bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cost-Effectiveness of Leveraging Social Determinants of Health to Improve Breast, Cervical, and Colorectal Cancer Screening: A Systematic Review
Authors: Mohan Giridhar , Chattopadhyay Sajal 
Published: November 2020

(Abstracted from JAMA Oncol 2020;6:1434–1444)
Persistent health disparities regarding screening for breast, cervical, and colorectal cancers exist in the United States. Health People 2020, the US Federal Government's health promotion and prevention agenda, describes 5 domains for social determinants: economic stability, education, social and community context, health and health care, and neighborhood and built environment.
Predictors of Severe Pain During Insertion of the Levonorgestrel 52 mg Intrauterine System Among Nulligravid Women
Authors: Ferreira Letícia Sanchez , de Nadai Mariane Nunes , Poli-Neto Omero B. , Franceschini Silvio A. , Juliato Cássia R. T. , Monteiro Ilza Maria U. , Bahamondes Luis , Vieira Carolina Sales 
Published: November 2020

(Abstracted from Contraception 2020;102:267–269)
A barrier to uptake of intrauterine devices (IUDs) is fear of pain at the time of insertion. Although nulliparity is a common factor associated with pain at IUD insertion, it is often underestimated by health care professionals.
The Role of Sonographic Phenotyping in Delivering an Efficient Noninvasive Prenatal Diagnosis Service for FGFR3-Related Skeletal Dysplasias
Authors: Mellis Rhiannon , Chandler Natalie , Jenkins Lucy , Chitty Lyn S. 
Published: November 2020

(Abstracted from Prenat Diagn 2020;40:785–791)
Skeletal dysplasia can be difficult to diagnose on prenatal sonogram because of phenotypic overlap between conditions. Two of the more common skeletal dysplasias, achondroplasia and thanatophoric dysplasia (TD), occur because of mutations in the FGFR3 gene.
Maternal and Perinatal Outcomes in Programmed Versus Natural Vitrified-Warmed Blastocyst Transfer Cycles
Authors: Makhijani Reeva , Bartels Chantal , Godiwala Prachi , Bartolucci Alison , Nulsen John , Grow Daniel , Benadiva Claudio , Engmann Lawrence 
Published: November 2020

(Abstracted from RBMO 2020;41(2):300–308)
Hypertensive disorders of pregnancy (HDPs), ranging from gestational hypertension to eclampsia, have been shown to have a higher incidence in women using assisted reproductive technologies (ARTs). Women undergoing ART are more likely to be of advanced maternal age, have multigestation, and have other characteristics that may partly explain this association.
Surgical Technique Used in the UK for Native Tissue Anterior Pelvic Organ Prolapse Repair (VaST)
Authors: Fairclough Emily , Segar Julia , Myers Jenny , Smith Anthony , Reid Fiona 
Published: November 2020

(Abstracted from Int Urogynecol J 2020;31:1519–1525)
Despite previous studies suggesting that surgery using polypropylene mesh provides a better anatomical cure of pelvic organ prolapse, the well-known complications of mesh-augmented repair have led to renewed interest in native tissue surgery. PROSPECT (PROlapse Surgery: Pragmatic Evaluation and randomized Controlled Trials) was a large United Kingdom–based surgical randomized controlled trial that compared outcomes of native tissue and mesh-augmented repairs.
SPRINTing to Innovation: Children’s Hospital of Philadelphia’s Strategic Approach to Discovering Its Untapped Innovation Potential
Authors: Hunter Ryan Brandon , Winston Flaura K. , Dehel Paul , Oh Kelsey , Nicklas Joshua , Hartung Helge 
Published: November 2020

Problem
There is a clear and urgent need for health care innovation in the United States. Hospital employees routinely recognize pain points that affect care delivery and are in a unique position to propose innovative and practical solutions, yet leaders rarely solicit ideas for investment and development from frontline providers and staff, revealing an untapped resource with innovation potential.

Approach
To address these deficiencies, the Children’s Hospital of Philadelphia expanded its innovation infrastructure with the competition-based SPRINT program in 2015. All hospital employees are encouraged to apply with early-stage innovative ideas, and if selected, are provided with business, legal, technical, and scientific project management support to help accelerate their projects toward commercial viability. SPRINT was modeled around 4 core tenets: (1) small, dynamic, and attentive project manager-led teams; (2) low barriers to entry; (3) emphasis on outreach; and (4) fostering innovators.

Outcomes
Over its first 4 cycles from 2015 to 2018, 271 innovative teams applied to the SPRINT program, which led to support for 30 projects (11% acceptance rate). About a quarter of the projects each year were submitted by physician-led teams (mean 23%), a third by nonphysician clinical providers (mean 33%), and almost half were submitted by employees without direct patient contact (mean 44%). Nurses have emerged as the largest applicant group. Eleven of the SPRINT-supported projects (37%) resulted in commercial endpoints.

Next Steps
SPRINT has proven to be an effective model for supporting institution-wide, employee-driven health care innovation, especially among frontline clinical and nonclinical personnel. Critical next steps for the program include a formal cost–benefit analysis and the earlier participation of technology transfer and intellectual property experts to improve the commercialization roadmap for many SPRINT projects.
Auditory Development of Frequency Discrimination at Extended High Frequencies
Authors: Mishra Srikanta K. , Renken Lauren , Hernandez Michelle , Rodrigo Hansapani 
Published: November 2020

Objectives:
Hearing in the extended high frequencies (EHFs; >8 kHz) is perceptually and clinically relevant. Recent work suggests the possible role of EHF audibility in natural listening environments (e.g., spatial hearing) and hidden hearing loss. In this article, we examine the development of frequency discrimination (FD) in the EHFs. Specifically, the objectives of the present study were to answer if the developmental timeline for FD is different for EHFs; and whether the discontinuity of FD thresholds across frequency—representing the hypothetical shift from a temporal to place code—for children occurs at about the same frequency as adults.

Design:
Thirty-one normal-hearing children (5 to 12 years) and 15 young adults participated in this study. FD thresholds were measured for standard frequencies (1, 2, 4, 6, and 8 kHz) and EHFs (10 and 12.5 kHz) using a three-alternative (odd-ball) forced-choice paradigm. Statistical analysis focused on examining the change of FD thresholds as a function of age and estimating the breakpoints in the discrimination threshold-frequency functions.

Results:
FD performance in younger children for EHFs was nearly six times poorer relative to older children and adults; however, there was no effect of test frequency on the child-adult difference. Change-point detection on group data revealed a higher knot frequency—representing the putative transition from temporal to place mechanisms—for adults (9.8 kHz) than children (~6 kHz). Individual spline functions suggest that the knot frequency varied from 2 to 10 kHz across participants.

Conclusions:
The present study provides evidence for a similar rate of maturation of FD for EHFs and standard frequencies. FD at EHFs matures by 10 to 12 years of age. Adult listeners may not all use temporal cues up to 10 kHz. Young children are relatively inefficient in using temporal fine-structure cues for FD at frequencies above 6 kHz.
Melanocytic Neoplasms With MAP2K1 in Frame Deletions and Spitz Morphology
Authors: Sunshine Joel C. , Kim Daniel , Zhang Bin , Compres Elsy V. , Khan Ayesha U. , Busam Klaus J. , Gerami Pedram 
Published: November 2020

Abstract:
With the advent of better molecular characterization of Spitz melanocytic neoplasms, there has been increasing effort to better understand and describe the relationships between specific driver fusion and/or mutations with the clinical and histomorphological characteristics of the lesions. Structural rearrangements in mitogen activated protein kinase genes have recently been noted to be important in Spitz neoplasms. Only very few reports, however, have described in detail melanocytic tumors with in frame deletions in MAP2K1. Cases in the literature with this aberration have been described as having a diagnosis of Spitz, deep penetrating nevi, or pigmented epithelioid melanocytoma. In this study, we describe a cohort of 6 cases with MAP2K1 activating in frame deletions. The morphologic spectrum of the cases was broad. Common features of these cases include Spitzoid cytomorphology (5/6) cases, prominent melanin pigmentation (4/6) cases, and deep penetrating nevi–like plexiform architecture (3/6) cases. The diagnoses at the time of clinical care of these cases included nevus of Reed (1/6), desmoplastic Spitz tumor (1/6), BAPoma (1/6), deep penetrating melanocytic nevus (2/6), and melanoma (1/6). Clinical follow-up was available in 3 of the 6 cases. None of the patients had a tumor recurrence. This builds on the growing literature to help expand the spectrum of changes associated with Spitzoid melanocytic neoplasms.
The Effect of an Educational Program on Nursing Knowledge and Empowerment in Antimicrobial Stewardship in a Surgical Intensive Care Unit
Authors: Fitzpatrick Eleanor R. , Pogorzelska-Maziarz Monika , Manning MaryLou , Gleason Vanessa M. 
Published: November 2020

Background
Hospital antimicrobial stewardship (AS) interventions have been shown to reduce the overuse and misuse of antimicrobials and rates of resistant organisms. To date, nurses have had limited involvement in AS. Improving nursing AS knowledge and sense of empowerment may improve their engagement in AS.

Objective
The purpose of this study was to evaluate the impact of an educational intervention on AS knowledge and sense of empowerment among bedside registered nurses (RNs) in a surgical intensive care unit in an academic medical center.

Methods
This was a quasi-experimental pre-post study.

Results
Forty-four RNs (85%) participated. There was a statistically significant (P < .01) increase in both AS knowledge and empowerment level of staff RNs. Registered nurses identified participation in patient care rounds and use of antibiotic timeouts as strategies for increasing their AS engagement. Perceived barriers included lack of physician/other team member support and knowledge deficits.

Conclusions
The findings of this study indicate that educating nurses on their role in AS improves their knowledge and sense of empowerment for this emerging role. Future studies should examine how nurses apply this knowledge and sense of empowerment to engage in unit-based AS activities and the resultant patient outcomes.
Sleep and Activity Patterns Are Altered During Early Critical Illness in Mechanically Ventilated Adults
Authors: Munro Cindy L. , Liang Zhan , Elías Maya N. , Ji Ming , Chen Xusheng , Calero Karel 
Published: November 2020

Background
Mechanically ventilated (MV) patients in the intensive care unit (ICU) often experience disturbed sleep and profound inactivity.

Objectives
The aim of this study was to report 5 consecutive days' descriptive analyses on sleep efficiency (SE), total sleep time (TST), daytime activity ratio (DAR), and hourly activity counts among critically ill MV adults from 9 ICUs across 2 hospitals.

Methods
A secondary analysis was undertaken from our parent National Institutes of Health–funded randomized controlled trial (NIH R01 NR016702). Subjects included 31 critically ill patients from multiple ICUs. Wrist actigraphy estimated SE and TST. Mean DAR, an indicator of altered sleep-wake cycles, was calculated. Continuous 24-hour activity counts over 5 consecutive days were summarized. Descriptive analyses were used.

Results
A total of 31 subjects with complete actigraphy data were included. Mean age was 59.6 (SD, 17.3) years; 41.9% were male; 83.9% were White, and 67.7% were Hispanic/Latino; and the mean APACHE III (Acute Physiology and Chronic Health Evaluation III) severity of illness score was 74.5 (SD, 25.5). The mean nighttime SE and TST over the 5-day ICU period were 83.1% (SD, 16.14%) and 6.6 (SD, 1.3) hours, respectively. The mean DAR over the 5-day ICU period was 66.5% (SD, 19.2%). The DAR surpassed 80% on only 17.5% of subject days. The majority of subjects' activity level was low, falling below 1000 activity counts per hour.

Conclusion
Our study revealed poor rest-activity cycle consolidation among critically ill MV patients during the early ICU period. Future interventional studies should promote quality sleep at nighttime and promote mobilization during the daytime.
How far would you travel to consult a rural Ugandan eye specialist? A cross-sectional study
Authors: Crossley Eleanor J. , Badhrinarayanan Shreya , Roberts Lesley M. 
Published: November 2020

Aims:
Blindness and visual impairment are major public health concerns. However there is only 1 ophthalmologist per million individuals in Africa. Hence, individuals must travel long distances to see an eye specialist leading to reduced uptake of eye care services. The aims were to review patients’ demographics and geographical distribution, and conditions diagnosed at a rural eye clinic in Uganda.

Methods:
The ophthalmic clinical officer made handwritten records of attendees at the once-weekly morning clinic over a 14-week period. Data, including demographics, town of residence and diagnoses, were collated and analyzed.

Results:
During the study period, 273 participants attended the clinic (96 males, 177 females). On average, 19.5 patients were seen in the clinic per week. Patient ages’ ranged from 3 days to 89 years old (mean age=32.5 y). The commonest diagnoses were allergic conjunctivitis (9.9%), bacterial conjunctivitis (9.2%), pterygium (8.8%), presbyopia (8.8%), and blunt trauma (5.9%). Patients lived an average distance of 25.1 km from the clinic, with 23.0% living >30 km away.

Conclusion:
The wide geographical distribution of attendees at the Ugandan eye clinic supports earlier research that these clinics are sparsely distributed requiring individuals to travel long distances to seek eye care services.
Stigma toward people with mental disorders in adolescents: comparison between Portugal and Moldova
Authors: Esanu Andrei , Morais Vitor , Araújo Joana , Ramos Elisabete 
Published: November 2020

Abstract

Background:
Mental disorders are one of the most significant public health challenges. Stigma toward people with mental disorders decreases help-seeking behaviors, and may be a cause of depression and anxiety. Research on the level of stigma and comparison between different countries in adolescence is scarce. We aim to study stigma toward people with mental disorders in adolescents, and to evaluate differences between Portugal and Moldova.

Methods:
In a cross-sectional analysis, we evaluated 657 high school students from Portugal and 612 from Moldova. Data were collected by a self-reported questionnaire that, beyond stigma, evaluated individual and family characteristics. Stigma was evaluated using the Attribution Questionnaire for Children (AQ-8-C) and the Depression Stigma Scale (DSS). Data were summarized using means and standard deviations, and comparison was performed using Student t test and analysis of variance.

Results:
The mean (standard deviation) level of mental disorder stigma measured by the AQ-8-C was 32.10 (8.77) in Moldova and 24.32 (9.20) in Portugal, P < .001. Adolescents from Moldova presented higher values for all items except for “Fear,” with higher mean value in Portugal and for “Help” with no significant differences between countries. Regarding the Depression Stigma Scale, adolescents from Moldova presented higher values, both for personal stigma [19.84 (4.78) vs 15.09 (5.08), P < .001] and for perceived stigma [26.43 (4.30) vs 22.62 (5.15), P < .001]. Stigma levels did not differ according to having or not someone with a mental disorder in the class or family.

Conclusion:
The level of stigma toward people with mental disorders is higher in Moldova than in Portugal.
Insights into hypersensitivity reactions in dentistry
Authors: Rama Tiago Azenha , Cernadas Josefina 
Published: November 2020

Abstract
Hypersensitivity reactions are an important hazard in healthcare. Modern dentistry depends on the use of drugs and materials widely known to elicit them. Such reactions are either immediate or nonimmediate – the former carries the risk of anaphylaxis, whereas the latter includes potentially fatal severe cutaneous adverse reactions.
Apart from well-established immunoglobulin E–mediated immediate hypersensitivity reactions (IHRs), recent advances have shed light on the pathophysiology of other IHRs, suggesting a role for MRGPRX2-induced mast cell activation.
Hypersensitivity to both drugs and metals may come as a challenge to dentists, often requiring changing to infrequently used compounds. Local anesthetics are cause for concern, but are a rare cause for IHRs. The opposite occurs with antimicrobials, as antibacterials frequently cause hypersensitivity reactions. Nonsteroidal anti-inflammatory drugs are another common cause, especially in patients suffering from asthma and/or chronic spontaneous urticaria. General anesthetics are a common cause for immediate hypersensitivity, whereas most drugs used for conscious sedation are rare elicitors. Chlorhexidine is a remarkable cause for anaphylaxis, nowadays, despite rare reports linked to rinsed formulations.
Preservatives, flavors, and other compounds present in dentifrices cause both irritative and allergic contact dermatitis/mucositis. Metals, notably nickel and cobalt, are a very common cause for hypersensitivity in dentistry. Acrylates may induce contact mucositis, due to lack of proper polymerization of residuals, being an important cause for contact stomatitis and a dentistry occupational hazard. Acute reactions require a prompt treatment, especially in the presence of anaphylaxis, which should be treated using intramuscular epinephrine. Delayed type reactions with fever should be referred to tertiary urgent care facilities. Suspicion of hypersensitivity in dentistry requires a thorough allergological study and referral is mandatory in all cases.
Erosive Vulvar Lichen Planus and Risk of Vulvar Neoplasia
Authors: Lyra Joana , Melo Catarina , Figueiredo Rita , Polonia-Valente Rita , Falcão Vera , Beires Jorge , Vieira-Baptista Pedro 
Published: November 2020

Objective
The aim of the study was to assess the risk of vulvar cancer and precursors in a cohort of women with vulvar lichen planus (LP) and the clinical and therapeutic features of these patients.

Materials and Methods
A retrospective cohort study, including all the women with the diagnosis of vulvar LP, followed in one institution during a period of 11 years, was performed. Demographic and clinical data, as well as treatment, follow-up, and histology results, were evaluated.

Results
A total of 127 women were diagnosed with vulvar LP. The mean follow-up time was 3.9 ± 0.5 years (range = 1–11 years). Ultrapotent topical corticosteroids were first-line treatment in 91.8% (n = 112), with 32 cases (25.2%) needing an alternative treatment. Overall, 30 biopsies were performed in 19 women (15%). Vulvar high-grade squamous intraepithelial lesion was diagnosed in 3 women (2.4%), 2 (1.6%) of whom were later diagnosed with vulvar squamous cell carcinoma. No cases of differentiated vulvar intraepithelial neoplasia were observed.

Conclusions
Premalignant/malignant transformation in women with vulvar LP under surveillance and compliant with treatment is low. A close follow-up seems to be crucial to prevent future malignancy. Biopsies should be performed whenever a suspicious lesion seems during follow-up.
Movement Synchrony and Facial Synchrony as Diagnostic Features of Depression
Authors: Altmann Uwe , Brümmel Maria , Meier Julija , Strauss Bernhard 
Published: November 2020

Abstract
The pilot study investigated with a matched-subjects design whether nonverbal synchrony is a diagnostic feature for depression and whether it mediates between depression and postsession ratings of the interviewer behavior. The sample includes n = 15 patients with major depression and n = 15 healthy controls (aged 20–30 years, 40% female). We conducted structured diagnostic interviews for somatic complaints to standardize the recording setting, issue, and course of conversation. Body movements and facial expressions were coded automatically frame by frame using computer vision methods. Ratings of the interviewers' professional behavior and positive affect were assessed using questionnaires. Patients with depression showed less movement synchrony and less synchronous positive facial expressions. Only synchronous positive expressions mediated between depression and less perceived positive affect. We conclude that the applied methodology is well suited to examine nonverbal processes under naturalistic but widely standardized conditions and that depression affects the nonverbal communication in medical conversations.
The Impact of Preeclampsia on Women’s Health: Cardiovascular Long-term Implications
Authors: Orabona Rossana , Sciatti Edoardo , Sartori Enrico , Vizzardi Enrico , Prefumo Federico 
Published: November 2020

Importance
Women with a history of preeclampsia have a 2- to 5-fold increased risk of cardiovascular diseases, which represent almost half of mortality in the female population worldwide.

Objective
To summarize the current evidence concerning women's future cardiovascular risk after pregnancies complicated by preeclampsia.

Evidence Acquisition
A PubMed and Web of Science search was conducted in English, supplemented by hand searching for additional references. Retrieved articles were reviewed, synthesized, and summarized. Relevant studies on cardiovascular risk after preeclampsia were included.

Results
Evidence suggests that the cardiovascular implications of preeclampsia do not cease with delivery, with a significant proportion of women demonstrating persistent asymptomatic myocardial impairment, aortic stiffening, and microcirculatory dysfunction. More severe and early-onset preeclampsia, as well as preeclampsia with concurrent neonatal morbidity, increases the risk of cardiovascular disease later in life.

Conclusions and Relevance
As former preeclamptics have been shown to be at increased cardiovascular risk, this identifies a subgroup of women who may benefit from early preventive measures.

Target Audience
Obstetricians and gynecologists, family physicians.

Learning Objectives
After completing this educational activity, the obstetrician/gynecologist should be better able to define what is meant by “cardiovascular long-term implications of preeclampsia”; identify women at higher risk of future cardiovascular disease; and evaluate intervention strategies proposed to manage this subgroup of the female population.
Where You Live Matters: A National Cancer Database Study of Medicaid Expansion and Endometrial Cancer Outcomes
Authors: Barrington David A. , Sinnott Jennifer A. , Calo Corinne , Cohn David E. , Cosgrove Casey M. , Felix Ashley S. 
Published: November 2020

(Abstracted from Gynecol Oncol 2020;158(2):407–414)
Individuals diagnosed with endometrial cancer (EC) and presenting with early-stage disease have favorable outcomes and a high probability of cure compared with those presenting with advanced disease. Aggressive early interventions including surgery that contribute to good outcomes may be less available for those with various barriers to screening and health care access, including lacking insurance coverage.
Candy Cane Compared With Boot Stirrups in Vaginal Surgery: A Randomized Controlled Trial
Authors: Gupta Ankita , Meriwether Kate , Tuller Molly , Sekula Michael , Gaskins Jeremy , Stewart J. Ryan , Hobson Deslyn , Cardenas-Trowers Olivia , Francis Sean 
Published: November 2020

(Abstracted from Obstet Gynecol 2020;136:333–341)
Incorrect patient positioning during surgery can lead to both transient and long-term injuries that affect patient recovery. Concerns about the role of patient positioning in neurologic injuries after gynecologic surgery have been raised in previous studies, especially the role of candy cane stirrups compared with boot stirrups.