of botulinum toxin A (BTX-A) for facial rhytides and hyaluronic acid (HA) injectable fillers for soft-tissue augmentation was performed. Data on ethnicity and sex were collected and examined.

RESULTS
Nineteen randomized controlled trials (RCTs) on BTX-A and 22 RCTs on HA were included for analysis. Men represented 11.8% of all participants. Men were more represented in the BTX-A RCTs (13.9%) compared with the HA RCTs (6.4%). Caucasian patients represented 67.1% of the total patients. Asian, Hispanic, and black patients represented 16.8%, 6.5%, and 5.4% of study participants, respectively.

CONCLUSION
The proportion of men in clinical trials of BTX-A and HA reflects the real-world demographics of men undergoing these procedures. Hispanic and black patients were underrepresented in clinical trials.
Variable association of 24-h peripheral and central hemodynamics and stiffness with hypertension-mediated organ damage: the VASOTENS Registry
Authors: Omboni Stefano , Posokhov Igor , Parati Gianfranco , Arystan Ayana , Tan Isabella , Barkan Vitaliy , Bulanova Natalia , Derevyanchenko Maria , Grigoricheva Elena , Minyukhina Irina , Mulè Giuseppe , Orlova Iana , Paini Anna , Peixoto Maldonado João M. , Pereira Telmo , Ramos-Becerra Carlos G. , Tilea Ioan , Waisman Gabriel 
Published: December 2019

Objective:
In this analysis of the telehealth-based Vascular health ASsessment Of The hypertENSive patients Registry, we checked how 24-h central and peripheral hemodynamics compare with hypertension-mediated organ damage (HMOD).

Methods:
In 646 hypertensive patients (mean age 52 ± 16 years, 54% males, 65% treated) we obtained ambulatory brachial and central SBP and pulse pressure (PP), SBP, and PP variability, pulse wave velocity and augmentation index with a validated cuff-based technology. HMOD was defined by an increased left ventricular mass index (cardiac damage, evaluated in 482 patients), an increased intima–media thickness (vascular damage, n = 368), or a decreased estimated glomerular filtration rate or increased urine albumin excretion (renal damage, n = 388).

Results:
Ambulatory SBP and PPs were significantly associated with cardiac damage: the largest odds ratio was observed for 24-h central SBP [1.032 (1.012, 1.051), P = 0.001] and PP [1.042 (1.015, 1.069), P = 0.002], the weakest for brachial estimates. The association was less strong for vascular damage with a trend to the superiority of 24-h central [1.036 (0.997, 1.076), P = 0.070] over brachial PP [1.031 (1.000, 1.062), P = 0.052]. No statistically significant association was observed for renal damage. SBP and PP variabilities, pulse wave velocity and augmentation index were not associated with any form of HMOD. In the multivariate analysis, age was associated with any type of HMOD, whereas central SBP and PP were predictive of an increased risk of cardiac damage.

Conclusion:
In hypertensive patients a variable association exists between peripheral and central hemodynamics and various types of HMOD, with the most predictive power being observed for central SBP and PP for cardiac damage.
Less invasive surfactant administration in preterm infants with respiratory distress syndrome—an updated meta-analysis
Authors: Cao Zhao-Lan , Pan Jing-Jing , Shen Xian , Zhou Xiao-Yu , Cheng Rui , Zhou Xiao-Guang , Yang Yang 
Published: December 2019

Background:
Less invasive surfactant administration (LISA) seems to have a good application prospect both in experimental models and patients with respiratory distress syndrome (RDS). Data regarding the effect of LISA procedure on RDS are conflicting.

Methods:
A search was conducted by two investigators involved in this research in PubMed, Embase, and Cochrane databases for studies in English and in Wanfang, VIP, and Cnki databases for Chinese studies (all last launched on December 18, 2018). Odds ratio and weighted mean difference were calculated using a random-effects or fixed-effects model, depending on the data type and heterogeneity of the included studies.

Results:
The comparison of effectiveness on RDS: (1) with respect to mechanical ventilation (<72 hours) and mechanical ventilation (all time periods). Data showed significant differences between LISA/control groups. (2) With respect to days of mechanical ventilation, data showed no significant differences between LISA/control groups. (3) With respect to bronchopulmonary dysplasia, the analysis showed that there was significant difference between LISA group and control group. (4) Regarding days of supplementary oxygen therapy and hospital stay, no significant differences were found. The comparison of possible complications of RDS: (1) data for mortality, pneumothorax and pulmonary hemorrhage showed no differences in the two groups. (2) Data for retinopathy of preterm comparison showed significant difference between the two groups. (3) Regarding intraventricular hemorrhage/periventricular leukomalacia, significant differences were found between the two groups.

Conclusion:
Based on the above evidences, LISA is an effective and safe treatment for preterm infants with RDS.
Impact of disease-specific care certification on clinical outcome and healthcare performance of myocardial infarction in Taiwan
Authors: Liao Hsun-Hsiang , Wang Pa-Chun , Yeh En-Hui , Lin Chii-Jeng , Chao Ting-Hsing 
Published: December 2019

Background:
The relationship between certification for specific disease care and clinical outcome was not well known. Previous studies regarding the effect of certification for acute stroke centers were limited by their cross-sectional design. This study aimed to investigate the effect of disease-specific care (DSC) certification on healthcare performance and clinical outcome of acute myocardial infarction (AMI).

Methods:
This retrospective, longitudinal, controlled study was performed by analyzing the nationwide Taiwan Clinical Performance Indicators dataset from 2011 to 2018. Hospitals undergoing DSC certification for coronary care and reporting AMI indicators 1 year before, during, and 1 year after certification were included in group C, whereas hospitals not seeking DSC certification but reporting AMI indicators during the same period were included in group U. The primary endpoint was in-hospital mortality of AMI.

Results:
In total, 20 hospitals (9 in group C and 11 in group U) and up to 16 173 AMI cases were included for analysis. In-hospital mortality was similar between both groups at baseline. However, the in-hospital mortality was significantly improved during and after certification periods in comparison with that at baseline in group C (6.8% vs 8.4%, p = 0.04; 6.7% vs 8.4%, p = 0.02), whereas there was no significant change in group U, resulting in a statistically significant difference between both groups during and after certification periods (odds ratio = 0.74 [95% CI = 0.60-0.91] and 0.78 [95% CI = 0.64-0.96]). Compared with group U, the improvement in healthcare performance indicators, such as door-to-electrocardiography time <10 minutes, blood testing for low-density lipoprotein cholesterol level, prescribing a beta-blockade or a P2Y12 receptor inhibitor during hospitalization, prescribing a statin on discharge, and consultation for cardiac rehabilitation, was significant in group C.

Conclusion:
The current study demonstrated the beneficial effect of DSC certification on clinical outcome of AMI probably mediated through quality improvement during the healthcare process.
A Quality Improvement Project to Increase Patient Portal Enrollment and Utilization in Women Living With HIV at Risk for Disengagement in Care
Authors: Plimpton Erica 
Published: December 2019

Abstract
Women living with HIV are less likely to be retained and engaged in consistent care than their male counterparts. The purpose of this quality improvement project was to increase the enrollment and utilization rate of a patient portal, an mHealth technology, by women living with HIV at risk of disengagement in care to improve their overall engagement and retention in care. At-risk women were identified, educated on, and enrolled in a patient portal system during routine clinic appointments. Engagement was measured using portal utilization rates and patient-initiated communication and analyzed using descriptive statistics. Paired 2-tailed Student t-tests were used to evaluate changes in adherence rates, viral loads, and CD4+ T-cell counts from 90-day pre-enrollment to 90-day post-enrollment. Overall results indicate improved utilization and engagement through the use of a patient portal system are feasible in this population and promote engagement and retention in care.
Usability and Feasibility of an Innovative mLearning Approach for Nurses Providing Option B+ Services in Manica and Sofala Provinces, Mozambique
Authors: Kim Jane , Floriano Florência , De Castro Georgina , Manuel João Luís , Inguane Celso , Asbjornsdottir Kristjana H. , Chale Falume , Zucule Justina , Sherr Kenneth , Gimbel Sarah 
Published: December 2019

Abstract
The scaling of Option B+ services, whereby all pregnant women who test HIV positive are started on lifelong antiretroviral therapy upon diagnosis regardless of CD4 T-cell count, is ongoing in many high HIV burden, low-resource countries. We developed and evaluated a tablet-based mobile learning (mLearning) training approach to build Option B+ competencies in frontline nurses in central Mozambique. Its acceptability and impact on clinical skills were assessed in maternal child health nurses and managers at 20 intervention and 10 control clinics. Results show that skill and knowledge of nurses at intervention clinics improved threefold compared with control clinics (p = .04), nurse managers at intervention clinics demonstrated a 9- to 10-fold improvement, and nurses reported strong acceptance of this approach. “mLearning” is one viable modality to enhance nurses' clinical competencies in areas with limited health workforce and training budgets. This study's findings may guide future scaling and investments in commercially viable mLearning solutions.
Living With Charcot-Marie-Tooth, Charlie, and Change
Authors: Inman Emma 
Published: December 2019

ABSTRACT
Charcot-Marie-Tooth (CMT) is a hereditary condition that affects the myelin sheath of peripheral nerves causing muscle weakness, atrophy, and peripheral neuropathy. This is a firsthand reflection of living with CMT disease from my personal experience and through my family. I hope this provides informative education to practitioners or individuals who may not be familiar with CMT.
Ureteral stents: the good the bad and the ugly
Authors: Lundeen Colin J. , Forbes Connor M. , Wong Victor K.F. , Lange Dirk , Chew Ben H. 
Published: December 2019

Purpose of review
Ureteral stents are necessary in the routine practice of an urologist. Choosing the correct stent and being aware of the options available will allow urologists to provide the best possible care for patients and value to the healthcare system. This review seeks to educate urologists regarding improvements in stent technology currently available or in development.

Recent findings
Research from around the world is underway to discover an ideal stent – one that is comfortable for patients, resists infection and encrustation and is affordable for hospital systems. Stent design alterations and stent coatings are revealing reductions in encrustation and bacterial colonization. Biodegradable stents and magnetic stents are being tested to prevent the discomfort of cystoscopic removal. Intraureteral stents are proving efficacious while eliminating an irritating coil from the bladder and the symptoms associated with it.

Summary
The studies highlighted in this review provide encouraging results in the pursuit of the ideal stent while opening discussion around new concepts and further areas of research.
Active surveillance in stage 1 disease: standard of care independent of risk factors?
Authors: Nason Gregory J. , Leao Ricardo , Hamilton Robert J. 
Published: December 2019

Purpose of review
Approximately 30% of clinical stage 1 (CS1) nonseminomatous germ cell tumours (NSGCT) and 15–20% of CS1 seminoma relapse without adjuvant treatment. Despite this, the 5-year survival for CS1 is 99%. The purpose of this review is to assess if active surveillance should be standard for all patients with CS1 testis cancer independent of risk factors.

Recent findings
Recent data from Princess Margaret Cancer Centre suggest a nonrisk-adapted surveillance approach avoids treatment in ∼70% of patients. Most relapse early at a median time of 7.4 months. The majority of relapses are confined to the retroperitoneum (66%) and only one modality of treatment is required: chemotherapy only in 61% and RPLND only in 73%.

Summary
Surveillance is the preferred option and a safe proven strategy for the management of CS1 disease independent of risk factors. The prognosis for CS1 disease is excellent and the decision to offer surveillance or adjuvant treatment needs to highlight the treatment-related morbidity in an otherwise fit and healthy young man.
Readmission Reduction Strategies for Patients Discharged to Skilled Nursing Facilities
Authors: McHugh John P. , Shield Renee R. , Gadbois Emily A. , Winblad Ulrika , Mor Vincent , Tyler Denise A. 
Published: December 2019

Background:
Some hospitals seek integration with skilled nursing facilities (SNFs) to reduce readmissions while others focus more on patients discharged home.

Purpose:
Our objective was to understand different approaches for readmission reduction for patients discharged to SNFs based on contrasting strategies from 2 competing hospital systems.

Methods:
Employing a case study methodology, we compared 1 hospital system that integrated with SNFs to a competing system that did not. We compared interview data from clinical and administrative staff and publicly reported rehospitalization rate changes from the 2 systems.

Results:
Analysis of integrating hospital system interviews noted providing patients detailed discharge information and educating SNF staff regarding care protocols. Integrated hospital system all-cause readmission rates declined by nearly 1 percentage point more than the nonintegrated hospital system (coefficient, −0.008; 95% confidence interval, −0.003 to −0.012) between 2014 and 2017.

Conclusion:
As hospitals explore care transition improvements to SNFs, developing more embedded relationships highlights one approach to improve value.
Total Protein Concentration and Tumor Necrosis Factor α in Tears of Nonproliferative Diabetic Retinopathy
Authors: Amil-Bangsa Nurul Hafizah , Mohd-Ali Bariah , Ishak Bashirah , Abdul-Aziz Che Nurul Nabihah , Ngah Nor Fariza , Hashim Hanizasurana , Ghazali Ahmad Rohi 
Published: December 2019

SIGNIFICANCE
Total protein concentration (TPC) and tumor necrosis factor α (TNF-α) concentration in tears are correlated with severity of retinopathy. However, minimal data are available in the literature for investigating tear TPC and TNF-α concentrations in Asian individuals with different severity of nonproliferative diabetic retinopathy (NPDR).

PURPOSE
This study evaluated differences of TPC and TNF-α concentrations in tears at different severity of NPDR among participants with diabetes in comparison with normal participants.

METHODS
A total of 75 participants were categorized based on Early Treatment for Diabetic Retinopathy Study scale, with 15 participants representing each group, namely, normal, diabetes without retinopathy, mild NPDR, moderate NPDR, and severe NPDR. All participants were screened using McMonnies questionnaire. Refraction was conducted subjectively. Visual acuity was measured using a LogMAR chart. Twenty-five microliters of basal tears was collected using glass capillary tubes. Total protein concentration and TNF-α concentrations were determined using Bradford assay and enzyme-linked immunosorbent assay, respectively.

RESULTS
Mean ± SD age of participants (n = 75) was 57.88 ± 4.71 years, and participants scored equally in McMonnies questionnaire (P = .90). Mean visual acuity was significantly different in severe NPDR (P = .003). Mean tear TPC was significantly lower, and mean tear TNF-α concentration was significantly higher in moderate and severe NPDR (P < .001). Mean ± SD tear TPC and TNF-α concentrations for normal were 7.10 ± 1.53 and 1.39 ± 0.24 pg/mL; for diabetes without retinopathy, 6.37 ± 1.65 and 1.53 ± 0.27 pg/mL; for mild NPDR, 6.32 ± 2.05 and 1.60 ± 0.21 pg/mL; for moderate NPDR, 3.88 ± 1.38 and 1.99 ± 0.05 pg/mL; and for severe NPDR, 3.64 ± 1.26 and 2.21 ± 0.04 pg/mL, respectively. Tear TPC and TNF-α concentrations were significantly correlated (r = −0.50, P < .0001). Visual acuity was significantly correlated with tear TPC (r = −0.236, P = .04) and TNF-α concentrations (r = 0.432, P < .0001).

CONCLUSIONS
This cross-sectional study identified differences in tear TPC and TNF-α concentrations with increasing severity of NPDR.
EEG in the Pediatric Intensive Care Unit: An Irish Experience
Authors: MacDarby Laura , Healy Martina , Curley Gerard , McHugh John C. 
Published: December 2019

Introduction:
Evidence for continuous EEG monitoring in the pediatric intensive care unit (PICU) is increasing. However, 24/7 access to EEG is not routinely available in most centers, and clinical management is often informed by more limited EEG resources. The experience of EEG was reviewed in a tertiary PICU where 24/7 EEG cover is unavailable.

Methods:
Retrospective EEG and clinical review of 108 PICU patients. Correlations were carried out between EEG and clinical variables including mortality. The role of EEG in clinical decision making was documented.

Results:
One hundred ninety-six EEGs were carried out in 108 PICU patients over 2.5 years (434 hours of recording). After exclusion of 1 outlying patient with epileptic encephalopathy, 136 EEGs (median duration, 65 minutes; range, 20 minutes to 4 hours 40 minutes) were included. Sixty-two patients (57%) were less than 12 months old. Seizures were detected in 18 of 107 patients (17%); 74% of seizures were subclinical; 72% occurred within the first 30 minutes of recording. Adverse EEG findings were associated with high mortality. Antiepileptic drug use was high in the studied population irrespective of EEG seizure detection. Prevalence of epileptiform discharges and EEG seizures diminished with increasing levels of sedation.

Conclusions:
EEG provides important diagnostic information in a large proportion of PICU patients. In the absence of 24/7 EEG availability, empirical antiepileptic drug utilization is high.