bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence and Effect of Obesity on Mobility According to Different Criteria in Polio Survivors
Authors: Seo Kyoung-Ho , Lee Joong Hoon , Lee Seung-Yeol , Lee Jae Yon , Lim Jae-Young 
Published: August 2020

Objective
Obesity is a major and functionally important problem in polio survivors. The aim of this study was to investigate the prevalence of obesity using body mass index and percentage body fat in polio survivors and to analyze the relationship between obesity and mobility.

Design
Eighty-four polio survivors were included. Anthropometric parameters, knee extensor strength, and the Short Physical Performance Battery were evaluated. A questionnaire was used to explore the late effects of poliomyelitis. Obesity was determined using both body mass index and percentage body fat.

Results
The prevalence of obesity in polio survivors was 39.3% and 81.5% using the body mass index and percentage body fat criteria, respectively. The Short Physical Performance Battery scores were significantly different between the obese and nonobese groups as determined by percentage body fat (P < 0.05). Only percentage body fat was significantly associated with mobility after controlling for the confounding variables in obese polio survivors (P < 0.05).

Conclusions
Obesity in polio survivors was underestimated when the body mass index criteria were used. Percentage body fat was a significantly associated factor for mobility in obese polio survivors. Obesity determined by percentage body fat criteria is useful to address obesity-related problems in polio survivors.
Expert Consensus on Currently Accepted Measures of Harm
Authors: Logan Merranda S. , Myers Laura C. , Salmasian Hojjat , Levine David Michael , Roy Christopher G. , Reynolds Mark E. , Sato Luke , Keohane Carol , Frits Michelle L. , Volk Lynn A. , Akindele Ruth N. , Randazza Juliette M. , Dulgarian Sevan M. , Shahian David M. , Bates David Westfall , Mort Elizabeth 
Published: August 2020

Background
Twenty-five years after the seminal work of the Harvard Medical Practice Study, the numbers and specific types of health care measures of harm have evolved and expanded. Using the World Café method to derive expert consensus, we sought to generate a contemporary list of triggers and adverse event measures that could be used for chart review to determine the current incidence of inpatient and outpatient adverse events.

Methods
We held a modified World Café event in March 2018, during which content experts were divided into 10 tables by clinical domain. After a focused discussion of a prepopulated list of literature-based triggers and measures relevant to that domain, they were asked to rate each measure on clinical importance and suitability for chart review and electronic extraction (very low, low, medium, high, very high).

Results
Seventy-one experts from 9 diverse institutions attended (primary acceptance rate, 72%). Of 525 total triggers and measures, 67% of 391 measures and 46% of 134 triggers were deemed to have high or very high clinical importance. For those triggers and measures with high or very high clinical importance, 218 overall were deemed to be highly amenable to chart review and 198 overall were deemed to be suitable for electronic surveillance.

Conclusions
The World Café method effectively prioritized measures/triggers of high clinical importance including those that can be used in chart review, which is considered the gold standard. A future goal is to validate these measures using electronic surveillance mechanisms to decrease the need for chart review.
The Morbidity and Mortality Conference: Opportunities for Enhancing Patient Safety
Authors: Lazzara Elizabeth H. , Salisbury Mary , Hughes Ashley M. , Rogers Jordan E. , King Heidi B. , Salas Eduardo 
Published: August 2020

Abstract
Since the 20th century, health care institutions have used morbidity and mortality conferences (MMCs) as a forum to discuss complicated cases and fatalities to capitalize on lessons learned. Medical technology, health care processes, and the teams who provide care have evolved over time, but the format of the MMC has remained relatively unchanged. The present article outlines 5 key areas for improvement within the MMC along with prescriptive and actionable recommendations for mitigating these challenges. This work incorporates the contributions of numerous researchers and practitioners from the educational, training, debrief, and health care fields. With the best practices and lessons learned from various domains in mind, we recommend optimizing the MMC by (1) encouraging a culture that leverages expertise from multiple sources, (2) allocating ample time for innovative thinking, (3) using a global approach that considers individual, team, and system-level factors, (4) leveraging learnings from errors as well as near misses, and (5) promoting communication, innovative thinking, and actionable planning. The 5 evidence-based recommendations herein serve to ensure that MMCs are structured learning events that promote, encourage, and support safe, reliable care. Furthermore, the outlined recommendations seek to capitalize upon the MMC’s opportunity to engage early discovery as well as proactive risk assessment and action-oriented solutions.
A Noninvasive Stroke Volume Monitoring for Early Detection of Minimal Blood Loss: A Pilot Study
Authors: Epstein Danny , Guinzburg Ariel , Sharon Saar , Kiso Shai , Glick Yuval , Marcusohn Erez , Glass Yehuda Daniel , Miller Asaf , Minha Sa’ar , Furer Ariel 
Published: August 2020

Abstract

Introduction:
Alternation in traditional vital signs can only be observed during advanced stages of hypovolemia and shortly before the hemodynamic collapse. However, even minimal blood loss induces a decrease in the cardiac preload which translates to a decrease in stroke volume, but these indices are not readily monitored. We aimed to determine whether minor hemodynamic alternations induced by controlled and standardized hypovolemia can be detected by a whole-body bio-impedance technology.

Methods:
This was a non-randomized controlled trial that enrolled healthy blood donors. Vital signs, as well as shock index and stroke volume (SV), were recorded using noninvasive cardiac system, a noninvasive whole-body impedance-based hemodynamic analysis system, during phlebotomy.

Results:
Sixty subjects were included in the study group and 20 in the control group. Blood loss of 450 mL resulted in a significant decrease in systolic blood pressure (5 mm Hg; 95% CI 3, 6) and SV (5.07 mL; 95% CI 3.21, 6.92), and increase in shock index (0.03 bpm/mm Hg; 95% CI 0.01, 0.05). Clinically detectable changes (≥10%) in blood pressure and shock index were detectable in 15% and 5%, respectively. SV decreased by more than 10% in 40% of blood donors. No significant changes occurred in the control group.

Conclusion:
Continuous noninvasive monitoring of SV may be superior to conventional indices (e.g., heart rate, blood pressure, or shock index) for early identification of acute blood loss. As an operator-independent and point-of-care technology, the SV whole body bio-impedance measurement may assist in accurate monitoring of potentially bleeding patients and early identification of hemorrhage.
Laparoscopic Liver Resections for Tumors in the Posterosuperior Segments: A Single-center Experience of 174 Consecutive Cases
Authors: Kirmizi Serdar , De Meyere Celine , Parmentier Isabelle , D’Hondt Mathieu 
Published: August 2020

Background:
Laparoscopic posterosuperior liver resection is a technically difficult and complex surgery. These patients are seen as poor candidates for laparoscopic surgery. This study aimed to show the safe and effective applicability of the posterosuperior segment resections by experienced surgeons in advanced centers.

Materials and Methods:
Patients who underwent laparoscopic posterosuperior liver resection between October 2011 and October 2019 at the Groeninge Hospital were evaluated retrospectively. Demographic and perioperative data were obtained from the prospectively maintained database. Resection of at least 3 consecutive Couinaud segments was accepted as a major surgery (trisegmentectomy). Postoperative complications were registered according to the Clavien-Dindo classification.

Results:
The median age of the 174 patients was 68 years [interquartile range (IQR): 60 to 75]. The semiprone position was used in the majority of operations (82.2%). Nonanatomic resection was performed in more than half of the operations (55.1%). A total of 5 patients underwent major hepatic resection. The median time of surgery was 150 (IQR: 120 to 190) minutes. Median blood loss was determined to be 150 (IQR: 50 to 300) mL. Malignancy was detected in 95% of the cases. The surgical margin was reported to be R0 in 93.3% of the specimens. The median hospitalization time was 4 (IQR: 3 to 6) days. The major complication rate was 1.7%, and only 1 patient died. Overall survival rates for patients who underwent a resection for colorectal liver metastases in the first and fifth years were 97.5% and 62.2%, and disease-free survival rates were 69.8% and 35.5%, respectively.

Conclusion:
Laparoscopic resections in the posterosuperior segments can be performed safely in experienced hands with good short and long term (oncologial) outcomes.
Functional and Short-term Outcomes in Elective Laparoscopic Colectomy for Symptomatic Diverticular Disease With Either Low Ligation or Inferior Mesenteric Artery Preservation: A Randomized Trial
Authors: Mari Giulio , Montroni Isacco , Origi Matteo , Crippa Jacopo , Achilli Pietro , Costanzi Andrea , Ferrari Giovanni , Ugolini Giampaolo , Maggioni Dario 
Published: August 2020

Background:
The current treatment of symptomatic diverticular disease is left colectomy/sigmoidectomy with low ligation of the inferior mesenteric artery versus the inferior mesenteric artery preservation. Up to now, there is no strong evidence in favor of one of the 2 strategies. The aim of this study is to compare the bowel-specific quality of life and functional outcomes between these 2.

Methods:
Between June 2015 and February 2019, patients were randomly assigned to inferior mesenteric artery low ligation or inferior mesenteric artery preservation during elective laparoscopic sigmoidectomy for diverticular disease. Gastrointestinal, genitourinary functions and surgical outcomes were compared postoperatively between groups.

Results:
One-hundred sixty-eight patients were randomized providing 2 homogenous groups. Gastrointestinal and genitourinary functions were not significantly different between groups after 1 and 6 months postoperative. In both groups, the function was restored to the preoperative level 6 months after surgery. There was no statistically significant difference in terms of conversion rate, blood loss, length of surgery, between groups. There was no difference in the overall complication rate and the anastomotic leak rate among groups.

Conclusions:
Inferior mesenteric artery low ligation or inferior mesenteric artery preservation during elective laparoscopic sigmoidectomy for a diverticular disease can be considered equivalent in affecting the postoperative bowel-related quality of life, genitourinary function, and surgical outcomes.
Uromodulin to Osteopontin Ratio in Deceased Donor Urine Is Associated With Kidney Graft Outcomes
Authors: Mansour Sherry G. , Liu Caroline , Jia Yaqi , Reese Peter P. , Hall Isaac E. , El-Achkar Tarek M. , LaFavers Kaice A. , Obeid Wassim , Rosenberg Avi Z. , Daneshpajouhnejad Parnaz , Doshi Mona D. , Akalin Enver , Bromberg Jonathan S. , Harhay Meera N. , Mohan Sumit , Muthukumar Thangamani , Schröppel Bernd , Singh Pooja , El-Khoury Joe M. , Weng Francis L. , Thiessen-Philbrook Heather R. , Parikh Chirag R. 
Published: August 2020

Background.
Deceased-donor kidneys experience extensive injury, activating adaptive and maladaptive pathways therefore impacting graft function. We evaluated urinary donor uromodulin (UMOD) and osteopontin (OPN) in recipient graft outcomes.

Methods.
Primary outcomes: all-cause graft failure (GF) and death-censored GF (dcGF). Secondary outcomes: delayed graft function (DGF) and 6-month estimated glomerular filtration rate (eGFR). We randomly divided our cohort of deceased donors and recipients into training and test datasets. We internally validated associations between donor urine UMOD and OPN at time of procurement, with our primary outcomes. The direction of association between biomarkers and GF contrasted. Subsequently, we evaluated UMOD:OPN ratio with all outcomes. To understand these mechanisms, we examined the effect of UMOD on expression of major histocompatibility complex II in mouse macrophages.

Results.
Doubling of UMOD increased dcGF risk (adjusted hazard ratio [aHR], 1.1; 95% confidence interval [CI], 1.02-1.2), whereas OPN decreased dcGF risk (aHR, 0.94; 95% CI, 0.88-1). UMOD:OPN ratio ≤3 strengthened the association, with reduced dcGF risk (aHR, 0.57; 0.41-0.80) with similar associations for GF, and in the test dataset. A ratio ≤3 was also associated with lower DGF (aOR, 0.73; 95% CI, 0.60-0.89) and higher 6-month eGFR (adjusted β coefficient, 3.19; 95% CI, 1.28-5.11). UMOD increased major histocompatibility complex II expression elucidating a possible mechanism behind UMOD’s association with GF.

Conclusions.
UMOD:OPN ratio ≤3 was protective, with lower risk of DGF, higher 6-month eGFR, and improved graft survival. This ratio may supplement existing strategies for evaluating kidney quality and allocation decisions regarding deceased-donor kidney transplantation.
Living Kidney Donors’ Financial Expenses and Mental Health
Authors: Barnieh Lianne , Arnold Jennifer B. , Boudville Neil , Cuerden Meaghan S. , Dew Mary Amanda , Dipchand Christine , Feldman Liane S , Gill John S. , Karpinski Martin , Klarenbach Scott , Knoll Greg , Lok Charmaine , Miller Matt , Monroy Mauricio , Nguan Chris , Prasad G.V. Ramesh , Sontrop Jessica M. , Storsley Leroy , Garg Amit X. ,   for the Donor Nephrectomy Outcomes Research (DONOR) Network
Published: August 2020

Background.
Living kidney donors incur donation-related expenses, but how these expenses impact postdonation mental health is unknown.

Methods.
In this prospective cohort study, the association between mental health and donor-incurred expenses (both out-of-pocket costs and lost wages) was examined in 821 people who donated a kidney at one of the 12 transplant centers in Canada between 2009 and 2014. Mental health was measured by the RAND Short Form-36 Health Survey along with Beck Anxiety Inventory and Beck Depression Inventory.

Results.
A total of 209 donors (25%) reported expenses of >5500 Canadian dollars. Compared with donors who incurred lower expenses, those who incurred higher expenses demonstrated significantly worse mental health–related quality of life 3 months after donation, with a trend towards worse anxiety and depression, after controlling for predonation mental health–related quality of life and other risk factors for psychological distress. Between-group differences for donors with lower and higher expenses on these measures were no longer significant 12 months after donation.

Conclusions.
Living kidney donor transplant programs should ensure that adequate psychosocial support is available to all donors who need it, based on known and unknown risk factors. Efforts to minimize donor-incurred expenses and to better support the mental well-being of donors need to continue. Further research is needed to investigate the effect of donor reimbursement programs, which mitigate donor expenses, on postdonation mental health.
The Introduction of cPRA and Its Impact on Access to Deceased Donor Kidney Transplantation for Highly Sensitized Patients in Australia
Authors: Sypek Matthew P. , Kausman Joshua Y. , Watson Narelle , Wyburn Kate , Holt Stephen G. , Hughes Peter , Clayton Philip A. 
Published: August 2020

Background.
In March 2016, Australia’s deceased donor kidney allocation program introduced calculated panel reactive antibody (cPRA) based on antibody exclusions using multiplex assays to define sensitization for waitlisted candidates. We aimed to assess the impact of this change and review access to transplantation for highly sensitized patients under the current allocation rules.

Methods.
Registry data were used to reconstruct changes in panel reactive antibody (PRA)/cPRA for all patients active on the waiting list between 2013 and 2018. A multilevel, mixed-effects negative binomial regression model was used to determine the association between sensitization and transplantation rate in the cPRA era.

Results.
Following the introduction of cPRA, there was an increase in the percentage of the waiting list classified as highly sensitized (PRA/cPRA ≥80%) from 7.2% to 27.8% and very highly sensitized (PRA/cPRA ≥99%) from 2.7% to 15.3%. Any degree of sensitization was associated with a decreased rate of transplantation with a marked reduction for those with cPRA 95%–98% (adjusted incidence rate ratio, 0.36 [95% confidence interval, 0.28-0.47], P < 0.001) and cPRA ≥99% (adjusted incidence rate ratio, 0.09 [95% confidence interval, 0.07-0.12], P < 0.001).

Conclusions.
The proportion of the waiting list classified as highly sensitized increased substantially following the introduction of cPRA, and despite current prioritization, very highly sensitized patients have markedly reduced access to deceased donor transplantation.
Dextromethorphan Abuse Among Opioid-Dependent Patients
Authors: Windhab Laura G. , Gastberger Salome , Hulka Lea M. , Baumgartner Markus R. , Soyka Michael , Müller Thomas J. , Seifritz Erich , Mutschler Jochen 
Published: August 2020

Background
Among opioid-dependent patients on maintenance therapy, concomitant drug abuse is a serious problem. Dextromethorphan, an over-the-counter antitussive agent that can be purchased without prescription, is a drug with a high potential for misuse, especially when consumed in high doses.
The objective of this study was to investigate possible abuse of dextromethorphan among substituted opioid-dependent patients and comparison of subjective and objective findings.
Due to its ability to increase serotonin levels, opioid-dependent patients may be particularly susceptible to dextromethorphan misuse. Dextromethorphan misuse may have side effects, including psychiatric symptoms and serotonin syndrome, and may induce assault, suicide, or homicide.

Methods
A total of 104 opioid-dependent patients in maintenance treatment were included in this cross-sectional study conducted in the outpatient department of the Psychiatric Hospital, University of Zurich. Study participants were divided into 2 groups based on laboratory results: dextromethorphan abusers (n = 12) and nonabusers (n = 92). The objective use and concentrations of dextromethorphan was detected using 3-month hair toxicology analysis.
Statistical analysis was performed by using χ2 test, Student t test, Mann-Whitney U test, and Barnard exact test.

Results
Dextromethorphan was abused by 12 (11.5%) patients, 11 (91.7%) of whom did not report concomitant abuse of dextromethorphan but were identified through hair analysis. In general, there were significant differences among patients abusing dextromethorphan compared with nondextromethorphan consumers in terms of trauma due to sexual maltreatment/violence, multiple traumas, or harmful use of hallucinogenic drugs.

Conclusions
Further studies are necessary to examine dextromethorphan and its impact on patients with psychiatric comorbidities and psychiatric medication. According to literature, there is a significant drug interaction risk due to the impact of dextromethorphan misuse on serotonin syndrome and psychiatric symptoms.1–3 We recommend active inquiry into and testing for concomitant drug abuse among substituted opioid-dependent patients to reduce the risk of drug interactions and side effects in this especially vulnerable group of patients.
One Plus One Sometimes Equals More Than Two: Long-acting Injectable Aripiprazole Adjunction in Clozapine-Resistant Schizophrenia
Authors: Balcioglu Yasin Hasan , Gokcay Hasan , Yesilkaya Umit Haluk 
Published: August 2020

Abstract
In this report, we present a patient whose positive symptoms did not improve despite being treated with clozapine monotherapy at a therapeutic dose for 4 months, and whose symptoms began to resolve after aripiprazole long-acting injection adjunction to clozapine. A 22-year-old man was diagnosed as having schizophrenia last year in his first admission, with symptoms of auditory hallucinations, persecutory delusions, and associated social withdrawal. His positive symptoms did not improve despite being treated with risperidone, olanzapine, and paliperidone. Oral clozapine monotherapy was planned, and the daily dose was increased to provide a therapeutic plasma clozapine concentration and measured as effective (545 mg/dL). Aripiprazole long-acting injection 400 mg monthly was combined with the ongoing clozapine treatment for augmentation. One week after the third injection, a psychiatric examination revealed a significant improvement in the positive symptoms, and his caregivers confirmed an increase in the social interaction of the patient. Although we cannot postulate on a single exact mechanism for the increased efficacy of clozapine and aripiprazole combination, we may suggest that, at least for a subgroup of patients with schizophrenia who respond clinically to clozapine at a suboptimal level, combination with aripiprazole may be an effective therapeutic strategy.
The latitudinal gradient in rates of evolution for bird beaks, a species interaction trait
Authors: Freeman Benjamin G , Schluter Dolph , Tobias Joseph A 
Published: August 2020

AbstractWhere is evolution fastest? The biotic interactions hypothesis proposes that greater species richness creates more ecological opportunity, driving faster evolution at low latitudes, whereas the “empty niches” hypothesis proposes that ecological opportunity is greater where diversity is low, spurring faster evolution at high latitudes. Here we tested these contrasting predictions by analyzing rates of bird beak evolution for a global dataset of 1141 sister pairs of birds. Beak size evolves at similar rates across latitudes, while beak shape evolves faster in the temperate zone, consistent with the empty niches hypothesis. We show in a meta-analysis that trait evolution and recent speciation rates are faster in the temperate zone, while rates of molecular evolution are slightly faster in the tropics. Our results suggest that drivers of evolutionary diversification are more potent at higher latitudes, thus calling into question multiple hypotheses invoking faster tropical evolution to explain the latitudinal diversity gradient.