bluuebunny/crossref_metadata_2025_split huggingface dataset:
Measuring meaningful markers of change
Authors: Stocks Helen , Kyriakopoulos Alex , Ashton Tony 
Published: November 2019

The current research aimed to identify areas of recovery specific to Group Analytic Psychotherapy (GAT) to facilitate the development of a suitable patient reported outcome measure (PROM) for this therapeutic modality. Two focus groups comprising respectively of four group analytic therapists or four service users were asked about components of recovery that they felt were specific to receiving GAT. Thematic Analysis (as described by Braun and Clarke, 2006) was employed to explore their views. Three overarching themes emerged from these groups: improvement in intrapsychic and interpsychic relationships; improvement in quality of life; improvement in functionality and symptom reduction. A conceptual model emerged with regards to how those themes could inform the development on a GAT specific patient reported outcome measure.
Association of Body Weight Change and Fluid Balance With Extubation Failure in Intensive Care Unit Patients: A Single-Center Observational Study
Authors: Maezawa Shota , Kudo Daisuke , Miyagawa Noriko , Yamanouchi Satoshi , Kushimoto Shigeki 
Published: November 2019

Purpose: To elucidate whether fluid balance and body weight change are associated with failed planned extubation. Materials and Methods: Patients who received invasive mechanical ventilation for over 24 hours were enrolled and divided into extubation success and extubation failure groups. Fluid balance and body weight fluctuation within 24 and 48 hours before extubation and from admission to planned extubation were calculated. The primary outcome was extubation failure (ie, all-cause reintubation within 72 hours). The association of extubation failure with fluid balance and body weight change was assessed via logistic regression analysis. Results: Extubation failure occurred in 12(7.4%)/161 patients. The extubation success group had a significantly lower fluid balance within 24 hours before extubation than did the extubation failure group (−276 mL [−1111 to 456] vs 1217 mL [503 to 1875], P = .002). However, fluid balance within 48 hours before extubation, cumulative fluid balance, and body weight change were not significantly different between the 2 groups. The sensitivity and specificity of water balance +1000 mL within 24 hours before extubation for the extubation failure group were 0.54 and 0.84, respectively, based on the receiver operating characteristic curve. Logistic regression analysis showed that fluid balance within 24 hours before extubation was associated with extubation failure (odds ratio: 22.9, 95% confidence interval: 4.1-128.4). Conclusions: A larger fluid balance within 24 hours before extubation is associated with extubation failure. Thus, fluid balance may be a good indicator of extubation outcome.
Milking the System: A Case Study of Donor Milk for a Child in Foster Care
Authors: Mannel Rebecca , Bennett Christina Juris 
Published: November 2019

Introduction: Use of pasteurized donor milk is recommended in many situations when own mother’s milk is not available. One existing knowledge gap is access to donor milk for infants in government custody (foster care). Main issue: The focus of this case study is an infant born at 41 weeks who was discharged from the hospital into foster care. The infant soon developed failure to thrive due to formula intolerance. Management: After trying multiple formulas, which included elemental formulas, and hospitalization, the infant began pasteurized donor milk. Within 24 hr, the infant began gaining weight. Medicaid denied two authorization requests for payment, and the state’s Department of Human Services ultimately agreed to cover the discounted donor milk fees until the infant reached 1 year of age. Conclusion: This foster child suffered through months of failure to thrive and hospitalization before receiving human milk feedings. This care violated ethical principles of beneficence, autonomy, and justice. State officials should review their policies and regulations for providing human milk to children in their care and facilitate access to that milk when needed.
Clinical Pharmacist’s Role in an Alcohol Detox Unit in a Correctional Setting
Authors: Muradian Ibrahim K. , Aminzadeh Arastou , Lin Cindy H. , Tran Ngocdung T. , Do Nguyen N. , Lu Quyen D. , Henderson Sean O. 
Published: November 2019

Introduction: Newly incarcerated inmates with chronic alcohol use are at high risk for alcohol withdrawal. This descriptive study aims to describe the role of a clinical pharmacist within an alcohol detoxification unit (ADU) in the Los Angeles County jail that serves nearly 18 000 inmates facility-wide daily. Methods: This descriptive analysis was conducted from August 2, 2018 through October 31, 2018 within the jail ADU. The pharmacist attended daily assessments on all alcohol detox patients; identified and assessed patients at high risk of severe withdrawal; and initiated, modified, and discontinued withdrawal medication for selected patients. Patients were determined to be high risk of severe withdrawal if they had history of severe withdrawal, any Clinical Institute Withdrawal Assessment for Alcohol-revised (CIWA-Ar) score ≥15, or polysubstance withdrawal. Results: A total of 1263 patients were admitted to the ADU during the study (average 97 per week). A total of 282 patients were assessed by the pharmacist. Patient assessments included substance use and medication history, CIWA-Ar score, response to pharmacotherapy, and referral to a substance use counselor. Medications were initiated, modified, or discontinued in 148 patients after discussion with a physician. Transfer to an acute care facility occurred in 48 patients. Zero alcohol detox patient deaths occurred during the study. Conclusion: This is a novel role of a pharmacist in a correctional setting. A pharmacist can aid in an ADU by identifying and assessing patients at high risk of severe withdrawal and managing pharmacotherapy. Future studies can examine pharmacist withdrawal management of additional substances.
Effect of barrel temperature and feed moisture on protein quality in pre-cooked Kabuli chickpea, sorghum, and maize flours
Authors: Wang Shuyang , Nosworthy Matthew G , House James D , Niefer Shannon-Hood , Nickerson Michael T 
Published: November 2019

The effect of barrel temperature (120 and 150 ℃, held constant in zones 4–6) and feed moisture (20 and 24%) on the protein quality of Kabuli chickpea, sorghum, and maize flours were examined, which included amino acid profile, in vitro protein digestibility and in vitro protein digestibility-corrected amino acid score (IV-PDCAAS). It was found that the limiting amino acid of chickpea changed from threonine to valine after extrusion, whereas both sorghum and maize were limiting in lysine before and after extrusion. The in vitro protein digestibility increased from 77 to 81% for chickpea and 73 to 76% for maize; values for sorghum remained at 74% after extrusion. However, the IV-PDCAAS for the extruded flours generally remained at the same level, 69% for chickpea, 22% for sorghum, and ∼35% for maize. The effect of extrusion temperature, moisture and their interaction was significant on protein quality of sorghum and maize, but in the case of chickpea, only the extrusion temperature was significant. Only chickpea extruded at 150 ℃ (regardless of the moisture) met the protein quality (PDCAAS > 70%) requirement to be used in food assistance products.
Deranged Pulmonary Function Tests in Allergic Rhinitis in North Indian Patients
Authors: Monga Seema , Malik Junaid , Sharma Arun Parkash , Jan Sabeena , Nabi Nighat , Bahadur Sudhir 
Published: November 2019

Introduction: Significant associations between allergic rhinitis and bronchial asthma have been established and as a result of bronchial hyper-responsiveness, patients can have deranged pulmonary function tests. We aim to compare previous such studies with the result of our study done in India wherein we identify among allergic rhinitis patients who despite not having overt asthmatic symptoms, have pulmonary function derangements, quite possibly at a subclinical disease level. Materials and Methods: We studied 74 patients of allergic rhinitis and after meticulous clinical work up, they underwent blood tests including hemogram, absolute eosinophil count, and total serum IgE followed by pulmonary function tests. Results: Out of 74 patients 60 (81%) had intermittent allergic rhinitis whereas only 14 (19%) had persistent allergic rhinitis. Pulmonary function tests showed reversible obstruction, ie, >10% improvement in FEV1 with inhaled bronchodilators (as seen in asthma) in 18 (24.3%), mild obstruction in 14, and moderate obstruction in 4 cases. Conclusion: The study emphasizes the importance of pulmonary symptoms and the performance of pulmonary function tests in cases of allergic rhinitis patients to rule out latent asthma.
Tele-emergency behavioural health in rural and underserved areas
Authors: Weigel Paula , Bhagianadh Divya , Merchant Kimberly AS , Wittrock Amy , Rahmouni Hicham , Bell Amanda , Laws Stephanie , Ward Marcia M 
Published: November 2019

Introduction Challenges accessing behavioural health services in rural and underserved areas are compounded by severe shortages of behavioural health specialists, and difficulties placing patients. Tele-emergency (tele-ED) behavioural health is a promising solution for enhancing access to specialists and assisting in patient placement. This paper describes two tele-ED behavioural health models in the Midwest delivering mental- and substance use disorder services to rural and underserved adult populations. Methods We performed an in-depth examination of two tele-ED behavioural health programmes and their consultation processes. We provide a retrospective case-control analysis of patient characteristics, patient diagnoses, and disposition status for each model. Data were collected from 19 spoke hospitals across the two programmes between November 2015 and December 2017. Results Tele-ED was activated in 15% of the Avera Health sample and 58% of the Union Hospital sample. This is primarily a reflection of the sample selection process in each model and how each programme is operationalised. Suicide and/or poisoning by drugs were the most frequent diagnoses followed by mood disorders. Rate of transfer to another inpatient facility was much higher for tele-ED cases than controls in both models. Discussion This paper describes how two distinct tele-ED behavioural health models operating in unique contexts address challenges in access and placement for patients in rural and underserved areas presenting to EDs with behavioural health conditions. The notable difference in disposition rates between cases and controls is indicative of the impact each model is having on care practices and processes.
Patient portal message characteristics and reported thoughts of self-harm and suicide: A retrospective cohort study
Authors: Duvall Michelle , North Frederick , Leasure William , Pecina Jennifer 
Published: November 2019

Introduction As use of electronic portal communication with healthcare teams increases, processes that effectively recognize messages that contain critical information are needed. This study aims to evaluate whether certain language and other characteristics of patient portal messages are associated with expressions of self-harm and suicidal ideation. Methods Using patient portal messages sent between 1 January 2013 and 30 June 2017, we searched for words and letter combinations ‘suicid’ (to identify words suicide and suicidal), ‘depress’ (for depression, depressed, depressing), ‘harm himself’ (or ‘herself ‘or ‘myself’), ‘hurt himself’ (‘herself’ or ‘myself’), ‘kill’, ‘shoot’, ‘cutting’, ‘knife’, ‘gun’, ‘overdose’, ‘over dose’ and ‘jump’. Results Of 831,009 messages, 11,174 messages contained one or more search terms. We manually reviewed 7,736 messages for content expressing self-harm or suicidality. Of the reviewed messages, 3.2% indicated thoughts of self-harm or suicide and 2.2% of messages suggested active suicidality. Of those expressing any thoughts of self-harm or suicide, 13.4% mentioned a specific plan, 20% were passively suicidal. Messages indicating thoughts of self-harm and suicide were more common in patients who were unmarried, non-white and younger than 18 years. Factors significantly associated with thoughts of self-harm were messages addressed to psychiatry or containing the letter combinations ‘suicide’, ‘die’, ‘depress’ and ‘harm/hurt my/her/himself’. Discussion Certain letter combinations and patient portal message characteristics may be associated with expressions of self-harm and suicide. These factors should be considered as we develop systems of effectively screening patient portal messages for critical clinical information.
Improvements in diabetic albuminuria and podocyte differentiation following Roux-en-Y gastric bypass surgery
Authors: Canney Aoife L , Cohen Ricardo V , Elliott Jessie A , M Aboud Cristina , Martin William P , Docherty Neil G , le Roux Carel W 
Published: November 2019

Background:Multiple studies demonstrate an albuminuria-lowering impact of Roux-en-Y gastric bypass surgery, but neither evaluation of its penetrance across different baseline levels of albuminuria nor its association with alterations in podocyte phenotype has previously been reported.Methods:We profiled changes in body weight, glycaemic control and urinary albumin excretion following Roux-en-Y gastric bypass surgery in 105 patients with type 2 diabetes, albuminuria of varying degrees of severity and classified as being at moderate or high risk of chronic kidney disease progression according to the Kidney Disease: Improving Global Outcomes 2012 criteria. In parallel pre-clinical studies, the impact of Roux-en-Y gastric bypass surgery on markers of podocyte injury was assessed in the Zucker diabetic fatty rat model of diabetic kidney disease.Results:At 12- to 18-month post-operative follow-up in patients at moderate or high risk of chronic kidney disease, significant reductions in albuminuria were observed across all tertiles of baseline albumin–creatinine ratio, with remission of albuminuria occurring in 78% of patients. Relative to sham-operated control animals, weight loss and improvements in glycaemia following Roux-en-Y gastric bypass surgery in Zucker diabetic fatty rats were paralleled by normalisation of glomerular tuft-size, reductions in podocyte expression of desmin, and preservation of podocyte foot process morphology.Conclusion:Improvements in podocyte differentiation likely underpin the reductions in albuminuria observed following Roux-en-Y gastric bypass surgery.
Incidence, predictors and outcomes of stress hyperglycemia in patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention
Authors: Khalfallah Mohamed , Abdelmageed Randa , Elgendy Ehab , Hafez Yasser Mostafa 
Published: November 2019

Background: Stress hyperglycemia is a common finding during ST elevation myocardial infarction in diabetic patients and is associated with a worse outcome. However, there are limited data about stress hyperglycemia in non-diabetic patients and its outcome especially in patients undergoing primary percutaneous coronary intervention. Methods: The study was conducted on 660 patients with ST elevation myocardial infarction who were managed with primary percutaneous coronary intervention. Patients were classified into two groups according to the presence of stress hyperglycemia: group I (patients with stress hyperglycemia) and group II (patients without stress hyperglycemia). Patients were analysed for clinical outcome including mortality and the occurrence of major adverse cardiac events. Results: Incidence of stress hyperglycemia was 16.8%, multivariate regression analysis identified the independent predictors of stress hyperglycemia, that were family history of diabetes mellitus odds ratio 1.697 (95% confidence interval: 1.077–2.674, p = 0.023), body mass index >24 kg/m2 odds ratio 1.906 (95% confidence interval: 1.244–2.922, p = 0.003) and cardiogenic shock on admission odds ratio 2.517 (95% confidence interval: 1.162–5.451, p = 0.019). Mortality, cardiogenic shock, contrast induced nephropathy and no reflow phenomenon were significantly higher in stress hyperglycemia group with p value = 0.027, 0.001, 0.020 and 0.037, respectively. Conclusion: Stress hyperglycemia in non-diabetic patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention is associated with increased incidence of no reflow phenomenon, contrast induced nephropathy, cardiogenic shock and higher mortality.
The Quality, Quantity, and Intraindividual Variability of Sleep Among Students and Student-Athletes
Authors: Leduc Cédric , Tee Jason , Weakley Jonathon , Ramirez Carlos , Jones Ben 
Published: November 2019

Background: Student-athletes are subject to significant demands due to their concurrent sporting and academic commitments, which may affect their sleep. This study aimed to compare the self-reported sleep quality, quantity, and intraindividual variability (IIV) of students and student-athletes through an online survey. Hypothesis: Student-athletes will have a poorer sleep quality and quantity and experience more IIV. Study Design: Case-control study. Level of Evidence: Level 4. Methods: Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), while sleep quantity and IIV were assessed using the Consensus Sleep Diary. Initially, the PSQI and additional questions regarding sport participation habits were completed by 138 participants (65 students, 73 student-athletes). From within this sample, 44 participants were recruited to complete the sleep diary for a period of 14 days. Results: The mean PSQI score was 6.89 ± 3.03, with 65% of the sample identified as poor sleepers, but no difference was observed between students and student-athletes. Analysis of sleep patterns showed only possibly to likely small differences in sleep schedule, sleep onset latency, and subjective sleep quality between groups. IIV analysis showed likely moderate to possibly small differences between groups, suggesting more variable sleep patterns among student-athletes. Conclusion: This study highlights that sleep issues are prevalent within the university student population and that student-athletes may be at greater risk due to more variable sleep patterns. Clinical Relevance: University coaches should consider these results to optimize sleep habits of their student-athletes.
The Relationship Between Proteoglycan Loss, Overloading-Induced Collagen Damage, and Cyclic Loading in Articular Cartilage
Authors: Henao-Murillo Lorenza , Pastrama Maria-Ioana , Ito Keita , van Donkelaar Corrinus C. 
Published: November 2019

Objective The interaction between proteoglycan loss and collagen damage in articular cartilage and the effect of mechanical loading on this interaction remain unknown. The aim of this study was to answer the following questions: (1) Is proteoglycan loss dependent on the amount of collagen damage and does it depend on whether this collagen damage is superficial or internal? (2) Does repeated loading further increase the already enhanced proteoglycan loss in cartilage with collagen damage? Design Fifty-six bovine osteochondral plugs were equilibrated in phosphate-buffered saline for 24 hours, mechanically tested in compression for 8 hours, and kept in phosphate-buffered saline for another 48 hours. The mechanical tests included an overloading step to induce collagen damage, creep steps to determine tissue stiffness, and cyclic loading to induce convection. Proteoglycan release was measured before and after mechanical loading, as well as 48 hours post-loading. Collagen damage was scored histologically. Results Histology revealed different collagen damage grades after the application of mechanical overloading. After 48 hours in phosphate-buffered saline postloading, proteoglycan loss increased linearly with the amount of total collagen damage and was dependent on the presence but not the amount of internal collagen damage. In samples without collagen damage, repeated loading also resulted in increased proteoglycan loss. However, repeated loading did not further enhance the proteoglycan loss induced by damaged collagen. Conclusion Proteoglycan loss is enhanced by collagen damage and it depends on the presence of internal collagen damage. Cyclic loading stimulates proteoglycan loss in healthy cartilage but does not lead to additional loss in cartilage with damaged collagen.
The diagnostic work‐up and outcomes of ‘presumed’ idiopathic acute pancreatitis: A post‐hoc analysis of a multicentre observational cohort
Authors: Hallensleben Nora D , Umans Devica S , Bouwense Stefan AW , Verdonk Robert C , Romkens Tessa EH , Witteman Ben J , Schwartz Matthijs P , Spanier Marcel B , Laheij Robert , van Santvoort Hjalmar C , Besselink Marc G , van Hooft Jeanin E , Bruno Marco J ,   for the Dutch Pancreatitis Study Group
Published: November 2019

IntroductionAfter standard diagnostic work‐up, the aetiology of acute pancreatitis remains unknown in 16–27% of cases, a condition referred to as idiopathic acute pancreatitis (IAP). Determining the aetiology of pancreatitis is essential, as it may direct treatment in the acute phase and guides interventions to prevent recurrent pancreatitis.MethodsBetween 2008 and 2015, patients with acute pancreatitis were registered prospectively in 19 Dutch hospitals. Patients who had a negative initial diagnostic work‐up with regard to the underlying aetiology of their pancreatitis were labelled ‘presumed’ IAP. The aim of this study was to assess the use of diagnostic modalities and their yield to establish an aetiology in ‘presumed’ IAP, and to assess recurrence rates both with and without treatment.ResultsOut of the 1632 registered patients, 191 patients had a first episode of ‘presumed’ IAP, of whom 176 (92%) underwent additional diagnostic testing: CT (n  = 124, diagnostic yield 8%), EUS (n  = 62, yield 35%), MRI/MRCP (n  = 56, yield 33%), repeat ultrasound (n  = 97, yield 21%), IgG4 (n = 54, yield 9%) and ERCP (n  = 15, yield 47%). In 64 of 176 patients (36%) an aetiological diagnosis was established, mostly biliary (n  = 39). In 13 out of 176 of patients (7%) a neoplasm was diagnosed. If additional diagnostic workup revealed an aetiology, the recurrence rate was lower in the treated patients than in the patients without a definite aetiology (15% versus 43%, p  = 0.014).ConclusionAdditional diagnostic testing revealed an aetiology in one‐third of ‘presumed’ IAP patients. The aetiology found was mostly biliary, but occasionally neoplasms were found. Identification of an aetiology with subsequent treatment reduced the rate of recurrence.